tbuckley/cabot-search huggingface dataset:
Abstract 233: Duration of Ventilations During CPR by Lay Rescuers Does Not Interfere with Delivering Chest Compressions
Authors: Stefanie G Beesems, Lizzy Wijmans, Rudolph W Koster
Journal: Circulation (2011)

Objective: In the AHA and ERC Guidelines 2005 (G2005) and 2010 for cardiopulmonary resuscitation the importance of minimally interrupted chest compressions (cc) is emphasized. The time taken to give two breaths should not be more than 5 s to allow for a sufficient number of cc delivered. The feasibility of this recommendation for lay rescuers was questioned after manikin studies. This study aims to determine if the expected short interruption for ventilations by trained lay rescuers can be achieved in reality. Methods: The Arrest study is a prospective database of all out-of-hospital cardiac arrest in the province North-Holland, in the Netherlands. We used Automatic External Defibrillator (AED) recordings where the chest impedance or sternal displacement was recorded during lay rescuer CPR. We excluded ECGs with a c:v ratio of 15:2, incomplete or technical deficient ECGs. Lay rescuers had received a standard ERC BLS and AED course in the past. A ventilation period was defined as a regular interruption of cc during the CPR cycle for more then 3 s where impedance changes suggest ventilations or during ventilation prompts. The chest compression fraction (ccf) was the time of the cycle that was used for cc. We analyzed the duration of each ventilation- and cc period, as well as the number of cc and ventilations during each 2 minutes CPR cycle. Results: We included all 222 AED recordings from lay rescuer CPR from September 2010 until March 2011, trained according to the G2005. The median (IQR) interruption time for two ventilations was 7.4 s (5.8-9.3 s). Of all, 19.4% of rescuers took &gt;10 seconds for a ventilation period. Of the lay rescuers 97% was able to give ≥60 cc min -1 and 66% to give ≥80 cc min -1 . The median ccf (IQR) was 76.7% (71.4-83.4%). Conclusion: For the great majority of lay rescuers it is feasible to give two rescue breaths in less than 7 s and to give at least 60 compressions per minute. Trained lay rescuers can deliver compressions and ventilate as recommended by the Guidelines.
Abstract 18390: Testing a Dietary Intervention Called ‰Pro-Heart” to Reduce Adiposity and Enhance Cardiac Structure, Functional Status, Lipid Profiles, Glycemic Control, and Quality Of Life in Obese, Diabetic Patients with Advanced Heart Failure
Authors: Lorraine S Evangelista, Dawn Lombardo, Dan Cooper, Tamara Horwich, Gregg C Fonarow
Journal: Circulation (2012)

BACKGROUND: To date, no known clinical trials have been done to test the effects of high protein (HP) diets in obese, diabetic patients with heart failure (HF). The goal of this four-year study is to explicate the role of HP diets in delaying the progression of disease in 90 patients with HF, New York Heart Association class II and III, body mass index (BMI) ≥30 kg/m 2 , and diabetes mellitus. We hypothesize that participants randomized to the HP diet compared to a standard protein (SP) diet will show greater reductions in adiposity (e.g. weight, waist circumference, percent body fat) and greater improvements in cardiac structure, functional status, lipid profiles, glycemic control, and quality of life following the 12-week intervention and that these changes will be maintained over time. METHODS/DESIGN: Recruitment and enrollment in this prospective, two-group, randomized trial is on-going; participants are randomized to either a HP diet which consists of 30% protein (∼110 g/day), 40% carbohydrates (CHO, ∼150 g/day) and 30% fat (∼50 g/day) or standard protein (SP) diet which consists of 15% protein (∼55 g/day), 55% CHO (∼200 g/day) and 30% fat (∼50 g/day). Participants will complete an intensive 12-week supervised weight loss intervention consisting of personalized nutritional counseling and support at baseline and asked to return at 2, 4, 8, and 12 weeks. After the intensive weight loss intervention, participants will be seen in clinic every 3 months for one year (6, 9, and 12 months) to monitor weight maintenance. Data will be obtained at baseline, 12 weeks (immediately after the intensive weight loss phase), and 15 months. DISCUSSION: Data from the proposed study will provide researchers and clinicians with evidence for rational recommendations for weight loss modalities that can be integrated in HF management and treatment guidelines.
Abstract 18829: Inhibiting Bone Morphogenetic Protein Signaling Reduces Diabetes-Associated Non-Alcoholic Fatty Liver Disease Independent of Plasma Lipid Levels
Authors: Trejeeve Martyn, Hannah R Shakartzi, Claire Mayeur, Kenneth D Bloch, Rajeev Malhotra
Journal: Circulation (2012)

Background: Non-alcoholic fatty liver disease (NAFLD) is associated with diabetes and atherosclerotic heart disease and its presence predicts worse cardiovascular outcomes. However, the mechanisms responsible for NAFLD remain unclear and no targeted medical therapy exists. Given the essential role for bone morphogenetic protein (BMP) signaling in the development of atherosclerosis and related inflammation, we hypothesized that BMP signaling is upregulated in livers of diabetic mice (db/db) known to develop NAFLD and that pharmacologic inhibition of BMP signaling may reduce fatty liver disease. Methods: Livers from adult male wild-type (WT) and db/db mice were harvested to quantify Smad 1/5 phosphorylation and Id1 gene expression (markers of BMP signaling). Diabetic mice were treated with either vehicle or the small molecule BMP type I receptor inhibitor, LDN-193189 (LDN, 3 mg/kg twice daily IP), for 28 days. Plasma samples were collected, and livers were harvested for biochemical and histological examination. Hepatic fat content was estimated using colorimetric intensity quantification of hematoxylin &amp; eosin stains. Results: Smad 1/5 phosphorylation and Id1 mRNA levels were 2.5- and 3.0-fold greater in livers of db/db mice than in WT mice (P=0.003 and 0.006, respectively; n=8 per group). Treatment of db/db mice with LDN decreased liver Smad 1/5 phosphorylation and Id1 mRNA levels associated with a 49% reduction in hepatic fat accumulation (P=0.017; see Figure). Furthermore, plasma alanine aminotransferase levels were less in LDN-treated mice than in vehicle-treated mice (mean ± SEM 194 ± 68 vs. 583 ± 153 U/L, n=7 per group, P=0.048); however, there was no difference in plasma cholesterol or triglyceride levels. Conclusions: Increased BMP signaling contributes to the development of NAFLD in a diabetic mouse model, independent of plasma lipid levels. Pharmacologic BMP inhibition may represent a novel therapy for NAFLD.
Abstract 18884: Coronary Flow Velocity Pattern After Primary Percutaneous Coronary Intervention as a Predictor of Transmural Extent of Infarction in Patients with St-segment Elevation Acute Myocardial Infarction
Authors: Sari Imamura, Kumiko Hirata, T Kubo, M Orii, K Ishibashi, T Yamano, T Tanimoto, Y Ino, T Yamaguchi, T Imanishi, T Akasaka
Journal: Circulation (2012)

Purpose: The purpose of this study was to investigate whether coronary flow velocity pattern after primary percutaneous coronary intervention (PCI) can predict the transmural extent of infarction (TEI) defined by contrast-enhanced cardiac magnetic resonance (ce-CMR) in patients with acute myocardial infarction (MI). Methods: In 91 patients after successful PCI for first acute MI, deceleration time of diastolic coronary flow velocity (DDT) were measured by transthoracic echocardiography. Ce-MRI were performed 7 days after onset of AMI. TEI was graded from 1 to 4 based on the transmural extent of hyperenhanced tissue (grade 1: 0-25% of left ventricular wall thickness, 2: 26-50%, 3: 51-75%, and 4: 76-100%). Infarct size by ce-CMR was also calculated. Results: Adequate recording of DDT were obtained in 87 of 91 patients (96%). Infarct size by ce-CMR and peak creatine kinase-myocardial band values were significantly correlated with DDT (r=0.54, p &lt;0.0001 and (r=0.40, p=0.006, respectively). Moreover, decreased DDT was significantly related to increased TEI-grade (p&lt; 0.0001) (figure) and existence of microvascular obstruction (p&lt;0.0001). Conclusion: DDT measured after primary PCI is a useful predictor for the TEI in patients with acute MI.
Abstract 61: A Novel Electrical Therapy for Postshock PEA in a Porcine Model
Authors: Yinlun Weng, Weilun Quan, Gary Freeman, Xiaobo Wu, Sen Ye, Wei Chen, Shijie Sun, Wanchun Tang
Journal: Circulation (2011)

BACKGROUND: Chest compression (CC) is currently recognized as the only effective intervention for the treatment of shock induced pulseless electrical activity (PEA). This study was designed to test a new form of therapy, packet electrical therapy (PET), for post shock PEA in a porcine model using medium energy electrical pacing. The main objective was to compare hemodynamic responses between the PET and the standard CC. METHODS: In 12 domestic pigs weighing 22-24kg, ventricular fibrillation (VF) was electrically induced and untreated for 2 to 7 minutes before delivering shock to induce post shock PEA with peak aortic pressures below 40 mm Hg. Once the PEA was induced, animals received 15 sec PET followed by 45 sec standard CC, and followed by 15 sec PET combined with the standard CC in sequence. If animals were resuscitated after the study sequence, after 30 minutes recovery, PEA induction and the study sequence were repeated. PET consisted of a train of narrow pulses with the amplitude of 2 amperes and the total duration of 200 ms, the depth of standard CC was maintained at 2 inches of the anterior posterior diameter of the thorax. RESULTS: A total of 35 qualified PEA events from 9 animals were included in the analyses as shown in the table: CONCLUSION: No significant differences were detected between coronary perfusion pressures for PET as compared to standard chest compressions. Both aortic and right atrial diastolic pressures were significantly increased with PET.
Abstract 19087: Improved Survival After Percutaneous Stenting of the Atrial Septum in Human Fetal Left Atrial Hypertension
Authors: Rajiv Chaturvedi, Greg Ryan, Michael Seed, Edgar Jaeggi
Journal: Circulation (2012)

Hypoplastic left heart syndrome with a highly restrictive or intact atrial septum (HLHS-RAS) has a very high mortality. The associated fetal LA hypertension results in abnormal lung development with lymphangiectasia and pulmonary vein muscularization. We report our experience of ultrasound-guided stenting of the human fetal atrial septum. Methods and Results. Retrospective review of fetuses with HLHS-RAS or a variant that underwent active perinatal management from 2000-January 2012. Ten fetuses were identified. Two fetuses became hydropic and died in utero (33, 29 weeks). Four fetuses required the urgent creation of an atrial communication immediately after birth but subsequently died (5-54 days), secondary to pulmonary hypertension. More recently, the atrial septum was stented in four fetuses at 28-36 weeks without maternal general anesthesia. Elevated left atrial pressure, massive dilatation of the pulmonary veins and MRI estimated pulmonary perfusion all improved after stenting. Two fetuses developed stent stenosis with recurrence of LA hypertension in utero for approximately four weeks and 1 day respectively. Three of four stented fetuses were born by vaginal delivery. Atrial septectomy and additional procedures were performed within 72 hours of birth. Intraoperative lung biopsy demonstrated muscularized pulmonary veins and lymphangiectasia in all four. Two died at 17 and 53 days of age from pulmonary hypertension and sepsis, respectively. The other two are still alive, a significant improvement in survival (p=0.03). Conclusion. Fetal left atrial decompression by stenting may improve survival in HLHS-RAS.
Abstract 18701: Activation of PPAR Delta Signaling Corrects Impaired Skeletal Muscle Oxidative Metabolism in Heart Failure
Authors: Cynthia Zizola, Hirokazu Akashi, Ruiping Ji, Shuiquin Yu, Paul Christian Schulze
Journal: Circulation (2012)

Background Exercise intolerance in heart failure (HF) has been linked to impaired skeletal muscle oxidative capacity. PPARδ signaling regulates oxidative metabolism and exercise capacity. We hypothesized that decreased skeletal muscle oxidative capacity in HF can be reverted by PPARδ agonists. Methods Left ventricular (LV) dysfunction was induced in C57BL/6 mice by left coronary artery ligature and confirmed by echocardiography. At 11 weeks post-MI, mice received the PPARδ agonist GW501516 (5 mg/kg body weight per day for 14 days, n=6) or vehicle (con, n=6). Exercise function was tested by swimming tests. Following sacrifice, skeletal muscle was harvested for RT-PCR, fatty acid (FA) and glucose oxidation assays, and ATP tissue content analysis. Cell culture analysis of signaling pathways was performed in C2C12 myotubes. Results Cardiac function decreased following MI (fractional shortening: 15.9±6.% vs 29.9±6.6% in sham; p&lt;0.001). FA oxidation was reduced in quadriceps muscle in MI mice (2.5±1.0 vs 4.0±0.8 pmol/mg tissue in sham; p=0.04) with a trend in glucose oxidation (-27%; p=0.07). Muscle ATP content decreased following MI (3.3±1.7 vs 6.1±1.1 uM ATP/ug protein in sham; p&lt;0.01). Expression of metabolic marker genes CPT1 (-86%), PDK4 (72%) and PGC1a (-94%) decreased in muscle post-MI (all p&lt;0.05). 2 weeks GW501516 administration increased muscle FA oxidation in animals with LV dysfunction (3.9±1.6 vs 1.8±0.4 pmol oleic acid/mg tissue in con; p=0.04) and also increased CPT1 expression by 309±175% (p&lt;0.001). There was a non-significant increase (+11%) in swimming duration in the GW501516 group. Treatment of C2C12 myotubes with 5 µM GW501516 protected from TNFα (25 ng/ml)-dependent decrease in FA oxidation (129.2±2.5 vs 237.8±6.8 pmol oleic acid/mg protein in TNFα+ GW501516 ; p&lt;0.001) Further, GW501516 prevented TNFα -dependent decrease in CPT1 expression (255±39 vs 58±5 % in TNFα alone, p&lt;0.01). Conclusion Treatment with the PPARδ agonist GW501516 corrects the impaired skeletal muscle oxidative capacity and metabolism in mice with ischemic LV dysfunction. Pharmacologic activation of PPARδ signaling could be an attractive intervention to counteract the progressive skeletal muscle dysfunction in HF.
Abstract 18440: Global Burden of Air Pollution on Heart Failure: A Systematic Review and Meta Analysis
Authors: Anoop S Shah, Jeremy P Langrish, Harish Nair, Amanda Hunter, David E Newby, Nicholas L Mills
Journal: Circulation (2012)

Introduction Air pollution is responsible for over a million deaths worldwide each year with predilection towards patients with chronic cardiovascular disease. We undertook the first meta-analysis to determine the association between gaseous and particulate air pollution and heart failure admissions and mortality. Methods Medline, EMBASE, CINAHL, Global health and Web of Science databases up to and including 01/02/2012 were searched for studies investigating the association between gaseous (carbon monoxide, sulphur dioxide, nitrogen dioxide, ozone) and particulate (PM2.5 and PM10) pollution and heart failure admission or mortality. Two independent reviewers extracted study information and risk estimates were meta-analysed and stratified by lag periods (days). Studies measuring air pollution up to and including a lag of seven days were included. Results 1,146 studies were identified in the primary search including a search of all relevant bibliographies. 195 articles were fully reviewed and 35 met the inclusion criteria. Except for ozone, heart failure admission or mortality was positively associated with all pollutants (Figure 1). Across all pollutants stronger associations were seen at Lag 0 with diminishing effect at longer lag times. Conclusion Gaseous and particulate air pollutants have a marked and close temporal association with heart failure admissions and mortality. The causality and biological mechanisms of this association now needs to be explored. Meanwhile, air pollution continues to remain a pervasive public health issue with significant cardiovascular consequences presenting a key target for national and international public health.
Abstract 18683: Outcomes of Patients Presenting with Acute Type A Aortic Dissection in the Setting of Prior Cardiac Surgery: An Analysis from the International Registry of Acute Aortic Dissection
Authors: Nicholas Teman, Mark D Peterson, Mark J Russo, Marek P Ehrlich, Truls Myrmel, Gilbert R Upchurch, Kevin Greason, Mark Fillinger, Alberto Forteza, Michael G Deeb, Daniel G Montgomery, Kim A Eagle, Eric M Isselbacher, Christoph A Nienaber, Himanshu J Patel
Journal: Circulation (2012)

Introduction: Prior cardiac surgery can complicate the clinical presentation, diagnosis, and management of patients with type A aortic dissection (TAAAD). This report from the International Registry of Acute Aortic Dissection (IRAD) examines this hypothesis. Methods: 352 of 2289 TAAAD patients (15.4%) enrolled in IRAD had cardiac surgery prior to dissection, including coronary artery bypass grafting (CABG, 34.6%), aortic or mitral valve surgery (38.4%), aortic surgery (44.7%), and other cardiac surgery (18.1%). Results: Comparative differences in baseline demographics, clinical presentation, and management time are shown in Table 1. Patients with prior cardiac surgery were more likely to undergo CABG (p=0.006) or mitral valve replacement (p=0.001) at the time of dissection repair. Total cardiopulmonary bypass time was higher in patients with prior cardiac surgery (p&lt;0.001); no difference was seen in cardiac arrest time (p=0.113) or cerebral ischemia time (p=0.286). In-hospital mortality was significantly higher for patients with prior cardiac surgery (33.5% vs. 24.0%, p70 (RR1.58, 95% CI 1.25-1.99), and medical management of acute dissection (RR 4.79, 95% CI 3.62-6.34). Kaplan-Meier analysis is shown in Figure 1. Conclusion: Prior cardiac surgery not only delays presentation and diagnosis of acute type A dissections, but is also an important adverse risk factor for early and late mortality. <!-- <inline-graphic xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="g18683_2"/>-->
Abstract 196: Measurement of Depth, Thrust and Thoracic Impedance During Mechanical Cardiopulmonary Resuscitation: Is Thoracic Impedance a Potential Indicator of Effective External Cardiac Massage in a Porcine Model of Cardiac Arrest?
Authors: Rebecca Di Maio, Andrew Howe, Paul Crawford, David Brody, Cesar Navarro, David McEneaney, Eddie Clutton, John Anderson, Jennifer Adgey
Journal: Circulation (2011)

Purpose of the Study: The 2010 AHA guidelines currently recommend a depth of at least 2 inches (5cm) during external cardiac massage. The purpose of this study was to determine if the use of an alternative measure to depth could assist in quantifying the effectiveness of CPR in an out-of-hospital setting and to determine how achievable depths of at least 2 inches are in experimental models of cardiac arrest. Materials and Methods: A total of 12 porcine models were used each weighing 30.7±4.2kg. Depth (mm), thrust (kg); End-tidal CO 2 , and Cardiac Output (CO) were measured at 2 minute intervals for each model. The Impedance Cardiogram (ICG)/Thoracic Impedance (non-invasive measure of cardiac output) was recorded via 2 standard defibrillation electrodes, as a method of detecting the presence of effective CPR. Ethical approval was granted by the Northern Ireland Home Office. Models were anaesthetised using Isoflurane and connected to a Datex Ohmeda® for anaesthesia monitoring. Depth and rate of CPR were continuously measured using Q-CPR®, Philips. CPR was administered using the HLR-201®, Michigan Instruments. Recordings from each experiment were acquired using the Datex Ohmeda for statistical analysis using Microsoft Access®. Results: During CPR, cardiac output was maintained at an average of 21% of normal CO levels. At thrusts of 60kg and a rate 112±2 compressions per minute, the average depth (using Q-CPR®, Philips) achieved using a stabilised mechanical CPR system was 37.12mm±3 (1.46±0.12inches). Using the HLR-201®, Michigan Instruments the average depth achieved was 50mm (1.97inches). A strong linear correlation was achieved when comparing depth (mm) using Q-CPR® and the thrust (kg) using the HLR-201®, Michigan Instruments; r=0.856. In addition a strong linear correlation was attained when the Impedance cardiogram (ICG) (ohms) was compared with depth (mm) using Q-CPR®, Philips of; r=0.86. Conclusions: A depth of at least 2 inches was almost unattainable in this porcine model, even at thrusts of 60 kg. An algorithm will incorporate the results from this study, providing feedback to the operator on the quality of CPR by measuring the ICG amplitude which has been strongly correlated with standard measures of depth as well as a number of physiological parameters.
Abstract 18927: Geographic Variation of AHA's ‰Life's Simple Seven in Women
Authors: Caitlin Johnson, Fatima Rodriguez, Yun Wang, JoAnne Foody
Journal: Circulation (2012)

Background: Evidence shows that individuals achieving AHA’s “Life’s Simple 7” cardiovascular health metrics have significantly reduced risk of CVD incidence and mortality. Geographic variation in CVD risk factors has been previously described. We sought to determine whether CV risk as defined by optimal CV health metrics varied geographically among women. Methods: In 2009, Sister to Sister provided free cardiovascular screenings to 9,442 women in 12 cities, including Atlanta, Baltimore, Boston, Chicago, Dallas, Detroit, Jacksonville, Los Angeles, Miami, St. Louis, Tampa, and Washington, DC. Using biometric data collected from screenings supplemented by surveys on CVD risk, we analyzed variance in the “Simple 7” cardiovascular metrics by city. These metrics were defined as being physically active, having normal blood pressure, weight and blood glucose and total cholesterol levels, and eating a healthy diet. We used 6 of these 7 metrics, excluding diet, to assign each city with a risk score. Results: Few cities were at optimal health. On average, cities achieved 3.8 out of 6 cardiovascular metrics. From a regional perspective, Atlanta, Dallas and Detroit were significantly lower, and Boston and St. Louis were significantly higher than the city-wide average (see figure 1). Conclusion: Significant geographic variation exists in proportion of individuals achieving “ideal CV health” as measured by the AHA’s “Life’s Simple 7”. Given this, solutions to improve community based CV risk will need to be tailored by region.