bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 5588: Paramedic Activated Cath Lab For STEMI Patients At Community Hospital Meets EMS Arrival-to-Intervention Guidelines With Low False-Positive Activation Rate
Authors: Vartanian Levon , Avendano Amilcar , Grieco Gustavo , Bober Steve , Bissell Catherine , Traynor Kevin , Kirk Terry , Egan Pam , Deloza Javier , Robbins Nick , Hicks Loretta , Shanks Molly 
Published: July 2021

Background: Recent ACC/AHA STEMI guidelines state “STEMI patients presenting to a hospital with PCI capability should be treated with primary PCI within 90 minutes of first medical contact.” To address this Houston Northwest Medical Center developed a STEMI protocol in 2006 with Cypress Creek EMS, its primary paramedic service, initially to decrease hospital door-to-intervention (DTI) times. System evaluation post implementation indicated that EMS arrival-to-intervention (ETI) times better reflect overall combined performance. ETI is defined as time of EMS arrival on scene to reperfusion treatment. The purpose of this study is to see if a paramedic activated cath lab for STEMI patients met guideline recommendations while maintaining a low false-positive activation rate.
Methods: The initial protocol planning team determined greatest DTI reduction could be achieved through transfer of authority for cath lab activation to field paramedics. After obtaining a 12-lead ECG, paramedics notify the emergency department of a possible STEMI and the cath lab team is activated. Upon arrival, the emergency department physician obtains the ECG for interpretation and upon STEMI confirmation, the patient bypasses the emergency department and is transported directly to the cath lab. Data for protocol development was collected from a historical control group using retrospective chart review. Since protocol initiation in June 2006, ETI data is collected prospectively.
Results: Between June 2006 and December 2007, 113 patients were transported utilizing the STEMI protocol. Mean hospital DTI time decreased from 121 minutes (control group) to 53 minutes (p<0.01, two-tailed t-Test). Mean ETI time is 87 minutes; Historical ETI data was not collected. 15 (13.3%) false-positive STEMI activations occurred in the study period. Diagnostic accuracy was confirmed angiographically. Mortality rate comparison did not meet statistical significance - 5.4% historical, 5.3% protocol.
Conclusions: A paramedic activated cath lab for STEMI decreased DTI and ETI times to meet current guidelines. STEMI diagnostic accuracy was maintained with a low false-positive activation rate. Mortality data is insufficient for statistical significance.
Abstract 5752: Epicardial Fat Assessed by Multi-Detector Computed Tomography (mdct) is a New Risk Factor of Coronary Artery Disease in Non-Obese Patients
Authors: Iwayama Tadateru , Nitobe Joji , Ishino Mitsunori , Tamura Harutoshi , Shishido Tetsurou , Nishiyama Satoshi , Miyashita Takehiko , Miyamoto Takuya , Watanabe Tetsu , Kubota Isao 
Published: July 2021

Objective: An increment of abdominal visceral fat has been reported to be a coronary risk factor associated with metabolic syndrome. However, adipose tissue surrounding heart has not been fully determined as coronary risk factors. Accurate volumetric measurement of epicardial fat can be easily obtained by MDCT. We examined the relationship between epicardial fat volume and clinical parameters in patients with coronary artery disease (CAD).
Method: We evaluated epicardial fat volume by 64 detector row CT scanner in CAD patients (obese, 13; non-obese, 11 patients) who underwent elective coronary artery bypass graft surgery and in non-CAD patients who showed normal coronary arteries on angiography (obese, 3; non-obese, 11 patients). Epicardial fat volume was obtained as the sum of fat areas on short axis images. Obese patients were defined as over 25 in body mass index (BMI).
Result: Epicardial fat volume was significantly higher in patients with CAD than in those without CAD (40.6 ± 14.7 ml vs. 20.0 ± 14.7 ml, p < 0.05). Epicardial fat volume was not correlated to following coronary risk factors such as HbA1c, fasting plasma glucose, lipid and blood pressure except for BMI. Although there was no difference epicardial fat volume between in obese patients with CAD and in those without CAD (48.3 ± 27.9 ml vs. 41.2 ± 11.0 ml, NS), it was significantly higher in non-obese patients with CAD than in those without CAD (32.1 ± 9.2 ml vs. 14.2 ± 9.2 ml, p < 0.05).
Conclusions: The quantity of epicardial fat using MDCT is related with the presence of CAD. Especially in non-obese patients, epicardial fat may affect directly progression of CAD independent of pathophysiological process of metabolic syndrome.
Abstract P047: Improved Clinical Outcomes Associated with Dual-Goal (HbA1c and LDL-C) Achievement in Newly Diagnosed Type 2 Diabetes Mellitus
Authors: Shi Lizheng , Ye Xin , Lu Mei , Wu Eric Q , Sharma Hari , Thomason Darren , Kang Amiee L , Fonseca Vivian A 
Published: July 2021

Background:
Compared with studies on achieving a single goal of either glycated hemoglobin (HbA1c) or low-density lipoprotein cholesterol (LDL-C) in type 2 diabetes mellitus (T2DM), the clinical benefits of dual-goal achievement (LDL-C<100 mg/dl and HbA1c<7%) are not well documented. This study investigated factors and clinical benefits associated with dual-goal achievement in newly diagnosed T2DM patients.

Methods:
Newly diagnosed adult T2DM patients with ≥2 measures of LDL-C and HbA1c were identified in the Veterans Integrated Services Network 16 data warehouse (01/2004-06/2010).

A logistic regression model was used to identify factors associated with dual-goal achievement during 7-12 months following the index date (first HbA1c recorded within three months of the first T2DM diagnosis). Factors included demographics and 0-6 month dual-goal achievement, as well as diabetes-related comorbidities, medications, surgeries, and healthcare utilization, all measured during the 1-year period surrounding the index date.
Multivariate Cox proportional hazards models were used to assess the association between time-varying goal achievement status and post-index date clinical outcomes, including microvascular complications (retinopathy, nephropathy, and neuropathy), cardiovascular-related complications (cardiovascular death, stroke, or myocardial infarction) and acute coronary syndromes (ACS).

Results:
A total of 16,829 T2DM patients were included in the study. Factors associated with an increased likelihood of dual-goal achievement include older age, higher Charlson Comorbidity Index (CCI), prior dual-goal achievement, diagnosis of ketoacidosis or hypersmolarity, and lipid-lowering drug use. Conversely, patients with prior diagnoses of retinopathy, neuropathy, and congestive heart failure, as well as prior insulin use were less likely to achieve both goals.

Compared with failure to achieve either goal, achieving only LDL-C goal was associated with a lower risk of cardiovascular-related complications (HR:0.76; 95% CI:0.71-0.81) and ACS (HR:0.76; 95% CI:0.67-0.86), while achieving only HbA1C goal was associated with a lower risk of microvascular complications (HR:0.73; 95% CI:0.71-0.74), cardiovascular-related complications (HR:0.80; 95% CI:0.74-0.87) and ACS (HR:0.66; 95% CI:0.60-0.72). Dual-goal achievement was associated with additional reduction in risk of microvascular complications (HR: 0.69; 95% CI: 0.63-0.76) vs. only LDL-C goal achievement, but had similar risk to achieving HbA1c goal alone.

Conclusions:
Older age, higher CCI, prior dual-goal achievement, and lipid-lowering drug use were associated with a greater likelihood of dual-goal achievement. Dual-goal achievement in newly diagnosed T2DM patients is associated with decreased risks of microvascular complications than those with only LDL-C goal achievement.
Abstract P303: Association of Overweight/Obesity and Self Reported Health Status in Hispanics: A Comparison with Non Hispanic Whites
Authors: Ingram Connie , Canossa-Terris Maria , Comerford Mary , Kurlansky Paul 
Published: July 2021

Introduction
The growing global prevalence of obesity is recognized as an important risk for cardiovascular disease. Understanding self perception of weight as it pertains to health is critical to the success of weight reduction programs. The impact of ethnicity on this association has not been examined.

Methods
The sample included 927 Hispanic (H) and 72 Non-Hispanics white (NHW) adults who received free cardiovascular screening from Florida Heart Research Institute. Overweight and obesity were measured by Body Mass Index. Self-perceived health status was characterized as excellent, very good, good, fair or poor health. Logistic regression was used to determine independent risk factors for perceived fair-poor health, as well as for excellent, very good health. Odds ratios and 95% Confidence Intervals were calculated.

Results
Both H and NHW overweight/obese subjects tended to view their health as good, very good or excellent: H (overweight 81.1%/obese 73%) and NHW (89.3%/66.7%). Logistic regression revealed the following independent correlates of self-perceived very good or excellent health: NHW (OR 3.618, CI 2.126, 6.157, p<0.001) and exercise (OR 1.640;CI 1.186, 2.268; p=0.003). Hypertension (OR 0.392; CI 0.246, 0.625; p<0.001), overweight (OR 0.551, CI0.386, 0.785, p=0.001) and obesity (OR 0.431, CI 0.288, 0.644; p<0.001) were all negatively associated with very good/excellent status.

Conclusions
Although it is not surprising that participation in regular exercise is associated with a better self-perception of health status, or that hypertension and obesity is correlated with a worse self-assessed health status, there are two striking findings that emerge from this data:

1. The vast majority of both H and NHW subjects do not perceive either overweight or obesity to be a major health problem.
2. Hispanics have a significantly worse self-perception of health status even after controlling for associated factors.This information provides a critical foundation for overcoming fundamental barriers to effective patient education_a critical first step in addressing the current epidemic of obesity in ethnically diverse populations.
Abstract P434: The Relationship Between Level of Glycemic Control and First Manifestation of Coronary Artery Disease (CAD) Differs by Sex in Type 1 Diabetes (T1D)
Authors: Miller Rachel G , Costacou Tina , Orchard Trevor J 
Published: July 2021

The nature of the association between glycemic control and CAD in T1D is unclear. The Pittsburgh Epidemiology of Diabetes Complications (EDC) study of childhood-onset T1D has not demonstrated a consistent relationship between glycemic control and incidence of CAD, with neither baseline HbA1c nor average HbA1c over follow-up reliably predicting CAD. However, it is possible that glycemic control may influence the type of first CAD event observed. As CAD often manifests differently in men and women, our objective was to examine whether the manifestation of CAD differs by glycemic control up to the time of the CAD event separately by sex.
Data are from 604 (304 men, 300 women) participants in the Pittsburgh EDC Study of childhood-onset (<17 years old) type 1 diabetes without prevalent CAD at baseline and represent 20 years of follow-up for CAD incidence ascertainment. Participants were first assessed 1986-1989 (mean age, 28 and duration, 19 years), with 8 subsequent exams occurring approximately every 2 years thereafter. First CAD event was divided into 5 categories: fatal event/CAD death, nonfatal myocardial infarction (MI), revascularization/stenosis >=50%, ischemia (Minnesota codes 1.3, 4.1, 4.3, 5.1, 5.3, 7.1), or angina. The average HbA1c from baseline until CAD event or last follow-up for noncases was calculated (median # HbA1c measures=4); the median average HbA1c was 8.7%. This value was used as a cut point to divide the cohort into 2 groups: persons with HbA1c≥8.7% at all study visits prior to CAD incidence (80 men, 60 women) versus all others (224 men, 240 women).
In women, the 20-year incidence of CAD was 40% (n=24) and 24.6% (n=59) in the consistently high HbA1c group and all others, respectively (p=0.02). In men, CAD incidence was 38.8% (n=31) and 28.6% (n=64) in the high HbA1c group and all others, respectively (p=0.09). Of the CAD cases, nonfatal MI was a significantly more frequent first event in the consistently high HbA1c group compared to all others in both men (48.4% v 21.9%, p=0.009) and women (37.5% v 15.3%, p=0.04). Angina was a significantly less frequent first event in the consistently high HbA1c group in women (25% v 52.5% in all others, p=0.02), but no significant difference in angina incidence by HbA1c group was observed in men. Fatal CAD was a marginally more frequent first event in the high HbA1c group in women (16.7% v 3.4%, p=0.06), but did not differ by HbA1c in men. No differences for revascularization or ischemia as first events were seen by HbA1c group in either sex.
These results suggest that, in T1D, glycemic control may influence the manner of CAD manifestation, in particular nonfatal MI and angina, and that this effect may differ by sex. Particularly, there may be a need for more aggressive monitoring and treatment of CAD risk factors in women with high HbA1c, as they may be at higher risk of fatal events.
Abstract P438: Cardiovascular Health in Adolescents with Type 1 Diabetes: The SEARCH CVD Study
Authors: Alman Amy , Talton Jennifer , D'Agostino Ralph , Mayer-Davis Elizabeth , Dolan Lawrence , Urbina Elaine , Marcovina Santica , Wadwa R. Paul , Daniels Stephen , Hamman Richard , Dabelea Dana 
Published: July 2021

In 2010, the American Heart Association (AHA) identified national goals for ideal cardiovascular health (ICH). Type 1 diabetes (T1D) significantly increases the risk of cardiovascular disease (CVD), and adolescents with T1D are a group particularly relevant for focus on ICH. The purpose of this study was to examine the prevalence of ICH in a population of adolescents with T1D and to examine the association of ICH with measures of CV function [arterial stiffness (AS) measured using pulse-wave velocity (PWV), augmentation index (AIX) and brachial distensibility (BD)], and structure [carotid intima-media thickness (cIMT; bulb, common carotid (CC), and internal carotid (IC))].
We used data from the retrospective cohort component of the SEARCH CVD study, which followed youth with T1D for approximately 6 years. Data collected at baseline (mean age 15 years) include diet, smoking, physical activity, BMI, cholesterol, blood pressure, and fasting plasma glucose. Measures of PWV, AIX, BD, and cIMT were obtained at follow-up (mean age 20 years, diabetes duration 10 years). Complete data were available on 182 subjects. Multiple linear regression models were fit to examine the association between the Number of metrics that met the ICH goal (NICH; range 0 to 7) and the subclinical CVD outcomes.
The prevalence of the ICH metrics is shown in Table 1. Prevalence of ICH ranges from none meeting the healthy diet to nearly all being never smokers (88%). While most youth met 3 or 4 goals, only 5% met 5 and none met all 7 criteria. Increasing NICH at baseline was associated with lower AS [lower PWV (β= -0.02, p=0.035), higher BD (β= 0.03, p=0.042)] and lower cIMT of the CC (β= -0.02, p=0.023), adjusted for age, sex, race, hemoglobin A1c, triglycerides, and diabetes duration.
In conclusion, youth with T1D are not meeting ICH goals. Meeting more ICH goals was associated with better CV health as indicated by lower AS and cIMT thickness. Measures targeted at increasing ICH in adolescents with T1D are needed in order to reduce the burden of CVD in this high risk population.
Abstract P429: Parallel Processes of Sedentary Behavior and Cardiometabolic Risk Factors in Obese Adolescents
Authors: Carlson Jordan , Norman Gregory , Kolodziejczyk Julia , Patrick Kevin 
Published: July 2021

Introduction:
Sedentary time has been negatively associated with cardiometabolic health in adults. These associations are less clear in youth, may differ by sedentary measurement method, and rarely have been investigated longitudinally.

Hypothesis:
Greater accelerometer measured sedentary time and reported screen time will be associated with poorer status on cardiometabolic risk factors at baseline and longitudinally.

Methods:
Obese (BMI ≥ 95th percentile for age and gender) 11-13 year olds were enrolled in a primary care weight loss trial. Half were girls and 82% were Hispanic. Of the 106 participants enrolled, 73 completed baseline and 12-month assessments. Assessments occurred in the clinic and included a fasting blood draw. Table 1 lists the risk factor variables.

The first dependent variable was reported screen time (television and computer/video games). The second was total sedentary time, calculated from waist-worn Actigraph accelerometers as percent of wear time with counts < 100 per 60-second epoch.
Mplus software was used to fit latent growth parallel processes models, with the intercept of the biomarker regressed on the sedentary time intercept (cross-sectional association), and the slope of the biomarker regressed on the sedentary time slope (longitudinal association). Models were adjusted for potential confounders. Full information maximum likelihood estimation was used to account for missing data.

Results:
Participants reported 3.2 (SD = 2.0) screen time hours. Associations between screen time and risk factors are presented in Table 1.

Total sedentary time (M = 61±11% of wear time) was positively associated with BMI (β = .22; p < .05) at baseline but not with other risk factors. Total sedentary time was not associated with risk factors longitudinally.

Conclusion:
Changes in screen time but not total sedentary time were associated with cardiometabolic risk factors, specifically BMI, blood glucose, LDL, AST, and ALT. Associations were independent of physical activity and psychosocial diet variables.
Abstract 11423: Mitochondrial Calcium Flux Modulates Pacemaker Activity in Mouse Stem Cell Derived Cardiomyocytes
Authors: Xie An , Zhou Anyu , Liu Hong , Shi Guangbin , Boheler Kenneth R , Dudley Samuel C 
Published: July 2021

INTRODUCTION:
Ca2+ release from sarcoplasmic reticulum (SR) is known to contribute to the pacemaker activity in embryonic stem cells (ESC) derived cardiomyocytes (CMs). Mitochondria are known to participate in Ca2+ cycling. Nevertheless, the role of mitochondria in pacemaker activity is unclear. We studied the role of mitochondrial Ca2+ flux in spontaneously activity of ESC derived CMs.

METHODS:
CMs were derived from Wt and ryanodine receptor type 2 knockout (RYR2-/-) mouse ESC. Action potentials (APs) were recorded by perforated whole-cell current-clamp. Cytoplasmic and mitochondrial Ca2+ transients were determined by Fluo-4 and Rhod-2 respectively. Mitochondrial Ca2+ uniporter (MCU) siRNA was used. The mRNA level was evaluated by qPCR.

RESULTS:
As predicted, SR Ca2+ handling inhibitors, 10 μM ryanodine and 2 μM 2-APB, reduced spontaneous beating rate to 56% and 73% respectively in Wt CMs. Inhibition of mitochondrial Ca2+ flux by 10 μM Ru360 showed a similar inhibition effect on the pacemaker activity as 2 μM 2-APB in Wt CMs.

To isolate the mitochondrial component, we used RYR2-/- CMs. In these cells, MCU inhibition by pharmacological or molecular biological means reduced beating rate. The MCU mRNA decreased by 96% after MCU siRNA silence 72 hrs (p<0.01). AP and mitochondrial Ca2+ transient synchronous recording revealed that the reduction of spontaneous beating rate accompanied with the depressed mitochondrial Ca2+ uptaking and releasing.
In RyR2-/- CMs, 2 μM 2-APB could significantly lower the spontaneous beating rate. While 2 μM 2-APB was applied to MCU silenced RyR2-/- CMs, the beating rate couldn’t be slowed down further. This indicated IP3 receptors reduced spontaneous beating rate via MCU. Thapsigargin could substantially slow down beating rate like 2-APB. Caffeine depletion experiments showed other ryanodine receptor subtypes didn’t contribute Ca2+ release in RyR2-/- CMs. A L-type Ca2+ channel block, 10 μM nifedipine, couldn’t reduce beating frequency. This indicated spontaneous beating rate is Ca2+ influx independent in RyR2-/- CMs.

CONCLUSIONS:
Mitochondrial Ca2+ handling plays an important role in decreasing spontaneous beating rate. IP3R reduced spontaneous beating rate through MCU.
Abstract 12150: Dronedarone is a Potent Cardiac and Hepatic CPT-1 Inhibitor
Authors: Chong Cher-Rin , Licari Giovanni , Westley Ian , Horowitz John D , Sallustio Benedetta C 
Published: July 2021

Purpose:
Dronedarone was developed on the basis that it would represent a class III anti-arrhythmic devoid of “amiodarone-like” adverse effects. Indeed, photosensitization and iodine-related thyroid toxicity do not occur with dronedarone. However, a number of other adverse effects have emerged. We tested the hypothesis that, like amiodarone, dronedarone modifies cellular metabolism by inhibiting mitochondrial fatty acid uptake via the carnitine shuttle.

Methods:
We compared the efficacy of dronedarone as an inhibitor of cardiac and hepatic carnitine palmitoyl transferase-1 (CPT-1) with that of the known CPT-1 inhibitors perhexiline and amiodarone. Male 6-week old Sprague-Dawley rats were euthanized under 2% isoflurane. Hearts and livers were rapidly removed, homogenised and placed on ice. CPT-1 activity was measured by the formation of palmitoyl-carnitine, as previously described1. Samples were ultracentrifuged and supernatants were injected for detection by liquid-chromatography/mass-spectometry. Dronedarone (5, 10, 50, 100 and 500μM) was compared to amiodarone (100, 200 and 500μM), perhexiline (20, 50, 100, 150 and 200μM), and the physiological inhibitor of CPT-1, malonyl-CoA (1μM). Concentration-response curves were expressed via log(inhibitor) vs normalized responses.

Results:
(1) Malonyl-CoA inhibited CPT-1 by >90% in both heart and liver, while perhexiline was more potent than amiodarone as CPT-1 inhibitor (Table). (2) Dronedarone was equipotent (IC50 approximately 40μM) in both heart and liver, and approximately 3-fold more potent than amiodarone.

Conclusion:
Dronedarone, like amiodarone and perhexiline, inhibits cardiac and hepatic CPT-1. This has potential advantages regarding haemodynamic stability in atrial fibrillation, but may predispose to eventual hepato- and cardiotoxic effects.

Ref:
1. Kennedy JA, Unger S, Horowitz JD. Biochem Pharmacology 1996, 52, p273-280.