bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 325: Differences in the Implications of the Time Interval from Collapse to Initiation of Cardiopulmonary Resuscitation and to Return of Spontaneous Circulation for the Prognosis of Out-of-Hospital Cardiac Arrest Patients
Authors: Kagawa Eisuke , Dote Keigo , Kato Masaya , Sasaki Shota , Nakano Yoshinori , Itakura Kiho , Ochiumi Yusuke , Takiguchi Yu , Honda Hideko , Inoue Ichiro , Kawagoe Takuji , Ishihara Masaharu , Kihara Yasuki
Published: April 2024

Introduction
: Out-of-hospital cardiac arrest patients have a poor prognosis even if cardiopulmonary resuscitation (CPR) is administered. The time interval from collapse to initiation of CPR (CA-CPR) and the time interval from collapse to return of spontaneous circulation (CA-ROSC) are reported to be predictors of survival in cardiac arrest patients. However, the clinical implications of both durations remain unclear.

Hypothesis
: We assessed the hypothesis that CA-CPR and CA-ROSC have different impacts on the prognosis of out-of-hospital cardiac arrest patients.

Methods
: We enrolled adult out-of-hospital cardiac arrest patients between 2006 and 2010 in this study. Receiver-operating characteristic curves of CA-CPR and CA-ROSC were generated to analyse favourable neurological outcomes. We assessed the independent predictors of return of spontaneous circulation (ROSC) and favourable neurological outcomes by using the logistic regression model. A P value of < 0.05 was considered statistically significant.

Results
: We enrolled 1194 patients. The median age was 74 y (interquartile range 61-83 y); 61% were males. Fifty-two percent of the patients involved witnessed cardiac arrest; 76% of the patients were received by-stander CPR, 11% of the patients whose initial recorded rhythm was shockable rhythm. The CA-CPR for patients who achieved ROSC (n = 422) was shorter than that for patients who did not achieved ROSC (7 min (1-14 min) vs. 19 min (8-51 min), P < 0.001). From the patients who achieved ROSC, the patients who had favourable neurological outcomes had shorter CA-CPR (2 min (1-7 min) vs. 8 min (2-15 min), P < 0.001) and CA-ROSC (13 min (9-22 min) vs. 46 min (34-58 min), P < 0.001). The area under the curve for the CA-CPR predicting ROSC was 0.74. The area under the curve for the CA-CPR and the CA-ROSC predicting favourable neurological outcomes in patients who achieved ROSC was 0.69 and 0.89, respectively. Multivariable analysis showed that the CA-CPR was associated with ROSC and CA-ROSC but not A-CPR was associated with favourable neurological outcomes.

Conclusions
: Early initiation of CPR is associated with ROSC, and early ROSC in turn is associated with favourable neurological outcomes in out-of-hospital cardiac arrest patients.
Abstract 330: Fluid Resuscitation Guided by Sublingual PCO2 During Hemorrhagic Shock in Swine
Authors: Xu Jiefeng , Ma Linhao , Lu Xiaoye , Wu Xiaobo , Sun Shijie , Tang Wanchun
Published: April 2024

Introduction: Aggressive fluid resuscitation during hemorrhagic shock to restore normal levels of aortic pressure often results in volume overload. We investigated whether fluid resuscitation guided by sublingual PCO
2
(PslCO
2
) would minimize volume overload without compromising the outcomes of hemorrhagic shock.

Hypothesis: Fluid resuscitation guided by PslCO
2
reduces the volume of fluid resuscitation without compromising the outcomes of hemorrhagic shock when compared with the fluid resuscitation guided by blood pressure (BP).

Methods: Ten male domestic pigs weighing between 34-37 kg were utilized. Forty-five percent of estimated blood volume (EBV) was removed over an interval of 1 hour. The animals were then randomized to receive fluid resuscitation based on either PslCO
2
or BP. In the PslCO
2
guided group, resuscitation was initiated when PslCO
2
exceeded 70 mm Hg and stopped when it decreased to 50 mm Hg. In the BP guided group, resuscitation was initiated when mean aortic pressure decreased to 60 mm Hg and stopped when it increased to 90 mm Hg. Ringer’s lactate solution (RLS) of 30 ml/kg was infused and followed with the shed blood if needed. All animals were observed for 72 hours.

Results: In the PslCO
2
guided group, fluid resuscitation was required in only 2 animals with a significantly low volume of RLS without the need of blood infusion. However, in the BP guided group, all animals required a significantly larger volume of fluid including both RLS and blood. There were no differences in the 72 hours of survival and neurological alertness score between groups (Table).

Conclusion: During hemorrhagic shock, fluid resuscitation guided by PslCO
2
significantly reduced the amount of resuscitation fluid without compromising the outcomes of hemorrhagic shock.
Abstract 40: Tissue Oximetry During Out-of-Hospital Cardiopulmonary Resuscitation
Authors: Frisch Adam , Frank Rachel , Suffoletto Brian , Martin-Gill Christian , Menegazzi James , Callaway Clifton
Published: April 2024

Introduction: Coronary perfusion pressure is a common surrogate marker for myocardial perfusion and the effectiveness of CPR. Peripheral perfusion is far less studied. We sought to evaluate tissue oxygen saturation (StO
2
) as a surrogate marker for peripheral perfusion during CPR and after return of spontaneous circulation (ROSC) during out-of-hospital cardiac arrest (OOHCA).

Methods: This study was approved by our IRB. EMS physicians responded to cases of cardiac arrest and placed a continuous near infrared tissue oximeter on the thenar eminence of the patient to measure StO
2
, which was recorded continuously during the resuscitation. Each case was then broken down into 30-second epochs classified as ongoing CPR or post-ROSC. The mean StO
2
for each epoch was calculated. A two-sample T test was used to compare the two conditions.

Results: 16 patient encounters were analyzed with a total of 390 epochs, 175 with pulses and 215 during CPR. Patients ranged in age from 34-88 and 10 were male (62.5%). The StO
2
average for the epochs during CPR was 50.04 (SD 18.5) and 66.74 (24.6) after ROSC in patients with pulses. A difference of 16.7 was seen between the two conditions (p<0.001).

Conclusion: In this cohort of patients, there was a lower average StO
2
reading in patients with CPR being performed when compared to the post ROSC group. While the cause of this difference may be multifactorial, lower tissue oxygen saturation may imply worse peripheral perfusion. Future studies will need to evaluate the cause of this difference and potential impacts it may have on cardiac arrest outcome in the prehospital setting.
Abstract 41: Initial Hyperoxia Is Associated with Survival in Postarrest Patients Enrolled in the PATH Database
Authors: Gaieski David F , Grossestreuer Anne V , Perman Sarah M , Neumar Robert W , Leary Marion , Napoli Anthony M , Becker Lance B , Abella Benjamin S
Published: April 2024

Introduction: During and after resuscitation from cardiac arrest, patients often receive supplemental oxygen with high FiO
2
. Recent human data suggest that arterial hyperoxia within hours after resuscitation is associated with worse outcomes. We hypothesized that neurologically intact survivors would more likely be normoxic rather than hyperoxic or hypoxic.

Methods: Retrospective chart review of post-arrest patients treated with therapeutic hypothermia (TH) in the Penn Alliance for Therapeutic Hypothermia (PATH) database from 11 institutions. Demographic variables were analyzed using chi-square tests. Data were collected at first arterial blood gas (ABG), and 12 hrs, 24 hrs, 36 hrs, and 48 hrs post arrest. Logistic regression was performed to assess the relationship between initial hypoxia (PaO
2
300 mmHg), mortality, and neurologic outcome.

Results: We enrolled 179 patients with mean age 59.6 ± 16.4 yrs, 54% male, and 31% of initial rhythms were VF/VT. Sixty-six (37%) survived to discharge; and 50/66 (76%) had good neurologic outcome (cerebral performance category 1 or 2). An increasing percentage of PaO
2
values were in the optimal range at consecutive times (51% 0 hr; 82% 12 hrs; 90% 24 hrs; 93% 36 hrs; 92% 48 hrs). Survivors had significantly higher initial PaO
2
values than non-survivors (242 vs. 187 mmHg; p=0.03). When controlling for initial rhythm and gender, initial hyperoxia (> 300 mmHg) was associated with improved survival relative to normoxia (OR 2.07, 95% CI 0.98-4.36, p=0.055) while initial hypoxia did not affect outcomes (OR 0.63, 95% CI 0.23-1.70, p=ns). Thirty percent (54/179) were hyperoxic at time 0 and 39% (21/54) of them survived with good neurologic outcome. No significant association was found between oxygen status and neurologic outcomes (hyperoxia (OR 1.89, 95% CI 0.83-4.32, p=ns); hypoxia (OR 0.91, 95% CI 0.30-2.77, p=ns).

Conclusions: Increasing percentages of patients had arterial oxygen levels optimized after ROSC. Increased survival was shown in patients with hyperoxic initial PaO
2
values when compared to normoxic values. There was no relationship between the arterial oxygen values and neurologic outcomes post-arrest.
Abstract 12688: Augmenting Mitofusin-2 in Females With Pulmonary Arterial Hypertension Increases Mitochondrial Fusion, Reduces Smooth Muscle Cell Hyperproliferation and Regresses Experimental Disease
Authors: Ryan John J , Marsboom Glenn , Fang Yong Hu , Toth Peter T , Marrow Erik , Luo Nancy , Piao Lin , Hong Zhigang , Zhang Hannah , Haney Chad , Chen Chin-Tu , Sharp Willard , Archer Stephen
Published: April 2024

John J Ryan, 2012 Finalist and Presenting Author
Abstract 9529: Effects of Sevelamer Carbonate on Arterial Stiffness and Left Ventricular Mass in Patients with Stage 3 Chronic Kidney Disease: Results of a Randomized Controlled Trial
Authors: Chue Colin D , Townend Jonathan N , Moody William E , Edwards Nicola C , Steeds Richard P , Ferro Charles J
Published: April 2024

Colin D Chue, 2012 Finalist and Presenting Author
Abstract 12621: B-Type-Natriuretic Peptide and C-Reactive Protein in the Prediction of Atrial Fibrillation Risk: The CHARGE-AF Consortium
Authors: Sinner Moritz F , Krijthe Bouwe , Aspelund Thor , Stepas Katherine , Pencina Michael , Moser Carlee , Sootodehnia Nona , Fontes Joao , Janssens Cecile , Kronmal Richard , Magnani Jared , Witteman Jacqueline , Chamberlain Alanna , Lubitz Steven , Schnabel Renate , Vasan Ramachandran , Wang Thomas , Agarwal Sunil , McManus David , Ellinor Patrick , Larson Martin , Burke Gregory , Launer Leonore , Hofman Albert , Levy Daniel , Gottdiener John , Kääb Stefan , Couper David , Harris Tamara , Soliman Elsayed , Stricker Bruno , Gudnason Vilmundur , Heckbert Susan , Benjamin Emelia , Alonso Alvaro
Published: April 2024

Moritz F Sinner, 2012 Finalist and Presenting Author
Abstract 14316: Blue Again: Recurrent Cyanosis in a 30-Year-Old Man with Surgically Palliated Cyanotic Congenital Heart Disease
Authors: Chyou Janice Y. , Roswell Robert O , Argilla Michael , Saric Muhamed , Mosca Ralph , Katz Stuart D , Rosenzweig Barry P
Published: April 2024

Janice Y. Chyou, 2012 Finalist and Presenting Author
Abstract 14678: Transcription Factor-Driven Conversion of Quiescent Cardiomyocytes to Pacemaker Cells
Authors: Cho Hee Cheol , Kapoor Nidhi , Liang Wenbin , Marbn áEduardo
Published: April 2024

Hee Cheol Cho, 2012 Finalist and Presenting Author
Abstract 19780: Mammalian Cardiac Renewal by Preexisting Cardiomyocytes
Authors: Senyo Samuel E , Steinhauser Matthew L. , Pizzimenti Christie L , Yang Vicky K , Wang Mei , Cai Lei , Wu Ting-Di , Guerquin-Kern Jean-Luc , Lechene Claude P , Lee Richard T
Published: April 2024

Samuel E Senyo, 2012 Finalist and Presenting Author
Abstract 16948: Numb and Numb-Like Are Required for Renewing Cardiac Progenitor Cell Fate
Authors: Shenje Lincoln T. , Hideki Uosaki , Laviel Fernandez , Chulan Kwon
Published: April 2024

Lincoln T Shenje, 2012 Finalist and Presenting Author
Abstract 14903: SPECT-CT and Bioluminescence Imaging Reveal the Important Contribution of Cellular Bioenergetics on the Molecular Imaging Signal from Stem Cells Expressing Luciferase and The Sodium-Iodide Symporter
Authors: Chan Angel , Chang Connie , Yu Jianhua , Afzal Junaid , Higuchi Takahiro , Sun Dongdong , Hosp Xijing , Wahl Richard , Pomper Martin , Tsui Benjamin , Abraham Maria Roselle
Published: April 2024

Angel Chan, 2012 Finalist and Presenting Author
Abstract 54: Does Telephone-Assisted Cardiopulmonary Resuscitation Improve the Outcome of Out-of-Hospital Cardiac Arrest?
Authors: Loeb Thomas , Ozguler Annna , Baer Geraldine , Groizard Charles , Baer Michel
Published: April 2024

Objectives:
In an effort to increase the proportion of victims who receive bystander cardiopulmonary resuscitation (CPR) in case of out-of-hospital cardiac arrest (OHCA), it is now clearly recommended to propose t-CPR. However, very few studies have demonstrated, in real life conditions, the clinical benefits of such recommendations.

The aim of this study was to assess the survival benefit of t-CPR on OHCA, compared with no bystander CPR.

Materials and methods:
This study was conducted over a seven-month period in 2011. It included all incoming calls to an Emergency Medical Service dispatch center in which t-CPR was instructed to non-priorly trained bystanders.

The comparison group was matched on the date of occurrence; we enrolled incoming calls for witnessed OHCA with no bystander-CPR performed before rescuers arrival.

Variables were given as means or percentages. Data were compared using Chi-square tests and Student’s t-test

Results:
The results appear in Table 1.

Conclusion
: This study showed that in OHCA, when bystanders initiated t-CPR, despite 1- a younger age population 2- more advanced life support and 3- higher rates of ROSC prior to hospital arrival, there was no improvement in survival rate after ICU discharge. As t-CPR does not seem sufficient to improve outcome, training citizens in CPR remains a top priority.
Abstract 17610: Noninvasive Assessment with N-Benzyl-N-[11C]Methyl-2-(7-Methyl-8-oxo-2-Phenyl-7,8-Dihydro-9H-Purin-9-yl)Acetamide ([11C]DAC) Delineates Dynamic Interaction Between Brain and Heart as Well as Local Denervation Status After Cardiac Injury in Rats
Authors: Okada Sho , Odaka Kenichi , Ming-Zhang Rong , Tadokoro Hiroyuki , Yui Joji , Wakizaka Hidekatsu , Xie Lin , Uchino Yoshio , Kawamura Kazunori , Kumata Katsushi , Komuro Issei , Minamino Tohru , Kobayashi Yoshio
Published: April 2024

Sho Okada, 2012 Finalist and Presenting Author
Abstract 14955: An Early Appointment to Outpatient Cardiac Rehabilitation at Hospital Discharge Improves Attendance at Orientation: A Randomized, Single-Blind, Controlled Trial
Authors: Pack Quinn R , Clinic Mayo , Mansour Mouhamad , Barboza Joaquim S , Hibner Brooks A , Mahan Meredith G , Ehrman Jonathan K , Vanzant Melissa A , Schairer John R , Keteyian Steven J
Published: April 2024

Quinn R Pack, 2012 Finalist and Presenting Author
Abstract 14933: Effect of Atherogenic Diets with Different Ratios of Omega-6 Polyunsaturated Fatty Acids to Eicosapentaenoic Acid Plus Docosahexaenoic Acid on Lipid Content and Inflammatory Response in Hepatic and Visceral Adipose Tissue in LDL Receptor Null Mice
Authors: Wang Shu , Miller Bradley , Matthan Nirupa R , Wu Dayong , Lichtenstein Alice H
Published: April 2024

Shu Wang, 2012 Finalist and Presenting Author
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 ex vivo studies of human platelets, animal models and human clinical trials that speak to the roles of PARs in platelet activation, hemostasis and thrombosis and on work in progress that speaks to roles for this system in blood vessel formation and other processes in the vertebrate embryo.
Translational Medicine in Atherosclerosis: From Human Genetics to New Biology to Novel Therapeutics
Authors: Rader Daniel J.
Published: April 2024

Despite advances over the last few decades, atherosclerotic cardiovascular disease (ASCVD) remains a major public health issue worldwide. New therapies for the prevention and treatment of ASCVD are still needed. The investigation of monogenic disorders, such as those associated with extremes of plasma lipids, have yielded new therapeutic targets and spurred the development of new therapeutic approaches. Unbiased genome-wide studies have identified a large number of novel genetic loci associated with different manifestations of ASCVD (eg. myocardial infarction and obstructive CAD) as well as risk factor traits (eg. plasma lipids). These discoveries are beginning to result in new insights into biology and physiology relevant to the development of ASCVD. For example, a locus on chromosome 1p13 was found to be significantly associated with MI, as well as noted to be one the strongest loci in the genome associated with LDL cholesterol. The causal gene at this locus, SORT1, encodes a protein sortilin that through action in the liver has important effects on LDL metabolism. Several other loci associated with plasma lipid traits have yielded new insights into the regulation of lipoprotein metabolism. Similarly, loci associated with MI and CAD are putting new molecules on the map that causally influence the development of atherosclerosis or plaque disruption. Just as the study of monogenic disorders has yielded new therapeutic targets, it is expected that translation of the new biology unfolding as a result of genome-wide studies of ASCVD and its risk factors will ultimately yield novel therapies for the treatment of atherosclerotic disease.
Crippling Cardiovascular Disease With Kruppels
Authors: Jain Mukesh
Published: April 2024

The metabolic and immune systems are evolutionary conserved, highly interdependent, and requisite for survival. Dysfunction of either system alters homeostasis and contributes to cardiovascular disease, cancer, and metabolic disorders. Studies from our laboratory have identified an essential role for a family of transcription factors termed Kruppel-like factors (KLFs) in innate immunity, metabolism, and the cardiovascular response to physiologic and pathologic stimuli. Mechanistically, this work has led to an appreciation of how KLFs intersect with nodal transcriptional and epigenetic pathways to exact their biological action. Here, I will first review how control of cellular inflammation and metabolism by KLFs impacts key steps in the pathogenesis of vascular disease, including endothelial dysfunction, immune cell activation, smooth muscle proliferation, and thrombosis. Next, I will discuss how KLFs coordinate systemic metabolic homeostasis by controlling flux of all three major cellular nutrient classes — glucose, amino acids, and lipids — observations that provide insights as to how diverse physiologic stimuli such as fasting, circadian rhythms, and exercise impact health. Finally, I will highlight the evidence linking KLFs to human disease and how these observations along with mechanistic insights are being exploited for therapeutic gain.
Abstract 65: Racial Disparities in Outcomes Following Nonshockable In-Hospital Cardiac Arrest
Authors: Razi Rabia R , Churpek Matthew M , Yuen Trevor C , Peek Monica E , Edelson Dana P ,   Get With the Guidelines®-Resuscitation Investigators
Published: April 2024

Background: Black patients have previously been shown to have worse outcomes from ventricular arrhythmias. This discrepancy was largely explained by individual patient characteristics and racial clustering by hospital. However, the vast majority of in-hospital cardiac arrests are due to pulseless electrical activity (PEA) and asystole and little is known about the relationship between race and outcomes in this patient group.

Methods: We analyzed PEA and asystolic in-hospital cardiac arrests in the Get With The Guidelines-Resuscitation (GWTG-R) database from 2000 to 2009. A generalized estimating equation model was used to estimate the average survival difference between black and white patients in the study population. Multilevel conditional fixed effects logistic regression models were then used to estimate the relationship between race and survival to discharge and ROSC, sequentially controlling for hospital, patient demographics, comorbidities, arrest characteristic, process measures and interventions in place at the time of arrest.

Results: We identified 76,385 eligible index arrests with a presenting rhythm of PEA or asystole, of which 19,236 (25%) were black. Black patients were younger on average (63 vs 71 years, p<0.001) and had more comorbidities than their white counterparts. Survival to discharge was 13% for white patients and 10% for black patients (unadjusted OR 0.83; 95% CI 0.78-0.88). This effect remained nearly constant after controlling for hospital, patient, and event-specific confounders (adjusted OR 0.85; 95% CI 0.79-0.92). Similar results were shown for ROSC (adjusted OR 0.88; 95% CI 0.84-0.92).

Conclusion: Black patients have significantly lower survival rates after in-hospital PEA and asystolic arrests. Hospital, patient demographics, event characteristics, and co-morbidities as measured in the GWTG-R database failed to explain this discrepancy. Furthermore, the consistency between the outcomes differences in ROSC and survival to discharge suggest that there are unmeasured intra-arrest and/or pre-arrest racial differences present. This is in contrast to shockable cardiac arrests in the same database, in which the disparity was greatly reduced after accounting for measured confounders.
Abstract 76: Early Institution of Hypothermic Total Liquid Ventilation After Prolonged Cardiac Arrest Protects Against Kidney Ischemic Alterations
Authors: Tissier Renaud , Giraud Sébastien , Quellard Nathalie , Fernandez Béatrice , Goujon Jean-Michel , Lidouren Fanny , Darbera Lys , Kohlhauer Matthias , Chenoune Mourad , Bruneval Patrick , Ghaleh Bijan , Berdeaux Alain , Hauet Thierry
Published: April 2024

Introduction: Warm ischemia before organ removal is a major cause of kidney alterations in transplants from non-heart-beating donors. In a rabbit model of cardiac arrest (CA), we showed that rapid cooling using total liquid ventilation (TLV) can improve survival and protect heart and brain after resuscitation.

Hypothesis: We hypothesized that TLV with perfluorocarbons can also limits kidney alterations after CA, with potential applications for controlled organ donation in the Maastricht III category.

Methods: Anesthetized rabbits were submitted to 15 min of untreated ventricular fibrillation. After resuscitation and resumption of spontaneous circulation (ROSC), rabbits underwent Control life support or hypothermia (32-33°C) induced by TLV and maintained with external blankets under mechanical ventilation. Life support was prolonged during 6 h before kidney removal and analysis. Other rabbits were submitted to similar follow-up with no CA (Sham group).

Results: In each group, 8 animals completed the protocol. Despite similar delays before ROSC (∼4 min), epinephrine doses required to maintain blood pressure throughout follow-up were lower in TLV vs Control (361±23 vs 990±179 µg/kg, respectively). This was accompanied by a decrease in creatinine blood levels after CA (12±1 vs 16±2 mg/l), while still altered when compared to Sham values (8±1 mg/l). Importantly, kidney lesions were also attenuated in TLV vs Control (Figure). The nephroprotective effect of TLV was not related to differences in delayed inflammatory or immune renal responses since transcriptions of, e.g., IFN-γ, TNF-α, IL-1β, MCP-1, TLR-2, TLR-4, VEGF, ICAM-1 and E-selectin were similarly altered in TLV and Control vs Sham. An immediate anti-ischemic effect of rapid cooling with TLV might accordingly be involved.

Conclusion: Ultra-fast cooling with TLV limits kidney alterations after prolonged experimental CA.

*, p<0.05 vs Sham; †, p<0.05 vs Control.
Abstract 79: The Predictive Value of NT-pro BNP in Cardiac Arrest Patients Treated with Mild Hypothermia
Authors: Wee Jung Hee , Park Jeong Ho , Youn Chun Song , Park Kyu Nam , Choi Seung Pill
Published: April 2024

Background

There has not been accurate, independent

biomarker to reliably predict neurological outcome in cardiac arrest survivors.

B-type natriuretic peptide (BNP) has both prognostic and diagnostic value in

heart diseases, and many studies showed NT-pro BNP had more accurate than BNP. We

speculated that NT-pro BNP measured after restoration of spontaneous

circulation (ROSC) may predict patient outcome.

Methods & Results

A retrospective review of comatose

survivors who were treated with mild therapeutic hypothermia after cardiac

arrest due to cardiac origin to two tertiary general hospitals between June

2007 and May 2011 was performed. NT-pro BNP level was checked in 87 patients

immediately after ROSC. 35 (40.0%) had a favorable neurological outcome (cerebral

performance category 1, 2) and 53 (60.9%) showed survival discharge. The mean value of NT-pro BNP was 557.1±1327.9pg/ml and 5,541.7±9,758.9pg/ml in

favorable and unfavorable outcome, respectively (p=0.001). The AUC for

favorable neurological outcome was 0.747, and 0.720 for death. The NT-pro BNP

cutoff value of 362.7pg/ml for a favorable neurological outcome had a

sensitivity of 65% and a specificity of 69%. The cutoff value of 393.8pg/ml for

mortality had a sensitivity of 71% and a specificity of 66%. Adjusted odds

ratios for favorable neurological outcome at 6 months were 0.686 (95% CI

0.205-2.295), 0.267 (0.0765-0.930), 0.060 (0.11-0.328) compared to the lowest

quartile, respectively (p<0.001).

Conclusion

The measurement of NT-pro BNP had valuable

information to predict the neurological outcome for comatose survivors treated

with mild hypothermia after out-of-hospital cardiac arrest of cardiac etiology.
Abstract 85: The Overall Performance Category and Cerebral Performance Category to Assess Neurologically Intact Survival at Discharge from Cardiac Arrest: A Good Estimate of Patients’ Functioning?
Authors: Beesems Stefanie G , Wittebrood Kim M , de Haan Rob J , Koster Rudolph W
Published: April 2024

Objective- It is known that recovery from neurologic damage takes 6-12 months. However, most studies on out of hospital cardiac arrest (OHCA) use the Overall Performance Category (OPC)/Cerebral Performance Category (CPC) as outcome at discharge from hospital. We studied the neurocognitive functioning and level of independence (LoI) of patients (pts) 6-12 months after OHCA and compared the results with the OPC/CPC at discharge.

Materials and methods- The study population comprises all pts (>18 year) who survived 6-12 months after OHCA from mid-2010 to mid-2011. Pts were interviewed by telephone with questionnaires validated for telephonic application. We used a validated cut-off score. Neurocognitive functioning was measured with the Telephonic Interview Cognitive Status (TICS) and LoI with the Modified Rankin Scale (MRS). If needed, the IQ-code was used as proxy-questionnaire to measure the neurocognitive functioning of the pt. Neurological outcome at discharge was assessed from hospital records estimating OPC/CPC (figure).

Results- Comparison between OPC at discharge and MRS at 6-12 months is shown in the figure. Of all pts, 93% was classified as having a good outcome (OPC 1-2) at discharge. At 6-12 months only 76% had a good outcome (MRS 0-2). Thirty of the 218 (13%) pts seemed to be cognitively impaired (TICS <31) at 6-12 months while they were classified as having a good outcome (CPC 1-2) at discharge.

Conclusion- MRS and other tests 6-12 months after discharge better reflect pts’ functioning at home than OPC/CPC at the moment of discharge. OPC/CPC cannot measure impairments that manifest themselves only in the home environment.
Abstract 8885: C1q-induced Activation of Wnt Signaling Triggers Hypertensive Arterial Remodeling
Authors: Sumida Tomokazu , Naito Atsuhiko T , Shiojima Ichiro , Komuro Issei
Published: April 2024

Hypertension is the leading risk factor of many cardiovascular diseases, and the structural remodeling of arteries in response to elevated blood pressure (hypertensive arterial remodeling) contributes to the end-organ damage associated with hypertension. The signaling mechanism that initiates hypertensive arterial remodeling remains elusive. Here we show that complement C1q-induced activation of Wnt signaling plays a critical role in arterial remodeling associated with hypertension. In the early phase of hypertension, proliferation of vascular smooth muscle cells (VSMCs) and activation of canonical Wnt signaling in VSMCs were observed, and inhibition of canonical Wnt signaling suppressed hypertension-induced VSMC proliferation. Complement C1q was highly expressed in macrophages recruited to the vessel wall following blood pressure elevation, and depletion of macrophages attenuated hypertension-induced VSMC proliferation and activation of canonical Wnt signaling in VSMCs. Furthermore, both C1s inhibition and C1qa gene deletion suppressed activation of canonical Wnt signaling in VSMCs and VSMC proliferation in the early phase of hypertension, and prevented subsequent structural arterial remodeling in the chronic phase. Our findings collectively suggest that macrophage-derived C1q triggers hypertensive arterial remodeling through activation of canonical Wnt signaling in VSMCs. Inhibition of C1q-induced Wnt signal activation may be a novel therapeutic strategy to reduce cardiovascular complications in patients with hypertension.
Abstract 89: Does Neighborhood Really Matter? How Location Influences Bystander CPR Rates
Authors: Buick Jason E , Ray Joel G , Kiss Alex , Morrison Laurie J
Published: April 2024

Introduction: Numerous studies have investigated determinants of bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) patients. Socioeconomic status and ethnicity have been linked to who receives bystander CPR, and recent studies have showed geographical differences in CPR rates. Research from other disciplines has suggested that location is a strong determinant of health and health related interventions and outcomes. Therefore, the objective of this study was to determine the role of neighborhoods in bystander CPR rates in a Canadian population.

Hypothesis: We hypothesized that neighborhood factors are associated with bystander CPR rates.

Methods: All treated OHCA within the City of Toronto between April 2006 and March 2010 were included. Geographic Information Systems were used to assign patients to census tracts (CT) based on their pick-up address and linked to neighborhood factors (instability, dependency, deprivation, ethnic diversity, crime rate and density of family physicians). Bivariate and hierarchical logistic modeling was performed to assess which factors were associated with bystander CPR.

Results: A total of 5,139 OHCA were eligible for enrollment and contained the required information for geographic mapping. The bystander CPR rate was 41.1%. The bystander CPR rate varied across census tracts (0 - 92%, IQR: 25.0 - 50.0%), where 10% had a bystander CPR rate lower than 15%. The CTs deprivation and density of family physicians were associated with bystander CPR (see table). After adjusting for individual characteristics, no CT level variables were associated with bystander CPR.

Conclusion: Deprivation and the density of family physicians were associated with higher rates of bystander CPR. However, after adjustment for patient characteristics, neighborhoods were not associated with CPR. Future research should explore the relationship between location and witnessed status and its role in bystander CPR.
Abstract 8903: Six-year Target Systolic Blood Pressure Less Than 120 mmHg For More Than 65 Aged Hypertension Patients With Chronic Renal Disease
Authors: Zeng Xianghong , zeng Xiangji , li Yunyun , liu Zhauhua , zeng Xianghong
Published: April 2024

Background:
Three year target SBP≦120 mmHg in elderly hypertension patients with chronic kidney disease(CKD) was safety and efficacy was reported in 2009 AHA meeting by us.The six year safety and efficacy of SBP≦120 mmHg in these patient is not reported.

Methods:
In a prospective, controlled open-label studies, the authors have evaluated the safety and efficacy of six-year treatment on progress of renal disease and risk of development of cardiovascular disease in 122 >65 aged hypertension patients with chronic renal disease III to IV stage and macroproteinuria. Before randomization, all patients have already been treated for one-year with angiotensin converting enzyme inhibitors(ACEI) or angiotensin AT1 receptor blockade(ARBs) and other antihypertensive drugs, but their SBP are above 140 mmHg,less than 150 mmHg. Blood pressure , serum creatinine(Cr) and potassium were monitored every 14 days in the period of follow-up by physician and healthcare nurse and more frequent patient-physician encounters will be improve that patients monitored their BP every day at home and adjusted their own medication according to pre-agreed rules.

Results:
By the end of six year,medication possession ratio between two groups was similar(94% vs 94%), mean BP in treatment group was 116/66±6/3 mmHg and in control was 146/78±13/9 mmHg, Cr clearance increased from 51±2.0 to 63±3.0 ml/min (p<0.001)in the group of strict control of SBP,by contrast, Cr clearance decreased significantly from 52±1.9 to 34±2.4 ml/min( P<0.01)in the controls. During this time, urine protein excretion decreased from 1.4±0.5 to 0.2±0.4g/24 hours(P0.05)in the controls. Ten patients had got ACS ,17 patients stroke.21 patients had got pneumonia , 10 patients renal dialysis and eight patient died (5 in SCD and 3 in heart failure) in controls, and three patients had got ACS, six patient had stroke ,nine pneumonia, 1 patient renal dialysis and four patients died in non-cardiac causes in the treatment group.Incidence of hyperkalaemia was similar between two groups.

Conclusions:
SBP≦120 mmHg is safe and was more apparently in decreasing proteinuria, slowing the progress of renal disease and reducing the risk of development of cardiovascular events and pneumonia in elderly hypertensive patients with CKD
Abstract 8999: Coronary Artery Revascularization Evaluation (CARE): Long term Outcomes Comparing Effectiveness of Revascularization Strategies in a Multi-center Community Hospital Registry
Authors: Mack Michael , Herbert Morley , Prince Syma , Kurlansky Paul
Published: April 2024

Background:
Data from randomized clinical trials (RCT) comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) may not accurately reflect current clinical practice, especially with diversity in the selection of drug eluting stents (DES), as well of on- vs. off-pump CABG. Registry data suggests that long-term follow-up is necessary in order to adequately compare the effectiveness of differing interventional strategies. A prospective registry of coronary revascularization (CR) by CABG--on- and off-pump--and PCI--bare metal (BMS) or DES--in a multicenter community hospital setting was accomplished. We hypothesize that the results of CR as performed in routine clinical practice may differ from the outcomes of RCT.

Methods and Results:
All patients (N=4338; 3090 PCI, 1248 CABG) undergoing isolated CR in eight community-based hospitals were enrolled. Follow-up(63.5±27.9, median 79.7 months)was obtained by patient and/or physician contact, and the Social Security Death Index. STEMI and salvage patients were excluded (after exclusion, N=3871; 2690 PCI, 1181 CABG). All clinical decisions were based on treating physician preference. Propensity matching was used to achieve PCI and CABG patient groups of comparable clinical parameters and extent of coronary disease. (N=613 in each group) The incidence of initial major adverse cardiac events (MACE) for CABG vs. PCI was 29.2% vs. 41.8% (p<0.001). Analysis of stent sub-groups showed more event in BMS vs. DES (47.9 vs. 40.0%; p<0.001). Amongst propensity matched groups, the odds ratio for CABG to PCI was 0.69 (CI 0.56-0.85; p<0.001) for morality and 0.58 (CI 0.45-0.75;p<0.001) for any MACE (figure).

Conclusions:
Long-term follow-up of a clinical registry which reflects current practice in the community hospital setting suggests that CABG, both on- and off- pump, may offer comparable patients with advanced coronary artery disease a survival advantage over PCI with either DES or BMS.
Abstract 9040: Three-Dimensional Speckle Feature Tracking Evaluation of Regional Left Ventricular Strain and Detection of Simulated Infarct on 4D Echocardiographic Images: An Experimental Study
Authors: Zhu Meihua , Streiff Cole , Panosian Jill , Ashraf Muhammad , Sahn David J
Published: April 2024

Background:
Cardiac strain generated from 2D speckle-tracking is a clinical standard despite the complex 3D architecture of the left ventricle (LV). Artida 3D Wall Motion Tracking (3D-WMT) permits LV strain quantification in true 3D. We aimed to validate the circumferential and longitudinal strain (CS, LS) calculated by this 3D feature-tracking program against sonomicrometry (sono) at different stroke rates (SRs).

Methods:
Five freshly harvested pig hearts were pumped at 30-70 ml stroke volumes (SVs). Full-volume data was acquired via 4D echo at SRs of 45 beats per second (bps) and 90 bps for SVs 30 and 40 ml. Additional data was recorded before and after simulated myocardial infarction (MI) at all SVs. CS and LS were calculated for each SV and SR and graphed against sono data.

Results:
Both CS (R² = 0.798) and LS (R² = 0.828) have excellent linear agreement with sono data (All p<0.001). Bland-Altman analyses demonstrate overestimation at both CS (7.809) and LS (5.451), with 96% of points within a 95% CI. After MI induction, CS and LS were significantly decreased, still with a good linear relationship with sono data (CS: R² = 0.7652, LS: R² = 0.8838) (p<0.001); the overestimation was 6.098 (CS) and 7.384 (LS), 96% and 98% of points within 95% CI respectively. Low and high SRs were found to have no significant difference in terms of strain (p=0.142).

Conclusion:
Toshiba’s 3D-WMT program works to determine CS and LS from 4D volumes with values comparable to sonomicrometry. Different SRs have no significant impact on analysis.
Abstract 9041: Cost Effective Risk Assessment of Asymptomatic Wolff Parkinson White Syndrome Patients
Authors: Snyder Christopher , Steinberg Joan
Published: April 2024

Background:
Asymptomatic ventricular pre-excitation (aVPE) is a conduction abnormality that may result in sudden death resulting from rapid conduction down the accessory pathway during atrial fibrillation (AFib). The purpose of this study was to identify the most cost effective approach to risk assessing aVPE patients.

Methods:
A cost effectiveness analysis was performed using a decision tree model (TreeAge Pro software) comparing aVPE patients undergoing a transvenous electrophysiology study (TVEPS) vs. step wise risk assessment consisting of exercise stress test(EST), transesophageal electrophysiology study (TEEPS) and TVEPS if risk could not be determined. A TEEPS followed EST when VPE did not disappear in a single beat and TVEPS followed TEEPS when not effective inducing Afib or was risky (shortest preexcited RR interval < 250 msc). Efficacy of EST was 15% and the ability of TEEPS at inducing Afib was 88%; with 78% having no risk (published results.) Sensitivity analysis investigated the impact of changes in the efficacy assumption on the cost effectiveness results. Costs were 2009 Medicare reimbursement rates with cost of EST $ 277, TEEPS $990, and TVEPS $4035.

Results:
The step wise approach involving EST, TEEPS and TVEPS when necessary is the most cost-effective method of identifying aVPE patients at risk with an expected cost of $2,174 compared to $4,035 for those initially undergoing TVEPS. Combining efficacy and cost data on these patients, this approach (EST- TEEPS - TVEPS) results in an average savings of $1,861 per patient. This step wise approach remained cost effective as long as TEEPS efficacy rate is > 31% on patients not screened out at EST.

Conclusions:
This step wise approach (EST-TEEPS-TVEPS) is the most cost effective way to risk assessment of aVPE patient. This approach yields an average savings of $1,861 per patient.
Abstract 9111: Augmented Cardiac Formation of Oxidatively-Induced Carbonylated Proteins Accompanies the Increased Functional Severity of Post-Myocardial Infarction Heart Failure in the Setting of Type 1 Diabetes Mellitus
Authors: Dennis Kathleen E , Odiete Oghenerukevwe , Hill Salisha , Rose Kristie L , Hill Michael F
Published: April 2024

Type 1 diabetes mellitus (DM) patients surviving myocardial infarction (MI) have substantially higher cardiovascular mortality than those without DM. We have previously shown that after MI, type 1 DM is associated with accentuated myocardial oxidative stress (OS) and concomitant worsening of left ventricular (LV) function. However, the precise mechanisms whereby type 1 DM-enhanced OS adversely affects HF after MI remain obscure. As carbonylation of proteins is an irreversible post-translational modification induced only by OS that often leads to the loss of function, we analyzed protein-bound carbonyls in the viable LV myocardium of MI and DM + MI rats in relation to residual LV function at 4 weeks post-MI. Type 1 DM was induced in male Sprague-Dawley rats by a single injection of streptozotocin (65 mg/kg i.p.). Two weeks after induction of type 1 DM, MI was produced in DM and non-DM rats by left coronary artery ligation. Residual LV function was assessed by echocardiography. Carbonylated proteins were detected through oxyblot analysis, and identified by mass spectrometry. Mortality following induction of MI was higher among the DM + MI group compared to the MI group (47% vs. 33%, respectively). Compared with MI rats, DM + MI rats exhibited significantly greater LV systolic dysfunction as well as elevated wet to dry weight ratios of the lungs (Table), indicating an increased functional severity of HF among the DM + MI group. No difference in the weight of myocardial scar caused by the infarction was observed between the MI and DM + MI groups (Table). Protein carbonyl content in cardiac tissue and isolated mitochondria of DM + MI rats was 20% and 48% higher, respectively, than in MI rats (n=4/group). Anti-oxidative enzymes and fatty acid utilization proteins were the predominant carbonylated proteins identified. The findings of this
in vivo
study implicate protein carbonylation as part of the molecular pathophysiology of aggravated HF in the type 1 diabetic post-infarction heart.
Abstract 9127: C-myb-regulated Expression Of Mir-143/145 In Embryonic Stem Cell-derived And Adult Vascular Smooth Muscle Cells
Authors: El-Mounayri Omar A , Ishida Masayoshi , Husain Mansoor
Published: April 2024

Background:
The c-myb gene encodes for the transcription factor c-Myb, which has been implicated in the differentiation of vascular smooth muscle cells (VSMCs) from neural crest and embryonic stem cells (ESCs). Mouse ESCs lacking c-myb (KO) failed to express SMC-specific genes and did not differentiate into contractile SMCs in embryoid bodies (EB), with c-Myb regulating the formation of a specific Flk-1+/PDGFRα- (F+/P-) progenitor of VSMCs. Others showed that expression of the miR-143/145 cluster is restricted to adult SMC lineages and promotes the expression of contractile genes. Hypothesis: c-Myb mediates the transcriptional regulation of miR-143/145.

Methods &Results
: Flow-sorting of cardiovascular-directed d3.75 EBs showed high levels of miR-143/145 expression in F+/P- (c-myb high) cells, with low levels in other (c-myb low: F+/P+ and F-/P+) cell populations. Importantly, no differences in the expression levels of miR-143/145 could be detected in F+/P-, F-/P+ and F+/P+ cells derived from c-myb KO EBs. Multiple putative c-Myb consensus-binding sites (conserved in human and mouse) were identified in 3kb and 20kb enhancers upstream of the miR-143/145 cluster. Chromatin immunoprecipitation assays in both cardiovascular-directed d3.75 EBs and immortalized mouse adult aortic SMCs (MOVAS) revealed c-Myb binding to multiple specific sites. Next, c-Myb responsiveness of wild-type and deletion mutant enhancer-reporter constructs was assayed in HEK293 cells. These studies confirmed two c-Myb-dependent miR-143/145 enhancer activities.

Conclusion:
Our data suggest that c-Myb-regulated VSMC differentiation and contractile gene expression may be mediated by direct binding to specific transcription enhancer elements in the miR-143/145 cluster. *Authors have contributed equally to this work.
Abstract 92: Prehospital Activation of an Emergency Department Cardiac Arrest Response Team Improves ROSC and Hypothermia Utilization
Authors: Deal Nathan , Borak Meredith , Karol Janet , Sharp Willard W , Shah Atman P , Beiser David G
Published: April 2024

BACKGROUND: The induction of therapeutic hypothermia (TH) in comatose survivors of out-of-hospital cardiac arrest (OOHCA) improves survival and neurologic recovery outcomes. Despite results from high-quality randomized control trials and international consensus statements, TH utilization rates remain low. Pre-hospital activation of specialized care teams improves outcomes at trauma, ST-segment elevation myocardial infarction, and stroke receiving centers. We hypothesized that pre-hospital activation of a cardiac arrest response team would augment Emergency Department resuscitation resources and thus improve TH utilization and outcomes for out-of-hospital cardiac arrest patients.

METHODS: An emergency department cardiac arrest response team (eCART) comprised of a cardiology fellow, pharmacist, respiratory therapist, hospital chaplain, and a therapeutic hypothermia expert (“Dr. COOL”) was created at an urban academic hospital. The eCART team was immediately activated by emergency department staff after receiving EMS radio notification of an arrest transport. We compared outcomes in consecutive adult OOHCA patients during the 8 month period before (PRE) and after (POST) instantiation of the eCART activation system.

RESULTS: Clinical characteristics of patients in the PRE (n = 46) and POST (n = 63) intervention periods were similar. The CART activation system was utilized for 97% of OOCHA cases presenting to the emergency department. Rate or return of spontaneous circulation (ROSC) was significantly higher during the POST vs. PRE period (37% vs. 17%, p < 0.05). Initiation of TH in eligible patients was also significantly higher during the POST vs. PRE period (100% vs. 80%, p < 0.05). No difference in the time from ROSC to TH goal temperature < 34 degrees Celsius (201 min +/- 125 vs. 212 min +/- 81, p >0.05) or cardiac catheterization laboratory utilization (43% vs. 50%, p > 0.05) was noted between POST and PRE periods respectively.

CONCLUSION: Pre-hospital activation of an eCART team is associated with improvements in ROSC rate and tended to increase TH utilization. These results suggest that rapid deployment of a specialized cardiac arrest response team to the emergency department may be an effective strategy for improving OOHCA resuscitation.