bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 64: A Tale of Seven EMS Systems: An Impedance Threshold Device and Improved CPR Techniques Double Survival Rates After Out-of-Hospital Cardiac Arrest
Authors: Aufderheide Tom P , Birnbaum Marvin , Lick Charles , Myers Brent , Romig Laurie , Stothert Joseph , Vartanian Levon 
Published: July 2021

Introduction: Maximizing outcomes after cardiac arrest depends on optimizing a sequence of interventions from collapse to hospital discharge. The 2005 American Heart Association (AHA) Guidelines recommended many new interventions during CPR (‘New CPR’) including use of an Impedance Threshold Device (ITD).
Hypothesis: The combination of the ITD and ‘New CPR’ will increase return of spontaneous circulation (ROSC) and hospital discharge (HD) rates in patients with an out-of-hospital cardiac arrest.
Methods: Quality assurance data were pooled from 7 emergency medical services (EMS) systems (Anoka Co., MN; Harris Co., TX; Madison, WI; Milwaukee, WI; Omaha, NE; Pinellas Co., FL; and Wake Co., NC) where the ITD (ResQPOD®, Advanced Circulatory Systems; Minneapolis, MN) was deployed for >3 months. Historical or concurrent control data were used for comparison. The EMS systems simultaneously implemented ‘New CPR’ including compression/ventilation strategies to provide more compressions/min and continuous compressions during Advanced Life Support. All sites stressed the importance of full chest wall recoil. The sites have a combined population of ~ 3.2 M. ROSC data were available from all sites; HD data were available as of June 2007 from 5 sites (MN, TX, Milwaukee, NE, NC).

Results: A total of 893 patients treated with ‘New CPR’ + ITD were compared with 1424 control patients. The average age of both study populations was 64 years; 65% were male. Comparison of the ITD vs controls (all patients) for ROSC
and
HD [Odds ratios (OR), (95% confidence intervals), and Fisher’s Exact Test] were: 37.9% vs 33.8% [1.2, (1.02, 1.40), p=0.022]
and
15.7% vs 7.9% [2.2, (1.53, 3.07), p<0.001], respectively. Patients with ventricular fibrillation had the best outcomes in both groups. Neurological outcome data are pending. Therapeutic hypothermia was used in some patients (MN, NC) after ROSC.

Conclusion: Adoption of the ITD + ‘New CPR’ resulted in only a >10% increase in ROSC rates but a doubling of hospital discharge rates, from 7.9% to 15.7%, (p<0.001). These data represent a currently optimized sequence of therapeutic interventions during the performance of CPR for patients in cardiac arrest and support the widespread use of the 2005 AHA CPR Guidelines including use of the ITD.
Abstract 72: Muscle Metabolomic Changes in a Porcine Model of Hemorrhagic Shock and Resuscitation
Authors: Witowski Nancy , Beilman Greg 
Published: July 2021

Introduction: Treatment of hemorrhage shock remains a clinical challenge despite decades of study. Investigation of metabolism during hemorrhagic shock and resuscitation may yield novel approaches for intervention strategies.
Methods: Pigs underwent a standardized hemorrhagic shock protocol after general anesthesia and instrumentation. Animals were hemorrhaged via IVC cannula, then resuscitated to a goal of 80 mm Hg systolic blood pressure after 45 minutes. Animals were fully resuscitated after 8 hours and weaned and extubated at 24 hours after beginning experiment. Survivors were sacrificed at 48 hours post-hemorrhage. Muscle samples were obtained at baseline (prior to hemorrhage), shock45 (after 45 min of shock), and 8, 23, and 48 h post resuscitation (PR). Muscle samples were processed using a dual-phase extraction process and the water-soluble metabolites examined by 1H and 31P NMR.
Results: The phosphocreatine:inorganic phosphate ratio decreases with shock and remains below baseline values at 48 h PR (A). Phosphoesters (glycolytic intermediates) increase during shock and return to levels below baseline at 48PR in successfully resuscitated pigs (B). Non-survivors exhibited higher levels of 1H NMR-visible lipids and of 31P NMR-visible ADP at baseline when compared to survivors (C).
Conclusions: Hemorrhage shock induces metabolic changes observable with NMR spectroscopy. Survivors exhibited persistent metabolic changes not resolved at 48 hours. Response to hemorrhage and risk of mortality may be dependent on initial metabolic state.
Abstract 93: The Potential Mechanisms of Reduced Incidence of VF as the Presenting Rhythm
Authors: Wang Hao , Tang Wanchun , Sun Shijie , Tsai Min-shan , Li Yongqin , Wang Tong , Weil Max H 
Published: July 2021

Background. In our previous studies, we have demonstrated that the administration of both beta-adrenergic receptor blocker (βετα-blocker) and angiotensin converting enzyme (ACE) inhibitor significantly shortened the duration of ventricular fibrillation (VF). In the present study, we investigated the potential mechanisms of shortened VF durations by pre-treatment of βετα-blocker and ACE inhibitor.
Hypothesis. Both βετα-blocker and ACE inhibitor increase the duration of monophasic action potential (MAP) and ventricular fibrillation threshold (VFT) which accounted for the decreased duration of VF.

Methods and Results. Three groups from a total of 15 Sprague-Dawley rats weighing 450 –550 g were fed βετα-blocker propranolol (40 mg/kg/day), ACE inhibitor captopril (100 mg/kg/day), or diluent placebo continuously for 30 days prior to the experiment. MAP90 were measured by self-made contact electrophysiology catheter in an open chest rat model. VFT was determined as the lowest current intensity at which two consecutive stimuli precipitated VF using a previously reported method. Both propranolol and captopril significantly increased the VFT and MAP90 in comparison with placebo controls (Table

).

Conclusions. Increased VFT and MAP90 in a rat model pretreated with propranolol and captopril may be the potential mechanisms of reduced duration of VF.
2007 Laennec Clinician/Educator Lecture—Unraveling the Mysteries of Diastology
Authors: Nishimura Rick 
Published: July 2021

Diastolic dysfunction plays a critical role in the pathophysiology of producing signs and symptoms of heart failure. Heart failure with a normal ejection fraction (HFnlEF) is one of the leading causes of hospital admissions today and is associated with significant morbidity and mortality. It is thus important to understand the pathophysiology of diastolic dysfunction, which itself is a complex series of multiple interrelated events, including relaxation, suction, ventricular interaction, ventricular arterial coupling, pericardial restraint, and myocardial viscoelastic forces.
It was difficult for the clinician to understand “diastology” in the past. Initial studies were limited to complex equations derived from animal models and were difficult to apply to patient care. The development of radionuclide angiography and Doppler echocardiography allowed noninvasive rapid assessment of volumetric filling and flow velocity curves, which began to provide insight into the complex process of diastolic filling for the clinician. As our understanding of diastology evolved over the past 2 decades, it has become clear that we now need to pursue new areas to understand this fascinating subject and apply it to patient care. These areas include the underlying mechanism HFnlEF (ventricular-vascular coupling versus true myocardial stiffness), relationship of rest versus exercise hemodynamics, and the complex ventricular fiber “twisting and shortening” of both contraction and relaxation.
Abstract 5820: The Clinical Value of Absolute Quantification of Myocardial Perfusion in The Detection of Coronary Artery Disease. A Study Using Positron Emission Tomography to Detect Multi-vessel Disease
Authors: Kajander Sami , Ukkonen Heikki , Joutsiniemi Esa , Mäki Maija , Saraste Antti , Ala-Knuuttila Erja , Pietilä Mikko , Airaksinen Juhani , Hartiala Jaakko , Saraste Markku , Knuuti Juhani 
Published: July 2021

Background: Perfusion imaging is standard technique in the detection of CAD. However, the analysis is based on assessment of relative perfusion defects that has known limitations in the detection of multi-vessel disease. Typically only the most severe perfusion abnormalities are detected but not less severe defects or balanced disease. PET measures myocardial perfusion in absolute terms potentially being able to avoid these drawbacks but the value of quantitation has not been shown in clinical studies.
Aims: To evaluate the accuracy of absolute quantification of myocardial perfusion in the diagnosis and the detection of multivessel CAD.
Patients and methods: 83 consecutive patients with moderate (30–70%) pretest likelihood of CAD were enrolled. PET perfusion imaging at rest and during adenosine stress were performed using O-15-water. The studies were analyzed using validated quantitative model and software. Both standard relative perfusion images and images that were scaled to known absolute scale (0.0–3.5 ml/min/g) were produced. The images were analyzed by two experienced readers blinded to clinical data, image scaling and invasive coronary angiography (ICA). The regions were classified as normal (>70% of uptake), mildly abnormal (50–70%) and severely abnormal (< 50%) in each vascular territory and compared against ICA.
Results: The PPV, NPV and accuracy of absolute perfusion in the detection of any CAD were 87%, 97%, 92% respectively. The corresponding values in the detection of multi-vessel disease were 94%, 96% and 95%. When standard relative images were used the respective values for multi-vessel disease were 33%, 69% and 60% against ICA. Relative analysis was able to detect only 39% of patients with multi-vessel disease. In addition, regional perfusion was often (31%) falsely interpreted as multi-vessel disease while preserved absolute perfusion was able to exclude significant stenoses.
Conclusions: The measurement of myocardial perfusion in absolute terms has significant impact on the interpretation of myocardial perfusion. Standard relative analysis is able to detect only small fraction of patients with multi-vessel disease and also quite commonly variability in perfusion is falsely interpreted as a sign of multi-vessel disease.
Abstract 5881: Influence Of Cardiac Inflammation And Extracellular Matrix Regulation On Diastolic Dysfunction In Patients With Heart Failure With Normal Ejection Fraction
Authors: Westermann Dirk , Kasner Mario , Lettau Olga , Noutsias Micheal , Schultheiss Heinz-Peter , Tschöpe Carsten 
Published: July 2021

Aims: One of the hemodynamic mechanisms underlying heart failure with normal EF (HFNEF) is increased LV stiffness. In order to clarify the pathological changes leading to increased stiffness we investigated the left ventricular (LV) function using pressure-volume loops under basal conditions and during atrial pacing and investigated endomyocardial biopsies of patients with HFNEF.
Methods: In 36 patients with HFNEF and 8 controls pressure volume loops were measured under basal conditions and during atrial pacing. Furthermore, endomyocardial biopsies were analyzed for changes in the extracellular matrix regulation, cardiac inflammation and changes in the titin isoforms.
Results: Patients with HFNEF had an increased LV diastolic stiffness (+350%) compared to controls. During atrial pacing, stroke volume decreased (−35%) due to a leftward shift of the PV loops. This was associated with increased collagen content in cardiac biopsies (+380%), which blunted their cardiac output response to enhanced cardiac demand. This may explain the exercise intolerance in HFNEF patients. The total collagen correlated with cardiac stiffness in the HFNEF group (r2=0.69). This was associated with increased mRNA levels of the pro fibrotic TGF-b. Furthermore, the collagenase matrix metalloproteinases (MMP) 1 was not changed while TIMP-1 was increased (+150%), which supposes a decrease in collagen degradation in HFNEF. Nevertheless, MMP 2 was increased (+160%). This MMP is also associated with inflammation, and coherently, we investigated cardiac inflammation. We documented increased cardiac inflammation by an increment of adhesion molecules (ICAM +55%) and invading cells (CD11b cells +250%) in the cardiac tissue of HFNEF patients compared to controls. Interestingly, there was no change in titin isoforms between both groups.
Conclusion: Patients with HFNEF have increased diastolic stiffness leading to an impairment of the Frank-Starling mechanism during atrial pacing. Since increased stiffness correlated with the cardiac collagen content, changes in the ECM regulation might be important for the development of HFNEF and invading cells triggering cardiac inflammation might further participate in this pathophysiology.
Abstract 5895: The Impact of Response to Cardiac Resynchronization Therapy on Ventricular Arrhythmic Events
Authors: Ando Kenji , Soga Yoshimitsu , Arita Takeshi , Shirai Shinichi , Goya Masahiko , Iwabuchi Masashi , Yokoi Hiroyoshi , Yasumoto Hitoshi , Nosaka Hideyuki , Nobuyoshi Masakiyo , Shizuta Satoshi , Doi Takahiro , Kimura Takeshi , Kit Toru 
Published: July 2021

Background: It’s well known that cardiac resynchronization therapy (CRT) is effective to reduce heart failure hospitalization. However, the impact of response to CRT on ventricular arrhythmic events is not well established.
Methods: We investigated 216 pts received CRT in two institutions (age 69.3+/−10.8 years, NYHA class 3.1+/−0.5, LVEF 25.8+/−7.4%, LVEDD 62.1+/−8.3mm, pre QRS duration 158+/−32ms, AF 19.4%, ischemic heart disease 33.3%, CRT-D 51.3%) and divided into two groups, Responders (n=145, 67.1%) and Non-responders (n=71, 32.9%). CRT responder was defined as improvement of LVEF > or =5%, or reduction of LVEDD > or = 5mm at 3–6 month echo data. Long-term ventricular arrhythmic events (ventricular tachycardia: VT, ventricular fibrillation: VF and sudden cardiac death: SCD) were obtained. Kaplan-Meier curve were draw and Long-Rank test was used to compare event rates of two groups.
Results: Mean follow up periods was 19.3 +/−12.7 months. Event free survival rates from ventricular arrhythmic events (VT, VF and SCD) were all significantly higher in Responders compared to Non-responders (VT: 89.2% vs. 77.8% at 2 year, Log-rank p=0.031, VF: 99.2% vs. 89.9% at 2 year, Log-rank p=0.0031, SCD: 98.6% vs. 89.2% at 2 year, Log-rank p=0.0038) and event free survival rate from combined VT, VF and SCD was also significantly higher in Responders (87.8% vs. 76.5% at 2 year, Log-rank p=0.0013).
Conclusion: Response to CRT seems to reduce not only heart failure events, but also ventricular arrhythmic events.

Figure:

Adverse events in new onset AF vs no AF
Abstract 5986: Drug-Eluting Stent versus Bare Metal Stent Use: Meta-Analysis of Randomized Trials and Observational Studies
Authors: Kirtane Ajay J , Gupta Anuj , Iyengar Srinivas , Mehran Roxana , Moses Jeffrey W , Martin B , Applegate Robert , Hannan Edward , Harjai Kishore , Racz Michael , Jensen Lisette O , Park S. J , Perry Raphael , Saia Francesco , Simonton Chuck , Tu Jack V , Waksman Ron , Stone Gregg W 
Published: July 2021

Background: The safety and efficacy of drug-eluting stents (DES) among more generalized patient populations than typically enrolled in pivotal randomized controlled trials (RCTs), including for “off-label” indications, is controversial. Objectives: We sought to perform a systematic review and meta-analysis of published/presented DES studies in order to estimate the relative impact of DES vs. BMS particularly outside of USFDA labeled indications, and to specifically assess differences between data derived from RCTs and observational (Obs) analyses.
Methods: Studies with >=100 total pts comparing DES to BMS and reporting mortality data with cumulative follow-up of >=1 year that were published and/or presented through 2/2008 were abstracted. Fixed effects and random effects models were used to generate summary estimates of the relative impact of DES vs. BMS upon all-cause mortality, myocardial infarction (MI), and target vessel revascularization (TVR). Data from 9,470 pts enrolled in 22 RCTs and from 182,901 pts studied in 34 Obs studies were included; RCT and Obs data were analyzed separately.

Results: Data from “off-label” RCTs demonstrated non-significant reductions in mortality with DES vs. BMS, with a significant reduction in TVR (Table

). The Obs studies (in which pts were treated for both on-label and off-label indications) demonstrated significant reductions in mortality and TVR with DES vs. BMS use (Table

).

Conclusions: Use of DES compared to BMS does not appear to be associated with adverse safety outcomes such as death or MI in either off-label RCTs or non-randomized Obs studies, and was associated with a significant and comparable reduction in TVR. In the absence of definitive large-scale randomized data directly comparing DES to BMS in unselected pts, these findings, derived from more than 190,000 total pts treated in 56 studies, suggest that DES are safe and have comparable efficacy in both RCTs and in the “real-world”.
Abstract 6019: The Impact of Blood Transfusion and Other Bleeding Measures on Subsequent Mortality Among Patients Undergoing Primary PCI for Acute Myocardial Infarction: The HORIZONS-AMI Trial
Authors: Kirtane Ajay J , Parise Roxana Mehran Helen , Witzenbichler Bernard , Guagliumi Giulio , Peruga Jan Z , Brodie Bruce , Dudek Dariusz , Pocock Stuart , Clayton Tim C , Tourkova Vilia , Dangas George D , Lansky Alexandra J , Stone Gregg W 
Published: July 2021

Background: Bleeding complications are strongly associated with subsequent mortality among pts with ACS. The relative importance of the individual components of the composite bleeding scales used in clinical trials is poorly understood.
Objectives and Methods: Data were drawn from the HORIZONS-AMI, in which 3602 pts with STEMI undergoing primary PCI were randomized to treatment with heparin plus a glycoprotein IIb/IIIa inhibitor vs. bivalirudin alone. Bleeding and mortality outcomes were independently adjudicated using the ACUITY major bleeding scale, which incorporates laboratory data, clinical bleeding measures including blood transfusions and access site hematomas, and other parameters. The relative impacts of various bleeding components upon 30 day mortality were examined using multivariable modeling with individual components of the ACUITY bleeding scale incorporated as time-updated covariates.

Results: By 30 days, 238 pts experienced a non CABG major bleeding event (6.6%), and 93 patients died, 26 of whom (28.0%) had a prior major bleed. Bleeding was independently associated with subsequent mortality (adjusted HR 4.29 [2.57, 7.17]). Of the individual components of the ACUITY scale (each modeled independently), retroperitoneal bleeding, reoperation for bleeding, receipt of a blood transfusion, and a reduction in hemoglobin concentration >=4 g/dL were all associated with subsequent mortality after controlling for baseline characteristics and randomized treatment assignment (Table

).

Conclusions: Objective assessment of the impact of specific components of bleeding scales upon subsequent mortality is possible, and suggests differing relative impacts of these components. A significant proportion of attributable deaths are related to a reduction in hemoglobin >=4 gm/dL and/or receipt of a blood transfusion.
Abstract 6057: Elevated LDL-Cholesterol Causes a Higher Exercise Blood Pressure Response
Authors: Duprez Daniel A , Florea Natalia , Xu Jia , Grandits Gregory A , Hoke Lynn , Cohn Jay N 
Published: July 2021

Background: Increased blood pressure (BP) response during exercise has been associated with an increased cardiovascular risk. It is unknown how LDL-cholesterol (LDL-c) is related to the exercise-induced BP response as well as to the large (LAE) and small artery (SAE) elasticity in subjects free from overt cardiovascular disease (CVD). We examined the relationship between serum LDL-c and the BP response during a moderate exercise treadmill test in subjects with no overt CVD and also the relationship between LDL-c and LAE and SAE.
Methods: 1229 Subjects (700 male, 529 female) free of overt CVD were recruited during a CVD prevention screening program. A fasting venous blood sample was taken for LDL-cholesterol determination. LAE and SAE were derived from radial pulse wave contour analysis. Resting BP was measured. Then they performed a treadmill exercise test for 3 minutes at a 5 METS (metabolic equivalents) workload. Systolic and diastolic BP were measured at the peak of the 3 min exercise test, The study population was divided in quartiles among distribution of LDL-cholesterol (LDL-c).

Results: Table 1

summarizes the results. There was no significant difference in large artery elasticity.

Conclusions: In asymptomatic subjects, LDL-c is not related with resting BP. Higher LDL-c is related with higher exercise systolic BP response. This higher BP response can be explained by a lower smaller artery elasticity which is a marker for endothelial dysfunction probably related to higher LDL-c. Further studies to examine the effect of lipid-lowering therapy on exercise BP response are warranted

Table 1
Abstract 6058: Fibroin, a Silk-Based Biodegradable Protein, is a Promising Material to Engineer Small-Diameter Vascular Graft
Authors: Enomoto Soichiro , Sata Masataka , Sumi Makoto , Tanaka Kimie , Nakamura Kazuto , Sahara Makoto , Asakura Tetsuo , Nagai Ryozo 
Published: July 2021

Background: Smaller vascular grafts made from synthetic biomaterials, particularly smaller than 5 mm in diameter, are associated with high incidence of thrombosis. Fibroin is a silk-derived biodegradable protein which provides anti-thrombotic surface and serves as a scaffold for various cell types in tissue-engineering. We evaluate the potential of fibroin to generate artificial vascular prosthesis for small arteries.
Methods and Results: A small artificial vessel with three layers was woven from fibroin thread. Fibroin-based grafts (1.5 mm in diameter, 10 mm in length) were implanted into the abdominal aorta of male 10 to 14-week-old Sprague Dawley rats by end-to-end anastomosis. Polytetrafluoroethylene (PTFE)-based grafts were used as control. Patency of fibroin grafts at 1 year after implantation was significantly higher than that of PTFE grafts (85.1% vs. 30%, p<0.01). Endothelial cells and smooth muscle cells (SMCs) migrated into the fibroin graft early after implantation and organized endothelial and medial layers, as determined by anti-CD31 or anti-α-smooth muscle actin immunostain-ing, respectively. Total number of SMCs increased 1.6-fold from 1 month to 3 months after implantation. Vasa vasorum was formed in adventitia. Sirius-red staining revealed that the content of collagen in fibroin grafts significantly increased at 1 year after implantation (520.9±0.2%, p<0.05) with decrease in fibroin fiber content (32.9±1.9%, p<0.05). To investigate the origin of the cells of neointima and media, bone marrow (BM) transplantation was performed from GFP rats to wild-type rats. GFP-positive cells substantially contributed to organization of endothelium and smooth muscle layers in the fibroin grafts implanted into the BM chimeric rats. The rate of BM-derived SMCs was 70% at 1 month and 55% at 3 months after implantation.
Conclusion: A small-diameter fibroin-based vascular graft has significantly higher patency than a PTFE-based graft. BM-derived cells substantially contribute to the initial formation of SMCs layer after graft implantation. The number of non-BM-derived SMCs increases at chronic phase. Fibroin might be a promising material to engineer vascular prosthesis for small arteries.