Citations

Abstract Introduction E-cigarette use has risen dramatically in the past decade, accompanied by recognition of e-cigarette or vaping-use associated lung injury (EVALI). Although increasingly reported, the pathophysiology of EVALI remains poorly defined, and its clinical presentation and diagnostic evaluation are often nonspecific. Clinicians should maintain a high index of suspicion given its varied manifestations. We describe a young patient with EVALI complicated by histopathologic evidence of secondary pulmonary alveolar proteinosis (PAP), progressing to severe hypoxemic respiratory failure that ultimately required bilateral lung transplantation. Case Presentation A 28-year-old man with a nine-year history of vaping nicotine and THC-containing hash oil presented with chronic hypoxemic respiratory failure requiring BiPAP. One year earlier, he developed digital clubbing, followed by progressive cough and exertional dyspnea. Initial chest CT showed diffuse centrilobular ground-glass opacities without septal thickening, thought to represent hypersensitivity pneumonitis. Despite vaping cessation several months prior to presentation, his symptoms progressed rapidly, and he required high-flow supplemental oxygen (Fi02 80% at 50 L/min) within weeks of admission. Bronchoscopy with bronchoalveolar lavage and biopsy demonstrated focal organizing pneumonia, pigmented foamy macrophages, and eosinophilic acellular debris within alveoli, consistent with pulmonary alveolar proteinosis (PAP). Cultures and cytology were negative for infection or malignancy. Autoimmune serologies were unrevealing, and no alternative exposures were identified. Due to worsening hypoxemic respiratory failure and lack of response to vaping cessation, steroids, and nebulized sargramostim (recombinant human granulocyte-macrophage colony-stimulating factor), he underwent bilateral lung transplantation. Whole lung lavage was considered but not pursued due to concern for further deterioration. Explant pathology showed interstitial fibrosis with a nonspecific interstitial pneumonia pattern and extensive PAP-like reaction with cholesterol clefts and small airway injury. Discussion EVALI encompasses a broad spectrum of radiographic and histopathologic findings, but secondary pulmonary alveolar proteinosis (PAP) is rarely reported. Diagnostic criteria include e-cigarette use within 90 days and pulmonary infiltrates or ground-glass opacities, with exclusion of malignant, autoimmune, and infectious causes. Although most often associated with ground-glass opacities and organizing pneumonia with diffuse alveolar damage, the pathology of EVALI is variable and poorly understood, further complicated by heterogeneity in vaping exposures. This case highlights PAP as a potential manifestation of EVALI, raising the possibility that impaired alveolar macrophage function and surfactant clearance contribute to hypoxemia in severe disease. Clinicians should maintain a high index of suspicion for EVALI and be aware of its diverse histopathologic spectrum. Continued research is needed to clarify underlying mechanisms and guide management. This abstract is funded by: None

Rationale: Cardiovascular disease remains the leading cause of death in women. To address its determinants including persisting cardiovascular risk factors amplified by sex and race inequities, novel personalized approaches are needed grounded in the engagement of participants in research and prevention. Objective: To report on a participant-centric and personalized dynamic registry designed to address persistent gaps in understanding and managing cardiovascular disease in women. Methods and Results: The American Heart Association and Verily launched the Research Goes Red registry (RGR) in 2019, as an online research platform available to consenting individuals over the age of 18 years in the United States. RGR aims to bring participants and researchers together to expand knowledge by collecting data and providing an open-source longitudinal dynamic registry for conducting research studies. As of July 2021, 15 350 individuals have engaged with RGR. Mean age of participants was 48.0 48.0±0.2 years with a majority identifying as female and either non-Hispanic White (75.7%) or Black (10.5%). In addition to 6 targeted health surveys, RGR has deployed 2 American Heart Association-sponsored prospective clinical studies based on participants’ areas of interest. The first study focuses on perimenopausal weight gain, developed in response to a health concerns survey. The second study is designed to test the use of social media campaigns to increase awareness and participation in cardiovascular disease research among underrepresented millennial women. Conclusions: RGR is a novel online participant-centric platform that has successfully engaged women and provided critical data on women’s heart health to guide research. Priorities for the growth of RGR are centered on increasing reach and diversity of participants, and engaging researchers to work within their communities to leverage the platform to address knowledge gaps and improve women’s health.

Background— Prior studies have demonstrated an inconsistent association between patients’ arrival time for acute myocardial infarction (AMI) and their subsequent medical care and outcomes. Methods and Results— Using a contemporary national clinical registry, we examined differences in medical care and in-hospital mortality among AMI patients admitted during regular hours (weekdays 7 am to 7 pm ) versus off-hours (weekends, holidays, and 7 pm to 7 am weeknights). The study cohort included 62 814 AMI patients from the Get With the Guidelines–Coronary Artery Disease database admitted to 379 hospitals throughout the United States from July 2000 through September 2005. Overall, 33 982 (54.1%) patients arrived during off-hours. Compared with those arriving during regular hours, eligible off-hour patients were slightly less likely to receive primary percutaneous coronary intervention (adjusted odds ratio [OR], 0.93; 95% confidence interval [CI], 0.89 to 0.98), had longer door-to-balloon times (median, 110 versus 85 minutes; P <0.0001), and were less likely to achieve door-to-balloon ≤90 minutes (adjusted OR, 0.34; 95% CI, 0.29 to 0.39). Arrival during off-hours was associated with slightly lower overall revascularization rates (adjusted OR, 0.94; 95% CI, 0.90 to 0.97). No measurable differences, however, were found in in-hospital mortality between regular hours and off-hours in the overall AMI, ST-elevated MI, and non–ST-elevated MI cohorts (adjusted OR, 0.99; 95% CI, 0.93 to 1.06; adjusted OR, 1.05; 95% CI, 0.94 to 1.18; and adjusted OR, 0.97; 95% CI, 0.90 to 1.04, respectively). Similar observations were made across most age and sex subgroups and with an alternative definition for arrival time (weekends/holidays versus weekdays). Conclusions— Despite slightly fewer primary percutaneous coronary interventions and overall revascularizations and significantly longer door-to-balloon times, patients presenting with AMI during off-hours had in-hospital mortality similar to those presenting during regular hours.