Circulation, Volume 150, Issue Suppl_1, Page A4139912-A4139912, November 12, 2024. Background:Tirzepatide (TZP) is a once weekly GIP and GLP-1 receptor agonist approved for the treatment of type 2 diabetes (T2D) and obesity. This post hoc analysis examined biomarkers of inflammation in people living with obesity, or overweight, without and with T2D, from SURMOUNT-1 and SURMOUNT-2. Furthermore, we evaluated the contribution of weight reduction- associated and – unassociated effects on biomarkers of inflammation.Methods:A total of 700 participants were randomly selected from SURMOUNT-1 and SURMOUNT-2 (100 participants from each treatment arm: placebo, 5, 10, and 15 mg in SURMOUNT-1 and placebo, 10 and 15 mg in SURMOUNT-2). The association of treatment with change from baseline in the inflammation biomarkers interleukin-6 (IL-6) and high sensitivity C-reactive protein (hsCRP) at 24 and 72 weeks was assessed along with the estimated percentages of the association attributable to weight loss through a mediation analysis.Results:In SURMOUNT-1, following 72 weeks of treatment with TZP without T2D, TZP was associated with significantly decreased IL-6 (-26% to -31%) and hsCRP (-51% to -65%), compared to placebo in all dose groups. In SURMOUNT-2, following 72 weeks of treatment with TZP in participants with T2D, changes of -16% to -23% in IL-6 and -55% to -56% in hsCRP were observed (significance seen for all groups except for TZP 15mg on IL-6). At 24 weeks, only 18% and 31% of hsCRP changes were associated with weight reduction in SURMOUNT-1 and -2, respectively. In SURMOUNT-1, 77% of IL-6 changes and 87% of hsCRP changes at 72 weeks were associated with weight reduction. In SURMOUNT-2, 78% of IL-6 changes and 57% of hsCRP changes at 72 weeks were associated with body weight reduction.Conclusions:In this post hoc analysis of SURMOUNT-1 and -2, early changes in hsCRP (week 24) were weight reduction-unassociated, while at week 72, changes in the inflammation biomarkers IL-6 and hsCRP observed in TZP-treated participants were mainly weight reduction-associated. The relative contribution of weight reduction-dependent effects was more prominent in participants without T2D, compared to those with T2D. Collectively, these data suggest TZP was associated with reduced inflammation in people with overweight/obesity and/or T2D.
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Abstract 4138062: Pharmacological inhibition of HDAC6 improves post-infarction cardiac function by limiting mitochondrial fission in type 2 diabetic mice
Circulation, Volume 150, Issue Suppl_1, Page A4138062-A4138062, November 12, 2024. Introduction:Histone deacetylase (HDAC) 6 functions to remove acetyl groups from lysine residues on histone and non-histone proteins. We showed that the augmented activity of HDAC6 in diabetic mice undergoing myocardial ischemia/reperfusion injury (MIRI) was associated with mitochondrial damage. However, it remains unclear how the inhibition of HDAC6 activity affects post-MIRI cardiac remodeling and function in type 2 diabetes.Hypothesis:HDAC6 inhibition suppresses adverse cardiac remodeling and improves mitochondrial dynamics and cardiac function after MIRI in type 2 diabetic mice.Methods:Type 2 diabetic db/db, db/+, and C57BL/6 mice underwent coronary artery occlusion for 20 min followed by reperfusion. Tubastatin A, a selective inhibitor of HDAC6, was injected intraperitoneally 60 min before coronary artery occlusion and once daily after surgery. Mouse hearts were evaluated with echocardiography 28 days after surgery. Myocardium was imaged using electron microscopy, and the expression of mitochondrial dynamin-related protein 1 (DRP1) and fission 1 was measured by Western blotting analysis. H9c2 cardiomyocytes were subjected to hypoxia for 3 hours followed by normoxia for 24 hours in the presence of 5.5- or 25.0-mM D-dextrose and tubastatin A or vehicle.Results:There were no significant differences in the activity of HDAC6, left ventricular diameters and fractional shortening, mitochondrial density volume and surface area, and the ratios of DRP1/GAPDH and fission 1/GAPDH between the db/+ and C57BL/6 groups. Compared to both db/+ and C57BL/6 groups, HDAC6 activity was lower, left ventricular diameters at both end diastole and end systole were longer, fractional shortening and mitochondrial surface area were smaller, and the expression of DRP1 and fission 1 was increased in the db/db group 28 days after MIRI. Interestingly, 10 mg/kg Tubastatin A significantly mitigated these effects of MIRI in db/db mice. Hypoxia/reoxygenation in the presence of 25.0-mM D-dextrose augmented HDAC6 activity and increased the expression of DRP1 and FIS1, which were blocked by Tubastatin A.Conclusions:Tubastatin A prevents post-MIRI cardiac remodeling and improves cardiac function by limiting mitochondrial fission in type 2 diabetic mice.
Abstract 4144199: Safety of Discontinuing Secondary Antibiotic Prophylaxis After Echocardiographic Normalization in Early Rheumatic Heart Disease, GOAL-Post Study
Circulation, Volume 150, Issue Suppl_1, Page A4144199-A4144199, November 12, 2024. Background:The current standard for children diagnosed with rheumatic heart disease (RHD) is secondary antibiotic prophylaxis (SAP) for at least 10 years or to a minimum age of 21. However, these recommendations were developed prior to the widespread use of echocardiography and based largely on expert opinion. A recent clinical trial in Uganda found that up to 50% of children with early RHD show echocardiographic normalization by 2 years. More research is needed to understand if continued SAP is needed after echocardiographic normalization.Hypothesis:There is a low risk of RHD recurrence in individuals who have had normalization of their echocardiogram following early RHD diagnosis.Aim:To determine the 2-year safety of not providing SAP to children and adolescents with early RHD who have shown echocardiographic normalization.Methods:The GOAL trial in Uganda, 2018-2021, compared SAP with Benzathine Penicillin G (BPG) to no prophylaxis among children with early RHD. GOAL-Post is a non-randomized prospective extension study of the GOAL Trial. Children with echocardiographic normalization at the end of GOAL, regardless of treatment arm, were followed prospectively without SAP, for 2 additional years. Echocardiograms were performed at the end of follow-up, uploaded to a cloud server, and interpreted by a four-person adjudication panel. Recurrence was determined by side-by-side comparison with GOAL enrollment and completion studies.Results:Of 345 eligible participants, 330 (96%) were enrolled, mean age 16 years (SD = 2.3), 56% female, and all completed the two-year follow-up. Only one of 330 (0.3%) progressed to moderate/severe RHD after the 2 years, and an additional 26 participants (7.9%) had evidence of mild RHD, which was clinically comparable to their cardiac status at the start of the GOAL Trial. No participants had clinical signs or symptoms of RHD and no documented rheumatic fever. This means that 99% of children and adolescents who had echocardiographic normalization were safe from moderate/severe RHD and 92% were safe from any RHD, without SAP.Conclusion:These findings suggest that it may be safe to consider stopping of SAP among children who show echocardiographic normalization, providing more individualized recommendations for SAP duration, rather than the current model of long-term SAP for all. Further study is needed including a stoppage of SAP trial, to generate higher quality evidence for this approach.
Abstract 4142315: Genetically enhanced CHA2DS2VASc score predicts post-ablation ischemic stroke in patients with atrial fibrillation
Circulation, Volume 150, Issue Suppl_1, Page A4142315-A4142315, November 12, 2024. Introduction:Although atrial fibrillation (AF) catheter ablation (AFCA) may reduce the risk of ischemic stroke (IS), those patients still have some risk. It is unclear whether post-AFCA IS has a genetic background as generally diagnosed IS. We explored the post-AFCA IS-associated single nucleotide polymorphisms (SNPs), and their polygenic risk score (PRS) has an incremental benefit to predict post-AFCA IS in addition to CHA2DS2VASc scores in the two independent cohorts.Methods:We developed PRS for post-AFCA IS from the UK Biobank (N=2,063) and validated from the independent Yonsei AF ablation cohort (N=2,897) after excluding the procedure-related IS (
Abstract Su1101: Evaluating Participant Comfort Levels Pre and Post Community-Based CPR and AED Education
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.
Abstract 4144823: Persistent Prothrombotic State in Post-Acute Sequelae of Mild SARS-CoV-2 Infection: Role of Extracellular Histones and Immune Complexes
Circulation, Volume 150, Issue Suppl_1, Page A4144823-A4144823, November 12, 2024. Post-Acute Sequelae of SARS-CoV-2 infection (PASC) have become a significant healthcare burden. Sustained increases in prothrombotic markers have been reported in hospitalized acute COVID-19 patients. However, whether patients with less severe acute infection also endure a persistent prothrombotic state remains uncertain. We tested for a prothrombotic state in this cohort and examined potential mediators. We enrolled 70 adult patients with prior mild acute SARS-CoV-2 infection and sustained PASC symptoms (per WHO criteria). A control healthy group matched for age and sex was also enrolled who were not previously diagnosed with COVID-19. Markers of platelet activation and platelet-neutrophil aggregates (PNA) were quantified using whole-blood flow cytometry. Markers of extracellular traps (citrullinated histones [H3Cit] and cell-free DNA [cfDNA]), anti-dsDNA IgG, and thrombin generation potential were measured in plasma. At recruitment (6 weeks to 3 years post infection), there was increased potential for thrombin generation in the plasma from PASC compared to control reflected by increased peak and velocity index (P
Abstract 4139840: Impact of Sodium-Glucose Cotransporter 2 Inhibitors on Acute Kidney Injury Post Coronary Artery Bypass Grafting :A Retrospective Cohort Study and Meta-Analysis
Circulation, Volume 150, Issue Suppl_1, Page A4139840-A4139840, November 12, 2024. Background:sodium-glucose cotransporter 2 inhibitors (SGLT2i) , a new type of oral hypoglycemics agent used to treat type 2 diabetes, have a positive effect on the progression of heart failure, but there is a concern with the association between SGLT2i and acute kidney injury (AKI).Materials and Methods:We retrospectively evaluated consecutive patients undergoing CABG surgery from January 2018 to December 2021 in the hospital. A cohort of patients who had been prescribed SGLT2i was identified and matched by propensity score with a cohort of patients who had not been prescribed SGLT2i in a ratio of 1:3. The primary outcome was AKI following CABG. Furthermore, a meta-analysis was conducted on the relationship between SGLT2i and acute kidney injury (AKI). Four studies, comprising a total of 25,116 patients, were included in the analysis.Results:A total of 403 patients who had received SGLT2i and 1209 without SGLT2i were included in the analysis. AKI was observed in 54 patients (13.4%) in the SGLT2i group and 373 patients (30.9%) in the non-SGLT2i group following CABG. The SGLT2i exhibited a lower incidence of AKI compared with the non-SGLT2i (P < 0.001). The findings of the meta-analysis indicated that SGLT2i was associated with a decreased incidence of AKI (P < 0.001; OR= 0.525, [95% CI, (0.437-0.631]).Conclusion:The results of our prospective study indicated a reduced risk of AKI in patients undergoing CABG and were treated with SGLT2i.
Abstract 4125252: Pre-Hematopoietic Stem Cell Transplantation Echocardiographic Indices and Post-Transplant Cardiovascular Outcomes
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.
Abstract 4140630: Serum Metabolites Predict Mortality or Transplant in Pre-capillary and Combined Pre- and Post-capillary Pulmonary Hypertension in the PVDOMICS Cohort
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
Abstract 4125157: Efficacy of Adding Sodium-Glucose Co-Transporter 2 Inhibitor versus Standard Therapy Alone in Post-Percutaneous Coronary Intervention Patients: A Systematic Review and Meta-Analysis
Circulation, Volume 150, Issue Suppl_1, Page A4125157-A4125157, November 12, 2024. Background:Recent evidence suggests that sodium-glucose cotransporter-2 inhibitors (SGLT2-i) may improve outcomes in patients with coronary artery disease (CAD) through various physiological pathways. However, their impact on patients who have undergone percutaneous coronary intervention (PCI) is not well established. This meta-analysis aims to evaluate the effectiveness of additive SGLT2 inhibitors versus standard therapy alone in patients with CAD after PCI.Methods:A systematic search was conducted across the Medline, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) and observational studies that compared the addition of SGLT2 inhibitors to standard therapy versus standard therapy alone in patients post-PCI. The outcomes analyzed were Major Adverse Cardiovascular Events (MACE), all-cause death, cardiovascular death, recurrent acute myocardial infarction (AMI), nonfatal stroke, revascularization, and hospitalization for heart failure (HF).Results:A total of 7 studies met the inclusion criteria, encompassing a total of 11,800 individuals (5,004 on SGLT2-i and 6,796 non-SGLT2-i; mean age of 62.7 years; 28% women; 95% diabetic patients). SGLT2 inhibitors significantly reduced the risk of all-cause mortality (RR 0.6, 95% CI: 0.5-0.72, p
Abstract Or110: Baseline Measurements of Cellular Respiration Affect the Response to Thiamine Treatment in Post-arrest Patients
Circulation, Volume 150, Issue Suppl_1, Page AOr110-AOr110, November 12, 2024. Introduction:Lactic acidosis and impaired oxygen extraction due to mitochondrial dysfunction are common post-arrest. Thiamine, a cofactor for pyruvate dehydrogenase, is necessary for aerobic metabolism. In two randomized controlled trials (RCTs) testing the effect of thiamine vs. placebo in out-of-hospital and in-hospital post-arrest patients (NCT03450707 and NCT02974257), no relationship was found between thiamine treatment and the primary outcome of change in lactate over 24 hours. Cellular oxygen consumption rates (OCRs) were measured in a subset of patients at baseline. Maximal and spare OCRs measure the capacity of mitochondria to increase cellular respiration from their basal state when stimulated, and may identify patients likely to benefit from thiamine. We conducted a post-hoc analysis of the two RCTs to evaluate the primary outcome in subgroups defined by baseline OCRs.Hypothesis:Patients with higher maximal and spare OCRs at baseline are more likely to benefit from thiamine treatment, as indicated by lower lactate levels.Methods:Basal, maximal and spare OCRs, collected at enrollment, were measured in peripheral blood mononuclear cells using an XFe96 Extracellular Flux Analyzer and XF Cell Mito Stress Test Kit (Seahorse Bioscience). Lactates (at 6, 12, and 24 hours) were log-transformed and analyzed using a linear mixed model controlling for baseline lactate. In patients who expired
Abstract 4144168: Five Years Post Heart Transplant Outcomes in Patients with Amyloidosis: A Single Center Experience
Circulation, Volume 150, Issue Suppl_1, Page A4144168-A4144168, November 12, 2024. Introduction:Many patients with amyloidosis can have advanced cardiac involvement, that drives mortality. Due to lack of definitive therapies that can reverse cardiac infiltration, cardiac replacement is the only hope for these patients. Durable left ventricular assist devices are not a good option; hence heart transplant remains mainstay. We present here long-term outcomes from a single center.Methods:Using EPIC Electronic Health Records’ database Clarity and UNOS center-specific report builder, we abstracted clinical information of patients who underwent a heart transplantation for cardiac amyloidosis at our center from 2004 to 2023.Results:Fifty-one patients underwent heart transplant for cardiac amyloidosis: 32 for Amyloid Light chain (AL) and 19 for Amyloidosis Transthyretin (TTR). Majority were males (Table 1). Of the AL transplants, 6 received concomitant kidney, 2 liver and 2 lung transplantation and of the TTR, 1 received concomitant kidney and 16 concomitant liver transplantation. There were more multi-organs in TTR compared to AL cardiac transplants (17 vs 10, p
Abstract 4146928: Inflammation, Adverse Cardiac Remodeling and Post-operative Atrial Fibrillation
Circulation, Volume 150, Issue Suppl_1, Page A4146928-A4146928, November 12, 2024. Background:Post-operative atrial fibrillation (POAF) is a common and serious complication following cardiac surgery, leading to increased morbidity and healthcare costs. Inflammation, particularly mediated by cytokines like IL-17A, is believed to play a significant role in the pathogenesis of POAF. We aim to investigate the association between blood IL-17A levels and the incidence of POAF.Hypothesis:We hypothesize that elevated IL-17A levels in the blood are associated with a higher incidence of POAF in patients undergoing cardiac surgery.Methods:Blood samples were collected from 16 patients undergoing open heart surgery. Patients were monitored during the index hospitalization for the surgery. IL-17A levels in the blood were quantified using Olink proteomics, where oligonucleotide-labeled antibodies bind to target proteins, forming a new PCR target sequence by a proximity-dependent DNA polymerization event. Quantitative PCR measured the amplicons, and the Olink NPX Manager Software calculated Normalized Protein Expression Units (NPX) by normalizing the Cq values to interpolate controls. Statistical analysis was performed using Student’s t-test to compare clinical variables and IL-17A levels across the two groups.Results:Our cohort had an average age of 63.8 ± 4.7 with 14% female participants, an average weight of 83.9 ± 14.6 kg, and an average BMI of 28.8 ± 4.7. The POAF group was slightly older (64.8 ± 3.8 years vs. 62.7 ± 4.6 years) but had a similar BMI compared to those who did not develop AF. Hypertension and hyperlipidemia were present in all POAF patients (100%) compared to 81.8% in those without AF, while anemia was more common in the POAF group (40% vs. 18.2%). IL-17A levels were significantly elevated in the POAF group (0.75 ± 0.10 NPX) compared to the non-POAF group (0.35 ± 0.05 NPX) with a p-value < 0.05. Cardiac function assessments showed non-significant differences in left atrial volume index (LAVI) (46.2 mL/m^2 vs. 36.3 mL/m^2) and left ventricular mass index (LVMI) (114.4 g/m^2 vs. 89.3 g/m^2) in the POAF group. These findings suggest a significant association between elevated IL-17A levels and POAF, with trends of differences in left atrial remodeling between the two groups.Conclusion:Elevated blood IL-17A levels are associated with an increased risk of developing POAF. This suggests that IL-17A may serve as a critical biomarker and potential therapeutic target for preventing POAF in patients undergoing cardiac surgery.
Abstract 4144055: Adverse Physical Environment, Housing, and Economic Conditions: Their Impact on Maternal Cardiovascular Health during and Post-Pregnancy
Circulation, Volume 150, Issue Suppl_1, Page A4144055-A4144055, November 12, 2024. Background:Maternal cardiovascular health is a critical concern, particularly during and following pregnancy. Previous studies have highlighted the influence of social determinants on health outcomes, but the specific impact of adverse Physical Environment, Housing, and Economic Conditions on maternal cardiovascular health remains underexplored.Methods:Using the TriNetX global health research network within the US Collaborative Network, we explored how adverse Physical Environment, Housing, and Economic Conditions (ICD10CM: Z58 and ICD10CM: Z59) impact maternal cardiovascular health during pregnancy and within one year postpartum. Using, propensity score matching (PSM) analysis, our study compared two cohorts: women aged 15 to 60 who experienced issues related to Physical Environment, Housing, and Economic Conditions during or after pregnancy from 2008 to 2023, and women in the same age range who did not face such issues, thus representing a favorable physical environment, housing, and economic conditions.Results:Challenges related to the physical environment, housing, and economic conditions significantly increased the risk of all-cause mortality (OR: 3.237, 95% CI: 2.064 to 5.075, p
Abstract 4135273: Frailty increases the risk of in-hospital mortality and post-procedural complications in patients undergoing Cardiac Implantable Electronic Devices placement
Circulation, Volume 150, Issue Suppl_1, Page A4135273-A4135273, November 12, 2024. Background:Heart failure with reduced ejection fraction (HFrEF) often necessitates the use of cardiac implantable electronic devices (CIED) such as cardiac resynchronization therapy defibrillators (CRT-D) or implantable cardioverter-defibrillators (ICD). These devices are proven to reduce mortality, prevent hospitalizations, and improve symptoms and quality of life. Frailty, characterized by an age-associated decline in physiological reserve, significantly impacts outcomes in these patients. This study uses the Hospital Frailty Risk Score (HFRS) to assess the effect of frailty on mortality and post-procedural complications in HFrEF patients undergoing CIED implantation.Hypothesis:Frail patients with HFrEF have worse in-hospital outcomes after CIED placementMethods:We conducted a retrospective cohort study using the 2020 National Inpatient Sample database from the Healthcare Utilization Project. Our population included patients aged 18 years or older with HFrEF who underwent CRT-D or ICD placement, identified using ICD-10 procedure codes. The primary risk factor was frailty, classified by an HFRS score of ≥5 (frail) or
Abstract 4141879: Post-procedure oral anticoagulation following pulsed-field ablation for atrial fibrillation
Circulation, Volume 150, Issue Suppl_1, Page A4141879-A4141879, November 12, 2024. Background:Current guidelines recommend oral anticoagulation (OAC) for at least two months post-radiofrequency ablation (RFA) in all patients with atrial fibrillation (AF). The endothelial injury during RFA that can promote thrombus formation, does not happen in pulsed-field ablation (PFA).Objective:We evaluated the optimal duration of OAC therapy needed for effective stroke prevention following PFA.Methods:Consecutive patients undergoing PFA for AF were included in the study and prospectively followed-up for 1 year. Based on the duration of post-ablation OAC [non-vitamin K OAC (NOAC)] therapy they were classified intogroup 1:NOAC for 1 month and group 2: NOAC for ≥2 months. Patients were closely monitored for thromboembolic (TE) events via telemedicine. Stroke/transient ischemic attacks that occurred while the patients were in full compliance with the anti-thrombotic therapy, were counted as the reportable TE events.Results:A total of 120 patients were included in this analysis. The mean age of the study population was 59.80 ± 16.39 years; 70 (58%) were male and the CHA2DS2-VASc score was 4.27 ± 1.22. Mean number of PFA applications given was 76.64 ± 36.04.Group 1included 49 (40.8%) andgroup 2was comprised of 71 (59.2%) patients. Baseline characteristics were comparable between the groups.At 1 year,no stroke or transient ischemic attacks were reported in group 1 and 2. At that time point, 42 (85.7%) and 60 (84.5%) patients were arrhythmia-free in group 1 and 2 respectively (p=0.85).Conclusion:In this series of patients, OAC could be safely discontinued after 1 month following the PFA procedure. Thus, it seems redundant to continue OAC beyond 1 month after PFA.