Search Results for: Atlante della salute mentale 2011

Circulation, Volume 150, Issue Suppl_1, Page A4145866-A4145866, November 12, 2024. Introduction:Aging is associated with changes in left ventricular (LV) structure and function, and with increasing incidence of heart failure. However, little is known about longitudinal changes in LV systolic function in late life.Aim:To quantify changes in systolic function in late life.Methods:Among 2,779 participants in the community-based Atherosclerosis Risk in Communities (ARIC) study who underwent protocol echocardiography at study Visits 5 (2011-2013) and 7 (2018-2019), systolic function was assessed by LV ejection fraction (LVEF), global longitudinal strain (GLS) and global circumferential strain (GCS). Abnormal function was defined using previously published ARIC-based cut-offs. Longitudinal change in systolic measures and abnormal prevalence were assessed using paired t-test and McNemar’s test respectively. Predictors of each abnormal systolic function measure at Visit 7 were assessed using logistic regression models adjusted for that measure at Visit 5 in addition to systolic blood pressure, heart rate and rhythm during echo at both visits.Results:Mean age was 74±4 years at Visit 5 and 81±4 years at Visit 7, 57% were female, and 24% reported Black race. At Visit 5, mean LVEF was 65±6%, GLS 18±2%, and GCS 28±4%. Over a mean of 6.5 years, LVEF decreased by 2±7%, GLS decreased by 0.5±2.9%, and GCS decreased by 0.6±4.2% (p< 0.001). The prevalence of abnormal LVEF increased from 14% to 23%, abnormal GLS prevalence increased from 18% to 23%, and abnormal GCS increased from 11% to 13% (Figure). At Visit 5, predictors of the development of abnormal LVEF and GLS included older age, male sex, prevalent coronary artery disease (CHD), diabetes, and chronic kidney disease, while only male sex and CHD associated with the development of abnormal GCS. On echocardiography, lower systolic measures, higher LV mass index, larger left atrial volume, and lower e’ at Visit 5 were each associated with higher odds of abnormal LVEF, GLS and GCS at Visit 7.Conclusions:LV systolic function decreases on average over 6 years in late life. Worse measures of both systolic and diastolic function associate with the development of subsequent systolic dysfunction.

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

Circulation, Volume 150, Issue Suppl_1, Page A4141779-A4141779, November 12, 2024. Background:Prior metabolomics studies in aortic stenosis (AS) have focused on patients with severe stenosis and their response to intervention. Limited data exist regarding circulating metabolites predictive of AS development.Aim:Identify circulating metabolites associated with aortic valve (AV) hemodynamics and incident AV events.Hypothesis:We hypothesized that large-scale metabolomics can identify novel circulating metabolites relevant to AS development.Methods:Among participants in the community-based ARIC cohort study who underwent protocol echocardiography and metabolomic profiling by chromatography mass spectrometry (Metabolon) at study Visit 5 (2011-2013) and were free of AV replacement, we related metabolite values to AV peak velocity (AVmax) and dimensionless index (DI) cross-sectionally and to incident AV events using multivariable linear and Cox regression models. Metabolites with ≤10% missingness (n=736 metabolites) were included and normalized using log2 transformation. Post-Visit 5 AV events were ascertained based on ICD codes for AV-related hospitalization and interventions. Regression models were adjusted for age, sex, race, center, heart rate, blood pressure, estimated glomerular filtration rate, and cardiovascular (CV) risk factors and diseases. Statistical significance was based on a False Discovery Rate (FDR)

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.

Circulation, Volume 150, Issue Suppl_1, Page A4145413-A4145413, November 12, 2024. Background:Patient, lesion, and procedural characteristics may impact the long-term risks of adverse limb outcomes differently after successful endovascular revascularization for lower extremity peripheral artery disease.Objective:To assess the relationships of patient, lesion, and procedural characteristics to the subsequent risk of major and minor adverse limb events over the decade after successful endovascular revascularization of the superficial femoral artery for chronic limb threatening ischemia (CLTI) or lifestyle limiting claudication.Methods :A retrospective cohort of patients who underwent endovascular revascularization between 2003-2011 were followed for a median of 9.3 (25-75%: 6.8, 11.1) years. Hazard ratios and 95% confidence intervals (HR, 95% CI) from Cox proportional hazards models assessed the risk of major adverse limb events (MALE) or minor revascularization, MALE alone, and minor revascularization alone.Results:There were 232 index limb revascularizations in 185 patients. Longer lesion length was associated with a higher risk of MALE or minor revascularization (HR=2.09, 95% CI=1.22, 3.60) and minor revascularization alone (HR=2.53, 95% CI=1.39, 4.61). Current smoking was linked with minor revascularization (HR=3.83, 95% CI=1.54, 9.56). CLTI was associated with MALE or minor revascularization (HR=1.89, 95% CI=1.09, 3.29), and MALE alone (HR=7.43, 95% CI=3.11, 17.79). Black race/ethnicity (HR=4.74, 95% CI=1.51, 14.9) and low density lipoprotein (LDL) >100 mg/dL (HR=2.76, 95% CI=1.20, 6.35) were linked to MALE alone.ConclusionFactors related to MALE differed from those related to minor revascularization. Lesion length and smoking were linked to minor revascularization, whereas CLTI, Black race/ethnicity and elevated LDL were linked to MALE.

Circulation, Volume 150, Issue Suppl_1, Page A4139236-A4139236, November 12, 2024. Background:New-onset atrial fibrillation (AF) is common among kidney transplant (KTx) recipients and is associated with reduced patient survival. Predictors of AF after KTx are not well understood, although AF can be associated with traditional and non-traditional risk factors. While artificial intelligence-enabled electrocardiography (AI-ECG) has shown promise in predicting incident AF, its predictive and prognostic implications in the KTx population have not yet been evaluated.Hypothesis:AI-ECG can predict new-onset AF and carries prognostic implications in patients undergoing KTx.Aims:To evaluate the clinical implications of applying AI-ECG to the preoperative ECGs of recipients of a KTx.Methods:Patients without a history of AF who underwent KTx at three referral centers between 2011 and 2021, with at least one preoperative ECG, were included in this retrospective study. Preoperative ECGs were analyzed using a previously developed AI-ECG algorithm to estimate the probabilities of new-onset AF. Based on these probabilities, patients were categorized into two groups: high and low probability of incident AF. The optimal cut-off value for the AI-ECG tool was determined using ROC analysis. The incidence of new-onset AF and mortality at 5 years post KTx were compared between these two groups using univariate and multivariate Cox regression analyses.Results:In total, 6246 patients were included (mean age 52.9 ±14.3 years, 58.7% males). A pre-transplant AI-ECG probability of AF >10% was identified as the most accurate cutoff point to distinguish between patients at low risk and high risk of incident AF (ROC = 0.72). The study found that a preoperative AI-ECG high risk of AF demonstrated not only a strong association with new-onset AF (HR 2.54, 95%CI 2.02-3.19, p

Circulation, Volume 150, Issue Suppl_1, Page A4141311-A4141311, November 12, 2024. Background:The association between oxidative stress score (OBS) and hypertension remains unclear in the US population.Hypothesis:We hypothesized that higher OBS was associated with a lower risk of hypertension.Methods:A total of 22,938 adults (mean age: 47.2 years) were enrolled from 8 survey cycles of NHANES (2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014, 2015-2016 and 2017-2018). The total OBS consisted of the dietary OBS and the lifestyle OBS, based on 16 dietary components (including dietary iron, zinc, total fat, copper, selenium, magnesium, calcium, vitamin C, E, B6 and B12, total folate, carotene, niacin, riboflavin, and fiber) and 4 lifestyle components (including body mass index, alcohol, smoking, and physical activity). Weighted multivariate logistic regression was used to investigate the association between OBS and hypertension, and restricted cubic spline (RCS) assessed the nonlinear relationship.Results:In the multivariate-adjusted model, a substantially inverse association was observed between total OBS and risk of hypertension. Comparing the extreme quartile groups, the OR and 95% CI were 0.62 (0.52-0.73). Furthermore, higher dietary OBS and lifestyle OBS were similarly associated with a lower risk of hypertension (OR (95%CI): 0.78(0.66,0.93); 0.38(0.33,0.44), respectively). The RCS exhibited a nonlinear dose-response association between total OBS and hypertension (Pnon-linearity< 0.001).Conclusion:These findings support the potential beneficial role of OBS for the prevention of hypertension in adults.

Circulation, Volume 150, Issue Suppl_1, Page A4136145-A4136145, November 12, 2024. Background:A report evaluating all-cause mortality in 30 major U.S. cities documented that inequality between Black and White populations in Washington, D.C. was the greatest. However, little is known about disparities in cause-specific mortality over time or by racial groups.Aims:Evaluate trends in all-cause and cause-specific mortality in D.C. from 2000 to 2020 by race, and concurrently examine trends in cardiovascular (CV) risk factors.Methods:Using the CDC WONDER database, we calculated age-adjusted mortality rates per 100,000 persons (2000-2020) for Non-Hispanic Black and Non-Hispanic White populations in D.C. and corresponding rate ratios. Average Annual Percentage Change (AAPC) was examined with joinpoint regression. We examined the prevalence of risk factors (obesity, hypertension, diabetes, smoking, and hypercholesterolemia) using the Behavioral Risk Factor Surveillance System (2000-2020).Results:Among 102,710 deaths that occurred in D.C. (80% Black), cardiovascular diseases (CVD, 32%) and cancer (22%) accounted for over half of the deaths. All-cause mortality declined between 2000-2012 (AAPC: -2.9%, 95% CI: -5.6, 1.0) but stagnated between 2012-2018 (AAPC:-1.1%, 95% CI: -4.6, 0.9) and increased after 2018 (AAPC: 7.7%, 95% CI: 0.6, 11.9). CVD mortality declined between 2000-2011 and plateaued thereafter among Black individuals, contrasting with a monotonous decline (AAPC: -4.7%, 95% CI: -5.3, -4.0) among White individuals, resulting in a magnification of the disparities. Cancer mortality decreased over time for both White and Black individuals (AAPC: -3.4%, 95% CI: -3.9, -2.9 vs. AAPC: -1.8%, 95% CI: -2.1, -1.4, respectively), with a greater magnitude in White individuals. Risk factors were more prevalent among Black individuals over the period.Conclusion:In D.C., the mortality rate is higher in Black vs. White populations, and disparities are increasing over time. While CVD and cancer mortality rates declined overall, profound disparities remain. CVD risk factors are more common in Black populations, with persisting disparities. There is an urgent need for CVD prevention and management, tailored to Black populations in D.C.

Circulation, Volume 150, Issue Suppl_1, Page A4139309-A4139309, November 12, 2024. Background:Between 2011-2017, US rural adults experienced higher cardiovascular (CV) death rates than their urban counterparts, and rural-urban disparities in CV mortality widened. Little is known about these trends have evolved in the wake of the pandemic. In this study, we provide an updated analysis of rural-urban differences in CV mortality.Methods:We used CDC WONDER to obtain national death data from 2010-2022. CV cause of death was identified by ICD-10 codes I00-99. Large metro, small/medium metro, and rural areas were defined using the National Center for Health Statistics Urban-Rural Classification. We calculated age-adjusted mortality rates (AAMRs) per 100,000 population and compared 2022 vs. 2010 using rate differences and two-sample t-tests. We then fit a Poisson regression model to estimate annual percent change (APC), evaluating trends from 2010-2019 and 2019-2022 due to reversal in CV mortality observed after 2019. We included an interaction term to assess differential trends by rurality, and repeated the analysis for younger (age 25-64) and older (age >64) adults.Results:Between 2010-2022, AAMRs were consistently highest in rural areas (Figure 1, Table 1). AAMRs increased in rural areas (rate difference [RD] +3.4 [95% CI 0.4, 6.4]) but declined in urban areas (RD -23.8 [-25.3, -22.2]). This significant differential change was driven by a rise in AAMRs among younger, rural adults (RD +23.2 [21.2, 25.1). In contrast, older adults experienced a decline in AAMRs, though this reduction was greater in urban vs. rural areas (Table 2).From 2010-2019, overall APCs in AAMR decreased for all areas. However, when stratified by age, younger rural adults saw a significant increase (+1.0% [95% CI 0.5, 1.5]), while those in large metro areas did not (-0.2% [-0.5, 0.1]). Older adults saw a significant decrease across all areas.Between 2019-2022, the overall APC in AAMR increased significantly in rural areas (+3.1% [0.4, 6]), but in not large metro areas (+1.2% [-0.4, 2.9]). CV mortality rose in most subgroups, but younger rural adults experienced the largest increase (+4.2% [1.3, 7.1]) (Table 2).Conclusions:Between 2010-2022, CV mortality increased in rural areas and decreased in urban areas. Younger, rural adults experienced the most pronounced rise in CV death, while older, urban adults experienced the steepest decline. These findings highlight an urgent need to address widening rural-urban disparities, particularly among younger adults.

Circulation, Volume 150, Issue Suppl_1, Page A4141522-A4141522, November 12, 2024. Background:Maternal nutritional status and periconceptional environmental conditions have been previously linked to the methylation of the vtRNA 2-1 promoter. Bariatric surgery is an effective treatment for morbid obesity, with most patients achieving significant weight control within 1-2 years post-surgery. However, some patients do not experience the desired weight loss. The clinical correlation between the methylation of the vtRNA 2-1 promoter and postoperative outcomes in obese patients remains unclear. This study aims to elucidate the relationship between the methylation of the vtRNA 2-1 promoter and the effectiveness of bariatric surgery.Hypothesis:The degree of methylation of the vtRNA 2-1 promoter is related to excess weight loss (EWL) after bariatric surgery.Methods:The OCEAN registry (Obesity and Clock for Elegant AgiNg) is a prospective cohort study collecting data from 2011 to 2017, including 381 obese patients, 179 of whom underwent bariatric surgery. Quantitative pyrosequencing was performed on all patients. Postoperative weight and EWL were tracked and recorded at 3, 6, 12, and 24 months. Statistical analyses were conducted using SPSS.26.Results:The degree of methylation of the vtRNA 2-1 promoter shows a bimodal distribution. Compared to the normal group from the Taiwan Biobank, the methylation distribution between the two groups differs significantly. Patients were categorized into hypomethylation (≤10%), intermediate-methylation (10-40%), and hypermethylation (≥40%) groups. Statistics indicate that hypermethylation is associated with higher EWL at one year (p=0 .047) and two years (p=0.04) post-surgery compared to the hypomethylation group. In the linear regression model, after controlling for variables including age, creatinine, cholesterol, TG, LDL, AC sugar and HbA1c, our analysis revealed a positive correlation between HDL and one year EWL.Conclusion:Obese patients who have hypermethylation of the vtRNA 2-1 promoter demonstrate improved EWL one and two years following bariatric surgery. Given the previous links between the methylation of the vtRNA 2-1 promoter and maternal nutritional status, these findings suggest that early life nutritional factors may influence the effectiveness of bariatric surgery outcomes. Further comprehensive and long-term studies are needed to confirm the methylation of the vtRNA 2-1 promoter as a viable indicator for predicting bariatric surgery outcomes and improving cardiovascular health.

Circulation, Volume 150, Issue Suppl_1, Page A4141564-A4141564, November 12, 2024. Introduction:Healthcare utilization in postoperative management and surveillance following endovascular aneurysm repair (EVAR) is an important factor in achieving long-term treatment success. However, factors associated with poor healthcare utilization have yet to be elucidated.Hypothesis:Disadvantaged patients have lower rates of surveillance and higher rates of emergency health service use than their counterparts.Aims:Examine rates of healthcare utilization stratified by age, sex, race, dual-enrollment in Medicare and Medicaid, and residence in a distressed community.Methods:We performed an observational retrospective cohort study of Medicare beneficiaries who underwent infrarenal EVAR with a bifurcated endograft between 2011-2019. We examined annual rates of post-operative surveillance (EVAR-related outpatient visits, surveillance imaging), use of emergency department (ED) visits, and hospital readmission across several disparity measures using Modified Poisson Regression models.Results:In 111,381 Medicare beneficiaries undergoing EVAR, comorbidities associated with poor postoperative surveillance were chronic kidney disease (aRR:1.06[1.04-1.07]), heart failure (1.10[1.09-1.11]), hyperlipidemia (1.16[1.14-1.19]), hypertension (1.09[1.07-1.12]), and ischemic heart disease (1.15[1.14-1.17]). For EVAR-related office visits, patients with worse post-operative care included those >85 years, female, Black, dual-enrolled, or living in distressed communities (Table 1). Similarly, less surveillance imaging was performed in patients >85 years, dual-enrolled, or living in distressed communities. There was a greater need for ER care or readmission among patients >85 years, female, Black, dual-enrolled, or living in distressed communities.Conclusions:Our study revealed patterns of disparities in post-procedure EVAR-related office visits and EVAR imaging studies, and greater use of emergency health services associated with patient age, sex, race, and socioeconomic status. These findings may suggest barriers in access to appropriate surveillance and care which could be addressed by targeting the identified groups for intervention efforts to improve EVAR surveillance.

Circulation, Volume 150, Issue Suppl_1, Page A4147544-A4147544, November 12, 2024. Introduction:Hispanic/Latino individuals are known to have higher traditional cardiovascular disease (CVD) risk factors compared to non-Hispanic Whites and Asians. However, inconsistencies and variability exist regarding the incidence of heart failure (HF) among Hispanics compared to other race/ethnic groups. We examined the incidence of HF in participants enrolled in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).Methods:The baseline HCHS/SOL population consisted of 16,415 participants enrolled between 2008 – 2011 and followed up for incident HF events through 2015 (mean follow up period of 5.8 years). A total of 1000 participants with pre-existing HF at baseline, or with missing information/response for baseline HF, socio-economic status (SES), CVD risk factors, and medication use were excluded. Outcome was ascertained via self-report of events at annual follow-up interviews. HF events were adjudicated by trained physicians who reviewed hospital records. HCHS/SOL participants were stratified into seven Hispanic/Latino heritage groups: Mexican, Dominican, Cuban, Puerto Rican, South or Central American, as well as more than one/other. Cox-proportional hazard regression models were used to calculate HRs for incident HF with Mexican Americans as the reference group and controlling for SES, CVD risk factors, and medication use.Results:A total of 15,415 participants [mean age 41 years, 52.2% Female) were included and 114 HF events (69 Males and 45 Females) were identified after 89,751 person-years follow up. The HF incidence rate was 94.6 per 100,000 persons-years. Hispanic/Latino individuals of Cuban background had the highest HF incidence rate (131.4 per 100,000 person-years) while those from Central American backgrounds had the lowest (42.8 per 100,000 person-years). Hispanic/Latino individuals of Cuban background [HR: 1.471 (95% C.I: 0.397,5.447)] and Dominican background [HR: 0.509 (95% C.I: 0.075, 3.429)] had the highest and lowest adjusted HR of incident HF compared to those of Mexican background.Conclusion:Among different Hispanic/Latino heritage groups, the incidence rate for HF was highest among those with Cuban background and lowest among those with a Central American background.

Circulation, Volume 150, Issue Suppl_1, Page A4139909-A4139909, November 12, 2024. Background:Along with in-person (IP) monitoring, remote monitoring (RM) is recommended for patients with a cardiac implantable electronic device (CIED) to improve clinical outcomes.Hypothesis:Rurality will adversely impact the delivery of both RM and IP monitoring as part of comprehensive CIED care.Aims:To define and compare CIED monitoring patterns among patients with a CIED in rural and urban geographies.Methods:All Medicare fee-for-service beneficiaries (2011-2021) with history of CIED implantation were included based on relevant CPT codes. Demographic characteristics were reported by implant year and stratified by rurality based on beneficiary rural-urban commuting area code. All IP and RM events in the year following implant were tabulated based on CPT and ICD-9/10 procedure codes and similarly stratified by geography.Results:Approximately 23% of the de novo CIED implants (approximately 150,000/year) were among patients living in rural areas. The mean age was 79-80 years across the study period and was slightly higher (

Circulation, Volume 150, Issue Suppl_1, Page A4143464-A4143464, November 12, 2024. Introduction:Patients with heart failure with preserved ejection fraction (HFpEF) have a high burden of comorbidities. To recognize the complex interplay of obesity, diabetes, and chronic kidney disease (CKD) in patients with cardiovascular disease, the cardiovascular-kidney-metabolic (CKM) syndrome was recently defined, but data on the burden of CKM in HFpEF is limited.Aim:We sought to describe the prevalence of CKM components in HFpEF leveraging data from control participants in clinical trials and NHANES.Methods:We analyzed data presented in publications from four randomized clinical trials that enrolled participants with HFpEF (all of which are available via NHLBI BioLINCC and will be included in the extant HeartShare dataset): TOPCAT, RELAX, NEAT-HFpEF, and INDIE. We abstracted baseline demographic and clinical variables from study publications to define CKM components (e.g., body mass index [BMI], diabetes status, hypertension, CKD status). We compared prevalence of CKM in these trials with a representative sample of US adults with self-reported history of heart failure (HF) from NHANES 2011-2018.Results:We included 1937 patients with HFpEF from four trials with enrollment between 2006-2016 and 715 adults representing 5.6 million adults aged ≥40 years with a self-report of HF between 2011-2018 from NHANES (Table). Mean age was similar among enrolled trial participants with HFpEF and those with HF in NHANES (~68-69 years). Mean BMI was in the obesity range and was similar among trial participants with HFpEF and HF in NHANES (31-35 kg/m2). A significant proportion of individuals had hypertension in HFpEF trials ( >80%) and in the NHANES sample with HF (89%). The proportion of stage ≥ 3 CKD in HFpEF trials (≥ 37%) was similar to the NHANES sample with HF (37%). Results are shown inTable.Conclusions:Patients with HFpEF enrolled in clinical trials and those with HF in general population are significantly enriched with CKM components that may contribute to morbidity and mortality. Similar prevalence estimates were observed despite variability in trial inclusion criteria and heterogeneity in defining HFpEF and highlight CKM as a central target for HFpEF management.

Circulation, Volume 150, Issue Suppl_1, Page A4136016-A4136016, November 12, 2024. Introduction:Aircraft noise is a concern for communities living near airports, but its impact on heart structure and function is unknown.Methods:Night-time (Lnight) and weighted 24-hour day (Lden) aircraft noise levels were provided by the UK Civil Aviation Authority for 2011 (Fig.1). Health data came from UK Biobank (UKB) participants living near four UK major airports (Heathrow, Gatwick, Manchester, and Birmingham) who had cardiovascular magnetic resonance (CMR) imaging starting from 2014 and self-reported no hearing difficulties. Generalized linear models investigated the associations between aircraft noise exposure and CMR metrics (derived using a validated convolutional neural network to ensure consistent image segmentations), after adjustment for demographics, socio-economic, lifestyle, and environmental covariates. Mediation by cardiovascular (CV) risk factors was also explored. Downstream associations between CMR metrics and major adverse cardiac events (MACE) were tested in a separate prospective UKB subcohort (n=26,658) to understand the potential clinical impact of noise-associated heart remodeling.Results:Of 3,635 UKB participants included, 3% experienced higher aircraft noise Lnight(≥45decibels) and 8% higher Lden(≥50decibels). Participants exposed to higher Lnighthad 7% [95% confidence interval: 4–10%] higher left ventricular (LV) mass and 4% [2–5%] thicker LV walls with a normal septal:lateral wall thickness ratio (Fig.2 A1). This LV concentric remodeling is relevant since 7% higher LV mass associates with 32% higher odds of MACE. They also had worse LV myocardial dynamics (Fig.2 A2) (e.g., 8% [4–12%] lower global circumferential strain which associates with 37% higher odds of MACE). Overall, a hypothetical individual experiencing the typical CMR abnormalities associated with higher Lnightexposure may have 5-times higher odds of MACE. Body mass index and hypertension appeared to mediate 20-50% of the observed associations. Findings were similar in those exposed to higher Lden(Fig.2 B1-2). Participants who did not move home during follow-up and were continuously exposed to higher aircraft noise levels had the worst CMR phenotype.Conclusion:Higher aircraft noise exposure associates with adverse LV remodeling, potentially due to noise increasing the risk of obesity and hypertension. Findings are consistent with the existing literature on aircraft noise and CV disease, and need to be considered by policymakers and the aviation industry.

Circulation, Volume 150, Issue Suppl_1, Page A4142090-A4142090, November 12, 2024. Background:The persistently patent arterial duct accounts for ~12% of congenital heart lesions. Untreated, it may result in heart failure due to volume loading of the left heart, pulmonary hypertension, and infective endarteritis. Percutaneous device closure is the preferred occlusion technique, with the standard approach consisting of femoral artery access for angiography and venous access for device delivery (AA). A venous-only strategy (VA) for angiography and device delivery can also be employed.Hypothesis:We hypothesized that VA would eliminate arterial complications, and reduce procedure times and radiation exposure compared to standard AA.Methods:This retrospective cohort study reviewed isolated arterial duct device closures at the Hospital for Sick Children from January 1, 2011 through December 31, 2022. Exclusions included premature neonates, children requiring arterial access for monitoring and those who underwent other procedures. Children were categorized based upon initial access determined by operator preference, into VA or AA groups.Results:The cohort consisted of 405 children, 252 (62.2%) females, with a median age of 3.1 years (IQR1.30–5.84), median weight 13.2kg (IQR 9.0–19.5), and duct diameter of 2.9mm (IQR 2.0–3.5) with no significant differences between the groups. Type A ducts were more frequent in the AA group (90% vs. 72%). The VA group included 106 children, of which 14 (13.2%) required AA conversion for angiography due to complex anatomy, to assess device positon prior to release, but remained in the VA group for analysis.Children in the VA group had lower dose area product (DAP) (p