Risultati per: Linee Guida per le cure post-parto

Circulation, Volume 146, Issue Suppl_1, Page A12180-A12180, November 8, 2022. Introduction:Late right heart failure (LRHF) after left ventricular assist device (LVAD) implant is associated with increased morbidity and mortality. Whether post-implant beta-blocker (BB) use can mitigate the incidence of LRHF is unknown.Methods:We queried the STS-INTERMACS registry from 2008-2018 for adults receiving a primary, continuous-flow LVAD and surviving to 3 months without ongoing RHF, defined as presence of a right ventricular assist device (RVAD) or inotropic support. We excluded patients with atypical LVAD cannulation, bridge-to-recovery strategy, ongoing renal replacement therapy, or missing BB status at 3 months. At 3 months post-implant, patients receiving BB were propensity-matched 1:1 to those not receiving BB using a nearest-neighbor method without replacement. The primary outcome was a composite of all-cause mortality or LRHF, including the need for RVAD, inotropic support, or hospitalization for RHF or fluid overload, and was compared between groups with the Kaplan-Meier method and log-rank testing.Results:Among 14,317 patients meeting inclusion criteria, 4,880 patients receiving BB at 3 months were matched with 4,880 not receiving BB. Baseline covariates were well-balanced (Figure, panel A) and 11.2% of patients experienced early RHF. Over 3-years of follow up, patients receiving BB had a lower incidence of the primary outcome hazard ratio (HR) 0.91 (95% CI: 0.85-0.97), p=0.007 (Figure, panel B). This difference was driven primarily by lower rates of hospitalization for RHF or fluid overload (HR 0.83, 95% CI: 0.72-0.95, p=0.008) and all-cause mortality (HR 0.91, 95% CI: 0.82-1.02, p=0.11) while rates of late RVAD or inotropic support were similar.Conclusions:In this retrospective, propensity-matched analysis, the use of beta blockers after LVAD implant was associated with a modest reduction in the composite of all-cause mortality and LRHF. These data suggest BB may mitigate LRHF and should be confirmed with prospective studies.

Circulation, Volume 146, Issue Suppl_1, Page A11736-A11736, November 8, 2022. Background:Parents of infants born with congenital heart disease (CHD) are at increased risk for mental health problems, including anxiety, depression, and post-traumatic stress (PTS). Few studies have examined to what extent the hospital experience influences these mental health symptoms over time. The purpose of this pilot study was to determine hospital factors predicting parent anxiety, depression, and PTS at 3 months post-discharge.Methods:A convenience sample of 28 biological mother-father dyads was enrolled consecutively from August 2018 to October 2019 from one children’s hospital in the Northeast, US. Parents were instructed to complete questionnaires, including valid and reliable instruments for mental health symptoms, within one week of their infant’s surgery and 3 months post discharge. Associations between hospital factors and each mental health symptom at 3 months post discharge were assessed using linear mixed effects models, accounting for the anticipated correlation between parents of the same infant using an unstructured covariance matrix. Separate linear mixed effects models were constructed for each mental health symptom using backward selection method.Results:For each one unit increase in parental role alteration, anxiety symptoms were estimated to be increased by 5.98 (SE+1.60; p=0.002). Parents with at least a college education were estimated to have greater anxiety symptoms compared to parents with high school/technical school or less (10.89+3.75; p=0.009). For each one unit increase in role alteration, depressive symptoms were estimated to be increased (4.41+1.72; p=0.02). PTS was also significantly predicted by role alteration (5.06+1.91; p=0.02) along with timing of CHD diagnosis, with postnatal diagnosis estimated to increase PTS symptoms by 21.80 (SE+10.07; p=0.04) units compared to prenatal diagnosis.Conclusion:Role alteration experienced by parents during their infant’s hospitalization significantly predicts anxiety, depression, and PTS symptoms 3-months after discharge. Additional factors were identified that can inform mental health screening in this population. Future interventions to enhance the role of parents during infant hospitalization may support parent mental health post discharge.

Circulation, Volume 146, Issue Suppl_1, Page A14609-A14609, November 8, 2022. Introduction:Infective endocarditis (IE) after cardiac valve surgery is associated with high morbidity and mortality. Nosocomial exposure is a growing cause of IE in general. We investigated the risk of post valve surgery endocarditis (PVE) in patient who had any hospitalization and specific nosocomial exposures after open heart valve surgery.Methods:We identified all ≥18yo patients who had their first open heart cardiac valve surgery between 2001-2017 in New South Wales, Australia from the Admitted Patient Data Collection (APDC) registry. Patients with prior/current IE diagnosis at time of index valve surgery were excluded. Follow up was until 31 Dec 2018 with mortality and morbidity tracked from the respective death and APDC registries. Analyses based on Cox regression modelling included age, sex, background diagnoses and features of index valve surgery as time independent covariates, with any hospitalization (separately for specific invasive procedures) post index valve surgery as time dependent exposure covariates for risk of PVE within 6 months of exposure.Results:In total 23747 patients (median age [IQR] 73yo [65-79yo, 63% male) had cardiac valve surgery: 60% isolated aortic valve (n=15065), 28% isolated mitral valve (n=6702), 10% multiple valves (n=2385) and 1.5% right sided valves (n=357). 5.4% (n=1293) of patients experienced PVE at a median 2.9 years (IQR 0.7-6.2) after index valve surgery, with 65% (n=838) occurring within 6 months of any hospitalization. Any hospitalization exposure was associated with an adjusted hazard ratio of 4.0 for developing PVE (95% confidence interval 3.5-4.5). In addition, specific invasive procedures including repeat valve surgery were associated with an elevated risk for PVE (Figure).Conclusions:PVE is significantly more common after any hospitalization with specific invasive procedures carrying differential risk. Care should be taken to avoid unnecessary hospitalizations and procedures in these patients.

Circulation, Volume 146, Issue Suppl_1, Page A11319-A11319, November 8, 2022. Introduction:The need for dialysis early post-heart transplant (HT) can be suprisng when it occurs in the setting of purportedly normal renal function pre-HT, as has been described in failing Fontan (FF) patients.Hypothesis:We hypothesized that FF patients may have an increased incidence of post-operative dialysis (POD).Methods:The Pediatric Heart Transplant Society (PHTS) database was used to identify all children ≥2 years of age with failing Fontan (FF) physiology or cardiomyopathy (CM, benchmark lesion) who underwent isolated HT from 2005-2019. The primary endpoint was POD, defined as any form of dialysis within the first 30 days post-HT. Pre-transplant estimated glomerular filtration rate (eGFR) was calculated using the modified Schwartz formula, and a subset of patients with provided supplemental data additionally had renal function evaluated by a non-creatinine-based method.Results:Of 2003 children who met the inclusion criteria, 263 had FF (13%) and 1740 had CM (87%). Whereas the mean ages were similar (FF 11.2 vs CM 12.2 years, P=0.3), FF patients were 11% shorter (134 vs. 148, P

Circulation, Volume 146, Issue Suppl_1, Page A15123-A15123, November 8, 2022. Introduction:Diastolic dysfunction after STEMI is under documented despite its impact on cardiovascular events. We focused on inflammatory biomarkers within hours after STEMI and their association with diastolic dysfunction at one month post STEMI.Hypothesis:Our aim was to identify an inflammatory profile promoting diastolic dysfunction in STEMI patients.Methods:We prospectively included STEMI patients admitted in our hospital from 2016 to 2019. We collected sera at 5 time points (admission (H0), 4 hours (H4), H24, H48 an 1 month). Inflammatory biomarkers serum levels were assessed using ELISA assays (cytokines, chemokines and endothelial activation biomarkers). Transthoracic echocardiogram and cardiac MRI to assess diastolic function and infarct size were carried out at one month post STEMI. We used last guidelines from the EACVI to grade diastolic function. Patients were followed for 12 months.Results:Complete echocardiographic data were available for 236 patients. There were 163 patients with normal diastolic function and 73 patients with diastolic dysfunction. As expected, patients with diastolic dysfunction had higher BNP level (197.0 ng/L versus 68 ng/L, p

Circulation, Volume 146, Issue Suppl_1, Page A14602-A14602, November 8, 2022. Background:Cancer treatment induced cardiotoxicity, can be a devastating outcome of cancer therapy. It is possible that a patient can survive cancer but develop cardiovascular disease (CVD).Aim:to determine whether there are differences in the characteristics of cancer patients who received potentially cardiotoxic cancer therapy and subsequently developed CVD and those who did not.Methods:This epidemiological study will comprise a retrospective analysis of de-identified linked health data sets, including the Integrated Activity Collection (ISAAC) of Hospital Separations, South Australian Cancer Registry (SACR), Northern Territory Cancer Registry (NTCR) and mortality (Births Deaths and Marriage Registry Data) and NT Hospital Separation data. The total population will be segregated in two distinct groups namely ‘Cancer with no HF’ and ‘Cancer with HF’ to compare the between group differences by demographic factors and medical history.Results:Of the (n=17,389) patients who received chemotherapy cancer treatment between July 2001-June 2017, 49% (8,530) were diagnosed with HF post cancer treatment( median age at cancer diagnosis 65 years; 58% male); crude mortality was 73% within the HF and cancer group; cause of death within this group was HF related 14%; cancer related 63%; other 22% compared to the non HF and cancer group ( median age at cancer diagnosis 58 years; 53% male) who had a mortality rate of 46%; 6.2% CVD related; 68.8% cancer related and 25% other.Conclusion:After adjusting for age, sex, tumour grade, cancer site and CVD admissions prior to cancer diagnosis patients with CVD and cancer had poorer outcomes.

Circulation, Volume 146, Issue Suppl_1, Page A10210-A10210, November 8, 2022. Introduction:Several studies evaluated the role of Selective Serotonin Reuptake Inhibitors (SSRIs) in several aspects of stroke recovery. However, the results of these studies were inconsistent.HypothesisThis study was conducted to assess the hypothesis that SSRIs improve post-stroke recovery.Methods:In this systematic review and meta-analysis, we searched the following databases: PubMed, Cochrane, Scopus and Google Scholar. The studies were included if they were placebo-controlled trials in design and reported SSRIs effects on post-stroke depression, anxiety, disability, dependence, motor abilities and cognitive functions.Results:The search yielded 44 articles that included 16,164 patients and about half of the participants were treated with SSRIs. Our results showed that SSRIs had significant effect on preventing depression (Figure 1: Weighted Mean Difference (WMD)=-7.05; 95%CI: -11.78- -2.31), treating depression (Figure 1; WMD=-1.45; 95%CI: -2.77- -0.14), anxiety (Figure 1: Relative Risk (RR)=0.23; 95%CI: 0.09-0.61), dependence (Figure 1: WMD=8.86; 95%CI:1.23-16.48), motor abilities (Figure 1: WMD=-0.79; 95%CI: -1.42- -0.15) and cognitive functions (Figure 1: WMD=1.00; 95%CI: 0.12-1.89). On the other hand, no significant effect of SSRI on disability was observed. Additionally, we found that treating with SSRIs increased the risk of seizures (RR=1.44; 95%CI:1.13-1.83).Conclusion:Our study showed that SSRIs are effective in preventing and treating depression, improving anxiety, motor function, cognitive function and dependence in post-stroke patients. These benefits were only reproducible with the citalopram sub-analysis but not fluoxetine; further well-conducted placebo-controlled trials are needed to investigate the safety and efficacy of citalopram among post-stroke patients.

Circulation, Volume 146, Issue Suppl_1, Page A14479-A14479, November 8, 2022. Introduction:Reducing mitochondrial ROS (mito-ROS) has been a novel approach for improving cardiac function. Here, we evaluated the effect of prolonged decrease in EC-specific mito-ROS on post-acute myocardial infarction (AMI) coronary angiogenesis and cardiac function.Hypothesis:We hypothesized that a prolonged decrease in EC-specific mito-ROS contributes to mitochondrial dysfunction in coronary EC resulting in post-AMI maladaptive cardiac remodeling.Methods:We used an EC-specific, tetracycline-controlled, transgenic MnSOD overexpression (MnSOD-OE) model. After 16 weeks of MnSOD-OE, mice underwent ligation of left anterior coronary artery (AMI). 28 days post-AMI, ejection fraction (EF), fractional shortening (FS), and left ventricle (LV) mass were determined by echocardiography (n=8/group). Isolated mouse heart ECs (MHEC) were evaluated by Seahorse for mitochondrial function and by western blot for cell signaling. Data were analyzed by Student’s t test. Ap-value ≤0.05 was considered statistically significant.Results:MnSOD-OE mice showed 33% decrease (44.4±2.3 vs. 29.7±3.5) in EF and 35% decrease (21.7±1.2 vs. 14.2±1.7) in FS, compared to control. LV mass was increased by 51% (76.4±1.8 vs. 115.1±12.33 mg) in MnSOD-OE heart. LV end systolic and diastolic areas were increased in MnSOD-OE, by 2-fold (5.8±0.4 vs. 12.6±1.8) and 1.7-fold (9.8±0.5 vs. 16.8±1.6 mm2), respectively. MnSOD-OE MHEC showed a reduction in mitochondrial maximal and spare respiration capacities, and decreased activation of Akt by 25% and ERK by 23%.Conclusions:Prolonged MnSOD-OE impaired mitochondrial respiration and inhibited Akt and ERK signaling in MHEC. These changes were associated with maladaptive remodeling post-AMI, including cardiac hypertrophy, LV dilatation, and systolic dysfunction. Together, these findings suggest that prolonged decrease in mito-ROS has detrimental effects on coronary EC resulting in maladaptive post-AMI cardiac remodeling.

Circulation, Volume 146, Issue Suppl_1, Page A12700-A12700, November 8, 2022. Introduction:Pulmonary arterial hypertension (PAH) is an enigmatic and morbid disease where insights are emerging regarding genetic susceptibility. Genome-wide Association Studies (GWAS) have identified genomic SNPs associated with increased PAH risk. It has been challenging to define the mechanisms underlying the contribution of non-coding PAH-associated functional SNPs (fSNPs) to the pathogenesis of this disease.Methods:We developed a post-GWAS functional genomics strategy to define the causative fSNPs and the associated biological mechanisms. It includes Reel-seq (Regulatory element-sequencing), an EMSA-based technique to identify fSNPs in a synthetic SNP library; SDCP-MS (SNP-specific DNA competition pulldown-mass spectrometry) to identify proteins that specifically bind to fSNPs; and AIDP-Wb (allele-imbalanced DNA pulldown-Western blot) to show allele-imbalanced binding of these proteins to fSNPs. The regulation of risk gene expression by fSNP-binding proteins and their pathogenicity were determined in human pulmonary arterial endothelial cells (PAECs) and confirmed in PAH animal models and patients.Results:An intergenic SNP rs4738801 was identified as a fSNP by Reel-seq. This non-coding fSNP resides in a remote upstream enhancer region of SOX17, an endothelial effector increasingly associated with PAH pathogenesis. Using SDCP-MS and AIDP-Wb, we found that transcription factor FUBP1 binds to rs4738801 risk allele C with lower affinity than non-risk allele G, resulting in a decrease in SOX17 expression. FUBP1 and target gene SOX17 controlled PAH-associated pathophenotypes in PAECs, including proliferation, apoptosis, and angiogenesis. Downregulated by major acquired PAH trigger hypoxia, FUBP1 and SOX17 were decreased in lungs and pulmonary ECs isolated from PAH patients and mouse models. A 3.8-fold enrichment of risk allele C was found in patients with PAH induced by hypoxia, but not in PAH associated with connective tissue disease or other etiology.CONCLUSION:Our functional genomics findings identify a novel role of FUBP1 in the functional regulation of SOX17 locus and elucidate a pathogenic mechanism that combines the acquired PAH-triggering factors and altered genetic susceptibility.

Circulation, Volume 146, Issue Suppl_1, Page A10315-A10315, November 8, 2022. Introduction:Biomarker research related to protease-activated receptor-1 (PAR-1) inhibition with vorapaxar in humans has essentially focused on platelets. Follow-up (FU) time has been short, whereas in the current study, focus has been on endothelial function during both short- and long-term PAR-1 inhibition.Aim:To assess short- and long-term effects of vorapaxar (V) as compared to Placebo (PL) on the following biomarkers: Angiopoietin-2 (ANGPT2), Angiopoietin-like 4 (ANGPTL4), VEGF, ICAM-1, VCAM-1, E-Selectin (ESEL), von Willebrand Factor (VWF), Thrombomodulin (TM), PAI-1 and PAI-2.Methods:In an independent collective subproject performed in Norway, post-MI patients at steady state were recruited from the “Trial to Assess the Effects of Vorapaxar in Preventing Heart Attack and Stroke in Patients with Atherosclerosis” (TRA2ᵒP-TIMI 50) and NSTEMI patients were recruited from the “Thrombin Receptor Antagonist for Clinical Event Reduction in acute coronary syndrome” (TRACER) trial. Biomarkers were measured in duplicate by enzyme immunoassays (EIA) in citrated plasma at one month follow-up and at study completion (median 2.3 years) for subjects recruited from both trials.Results:Biomarkers were measured in 265 consecutive patients [age median 62.0 years (Q1-Q3: 55.0-68.0 years), males 83%] with at least one change from baseline value. Among these, biomarkers were available at both short- and long-term follow-up in 221 subjects.ANGPT2 increased significantly in V as compared to PL at 1-month follow-up in the total population (p=0.034), and in males in both post-MI (p=0.031) and NSTEMI subjects (p=0.012), respectively. ANGPTL4 increased (p=0.028) and PAI-2 decreased (p=0.025) significantly in the total population in favor of V at final FU. In the total post-MI subgroup and among males of that group, a short-term significant increase in ESEL in favor of V was observed, p=0.029 and p=0.018, respectively. Also, a transient significant increase in VWF (p=0.032) in favor of V was seen at one month in NSTEMI patients.Conclusions:Significant changes suggesting potential harmful effects in some biomarkers were observed during 1-month and long-term PAR-1 inhibition as compared to placebo in post-MI and acute coronary syndrome patients.

Circulation, Volume 146, Issue Suppl_1, Page A13992-A13992, November 8, 2022. Introduction:Transcatheter Aortic Valve Replacement (TAVR) is a widely used minimally invasive treatment for severe aortic stenosis. Though the procedure is safe and effective, patients are still at risk for ischemic and hemorrhagic events after this intervention. The post-procedure antithrombotic management in these patients continues to be a source of debate, particularly in patients who do not have a preexisting or concurrent comorbidity which requires long-term anticoagulation therapy.Methods:We performed a systematic review and meta-analysis to compare Direct Oral Anticoagulants (DOACs) versus antiplatelet therapy after TAVR in patients without previous indication for chronic oral anticoagulation. PubMed, EMBASE, and Cochrane databases were searched for randomized controlled trials (RCTs). Risk ratio (RR) with P value < 0.05 were considered statistically significant. The primary endpoints of interest were death, obstructive valve thrombosis and major bleeding. No time for follow-up was limited.Results:Three studies involving 2922 patients undergoing TAVR were included. Of the participants, 1459 received antiplatelets and 1463 received DOACs. Antiplatelets were associated with significantly lower all-cause mortality (RR 1.68 [1.22-2.30], 95%IC; p=0.001). Major bleeding did not differ significantly between groups, but DOACs had a higher risk of bleeding when compared to antiplatelet drugs (RR 1.44 [0.90-2.32]; 95%IC, p=0.13). The antiplatelet group had a significantly higher risk of valve thrombosis than the DOACs group (RR 0.27 [0.14-0.51]; 95%IC; p

Circulation, Volume 146, Issue Suppl_1, Page A10006-A10006, November 8, 2022. Background:In the DECLARE-TIMI 58 trial, involving patients with type 2 diabetes at high cardiovascular (CV) risk, dapagliflozin reduced the risk for heart failure hospitalization and adverse kidney outcomes, compared to placebo. Whether dapagliflozin lowers the risks for the broader outcome of adverse event (AE)-related hospital admissions is unknown.Methods:The DECLARE-TIMI 58 trial randomized 17,160 subjects with type 2 diabetes and a high risk for or established CV disease, to receive dapagliflozin or placebo (1:1). Dapagliflozin effect on AE-related hospital admissions was assessed overall and by baseline cardiovascular and kidney subgroups. Investigator reported system organ class classification was used to evaluate dapagliflozin’s effects on admissions due to different etiologies.Results:Over a median follow up of 4.2 years, dapagliflozin reduced the risk of AE-related hospital admissions by 11% (32.4% vs. 35.4% of participants, HR 0.89 [95% CI 0.85, 0.94]; p

Circulation, Volume 146, Issue Suppl_1, Page A10209-A10209, November 8, 2022. Introduction:SGLT inhibitors demonstrate reductions in CV mortality and HHF in patients with diabetes and chronic HF. Despite therapy, patients hospitalized for worsening HF (WHF) are at high risk of death or readmission.Hypothesis:The SOLOIST-WHF trial admitted patients for their index WHF event and initiated randomized therapy during hospitalization. This study evaluated the effect of the SGLT1 and 2 inhibitor sotagliflozin on 30- and 90-day CV death and HF readmission rates after discharge.Methods:Of 1222 randomized patients with T2D, 86% were admitted for their index WHF event. Of them, 46% (n = 563) started study drug prior to or at discharge. In post hoc exploratory analyses, CV death and HF readmission (HHF or urgent visits for HF) rates were determined 30- or 90-days post discharge. Comparisons were done by Cochran-Mantel-Haenszel test stratified by region and baseline LVEF (50% for readmission for non-fatal HF-related events or the composite of CV death and readmission for HF-related events within 30 or 90 days of discharge vs placebo (Table 1). The sotagliflozin safety profile in those windows was generally consistent with the overall study duration. Incidence of adverse events (AEs) and serious AEs was similar between groups. Increased incidence of diarrhea and volume-related AEs was noted with sotagliflozin. No appreciable eGFR change from baseline occurred at 30 days, but there was lower incidence of AEs linked to acute kidney injury with sotagliflozin.Conclusions:Sotagliflozin, given to patients with T2D prior to or at hospital discharge after an episode of WHF, was well tolerated and resulted in a significant >50% reduction in CV mortality or readmission for a HF event at 30 and 90 days post-discharge.

Circulation, Volume 146, Issue Suppl_1, Page A12070-A12070, November 8, 2022. Introduction:The majority of patients resuscitated from cardiac arrest (CA) present in coma or with an altered level of consciousness. Although CA survivors are routinely sedated during targeted temperature management, the effects of sedation on CA outcomes remain to be determined.Hypothesis:Post-CA sedation would modulate cerebral physiology and improve neurological outcomes in mice.Methods:Adult C57BL/6J mice of both sexes were subjected to potassium chloride-induced CA and thereafter resuscitated with manual chest compression. Starting at return of spontaneous circulation (ROSC) or at 60 minutes after ROSC, mice received intravenous infusion of propofol at 40 mg · kg-1· h-1, dexmedetomidine at 1 μg · kg-1· h-1, or normal saline for 2 hours. Body temperature was lowered and maintained at 33°C during sedation. Cerebral blood flow was measured for 4 hours after ROSC. Telemetric electroencephalogram (EEG) was recorded in freely moving mice from 3 days before up to 7 days after CA.Results:Sedation with propofol or dexmedetomidine starting at ROSC attenuated brain injury and improved survival in hypothermia-treated post-CA mice (propofol [13/16] vs. no sedation [4/16],P= 0.008; dexmedetomidine [14/16] vs. no sedation [4/16],P= 0.002). Mice that were not sedated after ROSC exhibited cerebral hyperemia immediately after resuscitation and EEG power in all frequency bands remained less than 20% of the baseline in the first 4 hours after ROSC. Administration of propofol or dexmedetomidine starting at ROSC attenuated cerebral hyperemia and induced slow-wave (0.5-4 Hz) EEG activity that reached near baseline levels during and early after sedation. Increased EEG activity within 6 hours after ROSC was associated with improvement in neurological outcomes at 24 hours post-CA. In contrast, delayed sedation starting at 60 minutes after ROSC failed to improve outcomes, without attenuating cerebral hyperemia and inducing slow-wave EEG activity.Conclusions:Post-CA sedation with propofol or dexmedetomidine improved neurological outcomes and survival in mice resuscitated from CA and treated with hypothermia. The beneficial effects of sedation were accompanied by attenuation of the cerebral hyperemic response and induction of EEG slow-wave activity.

Circulation, Volume 146, Issue Suppl_1, Page A14439-A14439, November 8, 2022. Introduction:Post-transcatheter aortic valve replacement (TAVR) outcome of patients is an important research topic. To accurately assess post-TAVR mortality, we examined a family of new echo-parameters (augmented systolic blood pressure (AugSBP) and arterial mean pressure parameters (AugMAP)) derived from blood pressure and aortic valve gradient (Figure 1).Methods:Patients in the Mayo Clinic National Cardiovascular Diseases Registry-TAVR database who underwent TAVR between January 1, 2012, and June 30, 2017, were identified to retrieve baseline clinical, echocardiographic, and mortality data. The median of AugSBP and AugMAP were used to stratify patients in Kaplan-Meier analysis.Results:The final cohort contained 974 patients with a mean age of 81.4±8.3 years old, and 56.6% were male. The mean Society of Thoracic Surgeons risk score was 8.2±5.2. The median follow-up duration was 354 days, and the one-year all-cause mortality rate was 14.2%. Detailed characteristics are summarized inTable 1.AugMAP1 < 102.5 mmHg (median) was associated with a 3-fold risk of all-cause mortality post-TAVR at 1 year (hazard ratio 3.0, 95%confidence interval 2.0-4.5, p

Circulation, Volume 146, Issue Suppl_1, Page A12877-A12877, November 8, 2022. Introduction:Splenectomy is a relatively common surgical procedure in hematologic disorders, such as thalassemia, to improve anemia. However, splenectomy is clinically indicated as a strong risk factor for the development of post-splenectomy cardiovascular dysfunction. The underlying mechanisms have not been well established. We have found elevated levels of circulating FGF23 in thalassemia mice. As a hormone mainly expressed by osteocytes in bone, FGF23 has been shown to be an independent marker for cardiovascular risk in various patient populations. In this study we sought to investigate the role of FGF23 in the pathogenesis of post-splenectomy cardiovascular dysfunction.Methods:Splenectomy was performed in thalassemia (Hbbth-3) mice at 4 weeks of age and cardiovascular functions were evaluated at 10 weeks post-splenectomy. Right ventricular maximum systolic pressure (RVSP) was measured using a closed chest right heart catheterization approach. Cardiac structure and functions were evaluated using echocardiography. Realtime RT-PCR and immunostaining were used to determine FGF23 expression in mouse tissues. Hepatocyte specific FGF23 KO thalassemia mice were generated by cross breeding albumin-Cre, Flox-Fgf23 and thalassemia mice.Results:Using a thalassemia mouse model (Hbbth-3), we found thatHbbth-3mice with surgical splenectomy developed significant cardiovascular dysfunction including biventricular cardiac hypertrophy, impaired diastolic function as well as pulmonary hypertension. We also found circulating levels of intact FGF23 were dramatically elevated in splenectomisedHbbth-3mice, along with significantly upregulated FGF23 expression in liver and bone tissues. However, FGF23 levels in plasma were not normalized in hepatocyte specific FGF23 KO mice, suggesting bone-derived FGF23 is most likely the major source account for elevated FGF23 in circulation.Conclusions:Our findings suggest bone-derived FGF23 may contribute to the development of post-splenectomy cardiovascular dysfunction in thalassemia. The role of FGF23 in post-splenectomy pathogenesis will be further investigated using global FGF23 KO and osteocyte specific FGF23 KO mouse models.