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This study evaluates the Step UP! Bystander Intervention Program and explores whether training that addresses numerous problematic situations is warranted for both collegiate student-athletes and non-athletes. Data were collected from 731 students who participated in 49 trainings. Significantly more student-athletes compared to non-athletes reported witnessing 4 of the 5problem behaviors. Participation significantly improved knowledge, attitudes, and self-efficacy to use bystander intervention behaviors among collegiate student-athletes and non-athletes. The findings support addressing a variety of problem behaviors to promote safety and well-being of college students and suggest student-athletes should be targeted for enhanced programming. [ABSTRACT FROM AUTHOR]

The relationship between low-density lipoprotein cholesterol (LDL-C) and cardiac allograft vasculopathy (CAV) is unclear. The objectives of this study were to characterize lipid profiles early after heart transplant (HT), and to evaluate the relationship between early serum LDL-C and the development of CAV. We retrospectively reviewed consecutive adults who underwent HT at the University of Ottawa Heart Institute (Ottawa, Canada) and Toronto General Hospital (Toronto, Canada) from 2010-2018. The primary outcome was the incidence of CAV (ISHLT grade 1-3). The relationship between LDL-C and CAV was assessed using Cox proportional hazards and logistic regression models adjusted a priori for clinically important covariates including recipient and donor age, recipient sex, ischemic time and pre-HT diabetes. 386 patients followed for 4.4 (2.8-6.8) years were included. LDL-C at baseline (2.11±0.86 mmol/L) and at 1-year after HT (2.20±0.88 mmol/L) was similar (p=0.21) but was significantly lower at the end of study follow-up (1.89±0.74 mmol/L) (p<0.01). Of 309 patients who underwent angiography, 54% developed CAV. The risk of CAV did not vary according to baseline, 1-year or change from baseline to 1-year pre-specified LDL-C thresholds (Figure). The odds of CAV at 1-year was equally likely across LDL-C values (adjusted OR 1.00, 95% CI: 0.61-1.63 for baseline and adjusted OR 1.25, 95% CI: 0.74-2.10 for 1-year LDL-C). There was no relationship between early LDL-C and the development of CAV after HT. Our findings do not support targeting a specific LDL-C for patients who do not otherwise meet criteria for non-HT guideline recommended LDL-C targets. Randomized studies are warranted to determine if lipid-lowering to a specific LDL-C target decreases the development and progression of CAV. [ABSTRACT FROM AUTHOR]

Myocardial blood flow (MBF) quantification by positron emission tomography (PET) has diagnostic and prognostic utility in heart transplant (HT) patients. The purpose of this study is to assess the use of PET for early cardiac allograft vasculopathy (CAV) detection and risk stratification. Adult HT recipients, prospectively enrolled from 2 institutions between January 2018-March 2021, underwent evaluation at 3- and 12- months post HT with PET, myocardial biopsy, and intravascular ultrasound (IVUS). Macrovascular CAV was assessed by IVUS maximal intimal thickness (MIT) and percent intimal volume (PIV). Microvascular CAV was assessed by capillary density on myocardial biopsy. Linear regression was performed to determine post HT predictors of CAV progression according to PIV change from 3 to 12 months. Data was analyzed from 74 patients (mean age 51 years, 45% male) who underwent PET, including 69, 67 and 62 patients with examinations at 3-months baseline, 12-months follow-up, and both 3- and 12-months post HT, respectively. Baseline to follow-up IVUS showed median increases of 0.10 mm (IQR 0.10, 0.30) in MIT and 5.6% (IQR 0.9, 10.0) in PIV. Capillary density increased significantly: 485 capillaries/mm2 (IQR 143, 951) at baseline, 607 capillaries/mm2 (IQR 172, 1186), p = 0.04) at follow-up. There were significant correlations between PIV and capillary density at baseline (r = 0.41, p <0.01) and follow-up (r = 0.26, p = 0.04). Flow quantification by PET showed a significant increase from baseline in myocardial flow reserve (2.5 ± 0.7 vs. 2.9 ± 0.8, p <0.01) and stress MBF (2.7 ± 0.6 vs. 2.9 ± 0.6, p = 0.01) without significant change in coronary vascular resistance (47 ± 16 vs. 47 ± 11, p = 0.89). At baseline, there was no association between PET MBF and IVUS or myocardial biopsy. At follow-up, significant correlations were observed between stress MBF (r = -0.35, p <0.01), CVR (r = 0.33, p = 0.01) and PIV with positive correlation trend between CVR and capillary density (r = 0.23, p = 0.07). On linear regression analyses, baseline PET MBF was not associated with 1-year post HT CAV progression. There is significant improvement in graft myocardial blood flow in the first year of transplant. PET MBF at 1-year post transplant is associated with IVUS indices of CAV. Our results suggest potential use of PET for early 1-year post transplant noninvasive assessment of epicardial CAV. [ABSTRACT FROM AUTHOR]

Serum biomarkers may enable noninvasive screening for cardiac allograft vasculopathy (CAV) and may allow for tailored invasive coronary evaluation. We previously identified potential candidate CAV biomarkers using Slow Off-rate Modified Aptamer proteomics. The aim of this study is to validate selected candidate biomarkers for diagnosis of early CAV. Adult heart transplant (HT) recipients from 2 institutions underwent serum biomarker testing during prospective intravascular ultrasound (IVUS) evaluation at 3- and 12-months post-transplant. Enzyme linked immunoassays were used to measure intercellular adhesion molecule 2 (ICAM), receptor tyrosine-protein kinase ErbB3 (ERB), and tissue factor (TF). CAV was assessed on IVUS by percent intimal volume (PIV) and maximal intimal thickness (MIT). An MIT ≥0.5 mm was used to define CAV. : median age 55 years (IQR 44, 61), 59% male. An MIT ≥0.5 mm was present in 42 (51%) and 62 (75%) patients at 3- and 12- months post HT, respectively. There was a significant increase from 3 to 12 months post HT in ICAM (430 ± 178 U/mL vs. 613 ± 249 U/mL, p <0.01), while ERB and TF were unchanged. There were significant negative correlations (all p <0.05) between biomarkers and PIV at 3 months (r = -0.29 for ERB, r = -0.46 for TF) and 12 months (r = -0.27 for ICAM, r = -0.27 for ERB, r= -0.26 for TF). The Figure shows the diagnostic accuracy of individual biomarkers for CAV at 12 months post-transplant. Based on optimal diagnostic thresholds of ICAM <603 U/mL and ERB <4776 pg/mL; combined ICAM and ERB measurements yielded 77% sensitivity (52% specificity) if either biomarker is abnormal and 90% specificity (47% sensitivity) if both biomarkers are abnormal. Serum ICAM and ERB show potential as noninvasive diagnostic biomarkers for early CAV. Due to differing pathogenesis of early and late CAV, these biomarkers should be evaluated in patients with varying CAV disease severity and larger HT populations. [ABSTRACT FROM AUTHOR]