bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18095: Prognostic Impact of Sleep Duration and Sleep Efficiency on Mortality in Patients with Chronic Heart Failure
Authors: Reinhard Wibke , Plappert Nina , Hengstenberg Christian , Riegger Günter , Novak Victor , Maimon Nimrod , Pfeifer Michael , Arzt Michael
Published: April 2024

Context:
Both short and long self-reported sleep duration has been linked to increased mortality risk. The underlying mechanisms for the mortality risk increase in long sleepers are unknown.

Objective:
To test, whether long self-reported sleep duration is paralleled by impaired objectively measured sleep efficiency and to assess whether impaired sleep efficiency is an independent risk factor for death in patients with chronic heart failure (CHF). Hypotheses were formulated after data collection.

Design, Setting, Patients:
Observational study of 211 consecutive CHF patients (age 63±10 years, 89% men, left ventricular ejection fraction 34±10%), who underwent polysomnography and completed standardized questionnaires between 1/2002 and 12/2009 at the University Hospital Regensburg.

Main Outcome:
All cause mortality ascertained by medical documents. Follow-up was performed between 12/2009 and 01/2010 (mean follow-up time: 44±26 months).

Methods and Results:
Comparison of objective sleep efficiency in CHF patients showed an inverse U-shaped relationship according to quintiles of self-reported sleep duration: Sleep efficiency in CHF patients from the highest quintile (≥9h of self-reported sleep duration) was significantly lower as compared to the middle quintile with 7.25-8h of self-reported sleep duration (71±15% versus 77±11%, p=0.032) and identical to the lowest quintile (≤5.75h of self-reported sleep duration; 71±15% versus 71±16%, p=0.950). Fifty-seven patients died during follow-up. Objective sleep efficiency, age, left ventricular ejection fraction and cause of CHF were identified as independent risk factors for all-cause mortality in a multivariate adjusted survival analysis (p<0.001, p=0.022, p=0.005 and p=0.002, respectively), while self-reported sleep duration did not influence mortality.

Conclusions:
Objective sleep efficiency is significantly impaired in CHF patients with prolonged self-reported sleep duration compared to those with medium self-reported sleep duration, suggesting a misperception of sleep in these patients. In contrast to self-reported sleep duration, objective sleep efficiency predicts mortality in CHF patients independently from age, cardiac function and cause of CHF.
Abstract 18113: High Exercise-Induced Platelet Reactivity in Patients with Fabry Disease
Authors: Pieroni Maurizio , Smaldone Costantino , Camporeale Antonia , Scalone Giancarla , Macchione Andrea , Feliciani Claudio , Bellocci Fulvio , Lanza Gaetano A , Crea Filippo
Published: April 2024

Background:
Cerebrovascular events represent a major cause of disability in young patients with Fabry disease (FD). However the pathogenesis of cerebrovascular events in these patients is not fully understood and prevention, besides enzyme replacement therapy (ERT), is empirically based on antiplatelet drugs. We evaluated platelet function in patients with FD without evidence of coronary or carotid atherosclerosis.

Methods:
Fifteen patients with genetically confirmed FD (mean age 42, 6 F) underwent treadmill exercise stress test (EST). Platelet reactivity was assessed by flow cytometry at baseline and at peak EST, with and without ADP stimulation, by measuring monocyte-platelet aggregate (MPA) formation (expressed as percentage of monocyte binding platelets) and CD41 expression (assessed as mean fluorescence intensity). All patients underwent carotid ultrasound and coronary angiography to rule out carotid or coronary artery disease. Patients on ERT were submitted to EST the day before drug infusion. Thirty healthy sex- and age-matched subjects were studied as controls.

Results:
Coronary angiography and carotid ultrasound showed no evidence of atherosclerosis in all FD patients; EST showed signs of ischemia in 3 patients with FD cardiomyopathy. Thirteen patients were on ERT at the time of the study. Compared to resting values, MPA and CD41 expression,with and without ADP stimulation, significantly increased after exercise in the FD group but not in controls. Exercise-induced values of MPA (20.1vs18.7, p=0.001 - with ADP:25.2vs22.0, p<0.0001) and CD41 expression (20.3vs19.4 p=0.006 - with ADP:26.1vs21.9, p<0.0001) were higher in FD patients than in controls, while resting values didn't significantly differ.

Conclusions:
High exercise-induced platelet reactivity has been reported in patients at high risk for thrombotic events, like those with coronary or peripheral atherosclerosis. In this study we found high exercise-induced platelet reactivity in patients with FD, suggesting that enhanced platelet reactivity may contribute to the pathogenesis of cerebrovascular events in these patients. Our data support the inclusion of antiplatelet drugs in conventional therapy for FD. The effect of ERT on platelet function remains to be clarified.
Abstract 18335: The Heart in Duchenne Muscular Dystrophy Mouse Model (mdx Mice) Loses Beta-Adrenergic Reserve at Early Age Before the Onset of Heart Failure
Authors: Li Zhengzhou , Li Ying , Zhang Xiaoying , Ai Xiaojie , Zhang Li , Szeto Christopher , Ge Shuping , Chen Xiongwen
Published: April 2024

Duchenne muscular dystrophy (DMD) is a hereditary X-linked recessive disease that resulted from the mutation of dystrophin. Cardiac dysfunctions of this disease include heart failure and arrhythmias. The deterioration of cardiac function is manifested at the age of 6 months (6m). β-adrenergic stress test has been used to evaluate cardiac reserve in humans but so far not used for mdx patients. We studied cardiac β-adrenergic reserve to evaluate cardiac function alteration in mdx mice.

Methods:
Cardiac function of mdx mice and control (CTR) mice at different ages at baseline and post isoproterenol (a β-adrenergic agonist) stress was evaluated with in vivo echocardiography (ECHO), invasive intra-LV hemodynamic and ex vivo Langendorff measurements.

Results:
(1). Conventional M-mode ECHO analysis did not uncover differences in cardiac ejection fraction and fractional shortening at baseline between mdx mice and CTR mice before the age of 6m but ISO induced increases in LV ejection fraction (EF) and fractional shortening (FS) were lower in mdx mice as early as the age of 3m; (2). At baseline, speckle-tracing strain analysis had higher detection power for cardiac abnormalities and showed a subtle differences (Lateral strain of the endomyocardium: mdx 16.4% vs. control 18.4%) in myocardium contractility at baseline as early as 3m; with combination of ISO-stress and speckle-tracing strain analysis, reduced cardiac responses was very significantly at the age as young as 3m; (3). In vivo intra-LV hemodynamic measurements showed a reduction in dp/dt (21% ) and -dp/dt (30%) at the age of 8m; ISO responses was completely blunted in mdx mice at the age of 8 m and reduced in 4m mdx mice; (4). Ex vivo Langendorff studies showed that 4m mdx mouse hearts had marked decreased dp/dt and -dp/dt and after ISO, the difference was even larger (>35%). The dose-response curve shows that the mdx mouse hearts are less sensitive to ISO.

Conclusion:
Although basal cardiac function looked normal in mdx mice before the age of 6m, Langendorff preparations and subtle speckle tracking ECHO analysis reveal cardiac function depression in younger mdx mice. β-adrenergic stress further brings out the difference in cardiac reserve of mdx mice as young as 3m. ZL and YL contributed to this study equally.
Abstract 200: Temporal Relationship Between Left Ventricular Dysfunction and Plasma High-Sensitivity Cardiac Troponin T Levels in a Rat Model of Cardiac Arrest and Resuscitation
Authors: Russo Ilaria , Staszewsky Lidia , Fumagalli Francesca , Masson Serge , Latini Roberto , Ristagno Giuseppe
Published: April 2024

Introduction.
Post resuscitation left ventricular (LV) dysfunction is one of the leading causes of death after return of spontaneous circulation (ROSC). Impairment in cardiac myofilament cross-bridge cycling and the associated degradation and release of cardiac troponins (cTn) concur to depressed contractile function. We hypothesized that the severity of myocardial dysfunction would be associated with plasma cTn levels following cardiac arrest in rats.

Methods.
Ventricular fibrillation was induced in 17 rats and was untreated for 6 min. CPR, including mechanical chest compressions, ventilation, and epinephrine, was then initiated and continued for additional 6 min prior to defibrillations. Two, 4, and 72 hr following ROSC, LV morphology, systolic and diastolic function were assessed by echocardiography. Animals were then sacrificed, plasma collected and high sensitivity cTnT (hs-cTnT) assayed. Additional 5 rats were not subjected to cardiac arrest and served as controls.

Results.
At 2 and 4 hr post ROSC, LV end-diastolic volume was enlarged compared to controls (+22% and +25%, respectively) but similar at 72 hr. LVEF was lower than in control rats at 2 and 4 hr following ROSC (Fig., left pannel), but similar at 72 hr. Post ROSC deceleration time (DT) of the E wave showed similar trends (Fig., middle pannel). Plasma release of hs-cTnT increased at 2 and 4 hr post ROSC compared to controls, but was similar at 72 hr (Fig., right pannel). LVEF and DT were significantly inversely correlated with hs-cTnT (r=-0.89, p<0.0001 and r=-0.53, p=0.014).

Conclusions.
A strong relationship between LVEF and circulating hs-cTnT was observed at different time points following ROSC. Normal LV function at 72 hr post ROSC indicates that myocardial viability was preserved even after remarkable TnT release.
Abstract 220: Analysis of Actual CPR Through a Review of YouTube Video: Poor Performance Is Common in Professional and Lay Rescuers
Authors: Mendelson Jenny S , Grover Emily , Berg Marc D
Published: April 2024

INTRODUCTION:
Numerous studies have shown the performance of CPR in both prehospital and hospital settings often fails to meet recommended standards. We sought to analyze the quality of lay rescuer (LR) and professional rescuer (PR) CPR performance in real resuscitation events captured on video on the website YouTube.com.

METHODS:
We searched YouTube for videos of actual adult CPR recorded by bystanders. Videos which were staged for teaching, commercial use or entertainment were excluded. A convenience sample of 50 videos of CPR (in and out-of-hospital) was analyzed. Demographics and CPR quality parameters were collected. Compression depth was subjectively evaluated as adequate or inadequate (ie. not forceful enough).

RESULTS:
The 50 videos collected were uploaded between 12/2009 and 2/2011. They ranged from :07 to 9:57 minutes in length. Forty-two of 50 (84%) were of out-of-hospital arrests. CPR was done by LR in 17 and PR in 43. The mean chest compression (CC) rate was 110/m (SD 30, range 49-200) for all rescuers, 101/m (SD 29, range 46-166) for LR and 113/m (SD 28, range 49-200) for PR. In both groups, 40% of CC were slower than the recommended rate of 100/m. Inadequate release or leaning was seen in 66% of the time overall (11/17 (65%) of LR and 23/43 (53%) of PR). CC depth was adequate in 18/50 (36%) for both groups (3/17 for LR and 17/43 for PR). Depth was inadequate in 31/50 (62%) for both groups (14/17 for LR and 25/43 for PR). Compression depth adequacy was indeterminate in 1 video where the chest could not be seen. The mean time for rescue breath delivery was 7.8s (SD 4.4, range 3.4-25) overall, 6.3s (SD 3.1) for LR, 14.7s (SD 5.2) for PR. For PR, the mean ventilation rate by BVM alone or after intubation was 31/m (SD 17, range 3-66). 88% of ventilations were faster than the recommended 8-10/m.

CONCLUSIONS:
In actual bystander-recorded CPR, typical measures of CPR quality are often poor. Slow compression rates, excessive ventilation and significant periods of ‘leaning’ are common, in lay as well as professional rescuers. Mean CC rate is close to recommended rates, but with a very wide range making overall compliance poor. Poor compression depth was more common in LR CPR.
Abstract 221: Value of Initial Middle Latency Auditory Evoked Potential Index for Cardiopulmonary Arrest Resuscitation
Authors: Tsurukiri Junya , Kaneko Naoyuki , Mishima Shiro , Ikeda Yukiio , Ohta Shoichi
Published: April 2024

Introduction:
Non-invasive monitoring that can indicate cerebral resuscitation in cardiac arrest patients remains unknown. In an operative setting, middle latency auditory evoked potentials (MLAEP) provide a good discrimination of consciousness and cerebral function during anesthesia.

Hypothesis:
We seessed the hypothesis that initial MLAEP index (MLAEPi) can predict the return of spontaneous cardiac activity (ROSC) or survival on arrival at the emergency department (ED).

Methods:
This was a prospective study and included 50 patients with cardiac arrest who received BLS by prehospital paramedics. The patients were then administered ACLS by an emergency medical team member on arrival at ED. Initial MLAEPi was immediately measured using an aepEX monitor (1st version; Audiomex, Glasgow, UK) during the first cycle of ACLS in ED (Figure).

Results:
Seventeen (34%) patients who showed ROSC were admitted to our hospital (ROSC group); however, 33 patients did not show ROSC on resuscitation at the scene (non-ROSC group). Initial MLAEPi in the ROSC group was significantly higher than that in the non-ROSC groups (39±18 vs. 27±6, p<0.01). In the ROSC group, clinically significant correlations were identified between initial MLAEPi and the time to the beginning of ACLS (r=-0.57, p=0.02); time to ROSC from the beginning of BLS (r=-0.53, p=0.03); and lactate concentrations (r=-0.50, p=0.04). Eight patients were discharged from our hospital (survivors) and 4 of them had no disability as per Cerebral Performance Category 1. Initial MLAEPi of survivors was significantly higher than that of non-survivors (49±23 vs. 28±6, p<0.01). The ROC curve for initial MLAEPi demonstrated that area under the curve of 0.89 (95% CI=0.77-1.01, p<0.01), and MLAEPi cutoff point ≤ 33 predicted no survival with a likelihood ratio of 6.10 (sensitivity=76.2; specificity=87.5).

Conclusions:
In conclusion, although our sample size is small, it showed that initial MLAEPi is represented by simple numerical values for the initial evaluation of ROSC and survival in cardiac arrest patients. Alternatively, MLAEPi may help emergency medical teams as a clinical predictor for termination of resuscitative efforts in a clinical setting.
Abstract 226: Nurses' Retention of BLS and ACLS Skills Improves Survival from In-Hospital Cardiac Arrest
Authors: Kikuchi Migaku , Matsushima Hisao , Tosaki Yukiko , Tomizawa Ikue , Taguchi Isao , Abe Shichiro , Ono Kazuyuki , Inoue Teruo
Published: April 2024

OBJECTIVE:
To evaluate whether nurses' retention of BLS and ACLS skills improves survival from in-hospital cardiac arrest (IHCA).

METHODS:
A prospective interventional cohort study was performed. All of 24 registered nurses in a general ward were assigned to 6 groups after training of BLS and ACLS. At immediately and 9 months after training, the 6 groups were evaluated by skill performance tests based on the American Heart Association 2005 BLS and ACLS tools in simulated environment. Survival from IHCA after resuscitation efforts by nurses as first responders was classified after-training term (2010) and before-training term (2008-2009) and examined the outcome.

RESULTS:
The evaluation in 9 month after training resulted that core skills of chest compression were well-retained. Delivering 30 compressions and 2 ventilations, pressing first shock button of AED < 90 seconds from AED arrival and management of drug use were also well-retained in 6 groups, whereas both first 2 ventilations with bag-valve-mask were done in only one group. Checking carotid pulse or checking breathing was little done for at least 5 seconds but no more than 10 seconds. As concerns survival from IHCA, 53 patients (67.8 yr, M/F=35/18) received resuscitation efforts by nurses as first responders in 2008-2009, and 6 patients (77.4 yr, M/F=4/2) received resuscitation in ward in 2010. The outcome of in-ward cardiac arrest after training improved significantly compared with that of IHCA before training. The return of spontaneous circulation rate increased from 38% to 83% (P=0.04), 7-day survival increased from 19% to 83% (P=0.003), 30-day survival increased from 15% to 67% (P=0.01), and cerebral performance category 1 at hospital discharge increased from 11% to 50% (P=0.04).

CONCLUSIONS:
Registered nurses had well retained BLS and ACLS skills for 9 months. The nurses' retention of those skills improved survival from IHCA. Contrary to other skills, the skills of assessment for breathing and circulation were little retained. This assessment may not affect on the outcome, and thus, our results may support validity that “look, listen and feel for breathing” was removed from assessment step of the 2010 algorithm, as well as that “A-B-C” changed to “C-A-B”.
Abstract 229: Are There Any Cultural Barriers to Automated External Defibrillator Use in Middle Eastern Countries?
Authors: Merrigan Orla H
Published: April 2024

Background:
To date, no study has explored the role of cultural barriers to use of an Automated External Defibrillator (AED) in Arab Gulf countries. This study examines the role of ethnicity on acceptability ratings for resuscitation and use of an AED.

Methods:
Male and female respondents (n=345) at an exhibition completed a questionnaire assessing knowledge and attitudes towards the use of an AED in sudden cardiac arrest situations in a public setting. Participants were provided with one of twelve different photographed vignette scenarios of a victim in cardiac arrest with a rescuer of three different ethnic groups (European, Indian Sub-Continent and Arab). Participants then completed acceptability ratings in relation to CPR, AED and x use.

Results:
Results demonstrated no significant effect of gender in relation to AED usage but a significant difference between those who know what an AED was used for and those who did not. Significant differences were found on acceptability ratings of questions in relation to CPR, AED and X when the victim was female. Specifically, participants were significantly more likely to express low acceptability ratings for male rescuer intervention when the male was from the Indian sub-continent. No differences were observed between scores in relation to a European male rescuer and an Arab male rescuer.

Conclusion
This study indicates a lack of knowledge and awareness in the Bahraini population in relation to the correct function of AED and when it should be used. Specific ethnic grouping of the Indian sub-continent appears to be a barrier to both AED use and CPR when the victim is an Arab female. This has implications for the delivery of training in AED usage and possibly the selection of those who should be trained. Any area in Gulf Arab countries, who purchase an AED, should ensure that a majority of female rescuers should be trained in cardiopulmonary resuscitation and use of the AED.
Abstract 278: Successful Conversion of Ventricular Tachyarrhythmias by Wearable Defibrillator
Authors: Mossesso Vincent N , Li Jie , Landsittel Douglas , Ganz Leonard I
Published: April 2024

Ventricular fibrillation (VF) and ventricular tachycardia (VT) are lethal cardiac dysrhythmias which must be treated within minutes of onset to avoid death. Certain patients who are high risk for VF/VT are not eligible or appropriate in the short term for an implantable cardiac defibrillator (ICD). The wearable cardioverter defibrillator (WCD) is a bridge device for use during this waiting period. This study tested the hypothesis that the WCD would successfully convert VF/VT to a perfusing rhythm in all patients. In addition, we determined the incidence of shocks delivered to patients using the WCD and classified shocks as appropriate or inappropriate.

Methods:
We retrospectively reviewed data of all patients prescribed a WCD between January 1, 2007 and December 31, 2009 whose end of use date occurred on or prior to March 31, 2010 in the ZOLL LifeVest post-market registry. This included ECG recordings and customer call reports related to all shock events and deaths that occurred during WCD use. A single event was defined to include all episodes of VF/VT within a 24 hour period. Data were analyzed using summary statistics.

Results:
The registry included 15,193 persons with mean age 59.8 +/- 14.5 years (SD); 71.5% were male. Total exposure to WCD was 2,378 person-years in 14,475 persons with a mean duration of WCD use per person of 59.9 +/- 59.1 days. The most common indications were non-ischemic cardiomyopathy (40.1%), myocardial infarction (33.0%), and ICD pocket infection (12.1%). There were 203 VF/VT events and 378 individual episodes of VF/VT (0.16 episodes/person-year of WD use) in 185 persons (1.3% of WD users). Shock led to organized rhythm in 345 (91.3%) of VF/VT episodes and persistent VF/VT in 26 (6.9%). Event survival was 91.6%. None of the 223 inappropriate shocks delivered to 213 persons resulted in death.

Conclusion:
The WCD was highly effective for prevention of sudden death in persons at high risk of VF/VT but not yet eligible for an ICD, with no mortality from inappropriate shocks.
Abstract 279: Variables Associated with Successful Intubation Attempts Using Video Laryngoscopy: A Preliminary Report in a Helicopter Emergency Medical Service
Authors: Carlson Jestin N , Quintero Jorge , Guyette Francis X , Callaway Clifton W , Menegazzi James J
Published: April 2024

Introduction:
Multiple studies have demonstrated varying rates of successful endotracheal intubation (ETI) in the prehospital setting. Until the recent advent of video laryngoscopy, little information regarding the intubation process could be analyzed objectively by individuals other than the provider performing the ETI. We evaluated the association of variables recorded during video laryngoscopy and successful ETI attempts, defined as placing the endotracheal tube in the trachea.

Methods:
We retrospectively reviewed intubations performed by a single helicopter emergency medical service using a video larygoscope over an 8-month time period. Time intervals (e.g. attempt time) and intubation process variables (e.g. Cormack-Lehane view) were abstracted from all videos. We describe variables using means and standard deviations (continuous), medians with interquartile ranges (ordinal) and percentages (categorical). We examined the univariate associations between these variables and ETI success using logistic regression.

Results:
Results: We recorded 116 intubations during the study period. Twenty-nine recordings were either incomplete (n=26) or of insufficient quality for analysis (n=3). The remaining 87 videos represented 87 different patients with a total of 102 attempts at laryngoscopy. The first-pass success rate in this series was 76% (n=66) with 98% success within three attempts. Successful ETI attempts had lower entry to percentage of glottic opening (POGO) times (16.6 sec vs. 32.1 sec, p=0.013), entry to tube times (17.6 sec vs. 27.4 sec, p=0.04), higher POGO scores (76 vs. 39, p<0.001) and lower Cormack-Lahane views (1 vs. 3, p<0.001). Recognized esophageal intubation was more likely to occur during unsuccessful ETI attempts (43% vs. 8%, p<0.001).

Conclusion:
Video laryngoscopy provides a variety of time interval and intubation process variables regarding ETI that can be abstracted. Successful ETI attempts have significantly shorter entry to POGO times, entry to tube times, obtain better views of the glottic opening (POGO and C-L views) and a lower incidence of recognized esophageal intubation.
Abstract 33: Videolaryngoscopy Improves EMS Intubation Success in Cardiac Arrest Patients
Authors: Rothfield Kenneth P , Seaman Kevin G , Duell Michelle , Pellegrini Joseph E
Published: April 2024

Introduction:
Emergency intubation by prehospital providers may be associated with a high rate of complications, including intubation failure, multiple attempts, and esophageal intubation, with increased errors noted in providers that perform intubation infrequently(1-3). Compared to conventional laryngoscopy (CL), the Glidescope (GS) videolaryngoscope (Verathon, Bothell WA) requires less training, and may be used safely by providers less skilled in intubation (4,5). In Howard County, Maryland, the intubation success rate by EMS personnel in 2009 was approximately 61%. The GS was considered as a potential tool for performance improvement. The purpose of this prospective, descriptive study was to determine the success rates and complications encountered after the implementation of GS for emergency intubation by EMS providers in Howard County.

Methods:
After IRB and Maryland State EMS Board approval, GS Ranger units were acquired and incrementally placed on 12 EMS vehicles. Prior to implementation all paramedics received didactics and simulator training on the GS. Variables measured included indication for intubation, number of attempts, time to intubation, success rates, rescue airway requirements and intubating conditions. Conventional laryngoscopy (CL) and the King LTD were identified as rescue airway devices.

Results:
A total of 42 emergency intubations for cardiac arrest were evaluated during the first 90 days of the study. Overall intubation success was 95% (p<0.05), with 60% first pass success when GS was used. The King LTD was used successfully in 1 patient. Only 2 patients did not have a secured airway on transport to the ED. Average time for a successful intubation attempt was 23 seconds. Of note, there were no esophageal intubations, dental or soft tissue injuries.

Conclusions:
Following minimal training, prehospital providers intubate with a higher success rate when GS is available. These results should prompt further evaluation of videolaryngoscopy by EMS systems.

References:
1.Cobas, et al. Anesth Analg 2009:109, 489-93. 2.Katz et al. Ann Em Med 2001:37, 32-37. 3.Wang et al. Health Affairs 2006:25, 501-09 4.Nouruzi-Sedeh et al. Anesthesiology 2009:110, 32-37. 5.Rothfield et al. ASA Late Breaking Abstract #16, 2010.
Abstract 11152: Trends in Survival after In-Hospital Cardiac Arrest
Authors: Girotra Saket , Nallamothu Brahmajee K , Spertus John A , Li Yan , Krumholz Harlan M , Chan Paul S ,   American Heart Association Get With the Guidelines—Resuscitation (GWTG-Resuscitation) Investigators
Published: April 2024

Saket Girotra, 2011 Finalist and Presenting Author
Abstract 8811: Pheochromocytoma Cardiomyopathy: The Extreme Effect of Catecholamines on the Heart
Authors: Gupta Rajat M , Desai Akshay S
Published: April 2024

Rajat M Gupta, 2011 Finalist and Presenting Author
Abstract 54: The Impedance Cardiogram as an Indicator of Chest Compression Efficacy During Cardiopulmonary Resuscitation in a Porcine Model: Correlation with Physiological Parameters and Comparison with Compression Depth and Thrust
Authors: Howe Andrew J , Di Maio Rebecca , Crawford Paul , Brody David , Navarro Cesar , McEneaney David , Clutton Eddie , Anderson John , Adgey Jennifer
Published: April 2024

Introduction
The 2010 AHA resuscitation guidelines re-emphasised the importance of chest compressions as the cornerstone of effective CPR. In an attempt to improve chest compression efficacy numerous CPR feedback devices have been developed and have demonstrated their utility in improving guideline compliant CPR but not patient outcomes. The impedance cardiogram (ICG) provides a non-invasive measure of haemodynamic status and has been investigated as an additional method of improving CPR.

Objectives
The purpose of this study was to examine the relationship between chest compression thrust, depth and ICG amplitude during CPR and establish their correlation with invasive physiological measurements.

Materials and methods
Ethical approval for this study was granted by the Northern Ireland Home Office. A total of 12 porcine models were used weighing mean 31kg. Anaesthesia was achieved with intravenous propofol and inhaled isoflourane. Ventricular fibrillation was induced using a pacing wire inserted into the right ventricle. CPR was administered using the HLR-201®, Michigan Instruments. The Impedance Cardiogram (ICG) was recorded via 2 standard defibrillation electrodes. Depth (cm), thrust (kg), end-tidal CO
2
(kPa), systolic blood pressure (mmHg), carotid flow (ml/min) and cardiac output (L/min) were measured at 2 minute intervals for each model.

Results
There is a strong correlation between ICG amplitude and physiological parameters, comparable to correlations achieved with compression depth and thrust. (Table 1) Table 1: Summary of correlations between physiological parameters and ICG, compression depth and thrust during CPR

Conclusions
The ICG amplitude provides an additional measurement of CPR efficacy with physiological correlations comparable to both chest compression thrust and depth. This non-invasive measurement could be exploited in the development of new CPR feedback algorithms for automated external defibrillators.
Abstract 9306: Site-Specific Reporter Gene Imaging of Stem Cell Transplantation: Early Engraftment Predicts Late Improvement in Cardiac Function
Authors: Narsinh Kazim H. , Lan Feng , Liu Junwei , Robbins Robert C. , Wu Joseph C
Published: April 2024

Kazim H. Narsinh, 2011 Finalist and Presenting Author
Abstract 8089: A Novel Method to Inhibit Diabetes Accelerated Atherosclerosis in a Pig Model
Authors: Maile Laura , Nichols Timothy , Flowers William , Clemmons David
Published: April 2024

Smooth muscle cells grown in high glucose are more responsive to IGF-I than those grown in normal glucose. This requires ligand binding to a unique region of the β3 subunit (C-loop) of αVβ3 integrin. This study was undertaken to determine whether systemic administration of an anti-C-loop β3 (Cloop) antibody to hyperglycemic pigs would inhibit the IGF-I mediated signaling events and the development of atherosclerosis. Pigs were placed on a high fat diet containing between 0.5 and 2% cholesterol to maintain circulating cholesterol levels > 500mg/dL. Hyperglycemia (glucose levels > 350mg/dL) was induced with a single injection of streptozotocin (50mg/kg). At the onset of hyperglycemia subcutaneous injections of either control or Cloop antibody were given every 72 hours for 16 weeks (0.3mg/kg). The mean neointimal area (defined as the area inside the internal elastic lamina minus the luminal area) of the aorta was reduced by 70% in the pigs treated with the anti-Cloop antibody compared with the diabetic pigs treated with control antibody. There was a > 90% reduction in neointimal area in the left main artery in the treated compared with the untreated control pigs. Similarly, there was a greater than 75% reduction in neointimal area in the right coronary artery and circumflex artery. Treatment with the antibody reduced the neointimal formation in the left anterior descending artery by 30%. Biochemical analysis of femoral artery homogenates demonstrated that treatment with the anti-Cloop antibody reduced MAPK and AKT signaling by 36 and 40 % respectively compared with control treated animals. We have previously shown that IGF-I stimulation of these pathways is increased in hyperglycemia in a β3 ligand occupancy dependent manner and results in SMC migration and proliferation. To confirm inhibition of β3 activation we determined that there was a 43% reduction in β3 phosphorylation, a marker of its activation state. Our results demonstrate that systemic administration of the C-loop antibody to hyperglycemic hyperlipidemic pigs reduces IGF-I signaling and this is associated with a significant reduction in the development of atherosclerotic lesions in the coronary arteries and aorta.
Abstract 8273: Statins Enhance the Beneficial Effects of Olmesartan on Renal Injury in Salt-Sensitive Hypertensive Rats via the Reduction of an Angiotensin-Mineralocorticoid Receptor Signaling Interaction
Authors: Cheng Xian Wu , Inoue Aiko , Hu Lina , Song Haizhen , Sasaki Takeshi , Kuzuya Masafumi , Okumura Kenji , Murohara Toyoaki
Published: April 2024

Objective.
The renin-angiotensin-aldosterone system (RAAS) has been implicated in the pathogenesis of chronic cardiorenal diseases. Statins and angiotensin type 1 receptor (AT1R) antagonist improve hypertensive renal remodeling and dysfunction in patients with proteinuric kidney disease. The present study investigated the comparative effects of a combination of statin and AT1R antagonist and AT1R antagonist monotherapy on renal injury.

Methods and Results.
Dahl salt-sensitive (DS) rats on a high-salt diet were randomly assigned to four groups (
n
= 10 for each group) that were treated with either vehicle (0.5% carboxymethyl cellulose), a low or high dosage of olmesartan (1 or 3 mg/kg/d), or pitavastatin (1 mg/kg/d) plus olmesartan (1 mg/kg/d) from 12 to 19 weeks of age. Rats fed a low-salt diet served as age-matched controls. Rats on the high-salt diet developed massive proteinuria and glomerulosclerosis, and these changes were attenuated by olmesartan in a dose-dependent manner. The amounts of mRNAs for AT1R, mineralocorticoid receptor (MR), osteopontin, monocyte chemoattractant protein-1 and collagen type I, and the activities for matrix metalloproteinase-9 and cathepsin S were significantly higher in the failing kidneys of vehicle-treated rats than in the age-matched control rats; Olmesartan significantly attenuated these changes. Olmesartan attenuated both the decrease in the ratio of reduced to oxidized form glutathione and the increase in nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activity apparent in the kidney cortex of vehicle-treated rats. Furthermore, olmesartan inhibited kidney cortex vascular inflammation and renal fibrosis. The addition of pitavastatin significantly enhanced these beneficial effects of AT1R antagonism via anti-inflammation and anti-proteolysis.

Conclusions:
The beneficial renal effects of AT1R antagonism are likely attributable, at least in part, to the attenuation of renal oxidative stress and renal vascular inflammation induced by the AT1R-MR signaling interaction. The combination of statin with angiotensin receptor blocker (ARB) may be a potential therapeutic strategy for renal injury with proteinuria.
Abstract 8545: Left Atrial Function Assessed by Speckle Tracking Echocardiography as a Predictor of New-Onset Atrial Fibrillation: Results from a Prospective Study in 580 Adults
Authors: Fujii Tomoko , Kawasaki Masanori , Tanaka Ryuhei , Ono Koji , Matsuoka Reiko , Abe Shintaro , Tokoro Fumitaka , Goto Yoshiaki , Yoshizane Takashi , Kato Takashi , Warita Syunichiro , Kojima Tai , Iwama Makoto , Tanihata Shintaro , Noda Toshiyuki , Iida Mami , Watanabe Sachiro , Watanabe Takatomo , Minatoguchi Shinya
Published: April 2024

Background:
Risk stratification for atrial fibrillation (AF) based on left atrial (LA) remodeling may have a major public health impact. Although LA volume (LAV) or LA dimension have been proposed as predictors of AF, LA function have not yet been fully examined. Using speckle tracking echocardiography (STE), assessment of LA structure and function is feasible. The aim of this prospective study was to evaluate LA function for the prediction of increased risk of new-onset nonvalvular AF.

Methods:
We examined LA phasic emptying function (EF), strain rate (SR) and volume in apical 4-chamber view using STE in 580 consecutive adults (age 64±17) without a history of atrial arrhythmia and mitral valve disease. Left ventricular mass, ejection fraction and E/e’ and coronary risk factors were also evaluated. Then, we followed occurrence of AF prospectively.

Results:
During a mean follow-up period of 2.4±0.3 years, 32 subjects (age 73±9, 18 men) developed electrocardiographically-confirmed AF. Subjects with new-onset AF had lower LA active EF (16±5% vs. 28±8%, p<0.001) and lower LA SR at atrial contraction (-0.9±0.2 S
-1
vs. -1.4±0.5 S
-1
, p<0.001), but larger maximum LAV index (59±12 ml/m
2
vs. 46±16 ml/m
2
, p<0.001) compared with non-AF subjects at baseline. In multivariate logistic regression analysis, LA active EF was the only independent predictor of new-onset AF. Using an LA active EF cutoff of 20%, the sensitivity and specificity for new-onset AF based on receiver operator characteristic curve analysis were 88% and 81%, respectively (area under the curve (AUC): 0.92), whereas those of maximum LAV were 94% and 53% (AUC: 0.77).

Conclusion:
Reduced LA active EF (booster pump function) assessed by STE independently predicts the risk of new-onset AF, suggesting a stronger association between LA functional remodeling and AF than between LA size and AF.Noninvasive echocardiographic assessment of LA phasic function, especially LA ative contraction (booster pump function), in sinus rhythm would provide incremental value for the risk stratification and be a more useful predictor for new-onset AF than LA size.
Abstract 8572: Enhanced Angiogenesis By Transplantation Of iPS Cell-derived Flk-1
+
Cell Sheet Created By A Novel Magnetic Tissue Engineering Method
Authors: Kito Tetsutaro , Shibata Rei , Suzuki Hirohiko , Ishii Masakazu , Yamamoto Takashi , Numaguchi Yasushi , Murohara Toyoaki
Published: April 2024

Background:
Therapeutic angiogenesis using cell transplantation represents a novel strategy for severe ischemic diseases, but some patients had poor response to angiogenic cell therapy. Therefore, alternative cell source and cell application strategy have been extensively searched. Induced pluripotent stem cells are expected as one of powerful tools for regenerative medicine. We investigated a therapeutic potential of iPS cell sheet created by a novel magnetite tissue engineering technology for reparative angiogenesis.

Methods and Results:
Flk-1
+
cells, as a vascular progenitor marker were induced from mouse iPS cells after 5 day of culture. Flk-1
+
cells were purified by FACS sorting, and these cells differentiated into CD31
+
endothelial and α-SMA
+
smooth muscle cells. Sorted Flk-1
+
cells incubated with magneticnanoparticle-containing liposomes (MCLs) were cultured. MCL-labeled Flk-1
+
cells were mixed with diluted extracellular matrix (ECM) precursor, and a magnet was placed on the reverse side. Magnetized iPS cell-derived Flk-1
+
cells formed multilayered cell sheet after 24h incubation period. Nude mice were subjected to unilateral hind limb ischemia and separated into 3 groups. The constructed Flk-1
+
cells- or Flk-1
−
cells- sheet placed on the ischemic adductor muscles using the Alnico magnet before skin closure. For the control group, ECM precursor gel was layered onto the ischemic tissues. Blood flow recovery and the extent of angiogenesis were assessed by a laser doppler blood flowmetry and capillary density. The Flk-1
+
cell sheet group had a greater angiogenesis in ischemic tissues compared to the control and Flk-1
−
cells sheet groups (p<0.05). The angiogenic and tissue-preserving effects of Flk-1
+
cell sheets were attributable to an increased expression of VEGF mRNA in ischemic tissues. We did not detect formation of any tumors in Flk-1
+
cells, but not in Flk-1
−
cells, transplanted mice at least until post-operative day 60.

Conclusions:
Implantation of iPS cell-derived Flk-1
+
cells has augmented ischemia-induced angiogenesis. iPS cell-derived Flk-1
+
cell sheet created by the novel magnetic nanoparticle-based tissue engineering technology would represent a new modality for therapeutic angiogenesis and tissue regeneration.
Abstract 8575: Effects of Permanent Left Atrial Pacing in Patients with Heart Failure and Preserved Ejection Fraction.
Authors: Laurent Gabriel , Eicher Jean Christophe , Mathe Anaelle , Bertaux Géraldine , Barthez Olivier , Billard Philip Clotilde , Debin Duvernay Régine , Garnier Fabien , Philip Jean Luc , Wolf Jean Eric
Published: April 2024

Background
Although numerous patients are suffering from heart failure with preserved ejection fraction (HFPEF), no specific treatments have been shown to be efficient as the underlying mechanisms involved in this entity are still poorly understood. We hypothesized that inter-atrial conduction delay (IACD) associated with a short left atrio-ventricular interval (LAVI) may impair left ventricular active filling as it reduces the left atrium “kick” which occurs against the closing mitral valve. We assessed the clinical efficacy and safety of left atrial pacing therapy as a new treatment to restore the left ventricular active filling in severe HFPEF patients with IACD and a short LAVI.

Methods
Six NYHA class III patients with severe HFPEF and no other cause for heart failure symptoms than a short LAVI with IACD were implanted with pacemakers for left atrial permanent stimulation via the coronary sinus (lead screwed inside the Cs at 1 to 2 cm from the ostium). All patients were in sinus rhythm with an IACD defined as a p wave prolongation greater than 120ms in lead II, normal QRS interval. During electrophysiological (EP) studies, they all had a left atrio-ventricular interval (LAVI) shorter than 70ms. None of them had a standard indication for pacemaker implantation. This double-blind, randomized, crossover study compared the responses of the patients during two periods: a two-week period of inactive pacing (ventricular inhibited pacing at a basic rate of 30 bpm) and a two-week period of active (left atrial permanent pacing with dedicated algorithm for AF prevention). The primary end point was the distance walked in six minutes (6MWD). The secondary endpoint was the patient's treatment preference.

Results
During the inactive phase, two patients developed an acute heart failure 24 and 72 hours after the pacemaker was turned off. The mean (±SD) distance walked in six minutes was 21 percent greater with active pacing (237 ± 30m vs. 187 ± 18m, P<0.001). Active pacing was preferred by 100 percent of the patients.

Conclusions
Although the beneficial effects of left atrial permanent pacing need to to be confirmed by larger studies, this new pacing strategy may improve exercise tolerance in patients with HFPEF and short left atrio-ventricular interval.
Abstract 8690: The Junctophilin 2 Missense Mutation, E169K, Promotes Atrial Fibrillation in Mice
Authors: Ather Sameer , Dixit Sayali , Wang Wei , McCauley Mark , Beavers David , Garbino Alejandro , Landstrom Andrew , Olivotto Lacopo , Ackerman Michael , Wehrens Xander
Published: April 2024

Background:
Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death in young people. Recently, a patient with HCM with paroxysmal atrial fibrillation (AF) and sinoatrial block was found to have a missense mutation, E169K, in the junctophilin 2 (JPH2) protein. Loss of JPH2 has been shown to affect intracellular Ca2+ release in the heart. To date, no study has evaluated the effect of E169K mutation on Ca2+ handling and arrhythmogenesis.

Hypothesis:
The JPH2 E169K mutation promotes sarcoplasmic reticulum Ca2+ leak causing abnormal atrial conduction and AF.

Methods and Results:
We evaluated our hypothesis by generating 3 mice that overexpressed 1) JPH2 with E169K mutation (EK-Tg), 2) WT JPH2 (WT-Tg) and 3) JPH2 with inactive P584S mutation (PS-Tg). On Western Blot, JPH2 expression was increased by 2-3 fold in all the mouse groups compared to non-transgenic controls. Echocardiography at 6 months of age revealed normal fractional shortening in all mice. At baseline, EK-Tg mice had a shorter RR interval (104±1 ms, n=10) vs. WT-Tg (123±5 ms, n=8, p=0.001) and PS-Tg mice (121±5 ms, n=5, p<0.001). EK-Tg mice also had a shorter PR interval (36±1 ms, n=10) vs. WT-Tg (41±1 ms, n=8, p=0.01) and PS-Tg mice (39±1 ms, n=5, p=0.15). On intracardiac electrophysiology studies, EK-Tg mice had shorter AVERP (39±2 ms, n=10) vs. WT-Tg (51±2 ms, n=8, p=0.005) and PS-Tg mice (48±3 ms, n=5, p=0.05). On overdrive pacing of the atria in the presence of epinephrine and caffeine, EK-Tg mice had a 57% incidence of AF (n=10) vs. 21% in WT-Tg (n=8, p<0.05) and 33% in PS-Tg mice (n=5, p=0.2). Isolated cardiomyocytes from EK-Tg mice had a higher Ca2+ spark frequency (6.7±0.8 events/100 um/s, n=20) vs. cardiomyocytes from WT-Tg (1.8±0.5 events/100 um/s, n=10, p<0.001) and PS-Tg mice (3.3±1.0 events/100 um/s, n=16, p<0.05). Lastly, JPH2 levels were lower in RyR2 channels immunoprecipitated from EK-Tg mice vs. RyR2 from WT-Tg mice (65% vs. 100%, p<0.05).

Conclusion:
The JPH2 mutation, E169K, leads to reduced binding of JPH2 with RyR2, increased SR Ca2+ leak, abnormal atrial conduction and AF. The data suggest that JPH2 may serve as a critical stabilizing molecule for RyR2; further approaches to stabilize this interaction may lead to improved control of AF in susceptible populations.
Abstract 8803: Bioprosthetic Tricuspid Valve Regurgitation Associated with Device Lead Implantation
Authors: Eleid Mackram F , Blauwet Lori A , Cha Yong-Mei , Connolly Heidi M , Brady Peter A , Dearani Joseph A , Espinosa Raúl E
Published: April 2024

Background
Little is known about the effects of permanent transvenous device leads on bioprosthetic tricuspid valve (BTV) function.

Hypothesis
The goal of this study was to test the hypothesis that transvalvular device leads promote clinically significant BTV regurgitation.

Methods
A retrospective review of 58 patients who underwent BTV implantation and subsequently required endocardial pacemaker (n=52) or defibrillator (n=6) lead implantation through the BTV was conducted. Patient and prosthesis characteristics, lead type, and clinical events were collected. The incidence and severity of prosthetic tricuspid regurgitation (TR), determined by Doppler echocardiography, was compared to 265 patients who underwent BTV implantation without undergoing subsequent transvalvular device lead implantation.

Results
Over a mean follow up of 25 months, 5 patients (9%) with a transvalvular lead developed ≥ moderate prosthetic TR compared to 12 patients (5%) in the control group (P = 0.20). Kaplan Meier survival analysis revealed no significant difference in the incidence of TR in BTV patients with and without transvalvular leads (p = 0.45). Clinically significant prosthetic TR in patients with and without a transvalvular lead more commonly occurred 2 years or later after lead implantation or BTV implantation (4/5, 80% and 10/12, 83%).

Conclusions
Compared to BTV controls, there was no significant difference in the incidence of ≥ moderate prosthetic TR in patients with a transvalvular pacemaker or defibrillator lead (p = 0.45). Transvalvular lead implantation appears to be an acceptable approach for patients with a BTV who require permanent pacemaker or defibrillator placement.