tbuckley/cabot-search huggingface dataset:
Abstract 309: The Hiccup Method for BLS HPCPR for Pediatric Cardiac Arrest: Description of Technique and Quality Metrics in Simulated Pediatric Out of Hospital Cardiac Arrest (OHCA)
Authors: Karen O'Connell, Jennifer Anders, Camille Anderson, Cyndy Wright Johnson
Journal: Circulation (2023)

Key principles of high-performance CPR (HPCPR) include optimizing rate and depth of chest compressions, and minimizing pauses. Maryland EMS sought compromise to translate existing adult HPCPR protocol to accommodate AHA 15:2 compression: ventilation ratio pediatric recommendations. The resulting “Maryland Hiccup” method of HPCPR delivers 1 ventilation on each upstrokes after compressions 14 and 15, resulting in nearly continuous compressions. We sought to determine how the Maryland Hiccup (MH) style of CPR compares to the standard AHA 15:2 (AHA) style in simulated pediatric CPR performed by EMS clinicians. Methods: Teams of 2-person EMS providers utilized a child -size medium fidelity manikin to perform four-minute cycles of HPCPR. Teams were randomly assigned 2 cycles in either MH or AHA style, then crossed over to the other style. HPCPR performance metrics were compared: compression fraction, no flow time, rate, depth, and ventilation rate and volume using student’s t-test. Results: Thirty-eight clinicians (22 BLS, 16 ALS) participated. Both compression fraction (80% with AHA vs 98% with MH, p &lt; .001) and no flow time (2.79 seconds with AHA vs 0.16 seconds with MH, p&lt;.001) were improved with MH technique. Overall compressions were deeper than the recommended 2 inches or 5 cm, with AHA than MH (63mm vs 60mm respectively, p=0.01, Table 1). No differences were noted in compression rate, ventilation rate or ventilation volume. Conclusions: The Maryland Hiccup style of HPCPR with synchronized ventilations interspersed with chest compressions significantly improves CPR quality metrics in simulated pediatric CPR by EMS clinicians. While the CCF was superior with the MH method (98%), the chest compression depth was shallower than the AHA method by 3mm. How this translates to changes in actual patient outcomes has yet to be determined. Further study is warranted to explore physiologic benefits and patient outcome.
Abstract 13690: Diagnosis of Left Ventricular Hypertrophy on 12-leads Electrocardiogram by Historical Criterion and Machine Learning Models
Authors: Masato Shimizu, Takahiro Tsunoda, Eiko Sakai, Atsuya Shimizu, Yoshiki Misu, Tateishi Ryo, Masao Yamaguchi, Kato Nobutaka, Hiroshi Shimada, Ami Isshiki, Hidetoshi Suzuki, Hiroyuki Fujii, Makoto Suzuki, Mitsuhiro Nishizaki, Tetsuo Sasano
Journal: Circulation (2023)

Introduction: Diagnostic criterion of left ventricular hypertrophy (LVH) on 12-leads electrocardiogram (ECG) were established. We verified them comparing with artificial intelligence (AI) method. Hypothesis: Machine learning on 12-leads ECG show higher diagnostic performance comparing with historical criterion. Methods: First, consecutive 60 patients with LVH were recruited, and one to one matching with age and sex to patients with normal cardiac function was performed. Finally, 120 patients (69.6 ± 12.6years, 38men per group) were enrolled. LVH was defined as at least one LV wall (septum, posterior wall, apex) showed thickness over 15mm on ultrasound echocardiography. No sinus rhythm, and wide QRS cases were excluded. Results: By logistic regression analysis, 77 significant predictors were extracted. Among historical criterion, Cornell voltage showed high accuracy (0.783) and area under receiver operating characteristics curve analysis (AUROC; 0.808). Conversely, among AI methods, light gradient boosting machine demonstrated higher accuracy (0.843) and random forest method higher AUROC (0.882). V2/V2 S-wave amplitude and I/V5 T-wave amplitude played essential roles to build the AI models. Conclusions: AI diagnosis on ECG for LVH showed powerful diagnostic performance comparing historical criterion.
Abstract 16784: Utility of 4D Flow MRI to Quantify Improvement of Left Atrial Hemodynamics Following Cardioversion for Atrial Fibrillation
Authors: Ghaith Zaatari, Pradip M Pattany, Joel Fishman, Michael Markl, Daniel C Lee, Raul Mitrani, Jeffrey J Goldberger
Journal: Circulation (2023)

Background: Cardioversion (CV) for persistent atrial fibrillation (PeAF) restores sinus rhythm (SR) but its effects on left atrial (LA) and LA appendage (LAA) flow are not well established. Research question: Does restoring sinus rhythm improve LA/LAA hemodynamics in patients with PeAF? Aims: To compare changes in LA/LAA 4D flow MRI characteristics post-CV for PeAF versus repeated measurements in a control group without AF. Methods: We performed 4D flow MRI (3T Skyra) in 9 PeAF patients (8 males, age 68±8 yrs, 78% HTN, 44% DM, 22% CAD, CHA2DS2-VASc 2.7±1.5, LVEF 53±17%) prior to and 62±44 days after CV (in SR) (minimum 4 weeks after CV). We also performed repeat MRIs in 9 SR controls (6 males, age 51±11 yrs, 78% HTN, 22% DM, 11% CAD, CHA2DS2-VASc 1.6±0.9, LVEF 62±4%) 60±19 days apart, both in SR (minimum 4 weeks apart). Data analysis included 3D segmentation of LA and LAA for evaluation of atrial velocity data. Absolute atrial velocities were calculated for each voxel and time frame inside the LA and LAA, and used to derive blood stasis (quantified by determining number of cardiac time frames with velocities below a threshold of 20 cm/s, normalized by the total number of cardiac time frames: Stasis%= (Nstasis/ NTotal)*100 ) and median velocity. Results: In PeAF, restoring SR improved 4D flow characteristics by reducing stasis and increasing median velocity (p&lt;0.003, figure). In the controls, there was no significant change in median velocity or stasis % between the two scans in either the LA or LAA. Bland-Altman analysis for the two control scans showed no significant differences in the controls. Pre-CV median velocities and stasis% in PeAF significantly differed from controls while post-CV, they did not. Conclusion: AF is associated with impaired LA and LAA flow characteristics that improve substantially with CV toward control values. Use of 4D MRI to quantify LA and LAA hemodynamic function is feasible; future studies are needed to correlate 4D MRI measurements to thromboembolic risk.
Abstract 15414: Driving Distances and Durations to Nearest Transcatheter Aortic Valve Replacement Center for Medicare Beneficiaries Across Continental United States
Authors: Sohum Kapadia, Miles Shen, Jonathan Hanna, Kevin Wheelock, Lovedeep S Dhingra, Rohan Khera
Journal: Circulation (2023)

Background: Transcatheter aortic valve replacement (TAVR) is a rapidly expanding minimally invasive procedure. Although many centers across the continental US offer TAVR, accessibility is a consideration given extensive pre- and post-procedural care. We examined access to TAVR amongst Medicare beneficiaries across the US. Methods: We identified TAVR providers based on clinician billing records for CPT codes 33361-33369 in the 2020 Medicare provider dataset, available from Centers for Medicare and Medicaid Services. Residential and practice zip codes were identified from national geopolitical data. Across the US, haversine spherical pairwise straight-line distances were computed between all residential and provider zip codes. Based on proximate residential and provider zip code pairs, we used the Google Distance Matrix API to calculate average driving distance and travel time to providers for all residential zip codes. Results: There were 936 TAVR providers across 409 US zip codes, against a total of 29,089 residential US zip codes. Wyoming had no TAVR providers, while Florida had the most (n=69). Median travel duration (minutes) was lowest in the District of Columbia (20 min) and greatest in Montana (282 min). The median [IQR] traveling distance (miles) to the closest TAVR site was lowest in the Northeast (30 [13-55]) and greatest for the West (84 [29-151]), with the Midwest (46 [24-74]) and South (57 [26-90] in between (p &lt; 0.001). The median [IQR] traveling duration (minutes) showed similar trends to distance (Northeast: (38 [22-66]); Midwest: (52 [30-80]); South: (64 [34-97]); West: 91 [40-158]); p &lt; 0.001); Figure 1 ). 75% of zip codes travel a minimum of 30 minutes to the nearest TAVR provider. Conclusions: There are significant regional differences for TAVR accessibility in the US, with extended travel times of over 1 hour for 1 in 2 US zip codes and over 2 hours for 1 in 7 US zip codes to receive standard care.
Abstract 16226: Stressed Out - When Sinus Bradycardia is Not Benign
Authors: Gabriela Narowska, Shreya Makkapati, Lauren Tragesser, Syed M Zaidi, Joshua M Cooper
Journal: Circulation (2023)

Background Sinus bradycardia is often a benign and asymptomatic finding in athletes due to an increased vagal tone. However, when patients develop symptoms of decreased exercise tolerance, this warrants further investigation. We present a case of sinus bradycardia caused by adrenal insufficiency in a high-end athlete with exceptional physical reserve which resolved with treatment of the underlying cause and prevented unnecessary pacemaker implantation. Case Presentation A 44-year-old female athlete with no medical history who at baseline runs ultramarathons and weight lifts presented with severely symptomatic bradycardia. After initial recommendation of pacemaker placement during recent hospitalization, patient sought a second opinion. During her hospitalization, the patient underwent extensive work up including basic laboratory work, TSH, CT angiogram of the chest and TTE - all of which were found to be normal. She also had an exercise stress test and was only able to increase her HR to 50% of age-predicted rate. On further review, she was found to be hypothermic and reported menstrual irregularities, raising suspicion for endocrine abnormalities. Bradycardia, hypothermia and chronotropic incompetence prompted further workup which revealed a depressed cortisol with a low ACTH leading to a diagnosis of adrenal insufficiency. Further imaging revealed a pituitary microadenoma. The patient was referred to endocrinology and started therapy with steroids with resolution of her symptoms and is undergoing evaluation for surgical intervention. Conclusion Sinus bradycardia is a well-recognized occurrence in well trained athletes, caused by an increased vagal tone and is usually a benign finding. In our case, a patient underwent extensive work up for lightheadedness and exercise intolerance in the setting of her bradycardia which was unrevealing with initial recommendation of pacemaker placement. Upon further investigation, increased vagal tone alone was not responsible for severely symptomatic bradycardia and chronotropic incompetence. Notably, a combination of bradycardia, hypothermia, and irregular menses, resulted in work up revealing adrenal insufficiency, ultimately avoiding unnecessary pacemaker implant.
Simultaneous ischemic regions targeting and BBB crossing strategy to harness extracellular vesicles for therapeutic delivery in ischemic stroke
Authors: Huai-Bin Liang, Xiao Chen, Rong Zhao, Shen-Jie Li, Pei-Sheng Huang, Yao-Hui Tang, Guo-Hong Cui, Jian-Ren Liu
Journal: Journal of Controlled Release (2023)
Abstract 18085: Effect of Therapies on Quality of Life in Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis
Authors: Khawaja Hassan Akhtar, Siddharth Agarwal, Lance Ford, Yan Daniel Zhao, Tarun W Dasari
Journal: Circulation (2023)

Introduction: Minnesota Living with Heart Failure (MLWHF) questionnaire is a validated tool to assess quality of life in patients with heart failure with reduced ejection fraction (HFrEF) Hypothesis: We performed this systematic review and meta-analysis to evaluate the effect of therapies on improvement in MLWHF; analyzed across randomized controlled trials (RCTs) of drug based therapy, device based therapy, autonomic modulation, and exercise. Methods: We conducted a systematic search of MEDLINE and EMBASE for RCTs measuring MLWHF at baseline and follow-up in patients with HFrEF. Primary outcome was improvement in MLWHF. Meta-analysis was stratified in groups based on medical therapy, device based therapy (cardiac resynchronization therapy and cardiac contractility modulation), autonomic modulation (vagus nerve stimulation and baroreflex activation therapy), and exercise. Mean difference (MD) with 95% Confidence Interval (CI) were reported across multiple studies included in meta-analysis. Results: A total of 23 studies met the inclusion criteria. Analysis showed statistically significant improvement in MLWHF at follow-up for drug based therapy (MD: -2.77; 95% CI: -5.10, -0.44) (Panel A), device based therapy (MD: -6.86; 95% CI: -9.60, -4.12) (Panel B), autonomic modulation (MD: -15.21; 95% CI: - 19.25, -11.17) (Panel C), and exercise group (MD: -10.05; 95% CI: -16.66, -3.43) (Panel D). Sub-group analyses based on various treatment modalities showed statistically significant improvement in MLWHF at follow-up for cardiac resynchronization therapy (MD: -8.11; 95% CI: -11.88, -4.33), cardiac contractility modulation (MD: -5.47; 95% CI: -9.46, -1.49), and baroreflex activation therapy (MD: -19.79; 95% CI: -24.90, -14.67). Conclusions: Drug based therapy, device based therapy, autonomic modulation, and exercise are associated with improvement in quality of life in patients with HFrEF.
Abstract 15056: The Activation of Angiotensin II Type1a Receptors in the SFO and PVN is Necessary to Prime Immunity in Salt Sensitive Hypertension
Authors: Marialuisa Perrotta, Lorenzo Carnevale, Sara Perrotta, Fabio Pallante, Agnese Migliaccio, GIUSEPPE LEMBO, Daniela Carnevale
Journal: Circulation (2023)

Introduction: Salt sensitive hypertension (HTN) is associated with increased salt intake and elevated activity of the renin-angiotensin system (RAS) in the brain. We have found that DOCA-salt HTN partly depends on a sympathetic-mediated PlGF release in the spleen. Hypothesis: Whether this effect is related to the contribution of RAS signaling in brain nuclei mediating HTN responses is poorly known. We hypothesized that angiotensin type 1a receptors (AT1aR) within the circumventricular organs (CVOs) could mediate DOCA-salt hypertensive responses. Methods: To discriminate between CVOs, we used 3 mouse model with deletion of AT1aR in 3 in brain CVOs. AT1aRfloxed mice were 1) stereotaxically injected with an adenovirus encoding a Cre-recombinase (or GFP as control), directly in the subfornical organ (SFO), or 2) crossed with Sim1Cre+ (and Sim1Cre- as control) mice to delete the gene in the paraventricular nucleus of hypothalamus (PVN) or 3) crossed with Phox2bCre+ (and Phox2bCre- as control) mice to delete the gene in the dorsal motor nucleus of the vagus nerve (DMV). T Results: We implanted mice with pellets of DOCA or placebo, as control, and salt in drinking water for 3 weeks finding that: AT1aRfloxed mice + Virus encoding Cre Recombinase in the SFO and AT1aRfloxed;Sim1Cre+ mice were protected form HTN-DOCA-salt (SFO-SBP mmHg :133±1 vs 106±0,6, ***p&gt;0,0001; PVN-SBP mmHg :144±2 vs 112±2,***p&gt;0,0001 respectively to their controls); whereas AT1aRfloxed;Phox2bCre+ mice had increased blood pressure levels (SBP mmHg :144±1 vs 144±0,7, respectively to control mice). Additionally, deletion of AT1aR in the SFO and PVN attenuated egression of T cells from the spleen and infiltration on target organ with a reduced disruption of renal glomeruli and reduced accumulation of matrix protein in response to DOCA-salt (SFO-Bowman’s size μm 2 1761±150 vs 821±78, respectively, **p&lt;0,001; PVN-Bowman’s size μm 2 3927±212 vs 2805±252, respectively, **p&lt;0,001). Mice KO for AT1aR in the DMV were not protected from organ damage (Bowman’s size μm 2 776 ± 104 vs 1090 ± 94, respectively). Conclusions: ogether, these data indicate that SFO and PVN contribute to blood pressure in the DOCA-salt model of hypertension through AT1aR signaling, while the DMV role was independent from AT1aR.
Abstract 17153: Mitochondrial Cx43 and Gja1-20k Contribute to Sex-Specific Differences of Mitochondrial Response in Septic Cardiomyopathy
Authors: Olufisayo Anjorin, Susan R Scott, Mark Turrentine, Meijing Wang
Journal: Circulation (2023)

Introduction: Cardiac dysfunction contributes to morbidity and mortality of severe sepsis. Preserving mitochondrial (mito) activity is key to maintaining cardiac function. While epidemiological studies consistently report that male sex is an important risk factor for severe sepsis, it is unknown if male heart mito are susceptible to septic injury. We have shown that male cardiomyocyte mito were more vulnerable to TNFα- or H 2 O 2 -induced stress than females. We have also demonstrated that mito connexin 43 (Cx43 or Gja1) and its smaller isoform - Gja1-20k are implicated in sex-related heart response following myocardial ischemia. Hypothesis : In this study, we hypothesize that during sepsis, female (F) hearts exhibit preserved mito Cx43 and Gja1-20k to confer mitochondrial protection, thus improving cardiac function compared to male (M) myocardium. Methods: Age-matched adult M &amp; F C57BL/6 mice received LPS (7.5 mg/kg BW, i.p.) or PBS (n &gt; 6 mice/group). Cardiac function was detected 20h post LPS by 2D echocardiography. Cx43, Gja1-20k, OXPHOS, &amp; PGC-1 were evaluated in M &amp; F mouse heart mito 24h after LPS by Western Blot (n&gt;3 hearts/group). Mito Cx43 was also detected by Immuno-electron microscopy (EM). Mito membrane potential (ΔΨm) was analyzed in cardiomyocytes (from adult M &amp; F mice, n&gt;3 hearts/group) +/- 1h LPS (1 μg/ml) using JC1 fluorescent probe. Mito respiration capacity was further assessed in H9c2 cells transfected with Gja1 siRNA upon LPS exposure by Seahorse XF Mito Stress test. Results: Decreased cardiac function was observed in M mice after LPS injection, but not in F. Higher mito levels of Cx43, Gja1-20k, OXPHOS, &amp; PGC1 were noticed in F mouse hearts compared to M after LPS. Despite no difference in total Cx43 particles between M &amp; F hearts by EM, more gold Cx43 particles were observed in F heart mito compared to M mito following LPS. LPS reduced ΔΨm in M cardiomyocytes, but not in F. Cx43 knockdown decreased mito maximal respiration capacity &amp; ATP production in H9c2 cells with LPS stress. Conclusions: The mitochondria-derived protective mechanism is preserved in F mice, leading to better cardiac function than M mice following LPS-induced sepsis. F cardiac mito are more resistant to LPS challenge than M mito, partially due to preserved mito Cx43 and/or Gja1-20k.
Abstract 12499: The Incidence and Predictor of Persistent Iatrogenic Atrial Septal Defect in Patients Who Underwent Catheter Ablation
Authors: Hiroyuki Kamada, Yasuhisa Iriki, Issei Yoshimoto, Yuichi Ninomiya, Masaaki Miyata, YUKI HAMAMOTO, Yoshihisa Horizoe, Yoshiyuki Ikeda, Mitsuru Ohishi
Journal: Circulation (2023)

Background: The left atrium approach for atrial fibrillation (AF) ablation requires an atrial transseptal puncture that may cause an iatrogenic atrial septal defect (iASD). Aims: This study aims to investigate the incidence and predictor of iASD in patients who underwent catheter ablation. Methods: This retrospective study included 639 patients (489 male; 60.2 ± 10.7 years) who underwent initial catheter ablation for AF between May 2005 and June 2018. All patients received preoperative transesophageal echocardiography (pre-TEE), preoperative transthoracic echocardiography (pre-TTE), and TTE one day after the procedure (post-TTE). TTE 6 months after the procedure (6M-TTE) was performed in 533 patients. The iASD incidence after 6 months, pre-procedure characteristics, and methods were evaluated. Results: Patent foramen ovale (PFO) was diagnosed in 6.6% (42/639) using pre-TEE and detected in 26.2% (11/42) using pre-TTE. Of the 533 patients who underwent 6M-TTE, 497 had no PFO using pre-TEE. iASD was observed in 59.6% (296/497) using post-TTE and 4.6% (23/497) using 6M-TTE. In the multivariate analysis, the total diameter of sheath through the septum (OR 1.21, p &lt; 0.001) or two sheaths placed through a single puncture (OR 4.26, p = 0.001) was the independent risk factor on iASD incidence in 6M-TTE. iASD was more likely to occur in cryoballoon ablation using a larger sheath than radiofrequency catheter ablation. Conclusions: iASD was not a rare complication. A larger sheath diameter or two sheaths placed through a single puncture might be associated with the incidence of iASD. Careful procedural considerations might be required for patients with hemodynamic deterioration by iASD.
Abstract 14284: Anticoagulant Effects of Edoxaban in Cancer and Non-Cancer Patients With Venous Thromboembolism
Authors: Masashi Yoshida, Kazuhiro Kuroda, Koji Tokioka, Kunihiko Hatanaka, Ryohei Fujimoto, Hidenaru Yamaoka, Yutaka Kajikawa, Suruga Kazuki, Hiroki Sugiyama, Tsuyoshi Miyaji, Yoshimasa Morimoto, Nobuhiro Okamura, Naoaki Matsuo, Hiroshi Ito
Journal: Circulation (2023)

Introduction: Edoxaban, a direct oral anticoagulant (DOAC), is established as an anticoagulant medication in the treatment of venous thromboembolism (VTE) and suppression of VTE recurrences. While VTE recurrences in patients with cancer is greater than those in patients with non-cancer in spite of DOACs use, the reason is unclear. Anticoagulant effects of DOACs are not monitored because of less individual variability on their pharmacological effects and a short half-time. Although the plasma concentration of edoxaban correlates with prothrombin time (PT) and activated partial thromboplastin time (APTT) in healthy adults. PT and APTT are prolonged up to 5 hours after administration of edoxaban. Hypothesis: We hypothesized that anticoagulant effects of edoxaban are inhibited in patients with cancer and measured PT and APTT to assess its anticoagulant effects. Methods: This study is prospective observational study conducted in 12 hospitals. Patients with VTE taking edoxaban for treatment were included. PT and APTT were measured at 5-hours after first administration of edoxaban, and also measured at optional time after 7 days and/or 30 days. D-dimer, prothrombin fragment 1+2, and thrombin-antithrombin complex were measured once as coagulation markers. Results: Two hundred forty-three patients were included in the study, and 80 patients were with cancer. PT and APTT were measured at 465 points. PT and APTT at 5-hours after first administration of edoxaban were not significantly different between patients with cancer and non-cancer (17.1 ± 0.4 vs. 16.8 ± 0.3 seconds; PT, 35.1 ± 0.6 vs. 34.5 ± 0.5 seconds; APPT). PT values at 5-hours after first administration were prolonged compared with those at before administration in patients with cancer and non-cancer (13.8 ± 0.6 and 13.8 ± 0.4 seconds; before administration). Other coagulant markers were not significantly different between patients with cancer and non-cancer. Conclusions: Anticoagulant effects of edoxaban do not differ between patients with cancer and non-cancer, and those effects are sufficient. Greater VTE recurrences in patients with cancer may be due to hypercoagulable state by cancer, but not lowering anticoagulant effects of edoxaban.