tbuckley/cabot-search huggingface dataset:
Abstract 310: Early Access to Cardiac Catheterization Laboratory for Patients Resuscitated From Cardiac Arrest Due to a Shockable Rhythm. The Minnesota Resuscitation Consortium Twin Cities Unified Protocol
Authors: Demetris Yannopoulos, Brian Mahoney, Santiago Garcia, Ralph Frascone, Greg Helmer, Charles Lick, Marc Conterato, Kenneth Baran, Steven Roh, Carmelo Panetta, Randall Stark, Mark Haughland, Michael Mooney, Bradley Bart
Journal: Circulation (2013)

Background: Cardiac arrest patients that have been successfully resuscitated from shockable rhythms have a high prevalence of thrombotic and/or flow limiting coronary occlusion regardless of the presence of STEMI on the ECG. In 2012 the Minnesota Resuscitation Consortium (MRC) developed an organized approach for the management of all patients resuscitated from shockable rhythms to gain early access to the cardiac catheterization laboratory (CCL). Methods: Eleven metropolitan hospitals with 24/7 PCI capabilities agreed to provide early (within 2 hours of arrival to the emergency department) access to the CCL for all patients that were successfully resuscitated from VF/VT arrest regardless of the presence or absence of STEMI on the surface ECG. Inclusion criteria were: witnessed or un-witnessed, age &gt;18 and &lt;70, cardiac arrest of presumed cardiac etiology, comatose or conscious patients. Patients with PEA or asystole, known DNR/DNI, non-cardiac etiology, significant bleeding of any cause, terminal disease were excluded. Patient outcomes were recorded in the state database Cardiac Arrest Registry to Enhance Survival (CARES). Results: A total of 202 patients were resuscitated and met the inclusion criteria in 2012. Of those, 158 (78%) patients were taken to the CCL per the MRC protocol. Forty-two (20.7%) were not taken to the CCL. Of the patients that had early coronary angiography a total of 42% received primary angioplasty and had at least one vessel disease. A total of 113/158 (72%) were discharged alive and of those 106/113 (94%) were discharged neurologically intact with a cerebral performance category score of 1 or 2. All comatose patients received therapeutic hypothermia. Of the patients that did not gain early access to the CCL, 17/42 (40.5%) survived to hospital discharge and of those, 14/17 (82%) had normal neurological function [OR: 3.69; 1.82-7.48, p=0.0003]. Conclusions: Enabling early access to the catheterization laboratory after cardiac arrest due to a shockable rhythm was associated with 72% survival to hospital discharge and excellent neurological outcomes in a large metropolitan area and real-life clinical practice. Our results support the need for further outcomes based investigation
Abstract 15846: Disturbed flow-induced p90RSK activation elicits EC dysfunction and atherosclerosis formation via inhibiting de-SUMOylation
Authors: Kyung-Sun Heo, Nhat-Tu Le, Hannah J. Cushman, Carolyn J. Giancursio, Eugene Chang, Chang-Hoon Woo, Jack Taunton, Edward T.H. Yeh, Keigi Fujiwara, Jun-ichi Abe
Journal: Circulation (2013)

Kyung-Sun Heo, 2013 Finalist and Presenting Author
Abstract 362: Behavioral Testing With Morris Water Maze in Rats Resuscitated With Emergency Cardiopulmonary Bypass From 10 Min Ventricular Fibrillation Cardiac Arrest
Authors: Wolfgang Weihs, Florian Ettl, Ingrid A Magnet, Alexandra Warenits, Ursula Teubenbacher, Andreas Hilpold, Johann Sipoetz, Akos Tiboldi, Michael Holzer, Fritz Sterz, Andreas Janata
Journal: Circulation (2013)

Background: Rodent models of cardiac arrest help to investigate detailed pathophysiologic mechanisms of cerebral ischemia and reperfusion. Sensitive neurologic and behavioral tests would enhance the ability of such models to evaluate possible beneficial effects of protective therapies. The Morris Water Maze (MWM) is a procedure to study spatial learning and memory. The aim of this study was to investigate behavioral testing with the MWM in rats resuscitated from ventricular fibrillation (VF) cardiac arrest (CA) via emergency cardiopulmonary bypass (ECPB). Methods: Sprague-Dawley rats (450g, male, anesthetized) were put into VF CA. After 10 min of CA the animals were resuscitated with ECPB, epinephrine and defibrillations and cooled to mild hypothermia (33°C) . Ten surviving animals with favorable neurologic recovery were compared to 8 healthy rats. MWM was performed in each animal 2 times on 4 consecutive days for maximal 60 s with a hidden platform in a 22°C cold water tank and on day 7 and 14 with the platform removed for memory testing. Results: The latency time to find the hidden platform decreased in the CPB group and the control group from 60(IQR 39-60) s and 60(IQR 60-60) s to 9(IQR 6-29) s and 10(IQR 6-19) s respectively (p=0.46). After removal of the platform the time within the target sector on day 7 in 60 s was 17±6 s and 22±5 s (p=0.08) and on day 14 12±4 s and 13±4 s (p=0.76) respectively. Conclusions: Spatial learning and memory in clinical neurologically intact animals resuscitated from a 10 min VF CA cooled to mild hypothermia was comparable to normal healthy controls. With this MWM setup learning was performed well, the remembrance of platform position was kept for one week in both groups equally.
Abstract 12212: Atherosclerotic Plaque Detection with a Fluorescence/Radionuclide Intravascular Imaging System: Comparison of FDG and 6-NBDG
Authors: Raiyan T. Zaman, Hisanori Kosuge, Guillem Pratx, Colin Carpenter, Lei Xing, Michael V. McConnell
Journal: Circulation (2013)

Raiyan T. Zaman, 2013 Finalist and Presenting Author
Abstract 307: Selective Brain Perfusion in Addition to Emergency Cardiopulmonary Bypass Resuscitation After Prolonged Asphyxial Cardiac Arrest: Feasibility Studies in a Novel Rodent Model
Authors: Chih-Hsien Wang, Koichiro Shinozaki, Lance B Becker
Journal: Circulation (2013)

Brief Objectives: Poor neurological recovery is the major limiting factor in the use of emergency cardiopulmonary bypass (ECPB) in cases of refractory cardiac arrest. To better control cerebral perfusion we developed a novel rodent model of selective brain perfusion (SBP) in addition to ECPB resuscitation. We conducted pilot studies on feasibility of this unique approach Methods Male: Sprague-Dawley rats (450-550 gm) were instrumented for ECPB with venous and arterial cannulation. To provide SBP, we additionally cannulated the right common carotid artery (RCCA) and confirmed SBP flow with a Transonic flow probe. First feasibility studies were performed to demonstrate bilateral cerebral flow from unilateral perfusion, and to ascertain tolerability of surgical procedure. To test gross survival effects of SBP in the setting of lethal cardiac arrest, three groups of rats underwent 15 min of asphyxial cardiac arrest followed by resuscitation with 30-min ECPB using 3 different strategies: normothermia with SBP (NT w/ SBP, N=3), hypothermia with SBP (HT w/ SBP, N=3), and hypothermia without SBP (HT w/o SBP, N=3). After: ECPB, rats were weaned off ECPB, wounds were closed, and 4-h mechanical ventilation and IV fluids were provided. Rats were then extubated and checked for neurological score (NS: 0-12), development of gross seizures, and the length of time of survival after extubation until death. Results: To access feasibility, we injected blue dye into the RCCA and we confirmed that single RCCA perfusion could perfuse the whole brain. Sham studies with rats (3) were conducted with full SBP and ECPR instrumentation for 30-min, then the RCCA was ligated, which confirmed that all rats survived without neurological deficits or limb injury for 3 days. In the pilot survival studies, the longest survival after extubation was observed in HT w/ SBP animal (7.0h±3.0), in contrast to both HT w/o SBP (1.1h±0.4) and HT w/o SBP (2.3h±0.9 ). Similar trends for improved neuro score and fewer seizure were observed for the HT w/ SBP animals. Conclusion: Our pilot study showed the feasibility of using brain selective perfusion in a rodent model of highly lethal cardiac arrest. SBP plus hypothermic ECPB trended toward improved survival and neurological outcome and warrants further study.
Abstract 15298: Effects of Transendocardial CD34+ Cell Transplantation on Diastolic Parameters in Patients With Non-ischemic Dilated Cardiomyopathy
Authors: Mojca Bervar, Mirta Kozelj, Gregor Poglajen, Matjaz Sever, Marko Cukjati, Peter Cernelc, Francois Haddad, Joseph C Wu, Bojan Vrtovec
Journal: Circulation (2015)

Introduction: The underlying mechanisms of CD34+ cell therapy in patients with non-ischemic dilated cardiomyopathy (DCM) are poorly defined. Hypothesis: In a substudy of a protocol investigating the clinical effects of transendocardial CD34+ cell transplantation in DCM we sought to evaluate the effects of this therapy on diastolic parameters. Methods: From May 2013 until January 2014 we enrolled 38 DCM patients with NYHA class III and LVEF &lt;40%. All patients underwent transendocardial CD34+ cell transplantation. Peripheral blood CD34+ cells were mobilized by G-CSF, collected via apheresis, and injected transendocardially in the areas of electomechanical missmatch. Patients were followed for 1 year after the procedure. Results: At baseline, diastolic parametes were impaired (E/Em≥15) in 18 patients (Group A), and normal (E/Em&lt;15) in 20 patients (Group B). The two groups did not differ in age (54±9 years vs. 52±10 years; P=0.62), gender (male: 85% vs. 78%; P=0.57), or LVEF (31±7 % vs. 34±6 %; P=0.37). When compared to Group B patients in Group A had more segments with myocardial scar (4.9±2.7 vs. 2.7±2.9; P=0.03). and myocardial hibernation (2.2±1.6 vs. 0.9±1.1; P=0.02) on electroanatomical mapping. The number of injected CD34+ cells was 92.6±45.8 million in Group A, and 139.2±85.3 million in Group B (P=0.08). During follow-up there was an improvement in diastolic parameters in Group A (E/Em: from 24.3±12.1 to 16.3±8.0; P=0.005), but not in Group B (E/Em: from 10.2±3.7 to 13.2±9.1; P=0.19). Accordingly, in Group A, we found an increase in 6-minute walk distance (from 463±83 m to 546±91 m; P=0.03), and a decrease in NT-proBNP (from 2140±1743 pg/mL to 863±836 pg/mL; P=0.02). Conclusions: In non-ischemic DCM, diastolic parametes appear to correlate with areas of myocardial scar and hibernation on electroanatomical mapping. Transendocardial CD34+ cell transplantation may improve diastolic parameters in this patient cohort.
Abstract 14916: Adverse Event Reporting in &gt;48,000 Participants in Four Acute Coronary Syndrome Trials
Authors: André Zimerman, Amanda L Stebbins, Renato D Lopes, Patrícia O Guimarães, Stefan K James, John H Alexander, Pierluigi Tricoci, Matthew T Roe, E. Magnus Ohman, Kenneth W Mahaffey, Claes Held, Brian Tinga, Karen S Pieper, Karen P Alexander
Journal: Circulation (2015)

Background: Adverse event (AE) collection in randomized clinical trials establishes the safety of investigational products. Although costly and regulated, it is rarely a topic of study. Methods and Results: Post-discharge AEs were collected per protocol and classified as serious or non-serious in 48,118 participants from 40 countries enrolled in 4 clinical trials of antithrombotic therapy in acute coronary syndromes (APPRAISE-2, PLATO, TRACER, TRILOGY ACS). Pooled data was used to compare patterns and determinants of AE reporting; study endpoints were excluded. Overall, 46.1% of participants had no AEs, 16.3% had at least 1 serious AE (SAE), and another 37.7% had only non-serious AEs (nsAE). A total of 12,266 SAEs and 72,635 nSAEs were reported. AEs were generally well distributed in most system organ classes, including general disorders (11%), infection (10%), gastrointestinal (10%), respiratory (9%), and other (35%), whereas cardiac events were more common among SAEs (14.0% of SAEs, 8.4% of nSAEs). AE rates, particularly non-serious, were highest after hospital discharge, and decreased rapidly during the following 3 months (Figure 1). Using a Cox proportional hazards model, the independent predictors of having an SAE included older age (HR 1.07, 95% CI 1.05-1.09 for every 5-year increase), female sex (HR 1.11, 95% CI 1.03-1.18), and common comorbidities (HF, COPD, Afib, CKD, DM), while enrollment in Asia (HR 0.84, 95% CI 0.75-0.94) or Eastern Europe (HR 0.63, 95% CI 0.58-0.69) predicted fewer SAEs. Conclusions: Most reported AEs are non-serious, non-cardiac, and reported early in follow-up. The high volume of AEs and the significant variation in SAE reporting across patient characteristics and region of enrollment make efforts to focus the approach to AE collection in large trials warranted.
Abstract 13909: Predicting Factors for Chronic Phase Ventricular Tachycardia in Cardiac Sarcoidosis Under Corticosteroid Therapy
Authors: Tamami Fujiishi, Hidehira Fukaya, Shinichi Niwano, Hironori Nakamura, Tazuru Igarashi, Naruya Ishizue, Takeru Nabeta, Tomoharu Yoshizawa, Jun Oikawa, Shunsuke Ishii, Jun Kishihara, Akira Satoh, Masami Murakami, Junya Ako
Journal: Circulation (2016)

Background: Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Ventricular tachycardia (VT) is frequently observed in cardiac sarcoidosis (CS), which can be sometimes fatal. Corticosteroid therapy is effective for suppression of the lethal arrhythmias with CS, however, the lethal ventricular arrhythmia still occurs even in chronic phase under corticosteroids therapy. In the present study, we retrospectively evaluated the predictors for chronic phase VT in the patients with CS with corticosteroid therapy. Methods: The study population consisted of 37 consecutive patients diagnosed with CS. Corticosteroid therapy was indicated in all patients with a mean follow-up period of 59.9 ± 42.2 months. To exclude the events during unstable acute phase of the therapy, we focused on the occurrence of VT at least 3 months after the initiation of corticosteroids therapy as chronic phase events. Various clinical parameters including echocardiographic parameters, 12-lead electrocardiogram (ECG) and findings of laboratory data at 6, 12 and 24 months after the initiation of corticosteroid therapy, were obtained and compared between patients with and without chronic phase VT (VT and non-VT group). To adjust for the baseline diversity, all data were evaluated as change from baseline data, e.g., ▹QRS calculated by subtracting the baseline QRS duration from the QRS data at each month. Results: Out of the 37 patients, 7 exhibited VT in the chronic phase (19%). In the echocardiographic parameters, VT group showed larger ▹left ventricular end-diastolic diameter (LVDd) in 6 months (5.7±1.5 vs. -1.7±5.3 mm, p=0.028) and 24 months (4.5±1.0 vs. -0.8±7.2 mm, p=0.009) compared with those in the non-VT group (n=30), but there was no significant difference in ▹ejection fraction (EF). In the 12-lead ECG parameters, VT group showed longer ▹QRS in 6 months (30.0±19.8 vs. -6.1±11.2 ms, p=0.001) compared with those in the non-VT group. There were no significant differences in findings of laboratory data including the changes of brain natriuretic peptide (BNP) and angiotensin-converting enzyme (ACE) between 2 groups. Conclusions: Serial changes in echocardiographic parameters and QRS duration may predict chronic phase VT in CS after corticosteroid therapy.
Abstract 191: During Lipid Resuscitation, Lipid-Blood-Fraction Rapidly Transports Radiolabeled-Bupivacaine From Highly Perfused Organs to Liver for Accelerated Processing and Excretion
Authors: Michael Fettiplace, Richard Ripper, Kinga Lis, Adrian Pichurko, Dominic Vitello, Guy Weinberg
Journal: Circulation (2013)

Objective: Lipid emulsions (LE) reverse local anesthetic cardiotoxicity but the mechanism of reversal is not completely understood. We tested the hypothesis that LE accelerates removal of radiolabeled-bupivacaine from highly perfused tissue and transports it to the liver for conjugation and excretion. Methods: Animals were anesthetized using 1.5-2% isoflurane. Jugular veins and right carotid artery were cannulated; a flow probe was hooked around the left common carotid. Flow, pressure and EKG were monitored continuously. Sixty Sprague-dawley rats received a 10mg/kg i.v. bolus of tritium-radiolabeled bupivacaine over 20-seconds with the end of infusion signaling t=0. Animals were assigned to eight sacrifice time-points (t=0.5, 1.5, 2.5, 4.5, 5.5, 8, 12, 60 minutes) and two treatment groups (i.v.LE, null). At t=0.5, animals in the test-group received 10mL/kg i.v.-LE over one minute. After sacrifice, tissues and fluids were collected and analyzed for radiolabeled-bupivacaine concentration. Results: Concentrations in heart, cerebellum, and kidney dropped more rapidly in i.v.-LE-treated animals (Figure 1) while concentrations in blood, liver and urine rose in a sequential order. Elevated whole blood concentration of radiolabelled-bupivacaine was driven by the LE component. The drops in organ concentration were associated with improvements in cardiovascular (CV) parameters (flow, RPP, mean arterial pressure) but improvements in i.v.-LE treated animals were greater than the improvements seen in null animals with comparable cardiac bupivacaine concentrations. Conclusion: The study confirms LE’s ability to sequester bupivacaine in vivo, reducing the concentration in vital organs and elevating liver concentrations. Further it is the first to demonstrate that LE accelerates processing and excretion into the urine. Finally, it builds on a growing body of evidence that LE improves CV dynamics that are beyond the pure removal of bupivacaine for CV tissue.
Abstract 15310: Intracoronary Doppler Flow Velocity and Pressure Derived Hyperemic Microvascular Resistance is Independent of Epicardial Obstruction in Stable Coronary Artery Disease
Authors: Guus A de Waard, Koen M Marques, Sukhjinder S Nijjer, Paul F Teunissen, Peter M van de Ven, Justin E Davies, Paul Knaapen, Niels van Royen
Journal: Circulation (2015)

Introduction: Coronary microvascular function can be assessed invasively by combining measurements of coronary pressure and flow. The index of microcirculator resistance (IMR), obtained using thermodilution derived mean transit time, has conflicting data whether it is influenced by epicardial stenosis severity. For Doppler flow velocity derived hyperemic microvascular resistance (HMR) this has not been investigated. We aimed to explore whether HMR is a microcirculatory specific value. Methods: Simultaneous measurements of intracoronary distal Doppler flow velocity and pressure under hyperemic conditions, were obtained in an obstructed and non-obstructed coronary artery in 45 patients. 68 pairs containing one of the 57 obstructed vessels and one of the 55 non-obstructed vessels were formed. HMR was compared between obstructed and non-obstructed vessels using paired samples T-test and the correlation between HMR in the pairs was tested using the Pearson’s test. These analyses were repeated after excluding 3 patients and 7 pairs in which the obstructed vessel had an FFR &lt; 0.60 - which may suggest collateral flow from different territories was present Results: In the entire cohort, HMR was 2.51±0.88 in obstructed versus 2.40±0.88 mmHg/cm per second in non-obstructed values, was not significantly different (P=0.331). HMR values in the obstructed and non-obstructed vessels were significantly correlated: R=0.491, P&lt;0.001. After exclusion of obstructed vessels with an FFR &lt; 0.60, HMR approached equipoise in obstructed and non-obstructed vessels: 2.41±0.84 vs. 2.40±0.90 mmHg/cm per respectively (P=0.922). The correlation coefficient improved to: R=0.540; P&lt;0.001 after exclusion of vessels with FFR &lt; 0.60. Conclusions: HMR is a microcirculatory specific value that is independent of the presence of a stenosis, especially in vessels not receiving collateral supply. These results indicate that HMR can indeed be used clinically to assess microcirculatory function regardless of the presence of an epicardial coronary stenosis.
Abstract 14940: Determinants of Rehospitalization After Cardiac Surgery in Prolonged ICU Length of Stay Survivors
Authors: Rizwan A Manji, Rakesh C Arora, Rohit K Singal, Brett Hiebert, Alan H Menkis
Journal: Circulation (2015)

Introduction: Determining predictors of rehospitalization of prolonged ICU length of stay (prICULOS) post cardiac surgery (CS) survivors would help inform processes of care in regards to optimization of patients pre-discharge and having additional community supports for this vulnerable population. Methods: Data of CS patients with prICULOS (ICULOS of ≥5 days post CS) from Jan. 1, 2000 to Dec. 31, 2011 was extracted from linked administrative and clinical databases to describe rehospitalization parameters. Regression analysis was used to determine predictors of time to first rehospitalization. Results: Of 9209 CS patients discharged home and alive at 30 days (d), 596 (6.5%) experienced prICULOS. The 30d rehospitalization rate was 109/596 (18.3%) for prICULOS patients vs. 996/8613 (11.6%) for non-prICULOS patients (p&lt;0.01). For the prICULOS cohort, the cumulative rehospitalization rate at 1 year was 44.3%, and the median hospital LOS for readmissions was 7d. The most common reason for rehospitalization was heart failure. Out of 54 prICULOS patients that died within 1 year of discharge post CS, 32 (59%) died in hospital during rehospitalization. Predictors of time to first rehospitalization are in the table. Median time to first hospitalization of patients with the risk factors in the table was 54d compared to a median time of 70d in patients without these factors. Any rehospitalization within 1 year was independently associated with increased risk of death [OR 2.91, p&lt;0.01]. Conclusions: Survivors of prICULOS after CS have a high rate of rehospitalisation and nearly a 3 fold increase risk of death if needing rehospitalisation within 1 year of initial discharge. We have identified 6 independent risk factors associated with rehospitalisation that can be used to optimize patients pre-discharge as well as be used to identify patients that may need closer follow-up in the community to prevent rehospitalization.
Abstract 14982: Comparison of Hybrid Endovascular and Open Surgical Repair for Proximal Aortic Arch Diseases
Authors: Pyung Chun Oh, Woong Chol Kang, Young-Guk Ko, Eak Kyun Shin, Donghoon Choi, Chul-Hyun Park, Young Nam Youn, Do Yun Lee, Jeonggeun Moon, Sihun Kim, Wook-Jin Chung
Journal: Circulation (2015)

Background: To compare the outcomes of hybrid endovascular and open surgical repair for proximal aortic arch diseases. Methods: A total of 55 consecutive patients with an aortic arch aneurysm or aortic dissection involving any of zone 0 to 1 (39 male, age 63.4±14.3 years) who underwent a hybrid endovascular repair (n=35) or open surgical repair (n=20) from 2006 to 2014 were included in a retrospective analysis. Perioperative and late outcomes were compared. Results: The two groups had similar baseline characteristics, except age and EuroSCORE II, which were higher in the hybrid group. Perioperative mortality or stroke did not differ significantly between the two groups, but tended to be lower in the hybrid repair group than in the open repair group (11.4% vs. 30.0%, p=0.144). Incidences of other morbidities did not differ. During follow-up, similar over-all survival was observed between the hybrid group and the open repair group (87.3% vs. 79.7% at 1 year and 83.8% vs. 72.4% at 3 years; p=0.319). However, significantly lower reintervention-free survival was observed for hybrid repair compared with open repair (83.8% vs. 100% at 1 year and 65.7% vs. 100% at 3 years; p=0.022). Conclusions: Comparable perioperative and late outcomes were observed for hybrid endovascular repair of proximal aortic disease compared with open surgical repair, despite a higher reintervention rate during follow-up. Therefore, hybrid repair may be considered as an acceptable treatment alternative to surgery, particularly in patients at high surgical risk.