tbuckley/cabot-search huggingface dataset:
Abstract Sa1205: Understanding Barriers to Bystander Use of Automated External Defibrillators (AEDs) in Cardiac Arrest: A Cross-Sectional Survey in North Carolina
Authors: Harman Gailan Hassan Yonis, Lisa Kaltenbach, Nina Nouhravesh, Daniel Mark, Audrey Blewer, Carolina Malta Hansen, Kristian Kragholm, Christian Torp-Pedersen, Monique Starks, Sana Al-Khatib, Lisa Monk, James Jollis, Comilla Sasson, Konstantin Krychtiuk, Christopher Granger
Journal: Circulation (2024)

Introduction: Early defibrillation is a critical link in the chain of survival after out-of-hospital cardiac arrest. However, bystander defibrillation rates are extremely low (&lt;2% in North Carolina). Barriers to increasing bystander defibrillation rates and the reasons why bystanders rarely perform early defibrillation are not well-defined in North Carolina. Objectives: To assess public awareness of AEDs in areas with an accessible AED. Specifically, we investigated whether the public knew the locations of nearby AEDs, how to use them, and whether they were willing to use an AED in the event of cardiac arrest. Methods: We conducted a cross-sectional face-to-face survey study in two large cities in North Carolina (NC): Winston-Salem and Charlotte. The survey instrument consisted of a 14-item questionnaire, which was pre-tested before the study started. Survey locations were chosen based on the availability of a public AED within a radius of 900 feet or less, equivalent to less than a 3-minute round-trip run from the site. Only responders aged 18 years or older who regularly visited or worked in the area were included. Results: In total, 94 surveys were completed, with 52 in Charlotte and 42 in Winston-Salem. The survey population consisted of 57.4% males (n=54), 42.6% Black individuals (n=40), with the most frequently reported age category being 25- to 34-year-olds (n=21). In total, 69.1% (95% CI 59.2% to 77.6%) of responders knew what an AED was, and 83.0% (95% CI 74.1% to 89.2%) were willing to use an AED in the event of cardiac arrest. However, only 23.4% (95% CI 16.0% to 32.9%) knew how to use an AED and 19.2% (95% CI 12.5% to 28.3%) knew where the nearest AED was (Table). Previous CPR training was common but did not identify subjects with greater awareness or understanding about the use of AEDs. Conclusion: While a majority of respondents in our survey in urban NC were aware of what an AED was and were willing to use one, a concerning number lacked knowledge of how to use an AED and were unaware of an AED available within 900 feet of the assessment site. These results suggest areas in need for improvement in the current approach to public AED placement and signage.
Abstract 4147988: The association between E-cigarette use and atrial fibrillation in the All of Us Study: A prospective study
Authors: Samuel Mensah, Yakubu Bene-Alhasan, Isaac Acquah, Albert Osei, Lida Koskina, Olurotimi Mesubi
Journal: Circulation (2024)

Introduction: E-cigarette use, promoted as an alternative to traditional cigarette smoking, may have long-term clinical cardiovascular effects, including arrhythmias that have not yet been studied. Even though mouse models have shown significantly increased susceptibility to atrial fibrillation and ventricular tachycardia in rats exposed to e-cigs, there are no extensive human studies that investigate the association between e-cigarette use and atrial fibrillation in the US population. We sought to determine if e-cigarette use is associated with incident atrial fibrillation. Methods: This study was a longitudinal prospective study of participants enrolled in the NIH-sponsored ‘All of Us’ research study program. We excluded participants without electronic health records (EHR) and those with a diagnosis of Atrial fibrillation/flutter at baseline. We identified participants who had e-cigarette use at baseline using the Population Assessment of Tobacco and Health-styled questionnaire. We analyzed the association between both current and former e-cigarette use and incident atrial fibrillation using the Cox proportional hazards model adjusting for age, sex, race, ethnicity, income, education, alcohol use, diabetes mellitus, hypertension, dyslipidemia, BMI and other tobacco products (smokeless tobacco, cigar, hookah, and cigarette). Results: Of the 144, 743 participants eligible for the study at baseline, there were 2191 events of atrial fibrillation identified with a median follow-up time of 46 months. The mean age was 52 years; 21% were Blacks, 72.0% were White, and 3.5% were Asian. 2.6 % were of Hispanic ethnicity. 3.8%, 12.0%, and 84.2% were current, former, and never users of electronic cigarettes. Current and former use of e-cigarettes was not associated with incident atrial fibrillation after adjusting for confounders [aHR for current users= 0.77, 95%CI 0.52-1.12; for former users= 1.06, 95%CI 0.87 - 1.29] Conclusion: We did not find an association between e-cigarette use and incident atrial fibrillation or flutter. Further studies are needed in different populations to corroborate our findings.
Abstract 4147752: Agreement of Doppler Flow Velocity Reserve With PET Flow Reserve in Angina Without Obstructive Coronaries
Authors: Mahmoud Ismayl, Claire Raphael, Abhiram Prasad, Panithaya Chareonthaitawee, John Bois
Journal: Circulation (2024)

Background: Angina with no obstructive coronary arteries (ANOCA) is clinically challenging to diagnose and manage. The agreement between Doppler-derived coronary flow reserve (CFR Doppl ) and PET-derived CFR (CFR PET ) in patients with ANOCA remains unclear. Aims: To evaluate the correlation between Doppler- and PET-derived CFR in patients with ANOCA. Methods: We conducted a single-center, retrospective study of adult patients (age ≥18 years) with ANOCA who were referred for evaluation of possible microvascular ischemia with Doppler- and PET-derived CFR at the Mayo Clinic (Rochester, MN) between January 1, 2018, and May 1, 2024. Pearson correlation was used to quantify the association between Doppler- and PET-derived CFR. Agreement between Doppler- and PET-derived CFR was assessed by Bland-Altman analysis using a 2-way mixed effects model with measures of absolute agreement. Results: A total of 66 patients were initially identified, of which 40 were included in the final analysis (66.7% female, median age 58 years [Q1-Q3: 45-66 years]). Median time between PET- and Doppler-derived CFR was 8 days (Q1-Q3: 1-31 days). Median CFR Doppl was 2.75 (IQR: 2.23-3.28) and median CFR PET was 2.50 (IQR: 2.10-3.10). Doppler-derived CFR displayed a wider range than PET-derived CFR (0.8-5.2 vs 1.2-4.0). A strong correlation was found between Doppler- and PET-derived CFR ( r= 0.81; p&lt;0.001). The corresponding Bland-Altman plot showed an overall bias of 0.27±0.56 (intraclass coefficient=0.85; p&lt;0.001). Conclusions: While invasive coronary angiography with CFR Doppl is the gold-standard for the diagnostic evaluation of ANOCA, PET imaging with CFR PET offers an excellent first line non-invasive modality for diagnosis of coronary microvascular dysfunction.
Abstract 4147892: Outcomes with AngioVac Debulking of Tricuspid Valve Endocarditis with Stratification of Vegetation Size
Authors: Leonard Palatnic, John Sheppard, David Zlotnick
Journal: Circulation (2024)

Background: The AngioVac mechanical aspiration system has recently emerged in the literature for its use in the percutaneous debulking of intracardiac vegetations and masses. However, description of its efficacy in the setting of vegetation size stratification has remained sparse. We present our unique experience with the AngioVac system in patients with tricuspid valve infective endocarditis (TVIE) and high or prohibitive operative risk with a vegetation size ≥ 2cm compared to a vegetation size of &lt; 2cm. Methods: We performed a retrospective, in-hospital, comparative analysis on all patients who underwent percutaneous AngioVac vegetation debulking in the setting of TVIE with a vegetation size ≥ 2cm compared to a vegetation size &lt; 2cm from January 2017 to December 2023 at a large academic tertiary care hospital. Results: Of the 62 patients who underwent AngioVac debulking, 56 patients had the size of the vegetation described on echocardiography and were included. 35 patients had a vegetation size ≥ 2cm and underwent AngioVac debulking. 17 (48.6%) were women and mean age was 39.192 +/- 12.186 years. 21 patients had a vegetation size &lt; 2cm and underwent AngioVac debulking. 10 (47.6%) were women and mean age was 38.508 +/- 12.056 years. During their index admission, between patients with a vegetation size &lt; 2cm compared to ≥ 2cm, there was no difference in time (days) from procedure to blood culture clearance (P-value: 0.171, 95% CI: -1.178 – 6.360). There was no difference in the risk of stroke (P-value: 0.517, 95% CI: 0.000-8.792), or blood transfusion requirement (P-value 0.011, 95% CI: 0.039 – 0.757). There was no difference in the risk of experiencing worsening tricuspid regurgitation post-procedure (OR: 0.211, 95% CI: 0.004 – 1.884) or risk of recurrent endocarditis (OR: 0.778, 95% CI: 0.104 – 4.634). Finally, there was no difference in the length of hospital stay (days) between both groups (P-value: 0.234, 95% CI -4.966 – 19.758), and there was no difference in in-hospital mortality post-procedure (P-value: 0.626, 95% CI: 0.116 – 25.524). Notably, neither of the two groups required surgical or percutaneous tricuspid valve replacement. Conclusion: This retrospective, comparative analysis adds to the growing literature that Angiovac debulking may be a safe and effective long-term alternative to cardiac surgery in patients with TVIE and elevated perioperative risk, irrespective of vegetation size.
Abstract Or109: Systemic Nicotinamide Mononucleotide Administration for Post-cardiac Arrest Brain Injury
Authors: Daiki Kaito, Tomoyoshi Tamura, Sayuri Suzuki, Ryutaro Oonishi, Koichiro Homma, Junichi Sasaki
Journal: Circulation (2024)

Background: Nicotinamide mononucleotide (NMN), a precursor of nicotinamide adenine dinucleotide (NAD + ), has been shown to increase NAD + levels, reduce inflammation, and improve short-term survival in a rodent model of hemorrhagic shock. NAD + levels decrease after cardiac arrest (CA), but the effect of NMN on outcomes after CA remains undefined. Hypothesis: NMN administration increases NAD + content in the brain, reduces systemic inflammation, and improves outcomes after CA. Aims: This study aimed to investigate the effects of systemic NMN administration on neurological function, survival, and systemic inflammation after CA. Methods: In a murine model of CA, asystole was induced using potassium chloride. After 10 minutes of CA, mice were resuscitated with continuous epinephrine injections. Mice were randomly assigned to the NMN group (60 mg/kg body weight i.p.) or the control group (normal saline i.p.) 1.5 minutes after the return of spontaneous circulation (ROSC). The same treatment was repeated at 24 and 48 hours after CA. Neurological function score (on a scale from 0 to 12) at 48 hours post-CA and 7-day survival were compared between the NMN and control groups. Brain NAD + levels were measured 30 minutes post-ROSC. Plasma cytokine levels (IL-6 and TNF-α) were measured 2 hours post-ROSC. Results: Brain NAD + levels significantly increased 30 minutes post-ROSC in the NMN group compared to the control group (186 ± 15 pg/mg tissue and 131 ± 14 pg/mg tissue, respectively; P=0.02). NMN significantly improved neurological function score at 48 hours post-CA (NMN group median 12 [9–12] vs. control group 8 [4–11]; P=0.03). Moreover, NMN improved survival rate up to 7 days post-CA (NMN group 61.1% [11/18] vs. control group 22.2% [4/18]; P=0.03). Mean arterial pressure tended to be higher in the NMN group, although the difference was not significant (NMN group 113.8 ± 2.1 mmHg vs. control group 107.8 ± 2.9 mmHg; P=0.08). NMN showed a trend toward decreased IL-6 (NMN group 52.7 ± 14.3 pg/ml vs. control group 114.6 ± 33.3 pg/ml; P=0.15) and TNF-α (NMN group 6.9 ± 1.2 pg/ml vs. control group 11.7 ± 2.3 pg/ml; P=0.12). Conclusions: Systemic administration of NMN post-CA increased brain NAD + levels and improved neurological function and survival. NMN also showed a trend toward reduced systemic inflammation. NMN is a promising approach to improve outcomes after CA.
Abstract Sa1004: Chest compression synchronized ventilation is associated with improved oxygenation but also with increased incidence of pneumothoraces in an experimental CPR model.
Authors: Jukka Kopra, Lassi Mehtonen, Merja Laitinen, Erik Litonius, Robert Oestman, Juho Heinonen, Markus Skrifvars, Pirkka Pekkarinen
Journal: Circulation (2024)

Background: Recent experimental results have shown promising potential for chest compression synchronized ventilation (CCSV). This technique triggers ventilation during cardiopulmonary resuscitation (CPR) by the counterpressure from each chest compression (f = 100 min -1 ), with a positive inspiratory pressure of 60 mbar. The objective is to enhance the compressive force directed at the heart and increase venous return while preventing lung atelectasis. We examined the effects of CCSV on arterial blood gas levels, pH and lactate compared to manual ventilation in an animal model of CPR. The hypothesis was, that it would provide superior oxygenation sustained over 30 minutes of advanced life support (ALS). Methods: Anesthetized healthy Landrace pigs (n = 30; weight circa 50 kg) were electrically induced to ventricular fibrillation and randomized to either CCSV (delivered with the Medumat standard 2 ventilator) or conventional ventilation (manual bag-valve) with mechanical chest compressions by Lucas TM 2. After a 5 min no-flow time ALS was commenced and delivered for 35 minutes. The pigs were not defibrillated but received three 1 mg intravenous doses of epinephrine. Arterial blood gas samples were taken in 5 min intervals. Femoral artery pressure levels and end-tidal carbon dioxide (EtCO 2 ) were measured continuously. PaO 2 , PaCO 2 , pH, lactate, arterial pressures and EtCO 2 over time were compared using a mixed linear model. Chest injuries were diagnosed with post-mortem CT scans. Results: PaO 2 levels were significantly higher in the CCSV group (p = 0.0455, Figure 1 ). EtCO 2 levels were significantly lower in the CCSV group (p = 0.0047) whereas there was no difference in SBP or MAP ( Figure 2 ). The number of pneumothoraxes were significantly higher in the CCSV group (12 vs. 3, p = 0.0078) with 8 being severe. Conclusions: CCSV provides increased oxygenation but is associated with more pneumothoraces in this animal model. The effect on hemodynamics was neutral. The promising CCSV protocol warrants further research and refinement.
Abstract Sa204: Mitochondrial transplantation improves hemodynamics after cardiac arrest and resuscitation in pigs
Authors: Yusuke Endo, Lance Becker, Taku Miyasho, Chihiro Sugita, Kei Hayashida
Journal: Circulation (2024)

Introduction: Mitochondrial transplantation (MTx) is an innovative technology that has the potential to attenuate ischemia-reperfusion injury and improve outcomes. Our recent studies have demonstrated that MTx significantly enhances survival and neurological outcomes after resuscitation in a rat model of cardiac arrest (CA). Objective: This study aims to evaluate whether MTx, applied immediately after return of spontaneous circulation (ROSC), can improve cardiovascular parameters during the acute phase following CA and resuscitation using a pig ventricular fibrillation (VF)-induced CA model. Methods: Sixteen LWD pigs (age 3-4 weeks, weight 29-34 kg) were subjected to VF-induced CA via intravenous potassium chloride injection. Eight minutes after CA, mechanical ventilation with 100% O2, mechanical chest compressions, and administration of epinephrine and defibrillation according to the current ACLS guidelines with minor modifications. Three pigs that did not achieve ROSC within 20 minutes were excluded from the analysis. Among the remaining 13 pigs, 7 received intravenous respiration buffer as a vehicle (vehicle group, n=7) and 6 received intravenous MTx immediately after ROSC (MTx group, n=6). The donor mitochondria were freshly isolated from rectus femoris muscle of healthy pigs a few hours before MTx. The animals were observed until 240 minutes after ROSC. Results: All pigs successfully went into VF-CA after potassium administration. The time to ROSC was 370 ± 184 seconds in the vehicle group and 420 ± 62 seconds in the MTx group, with no significant difference between the two groups. The vehicle group showed a significant decrease in mean arterial pressure (MAP) compared to baseline after ROSC, while the MTx group prevented the decrease in MAP, maintaining significantly higher MAP than the vehicle group ( Fig A ). Transpulmonary thermodilution revealed that MTx maintained stroke volume and cardiac output (CO) at 240 minutes after ROSC, which were significantly higher than those in the vehicle group ( Fig B ). Blood gas analysis revealed significantly higher central venous oxygen saturation (ScvO 2 ) in the MTx group compared to the vehicle group at 30 minutes after ROSC ( Fig C ). Conclusions: Intravenous administration of MTx immediately after ROSC improved cardiovascular parameters and maintained the oxygen supply-demand balance in a pig model of CA. MTx shows promising potential for attenuating cardiovascular instability and improving overall outcomes after CA.
Abstract Sa1005: Differences in ETCO <sub>2</sub> Measurement between Sidestream and Mainstream Capnography during CPR.
Authors: Mikel Leturiondo, Jose Antonio Uriguen, Mohamud Daya, Nicholas Johnson, Jennifer Blackwood, Sofia Ruiz de Gauna
Journal: Circulation (2024)

Introduction: End-tidal CO 2 (ETCO 2 ) has long been proposed as a trustworthy non-invasive indicator of the effectiveness of cardiopulmonary resuscitation (CPR). In fact, ETCO 2 values and trends have been associated to return of spontaneous circulation (ROSC), likelihood of survival or possibility of death. Two different technologies are available to measure ETCO 2 , mainstream and sidestream. In mainstream, the sensor is directly placed on the patient’s airway and samples CO 2 tensions within the airway. Conversely, in sidestream, gas travels through a tubing connected to the patient’s airway, with the CO 2 values being measured from a sampling port on this circuit distant from the airway. Aim: Quantitatively analyze the differences in ETCO 2 values between mainstream and sidestream technologies measured concurrently in patients undergoing out-of-hospital CPR. Methods: Manual CPR out-of-hospital cardiac arrest cases with defibrillator, spirometry-based tidal volume and inspiratory flow, and concurrent capnography data recorded by both mainstream and sidestream approaches after intubation. For each episode, ventilations were automatically detected in the volume signal and characterized by the ETCO 2 values measured using the mainstream and sidestream waveform capnography tracings. Differences in the measurements obtained by both technologies were quantified in absolute (mmHg) and relative values (%). Results: A total of 25 cases were analyzed, comprising 3,275 ventilations with concurrent mainstream and sidestream waveform capnography. Median (IQR) ventilation rate was 12.4 (9.6, 15.6) per minute. Median (IQR) tidal volumes were 380 (318, 478) mL. ETCO 2 values for mainstream presented a median (IQR) of 45.7 (37.6, 62.2) mmHg, while for sidestream were 43.0 (35.0, 59.0) mmHg (p &lt; 0.001). The distribution of absolute differences was 2.6 (1.4, 4.3) mmHg, and of relative differences 6.0% (3.3%, 9.8%). Conclusion: Sidestream yielded ETCO 2 measurements that were almost always lower than those recorded by mainstream, with median differences close to 3mmHg, or more than 6%. Even if registered values are similar, precise measurements are vital in the context of monitoring the quality of CPR. Because both technologies are widely used, sensors may need to be calibrated to account for technical differences in order to yield accurate measurements.
Abstract 4147679: CD39 Expression on Tregs Associates with the Severity of Atherosclerosis in Mice and Humans: Impact on Efferocytosis.
Authors: Samuel Watson, Lauren Detrick, Eli DHerete, Oscar Bermeo-Blanco, Simon Robson, Roman Covarrubias, Richard Gumina
Journal: Circulation (2024)

Objective: Atherosclerosis is a chronic inflammatory condition. Extracellular nucleotide metabolism by CD39, encoded by the ENTPD1 gene, plays a role in modulating inflammation. Our objective of this study was to elucidate the molecular and inflammatory mechanisms by which CD39 activity modulates atherosclerosis Approach and Results: Here we identify that the genotype of SNP rs3814159 in the promoter region of the ENTPD1 gene strongly associates with the level of expression of Tregs (p&lt;0.001; GG=Treg CD39low; AA=Treg CD39high). Given the contribution of Tregs to regulating inflammation and atherosclerotic cardiovascular disease, we examined the extent of angiographic atherosclerosis using a 17-segment modified AHA model (Gensini Score) in 85 consecutive patients referred for coronary angiogram. Analysis of atherosclerotic burden by rs3814159 genotype demonstrated a significantly higher burden of disease in those patients with the GG (Treg CD39low) genotype (Fig. 1A: p=0.0373). To study how differences in CD39 activity in Tregs affect atherosclerosis. We generated a cre-lox Treg cell-specific CD39 knockout mouse model with green fluorescent protein (GFP) labeled FoxP3 (FoxP3-Cre GFP+ CD39flox) and crossed this into an Ldlr-/- background. We fed high-fat diet (21% saturated fat, 0.15% cholesterol) to Ldlr-/--FoxP3-Cre+-Cd39wt/wt (Treg Cd39high) and Ldlr-/-- FoxP3-Cre+-Cd39flox/flox (Treg Cd39low) mice for 16 weeks. Examination of the aortic sinus by Oil Red O-stained cross-sections revealed a significantly increased lesion area in Treg Cd39low mice (Fig. 1B: p= 0.0321). Next, using an established model of zymosan-induced peritonitis, macrophage efferocytosis of irradiated splenocytes was examined in vivo. Peritoneal macrophages from Treg Cd39low demonstrated a significant reduction in efferocytosis compared to Treg Cd39high mice (Fig. 1C: p=0.047). Conclusion: Our data support that a reduced expression of CD39 on Tregs results in increased atherosclerosis burden in humans and mice. The mechanism appears to involve Treg regulation of macrophage efferocytosis.