bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 3211: Diabetes is Associated with Greater Progression of Coronary Atherosclerosis than the Metabolic Syndrome: Insights from Serial Intravascular Ultrasound Studies
Authors: Bayturan O , Hu T , Schoenhagen P , Kapadia S , Tuzcu E.M , Nissen S E , Nicholls S J
Published: July 2021

Background:
While the metabolic syndrome (MetS) and diabetes (DM) share many pathophysiological features it remains to be determined if they influence coronary atherosclerotic disease progression to a similar degree.

Methods
: A systematic review of subjects participating in 7 clinical trials that monitored coronary atheroma progression with intravascular ultrasound was performed. Clinical characteristics, baseline atheroma burden and disease progression were compared in patients with the MetS (n=1119), DM (n=201) or their combination (n=878).

Results:
Patients with the MetS were younger, more likely to be female and had a greater risk factor burden than diabetics. At baseline the presence of DM was associated with a greater percent atheroma volume (PAV 41.0+/−8.5 vs 37.6+/−8.9 %, p<0.001) and total atheroma volume (TAV 202.5+/−84.1 vs 190.73+−84.9 mm
3
, p<0.001) than observed in patients with the MetS. Greater progression of PAV (+0.71+/−0.3 vs 0.28+/−0.2 % p=0.04) and TAV (−3.3+/−1.8 vs −1.0+/−2.1 mm
3
, p=0.1) was observed in the presence of DM compared with the MetS. The combination of MetS and DM was not associated with greater PAV (+0.82+/−0.2 vs +0.71+/−0.3 %, p=0.59) or TAV (−1.0+/−1.8 vs −1.0+/−2.1 mm
3
, p=0.98) than DM alone. Substantial progression rate were not differ between three groups (Table

). However, the combination of DM and the MetS did result in the lowest rate of patients undergoing substantial plaque regression (>.0 % chg in PAV, 14.9% vs 18.4%, p=0.01) when compared with patients with DM, not meeting the criteria for the MetS.

Conclusions:
Despite the presence of more risk factors, meeting the criteria for the MetS is not associated with a greater rate of progression of coronary atherosclerosis in patients with DM. This highlights the accelerated nature of disease in the setting of established DM.

Table.

Baseline and changes in IVUS disease burden according to metabolic syndrome and diabetes
Abstract 3213: Acarbose, an
α
-glucosidase Inhibitor, Reduces Myocardial Infarct Size in Rabbits via Stimulation of GLP-1 Receptors, Opening Mitochondrial KATP Channels, and Preventing Hydroxyl Radical Production
Authors: Minatoguchi Shinya , Ushikoshi Hiroaki , Bao Narantuya , Kobayashi Hiroyuki , Yasuda Shinji , Iwasa Masamitsu , Sumi Shouhei , Zhang Zengi , Nishigaki Kazuhiko , Takemura Genzou , Fujiwara Takako , Fujiwara Hisayoshi
Published: July 2021

Background: Acarbose, an anti-diabetic drug, is an α– glucosidase inhibitor that can inhibit glucose absorption in the intestine. A recent large-scale clinical trial, STOP-NIDDM, showed that acarbose reduces the risk of myocardial infarction. We examined whether acarbose reduces myocardial infarct size and investigated its mechanisms.

Methods and Results: Rabbits were fed with one of four diets in this study: normal chow, 30 mg acarbose/100 g chow, 8 g sucrose/100 g chow, or 30 mg acarbose plus 8 g sucrose/100 g chow for 7 days. Rabbits were assigned randomly to one of eight groups: control (n=10), acarbose (n=10), sucrose (n=10), acarbose+sucrose (n=10), acarbose+i.v. 5-hydroxydecanoate (5HD, a mitochondrial KATP channel blocker, 5 mg/kg) (n=10), 5HD (i.v. 5 mg/kg, n=10), acarbose+exendin(9 –39) (n=10, a Glucagon-Like Peptide-1(GLP-1) receptor blocker, 3 nmol/l) (45.4±1.2%) and exendin(9 –39)(n=10). Rabbits then underwent 30 min of coronary occlusion followed by 48 h reperfusion. Postprandial blood glucose levels were highest in the sucrose group and higher in the control groups, but decreased in the acarbose and sucrose+acarbose groups. The infarct size as a percentage of the left ventricular area at risk was reduced significantly in the acarbose (19.4±2.3%) and sucrose+acarbose groups (19.0±5.6%) as compared with the sucrose (47.4±4.2%) and control groups (42.8±5.4%). The infarct size-reducing effect of acarbose was abolished by 5HD (43.4±4.7%) and exendin(9 –39) (45.4±1.2%). The 5HD and exendin(9 –39) by itself did not affect the infarct size. Myocardial interstitial 2,5-DHBA levels, an indicator of hydroxyl radicals, increased during reperfusion after 30 min of ischemia but this increase was inhibited in the acarbose group.

Conclusions: Acarbose reduces myocardial infarct size via stimulation of GLP-1 receptors, opening mitochondrial KATP channels, and preventing hydroxyl radical production.
Abstract 3231: Resource Use and Costs of Heart Failure in Medicare Population, 2003–2005
Authors: Chen Er , Coustier Nicole , Ching Stephanie , Gee George , Layton Andrew , Tong Kuo B
Published: July 2021

Introduction
: Recent analyses suggest incidence of heart failure (HF) has declined among the elderly during the past decade. However, estimation of resource use and costs for HF management has not been well characterized. This study sought to examine the economic burden for patients with newly diagnosed HF during a 3-year period.

Methods
: The Medicare Standard Analytic File (SAF), a 5% national sample, was used in this retrospective analysis to identify patients with a primary HF diagnosis (ICD-9-CM 428.xx) from Jan to Mar 2003. Patients with prior HF diagnoses in 2002 were excluded. The identified patients were followed for three years through Dec 2005. Their Medicare claims were linked from different care settings to examine the characteristics of these patients, as well as the total and HF-related resource use and costs.

Results
: Of the 1.7 million patients in SAF, 30,386 patients were newly diagnosed with HF from Jan to Mar 2003 (18 per 1,000). Mean age was 77; 41% of the sample were male, and 84% were Caucasian. Among these patients, 76% had at least one comorbid disease in the 12 months before HF diagnosis. The 1- and 2-year mortality rates were 22% and 36%, respectively. These newly diagnosed HF patients cost Medicare $22,775, $16,026, and $17,050 on average from 2003 to 2005, respectively, compared to $5,828, $7,012, and $7,564 for the general Medicare population. HF-related services constituted a significant portion of the total costs, accounting for 38%, 49% and 54% from 2003 to 2005. HF-related inpatient hospitalizations most likely resulted in reimbursement with DRG 127, followed by DRG 124, and DRG 115. Oxygen concentrator use, skilled nursing care, and subsequent hospital care represented the highest cost components for HF-related outpatient services. These data translated into an estimated direct cost of $14 billion to the Medicare system, $5.2 billion of which were attributable to HF in 2003 alone.

Conclusions:
HF is associated with significant burden to Medicare. The high Medicare cost of HF patients will be a growing concern as the Medicare population grows. Optimal strategies for the prevention, treatment and management of this chronic disease will need to be identified.
Abstract 5023: Gender Difference in In-hospital Mortality Following Coronary Angioplasty: Is it True Only in an Emergency Context ?
Authors: Roncalli Jérôme , Boudou Nicolas , Dumonteil Nicolas , Lhermusier Thibault , Lairez Olivier , Baixas Cécile , Elbaz Meyer , Ruidavets Jean-Bernard , Galinier Michel , Carrié Didier
Published: July 2021

The aim of this study is to assess whether the excess risk of in-hospital mortality in women is noticed only when percutaneous coronary intervention (PCI) is performed in emergency after St+ acute coronary syndrome (ACS) or whether the excess risk is also observed after non-St+ ACS or unstable angina. During 3 years (2005–2007), 7847 consecutive PCI were performed in the University Department of Cardiology. The number of PCI performed in emergency for St+ ACS was 1529. The main end-point was in-hospital death and secondary outcomes included during the first 48 hours: stroke, emergency CABG surgery, recurrent myocardial infarction, new PCI and renal or vascular adverse events. The association between gender and in-hospital outcomes was assessed using multivariate logistic regression analysis. The proportion of women was 22.2% (n=340:1529) when angioplasty (in emergency) was performed in St+ ACS. History of renal failure was more prevalent in women (17.6% vs. 9.7%, p=0.001) whereas history of ischemic heart disease (previous myocardial infarction, coronary angioplasty or CABG surgery) was not significantly higher in men (24.1% vs. 20.9%). The percentage of deaths was 5.3% in women and 1.7% in men (p=0.001). The risk (OR [95% CI]) of in-hospital mortality for women vs. men (crude analysis) was 3.26 ([1.70 – 6.23], p=0.001) and 2.31 ([1.14 – 4.69], p=0.02) after multivariate adjustment for age, ischemic heart disease, year of procedure, renal failure, number of vessel disease, number of treated coronary arteries and thrombolytic therapy. The proportions of deaths were identical (0.64% and 0.60% in women and men respectively) when PCI was performed in a non-emergency setting in non-St+ ACS or unstable angina. The risk was similar before and after multivariate adjustment; 1.06 ([0.50 –2.26], p=0.87) and 0.91 ([0.42–1.98], p=0.81) respectively. The higher risk of in-hospital mortality for women is noticed only when PCI is performed in an emergency setting after St+ ACS. In non-urgent procedures the risk of death is similar to the one observed in men.
Abstract 5057: Habitual Dietary Intake of Fatty Acids in Relation to Insulin Resistance among Japanese Adults
Authors: Muramatsu Takashi , Yatsuya Hiroshi , Matsushita Kunihiro , Mitsuhashi Hirotsugu , Toyoshima Hideaki , Murohara Toyoaki
Published: July 2021

Background:
Asians including Japanese are more susceptible to glucose intolerance or type 2 diabetes mellitus (DM) than Caucasians. However little is known about the effects of dietary fatty acid (FA) intake on insulin resistance (IR) in Japanese.

Objective:
Our aim was to investigate associations between IR and habitual dietary intake of FAs among middle-aged Japanese adults.

Methods:
We designed a cross-sectional survey of 3383 Japanese adults aged 35– 66 years. IR was measured with homeostasis model assessment (HOMA-R) and nutrient intake was estimated by a self-administered diet history questionnaire. All amounts of nutrients were energy-adjusted as the residuals from regression model.

Results:
Log-transformed HOMA-R had a significant negative correlation with polyunsaturated fatty acid (PUFA). Multivariate-adjusted regression analysis demonstrated that IR had a significant positive association with saturated fatty acid (SFA) and inverse associations with n-6 series PUFA independently of age, sex, BMI, lipid profiles, other macronutrients and lifestyle. Multivariate-adjusted odds ratios of IR, defined as a top quartile of HOMA-R distribution, across the quartiles of energy-adjusted intakes were 1.0, 0.89, 0.73 and 0.57 for linoleic acid (
P
for trend = 0.007) and 1.0, 0.90, 0.68 and 0.61 for alpha-linolenic acid (
P
for trend = 0.010), respectively. Marine-derived n-3 PUFA and the ratio of n-6 to n-3 PUFA had no consistent association with IR.

Conclusions:
Our cross-sectional data suggest that a modification of dietary fat intake to substitute PUFA, in particular linoleic acid and alpha-linolenic acid, for SFA may have a clinical efficacy to prevent IR among a Japanese population.
Abstract 5103: Serum Matrix Metalloproteinase-8 Concentrations are Associated with Coronary Heart Disease Death in Men
Authors: Kurl Sudhir , Mäkikallio Timo , Laukkanen Jari A
Published: July 2021

Background:
Matrix metalloproteinase-8 (MMP-8) thins the protecting fibrous cap of the atherosclerotic plaque thereby increasing its vulnerability to unexpected rupture. However, results on the association of serum MMP-8 concentrations and coronary heart disease (CHD) death are very limited.

Methods:
We analysed the association of serum MMP-8 and tissue inhibitor of metalloproteinase-1 (TIMP-1) concentrations in a population-based prospective sample of 1018 men (aged 46 – 64 years) of the Kuopio Ischemic Heart Disease risk factor study with the follow-up time of 10 years.

Results:
During the follow-up, a total 172 of acute myocardial infarction and 62 deaths due to CHD occurred. MMP-8 concentrations were higher in men with prevalent cardiovascular disease or sub-clinical atherosclerosis (intima-media thickness ≥1 mm) at baseline than those without. MMP-8 concentrations were associated with the risk of acute myocardial infarction (RR 1.12, 95% CI 1.03 to 1.23, p=0.011), death from CHD (RR=1.19, 95 % CI 1.08 –1.31, p<0.001) and all-causes (RR 1.15, 95 % CI 1.07 to 1.23, p<0.001) per one standard deviation (SD) increase, after adjustment for age, history of CHD, body mass index, systolic blood pressure, smoking and serum LDL and HDL cholesterol. Serum TIMP-1 concentrations alone had no independent predictive value for CHD.

Conclusions:
The results indicate that serum MMP-8 concentrations are elevated in prevalent CHD or subclinical atherosclerosis and elevated MMP-8 concentrations predict the risk of CHD outcomes.
Abstract 6214: Comparison of Adiponectin Levels in Healthy Americans and Japanese: Results from Framingham and Fukuoka
Authors: Koga Tsunehisa , Furusyo Norihiro , Ai Masumi , Otokozawa Seiko , Asztalos Bela F , White Charles C , Banjaw Serkalem D , Cupples L A , Nakajima Katsuyuki , Schaefer Ernst J , Hayashi Jun
Published: July 2021

Background and Objectives: Adiponectin is an adipocytokine with insulin-sensitizing and anti-atherosclerotic effects. Serum adiponectin levels have been reported to be negatively correlated with body weight and waist circumference (WC). Low plasma adiponectin levels are known to predispose to the development of insulin resistance and type 2 diabetes mellitus. Adiponectin levels may vary according to ethnic group. The aim of this study was to investigate potential differences in plasma adiponectin levels between Japanese and Americans.

Methods: Subjects consisted of 2,060 healthy American male and female participants in exam 6 of the Framingham Offspring Study (mean age 57.0 ± 9.0 years, 57.4 ± 10.5 years, respectively), and 1131 healthy Japanese male and female participants in the Fukuoka Study (mean age 56.3 ± 5.5 years, 55.6 ± 5.4 years, respectively). Frozen plasma samples (at −80 degree C) from both studies were shipped to Tufts University, Boston. Plasma concentrations of direct LDL-C, fasting plasma glucose and adiponectin were measured using the same assay kits on the same machine (Hitachi 911) by the same staff. Anthropometric measurements including weight, height, body mass index (BMI) and WC, were also used in the analysis.

Results: Plasma adiponectin levels were significantly and inversely correlated with BMI, WC, glucose, insulin, triglycerides, and systolic and diastolic blood pressure. Moreover adiponectin levels were significantly and positively correlated with HDL-C in both populations. Mean BMI and WC of Japanese men and women were significantly lower (23.8 kg/m
2
and 22.1 kg/m
2
, 86.0 cm and 78.7 cm, respectively) than in US men and women (28.2 kg/m
2
and 27.0 kg/m
2
, 100.4 cm and 92.8 cm, respectively) (all p<0.05). However, mean adiponectin levels (± SD) in Japanese men and women were significantly lower (9.3 ± 4.5 micro g/mL and 14.7 ± 7.3 micro g/mL, respectively) than in US men and women (10.3 ± 5.2 micro g/mL and 16.3 ± 7.7 micro g/mL, respectively)(p<0.05).

Conclusion: Our data indicate a substantially lower prevalence of adiposity, but not higher adiponectin levels, in a healthy Japanese population as compared to an American population. The data indicate that population specific norms may have to be used for different ethnic groups.
Abstract 6234: Cost-Effectiveness Analysis Demonstrates Superiority of Screening Young Athletes with 12-Lead Electrocardiogram versus History and Physical in Preventing Sudden Cardiac Death
Authors: Wheeler Matthew T , Heidenreich Paul A , Froelicher Victor F , Hlatky Mark A , Ashley Euan A
Published: July 2021

Sudden cardiac death (SCD) is a rare but frightening event among young athletes. The Italian experience demonstrates a reduction in athlete SCD by screening with history, physical, and 12-lead electrocardiogram (ECG). American guideline statements have not recommended ECG for screening athletes due to perceptions of high cost and unclear effectiveness. We sought to model the cost-effectiveness (CE) of history and physical (H&P), ECG plus H&P, and no screening in US high school and college competitive athletes. A decision analysis model was used. Risks, prevalence, and test characteristics were derived from the medical literature. Costs were derived from publicly available datasets. Markov processes were used to simulate the natural histories of screened athletes. One-way sensitivity analyses and Monte Carlo simulation of all variables in the estimated ranges were performed. A societal perspective was used. Screening with an ECG plus H&P has lower overall costs and better outcomes than use of H&P alone. Compared with no screening, H&P saves 0.57 life years (LY) per 1000 athletes screened at an incremental cost of $111 per athlete, yielding a CE ratio of $195,600 per LY saved (simulation based 95% CI $116,000–514,000). ECG plus H&P when compared to no screening saves 2.7 LY per 1000 athletes at an incremental cost of $199 per athlete, for a CE ratio of $74,100 per LY saved (95% CI $46,000–158,000). Probabilistic sensitivity analysis shows that ECG plus H&P is the preferred strategy over H&P in terms of cost-effectiveness in 99.5% of simulations. ECG plus H&P is cost-effective below a threshold value of $100,000 per LY saved in 89% of simulations, while H&P is cost-effective in 1% of simulations. If the reduction in SCD risk per screening-identified, at-risk athlete is below 33%, or if more than 12% of screens are false positive, screening with ECG plus H&P is no longer cost effective. ECG plus H&P is superior to H&P for screening young athletes in our cost-effectiveness model. The incremental cost of adding an ECG, including screening, secondary testing, and subsequent treatment is under $100 per athlete screened. These data should inform the ongoing debate concerning pre-participation screening of US student-athletes.
Abstract 6241: Proton Pump Inhibitors May Attenuate the Benefits of Clopidogrel among ACS Patients: Empirical Evidence from 3,311 ACS Patients
Authors: Ho P. Michael , Maddox Thomas M , Wang Li , Fihn Stephan D , Jesse Robert L , Peterson Eric D , Rumsfeld John S
Published: July 2021

Background:
A prior report showed omeprazole decreases platelet inhibitory effects of clopidogrel (clopid). However, the clinical impact of these findings is unknown. We studied outcomes of patients taking clopid alone versus clopid and proton-pump inhibitor (PPI) after acute coronary syndrome (ACS) in a national VA registry.

Methods:
This was a retrospective cohort study of 3,311 ACS patients discharged from 127 VA hospitals on either clopid alone or clopid+PPI based on pharmacy dispensing data. The main outcome was AMI/death. Cox proportional hazards regression models assessed the association between drug use as a time varying covariate and outcomes. Mean follow-up was >1 year. During follow-up, patients could have gaps in their treatment and thus could be categorized as “no drugs” or “PPI-only” for short durations.

Results:
At discharge, 34% were prescribed clopid alone and 66% clopid+PPI. Baseline characteristics were quite similar (e.g. mean age 68.1 yrs for clopid vs 68.3 yrs for clopid+PPI) except clopid+PPI patients had less diabetes and more renal insufficiency. In multivariable analyses, clopid+PPI was associated with a higher risk of AMI/death risk compared to clopid alone (HR 1.28; 95% CI 1.07–1.53) (Figure

). Findings were consistent excluding patients with bleeding event during follow-up and using a nested case-control study design.

Conclusion:
Concomitant use of clopidogrel and PPI after ACS is associated with higher risk of adverse outcomes than clopidogrel use without PPI. These findings, coupled with the prior mechanistic study, suggest that concomitant PPI use attenuates the benefits of clopidogrel after ACS.
Abstract P29: Impaired Systemic but Preserved Cerebral Microcirculation Following Hemorrhagic Shock and Fluid Resuscitation
Authors: Wan Zhi , Sun Shijie , Ristagno Giuseppe , Li Yongqin , Weil Max H , Tang Wanchun
Published: July 2021

Background:
Decreases in buccal microcirculation are associated with severity and outcomes of circulatory shock. However, there is evidence that cerebral function is unimpaired after even severe states of hemorrhagic shock. We therefore hypothesized that in severe states of hemorrhagic shock with profound decreases in buccal microcirculation, the cerebral microcirculation may be preserved.

Method:
Craniotomies were performed in 15 male Sprague-Dawley rats, weighing 450–550g, to expose the parietal cortex for visualization of microcirculation. Animals were then bled via a catheter advanced into the descending aorta. An estimated 35% or 25% of blood volume was bled over 60 minutes and measurements were compared with unbled control. Sixty minutes after onset of hypotension, bled animals received normal saline infused over 30 minutes in amounts equivalent to two times the volume of shed blood. Cerebral and buccal microcirculations were visualized with orthogonal polarization spectral imaging.

Result:
Reductions in mean arterial pressure (MAP) were partially reversed after fluid infusion (Figure 1

). Buccal microcirculation was restored to baseline level after the 25% blood loss and partially restored after the 35% loss. The cerebral microcirculation, however, was unchanged during both hemorrhagic hypotension and following volume repletion.

Conclusion:
In contrast to the striking reduction in arterial pressure and systemic microcirculation, the cerebral microcirculatory blood flow was preserved during hemorrhagic shock of moderate and severe degrees. These findings confirm a dissociation between the macrocirculation and the cerebral microcirculation.
Abstract P75: Dissemination of CPR Skills to the Public - Can Schoolchildren Ensure Success?
Authors: Lorem Tonje , Palm Aud , Wik Lars
Published: July 2021

Training a large fraction of the general population in CPR could have major public health benefit if those most likely to witness cardiac arrest are trained. Mass distribution of self-training manikins as a two-tiered strategy with school children as first tier has been described as successful, but without information on second tier age or information strategy to second tier. We studied three different attempts at reaching older second tier persons. In groups 1 and 2 first tier consisted of 7
th
graders and in group 3 high school and medical school students. Information about the desirable second tier age group was given in writing prior to the distribution. In groups 1 and 3 information was only directed towards first tier. In group 2 both first tier, their parents and teachers were informed. The first tier participants reported the number of second tier trained for age-groups 12–25 years, 25–50 years, and >50 years. Approximately 64000 (group 1), 63000 (group 2) and 81 (group 3) self-education kits were provided with 2.7, 1.9, and 3.7 lay-rescuers trained per kit respectively (p<0.05) (Table 1

). Informing also the parents of the first tier prior to the distribution did not positively impact the number of second tier trained lay-rescuers, but higher age of first tier did. We speculate that 7
th
graders are too young to successfully disseminate CPR to those most likely to witness out of hospital cardiac arrest.

Table 1.

Percentage reported trained in first and second tier divided into age-groups.
Abstract P79: Application of the Video Self Instruction Kit (CPR Anytime
®
) for The Mass CPR Training Courses and Its Impact on the CPR Quality
Authors: Jung Sung Koo , Jeong Joong Sik , Shin Sang Do , Kim Tae Yun , Rhee Joong Eui , Suh Gil Jun
Published: July 2021

Background: We sought to determine whether the video self Instruction kit (CPR anytime
®
) could be a useful tool for the mass CPR training, and to evaluate its effects on the CPR quality compared to the traditional method of learning.

Methods: The CPR training courses were designed to 3 different types by the learning method: 45 munites self learning with CPR anytime
®
(group A), 1 hour lecture + 45 munites self learning with CPR anytime
®
(group B), 1 hour lecture + 1 hour practice with instructors (group C). From July 2007 to August 2007, 405 (34%) participants out of the 1,178 applied trainees were seleted by stratified sampling according to their sex, age, the date of learning, and the learning method. The trainees with any respiratory, skeletal disease or incomplete informed consents were excluded. At the end of the courses, the skill test was done by the checklist and their skill performance was tested using the Laerdal PC SkillReporting System
®
. Statistical analysis was performed using One Way ANOVA in continuous variables and
x
2
analysis in categorical variables.

Results: Two hundred twenty subjects were enrolled properly with 79(35.9%), 66(30.0%), 75(34.1%) belonging to group A, B, and C, respectively. The mean age was 36.3 years and females accounted for 77.3%. We found no significant differences in their willingness to participate, sex, weight, height, and educational status. The skill test indicated no differences among the three groups. In the skill performance, there were no significant differences between group A and B. When compared to group C, group A showed a higher rate of forceful ventilation (58.5 ±38.4% vs 41.3 ±37.9%,
p
=0.03), a larger amount of mean tidal volume (950.0±416.5 mL vs 745.6±343.8 mL,
p
=0.00), a lower rate of shallow compression (47.1±40.3% vs 65.4±40.6%,
p
=0.01), and a deeper depth of compression (38.6±9.6 mm vs 34.1±9.8 mm,
p
=0.01).

Conclusion: The trainees of self leraning with CPR anytime
®
showed similar results of the skill test with the trainees of other two longer leraning method, and presented relatively adequate chest compression with the tendency of frequent hyperventilation. On the condition of adding a solution to prevent hyperventilation, the CPR anytime
®
can be a helpful tool for the mass CPR education.
Abstract P103: Effects of Chest Compression Pressure Field on Stroke Volume during Cardiopulmonary Resuscitation
Authors: Lampe Joshua W , Noordergraaf Gerrit J , Noordergraaf Abraham , Becker Lance B
Published: July 2021

Hypothesis:
The way that chest compressions generate blood flow remains unclear. Additionally, different mechanical chest compression devices may create different thoracic pressure fields. We hypothesize that three thoracic pressure fields, direct ventricular massage, cardiac pump, and thoracic pump, generate blood flow through different mechanisms resulting in different stroke volumes.

Methods:
The Donder’s model of the human cardiovascular system models vessels as resistor-inductor-capacitor (RLC) circuits, where the resistive component describes the viscous resistance to blood flow, the inductive component describes the inertial resistance to blood flow changes, and the capacitive component describes the elastic properties of the vessel. The model can account for effects of respiration on blood flow. Cardiac output for the three pressure fields was modeled using sinusoidal compression waveforms with maximum pressures between 25 and 150 mmHg.

Results:
The figure

shows the dependence of stroke volume on the pressure maximum for the three pressure fields. Peak stroke volumes occur near 75 mmHg for ventricular massage, 125 mmHg for thoracic pump, and 25 mmHg for cardiac pump compressions. Ventricular massage and the cardiac pump model utilize the heart valves to generate blood flow. The thoracic pump model generates blood flow by utilizing the elastic differences between veins and arteries.

Conclusions:
The three pressure fields have unique values for optimum compression pressure. The Donder’s model may allow for rapid investigation of many pressure fields, pressure wave forms, and compression to ventilation ratios to accelerate the optimization of CPR.
Abstract P106: Cerebral Health Index as a Measure of Neurological Recovery in an Asphyxial Cardiac Arrest Model
Authors: Sherman David L , Jia Xiaofeng , Le Nhu-An T , Hathi Manan , Thakor Nitish V , Geocadin Romergryko G
Published: July 2021

Background
Cardiac arrest (CA) can lead to significant neurological damage following resuscitation. A real-time tool for monitoring of neurological status in CA survivors is likely to have a significant impact on post-CPR therapy. To avoid typical subjective prediction of outcome, we have developed a quantitative EEG-based Cerebral Health Index (CHI), a multiparametric algorithm combining several separate spectral, temporal and probabilistic features. CHI is a measure of outcome that evaluates and scores the EEG post-resuscitation from CA. In the present study, we compared CHI to a species-specific behavioral outcome scoring measure, the Neurological Deficit Scores (NDS). Previously calibrated and tested, NDS includes multiple generalized neural, motor, sensory and behavioral subscores. We demonstrated the utility of CHI as a measure of monitoring neurological status as given by NDS.

Methods
CHI is an empirically trained algorithm that allows for parameter weighting to uniquely characterize the recovering EEG. We investigated the utility of CHI by comparing 72-h CHI values to 72-h of an asphyxial CA rodent model. Sixteen rats underwent a baseline EEG recording followed by 7- or 9-min asphyxia and anesthesia washout which led to CA. The NDS was scored at 72 hr after CA with concurrent 30-min EEG recording. The rats were divided into two groups:

8 rats with known NDS outcomes were used for training the CHI algorithm and

8 rats were used for testing the algorithm in a single blinded fashion.

CHI values of the testing group were then compared to their corresponding NDS outcomes via Receiver Operator Characteristic (ROC) curve calculation.

Results
Physiological measures and arrest times were comparable in both poor and good outcome animals. On a scale basis of 0–80, average CHI values were 70 (±3.8) and 51 (±4.4) for the good and bad outcome animals, respectively. This translated to respective t-test p-values of p≤0.05. ROC analyses on testing cohorts at 72 hr showed an average area under the curve of 0.9.

Conclusion
CHI is a multi-feature index for accurately describing neurological status after CA in rats. CHI can potentially be used to supplement the traditional neurological exam to make EEG characterization a routine part of post-CA assessments.
Abstract P109: Alteration in Intracellular Calcium During Cardiac Arrest
Authors: Takeda Satoshi , Yoshida Hiroshi , Ogawa Takeki
Published: July 2021

AIM: A cytosolic free calcium is an important regulator of cardiac metabolism and contractility, and an increased [Ca2+]i has been implicated in irreversible cell injury and contractile dysfunction. We investigated intracellular calcium ([Ca2+]i) dynamics during cardiac arrest, especially in pulseless electrical activity (PEA) and asystole.

METHODS: Rat hearts (n=18) were perfused with a Langendorff system and loaded with Fura-2/AM, as a [Ca2+]i marker, and BCECF/AM, as a pHi marker. Surface fluorescence of the heart was recorded with an intracellular ion analyzer. A latex balloon was inserted into the left ventricle to monitor left ventricular pressure. Sustained normo-thermic cardiac arrest was induced for 20 min by clamping the aortic cannula.

RESULTS: After clamping (cardiac arrest), the left ventricular developed pressure decreased significantly, from 84.3±11 mmHg to 3.88±0.7 mmHg (p<0.01) at 2min. The rhythm was PEA in all cases in this period, followed by asystole. The amplitude of the [Ca2+]i transient (0.30±0.03) was maintained at 2 min, but further significant increases were observed in both systolic (1.14±0.04, p<0.01) and diastolic levels of [Ca2+]i (0.84±0.04, p<0.05), when compared with pre-arrest levels. The [Ca2+]i transient disappeared 4.7±0.6 min. The diastolic [Ca2+]i increased gradually after 5 min to 20 min. This diastolic [Ca2+]i increase was parallel with the increase in left ventricular end diastolic pressure (indicated ischemic contracture). The pHi increased (to 7.6±1.0) immediately after clamping. Thereafter pHi decreased rapidly and remained steady (at pH 6.6±0.6).

CONCLUSIONS: The change in the [Ca2+]i-pressure relationship rather than change in the amplitude of the [Ca2+]i transient was the main contributor in the early cardiac arrest phase. The diastolic [Ca2+]i increase might induce irreversible cell injury in the late cardiac arrest phase.
Abstract P117: A Mathematical and Physical Model for Non-Pulmonary Oxygenation for Resuscitation Utilizing Solid Peroxides
Authors: Sandhu Gurbhagat , Huvard Gary , Ward Kevin
Published: July 2021

Introduction
; Adequate tissue oxygenation is vital for resuscitation. Intravascular O
2
carrying compounds may enhance tissue O
2
delivery under ischemic conditions but use of both hemoglobin and nonhemoglobin O
2
carriers have limitations. Use of compounds capable of producing O
2
at the tissue level may be useful. Solid peroxides such as percarbamide may provide novel means of tissue O
2
delivery since they contain stored O
2
which can be released upon activation with catalase. However, the chemistry is complex and a product must be designed for controlled O
2
production.

Objectives
: To develop and use a mathematical and physical model to examine the feasibility of creating encapsulated solid peroxides for intravenous O
2
delivery.

Methods
: An O
2
delivery vehicle combining percarbamide, a non-aqueous liquid carrier, and a biodegradable-compatible polymer coating was developed for controlled O
2
production. Upon contact with plasma, water diffuses across the polymer coating to cause release of H
2
O
2
from percarbamide. The H
2
O
2
then diffuses back across the membrane into plasma reacting with the blood enzyme catalase to form O
2
and water. A permeation cell system was constructed to validate the physical chemistry of this controlled O
2
production approach. A mathematical model incorporating Fickian diffusion and shrinking surface kinetics was derived to model O
2
production.

Results
: The permeation cell experiments validated the physical chemistry approach of delivering O
2
using encapsulated percarbamide. The mathematical model successfully predicted O
2
release. Experimental and modeling results show that by tuning the coating thickness, coating type, non-aqueous carrier liquid, and solid peroxide size, the rate of O
2
production can be precisely controlled. Percarbamide (150 gms) would produce 250 cc/min of O
2
for 60 minutes to meet whole body metabolic demands.

Conclusions
: A mathematical and physical model of O
2
production was successfully created allowing manipulation of multiple variables related to releasing O
2
from a solid peroxide delivery system. Experimental results validate the model’s accuracy. This work suggests the feasibility of using encapsulated solid peroxides to produce life sustaining amounts of O
2
for intravenous tissue oxygenation.
Abstract P118: Influence of a Sulfide Donor on Resuscitability and Neurological Outcome in a Porcine Model of Prolonged Cardiac Arrest
Authors: Derwall Matthias , Cizen Aysegül , Loewer Celine , Westerkamp Maren , Schnorrenberger Nora , Deike-Glindemann Jan , Fries Michael
Published: July 2021

Introduction: Hydrogen sulfide (H2S) protects vital organs and promotes survival in ischemia-reperfusion injury.

Hypothesis: H2S increases resuscitability and neurological outcome in a porcine model of cardiac arrest (CA).

Methods: 16 pigs were instrumented with an arterial line and a pulmonary artery catheter to measure mean arterial pressure (MAP), mean pulmonary artery pressure (MPAP) and pulmonary capillary wedge pressure (PCWCP) before CA was electrically induced and left untreated for 10 minutes. One minute after starting cardiopulmonary resuscitation (CPR), animals were randomized to intravenous bolus injection of 1mg/kg of a liquid donor of H2S (Na2S; IK-1001, Ikaria, Clinton, NJ), followed by continuous infusion of 1mg/kg/h for two hours or placebo. After a total of 6 minutes of CPR defibrilation was attempted. Surviving animals were assessed for neurological outcome on four postoperative days using a neurological deficit score (NDS).

Results: In both groups 50% of the animals could be initially resuscitated. Hemodynamic variables did not differ at baseline (i.e. before CA). However, H2S treated animals showed significantly lower MAP, MPAP and PCWP 60 minutes post CPR. PCWP remained significantly lower after 2, 3 and 4 hours. Two animals in the H2S group died before day four. Furthermore, H2S animals performed worse on the NDS at all time points after CPR (Time point - H2S vs. Placebo: +1 − 79 vs. 84/+2 − 74 vs. 89/+3 − 72 vs. 88/+4 71 vs. 88).

Conclusion: In this pilot study, H2S at a dose of 1 mg/kg did not improve resuscitability and worsened post CPR hemodynamics and neurological outcome.
Abstract P125: A Novel Role for Survivin in Insulin-induced Inhibition of Myocardial Apoptosis in Ischemic/reperfused Heart
Authors: Si Rui , Yu Qiujun , Zhou Ning , Tao Ling , Guo Wenyi , Wang Haichang , Gao Feng
Published: July 2021

Objectives:
Insulin reduces post-ischemic myocardial apoptotic death, but the mechanism remains unclear. Survivin, an anti-apoptotic protein has recently found participating in vascular repair. This study aimed to test the hypothesis that the up-regulation of survivin by insulin may play a role in the antiapoptotic and cardioprotective effects in the ischemic/reperfused (I/R) heart, and further investigate the signaling mechanism involved.

Methods
: Isolated adult Sprague-Dawley rat hearts were subjected to 30 min regional ischemia and 3 h of reperfusion. The hearts were randomized to receive insulin, insulin plus LY294002 (specific inhibitor of PI3K), or insulin plus rapamycin (specific inhibitor of mTOR) at the start of reperfusion. To further confirm the correlation between survivin and myocardial survival in vitro, cardiomyocytes were infected with adenovirus encoding survivin or transfected with siRNA targeting survivin. Phosphorylation of Akt, mTOR, p70S6K and the expression of protein survivin were determined and infarct size was assessed using TTC staining, cardiomyocytes apoptosis were evaluated after reperfusion by TUNEL staining and DNA laddering.

Results:
I/R increased myocardial survivin expression. Insulin reperfusion (10
−7
mol/L) resulted in a 4.2-fold increase in survivin expression (P<0.01
vs.
I/R alone), which was almost completely blocked by LY294002. Both of the mTOR phosphorylation and survivin expression were inhibited in the group of insulin reperfusion plus LY294002. Rapamycin reperfusion did not change Akt phosphorylation but partially inhibited survivin expression (16.7±1.2 vs. 9.8±1.6, P<0.01 vs. I/R+Ins), which indicated a cardioprotective effect of survivin and a possible PI3K/Akt/mTOR/SVV signaling pathway during I/R. Moreover, over-expressed survivin provides protection against stimulated ischemia reperfusion induced cardiomyocyte apoptosis, while targeting survivin blunted the anti-apoptotic effect of insulin.

Conclusion:
This study demonstrates that insulin up-regulates myocardial survivin expression, partly at least, via PI3-kinase-mTOR mechanism, which contributes to the anti-apoptotic effect of insulin in the I/R heart.
Abstract P126: Effects of Carvedilol on Mortality and Inflammatory Responses to Hemorrhagic Cardiac Arrest in Rats
Authors: Taniguchi Takumi , Inaba Hideo
Published: July 2021

Recent studies showed that beta-blocker is often used in hypertensive and/or cardiac failure patients because of its drug efficacy. Moreover, several papers reported that beta-blocker has the beneficial effects in patients with cardiogenic shock. However, there are few studies about the effects of beta-blocker during hemorrhagic shock and hemorrhagic cardiac arrest. To evaluate the effects of beta-blocker in an animal model of hemorrhagic cardiac arrest. Carvedilol was used as the beta-blocker agents. Twenty-four male Sprague Dawley rats were used. Animals were randomly assigned to one of two groups (n = 12 per group): control group, no medication; treatment group, oral administration of carvedilol (10 mg/kg/day) for 5 days. After then, all animals were anesthetized with pentobarbital ip. Hemorrhagic cardiac arrest was induced with removing of blood. After 8 minutes of cardiac arrest, the all removing blood was administered. There were no other therapies before, during or after cardiac arrest. Hemodynamics and arterial blood gases were recorded, and mortality were calculated for the 5-hr observation period and plasma cytokine (TNF-alpha and Interleukin-6) concentrations were measured at 5-hr after cardiac arrest. The mortality rates at 5hrs after cardiac arrest were 8% and 50% for control and treatment groups, respectively. The increases of base deficit and lactate concentrations were less for the control group than the treatment group. Moreover, the increases of TNF-alpha and IL-6 concentrations were less for the control group than the treatment group. The present study showed that oral administration of carvedilol had the disadvantage effects on mortality and inflammatory effects to hemorrhagic cardiac arrest in rats. These finding suggest that beta-blocker may worsen the recovery of hemorrhagic shock.
Abstract P129: Role of the Autonomic Nervous System in Remote Postconditioning in Humans
Authors: Williams Rupert P , Okorie Michael I , Gill Harminder , Deanfield John E , MacAllister Raymond J , Loukogeorgakis Stavros P
Published: July 2021

Brief periods of ischaemia activate systemic mechanisms that induce whole-body tolerance to subsequent prolonged and injurious ischaemia. This phenomenon, remote ischaemic preconditioning (RIPC), is sufficiently acute to reduce ischaemia-reperfusion (IR) injury even when applied
simultaneously
with injurious ischaemia. This aspect of RIPC is termed remote postconditioning (RPostC). We have previously demonstrated a role for the autonomic nervous system in RIPC. Using an
in vivo
model of endothelial IR injury, we determined if RPostC is dependent on adrenergic autonomic mechanisms. Vascular ultrasound was used to assess endothelial function in healthy volunteers by measuring dilatation of the brachial artery in response to increased blood flow during reactive hyperaemia (flow-mediated dilatation; FMD). Endothelial IR injury was induced by 20 min of upper limb ischaemia (inflation of a blood pressure cuff to 200 mm Hg) followed by reperfusion. RPostC was induced by applying 2 cycles of 5 minutes ischaemia and 5 minutes reperfusion on the leg during arm ischaemia (via a second blood pressure cuff). In order to determine the dependence of RPostC on autonomic activation, we administered the alpha adrenoceptor blocker phentolamine (0.2– 0.7mg/min, intravenously) during the application of the RPostC stimulus. FMD was determined before ischaemia and at 20 minutes of reperfusion. FMD (percentage change from baseline diameter) was compared statistically by ANOVA. IR alone caused a significant reduction in FMD (5.9±0.7% pre- versus 2.2±0.4% post-IR, n=9, P<0.001). This reduction was prevented by RPostC (5.8±0.4% pre- versus 5.4±0.3% post-IR, n=8, P>0.05). Systemic phentolamine blocked the protective effects of RPostC (FMD 6.1±0.5% pre- versus 2.0±0.3% post-IR, n=7, P<0.001). These data indicate, for the first time in humans, that protection from RPostC depends on preservation of adrenergic signalling. Alpha blockade neutralises one of the endogenous mechanisms of ischemic protection in humans; the clinical consequences of this remain to be determined.
Abstract P149: CPR Feedback Improves the Quality of Chest Compressions Performed by Healthcare Providers
Authors: Peberdy Mary Ann , Silver Annemarie , Faulkenberry Phyllis , Ferland Lisa , Ornato Joseph
Published: July 2021

Purpose
: Healthcare providers are often unable to perform chest compressions (CC) consistently within AHA guideline recommendations of 100 CC/minute at a depth of 1.5–2 in. The present study examined the effect of audiovisual CPR feedback on the quality of CC performed by healthcare providers.

Methods:
One hundred twenty-five ACLS and BCLS trained hospital based healthcare professionals participated in “CPR challenges” at 14 U.S. hospitals. Participants performed 2 minutes of CC on a manikin without any feedback initially. Following a ≥90 second rest period and ~20 second orientation to the audiovisual feedback prompts, participants repeated 2 minutes of CC with feedback prompts. Data were recorded using a ZOLL AED Plus. Rescuers were categorized based upon mean depth of CC without feedback: 1) under-performers (depth<1.5in; n=60); 2) within guideline-performers (depth<1.5–2in; n=52); and 3) over-performers (depth>2in; n=13).

Results:
Mean depth of CC improved with CPR feedback (1.57±0.36in without feedback vs. 1.71±0.13in with feedback, mean±SD, p<0.0001) and the percentage of CC within 1.5–2in increased from 38 to 87% (p<0.0001). In under-performers, depth of CC substantially increased with CPR feedback (1.30±0.12 vs. 1.66±0.13in; p<0.0001) and the percentage of CC within 1.5–2in improved from 9 to 81% (p<0.0001). Over-performers were corrected to meet AHA guidelines for depth with feedback (2.31±0.40 vs. 1.83±0.07in, p=0.001). The percentage of CC within 1.5–2 in improved from 13 to 90% with feedback (p<0.0001). For within guideline-performers, depth of CC was similar with and without feedback (1.70±0.14 vs.1.74±0.10in, p=0.08) but the percentage of CC within 1.5–2 in increased with feedback from 79 to 92% (p<0.0001). Rate of CC was corrected with CPR feedback in under-performers (110±17 vs. 100±4 CC/min, p<0.0001) but was unchanged with feedback in within guideline-performers (103±15 vs. 100±3 CC/min, p=0.2) and over-performers (97±14 vs. 100±8 CC/min, p=0.4).

Conclusions:
Audiovisual feedback improves the quality of CC provided by hospital-based healthcare professionals in a manikin testing scenario. Healthcare providers can improve consistency of CC with CPR feedback regardless of their performance without feedback.