tbuckley/cabot-search huggingface dataset:
Abstract 88: High NT-proBNP in Cardiopulmonary Resuscitated Patients Treated With Mild Therapeutic Hypothermia is Associated With Mortality
Authors: Monique C de Waard, Bob Smit, Angelique M Spoelstra - de Man, Armand R Girbes
Journal: Circulation (2013)

Introduction: Despite the apparent appropriateness of mild therapeutic hypothermia (MTH) to limit neurological injury and improve survival in patients with return of spontaneous circulation (ROSC) after cardiac arrest (CA), mortality rates remain high. To date, no accurate and independent biomarker to predict survival in these patients exists. B-type natriuretic peptide (BNP) was found to provide both prognostic and diagnostic value in various cardiovascular diseases. However, the biologically inactive counterpart of BNP, NT-proBNP, was found to be more stable and accurate. Objective: Investigate the value of NT-proBNP to predict 28-day mortality in post-CA patients treated with MTH, as well as the influence of MTH on NT-proBNP levels. Methods and Results: NT-proBNP levels were measured in post-CA patients who were non-invasively cooled using body wraps (Medi-Therm ® , Gaymar). Plasma samples were obtained before cooling was started, during 24 hours maintenance and at the end of re-warming. Between 2009 and 2013 327 patients were admitted to the ICU for post-CA MTH treatment. Baseline NT-proBNP values were available for 81 (25%) patients and were subsequently included for the evaluation of NT-proBNP as a prognostic marker. In the 28 days following ICU admission, 38 patients died (47%). Non-survivors had significantly higher baseline NT-proBNP levels (median 1525ng/l, IQR 450-3859 versus median 267ng/l, IQR 99-1766; P &lt;0.001) compared to survivors. Adjusted odds ratios for 28-day mortality were 3.3 (95% CI = 0.8, 13.4), 4.4 (95% CI = 1.1, 17.8) and 9.3 (95% CI = 2.2, 40) for increasing quartiles of NT-proBNP as compared to the lowest quartile. A cut-off value of 643ng/l achieved a sensitivity of 67% and a specificity of 66% to predict 28-day mortality. During the different phases of MTH NT-proBNP values decreased or increased. The presence of either pattern in NT-proBNP expression was not associated with outcome. Conclusions: High NT-proBNP plasma levels on ICU admission are associated with high mortality in post-CA patients, but are of moderate prognostic value as an independent biomarker. Increases or decreases in patterns of NT-proBNP expression during the separate phases of MTH treatment appear unrelated to 28-day mortality.
Abstract 15619: Childhood Physical Fitness Phenotypes and Adult Carotid Arterial Stiffness
Authors: Malanka Lankaputhra, Costan G Magnussen, Terence Dwyer, Alison Venn, Quan L Huynh
Journal: Circulation (2015)

Background: Large artery stiffness is associated with fitness phenotypes in adulthood, but the association of childhood physical fitness with adult arterial stiffness is unknown. Aim: To determine the longitudinal association of childhood physical fitness phenotypes with adult carotid artery stiffness. Methods: Data were from 2,008 participants in the Childhood Determinants of Adult Health Study (52% female) with baseline measurements collected in 1985 when aged 7-15 years and follow-up measurements collected 20 years later. Fitness measures included muscular strength (isometric handgrip, shoulder, and leg strength), power (standing long jump), endurance (number of push-ups in 30 seconds), cardiorespiratory fitness (physical work capacity at heart rate of 170 bpm [PWC170] and time to complete a 1.6km run), and flexibility (sit and reach distance). All predictors were expressed as age- and sex-specific z-scores. Arterial stiffness was measured as carotid distensibility (CD) by ultrasound. Results: In univariable analysis, no association was found between childhood muscular strength (β=-0.029), power (β=-0.013), endurance (β=0.00051), PWC170 (β=0.00045), 1.6km run: (β=-0.0077), and adult CD (all p&gt;0.30). However, an association was present for flexibility in childhood and adult CD (β=-0.038, p=0.028). Following adjustment for relevant adult measures, age and sex, no childhood physical fitness measures were associated with adult CD (muscular strength: β=-0.044; power: β=0.0077, endurance: β=0.017; PWC170: β=-0.0010; 1.6km run: β=0.0058, flexibility: β=-0.035 all p&gt;0.20). Conclusion: Measures of physical fitness in childhood were weakly associated with adult arterial stiffness. Given the reported relationship of adult fitness phenotypes with arterial stiffness, our data suggest current fitness or activities associated with current fitness might play a greater role in determining adult arterial stiffness.
Abstract 295: After 2010 Guidelines Less Fear and More CPR
Authors: Simone Savastano, Vincenzo Vanni, Karen Langord
Journal: Circulation (2013)

Introduction: Prompt and good quality cardio-pulmonary resuscitation (CPR) is fundamental for cardiac arrest victims survival. The percentage of bystander CPR is generally low and one of the reasons are the fears of the rescuers. With 2010 guidelines, CAB replaced the ABC sequence and hands only CPR was recommended for untrained lay rescuers. The aim of our study was to evaluate the effects of these changes on lay rescuers’ willingness to perform CPR on an unknown adult or child, and on their fears. Materials and methods: At the end of each CPR course for lay rescuers we distributed a rigorously anonymous questionnaire written either in Italian or in English exploring the willingness to perform CPR on an adult or on a child and the related main fears (infectious disease, competency, causing damage, legal complications, and general fear). Each person received only one questionnaire and attended only one course. Results: 1374 questionnaires have been collected (82.1% males, 86.4% Italians, high school 63.2%, higher education degree 23.8%; 1000 before 2010: group A and 374 after 2011: group B). In the general population a significant difference between the percentage of subjects who would perform CPR on an adult or on a child has been demonstrated (88.4% vs 75.3% respectively p&lt;0.001). Moreover the willingness to perform adult CPR was significantly higher in group B than group A (94.4% vs 86,2% p&lt;0.001). A nearly significant trend has been demonstrated between group B and A (79% vs 74% p=0.05) for pediatric CPR. Comparing groups A and B on the fears of performing adult CPR we observed a significant reduction in the fear of legal complications (1.8% vs 0.3% p=0.03) and of general fear (6.8% vs 3.2% p=0.02). In the pediatric case the only significant reduction observed was of the competency fear (7.8% vs 2.1% p&lt;0.001). The expected reduction in the fear of infectious diseases has not been demonstrated neither for adult CPR (1.4% vs 0.5% p=0.26) nor for pediatric CPR (0.9% vs 0.3% p=0.31) Conclusions: After 2010, the willingness of lay rescuers to perform adult CPR has significantly increased due to a significant reduction of rescuers’ fears. On the basis of these results the new guidelines are thought to increase survival also by increasing incidences of bystanders CPR.
Abstract 9400: Obesity is Associated With Lower Mortality in Patients With Implantable Cardioverter-Defibrillator
Authors: Mahek Mirza, Beeletsega Yeneneh, Anton Strunets, Chi Cho, Indrajit Choudhuri, M. Eyman Mortada, Vikram Nangia, Atul Bhatia, Imran Niazi, Jasbir Sra, Arshad Jahangir
Journal: Circulation (2013)

Introduction: Higher body mass index (BMI) is associated with increased cardiovascular risk factors. Recent studies indicate an inverse relationship between obesity and overall survival after acute cardiovascular events. However, in patients at high risk of sudden cardiac death (SCD), the impact of obesity on mortality is not defined. Hypothesis: We assessed whether a paradoxical relationship between BMI and risk of overall mortality is present in patients with an implantable cardioverter-defibrillator (ICD). Methods: Consecutive patients who received an ICD for prevention of SCD at our institution from January 2010 to December 2011 were retrospectively divided into three groups based on BMI. Clinical parameters and long-term outcomes as determined by Kaplan-Meier and logistic regression models were compared among normal (BMI &lt;25), overweight (BMI 25-29.9) and obese (BMI ≥30) groups. Results: Of 1,151 patients (mean age 67 ± 13 years; 67% male), 26% had normal BMI, 32% were overweight and 42% were obese. There were no significant baseline differences in mean left ventricular ejection fraction (30 ± 12%), type of ICD implanted or indication for implantation, prior syncope or cardiac arrest, and prevalence of heart failure or atrial fibrillation. Patients with normal BMI were older (68 ± 14 years) compared with the overweight (68 ± 13 years) and obese (62 ± 12 years) groups (p&lt;0.001). Despite significantly higher prevalences of diabetes, hypertension, ischemic heart disease and prior myocardial infarction, the higher BMI groups had lower overall mortality than the normal BMI group. Median time to death after ICD implantation also was significantly shorter in the normal BMI group (figure). On multivariate logistic regression analysis, higher BMI (including obese and overweight groups) was protective against mortality. Conclusion: Patients with an ICD who were obese or overweight had lower mortality than those with normal BMI.
Abstract 12669: MicroRNA-181b inhibits endothelial NF-κB signaling, insulin resistance, and atherosclerosis
Authors: Xinghui Sun, Shaolin He, AKM Wara, Basak Icli, Eugenia Shvartz, Yevgenia Tesmenitsky, Timothy S. Blackwell, Galina K. Sukhova, Kevin Croce, Mark W. Feinberg
Journal: Circulation (2013)

Xinghui Sun, 2013 Finalist and Presenting Author
Abstract 308: There is a Correlation Between Neurologic Score and Discharge Location for Patients With Out-of-Hospital Cardiac Arrest of Presumed Cardiac Origin
Authors: Lars Wik, Jan-Aage Olsen, David Persse, Fritz Sterz, Michael Lozano, Marc A Brouwer, Mark Westfall, Chris M Souders, Reinhard Malzer, Pierre M van Grunsven, David T Travis, Ulrich R Herken, Cathrine Brunborg, E Brooke Lerner
Journal: Circulation (2013)

Background: The Circulation Improving Resuscitation Care (CIRC) Trial found equivalent survival in out-of-hospital cardiac arrest (OHCA) patients who received integrated AutoPulse CPR (iA-CPR) compared to high quality Manual CPR (M-CPR), and no difference in neurologic outcome. However, neurologic outcome was not available for some patients, and discharge location may serve as a proxy for neurologic outcome. The objective of this study was to determine if there is a correlation between modified Rankin Scale (mRS) Score at discharge and discharge location, and to determine the association between discharge location and study intervention. Methods: A subgroup-analysis of the CIRC randomized clinical trial comparing iA-CPR to M-CPR was conducted on patients who were discharged from hospital. Neurologic outcome was categorized as good (mRS ≤3), not good (mRS ≥4), or unknown, and according to discharge location of home or rehabilitation, nursing home or assisted living, and unknown or awaiting care, respectively. Spearman correlation was used to determine the relationship between mRS score and discharge location. Logistic Regression was used to compare iA-CPR to M-CPR in predicting neurologic outcome using discharge location and adjusting for the study covariates (study site, patient age, witnessed arrest, and initial rhythm). Results: CIRC enrolled 4,231 patients and 429 (10%) survived to hospital discharge. mRS score was known for 310 of those patients and discharge location for 300 patients, both were known for 292. A Spearman correlation analysis between mRS score and discharge location was statistically significant (r=0.622, p&lt;0.001). iA-CPR was documented to increase survival to hospital discharge with good neurologic outcome (using discharge location as a surrogate) compared to M-CPR (unadjusted OR 2.25, 95% CI 1.21-4.17, p=0.009). When adjusted for covariates there was a trend in favor of iA-CPR (OR 1.82, 95% CI 0.91-3.63, p=0.09). Conclusion: There was a correlation between mRS score and discharge location. More patients were discharged to a location with limited assistance and consequently potential better neurologic outcome in the iA-CPR group compared to the high quality M-CPR group.
Abstract 15802: Baseline Troponin T Levels Modulate the Effects of Implantable Cardioverter Defibrillator Shocks on All-cause Mortality
Authors: Victor Nauffal, Yiyi Zhang, Elena Blasco Colmenares, David D Spragg, Joseph E Marine, Barbara Butcher, Sanaz Norgard, Eliseo Guallar, Gordon F Tomaselli, Alan Cheng
Journal: Circulation (2015)

Introduction: Implantable cardioverter defibrillator (ICD) therapy (shocks or anti-tachycardia pacing (ATP)) has been associated with an increased risk for death. Whether this association is mediated by direct effects of ICD therapy, the underlying myocardial disease process that triggered the tachyarrhythmia, or both remains poorly understood. Methods and Results: We followed 736 patients from the Prospective Observational Study of ICDs (PROSE-ICD) over a median of 5.3 years for the occurrence of ICD therapy and all-cause mortality. Multivariable Cox proportional hazards models were used to calculate the risk-adjusted hazard ratio associated with the different types of ICD therapy, modeled as time-dependent covariates. Additionally, we tested for interaction between ICD shocks and baseline levels of cardiac troponin T (cTnT). Appropriate shock (HR=2.66 [1.77 - 3.98]; p&lt;0.001) was associated with increased mortality, while appropriate ATP (HR=1.02 [0.49 - 2.13]), inappropriate ATP (1.11 [0.48 - 2.58]) and inappropriate shocks (0.81 [0.50 - 1.32]) were not. Independent of the underlying arrhythmia, the mortality effects of ICD shock therapy were strongly modulated by baseline levels of cTnT (p-interaction=0.02). Patients with baseline cTnT≥0.01ng/ml had a significant increased mortality risk associated with ICD shocks (HR=1.73 [1.01 - 2.97] p=0.046) while patients with cTnT&lt;0.01ng/ml did not (HR=0.49 [0.18 - 1.31]). Furthermore, patients with 1 or multiple appropriate shocks and those with multiple inappropriate shocks had a significantly increased mortality risk only in the setting of elevated baseline cTnT≥0.01ng/ml (Figure 1). Conclusions: Elevated baseline cTnT increases the risk of death in patients experiencing ICD shocks regardless of the underlying triggering arrhythmia. These findings provide further insights into how the underlying myocardial substrate may affect the relationship between ICD shocks and all-cause mortality.
Havana NRG!
Journal: Circulation (2013)

Dr. William J. Rashkind and his family established this lecture in 1986 shortly before his death. Dr. Rashkind was an internationally known pediatric cardiologist credited for developing balloon atrial septostomy, also known as the Rashkind procedure. Dr. Rashkind was an active volunteer for the American Heart Association at the national and state levels. This lecture is made possible by a grant from the late Dr. Rashkind and his family. In honor of the Rashkind Lecture, the Council on Cardiovascular Disease in the Young is pleased to welcome Havana NRG!. After more than 10 years of great success, Havana NRG! continues to be one of the strongest up-and-coming Latin orchestras of the world. Since its launch in 2002, the group has traveled as far as New York City, Los Angeles, Las Vegas, Miami, and San Francisco. Its debut CD, “Camino al Cielo,” has become very popular in many US markets and in countries like Japan and Italy. Havana NRG! has proven that it is “a new breed of Latin band,” the New Rhythm Generation that is taking its Cuban roots to new levels of performance. The group’s second CD, titled “La Receta Perfecta,” is the mixture and perfection blends of Timba Cubana, Salsa, Cha Cha Cha, Merengue, Bachata, and even Pilon and Timbaton.
Abstract 346: Predictors of In-Hospital Outcome After Primary PCI of Left Main Coronary Artery Acute Myocardial Infarction With Cardiogenic Shock
Authors: Koshi Matsuo, Yasunori Ueda
Journal: Circulation (2013)

Background: In patients with acute myocardial infarction (AMI) and cardiogenic shock, emergency revascularization improves long-time survival. However, predictors of in-hospital outcome after primary PCI of left main coronary artery (LMCA) AMI remain unclear. Methods: Consecutive 21 patients admitted to our hospital presenting Killip IV heart failure and occluded LMCA on emergent coronary angiogram were enrolled. We performed primary PCI of LMCA. Patients’ clinical background, angiographic findings, results of primary PCI, laboratory data, usage of circulatory supporting devices (IABP and PCPS), performance of distal protection or not, and elapsed time (from onset to reperfusion) were retrospectively examined. Patients who died in hospital and those who survived were compared. Results: Successful reperfusion was achieved in 21 (100%) patients; IABP was used in 21 (100%) but PCPS in 6 (29%) patients; and 13 (62%) patients survived but 6 (29%) patients died in hospital. Elapsed time (5.1±2.5 vs. 2.8±1.0 hours; p&lt;0.05) was shorter in patients who survived than in those who died, and peak CK (15509±8686 vs. 6608±3613 U/l; p&lt;0.05) and peak CK-MB (567±316 vs. 925±387 U/l; p&lt;0.05) were higher in patients who died than in those who survived. And wide QRS in electro cardiogram was found more frequently in patients who died than in those who survived. In addition, we performed distal protection more frequently in patients who survived than in those who died. Conclusion: Short elapsed time and small infarct size were associated with good in-hospital outcome. Therefore, sooner primary PCI of LMCA should be an effective therapeutic strategy for LMCA AMI resenting cardiogenic shock. In addition, we should perform distal protection as possible as we can even in LMCA AMI cases.
Abstract 9313: Progression of Coronary Plaque Burden In Patients With Familial Hypercholesterolaemia: Assessment With Coronary CT
Authors: Hayato Tada, Masa-aki Kawashiri, Chiaki Nakanishi, Tetsuo Konno, Kenji Sakata, Kenshi Hayashi, Tsuyoshi Yoshimuta, Atsushi Nohara, Akihiro Inazu, Hiroshi Mabuchi, Masakazu Yamagishi
Journal: Circulation (2013)

Background: It is well known that patients with familial hypercholesterolemia (FH) exhibit markedly elevated LDL-C levels resulting premature coronary artery disease. Statins have been shown to be effective in delaying the onset of coronary artery disease even in patients with FH. However, the optimal timing for initiation of lipid-lowering therapy for heterozygous FH patients still remains unclear. The aim of our study was to determine the optimal timing for initiation of lipid-lowering therapy for heterozygous FH. Methods and Results: Genetically determined 42 heterozygous FH patients were included in this study (mean age 54±13, male=23, initial mean LDL-C=250±40mg/dl). All patients underwent contrast-enhanced 64-slice coronary CT using the standard protocol. We evaluated coronary plaque burden assigning score (0 to 5) to each of 15 coronary artery segments according to the Society Cardiovascular Computed Tomography guideline. Almost all FH patients were treated with statins during a period of 8±4 years before coronary CT. From the regression equations between age (X) and stenosis index (Y) (Figure), we can assume that coronary artery stenosis detectable by coronary CT will occur after 17 years of age in male, and 28 years in female heterozygotes FH patients, respectively even under the statin uses . Conclusions: These data suggest that coronary artery stenosis detectable by coronary CT will occur after 17 and 28 years of age in male and female heterozygous FH, respectively, even in the strong statin era. We suggest that the lipid-lowering therapy for heterozygous FH should start at least by these early ages in terms of prevention from coronary plaque burden.
Abstract 297: Performance-Improvement Based Resuscitation Training Decreases Cardiopulmonary Arrests and Improves Survival
Authors: Rebecca E Sell, Karen Carroll, Heather M Moore, Daniel P Davis
Journal: Circulation (2013)

Background: Despite recent advances in cardiopulmonary arrest resuscitation, survival remains poor. Traditional training models have difficulty achieving and maintaining resuscitation competency. The UCSD Advanced Resuscitation Training (ART) Program, a performance-improvement based resuscitation program, has led to a sustained increase in survival to discharge after inpatient cardiac arrest from 21% to 45%. Objective: To evaluate the effectiveness of the ART program on survival after inpatient cardiac arrest and hospital mortality at the Veterans’ Affairs (VA) Hospital System in San Diego. Methods: This was a prospective, observational study conducted in an urban, university-affiliated VA. All inpatient cardiopulmonary arrest (CPA) victims without an active "Do Not Attempt Resuscitation" order from October 2006 to June 2012 were included. The ART program was implemented in Summer 2007 and included a unique treatment algorithm constructed around the capabilities of our providers and resuscitation equipment, a rapid response team, a training program with flexible format and content including early recognition concepts, and a comprehensive approach to performance improvement feeding directly back into training. Our inpatient resuscitation registry and electronic patient care records were used to quantify arrest rates and survival-to-hospital discharge yearly after ART program implementation. Results: A total of 476 CPAs were included (176 within the Intensive Care Unit (ICU) and Emergency Department (ED), and 300 outside of the ICU/ED). Arrest incidence decreased yearly from an initial rate of 10.3 to 2.7 CPA per 1,000 patient discharges in non-ICU inpatient units. Survival-to-discharge rates at the VA were comparable to those documented at UCSD (44% versus 45%, p=NS). Conclusions: Implementation of the ART program at the Veterans Affairs Medical Center resulted in a decrease in the incidence of CPA with high survival-to-discharge rates.