Risultati per: Approccio pre-rete e Cure Palliative di base

Circulation, Volume 150, Issue Suppl_1, Page A4137781-A4137781, November 12, 2024. Background:Inequities in Preeclampsia/Eclampsia (PrE/E) persist. It is unknown if the receipt of cardiology care relates to future risk of major adverse cardiovascular events (MACE) in Black and White patients with PrE/E. We sought to determine the cumulative incidence of MACE by race and whether predelivery cardiology care was associated with the hazard of MACE up to 1-year post-delivery for Black and White patients with PrE/E.Methods:Using Optum’s Clinformatics® Data Mart Database (CDM), we identified Black and White patients with PrE/E who had a delivery between 2008 to 2019. MACE was defined as the composite of heart failure, acute myocardial infarction, stroke, and death. Cumulative incidence functions were used to compare the incidence of MACE by race. Cox regression models were used to assess the hazard of MACE by cardiology care for Black and White patients.Results:Among 29,336 patients (83.4% White, 16.6% Black, mean age of 30.9 years) with PrE/E, 11.2% received cardiology care (10.9% White, 13.0% Black). Black patients had a higher incidence of MACE than White patients at 1-yr post-delivery (2.7% vs 1.4%). After adjusting for age and clinical comorbidities, receipt of cardiology care was associated with lower hazard of MACE for White patients (HR= 0.68, 95%CI: 0.50-0.92 p=0.013) but not Black patients (HR: 1.22, 95% CI: 0.82-1.81; p= 0.328). The interaction effect between race and cardiology care was statistically significant (p=0.013)Conclusions:Among a well-insured population of patients with PrE/E, Black patients had a higher cumulative incidence of MACE up to a year post-delivery. However, cardiology care significantly lowered the hazard of MACE for only White women. This observation does not suggest that cardiology care is detrimental to Black individuals but underscores the necessity to investigate why outcomes are disparate among these racial groups.

Circulation, Volume 150, Issue Suppl_1, Page A4142506-A4142506, November 12, 2024. Introduction:Myocarditis has been reported after mRNA-based COVID-19 vaccination, but the immune mechanisms remain unclear. This study aimed to identify the proteome-based immunopathogenesis of post-vaccination myocarditis compared to viral myocarditis in the pre-COVID-19 era.Methods:Proteomic analysis of right ventricle (RV) biopsy specimens was performed in myocarditis patients (pre-pandemic viral myocarditis: n=3, post-vaccination myocarditis: n=3) and controls (normal endomyocardial biopsy specimens of heart transplant recipients, n=4) using mass spectrometry. Differentially expressed proteins were analyzed with CIBERSORTx, Gene Ontology (GO) analysis, and Ingenuity Pathway Analysis (IPA). To examine the relationship between the SARS-CoV-2 spike protein and post-vaccination myocarditis, immunohistochemistry (IHC), mass spectrometry analysis of spike protein, and activation-induced marker (AIM) assay in T cells from RV samples were conducted.Results:In the proteomic analysis, 6,861 proteins were identified. Post-vaccination myocarditis showed increased extracellular matrix formation and cardiac fibrosis. Both pre-pandemic and post-vaccination myocarditis had elevated pro-inflammatory cytokine activities. However, post-vaccination myocarditis exhibited higher expression of interferon-alpha (IFNα) and pattern recognition receptor activation, including TLR3 and TLR7. Pre-pandemic myocarditis showed higher activation of the complement system, neutrophils, and NK cells, whereas post-vaccination myocarditis showed increased Th2 cell activation and classical macrophage activation. Spike protein and related T-cell activation were not detected.Conclusion:The immune activation in myocarditis after COVID-19 mRNA vaccination may be triggered by the mRNA in the vaccine via an IFNα-driven immune response, leading to autoimmune-like features. Further studies are necessary to validate whether these proteins correlate with clinical characteristics.

Circulation, Volume 150, Issue Suppl_1, Page A4141790-A4141790, November 12, 2024. Background:There are currently no specific guidelines regarding pre-hospital antiplatelet therapy in patients with out-of-hospital cardiac arrest (OHCA) suspected of acute coronary syndrome (ACS).Purpose:To evaluate efficacy and safety of pre-hospital administration of antiplatelet therapy in patients with OHCA directed to a cardiac catheterization laboratory (cath lab).Method:Using the cath lab database of a tertiary cardiovascular center, we included consecutive patients referred for coronary angiography within 24 hours of OHCA for suspected ACS from January 2012 to January 2024. Pre-hospital antiplatelet treatment was defined as prescribing any antiplatelet therapy before cath lab admission (aspirin alone or combined with a P2Y12 inhibitor). The outcomes of interest were: 1) all-cause death at 30 days, 2) intra-hospital major adverse cardiovascular events (MACE), defined by the composite of all-cause death, myocardial infarction, or stroke, and 3) intra-hospital major bleedings (BARC ≥ 3). To help account for the non-randomized pre-hospital antiplatelet administration, an Inverse Probability Weighting (IPW) approach was used to compare outcomes between the two groups.Result:Between January 2012 and January 2024, n = 411 patients with OHCA were referred to the cath lab, of whom 217 (52.8%) received a pre-treatment. Pre-hospital antiplatelet administration did not show a reduced risk of death from any cause at 30 days (56.7% [50.0%;63.1%] vs 59.8% [52.8%;66.4%], p=0.21) (Figure 1). The rates of intra-hospital MACE (57.1% [50.5%;63.5%] vs (61.3% [54.3%;67.9%]), p=0.38) and major bleedings (18.9% [14.2%;24.6%] vs (18.6% [13.7%;24.6%], p=0.51) did not differ significantly in pre-treated patients compared to non-pre-treated ones.Conclusion:In our cohort of patients with OHCA suspected of ACS, we did not observe an association between pre-hospital administration of an antiplatelet loading dose and outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4147291-A4147291, November 12, 2024. Background:RNA-seq provides a powerful tool to dissect cellular heterogeneity in diseased hearts. It generates reads from both mature RNA and pre-mRNA. Traditionally, only mature RNA transcripts are considered for analysis, but studying both species of transcripts from single-cell RNA-seq of cardiomyocytes in post-infarcted hearts can reveal novel insights into the dynamic transcriptional changes and regulatory mechanisms that occur during heart repair and regenerationResearch question:Do nascent transcriptional events from pre-mRNA forecast the biological processes in failing hearts better than the mRNA and unravel the complexity of cardiomyocyte diversity?Aim:Execute an exon-intron analysis on cardiomyocyte single-cell RNAseq data obtained from post-infarcted mouse heartsMethods:Cardiomyocytes from mice (n=4) post-LAD ligation were isolated and single-cell RNAseq was performed using MegaKit v.2 (Parse Biosciences) on a NovaSeq 6000. Data was analyzed via theParsepipeline andSeurat v5. Pre-mRNA reference was built withAGAT. Gene set enrichment was done usingfgsea. Sham mice without ligation (n=4) served as controlsResults: We analyzed at least 70K cells for each transcript type and compared their enrichment profiles for post-infarcted hearts to sham. Infarction resulted in enrichment for biological processes predominantly for development and fatty acid metabolism, especially from pre-mRNA mapping (mRNA vs pre-mRNA;p=4.2 x 10-18vs 4.8 x 10-32). At the level of individual clusters, cardiomyocyte heterogeneity was revealed with cells enriched for distinct processes. Common to both types of transcripts were terms enriched for cell death (mRNA vs pre-mRNA;p=7.6 x 10-3vs 4.2 x 10-3), tissue remodeling (p=4.3 x 10-4vs 9.6 x 10-4), and respiratory&metabolic activity (p=8.9 x 10-5vs 7.2 x 10-8).However, compared to mRNA, the pre-mRNA had more cell clusters enriched for terms related to increased protein production activity (p=7 x 10-4), activation of key signaling pathways (p=8.5 x 10-4), and defense response (p=2.1 x 10-6). These additional processes show adaptive mechanisms that promisingly forecast cardiomyocyte repair and could be visualized by mapping pre-mRNAConclusion:Examining pre-mRNA offers a realistic view of stressed cardiomyocytes’ transcriptional dynamics. This study could identify new biomarkers to predict the onset of heart failure. Further insights into transitioning cells could aid in developing therapies for regeneration

Circulation, Volume 150, Issue Suppl_1, Page A4134851-A4134851, November 12, 2024. Introduction:Atherosclerosis (ATH) is a major risk factor for cerebrovascular disease (CEVD), with persistent mortality disparities. Our study aims to identify vulnerable regions and demographics in the US adult population with pre-existing ATH at risk of CEVD.Methods:CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) was used to access National Vital Statistics System data from 1999 to 2020. ATH-related CEVD was identified using CEVD as the underlying cause of death and ATH as a contributing cause of death. Results were presented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to examine changes in trend and annual percentage change (APC).Results:A total of 325,408 CEVD occurred in patients with ATH from 1999 to 2020 (AAMR = 6.9, 95% CI: 6.8-7). Increased mortality rates were observed in males (AAMR = 6.3) as compared to females (AAMR = 5.1) (Figure, Panel A). AAMRs were highest in Non-Hispanic Whites [NHW] (5.7, 95% CI: 5.7 – 5.8), followed by non-Hispanic blacks [NHB] (5.5, 95% CI: 5.4 – 5.5), Hispanics (4.1, 95% CI: 4.0 – 4.1) and non-Hispanic American Indian/Alaska Native [NH-AIAN] (3.6, 95% CI: 3.4 – 3.8). Non-Hispanic Asian/Pacific Islander [NH-API] had the lowest mortality rates (3.4, 95% CI: 3.4 – 3.5). Region-wise analysis revealed that mortality rates were highest in the West (6.4, 95% CI: 6.3-6.4) and Midwest (6.2, 95% CI: 6.1-6.2). The South reported the rate of 5.5 (95% CI: 5.5-5.6), while the Northeast had the lowest rate (4.4, 95% CI: 4.3-4.4). Mortality rates were consistently higher in rural areas (6.1, 95% CI: 6.0-6.1) compared to urban areas (5.3, 95% CI: 5.3-5.4) throughout the study period. Overall AAMR rose from 9.0 in 1999 to 10.4 in 2001, then steadily declined before increasing to 3.6 from 2016 to 2020 (APC: 0.41). After an initial decline, AAMR increased in men (APC: 1.09) from 2016 and in women (APC: 5.09) from 2018. AAMR also increased among NH-API (APC: 8.9) and NHB (APC: 8.3) from 2018 onwards, and NHW (APC: 0.1) from 2016 (Figure, Panel B).Conclusions:Our study reveals significant mortality disparities from CEVD in patients with ATH, identifying males, NHW, and residents in the West and Midwest as particularly at increased risk. Rural areas consistently show higher mortality rates than urban areas. These findings highlight the need for targeted interventions and strategic provision of healthcare resources to improve outcomes for vulnerable populations.

Circulation, Volume 150, Issue Suppl_1, Page A4146010-A4146010, November 12, 2024. Background:Pre-eclampsia (PE) affects approximately 4 million women annually, characterized by sudden-onset hypertension ( >20 weeks gestation) and proteinuria. It is a leading cause of maternal and perinatal morbidity and mortality and increases long-term cardiovascular risks for mothers and infants. This study examines the long-term risk of arrhythmias in women with PE to improve future cardiovascular outcomes.Methods:This observational cohort study utilized the US Collaborative Network to analyze electronic medical records from 64 healthcare organizations. We identified 7,463 women with PE and 7,463 matched women without PE, following them from their first pregnancy to the incidence of arrhythmia, death, or study end. Primary outcomes included heart failure, cardiac arrhythmias, atrial fibrillation/flutter, supraventricular tachycardia, and ventricular fibrillation. Incidence rates and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models over a median follow-up of 1 year.Results:Women with PE had significantly higher risks of heart failure (HR 6.39, 95% CI: 3.48–11.74, p = 0.007), cardiac arrhythmias (HR 1.70, 95% CI: 1.35–2.13, p < 0.001), and atrial fibrillation/flutter (HR 2.73, 95% CI: 1.22–6.13, p = 0.011). No significant difference was observed for supraventricular tachycardia (HR 0.93, 95% CI: 0.44–1.98, p = 0.116), while the risk of ventricular fibrillation was 49% higher in the PE cohort (HR 1.49, 95% CI: 1.01–2.19, p = 0.044).Conclusion:Women with pre-eclampsia have significantly higher risks of developing heart failure, cardiac arrhythmias, and atrial fibrillation/flutter compared to those without PE. No significant difference was found in the risk of supraventricular tachycardia, while the risk of ventricular fibrillation was moderately higher. These findings underscore the need for targeted cardiovascular monitoring in women with a history of PE.

Circulation, Volume 150, Issue Suppl_1, Page A4140630-A4140630, November 12, 2024. Introduction:Efforts to stratify mortality risk in pulmonary hypertension (PH) have focused on the minority of patients in WSPH group 1. Metabolomic studies in group 1 identify histidine, polyamines, tRNA metabolites, and homoarginine as predictors of mortality. Little is known about the role of metabolomics to predict mortality in the larger group of PH patients.Question:Which serum metabolites predict a composite of mortality or transplant in pre-capillary, post-capillary, and combined pre- and post-capillary PH (Cpc-PH), irrespective of WSPH group?Aims:To identify predictive metabolites in the Pulmonary Vascular Disease Phenomics Program (PVDOMICS) cohort and understand the pathobiology relating predictors to mortality/transplant.Methods:We generated peripheral venous metabolomic data in 649 PH subjects. We defined pre-capillary PH as pulmonary vascular resistance (PVR) >2 WU and pulmonary capillary wedge pressure (PCWP)≤15 mmHg (n = 453), post-capillary PH as PVR≤2 WU and PCWP >15 mmHg (n=25), and Cpc-PH as PVR >2 WU and PCWP >15 mmHg (n = 171). We used Cox models with multiple testing correction to identify predictive metabolites in each group. We then correlated select predictors with hemodynamic, laboratory, and echocardiographic data.Results:The hemodynamic groups included a mix of WSPH groups. We identified 249 predictors in pre-capillary PH, 0 in post-capillary PH, and 7 in Cpc-PH. Homoarginine predicts mortality/transplant in pre-capillary PH (HR=0.56, p

Circulation, Volume 150, Issue Suppl_1, Page A4146008-A4146008, November 12, 2024. Objective:Inflammation is associated with pathologies including post operative acute kidney injury (AKI). AKI is one of the common post operative conditions which prolongs hospitalization, intensive care unit stay and causes higher health costs and mortality. Pre-operative neutrophil to lymphocyte ratio (NLR) has predictive value for post-operative AKI after coronary artery bypass grafting (CABG). Hence, we aimed to evaluate the association of pre-operative NLR and post-operative AKI in patients undergoing CABG.Methods:A comprehensive literature review was conducted using PubMed, Google Scholar and SCOPUS databases from 2000 until 2024 using related keywords to identify studies reporting association of pre-operative NLR and post-operative AKI in patients undergoing CABG. The data was extracted and independently reviewed by four authors using standard forms. A random-effects model was used to calculate odds ratios (OR) and heterogeneity was assessed using I2 statistics. The sensitivity analysis was performed using the leave-one-out method.Results:Our final analysis included 6 retrospective studies which included 1757 patients with CABG. The mean age of the included patients was 64 years and 63.4% were males. Initial unadjusted analysis showed higher odds of post-operative AKI in patients having higher pre-operative NLR values with unadjusted OR 1.67, 95% CI 1.20-2.34, p

Circulation, Volume 150, Issue Suppl_1, Page A4125252-A4125252, November 12, 2024. Introduction:Hematopoietic stem cell transplantation (HSCT) is associated with adverse cardiovascular (CV) events including the development of heart failure (HF) and arrythmias. While transthoracic echocardiogram (TTE) is routinely obtained prior to HSCT, its role in predicting the incidence of HSCT related CV events is poorly understood.Methods:We used data from the Cardiovascular Registry in Bone Marrow Transplantation (CARE-BMT) study, a multicenter observational study of adult patients (aged ≥18 years) who underwent autologous/allogeneic HSCT for malignant or nonmalignant bone marrow disorders at the University of Michigan Health System (UMHS) and Rush University Medical Center from 2008-2019. In this analysis, we included patients from UMHS with a baseline TTE. Data on pre-HSCT TTE parameters and post-HSCT CV outcomes were collected through manual chart review. Left ventricular (LV) function and dimensions were categorized into normal, mildly abnormal, and moderately/severely abnormal based on American Society of Echocardiography guidelines. The primary outcomes were new-onset HF and atrial fibrillation/flutter post-HSCT. Analyses were conducted using a Fine-Gray model adjusted for the pre-HSCT CARE-BMT CV risk score.Results:Of the 2071 patients (mean age at HSCT 55.5+12.9 years; 59.5% male) with a pre-HSCT TTE (median 25 days pre-HSCT), 116 (5.6%) and 128 (6.2%) patients experienced HF and atrial fibrillation/flutter, respectively, over a median period of 2.2 years. Greater abnormalities in left ventricular internal diameter at end-diastole (LVIDd) and end-systole (LVIDs) were linearly associated with a higher risk of HF (P-trend 0.018 and 0.004, respectively) (Table). Similarly, moderately/severely abnormal LVIDd was associated with a 2.41-fold (95% CI: 1.07, 5.43) increase in risk of atrial fibrillation/flutter (Table). Pre-HSCT ejection fraction (EF) was not associated with either endpoint.Conclusion:LV dilation, even when mild, was notably associated with increased risk of developing new HF or atrial arrythmias post-HSCT, regardless of EF. Whether evidence of LV dilation should prompt the initiation of guideline directed medical therapy to minimize the risk of incident HF warrants further study.

Circulation, Volume 150, Issue Suppl_1, Page A4125729-A4125729, November 12, 2024. Background:Transcatheter edge-to-edge mitral valve repair (TEER) is an established procedure in patients with severe mitral regurgitation (MR) and elevated surgical risk on optimal medical therapy. However, there remains considerable mortality in this patient population. Some studies have shown that serum brain natriuretic peptide (BNP) and N-terminal pro b-type natriuretic peptide (NT-proBNP) predict all-cause mortality after TEER, whereas other studies have shown mortality to be independent of these markers. To address this gap in knowledge, we sought to examine the existing literature to determine whether there is an association between pre-procedural serum natriuretic peptides and mortality after TEER.Hypothesis:Among patients undergoing TEER, elevated pre-procedural BNP and NT-proBNP are associated with increased all-cause mortality.Methods:Databases including MEDLINE, Embase, and Cochrane Library were searched from inception through September 2023 for studies assessing pre-procedural serum natriuretic peptide levels and mortality among patients undergoing TEER. Pooled hazard ratios (HR) and standardized mean differences (SMD) were calculated using a random-effects model estimated by restricted maximum likelihood with the Hartung-Knapp modification.Results:A total of 30 studies comprising 10259 patients undergoing TEER met inclusion criteria. 25 studies measured NT-proBNP and 5 studies measured BNP. Elevated pre-procedural NT-proBNP ( >5000 or >10000 pg/mL) was associated with increased all-cause mortality in both adjusted (HR = 2.94; 95% CI = 1.75 – 4.95; I2 = 46.8%) and unadjusted (HR = 5.16; 95% CI = 1.85 – 14.40; I2 = 0.0%) analyses (Figures 1 and 2). Pre-procedural BNP and NT-proBNP were also significantly lower among survivors at 12 months compared to non-survivors (SMD = 0.82; 95% CI = 0.37 – 1.27; I2 = 78.3%) (Figure 3). This association was demonstrated in patients with primary or secondary MR.Conclusions:Pre-procedural BNP and NT-proBNP levels are significant predictors of all-cause mortality in patients undergoing TEER for primary or secondary MR. This supports the inclusion of BNP or NT-proBNP in pre-procedural assessments to help inform patient discussions and guide post-procedural follow-up and monitoring.

Circulation, Volume 150, Issue Suppl_1, Page A4140895-A4140895, November 12, 2024. Background:Red cell distribution width (RDW) is a measurement of variability in erythrocyte size and volume, routinely reported as part of a complete blood count. Recently, it has gained popularity as a novel prognostic biomarker for cardiovascular disease outcomes. Our study investigates the predictive value of pre-procedural RDW for all-cause mortality (ACM) within one year for patients undergoing transcatheter aortic valve implantation (TAVI).Methods:We comprehensively reviewed databases like PubMed, Google Scholar, Embase, and Scopus until May 2024, looking for studies reporting an association between pre-procedural RDW and outcomes in TAVI. A binary random effects model was used to calculate the pooled adjusted odds ratio (aOR), and subgroup analysis was performed. I2 statistics were used to determine the heterogeneity of studies, further enhancing the robustness of our research.Results:Our systematic review and meta-analysis included five studies (three retrospective, two prospective) encompassing 2,565 patients with a mean age of 81.32 years. Our study showed a slight female predominance (52%). The mean follow-up period was one year. Comorbidities like coronary artery disease, diabetes melitus, atrial fibrillation, prior myocardial infarction were commonly reported among the study population. Higher pre-procedural RDW was associated with increased odds of ACM at the end of one year with an unadjusted pooled OR 1.86 (95% CI: 1.30-2.67, p

Circulation, Volume 150, Issue Suppl_1, Page A4140896-A4140896, November 12, 2024. Background:Recent revisions in the guidelines for pre-clinical heart failure (HF), particularly concerning B-type natriuretic peptide (BNP) levels between 35-100 pg/mL, indicate a more detailed approach.Research question:1) BNP is influenced by several factors, including age, leading to potential variation in BNP’s predictive value for future HF events. 2) Risk stratification for HF in the pre-HF state (BNP levels: 35-100 pg/mL) has not been established.Hypothesis:We hypothesized that variations in BNP values predicting HF events exist in association with specific clinical variables.Methods:We prospectively evaluated consecutive HF patients in Stage A/B (stage A/B: 731/4,537) from the multicenter observational CHART-2 (Chronic Heart Failure Registry and Analysis in the Tohoku District-2) Study. Previous studies identified the following parameters for BNP levels: age, body mass index (BMI), and estimated glomerular filtration rate (eGFR). We assessed their 10-year HF-related events.Results:The enrolled patients had the following characteristics: mean age 67.6±12.0 years, 71.1% male, BMI 24.2±12.0 kg/m2, and eGFR 67.4±19.2 ml/min/1.73m2. As shown inFigures 1A-C, variations in AUC and cut-off values exist in each category (A: age quartiles, B: BMI per WHO criteria, and C: eGFR). The minimum cut-off value was 38.25 pg/mL in the youngest quartile. We performed risk stratification for those with BNP values of 35-100 pg/mL (n=1412) using classification and regression tree (CART) methods, identifying these cut-off values as shown inFigure 2. The hazard ratios (HR) for HF events were significantly higher in type 2 (age 50.9 pg/mL) (HR: 3.94, 95% CI: 2.88-5.38) compared to type 1 (both, P35 pg/mL) encompasses all at-risk patients in Stage A/B.

Circulation, Volume 150, Issue Suppl_1, Page A4143849-A4143849, November 12, 2024. Background:Maternal mortality in the United States continues to rise, with hypertensive disorders of pregnancy (HDP) playing a significant role in adverse outcomes. Patients of color have worse outcomes compared to their White counterparts. Data in non-pregnant patients suggests community health workers (CHWs) can help mitigate disparities and improve HDP outcomes. Does exposure to a CHW improve patient education about HDP and satisfaction and are these findings different between Black and non-Black patients?Methods:This was a prospective survey study that enrolled patients delivering at the University of Chicago (UCM). Patients with HDP are automatically enrolled in a standardized postpartum hypertension education program (STAMPP-HTN) where they receive education and a blue tooth compatible blood pressure monitor. Patients who did not record their blood pressures were contacted by a CHW and surveyed about their experience. Results were compared between Black and Non-Black patients using a Wilcoxon Rank Sum, X2or Fisher’s Exact test, as appropriate.Results:There were 32 survey responses from 22 respondents and 15 patients with complete baseline data, 6 of whom were Black and 9 of whom were non-Black. There were no differences in age, insurance status, or pregnancy outcomes between groups. Additionally, of the 32 survey responses, there were no significant differences in experiences with a CHW between Black and non-Black patients. Table 1 outlines the impact of CHW on patient’s education and attitude towards HDP. Most patients found that CHW involvement increased the amount of time they checked their blood pressure (76%) with no difference between races (p=0.23). Overall, 84% patients (strongly agreed or agreed) that their CHW knows the important issues about their healthcare.Conclusion:The incorporation of a CHW program into a pre-existing postpartum hypertension program was overall well-received by patients with no racial disparity. The program increased the patient’s understanding of HDP and lead to a better follow up of their blood pressures values. Further work is needed to determine how this program impacts long-term patient’s outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4147473-A4147473, November 12, 2024. Coronary microvascular disease (CMVD), or disease of the coronary pre-arterioles, arterioles, and capillaries, accounts for 30-50% of ischemic heart disease. Progress in the field requires preclinical models to assess the coronary microvasculature. There are several risk factors for CMVD including age, metabolic syndrome, and hypercholesterolemia. Here, we evaluate the effect of these risk factors on coronary microvascular function in mice.Male and female C57BL/6 mice aged 12-42 weeks (n=29) were treated with 45% high fat diet (HFD) for six months or aged > 9 months. Apolipoprotein E knockout (ApoE-/-) was used to induce hypercholesterolemia as a second risk factor. To assess coronary microvascular function, we measured the intramyocardial blood volume (IMBV) under hyperemic (2.5% isoflurane) and basal (1.25% isoflurane) conditions, as previously reported. Briefly, we labeled red blood cells using pyrophosphate and Technetium 99m-pertechnatate and imaged the heart using µ-SPECT (MI Labs). Coronary microvascular function is reflected by the percent change in intramyocardial activity concentration between rest and stress conditions or△IMBV. Outliers were removed based on Grubbs method (a=0.1) and groups were compared using Student’s T test.p

Circulation, Volume 150, Issue Suppl_1, Page A4137883-A4137883, November 12, 2024. Background:Living kidney donors (LKD) are at risk for developing hypertension (HTN); however, the levels of pre-donation blood pressure (BP) that may predict post-donation BP are unknown.Hypothesis:Higher pre-donation BP is associated with a greater risk of developing post-donation HTN.Goals:We aim to examine the association between pre-donation BP and the risk of developing HTN in LKD.Methods:A retrospective cohort study using OPTN/SRTR included adult LKD undergoing donation between 6/1972 and 9/2022. Systolic and diastolic hypertension (SHTN and DHTN) were defined by SBP ≥130 and DBP ≥80 mmHg, respectively. Multiple Cox regression was utilized to examine the association between decile of pre-donation BP and time-to-event of developing post-donation SHTN and DHTN.Results:Of 174,311 adult LKD, the mean±SD age was 41±12 years and 60% were female. Mean pre- and post-donation SBP and DBP and deciles of BP are shown in Table 1 and Figure 1, respectively. The median time to follow-up for developing SHTN was 13.2 (IQR 6.8, 24.4) and DHTN was 12.2 months (IQR 6.3, 24.1). The incidence rate of developing SHTN and DHTN was 0.020 and 0.03 person-months, respectively. After adjusting for age (

Circulation, Volume 150, Issue Suppl_1, Page ASu1101-ASu1101, November 12, 2024. Introduction:Bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use are interventions that can increase survival rates of out-of-hospital cardiac arrests (OHCA). However, willingness and comfort levels of such interventions amongst laypersons vary greatly, especially in racial and ethnic minoritized groups including African Americans and Hispanics.Research Question:To assess the comfort level and perceived barriers of participants before and after community-based CPR and AED education.Methods:We conducted a family-centered quasi-experimental study in primarily Black and Hispanic churches around the Will and Dupage counties of Illinois. Informed consent was obtained. Participants watched an instructor-facilitated CPR and AED 10-minute educational video. Comfort levels pre- and post-training were assessed on a scale of 1 (least confident) to 5 (extremely confident) and reported as percentages. A semi-structured questionnaire was used to assess perceived barriers to performing CPR.Results:Out of 27 participants who completed training assessment, majority were females 55.6% (n=15), with 44.4% (n=12) males; 66.7% (n=18) African Americans, and 33.3% (n=9) Hispanic or Latino. 70.4% (n=19) of the participants spoke English while 29.6% (n=8) spoke Spanish. Before training, 73% (n=19) and 81% (n=21) of participants were not confident in administering CPR or using AED respectively on someone in cardiac arrest. After training, confidence level increased to 100% for both CPR and AED use. Perceived barriers to CPR prior to training included participants not knowing how to perform CPR correctly (65%), concern that they may further harm someone (4%), concerns about potential legal liability (4%), and loss of recall on how to perform CPR (4%), while 23% had no barrier.Conclusion:Comfort levels of individuals performing CPR and AED use increased significantly after community-based CPR and AED education. Data collection is ongoing to assess comfort level with a larger number of participants. Implementing community-based CPR training in churches allows for community-oriented CPR trainings and may help improve bystander comfort level and willingness to perform CPR during OHCA, especially in minoritized communities.