tbuckley/cabot-search huggingface dataset:
Abstract 340: An Algorithm that Analyzes During Chest Compressions Exceeds Sensitivity and Specificity Recommendations
Authors: Joseph L Sullivan, Daniel W Piraino, Isabelle Banville, Robert G Walker, Fred W Chapman
Journal: Circulation (2012)

Background : Pauses in chest compressions during cardiopulmonary resuscitation (CPR) reduce survival from sudden cardiac arrest. Analyzing ECG during compressions (ADC) instead of pausing for analysis may improve outcomes. We assembled large development and test sets of clinical data and evaluated the performance of an ADC algorithm that classifies rhythms into categories of “Shock,” “No Shock,” and “Pause CPR for Analysis.” Methods : Defibrillator ECG and impedance recordings from 1097 (585 development, 565 test) patients with cardiac arrest were retrospectively gathered from 7 emergency medical systems. To compare against American Heart Association (AHA) recommendations, CPR-artifacted segments with coarse VF (&gt; 0.2 mV peak-peak) or non-shockable rhythms were paired with adjacent segments free of CPR artifact, enabling annotators to accurately identify the rhythm. One reviewer annotated and another verified rhythm designations, resulting in a development set of 2811 (716 coarse VF + 2095 non-shockable) CPR-artifacted segments and an independent test set of 2758 (707 coarse VF + 2051 non-shockable) segments. “Pct Pauses” was defined as the number of segments classified “Pause CPR for Analysis” divided by the total number of segments. Sensitivity, specificity, positive predictivity, and negative predictivity were calculated for segments not designated for a pause (i.e. analyzed during CPR). Results were compared to AHA recommended sensitivity and specificity for artifact-free ECG. Results : See table. Conclusions : ADC algorithm performance, evaluated on development and test sets of ECG with CPR artifact, exceeded the AHA recommendation for performance on ECG without CPR artifact. Incorporation of this algorithm into an AED may eliminate about 80% of analysis pauses without compromising analysis accuracy and may consequently improve the likelihood of resuscitation.
Abstract 9493: Plasma Levels Of Soluble CD36 In Type 2 Diabetes - A Link Between Platelet Activation, Inflammation And Oxidative <i>Stress</i>
Authors: Giovanni Davì, Rossella Liani, Bente Halvorsen, Simona Sestili, Aase Handberg, Francesca Santilli, Gloria Formoso, Pål Aukrust
Journal: Circulation (2011)

INTRODUCTION Inflammation, oxidative stress and platelet activation are involved in the pathogenesis of type 2 diabetes (T2DM) and its complications. Soluble CD36 (sCD36) has been proposed to early identify diabetic subjects at risk of developing accelerated atherothrombosis. HYPOTHESIS We aimed at characterizing the platelet contribution to sCD36 in T2DM, to correlate its formation with the extent of in vivo lipid peroxidation and to investigate the effects of low-dose aspirin on these processes. METHODS A cross-sectional comparison of sCD36, soluble CD40L (sCD40L) as a marker of platelet-mediated inflammation, urinary 11-dehydro-TxB 2 and 8-iso-PGF 2α , in vivo markers of platelet activation and lipid peroxidation, respectively,was performed between 200 T2DM patients (94 of them on low-dose aspirin) and 47 healthy controls. RESULTS sCD36 (median [IQR]: 0.72 [0.31-1.47] vs 0.26 [0.2-0.37], p=0.003) and urinary 11-dehydro-TxB 2 levels (666 [293-1336] vs 279 [160-396], p≤0.0001) were significantly higher in T2DM patients not on aspirin (n=106) than in healthy subjects. These variables were significantly lower in aspirin-treated diabetics than in untreated patients (p&lt;0.0001). Among patients not on aspirin, those with long-standing diabetes had significantly higher sCD36 levels in comparison to patients with diabetes duration &lt;1 year (1.01 [0.62-1.86] vs 0.44 [0.22-1.21], p=0.001). Consistently, in the same group of patients, a significant linear correlation was found between sCD36 and diabetes duration (rho=0.347; p=0.0001), fasting blood glucose (rho=0.378; p=0.002) and HbA 1c (rho=0.255; p=0.026). sCD36 linearly correlated with urinary 11-dehydro-TxB 2 , 8-iso-PGF 2 α and sCD40L in diabetics not on aspirin. On multiple regression analysis, 11-dehydro-TxB 2 ( β =0.360; SEM=0.0001, p=0.001), 8-iso-PGF 2α ( β =0.469; SEM=0.0001, p&lt;0.0001) and diabetes duration ( β =0.244; SEM=0.207, p=0.017) independently predicted sCD36 levels. CONCLUSIONS sCD36 may be a link among hyperglycemia, inflammation, lipid peroxidation and platelet activation. Because it can only incompletely be down-regulated by low-dose aspirin, additional antiplatelet strategies in T2DM should be investigated to interrupt CD36-dependent platelet activation.
Abstract 9281: Usefulness of Lipoprotein(a) to Predict Progression of Non-Culprit Coronary Lesions after Acute Myocardial Infarction for Paients with Normal Low-Density Lipoprotein Cholesterol
Authors: Hiroki ikenaga, Masaharu Ishihara, Ichiro Inoue, Takuji Kawagoe, Yuji Shimatani, Fumiharu Miura, Yasuharu Nakama, Kazuoki Dai, Takayuki Ohtani, Takashi Miki, Masayuki Nakamura
Journal: Circulation (2011)

Purpose: Lipoprotein(a) [Lp(a)] is associated with development of new coronary lesions after acute myocardial infarction (AMI) and Lp(a) value remains consistent within individuals across their lives. However, the efficacy of Lp(a) in patients with normal low-density lipoprotein cholesterol (LDL-C) was unclear. This study was undertaken to assess the efficacy of Lp(a) in patients with LDL-C. Methods: Lp(a) was measured 1 week after AMI in 410 patients who underwent primary percutanious coronary intervention (PCI) within 24 hours after symptom onset. Patients were stratified into two groups based on Lp(a); high Lp(a) group (&gt;40mg/dl:n=95) was compared with low Lp(a) group. Furthermore, patients were stratified into two groups based on LDL-C; high LDL-C group (&gt;120mg/dl) was compared with normal LDL-C group (≤120mg/dl). Clinical follow-up was obtained up to 1 years. Major Cardiac Coronary Event (MACE) was defined as cardiac death, myocardial infarction (MI) and/or revascularization for new lesions. Results: There was no significant difference with age, sex, hypertension, diabetes, infarct location, multivessel disease, final TIMI 3 and use of cardiovascular drugs between high Lp(a) group and low Lp(a) group. High Lp(a) was associated with higher 1-year cumulative incidence of MACE (25.2% vs 11.1%, p&lt;0.001) and new lesion revascularization (22.1% vs 6.6%, p&lt;0.001). Multivariate analysis showed that Lp(a) was an independent predictor for MACE (OR 1.64, 95% CI: 1.31-2.06, p&lt;0.001) and new lesions requiring revascularization (OR 1.67, 95% CI: 1.32-2.13, p&lt;0.001). In patients with normal LDL-C, Lp(a) was associated with the incidence of new lesion revascularization during 1-year (p=0.01, figure B) as same as in patients with high LDL-C (p=0.007, figure A). Conclusions: These results suggest that Lp(a) could predict MACE after AMI regardless of LDL-C.
Abstract 36: Etiology of In-Hospital Cardiopulmonary Arrest as a Predictor of Outcome
Authors: Ruchika Husa, Dorothy Scyoc, James Gordon, Ruth Chappel, Rebecca Sell, Anushirvan Minokadeh, Daniel Davis
Journal: Circulation (2012)

Background: Inpatient cardiopulmonary arrest (CPA) is poorly defined. However, understanding the factors contributing to incidence and outcome is critical in designing effecting CQI programs. Objective: To explore the effectiveness of an arrest taxonomy, using specific etiologies of inpatient CPA, to predict incidence and outcomes and direct CQI efforts. Methods: This study was conducted in two urban university hospitals from 2005-09. The Advanced Resuscitation Training (ART) program was implemented in 2007. Clinical and demographic data were abstracted from the institutional resuscitation database. Broad categories regarding arrest etiology [sepsis, hemorrhage, pulmonary embolus, VF/VT, vagal, neurologic, heart failure, intubated respiratory, and non-intubated respiratory] were incorporated into a multivariate logistic regression model using survival-to-hospital discharge as the primary outcome. In addition, chi-square analysis of incidence and graphical analysis of incidence and survival trends for specific etiologies before and after ART implementation were performed. Results: A total of 332 inpatients suffered CPA during the study period [pre-ART n=182, post-ART n=150]. Multivariate logistic regression revealed an independent association with outcome for each of the etiologies but not for other covariates. A decrease in the incidence and improvement in survival for certain arrest etiologies was observed following ART implementation. Conclusion: We observed important associations between arrest etiology and both incidence and outcome from inpatient CPA. This taxonomy may be helpful in guiding CQI efforts.
Abstract 324: Automated Classification of Proximal Left Anterior Descending and Proximal Right Coronary Artery Occlusion from More Distal Locations in ST-Segment Elevation Myocardial Infarction
Authors: Richard E Gregg, Miquel Fiol, Andrés Carrillo, Cheng-hao S Chien, Kjell C Nikus
Journal: Circulation (2012)

Background: Rapid classification of the occlusion location in the coronary artery tree during ST-elevation myocardial infarction (STEMI) can be used for further risk stratification. In this study, we introduce and characterize a complete automated algorithm for classifying occlusion location as left circumflex, or proximal or middle-to-distal in the left anterior descending and right coronary artery in STEMI. Methods: The new algorithm was developed and tested on two separate sets of ECGs using multiple decision trees optimized for high specificity. The development set of ECGs came from the emergency department of a large hospital. The test set of ECGs came from a prehospital emergency medical service using inclusion criteria of STEMI and angiogram confirmation of single culprit artery and lesion location (n=132). LBBB and paced ECGs were excluded. All left circumflex (LCx) locations (n=31) were lumped together. The split between proximal right coronary artery (RCA) lesion location (n=51) and middle-to-distal RCA location (n=50) was defined as above the acute marginal branch. Proximal lesion for the left anterior descending (LAD) coronary artery was defined as above the first major diagonal side branch. All patients met current age and gender based STEMI criteria. Accuracy of lesion location prediction was based on sensitivity and specificity calculated from a 2X2 table with the two groups as lesion location and other. Results: The automated algorithm classifies proximal LAD lesion location with a sensitivity and specificity of 75% and 94% respectively and sensitivity and specificity of 57% and 99% for proximal RCA lesion location. Conclusion: Since proximal lesion location indicates higher risk for both LAD and RCA, the classifier was designed for higher specificity and the specificity within STEMI cases was shown to be 94% and higher. High specificity is necessary for confidence in the classification before altering treatment. An automated algorithm for proximal lesion location allows for rapid risk assessment which should result in a valuable clinical decision support tool.
Abstract 298: Efficacy of Bag-Mask Ventilation for Ventricular Fibrillation Sudden Cardiac Arrest
Authors: Yoshio Tahara, Kazuo Kimura, Naoto Morimura, Yasufumi Oi, Naohiro Yonemoto, Hiroshi Nonogi, Takeshi Kimura, Ken Nagao
Journal: Circulation (2012)

Background: If bag-mask ventilation is adequate, an advanced airway is not urgently required. Although rescuers may defer insertion of an advanced airway until the patient fails to respond to initial cardiopulmonary resuscitation (CPR) and defibrillation attempts or has return of spontaneous circulation (ROSC), its effects and optimal timing remain unclear. Methods: An observational study was performed in 670,313 patients who had out-of-hospital cardiac arrest (OHCA) in Japan and received CPR between January 1, 2005 and December 31, 2010. Of these patients, 9,720 in whom age was from 18 to 74 years, OHCA was cardiogenic, the scene of OHCA was witnessed, bystander CPR was performed, and initial rhythm was ventricular fibrillation (VF) were studied. The subjects were divided into two groups according to the method used for airway management by emergency medical service (EMS) personnel: 5,358 who used a bag-valve mask (bag-mask ventilation group: BMV group) and 4,362 who used an advanced airway including a supraglottic airway device and endotracheal tube (advanced airway management group: AAM group). The rates of ROSC from the initiation of EMS-CPR to arrival at the hospital were compared. Next, subjects who did not have ROSC within 45 minutes before arrival at the hospital were divided into two groups, the pre-hospital non-ROSC BMV group (N=3,092) and the pre-hospital non-ROSC AAM group (N=3,291), and neurologic outcomes at 30 days were compared. A favorable outcome was defined as a Cerebral Performance Category (CPC) of 1 or 2. Results: The rate of ROSC from the initiation of EMS-CPR to arrival at the hospital was higher (41% vs. 21%, p&lt;0.01) in the BMV group than in the AAM group. The rate of favorable outcomes was higher (8% vs. 3%, p&lt;0.01) in the pre-hospital non-ROSC BMV group than in the pre-hospital non-ROSC AAM group. In particular, the rate of favorable outcomes was higher in the pre-hospital non-ROSC BMV group than in the pre-hospital non-ROSC AAM group during the first 20 minutes after the initiation of EMS-CPR. Conclusions: In patients with VF sudden cardiac arrest, the use of a bag-valve mask for airway management increases the rates of ROSC and favorable outcomes, particularly during the initial period from EMS-CPR to arrival at the hospital.
Abstract 9356: Diastolic Function Determines the Adrenergic Augmentation of Early Diastolic Intra-Ventriclular Pressure Gradient and Its Spatial Distribution
Authors: Takahiro Ohara, Cassie L Niebel, Kelley C Stewart, John J Charonko, Pamela R Burgess, Min Pu, Pavlos P Vlachos, William C Little
Journal: Circulation (2011)

Introduction: Early diastolic left ventricular (LV) filling results from a progressive intra-ventricular pressure gradient (IVPG) extending from the left atrium to the LV apex. Hypothesis: Adrenergic stimulation enhances the progressive IVPG in normal subjects but not in patients with diastolic dysfunction. Methods: We studied 218 consecutive patients undergoing stress echocardiography who had no inducible ischemia, of which 29 were graded as normal diastolic function, 20 impaired relaxation (IR), 103 pseudo-normal filling (PN) and 66 restrictive filling (RF) according to the EAE/ASE recommendations. Color M mode Doppler (CMMD) images in the apical four chamber view were obtained at rest and during peak dobutamine infusion (20-40 mcg/kg/min). Total IVPG from the mitral annulus to LV apex, IVPG from the mitral annulus to mid LV (2 cm into the LV from the mitral annulus) and IVPG from mid LV to LV apex were calculated using the CMMD data to integrate the Euler equation. Results: Mean age±SD was 60±12 years old. Male 51%. EF 59±8%. Total IVPG from the mitral annulus to LV apex was not different between groups at rest. The total IVPG increased more with dobutamine in normal subjects than in patients with diastolic dysfunction (Figure 1). The responses of IVPG from the mitral annulus to mid LV were not different among groups. The difference in the response of the total IVPG was due to the more marked augmentation of IVPG from mid LV to LV apex in normal subjects (Figure 2). Conclusions: Diastolic dysfunction is associated with an inadequate adrenergic augmentation of the IVPG from mid LV to LV apex reflecting less apical suction.
Abstract 235: The Glasgow Motor Score Before Induction of Therapeutic Hypothermia Is an Independent Predictor of Good Outcome in Cardiac Arrest
Authors: Chun Song Youn, Gi Woon Kim, Kyu Nam Park
Journal: Circulation (2012)

Background: With the recent introduction of therapeutic hypothermia, the application of sedation becomes necessary in cardiac arrest patients. Therefore early prediction of neurologic outcome in these patients is challenging problem. Nevertheless neurologic examination including the Glasgow coma scale should be basis for decision making. So, we investigated the usefulness of the Glasgow motor score before induction of therapeutic hypothermia for outcome prediction in survivors of cardiac arrest treated with therapeutic hypothermia. Methods: Between March 2009 and July 2011, patients who successfully resuscitated from cardiac arrest and treated with mild therapeutic hypothermia were included in this study. Data were collected by local post-cardiac arrest care registry. Neurologic outcome was assessed with Cerebral Performance Category (CPC) at hospital discharge and good neurologic outcome was defined CPC score of 1 and 2. Results: Total 89 patients were treated with therapeutic hypothermia during study period. Among these patients, 39 were good neurologic outcome and 50 were poor neurologic outcome. The value for prediction of good outcome was as follows: sensitivity 53.8%, specificity 96.0%, PPV 91.3%, NPV 72.7% and AUC 0.749. Conclusions: The results of this study show that the Glasgow motor score &gt; 1 before induction of therapeutic hypothermia is an independent predictor of good outcome in patients treated with therapeutic hypothermia. Thus, the patients with the Glasgow motor score &gt; 1 soon after ROSC should be treated aggressively including therapeutic hypothermia.
Abstract 9327: Depletion of Intracellular Ca <sup>2+</sup> Stores Induces Phosphorylation of Stromal Interaction Molecular 1 (STIM1), Which Contributes to the Sustained Phase of Store-operated Ca <sup>2+</sup> Influx in Vascular Endothelial Cells
Authors: Katsuya Hirano, Akiko Hanada, Mayumi Hirano
Journal: Circulation (2011)

Store-operated Ca 2+ influx (SOC) is a major Ca 2+ entry pathway in vascular endothelial cells, thus contributing to the regulation of endothelial barrier function, nitric oxide production, and angiogenesis. The basic molecular mechanisms underlying SOC have recently been elucidated. Namely, STIM1 serves as a store site Ca 2+ sensor and thereby activates SOC channels. However, the mechanisms regulating SOC remains largely unknown. STIM1 has been previously reported to be a phosphoprotein with unknown function. The present study thus investigated the role of STIM1 phosphorylation in the regulation of SOC. STIM1 phosphorylation was evaluated with a new SDS-PAGE technique utilizing a Phos-tag TM compound, which specifically binds to a phosphate group, thus allowing the separation of phosphoproteins from the unphosphorylated form. Thapsigargin, an inhibitor of endoplasmic reticulum Ca 2+ pump, induced a depletion of the Ca 2+ stores in porcine aortic endothelial cells (PAEC) and HeLa cells in the absence of extracellular Ca 2+ . The following repletion of the external Ca 2+ induced a sustained Ca 2+ influx. STIM1 knockdown abolished this influx. Thapsigargin induced &gt;95% phosphorylation of STIM1 in the absence of extracellular Ca 2+ , which persisted irreversibly even after the repletion of external Ca 2+ . Thrombin induced Ca 2+ depletion and subsequent activation of SOC in PAEC, at a lower level than that seen with thapsigargin. Thrombin also induced a lower level of STIM1 phosphorylation in PAEC. However, it returned to the pre-stimulation level after Ca 2+ repletion. Myosin light chain kinase inhibitors, ML-9 and wortmannin, inhibited thapsigargin-induced STIM1 phosphorylation, while Rho kinase inhibitors, Y27632 and H1152, or PKC inhibitor GF109203X had no effect. The effect of the kinase inhibitors were correlated with the effect on the sustained phase of SOC. Analysis of various STIM1 deletion mutants revealed that the C-terminal region is the site of phosphorylation. These results provide the first evidence that STIM1 is phosphorylated following depletion of Ca 2+ stores and this phosphorylation contributes to the maintenance of Ca 2+ influx via SOC. STIM1 phosphorylation may provide a new therapeutic target to maintain normal endothelial functions.
Abstract 292: Comparison of Pharmacological and Physical Hypothermia in Cerebral and Myocardial Function in a Porcine Model of Cardiac Arrest and Resuscitation
Authors: Yinlun Weng, Shijie Sun, Wei Chen, Xiaobo Wu, Jiefeng Xu, Wanchun Tang
Journal: Circulation (2012)

Objective: Non-selective cannabinoid (CB) 1/2 receptor agonist, WIN 55,212-2, has been demonstrated to produce pharmacological hypothermia and improved outcomes of CPR in a rat model. In this study, we compared the effects of pharmacological hypothermia induced by WIN 55,212-2 and physical hypothermia by surface cooling in myocardial and neurological function in a porcine model of CPR. Hypothesis: Pharmacological hypothermia by WIN 55,212-2 produced the similar or better cerebral and myocardial function as surface cooling. Methods and results:Ventricular fibrillation (VF) was induced in 14 male domestic pigs weighing between 35 ± 2 kg. CPR was initiated after 7 min of untreated VF. Defibrillation was attempted after 5 min of CPR. If ROSC was not achieved, two mins of CPR was continued and sequenced with defibrillation attempt until ROSC or for a total of 15 mins. At 5 min post resuscitation, animals are randomized to receive intravenous infusion with WIN 55,212-2 at a dose of 1.0 mg/kg/h or surface cooling until blood temperature cooled down to 34 celcius degree and maintained for 4 hrs. When compared to the animals treated with surface cooling, significantly improvement in neurological alertness score (NAS) was observed in the WIN 55,212-2 treated animals at 24 and 48 hrs, but not at 72 hrs (WIN 55,212-2 vs surface cooling: 24 hrs, 93 ± 5 vs 77 ± 12, p&lt;0.01; 48 hrs, 100 ± 0 vs 93 ± 6, p=0.01) (Figure 1A). As to the post resuscitation myocardial function, there was no significant difference in ejection fraction (EF) between these two groups (Figure 1B). Conclusions: Pharmacological hypothermia induced by WIN 55,212-2 exerted better post resuscitation short-term neurological function than physical hypothermia with the similar post resuscitation myocardial function.