tbuckley/cabot-search huggingface dataset:
Abstract 67: Secular Trends in Cardiovascular Comorbidities and Associated Mortality Among Patients Hospitalized Alive After Out-of-Hospital Cardiac Arrest: A 20-Year Experience from a Middle-Eastern Country (1991-2010)
Authors: Amar M Salam, Hajar A AlBinali, Abdul Wahid Al-Mulla, Rajvir Singh, Jassim Al Suwaidi
Journal: Circulation (2012)

Objectives: little is known about the trends of the cardiovascular comorbidities associated with cardiac arrest in the developing countries and how they affect mortality. This was examined in this study in patients hospitalized alive after out of hospital cardiac arrest in a real-world population in a Middle-Eastern Country. Methods : Retrospective analysis of prospective registry of all patients hospitalized alive after out of hospital cardiac arrest in Qatar from 1991 through 2010 was made. Rates and trends of cardiac comorbidities and in-hospital mortality were examined. Results : During the 20-years period 801 patients were hospitalized alive after out of hospital cardiac arrest; 577 men and 224 women. In the latter years of the study there was increase in the prevalence of diabetes mellitus and hypertension when compared to patients hospitalized in the earlier years. Associated ischemic heart disease and heart failure were also trending higher. The study also demonstrated an increasing trend of in-hospital mortality over the 20-year period [table]. Conclusions : recent improvements in the recognition and management of the cardiovascular comorbid conditions associated with cardiac arrest, especially acute coronary syndromes and heart failure were at least in part, offset by the increase in prevalence of diabetes mellitus and hypertension along with ischemic heart disease in our region. Tailored strategies for the prevention and treatment of these conditions are warranted to reduce the burden of cardiovascular disease and its related mortality.
Abstract 46: Circulating Levels of Leptin Are Reduced in Patients with Sudden Cardiac Arrest at the Time of the Event
Authors: Rasmus Havmoeller, Audrey Uy-Evanado, Carmen Teodorescu, Katherine Jerger, Dorothy Kwok, Jo Ayala, Adriana Huertas-Vazquez, Ida Chen, Kyndaron Reinier, Karen Gunson, Jonathan Jui, Sumeet S Chugh
Journal: Circulation (2012)

Introduction: In most published studies, elevated circulating levels of leptin have been associated with increased sympathetic tone and adverse cardiovascular outcomes. However, the specific association of leptin levels with sudden cardiac arrest (SCA) in the general population has not been evaluated. Methods: In an ongoing, prospective, community-based study of SCA in Northwest US, we compared levels of plasma leptin in 109 adult cases of adjudicated SCA and 107 age-matched controls with coronary artery disease (100% male, age 62.6±11.4 vs. 62.6±11.4 y). Plasma was obtained from blood drawn at the time of arrest (cases) and at a routine visit (controls), and analyzed using Quantikine Immunoassay (CV &lt;3.3%, normal range for healthy male controls 2.2-11.1 ng/ml). Leptin levels were log transformed and compared (T-test and Chi-square test) per quartiles (based on controls). Logistic regression was used to predict the adjusted odds of SCA case status associated with leptin levels (per increase in quartile). Results: Leptin was significantly lower in SCA cases vs controls (median 2.0 [range 0.6 - 7.5] vs 8.5 [4.6 - 14.7] ng/ml, P&lt;0.0001). Cases and controls did not differ regarding body mass index, smoking status, or prevalence of obesity (29.6±6.6 vs 29.2±5.3 and 40 vs 40%, both P&gt;0.05) but controls were more likely to be on statin therapy (72 vs 44%, P&lt;0.001). In a logistic regression model leptin was independently associated with decreased odds of SCA case status (OR/increased quartile of leptin 0.48 (95% CI 0.31 - 0.73, P=0.0006) also after adjusting for age, obesity, presence of coronary artery disease, smoking, and statin therapy (Table). Conclusions: We observed an inverse relationship between circulating leptin levels and survival from SCA. These findings could represent an impaired sympathetic response to the acute SCA event but further investigation is needed to understand the mechanistic link between leptins and SCA.
Abstract 56: Variability in Patient Selection Criteria for Postarrest Protocols
Authors: Donald R McNicol, Teresa R Camp-Rogers, Michael C Kurz
Journal: Circulation (2012)

Introduction The prevalence of therapeutic hypothermia (TH) for post-cardiac patients has yet to be established. Complicating this measure is the lack of standardized, universal recommendations on patient selection criteria for.TH. The objective of this study is to assess the amount of variability in patient selection criteria. Methods We conducted a systematic search of all publicly available TH protocols from published Internet sources. Protocols must be complete, associated with a hospital, and demonstrate clear patient selection criteria, to be included. The proportion of hospitals that considered each patient selection criteria was determined. Only descriptive statistics were provided. No statistical inferences were made. Results A total of 64 TH protocols were assessed. Among the protocols, the patient selection criteria are viewed as Utstein based or non-Utstein based (Table 1). The Utstein variables considered were initial rhythm, witnessed, location, time to BLS, and age. Non-Utstein variables included were total ischemic time, time since ROSC, baseline body temperature, etiology of arrest, and hemodynamic parameters. The widest variability was noted in the category of “hemodynamic parameters.” Some hospitals (0.19) eliminate any patients with subjective evidence of “shock or instability.” Other hospitals vary in consideration of systolic blood pressure (0.44) or mean arterial pressure (0.27) to determine eligibility. Conclusion The results of this observational study indicate wide variability in the patient selection criteria for post-arrest protocols. The criteria provide stricter selection criteria than international guidelines recommend. Inconsistently applied criteria may exclude patients who would benefit from treatment. The impact of patient selection criteria could have an effect on measured national survival rates and outcomes.
Abstract 53: Abnormal Continuous Electroencephalography Recordings Are Not Predictive of Survival Outcomes Following Cardiac Arrest
Authors: Archana Shrestha, Jenny A Campbell, Todd M Larabee
Journal: Circulation (2012)

Background: Cerebral anoxia following cardiac arrest can lead to poor neurological outcomes. Post-arrest therapeutic hypothermia (TH) has been shown to be neuroprotective in this setting. Early prognostication of survival outcomes is important for patient care and resource management. The use of continuous electroencephalography (cEEG) may be an important tool for prognostication of survival outcomes after cardiac arrest. Objectives: To determine if abnormal cEEG recordings are associated with survival outcomes following cardiac arrest. Methods: Retrospective study of all patients who suffered an in- or out-of-hospital cardiac arrest and were entered into the post-arrest management protocol (PAMP) at a single academic institution between May 2011 and May 2012. As part of the PAMP, cEEGs are recorded during TH, during the rewarming phase, and at normothermia. All cEEG reports were assessed for routinely described abnormal patterns: severe suppression, burst suppression, status epilepticus, intermittent epileptiform discharges (IED), generalized periodic epileptiform discharges (GPED), either α,β, or [[Unable to Display Character: ▵]] coma, or diffuse intermixed slowing. Descriptive statistics were analyzed. Results: Ninety-one patients were admitted to the ICU after cardiac arrest and 42 patients had PAMP and TH initiated. Of these, 36 (86%) received a neurologic consultation and 27(64%) had a cEEG placed. 24/27 (89%) survived to 24 hours and 7/27 (26%) survived to hospital discharge. Of the 7 survivors to discharge, 1 had severe suppression, 3 demonstrated α,β, or [[Unable to Display Character: ▵]] coma, and 3 demonstrated diffuse intermixed slowing during MTH. During early rewarming and normothermia, 3 had diffuse intermixed slowing, 2 demonstrated either α,β, or [[Unable to Display Character: ▵]] coma, and 1 demonstrated IEDs. Conclusion: Abnormal cEEG during MTH and early rewarming is not predictive of survival outcomes following cardiac arrest in this small, retrospective study. This study is limited by the small number of enrolled patients who have completed the protocol to date.
Abstract 68: Incidence and Outcomes of Unresolved Prehospital Rearrest in EMS-Treated Cases of Out-of-Hospital Cardiac Arrest
Authors: David D Salcido, Allison C Koller, Matthew L Sundermann, Clifton W Callaway, James J Menegazzi
Journal: Circulation (2012)

Background: The phenomenon of re-arrest (RA) - loss of pulses after successful return of spontaneous circulation (ROSC) - is of interest in resuscitation research because even transient loss of pulses prior to hospital arrival may have a detrimental impact on patient outcomes. Patients who experience RA may also demonstrate specific pathology, the identification and treatment of which may lead to better outcomes. Objective: Estimate the incidence and outcomes of one manifestation of RA, unresolved prehospital-RA (UP-RA), wherein pulses are not reestablished following at least one RA prior to arrival at the emergency department (ED). Methods: Case data spanning 2006-2008 were obtained from the Resuscitation Outcomes Consortium, a multisite clinical research consortium with cardiac arrest surveillance programs in 10 sites in North America. Non-traumatic emergency medical services (EMS)-treated cases of out-of-hospital cardiac arrest (OHCA) with any instance of prehospital ROSC were included. Prehospital ROSC events, patient vital status at ED admission, survival to hospital discharge, patient demographics, and ancillary resuscitation variables were ascertained through review of paramedic-generated patient care reports (PCRs), defibrillator data downloads, and hospital records. Prehospital ROSC was defined as a detectible return of pulses resulting in an obvious suspension of CPR. UP-RA status was assigned to any case with prehospital ROSC that did not have pulses upon ED arrival. Results: Out of 18,937 cases of OHCA across all sites, there were 11,456 (60.5%) EMS-treated cases. Prehospital ROSC was found in 4,609 (40.2%) cases. Of these cases, mean(SD) age was 63.7(17), 37.1% were female, 21.5% occurred in public, 13.5% were EMS witnessed, and overall survival to hospital discharge was 28%. Vital status at ED was available for 3,116 (67.6%) cases of which UP-RA was present in 473 (15.2%). Survival was 7.8% in cases with UP-RA, compared to 33.3% in cases without, and UP-RA was directly associated with death prior to hospital discharge (OR: 6.14, CI: 4.31-8.75, p&lt;0.001). Conclusion: When characterized as an irreversible event prior to ED arrival, incidence of RA is relatively uncommon but strongly predictive of non-survival at hospital discharge.
Abstract 9648: Neointimal Tissue Component Assessed by Tissue Characterization With 40MHz Intravascular Ultrasound Imaging - Comparison of Drug-Eluting Stents and Bare-Metal Stents
Authors: Kenichi Tsujita, Naoko Takaoka, Koichi Kaikita, Seiji Hokimoto, Takamichi Ono, Tadasuke Chitose, Eiji Horio, Koji Sato, Michio Mizobe, Naoki Nakayama, Michiyo Saito, Shinji Tayama, Seigo Sugiyama, Hiroshige Yamabe, Sunao Nakamura, Hisao Ogawa
Journal: Circulation (2011)

Background: Drug-eluting stents (DES) can cause impaired arterial healing, which constitutes the most important pathological substrate underlying late DES thrombosis. Intravascular ultrasound (IVUS)-based tissue characterization allows for the in vivo identification of neointimal tissue components. The present study used iMap IVUS system to compare neointimal tissue components between DES and bared-metal stents (BMS). Methods: Follow-up IVUS data after coronary stenting (9.8±9.4 months from index procedures) was obtained from consecutive 61 lesions (34 in DES, 27 in BMS). Region of interest was placed in neointima hyperplasia and plaque behind stent. The iMap tissue components (fibrotic, lipidic, necrotic, and calcified) were measured in every recorded frame and expressed as percentages of mean neointimal and plaque behind stent cross-sectional area for the stented segment. Results: Patients' characteristics were comparable between DES and BMS. Compared with BMS, smaller (2.9±0.4mm vs. 3.2±0.4mm, P=0.004) and longer (34±18mm vs. 26±14mm, P=0.03) DES were implanted. Although there was no significant difference in minimum lumen area at follow-up between DES and BMS, average neointimal area was significantly smaller in DES compared with BMS (1.6±0.8mm2 vs. 3.4±2.4mm2, P=0.02). The iMap analyses showed that neointima after DES placement was composed of smaller fibrotic component (70±8% vs. 77±10%, P=0.045), larger necrotic (13±5% vs. 9±3%, P=0.02) and calcified (12±4% vs. 5±4%, P=0.004) components compared with BMS, whereas the plaque component behind stent was identical. Logistic regression analysis showed that only intra-DES neointima was a significant predictor of necrotic neointima at follow-up. Conclusion: DES implantation would be associated with iMap-derived necrotic and less-fibrotic neointimal formation. In vivo iMap evaluation of neointimal tissue may provide useful information in detecting impaired healing after stenting.
Abstract 52: CPR Quality and Outcomes in Resuscitation of Suspected Drug-Related Cardiac Arrests
Authors: Allison C Koller, David D Salcido, Clifton W Callaway, James J Menegazzi
Journal: Circulation (2012)

Introduction: Cardiac arrest resulting from drug overdose (OD) is a significant public health issue and is the cause of many preventable deaths each year. Little is known about actual resuscitation process parameters of ODs and such arrests are often excluded from out-of-hospital cardiac arrest (OHCA) studies. We sought to investigate the characteristics of emergency medical services (EMS)-treated OHCA cases resulting from suspected OD. Methods: The University of Pittsburgh Institutional Review Board approved this study. Data from EMS-treated non-traumatic OHCAs were obtained from the Pittsburgh site of the Resuscitation Outcomes Consortium, a multi-center clinical research consortium with 10 sites across North America. Cases from 2006-2011 were analyzed. Case definition for OD was naloxone administration or drug overdose indicated on the patient care report. Resuscitation parameters including chest compression fraction, compression rate, and compression depth, shock delivery and the administration of resuscitation drugs were collected and compared between OD and non-OD groups. Demographic and outcome variables including age, sex, EMS- or bystander-witnessed status, return of spontaneous circulation and survival to hospital discharge were also compared by OD status. Resuscitation parameters were compared between groups using logistic regression or t-tests with alpha = 0.05. Results: We identified 180 OD cases and compared them to 2,162 non-OD OHCAs. Both groups were predominantly male (OD: 66%, non-OD: 59%; p = 0.0498). OD OHCAs were on average 20 years younger than non-OD OHCAs (45 vs. 65 years, p &lt; 0.001). OD cases were associated with higher overall CPR fraction than non-OD (66% vs. 63%, p = 0.0158) and survival (19%, vs.11%; OR: 1.82, CI: 1.12 - 2.94, p = 0.015). OD cases were also associated with higher probability of epinephrine (OR: 2.05, CI: 1.33 - 3.15, p &lt; 0.001) and sodium bicarbonate administration (OR: 2.70, CI: 1.98 - 3.68, p &lt; 0.001). Other variables did not differ. Conclusion: Patients with OD-related OHCA were more likely to receive resuscitation drugs, receive higher CPR fraction, and survive than non-OD OHCAs.
Abstract 9644: Deformation Dynamics and Mechanical Properties of the Aortic Annulus by Four-Dimensional Computed Tomography Insights Into the Functional Anatomy of the Aortic Valve Complex and Implications for Transcatheter Aortic Valve Therapy
Authors: Ashraf Hamdan, Victor Guetta, Eli Konen, Orly Goitein, Amit Segev, Ehud Raanani, Dan Spiegelstein, Ilan Hay, Elio Di Segni, Michael Eldar, Ehud Schwammenthal
Journal: Circulation (2011)

Objectives: To assess deformation dynamics and mechanical properties of the aortic annulus. Background: Understanding dynamic aspects of functional aortic valve anatomy is important for beating-heart transcatheter aortic valve implantation (TAVI). Methods: Thirty five patients with aortic stenosis and eleven normal subjects underwent 256-slice computed tomography (CT). The aortic annulus plane was reconstructed in 10% increments of the RR-interval. For each phase minimum diameter (Min), ellipticity index (EI), cross-sectional area (CSA), and perimeter (Perim) were measured (Figure 1). In a subset of 10 patients Young's elastic module was calculated from the stress-strain relationship of the annulus. Results: In both subjects with normal and with calcified aortic valves Min increased in systole (12.3 ± 7.3% and 9.8 ± 3.4%, respectively; P &lt; 0.001) and EI decreased (12.7 ± 8.8% and 10.3 ± 2.7%; P &lt; 0.001, respectively). CSA increased by 11.2 ± 5.4% and 6.2 ± 4.8, respectively (P &lt; 0.001). Perim increase was negligible in patients with calcified valves (0.56 ± 0.85%; P &lt; 0.001) and small even in normal subjects (2.2 ± 2.2%; P = 0.01). Young's modulus was calculated as 13.2 MPa in patients. Kolmogorov-Smirnov analysis, showed significant differences between maximum and minimum values for all parameters except perimeter. Conclusion: The aortic annulus, generally elliptic, assumes a more round shape in systole, thus increasing CSA without substantial change in perimeter. Perimeter changes are negligible in patients with calcified valve, because tissue properties allow very little expansion. Figure 1: Reconstruction of the aortic annulus from the sagittal (A) and the coronal planes (B). The aortic annulus is defined as the circumferential connection of the aortic leaflets' most basal attachments in the reconstructed axial plane (C). Measurements of the minimum and maximum diameter (D), the perimeter (E), and the area (F) were performed in this plane.
Abstract 60: Prognostic Performance of Diffusion-Weighted Magnetic Resonance Imaging in Comatose Patients Treated with Mild Hypothermia After Cardiac Arrest and Its Added Value in the Context of Neuron-Specific Enolase-Based Prognostication
Authors: Kyonghee Noh, Joonghee Kim, Kyuseok Kim, Byung Se Choi, Cheolkyu Jung, Jae Hyuk Lee, You Hwan Jo, Joong Eui Rhee, Tae Yun Kim, Kyeong Won Kang
Journal: Circulation (2012)

Objective: MRI-based prognostication of comatous resuscitated cardiac arrest patient has shown promising results. However, it was not validated in patients treated with therapeutic hypothermia and it is unknown how it might add to NSE-based prognostication. We sought to evaluate the prognostic performance of regional apparent diffusion coefficient (ADC) in comatose OHCA patients treated with mild hypothermia and its added value to NSE-based prognostication. Methods: OHCA registry was analyzed to identify OHCA patients older than fifteen who were treated with therapeutic hypothermia and underwent brain MRI between 2008 and 2011. Quantitative measurement of regional ADC was done by a radiologist blinded to clinical outcome. Results: Among 43 eligible patients, 11(18.6%) achieved good outcome (6-month CPC 1 or 2). Regional ADC of occipital cortex showed highest discriminatory power with its area under the curve of receiver- operating-characteristic (AUROC) 0.943 (95% CI, 0.872-1.000) and predicted poor outcome with a sensitivity of 90.6% and a specificity of 100%. For NSE (48-hour), its AUROC was 0.911 (95% CI, 0.801- 1.000) and it was correlated with the regional ADC significantly (Pearson’s r=-0.674, p&lt;.001). The ADC- based prognostication could identify additional 5 (35.7%) poor outcome patients among 14 with 48- hour NSE &lt;78.9ng/mL, a cutoff point suggested by a previous study. However, it did not provided additional prognostic information if 48-hour NSE was &gt;78.9ng/mL. Conclusions: Regional ADC-based prognostication was accurate in OHCA patients treated with mild hypothermia. However, in the context of 48-hour NSE-based prognostication, it provided additional prognostic information only when 48-hour NSE indicated good prognosis (48-hour NSE &lt;78.9ng/mL). Uploaded image: A scatterplot depicting the relationship between 48-hour NSE level and regional (occipital) ADC value. Vertical gray dash line: 33 ng/mL; Vertical black dash line: 78.9ng/mL
Abstract 4: Small-Volume 7.5% NaCl Adenocaine/Mg2+ Preserves Cardiac Function During Hypotensive Resuscitation in the Pig Following Severe Hemorrhagic Shock
Authors: Asger Granfeldt, Hayley L Letson, Janus A Hyldebrandt, Edward R Wang, Pablo A Salcedo, Torben K Nielsen, Else Tønnesen, Jakob Vinten-Johansen, Geoffrey P Dobson
Journal: Circulation (2012)

Background: Cardiac rescue is critical for successful resuscitation. Previously, we reported that ~1 ml/kg 7.5% NaCl with Adenocaine (adenosine and lidocaine) and Mg2+ (ALM) successfully resuscitated rats following severe hemorrhagic shock, and that in pigs ALM significantly reduced the volume of Ringers acetate required to raise MAP to a target of 50 mmHg following 74% blood loss. The present study examines the effect of small volume 7.5% NaCl ALM on cardiac function during 60 min hypotensive resuscitation following 90 min shock in the porcine model. Methods: Pigs (35-40kg) were subjected to pressure-controlled hemorrhage at a mean arterial pressure (MAP) of 35-40mmHg for 90 min (~75% blood loss). Pigs were randomly assigned to receive either 4 ml/kg 7.5% NaCl ALM (ALM n=8) or 4 ml/kg 7.5% NaCl (Control n=8). Cardiac output (CO), stroke volume, left-ventricular pressures and hemodynamics were collected continuously. Significance *p&lt;0.05. Results: MAP, end-systolic pressure and CO were significantly higher in the ALM pigs at the end of hypotensive resuscitation (Table). The higher CO was due to a higher stroke volume (SV) maintained at a significantly lower heart rate (HR). Paradoxically dP/dtmax tended to be higher in the Control group during the first 45min of hypotensive resuscitation (p=0.066) with no difference at 60min. Systolic ejection times were significantly increased in the ALM group and inversely related to HR. There was no difference in LV end-diastolic pressure between the two groups indicating that preload was similar during hypotensive resuscitation. LV blood flow at 30min resuscitation was comparable in the two groups (Control: 2.86±0.6 vs. ALM: 4.1±1.4 ml/min/g; p=0.7) Conclusion: Superior cardiac rescue was achieved in ALM by a higher SV and CO, lower HR and longer ejection times vs Controls. Longer isovolumic contraction and ejection times may be due to suppression of SA nodal activity or rebalancing of sympathetic/parasympathetic control.