Risultati per: Scoperte le cause biologiche della depressione

In an observational study, 9% of outpatient COPD exacerbations were caused by RSV infections.

Circulation, Volume 150, Issue Suppl_1, Page A4145889-A4145889, November 12, 2024. Background:Pulmonary Artery Elastance (PAE) is an echocardiographic value commonly calculated in Heart Failure (HF) patients. It is presumed to be associated with mortality and adverse outcomes. We aim to evaluate pulmonary artery elastance (PAE) as a predictor of all-cause mortality in heart failure (HF) patientsMethods:A comprehensive literature review was conducted on PubMed and Google Scholar from inception till May 2024 for articles relevant to the mortality outcomes in HF patients with respect to pulmonary arterial elastance as one of their predictors. Data were extracted independently by four different reviewers. We used a fixed-effects model meta-analysis model to evaluate and pool the outcomes in association with PAE and all-cause mortality. Further assessment of the outcomes was performed by sensitivity analysis with a one-study removal method and meta-regression analysis.Results:Out of 63 studies, 4 studies with 759 patients were included in our meta-analysis. Mean age ranged from 54 to 65 years. We found there was a statistically significant association between pulmonary artery elastance and all-cause mortality (OR: 1.12, 1.06 – 1.19, p < 0.0001] (Figure 1a). Sensitivity analysis with one-study removal showed overall effects in the meta-analysis still lean towards supporting PAE as the predictor for ACM (Figure 1b). Meta-regression analysis with age (Figure 1c), sex and other supportive variables did not show statistically significant associated confounders.Conclusion:This meta-analysis establishes a significant association between elevated PAE and increased risk for all-cause mortality in HF patients. These results suggest PAE could be a strong predictor for all-cause mortality in HF patients. Further research is needed to provide a more comprehensive understanding of the predictive value of PAE for HF patients. The association between PAE and mortality could provide significant insights that could influence clinical practice and improve patient outcomes in HF.

Circulation, Volume 150, Issue Suppl_1, Page A4144514-A4144514, November 12, 2024. Introduction:Human Immunodeficiency Virus Associated Cardiomyopathy (HIVAC) is characterized by left ventricular (LV) systolic or diastolic dysfunction with or without LV dilatation and heart failure symptoms. The introduction of antiretroviral therapy (ART) has changed the fulminant systolic heart failure presentation of HIV myocarditis to diastolic heart failure. We present a unique case of dilated cardiomyopathy in a young patient without advanced HIV illness which has rarely been documented in the literature. This is a rare presentation of HIVAC in the post-ART era.Case Report:A 32-year-old male with a past medical history (PMH) of the human immunodeficiency virus (HIV) presented with complaints of new onset worsening shortness of breath and lower extremity edema for four weeks. He was diagnosed with HIV seven years ago and was not compliant with ART. Laboratory testing showed a cluster of differentiation 4 (CD4) 823 and HIV load 2550. Myocarditis was ruled out by normal troponin levels and no new changes on the electrocardiogram (ECG). Transthoracic echocardiogram (TTE) showed dilated left ventricle (LV), LV global hypokinesis, LV ejection fraction (LVEF) 10-15%, dilated right ventricle, biatrial dilation, moderate to severe mitral regurgitation, severe tricuspid regurgitation, pulmonary artery (PA) systolic pressure 73 mmHg and no pericardial effusion. Coronary angiography was negative for coronary artery disease (CAD). The patient was started on carvedilol and outpatient evaluation for a left ventricular assistance device.Discussion:Systolic dysfunction in patients with HIVAC carried a poor prognosis in the pre-ART era and was common in patients with elevated c-reactive protein (CRP), tobacco use, and previous myocardial infarction (MI). After the advent of ART, systolic dysfunction is rare and replaced by diastolic cardiomyopathy in the setting of ART use. Diagnosis is usually by excluding other etiologies and biopsy is not necessarily required. Management is usually guideline-directed medical therapy (i.e. beta blocker, renin-angiotensin-aldosterone antagonists, sodium-glucose cotransporter-2) and device-based therapy but there is still data lacking to assess its benefit.

Circulation, Volume 150, Issue Suppl_1, Page A4124931-A4124931, November 12, 2024. Background:The AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score has been introduced to predict all-cause death (ACD) in patients with heart failure. There is no information available on the utility of this score for the prediction of ACD in patients with coronary artery disease (CAD).Hypothesis:The AHEAD score may provide superior predictive value for ACD compared to the CHADS2score, which has been reported to be useful for predicting poor clinical outcomes in patients with acute (ACS) and chronic coronary syndromes (CCS).Methods:This retrospective multicenter cohort study analyzed data of the patients who underwent percutaneous coronary intervention for ACS or CCS between April 2013 and March 2019 using the Clinical Deep Data Accumulation System (CLIDAS) database. The AHEAD score was calculated by assigning 1 point each for atrial fibrillation, hemoglobin 130 μmol/L), and diabetes mellitus. The CHADS2score was calculated as previously reported. The study endpoint was ACD.Results:In total, 9,033 patients were enrolled (median age, 72 years; 77% male; 3,920 with ACS and 5,113 with CCS). Higher AHEAD or CHADS2scores were significantly associated with a higher rate of left main disease or three-vessel disease in both patients with ACS and CCS. In addition, after accounting for multiple variables using Cox multivariate analysis, both the AHEAD (hazard ratio [HR], 1.83 [95% confidence interval, 1.63–2.06] for ACS and 1.66 [1.49–1.85] for CCS) and CHADS2scores (HR 1.27 [1.15–1.40] for ACS and 1.23 [1.12–1.35] for CCS) remained significantly associated with ACD. However, receiver operating characteristic curve analysis for predicting ACD revealed that the predictive value of the AHEAD score was significantly higher than that of the CHADS2score in both ACS and CCS (Figure). A significant difference was found in the rate of ACD among patients stratified by the AHEAD score in both groups (bothP

Circulation, Volume 150, Issue Suppl_1, Page A4145877-A4145877, November 12, 2024. Background:Heat exposure is associated with an increase in cardiovascular mortality, particularly among older adults. Climate change has led to an increase in days with hot temperatures. The burden of hospitalizations associated with heat exposure is not well known.Methods:Data on all hospitalizations among Medicare beneficiaries 65 years of age and older in summer months (May through September) for 2016 to 2019 were obtained from Medicare Provider Analysis and Review (MEDPAR) files. Total daily cardiovascular and all-cause hospitalizations in each US county in the contiguous United States (US) were determined and daily county-level maximum heat index levels were obtained from the gridMET dataset. Counties with

Circulation, Volume 150, Issue Suppl_1, Page A4140452-A4140452, November 12, 2024. Background:The recent REDUCE-AMI trial showed no benefit to beta-blockers (BB) for patients post-myocardial infarction (MI) with preserved ejection fraction (EF≥50%). Target doses were metoprolol 100 mg and bisoprolol 5 mg daily (50% of the target doses used in the initial randomized clinical trials [RCTs] of BB post-MI).Research question:Do lower BB doses improve survival in post-MI patients with EF≥50%?Aims:To compare the effect of BB dose on all-cause mortality post-MI in patients with EF≥50%.Methods:This is a sub-study from the OBTAIN prospective multi-center registry. Of 7057 patients enrolled with acute MI, 3402 with EF≥50% were discharged alive (age:62.5±13.4 years, 67% male, 28% diabetics, length of stay 6.1±6.0 days). Discharge BB dose was indexed to the target daily BB dose used in RCTs, reported as %. Dosage groups were >0-12.5%, >12.5-25%, >25-50%, and >50% of the target dose. Follow-up vital status was obtained by chart review, Social Security Death Index, or direct contact up to 3 years post-MI. Kaplan-Meier (KM) method was used to calculate three-year survival. Cox proportional hazard regression model was used to identify significant predictors and conduct univariate and multivariate analysis.Results:The KM 3 year survival estimates were 89.0% and 84.3% for patients on and off BB, respectively (unadjusted hazard ratio (HR)=0.66, p=0.012; adjusted HR=0.52, p=0.18). The KM 3 year survival estimates(figure) were 89.8%, 91.0%, 87.9%, and 83.1% for patients on >0-12.5%, >12.5-25%, >25- 50%, and >50% of the BB target dose (unadjusted HR of 0.58, p=0.007; 0.58, p=0.003; 0.70; p=0.066; and 0.98, p=0.93), respectively, compared to no BB. After multivariate analysis, BB target dose showed similar trend, but not statistically significant (adjusted HR=0.65, p=0.46; 0.42, p=0.13; 0.53, p=0.31; 1.01, p=0.92).Conclusion:In OBTAIN, patients treated with low dose BB (≤25% of the target dose) had improved survival post-MI. As this dose was not studied in REDUCE-AMI, these findings are complementary and confirm only that high dose BB therapy provides no benefit post-MI in patients with preserved EF. RCTs to assess the benefit of low dose BB therapy post-MI with preserved EF are needed.

Circulation, Volume 150, Issue Suppl_1, Page A4145015-A4145015, November 12, 2024. Case Presentation:A 98-year-old female with hypertension, atrial fibrillation on Metoprolol succinate 100 mg daily, and stage 3a chronic kidney disease presented to the emergency department with altered mental status. On arrival, her heart rate was 30 BPM and blood pressure was 79/47 mmHg. Physical examination revealed lethargy, bradycardia, and cool extremities. An electrocardiogram showed junctional bradycardia at 36 BPM with a known right bundle branch block. Laboratory tests indicated shock with elevated lactic acid (2.6 mmol/L), creatinine (1.71 mg/dL from a baseline of ~1.20 mg/dL), transaminitis (aspartate transaminase 68 U/L, alanine transaminase 79 U/L), and hyperkalemia (potassium 6.1 mmol/L). The diagnosis of BRASH syndrome was made based on bradycardia, renal dysfunction, AV nodal blockade, shock, and hyperkalemia. Due to concerns of cardiogenic shock resulting from profound bradycardia, an intravenous dopamine infusion was initiated, and the patient was transferred to the cardiac critical care unit. She responded to medical management addressing hyperkalemia and bradycardia, and did not require renal replacement therapy or pacemaker placement. Following these interventions, her mental status, vital signs, and signs of end-organ damage rapidly improved. The patient was downgraded and subsequently discharged with close cardiology follow-up.Discussion:This case highlights the under-recognized diagnosis of BRASH syndrome as a cause of cardiogenic shock. BRASH syndrome, an acronym for Bradycardia, Renal failure, AV node blockers, Shock, and Hyperkalemia, is typically observed in patients on AV nodal blocking medications. The proposed pathophysiology involves an acute kidney injury, often precipitated by dehydration in elderly patients with preexisting kidney disease. The renal impairment leads to hyperkalemia and accumulation of AV nodal blocking medications like beta-blockers, which act synergistically to produce significant bradycardia. This results in substantial cardiac shock, further worsening renal perfusion and fueling a vicious cycle. Clinicians should recognize the combination of features rather than focusing solely on individual components of the syndrome. Immediate recognition and initiation of advanced measures such as inotropic support can reverse the underlying disease process and lead to a promising recovery. BRASH syndrome, though rare, is a rapidly reversible cause of cardiogenic shock if promptly identified and managed.

Circulation, Volume 150, Issue Suppl_1, Page A4140078-A4140078, November 12, 2024. Background:Extreme heat events have increased in frequency and intensity and are projected to continue increasing due to climate change. Extreme heat is associated with an increase in both all-cause and cardiovascular (CV) mortality. However, how extreme heat impacts CV disease related emergency department (ED) visits is not well studied.Methods:Data on all ED visits among adults 20 years and older from 16 US states in summer months (May through September) for 2010 to 2018 were obtained from State ED all-payer claims databases. After determining the monthly number of ED visits in each county, the county-level monthly number of extreme heat days was determined. Extreme heat days were defined as any day with a maximum heat index ≥90°F (32.2°C) and in the 97.5thpercentile based on a county-specific historical period (1979-2007). CV ED visits were identified using ICD-10 diagnostic codes (I00-I99). A Poisson fixed effects regression model with county, year, and month fixed effects was estimated with monthly ED visits as the outcome and the monthly number of extreme heat days as the primary predictor of interest. Environmental, economic, and demographic variables were also included in the model. Excess ED visits were estimated as the difference between the number of visits, in each county, with the observed number of extreme heat days and the estimated number of visits if no extreme heat days had occurred.Results:There were approximately 91 million all-cause and 1.5 million CV ED visits across 985 counties during summer months in 2010 to 2018. The population-weighted, total median number of extreme heat days over the study period was 79 (IQR 63-98). From 2010-2018, each additional extreme heat day per month was associated with a 0.21% (95% CI 0.02-0.41,p=0.03) increase in monthly CV ED visits and a 0.20% (95% CI 0.06-0.35,p=0.006) increase in monthly all-cause ED visits. The estimated number of extreme heat associated excess CV ED visits over the study period was 5658.4 (95% CI 525.0-10791.9). The estimated number of excess all-cause ED visits was 329055.4 (95% CI 95625.4-562485.4)Conclusion:Extreme heat was associated with an increase in CV and all-cause ED visits in 16 states in the US between 2010 and 2018. As extreme heat events continue to increase, understanding how this will impact emergency departments and health systems across the country is important to be able to devise strategies to address the associated increase in utilization.

Circulation, Volume 150, Issue Suppl_1, Page A4140995-A4140995, November 12, 2024. Background:Coil-less ultrasonic vaping devices like Surge use an ultrasonic chip that vibrates at several million Hz, aerosolizing the e-liquid. They are advertised as emitting significantly lower levels of toxins than coiled e-cigs by heating to lower temperatures that produce fewer chemical breakdown products. We tested the hypothesis that ultrasonic e-cigs cause less adverse cardiac effects than coiled e-cigs.Methods:We exposed 3 groups of conscious Sprague Dawley rats (n=8/group) to aerosol from JUUL (Virginia Tobacco 5% nicotine), Surge (Rich Tobacco 18 mg/ml nicotine), or air. Pulsatile exposure consisted of 10 consecutive cycles, each consisting of 2s exposure to aerosol followed by 28s of clean air, over 5 min, for 9 weeks using a Gram Research universal vaping machine. Hearts were then isolated, sectioned, and stained for left and right ventricular fibrosis with Sirius Red. Temperature profiles for the Surge ultrasonic vaping device were obtained at the California Department of Public Health (CDPH) via a single point thermocouple probe.Results:Temperature profiles of Surge during one session of aerosol production (with airflow) showed temperatures not exceeding 132 degrees Celsius. (We previously reported that the USONICIG Zip ultrasonic vaping device with air flow heated to ~77 degrees Celsius; reported temperatures of coiled e-cigs are up to 300 degrees Celsius.) Fibrosis was significantly increased in the JUUL group compared to air (p=0.04). Mean fibrosis in the Surge group was comparable to that in the JUUL group (p=0.84) and was higher than air fibrosis but did not reach significance (p=0.15), potentially due to high variability of Surge values.Conclusion:Temperature profiles of ultrasonic vaping devices are substantially lower than those of coiled vaping devices, with Surge being warmer than USONICIG Zip under airflow conditions. Despite lower temperatures, ultrasonic vaping devices cause a comparable level of cardiac fibrosis to conventional coiled vaping devices. Therefore, Surge does not avoid the increase in cardiac fibrosis that we have reported for coiled e-cigs and for smoke from tobacco or marijuana.

Circulation, Volume 150, Issue Suppl_1, Page A4141427-A4141427, November 12, 2024. Introduction:In acute pulmonary embolism (PE), right ventricular (RV) remodeling and hemodynamic involvement using echocardiography data are associated with in-hospital prognosis. The impact on mid-term outcome of right atrial (RA), RV, left ventricle (LV), and left atrial (LA) involvement using myocardial deformation analysis is poorly evaluated.Hypothesis:We hypothesized that acute PE had a global impact on 4-heart cavities geometry and functions.Aims:We sought to evaluate the prognostic value at mid-term of myocardial strain of the 4-cardiac cavities in patients with acute PE.Methods:We retrospectively analyzed 488 patients hospitalized for acute PE. LV, LA, RA and RV strains were measured using speckle tracking transthoracic echocardiography (TTE) at admission. Primary outcome was mid-term all-cause mortality.Results:During a median follow-up of 3.6 (2.7-4.7) years, all-cause death occurred in 93 patients. At baseline, patients with the highest severity of PE, based on ESC risk score determination, had significantly lower LA (reservoir, conduit, contractile), RA (reservoir, conduit), LV (global, GLS) and RV (free wall) longitudinal strains (Figure 1). The optimal strain thresholds associated with mortality are displayed in Table 1: -19.1% for LV and RV, +36.4% for LA reservoir strain, +16.6% for LA conduit strain, +27.5% for RA reservoir strain, +16.0% for RA conduit strain. Kaplan Meier curves for cumulative hazards for all-cause death using strain parameters showed significant difference of survival according to LV GLS, RV free wall strain, LA and RA reservoir strains, LA and RA conduit strains (Figure 2).Conclusion:Beyond RV cavity remodeling and dysfunction, PE induces acute alteration of the 4-cardiac chambers strains. Strain analysis appears as an interesting tool in addition to conventional echocardiographic parameters to assess heart cavities dysfunction and predict mid-term outcome.

Circulation, Volume 150, Issue Suppl_1, Page A4141048-A4141048, November 12, 2024. Background:α1-antichymotrypsin (SERPINA3), high sensitivity C-reactive proten (hsCRP) and Pentraxin 3 (PTX3) are acute phase proteins triggered by inflammation. Hepatocytes are a primary source of SERPINA3 and CRP, while PTX3 is produced by a variety of tissues including endothelial cells. These inflammatory markers are upregulated after an acute myocardial infarction (AMI). Comparisons of their long-term prognostic value in acute coronary syndrome (ACS) patients by gender are scarce. We aimed to assess their long-term prognostic utility in females and males, respectively, hospitalized for chest pain of suspected coronary origin.Methods:A total of 871 consecutive patients (39.0% females) with a median age of 72.6 years (females 77.3, males 69.1) were admitted in the study. Of these, 386 were diagnosed with an acute MI based on Troponin-T (TnT) levels >50 ng/L. Stepwise Cox regression models, applying normalized continuous loge/SD values, were fitted for the biomarkers with total mortality within 7 years as the dependent variable.Results:At 7-year follow-up, 332 patients had died; 44.1 % females vs. 34.1 % males (χ2(1) = 9.368; p = 0.0022). Blood samples were available for analysis of SERPINA3, hsCRT and PTX3 in 847, 868 and 795 patients, respectively. There was no significant differences between the means of the sexes for SERPINA3 (p = 0.20), hsCRT (p = 0.84) and PTX3 (p = 0.068), respectively.None of the biomarkers predicted long-term outcome in females after multivariable adjustment (p=0.92, p=0.40 and p=0.57, respectively), but were good predictors in males [SERPINA3: HR 1.34 (95%CI 1.16-1.56), p=0.00001. hsCRP: HR 1.19 (95%CI 1.02-1.38), p=0.027. PTX3: HR 1.22 (95%CI 1.04-1.44), p=0.018]. Furthermore, the p-values for interaction would suggest a gender difference in the prognostic weighting, favoring SERPINA3 (p=0.015) and to a lesser degree hsCRP (p=0.074) and PTX3 (p=0.14).Conclusion:SERPINA3, hsCRT and PTX3 are good predictors of long-term all-cause mortality in males admitted with chest pain of suspected coronary origin, but were not shown to predict outcome among females of that population. The prognostic utility of the studied inflammatory biomarkers may essentially be related to males.

Circulation, Volume 150, Issue Suppl_1, Page A4136518-A4136518, November 12, 2024. Background:Beta blockers (BB) and particularly high dose beta blockers might be beneficial for patients with heart failure with preserved ejection fraction (HFpEF), however their use is often limited by commonly coexisting sinus node dysfunction. It is unclear whether the presence of permanent pacemakers (PPM) allows for adequate therapy with BB which in turn confers a mortality benefit.Objective:We sought to evaluate differences in BB treatment between HFpEF patents with and without PPM and evaluate their effect on outpatient mortality.Methods:We identified patients admitted to 1 of 13 Northwell hospitals receiving intravenous diuretics in response to elevated BNP and included in our analysis only those with left ventricular ejection fraction >45%. Status on BB therapy and presence of PPM was assessed at discharge. The vital status of our cohort was identified for the length of the observation period.Results:Of 17,682 patients (42.8% female, 73.5 ± 15.7 years) admitted for HFpEF, 7,910 (44.7%) were discharged on BB, while PPM was present in 397 (2.3%). Treatment with BB was more common among patients with PPM (51.4% vs 48.6%, p=X). There were 1,316 deaths during a follow-up period of 2.4 ± 0.9 years post index admission. Mortality was highest among patients discharged on a BB without PPM and lowest among patients on both BB and PPM (log rank p=0.003)Conclusion:Additional studies are required to assess the complimentary role of pacing and BB therapy in patients with HFpEF.

Circulation, Volume 150, Issue Suppl_1, Page A4136145-A4136145, November 12, 2024. Background:A report evaluating all-cause mortality in 30 major U.S. cities documented that inequality between Black and White populations in Washington, D.C. was the greatest. However, little is known about disparities in cause-specific mortality over time or by racial groups.Aims:Evaluate trends in all-cause and cause-specific mortality in D.C. from 2000 to 2020 by race, and concurrently examine trends in cardiovascular (CV) risk factors.Methods:Using the CDC WONDER database, we calculated age-adjusted mortality rates per 100,000 persons (2000-2020) for Non-Hispanic Black and Non-Hispanic White populations in D.C. and corresponding rate ratios. Average Annual Percentage Change (AAPC) was examined with joinpoint regression. We examined the prevalence of risk factors (obesity, hypertension, diabetes, smoking, and hypercholesterolemia) using the Behavioral Risk Factor Surveillance System (2000-2020).Results:Among 102,710 deaths that occurred in D.C. (80% Black), cardiovascular diseases (CVD, 32%) and cancer (22%) accounted for over half of the deaths. All-cause mortality declined between 2000-2012 (AAPC: -2.9%, 95% CI: -5.6, 1.0) but stagnated between 2012-2018 (AAPC:-1.1%, 95% CI: -4.6, 0.9) and increased after 2018 (AAPC: 7.7%, 95% CI: 0.6, 11.9). CVD mortality declined between 2000-2011 and plateaued thereafter among Black individuals, contrasting with a monotonous decline (AAPC: -4.7%, 95% CI: -5.3, -4.0) among White individuals, resulting in a magnification of the disparities. Cancer mortality decreased over time for both White and Black individuals (AAPC: -3.4%, 95% CI: -3.9, -2.9 vs. AAPC: -1.8%, 95% CI: -2.1, -1.4, respectively), with a greater magnitude in White individuals. Risk factors were more prevalent among Black individuals over the period.Conclusion:In D.C., the mortality rate is higher in Black vs. White populations, and disparities are increasing over time. While CVD and cancer mortality rates declined overall, profound disparities remain. CVD risk factors are more common in Black populations, with persisting disparities. There is an urgent need for CVD prevention and management, tailored to Black populations in D.C.

Circulation, Volume 150, Issue Suppl_1, Page A4144973-A4144973, November 12, 2024. Background:Cardiac calcium, which includes coronary and extra-coronary calcification, is often incidentally found in chest CT scans performed for various reasons. Despite its prognostic value, manual quantification of cardiac calcium in non-gated chest CT images is labor-intensive.Goals:This retrospective study aims to perform automatic quantification and scoring of cardiac calcium in non-contrast-enhanced chest CTs. The objective is to determine associations between automatic calcium scoring and outcomes such as all-cause mortality, non-fatal myocardial infarction (MI), and non-fatal stroke.Methods:We conducted a nationwide cohort study using the Taiwan National Health Insurance Research Database (NHIRD) from 2016 to 2022. Patients under 20 years old, with a diagnosis of malignancy, or with outcome events before the CT acquisition were excluded. HeaortaNet 1.0, a validated AI model, was used for cardiac calcium scoring. Comorbidities were determined using ICD diagnostic codes for ≥2 consecutive outpatient visits within the year before the index date. Outcomes were censored at the first occurrence of mortality or relevant ICD codes for MI or stroke.Results:The retrospective cohort included 279,415 patients (56.37% male, mean age 60.31±16.54). All-cause mortality occurred in 12.82% of patients within a 3-year follow-up. The 3-year incidence rates of non-fatal MI and non-fatal stroke were 0.86% and 2.07%, respectively. Multivariate-adjusted Cox hazard ratios (95% confidence intervals) for any composite outcome were 1.51 (1.46-1.57), 2.09 (2.01-2.17), 2.63 (2.53-2.74), and 3.37 (3.24-3.50) for cardiac calcium scores of 1-100, 101-400, 401-1000, and >1000, compared to a score of 0. Adjusted Cox hazard ratios for all-cause mortality were 1.62 (1.56-1.69), 2.29 (2.19-2.39), 2.91 (2.78-3.04), and 3.80 (3.64-3.96) for scores of 1-100, 101-400, 401-1000, and >1000, compared to a score of 0.Conclusion:AI-enabled opportunistic screening of non-contrast chest CT for cardiac calcium scoring is associated with all-cause mortality and cardiovascular events. This is the first large-scale cohort study to use an AI model for comprehensive cardiac calcium screening.

Circulation, Volume 150, Issue Suppl_1, Page A4147067-A4147067, November 12, 2024. Background:Short-term exposure to ambient air pollution, especially particulate matter smaller than 2.5 microns in diameter (PM2.5), is associated with an increased risk of acute coronary syndrome and is identified as the leading modifiable cause of cardiovascular mortality in the long term. In this study, we set out to examine the effect of acute exposure to high levels of PM2.5(≥12 μg/m3) on long-term mortality risk of ST-elevation myocardial infarction (STEMI) patients.Methods:From June 2010 to October 2021, 1,553 patients at Liverpool Hospital in Sydney met the 4th Universal Definition of MI criteria for STEMI. The average daily maximum PM2.5was measured using publicly available land-based air quality monitors in the catchment area. Mortality risk between the two groups was compared using a Kaplan-Meier plot and further assessed using the Cox regression model.Results:915 STEMI patients presented on days with maximum PM2.5≥12 μg/m3. These patients had a significantly increased risk of late all-cause mortality with a hazard ratio of 3.08 (CI= 2.01-4.71, p

Circulation, Volume 150, Issue Suppl_1, Page A4119129-A4119129, November 12, 2024. Background:Thirty-day readmission following hospital discharge for stroke is an important quality measure for US hospitals. Current US prediction models for post stroke readmission based on electronic medical records from single healthcare systems or hospitals have modest discrimination (AUC range 0.64 – 0.74).Aim:To develop 30-day all-cause readmission prediction model using a machine learning (ML) based method trained on linked stroke registry and administrative claims data.Methods:Using probabilistic linking, we matched acute stroke (ICD-10 I61-I63) discharges from 31 hospitals participating in the Michigan Acute Stroke registry between 2016-2020 to multipayer administrative claims data provided by the Michigan Value Collaborative for Medicare and Blue Cross Blue Shield of Michigan commercial beneficiaries. Stroke registry data included patient demographics, clinical characteristics, past medical history, and treatments. Claims data was used to identify readmissions within 30 days of discharge. We used multivariable LASSO logistic regression- a simple ML technique to predict 30-day all-cause-readmission and evaluated the prediction accuracy using a hospital-split internal validation scheme to generate hospital-specific and pooled AUC estimates with 95% confidence intervals (Figure 1).Results:Of 19,382 linked stroke discharges, 2,724 (14.1%) were readmitted within 30-days. Readmitted patients were older, more likely to be male, black, and have higher stroke severity (NIHSS >5). Registry hospitals were either primary (64%) or comprehensive (26%) stroke centers. Hospital-specific 30-day readmission ranged between 9.9%-23.1% (P