Risultati per: Long COVID: principali risultati, meccanismi e raccomandazioni

Circulation, Volume 150, Issue Suppl_1, Page A4145413-A4145413, November 12, 2024. Background:Patient, lesion, and procedural characteristics may impact the long-term risks of adverse limb outcomes differently after successful endovascular revascularization for lower extremity peripheral artery disease.Objective:To assess the relationships of patient, lesion, and procedural characteristics to the subsequent risk of major and minor adverse limb events over the decade after successful endovascular revascularization of the superficial femoral artery for chronic limb threatening ischemia (CLTI) or lifestyle limiting claudication.Methods :A retrospective cohort of patients who underwent endovascular revascularization between 2003-2011 were followed for a median of 9.3 (25-75%: 6.8, 11.1) years. Hazard ratios and 95% confidence intervals (HR, 95% CI) from Cox proportional hazards models assessed the risk of major adverse limb events (MALE) or minor revascularization, MALE alone, and minor revascularization alone.Results:There were 232 index limb revascularizations in 185 patients. Longer lesion length was associated with a higher risk of MALE or minor revascularization (HR=2.09, 95% CI=1.22, 3.60) and minor revascularization alone (HR=2.53, 95% CI=1.39, 4.61). Current smoking was linked with minor revascularization (HR=3.83, 95% CI=1.54, 9.56). CLTI was associated with MALE or minor revascularization (HR=1.89, 95% CI=1.09, 3.29), and MALE alone (HR=7.43, 95% CI=3.11, 17.79). Black race/ethnicity (HR=4.74, 95% CI=1.51, 14.9) and low density lipoprotein (LDL) >100 mg/dL (HR=2.76, 95% CI=1.20, 6.35) were linked to MALE alone.ConclusionFactors related to MALE differed from those related to minor revascularization. Lesion length and smoking were linked to minor revascularization, whereas CLTI, Black race/ethnicity and elevated LDL were linked to MALE.

Circulation, Volume 150, Issue Suppl_1, Page A4145229-A4145229, November 12, 2024. Background:Stress-induced cardiomyopathy (CM) is a form of acute transient left ventricular dysfunction triggered by underlying physiological stress which often leads to increased morbidity and mortality. Coronavirus disease 2019 (COVID-19) is thought to cause stress-induced CM due to overwhelming systemic inflammation. There is paucity of data regarding the impact of COVID-19 on in-hospital outcomes of patients with stress-induced CM. The purpose of this study is to investigate in-hospital outcomes, including mortality and cardiogenic shock, of patients with concomitant COVID-19 and stress-induced CM.Methods:We queried the 2020 USA National Inpatient Sample (NIS) Database in conducting this retrospective cohort study. We identified hospitalized adult patients ≥ 18 years old with stress-induced CM and concomitant COVID-19 using ICD-10 CM codes. We used a survey multivariable logistic and linear regression analysis to calculate adjusted odds ratios (aORs) for outcomes of interest. A p value of

Circulation, Volume 150, Issue Suppl_1, Page A4140036-A4140036, November 12, 2024. Background:Heart failure with reduced ejection fraction (HFrEF), defined as a left ventricular ejection fraction (LVEF) of

Circulation, Volume 150, Issue Suppl_1, Page A4118410-A4118410, November 12, 2024. Background:The tilt table test (TTT) serves as a widely adopted diagnostic tool for evaluating syncope of undetermined etiology, with a positive result often indicative of parasympathetic overstimulation. This excessive activation of the parasympathetic system holds the potential to influence QTc measurement not only through rate modulation but also by impacting potassium ionic channels, given that muscarinic activation inwardly rectifies the K+ current.Methods:In this cross-sectional study, 478 patients experiencing syncope of unknown origin underwent evaluation with TTT and 24-hour Holter electrocardiogram monitoring. The Schwartz Score, utilized for diagnosing Long QT syndrome, was computed for all participants. Those with secondary causes of long QT were excluded from the analysis. The association between positive TTT results and Schwartz Score was then examined.Results:A total of 478 patients were enrolled in the study, comprising 208 (43.4%) males and 270 (56.4%) females. The mean age of the patients was 42.43±17.979 years. TTT results were positive in 289 (60.46%) patients and negative in 189 (39.54%) patients. Patients with positive TTT results exhibited a significantly higher mean Schwartz Score compared to those with negative results (2.77±0.08 vs. 1.99±0.12) (P

Circulation, Volume 150, Issue Suppl_1, Page A4118242-A4118242, November 12, 2024. Background:The effect of pregnancy on individuals with Hypertrophic Cardiomyopathy (HCM) is not well investigated.Objective:To assess the impact of pregnancy on all-cause mortality and clinical outcomes among individuals with HCMMethods:Using the TriNetX research network, we identified individuals within reproductive age (≥ 18-45 years)with a diagnosis of HCM between 2012 and 2022 (n=10,936). Patients were stratified based on pregnancy history into two groups (a) those with a history of pregnancy/high-risk pregnancy supervision and (b) those without a history of pregnancy or subsequent antenatal/pregnancy supervision encounters throughout the study period. Propensity-score matching resulted in 3,399 patients in each cohort. The primary outcome was all-cause mortality. Secondary outcomes include a composite of arrhythmic events (SCD and SCD equivalents), major adverse cardiovascular events (MACE), and acute heart failure (HF) exacerbation during 10 years of follow-up.Results:Pregnancy in patients with HCM was associated with a comparable risk of all-cause mortality (adjusted OR:0.89; 95% CI: 0.7-1.14;p=0.37) at 10 years follow-up. MACE and acute HF exacerbation outcomes were lower in the pregnancy group; however, the arrhythmic events (SCD) did not differ between groups (adjusted OR: 0.93, 95%CI: 0.73-1.18;p=0.55).Conclusion:Pregnancy in individuals with HCM was not associated with a higher risk of adverse outcomes at long-term follow-up. Further efforts are warranted to better understand the short-term outcomes in this high-risk population

Circulation, Volume 150, Issue Suppl_1, Page A4141733-A4141733, November 12, 2024. Background:Lipid-lowering therapy (LLT) is a primary means of secondary prevention in patients with acute coronary syndrome (ACS) and the current guidelines recommend maximum tolerated statin and ezetimibe as LLT. Achilles tendon thickening (ATT) is one of the criteria for the diagnosis of familial hypercholesterolemia, which can sometimes be accompanied by ACS. However, the impact of ATT on the prognosis after ACS under the intensive LLT remains unclear.Hypothesis:ACS patients with ATT would have worse prognosis even with receiving intensive LLT.Aims:The aim of the current study was to compare the long-term prognosis of ACS patients with and without ATT.Methods:We retrospectively analyzed 218 patients who underwent successful percutaneous coronary intervention for ACS and received the intensive LLT with maximum tolerated doses of statins and ezetimibe at our hospital from September 2017 to May 2023. Thickness of Achilles tendon was measured on radiography, and ATT was defined as Achilles tendon ≥8.0 mm in males and ≥7.5 mm in females. The cumulative incidence of 5-year major adverse cardiovascular events (MACE), defined as a composite of cardiac death, spontaneous myocardial infarction, target vessel revascularization, and stent thrombosis, was estimated by the log-rank test and was compared between the patients with and without ATT. Hazard ratio (HR) and 95% confidence interval (CI) of ATT for MACE were estimated through a multivariable Cox model.Results:ATT was found in 58 patients (26.6%). The proportion of low-density lipoprotein cholesterol (LDL-C) < 70 mg/dL was significantly lower in patients with ATT (45% vs. 77%, p

Circulation, Volume 150, Issue Suppl_1, Page A4144416-A4144416, November 12, 2024. IntroductionCumulative exposure to LDL-C over time is independently associated with incident atherosclerotic cardiovascular disease (ASCVD), while the absence of coronary artery calcium (CAC) is associated with a low risk of ASCVD events regardless of baseline LDL-C. Whether cumulative LDL-C exposure influences clinical risk stratification in individuals with CAC=0 is unknown.Objectives:To assess whether cumulative LDL-C exposure in young adults with CAC=0 was associated with incident ASCVD events or future conversion to CAC >0.Methods:This analysis included Coronary Artery Risk Development in Young Adults (CARDIA) participants who underwent CAC scans at year 15 (Y15) (n=3043) or Y25 (n=3189) with measures of LDL-C from Y0 (baseline), 2, 5, 7, 10, 15, 20, 25, 30, and 35. Of those with CAC measured at Y15 and Y25, 2734 (89.9%) and 2282 (71.6%) had CAC=0, respectively. Cumulative LDL-C exposure was calculated using area under the curve (LDL-AUC) for three different time intervals: Y0-15, Y0-25, and Y15-25. Univariate and multivariate Cox regression models (adjusted for age, sex, race, and traditional ASCVD risk factors) were used to determine the association of LDL-AUC (per 100 mg/dL x years) with incident fatal and non-fatal ASCVD events with mean follow-up time 19.1 years after Y15 and 9.7 years after Y25. Logistic regression was used to measure the association of LDL-AUC with conversion from CAC=0 to CAC >0.Results:Of those with CAC=0 at Y15 (58% female, mean age 40 years) and Y25 (65% female, mean age 50 years), the event rate was 2.8 and 3.0 per 1000 person-years, respectively. After multivariate adjustment, LDL-AUC[Y0-15]in individuals with CAC=0 at Y15 was not associated with a significant increase in risk for ASCVD events (HR 1.01, 95% CI: 0.97-1.05). LDL-AUC[Y0-25]was associated with a significantly increased risk for ASCVD events after multivariate adjustment in those with persistent CAC=0 at Y25 (HR 1.05, 95% CI: 1.01-1.09). There was a significant association between LDL-AUC[Y15-25]and conversion from CAC=0 at Y15 to CAC >0 at Y25 (OR 1.10, 95% CI: 1.05-1.14).Conclusions:In young adults with CAC=0, long-term cumulative exposure to LDL-C remains independently associated with a significant increase in ASCVD events and development of future CAC. While the risk of cardiovascular events is low for those with CAC=0, risk is detectable over longer exposure to greater cumulative LDL-C, confirming the continued importance of long-term LDL-C control.

Circulation, Volume 150, Issue Suppl_1, Page A4146742-A4146742, November 12, 2024. Objective:Disparities in health outcomes exist between metro and non-metro areas for many medical conditions, but this issue has not been examined within the context of congenital heart disease (CHD). This study aims to determine the association of metro vs. non-metro residence status with long-term survival after congenital heart surgery (CHS).Methods:This retrospective cohort study included patients from the Pediatric Cardiac Care Consortium who had initial CHS between 1990 and 2003. Outcomes were tracked using the National Death Index through 2022. Analysis was restricted to counties where PCCC patients resided. Based on the description of Rural-Urban Continuum Codes (RUCCs), we categorized counties in metro and non-metro areas per the 1993 and 2003 RUCCs, including two subgroups (adjacent to a metro area and not adjacent to a metro area). Kaplan-Meier survival estimates were plotted to compare long-term survival in patients living in metro vs non-metro areas. Comparison of survival length between areas was performed by fitting semiparametric accelerated failure time models with adjustment for covariates.Results:Among 28,504 patients (47.0% female), 19,772 (69.4%) resided in metro areas. Patients living in non-metro areas experienced an absolute lower 30-year survival following discharge post initial CHS vs. patients living in metro areas (86.5 vs. 88.4%, log-rank p=0.015) (Figure) with a 22% reduction in median survival time [adjusted time ratio (aTR): 0.78; 95%CI 0.64-0.94] after adjustment for sex, birth era, CHD severity, and chromosomal abnormality. Additional adjustment for neighborhood socioeconomic status (nSES) attenuated the association’s magnitude (aTR: 0.91; 95% CI: 0.74-1.13). Subgroup analysis indicated that decreased survival time was significant only for those living in non-metro and not adjacent to metro areas (aTR: 0.73; 95% CI: 0.57-0.93).Conclusion:In this large multicenter study, non-metro residency, particularly in areas not adjacent to metro areas, was associated with reduced median survival time, an attenuated effect explained by nSES differences. Targeted interventions are needed to reduce disparities and improve outcomes post-CHS.

Circulation, Volume 150, Issue Suppl_1, Page A4140201-A4140201, November 12, 2024. Introduction:While implantable cardiac defibrillators (ICD) decrease sudden cardiac death, disparities in ICD use remain. The COVID-19 pandemic created strains on the US healthcare system that may have exacerbated these disparities.Methods:Using the US NCDR registry of primary and secondary prevention ICD implants, we compared sex, racial and ethnic disparities for 239,014 patients, aged 19-90 years, grouped into three time intervals from 2016 to 2022: Pre-COVID, COVID and Post-COVID. Centers without consistent reporting were excluded, as were patients with incomplete sex, race or ethnicity data. ICD implantation rates were compared using a Poisson regression model with interaction tests for sex, race and ethnicity by time window to see if disparities changed within this period. Implant rates by indication were also assessed.Results:Overall ICD implants decreased over the study period (Figure 1) with an average monthly rate of 3271 in the first three months of 2016 declining to 2334 in the last three months of 2022 (p=0.017). Disparities in ICD implantation for women, racial and ethnic minorities were observed pre-COVID and persisted (Table 1). Average ICD implant rates during these time periods varied by race with predominance in White patients. While gaps in ICD implant persisted, the disparities did not worsen during COVID-19 by sex, race or ethnicity (p-value for interactions were 0.79; 0.47; and 0.095, respectively). There was a more significant decrease in primary prevention ICD compared to secondary prevention ICD (p

Circulation, Volume 150, Issue Suppl_1, Page A4144649-A4144649, November 12, 2024. Introduction:Tricuspid regurgitation (TR) can have detrimental effects on heart failure (HF) patients clinically, and there is growing evidence supporting this association. We aim to study the impact of the severity of TR on the long-term outcomes in patients with HF.Methods:We systematically screened PubMed, SCOPUS, and Google Scholar databases up to May 2024 using appropriate keywords. The outcomes studied included 1-year mortality, 2-year mortality, HF hospitalizations, cardiovascular deaths, and composite events (HF hospitalization and mortality). The majority of studies included Journal of the American Society of Echocardiography 2017 guidelines to assess the severity of TR. Pooled odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using a binary random effects model. Heterogeneity was assessed using I2 statistics, and a leave-one-out analysis was performed. A p-value of

Circulation, Volume 150, Issue Suppl_1, Page A4140175-A4140175, November 12, 2024. Background:Heart failure (HF) may coexist with non-cardiac comorbidities. Yet, while relevant, the impact of non-cardiac comorbidities on long-term HF re-hospitalizations (Re-Hosp) is is not well established. Previous studies do not reflect modern HF management, often report just all-cause Re-Hosp, or are based on selected populations from randomizd trials.We investigated the association of non-cardiac comorbidities with long-term Re-Hosp for HFafter discharge for HF in a large, contemporary setting.Methods:Administrative hospital discharge data for HF (primary diagnosis) (Jan 1st 2015-Dec 31st 2019) of all >10 Million residents of Lombardy (Italy); follow up through June 30th 2021. Comorbidities assessed from discharge information and/or administrative codes for chronic diseases. Re-Hosp risk for HF (primary diagnosis) after HF discharge as a function of non-cardiac comorbidities was assessed by Cox proportional-hazard models (age- and sex-adjusted). Kaplan Meier curves for HFRe-Hosp were stratified for number of non-cardiac comorbidities.Results:88,528 consecutive patients received a HF primary discharge; over 42.8±18.3 months of follow-up, 79,533 HF Re-Hosp occurred (32.44/100 patient/year). Risk of HF Re-Hosp increased with increasing number of non-cardiac comorbidities. Adjusted by age, females with >4 comorbidities had a 3.08 (CI 2.73-3.47) greater risk of Re-Hosp compared with females without comorbidities; males with >4 comorbidities had a 2.62 (CI 2.39-2.87) greater risk compared with males without comorbidities. By multivariable analysis, number of comorbidities, age, and male sex, remained significantly associated with Re-Hosp risk (Figs 1, 2).Risk of all-cause death also increased with increasing number of non-cardiac comorbidities, from 1.42 for HF patients with 1-2 comorbidities to 2.20 for HF patients with >4 comorbidities.Also the number of days spent in hospital because of HF after index HF discharge significantly increased with increasing number of non-cardiac comorbidities, from 19.9±19.3 days in patients without non-cardiac comorbidities to 45.4±33.0 days for patients with >4 non-cardiac comorbidities (p

Circulation, Volume 150, Issue Suppl_1, Page A4142393-A4142393, November 12, 2024. Background:Aortic stenosis (AS) and septal hypertrophy are significant causes of left ventricular outflow tract obstruction (LVOTO). When both are present, the severity of LVOTO increases. For symptomatic patients, the treatment involves relieving both sources of obstruction through aortic valve replacement (AVR) and septal myectomy. AVR is associated with symptomatic improvement and better long-term outcomes in valvular causes of LVOTO. However, the long-term outcomes of AVR combined with septal myectomy in patients with coexisting septal hypertrophy and AS are not well studied.Aims:This study aims to assess the long-term outcomes, associated risk factors, and prognostic indicators in patients with left ventricular outflow tract obstruction who underwent aortic valve replacement and concomitant septal myectomy.Methods:We identified a retrospective cohort of 82 patients who underwent aortic valve replacement and concomitant septal myectomy for symptomatic LVOTO at the University of Pennsylvania between 2007 and 2021. We assessed preoperative and postoperative symptoms, electrocardiograms, echocardiograms, operative data, follow-up data, and mortality.Results:The mean age of the cohort was 68.2 ± 15.1 years (range 19 to 88). Of the patients, 52% underwent AVR and concomitant myectomy only, while 48% underwent AVR, myectomy, and additional cardiac procedures. Postoperatively, the mean IVSd/PWd ratio was significantly reduced (Figure 1, p0.05). The survival rates at 5 and 10 years post-operation were 74.6% and 44.8%, respectively. Additional cardiac procedures, alongside AVR and septal myectomy, did not increase mortality. Postoperative NYHA classifications at follow-up were markedly improved (Figure 3).Conclusion:Patients with symptomatic LVOTO who underwent AVR with concomitant septal myectomy have long-term symptomatic improvement. Postoperative arrhythmias are common sequelae but are not associated with increased mortality.

Circulation, Volume 150, Issue Suppl_1, Page A4143150-A4143150, November 12, 2024. Background:The FACTOR-64 study was a randomized controlled trial designed to assess whether routine screening for CAD by coronary computed tomography angiography (CCTA) in high-risk patients with diabetes followed by CCTA-directed therapy would reduce the risk of death and nonfatal coronary outcomes. Results at four years showed a lower revascularization rate (3.1% (14) vs. 8.9% (40), p

Circulation, Volume 150, Issue Suppl_1, Page A4122710-A4122710, November 12, 2024. Cigarette smoking is a significant risk factor for coronary artery disease (CAD). However, evidence regarding on the long-term clinical effects of smoking in the Asian population with chronic total coronary occlusion (CTO) is insufficient. This study aimed to assess the effects of smoking on 5-year (median follow-up period 4.2 ± 1.5 years, interquartile range 4.06-5.0 years) clinical outcomes in patients with CTO lesions who had undergone percutaneous coronary intervention (PCI) or medical treatment (MT). We enrolled 681 consecutive patients with CTO who had undergone diagnostic coronary angiography and subsequent PCI or MT. Patients were categorized into smokers (n = 304) and non-smokers (n = 377). The primary endpoint encompassed major adverse cardiovascular events (MACE), including a composite of all-cause death, myocardial infarction (MI), and revascularization over a 5-year period. Propensity score matching (PSM) analysis was used to adjust for potential baseline confounders. After PSM analysis, two propensity-matched groups (200 pairs, n = 400) were generated, and the baseline characteristics of both groups were balanced. The smokers exhibited a higher cardiovascular risk of MACE (29.5% vs. 18.5%,p= 0.010) and non-target vessel revascularization (17.5 vs. 10.5%,p= 0.044) than those of the non-smokers(Table 1). In a landmark analysis using Kaplan-Meier (KM) curvesat the 1-year, the smokers had significantly higher rate of MACE in early period (up to 1-year) (18.8% and 9.2%, p=0.008) compared with non-smokers(Figure 1). Cox hazard regression analysis by propensity score-adjustedwith , revealed that smoking was independently associated with an increased risk of MACE. The findings indicate that smoking is a strong cardiovascular risk factor in patients with CTO, regardless of treatment strategies (PCI or MT) (Figure 2). In addition, in a subgroup analysis, the risk of MACE was most prominently elevated in the group of smokers who underwent PCI.

Circulation, Volume 150, Issue Suppl_1, Page A4136554-A4136554, November 12, 2024. Background:In 2023, the AHA published the PREVENT equations for estimating atherosclerotic cardiovascular disease (ASCVD) risk in adults aged 30-79 years.Research Questions:In young adults aged 20-39 years, does PREVENT improve risk prediction for 10- and 30-year ASCVD compared with existing risk assessment tools recommended in the current US guidelines (i.e., Pooled Cohort Equations [PCEs] and Pencina et al. equations)?Aims:To compare the performance of PREVENT vs. PCEs in predicting 10-year ASCVD, and PREVENT vs. Pencina equations in predicting 30-year ASCVD in young adults.Methods:We analyzed data from two complementary sources: (1) pooled data from two large cohorts: Coronary Artery Risk Development in Young Adults (CARDIA) and Framingham Heart Study (FHS; including the Offspring, Third Generation, Omni 1, and Omni 2 cohorts), and (2) electronic health records from Kaiser Permanente Southern California (KPSC). We included adults aged 20-39 years without a history of ASCVD at baseline. The outcome was incident ASCVD (defined as myocardial infarction, fatal coronary heart disease, fatal and nonfatal stroke) at 10 or 30 years. Model discrimination (Harrell’s C) and mean calibration (estimated as the ratio of predicted to observed event rates) were calculated for the overall population and stratified by sex and race/ethnicity.Results:We included 7,606 young adults (mean age 29 years, 53% female, 30% Black) from the pooled cohorts, and 284,667 (mean age 32 years, 61% female, 8% Black, 46% Hispanic) from KPSC. When predicting 10-year risk, PREVENT improved discrimination in both the pooled cohort (ΔHarrell’s C=0.052; 95% CI: 0.014, 0.095) and KPSC (ΔHarrell’s C=0.039; 95% CI: 0.028, 0.049) compared with the PCEs. PREVENT had good calibration (mean calibration ranged from 0.77 to 1.54), whereas the PCEs overestimated 10-year risk (mean calibration ranged from 1.99 to 4.82). When predicting 30-year risk, discrimination was similar for PREVENT and Pencina equations, but both algorithms underestimated 30-year risk with PREVENT showing worse calibration (mean calibration 0.61).Conclusion:PREVENT improved 10-year ASCVD risk prediction in young adults compared to the PCEs but underestimated 30-year risk.

Circulation, Volume 150, Issue Suppl_1, Page A4114220-A4114220, November 12, 2024. Background:It is still not well understood whether cardiac injury observed during acute COVID-19 infection extends after recovery from the initial viral infection. The purpose of this study was to determine the incidence of left and right ventricular dysfunction in patients hospitalized with acute COVID-19 and evaluate for cardiac recovery.Methods:A multicenter, retrospective cohort study was conducted. Adult patients were identified by hospitalizations using ICD-10 code U07.1 from March 2020 to October 2021. Patients were included if they had: 1) acute COVID-19 infection confirmed by RT-PCR and 2) a transthoracic echocardiogram (TTE) performed during their hospitalization. Clinical and echocardiographic data were collected and analyzed. Longitudinal TTE parameters were obtained from follow-up studies performed after discharge.Results:A total of 750 patients (mean age 64.3 ± 15.3 years, 60.0% male) were included. The average time to follow-up TTE was 8.7± 7.4 months. 133 patients (17.7%) had new LV dysfunction seen on TTE (Figure 1). LV recovery (defined as normalization of LVEF or improvement of LVEF by >10% from baseline) was observed in 28 of 74 (37.8%) survivors. 9 of 26 patients (34.6%) who had a follow-up TTE