Risultati per: Trattamento dell’osteoporosi in post-menopausa

Circulation, Volume 146, Issue Suppl_1, Page A10570-A10570, November 8, 2022. Introduction:Mechanisms underlying cardiopulmonary symptoms following SARS-CoV-2 infection (post-acute sequelae of COVID-19 “PASC” or “Long COVID”) remain unclear. The purpose of this study was to elucidate the pathophysiology of PASC using cardiopulmonary exercise testing (CPET), cardiac magnetic resonance imaging (CMR) and ambulatory rhythm monitoring.Methods:We performed CMR, CPET, and ambulatory rhythm monitoring among adults > 1 year after confirmed SARS-CoV-2 infection in the UCSF Long-Term Impact of Infection with Novel Coronavirus cohort (LIINC; NCT04362150) and correlated findings with previously measured biomarkers. We used logistic regression to estimate associations with PASC symptoms and linear regression to estimate differences by symptoms adjusted for confounders.Results:Out of 120 participants, 46 participants (unselected for symptom status) had cardiac testing performed at median 17 months after infection. Median age was 52, 18 (39%) were female, and 6 (13%) were hospitalized for severe acute infection. On CPET (n=39), 13/23 (57%) with symptoms had reduced exercise capacity (peak VO2

Circulation, Volume 146, Issue Suppl_1, Page A13540-A13540, November 8, 2022. Introduction:Benefits of home-based exercise (HBE) interventions in lower extremity peripheral artery disease (PAD) are variable. This post-hoc analysis of the HONOR randomized trial studied characteristics of a home-based exercise intervention associated with greater 6-minute walk improvement in PAD.Methods:HONOR was a multi-centered randomized trial. PAD participants were randomized to either a HBE intervention or usual care for 9 months. The intervention consisted of four weekly in-person visits with an exercise coach followed by 16 telephone coaching calls over the next eight months. Participants were asked to walk for exercise five days/week, wear a Fitbit to monitor activity, upload their Fitbit on the study website, and visit the website at least weekly to view their exercise goals and monitor their progress toward exercise goals. The primary outcome was change in 6-minute walk distance at 9-month follow-up.Results:Of 200 people randomized (age 70 yrs. ±10.4, 52.5% female, 50% Black), 182 (91%) completed nine-month follow-up. Overall, the exercise intervention did not improve 6-minute walk compared to usual care [+5.5 vs. +14.4 m respectively (Mean diff: –8.9 m, 95% CI, –26.0, +8.2 m, P = .31)]. Among the 99 people randomized to HBE, change in 6-minute walk ranged from -239.2-233.7. See table for characteristics associated with greater six-minute walk improvement.Conclusion:In a home-based exercise intervention for PAD, more frequent use of the intervention website and greater exercise sessions/week, but not more time wearing a Fitbit, were associated with greater 6-minute walk improvement. Future home-based exercise interventions for PAD should help patients self-monitor exercise behavior and increase exercise sessions per week.

Circulation, Volume 146, Issue Suppl_1, Page A14979-A14979, November 8, 2022. Introduction:Diabetic patients are more likely to suffer from adverse cardiovascular events such as myocardial infarction (MI) compared to non-diabetics. Angiogenesis is crucial to limiting infarct size. However, this angiogenic response is blunted in patients with diabetes. MicroRNAs (miRNAs) have been shown to affect both physiological and pathological angiogenesis. However, the role of miRNAs in MI-associated angiogenesis in diabetes remains poorly defined. Here, we describe a novel role of miRNA-342-3p in angiogenesis following ischemic injury to the myocardium.Methods:We performed RNA sequencing on cardiac endothelial cells of Ldlr-deficient mice on either chow or high fat sucrose containing (HFSC) diet at 0-, 3-, 7- and 14-days post-MI. Gain and loss of function studies, functional assays, RNA-seq, bioinformatics, RNA-FISH, and light-sheet microscopy were used to ascertain the function and mechanism of this miRNA.Results:miR-342-3p was upregulated in cardiac ECs during the vascular remodeling phase post-MI in chow-fed mice compared to the HFSC-fed group. Overexpression of miR-342-3p promotes the number of endothelial sprouts (140% vs control), cumulative sprout length (311% vs control) and scratch closure (AUC 83% vs control, p

Circulation, Volume 146, Issue Suppl_1, Page A10739-A10739, November 8, 2022. Introduction:Despite increase in the incidence of chronic heart failure (HF) and sudden cardia death (SCD), the current use of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) in Japan is much lower than in Western countries. The HF Indication and SCD Prevention Trial Japan (HINODE) was designed to prospectively assess the rate of mortality, appropriately treated ventricular arrhythmias (VA) and heart failure (HF) for comparison with references from historical landmark trial MADIT-RIT in Japanese patients.Hypothesis:This sub analysis of HINODE evaluates the impact of ICD or CRT implantation in elderly Japanese patients concomitant with higher risk of heart failure.Methods:After treatment decisions following contemporary practice in Japan, patients were prospectively enrolled into four cohorts: (1) ICD (2) CRT with defibrillator (CRT-D) (3) standard medical therapy (‘non-device’) (4) pacing (indicated for CRT; received pacemaker or CRT pacing). We compared the all-cause mortality between elderly and non-elderly patients with elderly defined as age >70 at the time of study enrollment.Results:The HINODE study enrolled 354 patients (191 elderly) followed for 19.6 ± 6.5 months with a minimum of 12 months and an absolute death rate of 11.0%. The estimated survival rate for device recipients (n=239) through 24 months was 86.1% (97.5% LCL: 79.8%) with no significant difference for elderly vs non-elderly patients (HR 1.97, 95%CI: 0.86-4.54). Analysis within cohorts showed increased risk of all-cause mortality for elderly with an ICD compared to non-elderly with an ICD (HR 5.09 95% CI: 1.1-23.6). However, ICD cohort excluding those with CRT-D indication showed no significant difference (HR 3.70, 95% CI: 0.75-18.35). No significant difference showed in other cohorts: CRT-D (HR 1.53 95% CI: 0.34-6.84) or pacing (HR 0.84, 95%CI: 0.2-3.5). Ventricular event free rate in ICD and CRT-D patients also had no difference (HR 0.84 95% CI: 0.31-2.25)Conclusions:Although elderly patients might be associated with higher risk of mortality in general, benefit of device therapy is comparable to non-elderly patients. We might consider device therapy despite age as a standalone risk in contemporary Japanese clinical practice.

Circulation, Volume 146, Issue Suppl_1, Page A14914-A14914, November 8, 2022. Introduction:While breakthrough SARS-CoV-2 infections were expected among vaccinated individuals, less is known about the incidence of post-acute SARS-CoV-2 sequelae (PASC) and mortality among vaccinated individuals.Methods:A retrospective analysis of Alabama Health System electronic health record (EHR) data was performed for 4,274 individuals with vaccination, clinical, medical, and mortality information between December 2020 and December 2021. The study population consisted of patients who had documented evidence of vaccination (e.g., two doses of Pfizer-BioNTech, two doses of Moderna, or a single dose of Janssen/Johnson & Johnson vaccines).Results:Out of 4,274 individuals with EHR data in our cohort, 2,177 were female (51%), with a mean age equal to 56 ± 16.2; 1,245 individuals had received one or more doses of a COVID-19 vaccine. There were 640 COVID-19 related deaths, of which were 265 women (41%), 487 (76%) had obesity/overweight, and 133 patients (21%) that had an organ transplant or had a history of cancer. A greater percentage of unvaccinated individuals had documented COVID-19 deaths compared to individuals who were vaccinated (N=57, 5% and 583, 19%, respectively). The odds of mortality were lower among those who were vaccinated, compared to those who were unvaccinated (OR = 0.2, 95% CI = 0.15, 0.27). Sensitivity analyses showed that mortality among vaccinated individuals comprised of 6% (13) of patients with 1 dose, 5% (42) of patients with 2 doses, and

Circulation, Volume 146, Issue Suppl_1, Page A12574-A12574, November 8, 2022. Introduction:African Americans (AAs) have a higher risk for post-PCI ischemic events and worse COVID-19-related events than non-AAs. Race and gender-related post-PCI events before and during the COVID-19 pandemic in a community hospital setup are unknown.Methods:Demographics and one-year post-PCI ischemic event occurrences were compared between AAs and non-AAs undergoing PCI immediately before (2017-2019) and during COVID-19 (2020-2022) in an urban community hospital.Results:In total, 291 and 292 non-AAs and 221 and 219 AAs who underwent PCI before and during the COVID-19 pandemic respectively, were included in the analysis. AAs were younger and had a higher prevalence of diabetes and ACS (p

Circulation, Volume 146, Issue Suppl_1, Page A319-A319, November 8, 2022. Background:Grey-white matter ratio ( GWR) can estimate severity of cerebral edema after cardiac arrest and predict progression to brain death. Current approaches to calculating GWR have variable interrater reliability. We tested if a computational technique to quantify the distribution of whole-brain x-ray attenuation at hospital admission could predict ultimate progression to brain death.Methods:We identified in- and out-of-hospital post-arrest patients at our single center treated between 2018-2019. We extracted demographic data from our registry and Digital Imaging and Communication in Medicine (DICOM) files for the first post-arrest CT. We analyzed the 17th slice of each DICOM, corresponding to the level of the basal ganglia. We extracted the 512×512 array of Hounsfield units (HU). We excluded HU >40 or

Circulation, Volume 146, Issue Suppl_1, Page A13862-A13862, November 8, 2022. Introduction:Transcatheter Aortic Valve Replacement (TAVR) is a mainstay of treatment for aortic valve stenosis for patients. It is unclear if this has resulted in a significant change in post-procedural complications over time.Hypothesis:We hypothesised a reduction in major complication rates across our study period given the improvement in delivery systems.Methods:This is a nationwide temporal trends study utilizing the 2016-2019 National In Patient Sample (NIS) registry. Patients who underwent TAVR including those with major procedural complications (i.e: need for transfusion or permanent pacemaker implantation [PPMI]) were identified. The trends in overall complication rate and individual complication rates between 2016 to 2019 were analysed. Multivariate model was built to predict the factors influencing complications.Results:Between 2016-2019, 217,110 patients underwent TAVR of which 12.6% had atleast one major complication. Proportion of complications decreased significantly across the study period(see Fig 1). Overall, females had a 10% higher complication rate (aOR 1.1, p=0.002) mainly driven by bleeding with over a 50% need for transfusion (aOR 1.57, p3 having over a threefold risk (aOR 3.4, p

Circulation, Volume 146, Issue Suppl_1, Page A13884-A13884, November 8, 2022. Background:Fontan patients have limited exercise capacity primarily due to an absence of subpulmonary ventricle by which ventricular filling is hindered in response to incremental exercise. Little is understood as to how to improve exercise performance in Fontan patients.Methods:Cardiopulmonary exercise testing (CPET) in Fontan patients were studied retrospectively. The patients were divided into “Good” and “Poor” performance by peak oxygen consumption (pVO2) at 35 and 30 ml/kg/min for males and females, respectively. Data are shown as mean ± standard deviation.Results:Table 1 presents demographic data and CPET results of males and females with “Good” and “Poor” exercise performance (total 36 patients). Ventilatory anaerobic threshold (VAT) and peak work rate (pWR) were significantly lower in male “Poor” group than in male “Good” group whereas no significant difference was noted in female groups other than pVO2. A specific trend of each group emerged when weight (kg)-pVO2 (L/min) and maximum minute ventilation (maxVE: L/min)-pVO2 (L/min) relationship were assessed, which indicated that “Good” Fontan had higher skeletal muscle mass effects in given weight and better ventilatory efficiency for oxygenation, respectively, than “Poor” group (Figure 1).Conclusions:Under the same single ventricle physiology which mitigates ventricular filling, some Fontan patients showed better exercise performance than others due to higher skeletal muscle mass effects and better ventilatory efficiency for oxygenation. A simple method of plotting of 2 CPET parameters may be useful in assessing improvement in exercise performance by muscle and breathing training in Fontan patients.

Circulation, Volume 146, Issue Suppl_1, Page A177-A177, November 8, 2022. Objectives:The aim of this study was to investigate the optimal combinations that would enhance prognostic accuracy in post-resuscitation care after out-of-hospital cardiac arrest (OHCA).Methods:Prospectively registry data collected between May 2018 and January 2022 were analyzed. We analyzed the prognostic performance of all single predictors suggested from current guidelines: no ocular reflexes (OR) at 72 h, highly malignant pattern in electroencephalography at ≥ 24 h, neuron-specific enolase (NSE) at 72 h, and diffuse anoxic injury at 72 h on image studies of computed tomography (CT) and diffusion-weighted image (DWI). Gray-to-white matter ratio and high-signal intensity on CT and DWI, respectively, were used as a tool to estimate abnormal findings. We also analyzed the prognostic accuracy of combining strategies using 2 to 3 abnormal results from predictors. All prognostic accuracies were analyzed as sensitivities with false positive ratios (FPR) of < 2%. The primary outcome was poor neurological outcome after 3 months from OHCA.Results:We assessed 119 comatose adult survivors of OHCA, of whom 62 (52.1%) had poor neurological outcomes. The highest sensitivity among single prognostic modalities was found in abnormal DWI, with an FPR of < 2% (86.3%, 95% confidence interval [CI] 73.7 - 94.3). In multimodal assessments, combining NSE and DWI (87.8%, 95% CI 75.2 - 95.4) and combining NSE, OR, and DWI (87.8%, 95% CI 75.2 - 95.4) showed the highest sensitivities in dual and triple combining prognostic strategies, respectively. Combining strategies with image study at 72 h, regardless of whether CT or DWI, improved the sensitivities of every non-imaging study modality.Conclusions:This study emphasizes that combining prognostic strategies for multimodal assessment can enhance prognostic reliability. In particular, this combining strategy, along with the image study at 72 h, can be valuable to ensure the reliability of prognostication in post-resusciation care.1

Circulation, Volume 146, Issue Suppl_1, Page A14838-A14838, November 8, 2022. Introduction:Prosthetic valve endocarditis (PVE) may occur after trans-catheter aortic valve replacement (TAVR), resulting in bio-prosthetic valve dysfunction. We aim to assess the clinical characteristics and long-term outcomes post TAVR.Methods:We performed a systematic literature search in PubMed, Scopus, and Embase for relevant articles from inception until June 01, 2022. Primary outcome was all-cause mortality. Secondary outcomes include acute kidney injury, stroke, systemic embolisation, heart failure and valve re-intervention. All endpoints were pooled using a random-effect model.Results:A total of 33 studies were included, comprising 346,094 patients who underwent TAVR. Amongst the various co-morbidities, most common were diabetes (11%), chronic kidney disease (8%) and chronic obstructive pulmonary disease (COPD) (8%).The pooled incidence of PVE was 1% [95% CI (1%-2%)]. The most common approach was trans-femoral (n=15) (88% [95% CI (79%-95%)]) followed by trans-apical (n=9) (14% [95% CI(10%-18%)]). The most common organisms isolated were staphylococcus species (n=24) (34% [95% CI (30%-38%)]), followed by streptococcal species (n=23) in 23% and enterococcus species (n=22) in 24%. The leading complications reported were acute kidney injury (AKI) (30% [95% CI (19%-44%)]) (n=7), cerebrovascular accident (10% [95% CI (7%-14%)]) (n=13), embolisation (17% [95% CI (10%-26%)]) (n=11) and patients requiring a surgical valve replacement (12% [95% CI (8%-18%)] ) (n=14). The all-cause mortality was 49% [95% CI (41%-56%)], while the in-hospital mortality was 4% [95% CI (2%-9%)].Conclusions:Incidence of IE post TAVR is low (1%), but is associated with a higher rate of mortality (49%) and morbidity. As a result, aggressive management is needed to reduce post-TAVR complications.

Circulation, Volume 146, Issue Suppl_1, Page A211-A211, November 8, 2022. In children resuscitated from cardiac arrest, systemic hypotension occurs frequently and is associated with worse outcome. The first-line vasoactive treatment for post-arrest hypotension is continuous infusion of epinephrine. Epinephrine dose is titrated to maintain normal blood pressure for age. Epinephrine, however, also leads to vasoconstriction which may impair organ perfusion after resuscitation.We hypothesized that epinephrine infusion during the post-resuscitation period restores systemic blood pressure but not flow to vital organs. Using a model of severe pediatric asphyxial cardiac arrest in developing rats, we simultaneously measured blood pressure (ABP) and flow in carotid (Fc) and femoral (Ff) arteries after resuscitation. We then compared the effects of epinephrine or saline infusions on blood pressure vs flow. One hour after resuscitation from 11.5 minutes of asphyxial arrest, ABP, Fc and Ff were 61.73 ± 2.68; 42.58 ± 3.84; and 19.53 ± 7.00 % of baseline. Epinephrine infusion increased ABP in a dose-dependent manner, reaching 95.13 ± 7.93 % of baseline at 0.5 μg/kg/min. Saline infusion at equivalent volumes increased ABP only marginally to 69.88 ± 2.60 % of baseline. In contrast to its effect on ABP, epinephrine infusion increased Fc only to 49.55 ± 6.49 and Ff to 53.28 ± 7.13 % of baseline. Saline infusion at equivalent volumes, on the other hand, had a more salutary effect than epinephrine on improving blood flow (Fc 64.62 ± 6.64 and Ff 60.25 ± 7.60 % of baseline). Notably, a single 10 cc/kg saline bolus, administered when ABP decreased to ~80% of baseline post-ROSC, increased blood flow and ABP to 100% and 90% of baseline, respectively. These data indicate that epinephrine infusion in the post-arrest period adversely affects arterial blood flow despite normalizing arterial blood pressure. Continued fluid resuscitation with crystalloids potentially has beneficial effect on correcting post-ROSC hypoperfusion. Future studies need to explore the impact of targeting flow rather than blood pressure in the post-arrest period and its association to post-arrest end-organ function in children.

Circulation, Volume 146, Issue Suppl_1, Page A11278-A11278, November 8, 2022. Introduction:Post-stroke depression (PSD) is a common neuropsychiatric complication of stroke with a high incidence of 31% and that is associated with poor functional outcomes and increased mortality. Its pathophysiology is poorly understood, however, evidence suggests that neuroinflammation in reaction to the stroke could play a role in the development of PSD.Hypothesis:To compare C-reactive protein (CRP), and homocysteine (Hcy) levels in post-stroke patients with and without depression.Methods:We systematically searched all electronic databases from inception until May 30th 2022 comparing baseline CRP and Hcy.Results:A total of 12 studies with 3,154 Patients were included in this analysis. The mean age of the overall cohort was 64.8 years with PSD patients appearing to be older than non-PSD patients (mean 67.3 years vs 63.8 years). In terms of gender distribution, there were more females in the PSD group compared with non-PSD groups (48.9% vs 40.7%). PSD patients were more likely to be widowed (18% vs 7.25%) and had a family history of psychiatric disorder (10.4% vs 4.4%) compared to non-PSD patients. Patients with PSD had higher levels of baseline CRP [SMD 0.86, (95% CI 0.65 to 1.08), p

Circulation, Volume 146, Issue Suppl_1, Page A10720-A10720, November 8, 2022. Background:Parents of infants with congenital heart disease (CHD) have described substantial stress over infant growth. Poor growth trajectory (GT) during early infancy may be a source of traumatic stress. The purpose of this study was to determine if differences exist in parent posttraumatic stress (PTS) between parents of infants with healthy versus poor GTs from hospital discharge to 4 months post discharge.Methods:This secondary analysis of a previously reported RCT (REACH telehealth trial NCT01941667) included parents of infants with CHD with stress measures at discharge and study end (n=136). Posttraumatic Diagnostic Scale was used to measure PTS. Weights were converted to weight for age Z scores (WAZ) using World Health Organization standards. WAZ-GT classes were identified using latent class growth modeling. We used multivariate logistic regression modeling to examine associations between WAZ-GT and parental PTS over the study period, adjusting for covariates.RESULTSOne-quarter of parents (n=37, 28%) demonstrated at least moderate PTS symptom severity at discharge and one-third at study end (n=40, 31%). We identified four distinct classes of infant WAZ-GT (Figure). Among the identified GTs, two were considered healthy growth patterns: “stable around WAZ=0” (n=51, 37.5%) and “maintaining WAZ > 0” (n=12, 8.8%). Therefore, these two patterns were collapsed to serve as one reference group for the analysis. Two additional WAZ-GT classes were identified that reflected poor growth: “partially-recovered” (n=44, 32.4%) and “never-recovered” (n=29, 21.3%). Parents of infants in the “never recovered” GT were at greater risk (OR=4.58; CI=1.54-13.64) for experiencing at least moderate PTS symptom severity at end of study as well as over time from discharge to end of study (OR=3.91; CI=1.60-9.86).CONCLUSIONResults offer new insights that parents of infants with poor GT are at increased risk for persistent PTS and may need additional screening and intervention.

Circulation, Volume 146, Issue Suppl_1, Page A10754-A10754, November 8, 2022. Background:Acute myocardial infarction (MI) has got revolutionized therapeutic strategy by applying timely reperfusion therapy in a particular increase of primary percutaneous coronary intervention. Despite this cardiac remodeling following MI are very common with high mortality. A previous study claimed that AMPK played a pivotal role in intracellular adaptation to energy stress during myocardial ischemia. However, whether AMPKγ2 subunit played an important role in MI remains poorly defined.Hypothesis:We assessed the hypothesis that AMPKγ2 played an important role in regulating MI.Methods:AMPKγ2 level in monocytes of myocardial infarction patients was tested by ELISA. Ligation of left anterior descending branch (LAD) surgery was conducted to establish MI model. Lyz2-cre AMPKγ2 and AAV carrying F4/80 promoter for macrophage-specific overexpression AMPKγ2 mice were employed to investigate the role of AMPKγ2 in macrophages derived from MI.Results:AMPKγ2 was relatively highly expressed in the spleen and macrophage. Lyz2-cre AMPKγ2 mice developed worse cardiac dysfunction post-MI by boosting macrophage infiltration and inflammation. Overexpression of AMPKγ2 in macrophages repressed its migration and inflammation and alleviated myocardial injury. Mechanistically, CXCL16-CXCR6 axis was the contributor to macrophage migration, which was alleviated by AMPKγ2 via transcriptional regulation. Further, AMPKγ2 restrained YY1 expression, a key upstream transcription factor of CXCL16, to block the migration of macrophages. AMPKγ2 promoted YY1 degradation via smurf2 mediating ubiquitin-proteasome pathway depending on AMPKα1 subunit-mediating AMPK activity. Therefore, A769662 but not Metformin alleviated AMPKγ2 deficiency-induced migration and inflammation in macrophages. Finally, IFN-γ downregulated HOXA5 to repress AMPKγ2 transcriptional activity. Consistently, AMPKγ2 was dramatically declined in monocytes of MI patients compared to the control group.Conclusion:Macrophage AMPKγ2 deficiency played an important role in cardiac dysfunction following MI by activating the YY1-CXCL16-CXCR6 axis, which can be developed as a precision therapeutic target to ameliorate cardiac remodeling post-MI.

Circulation, Volume 146, Issue Suppl_1, Page A15633-A15633, November 8, 2022. Introduction:The prevalence of atrial fibrillation (AF) increases with age. Although catheter ablation is a recommended treatment for AF and is safe and effective in older adults, symptom outcomes post-ablation have not been well studied among older adults. The objective of this study was to investigate differences in the prevalence of symptoms post-ablation and the need for repeat ablation by age group.Methods:From electronic health records, we used International Classification of Diseases billion codes to identify all patients with an admitting diagnosis of paroxysmal AF who were treated at NewYork-Presbyterian Hospital between 2010 and 2020. We then used Current Procedural Terminology Codes to identify patients who underwent catheter ablation. We extracted age, gender, race, ethnicity, and prevalence of repeat ablations using structured queries. We extracted symptoms post-ablation from unstructured clinical notes using natural language processing. We separated patients into five age groups and evaluated associations between demographics, symptoms, repeat ablations and age group using Chi-square tests.Results:Of the 1,414 patients studied, 34.4% were female and 58.6% were white, and 4.1% were Hispanic or Latino. Significantly more female patients were age 61-80, and significantly more non-White participants were age 51-70, compared to other age groups. There was a clinically but not statistically significant difference in the prevalence of repeat ablations by age, with nearly half of those with repeat ablations being age 61-70. There were no significant differences in symptom prevalence 6 and 12 months post-ablation.Conclusion:A greater proportion of female and non-White patients undergoing ablation are older adults compared to younger or much older ( >80 years) patients. There were no differences in repeat post-ablation symptoms by age, suggesting older adults may experience similar symptom reduction following ablations as younger adults.