Search Results for: LBP (Low Back Pain): Cosa dicono le linee guida del mal di schiena

Circulation, Volume 150, Issue Suppl_1, Page A4131381-A4131381, November 12, 2024. Background:Dietary interventions play a crucial role in weight management and reducing cardiovascular risk factors. Our study aims to compare the effectiveness of four dietary macronutrient interventions on weight loss and cardiovascular (CV) risk factor reduction through a systematic review and network meta-analysis.Methods:We conducted a comprehensive literature search on PubMed, Scopus, Embase, and Cochrane Library up till May 2024 to identify randomized controlled trials (RCTs) comparing four macronutrient dietary interventions including Mediterranean Diet (MD), Keto, Dietary Approaches to Stop Hypertension (DASH), and Intermittent Fasting (IF) with study period ≥ 6 months or 24 weeks. The primary outcomes of interest were weight loss, systolic blood pressure (SBP), Diastolic blood pressure (DBP), Body Mass Index (BMI), High density lipoprotein (HDL), Low density Lipoprotein (LDL), cholesterol levels and C-reactive protein (CRP) levels. Outcomes were reported as standard mean difference (SMD).Results:Our analysis identified 50 studies enrolling 5368 patients (MD=3554; DASH=838; Keto=206; IF=770). Regarding BP outcome, MD and DASH had significant reduction in SBP and DBP respectively (MD [SBP]: -0.76 mmHg vs DASH [DBP]: -1.92 mmHg) respectively. In contrast, IF showed a significant rise in SBP (0.87). MD participants also had significant weight loss (-1.06 kg) and a moderate decrease in BMI (-0.79) when compared with other diets. Furthermore, IF, keto, and MD showed moderate increase in HDL levels (0.61, 0.77 and 0.33) respectively. In contrast, DASH resulted in a moderate decline in HDL levels (-0.92). IF and MD resulted in modest decline in LDL levels (-0.45 and -0.42) respectively. In contrast, Keto demonstrated non-significant rise in LDL (0.35). DASH showed a significant decrease in triglycerides (-3.02). Lastly, MD demonstrated a significant reduction in CRP (-0.89).Conclusions:MD and DASH were superior to other dietary interventions in terms of weight loss and CV risk factors. Further research is required to tailor specific types of dietary interventions and assess their long-term efficacy on weight loss and CV risk reduction.

Circulation, Volume 150, Issue Suppl_1, Page A4142146-A4142146, November 12, 2024. Introduction:Health literacy levels (HLL) in adults with chronic diseases correlate with health outcomes, especially in acquired cardiovascular disease. Data demonstrates that lower HLL correlate with lower education, and adult congenital heart disease (ACHD) patients have overall lower educational attainment. Currently, the HLL of ACHD patients is understudied and largely unknown. We hypothesized that adults with lower educational attainment would have a lower HLL.Methods:We conducted a cross-sectional study of health literacy between March and June 2024 in a large tertiary care ACHD outpatient clinic. We included patients ≥18 years old with simple, moderate, or great complexity CHD who spoke English or Spanish. We excluded patients with significant developmental delay and intellectual disability. The primary outcome was the Newest Vital Sign (NVS) Score, a validated 6-point adult health literacy assessment tool, where low HLL is a NVS score of 0-3. Our primary predictor variable was education level. Covariables included age, race/ethnicity, primary language, insurance type, and transition program participation. Analysis was performed using univariable logistic regression (Stata v.17).Results:Seventy-three in-person HLL assessments were completed. One patient was excluded for developmental delays on assessment. The median age was 32 years (25-75% IQR 24.5-46). Most of the cohort was female (58%) and had great complexity CHD (72.2%). Patients were 59.7% non-Hispanic White, 25% Hispanic, and 12.5% Black. 89% primarily spoke English. 72% had private insurance, and 76% had at least a high school education. The median NVS score was 5, with a range of 0-6 (Figure). Logistic regression demonstrated ~4x higher odds of low HLL for Hispanics (OR 3.92, 95% CI 1.07-14.33) and 4.6x higher odds of low HLL for public insurance (OR 4.6, 95% CI 1.23-17.23). There was no HLL association with age, education level, CHD severity, primary language, or transition program participation.Conclusion:This is the largest study assessing the HLL of the ACHD population in the modern era. While education did not correlate with HLL, lower HLL in Hispanic and publicly insured patients underscores a need for further evaluation in these populations.

Circulation, Volume 150, Issue Suppl_1, Page A4145908-A4145908, November 12, 2024. Background:Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal morbidity and contribute to cardiovascular disease later in life. Early identification of patients at highest risk of HDP may improve targeting of preventive therapies. Prior work within the Kaiser Permanente Northern California (KPNC) cohort demonstrated that early pregnancy blood pressure trajectories (BPT) improved HDP prediction compared to clinical factors alone. Our objective is to assess the performance of BPT models in a racially diverse patient population.Methods:We identified patients within Penn Medicine with a delivery from 2012-2020 and ≥3 outpatient BP measurements between 0 to 20 weeks gestation. Patients with pre-existing hypertension (HTN) or serious medical conditions were excluded. Covariates were obtained from the electronic medical record (EMR). Each patient was assigned one of six BPT groups based on KPNC latent class growth models. The primary outcome of HDP diagnosis, including preeclampsia and gestational HTN, was identified using ICD codes. Multivariable logistic regression was used to model the relationship between patient factors and HDP diagnosis. Predictive models were compared using the C-statistic.Results:Among 26,430 patients, the mean age was 30.8 years, 23% had Medicaid insurance, and 32% identified as Black. Overall, 22% of patients developed HDP and incidence varied by BPT group (Figure). After adjusting for age, race/ethnicity, parity, BMI, and diabetes, the moderate-stable group (aOR 5.42, 95% CI 3.7-8.3) and the elevated-stable group (aOR 10.2, 95% CI 6.9-15.8) had the strongest associations with HDP compared to the ultra-low-declining group. The prediction model including patient factors and BPT groups had better discrimination for HDP compared to patient factors alone (C-statistic 0.71 vs 0.66). Overall, models including BPT groups performed similarly to those from the KPNC cohort.Conclusions:Compared to the KPNC cohort, the Penn cohort had higher prevalence of patients with HDP, who identified as Black and had Medicaid insurance. Despite these differences, early pregnancy BPT groups demonstrated a similar improvement in HDP prediction compared to patient risk factors alone.

Circulation, Volume 150, Issue Suppl_1, Page A4139045-A4139045, November 12, 2024. Background:GLP-1 receptor agonists (RA) improve diabetes, reduce cardiovascular events, and cause substantial weight loss. However, concerns have been raised about increased adverse psychiatric effects – namely suicide. Given the explosive increase in use of these agents, detection of even rare side effects is of great clinical importance. We aimed to perform the first meta-analysis of adverse psychiatric outcomes (suicidal ideation/attempt/completion or self-harm) in randomized, placebo-controlled, clinical trials (RCTs) of GLP-1 RA.Methods:A comprehensive literature search through 8/29/23 was conducted to identify RCTs involving adults with diabetes and/or overweight/obesity treated with GLP-1 RA or placebo for ≥6 months. 7,229 non-duplicate articles were screened for inclusion and 144 had data extracted. After querying all available data sources, including direct contact with principal investigators or corresponding authors, 21 of the 144 studies were found to have recorded incidence of adverse psychiatric outcomes. A random-effects meta-analysis was performed to estimate risk ratios and 95% confidence intervals (CI) for the primary outcome.Results:In total, 36,168 subjects received GLP-1 RA and 30,445 placebo. The event rate was very low (63 – GLP-1 RA; 45 – placebo). The pooled odds ratio for incidence of the primary outcome was 0.88 [95% CI, 0.60-1.29]Figure. Notably, 6 studies, including a total of 11,828 subjects, had a history of suicide attempt/depression as exclusion criteria for enrollment. Removal of these studies did not change the overall findings (OR 0.77 [95% CI, 0.38, 1.57]).Conclusion:Our comprehensive meta-analysis of placebo-controlled RCTs does not support an association of GLP-1 RA use with increased adverse psychiatric events among adults with diabetes or overweight/obesity. However, these outcomes were recorded in 1/5 excluded subjects predisposed to these outcomes. More research is necessary, and continued surveillance remains warranted, to establish the safety of GLP-1 RA, particularly in patients at risk for self-harm/suicide.

Circulation, Volume 150, Issue Suppl_1, Page A4144705-A4144705, November 12, 2024. Background:Giant cell arteritis (GCA) is a chronic inflammatory condition associated with a significantly increased risk of various cardiovascular and thromboembolic events. Existing studies show that there may be an increased risk of cardiovascular disease in GCA, but the results are inconsistent. This meta-analysis aims to quantify the association between GCA and the risk of various cardiovascular outcomes, providing a comprehensive evaluation of the cardiovascular burden in patients with GCA.Methods:A comprehensive literature search was carried out using several databases. Studies were included based on predefined eligibility criteria. Using random effect models, Mantel-Haenszel odds ratios and associated 95% confidence intervals were produced to report the overall effect size. Funnel plots, Egger regression tests, and Begg-Mazumdar’s rank correlation test were used to assess publication bias. The endpoint included any cardiovascular events, myocardial infarction (MI), coronary artery disease (CAD), aortic aneurysm/dissection, peripheral artery disease (PAD), stroke, and venous thromboembolism.Results:The meta-analysis included 14 studies with a combined sample size of 609,954 patients, where the mean age was 73.8 years and 72.2% were female. Patients with GCA had significantly higher odds of experiencing any cardiovascular event (OR = 1.81, 95% CI = 1.55 to 2.15), MI (OR = 1.63, 95% CI = 1.34 to 1.97), CAD (OR = 1.51, 95% CI = 1.09 to 2.08), aortic aneurysm/dissection (OR = 1.95, 95% CI = 1.55 to 2.46), PAD (OR = 2.02, 95% CI = 1.69 to 2.41), stroke (OR = 1.52, 95% CI = 1.25 to 1.84), venous thromboembolism (OR = 1.92, 95% CI = 1.73 to 2.12), deep vein thrombosis (OR = 2.09, 95% CI = 1.50 to 2.91) and pulmonary embolism (OR = 2.45, 95% CI = 1.38 to 4.36). The heterogeneity of the outcomes ranged from low to high across different analyses. No publication bias was evident in the analysis.Conclusion:The meta-analysis highlights the critical need for vigilant cardiovascular monitoring and proactive management strategies in GCA patients. Further research is needed to identify specific factors that contribute to cardiovascular complications in these patients.

Circulation, Volume 150, Issue Suppl_1, Page A4139444-A4139444, November 12, 2024. Case Presentation:A 39-year-old Southeast Asian female presented with fatigue and exertional dyspnea. She underwent a myomectomy four years ago. Examination showed vital signs within normal limits, except for an SpO2 of 87%. Blood tests indicated microcytic hypochromic anemia and elevated D-Dimer levels of 1479 ng/mL.A transthoracic echocardiogram revealed a large mass occupying almost the entire right atrium, extending into the inferior vena cava. A CT scan showed a large, low attenuation, and minimally enhanced mass extending from the right atrium into the inferior vena cava and right hepatic vein, possibly invading segments VII-VIII of the liver (Figure 1). Abdominal CT and MR images revealed multiple degenerating uterine fibroids, bilateral dilated uterine tubes, and mild right hydronephrosis (Figure 2).The patient underwent surgical removal of the cardiac mass under general anesthesia with extracorporeal circulation and hypothermia. Pathological examination confirmed a benign tumor characterized by bundles of smooth muscle cells (Figure 3). Immunohistochemical staining with Actin (+), Progesterone receptor (+), Desmin (+), Ki67 (+) was consistent with a diagnosis of benign metastasizing leiomyoma (BML) of the heart. Subsequently, elective hysterectomy and bilateral salpingo-oophorectomy were performed.Discussion:Although rare, uterine leiomyoma can exhibit metastatic behavior, disseminating to extraneous anatomical sites. BML should be considered in the differential diagnosis when patients present with an atypical cardiac mass and have a history of uterine leiomyoma, myomectomy, or hysterectomy.BML of the heart is an exceptionally rare condition, predominantly affecting middle-aged women who have undergone hysterectomy or myomectomy. While BML commonly occurs in pre-menopausal patients and shares a potentially similar mechanism with endometriosis, as indicated by its response to estrogen-blocking agents, the occurrence of BML in post-menopausal women suggests the involvement of other contributing factors.Multiple imaging modalities play a significant role in the diagnosis and preparation for surgical management.

Circulation, Volume 150, Issue Suppl_1, Page A4138967-A4138967, November 12, 2024. Background:Acute kidney injury (AKI) is among the most common complications after cardiac surgery, with an 18% prevalence and is associated with an increased risk of death. Cardiopulmonary bypass surgery generates danger-associated molecular patterns that trigger a release of proinflammatory molecules that can lead to AKI. Obesity is also associated with chronic low-grade inflammation and an increased risk for AKI. We investigated the utility of inflammatory molecules in the diagnosis of AKI in obese and non-obese cardiac surgery patients.Methods:A panel of 13 circulating plasma molecules, including CXCL1, CXCL10, CXCL13, CCL22, IL-5,6,8,10,16, SLPI, TIM1, Properdin, Serpins E1 and A3, was measured using MAGPIX. The samples were collected from 95 MaRACAS patients (NCT02315183) before and 6-72 hours (h) after surgery. Obesity was defined as BMI >=32, based on our previous study.Results:There was no significant difference in the incidence of AKI between obese (46%) and non-obese patients (58%). The levels of the selected molecules were compared between AKI and non-AKI groups in patients with and without obesity. In obese patients with AKI, the levels of serpin E1 were lower before surgery (22.16 vs 40.94ng/mL, q=0.03) and higher 6h post-surgery (49.26 vs 21.65ng/mL, q=0.02), while properdin was lower 72h post-surgery (11.12 vs 14.35ng/mL, q=0.01). In the non-obese group, CXCL10 was higher in the AKI group 6-48h post-surgery, peaking at 6h (218.5pg/mL vs 131.38pg/mL, q=0.02); CXCL13 was higher at 6h (435.78 vs 291.0pg/mL, q=0.04) and 24h (215.18 vs 157.49pg/mL, q=0.04); IL-16 was higher at 6h (256.01 vs 174.44, q=0.04) and 24h (344.94 vs 174.02, q=0.02); and SLPI was higher 6-72h post-surgery, peaking at 6h (50.44 vs 33.53 at 6h, q

Circulation, Volume 150, Issue Suppl_1, Page A4124531-A4124531, November 12, 2024. Introduction:Guideline-directed medical therapy (GDMT) for Heart Failure with reduced ejection fraction (HFrEF) reduces adverse events by 70%, but is underutilized. The Human Centered Design (HCD) methodology can be useful to build a strategy to optimize GDMT centered on patients’ demands and perspectives. We aimed to reciprocally innovate a telephone-based digital health intervention (DHI) from a Brazilian trial to an app co-developed for a US trial and iterate it again to the Brazilian context using HCD. We will evaluate the app’s usability and utility to facilitate HF GDMT optimization, considering barriers of the Brazilian public health system users, such as low literacy and socioeconomic status.Methods:Mixed methods study. Steps were carried out according to HCD method: (1) empathizing and identifying challenges, (2) suggesting solutions, (3) prototype development, (4) ranking features for feasibility and utility (5) engineering work and (6) prototype testing. In stages 1-3, semi-structured interviews were held with 10 HF patients and 2 health professionals. Steps 4 and 5 were done by the research team. In stage 6, we conducted a pilot study with 10 HFrEF patients, with at least one GDMT drug with an optimization gap. The primary outcome was the app’s usability assessed by an engagement score, and the app’s utility at 4 weeks. Secondary outcomes included change in self-care score using the European Self-Care Behavior Scale. After step 6, new interviews were carried out to capture the user experience and identify new iterations. Interviews were recorded and transcribed for content analysis.Results:The average engagement score was 80% (SD 16) and the app’s utility score was 82% (SD 8). The average self-care score increased by 32% (SD 25) at the end of the pilot. The main challenges were lack of knowledge about HF and self-care. Technical difficulties and lack of trust in the app to handle health data were mentioned. In the pilot, patients reported the app was easy to use and contributed to self-care and understanding of HF. Among the DHI components, teleconsultation was best evaluated, followed by the educational videos. The greatest challenge was connecting the blood pressure cuff and scale via Bluetooth.Conclusion:The app was well accepted and considered useful by patients. User contributions were fundamental to create tools that facilitate engagement and utility. The final product will be evaluated in a randomized, multicenter, clinical trial.

Circulation, Volume 150, Issue Suppl_1, Page A4140089-A4140089, November 12, 2024. Background:Lipid-lowering therapy for patients with acute myocardial infarction (AMI) is highly recommended, however, a paradox may exist where lower low-density lipoprotein cholesterol (LDL-C) levels at myocardial infarction (MI) are associated with poorer prognoses.Aim:To evaluate the association between baseline LDL-C levels and cardiovascular events after MI.Methods:We studied 1,987 consecutive AMI patients who underwent primary percutaneous coronary intervention and who had available data on preprocedural LDL-C between 1999-2015 at Juntendo University Shizuoka Hospital. Patients were divided into quartiles based on their LDL-C levels. The incidence of major adverse cardiac events (MACE), including all-cause death and recurrent MI up to 5-year, were evaluated.Results:Patients in the lowest LDL-C group were older and had higher prevalence of hypertension, diabetes mellitus and chronic kidney disease. During follow-up, 455 (20.9%) MACE were identified. Cumulative incidence of MACE was significantly higher in the lowest LDL-C group than in other groups (p

Circulation, Volume 150, Issue Suppl_1, Page A4138701-A4138701, November 12, 2024. Background:Improved understanding of the high-risk features associated with HFpEF may facilitate risk stratification. Cardiac magnetic resonance (CMR)-based strain and structural data can define detailed myocardial structure, which can be leveraged to define heterogenous HFpEF phenotypes. This study used phenotypic clustering integrating CMR-based strain and structural data to identify a high-risk HFpEF phenotype.Methods:Retrospective analyses of 48 HFpEF participants, who underwent cardiac MRI and invasive cardiopulmonary exercise testing (median time between the two studies=40 days), was performed. We conducted unsupervised and unbiased K-means clustering analyses using CMR-based strain and myocardial structural variables. We associated two identified clusters with mortality using Cox proportional hazards modeling and constructed Kaplan-Meier survival curves. A p-value was considered significant if < 0.05.Results:We identified a low (n=32) and high-risk (n=16) cluster. Patients in the identified clusters had similar ages and comorbidities. The high-risk cluster had more male participants and hemodynamically had a higher exercise mPAP/CO and PAWP/CO slope, which are metrics of pulmonary vascular disease. The high-risk cluster displayed greater LV mass, worse biventricular longitudinal strain, decreased right ventricular ejection fraction, and greater interventricular septal angle (all P

Circulation, Volume 150, Issue Suppl_1, Page A4139421-A4139421, November 12, 2024. Introduction:Rates of progression of atherosclerosis have been derived from populations with established atherosclerotic cardiovascular disease and on plaque modifying therapies. However, the rate of atherosclerosis progression in populations with no history of MACE, risk factors or risk modifying interventions is not known. The aim of this study is to determine the rate of progression in healthy populations on serial CCTA.Aim:To determine whether in this population, the rates of progression can be classified in slow, intermediate, and rapid.Methods:NATURE-CT retrospectively selected 205 participants from two sites in Los Angeles. Subjects underwent at least two CCTA scans, the initial scan showing CAC ≤100, absence of MACE, not placed on lipid modifying therapy in the first and last scan, and at least 2 years apart. Patients with diabetes, familial hypercholesterolemia or chronic kidney disease were excluded. FDA cleared automated software Cleerly Labs (Cleerly.Inc, NY, NY) which quantified percent atheroma volume PAV% from CCTA. Annual change in PAV% is presented by tertile in this lipid-modifying naïve cohort to understand slow, intermediate and rapid plaque progression rates among subjects.Results:There were 205 subjects with a mean age of 54.9±10.2 years and 72% (148) were male. Average time between serial CCTA scans was 4.9±2.2 years. Annual change in PAV% was less than 0.075% in the first tertile (mild progression), between 0.075% and 0.275% with intermediate progression (2nd tertile) and those with greater than 0.275% in a rapid group (3rd tertile). The median and interquartile range [IQR] for annualized change in PAV% for slow progression was 0.03 (0.0, 0.05), intermediate progression was 0.17 (0.12, 0.20) and 0.46 (0.35, 0.67) for rapid progressors. The moderate and rapidly progressing subjects were more likely to be male, have higher BMI, triglyceride levels, and baseline plaque. Rapid progressors were more likely to have LAP present.Conclusions:Rates of atherosclerosis progression can be classified in slow, intermediate, and rapid progressors, based on a population with low plaque burden in the first scan, no lipid-modifying interventions, and no events. The presence of low-attenuation plaque correlates rapid progression of atherosclerosis and may offer a justification for plaque directed treatment if confirmed with further studies.

Circulation, Volume 150, Issue Suppl_1, Page A4145755-A4145755, November 12, 2024. Background:Lipid-lowering therapy plays a crucial role in the secondary prevention of coronary artery disease (CAD), particularly following acute myocardial infarction (AMI). While International Guidelines recommend the early initiation of high-intensity statins post-AMI, there remains limited insight into the patterns of lipid-lowering drug utilization across healthcare systems.Purpose:This study aims to analyze the temporal trends and influencing factors associated with the utilization of lipid-lowering therapy, with a focus on high-intensity statins, among patients hospitalized with AMI.Methods:Using data spanning 2012 to 2020 from the Japanese Registry of All Cardiac and Vascular Diseases (JROAD-DPC), including all procedures and prescriptions during hospitalization, we examined 381,046 AMI cases discharged alive from 1,091 hospitals. We defined lipid-lowering therapies as the use of statins, ezetimibe, or PCSK9 inhibitors, and high-intensity statin use based on the following dosages due to insurance limits in Japan: Atorvastatin 20 mg, Rosuvastatin 10 mg, or Pitavastatin 4 mg per day. We investigated trends in lipid-lowering drug and high-intensity statin use and examined associated factors through subcategory analysis, developing a multivariate mixed logistic regression model with each institute considered a random intercept.Results:Within the cohort (with an average age of 69.2 years and comprising 26.5% females), the proportion of patients receiving any form of lipid-lowering therapies increased from 78.0% to 88.2% between 2012 and 2020. Among these individuals, the percentage of those prescribed any statins rose from 77.8% to 85.8% over the same period. However, the utilization of high-intensity statins remained relatively low, accounting for only 31.3% of cases in 2020 (Figure). In subgroup analyses, the usage of high-intensity statins was notably lower among females (26.8%) compared to males (32.9%) in 2020 (p

Circulation, Volume 150, Issue Suppl_1, Page A4143330-A4143330, November 12, 2024. Background:Ischemic stroke remains a dreaded complication of paracorporeal (continuous-PC; pulsatile-PP) ventricular assist devices (VADs) in pediatric patients. Advancements in anticoagulation management have improved the stroke rate to 12-17%, however, the management of antiplatelet therapy varies across centers. This study examines the outcomes of an antiplatelet protocol for patients with paracorporeal VADs at our center.Methods:We developed an antiplatelet protocol (Fig. 1) with dose adjustments guided by platelet function assays, VAD fibrin burden, and bleeding risk. We retrospectively reviewed patients with a paracorporeal VAD between December 2018 to December 2023. Demographic variables, incidence of thrombotic and bleeding events, and outcomes were assessed using descriptive statistics.Results:The cohort comprised 44 patients (52% male), median age 19 months (1 month – 8 years), with 22 (50%), 9 (20.5%), and 13 (29.5%) patients supported on PP, PC, and multiple VAD types respectively. Median support duration was 131 (PP; IQR 87, 183), 31 (PC; IQR 16, 46), and 88 (multiple VADs; IQR 66, 196) days. Diagnoses included cardiomyopathy 38% (n=17), congenital heart disease 57% (n=25) and others 5% (n=2). Thrombotic complications included: ischemic stroke in 6.8% (n=3) (1.9 events/100 patient months compared to 6-11 events/100 months reported in recent multicenter registry data); 11% (n=5) patients underwent 6 pump exchanges for fibrin burden. Major bleeding rate was 29.5% (n=13), most commonly gastrointestinal bleed; there were no hemorrhagic strokes. Five (11.3%) patients had an asymptomatic subdural hematoma (n=4 tiny/small, n=1 moderate). A positive clinical outcome was achieved in 86%, with 77% (n=34) bridged to transplant, 5% (n=2) explanted for recovery, and 5% (n=2) alive on device. Overall mortality was 14% (2 died on device, 4 transitioned to ECMO and died).Conclusions:Our experience underscores the efficacy of a structured antiplatelet protocol in managing pediatric patients with paracorporeal VADs associated with a low stroke rate. Future studies are needed to assess the generalizability of these findings.

Circulation, Volume 150, Issue Suppl_1, Page A4144425-A4144425, November 12, 2024. Myocardial infarction with nonobstructive coronary artery disease (MINOCA) is an ischemic cause of chest pain with normal appearing coronary vessels on angiography. The prognosis for these patients is extremely dependent on etiology highlighting the importance for appropriate evaluation. Currently, several imaging modalities have been useful in diagnostic workup, however no diagnostic guidelines have been developed. As a result, many patients are likely not getting proper evaluation. The study’s main objective is to observe practice variations in the diagnostic evaluation for patients meeting criteria for MINOCA.A review of electronic medical records of patients presenting to a tertiary care center between Jan 2018 – Dec 2022 for chest pain who were referred for left heart catheterization was performed. Patients with prior history of obstructive CAD, whose imaging evaluation uncovered obstructive stenosis or had stenosis >50% as measured on LHC were excluded. Next, patients diagnosed with a nonischemic cause of hospital presentation were excluded. Examples of nonischemic etiologies include stress induced cardiomyopathy, myocarditis and pulmonary embolism. Data regarding medical management and follow-up imaging were collected.A total of 2,763 patients were reviewed. Among them, 168 patients met the exclusion criteria. Approximately 60% (n=101) of patients were female with an average age of 60 years. Medical management with aspirin (n=123), DAPT (n=22), beta-blocker (n=98), calcium channel blocker (n=58), statin (n=130), anti-anginal therapy (n=55), diuretics (n=47), and ACEi/ARB (n=69) were observed. Additional imaging was seen in only 26% of patients. The imaging modalities used were cardiac MRI (cMRI), fractional flow reserve (FFR) and intravascular ultrasound (IVUS). The most common imaging modality was cMRI (n=35), followed by FFR (n=8) and IVUS (n=1).MINOCA was identified in 6% of patients presenting with AMI and was primarily comprised of women, which is consistent with other reported figures. Our data demonstrates that nearly 75% of these patients were placed on medical therapy without further evaluation. MINOCA is a diagnosis with multiple pathophysiological etiologies that requires thorough workup including additional imaging for complete evaluation. This study demonstrates the importance of considering MINOCA as a potential diagnosis in patients presenting with AMI and the need for guidelines on its evaluation.

Circulation, Volume 150, Issue Suppl_1, Page A4142996-A4142996, November 12, 2024. Background:Secondary prevention after percutaneous coronary interventions (PCIs) is still challenging and lipoprotein(a) [Lp(a)] is believed to be a residual risk factor in this setting. However, the effect of Lp(a) in case of well-controlled low-density lipoprotein cholesterol (LDL-C) is still unclear. The interaction between Lp(a) and LDL-C has been studied in primary prevention but still needs to be investigated in secondary prevention.Hypothesis:Achieving adequate LDL-C control after PCI may reduce the cardiovascular (CV) risk associated with Lp(a).Methods:A retrospective study of consecutive patients who underwent PCI and reached their LDL-C target levels (

Circulation, Volume 150, Issue Suppl_1, Page A4147006-A4147006, November 12, 2024. Background:Subclinical myocardial injury (SCMI) and the triglyceride-glucose index (TyG), a marker for insulin resistance, are each linked to cardiovascular (CV) mortality. The impact of both SCMI and TyG on CV mortality is unclear.Objective:To investigate the relationship between TyG, SCMI, and CV mortality.Methods:This study utilized data from the third National Health and Nutrition Examination Survey (NHANES-III) including participants without cardiovascular disease (CVD). Baseline TyG was calculated as ln(fasting triglyceride level [mg/dL] × fasting plasma glucose [mg/dL]/2). High TyG was defined as ≥75th percentile, and low TyG as