tbuckley/cabot-search huggingface dataset:
Abstract 9399: Right Ventricular Dysfunction during Exercise: Potential Markers of Exercise Intolerance in Pulmonary Hypertension
Authors: Ahmad Anjak, Kathy Edelman, Angel LÓpez-Candales
Journal: Circulation (2012)

Background: Development of exercise-induced pulmonary hypertension (exPH) is a clinically important; but poorly characterized hemodynamic event. Even though bicycle echocardiography (BE) has been suggested as a useful non-invasive test to estimate pulmonary artery pressures (PAP) during exercise; simple measurement of pressures appears to be an unreliable approach to detect exPH. Consequently, we queried our BE database to examine if objective parameters of right ventricular (RV) function might be useful in distinguishing abnormal responses to exercise. To accomplish this goal, we identified patients who develop mild exPH and compared them to normal controls. Methods: In this retrospective analysis, we measured RV fractional area change, tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index (RV MPI), and systolic velocity of the tricuspid annulus (TA TDI). All these measures were collected at each stage of the BE protocol from 10 control individuals, and 10 patients who developed mild exPH with estimated exercise PAP of 62 ± 9. Results: Tricuspid regurgitation signal was an unreliable measure to estimate PAP with increasing workloads; however, all objective parameters were collected in all patients at every stage. In control individuals, not only TAPSE and TA TDI increased with each stage but also baseline RV MPI was significantly lower and remained largely unchanged during exercise. In sharp contrast, TAPSE and TA TDI remained largely unchanged (Fig 1 A&amp;B) while the baseline RV MPI not only was higher but also continued to increase with exertion in the mild exPH group (Fig 1 C). Also individuals with exPH were older in age (p value&lt;0.001). Conclusion: Even though age might be an unaccountable variable in this pilot study; our data seems to suggest that objective measures of RV function during BE, might be useful for the assessment of RV response to increasing exercise workloads.
Abstract 9284: Selective Complex Fractionated Electrogram Targeting For Atrial Fibrillation Study (Select AF): A Multicenter, Randomized Trial
Authors: Atul Verma, Prashanthan Sanders, Jean Champagne, Laurent Macle, Girish Nair, Hugh Calkins, David Wilber
Journal: Circulation (2012)

Introduction: This study compared pulmonary vein isolation (PVI) plus generalized CFAE ablation vs PVI plus selective CFAE ablation, specifically areas of continuous electrical activity (CEA)(ClinicalTrials.gov NCT00926783 ). Methods: Patients with persistent/high burden AF (age 63±9 yr, LA size 42±6 mm) were enrolled at 6 centers (n=86) &amp; randomized. For the generalized arm, all CFAE regions with an interval confidence level &gt;7 were ablated followed by PVI. For the selective arm, only those CFAE sites with CEA were ablated followed by PVI. For PVI, all PV antra were isolated with confirmed entrance block. Patients were followed with ECG, &amp; 48-hr Holter every 3 mos. AF symptoms were confirmed by loop recording. The primary endpoint was freedom from AF &gt;30 sec at 1 year. Results: Both generalized &amp; selective CFAE ablation prolonged AF cycle length (26±32 ms vs 22±33 ms, p=0.6). AF termination rates were also similar: 37% for generalized &amp; 31% for selective (p=0.6). In both groups, PVI was achieved after CFAE ablation in all patients. RF duration was significantly less in the selective arm vs the generalized arm (25±21 vs. 40±21 min, p=0.008). However, at 1 year follow-up, freedom from AF/AT recurrence was significantly higher in the generalized vs the selective arm after 1 procedure (59% vs 24%, p=0.005). Looking at AF/AT recurrence post 1st or repeat ablation, freedom from recurrence at one year in the generalized arm was 62%, still higher than 33% in the selective arm (p=0.02). There was a trend towards fewer repeat procedures in the generalized vs selective arm (14% vs 33%, p=0.057). Complications included tamponade (n=1) and a sedation-related event (n=1). Conclusions: In persistent/high burden AF, selective CFAE ablation + PVI results in similar AF cycle length prolongation and termination rates with significantly less RF time. However, long-term freedom from AF/AT is significantly better using generalized CFAE ablation + PVI.
Abstract 91: Pharmacologically Induced Hypothermia Minimizing Shivering Following Cardiopulmonary Resuscitation
Authors: Wei Chen, Shijie Sun, Yinlun Weng, Wanchun Tang
Journal: Circulation (2012)

Background: Therapeutic hypothermia reduces oxygen consumption and ischemic injury following successful resuscitation; thereby improves outcomes. However, all the currently available physical cooling techniques cause severe shivering which increases systemic oxygen consumption, and makes it more difficult to maintain target temperature. In this study, we examined the effects of pharmacologically induced hypothermia with WIN 55, 212-2 on shivering during hypothermia in a porcine model of CPR. Hypothesis: We hypothesized that when WIN55, 212-2 is administered following resuscitation together with surface cooling, it will rapidly reduce the body temperature (BT) without shivering; therefore it is easier to maintain the target temperature. Methods: Ventricular fibrillation was electrically induced and untreated for 7 mins in 21 male swine weighing 35±2kg. Defibrillation was attempted after 5 mins of CPR. The resuscitated animals were randomized to receive the treatment of either WIN 55, 212-2, surface cooling or the combination of WIN55, 212-2 + surface cooling at 5 mins post-resuscitation. The pharmacological cooling was induced by intravenous infused WIN 55, 212-2 (1.0mg/kg/h). The cooling blanket was utilized for surface cooling. The blood temperature, a total dosage of pentobarbital utilization and the incident and duration of shivering during hypothermia were continuously monitored. Results: During hypothermia, the incident and duration of shivering and the total usage of pentobarbital were significantly reduced in WIN55,212-2 and combination groups when compared with surface cooling group (p&lt;0.001). That was associated with more rapidly decreased blood temperature and easily maintained with 32-34°C in the combination group. Conclusions: The shivering during hypothermia is minimized by pharmacologically induced hypothermia with WIN 55, 212-2 alone or together with surface cooling. It may provide a new option for inducing hypothermia.
Abstract 9434: Cancer Risk Estimation from Cardiac Catheterization in Children with Heart Disease
Authors: Jason N Johnson, Christoph P Hornik, Jennifer S Li, Sara K Pasquali, Terry Yoshizumi, Robert E Reiman, Donald P Frush, Kevin D Hill
Journal: Circulation (2012)

Background: Radiation exposure is a concern in children because of their high radiosensitivity, small body size, and cancer risk. We evaluated the effective dose (ED) of radiation from cardiac catheterization to estimate the lifetime attributable risk (LAR) of cancer. Methods: Organ specific radiation doses were measured from conventional angiographic projections using dosimeters placed in 2 anthropomorphic phantoms representing 1 and 5 years of age. We used a proprietary radiation dose calculator developed from the phantom data to determine ED using catheterization fluoroscopy and cineangiography times for 3 patient cohorts (age &lt; 5yrs): those post Norwood operation, heart transplant and ASD device closure. Age- and sex-specific LARs of cancer above baseline were estimated using the approach of the Committee on Biological Effects of Ionizing Radiation (BEIR VII). Results: Eligible children undergoing catheterization between July 2005 and August 2011 were included in the analysis. The cohort consisted of 67 subjects post-Norwood (191 catheterizations, median time since Norwood: 161 days), 10 post-transplant (91 catheterizations, median time since transplant: 88 days) and 12 post-ASD closure (median age at catheterization 3.9 years). ED and LAR of cancer attributable to catheterization are presented for a single catheterization and for cumulative exposure in those cohorts that undergo repeat procedures (table). LAR of cancer varied depending on age at exposure, gender and ED and was &gt; 0.15% for 80% of all procedures. Adjusting for ED and age at exposure, the median LAR of cancer was twice as high in females vs. males (p&lt;0.01). Conclusion: Cardiac catheterization can result in radiation exposure that increases LAR of cancer to up to 6% above baseline in select populations. These data highlight the need for limiting radiation dose in females, children with normal life expectancy and children that require repeat catheterizations.
Abstract 92: Prehospital Activation of an Emergency Department Cardiac Arrest Response Team Improves ROSC and Hypothermia Utilization
Authors: Nathan Deal, Meredith Borak, Janet Karol, Willard W Sharp, Atman P Shah, David G Beiser
Journal: Circulation (2012)

BACKGROUND: The induction of therapeutic hypothermia (TH) in comatose survivors of out-of-hospital cardiac arrest (OOHCA) improves survival and neurologic recovery outcomes. Despite results from high-quality randomized control trials and international consensus statements, TH utilization rates remain low. Pre-hospital activation of specialized care teams improves outcomes at trauma, ST-segment elevation myocardial infarction, and stroke receiving centers. We hypothesized that pre-hospital activation of a cardiac arrest response team would augment Emergency Department resuscitation resources and thus improve TH utilization and outcomes for out-of-hospital cardiac arrest patients. METHODS: An emergency department cardiac arrest response team (eCART) comprised of a cardiology fellow, pharmacist, respiratory therapist, hospital chaplain, and a therapeutic hypothermia expert (“Dr. COOL”) was created at an urban academic hospital. The eCART team was immediately activated by emergency department staff after receiving EMS radio notification of an arrest transport. We compared outcomes in consecutive adult OOHCA patients during the 8 month period before (PRE) and after (POST) instantiation of the eCART activation system. RESULTS: Clinical characteristics of patients in the PRE (n = 46) and POST (n = 63) intervention periods were similar. The CART activation system was utilized for 97% of OOCHA cases presenting to the emergency department. Rate or return of spontaneous circulation (ROSC) was significantly higher during the POST vs. PRE period (37% vs. 17%, p &lt; 0.05). Initiation of TH in eligible patients was also significantly higher during the POST vs. PRE period (100% vs. 80%, p &lt; 0.05). No difference in the time from ROSC to TH goal temperature &lt; 34 degrees Celsius (201 min +/- 125 vs. 212 min +/- 81, p &gt;0.05) or cardiac catheterization laboratory utilization (43% vs. 50%, p &gt; 0.05) was noted between POST and PRE periods respectively. CONCLUSION: Pre-hospital activation of an eCART team is associated with improvements in ROSC rate and tended to increase TH utilization. These results suggest that rapid deployment of a specialized cardiac arrest response team to the emergency department may be an effective strategy for improving OOHCA resuscitation.
Abstract 9207: Zofenopril and Ramipril Plus ASA in Post-myocardial Infarction Patients With Left Ventricular Systolic Dysfunction: A Post-hoc Analysis in Preserved or Impaired Left Ventricular Fraction at Entry
Authors: Claudio Borghi, Ettore Ambrosioni
Journal: Circulation (2012)

Introduction: in the randomized, double-blind, parallel-group, multicenter, international SMILE-4 Study zofenopril 60 mg plus acetyl salicylic acid (ASA) was more effective than ramipril 10 mg plus ASA 100 mg in reducing 1-year occurrence of major cardiovascular (CV) events in patients with acute myocardial infarction (AMI) complicated by left ventricular dysfunction (LVD). Objective: to compare zofenopril and ramipril efficacy in combination with ASA in a subgroup of patients of the SMILE-4 with preserved (&gt;40%) or impaired (≤40%) left ventricular ejection fraction at the time of enrolment in the study. Methods: the SMILE-4 was a phase IIIb, randomized, double-blind, parallel-group, multicenter, European study comparing the safety and efficacy of zofenopril 60 mg/day and ramipril 10 mg/day plus ASA 100 mg/day, in patients with LVD (clinical signs of heart failure or a left ventricular ejection fraction or LVEF &lt;45%) following AMI. We analyzed the 1-year combined occurrence of death or hospitalization for CV causes. Information on LVEF at baseline was available in 710 out of the 716 patients of the intention-to-treat population. Results: in the main study population the primary outcome was significantly reduced by zofenopril vs. ramipril (odds ratio, OR and 95% confidence interval, CI: 0.70, 0.51-0.96; p=0.028). Overall, 448 (63.1%) patients had preserved and 262 (36.9%) impaired LVEF at baseline. In the first group, the rate of major CV events was significantly lower under zofenopril than under ramipril (22.5% vs. 32.8%; OR: 0.60, 0.39-0.91; p=0.016). This was the case also for the group of patients with impaired LVEF, though between-group difference was not statistically significant (37.7% zofenopril vs. 44.4% ramipril; OR: 0.77, 0.47-1.26; p=0.297). The reduction in the risk of major CV events was significantly larger (p=0.019) in patients with preserved LVEF at baseline. Conclusions: this retrospective analysis of the SMILE-4 Study confirmed the superiority of zofenopril plus ASA as compared to ramipril plus ASA in the prevention of long-term CV outcomes. The benefit was particularly evident in subjects with preserved left ventricular function at study entry.
Abstract 9254: Race Differences in Ventricular Remodeling Among College Football Players: Implications for a Cardiovascular Screening Program
Authors: Shanon Peter, Francois Haddad, Olivia Hulme, Armaghan Gomari, Jonathan Myers, Vic Froelicher, Euan Ashley
Journal: Circulation (2012)

Objective: Intensive athletic training is associated with increased cardiac ventricular mass and volume. We sought to investigate the hypothesis that African American (AA) football players remodel with a greater mass-to-volume (M:V) ratio than their Caucasian counterparts. We also sought to compare diastolic and systolic function between the two groups. We finally examined the correlation between precordial ECG voltage and M:V ratio. Methods: All entering Stanford Division I football players (81 Caucasian and 39 AA) over a 5 year period underwent cardiovascular screening with history, physical exam, ECG and focused echocardiogram. Comparison of remodeling and functional indices plus ECG voltage parameters was performed using Student’s t-test and multivariable logistic regression analysis adjusted for body size, resting blood pressure and field position. Results: Compared with their Caucasian counterparts, AA football players had on average higher LV mass index (77 ± 11 vs. 71±11 g/m 2 , p=0.009), higher relative wall thickness (0.31 ± 0.04 vs. 0.24 ± 0.20, p&lt;0.001) and higher mass to volume ratio (1.18 ± 0.16 vs. 1.06 ± 0.09 g/mL, p&lt; 0.001). AA football players had lower early diastolic tissue Doppler velocity (18 ± 2 vs. 19 ± 2 cm/s, p=0.043). There were no significant differences in systolic indices of LV ejection fraction or velocity of circumferential shortening. AA players showed significantly greater precordial voltage on QRS spatial vector magnitude score consisting of |V2-S| + |V5-R| (31.9 vs. 27.0 mV, p = 0.002). There were no significant relationships between M:V and net voltage. Conclusion: College footballers of African ancestry exhibit more physiologic concentric ventricular remodeling, lower early diastolic annular velocities and increased ventricular voltage when compared to Caucasian FP. These findings may be important in deriving race specific indices of ventricular remodeling for use in screening college athletes.
Abstract 9349: Asymptomatic Left Ventricular Apical Ballooning as a Potential Risk Factor in Patients with Nontraumatic Subarachnoid Hemorrage
Authors: Takanao Mine, Ikuo Sato, Hideyuki Kishima, Tohru Masuyama
Journal: Circulation (2012)

Background: The degree of consciousness impairment at onset in patients(pts) with non-traumatic subarachnoid hemorrhage (NSH) has been found to be closely related to prognosis. Pts with NSH sometimes present with ECG abnormalities or asymptomatic left ventricular apical ballooning (A-LVAB), however risk stratification in pts with NSH still remains unknown. We investigated whether ECG abnormalities and A-LVAB could provide additional risk stratification in patients with NSH. Methods: We studied 73 pts (51 females, mean age 69±15 yrs) without a history of heart disease. Neurological grade (Hunt and Kosnik grade) and clinical factors were evaluated. The standard 12-lead ECG and echocardiography were performed within 48 hours after the onset of NSH. ECG abnormalities were defined as abnormal Q wave, ST elevation, ST depression, T-wave inversion, giant T-wave inversion or QT prolongation. We assessed A-LVAB using echocardiography. Results: Intervention therapy (clipping 52pts, embolization 11pts) was performed in 63 of 73 patients and 8 of 73 patients (11%) died in the first month after the onset of NSH. A-LVAB was present in 6pts (8%). Death was significantly associated with intervention therapy (p=0.0002), neurological grade (p=0.0003) and A-LVA (p&lt;0.0001), while ECG abnormalities were not significantly associated. Neurological grade (p=0.0326) and A-LVAB (p=0.0107, hazard ratio 39.134, 95%CI 2.341 to 654.185) were independently associated with death. Conclusion: Asymptomatic left ventricular apical ballooning could provide additional risk stratification in the acute phase of patients with non-traumatic subarachnoid hemorrhage.
Abstract 9117: Changes in Left Ventricular Diastolic and Left Atrial Function One Month After Transcatheter and Surgical Aortic Valve Replacement in Severe Aortic Valve Stenosis
Authors: Kenji Harada, Jun Tanaka, Hasan Jilaihawi, Jasminka Stegic, Niraj Doctor, Mohammad Kashif, Mamoo Nakamura, Tarun Chakravarty, Raj Makkar, Shiota Takahiro
Journal: Circulation (2012)

Background: In the randomized Placement of Aortic Transcatheter Valves (PARTNER) trial, the NYHA functional class was improved at 1 year in both the transcatheter aortic valve replacement (TAVR) and the surgical bioprosthetic aortic valve replacement (SAVR). However, more patients in TAVR than in SAVR had a reduction in symptoms at 30 days. As part of a single center PARTNER trial experience, we compared left ventricular (LV) and left atrial (LA) function in patients after TAVR with those with SAVR for the treatment of severe aortic valve stenosis at one month follow-up. Methods and Results: A total of 83 severe aortic valve stenosis patients with preserved LV systolic function (EF &gt; 40%) and without moderate or severe valvular regurgitation were included in the study: 52 patients underwent TAVR and 31 patients underwent SAVR. Echocardiographic parameters were similar between the two groups. In each group, LVEF and peak early diastolic mitral annular velocity (e') increased significantly at one month follow-up. The ratio of peak S-wave to D-wave from pulmonary vain flow (PVS/PVD) was higher in the TAVR group as compared with the baseline, while there is no significant difference in SAVR group. LV end-diastolic dimension (LVEDD), left atrial area (LAA), the ratio of early transmitral flow velocity (E) to e' (E/e') and LV mass index significantly decreased as compared with baseline in each group (Table 1). There were no significant differences between the two groups in LVEDD, EF, LAA, PVS/PVD, e', E/e' and LV mass index one month after the procedure. At one month follow-up, however, the changes (post minus pre) of LAA, PVS/PVD, e' and E/e' were significantly larger in the TAVR group than the SAVR group (Table2). Conclusion: In patients with severe aortic stenosis, both TAVR and SAVR improved LV systolic and diastolic function and LA function one month after intervention. In particular, the improvement after TAVR appeared to be greater than after SAVR.
Abstract 9203: Relationships Among Left Ventricular Geometry, Arterial-Ventricular Stiffening and Insulin Resistance in Childhood Obesity
Authors: Kenji Harada, Yukiko Harada
Journal: Circulation (2012)

Background: Insulin resistance has been implicated in the mechanism of cardiovascular dysfunction in adulthood obesity. However, few studies have examined insulin resistance and cardiovascular function in overweight/obese children. The purpose of this study is to assess the relationship between arterial-ventricular stiffness and cardiovascular risk factors in children. Methods: Echocardiography was performed in 146 children aged 7 to 15 years (BMI 18 to 34 kg/m2). Left ventricular (LV) end-diastolic volume, LV mass, transmitral peak flow velocity (E), and mitral annular myocardial velocity (Em) were measured. LV mass/volume ratio was calculated. Stroke volume (SV) was measured using aortic diameter and pulsed Doppler velocity profile. SV was indexed for body surface area (SVI). Effective arterial elastance (Ea) was estimated by end-systolic pressure/SVI. End-systolic elastance (Ees) was calculated by a modified single-beat method. End-diastolic elastance (Ed) was calculated from Doppler indices reflective of atrial pressures (E/Em) and the diastolic filling volume (SV). High sensitive C-reactive protein (hs-CRP), fasting glucose, insulin, and homeostasis model assessment for insulin resistance (HOMA-IR) were also assessed. Results: Ea, Ees, and Ed all increased significantly with BMI(r = 0.33, 0.26, and 0.34, p &lt; 0.01, respectively). LV mass/volume ratio was positively associated with increased BMI (r = 0.48, p &lt; 0.01). There were significant relationships between BMI and fasting glucose (r = 0.20, p &lt; 0.05), insulin (r = 0.61, p &lt; 0.01), HOMA-IR (r = 0.64, p &lt; 0.01), and hs-CRP (r = 0.41, p &lt; 0.01). Ea, Ees, Ed, and LV mass/volume ratio correlated significantly with insulin(r = 0.34, 0.28, 0.27, and 0.36, p &lt; 0.01, respectively) and HOMA-IR (r = 0.31, 0.24, 0.23, and 0.35, p &lt; 0.01, respectively). No significant relationships were observed between LV mass/volume ratio and arterial-ventricular stiffness and hs-CRP. Conclusions: Insulin resistance, concentric LV hypertrophy, and combined arterial-ventricular stiffening may contribute to the increased prevalence of later cardiovascular diseases.