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

Circulation, Volume 146, Issue Suppl_1, Page A13976-A13976, November 8, 2022. Introduction:Identification of factors associated with preservation of cardiovascular health (CVH) during adolescence may inform strategies to reduce CV disease burden in adulthood.Hypothesis:CVH status is worse in later (16-18 years) vs early (13-15 years) adolescence and is influenced by socioeconomic factors.Methods:National Health and Nutrition Examination Survey (NHANES) 2007 to 2018 data (6 most recent complete survey cycles) analyzed. CVH status was characterized by AHA Life Simple 7 score (AHAS7). A representative sample (N=5874) of the US adolescent population was analyzed and weights used to estimate trends for the entire US adolescent population. The proportion of US adolescents with ideal (AHAS7 score 12-14), intermediate (8-11), and poor (0-7) CVH status calculated. Consecutive 2-year NHANES cycles were rescaled to consecutive integers to assess change in CVH score over time. Regression models were used to assess trend in CVH score over time and separately by age. Nonlinearity of secular trend was tested by assessing the significance of adding a quadratic term to the regression model (significance, p

Circulation, Volume 146, Issue Suppl_1, Page A11462-A11462, November 8, 2022. Introduction:Surgical Myectomy (SM) is the gold standard treatment for hypertrophic obstructive cardiomyopathy (HOCM). However, alcohol septal ablation (ASA) has emerged as an alternative option for selected patients. Nonetheless, the long-term efficacy and safety of ASA have been debated in recent years. The aim of this metanalysis is to evaluate the long-term outcomes of ASA vs SM in HOCM patients.Hypothesis:ASA is a safe and effective alternative to SM in HOCM.Methods:: Unrestricted searches of the PubMed, EMBASE, and Cochrane databases from inception till June 1, 2022, for studies comparing long-term outcomes of ASA with SM in HOCM patients. Relevant data were extracted and analyzed using Revman 5.3 software. Odds Ratio (OR) and 95% Confidence interval (CI) were calculated using the random-effects model.Results:: A total of 12 retrospective studies were included examining 7,599 HOCM patients (2,010 ASA vs 5,589 SM). After a mean follow-up of 5.04 years, all-cause mortality was similar between the two groups (OR 1.18; 95% CI 0.60-2.29). However, ASA was associated with high rates of reinterventions (OR 15.68; 95% CI 6.71-36.61), and pacemaker insertion (OR 2.74; 95% CI 1.39-5.41).Conclusions:Although there was no difference in mortality between ASA and SM, ASA was associated with higher rates of reinterventions and pacemaker insertion in long-term follow-up. Therefore, the selection of septal reduction therapy in HOCM should be individualized and should be performed in a comprehensive center after detailed risk and benefits discussions with an experienced team.

Circulation, Volume 146, Issue Suppl_1, Page A9624-A9624, November 8, 2022. Introduction:Incliciran, a small interfering ribonucleic acid (siRNA), is the new modulator of the proprotein convertase subtilisin kexin 9 (PCSK9) that has proven safe and effective in reducing LDL-C and ASCVD. However, it is unclear if incliciran is superior to the already established PCSK9 monoclonal antibodies (mAb) in reducing major adverse cardiac events (MACE).Methods:We performed a meta-analysis of randomized controlled trials of patients with high cardiovascular risk who underwent PCSK9 inhibition by either mAb or siRNA. The primary outcome was the reduction of MACE.Results:Thirty RCTs with a total of 92,775 patients were included. For patients with a high cardiovascular risk profile, the modulation of PCSK9 by mAb decreases the risk of MACE (HR 0.84, 95% CI 0.8 – 0.89, p

Circulation, Volume 146, Issue Suppl_1, Page A15119-A15119, November 8, 2022. Introduction:Marfan syndrome (MFS) carries a risk of aortic dissection and death. The current aneurysm repair guideline of diameter ≥5cm may neglect up to 15% of MFS patients who dissect at smaller diameters. Since dissection can occur biomechanically when wall stress exceeds tissue strength, patient-specific biomechanics may enhance risk stratification for MFS patients. The goal of this study was to compare aneurysm wall stresses between propensity score-matched MFS and non-MFS aneurysm patients.Methods:The cohort consisted of 5 MFS and 42 non-MFS patients with aortic aneurysm. Preoperative CTA or MR scans were used to create 3D hexahedral meshes. Finite element analysis was performed with MFS and nonMFS material properties to determine peak (99th percentile) diastolic stresses[TE1] . Propensity scores were calculated by logistic regression using age, sex, height, hypertension, diabetes, smoking history, valve type, and sinus diameter. Five pairs were formed by 1:1 optimal matching without replacement. Comparisons used the paired t-test.Results:Diameters were similar at the sinus but lower for MFS at the STJ (3.4±0.5 vs 3.9±0.7cm, p=0.003) and the ascending aorta (3.1±0.5 vs 4.3±0.5cm, p

Circulation, Volume 146, Issue Suppl_1, Page A15749-A15749, November 8, 2022. Introduction:Fluoroscopy-guided catheter ablation remains a common practice. With the presence of technologies such as intracardiac echocardiography (ICE) and electroanatomic mapping (EAM), it is possible to perform fluoro- and lead-free procedures to avoid the hazards of prolonged radiation exposure. Left atrial appendage electrical isolation (LAAEI) is a proven e!ective ablation strategy for atrial fibrillation (AF). We sought to assess the characteristics, complications, and outcomes of fluoroscopy-guided LAAEI and compare them to fluoroless LAAEI.Methods:We retrospectively analyzed patients with AF who underwent LAAEI as part of their ablation procedure. The study group included patients who underwent LAAEI either under fluoroscopy guidance or with ICE and EAM alone. We analyzed outcomes and procedural data, including procedural times, fluoroscopy times, radiation exposure (mGy), and radiofrequency times.Results:Overall, we analyzed 168 patients who underwent LAAEI; 110 under fluoroscopy guidance and 58 fluoroless. The mean procedural time was similar in both groups (248 ± 101 vs 264 ± 83 minutes, respectively, p=0.27). The mean RF time was longer in the fluoroscopy-guided group (50 ± 28.2 compared to 43 ± 17.1 minutes, respectively, p

Circulation, Volume 146, Issue Suppl_1, Page A14592-A14592, November 8, 2022. IntroductionSodium abnormalities are commonly associated with congestive heart failure (CHF). The main objective of this study is to analyze the impact of hyponatremia vs. hypernatremia on in-hospital outcomes in patients admitted with CHFMethodsThe National inpatient sample (NIS) data from 2017 to 2018 were queried using International Classification of Diseases 10 (ICD-10-CM) codes E871 and E870. Demographics and hospital characteristics were compared along with In-hospital mortality, length of stay (LOS), and total charge. The outcomes were measured using linear and logistic regression models to adjust the odds ratio for confounders.Results:A total of 350,144 patients with heart failure as a primary diagnosis (42% systolic and 32% diastolic HF) were included in the study. Among them, 37,129 (10.7%) had hyponatremia while 5839 (1.8%) had hypernatremia. In-hospital mortality rates were significantly higher with an adjusted odds ratio (OR) of 2.78 (p

Circulation, Volume 146, Issue Suppl_1, Page A15753-A15753, November 8, 2022. Epigenetic regulation is critical for cardiac electrophysiology and pathology. Epigenetic modulators, such as histone deacetylases (HDACs) and histone acetyltransferases (HATs) are known master regulators of gene expression. Recently, novel pharmacological agents, HDAC inhibitors, have been developed as treatments for cancer and immune diseases. The effects of HDAC inhibitors on cardiac ion channels (ICs) are of great interest. To exert specific gene modulation, we used small interfering RNAs against the known HDACs, including sirtuins, and deployed them in human induced pluripotent stem-cell-derived cardiomyocytes (hiPSC-CMs). Follow-up RNAseq data (n = 61) were compared to identically processed and normalized RNAseq data from human left ventricle (LV) from the GTEx database (n = 84). Gene expression of cardiac ICs displayed similar patterns, with some differences. For example, hiPSC-CMs showed upregulatedCACNA1C, SLC8A1and downregulatedKCNJ2andRYR2compared to the adult LV, most of which are known distinctions (Fig. 1A). Correlative analysis (Fig. 1B) and partial least square regression models helped visualize links between HDACs/HATs, key transcription factors (TFs) and cardiac ICs. Powerful TFs, includingMEF2A, GATA4, 6exerted positive effect on ICs in hiPSC-CM and the adult LV. In the hiPSC-CMs,HDAC1, HDAC10andSIRT6were found to be the strongest predictors of the expression of individual cardiac ICs, as revealed by permutation importance. Further studies will involve determination of the role of different cell types using single-cell sequencing data from the adult LV. Our analysis offers new insights about the role of epigenetic modifiers on cardiac electrophysiology and informs the utility of hiPSC-CM as a scalable, experimental model for cardiotoxicity testing of HDAC inhibitors.

Circulation, Volume 146, Issue Suppl_1, Page A9570-A9570, November 8, 2022. Introduction:Diagnosis of cardiogenic thrombosis is important because anticoagulant therapy is recommended for its secondary prevention. However, it is difficult to make a clear distinction in the pathogenesis between atherothrombosis and cardiogenic thrombosis.Hypothesis:Role of macrophage in thrombus formation is different between atherothrombosis and cardiogenic thrombosis.Methods:The Macrophage in Thrombus (MITO) study is a prospective observational study examining pathological and biological differences of arterial thrombus between atherothrombosis and cardiogenic thrombosis. Patients with ST elevation myocardial infarction (STEMI) or acute ischemic stroke (AIS) whose solid thrombus could be retrieved from the infarct-related artery were enrolled. Patients were divided into 2 groups as follows; STEMI with sinus rhythm: Group A (presumed atherothombosis) and AIS with atrial fibrillation (presumed cardiogenic thrombosis): Group C, and compared macrophage score as follows; 1:almost no macrophages detected byх40; 2:difficult to detect the macrophages in х20 but detected by х40; and 3:easy to detect macrophages in х20 in the thrombus. Serum levels of soluble CD163 were measured all the patients.Results:The score for CD163 positive macrophage of Group C (n=33) was significantly higher than that of Group A (n=32) (p

Circulation, Volume 146, Issue Suppl_1, Page A9569-A9569, November 8, 2022. Introduction:Tobacco use is a well-established risk factor for atherosclerotic cardiovascular disease (ASCVD) and associated with cardiac intervention complications. However, there is a lack of data on the effect of smoking status on the post cardiac procedural results.Methods:We conducted a retrospective analysis of the 2018 to 2019 Nationwide Readmission Database (NRD). Adult patients (Age > 18) with tobacco use who underwent either PCI or CABG were selected using the ICD-10-CM diagnosis and procedure code. Discharge-level weight analysis was used to produce a national estimate. Propensity score matching (1:1) with age, sex, and comorbidity burden was performed and the outcomes were compared between matched cohorts.Results:During the study period, 1,392,730 patients underwent PCI (991,730; 71.2%) or CABG (401,000; 28.8%) of which 18,574 patients (1.3%) used tobacco. Patients who underwent PCI with tobacco use were younger (59.7 SE 0.1 vs 62.4 SE 0.2) and with more female population (25.7% vs 18.2%) compared to those who underwent CABG with tobacco use. In discharged patients with tobacco use, unplanned 30-day readmission rate was 9.0%. The majority of the readmission was due to ischemic heart diseases (89.4%) and 2.7% was due to complications of cardiac implants or grafts. A half of readmission occurred within 9 days after the discharge. 9,223 discharged patient with tobacco use who underwent PCI or CABG were propensity-matched. 30-day readmission rate was significantly lower in patients with PCI (8.5% vs 10.7%; p = 0.006). Furthermore, PCI was associated with shorter length of stay (3.5 days SE 0.1 vs 10.1 days SE 0.1; p < 0.001) and lower total hospital cost ($111,492.2 SE 1,188 vs $231,603.6 SE 3,558.3; p < 0.001). In-hospital mortality was similar in PCI and CABG groups (2.0% vs 1.8%, p = 0.26).Conclusions:9.0% of tobacco use patients with ASCVD who underwent PCI or CABG had unplanned readmissions. The most common reason for readmission was ischemic heart disease, with more than 50% of patients returning to the hospital within the first two weeks of hospital discharge. Tobacco use patients who underwent PCI had statistically significantly lower readmission rates, length of stay, than their propensity-matched peers who underwent CABG.

Circulation, Volume 146, Issue Suppl_1, Page A14643-A14643, November 8, 2022. Introduction:Implantable cardioverter defibrillator (ICD) is the more effective and safer treatment for the primary prevention of sudden cardiac death. It remains unclear whether dual-chamber ICD offers the clinical benefits over single-chamber ICD without increasing complications.Hypothesis:The study aimed to evaluate the benefits and risks of dual-chamber ICD compared with single-chamber ICD for primary prevention of sudden cardiac death in clinical practice.Methods:Using the Korean National Health Insurance Service database from January 2008 to December 2019, we include patients with primary prevention ICD and no documented indication for pacing. The propensity score matching method was used to balance covariates across single- and dual-chamber ICDs. Primary outcomes were all-cause mortality, hospitalization of heart failure, and hospitalization of cardiovascular cause.Results:Among 1,929 patients, 1,098 (56.9%) received a single-chamber ICD and 831 (43.1%) received a dual-chamber ICD. In 752 pairs of patients after propensity matching baseline characteristics were balanced between the 2 groups (median age 62 years; male 72%). Over a mean follow-up of 2.7±2.4 years, 1- and 5-year all-cause mortality (5.5% vs. 5.6%, P=0.910; 19.4% vs. 19.3%, P=0.948), 1- and 5-year hospitalization for cardiovascular cause (14.9% vs. 14.9%, P=1.000; 23.9% vs. 22.6%, P=0.542), and 1- and 5-year hospitalization for heart failure (10.8% vs. 8.6%, P=0.163; 16.8% vs. 14.0%, P=0.133) were similar in both groups. However, cardiac tamponade in the rates of device-related complications was 0.1% in the single-chamber ICD vs. 1.1% in dual-chamber ICD groups (P=0.013).Conclusions:In the real-world population receiving a primary prevention ICD, dual-chamber ICD was associated with higher rates of cardiac tamponade than single-chamber ICD. One and five-year rates of all-cause mortality and hospitalization did not differ significantly between the two groups.

Circulation, Volume 146, Issue Suppl_1, Page A10979-A10979, November 8, 2022. Introduction:patients exposed to chest, breast or mediastinal RT, may present with accelerated atherosclerosis and CAD due to diffuse micro and macrovascular fibrosis. However, CAD risk has not been well established in a community-based study.Aims:Describe CAD risk in patients treated with chemotherapy with and without RT and evaluate the cumulative incidence of CAD (coronary revascularization, MI and abnormal stress test and coronary angiogram).Methods:From 1985-2010, we identified 744 patients with a new diagnosis of breast cancer or lymphoma, using the Rochester Epidemiology Project (REP) who received chemotherapy with or without RT. CAD risk was assessed by a proportional hazards model for time to event. RT was treated as a time dependent co-variable, with index date being chemotherapy start date, significance was considered as a p

Circulation, Volume 146, Issue Suppl_1, Page A11773-A11773, November 8, 2022. Background:The impact of recreational marijuana use/cannabis use disorder (CUD) in elderly chronic kideney disease (CKD) patients remains unknown amidst the rising use of cannabis in the USA. We conducted a nationwide study to assess the impact of CUD on cardiovascular outcomes in these patients.Methods:We used National Inpatient Sample (2016-2019) and geriatric (≥65 years) admissions with CKD. We compared baseline characteristics, comorbidities and composite in-hospital outcomes [MACCE- all-cause mortality, acute myocardial infarction-AMI, cardiac arrest and acute ischemic stroke-AIS] between the age-matched (1:1 propensity score matching) CUD+ vs. CUD- cohorts.Results:Age-matched (median 70 years, p=0.998) geriatric CKD-CUD+ (n=34255) and CUD- (n=34225) cohorts were compared. CUD+ cohort often consisted of males (75.0 vs. 53.8%), blacks (35.9 vs 20.8%) and patients from lowermost income quartile (38.7 vs. 33.5%) (p

Circulation, Volume 146, Issue Suppl_1, Page A12802-A12802, November 8, 2022. Introduction:Limited access is a key challenge in the management of chronic diseases, like heart failure (HF), in rural areas. Telehealth (TH), which is the delivery of care via remote technologies, and remote monitoring (RM), which allows a patient’s implanted device to be interrogated at a distance, are potential ways to improve access. However, many older adults live in rural areas and age is negatively associated with the adoption of novel technologies. The aim of this study is to understand the association between age and use of TH and RM in urban vs. rural areas.Methods:We created annual, cross-sectional cohorts of patients with HF in each year from 2013 to 2018 with approximately 5 million patients/year by requiring ≥1 inpatient or ≥2 outpatient ICD9/10 codes for HF in the 2 years prior. TH and RM use were determined using validated ICD-9/10 and CPT codes. Rurality was determined using the Rural/Urban Commuting Areas (RUCA) classification. Multivariable, logistic regression models were used to determine the association between age and use of TH and RM in urban vs. rural areas.Results:Increasing age was associated with a decreased odds of TH use in both urban and rural areas. However, the decline in use with age was greater in urban (OR=0.41 for 85+ vs 65-69) than rural areas (OR=0.65). In contrast, increasing age was associated with an increased odds of RM in both urban and rural areas, with a larger increase with increase age in rural (OR=1.47 for 85+ vs 65-69) compared to urban areas (OR=1.35).Conclusion:TH and RM are viable ways to improve access for rural patients with HFrEF across the age spectrum. With increasing age, TH use decreases but RM increases, suggesting that patients’ ability to navigate technology plays a significant role – TH technology requires more active engagement by the patient compared to RM technology. Efforts to simplify TH technology would likely mitigate the drop in TH use seen with increasing age and improve access to care for older adults with HFrEF.

Circulation, Volume 146, Issue Suppl_1, Page A10345-A10345, November 8, 2022. Introduction:The prevalence of obstructive sleep apnea (OSA) in heart failure (HF) patients varies from 30 to 50%. The differences in clinical characteristics, healthcare resource utilization (HCRU), and positive airway pressure (PAP) usage between HF with preserved ejection fraction (HFpEF) vs. HF with reduced ejection fraction (HFrEF) in OSA patients are not well known.Objective:To compare clinical characteristics, PAP usage, and HCRU in OSA patients with HFpEF vs HFrEF.Methods:Retrospective cohort study using US administrative claims data linked to objective PAP usage data over one year. HFpEF and HFrEF were identified by ICD-9/10 codes associated with healthcare encounters 1 year before starting PAP therapy. Pearson’s Chi-squared and Wilcoxon rank-sum tests were used as applicable to compare baseline characteristics and PAP usage, and the pre to post-PAP initiation difference in the number of health care encounters.Results:In total, 7,419 patients with HF and OSA were identified, of which 57% had HFpEF. HFpEF patients were majority female (54%) and older than those with HFrEF (64.1 ± 11.52 vs 59.7 ± 11.24 years, p

Circulation, Volume 146, Issue Suppl_1, Page A12656-A12656, November 8, 2022. Introduction:Pulmonary vein isolation (PVI) remains the cornerstone of atrial fibrillation (AF) ablation procedures. Because many patients have continued AF after PVI alone, posterior wall isolation (PWI) has been proposed as an adjunctive strategy to PVI. We conducted a meta-analysis of available data to assess the incremental impact of PWI based on whether patients had paroxysmal or persistent (PAF, PeAF) AF.Objective:To evaluate the incremental impact of PWI following PVI in patients with PAF and PeAF.Methods:The online databases (Pubmed, Medline, Embase) were searched using the terms “pulmonary vein isolation”, “posterior wall isolation”, or “posterior wall ablation”. Out of 1843 studies, 11 met our strict criteria (Table). Specifically, patients were undergoingde novoablation for treatment of PAF or PeAF using either cryoballoon or radiofrequency energy. Patients had PVI +/- PWI; studies that included additional ablations (except for cavotricuspid isthmus ablation) were excluded. The primary outcome was long-term freedom from recurrence of any atrial tachyarrhythmia (AT).Results:The cohort consisted of 1702 patients (65 ± 18 years, 75% male); 1404 (82%) pts with PeAF and 298 (18%) pts with PAF (Table). In the PeAF group, AT recurrence was significantly higher in patients who underwent PVI alone as compared to those who also had PWI (OR 1.85, 95% CI [1.23, 2.77], P = 0.003, Figure). In contrast, in the PAF group, outcome was similar in patients who did and did not undergo PWI in addition to PVI (OR 0.95, 95% CI [0.53, 1.72], P = 0.86, Figure).Conclusions:PWI was rarely used during thede novoablation procedure in PAF patients and did not seem to impart additional benefit. In contrast, PeAF patients seemed to derive favorable impact from the addition of PWI to PVI. Additional randomized studies are needed to determine the role of PWI in PeAF patient undergoing de novo ablation for management of AF.

Circulation, Volume 146, Issue Suppl_1, Page A15172-A15172, November 8, 2022. Introduction:Segmenting cardiac computed tomography (CT) to provide anatomic guidance for Atrial Fibrillation (AF) ablation is routinely applied, but is time-consuming and prone to error. Machine learning (ML) is a powerful approach that could automate this approach, but is hindered by the small size of available labeled datasets.Hypothesis:We hypothesized that a new computational pipeline, in which an ML model is trained mathematically in a small cohort (N=20) using geometrical heart avatars derived from computer graphics imaging (CGI), rather than on manually-segmented data, would enable rapid expert-level segmentation of raw cardiac CT scans.Methods:We first encoded anatomical knowledge with generic geometrical avatars and derived a “virtual dissection” method to geometrically parse the heart (Fig A). An ML model trained by virtual dissection using 20 cases was able to rapidly and accurately segment the pulmonary veins (PVs), left atrial appendage (LAA), and left atrium (LA) from cardiac CT scans (Fig B), which we tested in a retrospective study of N=100 patients (30% women, 64.7±10.1Y) and in a prospective clinical trial of N=42 patients (42.9% women, 65.2±10.8Y) undergoing AF ablation, against a panel of 3 experts (Fig C).Results:In a retrospective study (N=100), ML achieved median Dice scores of 96.6% (IQR: 95.1% to 97.5%), similar to experts (p