bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18444: Effects of Cardiac Resynchronization Therapy on Transcardiac Metabolomic Profile and Substrate Utilization
Authors: Dzeja Petras , Nemutlu Emirhan , Xu Yi-Zhou , Zhang Song , Terzic Andre , Cha Yong-Mei
Published: April 2024

Introduction:
Cardiac remodeling in heart failure (HF) is associated with conduction abnormalities and dyssynchrony which results in poorly coordinated contractions precipitating metabolic heterogeneity and energetic inefficiency. Cardiac resynchronization therapy (CRT) improves HF symptoms, ventricular function and overall survival. The aim of this study was to determine the changes in metabolomic profiles and substrate utilization after CRT.

Methods:
18 patients with advanced HF and 7 healthy controls were included in this study. Blood samples were collected from peripheral vein, femoral artery (FA) and coronary sinus (CS) before and 10-min after CRT. Metabolomic profiling of plasma samples were performed using GC/MS and
1
H NMR spectroscopy. Partial Least Squares Discriminant Analysis (PLS-DA) score plots and regression coefficients were used to examine metabolomic profiles.

Results:
HF patients have altered plasma metabolomic profile (Fig. A) with distinct panel of metabolites including free fatty acids (FFA), glycerol, 2-hydroxybutyrate, glycine, succinate and uric acid important in group classification compared to controls. Increased release of fumarate and glycerol-3-phosphate from myocardium in HF indicate mitochondrial and substrate shuttle dysfunction. Immediately after CRT, transcardiac metabolomic profile of plasma from CS shifted to a different state with increased myocardial uptake and metabolism of FFA and decreased release of creatinine indicating improved energetic conditions (Fig. B).

Conclusion:
Metabolomic profiling indicates that CRT improves myocardial substrate metabolism and utilization in patients with advanced HF.
Abstract 209: Evaluation of Quantitative Debriefing After Cardiac Arrest
Authors: Zebuhr Carleen , Sutton Robert , Morrison Wynne , Niles Dana , Boyle Lori , Nishisaki Akira , Meaney Peter , Leffelman Jessica , Berg Robert , Nadkarni Vinay
Published: April 2024

Introduction:
Debriefing after adult cardiac arrest is effective to improve CPR quality and survival outcomes. A rigorous investigation of pediatric resuscitation debriefing programs has not been done.

Objective:
To describe and evaluate a multidisciplinary, peer-led, pediatric cardiac arrest quantitative debriefing (QD) program. We hypothesized that QD would improve knowledge, confidence, and competence to perform high quality pediatric resuscitation.

Methods:
Physician-led 60 minute multidisciplinary QDs were conducted using downloaded data from CPR recording defibrillators/central monitors and forensic engineering analysis. Following each QD, attendees completed a semi-quantitative survey. Eight QD content elements divided,
a priori
, into chest compression (CC) related (e.g. no flow time, CC quality, end tidal CO2, defibrillation) and non-CC related (e.g. communication, rhythm recognition, medications, arrest physiology) categories were evaluated to determine those most useful overall (5- point Likert scale: 1 = very useful / 5 = not useful). Summary scores of each category were then calculated to evaluate their impact on providers' knowledge, confidence, and competence. Analysis by Wilcoxon rank sum test.

Results:
Between June 2010 and May 2011, 6 QDs were completed within 21 ± 13 days of the cardiac arrest. Thirty-four of 50 (68%) front line care providers were able to attend the QD and complete surveys: RN (15%), attending MD (35%), fellow MD (26%), resident MD (9%), ECMO (6%), and RT (9%). Thirty-four (100%) reported improved knowledge and performance; 33/34 (97%) noted improved confidence. QD content had an average overall usefulness score of 1.5 ±1.0. CC related items scored higher than non-CC related items to improve knowledge (1.9 ± 1.1 vs. 1.3 ± 1.2; p<0.02) and performance (2.1 ± 1.1 vs. 1.0 ± 1.2; p<0.01).

Conclusions:
A novel Quantitative Debriefing (QD) program improved self-reported knowledge, confidence, and competence to perform high quality pediatric resuscitation. CC related QD elements were rated more useful than non-CC related elements. Future studies are planned to measure and evaluate actual clinical performance impact of QD programs.
Abstract 237: Favorable Prognosis in Cardiovascular Disease from In-Hospital Cardiac Arrest Developed Within 48 Hours of Hospital Admission: From the Japanese Registry of CPR for In-Hospital Cardiac Arrest (J-RCPR)
Authors: Sasaoka Taro , Yonemoto Naohiro , Yokoyama Hiroyuki , Nonogi Hiroshi ,   J-RCPR Investigators
Published: April 2024

Background:
Recently, importance of in-hospital cardiopulmonary arrest (IHCPA) is recognized. Some studies showed the characteristics of IHCPA, however, the detail of IHCPA developed within 48-hours of hospital admission remains unknown.

Method:
A total of 491 adults with IHCPA were registered in J-RCPR from January 2008 to December 2009 as a multicenter prospective registry study. Among them, 182 IHCPA developed within 48-hours of hospital admission were retrospectively reviewed. They were divided in two groups according to the underlying disease, hospitalized for the treatment of cardiovascular disease (Group C, n=116, including ACS / Arrhythmia / Heart failure / Aortic diseases), and non- cardiovascular disease (Group N, n=66).

Result:
Baseline characteristics of sex, age, and pre-event consciousness were not statistically different in each group. The location of IHCA was significantly different, the prevalence of IHCPA in intensive care unit (ICU) and catheter laboratory were significantly higher in Group C (p<0.01). The percentages of patients with ECG monitor and developed IHCPA within 10 min of the last checking time were significantly higher in Group C than Group N (90.4% vs. 75.5%, 87.1% vs. 74.2%, p<0.05 respectively). In Group C (Group N), the prevalence of VF/VT as first documented rhythm was 37.8% (19.7%, p<0.0001), asystole was 16.5% (36.3%, p<0.0001), and pulseless electrical activity was 35.7% (44.0%, N.S.). Interestingly, in Group C, the rate of survival at 30 days after IHCPA was significantly higher than Group N (43.1% vs. 22.9%, p<0.001), even though the rate of return of spontaneous circulation and of survival at 24-hours was not significantly different. The rate of the favorable neurological function (CPC 1-2) among patients survived at 30 days after IHCPA was also higher in Group C (86.0% vs. 63.6%, p<0.05).

Conclusion:
Patients in Group C showed better survival than non-cardiovascular disease in this study; 37% of patients with cardiovascular disease developed IHCPA within 48-hours of hospital admission could recover without neurological deficiency. These results suggest the importance of careful observation of the patients in the first few days of hospital admission.
Abstract 26: Long-Term Prognosis Following Out-of-Hospital Cardiac Arrest: Role of Etiology and Initial Rhythm
Authors: Dumas Florence , Stubbs Benjamin A , Silver Jennifer , White Lindsay , Fahrenbruch Carol , Jouven Xavier , Rea Thomas D
Published: April 2024

Background:
The proportion of out-of-hospital cardiac arrest due to non-shockable rhythms or non-cardiac etiology is increasing. Little is known about long-term prognosis following resuscitation, especially as it relates to the presenting rhythm or arrest etiology. We investigated long-term survival among those discharged alive following resuscitation overall and according to presenting rhythm and etiology.

Methods:
We conducted a cohort investigation of all adults suffering out-of-hospital cardiac arrest in a large metropolitan EMS system between Jan 1,2001 and Dec 31,2009 who were resuscitated and discharged from hospital. We prospectively collected pre-hospital data including initial rhythm and arrest etiology. Long-term vital status was ascertained using death certificate records through Dec 31,2010. We used Kaplan Meier and Cox regression to evaluate survival.

Results:
During the study period, 6149 adults received EMS resuscitation,of whom 4165 (69%) presented a non-shockable rhythm and 2198 (36%) had a non-cardiac etiology. A total of 1001 were discharged alive, of whom 316/1001 (32%) presented a non-shockable rhythm and 213/1001 (21%) had a non-cardiac etiology. Overall median survival was 9.8 yrs with 62% surviving >5-yrs after hospital discharge. Five-year survival was 42% for non-shockable rhythms compared to 71% for shockable rhythms,and 45% for non-cardiac etiology compared to 66% for cardiac etiology (p<0.01 respectively) (Fig1).

Conclusion:
Cardiac arrest due to non-shockable rhythm or non-cardiac etiology comprises a substantial proportion of those who survive and are discharged from the hospital. Although long-term survival in these groups is less than their shockable or cardiac etiology counterparts, over half are alive 4 years following hospital discharge, a finding that suggests meaningful survival and supports continued efforts to improve resuscitation care for those with non-shockable rhythms or non-cardiac cause.
Abstract 260: The Changing Pattern of Utilization of Therapeutic Hypothermia Post Cardiac Arrest: A Single-Center Experience
Authors: Eid Shaker M , Lakshmanadoss Umashankar , Nazarian Skon M , Stewart Kerry J , Chandra-Strobos Nisha
Published: April 2024

Background:
In 2005, the AHA/ILCOR Guidelines recommended hypothermia as a class I therapy post VF/VT arrest. The benefit of this therapy in patients with non-VF rhythms remains disputed. Hence, the 2010 AHA guidelines encourage but do not list hypothermia as a class 1 therapy in patients with a non-VF rhythm. We evaluated the changing patterns of utilization of therapeutic hypothermia from 2004-2010.

Methods:
In 123 survivors of non-traumatic out-of-hospital cardiac arrest, data were collected utilizing the Utstein guidelines. Outcomes were examined for 3 time periods: all patients from 2004-2005, 2006-2007, and 2008-2010. Data are presented as mean ± SD, median and 25th, 75th percentiles, or as percentages for dichotomous variables. Analysis was by ANOVA.

Results:
There was no substantial change in the clinical profile of the patients resuscitated from 2004-2010. The use of hypothermia increased in VF/VT survivors to near 90% in 2010. However, the use of hypothermia in non-VF rhythm patients also increased from 21 % to 65.7 % (p<0.01) with no improvement in survival or neurological status (all p ns).

Conclusion:
Over 6 years the use of hypothermia for VF/VT patients has increased. However, with no data of proven benefit, the use of hypothermia in patients with non-VF rhythms has tripled. The appropriateness of such aggressive therapy in Non-VF/VT patients warrants reconsideration.
Abstract 271: Rapid Estrogen-Induced Cardioprotection Is Mainly Mediated by G-Protein--Coupled Estrogen Receptor 1 During Ischemia/Reperfusion
Authors: Bopassa Jean Chrisostome , Lu Rong , Singh Harpreet , Olde Bjorn , Krust Andree , Leeb-Lundberg L M Fredrik , Toro Ligia , Stefani Enrico
Published: April 2024

Introduction:
Numerous basic and clinical studies have demonstrated that 17β-estradiol (E2) has a protective effect on cardiovascular function. The long-term effects of E2 are mediated via classical estrogen receptors: alpha (ERα) and beta (ERβ) through genomic and non-genomic targets while rapid E2-induced protection seems to be mediated by the recent identified G-protein coupled estrogen receptor1 (GPER1).

Hypothesis:
We investigated the role of ERα, ERβ and GPER1 in mediating rapid E2-induced cardioprotection in male mice hearts subjected to ischemia/reperfusion (I/R) using wild type (WT) and specific knockout animals.

Methods:
Ventricles possess GPER1>ERα>ERβ mRNA levels quantified in absolute values with quantitative Real Time PCR. Isolated hearts from wild type (WT: C57BL/6NCrL), ERα
-/-
, ERβ
-/-
and GPER1
-/-
were perfused using Langendorff apparatus with Krebs Henseleit buffer (control) or with the addition of E2 (40 nM). Hearts were subjected to 18 min global ischemia followed by 60 min reperfusion. Cardiac function was recorded during the entire experiment and myocardial infarct size measured by TTC staining at the end of the reperfusion. Mitochondria calcium retention capacity (CRC) required to induce the mitochondrial permeability transition pore opening (mPTP) opening was assessed and protein levels were measured by Western Blot in whole heart lysates after 10 min reperfusion.

Results:
In WT, ERα
-/-
and ERβ
-/-
, E2 treatment significantly improved cardiac functional recovery, reduced infarct size and improved mitochondrial CRC. However, E2-induced cardioprotective effects were completely absent in GPER1
-/-
. Rapid E2 treatment induced up-regulation of GSK-3β, ERK
1/2
and PKC
β
II
phosphorylation in WT mouse compared to control but not in GPER1
-/-
. The reported results were statistically significant different with P<0.05 and n=3-6.

Conclusion:
These results suggest that GPER1 plays a major role in mediating rapid E2-induced cardioprotection after I/R. E2 effects through GPER1 are associated with phosphorylation of GSK-3β, ERK
1/2
and PKC
βII
and inhibition of the mPTP opening.
Abstract 283: Efficacy of a Novel Artificial Oxygen Carrier (LHb) on Ameliorating Lethal Arrhythmogenetic Property in Hemorrhagic Shock Heart: Optical Mapping Analysis
Authors: Takase Bonpei , Tanaka Yoshihiro , Hattori Hidemi , Ishizuka Takanobu , Kaneda Shinichi , Kikuchi Makoto , Ishihara Masayuki
Published: April 2024

Irreversible heart dysfunction despites restoring normal systemic circulation in shock, that is so called “Shock Syndrome”, is caused by prolonged low mean systemic blood pressure (BP) < 40 mmHg, and this heart dysfunction frequently associates with lethal arrhythmias leading to adverse prognosis in the hemorrhagic shock patients. To investigate if a novel artificial oxygen carrier (LHb) is effective to improve arrhythmogenetic property in hemorrhagic shock heart, we performed optical mapping analysis (OM) and electrophysiological study (EPS) in rat's heart obtained from 30% hemorrhagic shock model with repetitive bleedings, where sustained lower mean BP < 40 mmHg was kept for more than 30 min. Hemorrhagic shock was induced in Sprague-Dawley rats (n=32). Rats were resuscitated by LHb, washed red bold cell (wRBC), normal saline (NS) and 5% albumin (5%alb). Hearts were excised, perfused with Tyrode solution and stained with fluorescent dye. Ventricular fibrillation (VF) was induced by burst pacing stimulus to multiple sites in the left ventricle (LV) and OM was performed. VF was induced in all rats resuscitated by NS and 5%alb and their OM showed conduction delay and impaired action potential duration (APD) dispersion (APDd), defined as APDd = maximum APD - minimum APD, in LV. However, all rats rescued by LHb and wRBC had normal OM findings and no VF was induced. Conclusions; LHb can improve deteriorated electrophysiological property in LV of hemorrhagic shock heart and prevent lethal arrhythmias compatible with wRBC. LHb possibly and comparably ameliorates prognosis in massive hemorrhagic shock patients through reducing shock-related lethal arrhythmias with wRBC.
Abstract 41: Liquid Convection Surface Cooling Leads to High Rate of Recovery of Post-VT/VF Patients
Authors: McMullan Paul , Howes Daniel , Ohley William , Dorian Paul , Freedman Robert , Schock Robert B , Holzer Michael
Published: April 2024

Introduction:
Therapeutic hypothermia is an accepted standard of care for patients resuscitated from VT (ventricular tachycardia) and/or VF (ventricular fibrillation). Some prior studies have suggested that a faster time to target temperature may improve the chances of favorable neurological recovery.

Hypothesis:
We hypothesized that rapid cooling of post VT/VF patients using liquid convection surface cooling would lead to a high rate of recovery of such patients, compared to historical results with slower cooling methods.

Methods:
The Life Recovery Systems ThermoSuit System® was used to induce therapeutic hypothermia (approximately 33°C, maintained for 12 to 24 hours) in 37 post-resuscitation patients in 4 hospitals. Patient temperatures were monitored with an esophageal probe.

Results
were retrospectively analyzed for cooling rates, cardiac rhythm of VT/VF, favorable neurologic recovery (CPC 1 or 2), and adverse events.

Results:
Of the 37 patients, the mean cooling rate was 3.4 °C/hr (range 1.3-8.8). Of the 37 patients, 20 were resuscitated from VT or VF. Of these, 17 (85%) survived with favorable outcomes following the ThermoSuit treatment. There were no adverse events.

Conclusions:
Rapid induction of therapeutic hypothermia with the ThermoSuit System was associated with a very high rate of favorable neurologic recovery and an absence of adverse events in post-VT/VF patients. When compared with results of similar studies of slower cooling methods, these results suggest an advantage of faster cooling methods for the treatment of post-VT/VF patients.
Abstract 45: Gender Disparity in Resuscitation Efforts and Outcomes in Out-of-Hospital Cardiac Arrest
Authors: Shin Sang Do , Ahn Ki Ok , Hwang Seung Sik
Published: April 2024

Objectives
The aim of this study was to investigate the association between gender and cardiopulmonary resuscitation (CPR) efforts and outcomes in out-of-hospital cardiac arrests (OHCA).

Methods
We used a nationwide OHCA cohort database of emergency medical service (EMS) run sheets from 2008 and followed it with a retrospective medical record review. We extracted cases involving patients over the age of 20 years with presumed cardiac etiology. Potential predictors were collected using the Utstein style. The primary outcome was the use of resuscitation efforts, such as basic life support (BLS), by a bystander or an EMS provider, application of an automatic external defibrillator (AED) by an EMS provider, and advanced cardiac life support (ACLS) by emergency department (ED) physicians. Secondary outcomes related to the effect of the resuscitation on factors such as survival upon admission and discharge. Univariate and multivariate logistic regression models were applied by gender to calculating odds ratios (ORs) and 95% confidence intervals (95% CIs), with adjustment for potential predictors.

Results
The total number of eligible patients was 13,922. Of these, 5,158 patients (37.0%) were female. Females were significantly older (73.4 vs. 63.7) and had a lower probability of having a shockable rhythm (3.4% vs. 5.4%). Compared to males, females were less likely to receive BLS support (70.8% vs. 77.5%), AED (9.6% vs. 14.3%), and ACLS at the ED (42.2% vs. 49.2%). Survival to admission and to discharge for female patients, compared with male patients, were 11.8% vs. 12.3% (
p
=0.43) and 3.1% vs. 1.8% (
p
<0.001), respectively. Adjusted ORs (95% CIs) for BLS, AED, and ACLS use in female patients, compared with male patients were 0.91 (0.84-0.99), 0.77 (0.68-0.86), and 0.98 (0.91-1.06), respectively. Adjusted ORs for survival to admission and to discharge were 1.32 (1.17-1.48) and 0.82 (0.63-1.05), respectively.

Conclusions
Considering resuscitation efforts and hospital outcomes by gender, females were less likely to have received BLS or AED than were males. Gender influenced survival at admission to the hospital, but was not associated with survival at discharge.
Abstract 8688: Incident Stroke and Mortality Associated with First-detected Atrial Fibrillation in Patients Hospitalized with Severe Sepsis
Authors: Walkey Allan J , Wiener Renda S , Ghobrial Joanna M , Curtis Lesley H , Benjamin Emelia J
Published: April 2024

Allan J Walkey, 2011 Finalist and Presenting Author
Abstract 8683: Systemic to Pulmonary Collateral Flow as Measured by Cardiac Magnetic Resonance Imaging is Associated with Acute Post-Fontan Clinical Outcomes
Authors: Glatz Andrew C , Rome Jonathan J. , Small Adam J. , Gillespie Matthew J. , Dori Yoav , Harris Matthew A. , Keller Marc S. , Fogel Mark A. , Whitehead Kevin K.
Published: April 2024

Andrew C. Glatz, 2011 Finalist and Presenting Author
Abstract 9238: Fatty Acids and Sudden Cardiac Death
Authors: Chiuve Stephanie E , Rimm Eric B , Sandhu Roopinder K , Rexrode Kathryn M , Manson JoAnn E , Willett Walter C , Albert Christine M
Published: April 2024

Stephanie E Chiuve, 2011 Finalist and Presenting Author
Abstract 10952: Network Analysis Identifies the Orphan Receptor Tyrosine Kinase Ros1 as a Determinant of Glutathione Peroxidase-1 Mediated Vascular Remodeling
Authors: Ali Ziad A , de Jesus Perez Vinicio , Raiesdana Azad , Leeper Nicholas J , Pan Stephan , Qu Xiumei , Ali Ayyaz , Haghighat Roxanna , Kato Kimihiko , Channon Keith M , Rabinovitch Marlene , Quertermous Thomas , Ashley Euan A
Published: April 2024

Ziad A Ali, 2011 Finalist and Presenting Author
Abstract 13769: Too Early, Too Late: A 38-Year-Old Man with Cardiogenic Shock
Authors: Dewland Thomas A , Marcus Gregory M , Tong Kathleen L , De Marco Teresa
Published: April 2024

Thomas A. Dewland, 2011 Finalist and Presenting Author
The Interplay between Heart and Muscle Disease
Authors: Mcnally Elizabeth
Published: April 2024

One of the leading causes of congestive heart failure is cardiomyopathy, a disorder with a high heritable component. Dilated cardiomyopathy and hypertrophic cardiomyopathy are clinically distinct, but many of the same genetic defects can be associated with both forms of cardiomyopathy. Within these major forms of cardiomyopathy, it is not possible on clinical grounds to make a genetic diagnosis, yet genetic information helps predict outcome, particularly for complications such as conduction system disease, noncompaction, right ventricular involvement and extra-cardiac manifestations. Progressive skeletal muscle weakness can accompany cardiomyopathy, as it often does in the muscular dystrophies.

A common mutation in the gene encoding γ-sarcoglycan, a dystrophin associated protein, leads to a range of cardiomyopathy and muscle weakness. The variable phenotype in patients with this same
Sgcg
null mutation suggests the presence of genetic modifiers. Using the
Sgcg
mouse model of muscular dystrophy and cardiomyopathy, we interbred mice with mild and severe disease and then undertook a genomewide mapping strategy to search for modifier genes. We identified
Ltbp4
as a major modifier of muscle disease.
Ltbp4
encodes the latent TGFβ binding protein 4, a component of the extracellular matrix in both heart and muscle that sequesters and holds TGFβ inactive. TGFβ signaling has now emerged as a major mediator of not only fibrosis but also the stability of the sarcolemma. We also uncovered unique genetic modifiers of cardiac and diaphragm muscle fibrosis. These genetic interactions reveal the complexity of single gene disorders and highlight the value of studying a genetically well-defined cohort.
Protease-Activated Receptors in Hemostasis, Thrombosis and Beyond
Authors: Coughlin Shaun
Published: April 2024

Protease-activated receptors (PARs) provide a mechanism by which thrombin and related proteases can regulate the behavior of platelets and other cells. Overall, the coagulation cascade and PARs together provide an elegant system that links mechanical information in the form of disruption of vascular integrity to appropriate cellular responses involved in hemostasis, inflammation, repair, and even pain perception. This talk will focus on lessons from animal models regarding the roles of PARs in hemostasis and thrombosis and how these lessons might and might not relate to the pathophysiology of myocardial infarction in humans and ongoing trials of PAR1 antagonists for secondary prevention of the same. Recent work that reveals unexpected roles for PARs outside the context of response to injury –– specifically in vascular and neural development in vertebrate embryos –– will be also be briefly summarized.
Abstract 74: Cardiopulmonary Resuscitation Quality Assessed by Electrocardiography Signal Processing Using Hilbert-Huang Transform Correlates Well with Accelerometer
Authors: Yeh Huang-Fu , Lee Chiao-Hao , Lin Lian-Yu , Chiang Wen-Chu , Ko Patrick C , Chou Eric H , Chong Kah-Meng , Lo Men Tzung , Eilevstjønn Joar , Mykelbust Helge , Ma Matthew H
Published: April 2024

Objectives
High quality cardiopulmonary resuscitation (CPR) is paramount to patient outcomes in cardiac arrests (CA). Methods to assess CPR quality using widely available data should be explored. This study was aimed to compare CPR quality assessed by surface ECG signal processing vs. accelerometer.

Methods
Adult patients with CA receiving CPR in the emergency department of a tertiary university hospital, from Dec 2010 to March 2011 were included. CPR was monitored continuously by recording the surface ECG signals and sternal displacement via an accelerometer. CPR quality parameters including total compression numbers, no flow time (pause > 1.5 sec), total flow time (time with pause < 1.5 sec) and average compression rate for up to the first 10 min of CPR were obtained by 1) ECG signal processing algorithm using empirical mode decomposition via Hilbert-Huang Transform (ECG-HHT) and 2) sternal displacement recorded by an accelerometer (ACCEL).

Results
CPR sessions of 9 CA (6 males, mean age 79.9 years) were analyzed. Compared to ACCEL, ECG-HHT showed lower total compressions, higher no flow time, and lower total flow time. There are good correlations between ECG-HHT vs. ACCEL in total compression numbers (R=0.95) and total flow time (R=0.97).

Conclusions
ECG-HHT correlates well with ACCEL in certain CPR quality parameters and may be used to assess CPR quality through widely available ECG data.
Abstract 80: Mechanical vs Manual Chest Compressions in Out-of-Hospital Cardiac Arrest: Meta-analysis on the Effects on Return of Spontaneous Circulation
Authors: Westfall Mark , Krantz Steve , Kaufman Christopher , Mullin Christopher
Published: April 2024

Background:
Morbidity and mortality rates for out-of-hospital cardiac arrest (OHCA) remain high. A load-distributing band (LDB-CPR) device that provides circumferential thoracic compressions and a piston-driven device with active compression/decompression (PD-CPR) that provides sternal compressions are commercially available automated mechanical chest compression devices designed to supplement conventional CPR (C-CPR). To date, short-term survival data of LDB-CPR and PD-CPR vs. C-CPR are limited and inconclusive. A larger body of data exists on the effects of return of spontaneous circulation (ROSC) for these devices.

Methods:
A meta-analysis was performed to compare LDB-CPR and PD-CPR to C-CPR with the primary endpoint of ability to achieve ROSC. Selection criteria for the meta-analysis required that studies must be human controlled (randomized, phased, historical or case-control) investigations with confirmed OHCA cases. Random effects models were used to assess the relative effect of treatments on ROSC.

Result:
A total of 13 studies (LDB-CPR vs. C-CPR = 8, PD-CPR vs. C-CPR = 5), comprising a total of 6664 subjects with 1884 ROSC events, met the selection criteria. When compared to C-CPR, LDB-CPR had a significantly greater odds of ROSC (odds ratio (OR) = 1.62; 95CI%= 1.36, 1.92, p<0.001) (Figure). The treatment effect for PD-CPR was not significant (OR = 1.15; 95CI%= 0.87, 1.51, p=0.331).

Conclusion:
The ability to achieve ROSC with general automated mechanical chest compression devices is, at the least, comparable to C-CPR. In the case of LDB-CPR, it was superior to C-CPR as the odds of ROSC were over 1.5 times greater and statistically significant. The robustness of these findings should be confirmed in large randomized controlled clinical trials.
Abstract 8091: Left Ventricular Mechanical Dyssynchrony to Distinguish Hibernating versus Scarred Myocardium in Patients with Cardiomyopathy Undergoing Gated Positron Emission Tomography
Authors: Aljaroudi Wael , Alraies M Chadi , Cerqueira Manuel D , Brunken Richard , Jaber Wael A
Published: April 2024

Background:
We sought to determine whether left ventricular (LV) mechanical dyssynchrony can differentiate predominately hibernating versus scarred myocardium in patients with ischemic cardiomyopathy (ICM) on gated positron emission tomography (PET).

Methods and Results:
Stress/rest rubidium-82 gated PET with
18
FDG scan performed on consecutive patients with ICM and LV ejection fraction (EF) ≤35% were analyzed. Of 254 patients (age 65±11 years, QRS 108±10 ms, and LVEF 25±6), 25 (10%) had normal rest perfusion, and 229 had a fixed resting perfusion defect (77 (34%) with
≥
50% hibernating defect (82±21% hibernation) (Group 1) and 152 (66%) with >50% scar (8±12% hibernation) (Group2)). Patients in Group 1 had smaller fixed PDS, more ischemia, and similar LVEF and volumes to those in Group 2. Dyssynchrony indices were derived using Corridor 4DM software (figure 1). Phase SD was lowest in patients with normal perfusion, higher in Group 1, and highest in Group 2 (Figure 2). Using ROC analysis, a phase SD ms cut-off of 120 ms had a 75% specificity to distinguish predominately scarred versus hibernating myocardium (AUC 0.60 [0.52-0.68], P=0.015). By linear regression analysis, phase SD≥120 ms (beta =0.13 [95%CI 0.01;0.25]), implantable cardiac defibrillator (0.23 [0.096;0.36]), beta blockers (-0.17[-0.31;-0.025]), fixed PDS (0.046[0.013;0.079] per 10% increase), and reversible PDS (-0.036[-0.067;-0.005] per 10% increase) were independently associated with predicting scar verus hibernation.

Conclusion:
PET LV dyssynchrony analysis can potentially distinguish predominately hibernating from scarred myocardium.
Abstract 8096: Transplantation of Mesenchymal Stem Cells Alters Ion Channel Gene Expression and Mitigates Cardiac Electrophysiological Remodelling in a Rat Model of Myocardial Infarction
Authors: Lai Patrick F.H. , Panama Brian K , Massé Stéphane , Li Guangming , Zhang Yaoguang , Kusha Marjan , Asta John , Farid Talha A , Backx Peter H , Yau Terrence M , Nanthakumar Kumaraswamy
Published: April 2024

The aim of this study was to evaluate the impacts of mesenchymal stem cell (MSC) transplantation on electrophysiological remodelling following myocardial infarction (MI).

Methods:
Three weeks after coronary ligation, 3×10
6
MSCs, or culture medium alone, were directly injected into infarcted Lewis rat hearts. Hearts were excised one to two weeks later, Langendorff-perfused, optically mapped using the potentiometric dye di-4-ANEPPS, and then fixed and sectioned for morphometric and histological analyses. Gene expression was assessed by qRT-PCR.

Results:
Optical mapping showed that MSC transplantation attenuated the reduction in conduction velocity (CV) and the prolongation of effective refractory period (ERP) in infarcted hearts. These electrophysiological changes correlated with higher vascular density and better-preserved ventricular wall thickness in MSC-treated hearts. A number of ion channel genes showed post-MI changes in expression. In particular, the expression of Kir2.1, which mediates the inward rectifier K
+
current I
K1
, was reduced in MI and partially restored with MSC transplantation.

Conclusion:
Apart from well-documented benefits such as promoting angiogenesis and limiting adverse structural remodelling, MSC transplantation improves conduction and reduces refractoriness in infarcted hearts. MSCs also partially restore Kir2.1 expression, which would enhance I
K1
and contribute to a more negative resting membrane potential, allowing for more Na
+
channels to open during depolarization and improving CV. As I
K1
contributes to repolarization, restoring Kir2.1 expression would also attenuate ERP prolongation. Our experiments showed that MSCs have the capacity to alter cardiac ion channel expression and mitigate adverse electrophysiological remodelling following MI. Thus MSC transplantation may be a potential strategy to prevent post-MI arrhythmias.
Abstract 8128: Clinical Implications of ST-Segment Elevation in Leads V5-6 in Patients with Reperfused Inferior Wall Acute Myocardial Infarction
Authors: Kosuge Masami , Ebina Toshiaki , Hibi Kiyoshi , Endo Mitsuaki , Maejima Nobuhiko , Iwahashi Noriaki , Morita Satoshi , Uchino Kazuaki , Ishikawa Toshiyuki , Umemura Satoshi , Kimura Kazuo
Published: April 2024

Background:
During inferior wall acute myocardial infarction (IWMI), ST-segment elevation (ST↑) often occurs in leads V5-6, but its clinical implications remain unclear.

Methods:
We examined admission ECG in 357 patients with a first IWMI who had TIMI 3 flow of the right coronary artery (RCA) or left circumflex artery (LCX) within 6 h after symptom onset. Patients were divided according to the presence (n=76) or absence (n=281) of ST↑ of >2 mm in leads V5-6. Patients in the former group were divided into the 2 subgroups according to the degrees of ST↑ in leads III and V6: ST↑ III>V6 (n=53) and ST↑ III0.7.

Results:
Both ST↑ in leads V5-6 with ST↑ III>V6 and that with ST↑ III<V6 were associated with mega-artery occlusion, impaired myocardial reperfusion as defined by myocardial blush grade 0/1 on the final angiogram, and a larger infarct size. RCA occlusion was most common in the former, whereas LCX occlusion, especially proximal LCX occlusion, was most common in the latter. Multivariate analysis showed that both ST↑ in leads V5-6 with ST↑ III>V6 (odds ratio 4.81, 95%CI 2.10-11.0, p<0.001) and that with ST↑ III<V6 (odds ratio 5.96, 95%CI 3.28-27.6, p<0.001) were independent predictors of impaired myocardial reperfusion; but ST↑ in leads II, III, and aVF was not.

Conclusions:
In patients with reperfused IWMI, ST↑ in leads V5-6 on admission ECG was associated with mega-artery occlusion with a larger infarct size; furthermore, it was a strong predictor of impaired myocardial reperfusion. In addition, by comparing the degree of ST↑ in lead V6 with that in lead III, we could differentiate between RCA occlusion and LCX occlusion.
Abstract 8142: By Virtue of Its Interaction with the β
2
-adrenergic Receptor, CXCR4 Plays a Role in the Regulation of β
2
-adrenergic Receptor Signaling Pathway Affecting Calcium and Contractility in Cardiac Myocytes
Authors: LaRocca Thomas , Champion Hunter , Haddad Georges , Hajjar Roger , Devi Lakshmi , Schecter Alison , Tarzami Sima T
Published: April 2024

Chemokines are small secreted proteins with chemoattractant properties that play a key role in inflammation, metastasis, and embryonic development. We previously demonstrated a nonchemotactic role for one such chemokine pair, stromal cell-derived factor-1α (SDF-1α) and its G-protein coupled receptor, CXCR4. SDF-1 α /CXCR4 are expressed on cardiac myocytes and have direct consequences on cardiac myocyte physiology by inhibiting contractility in response to the nonselective β-adrenergic receptor (βAR) agonist, isoproterenol. As a result of the importance of β-adrenergic signaling in heart failure pathophysiology, we investigated the underlying mechanism involved in CXCR4 modulation of βAR signaling. We hypothesis that β
2
adrenergic receptor in the heart is negatively modulated by interactions with CXCR4 chemokine receptor. For this we have used biophysical techniques such as bioluminescence resonance energy transfer assay and biochemical techniques such as immunoprecipitation and signaling assays
to
identify the CXCR4-β2AR interaction and determine the physiological significance of this interaction. Our studies demonstrate activation of CXCR4 by SDF-1 leads to a decrease in βAR-induced PKA activity as assessed by cAMP accumulation and PKA-dependent phosphorylation of phospholamban, an inhibitor of SERCA2a. We determined CXCR4 regulation of βAR downstream targets is β2AR-dependent. In conclusion, we demonstrated a physical interaction between CXCR4 and β2AR as determined by coimmunoprecipitation, confocal microscopy, and BRET techniques. The CXCR4-β2AR interaction leads to G-protein signal switching from Gαs to Gαi-mediated pathway and suggests the interaction is a novel mechanism for regulating cardiac myocyte calcium handling and subsequent contractility. Chemokines are physiologically and developmentally relevant to myocardial biology and represent a novel receptor class of cardiac modulators. The CXCR4- β2AR complex could represent a hitherto unknown target for therapeutic intervention.
Abstract 8378: Novel System for the Molecular Imaging of Atherosclerotic Plaque with
68
Ga-DOTA-ApoA-I Mimetic Peptide (-FAMP)
Authors: Yahiro Eiji , Uehara Yoshinari , Hasegawa Koki , Kawachi Emi , Yano Tsuneo , Watanabe Yasuyoshi , Miura Shin-ichiro , Saku Keijiro
Published: April 2024

Cardiovascular disease is the leading cause of death, and atherosclerosis is a chronic, progressive disease with a long asymptomatic phase. Currently, most diagnostic modalities for atherosclerosis imaging can not provide information on the biology and metabolism of plaque, which could help to identify the stage of the disease. PET has the potential to provide information on the extent and activity of atherosclerotic plaque. We have previously described FAMP, a novel apoA-I mimetic 24-amino acid peptide, which may be able to remove cholesterol via specific ATP-binding cassette transporter A1. In this study, we investigated the potential of FAMP to image developing plaque lesions in vivo. FAMP was modified with 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA) and radiolabeled with
68
Ga for noninvasive PET in a familial hypercholesterolemic rabbit (WHHL) with atherosclerotic lesions in the presence or absence of aortic stenting. The uptake of
68
Ga-DOTA-FAMP in the atherosclerotic region in WHHL rabbit was visible on small-animal PET images. Aortic atherosclerotic plaque showed a high uptake of
68
Ga-DOTA-FAMP in WHHL rabbit (Fig.B), but not in normal (JW) (Fig.A) rabbit in both in vivo and in vitro imaging. Furthermore,
68
Ga-DOTA-FAMP also showed strong uptake in aortic-stenting lesion in Planar Positron Imaging System (Fig.C). In conclusion, we demonstrated that
68
Ga-DOTA-FAMP is a promising candidate tracer for PET imaging of atherosclerotic plaque. Detection of these plaques which are prone to rupture could be clinically important for the prevention of cardiac events.
Abstract 8395: Central Pressure Profiles as Predictors of Incident Cardiovascular Events and Heart Failure: The Multiethnic Study of Atherosclerosis
Authors: Chirinos Julio A , Kips Jan , Jacobs David R , Brumback Lyndia , Kronmal Richard , Duprez Daniel A , Bluemke David A , Townsend Raymond R , Vermeersch Sebastian , Segers Patrick
Published: April 2024

Background:
Experimental and physiologic data mechanistically implicate wave reflections in the pathogenesis of left ventricular failure and cardiovascular disease, but their association with these outcomes in the general population is unclear.

Methods:
Aortic pressure waveforms were derived from a generalized transfer function applied to the radial pressure waveforms recorded non-invasively at baseline from 5,958 participants in the Multi-Ethnic Study of Atherosclerosis. The central pressure waveform was separated into forward and reflected waves using a physiologic flow waveform. Reflection magnitude (RM=[reflected/forward wave amplitude]x100), augmentation index ([second/first systolic peak]x100) and pulse pressure amplification ([radial/aortic pulse pressure]x100) were assessed as predictors of cardiovascular events (CVE) and congestive heart failure (CHF).

Results:
During median 6.46 years of follow-up, aortic augmentation index and pulse pressure amplification did not independently predict CVE. After adjustment for established risk factors, RM was independently predictive of CVE (hazard ratio [HR] per 10%-increase=1.39; 95%CI=1.10-1.75; P=0.006) and strongly predictive of CHF (HR per 10%-increase=2.81; 95%CI=1.83-4.33; P<0.0001). RM was a stronger predictor of CHF risk than hypertension (HTN) and other established modifiable risk factors, judging by various measures of model performance and population-attributable risk. In fully adjusted models, compared to non-hypertensive subjects with low RM, the HR for hypertensive subjects with low RM, non-hypertensive subjects with high RM and hypertensive subjects with high RM were 1.82 (95%CI=0.85-3.86), 2.31 (95%CI=1.07-5.01) and 4.55 (95%CI=2.28-10.0), respectively (Figure).

Conclusions:
Arterial wave reflections represent an important novel modifiable risk factor for CHF in the general population and a potential therapeutic target for primary CHF prevention.
Abstract 8425: Fetal Cardiac Ventricular Volume and Mass Derived from Spatio-Temporal Image Correlation
Authors: Tutschek Boris , Ritgen Jochen , Zhang Minjuan , Li Xiaokui , Sahn David J
Published: April 2024

Background:
Fetal cardiac assessment is usually performed qualitatively. Functional and longitudinal studies of abnormal fetuses would benefit from reproducible quantitative cardiac measurements. We used spatio-temporal image correlation (STIC) to measure left and right ventricular (LV, RV) volumes and masses in normal and structurally abnormal fetal hearts.

Methods:
44 normal fetuses and 7 with structural heart disease (dextrocardia, DORV, d-TGA, HLHS, pulmonary stenosis PS, VSD) at gestational ages between 16 and 38 completed weeks were included. STIC volumes were acquired and analyzed in end-diastole and end-systole according to an established and validated method.

Results:
Measurements were possible in all fetuses. Ventricular volumes and masses increased with gestation. In fetal DORV, HLHS and PS, RV volumes were increased, in DORV and PS, RV mass was increased. In normal hearts, RV mass was 20% higher than LV mass throughout gestation, but the ejection fraction was slightly higher in the LV.

Conclusions:
Using STIC the human fetal heart can be studied quantitatively, taking into account the complex geometry especially related to the right ventricle.
Abstract 8454: High Resolution Echocardiography Can Detect Myocardial Damage in the Right Ventricle: A Feasibility Study
Authors: Yang Sarah K , Ashraf Shahryar , Krishnakumar Sheetal , Rajendran Anugraha , Chang Nicole , Kovch Galyna , Ashraf Muhammad , Sahn David J
Published: April 2024

Background:
The unique geometry and thinner walls of the right ventricle (RV) present a challenge for strain imaging.

Methods:
We studied 5 freshly harvested pig hearts. Each heart was mounted in a water bath for ultrasound imaging. A pulsatile pump was attached to the RV through a latex balloon inserted into the cavity with a fixed volume of water. Pulsatile flow into the RV cavity was generated by delivering 6 calibrated stroke volumes (15-40 ml) at 60 beats/min. Cardiac motion was scanned with 10S probe to acquire 2D short axis views on a GE Vivid 7 Dimensions ultrasound system at frame rates of 80-100fps. After baseline imaging, we injected 1-2ml of glutaraldehyde into the RV free wall to simulate myocardial fibrosis or scarring. The study was repeated at the same stroke volumes. Images were exported to EchoPac PC for analysis of circumferential and radial strain using speckle tracking by three observers.

Results:
Incremental increases in stroke volumes resulted in well correlated increases in stretching and thinning of RV walls, increased circumferential strain (r=0.87) and decreased radial strain (r=0.79). At each stroke volume, the modeled RV scar showed significantly diminished circumferential and radial strain deformation, with high reproducibility among observers (r=0.82).

Conclusions:
Speckle tracking based determination of cardiac mechanics provides a robust method for evaluation of altered function in the “infarcted” segments of the RV.
Abstract 8517: Randomized Double-Blind Placebo-Controlled Pilot Study of Ranolazine Before Elective Percutaneous Coronary Intervention
Authors: Pelliccia Francesco , Marazzi Giuseppe , Pasceri Vincenzo , Arrivi Alessio , Tanzilli Gaetano , Mangieri Enrico , Gaudio Carlo , Mercuro Giuseppe
Published: April 2024

Introduction.
Ranolazine is a novel antianginal drug that reduces intracellular sodium and calcium accumulation during ischemia thus limiting ischemic injury. It remains unknown, however, if the drug can play a role in the pathophysiology of small myocardial infarctions after percutaneous coronary intervention (PCI).

Hypothesis.
Aim of this study was to verify in a randomized study if pre-treatment with ranolazine before PCI has any protective effect.

Methods.
Fifty patients with stable angina (32 men, age: 55+13 years) scheduled for elective coronary intervention entered a randomized, double-blind, placebo-controlled pilot trial. For 7 days prior to the procedure, 25 patients were assigned to receive ranolazine (500 mg twice daily) and 25 patients had placebo. Creatine kinase-MB, troponin-I and myoglobin levels were measured at baseline and at 8 and 24 hours post procedure.

Results.
Comparison between the two groups did not show any difference in age, sex, risk factors, cardiac function, and extension of coronary artery disease. Also, there was no difference in any technical aspect of PCI. Detection of markers of myocardial injury above the upper normal limit was significantly lower in the ranolazine vs placebo group: 12% vs 35% for creatine kinase-MB (p=0.001), 20% vs 48% for troponin-I (p=0.0004) and 22% vs 51% for myoglobin (p=0.0005). Myocardial infarction by creatine kinase-MB determination was less commonly seen after PCI in the ranolazine than in the placebo-group (5% vs 18%, p=0.025). Postprocedural peak levels of creatine kinase-MB (2.9+18 vs 7.5+18 ng/mL, p=0.0002) were also significantly lower in the ranolazine vs placebo group. No significant side effect was reported by the two groups of patients.

Conclusions.
Pretreatment with ranolazine 500 mg twice daily for 7 days significantly reduced procedural myocardial injury in elective PCI. These findings indicate that ranolazine may provide a friendly protection to ischemic cardiomyocytes. A multicentre randomized study is now ongoing and complete results will be available by 2012.
Abstract 8523: Randomized Trial of Nutraceuticals in Statin-Intolerant Patients Treated with Percutaneous Coronary Intervention
Authors: Pelliccia Francesco , Marazzi Giuseppe , Pasceri Vincenzo , Arrivi Alessio , Tanzilli Gaetano , Mangieri Enrico , Rosano Giuseppe , Mercuro Giuseppe , Gaudio Carlo
Published: April 2024

Introduction.
Statins have a class I indication after percutaneous coronary intervention (PCI), but can not be used in statin-intolerant patients. Nutraceuticals, i.e. forms of compounds with biological activity derived from foods, that are capable of lowering LDL cholesterol might represent a useful therapeutic alternative. However, there are no data regarding the use of nutraceuticals after PCI.

Hypothesis.
We performed a randomized, prospective, parallel group, single-blind trial to investigate the efficacy, safety, and tolerability of a nutraceutical-based protocol in statin-intolerant patients treated with PCI.

Methods.
At time of PCI, we selected 80 patients with stable (70%) or unstable angina (30%) who had previously experienced statin withdrawn because of myalgias (75%), gastrointestinal intolerance (20%) or elevated alanine aminotrasferase (5%). Patients were randomized to receive for 1 year either nutraceutical combined pill (1 capsule/day containing red yeast rice 200 mg, policosanol 10 mg, and berberine 500 mg) or daily placebo. Primary outcomes included reasons for treatment discontinuation and a daily pain severity score, and secondary outcomes included plasma lipids.

Results.
At entry, 40 patients were randomized to nutraceuticals and 40 to placebo. Clinical features and lipid profiles were similar between groups. During the 1-year trial, 2 patients of the nutraceutical-group stopped the pill due to myalgia (N=1) or gastrointestinal intolerance (N=1). After 1-year treatment, the mean pain severity did not differ significantly between nutraceutical and placebo groups. Similarly, levels of triglyceride, liver enzyme or creatine kinase were similar between groups. Conversely, total cholesterol level (205+31 vs 241+41 mg/dl) and low-density lipoprotein cholesterol (105+31 vs 131+41 mg/dl) were significantly (P=0.001) lower in the nutraceutical-group than in the placebo-group.

Conclusions.
A combination of nutraceuticals with lipid-lowering biological activity can significantly decrease cholesterol levels without causing clinical or metabolic side effects, thus being a reliable treatment option in statin-intolerant patients treated with PCI.