Search Results for: Short Acting Opioid

Circulation, Volume 150, Issue Suppl_1, Page A4146330-A4146330, November 12, 2024. Background:Hutchinson-Gilford Progeria Syndrome (HGPS) is caused by a mutation in LaminA (progerin), and is characterized by accelerated aging and death from coronary or carotid disease in the mid-teens. We have shown that vascular smooth muscle cells (VSMCs) and endothelial cells (ECs) derived from HGPS children manifest many of the hallmarks of aging including telomere erosion, reduced proliferation, impaired function, DNA damage and senescence markers, altered cellular and nuclear morphology, and an aberrant transcriptional profile. These hallmarks of aging are substantially reversed by treatment with telomerase (hTERT) linear RNA,with greater benefit in HGPS cells than the current therapy, lonafarnib. However, linear RNA has a short half-life, which necessitates frequent administration. By contrast, circular (circ) RNA is more stable than linear RNA, and with an internal ribosome entry site can be translated into protein. We hypothesized the hTERT circRNA would provide for longer duration of telomerase expression, and would have a greater benefit for HGPS ECs.HGPS ECs were treated with hTERT linear or circ RNAs. A single treatment with 1 µg/ml hTERT circRNA reversed multiple stigmata of senescence. However, at day 28 post treatment, the benefit of hTERT circRNA exceeded that of hTERT linear RNA in all measured variables. hTERT circRNA provided for greater recovery of telomere length as determined by quantitative fluorescence in situ hybridization; induced a three-fold greater reduction in beta-gal positive cells and morphologically aberrant nuclei. In HGPS ECs, hTERT circRNA provided for a 2-3 fold greater reduction of senescentfactors, inflammatory cytokines and DNA damage signals, including Progerin, p16, p21, IL-1B, IL-6, IL-8 MCP-1 and gH2A.X. In addition, hTERT circRNA to a greater degree restored NO production, promoted cell proliferation, enhanced angiogenesis and improved LDL uptake. Importantly, mitochondrial functions, as evaluated by the oxidative stress marker (MitoSOX) and mitochondrial membrane potential marker (JC-1 staining), were restored more completely by hTERT circRNA.Conclusion:hTERT circRNA is more effective than hTERT linear RNA in rejuvenating senescent ECs, possibly because of its longer half-life. The novel hTERT circRNA is a promising therapy for HGPS and other disorders associated with accelerated vascular aging.

Circulation, Volume 150, Issue Suppl_1, Page A4135517-A4135517, November 12, 2024. Introduction:Cirrhosis, a late-stage liver disease, is associated with numerous systemic complications, making long-term mortality prediction challenging. Traditional models like Child-Pugh and MELD are primarily designed for short-term (3-month) mortality. This study evaluates the impact of incorporating echocardiographic (echo) variables in predicting long-term mortality in cirrhosis patients.Methods:A retrospective cohort study was conducted using data from 60 patients with clinically diagnosed cirrhosis from Hippokration Hospital, Greece, spanning 2018 to 2022. Patients were followed for up to 52 months. Exclusion criteria included pre-existing cardiovascular diseases and significant co-morbidities. Patients were categorized into survived to end of study (n=31) and died during study (n=29) groups. Outcomes were analyzed using multivariate logistic regression and Cox proportional hazards models, and include parameters for age, blood pressure, lab-based biomarkers (potassium, pro-brain natriuretic peptide, hemoglobin, platelet count, aspartate transaminase, gamma-glutamyl transferase, uric acid), and echo/ecg measurements (QT interval, left ventricular (LV) ejection fraction, LV global longitudinal strain (GLS), left atrial GLS, annulus velocities, and E/A ratio).Results:The multivariate logistic regression model (MELD+) that included echo variables showed a 10% improvement in area under the curve (AUC: 0.901) compared to the MELD model alone (AUC: 0.817). MELD+ improved risk classification accuracy by nearly 10% with a conservative threshold. The Cox proportional hazards model with MELD+ also demonstrated superior performance (AUC: 0.923; C-index: 0.875; Brier Score: 0.097) compared to the MELD model alone (AUC: 0.892; C-index: 0.831; Brier Score: 0.134). The MELD+ model showed less variation in hazard ratio confidence intervals, indicating more consistent risk estimation.Conclusion:Incorporating echocardiographic measurements enhances the accuracy of long-term mortality predictions in cirrhosis patients. These findings suggest that cardiac imaging should be considered in risk assessments for cirrhosis patients, particularly for predicting survival beyond three months.

Circulation, Volume 150, Issue Suppl_1, Page A4140212-A4140212, November 12, 2024. INTRODUCTION:Nicorandil, a dual mechanism anti-anginal used in Europe, Asia, and Australia for >20 years acts as NO donor and K+ATP channel opener, providing balanced pre- and afterload vasodilation. Antianginal efficacy matches beta and calcium channel blockers, and long-acting nitrates but without tolerance build-up. Immediate release nicorandil (IR NIC) taken 2-3 times daily with 80% dose release in 45 min, requires high patient adherence. While EU labeling and trials highlight no proarrhythmogenicity lack of recent data remains along with prior reports of potential impact of IR NIC on EKG patterns. Once-daily extended-release nicorandil (ER-NIC) AUX-001 is being developed to improve compliance, symptom control, and QoL for chronic stable angina patients.ONJECTIVE:Examine ER NIC impact on EKG patterns before and after 2 sequential 24h single-dose exposures during fed and fasting status.METHODS:12-lead EKG was recorded in 16 adult healthy volunteers at baseline. Peak systemic exposure of ER NIC was predicted at 6h post dose. Consequently, postdose EKG was scheduled at 6h after AUX-001 administration, with 24h monitoring. Variables included PR, ST, QT, and TP interval and P, QRS and T wave duration. QT interval was corrected using Bazett’s and Fridericia’s formula.Results:12-lead EKGs were available on 16 fasting and 15 fed patients. None discontinued due to safety or tolerability. 13 EKGs at baseline on day 1, and 14 on day 8 showed non-clinically relevant abnormalities. No clinically relevant abnormalities were found at baseline or 6h postdose. Mean HR was 58±5.8 and 59±6.2 at baseline and 68±8.2 and 67±6.7 at 6h for fasting and fed. Mean QTc (Bazett) was 395±19 ms pre- and 400±18 ms 6h postdose under fasting and 395±14 and 399±16 ms under fed status. Mean PR interval was 170±22 ms pre- and 160±21 ms 6h post-dose fasting and 169±17 and 158±18 under fed status.CONCLUSION:Single dose AUX-001 caused near no QTc changes in healthy volunteers compared to baseline. 6h postdose PR intervals physiologically adjusted to changing HR, and stayed within normal range. Similar to IR NIC, AUX-001 had no discernable effect on EKG patterns during fasting or fed conditions. Findings highlight no relevant AUX-001 effect on electrophysiological safety providing additional safety information supporting development of ER NIC. Findings also confirm previous healthy volunteer trials with IR NIC highlighting no tendency promoting arrhythmia in normal, non-ischemic myocardium.

Circulation, Volume 150, Issue Suppl_1, Page A4136013-A4136013, November 12, 2024. Introduction:The use of Transcatheter Aortic Valve Replacement(TAVR) has provided a safer alternative to open surgical approaches. The introduction of frailty scoring systems has proven effective in improving healthcare approaches and outcomes in various aspects of medicine. As there is a paucity of data on the impact of frailty among TAVR patients, we aim to conduct a retrospective study to investigate further.Methods:Our study analyzed adult cases with a primary procedural code for TAVR among hospitalizations between 2016 and 2021 through the National Inpatient Sample(NIS). Frailty status was explored through the criteria of Gilbert’s frailty index. Multivariable regression models helped evaluate differences in short-term outcomes and complications between them.Results:Our study involved 374200 cases of TAVR that were divided into LFR(285425 cases, 76.3%), IFR(86005 cases, 23.0%), and HFR(2770 cases, 0.7%). Compared to patients with LFR, patients with MFR and HFR showed higher odds of several complications, including cardiogenic shock(MFR: aOR 6.933, p

Circulation, Volume 150, Issue Suppl_1, Page A4147790-A4147790, November 12, 2024. Background:Anticoagulation therapy (ACT) remains the cornerstone of acute pulmonary embolism (PE) management and reduces the mortality risk to

Circulation, Volume 150, Issue Suppl_1, Page A4124370-A4124370, November 12, 2024. Background:Dual antiplatelet therapy (DAPT) is well established as standard of care following percutaneous coronary intervention (PCI). Recent trials have shown a potential benefit in the reduction of hemorrhagic events with a shorter course of DAPT. However, the optimal duration of DAPT following PCI remains unclear.Question:Is 1 month of DAPT followed by P2Y12 inhibitor monotherapy superior to the standard 12-month DAPT regimen in terms of cardiovascular outcomes in patients post-PCI?Methods:Medline, PubMed, and Cochrane Central Register of Controlled Trials databases were searched for randomized clinical trials (RCTs) comparing 1-month vs. 12-months of DAPT followed by P2Y12 inhibitor monotherapy post-PCI. The outcomes of interest were cardiovascular death, myocardial infarction, and major bleeding. We used R version 4.1.2 (The R Foundation, 2021) to pool the data using a random-effects model. Heterogeneity was assessed with I2.Results:We included three RCTs reporting data from 22,413 patients, of whom 11,180 (49.8%) were treated with 1-month of DAPT, followed by P2Y12 inhibitor monotherapy. Follow-up ranged from 12 months to 24 months. The incidence of all-cause death (RR 1.20; 95% CI 0.95-1.51; p=0.12) and myocardial infarction (RR 0.86; 95% CI 0.71-1.05; p=0.14) were not significantly different between the groups. However, major bleeding (RR 0.51; 95% CI 0.26-0.99; p=0.048) was significantly reduced with a short course of DAPT followed by P2Y12 inhibitor monotherapy, as compared with standard 12 months of DAPT.Conclusion:Following PCI, a transition from DAPT to P2Y12 inhibitor monotherapy at 1-month is associated with a significant reduction in major bleeding as compared with standard DAPT for 12-months, with no significant change in the incidence of all-cause mortality or myocardial infarction.

Circulation, Volume 150, Issue Suppl_1, Page A4145933-A4145933, November 12, 2024. Introduction:Cardiogenic shock (CS) remains a clinical challenge with a high mortality rate. An escalation strategy from intra-aortic balloon pump (IABP) to Impella has been proposed for patients with CS refractory to IABP therapy, but clinical data on this approach are lacking. This study aimed to elucidate the short-term clinical outcomes after IABP-Impella escalation in patients with CS.Methods and Results:From the Japanese nationwide registry of Impella (J-PVAD) database between 2020 and 2022, a total of 2,578 patients with CS who received Impella support were classified into the IABP-Impella group (n=189) or the Primary Impella group (n=2,389). We applied a 1:3 propensity score matching, selecting 180 patients in the IABP-Impella group and 540 patients in the Primary Impella group. Before matching, the IABP-Impella group presented significantly longer shock-to-Impella time, worse laboratory data indicating multiorgan damage, and more frequent inotrope use compared to the Primary Impella group. After matching, the baseline characteristics were well-balanced between the two groups. The clinical outcomes within 30 days after the initiation of Impella were compared between the matched groups. The IABP-Impella group showed a significantly higher rate of additional mechanical circulatory support (MCS) use than the Primary Impella group (33.9% vs. 25.6%, p=0.034). Although the incidence of mortality was similar between the two groups (30.6% vs. 30.9%, p >0.99), the incidence of major complications (a composite of bleeding, hemolysis, infection, stroke, myocardial infarction, limb ischemia, and vascular injury) tended to be higher in the IABP-Impella group (43.0% vs. 36.3%, p=0.053). Notably, the incidence of infection was significantly higher in the IABP-Impella group than in the Primary Impella group (10.0% vs. 4.8%, p=0.018). Kaplan-Meier estimates revealed that infection occurred more frequently in the IABP-Impella group during the 30-day follow-up period (log-rank p=0.016).Conclusions:Patients undergoing the IABP-Impella escalation strategy showed poorer baseline clinical conditions in baseline and were associated with a higher likelihood of further MCS upgrade and an increased risk of infection.

Circulation, Volume 150, Issue Suppl_1, Page A4141652-A4141652, November 12, 2024. Introduction/Background:Cardiomyopathy is the leading cause of death in Duchenne muscular dystrophy (DMD). While cardiac magnetic resonance (CMR) is used routinely to assess fibrosis and left ventricular ejection fraction (LVEF), CMR measures of LV filling and ejection in DMD have not been reported.Hypothesis:We hypothesized that patients with DMD would have abnormal LV filling and ejection measures compared to healthy controls and that these measures would associate with mortality.Aims:We aimed to assess LV filling and ejection curves in patients with DMD compared to healthy controls and whether these measures associate with mortality.Methods:Prospectively enrolled DMD patients and healthy controls underwent CMR, including LVEF and LV filling and ejection curves. Multivariable linear regressions were used to compare filling and ejection measures between groups to adjust for baseline differences. Cox regressions were used to evaluate the relationship between diastolic function measures and mortality in the DMD cohort.Results:A total of 179 patients with DMD (mean age 14.3 years) and 96 healthy controls (mean age 14.4 years) were included. DMD patients had lower baseline LVEF, though most (112, 62%) had normal systolic function. When adjusted for age, sex, heart rate, body surface area, and left ventricular end diastolic volume (LVEDV), patients with DMD had slower peak LV filling rates (PFR) and peak LV ejection rates (PER) as well as slower time to PER (Table 1). When limited to DMD patients with normal LVEF, PER remained slower. When adjusted for heart rate, lower PER and PFR normalized to LVEDV were associated with mortality in patients with DMD (Table 2).Conclusions:Patients with DMD have different baseline CMR filling and ejection indices compared with controls, including when limited to DMD patients with normal LVEF. While filling indices associate with mortality in the short-term, longitudinal follow-up is needed to refine their prognostic role in DMD.

Circulation, Volume 150, Issue Suppl_1, Page A4142158-A4142158, November 12, 2024. Introduction:Heart murmurs are abnormal sound signals generated by turbulent blood flow and are closely associated with specific heart disorders. Current methods to detect and qualify murmurs do not recognize that an important part of diagnosing a patient depends upon murmur location in the heart valves and timing between fundamental heart sounds. This research presents HM-Detect, a novel algorithm to provide accurate heart murmur characteristics to cardiologists, specifically in telemedicine. In particular, can we use signal processing and machine learning techniques to detect and classify heart murmur characteristics (e.g. timing and location) from heart sound signals?Approach:HM-Detect analyzes heart sound features, namely the filterbank energies and spectral sub-band centroids. Four separate Random Forest Classifiers (RFCs) were built for each of the four valves of the heart using statistical moments of these features. Additionally, an undersampling technique on heart sound data and a novel “multi-modal” long short-term memory (MMLSTM) neural network incorporate the temporal aspect of heart sounds. The algorithms were validated on signals from the CirCor DigiScope dataset, which is a clinically verified dataset. Three different neural network architectures with varying number of cells and MMLSTM layers were compared.Results and Data Analysis:The feature importance of the first four statistical moments from the RFCs show that the variance has the lowest importance (max value < 0.010) while the mean, skewness, and kurtosis, have higher importance (max value > 0.020). All RFC models were evaluated using the area under their receiver operating characteristic curves (AUROCs). The RFCs were much more successful at classifying murmurs from the pulmonary and tricuspid valves (AUROC = 0.83 and 0.78, respectively) when compared with the aortic and mitral valves (AUROC = 0.72 and 0.65, respectively). Furthermore, the proposed method for murmur timing can achieve a performance accuracy of around 90%, with the best of the three MMLSTM-based models having an F1 score of 0.91 and a test accuracy of 87%.Conclusions:Heart sound features, namely filterbank energies and sub-band spectral centroids, were successfully used to build RFC algorithms which accurately classify murmur locations. The combination of undersampling and MMLSTMs allow for an encapsulation of the spatiotemporal profile of heart sounds and accurately detect and classify heart murmurs based on murmur timing.

Circulation, Volume 150, Issue Suppl_1, Page A4145408-A4145408, November 12, 2024. Background:Stress cardiomyopathy (SCM) is rarely triggered by ketamine and seldom leads to cardiogenic shock. Ketamine-induced catecholaminergic surge can lead to myocardial stunning with transient ischemia and subsequent reversible heart failure. Mechanical circulatory support can be successfully leveraged in SCM-associated cardiogenic shock while awaiting myocardial recovery.Case Presentation:A 28-year-old female with chronic pain was admitted for failure to thrive secondary to opioid-induced gastroparesis. The patient was weaned off opiates while on ketamine over 4 days. After halting ketamine, the patient had a cardiac arrest with eventual return of spontaneous circulation. After being extubated, she developed chest pain, hypotension, and ventricular tachycardia with anterolateral ST elevations, troponin leak, and lactic acidosis. TTE revealed an EF

Circulation, Volume 150, Issue Suppl_1, Page A4139985-A4139985, November 12, 2024. Background:Right atrial (RA) function contributes 15 – 30% to right ventricular stroke volume. However, limited studies have evaluated RA function in the setting of submassive pulmonary embolism (PE). We investigated whether the severity of right atrial dyssynchrony was associated with short-term mortality in patients with submassive PE.Methods:We performed a retrospective cohort study of 251 patient with submassive PE. Strain analysis was applied retroactively using TomTec software. 201 patients had images sufficient for RA strain analysis. RA dyssynchrony was defined as absolute max opposing wall delay (maxOWD) which was the time interval between peak lateral and septal wall strain in RA (Figure1) The primary outcome was 30-day all-cause mortality. The severity of dyssynchrony was defined according to max OWD and divided into four groups; no delay, first tertile (mild), second tertile (moderate), and third tertiles (severe).Results:The patient groups were defined as follows: no delay (0 ms; n = 40), first tertile/mild delay ( > 0 ms, ≤ 4.49 ms; n = 52), second tertile/moderate delay ( > 4.49 ms, ≤ 13.1 ms; n = 51), and third tertile/severe delay ( > 13.1 ms; n = 52). Of 201 patients, 23 patients (11 %) died within 30 days after diagnosis. Kaplan-Meier curves showed significant difference among the four groups (p < 0.001). Additionally, there were significant differences between no delay and moderate delay groups (p = 0.0321) and between moderate and severe delay groups (p=0.010). (Figure2) Moreover, patients with severe RA dyssynchrony had 7.3 times higher risk of 30-day mortality compared to patients in other groups (p < 0.001).Conclusions:The severity of RA dyssynchrony on presentation was associated with mortality in patients with submassive PE. Assessment of RA dyssynchrony on presentation could risk stratify patients with submassive PE.

Circulation, Volume 150, Issue Suppl_1, Page A4124506-A4124506, November 12, 2024. Background:ATTR-CM has an age dependent prevalence and is a disorder that almost exclusively affects older adults. Objective evaluations of function are critical to assessing and managing ATTR-CM in older adults. The short physical performance battery (SPPB) is a valid measure of functional capacity that predicts morbidity and mortality in older adults but its utility in ATTR-CM remains unknown.Aims/hypothesis:To establish SPPB as a useful marker of disease severity and predictor of outcomes in ATTR-CM. We hypothesized that SPPB scores would correlate with validated markers of ATTR-CM severity and improve clinical prediction.Methods:This is a retrospective analysis of patients referred to the Columbia University Cardiac Amyloid Program. Patients were stratified into low (SPPB 0-6), moderate (7-9), and high (10-12) cohorts based on initial SPPB score and baseline characteristics were compared between groups. Cox proportional hazard models and Kaplan Meier (KM) curves were generated to assess associations with mortality as well as a composite of death and cardiovascular (CV) hospitalization in follow-up.Results:A total of 263 patients, age 78 years (IQR 73, 84), 86% male, 22% with ATTRv (variant) and 78% with ATTRwt (wild type) were studied. SPPB showed no limitation in 59%, mild limitation in 33%, and severe limitation in 8%. Lower SPPB was associated (p

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 A4124335-A4124335, November 12, 2024. Background:With the advent of newer generation drug eluting stents, the chorus for shortening the duration of dual antiplatelet therapy (DAPT) after percutaneous coronary interventions (PCI) is getting louder and louder. Ticagrelor monotherapy after a short course of DAPT has been studied in a few randomized controlled trials with promising results. We conducted a systematic review and meta-analysis comparing the ticagrelor monotherapy with DAPT after short duration DAPT in patients undergoing PCIs.Methods:PubMed, Embase and Cochrane databases were searched for RCTs comparing ticagrelor monotherapy to DAPT after PCI and reported the outcomes of Major Adverse Cardiac Events including death, myocardial infarction or stroke (MACE); Major Adverse Cardiac and Cerebrovascular Events including death, myocardial infarction, stroke, stent thrombosis or target vessel revascularization (MACCE); Major bleeding; Death from any cause; CV death; Stent thrombosis and Target vessel revascularization (TVR). Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. Statistical analysis was performed using Review Manager Web (Cochrane Collaboration). Heterogeneity was examined with I2test.Results:Out of 3208 database results, 5 RCTs with 32,393 patients were included; 16,188 (50%) received Ticagrelor monotherapy. Studies had mean follow-up ranging from 12 months to 24 months. Baseline characteristics are as per Table 1. Safety endpoints of major bleeding (HR 0.50; 95% CI 0.38-0.66; p < 0.0001; I2= 23 %; Figure 1A), was significantly less with ticagrelor monotherapy. Efficacy endpoints of MACE, MACCE, Death from any cause, CV Death, target vessel revascularization (TVR) and stent thrombosis were not significantly different between ticagrelor and DAPT (Figure 1 and 2).Conclusion:Ticagrelor monotherapy reduces major bleeding as compared to continued DAPT for 12 months after PCI. Major ischemic outcomes were similar in both groups. Ticagrelor monotherapy may be the way forward after short duration of DAPT in patients undergoing PCI.

Circulation, Volume 150, Issue Suppl_1, Page A4144674-A4144674, November 12, 2024. Introduction:While right ventricular pacing (RVP) is the conventional temporary pacing modality used for transcatheter aortic valve replacement (TAVR), this approach possesses inherent risks and procedural challenges. We aim to assess and compare safety and efficacy of left ventricular pacing (LVP) and RVP during TAVR and balloon aortic valvuloplasty (BAV).Methods:Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search was conducted in four databases from inception to December 15th, 2023. We included observational studies and clinical trials comparing LVP with RVP during TAVR and BAV procedures. The risk ratio (RR) with a 95% confidence interval (CI) was used to compare dichotomous outcomes, while continuous outcomes were reported in form of mean difference (MD).Results:Five studies involving 830 patients with RVP and 1577 with LVP were included. Short-term mortality was significantly higher in the RVP group (RR 2.32, 95% CI: [1.37-3.93], P = 0.002), as was the incidence of cardiac tamponade (RR 2.19, 95% CI: [1.11-4.32], P = 0.02). Subgroup analysis of the TAVR studies only revealed similar trends with higher short-term mortality in the RVP group (RR 1.99, 95% CI: [1.13-3.51], P-value = 0.02). LVP demonstrated shorter hospital stays (MD = 1.34 d, 95% CI: [0.90, 1.78], P

Circulation, Volume 150, Issue Suppl_1, Page A4142110-A4142110, November 12, 2024. Background:Coronary artery calcium (CAC) scans contain more actionable information than the Agatston CAC score. We have previously shown in the Multi-Ethnic Study of Atherosclerosis (MESA) that AI-enabled left atrial (LA) volumetry in CAC scans (AI-CAC) enabled prediction of atrial fibrillation (AF) as early as one year. Furthermore, we have recently shown adding AI-CAC LA volumetry to CHA2DS2-VASc risk score improved stroke prediction in MESA. In this study we evaluated the performance of AI-CAC LA volumetry versus LA measured by human experts using cardiac magnetic resonance imaging (CMRI) for predicting AF and stroke, and compared them with CHARGE-AF risk score, Agatston score, and NT-proBNP.Methods:We used 15-year outcomes data from 3552 asymptomatic individuals (52.2% women, age 61.7±10.2 years) who underwent both CAC scans and CMRI in the MESA baseline examination. We have applied the AutoChamberTM(HeartLung.AI, Houston, TX) component of AI-CAC to 3552 CAC scans. CMRI LA volume was previously measured by human experts. Data on NT-proBNP, CHARGE-AF risk score and the Agatston score were obtained from MESA. Discrimination was assessed using the time-dependent area under the curve (AUC).Results:Over 15 years follow-up, 562 cases of AF and 140 cases of stroke accrued. The AUC for 15-yearAF predictionby AI-CAC LA volume (0.801) was comparable to CMRI LA volume (0.797) and significantly higher than Agatston CAC Score (0.687) and NT-proBNP (0.704). Similarly, the AUC for 15-yearstrokepredictionfor AI-CAC volumetry (0.761) was comparable to CMRI volumetry (0.751) and significantly higher than NT-proBNP (0.631) and Agatston CAC Score (0.646). AI-CAC LA volume outperformed CHARGE AF over 1-3 years for incident AF (p