bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 4147071: Lupus Mitral Valve Disease Masquerading as an Absent Posterior Mitral Valve Leaflet
Authors: DiGregorio Helene , Khan Madiha , El Hajj Elia , Dhore Aneesh , Yao David , Reul Ross , Faza Nadeen 
Published: November 2024

Introduction/Background:
Marantic endocarditis and valvulitis are cardiovascular manifestations of autoimmune disease that can be challenging to diagnose.

Case Presentation:
A 23-year-old female with SLE presented with brief episodes of intermittent left eye vision loss and left sided weakness. She also reported fevers, a malar rash, and new onset dyspnea on exertion.

Serologic work-up was consistent with an SLE flair. MRI of the brain/orbits demonstrated two acute infarcts in the frontal and parieto-occipital lobes. CTA head and neck did not show any large vessel vasculitis. Transthoracic echocardiography showed thickening of the mitral valve (MV) leaflets, with moderate MR and an elevated MV gradient of 11 mm Hg. The posterior leaflet was not visualized, concerning for absent or hypoplastic posterior leaflet. A transesophageal echocardiogram was performed and showed severe thickening of posterior mitral leaflet with restricted motion and shortening secondary to extensive thrombus burden. In addition, there was evidence of thrombus at the tip of the anterior MV leaflet. The patient was managed with high dose steroids and warfarin for SLE flair and marantic endocarditis, respectively.
Two months later, she presented with amaurosis fugax. Cardiac MRI showed thickened MV leaflets with delayed enhancement along the posterior leaflet and MV annulus consistent with an organized thrombus. After multidisciplinary discussion, the patient underwent surgical MV replacement with a bioprosthetic valve. Intraoperative evaluation revealed severely thickened MV leaflets with fused commissures. In addition, there was fusion of the posterior leaflet and lateral side of the anterior leaflet to the papillary muscles as a result of thickened and shortened chordae. These findings were believed to be due to inflammatory changes involving the MV apparatus. Surgical pathology confirmed the diagnosis of valvulitis. The patient has done well post operatively.

Conclusion:
Valvulitis and marantic endocarditis can have devastating consequences if not treated promptly. Use of multimodality imaging can aid in the diagnosis. Multidisciplinary discussion is critical in achieving desired clinical outcomes.
Abstract 4147438: Use of Impella RP Flex for Right Ventricular Failure (RVF): A Single Center Review
Authors: Heyer Marissa , Walters Patricia , Stewart Scott , Mody Kanika , Landers David , Batsides George , Dudiy Yuriy , Anderson Mark 
Published: November 2024

Introduction/Background:
Right ventricular failure (RVF) is the inability of the RV to adequately perfuse pulmonary circulation and sufficiently fill the LV; it increases morbidity, mortality, and length of hospital stay. In critically ill patients, three main etiologies of RV failure are excessive preload, excessive afterload, and insufficient myocardial contractility. In addition to medical management, some patients at risk for refractory cardiogenic shock may require temporary mechanical circulatory support (TMCS).

Research Questions/Hypotheses:
The Impella RP flex (Abiomed, Danvers, MA) has provided an option for percutaneous RV support through the internal jugular vein and allows for early rehabilitation of complex cardiac patients.

Methods/Approach:
Consecutive cases at our center using the Impella RP flex were evaluated for hemodynamics and quality measures.

Research/Data:
Thirteen patients received RP flex support: 3 patients with pulmonary hypertension during mitral valve repair or replacement, 4 patients for prophylactic placement pre-LVAD, 3 patients with intraoperative placement during CABG, 2 patients with acute myocardial infarction, and 1 patient for salvage therapy. The average length of stay for our patients was 30.23 days; average duration of Impella support was 4.46 days.

Twelve patients required inotropic support with milrinone and 91.7% received epinephrine. Of the 12 patients who required vasodilators, 100% received inhaled nitric oxide and 50% received sildenafil. Four patients required sildenafil at the time of discharge (36.4%).
Internal jugular vein cannulation and intracorporeal support allows capable patients to participate in physical therapy early in the recovery process. Of our cohort, 30.77% of patients were successfully assisted out of bed to chair and 15.38% ambulated with assistance. All patients had pre- and post-creatinine levels collected, with an average pre-implantation creatinine level of 1.48 and post-explantation level of 1.76. The average pre-implantation lactic acid level was 4.75; only 11 patients had post-explantation lactic acid measurements collected, which averaged 3. Eleven patients were successfully discharged and no patients required home inotropes.

Conclusions:
The RP flex allows for RV unloading for patients requiring TMCS; it is best used early or prophylactically for patients who are otherwise high-risk for complications or who may require high-dose pressors and prolonged ICU level of care.
Abstract 4147920: Optimal Approach to Generate Patient-Level Decision from Study-Level Predictions Using a Multimodal Deep Learning Model for Detecting Transthyretin Cardiac Amyloidosis
Authors: Finer Joshua , Haggerty Chris , Jing Linyuan , Jain Sneha , Einstein Andrew , Maurer Matthew , Raghunath Sushravya , Rocha Daniel , Elias Pierre , Poterucha Timothy 
Published: November 2024

Background:
Transthyretin cardiac amyloidosis (ATTR-CA) is an underdiagnosed cause of heart failure and early disease detection is essential for improving outcomes. We previously developed a multimodal deep learning model, named ATTRact-Net, leveraging electrocardiogram (ECG) and echocardiogram data that can identify patients with ATTR-CA. Patients at risk for ATTR-CA often have multiple ECGs and echos available for analysis, leading to many different risk predictions by AI models. There is little evidence on how to go from study-level prediction to patient-level decision. We studied varying methods to integrate multiple ECG/echo pair predictions to maximize model performance in the detection of ATTR-CA. We hypothesized that retaining the patient-level mean risk across the prior 2 years would improve model performance compared to using maximum predicted risk.

Methods and Results:
ATTRact-Net was originally trained on 799 patients with 22,344 ECG/echo pairs completed within 2 years of PYP scan. Previously published performance of the model showed an AUROC of 0.83 in internal testing. For this study, a new test set composed of an outside hospital not used for training, had 422 patients with 12,387 pairs and ATTR-CA prevalence of 23%.

In this new hospital’s population, we tested model performance using four patient-level aggregation methods (mean, median, max, and no aggregation) for integrating predictions across multiple ECG/echo pairs. Performance was compared based on the area under the receiver operating characteristic curve (AUROC), Diagnostic Odds Ratio (DOR), and F1 score using the Youden index as the optimal threshold.
In the external validation dataset, the model achieved AUROCs of 0.78 (max), 0.82 (mean), 0.82 (median) and 0.82 (none) shown in Figure 1A. Mean and median aggregation outperformed both max and no aggregation by F1-score and DOR (Figure 1B).

Conclusion:
For a multimodal AI model detecting ATTR-CA, aggregating ECG/echo risk predictions using mean or median from the prior 2 years considerably improved diagnostic yield compared to using patient’s maximum score or no aggregation. A prospective clinical trial is underway using this strategy for early diagnosis of ATTR-CA across our healthcare system.
Abstract 4148199: Enhanced Diagnostic Value of High Sensitivity Troponin I After Indexation for Myocardial Mass, Renal Function and Age: the BioHEART-CT Study
Authors: Fathieh Sina , Gray Michael Patrick , Murtagh Gillian , Tang Owen , Vernon Stephen , Grieve Stuart , Figtree Gemma 
Published: November 2024

Background:
Atherosclerotic coronary artery disease (CAD) often goes undetected until acute myocardial infarction (AMI). High-sensitivity troponin (hs-cTn) assays, known for diagnosing acute coronary syndrome, are being explored for detecting subclinical CAD. Studies suggest hs-cTn's potential in identifying coronary atherosclerosis, indicating its value in early CAD screening.

Method and Results:
This study used the BioHEART-CT cohort (2015-2021) of 2,000 adults undergoing CCTA for known or suspected CAD, excluding those with prior cardiomyopathy, MI, or coronary revascularization. CAD severity was assessed using CACS and Gensini scores. Myocardial mass was estimated via automated segmentation. Hs-cTnI was measured using Abbott ARCHITECT i1000 and Beckman Access 2 assays.

We examined the association between hs-cTnI levels and the extent of myocardial involvement. Hs-cTnI significantly correlated with the total number of coronary artery segments containing detectable plaque (ρs = 0.25; p < 0.001; Figure 1). Additionally, Spearman’s correlation of segment location and stenosis degree with hs-cTnI indicated a stronger association in the proximal segments.
We examined the potential improvement of the association of hs-cTnI with clinically actionable CAD by incorporating myocardial mass (affecting baseline hs-cTnI release) and estimated glomerular filtration rate (eGFR) into the model. Using PLS with GLM regression, we projected hs-cTnI, age, eGFR, and myocardial mass into a latent feature. This improved detection of clinically actionable CAD, yielding an AUC of 0.79 and 0.80 in the participants without standard CAD risk factors. Using echocardiographic LV mass data (available for 362 patients), the AUC improved to 0.75 overall and 0.76 for SMuRF-less patients (Figure 2).

Conclusion:
Baseline serum hs-cTnI may indicate underlying subclinical CAD. The predictive value of troponin can be further enhanced by considering the effect of myocardial mass, renal function, and age.
Abstract Sa903: Adverse effect of Autoimmune Diseases on In-hospital Cardiac Arrest Mortality
Authors: Pius Ruth , Markson Favour , Antia Akanimo , ODUGBEMI OLUFEMI , Nwogwugwu Enyioma , Ong Kenneth 
Published: November 2024

Introduction:
Cardiac arrest (CA) has been linked with worse outcomes in patients with chronic medical conditions such as chronic obstructive pulmonary disease, chronic kidney disease, diabetes mellitus, hypertension, and coronary artery disease. Autoimmune diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) have been linked to increased risk of cardiovascular diseases, but their effect on the outcome of CA is not well studied.

Aim:
This study aimed to evaluate the effect of SLE and RA on the outcomes of admitted CA patients.

Methodology:
We identified all adult CA hospitalizations in the US between 2016 and 2020 using the National Inpatient Sample database and categorized them based on RA and SLE diagnoses. We applied logistic regression analysis to study the effects of SLE or RA diagnosis on CA outcomes, with a p-value threshold of 0.01.

Results:
A total of 1,099,235 adults were admitted with CA between 2016 to 2020. There were 5745 and 16920 patients with SLE and RA diagnoses among CA hospitalizations, respectively. Among CA patients, the mean age was 54.4 vs. 70.5 years among SLE and RA groups. CA patients with SLE diagnosis had 18% higher odds of in-hospital mortality (OR: 1.18 [1.04-1.34]; p=0.008), similar to those with RA diagnosis (OR:1.16 [1.08-1.24]; p<0.001) when compared to those without SLE or RA. Unlike RA, the SLE effect persisted (AOR:1.44 [1.26-1.64]; p< 0.001) after adjusting for sociodemographic factors (such as age and sex) and other co-morbidities (for RA, AOR: 1.09 [1.01-1.18]; p=0.023).

Further analysis to determine if this reported mortality effect of SLE on CA patients is explainable by a general SLE mortality revealed that the interaction of SLE and CA is associated with higher mortality in the broader adult patient population, independent of CA or SLE alone (OR:1.52 [1.34-1.71]; P<0.001). This synergistic effect persisted after controlling for comorbidities and sociodemographic factors (AOR: 1.9 [1.66-2.27]; p< 0.001).
RA or SLE diagnosis were not associated with acute heart failure, cardiogenic shock, and acute kidney injury outcomes in CA patients.

Conclusion:
Our findings suggest an adverse clinical interaction between SLE and CA that is independent of CA or SLE alone, and also independent of other comorbidities and sociodemographic factors. More research is needed to further explore the potential mechanisms involved.
Abstract Su106: Cardiac Protection using Inhaled Argon During Resuscitation from Cardiac Arrest in Rats
Authors: Barajas Matthew , Oyama Takuro , Kashif Hisham , Kumar Aayush , Li Zhu , Riess Matthias 
Published: November 2024

Recent investigations have demonstrated early promising results using inhaled noble gas therapy during cardiopulmonary resuscitation. Despite characterization as chemically inert, they have demonstrated biological activity at varied enzyme and receptor sites. Importantly, their mechanism of action on ischemia reperfusion injury remains unelucidated.1 We aimed to determine the efficacy of inhaled argon on ameliorating cardiac dysfunction associated with fibrillatory arrest in a rat model.
Fifteen male Sprague Dawley rats were utilized. Rats were mechanically ventilated via endotracheal tube and anesthetized with isoflurane. Femoral artery and vein were cannulated for pressure monitoring and drug delivery. An esophageal pacing probe provided low voltage current to induce fibrillatory arrest lasting a total of 7.5 minutes. CPR was initiated utilizing an automated chest compressor at a rate of 200/min with a controlled depth. Animals were randomly assigned to inhaled argon (70% with 30% O2) or control (70% N2 with 30% O2.) Defibrillation and epinephrine were given, in a standardized fashion. If return of spontaneous circulation (ROSC) was achieved, epinephrine drip was titrated to maintain a mean arterial pressure (MAP) of 70 mmHg. Data was collected at 15 min, 1 and 2 hr after ROSC. Data were analyzed using unpaired t-test. Significance set at p <.05, two-tailed.
There was no significant difference in rate of ROSC between groups (66% control vs 83% argon), however time to achieve ROSC was significantly reduced in the argon group, 350 v. 948 seconds, p = 0.02. Furthermore, animals treated with argon had increased survival time, 116 min vs 62 min control, p = 0.03. Decreased epinephrine requirement to maintain mean arterial pressure at 70 mmHg was seen in argon group 9.3 mcg min-1 vs 53.7 mcg min-1 in the control group, p = .04. There was no significant difference in peak lactate or other arterial blood gas markers.
Inhaled argon therapy remains a promising novel treatment after prolonged cardiac arrest. While other animal models have suggested similar findings, this is the first description in a fibrillatory rat model. Continued evaluation should aim to elucidate mechanism of action after demonstration of model effectiveness.
Abstract Su406: Acceptability and Effectiveness of a Novel, Video-Based CPR and AED Education Program in Canadian Schools
Authors: Allan Katherine , McCulloch Holly , Ruether Kim , Zotzman Jeanine , Blanchard Ian , Janczyszyn Mike , Wong Natalie , ONeil Emma , Sapp John , DHILLON Santokh 
Published: November 2024

Background:
Early cardiopulmonary resuscitation (CPR) and defibrillation are critical for favorable outcomes after sudden cardiac arrest (SCA). Scientific evidence supports CPR and Automated External Defibrillator (AED) training in school-age children. Few studies have used gamified, video-based training to teach students. This national project aimed to assess the acceptability and effectiveness of a brief, video-based educational program (CardiacCrash™), developed by the Heart and Stroke Foundation to teach students hands-only CPR and AED use within a classroom setting.

Methods/Results:
This study reports preliminary data from two Canadian provinces (Ontario, Alberta). The acceptability and effectiveness of training was measured using a pre/post survey evaluating students’ self-confidence in recognizing SCA, calling for help, and providing bystander CPR, including the use of an AED. CPR performance was measured by using Little Anne QCPR manikins that collected data on CPR effectiveness throughout the training session. Results are stratified by student cohort (elementary—grades 4-8, and secondary—grades 9-12).

A total of 1273 students from 6 Ontario and 7 Alberta schools were trained between October 2023 to April 2024. The average age for elementary students (n=729; 47.3% male) was 11.2 ± 1.3 years, and 39.9% had previous CPR training. The average age for secondary students (n=544; 54.4% male) was 15.5 ± 1.1, and 42.6% had previous CPR training. Both groups thought the training was easy (86%), fun (81%), the correct duration (59%) and would recommend it to their friends (85%).
All outcome variables improved post-training for both elementary and secondary students, including the self-confidence to recognize and assist in cases of SCA (p=0.008 for both cohorts), (Figure 1). Secondary students were significantly better at providing effective compressions vs. elementary for most CPR measures (Table 2).

Conclusion:
Preliminary data suggest that CardiacCrash™, a video-based educational program, is acceptable to school-age students and effective at teaching them to perform CPR and use an AED. While both elementary and secondary students achieved acceptable CPR performance, secondary students performed higher quality CPR.
Abstract Su505: Impact of a Targeted Automated External Defibrillator (AED) Program on Survival After Ventricular Fibrillation Cardiac Arrest in the Sao Paulo Metropolitan Subway System: A Landmark Initiative in Latin America
Authors: Timerman Sergio 
Published: November 2024

The targeted Automated External Defibrillator (AED) program in the Sao Paulo Metro has yielded promising results in improving survival rates for individuals experiencing out-of-hospital cardiac arrest (OHCA) due to ventricular arrhythmias. A longitudinal observational study conducted from September 2006 to November 2023 assessed the program's impact on survival outcomes.
The implementation of the full program led to a significant improvement in survival to hospital discharge with minimal neurological impairment (0% vs. 43%, P=0.001). These findings underscore the importance of a targeted AED program in improving survival outcomes for OHCA, particularly in densely populated urban environments such as the Sao Paulo Metro. The short interval between arrest and defibrillation emerged as a critical factor in achieving favorable long-term, neurologically intact survival rates.
The success of this program advocates for the strategic expansion of targeted AED initiatives in other large Latin American cities, emphasizing the potential to save lives and enhance public health outcomes through proactive emergency medical response measures.
Abstract Su707: Sex Differences in Bystander Cardiopulmonary Resuscitation and Survival to Hospital Discharge for Public Out-of-Hospital Cardiac Arrests in North Carolina and Singapore
Authors: Wee Glenda , Ostbye Truls , Hart Lauren , Hansen Carolina , Shahidah Nur , Starks Monique , Granger Christopher , Ong Marcus , Blewer Audrey 
Published: November 2024

Introduction:
Although it is known that women are less likely than men to receive bystander cardiopulmonary resuscitation (BCPR) in public, few studies have examined differences in receipt of BCPR and survival to hospital discharge for public out-of-hospital cardiac arrests (OHCAs) by patient sex between distinct regions.

Objectives:
We assessed if patient sex was associated with BCPR (primary outcome) and survival to hospital discharge (secondary outcome) for public OHCAs in North Carolina (NC) and Singapore (SG). We hypothesized that females in both regions would have lower receipt of BCPR and were less likely to survive to hospital discharge compared with men.

Methods:
We conducted a retrospective cohort study of the Cardiac Arrest Registry to Enhance Survival dataset (NC, 2013-2022) and Pan-Asian Resuscitation Outcomes Study (SG, 2010-2020). We excluded pediatric, traumatic, emergency medical services (EMS) witnessed cases, arrests in healthcare facilities and residential cases. Using logistic regression, we examined the association of sex with BCPR and survival to hospital discharge controlling for potential confounding variables such as age, race and the year of arrest.

Results:
There were 65,627 OHCAs in NC; upon exclusion 6,828 remained (78% males; mean age: 57±15, males, 54.7±18, females). In SG, there were 24,177 OHCAs; upon exclusion 3,617 cases remained (87% males; mean age: 57±14, males, 61±16.4, females).

In NC, public BCPR rates were 48% for males and 44% for females. Females had a 13% adjusted lower odds of receiving less BCPR (adjusted OR 0.87 (CI 0.77, 0.99)). In SG, BCPR rates were 59% for males and 52% for females. Similarly, females had a 22% lower adjusted odds of receiving BCPR (adjusted OR 0.78 (CI 0.62, 0.98)).
In NC, survival to hospital discharge rates for public OHCAs were 24% for males and 26% for females. Females had a 17% lower adjusted odds ratio of survival to hospital discharge compared to males (adjusted OR 1.17 (95% CI 1.01, 1.35)). In SG, public survival to hospital discharge rates were 12% for males and 9% for females. Females had a 36% adjusted lower odds of survival to hospital discharge compared to males (adjusted OR 0.64 (95% CI 0.43, 0.94)).

Conclusion:
In public OHCAs, females were less likely to receive BCPR than males in both regions. However, females were less likely to survive to hospital discharge in SG, whereas the opposite was seen in NC. Further research is needed to elucidate factors for these differences.
Research on the Upgrading of China’s Manufacturing under the Value-Added Capability and Correlation Effect of Global Value Chain
Authors: Gao Yang , Rong Jiurui 
Published: November 2024

Abstract
China’s manufacturing has developed rapidly due to the integration of the global value chain (GVC) production division system. But the early OEM and processing can hardly meet the needs of high-quality development of the manufacturing. The “low-end lock-in” and “double squeeze” faced by China’s manufacturing will impede the pace of upgrading the manufacturing. From the perspective of GVC accounting, this paper studies the industrial chain upgrading of China’s manufacturing industry through four indicators: GVC participation, GVC division of labor status index, share of foreign value added in domestic exports, and manufacturing ‘servitization’ index, which from the value chain value added effect at the national level and industrial chain correlation effect at the industrial level, and drawing on the WWYZ method of Wang Zhi et al. (2017) and the input-output method of Leontief (1936). Through the research, it is found that the servitization level of the mid and high-tech industry and high-tech industry of China has been steadily improved, gradually getting rid of the “low-end lock-in” of developed countries and climbing to the high value added production links; Not only do the reindustrialization strategy of developed countries provide the obstacle to the upgrading of the industrial chain and value chain of China’s high-tech industry, but also promote domestic talent training and technological innovation. The linkage and integration of the industrial chain of low-tech industry and low and mid-tech industry have been further improved, which plays a favorable role in relevant industry’s value chain climbing and industrial chain upgrading. China’s manufacturing is progressively improving its own value-added capability and international competitive advantage, further enhancing the two-way integration of the industrial chain, and gradually transitioning to both sides of the “smile curve”, to achieve high-quality development of the manufacturing.