Citations

This case report discusses a patient with vertebral pseudoaneurysm that spontaneously ruptured and led to vertebro-vertebral arteriovenous fistula requiring endovascular therapy.

BACKGROUND: The optimal antithrombotic treatment after transcatheter left atrial appendage closure (LAAC) remains to be determined. The objective of this trial was to compare anticoagulation and antiplatelet therapy for preventing device-related thrombosis (DRT) after LAAC. METHODS: This was a prospective multicenter international randomized trial comparing 2 different antithrombotic strategies for preventing DRT after LAAC in patients with nonvalvular atrial fibrillation. Patients were randomized (1:1) to receive direct oral anticoagulants (DOACs) or dual antiplatelet therapy (DAPT; aspirin+clopidogrel) for 60 days. Patients underwent transesophageal echocardiography at 60 days, and the images were analyzed in a central echocardiography laboratory by experienced echocardiographers blinded to the allocated treatment. The primary outcome was DRT as determined by transesophageal echocardiography 60 days after LAAC in patients receiving the allocated treatment at the time of transesophageal echocardiography (per-protocol analysis). The safety outcome included all-cause mortality, stroke, bleeding, or site-reported DRT within 60 days after LAAC in all randomized patients (intention-to-treat analysis). RESULTS: A total of 510 patients (mean age 77±9 years, 35% women) were included between October 2018 and May 2025, and 253 and 257 patients were randomized to the DOAC and DAPT groups, respectively. Of these, 399 patients underwent transesophageal echocardiography and were receiving the allocated treatment at 60 days after LAAC. The primary outcome occurred in 3 patients (1.5%) in the DOAC group compared with 8 patients (4.1%) in the DAPT group (difference, −2.7% [95% CI, −6.0% to 0.6%]; P =0.110). The safety outcome occurred in 52 patients (22.5%) in the DOAC group compared with 82 patients (34.9%) in the DAPT group (difference, −12.4% [95% CI, −20.6% to −4.2%]; P =0.003), and differences were mainly driven by a lower rate of bleeding events in the DOAC group (44 patients [17.4%] versus 64 patients [24.9%]; difference, −7.5% [95% CI, −14.6% to −0.4%]; P =0.038). CONCLUSIONS: The use of DOACs after LAAC failed to reduce DRT compared with DAPT, but it was associated with an improved safety profile. The results of this study should be interpreted with caution because of statistical power issues related to the narrower-than-expected between-group differences and will need confirmation in future larger studies. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03568890.

Intracardiac metastases from gastroenteropancreatic neuroendocrine tumors (NETs) are rare and challenging to diagnose. Lutetium (Lu)-177 DOTATATE therapy has demonstrated significant benefit in patients with metastatic NET; however, there are limited data regarding the direct impact on cardiac metastases. Patients with intracardiac metastasis from NET were evaluated. Patients were stratified by treatment with Lu-177 DOTATATE. Quantitative assessments of the progression of cardiac metastatic size (maximal diameter) and metabolic activity, as measured by maximal standardized uptake value (SUV max ), were performed on serial 68 Ga-DOTATATE PET imaging. In a cohort of 23 patients, 11 patients (47.8%) received Lu-177 DOTATATE therapy. Through a median of 2.2 years of follow-up, these patients showed some reduction in metastatic burden with a median reduction in maximal diameter of 1.0 mm (IQR: 0.0–3.0) and a median change in SUV max of −1.6 (IQR: −4.4 to 1.5). In contrast, patients who did not receive Lu-177 DOTATATE had some increase in maximal diameter of 0.5 mm (−2.0 to 2.0) and an increase in SUV max of 1.4 (−6.2 to 2.3). Overall, Lu-177 DOTATATE therapy may result in modest regression of intracardiac metastases as assessed by molecular imaging, whereas patients with cardiac metastases who did not receive therapy appeared to show progression.

Abstract Disclosure: M. Kakakhel: None. S. Fatima: None. H. Ahmad: None. A. Ibrahim: None. W. Rahman: None. R. Haider: None. H. Jawad: None. A. Qadeer: None. M. Khawar: None. F. Ahmed: None. J. Ikram: None. R. Kirchoff: None. Background: Across the world, type 1 diabetes mellitus (T1DM) is a major health problem for teenagers and young people. This study aims to examine the incidence and prevalence of T1DM by gender in the 15-39 age range between 1990 and 2021. Methods: We analyzed data from the Global Burden of Disease (GBD) to evaluate incidence and prevalence rates of T1DM in each gender from 1990 to 2021. The Annual Percentage Change (APC) and The Annual Average Percentage Change (AAPC) was used to assess trends, with p-values determining the statistical significance. Results: From 1990 to 2021, the global prevalence of T1DM was found to be increased steadily for both genders, with the highest rates recorded in 2021: 247.32 per 100,000 for females and 246.47 per 100,000 for males. Incidence rates in 2021 showed a contrasting pattern, with males exhibiting higher rates (7.18 per 100,000) compared to females (5.98 per 100,000). AAPC analysis showed that males exhibit a faster rise in both prevalence and incidence compared to females over the study period. The difference in AAPC between males and females is more pronounced for prevalence (+0.3748%) compared to incidence (+0.1956%), with all AAPC values being statistically significant (p < 0.000001). Following the APC analysis, other significant trends were revealed. Male incidence experienced the greatest increase during 2015-2021, with an APC of +1.9033% (p < 0.000001), whereas female incidence increased most between 2011 and 2014 (APC = +1.3050%; p < 0.000001). In contrast, the most significant decline in incidence was observed in females during 1990-1992, with an APC of +0.1665% (p = 0.006799), which was the lowest increase in the dataset. For prevalence, males exhibited the highest increase during 2015-2021, with an APC of +1.3938% (p < 0.000001), whereas females had their peak increase during 2006-2009, with an APC of +0.8957% (p < 0.000001). The slowest increase in prevalence for females occurred during 2014-2019, with an APC of +0.4591% (p < 0.000001). Conclusion: The prevalence and incidence of T1DM among people aged 15-39 increased significantly between 1990 and 2021, with a greater increase in males. This highlights the need for gender-specific strategies in T1DM prevention and management, and research into the factors driving these disparities. Presentation: Sunday, July 13, 2025

Abstract Disclosure: L.J. Plaza Enriquez: None. R. ibrahim: None. L. Ayari: None. R. Gavrilova: None. Y. Kudva: None. Introduction: Mitochondrial diabetes(mtDB) is a rare disease; hence its prevalence and associated comorbidities are not well defined. The aim of this study is to describe prevalence, glycemic control, treatment used for diabetes and comorbidities associated with this condition using a Mayo Clinic cohort of patients with mitochondrial mutations. Methods: We identified 23 patients with diabetes from an institutional cohort of patients with, mitochondrial mutations. Genetic mutations included the classic MTTL1 m.3243A>G in 22 of the patients and MTND5m.13513G>A in one patient. Statistical analysis was performed using BlueSky Statistics version 10.3.4 software. Categorical variables were compared using Fisher’s exact test and continuous variables were compared using ANOVA. Kaplan Meier survival curves were created. Unless otherwise stated, value of p of <0.05 was considered significant. Results: The cohort consisted of predominantly females (14 vs 9). The mean age at initial diabetes diagnosis was 39.5 years (CI: 30.6–48.4) for females and 32.0 years (CI: 20.9–43.1) for males (p = 0.253). Over 75% of patients were initially diagnosed with type 2 diabetes (T2D). The mean age at mtDB diagnosis was 51.7 years (SD 11.9) for females and 46.0 years (SD 8.5) for males, reflecting a >15-year gap between T2D and mtDB diagnosis. The mean BMI at initial diagnosis was similar between males and females (26.0 (CI: -8.4, 60.4)), though it was higher than the average reported in the literature. Most patients had multiple comorbidities associated with mtDB, including retinopathy, macular defects, cerebrovascular disease, CVD, arrhythmias, nephropathy, and gastrointestinal conditions. Retinopathy and macular defects typically developed within 5-10 years of diabetes diagnosis, while cerebrovascular disease and CVD had a later onset, at a mean of 8.25 years (SD = 6.76) and 5.0 years (SD = 5.75), respectively. However, the difference in onset times between these comorbidities was not statistically significant (p = 0.3228).Regarding glycemic control, there was no significant difference in HbA1c levels at diagnosis or later (HbA1c < 8% in >90% of the cohort). Various treatment modalities (13 on insulin therapy vs 10 on non-insulin treatments) did not show significant differences in glycemic control (p = 0.463), with mean HbA1c of 6.59 (SD 1.36). Mortality rates increased 10-15 years after initial diagnosis of mtDB, with 3 patients dying from complications related to the mitochondrial disorder. Conclusion: mtDB is associated with significant comorbidities/complications that developed earlier compared to T2D or even T1D from the literature. Initial misdiagnosis of this condition as T2D remains high. Different treatment modalities (insulin vs non-insulin) did not differ in glycemic control hence consideration as first options of treatment should be given to oral hypoglycemics. Presentation: Saturday, July 12, 2025

Abstract Aims The Society for Cardiovascular Angiography and Interventions (SCAI) Classification provides risk stratification of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). This sub-study of the ECLS-SHOCK trial investigates the prognostic impact of SCAI stages in AMI-CS and the influence of SCAI stages on the effect of extracorporeal life support (ECLS) therapy in AMI-CS patients. Methods Patients with AMI-CS enrolled in the multicentre, randomized ECLS-SHOCK trial were included. The outcomes, treatment effect and safety of ECLS were stratified according to SCAI stage at admission using a post-hoc classification. Results From a total of 417 patients enrolled in the ECLS-SHOCK trial between June 2019 and November 2022, 51.6% (n = 215), 13.4% (n = 56) and 35.0% (n = 146) presented in SCAI Stages C, D and E, respectively. SCAI stages were associated with the risk of 30 day all-cause mortality (C vs. D vs. E: 32.6% vs. 67.9% vs. 64.4%, P < 0.001), with rates of renal replacement therapy at 30 days (C vs. D vs. E: 7.0% vs. 19.6% vs. 13.7%, P = 0.03) and with poor neurological outcomes (C vs. D vs. E: 17.2% vs. 44.4% vs. 36.5%, P < 0.001). No interaction was observed between SCAI stage and the treatment effect of ELCS on 30 day all-cause mortality (ELCS vs. control SCAI C: 32.7% vs. 32.4%; SCAI D: 68.4% vs. 66.7%; SCAI E: 59.7% vs. 68.4%, P for interaction = 0.65). Conclusions In AMI-CS patients included in the ECLS-SHOCK trial, SCAI stages at admission were predictive for mortality and for the incidence of safety events. The efficacy of ECLS treatment was not affected by SCAI stage.

Abstract Aims Left ventricular assist devices (LVADs) are a critical intervention for advanced heart failure (HF), serving as destination therapy or bridge to transplantation. Obesity and diabetes impact outcomes in patients with LVADs. Glucagon-like peptide-1 receptor agonists (GLP1-RAs) demonstrate cardiovascular benefits; however, their role in patients with LVADs remains underexplored. We evaluated the association of GLP1-RA therapy with cardiovascular outcomes in patients with LVADs. Methods This retrospective cohort study used the TriNetX database, a research network database from 98 healthcare organizations. We queried for all adult LVAD recipients (≥18 years) and were stratified into GLP1-RA users and non-users. Propensity score matching (PSM) (1:1) balanced demographics, comorbidities, medication use and laboratory data. Outcomes included heart transplantation rates, heart failure hospitalizations, all-cause mortality, all-cause hospitalizations and cardiovascular events. Logistic regression models were used to estimate adjusted odds ratios (aOR). Results After PSM, we included a total of 1036 adult LVAD recipients (518 GLP1-RA users, 518 matched non-users) with a mean follow-up time of 311.6 ± 98.4 days for the GLP1-RA cohort and 304.0 ± 111.5 days for the non-GLP1-RAs cohort. Mean age was 56.7 ± 12.2 years in the GLP1-RA cohort and 58.0 ± 12.5 years in the non-GLP1-RA cohort. Females comprised 28.0% of both cohorts while White patients represented 52.1% of the GLP1-RA group and 53.1% of the non-GLP1-RA group. GLP1-RA users had higher heart transplantation rates [n = 98 (18.9%) vs. n = 44 (8.5%); aOR 2.514 (95% CI: 1.720–3.673)]. Acute HF events and all-cause hospitalizations were lower among GLP1-RA users compared with non-users [n = 288 (55.6%) vs. n = 357 (68.9%); aOR 0.565 (95% CI: 0.438–728) and n = 324 (62.5%) vs. n = 390 (75.3%); aOR 0.548 (95% CI: 0.420–0.716)]. No differences were observed when comparing the GLP1-RA cohort with the non-GLP1-RA cohort in regard to all-cause mortality [n = 32 (6.2%) vs. n = 44 (8.5%); aOR 0.709 (95% CI: 0.442–1.138)], stroke [n = 42 (8.1%) vs. n = 58 (11.2%); aOR 0.700 (95% CI: 0.461–1.062)] or cardiac arrest [n = 18 (3.5%) vs. n = 17 (3.3%); aOR 1.061 (95% CI: 0.541–2.082)]. Conclusions GLP1-RA therapy in patients with advanced HF and LVADs is potentially associated with improved heart transplantation rates while decreasing hospitalization and acute HF event rates.