Risultati per: Libro sugli antibiotici del WHO AWaRe (Access, Watch, Reserve)

Circulation, Volume 150, Issue Suppl_1, Page A4137423-A4137423, November 12, 2024. Background:Elevated lipoprotein(a) [Lp(a)] is an inherited, currently non-modifiable risk marker that increases lifetime ASCVD risk. Guidance vary on Lp(a) levels at which risk increases; hence prevalence of “elevated” Lp(a) depends on putative thresholds e.g. >1.3 billion people globally have Lp(a)≥125 nmol/L. Lp(a) levels are >90% genetically determined and stable throughout life; hence measurement once in adulthood is recommended. Awareness of Lp(a) levels may change patient management with more intensive control of traditional risk factors. However, testing all adults is costly and the test is not universally available.Research Question:Can Machine Learning (ML) models reduce the number needed to screen (NNS) compared to population universal screening for identifying individuals with elevated Lp(a)?Aims&Objectives:To derive a model from ML to help prioritise individuals likely to have high levels for Lp(a) testing and compare its yield to universal screening at different Lp(a) cut-points. This approach could enable automatic screening of large databases like EHRs for Lp(a) testing.Method:We conducted a cross-sectional predictive analysis using UK Biobank, including individuals ≥40 years old with Lp(a) measurements, split into feature importance, derivation, and validation datasets. Eight ML classification algorithms were used for feature importance analysis and model derivation. Models’ performance was evaluated in the validation set using sensitivity and NNS in comparison with the discrimination ability of the following guidelines across different populations: The 2019’s Heart UK and European Atherosclerosis Society (EAS) and Society of Cardiology guidelines, the 2022 EAS Consensus Statement, and threshold used in clinical trial —respective cut-offs: 90,430,125,200nmol/L.Results:438,579 patients were included. The best ML models were neural networks with different weights. Regardless of the Lp(a) threshold used, ML models resulted in higher rates of high Lp(a) cases identified per million tests with lower NNS compared to universal screening (Table 1). Using higher Lp(a) thresholds (200-430nmol/L) increased models sensitivity with far fewer tests required to identify those with high Lp(a).Conclusion:ML models could reduce the number of tests needed to identify individuals with high Lp(a), increasing efficiency and potentially helping to prioritize Lp(a) testing, with a potentially scalable cost-effective option for health systems.Work supported by Novartis

Circulation, Volume 150, Issue Suppl_1, Page A4138949-A4138949, November 12, 2024. Type 2 Diabetes (T2DM) and pre-existing coronary artery disease (CAD) are strong and independent risk factors for cardiovascular events, and data from large cohort studies suggest that the cardiovascular risk conferred by T2DM in the absence of CAD is equivalent to that conferred by CAD in the absence of T2DM. However, because the presence of CAD in these studies was defined clinically rather than by visualization, unrecognized subclinical CAD in T2DM patients may have biased results.We therefore prospectively investigated patients with T2DM and non-diabetic subjects in whom the baseline CAD state was diagnosed angiographically. We recorded cardiovascular events over a follow-up period of 22 years in a large cohort of 1819 patients undergoing coronary angiography for the evaluation of established or suspected stable CAD.From our patients, 595 had neither significant CAD nor T2DM (CAD-/T2DM-), 171 had T2DM but not significant CAD (CAD-/T2DM+), 701 had significant CAD but not T2DM (CAD+/T2DM-) and 352 had both T2DM and significant CAD (CAD+/T2DM+). The incidence of cardiovascular events was lowest in CAD-/T2DM- patients (24.7%). Compared to this group it was significantly higher in CAD-/T2DM+ patients (36.1%; p

Circulation, Volume 150, Issue Suppl_1, Page A4138602-A4138602, November 12, 2024. Background:Coronary Computed Tomography Angiography (CCTA) and CT-derived fractional flow reserve (CT-FFR) accurately assess the severity of coronary artery disease. However, the diagnostic accuracy of CT-FFR in patients with low left ventricular ejection fraction (LVEF) is unknown.Goal:Describe the per-vessel diagnostic performance of CT-FFR to detect significant coronary disease in patients with normal and reduced LVEF by echocardiogram.Methods:This was a retrospective study of 441 patients who underwent CCTA and CT-FFR at the UMass Memorial Health System between 2020 and 2023. Those with echocardiogram and invasive coronary angiography were analyzed and divided in two groups based on two-dimensional LVEF: those with LVEF < 55%, and with LVEF ≥ 55%. We excluded those with prior coronary stents, incomplete CCTA, CT-FFR data due to artifacts, or poor-quality echocardiographic images. CT-FFR ≤ 0.8 was considered abnormal. Significant coronary disease by invasive angiography (reference standard) was defined as lumen stenosis ≥ 70% (left main ≥ 50%), or abnormal physiologic characteristics by FFR, resting full-cycle ratio, or instantaneous wave-free ratio.Results:222 coronary vessels (102 patients) were analyzed. Of 102 vessels (44%) with significant coronary artery disease, 55 (53.9%) were treated with percutaneous coronary intervention, and 25 (24.5%) with coronary artery bypass grafting. Overall, CT-FFR sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 86.7% (95%CI 78.3-92.7), 75.0% (95%CI 66.4-82.3), 73.2% (95%CI 66.6-78.9), 87.7% (95%CI 81.0-92.3), and 80.1% (95%CI 74.3-85.2), respectively. 37 vessels corresponded to patients with LVEF < 55%, and 185 to those with LVEF ≥ 55%. Diagnostic accuracy in both groups is seen in table 1.Conclusions:Low-normal and reduced LVEF adversely affects the diagnostic performance of CT-FFR, by reducing sensitivity, and slightly increasing specificity.

Circulation, Volume 150, Issue Suppl_1, Page A4118444-A4118444, November 12, 2024. Background:Childhood cancer survivors are at risk of right ventricular (RV) dysfunction in relation to cardiac toxicity due to chemotherapy and radiation therapy. This study tested the hypothesis that RV contractile reserve and RV-pulmonary arterial (PA) coupling are altered in long-term survivors of childhood cancers.Methods:Thirty survivors (60% men) aged 24.3 ± 5.2 years at 15.3 ± 6.3 years after completion of chemotherapy and thirty healthy control subjects (47% men) were studied. Resting and submaximal supine bicycle stress echocardiography was performed for assessment of RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), left ventricular (LV) and RV longitudinal strain, mitral and tricuspid annular velocities and myocardial acceleration during isovolumic contraction (IVA). The slope of the RV force-frequency relationship was derived from the change in IVA with the change in heart rate during exercise (△IVA/△heart rate), while RV-PA coupling was determined by the ratio between TAPSE and pulmonary arterial acceleration time indexed to RV ejection time (PAATi).Results:At rest, tricuspid annular systolic velocity and RV systolic strain were significantly lower in survivors (P< 0.05 for both), while RV FAC, TAPSE and IVA were similar between the two groups (P > 0.05 for all). During submaximal exercise testing, all RV systolic functional indices were significantly lower in survivors than controls (P< 0.05 for all). The slope of the RV force-frequency relationship was significantly flatter in survivors compared to controls (0.038 ± 0.002 vs 0.059 ± 0.003 m/sec2beats/min,P< 0.001). For RV-PA coupling, TAPSE/PAATi was similar between survivors and controls at baseline but became significantly lower in survivors during submaximal exercise (P= 0.002).Conclusions:The RV contractile reserve and RV-PA coupling are impaired during exercise in long-term survivors of childhood cancers. Future studies aimed at determining the clinical and prognostic significance of these impairments are warranted.

Circulation, Volume 150, Issue Suppl_1, Page A4142989-A4142989, November 12, 2024. Background:Cardiovascular magnetic resonance (CMR) has an emerging role in graft surveillance for pediatric heart transplant recipients (PHTR). Transplanted grafts are susceptible to cardiac allograft vasculopathy, manifested as macrovascular narrowing on angiography, as well as micro-vessel disease. By CMR, myocardial perfusion abnormalities can be evaluated semi-quantitatively, by calculation of a myocardial perfusion reserve index (MPRI). However, normal MPRI values have not been well established in PHTR and prior investigation of associations between MPRI and graft pathology remain limited.Research Aims:The goals of this study were to describe the MPRI findings in a large cohort of PHTR and to evaluate clinical associations with low MPRI.Methods:We performed a retrospective chart review of consecutive, stress CMR studies at a single center from 2015-2024. Follow-up studies were excluded. Biventricular volume and function analyses were performed. A total dose of 0.15mg/kg gadobutrol was administered for rest and stress imaging. Regadenoson was the pharmacologic stressor at dose of 6-10mcg/kg, up to max 400mcg. Time signal intensity curves were obtained from perfusion datasets at stress and rest at the base, mid-ventricle, and apex. Segmental MPRI was calculated as a ratio of the maximal upslopes of the curves at stress versus rest. Global MPRI was computed as a mean of all segments.Results:128 PHTR were included. Mean age was 12.5±5.3y, with 5.9±3.8y since transplant. A clinical concern prompted CMR in 18% of studies; in 82% the indication was routine surveillance. History of CAV was present in 6% and moderate or severe rejection in 22%. In 11 studies, images were inadequate for MPRI analysis. In the 117 studies included for analysis, global MPRI was normally distributed with mean 1.38±5.3. Mean MPRI observed at the mid-ventricle (1.49±0.46) was higher than at the base (1.32±0.32) and apex (1.33±0.39), (p

Circulation, Volume 150, Issue Suppl_1, Page A4147087-A4147087, November 12, 2024. Introduction:Fractional flow reserve (FFR) is an invasive, lesion-specific surrogate for myocardial ischemia. The use of FFR to guide lesion selection for revascularization has been shown to improve outcomes compared to an angiographic approach because it allows revascularization of lesions based on hemodynamic significance.Purpose:To compare the outcomes of patients randomized to the invasive (INV) arm of the ISCHEMIA trial who underwent FFR during initial angiography with those whose treatment was guided by angiography alone.Methods:The ISCHEMIA data set was obtained from the NHLBI. Subjects randomized to the INV arm who underwent FFR were compared to those who underwent angiography alone. Unadjusted cumulative event probabilities were estimated using the Kaplan-Meier method. Multivariable Cox proportional hazards analysis was used to estimate the independent impact of FFR on outcomes. Primary endpoint of interest was cardiovascular death (CV) death or MI.Results:Of the 5,179 patients with chronic coronary syndromes and at least moderate ischemia on stress testing, 2,588 were randomized to the INV strategy, 2,475 underwent angiography and 2,210 had baseline data available for analysis. Of these, 410 (19%) had FFR performed during diagnostic angiograms. Females comprised 24% of FFR patients and 24% of non-FFR patients (P=0.85). FFR patients were older than non-FFR patients (65.7 [8.7] years vs. 64.3 [9.6] years, P=0.006). The incidence of hypertension, diabetes, smoking, or prior MI at baseline did not differ between groups. Fewer FFR patients had severe ischemia at baseline (45% vs. 52%) and more had mild or moderate ischemia (54% vs. 48%) (P=0.009). FFR patients had less extensive disease as manifested by fewer native vessels with >70% stenosis than non-FFR patients (1.0 [0.9] vs. 1.5 [1.0], P

Circulation, Volume 150, Issue Suppl_1, Page A4141616-A4141616, November 12, 2024. Background:Cardiopulmonary exercise testing (CPET) remains an important test for risk assessment in ambulatory heart failure patients to identify those who may benefit from advanced therapies, such as left ventricular assist device (LVAD) or heart transplantation (HT). The prognostic strength of cardiac performance variables at peak exercise, including oxygen consumption (VO2), oxygen pulse (O2pulse) and circulatory power (CP) is known. We explored the prognostic utility of augmentation of these parameters between resting and peak stress conditions.Methods:We performed a retrospective analysis of ambulatory heart failure patients from the National Heart, Lung, Blood Institute funded REVIVAL and our institutional PREDICT-HF databases. Patients with heart failure that underwent CPET and ≥ 1-year of follow-up were included. The primary outcome was a composite of death, HT, or LVAD at 1-year following CPET. The absolute change (Δ) in CPET variables was defined as the difference between resting and peak values.Results:A total of 351 patients from PREDICT-HF (n=110) and REVIVAL (n=241) were included; mean age 58, 70% male, 31% Black, 59% non-ischemic, median NYHA functional class 3, median INTERMACS profile 6, and mean LVEF 26%. At 1-year, there were 61 events (17%), which included 20 deaths, 19 HTs, and 22 LVAD implants. The ΔVO2, ΔO2pulse, and ΔCP were all higher in the non-event group (all p

Circulation, Volume 150, Issue Suppl_1, Page A4136358-A4136358, November 12, 2024. Background:Electrocardiography (ECG) stands as the gold standard for the evaluation of cardiac arrhythmias. Recent smartwatches aim to promptly detect rhythm abnormalities enhancing user experience. However, the accuracy of these devices remains controversial. Our purpose was to perform a systematic review and meta-analysis evaluating the diagnostic performance of the Apple Watch electrocardiogram in detecting atrial fibrillation (AF).Methods:The literature search was conducted on PubMed, Embase, and Cochrane through April, 2024 for studies comparing the diagnostic accuracy of Apple Watch to standard 12 Lead ECG. Statistical analysis was performed using R Software version 4.4.0. Pooled analyses of sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were determined along with their 95% confidence intervals (CI). The quality of studies was analyzed using the QUADAS-2 tool.Results:The meta-analysis included 11 studies comprising 13,490 participants. Their mean age was 62.56 ± 3.92 years and 28% of the population were females. The pooled sensitivity and specificity of Apple Watch for detecting AF was 94.8% (95% CI 91.7 – 96.8%) and 95% (95% CI 88.6 – 97.8%) respectively. The AUC was 0.96 (95% CI 0.92 – 0.97; Figure 1). Sensitivity analysis for heterogeneity revealed no significant change in values for sensitivity 94.8% (95% CI 91.7-96.8%) and specificity 94.9% (95% CI 88.6-97.8%). The studies had a low risk of bias in Index test and reference standard domains, but a high risk of bias in patient selection and Flow and timing domains.Conclusion:The Apple Watch ECG shows a high accuracy in detecting atrial fibrillation, providing a convenient and timely option for such patients.

Circulation, Volume 150, Issue Suppl_1, Page ASu701-ASu701, November 12, 2024. Background:This study aimed to evaluate the influence of public assistance on patients with out-of-hospital cardiac arrest (OHCA) who received extracorporeal cardiopulmonary resuscitation (ECPR) in Japan.Methods:We conducted a secondary analysis of data from the SAVE-J II study, a retrospective, multicenter registry study involving 36 participating institutions in Japan. Patients with cardiac arrest who received ECPR were divided into two groups depending on whether or not they had received public assistance. The primary outcome was 30-day survival. Secondary outcomes were as follows: 30-day favorable neurological outcomes (cerebral performance category scores 1-2); survival at discharge; favorable neurological outcome at discharge; number of intensive care unit, hospital, ventilator, and extracorporeal membrane oxygenation days; medical expenses; proportion of percutaneous coronary intervention; target temperature management; mechanical circulatory support (MCS) device use; and withdrawal of life-sustaining therapy.Results:Of 2,157 patients registered in the SAVE-J II study, 1,885 patients were enrolled in this study; 99 patients (5.3%) received public assistance and 1,786 patients (94.7%) did not. Multivariable logistic regression analysis did not show a significant difference in 30-day survival (OR 1.22, 95% CI 0.77-1.95, p=0.40). The log-rank test for the Kaplan-Meiercurve on 30-day survival did not demonstrate a significant difference (p=0.46). Except for the use of MCS devices, there were no significant differences in secondary outcomes.Conclusions:The use of public assistance did not influence the prognoses of OHCA patients receiving ECPR. Treatment option during hospitalization may be affected by the use of public assistance.

Circulation, Volume 150, Issue Suppl_1, Page A4141761-A4141761, November 12, 2024. Background:Rotational atherectomy has been performed using both radial and femoral access over the years, but there is a lack of consensus on the safety and efficacy of these access sites.Aim:To assess the safety and efficacy of radial access and femoral access.Methods:MEDLINE, Scopus, and Cochrane Library were searched until May 2024 for studies comparing radial approach with femoral approach in patients undergoing rotational atherectomy. The primary outcome was major vascular site bleeding. Secondary outcomes included short-term mortality, long-term mortality, myocardial infarction, major adverse cardiovascular events (MACE), acute stent thrombosis, procedural success, procedural time, hospital stay and radiation exposure. Effect estimates were synthesized using a random-effects model and expressed as risk ratios (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with corresponding 95% confidence intervals (CIs).Results:13 studies including 13,581 patients with mean age of 60.76 years in the radial group and 66.86 years in the femoral group, who had undergone rotational atherectomy, were included in the analysis. For the outcome of major vascular site bleeding, there was significantly lower risk (RR: 0.25; 95% CI [0.15, 0.43]; p

Circulation, Volume 150, Issue Suppl_1, Page A4123864-A4123864, November 12, 2024. Background:Fractional flow reserve (FFR) guided complete revascularization (CR) is an approach that can be used to improve clinical outcomes in patients with acute myocardial infarction (MI) and multivessel disease (MVD). The objective of the present meta-analysis was to investigate whether FFR-guided CR leads to better cardiovascular outcomes as compared to culprit-only revascularization (COR) in acute MI and MVD by pooling recently published data.Methods:A comprehensive literature search was conducted using PubMed/MEDLINE, Embase, and the Cochrane Library from inception until April 2024 to retrieve eligible randomized controlled trials (RCTs). Clinical outcomes were assessed using the random-effects model by pooling risk ratios (RRs) along with 95% confidence intervals (CIs). We assessed the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.Results:Four RCTs were pooled with 3,175 patients. FFR-guided CR significantly reduced the risk of repeat revascularization as compared to COR (RR = 0.52; 95% CI: 0.33-0.81, p = 0.004) [absolute risk difference 83 fewer per 1,000 patients (95% confidence interval: 116 to 33 fewer) moderate certainty]. Though there was a reduction in the risk of MACE with FFR-guided CR (RR = 0.68, 95% CI: 0.44-1.04,p= 0.08; moderate certainty), it didn’t attain statistical significance. Clinical outcomes such as all-cause death (RR = 1.10, 95% CI: 0.84-1.45, p = 0.48; moderate certainty), cardiac death (RR = 0.79, 95% CI: 0.53-1.17, p = 0.24; high certainty), risk of MI (RR = 0.94, 95% CI: 0.54-1.66, p = 0.84; moderate certainty) and major bleeding (RR = 0.95, 95% CI: 0.54-1.67, p = 0.87; moderate certainty) were comparable between the two groups.Conclusion:FFR-guided CR in patients with MI and MVD can lead to a decreased risk of repeat revascularizations while not affecting all-cause and cardiac deaths.

Circulation, Volume 150, Issue Suppl_1, Page A4134754-A4134754, November 12, 2024. Background:Screening studies have reported a prevalence of 3-8% for abdominal aortic aneurysms (AAA). Despite a positive trend of decline over the past two decades, mortality linked to AAA remains a significant public health concern. In the United States alone, AAA complications resulted in an estimated 13,640 deaths between 2018 and 2021. Thus, understanding trends and disparities in AAA mortality is crucial for evaluating the effectiveness of current approaches and identifying vulnerable populations.Methods:This study analyzed death certificates from 1999 to 2020 within the CDC WONDER Database. Deaths among individuals aged 25 years and older caused by AAA were identified using the International Classification of Diseases, Tenth Revision (ICD-10) codes I71.3 and I71.4. Age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and annual percent change (APC) were computed and categorized based on year, gender, race/ethnicity, and urbanization status.Results:Between 1999 and 2020, 195,117 deaths were reported in patients with AAA (both ruptured and non-ruptured). Overall, AAMRs for AAA significantly decreased from 69.0 deaths in 1999 to 27.9 deaths in 2020. This decline occurred in two phases: a steeper decrease from 1999 to 2014 (APC: -5.47; 95% CI: -5.68 to -5.29) followed by a further significant decrease from 2014 to 2020 (APC: -1.66; 95% CI: -2.46 to -0.57). Gender-based analysis revealed that men consistently had higher AAMRs than women (men: 65.6; 95% CI: 65.3 to 66.0; women: 24.5; 95% CI: 24.3 to 24.7). Similarly, AAMRs varied by race/ethnicity, with the highest rates observed among non-Hispanic Whites (45.6; 95% CI: 45.3 to 45.8), followed by non-Hispanic American Indian or Alaska Natives (30.3; 95% CI: 27.9 to 32.7), non-Hispanic African Americans (27.2; 95% CI: 26.7 to 27.8), non-Hispanic Asian or Pacific Islanders (20.7; 95% CI: 20.0 to 21.4), and Hispanics (17.5; 95% CI: 17.0 to 18.0). Additionally, individuals residing in non-metropolitan areas had significantly higher AAMRs than those in metropolitan areas (non-metropolitan: 50.7; 95% CI: 50.2 to 51.1; vs. metropolitan: 39.2; 95% CI: 39.0 to 39.4) (Figure 1).Conclusions:This analysis revealed a significant decline in mortality from AAA. However, disparities persist, with higher AAMRs observed among men, non-Hispanic Whites, and residents of non-metropolitan areas.

Circulation, Volume 150, Issue Suppl_1, Page A4144702-A4144702, November 12, 2024. Background:Gender disparities in outcomes for patients undergoing Transcatheter Aortic Valve Implantation (TAVI) with concomitant chemotherapy remain under-explored. This study investigates these disparities, focusing on mortality, procedural complications, and baseline characteristics.Methods:We conducted a retrospective analysis using data from the National Inpatient Sample (NIS) from 2016 to 2021. Gender differences in outcomes were examined in patients undergoing TAVI who have also received chemotherapy. Multivariate logistic regression was utilized for outcomes. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, with statistical significance determined by P-values.Results:The study included 7,275 patients, comprising 3,375 males and 3,900 females. The mean age was similar between males (76.19 years) and females (75.81 years). Outcome analysis revealed no significant gender difference in in-hospital mortality (OR: 1.63, 95% CI: 0.464-5.725, P = 0.445), heart block (OR: 1.061, 95% CI: 0.849-1.326, P = 0.6) or vascular injury (OR: 1.065, 95% CI: 0.572-1.981, P = 0.841). However, females had significantly higher odds of bleeding (OR: 1.601, 95% CI: 1.161-2.207, P = 0.004) and respiratory failure (OR: 1.792, 95% CI: 1.028-3.126, P = 0.04). Additionally, females had higher odds of sudden cardiac arrest (OR: 8.181, 95% CI: 1.092-61.26, P = 0.041) but lower odds of atrial fibrillation (OR: 0.689, 95% CI: 0.543-0.875, P = 0.002) and arrhythmia (OR: 0.537, 95% CI: 0.344-0.837, P = 0.006). Length of stay was longer for females (Coefficient: 0.515, 95% CI: 0.137-0.893, P = 0.008), but total charges did not differ significantly between genders (Coefficient: 2321, 95% CI: -10371.11-15013.54, P = 0.72).Conclusions:Significant gender disparities exist in specific procedural outcomes for patients undergoing TAVI who have also received chemotherapy. Females were at higher risk for bleeding, respiratory failure, and sudden cardiac arrest, while having lower rates of atrial fibrillation and arrhythmia compared to males. These findings highlight the necessity for gender-specific risk assessment and management strategies to improve outcomes for patients undergoing TAVI with chemotherapy.

Circulation, Volume 150, Issue Suppl_1, Page A4144797-A4144797, November 12, 2024. Background:In heart failure patients, the multiorgan system reserve capacity required to meet physiologic demands of exercise can be impaired at multiple levels. Cardiopulmonary exercise testing (CPET) with invasive hemodynamics can help dissect contributions of different organ systems to exercise intolerance.Aims:To map exercise limitations in patients with exertional dyspnea, comparing reserve capacities between HF with preserved ejection fraction (HFpEF) and HF with reduced EF (HFrEF).Methods:From a cohort of patients undergoing invasive CPET, we included an “overt” HFpEF group defined by hemodynamic criteria (LVEF≥0.5 and PCWP rest supine≥15 mmHg) and a HFrEF group (LVEF≤0.4). We defined 7 exercise performance limitations: pulmonary mechanical impairment (VE/MVV >80% with FEV12 mmHg/L/min); chronotropic incompetence (

Circulation, Volume 150, Issue Suppl_1, Page A4147752-A4147752, November 12, 2024. Background:Angina with no obstructive coronary arteries (ANOCA) is clinically challenging to diagnose and manage. The agreement between Doppler-derived coronary flow reserve (CFRDoppl) and PET-derived CFR (CFRPET) in patients with ANOCA remains unclear.Aims:To evaluate the correlation between Doppler- and PET-derived CFR in patients with ANOCA.Methods:We conducted a single-center, retrospective study of adult patients (age ≥18 years) with ANOCA who were referred for evaluation of possible microvascular ischemia with Doppler- and PET-derived CFR at the Mayo Clinic (Rochester, MN) between January 1, 2018, and May 1, 2024. Pearson correlation was used to quantify the association between Doppler- and PET-derived CFR. Agreement between Doppler- and PET-derived CFR was assessed by Bland-Altman analysis using a 2-way mixed effects model with measures of absolute agreement.Results:A total of 66 patients were initially identified, of which 40 were included in the final analysis (66.7% female, median age 58 years [Q1-Q3: 45-66 years]). Median time between PET- and Doppler-derived CFR was 8 days (Q1-Q3: 1-31 days). Median CFRDopplwas 2.75 (IQR: 2.23-3.28) and median CFRPETwas 2.50 (IQR: 2.10-3.10). Doppler-derived CFR displayed a wider range than PET-derived CFR (0.8-5.2 vs 1.2-4.0). A strong correlation was found between Doppler- and PET-derived CFR (r=0.81; p

Circulation, Volume 150, Issue Suppl_1, Page A4139457-A4139457, November 12, 2024. Introduction:The PARADIGM-HF trial demonstrated that angiotensin receptor-neprilysin inhibitor was superior to enalapril in reducing risks of death and hospitalization for heart failure; however, the trial excluded patients with a GFR