bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 5073: Relationship of Physical Activity with Circulating Progenitor Cell Counts and Adiponectin Levels in Healthy Non-Obese Individuals
Authors: Aznaouridis Konstantinos , Ali Sarfraz , Kavtaradze Nino , Mheid Ibhar Al , Quyyumi Farah , Ozkor Muhiddin , Dhawan Saurabh , Murrow Jonathan , Patel Riyaz , Weyand Connie , Goronzy J J , Alexander R W , Quyyumi Arshed
Published: July 2021

Background:
Physical activity is a determinant of cardiovascular performance and a predictor of risk. Levels of progenitor cells that contribute to repair of tissues including the cardiovascular system are modulated by cardiovascular risk factors and disease. Similarly, adiponectin levels, an anti-inflammatory adipokine, may be modulated by the sedentary state. We hypothesized that the benefits of physical activity may include enhancing the circulating progenitor cell counts and raising adiponectin levels. We investigated this relationship in healthy subjects.

Methods:
We studied 61 healthy, non-obese subjects free of risk factors (age 43±13 years, BMI 24.2±3.4 kg/m
2
). Levels of light (<3 METS), moderate intensity (3– 6 METS), vigorous (>6 METS) and total physical activity, expressed as MET-minutes/day of energy expenditure, were derived from the validated Cross-Cultural Activity Participation Study (CAPS) Typical Week Activity questionnaire. Levels of CD34+ hematopoetic progenitor cells and the sub-populations enriched for endothelial progenitors including CD34+/CD133+, CD34+/KDR+ and CD34+/CD133+/KDR+ cells were measured by flow cytometry. Adiponectin was measured by ELISA (n= 32).

Results:
The CD34+ count correlated with light (r = 0.30, p<0.05), vigorous (r = 0.30, p<0.05) and total physical activity (r = 0.28, p<0.05), independent of age and gender. The 34 subjects who fulfilled the CDC criteria for vigorous physical activity had higher CD34+/KDR+ (1.41±0.77 vs. 1.0±0.82 cells/μL, p<0.05) and CD34+/CD133+/KDR+ counts (0.68±0.36 vs. 0.50±0.38 cells/μL, p<0.05) compared to the 27 subjects who did not meet those criteria. There was a positive correlation between adiponectin levels and moderate-intensity physical activity (r=0.41, p<0.05).

Conclusion:
We show for the first time in a healthy, non-obese population that vigorous physical activity is associated increased levels of hematopoeitic and endothelial progenitors. Greater activity is also associated with increased adiponectin levels. These findings provide insights into the mechanisms underlying the protective role of regular exercise in cardiovascular and metabolic health.
Abstract 5076: Type 2 Diabetes but not the Coronary Angiographic State Is an Independent Determinant of Impaired Mobility in Angiographied Coronary Patients
Authors: Saely Christoph H , Dyballa Thomas , Rein Philipp , Vonbank Alexander , Beer Stefan , Drexel Heinz
Published: July 2021

Introduction:
The determinants of impaired mobility in the high risk population of angiographied coronary patients are unknown; in particular a potential impact of type 2 diabetes and of the coronary artery state has not been investigated yet.

Hypothesis:
We assessed the hypothesis that both type 2 diabetes and the coronary angiographic state are associated with impaired mobility.

Methods:
We enrolled 747 consecutive patients undergoing coronary angiography for the evaluation of stable coronary artery disease (CAD). Coronary stenoses with lumen narrowing ≥50% were considered significant; mobility was assessed by the standardized timed-up-and-go (TUG) test.

Results:
On average, our patients needed 9.6 ± 3.1 seconds to complete the TUG test, which showed impaired mobility (TUG time >10 sec) in 199 (26.6%) patients. The proportion of subjects with impaired mobility was significantly higher among patients with type 2 diabetes (T2DM) than among non-diabetic individuals (40.2% vs. 22.0%; p <0.001), whereas it did not differ significantly between patients with significant coronary stenoses and those without such lesions (p = 0.802). Multivariate adjustment in logistic regression analyses confirmed that T2DM (adjusted odds ratio (OR) = 2.05 [95% CI 1.35–3.11]; p = 0.001) but not the presence of significant coronary stenoses (adjusted OR = 0.81 [0.55–1.21]; p = 0.306) was independently associated with impaired mobility. Further independent determinants of impaired mobility were age (standardized adjusted OR = 3.27 [2.54 – 4.21]; p <0.001), female gender (adjusted OR 1.76 [1.16 –2.69]; p = 0.008), and body mass index (standardized adjusted OR = 1.49 [1.23–1.81]; p <0.001).

Conclusions:
In conclusion, T2DM but not coronary atherosclerosis is an independent determinant of impaired mobility among angiographied coronary patients. Mobility enhancing exercise programs are needed for diabetic coronary patients.
Abstract 5085: Cardiovascular Risk Factors and Coronary Atherosclerosis in Retired National Football League Players: Implications for Coronary Risk of Large Body Size in Athletes
Authors: Chang Alice Y , FitzGerald Shannon J , Cannaday John , Zhang Song , Patel Amit , Palmer M. D , Roberts Arthur J , Reddy Gautham P , Stillman Arthur E , Janowitz Warren , Radford Nina B , Levine Benjamin D
Published: July 2021

A high prevalence of obesity exists among national football league (NFL) players as classified by body mass index (BMI). It has not been established whether this elevated BMI is associated with a greater prevalence of cardiovascular (CV) risk factors or coronary artery disease in former NFL players as in non-athletes. This study compared CV risk factors and subclinical coronary atherosclerosis among retired NFL players versus community controls. The design was a case-control study of retired NFL players against matched controls from the population-based Dallas Heart Study (DHS) and a second physically active sample from the Aerobics Center Longitudinal Study (ACLS). CV risk factors were assessed by survey and health screening visit. Coronary atherosclerosis was determined with computed tomography measurements of coronary artery calcium (CAC). 201 NFL players completed measurements of CAC. Compared to DHS men, retired NFL players had a significantly lower prevalence of diabetes, hypertension, a sedentary lifestyle and the metabolic syndrome, yet a higher prevalence of impaired fasting glucose and hyperlipidemia. However, there was no significant difference in the prevalence of positive CAC (46 v 48.3%, p=0.69) or the distribution across subgroups of CAC (0 –10, 10 –100, 100 – 400, 400+, p=0.11) between the retired NFL players and DHS men. These results were not significantly different when controlling for ethnicity or linemen status. When compared to physically active controls (ACLS), retired NFL players had a greater BMI, waist size and prevalence of the metabolic syndrome, but no difference in other CV risk factors or CAC scores.

Conclusions:
Despite their large body size, former NFL players do not have a greater prevalence of CV risk factors or amount of CAC than community controls when matched by BMI and/or age. Age and hyperlipidemia, not body size, were the most significant predictors of subclinical coronary atherosclerosis among retired NFL players.

This research has received full or partial funding support from the American Heart Association, AHA National Center.

CV Risk Factors, Retired NFL Players versus Dallas Heart Study Participants
Abstract 5090: Impact of Adding a Single Allele in the 9p21 Locus to Traditional Risk Factors on Risk Classification for Coronary Heart Disease and Implications for Lipid-Modifying Therapy in the White Population of the Atherosclerosis Risk in Communities (ARIC) Study
Authors: Brautbar Ariel , Ballantyne Christie , Lawson Kim , Nambi Vijay , Chambless Lloyd , Folsom Aaron , Willerson James , Boerwinkle Eric
Published: July 2021

Aim:
A single nucleotide polymorphism on chromosome 9p21, rs10757274 (9p21 allele), has been shown to be a predictor of coronary heart disease (CHD) in whites. We evaluated if the addition of the 9p21 allele to traditional risk factors (TRF) improved CHD risk prediction in the white population of the Atherosclerosis Risk in Communities (ARIC) study, and whether changes in risk prediction will modify lipid therapy recommendation.

Methods:
Whites (n=10,004) in the ARIC study for whom the 9p21 genotype and TRF (age, gender, systolic blood pressure, total cholesterol, smoking, diabetes, HDL-C, and anti-hypertensive medication use) information was available were included. Using Cox proportional hazards models, the ARIC Cardiovascular Risk Score (ACRS) which is based on TRF was determined. The impact of adding the 9p21 allele to TRF with respect to the area under the curve (AUC) of a receiver operating characteristic (ROC) curve and then risk strata reclassification was determined.

Results:
The addition of 9p21 allele to TRF was associated with a hazard ratio (HR) of 1.25 (p<0.0001) and an increase in the AUC for incident CHD from 0.776 to 0.780 (Δ= 0.004, 95% CI=0.001, 0.008). The 9p21 allele’s greatest influence to the ACRS (Table

) was observed in the intermediate (5–10% 10-year CHD risk) and intermediate-high (10 –20% 10-year CHD risk) categories with 19.3% and 16.9% reclassified, respectively, which would impact therapy, as approximately 90% of these individuals had LDL-C >100 mg/dL.

Table:

Reclassification in the different ACRS categories after the addition of the 9p21 allele to the traditional risk factors
Abstract 5160: Obesity is Related to Concentric Left Ventricular Hypertrophy: Results from the Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Turkbey Evrim B , McClelland Robyn L , Kronmal Richard A , Bild Diane , Burke Gregory L , Tracy Russell P , Wilkins Linda , Arai Andrew , Bluemke David A
Published: July 2021

Obesity is a risk factor for cardiovascular disease but its association with left ventricular (LV) morphologic adaptations is debated because of obesity-associated co-morbidities. We evaluated the relationship of obesity to ventricular size and remodeling independent of other risk factors for LV hypertrophy. 5004 participants (age 45– 84 years; 52% female) of the MESA study free of clinical cardiovascular disease underwent cardiac MRI to assess LV size and function. The association of LV indices with measures of obesity, including fat mass (FM), body mass index (BMI) and waist circumference (WC), was determined using generalized additive models adjusted for established risk factors for LV hypertrophy and fat-free mass (FFM). FFM of participants was estimated based on height-weight models derived from bioelectrical impedance studies and FM was obtained by subtracting FFM from weight. LV mass and end diastolic volume were positively associated with FM, BMI and WC after adjustment for risk factors and FFM. For a given FFM, LV mass/volume ratio increased with FM up to approximately 50 kg FM (Figure

). Cardiac output and stroke volume were also positively associated with FM (slopes: CO 0.02 L/min per kg FM, SV 0.16 ml per kg FM, p<0.001 for each). Ejection fraction showed no significant association with FM. The associations of fat mass to increased LV mass and LV mass/volume were similar in patients with and without obesity associated co-morbidities. Obesity is associated with concentric LV hypertrophy, marked by increased LV mass/volume ratio, increased cardiac output and preserved ejection fraction.
Abstract 6223: The Appropriateness of PCI in a Regional Registry is High
Authors: Malenka David J , Olmstead Elaine M , Hearne Michael J , Kellett Mirle A , Robb John F , Lee Peter N Ver , Dauerman Harold L , Phillips William J , Ryan Thomas J , Silver M. Theodore , Piper Winthrop D , O’Connor Gerald T
Published: July 2021

Background.
Evidence based medicine mandates constant examination of the appropriateness of care. The ACC/AHA/SCAI have published, and updated, PCI guidelines. We assessed the concordance between these guidelines and actual clinical practice in our region.

Methods.
We evaluated 16,670 consecutive patients undergoing PCI in 2005–2006 at 10 hospitals contributing data to our regional PCI registry. As per the guidelines, we categorized patients into 5 groups (asymptomatic/CCS I-II angina, CCS III angina, UA/NSTEMI, STEMI, patients with prior CABG). Detailed clinical data, including number of diseased vessels and lesion location, myocardium at risk, the probability of angiographic success, and the probability of procedural risk, were then used to categorize procedures within subgroups as follows: Class I (useful and effective); Class IIa (evidence favors usefulness/efficacy); Class IIb (usefulness/efficacy less well established); Class III (not useful or effective).

Results.
We were able to assign 16,350 patients (98.1%) to a clinical subgroup and within subgroups, to classify 98.9% of procedures. Class I procedures totaled 38.1%; Class IIa 56.0%; Class IIb 0.7%; Class III 4.1%; unclassifiable 1.1%. The class distribution varied by clinical group (Figure

). Of the 664 Class III procedures, 64.6% were asymptomatic/CCS I-II angina, 32.5% UA/NSTEMI, and 2.9% CCS III angina.

Conclusion.
In this recent, regional experience we found that over 95% of PCI procedures were either Class I or Class II. In northern New England, actual clinical practice closely follows the ACC/AHA/SCAI recommendations for PCI appropriateness.

ACC/AHA/SCAI 2005 Guidelines for PCI
Abstract 6260: Up-Regulated Expression of MicroRNA-143 in Association with Obesity in the Adipose Tissue of Mice Fed High Fat Diet
Authors: Takanabe Rieko , Ono Koh , Takaya Tomohide , Horie Takahiro , Wada Hiromichi , Kita Toru , Shimatsu Akira , Hasegawa Koji
Published: July 2021

Obesity is the result of an expansion and increase in the number of individual adipocytes. Since changes in gene expression during adipocyte differentiation and hypertrophy are closely associated with insulin resistance and cardiovascular diseases, further insight into the molecular basis of obesity is needed to better understand obesity-associated diseases. MicroRNAs (miRNAs) are approximately 17–24nt single stranded RNA, that post-transcriptionally regulate gene expression. MiRNAs control cell growth, differentiation and metabolism, and may be also involved in pathogenesis and pathophysiology of diseases. It has been proposed that miR-143 plays a role in the differentiation of preadipocytes into mature adipocytes in culture. However, regulated expression of miR-143 in the adult adipose tissue during the development of obesity
in vivo
is unknown. To solve this problem, C57BL/6 mice were fed with either high-fat diet (HFD) or normal chow (NC). Eight weeks later, severe insulin resistance was observed in mice on HFD. Body weight increased by 35% and the mesenteric fat weight increased by 3.3-fold in HFD mice compared with NC mice. We measured expression levels of miR-143 in the mesenteric fat tissue by real-time PCR and normalized with those of 5S ribosomal RNA. Expression of miR-143 in the mesenteric fat was significantly up-regulated (3.3-fold, p<0.05) in HFD mice compared to NC mice. MiR-143 expression levels were positively correlated with body weight (R=0.577, p=0.0011) and the mesenteric fat weight (R=0.608, p=0.0005). We also measured expression levels in the mesenteric fat of PPARγ and AP2, whose expression are deeply involved in the development of obesity, insulin resistant and arteriosclerosis. The expression levels of miR-143 were closely correlated with those of PPARγ (R=0.600, p=0.0040) and AP2 (R=0.630, p=0.0022). These findings provide the first evidence for up-regulated expression of miR-143 in the mesenteric fat of HFD-induced obese mice, which might contribute to regulated expression of genes involved in the pathophysiology of obesity.
Abstract 6283: Obstructive Sleep Apnea Syndrome Associated with Major Cardiovascular Events in Male Diabetic Patients
Authors: Hermans Michel P , Ahn Sylvie A , Rousseau Michel F
Published: July 2021

Obstructive sleep apnea syndrome (OSAS), an obesity comorbidity, is an independent risk factor for diabetes (T2DM) and major cardiovascular events (MACE). While OSAS prevalence and association with MACE are well documented in the general population, such information is not available in T2DM. We analyzed 467 consecutive male T2DM outpatients in whom OSAS was diagnosed through Epworth’s Sleepiness Scale (ESS), overnight oximetry and polysomnography. OSAS (+) (n=43) were compared to OSAS (−) (n=424) regarding cardiovascular (CV) risk factors and MACE. Mean (1SD) age was 64 (12) years, diabetes duration 13 (9) years. Metabolic syndrome prevalence was 77%, HbA1c 7.6 (1.6) %. OSAS prevalence was 9%. There were no differences in age, diabetes duration, smoking, blood pressure and lipids between OSAS (+) and (−). There were significant differences in ESS score, ethanol intake, hypertension, BMI, waist, relative/absolute fat, conicity index, and visceral fat, all higher in OSAS (+) p<0.05. Nasal continuous positive airway pressure was used by 37% of OSAS (+). OSAS (+) were less often in primary prevention (PP) for CV disease than OSAS (−) (43 vs. 66%; p<0.003), with MACE and coronary artery disease (CAD) prevalence 61 and 63% higher (61 vs. 38%; p<0.01 and 44 vs. 27%; p<0.03), as well as much higher stroke prevalence (15 vs. 8%; NS) (see Figure

). OSAS is frequent in male T2DM patients (9%) and associated with a marked increase in MACE and CAD. With gender and diabetes ruled out as confounders, this increase is related to classical and emerging risk factors such as hypertension, BMI, waist, relative/absolute fat, conicity index, and visceral fat.
Abstract P14: Estradiol Does Not Improve Survival and Hemodynamic Parameters in Male Piglets after Hemorrhage and Ventricular Fibrillation
Authors: Semenas Egidijus , Wiklund Lars
Published: July 2021

Introduction:
Gender differences in organ functions and survival have been described in animal models of trauma and hemorrhagic shock. The female gender is associated with better cardiac, hepatic and immune functions compared to males after hemorrhagic shock. However, data about gender differences in hypovolemic normothermic cardiac arrest is lacking.

Hypothesis:
We hypothesized that the estradiol given during cardiopulmonary resuscitation (CPR) will improve survival and hemodynamic response in hypovolemic cardiac arrest and subsequent CPR.

Methods:
Twenty anesthetized male piglets (with a weight of 25.7 ± 1.7 kg [mean ± SD]) were bled 30% via the right femoral artery to a mean arterial blood pressure of 35 mm during 15 minutes. In the end of bleeding period estradiol group (n=10) received 17â-estradiol 50 ìg/kg intravenously, while the control group received no estradiol (n=10). Later all piglets were subjected to 4 min of untreated ventricular fibrillation followed by up to 15 min of open chest CPR. At 5 min of cardiac arrest piglets received vasopressin 0.4 U/kg, amiodarone 0.5 mg/kg, and hypertonic-hyperoncotic solution 3 ml/kg infusion for 20 minutes. Internal defibrillation was attempted from 8 min of cardiac arrest to achieve restoration of spontaneous circulation (ROSC). The experiment was terminated at 3 hours after initial resuscitation. Data were analyzed using Fisher’s exact test, Kaplan-Meier and repeated measures ANOVA methods.

Results:
All piglets were successfully resuscitated. No significant differences were observed in survival between the groups (p=0.24). All piglets needed dobutamine infusion and no differences were observed in either total dobutamin dose, or infusion start time (p=0.05). No significant changes were observed in any hemodynamic parameters (p>0.05). Troponin I levels did not differ between groups (p>0.75).

Conclusions:
Intravenous 17â-estradiol does not improve survival and hemodynamic parameters in male piglets after experimental hypovolemic cardiac arrest.
Abstract P35: Real-time Myocardial Contrast Echocardiography in Rat: Infusion vs. Bolus Administration
Authors: Su Hai Li , Qian Yun Qiu , Wei Zhang Rui , He Jian Guo , Li Guo Quan , Zhang Jun , Zhou Xiao Dong , Wang Jing
Published: July 2021

AIM:
To compare the feasibility of real-time myocardial contrast echocardiography (RTMCE) in rats with infusion and bolus administration of BR1.

Methods:
RTMCE was performed in 12 Sprague-Dawley rats using B-mode RTMCE following the BR1 infusion or bolus injection. The myocardium signal intensity (SI) was plotted against time and was fitted to exponential functions. The plateau SI (A) and rate of SI increase (â) for the infusion study and peak signal intensity (PSI) for the bolus study were obtained.
99m
Tc-Sestamibi and Evans blue were used to assess myocardial blood perfusion and to calculate the myocardium perfusion defect area
ex vivo
.

Results:
High-quality RTMCE images were successfully obtained using each method. At baseline, all LV segments showed even contrast distribution (Figure A

). Following left anterior descending (LAD) aorta ligation, significant perfusion defect was observed in LAD beds (Figure B

, arrows) with a significantly decreased A*â and PSI values compared to LCx beds (Infusion: A* â
LAD
: 5.42 ± 1.57dB, A* â
LCx
: 46.52 ± 5.32dB, p± 0.05; Bolus: PSI
LAD
: 2.11 ± 0.67dB, PSI
LCx
: 20.68 ± 0.72 dB, p<0.05), which was consistent with
99m
Tc-Sestamibi distribution findings. Myocardial perfusion defect areas assessed by both methods showed no differences and showed good correlation with Evans blue staining. ED frames were more favorable for imaging analysis.

Conclusions:
Both infusion and bolus administration of the contrast agent combined with RTMCE technique can provide a reliable and non-invasive approaches for myocardial perfusion assessment in rats, and the infusion method was more suitable for quantitative analysis of myocardial blood flow.
Abstract P53: Four Electrocardiogram Waveform Measures Quantify Differences between Electrically Induced and Ischemically Induced Ventricular Fibrillation
Authors: Sherman Lawrence D , Niemann James T , Rosborough John P , Menegazzi James J
Published: July 2021

Background:
Analysis of the ECG has been shown to be useful to estimate the duration of VF in swine and the probability of successful defibrillation in animals and in patients. We use four methods to analyze the waveform: the logarithm of the absolute correlations (LAC): the median slope (MS): the angular velocity (AV): the amplitude spectrum area (AMSA). We hypothesized that VF produced by ischemia differs from electrically induced VF when analyzed by these measures.

Methods:
Electrical VF (EVF) was induced in 10 anesthetized and instrumented swine using electrical stimulation of the endocardium. Ischemic VF (IVF) was induced in 10 animals by occlusion of the LAD. After 7 min of VF, chest compressions were performed for 1 min followed by defibrillation. The response to shock was recorded as ROSC if a BP of 60 mmHg was present. LAC, MS, AV and AMSA were calculated on sequential 5 second epochs of VF for 7 minutes. VF was analyzed in segments from1 to 3 minutes, 3 to 4 minutes, and 4 to 7 minutes using the generalized estimating equations method in SAS. Probability of ROSC at first shock was also evaluated for IVF and EVF groups.

Results:
Differences in curves for all four measures were significant for minutes 1–3 and 4 –7. Curves are shown in Figure

. No measure was significant for minute 3– 4. Probability of ROSC at first shock was 50% in the electric VF group and 10% in the ischemic VF group (p=0.039 for mean LAC prior to shock).

Conclusions:
EVF differs significantly from IVF for all measures both in early VF from 1–3 minutes and late VF from 4 –7 minute. All methods may be valid in predicting “down time” and choosing CPR first or Shock first.
Abstract P57: Atmospheric Conditions Predict an Occurrence of Out-of-Hospital Cardiac Arrests: A 9-year Population-based Utstein-style survey in Osaka
Authors: Tanigawa Kayo , Iwami Taku , Nishiyama Chika , Kitamura Tetsuhisa , Ando Masahiko , Goto Masashi , Hiraide Atsushi , Kajino Kentaro , Nishiuchi Tatsuya , Hayashi Yasuyuki , Ikeuchi Hisashi , Kawamura Takashi
Published: July 2021

Introduction:

Although an association between low temperatures and an increase in sudden cardiac arrest occurrence is reported, it is unclear other weather conditions including atmospheric pressure influence the occurrence of out-of-hospital cardiac arrest (OHCA).

Methods:

Design Population-based cohort study.

Participants

We enrolled all OHCA of presumed cardiac etiology in adults (>17 years old) treated by emergency medical service (EMS) in Osaka Prefecture (population, 8.8 million), Japan from May 1
st
1998 through December 31
st
2006.

Data collection and analyses

Patients’ data were prospectively collected by EMS personnel using an Utstein-style database. Meteorological data including mean and circadian variation of temperature and atmospheric pressure were collected from the database of Japan Meteorological Agency. We stratified temperature data to tertile categories and atmospheric pressure to quintile, and an association between a daily event rate of OHCA and weather conditions was analyzed.

Results:

There were 25,026 OHCA patients of presumed cardiac etiology during the period. Daily OHCA incidence increased with a decreasing of temperature. The higher atmospheric pressure was also associated with the increased daily event rate of OHCA on the days with middle temperature (12.0 –21.9 °C) (Pearson’s correlation coefficient, 0.02; p<0.05, Figure

).

Conclusions:

Data from a large-scaled population-based cohort suggests that atmospheric conditions including atmospheric pressure influence the occurrence of OHCA.

FIGURE.

Cardiac arrest daily event rates by atmospheric condidtion
Abstract P58: Impact of 2005 AHA Guidelines on OOHCA Survival
Authors: White Lynn J , Sayre Michael R , Cantrell Sarah A , Hiestand Brian C , Cudnik Michael , Koser Shawn C , Keseg David P
Published: July 2021

Objective: To describe changes in out-of-hospital sudden cardiac arrest (OOHCA) survival before and after the release of the 2005 AHA guidelines for CPR and ECC.

Methods: Analysis of survival data from a pre-established Utstein style OOHCA registry was conducted for 1923 adult cases of OOHCA treated by EMS between April 1, 2004 and December 31, 2007. These data represented all adult cases treated by one EMS system in a large metropolitan area (population 711,432). The primary endpoint was survival to hospital discharge. A convenience sample of 69 electronic ECG recordings was also analyzed using impedence waveform analysis to assess CPR quality parameters during corresponding time periods. Intervention: Implementation of the 2005 AHA Guidelines for CPR and ECC in Spring 2006.

Results: Annual OOHCA incidence rate was 72/100,000, and VF incidence rate was 15/100,000. Bystander CPR rates were 27%, and 8% of arrests occurred in a public location. PAD AED use was 2% over the entire study period and few patients received hypothermia therapy. Unadjusted OOHCA survival rates were significantly higher in the post-guidelines period 8.2% (n=1055) than in the pre-guidelines period 5.3% (n=868) despite similarities in all major predictors of outcome (OR 1.6; 95% CI 1.05–1.69). Bystander witnessed OOHCA survival for victims with VF on EMS arrival was 18 of 89 (20%) pre-guidelines vs. 31 of 110 (28%) post-guidelines (OR 1.55; 95% CI 0.8 –3.0). CPR quality measures showed significant improvement in the post-guideline period. The mean no-flow fraction (NFF) in the pre-guidelines group was 0.46 (95% CI 0.41– 0.51), while the mean NFF in the post-guidelines group was 0.34 (95% CI 0.29 – 0.40). Multivariate regression analysis controlling for significant predictors of survival showed that OOHCA in the post-guidelines time period were associated with 1.75 greater odds of survival than those in the pre-guidelines time period (95% CI 1.17–2.62).

Conclusion: Substantial improvement occurred in overall OOHCA survival rates following the implementation of the 2005 AHA Guidelines for CPR and ECC. These changes are associated with improvements in the quality of CPR.
Abstract P81: Role of Mitochondrial Permeability Transition Pore (mPTP) in the Transition from Reversible to Irreversible Myocardial Ischemia and Reperfusion
Authors: Bopassa Jean-C , Ferrera René , Benhabbouche Souhila , Ovize Michel
Published: July 2021

Introduction
. The aim of this study was to evaluate the role of mitochondrial permeability transition in the transition from reversible to irreversible injury following increasing times of ischemia- reperfusion.

Methods
. Rat hearts (n=72) were perfused according to Langendorff technique, arrested and submitted to global warm ischemia during 0 (sham), 10, 20, 30, 40 or 60 minutes at 37°C, and 60 min of reperfusion. Infarct size was evaluated by TTC staining and CK and LDH release. Functional recovery was assessed by rate-pressure product (RPP). Mitochondria were isolated to assess Ca
2+
resistance capacity (CRC) of the MPTP.

Results
. a transition from reversible to irreversible ischemia occurred between 20 and 30 minutes of warm ischemia. Hearts ischemic for less than 20 minutes exhibited better functionnal recovery with RPP averaging 31264±1341 and 28578±2176 mmHg/beats/min, respectively. In contrast, hearts that underwent 30, 40 and 60 min of ischemia displayed dramatic RPP decrease, averaging 12183±1895, 7411±578 and 4916±698 mmHg/min, respectively (p<0.001 vs 20 minutes ischemia). CK and LDH release and TTC staining confirmed absence of infarction with ischemia < 20 min (Panel A). In line with this, mean CRC was significantly reduced when ischemia lasted more than 20 minutes (p<0.001, Panel B).

Conclusion
. This study shows a parallel evolution between the alteration of mitochondrial calcium retention capacity of the appearance of irreversible damage in the reperfused heart.
Abstract P82: Implementation Of New Resuscitation Guidelines Takes One-and-a-half Year
Authors: Berdowski Jocelyn , Schmohl Andra , Koster Rudolph W
Published: July 2021

Objective- In November 2005, updated resuscitation guidelines were introduced world-wide, and will be revised again in 2010. This study aims to determine how long it takes to implement new guidelines.

Methods- This was a prospective observational study. From July 2005 to January 2008, we included all patients with a non traumatic out-of-hospital cardiac arrest. Ambulance paramedics sent all continuous ECG registrations with impedance signal by modem. We excluded ECGs from patients with Return Of Spontaneous Circulation at arrival, incomplete ECG registrations, ECGs with technical deficits or with continuous chest compressions. The same guidelines needed to be used in over 75% of the registration time in order to be labeled. We classified ECGs as guidelines 2000 if the c:v ratio was 15:2, shock blocks were present and there was rhythm analysis after each shock; guidelines 2005 if the c:v ratio was 30:2, a single shock protocol was used and chest compressions was immediately resumed after shock or rhythm analysis in a no shock scenario. We accepted 10% deviations in the amount of compressions (13–17 for 2000 guidelines, 27–33 for 2005).

Results- Of the 1703 analyzable ECGs, we classified 827 (48.6%) as guidelines 2000 and 624 (36.6%) as guidelines 2005. In the remaining 252 ECGs (14.8%) 31 used guidelines 1992, 137 applied guidelines 2000 with c:v ratio of 30:2 and 84 did not show distinguishable guideline usage. Since the introduction in November 2005, it took 17 months to apply new guidelines in over 80% of the cases (figure 1

).

Conclusion- Guideline changes are slowly implemented by professionals. This needs to be taken in consideration when new guideline revisions are considered.
Abstract P93: Heart Rate Variability Analysis using Wavelet Transform to Predict Hemorrhage Severity
Authors: Ji Soo-Yeon , Ward Kevin , Ryan Kathy , Najarian Kayvan
Published: July 2021

Introduction: The Pulse Initiative on resuscitation identified the need to develop biosensing for detection of critical limitations of blood flow. The ability to rapidly detect the severity of hemorrhage based on heart rate has been limited. Use of heart rate variability (HRV) is problematic. We used a number of new defined ECG features based on discrete wavelet transformation (DWT) that may be used to estimate blood loss severity. The features are defined based on the energy of detail coefficients of Daubecies DWT.

Methods: The performance of DWT was tested using ECG data from a human model of hemorrhage using lower body negative pressure (LBNP). LBNP consisted of a 5-minute rest period (0 mm Hg) followed by 5 minutes of chamber decompression of the lower body to −15, −30, −45, and −60 mm Hg and additional increments of −10 mm Hg every 5 minutes until the onset of cardiovascular collapse. These levels were divided into 3 classes (mild: −15 to −30 mmHg; moderate: −45 to −60 mmHg; severe: over −60 mmHg). These levels correspond to estimated blood losses of 400 –550 cc, 500 –1000 cc and greater than 1000 cc respectively. The ECG DWT features of subjects were used for classification of each ECG recording during volume loss levels. Before classification in order to eliminate redundancy among the features, principal component analysis is applied to the feature set. Machine learning algorithms (SVM, AdaBoost, C4.5) were then applied to analyze the processed features and predict the severity of blood loss.

Results: A 219 sample set was used to classify groups by using machine learning algorithms with 10-fold cross validation. C4.5 outperformed other algorithms with a prediction accuracy of 74.4%. The average precision and recall (sensitivity) for the three classes were 77.4% and 76.1%, respectively. In particular, 30 out of 39 cases in the severe class were correctly classified by C4.5. These results required sampling rates of only 125 Hz.

Conclusion: This is the first reported use of an ECG analysis method to classify volume loss. The DWT method described may have the ability to rapidly determine the degree of volume loss from hemorrhage providing for more rapid triage and decision making. This may be particularly helpful for remote monitoring of war fighters or for mass casualty care.
Abstract P160: Teaching Hospital Employees Basic Life Support using MiniAnne and a 24-minute Self-instruction Video
Authors: Bjørshol Conrad A , Søreide Eldar , Moen Leif , Sivertsen Linda , Glomsaker June , Sunde Kjetil
Published: July 2021

Introduction
Personal resuscitation manikins with self-instruction video have been shown to be as effective as traditional CPR courses in teaching lay people basic life support (BLS). In order to improve in-hospital skills and self confidence in BLS, we introduced a campaign consisting of this concept in a university hospital.

Material and methods
All 5,400 employees at Stavanger University Hospital received a personal resuscitation manikin (MiniAnne, Laerdal Medical, Stavanger, Norway) with a 24-min self-instruction video. In addition to recommended home training, video-facilitated training with the same system was offered on an hourly basis for nine days in a hospital meeting room. Prior to this all participants judged their own BLS self confidence (on a scale from 1 to 5, 1=very poor, 5=very good). In addition, randomly chosen employees, evenly distributed between the different departments, were asked to perform BLS on a MiniAnne equipped with a counting device measuring the number of correct chest compressions and mouth-to-mouth ventilations (MTMV) during the first two minutes. Their skills were reassessed six months later. Finally, all employees judged their BLS self confidence nine months after the campaign was initiated. Results were analyzed using the Wilcoxon signed rank test, Mann-Whitney U test and students t-test, as appropriate, and presented as median with inter-quartile range.

Results
The number of correct chest compressions increased from 60 (5–102) pre-course (n=59) to 119 (75–150) at the six-month follow up (n=39), p<0.0005. There was no difference in the number of correct MTMV with 3 (0–8) vs 4 (0–7), respectively, p=0.23. The self-reported confidence in BLS skills increased from 3.1 prior to MiniAnne introduction (n=3,466) to 3.8 (n=1,399) nine months later, p=0.031.

Conclusion
This in-hospital BLS campaign including a personal resuscitation manikin and a self-instruction video, increased the number of correctly performed chest compressions and lead to higher self confidence in BLS skills. Such a campaign has the potential to increase and improve BLS performance for in-hospital cardiac arrests.
Abstract P168: High Incidence of Delay in Emergency Call and Analysis of the Causes in Japan: Need of public relations that emphasize “Call 119 when someone becomes unresponsive”
Authors: Ohta Keisuke , Enami Miki , Takei Yutaka , Inaba Hideo
Published: July 2021

Incidence and causes of delay in Emergency call were analyzed in 3267 out-of-hospital cardiac arrests that were witnessed by bystanders or not witnessed but found by citizens from April 1, 2003 to March 31, 2007 in Ishikawa Prefecture. Emergency calls were considered to be significantly delayed when interval of collapse or event recognition to call exceeded 2 min. The incidence of delay was 32.9% (1076/3267) in the all arrests and significantly higher in urban (Non-Central) areas than in rural (the Central) area (691/1539 vs. 385/1728, p<0.001). Telephone-assisted CPR was performed in 501 out of 1076 delayed cases and CPR was initiated in 331 cases. The proportions of ROSC and successful resuscitation were significantly lower when the call was delayed (178/1076 vs. 490/2191 p<0.001, 153/1076 vs. 415/2191 p<0.001, respectively). As shown in Table, the major causes of delay were identified in 906 out of 1076 cases. The delay was considered to be correctable in 607 cases if the bystanders or citizens had understood when they should call 119. These results indicate that significance of early call should be more emphasized in basic life support courses. The public relations that emphasize “Call 119 when someone becomes unresponsive” may be necessary for all citizens to be aware of the significance of early call.
Abstract P193: A Cardiopulmonary Resuscitation Training Program for Family Members of In-Hospital Patients at Risk for Cardiac Arrest
Authors: Leary Marion , Albright Lori , Meshberg Emily B , Sugerman Noah T , Becker Lance B , Abella Benjamin S
Published: July 2021

Background:
Resuscitation from cardiac arrest often depends on prompt cardiopulmonary resuscitation (CPR) from the lay public, yet bystander CPR rates in the US are low. One barrier to bystander CPR delivery is that most arrests occur in the home, where only family members may be available to provide care. Little data exist regarding the ability to target and train family members of “at-risk” patients in CPR.

Objective:
We sought to implement a CPR video self-instruction (VSI) program for family members of in-hospital patients at risk for cardiac arrest. After training in situ before hospital discharge, we tested the hypothesis that at-risk patient family members would be motivated to secondarily train others in the home after leaving the hospital setting.

Methods:
Family members of patients hospitalized for cardiac conditions at one tertiary-care hospital between 12/07 and 6/08 who met pre-defined inclusion criteria were offered CPR VSI training requiring 25–30 min. All trainees were assessed for skill competence and video recorded for analysis. Trainees were encouraged to take the VSI kit home, and follow-up surveys were conducted to gauge secondary training of other family members.

Results:
Among 36 enrollees, mean age (SD) was 50 (13) and 78% of trainees were female; only 17% had been CPR trained within the past 10 years, and 44% had never been trained. Most (67%) of the trainees were either children or spouses of the at-risk hospitalized patients. Most (78%) trainees rated their experience with learning CPR via VSI as “comfortable” or “very comfortable”. During 2 min of CPR skills assessment, mean (SD) chest compression rate was 100 (19), mean percentage (SD) adequate depth was 89% (15%), and mean (SD) time for two breaths was 10.8 (4.6) sec. Follow-up surveys revealed that 33% of recipients performed secondary training at home, with a mean (SD) of 1.8 (1.3) secondary trainees.

Conclusions:
CPR VSI training for family members of hospitalized cardiac patients may serve as a cost-effective model to disseminate resuscitation skills and allows for secondary training in the home of patients at risk for sudden cardiac arrest.
Abstract 214: S100A6 Promotes Myocyte Survival by Interacting with the Receptor for Advanced Glycation End Products and Activating Akt
Authors: Tsoporis James , Ruby Shehla , Parker Thomas G
Published: July 2021

The receptor for advanced ligation end-products (RAGE) recognizes ligands from diverse families including the S100 calcium binding proteins S100A6 and S100B. In a rat model of myocardial infarction, we have reported the induction of S100B, the upregulation of S100A6 and RAGE mRNA and protein in peri-infarct left ventricular (LV) myocardium, increases in S100B and S1006 serum levels and demonstrated a direct interaction between S100B and S100A6 with RAGE in peri-infarct LV myocardium. To determine the functional role of the interaction of S100A6 and S100B with RAGE, we stimulated rat neonatal cardiac myocyte cultures transfected with a RAGE gene or a dominant-negative cytoplasmic deletion mutant of RAGE with S100B and/or S100A6 for 48 hrs. In RAGE overexpressing myocytes, although both S100 proteins induced the formation of reactive oxygen species, S100B > 10 nM induced myocyte apoptosis, as evidenced by increased terminal deoxynucleotidyltransferase-mediated UTP end labeling (TUNEL), FITC annexin V flow cytometry, cytochrome C release, phosphorylation of ERK1/2 and p53, and increased activity of caspase-3, whereas S100A6 < 10 nM inhibited basal myocyte apoptosis, increased the phosphorylation of Akt and the expression of NF-κB and in combination with S100B inhibited S100B-induced myocyte apoptosis [6.3±0.9% (vehicle), 16.1±0.1.2% (S100B), 4.1±0.4% (S100A6), 6.4±1.5% (S100B+S100A6) (TUNEL positive nuclei)]. The upstream Akt blocker LY294002, inhibited the RAGE dependent anti-apoptotic effects of S100A6 on basal- and S100B-induced myocyte apoptosis. In myocytes expressing dominant-negative RAGE, the contrasting effects of S100B and S100A6 on myocyte apoptosis were absent regardless of Akt inhibition. In conclusion, in a RAGE-dependent manner, S100A6 inhibits myocyte apoptosis via Akt activation.
Abstract 241: Intermittent Hypoxia Protects Cardiomyocytes Against Ischemia/Reperfusion-Induced Ca
2+
Overload and Contraction Suppression via Activation of α
1b
-adrenoceptors
Authors: Yang Huangtian , Gao Hong , Chen Le , Lu Zhi-Zhen , Zhang You-Yi , Zhou Zhao-Nian
Published: July 2021

We have demonstrated that long-term training to intermittent high altitude hypoxia (IH) protects hearts against ischemia-reperfusion (I/R)-induced Ca
2+
overload and improved postischemic myocardial contractility. This cardioprotection is non-invasive and maintains much longer time compared with that induced by ischemic preconditioning, thereby, it may have great clinical potential. However, its precise signaling pathways are not fully clarified. Here we hypothesized that IH may attenuate I/R-induced cytosolic and mitochondrial Ca
2+
overload via activation of α
1
-adrenoceptor (α
1
-ARs) pathways. To test it, dynamics of cytosolic free Ca
2+
concentration ([Ca
2+
]
c
), mitochondrial [Ca
2+
] ([Ca
2+
]
m
) and cell contraction were examined during preischemia and I/R in ventricular cardiomyocytes from normoxic and IH rats. IH significantly attenuated I/R-induced [Ca
2+
]
c
and [Ca
2+
]
m
overload by 63.5 ± 3.6% and 57.0 ± 4.5% at 30 min of reperfusion (R30), respectively. Consistently, I/R-induced depression on Ca
2+
transients and cell shortening was markedly attenuated by IH, with decreases in mitochondrial cytochrome
c
release and ATP reduction during reperfusion. Meanwhile, the α
1B
-AR and α
1D
-AR density obviously decreased during ischemia, while α
1A
-AR density remained unchanged. IH did not change α
1A
-AR density, but increased α
1B
-AR density by ~50% and decreased α
1D
-AR density further by 30% during I/R. Moreover, IH-induced protections were abolished by α
1B
-AR antagonist chloroethylclonidine but not α
1A
- or α
1D
-AR antagonist. Furthermore, IH-afforded protection was lost when epsilon isoform of protein kinase C (PKCϵ) was inhibited with PKCϵ V1–2 and mitochondrial ATP sensitive potassium (mitoK
ATP
) channels with 5-hydroxydecanoate, a downstream signaling pathway and effector of α
1
-ARs. Our findings indicate that α
1B
-AR subtype might be one of the important mediators in IH protects myocytes against I/R injury via maintaining intracellular Ca
2+
homeostasis and protecting the ability of mitochondria through activation of the α
1B
-ARs and PKCϵ pathway as well as mitoK
ATP
channel.. by via translocation of PKCϵ and opening of mitoK
ATP
channels. Mitochondrial function appears to be a determinant of cardioprotection induced by IH.
Abstract 298: Development of a Novel Heart Valve Tissue Engineering Scaffold with Incorporated Cytokine Delivery
Authors: Smith Meghan E , Elgudin Yakov , Arnoult Olivier , Greco Nicholas , Laughlin Mary , Emancipator Steven , Cmolik Brian , Wnek Gary
Published: July 2021

Background

: Through the use of nano- and microfiber constructs created by electrostatic processing, heart valve tissue engineering scaffolding with higher degrees of functionality can be achieved. Described herein is the development of a novel heart valve tissue engineering construct capable of serving as a delivery vehicle for cytokines, to aid in the direction of cell behavior and differentiation. The purpose of this study was to investigate the incorporation and release of various proteins, including immunoglobulin G (IGG), serving as a model protein system, and vascular endothelial growth factor (VEGF), from biodegradable polymer scaffolds, to assess delivery kinetics, mechanical properties and the impact on the activity of bioactive compounds.

Methods and Results:

Scaffold production was carried out by electrospinning a suspension of aqueous solution of IGG or VEGF in a solution of poly(ϵ-caprolactone) (PCL) dissolved in chloroform to obtain nonwoven fibrous polymer mats. Fluorescent labeling of the proteins and microscopy was used to locate the proteins within the fibers, and it was found that the proteins were fully isolated within the core of the polymer fiber. Mats were characterized via scanning electron microscopy for fiber diameters and porosity, with fiber diameters ranging from 4um to less then 1 um, and pore throat diameters in the range of 0.5 to 2 um. Using dynamic mechanical analysis, the elastic modulus and tensile strength of the scaffolds were found to be comparable to those of a decellularized porcine leaflet stabilized with a diepoxide, tested under identical conditions. ELISA demonstrated that protein release occurred over several weeks time, with limited burst release, and that activity of the protein was maintained.

Conclusions:

It was found that scaffolds with either an IGG model protein system of VEGF could be readily produced via electrospinning. Initial mechanical evaluation indicates similar properties to biological leaflets. Delivery of the encapsulated protein in an active state was also achieved, demonstrating that these tissue engineering constructs may be employed to create scaffolds serving both for mechanical cellular supports and to selectively control the cells biochemical environment.