Risultati per: World Alzheimer Report 2015

Circulation, Volume 150, Issue Suppl_1, Page A4115139-A4115139, November 12, 2024. In the real world only about 20 % of patients with ASCVD are at the target range, as shown by the SANTORINI trial (1). Therefore, there is still a great need for the improvement of lipid-lowering therapy (LLT).Our Lipid Registry was set up as a retrospective study including patients who visited our outpatients ward focusing on lipid-lowering therapy (LLT). The indications were: low-density lipoprotein cholesterol (LDL-c) > 130 mg/dL in LLT- naive patients with acute coronary syndrome (ACS), coronary artery disease (CAD) not on optimal LLT, familial hypercholesterolemia and LLT intolerance. We collected baseline characteristics as well as laboratory parameters of these patients during their visits. The dual LLT (high-potency statin and ezetimibe) was initiated in every patient during the hospitalization, if not contraindicated, as target variable we used non-HDL-C.In total 181 patients were included, of which 136 (75.1%) patients visited our clinic for control purposes. Patients who didn’t visit the clinic were predominantly men and had no or few pre-experiences with LLT. Fourty-one (36.9%) patients had a BMI >30, 126 (92.6%) of patients had CAD of which 85 (63%) had the diagnosis of a recent ACS. Arterial hypertension was present in 78.7% and diabetes mellitus type 2 in 23.5% of cases. At the 1stvisit to our LLT department 4-6 weeks after dismission from the hospital, 86 patients (61.9%) reached the recommended (ESC/EAS 2019) non-HDL-C goal. At the 2ndvisit (8-12 weeks after index hospitalization), 117 patients (86.2%) and at the 3rdvisit 120 patients (88.2%) reached their target. The analysis of patients initially presenting with ACS showed that 60 (69.8%) of them after 4-6 weeks and 77 (90.6%) patients after 8-12 weeks reached the recommended non-HDL-c goal. Among the study population 108 (79.4%) of patients, and 81 (95.3%) of ACS patients received dual LLT immediately during the index event. After the first visit, 31 (36.5%) of ACS patients needed the addition of the third lipid-lowering drug to achieve the recommended goal (see attached tables).Our strategy for managing hyperlipidemia in patients with a very-high cardiovascular risk showed high achievement of the non-HDL-C goal as recommended by the recent ESC guidelines in contrast to real-world data. We were able to demonstrate, that the strategy based on the idea to treat high-CV risk patients early and strong is the way to reach the treatment goal in a high percentage of patients (2).

Circulation, Volume 150, Issue Suppl_1, Page ASu603-ASu603, November 12, 2024. Background:Coronary artery disease is a common cause of out-of-hospital cardiac arrest (OHCA). Early recognition myocardial infarction (MI) and initiating appropriate therapy has been shown to improve outcomes in OHCA. While early coronary intervention is part of guidelines-based care, the implementation of these recommendation in actual US practice remains poorly described.Objectives:This study aims to characterize patients presenting with OHCA and MI in a cohort from 4 hospitals, to assess care of these patients in actual practice.Methods:We employed a database of OHCA patients admitted to four hospitals within the University of Pennsylvania Hospital System between 01/2019-12/2023. For this study, we included all patients that were diagnosed with STEMI during emergency department evaluation, and collected demographic, arrest, coronary angiographic, and ECG data from electronic health records. SAS was used for statistical analysis.Results:A total of 43 MI cases were included; mean age was 60.6±11.8 y, 65% male, mean BMI 30.0±6.3, 58.1% African American, 27.9% White or Caucasian, and 16.3% had a medical history of myocardial infarction. 74.4% were witnessed, and 44.2% received bystander CPR[BA1]. Initial shockable rhythm was present in 34.9%. 38 survived to hospital admission, and 9 were discharged alive. The first obtained 12-lead ECG (median time to ECG: 13min, (IQR: 3.5-26.5)) found that ST-segment elevations were present in 88.4%, ST-segment depressions in 44.2%, T-wave inversions in 4.7%, QT prolongation in 9.3%, and wide QRS in 18.6%. Sinus rhythm was most common (41.9%), followed by junctional rhythm (9.3%). Left and right bundle branch blocks (4.3% and 7%, respectively) and AV block (7%) were recorded. Coronary angiography (median time to angiography: 1.95hr (IQR: 1.3-4.2)) was performed in 29 patients and revealed that left anterior descending artery (28.6%) was the most common location for a culprit lesion, followed by the right coronary artery (21.4%), and left circumflex artery (10.7%). Notably, in 21.4% of cases, no culprit lesion was identified. 13 patients underwent angioplasty with stent, 4 received balloon angioplasty, and 1 underwent aspiration thrombectomy.Conclusion:This study highlights important attributes of OHCA patients presenting with MI. This paves the way for larger studies comparing ECG and coronary angiography findings between MI and control populations to help identify and improve acute care for OHCA MI patients.

Circulation, Volume 150, Issue Suppl_1, Page A4135712-A4135712, November 12, 2024. Background:Obesity is an adverse prognostic factor for breast cancer (BC). While liraglutide and semaglutide, derived from antidiabetic glucagon-like peptide-1 receptor agonists (GLP1RA), are established weight loss drugs known for their cardiovascular safety in the general obese population, their safety in BC patients undergoing cardiotoxic antineoplastic therapies remains less understood.Objective:To investigate the mortality and cardiovascular outcomes related to GLP1RA used for weight loss among the highly susceptible BC females.Methods:This retrospective cohort study was based on the TrinetX network, comprising real-time health records from over 60 US healthcare organizations. The study population included obese females (≥18 years old) who received at least three prescriptions of either exclusive GLP1RA (liraglutide or semaglutide) or non-GLP1RA weight loss drugs (phentermine, bupropion-naltrexone, orlistat) upon BC diagnosis between 01/01/2015 and 01/01/2022. The index date was the initiation of systemic anti-cancer treatment, including chemotherapy (anthracycline, taxane, or cyclophosphamide), and/or anti-HER2 agents (trastuzumab, pertuzumab, or lapatinib). We used 1:1 propensity score-matching (PSM) to balance demographics, BMI, comorbidities, concurrent medications for cardiovascular diseases and metabolic disorders, BC receptor status and prior treatment, and levels of serum cholesterol (LDL, HDL) and hemoglobin A1c. Cox regression models were applied to compute hazard ratios (HR) and 95% confidence intervals (CIs). Follow-up continued until 05/24/2024, or until adverse cardiovascular events or death occurred.Results:Among 380 PSM-balanced pairs, the GLP1RA group (mean age: 57.6±11) showed significantly lower risks of all-cause mortality (HR 0.593, 95% CI 0.457-0.77), acute heart failure (HR 0.496, 95% CI 0.286-0.859), angina pectoris (HR 0.566, 95% CI 0.343-0.936), and acute stroke (HR 0.661, 95% CI 0.46-0.951) than the non-GLP1RA group (mean age: 57.5±12). Otherwise, no significant difference was shown in acute myocardial infarction (HR 0.787, 95% CI 0.495-1.251), pulmonary hypertension (HR 0.777, 95% CI 0.55-1.099), or arrhythmias (HR 0.829, 95% CI 0.566-1.215).Conclusion:Compared to non-GLP1RA weight loss agents, GLP1RA offers better survival and cardiovascular protection for BC patients undergoing cardiotoxic therapies. Future studies are warranted to validate the safety of these weight loss drugs during the BC treatment continuum.

Circulation, Volume 150, Issue Suppl_1, Page A4145930-A4145930, November 12, 2024. Background:Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome caused by various pathophysiologic mechanisms, and has recently received increasing attention. Many research results show that the longitudinal left ventricular (LV) function is deteriorated, however, in the real world, we often encounter patients with preserved LV global longitudinal strain (GLS). This study sought to determine the prevalence, characteristics, and outcome of patients with preserved LV GLS in a real-world registry of HFpEF.Method:The registry data included 1,798 patients with HFpEF (72.2 ± 11.6 years, 55.2% female) who met the inclusion criteria of previous randomized controlled trials (New York Heart Association class II or higher symptoms, LVEF > 40%, and NT-proBNP > 300 pg/mL) at a single tertiary hospital between 2014 and 2021. LV GLS analysis was performed using vendor-independent 2D speckle-tracking imaging software (TomTec;Image Arena4.6, Munich, Germany). Patients with LV GLS ≤ -18% were defined as heart failure with preserved GLS. The primary outcome was a composite of heart failure admissions and cardiovascular death.Results:In this population, 757 (42.1%) patients had preserved LV GLS. The patients with preserved GLS were tended to be younger (71.7 ± 11.5 vs. 72.7 ± 11.6 years, p=0.073) and more female predominance (60.6 vs. 51.3%, p

Circulation, Volume 150, Issue Suppl_1, Page A4145273-A4145273, November 12, 2024. Background:Extraction of unstructured and semi-structured medical data is a key prerequisite for the application of bioinformatics. Portability, scalability, and protection of health information remain key problems in data analytics in medicine that cannot easily be solved using machine learning techniques alone, highlighting the importance of multi-faceted approaches.Research Question / Hypothesis:Can rule-based algorithms reliably and identify and extract transthoracic echocardiographic (TTE) report findings for use in a data analytics pipeline?Methods:Deidentified adult TTE reports were obtained between 09/14/2020 to 03/30/2023 within a single urban academic healthcare system. A rule-based algorithm was developed using derivatives of regular expressions in R to capture chamber parameters, cardiac function, and valvular disease. The accuracy was evaluated in a subset of manually adjudicated reports by study cardiologists.Results:Of the 1000 reports obtained, we were able to extract 23079 (78.4%) populated data points out of 29423 maximal data points for 37 variables. Out of 803 manually verified NA data points, 743 (92.5%) were accurate. The mean net accuracy of all variables was 99.8% (see Table 1). Continuous data points showed 100% accuracy. Modes of failure for data extraction were in categorical variables (7.5% of the 23 features), with the most common being in left atrial size (n=6), mitral valve structure (n=5), aortic valve structure (n=13), tricuspid valve structure (n=2) and right ventricular function (n= 7). All other categorical variables showed 93.6% mean accuracy of NA data points.Conclusions:A rule-based algorithm is effective at converting cardiologist-read TTE reports into datasets ready for use data analytics. Moving forward, it would be important to test this tool on metrics of speed, cluster computing and scalability.

Circulation, Volume 150, Issue Suppl_1, Page A4142149-A4142149, November 12, 2024. Background:As patients progress through the single ventricle palliation, changing hemodynamics and non-cardiac conditions can prevent completion of Fontan. We sought to determine the incidence of completion of Fontan at our institution and to investigate the reasons for non-Fontan candidacy.Methods:Institutional database was queried to identify patients who underwent single ventricle palliation from 2010 to 2020. Patients who underwent stage 2 palliation were included for analysis. The primary outcome of interest was reason for non-Fontan candidacy or reason for delayed Fontan.Results:526 patients who reached stage 2 single ventricle palliation were analyzed. 378 (71.9%) underwent Fontan procedure or were referred for Fontan before the age of 4-years-old at our center at the time of the study (Figure 1). 19 patients died prior to the typical age of Fontan and 38 were lost to follow up. Of the remaining 91 patients, 21 (23.1%) had a 1.5 or 2 ventricle repair, 12 (13.2%) had a Fontan at another center, and 29 (32%) had a late Fontan. Most patients with late Fontan were due to provider practice variation (22), whereas there were only 3 patients with medical conditions delaying pre-Fontan testing, and 4 patients had a Kawashima. Only 3 patients out of the 12 who had Fontan at another center were for second opinions, whereas the remainder either moved or had surgery at another center due to family preference. Reasons for non-Fontan candidacy were divided into cardiac and respiratory sources. Cardiac reasons included severely depressed ventricular function (12), diastolic dysfunction (2), atrioventricular valve stenosis or regurgitation (7), and pulmonary vein stenosis (3). Respiratory conditions leading to non-Fontan candidacy included severe OSA (1), pulmonary arterial malformation (1), and pneumonectomy (2). There are 17 patients in the non-candidacy group who had a heart transplant or were listed for transplant at the time of the study. No patient in our study was deemed not a candidate for Fontan after stage 2 palliation for developmental delay or syndrome.Discussion:This study demonstrates that the reasons for non-Fontan candidacy after completion of stage 2 palliation are broadly due to hemodynamic and respiratory condition, with many patients who are not candidates developing severe ventricular dysfunction after stage 2. There is a subset of patients who either move, are lost to follow up, or are delayed due to provider practice variation.

Circulation, Volume 150, Issue Suppl_1, Page A4139940-A4139940, November 12, 2024. Background:There are two approved methods for transcatheter aortic valve replacement (TAVR) namely balloon-expandable valves (BEV) and self-expanding valves (SEV). While several randomized controlled trials (RCTs) have compared the efficacy of SEV and BEV, the generalizability of their findings is questioned. Therefore, to generate concrete evidence regarding the superiority between the two, we conducted this real-world meta-analysis to compare the clinical efficacy and safety outcomes of SEV vs BEV in patients undergoing TAVR for aortic stenosis (AS).Methods:MEDLINE, EMBASE, and Scopus were queried to shortlist studies including AS patients undergoing TAVR. Primary outcomes included 30-day and 1-year all-cause and cardiac mortality. Secondary outcomes were permanent pacemaker implantation (PPI), paravalvular leak (PVL), aortic regurgitation (AR), stroke, major vascular complications (MVC), major bleeding (MB), acute kidney injury (AKI), myocardial infarction (MI), length of stay (LOS), patient prosthesis mismatch (PPM), and atrial fibrillation (AF). A random effects meta-analysis was conducted to derive risk ratios and mean differences with corresponding 95% confidence intervals (CI).Results:Our meta-analysis included 38 real-world studies. No significant association was seen in 30-day (RR=1.13, P=0.15) and 1-year all-cause mortality (RR=1.04, P=0.55), and cardiac mortality (RR=1.28, P=0.12). SEV was associated with a higher risk of 30-day PPI (RR=1.61, 95% CI 1.28-2.02, I2 = 88%, P

Circulation, Volume 150, Issue Suppl_1, Page A4141415-A4141415, November 12, 2024. Lead related venous obstruction (LRVO) is an often underrecognized complication of pacemaker implantation. Symptoms of LRVO may include mild asymmetric upper extremity swelling to highly morbid superior vena cava (SVC) syndrome. We present an unusual case of a 54-year-old man with a history of retained pacemaker leads placed 26 years ago who presents with abdominal distention, lower extremity edema, and shortness of breath. He was found to have new onset ascites and significant pleural effusions. A liver biopsy showed hepatic fibrosis and pleural studies were consistent with chylothorax. After significant workup and diagnostic testing, it was believed that he had late complications often seen in Fontan physiology, notably hepatic fibrosis, lymphatic leakage, and protein losing enteropathy. A venogram and pressure measurements were performed which confirmed obstruction at the junction of the SVC and right atrium with elevated central filling pressures and significant flow through a markedly dilated azygous vein. A lymphangiogram suggested lymphatic leakage through the thoracic duct. An SVC stent was placed in an attempt to relieve the obstruction but the patient had progressive hemodynamic compromise leading to placement of mechanical circulatory support. Ultimately, the patient underwent surgical extraction of the retained pacemaker leads and reconstruction of the superior vena cava and right atrial junction, leading to near-resolution of his symptoms. This unusual presentation of SVC syndrome as a late complication of retained pacemaker leads highlights the potential severity of cardiac implanted electronic device lead-related complications.

Circulation, Volume 150, Issue Suppl_1, Page A4141030-A4141030, November 12, 2024. Background:There are limited data on the treatment patterns of mavacamten and background therapies in real-world patients with obstructive HCM.Aims:To describe posology, discontinuation, adherence to mavacamten, and the use of HCM background therapies in real-world patients.Methods:This was a retrospective cohort study of adult patients using the Symphony Integrated Dataverse from Apr 28, 2022 to Jan 18, 2024. Patients were included if they had ≥ 1 approved claim for mavacamten and had continuous claims activity during the 12 months (baseline) before the first claim (index date). The stable dose (defined as the dose used for 6 months consecutively), discontinuation (defined as a treatment gap ≥ 95 days without restarting), and adherence (measured as proportion of days covered [PDC]) were described for mavacamten. The use of background therapies (beta blockers, calcium channel blockers and disopyramide) was described at index and during the follow-up.Results:A total of 1867 patients (mean ± SD age 64.7 ± 12.2 years, 63.1% female, median [interquartile range, IQR] follow-up 219 [107, 346] days) were included (Table). Among patients with ≥ 6 (n = 993), ≥ 9 (n = 640), and ≥12 (n = 394) months of treatment, 67.3%, 86.1%, and 93.7% reached stable dose, respectively. Among patients who reached stable dose (n = 691, median [IQR] treatment duration 345 [270, 435] days), 54.8% did not require any dose adjustment, and 33.0% required only one adjustment from treatment initiation. The most commonly used stable dose was 5 mg (49.6%), followed by 2.5 mg (25.0%), 10 mg (20.5%) and 15 mg (4.8%). The discontinuation rate for mavacamten was 10.8% and 8.7% among patients with ≥1 and ≥2 claims, respectively. Mean PDC for mavacamten was 93.7 ± 9.1%. Overall, 25% of patients did not have any claim for background therapy at index. For the remaining patients (n = 1401), 11.6% discontinued and 15.1% down titrated the index HCM background therapy.Conclusions:The vast majority of patients treated with mavacamten reached stable dose with no or only one dose adjustment. Discontinuation rate was 8.7-10.8% and adherence to mavacamten was high. A substantial proportion of patients discontinued or down titrated HCM background therapy.

Circulation, Volume 150, Issue Suppl_1, Page A4145932-A4145932, November 12, 2024. Background:A new ESC guidelines in 2023, the International Lipid Expert Panel (ILEP) 2021 recommendations, and a subsequent statement by EAS have been published based on recent advances in lipid lowering treatments. However, real world data are lacking regarding the implementation among the community of French cardiologists.Objective:To determine the current approach and therapeutic strategies concerning lipid lowering treatments post-acute coronary syndromes in France.Methods:This national survey was performed during October and November 2023 in France with an online questionnaire on the websites of 2 national French Societies of Cardiologists.Four mailings were sent to cardiologists to invite them to answer to the questionnaire. A total of 400 answers of cardiologists were collected during this 2-month period.Results:For ASCVD patients, cardiologists agreed with an LDL-C goal below 55 mg/dL (1.4 mmol/L) in 69%, below 70 mg/dL (1.8 mmol/L) in 16.5%, and 14.5% between 70 mg/dL and 100 mg/dL (1.8-2.5 mmol/L). An upfront lipid lowering combination strategy using fixed dose combination (FDC) of statins and ezetimibe was prescribed in less than 5% of patients, whereas high-intensity statins were prescribed in more than 90% of patients. No significant differences were observed in terms of sex of patients, geographical area, or strategies followed by male and female cardiologists (p > 0.05). A combination of statins and ezetimibe was prescribed only for a minority of patients, especially as an early upfront strategy. The use of PCSK9i remains marginal and the interval between the ACS and initiation of these medicines remains high.Conclusion:In this contemporary national survey, we report an excellent agreement of lipid goals in secondary prevention by cardiologists. Despite the declared consensus recommending a low LDL-C target in ACS patients, lipid lowering strategies are suboptimal, mainly consisting of high intensity statins. The lack of recommended use of ezetimibe and PCSK9i to lower LDL-C levels highlights the importance of better implementation of intensive and early upfront strategies to reduce recurrent ischemic events.

Circulation, Volume 150, Issue Suppl_1, Page A4137805-A4137805, November 12, 2024. Background:Many of the 1.4 million adults with congenital heart disease (CHD) are lost to follow up (LTF). We aimed to identify factors associated with LTF and compare to those who remained in care.Methods:In the Congenital Heart Disease Project to Understand Lifelong Survivor Experience (CHD PULSE), we performed a cross-sectional survey in 2021-2023 of CHD survivors with a history of intervention at 11 centers in the Pediatric Cardiac Care Consortium, a large US-based registry of CHD procedures. Participants reported their cardiac history, general health, education, income, health insurance, healthcare utilization, and marital status. LTF was defined as having seen a cardiologist three or more years ago.Results:Among the 3109 respondents with CHD (median age 33) there were 1157 (37%) LTF and 1952 (63%) in care. Age, sex, marital status, and household income were not risk factors for LTF; but lack of health insurance, lower severity of CHD, and increasing time since last heart surgery were. Notably, respondents who reported being told in adolescence about the lifelong need for a cardiologist were almost three times as likely to report being in care (79% vs 28%, p

Circulation, Volume 150, Issue Suppl_1, Page A4146448-A4146448, November 12, 2024. Introduction:Acute Coronary Syndrome (ACS) is a major global health issue, with smoking as a significant modifiable risk factor. Smoking cessation reduces recurrent coronary events, making it crucial in ACS management. Current protocols recommend smoking cessation education during hospitalization and referral to smoking cessation or outpatient cardiac rehabilitation programs, where nicotine replacement therapy (NRT) and bupropion are available. NRT, including patches, gum, and lozenges, helps alleviate withdrawal symptoms by providing a controlled nicotine dose.Hypothesis:We hypothesize that cautious initiation of NRT during hospitalization benefits ACS patients, with the benefits outweighing the risks. This study seeks to provide clarity and contribute to evidence-based guidelines for ACS management.Methods:In this retrospective cohort study, data were gathered from the TriNetX database. The study compared two cohorts: 122,198 patients who received NRT and were hospitalized for acute myocardial infarction (AMI) or unstable angina (UA), and 160,387 patients who did not receive NRT but were admitted for the same conditions. The follow-up period began on the day of the index event and continued for 30 days. Cardiovascular outcomes were compared between propensity score-matched patients with and without NRT.Results:Patients receiving NRT had a reduced risk of several cardiovascular outcomes compared to those who did not receive NRT, including atrial fibrillation and flutter (RR [95% CI]=0.822[0.792-0.854, p

Circulation, Volume 150, Issue Suppl_1, Page A4124065-A4124065, November 12, 2024. Introduction:CHIP is associated with CAD and mortality. The prognostic relevance of CHIP for high-risk patients with confirmed CAD is unknown.Hypothesis:CHIP variants are associated with cardiovascular (CV) events and mortality in high-risk patients with known CAD in the ISCHEMIA Trials Biorepository.Methods:895 ISCHEMIA and ISCHEMIA-CKD (hereafter, ISCHEMIA Trials) participants with moderate-severe ischemia and next-generation sequencing performed for CHIP variant allele fractions of ≥2% (CHIP) and ≥10% (large CHIP) were included. Unadjusted and multivariable adjusted (age, sex, diabetes, eGFR not on HD, HD, and LVEF) associations of CHIP and large CHIP with a) ISCHEMIA Trials initial phase primary endpoint (CV death, myocardial infarction (MI), or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest, RCA) and b) ISCHEMIA Trials combined initial and extended follow-up phase (hereafter, Cumulative) endpoint of all-cause death .Results:Median (IQR) age of sequenced participants was 67 (56 – 79) years, 19% were female, 83% white, and 6% Hispanic. Hypertension (84%), diabetes (45%) and obesity (47%) were common, 26% had an eGFR 1 gene. Over 3.1 years of RCT follow-up there were 135 (20%), 32 (16%) and 15 (18%) primary endpoints for no CHIP, CHIP and large CHIP, respectively. Over 6.8 years of EXTEND follow-up, there were 126 (18%), 47 (23%) and 24 (29%) deaths in the no CHIP, CHIP and large CHIP groups, respectively. After multivariable adjustment there was no association between CHIP or large CHIP and CV events or mortality (Figure 1c).Conclusion:Neither CHIP nor large CHIP was associated with adverse outcomes in 895 high-risk individuals with confirmed CAD, despite a high prevalence of these mutations.

Circulation, Volume 150, Issue Suppl_1, Page A4146270-A4146270, November 12, 2024. Background:Our team recently developed an Artificial Intelligence model that enables the identification of increased left ventricular filling pressures using a single-lead electrocardiogram (AI-ECG) with excellent performance (AUC 0.91). However, its ability to predict incident heart failure (HF) in the community is yet to be evaluated.Hypothesis:We tested the hypothesis that the output from the AI-ECG will predict the long-term incidence of heart failure (HF) and HF with preserved ejection fraction (HFpEF), and would refine the HF predictive capabilities of the AHA Predicting Risk of Cardiovascular Disease EVENTs (PREVENTTM) Equations.Methods:Leveraging the resources of the Rochester Epidemiology Project (REP) we analyzed data from patients who sought primary care in Olmsted County, MN, between 1997-2003 with passive follow-up until April 2024. We included those with a digital ECG at baseline and excluded those who were part of the original algorithm development or history of heart failure. The diagnosis of heart failure was ascertained by using ICD codes (ICD9-428,ICD10-I.50) and a word search for the terms related to heart failure. HFpEF was ascertained using the Ejection Fraction (EF) data closest to the heart failure diagnosis date, using EF more than 40% as the criterion. We tested the association between AI-ECG predicted probabilities and new-onset HF and HFpEF using Cox proportional hazard models. These models were also adjusted for cardiovascular risk factors and were stratified to evaluate the effect of the AI-ECG output on PREVENTTM-predicted HF at 10 years.Results:We included 20,276 subjects, mean age 55±14.03, 52% women, 92% non-Hispanic white. After 18.2±8.5 years of follow-up, 4,008 (19.76%) were diagnosed with HF and 3,812 (18.8%) HFpEF. Risks of HF and HFpEF significantly increased in patients with increased left ventricular filling pressures by AI-ECG, independent of risk factors, allpfor trend

Circulation, Volume 150, Issue Suppl_1, Page A4143176-A4143176, November 12, 2024. Background:Identifying predictors of mortality in CRT patients remains an active area of investigation.Objective:To establish a relationship between gait speed (GS) and mortality in heart failure patients with CRT.Hypothesis:Patients with slower gait speeds have worse survival rates after CRT implantation.Methods:This retrospective study included 504 patients who underwent CRT implantation at our institution between 2017-2022. All patients were followed up with a multidisciplinary team, including electrophysiology and heart failure physicians about 6 months after CRT implantation, where frailty was assessed. We used GS as a measure of frailty and divided patients into 2 groups: GS: 5% with reduction in LVESV >10%; anybody not meeting this definition was classified as a non-responder. Responder and non-responder rates among GS< 1 m/s and GS >1 m/s were 53.8% vs 66.4%; and 35.1% vs 26.2%, respectively. The median (IQR) GS was 1.15 m/s (0.91-1.37 m/s). 52 (10.3%) patients had a composite outcome within 2 years follow up. Non-parametric univariate analysis revealed that lower GS was significantly associated higher composite outcome rates (median GS 0.8 vs 1.18 m/s; p

Circulation, Volume 150, Issue Suppl_1, Page A4146286-A4146286, November 12, 2024. Introduction:The morphology and blood stasis of the left atrial appendage (LAA) in tandem with disorganized conduction in atrial fibrillation (AF) creates favorable conditions for thrombus formation. Left atrial appendage occlusion (LAAO) devices have become increasingly utilized for stroke prevention in select patients with AF who have contraindications to oral anticoagulation (OAC). We present a unique case of an embolized Amplatzer Amulet LAAO device through a MitraClip into the LV causing polymorphic VT and obstructive shock.Case Presentation:An 80-year-old man with AF and mitral valve prolapse status post MitraClip presented to the hospital for difficulty breathing and palpitations two days after implantation of a 31mm Amplatzer Amulet LAAO device. Notably, he underwent failed attempt at Watchman LAAO implantation due to peridevice leak one year prior. On arrival, he was hypotensive with numerous episodes of polymorphic VT, requiring cardioversion, vasopressors, and mechanical ventilation. TTE located the Amulet within the LV outflow tract (LVOT) creating LVOT obstruction and revealed single-leaflet attachment of the MitraClip. He was evaluated for device retrieval and mechanical support but was deemed not a surgical candidate due to severe thrombocytopenia and guarded prognosis. Despite ongoing resuscitative efforts, the patient became increasingly unstable and died in the cardiac ICU.Discussion:In patients who are unable to tolerate OAC, occlusion of the LAA for stroke prevention has garnered growing interest; however, these devices are not without complication and do not guarantee full occlusion of the LAA. Despite our patient’s history of failing Watchman deployment, he was discharged on the same day after implant of the Amulet device without post-procedure TTE. We postulate that the Amulet device dislodged shortly after deployment and was held within the left atrium by the MitraClip until detachment, allowing for device embolization and severe MR. To our knowledge this is the first documented instance of Amulet device migration into the LV in a patient with a MitraClip. This case highlights the need for heightened post-procedure monitoring, surveillance, and imaging in select patients.