Risultati per: Caratterizzazione dell'asma in base all'età di insorgenza: uno studio di coorte multi-database

Circulation, Volume 150, Issue Suppl_1, Page A4143939-A4143939, November 12, 2024. Introduction:Recent studies using deep learning techniques have demonstrated promising left ventricular ejection fraction (LVEF) assessment from transthoracic echocardiograms (TTEs). However, most prior studies have focused on videos from a single apical view, a technique known to be subject to limitations given the regionality of LV systolic function. We hypothesized that a deep learning model trained to include echocardiographic video clips from multiple views from a large dataset will improve accuracy in LVEF assessment.Methods:We identified all adult TTEs with a clinically reported LVEF at Columbia University between 2019-2024. A view classification model was trained to identify apical 4 and 2-chamber and parasternal long and short-axis views for LVEF assessment. The internal dataset was split into train, validation and test sets to train spatiotemporal convolutional models for each of the 4 views to assess LVEF for each video clip. The median clip-level LVEF within a study was used to derive a study-level LVEF. The model was evaluated on an internal test set and a large external test set, which included all available adult TTEs from Weill Cornell Medical Center since 2011. As benchmark comparison, the previously published EchoNet-Dynamic model was also evaluated on the external test set.Results:The model was trained and validated on 97,566 internal studies, comprising 1,424,265 videos from 60,741 unique patients. The model achieved state of the art performance on the internal test set (16,396 studies), with mean absolute error (MAE) of 3.4% and root mean squared error (RMSE) of 4.6%. Multi-view results were superior to all single-view models. Model showed robust predictions on external test set (179,298 studies), with MAE of 5.6% and RMSE of 7.1% and outperformed EchoNet-Dynamic (Table).Conclusions:We developed a deep learning model trained on multiple echocardiographic views using the largest dataset to date. Our model achieved state-of-the-art accuracy in assessing LVEF with a level of agreement between the AI and cardiologist LVEF assessments comparable to cardiologist interobserver variability. Further studies are underway to study the implementation of these models within clinical systems.

Circulation, Volume 150, Issue Suppl_1, Page A4145382-A4145382, November 12, 2024. Introduction:Myocarditis is more commonly reported among young males and may be complicated by cardiogenic shock. Animal models and clinical studies demonstrate that myocardial fibrosis after myocarditis disproportionately impacts males. There is limited contemporary data on sex-specific clinical outcomes among patients with myocarditis complicated by cardiogenic shock.Methods:This retrospective cohort study used an EHR-based data platform from large academic medical centers across the United States (TriNetX, Inc.) to identify patients diagnosed with cardiogenic shock secondary to myocarditis between January 2012 and January 2024. Baseline demographics, clinical characteristics, medication use, and outcomes were defined using standardized ICD codes. The primary study outcome was all-cause mortality at 6 months. Secondary outcomes included cardiac arrest, acute kidney injury (AKI), atrial fibrillation, and ventricular tachycardia/fibrillation (VT/VF). The study population was stratified based on sex. Propensity score matching (1:1), incorporating demographic factors, comorbidities, and medication usage, was employed to compare the risk of primary and secondary outcomes between groups.Results:We identified 3,048 individuals (1,857 males, 60.9%) with myocarditis complicated by cardiogenic shock. After propensity-score matching, there were 1,072 individuals in each group (Table). Females had a higher risk of all-cause mortality (HR: 1.27, 95%CI: 1.06-1.52), but a lower risk of AKI (HR: 0.83, 95% CI: 0.74-0.92) and VT/VF (HR: 0.74, 95%CI: 0.60-0.92). The risks of atrial fibrillation (HR: 0.88, 95% CI: 0.70-1.09) and cardiac arrest (HR: 1.04, 95% CI: 0.85-1.27) were similar between the two groups.Conclusion:Significant sex-based differences in clinical outcomes exist among patients with myocarditis complicated by cardiogenic shock. Further studies are warranted to investigate the pathophysiological basis of the higher risk of all-cause mortality, and lower risk of AKI and ventricular arrhythmias among females with myocarditis complicated by cardiogenic shock compared with males.

Circulation, Volume 150, Issue Suppl_1, Page A4137925-A4137925, November 12, 2024. Introduction:Thoracic endovascular aortic repair (TEVAR) has emerged as a promising treatment option for patients with type B aortic dissection (TBAD). However, there is a lack of evidence regarding the long-term morbidity of initial TEVAR compared to optimal medical therapy (OMT) in acute uncomplicated TBAD (uTBAD).Objective:To evaluate real-world data(RWD) on the long-term outcome of Japanese patients with acute uTBAD using a nationwide claims database.Methods:This retrospective cohort study utilizes JMDC, a nationwide claims database under Japan’s universal healthcare system. We included patients who were initially hospitalized with a diagnosis of acute TBAD. We defined acute uTBAD by excluding those who died within one month, suffered aortic rupture, traumatic thoracic aortic injury, underwent open-chest surgery, experienced stroke or paralysis, or had less than six months of history in the JMDC. Patients who underwent TEVAR within three months of the index hospitalization (TEVAR group) were compared with those who received optimal medical therapy (OMT group). Propensity score (PS) matching was performed based on age, sex, and year of hospitalization. Using the Kaplan-Meier method, we calculated the cumulative rate of all-cause mortality and aorta-related events.Results:Of 18,445 patients diagnosed with aortic disease between January 2005 and December 2020, 641 were included in the study (OMT group: n=580, TEVAR group: n=61). After PS-matching, demographics of the groups (OMT_PSM: n=183 vs. TEVAR_PSM: n=61) were female (12.6% vs. 13.1%), median age (54 years [IQR, 48-60] vs. 54 years [IQR, 50-61]) and follow-up time (18 months [8-32] vs. 19 months [9-32]), respectively. Kaplan-Meier curves for the aortic-related events (Figure1, 2) are shown as long-term outcomes.Conclusions:This study successfully demonstrated that the estimated 5-year aortic-related event rate in acute uTBAD patients undergoing OMT is approximately 20%, demonstrating the relevance of the RWD source. However, the number of death events in the TEVAR and OMT groups was not sufficient to provide statistical power. Therefore, further studies are warranted to evaluate the long-term prognosis of initial TEVAR for uTBAD.

Circulation, Volume 150, Issue Suppl_1, Page A4139880-A4139880, November 12, 2024. Background:Patients with Coronary Artery Disease are at an increased risk of Atrial Fibrillation related mortality via various mechanisms like Ischemia, Atrial stretch and remodeling, but largely as side effects of treatments. Thus, AF in patients with CAD is a critical health concern among older adults (65+) in the United States. Our CDC analysis focuses on unraveling mortality trends among patients grappling with both conditions from 1999 to 2020.Methods:A retrospective analysis was conducted using national mortality data from the multiple causes of death files in the CDC WONDER database from 1999 to 2020, employing ICD codes I48 for AF and I25.1 for CAD. Age-adjusted mortality rates (AAMRs) per 100,000 people were calculated for the total population, stratified by gender, race, urban/rural metro status, and census region. Annual Percent Change (APC) was calculated using the Joinpoint regression software.Results:A total of 564,952 AF-related deaths among older adults aged 65+ with CAD occurred in the U.S. between 1999 and 2020. Majorly occurred in medical facilities (36.5%). The overall AAMR for AF in CAD-related deaths increased from 49.7 per 100,000 in 1999 to 84.4 in 2020, with an AAPC of 2.52 (95% CI: 2.29 to 2.76, p < 0.000001). A moderate rise in AAMR from 1999 to 2016 (APC: 1.75, p < 0.000001), then significant surge from 2016 to 2020 (APC: 5.88, p < 0.000001). Men had higher AAMRs than Women (83.8 vs 46.6), with a more pronounced increase in men (AAPC: 3.44, p < 0.000001) compared to women (AAPC: 1.23, p < 0.000001). Racially, White population had the highest AAMRs (67.1), followed by American Indians or Alaska Natives (41.9), Hispanics (33.7), Blacks (32.2), and Asians (28.1). All racial groups saw significant increases in AAMRs, most notably among American Indians or Alaska Natives (AAPC: 4.64). Geographically, AAMRs varied, with Rhode Island having the highest (103.5) and Nevada the lowest (29.7). The Midwest had the highest regional AAMR (65.1), while nonmetropolitan areas exhibited higher AAMRs than metropolitan areas, both showing overall increase throughout study (3.34 vs 2.23).Conclusion:This analysis reveals increasing trends and demographic disparities in mortality rates due to AF in CAD patients among older adults in the U.S. The recent surge in mortality rates highlights the need for targeted interventions to address these disparities and improve health outcomes for this vulnerable population.

Circulation, Volume 150, Issue Suppl_1, Page A4138483-A4138483, November 12, 2024. Background:Hypoplastic left heart syndrome (HLHS) is classified by subtype: mitral atresia and aortic atresia (MA-AA), mitral stenosis and aortic atresia (MS-AA), and mitral stenosis and aortic stenosis (MS-AS). It is controversial whether specific HLHS subtypes and presence of ventriculocoronary connections (VCC) are associated with transplant-free survival. We aimed to determine whether there is an increased risk of mortality associated with specific HLHS subtypes, whether this risk is stratified by the presence of VCC, and if a specific type of stage I palliation in patients with VCC improves survival. We also aimed to determine practice variation in the evaluation of HLHS patients with VCC.Methods:We performed a multicenter retrospective cohort study of fetuses and infants < 2 months of age with HLHS admitted between 1/2012-12/2016 to participating Fetal Heart Society institutions. Patients with HLHS variants were excluded. We collected patient specific data and surveyed participating centers for practice variation. Kaplan-Meier curves with log-rank test were used to assess transplant-free survival and cox proportional hazard analysis was performed with adjustment for center as a random intercept.Results:341 patients from nine centers were included. MA-AA was the most common subtype (177, 52%), followed by MS-AA (102, 30%), and MS-AS (62, 18%). VCC were diagnosed or suspected in 65 patients (19%). A total of 287 patients were live born with intention to treat. HLHS subtype was not associated with transplant-free survival (Figure 1A). Presence of VCC was associated with a lower transplant-free survival (p=0.026, Figure 1B). In the subset of patients diagnosed with VCC, there was not a significant difference in survival based on type of stage I palliation (Figure 1C). Cox proportional hazard modeling adjusted for center demonstrates that presence of VCC has a hazard ratio of 1.74 (CI 1.02-2.98), p =0.04. Survey data regarding practice variation for patients with VCC (Figure 2) demonstrates 33% of centers modify the type of stage I palliation based on presence of VCC.Conclusions:In a multicenter cohort of HLHS patients, patients with VCC had lower transplant-free survival compared to those without VCC, while subtype and type of stage I palliation did not have a statistical difference. There is considerable practice variation in the management of HLHS patients with VCC that may warrant further investigation.

Circulation, Volume 150, Issue Suppl_1, Page A4140505-A4140505, November 12, 2024. Introduction:Syncope is a common condition often leading to testing and hospital admissions. Research assessing sex-based differences in the workup as well as disposition following emergency department (ED) syncope visits is scarce. In this study, we sought to address this gap using a national database.Methods:From 2010 to 2019, we identified syncope patients using ICD-9 and ICD-10 codes. Using data from the IBM MarketScan Research Database, which captures de-identified individual-level health data from approximately 100 commercial payers and self-insured corporations in the United States, we assessed the incidence of testing using CPT codes in the 3 months following syncope diagnosis. Furthermore, we evaluated the percentage of syncope patients discharged from the ED. Sex-based comparisons were performed using the Chi-square test.Results:A total of 557,416 patients (54.0% women) were included in the cohort to assess for testing disparities (these are the patients who had at least 3 months of continuous enrollment following syncope diagnosis). Compared to men, women had significantly lower testing in most domains: long-term monitoring (6.8% vs. 7.4%), echocardiogram (13.3% vs. 17.2%), cardiac stress test (4.0% vs. 7.4%), chest X-ray (17.7% vs. 25.5%), imaging for pulmonary embolism (1.5% vs. 2.0%) and carotid Doppler ultrasound (5.4% vs. 7.3%); p< 0.001 for all above comparisons, figure 1A. Tilt table testing was similar between both sexes (1.4% vs. 1.3%).A total of 1,325,023 patients (58.1% women) were included in the ED disposition cohort. Women presenting to the ED with syncope were more likely to be discharged compared to men (78.7% vs 72.1%; p< 0.001), and this trend remained consistent throughout the study period, figure 1B.Conclusion:Women presenting with syncope are less likely to receive testing compared to men, and more likely to be discharged from the ED. There is a need to evaluate the reasons behind these disparities and assess their impact on patients’ outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4124446-A4124446, November 12, 2024. Introduction:One in five individuals have elevated lipoprotein(a) [Lp(a)], an inheritable risk factor that is causally associated with atherosclerotic cardiovascular disease (ASCVD). Whether individuals with elevated Lp(a) derive similar benefit from control of ASCVD risk factors has not been well-studied.Hypothesis:The magnitude of benefit associated with optimal cardiovascular health will be similar across the spectrum of Lp(a).Aim:To assess the association of traditional risk factor burden and Life’s Simple 7 (LS7) score with incident ASCVD across Lp(a) values.Methods:We studied 6,676 participants from the Multi-Ethnic Study of Atherosclerosis who underwent Lp(a) testing and were followed for incident ASCVD events (coronary heart disease and stroke). Elevated Lp(a) was defined as >50 mg/dL. As defined by the American Heart Association, LS7 metrics included smoking, physical activity, body mass index, diet, total cholesterol, blood pressure, and glucose. Multivariable Cox proportional hazards regression assessed the association of traditional risk factor burden and LS7 score (poor: 0-8, average: 9-10, optimal: 11-14) with incident ASCVD for individuals with and without elevated Lp(a) during a median follow-up of 17.7 years.Results:The mean age was 62.1 years, 53% were women, and 61% were non-white. The median Lp(a) was 17 mg/dL and 20% had Lp(a) >50 mg/dL. Individuals with Lp(a) >50 mg/dL had the highest burden of traditional risk factors except cigarette smoking. Compared to those with a poor LS7 score, those with an optimal LS7 score had a lower ASCVD risk that was significant for participants with Lp(a) 50 mg/dL (HR=0.41, 95% CI: 0.16-1.02). Individuals with Lp(a) >50 mg/dL had the highest absolute event rates across all LS7 categories, and there was no significant interaction between Lp(a) and LS7 score on incident ASCVD (p-interaction=0.64,Figure).Conclusions:Participants with an optimal LS7 score had similar reduction in ASCVD risk regardless of their Lp(a) burden. These results emphasize the importance of a healthy lifestyle and ASCVD risk factor control among patients with elevated Lp(a).

Circulation, Volume 150, Issue Suppl_1, Page A4146635-A4146635, November 12, 2024. Background:Stroke in malignancy is a significant cause of mortality among older adults. This study analyzes demographic trends and disparities in mortality rates due to stroke in malignancy among adults aged 65 and older from 1999 to 2020.Methods:A retrospective analysis was conducted using CDC WONDER death certificate data from 1999 to 2020. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 persons stratified by year, sex, race/ethnicity, and geographical regions. Trends were assessed using Average Annual Percentage Change (AAPC) and annual percent change (APC).Results:Between 1999 and 2020, Stroke in Malignancy resulted in 198,659 deaths among adults (≥65 years) in the United States. Fatalities occurred predominantly in medical facilities (36.5%), followed by nursing homes (29.3%), and at decedents’ homes (24.2%). The overall age-adjusted mortality rate (AAMR) for Stroke in Malignancy-related deaths decreased from 32.8 in 1999 to 16.5 in 2020, with an Average Annual Percentage Change (AAPC) of -3.35 (p-value < 0.000001). Notably, there was a significant decline in AAMR from 1999 to 2018 (APC: -4.23, p-value < 0.000001), followed by a notable increase from 2018 to 2020 (APC: 5.33, p-value = 0.025595). Both men and women showed decreased AAMRs, with men having higher rates (men: 28.1; women: 17.5). AAMRs varied among racial/ethnic groups, with Black/African Americans having the highest AAMR (31.0), followed by Whites (21.8), American/Alaska Natives (18.6), Asian/Pacific Islanders (12.9), and Hispanics (12.5). AAMRs decreased across all races, with the most significant decline observed in Asians (AAPC: -4.62, p-value < 0.000001). Geographically, AAMRs varied among states, ranging from 11.0 in Arizona to 33.7 in Mississippi. Across regions, the Midwestern region had the highest mortality (AAMR: 23.4), with nonmetropolitan areas exhibiting slightly higher AAMRs (AAMR: 25.9). Both metropolitan and nonmetropolitan regions experienced decreased AAMRs over the study period (p-value < 0.000001).Conclusion:The analysis reveals substantial demographic disparities in mortality rates attributed to Stroke in malignancy among older adults. While the overall decline in mortality rates indicates progress, the concerning upsurge in recent years necessitates proactive measures. Addressing these disparities through targeted interventions and equitable healthcare access is imperative to optimize outcomes for this at-risk population.

Circulation, Volume 150, Issue Suppl_1, Page A4140549-A4140549, November 12, 2024. Introduction:Persistently elevated filling pressure leading to central venous congestion is associated with poor prognosis. This central venous congestion stimulates connective tissue hyperplasia causing tissue fibrosis and stiffness of the liver. However, risk stratification involving hepatic fibrosis in heart failure is limited.Research Question:Is liver stiffness associated with higher mortality in heart failure?Aims:To utilize liver stiffness measured by transient elastography as an imaging phenotype in HF risk stratification and prevention.Methods:De-identified data from 285 HF patients without pre-existing liver disease/cirrhosis, with liver stiffness measured (kPa) by transient elastography from 2015-2023 were extracted from TriNetX, a real-time, electronic, federated data network of 34 healthcare organizations. Liver stiffness was further classified as high and low with 8kPa as a cut-off. Comparisons employed the chi-square or Fisher’s exact test for categorical variables and the student’s t-test or Mann-Whitney-Wilcoxon test, as appropriate. Multivariable Cox proportional hazards models were applied to evaluate the association with mortality and readmissions in 30 days.Results:The mean age of the cohort is 65±11 years. The majority were women (57.9%). Participants were followed for a median of 3.8 (1.52-6.67) years; 83 out of 285 patients died. Multivariable analysis showed that 1 SD increase in liver stiffness was associated with increased mortality (HR 1.13, 95% CI 1.05-1.21; p

Circulation, Volume 150, Issue Suppl_1, Page A4147150-A4147150, November 12, 2024. Background:Coronary artery disease (CAD) in patients with hypertension is a significant health concern among adults in the United States. This study investigates trends and demographic disparities in mortality rates due to CAD in hypertensive patients aged 25 and older from 1999 to 2020.Methods:The CDC WONDER database’s mortality data from 1999 to 2020 was used for a retrospective analysis. Average Annual Percentage Change (AAPC) and Annual Percent Change (APC) were used to evaluate trends and calculate age-adjusted mortality rates (AAMRs) per 100,000 people. The year, sex, race/ethnicity, and geographic regions were used to stratify the data.Results:Between 1999 and 2020, CAD in hypertension caused 1,512,89 medical facilities, accounting for 37.9% of all deaths. With an AAPC of 1.88 (95% CI: -0.81 to 4.36, p = 0.118), the overall AAMR grew from 7.7 in 1999 to 36.0 in 2020. There was a notable increase between 1999 and 2001 (APC: 30.07, p = 0.040) and a minor growth between 2001 and 2020 (APC: 0.85, p = 0.030). Adult men had higher AAMRs than women (men: 40.2; women: 25.2), with increases for both sexes [Men: AAPC: 4.75, p = 0.002; Women: AAPC: 2.70, p = 0.058]. AAMRs varied significantly by race, highest among Black individuals (39.9), followed by Whites (31.4), American Indians (30.4), Hispanics (27.7), and Asians (21.3). The AAMR increased for all races from 1999 to 2020, most notably in American Indians (AAPC: 4.91, p = 0.004). AAMRs varied by state, from 16.4 in Utah to 51.4 in West Virginia. The Midwest had the greatest regional death rate (33.6), followed by the West (31.1), Northeast (31.0), and South (30.9). Nonmetropolitan areas had higher AAMRs than metropolitan areas (34.7 vs. 31.0), with a greater increase in nonmetropolitan areas (AAPC: 6.22, p < 0.000001).Conclusion:This analysis reveals significant demographic and geographic disparities in mortality rates due to CAD in hypertensive adults in the U.S. The AAMR has increased fivefold over the past two decades, particularly among certain racial groups and geographical regions. These findings underscore the urgent need for targeted interventions and equitable healthcare access to mitigate these disparities and improve outcomes.

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 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 A4136776-A4136776, November 12, 2024. Introduction:Resting Heart Rate (HR) and Heart Rate Variability (HRV) reflect autonomic control, and are implicated as prognostic factors. We aimed to evaluate the prognostic value of HR and HRV in a cohort from a nationwide telemedicine network.Methods:We assessed unique ECGs recorded from patients ≥16 years-old, from the tele-ECG database of the Telehealth Network of Minas Gerais, Brazil, between 2010 and 2017. Variables of interest were HR and standard deviation of normal RR intervals (SDNN). Self-informed data were collected: sex, age, risk factors (hypertension, dyslipidemia, diabetes, smoking) and comorbidities (myocardial infarction, Chronic Obstructive Pulmonary Disease, and Chagas disease). Outcomes of interest were all-cause and cardiovascular mortality, assessed by ICD codes reported in death certificates, through linkage with the Mortality Information System. Cox regression was applied to evaluate the association between HR and HRV and the outcomes, in 4 models: 1. Unadjusted; 2. Adjusted for sex and age; 3. Model 2 + risk factors + clinical comorbidities; 4. Model 3 + HRV or HR, respectively.Results:At total 992.611 individuals were included, median age of 55 years, 60% women. In 6 years, there were 33.292 deaths (3,37%), 21% due to cardiovascular causes. Patients who died had higher prevalence of all risk factors and comorbidities, as well as higher HR: 76 (IQR 66-87) vs. 74 (IQR 65-83) bpm, p

Circulation, Volume 150, Issue Suppl_1, Page A4142403-A4142403, November 12, 2024. Introduction:M-TEER is a minimally invasive procedure for selected patients with symptomatic mitral regurgitation. Data about the safety of the procedure among post-CABG patients is limited.Methodology:We used the Nationwide Inpatient Sample data between January 2016 and December 2020 to identify M-TEER hospitalizations with history of CABG. Baseline characterestics including demographic data and comorbidities were identified. Primary outcomes were in-hospital all-cause mortality and net all cardiac periprocedural complications defined as a composite of acute myocardial infarction, pacemaker placement, cardiac tamponade, pericardiocentesis, pericardiotomy, pericarditis, and hemopericardium.Results:48,835 cases of M-TEER were identified during the study period, of whom 9,655 (19.78%) had prior CABG. Patients with prior CABG undergoing M-TEER were older (76 vs. 75 years, p

Circulation, Volume 150, Issue Suppl_1, Page A4147314-A4147314, November 12, 2024. Background:The American College of Cardiology/American Heart Association guidelines recommend assessing aortic stenosis (AS) using American Society of Echocardiography-endorsed parameters and referring patients with severe symptomatic AS for treatment. Yet, multi-site real-world assessment of guideline adherence is lacking.Methods:We assessed consecutive echocardiographic reports for patients >18 years of age from 30 US institutions with appropriate permissions between January 2018–March 2024 (egnite Database; egnite, Inc.). Completeness of echocardiographic evaluation of AS was assessed. Patients with severe AS were stratified into high- and low-gradient (HG, mean aortic gradient [MG] ≥40 mm Hg; LG, MG

Circulation, Volume 150, Issue Suppl_1, Page A4142450-A4142450, November 12, 2024. Introduction:M-TEER is a minimally invasive procedure for selected patients with symptomatic mitral regurgitation. It remains unknown whether the concomitant C-CTO would affect the outcomes of M-TEER procedure.Methodology:We used the Nationwide Inpatient Sample Data between January 2016 and December 2020 to identify M-TEER hospitalizations with concomitant C-CTO. Baseline characteristics including demographic data and comorbidities were identified. Primary outcomes were in-hospital all-cause mortality and net all cardiac periprocedural complications defined as a composite of acute myocardial infarction, pacemaker placement, cardiac tamponade, pericardiocentesis, pericardiotomy, pericarditis, and hemopericardium.Results:48,835 cases of M-TEER were identified during the study period, of whom 700 patients (1.5%) had the diagnosis of C-CTO. The mean age of M-TEER patients was not significantly different between the two groups (76 vs. 75 years, p=0.11), however the CTO cohort had more males (66.72% vs. 53.41%, p=0.002), and more comorbisities as; previous myocardial infarction (32.14% vs.15.66%, p= 0.0003), peripheral artery disease (32.1% vs. 22.67%, p=0.03), complicated hypertension (80% vs. 68.6%, p= 0.001) and renal failure (52.8% vs. 37.3%, p= 0.0007). A higher percentage of M-TEER procedures in patients with CTO were performed in elective setting (62.8% vs. 46.5%, p=0.0008). M-TEER among patients with CTO was associated with a higher incidence of net all periprocedural cardiac complications (21.4% vs. 13.4%, p=0.04) with however similar in-hospital mortality between both groups (3.57% vs. 2.35%, p=0.46). The results remained consistent on adjusted analysis; M-TEER-CTO cohort had higher odds of net all cardiac periprocedural complications (aOR 1.83 ,95% CI (1.17-2.84), p=0.007) with no difference in in-hospital mortality (aOR 1.54, 95 %CI (0.52-4.56), p =0.43). M-TEER utilization in CTO patients was associated with higher costs ($270,385 vs. $237,190 p=0.05), however, no significant difference in mean length of stay (5.8 vs. 4.8 days, p 0.17)Conclusions:In patient undergoing M-TEER, concomitant C-CTO increases the risk of net all cardiac periprocedural complications with no significant increase in mortality