tbuckley/cabot-search huggingface dataset:
Abstract 82: Chest Stiffness and Force-Depth Relations Change Over Time During Prolonged CPR: An Animal Model
Authors: Paul Aelen, Igor Paulussen, Simone Ordelman, Gerrit-Jan Noordergraaf, Pierre Woerlee
Journal: Circulation (2012)

INTRODUCTION Chest deformation during CPR results in increased intrathoracic pressure and blood flow. A parameter linked to both deformation and internal pressures is reaction force. However, little is known about the time dependence of the force-depth relationship. In this study we assessed the hypothesis that chest stiffness and force-depth relations change during CPR in a pig model. MATERIAL AND METHODS Fourteen Yorkshire pigs with an average AP diameter of 20 cm were anesthetized after which ventricular fibrillation (VF) was induced. CPR was administered for 21 minutes at compression depths of 5 cm at frequencies of 80-120cpm during which absolute depth and force were measured continuously. The force-depth signal was divided into elastic and viscous components. Corrections were made for incomplete recoil. Chest stiffness was defined as the maximum force for each compression divided by its corresponding depth. Curvature and stiffness over time were studied. RESULTS The force versus depth relation shows that at the start of CPR the relationship is almost linear. As compressions continue, the curve becomes more curved. Chest stiffness starts at relatively high values of 118 +/- 28 N/cm which decreased to 96 +/- 19 N/cm of the original values after 250 compressions. After this point in time only minor changes in stiffness and nonlinearity were observed. CONCLUSION In conclusion, chest stiffness decreases and the force depth relation changes from linear to convex during CPR. Changes take mostly in the initial phase, where after they approach steady state. This is relevant for obtaining adequate blood flow during CPR.
Abstract 9691: Group X Secretory Phospholipase A <sub>2</sub> in Neutrophils Plays a Pathogenic Role in Abdominal Aortic Aneurysms in Mice
Authors: Kazuhiro Watanabe, Daisuke Fujioka, Yukio Saito, Takamitsu Nakamura, Jun-ei Obata, Kenichi Kawabata, Yosuke Watanabe, Hideto Mishina, Shun Tamaru, Kiyotaka Kugiyama
Journal: Circulation (2011)

Group X secretory phospholipase A 2 (sPLA 2 -X) is expressed in neutrophils and plays a role in the pathogenesis of neutrophil-mediated tissue inflammation and injury. Neutrophils have a critical role in development of abdominal aortic aneurysms. This study tested the hypothesis that sPLA 2 -X in neutrophils may contribute to the pathogenesis of abdominal aortic aneurysms using sPLA 2 -X knockout (sPLA 2 -X -/- ) mice. Methods and Results: Abdominal aortic aneurysms were created by application of CaCl 2 (0.5M) to the external surface of the aorta. As a result, a half of sPLA 2 -X +/+ mice had abdominal aortic aneurysm (&gt; 50% increase in aortic diameter from pretreatment) 6 weeks after CaCl 2 treatment, while none of sPLA 2 -X -/- mice had it. The aortas of sPLA 2 -X -/- mice had smaller diameters (% increase from pretreatment, 26.0 ± 3.7 vs. 42.4 ± 7.0, respectively, p &lt; 0.01), a reduced grade of elastin degradation and lower activities of elastase and gelatinase after CaCl 2 treatment compared with sPLA 2 -X +/+ mice. In sPLA 2 -X +/+ mice, immunofluorescence microscopic images showed that the immunoreactivity of sPLA 2 -X was detected only in neutrophils within aortic walls 3 days, 1, 2 and 6 weeks after CaCl 2 treatment, while the immunoreactivity was not detected in macrophages, mast cells or other cells in the aortic walls. Also, sPLA 2 -X immunoreactivity was colocalized in neutrophils expressing MMP-9. Neutrophils isolated from sPLA 2 -X -/- mice had lower activities of elastase, gelatinase and MMP-9 in response to PMA or fMLP compared with sPLA 2 -X +/+ mice. The attenuated release of proteases from sPLA 2 -X -/- neutrophils was reversed by the exogenous addition of mouse sPLA 2 -X protein. The aortic diameters and elastin degradation grades were significantly reduced in the lethally irradiated sPLA 2 -X +/+ mice reconstituted with sPLA 2 -X -/- bone marrow compared to irradiated sPLA 2 -X +/+ mice reconstituted with sPLA 2 -X +/+ bone marrow. The adoptive transfer of sPLA 2 -X +/+ neutrophils reversed aortic diameters and elastin degradation grade in the lethally irradiated sPLA 2 -X +/+ mice reconstituted with sPLA 2 -X -/- bone marrow to a similar extent seen in sPLA 2 -X +/+ mice. Conclusions: sPLA 2 -X in neutrophils plays a critical role in the pathogenesis of abdominal aortic aneurysms.
Abstract 8894: Comparison of More Than 3 Years Clinical Outcomes Between Drug-eluting Stent and Bypass Surgery for Unprotected Left Main Coronary Artery Disease: A Meta Analysis of Randomised and Risk Adjusted Studies
Authors: Dongxue Wang, Chenghui Zhou, Hong Liu, Shuang Xie, Yuqing Liu, Yishi Li
Journal: Circulation (2012)

Backgrounds: Previous data from meta analysis have reported controversial the short and midterm clinical outcomes between drug-eluting stent (DES) and coronary bypass surgery graft (CABG) for paitents with unprotected left main coronary artery disease (ULMCD). However, the long-term outcomes remain unknown. Methods: A systemic research was carried out in Pubmed, Embase, Cochrane library and scientific sessions of AHA, ACC and ESC (up to April 2012). All randomised and nonrandomised studies after &gt;=3 years of follow-up comparing DES and CABG in ULMCD were included. In order to control the potential confoundings in observational studies, risk adjusted hazard ratio (HR) or odds ratio (OR) by propensity score matching or Cox regresson method was abstracted. Results: 10 eligible studies (2 randomised, 8 nonrandomised) wth 6782 subjects were identified and selected. Mortality, death/MI/stroke and target vessel revascularizaton(TVR) were focused. Pooled analysis revealed that there was no statistical significant difference between DES and CABG in mortality (OR=0.92, 95% confidential interval [CI]: 0.65 to 1.31, P=0.646, heterogeniety test: 0.0%; Fig 1) and death/MI/stroke (OR=1.03, 95% CI: 0.75 to 1.42, P=0.841, heterogeniety test: 0.0%).However, compared with CABG, DES had a significant increased incidence of TVR(OR=3.45, 95% CI: 2.38 to 4.99, P&lt;0.00001, heterogeniety test: 0.0%). No evidence of significant publication bias was observed in mortality (Begg’s test, P=0.245; Egger’s test, P=0.518). Sensitivity analysis of mortality excluding each included study at one time revealed that most individual study was consisted with the direction and size of the overall effect ( all P&gt;0.1). Conclusions: Based on the available evidence, after long-term follow up, the mortality and composite outcome are similar between DES and CABG in patients with ULMCD, however, incidence of TVR is still high in DES comparing with CABG.
Abstract 80: Infliximab Is Superior to Etanercept for the Treatment of Postresuscitation Myocardial Dysfunction in a Swine Model of Ventricular Fibrillation
Authors: Scott T Youngquist, James T Niemann, Atman P Shah, Joseph L Thomas, John P Rosborough
Journal: Circulation (2012)

Introduction: Infliximab, a monoclonal antibody directed against the inflammatory cytokine TNF-α, has been shown to attenuate the myocardial dysfunction and hemodynamic decompensation associated with post-cardiac arrest syndrome. The aim of this study was to compare the effects of etanercept, a TNF-α receptor antagonist, to infliximab in a swine model of ventricular fibrillation (VF). Methods: Under general anesthesia, VF was induced electrically in domestic swine (n=30). After 7 minutes of VF, standard ACLS resuscitation was performed. Animals achieving return of spontaneous circulation (ROSC) were randomized to immediately receive infliximab (5 mg/kg, n=10) or etanercept (0.3 mg/kg [4 mg/m2], n=10) or vehicle (250 mL normal saline [NS], n=10) and LV function and hemodynamics were monitored for 3 hours. Results: Following ROSC, mean arterial pressure (MAP), stroke work (SW), and LV dP/dt fell from prearrest values in all groups. However, at the 30 minute nadir, infliximab-treated animals had higher MAP than either the NS group (difference 14.4 mm Hg, 95% confidence interval [CI] 4.2-24.7) or the etanercept group (19.2 mm Hg, 95% CI 9.0-29.5), higher SW than the NS group (10.3 gm-m, 95% CI 5.1-15.5, Figure) or the etanercept group (8.9 gm-m, 95% CI 4.0-14.4) and greater LV dP/dt than the NS group (282.9 mm Hg/sec, 95% CI 169.6-386.1) or the etanercep group (228.9 mm Hg/sec, 95% CI 115.6-342.2). Conclusions: In conclusion, only infliximab demonstrated a beneficial effect on post cardiac arrest hemodynamics and LV function in this swine model. Etanercept was no better in this regard than saline.
Abstract 9031: Visual Assessment of Brain MRI Detects Injury in Heart Failure
Authors: Alan Pan, Rajesh Kumar, Paul M Macey, Gregg C Fonarow, Ronald M Harper, Mary A Woo
Journal: Circulation (2012)

Introduction: Heart failure (HF) patients exhibit impairments in memory and executive function that contribute to HF mortality. Structural brain changes have been reported in areas which control these functions (mammillary bodies, hippocampi, and frontal cortex) using complex magnetic resonance imaging (MRI) quantitative analysis procedures. However, these quantitative MRI procedures are time-consuming to carry out and are not part of standard clinical assessment. It is unknown whether standard visual examination of MR images can detect changes in brain structures controlling memory and executive function in HF. Hypothesis: Heart failure patients would show more mammillary body, hippocampal, and frontal cortical atrophy versus control subjects. Methods: We visually assessed whole brain regions in 17 HF (mean age ± SD, 54.4 ± 8.1 years; LVEF, 0.28 ± 0.07) and 50 control subjects (age, 50.6 ± 7.0 years) using high-resolution T1-, T2-, and proton density-weighted images acquired from a 3.0 Tesla MRI scanner. Standardized visual scores were assigned to the mammillary bodies and frontal cortex for global atrophy and to the hippocampi for global and regional atrophy and scores were compared between HF and control groups. Results and Conclusions: Significant global changes emerged in the right mammillary body (1.18±1.13 vs. 0.52±0.74; p=0.024), right hippocampus (1.53±0.94 vs. 0.80±0.86; p=0.005), and left frontal cortex (1.76±1.03 vs. 1.24±0.77; p=0.034) in HF compared to controls. Global changes in the left mammillary body, left hippocampus, and right frontal cortex, and regional differences in bilateral hippocampi did not emerge. In conclusion, visual examination of MR images can detect brain damage in areas controlling memory and executive function in HF patients and may allow for increased opportunity to evaluate the progression of injury to these brain structures and to more easily identify and evaluate potential treatments for this damage in HF patients.
Abstract 9678: Long Term Results of Aortic Valve and Root Replacement in 1045 Patients Over Thirty-Three Years. A Single-Centre Experience
Authors: Davide Pacini, Antonio Pantaleo, Paolo Berretta, Luca Di Marco, Alessandro Leone, Emanuele Pilato, Giuseppe Marinelli, Roberto Di Bartolomeo
Journal: Circulation (2011)

Introduction. Aortic root replacement using composite graft represents the treatment of choice for a large variety of aortic root diseases. The aim of the current study is to evaluate the long-term results of this procedure. Methods. Between 1978 and 2010, 1045 patients aged 58.7±13.6 years (834 males) underwent aortic root composite graft replacement: 95 (9.1%) underwent Bentall operation, 926 (88.6%) were operated following the “button technique”, whereas 24 (2.3%) underwent Cabrol technique. Six-hundred thirty five patients (62.3%) had annuloaortic ectasia and 162 (15.5%) aortic dissection. Results. Overall in-hospital mortality was 5.3% (55/1045). Independent risk factors for in-hospital mortality at logistic regression analysis were age (p=0.051,OR=3.2), preoperative NYHA class III-IV (p=0.015,OR=5.9), aortic dissection (p=0.059,OR=3.6) and Cabrol technique (p=0.065,OR=2.2). Overall actuarial survival at 5, 10, and 20 years was 84.1%±1.3%, 65.5%±2.6%, and 40.7%±4.6%, respectively. Multivariate analysis revealed preoperative EF&lt;50% (p=0.057, OR=3.1), postoperative neurologic complications (p=0.013, OR=6.1) and postoperative pulmonary complications (p=0.046, OR=3.9) to be significant predictors of late death. Freedom from thromboembolism, freedom from bleeding complications, and freedom from endocarditis was 93.7%±2.6%, 90.3%±3.1%, and 98.4%±1% at 20 years, respectively. Freedom from aortic reoperation was 91.8%±2.1% at 20 years, and was significantly lower in patients with aortic dissection. Conclusions. Aortic root replacement for aortic root aneurysms can be performed with low morbidity and mortality and with satisfactory long-term results. Few late serious complications were related to the need for long-term anticoagulation or a prosthetic valve. Reoperation on the proximal or in the distal aorta was most commonly performed in patients with aortic dissection.
Abstract 304: Comparing a Novel Stochastic Integrative Machine Learning Model with AMSA for Predicting Defibrillation Success
Authors: Sharad Shandilya, Kevin Ward, Michael C Kurz, Kayvan Najarian
Journal: Circulation (2012)

Introduction A computational model of defibrillation success, based on physiologic signals, would be highly useful in guiding therapy during cardiac arrest. The Amplitude Spectrum Area (AMSA) measure has been explored in a number of studies as a predictor of countershock success for ventricular fibrillation (VF). We have developed a novel non-linear stochastic method for a unified predictive model of Return Of Spontaneous Circulation (ROSC) and compare this model to AMSA. Methods Ninety sample pre-hospital VF Electrocardiogram (ECG) signals including defibrillation were classified as successful (34) or unsuccessful (56) through 10-fold cross validation. A novel integrative model was developed with Machine Learning and features extracted from non-linear stochastic characterization of the ECG signal. This method was subsequently compared with the AMSA method. We replicated the procedure published by AMSA creators and attempted to discern a threshold. The performance of both methods in predicting post-countershock ROSC was measured. Accuracy is calculated as the correctly predicted countershock outcomes divided by all samples in the database. ROC AUC is a measure of predictive model robustness. Results The novel integrative model performs real-time, short-term (7.8 second) analysis of the ECGs with prediction Accuracy and Receiver Operator Characteristic (ROC) Area Under the Curve (AUC) of 82.2% and 85%, respectively. Sensitivity was 85.3% and specificity was 80.3%. Using the AMSA methodology, no clear threshold for shock success could be identified for comparison. Employing information-gain based decision stump (or one-rule) for AMSA values yielded 64.6% accuracy and 60.9% ROC AUC. Sensitivity was 44.1% and Specificity was 77.2%. Conclusion We report multiple performance metrics for a novel integrative model as well as the previously described, Fourier Transform based, AMSA model for predicting defibrillation success. A stochastic and non-linear basis for signal characterization proves to be more adept in dealing with the known dynamic and non-stationary characteristics/morphology of the VF waveform. It significantly improves performance in analyzing the VF signal to predict countershock success.
Abstract 90: Systolic and Diastolic Function in Cardiac Arrest Patients During Therapeutic Hypothermia
Authors: Shawn L Call, Staci L Milosavljevic, Nunzio Gaglianello, Michael E Widlansky, James F Kleczka, Byung-il (Bill) W Choi
Journal: Circulation (2012)

BACKGROUND: Previous studies and experience have suggested that the LVEF might be depressed in patients (pts) undergoing therapeutic hypothermia (TH) after cardiac arrest. We evaluated LV function by echocardiography (echo) during TH in pts with return of spontaneous circulation(ROSC) after cardiac resuscitation to observe whether TH may preserve cardiac function and contractile reserve compared to the patients without TH. METHOD: Retrospective chart review on 54 out of 292 pts with ROSC between 2007 and 2010 including echo reports performed prior to, during admission, and follow-up period; excluding 125 pts with no ROSC, and 113 pts with clear non-cardiac cause for arrest, age &lt;18 years, and no echo within 24 hrs of presentation post cardiac arrest. RESULTS: 32 non-TH patients and 22 TH patients were included in the study after applying the exclusion criteria. The two groups differed by location of arrest, with the non-TH group having 13/32 (41%) and the TH group having 16/22 (73%) out of hospital arrests, (p-value=0.028). 17 (53%) non-TH patients and 7 (31%) TH patients survived to discharge. Systolic function after ROSC in pts undergoing TH (average core temperature: 33.3 o C) and non-TH were 43 +/- 17% vs. 50 +/- 18% (P:NS), with normal EF (50-55%) in 7 vs. 17 pts (P:NS) and depressed EF (15-49%) in 15 vs. 15 pts (P:NS).Diastolic function in pts with TH and non-TH were normal in 6 vs. 10 pts, mild dysfunction in 3 vs. 6 pts, moderate dysfunction in 5 vs. 4 pts, severe dysfunction in 3 vs. 0 pts, and un-interpretable in 5 vs. 12 pts. (P:NS).Other echo variables i.e.systolic and diastolic dimension and LV mass indices were not statistically different in two groups. CONCLUSION: There was a trend of reduction in LVEF, but no significant deterioration of LV systolic and diastolic function, suggesting TH may not adversely affect cardiac performance during the procedure. A long term improvement in cardiac function in this population linked to TH warrants further investigation to prove the hypothesis that a reduced LVEF may be related to cardioprotective features associated with decreased demand and consumption of energy in the myocardium during TH following cardiac arrest.
Abstract 19153: Brachial Artery Diastolic Diameter is Associated with Noncalcified Coronary Artery Plaque Volume
Authors: Dhananjay Vaidya, Brian G Kral, Lisa R Yanek, Taryn F Moy, Diane M Becker, Lewis C Becker
Journal: Circulation (2012)

Background: Studies suggest that atherosclerosis in a primary vascular bed may be accompanied by generalized systemic remodeling in nonatherosclerotic vessels, resulting in larger arterial diameters, and that remodeling is related to plaque composition and stage of disease. We thus examined the extent to which diastolic brachial artery diameter (BAD) is associated with the extent of calcified (CP) and noncalcified coronary artery plaque (NCP) in an asymptomatic population of persons with a family history of early coronary artery disease. Methods: In 405 subjects (58% women, 37% African-American, mean age 51.2 ± 10.6 years), we measured BAD using B-mode ultrasound. Coronary plaque was assessed using 256 multidetector dual-source coronary CT angiography and total volumes of CP and NCP were calculated using a validated automated quantitation method. The association of resting BAD with NCP and CP plaque volumes was tested using two separate linear mixed models adjusted for age, sex, race, current smoking, diabetes, hypertension, body mass index, total and HDL-cholesterol, and nonindependence among family members. Results: NCP was present in 43.2% (N= 175) and CP in 37.5% (N= 152). The median BAD [IQR] was 4.6 [3.9 to 5.3] mm for persons with any plaque (n= 179) compared to 4.1 [3.6 to 4.6] mm for those without plaque (p &lt; 0.001). The unadjusted Spearman rho of BAD with NCP was 0.38 (p &lt; 0.001) and with CP was 0.32 (p &lt; 0.001). Among persons with plaque, there was a significant independent association between BAD and the extent of NCP (beta 38%/1mm larger BAD, p &lt; 0.001), but not with the extent of CP (beta 1%/1mm larger BAD, p=0.95). Conclusions: This study demonstrates a strong relationship between BAD, as a marker of systemic arterial remodeling in non-atherosclerotic vessels, and an incremental amount of noncalcified coronary plaque but not calcified plaque. This suggests that expansive vascular remodeling may occur with larger amounts of soft noncalcified plaque as an early adaptive response, whereas calcified plaque may represent a later atherogenic stage with a decrease in BAD adaptive potential. Studies are needed to examine plaque composition and its relation to systemic arterial remodeling in order to address prevention implications.
Abstract 9110: Elevated Glucose Increases ATP-Binding Cassette Transporter A1 mRNA Expression in Human Leukocytes and Murine Bone Marrow-Derived Macrophages and Decreases Cholesterol Efflux
Authors: Nicole L Spartano, Janey Ronxhi, Stefania Lamon-Fava, Nirupa R Matthan, Andrew S Greenberg, Martin S Obin, Alice H Lichtenstein
Journal: Circulation (2012)

Background: Individuals with diabetes are at increased CVD risk. Limited evidence suggests that this is partially attributed to hyperglycemic suppression of macrophage ATP-binding cassette (ABC) transporter mediated cholesterol efflux. The relationship between glucose concentrations and expression of ABC-transporters (ABCA1 and ABCG1) was assessed in human monocytes and leukocytes (study 1) and murine bone marrow-derived macrophages (BMDM) as well as cholesterol efflux in BMDM (study 2). Methods: Ten healthy subjects (4F/6M, 50-85 yrs, BMI 25-35 kg/m²) were recruited for study 1. At baseline, 1- and 2-hour post oral glucose challenge (50 g glucose), RNA was extracted from blood leukocytes (Paxgene RNA kit) and from monocytes isolated by magnetic cell sorting to assess ABC-transporter mRNA expression. For study 2, bone marrow cells were isolated from C57BL/6 mice and differentiated to BMDM with macrophage-colony stimulating factor. BMDM were stimulated with a 20mmol/L challenge of D- or L-glucose and/or 5mmol/L D-glucose (control), 16 hrs, followed by exposure to oxLDL (25 ug/mL, 24 hrs). Triglyceride (TG) and cholesteryl ester (CE) accumulation, ABC-transporter mRNA and protein expression, as well as HDL-mediated cholesterol efflux were evaluated. Results: A glucose challenge caused a 35% rise in human leukocyte ABCA1 mRNA expression after 1- (p=0.003) and 2- (p=0.020) hrs, but no significant effect on leukocyte ABCG1, or monocyte ABCA1 or ABCG1. Elevated glucose concentrations in BMDM culture media led to a 120% increase in ABCA1 mRNA (p=0.001) but no significant effects on expression of ABCG1 transcripts, ABCA1 or ABCG1 protein, or on intracellular TG or CE accumulation. Elevated glucose suppressed HDL-mediated cholesterol efflux by 10% (p=0.005). Conclusion: These results support the concept that hyperglycemia attenuates HDL-mediated cholesterol efflux from macrophages, potentially contributing to diabetes-associated CVD. Moreover, in the absence of altered ABC-transporter protein expression, our data suggest that hyperglycemia impairs HDL-mediated cholesterol efflux perhaps by attenuating transporter activity. Correspondingly, we found human monocyte ABC-transporter gene expression unresponsive to a glucose challenge.