Wiaam Elkhatib

Introduction: Cardiogenic shock (CS) carries high morbidity and mortality. However, evidence for mechanical circulatory support (MCS) in non‐ischemic CS remains limited, as prior trials have focused on infarct‐related shock. Methods: We performed a retrospective cross‐sectional study using the Nationwide Inpatient Sample (2017–2019), identifying hospitalizations with a principal diagnosis of CS and excluding acute myocardial infarction. Patients were categorized into mutually exclusive groups: no MCS, intra‐aortic balloon pump (IABP) only, Impella only, or extracorporeal membrane oxygenation (ECMO) only. Primary outcomes were in‐hospital mortality, length of stay (LOS), and total hospital cost. Survey‐weighted multivariable models adjusted for demographics, hospital characteristics, and comorbidity burden using Elixhauser and Charlson indices. Results: Among 104 045 hospitalizations, 6040 received MCS. IABP was most common, followed by Impella and ECMO. Among patients receiving a single MCS strategy, overall in‐hospital mortality was 29.5%., with lower mortality in the IABP group (19.9%) compared with Impella (37.4%) and ECMO (44.3%). After adjustment, IABP was associated with lower observed in‐hospital mortality versus no MCS (aOR 0.58, 95% CI 0.53–0.64; p < 0.01), whereas Impella and ECMO showed increased aOR. IABP and ECMO were associated with longer LOS, while Impella was not. All MCS strategies were associated with higher costs, with ECMO showing the greatest increase (cost ratio 3.30, 95% CI 3.12–3.50). Conclusion: In non‐ischemic CS, MCS strategies demonstrate distinct profiles of mortality and resource utilization. IABP was associated with lower observed in‐hospital mortality, whereas all MCS were linked to higher costs, highlighting heterogeneity in outcomes and the need for further research.

Racial minorities remain underrepresented among allied health providers. Pathway programs address this gap by fostering career exposure and mentorship for underrepresented students. A pilot program was designed to increase underrepresented minority (URM) students entering health professions through career exploration and mentorship. High school students were enrolled into a pre-post survey study through a healthcare magnet school having higher proportions of economically disadvantaged students. Career exploration included healthcare presentations and skills sessions. Students were matched with mentors based on career interests. 22 students participated. The program facilitated career exploration sessions, mentor-mentee meetings, and workshops with diverse healthcare professionals. Participants reported increased likelihood towards pursuing healthcare careers. Preliminary findings suggest similar pilot pathway programs may increase URM student interest in healthcare careers.

Background: Peak oxygen uptake (VO ₂ peak), standardized to total body mass (ml/kg/min) is a predictor of morbidity and mortality in cardiovascular disease patients. However, subsets of individuals undergoing exercise based cardiac rehabilitation (CR) show no improvement or reduction in VO ₂ peak despite improvement in other functional measures. Our aim is to assess the influence of CR on lean mass, and the effect of body composition compared to total body mass changes on peak VO ₂ following CR. Methods: This pre-post intervention study included adults >18 years old who completed CR between 2015-2022 at Mayo Clinic, Rochester. All patients completed both dual energy X-ray absorptiometry (DXA) and cardiopulmonary exercise testing (CPET) for measurement of body composition (total mass and lean mass) and VO ₂ peak pre-post CR. Improvement in VO ₂ peak was defined as positive percent change. Descriptive statistics, paired t-tests, univariable and multivariable linear regression modeling were performed. Results: Of 140 subjects, 19.3% were female and 96.4% White with a mean (SD) age of 63 (12.5) years, BMI of 30.2 (5.82), and a mean of 27.1 (11.7) completed number CR sessions. Pre-post CR total body mass loss was −1.28 (3.18) kg and lean mass gain was 0.84 (2.86) kg. All changes were statistically significant (p2 peak in absolute units had a percent change increase of 6.52 (13.1) mL/min, relative (corrected for total body mass) increase of 8.24 (13.6) mL/kg/min, and relative to lean mass increase of 5.73 (13.4) mL/lean-kg/min. Pre-post percentage of subjects with a positive change in peak VO ₂ in absolute units was 70%, relative was 75%, and relative to lean mass was 67.9%. Multivariable regression showed statistical significance in peak VO ₂ percent change for all units when adjusted for pre-CR peak VO ₂ . Conclusions: Our findings demonstrate significant increases in lean mass and VO ₂ peak following CR, with larger improvements reflected in units adjusted for total mass compared to other methods. These data suggest the reporting methodology for change in VO ₂ peak following CR impact overall results. CLINICAL PERSPECTIVE: Published studies have reported that subsets of patients undergoing exercise-based cardiac rehabilitation (CR) may show no improvement or even reduction in peak oxygen uptake (VO ₂ peak), a predictor of mortality in individuals with cardiovascular disease, which may be partly influenced by body composition. This pre-post intervention study of 140 adult patients who completed CR demonstrated significant increases in lean mass and VO ₂ peak following CR across the cohort while suggesting the reporting methodology for change in VO ₂ peak impacts overall results. Our findings could imply that a proportion of patients continue to demonstrate additional abnormalities that inhibit improvement in VO ₂ peak independent of body composition alterations, partially explaining why a subset of patients have a lack of positive change in VO ₂ peak. Significant predictors for reduced VO ₂ peak improvement following CR may include female sex and pre-CR VO ₂ peak. Despite CR significantly improving lean body mass, the ability to utilize that mass to generate useful oxidative metabolism could be limited and may require a longer duration of CR to maximize oxidative metabolic efficiency and improve patient outcomes following acute cardiac events.

Objectives: Aircrew are subject to thermal stress and heat-related illness (HRI). Published screening methods and safety thresholds remain limited. The objective of this review was to evaluate the available evidence, approaches and guidelines regarding HRI screening tools in aircrew and analogue occupational and athletic cohorts to create a broad compendium of relevant tools for aviation safety decision-makers which establish risk stratification. Design: A systematic literature review was conducted through 28 July 2025, of manuscripts and technical documents that reported HRI risk screening approaches. Pairs of independent reviewers selected studies and appraised risk of bias. Data sources: Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews and Scopus were searched. Eligibility criteria: Extrinsic and intrinsic factors checklists, protocols, diagrams, algorithms and screening approaches for HRI risk stratification and safety thresholds within occupational settings were included. Cohorts under 18 years of age and abstracts were excluded. Data extraction and synthesis: 3472 reports were identified and 37 were included in the final analysis. Common approaches relied on wet bulb globe temperature (WBGT), workload assessment and personal protective equipment used. WBGT thresholds ranged 27–32°C for extreme risk and 23–31°C for high risk. Identified tools used 19 common domains to establish risk. Data were insufficient to identify a singular ideal screening approach. Conclusions: This systematic review addresses knowledge gaps regarding occupational HRI risk screening protocols for use towards aviation workers. Limitations included lack of generalisability, risk definition variability and conflicting published author assumptions regarding intrinsic factors considered.

Background Pilots face significant occupational risks affecting cardiometabolic health and are subject to regulatory health screenings. Cardiometabolic risk factors, cardiac screening findings and outcomes among pilots have not been well reported. Objectives This study aimed to investigate cardiac evaluations of asymptomatic aircraft pilots and the association between clinical risk factors and outcomes. Methods Asymptomatic aircraft pilots referred for cardiac assessment between January 1991 and May 2023 were studied. Baseline characteristics, cardiac test findings and outcomes were evaluated. Major adverse clinical event (MACE) was defined as death, myocardial infarction, stroke, major arrhythmia, heart failure event or cardiac-related hospitalisation and estimated using Kaplan-Meier methods. Significant valvular disease by echocardiography was defined as stenosis, regurgitation or prolapse of moderate severity or greater. Aortic dilation by transthoracic echocardiogram (TTE) was defined as measuring ≥40 mm in diameter. Results 212 pilots met eligibility criteria for the study. The majority were white (92.9%) and male (91%) with a mean age of 58.5±10.9 years. Mean body mass index was 27.8±4.8 with comorbid hyperlipidaemia (48%), hypertension (32%), prior cancer (27%), sleep apnoea (15%), arrhythmia (12%) and known coronary artery disease (6%). Imaging revealed significant valvular disease (2.4%) and dilated aortas (16%) based on TTEs. Functional cardiac testing performed showed mean functional aerobic capacity of 109±24.6% reaching 11.89±2.65 metabolic equivalents with Conclusions Asymptomatic aircraft pilots have underlying cardiovascular risk factors but good overall functional capacity, long-term outcomes and life expectancy. Prevalence of cardiac structural findings like aortic dilatation warrants increased attention during examination of these patients.

**Introduction/Hypothesis:** Primary cardiac neoplasms are diagnosed infrequently and with poor clinical outcomes in comparison to metastatic hea | POSTER

Background and Objectives: Comorbid risk factors in chronic hypersensitivity pneumonitis (CHP) are poorly characterised. Gastroesophageal reflux disease (GERD) is linked to interstitial lung diseases like idiopathic pulmonary fibrosis (IPF), but its association and treatment in CHP is less understood. This study aims to understand the role and prevalence of GERD in CHP, plus the effect of GERD treatment on lung function and mortality. Methods: A tertiary referral centre panel was retrospectively reviewed for 214 patients diagnosed with CHP based on clinical history, bronchoalveolar lavage fluid analysis, imaging and histopathology. GERD diagnostic criteria included symptomology, acid suppressive therapy use and diagnostic testing. CHP patients with GERD (n = 89) and without GERD (n = 125) were compared via descriptive statistical analysis. Pulmonary function, GERD diagnosis plus treatment and other comorbidities were evaluated against CHP outcomes. Results: Respective differences between diagnosis and study termination dates in the GERD population versus without GERD for functional vital capacity (FVC) were − 1 L vs − 2.5 L, diffusing capacity of the lungs for carbon monoxide (DLCO) were − 2 mL/min/mmHg versus − 1 mL/min/mmHg, per cent alive at the time of study 88% versus 81%, median date of survival 574.5 versus 850 and supplemental oxygen requirement 41% versus 37%. GERD prevalence was higher in CHP patients relative to the general population. No statistical significance was found between survival curves, oxygen requirement, smoking history, FVC, or DLCO. Conclusions: GERD could be a harmful comorbidity in CHP though may not necessarily affect survival or functional outcomes. This aligns with previous IPF studies, though remains controversial. Further research is needed regarding this association and treatment benefit.

Cryptococcal species endocarditis is infrequently described, carries high mortality and nearly always occurs in immunocompromised states or on prosthetic valves. We report the case of a man in his 70s with multiple recent hospitalisations for pneumonia, hypercalcaemia and septic tank exposure who presented with intermittent fevers, progressive weakness,and worsening encephalopathy, manifested as confusion and word-finding difficulties for 3 weeks. Workup revealed cryptococcal species on blood serum gram stain, native aortic valve endocarditis and meningitis. Cerebrospinal fluid analysis demonstrated lymphocytosis, ultimately found to be secondary to chronic lymphocytic leukaemia. Surgical valve replacement was deemed medically contraindicated and antifungal therapy was initiated. Though poorly understood with very few documented cases, management of cryptococcal endocarditis relies on prompt diagnosis, early surgery when indicated, long-term antifungal therapy and treatment of underlying immunocompromising states where possible.