Risultati per: Low Back Pain: raccomandazioni

Circulation, Volume 150, Issue Suppl_1, Page A4140363-A4140363, November 12, 2024. Introduction:An estimated 23-85% of adults with chronic heart failure (HF) experience comorbid chronic pain, yet no comprehensive theoretical models have been developed or tested that completely capture the salient variables which affect pain. The aim of this study was to construct a preliminary theoretical model of pain in HF and evaluate the associations between identified variables in the model with pain presence.Methods:In this cross-sectional study, baseline data were obtained from the Cognitive Intervention to Improve Memory in Heart Failure Patients study (MEMOIR-HF) (n = 235). The Biopsychosocial Model of Chronic Pain was adapted for an HF-specific population. The dependent variable was pain presence (yes/no), which was measured using the Health Utilities Index Mark-3 (HUI-3). Independent variables were identified for the model using previous literature and univariate analyses comparing patients with vs. without pain in MEMOIR-HF. Logistic regression was used to test for differences between patients with pain present and not present.Results:Demographics were 45.5% men, 54.5% women, 86.4% White, 13.6% Black, mean age 66.39 (SD 12.04) years. Of 235 patients, 159 (67.66%) reported pain on the HUI-3 items.The variables that were included following univariate analysis and literature review were age, self-reported race and gender, comorbid conditions, sleep disturbances, HF severity, B-type natriuretic peptide, brain-derived neurotrophic factor, body mass index, and depression. Patients with pain were more likely to have worse HF severity (NYHA Class II or III compared with Class I) (Class II: OR 5.09 [1.71 – 15.08], p = .003, Class III: 5.05 [1.73 – 14.71], p = .003), more severe depression (OR 1.14 [1.06 – 1.23], p = .001), and worsened daytime sleepiness (OR 0.90 [0.83 – 0.98], p = .017), see Table 1.Conclusions:We believe this study is one of the first to construct and test a preliminary comprehensive model of pain in HF. Complete characterization of pain in HF is needed before treatments can be improved. Future research is needed to explore variables that were not available in the MEMOIR-HF dataset. More robust pain measures are needed to adequately test all variables.

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 A4143480-A4143480, November 12, 2024. Background:Social isolation and loneliness have been found to be associated with many chronic diseases including cardiovascular disease (CVD) and those with both CVD and social isolation may have a worse prognosis. Cardiac rehabilitation (CR) has been shown to improve outcomes following cardiac events. We hypothesize that CR may have beneficial impacts on quality of life, social support, depression, and pain rated via Dartmouth COOP Charts (COOP).Research Question:What is the impact of cardiac rehabilitation on quality of life, perceived social support, depression, and chronic pain?Methods:Data from Penn State Hershey Medical Center’s CR program was extracted pre-and post-CR, including Body Mass Index (BMI), Metabolic Equivalents (METs) performed, and components of COOP (social support, quality of life (QoL), depression, pain), with impairment rated from 1 to 5, with 5 representing worse impairment. Analysis was performed with paired t-test. Sensitivity analysis was performed including only high-risk participants (pre-rehab COOP score ≥ 3) for social support, depression, and pain as well as BMI ≥ 30 kg/m2.Results:A total of 743 participants were included with a mean (±SD) age of 66.3 (±11.3) years. CR improved METs performed, QoL, depression, and pain (Table 1). When analyzing all participants, CR did not improve social support or BMI. However, when only analyzing those with higher social support needs at baseline (n= 78) as well as elevated BMI ≥30kg/m2, CR was associated with improved social support and BMI. QoL, depression and pain also improved among the higher risk groups (Table 2).Conclusion:CR programs have demonstrated benefits for cardiovascular mortality and may have powerful impacts on patients’ mental health, pain, and social support. Further studies are needed to further elucidate the role CR may have in improving outcomes in participants with social isolation and loneliness.

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 A4141389-A4141389, November 12, 2024. Introduction:Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent form of heart failure (HF) in the US today. Our prior work revealed low albumin at first hospitalization for HF exacerbation with underlying HFpEF to be an independent predictor of all-cause mortality in a small cohort of patients. We now sought to confirm our earlier findings across a larger and more diverse patient population.Methods:Seven thousand, eight hundred and forty patients had a first admission to Mayo Clinic for HF exacerbation with an echo-confirmed left ventricular ejection fraction >50% between 2010 and 2020. Patient baseline demographics, co-morbidities, admission laboratory values, echocardiographic parameters, discharge medications, and outcomes were obtained from chart abstraction. To validate our previous model, patients were grouped based on the number of risk factors as previously defined: age >80 years, serum albumin level

Circulation, Volume 150, Issue Suppl_1, Page A4139036-A4139036, November 12, 2024. Background:Patients with low-flow low-gradient (LFLG) aortic stenosis (AS) are at risk of worse outcomes following transcatheter aortic valve replacement (TAVR). Flow is known to improve after TAVR, however the clinical and echocardiographic characteristics correlating with flow improvement in patients with LFLG AS are still unclear.Hypothesis:Some baseline and discharge clinical and echocardiographic characteristics correlate with flow improvement in patients with LFLG AS post-TAVR.Aims:The present study sought to explore the clinical and echocardiographic characteristics correlating with flow improvement in patients with LFLG AS post-TAVR.Methods:This is a retrospective cohort of patients >18 years of age who underwent TAVR at Cleveland Clinic between 2016 and 2020. Only patients with aortic valve (AV) area

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 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 A4130314-A4130314, November 12, 2024. Background:Diets high in sodium and low in potassium are associated with increased blood pressure level but associations with cardiovascular disease (CVD) remain controversial. Few studies have evaluated this relationship among Hispanic/Latino adults.Objective:To assess whether dietary sodium and potassium are associated with incident CVD among diverse US Hispanics/Latino adults.Methods:The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a cohort of 16,415 self-identifying Hispanic/Latino adults aged 18-74 four US urban communities in 2008-2011 (visit 1; V1). V1 included a comprehensive examination with in-person measurement of health information and interviewer administered questionnaires. Dietary sodium (mg/day) and potassium (mg/day) intakes were assessed from the average of two 24-hour dietary recall surveys administered by bilingual registered dietitians. CVD events occurring from V1 through 2019 were adjudicated by an expert panel of clinicians. We used Poisson regression to determine the association (incidence rate ratio, IRR) between sodium, potassium, and the sodium-to-potassium ratio, with CVD, using time to CVD as an offset. Models accounted for HCHS/SOL complex survey design and were adjusted for demographic, including Hispanic/Latino background, socioeconomic, and behavioral factors along with energy consumption, body mass index, cholesterol, and family history of CVD.Results:Among 15,291 participants without self-reported CVD at V1, mean age was 40 years, with 53% female. Mean daily intakes of sodium and potassium were 3,040 mg/day and 2,422 mg/day, respectively. Molar ratio of sodium to potassium was 1.33. Over 9.7 years of follow-up, there were 311 CVD events (2.0 events per 1,000 person years, 95% CI: 1.6, 2.5). In adjusted models, nutrients were associated with increased risk of CVD: by 17% for each 1g/day increment of sodium (IRR: 1.17, 95% CI: 1.03, 1.33); by 29% for each 1g/day decrement of potassium (IRR: 1.29, 95% CI: 1.01, 1.64); and by 112% for each 0.5 molar increment of sodium to potassium ratio (IRR: 2.12, 95% CI: 1.13, 4.11).Conclusions:In a large diverse sample of Hispanic/Latino adults, high dietary sodium and low dietary potassium were independently associated with an increased risk of CVD. Results underscore the importance of intensifying public health interventions to improve nutrient quality, by reducing dietary sodium and increasing dietary potassium consumption as a means of preventing CVD.

Circulation, Volume 150, Issue Suppl_1, Page A4127919-A4127919, November 12, 2024. Intro:DSP-encoded desmoplakin is implicated in a distinct form of arrhythmic cardiomyopathy (ACM), often involving the LV and characterized by myocardial inflammation. Conventional ACM diagnostic criteria has poor sensitivity forDSP-associated ACM, thus highlighting the need to identify the full spectrum of phenotypic risk associated with disease-associatedDSPvariants.Objective:To analyze the genotypic and phenotypic spectrum ofDSP-mediated disease at a large population level.Methods:UK Biobank participants with exome sequencing (ES) were included. Variants were filtered by gene evidence category, yielding 3 groups: predicted deleterious (pDel); subset with predicted loss of function (LOF); and ultra-filtered subset by ClinVar 2* pathogenic/likely pathogenic (P/LP). Phenotypic penetrance was analyzed withDSP-neg individuals as control. Variant location analysis assessed LOFs by susceptibility to nonsense mediated decay region and missenses by amino acid sequence to identify mutational hotspots where P/LPs localize.Results:Out of 200,580 with ES, 1407DSPcarriers had pDel, 168 with LOF, and 44 with ClinVar 2* P/LP.DSPcarriers had higher burden of myocarditis, cardiomyopathy (CM), and heart failure. A progressive enrichment in myocarditis and CM was observed by more stringent variant filtering inDSPcarriers compared to control. A higher proportion ofDSPcarriers had myocarditis – 0.28% (4) of the pDels, 1.8% (3) of LOFs, and 4.5% (2) compared to control 0.07% (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 A4146434-A4146434, November 12, 2024. Background:PET/CT stress test may be performed to risk stratify patients including those without known coronary artery disease (CAD) who may be at risk for short-term adverse cardiac events. In patients with low- to moderate (LTM) risk for short-term MACE and without a known history of CAD, a small percentage of these patients will undergo a coronary angiogram within 90-days, of which some will be diagnosed with high-grade stenosis. The purpose of this study is to determine factors associated with this approach and findings.Methods:Patients without a history of known CAD (n=43,271) undergoing a PET/CT from 2018-2023 at Intermountain Health, with scan interpreted clinically as LTM short-term risk for adverse cardiac events, and ischemic burden 70% stenosis in any vessel), an a priori list of clinical data and PET/CT results were examined.Results:Within 90 days of the LTM risk PET/CT, 3,163 (8.2%) had a coronary angiogram. Of these, 806 (25.5% of angiograms and 2.1% of total LTM) had high-grade CAD. The PET/CT ancillary findings were associated with the largest odds of performing an angiogram and the presence of high-grade CAD (Tables). Factors most likely to be associated with performing an angiogram were an ischemic burden of 7.5-10% (adjusted-OR [adj. OR]=11.54), coronary artery calcification (CAC) score of >300 (adj.-OR =1.62), and myocardial blood flow (MBF) of MBF 2.3). Other clinical parameters associated, after adjustment, with an angiogram were age, male sex, hypertension, elevated troponin, and inpatient status. Many of the same factors were found to be associated with the identification of high-grade CAD. However, being an inpatient was associated with increased odds of angiogram but a decrease in odds of high-grade CAD.Conclusions:In patients without a known history of CAD who underwent PET/CT clinically adjudicated as LTM short-term risk and ischemic burden

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 A4134364-A4134364, November 12, 2024. Introduction:Inclisiran, an siRNA, targeting PCSK9 mRNA, reduces LDL-c levels. In SIRIUS in silico trial (NCT05974345), inclisiran was predicted to lower cardiovascular (CV) events in virtual patients with atherosclerotic cardiovascular disease (ASCVD).Research question:This analysis predicted the potential efficacy of inclisiran on CV outcomes in virtual patients with or without prior ischemic stroke (IS).Methods:The SIRIUS trial was conducted using a calibrated and validated knowledge-based mechanistic computational model of ASCVD applied to a virtual population with LDL-C ≥ 70 mg/dL. Each virtual patient was its own control. SIRIUS compared the efficacy of inclisiran vs placebo on top of High Intensity (HI) statin with or without ezetimibe on 3-Point-MACE defined as a composite of time to first occurrence of CV death, nonfatal myocardial infarction (MI) or nonfatal IS over 5 years in patients with or without prior IS. Occurrence of fatal and non-fatal (IS) was also individually assessed in time-to-first-event analyses.Results:Among 204,691 virtual SIRIUS ASCVD patients, 39 371 (19%) had prior IS. At 5 years, the predicted mean percentage reduction in LDL-C with inclisiran as compared to placebo was –49.17% and –49.88% in patients with or without prior IS respectively. Patients with prior IS were at higher risk of 3P-MACE than patients without IS both with placebo and inclisiran (17.01% vs 14.41% with placebo and 13.44% vs 10.83% with inclisiran). However, the predicted rate of 3P-MACE in the inclisiran arm was consistently lower than in the placebo arm for both prior IS and no prior IS (HR 0.78 medium uncertainty and 0.74 low uncertainty respectively). Compared to placebo, inclisiran was also predicted to consistently reduce fatal and non-fatal IS in patients with or without prior IS (5.45% vs 7.22%; HR: 0.75 medium uncertainty and 1.87% vs 2.54%; HR: 0.73 medium uncertainty respectively).Conclusion:SIRIUS provides insights into the potential efficacy of inclisiran on CV events suggesting a substantial 3P-MACE and fatal and non-fatal IS reduction in ASCVD patients including those with prior IS, several years before the availability of results from ongoing outcomes trials (ORION-4, VICTORION-2P).

Circulation, Volume 150, Issue Suppl_1, Page A4134796-A4134796, November 12, 2024. Introduction:Over 6 million patients (pts) present to US emergency departments annually with chest pain (CP), of which the majority are found to have no serious disease. Evaluation of these pts results in substantial costs for unnecessary hospitalization and extensive testing. We evaluated the utility of early discharge of selected low-risk (LR) CP pts from a chest pain unit (CPU) in which no predischarge testing or risk scores were used.Methods:This retrospective study analyzed 1,037 consecutive LR CP pts from a prospectively recorded database. LR was based on normal examination, stable hemodynamics, normal electrocardiograms (ECG), and negative cardiac troponin I, without pre-discharge functional or anatomic cardiac testing or risk scores. We assessed demographics, comorbidities, medications, and major cardiac events at 30 d and 6 mos post-discharge.Results:The study group of 1037 pts comprised 26% of the 4010 pts admitted to the CPU during the study interval from May 2005 to March 2015. Mean patient age was 55 yrs, 56% (n=575) were women, and comorbid conditions were frequent: hypertension (64.1%), dyslipidemia (46.1%), diabetes (25.7%), documented coronary artery disease (19.3%), previous revascularization (20.6%), previous myocardial infarction (10.1%). Length of stay (LOS) in the CPU to discharge was 10.4 hrs. Women received more discharge cardiac medications than men: antiplatelet agents, statins, beta blockers, ACE inhibitors, angiotensin II blockers, calcium channel blockers, and nitrates (p=0.0002 – 0.04).Follow-up (F/U) at 30 d was 91% (n=948) complete and revealed 0.3% (n=3) cardiac deaths, 0.6% (n=6) acute coronary syndromes (ACS), and 6.2% (n= 64) receiving revascularization. F/U at 6 mos was 90% (n=936) complete and total cumulative cardiac deaths were 0.9% (n=9), 0.7% (n=7) ACS and 6.3% (n=65) revascularization.Discussion:Cardiac events at both 30 d and 6 mos were very low and did not differ in men and women (P=0.8). LOS in CPU was minimized and patient safety was maintained. These selected LR pts remained at reduced risk for cardiac events despite a high rate of comorbidities. Early discharge of selected LR CP pts based on history, examination, ECG, and biomarker evaluation was safe and effective.Conclusion:This approach in selected LR pts has the potential to reduce unnecessary diagnostic testing and CPU LOS. This strategy could lead to substantial savings in healthcare costs without compromising patient safety.

Circulation, Volume 150, Issue Suppl_1, Page A4138733-A4138733, November 12, 2024. Introduction:Identifying low-voltage areas (LVAs) within left atrium (LA) is crucial for predicting atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). Animal studies have shown that the parasympathetic neurotransmitter vasoactive intestinal peptide (VIP) affects atrial electrophysiological remodeling.Hypothesis:Thus, we hypothesized that elevated serum VIP levels might contribute to the development of LVAs and that serum VIP concentrations could serve as a biomarker for LVA presence in AF patients.Aims:The aim of this study is to investigate the relationship between the blood levels of VIP and the presence of LVAs in AF patients with electroanatomical mapping (EAM).Methods:We conducted an observational, prospective cross-sectional study on AF patients undergoing PVI between 2021 and 2023. Blood samples for VIP were collected before atrial septal puncture, and EAM was performed using CARTO 3® before PVI. VIP concentrations were measured using an enzyme-linked immunosorbent assay kit. Patients were divided into two groups based on LVA presence (≥5% or