tbuckley/cabot-search huggingface dataset:
Abstract Su1009: Effect of Increasing Force on Perfusion Pressures During Circumferential Constriction Cardiopulmonary Resuscitation
Authors: Aidan Paradis, Norman Paradis
Journal: Circulation (2024)

Introduction: Outcomes after treatment with currently available CPR remain poor. CPR related injuries are associated with worse outcomes. In comparison to standard sternal piston-type CPR, the utilization of pneumatic circumferential constriction CPR (CC-CPR) enables the application of a greater motive force while minimizing localized injury force. This technique has the potential to enhance hemodynamics and reduce skeletal injuries. Nonetheless, the optimal pneumatic belt pressure for CC-CPR, which equates force around the chest, has not been comprehensively studied. Hypothesis: CC-CPR with increasing force may be associated with improved perfusion pressures without increased skeletal injuries. Methods: Ventricular fibrillation was induced in female Yorkshire swine (n = 7, 30-40 kg). CPR was provided by inflating a circumferential pneumatic ‘belt’ 80 times per minute. Belt pressures were varied in one-minute treatment epochs among 200, 220, 240, 260, and 280mmHg. Aortic (Ao) and right atrial (RA) pressures were measured using micromanometer catheters. Coronary perfusion pressure (CPP) was derived as the difference between the Ao and RA pressures at the end of the decompression phase. Airway end-tidal CO2 ( ETCO2 ) was recorded as a secondary indicator of cardiac output. At the end of each experiment, animals were examined for rib fractures on postmortem. Results from all experiments were grouped by treatment type and evaluated by ANOVA. Results: Increasing pneumatic belt pressures were associated with a trend toward higher CPPS and a significant increase in ETCO2 (P &lt; 0.01) (See Figure). There were no palpable rib fractures in any of the animals, despite occasional constriction pressures as high as 300mmHg (5.8 PSI). Necropsy revealed visceral organ injury in some of the animals, but this could not be attributed to any specific CPR pressure. Conclusion: During CC-CPR, higher pneumatic belt pressures were associated with increased CPPs and ETCO2. Pressures as high as 300mmHg did not cause skeletal fractures. These trends may be affected by also optimizing rate and duty cycle. If confirmed in other models, higher belt pressures during CC-CPR merit evaluation in human clinical studies.
Abstract Sa707: The role of gender in conversations about suspected cardiac arrest with 9-1-1 callers and telecommunicators
Authors: Audrey Blewer, Lauren Hart, Anjni Joiner, Stephen Powell, Lee Van Vleet, Monique Starks, Fahad Siddiqui, Sungwon Yoon, Glenda Wee, Angel Gonzalez, Truls Ostbye, Janet PrvuBettger, Heather King
Journal: Circulation (2024)

Introduction: Women receive bystander cardiopulmonary resuscitation (BCPR) less frequently than men in public. Studies have demonstrated that the gender of the person calling 9-1-1 may influence receipt of BCPR for female patients with out-of-hospital cardiac arrests (OHCA). It is unknown how the tone, or the way a person speaks to someone else, and gender of the caller impact receipt of BCPR by gender of the patient. Objectives: We sought to understand whether the tone of the caller varies by gender of the caller and whether the tone impacts receipt of BCPR by gender of the patient. Methods: We performed a multiple methods retrospective analysis of 9-1-1 calls for suspected non-traumatic OHCAs in Durham, NC (08/2022-1/2024). Calls were professionally transcribed. We excluded pediatric arrests and those that occurred in a healthcare facility. We identified the gender of the caller and gender of the patient as well as receipt of BCPR. Using qualitative analysis, we coded a full range of tones through the transcripts and listening to the audio. Two team members double coded transcripts (AG, LH) and audio (LH, GW) until they reached interrater reliability. Theme matrix techniques were used to facilitate data analysis and presentation. Quantitative data were analyzed using descriptive statistics. Results: We included 170 total suspected OHCA calls. Mean age of patients was 56±20; 35% were women. Of these, 23% occurred in public and 50% received BCPR. When women called about women patients (16%), 50% received BCPR. When women called about men patients (42%), 51% received BCPR. When women were the callers, the primary tone was distressed (e.g., “Oh, my God. Give me one second, give me one second. I’m trying to think”) , independent of patient gender . When men called about women patients (19%), 50% of women patients received BCPR. In contrast, when men called about men patients (21%), 53% of men patients received BCPR. When the caller was a man, the primary tone was assertive (“Ma’am, she needs an ambulance!” ), independent of patient gender. Distressed or uncertain were also common tones for men callers (“I really rather a paramedic go up there and do that.”; "Yes, yes, please! I don’t have time to talk!"). Conclusion: Further research is needed to understand these interactions, including what types of interventions could improve equity and receipt of BCPR particularly for women.
Abstract 4146754: The Prognostic Value of Dobutamine Stress Echocardiography in Liver Pre-Transplant Evaluation
Authors: Jim Lu, Richard Ferraro, Amanda Su, Ryan Osgueritchian, Allison Hays, A. Gurakar, Monica Mukherjee
Journal: Circulation (2024)

Background: Dobutamine stress echocardiography (DSE) is a frequently used tool in cardiovascular (CV) risk assessment of liver transplantation (LT) candidates. Its prognostic value compared to traditional cardiac risk stratification remains unclear. Research Question: How does the prognostic value of pre-transplant DSE in LT candidates compare to the revised cardiac risk index (RCRI)? Aim: Compare DSE’s prognostic value to RCRI in LT patients and analyze post-transplant CV outcomes. Methods: This single-center study included adult patients undergoing pre-transplant DSE as part of LT evaluation from 2008-2021. DSE were categorized as positive, negative, or inadequate. Primary outcomes were post-operative ischemic cardiac events and mortality, with secondary outcome of transplant delays from inadequate DSE. Mann-Whitney U and Fischer’s exact tests compared variables; logistic regression assessed RCRI and DSE for 30-day mortality and cardiac events. Results: Of 981 LT candidates, 644 (66%) had pre-transplant DSE with minimum 2-year follow-up. Average age was 57 ± 7 years, with 33% women. Four and eleven patients experienced cardiac events and mortality &lt;30 days post-transplant, none of whom had positive pre-LT DSE. Six DSE exhibited inducible ischemia, with one revealing obstructive coronary artery disease on invasive assessment. DSE was inadequate in 113 patients (18%), with 34 (30%) undergoing further cardiac evaluation on average 33.8 days later (Table 2). Logistic regression showed a c-statistic of 0.52 for RCRI&gt;1 (p-value 0.50), 0.51 for DSE (p-value 0.82), and 0.52 for RCRI&gt;1 and DSE combined (p-value 0.80) in predicting 30-day mortality and cardiac events. Conclusion: Our study demonstrates limited prognostic value of DSE above RCRI score alone for predicting post-transplant mortality. Inadequate DSE was frequent and extended LT wait times. Further research is necessary to define clinically relevant subgroups and refine CV risk assessment in LT candidates.
Abstract 4146818: Interplay of Coronary Artery Calcium and Predicting Risk of cardiovascular disease EVENTs Equations in ASCVD Risk Prediction
Authors: Isaac Acquah, Kobina Hagan, Zulqarnain Javed, Izza Shahid, Khurram Nasir, Sadeer Al-Kindi
Journal: Circulation (2024)

Background: The American Heart Association recently introduced the Predicting Risk of CVD EVENTs (PREVENT) equations, which incorporate additional cardiometabolic risk factors to estimate atherosclerotic cardiovascular disease (ASCVD) risk in younger adults in a race-neutral manner. This study aims to assess the interplay of estimated ASCVD risk by PREVENT equations and coronary artery calcium (CAC) and their association with hard ASCVD events in a large population-based cohort. Methods: We analyzed data from 6,380 individuals aged 45-79 years and free of ASCVD at baseline from the Multi-Ethnic Study of Atherosclerosis (obtained from the Biologic Specimen and Data Repository Information Coordinating Center [BioLINCC]). Participants were classified by baseline CAC score (0, 1–100, &gt;100) and clinically relevant PREVENT categories (&lt;5%, 5%–&lt;7.5%, ≥7.5%). In unadjusted survival analysis, we evaluated the incidence and risk of hard CVD events across PREVENT and CAC scoring profiles. Results: Among individuals with &lt;5% risk, 70% had CAC=0 and 8% had CAC&gt;100, whereas among individuals with ≥7.5% risk, 27% and 42% had CAC=0 and CAC&gt;100 respectively, as shown in figure ( panel A ). Overall, 609 hard CVD events occurred in a median follow-up of 14.1 years (10-year observed rate of 14.3%). Individuals with &lt;5% PREVENT score and CAC &gt;100 had an event rate 1.5 times higher than individuals with ≥7.5% risk and CAC 0 (8.9% vs 5.9%). A CAC score of 0 was associated with 10-year CVD event rates of less than 7.5% across the estimated ASCVD risk categories ( Figure, panel B ). The interplay between continuous CAC and PREVENT is shown in figure ( panel C ) Conclusion: Across the spectrum of PREVENT-based ASCVD risk, the distribution of CAC is heterogeneous. A high CAC burden, even among individuals with a low estimated 10-year risk by PREVENT, is associated with an elevated event rate. Conversely, the absence of CAC, even among those with elevated risk, is associated with a low event rate. CAC testing can support individual preferences in the context of shared decision making when estimating ASCVD risk and subsequent management choices.
Abstract 4147462: Ambulatory Breath Analyzer for Measuring Cardiac Output
Authors: Joshua Hale, Alexandre Kolomenski, Hans Schuessler, Carl Tong
Journal: Circulation (2024)

Background: Knowing heart failure patients’ cardiac output at outpatient setting can guide optimization of medical therapy and detect decompensation early to trigger timely response; therefore, following patients’ cardiac output has potential to greatly improve care of heart failure patients. Unfortunately, an easy to use ambulatory device that can measure cardiac output at patients’ homes currently does not exist. Hypothesis: One can derive cardiac output by measuring carbon dioxide (CO 2 ) and flow of exhaled breath because right heart delivers CO 2 laden blood to the lungs, right heart = left heart in blood flow. Method: We made a novel breath analyzer that measures cardiac output from exhaled breath. This device uses [CO 2 ] and volume of exhaled breath as input. Exhaled flow rate of CO 2 is measured, then divided by the difference between venous and arterial [CO 2 ]. The difference is calculated from exhaled CO 2 input to a novel formula. We built and tested a prototype to implement this method. We designed a heated breath flow path with baffles to combat the high humidity in breath. Custom software then calculates cardiac output in real time. We used this prototype to measure the cardiac output at rest and after set pace treadmill jogging. Results: The prototype (fig) featured small dimensions, light weight, and compatibility with a typical laptop computer. Reliability testing showed a 1.85% standard deviation in volume detection over 70 test breaths. Carbon dioxide detection was compared to high-sensitivity cavity ringdown spectroscopy with an error of 1.14%. Measurement of cardiac output was performed on 11 human volunteer subjects. Echocardiogram of stroke volume X heart rate was used as reference. Cardiac output measurements from our device correlated strongly with echocardiogram reference both at rest and after exercise, giving an R=0.83 and p=3X10 -6 . Conclusions: We developed a novel method and device that measures cardiac output from exhaled breath, understanding that further validation in heart failure population is needed. This device can be used to measure cardiac output at outpatient settings to improve the quality of care for a great many patients.
Abstract Sa1201: Emergence of an Online Support Community for Cardiac Arrest Survivors, Co-Survivors, Lay Rescuers, and Advocates
Authors: Mary Newman, Alexander Presciutti, Joe Farrell, Joshua Lupton, Stephen Sanko, Sarah Perman
Journal: Circulation (2024)

Background: Cardiac arrest survivors often experience physical, cognitive, emotional, and social challenges that can linger for years. Co-survivors and lay rescuers can also experience distress. In January 2023, the Sudden Cardiac Arrest Foundation (SCAF) launched the Cardiac Arrest Survivor Alliance™ (CASA), an online community to support these individuals. CASA offers evidence-based information about common challenges post survival, easy connection with peers, access to experts, and pathways to further clinical support. Methods: We built CASA using Mighty Networks (MN) and assembled a leadership team that includes clinicians, researchers, and survivors with expertise in survivorship. We recruited members through SCAF’s existing Survivor Network and outreach via SCAF’s website, newsletters, and social media. Additional recruitment resulted from articles about CASA in multiple national news outlets, Internet searches, conference presentations, partner collaboration, and member invitations. We obtained analytic reports through MN to evaluate CASA’s growth and engagement during the past 12 months. Results: By early June 2024, there were 1,435 members primarily from the U.S. (92%), plus members from 26 other countries. This compares with 868 members from the U.S. and 21 other countries in June 2023. Approximately 65% of members are survivors. Other members include co-survivors (22%), advocates, lay rescuers, and bereaved. During the 12-month period, there were: 10,058 contributions (sum of actions taken by hosts, moderators, and members including posts, “cheers,” comments, chat messages, direct [private] messages [DMs], and RSVPs); 923 active members (total members who visited); 468 unique members providing contributions. Members have not only engaged publicly, but also privately; 189 members (21%) have sent 1,448 DMs, exceeding MN’s benchmark of 15%. Attendance at monthly webinars has ranged from 22 to 47 participants. Further, we have established a formal research protocol and are working with several researchers seeking to improve understanding of survivorship and develop resources to support survivorship. Conclusion: CASA has grown substantially during the past 12 months and there is a high level of engagement. Goals include providing additional evidence-based content, outreach to hospitals and targeted healthcare providers nationwide including in rural areas, and further collaboration with program partners.
Abstract 4147168: Left Atrial Remodeling By Cardiac MRI In Mitral Stenosis Patients Pre- and Post- Balloon Mitral Valvuloplasty
Authors: Mary Mishriky, Soha Romeih, Michael Gergis, Kerolos Shaker, Ahmed Elborae, Ahmed Hassan, Amir Samaan, Ramy Doss, Hesham Mohamed, Hossam Kandil, Magdy Abdelhamid
Journal: Circulation (2024)

Background: Mitral stenosis (MS) is associated with adverse left atrial (LA) structural changes. Mechanical relief of this obstruction via balloon mitral valvuloplasty (BMV) may be associated with LA reverse remodelling. Objective: To study LA and RV remodelling in isolated severe rheumatic MS patients before and 9-12 months after successful BMV. Methods: We included 49 patients with isolated severe rheumatic MS in sinus rhythm who underwent successful BMV. CMR was done at baseline and 9-12 months post BMV. Thirty age- and gender- matched healthy controls were included for comparison. Indexed LA volumes (V max , V min ,&amp;V pre-A ) were obtained from CMR cine images. LA phasic functions were evaluated using both volumetric and deformation indices. Deformation analysis including LA strain (global, passive,&amp;active strain)&amp;strain rate (SRs, SRe, and SRa ) measurements were performed using specialized MASS (R) software for CMR feature tracking. Results: At baseline, there was significant impairment of LA volumes and functions in severe MS patients compared to healthy controls. Following BMV, there was statistically significant reduction in all LA indexed volumes compared to baseline (p-value &lt;0.001 for all). There was significant improvement in LA phasic functions; Reservoir, conduit and pump functions as shown in Table. Higher mean gradient (MG) at baseline correlated significantly with passive strain and passive SR. Strain indices of reservoir and pump functions have normalized, however, the LA volumes and volumetric functions still remained significantly impaired compared to healthy controls. RV volumes, EF and RV free wall GLS were normal at baseline. Post BMV, both RV ESVi and RV EF showed significant improvement. Conclusion: Significant MS is associated with marked LA structural&amp;functional changes detected by CMR. Successful BMV results in reverse LA remodelling with reduction in LA volumes and improvement in LA functions and strain indices, This reverse remodelling was evident at 9-12 months post procedure. Longer term follow-up studies are needed to assess whether improvement in LA volumetric functions and strain indices are sustained or not.
Abstract 4147366: At-Home Management of Patients with Heart Failure Demonstrates Few Emergency Department Transfers and High Patient Satisfaction
Authors: Brock Daniels, Christina McGinnis, Meghan Reading, Leah Shafran Topaz, Ruth Masterson Creber, Rahul Sharma
Journal: Circulation (2024)

Background and Objective: Mobile Integrated Health (MIH) interventions enable community paramedics to perform structured assessments, physical exams, and medication reconciliation, provide disease education, review follow-up instructions, and adjust medications or administer intravenous diuretics under the direction of the telehealth physician. MIH has been shown in other studies to reduce emergency department (ED) transfers and healthcare costs while maintaining high patient satisfaction. We aimed to assess ED transfer rates and satisfaction in our population of largely medically underserved patients living with heart failure (HF) managed at home by MIH. Methods: Patients at a large, urban, academic medical center were enrolled in MIH via clinician referral as needed. After receiving an MIH visit, patients were invited to complete anonymous satisfaction surveys via REDCap. Paramedics documented whether an MIH home visit resulted in an ED transfer. Descriptive statistics were performed to evaluate the survey response distribution percentage and calculate ED transfer rates. Results: Between January 2021 and March 2024, 2,678 MIH visits were conducted for heart failure patients in NYC, with some patients receiving multiple visits. Among these, 239 patients completed at least one survey; only the first was considered for analysis. The average age of respondents was 74.01 (SD 14.8). Patient satisfaction was high: over 90% of participants expressed satisfaction across domains of ease of technology use, self-management and preference for receiving care at home. The net promoter score (patients recommending MIH to others) was 9.56 out of 10 (SD 1.27). Only 67 visits (2.5%) resulted in immediate ED transport during an MIH visit. Conclusions: High patient satisfaction with MIH care management at home and low rate of immediate transfers to ED indicate effective at-home care. These findings support MIH as a viable model for improving healthcare delivery and patient outcomes in HF management.
Abstract Su1101: Evaluating Participant Comfort Levels Pre and Post Community-Based CPR and AED Education
Authors: Ruth Pobee, Pavitra Kotini-Shah, Abbie Schmidt, Courtney Schwerin O'Reilly, Marina Del
Journal: Circulation (2024)

Introduction: Bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use are interventions that can increase survival rates of out-of-hospital cardiac arrests (OHCA). However, willingness and comfort levels of such interventions amongst laypersons vary greatly, especially in racial and ethnic minoritized groups including African Americans and Hispanics. Research Question: To assess the comfort level and perceived barriers of participants before and after community-based CPR and AED education. Methods: We conducted a family-centered quasi-experimental study in primarily Black and Hispanic churches around the Will and Dupage counties of Illinois. Informed consent was obtained. Participants watched an instructor-facilitated CPR and AED 10-minute educational video. Comfort levels pre- and post-training were assessed on a scale of 1 (least confident) to 5 (extremely confident) and reported as percentages. A semi-structured questionnaire was used to assess perceived barriers to performing CPR. Results: Out of 27 participants who completed training assessment, majority were females 55.6% (n=15), with 44.4% (n=12) males; 66.7% (n=18) African Americans, and 33.3% (n=9) Hispanic or Latino. 70.4% (n=19) of the participants spoke English while 29.6% (n=8) spoke Spanish. Before training, 73% (n=19) and 81% (n=21) of participants were not confident in administering CPR or using AED respectively on someone in cardiac arrest. After training, confidence level increased to 100% for both CPR and AED use. Perceived barriers to CPR prior to training included participants not knowing how to perform CPR correctly (65%), concern that they may further harm someone (4%), concerns about potential legal liability (4%), and loss of recall on how to perform CPR (4%), while 23% had no barrier. Conclusion: Comfort levels of individuals performing CPR and AED use increased significantly after community-based CPR and AED education. Data collection is ongoing to assess comfort level with a larger number of participants. Implementing community-based CPR training in churches allows for community-oriented CPR trainings and may help improve bystander comfort level and willingness to perform CPR during OHCA, especially in minoritized communities.