bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4147824: Comparing Mobile Health Strategies to Improve Medication Adherence for Veterans with Coronary Heart Disease (Mobile4Meds): Results of a Randomized Clinical Trial
Authors: Park Linda , Elnaggar Abdelaziz , Hoffmann Thomas , von Oppenfeld Julia , Collins Eileen , Raygani Setareh , Yong Celina , Soni Krishan , WINCHESTER DAVID , Minniefield Nicole , Whooley Mary
Published: November 2024

Background:
Despite adherence to antiplatelet medications being critical to prevent stent thrombosis and subsequent life-threatening complications, rates of long-term non-adherence range from 21-57%. Text messaging (TM) and mobile applications (apps) are practical and inexpensive strategies to potentially promote medication adherence.

Objective:
The Mobile4Meds study sought to determine whether TM or a mobile app for medication adherence, compared to control, improved antiplatelet use among patients who experienced acute coronary syndrome or percutaneous coronary intervention (ACS/PCI).

Methods:
We recruited participants for the randomized clinical trial (RCT) from 4 national Veterans Affairs (VA) and 2 non-VA Northern California medical centers from 2018-2022. Participants were randomly assigned to: 1) customized TM on medication reminders, 2) a commercially available mobile app for self-management of medication use, or 3) control, and followed at 3, 6, and 12 months. The primary outcome was medication adherence, measured by Medication Event Monitoring System (MEMS) electronic caps. Self-reported endpoints were derived from the Adherence to Refills and Medications Scale (ARMS), and 7- and 30-day recall of all medications and antiplatelet therapy. We used linear mixed models with predictor variables of group (with control as reference), time (baseline, 3, 6 months), and group-by-time interactions to detect group differences.

Results:
The mean age of participants was 66.9 (SD 11), 49.5% female (N=99). Significant missingness from MEMS caps precluded conclusive analyses. No significant group differences were found with the ARMS. There were significant main effects of 7- and 30-day recall for all medications at 3 months for the app group (B=3.16, standard error [SE]=1.17, p<.01; B=-1.99, SE=0.94, p<.05, respectively) vs. the control group. Differences in 30-day recall for antiplatelet medication use were detected at 3 months; however, did not reach statistical significance (B=-2.08, SE=1.14, p<.07).

Conclusions:
Our study signals the efficacy of using a mobile app for short-term medication adherence based on 7- and 30-day recall. The potential of mobile technology warrants additional research including measurement methodologies as medication nonadherence remains a major public health concern for individuals with CVD requiring strict medication adherence such as antiplatelet therapy after PCI.
Abstract 4147854: Cardiac Involvement is Prevalent in Patients with Pediatric Mitochondrial Disease and is Associated with Higher Likelihood of Hospital Admission
Authors: Lottes Robyn , Kinsinger Morgan , Joong Anna , Webster Gregory , Mithal Divakar
Published: November 2024

Background:
Mitochondrial disease has an estimated incidence of 1.6 per 5,000 live births and can affect nearly any organ system; however, the cardiac presentations and clinical implications of mitochondrial disease remain poorly understood. The purpose of this study was to describe the prevalence of cardiac disease in a cohort of patients with known mitochondrial disease and compare outcomes between patients with and without cardiac disease.

Methods:
This retrospective study performed at a single pediatric tertiary-care hospital included patients with a clinical and genetic diagnosis of mitochondrial disease that had at least one encounter with our hospital system between 2019 and 2024. Available echo and ECG data and cardiology documentation was reviewed. Clinical characteristics including hospital admissions and number of subspecialties involved in care were retrieved from the electronic medical record from 2007-2024. Analysis of clinical findings was performed using chi-squared analysis, and comparison of hospitalized days, ICU days, and number of subspecialties involved in care was performed using Student’s T test analysis. Cardiac abnormalities that were identified at the time of death or arrest unrelated to a primary cardiac etiology were not included as cardiac disease.

Results:
Cardiac disease was present in 31/94 patients. More than one cardiac diagnosis was present in 5 patients thus 37 unique cardiac diagnoses were made. Cardiomyopathy was most common (17/95), with hypertrophic cardiomyopathy in 9/17. Electrophysiology disease was present in 9/94 patients with 5/9 having antegrade ventricular pre-excitation. Two patients recieved heart transplant. Patients with cardiac disease were more likely to be hospitalized than those without disease (83% vs 59%, p=0.02), and more likely to require admission to an ICU (61% vs 37%, p=0.02). Hospital and ICU days varied widely within groups and there was no significant difference between those with vs those without cardiac disease. There was no statistical difference in mortality.

Conclusions:
Cardiac disease is present in a third of children with genotype positive, phenotype positive mitochondrial disease. No current guidelines exist to determine cardiac screening in most forms of mitochondrial disease, despite a higher prevalence of severe cardiac abnormalities than in many other populations where screening is vocally advocated, such as athletes and patients with a positive family history of cardiac disease.
Abstract 4147856: A TTN Frameshift Mutation Leads to Dysfunctional Sarcomere and Calcium Handling in iPSC-derived Atrial Cardiomyocytes
Authors: Baskaran Abhinaya , Arif Mahmud , Chen Hanna , Hill Michael , Barney Miles , Owais Asia , Sridhar Arvind , DeSantiago Jaime , Shah Anish , Griza Decebal , Chen Yining , Diaz Annette , Darbar Dawood
Published: November 2024

Background:
Increasingly, rare variants in genes encoding sarcomeric proteins like titin, have been associated with early-onset atrial fibrillation (EOAF) in part by the development of an atrial myopathy. Although TTN truncating variants (TTNtvs) have been causally linked with cardiomyopathy syndromes, their role in the pathogenesis of atrial myopathy and EOAF is poorly understood.

Hypothesis:
Atrial myopathy due to a TTNtv creates an arrhythmogenic substrate for EOAF by disrupting sarcomere structure and calcium handling.

Aims:
We investigated electrophysiologic (EP) mechanisms by which a TTNtv (TTN-Val23653 frameshift [FS]) in the A-band of titin causes an atrial myopathy and EOAF utilizing mature human induced pluripotent stem cell-derived atrial cardiomyocytes (hiPSC-aCMs) generated from a large Caucasian kindred with a strong cardiac phenotype.

Methods:
We performed clinical phenotyping and genetic testing of the proband and family members. hiPSC-aCMs generated from the proband and wild-type (WT) were characterized by immunofluorescence (IF) and calcium transients to determine contractility and calcium handling properties.

Results:
The proband presented with EOAF at age 57 years. Transthoracic echocardiography revealed moderate left atrial enlargement and reduced left ventricular ejection fraction (25-30%). Cascade screening of the TTN-FS kindred confirmed co-segregation of the variant with EOAF, dilated cardiomyopathy, heart failure, stroke, and ventricular arrhythmias (Fig. 1A-B). IF staining revealed disrupted sarcomere structures and shortened sarcomere length in TTN-FS iPSC-aCMs vs. WT (Fig. 1C). Calcium transient analysis revealed that TTN-FS iPSC-aCMs had a shorter latency to peak and smaller peak calcium transient amplitudes as compared to WT (Fig. 1D). However, the TTN-FS iPSC-aCMs exhibited a similar time to baseline vs. WT iPSC-aCMs which suggested that the TTNtv was critically involved in the contractile amplitude and peak formation kinetics, but not the relaxation phase.

Conclusions:
Our results suggest that a TTNtv disrupts sarcomere structure and calcium handling leading to an atrial myopathy and EOAF. Therapeutic targeting of the atrial myopathy may prevent the development of EOAF.
Abstract 4147891: The neutrophil-to-lymphocyte ratio as a novel predictor of idiopathic left ventricular versus right outflow tract premature ventricular contractions.
Authors: Ahmad Shaaf , Panuganti Pranati , Lu Edwin , Sanders Mason , Mazzella Anthony , Syed Faisal
Published: November 2024

Background:
The pathogenesis of idiopathic premature ventricular contractions (PVCs) may differ between patients with left- vs right- outflow tract (LVOT; RVOT) PVCs. We hypothesized that PVCs of LVOT origin would be associated with a higher prevalence of inflammatory conditions, such as coronary artery disease (CAD) and aortic sclerosis (AS), and elevation in the inflammatory biomarker, neutrophil-to-lymphocyte ratio (NLR).

Research Question:
Is NLR associated with LVOT PVCs?

Aim:
To compare clinical factors and NLR between patients with left- versus right-outflow tract origin of PVCs.

Methods:
We studied 140 patients undergoing idiopathic outflow tract PVC ablations at our institution. Patients with acute inflammatory conditions were excluded. NLR was calculated by dividing the absolute neutrophil by lymphocyte counts. Associations between clinical variables, NLR, and PVC site of origin at ablation were examined using logistic regression analysis.

Results:
An LVOT site of origin was present in 48 (35%) patients, with significant differences in clinical variables to RVOT patients. Independent predictors of LVOT (vs RVOT) PVCs were chronic kidney disease (CKD, odds ratio [OR]: 5.3, 95% CI: 1.3 - 22.1), age>50 (3.8, 1.6 - 8.6) and NLR (1.35, 0.9 - 1.9). An elevated NLR (≥3.92) was present in 14% of patients with LVOT PVCs vs 6.4% in those with RVOT PVCs (p<0.006).

Conclusions:
We found a significant difference in risk factors between otherwise idiopathic LVOT vs RVOT PVCs. In contrast to those with RVOT PVCs, patients with PVCs of LVOT origin are older and have a higher prevalence of CKD. NLR is an independent predictor for LVOT PVCs. Our findings highlight the potential importance of inflammation as a selective mediator of LVOT PVCs.
Abstract 4147941: Impact of a fractional flow reserve-guided invasive versus conservative management strategy on outcomes in the ISCHEMIA trial
Authors: Zuniga Joshua , Singh Ayesha , Rodman John , Brown David
Published: November 2024

Introduction:
Fractional flow reserve (FFR) is an invasive, lesion-specific surrogate for myocardial ischemia. However, the impact of an FFR-guided invasive strategy on outcomes in chronic coronary disease (CCD) when compared to a conservative strategy is unclear.

Purpose:
To compare the outcomes of patients with CCD enrolled in the ISCHEMIA trial randomized to the invasive (INV) arm who underwent FFR during initial angiography with those randomized to a conservative (CON) strategy with optimal medical therapy alone.

Methods:
The ISCHEMIA data set was obtained from the NHLBI. Patients randomized to the INV arm who underwent FFR at initial angiography were compared to those who were treated with a CON strategy using optimal medical therapy. Unadjusted cumulative event probabilities were estimated using the Kaplan-Meier method. The co-primary endpoints of interest were cardiovascular death (CV) death and myocardial infarction (MI). Secondary outcomes included all-cause mortality and health status as determined by the Seattle Angina Questionnaire (SAQ) angina frequency (AF), quality of life (QoL) and summary scores (SS).

Results:
Of the 5,179 patients with CCD and at least moderate ischemia on stress testing, 2,322 were randomized to the CON strategy and 2,475 were randomized to the INV strategy. Of these, 428 underwent angiography with FFR (INV-FFR). CON patients were younger than INV-FFR patients (64.3 [9.6] years vs. 65.5 [8.7] years, P=0.013). The incidence of hypertension, diabetes, smoking, BMI, or prior MI did not differ between groups. SAQ AF, QoL, and SS scores did not differ between groups at baseline. CON patients had more vessels with greater than 70% stenosis (1.49 [0.9] vs. 1.24 [1.0], P<0.001). Of CON patients, 87% had moderate or severe ischemia vs 83% of INV-FFR patients (P=0.009). The SAQ AF, QoL, and SS scores did not differ between groups at 1, 3 or 5 years. After 5 years of follow-up, there was no difference in freedom from CV death (94% vs 97%, P=0.11) or all-cause mortality (92% vs 93%, P=0.44) in CON compared to INV-FFR groups. However, 5-year freedom from MI was lower in CON patients (87.0% vs 92%, P=0.039).

Conclusion:
Despite selecting for patients with less extensive coronary disease and less severe ischemia, an FFR-guided INV approach did not result in reductions in CV or all-cause mortality at 5 years or improvements in health status at 1, 3 or 5 years. However, INV-FFR was associated with a reduction in MI at 5 years.
Abstract 4147945: Trends in Obesity-related Ischemic Heart Disease Mortality in the United States from 1999 to 2020
Authors: Shaukat Muhammad Talha , Mohsin Aleenah , Chaudhary Ahmed Jamal , Rehman Wania , Mirza Abdullah Tahir , Rehman Aqeeb Ur , Hayat Malik Saad , Qureshi Muhammad Ahmad
Published: November 2024

Background and Objectives:
Obesity, especially central obesity, is closely linked to both traditional and novel risk factors for Ischemic Heart Diseases (IHD). In view of the ongoing obesity epidemic in the United States, here we aim to assess the trends in obesity-related IHD mortality in the United States from 1999 to 2020, and identify the racial, local, regional, age and gender-wise differences in this trend.

Methods:
Data from CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database was examined from 1999 to 2020 for IHD and obesity-related mortality in individuals of all ages. Both crude mortality rates and age-adjusted mortality rates (AAMR) per 100,000 individuals were determined. Using joinpoint regression analysis, annual percentage changes (APC) in AAMR were calculated.

Results:
A total of 226,267 deaths occurred due to obesity related ischemic heart disease from 1999 to 2020 in the United States. There was a uniform rise in AAMR from 1999 to 2020, with an AAPC of 5.03 (95% CI 4.5-5.4). Overall, males had a higher AAMR than females (AAMR men=3.9; women=2.2). The incline in the mortality rates was also more prominent in males (AAPC=5.11; 95% CI 4.1-6.1), especially those aged 55-64 (AAMR=8.5). Age-adjusted mortality was the highest among Black patients (
AAMR=?
). Significant geographical difference was also observed, with the highest mortality observed in the midwestern states (AAMR: Midwest 3.3; West 3.1; South 2.9; Northeast 2.8). More specifically, Vermont (AAMR=10.4) had the highest AAMR and Alabama (AAMR=1.5) had the lowest. It was also found that non-metropolitan areas (AAMR=4) had higher AAMRs than metropolitan areas (AAMR=2.9).

Conclusion:
Obesity-related IHD mortality is on a rise in the United States. Highest mortality rates can be observed among Black people, males, patients in the Midwestern states and rural locale, and ages 55-64.
Abstract 4147947: Social Support and Blood Pressure Control Among Older US Adults (1999-2008)
Authors: David Michelle , Choi Eunhee , Fernandez Sedano Brandon , shurovi sumayya , Dansoko Fatma , Abdalla Marwah
Published: November 2024

Background:
Blood Pressure (BP) control is less likely among older adults compared to other age groups in the National Health and Nutrition Examination Survey (NHANES). Lack of social support is a growing epidemic among older adults and is associated with a higher prevalence of hypertension. It is unclear whether BP control among older adults with and without social support has changed over time.

Aim:
To determine if BP control among older adults with and without social support has changed from 1999 to 2008.

Methods:
We conducted weighted cross-sectional analysis of NHANES data from 1999 through 2008 (5 cycles). BP control was defined as BP <140/<90 mmHg. Having social support was assessed during 5 cycles. The proportion of adults with controlled BP was calculated for adults with and without social support and by demographics.

Results:
The analysis included 5,351 adults ≥60 years with systolic/diastolic BP ≥140/≥90 mmHg on antihypertensive medication; 45.1% were 60-69 years old, 19.4% were >80 years, 58.8% were female, 80.6% were non-Hispanic White adults. Among adults with social support, the proportion with controlled BP increased from 29.1% (95% CI, 24.3-33.8%) in 1999-2000 to 48.5% (95% CI, 44.1-52.9%) in 2007-2008 (p<.0001 for trend). Among adults without social support, the proportion with controlled BP increased from 13.5% in 1999-2000 and was 51.7% in 2003-2004 and then declined to 46.4% in 2007-2008 (p<.0001 for trend; Table 1). For those with social support, women, non-Hispanic White adults, and college graduates had consistently higher BP control rates compared to their counterparts. For those without social support, men had higher BP control compared to women except in 2005-2006. Non-Hispanic White adults had high BP control rates consistently. The proportion with controlled BP was highest for adults with <high school education in 1999-2000 then declined to 41.4% in 2007-2008.

Conclusion:
Among older adults with social support the prevalence of BP control increased between 1999-2008. Future research focusing on social support interventions for hypertension management should address possible disparities based on sex, race/ethnicity, and education.
Abstract 4147977: The association of Fontan fenestration patency on cardiopulmonary exercise performance in children and adults
Authors: Ortega Aviles Laura , Santos Patarroyo Sebastian , Opp Derek , Cetta Frank , Allison Thomas
Published: November 2024

Background:
Many children born with single ventricle physiology are palliated with Fontan operation, which may include a fenestration creation. This has been demonstrated to improve short-term outcomes after surgery. Reduced exercise capacity has been shown to be a predictor of prognosis in Fontan patients.

Aim:
We sought to compare cardiopulmonary exercise test (CPET) data between fenestrated and non-fenestrated Fontan patients.

Methods:
We conducted a retrospective cohort study of 185 patients referred for CPET from 2011 to 2024. Patients with complete CPET data were included. Type of Fontan, comorbidities, and echocardiogram data were ascertained electronically. Patients were divided into 2 different groups according to the fenestration patency. Fisher’s exact test or chi-square was used to compare categorical variables. T-test and Turkey-Kramer were used to compare continuous variables. Adjustment using General Lineal Models procedure were used to identify any confounder that could affect the results. P value <0.05 was considered significant.

Results:
142 patients were classified in the non-fenestrated (NF) group, and 43 in the fenestrated group (FF). Baseline characteristics of both groups are shown in
Table 1.
From the evaluated CPET variables, the minute ventilation-carbon dioxide production (VE/VCO2) was higher in the FF (p=<0.001), and oxygen saturation at peak exercise (SatO2) was lower in this group (p= <0.001)
(Figure 1).
There was no significant difference between peak oxygen consumption (VO2) between groups. When adjusted by comorbidities only VE/VCO2 nadir, slope and peak SatO2 were statistically significant different between groups
(Table 2).

Conclusion:
Ventilatory variables showed significant differences when fenestration was presented, secondary to V-Q mismatch from increased right to left shunt. Despite the theoretical advantage of increased cardiac output from Fontan fenestration, exercise performance was similar between both groups.
Abstract 4148117: Efficacy of TRISCORE in predicting the long-term survival in patients undergoing transcatheter tricuspid valve replacement or surgical tricuspid valve replacement: a systematic review and meta-analysis
Authors: Katsuyama Eric , Fernandes Julia , Fukunaga Christian , Andrade Naieli , Prata Alonzo , Scardini Pedro Gabriel , Falco Neto Wilson , Coan Ana Carolina , Petri Santos Pinheiro Rafael , Gioli-Pereira Luciana
Published: November 2024

Background:
Tricuspid regurgitation (TR) is a prevalent disease in the population and is usually progressive. Most patients are treated with conservative management due to the risk involving transcatheter tricuspid valve replacement (TTVR) and surgical tricuspid valve replacement (STVR). The TRI-SCORE was developed to evaluate the severity of patients with TR and their risk of undergoing a correction procedure. However, there is still controversy regarding the cutoff value of the score. Therefore, we aim to perform a systematic review and meta-analysis comparing the cutoffs ≥6 with <6 of the TRI-SCORE in patients with TR undergoing TTVR or STVR.

Methods:
We systematically searched Embase, Pubmed, and Cochrane for randomized controlled trials (RCT) and observational studies comparing cutoffs of >=6 with <6 of the TRI-SCORE in patients with TR undergoing STVR or TTVR. We focused on the primary outcomes of (1) all-cause mortality. A prespecified subgroup analysis was performed comparing STVR with TTVR. Odds Rartion(ORs) with 95% confidence interval (CI) were pooled across studies using a random effect model.

Results:
We included three studies encompassing 2063 patients, of whom 441 had a cutoff ≥6 (42.12%) at the TRISCORE.. The mean follow-up was 2.5 years). In the pooled analysis, our results show all-cause mortality significant decrease at the cutoff of <6 in TRISCORE, with lower mortality events (OR 1.15; 95%CI 1.06-2.26; p<0.01; Fig.1). The subgroup analysis revealed a significant subgroup difference between STVR and TTVR for the outcome of all-cause mortality (p<0.01) favoring the STVR group (OR 2.13; 95%CI 1.51 - 3.01;p<0.01; Fig.1).

Conclusion:
In our meta-analysis of patients with TR undergoing TTVR or STVR, a cutoff ≥ 6 at the TRISCORE was associated with a worse prognosis, with significantly higher rates of all-cause mortality and 30-day mortality. The subgroup analysis demonstrated a higher benefit in =TTVR subgroup
Abstract 4148154: Sex Outcomes associated with AngioVac Debulking of Tricuspid Valve Endocarditis at an Academic Tertiary Care Hospital
Authors: Palatnic Leonard , Sheppard John , Zlotnick David
Published: November 2024

Background:
The AngioVac mechanical aspiration system has recently emerged in the literature for its use in the percutaneous debulking of intracardiac vegetations and masses. However, description of gender-related outcomes and analysis has remained sparse. We present our unique experience with the AngioVac system in men compared to women with tricuspid valve infective endocarditis (TVIE) and high or prohibitive operative risk.

Methods:
We performed a retrospective, in-hospital analysis comparing all men and women who underwent percutaneous AngioVac vegetation debulking in the setting of TVIE from January 2017 to December 2023 at a large academic tertiary care hospital.

Results:
Of the 62 patients who underwent AngioVac debulking between January 2017 and December 2023, 32 (51.6%) were women with a mean age of 35.921 +/- 9.976 years. The mean length of the vegetation was 19.581 +/- 7.478 mm and time (days) to blood culture clearance was 8.667 +/- 7.799. Of the 62 patients, 30 (48.4%) were men with a mean age of 41.711 +/- 13.627 years. The mean length of the vegetation was 21.759 +/- 7.836 mm, and time (days) to blood culture clearance was 6.188 +/- 3.692. During their index admission, between both men and women, there was no difference in time (days) from procedure to blood culture clearance (P-value: 0.239, 95% CI: -6.717 – 1.758). There was no difference in the risk of stroke (P-value 0.489, 95% CI: 0.00 – 5.852), systemic embolism (P-value: 0.577, 95% CI: 0.124 – 164.863), vascular access bleeding (OR: 0.966, 95% CI: 0.011 – 78.416), or blood transfusion requirement (P-value 0.799, 95% CI: 0.270 – 2.622). There was no difference in risk of recurrent endocarditis (P-value: 0.712, 95% CI: 0.265 – 9.147) or worsening tricuspid regurgitation post-procedure (P-value: 0.470, 95% CI: 0.075 – 3.113). Finally, there was no difference in the length of hospital stay (days) between both groups (P-value: 0.990, 95% CI: -11.748 – 11.605), and there was no difference in in-hospital mortality post-procedure (P-value: 0.354, 95% CI: 0.384 – 218.472). Notably, neither of the two groups required surgical or percutaneous tricuspid valve replacement.

Conclusion:
This retrospective, comparative analysis adds to the growing literature that Angiovac debulking may be a safe and effective long-term alternative to cardiac surgery in both men and women with TVIE and elevated perioperative risk.
Abstract Or101: Evaluating the National Institutes of Health Pipeline for Resuscitation Science Investigators
Authors: Coute Ryan , Huebinger Ryan , Perman Sarah , Del Rios Marina , Kurz Michael
Published: November 2024

Background:
The pipeline of investigators studying resuscitation science and their contributions to the field after attaining research independence are largely unknown. Our objective was to identify and compare the number of National Institutes of Health (NIH) K awardees studying CA vs. stroke research and determine both cohorts’ success rates in transitioning to independent R01 funding.

Methods:
The NIH RePORTER database was queried from 2008 to 2018 to identify CA grants using published methodology. The CA grants were filtered by activity code to identify mentored individual K awards (defined as K01, K08, K23, or K99). A second query was then performed using principal investigators (PIs) for each K award, and the results were filtered to identify all R01 grants with the former K award recipients listed as the contact PI/PD or other PI/project lead. Stroke grants from the same epoch were exported from the NIH categorical spending reports, where stroke research is a distinct line item. Subsequent R01 funding for the stroke grants was identified using the above process. The outcome measures include: total K awards, R01 conversion within 5 or 7 years from K award receipt, and the proportion of awardees who remained focused on CA or stroke research at the R01 level. Data were presented as counts, proportions, and median/interquartile ranges. Proportions were compared using the Chi-Square test or Fisher’s exact test. P-values < 0.05 were considered statistically significant.

Results:
A total of 857 CA grants were identified, including 272 individual awards, compared to 8,520 stroke grants with 2,788 individual awards. K awards comprised 11.4% of CA grants versus 6.6% for stroke grants (p=0.003). The R01 conversion rate was 51.6% for CA and 57.3% for stroke (p=0.555). The median transition time from K to R01 was 5.5 years (IQR 4-6) for CA and 5 years (IQR 4-7) for stroke. CA K awardees secured 27 funded R01s, while stroke counterparts received 163. A total of 48.1% of CA K awardees continued CA research at the R01 level, versus 63.8% for stroke (p=0.121).

Conclusion:
Although the volume of federally funded grants and K awards focused on CA research is significantly smaller than that of stroke research, the outputs for both fields appear similar. More than half of R01 awards from the CA cohort departed from their original content focus. These findings should help inform efforts to expand the resuscitation science young investigator pipeline.
Abstract Or113: Response Times and Survival for Out-of-Hospital Cardiac Arrest Patients in Public Housing.
Authors: Flarup Louise , Malta Hansen Carolina , Kjaerholm Sofie Have , Ettl Florian , Krammel Mario , Sulzgruber Patrick , Krychtiuk Konstantin , Stieglis Remy , van Schuppen Hans , Tan Hanno , Schnaubelt Sebastian , Ersbøll Annette Kjær , Folke Fredrik , Juul Grabmayr Anne
Published: November 2024

Introduction:
Public housing areas have a high incidence of out-of-hospital cardiac arrest (OHCA) and are potential targets to improve OHCA survival. A fast emergency medical services (EMS) response is crucial to achieve OHCA survival. However, EMS response times in public housing areas remain unexplored.

Research Question:
Are EMS response times longer in public housing areas than in other residential areas?

Aim:
The primary objective was to investigate EMS response times for OHCA in public housing compared to other residential areas; differences in initial shockable rhythm and 30-day survival were secondary objectives.

Method:
Non-EMS witnessed OHCAs within residential areas from Amsterdam (2016-2021), Copenhagen (2016-2021), and Vienna (2018-2021) were included from the Amsterdam Resuscitation Studies and the Danish and Viennese Cardiac Arrest registries, excluding missing data on age, sex, and EMS response times. OHCAs were divided into public housing and other residential areas. Early dispatch was defined as <90 seconds from incoming call until dispatch of EMS vehicle; early arrival as < 6 minutes from dispatch of EMS vehicle until arrival on scene. We compared early dispatch, early arrival, initial shockable rhythm, and 30-day survival in public housing vs. other residential areas using a generalized estimation equation model adjusted for age, sex, and city and presented as adjusted odds ratios (aOR).

Results:
We included 8,659 patients, of which 2,883 (33,3%) occurred in public housing areas. OHCA patients in public housing areas were younger, more often female, less likely bystander witnessed, and less often received bystander interventions compared to other residential areas (Table 1). Comparing OHCAs in public housing vs. other residential areas (reference), early dispatch was 38.0% vs. 39.3%, aOR 0.83 [95% CI 0.73-0.93]; early arrival, 41.6% vs. 45.7%, aOR 0.84 [95% CI 0.76-0.92]; initial shockable rhythm, 17.0% vs. 22.8%, aOR 0.70 [95% CI 0.62-0.78]; and 30-day survival, 8.7% vs. 14.1%, aOR 0.57 [95% CI 0.48-0.66] (Figure 1).

Conclusion:
Dispatch and arrival of EMS vehicles took longer for OHCA patients in public housing compared to other residential areas, followed by a lower probability of initial shockable rhythm and 30-day survival. These findings suggest the EMS system as a relevant target for improving OHCA survival in public housing areas.
Abstract Sa103: Characterizing the Apnea Interval During Endotracheal Intubation and Out-Of-Hospital Cardiac Arrest Resuscitation
Authors: King Julia , Blackwood Jennifer , Kwok Heemun , Sharar Sam , Rea Thomas , Murphy David
Published: November 2024

Background:
Guidelines for resuscitation of OHCA recommend that advanced airway management be performed without interrupting chest compressions. However, the extent and impact of interrupting ventilation during OHCA resuscitation is unknown. We described the apnea interval that occurs during endotracheal intubation (ETI) and its associated clinical outcomes.

Methods:
We conducted a cohort investigation of adult ventricular fibrillation (VF)-OHCA patients who underwent attempted paramedic ETI during resuscitation in a metropolitan EMS system from 2017
–
19. We defined apnea interval as the elapsed time from the last breath delivered before an ETI attempt to the first breath delivered after the attempt. We collected patient, care, apnea interval and outcome data from review of OHCA and airway registries linked to digital defibrillator recordings. The defibrillator recording included an audio channel, ECG, transthoracic impedance, and end-tidal carbon dioxide biosignals. Using multivariable logistic regression, we determined the relationship between apnea interval (longest quartile [>120s] vs the shorter 3 quartiles [<120s]) and two outcomes: return of spontaneous circulation (ROSC) and survival to hospital discharge.

Results:
Among 185 eligible patients, median age was 63 [54
–
74] years, 32 (17%) were female, 181 (98%) had successful prehospital ETI, 106 (57%) achieved ROSC, and 53 (29%) survived to hospital discharge. The median apnea interval during attempted ETI was 89s [65
–
115s]: 16s pre-laryngoscopic, 53s laryngoscopic, and 7s post-laryngoscopic. Median chest compression fraction was 85% [79
–
89%] overall and 90% [76
–
97%] during the apnea interval. Non-airway care during the apnea interval occurred in more than half (94, 51%) of cases, most commonly as medication administration (68, 37%), defibrillation (36, 19%), and multiple laryngoscopic attempts (13, 7%). Apnea interval >120s compared to <120s was associated with a lower likelihood of ROSC (AOR=0.41 [0.20
–
0.83]) but not hospital discharge (AOR=0.84 [0.38
–
1.88]).

Conclusions:
In this cohort of VF-OHCA patients, the median apnea interval during attempted ETI was 89s, with an interquartile range of 50s. Apnea interval >120s was associated with lower likelihood of ROSC but not hospital discharge. Given its variability and relationship to near-term resuscitation outcomes, the apnea interval may be a modifiable intervention that can affect OHCA survival, supporting the need for further investigation.
Abstract Sa1204: Implementing Family-Centered CPR and AED Education for Hispanic and Black Americans in Churches
Authors: Pobee Ruth , Kotini-Shah Pavitra , Patel Bhumi , Schwerin O'Reilly Courtney , Del Marina
Published: November 2024

Background:
Despite the high rates of cardiac arrest incidence among minoritized groups, access to bystander cardiopulmonary resuscitation (CPR) training and automated external defibrillator (AED) use is limited.

Research Question:
How can we implement a program to provide CPR and AED education to Black and Hispanic American families within churches?

Methods:
An implementation study was conducted to provide CPR and AED education to individuals, parents, and children from Black and Hispanic churches in Will and DuPage counties, Illinois. In this process, the research team coordinated with church leaders to promote and register participants for CPR and AED education. Field observations, participant numbers, training environments, questions from participants, and recruitment challenges were documented. Weekly meetings were held by the research team to discuss field experiences and address challenges.

Results:
Out of 17 churches contacted, 6 leaders signed permission letters; responses from the remaining 11 are currently pending. Training has been conducted in 4 churches thus far. In these 4 churches, 65 participants registered, and 53 attended, including 27 families (6 couples and 21 families with children) and 26 individuals. Challenges encountered in implementing the trainings in the churches included religious concerns about science, immigration issues requiring confidentiality, and older participants needing approval from their adult children. Many participants dropped out due to scheduling conflicts or job responsibilities. Some parents couldn't attend with their children, though most couples participated. Despite these challenges, church leaders actively participated and connected the research team with other churches, broadening the study's reach. One participant, having experienced their child's cardiac arrest, expressed a strong desire to improve their CPR skills.

Conclusion:
Family-centered CPR and AED education was successfully implemented in churches which attracted families, hence providing an avenue to increase access to CPR and AED education for minoritized groups in a comfortable setting. Overall, participants appreciated the opportunity and once engaged, were eager to acquire or practice these skills. Venues such as churches are feasible implementation settings to promote time-sensitive, life-saving skills of bystander CPR among minority groups.
Abstract Sa204: Mitochondrial transplantation improves hemodynamics after cardiac arrest and resuscitation in pigs
Authors: Endo Yusuke , Becker Lance , Miyasho Taku , Sugita Chihiro , Hayashida Kei
Published: November 2024

Introduction:
Mitochondrial transplantation (MTx) is an innovative technology that has the potential to attenuate ischemia-reperfusion injury and improve outcomes. Our recent studies have demonstrated that MTx significantly enhances survival and neurological outcomes after resuscitation in a rat model of cardiac arrest (CA).

Objective:
This study aims to evaluate whether MTx, applied immediately after return of spontaneous circulation (ROSC), can improve cardiovascular parameters during the acute phase following CA and resuscitation using a pig ventricular fibrillation (VF)-induced CA model.

Methods:
Sixteen LWD pigs (age 3-4 weeks, weight 29-34 kg) were subjected to VF-induced CA via intravenous potassium chloride injection. Eight minutes after CA, mechanical ventilation with 100% O2, mechanical chest compressions, and administration of epinephrine and defibrillation according to the current ACLS guidelines with minor modifications. Three pigs that did not achieve ROSC within 20 minutes were excluded from the analysis. Among the remaining 13 pigs, 7 received intravenous respiration buffer as a vehicle (vehicle group, n=7) and 6 received intravenous MTx immediately after ROSC (MTx group, n=6). The donor mitochondria were freshly isolated from rectus femoris muscle of healthy pigs a few hours before MTx. The animals were observed until 240 minutes after ROSC.

Results:
All pigs successfully went into VF-CA after potassium administration. The time to ROSC was 370 ± 184 seconds in the vehicle group and 420 ± 62 seconds in the MTx group, with no significant difference between the two groups. The vehicle group showed a significant decrease in mean arterial pressure (MAP) compared to baseline after ROSC, while the MTx group prevented the decrease in MAP, maintaining significantly higher MAP than the vehicle group (
Fig A
). Transpulmonary thermodilution revealed that MTx maintained stroke volume and cardiac output (CO) at 240 minutes after ROSC, which were significantly higher than those in the vehicle group (
Fig B
). Blood gas analysis revealed significantly higher central venous oxygen saturation (ScvO
2
) in the MTx group compared to the vehicle group at 30 minutes after ROSC (
Fig C
).

Conclusions:
Intravenous administration of MTx immediately after ROSC improved cardiovascular parameters and maintained the oxygen supply-demand balance in a pig model of CA. MTx shows promising potential for attenuating cardiovascular instability and improving overall outcomes after CA.
Abstract Sa303: Active Decompression during Automated Head-up Cardiopulmonary Resuscitation
Authors: Pourzand Pouria , Moore Johanna , Suresh Mithun , Salverda Bayert , Hai Hamza , Kaizer Alexander , Duval Sue , bachista kerry , Lurie Keith , Metzger Anja
Published: November 2024

Background:
Active compression-decompression cardiopulmonary resuscitation (ACD-CPR) combined with an impedance threshold device (ITD) and controlled head-up positioning, collectively termed AHUP-CPR, is associated with improved outcomes compared with conventional CPR (C-CPR). Active decompression (AD) forcibly lifts the anterior chest wall with suction after each compression, while the ITD simultaneously impedes airflow into the lungs. AD and ITD synergistically lower intrathoracic pressure during decompression, improving venous return, ventricular refilling and cardiac output. Concurrently, head-up positioning lowers intracranial pressures and improves cardiac preload. This pig study focused on the physiological role of AD during AHUP-CPR, simulating real clinical scenarios.

Methods:
Ten male and female farm pigs (~40 kg) were anesthetized, intubated and ventilated. Hemodynamic parameters, end-tidal CO2 (ETCO2), and biventricular pressure-volume loops were recorded continuously. Ventricular fibrillation was induced and left untreated for 10 mins. Then, after 2 min of automated C-CPR in the flat position, AHUP-CPR with a 3 cm lift above the neutral position of the chest was performed for 13 min. AD was then abruptly discontinued, restarted 1 min later, and increased incrementally every min to up to 4 cm of active lift. Data were analyzed with a linear mixed-effects model, using random intercepts for individual pigs.

Results:
Upon cessation of AD, coronary and cerebral perfusion pressures, compression and decompression aortic pressures, compression right atrial pressure, ETCO2, right and left ventricular preload, compliance, stroke volume and cardiac output all decreased immediately and significantly (p<0.01), whereas decompression right atrial and biventricular pressures increased. With restoration of AD, physiological parameters returned to ≥ 90% of pre-AD discontinuation values (Figures 1 and 2).

Conclusion:
Full chest wall lift, achieved with
>
3 cm of AD, was needed to maintain and optimize hemodynamics during AHUP-CPR in pigs. After pausing AD, incremental restoration of AD resulted in nearly complete restoration of peripheral and central hemodynamic measures. These observations support the benefit of and need for ≥3 cm of AD to optimize AHUP-CPR. Effective means to generate ≥3 cm of AD should be considered when implementing and developing AHUP-CPR devices to optimize outcomes.
Abstract Sa308: Augmentation of Intraventricular Stroke Volume during Head Up Position CPR: Implications for Clinical Outcomes
Authors: Pourzand Pouria , Moore Johanna , Metzger Anja , Suresh Mithun , Salverda Bayert , Hai Hamza , Duval Sue , bachista kerry , Lurie Keith
Published: November 2024

Background:
Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR), an impedance threshold device (ITD) and controlled, gradual, automated head and thorax elevation, collectively termed automated Head Up Position (AHUP) CPR, increases cerebral perfusion pressure (CerPP), brain blood flow, coronary perfusion pressure (CorPP), end tidal CO2 (ETCO2) and cerebral oximetry (rSO2) in animal models when compared with conventional (C) CPR. AHUP-CPR in patients is associated with increased neurologically favorable survival versus C-CPR. This study tested the hypothesis that AHUP CPR will increase cardiac stroke volume (SV) and other hemodynamics compared with C-CPR in a porcine model of cardiac arrest.

Methods:
Farm pigs (n=15) were sedated, anesthetized, and ventilated. Hemodynamics, including intracardiac conductance catheter based biventricular (BiV) pressure-volume (PV) loops, were continuously measured and recorded. After 10 minutes of untreated ventricular fibrillation, C-CPR was performed for 2 minutes in the supine position using an automated CPR device designed for pigs at a rate of 100 compressions/minute, depth of 21% of the chest antero-postero diameter, a 50% duty cycle, and no active decompression. ACD+ITD was then performed with 3 cm of active decompression for 2 minutes, followed by AHUP-CPR, where the head and thorax were initially raised to 10 cm and 8 cm for a 2-minute priming phase, followed by elevation over the next 2 minutes to 24 cm and 9 cm. A linear mixed-effects model with a random intercept for individual pigs was used for statistical analysis.

Results:
CerPP, CorPP, ETCO2, and rSO2, as well as BiV SV and cardiac output, increased progressively and significantly with implementation of AHUP-CPR (p<0.05). C-CPR generated a right ventricular (RV) SV of 25.0 mL (48% of baseline pre-VF) and left ventricular (LV) SV of 17.5 mL (39% of baseline). ACD+ITD significantly increased RV and LV SV by an average of ~ 48% versus C-CPR; AHUP-CPR further increased BiV SV by an average of ~ 83%, reaching 85% and 75% of RV and LV pre-VF values, respectively. (Figure 1)

Conclusion:
This study demonstrated biventricular stroke volume is significantly augmented with AHUP-CPR versus C-CPR or ACD+ITD in the flat position. These findings, together with AHUP-enhanced higher ETCO2, rSO2, and CerPP values versus C-CPR or ACD-CPR in the flat position, help explain the improved clinical outcomes associated with early use of AHUP-CPR.
Abstract Sa311: Abdominal Counter-Constriction Versus Abdominal Binding as Hemodynamic Adjuncts to Circumferential Thoracic Cardiopulmonary Resuscitation
Authors: Paradis Aidan , Gaddy David , Moodie Karen , Mader Timothy , Dufresne Alexandre , Couturier Christine , Dufresne Simon , Davis Daniel , Sims Christopher , Paradis Norman
Published: November 2024

Introduction:
Previously, some investigators have reported that static abdominal binding (
AB
) is adjunctive to sternal piston-based CPR. Others have found that it is not. Circumferential thoracic CPR (
CT-CPR
) is an alternative pump mechanism and may have enhanced hemodynamics and safety. We have previously reported that addition of pulsatile abdominal counter-constriction (
ACC
) further improves the hemodynamics of CT-CPR. Simple AB requires less energy than ACC, however the efficacy of AB as an adjunct to CT-CPR has not been studied.

Hypothesis:
One of the CTA-CPR abdominal adjuncts, ACC or AB, may be associated with greater indicators of hemodynamics.

Methods:
Ventricular fibrillation was induced in female Yorkshire swine (n = 3, 30 kg). CPR was provided by a pneumatic CT-CPR prototype and circumferential pneumatic bands. Forty-five-second epochs of CT-CPR with ACC or AB were performed. Aortic (
Ao
) and right atrial (
RA
) pressures were measured using micromanometer catheters and coronary perfusion pressure (
CPP
) was calculated. The change in CPP (
Delta-CPP
) from the beginning to the end of each treatment epoch was the principal indicator of hemodynamics. Results from all experiments were grouped by treatment type and subjected to a paired t-test.

Results:
The delta perfusion pressures are shown in the Figure. Final aortic pressures averaged 62 and 37mmHg for static AB and pulsatile ACC respectively. Final right atrial pressures averaged 45 and 8mmHg for static AB and ACC respectively. These yielded final CPPs of 17 and 29mmHg for static AB and pulsatile ACC respectively. Pulsatile counter-constriction was associated with much higher final CPP in every treatment pair.

Conclusion:
CT-CPR with adjunctive abdominal binding consistently increased both Ao and RA pressures. However, compared to AC, AB showed a much greater RA pressure increase, resulting in lower CPPs and Delta-CPPs. Abdominal counter-constriction may be superior to abdominal binding as an adjunctive modality in circumferential thoracic CPR. These results are similar to those reported by JT Niemann and JM Criley in 1984 using piston-based CPR. They observed that it appeared to raise vascular pressures but lower CPP.