Risultati per: Low Back Pain: raccomandazioni

Circulation, Volume 146, Issue Suppl_1, Page A11151-A11151, November 8, 2022. Introduction:High energy requirements and poor feeding due to left-to-right shunting can lead to growth failure in patients with ventricular septal defect (VSD) but the effect of malnutrition on surgical outcomes is not well known, especially in low-resource settings. More data would inform decisions on whether nutritional repletion should occur pre-operatively or be deferred until after surgery.Methods:We analyzed cases of isolated VSD +/- ASD or PDA closure in children < 5 years old from 19 centers in 10 low- and middle-income countries with complete audited data collected as part of the International Quality Improvement Collaborative for Congenital Heart Disease from 2016 - 2020. Premature infants and those with known genetic/non-cardiac structural anomalies were excluded. We examined inter-center variation in weight-for-height z score (WHZ) and adjusted for age and major medical illness to calculate odds ratios (OR) of death and major infection (surgical site infection or bacterial sepsis) during hospitalization for changes in WHZ, and for patients with moderate acute malnutrition (-3 < WHZ ≤ -2; MAM) or severe acute malnutrition (WHZ ≤ -3; SAM) versus those without malnutrition (WHZ > -2).Results:Among 6441 VSD closures (5023 membranous, 160 muscular, 73 AV canal, 1046 infundibular, 139 DORV), median age was 8 months (1 day – 4.4 years). Median WHZ at time of surgery was -1.1 (-8.0 – 7.4); 949 patients (15%) had MAM and 1026 (16%) had SAM. Median WHZ (-3.52 – 0.35) and rates of MAM (19 – 80%) and SAM (6 – 63%) varied among centers. Overall, 0.5% died in hospital and 1.2% had major post-operative infection. Odds of major infection (OR 1.07, 95% CI 0.89-1.29) and mortality (OR 1.18, 0.93-1.49) increased for each one unit decrease in WHZ. For the MAM group, odds of major infection (OR 1.50, 0.67-3.37) and mortality (OR 1.32, 0.50-3.49) were increased compared to those without malnutrition. For SAM, odds were higher, and were significant for major infection (OR 2.15, 1.01-4.56) and nearly so for mortality (OR 1.93, 0.98-3.77).Conclusions:Malnutrition is common in children undergoing VSD closure in low-resource settings and increases risk of major infection and death, especially in cases of SAM. Pre-operative nutritional repletion may be considered to reduce risk.

Circulation, Volume 146, Issue Suppl_1, Page A12333-A12333, November 8, 2022. Introduction:There are many reports on the effects of on-treatment platelet reactivity using P2Y12reaction units (PRU) on the ischemic or bleeding risk in patients who underwent percutaneous coronary intervention (PCI). However, there was little report including low-dose prasugrel (2.5mg).Hypothesis:We assumed that low-dose prasugrel use may contribute to the effectiveness and safety in the chronic phase of PCI in Japanese patients.Methods:This prospective observational study included 398 patients who underwent PCI between 2017 and 2018 (mean age: 68±11 years, male: 83%). Serial PRU measurements were performed; the baseline was at 6 to 12 months after PCI, and the follow-up was after 6 months later. The PRU was measured by the VerifyNow® P2Y12assay, and we assessed the distribution of PRU in each P2Y12inhibitor, after defined PRU 86 to 238 as therapeutic window.Results:Among 398 patients, the follow-up PRU was obtained in 360 patients (90%), and 80 patients (22%) were taking prasugrel 2.5mg. The baseline PRUs of clopidogrel 75mg, prasugrel 3.75mg, and prasugrel 2.5mg were 175±64, 147±55, and 154±66, respectively (p

Circulation, Volume 146, Issue Suppl_1, Page A15478-A15478, November 8, 2022. Introduction:We present a case of spontaneous retroperitoneal bleed that presented as back pain until it required multiple transfusions.Case presentation:A 66-year-old gentleman with past medical history of only dyslipidemia, presented with chest pain and was found to have an anterior wall ST-elevation myocardial infarction. He underwent stenting to proximal LAD and was found to be in cardiogenic shock with elevated biventricular filling pressures and ejection fraction of 5-10%. IABP was inserted, which had to be upgraded to axillary Impella 5.5 the next day, and LVAD workup was initiated. He gradually improved with decreasing Impella needs when he started complaining of back pain 5 days into his admission. At the same time, his Impella requirements started to go up. He went on to develop sweating, pallor & hemodynamic compromise. Since he was on anticoagulation due to Impella, a CT scan was obtained, which showed a spontaneous left-sided retroperitoneal bleed (F1) (IABP had been on the right side) and drop in hemoglobin from 15.8 mg/dl on admission to 7.2 mg/dl. He went on to develop hemorrhagic shock requiring massive blood product transfusion with subsequent vessel embolization by interventional radiology. Afterwards, he continued to improve, and Impella was eventually removed. Later in the course, he had another drop in hemoglobin & was taken back for CT, which showed expanding retroperitoneal hematoma (F2). Hematology team was consulted due to 2 spontaneous bleeds; however, no underlying bleeding disorder was suspected. He stabilized; was weaned off of Impella and, was subsequently discharged on milrinone infusion.Conclusions:We conclude that providers highly suspect retroperitoneal bleeds in the proper clinical setting for optimum patient care.

Circulation, Volume 146, Issue Suppl_1, Page A10484-A10484, November 8, 2022. Introduction:Carotid plaque is recommended for cardiac risk stratification for intermediate risk patients but has not been integrated into cardiology community clinics to help refine testing and reduce risk for major adverse cardiovascular events (MACE). The purpose was to determine the clinical usefulness of carotid plaque score (PS) to guide management of low-intermediate risk patients.Methods:Patients 40-75 years who received a carotid ultrasound were followed up to 10 years for MACE (cardiovascular death, myocardial infarction, stroke). Low-intermediate risk participants (n = 9,114) with no known cardiovascular disease were included. Administrative data holdings housed at IC/ES were used for event follow-up. Kaplan-Meier curves and Cox proportional hazard ratios determined relative risk. Combining plaque score (Rotterdam method, plaque presence within carotid segments, PS 0 to 6) with stress echo (SE) was assessed in a subset of participants (n = 624).Results:The optimum threshold for PS = 2 for 1-year MACE (AUC = 0.738). The population rate of MACE over 10 years was 4%. In participants referred for SE, PS of

Circulation, Volume 146, Issue Suppl_1, Page A11108-A11108, November 8, 2022. Introduction:High-sensitivity cardiac troponin (hs-cTn) assays were first approved for use in the U.S. in 2017. They are the guideline preferred biomarker to evaluate patients with acute chest pain. Few data exist regarding implementation of hs-cTn assays in the U.S.Hypothesis:We hypothesize that use of hs-cTn assays has increased over time and that patients assessed with hs-cTn have a shorter length of stay (LOS) and similar use of cardiac testing.Methods:We examined trends in implementation of hs-cTn assays among participating hospitals in the NCDR Chest Pain MI Registry from 1/1/2019 through 9/30/2021. Excluding STEMI patients, associations between hs-cTn use, in-hospital diagnostic imaging, and patient outcomes were assessed using logistic or negative binomial regression models.Results:Among 550 participating hospitals with 251,000 patients in the registry, implementation of hs-cTn assays increased from 3.3% in Q1, 2019 to 32.6% in Q3, 2021 (Ptrend

Circulation, Volume 146, Issue Suppl_1, Page A13682-A13682, November 8, 2022. Introduction:Cardiac lipomas are rare primary cardiac tumors. Depending on the location, they can present with vague symptoms such as chest pain, palpitations, dizziness, or arrhythmias.Case Presentation:A 58 y.o. female with a PMH of HLD and HTN presents for evaluation of chest pain and palpitations. An initial CvCTA was negative for significant CAD. A TTE showed a 1.6cm x 1.42 cm echolucent mobile mass attached to the lateral wall of the LV (Figure 1.A). Initially, there was a reasonable concern for an LV thrombus. However, it was unusual since the TTE revealed a normal EF and overall wall motion. Due to suspicions of a non-thrombus LV mass, a cardiac MRI was performed which showed a highly mobile mass attached to the mid anterior/anterolateral wall and a chordae within the LV cavity (Figure 1.B, Figure 1.C). The lesion was T2-hyperintense with loss of signal during fat suppression, highly suspicious for a lipoma. Given the mass mobility and strong patient preference, an elective robotic surgical resection was performed with a surgical biopsy confirming a lipoma (Figure 1.D).Discussion:Cardiac lipomas are often silent; however, symptoms can range from benign palpitations to life-threatening arrhythmias and outlet obstruction. TTE is typically the first-line imaging choice, followed by either cardiac CT or MRI imaging used for further diagnostic evaluation. Treatment options include conservative observation or prophylactic resection for asymptomatic patients, and therapeutic resection for symptomatic patients.Conclusion:Cardiac lipomas should be considered in the differential for any cardiac mass. TTE is the first-line imaging choice followed by a cardiac CT or MRI. Treatment remains a discussion between the patient and physician, varying from conservative management of symptoms to definitive treatment with surgical resection.

Circulation, Volume 146, Issue Suppl_1, Page A11952-A11952, November 8, 2022. Introduction:Around 80% of patients with atherosclerotic cardiovascular disease (ASCVD) do not achieve adequate reduction of low-density lipoprotein cholesterol (LDL-C) in current clinical practice, especially among patients on statin monotherapy. Greater understanding of attributes favored by prescribing physicians may improve treatment outcomes.Methods:To understand attributes of putative statin ‘add-on’ LDL-C lowering therapies, we conducted a discrete choice experiment survey of 200 U.S. cardiologists and 50 primary care physicians (PCPs). The survey presented a series of discrete choices to respondents, systematically varied across 8 treatment attributes: % LDL-C reduction, myalgias, other side effects, route and frequency of administration, time to prior authorization, patient out-of-pocket cost (OOPC) and adherence. Data were analyzed using logistic regression with clustering and heterogeneity adjustments to estimate preference weights for each attribute.Results:Both cardiologists and PCPs most valued efficacy in LDL-C reduction, with odds ratio (OR) for treatment preference of 1.69 per additional 10% reduction in LDL-C, and minimization of monthly OOPC with OR of 0.90 per $10 increase. Cardiologists preferred injectable therapies, with 57.5% of respondents preferring a drug with attributes of a small interfering RNA (siRNA) injectable and 16.4% preferring attributes of a proprotein convertase subtilisin kexin type 9 inhibitor (PCSK9i) biologic over oral ezetimibe therapy, as compared to only 2.8% preference for siRNA injectable among PCPs vs. oral therapy. Across all respondents, preference for injectables was higher for patients with history of nonadherence, with 55.7% preferring a drug with health-care practitioner-based injection every 6 months and 25.4% preferring a drug with properties of monoclonal antibody-based home injections once or twice monthly.Conclusions:Results indicate LDL-C lowering efficacy is a primary driver of physician prescribing preferences, with PCPs placing increasing consideration on OOPC. For patients with suboptimal adherence – the majority of those seen in clinical practice – U.S. physicians are more likely to prefer less-frequent injectable to oral therapies.

Circulation, Volume 146, Issue Suppl_1, Page A14149-A14149, November 8, 2022. Introduction:High power radiofrequency ablation (RFA), a novel technique, is recently being employed for pulmonary vein isolation (PVI) for atrial fibrillation (AF). This study aimed to report our center’s procedural data and preliminary results of a high power RFA technique for AF without fluoroscopic guidance.Methods:Symptomatic AF patients were consecutively enrolled in this prospective observational study and underwent PVI. Ablation index (AI) was marginally used for at least 400 on the posterior wall and 500 on the anterior wall or 15 seconds total at 50 Watt ablation power, whichever came first. Contact-force catheter and esophageal temperature was used during the procedure. Post-ablation esophageal endoscopy was utilized. PVI was performed using CARTO and the ST SF D/F curve ablation catheter in a temperature-controlled mode.Results:PVI was achieved in all (n = 36, mean age: 68±11.3 years, female: 29%, CHADsVASc: 2.8±1.5, LA volume index:60.4±17.2 mL/m2). 29(80%) patients had paroxysmal AF. For left wide antral circumferential ablation (WACA); total duration was 7.4±11.3 min, total ablation sites were 49.9±11.2, average contact force was 9.97±2.2 g and average AI was 363.9±20.5. For right WACA total duration was 6.4±2 min, total ablation sites were 45.6±15.3, average contact force was 13.0±3.5 g and average AI was 403.6±32.9. WACA technique was employed for paroxysmal AF, additional ablation lines were targeted for persistent AF. For the entire flouro-less, 50W study population, average AI was 382.2±26.6, total ablation duration was 18.1±4.7 min, total ablation sessions were 118.4±33.4 and average temperature was 38.7±1.4 degree Celsius. During in-hospital follow-up no major complications such as death, stroke, tamponade, or atrio-esophageal fistula occurred.Conclusions:50 watts fluoro-less AF RFA is a safe and efficient procedure.

Circulation, Volume 146, Issue Suppl_1, Page A15317-A15317, November 8, 2022. Case Presentation:A 42-year-old male with a past medical history of recurrent myopericarditis treated with a combination of NSAIDs, colchicine, and steroids presented for left-sided chest pain. The pain first recurred when he attempted a prednisone taper and he was started on Anakinra. Upon presentation, physical examination and laboratory findings were within normal limits. Echocardiography and electrocardiogram were within normal limits. Cardiac magnetic resonance imaging (CMR) showed transmural enhancement of the basal-mid inferolateral segments and patchy mid-myocardial enhancement in the basal-mid anterolateral segments. Nuclear medicine PET showed FDG uptake in the basal anteroseptal, anterolateral, inferolateral, inferior, and apical segments suggestive of active inflammation. Initially, the diagnosis was thought to be recurrent myopericarditis of unknown etiology. Subsequent right heart catheterization with endomyocardial biopsy (EMB) showed mononuclear infiltrates in the interstitium associated with myocyte infiltration and focal moderate interstitial fibrosis. Due to his clinical, imaging, and pathologic findings, he was diagnosed with lymphocytic myocarditis. His anti-inflammatory therapy regimen was reinstated, and he was started on Mycophenolate Mofetil. On follow-up, the patient had significant symptomatic improvement.Discussion:Lymphocytic myocarditis is a pattern of myocardial inflammation that is typically associated with autoimmune and idiopathic causes. Myocarditis frequently manifests with signs and symptoms of heart failure, including chest pain, dyspnea, and arrhythmias. Diagnosis of myocarditis is often supported by CMR and FDG-PET findings, however, EMB is the gold standard for the diagnosis of myocarditis. Treatment is generally supportive, though immunomodulatory therapies have gained increased popularity due to benefits in treating symptoms and preventing complications of heart failure.

Circulation, Volume 146, Issue Suppl_1, Page A14329-A14329, November 8, 2022. Background:Cardiac tamponade is a potentially fatal complication of catheter ablation for atrial fibrillation (AF). The risk of cardiac tamponade during AF ablation in underweight patients has never been investigated. This study aimed to evaluate the impact of body mass index (BMI) on the prediction of cardiac tamponade during AF ablation.Methods:Patients who underwent catheter ablation for AF between April 2016 and March 2018 were analyzed using a Japanese nationwide claims database, the Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination (JROAD-DPC). Mixed-effects multivariable logistic regression analysis was performed to investigate the association between BMI and cardiac tamponade.Results:A total of 59,807 hospitalizations (median age: 67 [60-73], 29% women) with catheter ablation for AF were analyzed. Cardiac tamponade occurred in 657 patients (1.1%). Multivariable analysis revealed that being underweight (BMI

Circulation, Volume 146, Issue Suppl_1, Page A14221-A14221, November 8, 2022. Introduction:Cardiac amyloidosis (CA) is an increasingly recognized cause of heart failure. Novel therapies for transthyretin (TTR) CA elevate the need for early identification when treatment has the greatest efficacy. The TTR CA score (TCAS) was recently developed to predict the likelihood of TTR CA in patients undergoing 99mTc-pyrophosphate scintigraphy (PYP) scanning. Its simple inputs could be easily extracted from the electronic health record (EHR), suggesting possible use as a quick, EHR-based screening tool. We perform the first external validation of the TCAS using only EHR-extracted data. We hypothesized that a screening algorithm like TCAS could be generalizable and feasible to implement using our EHR.Methods:EHR data were extracted on all patients at a large academic medical center who underwent PYP scans between 2017 and 2022. PYP scan was considered positive if the patient was part of our institution’s registry of patients with confirmed CA. Inputs – age, sex, echocardiogram wall thickness and ejection fraction, and hypertension diagnosis codes – were converted to TCAS scores. Area under the receiver operating characteristic curve (AUROC) was calculated to analyze predictive performance. Using a TCAS ≥6 as the threshold for high-risk, performance characteristics were calculated.Results:Of 365 patients who underwent PYP scan, 335 had sufficient records to calculate a TCAS. Of these 335 patients, 69 (20.6%) had positive PYP scans. Median TCAS was 5 (interquartile range 4,7). The AUROC was 0.826, with a sensitivity of 87.0%, specificity of 63.9%, positive predictive value of 38.5%, and negative predictive value (NPV) of 95.0%.Conclusions:External validation of the TCAS supports its strong predictive performance with comparable AUROCs to the initial study (0.84-0.89). Clinically, with its high NPV, the TCAS has potential to serve as a simple, low-cost screen to avoid costly PYP scans. We demonstrate the ability to extract all inputs from the EHR, without need for manual chart review or calculation, suggesting that the TCAS could function as an EHR-based screening tool. Low-cost screening tools are needed to identify patients who would benefit from TTR CA workup with PYP scanning, facilitating treatment at earlier disease stages.

Circulation, Volume 146, Issue Suppl_1, Page A11270-A11270, November 8, 2022. Introduction:Sodium-glucose co-transporter2 inhibitors (SGLT2i) showed benefit in major cardiovascular diseases characterized by low-grade inflammation. However, the role and function of SGLT2 in the heart remain unclear.Hypothesis:This study evaluated whether SGLT1/2 are expressed in the heart of patients with cardiac diseases, and determined the role of low-grade inflammation and the functional consequences.Methods:Human left ventricle (LV) biopsies were collected from 17 patients with aortic and mitral valves stenosis or hypertrophic cardiomyopathy at Strasbourg Hospital. Cultured endothelial cells (EC) were from pig coronary arteries. Expression levels were assessed by RT-qPCR, Western blot analysis and immunofluorescence staining, and the level of oxidative stress and nitric oxide (NO) using fluorescent probes.Results:SGLT1/2 protein levels were observed in the LV of cardiac patients and correlated p-p65 NFκB levels. SGLT2, VCAM-1 and TNF-α staining was observed in the endothelium of coronary microvessels and, to some extent, cardiomyocytes. TNF-α upregulated SGLT1 and 2, VCAM-1, AT1R and ACE expression and decreased that of eNOS and the bradykinin-stimulated NO formation in EC. The stimulatory effect of TNF-α was inhibited by an NF-kB inhibitor and SGLT2 siRNA but not by SGLT1 siRNA. Oxidative stress in LV sections and TNF-α-treated EC was inhibited by VAS-2870 (NADPH oxidase inhibitor), losartan (AT1R antagonist) and empagliflozin (SGLT2i), and in LV by infliximab (TNF-α receptor inhibitor).Conclusions:The findings indicate that SGLT2 is expressed in the LV of cardiac patients in the coronary endothelium and cardiomyocytes, and associated with their low-grade inflammatory status. Moreover, TNF-α upregulated the AT1R/NAPDH oxidase/SGLT2 crosstalk to sustain oxidative stress promoting endothelial dysfunction. Thus, SGLT2 appears as an interesting target to protect the coronary microcirculation.

Circulation, Volume 146, Issue Suppl_1, Page A14056-A14056, November 8, 2022. Introduction:Isolated very low QRS voltage (VLV; ≤ 0.3mV) on frontal leads on the electrocardiogram (ECG) has been shown to predict recurrence of neurally mediated syncope (NMS). In most patients VLV occurs in only one isolated ECG lead, however a small number of patients have ≥ 2 leads with VLV (Figure A), the significance of this pattern being unknown.Hypothesis:The aim of the study was to explore the potential relationship between the number of frontal leads with VLV and NMS recurrence.Methods:We included 268 patients with NMS (age 48±20 years, 150 women), with a median of 3 syncopal episodes who were followed for a median of 12 months.Results:Very low voltage was present in one frontal lead in 98 patients (37%), in 2 leads in 16 patients (6%), and in 3 leads in 1 patient (0.4%). Patients with VLV in multiple frontal leads had significantly smaller left ventricular end diastolic diameter (LVEDD) and left ventricular systolic diameter (LVESD) than patients with no VLV (42.8±3.9mm vs. 45.6±5.2mm; p = 0.029, and 27.7±3.9mm vs. 30.3±5.0mm; p = 0.049, respectively). During follow-up 69 patients (26%) experienced recurrent syncope. The actuarial total syncope recurrence rate increased progressively with the number of frontal leads displaying VLV (log rank test chi2=34.78; p < 0.0001; Figure B). Multiple frontal leads with VLV was associated with a relative risk of syncope recurrence of 5.5 in univariate analysis. Multivariate Cox regression revealed that the number of frontal leads displaying VLV predicted recurrent syncope (HR 1.83, 95%CI 1.28-2.62) in a model that included history of presyncope and syncope (HR 3.43, 95%CI 1.77-6.65) and LVEDD (HR 0.94, 95%CI 0.89-0.99).Conclusions:Very low voltage in multiple frontal leads is rare. If this pattern occurs, it is associated with a high risk of recurrent NMS. This phenomenon, which appears to be related at least partially to a smaller LV cavity size, may help generate new diagnostic tools and insights into the pathogenesis of NMS.

Circulation, Volume 146, Issue Suppl_1, Page A15388-A15388, November 8, 2022. Background:Patients with heart failure (HF) commonly remain symptomatic after medical treatment. Symptoms are associated with rehospitalizations and mortality. We developed a 6-month nutrition intervention targeting the 3 most common HF symptoms: edema, shortness of air, and fatigue. The intervention involves 3 nutrients that target the pathologic pathways underlying symptoms: sodium, omega-3 fatty acids, and lycopene.Hypothesis:Time to first event will be longer in the nutrition intervention group than in the placebo group at 1-year follow-up.Methods:This was a randomized controlled double-blind clinical trial where 118 patients (mean age 63±12 years; 40% female; 64% NYHA class III or IV) with HF were randomized to active intervention vs placebo groups. The active intervention included a skill-building strategy based on Theory of Planned Behavior using Motivational Interviewing. It included a low sodium (LS) diet (2500mg sodium/day), lycopene supplementation daily (8 ounces [oz] of LS sodium tomato juice or 11.5 oz of LS V8 juice), and omega-3 fatty acid capsules (350mg EPA, 50 mg DHA/capsule) 3/meal with each meal. Placebo patients received generic instructions to follow a LS diet, 8 oz/day of fruit juice with no lycopene (e.g. cranberry juice) and capsules that contained soybean oil, but that looked like intervention capsules. Cox proportional hazards modeling was done to determine time to event of cardiac hospitalization or death based on intervention group. Models were adjusted for age, gender, NYHA class and HF medications.Results:The two groups were similar at baseline. The active intervention group had better event-free survival (Figure, p = 0.03) independent of covariates. Placebo patients were 2.2 (95% CI 1.025 – 4.584) times more likely to experience an event.Conclusion:A diet-based intervention aimed at the pathologic pathways underlying the 3 most common HF symptoms is successful in reducing cardiac rehospitalizations and mortality.

Circulation, Volume 146, Issue Suppl_1, Page A13079-A13079, November 8, 2022. Introduction:Glycosylated apolipoprotein J (ApoJ-Glyc) has been suggested to be a marker for the early detection of myocardial ischemia. Ischemia induces an intracellular accumulation of non-glycosylated ApoJ that mirrors a reduction in ApoJ-Glyc serum concentration in acute ischemic syndromes.Objective:The EDICA clinical trial – multi-centre, international, diagnostic study (NCT04119882)- was carried out to assess the performance of ApoJ-Glyc as a biomarker for the early detection of myocardial ischemia in patients attending the A&E department with chest pain suggestive of acute coronary syndrome (ACS).Methods:EDICA assessed 404 patients. Blood samples were obtained on admission, for assessment of high sensitivity-troponin (hs-Tn) and ApoJ-Glyc. ApoJ-Glyc serum levels were analyzed with a novel ELISA, targeting a specific glycosylated variant of ApoJ (ApoJ-GlycA6).Results:Based on clinical diagnostic tests, 291 patients were given a final diagnosis of “non-ischemic” event and 113 patients were considered to have had an ischemic event (33 STEMI, 48 NSTEMI, 27 Unstable Angina and 5 “unclassifiable” ACS). ApoJ-GlycA6 levels were significantly lower on admission in ischemic patients, compared with non-ischemic patients (66 [46-90]vs.73 [56-95] μg/ml, respectively; P=0.04). Ischemic patients who underwent PCI and had a pre-PCI TIMI 0-2 flow showed significantly lower ApoJ-GlycA6 levels at admission compared with non-ischemic patients (64 [37-81]vs.73 [56-95] μg/ml; P=0.01). Of interest, 51% of ischemic patients, had “inconclusive” or negative hs-Tn at admission. Among these, ApoJ-GlycA6 identified the ischemic event in 48% (

Circulation, Volume 146, Issue Suppl_1, Page A15393-A15393, November 8, 2022. Introduction:In 2015, the American Heart Association revised the Jones Criteria, the gold standard for diagnosis of acute rheumatic fever (ARF). This revision included changes to increase the sensitivity for ARF in high-risk settings. The objective of this study was to determine if there were children who were found to be ARF-negative by strict application of these criteria in a high risk setting but found to have rheumatic heart disease (RHD) on follow-up evaluation.Methods:Between 2017 and 2020, we conducted an epidemiological study to determine the incidence of ARF in Uganda. Children and adolescents, 3-17 years, presenting with clinical concern for ARF (fever and joint pain, suspicion of carditis, or suspicion of chorea) were enrolled and evaluated using the Jones Criteria. Children ultimately found to have a laboratory-confirmed alternate diagnosis and those who did not meet ARF criteria but had an unknown final diagnosis, were asked to participate in a longitudinal echocardiographic follow-up study to monitor for development of RHD. Presence of RHD was considered a false negative test and used to calculate the false negative error of not receiving a diagnosis of ARF.Results:There were 351 children determined to have an alternate diagnosis during the study period; 180 with a laboratory confirmed final diagnosis (127 malaria, 20 non-rheumatic cardiac disease, 15 influenza, 18 other) and 171 with an unknown final diagnosis. Of these, 220 (62.7%) had at least one follow-up visit (median 366 days, range 10-1054). One child (1/220,