bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 4143311: Non-statin Medication Utilization under Medicare Part D Population
Authors: Parajuli Shreyash , Majmundar Vidit , Pandey Priya , Joshi Amir , Yamparala Aishwarya , Dani Sourbha 
Published: November 2024

Introduction:
Statin intolerance is reported in 5–30% of patients and contributes to reduced statin adherence and persistence, as well as a higher risk for adverse cardiovascular outcomes. For patients with known or suspected statin intolerance and high ASCVD risk, non-statin therapy is currently a class IIa recommendation by the National Lipid Association (NLA).

Method:
We accessed publicly available datasets from the Centers for Medicare and Medicaid Services (CMS). The non-statin medications included in these studies are bempedoic acid, evolocumab, alirocumab, inclisiran, and evanicumab. Key variables, such as beneficiaries, claims, and total spending, were analyzed and presented below. We looked at the trend of medication from 2020 to 2022. All costs were adjusted for inflation and represented in 2022 US dollars.

Results:
We analyzed CMS Medicare Part D plans of Bempedoic Acid, Inclisiran, Alirocumab, Evolocumab and Evanicumab, covering 2020–2022. We noticed a 3- to 4-fold increase in total beneficiaries and claims for bempedoic acid, along with a sharp rise in total spending from 3.5 million dollars to 19.4 million dollars after adjusting for inflation rate using the consumer price index inflation calculator. The trends for other non-statin medications were similar. We also created comparative graphs for 2022 and noticed a total spending of 97.5% among proprotein convertase subtilisin/kexin type 9 (PCSK-9) in Medicare D CMS populations.

Discussion
We can see a rise in total Medicare spending among all the drugs. Amongst different lipid-lowering agents, proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors are the most commonly used, followed by bempedoic acid. Newer agents, like Evanicumab and Inclisiran are also available on the market, and their trend has not yet been determined. Inclisiran, however, has the highest average spending per beneficiary. How the Inflation Reduction Act of 2022 will affect drug utilization is yet to be seen.

Limitation
The pattern of data used may not be generalizable to other payer demographics. Policy changes can affect the comparability of data over different periods.

Conclusion
From 2020 to 2022, the number of claims, beneficiaries, and total spending on various lipid-lowering agents steadily increased.
Abstract 4143604: Efficacy and Safety of Rivaroxaban Versus Low Molecular Weight Heparin for Treating Venous Thromboembolism in Cancer Patients: A Systematic Review and Meta-Analysis
Authors: Shrestha Abhigan , Mainali Nischal , Shrestha Sajina , Jaiswal Vikash , Rajak Kripa , Hameed Maha , Edara Ravi Sankar Reddy , KC ANIL 
Published: November 2024

Background:
Rivaroxaban is a novel oral anticoagulant suggested as an alternative to low molecular weight heparin (LMWH). However, its efficacy and safety compared to LMWH for treating venous thromboembolism (VTE) in cancer patients remain unclear.

Hypothesis:
This study aims to compare the efficacy and safety of rivaroxaban against LMWH for treating VTE in cancer patients.

Methods:
We conducted a literature search for relevant articles on PubMed, Google Scholar, and Embase. Outcomes were pooled using the DerSimonian and Laird random-effects model as risk ratios (RR) with 95% confidence intervals (CI). A p-value of <0.05 was considered statistically significant.

Results:
A total of 14368 cancer patients (Rivaroxaban: 4378 and LMWH: 9990) from 13 studies were included with an average age of 62.5 and 61.9 respectively.

At 3 months, rivaroxaban was associated with a decreased risk of recurrent VTE (RR 0.73, 95% CI: 0.59, 0.86, p<0.05) and bleeding-related hospitalization (RR 0.79, 95% CI: 0.61, 0.97, p<0.05) with statistical signifcant whereas, major bleeding (RR 0.87, 95% CI: 0.09, 1.65), non-major bleeding (RR 0.84, 95% CI: 0.60, 1.08) and all-cause mortality (RR 0.91, 95% CI: 0.72, 1.09) were comparable.
At 6 months, rivaroxaban was associated with a decreased risk of all-cause mortality (RR 0.80, 95% CI: 0.62, 0.97, p<0.05), and bleeding-related hospitalization (RR 0.81, 95% CI: 0.65, 0.98, p<0.05) whereas major bleeding (RR 0.88, 95% CI: 0.52, 1.24), non-major bleeding (RR 0.85, 95% CI: 0.42, 1.29) and recurrent VTE (RR 0.83, 95% CI: 0.64, 1.01) were comparable.
At 12 months, rivaroxaban was associated with a decreased risk of mortality (RR 0.71, 95% CI: 0.50, 0.92, p<0.05), however non-major bleeding (RR 1.38, 95% CI: 0.83, 1.94), cancer-associated thrombosis recurrence (RR 0.94, 95% CI: 0.73, 1.16), and bleeding (RR 0.70, 95% CI: 0.26, 1.15) were comparable.

Conclusion:
While rivaroxaban is associated with low adverse outcomes suggesting its use in treating VTE in cancer patients, further research is recommended.
Abstract 4143844: Multidisciplinary management of a pregnant patient with advanced systolic heart failure
Authors: Mitchell Jameson , Hoffman Karlee , Singh Katherine 
Published: November 2024

A 35-year-old gravida 1, para 0 with biventricular heart failure (LVEF 25%), nonischemic cardiomyopathy, history stroke, history of left ventricular thrombus, class III obesity, and chronic kidney disease who had been followed by Cardio-Obstetrics throughout her pregnancy presented at 34 weeks gestation for planned induction of labor. Upon presentation, she underwent assessment with a pulmonary artery catheter (PAC) and was noted to be in cardiogenic shock with elevated biventricular filling pressures and low cardiac index necessitating hemodynamic stabilization followed by primary cesarean section.
The patient was admitted to the cardiac ICU for medical optimization prior to delivery. Home medications including isosorbide dinitrate, metoprolol, and hydralazine were continued. The patient was briefly placed on inotropic support with dobutamine, which was discontinued due to ectopy. After PAC-guided IV diuresis, anticoagulation transition from enoxaparin to heparin, and twice daily fetal monitoring via non-stress test, a multidisciplinary team, including cardiology, maternal fetal medicine, cardiac anesthesia, and cardiothoracic surgery assembled for the C-section. Following pre-delivery cannulation for potential ECMO support, the patient underwent C-section and elective salpingectomy under epidural anesthesia with delivery of a healthy neonate.
Post-delivery, the patient was monitored in the ICU, focusing on fluid management, anticoagulation transition to warfarin, and titration of heart failure medications, as the patient did not plan to breastfeed. After discharge, she was scheduled for a 2-week postpartum visit including echocardiogram, EKG, and NT-proBNP.

Discussion:
Given the patient's acute decompensation and fluid overload, medical optimization was essential prior to delivery. However, stabilization was expected to be temporary due to ongoing physiologic changes of pregnancy. Her limited mobility and concern for multiorgan compromise, such as new oxygen dependency and rising creatinine, made a prolonged induction of labor unfeasible. Due to concern for maternal intolerance of labor, unstable fetal lie, fetal distress due to decreased perfusion, and an increased likelihood of emergency C-section, a primary C-section was recommended as a safer option. The successful delivery of a healthy neonate and post-operative maternal stabilization highlights the importance of a multidisciplinary approach in managing complex cardio-obstetric cases.
Abstract 4144205: Diagnostic accuracy of artificial intelligence-based electrocardiogram algorithm to predict heart failure with reduced ejection fraction: a systematic review and meta-analysis
Authors: Carvalho Ferreira Andre , Antunes Vanio do Livramento Junior , Guida Camila , Vergara Ferraz de Souza Luciana , Defante Maria Luiza Rodrigues , Bulhoes Elisio , Begic Edin , Aziri Buena , Mazetto Roberto , Monteiro Sarah , Garcez Luanna , Benitez Maria 
Published: November 2024

INTRODUCTION:
AI-based EKG has shown good accuracy for diagnosing heart failure. However, due to the heterogeneity of studies regarding cutoff points, its precision for specifically detecting heart failure with reduced ejection fraction (LVEF <40%) is not yet well established.

Research question:
What it is the sensitivity and specificity of artificial-based electrocardiogram to diagnose heart failure with low ejection fraction(cut-off of 40%)

Aims: We conducted a meta-analysis and systematic review to evaluate the accuracy of artificial intelligence electrocardiograms in predicting an ejection fraction below 40%.

METHODS:
We searched PubMed, Embase and Cochrane Library for studies evaluating the performance of AI EKGs in diagnosing HFrEF. We computed true positives, true negatives, false positives and false negatives events to estimate pooled sensitivity, specificity and area under the curve, using R software version 4.3.1, under a random-effects model.

RESULTS:
We identified 8 studies,including 136151 patients with a paired artificial intelligence enabled electrocardiogram with an echocardiography. 9349(6.8%) patients had an ejection fraction below 40% according to the echocardiogram.

The AI-ECG data yielded areas under the receiver operator of, sensitivity of 0.861(0.815-0.897), and specificity of 0.874(0.834-0.905) , and area under the curve of 0.929(0.876-0.949).
Mean/median age ranged from 60±9 to 67.8±14.4 years.

CONCLUSIONS:
In this systematic review and meta-analysis, the use of electrocardiogram-based artificial intelligence models demonstrated high sensitivity and specificity for the diagnosis of heart failure with an ejection fraction below 40%
Abstract 4144260: Diversity is Essential in Cardiovascular Medicine and Subspecialties: A Comprehensive Report of Gender, Racial, and Ethnic Representation among Cardiovascular Fellows from 2005 to 2022
Authors: Obeidat Omar , Abughazaleh Saeed , Tarawneh Mohammad , Akhter Nausheen , tong ann 
Published: November 2024

Introduction:
The diversity of the healthcare workforce is essential for equitable and effective patient care. This comprehensive report analyzes the representation trends among cardiovascular fellows in the US over an 18-year period, focusing on gender, racial, and ethnic representation.

Methods:
Utilizing data from the National Graduate Medical Education Census, this study analyzes trends in representation across gender, race, and ethnicity among cardiovascular medicine fellows. It examines the expansion of cardiology programs and fellow positions in specialties, assessing the evolution of diversity between 2005 and 2022 using J point trend analysis software.

Results:
Growth Trends in Cardiology Specialties (2005-2022): Cardiology exhibited significant growth, with an AAPC of 2.6% for programs and 2.0-3.2% for fellow positions. IC showed an AAPC of 2.0% for programs and 2.8% for fellow positions. EP had a lower AAPC for programs (1.7%) but a higher rate for fellow positions (5.2%).

Gender Disparities: Women constituted 22% in CVM, 12.3% in EP, and 11% in IC. Despite these disparities, there was a promising increase in the representation of women over time, with a higher AAPC for women compared to men, indicating a shift towards greater gender diversity.
Racial and Ethnic Composition and Trends: White and Asian fellows accounted for over 70% of the total, while Black and Hispanic fellows made up less than 12%. The representation of White fellows decreased significantly, while Black fellows showed a significant increase in CVM. Hispanic fellows did not exhibit a significant increase and even showed a decrease in IC.
Medical School Backgrounds: USMDs comprised the majority of fellows, but DOs displayed the highest growth rate, particularly in EP (AAPC of 7.9%). IMGs had the highest AAPC in IC at 4%.

Conclusion:
Our analysis revealed continued racial and gender disparities in the cardiology specialty. This report calls for concerted efforts from academic institutions, healthcare organizations, and policymakers to implement effective strategies for diversity and inclusion, reflecting the aim of creating a workforce that mirrors the diversity of the population it serves.
Abstract 4145379: The Trojan Worm: A Tale of Strongyloides and Eosinophilic Myopericarditis
Authors: Yellapu Vikas , Magid Lindsey , Morgan Michael , Plamenac Jovan 
Published: November 2024

We present a perplexing case of a 33-year-old male with no prior cardiac history who presented to the emergency department with a 5-day history of worsening pleuritic chest pain and dyspnea. The patient had recently returned from El Salvador, where he resided near the beach. Notably, his chest pain worsened with inspiration but was not positional. He denied fevers, chills, or family history of cardiac disease, but reported recreational marijuana use.
Initial evaluation revealed normal vital signs and electrocardiogram, but marked eosinophilia (12%) and mildly elevated C-reactive protein. High-sensitivity troponin levels peaked at 8400 ng/L, raising suspicion for myocardial injury. Echocardiography demonstrated preserved left ventricular ejection fraction but revealed a moderate pericardial effusion. Pericardial fluid analysis showed benign reactive mesothelial cells.
Given the patient's travel history and eosinophilia, a broad differential diagnosis was considered, including parasitic etiologies such as Chagas disease. However, serological testing for Chagas was negative. Interestingly, IgG antibodies for Strongyloides stercoralis were positive, implicating strongyloidiasis as the underlying cause of the eosinophilic myopericarditis.
The patient was treated with non-steroidal anti-inflammatory drugs, colchicine, and empiric ivermectin therapy. A cardiac magnetic resonance imaging study was ordered to further characterize the myocardial involvement, but the patient was unfortunately lost to follow-up.
This case highlights the importance of maintaining a broad differential diagnosis and considering travel-related exposures in patients presenting with eosinophilic myopericarditis. Strongyloidiasis, though uncommon, can manifest with cardiac involvement and should be considered in at-risk populations, particularly those with eosinophilia and a compatible travel history.
It is also important to have a high clinical suspcision for stronglodies induced myopericarditis in high risk patinets such as ours as typical treatment with steroids could result in furthur desemination of strongyloidias infection leading to fulminant eosinophillic myocarditis.
Abstract 4146002: Advancing Cardiac Function Assessment with a Real-Time, Lightweight Deep Learning Network for Precise Left Ventricular Internal Diameter Measurement
Authors: Red Teddy , Tian Chao 
Published: November 2024

The purpose of this study is to develop a real-time, lightweight deep learning network to accurately detect the Left Ventricular Internal Diameter (LVID) for enhanced precision and efficiency in cardiac function assessment.
Our approach redefines the task of locating LVID endpoints by framing it as a classification problem along two axes, thereby significantly reducing the computational burden. This novel approach ensures high accuracy and enables real-time deployment in clinical settings.
We conducted extensive training using EchoNet-LVH, a primary dataset comprising 12,000 meticulously labeled echocardiogram videos sourced from diverse patients exhibiting various cardiac conditions. Furthermore, we evaluated our model on two external datasets and collected specialized datasets to assess its generalizability: a pediatric dataset consisting of 892 key frames from 138 children to evaluate accuracy in young patients with distinct cardiac dynamics, and an adult dataset encompassing 298 key frames from 39 adults representing a wide range of cardiac health statuses for testing effectiveness across diverse demographics. On the EchoNet-LVH dataset, the model exhibited exceptional accuracy by achieving a mean absolute error (MAE) of 2.39mm and a mean absolute percentage error (MAPE) of 6.5%, thereby establishing a new benchmark for precision in left ventricular internal diameter (LVID) measurement. Notably, the model also demonstrated excellent generalizability across diverse patient populations in external datasets, yielding MAPEs of 6.4% in the pediatric dataset and 5.6% in the adult dataset. Moreover, its efficiency was underscored by an impressive forward inference speed of up to 401.82 FPS on advanced GPU, representing a substantial improvement over previous approaches. This accelerated processing capability enables real-time analysis, which is crucial for clinical applications as it facilitates immediate diagnostic feedback essential for effective patient management and care.
The proposed model significantly enhances the efficiency of LVID measurements while maintaining a high level of precision, enabling real-time and automated assessments of cardiac function that are highly suitable for clinical application.
In addition, its robust performance suggests a strong potential for widespread adoption in routine cardiac evaluations. Our approach provides rapid, accurate assessments of LVID makes it an invaluable tool for cardiac function evaluation.
Abstract 4146263: Radiation Induced Valvular Heart Disease complicated by Concomitant Radiation Induced Coronary Artery Disease
Authors: Basile Sean , Venkataraman Ramesh , Gallagher Robert 
Published: November 2024

The cardiac adverse effects of radiation therapy include both radiation-induced valvular disease and radiation-induced coronary artery disease (RICAD). However, the management of each when present concurrently is minimally described by current research and guidelines.
A 60 year-old infectious disease physician with history of Stage IIA Hodgkin Disease s/p radiation therapy in 1976 (age 13) presented to cardiology for new dyspnea on exertion. She had known valvular heart disease followed with serial echocardiograms. Repeat TTE completed showing now moderate to severe aortic stenosis, moderate aortic regurgitation, moderate tricuspid regurgitation, and mild to moderate mitral regurgitation. After exercise stress testing aborted due to decrease in systolic blood pressure with exertion, patient underwent cardiac catheterization and found to have moderate-severe aortic stenosis as well as hemodynamically significant ostial disease of the right coronary artery and distal left main coronary artery; classic bi-ostial coronary stenosis characteristic of RICAD. After multidisciplinary discussion with interventional cardiology, cardiothoracic surgery, and second opinion with tertiary valve center, she was referred for surgical revascularization and aortic valve replacement (AVR). Patient underwent AVR with a 23mm bioprosthetic aortic tissue valve replacement, aortic root enlargement, tricuspid valve repair with 28mm ring, and three vessel coronary artery bypass grafting.
Notably, several retrospective studies have found increased mortality with surgical aortic valve replacement in patients with prior history of radiation with many centers preferring transcatheter aortic valve replacement as a safe and effective alternative in this demographic. Despite acknowledging this predilection, SAVR chosen in this patient specifically given her concurrent RICAD requiring revascularization. This case intimately highlights the need for further studies regarding management of radiation-induced valvular disease when complicated by RICAD.
Abstract 4146351: A Multicentre Study for Hands Only CPR (HOCPR) training assessment towards building a ‘Nation of Life Savers” in India
Authors: Ravikumar Thanjavur , Ravikumar Thanjavur , Sarkar Manuj , Debnath Dhrubajyoti , Behera Priyamadhaba , Ghate Dr Jayshri R , Trikha Divay , Samantaray A , Madhavi K , Sarma KVS 
Published: November 2024

Failure to rescue a subject sustaining sudden cardiac arrest is a public health issue requiring urgent action. The awareness, knowledge&skills of HOCPR is very low and the need-gap is very high in India with world’s largest and diverse population (socioeconomic, cultural, linguistic&educational). We undertook a structured multicentred approach with the following elements for improving HOCPR awareness, education&training for generalisability and scalability: i) an IRB/IEC approved pre-post training survey; ii) train-the-trainer program iii) pilot study in one district of a state; iv) validation study in 5 states (data validation is available for 4 out of 5 sites as of now) located in disparate regions of India with part financial support through AHA grants in aid.
The pilot cohort of 46,012 trainees covered 27 of 32 revenue divisions (mandals) in one state, comprising students and community members of diverse sections of society. Pre- post training statistical analyses include McNemer’s test&ChiSquare.

Results:
The reason for non-readiness for HOCPR was” do not know how” in 92.9% of trainees in pre-test, and 98.6% reported that they learnt HOCPR in post -test(p<0.001). Pre- post education/ training comparison statistical analysis showed a significant improvement in knowledge (p<0.0001)&skill (p<0.0001). There was 82.8% improvement in knowledge, and 60.4% improvement in readiness; showing that ‘readiness’ requires more effort than knowledge/skills alone in HOCPR. The quality of training (Likert scale) showed 86% responding excellent/ very good; and the reasons for improvement being more training time and unevenness in quality of training in 14% of trainees.

The ongoing validation study cohort comprises 59,646 trainees. Pre-post survey corroborated the pilot data with regards to knowledge/skills of trainees and quality of training.
This prospective multicentre HOCPR training impact analysis provides scientific platform for scaling up in a most heterogeneous and vast population like India. Further studies are planned to improve HOCPR readiness as well as downstream analysis of sudden cardiac arrest victims receiving HOCPR at the scene for mitigation of death and enhanced quality of life of survivors transported to hospital.