tbuckley/cabot-search huggingface dataset:
Abstract 9301: The Comparison of Warfarin and Dabigatran in the Incidence of Asymptomatic Cerebral Micro Thromboembolism after AF Ablation
Authors: Hitoshi Ichiki, Naoya Oketani, Yasuhisa Iriki, Hideki Okui, Ryuichi Maenosono, Fuminori Namino, Sanemasa Ishida, Yuichi Ninomiya, Takehiko Matsushita, Shuichi Hamasaki, Chuwa Tei
Journal: Circulation (2012)

Background: Asymptomatic cerebral thromboembolism after atrial fibrillation (AF) ablation has been reported in 4-20% of the patients. Uninterrupted anticoagulation therapy using warfarin has been shown to be effective for preventing perioperative cerebral thromboembolism without increasing the bleeding complications. Dabigatran, a new anticoagulation agent, has been reported the comparable effects for preventing symptomatic thromboembolic events in non-valvular AF patients. Thus we investigated the incidence of asymptomatic cerebral thromboembolism after AF ablation with dabigatran compared with warfarin using diffusion- and T2-weighted magnetic resonance imaging (DW/T2-MRI). Methods: This study was a prospective non-randomized observational study included 210 consecutive patients (112 paroxysmal AF) who underwent AF ablation solely guided by complex fractionated atrial electrograms (n=113) or combined with PVI (n=97). Warfarin was used for perioperative anticoagulation therapy in 180 patients (warfarin group), and dabigatran was used in 30 patients (dabigatran group). Warfarin was not discontinued for the procedure, whereas dabigatran was not prescribed in the morning of the procedure. Irrigation catheters with the maximum power of 40 watts were used in all the cases. All the patients underwent cerebral DW/T2-MRI in the day after ablation. Results: The incidence of asymptomatic cerebral thromboembolism and hemopericardium treated with pericardiocentesis was higher in dabigatran group than in warfarin group [20.0% vs 7.8% (P&lt;0.05), 13.3% vs 2.2% (P&lt;0.05), respectively]. Although left atrial (LA) diameter and left ventricular (LV) mass were smaller in dabigatran group than in warfarin group [40+9 mm vs 43+7 mm (P&lt;0.05), 189.6+53.0 g vs 161.9+34.8 g (P&lt;0.05), respectively], there was no significantly difference in age, CHADS2 score, the proportion of paroxysmal/persistent AF, LA appendage flow speed, LV ejection fraction, mean activated coagulation time during the procedure, and radiofrequency time between the both groups. Conclusion: Perioperative uninterrupted anticoagulation therapy using warfarin was safer and more effective compared with dabigatran for catheter ablation of AF.
Abstract 9917: The Site of Greatest Vulnerability is Most Often Located Proximally to the Site of Most Severe Narrowing: <i>A Virtual Histology Intravascular Ultrasound Study</i>
Authors: Michiel A de Graaf, Joella E van Velzen, Fleur R de Graaf, Jouke Dijkstra, Jeroen J Bax, Johan H Reiber, Martin J Schalij, Ernst E van der Wall, J. W Jukema
Journal: Circulation (2011)

Introduction: Previous angiographic studies have shown that almost two-thirds of vulnerable plaques are located in non-obstructive lesions. However, the spatial relationship between the location of most severe narrowing and vulnerable rupture sites has not been fully elucidated. Probably, the site of greatest vulnerability is not always identical to the site of most severe stenosis. Therefore, the aim of the present study was to assess the spatial relationship between the location of the site of greatest vulnerability and the location of most severe narrowing with VH IVUS. Methods: Overall, 77 patients (139 vessels) underwent VH IVUS. The site of greatest vulnerability was defined as the cross-section with the largest necrotic core area per vessel, the maximum necrotic core (Max NC) site. The site of most severe narrowing was defined as the minimum lumen area (MLA). Per vessel the distance from both the Max NC site and MLA site to the origo of the coronary artery was evaluated. In addition, the presence of a thin cap fibroatheroma (TCFA) was assessed. Results: The mean difference (mm) between the MLA site and Max NC site was 10.8±20.6mm (P&lt;0.001). Interestingly, the Max NC site was located at the MLA site in 7 vessels (5%) and proximally to the MLA site in 92 vessels (66%). Besides, a higher % of TCFA was demonstrated at the Max NC site as compared to the MLA site (24% versus 9%, P&lt;0.001). Conclusion: The present findings demonstrate that the site of greatest vulnerability is rarely at the site of most severe narrowing. Most often, the site of greatest vulnerability is located proximally to the site of most severe narrowing. Furthermore a higher percentage of TCFA (plaque phenotype with high-risk of rupture) was demonstrated at the site of greatest vulnerability. Figure 1 Difference in distance (mm) and distribution between Max NC site and MLA site. In the majority of vessels the site of Max NC is located proximal to site of MLA.
Abstract 9887: Patient Selection for Ventricular Assist Device Therapy in the Elderly: Application of the HeartMate II Risk Score
Authors: Jennifer A Cowger, Kartik Sundareswaran, Joseph G Rogers, Sudhir S Kushwaha, Francis D Pagani, Antone Tatooles, Robert M Adamson, Mark S Slaughter, David J Farrar
Journal: Circulation (2011)

Introduction: Advanced age is a risk factor for poor outcomes following left ventricular assist device (LVAD) implant. A means of identifying elderly patients with acceptable mortality risk following LVAD surgery is not currently available. The HeartMate II (HMII) Risk Score (HMRS) was recently developed and validated, providing good risk discrimination for predicting survival in patients undergoing HMII implant. Independent survival predictors in the model included age and markers of renal function, coagulopathy and nutrition. We hypothesize that the HMRS will provide utility for risk stratification of the elderly LVAD candidate. Methods: Elderly patients (age &gt;65 years) enrolled into the HMII Destination Therapy (DT) and Bridge to Transplant trials were selected for the study (n=444). Complete data for HMRS calculation was available in 98% (n=435). Preoperative patient HMRS was calculated according to the formula: HMRS = ln(1.29)*decade of age + ln(0.71)*Albumin + ln(1.37)*Cr + ln(1.86)*INR + ln(0.52)*LVAD Center Volume &gt;=15 + ln(0.67)*Implant after 2007. Patients were trichotimized into high (HMRS &gt;1.0), medium (HMRS 0.50-1.0), and low (HMRS &lt;=0.50) risk categories (as previously defined in model development) based on HMRS. The primary endpoint was survival at 1 year following LVAD implant, estimated using Kaplan-Meier methods. Results: The mean cohort age was 71±4 years and 84% (n=372) had devices implanted for DT. The table shows the HMRS along with mean±stddev values for the score's components. All between-group differences were statistically significant (Kruskal-Wallis p&lt;0.05), although differences in age were not clinically significant. Survival based on HMRS strata is shown in the figure. Patients in the low and medium risk groups had survivals &gt;80% at 1 year following LVAD implant. Conclusions: The HMRS can be used to identify elderly patients with survivals comparable to that of the general LVAD population.
Abstract 9575: Incidence of Subsequent Acute Coronary Syndrome in Patients with Atrial Fibrillation
Authors: Gautam R Shroff, Brooke M Heubner, Jeff Schein, Concetta Crivera, Charles A Herzog
Journal: Circulation (2012)

Background . Cardiovascular comorbidities associated with atrial fibrillation (AF) are also risk factors for acute coronary syndrome (ACS). We sought to determine the incidence of subsequent ACS in Medicare pts with newly diagnosed AF. Methods . The 5% Medicare database was used to identify pts (age 65+, no ESRD) with AF in 2006 without a prior diagnosis of ACS or AF. Medicare claims were used to identify patients hospitalized with ACS using ICD-9-CM codes for acute myocardial infarction (410) and unstable angina (411). The cumulative incidence of ACS and death was calculated during 3-year follow up using competing risk analysis and independent predictors of ACS were identified using a Cox proportional hazards model. Results . 18,445 Medicare pts were newly diagnosed with AF in 2006. The baseline characteristics of this population were: age 78 ± 7.8 yrs, hypertension (67%), CAD (33%), DM (26%), dyslipidemia (24%), CHF (21%), CVA/TIA (15%). 1392 (8%) patients from this cohort received an ACS diagnosis within 3 years (Figure). The rate of incident ACS was 11% in pts with prior CAD, CHF or DM. The rates of death at 3 years varied by age (49% for age ≥ 85, 26% for ages 75-84, 16% for ages 65-74). Independent risk factors for incident ACS included: female gender (HR 1.38, p==0.003), prior CAD (HR 1.78, p&lt;0.0001), DM (HR 1.48, p &lt;0.0001), CHF (HR 1.41, p &lt;0.0001). Conclusion . Pts with a new diagnosis of AF had an 8% incidence of ACS within 3 years of the diagnosis of AF; this risk was higher in the presence of comorbid conditions. These data have important implications in chronically anti-coagulated AF pts, as the subsequent diagnosis of ACS will entail additional antiplatelet therapy and increased hemorrhagic risk. In elderly pts with AF, however, mortality is much more frequent than subsequent ACS.
Abstract 9299: Gender Differences in Factors Influencing Electrocardiographic Findings of Left Ventricular Hypertrophy in Severe Aortic Stenosis
Authors: Shinji Satoh, Soichiro Omura, Hiroko Inoue, Yume Nohara, Shogo Ito, Takahiro Mori, Katsuhiko Takenaka, Kotaro Numaguchi, Etsuo Mori, Akemi Aso, Toshihiro Nakamura, Koji Hiyamuta
Journal: Circulation (2012)

Background: Functional and geometric responses of left ventricule (LV) to chronic pressure overload, such as hypertension and aortic stenosis (AS), have been reported to be different between genders. However, gender differences in factors influencing ECG findings of LV hypertrophy (LVH) in pressure overload are unknown yet. Methods: We conducted a prospective observational study in patients with isolated severe AS (aortic valve area [AVA] &lt;1.0cm 2 ; n: men 35, women 68). ECG LVH criteria were classified into the following three categories: 1) high voltage by the Sokolow-Lyon index associated with ST-T wave change (no digitalis); 2) only high voltage; and 3) normal. Groups 1) and 2) were defined as LVH on ECG. We compared the ECG findings in relation to AS severity between genders. Results: Women were older with no significant differences in prevalence of hypertension, AVA index (AVAI), mean peak pressure gradient or peak velocity, LV mass index (LVMI), or the distribution of ECG categories between genders (Table). Multiple logistic regression analysis including of age, gender, hypertension, AVAI, mean pressure gradient, and LVMI revealed that LVMI (p=0.001) and AVAI (p=0.0434) significantly related to the ECG categories. LVMI significantly predicted LVH on ECG in both genders, but AVAI did only in women (Figure). Conclusions: The ECG LVH in severe AS may be mainly determined by LVMI in men and by both LVMI and AVAI in women. ECG may reflect AS severity better in women than in men.phic_{9D8EC702-4573-41EF-9F9E-1A8D62620A97}$$
SAK Three for All
Journal: Circulation (2011)

Dr. William J. Rashkind and his family established this lecture in 1986 shortly before his death. Dr. Rashkind was an internationally known pediatric cardiologist credited for developing balloon atrial septostomy, also known as the Rashkind procedure. Dr. Rashkind was an active volunteer for the American Heart Association at the national and state levels. This lecture is made possible by a grant from the late Dr. Rashkind and his family. In honor of the 25 th anniversary of the Rashkind Lecture, the SAK Comedy Lab from Orlando, Florida, is pleased to present a special performance at the CVDY Council Dinner this year. The SAK “Three for All” is a hilarious and fast-paced improv comedy show, jam- packed with the group's favorite games, scenes and songs. This classic SAK show features audience participation and is guaranteed to have the entire audience engaged and laughing. SAK alumni can be seen regularly in television, film and stage productions, including Lauren Pritchard (MadTV, True Blood), Paul Vogt (MadTV), Jonathan Mangum (Let's Make a Deal) and most notably, Wayne Brady (the Wayne Brady Show, Whose Line is it Anyway, Let's Make a Deal). SAK shows have been enjoyed by over 2 million people worldwide.
Abstract 94: Is the Impedance Cardiogram a Potential Indicator of Effective External Cardiac Massage in a Human Model? A Study to Establish If There Is a Linear Correlation Between the Impedance Cardiogram and Depth in a Cardiac Arrest Setting
Authors: Rebecca Di Maio, Andrew Howe, Paul McCanny, Cesar Navarro, Gloria Crispino-O’Connell, Allister McIntyre, Mike Patton, David McEneaney, Jennifer Adgey
Journal: Circulation (2012)

Purpose of the Study: The 2010 AHA guidelines currently recommend a depth of at least 2 inches (5cm) during external cardiac massage. The purpose of this study was to assess the hypothesis that if using an alternative measure to depth could assist in quantifying the effectiveness of CPR in an out-of-hospital setting and to determine how achievable depths of at least 2 inches are in cardiac arrest patients. Materials and Methods: A total of 32 cardiac arrest patients were recruited by EMS operators in Belfast and cardiologists in Craigavon Area Hospital (CAH). Patient baseline characteristics are summarised below in the results section. A subset of the patients enrolled had simultaneous recordings of Impedance Cardiogram (ICG) and depth (mm) during CPR. The Impedance Cardiogram (ICG)/Thoracic Impedance (non-invasive measure of cardiac output) was recorded via 2 standard defibrillation electrodes, as a method of detecting the presence of effective CPR. Ethical approval was granted by Ethical Committee Northern Ireland and the study was conducted in accordance with ISO 14155:2011; GCP standards. Depth and rate of CPR were continuously measured using Q-CPR ® , Philips. CPR was administered manually by trained ALS operators. Recordings from each experiment were acquired using Philips Q-CPR review software and HeartSine download software for statistical analysis using R ® . Results: Patients were aged between 32 and 93 years (mean 77 years), 64% of this cohort was male. Excluding cases CPR traces with excessive motion artefact, a total of 1883 compressions were administered in patients with a mean weight of 73.85kg. The mean compression depth achieved was 1.79 inches. A strong linear correlation was achieved between depth (mm) using Q-CPR ® and the Impedance cardiogram (ICG)/ thoracic impedance (ohms); r=0749. Conclusions: It can be concluded that a depth of 2 inches is difficult to achieve both in-hospital and by EMS operators even with the support of real-time CPR feedback. An algorithm will incorporate the results from this study, providing feedback to the operator on the quality of CPR by measuring the ICG amplitude which has been strongly correlated with standard measures of depth as well as a number of physiological parameters.
Abstract 9690: CIKS (Act1 Or TRAF3IP2) is Critical in High Glucose-induced Endothelial Dysfunction
Authors: Balachandar Venkatesan, Anthony J Valente, Ulrich Siebenlist, Bysani Chandrasekar
Journal: Circulation (2012)

Endothelial dysfunction is characterized by enhanced inflammatory cytokine and adhesion molecule expression, and endothelial-monocyte adhesion. The adapter molecule CIKS (connection to IKK and SAPK/JNK; also known as CIKS or TRAF3IP2) mediates NF-κB and AP-1 activation, and plays a role in inflammation and injury. Here we show that the high glucose (HG; 25 mM versus 5 mM D-glucose)-induced increase in endothelial-monocyte adhesion, and inhibition of human primary aortic endothelial cell (EC) migration and proliferation are reversed by CIKS knockdown. HG induced CIKS mRNA and protein expression via DPI-inhibitable Nox4-dependent ROS generation. Further, HG-enhanced CIKS promoter-dependent reporter gene activation was blocked by DPI, knockdown of Nox4, c-Jun or C/EBPβ or mutations in AP-1 or C/EBP binding sites. Interestingly, HG enhanced CIKS nuclear translocation. Coimmunoprecipitation and immunoblotting revealed CIKS/IKKβ/JNK physical association under basal conditions that was enhanced following HG treatment. Importantly, CIKS knockdown reversed HG-induced (i) IKKβ and JNK phosphorylation, (ii) p65 and c-Jun nuclear translocation, (iii) NF-κB- and AP-1-dependent proinflammatory cytokine (IL-18, IL-1β), chemokine (IL-8, MCP-1) and adhesion molecule (ICAM-1, VCAM-1) expression, (iv) endothelial-monocyte adhesion, and (v) inhibition in EC migration and proliferation. Similar to HG, AGE-BSA and ox-LDL markedly increased CIKS expression, CIKS/p65/c-Jun-dependent ICAM-1 and VCAM-1 expression, and endothelial-monocyte adhesion. Notably, aortas from type 1 diabetic animals (streptozotocin-induced, and autoimmune NOD or Akita) expressed high levels of CIKS, IL-18, and VCAM-1. These results indicate that HG enhances CIKS expression both in vitro and in vivo. Since CIKS mediates HG-induced NF-κB and AP-1-dependent inflammatory signaling and endothelial dysfunction, targeting CIKS may have broader protective effects in vascular diseases, including diabetes mellitus, dyslipidemia, and atherosclerosis.
Abstract 9286: Patterns of Red Blood Cell Transfusion Use in Patients Undergoing Percutaneous Coronary Intervention in Contemporary Clinical Practice
Authors: Matthew W Sherwood, Yongfei Wang, Jeptha P Curtis, Eric D Peterson, Sunil V Rao
Journal: Circulation (2012)

Background Previous studies have shown marked variation in the use of red blood cell transfusion (RBCT) among patients with acute coronary syndromes. Contemporary post-procedure RBCT patterns in patients undergoing PCI are unclear. Methods Using the NCDR Cath-PCI database we evaluated frequency of RBCT in 1323965 patients undergoing PCI at 1282 hospitals between 7/2009-9/2011 excluding those who underwent in-hospital CABG. Site-level variation in RBCT use was examined; differences in patient baseline characteristics and in-hospital outcomes were compared between patients who did and did not receive RBCT. Logistic regression was used to determine the adjusted association between RBCT and in-hospital death, MI, or stroke. Results Of the total sample, 29255(2.2%) patients received RBCT. These patients were older, more often female, and more often had HTN, prior CHF, prior MI, cerebrovascular disease, peripheral arterial disease, diabetes, or be on dialysis. Patients receiving RBCT had lower median pre-procedure Hgb (10.7 g/dl vs 13.7 g/dl, P&lt;0.01) and post-procedure Hgb (8.6 g/dl vs 12.7 g/dl, P&lt;0.01) and more often experienced a post-PCI bleeding event (36% vs 1%, P&lt;0.01). RBCT was more frequent in patients with post-procedure Hgb &lt;10 g/dl, irrespective of PCI indication. With respect to site-level variation, 17% of hospitals gave no RBCT, 76% of hospitals used RBCT in 1-4% of patients, while just 7% of hospitals used RBCT in ≥5% of patients (Figure). After adjustment, the use of RBCT was significantly associated with in-hospital death, MI, or stroke (OR 2.18; 95% CI 2.09-2.26). Similar results were seen after excluding patients who bled. Conclusions In contemporary PCI practice, there is marked site-level variability in the use of RBCT. After adjustment for potential confounders, RBCT is associated with a higher risk for in-hospital adverse events. These data underscore the importance of understanding the appropriate role of RBCT in patients undergoing PCI.
Abstract 9116: Overlap Between Cognitive Brain Damage and Reduced Cerebral Blood Flow in Heart Failure
Authors: Mary A Woo, Rajesh Kumar, Gregg C Fonarow
Journal: Circulation (2012)

Heart failure (HF) subjects show reduced cerebral blood flow (CBF) in brain sites that control autonomic and cognitive functions. Brain structural injury also emerges in cognitive and autonomic control sites; however, it is unclear whether brain sites with reduced CBF overlap areas with structural brain injury. METHODS: We collected Diffusion Tensor Imaging (DTI) data from 9 HF (age, 54.6±10.4 years; BMI, 30.5±5.4 kg/m2; LVEF, 31.3±7.8, 6 male) and 7 control subjects (age, 53.7±3.1 years; BMI, 25.9±3.0 kg/m2, 6 male) using a 3.0 Tesla MRI scanner, and assessed regional brain injury and overlap with CBF changes. Using DTI data, whole brain mean diffusivity (MD) maps were calculated, normalized to a common space, and smoothed. The normalized and smoothed MD maps were compared voxel-by-voxel between HF and controls using ANCOVA (p = 0.005), with age and gender as covariates. The brain clusters with significantly increased MD values, indicative of brain injury, were overlaid onto background images. The brain clusters with significantly reduced regional CBF values were also overlaid onto background images. Both findings were compared region-by-region for overlap in structural injury and CBF changes. RESULTS: Multiple brain areas in HF subjects (Figure), including the right insular lobe (a), right hippocampus (b), and midline pons (c) showed overlap in structural injury and CBF changes (ANCOVA p=0.005; group comparisons in Table). CONCLUSIONS: HF subjects show brain sites with overlap in structural injury and CBF changes in autonomic and cognitive regulatory areas. The findings indicate that reduced CBF may contribute to structural injury in those sites.
Abstract 9509: Prognostic Value of Treadmill Stress Echocardiography at Extremes of Exercise Workload: Submaximal, &lt;85% Maximum Predicted Heart Rate and High Exercise Capacity, ≥10 Metabolic Equivalents
Authors: Siu-Sun Yao, Vikram Agarwal, Farooq A Chaudhry
Journal: Circulation (2012)

Background: Submaximal stress testing, &lt;85% maximum predicted heart rate (MPHR) may be non diagnostic and high exercise capacity (≥10 metabolic equivalents, METS) is a predictor of favorable prognosis. The purpose of this study was to evaluate the prognostic value of submaximal and high exercise capacity stress echocardiography (EXSE). Methods: We evaluated 1781 patients (55 ± 13 years; 59% male) undergoing EXSE divided into 811 with submaximal (&lt;85% MPHR) and 970 with high exercise capacity (≥10 METS). Resting left ventricular ejection fraction and wall motion was assessed. The left ventricle was divided into 16 segments and scored on a 5-point scale of wall motion. Abnormal EXSE was defined as stress-induced ischemia (wall-motion score of ≥1 grade). Follow-up (3.3 ± 1.5 years) for non-fatal myocardial infarction (n = 40) and cardiac death (n = 52) were obtained. Results: By univariate analysis, exercise work load (p&lt;0.0001), ejection fraction (p&lt;0.0001) and number of new ischemic wall motion abnormalities (p&lt;0.0001) were significant predictors of cardiac events. Cumulative survival was significantly worse in patients with abnormal vs. normal EXSE in submaximal (4.5%/year vs. 1.4%/year, p&lt;0.0001) and high exercise capacity groups (1.1%/year vs. 0.2%/year, p=0.001) (Graph). Multivariate logistic regression analysis identified number of new ischemic wall motion abnormalities as the best predictor of cardiac events (p&lt;0.05) in both groups. Conclusions: Despite normal EXSE, inability to achieve 85% MPHR conferred a higher, intermediate event rate of 3.0%/year. The ability to achieve nine minutes (≥10 METS) on EXSE conferred a benign prognosis (1.0%/year) regardless of EXSE results. In either group (submaximal or high exercise capacity), EXSE results (absence or presence ischemia) were useful in further, effectively risk stratifying patients.