bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 18130: Acute Changes of Glucose and Insulin Levels During Oral Glucose Tolerance Test are Related to Changes in Arterial Stiffness and Wave Reflection
Authors: Ikonomidis Ignatios , Koukoulis Charis , Lambadiari Vasiliki , Spanoudi Fotini , Tzortzis Stavros , Tritakis Vlassis , Triantafyllidi Helen , Lekakis John , Dimitriadis Georgios , Anastasiou-Nana Maria
Published: April 2024

Background:
Hyperglycemia is linked with arterial stiffness, a factor with significant prognostic value. We investigated whether the acute changes of glucose and insulin levels during oral glucose tolerance test (OGTT) are related with acute changes in arterial stiffness.

Methods:
In 60 consecutive subjects without known diabetes a standard 75-gr oral glucose tolerance test (OGTT) was performed and glucose and insulin levels were measured at 0, 30, 60, 90 and 120min after glucose loading. At the same time intervals, we measured the carotid- femoral pulse wave velocity (PWVc) using the Complior and aortic PWV (PWVa) and augmentation index (AI) using an oscillometric method (Arteriograph,TensioMed). We categorized patients in those with normal (n=21) and those with abnormal OGTT.

Results:
During OGTT, we found that increasing glucose levels were related with increasing PWVc and PWVa (r=0.28, r=0.42, p<0.01) and increasing insulin levels were related with decreasing AI (r=-0.27) in all patients. Patients with abnormal OGTT had higher baseline PWVc (10.4±2 vs. 9.1±1.8 m/sec), PWVa (9.4±1.9 vs. 6.9±1.8 m/sec), AI (24±9 vs. 17±11 %), insulin (14±6 vs. 11±4μU/ml) and glucose(114±26 vs. 93±7 mg/dl) and similar age sex and BMI than those with normal OGTT (p<0.05).Compared to baseline, AI was reduced by 44% at 30 min and 17% at 60 min in patients with normal OGTT (p<0.01) compared to 7.8% and 11 % in abnormal OGTT (p=0.7). In all patients, the % decrease in AI at 30 min was related with the corresponding %increase in insulin (r=-0.46, p<0.05) but not with % change in glucose. The % increase in glucose levels at 60, 90 and 120 min during abnormal OGTT was related to the % increase in PWVa (r=0.46, r=0.34, r=0.55, p<0.05), PWVc (r=0.40, r=0.32, r=0.33, p<0.05) and AI (r=0.36, r=0.34, r=-0.35, p<0.05).

Conclusions.
Patients with normal OGTT show an acute decrease in AI related with the increase in insulin level likely because of insulin stimulation of endothelial NO synthesis. During abnormal OGTT, this beneficial effect of insulin on AI is blunted likely because of insulin resistance and the acute changes in glucose levels are linked with an increase in arterial stiffness. Thus, insulin resistance determines the acute changes of arterial stiffness after postprandial hypeglycemia.
Abstract 18147: Role of Adenosine Receptor Engagement in Ectonucleotide Triphosphate Diphosphohydrolase-1 Mediated Resistance to Conduit Arterial Thrombosis in Mice
Authors: Huttinger Zachary M , Milks Michael W , Nickoli Michael S , Long Lawrence C , Wheeler Debra G , Dwyer Karen M , d'Apice Anthony J , Robson Simon C , Cowan Peter J , Gumina Richard J
Published: April 2024

Background:
Ectonucleoside Triphosphate Diphosphohydrolase-1 (ENTPD-1/CD39) plays a key role in regulating platelet reactivity; it converts prothrombotic ATP and ADP to AMP which is further degraded by ecto-5’-nucleotidase (CD73) to adenosine, an anti-thrombotic mediator. The objective was to determine role of adenosine receptor engagement in ENTPDase-1 mediated resistance to
in vivo
arterial thrombosis in mice.

Methods:
Transgenic mice expressing human ENTPD-1 and littermate controls (WT) were subjected to FeCl
3
-induced carotid artery thrombosis.

Results:
ENTPD-1 mice displayed marked resistance to thrombosis (WT: 13.7 ± 0.9 min vs. ENTPD-1: 281.5 ± 57.3 min;
P
<0.001; n=6/group; Figure). Treatment of mice with α-β-methylene-ADP (APCP; 2 mg/kg 15 minute prior to injury), a specific ecto-5’-nucleotidase antagonist, completely abrogated the protection from thrombosis mediated by ENTPD-1 overexpression (APCP-treated WT: 11.9 ± 1.0min vs. APCP-treated ENTPD-1: 26.5 ± 11.1 min; n=6/group; Figure), suggesting that ecto-5’-nucleotidase-mediated generation of adenosine is required for ENTPD-1 mediated resistance to
in vivo
thrombosis. Furthermore, in mice treated with the non-selective adenosine receptor antagonist 8-(p-Sulfophenyl) theophylline (8-SPT; 20 mg /kg 15 minutes prior to injury) the resistance to thrombosis observed in ENTPDase-1 overexpresssing mice was abrogated (8-SPT Treated WT (n=8): 10.5 ± 1.4 min vs. 8-SPT Treated ENTPD-1 (n=9): 14.3 ± 1.6 min; Figure).

Conclusions:
Adenosine receptor engagement contributes to the resistance to thrombosis mediated by ENTPDase-1 overexpression.
Abstract 18160: Predictors of Survival to Orthotopic Heart Transplant in Patients with Immunoglobulin Light Chain Amyloid Cardiomyopathy
Authors: Ton Khue , Watts James , Malhotra Rajeev , Sanchorawala Vaishali , Seldin David , Borase Megan , Semigran Marc
Published: April 2024

Introduction:
Heart failure from immunoglobulin AL amyloidosis is rapidly fatal. Serial orthotopic heart transplant (OHT) followed by high dose melphalan / autologous stem cell transplant (ASCT) improves outcomes in selected patients. Debates still focus on the appropriate selection criteria for this approach.

Methods:
We performed a retrospective analysis of all patients with AL amyloidosis evaluated at Massachusetts General Hospital (2000 - 2011). Demographic and clinical data were obtained at the time of evaluation for OHT and ASCT. Kaplan-Meier and Cox regression analyses were performed to identify predictors of survival to OHT.

Results:
Of 41 patients (age 56 ±9 years), 18 (44%) underwent OHT, of which 14 subsequently underwent ASCT. One patient died before ASCT of sepsis, and 3 are awaiting ASCT. Three-year survival is 75%. Of the 14 patients, 3 (21%) died from sepsis (n=1), progressive amyloidosis (n=1), or cardiac arrest (n=1). Of the 23 untransplanted patients, 21 (91%) died with a median time to death from initial evaluation of 55 days. Thirteen were listed for OHT but 12 died before transplant from cardiac arrest (n=5), progressive systemic amyloidosis (n=4), sepsis (n=2), and heart failure (n=1). Ten were not listed for OHT due to contra-indicating factors (severe systemic amyloidosis (n=3), cardiac arrest (n=2), coagulopathy (n=1), sepsis (n=1), heart failure (n=1), stroke (n=1), severe depression (n=1)). Of those listed for OHT (n=31), higher weight and BMI were associated with a lower likelihood of survival to transplant (189 ± 46 vs. 162 ± 20 lbs, P=0.03; Cox hazard ratio (HR) of death before OHT of 1.22 for every 10-lb increase in weight, 95% CI 1.03-1.44). For patients undergoing OHT, wait time from evaluation correlated with BMI (r=0.48, P=0.04). Of the hemodynamic variables studied, greater systemic arterial pulse pressure predicted survival to OHT (HR for death before transplant 0.43 for every 10 mmHg increase, 95% CI 0.19-0.98, P=0.045).

Conclusion:
Long-term survival is excellent in cardiac amyloid patients receiving serial OHT and ASCT. Mortality remains high while patients await cardiac donors. Predictors of survival to OHT include increased systemic pulse pressure and lower weight and BMI due to shorter wait time for suitable organs.
Abstract 18202: Multiple Arterial Grafts Improve Late Survival of Patients Undergoing CABG: Analysis of 8,622 Patients with Multivessel Disease
Authors: Locker Chaim , Schaff Hartzell V , Dearani Joseph A , Joyce Lyle D , Greason Kevin L , Li Zhuo , Daly Richard C
Published: April 2024

Objectives.
The use of the left internal mammary artery (IMA) in revascularization of multivessel coronary artery disease has been shown to improve survival following coronary artery bypass graft surgery (CABG), however the incremental survival benefit of multiple arterial grafts is still debated.

Methods.
We reviewed outcome of 8,622 pt that had isolated primary CABG for multivessel disease from 1993 to 2009.Pt were stratified according to the number of arterial grafts; (1) single IMA plus saphenous vein (SV) IMA/SV group (n=7,435; 83% 3VD) and (2) multiple arterial (MultArt) group (n=1,187; 74% 3VD)

Results.
Early mortality rate was 0.8% (n=10) in the MultArt group and 2.1% (n=154) in the IMA/SV group (P=0.004). However, the difference was not statistically significant (P=0.996) after adjusting for age, gender, chronic lung disease, renal failure, PVD, MI, EF, and number of diseased vessels. Late survival was significantly greater for the MultArt group compared to IMA/SV group (5-, 10- and 15-year survival rates were 95%, 84% and 71% versus 85%, 61% and 35% p<0.001). MultArt subgroups with the use of bilateral internal mammary artery (BIMA)/SV (n=589) and BIMA only (n=271), had significantly improved 15-years survival (97%, 86%, 76% and 94%, 82%, 75% at 5-, 10- and 15-years, p<0.001), and BIMA/RA (n=147) and LIMA/RA (n=169), had significantly greater 10-years survival (95%, 84% and 93%, 78% at 5- and 10-years, p<0.001) compared to IMA/SV group. In multivariate analysis, use of multiple arterial grafts remained a strong independent predictor of survival (HR=0.78, 95% CI 0.66 - 0.93, p=0.006).

Conclusion.
Use of the right IMA or radial artery in addition to the left IMA is associated with significantly better overall and late survival compared with single IMA and saphenous vein in patients with two and three-vessel disease undergoing isolated CABG.
Abstract 18219: Endothelial Canonical Sonic Hedgehog Signaling is Not Required for Sonic Hedgehog Mediated Angiogenesis or Ischemic Tissue Repair
Authors: Gupta Rajesh , Misener Sol , Mackie Alexander , Kamide Christine E , Schultz Kathryn M , Thorne Tina , Klyachko Ekaterina , Losordo Douglas W
Published: April 2024

Introduction:
Hedgehog signaling is a critical mediator of development, ischemic tissue repair, and carcinogenesis. Sonic hedgehog (Shh) signaling has been shown to mediate ischemic tissue repair in experimental models. However, there is controversy on whether Shh signaling improves tissue perfusion by the canonical hedgehog pathway in endothelial cells or via indirect effects on stromal cells. We tested the hypothesis that direct canonical endothelial Shh signaling via the Hedgehog signal transducer Smoothened (Smo) is required for Shh mediated angiogenesis and ischemic tissue repair.

Methods:
We utilized Cre-Lox mouse models to test this hypothesis. Two endothelial Cre mouse lines, the Tie2-Cre and Vascular Endothelial Cadherin-Cre lines were crossed with mice in which Smo was homozygously floxed to generate endothelial specific Cre+ Smo flox/flox (eSmoNull) mice. Baseline cardiac phenotype was assessed with echocardiography. eSmoNull and SmoWT mice were compared using the corneal angiogenesis and hind limb ischemia (HLI) mouse models.

Results:
eSmoNull mice were viable and appeared normal. Baseline echo demonstrated normal LV function (fractional shortening: 34.39±1.9 vs. 34.07±1.1, P=0.93). Collagenase digestion of eSmoNull and SmoWT hearts followed by CD31+ cell selection and RT-PCR confirmed effective deletion of Smo. Corneal angiogenesis was induced with Shh pellets revealing similar degrees of Shh induced angiogenesis in eSmoNull and WT mice. HLI was induced to determine the role of endothelial, Smo-mediated hedgehog signaling after ischemic injury. In striking contrast to the impairment in recovery following antibody-mediated global blockade of Shh (Pola, Nature Med, 2001), laser Doppler perfusion demonstrated no significant difference in perfusion at days 7, 14, 21, and 28 (Day 28 perfusion ratio ischemic/nonischemic: 0.56 vs. 0.74, P=0.07). Limb preservation and functional scores were not significantly different. The ratio of lectin+ capillaries per muscle fiber in the ischemic limb was similar (1.58±0.15 vs. 1.65±0.11, P=0.36).

Conclusion:
Endothelial canonical Shh signaling is dispensable for vascular development, resting cardiac function, Shh induced angiogenesis, and recovery after ischemic injury.
Abstract 18236: Perilipin 5 Links Lipid Droplets with Mitochondria
Authors: Wong Hong , Gong Da-Wei , Sreenivasan Urrmila , Saladino Andrew , Polster Brian M , Stanley William C , Sztalryd Carole
Published: April 2024

Maintaining cellular lipid homeostasis is crucial to heart function, and is compromised in obesity-induced cardiomyopathy. Lipid droplets (LDs) play a central role in lipid homeostasis by mediating fatty acids (FA) storage in the form of triglyceride (TAG), lowering intracellular lipid levels that mediate cellular lipotoxicity. LD and mitochondrial function are intimately related but mechanisms of interaction have not been uncovered. Perilipin 5 (Plin5) is the newest perilipin protein coating LD surfaces and is highly expressed in heart. We investigated Plin5's role in interactions between mitochondria and LDs using a combination of cell culture and transgenic model studies. We have studied cardiomyocytes using live confocal imaging and electron microscopy analysis and found that Plin5 expression recruits mitochondria to the LD surface thru a C-terminal region. At the molecular level, Plin5 interacts with the key lipolytic proteins adipocyte triglyceride lipase and its co-lipase CGI-58, as determined by FRET and co-immunoprecipitation studies. At the metabolic level, we found that Plin5 regulates LD hydrolysis by limiting basal lipolysis but not after protein kinase a (pka) activation and that plin5 is a phoshorylated protein and a putative pka downstream target. Compared to control cells, plin5 expressing cells show (p<0.05) decreased palmitate (PA) β-oxidation detected by cell respirometry and increased PA incorporation into TAG. These in vitro results suggest that Plin5 regulates cardiac LD hydrolysis and controls local FA flux to protect mitochondria against FA surge in physiological conditions. To investigate plin5 function in vivo, we obtained transgenic mice with heart-specific plin5 over-expression (αMHC-plin5). Preliminary results suggest that these mice have a strong cardiac lipid droplet phenotype. Hearts from αMHC-plin5 mice expressed at least 20-fold higher levels of plin5 and exhibit a 3.5- fold increase in TAG content versus non-transgenic littermate. These studies support a conclusion that Plin5 is a promising key gene in the pathways that efficiently couple the LD storage compartment to the mitochondria FA utilization compartment and will help unravel the underpinnings of cardiac cellular lipid homeostasis.
Abstract 18277: Role of the miR-204/miR-145 Communication in the Etiology of Pulmonary Arterial Hypertension
Authors: Courboulin Audrey , Barrier Marjorie , Bonnet Sébastien
Published: April 2024

Introduction:
Pulmonary arterial hypertension (PAH) is characterized by distal pulmonary arteries remodeling secondary to the proliferation and resistance to apoptosis of the pulmonary artery smooth muscle (PASMC). We recently described that this phenotype is associated with 7 aberrantly expressed miRNAs in PAH-PASMC. We showed that miR-204 was the most downregulated and accounts for the activation of the neoplasic axis STAT3/Pim1/NFAT, inducing PASMC proliferation and resistance to apoptosis. Because miR-204 downregulation precedes the development of PAH in chronic hypoxic mice and monocrotaline rats, we tested whether its downregulation accounts for the deregulation of the 6 others affected miRNAs in PAH. As miR-145 is implicated in systemic vascular remodeling and is the one of the most upregulated miRNA in PAH we focused our research on the regulation of miR-145 by miR-204.

Methods/Results:
Using lungs biopsies from 8 PAH and 8 control patients we confirmed the downregulation of miR-204 and the upregulation of miR-145 in PAH. Moreover, both miR-204 downregulation and miR-145 upregulation correlate with PAH severity. These findings were confirmed in both lungs and distal PAs of 5-MCT and 5 Sugen/Hypoxia/Normoxia rats compare to 5 control rats in which severity was assessed by CT-scan angiogram. Time to event analysis in both monocrotaline (1; 2; 3 and 4 weeks post MCT injection) and Sugen (8 and 15 weeks post Sugen) rats showed that miR-204 downregulation precedes miR-145 upregulation. In vitro using cultured human PASMC from 5 control and 3 PAH patients we showed that miR-204 upregulation in PAH-PASMC decreases miR-145; while miR-204 downregulation in control PASMC increases miR-145. Finally, in vivo nebulized MCT rats with miR-204 mimic had significantly less miR-145 compared to rats nebulized with mimic negative control.

Conclusion:
We demonstrated for the first time in PAH that one miRNA (miR-204) can regulate the expression of other miRNA such as miR-145. Because miR-204 downregulation precede miR-145 upregulation and PAH development, miR-204 could be considered as an early molecular marker of PAH and might represent the molecular origin of this lethal disease.
Abstract 183: Prevalence and Development of Clinical States During Resuscitation from In-Hospital Cardiac Arrest
Authors: Nordseth Trond , Edelson Dana P , Bergum Daniel , Olasveengen Theresa M , Eftestøl Trygve , Abella Benjamin , Skogvoll Eirik
Published: April 2024

Background
During resuscitation of a patient in cardiac arrest the clinical state determines the management. The state will change either spontaneously (e.g. pulseless electrical activity [PEA] - asystole [ASY]), or due to intervention (e.g. ventricular fibrillation/-tachycardia [VF/VT] - return of spontaneous circulation [ROSC] following shock). The aim of this study was to describe and analyze the development of clinical states in patients receiving advanced life support (ALS).

Methods
Defibrillator files from 261 in-hospital cardiac arrests at the University of Chicago Hospital (Il, USA) and St.Olav University Hospital (Trondheim, Norway) were analyzed. The clinical states ASY, PEA, VF/VT, ROSC and death were annotated along the time axis. The average transition probabilities over all 2-minute periods (recommended CPR “loop” duration), were estimated using a Markov model.

Results
The figure shows the development of clinical states during the first 30 minutes of ALS. The inserted matrix shows the estimated probabilities of moving from one state (rows) to another (columns), during the next two minutes of ALS. E.g. a patient in PEA has a probability of 0.16 of gaining ROSC during (any) two minutes. Relapse to PEA from ROSC has a probability of 0.17. The prevalence of ROSC continues to increase until about 25 minutes of ALS, where about 45% of the patients have obtained ROSC and 35% have been declared dead.

Discussion
We provide a basic description of the dynamics of resuscitation from in-hospital cardiac arrest. Understanding these dynamics enables the provider to focus on important transitions (e.g. relapse from ROSC), and may provide a basis for improved tailored therapy.
Abstract 18325: Pentraxin3 is Associated with Markers of Endothelial Cell Injury Hypercoagulable State and Severity of Peripheral Arterial Disease in Diabetic Subjects
Authors: El Eter Eman A , Al Masri Abeer A , Al Dokhi Laila , Bayomy Nervana , Sallam Reem , Al Omran Mohamed
Published: April 2024

Pentraxin3 (PTX3) was reported to be expressed in atherosclerotic plaques and high levels were seen in patients with atherosclerosis, however, its role in atherosclerosis needs to be further elucidated. In the present study we measured PTX3 levels in diabetic patients with peripheral atherosclerotic diseases (PAD) and investigated its relation to markers of endothelial dysfunction, severity of PAD using ABI, and platelet function. Data was collected from 118 patients and 20 control subjects, at KKUH. Fasting blood samples were used for measuring, blood sugar, triglesrides, ICAM-1, VCAM-1, PTX3, P-selectin, and fibrinogen. Ankle brachial index (ABI) was measured for all subjects. PTX3 was significantly elevated in patients with PAD compared to control healthy subjects. Markers of endothelial dysfunction (ICAM-1, VCAM-1 and P-Selectin) as well as fibrinogen were higher in patients with PAD compared to controls. These parameters correlated positively with PTX3 suggesting strong association of PTX3 with disease process, however, doesn't provide a causal link. Using multiple regression analysis with PTX3 as a dependent factor and other variables as independent, showed that fibrinogen followed by VCAM-1 is the most determinant factors influencing PTX3. An indirect association of PTX3 was found, with severity of peripheral vascular disease measured by ABI. As PAD is associated with hypercoagulable state, we investigated effect of PTX3, in vitro, on platelet aggregation, by incubating whole blood from healthy donors with PTX3 at different conc. A significant inhibition of platelet aggregation was seen at a conc of PTX3 of 200-400 ng/ml. This inhibition was ameliorated as concentration was increasing. These results might suggest PTX3 as a counter-regulatory molecule rather than inducer in atherosclerosis and its complications. Further investigations are required to study effect of PTX3 on platelet function and vascular smooth muscle cells.
Abstract 18410: Predicting Long-Term Mortality Following Coronary Artery Bypass Graft Surgery
Authors: Wu Chuntao , Camacho Fabian , Hannan Edward L
Published: April 2024

Background:
Simplified bedside risk scores have been created to predict short-term mortality, e.g. in-hospital mortality, following coronary artery bypass graft (CABG) surgery. However, no such scores have been developed to predict long-term mortality.

Objectives:
To create a simplified risk score to predict long-term mortality following CABG surgery.

Methods:
The New York State's Cardiac Surgery Reporting System was used to identify the study population, which consisted of 8,413 patients who underwent isolated CABG surgery and were discharged in July through December 2000. The National Death Index was used to ascertain patients' vital status through the end of 2007. A Cox proportional hazards model was fit to predict death following CABG surgery using pre-procedural risk factors. Then points were assigned to significant predictors of death based on the values of their regression coefficients, and for each possible point total (sum of points of risk factors) the predicted risks of death at years 1, 3, 5, and 7 were calculated.

Results:
Kaplan-Meier analysis showed that the 7-year mortality rate was 22.6% in the study population. Significant predictors of death included age, body mass index, ejection fraction, left main coronary artery disease, cerebrovascular disease, peripheral arterial disease, congestive heart failure, chronic obstructive pulmonary disease, diabetes, and renal failure. The C statistics measuring the discrimination of the Cox proportional hazards model were 0.781, 0.773, 0.770, and 0.780 for mortality at 1, 3, 5, and 7 years of follow-up. The points assigned to these risk factors ranged from 1 to 7; and the possible point totals ranged from 0 to 24. The observed and predicted risks of death at years 1, 3, 5, and 7 across patient groups stratified by point totals were highly correlated.

Conclusion:
We developed a simplified risk score for predicting the risk of mortality following CABG surgery at 1, 3, 5, and 7 years. This long-term risk score can be used by providers and patients as an aid in determining the appropriate treatment for patients with coronary artery disease based on each patient's specific risk factors.
Abstract 186: Coronary Angiographic Findings in Patients with or Without ST-Segment Elevation Resuscitated After Out-of-Hospital Cardiac Arrest
Authors: Kamal Ziaullah , Andersen Geir Oystein , Eritsland Jan , Draegni Tomas , Sunde Kjetil , Mangschau Arild
Published: April 2024

Background:
Long-term survival after out-of-hospital cardiac arrest (OHCA) has improved in the last decade with special focus on the post cardiac arrest syndrome. Therapeutic hypothermia and percutaneous coronary intervention (PCI) are the two most important in-hospital interventions. International guidelines recommend aggressive use of coronary angiography in patients with ST segment elevation myocardial infarction (STEMI), but it is not clear if also patients without ST elevation should undergo early coronary angiography (ECA). The aim of the study was to document outcome in all OHCA patients of cardiac etiology, with special focus on angiographic findings and survival among patients with or without ST segment elevation.

Methods:
All patients admitted to our hospital after primary resuscitated OHCA are registered in our Post-resuscitation care registry. Electrocardiogram (ECG), coronary angiographic findings and overall survival of patients admitted in 2008 with cardiac etiology were investigated retrospectively by reviewing medical charts. Patients were classified according to the presence of ST segment elevation on post-resuscitation ECG or not.

Results:
Altogether 62 patients were included. ST elevation was present in 33 (53%) patients in whom all underwent ECA, 24 (73%) had an acute coronary occlusion, 5 (15%) had old occlusions, 17 (51%) had multivessel disease, and 29 (88%) received PCI. Among the 29 (47%) patients without ST elevation, 24 (83%) underwent ECA, of whom 5 (17%) had an acute coronary occlusion, 12 (50%) had old occlusions, 18 (75%) had multivessel disease, and 12 (38%) received PCI. In total, 60% of the patients were treated with therapeutic hypothermia with no difference between the two groups. Overall survival was 64% and 59% in patients with and without ST elevation, respectively (ns).

Conclusion:
Overall survival after OHCA of cardiac etiology was good, with no difference between patients with or without ST segment elevation. The presence of ST elevation on ECG was highly associated with the presence of an acute coronary occlusion, but a substantial proportion of patients without ST elevation also had coronary occlusions treated by PCI and more studies are warranted to determine whether all patients should undergo ECA.
Abstract 187: Preshock Pause Intervals and Rearrest After Resuscitation from Out-of-Hospital Cardiac Arrest
Authors: Koller Allison C , Salcido David , Menegazzi James J
Published: April 2024

Background:
Loss of pulses after successful return of spontaneous circulation (ROSC) during resuscitation from out-of-hospital cardiac arrest (OHCA) is known as re-arrest (RA). Recent studies have provided estimates of the rate occurrence of re-arrest - as high as 38% -, but the causes and characteristics of RA are not yet fully understood. One plausible contributor to RA is the pre-shock pause (PSP) interval - the time interval between the last chest compression and a defibrillating shock - which has been shown to predict survival to hospital discharge.

Objective:
Measure the PSP time interval in cases of OHCA with and without RA in order to: a) provide an estimate of the PSP in cases with RA, and b) compare the PSP of cases with RA to cases without PSP.

Methods:
Case data for emergency medical services (EMS)-treated OHCA were obtained from the Pittsburgh site of the multi-center Resuscitation Outcomes Consortium (ROC) and were part of a previously identified dataset (n = 113) used to compare ECG characteristics of RA cases to those without RA. A subset of these cases was identified that received at least one shock during treatment by EMS. Time-coded impedance, compression force, compression depth, or audio recordings accompanying each ECG trace were used to calculate the PSP to the nearest second for each shock in each case. The PSP for shocks that followed ROSC without preceding compressions were calculated as the interval between loss of pulses and the shock. All other PSP were calculated as the difference between the time of the final pre-shock compression and shock delivery. The kruskal-wallis test was used to compare the medians of RA and no-RA PSP with an alpha level of 0.05.

Results:
Fifty-six cases were identified with at least 1 EMS-delivered defibrillating shock. Of these, 27 (48%) cases had at least one instance of RA. For a total of 159 shocks in both RA and no-RA groups, the median (IQR) PSP was 16s (12.75). The median (IQR) PSP for the RA group (n = 101) was 16s (14), while the median (IQR) PSP for the no-RA group (n = 58) was 14s (11). The median PSP of RA and no-RA groups were not significantly different (p = 0.15).

Conclusion:
The PSP for EMS-treated cases of OHCA with RA had a median duration of 16s. In this limited study, PSP were not different between groups with and without RA.
Abstract 213: Changing Hand Position During Manual Chest Compressions in Cardiac Arrest Affects the Hemodynamic Response: A Clinical Pilot Study
Authors: Qvigstad Eric , Tømte Øystein , Sunde Kjetil , Skålhegg Tore , Sørensen Øyvard , Kramer-Johansen Jo , Mariero Olasveengen Theresa
Published: April 2024

Introduction:
Optimal hand position during manual chest compressions (MCC) in cardiac arrest is unknown, but current Guidelines recommend a hand position on the lower half of the sternum. Recent imaging studies suggest that significant inter-individual anatomical differences exist, which might cause altered hemodynamic responses during standard MCC. In this prospective pilot study we wanted to assess the feasibility of utilizing capnography to optimize MCC and identify the optimal hand position in out-of-hospital cardiac arrest (OCHA).

Materials and methods:
Patients treated by the physician-manned ambulance for non-traumatic OCHA between February and May 2011 were included. Continuous EtCO
2
was measured by sidestream capnography (Lifepak 12, Physio Control, WA, USA). The three minute intervention period was initiated after endotracheal intubation. In the first minute chest compression rate and depth was optimized with hand-position at the recommended point (P0). A two-minute test phase followed; 50 compressions performed at three different sternal positions two cm below P0; P1 midline, P2 two cm to the left, P3 two cm to the right. The hand-position with the highest EtCO
2
value was used during the remaining resuscitation effort. EtCO
2
values are given as means (range), and presented in kPa (1 kPa = 7.5 mmHg).

Results:
Variations in EtCO
2
values could be documented in 15 OHCA patients. Average EtCO
2
values for 11 patients with cardiac etiology were 4.5 (1.9, 8.3), 5.3 (2.3, 9.6), 5.1 (2.4, 10.3), and 5.1 (2.5, 9.1) for P0 - P3, respectively, and for four non-cardiac etiology patients 4.8 (0.8, 9.7), 5.3 (0.8, 10.7), 5.8 (0.7, 10.3), and 5.1 (0.4, 8.4) for P0 - P3, respectively. The optimal EtCO
2
value was found in P0 in three patients, and in alternative hand positions in 12 patients, with the following distribution; P1: five patients, P2: five patients, P3: one patient, and in one patient P1, P2 and P3 was equally good.

Conclusions:
Monitoring and optimizing CPR performance and interventions using capnography was feasible. We could demonstrate inter-individual differences affecting hemodynamics, and there were no indications that one specific hand position could be expected to give optimal cardiac output in all patients.
Abstract 22: Acute Coronary Syndrome--Related Symptoms on the Scene and Actual Diagnoses
Authors: Nishiyama Chika , Iwami Taku , Kitamura Tetsuhisa , Hayashida Sumito , Matsuzono Tatsuya , Kawamura Takashi
Published: April 2024

Introduction
Little is known about the association between acute coronary syndrome (ACS)-related symptoms and actual diagnoses.

Objective
To compare the occurrence of ACS between those with ACS-related symptoms and those without.

Method Design:
Population-based cohort study.

Participants:
All persons aged 20 years or more who called an ambulance because of internal diseases and who were taken to a hospital by emergency medical service (EMS) personnel in Osaka, Japan in January, 2011.

Data collection and analyses:
Data on patients' symptoms including chest pain and other ACS-related symptoms; shortness of breath, syncope, cold sweat, vomiting, and palpitation were prospectively collected on the scene by an EMS interview. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of either chest pain or chest pain plus other ACS-related symptoms for the occurrence of ACS were calculated.

Results
Among 8876 cases, 207 (2.3%) was diagnosed as ACS. 424 (4.8%) had chest pain and 205 (2.3%) had both chest pain and other ACS-related symptoms. The sensitivity, specificity, PPV, and NPV of chest pain for ACS were 32.9% (68/207), 95.8% (8092/8448), 16.0% (68/424), and 98.3% (8092/8231), respectively (Table A). The sensitivity, specificity, PPV, and NPV of chest pain plus other ACS-related symptoms for ACS were 17.9% (37/207), 98.0% (8280/8448), 18.0% (37/205), and 98.0% (8280/8450), respectively (Table B).

Conclusion
The specificity and NPV of chest pain for ACS were very high. However, the PPV of ACS-related symptoms was poor even if the patient had both chest pain and other ACS-related symptoms. Further research is needed to detect additional factors to increase the diagnostic accuracy of ACS.
Abstract 25307: Treating Obesity in Primary Care Practice: A Two-Year Randomized Controlled Trial
Authors: Wadden Thomas , Volger Sheri , Sarwer David B , Vetter Marion L , Tsai Adam G , Berkowitz Robert I , Kumanyika Shiriki , Schmitz Kathryn H , Barg Ronald , Chittams Jesse , Moore Renee
Published: April 2024

Background:
Primary care providers (PCPs) are encouraged to screen adults for obesity and to offer lifestyle counseling for weight loss. This study assessed three lifestyle interventions of varying intensities, all provided by PCPs, working with medical assistant (MAs) in their practices.

Method:
A total of 311 women and 79 men (mean age=51.5±11.5 yr, BMI=38.5±4.7 kg/m2) were recruited at 6 primary care practices, owned by a university health system. Participants were randomized to: 1) Usual Care, consisting of quarterly PCP visits at which weight management was briefly (5-7 min) reviewed using handouts from NHLBI; 2) Brief Lifestyle Coaching (LC), which included the same PCPs visits, combined with monthly 10-15 min visits with MAs, who presented abbreviated lessons from the Diabetes Prevention Program; or 3) Enhanced LC, which provided the same visits as Brief LC, combined with the use of either meal replacements or weight loss medication (sibutramine or orlistat), selected by participants in consultation with PCPs. The study, sponsored by NHLBI, had 80% power to detect a 2.75 kg difference in weight loss between Usual Care and each of the LC interventions. (Sibutramine was removed from the U.S. market in October 2010 because of its association with CVD events.)

Results:
Study retention at Month 24 was approximately 85% in all three groups. At this time, participants in Usual Care, Brief LC, and Enhanced LC lost 1.7±0.7, 2.9±0.7, and 4.6±0.7 kg, respectively. Enhanced LC was superior (p<0.003) to Usual Care, with no other differences between groups. Forty percent of Enhanced LC participants lost ≥5% of weight vs 26% for Usual Care (p<0.027) and 30% for Brief LC (ns). A secondary analysis, eliminating the 44 participants exposed to sibutramine, revealed a 4.3±0.8 kg loss for Enhanced LC, superior to Usual Care (p<0.015).

Conclusions:
PCPs, by collaborating with MAs and prescribing meal replacements/medications, helped obese patients in their practices achieve clinically meaningful weight loss. Questions remain whether lifestyle counseling should be offered in primary care or could be provided more efficiently and at lower cost using Internet, smart phone, or call-center platforms.
Abstract 261: Effect of Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest in Early Phase of Implementation: Propensity-Score Matching and Inverse Probability of Treatment-Weighted Analysis
Authors: Kim Soo H , Kim Young M , Youn Chun S , Oh Sang H , Kim Han J , Park Kyu N
Published: April 2024

Introduction:
Therapeutic hypothermia (TH) is usually applied to selective patients in the early phase of implementation due to many local barriers. Thus therapeutic effects of TH could be overestimated or underestimated during the period. The objective of this study was to determine whether TH is associated with increased survival to discharge and favorable neurological outcome for adult out-of-hospital cardiac arrest (OHCA) patients during the first five years of implementation in a tertiary teaching hospital.

Hypothesis:
We hypothesized that TH would be associated with increased survival and favorable neurological outcome at hospital discharge in adult comatose survivors of OHCA during the early phase of implementation.

Methods:
Adult comatose survivors of OHCA from January 2006 to September 2010 were enrolled in the study. Favorable neurologic outcome was defined as cerebral performance category 1 or 2 at the time of hospital discharge. To reduce the effect of treatment-selection bias and potential confounding in the study, we performed rigorous adjustment for significant differences in the baseline characteristics of patients with the use of propensity-score (PS) matching and inverse probability of treatment weighted (IPTW) analysis. The adjusted odds ratio (OR) and its 95% confidence interval (95% CI) for the outcomes between TH and standard care group were calculated.

Results:
During the implementation period, 163 OHCA patients (41%) regained spontaneous circulation. Of those patients, 49 (30%) were treated with mild (32-34°C) TH for 24 hours. Using PS matching, 32 patients were equally assigned to each group. The adjusted OR for the survival and favorable neurological outcome at hospital discharge was 9.13 (95% CI 2.92-28.50) and 4.39 (95% CI 1.08-17.89), respectively in the PS-matched patients. Using the IPTW analysis, the adjusted OR for the survival and favorable neurological outcome at hospital discharge was 6.82 (95% CI 3.05-15.24) and 3.27 (95% CI 1.18-9.08), respectively.

Conclusions:
TH was associated with significant improvements in survival and neurologic outcomes at hospital discharge in adult comatose survivors of OHCA even in the early phase of implementation.
Abstract 273: Sildenafil and Beraprost Therapy Improve Arrhythmogenicity Through Connexin 43 Expression and Electrophysiological Property in Monocrotaline-Induced Rat Pulmonary Hypertension: Optical Mapping Analysis
Authors: Takase Bonpei , Tanaka Yoshihiro , Ishihara Masayuki
Published: April 2024

Severe pulmonary hypertension (PH) is associated with sudden cardiac death (SCD). Optical mapping analysis (OMP) with electrophysiological study (EPS) and connexin-43 measures were performed weekly in Sprague-Dawley rat with monocrotaline (MCTi, 60 mg/kg) induced PH. Right ventricular pressure (RVP) and pulmonary vascular remodeling (PVR) were measured. EPS for ventricular fibrillation (VF) induction and RT-PCR for mRNA expression of connexin-43 (Conx-Ex) were performed. Daily administration of sildenafil (5 mg/kg) and beraprost (100 μg/kg) was initiated at 2 or 3 weeks after MCTi. OMP revealed abnormal RV conduction and action potential dispersion with high VF induction rate. Decreased Conx-Ex with high RVP at 3,4 and 5 weeks after MCTi were observed. Sildenafil with beraprost improved PVR, RV arrhythmogenicity, Conx-Ex, cardiac function (Table) and survival rates.

Conclusions:
Sildenafil with beraprost therapy improves prognosis by preventing SCD and heart failure. These results give us further insights for understanding PH-induced SCD and therapeutic option for PH.
Abstract 29: Does Neighborhood Really Matter? How Where One Lives Influences Their Outcome Following Out-of-Hospital Cardiac Arrest
Authors: Buick Jason E , Ray Joel G , Kiss Alex , Allan Katherine S , Morrison Laurie J
Published: April 2024

Introduction:
Traditional Utstein factors for an out of hospital cardiac arrest (OHCA) have been extensively investigated, with numerous studies evaluating economic status for association with survival. Few studies have evaluated neighbourhood factors collectively as determinants of cardiac arrest outcomes. This will be the first multifactorial Canadian to investigate neighbourhood factors as determinants of OHCA outcomes.

Hypothesis:
We hypothesized that within 140 neighbourhoods in Toronto, Canada, there are neighbourhood level factors associated with survival to hospital discharge after an OHCA.

Methods:
A retrospective, observational study of all OHCA treated by Toronto EMS between April 2006 and March 2010. Using Geographic Information System (GIS) analysis, OHCA patients were assigned to a neighbourhood based on their residential address. Neighbourhood survival rates were calculated.

Results:
A total of 4408 OHCA were eligible for enrollment and contained the necessary information for GIS mapping. The mean (SD) age was 69.7 (16.4) y; 64% were male. The response time was 6.3 (3.6) min, 41.9% received bystander CPR, 16.8% occurred in a public location, 20.7% presented in a shockable rhythm, 27.7% had a ROSC and 5.3% survived to hospital discharge. Survival rates varied across all neighbourhoods: 25% of neighbourhoods had a 0% survival rate, while some had rates as high as 25% (See Figure).

Conclusions:
In conclusion, differences in survival following OHCA vary by neighbourhood, suggesting that a patient's home neighbourhood plays a role in outcomes. Further analyses are underway to investigate which neighbourhood factors are associated with improved survival.
Abstract 30: Women with a Bad Prognosis After Return of Spontaneous Circulation After Out-of Hospital Cardiac Arrest: A Retrospective Study in 1 Emergency Center
Authors: Kim Jin Joo , Oh Se Jong , Lee Hong Seop , Han Jo Eun , Hyun Sung Youl
Published: April 2024

Introduction:
Several studies were reported that women in child-bearing period have a good prognosis than men in hypoxic brain damage, traumatic brain injury and so on. That is, hormones like progesterone and estrogen have a neuroprotective effect and these are abundant in young women. The aim of this study was to analyze the gender factors associated with good or bad prognosis after return of spontaneous circulation after out-of hospital cardiac arrest

Methods:
The patients admitted to the intensive care unit after successful resuscitation after out-of hospital cardiac arrest were retrospectively identified and evaluated. Basal characteristic of the patients including factors associated with social history, basic life support and advanced cardiovascular life support were analyzed. Ninety days mortality after admission and neurologic outcome (cerebral performance category[CPC]) were evaluated.

Result:
One hundred forty-two patients were evaluated in this study; there were 101 males (71.1%). The median age was 52 years old (43-63). Ninety days after admission, 85 patients (59.9%) survived. 40 patients had a good neurologic outcome (CPC 1-2). The factors associated 90 days mortality were cause of death (non-cardiac, p=0.03), lactate in emergency department (p=0.05) and the factors associated with good neurologic outcome were males (p=0.007), young age (p=0.01), body weight and height (p=0.001), cause of death (cardiac, p=0.000), witnessed arrest(p=0.012). Alcohols and smoking were not associated with mortality and neurologic outcome. In multivariable logistic regression analysis, the patients in women had a 8-fold increased risk(odds ratio [OR] 8.038, 95% Confidence Interval [CI] 1.079-59.903) to poor neurologic outcome(CPC 3-5). Other factors associated with poor neurologic outcome were non-cardiac cause of death (OR 5.523, 95% CI 1.562-19.533) and old age (over 65 years old, OR 1.055, 95% CI 1.009-1.103).

Conclusion:
Women had a poor neurologic outcome after return of spontaneous circulation after out-of hospital cardiac arrest in one emergency center. Known gender-related neuroprotective hormonal factors might not be associated this gender differences. Other additional factors should be evaluated.
Abstract 49: Optimal CPR Loop Duration for Asystole and Pulseless Electrical Activity During In-Hospital Cardiac Arrest
Authors: Nordseth Trond , Edelson Dana P , Bergum Daniel , Olasveengen Theresa M , Eftestøl Trygve , Abella Benjamin , Skogvoll Eirik
Published: April 2024

Background
Cardiopulmonary resuscitation (CPR) is a process where time-cycled “loops” of chest compressions form the basis of action. Optimal loop duration is a compromise between interrupting compressions and detecting a change in the clinical state. Current CPR guidelines recommend a two-minute loop duration. The aim of this study was to investigate optimal loop duration in asystole (ASY) and pulseless electrical activity (PEA).

Material and methods
Detailed defibrillator recordings from 261 in-hospital cardiac arrests at the University of Chicago Hospital (Chicago, Ill., U.S) and St.Olav University Hospital (Trondheim, Norway) were analyzed. The clinical states ASY, PEA, ventricular fibrillation/-tachycardia (VF/VT), return of spontaneous circulation, and death were annotated along the time axis. We analyzed the development of clinical states ASY and PEA, both as initial and secondary states. As the development of initial VF/VT depended on heterogeneous shock strategies implemented by providers, these patients (n=46) were excluded from further analysis.

Results
The figure shows the development of PEA and ASY as Kaplan-Meier plots.ASY and PEA behaves similarly. By 5 minutes 50% percent of the patients with initial ASY/PEA have progressed to a different clinical state; by 8 minutes 25 % remain. Secondary ASY/PEA progresses earlier to other clinical states.

Discussion
To minimize pauses in chest compressions it is reasonable to aim between the 50th and 25th percentile, when a change of state most likely has occurred. Optimal loop in initial PEA and asystole appears to be between 5 and 8 minutes, and between 1 and 3 minutes in secondary PEA and ASY.
Abstract 9841: Microbubble Enhanced Sonothrombolytic Therapy Facilitates Reduction of Central Venous Catheter Associated Thrombi In Vivo
Authors: Kutty Shelby , Gao Shunji , Xie Feng , Drvol Lucas , Therrien Stacey L , Danford David A , Lof John , Hammel James M , Porter Thomas R
Published: April 2024

Shelby Kutty, 2011 Finalist and Presenting Author
Abstract 11415: NGAL is Independently Associated with Cardiovascular Disease and All-Cause Mortality in Community-Dwelling Older Adults: The Rancho Bernardo Study
Authors: Daniels Lori B , Clopton Paul , Laughlin Gail A , Ix Joachim H , Maisel Alan S , Barrett-Connor Elizabeth
Published: April 2024

Lori B. Daniels, 2011 Finalist and Presenting Author
Abstract 13954: Genetic Predisposition to Diabetes Associated With Cardiovascular Complications Among Patients With Type 2 Diabetes: Two Independent Studies
Authors: Qi Qibin , Meigs James B , Rexrode Kathryn M , Hu Frank B , Qi Lu
Published: April 2024

Qibin Qi, 2011 Finalist and Presenting Author
Abstract 13076: Genetic Mapping of a Modifier Locus Affecting Blood Pressure in Soluble Guanylate Cyclase α1-deficient Mice
Authors: Buys Emmanuel S , Raher Michael J , Kirby Andrew , Hayton Sarah R , Baron David M , Sips Patrick Y , Mohd Shahid , Rauwerdink Kristen M , Yan Qingshang , Tainsh Laurel T , Shakartzi Hannah , Stevens Christine , Decaluwé Kelly , Van de Voorde Johan , Wang Tong , Brouckaert Peter , Daly Mark J , Bloch Kenneth D
Published: April 2024

Emmanuel S Buys, 2011 Finalist and Presenting Author
Abstract 11412: Predictors of Overall Perceived Health in Patients with Heart Failure
Authors: Carlson Beverly , Hertzog Melody , Zimmerman Lani , Riegel Barbara , Pozehl Bunny
Published: April 2024

Beverly Carlson, 2011 Finalist and Presenting Author
Abstract 17107: Induced Vascular Progenitor Cells Derived from Endothelial Cells Stimulate Coronary Collateral Growth
Authors: Yin Liya , Ohanyan Vahagn , Pung Yuh Fen , Delucia Angelo L , Bailey Erin , Enrick Molly , Stevanov Kelly , Kolz Christopher L , Guarini Giacinta , Chilian William
Published: April 2024

Liya Yin, 2011 Finalist and Presenting Author
Abstract 9600: Coronary Artery Disease Patients with Normal Body Mass Index but Central Obesity Have the Worst Long-Term Survival When Compared to Other Patterns of Adiposity
Authors: Coutinho Thais , Goel Kashish , Correa de Sa Daniel , Kragelund Charlotte , Kanaya Alka , Zeller Marianne , Park Jong Seon , Kober Lars , Torp-Pedersen Christian , Cottin Yves , Lorgis Luc , Lee Sang-Hee , Kim Young-Jo , Thomas Randal , Roger Veronique , Somers Virend , Lopez-Jimenez Francisco
Published: April 2024

Thais Coutinho, 2011 Finalist and Presenting Author