Management of Post-transplant Infections in Collaborating Hospitals (MATCH) Programme: a prospective cohort of all transplant recipients at Copenhagen University Hospital–Rigshospitalet, Denmark

Purpose
The Management of Post-transplant Infections in Collaborating Hospitals (MATCH) programme, initiated in 2011 and still ongoing, was created to 1) optimise the implementation of existing preventive strategies against viral infections in solid organ transplant (SOT) recipients and allogenic haematopoietic stem-cell transplant (HSCT) recipients and 2) advance research in the field of transplantation by collecting data from a multitude of sources.

Participants
All SOT and HSCT recipients at Copenhagen University Hospital, Rigshospitalet, are followed in MATCH. By February 2021, a total of 1192 HSCT recipients and 2039 SOT recipients have been included. Participants are followed life long. An automated electronic data capture system retrieves prospective data from nationwide registries. Data from the years prior to transplantation are also collected.

Findings to date
Data entries before and after transplantation include the following: biochemistry: 13 995 222 and 26 127 817; microbiology, cultures: 242 023 and 410 558; other microbiological analyses: 265 007 and 566 402; and pathology: 170 884 and 200 394. There are genomic data on 2431 transplant recipients, whole blood biobank samples from 1003 transplant recipients and faeces biobank samples from 207 HSCT recipients. Clinical data collected in MATCH have contributed to 50 scientific papers published in peer-reviewed journals and have demonstrated success in reducing cytomegalovirus disease in SOT recipients. The programme has established international collaborations with the Swiss Transplant Cohort Study and the lung transplant cohort at Toronto General Hospital.

Future plans
Enrolment into MATCH is ongoing with no planned end date for enrolment or follow-up. MATCH will continue to provide high-quality data on transplant recipients and expand and strengthen international collaborations.

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FUPEC study, a prospective open-cohort on severe pre-eclampsia and cardiovascular risk factors based in the Netherlands

Purpose
The FUPEC (Follow-Up Pre-EClampsia) study aims to investigate the presence and development of cardiovascular risk factors, cardiovascular disease, as well as cardiovascular health following a pregnancy complicated by severe pre-eclampsia.

Participants
The FUPEC study is an open-cohort study conducted within routine care at the FUPEC clinic at Erasmus Medical Center in the Netherlands. This clinic is specifically designed for the cardiovascular follow-up of patients who have experienced severe pre-eclampsia. Women with a history of severe pre-eclampsia are invited to the FUPEC clinic at 6 weeks, 3 months, 1 year and every 2 years thereafter postpartum until they are 50 years of age. Clinical and biochemical data are routinely collected, encompassing pregnancy characteristics and outcomes, anthropometric measurements, cardiovascular risk factors, cardiovascular health scores, carotid intima-media thickness—including vascular age and ambulatory blood pressure measurements. Additionally, blood and urine samples are collected and stored in a biobank.

Findings to date
The first patient was enrolled in April 2011. As of March 2024, a total number of 1268 women have been enrolled in the FUPEC study, with an annual enrolment rate of 100–150 new patients. At inclusion, women had a median age of 33.5 years (IQR 30.1–37.9). At their first FUPEC visit, women were a median of 4.9 months (1.9–29.4) after delivery. At the first visit, the median body mass index was 25.7 (IQR 23.0–29.9) kg/m2, 23.4% of participants were using antihypertensive medication and 6.4% were smoking. Preliminary analyses of 24-hour blood pressure patterns and carotid intima-media thickness have previously been conducted on a subset of the cohort, with details provided in the ‘Findings to Date’ section.

Future plans
The FUPEC cohort serves as a robust clinical data source and biobank that can be used for future studies and collaborative research answering, for example, questions on the aetiology, risk factors and short-term and long-term complications of pregnancies complicated by severe pre-eclampsia. Since the FUPEC cohort is integrated with routine care, there is no strict completion of data collection, allowing for flexible data acquisition.

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Abstract 4146315: Complications Associated With the 4798 Attain Stability Active Fixation Coronary Sinus Lead: Insights from the MAUDE Registry

Circulation, Volume 150, Issue Suppl_1, Page A4146315-A4146315, November 12, 2024. Background:The Attain Stability Quad 4798 [Medtronic, Minneapolis, MN] lead was recently developed with a mechanism for active fixation into the venous wall, allowing for precise and secure placement in coronary venous branches. However, real-world data regarding complication rates are limited.Research Question:What are the real-world complications of the Medtronic 4798 lead?Goals:We reviewed the United States Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database for adverse events associated with the 4798 lead.Methods:We reviewed the MAUDE database on November 15, 2023, for all reported complications due to the 4798 lead from January 1, 2018 – a year before the lead was approved by the FDA – to the present.Results:A total of 2011 reports of adverse events occurred in mostly males (67.9%) patients with an average age of 70.86±12.1 years. Leads were used most frequently in 2023 (32.3%) for initial use (65.5%) but events commonly occurred intra-procedurally (73.7%). Device malfunction occurred in 43.4% of cases and included but was not limited to adverse events without an identified device problem (33.9%), device dislodgment (24.1%), infection (21.1%), and failure to capture (18.4%). In several cases, the guidewire was stuck (10.7%), or lead dislodgement (27.9%) occurred, resulting in direct helix damage (10.1%). Malfunctions resulted in injury and death in 55.8% and 1.1% of cases, respectively.Conclusions:The use of an active fixation CS lead has been associated with a significant incidence of intraprocedural helix mechanism malfunction. Further real-world surveillance and registry data can help clarify the true incidence of lead failure.

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Abstract 4140154: Highly Sensitized Heart Transplant Recipients Who Have Undergone Pre-Transplant Desensitization Therapies Demonstrate Acceptable Medium-Term Outcomes

Circulation, Volume 150, Issue Suppl_1, Page A4140154-A4140154, November 12, 2024. Introduction/Research Question:Allosensitization, the presence of circulating anti-HLA antibodies, is a barrier in heart transplantation (HT), restricting the donor pool size, and leading to increased waitlist mortality and rejection risk post-HT. Desensitization therapies can be used to broaden the donor pool in highly sensitized patients, defined as pre-HT calculated panel reactive antibodies (cPRA)≥50%, for antibodies with mean fluorescence intensity (MFI) >10,000. There is paucity of data on longer-term outcomes in such high-immunological risk patients.Methods:Sensitized patients with pre-HT cPRA >50%, who were treated with desensitization and then received HT between 2011-2022 at Cedars-Sinai Medical Center were included. Desensitization therapies included bortezomib, rituximab, tocilizumab, obinutuzumab, intravenous immunoglobulin (IVIG), and plasmapheresis. cPRA, donor-specific antibody (DSA) levels, and post-HT clinical outcomes were assessed up to 5-year follow-up, loss to follow-up, or death.Results:40 patients were analyzed. 77.5% of patients were female, and all had at least 1 risk factor for sensitization. cPRA decreased from 84.5±13.5% at baseline to 74.1±22.4% after completion of desensitization therapy, prior to transplant (p=0.005). Mean follow-up time post-HT was 4.3±2.9 years. 45.0% of patients had antibody-mediated rejection (AMR), 12.5% had CAV. Overall survival was 94.9%, 92.1%, and 87.5% at 1, 3, and 5 years respectively. All patients except 1 had normal left ventricular function at last follow-up. 72.5% of patients were transplanted in the presence of DSA, and 60.0% underwent post-HT induction with eculizumab in addition to antithymocyte globulin (ATG)/IVIG, while the remaining received ATG/IVIG alone. Among HT recipients with pre-formed DSA, 41.4% had high-level DSA (MFI > 10,000) at time of HT. At 6-12 months post-HT, only 17.2% had high-level DSA, and 41.4% had resolution of DSA.Conclusion:Highly sensitized HT candidates who underwent pre-HT desensitization had comparable survival and CAV rates as compared to the general HT population reported in the literature. However, sensitized patients experienced higher rates of AMR which were not associated with graft dysfunction or mortality.

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Abstract 4142783: Association of Body Roundness Index and Cardiovascular Disease among US Adults

Circulation, Volume 150, Issue Suppl_1, Page A4142783-A4142783, November 12, 2024. Background:Obesity is one of the major risk factors for cardiovascular disease (CVD), body roundness index (BRI) is more comprehensive in assessing fat distribution than traditional measurements. However, evidence regarding the association between BRI and the risk of CVD was limited, particularly in American people. This current study aimed to investigate the association between BRI and the risk of CVD among US adults.Hypothesis:We hypothesized that higher BRI was associated with a higher risk of CVD.Methods:A total of 21,852 participants were included in the National Health and Nutrition Examination Surveys from 6 survey cycles (2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014, 2015-2016 and 2017-2018). Weighted multivariate logistic regression was carried out to examine the relationship between BRI and the risk of CVD. Restricted cubic spline (RCS) curves were employed to analyze nonlinear relationships.Results:Among 21,852 US adults, the mean (SD) age was 47.5 (17.3) years, 10,669 (48.8%) were female, and 1886 were diagnosed with CVD. In the weighted multi-variable logistic regression model with adjustment for demographics, lifestyle, economic status and dietary factors, higher BRI was significantly associated with a substantially higher risk of CVD. Compared with the participants in the lowest quartile of BRI, those in the highest quartile of BRI had a higher CVD, with OR and 95%CI of 2.47 (1.92-3.17). Furthermore, the RCS demonstrated a linear dose-response relationship between BRI and CVD (Pnon-linearity=0.29).Conclusion:This national cohort study found a higher BRI was associated with a higher risk of CVD among US adults. BRI may provide a new perspective for CVD prevention among adults.

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Abstract 4135617: Large Scale Proteomics Identifies Circulating Biomarkers Relating Atrial Fibrillation to Heart Failure: the Atherosclerosis Risk in Communities Study

Circulation, Volume 150, Issue Suppl_1, Page A4135617-A4135617, November 12, 2024. Introduction:There is a bidirectional relationship between atrial fibrillation (AF) and heart failure (HF) risk. Data regarding shared and unique pathways underlying each are limited.Aims:Identify plasma proteins associated with both incident AF and HF and determine the extent to which associations with one outcome are conditional on interval occurrence of the other outcome.Methods:Among participants in the community-based Atherosclerosis Risk in Communities study free of HF and AF at study visit 5 (2011-2013), we measured 4,955 plasma proteins (SomaScan aptamer-affinity assay). We performed parallel analyses of individual protein associations with incident HF and AF using multivariable Cox regression adjusted for demographic and clinical covariates at Bonferroni significance. We then repeated the analysis for each outcome in models censoring participants with interval occurrence of the other outcome (i.e. incident AF censoring for interval HF, and vice versa). We tested associations of AF-related proteins with echocardiographic and Zio patch measures at Visit 5.Results:Among 4,118 participants included, mean age was 75±5 years, 60% were female, and 18% reported Black race. We identified 83 proteins associated with incident HF (n=355 incident events at 7 [IQR 6-8] year follow-up) and 24 with incident AF (n=517 incident events at 8 [7-9] years), of which 10 were associated with both. In models of incident HF censoring for interval AF, 63 (76%) proteins remained significantly associated with HF. In contrast, in the analysis of incident AF censoring for interval HF, only 4 (17%) proteins remained associated with AF, of which 3 were also associated with HF risk (Figure). These 4 AF-related proteins were associated with measures of LV diastolic function (LA volume, E/e’. average), LV mass index, LA function (LA reservoir, LA contraction), and supraventricular ectopy density (all p

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Abstract 4145845: The Impacts of Albumin Levels on Clinical Outcomes in Patients in the Coronary Care Unit

Circulation, Volume 150, Issue Suppl_1, Page A4145845-A4145845, November 12, 2024. Background:Hypoalbuminemia is frequently observed in critically ill patients, yet its significance regarding short-term mortality among these patients remains uncertain. We aimed to investigate the impact of albumin levels and their changes on clinical outcomes among patients who were admitted to intensive care units due to cardiac causes.Methods:This is a retrospective, single-center, cohort study. Consecutive patients admitted to coronary care unit (CCU) were enrolled between January 2011 and December 2020. Serum albumin levels were obtained upon CCU admission and tracked for changes. Clinical outcomes were defined as 30-day mortality.Results:A total of 4,004 patients were enrolled. Among them, 1,129 (28.2%) had acute coronary syndrome, 1,915 (47.8%) had coronary artery disease, 1,039 (25.9%) had arrhythmia, and 1,825 (45.6%) had heart failure. There were 643 deaths and 3,361 survivors within 30 days. When comparing to survivors, those who died within 30 days had lower initial albumin levels (3.2 ± 0.9 vs. 3.4 ± 0.8, P < 0.001) and albumin level reduction (-0.1 ± 0.9 vs. 0.0 ± 0.9, P = 0.005). Cox regression multivariate analysis indicated that higher initial albumin levels (HR, 0.638; 95% CI, 0.538 – 0.756, P < 0.001) and increase in albumin levels (HR, 0.638; 95% CI, 0.541 – 0.752, P < 0.001) were independently associated with lower 30-day mortality rates.Conclusions:Higher initial albumin levels and increase in albumin levels were linked to better clinical outcomes in patients admitted to CCU.

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Abstract 4148070: Clonal Hematopoeisis of Indeterminate Potential and Risk of Autopsy-defined Sudden Cardiac Death

Circulation, Volume 150, Issue Suppl_1, Page A4148070-A4148070, November 12, 2024. Introduction:Clonal hematopoiesis of indeterminate potential (CHIP) has been associated with an increased risk of coronary artery disease (CAD) and cardiovascular (CV) mortality. Whether CHIP may affect myocardium beyond promoting CAD, or its potential association with sudden cardiac death (SCD), the most feared manifestation of CV disease, is unknown.Research Questions/Hypothesis:We hypothesize that CHIP-mutant macrophages infiltrate the myocardium and are associated with autopsy-defined arrhythmic death.Goals/Aims:(1) determine rate of CHIP at time of death in an unselected, countywide study of all incident sudden deaths; (2) evaluate whether CHIP-mutant macrophages infiltrate into myocardium; and (3) evaluate potential association of CHIP with autopsy-confirmed arrhythmic causes among countywide sudden deathsMethods/Approach:We used autopsy to adjudicate arrhythmic from non-arrhythmic (PE, stroke, overdose, tamponade) causes in 1,148 sudden deaths and 141 trauma control deaths in San Francisco County from 2011-23. DNA was extracted from frozen blood samples collected at time of death from 399 consented cases. Sequencing of 22 CHIP-associated genes was performed to ~2000x mean target coverage. All pathogenic/likely pathogenic CHIP variants at >2% variant allele frequency (VAF) were considered CHIP+. DNA was then isolated from left ventricular (LV) tissue sampled at autopsy in all CHIP+ blood cases and sequenced as above.Results:Of 399 consented cases, 70 blood samples (17.5%) were CHIP+ (range 2%-39.6%; mean age 70.6 years vs. 58.1 years for CHIP-). The most frequent mutant genes were DNMT3A, TET2, and ASXL1. Proportion of arrhythmic causes among sudden deaths was similar for CHIP+ vs. CHIP- cases (36 of 70 [52%] vs. 171 of 329 [51%]). Sequencing of available LV tissue from 61 CHIP+ blood cases revealed 67% (n=41) harbored the same CHIP mutation identified in blood at >0.2% VAF (range 0.2%-4.3%). Proportion of arrhythmic causes among sudden deaths was significantly higher in cases where both blood and LV were CHIP+ (24 of 41 [58.5%] vs. 5 of 19 [26.3%] CHIP+ blood/CHIP- LV, p=0.02).Conclusions:Prevalence of CHIP positivity at sudden death is similar to published studies and correlated with age. CHIP+ status in myocardial tissue but not peripheral blood was associated with arrhythmic causes of sudden death, suggesting a direct tissue effect of CHIP-mutant macrophages.

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Abstract 4144585: Association of renal function with mortality and heart failure hospitalization rates after Transcatheter Mitral Valve Edge to Edge Repair

Circulation, Volume 150, Issue Suppl_1, Page A4144585-A4144585, November 12, 2024. Background:Transcatheter edge to edge repair (TEER) is an established treatment for patients with symptomatic severe functional MR on optimal medical therapy or severe symptomatic primary MR and high surgical risk. Renal dysfunction is associated with adverse outcomes but the threshold at which risks rise are uncertain.AimTo determine the association of estimated glomerular filtration rate (eGFR) with adverse outcomes in patients undergoing TEER for severe symptomatic mitral regurgitation (MR) in Ontario, Canada.Methods:This was a population-based retrospective cohort study using linked administrative datasets of patients who underwent TEER in Ontario, Canada, between 2011 and 2023. The key exposure was eGFR, which was modeled using restricted cubic splines. Outcomes were 1-year mortality, cardiovascular mortality (CV) and heart failure hospitalization (HF). Cause-specific hazards regression was used to model the association between eGFR and outcomes, utilizing eGFR 30ml/min/1.73m2 as the reference value.Results:We studied 2076 patients, of whom 294 (14.2%) had eGFR

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Abstract 4146319: Racial Disparities and Driving Factors in the AHA's Life's Essential 8 Among American Adults: Insights from NHANES 2011-2020

Circulation, Volume 150, Issue Suppl_1, Page A4146319-A4146319, November 12, 2024. Backgrounds:The AHA introduced “Life’s Essential 8” (LE8) in 2022 as a comprehensive metric to facilitate detailed tracking and management of cardiovascular health (CVH) at the population level. However, the racial/ethnic differences in LE8, how these differences change over time, and the driving factors of LE8 in each subgroup remain unclear.Methods:We utilized data from the continuous NHANES from 2011 to 2020 to examine racial disparities and driving factors in the AHA’s LE8 among American adults. To ensure national representation, appropriate weights were applied. Survey-weighted and age-standardized trends in LE8 scores by racial and ethnic groups were analyzed using generalized linear models (GLMs). To identify the driving factors—specific metrics influencing the LE8 overall score—we calculated z-scores for all components. Then we used the spider chart to visualize the driving factors.Results:A total of 13,915 adult were included, of whom the mean age is 47.9 ± 0.37 years, 6,612 (47.55%) were women, 3,485 (14.63%) were Hispanics, 5,335 (69.74%) were non-Hispanic Whites, 3,464 (10.82%) were non-Hispanic Blacks, and 1,631 (4.81%) were Asians. From 2011-2020, the LE8 scores did not change significantly overall and across all racial groups (all p-trend > 0.10,Figure 1). During the study period, racial/ethnic disparity persisted with Asian adults consistently having the highest LE8 scores and Black adults having the lowest scores. Notably, the lower LE8 scores in Black adults were primarily driven by lower scores of diet, blood pressure, and sleep health, whereas the higher LE8 scores in Asian adults primarily driven by higher scores of diet, nicotine exposure, and BMI. The LE8 scores in White adults were primarily driven by blood glucose and physical activity and the LE8 score in Hispanic adults were primarily driven by blood pressure (Figure 2-A). In 2017-2020 (Figure 2-B), Black adults had the lowest scores for all LE8 components, except for blood lipids. In contrast, Asian adults had the highest scores in diet, physical activity, nicotine exposure, and sleep health. Throughout the study period, the racial/ethnic disparity in LE8 score did not change significantly (all p >0.10).Conclusion:We found persistent racial disparities in cardiovascular health among U.S. adults, with Black adults having the lowest LE8 scores in almost all components. The driving factors for LE8 scores varied by racial subgroups, emphasizing the need for targeted interventions.

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Abstract 4120534: Long-Term Outcomes After Medication, Coronary Stenting or Surgery for Men and Women With Three-Vessel Coronary Disease

Circulation, Volume 150, Issue Suppl_1, Page A4120534-A4120534, November 12, 2024. Background:Sex is a vital prognostic factor in patients with coronary heart disease, however, the data on sex-treatment interaction among real-world patients with three-vessel coronary disease (TVD) are limited.Objectives:This study aimed to investigate the long-term outcomes after medication therapy (MT), percutaneous coronary intervention (PCI), and coronary artery bypass grafting surgery (CABG) according to sex in patients with TVD.Methods:Consecutive 8943 patients with TVD [2421 (27.1%) MT, 3825 (42.8%) PCI, and 2697 (30.2%) CABG] were enrolled from April 2004 to February 2011 at Fu Wai Hospital. The primary endpoint was cardiac death and major adverse cardiovascular and cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction (MI), stroke or repeat revascularization. The secondary endpoints were the components of MACCE.Results:Among 8943 TVD patients, 7122 (79.6%) were men and 1821 (20.4%) were women. While the number of women undergoing PCI was comparable to men, women opted for more MT and fewer CABG (Figure 1). During a median 6.6-year follow-up, CABG showed a lower risk of MACCE compared to PCI, with a similar treatment effect for women and men (female HR: 0.76; 95% CI: 0.60 to 0.97; male HR: 0.61, 95% CI: 0.55 to 0.69; p for interaction=0.222) (Figure 2 and Figure 3). CABG also showed lower risks of all-cause death, MI, and repeat revascularization, and a higher risk of stroke, which had no significant interaction with sex. PCI, compared to MT, was associated with lower risks of MACCE, all-cause death, and stroke and a higher risk of MI and repeat revascularization, without significant gender disparities. CABG versus MT was associated with lower risks of MACCE, all-cause death, MI and repeat revascularization and a higher risk of stroke, with a similar treatment effect for female and male patients (Figure 3).Conclusion:There was no significant sex differences in the risks of long-term outcomes of PCI vs. CABG, PCI vs. MT, and CABG vs. MT in real-world TVD patients.

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Abstract 4141703: Body Mass Index and Waist-Hip Ratio — Risk Factors for Aortic Valve Disease: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation, Volume 150, Issue Suppl_1, Page A4141703-A4141703, November 12, 2024. Introduction:Aortic valve disease (AVD) is common among older adults. Although body mass index (BMI) has been reported to be a risk factor for aortic valve stenosis (AS), it is unknown whether BMI or waist-hip ratio (WHR) is associated with aortic valve insufficiency (AI). Additionally, it is unknown whether there is a stronger association between BMI/WHR with AVD among Blacks compared with Whites.Hypothesis:Higher BMI/WHR is associated with an increased incidence of AS and AI in the ARIC study, a community-based cohort of Black and White adults.Methods:The analysis involved ARIC participants with echocardiograms at visit 5 (2011-2013) and visit 7 (2018-2019). BMI and WHR were ascertained from visit 5 and standardized by standard deviation (SD). Incident AVD between visits 5 and 7 was classified as aortic valve sclerosis, isolated AI, and AS regardless of AI, according to AHA guidelines. A multinomial regression model adjusted for multiple potential confounding variables, including age, sex, race, education, smoking status, drinking, diabetes, systolic blood pressure, antihypertensive medications, coronary heart disease, HDL-C LDL-C, and eGFR.Results:Of 1931 participants included in the analysis (mean age of 73.5 ± 4.1 years, 59.7% female, and 23.2% Black), 572 participants (29.6%) had incident AVD (n = 345 sclerosis, 159 pure AI, 68 AS). Higher BMI at visit 5 was associated with a greater incidence of aortic valve sclerosis (OR: 1.34 per 1-SD (5.78 kg/m2), 95% CI: 1.15-1.56) and AS (OR: 1.32, 95% CI: 1.00-1.74) but was not associated with AI. Higher WHR was associated positively with aortic valve sclerosis (OR: 1.17 per 1-SD (0.08 unit), 95% CI: 1.00-1.36), AS (OR: 1.44, 95% CI: 1.12-1.86), and also AI (OR: 1.24, 95% CI: 1.01-1.53) (Table 1). There were no race-by-obesity interactions in all analyses.Conclusion:A higher BMI is associated with a higher risk of AS, but not AI. By contrast, increased WHR is a risk factor for both AS and AI. Further research is warranted to replicate this novel finding and define potential underlying mechanisms.

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Abstract 4142044: The prognostic value of criteria for diagnosis of Immune Checkpoint Inhibitor Related Myocarditis: a comparison of the Bonaca et.al. criteria and European Society of Cardiology (ESC)-International Cardio-Oncology Society (ICOS) guidelines

Circulation, Volume 150, Issue Suppl_1, Page A4142044-A4142044, November 12, 2024. Background:Myocarditis is a dreaded complication of immune-checkpoint inhibitor (ICI) therapy but challenging to diagnose. There are no published data comparing the two leading diagnostic criteria for ICI myocarditis and their association with cardiovascular events.Methods:Patients treated with ICI and cardiac Troponin (cTnT) measurements thereafter at a tertiary institution from 2011 to 2022 were identified. Charts were reviewed for ICI-related myocarditis according to the Bonaca et. al criteria and the ESC-ICOS guideline criteria. A propensity matched control group was identified of patients treated with ICI but without developing myocarditis. Medical records were reviewed for baseline characteristics and long-term outcomes, including cardiac death, MACE (myocardial infarction, TIA/stroke, new heart failure diagnosis), and arrhythmias (V-tach, A-fib, complete heart block).Results:A total of 59 patients were identified as having a diagnosis of ICI-related myocarditis per Bonaca criteria (16 having definite, 13 probable and 30 possible myocarditis), and 47 met the ESC-ICOS guideline criteria. Mean age was 73.1±10.2 years, 60.1% were male, median follow-up was 2.5 years. ICI-related myocarditis as diagnosed by both diagnostic criteria had prognostic value for cardiac death (HR 13.94, 95%CI 1.84-105.64, p=0.011 per Bonaca, HR 6.22, 95%CI 1.77-21.88, p=0.004 per ESC-ICOS), MACE, (HR 3.17, 95%CI 1.34-7.47, p=0.008 per Bonaca, HR 2.97, 95%CI 1.37-6.45, p=0.006 per ESC-ICOS), and arrhythmias (HR 1.93, 95%CI 1.10-3.38, p=0.022 per Bonaca, HR 2.09, 95%CI 1.21-3.60, p

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Abstract 4139027: Glucagon-like Peptide-1 Receptor Agonist Use and Cardiac Outcomes in Patients with End Stage Kidney Disease

Circulation, Volume 150, Issue Suppl_1, Page A4139027-A4139027, November 12, 2024. Background:Despite the substantial cardiovascular (CV) risk experienced by people with end-stage kidney disease (ESKD), few medications improve CV outcomes in this population. Glucagon-like peptide-1 receptor agonists (GLP1RA) improve CV outcomes in CKD, and several are safe for use in ESKD, but no outcomes trial has studied GLP1RA in ESKD. We hypothesize that CV outcomes will be improved in people with ESKD and type 2 diabetes mellitus (T2D) who initiated GLP1RA as compared to dipeptidyl peptidase-4 inhibitors (DPP4i), an agent that comparably lowers glucose but has not been shown to improve CV outcomes.Methods:We analyzed electronic health records, claims, and Medicare Part D data from the United States Renal Data System between 2011 and 2021 to identify new users of GLP1RA or DPP4i after initiation of dialysis. We restricted the cohort to patients with T2D based on ICD codes and used 2:1 propensity score matching of DPP4i to GLP1RA users based on 22 covariates. The primary outcome was a modified major adverse cardiovascular events (MACE) composite of myocardial infarction (MI), stroke, and all-cause mortality. We applied cause-specific Cox proportional hazard models and Fine-Gray subdistribution hazard models to account for competing risks to analyze the primary outcome and its components.Results:The matched cohort included 10,196 DPP4i and 5976 GLP1RA initiators. The median age was 59 years, 49% were women, and 29% were of Black race. Compared to DPP4i initiators, GLP1RA initiators experienced a significantly lower risk of MACE (HR 0.92, 95% CI 0.89 – 0.96; Table). The risk of nonfatal MI or stroke was also significantly lower for GLP1RA initiators (HR 0.91, 95% CI 0.87-0.95). All-cause mortality did not differ based on cause-specific hazard modeling (HR 0.97, 95% CI 0.88-1.06), but was significant based on subdistribution hazard modeling (HR 0.86, 95% CI 0.79-0.94).Conclusion:Initiation of GLP1RA was associated with significantly lower risk of MACE in patients with T2D and ESKD compared to DPP4i.

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Abstract 4124182: Depression Symptomatology as Predictor of Incident Major Vascular Outcomes: Results from the Hispanic Community Health Study/Study of Latinos

Circulation, Volume 150, Issue Suppl_1, Page A4124182-A4124182, November 12, 2024. Background:Cardiovascular disease (CVD) has consistently been associated with higher depression symptoms and disorders. Conversely, fewer studies have shown that depression predicts risk of incident CVD and mortality.Objective:To examine the association of depression symptoms with incident major adverse cardiovascular events (MACE) among Hispanics/Latinos living in US.Methods:MACE-free Hispanic Community Health Study/Study of Latinos participants who underwent baseline evaluation between 2008-2011 (n=15,180) were included. MACE was defined as the composite of incident stroke, myocardial infarction (MI), or decompensated heart failure (HF), adjudicated using standard criteria up to year 2019. Depression symptoms were assessed at baseline with a 10-item Center for Epidemiological Studies Depression Scale (CES-D 10, range 0-30 points, 5 points increments), with clinically significant depression defined as CES-D 10 ≥10 points. The incident rate ratio (IRR) of MACE across CES-D 10 scores was determined using Poisson regression models, adjusting for baseline sociodemographic characteristics and Framingham Risk Scores. Analyses were weighted for complex survey design and non-response.Results:The mean age (95% CI) was 40.4 (39.9-40.9) years, and the mean CES-D 10 score was 8.4, 95%CI (7.2-9.5) for those with MACE vs 6.9, 95%CI (6.7-7.0) for individuals without MACE (p

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