Risultati per: Report aggiornato sulla qualità dell’aria in Europa (2015)

Circulation, Volume 146, Issue Suppl_1, Page A13272-A13272, November 8, 2022. A 49-year-old female presented with complaints of angina and dyspnea on exertion for last 4 months, which caused significant limitation of ordinary physical activity. She had poorly controlled diabetes mellitus type 2 with HbA1C of 10.3%. EKG showed complete LBBB with QRS duration of 180 milliseconds. Echocardiogram was consistent with dilated left ventricle and global hypokinesia of left ventricle with ejection fraction of 25-30%. There was marked reduction in GLS (GLPS average of -7.0%). She underwent coronary angiogram which revealed normal epicardial coronary arteries.99mTc-sestamibi SPECT myocardial perfusion imaging (MPI) at rest, demonstrated moderate to severe ischemia involving apical, antero-septal, adjacent anterior wall and adjacent basal 2/3rdof inferior wall segments of LV myocardium (involving approx.~73% of RCA territory and 57% of LAD territory at 50% uptake threshold). There was wall motion abnormality in above mentioned segments on ECG gated SPECT and estimated LVEF with QGS was ~29±5%. She has been started on anti-ischemic measures, guideline directed therapy for HFrEF and comprehensive diabetes care. Diabetic cardiomyopathy is myocardial dysfunction with normal epicardial coronary arteries and absence of other cardiovascular diseases. It is characterized by myocardial fibrosis and associated systolic dysfunction preceded by diastolic dysfunction. Cardiac insulin resistance leads to advanced glycation end products, microvascular dysfunction etc. Perfusion defects observed during MPI in patients with LBBB may be due to CAD, microvascular dysfunction, or artifacts. In the setting of LBBB, isolated anteroseptal defect has low probability of CAD but presence of perfusion defects in RCA territory and apical region increases probability of ischemic events.In this case, there was ischemia with systolic dysfunction in the absence of any overt clinical coronary artery disease and no other identifiable cause.

Circulation, Volume 146, Issue Suppl_1, Page A15281-A15281, November 8, 2022. Introduction:Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome especially in young patients. Factors associated with delays in presentation and care delivery are not well understood.Methods:We used data from the iSCAD Registry which is a prospective multicenter US registry of patients with SCAD. Early vs. delayed hospital presentation (< 24 vs. ≥ 24 hours), and early vs. delayed coronary angiography (time from hospital presentation to coronary angiography < 24 vs. ≥ 24 hours) for SCAD patients with AMI were assessed. Patient characteristics, and in-hospital events were compared between the two groups. Factors associated with delayed presentation and angiography were explored using multivariable logistic regression.Results:A total of 346 SCAD (294 white, 52 non-white) patients presented with STEMI (34%) or NSTEMI; 57 had a delayed presentation to the hospital after symptoms onset. No significant factors were identified for delays in seeking care. However, white race was less likely to have delayed invasive coronary angiography (multivariable OR=0.38; 95% CI 0.19 to 0.76; p=0.0059). Patients undergoing delayed angiography were also more likely to be medically managed (91.7% vs. 69.8%, p=0.0008), but less likely to receive dual antiplatelet therapy (57.0% vs. 73.1%, p=0.007). In-hospital outcomes were similar between the two groups.Conclusion:In this study, no patient-related variables were identified that predicted a delay in presentation with AMI secondary to SCAD. On the other hand, non-white race was associated with delays in performing invasive coronary angiography. Further investigation is required to determine the factors contributing to this potential disparity.

Circulation, Volume 146, Issue Suppl_1, Page A13419-A13419, November 8, 2022. Introduction:Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic cause of myocardial infarction. The demographics and clinical differences based on race in patients with SCAD are not well understood.Methods:Demographics and clinical variables were obtained from the prospective, multicenter iSCAD Registry. Characteristics of study participants (including demographics, past medical history, timeline, imaging studies, follow-up visits, SCAD presentation, and treatment) were compared between white and non-white patients. Race and ethnicity was self-reported by a patient questionnaire.Results:A total of 505 patients were included in the analysis. Among them, 427 (84.6%) were characterized as white and 78 (15.4%) were characterized as non-white. White patients were 49.5 years and non-white patients were 46.8 years at the time of the initial SCAD presentation (p=0.0435). White patients were more likely to be married (77% vs 51%, p

Circulation, Volume 146, Issue Suppl_1, Page A11377-A11377, November 8, 2022. Introduction:Association of takotsubo syndrome (TTS) with spontaneous coronary artery dissection (SCAD) has been described previously. Characteristics and in-hospital prognosis of SCAD patients with concomitant TTS remain unclear.Methods:Patients with angiography-confirmed SCAD were selected from the iSCAD Registry and underwent core lab adjudication of left ventriculography (LVG) and coronary angiography including assessment of SCAD lesion characteristics, TIMI Flow Grade (TFG), and TIMI Myocardial Perfusion Grade (TMPG). Classic TTS was defined as wall motion abnormality (WMA) presenting as apical ballooning. TTS variants were defined as non-apical WMA discordant to dissected coronary territory with apical sparing. In-hospital event was defined as composite of recurrent myocardial infarction (MI), cerebrovascular accident, heart failure requiring diuretics, or new arrhythmia.Results:On blinded review of LVG from 216 patients, TTS was identified in 38 (17.6%) patients (classic, midventricular, and focal pattern: 86.8%, 2.6%, and 10.5%, respectively). There was no significant difference in age, cardiovascular risk factors, history of anxiety or depression, recreational substance use, emotional or physical stressors, extracoronary vascular abnormalities, peak troponin levels, or TFG of dissected arteries between TTS and non-TTS groups. TTS patients were more likely to present with ST-segment elevation MI (47.4% vs 27.5%; p=0.02), left anterior descending artery (LAD) involvement (89.5% vs 59.0%; p=0.0004), and TMPG < 3 (68.4% vs 48.3%; p=0.02) compared to non-TTS patients. TTS patients had a greater risk of in-hospital events (32.4% vs 15.1%; p=0.01), mainly attributed to new arrhythmia (27.0% vs 6.5%; p=0.0009) and heart failure (11.4% vs 3.0%; p=0.03).Conclusion:Coexistence of TTS and SCAD was associated with ST-elevation MI, LAD involvement, impaired microvascular myocardial perfusion, and adverse in-hospital outcomes.

Circulation, Volume 146, Issue Suppl_1, Page A15038-A15038, November 8, 2022. Introduction:Myocardial ischemia in adult ALCAPA (Anomalous left coronary artery from the pulmonary artery) may lead to sudden death as the first clinical presentation. Cardiac blood supply from the right coronary artery alone is not sufficient for an adult ALCAPA. The aim of the present study was to describe a clinical case of severe myocardial ischemia in an adult female with ALCAPA supplied by the right coronary artery alone.Patient and Clinical data:45-year-old female patient admitted to our hospital due to recurrent palpitation with tachypnoea after physical exertion for 2 years. Resting ECG on admission with ST-T changes and frequent premature ventricular contractions (PVC) indicated significant myocardial ischemia. Transthoracic echocardiography (TTE) showed dilated left ventricle (LVDd 64mm) with regional systolic dysfunction anterolateral and posterolateral with EF of 44% and dilated right coronary artery. An ALCAPA was observed with dilated caliber of 9 mm at ostium (Panel A) which was confirmed by computed tomographic angiography of the coronary artery and coronary angiography. Well-developed collateral vessels between peripheral right posterior descending (RPD) and distal left anterior descending (LAD) were demonstrated (Panel F). No collateral vessel was found between bronchial artery and ALCAPA. The bronchial arteries were visualized in normal size. The left coronary ostium was not found in the aortic root at aortography. The patient underwent anatomical reconstruction of left main coronary artery by using autologous pulmonary flap and recovered well postoperatively.Results:Postoperative ECG showed that the preoperative ST-T changes and PVC disappeared completely. Cardiac magnetic resonance imaging and TTE one month and 6 months postoperatively demonstrated continuously improved LV systolic function and myocardial perfusion posterolaterally and anterolaterally.Conclusion:Collateral flow from the right coronary artery alone is not sufficient for adult ALCAPA and completely surgical correction is necessary.

Circulation, Volume 146, Issue Suppl_1, Page A11660-A11660, November 8, 2022. Introduction:Diagnosing a pulmonary embolism (PE) can be challenging, especially when it presents as another “can’t miss” diagnosis like acute coronary syndrome. Although electrocardiogram (EKG) abnormalities can be seen in many PE presentations, rarely are ST elevations noted. We describe a case report of PE presenting as STEMI.Case presentation:A 71-year-old woman with hypertension, hyperlipidemia, type 2 diabetes mellitus, and morbid obesity presented to the emergency department with chest pain radiating to the jaw along with shortness of breath. On initial presentation her heart rate was 110 bpm, respiratory rate 40, 84% SpO2 on room air, and blood pressure 150/84 mmHg. EKG showed ST elevation in anterior leads V1-V2 and reciprocal changes of ST depression in lateral leads I, aVL, V5-V6. Serial troponins were elevated and she underwent left heart catheterization which showed non-obstructive coronary artery disease and hyperdynamic left ventricular function. Right heart catheterization (RHC) showed an elevated mean pulmonary artery pressure of 49 mmHg, and pulmonary artery pulsatility index was 2.2, suggestive of right ventricular dysfunction which prompted an urgent CT pulmonary angiogram and transthoracic echocardiogram. The CT revealed extensive pulmonary embolism and echocardiogram demonstrated dilated right ventricle with hypokinesis and akinetic right ventricular free wall. A left lower extremity ultrasound revealed deep vein thrombosis.Discussion:This patient depicts an uncommon presentation of acute PE masquerading as acute coronary syndrome. Her case was diagnostically challenging as her EKG findings were not consistent with those typically seen in acute PE. Review of the literature reveals only a handful of case reports of a PE appearing to be a STEMI. Although rare, clinicians should entertain the idea of PE when presented with ST elevation and no culprit lesion and a careful RHC may be useful in establishing diagnosis.

Circulation, Volume 146, Issue Suppl_1, Page A9492-A9492, November 8, 2022. Introduction:Left Ventricular Pseudoaneurysm (LVP) is defined as cardiac wall rupture leading to a formation of wall with thrombus, pericardial, or scar tissue functioning as a pouch for blood. A loculated pericardial effusion (LPE), and right ventricular pericardial fistula (RVPF) have never been reported in literature. Here, we report the first case of a 70 year old male who developed a LVP, LPE, and RVPF.Case Description:A 70 year old male with a past medical history of hypertension presented with inferior wall STEMI. Cardiac catheterization demonstrated left anterior descending (LAD) with 80% occlusion and right coronary artery (RCA) with 100% occlusion. Percutaneous intervention of RCA with aspiration thrombectomy and two drug eluting stents was performed. Echocardiogram the following day demonstrated a LVP. A transesophageal echocardiogram (TEE) demonstrated LVP near the mid-inferior interventricular septum draining into the pericardial space, and LPE from the apical inferior left ventricle (LV) extending to the apical cap of the right ventricle (RV). Computed tomography angiography (CTA) demonstrated a multiloculated collection at the inferior septal aspect of LV contained by the pericardial space. Patient was a high risk for surgery. LVP was closed via a 24 mm atrial septal defect (ASD) occluder device. Intraoperative TEE demonstrated an ASD occluder device at the mid inferior septum at the location of the LVP neck with minimal residual flow into the LPE and a fistula connecting the LPE space with RV. RVFP was managed conservatively. LAD was managed medically. Patient was discharged home safely on guideline directed medical therapy.Discussion:LVP rate is 0.0026% following myocardial injury. It is reported that untreated LVP have a rupture risk of about 30% and a mortality rate of 50%. Prompt treatment is required to prevent mortality. Surgical management is the standard of care. A multidisciplinary heart team deemed the patient a high risk. Therefore, transcatheter treatment was sought in the patient above.Conclusions:Surgical treatment is standard of care for LVP, but transcatheter wall closure with an ASD device is a promising technique not only for high-risk surgical candidates such as above, but as a gold standard of treatment for LVP.

Circulation, Volume 146, Issue Suppl_1, Page A12670-A12670, November 8, 2022. Introduction:Although most pediatric VAD patients survive to transplantation, some die on device therapy. The end-of-life experience of pediatric VAD patients is not well characterized.Hypothesis:Invasive interventions are common in pediatric VAD patients at the end-of-life.Methods:Retrospective review of pediatric VAD patients in the ACTION registry who died on device therapy between 3/2012-9/2021. Demographic and clinical data, including invasive interventions used at the end-of-life and the location of death, were analyzed.Results:107/721 (15%) of patients died on device at a median age of 5 years (IQR:1, 16) at 43 days (IQR: 17, 91) post implant. Goals of VAD therapy were bridge to candidacy for 50 patients (51%), bridge to transplant for 44 (37.6%), destination therapy for 2 (1.7%). The most common cause of death was multi-organ failure (n=35, 30%), followed by infection (n=12, 10.3%). Eighty-five of 92 patients (92.4%) died with a functioning device in place. Most patients were receiving invasive interventions (mechanical ventilation, 75%; vasoactive infusions, 62%) at the end-of-life. (Table 1). Only 10 (9%) patients died at home. Utilizing these data, we identified and estimated the frequency of four common end-of-life trajectories for pediatric VAD patients. (Figure 1).Conclusions:Aggressive interventions are common at the end-of-life of pediatric patients with VADs. Dying at home is uncommon. Identification of common end-of-life patterns will serve as an outcome measure and inform future practices to promote informed patient and provider decision-making to reduce suffering in those who die on device support.

Circulation, Volume 146, Issue Suppl_1, Page A325-A325, November 8, 2022. Background:In nonshockable cardiac arrest (CA) patients, the 2020 cardiopulmonary resuscitation (CPR) guidelines have stressed that high-quality CPR improves survival from CA, as with the 2015 CPR guidelines. However, it is unknown whether the 2015 guidelines contributed to the favorable neurological outcomes in adult CA patients. The present study aimed to clarify the effects of the 2015 guidelines on adult CA patients using the data of the All-Japan Utstein Registry, a prospective, nationwide, population-based registry of out-of-hospital CA (OHCA).Methods:From the data of this registry, between 2011 and 2020, we included adult witnessed OHCA patients due to cardiac etiology who had non-shockable rhythm as an initial rhythm. We excluded patients who received prehospital care in 2011, 2015, 2016, and 2020 because it was difficult to distinguish prehospital care based on either 2010 CPR guidelines, 2015, or 2020. We also excluded patients who received bystander CPR by citizens because we cannot assess the quality of bystander CPR. Study patients were divided into two groups based on the different CPR guidelines; the era of the 2010 guidelines (2010G) and the era of the 2015 guidelines (2015G). The endpoint was the favorable neurological outcome at 30 days after OHCA. Potential confounding factors based on biological plausibility and previous studies were included in the multivariable logistic regression analysis. These variables included the age, sex (male, female), advanced airway or not, the administration of adrenaline or not, the administration of saline or not, and time interval from call EMS to the scene.Results:Of the 1,259,960 patients registered in the All-Japan Utstein Registry, the data of 54,219 patients were included in this analysis. The 2015G was significantly higher in the 30-day favorable neurological outcome than the 2010G (2010G vs. 2015G = 1.5% vs. 1.8%: p=0.008). In the multivariate analysis, the adjusted odds ratio for 30-day favorable neurological outcome in OHCA patients in the 2015G compared to in the 2010G was 1.37 (95%CI 1.19-1.58, p

Circulation, Volume 146, Issue Suppl_1, Page A10768-A10768, November 8, 2022. Introduction:Ruptured mycotic aortic aneurysm is a relatively rare, life-threatening disease, which is associated with remarkable mortality. In East Asia, mortality caused by this disease is high and it is commonly caused by Salmonella species. Majority of cases of mycotic aneurysms caused by Salmonella were in the abdominal aorta wherein most of them presented with chills and fever while some presented with diarrhea from 2 days to 1 month before the aneurysm was diagnosed. Patients who present with diarrhea and abdominal pain are likely to be missed. It is therefore important that mycotic abdominal aneurysm be recognized early, and prompt treatment be initiated.Case:A 78-year-old American male, Philippine immigrant with history of ischemic stroke and chronic smoking presented with diarrhea and severe abdominal pain. Complete blood count showed leukocytosis with neutrophilic predominance. A computed tomography scan of whole abdomen exhibited a fusiform aneurysm of the infrarenal abdominal aorta with large periaortic hematoma indicating prior rupture. Open abdominal aortic aneurysm repair was successfully done and intravenous Meropenem and Ciprofloxacin were given. Blood, urine, thrombus, and aortic plaque cultures were obtained and all revealed Salmonella specie with same antibiogram. Intravenous Meropenem and Ciprofloxacin was transitioned to intravenous Ceftriaxone and was continued for 6 weeks post-operatively.Conclusion:Mycotic abdominal aortic aneurysm can be diagnosed with the combination of clinical symptoms, laboratory, radiological findings, and intraoperative findings. However, vague and non-specific symptoms do not rule out the diagnosis. High index of suspicion and low threshold for CT imaging is necessary in any patient age >60 years who present with abdominal pain and with previous history of gastroenteritis. Prompt initiation of antibiotic therapy and surgical intervention are the treatment of choice.

Circulation, Volume 146, Issue Suppl_1, Page A14923-A14923, November 8, 2022. Introduction:Aortic-left ventricular tunnel (ALVT) is an extremely rare congenital cardiac lesion that is an abnormal passage connecting the ascending aorta to the left ventricle. ALVT can be diagnosed by the use of real-time two-dimensional and continuous-wave Doppler echocardiography.Case presentation:A two-year and seven-month-old boy with recently diagnosed influenza presented to the hospital because of severe tachypnea and fatigue after running. Physical examination revealed a grade 3/6 systolic and diastolic murmur at the second and third left intercostal space. Transthoracic echocardiography (GE E95 with a 5-MHz scanning head) demonstrated that the aortic valve was a bicuspid aortic valve (BAV) with mild-moderate insufficiency during diastole, the peak systolic velocity (PSV) and gradient of aortic valve were 1.9m/s and 14mmHg, respectively; The aortic sinotubular junction (ASJ) was stenotic, the PSV and gradient of ASJ were 2.7m/s and 29mmHg, respectively; A tubular-like structure originated in the outlet septum beneath the right coronary cusp and terminated in the ascending aorta superior to the right coronary aortic sinus (Fig. A, B), CDFI and continuous-wave Doppler showed unobstructed to-and-fro (systolic and diastolic) flow in the tunnel with a high-velocity color signal that aliased during systole (Fig. C-E). Clinical considerations for congenital heart disease: ALVT combines BAV with aortic insufficiency and supravalvar aortic stenosis. The patient was referred for possible surgical correction.Discussion:In this patient, the type of ALVT does not belong to any one of Hovaguimian’s classifications. Two-dimensional echocardiography can display the tunnel-like structure of ALVT in real-time, and CDFI can identify that two-stage bidirectional shunted blood flow, systolic ventricular ejection occurs through both the tunnel and the semilunar valve, and the diastolic flow reverses from the aorta to ventricle via ALVT.

Circulation, Volume 146, Issue Suppl_1, Page A14370-A14370, November 8, 2022. Introduction:Dual antiplatelet therapy (DAPT) is standard for patients (pts.) with acute coronary syndrome due to atherosclerosis. Evidence to support DAPT vs single antiplatelet therapy (SAPT) for spontaneous coronary artery dissection (SCAD) is limited.Hypothesis:Prescription of DAPT vs SAPT varies among specialized centers for SCAD.Methods:Analysis of 505 pts. with complete patient questionnaire, case report form, and angiography review enrolled in the iSCAD Registry from 9 sites with >20 pts. enrolled. Data are presented for 442 pts. with complete medication data who received DAPT or SAPT during index hospitalization (HOSP) and continued at discharge (DC).Results:Patient age 49.6+10.2 years, 83% were female. Presentation of SCAD: NSTEMI (55.9%), STEMI (26.9%), unstable angina (13.8%), cardiac arrest (4.3%), cardiogenic shock (0.2%). Most common SCAD location was the LAD (60.9%); 20.8% had multivessel SCAD. Management was: medical therapy (75.2%), PCI (22.5%), CABG (1.4%), or PCI + CABG (0.92%). During HOSP 70.1% (317/452) were treated with DAPT vs 29.9% SAPT (135/452). At DC, 74.7% were prescribed DAPT (339/442) vs 25.3% SAPT (112/452). In multivariable analyses, only PCI as SCAD treatment was associated with DAPT during HOSP (OR 3.57, 95% CI 1.90-6.70) or DC (OR 4.9, 95% CI 2.28-10.53). There was significant heterogeneity of antiplatelet regimen across sites ranging from 34.0%-87% DAPT during HOSP (p

Circulation, Volume 146, Issue Suppl_1, Page A12354-A12354, November 8, 2022. Background:Patients with preexisting heart disease suffer more severe outcomes after COVID-19. Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac conditions. We previously reported incidence and outcomes of COVID-19 in HCM in early days of the pandemic. We report results from an expanded and extended HCM cohort.Methods:343 patients with HCM [age 59±17 years, 55% men, 19% NYHA class >1, 63% obstructive, 14% septal reduction therapy, 24% positive family history, 42% selectively genotyped (43% positive for pathogenic mutations), 22% implantable cardioverter-defibrillator (ICD) implants, 27% paroxysmal or permanent atrial fibrillation (AF), 4% AF ablation] were evaluated for COVID-19 from December 2019 to May 2022.Results.Overall, 54 (16%) patients were diagnosed with COVID-19 [56% men, age 55±17 years, 60% obstructive HCM, 5.5% dilated phase HCM, 28% positive family history, 15% genotype positive, 28% with ICD, 17% NYHA class >1, 31% AF]. There were 289 patients without COVID-19 [55% men, age 58±17 years, 63% obstructive HCM, 3% dilated phase HCM, 23% positive family history, 17% genotype positive, 21% with ICD, 19% NYHA class >1, 27% AF]. Patients with COVID-19 were slightly younger (55±17 vs 58±17 years, p 0.046) and more often had dilated phase HCM (5.5% vs 3%) and more often had ICD (28% vs 21%). Eleven (20%) patients with COVID-19 were hospitalized and 1 (2%) died of the disease. Compared to those with mild disease, hospitalized patients with COVID-19 were more often men (82% vs 49%, p 0.04), older (age 59±15 vs. 54±18 years), with obstructive phenotype (73% vs 56%) and with NYHA class >1 symptoms (27% vs 12%). In the studied patient cohort 70% had at least one dose of COVID-19 vaccine. Prior to the infection 63% of patients had no vaccination against SARS-CoV2. Among hospitalized patients 9 (82%) had no vaccination and 2 (18%) were vaccinated and had mild disease.Conclusions.Although Covid-19 infection rate (16%) in studied cohort was slightly lower than in general US population (~25%), hospitalization rate was higher (20% vs 9%) with similar death rates (1-2%). Older man with symptomatic obstructive HCM phenotype noted to have higher risk for hospitalization. Patients with vaccination against SARS-Cov2 tended to require less hospitalization.

Circulation, Volume 146, Issue Suppl_1, Page A12536-A12536, November 8, 2022. Introduction:Aortic Dissection (AD) results from a tear between the layers of the aorta. This is often seen among older males or those with heritable connective tissue disorders, and it mostly presents as chest pain. Management involves surgical repair wherein post procedure complications are to be expected. Mediastinitis, or deep sternal wound infection, however, is likewise unusual.Case Presentation:We present a case of a 29-year-old Filipino male presenting with sudden diffuse abdominal pain; he had no comorbidities and had no significant history suggestive of connective tissue disorders. Physical examination was mostly unremarkable. CT Aortogram revealed presence of dissection from the proximal ascending aorta up to the common iliac arteries, with the entry tear measuring 8.5mm at the level of T5, with extension to the proximal branches of the aortic arch, both common carotid arteries, right renal, right internal and external iliac arteries. Echocardiogram also showed a normal aortic valve but with dilated sinus of Valsalva(4.5cm, z-score 5.13). The patient underwent a Modified Bentall Procedure with Cabrol Shunt, with delayed closure of operative site due to extensive bleeding. Cystic medial necrosis was not seen on biopsy. After developing persistent post-operative fever, repeat chest CT showed a fluid collection in the mediastinum encasing the ascending aorta and main pulmonary trunk; culture of abscess fluid was positive forCandida tropicalis. He was then given prolonged parenteral followed by oral antifungal therapy and subsequently discharged improved.Discussion:Vascular causes of abdominal pain should be considered in patients with scant history and physical findings. Major vascular surgery has expected complications such as bleeding and infection; the management of such complications should incorporate a multidisciplinary approach as in such cases, a trial of medical management may be safer than repeat surgery.

Circulation, Volume 146, Issue Suppl_1, Page A13631-A13631, November 8, 2022. Introduction:Suboptimal cardiovascular health (CVH) is associated with adverse pregnancy outcomes and long-term CV risk. Studies examining contemporary trends in CV risk factors (RF) and suboptimal CVH among US women of reproductive age are limited.Methods:We used the 2015 – 2020 Behavioral Risk Factor Surveillance System, a nationally representative survey of US adults, to conduct this serial cross-sectional study. We restricted our sample to nonpregnant reproductive-aged women (18-44 years) without CVD (n=336,102). We calculated the prevalence of each CV RF (current smoking, hypertension, diabetes, hypercholesterolemia, physical inactivity, poor diet, and overweight/obesity) and suboptimal CVH (≥2 RF) for each year and examined trends between 2015 and 2020Results:Between 2015 and 2020, diabetes prevalence remained relatively stable (2.9% to 3.0%; p=0.09) while overweight/obesity prevalence increased (53.1% to 58.4%; p

Circulation, Volume 146, Issue Suppl_1, Page A13763-A13763, November 8, 2022. Introduction:Transcatheter edge-to-edge repair (TEER) of the mitral valve has become an established therapy for patients with severe mitral regurgitation; however, the impact of institutional variations in the number of edge-to-edge TEER for readmission rates with large-scale data is not well investigated.Objectives:Our study aimed to describe the institutional variations of TEER, and also the association between the institutional volume and readmission rates after the procedure across the US institutions.Methods:We conducted a retrospective cohort study of TEER performed in the US between 2019 using the Nationwide Readmission Database. We divided the patients according to the tertiles based on site-specific case of TEER (Q1 [lowest]-Q3 [highest]) and evaluated its association with 30-day readmission rates using Cox proportional hazard model.Results:Overall, 4,922 patients who underwent TEER (mean age 76.8 ± 11.5 years, and 54.5% male) at 250 institutions were included in the analyses. Patients in Q3 (highest tertile) were more likely to be older, and have comorbidities, albeit risk adjusted 30-day readmission rates were similar in each group (Q1: 13.5%; Q2: 13.6%; Q3: 13.7%). Rather than the volume of the procedure, institutional characteristics, such as teaching hospitals located in metropolitan area (hazard ratio [HR 1.92, confidence interval [CI] 1.41-2.61) and institutions with predominantly non-elective (e.g. urgent or emergent) TEER cases (HR 1.75 95% CI 1.39-2.22), or patient characteristics such as chronic heart failure (HR 1.91 95%CI 1.33-2.73), cancer (HR 1.87 95%CI 1.15-3.06), chronic kidney disease (HR 1.45 95% CI 1.20-1.75), chronic pulmonary disease (HR 1.40 95% CI 1.13-1.72), diabetes mellitus (HR 1.39 95% CI 1.12-1.72), and history of percutaneous coronary intervention (HR 1.37 95% CI 1.07-1.76) were associated with a higher incidence of 30-day readmission.Conclusions:Among patients undergoing TEER in a contemporary representative US cohort, procedure volume variation was not associated with the 30-day readmission rate.