bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 253: Effect of First-Degree Heart Block on Left Ventricular Filling and Hemodynamics
Authors: Jadhav Amar P , Garg Nadish , Shekhar Rahul , Petruc Marius , Fresen John , Aggarwal Kul
Published: April 2024

Background:
First degree heart block (FHB) is considered a benign electrographic finding. However, recent studies have suggested that FHB is associated with excess mortality. In another study PR interval greater than 220msec was associated with increased rate of heart failure hospitalizations. So far, very little is known about the effect of FHB on left ventricular (LV) filling and hemodynamic.

Objective:
To evaluate the hemodynamic effects and LV filling in patients with FHB

Methods:
This was retrospective chart review of 133 patients with and without FHB. The patients were identified from our electrocardiography (EKG) database. All the patients that had both echocardiogram and EKG in 2010 were included for the study. FHB was confirmed with the ekg tracing on the echocardiogram. For LV filling we calculated mitral inflow velocity time integral (MV VTI), by tracing the mitral inflow pulse wave doppler tracing using the standard software. The data was analyzed using the R version 2.12 statistical package. Linear regression analysis was preformed to study the effect of FHB on LV filling. Several linear models were fitted to the data using the PR interval and HR as predictor variables.

Results:
The patients were divided in two groups, PR interval less than and greater than 220. In the patients with PR interval less than 220msec (n=65), LV filling (MV VTI) was noticed to progressively decrease with increase in PR interval (P<0.02) and was unaffected by heart rate (P=0.4). However, in patients with PR interval greater than 220 msec (n=66), LV filling progressively decreased with increase PR interval (P<0.03) and increase in heart rate (P<0.02). Interestingly, it appears that for lower heart rates HR-50 beats per minute ( BPM), increase in PR interval resulted a greater reduction in LV filling as compared to higher heart rate (HR-70 BPM)

Conclusion:
LV filling is adversely affected with increase in PR interval and heart rate. In addition, it appears that lower heart (<50 BPM) in patients with PR interval >260 msec results in more pronounced reduction of LV filling. Patients with PR intervals >220msec might benefit from higher heart rates which needs to be further evaluated.
Abstract 286: Resuscitation After Traumatic Cardiac Arrest
Authors: Gräsner Jan-Thorsten , Meybohm Patrick , Seewald Stephan , Wnent Jan , Fischer Matthias , Paffrath Thomas , Lefering Rolf
Published: April 2024

Introduction
In severe trauma patients with cardiac arrest (CA), pre-hospital CPR is performed infrequently and resuscitation outcome is much worse compared to cardiac causes. The purpose of the present study is to analyze CPR outcome in trauma patients with CA using two large German Registries - the German Resuscitation Registry (GRR) and the Trauma Registry of the German Society for Trauma Surgery (TR-DGU).

Methods
We combined two independent l registries to analyze outcome of trauma patients with CA. The GRR includes patients with pre-hospital CA followed by any resuscitation attempt, whereas the TR-DGU includes patients with severe trauma who reached a hospital alive. Combining both registries may have the potential to enable follow up of patients outcome from scene up to hospital discharge. Individual patients in both registries, however, were not identical.

Results and Conclusions
Within the GRR database data from 368 (2.8%) trauma CA patients were identified out of 13,329 CA patients. Compared to CA patients with cardiac cause (n=8637), trauma patients had a mean age of 51.2 +/-22.4 years (vs. 68.4 +/-15.2 years in cardiac patients, p<0.001), initial return of spontaneous circulation could be restored in 107(29,1%) patients (vs. 3980 (46,1%) in cardiac patients), and 95 (25,8%) trauma patients had ROSC on admission at hospital (vs. 3673 (42,5%) in cardiac patients). Within the TR-DGU resuscitation attempts were reported in 814 trauma patients (3%) out of 27,592 documented trauma patients. The overall in-hospital mortality rate of these trauma CA patients was 72.9% (n=593 of 814). A two-step approach including both registries revealed that 13% survived 24 hours and 2% had good neurological outcome at hospital discharge out of 100% with a pre-clinical traumatic CA. Trauma patients with CA, however, were significant younger than CA patients with cardiac origin. Therefore, starting CPR in each CA patient, irrespective of the primary cause of CA, should be recommended.
Abstract 3: Administration of Injectable Oxygen Suspension Rapidly Reverses Hypoxemia via Intravenous or Intraosseous Route
Authors: Kheir John , Reese James , Black Katie , Scharp Laurie , Velazquez Tony , Danforth Lauren , Cronin Julie , Dowling Catherine , McGowan Francis
Published: April 2024

Introduction.
Hypoxemia contributes to cellular dysfunction and death in a number of critical illness states. We investigated the possibility of rapidly reversing severe hypoxemia using intravenous and intraosseous infusions of lipid-based oxygen microparticles (LOMs).

Hypothesis.
Arterial oxygen tensions will increase during administration of LOMs via the intravenous or intraosseous route in a rabbit model of hypoxic ventilation.

Methods.
We manufactured LOMs from a lipid-based solution and oxygen gas. LOM diameter was determined by light scatter and oxygen content was determined by weight differential of a set volume of suspension. Adult New Zealand rabbits were anesthetized, paralyzed and mechanically ventilated. We placed venous, arterial and intraosseous lines. Hypoxemia was induced by ventilation with 10% oxygen. Following observation for 2 minutes, infusions of LOMs were administered at varying rates over a 2 minute period via either intravenous (n=5) or intraosseous line (n=9), followed by a 1 minute observation period. Endpoints included oxyhemoglobin saturations by pulse oximetry and arterial blood gas values drawn every 30 seconds. Endpoints during infusions were compared over time using a Friedman test.

Results.
LOM suspensions contained 52.8±3.0 mL of oxygen gas per dL of suspension. Mean particle diameter was 6.42 microns. Oxyhemoglobin saturation by pulse oximeter rose rapidly in a dose-dependent fashion in both intravenous and intraosseous infusions (Fig A). Relative to baseline measures, arterial PO2 (Fig B) and oxyhemoglobin saturation by co-oximeter (Fig C) increased during both IV and IO infusions (PaO2 p<0.0001 IO; SaO2 p<0.05 IV, p<0.0001 IO). There was a non-significant trend that the increase in oxyhemoglobin saturations was delayed in intraosseous infusions relative to intravenous infusions.

Conclusion.
Oxyhemoglobin saturation and oxygen tension can be acutely raised by intravenous or intraosseous infusion of LOMs.
Abstract 39: Intrathoracic Pressure Regulation During and After Cardiopulmonary Resuscitation: A Feasibility Study
Authors: Segal Nicolas , Parquette Brent , Yannopoulos Demetris , Ziehr Jonathon , Lindstrom David
Published: April 2024

Objective:
Reduction of intrathoracic pressures to -10 cm H2O during the decompression phase of cardiopulmonary resuscitation (CPR) increases cardiac preload, lowers intracranial pressures, and increases circulation and survival rates in pigs undergoing standard CPR. In this proof of concept study, we tested the hypothesis that augmentation of negative intrathoracic pressure during standard (S) CPR with intrathoracic pressure regulation (IPR) providing continuous negative intrathoracic pressure of -10 cm H2O between positive pressure ventilations will improve circulation, using end tidal (ET) CO2 as a non-invasive surrogate of organ perfusion, in patients receiving S-CPR.

Methods:
In this first clinical evaluation of IPR (CirQLatorTM, Advanced Circulatory Systems Inc, Roseville, MN) paramedic supervisors in Toledo OH performed CPR, applied IPR in 12 adult patients, and measured ETCO2, blood pressure and O2 saturation upon return of spontaneous circulation (ROSC) rates. IPR was continued after ROSC to help maintain perfusion. Values are expressed as mean ± SEM and statistical significance was determined by a paired Student's t-test. ETCO2 and blood pressure are expressed in mmHg.

Results:
IPR was used together with S-CPR to treat cardiac arrest in 12 patients: mean age 64 ± 3; 4 were male and the initial recorded rhythms were ventricular fibrillation (n=2), pulseless electrical activity (n=3), and asystole (n=7). Time from the initial 911 call to IPR application was 16±1 min. Initial ETCO2 when IPR was applied was 21± 3. Maximum ETCO2 during CPR was 44 ± 4, (p < 0.001 compared with initial ETCO2). There was ROSC in 9/12 patients: 3 patients with asystole did not have ROSC. Time from IPR application to ROSC was 16 ± 3 minutes. Systolic/diastolic blood pressures immediately after ROSC were 126 ±13/72 ± 8. O2 saturation at ROSC was 96 ± 1%. IPR was used in 8/9 patients post ROSC for 8 ± 3 min. There were no observed adverse events.

Conclusion:
Clinical application of IPR during CPR increased ETCO2 values and resulted in ROSC in 9/12 patients, providing first clinical proof-of-concept that this new non-invasive technology increases circulation during CPR. Based upon these positive data, further study of IPR in patients in cardiac arrest is warranted.
Abstract 48: Incidence, Outcome and Characteristics of Cardiac Arrest at Schools
Authors: Nishiuchi Tatsuya , Hayashino Yasuaki , Fukuhara Shunichi , Iwami Taku , Kitamura Tetsuhisa , Hayashi Yasuyuki , Kajino Kentaro , Hiraide Atsushi , Mizobata Yasumitsu
Published: April 2024

Background
Although automated external defibrillators (AEDs) are widely prevalent in public places in Japan, the impact of implementing AEDs at schools remains unclear.

Objectives
To clarify the incidence, outcomes, and characteristics of out-of-hospital cardiac arrest (OHCA) at schools.

Methods
The Utstein Osaka Project is a population-based cohort study aimed at identifying the incidence and outcomes of OHCA in Osaka (population of 8.8 million), Japan. From the data collected according to the Utstein Recommendations, we extracted cases of OHCA at schools between Jan. 1, 2005 and Dec. 31, 2009. In this study, the term “school” included all educational institutions defined by the Japanese School Education Act. Primary outcome measures were one-month survival and good neurological outcome, as defined as Cerebral Performance Category 1 or 2.

Results
During the study period, 34 cases of non-traumatic OHCA occurred at schools among the total of 33,901 registered OHCA cases. Of these 34 cases, 14 (41%) patients achieved one-month survival and 11 patients (32%) had good neurological outcome. A total of 23 (68%) patients, which consisted of 10 students, 4 school officials, and 9 adults not affiliated with schools, presented ventricular fibrillation (VF) as the first monitored rhythm. Of the patients presenting with VF, 12 (52%) survived one month after cardiac arrest and 10 (43%) had good neurological outcome. Twelve of the patients had a history of cardiac disease, with seven collapsing during physical exercise. An additional five patients without a history of cardiac disease experienced OHCA with VF during exercise. Citizen rescuers applied AED pads to ten patients and administered electrical shocks to five patients, with three of these patients surviving without neurological deficits.

Conclusions
Approximately 70% of the OHCA patients at schools presented VF as the first monitored rhythm. Most were students or adults with either a past history of cardiac disease or who were performing physical exercise. The characteristics of OHCA cases revealed in this study should be taken into consideration when creating and implementing medical emergency response plans for cardiac arrest at schools in Japan.
Abstract 13460: Sca-1 Identifies a Monocyte-predisposed Hierarchy Of Hematopoietic Progenitor Cells In The Postnatal Murine Aorta
Authors: Psaltis Peter J , Harbuzariu Adriana , Delacroix Sinny , Witt Tyra , Kleppe Laurel , Mueske Cheryl , Gulati Rajiv , Sandhu Gurpreet S , Simari Robert D
Published: April 2024

Peter J. Psaltis, 2011 Finalist and Presenting Author
Abstract 14193: Dynamin-Related Protein 1 (DRP1)-Mediated Mitochondrial Fission Promotes Smooth Muscle Cell Hyperproliferation in Human and Experimental Pulmonary Hypertension Which Can be Therapeutically Targeted by the Fission Inhibitor MDIVI-1
Authors: Marsboom Glenn , Toth Peter T , Hong Zhigang , Wu Xichen , Fang Yong-Hu , Thenappan Thenappan , Zhang Hannah J , Bache-Wiig Peter , Pogoriler Jennifer , Chen Yimei , Weir E Kenneth , Rehman Jalees , Archer Stephen L
Published: April 2024

Glenn Marsboom, 2011 Finalist and Presenting Author
Abstract 8256: Timing of Perioperative Methylprednisolone and Outcome in Infants Undergoing Heart Surgery
Authors: Pasquali Sara K , Jacobs Jeffrey P , He Xia , Jacobs Marshall L , O'Brien Sean M , Hall Matthew , Jaquiss Robert D , Welke Karl F , Peterson Eric D , Shah Samir S , Gaynor J. W , Li Jennifer S
Published: April 2024

Sara K. Pasquali, 2011 Finalist and Presenting Author
Abstract 13200: The Effect of Cardiopulmonary Bypass Prime Volume On The Need For Blood Transfusion After Pediatric Cardiac Surgery
Authors: Richmond Marc E , Charette Kevin , Chen Jonathan M , Quaegebeur Jan M , Bacha Emile
Published: April 2024

Marc E. Richmond, 2011 Finalist and Presenting Author
Abstract 17353: Effectiveness and Safety of Digoxin in Adults with Incident Systolic Heart Failure
Authors: Freeman James V , Yang Jingrong , Hlatky Mark A , Go Alan S
Published: April 2024

James V. Freeman, 2011 Finalist and Presenting Author
Abstract 12029: A Case of Nestled Rings - Micro and Macroscopic Cardiac Dysfunction in a 46 Year-Old Male with Progressive Heart Failure
Authors: Chorba John S , Yeghiazarians Yerem , McGlothlin Dana , Rao Rajni
Published: April 2024

John S Chorba, 2011 Finalist and Presenting Author
Abstract 15448: Blood Monocyte Recruitment in Microvascular Obstruction and Intramyocardial Hemorrhage: New Insights from Fluorine-19 Cellular Magnetic Resonance Imaging in Experimental Reperfused Myocardial Infarction
Authors: Ye Yuxiang , Basse-Luesebrink Thomas C , Arias-Loza Paula-Anahi , Kocoski Vladimir , Kampf Thomas , Gan Qiang , Bauer Elisabeth , Sparka Stefanie , Helluy Xavier , Hu Kai , Biovin Valerie , Hiller Karl-Heinz , Jakob Peter M , Jahns Roland , Bauer Wolfgang R
Published: April 2024

Yuxiang Ye, 2011 Finalist and Presenting Author
Abstract 16598: Regular Exercise Training Reduce Coronary Restenosis after Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction
Authors: Kim Jeong Hoon , Kim Byung Ok , Byun Young-Sup , Cho Sungwoo , Goh Choong Won , Ahn Hyo Seung , Rhee Kun Joo , Lee Hye Young , Chang Ji Min , Kim Chul
Published: April 2024

Hye Young Lee, 2011 Finalist and Presenting Author
Abstract 15615: Outcomes of Catheter Ablation of Ventricular Tachycardia in Patients with Arrhythmogenic Right Ventricular Dysplasia
Authors: Philips Binu , Madhavan Srinivasa , James Cynthia , Tichnell Crystal , Murray Brittney , Dalal Darshan , Bhonsale Aditya , Nazarian Saman , Judge Daniel P. , Russell Stuart D. , Abraham Theodore , Calkins Hugh , Tandri Harikrishna
Published: April 2024

Binu Philips, 2011 Finalist and Presenting Author
Abstract 59: Miniaturized Mechanical Chest Compressor for Cardiopulmonary Resuscitation
Authors: Sun Shijie , Chen Wei , Weng Yinlun , Wu Xiaobo , Ye Sen , Weil Max H , Tang Wanchun
Published: April 2024

After cardiac arrest, effective and uninterrupted chest compression provides blood flow to the vital organs and improves the success of CPR. In this study, we investigated the hemodynamic efficacy of a newly developed pneumatically driven miniaturized mechanical chest compressor (MCC) in a porcine model of cardiopulmonary resuscitation (CPR). Our hypothesis was that because of the design of the MCC, it should produce better hemodynamic efficacy with lesser compression depth. Ventricular fibrillation (VF) was induced in domestic pigs weighing between 35 and 36 kg. CPR was initiated after 7 minutes of untreated VF. Animals were randomized to receive mechanical chest compression with either the MCC or the conventional device (Thumper). Both devices provided the same compression rate of 100/min. The initial compression depth was adjusted to achieve a coronary perfusion pressure (CPP) above 12 mm Hg. After 5 minutes of CPR, a single 150J defibrillation (DF) was delivered. If resuscitation was not successful, CPR was continued for 2 minutes before the next DF. The protocol was continued until successful resuscitation or for a total of 15 minutes. All animals were resuscitated except 1 from the Thumper group. During CPR, significantly greater CPP with lesser compression depth was observed in the MCC group (Table). Significantly greater intrathoracic positive (31±6 vs 10±7 mm Hg, p<0.01) and negative pressures (-10±3 vs -3±2 mm Hg, p<0.01) were observed in MCC treated animals. Significantly shorter durations of CPR (5±0 vs 11±4 min, p<0.05) and lesser numbers of DF (1±0 vs 9.8±11, p<0.05) that were required for achieving successful resuscitation were observed in animals treated with MCC. None of the MCC treated animals had rib fracture compared with the Thumper group with an average of 2.75±1.9 rib fractures (p<0.05). MCC substantially improved hemodynamic efficacy and successful of CPR with significantly less injury.
Abstract 6: The Induction of Mild Hypothermia Prevents Acute Respiratory Failure During Endotoxemia in Pigs
Authors: Schwarzl Michael , Seiler Sebastian , Huber Stefan , Steendijk Paul , Mächler Heinrich , Truschnig-Wilders Martini , Pieske Burkert , Post Heiner
Published: April 2024

Background:
Acute respiratory failure is a major component of multi-organ failure during sepsis. The induction of mild hypothermia (MH, 33 °C) reduces whole body oxygen demand and exerts anti-inflammatory effects in experimental settings. We tested the effect of MH on respiratory function during experimental endotoxemia in pigs.

Methods:
Anesthetized pigs (65±2 kg) were acutely instrumented (closed chest) with a series of catheters (Swan-Ganz catheter, left ventricular pressure-volume catheter, intravascular cooling device). Pigs were ventilated in a volume controlled mode at a tidal volume of 10 ml/kg (FiO2 50%). Respiratory rate was adjusted to keep end-tidal pCO2 between 40 and 45 mmHg. Endotoxemia, a model of septic shock, was induced by lipopolysaccharid (LPS) infusion at 0.5 µg/kg/h for 1h and 1 µg/kg/h for further 3h. With the beginning of LPS infusion, pigs were assigned to either normothermia (NT, 38 °C, n=7) or MH (33 °C, n=6) and followed for a total of 8 hours. Data are reported at 8h after onset of LPS-infusion vs baseline. *: p<0.05 vs baseline, †: p<0.05 vs NT.

Results:
Heart rate (bpm) increased in NT (128±6* vs 97±4), but decreased in MH (79±4*,† vs 98±4). Mean aortic pressure (mmHg) decreased to the same degree in NT (53±4* vs 86±2) and MH (58±1* vs 85±2). Whole body oxygen consumption (WB-VO2) increased during LPS infusion in NT but fell markedly in MH (see graph). Respiratory minute volume (RMV) changed accordingly in the two groups. Moreover, arterial oxygen saturation (sO2,art) fell significantly in NT but was almost completely preserved in MH.

Conclusion:
MH prevents acute respiratory failure during endotoxemia. This may relate to (i) reduced systemic oxygen demand with subsequently less mechanical pulmonary stress associated with mechanical ventilation and (ii) a direct anti-inflammatory effect of MH that preserves the lungs capability to oxygenate blood. These data imply that MH may be a therapeutic option for acute pulmonary failure during sepsis.
MicroRNA Regulation of the Pathological Angiogenic Response
Authors: Cheresh David
Published: April 2024

During development, pro- and anti-angiogenic factors orchestrate a complex, dynamic process to allow initial sprouting and invasion, subsequent pruning and remodeling, and finally maturation and survival of blood vessels. However, in pathological conditions such as cancer, diabetic retinopathy, macular degeneration or inflammation the same angiogenic signaling pathways are misregulated and exploited, typically resulting in poorly organized vessels with leaky and tortuous properties. In the last decade, a new class of small non-coding RNA molecules termed microRNAs (miRs) have emerged as key regulators of several cellular processes including angiogenesis.

We recently profiled microRNAs that were regulated upon growth factor activation of human endothelial cells and identified miR-132 as a regulator of pathological neovascularization. We found that miR-132 was highly expressed in activated blood vessels, but was undetectable in normal endothelium. Ectopic expression of miR-132 in endothelial cells increased their proliferation and tube-forming capacity, whereas intraocular injection of an antagomir targeting miR-132, reduced postnatal retinal vascular development in mice. We identified p120RasGAP as a miR-132 target and showed that miR-132 and p120RasGAP are expressed reciprocally during pathological angiogenesis. Our observations in several in vitro and in vivo models suggest that miR-132 acts as an angiogenic switch by suppressing endothelial p120RasGAP expression, leading to Ras activation and the induction of neovascularization, whereas the application of anti–miR-132 inhibits neovascularization by maintaining vessels in the resting state.

In contrast to miR-132, a highly upregulated miR during angiogenesis, we have identified miR-34 as one of the most downregulated microRNAs in response to growth factors. Conversely, miR-34a is highly upregulated during endothelial stress responses. Our observations suggest that miR-34a functions as an ‘apoptomiR’ mediating endothelial cell death during stress by regulating the Notch pathway. Taken together, our data suggests a broad regulatory network of pro and anti-angiogenic microRNAs that target defined pathways to co-ordinate vascular responses in development and disease.
Abstract 65: Defining Lay Bystanders' Knowledge, Attitudes and Beliefs Toward Cardiopulmonary Resuscitation Training and Performance
Authors: Blewer Audrey L , Haley Danielle M , Xu Julie , Dine C Jessica , Leary Marion , Abella Benjamin S
Published: April 2024

Background:
Since less than 30% of lay witnesses to cardiac arrest attempt cardiopulmonary resuscitation (CPR), understanding the public's perception of CPR training and performance is essential to inform future CPR training methods. Little is known regarding layperson perspectives on CPR in context of the 2010 resuscitation guidelines and the development of hands-only CPR.

Objectives:
We hypothesized that bystanders would feel more confident performing CPR when made aware of the new guidelines support for hands-only CPR.

Methods:
Subjects participated in an hour-long semi-structured qualitative interview. The interview script covered general questions designed to understand subject's perspectives on CPR training and performance. Following transcription, all responses were coded and processed using NVivo 9 qualitative analysis software.

Results:
Interviews were completed by 19 subjects, of whom 11% were untrained, 47% had completed a training course within the past 5 years and 42% had completed a course in the past 5+ years. Less than 49% of the subjects could describe when to perform CPR, and those who described using CPR incorrectly confused the lifesaving skill with first aid (64%) or clearing of the airway (27%). Subjects described incomplete training, lack of hands-on practice time (38%) and difficulty with skill retention (21%) as top themes surrounding their previous CPR training. Lack of confidence in CPR skills was a commonly reported theme among 79% of interviewees, despite 41% of these respondents having been trained within 5 years. When asked about hands-only CPR, 74% of the subjects had not heard of the new technique and 68% were unaware of the updated 2010 CPR guidelines. When briefly educated about the 2010 guidelines, 89% felt more confident with performing CPR if they had the option of employing “hands-only” CPR (p<0.01).

Conclusions:
CPR trained individuals lacked confidence and retention of CPR knowledge, and were not aware of hands-only CPR and the 2010 resuscitation guidelines update. When informed about the option for hands-only CPR, individual's self-reported confidence increased significantly. This has implications for future public messaging surrounding layperson CPR and the need to promote hands-only CPR more broadly.
Abstract 68: Trends in Postresuscitation Care: A 7-Year Experience After Implementation of Therapeutic Hypothermia
Authors: Jacobshagen Claudius , Schmidt-Schweda Stephan , Pelster Theresa , Pax Anja , Unsoeld Bernhard , Seidler Tim , Hasenfuss Gerd , Maier Lars S
Published: April 2024

Background:
The 2010 AHA guidelines for CPR emphasize the crucial importance of patient care in the early post-resuscitation period. In particular, therapeutic hypothermia and adequate treatment of the post-cardiac arrest syndrome are of utmost importance.

Methods:
In a single center retrospective registry analysis, the data from all resuscitated patients treated in the cardiology ICU between 2003 and 2009 were evaluated systematically. All data on hemodynamics, respiration, hypothermia, diagnostic and therapeutic procedures and outcome were analyzed.

Results:
436 consecutive post-cardiac arrest patients were included. The proportion of patients treated with mild hypothermia could be increased from 56% (2003) to >80% (2006-2009). >90% of the patients with out-of-hospital arrest (OHA) were cooled. Induction of therapeutic hypothermia could be accelerated significantly (time to <34°C, 2003: 13h 59min, 2005: 6h 30min, 2009: 2:15min). The frequency of using cold infusions and intravascular cooling devices correlated directly with the velocity of cooling induction. The PaO2/FiO2 ratio on arrival at the ICU was 242±23 indicating an acute lung injury (ALI). The comparison of cooled and uncooled patients showed no significant differences in the parameters of respiration (in spite of significantly greater fluid intake in the hypothermia group). However, the cooled patients were significantly longer intubated than the uncooled patients (7.0±0.9 vs. 3.7±1.5 days). In patients treated with hypothermia the LVEF improved significantly from 35.4±0.7% at admission to 40.1±1.1% at hospital discharge. In contrast, in patients not treated with hypothermia there was no significant increase in LVEF. In-hospital mortality was 43%. Despite improvement in cooling measures, there was no significant improvement in the survival rates between 2003 and 2009.

Conclusion:
This registry provides an overview of trends in post-cardiac arrest treatment. By optimizing the post-resuscitation care cooling induction can be accelerated. An acute lung injury is part of the post cardiac arrest syndrome. Hypothermia might improve LVEF recovery in patients with post cardiac arrest syndrome.
Abstract 70: Increased Survival After Extracorporeal Membrane Oxygenation Support in Children with Cardiac Disease
Authors: Chrysostomou Constantinos , Morel Victor O , Kuch Bradley , O'Malley Elizabeth , Yoshida Masahiro , Wearden Peter
Published: April 2024

Background:
In children with cardiac disease ECMO has been used during cardiac arrest unresponsive to conventional CPR (E-CPR), in the cardiac operating room for failure to separate from cardiopulmonary bypass (OR-ECMO) and for low cardiac output syndrome (LCOS-ECMO). Though a life-saving intervention, the so far reported survival after ECMO ranges only from 38-51%.

Methods/Results:
Records of patients with cardiac disease who received ECMO support between 1/2006 - 12/2010 were evaluated. Measured outcomes included hospital and 28-day survival and transition to ventricular assist device (VAD) or transplant. There were 102 ECMO runs in 98 patients (41 E-CPR, 31 OR-ECMO and 26 LCOS-ECMO). Overall hospital survival was 76% and 28-day survival was 78%. In the E-CPR group more non-survivors (NS) had single ventricle (SV) anatomy, higher surgical complexity, persistent lactatemia and CNS injury. In the OR-ECMO, NS had longer ECMO run and worse ventricular function coming off ECMO. In the LCOS-ECMO, more NS had syndromic features, persistent lactatemia, decreased lung compliance and required plasma exchange (Tables 1, 2). The detailed outcomes of the 3 groups are shown in Table 3.

Conclusion:
An increased survival after ECMO support was noted in our patient population with cardiac disease. This increased survival was seen in all 3 groups including the E-CPR group where survival was > 75%.
Abstract 79: Improving the Quality of Cardiopulmonary Resuscitation by Training Dedicated Cardiac Arrest Teams in the Usage of a Mechanical Load-Distributing Device at the Emergency Department
Authors: Ong Marcus E , Quah Joy L , Annathurai Annitha , Tan Kenneth B , Pothiawala Sohil , Koh Zhi Xiong , Fook-Chong Stephanie , Poh Ah Ho , Loy Chye Khiaw , Mohamed Noor Noorkiah
Published: April 2024

Study Objective:
To determine if implementing cardiac arrest teams trained with a sequence protocol in using a load distributing band mechanical CPR device (AutoPulse ZOLL), improves the quality of CPR, as determined by the No-Flow Ratio [NFR] in the 1st 10 minutes of resuscitation. The NFR is a function of compressions to pauses during the CPR cycle.

Methods:
This is a phased, prospective, non-randomized, before-after cohort evaluation. Data collection was from April 2008 to February 2011. There were 100-before and 107-after cases. Continuous video and chest compression data with the Physiocontrol Codestat Suite 7.0, of all study subjects were analyzed. All non-traumatic, collapsed patients older than 18 years old, presenting to the Emergency Department were eligible.

Results:
After implementation, the mean total NFR for the 1st 5 minutes and the next 5 minutes respectively decreased from 0.42 to 0.27 (difference = 0.15, 95%CI 0.10 to 0.19, p<0.005), and from 0.24 to 0.18 (difference = 0.06, 95%CI 0.01 to 0.11, p=0.01). The mean time taken to apply AutoPulse (seconds) decreased from 208.8s to 144.5s (difference = 64.3, 95%C.I, 18.0 to 110.6, p=0.007). Overall, the mean CPR ratio, which is the percentage of time with active CPR in a resuscitation, increased from 46.4% to 88.6% (difference = 42.2%, 95%CI 37.1% to 47.2%, p<0.005) and the mean total NFR for the 1st 10 minutes decreased from 0.33 to 0.23 (difference = 0.10, 95%CI 0.07 to 0.14, p<0.005).

Conclusion:
Implementation of cardiac arrest teams was associated with a reduction in no-flow ratio in the 1st 10 minutes of resuscitation. We recommend that training cardiac arrest teams in a specially sequenced protocol can improve the quality of CPR at the ED.
Abstract 8149: A Prospective Randomized Controlled Trial of the Effects of Vitamin D Supplementation on Cardiovascular Disease Risk
Authors: Gepner Adam D , Ramamurthy Rekha , Krueger Diane C , Korcarz Claudia E , Binkley Neil , Stein James H
Published: April 2024

Background:
Low vitamin D (VitD) status is associated with increased cardiovascular disease risk. Some physicians prescribe VitD supplements for risk reduction, although little data support this intervention.

Methods:
This was a prospective, randomized, double-blind, placebo-controlled trial of healthy, post-menopausal women with serum 25-OH VitD concentrations >10 and <60 ng/ml. They were randomized to receive 2500 IU of VitD
3
or placebo daily for 4 months. Endothelial function was evaluated by ultrasound brachial artery flow-mediated dilation (FMD). Arterial stiffness was evaluated by carotid-femoral pulse wave velocity (PWV) and aortic augmentation index (AIx) using applanation tonometry. High-sensitivity C-reactive protein (CRP) was measured by nephelometry. Changes in these parameters were compared between treatment groups using T-tests and verified by general linear models that adjusted for treatment group, VitD status, and a treatment group x VitD status interaction.

Results:
The 114 subjects were mean (standard deviation) 63.9 (3.0) years old with a 25-OH VitD level of 31.3 (10.6) ng/ml. Low VitD status (<30 ng/ml) was present in 48% and was associated with higher body-mass index, systolic blood pressure, glucose, CRP, and lower FMD (all p<0.05). After 4 months, 25-OH D levels increased by 15.7 (9.3) ng/ml in the treatment group vs. -0.2 (6.1) ng/ml on placebo (p0.10). In multivariable models, there were no significant interactions between treatment group and low VitD status for changes in FMD (p=0.65), PWV (p=0.93), AIx (p=0.97), or CRP (p=0.26).

Conclusions:
VitD supplementation did not improve endothelial function, vascular stiffness, or inflammation in healthy post-menopausal women. This study does not support the use of VitD supplementation to reduce cardiovascular disease risk.
Abstract 8167: MiR-424 Promotes the Differentiation of Monocytes to Macrophages in Patients with Coronary Artery Disease, but Can Be Inhibited by Isoflavone In Vitro
Authors: Li Shao-Hua , Wang Ji-Zheng , Wang Chang-Xin , Jia Lei , Chen Jing-Zhou , Hui Rutai
Published: April 2024

MiR-424 has been demonstrated to inhibit the expression of its target protein Nuclear factor I-A (NFI-A) in monocytes and promote the differentiation of monocytes to macrophages in hemopoiesis. This differentiation is also one of the pivotal steps in atherosclerosis. Whether miR-424 has a potential role in the atherosclerosis has been still unknown. Isoflavone has been proved to be an agonist of PPARγ and play anti-atherosclerotic roles by reducing the level of IL-6 and TNF-α
in vitro
. We assessed the hypothesis that miR-424 might participate the progression of atherosclerosis by inhibiting the expression of NFI-A in monocytes and promoting the differentiation of monocytes to macrophages. Isoflavone might reduce the level of miR-424 in ox-LDL stimulated monocytes to prevent the differentiation of monocytes to macrophages
in vitro
. Totally 50 subjects were enrolled and divided into three groups: acute myocardial infarction (AMI) group, unstable angina (UA) group and control group. The relative expressions of miR-424 and NFI-A in peripheral monocytes were determined.
In vitro
, monocytes from healthy subjects were cultured with ox-LDL or ox-LDL combined with isoflavone to clarify whether isoflavone could inhibit the expression of miR-424 in ox-LDL stimulated monocytes. The relative expression levels of miR-424 were significantly increased in UA (1.38±0.33
vs
1.00±0.21,
P
<0.05) and AMI (3.69±0.92
vs
1.00±0.21,
P
<0.001) groups as compared to controls. The expression of NFI-A was significantly reduced in UA group, even lower in patients with AMI (AMI: 0.17±0.03; UA: 0.62±0.03; Control: 1.00±0.09).
In vitro
, the relative level of miR-424 was significantly increased (5.22±0.75
vs
1.02±0.11,
P
<0.001) in ox-LDL stimulated monocytes but obviously reduced (1.48±0.17
vs
5.22±0.75,
P
<0.01) after isoflavone added. The levels of IL-6 (10.49±2.15 pg/ml
vs
17.92±2.47 pg/ml,
P
<0.01) and TNF-α (42.81±2.62 pg/ml
vs
187.19±7.35 pg/ml,
P
<0.001) were also significantly reduced in ox-LDL combined isoflavone group as compared to ox-LDL alone group. Conclusively, miR-424 promotes the progression of atherosclerosis by inhibiting the expression of NFI-A in monocytes. Isoflavone can inhibit the increased level of miR-424 in ox-LDL stimulated monocytes
in vitro
.
Abstract 8171: Invasive Assessment of Atrioventricular Conduction Changes Following Transcatheter Aortic Valve Implantation with Self-expandable or Balloon-Expandable Prosthesis
Authors: Rollin Anne , Dumonteil Nicolas , Mondoly Pierre , Marcheix Bertrand , Duparc Alexandre , Boudou Nicolas , Lhermusier Thibault , Gautier Mathieu , Tchétché D , Delay Marc , Maury Philippe , Carrié Didier
Published: April 2024

Background:
Atrio-ventricular block (AVB) is one of the complications after transcatheter aortic valve implantation (TAVI), and is more frequent after implantation of a Medtronic CoreValve (MCV) than after implantation of an Edwards Sapien prosthesis (ES). The aim of this prospective study was to quantify and compare by invasive measurement the exact influence of TAVI with MCV or ES valve on atrioventricular conduction.

Methods:
between February 2010 and March 2011, consecutive patients who underwent TAVI with a MCV or an ES valve were included in this prospective, single center study. The His-Ventricle (HV) interval was measured during an electrophysiology study (EPS) before and at least 4 days after the procedure. Patients with pre-existent permanent PM implanted for AVB were excluded

Results:
60 patients were included. 25 (42%) were treated with a MCV, and 35 (58%) with an ES valve. Mean age was 83±6 years, 62% men with no significant difference of baseline clinical, ECG, echocardiographic data, Logistic EuroScore and STS Score between MCV and ES groups. There was no peri-procedural death. HV interval measurement was feasible in all patients. 19 patients (32%) needed implantation of a permanent PM. Indication was persistent complete AVB in 12 patients (20%) and transient high grade AVB in 4 patients (7%). PM implantation was required in 6 patients (17%) with ES valve and 13 patients (52%) with MCV (Odds Ratio: 6.8, [95% CI 1.9-24.8] p<0.01). HV interval remained stable (increased duration ≤5ms) in 10 patients (30%) with ES valve and in 5 patients (20%) with MCV (p: 0. 15). HV interval was prolonged by 10ms or more after procedure in 12 patients (35%) with ES valve and in 17 patients (68%) with MCV (Odds Ratio: 5. [95% CI 1. 5-16.9] p<0.01).

Conclusion:
This study supports the fact that atrioventricular and particularly infrahisian conductive tissue is frequently impaired after TAVI. This damage is more frequent and more severe with MCV compared with ES valve.
Abstract 8221: Cis Regulation of Genes in Human Atria Near SNPs Associated with Atrial Fibrillation and PR Interval
Authors: Chung Mina K , Barnard John , Hanna Peter , Hsu Jeffrey , Tchou Michael , Wirka Robert C , Gore Shamone , Serre David , Smith Jonathan D , Van Wagoner David R
Published: April 2024

Genome-wide association studies have identified genetic variants in 3 regions associated with atrial fibrillation (AF) and in 9 regions associated with PR interval (PR), an AF-related endophenotype. The mechanisms linking these top variants to the AF phenotype remain unknown. Our study aimed to elucidate these mechanisms by associating SNP genotypes in the 12 implicated regions with proximal (cis) gene expression in human left atria (LA) and by examining differential expression of cis genes with atrial rhythm status at time of surgery.

METHODS:
Gene expression (Illumina HT12) and SNP genotypes (Illumina Hap550/610) were measured on LA appendages from 234 cardiac surgery patients. Expression and genotypes were preprocessed using best practices. Probes for the 15 genes closest to the top AF and PR-associated SNPs were adjusted for gender, age, genetic stratification and latent expression factors then regressed on their corresponding cis SNP dosage counts to obtain expression quantitative trait SNP (eSNP) p-values. Similar adjustments were done to obtain differential expression p-values.

RESULTS:
7 significant eSNPs were found from 14 AF/PR SNPs: rs10033464 (p=0.033) and rs17570669 (9.9e-3) with
PITX2
, rs13376333 with
KCNN3
(0.046), rs3807989 with
CAV1
(4.9e-9), rs11897119 with
MEIS1
(2.2e-5),
rs427684
with
C5orf41
(4.6e-4), rs3825214 with
TBX5
(5.0e-3), with rs7660702 marginal for
ARHGAP24
(0.077). rs3807989 and rs11897119 were the strongest among all SNPs within 500 KB of their target gene. 8 out of 13 cis genes showed significant differential expression between the No AF (n=38) and AF Rhythm groups (n=100) or between the AF/In Sinus Rhythm (n=100) and AF Rhythm groups, respectively, with 3 showing both:
CAV1
(2.1e-3,7.0e-11),
TBX5
(0.015,NS),
PITX2
(0.015,NS),
BNIP1
(0.023,0.026),
ARHGAP24
(0.029,2.4e-7),
ZFHX3
(0.053,NS),
CAV2
(NS,7.1e-3) and
C5orf41
(NS,0.025).

CONCLUSIONS:
We have provided evidence that many of the SNPs associated with AF and PR also associate with expression levels of nearby genes in human left atria and that these genes are differentially expressed in AF.
Abstract 8238: Relationship Between Red Blood Cell Omega-3 Fatty Acid Index and Bleeding During Hospitalization for Acute Myocardial Infarction
Authors: Salisbury Adam C , Harris William S , Amin Amit P , Reid Kimberly J , O'Keefe James H , Spertus John A
Published: April 2024

Background:
Omega-3 fatty acids have established cardiovascular benefits, but may also inhibit platelet aggregation and increase bleeding. If this platelet inhibition is clinically meaningful, patients with the highest omega-3 indices (red blood cell eicosapentaenoic plus docosahexaenoic acid), which reflect long-term omega-3 fatty acid intake, should be at the greatest bleeding risk, particularly in the setting of acute myocardial infarction (AMI) when patients are aggressively treated with antithrombotic agents and frequently undergo invasive procedures.

Methods:
We studied 1523 patients from 24 US centers who had their omega-3 index assessed at the time of AMI. The rates of serious bleeding (TIMI major & minor) and mild-moderate bleeding (TIMI minimal) were identified in patients with low (<4%), intermediate (4-8%) and high (>8%) omega-3 indices. We used separate hierarchical modified Poisson models to identify the independent association between the omega-3 index and bleeding adjusting for age, gender, creatinine, heart failure, peripheral arterial disease, cath/PCI, and use of thienopyridines, warfarin, heparin, bivalirudin and GP IIb/IIIa inhibitors. Potential interactions between omega-3 index and antithrombotic medications were tested.

Results:
Omega-3 indices were high in 5.2% of patients, intermediate in 68.0% and low in 26.8%. There were no differences in bleeding across omega-3 index categories. There were also no significant differences in bleeding rates between those on omega-3 supplements and patients who were not (serious bleeding: 14/251 (5.5%) using omega-3 supplements vs. 103/1258 (8.2%) of patients who were not taking omega-3 supplements [p=0.16]; mild-moderate bleeding: 17/251 (6.8%) using omega-3 supplements vs. 67/1258 (5.3%) not taking omega-3 supplements[p=0.42]). There was no multivariable adjusted association between the omega-3 index and either serious (per 2% increase: RR 1.02, 95% CI 0.88-1.18) or mild-moderate (per 2% increase: RR 1.02, 95% CI 0.85-1.22) bleeding. There were no interactions between omega-3 index and antithrombotic medications (all p>0.05).

Conclusions:
We found no relationship between the omega-3 index and bleeding in this large, multicenter cohort of AMI patients.
Abstract 8269: Cysteine Protease Cathepsin K: A New Biomarker in Patients with Atrial Fibrillation
Authors: Fujita Masaya , Cheng Xian Wu , Inden Yasuya , Yoshida Naoki , Kitamura Kazuhisa , Shimano Masayuki , Okumura Kenji , Murohara Toyoaki
Published: April 2024

Background.
The cysteine protease cathepsin K is one of the most potent mammalian collagenases and elastases. It is overexpressed in cardiovascular tissues in response to injury, and is regulated by pro-inflammatory stimuli. Atrial remodeling in atrial fibrillation (AF) involves extensive extracellular matrix (ECM) remodeling that requires collagenolysis and elastolysis. We hypothesized that plasma levels of cathepsin K could be an important biomarker for atrial remodeling in AF patients receiving ablation therapy.

Methods and Results.
We examined a total of 156 subjects with paroxysmal AF (PAF) and 67 with chronic AF (CAF), as well as 21 individuals free from atrial disease. Plasma cathepsin K, interleukin-1β (IL-1β), high-sensitivity C-reactive protein (CRP), intact amino-terminal peptide of procollagen type I (I-PINP, as a marker of collagen type I synthesis), carboxyl-terminal telopeptide of collagen type I (ICTP, as a marker of collagen type I degradation), and lipid protein profiles were measured. Serum cathepsin K levels were significantly higher in patients with AF than in those without AF (AF vs. non-AF: 20.8 ± 3.5 ng/mL vs. 6.1 ± 0.8 ng/mL,
P
< 0.01). Patients with AF had higher levels of IL-1β, CRP, and ICTP than those without AF (
P
< 0.05). After subgrouping the AF patients into those with PAF or CAF, we found that patients with CAF had higher levels of cathepsin K and IL-1β than those with PAF (
P
< 0.05). Although a Spearman's correlation test showed that plasma cathepsin K correlated significantly with IL-1β (
P
< 0.01), ICTP (
P
< 0.05) and left atrial diameter (
P
< 0.05), and correlated weakly with I-PINP (
P
= 0.08), serum cathepsin K levels remained significantly higher in AF patients than in non-AF patients in a multiple linear regression test after adjusting for all of these confounders (P < 0.01).

Conclusions.
Our findings suggest that circulating cathepsin K represents a novel potential marker of atrial remodeling and therapeutic efficacy and that augmented cathepsin K, IL-1β, and ICTP levels could provide an underlying inflammation-induced proteolytic mechanism of atrial remodeling in cases of AF.
Abstract 8298: Cardiac Structure and Function and Mortality in the Oldest Old
Authors: Leibowitz David , Stessman-Lande Irit , Jacobs Jeremy , Cohen Aharon , Ein-Mor Eliana , Stessman Jochanan , Gilon Dan
Published: April 2024

Background:
People over the age of 85 are the world's most rapidly growing age group and have a high incidence of cardiovascular mortality. The prognostic significance of abnormalities in cardiac structure and function in this age group is unclear. The objective of this study was to prospectively determine the prognosis of abnormal cardiac structure and function in an age-homogenous, community-dwelling population of subjects born in 1920-1921.

Methods:
Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Echocardiography was performed with a portable echocardiograph at the subjects place of residence. Standard echocardiographic assessment of cardiac structure and function was performed. 5-year mortality was assessed via a centralized government database.

Results:
502 subjects (235 males, 267 females) were enrolled in the study of whom 107 (21%) died at the time of 5-year follow-up. Subjects who died had significantly higher left atrial volume index (LAVI) (42.3 ± 16.5 mL vs. 36.6 ± 12.5 mL; p < 0.01), and left ventricular mass index (LVMI) (133.1 ± 47.6 vs. 119.8 ± 30.6 g/m2; p < 0.05). Ejection fraction was significantly lower in subjects who died (52.5 ± 11.5% vs. 56.4 ± 9.4%; p < 0.003) however, indices of diastolic function were not significantly different between the two groups (E:e' 13.0 ± 5.3 vs. 12.2 ± 4.9; p = 0.18). these findings remained significant after correction for possible confounders.

Conclusions:
Elevated LAVI and LVMI and decreased systolic function predict 5-year mortality in a community-dwelling population of the oldest old Diastolic dysfunction did not predict 5-year mortality in this cohort.