bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 5797: New Biomarkers for Assessing the Activity of Takayasu Arteritis
Authors: Ishihara Takashi , Kamiishi Tetsuo , Haraguchi Go , Isobe Mitsuaki 
Published: April 2024

Background - Takayasu arteritis (TA) is a chronic vasculitis, mainly involving the aorta and its main branches. Erythrocyte sedimentation rate (ESR) and C-reactive protein(CRP)have generally been used for monitoring the disease activity. We frequently experience patients who show inflammatory symptoms without an elevation of CRP, even though they are treated with immunosuppressants. Therefore, we sought for useful and sensitive biomarkers to diagnose subtle activity of TA. We hypothesized that pentraxin3 (PTX3) and matrix metalloproteinases (MMPs) could be biomarkers of TA to detect patients who develop recurrence of the disease even in the absence of CRP elevation.
Methods and Results - Consecutive series of 45 patients with TA and 20 age-matched healthy controls were enrolled in this study. According to the clinical symptoms of the patients, 23 patients were in an active phase as evidenced by clinical recurrences within 2 years of blood sampling and 22 patients were in an inactive phase without any inflammation for more than 2 years. Circulating levels of PTX3, MMP-2, MMP-3 and MMP-9 were determined by ELISA. Patients in an active phase had significantly higher level of high sensitive CRP (hsCRP), PTX3, MMP-3 and MMP-9 than those in an inactive patients. Sensitivity (SE), specificity (SP) and area under the ROC curve (AUC) to detect active patients of each biomarker are as follows. hsCRP: SE 53.33%, SP 90.91%, AUC 0.798, PTX3: SE 76.19%, SP 76.19%, AUC 0.871. MMP-3: SE 60.87%, SP 86.36%, AUC 0.831, MMP-9: SE 61.90%, SP 66.67%, AUC 0.728. PTX3 was the best single marker with the highest diagnostic accuracy. Among 21 patients in an active phase, 9 patients showed negative hsCRP level (<4837ng/ml). However, PTX3 level was elevated (>5.27ng/ml) in 7 of the 9 patients. Patients with TA had significantly higher level of MMP-9 (active:360±75ng/ml, inactive:229±48ng/ml) than normal controls (23±5ng/ml) inspective of disease activity. Evaluation of MMP-9 may suggest prior existence of TA even in inactive patients.
Conclusions - PTX3, MMP-3 and MMP-9 could be new and sensitive biomarkers to estimate the activity of TA. We can predict recurrence of TA by elevation of PTX3 even patients whose CRP is negative.
Abstract 8500: Alcohol Effect on Incident Atrial Fibrillation in Individuals with Cardiovascular Disease: Analysis of Data from the ONTARGET and TRANSCEND Studies
Authors: Liang Yan , Mente Andrew , Yusuf Salim , Gao Peggy , Teo Koon K ,   ONTARGET and TRANSCEND Investigators
Published: April 2024

The relationship of alcohol consumption with atrial fibrillation (AF) is inconsistent, and little is known about the impact of alcohol intake on AF incidence in older people with cardiovascular diseases (CVD) or diabetes.
The purpose of this analysis is to assess the association between alcohol consumption and incident AF among older individuals with CVD or diabetes mellitus with end organ damage.
A cohort of individuals (n=30,430) without AF at baseline, aged ≥55 years, with established CVD or high risk diabetes mellitus, and participating in two randomized trials, the ONTARGET or TRANSCEND (median follow-up of 56 months), were included in the analysis. Alcohol intake was classified as low (Group 1, <1 drink/week, referent), medium (Group 2, 1-14 drinks/week for women and 1-21 drinks/week for men) and high (Group 3, >14 drinks/week for women or >21 drinks/week for men) consumption, according to the World Health Organization recommendations. Multivariable Cox regression was used to model the relationship between alcohol intake and incident AF.
There were 2093 new onset AF events in these patients. The age- and sex-standardized incidence rates were 14.47, 17.29 and 20.89 events per 1000 person years in Group 1, 2 and 3, respectively with an additional 6.42 events per 1000 person years in high compared to low alcohol consumers. The unadjusted and adjusted hazard ratios of incident AF associated with alcohol intake were shown in the Table. A significant linear dose response relationship was found (p for trend <0.0001 and =0.0019, respectively in the unadjusted and full-adjusted models).
In conclusion, moderate alcohol intake is associated with an increased incidence of AF in older individuals with CVD or diabetes mellitus and in a linear fashion with increasing consumption. Recommendations made about the protective effects of moderate alcohol intake in patients at high risk of CVD should be tempered with this new finding.
Abstract 18248: Should We Refrain to Perform TAVI Procedures in Patients with a Mitral Regurgitation? Insights from the FRANCE 2 Registry
Authors: van belle Eric , Juthier Francis , Vincentelli Andre , Iung Bernard , Eltchaninoff Helene , Laskar Marc , Fajadet Jean , Leguerrier Alain , Gilard Martine , Banfi Carlo , Leprince Pascal , Prat Alain , Teiger Emmanuel ,   France 2 investigators
Published: April 2024

Background: The presence of mitral regurgitation (MR) is an independent predictor of mortality after conventional aortic valve replacement for aortic stenosis. The predictive value of pre-procedural MR on clinical outcome after TAVI is unknown.
Methods: 3,195 consecutive patients were enrolled between January 2010 and October 2011 in 33 centres. MR was graded according to pre-procedural transthoracic echocardiography (TTE) as none/trivial (=0), mild (=1), moderate (=2), moderate-to-severe (=3), or severe (=4). The mean age was 82±7 years; 49% were female and mean logistic EuroSCORE was 21.9±14.3. Balloon (BE) and self-expendable (SE) devices were implanted in 66.9% and 33.1% of patients, respectively. Approaches were transarterial (transfemoral: 74.6%; subclavian: 5.8%), transapical (17.8%), and transaortic (1.8%).
Results: Pre-procedural TTE showed no MR in 32% of cases, a grade 1 MR in 46% of cases, a grade 2 MR in 20% of cases and a grade 3-4 in 2% of cases. Procedural success rate was 96.9%. Actuarial 1 year mortality was 19.5%. By univariate analysis, pre-procedural MR grade≥2, MR Grade=1 and MR Grade=0 were associated with a 1 year mortality rate of 24.0%, 20.1% and 15.8%, respectively (p=0.002). By multivariate analysis, 4 independent baseline characteristics were associated with preprocedural MR: a higer Logistic EuroSCORE (p=0.0001), a lower ejection fraction (p=0.0002), a higher NYHA class (p=0.0007), and female gender (p=0.001). By multivariate Cox analysis, independent predictors of one-year mortality were: logistic EuroSCORE (p=0.0001), NYHA class (p=0.0001) and transapical approach (p=0.0005). The presence of preprocedural MR was not significantly associated with 1-year mortality (p=0.31). Results did not differ when analyses were restricted only to BE or only to SE devices.
Conclusion: A mild (grade1) or a moderate (grade 2) MR preprocedural is associated with a higher 1-year mortality after TAVI. However, since preprocedural MR is associated with a higher NYHA class or a higher logistic Euroscore, pre-procedural MR is not an independent predictor of mortality. These findings suggest that, in itself, the presence of a mild or a moderate MR should not refrain from performing TAVI and should not impact the type of valve to be used
Abstract 18334: Electrocardiographic Alterations After Alcohol Septal Ablation Demonstrate 1-Year Lasting Reverse Remodeling Effect
Authors: Matsuda Junya , Kitamura Mitsunobu , Takayama Morimasa , Kubota Yoshiaki , Nakamura Shunichi , Murata Hiroshige , Takagi Gen , Takano Hitoshi , Asai Kuniya , Mizuno Kyoichi 
Published: April 2024

Background: Alcohol septal ablation (ASA) is a treatment option in patients with hypertrophic obstructive cardiomyopathy (HOCM) and its refractory symptoms in spite of optimal medical therapy. The improvements of the related symptoms were derived from the acute reduction of left ventricular pressure gradieint (LVPG) and the chronic reverse remodeling. In many patients, the reverse remodeling effects have been observed for several months over.
Methods: From 1998 through 2011, we performed 174 ASA procedures for drug-refractory symptomatic patients. We investigated clinical 2-years follow up and analyzed electrocardiogram (ECG) alternations from 1 month to 6months, 1 year and 2 years, to confirm the chronic effects. .
Results: Out of 174 prosedures treated by ASA, excluding right bundle branch block (RBBB) and DDD or ICD therapy after ASA, total 23 patients in which we could complete 2-years follow-up were assigned to this study. Immediately after ASA, LVPG significantly improved from 68±39 to 25±28 mmHg (p<0.001), associated with symptomatic improvement (NYHA class from 2.5±0.6 to 1.2±0.5, p<0.001). From ECG findings, Sokolow-Lyon index reduced until 1 year later (5.0±0.4 to 4.8±0.4, p=0.005) and QRS duration significantly reduced until 6 months later (100±11 to 96±13msec, p=0.038).
Conclusions: ASA improved not only the obstructive property but also the electrical abnormality in drug-refractory HOCM patients. The reduction of Sokolow-Lyon index and QRS duration suggested the reverse remodeling effects sustained 6 months to 1 year after ASA. Therefore, the effects should be monitored until 1 year from the ASA procedure.
Abstract 18761: Improved Quality of Life and Functional Capacity for Patients Receiving the HVAD
®
Pump
Authors: Birks Emma J , Slaughter Mark S , Boyce Steven W , McGee Edwin C , Cotts William G , Najjar Samer S , Pagani Francis D , Hathaway David , Jacoski Mary V , Najarian Kevin B , Aaronson Keith D 
Published: April 2024

Background: Patients with advanced heart failure experience significant impairment in quality of life (QoL) and functional capacity. Improved survival and longer waits for transplant following LVAD implantation means QoL and functional capacity outcomes are increasingly important. We reviewed the experience of patients receiving the HeartWare
®
Ventricular Assist System (HVAD), a novel design continuous flow, centrifugal pump in the pivotal ADVANCE Bridge to Transplant (BTT) Trial and Continued Access Protocol (CAP) to explore changes in QoL and functional capacity.

Methods: The QoL surveys analyzed in the combined BTT and CAP trials included the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary, and the EuroQOL-5D Visual Analog Scale (VAS). The 6 minute walk test (6MW) was used to determine functional capacity. Descriptive statistics were used to evaluate differences compared to baseline.
Results: In the combined BTT and CAP study (N=332), between 44% and 55% of patients completed paired QoL measurements, at baseline (pre-implant) and 180 days post-implant. Patients unable to complete a test for any reason other than incomplete follow-up visit had imputed values of zero. Of 231 patients who were available for follow-up at 6 months (i.e., not transplanted, explanted for recovery, or dead and had reached the 6 month post-implant assessment), paired data were obtained on 184, 164 and 146 patients for the 6MW, KCCQ and VAS, respectively. Of patients completing the paired assessments, there was a statistically significant improvement of 195.9 meters in the 6 Minute Walk Test. Both the EQ-5D Visual Analog Scale and KCCQ Overall Summary also showed statistically significant improvements in their scores of 27.0 and 31.1 points, respectively.
Conclusion: QoL and functional capacity was substantially improved at 6 months in bridge to transplant recipients of the HeartWare HVAD System.
Abstract 200: Regional Difference in Emergency Medical Services Dispatcher Cardiopulmonary Resuscitation Prearrival Instructions for Patients with Out-of-Hospital Cardiac Arrest in Japan
Authors: Hanada Hiroyuki , Hase Mamoru , Yonemoto Naohiro , Nonogi Hiroshi , Nagao Ken , Kimura Takeshi ,   J-ReSS Group
Published: April 2024

[Background] The 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care recommend that dispatchers should recommend cardio-pulmonary resuscitation (CPR) for unresponsive patients who are not breathing normally. This guideline also recommended special education for dispatchers. Every regional medical control system (the organization which was specially designed for presenting protocols to regional emergency medical system (EMS) and evaluating EMS operation) created dispatcher protocols to recognize cardio-pulmonary arrest and to helping CPR by bystander from July 2009 in Japan. Unfortunately, dispatchers in every regional emergency EMS could not be always specially educated.
[Goal] To evaluated regional difference in EMS dispatch prearrival CPR instruction for patients with out-of-hospital cardiac arrest (OHCA).
[Methods and Results] From January 1, 2005, through December 31, 2010, we conducted a prospective, population-based, observational study involving the consecutive patients across Japan who had OHCA (n=670,314). Dispatcher recommended CPR increased year by year, 33.8% of OHCA during 2005, 37.7% during 2006, 41.7% during 2007, 44.3% during 2008, 45.3% during 2009 and 46.3% during 2010 across Japan. Regional differences were shown in the figure.
[Conclusion] Although EMS dispatch CPR has been increased year by year, bystander CPR recommended by EMS dispatcher has been still less than 50% of all OHCA in Japan. There were regional differences in recommendation of CPR by dispatcher across Japan. Both EMS recommendation of CPR and CPR by bystander responding to EMS recommendation were lowest in Tokyo metropolitan area. Certain detailed protocols which can be done easily even after small amount of educational time for EMS dispatcher are needed.
Abstract 209: Time Intervals and Rearrest After Out-of-Hospital Cardiac Arrest
Authors: Koller Allison C , Salcido David D , Callaway Clifton W , Menegazzi James J 
Published: April 2024

Background: Re-arrest (RA) occurs when a patient loses pulses following return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA), but the exact causes of RA are not fully understood. Time-to-treatment intervals may affect patient outcome and could be a plausible contributor to RA.
Objectives: To compare emergency medical services (EMS) time intervals between cases with and without RA. We hypothesized that RA cases will have significantly longer time intervals than no-RA cases.
Methods: The Institutional Review Board of the University of Pittsburgh approved this study. Cases of EMS-treated, non-traumatic OHCA from 2006 to 2011 with at least one instance of prehospital ROSC were retrospectively gathered from the Pittsburgh site of the Resuscitation Outcomes Consortium. Prehospital event times were derived from computer assisted dispatch records. We calculated time intervals to the nearest minute, including 911 call to EMS arrival, arrival to first EMS CPR, EMS CPR to ROSC, and 911 call to arrival at the emergency department (ED). RA status was determined from electronic defibrillator downloads and patient care reports. We used logistic regression to examine the association between RA and each time interval while controlling for patient demographic and clinical variables with alpha = 0.05.
Results: Two-hundred and thirty-five cases were analyzed, and 79 (34%) cases had an instance of RA. Mean time intervals and patient demographics are in Table 1. The RA group had a significantly higher proportion of males and shocked cases than the non-RA group. Odds ratios for the outcome of RA by time interval are as follows: 911 to arrival: 1.09 (CI: .98 - 1.21, p = 0.10); arrival to CPR: 1.02 (CI: 0.89 - 1.19, p = 0.74); CPR to ROSC: 0.99 (CI: 0.96 - 1.02, p = 0.86); 911 to ED: 0.99 (CI: 0.96 - 1.01, p = 0.35).
Conclusion: EMS time intervals for OHCA were not predictive of RA.
Abstract 223: Kynurenine Pathway Activation Following Resuscitation from Cardiac Arrest: An Experimental and Clinical Investigation---from a Rat and a Pig Model to a Preliminary Clinical Validation
Authors: Ristagno Giuseppe , Brunelli Laura , Fries Micheal , Fumagalli Francesca , Bagnati Renzo , Pastorelli Roberta , Latini Roberto 
Published: April 2024

Background. Kynurenine pathway (KP) is a major route of the tryptophan catabolism, mainly activated upon several inflammatory stimulation and involved in the pathogenesis of numerous cerebral disorders shock states. In the present study, tryptophan and KP metabolites concentrations were measured in plasma from rats, pigs, and humans resuscitated from cardiac arrest (CA). We hypothesized that the KP would be markedly activated following CA.
Methods. Plasma was obtained from: A: 18 rats, subjected to 6 min CA and 6 min CPR; B: 10 pigs, subjected to 10 min CA and 5 min CPR with post-arrest normo- (n=5) or hypothermia treatment (n=5); and C: 3 healthy human volunteers and 5 patients resuscitated from CA, with or without hypothermia. Metabolites were extracted and levels analyzed by mass spectrometry with high performance liquid chromatography. Assessements were available at baseline and hrs and days post-arrest (Figure). The specific KP metabolites were subsequently correlated with specific functional measurements and survival.
Results. KP activaction after CA was observed in rats, pigs, and humans. More specifically decreases in tryptophan occurred after resuscitation period and were accompanied by significant increases in its major metabolites, 3-hydroxyanthranilic acid (3-HAA) and kynurenic acid in each species, that persisted up to 3-5 days post-arrest (p<0.01, Figure). In rats, changes in KP metabolites reflected changes in post-resuscitation myocardial dysfunction. In pigs, decreases in tryptophan (r=-0.728, p=0.017) and increases in 3-HAA (r=0.792, p<0.01) were significanlty related to the severity of hippocampal injuries. In humans, post-arrest increases in 3-HAA were inversly related with 72 hr survival (r=-0.94, p=0.18).
Conclusions. In this fully translational investigation, the KP was activated early following resuscitation from CA. KP activation might account for the severity of post resuscitation syndrome and ultimately to survival.
Abstract 230: Epidemiology and Outcomes of Emergency Medical Services-Assessed Out-of-Hospital Cardiac Arrest in Korea: A Nationwide Observational Study from 2006 to 2010
Authors: Shin Sang Do , Ro Young Sun , Song Kyoung Jun , Lee Eui Jung , Ahn Ki Ok 
Published: April 2024

Background
The goal of this study is to better understand the epidemiologic features and the patient-community-emergency medical service (EMS)-hospital factors affecting outcomes of out-of-hospital cardiac arrest (OHCA).
Methods and Results
This study was performed in an EMS system with a single-tiered basic-to-intermediate service level and approximately 900 destination hospitals for eligible OHCA cases. A nationwide OHCA database including demographic, Utstein, EMS, and hospital factors and outcomes was constructed using EMS run sheets of eligible cases transported by 119 EMS ambulances and followed by medical record review for 2006 to 2010. Cases with unknown outcome were excluded. The primary end points were survival to discharge. The epidemiologic characteristics of OHCA were described and adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated for main outcome, adjusting for potential predictors.
There were 97,291 EMS-assessed OHCAs excluding 14,798 cases because the medical records were not available (N=10,626) and the survival outcomes were unknown (N=4,172). Of these, 73,826 (75.9%) OHCAs were resuscitation attempted by EMS. The survival to discharge was 3.0% for EMS-assessed (3.3% for cardiac origin vs. 2.3% for non-cardiac origin), 3.6% for EMS-treated (4.0% for cardiac vs. 2.7% for non-cardiac), and 20.9% for cardiac origin with shockable rhythm. The drowning, intoxication, and asphyxia induced OHCAs had statistically better survival rates than cardiac origin. The odds for survival to discharge are significantly lower for elderly, asystole as primary ECG, OHCA with cardiac origin occurred in winter or 6PM to midnight, un-witnessed, no bystander cardiopulmonary resuscitation, OHCA with longer EMS response, and being transported to lower level of ED.
Conclusions
In this nationwide cohort study from 2006 to 2010, the standardized incidence rate increased 46.3 in 2006 to 52.0 per 100,000 person-years for EMS-assessed OHCA and overall survival rate was 3.0%. Potential factors for poor outcome were systemically identified in individual, community, EMS, and hospital chain.
Abstract 231: Predicting Outcome After Out-of-Hospital Cardiac Arrest: Results of a National Registry
Authors: Stelzig Katharina , Busch Hans-Jörg , Pittl Undine , Pfeifer Rüdiger , Killermann Dirk , Wolfrum Sebastian 
Published: April 2024

Background: Advanced post-resuscitation
care including mild therapeutic hypothermia reduces mortality and improves neurological outcome after OHCA. The aim of the current registry is to identify clinical parameters in OHCA patients treated with a modern post-resuscitation care in order to identify predictors of survival and neurological recovery.
Methods and Results: Data sets of 881 OHCA patients treated between 2002-2011 in 4 German university hospitals were analyzed retrospectively. ICU mortality was 36.5% increasing to 45.6% and 53.9% after 1 and 6 months, respectively. Several factors, such as age, initial rhythm, duration of no-flow phase and others were identified as predictive factors for 6 months mortality but not for a survival with good neurological outcome. Interestingly,temperature between hours 8 and 36 after start of cooling were lower in long-term survivors as compared to those who died (Fig A). There was no effect of cooling velocity, duration of cooling and re-warming velocity neither on survival nor neurological recovery after 6 months . In 497 patients neuron specific enolase (NSE) was measured. NSE levels between day 1 and 3 significantly predicted survival (Fig B) and a cut-off of 80µg/L was identified for a markedly increased mortality.
Conclusions: Even after implementation of an improved post resuscitation care, mortality after cardiac arrest is still high. Interestingly, target temperature slightly above the corridor of 32-34°C is associated with increased mortality. Furthermore, in this large cohort NSE has been shown to be a good predictor of long-term mortality with a cut-off markedly higher than previously proposed in the pre-hypothermia era.