Risultati per: Low Back Pain: raccomandazioni

Circulation, Volume 150, Issue Suppl_1, Page A4144944-A4144944, November 12, 2024. Background:The American Heart Association’s (AHA) Life’s Essential 8 (LE8) concept serves as a quantitative framework for assessing cardiovascular health (CVH). Post-operative coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) patients are at high-risk for subsequent cardiovascular events (CVE). However, LE8 scores for post-procedural CABG or PCI patients remain unknown.Methods:Isolated post-operative CABG (n=208) or PCI (n=739) non-institutionalized patients from the National Institutes of Health’s (NIH) All of Us (AoU) Research Program (2017-2022) were included. LE8 scores (range 0-100, higher = better CVH; excluding diet metric) were calculated using methods recommended by the AHA. Physical activity and sleep metrics were derived from patients’ Fitbit data, while all other metrics were sourced from electronic health records (EHR).Results:Overall LE8 scores for post-operative CABG (57.9 [95% CI: 56.6-59.2]) and PCI patients (55.3 [54.4-56.1]) were significantly lower than that of the general population (65.9 [65.1-66.7] (p

Circulation, Volume 150, Issue Suppl_1, Page A4125419-A4125419, November 12, 2024. Introduction:Metabolic syndrome (MS) is an important predisposing factor for atrial fibrillation, and is highly related to the autonomic nervous system. Triglyceride-rich very-low-density lipoprotein (VLDL) has specific VLDL receptors (VLDLR), which are abundantly expressed in cardiomyocytes.Hypothesis:VLDL affects neuronal growth through cardiomyocyte-secreted exosomes in metabolic syndrome.Goals/Aims:To determine whether exosomes from VLDL-incubated cardiomyocytes can alter neuronal proliferation.Methods/ Approach:HL-1 cardiomyocytes were incubated with VLDL isolated from human subjects with MS, and exosomes were extracted at the end of the incubation period. VLDLR knockdown HL-1 cells were used to determine the role of VLDLR in exosome secretion. The molecular contents of exosomes were determined by mass spectrometry, which identified neurotropic proteins only detected in the exosomes of MS VLDL-incubated cardiomyocytes. We selected transmembrane protein 14B (TMEM14B) to investigate its effect on neuronal proliferation in P19 cells.Results:Regardless of the knockdown or overexpression of VLDLR in HL-1 cardiomyocytes, exosomes isolated from after VLDL incubation were shown to cause 2.062-fold and 2.084-fold expression of tyrosine hydroxylase (TH) in P19 cells, relative to P19 cells induced by non-VLDL-treated HL-1 cardiomyocyte-secreted exosomes. A similar trend could be seen with HL-1 cardiomyocytes without VLDLR editing, as VLDL-incubated HL-1 cardiomyocytes produced exosomes that could cause 1.926-fold increase in P19 TH expression, relative to treatment by exosomes from HL-1 cardiomyocytes without VLDL-incubation. The P19 cells incubated with TMEM14B demonstrated increased neurite length, with an average of 2.342-fold neurite length when compared with that of control cells.Conclusions:VLDL in MS induced HL-1 cardiomyocytes to secrete exosomes containing neurotrophic molecules and increased dendritic growth of neuronal cells. This effect was VLDLR-independent and was partially caused by TMEM14B in the exosomes.

Circulation, Volume 150, Issue Suppl_1, Page A4147770-A4147770, November 12, 2024. Background:Randomized control trials (RCTs) have compared transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis (AS) at low-intermediate surgical risk.Objective:To compare TAVR vs. SAVR for AS in low-intermediate surgical risk patients.Methods:We systematically searched PubMed, Scopus, and Cochrane Central databases for studies comparing TAVR with SAVR for AS in low-intermediate surgical risk. Outcomes included composite death or stroke, death, stroke, myocardial infarction (MI), cardiac death, new atrial fibrillation (AF), new pacemaker implantation, acute kidney injury (AKI), bleeding, major vascular complications, endocarditis, aortic valve reintervention, and rehospitalization at 1 year. Random effects models were used to generate risk ratios (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using I2statistics.Results:The systematic review identified 8 RCTs including 9,239 patients (TAVR n=4,695, 50.8%). Death or stroke (RR 0.78; 95%CI 0.62-0.98; p=0.033; I2=52%), cardiac death (RR 0.79; 95%CI 0.63-0.98; p=0.029; I2=1%), bleeding (RR 0.39; 95%CI 0.25-0.60; p

Circulation, Volume 150, Issue Suppl_1, Page A4144749-A4144749, November 12, 2024. Background:Although high rates of P2Y12 inhibitor pretreatment for non-ST-elevation acute coronary syndrome (NSTE-ACS) have been reported, contemporary practice pattern in the U.S. are not well studied.Objectives:To investigate the temporal trends, variability, and clinical outcomes of P2Y12 inhibitor pretreatment in NSTE-ACS across U.S.Methods:Consecutive patients that underwent early invasive strategy for NSTE-ACS (coronary angiogram ≤ 24 hours of arrival) in National Cardiovascular Data Registry (NCDR) Chest Pain-Myocardial Infarction (MI) registry was analyzed. Initially, a time-trend analysis was conducted on the complete cohort from January 1, 2013, to March 31, 2023. Subsequently, a more recent cohort (January 1, 2019, to March 31, 2023), with a complete set of variables, was used to construct a hierarchical regression model to quantify variability in the use of pretreatment among institutions and hospital regions. For this contemporary cohort, instrumental variable analysis was performed to compare in-hospital outcomes between patients who received pretreatment and those who did not.Results:Use of P2Y12 inhibitor pretreatment has decreased from 24.8% in 2013Q1 to 12.4% in 2023Q3. Among the contemporary cohort of 110,148 patients (2019-23; mean age, 63.9 [SD 12.5] years; 33.0% female), 17,509 (15.9%) received pretreatment. Significant variability in P2Y12 inhibitor pretreatment was observed (range: 0-100%): hierarchical regression model demonstrated that two identical patients would have more than a three-fold difference in the odds of pretreatment by changing institution or hospital region (OR 3.63; 95% CI, 3.51-3.74 and 3.21; 95% CI, 2.90-3.54, respectively). Instrumental variable analysis demonstrated no significant differences in in-hospital all-cause death (1.5% vs 1.7%; p=0.071), recurrent MI (0.56% vs 0.57%; p=0.98), or major bleeding (2.7% vs 2.8%; p=0.98) between the two groups. However, in patients who underwent coronary artery bypass surgery, pretreatment was associated with a longer length of stay (11.2 ± 5.1 days vs 9.8 ± 5.0 days; p < 0.001).Conclusions:Within the nationwide registry in the U.S., we observed a significant variability in the use of P2Y12 inhibitor pretreatment among NSTE-ACS patients in the U.S. Given the lack of clear advantages and the potential for prolonged hospital stays, our findings highlight the importance of efforts to improve standardization.

Circulation, Volume 150, Issue Suppl_1, Page A4140323-A4140323, November 12, 2024. Introduction:Individuals with low socioeconomic status (SES) have a higher risk of CVD events yet are less likely to utilize outpatient cardiac rehabilitation (OCR), which is an evidence-based secondary prevention strategy. Understanding barriers and facilitators to the implementation of OCR among individuals with low SES is critical to design targeted interventions to improve attendance.Aims:To identify barriers and facilitators to OCR attendance among individuals with low SES using the Capability, Opportunity, Motivation, and Behavior (COM-B) theoretical model.Methods:We purposefully recruited patients for in-depth interviews who had: a recent CVD event (≤ 3 months); documented referral to OCR; low SES (Medicaid eligible, or in the top quartile of area deprivation index); those who attended ≥ 1 session of OCR and those who did not. Semi-structured interviews were recorded and transcribed verbatim. Codes were identified using a phenomenological approach guided by the COM-B model.Results:Participants (N=26) were 54% women, 58% Black, with mean age of 67.1 (12.7 years). Barriers and facilitators identified fit the COM-B model.Capabilitythemes included knowledge and awareness of OCR. OCR attendees (n=12) recalled discussing OCR, the benefits, and their physicians encouraging participation pre-discharge. Non-attendees (N=14) reported no, or very little knowledge about OCR, or weak recommendations by their physician.Opportunitythemes included social support from caregivers/family, peers, and their healthcare team. OCR attendees described a strong support network of caregivers who helped with logistics and motivation to participate, wanting to be with peers, and outreach of the healthcare team after discharge. Non-attendees described lack of social support, logistical barriers, and no outreach.Motivationthemes reflected the strong belief in the benefits of CR to improve physical and mental health, quality of life, and prevent future events among attendees. Non-attendees generally lacked a perceived need for OCR particularly if they had returned to baseline after their CVD event.Conclusions:Non-attenders of CR were distinguishable from attendees using the COM-B model, which can be used to guide intervention development. Our findings support a multi-level strategy that includes tailored education, social support, motivational enhancement, implemented by a trained health navigator, to overcome barriers to CR attendance among patients with low SES.

Circulation, Volume 150, Issue Suppl_1, Page A4134273-A4134273, November 12, 2024. Background:Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome and its pathophysiology is not fully understood. A monoamine, 5-hydroxytryptamine (5-HT), is involved in diverse biological functions and suggested to play a role in cardiovascular diseases. However, the clinical relevance of 5-HT in HFpEF remains unclear.Aims:This study aimed to elucidate the clinical significance and prognostic value of 5- HT in patients with HFpEF.Methods:We conducted a prospective study involving 240 consecutive hospitalized patients with HFpEF (mean age 72 years, 52% male). We measured circulating blood 5-HT levels using the enzyme-linked immunosorbent assay method. Clinical and outcome data were collected.Results:Correlation analysis revealed that 5-HT levels were negatively correlated with blood B-type natriuretic peptide concentration and tricuspid regurgitation pressure gradient. When patients were stratified into two groups based on the median 5-HT levels (90.5 ng/mL), Kaplan-Meier analysis showed that HFpEF patients with low blood 5-HT levels had lower event-free survival rates from the composite event of cardiac death and worsening heart failure over a median follow-up period of 725 days (Figure). In a multivariable Cox proportional hazard model adjusting for confounding variables, low levels of 5-HT were independently associated with increased risks of the composite of cardiac events (hazard ratio, 3.25; P < 0.01).Conclusion:Low 5-HT levels are associated with adverse outcomes in patients with HFpEF and 5-HT may serve as a useful biomarker for predicting prognosis in such patients.

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 A4129733-A4129733, November 12, 2024. Background:The impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on lipid components is unclear. The objective of this study was to measure the lipid-lowering effect of GLP-1RAs.Methods:A thorough database search was performed to identify placebo-controlled randomized controlled trials (RCTs) on GLP-1RA therapy through January 2023. From these trials, data was extracted and a robust statistical analysis was performed using a random effects model to determine outcomes with weighted mean difference (MD) in milligrams per deciliter (mg/dL) and 95% confidence intervals (CIs). The primary outcome was the mean difference in low-density lipoprotein cholesterol (LDL-C). Secondary outcomes were mean differences in total cholesterol (TC), triglycerides, high-density lipoprotein-C (HLD-C), and very low-density lipoprotein-C (VLDL-C). To account for covariates, subgroup analyses and meta-regression were performed.Results:A total of 33 studies were included in the final meta-analysis carried out between 2008 and 2023, which were conducted in 26 countries. Of the 5,918 participants, the study population comprised 2,603 (44%) males and 3,315 (56%) females, aged between 33.7 and 65.9 years. GLP-1RAs significantly reduced LDL-C compared to placebo (MD -2.93, 95% CI (-5.01, -0.85), P=0.01). Treatment effect was consistent regardless of duration of treatment;12 weeks or less MD: -5.39, 95% CI (-10.36, -0.42), P=0.03 vs >12 weeks MD: -2.39, 95% CI (-4.70, -0.007), P=0.04, P interaction 0.28). In our analysis, GLP-1RA reduced TC by ~7 mg/dl. There was no significant reduction in triglycerides (MD = -7.19, 95% CI (- 15.01, 0.62], P=0.07) and VLDL-C ~4 mg/dl (MD = -3.99, 95%, CI (-8.73, 0.75), P=0.10). Furthermore, GLP-1RA did not increase HDL-C (MD = -0.12, 95% CI (-0.73, 0.49], P=0.69. Regression analysis determined that weight loss did not affect the treatment effect on LDL-C (tau2=28.38, I2=99.83, R2=0.0, p=0.67), and total cholesterol (tau2=93.6, I2=99.86, R2=0.0, p=0.92).Conclusion:Patients on GLP-1RA experienced modest LDL-C and TC lowering compared to placebo. GLP-1RA did not decrease triglycerides and VLDL-C. GLP-1RA did not increase HDL-C.

Circulation, Volume 150, Issue Suppl_1, Page A4142085-A4142085, November 12, 2024. Background:Highly precise definition of high-risk features associated with HFpEF may guide targeted treatments and inform biological studies. The aim of this two-step study is to 1) define a high risk HFpEF cluster with unsupervised machine learning approach using cardiac magnetic resonance (CMR), 2) define novel pulmonary vascular mechanics at rest and with exercise in low- vs. high-risk phenotypes. Vascular mechanics defines vessel- and cardiac cycle-specific flow dynamics in pulmonary circulation.Methods:48 HFpEF participants underwent CMR and invasive cardiopulmonary exercise testing. With unsupervised K-means clustering analyses using CMR data, two specific clusters were identified with different survival outcomes at 12-months (mortality and heart failure hospitalizations): HR=5.4 (CI:1.7-17.4), log-rank p

Circulation, Volume 150, Issue Suppl_1, Page A4139970-A4139970, November 12, 2024. Introduction:Anticoagulation (AC) is the mainstay of thromboprophylaxis for stroke prevention in atrial fibrillation (AF) and is recommended. Gastrointestinal bleeding (GIB) is a common complication with varied severity and often poses a challenge for cardiologists and gastroenterologists. The decision of whether to continue anticoagulation, when to resume and at what dose is often the challenge. Our study assesses the safety and efficacy of low-dose apixaban compared to a full-dose in patients with AF who had GIB over the course of 5 years.Methods:We queried the US Collaborative Network (which contains 63 healthcare organizations) of TriNetX deidentified research database. Patients with atrial fibrillation who have history of gastrointestinal bleed who received apixaban were identified and divided into two cohorts; patients on low dose of 2.5mg and those on full dose of 5mg. We excluded patients with serum creatinine ≥ 1.5 mg/dL and patients with body weight ≤ 132 lbs.Two well-matched cohorts were created using a 1:1 propensity-score matching (PSM) model using patients’ baseline characteristics and comorbidities. PSM components were age, gender, race, PPI use, anti-platelets, hypertension, coronary artery disease, heart failure, COPD, and CKD. We compared the risk of stroke, GIB, and mortality in 5 years.Results:A total of 19,427 patients with UGIB who have AFIB received oral apixaban were identified. Of those, 19% (n=3,701) were on low dose of 2.5mg and 81% (n=15,726) were on full dose of 5mg of apixaban. After PSM, each cohort included 3,701 patients. There was no statistically significant difference in the risk of stroke in 5 years between the patients on low dose compared to those on full dose (10.9% vs 11.9%, p=0.3). However, patients on low dose had a statistically significant lower risk of GIB compared to those on full dose (30.4% vs 35.3%, p

Circulation, Volume 150, Issue Suppl_1, Page A4139207-A4139207, November 12, 2024. Background:Occurring in 0.6% to 10% of percutaneous coronary interventions (PCI), no-reflow is a complication associated with poor outcomes like myocardial infarction extension and death. The mechanism behind no-reflow is complex and likely multifactorial, and several drugs have been described for its management including intracoronary epinephrine (ICE) at doses ranging from 50 to 400 µg.Hypothesis:We hypothesize that supraselective administration of ICE at very low doses could be effective in the successful management of no-reflow.Methods:This single-center case series from Bucaramanga, Colombia (August 2021-October 2023) reports on 9 patients with/without ST-segment elevation myocardial infarction who underwent PCI and developed no-reflow. As first-line therapy for no-reflow management, supraselective administration of 5 to 50 µg of ICE was performed through an ad hoc fenestrated angioplasty balloon with a two-way drug perfusion technique (proximal to distal, and distal to proximal) at an approximate rate of 2 µg/min. All patients received a 1000 µg intracoronary bolus of Tirofiban during the procedure, and an IV infusion of 0.15 µg/kg/min was continued up to 24 hours postangioplasty.Results:The mean age of patients was 72.7±10.6 years, and 8 out of 9 patients were male. The mean LVEF was 34±11.3% before PCI. Patients received varying doses of ICE (5, 10, 20, 40 and 50 µg), 7 received it as the first-line treatment, while 2 received it as a second-line option after 360 µg of intracoronary adenosine failed to improve blood flow. TIMI 2 flow (4 patients) and TIMI 3 flow (5 patients) were achieved with no consistent association between higher ICE doses and achieving TIMI 3 flow. All 9 patients were discharged alive from the Cath Lab. However, one patient with LVEF 20% died of pulmonary edema 7 hours postangioplasty. The mean heart rate before and after the procedure was 78±20.8 bpm and 84±18.3 bpm respectively. No severe cardiac arrhythmias were observed. Transient inotropic support with a norepinephrine infusion was needed by 2 patients.Conclusion:The supraselective administration of ICE at very low doses (5-50 µg) resolved no-reflow in 100% of patients with acute coronary syndrome. We propose the use of this drug at very low doses as a first-line therapy for the management of coronary no-reflow, as well as the development of future randomized control trials to evaluate its effectiveness, and compare it to current therapies, in a larger population.

Circulation, Volume 150, Issue Suppl_1, Page A4147079-A4147079, November 12, 2024. Introduction:Observational studies in heart failure (HF) patients have shown that low levels of the thyroid hormone triiodothyronine (T3) with otherwise normal thyroid testing (‘low T3 syndrome’) is a risk factor for adverse clinical outcomes. Preclinical studies have shown beneficial effects from T3 therapy on myocardial contractility, myocardial relaxation, and vascular resistance, but human studies are lacking.Research Question:In patients with HF and low T3 syndrome, is oral liothyronine (LT3) safe, and does it impact cardiovascular clinical and physiologic phenotypes?Aims:Primary aim: To evaluate the safety of oral LT3 therapy in HFrEF and HFpEF. Secondary aim: To evaluate the feasibility and preliminary efficacy of oral LT3 therapy in HFrEF and HFpEF.Methods:A total of 28 participants with HFrEF and 28 with HFpEF aged 18+ years enrolled in a single-center, randomized, double-blind, placebo-controlled, crossover trial and were prescribed LT3 or placebo for 8 weeks with a 2-week washout period. Primary outcomes were safety as assessed by T3 level; arrhythmic events by EKG, 14-day adhesive patch monitoring, and ICD (HFrEF only); and adverse events. Secondary efficacy outcomes included Kansas City Cardiomyopathy Questionnaire, NT-proBNP level, peak O2 consumption during a cardiopulmonary exercise test, and actigraphy. Secondary mechanistic outcomes included non-invasive assessments of cardiac and arterial function measured via echocardiography and arterial tonometry.Results:Low T3 syndrome was present in 20% of screened participants. After LT3 treatment, T3 levels markedly increased compared with placebo. Heart rate was higher on LT3 (mean difference 2.4 beats per minute, p

Circulation, Volume 150, Issue Suppl_1, Page A4139930-A4139930, November 12, 2024. Introduction:Despite a rigorous screening process, including cardiac catheterization, a subset of single right ventricle (SRV) patients demonstrate suboptimal short-term outcomes after the Fontan operation. The goal of this study was to perform a comprehensive assessment of diastolic function in pre-Fontan SRV patients using invasive reference-standard measures and determine their associations with post-Fontan outcomes.Methods:Children 2-6 years old with SRV physiology undergoing pre-Fontan heart catheterization were recruited prospectively. SRV patients were divided into those who had an optimal or suboptimal outcome. A suboptimal outcome was defined as length of stay ≥14 days or heart transplant/cardiac death in first year after Fontan. Patients with hemodynamically insignificant patent ductus arteriosus referred for catheterization closure were recruited as controls. Patients underwent pressure-volume loop analysis using reference-standard methods. The measure of ventricular stiffness, β, was obtained via preload reduction. Cardiac magnetic resonance imaging for extracellular volume (ECV) and serum draws for matrix metalloproteinase (MMP) activity were performed.Results:Of 19 SRV patients, 9 (47%) had a suboptimal outcome. 15 controls were included. Demographic and catheterizations are shown in Table 1. Echocardiographic and MRI data are shown in Table 2. Patients with suboptimal outcomes had lower ventricular stiffness, lower ECV, and lower MMP-2 compared to patients with optimal outcomes (Figure 1). Patients with suboptimal outcomes had similar stiffness to biventricular controls. Patients with optimal outcome had less total fluid in the first 24 hours than the suboptimal group (1107 (IQR 953, 1303) vs. 1482 (IQR 1305, 1598) mL, p = 0.03). The only invasive measure that had an association with suboptimal outcome was β, p=0.038.Conclusion:SRV patients with suboptimal outcome after Fontan had lower ventricular stiffness compared to patients with optimal outcome. Lower stiffness led to an increased need for fluid resuscitation and higher chest tube output after Fontan. The usual response in chronically increased RV afterload is for the RV to hypertrophy and stiffen over time in order to maintain cardiac output. This is not seen in low SRV stiffness patients and may represent a maladaptive extracellular matrix response to chronic afterload elevation. This novel phenotype that may have important clinical implications and requires further study.

Circulation, Volume 150, Issue Suppl_1, Page A4138273-A4138273, November 12, 2024. Background:Rheumatic heart disease (RHD) causes 305,000 premature annual deaths, and education is one of the strategies to diminish disease burden. International RHD foundations aim do provide preventive and control efforts for RHD. We aimed to assess the acceptability and gain of knowledge of a series of education flipcharts presented during screening programs in high-burden areas of Brazil.Methods:Four flipcharts (“Introduction to rheumatic fever (RF) and RHD”, “RHD and pregnancy”, “RHD and surgery” and “RHD community awareness”) were developed over 3 years and taught during 36 months to patients, community, health and education professionals in Minas Gerais state. Training included in-person interactions and virtual workshops. Pre and post-training questionnaires were applied through an online and printed surveys in 2021 and 2022, and post-education evaluations were conducted from January 2023 to April, 2024.Results:Flipchart training was successfully delivered to 112 education professionals, 574 health providers and 598 community members (N=1284): 899 (70%) were enrolled in primary care, and 1109 (86%) responded the surveys. Among respondents of the survey for health and education professionals (N=589), 240 (41%) had been educated about RHD in the previous year. 569 (96%) learned any new information; the content was all new for 21 (4%). Nearly all professionals reported that flipcharts could improve patients’ lives (571, 97%) and felt confident to use the tool with someone with no knowledge about RHD (533, 91%); 86% of the teachers said they would use flipcharts as educational tools. In the survey for community / schoolchildren (N=520) only 128 (25%) respondents had previous education on RHD, 510 (98%) reported that learned new information, and content was completely new for 242 (47%). A total of 430 (83%) individuals reported that they will discuss RHD with families and community. All qualitative written reports were positive. In 2021/2022, 218/485 (45%) health and education professionals responded the pre/post questionnaire. Knowledge about RHD increased after training: RF as the cause of RHD (56% vs 86%), use of Benzathine Penicillin G (50% vs 97%), frequency of antibiotic prophylaxis (32% vs 90%) and overall moderate or expert understanding of RF or RHD (30% vs 82%).Conclusion:Flipchart educational sessions about RHD had a very positive acceptability in high-risk Brazilian populations, with remarkable gain of knowledge for health professionals.

Circulation, Volume 150, Issue Suppl_1, Page A4124323-A4124323, November 12, 2024. Background:Atrial fibrillation (AF) is a leading cause of stroke. However, predictors of stroke after AF ablation have not been well clarified, therefore, evidences of anticoagulation therapy after the procedure have been limited. Although left atrial low-voltage areas (LVAs) reflects atrial cardiomyopathy, which is a potential cause of thromboembolism, there are few reports of an association between LVAs and stroke. The purpose of this study was to investigate the association between atrial cardiomyopathy assessed by LVAs and stroke in patients undergoing AF ablation.Methods:The study design was a single center, retrospective observational study. This study included 1,486 (age, 68 ± 10 years; female, 501 [34%]; persistent AF, 905 [61%]) consecutive patients who underwent initial AF ablation from December 2014 to March 2022. The definition of LVAs were areas with a bipolar voltage of

Circulation, Volume 150, Issue Suppl_1, Page A4141710-A4141710, November 12, 2024. Background:Stress perfusion CMR has excellent diagnostic and prognostic values in assessing chest pain syndromes. AI-guided methods may overcome complex scanning and increase clinical adaptation of stress CMR.Aim:To assess the benefits of AI-guided stress perfusion CMR.Methods:Consecutive patients with stable chest pain underwent stress CMR using either a standard scanning method (SOC) or an AI-assist (AIA) machine learning protocol to automate scan planning, plane prescription, sequence tuning, and image reconstruction. Scan duration, the ratio of scan preparation time over the entire scan duration, and scan quality using a 5-point scale were compared between AIA and SOC. Cox regression models were constructed to associate evidence of ischemia on stress CMR, by either scanning method, with composite endpoints including cardiovascular death, non-fatal MI, unstable angina hospitalization, and late CABG. A second composite endpoint included the performance of additional cardiac imaging tests (stress imaging and CCTA) and invasive coronary procedures after CMR.Results:Among 594 patients (62.8 ± 14 years), 29% underwent stress CMR with AIA. 26% had stress-perfusion ischemia, and 39% had LGE present. AIA stress CMR had lower scan duration (median 44.0 [IQR 40-47] vs. 52.5 min [IQR 46-60]; p