bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 257: Epidemiological Trends In Mean Age At Cardiac Arrest
Authors: Khosla Shaveta , Del Rios Marina , Kotini-Shah Pavitra , Bunney E B , Campbell Teri L , Schwerin Courtney , Markul Eddie , Tataris Katie , Weber Joseph , Vanden Hoek Terry L
Published: June 2023

Background:
Nearly 1000 cardiac arrest cases are reported in the US every day, and 70-90% of the cases die before reaching the hospital. In this study, we aimed to describe trends in mean age of cardiac arrest in Chicago.

Method:
We analyzed adult out-of-hospital cardiac arrest (OHCA) cases reported to Cardiac Arrest Registry to Enhance Survival (CARES) database and served by Chicago Emergency Medical Services from 2014-2021. We excluded pediatric cases, and cases with missing age. The annual data were combined to create two-year cycles. The trends in the mean age of cardiac arrest cases were calculated using linear regression models.

Results:
21,532 OHCA cases occurred during 2014-2021, and 61% were males, 57% Black, 26% White, 12% Hispanic/Latino and 5% Others. The mean age of OHCA was 62.9 years. The mean age decreased from 64.7 (in 2014-2015) to 61.5 (in 2020-2021) with a biennial change of -1.1 (p<0.01). The median age followed the same pattern with a decrease from 65 (in 2014-2015) to 62 years (in 2020-2021). Similar trends were noticed by gender. The mean age decreased in males (biennial change of -1.2; p<0.01) and in females (biennial change=-0.6; p<0.01) but was less pronounced in females. The mean age decreased significantly in White, Black, and Hispanic/Latino cases. However, in Asian cases, even though a decrease was noticed, it was not statistically significant. The largest decrease in mean age was in Black cases (biennial change of -1.2; p<0.01), followed by Hispanic/Latino cases (-0.7; p=0.03). When examined by race/ethnicity and gender, Black male cases had the largest decrease in mean age at cardiac arrest (-1.4; p<0.01).

Conclusion:
This analysis presents a concerning trend and speaks to the need for additional research and surveillance mechanisms to identify people at risk for OHCA. Early age at cardiac arrest could mean more years of potential life lost (YPLL). Changes in YPLL and disability-adjusted life years should also be explored in future studies.
Abstract 260: The Relation of Country-of-Birth With Willingness to Respond to Out-of-Hospital Cardiac Arrest in Multiethnic Communities of New South Wales (NSW), Australia
Authors: Munot Sonali , Redfern Julie , Bray Janet , Angell Blake , Bauman Adrian , Coggins Andrew , Denniss Alan Robert , Ferry Cate , Jennings Garry , Kovoor Pramesh , Kumar Saurabh , Lai Kevin , Khanlari Sarah , Marschner Simone , Middleton Paul , Nelson Michael , Oppermann Ian , Semsarian Christopher , Taylor Lee , Vukasovic Matthew , Vukasovic Matthew , Ware Sandra , Chow Clara K
Published: June 2023

Introduction:
Bystander response including cardiopulmonary resuscitation (CPR) is critical to survival in out-of-hospital cardiac arrest (OHCA). Poorer outcomes have been reported in some immigrant communities but there has been less research about bystander response in these communities. Over a third of New South Wales (NSW) residents were born outside Australia.

Hypothesis:
Country of birth may explain variation in willingness to respond to OHCA.

Methods:
A survey was conducted between May 2021-May 2022. It employed multiple recruitment approaches including reaching out to 72 organisations and targeting multi-ethnic community organisations, advertising via social media, and leveraging local networks. Data were collected on demographic variables, CPR training, and attitudes towards responding to OHCA.

Results:
Of the 1267 respondents (average age 49.6 years, 52% female), 60% were born outside Australia; of which 44% (n=332) were from South Asia, 33% (n=246) from East Asia and the remaining 23% from a mix of other regions including north-west Europe, north Africa-middle east. Most immigrant respondents (73%) had lived in Australia for over ten years. Higher rates of previous CPR training were reported in Australian-born participants compared with South Asian-born and East Asian-born (76%, 35%, 47% respectively p<0.001) with current training rates i.e. in last 12 months (16%, 6%, 12% respectively, p=0.003). Higher rates of willingness to perform CPR on someone they did not know, was reported in Australian-born participants compared to South Asian-born and East Asian-born (74%, 63%, 56% respectively, p=<0.001. After adjusting for age, gender, education, employment status, self-reported general health, and previous CPR training, the odds of reporting willingness to perform CPR was OR:0.73 (95% CI: 0.51-1.04) among respondents born in South Asia and OR:0.58 (95% CI 0.41-0.83) among those from East Asian countries compared with Australian-born.

Conclusions:
Improving access to training and addressing barriers to response in multi-ethnic communities may improve willingness and consequently response to OHCA.
Abstract 264: Socioeconomic Status And Outcomes After In-Hospital Cardiac Arrest
Authors: Stankovic Nikola , Holmberg Mathias J , Granfeldt Asger , Andersen Lars W
Published: June 2023

Introduction:
We aimed to investigate the association between socioeconomic status and outcomes after in-hospital cardiac arrest in Denmark.

Methods:
We conducted an observational cohort study based on nationwide registries and prospectively collected data on in-hospital cardiac arrest from 2017 and 2018 in Denmark. Unadjusted and adjusted analyses using regression models were performed to assess the association between socioeconomic status and outcomes after in-hospital cardiac arrest. Outcomes included return of spontaneous circulation (ROSC), survival to 30 days, survival to one year, and the duration of resuscitation among patients without ROSC.

Results:
A total of 3,223 patients with in-hospital cardiac arrest were included in the study. In the analyses adjusted for patient and cardiac arrest characteristics, patients with high household assets had 1.20 (95%CI: 0.96, 1.51) times the odds of ROSC, 1.49 (95%CI: 1.14, 1.96) times the odds of survival to 30 days, 1.40 (95%CI: 1.04, 1.90) times the odds of survival to one year, and 2.8 (95%CI: 0.9, 4.7) minutes longer duration of resuscitation compared to patients with low household assets. Similar albeit attenuated associations were observed for education. While high household income was associated with better outcomes in the unadjusted analyses, these associations largely disappeared in the adjusted analyses.

Conclusions:
In this study of patients with in-hospital cardiac arrest, we found that high household assets were associated with a higher odds of survival and a longer duration of resuscitation among patients without ROSC compared to low household assets. However, the results varied pertinent to SES measure, outcome of interest, and across adjusted analyses.
Abstract 283: Cardiac Functional Recovery At One Year In Refractory Out-of-hospital Cardiac Arrest Survivors
Authors: Tsangaris Adamantios , Alexy Tamas , Kosmopoulos Marinos , Kalra Rajat , Bartos Jason , Elliott Andrea M , Gutierrez Alejandra , Yannopoulos Demetris
Published: June 2023

Introduction:
The survival to discharge of patients presenting with refractory out-of-hospital cardiac arrest (OHCA) in centers with a well-established extracorporeal cardiopulmonary resuscitation (ECPR) program has improved over the last decade. While quality of life is an important consideration for all survivors, long-term cardiac functional recovery as defined by the New York Heart Association (NYHA) of this population remains unknown.

Methods:
We performed a single center, retrospective analysis to evaluate the functional cardiac recovery of refractory OHCA survivors receiving ECPR with VA-ECMO between 2016 and 2020. Relevant demographic information as well as data on admission characteristics and index hospitalization were collected
(Table).
NYHA functional class was assessed at one month and at one year after hospital discharge. All patients had a transthoracic echocardiogram before discharge.

Results:
We identified 54 patients that were discharged following ECPR for OHCA during the study period. Forty-six (85%) were alive at one year. Complete functional outcome data were available for 37 survivors. Compared to the first assessment at 1 month, 15 patients (41%) had symptomatic improvement of at least one NYHA class at 1 year (
Figure
). No patients experienced clinical deterioration. Left ventricular ejection fraction assessed pre-discharge was the only significantly different parameter between those with improved and unchanged NYHA class at one year (
Table
).

Conclusions:
A large proportion of refractory OHCA survivors treated with ECPR have substantial improvement in their NYHA functional status at 1 year.
Abstract 288: Incidence And Outcomes Of In-hospital Cardiac Arrest Among Pulmonary Arterial Hypertension-related Hospitalizations In The United States
Authors: Olanipekun Titilope , Abe Temidayo , Udongwo Ndausung , Effoe Valery S
Published: June 2023

Background:
Cardiac arrest is a known complication of Pulmonary arterial hypertension (PAH) often due to acute right heart failure and arrhythmias. However, data on trends in the incidence and in-hospital outcomes of in-hospital cardiac arrest (IHCA) among PAH-related hospitalizations in the US is limited.

Hypothesis:
IHCA incidence has declined and In-hospital outcomes improved among PAH-related hospitalizations.

Methods:
We identified hospitalizations with a primary diagnosis of PAH in the nationwide inpatient database between 2010 and 2019, using the appropriate international classification of disease codes. We extracted patients who underwent cardiopulmonary resuscitation for IHCA and evaluated temporal trends in the incidence and in-hospital outcomes using the Cochrane-Armitage test. Logistic regression was used to evaluate factors associated with odds of survival to hospital discharge.

Results:
We identified 18,772 PAH-related hospitalizations during the study period. The IHCA incidence rate was 1.8% with a mean age (SD) of 62 years (16) and females predominantly affected (62.8%). There was a non-significant decline in IHCA incidence rate between 2010 and 2019 (1.9% vs. 1.2%, P=0.08). The overall survival to hospital discharge rate was 30.4% and this increased significantly during the study period (26.7% vs 36.9%, P = 0.04). Most of the survivors were discharged to a long-term acute care facility (44.2%) and 18.% were discharged home without the need for home health care. Factors associated with lower odds of survival were age > 65 years OR 0.97, 95% CI 0.96 - 0.98, P < 0.001), acute right heart failure (OR 0.74, 95% CI 0.60 - 0.90, P<0.001), acute respiratory failure (OR 0.20, 95% CI 0.16 - 0.24, P < 0.001), and severe comorbidity index (OR 0.83, 95% CI 0.71-0.96, P < 0.001). The presence of shockable rhythm (OR 1.67, 95% CI 1.31 - 2.26, P=0.03) and obesity (OR 1.33, 95% CI 1.02 - 1.72, P=0.03) were associated with higher odds of survival

Conclusion:
Though IHCA survival among resuscitated PAH-related hospitalizations improved during the 10-year study period in the US, only about 3 out of 10 patients still survive to hospital discharge. Additional studies are warranted to identify strategies that will improve resuscitation outcomes in these patients.
Abstract 290: Early Monitoring Of Neurological Recovery Using Poincare Analysis Index Of Heart Rate Variability - A Potential Biomarker For Asphyxial Cardiac Arrest Related Brain Injury
Authors: Agarwal Prachi , Geocadin Romergryko , Thakor Nitish
Published: June 2023

Heart rate variability (HRV) is influenced by autonomic nervous system including subcortical structures such as brainstem. We hypothesized that HRV would reflect graded response to hypoxic ischemic brain injury after cardiac arrest (CA). We investigated HRV based on the Poincare analysis method during the hyperacute recovery period after resuscitation to define its role in assessing neurologic recovery.

Adult male Wistar rats (360±20g) were subjected to either 5 /7-min of asphyxial CA and grouped based on neurologic recovery - good (n=17) and bad (n=16), assessed at 4 hr post resuscitation using a standardized Neurological Deficit Scale (NDS). A good outcome (GO) was defined as a NDS sub score (arousal+brainstem) of 36-40 and bad outcome (BO) as 23-35, with 40 as good and 0 as brain dead. A Poincare plot showing successive heart rate intervals was developed and analysed on 5-min ECG segments (first 1 hr) owing to the nonstationary HRV patterns during early recovery period. Several machine learning models were trained to assess the results from the standard deviations (SD1, SD2), to decipher the parasympathetic and sympathetic activities, and evaluated by the area under receiver operating characteristic curve (AUC). GO group demonstrated an NDS of 39.65±0.99, while the BO group had an NDS of (30±2.65) showing a statistical difference between groups (p<0.01). GO group exhibited an immediate increase post resuscitation in SD1 (0.55±0.23) and SD2 (0.67±0.29) with a gradual decrease ~1 hr, SD1 (0.20±0.12) and SD2 (0.13±0.09). No significant differences in initial SD1 (0.30±0.14) and SD2 (0.28±0.16) vs after 1 hr of recovery (SD1 (0.29±0.08), SD2 (0.30±0.16)) were observed across BO group. For GO, all parameters indicated a faster return to baseline values- SD1 (0.21±0.08) SD2 (0.15±0.16), showing a better recovery of the cardiac autonomic control, in agreement with the evolution of NDS. Logistic regression and naïve bayes performed best with SD2, giving an accuracy of 72% (AUC: 0.75) and 75% (AUC: 0.88) for recovery prognostication in 5-fold cross validation. Unlike previous studies to find biomarkers for CA related brain injury focused on cortical assessment, our results indicate that the novel HRV method can fill the gap in assessing subcortical injury after CA.
Abstract 292: Non-Arrest PulsePoint Activations In Public And Private Settings
Authors: Blackwood Jennifer E , Daya Mohamud R , Sorenson Ben , Schaeffer Brian , Dawson Mike , Charter Michael , Nania James M , Charbonneau Julie , Robertson Jeremy , Mancera Michael , Carbon Chris , Jorgenson Dawn , Gao Mengqi , Price Richard , Rea Thomas
Published: June 2023

Objectives:
Geospatial “smart” technology such as PulsePoint is increasingly used to crowdsource community response for suspected out-of-hospital cardiac arrest (OHCA). Although the clinical focus of this strategy is OHCA, dispatch identification is imperfect such that activation often occurs for the non-arrest patient. The frequency and clinical profile of such non-arrest patients has not been well characterized.

Methods:
Prospective 3-year cohort investigation of patients for whom the PulsePoint was activated for suspected OHCA in four United States communities (total population ~1 million). We evaluated those patients with a PulsePoint activation for suspected OHCA who were subsequently not found to be in cardiac arrest on arrival. The response cohort included off-duty, volunteer public safety personnel (verified responders) notified regardless of location (public or private) as well as laypersons who were only notified to public locations. We linked the PulsePoint information with EMS records to report the frequency, condition type, and EMS treatment for these patients.

Results:
Of 1779 calls where volunteers were activated, 756 were OHCA, which left 1023 non-arrest patients for evaluation. The most common EMS assessments were syncope (15.9%, n=163), altered mental status (15.5%, n=159), seizure (14.3%, n=146), overdose (13.0%, n=133), and choking (10.5%, n=107). These findings were similar for private and public locations. The most common EMS interventions included placement of an intravenous line (43.1%, n=441), 12-Lead ECG (27.9%, n=285), naloxone administration (9.8%, n=100), and airway or ventilation assistance (8.7%, n=89).

Conclusions:
More than half of patients activated for suspected OHCA by PulsePoint in both public and private had conditions other than cardiac arrest. A subset of these conditions may benefit from earlier care provided by both layperson and public safety volunteers if they were appropriately trained and equipped.
Abstract 305: Effect Of Initial Epinephrine Administration Time On Cerebral Perfusion In A Porcine Experimental Model Of Cardiac Arrest
Authors: Lim Hyoukjae , Song Kyoung Jun , Hong Ki Jeong , Yoon Hanna , LEE Stephen Gyung Won , Choi Seul Ki , Lee Gyeongmin , Park YongJoo , Hong Wonpyo , Lee Kang bin , Kim Ki Hong
Published: June 2023

Background:
The effect of initial epinephrine administration time from cardiac arrest on cerebral perfusion pressure (CePP) during CPR is controversial. The purpose of this study was to evaluate the association between initial epinephrine administration time and CePP in a porcine cardiac arrest model.

Methods:
Initial administration time of epinephrine was divided into 3 groups based on time after inducing ventricular fibrillation (VF): 5 minutes (early group), 10 minutes (intermediate group), and 15 minutes (delayed group). Twenty-four pigs were randomly assigned to each group. After 4 minutes of untreated ventricular fibrillation, 2 cycles of BLS (BLS1 and BLS2 phase) and 10 cycles of ACLS (ACLS1~10 phase) were conducted. Macrovascular circulation (CePP) and microvascular circulation using laser doppler flowmetry presented as a fraction of the baseline flow (f-LDF) were measured. Linear mixed model was used to measure median difference in CePP and f-LDF between groups.

Results:
A total of 22 pigs were analyzed. Early group showed higher and earlier peak of CePP and f-LDF compared to those of intermediate or delayed groups. There was a significant group by phase interaction in CePP where the early group showed a higher CePP on earlier phase. (Early group: median 38.2 [95% confidence intervals 30.7-50.5] mmHg at BLS 2 phase, intermediate group: 27.1 [14.1-35.7] mmHg at ACLS1 phase, late group: 12.2 [2.2-34.9] mmHg at ACLS 4 phase), p< 0.001). There was no significant group by phase interaction in f-LDF; however, there was a tendency of decreased peak and delayed reach to peak with time. (Early group: median 5.7 [95% confidence interval 3.5-7.8] at ACLS 2 phase, intermediate group: 3.6 [1.5-5.1] at ACLS 4 phase, late group: 2.2 [0.9-3.3] at ACLS 6 phase, p =0.93).

Conclusion:
In this VF cardiac arrest porcine study, the early administration of epinephrine group showed higher and earlier peak of CePP and f-LDF compared to those of the intermediate and delayed groups.
Abstract 316: Ultra-early Diffusion-weighted Magnetic Resonance Imaging For Assessment Of Prognosis In Out-of-hospital Cardiac Arrest Survivors
Authors: Min Jinhong , Park Jung Soo , In Yong , You Yeon Ho , Kang Changshin
Published: June 2023

Aim:
We investigated the association of poor neurological outcomes with ultra-early diffusion-weighted magnetic resonance imaging (DW-MRI) of the brain in out-of-hospital cardiac arrest (OHCA) survivors and how to complement for false-negative findings (FNF).

Methods:
This registry-based observational study included adult comatose OHCA survivors who underwent DW-MRI scans within 6 h after the return of spontaneous circulation (ROSC). This study was divided into four groups: Group A (poor outcome with high-signal intensity (HSI) on DW-MRI), Group B (poor outcome without HSI [FNF]), Group C (good outcome without HSI), and Group D (good outcome with HSI). We analyzed serum and CSF neuron-specific enolase (NSE), albumin quotient (albumin
CSF
/albumin
serum
) (Qa), apparent diffusion coefficient (ADC) value, and low flow time, among others, obtained within 6 h after ROSC. The primary outcome was the 3-month poor (CPC 3-5) outcome.

Results:
Of the 110 patients, 62 (56.4%) had poor outcomes, time from ROSC to MRI was 2.8 h (IQR, 2.0-4.0 h), and HSI on DW-MRI was observed in 46 (41.8%). The composition of Groups A, B, C, and D was 46 (41.8%), 16 (14.5%), 48 (43.6%), and 0 (0%) patients, respectively. Group B had significantly lower serum NSE, 650 ADC value, Qa, and low flow time than Group A; however, CSF NSE was higher than in Group C (Fig. 1). DW-MRI and CSF NSE identified patients with poor outcomes with 74.2% sensitivity (95% CI 61.5-84.5) and 100% specificity (95% CI 92.6-100), and 67.9% sensitivity (95% CI 53.7-80.1) and 100% specificity (95% CI 90.3-100), respectively. Combining the two tools increased identification to 87.1% sensitivity (95% CI 76.1-94.3) at 0% false positive rate (FPR).

Conclusions:
The HSI on ultra-early DW-MRI in OHCA survivors was significantly associated with poor outcomes. The CSF NSE is a complementary tool showing higher sensitivity at 0% FPR than DW-MRI alone. Multicenter prospective studies are required to determine the results’ generalizability.
Abstract 320: Gray-white Matter Ratio Under 1.12 Could Predict Poor Neurological Outcomes, Even When Measured Within Two Hours After Return Of Spontaneous Circulation
Authors: Murakami Yuya , Hongo Takashi , Ichiba Toshihisa , Iida Atsuyoshi , Maeyama Hiroki , Kosaki Yoshinori , Nakao Atunori , Naito Hiromichi
Published: June 2023

Introduction:
Literature on neuroprognostication suggests that gray-white matter ratio (GWR) measured from head computed tomography (CT) within two hours after return of spontaneous circulation (ROSC) can’t adequately predict neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients. However, severe cerebral edema may predict poor outcomes within two hours after ROSC.

Hypothesis:
We evaluated if GWR measurements obtained early after OHCA (≤ 2 hours) indicated poor neurological outcomes in patients with severe cerebral edema.

Methods:
We conducted a multicenter, retrospective cohort study using data from five hospitals collected between 2007 and 2019 in Japan. Inclusion criteria: adult comatose OHCA survivors with head CT within two hours after ROSC. Exclusion criteria was trauma, stroke, or pre-existing neurological disorders. Primary outcome was poor neurological outcome, defined as Cerebral Performance Category (CPC) score ≥ 3 at one month after admission. GWR was measured at the levels of the basal ganglia (BG), corpus callosum (CC), and posterior internal capsule (PIC). The prognostic value of GWR for predicting poor outcome was assessed using a receiver operating characteristic (ROC) curve analysis, area under the curve (AUC) with sensitivity/specificity.

Results:
A total of 377 patients were included. Of those, 281 (74.6%) exhibited poor neurological outcome at one month after admission. GWR values did not alter by the time of obtaining head CT: 1.22 (0-30 min: n=194); 1.22 (31-60 min: n=127); 1.22 (61-120 min: n=56). Using a cut-off GWR value of <1.2, ROC analysis demonstrated AUC for GWR-BG (0.69, 95% CI 0.65-0.73), GWR-CC (0.77, 95% CI 0.69-0.76), and GWR-PIC (0.76, 95% CI 0.72-0.79) with sensitivities/specificities of 45.5%/92.7%, 47.6%/97.9%, 55.8%/96.8%, and 46.2%/97.9%, respectively for poor outcomes. However, GWR values <1.12 demonstrated 100% specificity for poor outcomes: GWR-BG (AUC 0.56, sensitivity/specificity 13.5%/100%), GWR-CC (AUC 0.56, sensitivity/specificity 13.5%/100%), and GWR-PIC (AUC 0.59, sensitivity/specificity 19.5%/100%).

Conclusion:
GWR (<1.12) obtained even within two hours after ROSC could be used as a threshold for poor neurological outcome in OHCA patients.
Abstract 324: Out-of-hospital Cardiac Arrest Intervention and Outcome Variation in Detroit
Authors: Mathew Shobi , Harrison Nicholas E , Ajimal Sukhwindar , Linn Chase , Silvagi Ryan , Dunne Robert B , Oneil Brian J
Published: June 2023

Introduction:
Significant variation exists in treatment and outcomes from out-of-hospital cardiac arrest (OHCA). Disparities between hospitals serving a similar population is less known.

Hypothesis:
OHCA post-resuscitation practices and outcomes differ significantly between 4 hospitals in Detroit, which serve a similar population.

Methods:
The Detroit-Cardiac Registry to Enhance Survival were analyzed between January 1st, 2014 to December 31st, 2019. Patients <18 years age, had a pre-existing DNR, and those transferred to another facility were excluded. 4 tertiary care hospitals (median distance: 10.6 miles) were compared on utilization of 2 treatment decisions (coronary angiography, new DNR order) and 2 clinical outcomes (cerebral performance category {CPC} ≤ 2, in-hospital death) using logistic regression models adjusted for known confounders. Models for death and CPC outcome were tested with vs. without the addition of angiography and DNR initiation as additional confounders (sensitivity analysis).

Results:
999-included patients at hospitals A - D differed (p<0.05) before multivariable adjustment by age, race, witnessed arrest, dispatch-ED time, TTM, coronary angiography, DNR order, and in-hospital death, but not CPC ≤ 2. Rates of death and CPC ≤ 2 were worse in Hospital A (82.8%, 10%, respectively) compared to all others (69.1%, 14.1%). After multivariable adjustment, Hospital A performed angiography less compared to B (OR=0.17) and was more likely to initiate new DNR status than B (OR=2.9), C (OR=16.1), or D (OR=3.6). Multivariable-adjusted odds of CPC ≤ 2 were worse in Hospital A compared to B (OR=0.27) and D (OR=0.35). After sensitivity analysis for the different treatment propensities, CPC ≤ 2 odds did not differ for A versus B (OR=0.58, adjusted for angiography) or D (OR=0.65, adjusted for DNR order). Multivariable-adjusted odds of death, regardless of angiography and DNR differences, were worse in Hospital A compared to B (OR=1.87) and D (OR=1.81).

Conclusion:
OHCA treatment and outcome disparities were noted between nearby Detroit hospitals serving related patient populations. Rates of coronary angiography and DNR orders partially explain disparities in CPC
<2
but not death.
Abstract 325: Evaluation Of The 2015 Cardiopulmonary Resuscitation Guidelines For Patients With Nonshockable Out-of-hospital Cardiac Arrest; Results From The All-japan Utstein Registry 2022
Authors: Yagi Tsukasa , Nagao Ken , Tachibana Eizo , Chiba Nobutaka , Tani Shigemasa , Matsumoto Naoya , Okumura Yasuo , Yonemoto Naohiro W , Tahara Yoshio , Kobayashi Yoshio , Ikeda Takanori , Nonogi Hiroshi ,   the JCS ReSS Investigators
Published: June 2023

Background:
In nonshockable cardiac arrest (CA) patients, the 2020 cardiopulmonary resuscitation (CPR) guidelines have stressed that high-quality CPR improves survival from CA, as with the 2015 CPR guidelines. However, it is unknown whether the 2015 guidelines contributed to the favorable neurological outcomes in adult CA patients. The present study aimed to clarify the effects of the 2015 guidelines on adult CA patients using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital CA (OHCA).

Methods:
From the data of this registry, between 2011 and 2020, we included adult witnessed OHCA patients due to cardiac etiology who had non-shockable rhythm as an initial rhythm. We excluded patients who received prehospital care in 2011, 2015, 2016, and 2020 because it was difficult to distinguish prehospital care based on either 2010 CPR guidelines, 2015, or 2020. We also excluded patients who received bystander CPR by citizens because we cannot assess the quality of bystander CPR. Study patients were divided into two groups based on the different CPR guidelines; the era of the 2010 guidelines (2010G) and the era of the 2015 guidelines (2015G). The endpoint was the favorable neurological outcome at 30 days after OHCA. Potential confounding factors based on biological plausibility and previous studies were included in the multivariable logistic regression analysis. These variables included the age, sex (male, female), advanced airway or not, the administration of adrenaline or not, the administration of saline or not, and time interval from call EMS to the scene.

Results:
Of the 1,259,960 patients registered in the All-Japan Utstein Registry, the data of 54,219 patients were included in this analysis. The 2015G was significantly higher in the 30-day favorable neurological outcome than the 2010G (2010G vs. 2015G = 1.5% vs. 1.8%: p=0.008). In the multivariate analysis, the adjusted odds ratio for 30-day favorable neurological outcome in OHCA patients in the 2015G compared to in the 2010G was 1.37 (95%CI 1.19-1.58, p<0.001).

Conclusion:
In the OHCA patients with non-shockable rhythm, the 2015 CPR guidelines were superior to the 2010 guidelines in terms of neurological benefits.
Abstract 331: Impact Of Concomitant Use Of Veno-arterial Extracorporeal Membrane Oxygenation And Impella Support On Short-term Mortality In Acute Coronary Syndrome Patients With Refractory Cardiogenic Shock
Authors: Tsurusaki Yuta , Unoki Takashi , Nakayama Tomoko , Matsura Junya , Toyohuku Takaaki , Konami Yutaka , Suzuyama Hiroto , Inoue Masayuki , Horio Eiji , Yufu Tetsuo , Kodama Kazuhisa , Yamamuro Megumi , Taguchi Eiji , Sawamura Tadashi , Nakao Koichi , Sakamoto Tomohiro
Published: June 2023

Background:
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is one of effective therapeutic modalities for patients with cardiogenic shock (CS) and acute coronary syndrome (ACS). While VA-ECMO maintains end-organ perfusion, it increases damaged left ventricular (LV) wall tension. Combined treatment of VA-ECMO and a micro-axial Impella pump, referred to as ECPELLA, simultaneously provides systemic circulatory support and LV unloading. However, it remains unknown whether LV unloading effect on ECPELLA support further reduces mortality compared to currently available VA-ECMO+IABP support.

Purpose:
Investigate whether ECPELLA can reduce mortality in ACS patients with severe cardiogenic shock who required VA-ECMO.

Methods:
From January 2012 to May 2022, 100 consecutive patients with ACS and CS who received VA-ECMO before or after percutaneous coronary intervention were enrolled. Patients were divided into two groups; 39 patients in the ECPELLA; and 61 patients in the VA-ECMO with IABP. We assessed peak serum CPK-MB levels and 30-day mortality.

Results:
There were no significant differences in age, rate of male sex, coronary risk factors, ST-elevated ACS, left main trunk (LMT) lesion, multi-vessel disease (MVD), number of coronary lesions, extracorporeal cardiopulmonary resuscitation, and the time from onset to reperfusion between two groups. The ECPELLA had lower peak CPK-MB levels compared to VA-ECMO with IABP, but the difference did not reach statistical significance (p=0.056). Kaplan-Meier analysis revealed that the ECPELLA had significantly lower 30-day mortality (
p=0.0016
). Multivariable Cox proportional hazard analysis revealed that ECPELLA (HR: 0.22 95% confidence interval:0.11-0.45; p<0.0001) was inversely and independently associated with 30-day all-cause mortality.

Conclusion:
ECPELLA treatment appeared to have advantage in reduction of 30-day mortality.
Abstract 9252: Risk for Incident Coronary Heart Disease Associated With High Lipoprotein(a) by Levels of Factor VIII and High-Sensitivity C-Reactive Protein
Authors: Colantonio Lisandro D , Goonewardena Sascha N , Wang Zhixin , Jackson Elizabeth A , Farkouh Michael E , Li Mei , Malick Waqas , Kent Shia , Lopez J G , Muntner Paul , Bittner Vera A , Rosenson Robert S
Published: June 2023

Introduction:
Both coagulation and inflammation may contribute to the higher risk for coronary heart disease (CHD) associated with high lipoprotein(a) [Lp(a)]. The association of Lp(a) with CHD is stronger in individuals with high versus low high-sensitivity C-reactive protein (hsCRP), a marker of inflammation. It is unclear if coagulation Factor VIII also modifies the association of Lp(a) with CHD independently of hsCRP.

Hypothesis:
Lp(a) is associated with incident CHD in adults with high Factor VIII after adjustment for hsCRP but not among those with low Factor VIII.

Methods:
We analyzed data from 6,495 adults 45 to 84 years of age without a history of cardiovascular disease in the Multi-Ethnic Study of Atherosclerosis (MESA). Lp(a) mass concentration, Factor VIII antigen, and hsCRP were measured using blood collected at baseline (2000-2002). Lp(a), Factor VIII and hsCRP were categorized as high or low (≥75th or <75th percentile of the distribution). Participants were followed for incident CHD through 2015 (median follow-up 14 years).

Results:
The mean age of participants was 62 years and 47% were male. After log-transformation, the Pearson’s correlation between Factor VIII and hsCRP was 0.15 (p-value <0.001). High Lp(a) was associated with an increased risk for incident CHD in participants with high Factor VIII and high hsCRP, separately, but not among those with low Factor VIII or low hsCRP (Table). The adjusted hazard ratio (95%CI) for CHD associated with high Lp(a) was 1.09 (0.77, 1.53) in participants with low Factor VIII and low hsCRP, 1.49 (0.84, 2.67) in those with low Factor VIII and high hsCRP, 1.54 (0.92, 2.59) in those with high Factor VIII and low hsCRP, and 3.84 (1.85, 7.97) in those with high Factor VIII and high hsCRP (p-value comparing hazard ratios 0.02).

Conclusions:
High Lp(a) is a risk factor for incident CHD in adults with high Factor VIII or hsCRP. The activation of either the inflammation or coagulation pathway may modify the association of Lp(a) with CHD.
Abstract 9271: Risk of Cancer After Diagnosis of Cardiovascular Disease
Authors: Bell Caitlin , Lei Xiudong , Baylis Richard , Gao Hua , Luo Lingfeng , Giordano Sharon , Wehner Mackenzie , Nead Kevin , Leeper Nick J
Published: June 2023

Introduction:
Cardiovascular disease (CVD) and cancer share several known risk factors. While preclinical models have found that various types of CVD can accelerate cancer progression, clinical studies have not determined whether these associations are due to shared risk factors or a specific impact of atherosclerosis on cancer development.

Hypothesis:
CVD, particularly atherosclerotic CVD, is an independent risk factor for incident cancer.

Methods:
We used a 1:1 matched retrospective cohort study using IBM’s MarketScan insurance claims database from 2009 to 2019. Those with CVD were stratified as having either atherosclerotic (aCVD) or non-atherosclerotic disease (naCVD). Those with prior diagnostic codes for cancer were excluded. Cumulative risks of (1) any incident cancer, (2) organ-specific cancers according to CVD groups. Kaplan-Meier and multivariable adjusted Cox proportional hazards (PH) models with propensity score adjustment were used to evaluate the association of CVD groups and cancer.

Results:
Among 4,487,412 matched (1:1 no CVD vs. CVD) individuals, the mean age was 56 years, 48% were female, 31% had aCVD, and 19% had naCVD. Those without CVD had a 5-year cumulative cancer incidence of 5.4% (95% CI, 5.3%-5.4%), compared to 6.8% (95% CI, 6.7%-6.8%) among those with any CVD and 7.7% (95% CI, 7.6%-7.8%) for those with aCVD. After multivariable and propensity score adjustment, individuals with CVD were found to have a significantly increased risk of incident cancer compared to individuals without CVD (hazard ratio [HR], 1.14; 95% CI, 1.13-1.15). Those with aCVD had a significantly higher risk of cancer compared to the naCVD group (HR, 1.03; 95% CI, 1.02-1.05). These findings were consistent in sensitivity analyses which were further adjusted for smoking history and body mass index. Cancer subtype analyses showed a specific association of aCVD with lung, bladder, liver, brain, and other hematologic cancers.

Conclusions:
In this retrospective cohort study, individuals with CVD had an increased risk of incident cancer compared to those without CVD. This association may be driven by the relationship of aCVD with specific cancer subtypes, which persists after controlling for conventional risk factors.
Abstract 9343: Predictive Value of Baseline Serum High-Sensitivity Troponin I and NT-proBNP for Cardiac Immunotoxicity Risk During Immune Checkpoint Inhibitor Therapy
Authors: Rao Anjali , Prasad Tanushree , Simon Shayna , Zhu Hong , Venkatesh Vishnu , Ali Sadia , Bermas Bonnie , Bernabela Luigino , Bhai Salman , Brugarolas James , Castillo Pedro , Chandra Alvin , Dao Kathryn , Mammen Pradeep P , Garg Sonia , Homsi Jade , Oz Orhan , Ratti Gregory , Selby Chris , Vallabhaneni Srilakshmi , Zhang Kathleen , De Lemos James A , Sweetenham John , Hammers Hans , Zaha Vlad G
Published: June 2023

Introduction:
Immune checkpoint inhibitors (ICI) have revolutionized cancer treatment, but rarely and unpredictably cause fulminant myocarditis. It is unknown if circulating cardiac biomarkers can predict immunotoxicity in a real-world patient population.

Aim:
To evaluate the predictive value of baseline levels of high-sensitivity troponin-I (hs-TnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) for myocardial injury (hs-TnI>50ng/L) or potential heart failure (NT-proBNP>300pg/mL) risk during ICI therapy.

Methods:
An institutional multidisciplinary working group developed a monitoring protocol for immune-related adverse events due to ICI. Data recorded during clinical treatment plans over 12 months starting 5/1/2021 were analyzed.

Results:
621 patients received ICI therapy, and 6 developed myocarditis requiring hospitalization. Of 317 patients initiated on ICI after the start of this protocol, baseline and at least one follow-up hs-TnI and NT-proBNP values were measured in 183 and 126 patients, respectively. In 110 patients hs-TnI was undetectable (<5ng/L) at baseline. In 66% of these patients hs-TnI remained undetectable on follow-up. Of 88 patients with baseline NT-proBNP below the diagnosis limit for heart failure (<300 pg/mL), 75% had values below this limit on follow-up. The baseline value of the biomarkers was used as a predictor of increase in biomarkers during follow-up. Area under receiver operator curve for predicting an increase from baseline during ICI treatment was 0.67 for hs-TnI, 0.87 for NT-proBNP, and 0.86 combined (Figure).

Conclusions:
This single-center, prospectively protocolled, retrospectively-analyzed study indicates that hs-TnI and NT-proBNP values obtained at baseline and at least at one immunotherapy cycle can be used to categorize patients at risk or not for potential immunotoxicity during ICI treatment, thus may offer a helpful strategy in the monitoring and prevention of fulminant myocarditis.
Abstract 9376: TRPM77 Knockdown Prevents Hypomagnesemia-Induced Oxidative Stress and Cardiac Diastolic Dysfunction
Authors: Liu Man , Liu Hong , Kang Gyeoung-Jin , Feng Feng , Dudley Samuel C
Published: June 2023

Introduction:
Our previous study has shown that 6-week low-Mg diet-induced hypomagnesemia results in mitochondrial dysfunction, cardiac diastolic dysfunction, and seizure-related death. Transient receptor potential cation channel subfamily M 7 (TRPM7) is a Mg transporter with both channel and kinase function located in the plasma membrane. We investigated the role of TRPM7 in hypomagnesemia-associated changes.

Methods:
For cardiac-specific knockdown of TRPM7, pAAV[miR30]-cTnT>EGFP:Scramble-shRNA as control (Con) and pAAV[miR30]-cTnT>EGFP:TRPM7 shRNA as TRPM7 knockdown (T7KD) were injected into mice through the jugular vein at 10 weeks old. One week later, mice were fed with a normal diet (nlMg, 2000 mg/kg Mg) or a low-Mg diet (HypoMg, 15-30 mg/kg Mg) for 4 weeks.

Results:
TRPM7 was increased significantly in wild type mouse hearts under the low-Mg diet (1.45±0.18-fold of mice with normal diet, P<0.01). We therefore knocked down TRPM7 in the mouse heart to see if HypoMg-induced changes could be prevented. After 4 weeks of low-Mg diet, both Con and T7KD mice had hypomagnesemia with significantly decreased serum Mg levels (0.37±0.03 and 0.45±0.10 mM, respectively, vs 1.05±0.04 mM of Con-nlMg). All T7KD mice showed significantly decreased TRPM7 protein levels in the heart tissue (<30% of Con-nlMg, P<0.01). Cardiac diastolic dysfunction (E/e’) was prevented in T7KD-HypoMg mice (E/e’=16.2±1.9 vs. 20.7±1.5 of Con-HypoMg). Increased total protein oxidation (measured with nitro-tyrosine immunoprecipitation) in Con-HypoMg heart tissue (1.61±0.09-fold increase, P=0.045 vs. Con-nlMg) was normalized in the T7KD-HypoMg group (1.18±0.09-fold of Con-nlMg, P=0.45 vs. Con-nlMg).

Conclusions:
TRPM7 was upregulated in hypomagnesemia in hearts and its knockdown prevented hypomagnesemia-induced cardiac diastolic dysfunction and increased oxidative stress.
Abstract 9396: Calmodulin-Dependent Protein Kinase II Activation Promotes Kidney Mesangial Expansion in Streptozotocin-Induced Diabetic Mice
Authors: Mikhailov Alexei V , Cheng Heng-Jie , Lin Jen-Jar , Cheng Che Ping
Published: June 2023

Background:
Calmodulin-dependent protein kinase II (CaMKII) is upregulated in diabetes mellitus (DM), leading to the overproduction of collagen in the myocardium. We hypothesized that CaMKII also stimulates the extracellular matrix production in the kidneys leading to mesangial matrix expansion, a hallmark of diabetic nephropathy and a major cause of renal failure. To test this hypothesis, we developed an automated process of mesangial matrix measurement.

Methods:
We induced Type 1 diabetes (DM1) in wild type female FVB mice via an intraperitoneal injection of Streptozotocin (STZ, 200 mg/kg ip) and studied the dynamics of mesangial matrix fractional area (MMFA) over 10 weeks (W) in mice with:
DM
,
DM/KN93
, 6 W after STZ, followed by 4 W treatment with a CaMKII inhibitor KN93 (70 μg/kg/day, via mini pump), and Control (C) (vehicle only) mice. Both kidneys were retrieved. MMFA measurements were performed on 50 glomeruli from each animal on trichrome-stained paraffin sections using a trainable segmentation WEKA (Waikato Environment of Knowledge Analysis) plugin for Fiji, as well as on the electron micrographs of 4-5 whole glomeruli/animal.

Results:
Both DM and DM/KN93 mice were severely hyperglycemic (517 and 538 mg/dL compared to 161 mg/dL in C). In DM mice, the kidney weight increased by 76% and the MMFA significantly increased by 81% compared to C (9.4 ± 1% vs 5.2 ± 2.8%). In DM/KN93 mice, MMFA was similar to that in controls (6.2 ± 2.3%). The electron microscopy study has confirmed these MMFA changes. Other features of human diabetic nephropathy were not seen and the fractional mesangial cell area and the fractional podocyte area were relatively unchanged in DM and DM/KN93 mice.

Conclusions:
Our DM1 mouse model reproduces the key features of early human diabetic nephropathy. KN93 prevents DM-induced extracellular matrix production and kidney mesangial matrix expansion, suggesting that chronic inhibition of CaMKII could be a potential treatment for the early diabetic nephropathy. Reliable automated measurement of the MM area can be achieved after training by the WEKA plugin.
Abstract 9403: Sex Differences in Clinical Features, Utilization of Oral Anticoagulant Agents and One Year Outcome in the Middle East. the Jordan Atrial Fibrillation Study
Authors: Jarrah Mohamad , Hammoudeh Ayman J , Yahya Badaineh , Tabalat Ramzi , Khader Yousef , Shawer Haneen , Alhaddad Imad
Published: June 2023

Introduction:
Atrial fibrillation (AF) is the most common sustained arrhythmia in women and men on a global level. Sex-specific differences in the baseline clinical and demographic features, management strategies and prognosis in patients with AF have been studied extensively but have received less attention in the Middle East

Hypothesis:
To compare the clinical characteristics, therapeutic strategies and one-year incidence of major cardiovascular events between women and men with AF

Methods:
The Jordan AF Study enrolled consecutive patients with AF in 29 hospitals and cardiology clinics in Jordan from May 2019 through December 2020. Patients were followed up for one year. We used the study data to compare clinical features, use of pharmaceutical agents and outcome in women compared with men

Results:
Of 2020 AF patients enrolled, 1095 (54.2%) were women. Women were older than men (mean age±SD 69.4±11.1 vs. 66.0±14.7 years, p<0.001), and had higher prevalence of hypertension, diabetes, and obesity. Compared with men, women with nonvalvular AF had higher mean CH2DS2-VASc score(4.1±1.7 vs. 3.0±1.8, p<0.001) and HAS-BLED score (1.7±1.1 vs. 1.6±1.2, p=0.05). High-risk CHA2DS2-VASc score was present in 83.9% of women and 78.9% of men (p=0.07), and oral anticoagulant agents were prescribed for 84.7% of women and 81.7% of men (p=0.14).At one year, women and men did not differ significantly in rates of all-cause death (12.0% vs. 13.1%, p=0.51), stroke/systemic embolism (4.1% vs. 4.8%, p=0.44), major bleeding events (2.0% vs. 3.2%, p=0.13), and intracranial bleeding (0.3% vs. 0.8%, p=0.24). Multiple logistic regression analysis showed no sex differences in one-year all-cause death. Moreover, age
>
70 years, hypertension, diabetes, heart failure, ischemic heart disease were associated with higher incidence of all-cause death

Conclusions:
Despite the fact that Middle Eastern women with AF had worse baseline clinical profile and risk scores, they did not differ from men in one-year outcome. Female sex was not a predictor of one-year mortality in this cohort.
Abstract 9442: Increasing Patient Activation Among Black American Men in a Community-Based Lifestyle Intervention Pilot: Black Impact
Authors: Addison Sarah , Williams Amaris , Zhang Jing , Metlock Faith , Yang Yesol , Gregory John , Gray Darrell , Nolan Timiya S , Joseph Joshua J
Published: June 2023

Introduction:
Life’s simple 7 (LS7) is a seven-metric framework from which cardiovascular health can be measured. Black Americans have the lowest attainment of LS7 among all communities. This may be in part related to patient activation or “having the capability and the willingness to take on the role of managing one’s own health and health care”. Patients with lower patient activation scores on the Patient Activation Measure tool (PAM) are more likely to develop and suffer from chronic diseases like hypertension and stroke. Black Americans report lower patient activation as compared to Non-Hispanic Whites, and lower medication adherence. Here, we discuss changes in patient activation during a 24-week community-based, lifestyle intervention focused on improving cardiovascular health in Black American men.

Methods:
We recruited 74 Black men with less than 4 of 7 LS7 metrics in the “ideal” range to participate in Black Impact, a community-based lifestyle intervention adapted from the AHA’s Check, Change, Control Program and Diabetes Prevention Program. Participants met weekly in groups of 8-25 for 24 weeks, completing group-based physical activities and health education sessions. Biometric screenings and self-report surveys (including the PAM 10-item questionnaire) were administered at baseline, 12, and 24 weeks. Changes in PAM scores at 12 and 24 weeks were calculated using a linear mixed-effects model with random intercepts.

Results:
The mean baseline PAM score of participants, when adjusted for age, education, and income, was 64.68 (95% CI: 60.51, 68.85). At week 12, the PAM score increased by an average of 4.36 (95% CI: 1.09, 7.63; p = 0.01). At week 24, the increase from baseline was 8.22 (95% CI: 5.06, 11.38; p < 0.001). Increases in PAM were non-significantly associated with increases in LS7 over the 24 weeks (p= 0.346)

Conclusions:
In Black Impact, PAM scores increased substantially at 12 and 24 weeks. The 8-point PAM increase at 24 weeks is equivalent to a 16% reduction in the likelihood of hospitalizations and a 16% increase in medication adherence. These findings suggest community-based lifestyle interventions focused on increasing cardiovascular health may be a key strategy in advancing equity in patient activation.