tbuckley/cabot-search huggingface dataset:
Abstract 9937: Comparison of Aortic Root Dimensions using Multi Slice Computer Tomography and 2D Transthoracic Echocardiography. CARDIA Study
Authors: Joseph Yeboah, Gisela Teixido, David Jacobs, James G Terry, Joao A Lima, Yaorong Ge, Jame Lovato, Stephen Sidney, David Goff, Jeff Carr
Journal: Circulation (2013)

Introduction: Multislice computer tomography (MSCT) is the gold standard for measuring aortic root dimensions; however, in clinical practice 2D transthoracic echocardiography (2DTE) is commonly used to diagnose and monitor aortic root diseases. Limited data exist on the accuracy of the 2DTE approach. We assessed the agreement between MSCT and 2DTE dimensions of the aortic root in middle-aged adults free of clinical aortic diseases who were part of the ongoing Coronary Artery Risk Development in Young Adults (CARDIA) Study. Methods: 2DTE and MSCT were used to measure the aortic root dimensions in 1197 CARDIA participants. The MSCT aortic root dimension was measured on non-contrast enhanced images using 0.5-0.6mm slices reformatted to provide true cross sections perpendicular to the vessel centerline, 3 D Slicer® (planimetered: [ROI pixel count multiplied by unit pixel area]) while the 2DTE aortic root diameter was measured by leading-edge to leading-edge approach [MM mode, Parasternal long axis with aorta and left atrium in view] and the area obtained using π r2. Correlation coefficient and Bland Altman plots were used to assess the agreement between the 2 approaches. Results: Mean age 49.9 ±3.6 yrs, BMI 30.5 ±7.1 kg/m2, LDL-C 110.3 ±33.5 mg/dL, HDL-C 57.3 ±17.4 mg/dL, 52.9% blacks, 45.6% males, 11.1% diabetics, 39.3% former/current smokers and 35.4% had hypertension. Prevalence of aortic root dilation (&gt;4cm) was 1.7% by MSCT and 2.1% by 2DTE. The mean aortic root diameter and area by 2DTE and 3 D slicer® were 3.07 ±0.42 cm and 3.02± 0.33 cm; 8.3± 1.7 cm2 and 7.5 ±2.1 cm2 respectively. The aortic root diameters/ areas by the 2 approaches had a Pearson correlation coefficient of 0.67. In the Bland Altman analysis the bias and limits of agreement for aortic root diameter and area were -0.15 and -0.80 to 0.48 cm; -0.57 and -3.8 to 2.7cm2 respectively. The sensitivity, specificity, PPV and NPV of 2DTE for diagnosing aortic root dilation were 0.43 (0.22 to 0.66), 0.98 (0.976 to 0.991), 0.33 (0.17 to 0.54) and 0.99 (0.982 to 0.995) respectively. Conclusions: The accuracy of 2DTE for aortic root dimensions shows moderate agreement with the MSCT suggesting that there will often be disagreement between these 2 approaches which would have significant clinical and cost implications.
Abstract 9555: Ventricular Geometric Characteristics and Functional Benefit of Mild Right Ventricular Outflow Tract Obstruction in Patients With Significant Pulmonary Regurgitation After Repair of Tetralogy of Fallot
Authors: Chun-An Chen, Ssu-Yuan Chen, Jou-Kou Wang, Wen-Yih I Tseng, Hsin-Hui Chiu, Ming-Chun Yang, Chung-I Chang, Ing-Sh Chiu, Yih-Sharng Chen, Chun-Wei Lu, Ming-Tai Lin, Mei-Hwan Wu
Journal: Circulation (2013)

Aims: Right ventricular (RV) outflow tract obstruction (RVOTO) might protect the RV from adverse remodeling caused by pulmonary regurgitation (PR) in patients with repaired tetralogy of Fallot (rTOF), but the underlying mechanisms and influences on exercise tolerance remain unclear. This study sought to investigate the impacts from mild RVOTO on ventricular remodeling and exercise capacity in rTOF. Methods and results: 85 rTOF patients with a PR fraction ≥ 20% were assessed with cardiac magnetic resonance, cardiopulmonary exercise test, and echocardiography. Comparing to patients with isolated PR (a peak RVOT pressure gradient &lt; 20 mmHg, n = 56), patients with combined PR and mild RVOTO (a peak RVOT pressure gradient 20-50 mmHg, n = 29) had smaller RV and RVOT dimension, better RV and left ventricular (LV) ejection fraction (EF), and superior exercise capacity. PR severity and RV mass/volume ratio were similar between these 2 groups. LVEF was influenced by RVEF only in patients with isolated PR. Smaller RVOT dimension was an independent geometric factor related to smaller RV dimension (P &lt; 0.001) and better RVEF (P = 0.005) in multivariate analysis. Furthermore, mild RVOTO was independently associated with higher percentage of predicted peak oxygen consumption (P = 0.014) and predicted oxygen uptake efficiency slope (P = 0.005). Conclusion: Patients with combined PR and mild RVOTO had better RV remodeling and superior exercise capacity compared to those with isolated PR. Our findings confirm the benefits from mild residual RVOTO support a policy of conservative RVOTO relief at repair.
Abstract 340: Marked Attenuation of Cell Injury by Substrate Availability During Ischemia
Authors: Sathya Velmurugan, Jeejabai Radhakrishnan, Alvin Baetiong, Raúl J Gazmuri
Journal: Circulation (2013)

Background: Ischemic injury in cardiomyocytes results in rigor contracture (reduction of length by approximately one third) and reperfusion injury results in hypercontracture (change of morphology from rod-shaped to round forms). Rapid reoxygenation during reperfusion at high oxygen concentrations during limited substrate availability could augment cell injury. We therefore hypothesized that substrate availability during ischemia delays rigor and delayed and gradual reoxygenation reduces hypercontracture. Then, we compared the effects of normocarbic immediate (NIR) and hypercarbic delayed reoxygenation (HDR) following aglycemic anoxia (AA) and normoglycemic anoxia (NA) in isolated adult rat cardiomyocytes. Methods: The set-up for creating anoxic environment incorporated (i) a gas blender, (ii) equilibration of ischemic buffer with anoxic gas mixture and perfusing the chamber, and (iii) an acrylic hood, constantly flushed with anoxic gas mixture, to cover the chamber on the stage of the microscope. This set-up resulted in PO2 of 0 mmHg constantly over a period of time. The cells were subjected to 15 min of baseline, 45 min of simulated ischemia and 120 min of simulated reoxygenation (AA-NIR, NA-NIR, AA-HDR, and NA-HDR) with or without glucose as a substrate. Results: Substrate availability significantly reduced the occurrence of rigor and hypercontracture (AA vs NA followed by any reoxygenation protocol: p&lt;0.0001, Gehan Breslow survival analysis). Survival from rigor and hypercontracture were not different in AA-NIR and AA-HDR groups while they were significantly higher in NA-NIR compared to NA-HDR group (p&lt;0.0001, Gehan Breslow survival analysis). There was no difference in viability among the groups. Conclusions: Substrate availability during ischemia ameliorates ischemia and reperfusion injury while hypercarbic delayed reoxygenation does not appear to be beneficial.
Abstract 9876: Long-Term Treatment With Sitagliptin Provides Multiple Ultrasonic Manifested Antiatherosclerotic Effects Independent of Diabetic Improvement for Type-2 Diabetics
Authors: Tatsuaki Murakami, Sumio Mizuno
Journal: Circulation (2013)

Background: Diabetes mellitus is thought to be highly involved in complex atherothrombogenic processes, but the long-term antiatherosclerotic therapies in patients with type-2 diabetes mellitus have not been established. We previously demonstrated adverse prognostic impacts of endothelial dysfunction and intima-media thickening. Therefore we assessed hypothesis long-term treatment with sitagliptin, a dipeptidyl peptidase-4 inhibitor recently developed antidiabetic agent, chronically inhibits atherosclerotic progression in patients with type-2 diabetes mellitus. Methods: Thirty-four type-2 diabetic patients with stable coronary artery disease were randomized to group-S where they received sitagliptin (50mg/day), or to group-C where they received enhanced antidiabetic therapy without a dipeptidyl peptidase-4 inhibitor for 2 years. We quantified flow-mediated endothelium-dependent dilation of right brachial artery after transient forearm occlusion (FMD), endothelium-independent dilation of brachial artery after sublingual administration of nitroglycerin (TNG), and intima-media thickness of common carotid artery (IMT) using high-resolution ultrasonography. Changes in FMD, TNG, and IMT were compared between the two groups. Results: Group-S (n=17) manifested good compliance to the long-term treatment and improvements in diabetic and lipid variables represented by HbA1c and LDL after long-term medication of sitagliptin, while there were no improvements in group-C. FMD improved after medication in group-S (from 4.0±1.9% to 6.3±2.7%, p&lt;0.01) but not in group-C (from 4.1±2.0% to 4.0±1.9%, p=0.78). Changes of FMD in group-S did not correlate to those of HbA1c (r= 0.14, p=0.57). TNG (%) remained unchanged in both group-S and group-C. IMT did not increase in group-S (from 1.10±0.35mm to 1.08±0.40mm, p=0.17) but increased in group-C (from 1.09±0.47mm to 1.17±0.48mm, p&lt;0.01). Conclusion: This ultrasonic study suggests that long-term treatment of sitagliptin safely improves endothelial function of brachial artery independent of reversal for diabetic status and reduces progression of wall thickness in carotid artery, which may have beneficial potentials for long-term management of atherosclerosis in type-2 diabetics.
Abstract 249: Neurocardiac Triage: A Classification Scheme to Guide Post Resuscitation Cardiac Arrest Care
Authors: David B Seder, John Dziodzio, Kahsi Smith, Paige Hickey, Brittany Bolduc, Philip Stone, Barbara McCrum, Teresa May, GIlles Fraser, Richard R Riker
Journal: Circulation (2013)

Introduction: We previously described use of the bispectral index (BIS), a processed EEG modality that integrates EEG power, reactivity, and suppression ratio, to assess severity of hypoxic-ischemic brain injury (HIE) very early after cardiac arrest. We now propose a neurocardiac triage model based on bispectral index and coronary risk, and describe patient outcomes accordingly. Methods: Patients from our prospective cardiac arrest database were retrospectively classified by four cardiac risk groups: STEMI, VT/VF with shock, VT/VF without shock, and PEA/asystole. Neurological injury was described by the “BISi”-the BIS score recorded immediately after the first dose of neuromuscular blockade, and classified as mild (BISi&gt;20), moderate (BISi 10-20), or severe (BISi&lt;10). Results: The BISi was determined at (270±186) minutes after resuscitation (ROSC). Thirty-three patients presented with STEMI; 9 of these had severe HIE - 6 later died of neurological and 1 of cardiac causes. Sixteen patients with STEMI had mild HIE: none died of neurological and 1 of cardiac cause. Fifteen patients presented with VT/VF and shock: 5 had severe HIE - 4 died of neurological and 1 of cardiac etiology. Nine patients with VT/VF and shock had mild HIE: none died of neurological and 4 of cardiac etiology. Of 41 patients with VT/VF and without shock, 16 had severe HIE: 10 died of neurological and 2 of cardiac etiology, 22 had mild brain injury - 2 each died of neurological and cardiac causes. Finally, 80 patients had PEA/asystole; 36 of these had severe HIE - 34 died of neurological and 2 of cardiac causes. Thirty-four patients with PEA/asystole had mild HIE - 8 died of neurological and 9 of cardiac causes. Thirty-eight patients in the total cohort underwent urgent cardiac catheterization (CC) - 8 (21.1%) subsequently died of neurological causes; 5 of those 8 were identified as severe HIE by BISi. Of 56 non-STEMI patients with VT/VF (with or without shock), 24 were identified as having mild HIE yet did not undergo urgent CC - 5 (20.8%) of those patients subsequently died of a cardiac cause. Conclusion: A neurocardiac triage model based on early processed EEG and cardiac risk class suggested possible utility in selecting appropriate patients for urgent coronary angiography and PCI after cardiac arrest.
Abstract 95: Cutaneous Complications From Continuous Electroencephalographic Monitoring During Therapeutic Hypothermia After Cardiac Arrest
Authors: Michelle Gossip, Joseph P Ornato, Ferne Alderfer, Charlotte S Roberts, Tanya M Bazemore, Lynn Pettyjohn, Mary Ann Peberdy
Journal: Circulation (2013)

Background: Electroencephalographic (EEG) monitoring, preferably continuous, is a Level I Guideline for patients (pts) treated with therapeutic hypothermia (TH) after cardiac arrest (CA). Skin irritation is a known but infrequent complication of EEG monitoring. TH can decrease cutaneous blood flow which may lead to skin complications at lead placement sites. Hypothesis: Prolonged, continuous EEG monitoring in post arrest pts is associated with cutaneous breakdown. Methods: Retrospective, before and after cohort of 90 consecutive pts undergoing TH after CA with continuous EEG monitoring. Fifty-nine pts from 1-1-12 to 10-21-12 had forehead and scalp prepped with nuprep and Q-tip rub. Silver/silver chloride electrodes were placed by one of nine trained EEG technicians using conducting paste in a 10-20 system configuration. From 10-22-12 to 3-31-13, 31 consecutive pts had modifications to attempt to prevent skin breakdown found during the before phase with the use of hydrodot electrodes, Z-flow pillows, daily inspection of leads with alteration of placement at any sign of irritation, and standard wound care consultation. Multivariate logistic regression using age, sex, race, diabetes, renal failure, smoker, pressor use, inotrope use, total ischemic time (TIT), and duration of electrode placement was performed to determine clinical factors predictive of skin breakdown. Results: See Table. Results are reported as mean [95% CI]. Renal failure was the only clinical variable associated with skin breakdown (p=0.025). Conclusion: EEG electrode related skin breakdown is seen frequently after CA in pts treated with TH even after aggressive attempts to decrease its incidence. Post arrest pts undergoing TH with continuous EEGs should be monitored closely for cutaneous complications.
Abstract 17801: Investigating the Effects of Resveratrol on Chronically Ischemic Myocardium in a Swine Model of Metabolic Syndrome: A Proteomics Analysis
Authors: Ashraf A. Sabe, Ahmed A. Sadek, Nassrene Y. Elmadhun, Michael P. Robich, Frank W. Sellke
Journal: Circulation (2013)

Ashraf A. Sabe, 2013 Finalist and Presenting Author
Abstract 15606: Genome-wide loss-of-function screen identifies SNARE proteins as a central component of programmed cellular necrosis
Authors: John W. Elrod, Greg Davis, April C. Carpenter, Andrew J. Plassard, Jason Karch, Timothy Dwyer, Bruce J. Aronow, Jeffery D. Molkentin
Journal: Circulation (2013)

John W. Elrod, 2013 Finalist and Presenting Author
Abstract 9450: Exercise Reduces Myocardial Doxorubicin Accumulation by Upregulating Multidrug Resistance Protein Expression
Authors: Noah M Gibson, Colin J Quinn, Keith B Pfannenstiel, Alex C Bashore, David S Hydock, Reid Hayward
Journal: Circulation (2013)

Background: The anthracycline antibiotic doxorubicin (DOX) is an effective antineoplastic agent. However, treatment with DOX is associated with a dose-dependent cardiotoxicity that can lead to dilated cardiomyopathy and congestive heart failure. While previous studies have reported that exercise preconditioning can reduce DOX accumulation within the myocardium, the mechanisms are unknown. Members of the ATP binding cassette transporter superfamily, multidrug resistance proteins 1, 2 and 7 (MRP-1. -2, -7) are known to extrude DOX from cells and their expression may factor into the degree of cardiac DOX accumulation and therefore the severity of cardiac dysfunction. We hypothesized that exercise elicits an upregulation of MRP expression, which leads to a reduction in DOX accumulation. Methods and Results: Male Sprague-Dawley rats were randomly assigned to undergo 10-weeks of voluntary wheel running (WR: n=15) or remain sedentary (SED: n=15). Upon completion of 10-weeks, rats were further randomized to receive a 15mg/kg body weight bolus i.p. injection of DOX (WR-DOX: n=8, SED-DOX: n=7) or equivalent volume of saline (WR-SAL: n=8, SED-SAL: n=7). Animals were sacrificed 24-hours following injection and hearts were excised, flushed of blood, and left ventricles were isolated. High performance liquid chromatography was utilized to quantify myocardial DOX accumulation and Western blotting to analyze MRP expression. A significant reduction in DOX accumulation was observed in WR animals when compared to SED (1055±189 ng/g vs. 1284±151 ng/g). When compared to SED-SAL, all groups exhibited an increase in MRP-2 and MRP-7 expression (WR-DOX: MRP-2, 83% increase; MRP-7, 337% increase. SED-DOX: MRP-2, 107% increase; MRP-7, 193% increase. WR-SAL: MRP-2, 99% increase; MRP-7, 179% increase). In addition, MRP-1 was significantly increased in DOX treated groups (WR-DOX: 136% increase. SED-DOX: 79% increase), however, no significant differences were observed with exercise (WR-SAL: 56% increase). Conclusion: An upregulation of myocardial MRP-2 and MRP-7 expression with exercise contributes to a decrease in myocardial DOX accumulation and may result in a subsequent cardioprotective effect. DOX exposure alone also induces an upregluation of MRPs.
Abstract 9949: Prognostic Value of Longitudinal Strain of Right Ventricle in Patients With Stable Coronary Artery Disease
Authors: Wei-Ting Chang, Wei-Chuan Tsai, Yen-Wen Liu, Cheng-Han Lee, Ping-Yen Liu, Ju-Yi Chen, Yi-Heng Li, Liang-Miin Tsai
Journal: Circulation (2013)

Background: Regional strain by speckle tracking echocardiography is an emerging technique and can be used for assessment of right ventricle (RV). The aims of this study were to validate the prognostic value of RV strain as a new index of RV systolic function in patients with stable coronary artery disease. Methods and Results: We recruited 142 patients receiving elective coronary angiography for suspected coronary artery disease (mean age 64 ± 11 years, 113 men). RV lateral wall strain was measured by using speckle tracking echocardiography from apical 4 chamber view. The median follow-up duration for the entire patient population was 23.07 ± 6.58 months. During the follow-up, 21 patients died and 39 patients reached major adverse cardiovascular events. After excluding non-cardiovascular death, patients who died (18, 12.6%) had lower left ventricular ejection fraction (53.61±12.29 vs. 61.13± 14.27 %, p = 0.03 or greater impairment of RV lateral wall strain (-12.29 ±3.26 vs. -17.42± 5.12%, p = 0.01) compared with survivors. Besides, patients who developed arrhythmia had higher rate of right coronary artery involvement (82.9 vs 51.5 %, p = 0.001) or impaired RV lateral wall strain (-12.29 ±3.26 vs. -17.42 ±5.14 %, p = 0.001). Using -18% as a cutoff point for RV strain, patients with strain ≤ -18 % had superior outcome compared to patients with an RV lateral wall strain &gt; -18 % (log-rank X 2 , 9.04 and 6.94 for cardiovascular mortality and arrhythmia events respectively, p = 0.003 for both). After multivariate regression analysis, RV lateral wall strain was an independent prognostic factor for both cardiovascular mortality (hazard ratio 9.24; 95% confidence interval 1.2-71.2; p = 0.03) and arrhythmia (hazard ratio 2.44; 95% confidence interval 1.03-5.8; p = 0.04) (Fig). Conclusions: RV lateral wall strain by speckle-tracking echocardiography is significantly related to long-term cardiovascular outcome and newly developed arrhythmia of patients with stable coronary artery disease.
Abstract 330: Intralipid Rescues Delayed Cooling and Restores Contractions in Ischemia-Stunned Heart Cells
Authors: Jing Li, Sy-Jou Chen, Zuohui Shao, Xiangdong Zhu, Changqing Li, Huashan Wang, Shaun Harty, Michael Fettiplace, Guy Weinberg, Terry L Vanden Hoek
Journal: Circulation (2013)

Introduction: Cooling is a promising treatment for cardiac arrest. However, delayed cooling (DC) can result in loss of protection against ischemia/reperfusion (I/R) injury. We sought to develop drugs that mimic or augment cooling protection. Intralipid (ILP), a soy-based fat emulsion that is widely used in different clinical setting for parenteral nutrition, has been recently introduced as an antidote against local anesthetic-induced cardiotoxicity. In this study, we utilized a stunned mouse cardiomyocyte model to study the effect of ILP on improving contractile function and its potential role in rescuing abnormal contractility. Methods: Cardiomyocytes, isolated from 1-2-day old C57Bl6/J mice were used. Protocols: 1) Stunning: cells were exposed to 30 min simulated ischemia and 90 min reperfusion followed by 10 min isoproterenol (10 μM). 2) ILP treatment: ILP (0.25%) was administered during 90 min reperfusion. 3) Delayed ILP treatment: ILP was given at 20 min of reperfusion. 4) DC: cooling (32оC) was initiated at 20 min of reperfusion and lasted for 40 min, followed by 30 min re-warming. 5) DC + ILP: ILP was given at start of reperfusion for 90 min in DC. The contraction velocity was measured using Matlab software. Akt phosphorylation was analyzed by Western blot. Results: ILP administration at the onset of reperfusion significantly increased the contraction velocity in stunned cells (66.0 +/- 3.9 % vs. 40.6 +/- 1.7%, P &lt; 0.001) and enhanced the cell response to isoproterenol. The contractile function was not recovered when ILP administration was delayed. Intra-ischemic cooling (IC) improved contractile function that was abolished by DC. Co-treatment of ILP and DC significantly enhanced contractility (43.3 +/- 3.0 % vs. 20.1 +/- 3.9 %, P &lt; 0.01). Akt phosphorylation (p-Akt) was increased by ILP, but decreased when ILP was delayed. Similarly, DC attenuated p-Akt which was increased by ILP+DC. This ILP-induced p-Akt was blocked by API-2, an Akt inhibitor. Conclusion: Our results suggest that optimal ILP treatment improved contractile function and contractile preservation that was mediated by Akt in stunned mouse cardiomyocytes. ILP may serve as a therapeutic agent or adjunct agent to delayed cooling in patients after cardiac arrest.
Keys to Early Career Success
Authors: Kathleen A. Dracup
Journal: Circulation (2013)

Nurse scientists often travel diverse and challenging trajectories during their preparation for a productive career in cardiovascular and stroke nursing. Building on that diversity and using the resources available from the American Heart Association, National Institutes of Health, and other organizations to support an early career is a key component of success. In this lecture, we will consider the importance of good mentorship, the qualities to be looked for in mentors, the elements of a successful productive career, and the lessons to be learned and decisions to be made on the way to achieving work-life balance.
Abstract 18584: Alpha-2 Agonist Attenuates Ischemic Injury in Isolated Spinal Cord Neurons
Authors: Kirsten A. Freeman, Ferenc Puskas, Marshall T. Bell, Joshua M. Mares, Michael J. Weyant, Joseph C. Cleveland, David A. Fullerton, Xianzhong Meng, Paco Herson, T. Brett Reece
Journal: Circulation (2013)

Kristen A. Freeman, 2013 Finalist and Presenting Author