Worse Cardiovascular Outcomes Research Articles

Outcomes of pericardial complications among patients with solid and liquid cancer: Analysis of National Inpatient Sample database.

e23073 Background: Pericardial complications (PC) are common in malignancy as sequelae of metastasis, direct toxicity of radiation or chemotherapy, or pericardial infection/inflammation due to malignancy. The goal of this study was to assess the cardiovascular outcomes of pericardial complications among patients with solid and liquid cancer. Methods: The National Inpatient Sample from the years 2015 to 2018 was queried to assess cardiovascular outcomes in the setting of pericardial complications (acute pericarditis, chronic constrictive pericarditis, chronic adhesive pericarditis, hemopericardium, cardiac tamponade and other unspecified pericarditis) for patients that have any solid or liquid malignancy. Outcomes included in-hospital mortality, acute kidney injury (AKI), heart failure (HF), cardiogenic shock (CS), myocardial infarction (MI), sudden cardiac arrest (SCA), mechanical circulatory support (MCS), major adverse cardiovascular and cerebrovascular events (MACCE), and stroke. Outcomes were assessed using chi-square analysis using STATA. Results: A total of 1,183,619 cancer patients with PC (n = 20,410.00; 1.7%) and without PC (n = 1,163,209.60; 98.3%) were included. The mean age of patients with and without PC was 58 and 59 years, respectively. The average length of stay in the hospital was 14 and eight days in patients with and without PC, respectively. The most common complications were electrolyte disorders (51.2%, p = 0.000) and arrhythmias (40.4 %, p = 0.000) for patients with and without PC. Patients with PC had higher incidence of in-hospital mortality (11.7% vs 5.1%, p = 0.000), AKI (37.8% vs 22.1%, p = 0.000), HF (25.7% vs 15.5%, p = 0.000), CS (2.7% vs 0.4%, p = 0.000), MI (3.6% vs 2.0%, p = 0.000), SCA (3.2% vs 1.0%, p = 0.000), MCS (0.7% vs 0.1%, p = 0.000), and MACCE (17% vs 7.9%, p = 0.000) compared to cancer patients without PC. There was no difference in outcomes in terms of stroke (1.2% vs 1.2%, p = 0.879). The yearly trend was stable for length of stay among both groups while adjusted total hospital cost was progressively increasing from 2015 to 2018, with a greater net increase in those with PC. Yearly trends of complications were stable among both cohorts. Conclusions: Pericardial complications are prevalent in up to 1.7% of cancer patients, and they are associated with worse cardiovascular outcomes as compared to patients without pericardial complications. Patients with PC also have a higher incidence of in-hospital mortality.

Clonal hematopoiesis of indeterminate potential in patients with immunoglobulin light-chain AL amyloidosis

AbstractImmunoglobulin light-chain (AL) amyloidosis is characterized by the deposition of misfolded monoclonal free light chains, with cardiac complications accounting for patient mortality. Clonal hematopoiesis of indeterminate potential (CHIP) has been associated with worse cardiovascular outcomes in the general population. Its significance in AL amyloidosis remains unclear. We collected clinical information and outcome data on 76 patients with a diagnosis of AL amyloidosis who underwent deep targeted sequencing for myeloid neoplasia–associated mutations between April 2018 and August 2023. Variant allele frequency was set at 2% to call CHIP-associated mutations. CHIP mutations were present in patients with AL amyloidosis at a higher frequency compared with age-matched control individuals. Sixteen patients (21%) had at least 1 CHIP mutation. DNMT3A was the most frequent mutation (7/16; 44%). Compared with patients without CHIP, patients with CHIP had a higher prevalence of t(11;14) translocation (69% vs 25%, respectively; P = .004). Furthermore, among patients with renal involvement, those with CHIP had a lower Palladini renal stage (P = .001). At a median follow-up of 32.5 months, the presence of CHIP was not associated with worse overall survival or major organ dysfunction progression-free survival. Larger studies and longer follow-up are needed to better define the impact of CHIP in patients with AL amyloidosis.

Prosthesis Infolding Incidence and Short-Term Outcomes in Transcatheter Aortic Valve Implantation Using Evolut Self-Expandable Device: A Multicenter Study

Transcatheter aortic valve implantation (TAVI) is an established treatment strategy in aortic valve disease. Infolding, as a nonuniform expansion of the prosthesis leading to introflection of part of the device circumference, is a complication specific to self-expandable prostheses. The aim of the study is to determine incidence, predictors, treatment strategy, and outcomes of infolding during Medtronic Evolut TAVI (Minneapolis, MN, US). Between January 2018 and March 2022, all patients treated with Evolut TAVI were included in a multicenter observational retrospective study. According to the occurrence of infolding, the enrolled cohort was divided into 2 groups; periprocedural characteristics and 30-day outcomes were compared. A total of 1,470 patients were included; 23 infolding cases (1.6%) were detected. Preprocedural imaging showed larger aortic anatomy and greater calcium burden in the infolding group. Infolding occurred mostly with Evolut Pro+ and size 34 mm and was diagnosed before full prosthesis release in 78.3%. The rate of moderate-to-severe paravalvular regurgitation was higher in the infolding group (21.7% vs 1.9%, p <0.001). Short-term follow-up showed greater all-cause and cardiovascular mortality (respectively, 4.3% vs 0.7% and 4.3% vs 0.6%, p <0.05) and higher rate of pacemaker implantation (33.3% vs 15.7%, p = 0.042) in case of infolding. High right cusp calcium score and resheathing maneuvers were independent predictors of infolding. In conclusion, prosthesis infolding is a TAVI complication burdened by worse cardiovascular outcomes. Prompt intraprocedural infolding diagnosis is pivotal, especially in case of great native valve calcium burden and resheathing maneuvers, to safely overcome this complication by prosthesis recapture or postdilation.

A Systematic Review and Meta-Analysis of Percutaneous Coronary Intervention (PCI) and Coronary Bypass Grafting (CABG) Outcomes in Indigenous vs. Non-Indigenous Australians.

A major cause of death, coronary artery disease (CAD) often necessitates invasive procedures like coronary bypass grafting (CABG) and percutaneous coronary intervention (PCI). Cardiovascular outcomes vary between indigenous and non-indigenous Australian people; however, comprehensive knowledge of these differences is absent. To compare PCI and CABG results between indigenous and non-indigenous Australians, a systematic review and meta-analysis were carried out. Included were 10 retrospective observational studies that examined mortality, cardiovascular events, comorbidities, and operative success rates. Databases spanning 2014 to 2024 were searched, and research that directly compared Australia's indigenous and non-indigenous populations was among the inclusion criteria. Within 30 days of surgery, indigenous Australians receiving PCI had greater rates of comorbidities and were at higher risk of long-term mortality and MACE. Similarly, there was a greater long-term death rate among indigenous patients following CABG. Cultural safety, socioeconomic factors, and regional factors affecting treatment delays and access to care all affected disparities. For 30-day mortality, the pooled analysis shows an odds ratio of 1.04 (95% CI 0.78, 1.40), indicating no meaningful difference. The total odds ratio for unfavorable occurrences is 1.07 (95% CI 0.86, 1.33), meaning there is no statistically significant difference between Indigenous groups and those that are not. Indigenous Australians continue to have worse cardiovascular outcomes after PCI and CABG procedures, even with similar procedural success rates. To ensure equitable cardiovascular outcomes for indigenous groups, targeted therapies targeting underlying risk factors, increased access to culturally appropriate care, and decreased obstacles to healthcare access are critical.

Cardiac implantable electronic device-induced tricuspid regurgitation: Implications and management.

Tricuspid regurgitation (TR) secondary to cardiac implantable electronic devices (CIEDs) has been well documented and is associated with worse cardiovascular outcomes. A variety of mechanisms have been proposed including lead-induced mechanical disruption of the tricuspid valvular or subvalvular apparatus and pacing-induced electrical dyssynchrony. Patient characteristics such as age, sex, baseline atrial fibrillation, and pre-existing TR have not been consistent predictors of CIED-induced TR. While two-dimensional echocardiography is helpful in assessing the severity of TR, three-dimensional echocardiography has significantly improved accuracy in identifying the etiology of TR and whether lead position contributes to TR. Three-dimensional echocardiography may therefore play a future role in optimizing lead positioning during implant to reduce the risk of CIED-induced TR. Optimal lead management strategies in addition to percutaneous interventions and surgery in alleviating TR are very important.

NSTEMI'da Erken Evrede HALP Skorunun Öngörü Değeri

Introduction: Several inflammatory markers are associated with coronary artery disease severity and worse cardiovascular outcomes. The haemoglobin, albumin, lymphocyte, and platelet (HALP) score is an indicator of inflammation and nutritional status. We aimed to evaluate the practicity of HALP score in non-ST elevation myocardial infarction (NSTEMI) patients. Materials and Methods: This study was designed as a retrospective cohort study. Patients over the age of 18 who have been diagnosed with acute coronary syndrome were retrospectively searched from hospital records. The study groups were formed according to the results of the coronary angiography. Demographic data such as age, gender, total blood count, albümin levels, troponin levels and HALP scores of the patients were analyzed and comparisons between the groups were made decisively. Results: 201 patients were enrolled in the study and the data was obtained from hospital records retrospectively. 79 patients were excluded from the study due to ST segment elevation myocardial infarction (STEMI). The study population was collected under two groups; the NSTEMI group (n=66) and normal coronary arteries (NCA) group (n=56). The mean age of NSTEMI group was 62.3 ± 11.8 and 71.2% (n=47) was male. The mean age of NCA group was 51.8 ± 9.2 and 30.3% (n=17) was male. There were statistically significant difference between NSTEMI and NCA groups in term of age and gender (p&amp;lt;0.05). The HALP score was statistically higher in NSTEMI group compared to NCA group (p&amp;lt;0.001). Age and HALP score have explanatory powers on NSTEMI patients (p=0.001 and p=0.022, in order of). Conclusion: HALP score may be used as an easily applicable and inexpensive method in clinical practice that can contribute to the early diagnosis of NSTEMI patients.

Peripheral Artery Disease Ultrasound Assessment in Predicting the Severity of Coronary Artery Disease.

Atherosclerosis in a progressive disease that is systemic in nature, and hence the simultaneous presentation of coronary artery disease (CAD) and peripheral artery disease (PAD) is not uncommon. As clinically manifested PAD is associated with worse cardiovascular outcomes, the timely identification of subclinical atherosclerosis seems of utmost importance. Ultrasonography (US) is an ideal imaging modality for assessing PAD that is easy to use, accurate, widely available and avoids unnecessary exposure to radiation. Several US parameters have been proposed in the assessment of PAD, with varying prognostic usefulness, depending on disease location. The aim of this review is to summarize the most important evidence available on the association between US-detected atherosclerosis in different vascular sites and the presence and severity of CAD, as well as the impact of the early detection of PAD on the outcomes of patients presenting with CAD.

CPAP may promote an endothelial inflammatory milieu in sleep apnoea after coronary revascularization

Continuous positive airway pressure (CPAP) has failed to reduce cardiovascular risk in obstructive sleep apnoea (OSA) in randomized trials. CPAP increases angiopoietin-2, a lung distension-responsive endothelial proinflammatory marker associated with increased cardiovascular risk. We investigated whether CPAP has unanticipated proinflammatory effects in patients with OSA and cardiovascular disease. Patients with OSA (apnoea-hypopnea index [AHI] ≥15 events/h without excessive sleepiness) in the Randomized Intervention with CPAP in Coronary Artery Disease and OSA study were randomized to CPAP or usual care following coronary revascularization. Changes in plasma levels of biomarkers of endothelial (angiopoietin-2, Tie-2, E-selectin, vascular endothelial growth factor [VEGF-A]) and lung epithelial (soluble receptor of advanced glycation end-products [sRAGE]) function from baseline to 12-month follow-up were compared across groups and associations with cardiovascular morbidity and mortality assessed. Patients with OSA (n=189; 84% men; age 66±8 years, BMI 28±3.5kg/m2, AHI 41±23 events/h) and 91 patients without OSA participated. Angiopoietin-2 remained elevated whereas VEGF-A declined significantly over 12 months in the CPAP group (n=91). In contrast, angiopoietin-2 significantly declined whereas VEGF-A remained elevated in the usual care (n=98) and OSA-free groups. The changes in angiopoietin-2 and VEGF-A were significantly different between CPAP and usual care, whereas Tie-2, sRAGE and E-selectin were similar. Greater 12-month levels of angiopoietin-2 were associated with greater mortality. Greater CPAP levels were associated with worse cardiovascular outcomes. Greater CPAP levels increase proinflammatory, lung distension-responsive angiopoietin-2 and reduce cardioprotective angiogenic factor VEGF-A compared to usual care, which may counteract the expected cardiovascular benefits of treating OSA. National Institutes of Health/National Heart, Lung, and Blood Institute; Swedish Research Council; Swedish Heart-Lung Foundation; ResMed Foundation.

Sjögren's disease activity associates with cardiovascular disease and monoclonal gammopathy: a university cohort study of disease activity and comorbidities.

We used the University of Wisconsin cohort to determine the extent to which the EULAR Sjögren's syndrome disease activity index (ESSDAI) was associated with comorbidities that contribute to mortality. Our University of Wisconsin, Madison cohort had 111 patients with Sjögren's Disease (SjD) by 2016 ACR/EULAR criteria and 194 control patients with sicca. Our study was performed from March 1st, 2020 through April 1st, 2023. We collected data using a standardized collection tool, including components of the Charlson Comorbidity Index (CCI). Stratifying our SjD patients by ESSDAI < 5 and ESSDAI ≥ 5, we assessed differences in comorbidities associated with mortality. At time of SjD diagnosis, the ESSDAI ≥ 5 group had increased odds of peripheral vascular disease compared to controls (OR 10.17; 95% CI 1.18-87.87). Patients with a current ESSDAI ≥ 5 were more likely to have a myocardial infarction compared to controls (OR 9.87; 95% CI 1.17-83.49). SjD patients had increased prevalence of monoclonal gammopathy compared to controls (9.3% vs 0.5%, p < 0.001). SjD patients with high ESSDAI at diagnosis had greater prevalence of monoclonal gammopathy compared to the SjD patients with a low ESSDAI (16% vs 5%, p = .04). As reported elsewhere, the ESSDAI ≥ 5 group had increased odds of chronic pulmonary disease (OR 4.37; 95% CI 1.59-11.97). We found high ESSDAI scores were associated with worse cardiovascular outcomes, specifically peripheral vascular disease and myocardial infarction. Furthermore, monoclonal gammopathy was more frequent in SjD patients compared to sicca controls, supporting screening for monoclonal gammopathy in the appropriate clinical scenario. Key Points • High ESSDAI scores are associated with worse cardiovascular outcomes, specifically peripheral vascular disease and myocardial infarction. • Monoclonal gammopathy is more frequent in SjD patients than sicca controls, supporting screening for monoclonal gammopathy in the appropriate clinical scenario.

Evaluation of Midodrine Utilization in Patients with Cancer and Heart Failure.

The purpose of this study was to evaluate safety and cardiovascular outcomes as well as overall survival of cancer patients with concomitant heart failure (HF) treated with midodrine for hypotension. Adult patients diagnosed with cancer and HF who were treated with midodrine at a tertiary cancer center from 03/2013 to 08/2021 were identified. Demographic and clinical parameters were collected retrospectively. A total of 85 patients were included with a median age of 68years (IQR: 60, 74; 33% female and 85% White). Of those, 31% had HFpEF (EF ≥ 50%), 42% HF with mildly reduced EF (HFmrEF; EF 41-49%), and 27% HFrEF (EF ≤ 40%). The most common indication for midodrine use was orthostatic hypotension (49%). Midodrine was continued for at least one month in 57% of the patients. Supine hypertension was the only side effect reported in 6% of patients. No statistically significant changes in NYHA class, guideline-directed medical therapy, cardiac biomarkers (NT-proBNP or troponin T), echocardiographic findings or cardiovascular hospitalizations were observed between patients who continued treatment with midodrine compared to those who stopped using midodrine over a median follow-up of 38months. In the multivariable cox regression analysis, continuation of midodrine, compared to discontinuation, and use of midodrine for orthostatic hypotension, as opposed to other causes of hypotension, were not associated with an increased risk of mortality (HR 0.41, 95% CI 0.24-0.69, p < .0001; HR 0.34, 95% CI 0.18-0.64, p < .001, respectively). In contrast, elevated creatinine (> 1.3 for males and > 1.1 for females) was associated with an increased risk of mortality (HR 1.83, 95% CI 1.07-3.14). LVEF was not significantly associated with lower or higher risk of mortality. In our study, midodrine use in patients with cancer and HF was not associated with significant adverse effects, worse cardiovascular outcomes, or increased risk of mortality. Larger, prospective studies are needed to confirm these findings.

Triglyceride-glucose index as a suitable non-insulin-based insulin resistance marker to predict cardiovascular events in patients undergoing complex coronary artery intervention: a large-scale cohort study

BackgroundInsulin resistance (IR), a hallmark of proceeding diabetes and cardiovascular (CV) disease, has been shown to predict prognosis in patients undergoing percutaneous coronary intervention (PCI). The triglyceride-glucose (TyG) index, triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and metabolic score for insulin resistance (METS-IR) have been shown to be simple and reliable non-insulin-based surrogates for IR. However, limited studies have determined the associations between distinct non-insulin-based IR markers and CV outcomes in patients undergoing complex PCI who are at higher risk of CV events after PCI. Therefore, this study aimed to investigate and compare the prognostic value of these markers in patients undergoing complex PCI.MethodsThis was a descriptive cohort study. From January 2017 to December 2018, a total of 9514 patients undergoing complex PCI at Fuwai Hospital were consecutively enrolled in this study. The 3 IR indices were estimated from the included patients. The primary study endpoint was CV events, defined as a composite of CV death, nonfatal myocardial infarction and nonfatal stroke.ResultsDuring a median follow-up of 3.1 years, 324 (3.5%) CV events occurred. Multivariable Cox regression models showed per-unit increase in the TyG index (hazard ratio [HR], 1.42; 95% confidence interval [CI] 1.13–1.77), rather than per-unit elevation in either Ln(TG/HDL-C ratio) (HR, 1.18; 95%CI 0.96–1.45) or METS-IR (HR, 1.00; 95%CI 0.98–1.02), was associated with increased risk of CV events. Meanwhile, adding the TyG index to the original model led to a significant improvement in C-statistics (0.618 vs. 0.627, P < 0.001), NRI (0.12, P = 0.031) and IDI (0.14%, P = 0.003), whereas no significant improvements were observed when adding Ln (TG/HDL-C ratio) or METS-IR (both P > 0.05) to the original model.ConclusionsThe TyG index, not TG/HDL-C ratio and METS-IR, was positively associated with worse CV outcomes in patients undergoing complex PCI. Our study, for the first time, demonstrated that the TyG index can serve as the suitable non-insulin-based IR marker to help in risk stratification and prognosis in this population.

Cholesterol crystals at the culprit lesion in patients with acute coronary syndrome are associated with worse cardiovascular outcomes at two years follow up - results from the translational OPTICO-ACS study program

BackgroundCholesterol crystals (CCs) represent a feature of advanced atherosclerotic plaque and may be assessed by optical coherence tomography (OCT). Their impact on cardiovascular outcomes in patients presenting with acute coronary syndromes (ACS) is yet unknown. MethodsThe culprit lesion (CL) of 346 ACS-patients undergoing preintervention OCT imaging were screened for the presence of CCs and divided into two groups accordingly. The primary end-point was the rate of major adverse cardiac events plus (MACE+) consisting of cardiac death, myocardial infarction, target vessel revascularization and re-hospitalization due to unstable or progressive angina at two years. ResultsAmong 346 patients, 57.2% presented with CCs at the CL. Patients with CCs exhibited a higher prevalence of ruptured fibrous caps (RFC-ACS) (79.8% vs. 56.8%; p < 0.001) and other high-risk features such as thin cap fibroatheroma (80.8% vs. 64.9%; p = 0.001), presence of macrophages (99.0% vs. 85.1%; p < 0.001) as well as a greater maximum lipid arc (294.0° vs. 259.3°; p < 0.001) at the CL as compared to patients without CCs. MACE+ at two years follow-up occurred more often in CC-patients (29.2% vs. 16.1%; p = 0.006) as compared to patients without CCs at the culprit site. Multivariable cox regression analysis identified CCs as independent predictor of MACE+ (HR 1.705; 1.025–2.838 CI, p = 0.040). ConclusionsCCs were associated with conventional high-risk plaque features and associated with increased MACE+-rates at two years follow up. The identification of CCs might be useful as prognostic marker in patients with ACS and assist “precision prevention” in the future.

Abstract 16935: Distressed Community Index in Patients Undergoing Carotid Artery Stenting in Medicare-Linked Vascular Quality Initiative Registry

Introduction: Patients with high community-level socioeconomic distress have worse cardiovascular outcomes, yet its impact on carotid artery stenting (CAS) outcomes is unknown. We assessed the association between the Distressed Community Index (DCI), a zip-code level measure of community distress, with post-CAS mortality and stroke. Methods: We used the Vascular Quality Initiative database linked with Medicare claims outcomes data to identify patients undergoing CAS between 2015 and 2019. From a time-dependent ROC curve and using Youden index, we classified patients as high community distress if DCI≥65. Thirty-six-month cumulative mortality incidence using Kaplan-Meier by DCI groups, and hierarchical Cox regression with random intercept for site for linear DCI were used. For stroke, we used 36-month cumulative incidence function by DCI groups, and Fine and Gray models accounting for competing risk of death for linear DCI. Models were later adjusted for patient and procedural characteristics. Results: The final complete-case cohort included 8,595 patients (2,580/30% DCI≥65), had a mean age of 74.7 (±7.8) years, was 92.7% white and 97.6% non-Hispanic/Latino. The 36-month cumulative mortality incidence was similar in both groups (26.0% vs 22.5%, P=0.236). A 10-point increase in DCI did not increase mortality risk (unadjusted HR 1.00; 95% CI 0.98-1.03 and adjusted HR 1.01; 95% CI 0.87-1.17). At 36 months the high community distress group experienced higher stroke risk (29.8% vs 22.9%, P=0.008). However, a 10-point increase in DCI did not increase stroke risk (unadjusted sub-HR: 1.01; 95% CI 0.99-1.03, adjusted sub-HR: 1.00; 95% CI 0.98-1.02). Conclusions: In this selective set of patients with underrepresentation of demographic groups, for those who get prioritized to CAS, higher community distress was associated with an increased unadjusted 36-month stroke risk by DCI group. However, a 10-point increase in DCI was nonsignificant regardless of adjustment.

Abstract 16580: Cardiovascular Disease in Cushing Syndrome, Conns Syndrome and Malignant Pheochromocytoma: Which Adrenal Disorder is Associated With Thromboembolism and Cardiac Tumors?

Background: Adrenal disorders result in worse cardiovascular outcomes. Literature suggests that Cushing (CUSH) and Conn’s syndrome (CONS) are associated with coronary artery disease, congestive heart failure (CHF), arrhythmia and stroke. But the date comparing the association of various adrenal disorders with cardiovascular disease (CVD) is limited. We reviewed the prevalence of CVD in CUSH, CONS, and malignant pheochromocytoma (MPH) and explored their prognosis. Methods: A retrospective cohort analysis was conducted using National Inpatient Sample 2016-2020. Cohorts of patients hospitalized for CUSH, CONS, MPH and CVD were identified using respective ICD-10 codes. Primary endpoint was outcomes of CUSH, CONS, and MPH in terms of CVD. Multivariate logistic regression model was used to assess prognostic outcomes. Results: 58060 patients were admitted with CUSH, 3420 with CONS, and 1445 with MPH. CONS has the highest odds of association with CVD (OR 4.87, CI 3.74-6.3, p&lt;0.001), followed by CUSH (OR 3.45, CI 3.3-3.6, &lt;0.001), and MPH (OR 3, CI 2.1-4.3, p&lt;0.001). Upon subgroup analysis of CVD, we observed that CUSH has strongest association with venous thromboembolism (VTE, OR 2.56, CI 2.3-2.8, p&lt;0.001), pulmonary embolism (PE 2.3, OR 2.03-2.6, p&lt;0.001), and CHF (OR 2.2, CI 2.1-2.3, p&lt;0.001). CONS has highest odds of association with primary cardiac tumors (9.2, CI 1.29-65.3, p=0.027), hypertension (HTN, OR 2.8, CI 2.34-3.3, p&lt;0.001), and atrial fibrillation (AF, OR 1.66, CI 1.32-2.06, p&lt;0.001). While MPH is strongly associated with higher odds of pulmonary edema (OR 3.89, CI 1.71-8.8, p&lt;0.01), and HTN (OR 2.8, CI 2.1-3.6, p&lt;0.001). Conclusion: Most prevalent CVD in adrenal disorders are HTN, IHD, CHF, and AF. CONS has highest prevalence and strongest association with CVD followed by CUSH and MPH. CUSH is strongly associated with thromboembolism while CONS with primary cardiac tumors, and MPH with pulmonary edema.

Abstract 17089: In Hospital Cardiovascular Outcomes of Patients With End Stage Renal Disease and Septic Shock a Propensity Matched Analysis

Background: Sepsis affects approximately 1.7 million adults in the US every year, and progression to septic shock (SS) leads to an increase in cardiovascular disease (CVD) and a 26% increase in mortality. Patients with end stage renal disease (ESRD) on dialysis are at an increased risk of developing SS and CVD. The increase in mortality with SS is well established in the literature, however, there is limited data determining the impact of ESRD on SS. This study aims to identify the impact of ESRD on in-hospital mortality and CVD outcomes among patients with SS. Methods: The 2020 National Readmissions Database was analyzed. Patients with SS and ESRD were identified using relevant ICD-10 codes. Nearest propensity matching was conducted using a 1:1 ratio for several demographic, social and clinical variables. Subsequently, in-hospital outcomes were compared between patients with and without ESRD using t-test and chi-squared test as appropriate. Results: A total of 822,321 patients were included in this study, with a mean age of 65 years. Majority of patients in this study with and without ESRD respectively were male (54.39% and 50.83%, p &lt;0.001). In- hospital mortality for patients with SS, with and without ESRD, were 38.68% and 30.01%, respectively. Among patients with SS, mortality with and without ESRD was 38.36% and 30.01% (p &lt; 0.001) respectively. Other significant cardiovascular events among patients with and without ESRD, respectively were ischemic stroke (3.82% vs. 3.28%, p &lt;0.001), atrial fibrillation (11.85% vs. 10.2%, p &lt;0.001), Endocarditis (4.06% vs. 2.24%, p &lt;0.001), and acute diastolic heart failure (10.17% vs. 9.41%, p =0.001). Conclusions: SS in patients with ESRD is associated with an increased frequency of in-hospital mortality and worse cardiovascular outcomes when compared to patients without ESRD. Further research is needed to help establish and identify the causative factors in determining the association between SS and ESRD.

Abstract 15442: Street Gang Territories and Hypertension in Chicago

Hypertension is a major cardiovascular risk factor. Gang violence is an unfortunately common reality in urban communities and violence is associated with worse cardiovascular outcomes. However, the relationship between street gang territories and cardiovascular risk is unknown. We conducted a retrospective cohort study to determine if residence within a street gang territory is associated with higher blood pressure compared with demographically similar patients who resided outside of gang territories within Chicago. A balanced dataset of 1,016 unique-but-demographically-similar patients with at least 3 available pre-pandemic ambulatory blood pressure measurements at our urban, academic tertiary-care center were sampled from over 70,561 available patients. Patients were matched for the number of BP measurements, age, race, sex, and other sociodemographic variables. Patients were geo-coded and mapped, and known street gang territories were similarly geo-coded and mapped using publicly available data from the Chicago Police Department data portal. Out of 66 known street gangs in Chicago, our institution served patients from 28 unique gang territories. Patients residing within a known street gang territory had on average 6.2 mmHg higher BP than those living outside any known street gang territory (median = 133.2 vs 127.0, respectively,p&lt;0.001). SBP control in each unique street gang territory was highly variable with medians ranging between 108.8 to 165.0 mmHg (Figure). In conclusion, we find that residence within a street gang territory is associated with significantly higher systolic blood pressure compared with demographically similar patients who do not live in a gang territory. While poverty and other social determinants of health are known to affect hypertension and cardiovascular risk, residence within a gang territory may represent a new social risk factor for cardiovascular disease.

Sex-specific difference in cardiac function in patients with systemic sclerosis: association with cardiovascular outcomes

BackgroundCardiovascular involvement is one of the leading causes of mortality in systemic sclerosis (SSc) and is reported to be higher in men as compared with women. However, the cause of...

Potential Prognostic Relevance of Left-Ventricular Global Longitudinal Strain and of the Summation of the Mitral and Tricuspid Regurgitation Volume in Patients with Non-Ischemic Dilated Cardiomyopathy.

The aim of this pilot study was to determine the potential prognostic relevance of novel multidirectional myocardial and volumetric echocardiographic parameters in patients with non-ischemic dilated cardiomyopathy (NIDCM). Multidirectional myocardial parameters (longitudinal, radial, and circumferential left-ventricular (LV) strain using speckle tracking echocardiography) and a new volumetric parameter (the sum of the mitral and tricuspid regurgitation volume (mitral-tricuspid regurgitation volume) were assessed. The cardiovascular (CV) outcome was a composite of cardiac death and hospitalization for heart failure (HF) at 1 year. Approximately 102 patients were included in this pilot study. The mean LV ejection fraction (LVEF) was 28.4 ± 8.9%. During a follow-up of 1 year, the CV outcome occurred in 39 patients (10 HF deaths, and 36 hospitalizations for HF). The LV global longitudinal systolic strain (GLS) and mitral-tricuspid regurgitation volume were the main parameters that were seen to be significantly altered in the comparison of patients with events vs. those without events (GLS (absolute values) 7.4 ± 2.7% vs. 10.3 ± 2.6%; mitral-tricuspid regurgitation volume 61.1 ± 20.4 mL vs. 40.9 ± 22.9 mL, respectively; p-value < 0.01). In line with these findings, in a multivariate continuous logistic regression analysis, the GLS and mitral-tricuspid regurgitation volume were the main parameters associated with worse CV outcomes (GLS: OR 0.77 (95%CI 0.65-0.92); mitral-tricuspid regurgitation volume OR 1.09 (95%CI 1.01-1.25)), whereas the radial and circumferential LV global strain and mitral regurgitation volume and tricuspid regurgitation volume were not linked to the CV outcome. Furthermore, in a receiver operating characteristic curve analysis, a GLS cutoff of <7.5% and mitral-tricuspid regurgitation volume > 60 mL were the identified values for the parameters associated with worse CV outcomes. The findings of this pilot study suggest that the GLS and a novel volumetric parameter (the sum of the mitral and tricuspid regurgitation volume) are linked to worse CV outcomes in patients with non-ischemic dilated cardiomyopathy. Hence, these promising results warrant further validation in larger studies.

Renin-angiotensin system inhibitors reduce cardiovascular mortality in hypertensive patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: insights from the EffecTAVI registry.

Arterial hypertension is associated with the triggering of the renin-angiotensin system, leading to left ventricle fibrosis and worse cardiovascular outcomes. In this study, patients with comorbid arterial hypertension and severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) were selected from the EffecTAVI registry to evaluate the impact of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) on cardiovascular mortality. We enrolled 327 patients undergoing TAVI from the EffecTAVI registry. Using Kaplan-Meier event rates and study-stratified multivariable Cox proportional hazards regression models, we evaluated 2-year clinical outcomes according to the ACEI/ARB therapy status at enrollment. Among the included patients, 222 (67.9%) were on ACEIs/ARBs at baseline, whereas 105 (32.1%) were not. Treatment with ACEIs/ARBs was significantly associated with a 2-year decrease in the rate of cardiovascular mortality (HR = 0.44, 95% CI: 0.23-0.81, p = 0.009). This association remained stable after both multivariable adjustment and propensity score matching. In a cohort of hypertensive patients with severe AS who were selected from the EffecTAVI registry, ACEI/ARB treatment at baseline was found to be independently associated with a lower risk of 2-year cardiovascular mortality, suggesting a potential benefit of this treatment. More trials are needed to validate this finding and to understand the full benefit of this treatment.

Association of depression with hypertensive left ventricular hypertrophy in age, sex, and education level-specific differences.

Previous studies have shown that hypertension and depression are associated with worse cardiovascular outcomes and reduced quality of life. Left ventricular hypertrophy (LVH) is strongly linked to increased mortality and cardiovascular disease, and depression may be one of the key factors contributing to hypertensive LVH. The authors consecutively enrolled 353 patients with uncomplicated hypertension between November 2017 and May 2021. All participants completed the Hamilton Depression Scale (HAM-D) to assess their depression status, with depression defined as a HAM-D score of 20 or higher. Linear regression analysis revealed a positive association between HAM-D and LVMI (adjusted β, 1.51, 95% CI, 1.19-1.83, p<.001). Logistic regression models showed that individuals with hypertension and depression had a higher risk of LVH than those with hypertension alone (adjusted OR, 2.51, 95% CI, 1.14-5.52, p=.022). The association between depression and LVH significantly interacted with age, sex, education levels, but not BMI and household income. Following age, sex, and education levels stratification, an independent association of depression and LVH was observed only in age<60 years (age<60 years: OR, 7.36, 95% CI, 2.25-24.13, p<.001), male (male: OR, 16.16, 95% CI, 3.80-68.73, p<.001), and higher education levels (high school and above: OR, 11.09, 95% CI, 2.91-42.22, p<.001). Our findings suggest that depression is a significant risk factor for LVH in hypertensive patients, particularly in those who are under 60 years of age, male, and have higher education levels.