Search Results for: Prima terapia farmacologica per l’apnea notturna (OSAS)

Circulation, Volume 150, Issue Suppl_1, Page A4120918-A4120918, November 12, 2024. Aim:The association between obstructive sleep apnea and prediabetes using STOP-Bang questionnaire is unknown. We aimed to investigate prevalence of prediabetes among people according to sleep apnea status.Methods:This cross-sectional study included 10131 Korean adults without diabetes with information of STOP-Bang score were identified from the dataset of the Korea National Health and Nutrition Examination Survey 2019-2021. Prediabetes was categorized into three subsets: fasting blood glucose only (fasting blood glucose 100-125 mg/dL, HbA1c

Circulation, Volume 150, Issue Suppl_1, Page A4144389-A4144389, November 12, 2024. Background:Obstructive sleep apnea (OSA) may influence the outcomes of catheter ablation in atrial fibrillation (AF) patients, but its impact at different stages of AF is not well understood.Objective:This study aims to evaluate whether OSA influences catheter ablation outcomes differently in patients with paroxysmal AF compared to those with persistent AF.Methods:We included AF patients with and without obstructive sleep apnea (OSA) in a late gadolinium enhancement (LGE) MRI database of patients who underwent catheter ablation. Our study population was stratified based on the type of AF: paroxysmal or persistent. Patients were followed for 24 months post-ablation, with a 3-month blanking period. To analyze time-to-AF recurrence, we used Kaplan-Meier curve along with the log-rank test to compare recurrence rates between patients with and without OSA in both AF types. Additionally, we used Cox regression analysis to adjust for potential confounders.Results:324 patients with paroxysmal AF (mean age: 64.5) and 512 patients with persistent AF (mean age: 65.2) were included. The left atrial (LA) volume was similar between OSA and non-OSA patients in both the paroxysmal AF cohort (83.1 mm3 vs. 83.6 mm3; p=0.73) and the persistent AF cohort (115 mm3 vs. 119 mm3; p=0.37). Patients with OSA exhibited a higher prevalence of comorbidities, including congestive heart failure (CHF), coronary artery disease, obesity, and diabetes, compared to non-OSA patients (p

Circulation, Volume 150, Issue Suppl_1, Page A4132909-A4132909, November 12, 2024. Background:While the critical role of right ventricular dysfunction (RVD) in heart failure (HF) is increasingly recognized, the prevalence and prognostic impact of RVD across HF subtypes is poorly understood.Research Questions/Aims:We aimed to characterize differences in hemodynamic indices of RV function among patients with HF with preserved vs reduced ejection fraction (HFpEF, EF≥50% vs HFrEF, EF

Circulation, Volume 150, Issue Suppl_1, Page A4120332-A4120332, November 12, 2024. Introduction:Sleep apnea (SA) is often underrecognized and undertreated despite its high prevalence in the adult population and its association with adverse cardiovascular outcomes. There are limited estimates of national trends on cardiovascular mortality in older patients with sleep apnea. We aimed to assess the sex and race-related trends of ischemic heart disease (IHD) mortality in the older adults with SA using a large population-based database.Methods:We utilized the Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research (CDC WONDER) database which provides information from death certificates of all US residents according to the International Classification of Diseases, Tenth Revision (ICD-10). The demographic and mortality data were obtained for the United States population >65 years from 1999 to 2021. Ischemic heart disease (ICD-10 codes I20-I25) was listed as the underlying cause of death, and SA (G47.3) as a contributing cause of death. Age adjusted mortality rates (AAMRs) per 1,000,000 population were calculated by standardizing deaths to the year 2000 US population. We used Jointpoint Regression Program to analyze temporal trends in mortality from 2000 to 2021. Average annual percentage change (AAPC) with 95% CI were calculated to examine trends in AAMR over time.Results:Overall, AAMR of IHD mortality for patients with SA increased from 7.9 per 1,000,000 (95% CI, 6.9-8.8) in 1999 to 53.4 per 1,000,000 (95% CI, 51.4-55.4) in 2021 with an AAPC of 9.1% per year (95% CI, 8.8-9.5). Men had consistently higher AAMR than women throughout the study period (overall AAMR men: 45.51 (95% CI, 44.8-46.2); women: 12.5 (95% CI, 12.2-12.8). Both the groups had a similar increasing trend in AAMR, with men having a steeper increase. [AAPC men: 9.3% (95% CI, 8.5-10.8) versus AAPC women: 8.6%, 95% CI, 8.1-9.7]. Non Hispanic (NH) White population had the greatest AAMR throughout the study period, followed by NH Black and Hispanic or Latino. The NH White population had the largest increase in AAMR from 1999 to 2021 (AAPC 9.4%, 95% CI:8.9-10.1).Conclusion:In the United States, there has been a general increase in IHD mortality related to sleep apnea over the last two decades. This rising trend as noted in our analysis is concerning and underscores the need for more robust cardiovascular surveillance in these patients.

Circulation, Volume 150, Issue Suppl_1, Page A4141875-A4141875, November 12, 2024. Background:First pass isolation (FPI) improves freedom from AF, while acute pulmonary vein reconnection (PVR) predicts AF recurrence. There is little data to predict FPI or acute PVR based on individual patient characteristics. Height is a risk factor for incident AF and may be associated with AF recurrence after ablation.Hypothesis:We hypothesize that patient-specific factors can predict lack of FPI and acute PVR. If such factors are identified and used to modify ablation strategies, FPI will increase and acute PVR will reduce in those undergoing paroxysmal AF ablation.Methods:Patients were ablated utilizing CARTO3 with THERMOCOOL SMARTTOUCH SF catheters at 50W, 2mm overlapping lesions. A derivation cohort of patients were treated with standard Ablation Index (AI) targets of 450 on anterior and 350 on posterior surfaces. Subsequently, ablation strategies would be modified and outcomes were reassessed.Results:In the derivation cohort, median height (172cm) was the strongest predictor of FPI among all variables (age, sex, height, weight, BSA, diabetes, hypertension, sleep apnea, LA size), (B=1.68 p172cm had reduced FPI (50/107 [47%] vs 67/99 [68%] p172cm treated with standard AI targets, FPI increased (37/56 [65%] vs 50/107 [47%] p=0.02) and acute PVR decreased (1/56 [2%] vs 24/107 [22%] p

Circulation, Volume 150, Issue Suppl_1, Page A4145554-A4145554, November 12, 2024. Background:Cancer and obstructive sleep apnea (OSA) individually elevate cardiovascular diseases (CVD) and stroke risk. However, it is unclear whether OSA contributes additional CVD risk in persons with pre-existing cancer.Methods:Using the TriNetX, an electronic healthcare records-based database from large healthcare organizations, we compared adverse CVD outcomes and ischemic stroke incidence between patients with and without OSA diagnosed with cancer between 01/2012 and 06/2023. Adverse CVD outcomes was defined as a composite of incident heart failure, incident atrial fibrillation / flutter, incident myocardial infarction or all-cause mortality. Patients were eligible to enter the cohort on the day of cancer diagnosis. The follow-up period for outcome events began one year after patients entered the cohort and patients contributed follow-up time till the outcome event occurred or till the end of the study period.After propensity risk score matching on demographics and comorbidities we conducted a time-to-event analyses.Results:A total of 509,477 patients with both cancer and OSA were propensity score matched to 509,477 patients with cancer but without OSA. The table shows the demographic and comorbidities of the matched groups. Among persons with cancer, OSA diagnosis was associated with increased risk of adverse CVD outcomes (HR: 1.37, 95% CI: 1.36 – 1.38). OSA in persons with cancer increased the risk of heart failure, atrial fibrillation / flutter and myocardial infarction. OSA also increased the risk of ischemic stroke. However, total mortality risk was reduced among those with OSA. See the table for details.Conclusion:OSA increases the risk of adverse CVD outcomes and ischemic stroke in persons with cancer. These analyses suggest that persons with cancer should be screened and treated for OSA. Future studies will need to determine the impact of OSA treatment e.g., positive airway pressure (PAP) therapy on CVD related outcomes in persons with cancer. Further investigation into the paradoxical reduction in all-cause mortality with OSA is warranted.

Circulation, Volume 150, Issue Suppl_1, Page A4144386-A4144386, November 12, 2024. Background:Previous literature suggests that Obstructive sleep apnea (OSA) increases atrial fibrillation (AF) recurrence after catheter ablation, but its impact on atrial remodeling has not been investigated.Objective:The study assesses the impact of OSA and continuous positive airway pressure (CPAP) on atrial remodeling, AF burden, arrhythmia recurrence, QoL improvement.Methods:The study population consists of patients with persistent AF with late-gadolinium enhancement (LGE) MRI before and after undergoing catheter ablation from the DECAAF II trial. We compared a subgroup with OSA with the rest of the cohort. The three study outcomes were measured with the following: arrhythmia recurrence and AF Burden based on single-lead smartphone-based daily electrocardiogram (ECG) strips, and SF36 questionnaires (baseline, 3-month, 12 month). Survival analysis of arrhythmia recurrence was performed using cox regression analysis, controlling for confounders.Results:The study population consists of 815 patients. We compared 84 OSA patients with the remaining 731 non-OSA population. Amongst OSA patients 29 patients were treated with CPAP. Baseline characteristics including baseline fibrosis (18.8 vs 18.86; p=0.9426), left atrial volume index (LAVI) (62.4 mm3vs 62.6 mm3p=0.95), and comorbidities were not different between OSA and non-OSA patients except for body mass index (30.9 vs 35.1; p

Circulation, Volume 150, Issue Suppl_1, Page A4146184-A4146184, November 12, 2024. Introduction:Increasing evidence shows that obstructive sleep apnea (OSA) is a significant risk factor for cardiovascular disease. OSA may exacerbate recovery from ST-elevation myocardial infarction (STEMI), as chronic hypoxemia and hypercapnia has been shown to be associated with sympathetic hyperactivity, inflammatory response, endothelial dysfunction, and hypercoagulability. Acute outcomes of STEMI patients who have a diagnosis of OSA has not been well-studied.Research Question:Does OSA affect inpatient outcomes in patients with a primary diagnosis of STEMI?Methods:We conducted a retrospective analysis using the National Inpatient Sample database from 2016-2021 to examine the inpatient outcomes of STEMI patients in OSA patients compared to patients without OSA. Inclusion criteria encompassed patients diagnosed with acute STEMI and OSA based on ICD-10 codes.Results:A total of 1,203,915 STEMI patients were identified; among these, 1,128,880 (93.7%) did not have a diagnosis of OSA, while 75,035 (6.3%) had a known diagnosis of OSA. Patients with OSA had lower in-hospital mortality (aOR=0.86, CI 0.80-0.90, p

Circulation, Volume 150, Issue Suppl_1, Page ASa103-ASa103, November 12, 2024. Background:Guidelines for resuscitation of OHCA recommend that advanced airway management be performed without interrupting chest compressions. However, the extent and impact of interrupting ventilation during OHCA resuscitation is unknown. We described the apnea interval that occurs during endotracheal intubation (ETI) and its associated clinical outcomes.Methods:We conducted a cohort investigation of adult ventricular fibrillation (VF)-OHCA patients who underwent attempted paramedic ETI during resuscitation in a metropolitan EMS system from 2017–19. We defined apnea interval as the elapsed time from the last breath delivered before an ETI attempt to the first breath delivered after the attempt. We collected patient, care, apnea interval and outcome data from review of OHCA and airway registries linked to digital defibrillator recordings. The defibrillator recording included an audio channel, ECG, transthoracic impedance, and end-tidal carbon dioxide biosignals. Using multivariable logistic regression, we determined the relationship between apnea interval (longest quartile [ >120s] vs the shorter 3 quartiles [120s compared to 120s was associated with lower likelihood of ROSC but not hospital discharge. Given its variability and relationship to near-term resuscitation outcomes, the apnea interval may be a modifiable intervention that can affect OHCA survival, supporting the need for further investigation.

Circulation, Volume 150, Issue Suppl_1, Page A4142226-A4142226, November 12, 2024. Background:Males tend to lose less weight than females with semaglutide, a GLP-1 receptor agonist, for unknown reasons. One hypothesis is that lower average body weight in females may result in greater drug exposure, leading to more weight loss.Objective:Leveraging a multi-state network of clinico-genomic cohorts, we aimed to quantify the extent to which sex differences in baseline body weight could explain semaglutide-associated weight loss differences between males and females.Methods:We utilized electronic health record data and clinical-grade sequencing from multiple U.S. cohorts (n >100k). Among individuals starting semaglutide with BMI ≥27 kg/m2(consistent with guidelines), we analyzed weight measurements over a 12-month use period. A BMI polygenic score (PGS) using 27k variants (PGS001228) was calculated. Percent weight change was modeled using mixed effects models with quadratic and cubic terms for time and interaction terms with baseline weight, sex, and confounders (semaglutide dose, age, ancestry, BMI PGS, comorbidities, medications). We also conducted a mediation analysis to test whether baseline weight mediated the relationship between sex and weight loss.Results:Among 959 females and 352 males, 7,381 weight measurements occurred over a median of 8.9 months (IQR: 6.2-10.8). Median baseline weight was 102 kg (IQR: 90-119) for females and 114 kg (IQR: 100-133) for males. Median weight loss at 6- and 12-months was 5.2% (IQR: 1.9-9.1) and 6.5% (IQR: 2.0-11.8) for females and 3.3% (IQR: 1.0-6.5) and 4.5% (IQR: 1.3-7.7) for males. After adjustment, male sex was associated with a lower rate of weight loss (β=+0.95% [per 6 months], p=0.003). Other factors associated with lower weight loss were BMI PGS (β=+1.28% [top vs bottom quintile], p=0.002), type 2 diabetes (β=+0.88%, p=0.006), hypertension (β=+0.72%, p=0.025), obstructive sleep apnea (β=+0.65%, p=0.032), and insulin use (β=+0.76%, p=0.035). In the mediation analysis, the proportion of the sex-weight loss association that could be explained by baseline weight was 8.4% (95% CI: 2.9-20.6) and 16.0% (95% CI: 10.7-26.2) at 6- and 12-months.Conclusions:Baseline body weight explained only a small fraction of the observed sex difference in semaglutide-associated weight loss, suggesting that other factors (e.g., hormonal) may play a more significant role. Findings also highlight the impact of traditional metabolic risk factors and BMI-associated genetic variants on weight loss with semaglutide.

Circulation, Volume 150, Issue Suppl_1, Page A4144926-A4144926, November 12, 2024. Background:Sleep apnea is characterized by cessation of breathing during sleep. It is often prevalent among patients with cardiovascular disorders. Ticagrelor, an anti-platelet drug, can have significant implications on the health of a patient. It is suspected to have potential impacts on sleep including sleep apnea. However, the extent of the association between ticagrelor and sleep apnea is unclear.Hypothesis:This meta-analysis evaluates the association between ticagrelor and the association of sleep apnea compared to placebo.Method:We systematically searched for relevant articles published until March 2024, on PubMed, Google Scholar and Embase. Odds ratios (OR) were pooled using the random-effects DerSimonian-Laird model, and a p-value of

Circulation, Volume 150, Issue Suppl_1, Page A4141117-A4141117, November 12, 2024. Introduction:Although glucagon-like peptide-1 receptor agonists have been shown to reduce BP and major cardiovascular adverse events (MACE), little is known about whether the benefits of these therapies vary in individuals with hypertension (HT) or across the spectrum of BP categories.Research Question and Aim:To evaluate the effect of once-weekly semaglutide 2.4 mg vs placebo on cardiovascular (CV) outcomes by baseline BP categories in SELECT.Methods:SELECT was a double-blind, randomized, placebo-controlled trial that included patients aged ≥45 years with preexisting CV disease and BMI ≥27 kg/m2without diabetes. Patients received once-weekly semaglutide 2.4 mg or placebo; the primary endpoint was time to first MACE analyzed with a Cox proportional hazards model with semaglutide and placebo as fixed factors according to baseline BP categories.Results:Among 17,604 randomized patients, 14,392 (82%) had a history of HT. Patients with history of HT were older and more likely female, with a higher BMI, lower eGFR, and higher UACR. A higher proportion presented with atrial fibrillation, obstructive sleep apnea, and heart failure NYHA class II/III, but fewer underwent coronary revascularization (Table). Patients with HT who received placebo had a higher incidence rate of MACE vs semaglutide (2.6 vs 2.1 per 100 patient-years, respectively). Semaglutide generally exhibited consistent benefits for CV outcomes regardless of history of HT or baseline BP categories (Figure). Compared with placebo, semaglutide significantly and consistently reduced systolic BP (SBP) across BP categories (normal, −2.9 [95% CI−4.0; −1.9]; elevated BP, −2.8 [−4.0; −1.6]; stage 1, −3.4: [−4.1; −2.6]; stage 2, −3.7 [− 4.4; −2.9]).Conclusions:HT is highly prevalent in people with overweight or obesity and atherosclerotic CV disease without diabetes and is associated with increased MACE. Semaglutide led to consistent reductions in MACE and lowered SBP irrespective of baseline BP category.

Circulation, Volume 150, Issue Suppl_1, Page A4139567-A4139567, November 12, 2024. Introduction:Case series suggest that cardiac implantable electronic devices (CIEDs) with right ventricular leads may tether the tricuspid valve, leading to clinically relevant tricuspid regurgitation (TR). However, the impact of these devices on tricuspid disease in the general population has not been investigated.Methods:Using California’s Department of Health Care Access and Information databases, a longitudinal Cox proportional-hazards analysis of adults who received care in an emergency department, hospital, or outpatient surgery facility from 1 January 2005 to 31 December 2020 was performed. Patients with prevalent TR, rheumatic or congenital heart disease, and endocarditis were excluded. Outcomes were (1) the development of TR and (2) tricuspid intervention.Results:Of 16,893,314 participants contributing 56,095,327 person years, there were 11,234 instances of TR. In the unadjusted analyses, CIED implantation was associated with a 13-fold higher risk of incident TR. After adjusting for age, sex, race and ethnicity, income, heart failure, atrial fibrillation, hypertension, pulmonary hypertension, coronary artery disease, chronic kidney disease, hyperlipidemia, diabetes mellitus, chronic obstructive pulmonary disease, asthma, obstructive sleep apnea, alcohol use, cocaine use, methamphetamine use, opiate use, and tobacco use, patients with a CIED exhibited a 15% higher risk of TR (Figure 1). Heart failure, pulmonary hypertension, hypertension, and atrial fibrillation each exhibited larger magnitudes of risk for TR than having a CIED.In the same population, 74 tricuspid valve interventions were identified. While a CIED was associated with a subsequent tricuspid intervention with HR 19.43 (p

Circulation, Volume 150, Issue Suppl_1, Page A4146116-A4146116, November 12, 2024. Introduction:Sleep apnea is an independent risk factor for hypertension. Chronic intermittent hypoxia (CIH), a key feature of sleep apnea, is considered the main factor for the development of hypertension, which is attributed to sympathoexcitation. However, novel evidence shows that CIH enhanced CB chemosensory discharges triggering an increase in sympathetic outflow through neuronal activation in the nucleus of the solitary tract (NTS). This idea is supported by the fact that CB ablation abolish the hypertension and NTS neuroinflammation after 21 days of CIH even in the presence of CIH. However, whether CB mediate glial cell activation (well-known sentinels involved in brain inflammation) following long-term CIH remains unknown.Hypothesis:Accordingly, we propose that the maintenance of hypertension and glia cell activation within the NTS of mice exposed to long-term CIH, depends on the CB afferent discharge.Methods:We exposed male C57BL6 mice to CIH (5% FiO2, 12 times/h, 8 h/day) for 60 days. At 45 days of CIH, CBs were selectively denervated, and animals were kept in CIH for additional 15 days. At the end of the experiments, we measured arterial blood pressure (MABP), hypoxic ventilatory response (HVR) in awake mice and assessed astrocyte and microglia activity through morphological 3D reconstructions, and IL-1β, IL-6, and TNF-α gene expression in the NTS with real-time PCR.Results:CIH induces hypertension (MABP 83.5±1.4 vs. 95.0±2.2 mmHg; Sham vs CIH), enhances HVR (1.69±0.2 vs 4.3±0.9 VE/min; Sham vs. CIH), and change astrocytes morphology (N° of branches 13.0±0.7 vs 11.3±0.5; cable length 181.0±8.9 vs 148.1±1.5 pm, Sham vs CIH), and microglia arborization (N° of branches 196.1±8.4 vs 376.3±16.8; cable length 667.4±29.6 vs 1267±60.5 pm, Sham vs CIH). Remarkably, CB denervation (CIHd) normalized the hypertension (MABP 83.5±1.4 mmHg; CIHd), the enhanced HVR (1.63±0.43 VE/min; CIHd), reduced the increased IL-6 (1.2± 0.2 vs 0.4 ± 0.1, CIH vs CIHd), TNF-α (2.0±0.2 vs 1.1±0.2, CIH vs CIHd) but not IL-1β levels (3.0±0.4 CIH vs 2.6±0.5, CIH vs CIHd), and the changes observed in astrocytes (N° of branches 17.2±0.9, cable length 231.0±12.9) and microglia (N° of branches 126.2±13.3; cable length 126.2±1.3 CIHd).Conclusions:Present results suggest that CBs plays a critical role in the maintenance of high blood pressure and contribute to the inflammation in the NTS of mice exposed to long-term CIH. Supported by Fondecyt Grants 1211443 and 1220950.

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