bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 3577: Thickness of mitral annular calcification is directly associated with cardiovascular morbidity and mortality. The Northern Manhattan Study.
Authors: Kohsaka Shun , Sacco Ralph L , Jin Zhezhen , Liu Rui , Rundek Tatjana , Boden-Albala Bernadette , Homma Shunichi , Di Tullio Marco R 
Published: July 2021

BACKGROUND: Mitral annular calcification (MAC) is common in the elderly, and is associated with atherosclerotic risk factors. We sought to determine the magnitude of association between MAC and vascular events in the multiethnic prospective cohort of northern Manhattan.
METHODS: MAC was assessed by transthoracic 2D-echocardiography as binary (yes/no) and continuous (mm) variable. Subjects were aged ≥40 years at enrollment, and were free of prior myocardial infarction (MI) and stroke. The association between MAC and MI, ischemic stroke, and vascular death was examined, adjusting for established cardiovascular risk factors and for carotid artery stenosis (>60%) by means of Cox regression analysis.

RESULTS: Of 1,958 subjects, 502 (25.7%) had MAC. MAC was significantly associated with age, systolic blood pressure, male gender and history of atrial fibrillation. During a mean follow-up of 7.4 ± 2.5 months, there were 100 MI, 104 ischemic stroke and 156 vascular deaths recorded. After adjustment for other risk factors, MAC was associated with an increased risk of MI (HR 1.72, 95%CI 1.13–2.63; p=0.012) and vascular death (HR 1.57, 95%CI 1.12–2.20; p=0.008), but not of ischemic stroke (HR 1.36, 95%CI 0.89 –2.06; p=0.16). When MAC was categorized into mild to moderate (1– 4mm, n=253; 13.1%) or severe (≥4mm, n=245; 12.7%), severe MAC remained as a strong and independent predictor of vascular events, but not stroke (Table

).

CONCLUSION: MAC was a strong and independent predictor for MI and vascular death in this multiethnic cohort especially when its thickness is more than 4mm. Its predictive value for ischemic stroke was not independent of other cardiovascular risk factors.

Table.

Association of MAC severity with clinical vascular outcomes.
Abstract 3592: Early Detection Of CD4-positive Lymphocytes In Adipose Tissue During The Development Of Insulin Resistance
Authors: Hess Katharina , Marx Nikolaus , Wabitsch Martin , Skurk Thomas , Hauner Hans , Hartge Martin , Kintscher Ulrich 
Published: July 2021

Background: Adipose tissue inflammation may play a critical role in the pathogenesis of insulin resistance (IR) and arteriosclerosis. Previous work has mainly focused on the role of macrophages in human adipose tissue, but little is known about pro-inflammatory T-lymphocytes. Therefore the present study examined the role of CD4-positive lymphocytes in adipose tissue inflammation and IR.
Results: Both, CD4-positive lymphocytes and macrophages are present in human visceral adipose tissue as determined by immunohistochemical staining. Most macrophages were HLA-DR positive, reflecting activation through IFNγ, a cytokine released from CD4-positive lymphocytes. Furthermore, SDF-1α, a T-cell chemotactic protein, was also detectable in human adipose tissue. RT-PCR analyses confirmed the expression of IFNγ and SDF1α in visceral adipose tissue. Freshly isolated human adipocytes as well SGBS adipocyte cells express SDF-1α with a down regulation of its expression during adipocyte differentiation in both cell types. In a mouse model of IR, high fat diet induced IR already after 5 weeks which was associated with a marked lymphocyte infiltration in visceral adipose tissue as determined by immunohistochemical staining and RT-PCR. In contrast, macrophages were absent after 5 weeks of diet but could be detected at week 10, suggesting early infiltration of lymphocytes during the development of IR.
Conclusion: Pro-inflammatory T-lymphocytes are present in visceral adipose tissue and may contribute to local inflammatory cell activation before the appearance of macrophages. These data suggest that lymphocytes may play an important role in the initiation and perpetuation of adipose tissue inflammation as well as the development of insulin resistance.
Abstract 3614: Anticonceptive Drug Use And Increased Carotid and Femoral Plaque Prevalence: Population Data From Asklepios
Authors: Rietzschel Ernst , De Buyzere Marc , De Baquer Dirk , Bekaert Sofie , Segers Patrick , Cassiman Peter , Verdonck Pascal , De Backer Guy , Gillebert Thierry C 
Published: July 2021

Purpose: Combination therapy with the female hormones estrogen (E) and progestins are very frequently used with approximately 100 million women worldwide taking oral contraceptives (OC). Recent trials have cast doubt on the cardiovascular safety of hormonal replacement therapy (HRT). In contrast to the HRT-controversy, little attention has been focused on OC, a therapy using 10 –100 fold higher levels of E than HRT. We describe population correlates of long-term OC use.
Methods: The Asklepios study is a representative sample (2524 M/F volunteers, 35–55 years) from the Belgian general population free from overt cardiovascular disease. Vascular echography of the carotid and femoral arteries was systematically performed and atherosclerosis was defined by presence of carotid or femoral plaque.
Results: Of 1301 women (median age 45.7 y), 27.4% were taking OC and 10.0% were taking HRT. In contrast, past OC-use is far more prevalent: 81% of women having taken OC for at least 1 year, with a median exposition of 13 years. After multivariate adjustment for age, smoking, blood pressure, lipids, obesity, diabetes, physical activity, fruit, vegetable and alcohol intake, educational level and drug therapy (lipid-lowering, antihypertensive, aspirin), use of OC was associated with a significant increase in carotid or femoral unilateral plaque. Odds ratio’s (OR) per 10 years of OC exposure were: carotid plaque 1.17 (1.00 –1.33) and femoral plaque 1.28 (1.10 –1.47). We also looked at prevalence of bilateral disease (involvement of right and left carotid/femoral artery) as a more stringent phenotype of atherosclerosis. OR per 10 years OC exposure were: carotid plaque 1.42 (1.03–1.84); femoral plaque 1.34 (1.05–1.63).
Interpretation : Use of contraceptive therapy is very common and associated with an unexpected increase in the prevalence of carotid and femoral atherosclerosis in otherwise young, apparently healthy women. Our data suggest a 20 –30% increased prevalence of plaque in the carotid and femoral arteries per 10 years of OC exposure. In the light of widespread (>80% of our population sample; > 100 million women globally) and usually prolonged OC use (>10 years) these results suggest OC use could be an important factor in the global atherosclerotic burden.
Abstract 3616: Left Atrial Size Association with Incident Ischemic Stroke and All-Cause Mortality in African Americans: the Atherosclerosis Risks in Communities (ARIC) Study
Authors: Nagarajarao Harsha S , Penman Alan D , Taylor Herman A , Mosley Thomas , Butler Kenneth , Skelton Thomas N , Samdarshi Tandaw , Fox Ervin R 
Published: July 2021

Background: The association between left atrial (LA) size, ischemic stroke and mortality has been investigated in non-Hispanic whites but not in African Americans despite their disproportionately higher rates of stroke and cardiovascular mortality. Purpose: We examined the association of LA size assessed by echocardiogram with the incidence of ischemic stroke and all-cause mortality in a large population-based cohort of African Americans.
Methods: Participants in the Jackson cohort of the ARIC study have been extensively evaluated including echocardiograms during the third examination (1993–1995) and have been followed for incident cardiovascular events including stroke.
Results: The study population consisted of 1,887 participants of which 660 (35%) were men with a mean age of 58.9 ± 5.7 years. LA diameter by tertile was significantly related to hypertension, diabetes and body mass index (BMI) (p<0.0001 for each). Over a median follow-up period of 8.8 years, there were 103 incident strokes (6.47 per 1,000 person-years) and 206 deaths (13.3 per 1,000 person-years). Adjusting for age, sex, hypertension, smoking, diabetes, total cholesterol:HDL ratio, and BMI, LA size was associated with stroke (HR per 10 mm increment of LA diameter 1.44; 95% CI: 0.99, 2.08, p = 0.05) and significantly associated with mortality (HR 1.38; 95% CI: 1.06,1.79 p < 0.02). After further adjustment for prevalent CHD and congestive heart failure, only the association with mortality remained statistically significant (p < 0.03).
Conclusions: In this middle-aged population based cohort of African Americans, LA size was significantly associated with all-cause mortality independent of traditional cardiovascular risk factors.
Abstract 3668: Predictors of Four-Year Incident Arterial Hypertension From Initial Prehypertension: The Strong Heart Study.
Authors: De Marco Marina , Chinali Marcello , Roman Mary J. , Lee Elisa T. , Russell Marie , Howard Barbara V. , de Simone Giovanni , Devereux Richard B. 
Published: July 2021

Background: Pre-hypertension (defined by JNC-VII) frequently evolves to arterial hypertension (HTN) and is recently shown to increase cardiovascular risk, especially in diabetics. It is unclear which metabolic and cardiac characteristics predict development of HTN in pre-hypertensive subjects.
Methods: 627 pre-hypertensive participants in the Strong Heart Study, free of anti-hypertensive treatment and without prevalent cardiovascular disease or significant valve disease, were studied (64% women; 41% diabetic; 58±7 yrs). All participants underwent complete echocardiographic, anthropometric and laboratory testing. We evaluated 4-year incidence of HTN using anthropometric and metabolic profile as first predictors, and echocardiographic indices thereafter.
Results: Four-year incidence of HTN was 41%. Preliminary analysis identified diabetes (DM by ADA criteria) as a significant predictor of incident HTN (53% among participants with DM vs 33% in non DM; OR= 2.02, 95% CI=1.42–2.88; p<0.001). Accordingly, additional analysis was performed separately in participants with or without baseline DM. After adjusting for age, gender, and heart rate, strongest predictor of HTN in DM was baseline systolic blood pressure (OR= 1.07/mmHg, 95% CI=1.03–1.12; p=0.001) with weaker effect of echocardiographic relative wall thickness (p=0.03). In non-DM, independent predictors of HTN were systolic blood pressure (HR= 1.08/mmHg, 95% CI=1.04–1.12; p<0.001), non-HDL cholesterol (HR= 1.01/mg*dL-1, 95% CI=1.00–1.01; p=0.01) and high LV mass index (OR=1.04 g/m2.7, 95% CI=1.01–1.07; p= 0.007). Higher Doppler stroke volume and total peripheral resistance also entered alternative models without LV mass (each p<0.05).
Conclusion: In a population of pre-hypertension adults we demonstrate high incidence of HTN (41%). Independent predictors of HTN at 4-year follow-up are presence of diabetes and higher baseline systolic blood pressure. In non-DM, LV mass index is an indipendent predictor of incident HTN in addition to baseline systolic blood pressure and non-HDL cholesterol.
Abstract 3687: Microcirculatory Changes in Diabetic Subjects
Authors: Freeman Jenny , Nouvong Aksone , Mohler Emile , Davis Brian , Medenilla Elizabeth , Tajaddini Azita , Cornejo Martha , Arriga Wendy , Panasyuk Svetlana , Schomacker Kevin , Veves Aristidis 
Published: July 2021

INTRODUCTION: Hyperspectral Technology cutaneous Oxygenation Monitoring (HTcOM) quantifies oxyhemoglobin (HT-Oxy) & deoxyhemoglobin (HT-Deoxy) on a pixel by pixel basis, providing a scan that shows microcirculatory patterns of tissue oxygenation. Here, we test the use of HTcOM to define patients at higher risk of diabetic complications based on systemic microcirculatory changes.
METHODS: Data were extracted from an ongoing NIH/NIDDK study, following 210 type 1 & type 2 diabetic subjects at high risk for foot ulceration & 66 with ulcers for 18 months. HTcOM values were measured from volar forearm, palm & foot dorsum. Subjects with diabetic foot ulcers during the study were compared to high risk diabetics without ulcers. HT-Oxy and HT-Deoxy data was used as the primary basis for determining systemic microvascular disease in diabetic subjects.
RESULTS: Interim data was analyzed from 162 type 1 & 2 diabetics. Subjects with ulcers were compared to those without ulcers. Diastolic blood pressure, HbA1c, HDL & neuropathy disability scores were different between the 2 groups. Lower HT-Oxy was found in forearms & palms for the ulcer group when compared to the group without ulcers. Significant differences were also seen for the dorsum, but only when analyzing paired difference.
CONCLUSIONS: Previous work demonstrated that HTcOM could differentiate between subjects without diabetes, low risk diabetics & high risk diabetics. The current work demonstrates additional capabilities of HTcOM to discriminate even within the high risk group. Subjects with poorer systemic microcirculation as manifested by lower HTcOM readings on the forearm were significantly more likely to have or develop a foot ulcer than other subjects considered at high risk by standard clinical assessment. HTcOM provides for the first time, the possibility to perform a non-invasive assessment of the severity of systemic microvascular disease associated with diabetes progression.

Linear Regression Mixed Effects Model Results
Abstract 3774: Cost Effectiveness Of Enoxaparin In Patients With ST-elevation Myocardial Infarction: Results From EXTRACT-TIMI 25
Authors: Zhang Zefeng , Kolm Paul , Zhang Wei , Ewen Edward , Jurkovitz Claudine , Fidan Dogan , Weintraub William 
Published: July 2021

Background:
The efficacy of enoxaparin versus unfractionated heparin in the setting of ST-elevation myocardial infarction (STEMI) has been demonstrated in EXTRACT-TIMI 25, with 17% reductions in relative risk in the primary endpoint of death or nonfatal recurrent myocardial infarction (MI) (p<0.0001). This study considers the cost effectiveness of enoxaparin versus unfractionated heparin with fibrinolysis based on EXTRACT-TIMI 25.

Methods: The ITT population of 20,479 patients from 48 countries were monitored for clinical and adverse events during the index hospitalization and through 30 days. Trial-wide resource utilization from all participating countries was used in the analysis while all costs were based on 2004 US costs. Medicare Fee Schedule was used for outpatient procedures and DRGs were applied for index and subsequent hospitalizations costs. Lost life years associated with 30-day in-trial events (death, MI and stroke) were estimated from published data from Framingham.
Results: Overall, costs of index hospitalizations and outpatient procedures were lower, while costs for the subsequent hospitalization were higher for the enoxaparin patients. Total 30 days’ costs remained lower for enoxaparin, although the difference did not reach significance. Life years lost were significantly less with enoxaparin. For lifetime, when costs beyond the trial period were considered, the costs of enoxaparin in patients with STEMI were $506 higher, and the incremental cost-effectiveness ratio of enoxaparin compared to UFH was $4,369 per life year gained, with 99.9% of estimates falling below the $50,000 per life year gained threshold.
Conclusions: Enoxaparin is effective in reducing mortality or nonfatal MI, and is highly cost-effective strategy in the US settings for the treatment of STEMI patients.
Abstract 501: Function of Connexin30.2 and Connexin40 in AV-Nodal Conduction
Authors: Schrickel Jan W , Kreuzberg Maria , Ghanem Alexander , Troatz Clemens , Tiemann Klaus , Nickenig Georg , Willecke Klaus , Lewalter Thorsten 
Published: July 2021

Objective: Connexin30.2 (Cx30.2) and Connexin40 (Cx40) have been shown to be major components of the gap-junctions murine AV-nodal tissue. Cx30.2 has been shown to contribute to physiological conduction slowing of the AV-node but functional interactions of Cx30.2 and fast conducting connexins like Cx40 in the AV-node remaines unclear.
Methods: 18 wildtype-(WT), 10 Cx30.2-deficient (Cx30.2−/−), 6 Cx40-deficient (Cx40−/−) and 10 Cx30.2/Cx40 double-deficient (Cx30.2/Cx40−/−) mice were in vivo electrophysiologically investigated using transvenous right cardiac catheterization.
Results: Independent from a tendency towards P-wave prolongation in Cx40−/− and Cx30.2/Cx40−/− mice, PQ was significantly shorter in Cx30.2 (35.7±3.4 ms) as compared to all other investigated groups (WT: 46.6±4.0 ms; Cx40−/−: 50.8±6.2 ms; Cx30.2/Cx40−/−: 51.6±5.1 ms; p<0.0001). Accelerated AV-conduction was attributable to a significant faster supra-Hisian conductivity with shortened AH-intervals in Cx30.2−/− (28.2±4.3 ms vs. WT: 35.9±4.4 ms; Cx40−/−: 35.8±1.9 ms; Cx30.2/Cx40−/−: 37.3±5.5 ms, p<0.0001). A significantly lower Wenckebach-periodicity was present in Cx30.2−/− (basal stimulation cycle-length S1S1: 79.7±7.2 ms), but not in Cx30.2/Cx40−/−(81.5±6.7 ms; p<0.001) compared to the other groups. The HV-Interval was prolonged in Cx40−/− compared to WT and Cx30.2−/− as an indicator for impaired infra-Hisian conductivity. As a result, QRS was prolonged in Cx40−/− (21.3±2.7 ms) and Cx30.2/Cx40−/−(19.9±2.4 ms) compared WT (12.9±1.9 ms) and Cx30.2−/− (14.2±2.0 ms; p<0.0001).
Conclusions: Thefact that no acceleration of AV-nodal conduction is present in Cx30.2/Cx40−/− compared to Cx30.2−/− implicates that the presence of fast conducting Cx40 is essential for faster impulse propagation in Cx30.2−/−. This study strongly points towards functional interactions of Cx40 and slow conducting Cx30.2 in the murine AV-node. The conductive properties of the AV-node under physiological conditions and in pathological states (such as hereditary AV-blocks and AV-nodal reentrant tachycardia) might therefore be mediated by a differential expression or activation of such interacting connexins.
Abstract 4: Inducing Hypothermia During Resuscitation Improves Return Of Spontaneous Circulation In Prolonged Porcine Ventricular Fibrillation
Authors: Menegazzi James J , Rittenberger Jon C , Suffoletto Brian P , Logue Eric S , Salcido David D , Sherman Lawrence D 
Published: July 2021

Introduction: Induced hypothermia has been shown to improve survival and neurologic outcomes for ventricular fibrillation (VF) cardiac arrest. Clinical studies have not begun inducing hypothermia until after return of spontaneous circulation (ROSC). The effects of cooling during the resuscitation are not well-studied.
Hypothesis: We hypothesized that inducing hypothermia at the start of resuscitation would increase the rates of ROSC and short-term survival (20 minutes) in an established porcine model of prolonged VF. We compared intra-resuscitation hypothermia (IRH) with a normothermic control group (CTL).
Methods: We anesthetized and instrumented 28 domestic swine (mean mass 26.5 ±2.4 kgs) with ECG, esophageal temperature, and micromanometer-tipped aortic and right atrial catheters. We then randomly assigned them to IRH and CTL groups (n= 14 each). VF was electrically induced and untreated for 8 minutes. Then resuscitation was begun with mechanical chest compression and ventilation. Hypothermia was induced by rapid IV infusion of ice-cold normal saline (30 mL/kg) at the beginning of resuscitation in the IRH group. The CTL group got 30 mL/kg of body-temperature saline at the start of resuscitation. After 8 minutes of VF, two minutes of CPR was followed by delivery of drugs (epinephrine 0.1 mg/kg, vasopressin 40 U, and propranolol 1.0 mg) and 3 more minutes of CPR (first rescue shock at 13 minutes of VF). ROSC (systolic BP above 80 mmHg for one minute continuously) and survival were recorded, as was total fluid given and hematocrits. Temperatures are reported in degrees C. Rates were compared with 2-tailed Fisher’s exact test, with alpha=0.05.
Results: Baseline temperatures at 8 minutes VF did not differ (IRH=37.9° and CTL=37.7°). Post-infusion temperatures at 13 minutes of VF were IRH=34.9° and CTL=37.9°. ROSC occurred in 12/14 (86%) IRH animals and in 6/14 (43%) CTL, with p=0.046. Survival occurred in 8/14 (57%) IRH animals and 4/14 (36%) CTL, with p=0.15. Total fluid volumes given and hematocrits did not differ between groups.
Conclusions: IRH doubled the rate of ROSC compared to CTL. There was a non-significant 58% relative improvement in short-term survival. In this porcine model, rapid infusion of ice-cold saline quickly cooled during resuscitation.
Abstract 17: Ambulance Paramedics Interrupt Chest Compressions And Delay Defibrillation After Taking Over From Lay Rescuers With An Automated External Defibrillator
Authors: Berdowski Jocelyn , Schulten Ron J , Koster Rudolph W 
Published: July 2021

Introduction: There are no guidelines for transition of care from rescuers with AED to paramedics with ongoing CPR. After disconnection of the AED, clock time as running in the AED is not available for subsequent protocollized CPR duration, rhythm check and shock. We hypothesize that defibrillation shocks are delayed and CPR interrupted without reason after AED disconnection.
Methods: This was a prospective observational community study in an area of 2.6 million inhabitants. During 16 months, all available continuous ECG recordings of AEDs and associated manual defibrillator (mDFB) recordings of out-of-hospital cardiac arrests were collected. All clock times were synchronized. We observed CPR time through the impedance signal. For shockable rhythms, we measured the duration of CPR given between the connection time of the mDFB and expected time of defibrillation of the AED. For non shockable rhythms, the expected moment of AED rhythm analysis was the endpoint of the time interval. Time available for CPR given during that time interval was set at 100%. Delay in defibrillation was the difference between expected moment of the next shock as advised by the AED and the actual shock given by paramedics.

Results: Results are shown in table 1

. Of the 245 cases, 73 cases had a shockable rhythm during take over, 141 a non-shockable rhythm and 31 patients had Return of Spontaneous Circulation. A shock was delivered too early or too late in 68 of 73 patients. Four patients were never defibrillated.

Conclusion: Disconnection of the AED by professionals interrupts the treatment protocol of the AED, delaying time of defibrillation by almost two minutes. Premature defibrillation leads to decrease in CPR time. The optimal moment of disconnecting the AED should be described in new guidelines.

Table 1:

Shock delay and CPR interruption, devided in shockable and non shockable rhythms