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

Circulation, Volume 150, Issue Suppl_1, Page A4141628-A4141628, November 12, 2024. Introduction:Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality worldwide. Lipid-lowering therapies (LLTs) are a key element to reduce the risk of recurrence of ASCVD events. However, despite concordant guidelines, LLTs are often underused in real-life setting.Research questions:The aim of this study is to describe the use of LLTs and its impact on morbi-mortality in the year following a first ASCVD event.Methods:This retrospective study used the national health data system (SNDS), collecting health insurance claims and hospital discharge data from 99% of the French population. Incident cases in 2021 were identified, corresponding to all adults with a first ASCVD event, based on ICD-10 hospital coding. ASCVD includes coronary artery disease [myocardial infarction, unstable angina or coronary revascularization], cerebrovascular events [ischemic stroke, carotid revascularization] and peripheral artery disease (PAD) requiring artery revascularization. In patients discharged alive from the index event, longitudinal analyses were performed at 1-year from discharge to describe LLT use, occurrence of major ASCVD events and all-cause mortality.Results:In 2021, 195,211 newly diagnosed ASCVD cases were identified among 43,1M adults (mean age: 70.3 (±13.7) yo; 62% of male). The first ASCVD event was myocardial infarction (N=51,614) or ischemic stroke (N=52,865) in 53.5% of incident cases. The remaining 46.5% corresponded mostly to coronary revascularization procedures (N=83,910), followed by PAD (N=26,925). In-hospital mortality was 5.5% (N=10,673). In patients analyzed at 1 year (N=180,875), 16.9% did not receive any LLT. This value rose to 26.7% among patients who had no received LLT prior to the ASCVD event. After a myocardial infarction, patients were more likely to receive LLT (91.9%) compared to after an ischemic stroke (72.9%) or revascularization for PAD (68.0%). Finally, 1-year all-cause mortality was higher in non-LLT compared to LLT patients (20.9% vs 4.0%). Additional data on the recurrence of ASCVD events as a function of LLT use are currently being analyzed and will be presented at the congress.Conclusion:Contrary to recommendations, the underuse of LLTs after a first ASCVD event remains very high, particularly after a stroke. This is associated with a significantly higher mortality at 1 year, justifying the need to reinforce implementation of the guidelines in real life for a better management of residual lipid risk.

Circulation, Volume 150, Issue Suppl_1, Page A4143372-A4143372, November 12, 2024. Background:Cardiogenic shock is associated with significant morbidity and mortality, necessitating a multidisciplinary approach to achieve optimal outcomes.Aims:This study evaluated the impact of a multi-component, multidisciplinary cardiogenic shock program on clinical outcomes.Methods:In 2021, we initiated a cardiogenic shock program incorporating several key components: monthly meetings within the entirety of the heart and vascular service line for patient review and dissemination of protocols and initiatives; formation of a core leadership group comprising representatives from cardiac surgery, heart failure, interventional cardiology, cardiac intensivists, and shock nursing coordinators; implementation of a shock paging system for real-time multidisciplinary discussions; appointment of two nursing coordinators for protocol development, education, and data tracking; development of a temporary MCS quality scorecard; and establishment of a program to transition Impella patients to a stepdown unit for bed optimization. Patient outcomes were compared between the inaugural year and the subsequent year of the shock program.Results:143 patients in cardiogenic shock were activated through our shock paging system during the study period. Patient age averaged 54.5 years. 51.1% of patients were located at our institution and 48.9% were located at an outside hospital upon shock call initiation. The most common etiology for shock was decompensated HF (33.6%), followed by acute MI (25.2%), arrhythmia (14%), and other (27.3%). The majority of patients presented with a SCAI shock stage of C (41.3%), followed by D (25.9%) and E (20.3%). 78.3% of patients received an MCS device as a result of the shock call, with 33.6% receiving an Impella CP, 16.8% receiving an Impella 5.5, 29.4% receiving an IABP, and 27.3% requiring VA ECMO. Prior to the shock team initiation, historical hospital survival rates in cardiogenic shock patients approached 30% at our institution. After initiation of the shock program, survival to hospital discharge improved to 67.8% and 1-year survival was 53.2%. 30-day survival improved in the second year of the program compared to the inaugural year (70.1% vs. 53.6%, p=0.0447).Conclusion:Implementation of a multi-component multidisciplinary shock program facilitates a systematic approach to cardiogenic shock and is associated with improved hospital culture and collaboration and excellent outcomes in a challenging patient subset.

Circulation, Volume 150, Issue Suppl_1, Page A4139353-A4139353, November 12, 2024. Background:Coronary Artery Disease (CAD) in obese population is the most common cause of mortality worldwide. This study examines the variation in cardiovascular mortality rates due to CAD in obese adults aged 25 and above from 1999 to 2020.Methods:We performed a retrospective cohort study using death certificate data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) database from 1999 to 2020. We calculated age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) per 100,000 persons. The information was categorized based on year, gender, ethnicity, and geographic area.Results:Between 1999 and 2020, CAD in obesity accounted for 102,434 deaths among adults (≥25 years) in the United States. Majority of deaths occurred in medical facilities (49.0%), followed by decedents’ homes (36.8%). The overall AAMR for CAD in obesity-related deaths increased from 1.5 in 1999 to 3.3 in 2020, with an AAPC of 3.46 (95% CI: 2.83 to 3.92, p < 0.000001). Men exhibited higher AAMRs compared to women (men: 2.7; women: 1.6), with significant increases for both sex. The increase was more prominent in men (AAPC: 4.34, 95% CI: 3.73 to 4.83, p < 0.000001). Racial/ethnic disparities were evident, with American Indian or Alaska Native individuals having the highest AAMR (2.9), followed by Black or African American (2.4), White (2.3), Hispanic or Latino (1.3), and Asian or Pacific Islander (0.5). All racial groups experienced an increase in AAMR from 1999 to 2020, most pronounced in American Indian or Alaska Native individuals (AAPC: 5.06, 95% CI: 2.90 to 8.64, p < 0.000001). Geographically, AAMRs ranged from 1.0 in Alabama to 4.3 in North Dakota, with the Midwestern region having the highest mortality (AAMR: 2.6). Nonmetropolitan areas exhibited higher AAMRs than metropolitan areas (nonmetropolitan: 2.8; metropolitan: 2.0). (Figure 1)Conclusion:This study highlights significant demographic disparities in mortality rates due to CAD in obesity among adults aged 25 and older. Despite an overall increase in mortality rates, the significant rise in recent years, particularly among certain racial groups and geographical regions, emphasize the need for targeted interventions and equal healthcare access to improve outcomes for affected populations.

Circulation, Volume 150, Issue Suppl_1, Page A4147077-A4147077, November 12, 2024. Background:Tricuspid regurgitation (TR) worsens heart failure symptoms and perpetuates right ventricular failure (RVF). Given the limited efficacy of medicines and high risk of surgical mortality, percutaneous therapeutic options are gaining importance. The TRILUMINATE study reported an 86% reduction in TR severity and 4% mortality rate using Triclip G4 tricuspid transcatheter edge-to-edge repair (T-TEER) system with improvement in health status. Triclip subsequently gained FDA approval for TR on April 2, 2024.Objective:To evaluate reported device and patient related adverse events during early experience with Triclip system for T-TEER.Methods:The events reported for Triclip since it gained FDA approval were extracted from the FDA MAUDE database. Previously published reports, duplicates and events before FDA approval were excluded. Grades of TR at baseline and after T-TEER associated with single leaflet device attachment (SLDA) were compared using Wilcoxon rank sum test.Results:After excluding 14 reports, 45 were included, dating from 04/02/24 to 05/31/24. Of these, 31 (67.4%) featured patient complications, with SLDA being the most frequent (n=24, 53%).(Figure-1) Cause of SLDA was reported in 8 reports.(Figure-2) SLDA led to regression of TR to pre-procedure levels in 10 patients and Polymorphic VT in one patient. Other patient issues included damage to leaflets (n=7, 15.6%) which necessitated surgery in one case and prompted consideration of the same in another. There were 4 reports of clip entrapment in the chordae. Device-related issues included 3 cases of leaks in the steerable guide catheter affecting its ability to hold the column, knotting on the lock line, difficulties with positioning the second clip above the valve, clip reopening beyond the expected 5°, clip opening while locked but staying closed post-deployment, delays in clip delivery, and challengers in guiding catheter positioning. No acute deaths were reported in the MAUDE database within 2 months of device approval.Conclusion:Our research findings summarize the reported adverse events during the early period following FDA approval of Triclip G4 T-TEER system. This provides valuable insights into common failure modes and complications, offering guidance on their optimal utilization. Multiple adverse events can be noted soon after approval of the Triclip, underscoring the importance of good initial training and proctoring.

Circulation, Volume 150, Issue Suppl_1, Page A4146291-A4146291, November 12, 2024. Background:Circulatory diseases represent the primary cause of mortality in the US. Comprehending trends and potential disparities in the prevalence of circulatory conditions, such as angina pectoris (AP), myocardial infarction (MI), hypertension (HTN), and coronary heart disease (CHD), is essential for forming public health strategies.Aim:To investigate trends in the prevalence of circulatory conditions, including AP, MI, HTN, and CHD among US adults from 2019 to 2022.Methods:Prevalence percentages for all available circulatory diseases from the Centers for Disease Control and Prevention’s National Health Interview Survey (NHIS) database were retrieved for patients aged >18 years from 2019 to 2022. Annual Percentage Changes (APCs) along with their respective 95% CIs were calculated using regression analysis with Join point. The data was stratified by year, gender, age, race, nativity, veteran status, social vulnerability, employment status, metropolitan statistical area (MSA) status and census region.Results:Between 2019 and 2022, HTN was steadily the most prevalent, staying relatively constant at 27.0% (95% CI: 26.4, 27.7) in 2019 and 27.2% (95% CI: 26.5, 27.8) in 2022. Males consistently had higher prevalence than females with significant increases noted from 2019 to 2022 (APC: 1.0234). Black or African American had the highest prevalence (34.4% in 2022). The South (30.1% in 2022) and the West (22.5% in 2022) had respectively the highest and lowest rates. The second highest prevalence was seen in CHD increasing from 4.6% (95% CI: 4.3, 4.9) in 2019 to 4.9 (95% CI: 4.7, 5.2) in 2020. Males consistently exhibited a higher prevalence than females, with both genders showing significant increases in recent years (Male APC: 3.1448) (Female APC: 2.0165). For MI, a slight decrease was noted from 3.1% (95% CI:2.9, 3.4) in 2019 to 3.0% (95% CI:2.7, 3.2) in 2022. White individuals exhibited the highest prevalence (3.3% in 2022). AP had the lowest overall prevalence staying relatively consistent (1.7% in 2019 and 1.6% in 2022) (Figure 1).Conclusion:Significant trends (Figure 2) in most common circulatory diseases have been identified. Targeted interventions are imperative, particularly for high-risk demographics such as males, older adults, veterans, and unemployed individuals.

Circulation, Volume 150, Issue Suppl_1, Page A4134249-A4134249, November 12, 2024. Background:Inflammation plays a role in the development of cardiovascular disease (CVD). We have defined various non-cardiovascular and non-cancer conditions, both infectious and non-infectious, with a common basis of inflammation; collectively termed Chronic Inflammatory-Related Disease (ChrIRD). We have previously described that ChrIRD is common, associated with baseline inflammatory marker levels, associated with high mortality, and has a bidirectional association with CVD. The clinical implications of these data require further study.Aims:We hypothesize that many traditional risk factors for CVD are also associated with ChrIRD and that ChrIRD has additional unique risk factors. We also hypothesize that the treatment of traditional CVD risk factors is associated with a decreased likelihood of ChrIRD.Methods:We studied MESA participants free of overt CVD or significant illness at baseline. ChrIRD was determined based on review of ICD codes for hospitalizations and deaths. Incident CVD was adjudicated by review of medical records. We performed proportional hazards regression (time-dependent for CVD) to identify factors associated with a first diagnosis of ChrIRD. All variables were simultaneously entered into the model.Results:Participants (n=6155) had mean age 62±10 years and 47% male gender. ChrIRD was observed in 24% and CVD in 18%; including 8% with both conditions. Participants with a diagnosis of CVD, older age, higher heart rate, higher BMI, current or ever smoking status, higher HDL, higher baseline IL6 and GlycA levels, and NSAID use had increased likelihood of ChrIRD. Whereas those with female sex, higher total cholesterol, and statin use had a decreased likelihood of ChrIRD. Participant race/ethnicity, blood pressure, diabetes status, antihypertensive use, aspirin use, baseline CRP level, and baseline D-dimer level were not associated with ChrIRD. Regression results are summarized in Table 1.Conclusions:ChrIRD shares some risk factors with CVD, while other risk factors are opposite.Better understanding of ChrIRD could eventually lead to improved patient care.

Circulation, Volume 150, Issue Suppl_1, Page A4135861-A4135861, November 12, 2024. Background:Lipoprotein (a) (Lp[a]) is associated with an increased risk of cardiovascular disease and mortality, as well as heart failure and myocardial fibrosis. However, the link between Lp(a) and cardiac remodeling as a pathway to adverse cardiac outcomes remains unknown.Objectives:This study investigated the relationship between Lp(a) levels and longitudinal changes in the left ventricular (LV) remodeling over a decade among individuals without a previous history of cardiovascular disease.Methods:2,366 Multi-Ethnic Study of Atherosclerosis (MESA) participants who underwent cardiac MRI at Visit 1 (2000-02) and Visit 5 (2010-12) and had available Lp(a) at baseline were examined. Lp(a) was analyzed as a continuous and a categorical variable based on quartiles (Q1[38.8 mg/dL]). Multivariable linear regression analysis was used to examine the association of Lp(a) with changes in cardiac MRI measures of LV remodeling (Table).Results:Participants had a mean age 60±9 years and 53% were women. Over 10-year follow-up, LV indexed volumes decreased, while LV indexed mass and mass to volume ratio increased across all the Lp(a) quartiles. However, LV ejection fraction only decreased in the third and fourth Lp(a) quartiles. Lp(a) examined as a continuous variable was associated with an increase in LV end-systolic indexed volume (per log-unit Lp[a]; β 0.32 mL/m2;P= 0.01), LV indexed mass (per log-unit Lp[a]; β 0.38 g/m2;P= 0.02), and a decrease in LV ejection fraction (per log-unit Lp[a]; β -0.29 %;P= 0.02) over 10 years after adjusting for sociodemographic and traditional cardiovascular risk factors (Table). Similarly, the fourth Lp(a) quartile was associated with an increase in LV end-systolic indexed volume (β 1.07 mL/m2;P= 0.01), LV indexed mass (β 1.17 g/m2;P= 0.02) and a decrease in LV ejection fraction (β -1.01 %;P= 0.01) compared to the first Lp(a) quartile after controlling for risk factors. The observed associations remained significant after further adjusting for aortic valve calcium score at Visit 1 (Table- Model 3), and baseline coronary artery calcium score and interim myocardial infarction (Table- Model 4).Conclusions:In a multi-ethnic cohort of participants free of cardiovascular disease at baseline, higher Lp(a) levels were independently associated with an increase in LV end-systolic volume and LV mass as well as a decrease in LV ejection fraction over the span of a decade.

Circulation, Volume 150, Issue Suppl_1, Page A4120687-A4120687, November 12, 2024. Background:There are currently no approved medical therapies for acute fulminant myocarditis (AFM). Janus kinase (JAK) inhibitors target the JAK-STAT signaling pathway, which is crucial in immune activation. We report the first use of ruxolitinib, a JAK inhibitor, for treatment of AFM. Multi-omics single-cell technologies, including RNA-seq, T-/B-cell receptor seq, and CITE-seq, were employed to analyze immune profiles pre- and post-ruxolitinib treatment.Results:A 20-year-old female presented with AFM with cardiogenic shock and was supported by VA-ECMO and impella CP. Endomyocardial biopsy showed lymphocytic myocarditis. The patient received pulsed steroids and was listed for orthotopic heart transplant. Due to deteriorating conditions, ruxolitinib (10 mg BID) was added with immediate improvement in cardiac and inflammatory biomarkers and hemodynamics. ECMO was decannulated on day 6 and impella CP was removed on day 8. Repeat TTE on day 9 showed normalization of cardiac function (LVEF 58%, increased from 10%). She was discharged on ruxolitinib and is doing well in follow-up. Multi-omics single-cell technologies were employed on PBMCs collected at four time points: prior to ruxolitinib treatment (but after treatment with corticosteroids), and post-ruxolitinib treatment on day 5, day 8, and 2-months. At baseline, prior to treatment, scRNA-Seq and CITE-seq analysis revealed upregulated JAK-STAT signaling in pathogenic immune cells such as NK cells, CCR2+/CCR5+/HLA-DR+monocytes and activated T cells. Ruxolitinib treatment significantly decreased these pathogenic immune cells, with inhibition of STAT1/STAT3 signaling. Ruxolitinib also significantly decreased key cytotoxic genes PRF1, GZMB, and TBX21 in T and NK cells. TCR sequencing revealed clonal expansions of activated T cells with high levels of pro-inflammatory genes (IL2/IL6/IFNg) at baseline which were dramatically reduced post-treatment with ruxolitinib. Longitudinal data indicated normalization of naive T and B cell levels and clonal diversity, mirroring her clinical improvement.Conclusions:Ruxolitinib significantly modulates immune profiles and disrupts pathogenic signaling in AFM. This first reported use of ruxolitinib in AFM, coupled with our multi-omics analysis, highlights profound immune reprogramming and supports targeted immune modulation for rapid recovery, underscoring ruxolitinib’s therapeutic efficacy.

Circulation, Volume 150, Issue Suppl_1, Page A4148026-A4148026, November 12, 2024. Introduction:Multi-venous compression syndromes pose diagnostic and management dilemmas due to uncertainties in both etiology and clinical course. Clinical thresholds for surgical intervention are unclear, and systemic symptoms beyond the anatomic sites of compression are common, including exertional dyspnea, intermittent tachycardia, and fatigue. We hypothesize that multi-venous compression syndromes may represent a manifestation of autonomic dysfunction with impaired venous return to the right heart (preload failure physiology).Methods:Consecutive patients presenting to the Vascular Medicine clinic, Vascular Surgery clinic, or the vascular ultrasound laboratory at Brigham and Women’s Hospital from November 1, 2021 to May 1, 2024 with evidence of multi-vein compressions were retrospectively included in this cohort. Venous compressions evaluated were thoracic outlet syndrome, popliteal entrapment, left common iliac vein compression, and left renal vein compression. Data were analyzed from autonomic function testing and invasive cardiopulmonary exercise testing (iCPET) performed for clinical indications.Results:A total of 16 patients presented with imaging-confirmed multi-vein compressions. The average (standard deviation) number of compressed sites were 4 (2). Eleven patients (69%) had clinical symptoms of dysautonomia. Five patients (31%) underwent autonomic function testing; all had an abnormal result, most commonly manifesting as reduced orthostatic cerebral blood flow velocity. Seven patients (44%) underwent iCPET; the average right atrial pressure at peak upright exercise was abnormally low at 1 mmHg (1.5 mmHg) with a range of 0-4 mmHg. Four out of 7 patients had accompanying peak oxygen consumption less than 80% of predicted. Seven patients (44%) underwent surgery for at least one compression; the most common procedure was left common iliac vein stenting. Two patients with dysautonomia underwent venous decompression and reported no significant change in overall symptoms. Nine patients with dysautonomia were managed conservatively with medical therapy (salt/water repletion, oral pyridostigmine, beta blocker, midodrine, and/or compression garments). Eight of these patients reported improved functional status after at least 6 months.Conclusions:Patients with multi-vein compressions are enriched for autonomic dysfunction and preload failure. Medical therapy can improve overall functional status without requiring surgical intervention.

Circulation, Volume 150, Issue Suppl_1, Page A4140940-A4140940, November 12, 2024. Background:The 4th Universal Definition of Myocardial Injury (UDMI) recognizes several categories of myocardial injury, including acute myocardial infarction (MI) which is further sub-classified into five types. However, data on these different types of myocardial injury and their risk factors is limited.Methods:In the MESA study of 6814 participants, 15905 clinical events were identified over the first 14 years, 4079 of which meet MESA criteria for physician adjudication for a possible cardiovascular event. Herein, we developed a standardized data format and a REDCap tool with an interactive robust logic algorithm to re-adjudicate all 4079 cases for the presence and classification of all 9 types of myocardial injury as defined by the 4thUDMI. Adjudication process as shown inFigure 1. The prevalence of myocardial injury types was evaluated using descriptive statistics, and adjudicator agreement was assessed using Cohen’s kappa (κ) statistics and percent agreement.Results:Out of 4079 events, adjudication is completed on 2282, of which 15% classified into subtypes of myocardial injury. Adjudication was achieved for 91% of the events in phase 1, 7% in phase 2, 2% in phase 3. The overall agreement between two adjudicators for the presence of myocardial injury was 91% (κ: 0.67), but the agreement for the specific subtype was 53% (κ: 0.38). The most common events were Type 1 MI (N= 114), followed by Type 2 MI (N= 95), and Acute non-ischemic myocardial injury (N= 85) (Figure 2). Compared to the original MESA adjudication for the presence of MI, 97% (N= 72) of probable MI and 8% (N= 174) of no MI were reclassified into five and six types of myocardial injury events respectively.Conclusion:This study highlights the complexities in identifying subtypes of myocardial injury based on current definition. This study provides a novel dataset to explore diverse correlations with these myocardial injury subtypes.

Circulation, Volume 150, Issue Suppl_1, Page A4124226-A4124226, November 12, 2024. Introduction:Exposure to ambient air pollution may increase the risk of cardiovascular disease events and mortality, but prior publications have primarily included administrative cohorts with outcomes that have not been individually reviewed and with air pollution estimates created without cohort-specific exposure monitoring. Multi-Ethnic Study of Atherosclerosis (MESA) is a multi-site cohort study designed specifically to prospectively collect and adjudicate cardiovascular disease (CVD) events. MESA Air recruited additional participants into sub-cohorts for enhanced air pollution variation and sample size.Research Question:The aim of this analysis was to characterize the relationship between long-term exposure to nitrogen dioxide (NO2) and fine particulate matter (PM2.5) and all-cause mortality and CVD events.Methods:Air pollution exposure was assessed using address history with a purpose-built exposure model incorporating cohort-specific monitoring including measurement and validation at participant homes. We used Cox models to assess the risk of rolling 2-year average exposures on all cause-mortality and on a composite CVD endpoint (definite angina, probable angina with revascularization, myocardial infarction, atherosclerosis or other CVD death, resuscitated cardiac arrest, and stroke). Models were stratified for baseline hazard by age, sub-cohort, and recruitment year and were additionally adjusted for age, sex, race/ethnicity, field center, smoking/second-hand smoke, pack-years, physical activity, education, income, neighborhood socioeconomic status, and statin use.Results:MESA Air participants were aged 44-87 years at enrollment between 2000 and 2007; follow-up averaged 14 years. 6,915 participants had follow-up for events, NO2exposure, and covariate information. We observed 1,442 deaths and 985 CVD events. The interquartile range over all 2-year averages was 10.5-23.1 ppb for NO2and 10.1-14.9 µ/m3for PM2.5. The adjusted hazard ratio (aHR) for a 10 ppb increment in NO2was 1.38 (95% CI: 1.17, 1.64) for all-cause mortality and 1.16 (95% CI: 0.95, 1.42) for incident CVD events. The aHR for a 5 µg/m3increment in PM2.5was 1.20 (95% CI: 0.99, 1.46) for all-cause mortality and 1.15 (95% CI: 0.95, 1.39) for incident CVD eventsConclusions:These results add to growing literature demonstrating an association between air pollution exposure, mortality, and CVD in a cohort with well-characterized clinical endpoints and cohort-specific exposure assessment.

Circulation, Volume 150, Issue Suppl_1, Page A4141341-A4141341, November 12, 2024. Background:Aortic valve calcification (AVC) is the primary underlying process leading to aortic stenosis. Whether polygenic risk scores (PRS) are associated with AVC beyond traditional atherosclerotic cardiovascular disease risk factors (ASCVD) is unknown.Methods:This study included 6,812 Multi-Ethnic Study of Atherosclerosis participants who had AVC measured via CT at Visit 1 and single-nucleotide polymorphism (SNP) genotype data. Using previously published PRS for coronary artery disease (CAD), coronary artery calcium (CAC), and ASCVD risk factors we calculated a weighted PRS for each participant that was standardized within each ancestry group. The cross-sectional association of the individual PRS with AVC >0 was examined using multivariable logistic regression modeling with Bonferroni correction.Results:The mean age was 62 years old, 53% were women, and 913 (13.4%) of participants had AVC >0 at baseline. The PRS for CAD (HR 1.17, 95% CI 1.07-1.26), SBP (HR 1.13, 95% CI 1.04-1.24), LDL-C (HR 1.16, 95% CI 1.07-1.26), and lipoprotein(a) [Lp(a)] (HR 1.11, 95% CI 1.02-1.20) were significantly associated with AVC, while the other PRS including CAC (HR 1.02, 95% CI 0.94-1.10) and CRP (HR 0.97, 95% CI 0.89-1.05) were not (Table). In sex stratified analyses, the PRS for CAD, LDL-C, and Lp(a) were significantly associated with AVC >0 for both women and men (p0. Additionally, the lack of association for the CAC PRS with AVC >0 demonstrates that significant differences exist in the calcification pathways for AVC and CAC.

Circulation, Volume 150, Issue Suppl_1, Page A4134768-A4134768, November 12, 2024. Backgrounds:Heart failure (HF) associated with coronary artery disease (CAD) is a significant contributor to mortality in the elderly population of the United States. This study examines trends in HF in CAD-related mortality among adults aged 65 and older, focusing on geographic, gender, and racial/ethnic disparities from 1999 to 2020.Methods:A retrospective analysis was performed using the CDC WONDER database death certificates from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region.Results:Between 1999 and 2020, there were 6,571,263 deaths attributed to coronary artery disease (CAD) and 6,135,540 deaths related to Heart Failure (HF) in the US. Among adults aged 65 and older, HF in CAD caused 1,597,451 deaths, with 37.1% occurring in medical facilities and 30.3% in nursing homes. The AAMRs for HF in CAD decreased from 241.7 in 1999 to 156.2 in 2020 (AAPC: -2.23, p < 0.000001). This reduction was significant from 1999 to 2014, followed by a slight increase from 2014 to 2020. Men consistently had higher AAMRs than women (227.4 vs. 137.1), with women experiencing a more significant decline in rates (AAPC: -3.23, p < 0.000001). Racial disparities revealed the highest AAMRs among Whites (183.0), followed by American Indians/Alaska Natives (153.7), Blacks (134.6), Hispanics (123.7), and Asians/Pacific Islanders (81.6). The most significant reductions were observed in Hispanics (AAPC: -2.68, p < 0.000001). Geographically, AAMRs varied, ranging from 92.1 in Hawaii to 257.3 in West Virginia, with the Midwest showing the highest mortality (191.0). Nonmetropolitan areas exhibited higher AAMRs than metropolitan areas (202.6 vs. 166.1), although both showed moderate declines over time, more pronounced in urban areas (AAPC: -2.41, p < 0.000001).Conclusion:The study uncovers notable variances in HF in CAD-related mortality among elderly individuals in the United States based on race, gender, and geographic location. While the decrease in AAMRs from 1999 to 2014 indicates progress in cardiovascular care, the subsequent rise from 2014 to 2020 and enduring disparities call for specific public health measures to tackle these inequalities.

Circulation, Volume 150, Issue Suppl_1, Page A4148110-A4148110, November 12, 2024. Background:Critical Limb Ischaemia (CLI) is a concerning medical emergency condition with notable mortality among older adults. This study highlights the trends and demographic disparities in mortality rates due to CLI in patients aged 55 and older in the United States from 1999 to 2020.Aim:This study aimed to evaluate patterns and geographical variations in mortality associated with CLI among adults in the United States.Methods:Death certificates from CDC WONDER database from1999 to 2020 were analyzed to investigate mortality related to CLI among adults. Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, stratified by year, sex, race/ethnicity, and geographical regions.Results:CLI caused a concerning 620,205 deaths among US adults aged 55+ between 1999 and 2020, primarily in hospitals (42%). The overall AAMR for CLI-related deaths showed decline from 51.6 in 1999 to 40.1 in 2020, with an AAPC of -1.51 (95% CI: -1.75 to -1.25, p < 0.000001). The AAMR experienced a steeper decrease from 1999 to 2011 (APC: -3.31, p < 0.000001), followed by a slight increase from 2011 to 2020 (APC: 0.94, p = 0.031174). Men had higher AAMRs than women, though both sexes experienced reductions (men: 48.3; women: 32.6). The AAMR for men decreased from 64.9 in 1999 to 42.8 in 2011, increasing to 50.1 by 2020. For women, the AAMR decreased from 42.9 in 1999 to 28.3 in 2014, followed by a slight increase to 32.3 by 2020. Racial/ethnic disparities were apparent, with Black individuals having the highest AAMRs (58.7), followed by Whites (39.0), American Indians/Alaska Natives (38.0), Hispanics (28.5), and Asians/Pacific Islanders (13.8). All racial groups experienced decreases in AAMRs. Geographically, AAMRs varied from 20.4 in Utah to 53.2 in Ohio. The highest mortality noted in the Midwestern region (AAMR: 43). Nonmetropolitan areas unveiled higher AAMRs than metropolitan areas (nonmetropolitan: 43.5; metropolitan: 38.2). Both regions showed a decrease in AAMRs from 1999 to 2020 (metropolitan AAPC: -1.36, p < 0.000001; nonmetropolitan AAPC: -0.81, p = 0.001399).Conclusion:Our analysis highlights significant demographic and geographic differences in older adult mortality due to CLI in the U.S. Continued decreases over time but recent upturn in mortality rates emphasizes need for focused interventions to close these gaps and to improve population health outcomes for affected populations.

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 A4148114-A4148114, November 12, 2024. Introduction/Background:Use of the radial artery (RA) is associated with better clinical outcomes compared to the saphenous vein during coronary artery bypass grafting (CABG) and is strongly endorsed by society guidelines. While the safety of using the RA as a sequential T-graft from the internal mammary artery is established, evidence on the safety and efficiency of sequential radial artery grafts directly from the aorta is limited.Research Questions/Hypotheses:The use of a sequential radial artery originating on the aorta is safe and efficient and is associated with an increase in the number of arterial grafts used in patients undergoing CABG.Goals/Aims:To evaluate the safety and efficiency of using the radial artery in a sequential approach directly from the aorta during CABG.Methods:STS database analysis of patients undergoing isolated CABG with ≥1 RA by one surgeon at two centers (2001-2022). Patients with sequential vs. non-sequential RA grafting were compared. Primary outcomes included CPB and cross-clamp time, total number of arterial grafts, and incomplete revascularization. Secondary outcomes were 30-day mortality, reoperation, stroke, renal failure, sepsis, ICU length of stay, and deep sternal wound infection. Statistical methods included Mann-Whitney U test, Chi-Square test, and Optimal Matching Propensity Score analysis (1:3 ratio).Results:Of 503 patients who received an RA graft, 129 (25.6%) were sequential. Before matching, significant differences were noted in median age, BMI, CPB and cross-clamp (XC) time, and elective status between groups. Sequential RA use was associated with a higher median number of arterial grafts and total grafts (3 vs 2, and 4 vs 3, respectively, p