bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 3683: Gender Difference in the Impact of Fasting Serum Glucose Level on Risk of Coronary Heart Disease: Korea Medical Insurance Corporation Study
Authors: Ahn Song Vogue , Kim Hyeon Chang , Nam Chung Mo , Lee Hyun Chul , Suh Il
Published: July 2021

Objective:
Diabetic women have a greater relative risk of coronary heart disease than diabetic men. However, gender difference in the impact of blood glucose levels below diabetic range on risk of coronary heart disease is unclear. The aim of this study is to evaluate whether the association between nondiabetic blood glucose levels and the incident risk of coronary heart disease is different in men and women.

Methods:
We measured fasting serum glucose levels and other cardiovascular risk factors in 172,580 Koreans (108,461 men and 64,119 women), aged 35–59 years in 1990 and 1992. Our primary outcomes were hospital admissions and deaths from coronary heart disease in 11 year follow-up from 1993 to 2003. Cox proportional hazard models were used to estimate the hazard ratios for coronary heart disease according to the baseline fasting serum glucose levels, after adjustment for age, body mass index, blood pressure, total cholesterol level, and cigarette smoking.

Results:
During the 11 years, 3,769 coronary heart disease events occurred. Risk of coronary heart disease in men was significantly increased at fasting serum glucose levels of diabetic range (≥ 126 mg/dL), although risk of coronary heart disease in women was significantly increased from impaired fasting glucose levels ≥ 110 mg/dL. In fasting serum glucose levels ≥ 110 mg/dL, the hazard ratios for coronary heart disease incidence were higher in women than in men compared with women and men with fasting glucose levels <80mg/dL, respectively. There was no association between impaired fasting glucose from 100 to 109 mg/dL and risk of coronary heart disease neither in men nor in women.

Conclusions:
The stronger impact of fasting serum glucose levels on relative risk of coronary heart disease in women compared with in men was significant from impaired fasting glucose levels ≥ 110 mg/dL.

Adjusted Hazard Ratios (HRs) for Coronary Heart Disease by Fasting Serum Glucose Levels
Abstract 489: JTV-519 (K201) Reverses Abnormal Ca
2+
Release And Dynamic Ca
2+
Waves In Purkinje Cells From The Infarcted Canine Heart
Authors: Hirose Masanori , Stuyvers Bruno , Dun Wen , Shimokawa Hiroaki , Keurs Henk EDJ ter , Boyden Penelope
Published: July 2021

JTV-519 (K201) has been shown to be anti-arrhythmic in the ischemic/reperfusion setting. The mechanism is unknown.

Purpose:
To investigate the effects of JTV-519(K201) (Aetas Pharm Co.) in Purkinje cells dispersed from the subendocardium of the 48hr infarcted canine heart (IZPCs). IZPCs are the source of the triggered ventricular arrhythmias that occur at this time post coronary artery occlusion.

Methods:
Ca
2+
release events (elevations of basal [Ca
2+
] equivalent to F/F
0
3.4 SD over F
0
) in both intact and permeabilized single IZPCs were imaged using 2DCM with Fluo-4 and analyzed using a custom IDL program.

Results:
In intact IZPCs, the Ca
2+
release event (ev) rate was increased in the Subsarcolemmal region (SSL, a layer of ∼ 5μm thickness below the membrane; 0.0161±0.0031 ev/μm
2
/sec, n=cells=30, 1198 ev) but not in the Core region, when compared to normal Purkinje cells (NZPCs; SSL, 0.0089±0.0018 ev/μm
2
/sec, n=34, 747 ev, p<0.05). SR Ca
2+
ontent as estimated by rapid caffeine (20mM) application was comparable between NZPCs and IZPCs in both subcellular regions. Superfusion of JTV-519(K201) (1μM) normalized the SSL Ca
2+
event rate in intact IZPCs (to 0.0086±0.0016 ev/μm
2
/sec, n=17, 510ev, p<0.05 vs untreated IZPC value) without a change in SR Ca
2+
content. The incidence of spontaneous Ca
2+
waves is increased in intact IZPCs (0.0016/μm
2
/sec*1000, n=57) and was also normalized by JTV-519(K201)(0.0004/ μm
2
/sec*1000, n=30). In saponin-treated IZPCs ([Ca
2+
]
cyto=
100nM), JTV-519(K201) normalized the enhanced Ca
2+
event rate (from 0.0246±0.0030 ev/μm
2
/sec, n=28 to 0.0110±0.0023 ev/μm
2
/sec, n=7, P<0.05).

Conclusion:
In Purkinje cells that survive in the infarcted heart, the enhanced subcellular Ca
2+
event rate is due to enhanced Ca
2+
induced Ca
2+
release. This leads to cell wide Ca
2+
waves and arrhythmias. By normalizing Ca
2+
sensitivity of Ca
2+
release channels of IZPCs, JTV519(K201) reduces the spontaneous Ca
2+
event rate, the incidence of Ca
2+
waves and thus the likelihood of infarct Purkinje cell induced triggered arrhythmias.
Abstract 3713: Five Year Follow Up Of The Pci Vs. Exercise Training In Stable Coronary Artery Disease-Pilot Trial (Pet-pilot)
Authors: Möbius-Winkler Sven , Walther Claudia , Linke Axel , Erbs Sandra , Gielen Stephan , Lenk Karsten , Hambrecht Rainer , Schuler Gerhard C
Published: July 2021

Coronary revascularisation by percutaneous techniques is widely used in the treatment of patients (pts) with coronary artery disease (CAD). Among non-pharmacological therapeutic options for pts with stable CAD, regular physical exercise training (ET) is known to improve functional work capacity, myocardial perfusion and the 1 year event free survival rate. Aim of this study was to compare stent angioplasty (SA) with a conservative strategy including daily ET with regard to event-free survival after a 5 year follow up and clinical status.

Method:
101 pts with stable CAD were randomly assigned either to SA or to the ET-group. Pts in both groups received optimised medical standard therapy. Initially and at follow up visits, clinical status was assessed using the Canadian Cardiovascular Society classification (CCS). The primary endpoint was the composite of death from any cause, non-fatal myocardial infarction, cerebrovascular accident, need for any revascularization procedure due to unstable angina pectoris (UA) and hospitalisation due to worsening of angina pectoris.

Results:
The event free survival rate for the combined primary endpoint was 63 % (32 patients out of 51) in the exercise training group and 40% (20 patients out of 50) in the stent group (p=0.037) . Within the five years of follow up, 36 cardiovascular events occurred in 19 patients of the training group as compared to 55 cardiovascular events in 30 patients of the stent group.

Conclusion:
At long-term follow up of 5 years, daily exercise training additionally to a optimal medical treatment in stable CAD patients leads to a better event free survival rate compared with stent angioplasty.
Abstract 3727: Meeting Quality of Care Goals for Hypercholesterolemia: Understanding Deficiencies for Women and Black Men Compared With Non-Black Men
Authors: Turner Barbara J , Hollenbeak Christopher S , Weiner Mark G , Roberts Craig S
Published: July 2021

BACKGROUND: CAD risk reduction requires maintaining LDL cholesterol (LDL) below NCEP goals. We examined time to LDL control for women and black men versus non-black men and examined the role of demographic, clinical, or health care factors in observed differences.

METHODS: Among 35,165 patients at 6 academic primary care practices from 1/1/03 to 2/8/05, we used electronic medical records to identify 11,536 patients at increased risk of CAD due to hypertension (HTN) and age (>45 if male and >55 if female) and an LDL from 1/1/00 to 2/28/05. For 6,497 patients (56%), the last LDL was high (i.e., ≥130 mg/dl or high risk ≥100 mg/dl) before or at the start of our timeframe. We studied 5,146 patients with 2+ visits after that LDL and complete data. Hazard ratios (HR) for the outcome - LDL control - came from survival (Cox) models with censoring 6 months after the last visit or the study end if no LDL control. Models adjust for demographics (age, income, insurance), clinical factors (discordant comorbidities such as asthma, concordant comorbidities such as CAD, smoking, obesity, LDL level), health care (N of HTN drugs, visits/month, provider gender, race, type, annual patient workload), and time from high LDL to next visit in study timeframe.

RESULTS: 47% of the cohort had LDL control within two years. Median days (d) to LDL control were: 456 d for non-black men (N=1,058); 627 d for non-black women (N=1,563); 698 d for black men (N=1,114); and 828 d for black women (N=2,164) (p<0.001). Compared to non-black men, adjusted HRs of LDL control were still lower for: non-black women (0.73, CI 0.64–0.82), black men (0.73, 0.63–0.85), and black women (0.59, CI 0.51–0.67). LDL control was positively associated with discordant comorbidities, anti-HTN drugs, age 61–80 vs <50, and shorter time from high LDL to next visit. Low income, Medicaid/uninsured vs commercial insured, and very high baseline LDL were negatively associated.

CONCLUSIONS: Among HTN patients at increased risk of CAD, time to LDL control was significantly longer for all women and black men than non-black men and not due to many patient and health care factors. Access to and acceptance/persistence with lipid-lowering medication likely contribute to these important disparities in CAD risk reduction.
Abstract 3745: Asymmetric Dimethylarginine and Mortality after Acute Myocardial Infarction
Authors: Zeller Marianne , Korandji Claudia , Guilland Jean-Claude , Sicard Pierre , Vergely Catherine , Beer Jean-Claude , Duvillard Laurence , Lagrost Anne-Cecile , Moreau Daniel , Gambert Philippe , Cottin Yves , Rochette Luc
Published: July 2021

Background
. From a prospective cohort of patients with acute myocardial infarction (MI), we aimed to analyse the predictive value of ADMA concentrations on mortality at 1 year follow-up. ADMA is an endogenous competitive inhibitor of NO synthases.

Patients
. Blood samples from 204 consecutive patients hospitalised for acute MI < 24 hr were taken on admission. Serum levels of ADMA, its stereoisomer, symmetric dimethylarginine (SDMA), were determined using high-performance liquid chromatography and fluorescence.

Results
. The mean (SD) ADMA level was 1.07(0.37) μmol/L. ADMA was positively related to age, homocysteine, SDMA and L-arginine. The glomerular filtration rate (GFR) showed a trend toward an inverse relation with ADMA. ADMA concentrations showed a trend towards a higher level in women than in men (p=.101) and were lower in current smokers vs past or non smokers (p=0.022). Baseline ADMA and SDMA levels were higher in patients who had died than in patients who were alive at 1 year follow-up (respectively 1.22(1.06–1.54) vs 0.98(0.78–1.24), p=0.012 and 0.77(0.54–1.03) vs 0.47(0.35–0.64), p<0.001). By Cox stepwise multivariate analysis, high levels of ADMA were one of the strongest predictors for mortality (HR(95%CI), 6.63(2.55–17.21)), even when adjusted for potential confounders, such as biological and clinical factors, and reperfusion. In contrast, SDMA failed to independently predict the outcome (HR(95%CI): 1.88(0.33–10.70).

Conclusion
. Our study suggests that measurement of ADMA levels at baseline improves cardiovascular risk prediction after acute MI, beyond traditional risk factors and biomarkers. ADMA may thus constitute a novel and useful marker for risk stratification in acute MI.
Abstract 3760: Thiazolidinediones Do Not Reduce 1 Year Event Rates In Diabetic Patients Undergoing Percutaneous Coronary Intervention
Authors: Sheikh Abdul , Pohlel Khan , Veledar Emir , Vaccarino Viola , Douglas John S , Ghazzal Ziyad
Published: July 2021

Background:
Thiazolidinediones (TZD) have been shown to decrease intimal hyperplasia by intravascular ultrasound after coronary stenting. However, a recent meta-analysis showed increased MI and suggested increased CV deaths with TZD use. We examined the impact of TZD use on the 1-year clinical outcomes of diabetic patients undergoing percutaneous coronary interventions.

Methods:
From 2000 through 2003, 598 diabetic patients underwent percutaneous coronary intervention at Emory University. Medication profiles were available for all patients who were divided into two groups: those that had a TZD as part of their diabetes regimen and those that did not. We compared the baseline clinical characteristics, angiographic characteristics, and 1 year rate of a composite endpoint of death, myocardial infarction, and revascularization between the two groups.

Results:
There was no difference between the two groups with regards to age, sex, baseline medical conditions, medication regimens, and overall glycemic control at the time of percutaneous coronary intervention. The lesions in both groups were of similar length, diameter, and characteristics. At 1 year the composite of death, non-fatal myocardial infarction (MI), and revascularization was not statistically different in the diabetics taking TZDs compared to those not taking TZDs (28.5% vs. 23.2%, p=0.15). There were also no differences in the rates of death and non-fatal MI. There was however a statistically significant increase in the rate of revascularization in diabetics taking TZDs compared to those not taking TZDs (25.4% vs. 17.3%, p=0.02).

Conclusion:
Diabetic patients undergoing coronary stenting who were on TZDs had a statistically significant increased rate of revascularization. However, there was a similar rate of the combined endpoint of death, non-fatal MI, and revascularization in all diabetic patients irrespective of TZD usages.
Abstract 3778: Racial and Ethnic Differences in Cardiac Resynchronization Therapy Outside of Published Guidelines
Authors: Farmer Steven A , Kirkpatrick James N , Heidenreich Paul A , Curtis Jeptha P , Wang Yongfei , Groeneveld Peter W
Published: July 2021

Objective
Ethnic and racial disparities in cardiac care may partially result from over-provision of care among white patients. We hypothesized that whites were more likely than blacks and Hispanics to receive cardiac resynchronization therapy with defibrillator (CRT-D) devices outside of ACC/AHA/HRS guidelines.

Methods
We analyzed 01/2005– 04/2007 data from the ACC-National Cardiovascular Data Registry for implantable cardioverter-defibrillators (ICDs). We identified white, black and Hispanic patients who received CRT-D. We then fit a multivariable hierarchical logistic regression model with full ACC/AHA/HRS guideline concordance (QRS duration >=0.12 ms, LVEF <<26>35%, and class III or IV CHF) as a binary outcome. Independent variables included race/ethnicity, age, gender, cardiomyopathy etiology, duration of CHF, LVEF, blood pressure, QRS duration/morphology, prior coronary revascularization, atrial fibrillation, cerebrovascular disease, hypertension, diabetes, renal failure, and pulmonary disease.

Results
Of 108,341 registry patients, 39,088 CRT-D recipients were selected, including 33,310 (85%) non-Hispanic whites, 3,963 (10%) non-Hispanic blacks, and 1,815 (5%) Hispanics. Among all CRT-D recipients, univariate analyses indicated 9,430 (24%) patients lacked 1 CRT-D criterion, 1,840 (5%) patients lacked 2 criteria, and 217 (1%) patients lacked all 3 criteria. Specifically, 2,271 (6%) had an LVEF >35%, 6,758 (17%) had class I/II CHF, and 4,732 (12%) had a QRS duration <0.12 ms. In multivariate analyses, blacks (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.04 –1.23; p=0.004) and Hispanics (OR 1.10, 95% CI 0.97–1.24; p=0.13) were more likely to meet all 3 CRT-D eligibility criteria than non-Hispanic whites.

Conclusions
After multivariate adjustment, we observed greater guideline-concordant use of CRT-D among blacks and Hispanics than among non-Hispanic whites. Although it is possible that patients receiving CRT-D outside of published guidelines had other compelling clinical findings unrecorded in the registry, such as echocardiographic evidence of dyssynchrony, our findings suggest that racial and ethnic differences in CRT-D partially may be due to over-provision of this technology among white patients.
Abstract 3783: Antihypertensive Medications in the Department of Veterans Affairs (VA) 1999–2006
Authors: Lopez Julio R , Wong Sonya , Meier Joy L , Cunningham Fran , Siegel David
Published: July 2021

Objective: To evaluate national antihypertensive medication use we collected data from 2003–2006 and compared it to previously collected data from 1999 –2002. We examine the cost implications of shifts in antihypertensive medications prescribed.

Methods: National VA pharmacy data were used to determine the use of beta blockers (BB), calcium channel blockers (CCB), thiazide diuretics (TD) alone or with K sparing diuretics, angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and combinations of the aforementioned classes for 2003–2006. Total number of treatment days, determined from days supply of the prescription, was used to determine patterns of use over time.

Results: Antihypertensive medication use in the VA represented more than 1.5 billion days in 2006 and increased 2.5 fold from the 577 million estimated for 1999. ACEI were most commonly used, representing 31.8% and 31.7% of treatment days in 1999 and 2006, respectively. In the ACEI class lisinopril is the most commonly used drug. Increases in use from 1999 to 2006 were 21.2% to 25.2% for BB, 14.4% to 17.8% for TD, and 1.2% to 5.2% for ARB. Decreases in use from 1999 to 2006 were 26.7% to 17.6% for CCB. The decline in CCB was inversely correlated to the increase in BB or TD (p<0.001). Shifts in medication use are estimated to save the VA $33 million annually.

Conclusions: ACEI remain the most prescribed antihypertensive drug class in the VA, followed by BB, TD, CCB, and ARBs. TD use shows a slow steady increase while CCB use continues to decline. These findings suggest that VA has increasing adherence to JNC7 and VA HTN guidelines.
Abstract 3785: Red Wine Consumption Increases Circulating Endothelial Progenitor Cells and Improves Endothelial Function in Obese Type II Diabetics
Authors: Seck Catherine L , Mueller-Ehmsen Jochen , Kreuter Gerhard , Hauser Karl-Heinz , Braun Daniela , Moog Karin , Scheid Christoph , Schneider Thorsten , Flesch Markus
Published: July 2021

Objective: Cardiovascular risk factors are associated with decreased levels of circulating progenitor cells (CPC). The aim of this study was to determine whether the moderate consumption of red wine leads to an increase of CPCs.

Methods: CD34 positive and CD133/CD34 as well as CD117/CD34 double positive cells were measured by FACS analysis in peripheral blood of 15 obese patients suffering from type II diabetes with stable oral drug treatment (67.3 ± 2.3 years, BMI 32.3 ± 0.5 kg/ m
2
) prior to and after a six week period of drinking two units (300 ml) of red wine (Lemberger Classic, Württemberg, Germany). The drinking period was anticipated by a four week fasting period, in which no alcohol consumption was allowed at all. In addition, brachial artery flow mediated dilatation was determined prior to and after the drinking period.

Results: The six week drinking period had no effect on BMI, systolic and diastolic blood pressure, blood glucose levels, HbA1c-values and liver enzymes. There was a non-significant drop in LDL cholesterol, but no change in HDL cholesterol. Concerning CPCs, the following alterations were observed: CD34+ cells increased from 171 ± 22 to 354 ± 28 per million leucocytes. Within the CD34+ cells, the percentage of CD133+ cells increased from 30.8 ± 5.7 % to 53.1 ± 3.3 %, and the percentage of CD117+ cells increased from 38.1 ± 5.8 % to 57.5 ± 4.6 % (p<0.05 for all parameters). Brachial artery flow mediated dilatation increased from 5.57 ± 0.74 % to 11.13 ± 1.34 % (p<0.05) in response to six weeks of red wine consumption. Nitroglycerin mediated brachial artery dilatation increased from 7.45 ± 1.09 % to 11.31 ± 1.09 % (p<0.05).

Conclusion: In obese patients suffering from type II diabetes, moderate consumption of red wine leads to a significant improvement of circulating progenitor cell count and endothelial function. No adverse effects of wine consumption on metabolic and cardiovascular parameters were observed.
Abstract 3786: Exercise Capacity is Associated with Lower Mortality Risk in African-Americans than Caucasians with Type 2 Diabetes
Authors: Kokkinos Peter , Myers Jonathan , Kokkinos John Peter , Pittaras Andreas , Manolis Athanasios , Nylen Eric , Abella Joshua , Hsu Leon , Narayan Puneet , Jacob Roshney , Singh Steven
Published: July 2021

Introduction
: Exercise capacity is inversely associated with mortality in healthy and diabetic individuals. African-Americans have a higher prevalence of type 2 diabetes and overall mortality compared to Caucasians. Moreover, there is evidence that African-American diabetics have lower exercise capacity than Caucasians. Consequently, increased exercise capacity may affect African-Americans differently. To test this hypothesis, we assessed relationships between exercise capacity and mortality in African-American and Caucasian diabetics.

Method:
African-American (n=1,449; age=60 ± 10) and Caucasian (n=760; age=61 ± 10) male diabetics underwent a routine exercise test. Peak workload was estimated as metabolic equivalents (METs). We categorized those who achieved ≤ 5 METs as Low-Fit, 5.1– 8 METs as Moderate-Fit and >8 METs as High-Fit. The follow-up period was 6.5 ± 4.7 years.

Results:
There were 396 (27%) deaths in African-Americans and 141 (18.5%) in Caucasians. After controlling for age, BMI, traditional risk factors and medications, the risk for mortality was higher in African-Americans than Caucasians (RR=1.27; CI: 1.0 –1.5; p=0.018). Exercise capacity was the strongest predictor of risk for mortality for both races. For every 1-MET increase in exercise capacity we observed 15% lower mortality for the entire cohort (RR=0.85; CI: 0.81– 0.90; p<0.001), 16% lower in African-Americans (RR=0.84; CI: 0.78 – 0.89; p<0.001) and 13% lower in Caucasians (RR=0.87; CI: 0.79 – 0.97; p=0.013). When compared to the Low-Fit individuals, the mortality risk for African-Americans was 46% lower for those in the Moderate-Fit (RR=0.54; CI: 0.43– 0.67; P<0.001) and 50% lower for those in the High-Fit category (RR=0.50; CI: 0.33– 0.75; p<0.001). For Caucasians, the mortality risk was lower only for those in the High-Fit category compared to Low-Fit (RR=0.45; CI: 0.23– 0.9; p=0.024) and similar for those in the Low-fit and Moderate-Fit categories (RR=0.74; CI: 0.51–1.0; p=0.10).

Conclusion:
Exercise capacity was the strongest predictor of mortality in both African-American and Caucasian men with type 2 diabetes. The exercise capacity necessary for a similar reduction in mortality risk was notably lower for African-Americans than Caucasians.
Abstract 3795: Readjusting The Catabolic-anabolic Balance In Heart Failure: Beneficial Effects Of Physical Exercise On Protein Catabolism In The Skeletal Muscle
Authors: Gielen Stephan , Sandri Marcus , Adams Volker , Mangner Norman , Erbs Sandra , Linke Axel , Hambrecht Rainer , Schuler Gerhard
Published: July 2021

Background: Progressive muscle wasting frequently occurs in the course of chronic heart failure (CHF) and has recently been identified as independent predictor of mortality in clincal studies. However, the molecular mechanisms that mediate muscle catabolism are still largely unknown and no specific pharmacological agents are available to antagonize the loss of muscle mass. We therefore tested the potential of an established anabolic intervention, i.e. exercise training, to prevent cytokine-induced ubiquitin-proteasome-mediated protein degradation in the skeletal muscle of stable patients with advanced CHF.

Methods: 43 CHF-patients and 41 healthy subjects (HS) were prospectively randomized to 4 weeks of supervised bicycle ergometer training at 70% of the heart rate reserve 4 times 20 min/day or to a control group (C). Before and after the intervention a spiroergometry, echocardiography, and skeletal muscle biopsy from the vastus lateralis muscle were performed. Expression of TNF-alpha and the E3 ligase Murf-1, which tags proteins for degradation via the ubiquitin-proteasome system, were quantified by real-time PCR standardized for 18S-rRNA.

Results:

In CHF patients (age 60.3 ± 2.9 years, BMI 28.9 ± 1.7, LV-EF 27.4 ± 1.7%): training increased VO2max from 14.9 ± 3.3 to 18.1 ± 4.7 mL/min/kg (p<0.01 vs. C), and LV-EF from 26.8 ± 4.6 to 33.1 ± 5.5% (p=0.001 vs. C). At baseline Murf-1 expression was significantly higher as compared to HS. Training decreased Murf-1 expression from 0.49 ± 0.21 to 0.22 ± 0.07 rel. units (p<0.05) and TNF-alpha expression from 79 ± 7.1 to 44.7 ± 5.9 rel. units (p<0.001).

In HS (age 64.7 ± 2.7 years, BMI 26.2 ± 0.5, LV-EF 63 ± 0.8%) training increased VO2 max from 20.3 ± 2.1 to 27.9.2 ± 1.3 mL/kg min (p=0.01 vs. C). Murf-1 and TNF-alpha expression remained unchanged versus untrained HS.

Conclusions:

CHF is associated with local inflammatory and catabolic activation in the skeletal muscle as indicated by higher baseline TNF-alpha and Murf-1 levels.

Training cuts the elevated TNF-alpha and E3-ligase expressions by half within only four weeks of intervention.

These findings emphasize the role of training for the prevention of muscle atrophy and may provide a novel explanation for the prognostic benefits of exercise in CHF.
Abstract 19: Effects of Stomach Inflation on Hemodynamic and Pulmonary Function During Cardiopulmonary Resuscitation in Pigs
Authors: Paal Peter , Neurauter Andreas , Loedl Michael , Pehböck Daniel , Herff Holger , von Goedecke Achim , Lindner Karl H , Wenzel Volker
Published: July 2021

Background
: Stomach inflation during cardiopulmonary resuscitation (CPR) is frequent. The purpose of this study was to evaluate effects of different levels of stomach inflation on hemodynamic and pulmonary function during CPR in a porcine model.

Methods:
After 4min of ventricular fibrillation, randomization to 0, 5, or 10L of stomach inflation was performed in 21 piglets. Basic life support CPR was then initiated for 3min, followed by a combination of epinephrine (45mcg/kg) and vasopressin (0.4U/kg) and defibrillation 2min later, and a post resuscitation phase of 30min. Kruskal-Wallis test was used for analysis; results are given as median (range).

Results
: During basic life support CPR, 0, 5, and 10L stomach inflation resulted in comparable coronary perfusion pressure between groups [10 (2–20), 8 (4–35), and 5 (0 –18) mmHg, respectively]. Increasing (0, 5, and 10L) stomach inflation resulted in significantly (P<.05) decreasing static pulmonary compliance [52 (38 –98), 19 (8 –32), and 12 (7–15) mL/cmH
2
O, respectively], and significantly increasing mean airway pressure during mechanical ventilation [14 (12–15), 26 (20 – 66), and 40 (13– 46) cmH
2
O]. Arterial partial pressure of oxygen was significantly higher with 0L when compared with 5 and 10L stomach inflation, but comparable between 5 and 10L stomach inflation [378 (88–440), 58 (47–113), and 54 (43–126) mmHg, respectively]. Similarly, arterial partial pressure of carbon dioxide was significantly lower with 0L when compared with 5 and 10L of stomach inflation [30 (24–36), 41(34 –51), and 56 (45– 68) mmHg, respectively]. Return of spontaneous circulation rates were comparable between groups [5/7 in 0L, 4/7 in 5L, and 3/7 in 10L stomach inflation].

Conclusion
: In this CPR model, increasing levels of stomach inflation had adverse effects on pulmonary, but not on hemodynamic function.
Abstract 23: The Systemic Inflammatory Response Syndrome Following Cardiac Surgery
Authors: MacCallum Niall S , Gordon Sarah E , Quinlan Gregory J , Evans Timothy W , Finney Simon J
Published: July 2021

The systemic inflammatory response syndrome (SIRS) is the leading cause of morbidity & mortality in the critically ill. It is associated with a 50% reduction in 5 year life expectancy. SIRS is defined as 2 of the following criteria: heart rate >90, respiratory rate >20 or pCO
2
<4.3kPa, temperature <36 or >38°C, white cell count <4 or >12 x10
9
/l. These criteria are used to stratify patients for specific therapies & in research to define interventional groups. Cardiac surgery is associated with systemic inflammation. The validity of the SIRS criteria have never been formally evaluated post cardiac surgery. We undertook to describe the incidence of SIRS post cardiac surgery & relate this to outcome.

Methods:
We retrospectively analysed prospectively collected data from 2764 consecutive admissions following cardiac surgery (coronary bypass grafting 1425, valve surgery 763, combined procedure 252, other 324). The number of criteria met simultaneously within 1 hour epochs was recorded for the entire admissions.

Results:
96.4%, 57.9% & 12.2% of patients met at least 2, 3 or 4 criteria respectively within 24hrs of admission. The temperature criterion was least often fulfilled. ICU mortality was 2.67%. Length of stay exceeded 3 days in 18.5% of patients. The capacity of the criteria to predict mortality & prolonged ICU stay is presented in the table

.

Discussion:
Nearly all patients fulfilled the standard 2 criteria definition of SIRS within 24hrs of admission. This definition does not adequately define the subgroup of patients with greater systemic inflammation, mortality or length of stay. Thus, some clinical manifestations of inflammation are very common following cardiac surgery, although not necessarily prognostic. By contrast, the presence of 3 or more criteria was more discriminatory of death & prolonged ICU stay. We propose that 3 or more SIRS criteria is a more appropriate threshold that defines those patients with clinically significant inflammation post cardiac surgery.
Abstract 41: Early Post-Resuscitation Levels of Cytochrome-
c
and Interleukin-6 after Prolonged Porcine Cardiac Arrest
Authors: Salcido David D , Logue Eric S , Suffoletto Brian P , Rittenberger Jon C , Menegazzi James J
Published: July 2021

Background: The identification of serum biomarkers of ischemic injury could provide a means of assessing interventions designed to limit reperfusion injury after return of spontaneous circulation (ROSC). We sought to characterize the early post-ROSC timecourse of two candidate biomarkers of ischemic injury (cytochrome-
c
and IL-6) in a swine model of ventricular fibrillation (VF). We hypothesized that these two biomarkers would be elevated immediately after ROSC.

Methods: Twenty-five mixed breed domestic swine were anesthetized and instrumented with ECG, temperature probe, and aortic and right atrial pressure transducers. VF was induced with a transthoracic shock and untreated for 8 minutes. Then mechanical CPR was done for 2 minutes, before drugs were given (epinephrine, vasopressin, and propranolol) with 3 additional minutes of CPR (first defibrillation attempt at 13 minutes of VF). Blood samples were drawn at the end of instrumentation (i.e. just prior to VF), and at 20, 40, and 60 minutes after ROSC. Samples were centrifuged and serum extracted. Cytochrome-
c
was analyzed via Western immunoblotting. IL-6 was analyzed with ELISA.

Results: No cytochrome-
c
was detected in any animal, at any timepoint through 60 min. IL-6 was similar to baseline levels through 40 min, but was 121% of baseline at 60.

Conclusions: Neither biomarker was elevated immediately after ROSC. Mitochondrial damage (as indicated by the absence of cytochrome-
c
) may be delayed by as much as an hour after ROSC, hinting at a possible therapeutic window for interventions like hypothermia. Likewise, inflammatory cascades (as indicated by IL-6) may not begin immediately post-ROSC, but might by one hour.
Abstract 54: Preliminary Results With The Use Of
Stat
·
Padz
Pacing Electrode For Treatment Of Symptomatic Bradycardia In Emergency Department.
Authors: Gonzalez Maria Margarita , Dallan Luis Augusto , Ramos Rogerio B , Trindade Evelinda , Timerman Sergio , Mansur Antonio P
Published: July 2021

Background:
Since the mid-1980’s transthoracic pacing has been a common temporary treatment for arrhythmias. Present external pacing technology requires the application of both multifunction defibrillation electrodes and separate leads for electrocardiogram (ECG) monitoring. Separate ECG leads are required as the current from the pacing pulse creates artifact in the signal that prevents one from distinguishing between pace-captured and non-captured rhythms when using the defibrillation electrode alone.

Hypotheses:
We hyothezised that Stat·
padz
MWP electrode, a transthoracic electrode that integrates the ECG electrodes into the defibrillation and pacing pad woud be abble to reconize captured and non-captured rhythms in a typical clinical setting of the syntomatic bradycardia.

Methods:
We conducted a prospective study at Emergency Department of a University Hospital. During October 2006 to April 2007, 28 patients with symptomatic bradycardia were include in the study. Comparison between monitoring by conventional electrode and Stat·
padz
MWP electrode was performed. After that was selected Lead II, and adjusted pacing rate and milliamps for the stimulation. Records and comparison of electrical capture was performed with the three lead conventional electrodes and Stat·
padz
MWP electrodes.

Results:
The mean electrocardiographic diagnoses was third degree atrio-ventricular block in 50% of patients, and the principal symptoms were presyncope in 82 %, symptoms of reduced cardiac output in 79% and syncope in 43%. Previous diagnoses were Hypertension in 57%, Chagas’s heart disease in 21%, Valvar heart disease in 14% and Dilated Cardiomyopathy in 18 %. Monitoring of cardiac rhythm, electrical and mechanical capture were obtained in 100 % of patients. The mean energy for capture was 69±18 milliamps. When compared the records of electrocardiographic capture with Stat·
padz
MWP electrode, it was equal than conventional electrodes in 46 % and better in 54 %.

Conclusion:
The Stat·
padz
MWP electrode has the feasibility of recognise capture and non-capture rhythms and to perform pacing function effectively. It presents the possibility of providing rapid treatment in patients with syntomatic bradycardia avoiding monitoring by conventional electrodes.
Abstract 67: Vasopressin impairs Brain, Heart and Kidney Perfusion in Acute Heart Failure
Authors: Müller Stig , How Ole-Jakob , Hermansen Stig E , Myrmel Truls
Published: July 2021

Arginin Vasopressin (AVP) is increasingly used to restore mean arterial pressure (MAP) in various circulatory shock states including cardiogenic shock. This is potentially deleterious since AVP is also known to reduce cardiac output by increasing vascular resistance.

Aim:
We hypothesized that restoring MAP by AVP improves vital organ blood flow in experimental acute cardiac failure.

Methods:
Cardiac output (CO) and arterial blood flow to the brain, heart, kidney and liver were measured in nine pigs by transit-time flow probes. Heart function and contractility were measured using left ventricular Pressure-Volume catheters. Catheters in central arteries and veins were used for pressure recordings and blood sampling. Left ventricular dysfunction was induced by intermittent coronary occlusions, inducing an 18 % reduction in cardiac output and a drop in MAP from 87 ± 3 to 67 ± 4 mmHg.

Results:
A low-dose therapeutic infusion of AVP (0.005 u/kg/min) restored MAP but further impaired systemic perfusion (CO and blood flow to the brain, heart and kidney reduced by 29, 18, 23 and 34 %, respectively). The reduced blood flow was due to a 2.0, 2.2, 1.9 and 2.1 fold increase in systemic, brain, heart and kidney specific vascular resistances, respectively. Contractility remained unaffected by AVP. The hypoperfusion induced by AVP was most likely responsible for observed elevated plasma lactate levels and an increased systemic oxygen extraction. Oxygen saturation in blood drawn from the great cardiac vein fell from 31 ± 1 to 22 ± 3 % dropping as low as 10 % in one pig. Finally, these effects were reversed forty minutes after weaning the pigs form the drug.

Conclusion:
The pronounced reduction in coronary blood flow point to a potentially deleterious effect in postoperative cardiac surgical patients and in patients with coronary heart disease. Also, this is the first study to report a reduced cerebral perfusion by AVP.
Abstract 531: Is Earlier Hepatitis A Associated with Abnormal Hepatic Response to Statin Therapy?
Authors: Sinzinger Helmut , Marchesi Simona , Lupattelli Graziana
Published: July 2021

Hepatic enzyme elevation is low (< 3%) in large statin trials. Elevations are reversible after dose reduction or statin withdrawal. Very rare cases of hepatitis have been reported. No data are available how predisposing risk factors /diseases might influence hepatic statin response. Among the patients suffering from hepatic side effects during statin therapy 896 (477 m, 419 f; aged 31–76 years) admitted with (one or more) elevated hepatic enzyme, anamnestic data on hepatitis A, B, C, hepatic steatosis, alcohol abuse, hepatobiliary problems, abnormal enzymes (GOT, GPT, γGT) were assessed. The prevalence (% vs. % statin use in Austria) was for lovastatin n= 4; 0,2 (0,7), fluvastatin n = 111; 12,4 (14,0), simvastatin n = 297; 33,1 (34,8), pravastatin n = 82; 9,2 (11,8), rosuvastatin n = 69; 7,9 (1,5), atorvastatin n = 333; 37,2 (37,2). Only 41 patients (4,27%) had concomitant muscle complaints (21 cramps, 16 aches, 3 stiffness, 1 weakness), 12 (1,33%) CK elevation, 261 (29,13%) elevated isoprostane 8epiPGF
2α
. Those with muscle complaints had normal CK levels and vice versa. Pretherapeutic findings (more than one possible) were hepatitis A 326 (36,4% !!), hepatitis B 7 (0,8%), hepatitis C 3 (0,3%), hepatic steatosis 141 (15,7%), alcohol abuse 104 (11,6%) and /or hepatobiliary problems 17 (1,9%). Abnormal enzymes GOT 116 (12,9%), GPT 113 (12,6%), γGT 147 (16,4%) persisted for < 1 week. Patients after hepatitis A had significantly (p < 0,001) higher transaminases as compared to the other patients. Withdrawal of the respective statin normalized transaminases within 4 weeks in 129 patients (14,4%), in only 7 elevation persisted for a longer period (up to 7 months). After 1 year all were in the normal range. Transaminase levels due to steatosis hepatis even sometimes showed improvement after statin therapy (mean: −12,7% GOT; −14,1 GPT; −16,0 γGT). Reexposure to another statin compound after a 4 weeks drug free interval caused recurrence of side effects in 87 patients (49 with earlier hepatitis A = 56,3%). Hepatitis A seems to represent a high risk for abnormal liver function response on statin therapy and reexposure to other compounds of this family. The combination of abnormal hepatic response with muscle complaints is very rare.
Abstract 78: Cardiopulmonary and Automatic External Defibrillator handling skills evaluation in lay persons
Authors: Silva Thiago L , Olival Luana D , Quilici Ana P , Gonzalez Maria Margarita , Timerman Sergio
Published: July 2021

Background:
Since the public access of defibrillation law was approved in Sao Paulo city in 2005, it has been increasing the number of lay people who demand for cardiopulmonary resuscitation (CPR) and Automatic External Defibrillator (AED) training courses. According to the law, subway stations should have an AED and 30 per cent of the Agents should be trained in Heartsaver AED. The American Heart Association advises a Basic Life Support (BLS) refresh every two years. However, recent published papers demonstrated a significant decrease in CPR skills only 6 months following a BLS course.

Hypothesis:
we hypothesized that retention of skills in CPR and AED use considerably diminish after 8 month of training in Heartsaver AED course.

Methods:
This is an observational prospective study on the retention of CPR and AED handling skills. Twenty Subway Agents who were previously trained in these maneuvers were evaluated . The evaluation of the skills retention was performed 8 months after the success completion of the first Heartsaver AED course, consisting in a cardiopulmonary arrest simulation in a training mannequin. An experienced Heartsaver AED instructor evaluated the following performed skills:

Check for response;

Activate Emergency Response System and Get an AED;

Open airway;

Check breathing;

Give two breaths;

Perform compressions hard and fast in a correct hands position;

AED operation

Results:
It was observed that the totality of the participants did not fill, at least, one of the requirements of the evaluation: 85% of the participants checked response, 55% asked for help after check response, 45% asked for help at another moment, 45% opened correctly the airway, 30% checked breathing, 50% gave two breathings, 80% performed 30 compressions, 35% performed compressions in a correct frequency and 60% had performed correct chest place CPR. Concerning the AED use, 30% powered the AED in an appropriated manner and 15% correctly attached the pads but 15% removed the pads after the chock.

Conclusion:
The results suggest a possible necessity of a continuous CPR and AED training in view of a significant decreasing in the performance of these skills 8 months following the first training course.
Abstract 94: Difference of Clinical Characteristics of Sudden Cardiac Arrest and Syncope Related to Coronary Vasospasm
Authors: Togashi Ikuko , Sato Toshiaki , Soejima Kyoko , Miyoshi Shunichiro , Tanimoto Koujiro , Yada Hirotaka , Fukumoto Koutaro , Nakamizo Hikaru , Ogawa Satoshi
Published: July 2021

Patients with coronary vasospasm generally have a good prognosis although lethal arrhythmia can result in sudden cardiac arrest (SCA) or syncope. Clinical predictors of SCA related to coronary vasospasm were not clear. We investigated the differences of clinical characteristics and outcome of pts with SCA and syncope related to coronary vasospasm.

Method and results;
Out of consecutive 47 pts with coronary vasospasm, pts presented SCA(n=13) and syncope(n=26) were enrolled in the study. Pts complicated with 5 idiopathic VF/VT and 3 neurally-mediated syncope were excluded. All pts had a normal LV function except 1 pt with ACS. One pt had coronary artery disease. SCA was experienced during first cardiac event in 77% of SCA group, whereas syncope in 31% of syncope group (p=0.04, as shown in Table

). In SCA group, 2 pts resulted in hospital death after DC-resistant VF, 1 pt died suddenly at home after medical-refractory angina. ICD was implanted in 3 survivors. Ca channel blockers were administered in all pts of each group. After discharge of hospital, during a follow-up period of 3.7±4.1yrs, survivors of SCA group did not experience any additional arrhythmic events and all pts of syncope group were alive while 1 pt had recurrent syncope.

Conclusion;
Coronary vasospasm can results in SCA during a first cardiac event. The prognosis of the survivors and pts with a history of syncope may be favorable under good medical control of spasm.
Abstract 99: Differences of B-Type natriuretic peptide and N-terminal pro B-type natriuretic peptide levels in Patients With Cardiogenic Shock
Authors: Buerke Michael , Prondzinsky Roland , Geppert Alexander , Jaral Rudolf , Huber Kurt , Russ Martin , Lemm Henning , Schlitt Axel , Werdan Karl
Published: July 2021

Background B-Type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are frequently used in diagnosing and monitoring patients with heart failure. Recent studies have demonstrated that BNP and NT-proBNP concentrations reflect LV function and prognosis. However, the role of natriuretic peptides in patients with cardiogenic shock is unclear.

Methods. In 40 patients with cardiogenic shock due to acute myocardial infarction treatment with primary percutaneous transluminal coronary angioplasty (PCI) was performed initially with subsequent medical treatment and intraaortic balloon pump (IABP) counterpulsation. Cardiac catheterization was performed in all patients. Creatinine, Creatinine clearance, LVEDP, and survival were determined, and BNP and NT-proBNP obtained at the start, 24, 48 and 72 hours thereafter. Results. BNP was able to detect differences in treatment regarding LV-unloading. Interestingly, NT-proBNP levels were able to differentiate between survivors and non survivors (4590±1230 vs 14370±4886pg/ml, p<0.05). However, there was no significant difference between survivors and non survivors with regard to BNP levels. Clearly, elevated levels of NT-proBNP in patients with cardiogenic shock were more dependent on decreased renal function which might reflect additional organ dysfunction (24965±9567pg/ml vs 7246±2650, p<0.05).

Conclusions In myocardial infarction complicated cardiogenic shock patients concentrations of BNP and NT-proBNP provide additional information. Our data suggest that the cardiac status and improvement upon therapy can be monitored with BNP. However, NT-pro-BNP is a valuable indicator for prognosis in patients with cardiogenic shock.
Abstract 107: Community Public Access Defibrillation Sites: Compliance with American Heart Association Recommendations
Authors: Post Michael J , Cram Peter , Atkins Dianne L
Published: July 2021

Introduction

The Public Access Defibrillation (PAD) Trial demonstrated improved survival of cardiac arrest victims when automated external defibrillators (AEDs) were combined with CPR by lay responders. These PAD sites incorporated American Heart Association (AHA) recommended elements of a PAD site and the volunteer responders received refresher CPR/AED training. It is unknown if typical community PAD sites maintain these elements after initial program development. The Johnson County Early Defibrillation Task Force (JCEDTF) in Johnson County, IA distributed AEDs throughout the county in 2002. CPR training was provided at program initiation. The purpose of this study was to evaluate the PAD sites 5 years later to assess compliance with AHA recommendations.

Methods

A 25 point scoring system was developed to assign numerical values to the components of a PAD site: planned and practiced response, links with local EMS, and training of rescuers. Surveys were mailed to all 39 PAD sites. Site visits with tours were conducted at each the site to confirm the survey. Sites were grouped into educational, community, or business sites.

Results
Thirty two surveys were returned (response rate 82%): 5 educational sites, 13 business and industrial sites and 14 community sites. The Table

shows the percentage of points that each group achieved for the components of an AED program. No site had incorporated all the recommended elements: the best sites included only 2/3 of the recommendations. There was a statistical difference in CPR training, with business and industrial sites performing best. Community sites were particularly weak with CPR training.

Conclusions
PAD sites incorporate approximately half of the elements of an effective PAD program. Business and industrial sites perform slightly better than educational or community sites. CPR training and EMS links are the poorest areas of compliance. These results may indicate that the effectiveness of a PAD site may diminish with time.

Table:

Percentage of Achieved Points