tbuckley/cabot-search huggingface dataset:
Abstract 19723: Randomized Comparison of Bosentan in Intermittent Claudication in Peripheral Arterial Disease : The Clinical and Endotelial Function Assessment after Endothelin Receptor Antagonism (CLAU) Randomized Controlled Trial
Authors: Joaquin De Haro, Silvia Bleda, Cesar Varela, Leticia Esparza, Ignacio Lopez de Maturana, Francisco Acin
Journal: Circulation (2012)

INTRODUCTION There is evidence that endothelin-1 (ET-1) is involved in the etiopathology of Peripheral Arterial Disease (PAD) due to its capacity to induce impairment of the endothelial function, its vasoconstrictor effects, its pro-inflammatory cytokine action, fibrosis and induction of cell proliferation. Bosentan is a dual ET-1 receptor antagonist, administered orally with antifibrotic, antiinflamatory, antihipertrophic properties and the capacity to vasodilate selectively the damaged vascular bed. MATERIAL AND METHODS A prospective, randomized, controlled, parallel groups, simple blind, proof-of-concept trial was performed in 30 male patients (50-60 years old) with Intermittent Claudication (Rutherford category 1-2) recently diagnosed, and clinical manifestations not exceeding 6 months, with hypertension and/or dyslipidemia as unique cardiovascular risk factors burden permitted. After a 2-weeks period of stabilization of the claudication distance verified in two consecutive treadmill test (12.5%,3.2 km/h), patients were randomized 1:1 to the experimental arm (Bosentan 62.5 mg twice daily/four weeks and 125mg twice daily/eight weeks) or control group. RESULTS After six months of treatment there was an increase in the Absolute Claudication Distance (ADC) of 549% (p=0.003), the Flow-Mediated Artery Dilation (FMAD) of 768% (p=0.001), the Ankle-Brachial Index (ABI) 24% (p&lt;0.001) and a decrease in the C Reactive Protein (CRP) of -22,7%(p&lt;0.019) vs. control group (22%,-16%,-8%,21%, respectively). The patient subjective claudication assessment corroborated the improvement in the ability to walk (589%, p &lt;0.001) in the treatment group. No severe adverse events were reported in the experimental group. CONCLUSIONS Bosentan improves significantly the Claudication Distance, the endothelial function, inflammatory and the hemodynamic status in patients with incipient PAD.
Abstract 7: Enhancing Glucose Oxidation Following Ventricular Fibrillation Resuscitation Mitigates Cardiac Systolic Dysfunction
Authors: Mohammed Ali Azam, Cory Wagg, Stéphane Massé, Talha Farid, Patrick F Lai, Marjan Kusha, John Asta, Gary D Lopaschuk, Kumaraswamy Nanthakumar
Journal: Circulation (2012)

Background: Ventricular fibrillation (VF) is an important cause of cardiac arrest. After initial successful resuscitation, decreased cardiac contractility during reperfusion is a common problem that is poorly understood. In normal hearts the major energy source for cardiac contractility is oxidation of fatty acids (FA), while only a lesser amount of energy originates from glucose oxidation. Previous investigations showed that during and after ischemia, cardiac contractile dysfunction depends on the type of energy substrate metabolized, with increased FA oxidation and decreased glucose oxidation not being beneficial. Increasing glucose oxidation and decreasing FA oxidation has not been evaluated as a strategy to improve contractile dysfunction following VF resuscitation. One such approach could be the use of dichloroacetate (DCA), a metabolic modulator that increases glucose oxidation and decreases FA oxidation. Methods and Results: Rat hearts (n=40) were Langendorff-perfused in Tyrode’s buffer and allowed to equilibrate for 15min followed by 15min of global ischemia and 5min of reperfusion. During reperfusion a short duration burst pacing stimulation was used to induce VF. Hearts were divided into two groups; untreated control (n=20) and DCA-treated during reperfusion (1mM; n=20). One minute later VF was terminated. Left ventricular (LV) pressure, heart rate and coronary flow were monitored during the post VF period. The incidence of VF was 60% in untreated controls, and 66% in DCA-treated hearts. LV developed pressure (LVDP) was reduced after VF and post-resuscitation period compared to the baseline period (90.7±3.5mmHg vs 52.3±6.8mmHg, respectively, n=8, p&lt;0.01). DCA improved post-resuscitation LVDP (74.3±6.5mmHg, n=8, p&lt;0.05 vs untreated controls). Post-resuscitation lactate production was reduced in DCA-treated hearts compared to untreated controls (1.0±0.3µM/g/min vs 1.9±0.2µM/g/min, n= 8, p&lt;0.05). Conclusions: Cardiac contractility is impaired following resuscitation after VF. Enhancement of glucose oxidation with DCA mitigates post VF cardiac dysfunction and may have a therapeutic role under these conditions.
Abstract 9203: Detecting Myocardial Ischemic Territories in the Setting of Acute Coronary Obstructions at Rest with Cardiac Phase-Resolved Blood Oxygen Level Dependent (CP-BOLD) MRI
Authors: Sotirios Tsaftaris, Xiangzhi Zhou, Richard Tang, Debiao Li, Rohan Dharmakumar
Journal: Circulation (2011)

Introduction: In the setting of ACS, particularly in non ST elevation myocardial infarction (NSTEMI), triaging patients for coronary catheterization from the emergency department can benefit from an imaging approach that does not resort to provocative stress or exogenous contrast media. We propose a MRI method that has the capacity to non-invasively and rapidly identify ischemic territories and assess functional status under resting conditions. Hypothesis: Tested in a canine model, we hypothesize that on the basis of phasic changes in blood volume and oxygenation it is possible to arrive at an imaging metric that can identify myocardial territories affected by acute coronary obstruction without exogenous contrast media at rest. Methods: Flow and motion compensated CP-BOLD and standard cine (cine) images were acquired at 1.5T in 11 canines at baseline and under severe LAD stenosis at rest. First-pass perfusion was performed in order to identify the affected and remote (healthy) territories in end-systolic (ES) and end-diastolic (ED) images. S/D, defined as a ratio of the mean intensity between ES and ED were computed from CP-BOLD and cine images. Two-way repeated measurement ANOVAs were used to test the effects of region (remote, affected) and condition (baseline, stenosis) and their interaction on S/Ds. Results: On CP-BOLD, affected regions had S/D&lt;1 consistent with the expectations of physiologic changes in blood volume and oxygenation. No effects were found on S/D computed from cine, indicating that the BOLD sensitivity from CP-BOLD MRI is the principal mechanism enabling the detection of myocardial ischemic territories at rest. Conclusions: S/D &lt; 1 (from CP-BOLD MRI) can serve as a potential biomarker for identifying ischemic territories under rest. Since cardiac-phased resolved images are acquired with CP-BOLD, functional changes can also be determined without additional scans, permitting rapid assessment of ACS. The method remains to be tested in patients.
Abstract 32: Successful Use of Supraglottic Airway Devices by Surf Lifeguards: A Randomized Comparison of 3 Different Devices
Authors: Kasper Adelborg, Christian Dalgas, Lars H Nielsen, Martin B Mortensen, Rozh H Al-Mashhadi, Bo Løfgren
Journal: Circulation (2012)

Objective: During resuscitation of a drowning victim, adequate ventilations are of paramount importance. The feasibility of using supraglottic airway devices (SAD) among surf lifeguards is unexplored. We aimed to compare time to first effective ventilation and ventilation quality using three different SAD among surf lifeguards. Methods: Surf lifeguards in active service over the age of 18 years were invited to participate. Participants were trained to Portex ® Soft Seal ® Laryngeal Mask (Soft Seal), Intersurgical ® I-gel supraglottic airway (I-gel) and Ambu ® AuraOnce TM (AuraOnce). Participants inserted and provided five ventilations using each of the SADs in randomized order. Data were obtained from a resuscitation manikin and video recordings. Results: A total of 40 surf lifeguards (11 female, 29 male, mean age: 24.7 years) participated. Only three participants failed to obtain any effective ventilation (one using I-gel and two using AuraOnce). The time to first effective ventilation (visible chest rise) was significantly reduced using I-gel (15.6+/-3.3 s) compared to Soft Seal (35.2+/-7.2 s, p&lt;0.001) and AuraOnce (35.2+/-8.5 s, p&lt;0.001) whereas no difference was detected when comparing Soft Seal to AuraOnce. On-going chest compressions did not delay time to ventilation. The number of effective ventilations was higher using Soft Seal (100%) compared to AuraOnce (92%, p&lt;0.0001), while no significant differences were observed when comparing I-gel (97 %) to Soft Seal and AuraOnce. Soft Seal delivered a higher tidal volume, (0.65+/-0.14 L) compared to I-gel (0.50+/-0.16 L, p&lt;0.001) and AuraOnce (0.39+/-0.19 L, p&lt;0.001). The inspiratory time was longer with Soft Seal (0.61+/-0.17 s) compared to I-gel (0.47+/-1.3 s, p&lt;0.001) and AuraOnce (0.42+/-0.13 s, p&lt;0.001). No differences were found comparing I-gel and to AuraOnce on tidal volume and inspiratory time. The majority of surf lifeguard (85%) listed I-gel as their preferred SAD. Conclusion: Surf lifeguards can successfully use SADs. Time to ventilation was not delayed due to on-going chest compressions. I-gel was superior compared to Soft Seal and AuraOnce in significantly reducing time to first effective ventilation and delivering tidal volumes within the recommended range.
Abstract 9903: Left Atrial Appendage Contractility Assessed by Speckle Tracking Transesophageal Echocardiography as a Determinant of Thrombus Formation in Patients Receiving Warfarin for Chronic Atrial Fibrillation: beyond CHADS2 and CHA2DS2-VASc Score
Authors: Takeshi Hirose, Masanori Kawasaki, Ryuhei Tanaka, Koji Ono, Takatomo Watanabe, Maki Saeki, Hiroto Yagasaki, Singo Minatoguchi, Hirotaka Miwa, Takafumi Tokoro, Reiko Matsuoka, Sintaro Abe, Yoshiaki Goto, Takashi Yoshizane, Takashi Kato, Masashi Kawade, Shunichiro Warita, Tai Kojima, Makoto Iwama, Toshiyuki Noda, Sachiro Watanabe, Shinya Minatoguchi
Journal: Circulation (2012)

Background: Establishment of optimal risk stratification is the best hope for decreasing the burden of atrial fibrillation (AF)-related thromboembolism. Left atrial appendage (LAA) thrombus is a high risk factor of embolism even in AF with warfarin. LAA contractility evaluated by LAA emptying function (EF), strain and radial velocity (RV) of LAA wall motion could contribute to blood stasis and be an important determinant of thrombus in chronic AF, especially in patients with low CHADS2 or CHA2DS2-VASc score. Methods: Consecutive 260 chronic AF patients with warfarin were examined and divided into 2 groups according to the presence of thrombus; AF with thrombus (n=43, 69±10) and AF without thrombus (n=217, age 66±11). Each group was divided into subgroup according to CHADS2 or CHA2DS2-VASc score≤2 (low CHADS2 or CHA2DS2-VASc subgroup). LAA EF, peak strain and peak RV of LAA wall were measured using speckle tracking echocardiography. LAA volume, spontaneous echo contrast (SEC) and LAA flow velocity were measured. Results: Seventy one % of patients with thrombus and 61% without thrombus met the target INR recommended by Japanese Circulation Society. AF with thrombus had more increased CHADS2 and CHA2DS2-VASc score and reduced LAA EF and strain compared to AF without thrombus (Table). LAA EF and strain were also reduced in low CHADS2 and CHA2DS2-VASc subgroup with thrombus. In multivariate analysis, LAA EF and strain were independent determinants of LAA thrombus. Using 20% of LAA EF as a cutoff, sensitivity and specificity for thrombus were 84% and 90%, using 5 of LAA peak strain, those values were 88% and 76%. Conclusion: LAA EF and peak strain were more useful predictors of thrombus in chronic AF than LAA flow velocity, SEC and CHADS2 and CHA2DS2-VASc score. LAA thrombus formation may depend on LAA contractility. Thus, AF patients with reduced LAA contractility should have a strict anticoagulant therapy regardless of CHADS2 or CHA2DS2-VASc score.
Abstract 280: Association Between Duration of Hyperoxia, Organ Failure and Survival After Cardiac Arrest
Authors: Raghavesh Pullalarevu, Bo Wang, Nishit M Vaghasia, Frank Guyette, Clifton Callaway, Jon Rittenberger, Cameron Dezfulian
Journal: Circulation (2012)

Background: Prior administrative database studies correlate hyperoxia (based on initial paO2) after cardiac arrest (CA) with increased mortality. These studies did not quantify duration of hyperoxia or incorporate important variables in predicting post-CA survival. We hypothesized hyperoxia duration would not be associated with organ failure or mortality after adjustment for important CA prognostic variables. Methods: 185 CA survivors receiving &gt;24h mechanical ventilation had oxygen exposure classified hourly based primarily on ABG paO2 or if missing within 2h based on SpO2 as: hypoxic (paO2≤50 or SpO2≤88%), normoxic (paO2 51-150 or SpO2 89-99% or 100% on FiO2≤0.40), moderately hyperoxic (paO2 151-300), severely hyperoxic (paO2&gt;300) and probably hyperoxic (SpO2=100 when Fio2&gt;0.40, no ABG). Univariate regression correlated durations of oxygen exposure to 24h SOFA score and survival to hospital discharge with multivariate regressions incorporating CA type, sex and use of hypothermia (p&lt;0.10 in univariate correlations to outcomes). Results: Classification based on initial paO2 revealed no significant differences in survival or SOFA (Table 1). Moderate hyperoxia and to a lesser degree combined moderate and severe hyperoxia exposure were associated with SOFA reduction whereas normoxia and hypoxia exposure were associated with higher SOFA, even after multivariate adjustment (Table 2). Severe hyperoxia exposure was associated with reduced survival in univariate but not multivariate analyses. Conclusions: Exposure to moderate hyperoxia was associated with reduced organ failure whereas severe hyperoxia exposure was not and may correlate with worse survival.
Abstract 8999: Coronary Artery Revascularization Evaluation (CARE): Long term Outcomes Comparing Effectiveness of Revascularization Strategies in a Multi-center Community Hospital Registry
Authors: Michael Mack, Morley Herbert, Syma Prince, Paul Kurlansky
Journal: Circulation (2012)

Background: Data from randomized clinical trials (RCT) comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) may not accurately reflect current clinical practice, especially with diversity in the selection of drug eluting stents (DES), as well of on- vs. off-pump CABG. Registry data suggests that long-term follow-up is necessary in order to adequately compare the effectiveness of differing interventional strategies. A prospective registry of coronary revascularization (CR) by CABG--on- and off-pump--and PCI--bare metal (BMS) or DES--in a multicenter community hospital setting was accomplished. We hypothesize that the results of CR as performed in routine clinical practice may differ from the outcomes of RCT. Methods and Results: All patients (N=4338; 3090 PCI, 1248 CABG) undergoing isolated CR in eight community-based hospitals were enrolled. Follow-up(63.5±27.9, median 79.7 months)was obtained by patient and/or physician contact, and the Social Security Death Index. STEMI and salvage patients were excluded (after exclusion, N=3871; 2690 PCI, 1181 CABG). All clinical decisions were based on treating physician preference. Propensity matching was used to achieve PCI and CABG patient groups of comparable clinical parameters and extent of coronary disease. (N=613 in each group) The incidence of initial major adverse cardiac events (MACE) for CABG vs. PCI was 29.2% vs. 41.8% (p&lt;0.001). Analysis of stent sub-groups showed more event in BMS vs. DES (47.9 vs. 40.0%; p&lt;0.001). Amongst propensity matched groups, the odds ratio for CABG to PCI was 0.69 (CI 0.56-0.85; p&lt;0.001) for morality and 0.58 (CI 0.45-0.75;p&lt;0.001) for any MACE (figure). Conclusions: Long-term follow-up of a clinical registry which reflects current practice in the community hospital setting suggests that CABG, both on- and off- pump, may offer comparable patients with advanced coronary artery disease a survival advantage over PCI with either DES or BMS.
Abstract 229: Access to a Portable Miniaturized Extracorporeal Membrane Oxygenation System Increases Utilization for Cardiac Arrest Patients
Authors: Atman P Shah, Mark J Russo, Janet Karol, David Beiser, Tom Bozzay, Jonathan Paul, Nathan Deal, Sandeep Nathan, Elizabeth Retzer, Maya Kommineni, Dana Edelson, Valluvan Jeevanandam
Journal: Circulation (2012)

Background: Extracorporeal membrane oxygenation (ECMO) has improved outcomes in patients with cardiogenic shock (CS). Recent data and guidelines have recommended the use of venous-arterial (VA) ECMO in patients who have been successfully resuscitated from cardiac arrest (ROSC) to ameliorate the effects of post-resuscitation myocardial dysfunction. Use of ECMO often involves taking a patient to the operating room delaying the onset of care. We hypothesized that utilization of the Maquet Cardiohelp, a portable miniaturized ECMO system, in the cardiac catheterization laboratory (CCL), would increase use of ECMO for cardiac arrest patients. Methods: Cardiohelp (CH) ECMO was acquired in March 2012 by our tertiary care university hospital. We performed a retrospective analysis comparing the patients who received CH ECMO from March 2012 until June 2012 to those that received Centrimag (CM), a traditional ECMO circuit, in the in the 6 months prior to March 2012. Results: All patients were treated with femoral VA ECMO with antegrade perfusion distal via a percutaneous catheter in the superficial femoral artery. Overall, more patients were treated with CH compared to CM. Compared to patients who received CM, CH patients were more likely to have been referred for ECMO after ROSC from cardiac arrest and were more likely to have been transferred directly from the Emergency Department (ED). CM patients were slightly younger and were referred for ECMO treatment primarily due to cardiogenic shock (SBP3 pressors). 30 day survival was similar in both groups and there were no cases of stroke or limb ischemia. Conclusions: Use of the portable CH ECMO system with CCL initiation is associated with increased utilization of ECMO and particularly for the treatment of ED ROSC patients. This may be due to the portability of the device and existing relationships between the CCL and the ED. Rapid utilization of ECMO for these patients may lead to improved clinical outcomes.
Abstract 19127: First Simultaneous Assessment of the Effects of Fish Oil Supplementation on Lipid and Thrombogenicity Profiles
Authors: Kevin Bliden, Anand Singla, Udaya Tantry, Young-Hoon Jeong, Gordon Ens, Paul A Gurbel
Journal: Circulation (2012)

Background: Fish Oil supplementation may have anti-atherosclerotic effects by reducing triglycerides, improving endothelial function, and reducing inflammation. However, inconsistent results have been reported on the effects of fish oil on platelet function. We aimed to determine if fish oil supplementation reduced the atherothrombotic risk profile by measuring lipids and thrombogenic factors simultaneously . Methods: Patients with suspected coronary artery disease with (n=79) and without (n=324) fish oil supplementation were enrolled in the Multi-Analyte, Thrombogenic, and Genetic Markers of Atheroclerosis (MAGMA) study. The lipid profile was determined by vertical density gradient ultracentrifugation technique, and thrombogenicity by thrombelastography immediately prior to elective coronary angiography. Urinary 11-dehydrothromboxane B 2 and AtherOx were performed by immunoassay. ADP and collagen-induced platelet aggregation were measured in aspirin+ clopidogrel- treated patients. Results: Baseline demographics and cardiac risk factors were similar between groups. Fish oil supplementation was associated with significantly lower triglycerides, VLDL, remnant lipoproteins, and AtherOx levels and increased HDL levels (p&lt;0.05). Among patients on aspirin + clopidogrel therapy, fish oil supplementation was associated with lower collagen-induced platelet aggregation (p=0.05, Table). Conclusion: This is the first study to simultaneously examine the influence of fish oil supplementation on lipid and thrombogenicity profiles. Our study supports prior evidence of an improved lipid profile and suggests an enhancement of the anti-platelet effects of DAPT. Prospective studies are needed to determine the contribution of each of these effects of fish oil supplementation on thrombotic event occurrence.
Abstract 9002: Off-pump Rather than On-pump Coronary Artery Bypass Grafting Increases Late Mortality: A Meta-analysis of Randomized controlled Trials
Authors: Shin-nosuke Goto, Hisato Takagi, Kotaro Iwata, Hirotaka Yamamoto, Takuya Umemoto
Journal: Circulation (2012)

Background: A recent meta-analysis incorporating 59 randomized controlled trials (RCTs) of off-pump versus on-pump (conventional) coronary artery bypass grafting (CABG) suggests that there appears to be a beneficial effect of off-pump CABG on post-operative (30-day or in-hospital) stroke but neither all-cause mortality nor myocardial infarction. To determine whether off-pump CABG reduces late all-cause mortality, we performed a meta-analysis of RCTs of off-pump versus on-pump CABG. Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through January 2012. Eligible studies were RCTs of off-pump versus on-pump CABG and reporting late (≥1-year) all-cause mortality as an outcome. For each RCT, data regarding mortality in both the off-pump and on-pump CABG groups were used to generate odds ratios (ORs) and 95% confidence intervals (CIs). Results: Eighteen RCTs enrolling 5358 patients were identified. Pooled analysis suggested a significant increase in late total mortality among patients randomized to off-pump versus on-pump CABG in the fixed-effects model (OR, 1.35; 95% CI, 1.07-1.70; P =0.01; Figure). There was minimal trial heterogeneity ( P =0.87) and accordingly little difference in the pooled result from the random-effects modeling. Mortality increase remained significant even after elimination of the largest and highest-weight RCT (Randomized On/Off Bypass [ROOBY] study) (OR, 1.32; 95% CI, 1.01-1.72; P =0.04). In general, exclusion of any single RCT from the analysis did not substantively alter the overall result of our analysis. There was no evidence of significant publication bias. Conclusions: Off-pump rather than on-pump CABG appears to significantly increase late (≥1-year) mortality