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Circulation, Volume 148, Issue Suppl_1, Page A16924-A16924, November 6, 2023. Introduction:Cardiac screening is mandated by most sporting organisations. A resting 12-lead ECG may identify individuals who harbour cardiac disorders who may be at risk of sudden cardiac death (SCD). Lateral wave inversion (TWI) may identify subjects with cardiac phenotypes that are linked to SCD.Aim:The aim of this study was to ascertain the prevalence of lateral TWI in adolescent individuals as part of a systematic nationwide cardiac screening. The yield of family screening in these probands was also evaluated.Methodology:A national cardiac screening program (BEAT-IT) was set up in the 2017/2018 scholastic year for students attending year 11 classes. 2672 students (14-17 years) and their legal guardians gave consent. Screening protocol consisted of a questionnaire/ECG at school. ECGs were reported as per the ‘International Recommendations for ECG interpretation’ (2017). Those with contiguous TWI in ≥2 lateral leads were evaluated. An athlete was defined as an individual who participated in organized sport and/or engaged in >4 hours of physical activity weekly.Results:2672 adolescents gave consent (mean age 15 years, 50.4% female, 95.8% Caucasian, 39.0% athletes). 6 (0.22%) had lateral TWI, extending into the inferior (n=4, 0.15%) or anterior (n=2 (0.07%) leads. The prevalence was the same in both genders (p=0.477) and athletic status (p=0.580). 2 (0.07%) had symptoms, 4 (0.15%) were female, all were Caucasian, 3 (0.11%) were athletes. 4 (0.15%) had borderline or other pathological ECG changes (n=2 LAE, n=1 RAE, n=1 ST depression). 4 (0.15%) had deep TWI (≥2mm). One patient was diagnosed with HCM (0.04%). All subjects are under surveillance. Family screening in relatives (n=27) identified two (7.4%) with cardiomyopathy (n=1 HCM, n=1 DCM). Another 5 (18.5%) had an abnormal ECG requiring surveillance. These findings suggest that some of the participants identified at screening may harbour pre-clinical phenotypes.Conclusion:Lateral TWI is an infrequent finding in young individuals and requires surveillance as it may be a manifestation of heart disease. Family screening may help increase the degree of suspicion of pre-clinical disease in peripubertal individuals.

Circulation, Volume 148, Issue Suppl_1, Page A18034-A18034, November 6, 2023. Background:Gunshot wounds cause catastrophic injuries. When bullets embolize to heart, without penetrating cardiac injury, optimal management remains unclear.Case:25 year old male, presented after multiple gunshot wounds (GSW). On exam, perirectal GSW, 3 GSWs to right thigh and 2 GSW to left thigh noted. Lungs CTA bilaterally, CVS normal S1, S2. CTA chest showed Infra renal IVC injury and large retroperitoneal hematoma. (1,2). ECHO revealed a bullet in the dependent part of right atrium, abutting the tricuspid valve (3). No chest injury noted, suggesting migration of bullet from IVC, following the trajectory of venous return to right atrium. He underwent IVC patch repair. Percutaneous approach was unsuccessful to snare the bullet using 8-mm and 14-mm triloop snare, 15-mm gooseneck snare (4), bronchial forceps (5) and balloon. Multidisciplinary team decided to abandon further percutaneous or surgical extraction attempts as the bullet firmly lodged in sub-tricuspid chordo papillary apparatus with no valvular dysfunction.Discussion:In hemodynamically stable patient with intracardiac bullet, there is no standard treatment approach. 65% of bullets entering vena cava, migrate and lodge in chordo papillary apparatus or trabeculations. Low risk percutaneous extraction approaches have gained popularity, with about 50% success. When percutaneous extraction fails, clinicians face a critical decision to observe or perform open sternotomy extraction. Numerous case reports support observation only approach. This patient has done well with observation, suggesting non-operative initial management is reasonable in hemodynamically stable patient with intracardiac bullet.

Circulation, Volume 148, Issue Suppl_1, Page A15076-A15076, November 6, 2023. Introduction:Cryoballon (CB)-guided pulmonary vein isolation (PVI) is an accepted treatment option for atrial fibrillation (AF). The cardiac autonomic nervous system (ANS) plays a crucial role in the regulation of AF.Hypothesis:ANS modulation has an impact on patients’ AF free survival following CB-ablation. The aim of this observational clinical trial was to analyze the impact of vagal reactions (VRs), as a surrogate parameter for ANS modulation, on the long-term outcome of CB-ablation in patients with persistent AF (PERS AF).Methods:Data from consecutive PERS AF patients treated with a CB-guided PVI for symptomatic drug refractory AF between 2013-2023 were analyzed. VRs were defined as bradycardia < 40 beats/min, asystole or higher-degree atrioventricular block. All patients were continuously followed up in our outpatient clinic. AF-recurrence was defined as AF lasting > 30 seconds beyond a 3-month blanking period.Results:A total of 250 consecutive patients (mean age 63.9 ± 10.0 years, 70% male) were included. VRs were recorded in 61 patients (24%). The mean follow-up duration amounted to 84±14 months. Within this observation period 101 patients (40%) developed AF recurrence a mean of 1.75 ± 0.80 times. Re-ablation procedures were performed in 61 patients (60%) a mean of 1.28 ± 0.55 times. Reconnected PVs were documented in 41 cases (67%). An additional substrate modification was performed in 34 procedures (42%). Patients with procedure associated VRs presented with a significantly higher estimated AF-free survival rate compared to those without (log-rank p-value=0.016) (Figure1). Multivariate analyses revealed the days to first AF recurrence following primary CB-ablation as an independent predictor for AF-free survival (CI 0.841-0.928, HR, 0.883, p

Circulation, Volume 148, Issue Suppl_1, Page A17715-A17715, November 6, 2023. In a 2-center trial (PulseReductiononBeta-Blocker andIvabradineTherapy (PROBE-IT)) we tested the hypothesis that failure to adequately reduce heart rate (HR) contributes to non-response to beta-blockers. Twenty-two dilated cardiomyopathy patients (DCM) with a sinus rhythm (SR) heart rate (HR) ≥70 bpm without reverse remodeling after target doses of beta-blockers were randomized 2:1 to 5±2.5 mg b.i.d of ivabradine (IVB) or matching placebo, and treated for 24 weeks with continuation of beta-blockers. Echocardiograms for LVEF measurements and endomyocardial biopsies for measurement of global gene expression by RNA-Sequencing were performed at baseline and end of study. The protocol design aimed for approximately equal numbers of patients with a HR reduction (HRι) and a control group with no change in HR (HRν), with the predefined statistical analysis plan comparing subjects above and below the median HR change. Characteristics and changes from baseline in the 17 patients who completed the trial were (*P

Circulation, Volume 148, Issue Suppl_1, Page A15913-A15913, November 6, 2023. Introduction:Takotsubo cardiomyopathy (TCM) is a reversible type of heart failure that occurs mostly in postmenopausal women. There are no definitive preventive measures in literature for this condition.Case:A 75-year-old female with a past medical history of hypertension presented with a new intermittent pressure-like chest pain and dyspnea right after a 1000-miles road trip. she reported that she had been feeling sad after her best friend died. Physical exam showed bilateral lower lung lobes crepitation and hypoxia. Lab work up revealed troponin of 1522 ng/L trending up to 2400 ng/L on serial measurements and elevated BNP. EKG showed ST changes and inverted T wave. Chest x-ray showed pulmonary vascular congestion and small bilateral pleural effusion. TTE showed LVEF 25-30% and mid and apical LV hypokinesis. Chest CT angiography was normal. Left heart catheter showed nonoccluded coronary arteries. LV angiogram portrayed mid and apical hypokinesis. Serology and PCR of EBV, Coxsackie B virus, CMV, HSV, influenza A and B, adenovirus and parvo virus were negative. She was started on a diuretic, a Beta blocker and an ACE inhibitor. Her symptoms improved. A follow up echocardiogram after 1 month showed improved ejection fraction and resolution of LV mid and apical hypokinesis. Recent combined emotional and physical stress of driving a long distance were thought to be the cause of stress cardiomyopathy.Discussion:Approximately 1-2% of patients presenting with symptoms of MI meet the criteria for TCM. A recent systematic review by Nyman et al on triggers of TCM found that physical factors are more common than emotional factors. However, some cases had both emotional and physical stressors. This patient had combined psychological and physical stressors, which may have precipitated TCM. postmenopausal women with recent emotional stressors should be advised to avoid physical stress until emotional issues have been resolved.

Circulation, Volume 148, Issue Suppl_1, Page A13999-A13999, November 6, 2023. Background:African American women (AA) are at disproportionally high risk for diabetes and cardiovascular disease (CVD) which is accelerated when residing in resource-limited neighborhoods. Extracellular vesicles (EV) are emerging to be of importance in CVD development and progression, but little is known about a potential impact of neighborhood socioeconomic deprivation (NSD). In this study we examined associations between NSD, plasma EV, and markers of diabetes risk in a community-based cohort of AA women at risk for CVD from resource-limited neighborhoods in Washington, DC.Methods:Participants were enrolled in pilot testing of Step It Up, a community engaged physical activity intervention. Blood samples were drawn to measure clinical labs during participants’ baseline visit to the NIH Clinical Center. EV were isolated from heparinized plasma using size exclusion chromatography with size and numbers determined by nanoparticle tracking analysis. NSD was calculated using 2018 US Census tract data as a measure of neighborhood deprivation. Associations between NSD, EV, and diabetes-related clinical measures were analyzed using multivariable regressions adjusted for BMI and ASCVD 10-year risk score.Results:The study cohort was a convenience sample of AA women at risk for CVD (N=24, Age: 57±12, BMI: 35±6, ASCVD: 9±5). NSD associated with fasting glucose (β=0.54, p=0.007) and Hemoglobin A1c (HA1c) (β=0.51, p=0.007). Additionally, NSD associated with lower EV size (β=-0.42, p=0.03), with no association with EV concentration. Fasting glucose and HA1c associated negatively with EV size (β=-0.48, p=0.03 and β=-0.50, p=0.02, respectively) but no association was found with EV concentration.Conclusions:Thus, our data show that higher neighborhood deprivation is associated with lower EV size which, in turn, is associated with higher diabetes risk markers. More research is needed to understand the role of EV in diabetes and CVD development and progression. While larger studies further evaluating these observations are needed, our data highlight the importance of increased diabetes screening and multi-level interventions in patients residing in under-resourced communities to reduce existing health disparities.

Circulation, Volume 148, Issue Suppl_1, Page A17627-A17627, November 6, 2023. Background:Diabetes and cardiovascular disease (CVD) disproportionally affect African American (AA) women. Prior studies suggest extracellular vesicles (EV) are involved in atherogenesis, but little is known about relationships between PA and EVs in AA women. Thus, we examined associations between diabetes risk markers, EV, and PA in a community-based cohort of AA women at risk for CVD from resource-limited Washington, D.C. neighborhoods.Methods:Participants were enrolled in pilot testing of Step It Up, a place-tailored mobile app designed to increase PA. Baseline daily step counts for PA were measured by Fitbit® (Charge 2) and fasting baseline blood samples were cryopreserved. NMR (Nuclear magnetic resonance) spectroscopy was used to measure Lipoprotein Insulin Resistance Index (LP-IR), a diabetes risk marker. EV were isolated from heparinized plasma using size exclusion chromatography with size and numbers determined by nanoparticle tracking analysis. Associations between LP-IR, EVs, and daily step count were analyzed using multivariable regressions adjusted for BMI and ASCVD 10-year risk score.Results:The study cohort was a convenience sample of AA women with overweight/obesity (N=24, Age: 57±12, BMI: 35±6, ASCVD: 9±5). Smaller EV size associated with higher LP-IR (β=-0.45, p=0.04) with EV concentration trending to a positive association with LP-IR (β=0.38, p=0.08). Higher daily step count associated with larger EV particle size (β=0.48, p=0.02) but not with EV concentration. Additionally, higher daily step count associated with lower LP-IR (β=-0.42, p=0.04).Conclusions:Our data show that reduced EV size and increased EV concentration associate with higher LP-IR, a diabetes index among a community-based cohort of AA women. Additionally, our findings suggest that PA might help mitigate these associations. More research is needed to understand the potential impact of PA on EV, diabetes risk and subsequent CVD. Future PA interventions in at-risk patients may reduce existing diabetes and CVD-related health disparities and EVs may emerge as a mechanistic link.

Circulation, Volume 148, Issue Suppl_1, Page A18248-A18248, November 6, 2023. Background:Increased self-efficacy facilitates health promoting behaviors such as physical activity (PA). Perceived discrimination may limit PA among minoritized populations, but little is known about the relationship between PA and nutrition self-efficacy (PANSE) and perceived discrimination (PD) among African American (AA) women with overweight/obesity.Methods:We examined the associations between PANSE and PD in 106 AA women in the Step It Up, a community-engaged, digital health intervention. All completed the PANSE (higher scores = higher self-efficacy), the everyday discrimination scale (higher scores = higher frequency of everyday discrimination), and a sociodemographic survey. We used linear regression to assess the associations between PANSE and PD adjusting for covariates and the interaction effects of discrimination and income.Results:The participants had a mean age of 55.9 (SD±12.7) years with mean BMI 36.3 (SD±6.9) kg/m2. PD was negative and significantly associated with PANSE in both our unadjusted model and after adjusting for age and educational level (Table 1). The association trended marginally significant in the third model when we adjusted for income. We found no interaction effect between PD and income.Conclusion:PD is associated with PANSE among this AA women cohort. This suggests an urgent need for future research to better extricate the relationship between PD and PANSE to inform interventions that addresses everyday discrimination among diverse population groups; particularly in AA women with overweight/obesity.

Circulation, Volume 148, Issue Suppl_1, Page A13909-A13909, November 6, 2023. Introduction:Metabolically obese normal weight (MONW) refers to metabolic abnormalities despite normal body mass index (BMI).Hypothesis:Because obesity is generally defined by BMI, it is assumed that people with MONW do not have excessive adiposity but still have the metabolic dysregulation associated with adiposity.Methods:We included participants aged 20-65 of the National Health and Nutrition Examination Surveys from 1999-2006 and 2011-2018 with normal BMI (18.5-25 kg/m2), fasting blood samples, and DEXA data. According to the AHA criteria, MONW was defined having ≥3 of the following criteria, besides a normal BMI: Hypertriglyceridemia (≥ 150 mg/dL) or treatment for elevated triglycerides; HDL cholesterol level < 40 mg/dL in men or

Circulation, Volume 148, Issue Suppl_1, Page A19066-A19066, November 6, 2023. BackgroundMitral Valve prolapse (MVP) occurs in 1.2 to 3% of the population. Myxomatous degeneration is the most common cause of MVP in the United States. Clinical features range from asymptomatic to serious complications such as heart failure, endocarditis, arrhythmias, and sudden cardiac death. Patients with MVP may develop severe mitral regurgitation (MR) requiring surgery. We present a unique case of severe MR in a patient with MVP.CaseA 67-year-old male with a history of Dysautonomia and Parkinson’s disease presented to the cardiology clinic with complaints of exertional dyspnea, lightheadedness, and palpitation. Transthoracic echo was obtained as part of the workup revealing ejection fraction >55%, Myxomatous Mitral Valve with significant prolapse of the posterior leaflet which was partially flail causing severe MR, regurgitant volume of 149 cc, and percentage of 69%. Cardiac catheterization showed normal coronaries. A transesophageal echo to evaluate the MR and surgical repair of the mitral valve was offered, but the patient refused surgery. He was later lost to follow-up. After 4 years, he presented to the clinic with some exertional dyspnea. Repeat echo revealed moderately calcified posterior leaflet with less mobility causing only moderate MR. His MR continued to improve, an echo after 5 years revealed increasing calcific changes involving posterior leaflet and chordal attachment, causing mild MR and mitral stenosis.DiscussionIsolated MVP can develop degenerative MR in up to 25%, and 0.4 to 1.9% can suffer sudden cardiac death. Surgery is recommended for severe symptomatic MVP with MR and it is considered fatal if left unrepaired. In this case, the patient refused surgery and had an unusual natural history of valve calcification leading to decreased mobility, reduced prolapse, and converting severe MR into mild. To our knowledge, this is the first case in literature where there is a self-correction of MVP due to the calcification of the valve leaflet.

Circulation, Volume 148, Issue Suppl_1, Page A15514-A15514, November 6, 2023. Introduction:Patients undergoing heart transplant evaluation wait in the hospital for weeks. The intra-aortic balloon pump (IABP) is commonly used as a bridge to heart transplants. However, patients with a femoral-inserted IABP may face mobility limitations. Goal: To address this issue, the Cardiac Intensive Care Unit (CICU) implemented a modified Ramsey protocol aimed at ambulating patients with IABP.Goals:The goal was to improve patient health outcomes. The project aims to ambulate patients with f-IABP in Cardiac Intensive Care Unit (CICU) to prevent functional decline due to bed rest.Methods:The provider prescribed all IABP patients in the CICU ambulation. Before ambulation, patients who met the criteria were verticalized, utilizing the KREG Catalyst™ bed at 70 degrees for at least 45 minutes three times/day. After tolerating the verticalization at 70 degrees, nurses and physical therapists will assist the patient in stepping off the bed for at least 45 minutes 2 before ambulating around the unit.Results:A total of 14 patients were ambulated, of which twelve were male and two were female. The mean aged is 59 years, ranging from 30 to 72 years. The participants underwent an average of 15 ambulation sessions, with the minimum being one session and the maximum being 52 sessions. During these sessions, the participants covered an average total distance of 9619.29 feet, ranging from a minimum of 70 feet to a maximum of 36250 feet. The participants spent an average of 4061.86 seconds ambulating, with a minimum duration of one minute and a maximum of 30 minutes. The average catheter migration was 0.2229 centimeters upon implementation of the intervention. The findings show no significant adverse events with implementing this protocol.Conclusions:By implementing this protocol, healthcare professionals can enhance patient care and optimize post-heart transplant length of stay.

Circulation, Volume 148, Issue Suppl_1, Page A289-A289, November 6, 2023. Background:In Denmark, volunteer responders have been dispatched to suspected pediatric out-of-hospital cardiac arrests (OHCAs) through a smartphone application since February 2022. However, it is unknown how volunteer responders experience assisting pediatric OHCAs.Aim:To explore how volunteer responders experienced being involved in pediatric OHCAs.Method:The study population comprised volunteer responders alerted to an OHCA patient

Circulation, Volume 148, Issue Suppl_1, Page A16816-A16816, November 6, 2023. Background:The Impella ventricular assist device is often used in patients (pts) with complex coronary artery disease undergoing high-risk percutaneous coronary interventions (PCI). Limited data exits on the risks and benefits of these devices in elderly pts.Aim:To compare major bleeding and major adverse cardiac and cerebrovascular events (MACCE) in pts undergoing Impella-assisted PCI, categorized by age groups.Methods:Data was collected for quality control on pts undergoing Impella-assisted PCI. Pts were divided by age into three groups: ≤69, 70-79 and ≥80 years. Bleeding was classified by Bleeding Academic Research Consortium (BARC). MACCE was the composite of major bleeding (BARC ≥3), death and post-PCI myocardial infarction and stroke.Results:From 2010 to 2018, 252 pts had Impella-assisted PCI (Table). Pts ≤69 were often male, presented with STEMI or NSTEMI (61%) and had lower left ventricular ejection fraction (LVEF) complicated by cardiogenic shock (CS). Bleeding complications, mortality and MACCE were similar among the groups. Covariate adjustment showed pts 70-79 were not at a higher risk of MACCE compared to ≤69 pts, whereas pts ≥80 had 2.7-fold odds of MACCE compared to pts ≤69 (Figure).Conclusion:In Impella-assisted PCI pts: 1) indications for Impella varies across different ages; 2) younger pts (≤69) were healthier but in the midst of an acute coronary syndrome with severely reduced LVEF and CS; 3) BARC ≥3, mortality and MACCE were similar among the three groups; 4) by multivariable analysis, older age, female sex, STEMI and pre-PCI CS were independent predictors of MACCE; and 5) the odds of MACCE increased by almost 3-fold in pts ≥80 when compared to younger pts.

Circulation, Volume 148, Issue Suppl_1, Page A17250-A17250, November 6, 2023. A 21 year-old college athlete presented with palpitations during exercise. ECG and transthoracic echo were normal. He underwent electrophysiology study. With catheter placement, the patient had atrial fibrillation without preexcitation. On isoproterenol, spontaneous salvos of supraventricular tachycardia (SVT) occurred. Coronary sinus activation was concentric. SVT never sustained, limiting diagnostic maneuvers. In SVT, the ventriculoatrial (VA) time was 145 msec, and there was no decrement of VA conduction with ventricular extrastimuli. Para-Hisian pacing (PHP) was performed. At high output, local myocardial + Purkinje (LM+P) capture was observed, with a VA time of 130 msec; at lower output, selective Purkinje (SP) capture was observed, with a narrower QRS (Figure 1A), and paradoxicallylongerVA time (160 msec) (Figure 1B). The diagnosis of a retrograde conducting-only accessory pathway (AP) was made, mapped with ventricular pacing, and ablated on the posteroseptum. SVT was no longer inducible.Discussion:PHP is employed to identify presence of a septal retrograde conducting AP based on findings ofequalVA times with LM and LM+P capture. Here, the traditional findings of PHP (LM and LM+P capture) were absent because LM capture did not occur, and a third, distinct manner of activating the ventricle (via SP capture) produced unexpected results. In the presence of a retrograde conducting AP, the VA time with narrow-QRS by way of SP capture (sequential activation of the Purkinje system then myocardial conduction) was paradoxically longer than that of wider-QRS LM+P capture (concurrent Purkinje and myocardial conduction), because the path of VA conduction via the AP is “closer” to the site of first ventricular activation. The comparison of SP to LM+P capture may in and of itself declare the presence of an AP; however, LM, LM+P, and SP capture together may be useful to identify a second concealed AP providing incremental diagnostic information to conventional PHP.

Circulation, Volume 148, Issue Suppl_1, Page A14051-A14051, November 6, 2023. Background:Loneliness is a public health crisis and recent reports suggest that people suffering from loneliness have increased cardiovascular disease (CVD) risk. A potential link between loneliness and CVD is an atherogenic shift in the lipoprotein profile. We investigated associations between loneliness and lipoproteins in African American (AA) women residing in resource-limited neighborhoods of Washington, DC.Methods:Participants were enrolled in Step It Up, a technology-based, community-engaged PA intervention. Fasting blood samples were drawn at baseline to measure lipoproteins using nuclear magnetic resonance (NMR) technology. The Lipoprotein Insulin Resistance Index (LP-IR), a diabetes risk marker, was calculated. Loneliness was measured using the UCLA Loneliness scale. Associations between loneliness, lipoprotein particles and LP-IR were analyzed using multivariable regression adjusted for BMI, ASCVD 10-year risk score, and lipid-lowering therapy.Results:106 AA women with CVD risk (Age 55.9±13, BMI 36.3±6.7) were enrolled into Step It Up. We found that higher loneliness at baseline was associated with higher Apo-B, LDL concentration (LDL-c), and LDL particle number (LDL-p) but not with LDL particle size (LDL-z, Table). We observed that higher loneliness associated with increased triglyceride rich lipoprotein size (TRL-z). This relationship seems to be due to very large and large TRL particles (TRL-p, Table). No significant associations were found with the HDL-related measures. Lastly, loneliness significantly associated with LP-IR, a new diabetes risk marker (Table).Conclusions:Thus, our data show that higher loneliness in AA women from under resourced neighborhoods is associated with increased hyperlipidemia and diabetes risk. This highlights a potential mechanism by which loneliness may accelerate CVD risk and support the urgent need for multilevel interventions to reduce loneliness and CVD risk in at-risk populations.

Circulation, Volume 148, Issue Suppl_1, Page A14087-A14087, November 6, 2023. Background:Physical activity (PA) reduces cardiovascular disease (CVD) risk; those living in lower-resourced neighborhoods have higher CVD risk in part due to limited PA access. Monocyte subsets (classical, intermediate, and non-classical) with their platelet aggregates (PlAgg) are key in CVD, but less is known about relationships between PA and monocytes. We investigated associations between PA and monocyte subsets with PlAgg in African American (AA) women at risk for CVD living in resource-limited Washington, DC areas.Methods:Participants were enrolled in Step It Up, a technology-enabled, community-engaged PA intervention. Baseline PA was measured as daily step counts using a FitBit Charge 2. Monocyte subsets and PlAgg were measured in fasting blood samples by flow cytometry. Multivariable linear regression was used to determine relationships between PA and monocytes adjusting for BMI and ASCVD 10-year risk score. We examined neighborhood deprivation index (NDI), a 2018 Census-tract based measure of neighborhood socioeconomic deprivation, as a moderator of associations between PA and monocytes.Results:The study cohort was a sample of AA women with overweight/obesity enrolled in Step It Up (N=106, age=57±12 y, BMI=34.8±6.3kg/m2). Higher baseline PA associated with monocyte subsets, but not overall monocyte presence (Table). Furthermore, higher baseline PA negatively associated with PlAgg on all monocytes. PA and monocyte subsets were most associated among those residing in higher deprivation neighborhoods (Table).Conclusion:Baseline PA was associated with monocyte subsets and lower monocyte-PlAgg formation among AA women living in lower-resourced conditions. Future work should examine the relationship between PA changes and changes in monocyte subsets in community engaged PA interventions like Step It Up, particularly among those residing in limited resource communities.