bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 184: Acre ST-Segment Elevation Myocardial Infarction (STEMI) Registry (ASTEMIR): Interval Times Since Symptoms and Reperfusion Success
Authors: Timerman Sergio , Gonzalez Maria Margarita Castro , Neves Sebastiao V , Ramires Jose A , Holanda Rejane M S , Kalil Filho Roberto 
Published: April 2024

Proposal: STEMI treatment and its impact on outcomes are highly dependent on time since symptoms onset. We aimed to evaluate the time intervals between symptoms onset, emergency unit admission, electrocardiogram (EKG) and treatment or transfer to treatment thrombolytic therapy(TT) capable unit and their relation to reperfusion success in the public health system (SUS) of ACRE, Rio Branco, Brazil.
Method: The ASTEMIR(Jan 2010-Dec 2011) is the first Brazilian prospective TT registry to include community-based emergency units and general hospitals patients, with a more reliable record of the AMI care reality. It included consecutive STEMI admitted to 3 general hospitals and 8 community-based emergency units.
Results: 189 patients (61±12y, 54% males), with high prevalence of hypertension (71%), diabetes (33%) and previous AMI (13%). On admission, 81% had typical chest pain and 37% Killip class≥II. Half of the patients received TT with tenecteplase (median ambulance--to-needle 104min, IQR 87-207) or door-to-needle 289min, IQR 234-437 reperfusion. The general pain-to-admission time was 155min (76-324) and admission-to-EKG,162min (90-393). Both, pain-to-admission and admission-to-EKG were lower in the reperfusion group (110 vs 205 min,p=0.002, and 155 vs 220min,p=0.001,respectively).
Conclusion: Pain-to-admission and admission-to-EKG times are related to reperfusion success. Regardless of this, the interval times observed in Acre, Rio Branco are close to the ideal recommended by the guidelines. Improvements in population awareness for readily identificationof AMI and health professional education for higher suspicion of STEMI could meliorate this reality in Acre.
Abstract 18518: Effect of Medical Treatment for Aortic Dissection on In-Hospital Mortality and Follow-Up Aortic Expansion in Patients with and Without Marfan Syndrome; Observations from the International Registry of Acute Aortic Dissection
Authors: Suzuki Toru , Isselbacher Eric M , Eagle Kim A , Nienaber Christoph A , Sawaki Daigo , Hagan Lindsay M , Montgomery Daniel G , Froehlich James B 
Published: April 2024

Background: Medical management of acute aortic dissection (AAD) is poorly understood and based mainly on personal experience, expert opinion and observational studies. Society guidelines reaffirm this lack of evidence. We sought to determine the association of specific medications on outcomes in AAD patients.
Methods: Prior analyses from the International Registry of Acute Aortic Dissection (IRAD) suggest beta blockers (BB) are associated with lower long-term mortality after AAD, and calcium channel blockers (CCB) are associated with lower long-term mortality after type B AAD. For this abstract, we analyzed factors associated with in-hospital mortality and aortic growth at follow-up, including medication use, using IRAD. We also looked at medication use and long-term survival in AAD patients with Marfan Syndrome (MFS).
Results: Among 817 patients with type B AAD, improved in-hospital survival was associated with BB use (OR 23.09, 95% CI 6.62-80.58, p<0.001), absence of mesenteric ischemia (OR 10.53, 95% CI, 1.31-84.7, p=0.03) and absence of hypotension/shock (OR 7.55, 95% CI, 1.15-49.4, p=0.04). No benefit was associated with use of angiotensin converting enzyme inhibitor (ACE). On follow-up, CCB were associated with slower aortic growth in medically treated type B patients (p=0.013), and CCB use during the first two years after AAD is associated with negative growth of the aorta ( -0.07mm/yr for patients on CCB vs. 0.42mm/yr for those not, p=0.008). Analysis of 68 MFS patients showed improved long-term survival in type A patients receiving BB (p=0.01); ACE were associated with increased mortality after 30 months (p=0.008).
Conclusions: This analysis suggests BB are associated with improved in-hospital survival in AAD patients. CCB in Type B patients are associated with improved survival and slower descending aortic growth. MFS patients also benefited from BB use. RAS inhibitors were not associated with improved in-hospital or long-term survival in patients (including MFS patients) with AAD. Whether these observed associations between treatment and outcome are due to cause-and effect cannot be determined. Optimal management needs to be confirmed in randomized controlled trials.
Abstract 18555: Pre-operative Three-Dimensional Echocardiography Predicts Repair Failure in Ischemic Mitral Regurgitation
Authors: Levack Melissa M , McCarthy Fenton H , Takebe Manabu , Cheung Albert T , Woo Y. J , Acker Michael A , Gorman Joseph H , Gorman Robert C , Jackson Benjamin M 
Published: April 2024

Objective: Early recurrence (≤ 6 months) of mitral regurgitation after ring annuloplasty for ischemic mitral regurgitation (IMR) is common. We hypothesized that the degree of pre-repair leaflet tethering as assessed by a novel three-dimensional (3D) echocardiographic based algorithm would be a sensitive predictor of repair failure within 6 months of surgery.
Methods: Real-time 3D full volume transesophegeal echocardiography loops were acquired on patients (N=12) undergoing mitral valve repair for IMR. Images were segmented using previously described methodology. Using custom algorithms, leaflets were divided into six regions for calculation of the respective degree of tethering in each leaflet region. Patients received 2D echocardiography follow-up six months after surgery to assess for recurrence of MR. Pre-operative tethering of patients who recurred were compared to those who did not recur to identify predictors of repair failure. Students’ t-tests were used to compare groups; to account for multiple dependent variables, P<.026 was considered statistically significant (Bonferroni correction).
Results: 33% of patients had moderate to severe MR at the six month follow-up. The degree of horizontal tethering for the P3 leaflet region was 13.77 ± 4.29º compared to 36.71 ± 8.04º (P<0.001) in the group which recurred. Repair failure at six months was predicted by A3 and P3 horizontal tethering angles. (Table 1) Tenting index and 2D echocardiography measurements of left ventricular size and ejection fraction were not predictive of failure.
Conclusions: Pre-operative 3D posterior leaflet tethering is predictive of mitral valve repair failure. Three-dimensional modeling may aid in determining which patients should undergo replacement rather than repair in IMR.
Abstract 18928: Cardiac Soluble Guanylate Cyclase Protects Against Cardiac Dysfunction Induced by Chronic Doxorubicin Treatment in Mice
Authors: Vandenwijngaert Sara , Swinnen Melissa , Pokreisz Peter , Gillijns Hilde , Caluwé Ellen , Bartunek Jozef , Bloch Kenneth D , Janssens Stefan P 
Published: April 2024

Background - The chemotherapeutic use of doxorubicin (DOX) is limited by cardiotoxicity. Growing evidence suggests a protective role for cyclic guanosine monophosphate (cGMP) in pathological LV remodeling. We therefore tested the hypothesis that reduced cGMP bioavailability in cardiac myocytes worsens myocardial dysfunction in mice after chronic DOX treatment.
Methods and Results - We generated mice with an inducible (Tet-Off) cardiac myocyte-specific expression of a dominant-negative soluble guanylate cyclase (dnsGC) mutant, which inhibits sGC signaling selectively in the heart. Cardiac cGMP levels, measured using an enzyme immunoassay, were lower in dnsGC mice (n=10) than in WT littermates (n=20) 5 minutes after administration of the NO-donor GSNO (1mg/kg) (0.99±0.34 vs 1.85±0.17 nmol/mg protein, respectively, P<0.05). At baseline, transthoracic echocardiography (TTE) demonstrated similar LV dimensions and function in dnsGC and WT (data not shown). Heart to body weight ratio was also comparable (HW/BW; 4.3±0.2 mg/g in dnsGC, n=13, vs 3.9±0.1 mg/g in WT, n=21). After 12 weeks DOX (2 mg/kg weekly), LV function was significantly reduced and LV diameters significantly enlarged as compared to saline-treated WT (Table). The impact of DOX on cardiac function and dimensions was more marked in dnsGC than in WT (P<0.05 for both, Table). Survival was similarly impaired in DOX-treated dnsGC (67%, n=30) and WT (59%, n=24) compared with saline-treated WT (100%, n=25). HW/BW was similar in DOX-treated dnsGC and WT (4.3±0.1 vs 4.2±0.1 mg/g), as was the % bromodeoxyuridine (BrdU)-positive cardiac myocytes or cardiac progenitor cells (0.8±0.4%, n=7 vs 1.6±0.7%, n=9, respectively, P=NS).
Conclusions - Reduced myocardial cGMP results in increased LV dysfunction and dilatation in doxorubicin-treated mice. Stimulation of sGC activity in cardiac myocytes may represent a promising therapeutic approach for doxorubicin cardiotoxicity.
Abstract 193: Transthoracic Impedance Patterns During Systole Reveal Changes in Cardiac Hemodynamics Using External Defibrillators
Authors: Didon Jean-philippe , Jekova Irena , Ménétré Sarah , Trendafilova Elina , Krasteva Vessela 
Published: April 2024

BACKGROUND: This study aims to test the Automated external defibrillators (AED) transthoracic impedance cardiogram (EICG) as a potential sensor for detection of compromised hemodynamics in different arrythmias (atrial fibrillation (AFIB), atrial flutter (AFL), ventricular tachycardia (VT)) vs. sinus rhythm (SR).
METHOD: ECG and ICG recordings via pads in antero-apical position from 106 patients with AFIB, AFL, VT, who received external cardioversion (ECV) with external cardioverter/defibrillator are retrospectively processed. EICG patterns are accumulated to compute EICG measures (maximal EICG velocity (dZ/dt-PEAK), ventricular ejection time (VET), ventricular ejection ratio (VER=VET/ RR interval)), static impedance (Z). Hemodynamical indices are collected: heart rate (HR), HR variability (HRV), systolic and diastolic blood pressure (SYS, DIA).
RESULTS: ANOVA test indicates that EICG measures significantly differ in AFIB, AFL, VT vs. SR (Table 1). Multiple linear regression shows that EICG measures are significantly dependent on hemodynamical indices (HR, HRV, SYS, DIA) with multiple correlation coefficient R=0.49 (VET), 0.54 (dZ/dt-PEAK), p<0.001, whereas Z is not correlated. Linear discriminant analysis (LDA) shows that a combination of dZ/dt-PEAK, VET, VER is able to discriminate either AFIB, or AFL, or VT from SR with respective accuracy of 92.8%, 93.9%, 99.1%.
CONCLUSION: EICG measures are significantly correlated to hemodynamical indices and are altered in AFIB, AFL, VT compared to SR. EICG is a potential sensor for compromised cardiac hemodynamics in AFIB, AFL, VT with a discrimination ability for VT vs. SR of 99.1%, but lower for AFIB and AFL vs. SR (around 93%).
Abstract 21: Mobile Extracorporeal Life Support for Patients With Refractory Cardiogenic Shock or Reanimation - The Concept of a Regional Supply Network
Authors: Albert Alexander , Born Frank , Kamiya Hiro , Saeed Diyar , Akhyari Payam , Kindgen-Milles Detlef , Lichtenberg Artur 
Published: April 2024

Objectives: To prove the concept of a regional supply network for mobile extracorporeal life support (ECLS), provided by an university heart centre, specialised on mechanical support.
Methods: We established a mobile ECLS service for regional catheter laboratories (cath-lab). We included patients with severe refractory cardiogenic shock and/or resuscitation if locally available therapies failed and a safe transport to a heart centre was not possible. Without immediate mechanical support the patients are considered to die. Logistic optimization was achieved by 1) use of a miniaturized ECLS device (Life Box, Sorin), which is 24-hours instantly ready for use, 2) provision of a passenger car with flash lights for going, 3) placement of stickers with the 24 hours emergency numbers on prominent places, 4) training of cardiologists in insertion of femoral ECLS cannulae.
Results: Seven cath-labs joined the supply network. From 08/2011 until 05/2012 mobile ECLS was used in 39 cases (age: 3 to 86 years; mean 58). Distance: 0.5 to 224 km. Resuscitation time: 5 -240 min. All patients received on-site femoral veno-arterial ECLS. Duration of support: 1 to 28 days (mean:8.3). Further treatment include: implantation of a ventricular assist device, cardiac transplantation, coronary artery bypass grafting, left ventricular thrombectomie, PTCA, mitral- and aortic valve replacement. 30-day survival without significant neurological deficits was 44% for men, 50% for women.
Conclusion: Mobile ECLS therapy, using recent technology, offers new options for patients, who are otherwise likely to die. The concept of a regional ECLS supply network ensures an optimized logistic and minimization of loss of time
Abstract 232: Sensitivity of Individual Data Modalities for Detecting Return of Spontaneous Circulation and Rearrest with Defibrillator Data
Authors: Sundermann Matthew , Salcido David D , Menegazzi James J 
Published: April 2024

Background

Determining the presence of return of spontaneous circulation (ROSC) and re-arrest (RA) in out-of-hospital cardiac arrests offers a challenge for health care providers and researchers. A better understanding of how different data streams reflect patient vital status could improve patient care by reducing time to identification of ROSC and RA and by improving the efficiency of retrospective analyses. We hypothesized that some data streams in the absence of others may be insufficient in determining rhythm status and we sought to determine the extent of these insufficiencies.

Methods

Defibrillator data for non-traumatic cardiac arrests collected by the Resuscitation Outcomes Consortium’s (ROC) Pittsburgh site from 2006-2008 and 2011 were analyzed. Custom software was used to identify ROSC/RA status during the resuscitation and post-resuscitation phases of EMS treatment. The data streams included audio, force of compression (COMP), transthoracic impedance (IMP) and patient care reports (PCR). Official ROSC/RA status was established using all available channels. We then analyzed each channel for indicators of ROSC/RA at those time-points when ROSC/RA were noted in the initial analysis. Sensitivities and specificities for detecting ROSC/RA were calculated for each channel relative to the clinical benchmark, a combination of ECG +IMP signals in Stata 12.

Results

The ROSC sensitivities for each signal compared to our clinical benchmark were .890(audio), .912(ECG), .934(IMP), .868(COMP) and .813(PCR). ROSC/RA combined sensitivities were calculated to be .851(audio), .900(ECG), .933(IMP), .880(COMP) and .719(PCR). The RA sensitivities were calculated to be .767(audio), .860(ECG), .933(IMP), .833(COMP) and .430(PCR) while specificities were calculated to be 1(audio), 1(ECG), 1 (IMP), 1(COMP) and 0(PCR).

Conclusion

The ECG and IMP individual signals produced the highest sensitivity in detecting ROSC/RA when compared to our benchmark of ECG + IMP. When analyzing a case with just
one signal, the sensitivity for detection of ROSC/RA may be grossly inadequate particularly with only PCR information. However, the most commonly available pairing of data streams in modern defibrillators, ECG and transthoracic impedance, is accurate.
Abstract 248: Continuous Chest Compressions with Interposed Ventilations Are Associated with Improved Outcomes from Suspected Asphyxial Arrest
Authors: Lemieux Justin , Husa Ruchika , Scyoc Dorothy , Gordon James , Sell Rebecca , Chappel Ruth , Minokadeh Anushirvan , Davis Daniel 
Published: April 2024

Background: A continuous chest compression (CCC) approach to CPR avoids pauses that decrease coronary perfusion pressure. However, the ability to provide adequate ventilation during CCC remains unclear. Cardiopulmonary arrest (CPA) victims with suspected asphyxia would be expected to be the most impacted by inadequate ventilation during CPR.
Objective: To explore the impact of CCC on outcome from inpatients with suspected asphyxial CPA.
Methods: This study was conducted in two urban university hospitals from 2005-09. The Advanced Resuscitation Training (ART) program was implemented in 2007. The ART program advocates CCC with interposed ventilations performed at a 10:1 ratio. Ventilations are initiated with the onset of compression recoil for both unprotected and protected airways. Data for all CPAs are entered into a resuscitation database. CPA events are categorized based on suspected etiology. Survival-to-discharge rates before and after implementation of the ART protocol were evaluated using chi-square analysis including test for trend. Ventilation rates were measured over the final 18 months of the study.
Results: A total of 140 inpatients had suspected asphyxial CPA during the study period. Survival-to-discharge increased from 21.8% to 47.2% following implementation of the ART CCC protocol (p<0.001). Average ventilation rates associated with CCC were 9.7 breaths/min.
Conclusions: An inpatient CCC protocol with ventilations interposed at a 10:1 ratio was associated with marked improvements in outcome among patients with suspected asphyxial CPA. These data suggest that adequate ventilation can be achieved with synchronous delivery of breaths with the recoil phase of compressions. Controlled ventilation rates were also achieved.
Abstract 302: Transthoracic Impedance Is Poorly Predicted by Patient Characteristics but Significantly Reduced by Placement of Defibrillator Pads in the Anteroposterior Position
Authors: Howe Andrew J , DiMaio Rebecca , McEneaney David 
Published: April 2024

Introduction
The American Heart Association Resuscitation Guidelines advocate four pad positions to achieve defibrillation success following cardiac arrest. Transthoracic impedance (TTI) reflects the electrode-skin interface and patient impedance and affects current amplitude, energy delivered and defibrillation efficacy. Modern defibrillators utilise an impedance compensated waveform to account for changes in TTI to improve defibrillation success. However the effect of electrode pad position and patient characteristics on TTI remains unclear.
Objective
To evaluate the effect of patient characteristics and pad position on Transthoracic impedance (TTI).
Methods
Patients undergoing diagnostic cardiac catheterisation were recruited for the study following regional ethical approval. Standard self-adhesive defibrillator electrodes were applied to patients in both the anterolateral and anteroposterior positions and connected to Heartsine Samaritan defibrillators. TTI was measured by applying a 30kHz sinusoidal signal through the chest. The voltage was then converted to digital samples using an 8-bit microprocessor. The digital samples were then stored on the secure digital card to be retrieved using custom-made download data recovery software. TTI was measured at 10 second intervals in both positions for the duration of the clinical procedure.
Results
32 patients (mean age 63), (66% male), were recruited. TTI measured at 10 seconds was significantly higher in the anterolateral position (88.3ohms vs 68.5ohms, p <0.001). Mean TTI reduction over 5 minutes was 2.4% in the anterolateral position and 1.9% in anteroposterior position. There was no significant correlation between TTI measured from either pad position and age, height, weight, body surface area and Haemoglobin (r<0.4 for all parameters).
Conclusion
TTI is significantly reduced by placement of defibrillator pads in the anteroposterior position. Furthermore patient characteristics are poorly predictive of TTI from either pad position. Patients suffering failed defibrillation attempts from pads positioned in the anterolateral position may benefit from prompt relocation to the anteroposterior position to improve defibrillation efficacy.
Abstract 320: Simulation of Cardiac Arrhythmias in Hospitalized Patients to Measure and Improve Response Time
Authors: Wright Melanie C , Dorsey Kyle W , DeLong Robert , Decker Ronda , Patterson Anita , McBroom Kathryn , Granger Christopher B 
Published: April 2024

Introduction: Hospitals have limited means of assessing time to respond to in-hospital life-threatening cardiac arrhythmias. Metrics of time to recognition are lacking and effectiveness of remote monitoring is not well understood. We sought to determine whether it was feasible and valid to measure response time to arrhythmias by inserting simulated arrhythmias into ongoing in-hospital cardiac monitoring.
Hypothesis: We hypothesized that monitoring personnel would perceive a simulated arrhythmia, placed in the slot of a patient, as real and respond as such. We hypothesized that, compared to on-unit local monitoring (of monitors in the care area by direct care nurses), off-unit remote monitoring (of a bank of monitors by technicians), requiring more communication steps, would result in slower response time from arrhythmia onset to nurse-in-room.
Methods: We conducted 50 simulated life-threatening arrhythmias (Vfib or Vtach) at two hospitals. We measured time from start of simulated arrhythmia to nurse-in-room. We asked 40 nurses and 13 monitoring technicians whether they perceived the event to be “real” (not a simulation). We compared nurse-to-room times between 28 locally and 15 remotely-monitored patient arrhythmias using non-parametric Wilcoxon sum of ranks statistics.
Results: The event was interpreted as real by 38 of 40 nurses and 11 of 13 remote technicians. Among a subset (30 nurses, 6 technicians), about one-third, in hindsight, recalled aspects of the rhythm or work environment that could have cued them that the event was not real. Average nurse-to-room time for locally monitored patients was 23 seconds, significantly faster (p = 0.0002) than the 58 seconds required for remotely monitored patients.
Conclusions: This study provides preliminary evidence that arrhythmia simulators may be used to effectively measure recognition and response time to life-threatening cardiac arrhythmias. Careful implementation is required to ensure realism.