tbuckley/cabot-search huggingface dataset:
Abstract 74: Sequential Organ Failure Assessment Score at Presentation Predicts Survival in Venoarterial Extracorporeal Membrane Oxygenation
Authors: Peter Czobor, Kishan Parikh, Sandeep Nathan, Janet Karol, Atman P Shah
Journal: Circulation (2013)

Background: Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) has been reported to improve survival in patients with cardiogenic shock (CS) or cardiac arrest (CA). However, overall mortality remains high and many patients may not benefit from ECMO. The Sequential Organ Failure Assessment (SOFA) score is an assessment of a patient’s organ function in the setting of shock composed of scores for the respiratory, cardiovascular, hepatic, coagulation, renal, and neurologic systems, graded 0 to 4 based on level of dysfunction. We investigated the role of the SOFA score in predicting survival in CS and CA patients treated with ECMO. Methods: We performed a retrospective review of all patients treated with percutaneous VA ECMO at the University of Chicago Medical Center from January to December 2012. SOFA score at presentation was calculated using available clinical data. Demographics, clinical characteristics, and outcomes of survivors versus non-survivors were compared using fisher’s exact test. An age adjusted logistic regression model was used to calculate the association between SOFA score and survivor status. Results: Percutaneous VA ECMO was initiated in 15 patients. 7 were alive at 30 days after ECMO initiation. Survivors had a significantly lower baseline median SOFA score (9 vs 16, p= 0.03, OR 0.577 ). The only other significant predictors of survival were female sex and smaller cannula size. Major complications included hemorrhage (2), HIT (1) and DIC (1). Limb ischemia was not seen in any patients as all patients underwent anterograde cannulation at the time of ECMO initiation Conclusions: The presenting SOFA score predicts survival in patients with CS or CA who undergo VA ECMO. Calculation of the SOFA score at presentation may help physicians decide which patients may derive benefit from ECMO.
Abstract 15833: Circulating MicroRNAs Provide Insight Into Potential Molecular Links Between Hypertensive Disorders of Pregnancy and Cardiovascular Disease
Authors: Natalie Dayan, Kenny Schlosser, Duncan J Stewart, Marisa Okano, Sophie Grand’Maison, Louise Pilote
Journal: Circulation (2015)

Introduction: Hypertensive disorders of pregnancy, such as preeclampsia and gestational hypertension, are strong sex-specific risk factors for cardiovascular disease (CVD). The molecular determinants underlying this risk have not been clearly defined, but potentially involve sustained vascular damage and/or dysfunction. This may be reflected by alterations in the levels of specific circulating microRNA (miRNA). Study Objective: To identify miRNAs that circulate at different levels in women diagnosed with acute coronary syndrome (ACS), with and without a prior history of preeclampsia or gestational hypertension. Methods: The present study is a derivation cohort of women with a diagnosis of premature (age &lt; 55 yrs) ACS, divided into three groups based on a prior history of gestational hypertension, preeclampsia, or normotensive pregnancy (n=11-13/group). The three groups were closely matched on potential confounding variables including age, chronic hypertension, diabetes, smoking status and type of ACS. Total RNA was extracted from citrate plasma of each participant, and the relative levels of 372 miRNAs were measured by high-density PCR array. Measurements and analyses were performed blinded to exposure status. Results: The circulating levels of 16 miRNAs were significantly (p&lt;0.05) altered in the preeclampsia versus normotensive pregnancy groups (from -2.8 fold down to +2.0 fold change), and 32 miRNAs were significantly altered between the gestational hypertension and normotensive pregnancy groups (from -2.8 to +2.7 fold change). These miRNAs showed little to no overlap with previously published reports of circulating miRNAs that were altered acutely at the time of preeclamptic pregnancy or ACS event. Several priority candidates have previously been functionally annotated, including miRNAs linked to angiogenesis (miR-126-3p), inflammation (miR-146a-5p), and cholesterol metabolism (miR-122-5p). Conclusions: Circulating levels of multiple miRNAs were altered between female ACS patients with and without prior hypertensive disorders of pregnancy. These miRNAs provide novel insight into the potential molecular pathways that may contribute to vascular dysfunction and risk of CVD.
Abstract 358: Predictors for Not Transferring the Major Trauma Patients to Trauma Centers. A Nation-wide Population Based Research in Taiwan
Authors: Dorji Harnod, Chu-Hui Chang, Ray-E Chang, Tomor Harnod
Journal: Circulation (2013)

Background: The predictors for not-transferring the major trauma patients to trauma centers were analyzed in a logistic regression model. Methods: From the claim data of one million beneficiaries of Taiwan National Health Insurance during the year of 2006 to 2008, all of the trauma patients were identified from the database by the ICD-9-CM system. ICD-MAP 90 was used for calculating the Injury Severity Score as the variable controlling the disease severity. The patients of major trauma were defined as ISS more than fifteen. We used patients’ diagnosis one year before trauma admission for calculating Charlson Comorbidity Index. We set up the rule for transferring major trauma patients to trauma centers as (1)Triage class I &amp; II or (2)ISS&gt;25 or (3)age&gt;55. Factors like age, genders, intubation, ICU admission, different SES levels and triage classifications were adjusted in a logistic regression model for finding out the predictors of “not transferring to trauma centers”. Results: There were 5912, 5611 and 5760 trauma patients admitted from emergency department from 2006 to 2008, and there were 2497 major trauma patients (ISS more then 15). The totally mortality rate was 12.49% (6.98% in the youngest group and 18.19% in the oldest group, P&lt;0.01). All the variables like age, genders, co-morbidity, injury severity, triage classifications and the SES were not the significant predictors for not transferring major trauma patients to the trauma centers. But, intubation and ICU admission in the first hospitals were significant predictors for not transferring the major trauma patients to the trauma centers. Compared with the patients not admitted to ICU, the odds ratio for “patients admitted to ICU” was 0.54 (OR=0.54, P &lt; 0.001). Compared with the patients were not intubated, the odds ratio for “patients who were intubated” was 0.65 (OR=0.65, P=0.013). Conclusions: Our results hint that pre-hospital transfer protocols are important for sending major trauma patients to trauma centers. Based on our results, once the major trauma patients were intubated or admitted to ICU in the first regional hospitals, the patients got lower chance to be transferred to trauma centers.
Abstract 9366: Generation of Human Embryonic Stem Cell-Derived Cardiac Progenitors: Is the Risk of Teratoma Still A Clinically Relevant Roadblock ?
Authors: Valérie Vanneaux, Alain Bel, Hany Nematalla, Sylvie Garcia, Valérie Bellamy, Marie-Cécile Périer, Estelle Robidel, Lucie Tosca, Jean-Roch Fabreguettes, Jean-Hugues Trouvin, Gérard Tachdjian, Albert A Hagége, Patrick Bruneval, Jérôme Larghero, Philippe Menasché
Journal: Circulation (2013)

Background: The risk of teratoma is a major limitation to a safe clinical use of human embryonic stem cells (ESC) for heart repair.We developed a straightforward and clinically usable method for generating ESC-derived cardiac progenitors and assessed its safety in vitro and in animal models. Methods: Human ESC (I6 line) were treated for 4 days by bone morphogenetic protein (BMP)-2 in an insulin-free medium. Taking CD15 as a marker for cell differentiation, the lineage-directed population was immunomagnetically sorted and assessed for purity (flow cytometry), genetic stability (caryotype, FISH focused on chromosomes 12, 17, and 20 and 105K oligonucleotide-based array CGH) and phenotype (transcriptome). For in vivo testing, 58 nude rats underwent a myocardial infarction and, 4-6 weeks later, received a CD15 + -loaded fibrin patch overlaying the infarct area (n=26), a cell-free fibrin patch (controls; n=16) or were sham-operated (n=16). In addition, 54 immunodeficient RAG2-/- γc-/- C5-/- mice were subcutaneously injected with CD15 + cells, undifferentiated ESC, CD15 + cells spiked with different ratios of undifferentiated ESC or 100% CD15-negative cells. Results: The mean ± SD purity rate of the sorted CD15 + population was 96.2 ± 1.8% (average of 25 preclinical runs). These cells were genetically stable with gene polymorphisms considered usual in the human species and expressed cardiac markers, predominantly Isl-1. After 3 months of follow-up, none of the nude rats treated with the CD15 + -loaded fibrin patch had developed a teratoma and monthly echocardiograms showed that they yielded the highest values of LVEF ( p &lt;0.003 vs baseline) and the smallest degree of remodeling compared to control or sham-operated rats. Likewise, while mice receiving undifferentiated ESC developed teratomas within 6 months post-injections, none of those (n=12) injected with the CD15 + cells presented a teratoma or an extra-cardiac tumor (maximal follow-up: 7 months). The CD15-negative population was not tumorigenic either (0/8). Conclusion: This CD15 + progenitor cell population had an overall reassuring safety profile, suggesting that our process of lineage commitment and purification may represent an efficient translational step towards a safe clinical use of these cells.
Abstract 344: Periodic Acceleration (pGz) Improves Left Ventricular Function and Remodeling in Rats After Myocardial Infarction
Authors: Arkady Uryash, Paul Kurlansky, Jose A Adams
Journal: Circulation (2013)

BACKGROUND: Heart Failure (HF) post MI remains a important cause of mortality and morbidity Whole body periodic acceleration (pGz) is the repetitive motion of the supine body in a sinusoidal head to foot direction achieved with a motorized platform. pGz induces pulsatile shear stress on the vascular endothelium. Pulsatile shear stress activates endothelial nitric oxide synthase (eNOS) to produce increased release of nitric oxide (eNO). pGz pre-and postconditioning can induce cardioprotective affects in an in-vivo rat model of myocardial infarction (MI) reducing mortality, arrhythmias and infarct size. The effects of pGz on myocardial function and remodeling after MI are unknown. Left ventricular (LV) pressure-volume (PV) relationships are an invasive but comprehensive method to assess myocardial function. OBJECTIVE: We investigated the effects of pGz on LV function and remodeling induced by chronic MI in rats. Methods: After MI, rats (SD-300gms) were randomized to receive pGz (MI-pGz) (n=5) Control (MI-C) (n=5) for 4 weeks and a separate sham surgery group (n=5). In vivo LV pressure-volume relationships were analyzed using a conductance catheter (Millar Instruments, Texas). LV fibrosis was analyzed using trichrome staining and digital microscopy. RESULTS: pGz after MI reduced left ventricular fibrosis by 40% [MI-C 36( 4 )% vs MI-pGz 21(2)% (p &lt; 0.01) as a % of the LV]. There were no differences in heart rate between groups. pGz significantly improved ejection fraction (EF), left ventricular end systolic pressure (LVESP), dP/dtmax, and both end systolic (ESPVR) and diastolic (EDPVR) pressure volume relations (Table). Data: X(SD) * p&lt; 0.01 (Sham vs. MI-C) and † p&lt; 0.01 (MI-C vs MI-pGz) Conclusions: In a rat model HF induced by chronic MI, pGz markedly improved LV function. These findings have implications for cardiac rehabilitation post MI.
Abstract 325: Adverse Events During Therapeutic Hypothermia and Advanced Critical Care After Out-of-Hospital Cardiac Arrest Which Are Associated With Poor Neurological Outcome at Hospital Discharge
Authors: Young-Min Kim, Chun Song Youn, Soo Hyun Kim, Byung Kook Lee, In Soo Cho, Gyu Chong Cho, Kyung Woon Jeung, Sang Hoon Oh, Seung Pill Choi, Jong Hwan Shin, Kyoung-Chul Cha, Hyeon Woo Yim, Kyu Nam Park
Journal: Circulation (2013)

Purpose: The aim of this study was to investigate the association between adverse events (AEs) recorded during therapeutic hypothermia (TH) and advanced critical care after out-of-hospital cardiac arrest (OHCA) and poor neurological outcome in an Asian country where withdrawal of life support by prognostication is not yet permitted. Methods: We performed a multicenter retrospective registry-based study of adult OHCA patients treated with TH presenting to 24 hospitals across South Korea during the period from January 2007 to December 2012. The primary outcome was poor neurological outcome, defined as Cerebral Performance Category (CPC) of 3-5, at hospital discharge. AEs and concomitant treatments during cooling, rewarming and advanced critical care period were entered one at a time into the best predictive model for poor neurological outcome for evaluation of association. Results: Of a total of 930 OHCA patients entered in the registry, 704 (76%) with a full set of adverse events and covariates for multivariate modeling were included in the analysis. Patients with a poor neurological outcome were 476 [CPC3 = 50 (11%), CPC4 = 214 (45%), CPC5 = 212 (44%)]. Hyperglycemia (46%), hypokalemia (31%) and hypotension (29%) during cooling, and hypotension (22%) during rewarming were common AEs, whereas bleeding were rare (2%). During advanced critical care period, pneumonia (40%), hypoglycemia (23%), myoclonus (22%) and seizure (22%) were common AEs. Sepsis, hypoglycemia, myoclonus, seizure, anticonvulsants and continuous renal replacement therapyduring advanced critical care were associated with poor neurological outcome (Table). Conclusions: AEs were common during TH but not associated with poor neurological outcome at hospital discharge. Sepsis, hypoglycemia, myoclonus, seizure, anticonvulsants and continuous renal replacement therapy during advanced critical care period were associated with poor neurological outcome at hospital discharge in our study.
Abstract 337: Impact of High Glucose Level at Admission on Thirty Days Clinical Outcomes for the Out-of-Hospital Cardiac Arrest Patients With Acute Coronary Event Undergoing Coronary Intervention With Hypothermia Therapy
Authors: Junichi Shimotakahara, Shinichi Shirai, Ken Nagao, Hiroshi Nonogi, Hiroyuki Yokoyama, Naohiro Yonemoto
Journal: Circulation (2013)

Background: The aim of this study was to evaluate the effect of hyperglycemia at admission on the 30-days clinical outcomes of the patients (pts) with cardiac arrest due to acute coronary event (ACE) undergoing PCI with mild therapeutic hypothermia (MHT). Methods: Data over a five-year period (2005-2009) were obtained for 452 patients treated with MHT from a multicenter registry in Japan. Of these patients, all of 185 pts were diagnosed with ACE by emergency angiography immediately after recovery of spontaneous circulation (ROSC), and were subsequently treated with MHT and PCI. These patients were divided into groups based on the blood glucose (BS) at admission by receiver operating characteristics; Group A: BS at admission &gt;=306mg/dl and Group B: BS at admission &lt;306mg/dl. Cerebral performance category (CPC) with levels 1 (Normal mental performance), 2 (moderate disability), 3 (severe disability), 4 (vegetative state), 5 (death) was used at 30days. Poor neurologic outcome was defined in CPC 3, 4 and 5. Results: Patient demographics of Group A (n=67) were younger (mean age 57 vs. 63, p&lt;0.0001), longer time from arrest to ROSC (35min. vs. 24 min., p=0.0004). The proportions of shockable rhythm and the time to achieve target temperature were not different. The rates of STEMI was more seen in Group A (76.1%) compared with Group B (63.6%); however, there was no significant differences (p=0.0781). There was no significantly different in mortality rate (25.4% vs. 17.8%, p=0.2202) between the two groups, however, neurologic outcome was significantly better in group B compared with group A (35.8% vs. 65.3%, p=0.0001). Logistic regression analysis revealed that the predictors of poor neurologic outcome were unshockable rhythm (Odds ratio [OR]: 3.82, p=0.0026), age over 70 (OR: 9.3, p&lt;0.0001), time from collapse to ROSC (OR 1.04, p&lt;0.0001), and BS at admission over 306mg/dl (OR: 3.8, p=0.0005). Conclusions: High glucose level at admission did not affect the mortality; however, had an impact on neurologic outcome for the patients with ROSC after cardiac arrest due to ACS undergoing PCI with MHT.
Abstract 9434: Post-infarct Treatment With Microrna145 Protects the Heart Against Myocardial Ischemia-reperfusion Injury Through Acceleration of Myocyte Autophagy
Authors: Kenshi Higashi, Yoshihisa Yamada, Minami Kumazaki, Takuma Aoyama, Shinya Baba, Shingo Minatoguchi, Kazuhiko Ninigaki, Genzou Takemura, Yukihiro Akao, Shinya Minatoguchi
Journal: Circulation (2013)

Background: We previously reported that microRNA145 (miRNA145) attenuates the ischemia-reperfusion injury. However, the mechanism how miRNA145 reduces the myocardial infarct size is still unclear. Objective: We aimed to investigate whether post-infarct treatment with miRNA145 reduces myocardial infarct size and its precise mechanism in a rabbit model of myocardial infarction. Methods: Male Japanese white rabbits underwent 30 min of coronary occlusion followed by 14 days of reperfusion. Rabbits received intravenous injection of saline (control group, n=7) or 0.035 mg/kg of miRNA145 encapsulated with liposome (miRNA145 group, n=7) immediately after reperfusion. At 14 days after reperefusion, rabbits were sacrificed and the hearts were removed. The area at risk and infarct areas were measured by evans blue dye and TTC staining, respectively. The infarct size was calculated as a percentage of the risk area of the left ventricle. Heart tissues were sampled and the morphological changes were investigated by electron microscopy, and the expression of LC3B, an indicator of autophagy, was assessed by western blot analysis. In another series of experiments, rat myoblast H9C2 were treated with 20 nM of miRNA145 and investigated the morphological changes by electron microscopy and the expression of LC3B by western blot analysis. Results: Post-infarct treatment with miRNA145 significantly reduced the myocardial infarct size (16.0±3.1 %) as compared to the control (28.7±6.1 %) group. Post-infarct treatment with miRNA145 significantly improved LV remodeling and improved ±dp/dt as compared to the control group. Both in vitro myoblast and in vivo experiments, treatment with miRNA145 induced autophagic changes such as autophagosome and autolysosome, and activated LC3B. Conclusions: It is suggested that post-infarct treatment with miRNA145 attenuated ischemia-reperfusion injury through acceleration of myocyte autophagy. The miRNA145 may be a promising strategy for treatment of acute myocardial infarction.
Abstract 9296: Three-Stage Fontan Without Cardiopulmonary Bypass
Authors: Richard D Mainwaring, V. M Reddy, Frank L Hanley
Journal: Circulation (2013)

Objectives: The 3-stage surgical approach is now accepted as the gold standard for management of children born with functional single ventricle. However, there is little consensus on the cardiopulmonary bypass strategies employed for these procedures. We have attempted to avoid cardiopulmonary bypass in single ventricle patients whenever possible to eliminate the adverse effects that are induced by this process. The purpose of this study was to review our experience in patients who underwent all 3 stages of the Fontan pathway without ever being exposed to bypass. Methods: 52 single ventricle patients underwent "off-pump" treatment at all 3 stages of their surgical management. The time period of the study was from 2002 to 2013. There were 31 males and 21 females. Anatomic diagnoses included: double outlet left ventricle (n=11), pulmonary atresia with intact ventricular septum (n=11), tricuspid atresia (n=10), double outlet right ventricle (n=9), and other (n=11). 42 of 52 patients underwent a neonatal off-pump palliative procedure, including systemic-to-pulmonary artery shunt in 33 and pulmonary artery band in 9. 52 patients underwent an off-pump bi-directional Glenn: 38 had a single superior vena cava (facilitated by construction of a veno-venous shunt) and 14 had bilateral superior vena cavae. All 52 patients underwent an off-pump extra-cardiac conduit Fontan. Results: There was no operative mortality in the 52 patients undergoing Fontan completion. The patients have been followed for an average of 5.1± 2.5 years, with one late mortality. The median length of hospital stay for the 3 stages was 17, 5, and 9 days, respectively. 47 of the 52 patients were able to undergo all 3 stages without the need for a blood transfusion. Conclusions: This series demonstrates the feasibility of achieving a Fontan circulation without patients exposed to cardiopulmonary bypass. There was no operative mortality and very low mid-term mortality, and it is notable that less than 10% of patients ever had a blood transfusion. We believe that elimination of cardiopulmonary bypass does have clinical benefits in this highly select subset of single ventricle patients.
Abstract 341: Vasopressin With Low-Volume Resuscitation is Highly Effective for Resuscitation and Survival From Severe Hemorrhagic Shock
Authors: Raúl J Gazmuri, Kasen Whitehouse, Karla Lima Whittinghill, Alvin Baetiong, Jeejabai Radhakrishnan
Journal: Circulation (2013)

Background: We have previously shown in a swine model of controlled bleeding that vasopressin (VP) infusion promotes hemodynamic stabilization. We hypothesized that administering VP with or without modest amounts of normal saline (NS, half the volume of blood removed) could improve survival from severe and protracted hemorrhagic shock. Methods: Hemorrhagic shock was induced in 24 pigs by removing blood according to a mono-exponential decay function to 65% or 75% of the animal’s blood volume in 60 or 80 minutes. Pigs were randomized 1:1 to receive an intraosseous infusion of VP at a constant rate of 0.04 U/kg•min-1 from the onset of blood removal until the start of blood reinfusion with NS given at the end of hemorrhage over 30 minutes in half of the pigs. Results: Survival analysis by Kaplan-Meier method is shown in Figure comparing the effects of administering VP and NS (VP-NS), VP without NS (VP-noNS), no VP but NS (noVP-NS), and neither VP nor NS (noVP-noNS). The 72-hour survival was significantly different (p=0.009 by Log-rank test), with the highest survival in animals that received both VP and NS (100%) followed by VP-noNS (37.5%), noVP-NS (25%), and noVP-noNS (0%) regardless of shock severity. Conclusion: Intraosseous infusion of vasopressin in combination with normal saline was highly effective in securing initial resuscitation and 72-hour survival under conditions of severe hemorrhagic shock.