tbuckley/cabot-search huggingface dataset:
Abstract 15101: Does Echocardiography Provide Additional Insight Into Outcome in Patients Admitted With Acute Respiratory Decompensation?
Authors: Divya Gumber, Vedha Sanghi, Laura Young, Michael Zdradzinski, Madhu Sasidhar, Richard A Krasuski
Journal: Circulation (2015)

Background: Hospitalization for decompensated lung disease is known to portend a poor prognosis. Scoring systems can predict clinical outcome, though few have included cardiac features. Whether echo provides additional prognostic benefit is unknown. Methods: We manually reviewed the electronic medical records of patients admitted with acute respiratory failure to a special pulmonary recovery unit. We examined demographic characteristics and echos performed during hospitalization. When available we also reviewed echos prior to admission. All death certificates were reviewed, as were the discharge summaries. Results: Among 327 patients only 241 (74%) survived to discharge. Survivors were similar to descendents with respect to age (64 years), sex (42% vs. 49%), obstructive lung disease (70 vs. 61%), diabetes (41% vs. 51%) and coronary disease (33% vs. 25%). Patients who died had more chronic kidney disease (35% vs. 19%, p=0.007), lower albumin (3.2±0.7 vs. 3.0±0.7, p=0.018), lower sodium (136±7 vs. 139±5, p=0.003) and higher serum lactate (2.4±2.0 vs. 1.5±1.4, p=0.001). Interestingly there were no differences in left ventricular size, function or valve disease based on survival. Similarly right ventricular size and function were not different, and right ventricular systolic pressure was comparable. Right atrial dilatation was present in 11% of descendents, compared with 28% of survivors (p=0.007); similarly right atrial pressure was lower in descendents (6.0±3.6 vs. 7.1±3.9, p=0.013). Renal function worsened more frequently in descendents (p=0.005), suggesting possible prerenal azotemia. Different multivariable models each demonstrated right atrial dilatation as the most potent predictor of outcome. Interestingly on the prior echo no difference was seen in right atrial dilatation (35% vs. 34%), again suggesting transient volume depletion. Conclusions: In patients admitted with respiratory decompensation, mortality is high (&gt;25%). Echo provides independent prognostic information, surprisingly not related to pulmonary pressure or biventricular size and function, but by presence of right atrial enlargement. The latter appears protective, suggesting an important role for properly maintaining volume status in these patients.
Abstract 14711: Effect of Release of the First Pediatric Appropriate Use Criteria on Outpatient Transthoracic Echocardiogram Ordering Practice
Authors: Ritu Sachdeva, Michael S Kelleman, Courtney McCracken, Joseph Allen, Oscar Benavidez, Robert M Campbell, Pamela S Douglas, Benjamin W Eidem, Lara Gold, Leo Lopez, Kenan W Stern, Rory B Weiner, Elizabeth Welch, Wyman W Lai
Journal: Circulation (2015)

Background: The first pediatric appropriate use criteria (PAUC) were recently published for initial outpatient transthoracic echocardiography (TTE). We sought to determine the effect of release of the PAUC on the appropriateness of TTE ordering patterns of pediatric cardiologists. Methods: Data were prospectively collected from patients having initial outpatient TTE ordered prior to (Phase I, 6 mo) and 3 months after release (Phase II, 4 mo) of PAUC. Site-investigators determined the indication of the study and assigned appropriateness rating based on the PAUC document [Appropriate (A), May Be Appropriate (M), or Rarely Appropriate (R)] or "Unclassifiable" (U). Results: A total of 4562 TTEs (2655 Phase I, 1907 Phase II) were ordered by 103 physicians at 6 sites. Overall comparison of appropriateness rating for Phase I and II showed no change in the rate for A or M, but a decline in the rate of R and increase in U. Similar results were noted when comparisons were made for physicians that ordered at least 20 TTEs during each phase (N = 30/103, 29%), Table 1. There was no change in any appropriateness rating at 3 sites, a decline in R at 2, an increase in A at 1, and an increase in U at 2 sites. Overall and site-specific comparisons of rate of R TTEs are shown in Fig 1. Conclusions: The release of PAUC document had only a small impact on physician ordering behavior for initial TTEs, including a small decrease in R. Overall, these data suggest that more focused interventions are required to fully implement guideline recommendations and improve the appropriate use of pediatric TTE. This information should be helpful in designing educational interventions to reduce the rate of TTEs ordered for R indications.
Abstract 14809: Murc/cavin-4 Regulates Cardiac Function via β-adrenergic Receptor Signaling
Authors: Tetsuro Hamaoka, Takehiro Ogata, Daisuke Naito, Naohiko Nakanishi, Kotaro Miyagawa, Naoki Maruyama, Takeru Kasahara, Masahiro Nishi, Takeshi Shirayama, Tomomi Ueyama
Journal: Circulation (2015)

Background: Muscle-restricted coiled-coil protein (MURC), also referred to as Cavin-4, is a member of the cavin family, which regulates caveolae function together with caveolins. In cardiomyocytes, caveolin-3, a critical and muscle-specific component of caveolae, regulates caveolar structure and function and forms a complex with MURC/Cavin-4. Caveolin-3 overexpression induces cardiac protection, and caveolin-3 deficiency causes progressive cardiomyopathy. The caveolin-3 scaffolding domain peptide inhibits type 5 adenylyl cyclase (AC5), which is an enzyme to synthesize cAMP and an effector of β-adrenergic receptor (AR) signaling. Mutations in MURC/Cavin-4 have been identified in patients with dilated cardiomyopathy. However, molecular mechanisms of MURC as a caveolar component in cardiac function remain unknown. Methods and results: To assess the role of MURC/Cavin-4 in cardiac function, wild-type (WT) and MURC/Cavin-4-knockout (MURC-KO) mice were subjected to a model of pressure overload induced by transverse aortic constriction (TAC). After TAC, WT mice showed cardiac hypertrophy and heart failure, whereas MURC-KO mice were resistant to pressure overload-induced cardiac hypertrophy and heart failure accompanied by fibrosis. We then focused on β-AR signaling, because β1-AR signaling is one of the essential parts in heart failure. MURC/Cavin-4 was co-localized with β1-AR in cardiomyocytes. Isoproterenol (ISO) treatment induced cardiac hypertrophy with fibrosis in WT mice, while ISO-induced cardiac hypertrophy and fibrosis was markedly attenuated in MURC-KO mice. In cardiomyocytes, MURC/Cavin-4 knockdown suppressed ISO-induced cAMP production, while MURC/Cavin-4 overexpression and caveolin-3 knockdown stimulated cAMP production, indicating that caveolin-3 and MURC/Cavin-4 have opposite effects on cAMP production. MURC/Cavin-4 bound to caveolin-3 and interferes with the association between caveolin-3 and AC5. Moreover, MURC-knockdown suppressed ISO-induced PKA activity and phospholamban phosphorylation. Conclusion: Our findings suggest that MURC/Cavin-4 regulates cardiac function via β-AR signaling.
Abstract 13806: Association Between Coronary Angiography With or Without Percutaneous Coronary Intervention and Outcomes After Out-of-Hospital Cardiac Arrest
Authors: Tyler F Vadeboncoeur, Vatsal Chikani, Daniel W Spaite, Chengcheng Hu, Margaret Mullins, Bentley J Bobrow
Journal: Circulation (2016)

Introduction: Coronary angiography (CA) is recommended after out-of-hospital cardiac arrest (OHCA) when ST-elevation is present but the ideal timing and benefit of CA when ST-elevation is not present are unknown. Methods: Prospective observational study of adult (age &gt;17) OHCA of presumed cardiac etiology from 1/01/2010-12/31/2014 who were admitted to one of 40 recognized cardiac receiving centers within a state resuscitation center network. DNR patients, those who did not achieve ROSC, and/or those who died in the ED were excluded since the likelihood of percutaneous coronary intervention (PCI) impacting outcome in these patients is low. An in-hospital database was linked with a statewide OHCA database. Results: Among 6,615 cases, 1,247 remained for analysis after exclusion [DNR (1254); failed to achieve ROSC/died in ED (4,020); missing prehospital variable (92); and missing outcome (2)]. Median age was 63 and 70% were male. There were 62% witnessed arrests, 54% received bystander CPR and the initial rhythm was VF/VT in 55%. Sixty-four percent survived to hospital discharge, 82% of which had a CPC score of 1 or 2. Of the 326 STEMI cases, 298 (91%) underwent CA with resultant PCI in 206 (63%). Of the 849 non-STEMI cases, 361 (43%) underwent CA with resultant PCI in 107 (13%). Overall survival was: 54% in cases without CA; 73% in cases with CA but without PCI; and 73% in those with PCI. Survival in non-STEMI cases was: 55% in cases without CA; 82% in cases with CA but without PCI; and 80% in those with PCI. In non-STEMI cases, the adjusted odds of survival for CA without PCI vs no CA was 2.70 (95% CI: 1.81, 4.02) and for PCI versus no CA it was 2.01 (95% CI: 1.16, 3.48). Conclusion: In this statewide analysis over 90% of OHCA cases with STEMI underwent CA. In cases that were not STEMI, CA was strongly and independently associated with survival regardless of whether PCI was performed. Since there is no reason to believe that CA without PCI confers a survival benefit, these findings suggest a component of selection bias in those without STEMI who undergo CA.
Abstract 196: Remote Ischemic Pre-Conditioning Improves Microcirculation following Severe Hemorrhagic Shock in a Rat Model
Authors: Xianwen Hu, Jiefeng Xu, Zhengfei Yang, Min Yang, Jie Qian, Jena Cahoon, Shijie Sun, Wanchun Tang
Journal: Circulation (2013)

Introduction: The microcirculatory flow is a major determinant of tissue oxygen delivery. A significantly reduced microcirculatory flow has been described during and following hemorrhagic shock. We investigated whether remote ischemic pre-conditioning (RIPC) would improve microcirculation following severe hemorrhagic shock. Hypothesis: RIPC improves sublingual microcirculation following hemorrhagic shock. Methods: Fourteen male Sprague-Dawley rats were randomized into two groups: 1) Remote ischemic pre-conditioning (RIPC) group, 2) Control group. RIPC was performed by four cycles of 5 mins of limb ischemia followed by reperfusion for 5 mins. Hemorrhagic shock was induced by reduction of total blood volume by 50% over an interval of 1 hour, 30 mins after bleeding, reinfusion was initiated with the shed blood over the ensuing 30 mins. Sublingual microcirculation was measured by a sidestream dark-field imaging device at baseline, 1 hour after bleeding, 30 mins after shock, 30 mins after reinfusion and at hourly intervals thereafter for a total of 120 mins. Results: The sublingual microvascular flow index (MFI) and perfused vessel density (PVD) were significantly reduced during hemorrhage (P&lt;0.001) when compared with the baseline values. The MFI and PVD were significantly greater after reinfusion in the RIPC group than that in the Control group (P&lt;0.001)(Table). Conclusions: RIPC improved sublingual microcirculation following severe hemorrhagic shock.
Abstract 13934: Echocardiographic Predictors of Change in Renal Function With Intravenous Diuresis for Decompensated Heart Failure
Authors: Stephen Gannon, Kenneth J Mukamal, James D Chang
Journal: Circulation (2016)

Title: Echocardiographic Predictors of Change in Renal Function with Intravenous Diuresis for Decompensated Heart Failure Background: Worsening or improved renal function occurs in a significant proportion of patients with decompensated heart failure who receive intravenous diuretic therapy. The direction of change in renal function has been difficult to predict with current biochemical, physical exam and imaging assessments. Hypothesis: We proposed the following hypotheses: (1) Patients with right ventricular (RV) dilation and systolic dysfunction would be more likely to experience improved renal function (IRF) with diuresis compared to those with normal RV size and function; (2) Patients with heart failure and a preserved left ventricular ejection fraction (LVEF) would be more likely to experience worsening renal function (WRF) with diuresis than those with a reduced LVEF (≤40%). Methods: Retrospective review of 363 patients admitted to a single center from January, 2011 to November, 2014 for decompensated heart failure who underwent intravenous diuresis and transthoracic echocardiography. Data regarding chamber quantification, right and left ventricular systolic function, valvular lesions and diastolic function were collected. Change in renal function was determined using validated GFR estimates based on serum creatinine. Results: Within our study population, 36.4% of patient experienced a decrease in eGFR by at least 10%, 34.7% had stable renal function and 28.9 had an improvement in eGFR by at least 10%. Patients with WRF were more likely to have a preserved LVEF (81/132; 61%) compared to those with stable (59/126, 47%) or improved (47/105, 45%) renal function (p-value 0.015). Patients with IRF were more likely to have a dilated, hypokinetic RV (p-value 0.008). Left atrial size, left ventricular internal diastolic dimension and diastolic dysfunction did not significantly predict change in renal function. Conclusions: Patients with WRF during diuresis for decompensated heart failure are more likely to have a preserved LVEF than those with stable or improved renal function. Those with IRF are significantly more likely to have a dilated, hypokinetic RV.
Abstract 14810: Relationship of Baseline Right Ventricular Function With Response to Cardiac Resynchronization Therapy
Authors: Abhishek Sharma, Ajay Vallakati, Sunny Goel, Carl Lavie, John Kassotis, Nikhil Warrier, Debabrata Mukherjee, Jason Lazar, Andrew J Einstein
Journal: Circulation (2015)

Background: Right ventricular (RV) dysfunction has been associated with adverse clinical outcomes in patients with heart failure (HF). Cardiac resynchronization therapy (CRT) improves left ventricular (LV) size and function in patients with markedly abnormal ECG QRS duration. However, relationship of baseline RV function with response to CRT has not been well described. Objective: To investigate the relationship of baseline RV function with response to CRT as assessed by change in LV ejection fraction (LVEF). Methods: A systematic search of studies published between 1966 to February 2015 was conducted using Pub Med, CINAHL, Cochrane CENTRAL and the Web of Science databases. Studies were included if they have reported a) parameters of baseline RV function [tricuspid annular plane systolic excursion (TAPSE) or RV ejection fraction (RVEF) or RV basal strain or RV fractional area change (FAC)] and b) LVEF before and after CRT. Random-effects meta-regression was used to evaluate the effect of baseline RV function parameters and change in LVEF. Results: Sixteen studies (N=1764) were selected for final analysis. Random-effects meta-regression analysis showed no significant association between the magnitude of the difference in EF pre and post CRT with baseline TAPSE (beta 0.005, p 0.989); baseline RVEF (beta 0.270, p 0.493); baseline RVFAC (beta - 0.367, p 0.06); baseline basal strain (beta -0.342, p= 0.462) after a mean follow up period of 10.5 months Conclusion: Baseline RV function as assessed by TAPSE, FAC, basal strain or RVEF, does not determine response to CRT as assessed by change in LVEF. Future studies should assess the relationship of baseline RV function with response to CRT in terms of improvement in symptoms, quality of life and major HF morbidity and mortality.
Abstract 201: Beta-Adrenergic Stimulation Promotes Early Electrical Failure During Simulated VF-Induced Cardiac Arrest And Delays Electrical Recovery Upon Reperfusion
Authors: Tyson G Taylor, Vivek Garg, Paul W Venable, Katie J Sciuto, Junko Shibayama, Alexey V Zaitsev
Journal: Circulation (2013)

During cardiac arrest adrenergic stimulation is enhanced due to both endogenous increase in myocardial tissue catecholamine levels and exogenous epinephrine administration during resuscitation. Whereas alpha-adrenergic stimulation may be beneficial for hemodynamic recovery, there is growing evidence that beta-adrenergic stimulation is detrimental. Clinically, there is controversy as to whether epinephrine administration improves overall survival in cardiac arrest. Here we investigated the effects of beta-adrenergic stimulation on electrical activity during simulated ventricular fibrillation (VF) [[Unable to Display Character: –]] induced cardiac arrest and subsequent reperfusion. We performed optical mapping of the voltage-sensitive dye RH237 in the anterior right and left ventricles (RV and LV) of Langendorff-perfused rabbit hearts subjected to normothermic global no-flow ischemia and rapid pacing (cycle length 200 ms) in the presence or in the absence of isoproterenol (ISO, 30 nM). 2,3-butanedione monoxime (20 mM) was used to reduce motion artifact. Excitable area was measured in optical maps based on the criterion of the minimum time-derivative of the upstroke of the optical action potential. ISO markedly accelerated electrical depression in both LV and RV (more in LV) compared to control hearts (see Figure, * indicate comparisons with significant difference between groups at p&lt;0.05). In addition, ISO delayed recovery of electrical activity upon reperfusion (62±14% recovery in ISO vs.98±2% recovery in control at 5 min of reperfusion, p&lt;0.01). Furthermore, ISO tended to increase the incidence of post-reperfusion arrhythmias compared to control (83% vs. 25%, respectively; p=NS). We conclude that beta-adrenergic stimulation aggravates electrical dysfunction under conditions typically present during cardiac arrest/resuscitation, which might contribute to the overall detrimental outcomes of natural or induced catecholamine increase in this setting.
Abstract 15182: Factors Associated With Aortic Dissection in Patients With <i>TGFBR1</i> Or <i>TGFBR2</i> Mutations: Results From the Montalcino Aortic Consortium
Authors: Guillaume Jondeau, Jacques Ropers, Ellen Regalado, Alan Braverman, Arturo Evangelista, G Teixedo, Julie De Backer, Sophie Naudion, Cecile Zordan, Takayuki Morisaki, Hiroko Morisaki, L Muino Mosquera, Yskert von Kodolitsch, Sophie Dupuis-Girod, Shaine A Morris, Richmond Jeremy, Sylvie Odent, Maud Langeois, Myrtille Spentchian, Olivier Milleron, Catherine Boileau, Reed Pyeritz, Dianna Milewicz
Journal: Circulation (2015)

Introduction: Natural history of patients with TGFBR1 or TGFBR2 mutations is not well known Hypothesis: Physical features may indicate high risk patients Methods: Data were collected on 403 patients with either TGFBR1 or TGFBR2 mutations. We compared the phenotypic features of patients with and without aortic dissection. Results: Patients with aortic dissection were diagnosed when older, suggesting delay in diagnosis being one of the main parameter related to the occurrence of this deadly complication. Features of Loeys Dietz Syndrome (arterial tortuosity, hypertelorism, broad or bifid uvula and wide scars) were more frequently associated with dissection,suggesting that these features may help identifying high risk patients, in whom aortic surgery may have to be proposed earlier. In contrast, the systemic score proposed for the diagnosis of Marfan syndrome was not helpful in recognizing high-risk patients. Of note, a systemic score ≥ 7 was present in 1/5 of the population. The risk of aortic dissection was similar in patients carrying a TGFBR1 mutation or a TGFBR2 mutation (35/159 (22%) vs. 57/244 (23%). However, - The last maximal aortic root diameter before or at the time of type A aortic dissection was greater in TGFBR1 than in TGFBR2 (65 (22) vs. 50 (12)mm ; p= 0.039). - Type B aortic dissection was less frequently reported in TGFBR1 (6% vs 12% of the patients) - Lastly aortic event (surgery or dissection) occurred more frequently in males than in females carrying a TGFBR1 mutation {53.7% of males (median age 27 years [21-39]) and 29.3% of females (34 years [28-44]), p=0.003} but not a TGFBR2 mutation (46.2% of males (median age 32 [20-41]) and 40.5% of females (30 years [19-42], NS} Conclusions: Aortic dissection was associated with delayed/unknown diagnosis, and the presence of clinical features of LDS. The prevalence for aortic events differs between men and women with TGFBR1 mutation but not TGFBR2 mutations
Abstract 13941: CT-derived Skeletal Muscle Index: A Novel Predictor of Frailty and Hospital Length of Stay After Transcatheter Aortic Valve Replacement
Authors: Vishal Dahya, Wayne Batchelor, Jingjie Xiao, Carla Prado, Dan McGee, Aline Silva, Penny Burroughs, Thomas Noel, Julian Hurt, Shafi Mohamed
Journal: Circulation (2016)

Introduction: We determined the prevalence of sarcopenia in patients undergoing transcatheter aortic valve replacement (TAVR) and whether skeletal muscle mass measured from preoperative computed tomography (CT) images provides value in predicting post-operative length of stay. Background: There is limited data on the use of body composition as a frailty measure in TAVR patients and no studies have determined if this measure predicts length of stay. Methods: We studied 104 consecutive patients who underwent TAVR at Tallahassee Memorial Hospital from 2012 to 2016. Patient demographics, frailty measures (hand grip, albumin, and 5m walk test), clinical comorbidities and echocardiographic data were recorded. Skeletal muscle index (SMI) [skeletal muscle mass cross-sectional area/height 2 ] was measured from CT images using Slice-O-Matic software (Tomovision, Montreal, Quebec, Canada) (Figure 1). Clinical outcomes were assessed and multivariate methods used to determine predictors of LOS. Results: Sarcopenia was prevalent in men (83%) and women (56%). Only SMI and mitral regurgitation showed a univariate relationship with LOS, while none of the established frailty measures predicted LOS. SMI was correlated with age, gender, BMI, handgrip strength, previous PCI and previous CABG. A multivariate model including age, gender, major complications, BMI, SMI, mitral regurgitation, grip strength and walk test showed only SMI, MR, and major complications as independent predictors of LOS. For every 8.6 cm 2 /m 2 increase in SMI, there was a 1 day reduction in LOS. Conclusions: SMI, a measure of sarcopenia readily determined from pre-TAVR CT scans, independently predicts TAVR LOS better than standard frailty testing. Further evaluation of SMI as a frailty measure after TAVR is warranted.