tbuckley/cabot-search huggingface dataset:
Abstract 18562: Severity of Posterior Coaptation Displacement of the Anterior Mitral Leaflet Contributes to Irreversibility of Mitral Regurgitation Following Left Ventricular Assist Device Placement
Authors: Shuichi Kitada, Tomoko S Kato, P. Christian Schulze, Maryjane Farr, Suzanne D Conwell, Hiroo Takayama, Ulrich P Jorde, Marco DiTullio, Yoshifumi Naka, Donna M Mancini, Shunichi Homma
Journal: Circulation (2012)

Background The usefulness of concomitant mitral valve surgery at the time of left ventricular assist device (LVAD) placement has not been fully elucidated. We investigated factors associated with irreversibility of mitral regurgitation (MR) after LVAD surgery. Methods We reviewed 61 consecutive patients undergoing continuous-flow LVAD placement at Columbia University between 2007 and 2010. Echocardiograms within 2 weeks before and 1 week after surgery were analyzed. Irreversibility of MR was defined as the persistence of moderate or severe MR after LVAD placement. We evaluated clinical characteristics and echocardiographic parameters including left ventricular (LV) dimension, left atrial area (LAA), and the mitral leaflet configuration quantified by posterior (D P ) and apical (D A ) displacement of the coaptation point of anterior mitral leaflet (AML). (Figure) The change ([[Unable to Display Character: ⊿]]) of each parameter before and after LVAD placement was also calculated. Results Fifty-six patients (92.9%) showed a reduction of LV dimension after LVAD placement. Thirty-three patients (54.1%) had moderate to severe MR before surgery. Among those, 5 patients (5/33, 15.2%) underwent concomitant mitral valve repair at the time of LVAD placement, and 19 patients (19/33, 67.9%) showed only mild or less MR due to mechanical unloading by LVAD, but 9 (32.1%) still had at least moderate MR. The [[Unable to Display Character: ⊿]]LV end-diastolic dimension was correlated with [[Unable to Display Character: ⊿]]D P and [[Unable to Display Character: ⊿]]D A (r=0.408, p=0.002, r=0.468, p&lt;0.0001, respectively). Pre-operative echo-parameters associated with irreversibility of MR were LV end-diastolic and systolic dimensions, LAA and D p . Multivariate analysis revealed that only D p was significantly associated with irreversible MR (HR 1.278, 95%CI 1.015-1.610, p=0.037). Conclusions Pre-operative echocardiographic severe posterior coaptation displacement of the AML may predict irreversibility of MR following LVAD placement, and could help identify patients that might benefit from MV repair.
Abstract 18358: Active Aging and Self-Management of Cardiovascular Medications
Authors: Susan Swanlund
Journal: Circulation (2011)

The rising population of community-dwelling older adults in the United States (US) independently administers an average of five to seven different medications per day. Problems associated with cardiovascular medication self-management include increasing adverse effects and failed symptom management, both possibly leading to hospitalization. Objectives: The objective of this research was to explore lifestyle patterns and characteristics and their influence upon successful cardiovascular medication management as perceived by adults over age 65. Methods: Guided by naturalistic inquiry, two qualitative exploratory studies were conducted in different US geographical locations. Each study's methodology consisted of qualitative interview sessions with 19 older adults living in community-based settings. Results: Inductive data analysis from the first group of participants revealed the themes of organization in daily living, being active and perceiving oneself as healthy as important in medication self-management. Data analysis from the second study revealed parallel findings, with the inclusion of some potential barriers to successful medication self-management: unorganized or inactive lifestyles. Results from both of these studies indicate that older adults whose lifestyle patterns reflect activity and organization are more likely to be successful with their medication self-management than those whose lifestyle patterns reflect inactivity or unorganization. Participants from both studies provided examples of methods to maintain order and remain active despite physical limitations. Older adults' descriptions of themselves as healthy equated with mobility and activity and descriptions of themselves as unhealthy centered on immobility and weakness. Conclusions: Through their scheduled days, older adults who accomplished the goals of exercise, social interaction, and taking care of self and others to remain independent were more successful in their medication management processes than those who did not exhibit these characteristics. This information is important to cardiovascular health care professionals as they educate and encourage older adults about health promotion activities and self-management of medications.
Abstract 18610: Mitochondrial Transfer Restores Endothelial Dependent Vasodilation
Authors: Vahagn A Ohanyan, Christopher L Kolz, Suzanna Logan, Liya Yin, Giacinta Guarini, Yeong-Renn Chen, Chwen Lih Chen, Yuh Fen Pung, James P Hardwick, William Chilian
Journal: Circulation (2012)

Although endothelial dysfunction is a hallmark of vascular disease, the mechanisms underlying this impairment are unknown. Recently, impaired mitochondrial function was observed in vascular pathologies with endothelial dysfunction; yet a causal link between mitochondrial and endothelial function is not established. We sought to establish this link by demonstrating that restoration of mitochondrial function rescues endothelium-dependent dilation in a model of endothelial dysfunction (metabolic syndrome). Initially, we evaluated activities of mitochondrial complexes I-IV in aortas), and endothelial-dependent dilation (isolated, perfused mesenteric small arteries [MA’s], 289±32 µm, id) in Zucker Obese Fatty (ZOF) and Zucker Lean (LN) rats. Activity of complex I, II, III, or IV (per mg/mitochondrial protein) was lower (56%, 65%, 72% or 59% reduction, respectively) in ZOF than LN (P&lt;0.05). Dilation to the endothelium-independent agonist, nitroprusside (NP) was equivalent in LN and ZOF rats suggesting normal smooth muscle function. Dilation to vasoactive intestinal peptide (VIP, endothelium-dependent agonist) in LN was completely blocked by L-NAME (10 -4 M) (Figure 1). Dilation to VIP was markedly compromised in ZOF (Figure 1). To acutely restore mitochondrial function, mitochondria from livers of lean rats were isolated, labeled with Mitotracker, administered into the perfusion circuit, and “transferred” into the endothelium of MA’s of ZOF via electroporation (confirmed by Mitotracker fluorescence). Thirty minutes after electroporation, dilation of mitochondria-treated vessels (ZOF+Mito) was restored to near normal levels (Figure 1, ZOF+Mito vs LN) and significantly greater than untreated ZOF. Dilation to NP was unaffected by transfer (not shown). These results suggest that mitochondria play a key role in endothelial function, and that treatment regimens for vascular disease should consider mitochondrial directed therapies.
Abstract 18309: Wireless Electrocardiographic Transmission with <i>e</i> -Activation of PCI Team and Reconstructed System of Care Shortens Door-to-Balloon Time in Acute Myocardial Infarction
Authors: Wei-Tien Chang, Chee-Ming Lee, Li-Chin Chen, Chih-Hung Wang, Chiao-Hao Lee, Bey-Jing Yang, Li-Fen Yang, Chuen-Den Tseng, Jiunn-Lee Lin, Shyr-Chyr Chen, Kuan-Yu Hung, Ming-Fong Chen
Journal: Circulation (2011)

Background: Early reperfusion of the occluded coronary artery is the first priority in the treatment of acute ST-elevation myocardial infarction (STEMI). Time to primary percutaneous coronary intervention (PCI) can be shortened by improved system of care. Electronic transmission of electrocardiogram (ECG) to cardiologist's cell phone enables earlier activation of the PCI team. We therefore sought to improve the door-to-balloon (DTB) time by e -technologies and reorganized system of care. Methods: An ECG system capable of wireless cell phone transmission and e -activation of PCI team (Fig 1A) was introduced to a university medical center in Dec., 2009. The processing of STEMI patients was also reorganized, including performance of ECG at the triage of emergency room (ER) with immediate physician's confirmation, e -transmission of ECG to cardiologist's cell phone with e -activation of the PCI team, standardized ER treatment with prompt transportation to catheterization lab, packaged PCI instruments, and integrated care at the catheterization room. The door-to-ECG (DTE), door-to-door (DTD) and DTB times of STEMI were recorded. The achievement rate of DTE &lt; 10 min, DTD &lt; 60 min and DTB &lt; 90 min were also analyzed. Comparison was made between 2009 and 2010. Results: Sixty one STEMI patients eligible for PCI in 2009 and 62 in 2010 were included. After implementation of the above system, the rate of DTE &lt; 10 min was increased from 55.7% in 2009 to 90.3% in 2010 ( P &lt; 0.001). The rate of DTD &lt; 60 min was raised from 50.8% to 85.5% ( P &lt; 0.001), and rate of DTB &lt; 90 min raised from 65.6% to 88.7% ( P &lt; 0.01). The average DTE, DTD and DTB times were also significantly shortened (all P &lt; 0.001, Fig 1B). Conclusion: Electronic ECG transmission to cell phone enables early notification of STEMI and rapid activation of PCI team. Combined with reconstructed in-hospital system of care, these altogether lead to shortened DTE, DTD and DTB times, better compliance with the guidelines and improved quality of care.
Abstract 18325: Pentraxin3 is Associated with Markers of Endothelial Cell Injury Hypercoagulable State and Severity of Peripheral Arterial Disease in Diabetic Subjects
Authors: Eman A El Eter, Abeer A Al Masri, Laila Al Dokhi, Nervana Bayomy, Reem Sallam, Mohamed Al Omran
Journal: Circulation (2011)

Pentraxin3 (PTX3) was reported to be expressed in atherosclerotic plaques and high levels were seen in patients with atherosclerosis, however, its role in atherosclerosis needs to be further elucidated. In the present study we measured PTX3 levels in diabetic patients with peripheral atherosclerotic diseases (PAD) and investigated its relation to markers of endothelial dysfunction, severity of PAD using ABI, and platelet function. Data was collected from 118 patients and 20 control subjects, at KKUH. Fasting blood samples were used for measuring, blood sugar, triglesrides, ICAM-1, VCAM-1, PTX3, P-selectin, and fibrinogen. Ankle brachial index (ABI) was measured for all subjects. PTX3 was significantly elevated in patients with PAD compared to control healthy subjects. Markers of endothelial dysfunction (ICAM-1, VCAM-1 and P-Selectin) as well as fibrinogen were higher in patients with PAD compared to controls. These parameters correlated positively with PTX3 suggesting strong association of PTX3 with disease process, however, doesn't provide a causal link. Using multiple regression analysis with PTX3 as a dependent factor and other variables as independent, showed that fibrinogen followed by VCAM-1 is the most determinant factors influencing PTX3. An indirect association of PTX3 was found, with severity of peripheral vascular disease measured by ABI. As PAD is associated with hypercoagulable state, we investigated effect of PTX3, in vitro, on platelet aggregation, by incubating whole blood from healthy donors with PTX3 at different conc. A significant inhibition of platelet aggregation was seen at a conc of PTX3 of 200-400 ng/ml. This inhibition was ameliorated as concentration was increasing. These results might suggest PTX3 as a counter-regulatory molecule rather than inducer in atherosclerosis and its complications. Further investigations are required to study effect of PTX3 on platelet function and vascular smooth muscle cells.
Abstract 9251: Increasing Prevalence and Decreasing Mortality in Pulmonary Hypertension Related Hospitalizations in the United States: An Analysis of Over 20,000 Hospital Admissions
Authors: Joseph W Rossano, Matthew A Crystal, David L Morales, Daniel E Graves, Brian D Hanna, George B Mallory
Journal: Circulation (2011)

Introduction: Pulmonary hypertension (PH) is a serious but uncommon disorder. However, few large scale data exist on the prevalence or mortality associated with PH hospitalizations in children. Risk factors for hospital mortality are also unknown. Hypothesis: The prevalence of pediatric PH admissions has increased, but the mortality has decreased, over the 7-year period from 2000 - 2006. Methods: A retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database was performed for pediatric (age ≤ 20 years) PH related admissions for the years 2000, 2003, and 2006. The database is a nationwide sampling of pediatric hospital discharges and is weighted to provide national estimates. Results: In 2000 there were 7,348 (95%CI 6,176 to 8,521) pediatric PH related admissions and in 2006 there were 9,378 (95%CI 8,068 to 10,687) admissions (p&lt;0.001). Congenital heart disease was the most common associated diagnosis in all years (range 46.5% to 50.4%). Bronchopulmonary dysplasia (BPD) with PH increased over time from 4.2% in 2000 to 10.2% in 2006 (p&lt;0.001). Several comorbidities increased over time including sepsis, acute renal failure, and respiratory failure (p&lt;0.05 for all). Overall hospital mortality was greater for patients with PH (6.2%) compared to patients without PH (0.4%) (OR 17.7, 95%CI 16.1 to 19.4). Mortality for PH patients decreased over time from 7.7% in 2000 to 4.8% in 2006 (p&lt;0.001). Mortality was greatest among infants (8.2%), those with BPD (9.5%), respiratory failure (19.9%), renal failure (38.2%), and with extracorporeal membrane oxygenation (ECMO) (34.1%). On multivariable analysis, factors associated with increased mortality included earlier year (OR 2.0, 95% CI 1.6 to 2.5), respiratory failure (OR 4.5, 95% CI 3.6 to 5.7), ECMO (OR 4.8, 95% CI 3.1 to 7.4), and acute renal failure (OR 6.3, 95% CI 4.2 to 9.4). Conclusions: There were 2,000 more PH related hospitalizations in children in 2006 than in 2000. Comorbidities increased over this time period; however, hospital mortality decreased over 60%. These findings have critical implications for pediatric hospital utilization and planning. Increased off-label application of PH pharmacotherapeutic agents may have contributed to the improved survival.
Abstract 19554: Cardiologist Involvement in Heart Failure Hospitalizations is Associated with Reduced Rates of Readmissions and Increased Severity of Illness
Authors: Anna Griffin, Craig Strauss, Stephanie Rutten-Ramos, Ross Garberich, Casey Lawler
Journal: Circulation (2012)

Background: Congestive Heart Failure (CHF) is the most common cause for hospital readmission in patients over the age of 65 years. Whereas, efforts to reduce readmission rates have focused on transitions of care and short-term outpatient follow-up, limited data exist on the impact of specialist care during the index admission in reducing readmission rates. Methods: All CHF admissions between January 1, 2009 and December 31, 2011 were identified retrospectively by primary discharge codes. Patient demographics, length of stay (LOS), time to readmission, all patient refined diagnosis related groups (APRDRG), hospital attending at time of discharge, and total hospital costs were abstracted and analyzed based on the attending provider at discharge. Because traditional methods for standardization/transformation of data were insufficient to adjust for patient APRDRG, bootstrapping was employed. Results: Among 2311 patients (median age 75, 49.9% male), 1505 (65%) patients were treated by a Hospitalist attending, whereas, the remaining 808 (35%) patients were treated by a Cardiologist attending. 535 (23.2%) patients were readmitted within 30 days of discharge. Readmission rates were significantly lower when the attending was a cardiologist as compared to a hospitalist (16.0% [95% CL: 12.3%, 20.8%] vs. 27.1% [95% CL: 24.9%, 29.4%]; p&lt;0.001). The APRDRG geometric mean for patients with a cardiologist either as consultant or attending was 1.80 (95% CL: 1.74, 1.87) and 1.02 (95% CL: 0.98, 1.05) for those without (p&lt;0.001), indicating cardiologists were seeing higher severity cases. Median LOS was similar between attending cardiologists and hospitalists (4.8 days vs. 4.2 days; p=0.60). Adjusting for APRDRG, mean total costs for patients treated by a cardiologist were higher than those treated by a hospitalist ($9850 [95% CL: $9614, $10093] vs. $7741 [95% CL: $7560, $7926]; p&lt;0.001). Conclusions: Reduced rates of hospital readmissions despite an increased severity of illness among patients with a cardiologist as the attending compared to those with a hospitalist attending highlights the value of specialized care in heart failure treatment. Additionally, total costs for patients treated by cardiologists are likely over-stated due to interventional charges.
Abstract 17956: Serpin Treatment Reduces Inflammation in Transplanted Temporal Artery Biopsy Specimens from Patients with Suspected Giant Cell Arteritis in Immunodeficient Mice
Authors: Hao Chen, Donghang Zheng, Erbin Dai, Liying Liu, Hazem Samy, Nancy Staples, Thomas Beaver, Phil Hess, Thomas Martin, Charles Klodel, Sally Ryden, Cornelia M Weyand, Westley Reeves, Robert Thoburn, Eric Sobel, Alexandra R Lucas
Journal: Circulation (2011)

Background - Giant cell / temporal arteritis (GCTA) is a severe inflammatory vasculitic syndrome (IVS), which causes arterial occlusion and sudden loss of vision. Treatment for IVS remains limited. Intra-aortic full thickness implants of human TA biopsy and left internal mammary artery (LIMA) specimens were surgically engrafted into the abdominal aorta of immunodeficient SCID mice as a new model for analyzing development of vascular inflammation, as well as response to new treatments. Serp-1 is a myxomaviral-derived serine protease inhibitor (serpin) that blocks thrombotic and thrombolytic protease pathways, arterial inflammation, and plaque growth. Serp-1 was recently tested in acute coronary syndromes (ACS), where reduced markers of myocardial damage were detected after stent implant. Objective - We assessed the effects of Serp-1 or saline treatment on inflammatory cell invasion and plaque growth after TA and LIMA engraftment in NOD-SCID mice. Results - Normal arterial (LIMA) specimens were harvested during bypass surgery and implanted into 24 SCID mice. Half the mice had saline (N=12) and half had Serp-1 treatment (N=12). In each group 6 mice had 5x106 peripheral blood mononuclear cells (PBMCs) infusions from the same patient as the donor LIMA graft, given immediately postop by tail vein and 6 had no cell infusion. TA grafts from patients with suspected GCA were implanted into a separate group of 24 SCID mice - 12 mice had saline (100µl) and 12 Serp-1 (100ng/g/100µl) treatment (one i.v. injection followed by daily i.p. injection for 10 days). in each treatment group 4 mice had infusion of non-matched PBMCs. At 4 weeks LIMA (P &lt; 0.034) or TA (P &lt; 0.0001) grafts, had significantly reduced plaque growth with Serp-1 treatment when human PBMC were also infused (p&lt;0.05). In the absence of PBMC, Serp-1 had minimal effect. Mononuclear cell invasion was reduced in Serp-1 treated mice with PBMCs. Flow cytometry did not detect significant changes in splenocytes. Conclusions - Aortic implant of human LIMA or TA xenografts in SCID mice provides a physiological model for investigating inflammatory vasculitis. With PBMC infusion, treatment with the myxomaviral Serp-1, reduced inflammatory cell invasion and plaque growth in arterial xenografts.
Abstract 18001: Shear Stress-Induced Endothelium-Dependent Dilation of Mouse Coronary Arteries is Caveolae-Dependent
Authors: Qiang Chai, Hon-Chi Lee
Journal: Circulation (2011)

BACKGROUND: Shear stress-induced dilation (SSD) is an important vascular endothelial function that is impaired in diseases such as diabetes mellitus. Caveolin-1 is the major structural protein required for the formation of endothelial caveolae, where signaling molecules and pathways are assembled. In this study, we hypothesized that SSD of mouse small coronary arteries (MCA) is caveolae-dependent. METHODS: MCA (80-130 μm) freshly isolated from WT and Cav-1 knockout (KO) mice were mounted in a vessel chamber, pressurized at 80 mmHg, pre-contracted to 60-80% baseline diameter with endothelin-1, and subjected to physiological levels of shear stress at 25 dyn/cm 2 using a microinjection pump coupled to a pressure servo controller. SSD was measured by videomicroscopy and expressed as % of maximum diameter measured in the absence of Ca 2+ . Donor (intact WT or KO) and detector (WT with no endothelium) vessels were mounted in separate chambers connected by a micropipette. Diabetes mellitus was produced by streptozotocin (STZ) injection. RESULTS: SSD of MCA is significantly diminished in KO mice. 25 dyn/cm 2 produced 92.9±1.2% SSD in WT but only 42.0±0.7% in KO (n=10 for both, *p&lt;0.05). Removal of endothelium reduced SSD to 22.3±3.3% in WT and to 14.9±1.3% in KO (n=8 for both, * vs. intact vessels but not WT vs. KO). Inhibition of eNOS (L-NAME), PGIS (Indocin), and CYP monooxygenase (SKF525A) reduced endothelial-dependent SSD by 44%, 34%, and 21% respectively in WT (all * vs control) but had no effect in KO, suggesting deficiency in shear stress-induced generation of vasodilators in KO. This is confirmed by the significant reduction in SSD in detector vessels with KO serving as donors (*42.0±0.7%, n=6 vs. 64.3±6.4% n=4, WT donor). With diabetes, MCA from WT and KO lost the ability for SSD (WT 25.9±2.4%, n=6 and KO 24.4±2.3%, n=5), which was similar to the effects of endothelium denudation. CONCLUSION: Integrity of caveolae is critical for endothelium-dependent SSD in MCA. KO endothelium is deficient in shear stress-mediated generation of vasodilators including NO, PGI 2 , and EET. Diabetic MCA have impaired endothelial function with loss of SSD. Caveolae plays a critical role in endothelial signal transduction from shear stress to vasodilator production and release.
Abstract 18593: Impact of National Screening Intervention on AHA's ‰Life's Simple Seven Cardiovascular Metrics
Authors: Caitlin Johnson, Fatima Rodriguez, Yun Wang, JoAnne Foody
Journal: Circulation (2012)

Background: Recent AHA recommendations promote 7 CV health metrics: not smoking; being physically active; having normal blood pressure, blood glucose and total cholesterol levels, and weight; and eating a healthy diet to reduce CV morbidity and mortality. As few studies have explored interventions to promote these "Simple 7", we examined the impact of a national screening program on CV health metrics in women. Methods: In 2009, Sister to Sister provided free CV screenings in 12 cities nationwide to 9,443 women, all of which were offered enrollment into a 6-month follow-up survey study. Using data collected from baseline and 6-month surveys on CVD risk, we measured changes in “Simple 7” health metrics (excluding diet) following screening intervention. Results: A total of 1,869 women enrolled into the study, 400 of which completed baseline and 6-month surveys. Among those completing both surveys, we observed significant overall improvement in risk scores between screening intervention and 6-month follow-up (3.8 vs. 4.2, p&lt;0.001). We observed improvements 4 of the 6 health metrics measured (Table 1), although only blood pressure improvements were statistically significant. Conclusion: Screening intervention was effective in improving overall health of women at 6-months, based on optimal CV health metrics. Screenings were particularly effective in improving blood pressure control. Although larger studies are needed to further assess the impact of CV screenings on health metrics, our study suggests that screenings may serve as an effective model to promote CV health metrics, especially among women.