Risultati per: AGA: linee guida sulla de-prescrizione degli inibitori della pompa protonica

Circulation, Volume 150, Issue Suppl_1, Page A4143019-A4143019, November 12, 2024. Background:Placental malperfusion (PMP), and perturbation of shared developmental pathways between the fetal heart and placenta, may play a role in the development and outcomes of congenital heart disease (CHD). We hypothesize that genomic variation in pathways involved in vascular or placental development underlie PMP in CHD, which in turn impacts outcomes.Methods:Fetuses were diagnosed prenatally with structural CHD in our Fetal Heart Program. Maternal characteristics, neonatal biometrics, genomic diagnoses, and outcomes data were reviewed. Placentas with PMP met pathological criteria according to the Amsterdam Placental Workshop classification for maternal or fetal vascular malperfusion, or placental weight

Circulation, Volume 150, Issue Suppl_1, Page A4142264-A4142264, November 12, 2024. Background:Two de-escalation options of dual antiplatelet therapy (DAPT) have been proposed to mitigate bleeding risk in patients (pts) with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI), including maintaining DAPT but reducing its intensity by changing potent P2Y12 inhibitor (P2Y12i) to clopidogrel or discontinuation of DAPT by using P2Y12i monotherapy. Our study aims to evaluate the use of de-escalation therapies after discharge in AMI pts undergoing PCI and compare the clinical outcomes of the two de-escalation options.Methods and Results:In the Taiwan National Health Insurance Research Database, we included adult pts (≥ 18 yrs) who received PCI for AMI and survived to discharge with DAPT. Pts who need oral anticoagulant were excluded. From 2011 to 2021, 58989 pts (mean age 61.9±13.2 yrs, male 81.4%) were included. After 2016, >70% pts were treated with aspirin plus ticagrelor (A+T) at discharge. In A+T users (n=28698), de-escalation for any reason occurred in 52.2% during follow-up. Among de-escalation therapy, aspirin plus clopidogrel (A+C, 55.8%) and ticagrelor monotherapy (T mono, 15.5%) were most commonly used in the first 6 mo. The mean duration from discharge to de-escalation to T mono vs. A+C was 52.5±69.3 vs. 68.4±70.7 days (p

Circulation, Volume 150, Issue Suppl_1, Page A4140540-A4140540, November 12, 2024. Background:Timely initiation of temporary mechanical circulatory support (tMCS), escalation and de-escalation strategies are key components for treatment of cardiogenic shock (CS). However, little is known about tMCS strategies and outcomes based on etiology of CS and chronicity of heart failure. We evaluated differences of tMCS strategies and outcome in patients supported with Impella in acute myocardial infarction related CS (AMI-CS), de novo heart failure related CS (de novo HF-CS), and acute on chronic heart failure related CS (acute on chronic HF-CS).Methods and Results:The Japan Registry for Percutaneous Ventricular Assist Device (J-PVAD) is multicenter, observational registry enrolling all consecutive patients treated with Impella in Japan. We conducted a retrospective analysis of patients with Impella in J-PVAD between February 2020 and December 2022. Among 3678 CS patients supported with Impella. 2418 (65.7%) patients were presented with AMI-CS, 758 (20.6%) patients with de novo HF-CS, and 502 (13.7%) patients with acute on chronic HF-CS. The median time from hospital entry to initiation of Impella were 127 min, 339 min, and 1117 min in AMI-CS, de novo HF-CS, and acute on chronic HF-CS, respectively (P < 0.001 for each). 2233 (92.4%) patients with AMI-CS underwent percutaneous coronary intervention during index hospitalization with median door-balloon-time of 108 min. Patients treated with multiple mechanical circulatory supports were 51.4%, 64.2%, and 55.2% in AMI-CS, de novo HF-CS, and acute on chronic HF-CS, respectively. Using de novo CS-HF as a reference, the risk for in-hospital mortality for AMI-CS and acute on chronic HF-CS were: odds ratio (OR) 1.24 [95% confidence interval (CI) 1.04–1.50], P = 0.02 and OR 1.43 (95% CI 1.12–1.81), P = 0.004, respectively.Conclusions:In CS patients supported with Impella, time course and utilization of tMCS varied in AMI-CS, de novo HF-CS, and acute on chronic HF-CS. De novo HF-CS had significantly better mortality relative to AMI-CS and acute-on-chronic CS. Further research is required for tMCS strategies based on etiology of CS and chronicity of heart failure.

Circulation, Volume 150, Issue Suppl_1, Page A4144239-A4144239, November 12, 2024. Background:The previous our study showed that vasomotion may be better preserved after drug-coated balloon (DCB) treatment than after stenting. However, there is no information available on the relationship between endothelial function and tissue characterization after DCB treatment.Aims:The purpose of this study was to investigate the relationship between endothelial function and tissue characterization after DCB for de-novo coronary lesion.Methods:We prospectively studied 19 patients who underwent acetylcholine provocation test and intravascular imaging at 8-month after DCB treatment. To evaluate endothelial-dependent vasomotion, the mean lumen diameter of the distal segment, beginning 5 mm and ending 15 mm distal to the edge of the treated segment, was quantitatively measured by angiography during the acetylcholine provocation test. Tissue characterization was assessed with integrated backscatter intravascular ultrasound (IB-IVUS).Results:There was a positive correlation between endothelial-dependent vasomotion and the proportion of lipid plaque in treated segments (r2=0.610, p=0.009). On the other hand, there were negative correlations between endothelial-dependent vasomotion and the proportion of dense fibrous or calcified plaque in treated segments (r2=-0.709, p=0.001, r2=-0.773, p

Circulation, Volume 150, Issue Suppl_1, Page A4146046-A4146046, November 12, 2024. Background:Toll-like receptor 3 plays a role in the development of calcific aortic valve disease (CAVD). However, there are currently no pharmacological treatments for CAVD, and the discovery of de novo molecules targeting a specific protein is a time-intensive and financially demanding process. It is hypothesized that language models, trained on encodings of molecular graphs, can tailor the design of novel molecules with specific molecular and pharmacological properties.Objective:This study aims to develop a chemical language model tailored for designing novel molecules that target the inhibition of TLR3.Methods:A language model was pre-trained on 25,000 chemical structures sourced from the ChEMBL database. Each chemical structure was represented through Simplified Molecular Input Line Entry System (SMILES) strings, which were subsequently tokenized into discrete atomic and functional group tokens. The model leverages an Average-Stochastic Gradient Descent Weight-Dropped Long Short-Term Memory (AWD-LSTM) architecture. Transfer learning was employed for domain-specific fine-tuning of the pre-trained language model on the target chemical structures.Results:The model achieved strong performance by unfreezing the pre-trained language model’s parameters for fine-tuning in all layers. Specifically, it achieved an accuracy of 85.49%, a weighted F1-score of 83.28%, and a perplexity of 1.44. This approach yielded better results compared to partially freezing the model’s parameters, where only the latter layers were fine-tuned. The partial freezing approach resulted in an accuracy of 85.06%, a weighted F1-score of 82.44%, and a perplexity of 1.44.Conclusion:A chemical language model was developed for designing novel molecules that target the inhibition of TLR3. This provides an efficient and automated method for developing novel molecules with specific molecular and pharmacological properties.

Circulation, Volume 150, Issue Suppl_1, Page A4140472-A4140472, November 12, 2024. Introduction:Hypertension (HTN) is a major risk factor for cardiovascular disease, and its prevention and management are influenced by health knowledge. This paper reviews the findings of a community-based HTN health knowledge program in Puerto Rico, facilitated by Community Health Workers (CHWs), also known as Promotores de Salud, who maintain a close relationship with their communities.Hypothesis:CHWs will positively impact a community’s HTN health knowledge and self-reported confidence in making lifestyle/behavior modifications with the use of Empowered to Serve (ETS) Health modules.Methods:American Heart Association (AHA) partnered with One Stop Career Center, a community-based organization in Puerto Rico. The program utilized AHA ETS modules focused on HTN prevention and management. CHWs instructed and implemented these modules across 10 community-based settings from 09/20/23 to 12/26/23. Participants were given a multiple-choice survey before and after each module. Descriptive Analysis and Two Proportion Z Test was performed on the surveys.CHWs also conducted a community discussion, distributed blood pressure devices, and referred participants to a self-measured blood pressure program.Results:The total count for pre-surveys was 214 and post-surveys was 224. Majority of participants identified as female (67.9% female) and Hispanic (95.2%), with 46.4% completed high school or less.Comparing pre- and post-surveys, confidence scores improved in monitoring blood pressure at home (41.0%, n/N=34/83 to 68.5%, n/N=61/89; p value=