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

Circulation, Volume 150, Issue Suppl_1, Page ASu904-ASu904, November 12, 2024. Background:The relationship between base-excess (BE) values, which take into account the time interval from cardiac arrest to blood test, and neurological outcome after out-of-hospital cardiac arrest (OHCA) is not well understood. The purpose of this study was to evaluate the association between BE on arrival at the hospital and neurological outcomes in OHCA patients.Methods:The CRITICAL study, a prospective, multicenter observational study in Osaka, Japan, registered consecutive OHCA patients who were transported to 16 participating critical care centers from 2012 to 2021. We included adult patients aged 18 years with witnessed OHCA whose BE values on hospital arrival was available, and divided patients into quartiles based on BE values of initial blood test on arrival at the hospital: Q1 (BE ≤ −21.1 mmol/L), Q2 (−21.1 < BE ≤ −15.7 mmol/L), Q3 (−15.7 < BE ≤ −10.4 mmol/L), and Q4 (BE > −10.4 mmol/L). The primary outcome was one-month survival with favorable neurological outcome, defined as cerebral performance category scale 1 or 2.Results:A total of 23,854 patients were registered, and 6,066 of them were eligible for analyses. Neurologically favorable outcome was the lowest in the Q1 group (3.2% [49/1,528]), followed by the Q2 (4.7% [70/1,493]), Q3 (9.8% [148/1,515]), and Q4 (23.5% [359/1,530]) group. In the multivariable logistic regression analysis, the adjusted odds ratio of Q1 compared with Q4 for one-month favorable neurological outcome was 0.13 (95% CI 0.090–0.18). The proportion of one-month favorable neurological outcome decreased progressively across decreasing quartiles (p for trend < 0.001). In subgroup analysis, there was an interaction between presence of return of spontaneous circulation (ROSC) before blood test and neurological outcome (p for interaction < 0.001). The neurological outcome worsened as the BE values decreased among those who achieved ROSC before the blood test (p for trend < 0.001), but not in those without ROSC (p for trend = 0.078). There was not a significant interaction between BE values without ROSC before blood test and time from witness to blood test (p for interaction = 0.501).Conclusions:We demonstrated that lower BE values at hospital arrival were associated with worse neurological outcome. The BE values may be one of the effective prognostic indications for neurological outcome, especially in OHCA patients with ROSC before hospital arrival.

Circulation, Volume 150, Issue Suppl_1, Page A4144617-A4144617, November 12, 2024. Introduction:Over the past two decades, treatment advances for atrial fibrillation (AF) and stroke have improved overall survival (OS). However, a significant proportion of the population still faces high mortality, suggesting an uneven distribution of improvements. This study analyzes mortality after stroke in older adults with AF in the United States (US), highlighting disparities and trends.Method:A retrospective analysis was conducted using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, extracting data through ICD-10 code I48, I63.1, I63.2, I63.4, I63.5, I63.8, I63.9, I64, I69.4, to find stroke-related deaths among people diagnosed with AF, aged ≥65 years old from 1999 to 2019. We examined demographic disparities in mortality rates by age, gender, race, geographic region, rural/urban classification, and place of death. Results were reported as age-adjusted mortality rates (AAMR) with 95% confidence intervals (CI). Joinpoint regression assessed trend changes and average annual percentage change (AAPC).Results:Between 1999 and 2019, 398,571 individuals aged 65 and older died from AF and stroke in the US, with an AAMR of 45.6 per 100,000 (95% CI: 45.5-45.8). The AAMR declined from 47.0 in 1999 to 45.7 in 2019. Mortality rates showed disparities: females had a higher AAMR than males (46.4 vs. 43.4), non-Hispanics higher than Hispanics (46.7 vs. 27.9), and Whites higher than Blacks (48.5 vs. 32.8). The West was the most affected region (53.9), while the Northeast was the least affected (42.1). State variations were most pronounced in Vermont and Oregon (84.9 and 78.6) and lowest in Louisiana and Nevada (28.3 and 27.0). Rural areas had higher AAMR than urban areas (51.1 vs. 44.4). Most deaths occurred in inpatient settings (39.3%), followed by nursing homes (32.6%). The age group 85 years and older accounted for the majority of deaths (56.5%).Conclusions:Overall mortality due to stroke and AF has decreased, yet disparities persist. Focused action is needed to mitigate these deaths. Expanding access to healthcare in rural areas and promoting stroke prevention programs are vital for improving survival rates.

Circulation, Volume 150, Issue Suppl_1, Page A4143692-A4143692, November 12, 2024. Hypothesis:Small prospective and dataset-based studies predicted the rates of sudden cardiac death (SCD) are higher in the African American (AA) population as compared to White Americans (WA). However, there is a lack of long-term data over two decades lookingfor racial differences in SCD.Aim:Our study aims to analyze and quantify the racial differences in age-adjusted mortality rates(AAMR) related to SCDs between AA and WA to further explore potential contributing factors, such as socioeconomic status, sex, and varied comorbidity burdens, to these differences.Methods:We analyzed the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database, containing death certificate records for various causes of mortality in the US from 1999 to 2020. We searched the CDC WONDER database for patients, 18-45 years old whose cause of death was SCD corresponding to ICD-10 code; I46.1. We searched for AAMR and stratified patients based on race and gender on a total population of 48668 (41975 WA; 6693 AA). Temporal trends were analyzed by fitting log-linear regression models using the Joinpoint Regression Program.Results:We calculated annual percent change (APC) with 95% confidence intervals (CIs) in AAMR for the line segments linking joint points. The AAMR for SCDs in AA males ranged from 2.1% in 2000 to 0.9% in 2020 with an APC of 0.68 between 1999 and 2009, -26.72 between 2009 and 2012, and 4.34 between 2012 and 2020 suggest that the rate peaked between 2008 and 2010, followed by a significant decline in the following years. WA males had consistently lower rates compared to AA males. The AAMR for WA males peaked at 1.5% in 2000 followed by a stepwise decline until it reached a rate less than 0.9% in 2020, with APCs -1.32 between 1999 and 2009, -19.58 between 2009 and 2012. [Figure A]. AA females had APCs of 2.01, -31.88, and 1.73 while WA females had APCs of -2.32, -21.38, and 0.43 between 1999 and 2009, 2009 and 2012, and 2012 and 2020, respectively [Figure B]. Rates in AA females had a similar progression to that in AA males [Figure C].Conclusion:Racial disparities in SCDs related AAMR in the US suggest the role of a complex interplay between healthcare delivery, underlying pathological processes, and race. AA demonstrated higher age-adjusted SCD rates than WA. These findings should be used to guide policymaking and address areas of unmet need in providing racially equitable healthcare for all patients.

Circulation, Volume 150, Issue Suppl_1, Page A4146424-A4146424, November 12, 2024. The role of genetic ancestry (GA) in hypertensive pregnancy disorders in Latin-American women is poorly understood.Using data from amulti-center case-control study (GenPE) of preeclampsia (PE) in young Colombian women(median age = 19) of predominantly low socioeconomic status (2364 controls and 1811 cases), who identify as Afro-Caribbean (AFR-C), White Hispanic (HISP), Amerindian, and Mixed ethnicity,we evaluated associations between 1) reported ethnicity, and 2) empirically estimated GA, with PE. We performed 3-way admixture mapping using European (EUR), African (AFR) and Amerindian (AMR) ancestry references from the Human Genome Diversity Project using the FLARE software to estimate local and global ancestry in GenPE samples. Statistical significance threshold, for three-way local ancestry analyses, was empirically estimated using STEAM (P = 3.45×10-6).In multivariable logistic regression modelsfor reported ethnicity,AFR-C were 33% more likely to have PE (OR = 1.33; P = 0.02) than HISP women.In models evaluating empirically estimated global GA,AFR was positively associated (OR per 10% increase in ancestry = 1.05; P = 0.002), while AMR (OR = 0.91; P = 0.035) and EUR (OR = 0.95; P = 0.009) were inversely associated with PE. Additionally,adjusting for reported ethnicity in models evaluating global GA and PEchanged estimates only marginally for AFR (OR = 1.04; P = 0.025) and EUR (OR = 0.92; P = 0.009).Evaluation of GA and PE in a subset of women who reported AFR-C ethnicity, showed stronger estimates for all global ancestries: AFR (OR = 1.11; P = 0.013, EUR (OR = 0.82; P = 0.026), and AMR (OR = 0.83; P = 0.01).Association analyses with AFR local GA identified three loci associated with PE.The top locusat chromosome 11, rs2021740 (a smooth muscle enhancer inOTOG1and nearMYOD1), each additional allele of AFR origin associated with 27% increased odds of PE (OR = 1.27; P = 1.13×10-7).The A-allele for this variantis found in greater frequency in AFR reference populations (22%) than in EUR (5%).Subgroup analyses with HELLP syndrome(279 cases and 2364 controls) shows intriguingly opposite findings with increased risk for global AMR and EUR ancestry and decreased risk for AFR ancestry.Using a genetically diverse hispanic population, we showgenetic ancestry is associated with PE independent of reported ethnicityand further demonstrate thepower of admixture mapping to identify a candidate locus for PE.

Circulation, Volume 150, Issue Suppl_1, Page A4146331-A4146331, November 12, 2024. Background:Acute Myocardial Infarction (AMI) in malignancy is a significant cause of mortality globally. This study analyzed demographic trends and disparities in mortality rates due to AMI in malignancy among adults aged 65 and older from 1999 to 2020.Methods:A retrospective analysis was performed using death certificate data from the Centers for Disease Control and Prevention database from 1999 to 2020. The analysis utilized ICD* codes I21 for AMI and C00-C97 for malignancies. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 persons, and trends were assessed using Average Annual Percentage Change (AAPC) and annual percent change (APC). Data were stratified by year, sex, race/ethnicity, and geographical regions.Results:Between 1999 and 2020, AMI in malignancy caused 172,691 deaths among U.S. older adults aged ≥65 years. The majority of deaths occurred in medical facilities (56.9%) and at decedents’ homes (24.2%). The overall AAMR for AMI in malignancy-related deaths decreased from 30.2 in 1999 to 14.2 in 2020, with an AAPC of -3.90 (p < 0.000001). Men showed higher AAMRs than women (28.6 vs. 12.3), with a more pronounced decrease in men (AAPC: -4.22, p < 0.000001) compared to women (AAPC: -3.78, p < 0.000001). Racial disparities were significant, with Black individuals having the highest AAMR (22.7), followed by Whites (19.3), American Indians or Alaska Natives (14.4), Hispanics (12.2), and Asians or Pacific Islanders (10.8). The decline in AAMR throughout the study was most pronounced in Black individuals (AAPC: -4.30, p < 0.000001). Geographically, the highest AAMRs were observed in Arkansas (32.3) and the lowest in Nevada (8.1). The Northeastern U.S. had the highest regional AAMR (20.2), followed by the Midwest (19.9), South (18.3), and West (17.4). Nonmetropolitan areas had higher AAMRs than metropolitan areas, though both saw significant declines from 1999 to 2020 (Metropolitan: AAPC: -3.97, p < 0.000001; Nonmetropolitan: AAPC: -2.64, p < 0.000001).Conclusion:This study reveals significant demographic disparities in mortality rates related to AMI in malignant older adults. These findings emphasize the need for targeted interventions and improved access to care to reduce mortality and enhance outcomes in this vulnerable population.

Circulation, Volume 150, Issue Suppl_1, Page A4145056-A4145056, November 12, 2024. Introduction:Iron deficiency anemia (IDA) affects millions of people with heart failure (HF) and is of a higher proportion in patients admitted for HF than those seen as an outpatient. The cause of IDA in patients with HF is postulated to be related to the chronic inflammatory process that occurs resulting in decreased erythropoiesis. This could also be a side effect of the extensive treatment. The fate of patients admitted for exacerbation of heart failure, especially those with IDA could be fatal. This study uses the NIS HCUP database to assess the outcome of patients admitted from 2016 to 2019 with heart failure and co-existing iron deficiency anemia.Research question/ hypothesis:Patients with HF and co-existing IDA have worse outcomes than those without.Method:We used the NIS HCUP 2016 to 2019 database for the analysis. The primary outcome was inpatient mortality. Secondary outcomes such as mean length of hospitalization (LOS), mean total hospital charges (THC) adjusted for inflation and proportion of complications were computed. Data was analyzed using regression models adjusted for significant, confounding, sociodemographic and comorbid conditions.Discussion/ Results::The total population of hospitalizations for HF from 2016 to 2019 was 1270784 with 6.9% having IDA. A higher proportion of hospitalizations with IDA were women. The mortality from the HF admission was 39350 patients. IDA was associated with lower adjusted odds of inpatient mortality (2.5 vs 3.2%, aOR: 0.75, 95% confidence interval (CI) of 0.68-0.84. However, patients with IDA had significantly longer mean LOS and higher THC compared to patients without IDA. Patients with IDA also had increased adjusted odds or requiring pressors, developing acute kidney failure and respiratory failure.Conclusion::Although IDA did not appear to impact mortality in patients with HF, it was associated with higher inpatient complications and higher healthcare cost utilization. Researchers postulate that limitation of different codes being used when data is recorded could have contributed to the unimpacted mortality. Further studies are needed to decipher other factors. Addressing comorbid IDA in the outpatient setting may significantly decrease the cost associated with hospitalization for HF by decreasing the length of hospitalization and the hospital charges associated with those hospitalizations.

Circulation, Volume 150, Issue Suppl_1, Page A4141762-A4141762, November 12, 2024. Introduction:Chronic heart failure (HF) is linked to elevated serum TNF-α levels and affects multiple signaling pathways in non-cardiomyocytes, such as immune cells, intestinal epithelial cells, lymphatic endothelial cells, vascular cells, and their interactions. The combined dysbiosis of host transcriptomics and gut microbiota concerning altered TNF-α signaling in older adults with HF remains unknown.Methods:We recruited 10 older adults with heart failure (HF) (6 females) and 16 healthy controls (HCs) (10 females) from the Northeastern U.S. Non-fasting peripheral blood and stool samples were collected. Serum TNF-α was assayed using Enzyme-linked Immunosorbent Assay (ELISA) kits. Differentially expressed genes (DEGs) between HF and HCs were investigated using the R package “DESeq2” after aligning the raw blood RNA sequence data to the reference database and undergoing quality control. The QIAGEN Ingenuity Pathway Analysis (IPA) was used to analyze the canonical pathways associated with the DEGs. The 16S rRNA V4 gene regions of stool samples were sequenced and processed using the Mothur 1.42.3 pipeline. The Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) was used to predict the metagenomic functions of different gut microbiota compositions.Results:The mean ages of the HF and HC subjects were 73.50 (SD = 8.33) and 63.19 (SD = 7.75), respectively. HF subjects had significantly higher serum TNF-α levels than HCs (p < 0.05). Among the DEGs, HF subjects had 18 downregulated genes (e.g.,AK5,FAM167A,RGCC, andSARDH) and 3 upregulated genes (SMPD3,TMIGD3, andFRRS1) compared with HCs. TNF signaling (p < 0.01) was one of the significantly different canonical pathways in the DEGs between HF and HCs. HF subjects had significantly enrichedMogibacteriumand diminishedSutterellathan HCs (p < 0.05) and lower P53 signaling pathway activity than HCs (p < 0.05) among the predicted functions in stool samples.Conclusions:By analyzing serum TNF-α, whole transcriptomics, and gut microbiota, we identified higher serum TNF-α, differentially expressed genes (DEGs) and their canonical pathways, and distinct compositions and predicted functions of gut microbiota in older adults with HF compared to healthy controls. These findings suggest that TNF-α signaling may be a potential target for developing precise HF interventions and highlight the need for further large-scale multi-omics analysis in understanding and treating HF.

Circulation, Volume 150, Issue Suppl_1, Page A4143977-A4143977, November 12, 2024. Introduction:Chimeric Antigen Receptor T-cell therapy (CAR-T) has revolutionized the treatment of relapsed refractory multiple myeloma (RRMM) and lymphoma over the past decade. Our objective is to examine the incidence, patterns, and outcomes of cardiac events in patients with RRMM and lymphoma who are receiving CAR-T therapy, utilizing the FDA Adverse Event Reporting System (FAERS) database.Methods:We employed the FDA Adverse Event Reporting System (FAERS) database and the Medical Dictionary for Regulatory Activities (MEDRA) to conduct a retrospective post-marketing pharmacovigilance inquiry. We analyzed the incidence of cardiac events associated with six CAR-T products, namely Idecabtagene vicleucel, Cilitacabtagene autoleucel, Axicabtagene ciloleucel, Tisagenlecleucel, Lisocabtagene maraleucel, and Brexucabtagene autoleucel, since their FDA approval (accessed 05/01/2024). We assessed the cardiotoxicities such as coronary artery disease (CAD), myocardial infarction (MI), arrhythmia, heart failure, and hypotension.Results:A total of 12,949 adverse events, including Axicabtagene ciloleucel (n=6222, 48%), Brexucabtagene autoleucel (n=1127, 8.7%), Tisagenlecleucel (n=3290, 25.4%), Lisocabtagene maraleucel (n=463, 3.5%), Idecabtagene vicleucel (n=722, 5.5%), and Cilitacabtagene autoleucel (n=1125, 8.6%). Of those, 675 cases (5.2% of the total) that were related to cardiac events, regardless of their severity. The cardiotoxicity incidence was highest in Brexucabtagene autoleucel (n=85,7.5%), followed by Idecabtagene vicleucel (n=50,6.9%), Tisagenlecleucel (n=208,6.3%), Axicabtagene ciloleucel (n=278,4.5%), Lisocabtagene maraleucel (n=17,3.6%), and Ciltacabtagene autoleucel (n=37,3.2%).Cytokine release syndrome (CRS) is linked to nearly 440 cardiac events,accounting for 65% of all cardiac events.The most prevalent cardiotoxic event was Atrial Fibrillation (122), followed by the development of heart failure (113), Ventricular arrhythmia (108), hypotension (87), and Brady arrhythmia (41).The recipients of Brexucabtagene autoleucel had the highest mortality rate (n = 26,2.3%), followed by those receiving Tisagenlecleucel (n = 71,2.1%) and Lisocabtagene maraleucel (n = 10,2.1%).Conclusion:The cardiotoxic properties of CAR-T therapy can lead to fatal adverse events. Improving outcomes and preventing mortality in these populations can be achieved through timely monitoring.

Circulation, Volume 150, Issue Suppl_1, Page A4117772-A4117772, November 12, 2024. Background:Aortic valve calcium (AVC) is strongly associated with an increased risk for severe aortic stenosis (AS). The prevalence of AVC increases with age affecting 40-50% of individuals ≥80 years. The impact of age on the progression of AVC and its association with incident AS remains unknown.Methods:Our study included 6,810 participants (52.9% women) free of cardiovascular disease between ages 45 and 84 from the Multi-Ethnic Study of Atherosclerosis. AVC was measured using non-contrast cardiac CT at Visit 1. Progression was calculated as the change in AVC divided by years between CT scans with up to 10 years between scans. Long term incident AS was adjudicated using medical chart review and echocardiogram data from Visit 6 with a median follow up of 16 years. Multivariable adjusted 1) linear regression was used to examine AVC progression and 2) multivariable adjusted Cox proportional hazards ratios (HR) were used to examine the association of AVC with incident AS.Results:The prevalence of AVC >0 was 4.9% among participants 0, the median AVC was 34.1 (IQR 13-1,113) for participants 0 was associated with significantly increased risk of incident AS for both younger (HR 13.37; 95% CI 5.67-31.52) and older participants (HR 10.59, 95% CI 6.77-16.56).Conclusion:We observed a similar progression of AVC for younger versus older persons after adjusting for baseline AVC burden. Additionally, AVC >0 independently conferred at least a ten-fold higher risk for severe AS among both younger and older participants. These findings demonstrate that the AVC progression is primarily associated with baseline AVC burden and that AVC is a strong marker of risk for severe AS for both younger and older persons.

Circulation, Volume 150, Issue Suppl_1, Page A4138722-A4138722, November 12, 2024. Introduction:Multidisciplinary team (MDT) discussions are integral to Transcatheter Aortic Valve Implantation (TAVI) decision making. Large language model (LLM) ubiquity and low-code no-code platforms have enabled clinician lead solution development. Specialised chatbots or ‘agents’ have evolved into multi-agent systems that can personify human collaboration. We assess the performance of an artificial intelligence (AI) multi-agent TAVI MDT.Methods:Four de-identified TAVI cases from two metropolitan Australian hospitals were assessed by a mock human TAVI MDT (h-MDT) and an AI multi-agent TAVI MDT (ai-MDT). The ai-MDT was created with Agentflow within Flowise AITM and had a hierarchical multi-agent architecture suited to complex reasoning required for TAVI MDT simulation (figure). LLM limitations necessitated the ai-MDT rely on imaging reports rather than clinical images. The h-MDT and ai-MDT consisted of similar team members. Outputs from the h-MDT and ai-MDT was adjudicated by a panel of four blinded TAVI doctors that determined if output was human vs AI and assigned a SMIC score (4-12, 4=good, 12=poor) that assessed structure, missing information, incorrect information and clinical utility. Time durations for h-MDT and ai-MDT were recorded.Results:Adjudicators differentiated human vs. AI output 100% of the time and ai-MDT output had better SMIC scores than h-MDT (U-stat 213, p=0.0011). ai-MDT outperformed h-MDT in the domains of structure, missing information and clinical utility but was not statistically different in the incorrect information domain (U-stat 132, p=0.88). The average time for each case in h-MDT was 15 minutes and 45 seconds compared to 97 seconds for ai-MDT.Conclusion:This demonstrates the potential of using LLM based multi-agent systems as a clinical adjunct in highly specialized multidisciplinary clinical meetings. AI responses were superior for structure, clinical utility and missing information and non-inferior for incorrect information compared to humans, which highlights that hallucinations remain an issue with generative AI. Time was saved but image interpretation still requires human input, for now. Cognitive AI continues to require human supervision for implementation.

Circulation, Volume 150, Issue Suppl_1, Page A4141384-A4141384, November 12, 2024. Introduction:Recent transcriptomic and metabolomic studies have suggested heart failure with preserved ejection fraction (HFpEF) myocardium exhibits metabolic insufficiency. Here we integrated targeted gene expression and proteomics to identify which fuel use pathways are likely compromised in HFpEF.Hypothesis:We hypothesize HFpEF has depressed gene/protein/metabolite levels related to metabolism of fatty acids, branched chain amino acids, and anaplerosis.Methods:Myocardial septal biopsies from HFpEF patients and non-failing controls were studied by Western blot for key proteins in fuel metabolism and cross-related to metabolomics (38 HFpEF, 20 control) and bulk RNAseq (41 HFpEF, 24 control). Protein abundance between groups was tested using Welch’s t-test.Results:Protein levels of CPT1 and CPT2 enzymes needed for acylcarnitine formation and rate-limiting for fatty acid metabolism, were similar in HFpEF vs controls. Proteins related to fatty acid uptake (ACSL1, P=0.002) and oxidation (ACAD [ACADM, P=0.02; ACADVL, P=0.009], HADH [HADHA, P

Circulation, Volume 150, Issue Suppl_1, Page A4141571-A4141571, November 12, 2024. Background:Although ambient air pollution exposure has been linked with increased mortality in many cardiovascular or pulmonary diseases, its relationship with pulmonary arterial hypertension (PAH) is still unknown. The present study aims to investigate the association of ambient particulate matter (PM) exposure with pulmonary hemodynamics and long-term survival in patients with PAH in China.Methods:This retrospective multi-center cohort study included 1511 participants who underwent invasive right heart catheterization and were eventually diagnosed with PAH from January 2014 to December 2020. The primary outcome was transplant-free survival from the time of diagnosis. The association of PM2.5and PM10with all-cause death or lung transplantation was assessed by fitting Cox proportional risk models. Generalized linear models were used to examine the relationship between PM exposure and pulmonary hemodynamic severity at baseline. Restricted cubic splines were used to describe exposure-response curves. Mediation analysis with bootstrap method was used to explore whether potential variables mediated the associations.Results:During a median follow-up of 36.7 months, all-cause death or lung transplantation occurred in 149 patients. Per 10 µg/m3increase of PM2.5and PM10were associated with 14.5% and 7.9% increased risk of primary outcomes adjusting for potential confounding variables, respectively. PM2.5and PM10were associated with European Society of Cardiology risk stratification and with pulmonary hemodynamics at baseline, in particular pulmonary vascular resistance (PVR), mean pulmonary artery pressure (mPAP), cardiac index, and mixed venous oxygen saturation (SVO2). Effect of PM may be mediated in part by impaired glucolipid metabolism and inflammation-associated lymphocyte.Conclusions:Particulate matter exposure was associated with disease severity and pulmonary hemodynamics at baseline in patients with PAH, and higher chronic exposure to PM2.5and PM10independently predicted shorter transplant-free survival.

Circulation, Volume 150, Issue Suppl_1, Page A4146540-A4146540, November 12, 2024. Background:Myocarditis is an inflammatory disease of the myocardium associated with numerous adverse outcomes such as arrhythmias, heart failure, cardiac arrest as well as death. Clinical characteristics and mortality outcome data in myocarditis specific to Asian patients is limited.Research Question:To evaluate characteristics and mortality outcome amongst a multi-ethnic cohort of Asian patients diagnosed with myocarditis.Methods:This retrospective, single-center cohort study involved consecutive patients diagnosed with myocarditis between 2010 and 2021 in a tertiary academic center. Patient respective clinical profile, diagnostic results and outcomes were detailed. Categorical variables were compared between mortality groups using the chi-squared test, and continuous variables with t-tests or Mann-Whitney U tests.Results:A total of 203 patients (mean age 41.8, 40.9% female) diagnosed with myocarditis were included in the study. The prevalence of fulminant myocarditis, acute non-fulminant myocarditis and chronic inflammatory cardiomyopathy in this cohort was 31%, 67.2% and 5.5% respectively. Over a mean follow up period of 4.7 years (SD 3.5), the all-cause mortality was 17.7% (36 patients) (p=

Circulation, Volume 150, Issue Suppl_1, Page A4136289-A4136289, November 12, 2024. Background:Aortic valve calcium (AVC) is associated with an increased risk of cardiovascular disease, non-cardiovascular disease such as dementia, and all-cause mortality. Traditional atherosclerotic cardiovascular disease risk factors are associated with both AVC and chronic kidney disease (CKD), but whether there is an association between AVC and CKD is unknown.Objectives:To ascertain whether AVC quantified by cardiac CT scanning is independently associated with the long-term risk of incident CKD among individuals without a previous history of cardiovascular disease.Methods:We examined 6,346 Multi-Ethnic Study of Atherosclerosis (MESA) participants who underwent cardiac CT scanning at Visit 1 (2000-02) and had an eGFR of ≥ 60 mL/min/1.73 m2. AVC was quantified using the Agatston method and categorized as 0, 1-99, and ≥100. Incident CKD was defined as an eGFR < 60 mL/min/1.73 m2accompanied with an at least 40% decline in eGFR from baseline, and/or a diagnosis of CKD and indicators of end stage renal disease extracted from hospital records using the International Classification of Disease (ICD) codes. We performed Kaplan-Meier survival curve analyses along with multivariable Cox proportional hazard regression models, adjusted for age, gender, race/ethnicity, highest level of education and traditional cardiovascular risk factors along with coronary artery calcium (CAC), lipoprotein (a) (Lp[a]), and the APOE-ε4 genotype to examine the association between AVC (categorical and log-transformed) and incident CKD.Results:Participants had a mean age 62.2±10.1 years, 53% were women, and AVC >0 was present in 795 (12%) participants. During a median follow-up time of 16.9 years, 982 (15%) participants developed incident CKD. AVC examined as a continuous variable was associated with a significantly increased risk of developing CKD (per log-unit [AVC+1] HR 1.06 [95% CI: 1.02-1.10];p= 0.005). There was a stepwise increased risk for CKD with higher AVC levels (Figure). Similarly, in the multivariable adjusted Cox models, participants with AVC ≥100 had a higher risk of incident CKD, compared with the AVC=0 group (HR 1.48 [95% CI: 1.15-1.89];p= 0.002). The observed associations remained after further adjusting for CAC score (p= 0.024), Lp (a) (p= 0.004), and the APOE-ε4 genotype (p= 0.004).Conclusions:In a multi-ethnic cohort of participants free of CKD at baseline, AVC was independently associated with a higher risk of incident CKD.

Circulation, Volume 150, Issue Suppl_1, Page A4144108-A4144108, November 12, 2024. Background:The CHA2DS2-VASc risk score is a clinical tool for stroke prediction. It is mainly used in patients with atrial fibrillation (AF) but is also applied to the non-AF population. We previously reported that artificial intelligence (AI)-enabled left atrial (LA) volumetry from coronary artery calcium (CAC) scans (AI-CAC) predicts AF as early as one year and outperformed CHARGE-AF and NT-proBNP. In this report, we compare AI-CAC LA volumetry to the CHA2DS2-VASc risk score and evaluate the incremental value of incorporating AI-CAC LA volume to CHA2DS2-VASc for incident stroke prediction in the non-AF population.Methods:We applied the AutoChamberTMLA volumetry component of AI-CAC to CAC scans of 5830 people without AF (52.2% women, age 61.7±10.2 years) enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA) baseline (2000-2002). We used the 15-year outcomes data for incident stroke (ischemic and hemorrhagic) and assessed discrimination using the time-dependent area under the curve (AUC) between AI-CAC LA volume vs. CHA2DS2-VASc risk score. Notably, the CHA2DS2-VASc score in this non-AF population ranges from 0 to 5, whereas in the AF population it typically ranges from 0 to 9 points.Results:252 cases of stroke accrued over 15 years. The median and mean ± SD of CHA2DS2-VASc score at baseline were 1.0 and 1.58 ± 1.15, respectively. The cumulative incidence of stroke for the 95thpercentile of AI-CAC LA volume (n=291) vs. CHA2DS2-VASc 4 or 5 points (n=364) was 13.0% and 13.7%, respectively. AI-CAC LA volume significantly improved the AUC of CHA2DS2-VASc for stroke prediction at 2-year follow-up (0.76 for CHA2DS2-VASc vs. 0.81 for CHA2DS2-VASc plus LA volume, p=0.03), 5-year follow-up (0.73 vs. 0.77, p=0.01), 10-year follow-up (0.70 vs. 0.75, p

Circulation, Volume 150, Issue Suppl_1, Page A4139238-A4139238, November 12, 2024. Intro:Myocarditis is an inflammatory cardiac condition that may progress to dilated (DCM) or arrhythmic (ACM) cardiomyopathy. Prior cohort studies indicate genetic factors significantly influence myocarditis susceptibility and outcomes; yet, this has not been studied at a population level, which holds potential for clinical risk prediction.Objective:To investigate DCM and ACM gene variant burden and clinical consequences by a multi-population approach encompassing diverse genetic ancestries.Methods:Individuals with exome sequencing (ES) in UKBB and AoU were included, and poor-quality samples excluded. Individuals with myocarditis were identified by ICD code and compared with myocarditis-neg population. Cardiomyopathy (CM) genes in ClinGen DCM- and ARVC-associated genes with at least moderate evidence of disease causality were included and filtered by our previously published variant pipeline and ClinVar 2* criteria for pathogenic/likely pathogenic (P/LP). Cardiac phenotype and CM variant burden were analyzed by chi-squared analysis.Results:200,580 individuals in UKBB and 230,013 in AoU had ES. 137 in UKBB and 284 in AoU had myocarditis. Myocarditis cohorts in both populations had increased phenotypic burden of CM, ventricular arrhythmia, and HF vs myocarditis-neg. Myocarditis-pos showed increased CM (16.8% vs 0.2%); VA (10.9% vs 0.9%) and HF (32.8% vs 3.1%) in UKBB (p