tbuckley/cabot-search huggingface dataset:
Abstract 219: Systolic Blood Pressure on ER Arrival and its Impact on In-Hospital Mortality in Patients With Acute Heart Failure
Authors: Yasuyuki Shiraishi, Shun Kohsaka, Hiroaki Miyata, Masashi Takahashi, Atsutoshi Takagi, Kazumasa Harada, Takamichi Miyamoto, Kiyoshi Iida, Shuzou Tanimoto, Tetsuo Sakai, Naoki Sato, Ken Nagao, Takeshi Yamamoto, Morimasa Takayama
Journal: Circulation (2013)

Background: Evaluating patients with acute heart failure (AHF) in ER is still a significant challenge. Accurate management of AHF is a time-dependent event and the triage process must be initiated immediately once the symptoms of HF are identified. However, detailed clinical information is often unknown in patients presenting with AHF. Large controlled trials conducted on chronic heart failure have identified therapies that improve clinical outcomes. In contrast, few large and randomized AHF trials have been conducted over the last 2 decades, and few significant predictors and treatments are available for AHF. Purpose: To determine whether the ER assessment information could be used to predict patients’ acute outcome. Methods: We extracted data of patients admitted with acute HF from Tokyo CCU Network database (TCND) from 2005 to 2007. TCND collected information of patients who were emergently admitted to acute cardiac care facilities from 62 participating hospitals in the Tokyo metropolitan area. We identified 2220 patients who were admitted for AHF. AHF was defined as a rapid onset or change in the signs and symptoms of HF, resulting in a need for urgent therapy. Patients with ACS were excluded from this analysis. A logistic regression analysis was performed to detect the predictors of in-hospital mortality. Results: The patients were predominantly elderly (74.4±12.6) and male (55.1%). There were 154 (6.9%) in-hospital deaths. Significant predictors of in-hospital death were age (OR 1.02; p&lt;0.001), history of chronic lung disease (OR 2.06; p=0.02), and systolic blood pressure values on presentation (OR 3.12; p&lt;0.001 for SBP &lt;90mmHg, and OR 0.64; p&lt;0.001 for SBP 90-130mmHg). Conclusion: Systolic BP on presentation was the key indicator for AHF risk stratification, and it was inversely correlated with in-hospital mortality.
Abstract 19218: Are the Guidelines Recommendations Followed in the Clinical Practice in Patients With Atrial Fibrillation Undergoing Coronary Stenting?
Authors: Albert Alonso, Antonia Sambola, Maria Mutuberria, Bruno Garcia, Jose A. Barrabes, David Garcia Dorado
Journal: Circulation (2013)

Background: Patients with atrial fibrillation (AF) undergoing coronary stenting (CS) have an increased risk of bleeding due to the combination of dual antiplatelet therapy (DAPT: aspirin and clopidogrel) with anticoagulation (TT:triple therapy). The use of TT is a class IIb recommendation of the ACC/AHA/ESC guidelines. Other recommendations such as the use of drug eluting stent(DES), radial approach and closure devices in femoral access are preferred. Objective:to assess adherence in clinical practice to triple therapy, vascular access, the use of closure devices and the type of stent implanted. Methods: a multicenter study from 2007 to 2011 identified patients with non-valvular AF submitted to CS. In the included patients the risk associated to TT in terms of use and duration of TT, vascular access, and DES were assessed. Results: We identified 640 consecutive patients with AF, 320 (50%) of them were ≥75 years. Among them, 224 (35.2%) had CHADS2 score &gt; 2, 46(73%) CHA2DS2VASc&gt;2, and 164 (25.6%) had a high bleeding risk (HASBLED&gt;3). In 328 (51.3%) a radial approach was chosen.At discharge, 321 (50.2%) patients received TT, 44(6.9%) warfarin plus clopidogrel and 275(41.3%) DAPT. During follow-up, 63 patients(9.8%) died for any cause, and 46(7.2%) because of a cardiovascular cause. 116(18.1%) had a bleeding event, and 37(5.8%) of them were major bleedings. A major adverse cardiac event(MACE: death, acute myocardial infarction and/or target vessel failure) occurred in 111(17.3%) patients and major adverse event (MAE: MACE and/or major bleeding) in 190(29.7%). A multivariate analysis identified as predictors of cardiovascular mortality the age(OR: 1.05; 95%CI 1.00 to 1.11, p=0.043), renal failure(OR 6.24; 95% CI 2.77 to 14.06, p=0.01), and the use of warfarin plus clopidogrel(OR 4.62; 95%CI 1.68 to 12.7, p=0.03).The use of DES, used arterial approach or the use of closure device were not predictors. Conclusions: In patients with non-valvular AF submitted to CS guidelines recommendations are not always followed in clinical practice. In these patients, the use of warfarin plus clopidogrel is associated to a higher cardiovascular mortality, while other recommendations such as the use of DES, arterial access approach or closure devices did not seem have effect.
Abstract 232: Temperature Profile of Esophageal, Rectal and Tympanic Temperature Probes in a Rodent Model of Cardiopulmonary Bypass Resuscitation from Ventricular Fibrillation Cardiac Arrest
Authors: Ingrid A Magnet, Florian Ettl, Wolfgang Weihs, Alexandra Warenits, Daniel Grassmann, Michael Wagner, Ursula Teubenbacher, Johann Sipötz, Fritz Sterz, Andreas Janata
Journal: Circulation (2013)

BACKGROUND: Exact and valid temperature measurement is crucial to assess the effects of temperature levels on outcome after cardiac arrest (CA). In this study, we assessed the temperature profile in different body locations in our rat ventricular fibrillation (VF) CA model with emergency cardiopulmonary bypass (ECPB) resuscitation. METHODS: Adult Sprague-Dawley rats (400g) were equipped with esophagus (Tes), tympanic (Ttym) and rectal (Trec) temperature probes along standard instrumentation. Following 10 min of VF CA, rats were randomized to normothermic control (NT, 37±0.5°C), mild hypothermic (MH, 33±0.5°C) or deep hypothermic (DH, 27±0.5°C) reperfusion and put on ECPB for 15 min. On ECPB rats were rapidly cooled to and maintained at target temperature. After ECPB and return of spontaneous circulation (ROSC), MH and DH were maintained mild hypothermic with surface cooling/warming. Temperature profiles for the first five rats in the DH group are presented as mean±SD, variances tested by ANOVA and post-hoc Tukey analysis. Results: Before CA, all rats were normothermic with all three probes and cooled passively by 0.8±0.6°C during CA. In the MH and NT group, no differences in temperature measurements were found during the entire experiment, whereas in the DH group, temperature profile of the three probes significantly differed, which is presented below. With start of ECPB, cooling rate was significantly higher according to Tes (2.5±0.7°C/min) versus Ttym (1.4±0.6, p=0.44) or Trec (0.6±0.2, p=0.002) and target temperature reached by Tes within 2.8±1.0 min, but only in two animals by Ttym (4.5±0.7 min) and not at all by Trec. Rewarming rate to mild hypothermia at the end of ECPB did not vary significantly between probes (0.12±0.02) and was reached by 33±4 min. CONCLUSION: Even in a small animal model, temperature differs significantly in measurement locations. But what is true brain temperature? In future studies, measurement of brain temperature might be indicated.
Abstract 231: The Effect of Dispatcher Call Processing Interval and Ambulance Response Interval for Survival From Cardiac Arrest
Authors: Malin Ljunggren, Maaret Castrén, Katarina Bohm
Journal: Circulation (2013)

Introduction: Out-of hospital cardiac arrest (OHCA) affects millions of people in the world annually but the survival rate is low. Survival from OHCA has been associated with the ambulance response interval, but not demonstrated to be associated with the dispatcher call processing interval. We assessed the hypothesis that the dispatcher call processing interval and the ambulance response interval were related to survival from OHCA. Aim: To describe the dispatcher call processing interval and the ambulance response interval and their association with 30-day survival from OHCA with ventricular fibrillation (VF) or ventricular tachycardia (VT) as the presenting rhythm. The secondary aim was to investigate the association to the secondary outcome measure 1-day survival. Methods: This retrospective cohort study included 400 witnessed OHCAs with VF/VT as the presenting rhythm in Sweden between February 2005 and January 2009. The patients were randomized to different types of telephone-instructed cardiopulmonary resuscitation in accordance with the previous study (TANGO) which the current study is based on. Patients that the ambulance personnel did not attempt to resuscitate, children below 8 years of age, and OHCAs caused by trauma, airway obstruction, drowning or intoxication were excluded. Logistic regression models were used to investigate the association between survival and the intervals. Results: The odds of survival were increased when the dispatcher call processing interval (median = 1 minute) was shortened from ≥ 4 minutes to 2-3 minutes (OR 3.8; CI 1.03-14.3) and 0-1 minutes (OR 1.9; CI 0.5-7.1, after adjusting for differences in baseline characteristics (overall p=0.026). The odds of survival were increased when the ambulance response interval (median = 8 minutes) was shortened from ≥ 11 minutes to 5-10 minutes (OR 2.1; CI 0.94-4.7) and 0-4 minutes (OR 4.5; CI 1.8-11), after adjusting for differences in baseline characteristics (overall p=0.026). Conclusions: Survival from out-of-hospital VF/VT is increased, not only by shortening the ambulance response interval, but also by shortening the dispatcher call processing interval.
Abstract 19205: Most Hospitalized Patients With Elevated Cardiac Troponin Levels Die From Non Cardiac Causes
Authors: John K French, Thomas Briffa, Bernadette Aliprandi-Costa, Bridie Carr, David Brieger
Journal: Circulation (2013)

Cardiac troponins (Tn) have major prognostic importance as bio-markers in acute coronary syndromes (ACS). However during hospitalizations, Tn levels are often assayed in patients who do not have an acute coronary syndrome. To examine the prognostic implications of elevated Tn levels in patients with and without cardiovascular disease, survival at 12 months among 251,944 patients admitted in the period 2006-8 to public hospitals in NSW, Australia, was linked to measured troponin levels and their ICD-109 diagnostic code. In total 171,253 patients (68%) had a cardiovascular ICD code (CVD100-199) and 80,691 (32%) had a non-CVD code. Troponin positivity was defined as ≥ 1X the upper reference limit (URL) for the troponin T or I assay used at each institution. In total, of troponin positive patients at 12 months, 3,120 (33%) who had a CVD code had died whereas 6,205 (67%) of patients with a non CVD code had died. The hazard ratios for mortality among patients who were ‘troponin positivity’ and had non-CVD codes, adjusted for age and gender, were 2.0 [1.09-2.01] and for CVD codes 100-199 was 2.5 [2.3-2.7]. Among troponin positive patients with non-CVD admission diagnoses, the three most frequent causes of death at 12 months were: 1) diseases of the respiratory system, and 2) neoplasia, and 3) injury, poisoning and or external causes. In conclusion, among a large cohort of patients admitted over a two year period to public hospitals in NSW, Australia, more troponin positive patients with a non-CVD ICD code died at 12 months than those with an CVD code for their admission. Non cardiac disease is a common cause of elevated troponin levels and it has significant adverse prognostic consequences.
Abstract 19211: The Relationship Between Anatomical and Functional Coronary Artery Disease Severity and Transmural Myocardial Blood Flow Distribution
Authors: Ibrahim Danad, Pieter G Raijmakers, Hendrik J Harms, Martijn W Heymans, Niels van Royen, Adriaan A Lammertsma, Mark Lubberink, Albert C van Rossum, Paul Knaapen
Journal: Circulation (2013)

Objectives: To determine the impact of lesion severity as assessed by the fractional flow reserve (FFR) on the transmural perfusion gradient (TPG) using H215O positron emission tomography (PET) imaging in patients evaluated for coronary artery disease (CAD). Background: Myocardial ischemia occurs principally in the subendocardial layer, whereas conventional myocardial perfusion imaging provides no information on the transmural myocardial blood flow (MBF) distribution. Methods: Sixty-six patients evaluated for CAD were prospectively enrolled and underwent H215O PET imaging for quantification of TPG. Subsequently, invasive coronary angiography was performed and FFR obtained in all coronary arteries irrespective of the PET imaging results. Results: Thirty (45%) patients were diagnosed with significant CAD (i.e. FFR ≤ 0.80), whereas on a per vessel analysis (n=198), 53 (27%) displayed a positive FFR. Hyperemic MBF decreased significantly from 3.09 ± 1.16 to 1.67 ± 0.57 mL·min-1·g-1 (p &lt; 0.001) in nonischemic and ischemic myocardium, respectively. The TPG decreased during hyperemia as compared with baseline (1.20 ± 0.14 vs. 0.94 ± 0.17, p&lt;0.001), and was lower in arteries with a positive FFR (0.97 ± 0.16 vs. 0.88 ± 0.18, p&lt;0.01). A TPG threshold of 0.94 yielded anc accuracy to detect CAD of 59%, which was inferior to transmural MBF with an optimal cutoff of 2.20 mL·min-1·g-1 and an accuracy of 85% (p &lt; 0.001). Conclusions: Cardiac H215O PET imaging is able to detect TPGs and demonstrates a significantly lower hyperemic TPG in ischemic myocardium. However, the diagnostic accuracy of TPG seems to be limited compared to quantitative transmural MBF.
Abstract 13741: Neurologic Injury and Cerebral Blood Flow In Single Ventricles Throughout Staged Surgical Reconstruction
Authors: Mark A Fogel, Tom Pawlowski, Christine Li, Peter Schwab, Felice Wilson, Susan Nicolson, Lisa Montenegro, Laura Diaz-Berenstein, Thomas Spray, J William Gaynor, Stephanie Fuller, Christopher Mascio, Marc keller, Matthew Harris, Kevin K Whitehead, Okan Elci, James Bethel, Daniel Licht, Arastoo Vossough
Journal: Circulation (2016)

Introduction: Single ventricle pts experience a high rate of brain injury and adverse neurodevelopmental outcome. Hypothesis: The incidence of brain abnormalities is different at various surgical stages and is linked with cerebral blood flow (CBF), oxygen delivery and carbon dioxide reactivity. Methods: Single ventricle pts were studied with MRI scans immediately prior to bidirectional Glenn (pre-BDG), prior to Fontan and then 3-9 months after Fontan reconstruction. Results: 168 consecutive subjects recruited into the project underwent 235 scans: 63 pre-BDG (4.8±1.7 months), 118 BDG (2.9±1.4 years) and 54 after Fontan (3.4±1.1 years). Non-acute ischemic white matter changes on T2 weighted imaging, focal tissue loss, punctate microbleeds and ventriculomegaly were all more commonly detected in BDG and Fontans compared to pre-BDG (see figure); punctate microbleeds were also more common in Fontan than pre-BDG (P&lt;0.05). CBF was higher in BDG than Fontan and almost reached statistical significance versus pre-BDG (see graph). The odds of discovering brain injury adjusting for surgical stage as well as 2 or more co-existing lesions within a patient all decreased (63-97% and 44% respectively) with increasing amount of CBF (P&lt;0.05). In general, there was no association of oxygen delivery or carbon dioxide reactivity with neurological injury. Conclusion: Significant brain abnormalities are commonly present in single ventricle pts and detection of these lesions increase as children progress through staged surgical reconstruction with multiple co-existing lesions more common earlier than later. Cumulative exposures to surgery may account for increased incidence, though changes in brain maturation may increase detection of white matter injury. In addition, an inverse association of various indices of CBF with these brain lesions is present (CBF highest in BDG stage), however, CO 2 reactivity, oxygen delivery were not associated with brain lesion development.
Abstract 19432: Difference in Outcomes After Repeat Percutaneous Coronary Intervention for Sirolimus-Eluting Stent Restenosis Lesions With or Without Stent Fracture
Authors: Yasunari Sakamoto, Toshiya Muramatsu, Reiko Tsukahara, Yoshiaki Ito, Hiroshi Ishimori, Keisuke Hirano, Masatsugu Nakano, Masahiro Yamawaki, Motoharu Araki
Journal: Circulation (2013)

Background: Presence of stent fracture (SF) after sirolimus-eluting stent (SES) implantation has reported to be associated with an increased risk of in-stent restenosis and target lesion revascularization (TLR). Incidence of SF and the relevance to cardiovascular events are previously reported. But little is known about the outcomes after repeat percutaneous coronary intervention (PCI) for SES restenosis lesion with SF. So this study compared the outcomes after repeat PCI for SES restenosis lesion with or without SF. Method: From April 2007 to September 2011, total 2020 lesions implanted SES during PCI at our hospital. Total 148 lesions, 7.3% had restenosis (defined as % diameter stenosis &gt;50%) in follow up angiogram. Of the restenosis lesion, 107 lesions went to TLR those consisted of 75 lesions with repeat DES implantation and 32 lesions with balloon angioplasty alone. SF was defined as complete or partial separation of the stent as assessed by plain fluoroscopy and detected in 61 lesions of SES restenosis lesions. Thirty-three SES restenosis lesions with SF (SF group) and 42 SES restenosis lesions without SF (non SF group) were retrospectively evaluated re-restenosis rate during follow up after repeated implantation of DES. Result: Baseline characteristics were similar. One-year cumulative incidence of re-restenosis after repeat DES implantation for SF group and non SF group which calculated by Kaplan-Meier method were 68% and 36% (Log-rank test P=0.0332), respectively (figure). Conclusion: Restenosis lesions with SF had significantly high incidence of re-restenosis after repeat DES implantation.
Abstract 13978: Response to Isoproterenol Infusion may Predict Procedural Success Following Ablation for Atrial Fibrillation
Authors: Takashi Kanda, Masaharu Masuda, Masashi Fujita, Osamu Iida, Shin Okamoto, Takayuki Ishihara, Kiyonori Nanto, Akihiro Sunaga, Takuya Tsujimura, Shota Okuno, Yasuhiro Matsuda, Koji Yanaka, Takuya Ohashi, Hiroyuki Kawai, Aki Tsuji, Yosuke Hata, Masaaki Uematsu
Journal: Circulation (2016)

Introduction: Atrial fibrillation (AF) trigger elimination, such as pulmonary vein (PV) isolation, is one of the major procedural endpoints in AF ablation. We have previously found that the ectopies with short coupling interval (CI) more likely initiate AF, and found that %CI&lt;40%, where %CI = CI/P-P interval of the preceding 2 beats) х100, was the best cut-off value to detect AF-trigger ectopies. Hypothesis: We hypothesized that patients who have AF-trigger ectopies have better procedural outcome than those without AF-trigger ectopies. Methods: We studied 120 consecutive patients with AF who underwent an initial ablation. Prior to ablation, AF induction was performed using isoproterenol infusion. PV isolation was performed, and non-PV trigger elimination was added if necessary. AF recurrence-free survival rates were compared between patients with the ectopies that triggered AF or had %CI &lt;40% (identified trigger group) and those without them (unknown trigger group). Results: Identified trigger group comprised 39 (33%) patients. Patient characteristics were similar between the groups including age (67±10 vs. 67±8 years, p=0.83), persistent AF (42% vs. 44%, p=0.50) and left atrial diameter (38±9 vs. 39±6 mm, p=0.30). Of 276 ectopies provoked, 77(28%) triggered AF and 92(33%) demonstrated short CI without AF initiation. All of them were originated from PVs (92%) or superior vena cava (8%). At 11±2 months, 23 (20%) patients developed AF recurrence. Identified trigger group showed a significantly better AF recurrence-free survival rate than unknown trigger group (92% vs. 70%, p=0.033). In multivariate analysis, identified trigger was an independent predictor of AF recurrence-free survival (Adjusted Hazard ratio [95% CI] = 0.21 [0.05, 0.90] (p=0.036)). Conclusions: AF-trigger identification by isoproterenol infusion may be a useful predictor of procedural success in patients undergoing AF ablation.
Abstract 15155: Good Exercise Capacity Alleviates the Effect of High Coronary Atherosclerotic Burden on All-cause Mortality
Authors: Jidong Sung, Ji Hyun Yoon, Su-Yeon Choi, Hyuk-Jae Chang
Journal: Circulation (2015)

Introduction: Both exercise capacity and coronary artery calcium score (CACS) have been reported to be important prognostic factors. It has not been well studied whether there is significant interaction between these two factors in influencing clinical outcome. Hypothesis: The effect size of CACS on all-cause mortality is reduced by higher level of exercise tolerance. Methods: From multicenter registry of health screening cohort, 26,286 subjects were included in the final dataset for analysis who underwent both coronary calcium scoring and treadmill exercise test. All-cause mortality data were obtained from national mortality registry. Results: The mean age of study subjects was 54 ± 8 years and proportion of male subjects 81%. Median follow-up duration was 5.5 (interquartile range 3.6 - 7.5) years and 232 (0.9%) deaths occurred. In fully adjusted Cox’s proportional hazard model with interaction term, exercise capacity ≥ 10 METs (hazard ratio (HR) 0.684, 95% CI 0.483 - 0.971) and CACS ≥ 400 (HR 3.328, 95% CI 1.850 - 5.988) were significant predictors of mortality and the HR of CACS ≥ 400 in those with lower exercise capacity is estimated to be about three times of that in those with higher exercise capacity. (HR 3.328 in &lt; 10 METs vs. 1.108 in ≥ 10 METs, p for interaction = 0.024) after adjustment for age, gender, fasting glucose, serum creatinine, serum ALT and serum albumin. Conclusions: In subjects with higher exercise capacity, the effect of very high CACS on all-cause mortality was significantly smaller than in those with lower exercise capacity. Good physical fitness is likely to override, at least partially, the adverse effect of high coronary atherosclerotic burden.