bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 21036: Differences in Arrhythmia Induction Between Isoproterenol versus Combination of Drugs and Impact on Outcomes in Patients Undergoing Catheter Ablation for Ventricular and Supraventricular Arrhythmias
Authors: Turagam Mohit K , Swarup Vijay , Cheng Jie , Bomma Chandra , Atkins Donita , Makkar Akash , Di Biase Luigi , Natale Andrea , Lakkireddy Dhanunjaya
Published: March 2022

Background:
Catheter ablation (CA) has an estimated success rate of 50-90% after first procedure for atrial tachycardia/fibrillation (AT/AF), supraventricular tachycardia (SVT), premature ventricular complexes (PVC) and ventricular tachycardia (VT). We studied if combination of induction agents including isoproterenol (ISO), Caffeine, Calcium Chloride (CC), Atropine and Phenylephrine (PE) is better than ISO alone to uncover additional arrhythmic triggers or substrates, where supplemental CA may potentially improve long term procedural success.

Methods:
This is an observational study including 132 consecutive patients [AT/AF (N=27), SVT (N=25), PVC (N=42), VT (N=38)] undergoing CA for symptomatic atrial and ventricular arrhythmias. We compared combination chemical induction protocol (COMBO) which included ISO (range 5-20mcg/min) + Caffeine (50-250 mg) +CC (1gm) ± PE (range 5 -10 mcg/kg) ±intravenous atropine (0.25 mg, one time) with ISO-only (5-20 mcg/min) infusion to assess for arrhythmia re-inducibility after performing standard CA.

Results:
There was no significant difference in baseline or procedural characteristics between both groups. COMBO group had significantly higher induction of stable clinical arrhythmia triggers and substrates in patients undergoing CA for AT/AF (53.3% vs. 8.3%, p=0.01), SVT (33% vs 0%, p=0.04), PVC (28.5% vs 0%, p=0.02) and VT (33.3% vs. 4.3%, p=0.02) when compared with ISO group which were additionally ablated. At 1-year follow up, COMBO group had significantly higher freedom from arrhythmias in AT/AF (20% vs. 41.6%, p=0.05), SVT (0% vs. 23%, p=0.04), PVC (4.7% vs. 43%, p=0.009) and VT ablation (26% vs. 61%, p=0.05) groups.

Conclusion:
COMBO induction protocol during CA may uncover additional triggers and arrhythmia substrates in patients with supraventricular and ventricular arrhythmias. COMBO directed supplemental CA may improve freedom from clinical arrhythmias on long term follow up.
Abstract 21041: Cardiac Resynchronization Therapy for Pacemaker Induced Cardiomyopathy Results in Super Response
Authors: Kapoor Ridhima , Tyagi Sudhi , Fox Judy , Widlansky Michael , Roth James , Oujiri James , Rubenstein Jason , Berger Marcie
Published: March 2022

Background:
Sustained right ventricular (RV) pacing can cause cardiomyopathy due to electrical dyssynchrony. Cardiac resynchronization therapy (CRT) can lead to reverse left ventricular (LV) remodeling by minimizing conduction delay. We hypothesized that CRT in pacemaker induced cardiomyopathy (PICM) would result in a greater improvement in EF compared to other causes of cardiomyopathy.

Objective:
To determine the change in ejection fraction after CRT upgrade in patients with PICM.

Methods:
A retrospective EMR review was conducted for individuals who underwent CRT upgrade between January 1, 2010 and January 31, 2016. Inclusion criteria were normal EF prior to pacemaker placement, RV pacing ≥ 80% and EF ≤ 45% prior to CRT upgrade. Frequency of improvement in EF of greater than or equal to 5% and 10% were calculated.

Results:
The study population included 22 patients with average age 69.7 ± 13.1 and average EF of 36.8 ± 6.9% at the time of CRT upgrade. Eight patients had aortic stenosis prior to CRT upgrade. Sixteen patients (73%) experienced at least 5% improvement in EF one year after upgrade to CRT and 12 patients (55%) improved by at least 10%. Average change in EF was 9.2 ± 12.3% compared to 4.6% improvement in all-comers with heart failure in the MIRACLE study. Ninety-two percent of participants without aortic stenosis had improvement in EF of at least 10% or to greater than 50% compared to only 8.3% of participants with aortic stenosis experiencing this degree of improvement (p=0.002).

Conclusion:
In patients with PICM, EF improvement after CRT upgrade is higher than in all-comers. Furthermore, the presence of concomitant aortic stenosis was associated with an attenuated improvement in EF.
Abstract 21050: Long Term Survival and Neurological Status of Patients With Tracheostomy After Cardiac Arrest
Authors: Agarwal Sachin , Curiel Omar , Sobczak Evie , Presciutti Alex M , Roh David , Park Soojin , Claassen Jan
Published: March 2022

Background:
Overall survival and functional status is poor in patients that undergo a tracheostomy after respiratory failure. Little data exists on cardiac arrest (CA) patients’ in-hospital and long-term survival, and neurological status after tracheostomy.

Methods:
We retrospectively reviewed 509 consecutive patients that were more than 18 years of age, admitted to one of the intensive care units between 12/2007 and 12/2015, resuscitated following either in-hospital or out-of-hospital CA, and considered for targeted temperature management. Tracheostomy and other data was collected via chart review. Chi-square and Wilcoxon rank sum tests were used for analysis. Survival and Cerebral Performance Category score (CPC) at discharge and one year were compared between patients with and without tracheostomy.

Results:
Of 509 patients, 389 (76.4%) did not undergo a tracheostomy, 83 (16.3%) had new tracheostomies placed during the hospitalization, and 37 (7.3%) had pre-existing tracheostomy before the index cardiac event. In comparison to the non-tracheostomy group, the new tracheostomies patients had a greater number of in-hospital arrests with shorter duration of median return of spontaneous circulation, while the pre-existing tracheostomy group was older, worse CPC on admission, were mostly living in a subacute nursing facility, had lower rates of ventricular tachycardia/fibrillation as initial rhythm, and lower rates of therapeutic hypothermia. At the time of hospital discharge, there were 64/83 (77%) survivors in the new tracheostomy group, 104/389 (26.7%) in the non-tracheostomy, and 7/37 (19%) in the pre-existing tracheostomy group. Available one year data on 53 patients in the new tracheostomy group showed a 55% (n=29) survival rate, with neurological status as follows: {CPC 1: 7 (24%), CPC 2: 6 (21%), CPC 3: 8 (27.5%), CPC 4: 8 (27.5%)} compared to 66/81 (81%), {(CPC 1: 34 (51%), CPC 2: 15 (23%), CPC 3: 16 (24%), CPC 4: 1 (0.01%)} in the non-tracheostomy group (p=0.005).

Conclusions:
Cardiac arrest survivors that undergo a tracheostomy have reduced survival and poor neurological status at one year compared to those discharged without receiving a tracheostomy. Pre-existing tracheostomy patients suffer from high rates of in-hospital mortality.
Abstract 21055: Baseline Cardiovascular Magnetic Resonance Imaging Measurements Are Associated With Clinical Outcomes at Three Years of Follow-Up: Results From a Prospective, International, Multi-Site Study of Patients With Significant Pulmonary Regurgitation Late After Tetralogy of Fallot Repair
Authors: Wald Rachel M , Farkouh Michael , Caldarone Christopher , Dahdah Nagib , Dallaire Frédéric , Drolet Christian , Grewal Jasmine , Kayedpour Camilla , Khairy Paul , Kovacs Adrienne , Leonardi Benedetta , McCrindle Brian , Nadeem Syed Najaf , Ng Ming Yen , Oechslin Erwin , Redington Andrew , Silversides Candice , Tham Edythe , Therrien Judith , Vonder Muhll Isabelle , Warren Andrew , Wintersperger Bernd , Hickey Edward
Published: March 2022

Introduction:
Late complications after tetralogy of Fallot repair (rTOF) often arise from chronic pulmonary regurgitation (PR). Prospective studies of outcomes in those with rTOF and significant PR are lacking.

Hypothesis:
We hypothesized that cardiovascular magnetic resonance imaging (CMR) imaging measurements would be associated with poor outcomes in an “at risk” population with rTOF and ≥moderate PR.

Methods:
This was a prospective, international study (North America, Europe and Asia) of children and adults. Inclusion criteria were rTOF in childhood, age ≥12 years, ≥moderate PR, and CMR within 18 months of enrollment. All CMR analysis occurred in a central core laboratory. Patient reported outcomes were collected using standardized tools. The primary clinical outcome was death or sustained (>30 seconds) ventricular tachycardia (VT) recorded at 3 year follow-up.

Results:
We enrolled 629 patients (55% male) at 29±14 years (2013-2017). Primary rTOF was done at 1.6 years (IQR 0.6,4.2) with a transannular patch in 55%. By standardized symptom assessment, 78% were asymptomatic (NYHA 1). Baseline CMR findings included PR fraction 38±14%, right ventricular (RV) end-diastolic volume indexed (EDVi) 155±41mL/m2, RV ejection fraction (EF) 44±7%, RV mass indexed 59±16 g/m2, left ventricular (LV) EDVi 85±18mL/m2, LVEF 55±7% and LV mass indexed 88±27 g/m2. Outcomes at 3 years were recorded (available in n=101). During follow-up, surgical pulmonary valve replacement (PVR) occurred in 38 patients (38%). In the PVR group compared with the non-PVR group, baseline RVEDVi was larger (189 vs. 152 mL/m2, p<0.0001) and RV mass was higher (65 vs. 58 g/m2, p=0.04); RVEF, LVEF and LV mass did not differ between groups. At 3 year follow-up, 4 patients (4%) had an outcome (n=2 deaths, n=2 VT) and half of these patients (n=2) had PVR. Those with outcomes had higher baseline RV mass and LV mass as compared to those without outcomes (73±12 vs. 59±13g/m2, p=0.04 and 132±32 vs. 89±28g/m2, p=0.01); volumes and function did not differ between groups.

Conclusions:
Despite significant PR, most patients with rTOF were asymptomatic. At 3 year follow-up, PVR occurred in more than one third of patients. Death or VT was observed in a small number of patients who had higher RV and LV mass on baseline CMR.
Abstract 21060: The Association Between Post-Resusciation Cerebral Oxygenation and Survival With Favorable Neurological Outcomes: A Multicenter Study
Authors: Tran Linh N , Yang Jie , O'Neill Caitlin M , Yin Donglei , Sinha Niraj , Nguyen Robert T , Chabra Vikram , Parnia Sam
Published: March 2022

Background:
Cerebral ischemia/reperfusion injury in the post-resuscitation period contributes to morbidity and mortality following cardiac arrest (CA). Cerebral oximetry is a non-invasive system that uses near infrared spectroscopy to measure regional cerebral oxygenation level (rSO2) in the frontal lobe of the brain. Studies have shown that post-resuscitation rSO2 may be associated with survival and neurological outcomes in out-of-hospital cardiac arrest patients, however no studies have examined this in in-hospital cardiac arrest (IHCA) patients.

Hypothesis:
rSO2 changes following return of spontaneous circulation (ROSC) after IHCA are associated with survival with favorable neurological outcomes.

Methods:
A multi-site prospective study of consecutive day-time IHCA patients admitted to the ICU after ROSC at 7 sites. Continuous rSO2 monitoring (Equanox 7600, Nonin Medical, MN, USA) was applied for 48 hours after ROSC using a forehead sensor. Mean rSO2 was calculated hourly between 1-6 hrs. and at 6, 12, 18, 24, 48 hr. intervals. Demographic and data pertaining to possible confounding variables for rSO2 and survival with favorable neurological outcomes (cerebral performance scale [CPC] 1-2) vs death or severe neurological injury (CPC 3-5) at hospital discharge were collected.

Results:
Among 87 studied patients, 26 (29.9%) achieved CPC1-2. There were no differences in age, Charlson comorbidity index, APACHE II scores, and resuscitation duration, however, CPC 1-2 was higher in men vs. women (36.5% vs. 12.5%, p = 0.036). A significant difference in mean rSO2 was observed during hours 1-2 after ROSC in CPC 1-2 vs CPC3-5 (73.08 vs. 66.59, p = 0.031) but not at other time points. There were no differences in mean arterial pressure, PaO2, PaCO2, and hemoglobin levels, however subjects with CPC 1-2 had lower glucose (154.4mg/dL vs. 202.8mg/dL, p = 0.0054), lactate level (4.11 mmol/dL vs. 6.39 mmol/dL, p = 0.030), and higher Glasgow coma scale (9.42 vs. 5.96, p = 0.0026) within the first 24 hours.

Conclusions:
Changes in rSO2 as measured by cerebral oximetry in the first two hours after ROSC may predict survival with neurological outcomes after resuscitation following IHCA.
Abstract 21062: Association Between High-Density Lipoprotein Cholesterol With All-Cause Death and Cardiovascular Events in a Primary Prevention Population
Authors: Pagidipati Neha J , Phelan Matthew , Navar Ann Marie , Pencina Michael , Peterson Eric
Published: March 2022

Introduction:
Higher levels of high density lipoprotein cholesterol (HDL-C) are associated with reduced risk of cardiovascular disease (CVD). However, observational data suggest very high HDL-C may be associated with increased all-cause mortality. We aimed to investigate the relationship between HDL-C and CV mortality and morbidity.

Methods:
Using data from adults without prior CVD from 5 large U.S.-based cohorts available through NIH BioLINCC (Framingham Cohort Study, Framingham Offspring, Multi-ethnic Study of Atherosclerosis, Atherosclerosis Risk in Communities, and Cardiovascular Health Study), we assessed the association between HDL-C and all-cause death and CVD composite events (CV death, myocardial infarction, angina, or stroke) using Cox proportional hazards models, modeling HDL-C with restricted cubic splines to allow for non-linearity. Adjustment factors included age, race, systolic blood pressure, antihypertensive medications, diabetes, body-mass index, smoking status, low-density lipoprotein cholesterol, and weekly alcohol use.

Results:
Among 22,569 individuals (median age 56 years, 55% women), median (IQR) HDL-C was 50 mg/dL (41, 62). Those with HDL-C>50 mg/dL were more frequently female, non-smokers, and less obese. Over median follow up of 19.5 years, 6,539 deaths occurred (31% CV deaths). After adjustment for clinical factors, there was a U-shaped association between HDL-C and all-cause death in men, and to a lesser degree in women (Figure). As compared with a reference point of 50 mg/dL, lower HDL-C was associated with higher CVD composite events in both men and women, but higher HDL-C was not associated with increased CVD composite risk in either sex.

Conclusions:
In this large, U.S.-based study of well-characterized clinical cohorts and long-term follow-up, HDL-C displayed a U-shaped relationship with all-cause death. Low, but not high, HDL-C is associated with higher CVD composite events in both men and women.
Abstract 21067: Improvements in Regional Myocardial Function on 2D STE With Optimized Chelation in Patients With Thalassemia Major (TM)
Authors: Chowdhury Devyani , Alvi Najveen , Tomredle Rebekah , Bijnens Bart , Hasan Babar
Published: March 2022

Intro:
Thalassemia Major (TM) is characterized by recurrent blood transfusions leading to myocardial siderosis and complications including arrhythmias and heart failure. These can be reversible with adequate chelation. We explored the effect of improved chelation and subsequent cardiac T2* MRI (CMR) values on regional myocardial function assessed by 2D STE in setting of normal LVEF.

Methods:
Data was derived from TM patients recruited for the AMIT study (efficacy of amlodipine with chelation in reducing myocardial iron). All patients underwent echocardiographic imaging at baseline, 6 and 12 months. LSsys was extracted from basal, mid, and apical segments of the LV medial and lateral wall by 2D STE technique. A linear regression model was run to determine the effect of improved T2* in the setting of improved chelation on regional LSsys strain parameters.

Results:
Nineteen TM patients (11 males), median age 16 (8-21) yrs. All participants were transfused every 2-3 weeks. (median pre-transfusional Hb of 9.3 (8.3-10.8) mg/dL). T2* based chelation regimen was initiated at baseline and compliance to this regimen was gauged at regular clinical visits. 25 data points were available from interval 2D STE imaging for analysis. Medial basal LSsys (-17.3% ± 2.2) and lateral basal LSsys (-16.7% ± 4.4) strains were significantly lower than mean apical LSsys strains (-24.9% ± 4.0) (p <0.01). With optimized improved chelation, we determined up to a 6.3% improvement was seen in LSsys basal septal and 6.7% improvement in LSsys apical septal for each 1 ms improvement in T2* (p values < 0.05).

Conclusion:
2D STE can help identify regional myocardial dysfunction prior to development of overt cardiac dysfunction. In patients with transfusion dependent TM, compliance to an optimized chelation regimen can help improve regional myocardial function prior to progression to systolic dysfunction and clinically symptomatic sideroblastic complications.
Abstract 21073: Succinate Dehydrogenase Assembly Factor 1 Regulates Mitochondrial Reserve Respiratory Capacity
Authors: Jeon Yong Heui , Pfleger Jessica , He Minzhen , Abdellatif Maha
Published: March 2022

Under normal conditions, the myocyte runs on a fraction of its mitochondrial bioenergetics’ capacity, where the difference between the maximum respiratory capacity and basal respiratory capacity constitutes the reserve respiratory capacity (RRC). We have shown that the RRC allows the cell to respond to an increase in energy demand by promptly increasing supply, avoiding an “ATP crisis”. Our objective is to understand the source and mechanism of regulation of the RRC, which would allow us to augment it during increases in energy demand. Our data show that activation of AMP-activated kinase (AMPK) by AICAR or adiponectin, increases RRC (1.34-fold to 1.9-fold) in a substrate and Sirt3-dependent fashion, whereas, the level of the RRC positively correlates with cell survival. We have identified complex II (cII, or succinate dehydrogenase complex) as the source of RRC, as its inhibition completely abrogates the reserve with no significant effect on basal oxygen consumption rates (OCR). In corroboration, disassembly of cII via knockdown of succinate dehydrogenase assembly factor 1 (Sdhaf1; mutated in infantile mitochondrial disease), also completely abrogates RRC, as higher doses induce cell death and reactive oxygen species (ROS) production. Conversely, over-expression of Sdhaf1 increases RRC (1.2-1.5-fold) during normoxia, and after non-lethal hypoxia (2 to 6-fold). Moreover, a unique acetylation-resistant Sdhaf1 mutant, has a more robust effect on RRC (4 to10-fold). We were further able to confirm that overexpression of Sdhaf1 or Sirt3 in cardiac myocytes reduced hypoxia-induced disassembly of cII. In summary, our data suggest that the RRC increases the survivability of myocytes after non-lethal periods of hypoxia, and can be manipulated by factors that regulate Sdhaf1 and assembly of cII.
Abstract 21081: Coffee Intake Affects Heart Failure and Stroke Survival and is Significant in Predicting Heart Failure and Stroke Risk
Authors: Stevens Laura , Görg Carsten , Kao David
Published: March 2022

Introduction:
Heart Failure (HF) and stroke are complex diseases with multiple phenotypes. While many risk factors for these diseases are well known, it is likely that there are as-yet unidentified risk factors given the complex pathophysiology of each disease. We investigated the diet domain in the Framingham Heart Study (FHS), Cardiovascular Heart Study (CHS), and Atherosclerosis Risk In Communities (ARIC) study to identify potential diet factors associated with HF and stroke.

Methods:
We used random forest machine-learning methods to identify risk factors associated with cardiovascular diseases in the Framingham Heart Study. We used Cox proportional hazards analysis to investigate these findings further in the FHS and validated our findings using the CHS and ARIC datasets.

Results:
Random forest analysis identified known risk factors such as blood pressure, age, and cholesterol. In addition, coffee and red meat intake were also found to be important in predicting heart failure and stroke. Survival analysis confirmed these results suggesting coffee intake is significantly associated with HF and stroke. Coffee decreased risk with HF and stroke by 7% and 8% respectively with every increased cup consumed per week (p = .001 for both HF and Stroke). Validation of this trend was confirmed in the CHS and ARIC which resulted in similar outcomes. Furthermore, we built a risk model using known risks from the Framingham Risk Score guidelines and predicted CHF and stroke outcomes. By including coffee in the model, the prediction accuracy increased by 4%.

Conclusion:
Increased coffee intake is associated with reduced HF and stroke outcomes in FHS, CHS and ARIC.
Abstract 21095: Medical Emergency Team (MET) Criteria in the Intensive Care Unit Setting
Authors: Denny Logan , Deane Adam , Morley Peter T
Published: March 2022

Introduction:
MET criteria are widely used in the hospital setting to provide an early warning system to facilitate escalation of care. We aimed to determine the proportion of RMH Intensive Care Unit (ICU) patients who have met MET call criteria within several separate 24-hour snapshot periods. The RMH ICU has over 2500 admissions per year (73.6% emergency admissions), with a mean age of 56.4 years, a mean length of stay of 79.6 hours, a mean APACHE 3 score 58.9, and an overall ICU mortality of 8%.

Methods:
This prospective study collected information retrospectively from a convenience sample, during the period from 01/03/2017 to 08/06/2017. Snapshots were collected at a set time by review of all the current RMH ICU inpatient observation charts, on separate occasions at least two days apart. Observation charts were examined for the prior 24 hours of data, or fewer hours if the patient had been more recently admitted to the ICU. Each of these discrete episodes was examined to determine whether or not specific MET criteria had been met. MET criteria occurring multiple times within one episode were not additionally recorded. The data below is from 10 separate days of data collection.

Results:
Over 10 separate snapshots examining 237 patient episodes, 230 observation charts could be reviewed. Of the 230 patients, 147 were mechanically ventilated (63.9%), while 116 were receiving vasopressor/inotrope infusions (50.4%). Of the 230 patients, 177 (77%) met at least one MET call criteria in the previous 24-hour period. The most common MET criterion was a spontaneous respiratory rate of <8 breaths/minute (87/230, 37.8%); 86 of these 87 patients were mechanically ventilated. Other MET criteria detected were systolic blood pressure <90 mmHg (60/230, 26.1%), respiratory rate >30 breaths/minute (55/230, 23.9%), heart rate >130 beats/minute (32/230, 13.9%), and pulse oximetry saturation <90% (27/230, 11.7%). 175 of the patients (76.1%) had adjusted daily physiological aims recorded on their observation charts.

Conclusions:
ICU patients commonly meet standard MET criteria. Unadjusted MET criteria by themselves cannot be used to activate an escalation of care in Intensive Care.
Abstract 21100: Long-Term Clinical Outcomes of Patients With Chronic Kidney Disease and Critical Limb Ischemia Underwent Percutaneous Transluminal Angioplasty
Authors: Rha Seung-Woon , Choi Byoung Geol , Her Ae-Young , Kim Yong Hoon , Choi Se Yeon , Byun Jae Kyeong , Park Yoonjee , Mashaly Ahmed , Jang Won Young , Kim WooHyeun , Choi Jah Yeon , Park Eun Jin , Na Jin Oh , Choi Cheol Ung , Lim Hong Euy , Kim Eung Ju , Park Chang Gyu , Seo Hong Seog , Oh Dong Joo
Published: March 2022

Background:
Critical limb ischemia (CLI) and chronic kidney disease (CKD) are associated with poor outcomes. We assessed the 5-year clinical outcomes of CKD versus non-CKD patients (pts) with CLI who underwent peripheral transluminal angioplasty (PTA).

Methods:
A total 765 consecutive CLI pts underwent PTA were analyzed. CKD is defined as either kidney damage or estimating glomerular filtration rate (GFR) < 90 mL/min/m
2
. Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging studies. Patients (pts) were divided into two groups according to the presence of CKD (CKD group: 465 pts, non-CKD group: 300 pts). To adjust for any potential confounders that could cause bias, propensity score matching (PSM) analysis was performed. Five-year clinical outcomes were assessed by Kaplan-Meier curved analysis and log rank test.

Results:
The CKD stage of study populations showed that 42% had mild, 21% moderate, 3% severe, and 32% kidney failure or dialysis. After PSM analysis, two matched groups (226 pairs, n= 452 pts) were generated and their baseline characteristics were balanced. During the 5-year clinical follow-up, there were no differences in the incidence of myocardial infarction, strokes and coronary or peripheral revascularization between the two groups. However, the incidence of total death and the above the ankle amputation were higher in the CKD group than the non-CKD group [Table].

Conclusion:
CKD pts with CLI had higher incidence of mortality and amputation rate at 5 years following standard PTA compared with non-CKD pts. Improved therapies and special care are needed for this high-risk group of patients.
Abstract 21112: Trends in Acute Ischemic Stroke Admissions in Patients With Atrial Fibrillation and Flutter From 2004 to 2014
Authors: Ahsan Syed A , Lee Shawn , Hosseini Dehkordi Seyed Hamed , Gholitabar Farid , Lemor Alejandro , Gholitabar Navid , Mehta Davendra
Published: March 2022

Introduction:
Atrial Fibrillation and Flutter (AF) predispose patients to acute ischemic strokes and increased mortality. We aim to assess the impact of new guidelines, innovations in technology and several new drugs on mortality and morbidity of patients hospitalized for ischemic stroke with concurrent AF over 10 years. We assessed the hypothesis that these advances would be associated with improvements in mortality over that time period.

Methods:
This is a retrospective cohort study using the 2004-2014 National Inpatient Sample, the largest publicly available inpatient database in the United States. We included women and men >18 years of age admitted between 2004 and 2014 with primary diagnoses of atrial fibrillation or flutter and with secondary diagnoses of acute ischemic stroke and transient ischemic attack (using ICD-9 CM codes). The primary outcome was in-hospital mortality and the secondary outcomes were total hospital cost and mean length of stay (LOS). STATA 13.0 was used for data analysis.

Results:
222,074 patients were included in this study. The mean age was 79.2 years and 58.8% were female. The inpatient mortality rate in 2004 was 11.6% and it decreased consistently until 2014 at 8.0% (p trend <0.001). Mean total hospital cost was $10,582 in 2004 and it increased consistently until 2014 at $13,849 (p trend < 0.001). Mean length of stay steadily decreased from 6.9 days in 2004 to 5.7 days in 2014.

Conclusion:
Over the past 10 years, new innovations in technology and the approval and use of several novel oral anticoagulants for use in AF have been implemented. While there is a trend of increasing costs, these measures seem to show a trend of improving mortality and decreasing length of stay in patients hospitalized with ischemic strokes and AF.
Abstract 21117: Comparison of Clinical Outcomes Between Clopidogrel and New P2Y12 Antagonist in Acute Myocardial Infarction Patients Treated With Percutaneous Coronary Intervention
Authors: Lee Jung-Hee , Kim Hongju , Jung Sungyun , Choi Kang-Un , Lee Chan-Hee , Kim Ung , Son Jang-Won , Park Jong-Seon , Shin Dong-Gu
Published: March 2022

Background:
Recent studies have suggested new P2Y12 antagonists (prasugrel /ticagrelor) are more effective in high thrombotic conditions than conventional clopidogrel The aim of this study was to compare the clinical outcomes between clopidogrel abd new P2Y12 antagonist in acute myocardial infarction patients treated with percutaneous coronary intervention (PCI).

Methods:
Between November 2011 and January 2016, a total of 11,731 AMI patients treated with PCI (7580 patients were prescribed clopidogrel and 4151 patients new P2Y12 antagonists) were enrolled in the Korean Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) database. Propensity score matching was performed to adjust for differences in baseline clinical variables. The primary endpoints were major adverse cardiovascular and cerebrovascular events (MACCEs), a composite of cardiac death, myocardial infarction, target-lesion revascularization (TLR), and stroke.

Results:
After propensity matching (4151 pairs), the rate of MACCEs were more frequently occurred in the clopidogrel group than in the new P2Y12 (8.2% vs. 6.4%, p=0.002). The difference in MACCE between two groups was driven by cardiac death (4.7% vs. 3.3%, p<0.001). There was no significant difference in myocardial infarction (0.7% vs. 0.6%, p=0.783), TLR (2.4% vs. 1.8%, p=0.337), and stroke (0.8% vs. 0.7%, p=0.336). However, the incidences of Thrombolysis In Myocardial Infarction (TIMI) minor bleeding showed a trend toward a lower incidence in the clopidogrel group (13.8% vs. 17.3%, p=0.057).

Conclusion:
Our study shows that new P2Y12 antagonist was associated lower rate of MACCE and cardiac mortality in AMI patients treated with PCI.
Abstract 21118: A Systematic Review on the Risk of Mortality Related to the Timing of Coronary Artery Bypass Grafting Following Myocardial Infarction
Authors: Krakowski George A , Foy Andrew J
Published: March 2022

Introduction:
The optimal timing for coronary artery bypass grafting (CABG) following an acute myocardial infarction (MI) is a topic of controversy among cardiologists and cardiothoracic surgeons. We sought to perform a systematic review of the evidence.

Methods:
PubMed was searched for studies that compared mortality between patients who underwent CABG, at different time points, following an acute MI. The quality of evidence was assessed using the National Institute of Health (NIH) quality assessment tool for observational cohort and cross-sectional studies. Mortality was compared between groups who had CABG performed <24 hours (acute), 24-72 hours (sub-acute), and >72 hours (delayed) following MI.

Results:
Sixteen observational studies were identified (1 prospective, 15 retrospective) which included 94,841 patients. There were no randomized controlled trials (RCT). Five studies used data from official registries while 11 relied upon data from a single site. Two studies specified the MI type as NSTEMI, 2 as STEMI, and it was unspecified in 12. Mortality was assessed as ‘in-hospital’ in 10 studies, ‘perioperative’ in 5, and ‘one month’ in 1. Using the NIH quality assessment tool, we scored 12 domains on a dichotomous scale of ‘yes’, ‘no’, or ‘other’ and found the average number of ‘yes’ answers was 6.5/12 with a range of 4 to 8/12. A quantitative comparison of mortality risk between timing groups could not be performed due to heterogeneity between recorded baseline covariates across studies as well as heterogeneity between MI-type, timing cut-offs, and specific mortality endpoints across studies. Only 1 study used propensity-matching, most used some logistic regression but 4 did not adjust at all for baseline cofounders. Most studies found that mortality was increased when patients underwent CABG <24 hours following MI but there was no consistent difference in mortality between sub-acute versus delayed groups.

Conclusions:
The current evidence base for timing of CABG post-MI is poor, being composed of low to fair quality observational studies and expert opinion. Selection bias is a major concern for all studies that were reviewed. Well-conducted RCTs are urgently needed to better inform this important clinical question.
Abstract 21127: Evaluation of Pulmonary Regurgitation and Aspiration During Cardiopulmonary Resuscitation (cpr): A Crossover Pilot Human Cadaver Study-Preliminary Data
Authors: Ruetzler Kurt , Leung Steve , Chmiela Mark , Cohen Barak , Drake Richard , Zimmerman Nicole , Sessler Daniel
Published: March 2022

Introduction:
Chest compression and ventilation during CPR may increase risk of regurgitation and aspiration. Pulmonary aspiration is a clinically relevant endpoint as it is associated with significant mortality. There is limited data comparing the impact of continuous and interrupted chest compression during CPR on risk of regurgitation and aspiration. Thus, we aim to obtain a preliminary estimate of incidences of regurgitation and aspiration of continuous versus interrupted chest compression using a cadaver model.

Hypothesis:
Interrupted chest compression, compared with continuous chest compression during CPR, is associated with a lower risk of regurgitation and aspiration.

Methods:
In a cross-over design, 10 cadavers (BMI<45 kg/m
2
) with no airway pathologies were studied. Cadavers were suctioned for pre-existing stomach contents, applied the Lucas CPR board (Physio Control, Redmond, WA) and a King LTS-D supraglottic device was placed. Stomach content was simulated by methylene-blue and barium sulfate for the first and second interventions, respectively. Cadavers were randomized to receive CPR starting with either 1) Continuous compressions (rate of 100/min), while ventilating at rate of 10/min or 2) Interrupted compressions, while ventilating at a rate of 30:2. Each CPR session lasted 14 minutes. Stomach was properly suctioned prior to the next intervention to avoid cross-over contamination. Regurgitation and/or aspiration was assessed by bronchoscopy (methylene blue) and radiography (barium sulfate).

Results:
The incidence of regurgitation was 100% for continuous chest compression, while that of interrupted chest compression was 70%. The incidence of aspiration of continuous chest compression was 50% while that of interrupted chest compression was 30%.

Conclusions:
In conclusion, interrupted chest compression was associated with 20% less incidence of aspiration compared to continuous compression during CPR in our cadaver model. Our study is limited by its small size and use of cadavers, but nonetheless estimated incidences of pulmonary aspiration by CPR method to provide insight for future studies.
Abstract 21137: Nationwide Trends and Outcomes of Mechanical Circulatory Support With and Without Therapeutic Hypothermia for In-Hospital Cardiac Arrest
Authors: Hernandez Gabriel A , Lemor Alejandro , Blumer Vanessa , Patel Nish , Patel Nilesh , Chaparro Sandra V , Alfonso Carlos
Published: March 2022

Introduction:
In-hospital cardiac arrest (IHCA) is associated with elevated morbidity and mortality. Despite advances in cardiopulmonary resuscitation (CPR), survival remains dismal. The use of mechanical circulatory support (MCS) and therapeutic hypothermia (TH) have shown to improve outcomes when compared to conventional CPR in selected patients with IHCA. Limited studies describe the use of TH in patients receiving MCS during IHCA and there is currently no evidence demonstrating benefit of MCS with TH over MCS at normothermia.

Methods:
Using the National Inpatient Database we identified patients with IHCA from 2004 to 2014. Using ICD-9 procedure codes, we identified the use of TH and MCS. Univariate and multivariate linear and logistic regression models were generated to identify specific outcomes and in-hospital mortality.

Results:
Of 1,073,093 patients that underwent in-hospital CPR during 2004 to 2014, 2.7% had MCS without TH, 0.84 % underwent TH without MCS and 0.1% underwent TH with MCS. Baseline characteristics for each group are shown in Table 1. In patients who underwent MCS alone, 90.6% had balloon pump, 6.1% had extracorporeal membrane oxygenator and 3.3% had peripheral ventricular assisted device. In this group, 48% underwent percutaneous coronary intervention (PCI) and 42.5% of patients survived to discharge with half of them being discharged home (52.2%) and 31.2% to a nursing home or facility. Of those who received TH without MCS, fewer patients underwent PCI (6.1%) and 28.8% survived to discharge (48.6% being discharge to nursing home or facility). Of those who underwent MCS and TH, 55.6% underwent PCI and 35.8% survived to discharge.

Conclusions:
Use of MCS was associated with better survival outcomes and higher rate of PCI, regardless of the use of TH. No significant difference in mortality was noted in patients with HT without MCS (28.8% compared to the overall sample 27%).
Abstract 21141: Cystathionine Gamma-Lyase Regulates Autophagy in Ischemic Endothelial Cells
Authors: Rajendran Saranya , Kevil Christopher G
Published: March 2022

Introduction:
Peripheral arterial disease (PAD) is a chronic arterial occlusive disease leading to lower limb ischemia. Autophagy is a cell adaptive response associated with ischemic stress that may act as a double edged sword. It is essential during tissue ischemia, but may also phagocytize more organelles promoting cell death. Hydrogen sulfide (H
2
S), a gasotransmitter predominantly produced in the vasculature via cystathionine-γ-lyase (CSE), play a key regulatory role in the cardiovascular functions. However, role of H
2
S/CSE in autophagy, and its associated impact on ischemic injury is poorly understood.

Objective:
To investigate the role of CSE/H2S in the regulation of autophagy under ischemia using murine hind limb ischemia model and in vitro studies.

Methods:
Unilateral femoral artery ligation (FAL) was performed on C57BL/6J(WT) mice and tissue blood perfusion was measured using laser Doppler flowmetry. LC3B expression was measured in the skeletal muscle tissues by immunohistochemistry. We utilized mouse aortic endothelial cells (MAECs) isolated from WT and CSE deficient (CSEKO) mice respectively and immortalized them. We treated WT and CSE KO MAECs were subjected to normoxia and hypoxia with and without autophagy inhibitor bafilomycin and evaluated for LC3B. ROS levels were evaluated by DCFDH. Apoptosis was measured by LDH assay and cleaved caspase-3.

Results:
Compared to WT, CSEKO MAECs showed significant reduction in LC3B protein expression. Reduced LC3B and p62 mRNA expressions were also observed in CSEKO cells. In the WT mice subjected to FAL, blood perfusion was significantly reduced in the ligated limbs compared to non-ligated. Interestingly, LC3B was significantly higher in ischemic muscle compared to non-ischemic tissues. Additionally, CSE genetic deletion significantly increased ROS levels that lead to increased apoptosis. CSEKO MAECs showed increased LDH activity and elevated cleaved caspase-3 expression under hypoxia.

Conclusions:
Our study reveals for the first time that CSE/H
2
S regulates autophagy in ischemic endothelial cells. CSE/H
2
S may be used as a therapeutic agent to protect against ischemia injury by inhibiting autophagy during PAD.
Abstract 21142: Ultrafiltration on CPB Predicts AKI and Transfusion
Authors: Manning Michael , Li Yi-Ju , Linder Dean , Haney John , Wu Yi-Hung , Podgoreanu Mihai , Schroder Jacob , Swaminathan Madhav , Milano Carmelo , Welsby Ian , Daneshmand Mani , Stafford-Smith Mark , Ghadimi Kamrouz
Published: March 2022

Introduction:
Postoperative acute kidney injury (AKI) confers poor outcomes after cardiac surgery. Conventional ultrafiltration (CUF) is performed on cardiopulmonary bypass (CPB) to raise hematocrit, avoid intraoperative blood transfusion, and provide renal protection. These protective effects remain unclear with high CUF volumes, which may cause hypovolemia and renal hypoperfusion.

Hypothesis:
Higher CUF volumes will be associated with increased AKI and poor outcomes.

Methods:
Retrospective analysis of 1,791 consecutive patients undergoing cardiac surgery (CABG, CABG/Valve, Valve only) was performed between June 2013 and December 2015. Institutional CPB protocol with CUF was used during all cases. Uni- and multivariable logistic regression analyses determined predictors for AKI. CUF volume analyses were performed, defined by two extreme quartiles or by Youden index derived from ROC analysis, and compared for their effect on AKI rate. Mortality data was acquired from the Social Security Administration’s Death Master File through 1 year after index surgery.

Results:
CUF volume independently predicted AKI (p<0.0001)(Fig 1A). Critical CUF volume associated with AKI, defined by 3
rd
quartile, was > 2,900 ml (OR=1.72, 95% CI 1.25, 2.38) and defined by Youden index, was > 2,239 ml, (OR=1.52, 95% CI 1.22, 1.89). While associated with increased intraoperative blood transfusion volume (p=0.002), CUF volume in AKI patients (N=903) predicted increased ICU (p<0.001) and hospital LOS (p<0.001). AKI incidence was associated with increased 30-day mortality (HR=2.78, 95% CI 1.06 - 7.27; p=0.037) but no significant difference in survival was seen when AKI group was stratified by CUF volume (Fig 1B), based on a small number of events (N=25). AKI did not yield significant HR for death between 30 days - 1 year.

Conclusions:
CUF volume removal during CPB predicted blood transfusion requirements, postoperative AKI, and ICU/Hospital LOS, while AKI predicted 30-day mortality.
Abstract 21148: Stress-Induced Cardiac Repolarization Changes Are Associated With Mental Stress-Induced Mycoardial Ischemia
Authors: Shah Amit J , Pimple Pratik M , Almuwaqqat Zakaria , Amin Matt , Hammoud Mhd Alaa , Hammadah Muhammad , Gafeer Mohamad M , Alkhoder Ayman , Abdelhadi Naser , Wilmot Kobina , Levantsevych Oleksiy , Al Mheid Ibhar , Garcia Ernest , Kutner Michael , Raggi Paolo , Lampert Rachel , Isakadze Nino , Soliman Elsayed Z , Quyyumi Arshed A , Vaccarino Viola
Published: March 2022

Introduction:
Mental Stress-Induced Myocardial Ischemia (MSIMI) can occur in patients with coronary artery disease (CAD) during acute mental stress challenge and is associated with an increased risk of adverse cardiovascular events. Adverse dynamic changes in repolarization with stress may also be particularly important when assessing risk of MSIMI.

Hypothesis:
In subjects with CAD, dynamic ECG repolarization changes during stress and recovery are associated with MSIMI.

Methods:
We studied 419 individuals with CAD who underwent mental stress challenge via a standardized speech stressor. Digital 12-lead ECGs were collected at baseline during resting , 1 minute after speech started, immediately after speech, and during recovery (5 minutes after speech ended). Repolarization metrics, including QRS-T angle, T-axis, ST depression, and T wave area were quantified in all 12 leads. Heart rate was also included. Subjects with baseline artifact were excluded. Changes amongst baseline, stress, and recovery were analyzed. Forward selection with alpha=0.01 was used to help guide the final model. MSIMI was assessed via Tc99m myocardial perfusion imaging (read by experienced clinicians).

Results:
The mean (SD) age was 56 (10), 38% were women, and 17% had MSIMI. The most significant predictors of MSIMI, based on the multivariate model, are summarized in the table. The C-statistic was 0.73, but reduced to 0.71 after leave-one-out cross validation. Goodness of fit was adequate. No significant race or gender differences were noted.

Conclusion:
Baseline and dynamic ECG repolarization changes in recovery (but not peak stress) contribute to MSIMI classification, and may be useful for risk stratification of arrhythmia risk due to emotional triggers. While the mechanisms regarding the relationship of MSIMI and ECG metrics during recovery are unknown, they could be due to hysteresis phenomena and/or known autonomic changes during recovery from stress.
Abstract 21149: Long-Term Clinical Outcomes of Patients With Critical Limb Ischemia Underwent Percutaneous Transluminal Angioplasty and Routine Coronary Angiography
Authors: Rha Seung-Woon , Choi Byoung Geol , Her Ae-Young , Kim Yong Hoon , Choi Se Yeon , Byun Jae Kyeong , Park Yoonjee , Mashaly Ahmed , Jang Won Young , Kim WooHyeun , Choi Jah Yeon , Park Eun Jin , Na Jin Oh , Choi Cheol Ung , Lim Hong Euy , Kim Eung Ju , Park Chang Gyu , Seo Hong Seog , Oh Dong Joo
Published: March 2022

Background:
Critical limb ischemia (CLI) and coronary artery disease (CAD) are associated with a high risk of mortality and cardiovascular events. Also, CAD is well-known for its higher prevalence in CLI patients (pts). We evaluated long-term clinical outcomes of the strategy of routine coronary angiography and subsequent coronary revascularization, if clinically indicated, in patients with CLI who underwent percutaneous transluminal angioplasty (PTA).

Methods:
A total 674 consecutive CLI patients underwent PTA and coronary angiography. Coronary artery disease (CAD) was defined as angiographic stenosis ≥70 %. Patients were divided into two groups according to the presence of CAD (CAD group: 413 pts, Non-CAD group: 261 pts). To adjust for any potential confounders that could cause bias, propensity score matching (PSM) analysis was performed. Clinical outcomes were assessed in a follow-up of 5 years by Kaplan-Meier curved analysis.

Results:
After PSM analysis, two matched groups (160 pairs, n=320 pts) were generated and their baseline characteristics were balanced. During the 5-year clinical follow-up, there were no differences between the two group regarding mortality, myocardial infarction, strokes, peripheral revascularization, and target extremity surgery except that the coronary revascularization was higher in the CAD group than the non-CAD group [Table].

Conclusion:
A strategy of routine coronary angiography and coronary revascularization may be a reasonable treatment option for patients who have high risk for severe CAD at least for 5 years. A randomized trial is needed to determine if this is the preferred strategy for CLI patients.
Abstract 21151: Safety and Feasibility Report of Investigational Therapy With Interleukin-11 Against Acute Myocardial Infarction
Authors: Maeda Makiko , Nakagawa Masaki , Owada Yasuko , Izumi Yasukatsu , Nonin Shinichi , Sugioka Kenichi , Nakatani Daisaku , Iwata Shinichi , Mizutani Kazuki , Nishimura Satoshi , Ito Asahiro , Fujita Suwako , Daimon Takashi , Sawa Yoshiki , Asakura Masanori , Fujio Yasushi , Yoshiyama Minoru
Published: March 2022

Introduction:
The benefits of vessel recanalization in acute myocardial infarction (AMI) are limited by ischemia/reperfusion (IR) injury. We have reported IL-11, a kind of IL-6 family cytokine, confers resistance to IR injury on cardiomyocytes both in vitro and in vivo and reduces infarct size and improved ventricular function after I/R injury in vivo. Importantly, recombinant human IL-11 (rhIL-11) was clinically used for the prevention of severe thrombocytopenia after chemotherapy under the approval of FDA.

Hypothesis:
The aim of this study was to evaluate the safety and feasibility of rhIL-11, adjunct to primary percutaneous coronary intervention (PCI) in AMI.

Methods:
Four patients with STEMI undergoing primary PCI were enrolled based on inclusion criteria, such as culprit lesion of #6 or #7 with TIMI flow grade 0 or 1 on coronary angiography (CAG). Just after diagnosis by CAG, rhIL-11 (6 or 25 μg/kg) was intravenously administered for a period of 3 hours (hr). The primary endpoint were safety and tolerability for 7days after the administration. Serum creatine kinase (CK) was measured pre- and 1, 2.5, 3, 6, 10, 15, 24, 48 hr after injection. Echocardiography was performed pre-, 7days, 3 and 6 months after injection.

Results:
Just after injection of rhIL-11, PCI was successfully performed and no severe or serious drug adverse events occurred through the observation period in any cases. And they left the hospital without symptoms of heart failure. In addition, no unexpected reduction in left ventricular ejection fraction (LVEF) was observed in the patients treated with rhIL-11 (LVEF, 39.8±8.8 %; CK
max
, 6906.3±3546 U/L), compared with non-treated internal controls with similar baseline demographics including CK
max
and LVEF at chronic phase after AMI.

Conclusions:
Conclusively, we described the four cases of rhIL-11 therapy against STEMI as a novel cytokine therapy for the first time, and this therapy was feasible and well tolerated in AMI. In order to address the efficacy of rhIL-11 therapy, we have been preparing randomized controlled trial to investigate efficacy and safety of rhIL-11 in the patients with STEMI, and the protocol for the trial was approved as advanced medical care by Japanese Ministry of Health, Labour and Welfare last December.