Advocate Illinois Masonic Medical Center

BackgroundPeople living with HIV (PLWH) experience up to twofold increased risk of cardiovascular disease compared to the general population. The coronary artery calcium (CAC) score offers a non-invasive and quantifiable assessment of subclinical coronary artery disease (CAD), making it a valuable tool for early detection and risk stratification in this high-risk population.MethodsA systematic review and meta-analysis were conducted to quantify the percentage of detectable CAC among PLWH. Detectable CAC was defined as a CAC >0 based on the Agatston method. CAC scores were further categorized into mild (1–100), moderate (101–399), and high ( >400). Pooled percentages with corresponding 95% confidence intervals (95%CI) were calculated. Subgroup analyses were performed by continent to assess geographic variations in the prevalence of detectable CAC among PLWH.ResultsA total of 56 studies were included, with a pooled percentage of detectable CAC among PLWH of 45.7% (95%CI 36.5-48.2). The pooled percentage with mild CAC was 27.7% (95%CI 22.7-32.9%, N=17), moderate CAC was 9.8% (95%CI 7.7-12.0, N=16) and high CAC 4.4% (.8-6.3%, N=10). Significant regional variations were found in the percentage of PLWH with detectable CAC (p< 0.01): with the highest percentage reported in North America (49.3%, 43.6-55.1, N=35) followed by Asia (42.3%, 95%CI 37.7-48.2, N=5), Europe (42.3%, 95%CI 36.5-48.2, N=12) and Africa (13.4%, 95%CI 9.6-17.6, N=3). A single study from South America reported a pooled percentage of PLWH with detectable CAC of 67.4% (95%CI 50.9-81.4).ConclusionAlmost half of PLWH had detectable CAC, indicating a substantial burden of subclinical coronary artery disease in this population. The higher prevalence observed in North America highlights the importance of targeted preventive strategies, including lifestyle interventions and pharmacologic therapies. The scarcity of data from South America, Oceania and Africa highlights a critical need for further research in these underrepresented regions.DisclosuresAniruddha Hazra, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|ViiV Healthcare: Advisor/Consultant

Abstract Background Infection represents a significant health burden affecting all patient demographics, and thousands of pathogens are known to cause infections in humans; however, many pathogens may not be identified using traditional diagnostic methods. This limitation arises partly from the challenges of growing organisms in conventional culture media, and when employing PCR, the requirement for sequence-specific amplification complicates matters. To overcome these obstacles, in recent years, plasma cell-free metagenomic next-generation sequencing (NGS) has emerged as a noninvasive method to identify and quantify pathogen DNA in plasma. We aimed to gather insights on the clinical use of NGS from both Infectious Diseases (ID) and Non-ID providers.Table 1:Demographics and Question Responses of Perspectives of Next-generation Sequencing Serologic Tests Among All Participants Page 1Table 1:Demographics and Question Responses of Perspectives of Next-generation Sequencing Serologic Tests Among All Participants Page 2 Methods From October 1-November 30, 2024, we conducted a cross-sectional survey among USA and Canadian providers using a purpose-driven sampling among national ID and internal medicine society membership databases. Questions related to NGS use in specific scenarios (Supplemental Document 1). 6 weekly email reminders were sent.Table 2:Comparison of Clinical Utilization Perspectives and Practices of Next-generation Sequencing Serologic Tests Between Infectious Diseases and Non-Infectious Diseases Providers Page 1Table 2:Comparison of Clinical Utilization Perspectives and Practices of Next-generation Sequencing Serologic Tests Between Infectious Diseases and Non-Infectious Diseases Providers Page 2 Results 55 participants initiated the survey, and 34 reported using NGS and completed the remainder of the survey. There most common specialties represented were adult ID (33%), pediatric hematology-oncology (33%), and pediatric ID (18%). The median age was 39 years (IQR 33-54), and 63.6% were female. 81.8% participants were from academic centers (Table 1). Compared to Non-ID providers, ID specialists were older (Median age 33 v. 44, p &amp;lt; 0.04) more likely to have ordered NGS in the past (85% v. 46%, p-value &amp;lt; 0.01), and less likely to order for infection surveillance/pre-emptive therapy in an at-risk population (0% v. 8.8%, p-value &amp;lt; 0.01; Table 2). Conclusion Our cross-sectional survey revealed notable differences among providers regarding specific applications of NGS in clinical care. Although limited by a low response rate and survey completion percentage, this preliminary data could inform the development of enhanced NGS assessment projects. These insights may illuminate the use of NGS and influence future implementation and cost-effectiveness studies. Disclosures All Authors: No reported disclosures

Cardiac amyloidosis is frequently overlooked, leading to delayed diagnosis and underestimation of its true impact on cardiac mortality. Using CDC WONDER (1999-2020), we identified U.S. decedents aged ≥ 25 years with amyloidosis (ICD-10 E85) as the underlying cause of death and at least one cardiac-related condition as a contributing cause. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated, and trends were analyzed using Joinpoint regression and autoregressive integrated moving average (ARIMA) forecasting through 2040. Among 16,673 deaths, the AAMR rose from 0.261 in 1999 to 0.608 in 2020, with inflection points in 2012 and 2017 and an overall annual increase of 3.96%. Mortality was higher in men (0.537 vs. 0.210) and Black individuals (0.83 vs. 0.32), with a sharp post-2017 rise, especially among Black decedents. Geographic disparities were also observed, with the highest rates in the Northeast and urban areas. Most deaths occurred in hospitals (43.2%) or at home (31.4%), and mortality rates peaked in those aged 85 and older. Forecasting models project continued increases in AAMR through 2040, reaching approximately 2.0 overall, with especially elevated rates among Black (≈ 5.9) and male (≈ 3.8) decedents. Cardiac mortality in amyloidosis has risen sharply since 2017, likely driven by improved ATTR-CM detection through non-biopsy imaging and guideline adoption. Disparities by sex, race, and geography persist, reflecting uneven diagnostic capacity concentrated in urban and Northeastern centers. Forecasts project continued increases, particularly among Black and male individuals, underscoring the need for more equitable access to diagnosis and treatment.

Anemia is common among women undergoing elective percutaneous coronary intervention (PCI), yet remains under-addressed in contemporary ACC/AHA guidelines. We evaluated the association between baseline anemia and short- and long-term outcomes after PCI. Using the TriNetX federated electronic health record network, we identified women undergoing first-time elective PCI and compared anemic vs. non-anemic patients. One-to-one propensity score matching yielded N = 1,153 per group, balancing demographics, comorbidities, medications, and labs. Clinical outcomes were assessed at 7 days, 30 days, 6 months, and 12 months, and included major adverse cardiovascular events (MACE), acute coronary syndrome (ACS), acute kidney injury (AKI), stroke or transient ischemic attack (TIA), major bleeding, transfusion requirements, all-cause hospitalization, in-stent restenosis, stent thrombosis, and all-cause mortality. Hazard ratios (HRs) and 95% confidence intervals were estimated using Cox proportional hazards models. At 7 days post-procedure, baseline anemia was significantly associated with an increased risk of AKI (HR 2.2; 95% confidence interval [CI], 1.1-4.5; p = 0.03), major bleeding events (HR 3.2; 95% CI, 1.4-7.5; p < 0.01), and transfusion requirements (HR 9.1; 95% CI, 2.1-39.2; p < 0.01). Notably, all 7-day mortality events occurred in the anemic cohort (0.9% vs. 0.0%). By 30 days, patients with anemia continued to demonstrate higher rates of AKI, major bleeding, and transfusion needs. At 12 months, these risks persisted and, in some cases, widened. Anemia was independently associated with increased rates of major adverse cardiovascular events (MACE) (HR 1.4; 95% CI, 1.1-1.8; p = 0.01), AKI (HR 1.9; 95% CI, 1.5-2.5; p < 0.01), all-cause hospitalization (HR 1.3; 95% CI, 1.1-1.5; p < 0.01), and all-cause mortality (HR 2.3; 95% CI, 1.4-3.8; p < 0.01). Differences in stroke or TIA rates were not statistically significant, and the incidence of stent thrombosis or restenosis was comparable between anemic and non-anemic groups. Among women undergoing elective PCI, baseline anemia emerged as a strong predictor of adverse outcomes, spanning early kidney/bleeding complications and sustained increases in MACE, hospitalizations, and mortality over one year, without clear differences in stent-related events. These data support integrating anemia into pre-PCI risk assessment and motivate randomized trials of pre-procedural anemia optimization.

Abstract Purpose Angiotensin receptor-neprilysin inhibitors (ARNI) are well-established for chronic heart failure (HF) with reduced ejection fraction. However, their efficacy and safety when initiated in acute decompensation (ADHF) remain less well characterized. This meta-analysis evaluates the efficacy and safety of ARNI compared to angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) for ADHF. Methods A meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed, Scopus, WOS, Embase, and CENTRAL till November 2024. Risk ratios (RR) were applied for dichotomous outcomes and standardized mean differences (SMD) for continuous outcomes, both with 95% confidence intervals (CI). Results Three RCTs with 1,741 patients were included. Use of ARNI after stabilization of ADHF resulted in a significant reduction of HF rehospitalization/all-cause mortality (RR: 0.71; 95% CI: 0.57 to 0.88; p &amp;lt; 0.01), HF rehospitalization (RR: 0.73; 95% CI: 0.57 to 0.93; p = 0.01), worsening renal function (RR: 0.80; 95% CI: 0.64 to 1.00; p = 0.048), and NT-proBNP at 4 weeks (SMD: -0.24; 95% CI: -0.34 to -0.14; p &amp;lt; 0.0001) or 8 weeks (SMD: -0.21; 95% CI: -0.31 to -0.10; p = 0.0001). However, ARNI was associated with a higher risk of symptomatic hypotension (RR: 1.33; 95% CI: 1.04 to 1.71; p = 0.024). Conclusion Pooled data demonstrate that the initiation of ARNI post-ADHF can be effective compared with ACEIs/ARBs for both cardiovascular and renal benefits at the expense of increased risk for symptomatic hypotension.

Abstract Background Stroke prevention in atrial fibrillation (AF) patients is commonly managed with direct oral anticoagulants (DOACs), which carry an inherent risk of bleeding. We aimed to compare the safety of Factor XI/XIa inhibitors to DOACs, specifically focusing on the risk of major bleeding complications. Purpose We conducted a meta-analysis to assess the safety and efficacy of Factor XI/XIa inhibitors in patients with AF requiring stroke prevention. Methods We conducted a systematic search of different databases for randomized controlled trials (RCTs) comparing Factor XI/XIa to DOACs for stroke prophylaxis in AF Patients. Statistical analysis was performed using R, with Risk Ratios (RR) calculated using a random-effects model. Heterogeneity was assessed using I² and Chi² indices. Results Three RCTs comprising 16,772 patients with AF were included. Of the participants studied, 8,728 (52%) received Factor XI/XIa inhibitors, and 8,044 (48%) received DOACs. Overall, Factor XI/XIa inhibitors were associated with a significantly lower risk of major bleedings (RR 0.39, 95% confidence interval [CI] 0.29–0.53; p &amp;lt; 0.01; I² = 2.8%) compared to Factor Xa inhibitors. There was no significant difference in all-cause mortality between the groups (RR 0.85, 95% CI 0.63–1.15; p = 0.29; I² = 0.0%). Adverse events occurred at similar rates in both treatment arms, with no statistically significant differences observed (RR 1.01, 95% CI 0.97–1.05; p = 0.61; I² = 0.0%). Conclusion This meta-analysis shows that Factor XI/XIa inhibitors significantly reduce the risk of major and clinically relevant non-major bleeding compared to Factor Xa inhibitors, with no significant differences in all-cause mortality or adverse events. These findings highlight Factor XI/XIa inhibitors as promising alternatives for anticoagulation therapy in AF, particularly for patients at high risk of bleeding.