SUNDAY | NOV. 17, 2024 Daily News #AHA24 Celebrating a Century of Cardiovascular Science: From Prevention to Treatment, to Cure Trial results were presented for new approaches to managing blood pressure in diabetes, HFpEF and obesity, and transthyretin amyloid cardiomyopathy at the Opening Session on Saturday. They found: • Intensive blood pressure control strategy may improve cardiovascular outcomes in patients with type 2 diabetes. • Tirzepatide shows clinical benefit in patients with heart failure with preserved ejection fraction and obesity. • Novel gene editing therapy shows promise for patients with transthyretin amyloid cardiomyopathy. An intensive blood pressure control strategy for patients with type 2 diabetes may be considered There is a lack of consensus on blood pressure reduction targets in patients with type 2 diabetes and current clinical guidelines offer inconsistent recommendations due to limited evidence from well-conducted clinical trials. Still, results of the Intensive Blood-Pressure Control in Patients with Type 2 Diabetes (BPROAD) trial contribute to the body of evidence supporting more intensive systolic blood pressure control in patients with type 2 diabetes for the prevention of major cardiovascular events. The multicenter, open-label, parallel-group clinical trial randomized 12,821 patients with type 2 diabetes and elevated systolic blood pressure and increased cardiovascular risk from 145 clinical sites in mainland China between February 2019 and December 2021 to intensive treatment (6,414 patients) or standard treatment (6,407 patients) for up to five years. Systolic blood pressure was targeted to <120 mmHg in the intensive treatment group and <140 mmHg in the standard treatment group. Mean age of patients was 63.8 years; 45.3% were women and 22.5% had a self-reported history of cardiovascular disease at baseline. Median follow-up was 4.2 years. The primary outcome was major cardiovascular events defined as the composite endpoint of the first occurrence of non-fatal stroke, non-fatal myocardial infarction, treated or hospitalized heart failure, and cardiovascular death. Following randomization, the intensive treatment was associated with a significant 21% reduction in risk of cardiovascular disease compared with patients receiving the Today’s Late-Breaking Science and Featured Science 2 What women want: Better cardiovascular health 3 Inside Nurses drive programs, clinics to treat heart disease 5 Simulation Zone 14 Generative AI could change the way medical training and education are done. As artificial intelligence causes a buzz across medicine, it could be making significant inroads in cardiology, according to speakers at the Saturday session “Generative AI in Cardiovascular Health: A Transformative Force.” AI, they said, has the potential to shape the future of treatment, education and research. Rohan Khera, MD, MS, assistant professor of medicine and biostatistics at Yale University, said AI-programmed large language models, such as the kind of algorithms that power the popular ChatGPT, are increasingly being used to improve workflows in health care systems. But he sees potential for much more. “I think there’s value beyond that in many domains,” he said. “For instance, we’re doing a lot of work in rethinking evidence generation, which we have done using randomized clinical trials. Could generative AI enable possibilities in this domain?” Specifically, he and colleagues asked whether it’s possible to replicate information from a randomized clinical trial in a new population using a process called digital twin technology. Then there are other, completely different applications, Khera said. See AI LEARNING, page 6 See CENTURY, page 12 Early Career Investigator Showcase 6 Exhibitors and Science & Technology Hall map 8-10 Khera Berlacher Artificial intelligence, real learning
Today at Sessions Late-Breaking Science LBS.04: From Intervention to Prevention: Advances in Coronary and Valvular Heart Disease 8-9:15 a.m. | Main Event I • Efficacy of Restrictive vs. Liberal Oxygenation in Patients Undergoing Coronary Artery Bypass Grafting or Aortic Valve Replacement: A Randomized Clinical Trial (GLORIOUS) • Efficacy of a Glucagon-Like Peptide-1 Agonist in Patients Undergoing Coronary Artery Bypass Grafting or Aortic Valve Replacement: A Randomized Clinical Trial (GLORIOUS) • Efficacy and Safety of Edoxaban in Anticoagulant Therapy Early After Surgical Bioprosthetic Valve Replacement: ENBALV Trial • The CLEAR SYNERGY (OASIS 9) Trial: A 2x2 Factorial Randomized Controlled Trial of Colchicine vs. Placebo and Spironolactone vs. Placebo in Patients With Myocardial Infarction: The Results of the Spironolactone Factorial LBS.05: Innovation in Prevention and Global Implementation 3:30-4:45 p.m. | Main Event I • TOPSPIN - A Three-Arm Randomized Trial for Treatment Optimization of Blood Pressure With Single-Pill Combinations In India • Electronic Nudges to Increase Influenza Vaccination Among Patients With History of Myocardial Infarction: Insights From 3 Randomized Clinical Trials Enrolling >2 Million Patients (NUDGE-FLU) • Pragmatic Randomized Controlled Trial of a Decision Support System to Aid Physician Optimization of Early Lipid Lowering Therapies After Acute Coronary Syndrome (ZODIAC) • Preliminary Results of Randomized Trial of New vs. Reconditioned Pacemakers for Patients Unable to Obtain a New Device in Low- and Middle-Income Countries: The My Heart Your Heart (MHYH) Randomized Trial Featured Science FS.03: Getting Closer to the Summit: New HFpEF Treatments 8-9:15 a.m. | S100A • Effect of Finerenone on a Hierarchical Composite Endpoint Analyzed Using Win Statistics in Patients With Heart Failure and Mildly Reduced or Preserved Ejection Fraction: A Prespecified Analysis of FINEARTS-HF • Efficacy and Safety of Finerenone in Patients With Heart Failure and Mildly Reduced or Preserved Ejection Fraction: A Prespecified SexSpecific Analysis of the FINEARTS-HF Trial • Finerenone and Risk of Hyperkalemia in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction (FINEARTS-HF) • Effects of Tirzepatide on Cardiorenal End-Organ Damage in Heart Failure and Preserved Ejection Fraction: Insights From the SUMMIT Trial Main Events Paul Dudley White International Lecture and Session 3:30-4:45 p.m. | S100A Environmental Crisis Exposome: Reshaping the Landscape of CV Basic Research and Health Care 8-9:15 a.m. | Main Event II GLP-1RAs and Beyond: Incretin Analogues and a New Frontier in Cardiovascular Therapeutics 9:45-11 a.m. | Main Event II SCIENTIFIC SESSIONS DAILY NEWS | Day 2 Sunday, Nov. 17, 2024 2 Meet the Trialist MTT.02 | Brain AF* 8–8:30 a.m. | Overflow Theater 2, North Building, Level 2 MTT.03 | GLORIOUS* 3:30–4:15 p.m. | Overflow Theater 2, North Building, Level 2 *Not a CE accredited session. Scan the QR code to view the Industry Programming Guide. Check the Mobile Meeting Guide app for updates. Paul Dudley White International Lecture and Session 3:30-4:45 p.m. | Main Event II “Atrial Cardiomyopathy and Ischemic Stroke: The Jury Is Out” Barbara Casadei, FRCP, FMedSci Claiming CE credit for #AHA24 #AHA24 attendees can receive up to 24.75 Continuing Education credits. CE credit claiming is limited to participation during the event Nov. 15-18, 2024. Complete the credit claim process within 30 days to avoid credit expirations. Log in a. Go to education.heart.org. b. Enter your username and password and sign in. c. Click on your name in the upper righthand corner and select My Library. Claim credit a. Click Start Survey to complete conference evaluation. b. Click Claim CE. c. Complete information and save. d. Your certificate is located in ‘My Account’ under ‘CE Details.’ Need assistance? For customer support, call 1-877-340-9899 (Monday-Friday between 8 a.m.-6 p.m. CST) or email education.help@email.education.heart.org.
3 #AHA24 ScientificSessions.org Lp(a) Toolkit for Healthcare Professionals High levels of plasma lipoprotein(a) (Lp(a)) are independently associated with atherosclerotic cardiovascular disease (ASCVD) and increased risk of myocardial infarction, peripheral arterial disease, and stroke. Learn more in this toolkit for healthcare professionals. Lp(a) Survey for Healthcare Professionals We invite you to take part in a brief survey designed to assess your knowledge of Lp(a) and help us understand your practice. Your responses will help the American Heart Association shape future educational activities that drive further awareness of Lp(a) screening and overall ASCVD risk management. Novartis is proud to support the American Heart Association’s Lp(a) Awareness and Testing Initiative. Find out how Lp(a) impacts your patients Lifelong Learning is a trademark of the AHA. Unauthorized use prohibited. WF650001 10/24 Paid Advertisement WF_650001_IPPC_PPD_date_Jr_Print_Ad_03kk.indd 1 10/8/24 11:31 AM What women want: Better cardiovascular health Identifying, improving and preventing common cardiovascular disorders in women. Determined to change the course of cardiovascular disease in women, a panel of experts convened Saturday to highlight recent research and provide suggestions to reframe cardiovascular disease at various stages of women’s lives, including pregnancy and menopause. “Cardiovascular disease in women is understudied, underrecognized, underdiagnosed and undertreated,” said Demilade Adedinsewo, MD, MPH, FACC, assistant professor of medicine at Mayo Clinic in Jacksonville, Florida. “There are myriad research and public health efforts underway to change this narrative.” Heart disease often presents differently in biological females, compared with males, and certain cardiovascular disorders are unique or more commonly diagnosed in women, said Adedinsewo. These include peripartum cardiomyopathy, heart failure with preserved ejection fraction and spontaneous coronary artery dissection. The goal of the session, “2024 Update on CV Disorders That Disproportionately Affect Women,” was to “dive into specific topics in this field, demystify underlying assumptions about heart disease in women and explore novel diagnostic and therapeutic approaches,” said Adedinsewo. In addition to reviewing some of the sex-based similarities and differences of heart disease, the panel also shared innovative approaches and interventions for screening, detecting and managing CV disorders in women, such as how (and why) to perform cardiovascular risk assessments in the perinatal period. The session also examined the interrelationship that pregnancy and the menopause transition have with cardiovascular health. Adedinsewo was joined by Thais Coutinho, MD, senior associate consultant in the Department of Cardiovascular Medicine at Mayo Clinic in Rochester, Minnesota, and Jennifer H. Mieres, MD, FACC, MASNC, FAHA, professor of cardiology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New York. Mieres, who is also chief diversity and inclusion officer and senior vice president, Center for Equity of Care, at Northwell Health, noted the importance of ongoing initiatives such as the American Heart Association’s Go Red for Women movement, launched in 2004. Its goal is to increase awareness of cardiovascular disease in women, close gaps in knowledge and care and ultimately save women’s lives. “Over the past two decades, the AHA’s Go Red for Women campaign, along with other integrated efforts, has increased awareness, expanded research funding, catalyzed discovery of unique biological pathways, enhanced knowledge and fostered specific guidelines for prevention and treatment of CVD in women,” Mieres said. “Despite improvement in awareness, significant gaps persist, and adverse CVD trends are emerging.” Adedinsewo Mieres Coutinho
4 SCIENTIFIC SESSIONS DAILY NEWS | Day 2 Sunday, Nov. 17, 2024 Scientific Sessions Daily News is produced for the American Heart Association for Scientific Sessions by Ascend Media, LLC (ascendmedia.com). After you have read this issue of Scientific Sessions Daily News, please share with colleagues or deposit it in an approved paper recycling bin. ©2024 by the American Heart Association 7272 Greenville Ave. Dallas, TX 75231 214-570-5935 ScientificSessions.org Visit us at BOOTH #1112 NewAmsterdam Pharma is dedicated to Defusing the LDL-C Threat © NewAmsterdam Pharma B.V. 2024. 09/24 UM---0004 NewAmsterdam Pharma recognizes the need for alternative pharmacologic approaches to LDL-C management and is committed to developing novel, nonstatin, oral therapies that will potentially reduce patients’ ASCVD risk. Paid Advertisement ACC, American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; LDL-C, low-density lipoprotein cholesterol. Reference: 1. Family Heart Foundation. Prioritizing LDL-cholesterol control. Accessed August 21, 2024. https://familyheart.org/prioritizing-ldl-cholesterol-control 72% of high-risk hypercholesterolemia patients never reached ACC/AHA guideline LDL-C goals1 IT’S TIME TO EXPECT MORE Scan to learn more The American Heart Association (AHA) marks an historic landmark this year: its 100th anniversary! A wide range of celebratory events is planned to commemorate this important anniversary, to catalog, celebrate and honor the AHA’s 100 year-long journey. This is a time to recognize and honor the AHA’s numerous successes and enormous influence. Beyond that, many are working to envision and sculpt the next 100 years of the AHA’s influence and impact. As part of this exciting yearlong celebration, the AHA’s journals are launching a series of short articles termed Centennial Collection. Visit www.ahajournals.org/ centennial for a full listing of Centennial Collection articles and more. New: 100 Years of Lifesaving Work and Counting: Happy Birthday to the American Heart Association Highlights from the Centennial Collection The American Heart Association Journals Centennial Collection • Joseph A. Hill, MD, PhD, FAHA, and on behalf of the editorsin-chief of the American Heart Association Journals CEO Foreword: The Centennial Presidential Advisory • Nancy Brown, AHA CEO Cardiology: A Century of Progress • Eugene Braunwald, MD, MACC, FAHA The Feminine Face of Heart Disease 2024 • Nanette K. Wenger, MD, MACC, MACP, FAHA Centennial Collection AHA marks its 100 years with journal articles highlighting its 100 years of lifesaving work.
5 #AHA24 ScientificSessions.org Nurses drive programs, clinics to treat heart disease Initiatives committed to shared decision-making and evidence-based care can improve patient outcomes. Clinical programs described at a session Saturday help show how nurses can be vital guides for cardiovascular patients on the road to better health. At the session, “Clinical Initiatives Driving Meaningful Change for Patients With Advanced Heart Disease,” four nursing leaders explored unique elements and benefits of nurse-led clinics and programs for cardiovascular disorders. “Nursing is the most trusted profession,” said Megan Streur, PhD, ARNP, of the University of Washington School of Nursing in Seattle. “When patients and their loved ones trust their care provider, they are more likely to be open about their concerns and preferences and to engage in shared decision-making.” These two factors — trust and shared decision-making — are what allow clinics developed and directed by nurses to be so successful, said Streur, assistant professor and Lila Scott Endowed Faculty Fellow in Cardiovascular Disease Prevention in the Department of Biobehavioral Nursing and Health Informatics. Streur co-presented alongside Dillon Dzikowicz, PhD, RN, PCCN, Bradi Granger, PhD, MSN, and Jonathan R. Medina-Beckwith, DNP, ARNP, FNP-C. “In health care, we strive to provide evidence-based care in order to achieve the best outcomes,” Streur said. “Nurse-led clinics often utilize structured clinical care pathways or algorithms to improve adherence to evidence-based, guideline-directed medical therapy.” Nurse-driven clinics are often initiated by clinicians who see unmet needs or gaps in care firsthand. For example, the Community Heart Failure Program at UW Medicine’s Harborview Medical Center was established by a nurse practitioner and registered nurse after observing some groups of people did not have equitable access to traditional clinic-based care. Now, nurses in the program travel to see patients where the patient is most comfortable — be it a house, apartment, car or even tent — to provide care. “They proposed a solution … and their program has been successful at improving outcomes,” Streur said. Besides heart failure, nurse-led clinics focus on other common cardiovascular conditions, such as stroke, hypertension, atrial fibrillation and genetic-based disorders. Although these clinics have simple goals and documented results, they require support from affiliated health care systems and may require certain oversight, depending on local and federal regulations. This can make comparisons among clinics difficult and successful replication challenging. “I think as more research emerges that demonstrates the benefits of nurse-led programs across a variety of settings, it will hopefully become easier to get buy-in from key stakeholders and decision-makers,” Streur said. Another benefit of nurse-led programs, besides improved patient outcomes, is increased job satisfaction, perhaps due to the additional autonomy clinicians have in workplace practices. Streur and her colleagues hope Saturday’s session provided awareness of and insight into nurseled cardiovascular clinics as well as inspired clinicians and researchers to get involved in similar initiatives at their own institutions. “Patients and their loved ones receive excellent, evidence-based care,” she said. “The health care system at large benefits when patient outcomes improve.” At the intersection of heart and brain Leaders in cardiac monitoring and neurology pursue strategies to treat patients with AFib and stroke. Atrial fibrillation and stroke are each serious health events — but combined, outcomes can be especially debilitating and complex. At a session Sunday afternoon, experts will address the relationship between the two as well as the role of anticoagulation and monitoring strategies for detecting and treating AFib. The session “Atrial Fibrillation and Stroke: From Wearables and Implantables to Prevention and Outcomes — CRYSTAL Clear or Clear as Mud?” also will cover some of the latest research, new advancements and relevant guidelines. Ten years ago, the American Heart Association published Guidelines for the Primary Prevention of Stroke, which include approaches to stratify risk and select treatments to mitigate stroke in patients with AFib. Since then, new studies and guidelines have further assessed therapeutic applications and defined management recommendations, said session speaker Rajesh Kabra, MD, FACC, FHRS. For example, the CRYSTAL AF clinical trial demonstrated that more intensive monitoring with an implanted device after a stroke of undetermined cause resulted in discovery of more occult AFib, a finding that typically prompts initiation of anticoagulation to prevent future stroke. “Several contemporary studies have also shown that a significant proportion of patients with AFib and a high risk of stroke do not receive anticoagulation due to perceived increased risk of bleeding,” said Kabra, who is director of clinical operations at the Kansas City Heart Rhythm See AFIB AND STROKE, page 11 Pellegrini Kabra Healey UPCOMING SESSION EA.CVS.06 Atrial Fibrillation and Stroke: From Wearables and Implantables to Prevention and Outcomes - CRYSTAL Clear or Clear as Mud?? 3:30–4:45 p.m. | Sunday, Nov. 17 N230A Streur
6 SCIENTIFIC SESSIONS DAILY NEWS | Day 2 Sunday, Nov. 17, 2024 Early Career Investigator Showcase illuminates paths forward in research Friday session highlighted AHA-funded population and clinical scientists. Attention to research in a cardiology career can be arduous yet rewarding — especially when that research leads to life-changing patient outcomes. Getting started early is an important first step, and one that the American Heart Association fosters in many ways. One example is the AHA Early Career Investigator Showcase, an annual event at Scientific Sessions. Marat Fudim, MD, MHS, associate professor of medicine at Duke University School of Medicine in Durham, North Carolina, was the director of this year’s showcase spotlighting AHA-funded investigators in clinical and population science. Fudim said his experience with the showcase years ago strengthened his devotion to shaping future patient care. One of his first experiences with Scientific Sessions was as a fellow at the Early Career Day, he said. “It shaped my outlook on mentorship, networking and academic work as a fellow and beyond.” The showcase spotlights inspiring young AHA-funded investigators, he said. “This session is a platform for predoctoral fellowship, postdoctoral fellowship and career development recipients to discuss their exciting research, receive exposure at a critical junction in their career and make more connections within the AHA early career community and larger AHA community.” Clinical research can range from pure data projects to randomized clinical trials with novel interventions, such as drugs and devices,” Fudim said. “The fact that a researcher can participate in all types of research during the span of their career is fulfilling and promises never to get boring.” Since his early exposure to the research showcase, Fudim said he has watched his own research projects, and those of his early career colleagues, translate into clinical practice. He has also benefited from his involvement with the showcase — for instance, the opportunity during last year’s meeting to connect with AHA Fellows in Training and Early Career members. “I learned about their pathways in clinical medicine and clinical investigation,” Fudim said. “The Early Career Day is not primarily focused on communicating original research, but rather how to fund, publish and conduct successful and impactful research projects.” Fudim “For instance, there’s a lot of discussion on creating augmented reality experiences for trainees in education. So how can we make educational experiences better for people by providing technology to create, say, a visual representation of the heart when some abnormality is there?” he said. “You could read about it in a book, but that experience might make the trainee learn more about what that might actually look like.” Building on the application of AI in education, Katie Berlacher, MD, MS, FACC, associate chief of cardiology for education at the University of Pittsburgh Medical Center, said there are other innovative uses of the technology for anyone learning medicine — including students, residents and fellows along with practitioners and cardiovascular team members. “Learners often use AI to simplify concepts or generate answers to questions they have, ideally after they have tried to come up with the answers themselves,” she said. “For example, it could be used to generate a differential for a patient with specific presenting symptoms. “Educators are also using this often to help ease their burden of work, such as to help them write more questions, develop variation on curricula, draft learning objectives or even write a first draft of a letter of recommendation.” That’s not to say AI isn’t without its drawbacks. For education, Berlacher said one of the biggest concerns is that it could be used by students to take the easy way out. “The biggest pitfall I see with regards to generative AI and medical education is that AI can be used as a shortcut to find content and answers, which can circumvent the essential and beneficial work that is required for the brain to actually learn,” she said. “Remember, learning science has taught us that learning — the acquisition of knowledge — is work for the brain. It should be a bit uncomfortable and a bit of a struggle to learn new things. If or when AI is used in a way that eliminates that struggle, it also eliminates the actual learning.” Beyond that, Khera said, there are the usual concerns with privacy, data security, data inaccuracy and especially bias in the algorithms used by generative AI. One of the main concerns that isn’t always recognized is that of equity in deployment of the technology, he said. “There’s nothing saying every health system will adopt these AI systems,” Khera said. “The only way to (maintain equity) is to ensure that AI is treated like any other diagnostic tool. There should be a standard of care, making sure we ensure technological equity when we apply AI technology in care.” Despite these concerns, Berlacher said AI isn’t going away, and the medical community needs to lead the way in determining how it will be used. “Generative AI is here to stay in medicine as well as in education and training,” she said. “Proper integration of generative AI into medical education will take thoughtful training of learners as well as faculty development for educators. We should all be both curious and cautious as we integrate generative AI into our own learning.” AI LEARNING continued from page 1
7 #AHA24 ScientificSessions.org Collaborating across the Atlantic on critical care cardiology CCC specialists in Europe and the U.S. exchange ideas and best practices. Critical care cardiology, a relatively new field, has made strides in the U.S. But Carlos L. Alviar, MD, FACC, assistant professor of medicine at New York University’s Grossman School of Medicine and director of the Cardiac Intensive Care Unit at Bellevue Hospital Center in New York City, said the specialty has evolved faster in Europe, thanks in part to the European Society of Cardiology’s Association for Acute Cardiovascular Care (ACVC). “We really have been looking at ACVC as a model for us in America to grow this field,” Alviar said. That was the impetus behind Saturday’s session, “Building a Trans-Atlantic Collaborative Network in Critical Care Cardiology Education and Care Delivery: Collective Wisdom From AHA and the Association of Acute Cardiovascular Care.” Critical care cardiology, or CCC, is a relatively new field. It began to take off in 2012 when the American Heart Association published a scientific statement on its evolution and the need for new medical staffing and training modules for cardiac intensive care. Garima Dahiya, MD, MBBS, one of the panelists in Saturday’s session, said CCC care delivery presents a number of challenges. “These include regional variability in practice patterns, lack of robust clinical evidence and insufficient societal guidelines directing patient care,” said Dahiya, a critical care cardiologist and senior associate consultant at Mayo Clinic Rochester. “These issues are inherent to the heterogenous, high-acuity and complex patient population seen in cardiac intensive care units,” she said. “Building a trans-Atlantic collaboration is an important step toward closing the care delivery gap by fostering comparative effectiveness research, learning from a wide scope of real-world practice and achieving joint consensus on treatment paradigms and subspecialty education.” One critical tool that can help build the collaboration is the AHA’s Cardiogenic Shock Registry. With a mortality rate of about 50%, cardiogenic shock has been at the center of CCC. The registry is designed to help the medical community study cardiogenic shock, including its diagnosis, treatment and outcomes, in patients in acute care clinical settings throughout the U.S. See TRANS-ATLANTIC, page 13 Barnett Dahiya Proudfoot Alviar
2502 2512 Posters Zone 2 Moderated Digital Posters 6-11 201 Public Service 1 2 12 320 Puppy Snuggles Supported by Sanofi 323 324 326 327 328 331 423 424 426 427 521 Bayer 526 Bridgebio 531 Eli Lilly and Company 702 Duke Clinical Research Institute 706 708 710 712 BMS/ Pfizer 716 Mayo Clinic 902 Bristol Myers Squibb 909 Intermountain Health 914 917 Merck & Co., Inc. 921 1109 Boehringer Ingelheim/Lilly Commercial 1112 New Amsterdam Pharma 1115 Pfizer, Inc. 1119 ZOLL Medical Corporation 1123 Medtronic 1302 Novartis Pharmaceuticals Corporation 1308 Novartis Pharmaceuticals Corporation 1312 Cytokinetics 1316 AstraZeneca 1322 Merck & Co., Inc. 1702 Esperion Therapeutics 1705 Idorsia Pharmaceuticals US Inc. 1708 1710 1714 1717 Arrowhead Pharmaceuticals 1720 1721 1808 1809 1820 1821 1902 Johnson & Johnson 1912 Amgen 1920 1921 1924 Amarin Pharma, Inc. 2020 2021 2022 2109 Silence Therapeutics 2120 2122 2220 2224 Kiniksa Pharmaceuticals 2302 Novo Nordisk, Inc. 2308 2309 2310 2312 2313 2315 2316 2318 Amgen 2321 Alnylam Pharmaceuticals 2408 2409 2410 2412 2413 2415 AtriCure 2514 BMS/J&J Alliance 2517 American College of Cardiology 2520 Viatris 2526 2527 2528 2531 2532 2533 2534 2712 2713 2714 2715 2717 2718 2719 2720 2721 2812 2813 2814 2815 2817 2818 2819 2820 2821 2222 806 808 809 Posters Zone 1 Moderated Digital Posters 1-5 CardioTalk Theater I Eli Lilly and Company DOWN UP UP Best of Specialty Conferences Posters Down to Level 2.5 ENTRANCE Information Counter/ Concierge Mobile App Desk Poster Attendant Booth GRAND CONCOURSE rd reet afe Global Quality Showcase HeartQuarters Heart Theater I FIRST AID FedEx Kinkos Business Center TO MAIN EVENT I Exhibit Hall Concierge Desk B39 B40 B41 B42 1909 2009 2010 Be sure to visit the Posters: Located within the Science & Technology Hall, posters are grouped into four zones by subject matter plus a fifth zone dedicated to Best of Specialty Conferences posters. Moderated digital posters are located in each poster area. Check the Mobile Meeting Guide app for the schedule. Recharge in the Charging Lounge In the Heart Hub, 9 Take a break and recharge inside the Science & Technology Hall. Charging Lounge sponsored by Eli Lilly and Company
Posters Zone 4 Moderated Digital Posters 17-23 3468 Posters Zone 3 Moderated Digital Posters 12-16 3 4 5 6 Simulation Zone 8 9 10 11 13 14 3072 AHA Scholars’ Posters Supporting Undergraduate Research Experiences (S.U.R.E.) Program 15 16 537 Daiichi Sankyo, Inc. 541 Getting to the Heart of Stroke 2542 Novo Nordisk, Inc. 2550 CardioTalk Theater II 2739 Lexicon Pharmaceuticals, Inc. 2754 Lp(a) Testing Supported by Novartis Pharmaceuticals Corporation HEART HUB HIPods 1-3 HIPods 4-6 Health Innovation Pavilion STAGE UP UP UP NCY EXIT EMERGENCY EX Charging Lounge Supported by Eli Lilly and Company Member Lounge Learning Studio I Learning Studio II FAHA Lounge Heart Theater II Abstracts on USB Supported by Lexicon 7 B1 B2 B3 B4 B5 B6 B7 B8 B9 B10 B11 B12 B13 B14 B15 B16 B17 B18 B19 B20 B21 B22 B23 B24 B25 B27 B28 B31 B34 Exhibitor Lounge/ Sales Office B35 Business Suites B26 B30 B36 B48 B45 B41 B42 B47 B46 Publisher's Row 2939 2942 2943 2945 Wolters Kluwer 2951 2952 3042 3043 3051 3052 3139 3140 3141 3142 3143 3145 3151 3152 3239 3240 3241 3242 3243 3251 3252 2654 2557 Rocket Pharmaceuticals, Inc. Dedicated IT 2554 Explore these useful learning and networking opportunities. Science & Technology Hall South Hall, Level 3 Hours: Sunday, Nov. 17 9 a.m.-4:30 p.m. Monday, Nov. 18 9 a.m.-3 p.m. Coffee and Tea Breaks: Stop by for a complimentary coffee or tea at one of the stations located within the Science & Technology Hall. Don’t miss Lp(a) Testing Booth 2754 Sunday, Nov. 17 9 a.m.-4:30 p.m. Lp(a) testing sponsored by Novartis
2024 Exhibitors AHA HeartQuarters . . . . . Heart Hub 1 Global Quality Showcase . . Heart Hub 2 FAHA Lounge . . . . . . . . Heart Hub 3 Member Lounge . . . . . . Heart Hub 4 Health Innovation Pavilion . . Heart Hub 5 Simulation Zone . . . . . . Heart Hub 6 Heart Theater II . . . . . . Heart Hub 7 Learning Studio II . . . . . . Heart Hub 8 Charging Lounge . . . . . . Heart Hub 9 Learning Studio I Heart Hub 10 AHA Scholars Posters . . . . Heart Hub 11 Heart Theater I . . . . . . . Heart Hub 12 Located in the Heart Hub Scan the QR code for a list of First-Time Exhibitors at #AHA24 Abcentra . . . Health Innovation Pavilion, B46 AccurKardia . . . . Health Innovation Pavilion ADInstruments . . . . . . . . . . . . .2021 Agepha Pharma FZ-LLC . . . . . . . . . 2220 AliveCor . . . . . . Health Innovation Pavilion Alnylam Pharmaceuticals . . . . . . .2321,B1 ALZET® Osmotic Pumps/DURECT Corp . . . 2410 Amarin Pharma, Inc. . . . . . . . . . . 1924 American Association of Heart Failure Nurses . 2814 American College of Cardiology . . . . . 2517 American College of Physicians/ Annals of Internal Medicine . . . . . . . 1808 American Medical Association . . . . . . 2720 Amgen. . . . . . . . . . . . . .1912,2318 AnkrHealth..............2533 Anumana................708 Arrowhead Pharmaceuticals . . . . . . . 1717 AskBio . . . . . . . . . . . . . . . 2312,B8 Association of Black Cardiologists . . . . 2715 AstraZeneca c/o TCEG . . . 1316, B23, B24, B25 AtriCure . . . . . . . . . . . . . . . .2415 Banner Health . . . . . . . . . . . . . .328 Bayer . . . . . . . . . . . . . . . 521, B13 BAYER AG . . . . . . . . . . . . . . B12, B15 Billings Clinic . . . . . . . . . . . . . . 424 Biobeat . . . . . . Health Innovation Pavilion BMS/J&J Alliance . . . . . . . . . .2514, B44 BMS/Pfizer . . . . . . . . . . . . . 712, B16 Boehringer Ingelheim Pharmaceuticals, Inc. . 2531 Boehringer Ingelheim/Lilly . . . . . . . .1109 Bridgebio . . . . . . . . . . . . . .526, B30 Bristol Myers Squibb . . . . . 902, B9, B47, B48 Bruker BioSpin . . . . . . . . . . . . . 2309 Cardiac Insight Inc. . Health Innovation Pavilion Cardio Flow Design Inc. . . . . . . . . . 2532 CardioTalk Theater I . . . . . . . . . . . 331 CardioTalk Theater II . . . . . . . . . . 2550 Carematix,Inc . . . . . . . . . . . . .1820 Caristo Diagnostics . . . . . . . . . . . 1714 CL Laboratory, LLC . . . . . . . . . . . 2527 Cleerly . . . . Health Innovation Pavilion, B14 Conquering CHD . . . . . . . . . . . .2712 Cytokinetics . . . . . . . . . . . . . .1312 Daiichi Sankyo, Inc. . . . . . . . . . . . 537 Decentralized Biotechnology Intelligence Co, LTD . . Health Innovation Pavilion DedicatedIT. . . . . . . . . . . . . .2554 Doximity . . . . . . . . . . . . . . . .706 Duke Clinical Research Institute . . . . . . 702 Edwards Lifesciences . . . . . . . . . . 1921 EkoHealth...............1809 Eli Lilly and Company . . . . . . 914, B26, B35 Eli Lilly and Company Medical Affairs . . . 531 Elsevier,Inc.. . . . . . . . . . . . . . 2942 Esperion Therapeutics . . . . . . . . 1702, B17 Exemplar Genetics . . . . . . . . . . . . 326 Family Heart Foundation . . . . . . . . 2222 FDA Center for Tobacco Products . . . . . 2714 Foresee Pharmaceuticals . . . . . . . . 2316 Foundation for Sarcoidosis Research . . . 2815 FUJIFILM VisualSonics . . . . . . . . . .1708 GenomadixInc. . . . . . . . . . . . . 2412 Getting to the Heart of Stroke . . . . . . . 541 HealthSeers, Inc. . . Health Innovation Pavilion HeartBeam, Inc. . . . . . . . . . . . . 2313 HeartFlow . . . . . . . . . . . . . 1909, B31 HeartLung.AI . . . . . . . . . . . . . .2952 Hypertrophic Cardiomyopathy Association . . 809 Idorsia Pharmaceuticals US Inc. . . . . . 1705 Inspire Medical Systems, Inc. . . . . . . . 2408 Intellia Therapeutics . . . . . . . . 2534, B27 Intermountain Health . . . . . . . . . . 909 Ionis Pharmaceuticals, Inc. . . . . . . . . 323 IonOptix................2315 JAMA Network . . . . . . . . . . . . . 2943 Johnson & Johnson . . . . . . . . . . . . . . . .1902, B5, B6 Kaneka - LIPOSORBER . . . . . . . . . .1710 Kiniksa Pharmaceuticals . . . . . . .2224, B18 Kusmo.................710 LetsGetChecked . . . . . . . . . . . . 2413 Lexicon Pharmaceuticals, Inc. . . . . . . 2739 Lp(a)Testing . . . . . . . . . . . . . .2754 MayoClinic...............716 McFarland Clinic . . . . . . . . . . . . . . . . . . . . . . . . .423 Medtronic . . . . . . . . . . . . . 1123, B45 Merck & Co., Inc. . . . . 1322, 1821, 917, B10, B11 Metabolic Endocrine Education Foundation . 2717 Mineralys Therapuetics, Inc. . . . . . . 427, B21 Moor Instruments . . . . . . . . . . . . 2122 Nanion Technologies . . . . . . . . . . 2020 New Amsterdam Pharma . . . . . . 1112, B22 Nightingale Health Plc . . . . . . . . . 1920 Noah Labs . . . . . Health Innovation Pavilion Northwell Health . . . . . . . . . . . . 2409 Novartis Pharmaceuticals Corporation . 1302,1308 Novo Nordisk Inc . . . . . . . 2302, 2542, B19 Omron Healthcare, Inc . . . . . . . . . 2308 Patient Advocate Foundation . . . . . . 2718 Pfizer Inc. . . . . . . . . . . . . . 1115, B20 PPD™, part of Thermo Fisher Scientific . . .1720 Propria . . . . . . . . . . . . . . . . 2528 PuppySnuggles . . . . . . . . . . . . .320 Radcliff Cardiology . . . . . . . . . . . 921 Regeneron Pharmaceuticals, Inc. . . . .806, B7 RepPass................2022 Research Diets, Inc. . . . . . . . . . . . 2310 Rocket Pharmaceuticals, Inc. . . . . . . . 2557 SANOFI................. B28 scPharmaceuticals . . . . . . . . . . . . 426 SeeMedX . . . . . . . . . . . . . . . 2009 Silence Therapeutics . . . . . . . . . . 2109 Sky Labs . . . . . . Health Innovation Pavilion StopAfib.org . . . . . . . . . . . . . .2713 The Japanese Circulation Society . . . . .2719 The National Heart, Lung, and Blood Institute . . . . . . . . . . .1721 TIMIStudyGroup . . . . . . . . . . . .2120 Ultrahuman Healthcare Private Limited . . 2526 Vantari VR . . . . . Health Innovation Pavilion VectorBuilder Inc. . . . . . . . . . . . . 808 Viatris . . . . . . . . . . . . . . . 2520, B2 VitalSight by Omron . Health Innovation Pavilion WoltersKluwer . . . . . . . . . . . . .2945 World Heart Federation . . . . . . . . . 2721 ZOLL Medical Corporation . . . . . . . . 1119
11 #AHA24 ScientificSessions.org Learn strategies to better manage VTE in your practice with our on-demand digital learning activities. These activities are supported by a medical education grant from the Bristol Myers Squibb and Pfizer Alliance. PAID ADVERTISEMENT Advancing Management and Care in Venous Thromboembolism (VTE) Institute. “Clinical pathways need to be created so that these patients can be referred for alternative nonpharmacological therapy for stroke prevention using left atrial appendage closure devices.” Patients should receive a comprehensive stroke assessment before beginning treatment with oral anticoagulation (OAC) to attempt to weigh their absolute risk of stroke with appropriate consideration of bleeding risk, said session speaker Cara Pellegrini, MD, FHRS. “Those who have had a stroke are at particularly high risk of a repeat event, but it may not be from the same mechanism. Their secondary stroke prevention will likely include other pharmacologic targets in addition to OAC,” said Pellegrini, director of cardiac electrophysiology at the San Francisco VA Medical Center and professor of medicine at the University of California, San Francisco. “The impact of initiating OAC upon discovery of subclinical AFib is about as unclear among those with and without a stroke history, though our current practice does not necessarily reflect that,” she said. The use of implantable and wearable cardiac monitoring devices in diagnosing and managing AFib and preventing stroke has evolved. Implantables are smaller and have greater diagnostic capabilities, in part due to the use of artificial intelligence and machine learning in applying sophisticated algorithms to quickly process data and identify real-time actionable factors versus false alerts. “Implantable loop recorders have significantly improved detection and management of AFib,” Kabra said. “A recent study (MONITOR AF) showed that use of ILRs resulted in early therapy, better rhythm control and decreased AFib-related complications.” Implantables are still the “gold standard,” Pellegrini said, but wearable devices have also advanced in their ability to monitor cardiac vitals and AFib. Many of them are inexpensive, less intrusive and relatively easy to use. “While patient-facing wearables often use surrogates other than an electrogram to diagnose AFib and don’t yet have the specificity of traditional monitoring modalities, their ubiquity and accessibility brings advantages in terms of personal health agency,” Pellegrini said. The session’s moderators and speakers will also discuss the impact of other large, randomized studies — NOAH-AFNET 6 and ARTESIA — that examine the impact of OAC on device-detected AFib. They also will review recently published guidelines, including the 2023 ACC/AHA/ACCP/ HRS Guideline for the Diagnosis and Management of Atrial Fibrillation, the 2024 ESC Guidelines for the Management of Atrial Fibrillation, the 2024 ESC consensus statement on embolic strokes of undetermined source and the American Heart Association/American Stroke Association 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. “The totality of evidence shows that oral anticoagulants reduce stroke in device-detected atrial fibrillation, despite the fact that baseline risk is low, and the results of the two trials have been shown in a meta-analysis to be consistent,” said session speaker and cardiologist/electrophysiologist Jeff Healey, MD, MSc, FRCPC, FHRS. Healey said multiple secondary analyses demonstrate that anticoagulant treatment provides the greatest benefits among: • Patients with a CHA2DS2-VASc score of greater than four • Patients with a history of stroke/TIA • Patients with vascular disease (peripheral vascular disease, coronary artery disease, cerebrovascular disease) Healey, professor of medicine, Yusuf Chair in Cardiology and director of cardiology at McMaster University in Hamilton, Ontario, points out that episode duration does not play a major role in determining who benefits from the therapy. “I hope this session gives attendees a framework for compiling seemingly discrepant results and a better understanding of the continued gaps in knowledge — the nuances of which are not always transparent in discrete guideline recommendations,” Pellegrini said. “The more we can do to be selective and specific in who and how we screen, the more useful the data we generate will be.” AFIB AND STROKE continued from page 5
12 SCIENTIFIC SESSIONS DAILY NEWS | Day 2 Sunday, Nov. 17, 2024 standard treatment during up to five years of follow-up. At one year, the mean (median) systolic blood pressure was 121.6 mm Hg (118.3mm Hg) in the intensive-treatment group and 132.2 mm Hg (135.0 mm Hg) in the standard-treatment group. Primary outcome events occurred in 393 patients (1.65 events per 100 person-years) in the intensive group and 492 patients (2.09 events per 100 person-years) in the standard treatment group (HR = 0.79; 95% CI; 0.69 to 0.90; p < 0.001). Serious adverse events were generally similar between the two groups. However, symptomatic hypotension and hyperkalemia occurred more frequently in the intensive-treatment group. Ning “For most people with type 2 diabetes with an elevated cardiovascular disease risk, intensive treatment to lower systolic blood pressure to a level less than 120 mmHg might have additional benefits in the prevention of major cardiovascular diseases compared with standard treatment to lower systolic blood pressure to a level less than 140 mmHg,” said Guang Ning, MD, PhD, the study’s principal investigator and the Guang Qi Professor at Shanghai Jiao Tong University School of Medicine in China. “Meanwhile, although it is generally safe, hypotension and hyperkalemia should be monitored and prevented during intensive blood pressure reduction.” Ning noted that BPROAD’s results are consistent with findings from the SPRINT study, which found a significant 27% reduction in the incidence of cardiovascular diseases in patients with hypertension but without diabetes. “Future clinical practice guidelines should consider these lines of evidence when making recommendations of blood pressure treatment in patients with type 2 diabetes,” he said. The study was published in the New England Journal of Medicine following the presentation. Weight-loss drug reduced worsening heart failure in people with obesity Tirzepatide, a long-acting agonist of glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors, significantly reduced the risk of a composite of cardiovascular death or worsening heart failure and improved health status in patients with heart failure with preserved ejection fraction (HFpEF) and obesity, according to Tirzepatide for Patients With Heart Failure With Preserved Ejection Fraction and Obesity: The SUMMIT Trial. Packer Tirzepatide and other incretinbased drugs are approved for use in adults with type 2 diabetes and for patients with obesity or overweight in the presence of at least one weight-related comorbid condition, such as cardiovascular disease. “Data were lacking on the effects of incretin-based drugs on cardiovascular outcomes in patients with heart failure, but we now have compelling information about the influence of these drugs on the clinical course of patients with heart failure and preserved ejection fraction with obesity,” said Milton Packer, MD, distinguished scholar in cardiovascular science at Baylor University Medical Center in Dallas and the study’s principal investigator. The international, multicenter, double-blind randomized placebocontrolled trial randomly assigned 731 patients with heart failure, ejection fraction ≥50% and body mass index ≥30 kg/m2 1:1 to tirzepatide up to 15 mg subcutaneously weekly or placebo for a median of 104 weeks. The two primary outcomes were the time to first cardiovascular death or worsening heart failure events and the change in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQCSS) at 52 weeks. Scores ranged from 0 to 100, with higher scores indicating better health status. Overall, tirzepatide benefited patients with HFpEF and obesity compared with placebo. Cardiovascular death or worsening heart failure events occurred in 9.9% of patients in the tirzepatide group and 15.3% in the placebo group (HR 0.62; P=0.026). Worsening heart failure events occurred in 8% of patients in the tirzepatide group and 14.2% in the placebo group (HR 0.54, P=0.008), with no apparent differences between groups in cardiovascular death. At 52 weeks, the mean change in KCCQ-CSS was 19.5 in the tirzepatide group compared with 12.7 in the placebo group (P<0.001). Tirzepatide was also well tolerated; 6.3% of patients in the tirzepatide group stopped the drug due to adverse events (mainly gastrointestinal), compared with 1.4% in the placebo group. “The SUMMIT Trial’s impressive outcomes data shows that tirzepatide doesn’t just make people with obesity feel better, it changes the clinical trajectory of heart failure with preserved ejection fraction in these patients,” Packer said. Packer noted that the SUMMIT Trial’s results can’t be extrapolated to patients with heart failure with reduced ejection fraction (HFrEF); these patients were not enrolled in the trial. “For the heart failure benefits of incretin-based drugs, the type of heart failure matters,” he said. The study was published simultaneously in the New England Journal of Medicine. Novel gene editing therapy shows promise for patients with transthyretin amyloidosis with cardiomyopathy Despite earlier diagnosis and currently available therapies, transthyretin amyloidosis with cardiomyopathy (ATTR-CM) remains a progressive and ultimately fatal disease with significant unmet need. But a single dose of Nexiguran ziclumeran (nex-z), previously known as NTLA-2001, an investigational CRISPR/Cas9based in vivo gene editing therapy, demonstrated favorable safety, tolerability, durable reductions in serum TTR levels with very low variability among patients, and evidence of disease stabilization, according to CRISPR-Cas9 Gene Editing with Nexiguran Ziclumeran for ATTR Cardiomyopathy therapy for patients with ATTR-CM: interim report of the Phase 1 study. In the open label trial, 36 patients with ATTR-CM, 50% New York Heart Association (NYHA) class 1-III; 31% variant ATTR-CM, received a weight-based (0.7 or 1.0mg/kg) or fixed dose (55mg) of nex-z as a one-time IV infusion and completed at least 12 months of follow-up. The primary outcome assessed nex-z safety and serum TTR levels. Secondary endpoints included nex-z effect on N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-Troponin-T), 6-minute walk test (6MWT) distance in addition to changes in NYHA class, measurements of cardiac remodeling on echocardiography and cardiovascular magnetic resonance imaging (CMR), cardiopulmonary exercise testing (CPET) and KCCQ score. Reductions in TTR were accompanied by stability or improvement of several disease markers. Mean 95% CI percent change from baseline in serum TTR levels at day 28 and month 12 was -89% and 90%, respectively. Geometric mean (95% CI) fold change from baseline to month 12 in NT-proBNP and hs-Troponin-T was 1.02 (0.88 to 1.17) and 0.95 (0.89 to 1.01), respectively. Median interquartile range change from baseline to month 12 in 6MWT distance was 5 meters and 92% of patients experienced an improvement or no change in NYHA class. Mild to moderate, transient infusion-related reactions were the most common treatment-related adverse events. Nex-z is a single-guide RNA molecule that targets the human TTR gene and the human-codon–optimized mRNA sequence encoding the Streptococcus pyogenes Cas9 protein, encapsulated in a lipid nanoparticle (LNP). Following IV administration of the LNP, nex-z is transported directly to the liver and taken up via the LDL receptor on hepatocytes. The Cas9 mRNA is translated, producing the Cas9 enzyme, which interacts with the single guide RNA to form a complex that binds to the TTR gene and leads to precise cleavage in the targeted TTR gene sequence to reduce TTR production. Fontana “For the results we’ve seen thus far, patients would only need a one-time nex-z treatment to obtain, rapid, deep and durable knockdown of TTR, which translates into a clinically meaningful benefit without the need for long-term therapy,” said Marianna Fontana, MD, PhD, professor of cardiology and honorary consultant cardiologist at the National Amyloidosis Center at University College London, the study’s principal investigator. Although results will need to be confirmed in a randomized controlled trial, “this therapy is a potential game changer for patients with ATTR-CM,” Fontana said. The study was simultaneously published in the New England Journal of Medicine. CENTURY continued from page 1
13 #AHA24 ScientificSessions.org Christopher Barnett, MD, MPH, associate chief for inpatient services, Division of Cardiology and chief of the Critical Care Cardiology section at University of California, San Francisco Health, said the registry can help U.S. cardiology specialists complement the work being done in Europe. “The evidence being generated for how to take care of these patients is coming from both sides of the Atlantic and around the world,” Barnett said. “We’re both looking for the best evidence to understand how best to treat patients. We have similar goals in mind, but we’re approaching that using the unique characteristics of tools that we have in the U.S.” An important difference between the U.S. and Europe regarding research is differing regulatory structures, allowing things to progress along different paths, Alviar said. “Their regulatory processes have allowed our European colleagues to develop robust research at a different pace, particularly randomized control trials, in conditions that are more challenging to execute in the United States,” he said. Alastair Proudfoot, MBChB, FRCP (Edin), FFICM, PhD, a consultant in critical care and lead for cardiogenic shock at Barts Heart Centre in London, highlighted potential advantages of the collaboration. “Rather than being competing entities, trans-Atlantic collaborations should leverage such differences in research priorities, structure and ethics to complement each other,” he said. “For example, established U.S. registry infrastructure should inform the focus of future clinical trials in Europe, where the deferred consent model may lend itself to clinical trial enrollment in adults lacking capacity. Similarly, the development of collaborative trans-Atlantic biobanks will support mechanistic insights into cardiac critical care and opportunities for validation of novel findings across jurisdictions.” Regardless of the differences, Barnett said the U.S. and Europe are reaching some of the same conclusions regarding acute cardiac care. “Despite the fact that we have very different systems … many different people from many different parts of the world are arriving at the same space. I don’t think that’s coincidence,” he said. “Everyone’s taking different pathways, but we are all arriving at the same place.” TRANS-ATLANTIC continued from page 7 Watch AHAtv, your source for Science News and Scientific Sessions highlights. Check the #AHA24 home page for bonus video and streaming content throughout the meeting. Supported by:
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