{
  "cases": [
    {
      "caseId": "GLN-32-HFREF-VASODIL",
      "labelEn": "HFrEF Systolic Failure: Afterload Unloading (-25% SVR Vasodilator)",
      "labelKo": "수축기 심부전(HFrEF): 혈관확장제 후부하 감압(-25% SVR) 박출량 회복",
      "metrics": {
        "baselineEfPct": 23.13,
        "baselineMapMmHg": 89.0,
        "deltaSvMl": 5.36,
        "pcwpDropMmHg": -0.61,
        "therapyEfPct": 27.08,
        "therapyMapMmHg": 81.3
      },
      "verdict": "PASS",
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            25.91
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            30.37
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            32.82
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            145.7,
            35.77
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            145.7,
            39.17
          ],
          [
            145.7,
            43.01
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          [
            145.7,
            47.25
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            145.7,
            51.84
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          [
            145.7,
            56.73
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          [
            145.7,
            61.89
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            145.7,
            67.25
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            145.7,
            72.77
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          [
            145.63,
            78.34
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            83.52
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            106.34
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            112.5,
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            112.0,
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            47.19
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            38.83
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            31.29
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            112.97,
            25.2
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            21.28
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          [
            144.83,
            25.53
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            144.95,
            25.59
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            145.06,
            25.64
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          [
            145.18,
            25.69
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          [
            145.29,
            25.74
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          [
            145.63,
            25.9
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          [
            145.66,
            25.91
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        ],
        "edpvrCurve": [
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            2.7
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            47.0,
            3.35
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            53.0,
            4.03
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            83.0,
            8.22
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            95.0,
            10.4
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            11.64
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            19.99
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            167.0,
            37.96
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            173.0,
            42.32
          ]
        ],
        "esvrSlope": 1.05,
        "interventionLabel": "Vasodilator (-25% SVR)",
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        "therapyLoop": [
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            25.26
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          [
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            25.57
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            26.4
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            27.78
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            29.7
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            32.13
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            35.05
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            38.43
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            42.25
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            46.45
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            51.0
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            55.86
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            60.98
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          [
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            24.38
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          [
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          [
            142.82,
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          [
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          [
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          [
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          [
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          [
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            25.13
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          [
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          [
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            25.25
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          [
            144.22,
            25.26
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        ]
      }
    },
    {
      "caseId": "GLN-32-SEPSIS-PRESSOR",
      "labelEn": "Septic Vasoplegic Hypotension: Fluid (+250 mL) + Vasopressor (+40% SVR)",
      "labelKo": "패혈성 혈관마비 저혈압: 수액 부하(+250 mL) 및 승압제(+40% SVR) 적정",
      "metrics": {
        "baselineCoLpm": 5.136,
        "baselineMapMmHg": 66.6,
        "deltaSvMl": 6.01,
        "therapyCoLpm": 5.464,
        "therapyMapMmHg": 98.2
      },
      "verdict": "PASS",
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            12.37
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          [
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            12.68
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            13.48
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            14.79
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            16.62
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            18.95
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            21.76
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            25.03
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            28.75
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            32.88
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            37.39
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            42.26
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            47.44
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            104.48,
            52.91
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          [
            104.19,
            58.41
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          [
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            63.7
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            68.68
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          [
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            73.28
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            77.42
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            96.25,
            81.07
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          [
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            84.2
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            91.17,
            86.78
          ],
          [
            88.45,
            88.84
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          [
            85.7,
            90.38
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            82.95,
            91.45
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          [
            80.25,
            92.07
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            92.3
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            75.13,
            92.2
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            72.75,
            91.8
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            70.53,
            91.16
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            68.47,
            90.32
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            66.57,
            89.33
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            88.22
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            87.02
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            84.44
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            83.08
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            58.7,
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            67.59
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            62.79
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            51.56
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            45.44
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            39.2
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            33.03
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            27.11
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            21.59
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            16.64
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            10.18
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            67.25,
            8.25
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            72.65,
            7.23
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            77.73,
            7.37
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            81.87,
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            85.13,
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            10.79
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            10.96
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            11.04
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            11.25
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            11.5
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            11.57
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            11.63
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            11.75
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            11.81
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            12.04
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            12.1
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            12.16
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            12.22
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          [
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            12.28
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            104.12,
            12.34
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          [
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            12.37
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        ],
        "edpvrCurve": [
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            35.0,
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          [
            41.0,
            2.7
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          [
            47.0,
            3.35
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          [
            53.0,
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          [
            71.0,
            6.36
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            77.0,
            7.25
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          [
            83.0,
            8.22
          ],
          [
            89.0,
            9.26
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          [
            95.0,
            10.4
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            11.64
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            107.0,
            13.01
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            113.0,
            14.5
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            119.0,
            16.15
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            137.0,
            22.23
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            27.5
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            155.0,
            30.6
          ],
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            161.0,
            34.07
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        ],
        "esvrSlope": 1.75,
        "interventionLabel": "Fluid +250 mL & Norepinephrine (+40% SVR)",
        "kind": "pv_loop",
        "therapyLoop": [
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            19.79
          ],
          [
            130.57,
            20.39
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            130.57,
            22.07
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            24.83
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            130.57,
            28.65
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            130.57,
            33.49
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            130.57,
            39.29
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            130.57,
            45.97
          ],
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            130.57,
            53.46
          ],
          [
            130.57,
            61.67
          ],
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            130.57,
            70.5
          ],
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            130.57,
            79.84
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          [
            130.16,
            89.23
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            128.65,
            97.82
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            126.23,
            105.42
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            119.42,
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            115.41,
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            85.87,
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            71.33
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            59.77
          ],
          [
            77.0,
            48.24
          ],
          [
            77.0,
            37.3
          ],
          [
            77.0,
            27.46
          ],
          [
            78.69,
            19.76
          ],
          [
            85.38,
            14.96
          ],
          [
            94.44,
            12.3
          ],
          [
            103.39,
            12.2
          ],
          [
            110.05,
            13.75
          ],
          [
            114.51,
            14.9
          ],
          [
            117.48,
            15.72
          ],
          [
            119.49,
            16.29
          ],
          [
            120.87,
            16.7
          ],
          [
            121.86,
            16.99
          ],
          [
            122.6,
            17.22
          ],
          [
            123.18,
            17.4
          ],
          [
            123.67,
            17.55
          ],
          [
            124.1,
            17.68
          ],
          [
            124.49,
            17.81
          ],
          [
            124.85,
            17.92
          ],
          [
            125.2,
            18.03
          ],
          [
            125.54,
            18.14
          ],
          [
            125.87,
            18.25
          ],
          [
            126.19,
            18.35
          ],
          [
            126.51,
            18.46
          ],
          [
            126.82,
            18.56
          ],
          [
            127.13,
            18.66
          ],
          [
            127.43,
            18.76
          ],
          [
            127.73,
            18.86
          ],
          [
            128.03,
            18.96
          ],
          [
            128.33,
            19.06
          ],
          [
            128.62,
            19.16
          ],
          [
            128.91,
            19.26
          ],
          [
            129.19,
            19.36
          ],
          [
            129.47,
            19.45
          ],
          [
            129.75,
            19.55
          ],
          [
            130.03,
            19.65
          ],
          [
            130.3,
            19.74
          ],
          [
            130.44,
            19.79
          ]
        ]
      }
    },
    {
      "caseId": "GLN-32-HFPEF-HTN",
      "labelEn": "Preserved-EF Hypertensive Crisis: Arterial Unloading (-25% SVR, Stiff EDPVR)",
      "labelKo": "박출률 보존 고혈압 위기(HFpEF): 동맥 감압(-25% SVR) 및 이완기 충만압 완화",
      "metrics": {
        "baselineEfPct": 42.81,
        "baselineSbpMmHg": 167.0,
        "therapyEfPct": 48.72,
        "therapyPcwpMmHg": 25.88,
        "therapySbpMmHg": 144.3
      },
      "verdict": "PASS",
      "viz": {
        "baselineLoop": [
          [
            117.81,
            27.45
          ],
          [
            117.84,
            28.48
          ],
          [
            117.84,
            31.5
          ],
          [
            117.84,
            36.49
          ],
          [
            117.84,
            43.37
          ],
          [
            117.84,
            52.05
          ],
          [
            117.84,
            62.41
          ],
          [
            117.84,
            74.29
          ],
          [
            117.84,
            87.52
          ],
          [
            117.84,
            101.93
          ],
          [
            117.66,
            117.05
          ],
          [
            115.77,
            130.29
          ],
          [
            112.41,
            141.2
          ],
          [
            108.17,
            150.0
          ],
          [
            103.47,
            156.94
          ],
          [
            98.66,
            162.21
          ],
          [
            93.97,
            166.04
          ],
          [
            89.57,
            168.69
          ],
          [
            85.54,
            170.36
          ],
          [
            81.94,
            171.27
          ],
          [
            78.78,
            171.57
          ],
          [
            76.05,
            171.39
          ],
          [
            73.75,
            170.82
          ],
          [
            71.83,
            169.92
          ],
          [
            70.26,
            168.72
          ],
          [
            69.04,
            167.24
          ],
          [
            68.12,
            165.49
          ],
          [
            67.52,
            162.8
          ],
          [
            67.4,
            157.38
          ],
          [
            67.4,
            148.23
          ],
          [
            67.4,
            135.54
          ],
          [
            67.4,
            120.0
          ],
          [
            67.4,
            102.52
          ],
          [
            67.4,
            84.07
          ],
          [
            67.4,
            65.7
          ],
          [
            67.4,
            48.46
          ],
          [
            67.4,
            33.31
          ],
          [
            71.65,
            23.07
          ],
          [
            83.09,
            17.87
          ],
          [
            95.87,
            16.77
          ],
          [
            104.72,
            19.84
          ],
          [
            108.8,
            21.95
          ],
          [
            110.59,
            22.95
          ],
          [
            111.43,
            23.43
          ],
          [
            111.89,
            23.7
          ],
          [
            112.2,
            23.88
          ],
          [
            112.45,
            24.03
          ],
          [
            112.68,
            24.16
          ],
          [
            112.89,
            24.29
          ],
          [
            113.1,
            24.42
          ],
          [
            113.3,
            24.54
          ],
          [
            113.5,
            24.66
          ],
          [
            113.7,
            24.79
          ],
          [
            113.9,
            24.91
          ],
          [
            114.09,
            25.02
          ],
          [
            114.28,
            25.14
          ],
          [
            114.46,
            25.26
          ],
          [
            114.64,
            25.37
          ],
          [
            114.82,
            25.49
          ],
          [
            115.0,
            25.6
          ],
          [
            115.18,
            25.71
          ],
          [
            115.35,
            25.82
          ],
          [
            115.52,
            25.93
          ],
          [
            115.69,
            26.04
          ],
          [
            115.86,
            26.15
          ],
          [
            116.02,
            26.25
          ],
          [
            116.18,
            26.36
          ],
          [
            116.34,
            26.46
          ],
          [
            116.49,
            26.57
          ],
          [
            116.65,
            26.67
          ],
          [
            116.8,
            26.77
          ],
          [
            116.95,
            26.87
          ],
          [
            117.1,
            26.97
          ],
          [
            117.25,
            27.07
          ],
          [
            117.39,
            27.17
          ],
          [
            117.53,
            27.26
          ],
          [
            117.67,
            27.36
          ],
          [
            117.81,
            27.45
          ]
        ],
        "edpvrCurve": [
          [
            35.0,
            2.42
          ],
          [
            41.0,
            3.18
          ],
          [
            47.0,
            4.01
          ],
          [
            53.0,
            4.93
          ],
          [
            59.0,
            5.96
          ],
          [
            65.0,
            7.1
          ],
          [
            71.0,
            8.39
          ],
          [
            77.0,
            9.85
          ],
          [
            83.0,
            11.51
          ],
          [
            89.0,
            13.4
          ],
          [
            95.0,
            15.58
          ],
          [
            101.0,
            18.09
          ],
          [
            107.0,
            20.99
          ],
          [
            113.0,
            24.36
          ],
          [
            119.0,
            28.28
          ],
          [
            125.0,
            32.84
          ],
          [
            131.0,
            38.18
          ],
          [
            137.0,
            44.43
          ],
          [
            143.0,
            51.76
          ],
          [
            149.0,
            60.36
          ],
          [
            155.0,
            70.47
          ]
        ],
        "esvrSlope": 2.95,
        "interventionLabel": "Arterial Vasodilator (-25% SVR)",
        "kind": "pv_loop",
        "therapyLoop": [
          [
            115.39,
            25.85
          ],
          [
            115.43,
            26.84
          ],
          [
            115.43,
            29.73
          ],
          [
            115.43,
            34.5
          ],
          [
            115.43,
            41.08
          ],
          [
            115.43,
            49.39
          ],
          [
            115.43,
            59.31
          ],
          [
            115.43,
            70.7
          ],
          [
            115.43,
            83.4
          ],
          [
            115.31,
            97.1
          ],
          [
            113.65,
            109.64
          ],
          [
            110.47,
            120.32
          ],
          [
            106.26,
            129.15
          ],
          [
            101.44,
            136.2
          ],
          [
            96.36,
            141.57
          ],
          [
            91.28,
            145.42
          ],
          [
            86.41,
            147.95
          ],
          [
            81.87,
            149.42
          ],
          [
            77.77,
            150.05
          ],
          [
            74.12,
            150.05
          ],
          [
            70.94,
            149.6
          ],
          [
            68.21,
            148.81
          ],
          [
            65.89,
            147.78
          ],
          [
            63.96,
            146.55
          ],
          [
            62.39,
            145.16
          ],
          [
            61.14,
            143.61
          ],
          [
            60.18,
            141.9
          ],
          [
            59.49,
            139.9
          ],
          [
            59.19,
            136.0
          ],
          [
            59.19,
            129.47
          ],
          [
            59.19,
            119.8
          ],
          [
            59.19,
            107.52
          ],
          [
            59.19,
            93.31
          ],
          [
            59.19,
            77.97
          ],
          [
            59.19,
            62.32
          ],
          [
            59.19,
            47.24
          ],
          [
            59.19,
            33.57
          ],
          [
            61.94,
            23.47
          ],
          [
            71.91,
            17.85
          ],
          [
            84.79,
            14.9
          ],
          [
            96.25,
            16.07
          ],
          [
            102.72,
            18.88
          ],
          [
            105.76,
            20.36
          ],
          [
            107.21,
            21.1
          ],
          [
            107.96,
            21.5
          ],
          [
            108.42,
            21.75
          ],
          [
            108.76,
            21.93
          ],
          [
            109.04,
            22.08
          ],
          [
            109.3,
            22.22
          ],
          [
            109.55,
            22.36
          ],
          [
            109.79,
            22.5
          ],
          [
            110.03,
            22.63
          ],
          [
            110.26,
            22.76
          ],
          [
            110.49,
            22.89
          ],
          [
            110.72,
            23.02
          ],
          [
            110.94,
            23.14
          ],
          [
            111.16,
            23.27
          ],
          [
            111.37,
            23.39
          ],
          [
            111.58,
            23.52
          ],
          [
            111.79,
            23.64
          ],
          [
            112.0,
            23.76
          ],
          [
            112.2,
            23.88
          ],
          [
            112.4,
            24.0
          ],
          [
            112.6,
            24.12
          ],
          [
            112.79,
            24.23
          ],
          [
            112.98,
            24.35
          ],
          [
            113.17,
            24.46
          ],
          [
            113.36,
            24.57
          ],
          [
            113.54,
            24.69
          ],
          [
            113.72,
            24.8
          ],
          [
            113.9,
            24.91
          ],
          [
            114.07,
            25.02
          ],
          [
            114.25,
            25.12
          ],
          [
            114.42,
            25.23
          ],
          [
            114.58,
            25.34
          ],
          [
            114.75,
            25.44
          ],
          [
            114.91,
            25.54
          ],
          [
            115.07,
            25.65
          ],
          [
            115.23,
            25.75
          ],
          [
            115.39,
            25.85
          ]
        ]
      }
    },
    {
      "caseId": "GLN-32-SHOCK-HOLD",
      "labelEn": "Extreme Tachyarrhythmia & Cardiogenic Shock (HR 168 bpm, Emax 0.42 -> Safety HOLD)",
      "labelKo": "극단적 빈맥성 심인성 쇼크(HR 168 bpm, Emax 0.42): 폐부종 위험 임상 보류(HOLD)",
      "metrics": {
        "baselineMapMmHg": 42.6,
        "eMaxMmHgPerMl": 0.42,
        "fluidChallengePcwpMmHg": 30.76,
        "holdReason": "OUT_OF_DOMAIN_TACHY_CARDIOGENIC_SHOCK_MCS_REQUIRED",
        "hrBpm": 168
      },
      "verdict": "HOLD",
      "viz": {
        "baselineLoop": [
          [
            133.36,
            20.84
          ],
          [
            133.38,
            20.88
          ],
          [
            133.39,
            21.0
          ],
          [
            133.39,
            21.18
          ],
          [
            133.39,
            21.43
          ],
          [
            133.39,
            21.76
          ],
          [
            133.39,
            22.15
          ],
          [
            133.39,
            22.62
          ],
          [
            133.39,
            23.14
          ],
          [
            133.39,
            23.73
          ],
          [
            133.39,
            24.38
          ],
          [
            133.39,
            25.09
          ],
          [
            133.39,
            25.85
          ],
          [
            133.39,
            26.66
          ],
          [
            133.39,
            27.51
          ],
          [
            133.39,
            28.4
          ],
          [
            133.39,
            29.33
          ],
          [
            133.39,
            30.3
          ],
          [
            133.39,
            31.29
          ],
          [
            133.39,
            32.3
          ],
          [
            133.39,
            33.33
          ],
          [
            133.39,
            34.37
          ],
          [
            133.39,
            35.43
          ],
          [
            133.39,
            36.48
          ],
          [
            133.39,
            37.53
          ],
          [
            133.39,
            38.57
          ],
          [
            133.38,
            39.6
          ],
          [
            133.32,
            40.59
          ],
          [
            133.21,
            41.53
          ],
          [
            133.04,
            42.42
          ],
          [
            132.82,
            43.26
          ],
          [
            132.56,
            44.05
          ],
          [
            132.27,
            44.78
          ],
          [
            131.95,
            45.45
          ],
          [
            131.61,
            46.06
          ],
          [
            131.25,
            46.61
          ],
          [
            130.87,
            47.1
          ],
          [
            130.49,
            47.52
          ],
          [
            130.11,
            47.88
          ],
          [
            129.72,
            48.18
          ],
          [
            129.34,
            48.4
          ],
          [
            128.96,
            48.56
          ],
          [
            128.6,
            48.66
          ],
          [
            128.25,
            48.69
          ],
          [
            127.92,
            48.66
          ],
          [
            127.61,
            48.56
          ],
          [
            127.32,
            48.27
          ],
          [
            127.08,
            47.71
          ],
          [
            126.89,
            46.9
          ],
          [
            126.76,
            45.86
          ],
          [
            126.7,
            44.6
          ],
          [
            126.7,
            43.14
          ],
          [
            126.7,
            41.5
          ],
          [
            126.7,
            39.69
          ],
          [
            126.7,
            37.76
          ],
          [
            126.7,
            35.74
          ],
          [
            126.7,
            33.68
          ],
          [
            126.7,
            31.61
          ],
          [
            126.7,
            29.58
          ],
          [
            126.7,
            27.61
          ],
          [
            126.7,
            25.76
          ],
          [
            126.7,
            24.06
          ],
          [
            126.7,
            22.54
          ],
          [
            126.76,
            21.25
          ],
          [
            127.24,
            20.34
          ],
          [
            128.03,
            19.79
          ],
          [
            128.94,
            19.55
          ],
          [
            129.82,
            19.6
          ],
          [
            130.56,
            19.83
          ],
          [
            131.13,
            20.03
          ],
          [
            131.58,
            20.19
          ],
          [
            131.92,
            20.32
          ],
          [
            132.2,
            20.41
          ],
          [
            132.41,
            20.49
          ],
          [
            132.58,
            20.55
          ],
          [
            132.72,
            20.6
          ],
          [
            132.83,
            20.64
          ],
          [
            132.92,
            20.68
          ],
          [
            133.0,
            20.71
          ],
          [
            133.07,
            20.73
          ],
          [
            133.12,
            20.75
          ],
          [
            133.17,
            20.77
          ],
          [
            133.22,
            20.79
          ],
          [
            133.26,
            20.8
          ],
          [
            133.3,
            20.82
          ],
          [
            133.34,
            20.83
          ],
          [
            133.37,
            20.84
          ],
          [
            133.4,
            20.86
          ],
          [
            133.44,
            20.87
          ],
          [
            133.47,
            20.88
          ],
          [
            133.36,
            20.84
          ]
        ],
        "edpvrCurve": [
          [
            35.0,
            2.09
          ],
          [
            41.0,
            2.7
          ],
          [
            47.0,
            3.35
          ],
          [
            53.0,
            4.03
          ],
          [
            59.0,
            4.76
          ],
          [
            65.0,
            5.53
          ],
          [
            71.0,
            6.36
          ],
          [
            77.0,
            7.25
          ],
          [
            83.0,
            8.22
          ],
          [
            89.0,
            9.26
          ],
          [
            95.0,
            10.4
          ],
          [
            101.0,
            11.64
          ],
          [
            107.0,
            13.01
          ],
          [
            113.0,
            14.5
          ],
          [
            119.0,
            16.15
          ],
          [
            125.0,
            17.97
          ],
          [
            131.0,
            19.99
          ],
          [
            137.0,
            22.23
          ],
          [
            143.0,
            24.72
          ],
          [
            149.0,
            27.5
          ],
          [
            155.0,
            30.6
          ],
          [
            161.0,
            34.07
          ],
          [
            167.0,
            37.96
          ],
          [
            173.0,
            42.32
          ]
        ],
        "esvrSlope": 0.42,
        "interventionLabel": "HOLD: Contraindicated +250 mL Fluid Overload Warning",
        "kind": "pv_loop",
        "therapyLoop": [
          [
            154.69,
            30.43
          ],
          [
            154.7,
            30.47
          ],
          [
            154.7,
            30.58
          ],
          [
            154.7,
            30.76
          ],
          [
            154.7,
            31.01
          ],
          [
            154.7,
            31.33
          ],
          [
            154.7,
            31.71
          ],
          [
            154.7,
            32.17
          ],
          [
            154.7,
            32.68
          ],
          [
            154.7,
            33.26
          ],
          [
            154.7,
            33.9
          ],
          [
            154.7,
            34.59
          ],
          [
            154.7,
            35.33
          ],
          [
            154.7,
            36.12
          ],
          [
            154.7,
            36.96
          ],
          [
            154.7,
            37.83
          ],
          [
            154.7,
            38.74
          ],
          [
            154.7,
            39.69
          ],
          [
            154.7,
            40.66
          ],
          [
            154.7,
            41.65
          ],
          [
            154.7,
            42.66
          ],
          [
            154.7,
            43.68
          ],
          [
            154.7,
            44.71
          ],
          [
            154.7,
            45.74
          ],
          [
            154.7,
            46.77
          ],
          [
            154.7,
            47.79
          ],
          [
            154.7,
            48.79
          ],
          [
            154.64,
            49.76
          ],
          [
            154.52,
            50.67
          ],
          [
            154.35,
            51.54
          ],
          [
            154.14,
            52.35
          ],
          [
            153.89,
            53.11
          ],
          [
            153.6,
            53.82
          ],
          [
            153.29,
            54.48
          ],
          [
            152.96,
            55.07
          ],
          [
            152.6,
            55.61
          ],
          [
            152.24,
            56.09
          ],
          [
            151.86,
            56.51
          ],
          [
            151.48,
            56.87
          ],
          [
            151.1,
            57.16
          ],
          [
            150.73,
            57.39
          ],
          [
            150.36,
            57.55
          ],
          [
            150.0,
            57.65
          ],
          [
            149.66,
            57.68
          ],
          [
            149.33,
            57.65
          ],
          [
            149.03,
            57.55
          ],
          [
            148.75,
            57.27
          ],
          [
            148.51,
            56.71
          ],
          [
            148.32,
            55.89
          ],
          [
            148.19,
            54.83
          ],
          [
            148.14,
            53.55
          ],
          [
            148.14,
            52.07
          ],
          [
            148.14,
            50.4
          ],
          [
            148.14,
            48.57
          ],
          [
            148.14,
            46.61
          ],
          [
            148.14,
            44.56
          ],
          [
            148.14,
            42.47
          ],
          [
            148.14,
            40.37
          ],
          [
            148.14,
            38.3
          ],
          [
            148.14,
            36.31
          ],
          [
            148.14,
            34.43
          ],
          [
            148.14,
            32.7
          ],
          [
            148.15,
            31.16
          ],
          [
            148.49,
            30.0
          ],
          [
            149.26,
            29.28
          ],
          [
            150.21,
            28.93
          ],
          [
            151.19,
            28.87
          ],
          [
            152.05,
            29.05
          ],
          [
            152.72,
            29.38
          ],
          [
            153.19,
            29.63
          ],
          [
            153.53,
            29.81
          ],
          [
            153.77,
            29.94
          ],
          [
            153.95,
            30.03
          ],
          [
            154.08,
            30.1
          ],
          [
            154.18,
            30.15
          ],
          [
            154.26,
            30.19
          ],
          [
            154.31,
            30.23
          ],
          [
            154.36,
            30.25
          ],
          [
            154.4,
            30.27
          ],
          [
            154.44,
            30.29
          ],
          [
            154.47,
            30.31
          ],
          [
            154.49,
            30.32
          ],
          [
            154.52,
            30.34
          ],
          [
            154.54,
            30.35
          ],
          [
            154.57,
            30.36
          ],
          [
            154.59,
            30.37
          ],
          [
            154.61,
            30.39
          ],
          [
            154.63,
            30.4
          ],
          [
            154.65,
            30.41
          ],
          [
            154.68,
            30.42
          ],
          [
            154.69,
            30.43
          ]
        ]
      }
    }
  ],
  "findings": [
    {
      "detailEn": "In extreme biventricular failure with Emax = 0.42 mmHg/mL, simulating a +250 mL fluid challenge elevates pulmonary capillary wedge pressure (PCWP > 24 mmHg) along the exponential EDPVR limb without meaningful stroke volume gain, risking acute pulmonary edema. The Twin explicitly holds automated fluid recommendations under ISO 14971 hazard control.",
      "detailKo": "좌심실 최대 탄성도(Emax = 0.42 mmHg/mL)가 붕괴된 중증 심인성 쇼크에서 +250 mL 수액 부하 시 비선형 EDPVR 급경사 구간을 따라 폐모세혈관쐐기압(PCWP)만 급증하고 박출량 증가는 미미하여 급성 폐부종 위험이 발생합니다. ISO 14971 위해관리 규칙에 따라 자동 권고를 보류(HOLD)합니다.",
      "id": "TWIN32-F1-SHOCK-EXTRAPOLATION-HOLD",
      "severity": "HOLD",
      "status": "HOLD",
      "titleEn": "Severe Tachyarrhythmic Cardiogenic Shock (Emax < 0.50, HR > 155 bpm) Requires MCS HOLD",
      "titleKo": "중증 빈맥성 심인성 쇼크(Emax < 0.50, HR > 155 bpm) 영역 외 약물·수액 외삽 차단(HOLD)"
    },
    {
      "detailEn": "While arterial/oscillometric SBP, DBP, MAP, and HR constrain systemic coupling across 138 MIMIC-IV ICU stays, latent venous unstressed volume and right-ventricular coupling carry structural non-identifiability without Swan-Ganz catheterization or bedside Doppler echocardiography.",
      "detailKo": "MIMIC-IV 138건 체류의 동맥압·심박수로 전신 혈역학 결합 파라미터를 보정했으나, 스완-간즈 우심도자술이나 심초음파 측정치가 없는 환자의 정맥 무부하 용적 및 우심실 결합도는 잠재적 비식별성 구간이 존재함을 명시합니다.",
      "id": "TWIN32-F2-NONINVASIVE-CUFF-LIMITATION",
      "severity": "HOLD",
      "status": "HOLD",
      "titleEn": "Cuff-Only ICU Stays Lack Direct Invasive Wedge Pressure (PCWP) & Right-Heart Thermodilution",
      "titleKo": "비침습 혈압계 단독 측정 환자군에서의 직접 폐동맥쐐기압(PCWP)·열희석 심박출량 부재 한계"
    },
    {
      "detailEn": "Advancing from TRL 4/5 open-cohort validation to clinical therapy-planning SaMD approval requires ASME V&V 40 Context-of-Use credibility review and prospective multi-center echocardiographic / invasive right-heart catheterization concordance under IRB oversight.",
      "detailKo": "치료계획 보조 SaMD 상용 인허가를 위해서는 의료기기 전산모델링 국제규격(ASME V&V 40) 적합성 심사와 국내 순환기내과·중환자의학과 심초음파·우심도자술 전향적 일치도 IRB 임상 실증이 필수입니다.",
      "id": "TWIN32-F3-ASME-VV40-STATUTORY-GATE",
      "severity": "EXT",
      "status": "EXT",
      "titleEn": "Statutory Gate: ASME V&V 40 Credibility Dossier & Prospective Echo / RHC Clinical Concordance",
      "titleKo": "법정 외부 게이트: ASME V&V 40 전산모델 신뢰성 입증 및 심초음파·우심도자술 전향적 임상 실증"
    }
  ],
  "gates": {
    "G1": {
      "detailEn": "Verified all 5 MIMIC-IV Demo tables by SHA-256 across 137 ICU stays (100 patients) with strict early->late temporal separation and zero raw patient identifiers exported.",
      "detailKo": "MIMIC-IV Demo 5개 원시 테이블의 SHA-256 해시 일치, 137건 중환자실 체류의 엄격한 선후 시간분할, 원시 환자 식별자 외부 유출 0건을 확인했습니다.",
      "observed": {
        "errors": [],
        "evaluatedStays": 137,
        "hypotensiveEvents": 91,
        "rawPatientIdsExported": false
      },
      "status": "PASS",
      "titleEn": "MIMIC-IV 2.2 SHA-256 Provenance, Pseudonymization & Chronological Split",
      "titleKo": "MIMIC-IV 2.2 공개 코호트 해시 무결성·가명화 및 시간순 분할 검증"
    },
    "G2": {
      "detailEn": "Independent RK4 re-integration confirmed max volume drift=3.00e-12 mL (< 1e-5 mL) and max MAP(dt=2ms vs 1ms) difference=0.00100 mmHg.",
      "detailKo": "솔버 독립 RK4 재적분 결과 총혈액량 보존 오차 3.00e-12 mL (< 1e-5 mL) 및 dt=2ms 대 1ms 평균동맥압 수렴 오차 0.00100 mmHg를 증명했습니다.",
      "observed": {
        "checkpointsReintegrated": 12,
        "errors": [],
        "maxRk4DtHalfDiffMmHg": 0.001,
        "maxVolumeDriftMl": 3e-12
      },
      "status": "PASS",
      "titleEn": "Closed-Loop Blood Volume Conservation (<1e-5 mL) & RK4 dt/2 Convergence",
      "titleKo": "폐루프 총혈액량 질량보존(<1e-5 mL) 및 RK4 시간간격(dt 대 dt/2) 수렴 증명"
    },
    "G3": {
      "detailEn": "Recomputed hypotensive instability (MAP < 65 mmHg) AUROC=0.8392 (vs Static Shock/Windkessel=0.6536) and MAP RMSE=8.44 vs 12.78 mmHg.",
      "detailKo": "홀드아웃 저혈압(MAP < 65 mmHg) 예측 AUROC 0.8392(정적 비교군 0.6536) 및 평균동맥압 RMSE 8.44 mmHg(정적 Windkessel 12.78 mmHg)를 독립 재검산했습니다.",
      "observed": {
        "errors": [],
        "recomputedAuroc": 0.839226,
        "recomputedBaselineAuroc": 0.653607,
        "recomputedMapRmseMmHg": 8.444867,
        "recomputedStaticMapRmseMmHg": 12.782823
      },
      "status": "PASS",
      "titleEn": "Solver-Free ICU Instability AUROC & Held-Out MAP RMSE Recomputation",
      "titleKo": "솔버 독립 중환자 저혈압 불안정성 AUROC 및 미래 평균동맥압 RMSE 재검산"
    },
    "G4": {
      "detailEn": "Enforces automatic HOLD when extreme tachyarrhythmia (HR > 155 bpm) or severe systolic collapse (Emax < 0.50 mmHg/mL) invalidates pharmacologic/fluid monotherapy without mechanical circulatory support.",
      "detailKo": "극단적 빈맥(HR > 155 bpm) 또는 중증 수축력 붕괴(Emax < 0.50) 상태에서의 무리한 수액·단독 약물 외삽을 차단(HOLD)하고 기계적 순환보조(ECMO/LVAD) 전문의 판단으로 이관합니다.",
      "observed": {
        "cohortOutOfDomainHolds": 11,
        "errors": [],
        "interactiveHoldCases": 1
      },
      "status": "PASS",
      "titleEn": "Out-of-Domain Cardiogenic Shock HOLD & ASME V&V 40 Statutory Boundary",
      "titleKo": "영역 외 심인성 쇼크 자동 보류(HOLD) 및 ASME V&V 40·임상도자술 법정 경계 명시"
    }
  },
  "humanAuditorSignature": null,
  "inputProvenance": [
    {
      "label": "icustays.csv.gz",
      "records": 140,
      "sha256": "e05e81aa52a3022e522b6832a898101a69b84e64c17bb344d819e458d5bc21b3"
    },
    {
      "label": "chartevents.csv.gz",
      "records": 668862,
      "sha256": "90f096ad3db847ed1aaec073f8d86053c51fea7b616d3b046410e030f083d560"
    },
    {
      "label": "d_items.csv.gz",
      "records": 4014,
      "sha256": "1690467a822345226a041c1149237c418aa60098c6b699fb4cef64d73588a01f"
    },
    {
      "label": "admissions.csv.gz",
      "records": 275,
      "sha256": "910b9f160ffdf1e08ea673585393f347c773ccc87d66875c627584a903ae8493"
    },
    {
      "label": "labevents.csv.gz",
      "records": 107727,
      "sha256": "d51a4cf1ea63245abe7d544b0d50a928e9ee2ec5eb9a5ce85500aed0bd6c6dfc"
    }
  ],
  "narrative": {
    "headlineEn": "Closed-loop 4-compartment RK4 cardiopulmonary Twin calibrated on 138 real PhysioNet MIMIC-IV ICU stays achieves 0.8392 AUROC for held-out hypotensive decompensation (vs 0.6536 static baseline) and reduces forward MAP RMSE from 12.78 to 8.44 mmHg with 3.00e-12 mL blood volume drift.",
    "headlineKo": "PhysioNet MIMIC-IV 실제 중환자실 체류 138건을 초기 구간에서 보정한 4구획 폐루프 RK4 심폐 디지털트윈이 후속 저혈압 불안정성(MAP < 65 mmHg) 예측 AUROC 0.8392(정적 비교군 0.6536)를 달성하고, 평균동맥압 예측 RMSE를 12.78에서 8.44 mmHg로 단축(혈액량 보존 오차 3.00e-12 mL)했습니다.",
    "methodEn": "Integrates Suga-Sagawa time-varying LV elastance E_lv(t), nonlinear exponential EDPVR, diode aortic/mitral valves, 3-element arterial Windkessel (R_c, C_sa, R_svr), systemic venous reservoir, and pulmonary capillary wedge coupling via 4th-order Runge-Kutta (dt = 2 ms).",
    "methodKo": "좌심실 시변 탄성도 E_lv(t)와 비선형 지수형 이완기 압력-부피 곡선(EDPVR), 대동맥·승모판 다이오드 판막, 3요소 전신 동맥 Windkessel(R_c, C_sa, R_svr), 정맥 저장소 및 폐모세혈관쐐기압(PCWP) 결합 미분방정식을 4차 Runge-Kutta(dt = 2 ms)로 적분하여 반사실 약물·수액 반응을 정량화합니다."
  },
  "overallStatus": "PASS",
  "package": "twin11_32",
  "primaryMetric": {
    "baselineNameEn": "Early Window Static Shock-Index / Linear Windkessel Baseline",
    "baselineNameKo": "초기 구간 정적 쇼크지수·선형 Windkessel 베이스라인",
    "baselineValue": 0.653607,
    "ci95": [
      0.760392,
      0.914477
    ],
    "denominator": 137,
    "nameEn": "Held-Out ICU Hypotensive Instability (MAP < 65 mmHg) Prediction AUROC",
    "nameKo": "중환자실 홀드아웃 저혈압 혈역학 불안정성(MAP < 65 mmHg) 예측 AUROC",
    "targetSpec": "AUROC >= 0.78 & MAP RMSE < Static Windkessel with Volume Drift < 1e-5 mL",
    "unit": "AUROC",
    "value": 0.839226
  },
  "rfpCode": "11-1 [3-2]",
  "runSha256": "e6db9265e1a7f08daece56ba86eeb6356dfe17c851a566cacdf00280492dcce2",
  "schemaVersion": 1,
  "secondaryMetrics": [
    {
      "ci95": null,
      "id": "twin_map_rmse_mmhg",
      "nameEn": "Held-Out Subsequent Window MAP Prediction RMSE (Closed-Loop RK4 Twin)",
      "nameKo": "홀드아웃 후속 구간 평균동맥압(MAP) 예측 오차 RMSE (폐루프 RK4 트윈)",
      "unit": "mmHg",
      "value": 8.444867
    },
    {
      "ci95": null,
      "id": "static_windkessel_map_rmse_mmhg",
      "nameEn": "Baseline Comparison: Naive Static Linear Windkessel MAP RMSE",
      "nameKo": "비교 베이스라인: 정적 선형 Windkessel 모델 평균동맥압 예측 오차 RMSE",
      "unit": "mmHg",
      "value": 12.782823
    },
    {
      "ci95": null,
      "id": "twin_pp_mae_mmhg",
      "nameEn": "Held-Out Arterial Pulse Pressure Prediction MAE",
      "nameKo": "홀드아웃 동맥 맥압(Pulse Pressure) 예측 절대오차 MAE",
      "unit": "mmHg",
      "value": 6.048404
    },
    {
      "ci95": null,
      "id": "rk4_volume_conservation_ml",
      "nameEn": "Closed-Loop 4-Compartment Blood Volume Conservation Residual",
      "nameKo": "4구획 폐루프 총혈액량 질량보존 최대 잔차",
      "unit": "mL",
      "value": 3e-12
    },
    {
      "ci95": null,
      "id": "rk4_dt_convergence_mmhg",
      "nameEn": "RK4 Timestep Halving Convergence Error |MAP(2ms) - MAP(1ms)|",
      "nameKo": "RK4 시간간격 반감 수렴 오차 |MAP(2ms) - MAP(1ms)|",
      "unit": "mmHg",
      "value": 0.001
    },
    {
      "ci95": null,
      "id": "hfref_vasodilator_sv_gain_ml",
      "nameEn": "Counterfactual HFrEF Vasodilator (-25% SVR) Stroke Volume Gain",
      "nameKo": "반사실 시뮬레이션: 수축기 심부전 혈관확장제(-25% SVR) 1회 박출량 증가분",
      "unit": "mL/beat",
      "value": 5.363
    }
  ],
  "solverFreeAst": {
    "file": "audit.py",
    "importedModules": [
      "__future__",
      "audit_lib.independent_metrics",
      "audit_lib.track_contract",
      "json",
      "math",
      "pathlib",
      "typing"
    ],
    "solverFree": true,
    "violations": []
  }
}