bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 261: Intentional or Inadvertent Hyperventilation of Patients with Out-of-Hospital Cardiac Arrest on Hospital Arrival
Authors: Helfenbein Eric , Firoozabadi Reza , Babaeizadeh Saeed , Daya Mohamud
Published: April 2024

Background

The deleterious effects of intentional or inadvertent hyperventilation of out-of-hospital cardiac arrest (OHCA) patients include decreased venous blood return, increased intracranial pressure and decreased coronary perfusion pressure. Recent AHA guidelines specify ventilation rates between 8-12 breaths per minute (bpm). We previously presented findings that hyperventilation is common immediately following placement of an airway device. We also observed a number of cases in which hyperventilation occurred close to the end of recordings from EMS monitor-defibrillators presumably corresponding to the time of hospital arrival and transfer of care.

Objective

Determine the prevalence of intentional or inadvertent hyperventilation of OHCA patients upon hospital arrival and transfer of care to hospital staff.

Methods

Capnogram recordings from a convenience sample of 205 OHCA patients collected between 2006 to 2010 from a single EMS agency using Philips HeartStart MRx defibrillators were examined. An automated breath detection algorithm that relied on capnographic waveforms was used to compute ventilation rates and EtCO2 levels. Clinical charts written by the EMS personnel were examined to determine cardiac rhythm and if spontaneous breathing was observed upon hospital arrival, which was excluded.

Results

23 cases (11.2%) were identified which were determined to have an episode of hyperventilation at the end of the recordings, with times corresponding to transfer of care after hospital arrival. Running average hyperventilation rates were 28±8 bpm, with average peak instantaneous rate 36±10 bpm, range 24-46 bpm. Average minimum EtCO2 during hyperventilation was 12±14 mmHg, range 1.8-70 mmHg.

Conclusion

Intentional or inadvertent hyperventilation of OHCA patients at rates well above AHA guidelines was present in 11% of cases at times corresponding to transfer of care from EMS to hospital staff. It is unclear if this was performed by EMS staff or hospital staff. Better awareness and communication of this potentially harmful behavior to EMS personnel and hospital staff is warranted.
Abstract 30: Therapeutic Hypothermia Suppresses Arrhythmogenic, Calcium-Mediated Delayed Afterdepolarizations
Authors: Fukaya Hidehira , Piktel Joseph S , Plummer Bradley N , Laurita Kenneth R , Wilson Lance D
Published: April 2024

Background
: Therapeutic hypothermia (TH) is recommended for patients with return of spontaneous circulation after resuscitation from cardiac arrest. Hypothermia is known to cause derangements in cellular calcium (Ca) cycling, leading to Ca overload; however, the effect of TH on Ca-mediated arrhythmogenic substrates remains unclear. We hypothesized abnormal Ca cycling during TH would promote spontaneous Ca release and delayed afterdepolarizations (DADs).

Methods and Results
: Transmural dual optical mapping of Ca transients and action potentials was performed in canine wedge preparations during normothermia (36ºC; N group, n=5) or TH (32ºC; n=6). Multicellular spontaneous Ca release events (mSCR) and resultant DADs were induced by rapid pacing. TH significantly slowed the kinetics of Ca cycling compared to normal controls, significantly prolonging the time to peak (60.4 ± 5.7 vs. 40.1 ± 2.6 ms), duration (401.2 ± 13.8 vs. 305.8 ± 12.4 ms) and rate of decay (247.4 ± 29.2 vs. 146.0 ± 12.6 ms, all p<0.05) of full Ca transients. The maximal mSCR amplitude was not significantly different in TH (21.1 ± 6.0%) compared to normals (28.4 ± 1.9%, p=NS). However, the slope (mSCR amplitude/time to peak) of mSCR activity, an important determinant of triggered activity, was significantly slower in TH (14.3 ± 3.7 %/s) compared to N (29.9 ± 3.9%/s, p<0.05). Importantly, DAD amplitude was also significantly lower in TH (4.1 ± 2.2%) compared to N (11.1 ± 1.5%, p<0.05).

Conclusion
: Even though therapeutic hypothermia did not decrease the magnitude of spontaneous calcium release, it did significantly reduce the slope, which was associated with significantly lower DAD amplitude. These results suggest that TH could be antiarrhythmic, in part, by slowing the kinetics of spontaneous calcium release and, thus, decreasing delayed afterdepolarizations, an important cause of triggered activity and arrhythmias.
Abstract 305: The Patients’ Experiences in Emergency Research (PEER) Study
Authors: Dickert Neal W , Mah Victoria , Jill Baren E , Biros Michelle , Govindarajan Prasanthi , Pancioli Arthur M , Silbergleit Robert E , Wright David W , Pentz Rebecca D
Published: April 2024

Background

Resuscitation research requires enrolling patients under an exception from informed consent (EFIC), but there remains ethical controversy and confusion about EFIC regulations. One concern is that patients may find enrollment unacceptable, but no study has systematically assessed views and experiences of patients enrolled in an EFIC study. The “Patients’ Experiences in Emergency Research (PEER)” study addresses this gap.

Methods

PEER was nested within the Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) of pre-hospital treatment of status epilepticus. PEER included 61 EFIC enrollees (or surrogates) from 5 sites. Interviewers used a structured interactive guide containing open and closed-ended questions focusing on views of personal and general acceptability of EFIC enrollment in RAMPART and existing regulatory protections. Closed-ended responses were directly coded. Simple descriptive and bivariate statistics were generated, consistent with our hypothesis-generating goals. Textual data were analyzed for common themes and to contextualize the data.

Results

24 patients and 37 surrogates were interviewed. Two interviews were incomplete. 49 (82%) subjects were glad they (or family member) were included in RAMPART; 54 (92%) felt research on emergency seizure treatment is important. 43 (72%) found their inclusion in RAMPART under EFIC acceptable. 10 (17%) found it unacceptable, and 6 (10%) were neutral. There were no statistically significant demographic associations with enrollment attitudes. In textual analysis, 24 (41%) subjects expressed concern about absence of consent; 11 (19%) felt they were not told enough about the study. Positive responses mostly related to perceived medical benefits (53%) from RAMPART and trust in doctors/researchers (25%). More than a quarter had difficulty understanding concepts of clinical trials and EFIC.

Conclusions

Most subjects had positive views of their enrollment in RAMPART. A significant number were concerned about absence of consent, and many had difficulty understanding EFIC and clinical research. These approval rates cohere with data from other populations. They are largely reassuring but suggest the importance of post-enrollment communication.
Abstract 31: Mutation of Tnni3k Gene Increased Incidence of Arrhythmias in Culture Cardiomyocytes and In Vivo Mouse Hearts
Authors: Lai Zhong-fang , Chen Yu-Zhen , Chen Jun , Tsuda Hiroshisa , Kitamoto Yasunori , Kim-Mitsuyama Shokei
Published: April 2024

Aims
: Our recent studies showed that overexpression of TNNI3K promoted cardiac myogenesis, enhanced cardiac performance, and protected the myocardium from ischemic injury. Here, we report that replaced serine of the 835 and 836th in the C-terminal modulation area of TNNI3K gene with alanine increased the incidence of arrhythmia outbreak in culture cardiomyocytes and in mouse hearts in vivo.

Methods and results
: Wild TNI3K and mutated TNNI3K gene obtained from substitution of serine at 835-836 sites with alanine (S835A, S836A) were transfected respectively into P19CL6 cells for differentiation into cardiomyocytes, or directly transfected into beating hearts for in vivo experiments. Then, beating rhythm and frequency were observed in the cardiomyocytes at 16 day after inducer or in the whole heart of mice. Results obtained from culture cardiomyocytes show that the incidence of arrhythmia-like beating activities including bigeminy, trigeminy and tachycardia was more frequent in the TNNI3K-mutant group than that in the wild-TNNI3K group (P<0.05). By the in vivo experiment, incidence of arrhythmic outbreak was examined in 1) control group (n=9) of the male C57BL6 mouse, 2) the wild TNNI3K group (n=12), 3) the mutant-TNNI3K gene group (n=12). Incidences of bigeminy (66.7%), tachycardia (50.0%) and bradycardia (41.9%) in the TNNI3K mutant group were significantly higher than that in the other two groups. To investigate possible mechanisms involved on the TNNI3K mutant-induced arrhythmias, intracellular Ca
2+
-response was investigated after application of ryanodine at concentrations of 1, 10, 20, and 50μM. The ryanodine-induced increase of Ca
2+
-concentrations in the wild group was stronger than that in the mutant group (P<0.05). Furthermore, action potentials of cultured cardiomyocytes were recorded with glass microelectrode techniques and data showed that the incidence of early or delayed afterdepolarization is significantly increased the mutant group (p<0.01).

Conclusions
: TNNI3K-mutation increased the incidences arrhythmias in cultured cardiomyocytes and in mouse hearts in vivo. Elucidation of the molecular mechanism involved would be useful for innovation of new anti-arrhythmic drugs.
Abstract 310: Evaluation of the Appropriate Timing for Inducing Therapeutic Hypothermia with Extracorporeal Membrane Oxygenation for Out-of-Hospital Cardiac Arrest in Acute Coronary Syndrome
Authors: Arimoto Hideki , Rinka Hiroshi , Miyaichi Toshinori , Fuke Akihiro , Ishikawa Junichi , Morooka Takaya
Published: April 2024

Purpose: Mild therapeutic hypothermia has been integrated into management strategies for improving the neurological outcome of cardiac arrest for out of hospital cardiac arrest. On the other hand, acute coronary syndrome (ACS) cases should be treated as earlier. We have the dilemma between two procedures when we face any cases of post cardiac arrest syndrome (PCAS). We reported rapid and safe hypothermia induction with Less Invasive Cardiopulmonary bypass Hypothermia (LICH) before. This study aimed to evaluate an appropriate timing to induce LICH ‘before or after’ investigations for coronary angiography (CAG).

Methods: Sixteen PCAS patients for ACS were treated with LICH. These patients were divided into before CAG (Group B, N=12) and after CAG (Group A, N=4) groups. The LICH procedure was indicated for unconscious ROSC patients under 75 years of age, and excluded with brain hemorrhage, traumatic cardiac arrest, and any risk of bleeding. Target temperature was set at 34 to 35°C for 36 to 48 hours. The specifications LICH procedure were quickly induced hypothermia via narrow pediatric cannulas on low-perfusion (1 l/min) artery-venous extra corporeal membranous oxygenation with minimal anticoagulation. Any complications, time to target temperature, temperature stability, cytokines and neurological outcomes were compared. A favorable outcome was defined as a Cerebral Performance Category (CPC) of 1-2.

Results: There were no significant characteristic differences except the time to target temperature (69min vs. 161min, p<0.01) between group B and A. Any complications and favorable outcomes were no significant differences in both groups.

Conclusions: We suggest that we can choice both way early and late induction for hypothermia with LICH. These results mean an early coronary reperfusion is acceptable because of the advantages of quick induction to the target temperature.
Abstract 32: Successful Use of Supraglottic Airway Devices by Surf Lifeguards: A Randomized Comparison of 3 Different Devices
Authors: Adelborg Kasper , Dalgas Christian , Nielsen Lars H , Mortensen Martin B , Al-Mashhadi Rozh H , Løfgren Bo
Published: April 2024

Objective:
During resuscitation of a drowning victim, adequate ventilations are of paramount importance. The feasibility of using supraglottic airway devices (SAD) among surf lifeguards is unexplored. We aimed to compare time to first effective ventilation and ventilation quality using three different SAD among surf lifeguards.

Methods:
Surf lifeguards in active service over the age of 18 years were invited to participate. Participants were trained to Portex
®
Soft Seal
®
Laryngeal Mask (Soft Seal), Intersurgical
®
I-gel supraglottic airway (I-gel) and Ambu
®
AuraOnce
TM
(AuraOnce). Participants inserted and provided five ventilations using each of the SADs in randomized order. Data were obtained from a resuscitation manikin and video recordings.

Results:
A total of 40 surf lifeguards (11 female, 29 male, mean age: 24.7 years) participated. Only three participants failed to obtain any effective ventilation (one using I-gel and two using AuraOnce). The time to first effective ventilation (visible chest rise) was significantly reduced using I-gel (15.6+/-3.3 s) compared to Soft Seal (35.2+/-7.2 s, p<0.001) and AuraOnce (35.2+/-8.5 s, p<0.001) whereas no difference was detected when comparing Soft Seal to AuraOnce. On-going chest compressions did not delay time to ventilation. The number of effective ventilations was higher using Soft Seal (100%) compared to AuraOnce (92%, p<0.0001), while no significant differences were observed when comparing I-gel (97 %) to Soft Seal and AuraOnce. Soft Seal delivered a higher tidal volume, (0.65+/-0.14 L) compared to I-gel (0.50+/-0.16 L, p<0.001) and AuraOnce (0.39+/-0.19 L, p<0.001). The inspiratory time was longer with Soft Seal (0.61+/-0.17 s) compared to I-gel (0.47+/-1.3 s, p<0.001) and AuraOnce (0.42+/-0.13 s, p<0.001). No differences were found comparing I-gel and to AuraOnce on tidal volume and inspiratory time. The majority of surf lifeguard (85%) listed I-gel as their preferred SAD.

Conclusion:
Surf lifeguards can successfully use SADs. Time to ventilation was not delayed due to on-going chest compressions. I-gel was superior compared to Soft Seal
and
AuraOnce in significantly reducing time to first effective ventilation and delivering tidal volumes within the recommended range.
Abstract 327: Efficacy of Lower Limb Compression in the Management of Vasovagal Syncope: A Randomized Crossover Study
Authors: Barbisan Juarez , Queiroz dos Santos Rafael , Suzigan Bruna H , Souza Lucas , Santánna Patricia , Smidt Luis , Pedrozo Vitor , Gazeta Cristina , Dossin Isabella
Published: April 2024

Introduction:
Vasovagal syncope (VS) is the most prevalent cause of transient loss of consciousness among the population. The treatment consists of lifestyle modifications and the use of a pacemaker in some subgroups of patients. The purpose of this study is to evaluate the effect of measures to compress the lower limbs in patients with recurrent episodes of VS submitted to the Tilt Test (TT).

Methods and Results:
Twenty patients, average age 30.5 years (15-75), 13 (65%) female, with a clinical diagnosis of VS and previous TT with a positive result and who had at least one episode of syncope during the last year were included in this placebo-controlled randomized cross-over study. The patients underwent two consecutive TT, at a one-hour interval, with and without compression by pneumatic compression boots with 40 mmHg at the heels and 30 mmHg for the legs. The blood pressure (BP) and heart rate (HR) of these patients were monitored continuously. The outcome assessor was blinded. The results of the TT were positive in 13 (65%) of the patients in the control groups and in 2 (10%) of the patients with compression (p<0.0001). Throughout the tests, the systolic BP measures were not different among the groups. On the other hand, the HR measures showed a difference only in the tilted position at two minutes, of 73±16 bpm in the control group and of 69±16 bpm (p=0.047) in the compression group.

Conclusion:
Compression of the lower limbs is very effective to render the TT negative in patients with a diagnosis of VS.
Abstract 340: An Algorithm that Analyzes During Chest Compressions Exceeds Sensitivity and Specificity Recommendations
Authors: Sullivan Joseph L , Piraino Daniel W , Banville Isabelle , Walker Robert G , Chapman Fred W
Published: April 2024

Background
: Pauses in chest compressions during cardiopulmonary resuscitation (CPR) reduce survival from sudden cardiac arrest. Analyzing ECG during compressions (ADC) instead of pausing for analysis may improve outcomes. We assembled large development and test sets of clinical data and evaluated the performance of an ADC algorithm that classifies rhythms into categories of “Shock,” “No Shock,” and “Pause CPR for Analysis.”

Methods
: Defibrillator ECG and impedance recordings from 1097 (585 development, 565 test) patients with cardiac arrest were retrospectively gathered from 7 emergency medical systems. To compare against American Heart Association (AHA) recommendations, CPR-artifacted segments with coarse VF (> 0.2 mV peak-peak) or non-shockable rhythms were paired with adjacent segments free of CPR artifact, enabling annotators to accurately identify the rhythm. One reviewer annotated and another verified rhythm designations, resulting in a development set of 2811 (716 coarse VF + 2095 non-shockable) CPR-artifacted segments and an independent test set of 2758 (707 coarse VF + 2051 non-shockable) segments. “Pct Pauses” was defined as the number of segments classified “Pause CPR for Analysis” divided by the total number of segments. Sensitivity, specificity, positive predictivity, and negative predictivity were calculated for segments not designated for a pause (i.e. analyzed during CPR). Results were compared to AHA recommended sensitivity and specificity for artifact-free ECG.

Results
: See table.

Conclusions
: ADC algorithm performance, evaluated on development and test sets of ECG with CPR artifact, exceeded the AHA recommendation for performance on ECG without CPR artifact. Incorporation of this algorithm into an AED may eliminate about 80% of analysis pauses without compromising analysis accuracy and may consequently improve the likelihood of resuscitation.
Abstract 36: Etiology of In-Hospital Cardiopulmonary Arrest as a Predictor of Outcome
Authors: Husa Ruchika , Scyoc Dorothy , Gordon James , Chappel Ruth , Sell Rebecca , Minokadeh Anushirvan , Davis Daniel
Published: April 2024

Background: Inpatient cardiopulmonary arrest (CPA) is poorly defined. However, understanding the factors contributing to incidence and outcome is critical in designing effecting CQI programs.

Objective: To explore the effectiveness of an arrest taxonomy, using specific etiologies of inpatient CPA, to predict incidence and outcomes and direct CQI efforts.

Methods: This study was conducted in two urban university hospitals from 2005-09. The Advanced Resuscitation Training (ART) program was implemented in 2007. Clinical and demographic data were abstracted from the institutional resuscitation database. Broad categories regarding arrest etiology [sepsis, hemorrhage, pulmonary embolus, VF/VT, vagal, neurologic, heart failure, intubated respiratory, and non-intubated respiratory] were incorporated into a multivariate logistic regression model using survival-to-hospital discharge as the primary outcome. In addition, chi-square analysis of incidence and graphical analysis of incidence and survival trends for specific etiologies before and after ART implementation were performed.

Results: A total of 332 inpatients suffered CPA during the study period [pre-ART n=182, post-ART n=150]. Multivariate logistic regression revealed an independent association with outcome for each of the etiologies but not for other covariates. A decrease in the incidence and improvement in survival for certain arrest etiologies was observed following ART implementation.

Conclusion: We observed important associations between arrest etiology and both incidence and outcome from inpatient CPA. This taxonomy may be helpful in guiding CQI efforts.
Abstract 43: Comparative Study of Survival After In-Hospital Cardiac Arrest in Patients with Chagas Cardiomyopathy and Idiopathic Dilated Cardiomyopathy
Authors: Gonzalez Maria Margarita , Vianna Caio B , Gianotto-Oliveira Renan , Timerman Sergio , Kalil Filho Roberto
Published: April 2024

INTRODUCTION: Chagas Cardiomipathy, among all causes of cardiac insufficiency, appears to be what brings the worst prognosis. The evolution of these patients after in-hospital cardiac arrest is not adequately evaluated in the medical literature.

METHODS: To this propose, from April 2004 to June 2008, Utstein-style data, were prospectively collected from 1027 consecutive in-patient adult index cardiac arrests in an observational, single-center study at a tertiary cardiac care hospital. Of them, 715 (77%) patients performed echocardiograms during admission or until three months pre arrest. We compare the evolution of hospital patients with moderate or severe systolic dysfunction (LVEF <45%) and diagnosis of Chagas Cardiomyopathy (74 patients) and Idiopathic Dilated Cardiomyopathy (74 patients), by univariate and multivariate (logistic regression). The primary end-point was survival to discharge. Secondary outcomes were return of spontaneous circulation for more than 20 minutes, 24-hour survival after cardiac arrest, and discharged with satisfactory neurological evaluation, defined as cerebral performance category 1 or 2.

RESULTS: Survival to discharge was 15% in patients with Idiopathic Dilated Cardiomyopathy compared with 4% in patients with Chagas Cardiomyopathy (after logistic regression; “odds ratio” adjusted = 0.89, 95% CI, 0.09 to 0.907, P <0.001). Another factor associated with lower hospital survival was use of atropine during resuscitation. The rhythm of VF /VT pulseless as the initial rhythm of arrest was associated with higher hospital survival. Both groups did not differ regarding return of spontaneous circulation (54% vs. 58%, P = 0.468), 24-hour survival (39% vs. 41 %, P =0.550), or survival with CPC 1 or 2 (100% vs. 91%, P =0.660).

CONCLUSION: As hypnotized, Chagas Cardiomiopathy was associated with lower rates of survival to hospital discharge, despite similar rates of sustained return of spontaneous circulation and 24-hour survival post-arrest. Peculiarities of Chagas Cardiomyopathy associated with myocardial dysfunction, hyperadrenergic state, postresuscitation inflammatory response seem to contribute strongly to this development more unfavorable.
Abstract 19681: Endothelial PGC-1alpha Mediates Vascular Dysfunction in Diabetes
Authors: Sawada Naoki , Jiang Aihua , Takizawa Fumihiko , Croce Kevin , Manika Andre , Tesmenitsky Yevgenia , Kang Kyu-Tae , Bischoff Joyce , Kalwa Hermann , Michel Thomas , Kamei Yasutomi , Benjamin Laura , Sata Masataka , Ogawa Yoshihiro , Arany Zolt
Published: April 2024

Naoki Sawada, 2012 Finalist and Presenting Author
Abstract 12705: Mechanisms of Decreased Exercise Capacity with Sleep Disordered Breathing in Hypertrophic Cardiomyopathy
Authors: Konecny Tomas , Brady Peter , Ludka Ondrej , Placek Alexander , Orban Marek , Kara Tomas , Gersh Bernard , Tajik Jamil A , Allison Thomas , Ommen Steve R , Somers Virend
Published: April 2024

Tomas Konecny, 2012 Finalist and Presenting Author
Abstract 19168: Effect of Endurance Exercise on Transgenic Arrhythomeginc Right Ventricular Cardiomyopathy Mice
Authors: Jain Rahul , Martherus Ruben , Takagi Ken , James Jeanne , Kramer Kristen , Purevjav Enkhsaikhan , Towbin Jeffrey A
Published: April 2024

Rahul Jain, 2012 Finalist and Presenting Author
Abstract 16311: Resistance Training Improves Cardiac Output, Exercise Capacity and Tolerance to Positive Airway Pressure in Fontan Physiology
Authors: Cordina Rachael L , O’Meagher Shamus , Rae Caroline L , Leiss Carsten , Kemp Graham J , Puranik Raj , Singh Nalin , Celermajer David S
Published: April 2024

Rachael L Cordina, 2012 Finalist and Presenting Author
Abstract 11066: Acute Efficacy of Systemic to Pulmonary Arterial Collateral Embolization
Authors: Dori Yoav , Glatz Andrew C , Hanna Brian D , Gillespie, Matthew J. , Harris Matthew A , Keller Marc S. , Fogel Mark A , Rome Jonathan J , Whitehead Kevin K
Published: April 2024

Yoav Dori, 2012 Finalist and Presenting Author
Abstract 9363: Intervention for Re-coarctation in the Single Ventricle Reconstruction Trial: Incidence, Risk and Outcomes
Authors: Hill Kevin D , Rhodes John F. , Aiyagari Ranjit , Baker G. Hamilton , Bergersen Lisa , Chai Paul J. , Fleming Gregory A. , Fudge J. Curt , Gillespie Matthew J. , Gray Robert G. , Hirsch Russel , Lee Kyong-Jin , Li Jennifer S. , Ohye Richard G. , Oster Matthew E. , Pasquali Sara K. , Pelech Andrew M. , Radtke Wolfgang A.K. , Takao Cheryl M. , Vincent Julie A. , Hornik Christoph P.
Published: April 2024

Hill Kevin D 2012 Finalist and Presenting Author
Abstract 13282: Aspirin Exposure Reveals Novel Genes Associated with Platelet Function and Cardiovascular Events
Authors: Voora Deepak , Cyr Derek , Lucas Joseph , Chi Tsan , McCaffrey Timothy , Katz Richard , Newby L. Kristin , Kraus William , Becker Richard , Ortel Thomas , Ginsburg Geoffrey
Published: April 2024

Deepak Voora, 2012 Finalist and Presenting Author
Abstract 13482: Hydrogen Sulfide Stimulates Ischemic Vascular Remodeling Through Xanthine Oxidase Dependent Nitrite Reduction Activity Stimulating cGMP, HIF-1 And VEGF Mediated Angiogenesis
Authors: Bir Shyamal , Kolluru Gopi Krisna , Shen Xinggui , Pattillo Christopher B , Kevil Christopher G
Published: April 2024

Shyamal Bir, 2012 Finalist and Presenting Author
Abstract 13604: No Longer Idiopathic: A Case of Recurrent Pericarditis in a Military Recruit
Authors: Natarajan Pradeep , Francis Sanjeev , Dec George William
Published: April 2024

Pradeep Natarajan, 2012 Finalist and Presenting Author
Abstract 53: Abnormal Continuous Electroencephalography Recordings Are Not Predictive of Survival Outcomes Following Cardiac Arrest
Authors: Shrestha Archana , Campbell Jenny A , Larabee Todd M
Published: April 2024

Background: Cerebral anoxia following cardiac arrest can lead to poor neurological outcomes. Post-arrest therapeutic hypothermia (TH) has been shown to be neuroprotective in this setting. Early prognostication of survival outcomes is important for patient care and resource management. The use of continuous electroencephalography (cEEG) may be an important tool for prognostication of survival outcomes after cardiac arrest.

Objectives: To determine if abnormal cEEG recordings are associated with survival outcomes following cardiac arrest.

Methods: Retrospective study of all patients who suffered an in- or out-of-hospital cardiac arrest and were entered into the post-arrest management protocol (PAMP) at a single academic institution between May 2011 and May 2012. As part of the PAMP, cEEGs are recorded during TH, during the rewarming phase, and at normothermia. All cEEG reports were assessed for routinely described abnormal patterns: severe suppression, burst suppression, status epilepticus, intermittent epileptiform discharges (IED), generalized periodic epileptiform discharges (GPED), either α,β, or [[Unable to Display Character: ▵]] coma, or diffuse intermixed slowing. Descriptive statistics were analyzed.

Results: Ninety-one patients were admitted to the ICU after cardiac arrest and 42 patients had PAMP and TH initiated. Of these, 36 (86%) received a neurologic consultation and 27(64%) had a cEEG placed. 24/27 (89%) survived to 24 hours and 7/27 (26%) survived to hospital discharge. Of the 7 survivors to discharge, 1 had severe suppression, 3 demonstrated α,β, or [[Unable to Display Character: ▵]] coma, and 3 demonstrated diffuse intermixed slowing during MTH. During early rewarming and normothermia, 3 had diffuse intermixed slowing, 2 demonstrated either α,β, or [[Unable to Display Character: ▵]] coma, and 1 demonstrated IEDs.

Conclusion: Abnormal cEEG during MTH and early rewarming is not predictive of survival outcomes following cardiac arrest in this small, retrospective study. This study is limited by the small number of enrolled patients who have completed the protocol to date.
Abstract 14710: Myocardial Bridging: Novel Insights from Exercise Echocardiographic Correlations with Hemodynamic Measurements - The Venturi Effect
Authors: Lin Shin , Tremmel Jennifer , Yamada Ryotaro , Yong Celina M , Rogers Ian S. , McConnell Michael V. , Dash Rajesh , Schnittger Ingela
Published: April 2024

Shin Lin, 2012 Finalist and Presenting Author
Abstract 13170: Microvascular Notch Signaling is Upregulated in Response to Vascular Engothelial Growth Factor and Chronic Myocardial Ischemia
Authors: Lassaletta Antonio D , Elmadhun Nassrene Y , Burgess Thomas A , Robich Michael P , Chu Louis M , Sellke Frank W
Published: April 2024

Antonio D Lassaletta, 2012 Finalist and Presenting Author
Broken Hearts, Broken Brains and the Blues
Authors: Mitchell Pam
Published: April 2024

Upwards of 30% of people with stroke, coronary heart disease and many other chronic disorders are clinically depressed. This is in contrast to roughly 5% of the general population. In this lecture we will explore the current biobehavioral theories about why depression might be so much more prevalent in acute and chronic cardiocerebrovascular disease, how our genes might interact, and what we can do to improve the quality of life for our patients with broken hearts, broken brains and the blues.
Cryptogenic Stroke: Search Your Heart!
Authors: Kasner Scott E.
Published: April 2024

About 30-40% of all ischemic strokes are classified as cryptogenic because no well defined cause can be identified. Without a known cause, the treatment is arbitrary, usually defaulting to antiplatelet therapy and the risk of future stroke is uncertain. Cryptogenic stroke is an imprecise term that includes four subcategories: strokes without a sufficient evaluation, those with a thorough but seemingly negative evaluation, those that don't strictly meet criteria for other established causes, and those with multiple competing causes. High risk etiologies that are often missed include aortic arch atherosclerosis, paroxysmal atrial fibrillation, and akinetic left ventricular segments. The risk related to a low ejection fraction or an enlarged left atrium has been incompletely studied. The role of patent foramen ovale in the pathogenesis of cryptogenic stroke remains complex and unresolved. Rare causes often are not considered at all. Specific attention to detecting these cardiac problems with echocardiography and prolonged rhythm monitoring could cut the proportion of cryptogenic strokes by as much as half and result in improved prevention of recurrent stroke.
Abstract 63: Time to Target Temperature and Neurological Outcome in Survivors of Cardiac Arrest
Authors: Perman Sarah M , Grossestreuer Anne V , Leary Marion , Gaieski David F , Carr Brendan G , Abella Benjamin S
Published: April 2024

Introduction: Substantial variability exists in time to target temperature for patients who undergo therapeutic hypothermia (TH) after cardiac arrest. How this variability may affect or predict neurologic outcomes is unknown.

Hypothesis: Prolonged pre-induction time, or shorter times to target temperature will be associated with poor neurologic outcomes compared to shorter pre-induction times and a more gradual decline to target temperature.

Methods: We conducted a retrospective chart review of TH patients from three institutions with identical TH protocols (PATH Database). Demographic variables were collected and analyzed using chi square and Student’s t-tests. We examined the association between time from arrest to return of spontaneous circulation (ROSC) (downtime), time from ROSC to initiation of TH (pre-induction) and time from initiation of TH to arrival at target temperature (induction) and Cerebral Performance Category (CPC) using logistic regression.

Results: We enrolled 180 patients with mean age 59.1 ± 15.5 yrs, 56% male, and 26.1% with VF/VT as an initial rhythm. At discharge, 26% (47/180) of the cohort had CPC category 1 or 2 (good neurologic outcome). Mean downtime for survivors with a good outcome was 21.5 ± 13.7 mins vs. 32.6 ± 21.7 mins (p=0.004) for those with poor outcome. Mean pre-induction time for good outcome (CPC 1 or 2) was 144.5 ± 205.4 mins compared to 145.5 ± 171.1 mins for bad outcome (p=ns). Mean induction time for good outcome (CPC 1 or 2) was 270.8 ± 160.8 mins compared to 252.3 ± 151.3 mins for bad outcome (p=ns). In analyses adjusting for gender, initial rhythm, and downtime, there was no association between pre-induction time (OR 1.00, 95% CI 0.99-1.0, p=ns) or induction time (OR 0.99, 95% CI 0.99-1.0, p=ns), and neurologic outcome.

Conclusion: In this cohort of post-arrest TH patients, pre-induction time and induction time do not appear to be associated with poor neurologic outcome. Further analysis is necessary to examine this phenomenon.
Abstract 67: Secular Trends in Cardiovascular Comorbidities and Associated Mortality Among Patients Hospitalized Alive After Out-of-Hospital Cardiac Arrest: A 20-Year Experience from a Middle-Eastern Country (1991-2010)
Authors: Salam Amar M , AlBinali Hajar A , Al-Mulla Abdul Wahid , Singh Rajvir , Al Suwaidi Jassim
Published: April 2024

Objectives:
little is known about the trends of the cardiovascular comorbidities associated with cardiac arrest in the developing countries and how they affect mortality. This was examined in this study in patients hospitalized alive after out of hospital cardiac arrest in a real-world population in a Middle-Eastern Country.

Methods
: Retrospective analysis of prospective registry of all patients hospitalized alive after out of hospital cardiac arrest in Qatar from 1991 through 2010 was made. Rates and trends of cardiac comorbidities and in-hospital mortality were examined.

Results
: During the 20-years period 801 patients were hospitalized alive after out of hospital cardiac arrest; 577 men and 224 women. In the latter years of the study there was increase in the prevalence of diabetes mellitus and hypertension when compared to patients hospitalized in the earlier years. Associated ischemic heart disease and heart failure were also trending higher. The study also demonstrated an increasing trend of in-hospital mortality over the 20-year period [table].

Conclusions
: recent improvements in the recognition and management of the cardiovascular comorbid conditions associated with cardiac arrest, especially acute coronary syndromes and heart failure were at least in part, offset by the increase in prevalence of diabetes mellitus and hypertension along with ischemic heart disease in our region. Tailored strategies for the prevention and treatment of these conditions are warranted to reduce the burden of cardiovascular disease and its related mortality.
Abstract 71: A Novel Animal Model of Pulseless Electrical Activity Cardiac Arrest: Adrenergic Blockade and Coronary Occlusion
Authors: Shah Atman P , Niemann James T , Youngquist Scott T , Thomas Joseph L , Rosborough John P
Published: April 2024

Introduction:
The incidence of VF as the first documented rhythm in out-of-hospital cardiac arrest (OOHCA) has been declining, while the incidence of pulseless electrical activity (PEA) has been increasing. The increasing proportion of PEA as the initial rhythm for OOHCA has paralleled the increasing use of adrenergic antagonist therapy in the population most at risk for cardiac arrest. We hypothesized that PEA cardiac arrest can result from acute coronary occlusion in the setting of pre-arrest adrenergic blockade.

Methods:
Twenty-six anesthetized and instrumented immature male swine (mean weight 36 kg) were pre-treated with an infusion of labetalol, a β-1 and α-1 adrenergic blocker (mean dose 6 ± 3 mg/kg). Adequacy of adrenergic blockade was determined using an intravenous challenge of epinephrine 0.1 mg IV. After challenge and return to baseline, balloon occlusion of the left anterior descending (LAD) or proximal right coronary artery (RCA) was performed and the rhythm and hemodynamic response observed during sustained occlusion.

Results:
Occlusion of the RCA was followed by PEA or pseudo-PEA (defined as an organized rhythm with systolic arterial pressure <50 mm Hg) in 10/13 animals (77%). During RCA occlusion, cooling of the vagus nerve (reversible thermal vagotomy) did not prevent the hypotensive hemodynamic response. LAD occlusion was followed by PEA in 6/13 animals (46%). Brief occlusion of the RCA followed by occlusion of the LAD was followed by PEA in 5/7 animals (71%).

Conclusions:
Adrenergic blockade followed by coronary occlusion may be followed by PEA. This combination may play a role in the declining incidence of VF as the initial cardiac arrest rhythm in out-of-hospital cardiac arrest.
Abstract 8: Dynamic ECG Changes in Wearable Cardioverter-Defibrillator Patients Predict Sudden Cardiac Arrest
Authors: Karia Darshak , Bianco Nicole R , Wan Chingping , Glad Jo Ann M , Szymkiewicz Steven J
Published: April 2024

Purpose:
 Sudden cardiac arrest (SCA) prediction continues to be an active area of investigation. The wearable cardioverter defibrillator (WCD) records ECG periodically. The objective of this study was to study the predictive value of dynamic ECG changes occurring between baseline (Base), one week prior to SCA (1WK), and immediately prior to shock (pre-S) for ventricular tachyarrhythmias VT/VF

Methods:
 100 sequential patients (pts) who were prescribed a WCD for bridge to ICD or recovery, and who were shocked for VT/VF between November 2009 and June 2011 were retrospectively analyzed. ECG’s were examined for dynamic changes in heart rate (HR), QRSd, QRS amplitude, QTc, PVCs, rhythm, and NSVT to see if they were predictive of impending shock. Individual manual measurements were collected at Base, 1WK, and pre-S. Only pts wearing the WCD ≥1 week were included for analysis.

Results:
 Pts (68% male, age 59 ± 16 years, mean LVEF 23±7.5%) had dynamic increases in mean HR and PVC burden from Baseline to 1WK to pre-S (p≤0.0001)(Table 1). Interestingly, changes in traditional measures such as QTc or QRSd or amplitude did not predict shock.

Conclusions:
 The WCD provides a unique opportunity to monitor ECG patterns in at-risk pts prior to defibrillation. A dynamic increase in HR and ventricular ectopy changes prior to VT/VF could indicate a shift of sympathetic-vagal balance towards sympathetic predominance and reduced vagal modulation.
Abstract 83: Cardiac Arrest and Cardiopulmonary Resuscitation Knowledge at an Academic Research Organization in Durham, North Carolina
Authors: Anderson Monique L , Jollis James G , Peterson Eric D , Lopes Renato D , Blanco Rosalia G , Fraulo Elizabeth , Pathman Joshua , Moore Angel , Short Leatrice , Granger Christopher B
Published: April 2024

Purpose: Bystander CPR is a critical step in the chain of survival for out of hospital cardiac arrest (OHCA). In North Carolina, survival is estimated to be 12%; 17% of victims receive bystander CPR. Current public knowledge of cardiac arrest and CPR skills are not well described.

Methods: We implemented a CPR awareness/ training program during CPR Awareness Week at the Duke Clinical Research Institute (DCRI), a large academic research organization (ARO) traditionally focused on cardiovascular care, to increase awareness of OHCA and CPR. Prior to implementation, employees completed an online survey to gauge prior CPR training, current confidence with CPR, and knowledge of cardiac arrest and CPR skills. The program included expert lectures on cardiac arrest and CPR, a documentary on a Duke patient’s cardiac arrest, as well as a video demonstration (AHA) of Hands-Only CPR. After the education session, trained volunteer instructors taught and evaluated the practical CPR performance skills of each participant. An online post-program survey concluded the program (data collection ongoing).

Results: A total of 173 (14.5%) employees completed the pre-program survey. 75% (n=134) of participants were not health care professionals. 67% (n=120) had been previously trained in CPR, of which 60% (n=70) were trained ≥ 5 years ago. Only 16% (n=28) of participants were “very sure” they could perform CPR if needed immediately. Only a minority of respondents were aware that cardiac arrest is associated with very high mortality rates (20%) or that most cardiac arrests occur in the home (21%). 66% of respondents knew that calling 911 is a necessary first step after witnessing a cardiac arrest. While 84% (n=145) respondents knew correct hand placement position for CPR, only 27% (n=47) and 29% (n=54) knew correct compression rate and depth for CPR performance, respectively. In the presence of gasping, only 37% (n=60) knew to start or continue performing CPR on OHCA victims.

Conclusion: Cardiac arrest and CPR knowledge are not optimal at our ARO, despite one of our research mission’s to improve emergency cardiovascular care. Community awareness is likely lower than observed at the DCRI. These data highlight opportunities for CPR awareness programs in academic settings and in the community.
Abstract 88: Delayed Administration of Argon Reduces Ischemic Brain Damage and Preserves Functional Recovery After Cardiac Arrest in Rats
Authors: Brücken Anne , Bleilevens Christian , Derwall Matthias , Nolte Kay , Weis Joachim , Rosaint Rolf , Fries Michael
Published: April 2024

Introduction: Argon is neuroprotective when given 1 hour after cardiac arrest (CA) in rats. Here, we investigated if a delayed administration of argon would also reduce neurologic dysfunction.

Material and Methods: 18 male Sprague-Dawley rats were subjected to 7 mins of CA and 3 mins of cardiopulmonary resuscitation (CPR). Three hours after successful CPR, animals were randomized to ventilation with 70% argon for 1h in comparison to untreated controls receiving 70% nitrogen. A neurologic deficit score (NDS) was calculated on seven days following the experiment before the animals were killed and the brains harvested for histopathological analyses. Neuronal damage was semiquantitatively assessed by determining the proportion of neuronal cells showing shrunken and/or hypereosinophilic cytoplasm (HE staining) in combination with a loss of nuclear NeuN-immunoreactivity.

Results: All animals survived. Untreated controls exhibited severe neurologic dysfunction while animals from the argon group showed significant improvements in the NDS at all points in time (Fig.1). This was paralleled by a significant reduction in the degree of ischemic brain damage in the neocortex, the basal ganglia and the hippocampal CA 3/4 region (Fig.2).

Conclusions: Our study demonstrates that a one hour application of 70% argon, even when treatment was delayed for 3 hours after CA, provided a significant reduction in histopathological damage of the neocortex, basal ganglia and hippocampus which was associated with a marked improvement in functional neurologic recovery.
Abstract 8905: Protein Kinase G Positively Regulates Proteasome Proteolytic Function in the Heart
Authors: Ranek Mark J , Kost Curtis , Martin Douglas S , Wang Xuejun
Published: April 2024

The Ubiquitin Proteasome System (UPS) plays a pivotal role in the intracellular protein homeostasis, thereby regulating a variety of cellular processes including protein quality control (PQC). Inadequate PQC and proteasome functional insufficiency are associated with and may play an important role in adverse cardiac remodeling and cardiac failure (CHF). This is best reflected by the increased presence of misfolded proteins and protein aggregates in failing human hearts. While the regulatory mechanisms of these processes remain poorly understood they carry significant clinical implications. Reduced protein kinase G (PKG) activity is well documented in CHF. Increasing the activity PKG, during various cardiovascular diseases improves patient prognosis. We hypothesize that PKG plays a role in regulating UPS function. Using both genetic and/or pharmacological manipulation of PKG activity in cultured cardiomyocytes and intact mice and taking advantage of a previously validated surrogate misfolded protein (GFPu or GFPdgn) as well as a bona fide misfolded protein (R120G-CryAB) that is known to cause proteinopathy in human and mice, our studies have revealed a significant role for PKG in UPS regulation. In cultured cardiomyocytes, PKG inhibition was achieved by PKG-specific siRNA transfection or administration of PKG pharmacological inhibitor while PKG activity was induced by adenoviral delivery of a constitutively active PKG or by the treatment of phosphodiesterase 5A inhibitor Sildenafil. PKG activation significantly stimulated UPS activity in cultured cardiomyocytes as indicated by a reduced protein level of GFPu and increased proteasome activities; while PKG inhibition reduced UPS proteolytic activity. Furthermore PKG activation resulted in enhanced removal of R120G-CryAB. These findings from cell culture studies were further corroborated by in vivo findings from manipulating the muscarinic (M) receptor in GFPdgn transgenic mice. The M receptor signals through PKG. Activating the M receptor deceased, while antagonizing the M receptor increased, the steady protein level of GFPdgn in the heart. Hence, we conclude that PKG positively regulates the UPS thereby supporting cardiomyocyte PQC.
Abstract 8927: Double-hump Syndrome: The Presence Of Extreme Interatrial Conduction Delay is Associated With Regularization and Progressive Slowing of Atrial Arrhythmias in a Subgroup of Patients With Hypertrophic Cardiomyopathy
Authors: Akca Ferdi , Caliskan Kadir , Ten Cate Folkert , Jordaens Luc , Szili-Torok Tamas
Published: April 2024

Background:
In patients with hypertrophic cardiomyopathy (HCM) extreme interatrial activation delay (IAD), indicated by complete separation of the right and left atrial activation on the surface ECG (double hump P wave), was associated with regularization and increase of the cycle length (CL) of recurrent atrial tachycardias (ATs).We aimed to determine the prevalence and the predisposing clinical factors for this clinical entity.

Methods:
We used data from our HCM registry (n=174 pts, mean age: 53±14 yrs). Data of patients with separated P wave, regularization and slowing of ATs (group I, 5 pts, 2.9%) were compared with 122 control patients with HCM without ATs (group II.). The following parameters were analyzed: P wave morphology and change in P wave duration (ΔP and Pmax), changes in AT CL (ΔATCL), echocardiography parameters including interatrial septal thickness (IAS-T), E/A ratio, E/E prime ratio and fractional shortening (FS) and results of genetic testing.

Results:
Overall, 9 pts (5.1%) had double hump P waves. This was associated with AT CL prolongation in 5 pts, who were older (66±11 yr vs. 50±14 yr, p=0.016) and had longer follow-up (13,8±1,8 years vs. 7,8± 4,7 years, p=0.005). The ΔATCL was 121±134 ms (range [40-360]) in group I. Echocardiography confirmed double mitral and tricuspid inflow A waves in all group I. pts. Pmax and ΔP were significantly larger in group I (166±33 ms vs. 105±22 ms, p<0.001; 52±26 ms vs. 9±13 ms, p<0.001, respectively). Group I. had an increased LA size as compared to group II. (58±12 mm vs. 45±8 mm, p=0.001) and higher E/A and E/E prime ratios (1,99±1,2 vs. 1,23±0,5, p=0.005 and 20,9±13 vs. 13,1±6,0, p=0.011, respectively). There were no differences in IAS-T and in FS (superior IAS: 4,4±0,1 mm vs. 5,2±1,7 mm, p=NS; inferior IAS: 5,8±0.1 mm vs. 5,7±2,2 mm, p=NS; 38,4±5 % vs. 40,4±9 %, p=NS, respectively). All identified mutations were typical Dutch founder mutations of the MYBPC3 gene.

Conclusions:
A subgroup of HCM patients have an unique combination of symptoms of separated P wave, regularization and slowing of ATs. Interatrial conduction delay is not related to IAS-T, however, it is associated with larger atria and higher LA pressures. The presence of double hump syndrome is associated with MYBPC3 myosin binding protein mutations.