Risultati per: Short Acting Opioid

Circulation, Volume 150, Issue Suppl_1, Page A4145682-A4145682, November 12, 2024. Background:Heart transplantation (HTx) is a life-saving procedure for patients with end-stage heart disease. Sarcoid myocarditis (SM) is a rare condition characterized by granulomatous inflammation of the myocardium. The mainstay of therapy is immunosuppression but the incidence of cardiac sarcoidosis leading to advanced heart failure is increasing. HTx is a valid option in such cases however post-HTx outcomes in sarcoid population have been poorly investigated.Methods:A retrospective analysis of the National Inpatient Sample (NIS) from 2016 to 2021 was conducted. Outcomes compared between sarcoid and non-sarcoid HTx groups were mortality, length of stay (LOS), hospital charges, transplant rejection and graft failure. Mann-Whitney U test was utilized to compare differences between non-parametric variables, while multivariable logistic regression was applied to adjust for confounders.Results:During our study period a total of 17,635 patients underwent HTx out of which 235 (0.013%) had HTx due to sarcoid myocarditis. Multivariable analysis revealed a comparable mortality between sarcoid and non-sarcoid HTx (Adjusted Mortality: aOR 1.35; CI 0.40-4.56; p=0.61). Median length of stay in sarcoid myocarditis group was 29[IQR19-55] vs 28[IQR16-50] p=0.57. Total hospitalization charges were also comparable 956,893[IQR 649,498-1,451,199] vs 800,898[IQR 533,047-1,349,074], p=0.18. There was no significant increase in transplant rejection (aOR 1.43; CI 0.64-3.20; p=0.37) or graft failure (aOR 1.92; CI 0.55- 6.70; p=0.30) in the sarcoid myocarditis group (Table 1, Table 2).Conclusion:Sarcoid myocarditis patients undergoing HTx showed comparable mortality, LOS, total hospital charges, transplant rejection, or graft failure rates to patients undergoing HTx for other causes.While these findings suggest that SM, while rare, does not adversely affect transplant outcomes, we strongly advocate for more studies to adjust for limitations.

Circulation, Volume 150, Issue Suppl_1, Page A4144188-A4144188, November 12, 2024. Objectives:Trans-catheter Aortic Valve Replacement (TAVR) is the preferred treatment of choice for improving clinical outcomes in patients with Severe Aortic Stenosis. Studies published in the past in patients undergoing TAVR with cancer have shown a lower risk of short-term mortality but an increased risk of long-term mortality. This study aims to compare short-term (within 30 days) and long-term (3 years) outcomes in patients with and without a diagnosis of cancer.Methods:Electronic databases like MEDLINE, PUBMED, and COCHRANE library were thoroughly searched from the date of inception till May2024. 4 observational prospective studies were included in this meta-analysis. Outcomes of interest included short-term mortality (3 year). The results were reported as Risk Ratio (RR) with 95% confidence intervals (CI), using a random effects model.Results:This meta-analysis included 6603 patients from 4 studies. Among those undergoing TAVR, individuals with cancer showed clinically significant reduction in short-term mortality (RR 0.63, 95% CI: 0.43-0.94, p = 0.02) but had higher rate of long-term mortality (RR 1.27, 95% CI: 1.15-1.42, p = 0.00001) compared to those without cancer. Additionally, more major bleeding episodes (RR of 1.17, 95% CI: 1.06- 1.29, p: 0.001) were observed in the cancer group compared to the non-cancer population. No significant difference was noted between the two groups regarding risk of Stroke (RR of 0.98, 95% CI: 0.67- 1.43, p: 0.91), pacemaker (PPM) insertion (RR 1.09, 95% CI: 0.96-1.24, p: 0.20), and Vascular site complications (RR 1.09, 95% CI: 0.95- 1.25, p: 0.20).Conclusion:Our study shows that cancer patients undergoing TAVR have good short-term mortality rates and comparable perioperative outcomes, but higher long-term mortality as compared to those without cancer. More randomized controlled trials are needed to further assess the long-term outcomes in this population.

Circulation, Volume 150, Issue Suppl_1, Page A4146149-A4146149, November 12, 2024. Background:The WHO estimates that air pollution causes 7 million premature deaths or about 1 in 8 global deaths. Epidemiological studies indicate that 60-70% of the premature mortality attributed to air pollution are cardiovascular deaths especially in those with pre-existing conditions such as hypertension and heart failure. The underlying pathophysiological mechanisms by which exposures to air pollution worsen cardiovascular disease are unclear.Hypothesis:We hypothesized that the cardiovascular toxicity of particulate air pollution (PM2.5) exposure would be enhanced in the setting of hypertension.Methods:To test this, we combined air pollution exposure with a hypertension model (angiotensin II, 2.5 mg/kg bwt/day: ANGII osmotic pump) where normotensive and hypertensive male wildtype (WT, C57BL/6J) mice were exposed to filtered air or concentrated ambient PM2.5(CAP) for 3 weeks. To understand how combined hypertension and CAP exposure may alter cardiac remodeling, fibrosis and gene transcription (bulk RNAseq) were quantified.Results:Mice with ANGII-infusion developed hypertension (non-invasive tail cuff) that was significantly elevated by CAP exposure. Hypertensive mice also developed cardiac hypertrophy (heart weight/tibia length ratio, mg/mm) independent of exposure [hypertensive: WT+Air, 9.6±0.4; WT+CAP, 10.3±0.4; normotensive groups: WT+Air, 8.3±0.3; WT+CAP, 7.4±0.1). CAP exposure had no effect on differential gene transcription in normotensive mice, yet CAP exposure significantly induced 996 differentially expressed genes (DEG) in hypertensive mice (332 up, 664 down). Gene Ontogeny (GO) analysis found dysregulated gene clusters ( >40 genes) primarily for cardiac and striated muscle development and differentiation. Increased genes included caspase 12 (Casp12) and catechol-O-methyltransferase (Comt)genes that likely reflect enhanced apoptosis and sympathetic input. Downregulated genes included 2 collagen genes (Col5a3andCol6a3) and death inducer-obliterator 1 (Dido1) — reflecting dysregulated cardiac remodeling.Conclusions:Hypertension enhanced the susceptibility of short-term air pollution exposure to worsen cardiovascular effects especially cardiac remodeling. This study reveals potential genetic mechanisms by which air pollution hastens cardiac dysregulation and promotes heart failure – a serious, globally relevant cardiovascular health risk of particulate air pollution.

Circulation, Volume 150, Issue Suppl_1, Page A4135178-A4135178, November 12, 2024. Background:Tricuspid regurgitation (TR) is no longer considered forgotten. Transcatheter tricuspid valve repair/replacement (TVRR) has become widely accepted as gauged by clinical outcomes. FDA approved two tricuspid valve devices for the purpose of improving quality of life and not necessarily to improve TR severity. We aim to support evidence-based use of TVRR, by summarizing the latest evidence on the clinical effectiveness in terms of post-procedural length of hospital stay, readmissions for heart failure and procedure success if an Intracardiac device is present.Methods:We searched Pubmed, Embase and Cochrane databases and performed a meta-analysis of the included cohort studies using a fixed-effects model. Studies were excluded if they did not present an outcome in each intervention group or did not have enough information required for continuous data comparison. We performed a meta-analysis of hazard ratio (HR) for two outcomes and odds ratio (OR) for one outcome using the random effects model to remove inconsistency and compared the results with fixed effects model. The compared findings of both methods were similar. The variables used for analysis were number of events in exposure group and total amount of events. All data analyses were performed using MedCalc® Statistical Software version 22.023.Results:Of 161 potentially relevant studies, 8 retrospective studies with a total of 1,717 patients were included in the meta-analysis. Procedure (TVRR) success was associated with fewer readmissions for heart failure in all three studies included in the analysis of pooled HR (HR = 0.46, 95% confidence interval [CI]: 0.33 – 0.63, p

Circulation, Volume 150, Issue Suppl_1, Page A4147962-A4147962, November 12, 2024. Introduction:Heart transplants (HT) and left ventricular assist devices (LVADs) are treatment options for advanced heart failure refractory to standard therapy. Historically, LVADs have been used as either destination therapy or a bridge to transplant. However, recent changes to the organ allocation system have deprioritized patients on LVADs as transplant recipients, leading to divisive views on the role of an LVAD. We sought to describe outcomes with each modality, highlighting each option’s strengths and clinical utility.Aim:To assess costs related to index hospitalization, 30-day (30DRC) and 90-day (90DRC) readmission categories for both subgroups.Method:We analyzed the National Readmission Database (NRD) from January 1, 2018, to December 31, 2021, identifying patients with HT and LVAD via ICD-10-CM codes. We selected this recent time frame to limit the influence of older LVAD technology and heart allocation schemes. We excluded patients

Circulation, Volume 150, Issue Suppl_1, Page A4147145-A4147145, November 12, 2024. Introduction:Current guidelines recommend dual antiplatelet therapy (DAPT) for 6 months for stable ischemic heart disease and 12 months for acute coronary syndrome following percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation. However, long-term DAPT is associated with increased bleeding risk.Objective:To compare short DAPT (≤3 months) followed by P2Y12 inhibitor (P2Y12i) monotherapy until 12 months vs. standard DAPT for 12 months in patients undergoing PCI with DES.Methods:We systematically searched PubMed, Scopus, and Cochrane Central databases for studies comparing short DAPT followed by P2Y12i monotherapy vs. 12-month DAPT following PCI. The co-primary outcomes were composite major adverse cardiovascular/cerebrovascular events (MACCE) and net adverse clinical events (NACE; MACCE + bleeding events) at 12 months post-PCI. Secondary outcomes were major and any bleeding, myocardial infarction (MI), stroke, stent thrombosis, all-cause and cardiovascular mortality, and target vessel revascularization (TVR) at 12 months post-PCI.Results:The systematic review identified 8 randomized controlled trials including 39,782 patients (short DAPT n=19,877, 49.96%). MACCE (RR 0.88; 95%CI 0.78-0.98; p=0.023; I2=0%) and NACE (RR 0.75; 95%CI 0.65-0.86; p

Circulation, Volume 150, Issue Suppl_1, Page A4137905-A4137905, November 12, 2024. Background:In out-of-hospital cardiac arrest (OHCA) patients with an initial shockable rhythm, epinephrine increases the likelihood of return of spontaneous circulation (ROSC), but its effect on neurological outcome remains uncertain. Epinephrine administered before extracorporeal resuscitation (ECPR), which is a non-pharmacological method to obtain ROSC, may have worsened neurological outcome.Aim:To evaluate the impact of prehospital epinephrine administration on the prognosis of OHCA patients undergoing ECPR.Methods:This is a retrospective analysis of a cohort study from a multicenter, prospective registry of 81234 OHCA patients between 2014 and 2021. After the application of exclusion criteria, 1061 OHCA patients with an initial shockable rhythm and who underwent ECPR were eligible for this study. The primary outcome was favorable neurological outcome at 30 days after the OHCA and the secondary outcome was ROSC during transfer. Patients who did and did not receive prehospital epinephrine were propensity score-matched on the basis of age, gender, witness arrest, bystander-initiated CPR, dispatcher-assisted CPR, advanced airway management, call-to-defibrillation interval, year and district.Results:Among 1061 eligible patients, 442 patients received epinephrine and 619 patients did not. Matching was successful in achieving covariate balance as shown by a standardized difference of

Circulation, Volume 150, Issue Suppl_1, Page A4146863-A4146863, November 12, 2024. Introduction:The treatment of heart failure (HF) with hydralazine-isosorbide dinitrate (H-ISDN) in African Americans (AA) with New York Heart Association (NYHA) III-IV who remain symptomatic despite optimal medical therapy is a class Ia indication. However, the efficacy of guideline directed medical therapy (GDMT) which combines sodium-glucose cotransporter-2 inhibitors (SGLT2i) and H-ISDN in reducing hospital readmissions has not been well studied.Hypothesis:In self-identified AA adults with advanced heart failure on GDMT including hydralazine-isosorbide dinitrate, the use of a SGLT2i reduces hospitalization for HF.Methods:The patients studied were self-identified AA with advanced HF on GDMT [including any dose of an angiotensin receptor-neprilysin inhibitor (ARNi) or an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin II receptor blocker (ARB), a mineralocorticoid receptor antagonist (MRA), a beta-blocker (BB), H-ISDN, with or without treatment with an SGLT2i]. Data was obtained from the Hospital Corporation of America (HCA) enterprise-wide database from January 2020 to September 2023 using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). The final cohort was divided into two groups: Group 1 consisted of those treated with an ARNi/ACEi/ARB, MRA, a beta blocker, and H-ISDN while Group 2 included those receiving the same combination of medications with the addition of an SGLT2i. Differences in baseline characteristics were analyzed between the two groups. Logistic regression was used to analyze the relationship between the treatment groups and hospital readmission within 90 days.Results:Only 517 AA met inclusion criteria and did not meet exclusion criteria, which included a history of valvular heart disease, hypertrophic or restrictive cardiomyopathy, active myocarditis, history of cardiac arrest, and life-threatening arrhythmias. When controlling for age, gender, diabetes, chronic kidney disease, atrial fibrillation, body mass index, and smoking status, there was no significant difference in the likelihood of 90-day hospital readmission between patients whose GDMT with H-ISDN included an SGLT2i and those whose treatment did not.Conclusions:The results suggest the incorporation of an SGLT2i into GDMT with H-ISDN in AA with advanced HF does not confer additional benefits in the reduction of short-term hospital readmissions for heart failure.

Circulation, Volume 150, Issue Suppl_1, Page A4140779-A4140779, November 12, 2024. Background:Treatment of calcified coronary artery stenosis remains challenging and is associated with worse clinical outcomes. For successful PCI of calcified lesions, it is imperative to achieve sufficient plaque modification before stent implantation.Aims:The aims of the current study were to evaluate coronary microvascular dysfunction and short-term outcomes in heavy calcified coronary lesion underwent PCI with intravascular lithotripsy (IVL) versus rotational atherectomy (RA).Methods:We retrospectively analyzed 91 patients underwent PCI with severely calcified coronary stenosis treated with atherectomy devices. Of these, coronary microvascular function was assessed using temperature-sensor guidewire(PressureWire X, Abott) in 40 patients (IVL: 21, RA: 19) before and after PCI. Procedural success including successful stent delivery with

Circulation, Volume 150, Issue Suppl_1, Page A4146866-A4146866, November 12, 2024. Introduction:Accumulating evidence suggests that cardiovascular disease (CVD) risk is associated with climatic variables and the impact of these factors is likely to be increasing with changes in the global climate. Nevertheless, the underlying physiological mechanisms remain unclear, and it remains unknown whether urban greenspaces could contribute to climatic resilience by mitigating these mechanisms. Moreover, to-date most studies assessing CVD risk consider only ambient temperature, which may not fully capture physiologically relevant thermal conditions. Accordingly, using varied measures of heat, our objective was to assess how short-term heat exposure is related to arterial stiffness, and whether these associations are modified by area greenness.Methods:Adult participants, aged 25-70 years, were recruited from a neighborhood in Louisville, KY during the summer months of 2018 and 2019. Arterial Stiffness was measured by augmentation index (AIX) via pulse wave analysis in 714 participants. We assessed 7 heat metrics, including ambient temperature, dew point temperature, net effective temperature, Heat Index, and Universal Thermal Climate Index (UTCI), calculated as the 24h mean on the day of participants’ visit. Greenness surrounding participants’ homes was assessed by tree canopy within a 500m buffer. Linear regression was used to estimate associations between heat metrics and arterial stiffness, adjusting for socio-demographic and behavioral factors. Subgroup analysis was performed by tertiles of greenness.Results:Participants were predominantly female (61%) and White (77%), with an average age of 49.5 years. The median daily temperature during study visits was 24.4°C (range=12.2 to 28.9°C) and the median daily UTCI was 26.1°C (IQR=5.4°C). The strongest association between heat metrics and AIX was observed for UTCI (2.0% per IQR; 95% CI:0.4, 3.6), followed by net effective temperature (1.8% per IQR; 95% CI: 0.1, 3.6), while dew point temperature had the weakest association (0.6% per IQR; 95% CI: -0.8, 2.0). Stratifying our analysis by tertiles of tree canopy, we observed significant associations between heat metrics and AIX in low canopy areas, with a dose response decrease in associations among medium and high canopy areas.Conclusion:Increased arterial stiffness could be an important contributor to excessive CVD risk associated with physiologically relevant measures of heat exposure, which could be mitigated by surrounding greenspaces.

Circulation, Volume 150, Issue Suppl_1, Page A4139791-A4139791, November 12, 2024. Intro:Drug Development for Heart failure with Preserved Ejection Fraction (HFpEF) is a major challenge facing cardiovascular research due to its complex pathophysiology and existence of comorbidities, leading to recognize distinct HFpEF phenogroups. Animal model development should consider this heterogeneity and each model capturing features of specific phenogroups.Hypothesis:We established a 2-hit model consistent with one of the leading phenogroups, the cardiometabolic and mild hypertension associated HFpEF, by combining a high fat diet to trigger obesity/metabolic syndrome and L-NAME to induce mild hypertension (HFD/L-NAME). We evaluated the presence of HFpEF hallmark and corroborated our data with literature. Empagliflozin (EMPA), the clinical benchmark, was used to confirm the relevance of the model.Methods:To induce obesity/metabolic syndrome, mild and HFpEF, C57BL6N mice were fed HFD (60% Kcal from fat) and water with L-NAME (0.5g/l) for 8 weeks. Control mice (Ctrl) were fed normal chow and water. At 5weeks, mice were randomized based on E/A ratio and ejection fraction and were treated QD for 3weeks with vehicle or EMPA (10mg/kg). Then, treadmill exercise tolerance test was performed, cardiac geometry, systolic and diastolic function were evaluated by echocardiography and heart and lungs were harvested. Longitudinal blood pressure was evaluated by tail cuff.Results:Compared with Ctrl, HFD/L-NAME mice showed cardiac remodeling, preserved systolic function and moderate diastolic dysfunction characterized by inverted or pseudonormal profiles and higher filling pressure (E/A=1.2±0.04 E’/A’=1.1±0.02 E/E’=16.4±0.6 in HFD/L-NAME vs E/A=1.4 ± 0.02 E’/A’=1.3±0.01 E/E’=14.4±0.4 in Ctrl). HFD/L-NAME mice showed altered exercise capacity (p

Introduction
Buprenorphine is a highly effective treatment for opioid use disorder (OUD). However, provider observations and preliminary research suggest that the current standard maintenance dose may be insufficient for suppressing withdrawal and preventing cravings among people who use or have used fentanyl. Buprenorphine dosing guidelines were based on studies among people who use heroin and have not been formally re-evaluated since fentanyl became predominant in the unregulated drug supply. We aim to compare the effectiveness of a high (24 mg) vs standard (16 mg) maintenance daily dose of buprenorphine for improving retention in treatment, decreasing the use of non-prescribed opioids, preventing cravings and reducing opioid overdose risk in patients.

Methods and analysis
Adults who are initiating or continuing buprenorphine for moderate to severe OUD and have a recent history of fentanyl use (n=250) will be recruited at four outpatient substance use treatment clinics in Rhode Island. Patients continuing buprenorphine must be on doses of 16 mg or less and have ongoing fentanyl use to be eligible. Participants will be randomly assigned 1:1 to receive either a high (24 mg) or standard (16 mg) maintenance daily dose, each with usual care, and followed for 12 months to evaluate outcomes. Providers will determine the buprenorphine initiation strategy, with the requirement that participants reach the study maintenance dose within 7 days of randomisation. Providers may adjust the maintenance dose, if clinically needed, for participant safety. The primary study outcome is retention in buprenorphine treatment at 6 months postrandomisation, measured using clinical and statewide administrative data. Other outcomes include non-prescribed opioid use and opioid cravings (secondary), as well as non-fatal or fatal opioid overdose (exploratory).

Ethics and dissemination
This protocol was approved by the Brown Institutional Review Board (STUDY00000075). Results will be presented at conferences and published in peer-reviewed journals.

Trial registration number
NCT06316830.

New England Journal of Medicine, Ahead of Print.

This Viewpoint discusses the spread of medetomidine in the US illicit opioid market and the need for monitoring and a public health response.

Introduction
As the US continues to battle the opioid epidemic, recovery residences remain valuable services for people in recovery. While there is a growing body of literature describing positive outcomes experienced by people who live in recovery residences, little is known about the experience of people who live in these residences while taking medications for an opioid use disorder (MOUD) as part of their recovery. Thus, this study has three aims: (1) expand the availability of recovery residences that meet the National Alliance for Recovery Residences standards in Texas and serve individuals taking medications for an opioid use disorder as part of their recovery; (2) evaluate recovery residences for people taking MOUD as part of their recovery; and (3) compare the cost-effectiveness of recovery residences to treatment-as-usual.

Methods and analysis
In collaboration with community partners, we opened 15 recovery residences in the State of Texas to house people taking MOUD as part of their recovery. We are collecting quantitative and qualitative data to evaluate outcomes at the intrapersonal, interpersonal, organisational and community levels. At the intrapersonal level, we are assessing changes in behavioural and psychosocial constructs using a longitudinal survey, objectively measuring current substance use with a point-of-interview breathalyser and urinalysis, and examining changes in healthcare utilisation using data obtained from a healthcare information exchange. We are collecting interpersonal data using in-depth individual interviews with residents and staff. We are collecting organisational data using field observation and a cost-effectiveness study, and we are collecting community data using neighbourhood mapping.

Ethics and dissemination
The UTHealth institutional review board approved all protocols. We will disseminate study findings via conference presentations, peer-reviewed publications and brief community reports.

This systematic review and meta-analysis examines evidence from 39 studies on hypersensitivity to cold pain among patients with opioid use disorder and its association with indices of opioid tolerance, withdrawal, and abstinence.