Risultati per: Passo 10. Intervenire sul singolo paziente in visita: GPG Patient

Background
Hepatocellular carcinoma (HCC) is plagued by failures across the cancer care continuum, leading to frequent late-stage diagnoses and high mortality. We evaluated the effectiveness of mailed outreach invitations plus patient navigation to promote HCC screening process completion in patients with cirrhosis.

Methods
Between April 2018 and September 2021, we conducted a multicentre pragmatic randomised clinical trial comparing mailed outreach plus patient navigation for HCC screening (n=1436) versus usual care with visit-based screening (n=1436) among patients with cirrhosis at three US health systems. Our primary outcome was screening process completion over a 36-month period, and our secondary outcome was the proportion of time covered (PTC) by screening. All patients were included in intention-to-screen analyses.

Results
All 2872 participants (median age 61.3 years; 32.3% women) were included in intention-to-screen analyses. Screening process completion was observed in 6.6% (95% CI: 5.3% to 7.9%) of patients randomised to outreach and 3.3% (95% CI: 2.4% to 4.3%) of those randomised to usual care (OR 2.05, 95% CI: 1.44 to 2.92). The intervention increased HCC screening process completion across most subgroups including age, sex, race and ethnicity, Child-Turcotte-Pugh class and health system. PTC was also significantly higher in the outreach arm than usual care (mean 37.5% vs 28.2%; RR 1.33, 95% CI: 1.31 to 1.35). Despite screening underuse, most HCC in both arms were detected at an early stage.

Conclusion
Mailed outreach plus navigation significantly increased HCC screening process completion versus usual care in patients with cirrhosis, with a consistent effect across most examined subgroups. However, screening completion remained suboptimal in both arms, underscoring a need for more intensive interventions.

Trial registration number
NCT02582918.

Hepatocellular carcinoma (HCC) is a significant global health problem, and its incidence is expected to exceed 1 million new HCC annually by 2025.1 The reported 3-year survival rate for advanced-stage HCC is less than 17%, while 70% of patients diagnosed with early-stage HCC can achieve 5-year survival.2 Despite well-established guidelines and the clear benefits of early detection, the meta-analysis results (29 papers, 1 18 799 patients) showed that only 24% of individuals at risk for developing HCC were screened.3 Efforts to surmount barriers at patient, provider and healthcare levels have shown a minimal screening rate increase over time.3 4 One of the reasons for the disappointing results might be the fact that authors focused on individual barriers, rather than considering the screening failure the result of the interplay of different factors. Additionally, the published studies have the following limitations, detailed reasons for…

Circulation, Volume 150, Issue Suppl_1, Page A4136975-A4136975, November 12, 2024. Introduction:It is estimated that 1 in 5 Americans have high lipoprotein (a) [Lp(a)] levels. High levels of Lp(a) are an independent, predominantly inherited, and causal risk factor for atherosclerotic cardiovascular disease (ASCVD). More investigation is needed to better understand the gaps in both professional and patient education on Lp(a) and its associated risk with ASCVD.Goals:The American Heart Association (AHA) is implementing a national 3-year initiative called the Lp(a) Discovery Project to understand system-level practice patterns for patients screened for high Lp(a) and develop models for national education. We aim to gauge an understanding of healthcare professional (HCP) and patient awareness, perceptions, knowledge, and behaviors of Lp(a) to develop a comprehensive educational approach that ultimately encourages patient-provider shared decision-making.Methods:To assess patient education needs, an online survey was conducted from October 11 to November 6, 2023, by Harris Insights&Analytics LLC with a nationally representative sample of 3,006 U.S. adults 18 years+. To assess professional education needs, the AHA engaged 10 champions from diverse health systems with established Lp(a) screening processes and workflows to participate in a Learning Healthcare System model to share best practices, inform on models for Lp(a) screening, and provide input on professional education topics.Results:The patient survey revealed that 34% of adults do not perceive high Lp(a) to pose an increased risk of heart attack, peripheral artery disease or stroke. If told that high Lp(a) does increase this risk, 63% are motivated to have their Lp(a) level checked and 88% would be motivated to reduce their risk for these conditions if they had high Lp(a). Ultimately, HCP recommendation was the most significant driver in getting screened among those who had their Lp(a) measured (61%). AHA-led champion interviews revealed that primary and specialty care HCPs need education on the importance of Lp(a) testing and cascade screening for family members as well as care considerations for patients with high Lp(a).Conclusion:Given that patients are most likely to be screened for Lp(a) if their HCP recommends it, we will focus on 1) educating patients and HCPs on the connection between Lp(a) and risk for cardiovascular disease and stroke and 2) providing HCPs with guidance on care considerations for those with high Lp(a) including cascade screening.

Circulation, Volume 150, Issue Suppl_1, Page A4148073-A4148073, November 12, 2024. Case Description:A 26 yo woman with Marfan Syndrome (MFS,FBN1), ectopia lentis, aortic dilation and no family history of MFS or aortic dissection was evaluated for preconception counseling. She was asymptomatic, and the size of her aortic root (~4cm) and ascending aorta (~3.5cm) had been stable for over 5 years. She was counseled that risk of cardiac events during her pregnancy is high, but lower compared to those with aortic sizes >4.5cm. Once pregnant, she was followed closely with imaging every trimester (MRA at 25 weeks gestation showed stable aortic sizes). Cardio-obstetric recommendations included: CARPREG II score: 2, mWHO class: III, consideration of assisted second stage due to aortic root dilation. She was counseled on symptoms of aortic dissection and to seek emergency care should those symptoms arise. At 27 weeks gestation, she presented to the ED with intense chest and neck pain, shortness of breath, and headache. Emergent CT showed aortic root (4.1cm) and proximal ascending aortic dissection with propagation into the left main coronary artery(Figure 1).She underwent emergent C-section followed by aortic root and ascending aorta replacement and mechanical aortic valve replacement due to severe regurgitation. She was discharged in stable condition 8 days after an uncomplicated post-operative recovery. Her baby is recovering in the NICU.Discussion:While risk of aortic dissection in women with MFS is higher during pregnancy, recent studies suggest relative safety with aortic root diameters up to 4.5cm. Our case highlights that even at “lower risk” aortic sizes, aortic dissection remains an important risk for such women. Educating patients and providers about the acute symptoms of aortic dissection and forming an action plan for timely intervention can be lifesaving. Furthermore, some genetic mutations (e.g.TGBR1/2orSMAD3) and sequence variants within theFBN1gene may pose a higher risk of aortic dissection at smaller aortic diameters. Our patient’s pathogenicFBN1mutation (-c.2114-5T >G, previously classified as a VUS) highlights the importance of genetic testing: prophylactic surgery at sizes

Circulation, Volume 150, Issue Suppl_1, Page A4134309-A4134309, November 12, 2024. Introduction:We report the case of a heart transplant patient on chronic immunosuppression diagnosed with cryptococcal meningitis. Up to 5% of solid organ transplant patients develop cryptococcosis, carrying a 50% mortality rate in central nervous system involvement.Case Presentation:This is a 57-year-old male with a past medical history of heart failure with reduced ejection fraction (HFrEF) status post orthotopic heart transplantation (on prednisone 7.5 mg daily, mycophenolate, tacrolimus and sirolimus), pulmonary sarcoid, and chronic hepatitis B (on tenofovir and entecavir) who presented with headache, nausea, vomiting and seizure-like activity. The patient’s heart rate was 129 beats per minute, blood pressure 188/92 mmHg, but was afebrile. He eventually underwent a lumbar puncture with the cerebrospinal fluid (CSF) positive for cryptococcal antigen (1:2560). The patient was started on liposomal amphotericin B and flucytosine. Mycophenolate and sirolimus were held in the setting of his infection. The patient’s hospital course was complicated by acute kidney injury likely secondary to elevated tacrolimus levels while on fluconazole. He was ultimately discharged with plans to repeat CSF studies as an outpatient.Discussion:Here we report a case of cryptococcal meningitis in a heart transplant patient in the context of pulmonary sarcoidosis, chronic hepatitis B and quadruple immunosuppression. Of note, as part of rejection surveillance, the patient undertook serial AlloSure and AlloMap testing. Sirolimus was added to his regimen due to persistently elevated AlloSure scores. Indeed, immunosuppressive agents are the leading risk factor for cryptococcosis in organ transplant patients. Our patient also has two important risk factors for cryptococcal infection. Firstly, sarcoidosis is associated with T-cell dysregulation, compromising cell-mediated immunity. Additionally, hepatitis B carriers have an increased predisposition for cryptococcal infections, notwithstanding that our patient had been on dual antiviral therapy.Conclusion:Quadruple immunosuppression in heart transplant patients, especially in the context of risk factors such as sarcoidosis and hepatitis B infection, can result in cryptococcal meningitis and should be considered in patients with suggestive symptoms. Effective prophylactic regimens for such higher risk patients may be a potential area for further investigation.

Circulation, Volume 150, Issue Suppl_1, Page A4141445-A4141445, November 12, 2024. Introduction:Bicuspid aortic valve (BAV) is associated with progressive ascending aorta (AAo) dilation, often leading to aneurysms, dissections, and ruptures. Thus, current guidelines recommend preventive surgery for AAo dilation. Recent 4D flow MRI studies show that BAV morphology causes abnormal transvalvular flow patterns, increasing wall shear stress (WSS), a trigger of aortic growth. Further studies have delineated areas of abnormally high WSS by comparing to estimates of matched controls, and show promise in detecting risk for aortic growth. However, since the long-term prognostic significance of this marker is unclear, we aimed to quantify WSS in BAV patients to assess its value in predicting the need for aortic surgery up to 10 years post-4D flow MRI acquisition.Methods:BAV patients without prior surgical intervention scanned before April 1, 2014 were identified. Using medical records, patients were categorized as ‘operated’ if they underwent aortic surgery post-scan and ‘non-operated’ if they were surgery-free for at least 10 years post-scan. 4D flow MRIs were processed with an AI pipeline, including 3D segmentation of the aorta, followed by peak velocity (PV) and WSS quantification in the AAo (Fig. 1A-C). Patient-specific WSS heatmaps were computed relative to a map based on the WSS of 10 or more sex and age-matched controls. Relative areas of elevated WSS in the AAo were then calculated (Fig. 1D-F).Results:115 patients were included, with 73 non-operated (age: 42.5±11.5y, 49M) and 42 operated patients (age: 53.5±12.1y, 34M). The mean baseline mid-AAo diameters for non-operated and operated patients were 3.8±0.6 cm and 4.1±0.5 cm, respectively. Among operated patients, the mean scan to surgery time was 5.7±3.3y. All three 4D flow metrics were significantly higher in operated compared to non-operated patients: PV: 2.6±0.6 vs. 1.7±0.4 m/s (p

Circulation, Volume 150, Issue Suppl_1, Page A4147628-A4147628, November 12, 2024. Introduction:Patient knowledge of lower extremity peripheral artery disease (PAD) is low compared to other cardiovascular diseases.Research Questions/Hypothesis:We hypothesize that demographic and socioeconomic factors impact patient knowledge of PAD.Goals/Aims:To obtain qualitative description of and identify factors associated with patient knowledge of PAD.Methods/Approach:We performed a convergent parallel mixed methods study of participants with an established PAD diagnosis. Participants completed an 87-item survey assessing demographics, awareness of PAD diagnosis, and PAD knowledge. Functional health literacy (FHL) was measured using the short Test of Functional Health Literacy Assessment. Multivariable linear regression was used to identify factors associated with PAD knowledge scores. Semi-structured interviews were used to describe understanding of PAD. Transcripts were analyzed with inductive and deductive coding, and a constant comparative approach was used to identify themes.Results/Data:There were 91 participants (77.2% response rate, 49.5% female, 29.7% Black, mean age 68.6 years). Most participants (51.7%) had chronic limb-threatening ischemia and 17.6% had a previous major amputation. While 21.3% had poor FHL and 24.4% were unaware of their PAD diagnosis, the average knowledge score was 79.1%. On bivariate analysis, non-White race, non-ambulatory status, poor FHL, lack of awareness of PAD diagnosis, and not knowing the chronicity of diagnosis were inversely associated with knowledge score. Multivariate linear regression showed that poor FHL, non-White race, and not knowing the chronicity of PAD diagnosis were independently associated with low PAD knowledge. Qualitative analysis of 22 participants revealed that patients have difficulty understanding the name “PAD”, confuse PAD with other comorbidities, and have incorrect beliefs about PAD despite high knowledge scores.Conclusions:Knowledge of PAD is associated with health literacy. However, patients have incorrect beliefs and difficulty understanding the terminology associated with PAD despite a high average knowledge score. Knowledge scores may not adequately reflect understanding. Future research will focus on optimizing patient education, identifying strategies to appropriately gauge patient understanding, and understanding the association between knowledge and behavior in PAD.

Circulation, Volume 150, Issue Suppl_1, Page A4120573-A4120573, November 12, 2024. A Japanese male in his 80s was admitted to our emergency department with chest pain. His prior history was syncope and ventricular tachycardia. Transthoracic echocardiography (TTE) revealed thickening of the basal part of the antero-septal wall and thinning of the basal part of the inferior wall. Coronary angiography (CAG), cardiac MRI and blood test revealed no specific abnormalities. The day before his emergency admission, he visited the cardiology outpatient department for a periodic examination of cardiac hypertrophy. ECG, chest X-ray, and TTE were unchanged from his prior examination. However, that night, he experienced chest pain and was transferred to our hospital. On arrival, his vital signs were critical, with a blood pressure of 70/59 mmHg. ECG indicated ST elevation in antero-lateral leads. TTE detected pericardial effusion, and contrast-enhanced CT identified two focal areas of non-enhancement in the myocardium and pericardial effusion without signs of aortic dissection. CAG revealed no significant stenosis or obstructive lesion. During coronary angiography, the patient deteriorated to asystole. Cardiopulmonary resuscitation and percutaneous pericardial drainage were initiated. Hemorrhagic pericardial effusion was aspirated. Immediate surgical hemostasis was undergone, revealing about 2 cm lacerations and hematoma in the anterior and inferior wall. After surgery, he complained of abdominal discomfort. Esophageal gastrointestinal endoscopy was undergone to investigate the abdominal discomfort, and he was diagnosed with early gastric cancer. Endoscopic submucosal dissection (ESD) was undergone, and histopathological examination revealed adenocarcinoma and eosinophilic amorphous materials deposited in the submucosal vessels. Congo red staining of the submucosal vessels revealed orange-red areas. A technetium-99m pyrophosphatase scintigraphy showed Grade 2 uptake in the heart. Transthyretin (TTR) staining was positive in the specimen from ESD, leading to a diagnosis of TTR amyloidosis. Genetic test for TTR was negative, which led to a diagnosis of wild-type TTR amyloidosis and tafamidis was started. In cases of acute pericardial effusion and/or cardiac rupture, it is imperative to consider cardiac amyloidosis as a potential etiology, in addition to myocardial infarction and aortic dissection, especially in patients with left ventricular wall thickening, neuropathy, or abnormal ECG, also known as “red flag”.

Circulation, Volume 150, Issue Suppl_1, Page A4148214-A4148214, November 12, 2024. Background:Advancements in diagnostics and increased awareness have led to higher identification of cardiac amyloidosis. This condition, characterized by the abnormal deposition of amyloid proteins in the heart, has created a greater need for comprehensive educational materials for patients and their families. Patients with cardiac amyloidosis often require specialized care from subspecialists at academic medical centers (AMCs). Our study aims to evaluate whether the readability of patient education materials provided by AMCs meets the National Institutes of Health (NIH) standard of an 8th-grade reading level or below.Methods:We conducted a Google search to find educational materials on cardiac amyloidosis from AMCs. Text from these websites was analyzed using 10 readability assessment tools, including Flesch-Kincaid Grade Level and Gunning Fog Index. We used simple linear regression to assess the relationship between readability scores and independent variables such as word count, U.S. News ranking, and Google Search ranking.Results:We identified 32 AMC websites with information on cardiac amyloidosis. The overall median reading level was 11.3 (IQR 10.5 – 11.9). There was no significant correlation between readability scores and word count (r2= 0.00, p = 0.95), Google ranking (r2 = 0.021, p = 0.42), or U.S. News ranking (r2 = 0.013, p = 0.65). This indicates that the readability of the materials is independent of text length and AMC authority.Conclusion:This study is the first to examine the readability of patient educational materials on cardiac amyloidosis. The 32 AMC websites had a median reading grade level of 11.3, which does not meet the NIH readability standard. The lack of significant correlation between readability and Google or U.S. News rankings suggests that AMC status does not affect communication effectiveness. The absence of a relationship between word count and readability highlights the need for better content quality. There is a critical shortage of accessible patient education materials on cardiac amyloidosis. Providing materials that meet NIH readability standards is essential to alleviate patient anxieties and improve adherence to treatment protocols. Academic medical centers, along with cardiology and oncology groups, should ensure patient education materials are both accessible and informative, enhancing patient outcomes and quality of life.

Circulation, Volume 150, Issue Suppl_1, Page A4142032-A4142032, November 12, 2024. Introduction:. The hospital discharge process is non-standardized and contributes to post-discharge adverse events, re-hospitalization and high cost. To address this, we developed the Re-Engineered Discharge (RED) program designed to provide high quality discharge education, shown to lower readmission rates and improve patient satisfaction. Integrating digital technologies could facilitate its implementation into hospital workflow.Methods:We designed “MayaRED”, a digital conversational agent that simulates face-to-face human interactions through personalized, conversational dialogue to deliver discharge education. MayaRED employs the “teach-back” method to document patient understanding. Upon completion, a report documents what was taught by MayaRED and understood by the patient. Participants were asked to complete a survey regarding their perceptions of the acceptability and usefulness of MayaRED. Participants were matched to controls subjects to evaluate the comparative effectiveness.Results:HF patients (N=18) using MayaRED averaged 69 years, 13,003 pg/ml pro-BNP, 42% ejection fraction and 3 mg/dl creatinine were compared to 17 matched controls. On a 1 to 7 point Likert scale (1=strongly disagree; 7=strongly agree), patients using MayaRED reported that they had “their questions answered” (mean 6.47 vs. 4.76; P

Circulation, Volume 150, Issue Suppl_1, Page A4142190-A4142190, November 12, 2024. Introduction:The prevalence of heart failure with improved ejection fraction (HFimpEF) is growing. The association of ejection fraction recovery and changes in health status has not been previously reported.Hypothesis:We hypothesized patient-reported health status (HS) will be significantly better among patients with HFimpEF compared with those with HF with reduced ejection fraction (HFrEF) or HF with mid-range/preserved ejection fraction (HFmrEF/HFpEF).Methods:We identified patients with HF with at least 2 encounters with the Stanford cardiology clinic who completed a routinely collected Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 from 8/2020 to10/2023. HFimpEF was defined as most recent EF >40% from a preceding echocardiogram >30 days prior with EF

Circulation, Volume 150, Issue Suppl_1, Page A4145234-A4145234, November 12, 2024. Background:Leadless pacemakers (LPM) utilization has grown significantly, yet data on LPM removal and/or revision (LPM-RR) remains limited. This study aims to evaluate trends in 30-day readmission rate (30-dRr), mortality, and resource utilization associated with LPM-RRMethod:We analyzed data from the Nationwide Readmission Database from 2016 to 2021. Patients ≥ 18 years who underwent LPM-RR were identified using ICD-10 codes. The primary outcome was the trend on 30-dRr following LPM-RR. Secondary outcomes included mortality, resource utilization (Length of stay {LOS}&inflation-adjusted mean hospital cost),&most common readmission diagnosis. Predictive marginal effects over the years&regression analyses were conducted.Results:LPMs placement increased from 350 in 2016 to 16,225 in 2021 (p-trend < 0.001), while the rate of revisions and removals declined from 6.2% to 1.2% (p-trend < 0.001). The mean age at index admission was 70.9 years with 51.6% females, compared to 71.6 years and 60.8% males among readmitted patients. The 30-dRr increased slightly from 13.8% in 2016 to 16% in 2021 (p trend = 0.1). Index admission mortality trends were non-significant, decreasing from 7.4% in 2017 to 4.2% in 2021 (p-trend = 0.4). Readmission mortality trends also remained non-significant, from 8.3% in 2016 to 8.4% in 2021 (p-trend = 0.3). The index admission mean LOS was 12.1 days in 2016 to 10.2 days in 2021 (p trend = 0.09), while readmission mean LOS was 4.1 days to 3.8 days (p trend = 0.9). The inflation-adjusted mean hospital cost for index admissions decreased from $76,432.5 in 2016 to $61,501 in 2021 (p trend = 0.08), whereas readmission costs increased from $6,773 to $9,358 (p-trend = 0.7). The most common reason for readmission was hypertensive heart disease with heart failure.Conclusion:From 2016 to 2021, LPM implantation grew rapidly with a significant decline in revision and removal rates. During this period, 30-dRr&resource utilization have remained relatively stable, with a trend toward decreasing mortality within 30 days after LPM implantation, likely owing to technology/technique advancements, increased experience, as well as patient selection. Further research is needed to assess outcomes for the rapidly evolving use of LPM in an increasingly broader range of patient populations.

Circulation, Volume 150, Issue Suppl_1, Page A4143153-A4143153, November 12, 2024. Background:The correlation between CRT response and patient-reported outcomes is uncertain.Objective:To identify whether patient reported outcomes correlate with CRT response through a decision regret scale (DRS) in patients with heart failure with reduced ejection fraction (HFrEF).Hypothesis:CRT non-responders have more regret over having undergone device implant compared with responders.Methods:We included a total of 150 patients with HFrEF who underwent CRT implantation at the Cleveland Clinic from 2020-2022. Each patient was given a DRS questionnaire at 6 months post-CRT implant, and their CRT response status was assessed echocardiographically. Response was defined as an improvement in LVEF >5% with reduction in LVESV >10%. Patients were unaware of their response status at the time of filling out the questionnaire. The DRS Questionnaire asks patients whether they regret their decision to undergo a procedure. Patients rated, on a scale of 1 (strongly agree) to 5 (strongly disagree)- their agreement with five statements: It was the right decision; I regret the choice that I made; I would go for the same choice again; The choice did me a lot of harm; and The decision was a wise one. We grouped questions 1,3, and 5 from the DRS together for positive score (higher is more regret), and questions 2 and 4 were grouped together for negative score (lower is more regret). This data was compared between 2 groups based on responder (107; 71.33%) and non-responder status (43; 28.67%).Results:The median IQR positive score and negative score among all patients was 3 (3-5), and 10 (8-10) respectively. There were no patients who voiced significant regret for having undergone device implant. In comparing the scores between responders and non-responders, the Mann-Whitney U test revealed no difference in scores. [Median IQR positive score 3 (3-6) in non-responders, 3 (3-4.5) in responders; p=0.19; negative score 10 (8-10) non-responders,10 (9-10) in responders; p=0.44] (Figure 1).Conclusion:Patients with HFrEF undergoing CRT overwhelmingly do not regret their decision to undergo device implantation. The presence or absence of significant remodeling had no impact on patient satisfaction feelings towards the decision to undergo device implantation.

Circulation, Volume 150, Issue Suppl_1, Page A4139936-A4139936, November 12, 2024. Background:Shared decision-making aims to improve health outcomes by empowering patients to make informed decisions with their healthcare providers. While decision aids guide treatment choices, they may not help providers effectively communicate the importance of treatment and the risks of non-adherence. We explored patient perspectives on shared decision-making and communication of CVD risks upon diagnosis with elevated LDL-C, a significant risk factor for CVD.Aims:To learn from people with high cholesterol about their experiences, decisions, and perspectives on being diagnosed and living with high LDL-C, including awareness of the association between high LDL-C and other risk factors for heart disease and stroke.Methods:The design and interpretation of this cross-sectional, qualitative study were guided by a global multi-disciplinary steering committee. Fifty people with confirmed high LDL-C in Brazil, Australia, and the United States participated in 60-minute interviews between November 2023-March 2024. Half were required to have an ASCVD-related hospitalization. Interview transcripts were thematically analyzed.Results:Table 1 describes participant characteristics. During their high-LDL-C diagnosis encounter, participants often described being overwhelmed by multiple concurrent diagnoses, unfamiliar medical terms, and concerns about elevated cardiac risk. Most participants stated that their primary source of information, upon diagnosis and throughout their experiences with high LDL-C, is their HCP. Some described underestimating cardiac risks if treatment plans included lifestyle changes only or if discussions focused primarily on comorbidities. Reflecting on time between diagnosis and an ASCVD event, many participants acknowledged they had not taken their care plan as seriously as they should have. Participants offered messages and suggestions for communicating effectively with others with high LDL-C at diagnosis and regularly after diagnosis (see Table 2).Conclusions:Findings highlight an opportunity to improve cardiovascular care by overcoming indifference towards high LDL-C. Effective communication by healthcare providers at diagnosis and beyond, such as emphasizing the severity of high cholesterol and providing a realistic care plan, is crucial.

Circulation, Volume 150, Issue Suppl_1, Page A4142124-A4142124, November 12, 2024. Background:Persistent systolic anterior motion (SAM) following robotic mitral valve repair can lead to symptomatic left ventricular outflow tract (LVOT) obstruction. Percutaneous mitral valve edge-to-edge repair using MitraClip to manage LVOT obstruction from SAM following mitral valve repair has been rarely reported.Case:A 64-year-old male with history of mitral regurgitation from posterior leaflet prolapse who underwent robotic mitral valve repair with posterior leaflet butterfly resection and 38 mm Cosgrove annuloplasty band presented with progressive dyspnea with exertion and fatigue three years later. Transesophogeal echocardiogram (TEE) revealed 3+ mitral regurgitation (MR) (mean mitral valve pressure gradient 4.2 mmHg, heart rate 88 bpm) and SAM of the mitral valve with LVOT obstruction (resting gradient of 78 mmHg). He underwent a left heart catheterization to accurately measure the LVOT gradient with Dobutamine infusion. Baseline LVOT gradient was 20 mmHg that increased to 40 mmHg, 60 mmHg, and 140 mmHg with Stage 1 (5 mcg/kg/min), Stage 2 (10 mcg/kg/min), and Stage 3 (20 mcg/kg/min) of Dobutamine infusion, respectively.Decision-Making:Given his symptomatic LVOT obstruction from SAM, he was initially referred to CT Surgery for consideration of mitral valve replacement, however, given his desire to avoid long-term anticoagulation and risk of redo surgery, he was evaluated for percutaneous management. He underwent TEE guided transcatheter mitral edge-to-edge repair using a single XTW MitraClip with capture of the A2 and P2 leaflets. Post-procedural transthoracic echocardiogram (TTE) revealed trace MR and no SAM or LVOT obstruction with a resting LVOT gradient of 8 mmHg. At outpatient follow up, his shortness of breath and fatigue had significantly improved.Conclusion:Mitral valve edge-to-edge repair using MitraClip can be a safe and effective management option for patients who develop persistent SAM resulting in symptomatic LVOT obstruction following mitral valve repair.

Circulation, Volume 150, Issue Suppl_1, Page A4142999-A4142999, November 12, 2024. Patients with heart failure (HF) can range from being asymptomatic to experiencing various combinations of symptoms. Left ventricular ejection fraction (EF), measured via echocardiography, is the primary tool to differentiate between different HF types and guide therapies. However, the availability of echocardiography varies geographically. In contrast, electrocardiograms (ECGs) are more common and easily accessible. In this study, we use a deep learning approach to correlate ECG readings with their corresponding EF. Low EF is defined as ≤ 35%.Patients with the International Classification of Diseases codes for HF were screened retrospectively at Changhua Christian Hospital, Taiwan, from 2016 to 2022 with IRB approval. Only data comprising sex, age, a 10-second ECG record with a sampling rate of 500 Hz, and an echocardiography report obtained within 7 days after ECG acquisition were included. There were 3,508 samples (low EF: normal EF = 1,430:2,078) from 1,240 patients in the dataset. We reserved 10% of the samples as the final testing set (n=351) and split the remaining 90% randomly into the training and validation sets (n=2,525 and n=632) in a ratio of 8:2. A convolutional neural network was trained to classify input ECG lead(s) as either low or normal EF. For simplicity, the model with the lowest validation loss was selected and further evaluated on the final testing set.There were 721 males and 519 females with a mean age of 70.47 (±14.59). We experimented with various combinations of limb and chest leads as input ECG data and used the validation set to assess their performance, as shown in Table 1. The model trained with leads V2, I, and II had the lowest validation loss and achieved 71.3% sensitivity, 88.6% specificity, and an AUC of 87.6% on the testing set.With more information from multiple leads, a patient’s EF could be better predicted; however, the incremental benefits tapered off quickly. In our investigation, the best model was found by combining information from three leads: I, II, and V2. Our study discovered a pathway to ECG-based artificial intelligence applications and provided innovative insights into medical device design, which could benefit patients in under-resourced areas.