Risultati per: Caratterizzazione dell'asma in base all'età di insorgenza: uno studio di coorte multi-database

Circulation, Volume 150, Issue Suppl_1, Page A4144083-A4144083, November 12, 2024. Background:The AI-CVD initiative aims to extract all useful opportunistic screening information from coronary artery calcium (CAC) scans and combines them with traditional risk factors to create a stronger predictor of cardiovascular diseases (CVD). These measurements include cardiac chambers volumes (left atrium (LA), left ventricle (LV), right atrium (RA), right ventricle (RV), and left ventricular mass (LVM)), aortic wall and valvular calcification, aorta and pulmonary artery volumes, torso visceral fat, emphysema score, thoracic bone mineral density, and fatty liver score. We have previously reported that the automated cardiac chambers volumetry component of AI-CVD predicts incident atrial fibrillation (AF), heart failure (HF), and stroke in the Multi-Ethnic Study of Atherosclerosis (MESA). In this report, we examine the contribution of other AI-CVD components for all coronary heart disease (CHD), AF, HF, stroke plus transient ischemic attack (TIA), all-CVD, and all-cause mortality.Methods:We applied AI-CVD to CAC scans of 5830 individuals (52.2% women, age 61.7±10.2 years) without known CVD that were previously obtained for CAC scoring at MESA baseline examination. We used 10-year outcomes data and assessed hazard ratios for AI-CVD components plus CAC score and known CVD risk factors (age, sex, diabetes, smoking, LDL-C, HDL-C, systolic and diastolic blood pressure, hypertension medication). AI-CVD predictors were modeled per standard deviation (SD) increase using Cox proportional hazards regression.Results:Over 10 years of follow-up, 1058 CVD (550 AF, 198 HF, 163 stroke, 389 CHD) and 628 all-cause mortality events accrued with some cases having multiple events. Among AI-CVD components, CAC score and chamber volumes were the strongest predictors of different outcomes. Expectedly, age was the strongest predictor for all outcomes except HF where LV volume and LV mass were stronger predictors than age. Figure 1 shows contribution of each predictor for various outcomes.Conclusion:AI-enabled opportunistic screening of useful information in CAC scans contributes substantially to CVD and total mortality prediction independently of CAC score and CVD risk factors. Further studies are warranted to evaluate the clinical utility of AI-CVD.

Circulation, Volume 150, Issue Suppl_1, Page A4142443-A4142443, November 12, 2024. Introduction:Abdominal aortic aneurysm (AAA) is a significant cause of morbidity and mortality in older adults. The AAA screening guidelines from the Society of Vascular Surgery include risk factors such as sex, age, smoking, and family history. This study explored whether integration of a polygenic risk score (PRS) and proteomics with clinical data could improve AAA prediction in the ARIC Study.Methods:Over a median follow-up of 24 years from ARIC visit 2 (1990-92) baseline, we identified 487 clinical AAA cases among 9,373 ARIC participants (7,397 Whites and 1,976 Blacks) through hospital discharge diagnoses or death certificates. We selected AAA-associated clinical risk factors based on literature and our expertise, including age, gender, race, field center, smoking status, smoking pack-years, waist girth, BMI, levels of total and HDL cholesterols, hypertension, diabetes, and eGFR. We calculated the PRS[WT1] based on SNP dosage in ARIC and the latest genome-wide association study for AAA, which reported 141 independent associations from 14 discovery cohorts (PMID: 37845353). ARIC used SOMAscan v4 to measure 4,955 plasma proteins at baseline, of which 24 were significantly associated with clinical AAA (p < 1x10^-5) independent of the clinical risk factors. The prediction equation for AAA risk was constructed in 3 Cox regression models: 1) clinical risk factors measured at baseline, 2) model 1 variables plus PRS, and 3) model 2 variables plus the 24 AAA-associated proteins identified through proteomics analysis. We used the area under the curve (AUC) to evaluate the prediction performance of these models for AAA risk.Results:Participants in the top quintile of PRS showed significantly higher AAA risk compared to the lowest quintile (HR 1.41, 95% CI: 1.03 – 1.85) after adjustment for clinical risk factors. Adding the PRS to clinical risk factors did not improve the AUC: 0.890 (95% CI: 0.869 - 0.945) in model 1 vs 0.891 (95% CI: 0.853 - 0.961) in model 2. Further adding the 24 AAA-associated proteins substantially improved the performance of the prediction model [AL2] (AUC=0.950, 95% CI: 0.939 - 0.986 in model 3), with 289 AAA events in the top quintile of predicted risk compared to 12 in the lowest quintile.Conclusion:A proteomics-integrated approach that combined clinical risk factors and proteomics data enhanced AAA risk prediction and has the potential to improve risk stratification and early intervention for AAA.

Circulation, Volume 150, Issue Suppl_1, Page A4140798-A4140798, November 12, 2024. Background:The renin angiotensin aldosterone system (RAAS) is crucial for circulatory homeostasis and multiple cardiovascular diseases. Despite research on key RAAS components, resulting in multiple therapeutics, the role of angiotensinogen, the sole substrate, remains less understood. We sought to elucidate the relationship between circulating angiotensinogen levels and single nucleotide polymorphisms (SNPs) in a multi-ethnic cohort study.Methods:Genome-wide association analyses of plasma angiotensinogen levels were conducted in 4,899 MESA participants (self-identified as White, n=1,868; Hispanic, n=1,115; Black, n=1,283; and Chinese, n=633). Plasma angiotensinogen levels were measured at the baseline using an enzyme-linked immunoassay. Linear models were adjusted for age, sex, comorbidities, and sex hormones, along with top principal components to account for population structure. Furthermore, we conducted conditional analysis identifying SNPs meeting genome-wide significance for population-specific associations conditioned on the lead SNP in each race/ethnicity.Results:We identified 115 SNPs associated with angiotensinogen levels (p< 5×10−8), including the lead SNP rs4762 (Thr174Met) in exon 2 (β=-0.159, p=1.51E-100) and SNP rs5050 (A-20C) in the promoter region (β=-0.109, p=2.26E-69) within theAGTgene. Strong Linkage Disequilibrium [LD (r2 >0.8)] was observed between rs4762 and rs35837081 for White, Black, and Hispanic ethnicities. Conversely, this level of LD was noted between rs4762 and rs3789657 specifically within Chinese. The LD between rs4762 and rs5050 was higher for White (r2=0.65), followed by Chinese (r2=0.56), Hispanic (r2=0.55), and Black (r2=0.29). Conditioned on rs4762 in the White population, we identified four secondary signals associated with angiotensinogen including rs2493151 (β=0.053, p=4.08E-9), implicated in transcription factor binding. Measured angiotensinogen levels were 9.7%, 12.8%, and 17.3% lower in Black, Hispanic, and Chinese, respectively, compared to White participants.Conclusions:These findings extend angiotensinogen research, highlighting the SNPs rs4762 and rs5050 as the key variants associated with angiotensinogen levels, both previously linked to hypertension.

Circulation, Volume 150, Issue Suppl_1, Page A4134977-A4134977, November 12, 2024. Introduction:Coronary artery calcium (CAC) scoring is a powerful tool for atherosclerotic cardiovascular disease (ASCVD) risk assessment. Guidelines recommend consideration of CAC scoring in intermediate risk patients, but it’s utility in low and borderline risk patients is less clear.Methods:We used data from 2,894 participants from MESA with low (

Circulation, Volume 150, Issue Suppl_1, Page A4143840-A4143840, November 12, 2024. Introduction:Transthyretin (TTR) dissolution into monomer form and subsequent misfolding causes amyloidosis through deposition of beta-pleated sheets in end organs. Genetic sequence variations can decrease the stability of TTR leading to earlier disease manifestation, a condition known as hereditary TTR amyloidosis (hATTR). The most common variant in the U.S. – V142I, is most prevalent in individuals of African descent. We sought to explore the relationship of V142I and cardiac manifestations of hATTR, using the Million Veteran Program (MVP) dataset.Methods:We identified all V142I carriers in the MVP dataset who had a first visit before January 2008. Carriers were matched with controls at a 1:5 ratio based on age, sex, and race. The outcome studied was development of heart failure (HF)/cardiomyopathy (CM). Cumulative incidence and multivariable Cox proportional hazards regression models were performed to compare V142I carriers with the matched control group.Results:A total of 2,658 V142I carriers (3.1% of veterans of African descent in MVP) and 13,467 matched control patients were included in our final study cohort. Carriers at baseline had a median age of 53 [46-60] years, 87.2% were male, 3.5% had HF, 34.0% had type 2 diabetes mellitus (T2DM), 8.0% had bilateral carpal tunnel syndrome (BCTS), 5.2% had spinal stenosis (SS), and 19.4% had neuropathy. Patients in the control group at baseline had a median age of 53 [46-60] years, 87.2% were male, 3.4% had HF, 33.6% had T2DM, 7.9% had BCTS, 5.0% had SS, and 19.6% had neuropathy. Cumulative incidence of HF/CM at age 70, 80 and 90 years was 23.8%, 48.0%, and 68.8% for cases, and 23.7%, 40.5%, and 56.7% for controls (p=0.006), respectively(Figure).In a multivariable Cox proportional hazards regression model, carrier status was associated with higher incidence of HF/CM – HR of 1.13 (CI: 1.03-1.23, p=0.004). T2DM, hypertension, Charleston comorbidity index and current smoking were also associated with the outcome.Conclusions:We report on higher risk of developing HF/CM in V142I variant carriers compared to controls in the MVP cohort. Further research is needed to determine the most effective diagnostic and treatment approaches in veterans who may be V142I carriers at risk of developing HF/CM.

Circulation, Volume 150, Issue Suppl_1, Page A4144043-A4144043, November 12, 2024. Introduction:Artificial intelligence-powered coronary artery calcium scan (AI-CAC) provides more actionable information than currently reported. We have previously shown in the Multi-Ethnic Study of Atherosclerosis (MESA) that AI-enabled left atrial (LA) volumetry in CAC scans (AI-CAC) enabled prediction of atrial fibrillation (AF) as early as one year. Furthermore, we have shown adding AI-CAC LA volumetry to CHA2DS2-VASc risk score improved stroke prediction in MESA. We have recently reported that AI-CAC left ventricular (LV) volumetry and mass significantly predicted incident heart failure (HF) and outperformed NT-proBNP. In this study, we compared LV volume measured by AI-CAC versus cardiac magnetic resonance (CMR) imaging and NT-proBNP for predicting HF. Additionally, we compared AI-CAC vs. NT-proBNP for detection of left ventricular hypertrophy (LVH) defined by the 95th percentile of CMR LV mass.Methods:We used 15-year outcomes data for incident HF from 3078 asymptomatic MESA participants (52.3% women, age 62.2±10.3 years) who underwent both CAC scans and CMR at the baseline examination. We applied the AutoChamberTM(HeartLung.AI, Houston, TX) component of AI-CAC to 3078 CAC scans.Data on CMR semi-automated LV volume, NT-proBNP, and Agatston CAC score were obtained from MESA. Discrimination was assessed using the time-dependent area under the curve (AUC) for incident HF.Results:Over 15 years of follow up, 133 cases of HF were diagnosed. The AUC for AI-CAC (0.789) and CMR (0.793) were not significantly different (p=0.67) but were significantly higher than NT-proBNP (0.719) and Agatston score (0.664) (p

Circulation, Volume 150, Issue Suppl_1, Page A4141934-A4141934, November 12, 2024. Introduction:Heightened psychosocial stress is a CVD risk factor. While stressors are common and often co-occur, identifying sources and patterns of psychosocial stress exposure may provide insight into individual susceptibility to CVD. Therefore, we sought to identify and examine the longitudinal associations of baseline psychosocial stress subgroups with CVD events in MESA.Methods:Data from 6,349 adults (aged: 62.2±10.2 years; 52.9% women) from the MESA cohort with no prior CVD event at baseline (years 2000-2002) were used in this analysis. Latent class analysis (LCA) was used to specify distinct stress subgroups based on 6 variables: chronic burden, neighborhood safety, adequate food shopping, neighborhood noise, lifetime- and past-year discrimination. Five classes were determined after examining traditional fit indices. Adjudicated fatal and nonfatal CVD events were ascertained in annual follow-up visits through the year 2019. Cox proportional hazards models with sequential adjustment of baseline variables were used to examine the associations between subgroup membership and CVD events.Results:Five distinct stress subgroups were identified via LCA and were labeled “moderate neighborhood noise” (12.1%), “excessive noise/crime” (6.4%), “elevated on all” (6.3%), “high discrimination/safe neighborhood” (21.4%), “optimal” (53.8%) (see figure). By the year 2019, 1,121 participants had experienced a CVD event. Membership in the “elevated on all” and “high discrimination/safe neighborhood” subgroups (see table) were associated with higher risk of a CVD event when adjusted for sociodemographic characteristics and cardiovascular health metrics. However, when adjusted for measures of anxiety and depression, possible mediators, only membership in the “high discrimination/safe neighborhood” subgroup was associated with increased risk of a CVD event.Conclusions:Among 5 distinct stress subgroups those experiencing high discrimination had higher risk for CVD events.

Circulation, Volume 150, Issue Suppl_1, Page A4144064-A4144064, November 12, 2024. Background:The association between low bone mineral density (BMD) and coronary artery calcium (CAC) has been reported before using manual measurement of thoracic BMD. Such manual measurements are time-consuming and subject to operator errors. We therefore used an AI-enabled BMD measurement tool to explore the relationship between CAC and BMD independent of traditional risk factors.Methods:The validation of AutoBMD AI (HeartLung.AI, Houston TX) has been reported previously. We applied AutoBMD to CAC scans of 6043 individuals (53.3% female, age 61.9±10.2 years) from the baseline examination (2000-2002) of MESA. Thoracic BMD was measured in T7-T9 vertebrae. Osteoporosis was defined as a T-Score below -2.5. Cox proportional hazards regression was used to calculate hazard ratios (HR) per unit change for 10-year coronary heart disease (CHD) prediction.Results:Average BMD in men and women were 164.4 ± 45.1 and 163.1 ± 50.0 g/cm3respectively (P=0.3467). Average CAC score for men and women were 223.4 ± 544.0 and 76.2 ± 241.3 cm3respectively (P

Circulation, Volume 150, Issue Suppl_1, Page A4112775-A4112775, November 12, 2024. Aims and Background:Kaposi sarcoma (KS) is a vascular neoplasm caused by human herpesvirus. Despite its significance, there is limited data regarding the causes and mortality factors associated with KS, particularly concerning cardiovascular mortality rates and specific influencing factors.Methods:The Surveillance, Epidemiology, and End Results (SEER) database was used to gather data from 2000 to 2020. The primary endpoint was overall survival, assessed via log-rank analysis and Kaplan-Meier plots. Hazard ratios (HR) with 95% confidence intervals (CIs) were calculated using SAS v9.4, with significance set at p80 years) vs. 0-19 year age group (HR: 2.263; 95% CI: 1.068-4.795; p=0.033), non-Hispanic Black race vs. non-Hispanic White race (HR 1.492; 95% CI: 1.369-1.627; p=0.001), and visceral involvement vs. cutaneous KS (HR 1.709; 95% CI: 1.487-1.963; p=0.001) were factors associated with increased mortality. Females had a slightly lower long-term survival than males (p

Circulation, Volume 150, Issue Suppl_1, Page A4143939-A4143939, November 12, 2024. Introduction:Recent studies using deep learning techniques have demonstrated promising left ventricular ejection fraction (LVEF) assessment from transthoracic echocardiograms (TTEs). However, most prior studies have focused on videos from a single apical view, a technique known to be subject to limitations given the regionality of LV systolic function. We hypothesized that a deep learning model trained to include echocardiographic video clips from multiple views from a large dataset will improve accuracy in LVEF assessment.Methods:We identified all adult TTEs with a clinically reported LVEF at Columbia University between 2019-2024. A view classification model was trained to identify apical 4 and 2-chamber and parasternal long and short-axis views for LVEF assessment. The internal dataset was split into train, validation and test sets to train spatiotemporal convolutional models for each of the 4 views to assess LVEF for each video clip. The median clip-level LVEF within a study was used to derive a study-level LVEF. The model was evaluated on an internal test set and a large external test set, which included all available adult TTEs from Weill Cornell Medical Center since 2011. As benchmark comparison, the previously published EchoNet-Dynamic model was also evaluated on the external test set.Results:The model was trained and validated on 97,566 internal studies, comprising 1,424,265 videos from 60,741 unique patients. The model achieved state of the art performance on the internal test set (16,396 studies), with mean absolute error (MAE) of 3.4% and root mean squared error (RMSE) of 4.6%. Multi-view results were superior to all single-view models. Model showed robust predictions on external test set (179,298 studies), with MAE of 5.6% and RMSE of 7.1% and outperformed EchoNet-Dynamic (Table).Conclusions:We developed a deep learning model trained on multiple echocardiographic views using the largest dataset to date. Our model achieved state-of-the-art accuracy in assessing LVEF with a level of agreement between the AI and cardiologist LVEF assessments comparable to cardiologist interobserver variability. Further studies are underway to study the implementation of these models within clinical systems.

Circulation, Volume 150, Issue Suppl_1, Page A4143707-A4143707, November 12, 2024. Introduction:The population of men and women who are overweight (defined as a BMI 25-29.9 kg/m2) continues to grow at fast pace. The prevalence and prognostic implications of a high coronary artery calcium (CAC) score in this group are poorly defined.Aims:Using a multiethnic cohort of men and women, we compared the ASCVD event-risk at follow up in normal weight, overweight, and obese individuals, overall and further stratified by CAC scores.Methods:Individual-level pooled analysis of participants from MESA, JHS, HNR, and FHS free of ASCVD at baseline and in whom CAC and BMI data were available. Participants with BMI 0, and 22% had CAC≥100 (17% prevalence among individuals with normal weight). The distribution of CAC by BMI categories is presented in the Figure. The incidence of ASCVD events among overweight participants was: 3.8 per 1000 person-years for those with CAC=0, 8.1 for CAC >0 –

Circulation, Volume 150, Issue Suppl_1, Page A4140800-A4140800, November 12, 2024. Introduction:Peripartum cardiomyopathy (PPCM) is the leading cause of late postpartum pregnancy-related death and often precipitates acute heart failure and cardiogenic shock. Limited contemporary data exists on long-term outcomes among PPCM patients who develop cardiogenic shock (PPCM-CS), especially those who require extra-corporeal membrane oxygenation (ECMO).Methods:This retrospective cohort study identified patients with PPCM-CS from January 2012-January 2024, using EHR-based data from academic medical centers across the US (TriNetX, Inc.). The primary outcome was all-cause mortality over a 180-day follow-up period. Secondary outcomes included acute kidney injury (AKI), new-onset atrial fibrillation (AF), ventricular tachycardia/fibrillation (VT/VF), mechanical circulatory support (MCS), and heart transplantation (HT). The outcomes were reported in the overall population and among those requiring ECMO support.Results:We identified 856 females (mean age 36 ± 12 years; 41% White, 41% Black individuals) with PPCM-CS (Table). During a mean follow-up of 144 ± 63 days, all-cause mortality occurred in 17.9%. There were high incidences of AKI (53.7%), AF (19.4%), and VT/VF (29.3%) (Fig 1). 8.1% of patients successfully underwent HT. There was substantial MCS use, with percutaneous ventricular assist device (pVAD) used in 8.7% and intra-aortic balloon pump (IABP) used in 11.0%. Among those requiring ECMO (N=97, 11.3%), there was high all-cause mortality (26.8%). The concomitant use of pVAD and IABP was 14.4% and 15.5%, respectively. 14.4% of ECMO-supported patients underwent successful HT.Conclusion:This study provides insights into long-term clinical outcomes among patients with PPCM-CS, highlights those requiring ECMO support. Further investigation is needed for early disease recognition and to establish optimal utilization of MCS to improve outcomes in PPCM-CS.

Circulation, Volume 150, Issue Suppl_1, Page A4139651-A4139651, November 12, 2024. Background:Despite expert opinion recommending patient-tailored cardiac rehabilitation (CR) after acute aortic dissection, both patient participation in CR and the associated risk factor modification after CR following aortic dissection repair are poorly understood.Objectives:To describe the characteristics of patients referred to CR, as well as the enrollment rate and outcomes of those referred to CR following thoracic aortic dissection.Methods:We reviewed electronic health records of adults (≥18) discharged alive following thoracic aortic dissection surgery across the Mayo Clinic Enterprise (01/01/2020-11/15/2022) with follow-up to 05/15/2024 (IRB #24-001141). Data are presented using summary statistics.Results:During the study period, 85 patients were included (median [IQR] age: 65 [50-75] years; 40% female;Table 1). Across 84% (N=71) who were referred to CR at discharge, 55% (N=39) enrolled. In those patients referred versus not referred to CR, the prevalence of type A dissection (75% vs. 43%), end-organ involvement (27% vs. 0%), and underlying CAD (54% vs. 21%) were greater while current tobacco use (9% vs. 29%) was lower. Of those enrolled at Mayo Clinic (N=16), CR was started 35 (28-65) days following surgery. These patients completed 21 (13-30) CR sessions at an exercise intensity of 59% (50-65%) maximum predicted heart rate. CR was discontinued in 44% (N=7) due to non-cardiac reasons (Table 2). Of the 9 patients who completed CR, general health status (Dartmouth index: 19 [17-21] vs. 26 [22-34]), depressive symptoms (PHQ-9: 1 [0-1] vs. 4 [1-4]), and exercise capacity (6MWT: 214 [196-244] vs. 384 [305-597] meters) improved (Table 2). There were no reported complications or deaths, with stable aortic sizes reported at 18 months.Conclusions:CR improves functional capacity and well-being without complications in patients after thoracic aortic dissection surgery. Further investigation is needed to better assess CR efficacy and usage in this population.

Circulation, Volume 150, Issue Suppl_1, Page A4134911-A4134911, November 12, 2024. Background:There is residual risk of atherosclerotic cardiovascular disease (ASCVD) that remains despite adequate risk factor (RF) control. Coronary artery calcium (CAC) has demonstrated value in ASCVD risk stratification. We evaluated the value of CAC in identifying residual risk of ASCVD events among those with traditional RF control.Methods:Participants without clinical ASCVD were pooled from the Multi-Ethnic Study of Atherosclerosis, Heinz Nixdorf Recall Study, Framingham Heart Study, and Jackson Heart Study. RF control was classified as “guideline-concordant” and “optimal” (Figure 1). Participants were stratified by the number of controlled RFs at baseline and CAC score (CAC = 0, 1-99, ≥100). Cox proportional hazards models examined the association between CAC and incident ASCVD events.Results:The study included 14,780 individuals (mean age 58 years (SD: 11), 54% female, 59% White, 27% Black, 50% CAC = 0). Over a median follow-up of 14.6 years, there were 1,441 incident ASCVD events. The distribution of CAC and ASCVD event incidence is shown in Panel A; 10% of those with 3 optimal RFs and 19% of those with 3 guideline-concordant RFs controlled had CAC >100. The rate of ASCVD events decreased with more RFs controlled and increased with higher CAC. Overall, optimal RF control was associated with lower ASCVD event rates compared to guideline-concordant control. At every level of RF control, CAC >100 was associated with increased HRs for incident ASCVD (Panel B). Those with CAC ≥ 100 and controlled RFs experienced ASCVD rates numerically comparable to or exceeding those with uncontrolled RFs but CAC = 0 (Panel A). Adjusted HR (95% CI) for ASCVD events with CAC >100 compared to CAC = 0 was 5.0 (2.0, 12.9) in optimal RF control and 3.7 (2.6, 5.4) in guideline-concordant RF control.Conclusion:There is significant heterogeneity in residual ASCVD risk among those with optimal or guideline-concordant traditional RF control and CAC can help identify this risk. Irrespective of RF control, a higher CAC burden was associated with increased ASCVD risk. Future studies could use CAC testing to identify those with higher residual ASCVD risk despite effective traditional RF control to target for novel therapies.

Circulation, Volume 150, Issue Suppl_1, Page A4137177-A4137177, November 12, 2024. Background:Arrhythmia is always a concern in oncological treatments. The advent of immune checkpoint inhibitors (ICIs) has revolutionized cancer treatment, enhancing the immune system’s ability to combat malignancies. They are being more frequently used, revealing a range of immune-related adverse events (irAEs). This study aims to investigate the incidence of cardiac arrhythmias in patients receiving Pembrolizumab.Methods:We conducted a retrospective analysis of the FDA Adverse Event Reporting System (FAERS) database, focusing on reports submitted between 2006 to 2024. Cases involving patients treated with ICs were identified, and information related to cardiac arrhythmias was extracted using the Medical Dictionary for Regulatory Activities (MedDRA). Patients ≥ 18 years of age treated with ICIs were included in this study. A disproportionality analysis was conducted to identify arrhythmia events associated with pembrolizumab by comparing it with other immune checkpoint inhibitors (nivolumab, ipilimumab, and atezolizumab) and the entire FAERS database using the reporting odds ratio (ROR) and information component (IC).Results:A comprehensive analysis of 61,236 reported cases of pembrolizumab use revealed a total of 3,901 cases with cardiac complications. Among these, 672 cases (17.22 %) of arrhythmias were reported, with 452 individuals (67.26%) requiring hospitalization and 172 cases (25.59%) resulting in fatalities.Atrial fibrillation emerged as the most prevalent arrhythmia (49.7%). The occurrence of ventricular tachycardia with an ROR of 1.67 (1.18–2.35) and an IC of 0.44 (0.01–1.46) and complete atrio-ventricular block with an ROR of 1.57 (1.19–2.08) and an IC of 0.40 (0.04–1.24) were statistically significant. The reported arrhythmias associated with pembrolizumab are tabulated inTable 1. The majority of events were reported in males, as shown inFigure 1.Conclusion:This research offers significant insights into the connection between ICIs and cardiac arrhythmias, utilizing real-world data from the FAERS database. Healthcare providers should monitor cardiac events in patients receiving ICIs and aim to achieve a balance between anticancer effectiveness and cardiovascular safety. Further investigation is necessary to better understand the underlying mechanisms of arrhythmia and enhance risk stratification strategies for this specific patient group.

Circulation, Volume 150, Issue Suppl_1, Page A4147096-A4147096, November 12, 2024. Introduction:Increased prevalence and incidence of heart failure have resulted in a significant rise in the number of patients progressing to advanced heart failure (AHF). Heart transplantation (HT) has been the gold standard treatment for AHF. However, there is limited long-term data on trends in HT procedures and associated costs.Aim:This study aims to perform a comprehensive analysis to ascertain the trends in the number of HTs and the corresponding costs incurred.Methods:Utilizing the National Readmission Database 2010 to 2021, the study population was identified as new recipients of HT, and their median index admission charges were evaluated. We excluded patients aged < 18 with HT and LVAD during the index hospitalization.Results:We identified 36,379 weighted index hospital admissions from January to December 2010 - 2021. The annual HTs increased from 2,905 to 4,046, and the HT numbers increased by 39.28% (Figure 1). From 2010 to 2017, the HT numbers increased by approximately 11.46%; from 2018 to 2021, the increase was about 19.81%. Concurrently, median index admission costs increased from $146,817 in 2010 to $243,079 in 2021 (Figure 2), with a 65.57% cost increase. Considering patient demographics, 47% had private insurance, and Medicare covered 34%. Most patients were discharged home (48%) or to home with health care services (42%).Conclusion:Over the past 12 years, the total number of HT procedures rose by 39.28%. However, associated costs have surged disproportionately by 65.57% since 2010. A significant increase in OHT procedures from 2018 may be linked to policy changes by the United Network for Organ Sharing(Maitra, Dugger et al., 2023). Escalating costs warrant in-depth evaluation and potential policy revisions to curb healthcare expenses for managing advanced end-stage heart failure.