bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 270: Eligibility Of Out-of-hospital Cardiac Arrest Patients For Extracorporeal Cardiopulmonary Resuscitation In The United States: A Geographic Information System Model
Authors: Gottula Adam L , shaw Christopher , Gorder Kari , Lane Bennett , Latessa Jennifer , Qi Man , Koshoffer Amy , Al-Araji Rabab , Young Wesley , Bonomo Jordan , Langabeer James R , Yannopoulos Demetris , Hsu Cindy H , Henry Timothy D , Benoit Justin L , . CARES Surveillance Group
Published: June 2023

Introduction:
Recent evidence suggest that ECPR may improve survival rates for nontraumatic out-of-hospital cardiac arrest (OHCA). Eligibility criteria for ECPR are often based on patient age, clinical variables, and facility capabilities. Expanding access to ECPR across the U.S. requires a better understanding of how these factors interact with transport time to ECPR centers.

Methods:
We constructed a Geographic Information System (GIS) model to estimate the number of ECPR candidates in the U.S. We utilized a Resuscitation Outcome Consortium (ROC) database to model time-dependent rates of ECPR eligibility and the Cardiac Arrest Registry to Enhance Survival (CARES) registry to determine the total number of OHCA patients who meet pre-specified ECPR criteria within designated transportation times. Potential ECPR centers were categorized as Extracorporeal Membrane Oxygenation (ECMO)-ready, ECMO-capable, or percutaneous coronary intervention (PCI)-capable centers using data from the Extracorporeal Life Support Organization and the American Hospital Directory. The combined model was used to estimate the total ECPR candidates and the effects of patient and hospital factors on ECPR eligibility.

Results:
There were 588,203 OHCA patients in the CARES registry from 2013 to 2020. After applying clinical eligibility criteria, 22,104 (3.76%) OHCA patients were eligible for ECPR. The rate of ROSC increased with longer resuscitation time, which resulted in fewer ECPR candidates. The proportion of OHCA patients eligible for ECPR increased with older age cutoffs. Only 1.68% (9,889/588,203) of OHCA patients in the U.S. were eligible for ECPR based on a 45-minute transportation time to an ECMO-ready center model, representing the current state of ECPR in the U.S. The proportion of OHCA patients eligible for ECPR ranged from 0.68% (4,027 patients in the 15-minute transportation time to ECMO-ready center model) to 2.81% (16,558 patients in the 45-minute transportation time to PCI-capable center model).

Conclusions:
Less than 2% of OHCA patients are eligible for ECPR in the U.S. GIS models can identify the impact of clinical criteria, transportation time, and hospital capabilities on ECPR eligibility to inform future implementation strategies.
Abstract 281: External Validation Of The Tips65 Score For Predicting Good Neurological Outcome In Out-of-hospital Cardiac Arrest Patients Treated With Extracorporeal Cardiopulmonary Resuscitation
Authors: Makino Yuto , Okada Yohei , NISHIOKA NORIHIRO , Kiguchi Takeyuki , Kitamura Tetsuhisa , Iwami Taku ,   the CRITICAL Study Group Investigators
Published: June 2023

Introduction:
Estimating prognosis after out-of-hospital cardiac arrest (OHCA) at early timing during resuscitation efforts is important to select appropriate candidates for extracorporeal cardiopulmonary resuscitation (ECPR). The TiPS65 scoring system is a prediction model that can be used for predicting favorable neurological outcome of adult OHCA patients treated with ECPR using the following four variables: time from call to hospital arrival, initial cardiac rhythm on hospital arrival, initial pH value, and age. However, it is not yet externally validated. We aimed to perform the external validation of the TiPS65 score.

Methods:
This prognostic study used data from the Japanese Association for Acute Medicine Out-of-Hospital Cardiac Arrest registry, a nationwide, multicenter, prospectively registered database including 83 emergency departments in Japan from January 2018 to December 2019. All adult OHCA patients with shockable rhythm who were treated with ECPR were included. The primary outcome was 30-day survival with favorable neurological outcome defined as Cerebral Performance Category 1 or 2. The predicted probability of outcomes in this cohort was calculated according to the formula developed in the original study. The discrimination and calibration performances were investigated with c-statistic and calibration plots, respectively.

Results:
A total of 590 patients (men: 517 [81.6%], median age [interquartile range]: 60 [50-69] years) were included, and favorable neurological outcome were reported in 64 (10.8%). The c-statistic of the prediction model was 0.752 (95% CI: 0.694-0.81). The mean predicted probabilities were 1.6% (range: 1.6%-1.6%), 4.5% (3.1%-5.9%), 12% (10.1%-13.9%), 26.2% (22.7%-29.7%), and 48.8% (48.8%-48.8%) for a TiPS65 score of 0, 1, 2, 3, and 4, respectively. These scores were generally well-calibrated to the observed outcomes.

Conclusions:
In our external validation study of the TiPS65 score for OHCA patients treated with ECPR, the score showed good discrimination and calibration performances. This score would be helpful in the decision-making process for patient selection for ECPR after OHCA.
Abstract 301: RescueDoppler: Non-invasive Handsfree Carotid Doppler Ultrasound For Continuous Hemodynamic-guided Resuscitation
Authors: Faldaas Bjoern O , Nielsen Erik W , Storm Benjamin S , Lappegård Knut Tore , How Ole-Jakob , Nilsen Bent Aksel , Kiss Gabriel , Skogvoll Eirik , Torp Hans , Ingul Charlotte B
Published: June 2023

Introduction:
Intermittent carotid pulse palpation (PP) is used to determine the return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR). PP requires interruption of CPR and has low accuracy. Therefore, we investigated if a novel continuous non-invasive hands-free Doppler ultrasound system (RescueDoppler; RD) could detect the presence of pulse/no pulse and ROSC in an experimental setting with ventricular fibrillation (VF) and severe hypotension.

Methods:
RD was attached to the neck with a self-adhesive bandage onto twelve pigs (mean weight of 30.4 kg). RD used multirange Doppler, with 32 depth ranges over 8 - 45 mm. The transducer dimension was 30 x 6 mm. The RD probe was placed over the carotid artery, while invasive blood pressure was recorded on the contralateral side. Two profound circulatory disturbances were initiated; 1) severe hypotension by vena cava inferior occlusion (VCO) using a 7 Fr Fogarty catheter with gradual balloon inflation and 2) VF by applying a 7.5 V direct current in the myocardium for 2 seconds using an implantable cardioverter-defibrillator placed in the right ventricle apex. The pigs were defibrillated back to ROSC. Mean velocity over one cardiac cycle (time-averaged velocity; TAV) was compared with mean arterial pressure (MAP).

Results:
RD detected flow in the carotid artery in all 41 VCO sequences (figure), including the lowest induced systolic blood pressure of 19 mmHg. The intraclass correlation coefficient was 0.76 between TAV and MAP. ROSC was equally identified by RD and invasive blood pressure in all 21 VF sequences where the pigs were defibrillated from VF to sinus rhythm (figure).

Conclusion:
The RD system was simple and required no ultrasound knowledge. RD detected ROSC and blood flow at extremely low invasive carotid blood pressures during VF and VCO. TAV correlated well with MAP. RD could become an essential non-invasive, hands-free tool for continuous hemodynamic-guided CPR.
Abstract 313: Association Of Gray-White Matter Ratio With Severe Cerebral Edema In Comatose Cardiac Arrest Patients
Authors: Dodelson Jacob A , Copen William A , Perez Maria , Keenan Caitlyn , Musatova Darya , Rubenstein Alexandra , Schaefer Pamela W , Greer David M , Wu Ona
Published: June 2023

Introduction:
Previous studies have shown that lower gray:white matter ratio (GWR) is associated with poor outcomes in patients initially comatose after cardiac arrest. However, those studies focused on survival, a measure that may be confounded by withdrawal of life-sustaining therapy (WLST) decisions. We assessed the association of GWR with severe cerebral edema (SCE), a more objective imaging surrogate for neurologic injury.

Methods:
We retrospectively analyzed datasets acquired as part of a prospective observational study of 500 cardiac arrest patients with non-traumatic coma. Our analyses were limited to patients who underwent CT within 72 h of arrest, resulting in 151 patients. Some patients underwent repeat imaging, leading to a total of 175 imaging studies. Regions of interests (ROIs; 3x3) were drawn bilaterally in the caudate nuclei (CN) and posterior limbs of the internal capsule (PLIC) at the level of the basal ganglia on non-contrast axial CT scans. GWR was calculated as the ratio of mean x-ray attenuation in the CN to that in the PLIC. Scans whose radiology report described herniation or more than minimal ventricular effacement were classified as SCE. Poor outcome was defined as modified Rankin Scale Score > 4 at 6 months.

Results:
Patients with SCE were more likely to be younger (P<.0001), have a non-shockable rhythm (P=0.028), have a worse Glasgow Coma Scale (GCS) score on hospital admission (P=0.0047) and have a significantly lower GWR (P<.0001) compared to patients without SCE (see Table 1). Patients with SCE had a higher proportion of deaths at discharge due to brain death (P<0.0001). There was no significant difference in the proportion of patients with poor outcomes between the groups (P=0.13).

Conclusion:
For patients initially comatose after cardiac arrest, significant reductions in GWR are associated with SCE. Since this study utilized SCE as intermediate outcome measure for neurologic injury, these GWR results are not confounded by WLST decisions.
Abstract 323: Global Prevalence Of Cardiopulmonary Resuscitation And Automated External Defibrillator Training: A Systematic Review And Meta-analysis
Authors: Ting Joel Xin Rui , Ng Trina , Eng Sean , Yeo Jun Wei , Bok Chermaine , Kong Joyce Yeon , Stassen Willem , Zhang Lin , Ong Eng Hock Marcus , Blewer Audrey L , Tay Girvan , Ho Andrew Fu Wah
Published: June 2023

Global prevalence of cardiopulmonary resuscitation and automated external defibrillator training: a systematic review and meta-analysis

Aim:
Sudden cardiac arrest exerts a large disease burden, which may be mitigated by bystander cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED). The global prevalence and distribution of laypersons trained in these skills are poorly understood. We aimed to estimate the global prevalence of CPR and AED training, and identify their determinants.

Method:
We searched Medline, Embase and Cochrane Library from inception to October 24th, 2021, for cross-sectional studies reporting the prevalence of CPR or AED training from representative samples of laypersons. Prevalences were pooled using random effects models. We examined varying definitions of being identified as CPR-trained, namely CPR-V (valid training within 2-years), CPR-E (ever been trained). Subgroup analysis and meta-regression were used to examine determinants of interest.

Results:
28 studies were included, representing 53,397 laypersons. Among national studies, the prevalence of CPR-V training was 10.02% (95% CI 6.60 to 14.05), prevalence of CPR-E training was 39.64% (95%CI 29.11 to 50.67), and prevalence of AED training was 15.70% (95% CI 10.17 to 22.18). Subgroup analysis revealed differences in prevalences between continents,with prevalence highest in Oceania and lowest in Asia (p<0.01). Meta-regression showed a positive correlation between a country’s income and CPR-E training prevalence (​​ p=0.0325). Comparative meta-analysis showed that the prevalence of CPR-E training was higher among the employed (p<0.00001), and the more highly educated (p<0.00001).

Conclusion:
Large regional variation exists in the data availability, and prevalence of CPR and AED training amongst laypersons. Socioeconomic status correlated with prevalence of CPR training and regional disparities were apparent between continents. As such, community bystander training should be promoted, particularly in Asia and low-income regions, while data availability should be encouraged from under-represented regions.
Abstract 9345: Midline1 is a Critical Regulator of Viral Myocarditis
Authors: Xing Junji , Fang Mingli , Lu Wenting , Wang Junying , Zhang Zhiqiang
Published: June 2023

Introduction:
Infections by viruses including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could cause viral myocarditis. Innate immunity to viral nucleic acids mediates antiviral immunity as well as inflammatory organ injury. However, the innate immune mechanisms that control the pathogenesis of viral myocarditis are unclear.

Methods:
To understand the role of the E3 ligase Midline1 in controlling viral myocarditis, wild-type and Midline1 knockout mice were infected with coxsackievirus B3 (CVB3) or encephalomyocarditis (EMCV) for inducing viral myocarditis. Mice survivals and heart functions were monitored by transthoracic echocardiography, and hearts were harvested for histology analysis. Real-time PCR, western blotting, co-immunoprecipitation, enzyme-linked immunoassay, luciferase assay, flow cytometry, over-expression and knockdown techniques were used to understand the molecular mechanisms of Midline1 in regulating type I interferon production after virus infection in this study.

Results:
We find that Midline1 is induced by RNA viruses with heart tropisms CVB3 and EMCV. Knockdown or deletion of Midline1 in human or mouse macrophages enhances production of type I interferon (IFN) in response to double strand (ds) RNA, RNA viruses CVB3 or EMCV. Importantly, deletion of Midline1 protects mice from viral myocarditis induced by CVB3 or EMCV due to enhanced type I IFN production in vivo. Mechanistically, we show that Midline1 recruits protein phosphatase 1A (PPM1A) to dephosphorylate TANK binding kinase 1 (TBK1), which inactivates TBK1 to block TBK1 from interacting with its upstream adaptor mitochondrial antiviral signaling (MAVS), thereby dampening antiviral signaling during viral infections. Moreover, Midline1 stabilizes PPM1A by inducing K63-linked ubiquitination of PPM1A.

Conclusions:
Our results indicate that Midline1 serves as a negative regulator of viral myocarditis by downregulating innate immune activation induced by RNA viruses CVB3 and EMCV. Our data reveal that Midline1 is a critical regulator of innate immunity in viral myocarditis, thereby identifying a potential therapeutic target for treating viral induced cardiovascular diseases.
Abstract 9440: Acs in a Patient With Amegakaryocytic Thrombocytopenia: A Management Dilemma
Authors: Ahmed Ashraf O , Abdelghani Mohamed , Abu-Tineh Mohammad , Ibrahim Feryal , Bakr Mohammad , Rahhal Alaa , Arabi Abdulrahman
Published: June 2023

Introduction:
The management of Acute Coronary Syndrome (ACS) in thrombocytopenia is challenging. This abstract highlights the management dilemma of a patient who presented with high-risk ACS and was found to have Amegakaryocytic thrombocytopenia (AMT).

Case Presentation:
A fifty-five-year-old man with no cardiovascular risk factors was admitted with high-risk ACS with recurrent ischemic ECG changes and high troponin-T. He was found to have a low platelet count of 9 x10^3/uL. The initial impression was ACS and ITP.

Course:
No antiplatelet or anticoagulation was commenced. CT coronary angiography showed ostial left main (LM) severe stenosis. The patient received steroids and IVIG. A week later, cyclosporin and eltrombopag were added as the thrombocytopenia was refractory. Bone marrow biopsy showed AMT. His chest pain was persistent with ECG ischemic changes. A multidisciplinary team (MDT) decided that revascularization is urgently required, but the surgical option would have an extremely high bleeding risk. Alternatively, the Percutaneous option using radial access would have significantly less bleeding risk. However, he will need DAPT for at least the first week, which if interrupted, he will be at risk for stent thrombosis. The final decision was for platelet transfusion, then to proceed with the PCI once the platelet count is 50,000 or more, and to maintain the count > 15,000 by transfusion whenever required.

Management:
After the targeted transfusion, the patient was started on aspirin and clopidogrel, then successful IVUS guided PCI to ostial LM with new generation DES was done via radial access and low therapeutic ACT range. Post PCI, the patient remained asymptomatic; he was observed as an inpatient for 14 days, during which he required platelet transfusion once when his platelet count dropped < 15.000. DAPT was given for a week and then he was maintained on clopidogrel. In 3 months of follow-up, the patient had no cardiac complaints, no bleeding, and platelets were maintained between 15 to 30 on clopidogrel.

Conclusion:
ACS with severe thrombocytopenia is a management dilemma. Platelets transfusion, radial access, targeting low ACT, and using new generation stents for shorter DAPT duration might decrease the bleeding risk and thrombotic events.
Abstract 9479: Defined Subsets of Sympathetic Neurons Innervate the Heart and Differentially Respond to Cardiac Pathology
Authors: Sharma Sachin
Published: June 2023

Introduction:
Sympathetic regulatory aspect of cardiac functions is governed by neural circuit originating from postganglionic sympathetic neurons (PGNs) that primarily reside in stellate ganglia. PGNs is comprised of a diversified neuronal population that innervate heart and other tissue beds.

Hypothesis:
We hypothesize that cardiac innervating stellate ganglionic neurons (SGNs) exhibit diversity and distinction from those innervating other organs. In the settings of cardiac pathology, distribution of cardiac neuronal subtypes is altered, yielding a dominant neuronal subtype.

Methods:
We utilized method of retrograde axonal transport from heart and paw using adeno-associated virus (AAV-GFP/tdTomato, 1+e12 gc/ml, 10μl) followed by single cell RNA sequencing (scRNAseq) to identify and resolve transcriptomic profiles of SGNs in normal (n=8) and heart-failure mice (n=4). Using NPY-hrGFP mice, we characterized membrane excitability for NPY
high
and NPY
low
neurons (n=11). We delineated impact of NPY on cardiac sympathoexcitation by injecting AAV5-Flex-taCasp3 in NPY-Cre mice (n=8) and afterwards electrically stimulating right stellate ganglia (RSG).

Results:
In our scRNAseq study, we identified 3 adrenergic neuronal subtypes (NA1a, NA1b, and NA3) innervate heart. These subtypes differentiated as NPY
high
(NA1a) and NPY
low
(NA1b and NA3) subpopulations. NPY
high
(4.250±0.90) showed higher number of action potentials compared to NPY
low
(1.818±0.18). Cardiac sympathoexcitation was diminished in NPY-ablated mice compared to controls in response to escalating intensities (1, 5, 10, 15, & 20 Hz). Maximal heart-rate change was detected at 10 Hz (p = 0.0240) for NPY-ablated mice (91.061±12.62 bpm) vs. controls (27.017±11.88). Across mice, ~70% of cardiac neurons are NPY+. In dilated cardiomyopathy mice, NA1b is a predominant subtype, consists of increased expression of Kcnq2 (M-current) and significant enriched pathways neurodegenerative disorders and neurotrophic signaling.

Conclusion:
These findings provide novel insights into the unique properties of neurons responsible for cardiac sympathetic regulation, with implications for novel strategies to target specific neuronal subtypes for sympathetic blockade in cardiac disease.
Abstract 9513: Association of Statins for Primary Prevention of Cardiovascular Disease With Hospitalization for Covid-19: A Nationwide Matched Population-Based Cohort Study
Authors: Bouillon Kim , Baricault Berangere , Semenzato Laura , Botton Jeremie , Bertrand Marion , Drouin Jerome , Dray-Spira Rosemary , Weill Alain , Zureik Mahmoud
Published: June 2023

Background:
Numerous studies have reported a lower risk of serious in-hospital outcomes of COVID-19 associated with statin use. However, there is little evidence on the relationship between statin use and the risk of hospitalization due to COVID-19.

Methods:
The French National Health Insurance database was used to conduct a matched-cohort study. For each adult aged 40 years or more receiving statin for primary prevention of cardiovascular disease, one non-user was randomly selected matched for year of birth, sex, residence area, and comorbidities (hypertension, diabetes mellitus, and chronic respiratory condition). The association between statin use and hospitalization for COVID-19 was examined using the conditional Cox proportional hazards models, adjusted for baseline characteristics, comorbidities, and long-term medications. Its association with in-hospital death from COVID-19 was also investigated. Multivariable analysis weighted with inverse probability of treatment weights was also performed. All participants were followed-up from February 15 to June 15, 2020.

Results:
The 1:1 matching procedure generated 2,058,249 adults in the statin group and 2,058,249 in the control group composed of 46.6% of men with a mean age of 68.7 years. Statin users had a 16% lower risk of hospitalization for COVID-19 than non-users (adjusted hazard ratio (HR), 0.84; 95%CI, 0.81-0.88). All types of statin were significantly associated with a lower risk of hospitalization; adjusted HR ranging from 0.75 (95%CI, 0.57-0.99) for fluvastatin to 0.89 (95%CI, 0.84-0.95) for atorvastatin. Low- and moderate-intensity statins also showed a lower risk compared with non-users (HR, 0.78; 95%CI, 0.71-0.86 and HR, 0.84; 95%CI, 0.80-0.89, respectively) whereas high-intensity statins did not (HR, 1.01; 95%CI, 0.86-1.18). We found similar results with in-hospital death from COVID-19.

Conclusions:
Our findings support the hypothesis that the use of statin for primary prevention is associated with lower risks of hospitalization for COVID-19 and of in-hospital death from COVID-19.
Abstract 9623: Shared Decision Making for Atrial Fibrillation: An Overview of Seven Studies Within an Encounter - Randomized Trial
Authors: Kunneman Marleen , Branda Megan , Hargraves Ian , Sivly Angela , Lee Alexander , Gorr Haeshik , Burnett Bruce , Suzuki Takeki , Jackson Elizabeth A , Hess Erik , Linzer Mark , McCarthy Sarah , Kamath Celia , Brito Juan , Noseworthy Peter A , Montori Victor M ,   Shared Decision Making for Atrial Fibrillation (SDM4AFib) Trial Investigators
Published: June 2023

Introduction:
Shared decision-making (SDM) about anticoagulant treatment in patients with atrial fibrillation (AF) is widely recommended but its effectiveness is unclear. We assessed the extent to which using an SDM tool promotes high-quality SDM.

Hypothesis:
SDM will improve communication quality, knowledge, and decisional conflict and will translate to improved medication adherence and outcomes.

Methods:
In this multicentre encounter-randomized trial, we included patients with nonvalvular AF considering starting/reviewing anticoagulation, and their clinicians. We compared usual care with or without ANTICOAGULATION CHOICE, an SDM conversation tool for use during the clinical encounter that presents individualized risk estimates and compares anticoagulation options across patient important issues.

Results:
We enrolled and video-recorded 922 patient-clinician encounters. So far, our data have shown that participants in both arms reported near-optimal communication quality, knowledge, and decisional conflict (JAMA IM-2020). Patients in intervention-arm estimated their stroke risks more accurately and were more involved in decision-making (JAMA IM-2020), clinicians were more satisfied (JAMA IM-2020), and cost conversation were more common (JAMA NO-2021). Use of the intervention had no effect on treatment decisions, encounter duration (JAMA IM-2020), treatment adherence, clinical outcomes (JAHA-epub) or patient-perceived sense of the care plan (PEC-epub). New analyses have shown that compared to eligible white participants, black participants more frequently did not enrol to the study. Enrolment of Black, indigenous, and people of colour benefited most form including and prioritizing practices most likely to care for them. We found no evidence of contamination (tool use, functional, or learned) between study arms.

Conclusions:
Use of an SDM tool improved some measures of SDM quality, without affecting treatment decisions and their sensibility, encounter duration, patient adherence, or clinical outcomes. Our results should calibrate expectations as to what could be accomplished by implementing SDM tools about anticoagulation in the care of patients with AF
Abstract 9773: Nourin Mirnas: Novel Blood Biomarkers for Early Identification or Exclusion of Myocardial Ischemia in Women Suspected of Having Coronary Artery Disease (CAD)
Authors: Elgebaly Salwa A , Christenson Robert H , Azrin Michael , Rizk Hussien , El-Khazragy Nashwa , Kreutzer Don , Van Buren Charles , Poston Robert
Published: June 2023

Introduction:
Women are frequently present with
questionable angina
. Lack of specificity and sensitivity in imaging procedures and absence of a blood-based biomarker that can detect myocardial ischemia
earlier than cell death,
may contribute to women being under-investigated and under-treated, with worse outcomes.
The blood-based biomarkers,
Nourin
protein and its regulatory miRNAs (miR-137 and miR-106b) are elevated in the setting of
myocardial ischemia before it progresses to infarction
.

Hypothesis:
Unlike hs-TnI, Nourin-dependent miR-137 and miR-106b can identify or exclude myocardial ischemia in patients suspected of having CAD, as proven by stress test results.

Methods:
Serum levels of Nourin miRNAs (qPCR) and plasma hs-TnI were measured
blindly
in: 1) chest pain patients suspected of having CAD (n=12) both before stress ECHO/ECG test (pre-test) and 30 minutes after test completion (post-test); 2) STEMI patients (n=16); and 3) healthy subjects (n=16).

Results:
1) very low baseline levels of Nourin miRNAs in healthy (range: 1.38 to 1.43) and CAD negative (range: 1.84 to 4.53); 2) significant upregulation of
miR-137
(2,156 pre and 2,574 post) and
miR-106b
(423 pre and 521 post) in CAD positive (n=5) compared to CAD negative (n=7) (range: 1.84 to 4.53) pre-test (continuous release in response to chronic myocardial ischemia) and post-test; 3) higher levels in STEMI (4,509 (miR-137) and 950 (miR-106b) pre) compared to CAD (2,156 and 423 pre); 4) over 86% sensitivity and

100% specificity
that can
“rule out” myocardial ischemia,

just as NT-proBNP for heart failure and D-dimer for deep vein thrombosis;
and 5) hs-TnI was elevated only in STEMI, but
not
in CAD patients, pre & post.

Conclusions:

Assessment of Nourin miRNAs enables the identification of a population of
patients with ischemia, but without injury or infarction
, and exclusion of myocardial ischemia, based on its strong negative predictive value, thus potentially improving the treatment algorithms for women

.
Abstract 9853: Trends in National Death Rates From Heart Disease in the United States, 2010–2020
Authors: Woodruff Rebecca C , Tong Xin , Jackson Sandra L , Loustalot Fleetwood V , Vaughan Adam S
Published: June 2023

Introduction:
Heart disease (HD) death rates have been declining for decades. Updated trend data for 2010–2020 are needed to inform clinical and public health practice.

Methods:
We obtained age-standardized death rates per 100,000 population from the US Centers for Disease Control and Prevention’s WONDER database, which aggregates death certificate data from the National Vital Statistics System. Among adults aged ≥35 years, HD deaths were defined by underlying cause of death International Classification of Diseases, 10th revision codes. We calculated percent change between 2010, 2019, and 2020 death rates overall and by HD subtypes and demographic subgroups.

Results:
HD death rates declined during 2010-2019 and increased in 2020 across age, sex, and race and ethnicity groups. The national HD death rate declined by 9.8% from 2010 to 2019 (347.3 vs. 313.0 per 100,000) and increased by 4.1% in 2020 to 325.9 per 100,000, which approximated the 2015 rate (326.5 per 100,000). Coronary heart disease accounted for 55% of total HD deaths in 2020. Among non-Hispanic Black adults, the HD death rate declined by 10.4% during from 2010 to 2019 and increased by 11.2% in 2020, returning the 2020 HD death rate (440.7 per 100,000) to approximately the 2010 rate (442.4 per 100,000). Among adults aged 35–54 and 55–74 years, HD death rates declined from 2010 to 2019 (35–54: 5.5%, 55–74: 2.3% decline) and increased in 2020 (35–54: 12.0%, 55–74: 7.8% increase), resulting in a higher HD death rate in 2020 (35–54: 54.1, 55–74: 297.3 per 100,000) than in 2010 (35–54: 51.1, 55–74: 282.5 per 100,000).

Conclusions:
National declines in HD death rates had reversed by 2020 during the Coronavirus Disease-2019 pandemic. Setbacks represented approximately 5 years of lost progress among all adults and ≥10 years of lost progress among non-Hispanic Black adults and younger adults. Clinical and public health efforts may need to be modified to reverse negative trends in HD mortality.
Abstract 9874: Correlation of Left Ventricular Strain Derived From Rb-82 ECG-Gated PET Myocardial Perfusion Imaging vs 2D Echocardiography
Authors: Huang Jingwen , Mitchell Adam , Garcia Ernest , Cooke David , Folks Russell , Pernetz Maria , Piccinelli Marina , Nye Jonathon
Published: June 2023

Introduction:
Global longitudinal strain (GLS) by two-dimensional (2D) transthoracic echocardiography (TTE) is a robust index for identifying early left ventricular (LV) myocardial dysfunction. Positron emission tomography (PET) myocardial perfusion imaging (MPI) is widely used in the assessment of ischemic heart disease (IHD) but has not been used for strain analysis.

Hypothesis:
Longitudinal, radial, and circumferential myocardial strain measures at rest and at pharmacologic stress by Rb-82 ECG-gated PET MPI are correlated to those measured by resting 2D TTE.

Methods:
We developed a novel PET MPI method to track the LV myocardium throughout the cardiac cycle processed in the Emory Cardiac Toolbox, to measure LV strain from longitudinal, radial, and circumferential direction at regadenoson-stress and at rest. We retrospectively identified 80 patients who underwent Rb-82 PET MPI and also had TTE with strain analysis within 3 months. The agreement between LV strain and LVEF derived from PET MPI and resting TTE was assessed with Bland-Altman analysis, Pearson’s correlation, and the concordance correlation coefficient (CCC).

Results:
PET MPI derived measurements of longitudinal (Figure 1A-1B: Bland-Altman analysis; 1C-1D: Pearson’s correlations), circumferential (Figure 1E-1F: Pearson’s correlations) and radial (Figure 1G-1H: Pearson’s correlations) strain measures at rest and stress were strongly correlated to resting TTE derived GLS (p<.001). LVEF showed strong correlations at stress (0.83, p<.001) and rest (0.80, p<.001). Inter-observer agreements of PET MPI strain measures showed high correlation between 2 independent observers for all 3 directions (p<.001).

Conclusions:
LV strain measures by PET MPI using a novel automated technique correlated strongly with GLS by TTE. PET MPI measures are highly reproducible. Strain by PET MPI should be investigated further to establish its value in routine clinical practice.
Abstract 9900: Virtual Simulation-Based CME Improves Management of Patients With Vascular Disease
Authors: Harris Margaret , Lacouture Michael , Capparelli Catherine , Marc Bonaca , Beckman Joshua , Aronow Herbert D
Published: June 2023

Introduction:
The ability of virtual patient simulation (VPS) case-based interventions to improve clinical decision making for patients with peripheral artery disease (PAD) is unknown.

Methods:
Two patient cases were presented using a VPS platform where learners could order tests, make diagnoses, and order treatments in a manner matching the scope and depth of actual practice. Clinical decisions were analyzed, and learners received clinical guidance (CG) based on current evidence and expert recommendations. Learners could modify their decisions post-CG. Pre-(baseline) vs. post-CG decisions were compared using McNemar’s test. The intervention launched on July 30, 2021, and data were collected through October 13, 2021.

Results:
Overall, 143 physicians participated (76 case 1, 67 case 2). Physician specialties included cardiology (74%), and vascular surgery (26%). Most physicians were male (62%) with the following age distribution < 30 (8%), 30-39 (25%), 40-49 (19%), 50-59 (17%), and ≥ 60 (31%). Significant improvements were seen for appropriate diagnosis and treatment selection in the overall learner population; treatment improvements were greatest for tailoring antithrombotic therapy in patients with newly diagnosed PAD (
Table
). Improvements in selection of appropriate antithrombotic treatment were observed for all specialties, although specialty-specific differences were apparent (
Table
).

Conclusions:
Case-based PAD intervention employing VPS was associated with improvements in diagnostic and therapeutic decision-making among cardiologists and vascular surgeons. Despite the observed improvements, gaps remain in diagnosing and selecting appropriate antithrombotic strategies for patients with PAD.
Abstract 9913: Possible Disparities in Outcomes Among Patients With Hearing Loss Admitted for Acute Myocardial Infarction
Authors: Ramphul Kamleshun , Verma Renuka , Kumar Nomesh , Sombans Shaheen , Ramphul Yogeshwaree , Kumari Komal , Joynauth Jyotsnav , Arti Fnu , Lohana Petras
Published: June 2023

Introduction:
Patients with hearing loss (HL) experience different levels of difficulties throughout their lives, impacting their quality of care. Little is known about the outcomes of patients with hearing loss following admission for Acute Myocardial Infarction (AMI).

Method:
Patients with a principal diagnosis of AMI and patients with any form of HL were recruited in our study from the 2019 National Inpatient Sample (NIS). Various comorbidities were studied.

Results:
Our analysis found 14,100(2.1%) AMI cases with HL diagnosis. The majority of the patients were Males (64.5%, p<0.01) or Whites (84.4%, p<0.01). HL patients also showed a higher number of various comorbidities as 89.0% had hypertension, 74.3% had hyperlipidemia, and 23.8% had acute kidney injury. Meanwhile, HL patients had a lower prevalence of diabetes (40.0%), using cannabis (0.7%), and smoking (46.8%). HL patients were also less likely to undergo Coronary artery bypass graft surgery (CABG) (5.8% vs.7.5%, OR:0.763, p<0.01) or Percutaneous coronary intervention (PCI) (35.0% vs. 45.2%, OR 0.651, p<0.01). They also reported more cases of several cardiac arrhythmias as 3.2% of patients also experienced supraventricular tachycardia, and 15.4% had paroxysmal atrial fibrillation. In comparison, HL patients showed a lower rate of ventricular fibrillation (2.0% vs. 3.3%). However, a slightly higher risk of mortality (aOR: 1.104, 95% CI 1.021-1.194, p=0.013) was found among all HL patients (5.4%) with AMI compared to non-HL patients (4.5%).

Conclusion:
Our study raises several concerns about the outcomes of HL patients following admission for AMI. In the acute setting, patients with HL may not be able to provide adequate information about their symptoms and their medical history, which can predispose them to a poorer prognosis. We, therefore, encourage hospitals to improve communication for HL patients via easier access to ASL translators in different hospital settings.
Abstract 9947: Prospective Prediction of Left Atrial Flutter From Computer Simulation
Authors: Lange Matthias , Kwan Eugene , Macleod Robert , Bunch T J , Ranjan Ravi
Published: June 2023

Introduction:
Atypical left atrial flutter (ALAF) is often the result of ablation treatment for AF. Many patients report a reduction in quality of life from AF to ALAF. If pharmacological rate control fails additional ablation can provide solutions. However, success rates are low due to difficulties in mapping all potential flutters accurately.

Hypothesis:
LGE-MRI can inform computation simulation to predict all possible ALAF pathways and increase the information available to the electrophysiologist.

Methods:
Informed and consented patients scheduled for ALAF ablation received an MRA and LGE-MRI. Fig1. From the MRA the left atrial wall was segmented and registered to the LGE-MRI. Scar and gray areas were estimated by threshold segmentation. The threshold was calculated with the intensity value ratio. The information was integrated into a monodomain model. Ionic currents were modeled according to Courtemanche with a reduction of some conductance in fibrotic regions. To induce ALAF S1S2 pacing was done with an S1 cycle length of 600ms and S2 decreased from 250 to 170ms. Induction was tested at 10 different locations. Results were provided to the electrophysiologist.

Results:
Prospective prediction of the ALAF pathway for six patients was successful and the clinically observed flutter was predicted. Fig. 2) shows the value of the prediction, electroanatomic mapping was inconclusive even unable to exclude the right side. Ablation on the right side did not alter the flutter, but ablation near the mitral valve.

Conclusions:
We successfully predicted clinically observed ALAF pathways. The next step is to find ablation points for all predicted pathways.
Abstract 9976: Contrasting Mortality Trends of Aortic Emergency: Dissection and Rupture in the UK, Japan, USA, and Canada
Authors: Hibino Makoto , Verma Subodh , Baeza Cristian , Aune Dagfinn , yanagawa bobby , Usui Akihiko , Nienaber Christoph , Pelletier Marc
Published: June 2023

Introduction:
Aortic dissection and aneurysm rupture are aortic emergencies. Surgical outcomes and interventional procedures have improved over the past two decades; however, whether this has translated into lower mortality across countries remains an open question.

Hypothesis:
We hypothesized that given improved surgical mortality, there will be improvement in mortality from aortic dissection and rupture in the UK, Japan, USA, and Canada.

Methods:
We analyzed the WHO mortality database to determine trends in mortality from aortic dissection and rupture in 4 countries from 2000 to 2019. Crude mortality rate and age-standardized mortality rate per 100,000 persons were calculated, and annual percentage change was estimated using joinpoint regression.

Results:
In 2019, crude and age-standardized mortality rates from aortic dissection were 2.15 and 1.04 in UK, 8.67 and 2.66 in Japan, 1.21 and 0.76 in USA, and 1.30 and 0.67 in Canada, respectively. In 2019, crude and age-standardized mortality rates from aortic rupture were 4.86 and 1.80 in UK, 5.22 and 1.16 in Japan, 1.04 and 0.52 in USA, and 1.99 and 0.81 in Canada, respectively. There was a significantly decreasing trend in age-standardized mortality from aortic aneurysm rupture in all 4 countries over the study period, and a decreasing trend in age-standardized mortality from aortic dissection in the UK over the study period, in USA until 2010, and in Canada until 2012. There was a significantly increasing trend in mortality from aortic dissection in Japan over the study period, in the USA after 2010, and in Canada after 2012. Joinpoint regression identified significant changes in the trends from decreasing to increasing in USA and Canada. In sensitivity analyses stratified by sex, similar trends were observed.

Conclusions:
Trends in mortality from aortic aneurysm rupture are decreasing, however, mortality from aortic dissection is increasing in Japan, USA, and Canada. Further study to explain these trends is warranted.
Longitudinal Hemodynamic Correlates of and Sex Differences in the Evolution of Blood Pressure Across the Adult Lifespan: The Framingham Heart Study
Authors: Mitchell Gary F. , Rong Jian , Larson Martin G. , Cooper Leroy L. , Xanthakis Vanessa , Benjamin Emelia J. , Hamburg Naomi M. , Vasan Ramachandran S.
Published: June 2023

Background

Systolic blood pressure increases with age after midlife, particularly in women, and contributes to development of wide pulse pressure hypertension in middle‐aged and older adults. Relative contributions of aortic stiffness and premature wave reflection to increases in pulse pressure remain controversial.

Methods and Results

We evaluated visit‐specific values and change in key correlates of pulse pressure, aortic characteristic impedance, forward and backward wave amplitude, and global reflection coefficient, at 3 sequential examinations of the Framingham Generation 3 (N=4082), Omni‐2 (N=410), and New Offspring Spouse (N=103) cohorts (53% women). Data were analyzed using repeated‐measures linear mixed models adjusted for age, sex, and risk factor exposures. Pulse pressure increased markedly with age after midlife (age and age‐squared terms,
P
<0.0001), particularly in women (age slope 3.1±0.2 mm Hg/decade higher in women,
P
<0.0001). In sex‐specific models, change in pulse pressure was closely related (all
P
<0.0001) to baseline (6.7±0.2 and 7.3±0.2 mm Hg/SD in men and women, respectively) and change (11.8±0.1 and 11.7±0.1 mm Hg/SD) in forward wave amplitude, whereas relations with baseline (2.1±0.15 and 2.0±0.14 mm Hg/SD) and change (4.0±0.13 and 3.4±0.11 mm Hg/SD) in global reflection coefficient were weaker. Global reflection coefficient fell as aortic characteristic impedance increased (
P
<0.0001), consistent with the hypothesis that impedance matching reduces relative wave reflection in the arterial system.

Conclusions

Proximal aortic stiffening, as assessed by higher aortic characteristic impedance and larger forward wave amplitude, is strongly associated with longitudinal increase in pulse pressure, especially in women, whereas wave reflection has more modest relations.
Comparative Outcomes of Interventions for Femoropopliteal Chronic Total Occlusion Versus Non–Chronic Total Occlusion Lesions From the Multicenter XLPAD Registry
Authors: Tsai Shirling , Liu Yulun , Hoang Lawrence , Vu Michael , Lu Hua , Ramanan Bala , Fernandez Vazquez David , Rosol Zachary , Sayfo Sameh , Alaiti Mohamad Amer , Koutakis Panagiotis , Brilakis Emmanouil S. , Shishehbor Mehdi H. , Banerjee Subhash
Published: June 2023

Background

Endovascular intervention of femoropopliteal chronic total occlusions (CTOs) is technically more complex. However, there is lack of comparative analysis between CTO and non‐CTO femoropopliteal interventions.

Methods and Results

We report procedural details and outcomes of patients treated for femoropopliteal CTO and non‐CTO lesions in the XLPAD (Excellence in Peripheral Artery Disease) registry (NCT01904851) between 2006 and 2019. Primary outcomes were procedural success and 1‐year major adverse limb events, a composite of all‐cause death, target limb revascularization, or major amputation. Analysis included 2895 patients (CTO: n=1516 patients; non‐CTO: n=1379 patients) with 3658 lesions (CTO: n=1998 lesions; non‐CTO: n=1660 lesions). Conventional balloon angioplasty (20.86% versus 33.48%,
P
<0.001) or drug‐coated balloon angioplasty (1.26% versus 2.93%,
P
<0.001) were more frequent in the non‐CTO group, whereas bare‐metal stents (28.09% versus 20.22%,
P
<0.001) or covered stents (4.08% versus 1.83%,
P
<0.001) were more frequent in the CTO group. Debulking procedures were more commonly performed in the non‐CTO group (41.44% versus 53.13%,
P
<0.001), despite a similar degree of calcification between the 2 groups. Procedural success was higher in the non‐CTO group (90.12% versus 96.79%,
P
<0.001). Procedural complications were higher in the CTO group (7.21% versus 4.66%,
P
=0.002), mainly due to excess distal embolization (1.5% versus 0.6%,
P
=0.015). Adjusted 1‐year major adverse limb events were higher in the CTO group (22.47% versus 18.77%,
P
=0.019), driven mainly by target limb revascularization (19.00% versus 15.34%,
P
=0.013).

Conclusions

Procedural success is lower for endovascular treatment of femoropopliteal CTO compared with non‐CTO lesions. CTO lesions are associated with higher rates of periprocedural complications and reinterventions after 1 year.
Lymphatic Abnormalities on Magnetic Resonance Imaging in Single‐Ventricle Congenital Heart Defects Before Glenn Operation
Authors: Kristensen Rasmus , Kelly Benjamin , Kim Emily , Dori Yoav , Hjortdal Vibeke E.
Published: June 2023

Background

In the palliative pathway of single‐ventricle physiology, lymphatic abnormalities on T2‐weighted magnetic resonance imaging have been shown after the Glenn operation. It is believed that postsurgical hemodynamic changes contribute to the lymphatic changes.However, little is known about how early these abnormalities occur. Our purpose was to determine if lymphatic abnormalities occur as early as before the Glenn operation.

Methods and Results

We retrospectively reviewed patients with single‐ventricle physiology and a T2‐weighted magnetic resonance imaging scan before their Glenn operation (superior cavopulmonary connection) at The Children's Hospital of Philadelphia from 2012 to 2022. Lymphatic perfusion patterns on T2‐magnetic resonance imaging were categorized from type 1 (no supraclavicular T2‐signal) to type 4 (supraclavicular, mediastinal, lung parenchymal T2‐signal). Types 1 and 2 were considered normal variants. Distribution of lymphatic abnormalities were tabulated, as well as secondary outcomes including chylothorax and mortality. Comparison was done using analysis of variance, Kruskal–Wallis test, and Fisher's exact test. Seventy‐one children were included: 30 with hypoplastic left heart syndrome and 41 with nonhypoplastic left heart syndrome. Lymphatic abnormalities were present before Glenn operation in 21% (type 3) and 20% (type 4), and normal lymphatic perfusion patterns (type 1–2) were seen in 59% of patients. Chylothorax was present in 17% (only types 3 and 4). Pre‐Glenn mortality and mortality at any time was significantly increased when having a type 4 lymphatic abnormality compared with types 1 and 2 (
P
=0.04).

Conclusions

Lymphatic abnormalities can be found on T2‐weighted magnetic resonance imaging in children with single‐ventricle physiology before their Glenn operation. Mortality and chylothorax were more prevalent with advancing grade of lymphatic abnormality.
The Parallelism Tradeoff: Limitations of Log-Precision Transformers
Authors: Merrill William , Sabharwal Ashish
Published: June 2023

Despite their omnipresence in modern NLP, characterizing the computational power of transformer neural nets remains an interesting open question. We prove that transformers whose arithmetic precision is logarithmic in the number of input tokens (and whose feedforward nets are computable using space linear in their input) can be simulated by constant-depth logspace-uniform threshold circuits. This provides insight on the power of transformers using known results in complexity theory. For example, if L≠P (i.e., not all poly-time problems can be solved using logarithmic space), then transformers cannot even accurately solve linear equalities or check membership in an arbitrary context-free grammar with empty productions. Our result intuitively emerges from the transformer architecture’s high parallelizability. We thus speculatively introduce the idea of a fundamental parallelism tradeoff: any model architecture as parallelizable as the transformer will obey limitations similar to it. Since parallelism is key to training models at massive scale, this suggests a potential inherent weakness of the scaling paradigm.