bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 2011: Basic Resuscitation with Chest Compression Only for Patients Who Had Out-Of-Hospital Cardiac Arrest Not Witnessed by Bystanders
Authors: Nagao Ken , Sakamoto Tetsuya , Igarashi Masaki , Ishimatsu Shinichi , Sato Akira , Hori Shingo , Kanesaka Shigeru , Hamabe Yuichi , Kitamura Nobuya , Kikushima Kimio 
Published: July 2021

BACKGROUND SOS-KANTO study showed that bystander chest compression-only resuscitation was the preferable approach to resuscitation for adult patients with witnessed out-of-hospital cardiac arrest (

Lancet

2007
;
369

), but few clinical studies have focused on the efficacy of basic resuscitation with chest compression only for patients with unwitnessed out-of-hospital cardiac arrest.

METHODS SOS-KANTO study was conducted in 58 emergency hospitals and emergency medical service units. On arrival at the scene, paramedics assessed the technique of basic resuscitation and asked additional questions. The primary endpoint was favorable neurological outcome 30 days after cardiac arrest.
RESULTS Of the 9,592 patients with out-of-hospital cardiac arrest, 4,347 adult patients with unwitnessed arrest were included; 385 (8.9%) received chest compression-only resuscitation, 507 (11.7%) received chest compression plus mouth-to-mouth ventilation resuscitation, and 3,456 (79.5%) received no resuscitation. Any resuscitation attempt was associated with a higher proportion of the favorable neurological outcome than no resuscitation (1.1% vs. 0.4%, p=0.009). The chest compression-only resuscitation group had higher proportions of the favorable neurological outcome than the no resuscitation group in the whole cohort (1.3% vs. 0.4%, p=0.018) and in the subgroups of patients with cardiac causes (2.0% vs. 0.6%, p=0.018) and with time interval from EMS call to arrival at patient’s side for ≤ 8 min (2.0% vs. 0.6%, p=0.020). However, the chest compression-only resuscitation group had a similar proportion of the favorable neurological outcome than the chest compression plus ventilation resuscitation in the whole cohort (1.3% vs. 1.0%, p=0.662) and there was no evidence for any benefit from the addition of ventilation in any subgroups. The adjusted odds ratios for the favorable neurological outcome after chest compression-only resuscitation and after chest compression plus ventilation resuscitation were 3.4 (95% CI, 1.1 to 10.5, p=0.033) and 3.3 (95% CI, 1.1 to 10.1 p=0.035).
CONCLUSIONS Basic resuscitation with chest compression only is the preferable approach to resuscitation even though the adult patients with unwitnessed out-of-hospital cardiac arrest.
Abstract 311: Osteogenic Transcription Factor Runx2 Represses Connective Tissue Growth Factor Gene Expression And TGFβ Signaling In Vascular Smooth Muscle Cells
Authors: Tanaka Toru , Shimizu Takehisa , Koitabashi Norimichi , Matsui Hiroki , Doi Hiroshi , Iso Tatsuya , Arai Masashi , Kurabayashi Masahiko 
Published: July 2021

[Objective] Runx2, a key transcription factor in osteoblast differentiation, is expressed in calcified atherosclerotic plaques. We have recently shown that Runx2 represses vascular smooth muscle cells (VSMCs) differentiation and promotes their osteogenic differentiation. Connective tissue growth factor (CTGF) has been implicated in the progression to vulnerable plaque by inducing mononuclear cell chemotaxis and VSMCs apoptosis despite of its potent stimulatory effect on connective tissue cell the proliferation and extracellular matrix synthesis. To assess the role of Runx2 in the process of plaque development, we investigated the molecular mechanism of the CTGF gene expression by Runx2 in VSMCs.
[Methods and Results] RT-PCR analyses showed that adenovirally overexpressed Runx2 significantly repressed the basal expression of the CTGF gene in human aortic SMCs (HASMCs). Consistent with this, knockdown of the Runx2 expression in HASMCs by small interfering RNA (siRNA) increased CTGF mRNA levels. Luciferase assays showed that Runx2 reduced the transcriptional activity of the CTGF promoter. Transfection of a series of 5′-deletion constructs revealed that Runx2 inhibited CTGF expression through the sequence element located at 5′ untranslated region of CTGF mRNA. We next examined the effects of Runx2 on the TGFβ-induced CTGF expression. Runx2 overexpression significantly repressed CTGF expression in HASMCs stimulated with TGFβ, and knockdown of Runx2 by siRNA enhanced the induction of CTGF expression in response to TGFβ. Runx2 repressed TGFβ-induced CTGF promoter activity through the sequence including Smad binding element (SBE). Overexpression of Runx2 significantly reduced TGFβ- and Smad3-mediated luciferase activity of Smad-dependent promoter which contains four copies of SBE. Biotinylated DNA pulldown assay using SBE of CTGF promoter showed that Runx2 formed a complex with Smad3 and Smad4.
[Conclusion] Runx2 repressed basal and TGFβ-induced CTGF gene expression in VSMCs. Thus, in addition to the potential for inducing vascular calcification, Runx2 may affect plaque stability by modulating extracellular matrix synthesis through inhibiting CTGF gene expression and TGFβ signaling.
Abstract 2232: Survival Is Decreased If Ambulance Dispatchers Do Not Recognize Out-of-Hospital Cardiac Arrest
Authors: Berdowski Jocelyn , Beekhuis Fred , Koster Rudolph W 
Published: July 2021

Introduction Exact content of 112 emergency calls for suspected cardiac arrest (CA) are rarely analyzed. The purpose of this study was to investigate if not recognizing a CA by emergency medical dispatchers influences survival rates.
Methods This was a prospective, observational study. During 8 months, all digitalized voice recordings of consecutive 112 high priority emergency calls were collected from the Amsterdam dispatch center and audited for CA recognition, time to recognition of CA and telephone CPR. Also, description of breathing and consciousness that the caller uses to describe a CA were scored. Actual presence of CA during call was assessed from the ambulance crew report. Calls were placed by laypersons on site, not involving trauma. Exclusion criteria were calls by a professional, by the victim or when victim was known to be conscious. Time recordings of call, dispatching and arrival were generated automatically. Survival after 3 months was taken as the primary endpoint.

Results Results are shown in table 1

. In 8 months, out of 11.329 calls, 285 involved patients in CA. Of these, 203 were recognized during the call; the remaining 82 cases (29%) were only diagnosed on site. Recognizing CA resulted in faster dispatch and earlier arrival on scene. When not recognizing CA, the dispatchers did not ask the caller about respiration in over 50% of the calls. Not recognizing the CA was associated with no telephone CPR, and significantly lower three-month survival.

Conclusion If the dispatcher did not recognize the CA, no CPR instruction is given. The ambulance is dispatched less rapidly and arrives a median of 2 minutes later at the scene. Both factors may contribute to the lower survival rates. Consequent interrogating the caller about the patientâ™s consciousness and respiration could improve CA recognition. In conclusion, not only early call, but also early recognition of a CA by dispatcher contributes to the survival after CA.

Table 1:

A comparison between calls where the dispatcher did and did not recognize CA
Abstract 2243: Real-Time Computed Tomography (RT-CT) for Guidance of Catheter Navigation, Transseptal Puncture and Anatomically Targeted Radiofrequency Ablation
Authors: Dickfeld Timm , Engelhardt Martin , Read Katrina , Kocher Christopher , Akella Jagan , Johnson Anthony , Peters Robert , Saba Magdi , Shorosfsky Stephen , Fleiter Thorsten 
Published: July 2021

Background: Recent ablation strategies for complex arrhythmias such as atrial fibrillation or ischemic ventricular tachycardia are increasingly based on anatomic considerations. While fluoroscopy and 3D-mapping systems are widely used to guide these ablations, they are limited by poor soft tissue visualization and the lack of real-time anatomic data. Therefore, this study sought to evaluate if real-time computed tomography (RT-CT) could overcome these limitations and guide catheter navigation, transseptal puncture and anatomically targeted ablation.
Methods: Catheter real-time guidance was assessed in 5 swine (40kg) using a 40-slice RT-CT. First, right/left heart catheterization was performed from the femoral vein and artery with the goal to access all cardiac chambers and the great cardiac vessels. Second, transseptal puncture was attempted with targeted ablations at pre-specified locations at the left lateral wall. Third, targeted ablation at the pulmonary vein (PV) orifice and repeat ablations at the right lateral wall were created to assess accuracy and precision, respectively. Fourth, creation of a straight ventricular four-point line was attempted. Necropsy was performed to assess possible complications and to compare the location of the ablation sites with the CT images.
Results: Catheter navigation was performed safely from the femoral vein to the pulmonary artery and the femoral artery to the left ventricle. Misguided catheters to the renal vein, jugular vein, and carotid artery were correctly identified and removed. Transseptal puncture using a Brocken-brough needle was successfully performed and confirmed with anatomically targeted ablations at the left lateral atrial wall. Accuracy as assessed by PV ablations was in the range of 1–3mm. Repeat ablations in the right atrial wall revealed a precision of 2–3mm. Maximum deviation from a straight 4-point ventricular line was 2.8mm. No complications were seen at necropsy.
Conclusions: Catheter navigation (in all four cardiac chambers) as well as transseptal puncture can be performed guided exclusively by RT-CT. Anatomically targeted ablations can be created with good accuracy and precision under real-time guidance. This suggests a possible role of RT-CT to guide ablation procedures.
Abstract 2344: Cumulative Radiation Dose Estimate From Medical Testing in Grown-Up Patients With Congenital Heart Disease
Authors: Ait-Ali Lamia , Botto Nicoletta , Andreassi Maria Grazia , Festa Pierluigi , Picano Eugenio 
Published: July 2021

Background: The “Biological effects of Ionizing Radiation” (BEIR VII,2005) underlines “the need of studies of infants who are exposed to diagnostic radiation”.
Aim: to assess the individual cumulative lifetime radiological dose in grown up congenital heart disease (GUCH) patients.
Methods: In 41 consecutive operated GUCH patient (24 males, age= 27 ± 9 years old), followed in our outpatient clinic, a cumulative radiological history was collected with a structured questionnaire and access to lifetime hospital records. All patient underwent at least one surgical intervention during the infancy for Tetralogy of Fallot (n=18), aortic coarctation (n=10), anatomical/functional univentricular heart (n=8), other congenital heart disease (n=5) The cumulative exposure was expressed in milliSievert (mSv) and derived from average effective dose estimates of individual examinations proposed by the European Commission Medical Imaging Guidelines (2001). The attributable cancer risk was estimated from BEIR VII, 2005 document.

Results: On average, cumulative dose estimate was 22.3 ± 12.4 (mean ± SD) mSv per patient, equivalent to about 1115 ± 620 chest x-rays. Diagnostic and interventional catheterization accounted for the most important sources of exposure (see figure

). The median cumulative dose gave an average extra-risk of cancer of about 1 out of 200 patients (range, 1 in 448 to 1 out of 58).

Conclusion: the average contemporary GUCH patient is exposed to a significant cumulative radiological effective dose. Every effort should be done to justify the indications and to optimise dose delivery during ionizing testing.
Abstract 2367: Omega 3 Fatty Acid Supplementation Reduce One-Year Risk of Atrial Fibrillation in Patients Hospitalized with Myocardial Infarction
Authors: Macchia Alejandro , Monte Simona , Pellegrini Fabio , Romero Marilena , Ferrante Daniel , Doval Hernan , Maggioni Aldo P , Tognoni Gianni 
Published: July 2021

Background: Current medical strategies for avoidance of atrial fibrillation (AF) are of limited value. Anti-arrhythmic agents faced major challenges related to their limited efficacy and their serious and frequent side effects. Epidemiological studies, clinical trials and basic science support the role of Omega-3 fatty acids (n-3 PUFA) in reducing all cause mortality among patients with previous myocardial infarction (MI), mostly by reducing ventricular arrhythmias. However their effects regarding supraventricular arrhythmia are not well characterized.
Aim: To assess the effect of supplementation with n-3 PUFA for the prevention of AF.
Methods: Population study, linking administrative datasets from hospital discharge, prescription databases and vital statistics, including all consecutive patients with MI (code ICD-9: 410) in 6 Italian regions during a 3-year period. Follow up was extended up to one year or to time to event. A Cox regression model adjusted for propensity score (PS) quintiles was used. Further a PS-based 5 to 1 greedy matching algorithm and sensitivity analysis were used to assess robustness of our findings.
Results: Three thousand two hundred and forty-two (3,242) patients were identified and included in the analysis. Of these, 208 (6.4%) were exposed to n-3 PUFA during follow up. Four out of 208 (1.9%) patients exposed to n-3 PUFA were hospitalized with AF during follow up as compared with 467 out of 3,034 (15.4%) of those not exposed to supplement n-3 PUFA. The PS-quintiles adjusted hazard ratio (HR) estimate was 0.19 (95%CI 0.07– 0.51; p=0.001). The PS based 5 to 1 greedy matching algorithm and sensitivity analysis confirm main results (HR=0.13; 95%CI 0.04 – 0.44; p=0.001).
Conclusion: n-3 PUFA reduce the occurrence of one year AF in patients hospitalized with MI.
Abstract 2466: Transapical Aortic Valve Implantation At One Year
Authors: Walther Thomas , Falk Volkmar , Borger Michael A , Kempfert Jörg , Fassl Jens , Rückert Yvonne , Rastan Ardawan , Linke Axel , Schuler Gerhard , Mohr Friedrich W 
Published: July 2021

Objective: To evaluate the results of minimally invasive transapical aortic valve implantation (TAP-AVI) at one year follow-up.
Methods: 61 high risk patients with symptomatic aortic valve stenosis received TAP-AVI at our institution since 02/2006. A pericardial xenograft fixed within a stainless steel, balloon expandable stent (Edwards SAPIEN™ THV, Edwards Lifesciences, Irvine, CA, USA) was used. All valves were implanted in a hybrid operative theatre under fluoroscopic and echocardiographic guidance. Patient age was 82.7 ±4.5 years, 79% were female, NYHA class was 3.4 ±0.5, previous cardiac surgery had been performed in eight patients, logistic EuroSCORE risk for mortality was 28.1 ±11.9% and STS score risk for mortality was 15.9 ±8.6%.
Results: TAP-AVI was performed successfully in 58 (95.1%) of the patients; three patients required early conversion due to proximal dislocation, secondary dissection of the aortic root and main stem occlusion. Two of the converted patients were discharged alive. A total of 73.7% of the patients were treated completely off-pump, secondary use of cardiopulmonary bypass was required in 3/39 (7.8%). 82% of the patients were extubated early after 80 ±17min. Echocardiography revealed good valve function; trivial to mild (1°), paravalvular incompetence was present in 41%. At thirty days four (6.6%) patients and during follow-up eight patients (15.3%) died, all with good valve function at most recent echo. Thirty day survival was 93 ±3.4%, six months survival 74.4 ±6.6% and one year survival 70.5 ±7.3%, respectively. There were no neurological events.
Conclusions: Transapical aortic valve implantation is a safe, minimally invasive and off-pump technique to treat high risk patients with aortic stenosis. One year results are good, especially when considering the overall risk profile of these patients.
Abstract 2486: Early Diastolic Mitral Annulus Lengthening Velocity Reflects Coupling between Systolic and Diastolic Function
Authors: Opdahl Anders , Remme Espen W , Helle-Valle Thomas , Vartdal Trond , Pettersen Eirik , Elstad Maja , Edvardsen Thor , Walloe Lars , Smiseth Otto A 
Published: July 2021

Background:
Peak early-diastolic mitral annulus velocity (E’) by tissue Doppler imaging (TDI) has been introduced as a marker of diastolic function. This study investigates mechanisms of E’.

Methods:
In 7 anesthetized dogs we measured E’ and systolic long-axis shortening (SS) by sonomicrometry and TDI, and the time constant (
tau
) of LV relaxation by micromanometer. In 8 healthy subjects (HS) we measured E’ by TDI and SS by M-mode echo at baseline and during lower body negative pressure (LBNP). We studied 6 patients with myocardial infarction, acutely and after 6 –12 months.

Results:
In dogs there was a strong correlation between E’ and SS (Fig 1

), suggesting that E’ is determined primarily by systolic function. However, during ischemia which increased
tau (p<<med>0.01)
, the relationship between E’ and LV end-diastolic pressure (LVEDP), shifted markedly downwards (Fig 2

). During volume loading which increased LVEDP (p<0.01), the relationship between E’ and
tau
shifted markedly upwards (Fig 3

). Consistent with findings in dogs, healthy subjects demonstrated a strong correlation between E’ and SS during LBNP (Fig 4

). However, in patients with chronic myocardial infarction the relationship between E’ and systolic shortening was shifted downwards (Fig 4

).

Conclusions:
During a wide range of hemodynamic conditions there were strong correlations between E’ and SS. The shifts in the relationships between E’ and LVEDP during ischemia and between E’ and
tau
during volume loading, indicates that diastolic function modulates E’. These observations indicate a tight coupling between systolic and diastolic function, and challenge the concept that E’ is a specific marker of LV relaxation.

Fig 1

Experimental study
Fig 2 Experimental study
Fig 3 Experimental study
Fig 4 Clinical study
Abstract 2559: Impact of Stent Thrombosis On MACE In The ARTS-II Study
Authors: Serruys Patrick W , Daemen Joost , Vranckx Pascal , Smits Peter , Hanet Claude , Herrman Jean-Paul , Wittebols Kristel , Stoll Hans-Peter 
Published: July 2021

PURPOSE: There is still scarce data about the incidence of (late) stent thrombosis (ST) following implantation of drug-eluting stents in patients treated for multivessel coronary artery disease (MVD). Recent concerns were raised about a possible erosion of the long-term treatment benefit of sirolimus-eluting stents (SES) due to ST. Our aim was to assess the impact of ST on Major Adverse Cardiac Events (MACE) up to 3 years in patients treated with SES for MVD in the Arterial Revascularization Therapies Study part II (ARTS-II) trial.
METHODS: ARTS-II is a non-randomized, open label, stratified trial with 607 patients exclusively treated with SES for multivessel coronary artery disease including mandatory involvement of the LAD. The 3-year clinical data from ARTS-II were re-adjudicated by an independent clinical events committee for the incidence of ST according to the definitions recently proposed by an Academic Research Consortium (ARC) using the categories of definite (angiography or autopsy), probable (myocardial infarction in target area, unexplained death within 30 days), and possible ST (unexplained death).
RESULTS: The majority of patients (53.5%) had 3-vessel disease. Total stented length was 72.5 ± 32.1mm, and 3.7 ± 1.5 stents were implanted per patient on average. At 3 years, 18/607patients died (3.0%), and MI was observed in 49/607 patients (8.1%). Stent thrombosis occurred in 39/607 patients (6.4%), 21 patients had ``definite” ST, and 32 patients had ``definite or probable” ST according to the ARC classification. From the 39 patients experiencing ST only 8 died, 7 of which were contributed by the ARC ``possible” ST category.
CONCLUSIONS: In ARTS-II, the majority of deaths in patients with ST was contributed by the ARC possible category. The final impact of ST on the individual MACE categories will be presented at the conference.
Abstract 2593: Noninvasive Coronary Angiography by Dual Source Computed Tomography in patients with an intermediate pretest likelihood for coronary artery disease
Authors: Leber Alexander , Ovrehus Kristian , Tittus Janine , Johnson Thorsten , Becker Christoph , Becker Alexander 
Published: July 2021

Introduction: Multislice CT has gained acceptance as a noninvasive tool to evaluate coronary arteries but its utility is limited by the occurrence of motion artifacts in patients with heart rates exceeding 70bpm. Furthermore little is known about the accuracy of MSCT in patient populations with an intermediate pretest likelihood for obstructive coronary artery disease.
Objectives: The aim of the present study was to assess the clinical performance of a dual x-ray source MSCT with high temporal resolution without using negative chronotropic pretreatment.
Methods: Dual source CT angiography (DSCT) (Siemens Definition) was performed in 130 patients with an intermediate likelihood for coronary artery disease, according to the Morise Scoring method, who were referred for invasive coronary angiography.
Results: DSCT generated datasets with diagnostic image quality in overall 127/130 patients. In 13 of 15 patients with atrial fibrillation and in 63 of 65 patients with heart rates > 65 bpm image quality was diagnostic. 13/13 patients with at least 1 stenosis > 75% (Sensitivity 100%) were correctly identified and in 110/114 patients (Specificity 96%, positive predictive value 76%) coronary stenosis >75% were correctly excluded. The accuracy to detect patients with coronary stenoses > 75% was not significantly different among patients with heart rates > 65bpm and < 65bpm.
Conclusion: This is one of the first studies using Multislice CT to assess the coronary status of patients with an intermediate pretest likelihood for coronary artery disease. We have shown that Dual Source Multislice CT (DSCT) allows to rule out coronary artery stenoses in such patients with excellent sensitivity. Due to a trend to overestimate the stenosis severity the positive predictive value of this technique is moderate in patient cohorts with a low prevalence of coronary stenoses. Fast heart rates and arrhythmias are no limitations for this technique anymore.