bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 3775: Average Blood Glucose and Mortality in Patients Hospitalized with Acute Myocardial Infarction
Authors: Kosiborod Mikhail , Inzucchi Silvio , Krumholz Harlan M , Xiao Lan , Jones Phillip G , Fiske Suzanne , Masoudi Frederick A , Marso Steven P , Spertus John A 
Published: July 2021

Background: Elevated blood glucose (BG) on admission is associated with higher mortality risk in patients (pts) hospitalized with AMI. However, the prognostic value of average BG, which reflects overall glycemic exposure much better than admission BG, is unknown. Furthermore, the nature of the relationship between average BG and mortality has not been determined.
Methods: We evaluated a cohort of 16,871 AMI pts hospitalized from January 2000-December 2005, using Cerner Corporation’s Health Facts® database from 40 hospitals, which contains demographics, clinical and comprehensive laboratory data. Logistic regression models evaluated the nature of the relationship between mean BG during the entire AMI hospitalization and in-hospital mortality, after adjusting for multiple patient factors and confounders. Similar analyses were performed in subgroups of pts with and without diabetes (DM).

Results: A J-shaped relationship was observed between mean BG and in-hospital mortality, which persisted after multivariable adjustment (Figure

). Mortality increased with each 10 mg/dL incremental rise in mean BG over >120 mg/dL, and with incremental decline in mean BG <80 mg/dL. The slope of these relationships was much steeper in pts without DM.

Conclusions: Average BG during the entire AMI hospitalization is a powerful independent predictor of in-hospital mortality. Both persistent hyper- and hypoglycemia are associated with adverse prognosis. Whether strategies directed at optimizing BG control will improve survival remains to be established.

Association Between Mean BG and In-Hospital Mortality After Multivariable Adjustment (Reference: Mean BG 100 to <110)
Abstract 25: Effect of Thrombolytics on the Immediate Prognosis for Out-of-Hospital Cardiac Arrest
Authors: Renard Aurelien , Jost Daniel , Verret Catherine , Briche Frederique , Fontaine David , Banville Isabelle L , Martin Anne-Celine , Val-de-Grâce Ecole du , Benner Patrick , Spiegel Andre , Fuilla Claude 
Published: July 2021

Immediate care of out-of-hospital cardiac arrest (CA) is standardized by the established ILCOR ACLS Guidelines. Studies concerning the impact of thrombolysis, generally for CA of cardiac etiology have not shown a benefit. We sought to evaluate the rate of hospital admission for all CA patients treated with pre-hospital thrombolytics.
Methods: Non-randomized retrospective study was conducted from 09/1/2005 to 02/15/2007 of non-traumatic CA patients treated with (T+) or without (T-) thrombolysis. The protocol for administration of thrombolytics was at the discretion of the field physician, aiming for within 20 minutes of collapse in almost all cases, and prior to return of spontaneous circulation. The primary endpoint was admission alive to the hospital. We performed multivariate analysis by logistic regression to identify risk factors independently associated with outcome: age, gender, response time, defibrillation, witnessed arrest, bystander CPR.
Results: We reviewed 1331 consecutive patient records, of which 116 (8.7%) received thrombolytics. Both T+ and T- groups had comparable response times, witnessed arrest, and bystander CPR. Patients in T+ were significantly younger (59±14 vs 67±19 years old), predominantly males (81% vs 61%), and received more defibrillation shocks (61% vs 26 %). Significantly more patients T+ arrived alive to hospital for admission (45% vs 24%). Risk factors independently associated with hospital admissions were thrombolysis, age, response time, witnessed arrest, and bystander CPR. The impact of thrombolysis was different whether or not the patient was defibrillated (odds ratio with shocks 1.1 [95%CI: 0.2–5.0] vs without shocks 3.6 [95%CI: 1.9 – 6.9]), despite a greater overall rate of hospital admission for shocked patients.
Conclusion: Thrombolysis appears to improve the rate of admission alive to the hospital in patients that were not defibrillated with adjustment for age, gender, response time, witnessed arrest, and bystander CPR. These preliminary results should be confirmed by a prospective randomized study. This analysis can help determine appropriate inclusion criteria for a future study.
Abstract 45: A Mathematical Model of Ventilation, Perfusion, and Oxygenation in Low-Flow States
Authors: Davis Daniel P , Davis Paul W 
Published: July 2021

Background: Recent investigations underscore the critical importance of ventilation strategies on resuscitation outcomes. In low perfusion states, such as cardiac arrest and traumatic shock, the rise in intrathoracic pressure that accompanies positive-pressure ventilation (PPV) can significantly impede venous return and lead to a decrease in cardiac output. The optimal ventilation strategy in these “low-flow” states remains unclear.
Objectives: To create a mathematical model of perfusion and oxygenation to predict the effects of PPV with both normotension and hypotension.
Methods: The lung pressure-volume relationship was modeled using a novel formula allowing manipulation of various lung characteristics, including vital capacity, compliance, and the upper and lower inflection points. A separate formula was then derived to predict mean intrathoracic pressure for a given minute ventilation using the pressure-volume formula. The addition of positive end-expiratory pressure was also modeled. Finally, a formula was derived to model oxygen absorbance as a function of alveolar surface area and flow based on ventilation rate and mean intrathoracic pressure.
Results: Mathematical models of the lung pressure-volume relationship, mean intrathoracic pressure, and absorbance were successfully derived. Manipulation of vital capacity, compliance, upper and lower inflection points, positive end-expiratory pressure, and minute ventilation allowed prediction of optimal ventilation rate and tidal volume for a normal and an ARDS lung. For a normal lung, optimal values for both mean intrathoracic pressure and absorption were achieved with a ventilation rate of 4 breaths/min. A decrease in the upper inflection point or increase in minute ventilation resulted in faster optimal ventilation rates, although none exceeded 14 breaths/min.
Conclusions: A mathematical model of ventilation was successfully created allowing manipulation of multiple variables related to lung compliance and ventilation strategy. This model suggests the use of lower ventilation rates with larger tidal volumes to minimize the hemodynamic effects of PPV and maximize oxygen absorbance.
Abstract 48: Reduction of Histological Damage with Mild Therapeutic Hypothermia after Prolonged Cardiac Arrest
Authors: Springler Gregor , Janata Andreas , Weihs Wolfgang , Bayegan Keywan , Schratter Alexandra , Robak Oliver , Holzer Michael , Frossard Martin , Behringer Wilhelm , Schock Robert B , Coté Marc , Freedman Robert J , Losert Udo M , Schmidt Peter , Laggner Anton N , Sterz Fritz 
Published: July 2021

Purpose: The aim of our study was to assess the effect of hypothermia on histological damage in 19 brain regions after prolonged cardiac arrest in pigs.
Methods: Pigs were anaesthetized and mechanically ventilated. After stabilisation of pulmonary artery temperature (Tpa) at 38.5±0.2 °C, ventricular fibrillation (VF) was induced and 10 min of untreated VF were followed by 8 min of cardiopulmonary resuscitation (mechanical chest compressions, two doses of vasopressin 0.4 IE/kg). At 8 min of CPR, up to 3 countershocks were delivered. Pigs that had return of spontaneous circulation (ROSC) were randomized to one of 2 groups (control, hypothermia). Pigs in the hypothermia group were cooled to Tpa 33.0±1.0 °C with a surface cooling device (LRS Thermosuit™) circulating ice water over most of the skin surface. Pigs in the control group were kept at 38.5±1.0 °C throughout the experiment. After 14 hours of hypothermia, pigs were rewarmed, weaned and brought to the stable. At day 9 of the experiment, final neurologic examination was performed. After that the animals were sacrificed and perfused with 4 liters of saline, followed by 1 liter of paraformaldehyde (3%, pH 7.4). The brain was removed and 19 different regions of the brain were examined by means of lightmicroscopy using a histopathologic damage score that was used in previous studies. Following damage qualities were considered: edema, eosinophilic necrosis (oncosis), vacuolar degeneration and malacia. The total numeric histological damage score (HDS) was the sum of all area scores. Data are presented as median and interquartile range, group comparison was done with a Mann-Whitney-U test.
Results: 16 (29 –35 kg) pigs were randomized. The time to reach target temperature in the hypothermia group (n = 8) was 9.0 (5.3; 11.9) min. Total HDS in the hypothermia group was 71 (61; 84), in the control group 132 (124; 174; p<0.001). Significant (p<0.05) improvements in damage were found in hippocampus, temporal, parietal, frontal and occipital cortex.
Conclusions: Histological damage after prolonged cardiac arrest was improved significantly in cooled animals compared to control animals. Not all brain regions could benefit to the same extent.
Abstract 69: Evaluation Of Abdominal Blood Flow During Chest Compression In Cardiac Arrest Patients Using Enhanced Computed Tomography (CT)
Authors: Oode Yasumasa , Shimizu Kentarou , Matsushima Asako , Kajino Kentarou , Nakagawa Yuukou , Tasaki Osamu , Shiozaki Tadahiko , Ogura Hiroshi , Kuwagata Yasuyuki , Tanaka Hiroshi , Shimazu Takeshi , Sugimoto Hisashi 
Published: July 2021

Background: The mechanism of blood flow during chest compression in cardiac arrest patients remains under investigation. We often experience that cardiac arrest patients suffer severe diarrhea after successful cardiopulmonary resuscitation(CPR), which would be attributable to intestinal ischaemia during cardiac arrest and resuscitation. However, few studies have been made to evaluate abdominal blood flow during chest compression in cardiac arrest patients.
Patients and Methods: The study was made in four patients immediately after termination of cardiopulmonary resuscitation. A 100ml bolus of 300 mgI/ml contrast medium was injected from a short femoral vein catheter, followed by continuous chest compression at a rate 100/min. In order to evaluate the distribution of contrast medium, CT images of the chest and abdomen were taken after 100 and/or 200 chest compressions, respectively.
Results: CT scans showed similar enhance patterns in the patients. After 100 chest compressions, enhancement values were higher at inferior vena cava(IVC) regions compared to ascending aorta and main arteries. After 200 compressions, enhancement values of the arteries were increased by two to four times. However, significant enhancement of hepatic veins and limited enhancement of portal veins suggest impaired perfusion of the liver and the bowel.
Conclusion: One hundred or 200 chest consecutive compressions are not sufficient to enhance abdominal organs including the liver and bowel.

Figures:

Typical MPR(Multiplanar reconstruction) images after 100compressions at two different coronal planes; hepatic vein and IVC(left), portal veins(right) are depicted.
Abstract 5818: Stress Thallium-201/Rest Tc-99m Sequential Dual Isotope High-Speed Myocardial Perfusion Imaging
Authors: Berman Daniel S , Hayes Sean W , Wolak Arik , Kang Xingping , Thomson Louise E , Kite Faith , Cohen Ishac , Slomka Piotr J , Friedman John D 
Published: July 2021

Recent advances in gamma camera technology are providing opportunities for novel high-speed myocardial perfusion imaging (HS-MPI) protocols. We aimed to develop and evaluate a stress thallium-201 (Tl-201) and rest Tc-99m sestamibi or tetrofosmin imaging protocol that could reduce imaging time and radiation burden.
Methods: We studied 410 consecutive patients undergoing exercise or pharmacologic low-dose stress Tl-201 HS-MPI (4 min/acquisition) in the semi-upright and supine positions (D-SPECT, Spectrum-Dynamics) followed by rest Tc-99m sestamibi (n= 139) or tetrofosmin (n= 271) with immediate post-injection rest imaging. Of 330 patients with no known coronary artery disease (CAD), 29 patients also underwent invasive coronary angiography (ICA) or coronary computed tomography angiography (CCTA) within a three month period and 36 had a < 5% pre-test likelihood of CAD (LLk). Despite low injected doses [Tl-201 (2.2± 0.3 mCi) and Tc-99m sestamibi or tetrofosmin (8.9± 2.4 mCi), the 3 acquisition MPI protocol (2 stress/1 rest) was accomplished < 20 minutes. The quality of stress and resting image was good to excellent in >96% of cases; importantly, no or minor extracardiac activity was seen on 99% of stress and 93% of rest images. HS-MPI was nondiagnostic or uninterpretable in only 2/410 patients. In the 29 patients with CCTA or ICA, the sensitivity and specificity for the detection of ≥70% stenosis were 73% and 89%, respectively, and in 15 patients with ICA, the sensitivity was 89%. The normalcy rate in the LLk group was 100%. A fast stress Tl-201/rest Tc-99m HS-MPI protocol offers promise as a time-efficient, low radiation dose method, in which the superior qualities of Tl-201 for stress imaging and of Tc-99m agents for rest imaging can be utilized.
Abstract 5865: High-density Lipoproteins (HDL) Are Present In Stenotic Aortic Valves And May Protect Them Against Calcification
Authors: Lommi Jaakko I , Kovanen Petri T , Lee-Rueckert Miriam , Kupari Markku , Helske Satu 
Published: July 2021

Purpose: The pathogenesis of aortic valve stenosis (AS) is characterized by accumulation of low-density lipoprotein (LDL) cholesterol and inflammatory cells in aortic valves, as well as by marked calcification and bone formation in the affected leaflets. Hitherto, the factors which inhibit aortic valve calcification have remained obscure. We aimed to determine, whether HDL cholesterol particles enter aortic valve leaflets and whether HDL could protect the valves from cholesterol accumulation and calcification.
Methods: Stenotic aortic valves were obtained from 10 AS patients undergoing valve replacement surgery. Non-stenotic control valves (n=10) were collected from cardiac transplantations. The amount and localization of HDL/apolipoprotein (apo) A-I, apoB, apoE, and osteoprotegerin (OPG) were analyzed by immunohistochemistry and computer-assisted morphometry. Myofibroblasts were isolated from aortic valves and their secretion of calcific mediators in response to HDL-stimulation was studied by real-time PCR and ELISA.
Results: Accumulation of HDL/apoA-I was detected in both control and stenotic aortic valves. HDL was detected particularly around calcific deposits in the stenotic valves, in which it was colocalized with apoB and apoE, as well as with OPG. Stimulation of cultured aortic valve myofibroblasts with HDL or apoA-I significantly increased secretion of OPG by these cells (p>0.001), whereas the secretion of RANKL, which counteracts the effects of OPG, remained unchanged.
Conclusions: HDL is present locally in human stenotic aortic valves and induces secretion of OPG in valvular cells in vitro. Since OPG is known to inhibit aortic valve calcification, this mechanism may provide HDL a protective role in AS.
Abstract 6072: Waitlist Mortality for Infants Awaiting Heart Transplantation in the United States in the Current Era: Analysis of Data from the United Network for Organ Sharing
Authors: Mah Doug , Singh Tajinder , Thiagarajan Ravi R , Gauvreau Kimberlee , Piercey Gary E , Fynn-Thompson Francis , Almond Christopher S 
Published: July 2021

BACKGROUND UNOS (United Network for Organ Sharing) data suggest that of all pediatric transplant candidates, infants awaiting heart transplantation face the highest waitlist mortality. We sought to determine the mortality rate for waitlisted infants in the current era and to identify the risk factors associated with waitlist mortality.
METHODS In this multi-center cohort study using the US Scientific Registry of Transplant Recipients, we analyzed all infants <12 months of age listed for first heart transplant between January 1999 and July 2006. Clinical and demographic characteristics were recorded at the time of listing. Multivariate logistic regression modeling was used to identify predictors of waitlist mortality.
RESULTS In this six year period, 1133 patients less than 12 months of age were identified with a median age of 1 month (IQR 0 to 5 mo) and median weight of 4.0 kg (IQR 3.2 to 5.6 kg). 516 (45%) were female, 438 (39%) were non-white, 724 (64%) had congenital heart disease (CHD) and 910 (80%) were listed status 1A. Overall, 250 (22%) died while waiting including 179 (72%) listed at age <3 mo, 190 (76%) with CHD, 89 (35%) listed on mechanical ventilation, and 68 (27%) on ECMO. In multivariate analysis, risk factors for waitlist mortality (reported as hazard ratio, 95% CI) included age <3 months (1.5, 1.1–2.0), CHD (2.0, 1.5–2.7), ventilator support (2.0, 1.5–2.7), ECMO support (5.0, 3.6 –7.0) and non-white race (1.7, 1.4 –2.2).
CONCLUSION Mortality of infants waiting for heart transplantation remains high with a 22% waitlist mortality in the current era. ECMO support, ventilator support, CHD, age less than 3 months, and non-white race were independently associated with waitlist mortality whereas listing status was not. Measures to improve donor availability for this age group and refinements in organ allocation to lower waitlist mortality are urgently needed.
Abstract 3176: Differerential Impact Of Acute Myocardial Risk Factors And Chronic Comorbidities On Use Of Guideline-recommended Therapies In Patients Presenting With Acute Coronary Syndromes
Authors: Joynt Karen E , Huynh Luan , Amarena John , Brieger David , Coverdale Steven , Rankin Jamie , Soman Ashish , Chew Derek P 
Published: July 2021

Background: Prior investigations show that patients presenting with ACS with high-risk features are less likely to receive evidence-based therapies (EBT). Current risk stratification tools combine acute and chronic risk factors (RF); these may contribute differently to receipt of proven therapies.
Methods: Using data from a prospective audit of 2600 patients in Australia, the impact of acute myocardial RF (biomarker elevation, ECG changes, cardiac arrest, Killip class ≥ 2), chronic co-morbid RF (prior CHF, chronic lung disease, malignancy, prior CVA, GFR < 60, age > 75), and traditional RF on patient management were examined using logistic regression.

Results: the best predictor of receipt of EBT was the number of myocardial RF; the best predictor of a low likelihood of receipt was the number of co-morbid RF (Table

). The presence of three or more myocardial RF conferred an OR of 2.21 for receiving clopidogrel and 4.3 for undergoing angiography, while the presence of four or more co-morbid RF lowered the OR to 0.47 for clopidogrel and 0.09 for angiography (Figure 1a

/b

).

Conclusions: High-risk patients may be less likely to receive EBT than low-risk patients, but this is driven by comorbid conditions rather than markers of severity of illness. Research is needed to validate these therapies in high-risk patients, and ongoing efforts at quality improvement should focus on high-risk populations.

Figure 1a.

Odds of receiving clopidogrel during hospitalization

Figure 1b.

Odds of receiving angiography during hospitalization

Application of management recommendations within 24 hours of admission and at discharge, adjusted for cardiovascular risk factors and prior coronary artery bypass grafting.
Abstract 5020: The Association between Different Measures of Blood Pressure and Coronary Artery Calcium in Postmenopausal Women
Authors: Allison Matthew A , Manson JoAnn , Langer Robert , Aragaki Aaron , Smoller Sylvia , Lewis Cora , Thomas Asha , Lawson William , Cochrane Barbara , Hsia Judith , Hunt Julie , Robinson Jennifer 
Published: July 2021

Background: The aim of this study was to determine the magnitude and significance of the associations between coronary artery calcium (CAC) and different measures of blood pressure among postmenopausal women.
Methods: Subjects were a subset of women aged 50 to 59 at baseline in the Women’s Health Initiative (WHI) clinical trial of conjugated equine estrogen (CEE) who underwent a one-time computed tomography (CT) scan of the chest following the end of the trial to determine CAC. At the baseline WHI clinic visit, CEE trial participants provided data on a wide range of factors to include blood pressure measurements which were measured twice with the participant in the seated position using a conventional mercury sphygmomanometer and appropriately sized cuffs.
Results: The sample consisted of 1,064 women with a mean age of 55.1 (2.8) years at WHI randomization and 64.8 (2.9) years at CAC ascertainment. The prevalence of a CAC score > 0 was 47%, while the prevalence of a CAC score >= 10 and > 100 was 39 and 19%, respectively. There was a linear association between the log-odds of any CAC and SBP while there was a curvilinear and inverse association with DBP that was independent of CVD risk factors and blood pressure medication status. For any value of diastolic blood pressure, the probability of CAC increased with higher levels of SBP. Conversely, for any given value of SBP, the probability of any CAC decreased with higher levels of DBP. Those with a PP >= 55 mmHg had nearly a two-fold higher odds for having any CAC (Odds Ratio: 1.95, 95% CI: 1.24 – 3.06) while individuals with isolated systolic hypertension (SBP >= 140 and DBP < 90) had a 73% higher odds for CAC (95% CI: 1.03 – 2.90, p = 0.04) independent of other risk factors and blood pressure medication status. There was no significant associations between mean arterial pressure and CAC.
Conclusions: In postmenopausal women over the age of 50 years, both SBP and DBP are relevant for determining the risk for coronary artery calcium. Notably, higher levels of pulse pressure and systolic blood pressure were strong determinants of CAC, while diastolic blood pressure was inversely related. Consequently, isolated systolic hypertension may be relevant in women. These results may be of clinical relevance for the prevention of coronary artery disease.
This research has received full or partial funding support from the American Heart Association, AHA National Center.