Risultati per: Low Back Pain: raccomandazioni

Circulation, Volume 150, Issue Suppl_1, Page A4143309-A4143309, November 12, 2024. Introduction:Very Low-Density Lipoproteins (VLDLs) serve as crucial transporters of triglycerides (TG) and cholesterol (C) from the liver to peripheral tissues, thereby contributing significantly to metabolic disorders such as atherosclerosis. Assessing the dynamic of VLDLs function involves evaluating its clearance from the bloodstream and distribution across various organs. Although VLDLs clearance has been extensively studied using dual radioactive isotopes3H and14C to label TG and C, this method requires large amounts of expensive tracers, compliance, and technical complexities. Our objective is to design and test a fluorescence-based approach to simultaneously assess and visualize VLDLs kinetics in a mouse model. Through this approach, we aim to unravel the intricate interplay between thermogenesis and VLDLs metabolism and provide insights into their collective influence on the progression of atherosclerosis in vivo.Method:Fluorescence-labeled VLDLs-like TG-rich nanoparticles (F-VLDLs) were prepared at various intensity by incorporating lissamine rhodamine-TG (Rhoda-TG, 1-5% of total TG) and TopFluor®-C (TopF-C, 20-80% of total C) to a mixture containing glycerol trioleate (7mg), egg yolk phosphatidylcholine (2.3mg), lysophosphatidylcholine (0.23mg), cholesteryl oleate (0.3mg), cholesterol (0.2mg) and kolliphor HS15 (2mg). B6 mice were fasted for 4 hours and injected via the tail vein with various intensities of F-VLDLs (2 mg TG/mouse). Blood samples were collected at 5-, 10- and 15-min post-injection to determine the plasma clearance of Rhoda-TG and TopF-C, after which mice were euthanized, and tissues harvested and imaged using an IVIS® spectrum in vivo imaging system.Results:The mean particle size of F-VLDLs was 80nm, with polydispersity index values of about 0.2. The Zeta potential of freshly made F-VLDLs was about −20 mV. In B6 mice, both Rhoda-TG and TopF-C signal intensities peaked at 5 minutes post-injection and subsequently declined in an intensity-dependent manner. In the collected tissues, Rhoda-TG and TopF-C intensity was as follows: liver >brown fat >subcutaneous white fat >visceral white fat.Conclusion:We have designed novel fluorescence-labeled VLDVs-like particles as a viable approach for quantifying and visualizing dynamic VLDLs-TG and C flux in vivo. This approach will facilitate the assessment of how various metabolic interventions impact VLDLs metabolism and atherosclerosis.

Circulation, Volume 150, Issue Suppl_1, Page A4144964-A4144964, November 12, 2024. Major adverse cardiovascular (CV) events (MACE) occur in a substantioal percentage of individuals following acute coronary syndromes (ACS), primarily driven by residual vascular inflammation. Anti-inflammatory drugs have improved CV outcomes but their use is limited by significant side-effects. Low-dose interleukin 2 (IL2) increases regulatory T (Treg) cells, which are powerful endogenous regulators of the immune response, and could provide a new, targeted anti-inflammatory strategy in high-risk ACS patients. In IVORY, we hypothesised that treatment with low-dose IL2 would reduce arterial inflammation measured by18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), compared to placebo. In IVORY FINALE we hypothesised that low dose IL2 could reduce MACE compared to placebo at follow up (up to 5 years.)IVORY was a double-blind, placebo-controlled, Phase IIb trial randomising ACS patients with high-sensitivity CRP levels ≧ 2mg/L to receive either 1.5×106IU IL2 or placebo (1:1). Dosing consisted of a daily induction (5 days) and a weekly maintenance phase (7 weeks).18F-FDG-PET/CT imaging of the ascending aorta and carotid arteries was performed before and after treatment. The primary outcome was the difference in the mean maximum target-to-background ratio (TBRmax) in the index vessel on follow-up imaging between the groups.60 patients (IL2:placebo, n=31:29) completed the trial. Arterial inflammation in the index vessel was lower at the end of treatment in the IL2 group than in placebo (TBRmax = -0.171[-7.7%], 95% CI -0.308 to -0.034, p=0.015)[Fig1]. In more inflamed areas with a mean TBRmax ≧ 2 (active slices), the difference between the groups was greater (-0.185 [-8.3%], P=0.009, 95% CI -0.323 to -0.0478). Overall, the additive treatment effect of low-dose IL2 was greater at higher baseline inflammation [Fig 2]. Low-dose IL2 significantly increased circulating Tregs compared to placebo (p

Circulation, Volume 150, Issue Suppl_1, Page A4128599-A4128599, November 12, 2024. Background:Inferior vena cava (IVC) filters are commonly implanted in patients with venous thromboembolism (VTE) who are unable to receive anticoagulation, to protect against clot migration to the heart. With prolonged implantation, IVC filters are associated with complications: device fracture, migration, penetration into adjacent organs and worsened VTE. Two Federal Drug Administration advisories and multi-society guidelines have emphasized the importance of timely retrieval but national retrieval rates remain low (= 18 years was identified in the 2016-2020 inpatient and outpatient 100% limited data set Medicare files using claims codes. Hospital information for the implanting facility was cross-linked from the American Hospital Association and Healthcare Cost Report Information System files, including identifying information, teaching status, census location, operating margin and % uncompensated care. IVC filter retrieval rates and time to retrieval from implantation was calculated. Bayesian hospital profiling methods were used to quantify 1-year retrieval rate for all U.S. facilities, adjusting for patient factors – demographics, diagnostic indications and comorbidities.Results:Among Medicare beneficiaries, there were 140,481 IVC Filter implantations across 2,850 facilities. Excluding patients who died within 90 days of implantation (25.7%), retrieval rates at 3 months, 1 year and anytime were 7.9%, 18.7% and 20.0% respectively. IVC Filter retrieval within 1 year varied significantly at the facility-level, from 0-100%.Focusing on facilities with at least 13 IVC filter implantations each year (top 25%ile volume), 1-year retrieval ranged from 0 to 74.5%. Higher 1-year retrieval was seen among higher implantation volume (12.4% bottom quartile, 20.5% top quartile), teaching (21.1% teaching vs. 16.9% nonteaching) and non-safety net (21.1% low uncompensated care, 15.0% high uncompensated care) hospitals. Retrieval rates did not vary significantly by hospital operating margin or rurality.Conclusion(s):There is low overall IVC filter retrieval in the United States with large underlying facility-level variation. Focused examination of high-performing facilities could yield insights on how to improve device retrieval nationally.

Circulation, Volume 150, Issue Suppl_1, Page A4136677-A4136677, November 12, 2024. Introduction:Waist circumference (WC) has been recognized as an appropriate index of obesity and is closely associated with the amount of abdominal fat. Although abdominal fat distribution (AFD), which is represented by the ratio of visceral adipose tissue (VAT) to subcutaneous adipose tissue (SAT) area (V/S ratio), is possibly related to an increased risk of cardiovascular disease (CVD), few studies have explored the relationship between AFD and CVD outcomes. This study aimed to assess the influence of AFD based on the V/S ratio and physique categorized by WC on long-term clinical results in patients with suspected coronary artery disease (CAD).Methods:We evaluated 931 consecutive patients (mean age, 67 years; 42.4% women) with suspected CAD who underwent computed tomography (CT) angiography. The patients also underwent plain abdominal CT to assess and measure VAT and SAT areas; V/S ratio was calculated to assess AFD. The patients were divided into four groups based on the median V/S ratio (0.624) and reference values of WC for metabolic syndrome in Japan (85 cm for men, 90 cm for women). We assessed the relationship between the V/S ratio and long-term clinical outcomes in each WC group. The main outcome was major adverse cardiac events (MACEs, including cardiac death, any coronary revascularization, acute coronary syndrome, and emergency hospitalization due to cardiac cause).Results:Over a median follow-up of 1869 days, although the incidence of any cardiovascular event was not related to the V/S ratio among patients with high WC, a higher incidence of MACE and cardiac death was noted among patients with low WC in the high V/S ratio group than in the low V/S ratio group. Furthermore, Kaplan–Meier analysis revealed a significantly lower MACE-free survival rate among patients with low WC in the high V/S ratio group than in the low V/S ratio group, despite of no differences being noted among high WC patients in both the V/S ratio groups (Figure).Conclusion:Only in patients with low WC, a high V/S ratio was linked to increased risks of MACE. Thus, high V/S ratio may be an essential risk factor for CVD, specifically in patients with low WC. However, AFD did not influence CVD prognosis in patients with high WC.

Circulation, Volume 150, Issue Suppl_1, Page A4147314-A4147314, November 12, 2024. Background:The American College of Cardiology/American Heart Association guidelines recommend assessing aortic stenosis (AS) using American Society of Echocardiography-endorsed parameters and referring patients with severe symptomatic AS for treatment. Yet, multi-site real-world assessment of guideline adherence is lacking.Methods:We assessed consecutive echocardiographic reports for patients >18 years of age from 30 US institutions with appropriate permissions between January 2018–March 2024 (egnite Database; egnite, Inc.). Completeness of echocardiographic evaluation of AS was assessed. Patients with severe AS were stratified into high- and low-gradient (HG, mean aortic gradient [MG] ≥40 mm Hg; LG, MG

Circulation, Volume 150, Issue Suppl_1, Page A4136561-A4136561, November 12, 2024. Background:Patients undergoing cardiac surgeries often experience significant levels of pain and anxiety, which can impair effective recovery. Music therapy has been proposed as a non-pharmacological intervention to alleviate these symptoms. This meta-analysis aimed to evaluate the effectiveness of music therapy in patients undergoing cardiac surgeries.Methods:We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) analyzing music therapy in patients undergoing cardiac surgeries. We pooled mean differences (MD), and standardized mean differences (SMD) for continuous outcomes with 95% confidence intervals (CI) with a random-effects model. We performed a trial sequential analysis (TSA) to assess the random risk of pain, and conducted a subgroup analysis to compare heart and respiratory rate between children and adults. We used R version 4.3.2 and TSA version 0.9.5.10 for statistical analyses.Results:Our meta-analysis included 20 RCTs comprising 1379 patients, of whom 715 (51.9%) were randomized to music therapy. Compared with control, music significantly reduced postoperative pain (SMD -0.59; 95% CI: -0.76 to -0.41; p

Circulation, Volume 150, Issue Suppl_1, Page A4116285-A4116285, November 12, 2024. Background:Low molecular weight heparin (LMWH) is the preferred anticoagulant for venous thromboembolism (VTE) prophylaxis in patients with ischemic stroke and reduced mobility. However, some patients may have indications for early direct oral anticoagulants (DOACs) and are continued on this therapy rather than transitioning to LMWH. Whether outcomes differ between these groups is unknown. We compared the safety and efficacy of early DOACs versus LMWH from a large retrospective database.Methods:Patients within the TriNetX Research Network receiving either DOACs or LMWH within 72 hours of ischemic stroke and a Modified Rankin Scale of 4-5 were included. A 1:1 propensity score matching analysis was performed using 27 covariables including demographic information, comorbidities, and medications. Chi-square and independentt-tests were used in bivariable analyses. Outcomes were all-cause mortality, VTE, intracranial and extracranial hemorrhage at 30 and 90 days.Results:Of 5,492 propensity-matched patients, mean age was 73±13, and 43% were male. Mortality in the DOAC group was significantly lower than in the LMWH group at 30 days (RR=0.59, 95% CI: 0.51-0.69) and 90 days (RR=0.63, 95% CI: 0.56-0.71). Risk of VTE was not significantly different at 30 days (RR=0.80, 95% CI: 0.43-1.50) or 90 days (RR=0.74, 95% CI: 0.45-1.22). Risk of intracranial hemorrhage was not significantly different at 30 days (RR=0.81, 95% CI: 0.36-1.80) or 90 days (RR=0.62, 95% CI: 0.34-1.15).Conclusions:In patients with acute ischemic stroke and reduced mobility, early use of DOACs was associated with lower mortality compared to early use of LMWH.

Circulation, Volume 150, Issue Suppl_1, Page A4145490-A4145490, November 12, 2024. Background:Cancer is well known to cause a pro-thrombotic state, however, the pharmacologic therapy for prevention of Venous Thromboembolism (VTE) remains under contention. Direct Oral Anticoagulants (DOACs) and Low Molecular Weight Heparins (LMWHs) remain the mainstay treatment to prevent VTE in active malignancy. The purpose of this pooled analysis is to clarify the safety and efficacy of DOACs and LMWHs in the prevention of VTE and the risk of bleeding.Methods:A systematic search of MEDLINE was conducted using PRISMA guidelines using the search terms “DOAC”, “VTE”, “LMWH” and “Cancer OR Malignancy”. Studies were only included if they were prospective and randomized with a control group. Clinical characteristics of patients and outcomes were aggregated according to the Cochrane Manual. A random effects model using clinical events as dichotomous variables and was utilized to calculate Odds Ratios with 95% confidence intervals. Revman 5.3 was used to aggregate outcomes and statistics.Results:A total of 3880 patients were included in this analysis. Solid organ tumors remained the most enrolled malignancies included in the trials, with gastrointestinal malignancies being the most common. Apixaban, Rivaroxaban, Edoxaban, and Dalteparin were compared in these trials. There was a significant reduction in VTE in favor of the DOACs (OR: 0.64 [0.49, 0.82], P=0.0004). There was no significant difference in major bleeding between DOACs and LMWH (OR: 1.22 [0.80, 1.86], P= 0.36). There was a significant increase in Clinically Relevant Non-Major Bleeding in the DOAC group (OR: 1.68 [1.3, 2.17], P

Circulation, Volume 150, Issue Suppl_1, Page A4140693-A4140693, November 12, 2024. Introduction:Patients presenting to the emergency department (ED) with chest pain are frequently admitted to inpatient or observation units. We sought to assess gender, racial, and ethnic variations in the care of chest pain patients presenting to the ED.Methods:A retrospective chart review of patients presenting to UF Health Shands ED from 6/2019–12/2023 with chest pain was conducted. We included patients with high-sensitivity troponin I levels below the 99thpercentile (

Circulation, Volume 150, Issue Suppl_1, Page A4142501-A4142501, November 12, 2024. Background:Foreign body airway obstruction (FBAO) represents a major public health challenge in developed countries with aging populations. We previously reported that bystander FBAO interventions were associated with about a two-fold increase in favorable neurological outcomes; however, the impact of each different type of intervention on patient outcomes remains unknown.Hypothesis:We hypothesize that abdominal thrusts and back blows are associated with favorable neurological outcomes in patients with FBAO compared to no bystander intervention.Methods:The MOCHI (Multi-center Observational CHoking Investigation) registry is a prospective, multi-center study conducted in Japan, focusing on patients with FBAO in emergency departments. From April 2020 to March 2023, 25 hospitals, including eight university hospitals, participated. For this analysis, we included only adult patients who were over 18 years. Data were collected electronically, documenting demographics, FBAO specifics, bystander characteristics, intervention types, and 30-day outcomes. Primary outcomes were favorable neurological outcome defined as Cerebral Performance Category 1 or 2 and survival outcome at 30 days. Inverse probability of treatment weighting (IPTW) and logistic regression were used to adjust for potential confounders.Results:Among 407 patients, 24, 76, and 175 received abdominal thrusts, back blows, and no bystander interventions, respectively, while the rest received other interventions. Median age was 81, with equal male-to-female ratio. FBAO incidents mainly occurred at home (57%). Patients with abdominal thrusts or back blows had higher rates of favorable neurological outcome than those without bystander interventions (37% vs. 15%, p = 0.01 for abdominal thrusts; 32% vs. 15%, p = 0.004 for back blows). IPTW analysis showed that abdominal thrusts and back blows groups had higher rates of favorable neurological outcome compared to the no-bystander intervention group (38% vs. 15%, p = 0.038 for abdominal thrusts; 31% vs. 16%, p = 0.013 for back blows). Cox proportional models showed that the back blow was independently associated with survival (adjusted Hazard Ratio [HR] 0.52, 95% CI, 0.35–0.78); however, abdominal thrusts was not independently associated with survival (adjusted HR 0.73, 95% CI, 0.40–1.35).Conclusion:Bystander abdominal thrusts and back blows were associated with favorable neurological outcomes in FBAO compared with no bystander intervention.

Circulation, Volume 150, Issue Suppl_1, Page A4144284-A4144284, November 12, 2024. Background:Proprotein convertase subtilisin/kexin type 9 (PCSK9) binds to low-density lipoprotein (LDL) receptors, leading to their degradation and decreasing serum LDL-cholesterol (LDL-C) to reduce risk of coronary heart disease. We aimed to investigate the safety, tolerability, pharmacodynamic characteristics of RN0191, a novel structure small interfering RNA that inhibits PCSK9 mRNA translation process, in healthy Chinese adults with elevated LDL-C who were not on lipid-lowering treatment.Methods:We did a randomized, single-blind, placebo-controlled, Phase 1 dose-ascending study in healthy Chinese volunteers with serum LDL-C≥100 mg/dL (2.6 mmol/L). Subjects were randomly assigned in a 6:2 ratio to receive single subcutaneous injection of RN0191 (dose ranging from 60mg to 600mg) or placebo. Primary endpoint was the safety and tolerability of RN0191. Secondary endpoints included RN0191’s pharmacodynamic effects on PCSK9, LDL-C and other lipid biomarkers. All subjects were masked to treatment assignment. The study registered in ClinicalTrials.gov (NCT06132360) and is still on-going.Results:Of 32 subjects, 24 were randomly allocated to receive a single dose (60mg/200mg/400mg/600mg) of RN0191 (6 in each active arm) and 8 to placebo. The analysis spans all cohorts at Day 56 post-administration. All the adverse events are mild or moderate. There is no severe treatment-emergent AE (TEAE), death or TEAE leading to study discontinuation. The numbers of subjects affected by TEAEs in each cohort of RN0191 (3,4,2,2) are similar to that of placebo (3). The interim data indicates a profound dose-dependent lowering impact of RN0191 on several key lipid biomarkers. Substantial PCSK9 protein reduction is demonstrated in a dose-dependent manner. In high dose (400 mg and 600 mg) cohorts, mean maximal decreases of PCSK9 level of 85.84% on Day 21 and 86.14% on Day 28 are achieved respectively. Notably, LDL-C exhibits progressively greater reductions across escalating doses. The mean maximal decreases of LDL-C are achieved as 54.65% of 400mg cohort on Day 42 and 51.35% of 600mg cohort on Day 21 respectively. Additionally, a significant lipoprotein (a) reduction is observed with mean maximal lowering level of 43.95% at 400mg cohort on Day 21 and 52.95% at 600mg on Day 28 respectively.Conclusions:The preliminary safety and efficacy profile of RN0191 underscoring its comprehensive lipid-lowering capacity as a promising therapeutic candidate for managing dyslipidemia.

Circulation, Volume 150, Issue Suppl_1, Page A4144271-A4144271, November 12, 2024. Background:Transseptal puncture (TSP) is a critical step allowing access from right atrium to left atrium in cardiac interventions. The operation relies heavily on real-time X-ray imaging and often involves subjective decision-making needing experience. Recent advancements in artificial intelligence (AI), particularly visual foundation model offer promising solutions to enhance the precision and consistency of TSP.Research questions:We hypothesize that a foundation model fine-tuned on real TSP images and expert annotations, can accurately predict the optimal puncture site on imaging.Aims:This study aims to develop and validate an AI method that automatically identifies the ideal TSP site using only the CS catheter as a reference in X-RAY image. This approach seeks to replicate the decision-making process of experienced clinicians, thereby improving the accuracy and safety of the procedure.Methods:A pilot study enrolled 101 patients in one center. Three experienced senior practitioners are responsible for labeling these images. To learn information from limited X-RAY images, we design a co-training framework based on Segment Anything Model (SAM) to fine-tune the decision module for TSP by combining visual prompts of the three bounding boxes (heart edge, spine, and coronary sinus electrode). The input images are captured before puncture and resized to 512*512. The candidate puncture area is set as a circle centered at actual puncture point with a radius of 10 pixels.Results:Images from 80 patients were used to fine-tune the decision module, while 21 for validation. The Intersection over Union (IoU) on validation set is 70.22% for the pre-defined candidate TSP circle. In validation, the success rates of the predicted TSP point (the center of the predicted area) falling within radii of 5, 10, 15 pixels cantered on the actual TSP site are 56.30%, 72.01% and 83.54%, respectively.Conclusions:In this study, we introduce an AI-assisted visual prompt for TSP using SAM-based fine-tuning. With the limited samples, the performance of puncture-site prediction underscores the potential of our framework as an efficient solution for TSP guidance and assistance. The future works include expanding the sample size and testing whether visual prompts can enhance TSP quality and clinical training.

Circulation, Volume 150, Issue Suppl_1, Page A4114461-A4114461, November 12, 2024. Introduction:It is unclear if young adults with hyperlipidemia are also more likely to have non-lipid cardiovascular disease (CVD) risk-factors or higher long-term CVD risk. As such, we assessed associations between low-density lipoprotein cholesterol (LDL-C) levels and non-lipid CVD risk factors as well as 10- and 30-year risk of CVD in young adults.Methods:We included a nationally representative sample of adults 20-

Circulation, Volume 150, Issue Suppl_1, Page A4137186-A4137186, November 12, 2024. Background:Fontan patients reveal decreased peak exercise performance in combination with low peak heart rate (HR), which is frequently interpreted as chronological incompetence. This is counterproductive as HR increase has to be enhanced to compensate limited stroke volume increase in Fontan physiology.Methods:Cardiopulmonary exercise testing (CPET) data in asymptomatic Fontan patients and age-matched control subjects were retrospectively studied. Peak and submaximal CPET parameters were obtained by cycle ergometer. Chronotropic capacity was assessed by peak HR/peak [WR/kg] and submaximal slope of HR/[work rate (WR)/kg] (ΔHR/Δ[WR/kg]) for males and females, separately.Results:Table 1 presents CPET data of Fontan patients (51) and controls (65). Fontan patients showed significantly lower peak HR, peak WR, peak oxygen consumption (VO2)/kg, %predicted maximum VO2, and peak oxygen pulse (pOP)/kg than controls in both sexes whereas peak HR/peak [WR/kg] was significantly higher in Fontan patients, indicating higher HR at the maximum effort in Fontan patients than in controls. Fontan patients showed higher ΔHR/Δ[WR/kg], a marker for HR-dependency, and lower Δ[VO2/kg]/ΔHR, a surrogate of stroke volume, suggesting higher HR was compensating lower stroke volume during submaximal phase of exercise in Fontan patients. Figure 1 demonstrates a linear relationship between ΔHR/ΔWR and peak HR/peak WR in both sexes. Male Fontan patients revealed a comparable trend with controls, whereas female Fontan patients showed higher HR increase at the peak exercise effort than controls with the same ΔHR/ΔWR, suggesting more limited stroke volume reserve than male Fontan patients.Conclusions:Fontan patients showed higher HR-response to exercise than controls in both sexes due to limitation in stroke volume increase. Our data indicate that lower peak HR in Fontan patients results from early exhaustion due to limited stroke volume reserve rather than primary chronotropic incompetence.

Circulation, Volume 150, Issue Suppl_1, Page A4136678-A4136678, November 12, 2024. Background:Evaluation of sarcopenia requires quantifying appendicular skeletal muscle mass and functional capacity, but resource constraints often limit feasibility. Alterations in muscle quality, especially intramuscular lipid infiltration (i.e., myosteatosis), and systemic metabolic derangements are associated with disability.Hypothesis:Opportunistic CT imaging and plasma amino acid profiling could identify low physical function in patients with heart failure (HF).Methods:We retrospectively examined 220 HF patients (74 ± 13 years old; 59% male) who underwent plasma amino acid profiling, abdominal CT imaging, and dual-energy X-ray absorptiometry (DXA) scan within two months. Myosteatosis was evaluated using single-slice CT imaging at the L3/4 level and quantified as mean muscle attenuation (MMA). Physical function was assessed by the short physical performance battery (SPPB), with low physical function defined as SPPB ≤9.Results:CT-derived single-slice areas of skeletal muscle and adipose tissue were highly correlated with DXA-derived appendicular skeletal muscle mass and total fat mass. Logistic regression analyses revealed that higher age and lower MMA, but not skeletal muscle area, were significantly associated with low physical function independently of NT-proBNP. Subjects with MMA below the median value (32.0 HU for males and 23.7 HU for females) had higher odds of low physical function (adjusted OR 2.04, 95% CI 1.04-3.96). Ten amino acids and the Fischer ratio were significantly correlated with MMA levels. Multivariate regression analyses, adjusted for potential confounders including age, gender, and body mass index, demonstrated that serum albumin and Fischer ratio were independent determinants of MMA levels. When serum albumin and Fischer ratio were dichotomized by their median values (3.6 mg/dL and 3.23, respectively), the prevalence of low physical function was significantly higher in subjects with low albumin and low Fischer ratio, but not in those with low levels of only either parameter, compared to those with high albumin and high Fischer ratio (adjusted OR 2.36, 95% CI 1.02-5.49).Conclusions:Myosteatosis assessed by single-slice abdominal CT imaging is an independent determinant of low physical function in HF patients. Combined with an assessment of serum albumin and Fischer ratio, these simple biomarkers could facilitate the early detection of patients at risk for developing frailty.

Circulation, Volume 150, Issue Suppl_1, Page A4141198-A4141198, November 12, 2024. Introduction:As substrates for nitric oxide, arginine (Arg) and its metabolites are involved in the regulation of vascular function. Ischemia caused by vascular dysfunction is common in patients with non-obstructive coronary artery disease (NOCAD) and may indicate a subgroup at increased risk of cardiovascular disease (CVD) mortality.Research question:We evaluated serum arginine (Arg), homoarginine (hArg), symmetric dimethylarginine (SDMA), and asymmetric dimethyl arginine (ADMA) as long-term predictors of CVD mortality in patients with chronic coronary syndrom. Particularly, we were interested in potential effect modifications according to diagnoses of NOCAD versus obstructive coronary artery disease (OCAD) at baseline invasive coronary angiography (ICA).Methods:4164 patients underwent elective ICA from 2000-2004. Serum metabolite concentrations were measured by liquid chromatography-tandem mass spectrometry using isotope labelled internal standards. Metabolite associations with CVD mortality risk were explored by Cox regression adjusting for age, sex, body mass index, HbA1c, hypertension, smoking status, serum LDL cholesterol, previous myocardial infarction, and estimated glomerular filtration rate. HRs (95% CI) are reported per SD increment of (log transformed) metabolites. Potential effect modifiers were evaluated by adding interaction terms to the model.Results:Median age was 62 years at inclusion. 72 % were men, 25 % had NOCAD, while 75 % had OCAD. During median 14 years of follow-up, 14 % of patients died from CVD. In multivariable analyses, serum concentrations of Arg, hArg and SDMA predicted CVD mortality with HRs (95% CI) of 0.90 (0.83-0.98), 0.81 (0.74-0.88) and 1.30 (1.12-1.50), respectively. Serum hArg was a significantly stronger inverse predictor in patients with NOCAD than in OCAD with HR (95% CI) of 0.54 (0.40-0.73) versus 0.84 (0.77-0.92), respectively (Pint = 0.037). No significant effect modifications were observed for the other arginine form (Pint ≥ 0.09).Conclusion:In patients with stable chest pain, Arg, hArg and SDMA significantly predicted long term CVD mortality. Interestingly, hArg was a stronger inverse predictor among NOCAD compared to OCAD patients. Further studies investigating hArg as a potential marker of a high-risk phenotype in NOCAD are merited.