bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 304: Comparing a Novel Stochastic Integrative Machine Learning Model with AMSA for Predicting Defibrillation Success
Authors: Shandilya Sharad , Ward Kevin , Kurz Michael C , Najarian Kayvan
Published: April 2024

Introduction

A computational model of defibrillation success, based on physiologic signals, would be highly useful in guiding therapy during cardiac arrest. The Amplitude Spectrum Area (AMSA) measure has been explored in a number of studies as a predictor of countershock success for ventricular fibrillation (VF). We have developed a novel non-linear stochastic method for a unified predictive model of Return Of Spontaneous Circulation (ROSC) and compare this model to AMSA.

Methods

Ninety sample pre-hospital VF Electrocardiogram (ECG) signals including defibrillation were classified as successful (34) or unsuccessful (56) through 10-fold cross validation. A novel integrative model was developed with Machine Learning and features extracted from non-linear stochastic characterization of the ECG signal. This method was subsequently compared with the AMSA method. We replicated the procedure published by AMSA creators and attempted to discern a threshold. The performance of both methods in predicting post-countershock ROSC was measured. Accuracy is calculated as the correctly predicted countershock outcomes divided by all samples in the database. ROC AUC is a measure of predictive model robustness.

Results

The novel integrative model performs real-time, short-term (7.8 second) analysis of the ECGs with prediction Accuracy and Receiver Operator Characteristic (ROC) Area Under the Curve (AUC) of 82.2% and 85%, respectively. Sensitivity was 85.3% and specificity was 80.3%. Using the AMSA methodology, no clear threshold for shock success could be identified for comparison. Employing information-gain based decision stump (or one-rule) for AMSA values yielded 64.6% accuracy and 60.9% ROC AUC. Sensitivity was 44.1% and Specificity was 77.2%.

Conclusion

We report multiple performance metrics for a novel integrative model as well as the previously described, Fourier Transform based, AMSA model for predicting defibrillation success. A stochastic and non-linear basis for signal characterization proves to be more adept in dealing with the known dynamic and non-stationary characteristics/morphology of the VF waveform. It significantly improves performance in analyzing the VF signal to predict countershock success.
Abstract 313: Effects of Therapeutic Hypothermia on Myocardial Oxygen Demand and Coronary Flow Velocity
Authors: Gasparetto Nicola , Cacciavillani Luisa , Scarpa Daniele , Tona Francesco , Perazzolo Marra Martina , Marzari Armando , Iliceto Sabino
Published: April 2024

Therapeutic hypothermia (TH) has been recently introduced as a therapeutic strategy for brain protection in comatose patients after cardiac arrest (CA). It has been hypothesized that TH could be also useful for myocardial protection thanks to the temporary reduction of myocardial oxygen demand. We aimed to evaluate the effects of mild TH on myocardial oxygen demand and coronary flow velocity (CFV).

Material and methods: We studied 11 comatose patients (9 male, aged 59 ± 12) treated with TH after CA of cardiac origin, and with angiographically normal left descending coronary artery (LAD). Rest CFV in the LAD was detected by transthoracic Doppler echocardiography at TH maintenance phase (32.7 ± 0.8 °C) and after rewarming (36.9 ± 0.5 °C).At same time we evaluated the rate-pressure product as a simple way for the estimation of myocardial oxygen demand.

Results: During TH, CFV was lower than in normothermic condition (11.5± 2.3 vs. 18.4 ± 4.8, p=0.007) as rate-pressure product (6476 ± 1261 vs. 9565 ± 2332, p=0.021). At linear unadjusted regression analysis the relationships between CFV in LAD and rate-pressure product during TH and after rewarming were close (R2=0.598, p=0.0001, figure). Furthermore, TH reduced CFV by 8.8 ± 6.9% for each 1°C reduction in body temperature.

Conclusions: TH reduces rate-pressure product and CFV thus suggesting its potential in reducing myocardial oxygen demand. CFV reduction, induced by hypothermia, parallels that of oxygen demand reduction and is related to the entity of temperature decrease. TH has a potential in protecting myocardium from ischemic damage.
Abstract 319: Prehospital Indication of Reperfusion in STEMI Patients and 1-Month Mortality
Authors: Rosell Fernando , Mellado-Vergel Francisco J , Rivas-Ruiz Francisco ,   Pre-hospital Acute Cardiac Care Group of EPES
Published: April 2024

The indication of reperfusion at first medical contact (RFMC), proceeding directly to Cath-Lab (DCL) or, if not possible, performing pre-hospital thrombolisys on site (PhT), is a key action for STEMI patients. Our objective is to analyse if changes in RFMC are associated with one-month mortality in STEMI patients.

Methods: Retrospective observational study of two periods, P1 (Jan2001-Dec03) and P2 (Jan2005-May2009), from a continuous pre-hospital registry of patients with STEMI. Patients were followed up in-hospital and one month later. Univariate analysis to compare both periods and logistic regression for one-month mortality (from in-hospital admission to one month later).

Results: Total patients included 5522 (2248 P1 and 3274 P2). Univariate analysis (P1 vs P2) found significant differences in (%): age (64.3 vs 63.5, p=0.032), dyslipidemia (33.6 vs 36.7, p=0.02), hypertension (48.4 vs 53.1, p=0.01), history of angina (14.9 vs 11.1, p<0.0001), history of AMI (16.4 vs 13, p=0.001), hypotension (systolic blood pressure<90 mm Hg) (15.2 vs 13.3, p=0.049), Killip>I (19 vs 12.7, p<0.0001), onset-symptoms-call <60 min. (56.5 vs 60.1, p=0.01), PhT (20.8 vs 40.4, p<0.0001), DCL (0 vs 7.1, p<0.0001), in-hospital thrombolysis (46.8 16.4, p<0.0001) primary PCI (4.1 vs 17.5, p<0.0001), rescue PCI (4.3 vs 12, p<0.0001), PCI during hospital admission (16.9 vs 29.8, p<0.0001), RFMC (20.8 vs 47.5, p<0.0001),one-month mortality (18.8 vs 13.8 p<0.0001). The logistic regression in table 1. After adjust for clinical conditions and any PCI treatment preformed, RFMC was associated with less one-month mortality.

Conclusions: There were significant increases of RFMC and percentages of PCI throughout the process in P2. Despite the fact of worst clinical conditions of P1 patients, one-month mortality decreased in P2. RFMC was associated to one-month mortality reduction in STEMI patients.
Abstract 331: Insulin Resistance Is Independently Associated with Sudden Cardiac Death in the Community
Authors: Ahmadi Naser , Teodorescu Carmen , Uy-Evanado Audrey , Reinier Kyndaron , Havmoeller Rasmus , Kowk Dorothy , Huertas-Vazquez Adriana , Chugh Harpriya , Gunson Karen , Jui Jonathan , Chugh Sumeet
Published: April 2024

Background: Insulin resistance(IR) increases atherogenesis and atherosclerotic plaque instability, but apotential association with sudden cardiac death(SCD) has not been evaluated. We assessed the relationship of triglyceride(TG)/HDL-c ratio, a simple measure of IR, with out-of-hospital SCD.

Methods: From an ongoing large community-based study in the Northwest US, SCD cases(n=529)were compared to 3174 age and gender matched-controls without history of ventricular arrhythmias from a coronary angiography database in the Western US. Medical-diagnoses, procedures, risk-factors and laboratory tests of all-individuals were obtained through medical chart-review prior and unrelated to SCD. Logistic-regression was employed to assess the relation of IR with SCD. IR was defined as TG/HDL-c ratio≥3.8. Left ventricular systolic dysfunction(LVSD) was defined as EF≤35%.

Results: The mean TG/HDL-c ratio was significantly higher in SCD compared to controls (4.24±3.76 vs. 2.71±2.69, p=0.0001). Similarly, IR was more prevalent in SCD vs. controls (39.9% vs. 19.7%, p=0.0001). After adjustment for other clinical conditions and risk factors, the relative risk of SCD conferred by IR was 1.93(95%CI 1.4-2.6) and 1.77(95%CI 1.2-2.6) in subjects with and without diabetes mellitus, respectively (p=0.001). The population risk of SCD attributable to IR was 23%. The risk of SCD increased substantially with the combination of IR with obesity, peripheral vascular disease (PVD) and LVSD (p=0.001). The area under the ROC-curve for prediction of SCD was 0.75 for PVD, 0.76 for IR, 0.80 for LVSD and 0.86 for the combination.

Conclusions: In this population, IR was an independent predictor of SCD. Furthermore, the combination of IR with PVD and LVSD substantially increased the cumulative risk of SCD.
Abstract 333: Sudden Death Expertise Center: A Sudden Cardiac Arrest (SCA) Registry
Authors: Lamhaut Lionel , Bougouin Wulfran , Loeb Thomas , Revaux Francois , Varenne Olivier , Marijon Eloi , Carli Pierre , Jouven Xavier ,   Sudden Death Expertise Ctr Investigators
Published: April 2024

Introduction - Knowledge of the epidemiology of the SCA is scarce, requiring collaboration of Emergency Medical Services and Intensive Care Units. Thus we developed a Sudden Death Expertise Center which first step was to develop a exhaustive register.

Methods - We considered cases from a large ongoing population-based register, conducted in Paris and suburbs (population of 6.6 millions). Using multiple-source and central adjudication, we prospectively enrolled all out-of-hospital cardiac arrests since May 2011. Sources are fire departments (BLS), Mobile intensive care ambulance (ALS) and hospital services (Emergency, Intensive Care, Cardiology). Completeness is ascertained through informatic queries in some hospitals.

Results - Over the first 8 months, we reported 2,214 out-of-hospital cardiac arrests, including 1449 with resuscitation attempted and 1193 with presumed cardiac cause (Figure 1). Among them, mean age was 64.5 years, and they occurred at home in 826 case (72.2%). Initial shockable rhythm was reported in 186 cases (16.2%), and 375 patients (31%) were admitted to hospital. Coronary angiography was performed in 198 patients (53%) and therapeutic hypothermia was applied in 192 patients (51%). Survival at discharge was 3,1% considering all OHCA, and 5,7% for SCA when the resuscitation was attempted. Completeness of the registry was 93%.

Conclusion - This registry allow a better understanding of epidemiology of SCA. The next step is the establishment of a multidisciplinary approach to improve survival, through prevention (education programs), treatments (AED programs), and familial screening.
Abstract 337: Plasma Oncotic Pressure Is Reduced in Transfused Trauma Patients
Authors: Rahbar Elaheh , Baer Lisa A , Cotton Bryan A , Holcomb John B , Wade Charles E
Published: April 2024

Objective:
Hemorrhagic shock is the leading cause of potentially preventable traumatic death. Many of these deaths are believed to be avoidable with appropriate resuscitation. We investigated the role of initial plasma colloid osmotic presure (COP, i.e. oncotic pressure) on outcomes in trauma patients.

Methods:
Plasma samples were collected from 10 healthy consented volunteers and 27 patients (TRPs) upon admission to the emergency department (ED). Biophysical properties of plasma including osmolality, COP, and serum protein were measured and correlated to clinical data. Initial vital signs, routine laboratory values, type and volume of resuscitative fluids were recorded 24 hours post-ED admission as was length of hospital stay.

Results:
COP was significantly reduced in TRPs compared to controls 17.7±2.6 vs 20.7±2.1 mmHg (p<0.05). COP strongly correlated (R
2
=0.8) to serum protein values, 6.1±0.8 in TRPs compared to controls, 6.6±0.4 g/dL. COP in TRPs were further categorized into Low (L<15.3 mmHg, N=7), Moderate (M=15.3-19.3 mmHg, N=13) and Normal COP (N>19.3 mmHg, N=6) subgroups, based on the interquartile range. TRPs with low and moderate COP had similar heart rates, systolic and diastolic blood pressures (128/75 mmHg, HR=94); whereas TRPs with N COP had higher blood pressures (148/93 mmHg). TRPs with L COP also received more blood transfusions within the first 24 hours of admission (L=1340±1568 ml, M=131±316 ml, and N=0 ml). Crystalloid infusions during the first 24 hours were similar among all groups (L=1480±1051 ml, M=1130±1040 ml, N=1171±965 ml). TRPs with L COP had longer hospital stays than M and N COP groups (13.5 vs. 7 days).

Conclusions:
Reduced COP and protein levels in TRPs are indicative of injury and hemorrhage. TRPs with low COP were more likely to receive blood transfusions during the first 24 hours and had longer hospital stays despite having similar vital signs as the M and N COP groups. In the absence of significant alterations in blood pressures and heart rate, COP and protein levels were indicative of a requirement for blood transfusions. We believe that using COP and protein levels in conjunction with current protocols could potentially improve resuscitation strategies for trauma patients.
Abstract 46: Circulating Levels of Leptin Are Reduced in Patients with Sudden Cardiac Arrest at the Time of the Event
Authors: Havmoeller Rasmus , Uy-Evanado Audrey , Teodorescu Carmen , Jerger Katherine , Kwok Dorothy , Ayala Jo , Huertas-Vazquez Adriana , Chen Ida , Reinier Kyndaron , Gunson Karen , Jui Jonathan , Chugh Sumeet S
Published: April 2024

Introduction:
In most published studies, elevated circulating levels of leptin have been associated with increased sympathetic tone and adverse cardiovascular outcomes. However, the specific association of leptin levels with sudden cardiac arrest (SCA) in the general population has not been evaluated.

Methods:
In an ongoing, prospective, community-based study of SCA in Northwest US, we compared levels of plasma leptin in 109 adult cases of adjudicated SCA and 107 age-matched controls with coronary artery disease (100% male, age 62.6±11.4 vs. 62.6±11.4 y). Plasma was obtained from blood drawn at the time of arrest (cases) and at a routine visit (controls), and analyzed using Quantikine Immunoassay (CV <3.3%, normal range for healthy male controls 2.2-11.1 ng/ml). Leptin levels were log transformed and compared (T-test and Chi-square test) per quartiles (based on controls). Logistic regression was used to predict the adjusted odds of SCA case status associated with leptin levels (per increase in quartile).

Results:
Leptin was significantly lower in SCA cases vs controls (median 2.0 [range 0.6 - 7.5] vs 8.5 [4.6 - 14.7] ng/ml, P<0.0001). Cases and controls did not differ regarding body mass index, smoking status, or prevalence of obesity (29.6±6.6 vs 29.2±5.3 and 40 vs 40%, both P>0.05) but controls were more likely to be on statin therapy (72 vs 44%, P<0.001). In a logistic regression model leptin was independently associated with decreased odds of SCA case status (OR/increased quartile of leptin 0.48 (95% CI 0.31 - 0.73, P=0.0006) also after adjusting for age, obesity, presence of coronary artery disease, smoking, and statin therapy (Table).

Conclusions:
We observed an inverse relationship between circulating leptin levels and survival from SCA. These findings could represent an impaired sympathetic response to the acute SCA event but further investigation is needed to understand the mechanistic link between leptins and SCA.
Abstract 48: A Multicenter Prospective Cohort Study on a Novel Neurological Prognostic Index, Regional Brain Oxygen Saturation, in Patients with Out-of-Hospital Cardiac Arrest
Authors: Ito Noritoshi , Kai Tatsuro , Tsuruoka Ayumu , Honma Yosuke , Yasuda Hideto , Mizobuchi Masahiro , Yamada Noriaki , Otsuka Masafumi , Fujioka Masayuki , Endo Tomoyuki , Orita Tomohiko , Unoki Takashi , Hayashida Kei , Morooka Takaya , Nishiyama Kei , Doi Yasuji , Komuro Issei
Published: April 2024

BACKGROUNDS:
A reliable and readily available neurological prognostic index for the cerebral resuscitation of out-of-hospital cardiac arrest (OHCA) patients (pts) is required. We have previously reported in a single center cohort study of OHCA pts that regional brain oxygen saturation (rSO
2
) measured on hospital arrival may help predict neurological outcomes.

OBJECTIVE:
To compare the power of rSO
2
and conventional indexes−lactate, base excess (BE), and ammonia (NH
3
)−measured on hospital arrival to prognose neurological outcomes at 30 days after cardiac arrest that are assessed according to the cerebral performance category (CPC) criteria in a multicenter prospective cohort study.

METHODS:
The database of the J-POP registry (conducted at 14 tertiary emergency hospitals in Japan) has prospectively enrolled 764 OHCA pts. Of these pts, 596 (77.5%) who were examined for rSO
2
, lactate, BE, and NH
3
were analyzed in the present study. The exclusion criteria included 1) trauma, 2) accidental hypothermia, 3) age under 18, 4) do not attempt resuscitation order, 5) Glasgow Coma Scale > 8 on hospital arrival, and 6) missing data. Immediately after hospital arrival, rSO
2
was measured using a near-infrared spectroscopy device (INVOS; Covidien, USA) placed on the forehead, along with the measurement of lactate, BE, and NH
3
. Regardless of the rSO
2
readings, all pts received the best available therapy.

RESULTS:
Among 596 OHCA pts, 31 (5.2%) had good neurological outcome. The areas under the curve (AUCs) for the prognostic indexes-rSO
2
, lactate, BE, and NH
3
−were 0.912, 0.794, 0.773 and 0.853, respectively (Table). The AUC was significantly greater for rSO
2
than for lactate (
p
= 0.0001) or BE (
p
= 0.0057) and tended to be greater for NH
3
(
p
= 0.0844).

CONCLUSIONS:
Compared with the conventional neurological prognostic indexes, rSO
2
may be more reliable for neurological prognostication based on its specificity, positive predictive value, and AUC.
Abstract 15753: High-Sensitivity Cardiac Troponin T and Secondary Events in Outpatients with Coronary Heart Disease: Data from the Heart and Soul Study
Authors: Beatty Alexis L , Ku Ivy A , Permanente Kaiser , Christenson Robert H , DeFilippi Christopher R , Schiller Nelson B , Whooley Mary A
Published: April 2024

Alexis L Beatty, 2012 Finalist and Presenting Author
Abstract 14573:L Cardiac Developmental Roadmap Predicts Cardiogenic Outcome of Pluripotent Stem Cells
Authors: Martinez Fernandez Almudena , Li Xing , Harthes Katherine A , Terzic Andre , Nelson Timothy J
Published: April 2024

Almudena Martinez Fernandez, 2012 Finalist and Presenting Author
Abstract 18972: A 36-Year-Old Man with Stroke and Severe Hyperlipidemia: From Phenotype to Genotype
Authors: Green Eric M , Hung Judy , Macgillivray Thomas E , Stone James R , Macrae Calum A
Published: April 2024

Eric M Green, 2012 Finalist and Presenting Author
Abstract 15061: Mst1-Mediated Phophorylation of Foxo1 and C/EBP-β Stimulates Cell Protective Mechanisms In Cardiomyocytes
Authors: Maejima Yasuhiro , Peiyong Zhai , Tong Liu , Hong Li , Junichi Sadoshima
Published: April 2024

Yasuhiro Maejima, 2012 Finalist and Presenting Author
Abstract 17512: Toll-Like Receptor 4 Dependent Macrophage Activation is Critical in Spinal Cord Ischemia-Reperfusion Injury
Authors: Bell Marshall T , Puskas Ferenc , Agoston Viktor A , Cleveland Joseph C , Fullerton David A , Gamboni Fabia , Herson Paco , Meng Xianzhong , Smith Phillip D , Weyant Michael J , ReeceT Brett
Published: April 2024

Marshall T Bell 2012 Finalist and Presenting Author
Abstract 74: Extracorporeal Membrane Oxygenation to Support Cardiopulmonary Resuscitation in a Sheep Model of Refractory Ischemic Cardiac Arrest
Authors: Stub Dion , Byrne Melissa , Pellegrino Vincent , Kaye David M
Published: April 2024

Background: Survival after cardiac arrest in the field remains limited. It is therefore imperative to develop new resuscitation techniques. We aimed to determine the potential role of extracorporeal membrane oxygenation assisted CPR (ECPR) in an animal model of refractory ischemic cardiac arrest.

Methods: Twelve sheep were assigned to either ECPR (n = 6) or ‘conventional’ (n = 6) resuscitation. All sheep had coronary occlusion, followed by induction of ventricular fibrillation. CPR was than commenced for 10 minutes in both groups, followed by randomisation to ECPR or CPR for a further 10 minutes. At 23 minutes post induction of VF, advanced life support measures were commenced with direct cardioversion, adrenaline and amiodarone. Outcomes measures included rates of return of spontaneous circulation (ROSC), and analysis of VF wave form.

Results: Baseline hemodynamics were similar between the two groups. CPR consistently produced coronary perfusion pressures (CPP) greater than 15mmHg in both groups, with significantly increased CPP post commencement of ECMO in the ECPR group (17.8 4+/-2mmHg vs 22.94+/-3mmHg, p=0.04). Number of shocks, pH, lactate and oxygenation were also comparable. Significantly greater rates of ROSC were seen in the ECPR sheep, 3/6 (50%) vs 0/6 (0%) (p=0.032), which was also associated with significantly increased VF amplitude measures (0.51+/-0.02Mv vs 0.42+/-0.04Mv, p=0.04).

Conclusions: This study indicates that ECPR provides a valuable adjunct to the management of patients with refractory VF arrest. Our findings have supported the development of a pilot trial into the effectiveness and feasibility of ECPR in the clinical setting.
Abstract 8910:
In Vitro
and i
n vivo
Performance of a Completely Autologous Aortic Valved Conduit (BIOVALVE Type VII) Prepared by in Body Tissue Architecture Technology Using a Novel Separable Mold
Authors: Nakayama Yasuhide , Takewa Yoshiaki , Sumikura Hirohito , Matsui Yuichi , Yamanami Masashi , Kishimoto Yuichiro , Arakawa Mamoru , Omuma Kentaro , Mizuno Takeshi , Oie Tomonori , Kanda Keiichi , Tatsumi Eisuke
Published: April 2024

Purpose: In body tissue architecture technology, attempted as novel and practical regeneration medicine by us, can prepare a completely autologous valved conduit (BIOVALVE) consisting of only recipient’s own tissue. In this study, the latest type of BIOVALVE was successfully implanted as an aortic valve in a goat model after in vitro evaluation with a pulsatile circulation circuit.

Methods and Results:
BIOVALVEs with 3 leaflets in the inner side of the conduit with the sinus of Valsalva were prepared by 2-month embedding of the specially designed separable molds, assembled using 5 plastic parts, in the dorsal subcutaneous spaces of goats. The valve tissue formation in the body was observed non-invasively by wireless capsule endoscope, impregnated into the molds. The obtained BIOVALVE had adequate mechanical properties including highly pressure resistance close to native valves. In vitro evaluation using a pulsatile circulation circuit (LaboHeart NCVC, IWAKI) showed that good valvular function (regurgitation: less than 15%) at mean flow rate of 4.8 L/min, AoP of 129-49 (82.2) mmHg, and beating rate of 70 and high durability (over 1 month). BIOVALVEs (n=3) were implanted in the specially designed apico-aortic bypass of goats to evaluate the possibility as an aortic valve for 1 month. Postoperative echocardiography showed smooth movement of the leaflets with little regurgitation under systemic circulation (2.6 ±1.1 L/min). The luminal surface after implantation was very smooth and covered with thin pseudointima without thrombus formation.

Conclusion:
Completely autologous BIOVALVE type VII developed satisfied the higher requirements of systemic circulation in vitro and in vivo and has potentiality for clinical application.
Abstract 9045: Electrocardiographic Changes Associated with Smoking and Smoking Cessation: Outcomes from a Randomized Controlled Trial
Authors: Gepner Adam D , Piper Megan E , Leal Miguel A , Fiore Michael C , Baker Timothy B , Stein James H
Published: April 2024

Background
Cardiovascular disease (CVD) prevalence and risk can be detected and quantified by analysis of the electrocardiogram (ECG), however the effects of smoking and smoking cessation on the ECG have not been characterized.

Methods
ECGs were performed on subjects enrolled in a prospective, randomized, placebo-controlled clinical trial of the effects of 5 smoking cessation pharmacotherapies. 12-lead ECGs from the baseline and 3-year visits were read in duplicate. Smoking burden was described by pack-years. Current smoking was described by cigarettes/day. Abnormalities were classified using the Minnesota ECG Code Classification (major and minor criteria). The effects of (i) smoking burden on the prevalence of ECG findings, and (ii) smoking and smoking cessation on ECG changes after 3 years were investigated by multivariable linear and multinomial regression analyses.

Results
At baseline, the 532 smokers were (mean [SD]) 43.3 (11.5) years old, smoked 20.6 (7.9) cigarettes/day, and had a smoking burden of 26.7 (18.6) pack-years. Major and minor ECG criteria were identified in 87 (16.4%) and 131 (24.6%) of subjects, respectively. After adjusting for age, sex, race, education, body-mass index, fasting glucose, and lipids, major ECG criteria were associated with greater pack-years (p=0.02), but not current cigarettes/day (p=0.23). After 3 years, 42.9% of subjects were abstinent from smoking. New major and minor ECG criteria were observed in 7.2% and 15.6% of subjects respectively, but in a similar number of abstinent subjects and continuing smokers (p>0.2 for both). Continuing smokers had a significant reduction in current smoking (-8.4 [8.8] cigarettes/day, p<0.001) compared to baseline.

Conclusions
Even in relatively young adults, major ECG abnormalities are independently associated with smoking burden. After 3 years, continued smoking was not associated with an increase in ECG abnormalities, though cigarettes smoked per day decreased among continuing smokers.
Abstract 9198: Clinical characteristics, Presentation and Outcomes of Percutaneous Coronary Intervention among HIV-positive Patients Compared to Controls: A Comprehensive Meta-Analysis of Existing Studies
Authors: Bandeali Salman J , Alam Mahboob , Ballantyne Christie , Lakkis Nasser
Published: April 2024

Introduction:
The impact of human immunodeficiency virus infection on the outcomes of patients undergoing percutaneous coronary intervention (PCI) is not well defined. We conducted a meta-analysis of all existing studies comparing the clinical events in HIV (+) patients and controls. Hypothesis: HIV infection and antiretroviral therapy may portend a higher risk for recurrent coronary events after PCI.

Methods:
A comprehensive PubMed search identified 6 studies comparing 366 HIV (+) patients and 1021 controls. Angiographic and clinical outcomes (including all-cause mortality, cardiovascular mortality, stent thrombosis, recurrent ACS, repeat revascularization and stroke) were studied. Review Manager 5.1 was used to conduct statistical analysis. Odds ratio (OR) and 95% confidence interval (CI) were calculated using random effects model. A p-value of <0.05 was considered significant.

Results:
HIV (+) patients were more likely to be young males with reduced prevalence of DM, HTN and hyperlipidemia. The proportion of smoking and illicit drug use was higher in the HIV (+) group. A higher proportion of HIV (+) patients presented with ST-elevation myocardial infarction prior to PCI compared to controls (38.7% vs. 30.5%; p=0.007). There were no differences in the angiographic characteristics (stent type, stent diameter, stent length, no. of vessels involved). The proportion of individuals undergoing revascularization with angioplasty or stent implantation was similar between HIV and non-HIV groups. Over a mean follow up of 13 months, there was no difference in mortality, stroke, and stent thrombosis. Recurrent ACS was more frequent in HIV (+) patients (OR: 2.67; 95% CI: 1.53-4.67) with a trend towards increased repeat revascularization in HIV (+) patients [Table].

Conclusion:
In conclusion, HIV (+) patients are more likely to be readmitted with recurrent ACS after PCI compared to non-HIV patients. HIV status is not associated with increased mortality after PCI.
Abstract 9203: Relationships Among Left Ventricular Geometry, Arterial-Ventricular Stiffening and Insulin Resistance in Childhood Obesity
Authors: Harada Kenji , Harada Yukiko
Published: April 2024

Background:
Insulin resistance has been implicated in the mechanism of cardiovascular dysfunction in adulthood obesity. However, few studies have examined insulin resistance and cardiovascular function in overweight/obese children. The purpose of this study is to assess the relationship between arterial-ventricular stiffness and cardiovascular risk factors in children.

Methods:
Echocardiography was performed in 146 children aged 7 to 15 years (BMI 18 to 34 kg/m2). Left ventricular (LV) end-diastolic volume, LV mass, transmitral peak flow velocity (E), and mitral annular myocardial velocity (Em) were measured. LV mass/volume ratio was calculated. Stroke volume (SV) was measured using aortic diameter and pulsed Doppler velocity profile. SV was indexed for body surface area (SVI). Effective arterial elastance (Ea) was estimated by end-systolic pressure/SVI. End-systolic elastance (Ees) was calculated by a modified single-beat method. End-diastolic elastance (Ed) was calculated from Doppler indices reflective of atrial pressures (E/Em) and the diastolic filling volume (SV). High sensitive C-reactive protein (hs-CRP), fasting glucose, insulin, and homeostasis model assessment for insulin resistance (HOMA-IR) were also assessed.

Results:
Ea, Ees, and Ed all increased significantly with BMI(r = 0.33, 0.26, and 0.34, p < 0.01, respectively). LV mass/volume ratio was positively associated with increased BMI (r = 0.48, p < 0.01). There were significant relationships between BMI and fasting glucose (r = 0.20, p < 0.05), insulin (r = 0.61, p < 0.01), HOMA-IR (r = 0.64, p < 0.01), and hs-CRP (r = 0.41, p < 0.01). Ea, Ees, Ed, and LV mass/volume ratio correlated significantly with insulin(r = 0.34, 0.28, 0.27, and 0.36, p < 0.01, respectively) and HOMA-IR (r = 0.31, 0.24, 0.23, and 0.35, p < 0.01, respectively). No significant relationships were observed between LV mass/volume ratio and arterial-ventricular stiffness and hs-CRP.

Conclusions:
Insulin resistance, concentric LV hypertrophy, and combined arterial-ventricular stiffening may contribute to the increased prevalence of later cardiovascular diseases.
Abstract 9262: Physical Activity, Nutritional Status and the Risk of Normal-weight Obesity in the US Population
Authors: Sahakyan Karine , Somers Virend K , Rodriguez-Escudero Juan P , Squires Ray W , Allison Thomas G , Thomas Randal J , Sochor Ondrej , Singh Prachi , Lopez-Jimenez Francisco
Published: April 2024

Purpose:
Subjects with normal weight obesity (NWO), defined as normal BMI but high body fat (BF)%, are at increased cardiovascular risk. Factors contributing to NWO are not well studied. We hypothesized that NWO is associated with reduced physical activity and unhealthy eating patterns.

Methods:
We analyzed 5942 people ≥18 years with normal BMI (18.5-24.9 kg/m
2
) from the NHANES III survey (1988-1994), a representative sample of the US population. Subjects were classified as NWO based on BF% (>35% in women and >25% in men). Leisure-time physical activity was measured with a standard survey. Subjects were stratified as INACTIVE (no physical activity reported), ACTIVE (3-6 METs for ≥ 5 times/week or >6 METs, ≥3 times/week), or insufficiently active (those who were not INACTIVE but did not meet criteria for ACTIVE). Total activity was expressed in METs/hr/month, assuming an exercise duration of 30 minutes for each day reported. A Healthy Eating Index was based on 24-hour dietary recall data. Analyses were weighted for the complex study design.

Results:
Mean age was 43 years, 54.4% were men; 1170 people (19.7%) with normal BMI had NWO. Table shows demographics, physical activity and nutritional habits by group. After controlling for age, gender, poverty levels, smoking status and Healthy Eating Index, METs/hr/month was an independent predictor of NWO (OR per 100 MET/hours/month is 0.72(95%CI 0.60;0.88). People who were inactive and insufficiently active had higher odds of NWO as compared with active people (OR-1.47; 95%CI 1.10;1.96 and OR-1.60, 95% CI 1.25; 2.05, respectively). Also, strength training was independently associated with a decreased odds of NWO (0.63; 95%CI 0.44;0.89). Dietary pattern was not predictive of NWO.

Conclusions:
Physical activity, particularly resistance exercise, but not diet, was associated with NWO independently of potential confounders. Promoting physical activity may be an important interventional strategy in these patients.
Abstract 9264: Do Interventional Cardiology Training Programs Have Worse Outcomes Early in the Academic Year? An Assessment of the “July Effect” from the NCDR
®
Authors: Hawkins Beau , Kaltenbach Lisa , Shivapour Daniel , Neely Megan , Rao Sunil , Yeh Robert
Published: April 2024

Introduction:
Prior studies have demonstrated worse patient outcomes at training institutions during the early months of the academic year, a concept commonly referred to as the “July effect.” Whether the July effect exists in modern interventional cardiology practice is unknown. We hypothesized that percutaneous coronary intervention (PCI) outcomes at training institutions are worse early in the academic year.

Methods:
All patients undergoing PCI for non-salvage indications from 2009-2011 within the CathPCI Registry
®
were eligible for inclusion. To identify training hospitals, we obtained a list of accredited interventional cardiology fellowship programs, matched them to their affiliated hospitals, and linked these training hospitals to the CathPCI Registry database through hospital identification numbers. PCI procedures were categorized as early (July 1-August 31) or non-early (September 1- June 30) based on timing within the academic year. Risk-adjusted in-hospital bleeding and mortality rates were compared for early and non-early time periods using validated risk models.

Results:
A total of 216,927 procedures were performed in training hospitals during the study period. Early and non-early PCI outcomes were similar (Table 1, early vs. non-early bleeding OR 0.97, CI 0.92-1.02, mortality OR 0.94, CI 0.85-1.03). The associations between PCI timing and in-hospital bleeding and mortality were similar between hospitals with and without training programs (P for interaction 0.59, and 0.95, respectively).

Discussion:
PCIs performed early in the academic year at training institutions are not associated with worse patient outcomes. Importantly for patients, within these training hospitals, this finding provides reassurance that care is not compromised when it involves trainees early in the academic year.
Abstract 9284: Selective Complex Fractionated Electrogram Targeting For Atrial Fibrillation Study (Select AF): A Multicenter, Randomized Trial
Authors: Verma Atul , Sanders Prashanthan , Champagne Jean , Macle Laurent , Nair Girish , Calkins Hugh , Wilber David
Published: April 2024

Introduction:
This study compared pulmonary vein isolation (PVI) plus generalized CFAE ablation vs PVI plus selective CFAE ablation, specifically areas of continuous electrical activity (CEA)(ClinicalTrials.gov
NCT00926783
).

Methods:
Patients with persistent/high burden AF (age 63±9 yr, LA size 42±6 mm) were enrolled at 6 centers (n=86) & randomized. For the generalized arm, all CFAE regions with an interval confidence level >7 were ablated followed by PVI. For the selective arm, only those CFAE sites with CEA were ablated followed by PVI. For PVI, all PV antra were isolated with confirmed entrance block. Patients were followed with ECG, & 48-hr Holter every 3 mos. AF symptoms were confirmed by loop recording. The primary endpoint was freedom from AF >30 sec at 1 year.

Results:
Both generalized & selective CFAE ablation prolonged AF cycle length (26±32 ms vs 22±33 ms, p=0.6). AF termination rates were also similar: 37% for generalized & 31% for selective (p=0.6). In both groups, PVI was achieved after CFAE ablation in all patients. RF duration was significantly less in the selective arm vs the generalized arm (25±21 vs. 40±21 min, p=0.008). However, at 1 year follow-up, freedom from AF/AT recurrence was significantly higher in the generalized vs the selective arm after 1 procedure (59% vs 24%, p=0.005). Looking at AF/AT recurrence post 1st or repeat ablation, freedom from recurrence at one year in the generalized arm was 62%, still higher than 33% in the selective arm (p=0.02). There was a trend towards fewer repeat procedures in the generalized vs selective arm (14% vs 33%, p=0.057). Complications included tamponade (n=1) and a sedation-related event (n=1).

Conclusions:
In persistent/high burden AF, selective CFAE ablation + PVI results in similar AF cycle length prolongation and termination rates with significantly less RF time. However, long-term freedom from AF/AT is significantly better using generalized CFAE ablation + PVI.
Abstract 9298: Detection of Atrial Fibrillation Using an iPhone 4S
Authors: Maitas Oscar , Lee Jinseok , Robotis Dionyssios , Bourell Peter , Chon Ki H , McManus David D
Published: April 2024

BACKGROUND:
Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with increased risk for stroke, heart failure, and death. Timely detection of AF can be challenging using traditional diagnostic tools. Smartphone use is increasing among individuals susceptible to AF and may provide an inexpensive and user-friendly means to diagnose AF. Our aim was to to develop methods for accurately detecting AF using a smartphone camera.

METHODS:
In this prospective clinical investigation, we recruited 52 adults presenting to the University of Massachusetts Medical Center for electrical cardioversion of AF. Participants underwent rhythm assessment using a novel iPhone 4S application before and after electrical cardioversion. Two minutes of pulsatile time series recordings were obtained from each participant’s index finger (placed on the iPhone 4S camera). The iPhone 4S application used 2 statistical methods (Root Mean Square of Successive RR Differences; Shannon Entropy) to examine heart beat intervals and beat-to-beat variability. We used receiver operating characteristic (ROC) curves to establish a threshold for sensitivity, specificity, and predictive accuracy of our application as compared to the gold-standard of 12-lead electrocardiogram.

RESULTS:
The AF detection accuracy was 99.14% (sensitivity of 99.77% and specificity of 98.58%) for each sample when a combination of the three signal processing techniques were applied compared to the gold-standard electrocardiographic recordings. All of the 52 AF episodes were detected. In addition, we tested on 29 healthy subjects and found that the accuracy (specificity) was 99.51%.

CONCLUSIONS:
Our iPhone 4S AF Detection application performed well, demonstrating excellent sensitivity, specificity, and accuracy for beat-to-beat discrimination of AF from normal sinus rhythm. For clinical applications, the relevant objective is to detect the presence of AF from a given recording. Using this criterion, the AF detection accuracy was 100% based on a 2-minute sample. Our findings show that AF can be accurately detected from pulsatile signals in the human fingertip using the camera of an iPhone 4S.
Abstract 9451: Determinant Factors of Elevated Plasma B-type Natriuretic Peptide Level in Severe Aortic Stenosis
Authors: Daimon Masao , Kawata Takayuki , Miyazaki Sakiko , Ichikawa Ryoko , Hirose Kuniaki , Maruyama Masaki , Suzuki Hiromasa , Makinae Haruka , Chiang Shuo-Ju , Miyauchi Katsumi , Daida Hiroyuki
Published: April 2024

Background:
Elevated plasma B-type natriuretic peptide (BNP) level reflects left ventricular (LV) dysfunction and is associated with poor outcome in aortic stenosis (AS). We aimed to determine the echocardiographic and clinical factors that are associated with elevated plasma BNP level in patients with severe AS.

Methods:
We performed echocardiography in 142 patients (age 72±10 years) with severe AS (aortic valve area (AVA) < 1.0cm
2
). We excluded patients with chronic renal failure and other significant valvular disease. We used multivariate linear regression analysis to evaluate factors that are associated with the plasma BNP levels in these patients.

Results:
Mean AVA was 0.77±0.16cm
2
. The factors associated with plasma BNP levels were left ventricular (LV) ejection fraction, E/A, E/e’, left atrial diameter, estimated systolic pulmonary artery pressure (SPAP), AVA, LV mass index, e’, systolic systemic blood pressure and the presence of atrial fibrillation (Table). In multivariate stepwise linear regression analysis, LV ejection fraction was the strongest independent determinants of plasma BNP level. In addition, estimated SPAP, and E/e’, and AVA were also found to be independently associated with plasma BNP level.

Conclusions:
In patients with severe AS, plasma BNP levels mainly correlates with LV systolic dysfunction. However, LV diastolic dysfunction, elevated pulmonary hypertension, and AS severity are also independently associated with elevated plasma BNP levels in severe AS.
Abstract 9501: Gender Differences in Mortality Associated with Implantable Cardioverter-Defibrillator Infections
Authors: Sohail Muhammad R , Henrikson Charles A , Braid-Forbes Mary Jo , Forbes Kevin , Lerner Daniel J
Published: April 2024

Introduction:
Implantable cardioverter-defibrillators (ICDs) reduce morbidity and mortality in appropriately selected patients, but device-related infections are associated with significant mortality that can mitigate this benefit. Women are at higher risk for adverse events during ICD procedure admissions, but there are limited data on the mortality associated ICD infection in women.

Objective:
To compare the clinical characteristics and mortality rate of men and women who have an infection associated with ICD procedure.

Methods:
Retrospective cohort study of 64,903 Medicare fee-for-service patients admitted for ICD generator implantation, replacement, or revision from January 1, 2007 to December 31, 2007. Primary outcome measures were unadjusted and risk-adjusted longer-term mortality associated with ICD infection.

Results:
There were a total of 1,855 (2.89%) admissions with an ICD infection. Longer-term mortality (death during admission quarter and subsequent 4 quarters) was significantly higher with ICD infection than without (28.4% vs. 16.7%, P<0.001). While longer-term mortality without ICD infection was significantly lower for women (hazard ratio=0.89 [95%CI 0.85-0.93]), longer-term mortality with ICD infection was significantly higher for women, compared to men (hazard ratio=1.20 [95%CI 1.03-1.41]. Multivariate regression analysis adjusting for age, gender, race/ethnicity and 28 comorbidities demonstrated a significant interaction between gender and ICD infection associated short and, and longer-term mortality. The risk-adjusted longer-term mortality with ICD infection was significantly higher for women compared to men (hazard ratio = 1.25 [95% CI 1.02-1.53]).

Conclusions:
Women have significantly higher rate of death, compared to men, following infection associated with ICD procedures. Further studies to determine the underlying causes of this disparity are warranted.
Abstract 9529: Effects of Sevelamer Carbonate on Arterial Stiffness and Left Ventricular Mass in Patients with Stage 3 Chronic Kidney Disease: Results of a Randomized Controlled Trial
Authors: Chue Colin D , Townend Jonathan N , Moody William E , Edwards Nicola C , Steeds Richard P , Ferro Charles J
Published: April 2024

Introduction:
Serum phosphate independently predicts cardiovascular mortality in the general population and in chronic kidney disease (CKD), even when levels are in the normal range. Phosphate has been implicated in the development and progression of vascular calcification and increased arterial stiffness, which is a driver of structural heart disease. We hypothesised that the non-calcium-based phosphate binder sevelamer carbonate would reduce left ventricular (LV) mass, reduce arterial stiffness and improve LV systolic and diastolic function in patients with stage 3 non-diabetic CKD.

Methods:
This was a single-centre, randomised, double-blind, placebo-controlled trial (figure). All patients received sevelamer carbonate for four weeks before randomisation to sevelamer or placebo for a further 36 weeks. Cardiovascular magnetic resonance imaging and echocardiography were used to assess LV mass and systolic and diastolic function. Arterial stiffness was determined by carotid-femoral pulse wave velocity (PWV).

Results:
A total of 120 patients were recruited. Mean age was 55 ± 14 years with 55% male and mean glomerular filtration rate 50 ± 13ml/min/1.73m
2
. Mean baseline LV mass, function and volumes were normal. After 40 weeks there were no significant changes in LV mass (-1.0 ± 7.2 vs. -0.2 ± 6.6 grams,
P
=0.6), LV systolic and diastolic function or PWV between sevelamer and placebo groups (table). Despite regular monitoring only 56% of subjects took ≥80% of prescribed therapy.

Conclusion:
In patients with stage 3 non-diabetic CKD, 40 weeks of treatment with sevelamer carbonate did not improve LV mass, LV systolic and diastolic function, or arterial stiffness.
Abstract 9532: Anaemic Patients With Chronic Heart Failure are Common in Clinical Practice, Insufficiently Treated and With an Impaired Prognosis Independent of Confounding Factors
Authors: Wienbergen Harm , Osteresch Rico , Hochadel Matthias , Boehm Michael , Pauschinger Matthias , Strasser Ruth H , von Scheidt Wolfgang , Senges Jochen , Hambrecht Rainer
Published: April 2024

Introduction:
There is an increasing interest in the role of anaemia in patients with heart failure (HF). We analyzed data of the EVITA-HF registry with respect to prevalence, therapy and prognosis of patients with chronic HF and hemoglobin < 12 g/dl in the actual clinical practice.

Methods:
The EVITA-HF registry is a multicenter registry of consecutive patients with chronic HF and left ventricular ejection fraction < 40%. Data are collected in 17 centers in Germany, Austria and Switzerland.

Results:
3082 HF-patients were included in the EVITA-HF registry in the time period 01/2009 to 03/2012. In 734 patients (23.8%) hemoglobin levels were < 12 g/dl. Anaemic patients were older (71 + 12 years vs. 65 + 13 years, p < 0.01) and more often female (33.2% vs. 20.6%, p < 0.01) than patients without anaemia and had a higher rate of comorbidities as renal failure and malignant comorbidities. Patients with anaemia received less often adequate medical HF-therapy (especially ACE inhibitors, aldosterone antagonists), had a lower rate of oral anticoagulatives in spite of a high rate of atrial fibrillation and had less often ICD/CRT implanted (32.1% vs. 40.3%, p <0.01) compared to patients without anaemia. Patients with anaemia had a worse clinical outcome compared to their non-anaemic counterparts with a significantly increased hospital (3.8% vs. 1.4%, p < 0.01) and 1-year mortality (23.3% vs. 10.6%, p <0.01). In a multivariate analysis adjusting for 14 prognostic factors hemoglobin < 12 g/dl was independently associated with a significantly elevated 1-year mortality (HR 1.45, 95% CI 1.04-2.02, p 0.031).

Conclusions:
Nearly ¼ of the HF-patients of the EVITA-HF registry had hemoglobin levels < 12 g/dl. These patients received less often adequate guideline-recommended HF-therapy compared to non-anaemic patients. HF-patients with hemoglobin < 12 g/dl had a more than doubled 1-year mortality, nearly every fourth of these patients died within 1 year. Anaemia in HF-patients was not only a marker of a high-risk patient group, but also an independent prognostic risk factor in a multivariate analysis.