Risultati per: Terapia antibiotica: breve durata vs. lunga durata

Circulation, Volume 150, Issue Suppl_1, Page A4125106-A4125106, November 12, 2024. Background:Internationally, drug-coated balloons have emerged as a new treatment approach in In-Stent Restenosis (ISR) offering localized drug delivery to inhibit neointimal growth without the need for additional stent layers. However, their use has not been assessed or approved in the United States. Paclitaxel-coated balloons (PCBs) are gaining traction as alternatives for in-stent restenosis patients. Yet, their safety and effectiveness compared to uncoated balloons remain uncertain. This meta-analysis seeks to systematically assess PCBs’ safety and efficacy for ISR treatment by comparing them to uncoated balloons.Research Question:Are paclitaxel-coated balloons (PCBs) superior to uncoated balloons (UCBs) in terms of safety and efficacy for the treatment of coronary in-stent restenosis (ISR)?Aims:Systematically assess the safety and efficacy of paclitaxel-coated balloons (PCBs) compared to uncoated balloons (UCBs) for the treatment of coronary in-stent restenosis (ISR).Methods:A comprehensive literature review was conducted utilizing multiple databases up to May 2024, focusing on randomized controlled trials comparing PCB vs UCB in patients with coronary in-stent restenosis. Six randomized controlled trials with a total of 1,347 patients who completed 1-year follow-up were included. Dichotomous data were calculated as odds ratios (ORs) and 95% confidence intervals (95% CI). P

Circulation, Volume 150, Issue Suppl_1, Page A4147387-A4147387, November 12, 2024. Introduction:Metabolic pharmacotherapies [Glucagon-like peptide-1 receptor agonists (GLP1RA) and sodium-glucose cotransporter type 2 inhibitors (SGLT2i)] have shown benefit in patients with heart failure and preserved ejection fraction (HFpEF). It remains unclear whether the two classes would have additive effects.Methods:We performed a retrospective study using a de-identified federated database with 89 contributing health care organizations (HCO), including over 126 million patients (TriNetX Research Network, Cambridge, MA; date of data access: May 23, 2024). TriNetX regularly aggregates clinical data directly from participating HCOs, and performs extensive data quality and accuracy assessment. While TriNetX obfuscates institutional information relating to participating HCOs, a typical HCO includes a large academic health center with inpatient, outpatient, and specialty care services. We identified all patients with a diagnosis of Heart failure with preserved ejection fraction (HFpEF, ICD-10: I50.3), and SGLT2i usage. We then categorized this patient population into two cohorts, including patients with concomitant GLP1RA use, and patients without GLP1RA use. For both cohorts, we collected data on patient demographics, and the outcomes of all-cause mortality, and all-cause hospitalization, occurring up to 10-years after the index diagnosis. We evaluated differences in outcome risk using hazards ratios and 95% confidence intervals.Results:Prior to propensity score matching, we identified 114,329 patients, with 7931 patients receiving SGLT2i +GLP1RA vs 106398 receiving SGLT2i-alone. Majority (55.7%) identified as white and 24.4% as African Americans and >90% of the patients had a diagnosis of type 2 diabetes mellitus. After propensity matching, the rate of all-cause hospitalization within the combination group was lower than SGLT2i group (29.6% vs 32.4%, HR 0.76 [0.73- 0.79], P

Circulation, Volume 150, Issue Suppl_1, Page A4139506-A4139506, November 12, 2024. Introduction:Data on multivalvular surgery are heterogeneous, not contemporary, and are underrepresented from low-income countries where rheumatic disease is prevalentObjectives:To compare clinical, epidemiological data, and surgical outcomes between patients undergoing surgery for one vs. 2 or more concomitant valve diseases.Methods:Patients in the INCORVALV Registry were divided into groups based on the number of valves treated in the same procedure: univalvular vs. multivalvular (2 or more). Outcomes were evaluated at 30 days.Results:Of 459 patients, 400 had single-valve and 59 had multivalve surgery, with only 1 having 3-valve surgery. Groups were similar in age (55±16 vs. 55±15 years, p=0.98), male sex (49.3% vs. 52.5%, p=0.74), NYHA class III or IV (66.7% vs. 76%, p=0.08) and comorbidities such as hypertension (59.6% vs 54.2%, p=0.57) and diabetes (18% vs 22%, p=0.57). Multivalvular patients had higher pulmonary arterial pressure (47.7±19.4 vs. 59.2±19.6 mmHg, p

Circulation, Volume 150, Issue Suppl_1, Page ASu1204-ASu1204, November 12, 2024. Introduction:Temperature management (TM) to prevent fever is crucial to mitigate neurological deterioration post-cardiac arrest. Whether hypothermic TM (h-TM) is superior or equal to normothermic TM (n-TM) after out-of-hospital cardiac arrest (OHCA) is debatable, prompting ongoing effects to identify patients who might benefit more from h-TM. We hypothesized that effect of TM would differ based on body temperature at hospital arrival.Aim:Explore which post-cardiac arrest patient subsets might benefit from h-TM by stratifying them based on body temperature at hospital arrival.Methods:This retrospective, observational study used data from the OHCA registry in Japan. Patients 18 years and older who experienced OHCA due to medical cause and received TM in the intensive care unit were included. Primary outcome measure was 30-day favorable neurological outcomes, defined as a Cerebral Performance Category score of 1 or 2. Patients were stratified into groups based on body temperature at hospital arrival: normothermia (36.0-38.0°C), hypothermia (38.0°C). Effect of TM post-cardiac arrest (h-TM [32-34°C] or n-TM [35-36°C]) was evaluated in each stratified group. Univariable and multivariable logistic regression analysis was used for comparison. Adjusted odds ratio (OR) for favorable neurological outcome with h-TM was calculated using n-TM as a reference. Hyperthermia was excluded from multivariable analyses due to small sample size.Results:We analyzed 3,044 patients, 1,273 in the normothermia group, 1,747 in the hypothermia group, and 24 in the hyperthermia group. Numbers of patients with favorable neurological outcomes were as follows: 530/1,273 (41.6%) in the normothermia group, 584/1,747 (33.4%) in the hypothermia group, and 4/24 (16.7%) in the hyperthermia group. There were no differences in favorable 30-day neurological outcomes between h-TM and n-TM in any stratified group in the univariable analysis: normothermia (h-TM 323/785 [41.2%] vs. n-TM 207/488 [42.4%], p=0.66); hypothermia (411/1,185 [34.7%] vs. 173/562 [30.8%], p=0.11); hyperthermia (3/13 [23.1%] vs. 1/11 [9.1%], p=0.59). Multivariable analysis also showed no differences: normothermia (OR: 0.96, 95% CI: 0.72-1.26), hypothermia (OR: 1.10, 95% CI: 0.85-1.42).Conclusion:TM (h-TM vs. n-TM) did not significantly affect 30-day neurological outcomes, regardless of initial temperature at hospital arrival.

Circulation, Volume 150, Issue Suppl_1, Page A4144899-A4144899, November 12, 2024. Introduction:Non-ST elevation myocardial infarction (NSTEMI) significantly contributes to the burden of cardiovascular diseases, affecting millions of patients. The management of NSTEMI has evolved and it involves invasive and conservative strategies, the optimal management remains unclear. We conducted this systematic review and meta-analysis to compare the two different strategies and their long-term outcomes.Methods:We systematically examined the clinical outcomes of conservative and invasive management of patients with NSTEMI using medical records from Web of Science, PUBMED, Scopus, and Cochrane. Our outcomes of interest were all-cause mortality, myocardial infarction (MI), and major bleeding. Odds Ratios (OR) and 95% CI were used in a fixed-effect model to analyze the data.Results:Our study included 24 studies with a total of 1,076,572 patients. the invasive strategy was significantly associated with a reduction in all-cause mortality (OR: 0.52, 95% CI: 0.51 to 0.53), and the incidence of myocardial infarction (OR: 0.84, 95% CI: 0.73 to 0.97). However, the invasive strategy showed a significant increase in major bleeding events (OR: 1.93, 95% CI: 1.87 to 1.98).Conclusion:The invasive strategy showed better clinical outcomes on the long-term follow-up related to all-cause mortality and myocardial infarction, with an increase in the incidence of major bleeding events.

Circulation, Volume 150, Issue Suppl_1, Page A4138558-A4138558, November 12, 2024. Background:Pulsatile perfusion is a developing technique that attempts to mimic the natural pulsatile flow of blood during cardiopulmonary bypass (CBP).Purpose:Our meta-analysis was done to evaluate the effects of pulsatile perfusion in CPB compared to non-pulsatile on hospital stay, ICU stay, and intubation time.Methods:Randomized control trials that evaluated the implementation of pulsatile perfusion during CPB were identified by a literature search of the following databases (PubMed, Web of Science, Scopus, Central, and Embase) up to February 2024.Results:Our search yielded 33 trials with 3174 patients, the analysis showed that pulsatile perfusion led to a significant decrease in hospital stay [MD = -1.38, 95% CI (-2.51, -0.25), P = 0.016], ICU stay [MD = -0.47, 95% CI (-0.82, -0.13), P = 0.007], intubation time [MD = -3.73, 95% CI (-5.42, -2.04), P < 0.001]. However, no significant difference between the two regimens was detected in the adult subgroup when we performed sungroup analysis based on the age for hospital stay and ICU stay outcomes [MD = -0.31, 95% CI (-0.95, 0.33), P = 0.334] and [MD = -3.73, 95% CI (-5.42, -2.04), P < 0.001] respectively.Conclusion:Pulsatile perfusion showed positive effects on hospital stay, ICU stay, and intubation time. However, there was no difference between the two methods on hospital and ICU stay in the adult’s subgroup. Also, the outcomes showed significant heterogeneity, which requires more robust RCTs to be conducted to increase the quality and the certainty of evidence.

Circulation, Volume 150, Issue Suppl_1, Page ASa105-ASa105, November 12, 2024. After the implemetation of special emergency services, advanced airway management(AAM) in cardiac arrest has been tried actively. We aim to compare the success rates and patient outcomes of supraglottic airway(SGA), endotracheal intubation with direct laryngoscope(ETI with DL), and endotracheal intubation with video laryngoscope(ETI with VL) in patients with sudden cardiac arrest, and evaluate the effectiveness of the video laryngoscope in the pre-hospital stage.This study was conducted on cardiac arrest patients who transferred to ED by EMS from July 2019 to December 2021. Using the Korean OHCA registry, EMS ambulance runsheet, and cardiac arrest in-depth registry, patients with sudden cardiac arrest over 18 years old, caused by medical cause, and who were treated by the special EMS team at the site and got AAM were enrolled. Cases with unknown information on AAM success or time of arrival/death were excluded. Pre-hospital ROSC, 72 hr survival, survival to discharge, good neurological outcome were compared among SGA, ETI with DL and ETI with VL using multivariable logistic regression. Initial AAM success and final success rates were also compared.10,587 cases were enrolled in the study, of which 9379 cases got SGA, 493 ETI with DL, and 985 ETI with VL. In the first attempt, the insertion success rate is higher with SGA, but the overall success is higher with VL. For any prehospital ROSC, compared to SGA, ETI with DL was 1.33 (1.00-1.75), and ETI with VL was 1.92 (1.57-2.34). Compared to SGA, aOR for survival within 72 hours was 1.13 (0.81-1.56), 1.34 (1.06-1.70), survival to discharge was 1.05 (0.64-1.65), 1.06 (0.74-1.49), and good neurological outcome was 0.64 (0.31-1.25), 1.17(0.71-1.86) in ETI with DL or ETI with VL respectively. Compared to the SGA, aOR of the initial success was 0.44 (0.32-0.61) and 0.48 (0.38-0.62) in the ETI with DL and ETI with VL groups, respectively, and the final success rate was 0.78 (0.45-1.44), 1.14 (0.72-1.94).Endotracheal intubation in EMS showed the lower initial success rate than SGA, but when using a video-laryngoscope, the final success rate rises to a sufficiently similar level, and the pre-hospital ROSC success rate is higher than that of SGA.

Circulation, Volume 150, Issue Suppl_1, Page A4144844-A4144844, November 12, 2024. Background:To improve outcome of catheter ablation for persistent atrial fibrillation (AF), adjunctive strategies targeting non-pulmonary vein triggers and atrial substrate modification were pursued.Objectives:To investigate the efficacy of cryoballoon left atrial roof ablation as an adjunctive ablation for persistent AF.Methods:This retrospective study included 448 consecutive patients who underwent their first ablation procedure for persistent atrial fibrillation at Keio University Hospital from January 2016 to May 2023. Using propensity score matching, we extracted 79 pairs who underwent cryoballoon left atrial roof ablation (CB-RA) or BOX posterior wall isolation (BOX-PWI) using radiofrequency. We evaluated procedural characteristics and the recurrence incidence of atrial arrhythmia after a 90-day blanking period within one year.Results:In the matched cohort of 158 patients (median age 64 [58-70], 88% male, 30.4% with longstanding persistent AF), 25 patients (15.8%) experienced atrial arrhythmia relapse after the blanking period within one year. CB-RA was successfully completed in 55 patients (69.6%), and touch-up radiofrequency roof line ablation was required in 24 patients (30.4%). Additional bottom linear ablation was performed with cryoballoon or radiofrequency in 22 patients (27.8%) in the CB-RA group, based on the physician’s decision during the procedure. Freedom from atrial arrhythmia recurrence was comparable between groups over one year of follow-up (83.5% for CB-RA vs. 84.8% for BOX-PWI; hazard ratio (HR) 1.34, 95% confidence interval (CI) 0.61–2.94, P=0.48).Conclusion:In Japanese clinical practice, cryoballoon-based left atrial modification as an adjunctive therapy for persistent atrial fibrillation demonstrated acceptable outcomes comparable to those of posterior left atrial box isolation using radiofrequency.

Circulation, Volume 150, Issue Suppl_1, Page A4141927-A4141927, November 12, 2024. Background:Prior data suggest the MI risk may be higher with paroxysmal AF (PAF) vs. non-paroxysmal AF (non-PAF). Proposed mechanisms include tachycardia-induced oxidative stress (via LOX-1) with microvascular flow abnormalities, ischemia downstream of a fixed coronary obstruction, and plaque rupture.Methods:We compared MI rates in pts with PAF vs. non-PAF in COMBINE AF, a patient-level metanalysis of 4 RCTS of DOACs vs warfarin (ARISTOTLE, ENGAGE AF-TIMI 48, RE-LY,ROCKET AF). Secondary endpoints were ischemic stroke and CV death. Cox proportional-hazards models stratified by trial and adjusted for elements of the CHADS-VASc score were constructed. Sensitivity analyses were performed across subgroups, omitting pts on lower-dose DOAC regimens, and accounting for competing risk of death.Results:Of 71,466 pts, 16,609 (23%) had PAF at enrollment. Pts with PAF vs non-PAF were similar age (median 72 vs 72. P=0.15), but more likely women (43 vs 36%), with prior CAD (35 vs 31%), and on aspirin (41 vs 32%); but less likely Asian race (12 vs 15%) or with CHADS-VASc score >4 (59 vs 60%), p160,000 pt-yrs of follow-up, 1033 MIs occurred: 277 (1.67%) in pts with PAF vs 766 (1.40%) in pts with non-PAF, corresponding to rates of 0.81% and 0.70% per pt-year. The HRadjfor MI with PAF vs non–paroxysmal AF was 1.17 [1.02-1.35], p=0.028 (Fig). Ischemic stroke occurred in 364 (2.19%) vs 1425 (2.60%) pts with PAF vs non–paroxysmal AF (HRadj0.81 [0.72-0.91], p

Circulation, Volume 150, Issue Suppl_1, Page A4146115-A4146115, November 12, 2024. Introduction:We recently observed that transient elevations in preload are common in swine with multi-vessel coronary artery disease (MV-CAD), presumably due to intermittent demand-induced ischemia of a large perfusion territory. Based on evidence that repetitive preload elevation can lead to fibrosis in the absence of ischemia, we hypothesized that mechanical stretch, rather than ischemia, maybe a key mechanism underlying extracellular matrix (ECM) remodeling in chronic CAD. To test this hypothesis, we compared regional pro-fibrotic gene expression and interstitial collagen in swine with MV-CAD to that observed in swine with single-vessel CAD (SV-CAD) in which the size of the culprit artery perfusion territory is insufficient to cause preload elevation during acute ischemia.Methods:Juvenile swine were instrumented with fixed 1.5 mm stenoses on the left anterior descending and left circumflex (LCx) coronary arteries (MV-CAD; n=6) or the LCx only (SV-CAD; n=6). Three months later, LV tissue was collected from the free wall (ischemic region) and posterior wall (non-ischemic region) to quantify pro-fibrotic gene expression (qPCR) and interstitial collagen (picrosirius red staining) vs. controls (n=11).Results:LCx stenosis severity was similar between MV-CAD and SV-CAD groups (90±4 vs. 82±7%; p=0.4). Pro-fibrotic gene expression was significantly elevated in both ischemic and non-ischemic regions within the MV-CAD group but was generally absent in animals with SV-CAD (A). This corresponded with a significant increase in interstitial collagen in ischemic and non-ischemic regions of the LV in animals with MV-CAD (B). In contrast, the SV-CAD group did not exhibit increased interstitial collagen in either the ischemic or non-ischemic region of the LV vs. controls.Conclusion:Pro-fibrotic gene expression and interstitial collagen are not altered in swine with chronic LCx stenosis, suggesting that ischemia alone may not be sufficient to elicit ECM remodeling. Conversely, swine with MV-CAD exhibit an increase in pro-fibrotic gene expression and interstitial collagen that is not restricted to the ischemic area of the LV, implicating repetitive preload elevation as a potential mechanism underlying ECM remodeling in CAD.

Circulation, Volume 150, Issue Suppl_1, Page A4140489-A4140489, November 12, 2024. Background:Coronary artery bypass grafting (CABG) can be performed using on-pump or off-pump techniques. The optimal approach remains debated. Objectives: The COMPARE CABG (Comparative Outcomes of Mortality, Perioperative complications, cARdiac function, and Hospital stay in On-Pump versus Off-Pump Coronary Artery Bypass Grafting) study aims to systematically compare the outcomes of these surgical approaches.Methods:A comprehensive search was conducted in Pubmed, Cochrane Library, and other databases. Studies with a sample size > 4000 were included. Outcomes analyzed included mortality, complications, cardiac function, and hospital stay.Results:Meta-analysis of 5 studies with 58,232 patients showed that off-pump CABG was associated with a slightly lower complication rate: 15% for on-pump CABG and 13.5% for off-pump CABG with a pooled effect size of 0.90 (95% CI: 0.85-0.95). In terms of cardiac function and hospital stay, results were also favorable to off-pump CABG with an effect size of 1.12 (95% CI: 1.05-1.19) and 1.15 (95% CI: 1.10-1.20), respectively. The pooled mortality rate was 2.5% for on-pump and 2.4% for off-pump CABG, with an effect size of 1.05 (95% CI: 0.98-1.12), indicating no significant difference between the groups.Conclusion:These findings suggest that off-pump CABG may be a preferable option for reducing surgical complications, though both techniques yield comparable mortality outcomes. Further research is needed to explore long-term cardiac function and patient-specific factors influencing the choice of surgical method.

Circulation, Volume 150, Issue Suppl_1, Page A4141103-A4141103, November 12, 2024. Introduction:Atrial fibrillation (AF) decreases sports performance in athletes, and ablation is associated with a greater improvement in performance compared to medication. Endurance sports predispose males to AF more than females. However, once AF develops, it is unknown whether its impact in female athletes differs from that of males.Aims:To investigate the impact of AF and AF treatments in female versus male athletes.Methods:An internet-based survey, initiated via StopAfib.org, queried the impact of AF and treatment modalities on sports performance, training, and symptoms. Responses were categorized by reported sex. Reported performance (rated in comparison to personal best), frequency of training, and competition engagement were compared before the onset of AF symptoms versus when symptoms were at their worst, between males and females. These outcomes were similarly compared in relation to participants’ AF treatments.Results:Between 5/13/2019 and 2/29/2020, 219 female and 772 male athletes, 40% of whom were less than 60s years old, answered the survey. Development of AF was associated with declining reported sports performance, competition, and training frequency, with no significant difference between genders. Ablation in both males and females was associated with greater reported improvement in sports performance than the use of medications. Among 141 female athletes and 509 male athletes who have taken medication currently and/or in the past, 52% and 40% reported side effects, respectively. The most prevalent side effects for both males and females were fatigue/low energy and decreased athletic performance.Conclusion:Once AF develops, the impact on decreasing sports performance is similar in females and males. Both genders similarly reported more improvement with ablation than medications, which were frequently and similarly associated with side effects for females and males.

Circulation, Volume 150, Issue Suppl_1, Page A4147426-A4147426, November 12, 2024. Background:Calcified left main disease is a high-risk and procedurally complex subset of coronary artery disease. So, adequate lesion preparation before stenting is crucial in achieving a favorable outcome. We performed a meta-analysis to compare the safety of intravascular lithotripsy (IVL) and rotational atherectomy (RA) in preparation of calcified left main coronary artery disease.Hypothesis:We hypothesize that there are no significant differences in angiographic and in-hospital outcomes between RA and IVL while treating calcified left main coronary disease.Methods:We systematically searched PubMed, Embase, and Cochrane databases until May 2024 for studies comparing IVL and RA in calcified left main coronary disease. A random-effects model was used to pool risk ratios (RR) with corresponding 95% confidence intervals (CI). Statistical analyses were performed using software R and heterogeneity was assessed using I2statistics.Results:We included 3 studies comprising 276 patients undergoing PCI for calcified left main disease, of whom 109 (39.5%) underwent lesion preparation with IVL. The mean age was 72.9 years and 73.1% were males. In the pooled analysis, there were no significant differences between the IVL and RA treated groups in terms of in-hospital mortality (RR 0.30; 95% CI 0.08 to 1.13, p=0.07, I2=0%; Figure 1A) and in-hospital myocardial infarction (RR 0.85; 95% CI 0.17 to 4.11, p=0.83, I2=0%; Figure 1B). There was also no significant difference in angiographic outcomes such as coronary perforation (RR 0.56; 95% CI 0.15 to 2.04; p=0.37, I2=0%; Figure 2A) and slow-flow/no-reflow (RR 1.43; 95% CI 0.22 to 9.51; p=0.70, I2=0%; Figure 2B).Conclusion:This meta-analysis showed that both IVL and RA were comparable in terms of in-hospital and angiographic outcomes while treating calcified left main coronary disease.

Circulation, Volume 150, Issue Suppl_1, Page A4138221-A4138221, November 12, 2024. Background:Dyslipidemia is a major risk factor for Atherosclerotic Cardiovascular Disease (ASCVD). Statin is a crucial intervention to fix dyslipidemia and reduce the ASCVD risk. Still, there are several regimens to achieve blood lipid level targets, including increasing the statin dose or adding ezetimibe to the statin used. However, the best option between the two regimens is still a matter of debate.Research Question:We aim to evaluate the efficacy and safety of Ezetimibe plus any type of statin versus a double dose of the same statin in patients with ASCVD risk.Methods:A systematic review and meta-analysis based on randomized controlled trials (RCTs) obtained from PubMed, Embase Cochrane, Scopus, and WOS till December 2023. We used the random-effects model to report dichotomous outcomes using odds ratio (OR) and continuous outcomes using mean difference (MD), with a 95% confidence interval (CI).Results:Forty-seven studies with a total of 18592 patients were included. Ezetimibe plus statin was associated with a decrease in low-density lipoprotein (LDL) levels [MD: -13.69 with 95% CI (-15.64, -11.74), P

Circulation, Volume 150, Issue Suppl_1, Page A4132291-A4132291, November 12, 2024. Introduction:Rupture and thrombosis of lipid-rich atherosclerotic plaques (vulnerable plaques) contributes to majority of acute coronary syndrome (ACS). Current guidelines recommend optimal medical therapy (OMT) for stabilization of vulnerable plaques. Recent evidence of preventive percutaneous intervention (PCI) as a targeted treatment shows improvement in outcomes in these patients.Hypothesis/Goals/Aims:We aim to evaluate the efficacy of preventive percutaneous coronary intervention (PCI) compared to optimal medical therapy (OMT) for treatment of non-vulnerable plaque within five years of follow up from available selected randomized controlled trials (RCTs).Methods:PubMed, Cochrane, OVID, and NIH Clinical Trials were searched for RCTs evaluating preventive PCI compared to standard of care medical therapy. All trials reported primary common endpoints as death from cardiac cause and myocardial infarction (MI). Secondary outcomes included all-cause mortality, any revascularization, hospitalization for unstable and progressive angina, and composite death (any cause, MI, or any revascularization). Sub analyses for secondary outcomes were included if measured by RCT. A fixed effect model with Mantel-Haenszel statistical method was used to calculate risk ratios, Z scores, and a 95% confidence interval.Results:Ten RCTs (n=15955 patients) were included. Preventive PCI of vulnerable plaques revealed a significant benefit in lowering incidence of MI (RR: 0.86 [0.77, 0.86], p=0.01) and death from cardiac cause (RR: 0.73 [0.62, 0.86], p=0.004). Similarly, patients undergoing preventive PCI had a lower incidence of hospitalization for unstable or progressive angina (RR: 0.75 [0.62, 0.91], p

Circulation, Volume 150, Issue Suppl_1, Page A4144057-A4144057, November 12, 2024. Introduction:Coronary artery calcium (CAC) scans contain more information than is currently reported. 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 shown adding AI-CAC LA volumetry to CHA2DS2-VASc risk score improved stroke prediction in MESA. We have recently reported that AI-CAC left ventricular (LV) volumetry and mass significantly predicted incident heart failure (HF) and outperformed NT-proBNP. In this report, we examined whether AI-CAC can distinguish heart failure with reduced ejection fraction (HFrEF) versus heart failure with preserved ejection fraction (HFpEF).Methods:We applied the AutoChamberTM(HeartLung.AI, Houston, TX) component AI-CAC to data from 75 patients who underwent both a cardiac CT scan and echocardiography at Harbor UCLA medical center. AI-CAC took on average 21 seconds per scan and reported estimated volume for left atrium (LA), left ventricle (LV), right atrium (RA), and right ventricle (RV). LV volume was indexed (LVVI) by dividing LV volume by body surface area (BSA) to allow a more accurate assessment of the size of the left ventricle relative to the size of the individual. The average BSA for males and female were 1.59 ± 0.3 and 1.29 ± 0.2, respectively. HFrEF and HFpEF were defined as EF50% respectively.Results:Average EF was 57.5 ± 7.0 in males and 59.7 ± 8.1 in females, respectively. AutoChamber volume for HFpEF vs HFrEF were LA (84.8+35.3 vs 113.2+32.8 p=0.002), LV (109.9+36.7 vs 170.7+65.9 p=0.0007), RA (97.5+58.3 vs 117.2+51.1 p=0.18), RV (135.6+52.1 vs 176.2+70.8 p=0.008), LVW (116.1+39.1 vs 170.6+56.9 p=0.0005). Density plots in the figure show a clear distinction between HFpEF and HFrEF using AI measured LVVI and comparable results.Conclusion:AI-enabled automated cardiac chambers volumetry in CAC scans correlates well with echocardiography-based LVVI and detects HFrEF vs. HFpEF. Further studies are needed to evaluate the clinical utility of AI-CAC and the ability of AutoChamber for prospective detection of patients at risk of HFrEF vs. HFpEF.