tbuckley/cabot-search huggingface dataset:
Abstract 15753: Center Based Care Improves Survival in Patients Suffering From Peripheral Arterial Disease
Authors: Clemens Hoebaus, Maximilian Tscharre, Marie-Therese Howanietz, Alexander Winkler, Renate Koppensteiner, Gerit Schernthaner
Journal: Circulation (2015)

Introduction: Advances in cardiovascular management have ameliorated mortality rates. However, management of peripheral arterial disease (PAD) remains challenging due to the comorbidities in those mostly elderly patients. Hypothesis: Possible reduction of mortality in PAD patients by center-based care. Methods: All patients were examined at baseline at the vascular medicine center (VMC) of the Medical University Vienna. The cohort was longitudinally followed-up for five years in two groups managed by their general practitioner (GP, N=332) or VMC (N=370). VMC patients had visits every six month including physical examination of the feet, non-invasive imaging of arterial perfusion, and blood draws (glucose tolerance test, HbA1c, LDL-cholesterol). Furthermore, reassessment of the current medication schedule and, if indicated, non-invasive tests of cardiac and pulmonary function were performed. Results: Survival was 66% for GP managed patients and 90.8% for patients managed at VMC within five years. In a multivariate model including the known risk factors for PAD (gender, age, diabetes, smoking, hypertension, hyperlipidemia, c-reactive protein (CRP) and nephropathy) at baseline only nephropathy (HR 2.7 (95% CI: 1.38-5.45)), CRP (HR per 1STD: 1.36 (95% CI: 1.10-1.73) and age (HR per 1 STD 1.46 (95% CI: 1.03-1.86)) were connected to mortality during 5 years of follow up in VMC patients. In the GP group no single predictive risk factor could be identified. Patients in both groups were equally affected by coronary (p=0.076) or carotid artery disease (p=0.555) at baseline. Center based patients showed significantly higher prevalence of hypertension (p&lt;0.001), hyperlipidemia (p&lt;0.001), and nephropathy (p=0.001). Both groups were comparable for the risk factor smoking (p=0.988) and diabetes (p=0.074). Conclusions: Center based care of patients with PAD including physical examination of the feet and repetitive vascular assessment by non-invasive imaging technics improves mortality. Furthermore, constant screening for diabetes, hyperlipidemia and cardiovascular and pulmonary complications in these high-risk patients can accelerate further medical decision including medication changes.
Abstract 13017: CD8+ T Cells Elicited by an ApoB-100 Related Peptide Vaccine Protect Against Angiotension II-induced Aortic Aneurysm Formation by Inhibiting Aortic Macrophage Infiltration and Modulating Th17 Polarization
Authors: Tomoyuki Honjo, Paul C. Dimayuga, Kuang-Yuh Chyu, Juliana Yano, Wai Man Lio, Portia Trinidad, Xioaning Zhao, Jianchang Zhou, Bojan Cercek, Prediman K. Shah
Journal: Circulation (2013)

Tomoyuki Honjo, 2013 Finalist and Presenting Author
Abstract 282: Poloxamer 188 Improves Intra-CPR Hemodynamics and Post-Resuscitation LV Function in a Pig Model of Prolonged Cardiac Arrest
Authors: Timothy Matsuura, Jason Bartos, Mahammad Sarraf, Evelyne Houang, Scott McKnite, Jennifer Rees, Daniel Sloper, Emily Caldwell, Frank Bates, Joseph Metzger, Demetris Yannopoulos
Journal: Circulation (2013)

Introduction: Poloxamer 188 (P188) is a copolymer surfactant that has been shown to protect against ischemia/reperfusion injury. We hypothesized that P188 administration at the initiation of cardiopulmonary resuscitation (CPR) would improve post-resuscitation LV function. Methods: Following 15 min of untreated ventricular fibrillation (VF), 12 pigs received 4 minutes of CPR with automated active compression/decompression and an impedance threshold device. Six animals received an IV bolus (250 mg/kg) at the initiation of CPR and infusion of 120 ml of 150 mg/ml of P188 for 4 hours after return of spontaneous circulation (ROSC). Six other animals received no P188 (CTL). Aortic systolic (AoS), diastolic (AoD), and right atrial diastolic (RAD) pressures were recorded continuously. Coronary perfusion pressure (CPP) was calculated as the difference between AoD and RAD. All animals received 0.5 mg of epinephrine 1 min prior to defibrillation. Left ventricular ejection fraction (LVEF) was obtained with echocardiography 1 and 4 hours after return of spontaneous circulation (ROSC). Unpaired t-tests were used for statistical analysis; significance assumed at p&lt;0.05 (two-tailed). Results: 5/6 animals treated with P188 and 6/6 CTL animals had ROSC. P188 significantly increased intra-CPR hemodynamics (table) and eliminated post resuscitation LV ventricular dysfunction. LVEF at 1 and 4 hours post ROSC with P188 vs. CTL was 58±7 and 62±11% versus 36±12 and 38±9 %, respectively (p&lt;0.05). Conclusion: Poloxamer 188, when administered at the initiation of CPR as a bolus and as an infusion post ROSC, improved intra-CPR hemodynamics and post-ROSC LVEF after 15 minutes of untreated VF in an animal model. The mechanism of action is thought to be membrane stabilization and this will be the aim of future studies.
Abstract 3: Early, Single-Dose Post-Burn Estrogen Significantly Decreases Apoptosis at 7 Days and Pro-Inflammatory Cytokines for 45 Days in the Spleen Following Severe Burns
Authors: Victoria Warren, David L Maass, Ahamed H Idris, Paul E Pepe, Joshua W Gatson, Lisha Ma, Qun S Zang, Kareem AbdelFattah, Joseph P Minei, Steven Wolf, Jane G Wigginton
Journal: Circulation (2013)

Introduction: In patients with severe burns, remote splenic injury is thought to be a significant contributor to immunosuppression and subsequent morbidity and mortality. We tested estrogen, a potent anti-oxidant, anti-apoptotic, and anti-inflammatory drug as a potential therapy for mitigation of splenic inflammation following severe remote burns. Methods: 177 male rats were randomized into 3 groups: Group 1 (0.5mg/kg of 17-β estradiol (E2) SQ 15 min after injury), n=84; Group 2 (placebo), n=84; and Group 3 (sham-burn control), n=9. Groups 1 &amp; 2 were given a 3° 40% TBSA dorsal scald burn. Eight burned/treated rats per group were sequentially sacrificed at 0.5, 1, 2, 4, 6, 8, 12, 18, 24 hours and 7 days post-burn, with four rats/treatment sacrificed 45 days post-burn. Spleen tissue was analyzed by ELISA for proinflammatory cytokines (including IL-6, TNF-α, IL-1β). TUNEL staining was performed on the histological specimen. Results: Administration of a single, early dose of E2 greatly decreased all measured cytokines for 45 days, as exemplified by IL-1β (see Figure), and decreased apoptosis significantly at the evaluated time point of seven days. Conclusions: Early, single-dose estrogen administration following severe remote burns reduces the pro-inflammatory responses in the splenic tissue at all measured time points for 45 days post-burn, and significantly decreases apoptosis in the spleen at seven days. These findings help support consideration of clinical testing of estrogen as a post-burn resuscitation therapy in the future.
Abstract 9268: NT-proBNP and Myocardial Perfusion in Asymptomatic Adults: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Adam Mitchell, Jeffery R Misialek, Aaron R Folsom, Alvaro Alonso, Daniel Duprez, Michael Jerosch-Herold, Karol E Watson, Tamer Sallam, Suma H Konety
Journal: Circulation (2013)

Introduction: B-type natriuretic peptide (BNP) is a cardiac neurohormone secreted from membrane granules in the cardiac ventricles as a response to ventricular volume expansion and pressure overload. While it is a sensitive marker of heart failure, it may also be elevated in the setting of reduced myocardial perfusion. We hypothesized that reduced myocardial blood flow (MBF) would be associated with elevated NT-proBNP in the MESA study. Methods: MBF was measured by cardiac MRI in 184 MESA participants without overt coronary heart disease, before and after adenosine infusion, for whom serum NT-proBNP levels were available (mean age 60 ± 10.4, 58% white, 42% Hispanic, 44% female). Hyperemic MBF was modeled with adjustment for resting MBF. A linear regression analysis, adjusted for demographics, established cardiovascular risk factors, left ventricular mass, body mass index and medications, was used to determine the association between hyperemic MBF and NT-proBNP. Results: Individuals with low hyperemic MBF were more likely to be older, male, diabetic, have higher blood pressure and higher coronary artery calcium (CAC) score. Hyperemic MBF was 3.04 ± 0.829 ml/min/g and was inversely associated with NT-proBNP levels. In the fully adjusted model, every one standard deviation decrement in hyperemic MBF was associated with a 21% increment in NT-proBNP (p=0.04) (TABLE). Conclusions: Hyperemic MBF is inversely associated with NT-proBNP level in this cross sectional study of asymptomatic individuals free of overt coronary artery disease. These results suggest that higher NT-proBNP levels may signify subclinical myocardial microvascular dysfunction.
Abstract 336: Selective Use of Neuromuscular Blockade in Therapeutic Hypothermia Does Not Delay Time to Target Temperature
Authors: Kathleen Ryan Avery, Molly H O’Brien, Beth Anne Hirning, Paul M Szumita, Carol D Pierce, AnnMarie Chase, Stefan Strojwas, Michael Kyller, Karen Griswold, Raghu Seethala, Anthony F Massaro, Galen V Henderson, Peter Stone, David A Morrow, Benjamin M Scirica
Journal: Circulation (2013)

Background: Optimal management of shivering during Therapeutic Hypothermia(TH) is important to quickly achieve target temperature with a goal of improving neurological outcomes. Interventions (pharmacological and non-pharmacological) to manage shivering vary among institutions. We developed a step-wise guideline approach to: 1) prevent and manage shivering during the different phases of TH, 2) avoid delays to achieving target temperature (TT) and 3) reduce the use of neuromuscular blocking agents (NMBA). Methods: We report a single center experience examining the differences in time to target temperature, medication use and patient outcomes pre-(Jan2009-June2011) and post-(July2011-April2013) implementation of a TH Prevention and Management of Shivering algorithm. Results: A total of 138 patients had TH (62 patients pre vs 76 in the post-guidelines). Fewer patients post-guideline implementation received any NMBA (55.3% vs 83.9%, p=0.001), with a lower total dose of NMBA (59.4± 58.7 vs 99.8 ± 70.3 mg, p=0.001). In patients who received NMBA, the post group received more bolus only (64.3% vs 5.8%); and less infusion only (9.5% vs 48.1%) or infusion + bolus (26.2% vs 46.1% p &lt;0.001) therapy. As expected, propofol use increased in the post- group (3.1 vs 2.5 mg/kg/hr, p=0.02) as did increased use of fentanyl boluses (n=44 [4.1 ± 3] vs n=17 [2.5 ± 1.4] p=0.03). While more shivering was noted in the post group (43.5% vs 27.4%; p=0.04), there was no significant difference between the groups in the ROSC to TT time or ICU days. Survival and neurological outcomes were similar between the two groups. Conclusion: Selective use of NMBA as part of a shivering algorithm does not delay time to TT in TH. The decreased use of NMBA resulted in increased doses of sedation and analgesia without effects on patient survival or neurological outcome. Further research on optimal usage of NMBA in TH is needed.
Abstract 15674: Can Heart Rate Turbulence and T-Wave Alternans on Holter Electrocardiograms Predict Serious Cardiac Events in Patients After Myocardial Infarction?
Authors: Jong-Ho Nam, Chan-Hee Lee, Kyu-Hwan Park, Jang-Won Son, Ung Kim, Jong-Seon Park, Dong-Gu Shin, Young-Jo Kim
Journal: Circulation (2015)

Backgrounds: Patients who survive a myocardial infarction (MI) are at risk of serious events such as sudden cardiac death (SCD). Although the implantable cardioverter-defibrillator (ICD) reduces mortality after MI, there is no reliable method to predict SCD. Because of the relatively low accuracy of Left ventricular ejection fraction (LVEF), noninvasive measures of autonomic tone and cardiac electrical substrate have been developed to identify patients at risk of SCD. Recent studies have reported that heart rate turbulence (HRT) and T-wave alternans (TWA), which can be assessed simply using 24-hr Holter electrocardiogram is a significant index for cardiac events. Material and Methods: A total of 464 patients who was first diagnosed with myocardial infarction and treated with percutaneous coronary intervention (age 63 ± 12, 70.9% male) were analyzed. All patients performed 24-h Holter ECG monitoring during hospitalization (mean duration after MI 2.7 ± 1.8 days) to measure HRT, modified moving average method (MMA)-TWA and other conventional parameters. HRT was determined positive when both turbulence onset and turbulence slope were abnormal and MMA-TWA was determined positive when the maximal voltage was &gt; 64 μV. The cardiac mortality and sudden cardiac death were analyzed for 2 years. Results: HRT was positive in 48 patients (10.3%) and MMA-TWA was positive in 250 patients (53.9%). During 2 years follow-up, 23 patients (4.9%) were died from cardiac disease, including 19 patients (4.1%) with SCD. On univariative analysis, HRT was a significant predictor for cardiac death (Hazard ratio, 4.29; 95% C.I. 1.66-10.98; P = 0.003) and SCD (Hazard ratio, 5.75; 95% C.I. 2.14-15.41; P = 0.001). On multivariative analysis, HRT had the significant value, with a hazard ratio of 3.25 (95% C.I. 1.09-9.74, P = 0.035) for SCD. Older age, lower LVEF, non-use of beta-blocker, presence of non-sustained ventricular tachycardia were another predictor of cardiac events. However, MMA-TWA can not predict cardiac events in this study. Conclusion: The present study revealed that HRT was a significant predictor of SCD. However, MMA-TWA can not predict cardiac events in acute phase of myocardial infarction.
Abstract 329: High Volume Femoral Vein Infusion Significantly Increases EtCO2 During Prolonged CPR
Authors: Joshua W Lampe, George Bratinov, Theodore Weiland, Josiah D Garcia, Uday Illindala, Lance B Becker
Journal: Circulation (2013)

Introduction: Animal research has suggested that inducing therapeutic hypothermia during the arrest period (e.g. during chest compressions) may provide more benefit than inducing hypothermia after return of spontaneous circulation. Hypothermia induction technologies can be divided into two classes: technologies that require volume infusions, and technologies that do not. We hypothesize that a prolonged cold volume infusion during ongoing CPR will alter CPR hemodynamics, particularly venous return of blood to the heart. Methods: Eighteen temperatures were monitored in 24 domestic swine (~30 Kg) during intra-arrest hypothermia induction with ongoing CPR. Mechanical chest compressions and hypothermia induction were started after ten minutes of untreated VF. Chest compressions were performed at a rate of 100 per minute and a depth of 1.25 inches for 60 minutes. Hypothermia induction techniques included: control, femoral vein cold saline infusion, femoral vein ice slurry infusion, carotid cold saline infusion, carotid ice slurry infusion, nasopharyngeal cooling, heat exchange catheter cooling, and blanket cooling. The experiment was terminated after 60 minutes of chest compressions and cooling. Results: 3 Liter femoral vein (FV) infusions of cold saline and ice particulate slurry at a rate of ~ 75 ml/min significantly increased EtCO2 during CPR at times 20-30 min (ETCO2_FV = 29.63 mmHg vs. ETCO2 = 22.16 mmHg, p&lt;0.05), 30-40 min (ETCO2_FV = 23.8 mmHg vs. ETCO = 13.94 mmHg, p&lt;0.05), and 40-50 min (ETCO2_FV = 20.07 mmHg vs. ETCO2 = 10.69 mmHg, p&lt;0.05), with a trend toward significance at 50-60 min (ETCO2_FV = 16.84 vs. ETCO2 = 8.26, p = 0.056). Carotid infusions of similar volumes at similar rates did not improve ETCO2 during prolonged CPR. Conclusions: High volume femoral infusions administered during CPR significantly increased measured values of ETCO2. While not definitive, this data supports the hypothesis that imposing a volume driven flow in the femoral vein during CPR improves venous return. Interestingly, imposing a similar flow through the carotid artery did not increase measured values of ETCO2. The interplay between volume infusions and chest compression generated blood flow requires further study.
Abstract 9321: Selective Inhibition of Inositol Hexakisphosphate Kinases Enhances Mesenchymal Stem Cell Engraftment and Improves Therapeutic Efficacy for Myocardial Infarction
Authors: Zhang Zheng, Xue Gao, Haichang Wang, Feng Cao
Journal: Circulation (2013)

Rationale: 5-diphosphoinositol pentakisphosphate (IP7), formed by a family of inositol hexakis phosphate kinases (IP6Ks), has been demonstrated to be a physiologic inhibitor of Akt. IP6K inhibition may increase Akt activation in mesenchymal stem cells (MSCs), resulting in enhanced cardiac protective effect after transplantation. Objective: To investigate the role of IP6Ks for improving MSCs’ functional survival and cardiac protective effect after transplantation into infarcted mice hearts. Methods and results: Bone marrow-derived mesenchymal stem cells (BMMSCs), isolated from dual-reporter firefly luciferase and enhanced green fluorescent protein positive (Fluc + -eGFP + ) transgenic mice, were preconditioned with IP6Ks inhibitor TNP (0.5μmol/L, 1μmol/L, 5μmol/L, and 10μmol/L) for 2 h followed by 6 hours of hypoxia and serum deprivation (H/SD) injury. TNP dose dependently significantly decreased IP7 production with increased Akt phosphorylation. Moreover,TNP at 10μmol/L significantly improved the viability and enhanced the paracrine effect of MSCs after H/SD. Furthermore, MSCs were transplanted into infarcted hearts with or without selective IP6Ks inhibition. Longitudinal in vivo bioluminescence imaging (BLI) and immunofluorescent staining revealed that TNP pretreatment enhanced the survival of engrafted MSCs, which promoted the anti-apoptotic and pro-angiogenic efficacy of MSCs in vivo . Furthermore, MSCs therapy with IP6Ks inhibition significantly decreased fibrosis and preserved heart function. Conclusion: Inhibition of IP6Ks promotes MSCs engraftment and paracrine effect in infarcted hearts at least in part by down-regulating IP7 production and enhancing Akt activation, which might contribute to the preservation of myocardial function after MI.
Building Successful International Cardiovascular Nursing Research in Heart Failure Care
Authors: Tiny Jaarsma
Journal: Circulation (2013)

International collaboration is vital to address the causes and deal with the impacts of many of the global challenges that society faces. One example of this is an international approach to fighting cardiovascular disease and its consequences for patients and their families. Selective national initiatives might not always be an optimal use of recourses, but instead international collaboration in cardiovascular caring research can help us in seeking excellence, build capacity and improve political influence, all needed to ultimately improve patient care. However, several countries worldwide have different health care systems, medical and nursing education programs and professional roles, and responsibilities, posing a major challenge to optimal collaboration and implementation of research findings. An example of successful international teamwork is illustrated by research in the area of self-care in heart failure patients with collaboration in the area of empirical research, theory development and instrument development. Several intervention studies on improving self-care are conducted in different parts of the world, strengthening the evidence base of nursing interventions to improve outcomes of heart failure patients. Current international professional guidelines for the management of heart failure patients include advices on self-care. However, to transcend above post hoc pooling of data or adding a new data collecting site in another country, other structural forms of collaboration should be considered. Capacity building, including joint proposal writing, funding and joint policy statements need to be extended globally if it is to optimize reach and impact.
Abstract 360: Evaluating the Challenges of Functional Outcomes in Traumatic Brain Injury Research: Timing of Follow-Up, Prognostic Models, and Missing Data
Authors: Leila R Zelnick, Laurie J Morrison, Sean M Devlin, Eileen M Bulger, Karen J Brasel, Kellie Sheehan, Joseph P Minei, Jeffrey D Kerby, Samuel A Tisherman, Sandro Rizoli, Riyad Karmy-Jones, Rardi van Heest, Craig D Newgard
Journal: Circulation (2013)

Background: Traumatic brain injury (TBI) is common and debilitating. Randomized trials of interventions for TBI usually assess effectiveness by using long-term functional neurological outcomes but this is costly and difficult. If patient characteristics available at hospital discharge are predictive of 6-month functional outcome, then shorter-term outcomes may be adequate for use in future clinical trials. We evaluated models to predict long-term outcomes after TBI from short-term functional measures and easily obtainable demographic and injury characteristics as covariates, using data from a previously published randomized clinical trial. Methods: The Hypertonic Saline TBI trial of the Resuscitation Outcomes Consortium (ROC) enrolled 1282 TBI patients but had 15% missing data for the primary outcome of 6-month Glasgow Outcome Score Extended (GOSE). We evaluated patterns of missing data, whether functional outcome obtained earlier than six months would adequately reflect 6-month GOSE, and three prognostic models that predict 6-month severe disability (GOSE ≤ 4) via logistic regression using covariates and outcomes at discharge. Results: Patients with missing 6-month GOSE had less severe injuries, higher neurological function at discharge (GOSE), and shorter hospital stays than patients whose GOSE was obtained. Of 1066 (83%) patients with available discharge and 6-month outcomes, 71.2% of patients had the same functional status (severe disability/death vs. moderate /no disability) after 6 months as at discharge, 28% had an improved functional status, and 1% had worsened. Performance was excellent (AUC between 0.88 and 0.91) for all three prognostic models and calibration adequate for two models (p-values 0.22 and 0.85). Conclusion: Missing data was more common in healthier patients suggesting an ascertainment bias if the missing data were ignored during analysis. Shorter duration follow-up appears inadequate in representing long-term functional neurological outcome following TBI; however, all three prognostic models were highly predictive of long-term outcome. Our results support the more widespread use of multiple imputation of the standard 6-month GOSE when the primary outcome cannot be obtained through other means.