Risultati per: Sindromi coronariche acute

Circulation, Volume 146, Issue Suppl_1, Page A12589-A12589, November 8, 2022. Introduction:Left ventricular (LV) unloading by percutaneous ventricular assist device (pVAD) reduces myocardial workload and oxygen consumption and provides a new concept for improving outcome for acute myocardial infarction complicated with cardiogenic shock (AMI-CS). AMI results in reduced LV ejection fraction and left atrium remodeling, and increased the incidence of atrial fibrillation. The aim of this study is to investigate the effectiveness of LV unloading by pVAD in terms of mid-term mortality, LV function, and the incidence of atrial fibrillation.Methods:We retrospectively reviewed AMI-CS patients who were admitted to our hospital between July 2014 and December 2021. We investigated patient demographics and baseline characteristics, mid-term clinical outcome, re-admission rate as well as new-onset atrial fibrillation compared between the patients supported with pVAD and without pVAD group during 180-day follow-up.Results:A total of 82 AMI-CS patients treated with pVAD (n=54) or without pVAD (n=28) were analyzed. Mean age was 70±15 years old and 56 patients were male. Door to balloon time (110±56min vs. 91±53min, p=0.33) and Peak CK-MB (471.8±338mg/dl vs. 486.0±545mg/dl, p=0.43) were similar in both groups. During the 180-days follow-up, 23 patients died and 12 patients were re-hospitalized for heart failure (HF). New-onset atrial fibrillation occurred in 16 patients, which was significantly less frequent in pVAD group (11% vs. 36%. p=0.016). Between baseline and 180-days follow-up period, changes of LV ejection fraction (16% vs. 6%, p=0.02) and NT-proBNP (-28% vs. -5%, p=0.03) were significantly higher in pVAD group. There was no significant difference in 180-day all-cause mortality (28% vs. 29%, p=1.0) between the two groups. Multivariate logistic regression showed new-onset atrial fibrillation was independently associated with an increased risk of HF readmission (hazard ratio 2.63, 95% confidence interval 1.91-3.57; p=0.01).Conclusion:pVAD support preserves LV function following ventricular unloading and reduces new-onset atrial fibrillation, which might be contributed to the improvement of mid-term outcome.

Circulation, Volume 146, Issue Suppl_1, Page A11958-A11958, November 8, 2022. Introduction:Although there is robust evidence for the superiority of contemporary femoropopliteal (FP)-specific devices to traditional therapy using non-coated balloon or bare metal stent, cohesive reports on the incidence of acute thrombotic occlusion (ATO) after endovascular therapy (EVT) with contemporary FP devices are scarce. This study investigated the incidence of ATO and its predictors after contemporary FP-EVT for peripheral artery disease.Methods:We retrospectively examined 763 limbs (chronic limb-threatening ischemia [CLTI]: 44%, involving popliteal arterial lesion: 44%) in 644 patients (mean age: 75±9 years, male: 71%, hemodialysis: 34%) who successfully underwent EVT with contemporary FP devices (drug-coated balloon [DCB]: n=235, scaffold: n=528 [drug-coated stent: n=220, stent graft: n=158, drug-eluting stent: n=150]) from June 2012 to July 2020. The outcome measure was ATO defined as acute onset of claudication and/or signs of CLTI in combination with angiographic evidence of occlusive thrombus formation within the treated segment. Cox proportional hazards regression models were used to identify baseline characteristics associated with the incidence of ATO after contemporary FP-EVT.Results:The 24-month incidence of ATO in the overall population was 4.3±0.8% (DCB: 1.0±0.7% versus scaffold: 5.8±1.1%, P

Circulation, Volume 146, Issue Suppl_1, Page A10724-A10724, November 8, 2022. Background:Right Heart Catheterization (RHC) is an important tool in the assessment of hemodynamic status in patients with right heart failure (RHF), however is underutilized.Objective:To evaluate the use of RHC in RHF with the primary outcome as mortality and secondary outcome as length of stay (LOS) using the National Inpatient Sample (NIS).Methods:Using 2018 NIS database, we queried for adults over 18 years with the diagnosis of acute RHF and RHC as a procedure using the ICD-10 code via STATA program. Multivariate logistic regression method was used to adjust for age, gender, race, Charlson comorbidity index, cardiogenic shock, septic shock, respiratory failure, acute coronary syndrome, heart failure, atrial fibrillation/flutter, acute kidney injury, chronic kidney disease, end-stage renal disease. Using a 95% confidence interval (CI), a p-value less than 0.05 was considered statistically significant.Results:A total of 49010 admissions was recorded for acute RHF of which 4795 underwent RHC. 360 patients (7.5%) died in the RHC group versus 4615 (10.4%) in the non-RHC group.16.9% of patients in the RHC group had cardiogenic shock versus 7.3% in the non-RHF group. On univariate analysis, patients undergoing RHC had decreased odds of mortality compared to patients without RHC [Odds ratio (OR) = 0.69, p=0.003] and patients undergoing RHC had increased LOS compared to patients without RHC [OR= 3.15, p=0.012]. The mean LOS for the RHF group was 13.3 days versus 7.5 days in the non-RHF group. On multivariate analysis, those undergoing RHC had decreased odds of mortality compared to those without RHC [OR= 0.47, p=0.000] and LOS was longer for those undergoing RHC [OR= 3.15, p=0.008]. All the outcomes were statistically significant.Conclusion:Right heart catheterization, when used in acute right failure, showed decreased odds of mortality when compared to patients receiving non-invasive medical management only however, no difference in length of stay was observed.

Circulation, Volume 146, Issue Suppl_1, Page A13774-A13774, November 8, 2022. Introduction:We aim to investigate the association between heart failure (HF) during hospitalization with acute coronary syndrome (ACS) and the long-term cancer risk.Methods:This prospective study included 571 patients admitted to 3 Italian hospitals and with ACS discharged alive and free from cancer. They were followed for 24 years or until death.Results:All except for three patients completed the follow-up, representing 6416 person-years. Patients’ mean age was 66 ± 12 years and 70% were males. Baseline clinical HF was diagnosed in 192 (34%) patients. During follow-up, 129 patients (23%) developed cancer; of them, 103 with no HF [27% of patients without HF] and 26 had baseline HF [14% of patients with HF].The incidence rates for cancer were 21 and 18 per 1000 person-years for patients without and with baseline HF, respectively (p = 0.61).The risks for cancer associated with HF were (HR: 0.96; 95% CI: 0.62-1.47; p=0.84). Similar associations were observed among men, women, and patients younger than 75 years of age. Yet, in patients older than 75 years the unadjusted risk was (HR: 0.30; 95% CI: 0.09-0.92; p=0.04). Although, the fully adjusted risk was (HR: 0.39; 95% CI: 0.12-1.30; p=0.13). The unadjusted HRs for cancer development were (HR: 0.88; 95% CI: 0.45-1.74; p=0.73) and (HR: 0.91; 95% CI: 0.48-1.71; p=0.77) for patient with HFrEF and HFpEF respectively.We observed a positive interaction between age and LVEF for the risk of cancer onset (HR: 1.002; 95% CI: 1.0003 -1.004; p=0.02) in the unadjusted model. Results were the same in fully adjusted model.Conclusions:This prospective study of unselected ACS patients showed a lack of association between clinical heart failure at admission for ACS and the long-term cancer risk. A positive independent interaction between age and LVEF for the long-term risk of cancer was also observed.Figure 1:Cumulative hazards of cancer according to HF status (A) and interaction between age and LVEF for the risk of cancer (B) 24-years after ACS.

Circulation, Volume 146, Issue Suppl_1, Page A9746-A9746, November 8, 2022. Introduction:Amyloidosis can disrupt several tissues, including the heart, causing various cardiac arrhythmias. Factors influencing the presence of Atrial Fibrillation in the elderly with amyloidosis admitted for Acute Ischemic Stroke (AIS) have been sparsely studied.Methods:Elderly patients of ages 60 and more with a diagnosis of amyloidosis and a principal diagnosis of Acute Ischemic Stroke (I63.x) were filtered from the 2019 National Inpatient Sample (NIS). All forms of Atrial Fibrillation and multiple risk factors were also identified via their appropriate codes provided by HCUP and based on recommendations from past studies.Results:Our analysis found 1570 elderly amyloidosis patients admitted for AIS in 2019. Among them, 490 cases (31.2%) also had a diagnosis of Atrial Fibrillation. Predictors of atrial fibrillation included hypertension (aOR 1.543, p=0.024), chronic pulmonary disease (aOR 1.541, p

Circulation, Volume 146, Issue Suppl_1, Page A13575-A13575, November 8, 2022. Introduction:Patients who present to the hospital with acute coronary syndromes (ACS) often have poor control of cardiac risk factors. Multiple studies have demonstrated that lipid lowering therapy is not appropriately initiated or intensified in these patients.Hypothesis:We hypothesized that an interruptive alert delivered via the electronic medical record would increase the initiation and intensification of lipid lowering therapies.MethodsUsing Epic EHR (Epic Systems, Verona, WI), an interruptive alert was designed to trigger upon opening the patient’s chart when the patients were admitted with an ICD code that indicated an ACS (i.e., STEMI, NSTEMI, or Unstable Angina). The alert included an order set to obtain a cholesterol panel or if a cholesterol panel had already been collected it would be displayed and suggest modifications to the patient’s current medication regimen. These alterations included statin intensification or the addition of ezetimibe.ResultsBetween September 1, 2021 and May 30, 2022 172 unique patients were identified. The mean age was 64.8 ±13.8 years, 64.5% were male, 74% were white, and 12% were black. The identified patients had multiple comorbidities including cerebrovascular disease (23%), heart failure (47%), peripheral vascular disease (30%), and being a current or former smoker (53%). The triggered order set had a direct effect on 42 (24%) patients, with 10 initiating ezetimibe and 32 having their statins intensified. The most common indicated reason for overriding the alert (n=99) was not meeting criteria. Of these 99 patients, 4 were ultimately started on ezetimibe, 57 had their statin intensified, and 23 were appropriately excluded (including patients with type II myocardial infarctions who were not the target of this intervention). Of note, 15 patients should have received intensified therapy but had their alert over ridden.ConclusionsThis targeted alert led to direct intensification of lipid lowering therapy in 24% of ACS patients with an additional 35% of patients identified by the alert also having therapeutic intensification. This alert will remain in place to allow for further assessment of its effects and can be easily translated to other clinical systems.

Circulation, Volume 146, Issue Suppl_1, Page A12429-A12429, November 8, 2022. Introduction:As Chimeric Antigen Receptor T cell (CAR-T) therapy gains advantage in the management of diffuse large B cell lymphoma (DLBCL), accumulating evidence shows that it frequently accompanies cardiac dysfunction. Previous retrospective studies indicated the potential involvement of cytokine release syndrome (CRS) in cardiac dysfunction after CAR-T therapy, but no prospective study has reported the time course of cardiac dysfunction and its association with prognosis. Purpose: To prospectively examine the sequential changes in cardiac markers over time after CAR-T therapy and to clarify their association between the grade of CRS, cardiac markers, and prognosis.  Methods:In this prospective study, 30 DLBCL patients who underwent CAR-T therapy were enrolled. Before and after the treatment, the level of cardiac biomarkers and echocardiographic index were sequentially collected. We classified all patients into two groups according to the severity of CRS after CAR-T therapy, namely Low-CRS group (CRS

Circulation, Volume 146, Issue Suppl_1, Page A12208-A12208, November 8, 2022. Introduction:The marked rise in left ventricular (LV) filling pressure (ie., pulmonary capillary wedge pressure [PCWP]) during exercise and its association with adverse prognosis in patients with heart failure with preserved ejection fraction (HFpEF) has stimulated interest in therapies to decrease LV filling pressures. Although reducing LV filling pressure may improve exercise hemodynamics, this may also reduce pulmonary perfusion (Qc) and increase ventilation-perfusion (V/Q) mismatch, manifesting as an increase in ventilatory inefficiency during exercise (ie., slope of the ventilation [V̇E] and carbon dioxide elimination [V̇CO2] relationship), which is a strong prognostic indicator of adverse outcomes in heart failure.Hypothesis:Reducing PCWP via acute nitroglycerin (NTG) treatment would increase the V̇E/V̇CO2slope when compared with a placebo treatment in patients with HFpEF.Methods:26 subjects were evaluated (age: 69±5y; BMI: 39.5±7.1kg/m2; V̇O2peak: 1.39±0.46L/min; 16 women/10 men). All subjects performed a six-minute constant-load cycling test at 20W with placebo or NTG treatment. PCWP was measured via a right-heart catheter, arterial blood gases were measured via a radial artery catheter, Qc was measured via direct Fick, and pulmonary gas exchange was measured via a customized breath-by-breath metabolic system. The V̇E/V̇CO2slope was calculated as the relation between the rest-to-20W change in V̇Eand the rest-to-20W change in V̇CO2.Results:PCWP decreased with NTG at 20W (placebo: 20.8±5.8 vs. NTG: 16.4±5.1 mmHg, p=0.001). Qc also decreased with NTG at 20W (placebo: 8.69±1.84 vs. NTG: 8.26±1.87 L/min, p=0.01). In contrast, the V̇E/V̇CO2slope increased with NTG (placebo: 37.5±5.8 vs. NTG: 39.6±7.0, p=0.01).Conclusions:These findings suggest that reducing LV filling pressure increases ventilatory inefficiency, possibly due to an increase in V/Q mismatch caused by a reduction in pulmonary perfusion. Since therapies to decrease LV filling pressure have gained considerable interest to improve exercise hemodynamics in HFpEF, further investigation is required to determine the clinical consequences of ventilation-perfusion mismatch and ventilatory inefficiency caused by a reduction in PCWP in these patients.

Circulation, Volume 146, Issue Suppl_1, Page A14850-A14850, November 8, 2022. Background:Acute kidney injury (AKI) is common in patients with COVID-19 and mediated, in part, by thromboinflammation. In non-critically ill patients with COVID-19, therapeutic-dose anticoagulation with heparin increased the probability of survival to hospital discharge with reduced use of cardiovascular or respiratory organ support. We investigated whether therapeutic-dose heparin reduces the incidence of AKI or death in non-critically ill patients hospitalized for COVID-19.Methods:Non-critically ill patients hospitalized for COVID-19 were enrolled in an open-label, multiplatform randomized trial of therapeutic-dose heparin versus usual-care pharmacologic thromboprophylaxis. The primary endpoint of this analysis was in-hospital diagnosis of AKI or death. AKI was defined as Kidney Disease Improving Global Outcomes stage 2 or 3 AKI (≥2-fold increase in serum creatinine or initiation of renal replacement therapy). A Bayesian statistical model estimated the risk of AKI or death between those randomized to therapeutic-dose anticoagulation versus usual-care thromboprophylaxis, adjusted for age, sex, D-dimer, time epoch, country, site, and platform.Results:Among 1922 enrolled from ACTIV4a and ATTACC, 23 were excluded due to ESRD at enrollment. Baseline or follow-up creatinine was missing for 205 individuals. Among 1694 participants analyzed, median age was 60, 58% were men, and median baseline creatinine was 0.9 mg/dL. The primary endpoint occurred in 83 participants (4.9%); 4.4% assigned to therapeutic-dose heparin and 5.5% assigned to thromboprophylaxis (adjusted relative risk [aRR] 0.72, 95% CrI 0.47-1.10; posterior probability of superiority [defined as relative risk < 1.0] was 93.6%). Therapeutic-dose anticoagulation was associated with a 97.7% probability of superiority to reduce the composite of stage 3 AKI or death (3.1% vs. 4.6%; aRR 0.64, 95% CrI 0.40-0.99) compared to usual-care thromboprophylaxis.Conclusions:Therapeutic-dose anticoagulation with heparin was associated with a high probability of superiority to reduce the incidence of in-hospital stage 3 AKI or death in non-critically ill patients hospitalized for COVID-19, compared with usual-care thromboprophylaxis.

Circulation, Volume 146, Issue Suppl_1, Page A11885-A11885, November 8, 2022. Background:cardiac magnetic resonance (CMR) is central for diagnosis, follow up and prognostic stratification of acute myocarditis. Late gadolinium enhancement (LGE) extent and persistence at follow-up represents a negative prognostic marker. However, time course of oedema resolution and LGE stabilization and optimal timing to repeat CMR are unclear.Hypothesis:we assessed time course of oedema and LGE evolution to identify optimal timing to repeat CMR in acute myocarditis.Methods:36 acute myocarditis patients (35M, 28,8±10,3 years) underwent CMR at clinical presentation (CMR-1), after 3 months (CMR-2) and after 12-months (CMR-3). We assessed oedema and LGE and measured left ventricular ejection fraction (LVEF) and indexed mass (iLVM). After CMR-3 all patients were followed up yearly with clinical evaluation, Holter ECG and echocardiography.Results:all patients had oedema and LGE at CMR-1. At CMR-2 significant reduction of oedema (T2 positive segments 0,4±0,9 vs 4,1±3,2 p

Circulation, Volume 146, Issue Suppl_1, Page A12335-A12335, November 8, 2022. Introduction:High sensitivity troponin (hs-cTnT and hs-cTnI) aimed to reduce costs, observation times and hospital stays. However, since their implementation in many hospital systems across the US many healthcare professionals still struggle in regards to their appropriate utility and interpretation.Hypothesis:We assessed the hypothesis that a web-based training interface is an effective tool to increase education about the proper utility and interpretation of High sensitivity troponin in an acute care setting.Methodology:A web-based training interface was designed with 2 pre-education questions, a slide show based on the 2021 guidelines for chest pain (ie ordering troponin based on presentation, 0+1/2/3 hour) and 2 post-education questions. This interface was sent out to healthcare professionals in a community hospital through email bursts and QR codes. 52 providers participated in the training interface: Internal Medicine residents (n=24), Hospital medicine attendings (n=13), Cardiology Attendings (n=3), Emergency medicine attendings (n=3) and Advanced practice providers (APPs), included nurse practioners and physician assistants (n=9). We measured change in awareness of appropriate and inappropriate troponin use. Fisher’s exact test was performed to compare all subgroups. P value

Circulation, Volume 146, Issue Suppl_1, Page A10470-A10470, November 8, 2022. Introduction:In the ODYSSEY OUTCOMES trial, alirocumab improved cardiovascular outcomes and reduced death after acute coronary syndrome (ACS). Median follow-up was 2.8 yrs (range 2-5). The effects of alirocumab on long-term survival are unknown.Objective:To calculate projected life span and potential survival gains with alirocumab vs placebo after ACS using validated nonparametric age-based methods.Methods:In ODYSSEY OUTCOMES (NCT01663402), 18,924 patients with recent ACS and elevated atherogenic lipoproteins despite high-intensity or maximum-tolerated statin therapy were randomized to alirocumab or placebo. All-cause death was a secondary trial outcome. Age-based estimates of projected survival and event-free (all-cause death, nonfatal myocardial infarction, nonfatal ischemic stroke) survival were calculated. In each treatment arm at every year of age, lifespan was estimated from area under the survival curve, to a maximum of 85 yrs. Differences in areas under the survival curves provide an estimate of the benefit of alirocumab on survival.Results:Mean (SD) baseline age was 58.5 (9.3) yrs. Mean survival benefits with alirocumab vs placebo ranged from 0.03 to 1.62 yrs, decreasing with age and becoming neutral at age 80-85 yrs. For example, at age 40, estimated survival was another 37.5 yrs with alirocumab and 35.9 yrs with placebo (difference 1.62 yrs [95% CI, 0.30-2.94];P=0.016). At age 60, it was 20.5 vs 19.6 yrs (difference 0.88 [95% CI, 0.16-1.61];P=0.017); at age 75 it was 8.8 vs 8.3 (difference 0.57 [0.09-1.05];P=0.019); and at age 80, it was 4.5 vs 4.5 years (difference 0.03 [-0.28 to 0.35];P=0.83). Mean event-free survival benefit similarly ranged from 1.85 to 0.0 yrs.Conclusions:Modeling suggests that long-term treatment with alirocumab may result in a meaningful increase in survival among patients less than 80 yrs of age. This analysis may facilitate shared decision-making with patients.Funding:Sanofi, Regeneron Pharmaceuticals

Circulation, Volume 146, Issue Suppl_1, Page A14147-A14147, November 8, 2022. BackgroundAcute pulmonary embolism (PE) is associated with an increased risk of short- and long-term mortality. Since interventricular septal systolic function contributes to a third of right ventricular (RV) cardiac output, we sought to investigate the potential value of septal strain in PE.MethodsThis was a retrospective cohort study of patients admitted with acute pulmonary embolism. Patients underwent echocardiography during admission and included left ventricular (LV) speckle tracking, by which global longitudinal strain (GLS) and regional strain were acquired. Multivariable adjustments were made for age, sex, simplified PE index (sPESI), abnormal cardiac biomarkers (troponin or proBNP) and RV systolic function. The endpoint was all-cause death.ResultsThe cohort consisted of 186 patients (mean age 68 years, 54% men), of whom 49 (26%) died during a median follow up of 3.5 years (IQR: 2.9-6.7 years). All LV systolic measures were univariable predictors of death (LVEF: HR: 1.04 (1.02-1.06), per 1% decrease; GLS: HR: 1.15 (1.07-1.22), per 1% absolute decrease; septal strain: HR: 1.15 (1.08-1.23), per 1% absolute decrease] (figure). RV systolic function was also associated with death [TAPSE: HR: 1.06 (1.01-1.12), per 1mm decrease). After multivariable adjustments, only septal strain remained significantly associated with outcome (HR: 1.09 (1.01-1.19), p=0.029, per 1% absolute decrease).Furthermore, septal strain significantly increased C-statistics when added to a base model of sPESI score, abnormal biomarkers and presence of hypotension (base model C-stat: 0.76; base model and septal strain C-stat: 0.83, p for increment = 0.006).ConclusionSeptal strain is associated with death in acute PE and provides prognostic information beyond conventional risk assessment.

Circulation, Volume 146, Issue Suppl_1, Page A15393-A15393, November 8, 2022. Introduction:In 2015, the American Heart Association revised the Jones Criteria, the gold standard for diagnosis of acute rheumatic fever (ARF). This revision included changes to increase the sensitivity for ARF in high-risk settings. The objective of this study was to determine if there were children who were found to be ARF-negative by strict application of these criteria in a high risk setting but found to have rheumatic heart disease (RHD) on follow-up evaluation.Methods:Between 2017 and 2020, we conducted an epidemiological study to determine the incidence of ARF in Uganda. Children and adolescents, 3-17 years, presenting with clinical concern for ARF (fever and joint pain, suspicion of carditis, or suspicion of chorea) were enrolled and evaluated using the Jones Criteria. Children ultimately found to have a laboratory-confirmed alternate diagnosis and those who did not meet ARF criteria but had an unknown final diagnosis, were asked to participate in a longitudinal echocardiographic follow-up study to monitor for development of RHD. Presence of RHD was considered a false negative test and used to calculate the false negative error of not receiving a diagnosis of ARF.Results:There were 351 children determined to have an alternate diagnosis during the study period; 180 with a laboratory confirmed final diagnosis (127 malaria, 20 non-rheumatic cardiac disease, 15 influenza, 18 other) and 171 with an unknown final diagnosis. Of these, 220 (62.7%) had at least one follow-up visit (median 366 days, range 10-1054). One child (1/220,

Circulation, Volume 146, Issue Suppl_1, Page A12221-A12221, November 8, 2022. Introduction:Recent innovations in mechanical circulatory support (MCS) enable physicians to deal with challenging cases with cardiogenic shock. As the number of MCS has increased, the excessive workload of clinical engineers (CEs) who manage MCS has become a serious problem. To overcome such situation, we introduced innovative remote monitoring system of circulatory assist pump catheters (Impella) called Impella Connect (IC) from 2020, which allows medical staff to monitor driving status and alarms of Impella in their mobile devices. Here we reported our experience of IC and the safety and efficacy of our protocol using IC for management of Impella.Methods:We identified 63 Impella cases for cardiogenic shock from 2018 to 2021 in our institution. We utilized Impella 2.5/CP in 53 cases and Impella 5.0 in 10 cases depending on their hemodynamic condition. Before introducing IC (nIC period: n=17), CEs were responsible for Impella management in all time periods and needed to work overtime to manage devices in night time. However, after introducing IC (IC periods: n=46), CEs were responsible only in daytime and non-MCS expert medical stuff were responsible in night time supporting by CEs’ remote monitoring with IC. We retrospectively evaluated the safety and efficacy of our management using IC.Results:Impella insertion was performed emergently in all cases and the 34 cases (53.9 %) were inserted in night time. Average support time was 6.5±0.6 days (nIC 7.7 vs. 6.0 days). We encountered 13 device trouble in nIC periods (purge system in 8, pressure sensor in 4 and pump malfunction in 1) and 14 in IC periods (purge system in 9, pressure sensor in 3 and pump malfunction in 2). Device trouble requiring intervention was not significantly different in both periods (nIC/IC 10 vs. 11 cases, p=0.85) and adverse event related to delayed or inappropriate response was not observed in both periods. The average of overtime working hours of CEs per month was significantly decreasing in IC periods (53.1±16.8 vs. 8.6±2.6 hours per month, p

Circulation, Volume 146, Issue Suppl_1, Page A15637-A15637, November 8, 2022. LongCovid or Post-Acute Sequelae of COVID-19 (PASC) is a diagnosis given to patients who experience a wide range of debilitating chronic symptoms after infection with SARS-CoV-2. The majority of individuals are PCR negative, indicating microbiological recovery. There are currently few LongCovid/PASC blood-based biomarkers. We used fluorescence microcopy to identify unique fibrin/amyloid micro-thrombosis and hyperactivated platelets in individuals with PASC. These fibrin/amyloid microclots may impede blood flow to tissue.Methods:Whole blood was collected in citrate tubes from 30 matched healthy subjects and 30 PASC subjects. Platelet poor plasma (PPP) was prepared by centrifugation and stored at -80 °C. PPP was then exposed to thioflavin T (ThT), a fluorescence marker known to bind to and open hydrophobic areas on damaged amyloidogenic protein. Samples were viewed with fluorescence microscopy using a 63x/1.4 Oil DIC M27 objective (excitation wavelength 450nm-488nm, emission 499nm- 529nm). After a double-trypsin PPP digestion method, proteomic analysis of the PPP samples was performed.Results:Significant microclot load was observed in the PPP of participants with PASC compared to healthy participants (Fig. 1). Proteomic analysis revealed the presence of inflammatory molecules within digested microclots.Conclusion:Preliminary results suggest that the presence of microclots in PPP may be used as a diagnostic biomarker for the PASC. Characterization of inflammatory molecules and antibodies trapped within microclots might provide insight into the pathogenesis of PASC and serve as a basis for novel treatment strategies or preventative medicine.Figure:Representative specimensA)Microclots in healthy plasma.B)Microclots in PASC plasma.