Risultati per: Progressi nel trattamento della psoriasi: review

Circulation, Volume 150, Issue Suppl_1, Page A4144031-A4144031, November 12, 2024. Introduction:Catheter ablation (CA) therapy is well established therapy for different types of atrial fibrillation, with some concern including post ablation pericarditis which increases the morbidity and mortality. Colchicine, known for its anti-inflammatory effects has shown to be effective in reducing the incidence of perioperative AF after cardiac surgery. However, the efficacy of post ablation colchicine is still debatable. We aimed to establish evidence on the use of colchicine for preventing pericarditis after catheter ablation.Methods:We searched PubMed, Scopus, WOS and Cochrane until May 2024 for relevant studies that assessed colchicine after CA. The primary outcome of interest was the incidence of pericarditis following AF. Other secondary outcomes were the incidence of pericardial effusion, GI adverse events, and hospitalization rates.Results:A total of nine studies were included with a total of 2795 patients aged 66 to 69.4 years, Colchicine administration before catheter ablation showed a significant decrease in the occurrence of clinical pericarditis after AF ablation compared to placebo (RR=0.38; 95% CI: 0.27, 0.53). Moreover, colchicine was favored to decrease the incidence of AF recurrence rate at 3, 6, and 12 months with the following values, respectively (RR=0.58, 95% CI: 0.42 to 0.80, 0.69, 95% CI: 0.5 to 0.97, and 0.76, 95% CI: 0.66 to 0.87). On the other hand, colchicine was associated with a significant increase in GI adverse events (RR= 2.62, 95% CI: 1.57, 4.37).Conclusion:Colchicine was found to be a promising intervention for reducing the incidence of pericarditis following atrial fibrillation ablation. Despite some contradictory data about gastrointestinal side effects, cautious dosage measures, such as weight-adjusted doses, may improve tolerability while maintaining efficacy in reducing post-ablation events.

Circulation, Volume 150, Issue Suppl_1, Page A4139706-A4139706, November 12, 2024. Background and Aim:For metastatic castrate-resistant prostate cancer (mCRPC), the European Association of Urology recommends multiple therapies as first-line. However, these recommendations do not account for additional cardiotoxicity of the therapies for prior stages of the disease, such as the metastatic hormone-sensitive prostate cancer (mHSPC) stage. We seek to adjudicate the cardiotoxicities of first-line mCRPC therapies assuming history of mHSPC treatment based on the five International Cardio-Oncology Society (IC-OS) cardiotoxicity domains: heart failure, myocarditis, vascular toxicity, hypertension, and arrhythmias.Methods:Ovid Medline, Elsevier Embase, and the Cochrane Library were searched for randomized clinical trials (RCTs) of mCRPC and mHSPC patients from inception until January 2024. Studies reporting at least one first-line therapy and effect size of at least one cardiotoxicity domain were included. Network meta-analyses with indirect treatment comparison with multivariate multi-level analysis were performed for each cardiotoxicity domain to estimate relative risk (RR) with 95% confidence intervals (CI) for mCRPC and mHSPC therapies. A Bayesian model was then constructed using the mHSPC network as a prior for informing the RRs and 95% CIs of mCRPC first-line therapies.Results:Network meta-analyses of mHSPC treatment cardiotoxicity, mCRPC treatment cardiotoxicity assuming no treatment history, and mCRPC treatment cardiotoxicity assuming prior mHSPC treatment are provided in Images 1-2. We did not find any studies assessing myocarditis. For patients with mHSPC treatment history, olaparib (OLA) plus androgen deprivation therapy (ADT) plus abiraterone with prednisone (AA+P) decreased hypertensive risk relative to ADT+AA+P (RR 0.20, 95% CI 0.16-0.26).Conclusion:OLA may offer a protective antihypertensive effect when superimposed on ADT+AA+P for mCRPC treatment after prior androgen deprivation from mHSPC therapy.

Circulation, Volume 150, Issue Suppl_1, Page A4146837-A4146837, November 12, 2024. Background:Bruton Tyrosine Kinase inhibitors (BTKi) are targeted therapies that have demonstrated promising results in the treatment of hematological malignancies; however, they are associated with adverse cardiac events. Direct comparisons of the cardiotoxic profile between old-generation and new-generation BTKi are limited.Research Question:Are novel BTKi associated with a lower incidence of cardiac adverse events compared with ibrutinib?Aims:We aimed to perform a systematic review and meta-analysis of cardiac events from studies comparing new-generation BTKi versus ibrutinib in patients with hematological malignancies.Methods:We searched PubMed, Embase, and Cochrane Library for studies comparing any new-generation BTKi with ibrutinib in patients with hematological malignancies. Outcomes included 1) risk of cardiac events; 2) atrial fibrillation (AF); 3) rate of treatment discontinuations due to AF; and 4) hypertension. We pooled risk ratios (RR) with 95% confidence intervals (CI). Statistical analysis was performed using R software 4.3.1, under a random-effects model. Heterogeneity was assessed using I2statistics.Results:We included four randomized controlled trials with 1905 patients, of whom 957 (50%) received new-generation BTKi. Age ranged from 28 to 90 years, with 1337 (70%) male patients. Prior lines of systemic therapy ranged from none to 12. Overall cardiac events were significantly lower in patients who received novel BTKi compared with those who received ibrutinib (RR 0.75; 95% CI 0.63 to 0.90; p=0.002; I2=0%; Fig.1A). New-generation BTKis were associated with a statistically significant reduction in the risk of AF (RR 0.48; 95% 0.35 to 0.64; p

Circulation, Volume 150, Issue Suppl_1, Page A4117397-A4117397, November 12, 2024. Background:Diabetes Mellitus (DM) significantly impacts global health through cardiovascular and renal complications. SGLT2 inhibitors (SGLT2i) have emerged as beneficial for cardiovascular outcomes in Type 2 Diabetes Mellitus (T2DM). However, only few studies report outcomes related to renal function.Aim:This study aims to analyse the efficacy of SGLT2i on cardiorenal outcomes in adults with T2DM.Methods:A systematic review and meta-analysis, following PRISMA-2020 guidelines was conducted. We evaluated the efficacy of SGLT2i on cardiorenal outcomes in adults with T2DM. We included randomized controlled trials(RCT) and post hoc analyses that compared SGLT2i with placebo, focusing on cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, heart failure hospitalizations, and renal outcomes such as the progression of albuminuria and the decline of eGFR. Dichotomous outcomes were calculated using relative risk (RR) with 95% confidence interval (CI).Results:We identified 2753 studies, registered in PubMed(=788), Embase(n=538), WoS(n=369), Scopus(n=908), and Cochrane(n=150). We included 11 studies 6 RCT and 7 Post Hoc Analysis, sample size of 50.653 patients. Meta-analysis showed that SGLT2i improve cardiovascular outcomes such as reduced cardiovascular mortality (RR 0.84 [95% CI 0.73–0.97] p=0.02), heart failure hospitalizations (RR 0.65 [95%CI 0.54–0.77]p

Circulation, Volume 150, Issue Suppl_1, Page A4147450-A4147450, November 12, 2024. Introduction:Conventional thermal ablation (TA) has been used to treat paroxysmal atrial fibrillation (AF) refractory to medical therapy. Despite this, the energy used to isolate the pulmonary veins can extend through the myocardium and adjacent tissues, causing complications. Pulsed-field ablation (PFA), which delivers high-voltage electric fields in microseconds, may limit this tissue damage outside the myocardium. However, the efficacy of pulsed-field ablation compared with conventional thermal ablation in this population remains uncertain.Research Question:What are the benefits of using PFA in patients with paroxysmal atrial fibrillation compared to ATObjective:The purpose of this study was to evaluate the efficacies and safety of PFA compared with TA in patients with paroxysmal atrial fibrillationMethods:PubMed, Embase, and Cochrane Central databases were systematically searched in May 2024 for studies that directly compared PFA and TA for the treatment of paroxysmal AF and reported safety or efficacy outcomes. We evaluated the following outcomes at ≥12 months of follow-up: (1) stroke, (2) arrhythmia recurrence and (3) redo procedures. Heterogeneity was assessed with I2statistics. Rstudio was used for statistical analysis.Results:We included 1,677 patients (734 male – 43.76%) from three studies. PFA was used to treat AF in 519 (30.94%) patients and thermal energy was used in 1.158 (69.05%) patients. There was no significant incidence of stroke after performing PFA compared to TA in the pooled population (OR 1.31; 95%CI 0.11-15.59; P = 0.832). As compared to thermal ablation, PFA demonstrated similar freedom from recurrent atrial fibrillation (OR 0.77; 95%CI 0.51- 1.18; P = 0.237). There were no statistically significant differences in redo procedures (OR 0.61; 95%CI 0.36- 1.03; P = 0.066).Conclusion:Compared to TA, PFA did not show significant differences in the occurrence of stroke after the procedure or in the recurrence of paroxysmal atrial fibrillation. Additionally, it was not associated with a lower rate of redo procedures.

Circulation, Volume 150, Issue Suppl_1, Page A4144910-A4144910, November 12, 2024. Introduction:Traditional ST-elevation criteria do not exhibit high sensitivity for acute occlusion detection, with many total occlusions presenting as NSTEMI, often resulting in worse outcomes. AI-based EKG interpretation may improve the identification of occlusion myocardial infarction (OMI). This study evaluates a novel AI-EKG device’s accuracy and clinical outcomes for detecting OMI in suspected ACS patients.Methods:Adult patients who underwent coronary angiogram (CAG) at Mount Sinai Morningside Hospital for unstable angina, NSTEMI, or STEMI between January 1 and December 31, 2022, were included. The AI model (PMCardio) analyzed all pre-CAG ECGs. Inclusion criteria: suspected ACS at the emergency department, no outside hospital transfers, and available peak troponin levels. OMI was defined as a culprit vessel with TIMI 0-2 flow or TIMI 3 flow and peak cTnI > 10.0 ng/mL. Primary outcome: AI EKG model’s sensitivity and specificity for predicting OMI on CAG. Secondary outcomes: F1 score, predictive values, AI OMI prediction of inpatient mortality, reduced ejection fraction at 1 year, unplanned readmissions, and STEMI criteria performance.Results:Of 257 patients, 222 met the inclusion criteria: 72 STEMI (32%), 145 NSTEMI (65%), and 5 unstable angina (3%). Confirmed angiographic OMI: 60 (83%) STEMI and 51 (35%) NSTEMI patients. AI model sensitivity was 81.08%, specificity 87.39%, AUROC 0.8423, F1 score 0.8372, PPV 86.54%, NPV 82.20%. Odds ratio of 12.44 (1.56 – 98.98) for AI-detected OMI patients, unplanned readmissions (OR 1.15 [0.53 – 2.51]), and reduced ejection fraction at 1 year (OR 0.24 [0.26 -2 .16]). Traditional STEMI criteria sensitivity for OMI was 54.05%, and specificity 89.29%. The AI model was 100% sensitive for STEMI-OMI and correctly reclassified 8 out of 12 false positive STEMI patients as NOMI.Conclusion:The AI model nearly doubles the sensitivity of traditional STEMI criteria for OMI, enabling more accurate and earlier detection. Further studies are needed to determine if earlier OMI detection with AI improves clinical outcomes. The AI’s high specificity in detecting STEMI-OMI may also reduce false positive catheterization lab activations while ensuring no true positive STEMI OMI cases are missed.

Circulation, Volume 150, Issue Suppl_1, Page A4144289-A4144289, November 12, 2024. Introduction:Atrial fibrillation is the most encountered arrhythmia in clinical settings, with an estimate of 6 million cases in the United States. A growing amount of evidence has been supporting the role of left atrial appendage in left sided atrial fibrillation with conflict results. We aim in this study to provide a more in-depth guide for optimal left sided atrial fibrillation ablation strategy.Methods:We searched PubMed, Web of Science, Cochrane and Scopus for published studies until May 2024. We included relevant studies that compared the left atrial appendage electrical isolation versus the standard ablation and reported our outcomes of interest. The main outcomes of the study were the recurrence of atrial arrhythmia and the incidence of stroke or transient ischemic attack during the follow-up period. Data were pooled as Mean difference (MD) or risk ratio (RR) with their 95% CI using a fixed-effect model.Results:Eleven studies with 3040 patients were included in the final analysis. Left atrial appendage electrical isolation was associated with a significant reduction in atrial arrhythmia recurrence compared to the standard ablation alone (OR: 0.41, 95% CI: 0.35 to 0.48). However, it was also associated with a significant increase in stroke or transient ischemic attack incidence (OR: 1.48, 95% CI: 1.09 to 3.12).Conclusion:Left atrial appendage electrical isolation led to a significantly lower atrial arrhythmia recurrence, but this was achieved with an increased risk of stroke and transient ischemic attack incidence during the follow-up period.

Circulation, Volume 150, Issue Suppl_1, Page A4125157-A4125157, November 12, 2024. Background:Recent evidence suggests that sodium-glucose cotransporter-2 inhibitors (SGLT2-i) may improve outcomes in patients with coronary artery disease (CAD) through various physiological pathways. However, their impact on patients who have undergone percutaneous coronary intervention (PCI) is not well established. This meta-analysis aims to evaluate the effectiveness of additive SGLT2 inhibitors versus standard therapy alone in patients with CAD after PCI.Methods:A systematic search was conducted across the Medline, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) and observational studies that compared the addition of SGLT2 inhibitors to standard therapy versus standard therapy alone in patients post-PCI. The outcomes analyzed were Major Adverse Cardiovascular Events (MACE), all-cause death, cardiovascular death, recurrent acute myocardial infarction (AMI), nonfatal stroke, revascularization, and hospitalization for heart failure (HF).Results:A total of 7 studies met the inclusion criteria, encompassing a total of 11,800 individuals (5,004 on SGLT2-i and 6,796 non-SGLT2-i; mean age of 62.7 years; 28% women; 95% diabetic patients). SGLT2 inhibitors significantly reduced the risk of all-cause mortality (RR 0.6, 95% CI: 0.5-0.72, p

Circulation, Volume 150, Issue Suppl_1, Page A4145344-A4145344, November 12, 2024. Background:The prevalence of atrial fibrillation (AF) increases with age. However, limited data are available regarding the prognostic implications of rhythm versus rate control strategies for AF in the elderly. We have conducted this systematic review and meta-analysis to explore the effects of early rhythm control strategy in elderly (age >65 years) AF patients.Methods:A literature search was conducted for relevant studies using MEDLINE (PubMed), EMBASE, Scopus, Cochrane CENTRAL, Conference Abstracts, and ClinicalTrials.com through March 19th, 2024. The primary outcome was all-cause mortality. Meta-analysis was performed using the random-effects Mantel-Haenszel method, and pooled risk ratios (RRs) along with 95% confidence intervals (CIs) were calculated using RevMan 5.4.Results:Six studies with 39,181 patients (rhythm control 11,446; rate control 27,735) were included. The mean age was 79 years in the rhythm control and 81 years in the rate control cohort. Females were 52% in rhythm control and 55% in the rate control group. The rhythm control strategy was associated with a lower risk of stroke (RR 0.73, 95%CI 0.66-0.81, p

Circulation, Volume 150, Issue Suppl_1, Page A4145568-A4145568, November 12, 2024. Background:Embolic stroke of undetermined source (ESUS) is a nonlacunar ischemic stroke with no clear cause, having a 4%-5% annual recurrence rate. The potential benefits of direct oral anticoagulants (DOACs) relative to aspirin in patients with ESUS remain unclear.Objective:We aimed to perform a systematic review and meta-analysis to determine the efficacy of the DOACs in secondary prevention for patients with ESUS compared with aspirin.Methods:MEDLINE, Embase, Cochrane, and ClinicalTrias.gov were searched for RCTs comparing DOACs versus aspirin for secondary stroke prevention after ESUS. We performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Review (PRISMA) and Cochrane guidelines. Statistical analysis was performed using R software 4.3.2. A random-effects model was employed to measure mean differences and hazard ratios (HR) with 95% confidence intervals (CI).Results:We included 4 RCTs comprising 13,970 patients. The median age was 67 years (IQR 65.5-68.2), 61% were male, 76% had hypertension, and 51% had diabetes. DOACs were administered to 50% of the participants. No significant difference was found between groups for stroke recurrence [RR 0.95 (95% CI 0.8-1.11) p=0.52; I2=0%]. Death from any cause [HR 1.11 (95% CI 0.87-1.42) p=0.38; I2=0%], cardiovascular death [HR 1.08 (95% CI 0.61-1.94) p=0.77; I2=18%] and myocardial infarction [HR 0.92 (95% CI 0.54-1.54) p=0.76; I2=16%] were also similar between groups. However, there was a significant increase in clinically relevant non-major bleeding for patients treated with DOACs [HR 1.53 (95% CI 1.22-1.92) p

Circulation, Volume 150, Issue Suppl_1, Page A4146871-A4146871, November 12, 2024. Background:Transcatheter mitral valve replacement (TMVR) has emerged as a promising alternative to conventional redo-surgical intervention in patients presenting with mitral valve prosthesis failure. We conducted a meta-analysis to delineate efficacy and safety of transcatheter mitral valve replacement (TMVR), encompassing both valve-in-valve (ViV) and valve-in-ring (ViR) procedures, compared to redo-surgical mitral valve replacement (SMVR).Aim:The primary aim of our meta-analysis was to investigate the early clinical outcomes following either ViV/ViR TMVR or SMVR.Methods:PubMed/MEDLINE, Cochrane Library, and clinicaltrials.gov were systematically searched according to predefined inclusion and exclusion criteria. Several efficacy and safety outcomes were pooled and reported as risk ratios (RRs) with 95% confidence intervals (CIs).Results:Fourteen retrospective cohort studies (patients=18,519) were evaluated in this analysis. Compared with redo-SMVR for mitral valve prosthesis failure, TMVR exhibited lower in-hospital mortality (OR=0.69; 95% CI 0.56–0.86; p

Circulation, Volume 150, Issue Suppl_1, Page A4134873-A4134873, November 12, 2024. Background:Hypertriglyceridemia, a common lipid disorder linked to increased risks of cardiovascular diseases and metabolic syndrome, remains a global health challenge. Traditional treatments, though widely used, often have limited efficacy and adverse effects. Olezarsen, a novel antisense oligonucleotide, targets apolipoprotein C-III and shows promise in significantly reducing triglyceride levels.Aim:To conduct a meta-analysis comparing Olezarsen with placebo in patients with hypertriglyceridemia.Methods:We performed an extensive literature search of PubMed, EMBASE, and Cochrane Library databases up to May 2024 to identify studies comparing Olezarsen and placebo in patients with hypertriglyceridemia, irrespective of comorbid cardiovascular disease. Effect estimates were pooled using a random-effects model and reported as risk ratios (RR) for dichotomous outcomes and standard mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CIs) for each.Results:Three randomized controlled trials (RCTs) with a total of 334 participants were included. Olezarsen significantly reduced triglyceride levels at 6 months (SMD: -1.69; 95% CI -2.22 to -1.17; P < 0.00001;Figure) and 12 months (SMD: -1.64; 95% CI -2.22 to -1.07; P < 0.00001;Figure). VLDL levels also decreased at 6 months (SMD: -1.95; 95% CI -2.38 to -1.51; P < 0.00001) and 12 months (SMD: -0.83; 95% CI -1.13 to -0.53; P < 0.00001). Lipid profile improvements included reductions in total cholesterol, non-HDL cholesterol, and apoB levels, with increases in HDL cholesterol and apoA-1. Adverse events were comparable between Olezarsen and placebo, although serious adverse events were significantly higher in the Olezarsen group (RR: 2.55; 95% CI 1.17 to 5.58; p = 0.02).Conclusion:Olezarsen demonstrates significant efficacy in reducing triglyceride and VLDL levels while improving overall lipid profiles in hypertriglyceridemia patients. Despite higher rates of serious adverse events, its overall safety profile remains acceptable.

Circulation, Volume 150, Issue Suppl_1, Page A4147438-A4147438, November 12, 2024. Introduction/Background:Right ventricular failure (RVF) is the inability of the RV to adequately perfuse pulmonary circulation and sufficiently fill the LV; it increases morbidity, mortality, and length of hospital stay. In critically ill patients, three main etiologies of RV failure are excessive preload, excessive afterload, and insufficient myocardial contractility. In addition to medical management, some patients at risk for refractory cardiogenic shock may require temporary mechanical circulatory support (TMCS).Research Questions/Hypotheses:The Impella RP flex (Abiomed, Danvers, MA) has provided an option for percutaneous RV support through the internal jugular vein and allows for early rehabilitation of complex cardiac patients.Methods/Approach:Consecutive cases at our center using the Impella RP flex were evaluated for hemodynamics and quality measures.Research/Data:Thirteen patients received RP flex support: 3 patients with pulmonary hypertension during mitral valve repair or replacement, 4 patients for prophylactic placement pre-LVAD, 3 patients with intraoperative placement during CABG, 2 patients with acute myocardial infarction, and 1 patient for salvage therapy. The average length of stay for our patients was 30.23 days; average duration of Impella support was 4.46 days.Twelve patients required inotropic support with milrinone and 91.7% received epinephrine. Of the 12 patients who required vasodilators, 100% received inhaled nitric oxide and 50% received sildenafil. Four patients required sildenafil at the time of discharge (36.4%).Internal jugular vein cannulation and intracorporeal support allows capable patients to participate in physical therapy early in the recovery process. Of our cohort, 30.77% of patients were successfully assisted out of bed to chair and 15.38% ambulated with assistance. All patients had pre- and post-creatinine levels collected, with an average pre-implantation creatinine level of 1.48 and post-explantation level of 1.76. The average pre-implantation lactic acid level was 4.75; only 11 patients had post-explantation lactic acid measurements collected, which averaged 3. Eleven patients were successfully discharged and no patients required home inotropes.Conclusions:The RP flex allows for RV unloading for patients requiring TMCS; it is best used early or prophylactically for patients who are otherwise high-risk for complications or who may require high-dose pressors and prolonged ICU level of care.

Circulation, Volume 150, Issue Suppl_1, Page A4135178-A4135178, November 12, 2024. Background:Tricuspid regurgitation (TR) is no longer considered forgotten. Transcatheter tricuspid valve repair/replacement (TVRR) has become widely accepted as gauged by clinical outcomes. FDA approved two tricuspid valve devices for the purpose of improving quality of life and not necessarily to improve TR severity. We aim to support evidence-based use of TVRR, by summarizing the latest evidence on the clinical effectiveness in terms of post-procedural length of hospital stay, readmissions for heart failure and procedure success if an Intracardiac device is present.Methods:We searched Pubmed, Embase and Cochrane databases and performed a meta-analysis of the included cohort studies using a fixed-effects model. Studies were excluded if they did not present an outcome in each intervention group or did not have enough information required for continuous data comparison. We performed a meta-analysis of hazard ratio (HR) for two outcomes and odds ratio (OR) for one outcome using the random effects model to remove inconsistency and compared the results with fixed effects model. The compared findings of both methods were similar. The variables used for analysis were number of events in exposure group and total amount of events. All data analyses were performed using MedCalc® Statistical Software version 22.023.Results:Of 161 potentially relevant studies, 8 retrospective studies with a total of 1,717 patients were included in the meta-analysis. Procedure (TVRR) success was associated with fewer readmissions for heart failure in all three studies included in the analysis of pooled HR (HR = 0.46, 95% confidence interval [CI]: 0.33 – 0.63, p

Circulation, Volume 150, Issue Suppl_1, Page A4144238-A4144238, November 12, 2024. Background and Aims:High neutrophil counts, an easily accessible inflammation biomarker, has been linked to risk of cardiovascular disease (CVD), and mortality, but with mixed results. We aimed to summarize published associations between neutrophil counts with risk of CVD and all-cause and cause-specific mortality among generally healthy populations.Methods:We searched Medline, Embase, Web of Science, and Cochrane CENTRAL databases until March 2024. Random effect meta-analysis was conducted to calculate pooled risk ratios (RRs) and 95% confidence intervals (95%CIs) for highest versus lowest categories of neutrophil counts in relation to risk of CVD and all-cause and cause-specific mortality among general healthy populations. Linear and non-linear dose-response analyses were also performed.Results:Our systematic review and meta-analysis included 22 prospective cohort studies. During a median/mean follow-up period of 3.8 to 18.3 years, 73,934 CVD events and 80,317 deaths occurred among 1,962,191 participants. Higher neutrophil counts were associated with a higher risk of CVD incidence and all-cause mortality, CVD mortality, and non-CVD mortality. The pooled RRs (95%CIs) of highest versus lowest categories of neutrophil counts were 1.32 (1.20, 1.45) for risk of CVD incidence, 1.61 (1.23, 2.11) for all-cause mortality, 1.71 (1.45, 2.01) for CVD mortality, and 1.68 (1.17, 2.40) for non-CVD mortality. Further, per 1 SD increase of neutrophil counts was associated with a 4%, 12%, 14%, and 24% higher risk for CVD events, all-cause mortality, CVD mortality, and non-CVD mortality, respectively. In addition, a secondary dose-response analysis revealed a non-linear association of neutrophil counts with risk of CVD events (Pnon-linearity= 0.01), but a linear positive association with CVD mortality (Pnon-linearity= 0.87). The pooled associations of neutrophil counts with CVD risk, and all-cause, CVD, and non-CVD mortality did not differ by age, sex, region, and follow-up duration.Conclusions:Higher neutrophil counts were associated with a substantially higher risk of CVD events and all-cause, CVD, and non-CVD mortality.

Circulation, Volume 150, Issue Suppl_1, Page A4141922-A4141922, November 12, 2024. Advances in modeling methodology and increased democratization of software led to rapid increase in novel prediction models. In clinical research, these models proclaim novel predictors, promise superior accuracy and meaningful improvements in patient outcomes. Developing an accurate prediction model requires rigorous methodology with great attention to study design and conduct. Failure to adhere leads to prediction bias and may result in harmful decisions.We conducted a systematic review of research articles in heart failure listed in PubMed 2018 – 2023 and presented by their authors as developing prediction models, either diagnostic or prognostic. The study variables were selected based on PROBAST and TRIPOD (Table 1). These were summarized and the study conducts were evaluated against the gold standard of prediction modeling per PROBAST and TRIPOD. For each study, we calculated the optimal sample size, i.e. the minimal size required for at least 5% prediction accuracy and 90% shrinkage in parameters. Sentiment analysis was performed to estimate the prevalence of promotional language in the abstract corpus.From 6,429 studies, 212 studies were presented as developing prediction models. Of those, 83 (39%) were truly about developing prediction models (TPM) and the rest were impostors, i.e. inferential models misrepresented as predictive.Mostly, TPMs were prognostic, modeled binary outcomes, and employed machine-learning methods (Table 1). Commonly, essential data volume summaries were lacking and handling of missing data was inadequate. The deficit in the number of samples in model training was 1499 (-316, 3866) samples with 52(71%) studies below the optimal size.Model validation or testing was not performed in 30% of the studies. Discrimination statistics were reported often in testing but not in validation. The calibration was rarely assessed at either phase. Thirty (36%) studies had enough information to implement risk score calculations. The sentiment analysis showed increased use of hype words in both TPMs and impostors relative to 2020-rates in Millar et al (2022).Most TPM studies exhibit poor design, insufficient sample size, mishandling of missing data, and inadequate model evaluation. These deficiencies result in biased risk estimates, degrade the performance in external data limiting generalizability and clinical utility of the developed models. Excessive use of hype can be misleading and may impede objective evaluation by the readers.