Risultati per: Low Back Pain: raccomandazioni

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 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 A4143309-A4143309, November 12, 2024. Introduction:Very Low-Density Lipoproteins (VLDLs) serve as crucial transporters of triglycerides (TG) and cholesterol (C) from the liver to peripheral tissues, thereby contributing significantly to metabolic disorders such as atherosclerosis. Assessing the dynamic of VLDLs function involves evaluating its clearance from the bloodstream and distribution across various organs. Although VLDLs clearance has been extensively studied using dual radioactive isotopes3H and14C to label TG and C, this method requires large amounts of expensive tracers, compliance, and technical complexities. Our objective is to design and test a fluorescence-based approach to simultaneously assess and visualize VLDLs kinetics in a mouse model. Through this approach, we aim to unravel the intricate interplay between thermogenesis and VLDLs metabolism and provide insights into their collective influence on the progression of atherosclerosis in vivo.Method:Fluorescence-labeled VLDLs-like TG-rich nanoparticles (F-VLDLs) were prepared at various intensity by incorporating lissamine rhodamine-TG (Rhoda-TG, 1-5% of total TG) and TopFluor®-C (TopF-C, 20-80% of total C) to a mixture containing glycerol trioleate (7mg), egg yolk phosphatidylcholine (2.3mg), lysophosphatidylcholine (0.23mg), cholesteryl oleate (0.3mg), cholesterol (0.2mg) and kolliphor HS15 (2mg). B6 mice were fasted for 4 hours and injected via the tail vein with various intensities of F-VLDLs (2 mg TG/mouse). Blood samples were collected at 5-, 10- and 15-min post-injection to determine the plasma clearance of Rhoda-TG and TopF-C, after which mice were euthanized, and tissues harvested and imaged using an IVIS® spectrum in vivo imaging system.Results:The mean particle size of F-VLDLs was 80nm, with polydispersity index values of about 0.2. The Zeta potential of freshly made F-VLDLs was about −20 mV. In B6 mice, both Rhoda-TG and TopF-C signal intensities peaked at 5 minutes post-injection and subsequently declined in an intensity-dependent manner. In the collected tissues, Rhoda-TG and TopF-C intensity was as follows: liver >brown fat >subcutaneous white fat >visceral white fat.Conclusion:We have designed novel fluorescence-labeled VLDVs-like particles as a viable approach for quantifying and visualizing dynamic VLDLs-TG and C flux in vivo. This approach will facilitate the assessment of how various metabolic interventions impact VLDLs metabolism and atherosclerosis.

Circulation, Volume 150, Issue Suppl_1, Page A4128599-A4128599, November 12, 2024. Background:Inferior vena cava (IVC) filters are commonly implanted in patients with venous thromboembolism (VTE) who are unable to receive anticoagulation, to protect against clot migration to the heart. With prolonged implantation, IVC filters are associated with complications: device fracture, migration, penetration into adjacent organs and worsened VTE. Two Federal Drug Administration advisories and multi-society guidelines have emphasized the importance of timely retrieval but national retrieval rates remain low (= 18 years was identified in the 2016-2020 inpatient and outpatient 100% limited data set Medicare files using claims codes. Hospital information for the implanting facility was cross-linked from the American Hospital Association and Healthcare Cost Report Information System files, including identifying information, teaching status, census location, operating margin and % uncompensated care. IVC filter retrieval rates and time to retrieval from implantation was calculated. Bayesian hospital profiling methods were used to quantify 1-year retrieval rate for all U.S. facilities, adjusting for patient factors – demographics, diagnostic indications and comorbidities.Results:Among Medicare beneficiaries, there were 140,481 IVC Filter implantations across 2,850 facilities. Excluding patients who died within 90 days of implantation (25.7%), retrieval rates at 3 months, 1 year and anytime were 7.9%, 18.7% and 20.0% respectively. IVC Filter retrieval within 1 year varied significantly at the facility-level, from 0-100%.Focusing on facilities with at least 13 IVC filter implantations each year (top 25%ile volume), 1-year retrieval ranged from 0 to 74.5%. Higher 1-year retrieval was seen among higher implantation volume (12.4% bottom quartile, 20.5% top quartile), teaching (21.1% teaching vs. 16.9% nonteaching) and non-safety net (21.1% low uncompensated care, 15.0% high uncompensated care) hospitals. Retrieval rates did not vary significantly by hospital operating margin or rurality.Conclusion(s):There is low overall IVC filter retrieval in the United States with large underlying facility-level variation. Focused examination of high-performing facilities could yield insights on how to improve device retrieval nationally.

Circulation, Volume 150, Issue Suppl_1, Page A4138757-A4138757, November 12, 2024. Background:Optimizing lipid-lowering therapy (LLT) use is foundational to reduce atherosclerotic cardiovascular disease (ASCVD) risk, especially among patients who have already experienced an ASCVD event. This study aimed to evaluate the patterns of LLT intensification and LDL-C testing within 12 months following an ASCVD event in US patients.Methods:Adults who experienced an ASCVD event (acute coronary syndrome, coronary revascularization, stable angina, ischemic stroke, transient ischemic attack, or peripheral arterial disease) between January 1, 2016 and December 31, 2022 in the IQVIA Longitudinal Access and Adjudication Data were included. The first instance of LLT intensification after the event was defined as an increase from a low-moderate to high intensity statin, or the initiation of statins, ezetimibe, PCSK9i, or bempedoic acid in addition to a baseline LLT regimen that did not include these medications. Baseline medication use was defined during 6 months before the ASCVD event.Results:Among 6,028,573 patients who had an eligible ASCVD event (mean age: 63.6 years, 51.5% male), 53.9% were not taking any LLT and 43.2% were taking statins only (low-moderate intensity: 26.7%; high intensity: 16.4%) during baseline. Within 1, 3, and 12 months after the event, 16.3%, 21.3%, and 30.0% of patients intensified LLT, respectively. Among patients who intensified LLT within 12 months (n= 1,820,246), the most commonly observed intensification was from no LLT use at baseline to low-moderate (29.0%) or high-intensity statins (43.5%), followed by intensification from low-moderate to high-intensity statins (20.3%). LDL-C values at baseline were available in a subset of 10.7% of patients, with the median being 95 mg/dL (78.9% ≥70 mg/dL). LDL-C values were observed in 17.7% of patients within 12 months after the ASCVD event, with the median being 84 mg/dL (68.3% ≥70 mg/dL).Conclusions:Within 12 months after an ASCVD event, only about one-third of patients intensified LLT and two-thirds did not achieve guideline-recommended LDL-C levels. The results highlight a missed opportunity to reduce recurrent ASCVD events. Future effort is warranted to address the clinical inertia that may be contributing to this unmet need.

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 A4142690-A4142690, November 12, 2024. Introduction:Given the well-documented benefits of yoga on the cardiovascular system and improvement of exercise tolerance and quality of life, the American Heart Association recently recommended yoga as a safe and well-tolerated adjunctive therapy for patients with heart failure (HF). However, most studies have focused on testing yoga with moderate levels of physical movement, leaving a gap in our understanding of the potential benefits of yoga with low levels of physical movement.The specific aims of this pilot study were to explore the potential benefits of yoga with low levels of physical exercise movement, combined with longer deep breathing and meditation, on the psychological and physical health outcomes of patients with HF.Methods:Yoga was delivered using tele-health to patients with HF at home. Outpatients with HF (N=17) were randomly assigned to either the intervention (n=11) or the control (n=6) groups using a 2:1 ratio. The intervention group participated in twice-weekly live-streamed yoga sessions over a 12-week period led by nurse yoga instructors. Outcome measures included depressive symptoms (Patient Health Questionnaire-9), anxiety (Hospital Anxiety Index), sleep quality (Pittsburgh Sleep Quality Index), perceived control (Control Attitude Scale-Revised), sit-stand test, and length of activity measured with an ActiGraph watch worn for 7 days. Paired t-tests were conducted to examine the differences in outcomes over time.Results:For the intervention group, there was a significant improvement in global sleep quality (8.8 vs. 6.0, p= 0.4 respectively), with a significant increase in sleep duration (3.0 vs 0.6, P

Circulation, Volume 150, Issue Suppl_1, Page A4143426-A4143426, November 12, 2024. Background:Massage therapy has been increasingly recognized as a complementary intervention that can help alleviate pain and anxiety in various clinical settings. However, the efficacy of this intervention in patients undergoing cardiac surgeries remains unclear. This systematic review and meta-analysis aims to evaluate the existing evidence of massage therapy for postoperative pain in cardiac surgery patients.Methods:We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) analyzing the efficacy of massage therapy in patients undergoing cardiac surgeries. We pooled standardized mean differences (SMD) for continuous outcomes with 95% confidence intervals (CI) with a random-effects model. We utilized mean change from baseline values and post intervention values in separated plots to preserve the weighting of this meta-analysis. We performed a trial sequential analysis (TSA) to assess the random risk of postoperative pain with mean change from baseline values. We used R version 4.3.2 and TSA version 0.9.5.10 for statistical analyses.Results:Our meta-analysis included 12 RCTs comprising 1015 patients, of whom 484 (47.7%) were randomized to massage therapy. Compared with control, massage significant reduced postoperative pain based on mean change from baseline values (SMD -0.47; 95% CI: -0.73 to -0.21; p

Circulation, Volume 150, Issue Suppl_1, Page A4141419-A4141419, November 12, 2024. Introduction:Many patients with heart failure with preserved ejection fraction (HFpEF) have relatively low natriuretic peptide (NP) levels, often related to obesity. The predictors of mortality and hospitalization (CV outcomes) within HFpEF patients with low NT-proBNP levels remain unclear. In this study, we examined these predictors, comparing HFpEF with low NT-proBNP (HFpEF-LoBNP) and high NT-proBNP (HFpEF-HiBNP) groups.Methods:Patients from the Johns Hopkins HFpEF Clinic (July 2014 – May 2024) were categorized into HFpEF-LoBNP (

Circulation, Volume 150, Issue Suppl_1, Page A4124369-A4124369, November 12, 2024. Background:Several clinical trials have demonstrated non-inferiority of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS) and low to intermediate surgical risk. However, mid-term results are still contentious.Question:Is TAVR superior to SAVR in the mid-term in terms of mortality outcomes or adverse cardiovascular events?Methods:We searched Embase, Pubmed and Cochrane databases for RCTs that compared TAVR with SAVR in patients with symptomatic severe AS with a follow-up of at least 4 years. Outcomes of interest were all-cause mortality and disabling stroke.Results:We included six RCTs involving 6,444 patients with severe AS, of whom 3,282 (50.9%) underwent TAVR. There was no difference in mortality from all causes (RR 1.08; 95%CI 0.94-1.25; p=0.30; I2=45%) and disabling stroke (RR 0.95; 95%CI 0.75-1.21; p=0.67; I2=9%) between groups. In the subgroup analysis, 5-year mortality (RR 1.28; 95%CI 1.10-1.49; I2=0%) was higher in the TAVI group. The new pacemaker implantation rate was higher in the TAVI group (RR 2.22; 95%CI 1.42-3.45; p=0.0004 ; I2=91%). However, new atrial fibrillation rate was higher in the SAVR group (RR 0.42; 95%CI 0.37-0.49; p=0.00001; I2=62%).Conclusion:Mid-term mortality and disabling stroke of patients with severe AS treated with TAVR or SAVR were similar.

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 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 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 A4147691-A4147691, November 12, 2024. Background:The prognosis of patients with paradoxical low flow, low gradient, severe aortic stenosis (LFLGAS) is variable, necessitating improved risk stratification. Although this entity is more common in women, the impact of sex on outcomes remains unclear. Energy loss index (ELI), which accounts for aortic root size in estimating the severity of aortic valve stenosis, may enhance risk prediction in LFLGAS. This study aims to investigate sex-based ELI prognostic value in patients with paradoxical LFLGAS.Methods:This study analyzed clinical, echocardiographic, and outcome data collected in 294 patients with paradoxical LFLGAS, with AVA

Circulation, Volume 150, Issue Suppl_1, Page A4136136-A4136136, November 12, 2024. Background:The optimal clinical management and timing of intervention are less well defined in paradoxical low-flow, low-gradient severe aortic stenosis (PLFLG AS). Left ventricular global longitudinal strain (LV-GLS) has been shown to predict outcomes in high flow severe AS, but there is lack of data in patients with PLFLG AS. Given the exaggerated LV hypertrophy and remodeling pattern in PLFLG AS, LV-GLS may be a mechanistic imaging marker for worse outcomes.Hypothesis:In patients with PLFLG AS, LV-GLS is associated with adverse clinical outcomes by detecting subclinical myocardial fibrosis resulting from myocardial remodeling due to LV pressure overload.Methods:We examined patients with PLFLG AS defined as AVA

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