bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 20536: ALLogeneic Heart STem Cells to Achieve Myocardial Regeneration (ALLSTAR): the One Year Phase I Results
Authors: Makkar Raj , Schatz Richard , Traverse Jay , Hamer Andrew , Beattie Katherine , Smith Rachel R , Kivel Francie , Marbán Linda , Marbán Eduardo , Henry Timothy D
Published: July 2021

Introduction:
In CADUCEUS, autologous cardiosphere-derived cells decreased infarct size and increased viable tissue in post-myocardial infarction (MI) subject s.

Hypothesis:
The first-in-human Phase I ALLSTAR trial was designed to test the safety and feasibility of intracoronary infusion of allogeneic cardiosphere-derived cells (CAP-1002) in patients with an anterior MI, within the prior 12 months with a scar size >15% by Magnetic Resonance Imaging (MRI).

Methods:
A total of 14 adult subjects (mean age = 55.6 yr; range 40-66 years) with a recent (28 - 90 days; n=9) or chronic (91-365 days; n=5) anterior MI (mean infarct size 25.4%; range 15.3% - 32.7%) and LV dysfunction (mean LVEF 42%; range 26.7% - 55.1%) were prospectively enrolled and infused with CAP-1002 (n=4 at 12.5M dose; n=10 at 25M dose) via stop-flow intracoronary infusion. Primary safety endpoints were: MACE events (recurrent MI, hospitalization or ER treatment for heart failure, Left Ventricular Assist Device placement or heart transplantation), acute myocarditis, death due to arrhythmias or unwitnessed death. Humoral and cellular immunologic responses were assessed via single antigen bead and ELISpot assays.

Results:
No pre-specified safety endpoint occurred. Only two adverse events were treatment-related, both transient hypotension related to nitroglycerin. There were no clinically significant rises in peri-procedural cardiac enzymes. Donor specific antibodies (DSAs) were present in four subjects prior to infusion; one resolved and three presistent at 6 months of follow up. De novo DSA’s developed in four subjects, three resolved during follow up and one persisted at 6 months of follow up. All DSA levels were low (MFI<5000). ELISpot revealed no de novo cellular immune responses. One year follow-up safety data as well as full 6 month and available 12 month MRI results on scar size and LVEF will be presented.

Conclusions:
Intracoronary infusion of allogeneic cardiosphere-derived cells (CAP-1002) appears to be safe and feasible. On the basis of the Phase 1 findings, the ALLSTAR trial has proceeded to a Phase II randomized, double-blind trial, powered to assess reduction of scar size by MRI.
Abstract 20657: Plasma MicroRNAs Correlate With Platelet Reactivity in Patients With Acute Coronary Syndrome: Association With Platelet Function
Authors: Mayr Manuel , Kaudewitz Dorothee , Skroblin Philipp , Willeit Peter , Zampetaki Anna , Morton Allison C , Storey Robert F
Published: July 2021

Introduction:
Platelets contribute plasma microRNAs (miRNAs). Levels of platelet-related miRNAs change in plasma in response to platelet inhibition.

Hypothesis:
It is currently unclear how plasma miRNAs correlate to platelet function in patients with acute coronary syndrome (ACS).

Methods:
We measured plasma miRNAs in 125 patients with a history of ACS (STEMI, NSTEMI or unstable angina) who have undergone detailed assessment of platelet function 30 days after the acute event.

Results:
Using custom-made quantitative real-time polymerase chain reaction plates, 92 miRNAs were assessed in patients on different anti-platelet therapies (clopidogrel, prasugrel, aspirin). Key platelet-related miRNAs were correlated with platelet function tests, including optical aggregometry using the agonists ADP and arachidonic acid, VerifyNow P2Y12 assay and vasodilator-stimulated phosphoprotein (VASP) phosphorylation assay. Significant associations were obtained for miR-126 with the VerifyNow (rp=0.347, n=39, P=0.033) and VASP assay (rp=0.224, n=125, P=0.013). Other abundant platelet miRNAs also showed strong correlations with the VASP assay: miR-223 (rp =0.231, P=0.003), miR-191 (rp =0.243, P=0.007), miR-24 (rp =0.246, P=0.006), miR-197 (rp=0.293, P=0.008), miR-30b (rp=0.230, P=0.010) and miR-20b (rp=0.231 , P=0.010).

Conclusions:
Levels of platelet-related plasma miRNAs correlate with platelet function tests in ACS patients. Our findings reinforce the concept that platelets are an important contributor to the plasma miRNA pool.
Abstract 20674: Genetic CETP Deficiency Associated With Higher eGFR and Lower Coronary Stenosis Index in Dyslipdemic Patients in Japan
Authors: Nohara Atsushi , Inazu Akihiro , Okazaki Satoko , Yoshida Mie , Mori Mika , Nakanishi Chiaki , Tada Hayato , Kawashiri Masa-aki , Yagi Kunimasa , Yamagishi Masakazu , Mabuchi Hiroshi
Published: July 2021

Background:
It is still controversial whether lower CETP is anti-atherogenic or not. Genetic deficiency should have greater impact on clinical course because its lifetime long effect. We evaluated impact of CETP deficiency on coronary atherosclerosis among dyslipidemic patients with non-familial hypercholesterolemia (non-FH) and with FH in Japanese population that include approximately 10% of heterozygous CETP deficiency.

Methods:
374 non-FH dyslipidemic patients (170 males, mean age of 58 ± 14) including 201 subjects coronary angiography (CAG) assessed, and 235 genetically confirmed FH heterozygotes (121 males, mean age of 47 ± 17) including 61 CAG assessed were enrolled. Two common CETP variant, intron 14 G(+1)-to-A transition and D442G missense mutation in exon 15, were genotyped. Fasting lipid profiles without lipid drugs were analysed. Subgroup with LDL-C ≥140mg/dL (52% of non-FH) was defined as “hyper-LDL” in this study. Estimated Glomerular Filtration Rate (eGFR) and other conventional coronary risk factors were also analyzed.

Results:
Heterozygotes of CETP mutations were identified in 12% in non-FH group, and 8% in FH group. There were no differences in age or sex. In non-FH group, CETP mutations showed higher HDL-C (56 ± 22 vs. 50 ± 15 mg/dL,
p
<0.05), lower non-HDL-C (172 ± 39 vs. 188 ± 48 mg/dL,
p
<0.05), lower plasma CETP (2.1 ± 0.8 vs. 2.5 ± 0.7 μg/mL,
p
<0.05), higher eGFR (83.6 ± 18 vs. 78.1 ± 21 ml/min/1.73m
2
,
p
<0.05), and lower coronary stenosis index (CSI) (7.0 ± 7 vs. 11.1 ± 11,
p
<0.05) in CAG. Plasma CETP showed strong positive correlation with LDL-C (
p
<0.0001, R
2
13%). In non-FH subgroup, CETP mutation showed lower CSI in hyper-LDL group (5.7 ± 8 vs. 12.6 ± 11,
p
<0.05), but no difference in normal-LDL group (8.0 ± 7 vs. 10.2 ± 11,
ns
). In FH group, CETP mutations showed higher HDL-C (58 ± 19 vs. 48 ± 14 mg/dL,
p
<0.005), tendency of lower LDL-C (258 ± 51 vs. 275 ± 102 mg/dL,
ns
) and higher eGFR (92.4 ± 27 vs. 83.1 ± 21 ml/min/1.73m
2
,
ns
), but no difference in CSI (16.2 ± 15 vs. 19.2 ± 11,
ns
). High HDL may have favorable effect also on kidney function, but further study will be required for the mechanism.

Conclusion:
CETP deficiency carriers showed favourable lipid profiles, eGFR, and CSI in non-FH dyslipidemic group especially with high LDL-C.
Abstract 214: Serum VEGF Levels Are Inversely Associated with Ionized Calcium Levels During the Early Postarrest Period
Authors: Youngquist Scott , Shah Atman P , Rosborough John P , Niemann James T
Published: July 2021

BACKGROUND:
Vascular endothelial growth factor (VEGF) is a signaling peptide released in response to hypoxia that induces the influx of calcium into endothelial cells. Decreases in serum levels of ionized calcium (iCa2+) are observed following resuscitation from cardiac arrest. We hypothesized that elevations in VEGF would correlate with the decrease in iCa2+ observed in a swine model of cardiac arrest.

METHODS:
Thirty-five mixed breed Yorkshire swine were premedicated, intubated, and placed under general anesthesia with inhaled isoflurane and nitrous oxide. Under fluoroscopic guidance, balloon occlusion of the left anterior descending coronary artery was performed, just distal to the first septal perforator to induce ventricular fibrillation (VF). Following 7 minutes of untreated VF, standard ALS resuscitation was attempted. Upon return of spontaneous circulation, blood was sampled at 0, 15, and 30 min post arrest for levels of iCa2+ and VEGF.

RESULTS:
iCa2+ demonstrated an inverse correlation with VEGF levels, with a Spearman rank correlation of rho=-0.52, p<0.0001. In generalized linear mixed modeling (FIGURE 1), a 1 pg/mL increase in VEGF concentrations was associated with a decrease in iCa2+ of 0.001 mg/dL (95% CI 0.003-0.001, p<0.0001).

CONCLUSIONS:
VEGF is inversely associated with iCa2+ during the early post arrest period. Its production may be responsible for the observed decrease in circulating iCa2+, which may in turn contribute to post arrest hypotension and myocardial dysfunction.
Abstract 221: Prognostic Impact of Estimated Glomerular Filtration Rate in Patients with Percutaneous Veno-arterial Extracorporeal Membrane Oxygenation
Authors: Kuroki Norihiro , Abe Daisuke , Ohashi Koichi , Miyazaki Kazuki , Tateishi Kazuya , Kaneko Masakazu , Harunari Tomohiko , Yuba Takao , Sugiyama Kazuhiro , Akashi Akiko , Suzuki Kou , Hamabe Yuichi , Iwama Toru
Published: July 2021

Purpose:
Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) has been reported to improve survival in patients with cardiogenic shock or cardiac arrest. We investigated the association between initial renal function just before implantation and clinical outcome in patients undergoing VA-ECMO due to cardiogenic shock and cardiac arrest.

Methods:
A cohort of 212 patients (58.8±16.2 years old, 86% male) who underwent ECMO at our hospital was registered from January 2007 to December 2013. We excluded 68 patients caused by non-cardiogenic event. The remaining 144 patients (91 with acute myocardial infarction, 37 with refractory ventricular fibrillation, 6 with refractory congestive heart failure, and 6 with fulminant myocarditis) were divided into 2 groups according to initial estimated-glomerular filtration rate (eGFR). Non-CKD Group: eGFR ≥60ml/min/1.73m
2
(n=98); CKD Group: eGFR <60 (n=46). Clinical outcome was defined as all-cause death at discharge.

Results:
The 82% of patients received VA-ECMO due to cardiac arrest. In baseline characteristics, Non-CKD group was significantly younger (50.4 vs. 62.8 years old), lower incidence of hypertension in past history (26.1 vs.52.0 %), lower BUN (13.7 vs. 24.3 mg/dl), and lower K (3.9 vs. 4.5 mEq/l, all p<0.05) than CKD group. Incidence of all-cause death was significantly lower in Non-CKD group than in CKD group (Non-CKD vs. CKD: 60.9% vs. 78.6%: p=0.026) (Figure). The low eGFR was an independent predictor of mortality after adjustment of multiple cofounders (eGFR <60, OR: 2.87, 95% confidence interval: 1.04-7.94, p=0.042). Negative independent predictors of mortality were fulminant myocarditis (OR: 0.08, 95% CI: 0.007-0.99, p=0.049) and count of platelet (per increase, OR: 0.94, 95% confidence interval: 0.88-0.99, p=0.037)

Conclusion:
Initial low e-GFR just before implantation provides worse clinical outcome in patients with VA-ECMO due to cardiogenic shock and cardiac arrest.
Abstract 234: The Association Between Post--Cardiac Arrest Hemoglobin Levels and Neurological Outcome
Authors: Rosselot Babette R , Grossestreuer Anne V , Lee Nora L , Dodampahala Kalani , Goyal Munish , David Abel , Abella Benjamin S , Gaieski David F
Published: July 2021

Background:
Inadequate cerebral oxygenation is a risk factor for neurologic damage in successfully resuscitated cardiac arrest patients. One therapy to address this problem is early goal-directed hemodynamic optimization. However, the role of hemoglobin (Hgb) levels, a potential target for optimization, on outcomes in post-cardiac arrest patients is not known.

Objective:
To determine the association between Hgb levels in post-cardiac arrest patients and neurologic outcome (dichotomized into “good,” a Cerebral Performance Category (CPC) of 1 or 2 and “poor,” a CPC of 3, 4, or 5, at hospital discharge). The association between Hgb levels and survival to discharge was analyzed as a secondary outcome.

Methods:
A retrospective cohort study was conducted to compare patient demographics and Hgb levels. Hgb was analyzed as both a continuous and binary variable. To determine the association between Hgb levels and outcomes, multivariate logistic regression models controlling for gender, age, pulseless rhythm, and transfusion were used.

Results:
There were 598 eligible subjects from 21 hospitals in the US. Patients with ≤10 g/dL of Hgb had a higher percentage of subjects with good neurologic outcome than those with Hgb levels below 10 g/dL (41% vs. 26%; p
<
0.001). Patients with good neurologic outcome had higher median Hgb levels in the first six hours after arrest than those with a poor neurologic outcome (12.6 g/dL vs. 10.5 g/dL; p
<
0.001). Controlling for gender, age, pulseless rhythm, and transfusion, there was a significant relationship between Hgb levels within the first six hours after arrest and good neurologic outcome (OR: 1.21, 95% CI: 1.06 [[Unable to Display Character: –]] 1.39) and the first 24 hours after arrest and good neurologic outcome (OR: 1.14, 95% CI: 1.01 [[Unable to Display Character: –]] 1.28). There was a significant association between Hgb levels within the first six hours after arrest and survival to discharge (OR: 1.22, 95% CI: 1.07 [[Unable to Display Character: –]] 1.39) and Hgb levels within the first 24 hours after arrest and survival to discharge (OR: 1.14, 95% CI: 1.02 [[Unable to Display Character: –]] 1.28).

Conclusions:
Higher hemoglobin levels, particularly within the first six hours after cardiac arrest, are associated with better neurologic outcomes at hospital discharge in post-cardiac arrest patients admitted to the hospital.
Abstract 242: The Association Between Global Hemodynamics, Cerebral Oxygenation and Survival in Post--Cardiac Arrest Patients
Authors: Ameloot Koen , De Deyne Cathy , Meex Ingrid , Genbrugge Cornelia , Mullens Wilfried , Jans Frank , Dupont Mathias , Dens Jo
Published: July 2021

Purpose:
the relationship between global hemodynamics, cerebral saturation and patient survival has been poorly investigated in post-cardiac arrest patients. In analogy with sepsis, current guidelines recommend to target mean arterial pressure (MAP) above 65mmHg and SVO2 above 70%. This is unsupported by mortality or cerebral perfusion data. Therefore the aims of the present study were to explore the relationships between MAP, SVO2, cerebral oxygenation and patient survival in post-cardiac arrest patients.

Methods:
Prospective observational study in 82 post-cardiac arrest patients

Results:
During the first 24 hours after ICU admission, the mean SVO2 was 67±9% and the mean MAP 76±8mmHg. Thirty-nine patients died and 43 survived (43/82 patients, 52%) until ICU discharge. The mean SVO2 range during the first 24 hours after admission associated with maximal survival was 67-72% (OR 8.23, 95% CI [2.07; 32.68], p=0.001). The mean MAP range associated with maximal survival was 76-86 mmHg (OR 2.63, 95% CI [1.01; 6.88], p=0.04). Achievement of the currently recommended MAP above 65mmHg or SVO2 above 70% was not associated with increased survival. Multivariate regression revealed early bystander CPR and a mean SVO2 in the optimal range (OR 6.30, 95% CI [1.12; 35.5], p=0.04) as independent factors associated with increased survival. Based on more than 1625000 data points, we found a strong linear relation between SVO2 (range 40-90%) and average cerebral saturation (R2 0.86) and between MAP and average cerebral saturation for MAP’s between 40-87 mmHg (R2 0.70). The predicted optimal SVO2 (72%) and MAP (87mmHg) based on this hemodynamic model matched with the optimal SVO2 (67-72%) and MAP (76-86mmHg) associated with maximal survival.

Conclusion:
We found an SVO2 between 67-72 % and a MAP between 76-86 mmHg during the first 24 hours after cardiac arrest to result in optimal cerebral oxygenation while being associated with maximal survival. Prospective intervention studies to reach or maintain these targets are needed to confirm these findings.
Abstract 257: Combining the Initial Four B Score and Continuous EEG to Predict Survival After Cardiac Arrest
Authors: Youn Chun Song , Callaway Clifton W , Rittenberger Jon C
Published: July 2021

Background:
Outcome prediction after cardiac arrest is a challenging problem and multiple tests should be performed to predict outcome accurately. We tested whether the combination of initial brainstem reflex examination (FOUR_B score) and continuous EEG were superior to either test alone for predicting survival after cardiac arrest.

Methods:
Review of consecutive patients receiving continuous EEG monitoring between April 2010 and June 2013. Patients were divided into three groups according to initial FOUR_B score; FOUR_B = 0-1, FOUR_B = 2 and FOUR_B = 4. A blinded rater dichotomized continuous EEG patterns during the first 48 hours into malignant patterns (non-convulsive status epilepticus, convulsive status epilepticus, myoclonic status epilepticus and generalized periodic epileptiform discharges). The primary outcome was survival to hospital discharge.

Results:
Of 380 subjects, 45 were excluded (44 missing initial FOUR_B score, 1 with age of 16 years). Mean (SD) age was 58 (17) and 208 (62.1%) subjects were male. Ventricular fibrillation was initial rhythm for 95 (28.4%) subjects. Survival to hospital discharge rate was 7.8% for FOUR_B 0-1, 32.0% for FOUR_B 2 and 51.9% for FOUR_B 4, respectively. Among subjects with malignant cEEG, survival to hospital discharge rate was 0% for FOUR_B 0-1, 8.1% for FOUR_B 2 and 12.5% for FOUR_B 4, respectively. All 42 subjects with no pupillary light reflex, no corneal reflex and malignant cEEG, had poor outcome (false positive rate 0; 95% CI, 0-7%). In the multivariate analysis, survival was independently associated with shockable rhythm (OR 5.76; 95% C.I. 2.88-11.54), FOUR_B 2 (OR 7.36; 95% C.I. 2.83-19.90), FOUR_B 4 (OR 8.99; 95% C.I. 3.58-22.56) and non-malignant cEEG (OR 19.91; 95% C.I. 6.44-61.51).

Conclusion:
Initial FOUR_B score and malignant cEEG pattern were independently associated with survival to hospital discharge. All subjects who have no pupillary light reflex, no corneal reflex and malignant cEEG did not survive to hospital discharge.
Abstract 284: Extracorporeal CPR with Therapeutic Hypothermia Plus Percutaneous Coronary Intervention for Patients with Out-of-Hospital Shockable Cardiac Arrest Due to Acute Coronary Syndrome
Authors: Nagao Ken , Sakamoto Tetsuya , Morimura Naoto , Asai Yasufumi , Yokota Hiroyuki , Nara Satoshi , Hase Mamoru , Tahara Yoshio , Atsumi Takahiro ,   SAVE-J Study Group
Published: July 2021

BACKGROUND:
There is insufficient evidence for a treatment bundle including extracorporeal cardiopulmonary resuscitation (ECPR) and therapeutic hypothermia plus percutaneous coronary intervention (PCI) for out-of-hospital cardiac arrest (OHCA) due to acute coronary syndrome (ACS).

METHODS:
From the SAVE-J, a prospective, multicenter, comparative study of ECPR, ACS patients who arrived at the hospital in cardiac arrest after OHCA due to ventricular fibrillation (VF) were included. We investigated whether ECPR and therapeutic hypothermia plus PCI for ACS had neurological benefit. The primary endpoint was favorable 30-day neurological outcome after OHCA.

RESULTS:
Of the 454 patients meeting the criteria of the SAVE-J, 280 (61.7%) were ACS, including 165 in the ECPR group and 115 in the non-ECPR group. Based on intention-to-treat analysis, frequency of favorable 30-day neurological outcome was 10.3% (17/165) in the ECPR group and 1.7% (2/115) in the non-ECPR group (p<0.001). By per protocol analysis, frequency of favorable 30-day neurological outcome was 11.3% (17/151) in the ECPR group and 2.2% (2/89) in the non-ECPR group (p<0.001). In the ECPR group (n=165), treatment included therapeutic hypothermia in 91.5% and emergency PCI in 90.3%. After adjustment for confounders, in 131 ACS patients treated with ECPR and therapeutic hypothermia plus PCI, longer collapse-to-hospital-arrival interval (adjusted OR, 0·93, 95% CI, 0.87-0.99) and female (adjusted OR, 0·14, 95% CI, 0.02-0.97) resulted in worse neurological outcome, and lower age and longer duration of cooling showed a tendency toward neurological benefits.

CONCLUSION:
In ACS patients who arrived at the hospital in cardiac arrest after OHCA due to ventricular fibrillation (VF), a treatment bundle including ECPR, therapeutic hypothermia plus PCI was associated with improved neurological outcome.
Abstract 43: Could Serum Lactate Level Predict Neurological Outcome in Patients Undergoing Therapeutic Hypothermia After Out-of-Hospital Cardiac Arrest?
Authors: Verginella Francesca , Scamperle Alice , Rossini Perla , Zuliani Michele , Campanile Vincenzo , Peratoner Alberto , Alongi Fabio Salvatore ,   Ice 2 Group
Published: July 2021

Until November 2013 and the printing of TTM trial, TH was a standard of treatment in OHCA.

In Italy 55.000 events of CA occur every year. Early Prognostication in neurological outcome is still difficult and controversial. We decided to investigate the influence of lactacidemia at the time of start(T0) TH and after 24 hours(T24) on neurological outcome at 6 months.

After the ischemic injury, microcirculation is dysfunctional. Lactacidemia explains how the microcirculation is going to restore itself
1,2
.

Methods:
We did a retrospective analysis of 88 patients admitted to several Italian ICUs. Patients underwent TH trough endovascular or surface cooling. We tested lactate in mmol/L at ICU admission and after 24 hours. Neurological outcome was measured using the Pittsburgh Cerebral Performance Category Scale (CPC) by phone-interview. We analysed the data using the ROC curve.

Results:
The mean value of Lactate at T0 was 5,7 mmol/L and and at T24 was 3,6 mmol/L. 47 patients had a good neurological outcome (CPC score of 1-2). 41 patients had a bad neurological outcome (CPC score 3-5).

Discussion and Conclusion:
At T0 the AUC is 0,69, P value is 0,001. At T24 the AUC is 0,56, P value is 0,288.

Lower serum lactate at T0 is weakly associated with CPC 1-2 at 6 months. On the contrary there is no correlation between lower serum lactate at T24 and good neurological outcome. This conclusion is in contrast with current evidence based in literature
3
.

Despite Lactacidemia being a sign of microcirculatory damage, our study explains that Lactate at T24 can not be used to predict the neurological outcome. More studies are needed to explain if Lactates Level could be a strong prognostication index.

1
“Post-cardiac arrest syndrome” Nolan et al. Resuscitation 2008;79

2
“Microcirculation during CA and resuscitation” Fries M, et al. Crit Care Med 2006;34

3
“Association of serum lactate and survival outcomes in patients undergoing

TH after CA” Starodub et al; Resuscitation 2013;84
Abstract 51: Seasonal Variation in Out-of-Hospital Cardiac Arrest
Authors: Deshmukh Awani , Patel Nileshkumar J , Deshmukh Abhishek , Patel Neil , Patel Achint , Desimone Christopher , Solanki Shantanu , Guha Avirup , Dhaduk Grishma , Pant Sadip , Manvar Sohilkumar , Arora Shilpkumar , Patel Nilay , Panchal Vinaykumar , Thakkar Badal , Badheka Apurva O , Kowalski Marcin , Paydak Hakan , Al Khasawneh Khaled , Joshi Manish
Published: July 2021

Introduction:
Heart Disease and Stroke Statistics_2014 Update suggests more than 424,000 people suffer out of hospital cardiac arrest (OHCA) in the United States.

Hypothesis:
We assessed seasonal variation in OHCA from a large national hospitalisation database in the past decade.

Methods:
The Nationwide Inpatient Sample database was used to estimate the annual number of hospitalisations with from 2000-2011. Identification of out of hospital cardiac arrest related hospitalisations was based on the designation of the International Classification of Diseases (9th Edition) Clinical Modification (ICD-9-CM) diagnosis code 427.5 (OHCA) as the principal discharge diagnosis. The frequency of hospitalisation for each month cumulative over 11 years was calculated and divided by number of days in that month to obtain the mean hospitalisations per day for each month. All calculations were carried out using the weighted estimates approximating nationwide population estimates.

Results:
An estimated 93,209 hospitalisations with primary diagnosis of OHCA occurred in the United States from the beginning of the calendar year 2000 to the end of the calendar year 2011. The number of hospitalisations per day in each month is shown in Figure 1.The number of hospitalisation was maximum in the winter months and minimum in summer months. Specifically, the mean number of hospitalisation each day (averaged over 11 years) was least in August (242). There was a rising trend from August to January. The average number of hospitalisation was highest in January (310); thereafter, the hospitalisation rate dropped to a nadir in August. There was however no seasonal pattern in inhospital mortality.

Conclusions:
We identified for the first time in United States an impressive pattern of seasonal variation in hospitalisations for OHCA. Further efforts must be made to identify triggers and methods to prevent OHCA and reduce its burden on health care system.
Abstract 56: The Association Between Early Hyperoxemia and Oxygen Exposure with Development of Pulmonary Dysfunction, Survival and Neurological Outcomes After Cardiac Arrest
Authors: Elmer Jonathan , Pullalarevu Raghevesh , Wang Bo , Melhem Samer , Vaghasia Nishit , Buddineni Jaya , Rittenberger Jon C , Callaway Clifton W ,   The Pittsburgh Post-Cardiac Arrest Service (PCAS)
Published: July 2021

Introduction:
Prior studies inconsistently report an association between hyperoxemia and worse outcomes after cardiac arrest (CA), but are methodologically limited. We used a high-resolution CA-specific database to control for cumulative early oxygen exposure, disease-specific covariates and care processes to test if rigorous adjustment would eliminate any association between hyperoxemia and outcomes. We also tested if exposure to higher inspired oxygen (FiO2) was associated with development of lung dysfunction.

Methods:
We included patients surviving and ventilated for >24 hours after ROSC. To test the association between hyperoxemia and outcomes, we categorized PaO2 hourly for 24h as severe hyperoxemia (>300mmHg), moderate hyperoxemia (101-299mmHg), normoxia (60-100mmHg) or hypoxia (<60mmHg). We controlled for CA-specific covariates and markers of potentially less attentive care (time to first FiO2 wean, number of weans, etc). We used multiple logistic regression to test the association between PaO2 and survival and discharge CPC. To test for development of lung dysfunction, we calculated oxygen exposure as the area under the curve of the FiO2 x hour (FiO2AUC) for each patient over 24h. Our main outcomes in this analysis were change in the respiratory SOFA score (SOFA-R) and change in dynamic lung compliance from baseline to 48h.

Results:
Of 184 patients overall mortality was 54% and 36% had severe hyperoxemia. The first PaO2:FiO2 ratio was 241±137, and at baseline 85% had pulmonary failure and 55% had cardiovascular failure as assessed by SOFA. Only severe hyperoxemia was independently associated with decreased survival to hospital discharge (adjusted OR 0.83 per hour, P=0.04) and worse discharge CPC. Higher FiO2AUC was not associated with worsened SOFA-R or lung compliance over 48h but was associated with decreased survival to discharge and worse discharge CPC. This was driven by 50% decreased survival in the highest quartile of FiO2AUC (FIO2>80%/24h) compared to other quartiles.

Conclusion:
Despite rigorous adjustment, severe hyperoxemia was independently associated with decreased survival to hospital discharge and discharge CPC. We did not observe toxicity at lower levels. High FiO2 was not associated with pulmonary toxicity.
Abstract 9408: ST-Segment Elevation in Leads V5-6 Predicts In-Hospital Adverse Outcomes in Patients With Reperfused Inferior Acute Myocardial Infarction
Authors: Kosuge Masami , Ebina Toshiaki , Hibi Kiyoshi , Tsukahara Kengo , Iwahashi Noriaki , Maejima Nobuhiko , Akiyama Eiichi , Umemura Satoshi , Kimura Kazuo
Published: July 2021

Introduction:
In inferior wall acute myocardial infarction (IWMI), ST-segment elevation in leads V5-6 (STE V5-6) is often observed, but its prognostic impact is unclear.

Methods:
We examined admission ECGs in 361 patients with a first IWMI who had TIMI 3 flow of the right coronary artery (RCA) or left circumflex artery (LCX) by reperfusion therapy within 6 hours after symptom onset. Patients were divided according to the presence (n=77) or absence (n=284) of STE V5-6 >2 mm, and the former was subdivided into the 2 groups according to the degree of STE in leads III and V6: STE:III>V6 (n=53) and STE:III≤V6 (n=24). The perfusion territory of the culprit artery was assessed by angiographic distribution score, and mega-artery was defined as a score ≥0.7.

Results:
Age, sex, time to admission, reperfusion therapy, or time to reperfusion was similar in the 3 groups. STE V5-6 was associated with mega-artery occlusion, larger infarction, and in-hospital adverse events (death, reinfarction, or heart failure). RCA occlusion was most common in STE V5-6 with STE:III>V6, whereas LCX occlusion, especially proximal LCX occlusion, was most common in STE V5-6 with STE:III≤V6. In multivariate analysis, STE V5-6 with STE:III>V6 (OR 2.90, 95%CI 1.10-7.02, p<0.01) and that with STE:III≤V6 (OR 3.63, 95%CI 1.58-8.96, p<0.01) were independent predictors of in-hospital adverse events.

Conclusions:
In reperfused IWMI, ST-segment elevation in leads V5-6 on admission ECG strongly predicts in-hospital adverse outcomes; furthermore, comparing the degree of ST-segment elevation in leads III and V6 is useful for predicting the culprit artery (i.e., RCA or LCX).
Abstract 9509: Heart Fat, but Not Peri-Aortic Fat Depots Were Significantly Associated With Presence and Severity of Coronary Calcification in Women at Midlife: The Study of Women’s Health Across the Nation (SWAN) Ectopic Cardiovascular Fat Ancillary Study
Authors: El Khoudary Samar R , Shields Kelly , Budoff Matthew , Barinas-Mitchell Emma , Janssen Imke , Everson-Rose Susan , Matthews Karen A
Published: July 2021

Introduction:
Increasing evidence demonstrates a role of cardiovascular fat in the pathogenesis of CAD. It is unknown whether heart and vascular fat depots are related to atherosclerotic burden in women transitioning through menopause, a time of increasing CAD risk.

Hypothesis:
We hypothesize that volumes of epicardial (EAT), pericardial (PAT), total heart (TAT=EAT+PAT) and peri-aortic (PVAT) adipose tissues are associated with presence and severity of coronary artery calcification (CAC) in a sample of white and black midlife women.

Methods:
CAC and cardiovascular fat depots were quantified by electron beam CT. Outcomes were presence of CAC (none vs. any: Agatston score >0), and severity of CAC (CAC Agatston score). Logistic and tobit regression were used. Final models were adjusted for age, race, study site, menopausal status, obesity (BMI ≥30 Kg/m
2
), systolic blood pressure, lipids, homeostasis model assessment insulin resistance index, current smoking, physical activity, comorbidity (history of hypertension, stroke, angina, heart attack or diabetes) and medication use (cholesterol lowering, antihypertensive or antidiabetic medications).

Results:
The study included 509 women (37.9% black; 58.4% pre-/early perimenopausal, 41.6% late peri-/postmenopausal) aged 46-59 years with data on any of the 4 fat depots. CAC was found in 47.4% of the participants. Odds ratios (95% CI) from final logistic regression models showed that higher volumes of EAT (2.43 (1.22, 4.86), PAT (1.57 (1.04, 2.37), and TAT (2.43 (1.22, 4.87), were significantly associated with higher odds of presence of CAC. Similarly, tobit regression models showed that higher volumes per 1 log-unit increase of EAT (β (SE): 28.0 (10.7)), PAT (16.5 (6.6)), and TAT (30.0 (10.7)), were significantly associated with greater severity of CAC in final adjusted models. PVAT was not associated with either CAC presence or severity in final models.

Conclusions:
Heart fat (EAT, PAT and TAT), but not peri-aortic fat were independently associated with greater presence and severity of CAC in women at midlife, suggesting that local cardiovascular fat depots may contribute to CAD in midlife women. Future work is warranted to understand the underlying mechanistic pathways.
Abstract 9749: In Vivo Results of Cobra Pzf ™ Stented Rabbit Iliac Arteries
Authors: Maillard Luc , Corseaux Delphine , Altié Alexandre , Ung Alexandre , Courageot Joël , Teiger Emmanuel , Van Belle Eric
Published: July 2021

Introduction:
The CeloNova Cobra PzF™ coronary stent is a new stent design, balloon expandable cobalt chromium alloy that is pre-mounted on a custom rapid exchange balloon delivery catheter. The alloy stent is surface treated with a nano-layer Polyzene®-F (PzF). In vitro studies have indicated that the PzF surface treatment is a nonthrombogenic and has pro-endothelialization properties.

Methods:
Only 3.0 mm diameter x 15 mm length stents were used, 32 external right iliac rabbit arteries were harvested at 7 days for electron microscopy analysis, half cylinder for thrombus area formation and the other half cylinder for reendothelialization. Then, a time course of reendothelialization was performed with 10 additional animals. Five animals were examined at day 3 and 5 animals at day 5. Each animal received in one leg a Cobra PzF stent and on the opposite leg a control stent randomly assigned. The 2 half cylinders were examined for reendothelialization.

Results:
Thrombotic occlusion was a rare event in this experiment (3/52, 5.76%) of the stented vessels. The 3 occluded stents were observed in control Cobra BMS group (3/27, 11.11%) versus 0 (0/25, 0%) in the Cobra PzF™ group (p = 0.04). At day 7, almost a complete coverage of endothelial cells was observed in both group. 99.86 +/- 0.09 % in the Cobra BMS group versus 99.54 +/- 0.25% in the Cobra PzF™ group, (p = NS). The only defects of reendothelialization were observed on pieces of struts of stents in front of take off of large side branches in both group. No thrombus area was observed in both group at day 7, 0% versus 0%, (p = NS). At day 3, more than half area of the examined pieces was reendotheliazed in both group, 54.25 +/- 4.4 % in the Cobra PzF™ group versus 53.78 +/- 4.4 % in the Cobra BMS group (p = NS), and reached 78.30 +/- 3.7 % in the Cobra PzF™ group versus 79.03 +/- 4.% in the Cobra BMS group (p = NS). All stents were well expanded against the arterial wall and no struts were malapposed with no difference between groups.

Conclusions:
There is a significant reduction of stent occlusion in the Cobra PzF™ group as compared to the same stent without PzF modified surface, with a complete and rapid reendothelialization in both group at day 7 that proves the benefit both of this new thin struts deign and the modified PzF surface.
Abstract 9768: Cr(nMe)eka-Conjugated Micellar Formulation Improves Anticoagulation Efficacy of Bivalirudin
Authors: She Zhi-Gang , Liu Xiangyou , Kotamraju Venkata R , Ruoslahti Erkki
Published: July 2021

Anticoagulant therapies are the primary treatment modalities for preventing and treating thrombosis. However, high rate of bleeding complications is a serious side effect of anticoagulant therapies, which compromised their applications. Bivalirudin is an oligopeptide anticoagulant that has the advantage of not causing thrombocytopenia and exhibits lower potential for bleeding risk compared to heparin. Nevertheless, hemorrhage is still the most common complication. And there is no effective antidote for bivalirudin. We report here a strategy to deliver bivalirudin specifically to the site of clotting area, and thereby reduce the bleeding risk. The site-specific delivery of bivalirudin was achieved with micellar nanocarriers which has a thrombosis-targeting peptide CR(Nme)EKA. These peptide-conjugated micellar nanocomplexes are highly dispersed and stable in aqueous solution with an average size of 30 nm. The anticoagulant activity of bivalirudin was well remained after it was incorporated into the micelles. These micellar nanocomplexes specifically accumulated in the site of clotting in mice lung thrombosis. Moreover, the micellar formulation significantly prolonged the half-life and increased the bioavailability of bivalirudin. Most importantly, this effective formulation significantly improved the anticoagulant activity of bivalirudin, when tested in both thromboplastin-induced lung thrombosis mouse model and ferric chloride (FeCl3)-induced carotid artery thrombosis mouse model. Taken together, these results demonstrate that the micellar nanocomplexes specifically target thrombi, deliver bivalirudin directly into site of clotting and exhibit improved antithrombotic activity over free bivalirudin. This strategy may improve the safety and efficacy of bivalirudin in clinical use.
Abstract MP53: The Impact of the Obesity Epidemic on Atherosclerotic Cardiovascular Disease Risk Scores: The CARDIA Study
Authors: Appiah Duke , Schreiner Pamela J , Durant Raegan W , Person Sharina D , Kiefe Catarina I , Lewis Cora E , Loria Catherine , Sidney Stephen , Williams O. Dale
Published: July 2021

Introduction:
Cardiovascular disease (CVD) mortality has decreased over recent decades, in part, due to changes in the prevalence of risk factors. However, few studies have explored the impact of the obesity epidemic on CVD risk prediction in young adults.

Hypothesis:
We assessed the hypothesis that BMI trends are positively associated with changes in 10-year AHA/ACC atherosclerotic cardiovascular disease (ASCVD) risk scores from young adulthood to middle age beyond the effect of other CVD risk factors included in the scores (age, sex, race, lipids, blood pressure, hypertension medication, diabetes, smoking).

METHODS:
Data were obtained from 2437 black and white men and women aged 18-30 years at baseline (1985-1986) enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study with follow-up exams at year 0, 5, 10, 15, 20 and 25 (ages 43-55 years). Repeated-measures regression was used to model the association between ASCVD risk scores and time-varying BMI measures.

RESULTS:
The average 10-year ASCVD risk increased from 0.6% at baseline (mean age: 25.3) to 3.9% at year 25 (mean age: 50.3) with the change higher for men (blacks: 1.0 to 8.2%, whites: 0.3 to 4.6%) than women (blacks: 0.5 to 3.6%, whites: 1.2 to 1.4%). The overall prevalence of obesity at baseline and year 25 was 10% and 42% respectively. BMI trends were positively associated with 10-year change in ASCVD risk scores (0.12% per 1 kg/m2 increase, p<0.001). BMI adjustment minimally reduced risk scores trends with the greatest change between unadjusted and adjusted risk scores observed among black women (0.1 to 3.0%) (Figures A and B).

CONCLUSION:
In young adults, BMI trends are associated positively with 10-year changes in ASCVD risk independent of other risk factors. This adds to the evidence that weight control in early adulthood is an important predictor of lower future CVD risk.
Abstract MP58: Vitamin D Consumption is Not Associated with Incident Heart Failure: the Physicians' Health Study
Authors: Robbins Jeremy , Petrone Andrew , Gaziano J. Michael , Djousse Luc
Published: July 2021

Background:
Previous research investigating the relationship between vitamin D supplementation and incident heart failure (HF) has yielded equivocal results. Limited research exists on the association of dietary vitamin D consumption and the risk of incident heart failure.

Objective:
We sought to test the hypothesis that vitamin D consumption is associated with a lower incidence of heart failure.

Methods and Results:
Using a validated food frequency questionnaire, we estimated dietary vitamin D consumption for 19,635 participants of the Physician’s Health Study who were free of HF at baseline. The mean age at baseline was 66.4 ± 9.2 years. Over a mean followup of 9.3 years, 858 cases of incident HF were captured using an annual follow-up questionnaire with validation in a subsample. From the multivariable Cox regression model, hazard ratios (95% CI) of incident HF were 1.0 (reference), 1.49 (1.17 to 1.89), 1.37 (1.07 to 1.75), 1.34 (1.02 to 1.75), and 1.28 (0.94 to 1.75) from lowest to highest quintile of calorie-adjusted vitamin D, respectively, after adjusting for age, BMI, smoking, alcohol, exercise, multivitamin use, fruits and vegetables, chocolate, and breakfast cereal consumption, atrial fibrillation, and valvular heart disease (p for linear trend = 0.71).

Conclusions:
In this prospective study of male health professionals, dietary vitamin D consumption is associated with a higher risk of HF.
Abstract MP92: Changes in Ectopic Fat are Associated with Changes in Adipokines in Healthy, Overweight/Obese Young Adults
Authors: Radomski Thomas R , Bai Lina , Barinas-Mitchell Emma , Conroy Molly B
Published: July 2021

Background:
Excess ectopic fat has been associated with increased cardiometabolic risk, which may partially stem from changes in adipokines such as leptin and adiponectin. Prior studies have demonstrated that increased leptin and decreased adiponectin are associated with an increase in body mass index (BMI), but few have examined changes in adipokines related to changes in ectopic fat. We hypothesized that in healthy overweight and obese young adults, a decrease in ectopic fat will be associated with decreased levels of leptin and increased levels of adiponectin.

Methods:
We analyzed 244 subjects participating in the Slow Adverse Vascular Effects (SAVE) study, a randomized trial of a behavioral weight loss intervention in 349 overweight and obese (BMI 25-40 kg/m2) men and women ages 20-45 years. Subjects underwent a CT scan of their abdomen and left thigh to quantify their amount of visceral (VAT) and intramuscular (IMAT) adipose tissue at baseline and 12 months. Serum concentrations of leptin and adiponectin were also measured at baseline and 12 months. We generated variables for the change in VAT, IMAT, adiponectin and leptin by subtracting 12-month from baseline values. To evaluate the association between changes in serum adipokine (dependent variable) levels with changes in VAT and left thigh IMAT (independent variables), we performed a series of multiple linear regression analyses controlling for: 1) age, sex, race and 2) previous variables + change in BMI tertile.

Results:
The mean age at baseline was 38 ± 6 years; 181 (74.5%) subjects were female; and 198 (81.5%) were white. Mean VAT at baseline was 115.27 ± 53.58 cm2 with a mean decrease of 17.54 ± 36.71 cm2 at 12 months. Mean left thigh IMAT was 12.76 ± 4.87 cm2 at baseline with a mean decrease of 5.05 ± 3.20 cm2 at 12 months. Serum adiponectin was 11.90 ± 6.15 μg/mL at baseline, with a mean increase of 0.14 ± 3.79 μg/mL at 12 months. Serum leptin was 25.11 ± 13.38 μg/mL at baseline, with a mean decrease of 4.26 ± 10.71μg/mL at 12 months. After adjusting for age, sex, and race, a decrease in VAT was significantly associated with an increase in adiponectin (P=0.010) and decrease in leptin (P<0.001); a decrease in IMAT was significantly associated with an increase in adiponectin (P=0.003), but was not significantly associated with a decrease in leptin (P=0.297). Except for the association between a decrease in IMAT and decrease in leptin (P=0.048), these relationships were no longer significant after adjusting for change in BMI tertile.

Conclusion:
A decrease in ectopic fat was associated with an increase in adiponectin and a decrease in leptin in young overweight/obese adults after adjusting for age, sex, and race. This underscores the metabolic activity of ectopic fat and supports the role of adiponectin and leptin as mediators of cardiometabolic risk.
Abstract P016: Preventing Heart Disease, Stroke, and Related Chronic Diseases in the Mississippi Delta Region: Clinical Community Health Worker Initiative
Authors: Mendy Vincent , Walls Tameka , Cole Amanda , Dove Cassandra , Bilbro Augusta
Published: July 2021

Background:
Community Health Workers (CHW) are increasingly being used to address chronic disease prevention, but knowledge of their use in underserved rural settings is limited. CHW can be instrumental in linking underserved populations to clinical care and navigating the health care system. We report on the influence of our Clinical Community Health Worker Initiative (CCHWI) intervention program on clinical risk factors for heart disease and stroke in the Mississippi Delta region.

Methods:
Patients diagnosed with hypertension, diabetes or high cholesterol, and ≥18 years and consented to participate in the CCHWI were referred to a CHW for follow-up. CHW conducts an initial home visit, a follow-up phone call 7 to 10 days after the initial visit, a second home visit after 30-45 days and a subsequent recurring 90-day follow-up home visit. CHW activities include appointment scheduling and transportation arrangement, interpretation of health information, demonstrating proper procedures in monitoring blood pressure and blood glucose and encouraging patients to keep monitoring logs, assisting patients in documenting questions or concerns regarding medication and/or treat regimens for next doctors visit, assisting patients in setting nutrition target and goals, explaining the benefits of changing lifestyle habits, performing height, weight, and blood pressure measurements, encouraging patient to enroll in chronic disease self-management classes, and arranging referral for counseling to tobacco cessation treatment programs. Clinical data from 432 participants contacted by CHWs during home visits and phone calls from August 2012 to August 2014 were evaluated. We used paired t tests to assess changes from baseline for the following clinical measures: blood pressure, hemoglobin A1c, total blood cholesterol, high density lipoprotein cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides, and body mass index.

Results:
Mean age of participants was 57.6 (range 20-89) years; 71.1% were female, and 91.9% were black. The majority of the participants were diagnosed with hypertension (82.4%) and diabetes (72.0%) and more than half (57.2%) with high cholesterol. One in five (21.1%) participants had only one condition, 46.3% had two conditions and a third (32.6%) had all three conditions. We observed statistically significant improvements (baseline vs most recent value) for diastolic blood pressure (p=0.0045), total cholesterol (p=0.0014), LDL cholesterol (p=0.0117), and triglycerides (p=0.0255).

Conclusion:
The use of CHW may help improve heart disease and stroke clinical risk factors among rural underserved populations.