tbuckley/cabot-search huggingface dataset:
Abstract 18318: Clinical Value of Increased High-Sensitivity Cardiac Troponin T in Patients with Essential Hypertension
Authors: Koichi Setsuta, Akihiro Nishizawa, Yasuyuki Kitahara, Yoshihiko Seino, Kyoichi Mizuno
Journal: Circulation (2012)

Background: Many studies including ours have shown the existence of ongoing myocardial damage detected as increased levels of cardiac troponin T (cTnT) in patients with chronic heart failure. We previously reported elevated levels of conventional cardiac troponin T in some patients with essential hypertension (EHT), an important precursor of heart failure. However, it has remained unclear whether myocardial damage and/or injury exist and its clinical value in patients with EHT. Newly developed high sensitive cardiac troponin T (Hs-cTnT) is more sensitive for the detection of myocardial damage and/or injury. Methods: We measured Hs-cTnT in 103 consecutive patients with EHT without prior ischemic heart disease, myocarditis and heart failure, and left ventricular (LV) systolic (LVEF &lt;55%) and renal dysfunction (estimated glomerular filtration rate [eGFR] &lt;30ml/min/1.73m2), and 20 normal controls. Hs-cTnT levels were compared with clinical parameters including neurohumoral factors (plasma renin activity and plasma aldosterone, norepinephrine and B-type natriuretic peptide [BNP] concentrations) and echocardiographic findings (left atrial dimension [LAD], LVEF, LV end-diastolic diameter, Tei index and mass index, E/A ratio and E/e’). Results: Hs-cTnT was detectable (&gt;0.003 ng/ml) in 61 of 103 (59%) patients, but 2 (10%) of 20 controls (p&lt;0.0002). In patients with EHT, univariate logistic regression analyses showed that age &gt;70 years, eGFR &lt;60 ml/min/1.73m2, BNP &gt;23.2 pg/ml and LAD &gt;36mm were significantly associated with Hs-TnT detection. In multivariate logistic regression anaysis including 7 variables (age, BNP, LAD and plasma renin activity and aldosterone concentration &gt; median value, E/A ratio &lt; median value and eGFR &lt;60 ml/min/1.73m2) that were associated with Hs-cTnT detection at p &lt;0.1 in univariate analyses, BNP &gt;23.2 pg/ml (odds ratio 4.00, p=0.01) and LAD &gt;36mm (odds ratio 3.96, p=0.007) were independently associated with Hs-TnT detection. In 61 patients with Hs-cTnT detection, Hs-cTnT significantly correlated with BNP(r=0.28, p=0.03) alone. Conclusion: The results of the present study suggest the presence of minute myocardial injury that might be associated with myocardial stress in patients with EHT.
Abstract 9149: Mechanism of Thyroid-Hormone-Deficiency-Caused Cardiac Injury in a Rat Model: Effects of Left Ventricle and Myocyte Functional Performance, [Ca <sup>2+</sup> ] <sub>i</sub> Transient Response and Beta-Adrenergic Modulation
Authors: Qun Shao, Heng-Jie Cheng, Michael F Callahan, Steven H Wong, Deborah J Wesley, Wei-Min Li, Che Ping Cheng
Journal: Circulation (2011)

Background. Thyroid hormone deficiency is associated in some patients with the development of congestive cardiomyopathy. However, the mechanism is unclear. Although hemodynamic abnormalities have been described, the cardiac pathophysiology is unclear. We assessed cardiac insufficiency in male SD rats with methimazole-induced hypothyroidism (Hypo). We tested the hypothesis that Hypo rats would demonstrate impaired left ventricular (LV) myocyte function and [Ca 2+ ] i regulation with desensitization of cardiac β-adrenergic signaling. Methods. We compared myocyte β 1 -adrenoceptor (AR) expression and assessed LV and myocyte basal systolic and diastolic function, peak [Ca 2+ ] i transient ([Ca 2+ ] iT ) and response to β-adrenergic simulation in 10 normal control (C) and 6 Hypo rats induced by methimazole (∼30 mg/kg/day for 8 weeks in the drinking water). Results. Compared to controls, total serum concentrations of T 3 and T 4 were significantly reduced in Hypo rats (T 3 : 21.5 vs 99.5 ng/dl and T 4 : 1.0 vs 4.8 μg/dl). Ejection fraction (33% vs 63%), LV contractility measured by E ES (0.7 vs 1.2 mmHg/μl) and M SW (57.2 vs 88.9 mmHg) were significantly decreased. LV time constant of relaxation (τ) (16.8 vs 10.7 ms) was increased by 57%. Importantly, these abnormalities of LV in Hypo rats were paralleled by concomitant depressions in myocyte contraction and relaxation indicated by decreased dL/dt max (57%, Hypo: 63.5±5.4 vs C: 147.8±5.6 μm/s) and dR/dt max (52%, 59.4±7.4 vs 123.8±7.5 μm/s) with reduced [Ca 2+ ] iT (-31%, 0.18 vs 0.26) and markedly slowed the decline of [Ca 2+ ] i . β 1 -AR expression decreased about 36% in Hypo compared with controls (0.48 vs 0.75). This was accompanied by attenuated responses to β-adrenergic stimulation. Isoproterenol (10 -8 M) produced significantly less increases in dL/dt max (30.7% vs 92.9%), dR/dt max (23.4% vs 66.9%), and [Ca 2+ ] iT (17% vs 34%) in Hypo myocytes compared to normal. Conclusions. Hypothyroidism produces LV and myocyte systolic and diastolic dysfunction, [Ca 2+ ] iT reduction and decreased myocyte β 1 -AR expression with impaired β-adrenergic regulation. The defects in cardiomyocyte force-generating capacity and relaxation process with impaired [Ca 2+ ] i regulation may be the primary cause of hypothyroid cardiomyopathy.
Abstract 18262: Comparison of Transradial Versus Transfemoral Coronary Intervention in Octogenarians with Acute Myocardial Infarction: Results from the Korea Working Group on Myocardial Infarction
Authors: Hye Won Lee, Kwang Soo Cha, Jin Hee Ahn, Jung Cheon Choi, Jun-Hyok Oh, Jung-Hyun Choi, Han Cheol Lee, Hye yoon Jang, Jong Hyun Choi, Eunyoung Yun, Taek Jong Hong
Journal: Circulation (2012)

Background: The transradial (TR) approach is associated with fewer bleeding and vascular complications during percutaneous coronary intervention (PCI), but is more technically challenging and associated with failure in elderly patients because the elderly may be associated with advanced vascular disease with tortuosity of subclavian artery, aortic root dilation and calcification, and diffuse atherosclerosis. We compared the results of TR versus transfemoral (TF) approach in patients ≥80 years old with acute myocardial infarction (MI) who underwent PCI. Methods and Results: A total of 1,945 (8.9%) octogenarians were enrolled from 21,815 patients in the Korea Working Group on Myocardial Infarction Registry. TR group was consisted of 336 (17.3%) patients and TF group 1,609 (82.7%) patients. Procedural success and complications, door-to-balloon-time, in-hospital mortality and major adverse cardiovascular event (MACE, defined as death, MI, and revascularization) as well as those of one-year were evaluated. TR group had lower Killip class, but used more drug-eluting stents and longer stents compared to TF group. Extent of coronary disease and lesion severity were similar in both groups. Procedural success was not different (97.7% vs 98.3%), but in-hospital complications were significantly lower in TR group (8.1% versus 20.3%, p&lt;0.0001). Door-to-balloon time was not different in both groups (84.5 vs 87.0 minutes, p=0.372) in 1,170 (60.2%) patients with ST-segment elevation MI. In-hospital mortality and MACE were significantly lower in TR group compared to TF group (3.4% vs 11.4%, p&lt;0.0001; 3.4% vs. 11.4%, P&lt;0.0001, respectively). One-year mortality and MACE were also lower in TR group (9.8% vs. 18.4%, p&lt;0.0001; 13% vs. 21.9%, p=0.001, respectively). Conclusion: This study shows that, in octogenarians with acute MI who underwent PCI, TR approach for PCI was more effective than TF approach with regard to comparable procedural success, lower complications, and better clinical outcomes at one-year.
Abstract 18247: In Vitro Perfused Human Capillaries
Authors: Monica L Moya, Yu-Hsiang Hsu, Christopher C Hughes, Abraham P Lee, Steven C George
Journal: Circulation (2012)

Understanding the function and structure of the microcirculation is key to improving our understanding of pathophysiological process in many areas of cardiovascular disease including myocardial infraction and hypertension. Many of the techniques used to investigate the microcirculation include costly clinical human observations, in vivo animal studies, which require extrapolation of results to human, or in vitro models that lack the dynamic feature of perfusion. We have developed an in vitro model system of microtissues with perfused, living, dynamic human capillaries. In this work we demonstrate the ability to develop capillaries under two different pressure distributions and we assess features of the in vitro formed capillaries including permeability and shear rate. Our device consist of a PDMS casing consisting of two microfluidic channels on either side of 12 diamond shaped chambers containing stromal cells co-seeded with endothelial cells in a fibrin matrix. In both designs, formation of perfused vessels was encouraged by both mechnical and chemical stimuli. Finite element simulations demonstrate the ability to control the pressure distribution (Fig 1a &amp; 1b) and subsequent interstitial flows within the two designs. Varying or equal transverse pressure drops across each tissue chamber were created by either decreasing or increasing the pressure at the pores (Figure 1c &amp; 1d). Within 2-3 weeks of culture, a network of vessels (diameter=15-50µm) was observed (Fig 1e) in both designs. Perfusion of the vessels was confirmed at day 21 by perfusing FITC-dextran through the vessels by convection. The vessels were impermeable to 70 and 150 kDa FITC-dextran (Fig 1f). Microspheres tracked as they moved through the vessels revealed fluid velocities ranging from 0-4,000 µm/s at various locations along the vessel.
Abstract 189: Potential Negative Effects of Epinephrine on Carotid Blood Flow and ETCO <sub>2</sub> During Active Compression-Decompression CPR Utilizing an Impedance Threshold Device
Authors: Aaron M Burnett, Joshua G Salzman, Nicolas Segal, Ralph J Frascone, Scott McKnite
Journal: Circulation (2011)

Objectives: This study examined the effects of IV epinephrine administration on carotid blood flow and end tidal CO 2 (ETCO2) production of a swine undergoing active compression-decompression CPR with an impedance threshold device (ACD-CPR + ITD). Methods: Six female swine (32±1Kg) were anesthetized, intubated and mechanically ventilated. Intracranial, thoracic aorta and right atrial pressures were recorded via indwelling catheters. Carotid blood flow (CBF) was recorded via Doppler. ETC02, Sp02 and EKG were monitored. V-fib was induced and went untreated for 6 minutes. 3 minutes each of standard CPR (STD), STD-CPR+ITD and ACD-CPR+ITD was preformed. At minute 9 of the resuscitation, 40µg/Kg of IV Epinephrine was administered and ACD-CPR+ITD was continued for 1 minute. Statistical analysis was performed with a Paired t test. Results: Aortic pressure and calculated cerebral and carotid perfusion pressures increased from STD &lt; STD+ITD &lt; ACD-CPR &lt; ACD-CPR+ITD (p=&lt;.001). Epinepherine administered during ACD-CPR+ITD signficantly increased mean aortic (29±5vs42±12, p=0.01) cerebral (12±5 vs 22±10, p=0.01), and coronary perfusion pressures (8±7 vs 17±4, p=0.02); however, mean CBF and ETCO 2 decreased (respectively 29±15 vs 14±7.0, p=0.03; 20±7 vs 18±6, p=0.04). Conclusions: The administration of epinepherine during ACD-CPR+ITD signficantly increased markers of macrocirculation, while significantly decreasing ETCO 2 , a proxy for organ perfusion. While the calculated cerebral perfusion pressures increased, the directly measured CBF decreased. This calls into question the ability of calculated perfusion pressures to accurately reflect blood flow and oxygen delivery to end organs.
Abstract 8526: Comparison of Transradial Coronary Angiography via Right or Left Radial Artery Approaches in Contemporary Real World Cardiology Practice. A PREVAIL Study data subanalysis
Authors: Francesco Pelliccia, Carlo Trani, Marco Nazzaro, Andrea Berni, Giuseppe Patti, Roberto Patrizi, Bruno Pironi, Pietro Mazzarotto, Gaetano Gioffrè, Christian Pristipino
Journal: Circulation (2011)

Introduction. Previous studies in small subgroups of patients undergoing transradial catheterization have suggested that the right radial artery approach may encounter more technical difficulties than the left radial approach. Hypothesis. We performed a subanalysis of the PREVAIL study in order to test the hypothesis that the two approaches are actually different in the contemporary real world practice. Methods. PREVAIL study was a prospective, observational survey of unselected consecutive patients undergoing invasive cardiovascular procedures at 9 Italian hospitals over a one month observation period specifically aimed at assessing the outcomes of radial approach in contemporary real world. The choice of arterial approach (radial vs femoral, right radial vs left radial) were left to the discretion of the operator. Pre-specified end-points of this subanalysis were the procedural characteristics, expressly defined in the case report form to control for confounders Results. Of 1,052 patients consecutively enrolled, 509 patients underwent transradial catheterization (304 right radial and 205 left radial approach). The clinical characteristics were similar between the 2 groups. A similar proportion of patients in the 2 groups had coronary angiography only (59% vs 61%) or percutaneous coronary intervention (41% vs 39%), with no difference in urgent cases (37% vs 34%). Also, procedural success rates were similar in the 2 groups (97% vs 96%, respectively). As compared with left radial, the right radial group had longer total duration of the procedure (46+29 vs 33+24 min, P&lt;0.0001) and fluoroscopy time (765+787 vs 533+502 s, P&lt;0.0001). No differences were found in quantity of contrast injected (182+115 vs 176+112 ml) and numbers of catheters used per procedure (2.8+1.1 vs 2.8+1.1). Similar results were obtained when only operators with high (&gt;65%) right radial vs left radial volume were compared. Conclusions. The right and left radial artery approaches are feasible and effective to perform coronary angiography and intervention. In contemporary real world, however, patients undergoing the left radial route had shorter procedures and lower radiological exposure as compared to those undergoing a right radial approach.
Abstract 18242: Left Ventricular Non-Compaction on Cardiac Magnetic Resonance Imaging is prevalent in patients with Myotonic Dystrophy
Authors: Preeti Choudhary, Ramasami Nandakumar, Stuart Grieve, Paul Broadhurst, John C Dean, Rajesh Puranik, David S Celermajer, Graham Hillis
Journal: Circulation (2012)

Aims: Myotonic dystrophy (MD) is an autosomal dominant neuromuscular disorder characterised by myotonia, skeletal muscle weakness and multi-system disease. Patients with MD are at high risk of premature cardiovascular death related primarily to arrhythmias, conduction abnormalities and dilated cardiomyopathy. Cardiac magnetic resonance imaging (cMR) is the optimal modality to detect early abnormalities of left ventricular (LV) structure and function. There are, however, few data exploring the prevalence of cMR abnormalities in this setting. The aim of the current study is therefore, to address this. Methods: Forty patients with MD and 41 age and gender matched controls underwent clinical evaluation, standard 12 lead EKGs, 24 hour Holter monitoring, echocardiography and cMR. Cardiac MR scans were analysed by blinded two observers. Results: There was a significantly higher prevalence of compaction abnormalities in patients with MD (non-compaction [NC] in 34% in MD vs. 12% in controls; p=0.02). LV function, however, was similar in MD patients and controls, (MD mean EF = 58 standard deviation [SD] 7% vs. mean 59 SD 6% in controls, p = 0.4). PR interval and QRS durations were also significantly prolonged in patients with MD (mean MD PR interval = 186 SD 29 ms vs. 155 SD 24 ms, mean MD QRS duration = 100 ms SD 12ms vs. 88 ms SD 9 ms in controls; p &lt;0.001 for both). There was no significant difference in QTc in MD patients compared to controls (MD mean QTc = 410 SD 10 ms. vs. 409 SD 15 ms. in controls p=0.51). Among patients with myotonic dystrophy, there were no significant differences in the PR, QRS durations and the QTc between patients with normal compaction and NC (p=0.87). No other Holter parameters correlated with NC. Conclusion: LV non-compaction is common in patients with MD and has not been well characterised previously. Non-compaction in patients with MD is not associated with conduction abnormalities within this cohort. The clinical relevance of these findings require further study.
Abstract 18339: Biomarkers and Recurrence of Atrial Fibrillation After Successful Cardioversion: Results of a Meta-Analysis
Authors: Rajeev K Pathak, Walter P Abhayaratna, Abhinav Mehta, Dennis Lau, Muayad Alasady, Prashanthan Sanders
Journal: Circulation (2012)

Background: An increasing body of evidence suggests the role of inflammation in the genesis and perpetuation of atrial fibrillation (AF). However, inconsistent results have been published with regard to the role of inflammatory markers in predicting the maintenance of sinus rhythm after a successful direct current cardioversion (DCCV). Methods: Using Ovid and EMBASE, we searched for literature published prior to December 2011. Of the 405 studies identified, 16 studies with 1054 patients (501 with and 553 without AF relapse) were included for analysis. Results: Mean CRP, BNP group levels from each study were recorded and the standardized difference in mean and odds ratio was calculated. Using the fixed effects model (FEM), CRP and BNP group levels were significantly higher in patients with recurrence of AF post DCCV (odds ratio (OR) for CRP = 2.30 (CI: 1.63-3.26); for BNP = 4.44 (CI: 3.11-6.33)). There was some evidence of heterogeneity (p-value for CRP &lt; 0.002; p-value for BNP group = 0.001). Using random effects model, the effect size for CRP increased to 2.53 (CI: 1.33-4.82) and for BNP group the effect size increased to 6.38 (CI: 1.58-25.82). Publication bias was not evident for CRP and BNP group (p-value 0.43 and 0.24 respectively). Conclusion: Increased CRP and BNP levels are associated with greater risk of AF recurrence after successful DCCV. The use of these markers for the prediction of those who maintain sinus rhythm after DCCV appears promising but requires further study.
Abstract 18268: Jund is a Critical Modulator of Oxidative Stress-induced Vascular Aging
Authors: Elena Osto, Paneni Francesco, Bogdan Mateescu, Sylvie Briand, Giuseppe Coppolino, Enrico Perna, Sarah Costantino, Pavani Mocharla, Alexander Akhmedov, Ruslan Kubant, Lucia Rohrer, Christian Matter, Tadeusz Malinski, Massimo Volpe, Fatima Metcha-Grigoriou, Thomas F Luescher, Francesco Cosentino
Journal: Circulation (2012)

Background. Reactive oxygen species (ROS) are the major determinant of vascular aging. JunD, a member of the activated protein 1 (AP-1) family of transcription factors, promotes the intracellular redox homeostasis. The present study investigates the role of JunD in aging-associated endothelial dysfunction. Methods and Results . Blunted vasorelaxation was found in young and old JunD -/- mice as compared with age-matched WT animals [maximal relaxations were 51±1.5 %vs 83±4.8 (young) and 34±2.3 vs 58±2.4 (old) for JunD -/- and WT mice, respectively, n=6-8, p&lt;0.05 vs age-matched group]. ROS scavengers superoxide dismutase (PEG-SOD) and catalase restored endothelial function. Accordingly, JunD-/- mice displayed not only an age-independent decline of NO release but also increased superoxide and peroxynitrite levels in endothelial cells assessed by chemoluminescence. Nitrotyrosine residues, identified by immunofluorescence, were also elevated. ROS scavenging enzymes manganese (Mn) and extracellular (ec) SOD, aldehyde dehydrogenase-2 and glutathione peroxidase-1(GPx-1) were downregulated in JunD -/- mice. In contrast, NADPH oxidase subunit p47phox was upregulated. Furthermore, in JunD-/- mice eNOS expression and eNOS activating Ser-1177 phosphorylation were reduced. Interestingly, age-induced endothelial dysfunction was paralleled by a significant reduction of JunD protein expression in old as compared with young WT mice. In human aortic endothelial cells, siRNA-mediated JunD knockdown elicited a similar impairment of NO/O2- production, which was abolished by simultaneous silencing of p47phox. Notably, JunD mRNA expression was reduced in peripheral monocytes from old compared with young healthy blood donors (63.30 ± 6.0 vs 113.9 ± 6.7, respectively, values normalized to TBP mRNA, n=6; p&lt; 0.0004), and correlated with gene expression of MnSOD (r=0.65, p&lt;0.05). Conclusions. Aging-induced oxidative stress and endothelial dysfunction were markedly accelerated in JunD -/- mice compared with age-matched WT littermates. JunD may be a crucial modulator of ROS-mediated vascular aging, representing a novel molecular target to slow down this process.
Abstract 18282: Atrial Fibrillation Independently Increases Risk of All-Cause Mortality: The Honolulu Heart Program
Authors: Kahealanik K Rivera
Journal: Circulation (2012)

Introduction: Atrial fibrillation (AF) increases cardiovascular and cerebrovascular mortality. However, there are few studies examining the natural history of AF in Asian populations in the US. Objective: To determine the long-term effect of AF detected in mid-life and late-life on all-cause mortality in a population of Japanese-American men. Methods: The Honolulu Heart Program prospective cohort included Japanese-American males (born 1900-1919) living on O`ahu, Hawai`i in 1965. Analyses included 6,860 and 2,675 participants with electrocardiograms from mid-life and late-life, followed over 36 years and 13 years, respectively. Mid-life AF was defined as having fibrillation or flutter at any of the 3 mid-life exams (ages 45-68 years old) and late-life AF was defined as having fibrillation or flutter at any of 2 late-life exams (ages 71-94 years old). The primary outcome was all-cause mortality. Results: AF prevalence was 0.74% and 4.36% in mid-life and late-life, respectively, and increased significantly with age (p&lt;0.05), up to 12% in nonagenarians. After adjustment for multiple potential confounders, AF was an independent predictor of mortality in mid-life (RR=1.37, 95% CI=1.03-1.82, p=0.033) and late-life (RR=1.44, 95% CI=1.13-1.83, p=0.003). This relationship remained significant even in those without prevalent coronary heart disease, left ventricular hypertrophy, heart failure, and rheumatic heart disease in both mid-life (RR=1.45, 95% CI=1.04-2.02, p=0.029) and late-life (RR=1.51, 95% CI=1.13-2.02, p=0.005). Conclusions: In conclusion, atrial fibrillation was a significant independent predictor of all-cause mortality in both mid-life and late-life, including previously healthy participants.