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

Circulation, Volume 150, Issue Suppl_1, Page A4118777-A4118777, November 12, 2024. Introduction:Hypertrophic Cardiomyopathy (HCM) is an uncommon heart condition associated with serious complications. Advances in medicine have improved its prognosis. Despite this, such potentially life-saving improvements concerning the implementation of best practices are not ubiquitous; guidelines recommend management at specialized centers. Unfortunately, not all hospitals have specialized HCM centers. However, given that a sizeable portion of these specialists are also in academic centers (ACs), we hypothesize that ACs may be better positioned than non-academic centers to provide the highest quality care for HCM patients.Purpose:Our study aimed to assess in-hospital outcomes and healthcare burdens among patient admissions with HCM diagnoses, comparing those treated at academic centers with those receiving care at non-academic centers. We examine all-cause in-hospital mortality, length of stay (LOS), hospital costs, and investigate ethnic differences in patients with HCM.Methods:The National Inpatient Sample database was utilized to obtain HCM patient hospitalizations from 2012 through 2020 in the United States. Patient hospitalizations for which adult patients had a primary diagnosis of HCM were identified. Outcomes included all-cause in-hospital death, LOS, and hospital costs. All-cause in-hospital mortality was evaluated using multivariable logistic regression analysis. Multivariable lognormal regression models were used to estimate LOS and inflation adjusted cost outcomes.Results:All-cause mortality unadjusted rates were 2.2% in non-teaching hospitals compared with 1.7% at teaching hospitals; however, this difference was not statistically significant (p=.235). Both unadjusted and adjusted hospital LOS were 32% shorter for non-teaching hospitals (p

Circulation, Volume 150, Issue Suppl_1, Page A4142234-A4142234, November 12, 2024. Introduction:The mechanisms underlying the persistence of atrial fibrillation (AF) are still debated. Studies in animal and human cardiac bench top models suggest that different mapping techniques influence the detection of localized sources or self-sustaining, transient wavelets in AF. Despite this, no human studies have examined the influence of a local versus global mapping approach on the detection of these sources simultaneously in the same patient.Objective:We hypothesize that local and global mapping of AF offer different spatiotemporal resolutions that influence the nature of sustaining mechanisms but not their location in the chamber. This will be particularly evident for rotational sources.Methods:16 patients who underwent catheter ablation for AF, atrial flutter (AFL), or premature atrial contractions (PACs) were studied. All patients underwent electroanatomic mapping of the left and right atria with both local and global approaches. Anatomical locations were subdivided into different regions (Figure 1A, 1B). Mechanisms were classified as focal, rotational, or localized irregular activation (LIA) using mapping algorithms. Analyses were done using Chi-squared tests.Results:A total of 40 AF, 12 AFL, and 4 PAC simultaneous electroanatomic maps were obtained. Both local and global mappings identified an AF source (n=52) within close anatomical proximity 86.5% of the time (p

Circulation, Volume 150, Issue Suppl_1, Page A4145382-A4145382, November 12, 2024. Introduction:Myocarditis is more commonly reported among young males and may be complicated by cardiogenic shock. Animal models and clinical studies demonstrate that myocardial fibrosis after myocarditis disproportionately impacts males. There is limited contemporary data on sex-specific clinical outcomes among patients with myocarditis complicated by cardiogenic shock.Methods:This retrospective cohort study used an EHR-based data platform from large academic medical centers across the United States (TriNetX, Inc.) to identify patients diagnosed with cardiogenic shock secondary to myocarditis between January 2012 and January 2024. Baseline demographics, clinical characteristics, medication use, and outcomes were defined using standardized ICD codes. The primary study outcome was all-cause mortality at 6 months. Secondary outcomes included cardiac arrest, acute kidney injury (AKI), atrial fibrillation, and ventricular tachycardia/fibrillation (VT/VF). The study population was stratified based on sex. Propensity score matching (1:1), incorporating demographic factors, comorbidities, and medication usage, was employed to compare the risk of primary and secondary outcomes between groups.Results:We identified 3,048 individuals (1,857 males, 60.9%) with myocarditis complicated by cardiogenic shock. After propensity-score matching, there were 1,072 individuals in each group (Table). Females had a higher risk of all-cause mortality (HR: 1.27, 95%CI: 1.06-1.52), but a lower risk of AKI (HR: 0.83, 95% CI: 0.74-0.92) and VT/VF (HR: 0.74, 95%CI: 0.60-0.92). The risks of atrial fibrillation (HR: 0.88, 95% CI: 0.70-1.09) and cardiac arrest (HR: 1.04, 95% CI: 0.85-1.27) were similar between the two groups.Conclusion:Significant sex-based differences in clinical outcomes exist among patients with myocarditis complicated by cardiogenic shock. Further studies are warranted to investigate the pathophysiological basis of the higher risk of all-cause mortality, and lower risk of AKI and ventricular arrhythmias among females with myocarditis complicated by cardiogenic shock compared with males.

Circulation, Volume 150, Issue Suppl_1, Page A4120919-A4120919, November 12, 2024. Introduction:Congenital heart diseases (CHDs) are the leading cause of childhood morbidity and mortality. The dysregulation of several cardiac transcription factors (TFs) leads to CHD. The coordination of several cardiac TFs is required and essential for cardiogenesis. However, the mechanisms to acquire its cardiac cell identity remain unclear.Hypothesis:MutantTbx5dysregulates embryogenesis during mesoderm specification, prior to its expression in the tissues in Holt-Oram syndrome.Methods:Using cellular physiology and multiomics analysis in both human ES cells and a zebrafish model ofTBX5germline mutation. we evaluated embryonic structure and function, prior to the onset of gastrulation in the context of both heterozygous and homozygousTBX5mutation.Results:Zebrafish time course transcriptome profiles over gastrulation revealed that loss ofTbx5impacted transcriptional profiles at the blastula stage. Single cell RNA sequencing (scRNA-seq) on 16243 zebrafish blastula stage cells showed loss ofTbx5impacted transcription noise at the blastula stage prior to the expression of zygoticTbx5with associated effects on chromatin accessibility using omni-assay for transposase-accessible chromatin (ATAC) and evidence of aberrant Wnt signaling even at the blastula stage. Embryo-wide cell structure and function were abnormal in bothTbx5mutant zebrafish heterozygotes or homozygotes. To validate Undifferentiated human ES cell H3K4me3 Cleavage Under Targets&Release Using Nuclease (CUT&RUN) also showed abnormal Wnt signaling inTBX5homozygous mutation andTBX5CUT&RUN showed aberrant mesoderm pathway. Calcium imaging analysis demonstrated the lowest excitation frequency inTBX5homozygous mutation prior to mesoderm specification.TBX5homozygous human ES derived mesoderm cells exhibited low expression levels of mesoderm marker genes compared toTBX5wild type mesoderm.Conclusion:Integrating single cell physiology and multi-omics technologies, we idneifified fundamental dysregulation of embryogenesis in mutant cardiac-restricted gene disorder prior to mesoderm specification or the zygotic expression of the mutant gene. These findings suggest thatTbx5started to determine cell fate prior to mesoderm specification by altering chromatin accessibilities and histone modification.Tbx5affected mesoderm differentiation by influencing Wnt signaling and cell physiology.

Circulation, Volume 150, Issue Suppl_1, Page A4138486-A4138486, November 12, 2024. Introduction:Acute myocardial infarction (MI) is a leading cause of morbidity and mortality worldwide. Despite advances in treatment, readmissions within 30 days remain a significant concern, impacting both patient outcomes and healthcare costs. This study aims to analyze trends in 30-day readmission rates (30-dr) for patients discharged after an acute MI.Methods:We analyzed the 2016-2020 Nationwide Readmission Database for patients aged ≥ 18 years with initial admission of acute MI and were readmitted within 30 days. Variables were identified using ICD-10 codes. The primary outcome was trends in 30-dr; secondary outcomes included trends in complications, mortality rate, length of stay (LOS), and healthcare costs. Multivariate and descriptive bivariate analyses were conducted, with p-values

Circulation, Volume 150, Issue Suppl_1, Page A4121672-A4121672, November 12, 2024. Introduction:The determinants of type 2 diabetes (T2D) are multifaceted, encompassing individual, psychosocial, health, and neighborhood factors. While these factors have been explored, the mechanisms underlying perceived neighborhood measures and T2D remain understudied. Weaimedto test whether psychosocial, health, and inflammatory factors mediate the association between perceived neighborhoods and T2D among adults. Wehypothesizedthat these factors mediate the relationship between perceived neighborhoods and T2D.Methods:Data from the Midlife in the United States 3 (MIDUS3, 2013-2014; MUDIS3 Biomarker Project, 2017-2022) were used (n=564, mean age: 60.7y, female:53.2%, White adults:95.7%). Higher perceived neighborhood scores (social cohesion, safety, quality) represent favorable neighborhoods. T2D (y/n) was defined as either A1c≥6.5%, FGL≥126mg/dL or self-reported T2D. Physical activity (PA), BMI, depression, stress, and CRP were tested as mediators in the cross-sectional association between perceived neighborhood measures and T2D using linear regression (reported odds ratio [OR]) with bootstrap-generated 95% bias-correct confidence intervals (BC CIs) adjusted for covariates (Table).Results:Higher neighborhood social cohesion was indirectly related to lower odds of T2D by PA (OR: 0.93 [95%BC CI: 0.86, 0.98]), BMI (OR: 0.90 [0.80, 0.99]), depression (OR: 0.86 [0.75, 0.97]), stress (OR: 0.88 [0.78, 0.97]), and CRP (OR: 0.91 [0.82, 0.98]). Higher neighborhood safety was indirectly related to lower odds of T2D by depression (OR: 0.90 [0.79, 0.98]) and stress (OR: 0.89 [0.77, 0.97]). Higher neighborhood quality was indirectly related to lower odds of T2D by PA (OR: 0.90 [0.82, 0.98]), depression (OR: 0.82 [0.68, 0.96]), stress (OR: 0.83 [0.70, 0.96]), and CRP (OR: 0.88 [0.75, 0.98]).Conclusions:Favorable perception of neighborhoods had significant indirect associations with T2D via PA, BMI, depression, stress, and CRP. These mediators could be potential targets for intervention alongside promoting better neighborhoods to improve T2D outcomes. Future studies should replicate this line of research in diverse cohorts to address T2D disparities by socioeconomic status.

Circulation, Volume 150, Issue Suppl_1, Page A4142450-A4142450, November 12, 2024. Introduction:M-TEER is a minimally invasive procedure for selected patients with symptomatic mitral regurgitation. It remains unknown whether the concomitant C-CTO would affect the outcomes of M-TEER procedure.Methodology:We used the Nationwide Inpatient Sample Data between January 2016 and December 2020 to identify M-TEER hospitalizations with concomitant C-CTO. Baseline characteristics including demographic data and comorbidities were identified. Primary outcomes were in-hospital all-cause mortality and net all cardiac periprocedural complications defined as a composite of acute myocardial infarction, pacemaker placement, cardiac tamponade, pericardiocentesis, pericardiotomy, pericarditis, and hemopericardium.Results:48,835 cases of M-TEER were identified during the study period, of whom 700 patients (1.5%) had the diagnosis of C-CTO. The mean age of M-TEER patients was not significantly different between the two groups (76 vs. 75 years, p=0.11), however the CTO cohort had more males (66.72% vs. 53.41%, p=0.002), and more comorbisities as; previous myocardial infarction (32.14% vs.15.66%, p= 0.0003), peripheral artery disease (32.1% vs. 22.67%, p=0.03), complicated hypertension (80% vs. 68.6%, p= 0.001) and renal failure (52.8% vs. 37.3%, p= 0.0007). A higher percentage of M-TEER procedures in patients with CTO were performed in elective setting (62.8% vs. 46.5%, p=0.0008). M-TEER among patients with CTO was associated with a higher incidence of net all periprocedural cardiac complications (21.4% vs. 13.4%, p=0.04) with however similar in-hospital mortality between both groups (3.57% vs. 2.35%, p=0.46). The results remained consistent on adjusted analysis; M-TEER-CTO cohort had higher odds of net all cardiac periprocedural complications (aOR 1.83 ,95% CI (1.17-2.84), p=0.007) with no difference in in-hospital mortality (aOR 1.54, 95 %CI (0.52-4.56), p =0.43). M-TEER utilization in CTO patients was associated with higher costs ($270,385 vs. $237,190 p=0.05), however, no significant difference in mean length of stay (5.8 vs. 4.8 days, p 0.17)Conclusions:In patient undergoing M-TEER, concomitant C-CTO increases the risk of net all cardiac periprocedural complications with no significant increase in mortality

Circulation, Volume 150, Issue Suppl_1, Page A4137155-A4137155, November 12, 2024. Background:With demographic trends transitioning towards older adults, dementia and cognitive impairment are predicted to increase dramatically. We aim to elucidate the relationship between subclinical myocardial injury, as indicated by asymptomatic increased levels of high-sensitivity cardiac Troponin (hs-cTnT), and cognitive performance.Methods:We studied MESA participants from Exam 1 (2000-02) to Exam 6 (2016-18), categorizing them based on baseline hs-cTnT at Exam 1. Cognitive decline was defined as a decrease of ≥5 units in CASI between Exam 5&6. We used Pearson correlation and linear regression to analyze the association of hs-cTnT levels with CASI scores, and logistic regression to examine the association with cognitive decline. We also explored the relationship between different hs-cTnT categories and cognitive measures. Models were adjusted for demographics, lifestyle, APOE status, comorbidities, and medication use (Figure).Results:4445 participants had both baseline hs-cTnT and valid Exam 5 CASI scores while only 1776 participants had valid Exam 6 CASI scores. Cohort was predominantly female (53%), mean age of 60 years, and 27% had at least one APOE e4 allele. Median hs-cTnT was 6.32 ng/L, and median CASI scores were 89 at Exam 5 and 91.5 at Exam 6. We found a negative correlation between the log-hs-cTnT at Exam 1 and Exam 5 with CASI scores at Exam 5. An increase of one unit in log-hs-cTnT level was associated with a decrease of 0.67 (CI -1.17, -0.17) in CASI and corresponded to higher odds (OR: 1.44; CI 1.05-1.95) of cognitive decline, after adjusting for covariates. When comparing various categories of hs-cTnT with category 1, we observe that the odd of cognitive decline increases as the category increases. However, this trend does not hold for category 5 with significantly lower sample size (Figure).Conclusion:Our findings indicate an inverse relationship between hs-cTnT and cognitive function years later, which is significantly attenuated by known risk factors for cognitive decline. Further research is needed to determine hs-cTnT as a predictor of future global cognitive functions.

Circulation, Volume 150, Issue Suppl_1, Page A4138483-A4138483, November 12, 2024. Background:Hypoplastic left heart syndrome (HLHS) is classified by subtype: mitral atresia and aortic atresia (MA-AA), mitral stenosis and aortic atresia (MS-AA), and mitral stenosis and aortic stenosis (MS-AS). It is controversial whether specific HLHS subtypes and presence of ventriculocoronary connections (VCC) are associated with transplant-free survival. We aimed to determine whether there is an increased risk of mortality associated with specific HLHS subtypes, whether this risk is stratified by the presence of VCC, and if a specific type of stage I palliation in patients with VCC improves survival. We also aimed to determine practice variation in the evaluation of HLHS patients with VCC.Methods:We performed a multicenter retrospective cohort study of fetuses and infants < 2 months of age with HLHS admitted between 1/2012-12/2016 to participating Fetal Heart Society institutions. Patients with HLHS variants were excluded. We collected patient specific data and surveyed participating centers for practice variation. Kaplan-Meier curves with log-rank test were used to assess transplant-free survival and cox proportional hazard analysis was performed with adjustment for center as a random intercept.Results:341 patients from nine centers were included. MA-AA was the most common subtype (177, 52%), followed by MS-AA (102, 30%), and MS-AS (62, 18%). VCC were diagnosed or suspected in 65 patients (19%). A total of 287 patients were live born with intention to treat. HLHS subtype was not associated with transplant-free survival (Figure 1A). Presence of VCC was associated with a lower transplant-free survival (p=0.026, Figure 1B). In the subset of patients diagnosed with VCC, there was not a significant difference in survival based on type of stage I palliation (Figure 1C). Cox proportional hazard modeling adjusted for center demonstrates that presence of VCC has a hazard ratio of 1.74 (CI 1.02-2.98), p =0.04. Survey data regarding practice variation for patients with VCC (Figure 2) demonstrates 33% of centers modify the type of stage I palliation based on presence of VCC.Conclusions:In a multicenter cohort of HLHS patients, patients with VCC had lower transplant-free survival compared to those without VCC, while subtype and type of stage I palliation did not have a statistical difference. There is considerable practice variation in the management of HLHS patients with VCC that may warrant further investigation.

Circulation, Volume 150, Issue Suppl_1, Page A4142403-A4142403, November 12, 2024. Introduction:M-TEER is a minimally invasive procedure for selected patients with symptomatic mitral regurgitation. Data about the safety of the procedure among post-CABG patients is limited.Methodology:We used the Nationwide Inpatient Sample data between January 2016 and December 2020 to identify M-TEER hospitalizations with history of CABG. Baseline characterestics including demographic data and comorbidities were identified. Primary outcomes were in-hospital all-cause mortality and net all cardiac periprocedural complications defined as a composite of acute myocardial infarction, pacemaker placement, cardiac tamponade, pericardiocentesis, pericardiotomy, pericarditis, and hemopericardium.Results:48,835 cases of M-TEER were identified during the study period, of whom 9,655 (19.78%) had prior CABG. Patients with prior CABG undergoing M-TEER were older (76 vs. 75 years, p

Circulation, Volume 150, Issue Suppl_1, Page A4122840-A4122840, November 12, 2024. Background:Patient activation, a person’s level of confidence, comprehension, and autonomy toward their health, is an essential goal of cardiovascular disease therapy. Previous research has shown a link between high levels of patient activation and better patient outcomes and experiences. However, whether individualized interventions such as a text-based mobile health (mHealth), improve patient activation is unclear. Research on patient activation in people at risk for cardiovascular disease and influential factors is minimal.Aims:This study aimed to 1) determine the effect of a multi-component mHealth intervention on patient activation and 2) examine its predictors among older adults at risk for cardiovascular disease.Methods:In this pilot randomized controlled trial, community-dwelling older adults with poor eating behaviors and reduced physical activity (n=54) were randomly assigned to theGetFIT(control) orGetFIT+(intervention) groups, with three- and six-month follow-up periods. TheGetFITgroup received healthy lifestyle counseling from a licensed health coach, a free commercial mHealth app with push alerts on physical activity, and an activity tracker for physical activity monitoring. TheGetFIT+ group received the same components but had personalized text messages instead of push alerts. The 13-item Patient Activation Measure assessed patient activation; higher scores indicate better activation. Linear mixed-effects models were used to investigate between-group changes in outcomes across time.Results:The mean age was 65.4 ± 6.0 years; 61% were females and 61% were married. Baseline characteristics were comparable between groups. Significant improvements were observed in theGetFIT+group at three months (mean 3.53, 95% CI 0.11, 6.96; p=0.043) and six months (mean 4.37, 95% CI 0.91, 7.83; p=0.014), whereas improvements in theGetFITgroup were non-significant. Adjusting for age, gender, education, employment, marital status, social support, smartphone confidence, and self-perceived health did not alter the results. Nevertheless, only social support was associated with higher patient activation overall (B=5.14, 95% CI 1.00, 9.27; p=0.015).Conclusions:People at risk for cardiovascular disease can improve their self-management abilities, knowledge, and confidence through personalized text messaging. Possessing social support is critical for maximizing the benefits of mHealth interventions.

Circulation, Volume 150, Issue Suppl_1, Page A4124655-A4124655, November 12, 2024. Introduction:Thoracic aortic aneurysm and dissection (TAAD) is a morbid cardiovascular disease with 21 known common-variant genomic risk loci. Aneurysm represents an extreme of diameter, so we sought to jointly analyze TAAD and aortic diameter to enhance discovery power.Methods:Genome-wide association studies (GWAS) were performed for UK Biobank MRI-derived aortic diameter measured at the aortic root (N=62,919), ascending aorta (N=61,156), and descending aorta (N=62,412). Separately, TAAD GWAS summary statistics from UKB (1,076 cases, 416,263 controls), FinnGen (3,880 cases, 381,977 controls), and the Million Veteran Program (8,626 cases, 453,043 controls) were meta-analyzed. Genetic correlation was assessed withldsc. Multi-trait analysis was then performed for the aortic measurements and TAAD withMTAG. A 1.1-million-variant polygenic risk score (PRS) was produced and tested in theAll of Usbiobank.Results:The genetic correlation between ascending aortic diameter and TAAD was 0.83 (P=6.6E-129). The TAAD meta-analysis had an effective sample size of 53,516, augmented to 147,377 after multi-trait analysis. We identified 59 risk loci for TAAD (189 in the multi-trait analysis). These loci included one on the X-chromosome nearMIR222HG, previously reported to be regulated by angiopoietin-2; others were near TGF-β-superfamily members (FBN1,FBN2,GDF6,GDF7,LTBP4,TGFB2,SMAD3); genes involved in vasoconstriction (ADRA1D,ADRB1,ANGPT1,EDN1,EDN2,EDNRA,PDE3A); and cell cycle regulators (CCND2,CCNE1,CDC27,CDK6,CDKN1A,CDKN1B,CENPW,DSCC1,MAD2L1,TP53). 307 distinct loci were significantly associated with at least one of the four traits; all but 7 TAAD loci were genome-wide significant for one of the three aortic measurements, and all loci had at least sub-significant signal in those traits. Gene-set analyses highlighted contributions from fibroblasts, pericytes, and vascular smooth muscle cells. InAll of Us, a one standard deviation (SD) greater PRS was associated with a hazard ratio (HR) of 1.88 for TAAD (P=1.2E-78) and 1.62 for thoracic aortic dissection (P=5.7E-05). Individuals in the top 5% for the PRS had HR 3.77 for TAAD (P=2.7E-48) and HR 2.87 for thoracic aortic dissection (P=3.3E-03).Discussion:The multi-trait analysis yielded an eight-fold expansion of loci for TAAD risk. The findings underscore that sporadic TAAD is a complex, common disease—intricately linked with the processes associated with normal variation in aortic diameter.

Circulation, Volume 150, Issue Suppl_1, Page A4146039-A4146039, November 12, 2024. Background:While hypertension (HTN) is a major risk factor causing morbidity and mortality following anticancer treatment, the current trends regarding its impact remain unclear.This study utilizes CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to examine HTN and malignancy-related deaths in the US.Methods:CDC WONDER accessed mortality data for adults aged ≥25 from 1999 to 2020, citing HTN and malignant neoplasms as contributing causes of death. Results, presented as age-adjusted mortality rates (AAMRs) per 100,000, underwent Joinpoint regression for trend analysis and annual percentage change (APC)Results:From 1999 to 2020, 1,067,143 deaths occurred in patients with neoplasms and HTN (AAMR = 22.3, 95% CI: 22.3 – 22.4). Males had higher mortality (AAMR = 27.9) than females (AAMR = 18.4). AAMRs varied across racial groups: highest in non-Hispanic blacks (NHB) (35.9), followed by non-Hispanic Whites (NHW) (21.2), Hispanics (17.9), non-Hispanic American Indian/Alaska Native (NH-AIAN) (16.4), and lowest in non-Hispanic Asian/Pacific Islander (NH-API) (15.3). Region-wise analysis showed that mortality rates were highest in the Midwest region (23.2, 95% CI: 23.1 – 23.3) followed closely by the South region at (23.0, 95% CI: 22.9 – 23.0), and then the West region rates of (22.3, 95% CI: 22.2 -22.4) while the Northeast reported the lowest mortality rate (19.8, 95% CI: 19.7 – 19.9). Mortality rates in rural areas were consistently greater throughout the study period compared to urban areas (Rural: 26.0, 95% CI: 25.8 – 26.1; Urban = 22.2, 95% CI: 22.1 – 22.3). Overall AAMR increased sharply from 12.0 in 1999 to 18.1 in 2001, followed by a gradual increase till 2018 (24.4) and then 29.9 in 2020 (APC: 3.9 [95% CI=3.4,4.4]). AAMR rose in men (APC:4.3), and women (APC: 3.4) throughout the study (FigureA). Across races, NH-AIAN showed the largest increase (APC: 5.5), followed by NHW (APC: 4.4), Hispanic (APC: 4.8), NHB (APC: 2.1), and NH-API (APC: 2.0) (FigureB)Conclusion:Despite recent improvements, HTN-malignancy-related mortality is rising. AAMR increased among men, all racial groups, and those in rural areas. Associated risk factors and examining social determinants of health are crucial for better care

Circulation, Volume 150, Issue Suppl_1, Page A4144067-A4144067, November 12, 2024. Background:Coronary artery calcium (CAC) scans contain valuable information beyond the Agatston score which is used for coronary artery disease prediction only. We have previously reported AI-enabled cardiac chambers volumetry in CAC scans (AI-CAC) predicts incident atrial fibrillation (AF), heart failure (HF), and stroke in the Multi-Ethnic Study of Atherosclerosis (MESA). Here we compare the distribution of cardiac chambers volumes vs. risk categories of ASCVD pooled cohorts’ equation (PCE) and PREVENTTMrisk scores.Methods:We applied the AutoChamberTMcomponent of AI-CAC to 5830 individuals (52.2% women, age 61.7±10.2 years) without known CVD that were previously obtained for CAC scoring at the baseline examination of MESA. We calculated 10-year estimated risk from the PCE and PREVENT Risk Scores based on 4 categories of risk: 20% using baseline risk factors. The PREVENT total CVD base model was used in analysis, which excludes urinary albumin to creatinine ratio and social depravity index. We compared the distribution of the quartiles of left atrial (LA) and left ventricle (LV) volumes to categories of both risk scores. We defined enlarged cardiac chambers as the top quartile of LA ( >82.7 cc) and LV ( >136.5 cc) volume, which corresponded to 33% and 21.1% incidence of all-CVD events over 10 years (CHD, HF, AF, stroke, CVD deaths), respectively. LA and LV volumes were standardized by adjusting for body surface area (BSA).Results:A substantial portion of cases categorized by PREVENT as low risk (10-year risk

Circulation, Volume 150, Issue Suppl_1, Page A4137925-A4137925, November 12, 2024. Introduction:Thoracic endovascular aortic repair (TEVAR) has emerged as a promising treatment option for patients with type B aortic dissection (TBAD). However, there is a lack of evidence regarding the long-term morbidity of initial TEVAR compared to optimal medical therapy (OMT) in acute uncomplicated TBAD (uTBAD).Objective:To evaluate real-world data(RWD) on the long-term outcome of Japanese patients with acute uTBAD using a nationwide claims database.Methods:This retrospective cohort study utilizes JMDC, a nationwide claims database under Japan’s universal healthcare system. We included patients who were initially hospitalized with a diagnosis of acute TBAD. We defined acute uTBAD by excluding those who died within one month, suffered aortic rupture, traumatic thoracic aortic injury, underwent open-chest surgery, experienced stroke or paralysis, or had less than six months of history in the JMDC. Patients who underwent TEVAR within three months of the index hospitalization (TEVAR group) were compared with those who received optimal medical therapy (OMT group). Propensity score (PS) matching was performed based on age, sex, and year of hospitalization. Using the Kaplan-Meier method, we calculated the cumulative rate of all-cause mortality and aorta-related events.Results:Of 18,445 patients diagnosed with aortic disease between January 2005 and December 2020, 641 were included in the study (OMT group: n=580, TEVAR group: n=61). After PS-matching, demographics of the groups (OMT_PSM: n=183 vs. TEVAR_PSM: n=61) were female (12.6% vs. 13.1%), median age (54 years [IQR, 48-60] vs. 54 years [IQR, 50-61]) and follow-up time (18 months [8-32] vs. 19 months [9-32]), respectively. Kaplan-Meier curves for the aortic-related events (Figure1, 2) are shown as long-term outcomes.Conclusions:This study successfully demonstrated that the estimated 5-year aortic-related event rate in acute uTBAD patients undergoing OMT is approximately 20%, demonstrating the relevance of the RWD source. However, the number of death events in the TEVAR and OMT groups was not sufficient to provide statistical power. Therefore, further studies are warranted to evaluate the long-term prognosis of initial TEVAR for uTBAD.

Circulation, Volume 150, Issue Suppl_1, Page A4137737-A4137737, November 12, 2024. Background and Aims:Cardiac angiosarcoma is a rare and highly aggressive cancer originating from the endothelial cells lining the heart. It accounts for approximately 30% of all primary cardiac tumors. Given its aggressive nature and poor prognosis, it is critical to enhance our understanding of its epidemiology and the factors influencing mortality.Methods:The Surveillance, Epidemiology, and End Results (SEER) database was utilized to gather data spanning from 2000 to 2021 using the International Classification of Diseases for Oncology (ICD-O-3), anatomical codes (C38.0-Heart), and histological code 9120.Results:We identified 194 patients with cardiac angiosarcoma, of which 102 were males and 92 were females. The majority of patients were aged 50 years or younger (59%). Non-Hispanic whites constituted the largest group (56%), followed by non-Hispanic blacks (18%), and Hispanics (16%). Mortality data showed that 91% of the diagnosed patients died (n=176), with a mean survival period of 15 months after diagnosis. The overall survival rate at 1 year was 0.461 (95% CI: 0.39-0.53), at 3 years was 0.09 (95% CI: 0.05-0.14) and at 5 years was 0.052 (95% CI: 0.03-0.10). Advanced age (51-70 years) compared to the 0-50 year age group (HR: 0.57; 95% CI: 0.003-1.14; p=0.049), distant stage (HR: 0.91; 95% CI: 0.01-1.83; p=0.047), patients who did not receive therapeutic radiation therapy compared to those who did (HR: 2.69; 95% CI: 0.10-5.28; p=0.042), and patients who did not undergo surgical resection for angiosarcoma compared to those who did (HR=1.232; 95% CI: 0.69-1,77; p