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Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This study was supported by unrestricted grants from the Korean Society of Interventional Cardiology. Aims Despite the benefit of culprit-only percutaneous coronary intervention (PCI) in the CULPRIT-SHOCK trial, the optimal revascularization strategy for a refractory cardiogenic shock (CS) requiring mechanical circulatory support devices remains controversial. This study aimed to compare clinical outcomes between the culprit-only and immediate multi-vessel PCI strategies in patients with acute myocardial infarction (AMI) complicated by CS who underwent venoarterial-extracorporeal membrane oxygenation (VA-ECMO). Methods and Results This study was patient-pooled data from the RESCUE and SMC-ECMO registries. A total of 408 AMI patients with multi-vessel disease who underwent VA-ECMO due to refractory CS were included in this analysis. The study population was classified into culprit-only versus immediate multi-vessel PCI according to non-culprit lesion (NCL) treatment strategies. The co-primary endpoints were 30-day mortality or renal-replacement therapy and 12-month follow-up mortality. Among the study population, 241 (59.1%) underwent culprit-only PCI and 167 (40.9%) underwent immediate multi-vessel PCI. Compared with culprit-only PCI, immediate multi-vessel PCI was associated with significantly lower risks of 30-day mortality or renal-replacement therapy (66.8% vs. 54.5%, p=0.02) and all-cause mortality during 12 months of follow-up (59.5% vs. 47.8%, hazard ratio [HR] 0.70; 95% confidence interval [CI] 0.53–0.92, p=0.01) in patients with AMI and CS who underwent VA-ECMO. These results were also consistent in the 290 pairs of propensity score-matched population (55.6% vs. 46.1%, HR 0.71; 95% CI 0.51–0.98, p=0.04). Conclusion Among AMI patients with multi-vessel disease complicated by advanced CS, immediate multi-vessel PCI might be associated with improved clinical outcomes in those undergoing VA-ECMO.

Funding Acknowledgements Type of funding sources: None. Introduction Despite the introduction of mechanical circulatory support (MCS), short-term mortality rates in cardiogenic shock (CS) remain high. Prior CS risk scores have limited reliability because of selected derivation cohorts or inadequate validation. Purpose The aim of this study is to develop and validate externally the risk prediction model for in-hospital mortality in CS patients using machine learning (ML) algorithms. Methods 1247 patients of all-cause CS from the RESCUE registry (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Device for Korean Patients with CS) between January 2014 and December 2018 were analyzed. Patients were randomly divided into two groups for training and testing at a ratio of 7 to 3. Risk prediction models were estimated with the logistic regression analysis and four ML algorithms: Least absolute shrinkage and selection operator analysis (LASSO), Support vector machine (SVM), Extreme Gradient Boosting (XGB), and Random Forest classifier. Internal validation with the RESCUE registry and external validation with the single center CS registry including 678 patients were performed. Results All four ML models made an agreement with the seven important variables associated with mortality as follows; age, vasoactive inotropic score, left ventricular ejection fraction, lactic acid, cardiac arrest at presentation, requiring continuous renal replacement therapy, and mechanical ventilator. The logistic regression analysis was performed with the risk factors which were derived by ML models. The logistic regression model named RESCUE score showed the predictive performance with an area under the curve (AUC) of 0.86 [95% CI 0.83-0.88] for in-hospital mortality. External validation showed excellent discrimination with an AUC of 0.80 [95% CI 0.76-0.84]. Decision curve analysis indicated that the nomogram conferred high clinical net benefit. Conclusion The RESCUE score using advanced machine learning techniques has excellent predictive performance for the in-hospital mortality of CS regardless of the underlying cause. This model may be useful as a tool to estimate the risk stratification of CS patients.

A high-speed infrared small-angle infrared thermography system (SATS) has been developed and installed on the Experimental Advanced Superconducting Tokamak (EAST) for measuring the surface temperature of the divertor target to calculate the high heat flux induced by Edge Localized Modes (ELMs) and providing observation means for the further physical study of some key parameters, such as power decay length λq and the characteristic time of different types of ELMs. An endoscopic optical system is applied to realize the SATS for clear imaging of the divertor plate area and protection from the harm of impurity deposition and latent tungsten ablation during discharge. The field of view (FOV) of the endoscopic optical system is designed to be 13° in the horizontal direction and 9° in the vertical direction. As a consequence, ∼35° of coverage of the lower-outer divertor and a small part of the lower-inner divertor in toroidal are covered by the FOV with a spatial resolution of around 2 mm/pixel. This paper presents a detailed description of the new SATS and the preliminary experimental diagnostic results. The radial distribution of heat flux induced by an ELM crash was demonstrated.

Background In a few studies, obesity was associated with better outcomes in patients with cardiogenic shock (CS). Although this phenomenon, the “obesity paradox”, reportedly manifests differently based on sex in other disease entities, it has not yet been investigated in CS patients. Methods and results 1,227 patients with CS from The REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock (RESCUE) registry in Korea were analyzed. The study population was classified into obese and non-obese groups according to Asian-Pacific criteria (BMI >25.0 kg/m2 for obese). Clinical impact of obesity on in-hospital mortality according to sex was analyzed using logistic regression analysis and restricted cubic spline curves. In-hospital mortality rate was significantly lower in obese men than non-obese men (34.2% vs. 24.1%, p=0.004) while the difference was not significant in women (37.3% vs. 35.8%, p=0.884). As a continuous variable, higher BMI showed a protective effect in men conversely, BMI was not associated with clinical outcomes in women. Comparing to normal-weight patients, obesity was associated with a decreased risk of in-hospital death in men (multivariable-adjusted OR 0.63, CI 0.43–0.92, p=0.016), not in women (multivariable-adjusted OR 0.94, 95% CI 0.55–1.61, p=0.828). Interaction P value for the association between BMI and sex was 0.023. Conclusions Obesity paradox exists and apparently occurs in men among CS patients. The differential effect of BMI on in-hospital mortality was observed according to sex. Funding Acknowledgement Type of funding sources: None.

Background p.Arg4810Lys variant of the ring finger protein 213 (RNF213) vasculopathy is a nonsyndromatic vasculopathy involving multisystemic organs including pulmonary arteries. Peripheral pulmonary arterial stenosis (PPAS) with diffuse stenosis and beaded appearance is a unique feature of this disease and no treatment option has been tried before. Methods We performed BPA for PPAS in RNF213 patients (n=7). Severity of pulmonary hypertension was assessed by echocardiography and right heart catheterization at the baseline. Several clinical and hemodynamic parameters were followed up after each BPA sessions. Results All of the patients had dyspnea on exertion. Right ventricular dysfunction was observed in six patients and NT-proBNP was elevated (949.2±1148.1 pg/mL). Baseline echocardiography showed severe pulmonary hypertension (70.1±19.2 mmHg). Pulmonary arterial ballooning was performed to all patients, but stenting (n=6) and cutting balloon (n=1) was necessary due to elastic recoil. Improvement of clinical and hemodynamic parameters was achieved in six patients after 5.3 sessions of BPA in average. Reperfusion edema was seen in four patients, eventually leading to death in one patient. Conclusions Pulmonary arterial angioplasty, when coupled with stenting, is an effective treatment for PPAS with RNF213 vasculopathy. Although reperfusion injury was common and fatal in a few cases, it is the only modality to improve the patient's symptom and hemodynamics till now. Careful selection of the target population should be preceded to perform the intervention. Funding Acknowledgement Type of funding sources: None.

Background Even though the presence of hyperglycemia has shown to affect the clinical outcome of cardiogenic shock patients, the extent of hyperglycemia and its association with prognosis have not been fully addressed in large population Purpose Investigate the clinical relationship between hyperglycemic status and in-hospital mortality in cardiogenic shock patients Method A total of 1,177 consecutive cardiogenic shock patients were enrolled from January 2014 to December of 2018 at 12 hospitals in South Korea. The primary outcome was in-hospital mortality. Patients were divided into four groups according to their initial plasma glucose level in each of diabetes patients (n=752) and non-diabetes patients (n=425); group 1 (≤8 mmol/L), group 2 (8–12 mmol/L), group 3 (12–16 mmol/L) and group 4 (≥16 mmol/L). Results The groups with higher admission plasma glucose were associated with lower systolic blood pressure and higher lactic acid level in both diabetic and non-diabetic patients. In-hospital mortality increased in groups with higher admission plasma glucose level in non-diabetic patients (group-1:24.2%, group-2: 28.6%, group-3: 38.1%, group-4: 49.0%, p Conclusion In cardiogenic shock patients, plasma glucose obtained at admission was associated with in-hospital mortality in non-diabetic patients Funding Acknowledgement Type of funding sources: Private hospital(s). Main funding source(s): Inha University hospital

Background Chronic thromboembolic pulmonary disease (CTEPD) without pulmonary hypertension could cause significant exercise limitations. However, interventional or surgical treatments for CTEPD with mild pulmonary hypertension or normal pressure are on controversy. Purpose We aimed to evaluate cardiopulmonary function through cardiopulmonary exercise test (CPET) with stress echocardiography and to determine whether exercise pulmonary hypertension can explain exercise limitations in CTEPD patients with mPAP Methods Patients diagnosed as CTEPD with mPAP less than 30mmHg was derived from our pulmonary hypertension center registry from April 2014 to October 2021.Transthoracic echocardiography (TTE) was performed at baseline (resting state) and immediately after CPET. TTE derived parameters and CPET parameters were compared with hemodynamic parameters measured by right catheterization. Results Total 37 patients were enrolled. Of these, Thirty-five patients had previously been diagnosed with CTEPH and had undergone PEA, BPA, or both. Most of the patients complained dyspnea of WHO functional class II or III. Pulmonary vascular resistance (PVR) was slightly higher than normal (185.0±102.2 dyne sec cm–5). Also VO2max was decreased in CPET (23.1±6.5 mL/kg/min). In correlation analysis, the higher the mPAP and PVR at rest, the lower VO2max during exercise. Meanwhile basal right ventricular (RV) function was normal, an increase in RVSP was notably observed during exercise (RVSP: pre-exercise 36.2±11.9, post-exercise 60.7±19.3, p value Conclusions CTEPD patients with mild or normal PAP showed limited exercise capacity with exercise induced hypertension. Even in the mPAP less than 30mmHg, PVR and mPAP was significantly associated with exercise capacity. CPET with stress echocardiography could help to identify the main cause of exercise limitation in CTEPD patients and possibly provide the guideline for treatment plan. Funding Acknowledgement Type of funding sources: None.

Preliminary evidence has demonstrated a link between anxiety and memory impairment in Parkinson’s disease (PD). This study further investigated this association using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for anxiety disorders and a standardized cognitive test battery. A convenience sample of 89 PD patients without dementia was recruited from neurology outpatient clinics. A cross-sectional design was applied. Participants completed two semi-structured interviews. The first interview diagnosed DSM-5 anxiety disorders, unspecified anxiety disorder, and no anxiety. The second interview applied a neurocognitive test battery comprising two tests for each domain. Logistic regression models compared cognitive characteristics associated with anxiety disorders to no anxiety. Clinically significant anxiety was associated with immediate verbal memory impairment compared to the no anxiety group (OR, 95% CI 0.52, 0.30–0.89; p = 0.018), controlling for sex and age. The anxiety disorders group demonstrated immediate (OR, 95% CI 0.46, 0.26–0.83; p = 0.010) and delayed (OR, 95% CI 0.63, 0.40–0.99; p = 0.047) verbal memory impairments compared to those without anxiety, controlling for sex and age. This association remained for immediate (OR, 95% CI 0.43, 0.22–0.84; p = 0.013), but not delayed verbal memory impairment (OR, 95% CI 0.65, 0.39–1.06; p = 0.081) when additionally controlling for disease severity, education and levodopa dose. These findings present first evidence that anxiety disorders are associated with verbal memory impairment in PD and have implications for the management and treatment of anxiety in PD.

Human-guided machine learning can improve computing intelligence, and it can accurately assist humans in various tasks. In education research, artificial intelligence (AI) is applicable in many situations, such as predicting students’ learning paths and strategies. In this study, we explore the benefits of repetitive practice of short-answer questions could enhance students’ long-term memory for subsequent improvements in learning performance. However, frequent authoring questions and grading requires teachers’ professionalism, experience, and considerable efforts. Therefore, this study using modern AI technologies, specifically natural language processing, to provide Automatic question generation (AQG) solution, a combined semantics-based and syntax-based question generation system: Hybrid automatic question generation (Hybrid-AQG) was proposed in this study. We assessed its functionality and student learning performance by asking 91 students to complete short-answer questions and then applied a process similar to the Turing test to evaluate the question and grading quality. The results demonstrated that modern AI technologies can generate highly realistic short-answer questions because: (1) Compared with the control group, the experimental group exhibited significantly better learning performance, implying that students acquired long-term memory of course knowledge through repetitive practice with machine-generated questioning. (2) The experimental group could better distinguish machine-generated and expert-authored questions. Nevertheless, both groups in distinguishing questions presented like guessing. (3) Machine grading was deficient in some respects; but the way students answer questions can be adapted for machine understanding through repetitive practice.