Risultati per: Scoperte le cause biologiche della depressione

Circulation, Volume 150, Issue Suppl_1, Page A4144973-A4144973, November 12, 2024. Background:Cardiac calcium, which includes coronary and extra-coronary calcification, is often incidentally found in chest CT scans performed for various reasons. Despite its prognostic value, manual quantification of cardiac calcium in non-gated chest CT images is labor-intensive.Goals:This retrospective study aims to perform automatic quantification and scoring of cardiac calcium in non-contrast-enhanced chest CTs. The objective is to determine associations between automatic calcium scoring and outcomes such as all-cause mortality, non-fatal myocardial infarction (MI), and non-fatal stroke.Methods:We conducted a nationwide cohort study using the Taiwan National Health Insurance Research Database (NHIRD) from 2016 to 2022. Patients under 20 years old, with a diagnosis of malignancy, or with outcome events before the CT acquisition were excluded. HeaortaNet 1.0, a validated AI model, was used for cardiac calcium scoring. Comorbidities were determined using ICD diagnostic codes for ≥2 consecutive outpatient visits within the year before the index date. Outcomes were censored at the first occurrence of mortality or relevant ICD codes for MI or stroke.Results:The retrospective cohort included 279,415 patients (56.37% male, mean age 60.31±16.54). All-cause mortality occurred in 12.82% of patients within a 3-year follow-up. The 3-year incidence rates of non-fatal MI and non-fatal stroke were 0.86% and 2.07%, respectively. Multivariate-adjusted Cox hazard ratios (95% confidence intervals) for any composite outcome were 1.51 (1.46-1.57), 2.09 (2.01-2.17), 2.63 (2.53-2.74), and 3.37 (3.24-3.50) for cardiac calcium scores of 1-100, 101-400, 401-1000, and >1000, compared to a score of 0. Adjusted Cox hazard ratios for all-cause mortality were 1.62 (1.56-1.69), 2.29 (2.19-2.39), 2.91 (2.78-3.04), and 3.80 (3.64-3.96) for scores of 1-100, 101-400, 401-1000, and >1000, compared to a score of 0.Conclusion:AI-enabled opportunistic screening of non-contrast chest CT for cardiac calcium scoring is associated with all-cause mortality and cardiovascular events. This is the first large-scale cohort study to use an AI model for comprehensive cardiac calcium screening.

Circulation, Volume 150, Issue Suppl_1, Page A4139432-A4139432, November 12, 2024. Background:Over the last two decades substantial efforts have been aimed at improving acceptability of pacemakers and ICD’s in the MRI scanner. Many labs have evaluated the construction, safety, efficacy, reproducibility and more recently, clinical impact value in such legacy devices. In conjunction, there has been extensive effort by the major vendors to develop safe MRI compatible devices. We believe that there remain few reasons for hesitation in more universal useage of any PM/ICD in the MRI bore. Yet, mixing vendor leads and generators remain a major hurdle considerably limiting contemporary MRI usage innearlyall MRI laboratories. Accordingly, weHypothesize:mixed leads and generators have no distinct safety signal from common devices; whether CIED or non-CIED.Methods:We undertook a retrospective DB analysis to determine safety signals in those patients possessing mixed vendor leads and devices. Comparisons of impedance, amplitude, threshold and battery voltage and patient safety etc. were performed.Results:Patients from 5/2004 to 5/2024, representing 2008 pts with CIED (78%) and non-CIED (22%) underwent an MRI in a dedicated CMR Lab. The majority of the mixed cohort were obtained from the non-CIED cohort ( >98%), having no need for generator replacement.Accordingly, 12% of these underwent MRI to include: 76% neurologic, 7% orthopedic and 17% cardiac indications.In safety signals comparisons between standard and mixed lead/generator implants, there were no differences in any implant parameters either pre-MRI or post-interrogation (p=NS). Similarly, there were no peri-MRI pt events reported in the 30d, 180d and 365 day post-MRI scan (p=NS). Importantly, especially for EP considerations, there were no added complications to interrogations.Moreover, utilizing a similar approach to manipulation of MRI parameters for maximum safety intrinsic to dependent/non-dependent PM status was employed regardless of lead/generator configuration yielding no complications.Conclusions:Developing a similar approach to MRI scanning in those patients with mixed vendor lead/generator configurations yielded no difference in a multitude of safety, interrogation, devices and efficacy parameters implementing a similar device interrogation/programming strategy as in traditional devices. This reassurance derived from a large MRI lab suggests, despite inherent incompatibility concerns between vendors while in the magnetic field, suggests no such fears are truly warranted.

Circulation, Volume 150, Issue Suppl_1, Page A4145216-A4145216, November 12, 2024. Background:The neutrophil-lymphocyte ratio (NLR) has been proposed as a potential prognostic marker for mortality outcomes in various conditions, yet its association with chronic hemodialysis (HD) remains underexplored. We aim to study its utility by conducting a meta-analysis of this specific population.Methods:We conducted a comprehensive systematic search from PubMed, Google Scholar, and Scopus to identify studies showing the association between NLR and mortality outcomes in patients with chronic HD. Random-effects model with 95% confidence intervals (CI) were employed to pool adjusted hazard ratios (aHRs) and odds ratios (OR), I2statistics for evaluating heterogeneity for all-cause mortality (ACM) and cardiovascular mortality (CVM) outcomes. Leave-one-out sensitivity analysis and meta-regression analyses assessed changes in overall effects and identified confounders, respectively. The Joanna Briggs Institute (JBI) tool was used to assess the quality of the studies.Results:Out of 180 articles analyzed, nineteen studies comprising 9,047 patients with a mean age of 59.5 ± 5.86 years and a mean follow-up duration of 46.7 months were included in our meta-analysis. The majority of the sample had a smoking history, hypertension, diabetes, and cerebrovascular diseases. Our meta-analysis revealed a significant association between higher NLR ( >2.5) and increased risks of both ACM (aHR: 1.24, 95% CI: 1.13-1.36, P < 0.0001) (Figure 1a) and CVM (aHR: 1.23, 95% CI: 1.02-1.49, P = 0.03). (Figure 1b) Studies reporting outcomes in OR also reported similar findings for ACM (OR: 4.58, 95% CI: 1.73 - 12.1, p = 0.002) (Figure 1c) and CVM (OR: 1.11, 95% CI: 1.01 - 1.23, p = 0.03). Sensitivity analysis revealed no variations. The pooled AUC was 0.711 (95% CI: 0.63 - 0.80, p < 0.0001). JBI tool revealed higher scores indicating higher quality studies. Meta-regression analysis did not identify significant associations between NLR and confounding variables such as age. (Figure 1d)Conclusion:This meta-analysis strongly concludes that NLR ( >2.5) is significantly associated with ACM and CVM in patients with chronic HD and can be useful in planning for the prevention of mortality-related strategies.

Circulation, Volume 150, Issue Suppl_1, Page A4147067-A4147067, November 12, 2024. Background:Short-term exposure to ambient air pollution, especially particulate matter smaller than 2.5 microns in diameter (PM2.5), is associated with an increased risk of acute coronary syndrome and is identified as the leading modifiable cause of cardiovascular mortality in the long term. In this study, we set out to examine the effect of acute exposure to high levels of PM2.5(≥12 μg/m3) on long-term mortality risk of ST-elevation myocardial infarction (STEMI) patients.Methods:From June 2010 to October 2021, 1,553 patients at Liverpool Hospital in Sydney met the 4th Universal Definition of MI criteria for STEMI. The average daily maximum PM2.5was measured using publicly available land-based air quality monitors in the catchment area. Mortality risk between the two groups was compared using a Kaplan-Meier plot and further assessed using the Cox regression model.Results:915 STEMI patients presented on days with maximum PM2.5≥12 μg/m3. These patients had a significantly increased risk of late all-cause mortality with a hazard ratio of 3.08 (CI= 2.01-4.71, p

Circulation, Volume 150, Issue Suppl_1, Page A4148133-A4148133, November 12, 2024. Background:Left ventricular assist devices (LVADs) are crucial for the management of advanced heart failure patients acting, both as a bridge to heart transplant or destination therapy. Existing studies revealed mixed results on the impact of pre-implant left ventricular end-diastolic diameter (LVEDD) on post-LVAD mortality. Some studies found smaller LVEDD increases mortality, while others revealed no significant impact. Due to the limited evidence, this meta-analysis aims to determine the association between pre-LVEDD and post-LVAD implantation mortality through a systematic review and meta-analysis.Method:We systematically reviewed articles until May 2024 examining the association between pre-implant LVEDD and post-LVAD implantation mortality using PubMed, Google Scholar, Embase, and Scopus. A random effects model was used to calculate the pooled adjusted odds ratio (aOR). We used I2statistics to determine the heterogeneity of studies. Leave-one-out sensitivity analysis was done to evaluate each study’s effect on the overall estimate, with statistical significance set at p

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 A4141589-A4141589, November 12, 2024. Background:Race and neighborhood socioeconomic disadvantage are linked to worse health outcomes in heart failure, but studies have not specifically focused on patients with heart failure with preserved ejection fraction (HFpEF).Research Question:Is race associated with all-cause mortality among patients with HFpEF and does the area-level poverty moderate this association?Methods:ICD diagnostic codes for HFpEF were used to identify patients with first hospitalizations for HFpEF in University of Alabama in Birmingham (UAB) Medicine EHR data from 2017-2023. Demographics, comorbidities, and laboratory data were extracted at admission. Patient zip codes were merged with Census zip code poverty data. All-cause mortality was ascertained in the EHR. Multivariable-adjusted Cox proportional hazard models examined the association between race and all-cause mortality and interaction between race and zip-level poverty ratio, dichotomized at the median.Results:Between 2017-2023, 14,043 adults had a first hospitalization for HFpEF at UAB; 37% were African American (AA), 58% white, 4.5% from other race/ethnicities. Half resided in high poverty areas (19% of area residents with income below the median poverty level). Compared to whites, AA adults with HFpEF were more likely to be younger, women, reside in high-poverty areas, and have hypertension, diabetes, obesity, worse kidney function and higher brain-natriuretic peptide at admission (Table). Over a median follow-up of 2.7 years [IQR: 0.9-4.9 years], there were 3,747 deaths; 2146 (26.2%) among whites, 1447 (27.8%) among AAs, and 154 (24.3%) among other ethnicities. AA adults had increased all-cause mortality compared to whites, with an adjusted HR 1.14 [95% CI: 1.06-1.23, p=0.001]. The race* poverty interaction p-value was 0.02, indicating that the association between race and all-cause mortality was significantly more pronounced among those residing in higher poverty areas (Table). This was not observed for AA adults in lower poverty areas or for other ethnicities.Conclusion:In this study, AA patients with HFpEF, residing in high poverty areas, had higher all-cause mortality rates compared to white patients. No racial differences in mortality were observed in lower poverty areas.

Circulation, Volume 150, Issue Suppl_1, Page A4140995-A4140995, November 12, 2024. Background:Coil-less ultrasonic vaping devices like Surge use an ultrasonic chip that vibrates at several million Hz, aerosolizing the e-liquid. They are advertised as emitting significantly lower levels of toxins than coiled e-cigs by heating to lower temperatures that produce fewer chemical breakdown products. We tested the hypothesis that ultrasonic e-cigs cause less adverse cardiac effects than coiled e-cigs.Methods:We exposed 3 groups of conscious Sprague Dawley rats (n=8/group) to aerosol from JUUL (Virginia Tobacco 5% nicotine), Surge (Rich Tobacco 18 mg/ml nicotine), or air. Pulsatile exposure consisted of 10 consecutive cycles, each consisting of 2s exposure to aerosol followed by 28s of clean air, over 5 min, for 9 weeks using a Gram Research universal vaping machine. Hearts were then isolated, sectioned, and stained for left and right ventricular fibrosis with Sirius Red. Temperature profiles for the Surge ultrasonic vaping device were obtained at the California Department of Public Health (CDPH) via a single point thermocouple probe.Results:Temperature profiles of Surge during one session of aerosol production (with airflow) showed temperatures not exceeding 132 degrees Celsius. (We previously reported that the USONICIG Zip ultrasonic vaping device with air flow heated to ~77 degrees Celsius; reported temperatures of coiled e-cigs are up to 300 degrees Celsius.) Fibrosis was significantly increased in the JUUL group compared to air (p=0.04). Mean fibrosis in the Surge group was comparable to that in the JUUL group (p=0.84) and was higher than air fibrosis but did not reach significance (p=0.15), potentially due to high variability of Surge values.Conclusion:Temperature profiles of ultrasonic vaping devices are substantially lower than those of coiled vaping devices, with Surge being warmer than USONICIG Zip under airflow conditions. Despite lower temperatures, ultrasonic vaping devices cause a comparable level of cardiac fibrosis to conventional coiled vaping devices. Therefore, Surge does not avoid the increase in cardiac fibrosis that we have reported for coiled e-cigs and for smoke from tobacco or marijuana.

Circulation, Volume 150, Issue Suppl_1, Page A4147579-A4147579, November 12, 2024. Background:The American Heart Association (AHA) has acknowledged the interconnection of obesity, type 2 diabetes mellitus (DM), cardiovascular disease (CVD), and chronic kidney disease (CKD) as a complex health disorder named Cardiovascular-Kidney-Metabolic (CKM) syndrome. Patients with CKM progress to major adverse cardiac and cerebrovascular Events (MACCE). The aim of the study is to analyse nationwide trends in MACE and all causes. mortality among patients aged 65 years and older with CKM syndrome.Methods:Using a National Inpatient Sample (2016–2020) geriatric admissions among patients admitted with CKD and at least One cardiometabolic risk factor (HTN, DM, HLD, and obesity) were selected using ICD-10. codes. Patients were classified into MACCE+ve cohorts if they had acute myocardial infarction, cardiac arrest or acute ischaemic stroke present otherwise into MACCE-ve. Trends, Demographics, comorbidities, and all-cause mortality were analysed between the two cohorts.Results:In our NIS study, the MACCE+ve and -ve cohorts had median ages of 78 (72–85) and 78 (72–85). years with 55.9% and 51.1% males and 44.1%. and 48.9% females, respectively. over a period of 5 years (2016–2020) in patients with CKM syndrome hospitalisation has increased with MACCE (from 10.4% to 12.7%) with an increase in hospital mortality (4.6% to 6%) (ptrend

Circulation, Volume 150, Issue Suppl_1, Page A4141427-A4141427, November 12, 2024. Introduction:In acute pulmonary embolism (PE), right ventricular (RV) remodeling and hemodynamic involvement using echocardiography data are associated with in-hospital prognosis. The impact on mid-term outcome of right atrial (RA), RV, left ventricle (LV), and left atrial (LA) involvement using myocardial deformation analysis is poorly evaluated.Hypothesis:We hypothesized that acute PE had a global impact on 4-heart cavities geometry and functions.Aims:We sought to evaluate the prognostic value at mid-term of myocardial strain of the 4-cardiac cavities in patients with acute PE.Methods:We retrospectively analyzed 488 patients hospitalized for acute PE. LV, LA, RA and RV strains were measured using speckle tracking transthoracic echocardiography (TTE) at admission. Primary outcome was mid-term all-cause mortality.Results:During a median follow-up of 3.6 (2.7-4.7) years, all-cause death occurred in 93 patients. At baseline, patients with the highest severity of PE, based on ESC risk score determination, had significantly lower LA (reservoir, conduit, contractile), RA (reservoir, conduit), LV (global, GLS) and RV (free wall) longitudinal strains (Figure 1). The optimal strain thresholds associated with mortality are displayed in Table 1: -19.1% for LV and RV, +36.4% for LA reservoir strain, +16.6% for LA conduit strain, +27.5% for RA reservoir strain, +16.0% for RA conduit strain. Kaplan Meier curves for cumulative hazards for all-cause death using strain parameters showed significant difference of survival according to LV GLS, RV free wall strain, LA and RA reservoir strains, LA and RA conduit strains (Figure 2).Conclusion:Beyond RV cavity remodeling and dysfunction, PE induces acute alteration of the 4-cardiac chambers strains. Strain analysis appears as an interesting tool in addition to conventional echocardiographic parameters to assess heart cavities dysfunction and predict mid-term outcome.

Circulation, Volume 150, Issue Suppl_1, Page A4145015-A4145015, November 12, 2024. Case Presentation:A 98-year-old female with hypertension, atrial fibrillation on Metoprolol succinate 100 mg daily, and stage 3a chronic kidney disease presented to the emergency department with altered mental status. On arrival, her heart rate was 30 BPM and blood pressure was 79/47 mmHg. Physical examination revealed lethargy, bradycardia, and cool extremities. An electrocardiogram showed junctional bradycardia at 36 BPM with a known right bundle branch block. Laboratory tests indicated shock with elevated lactic acid (2.6 mmol/L), creatinine (1.71 mg/dL from a baseline of ~1.20 mg/dL), transaminitis (aspartate transaminase 68 U/L, alanine transaminase 79 U/L), and hyperkalemia (potassium 6.1 mmol/L). The diagnosis of BRASH syndrome was made based on bradycardia, renal dysfunction, AV nodal blockade, shock, and hyperkalemia. Due to concerns of cardiogenic shock resulting from profound bradycardia, an intravenous dopamine infusion was initiated, and the patient was transferred to the cardiac critical care unit. She responded to medical management addressing hyperkalemia and bradycardia, and did not require renal replacement therapy or pacemaker placement. Following these interventions, her mental status, vital signs, and signs of end-organ damage rapidly improved. The patient was downgraded and subsequently discharged with close cardiology follow-up.Discussion:This case highlights the under-recognized diagnosis of BRASH syndrome as a cause of cardiogenic shock. BRASH syndrome, an acronym for Bradycardia, Renal failure, AV node blockers, Shock, and Hyperkalemia, is typically observed in patients on AV nodal blocking medications. The proposed pathophysiology involves an acute kidney injury, often precipitated by dehydration in elderly patients with preexisting kidney disease. The renal impairment leads to hyperkalemia and accumulation of AV nodal blocking medications like beta-blockers, which act synergistically to produce significant bradycardia. This results in substantial cardiac shock, further worsening renal perfusion and fueling a vicious cycle. Clinicians should recognize the combination of features rather than focusing solely on individual components of the syndrome. Immediate recognition and initiation of advanced measures such as inotropic support can reverse the underlying disease process and lead to a promising recovery. BRASH syndrome, though rare, is a rapidly reversible cause of cardiogenic shock if promptly identified and managed.

Circulation, Volume 150, Issue Suppl_1, Page A4141389-A4141389, November 12, 2024. Introduction:Heart failure with preserved ejection fraction (HFpEF) is an increasingly prevalent form of heart failure (HF) in the US today. Our prior work revealed low albumin at first hospitalization for HF exacerbation with underlying HFpEF to be an independent predictor of all-cause mortality in a small cohort of patients. We now sought to confirm our earlier findings across a larger and more diverse patient population.Methods:Seven thousand, eight hundred and forty patients had a first admission to Mayo Clinic for HF exacerbation with an echo-confirmed left ventricular ejection fraction >50% between 2010 and 2020. Patient baseline demographics, co-morbidities, admission laboratory values, echocardiographic parameters, discharge medications, and outcomes were obtained from chart abstraction. To validate our previous model, patients were grouped based on the number of risk factors as previously defined: age >80 years, serum albumin level

Circulation, Volume 150, Issue Suppl_1, Page A4113475-A4113475, November 12, 2024. Introduction:Diabetes is a leading cause of morbidity and mortality in the United States, causing an estimated 440,000 deaths among US adults in 2019. Establishing the relevance of diabetes diagnosis at various ages to mortality in the contemporary US population, both overall and among major demographic subgroups, may inform public health policy and strategy.Methods:We aimed to quantify the association between age at diabetes diagnosis and all-cause and cardiovascular mortality among US adults using publicly-available data from the National Health Interview Survey 1997-2018, linked to the National Death Index through 2019. We used Cox regression adjusted for age, sex, race and ethnicity, educational attainment, smoking status, body-mass index, physical activity, and insurance coverage to estimate all-cause and cardiovascular mortality rate ratios overall, by sex, and by race and ethnicity.Results:Among 601,467 included adults (56% female, 16% Hispanic and 14% non-Hispanic Black) there were 75,122 deaths during 6.6 million person-years of follow-up. Overall, the all-cause mortality rate ratio associated with diabetes diagnosed at ages 20-29, 30-39, 40-49, 50-59, 60-69, or 70-79 years were 3.87 (95% CI 3.47-4.32), 2.87 (2.68-3.07), 2.26 (2.16-2.36), 1.72 (1.65-1.79), 1.47 (1.41-1.53), and 1.26 (1.19-1.33), respectively. The corresponding cardiovascular mortality rate ratios were 5.02 (4.09-6.16), 3.37 (2.99-3.78), 2.88 (2.65-3.13), 1.94 (1.81-2.09), 1.53 (1.43-1.65), and 1.27 (1.15-1.40), respectively. Although these associations were similar by sex and by race and ethnicity, the age-specific prevalence of diabetes was greatest among non-White participants. Among individuals with diabetes diagnosed at ages 20-29, 30-39, 40-49, 50-59, 60-69, or 70-79 years, an estimated 74%, 65%, 56%, 42%, 32%, or 20% of deaths from any cause were attributable to diabetes.Conclusion:Age at diabetes diagnosis was associated with all-cause and cardiovascular mortality in a dose-dependent and approximately log-linear manner. Although associations were similar across diverse demographic groups, age-specific diabetes prevalence was greatest among non-White individuals, leading to greater mortality burden. If these associations were interpreted as largely causal, diabetes accounted for more than half of all deaths among those diagnosed before age 50 years. Preventing, delaying, and appropriately managing diabetes could prevent substantial excess mortality among US adults.

Circulation, Volume 150, Issue Suppl_1, Page A4146444-A4146444, November 12, 2024. Introduction:Higher levels of physical activity (PA) are associated with lower mortality in different populations. However, no previous study evaluated this association among patients with Chagas disease (CD), a neglected tropical disease that affects approximately 7 million people worldwide associated with high mortality rates in its more advanced stages.Aim:This study aimed to assess the association between PA level and all-cause mortality in patients with CD.Methods:This was an observational study including CD patients (confirmed by two serological methods) followed-up at the National Institute of Infectious Diseases Evandro Chagas (INI/Fiocruz). Baseline assessment was conducted from March 2014 to March 2017. PA level was assessed using International Physical Activity Questionnaire short version (IPAQ). Deaths were assessed using patients’ medical records and the regional death registry system. The association between PA levels (tertiles and as continuous variable) and mortality was determined by log-rank test and Cox regression models. Adjusted analyses were conducted for potential confounding variables including age, sex, hypertension, diabetes mellitus, dyslipidemia, obesity, clinical form of CD, ejection fraction, and prior use of benznidazole.Results:Of the 361 participants included, 56.2% were women (mean age 60.7±10.7 years). During a median follow-up of 7.2 years (IQR 25-75% 5.4 to 8.0 years), there were 90 deaths (24.9%), of those 39 (32.2%) in the lowest PA tertile, 32 (26.7%) in the intermediate PA tertile, and 19 (15.8%) in the highest PA tertile (p=0.006, Log-Rank test). In adjusted Cox regression analysis, the risk of death was lower in the highest PA tertile compared to those in the lowest PA tertile (HR 0.55; 95% CI 0.31 to 0.96; p

Circulation, Volume 150, Issue Suppl_1, Page A4140452-A4140452, November 12, 2024. Background:The recent REDUCE-AMI trial showed no benefit to beta-blockers (BB) for patients post-myocardial infarction (MI) with preserved ejection fraction (EF≥50%). Target doses were metoprolol 100 mg and bisoprolol 5 mg daily (50% of the target doses used in the initial randomized clinical trials [RCTs] of BB post-MI).Research question:Do lower BB doses improve survival in post-MI patients with EF≥50%?Aims:To compare the effect of BB dose on all-cause mortality post-MI in patients with EF≥50%.Methods:This is a sub-study from the OBTAIN prospective multi-center registry. Of 7057 patients enrolled with acute MI, 3402 with EF≥50% were discharged alive (age:62.5±13.4 years, 67% male, 28% diabetics, length of stay 6.1±6.0 days). Discharge BB dose was indexed to the target daily BB dose used in RCTs, reported as %. Dosage groups were >0-12.5%, >12.5-25%, >25-50%, and >50% of the target dose. Follow-up vital status was obtained by chart review, Social Security Death Index, or direct contact up to 3 years post-MI. Kaplan-Meier (KM) method was used to calculate three-year survival. Cox proportional hazard regression model was used to identify significant predictors and conduct univariate and multivariate analysis.Results:The KM 3 year survival estimates were 89.0% and 84.3% for patients on and off BB, respectively (unadjusted hazard ratio (HR)=0.66, p=0.012; adjusted HR=0.52, p=0.18). The KM 3 year survival estimates(figure) were 89.8%, 91.0%, 87.9%, and 83.1% for patients on >0-12.5%, >12.5-25%, >25- 50%, and >50% of the BB target dose (unadjusted HR of 0.58, p=0.007; 0.58, p=0.003; 0.70; p=0.066; and 0.98, p=0.93), respectively, compared to no BB. After multivariate analysis, BB target dose showed similar trend, but not statistically significant (adjusted HR=0.65, p=0.46; 0.42, p=0.13; 0.53, p=0.31; 1.01, p=0.92).Conclusion:In OBTAIN, patients treated with low dose BB (≤25% of the target dose) had improved survival post-MI. As this dose was not studied in REDUCE-AMI, these findings are complementary and confirm only that high dose BB therapy provides no benefit post-MI in patients with preserved EF. RCTs to assess the benefit of low dose BB therapy post-MI with preserved EF are needed.

Circulation, Volume 150, Issue Suppl_1, Page A4144083-A4144083, November 12, 2024. Background:The AI-CVD initiative aims to extract all useful opportunistic screening information from coronary artery calcium (CAC) scans and combines them with traditional risk factors to create a stronger predictor of cardiovascular diseases (CVD). These measurements include cardiac chambers volumes (left atrium (LA), left ventricle (LV), right atrium (RA), right ventricle (RV), and left ventricular mass (LVM)), aortic wall and valvular calcification, aorta and pulmonary artery volumes, torso visceral fat, emphysema score, thoracic bone mineral density, and fatty liver score. We have previously reported that the automated cardiac chambers volumetry component of AI-CVD predicts incident atrial fibrillation (AF), heart failure (HF), and stroke in the Multi-Ethnic Study of Atherosclerosis (MESA). In this report, we examine the contribution of other AI-CVD components for all coronary heart disease (CHD), AF, HF, stroke plus transient ischemic attack (TIA), all-CVD, and all-cause mortality.Methods:We applied AI-CVD to CAC scans of 5830 individuals (52.2% women, age 61.7±10.2 years) without known CVD that were previously obtained for CAC scoring at MESA baseline examination. We used 10-year outcomes data and assessed hazard ratios for AI-CVD components plus CAC score and known CVD risk factors (age, sex, diabetes, smoking, LDL-C, HDL-C, systolic and diastolic blood pressure, hypertension medication). AI-CVD predictors were modeled per standard deviation (SD) increase using Cox proportional hazards regression.Results:Over 10 years of follow-up, 1058 CVD (550 AF, 198 HF, 163 stroke, 389 CHD) and 628 all-cause mortality events accrued with some cases having multiple events. Among AI-CVD components, CAC score and chamber volumes were the strongest predictors of different outcomes. Expectedly, age was the strongest predictor for all outcomes except HF where LV volume and LV mass were stronger predictors than age. Figure 1 shows contribution of each predictor for various outcomes.Conclusion:AI-enabled opportunistic screening of useful information in CAC scans contributes substantially to CVD and total mortality prediction independently of CAC score and CVD risk factors. Further studies are warranted to evaluate the clinical utility of AI-CVD.