bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictive role of platelet indices on hospital admission and discharge in the long-term prognosis of acute coronary syndrome: Platelets do count
Authors: Psarakis G , Farmakis I , Zafeiropoulos S , Tsolakidis C , Konstantas O , Kourti O , Touriki AB , Psathas T , Vrana E , Graidis S , Spyridaki K , Daniilidou A , Baroutidou A , Karvounis H , Giannakoulas G
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction: Previous clinical studies have underlined the prognostic role of platelet indices in acute coronary syndrome (ACS). However, the effect of their dynamic change during hospitalization has not thoroughly been examined. Purpose: We aimed to investigate the association between platelet indices on admission, on discharge and their change during hospitalization and the long-term prognosis of patients with ACS. Methods: Data from a randomized controlled trial recruiting ACS patients were analyzed in a survival analysis. Platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT) on admission and on discharge dichotomized at the median value, as well as the change between admission and discharge of each variable dichotomized at the zero value. Primary endpoints were major adverse cardiac events (MACE), defined as occurrence of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke or hospitalization for unstable angina, while secondary endpoints were all-cause mortality, all-cause hospitalization and major or minor bleeding events. Results: The study included 252 individuals who were followed-up for a median of 39 months. In the univariate Cox regression analysis, only PC at discharge (HR 2.20, 95% CI 1.10-4.40), MPV at discharge (HR 0.48, 95% CI 0.25-0.94) and PC reduction during the hospitalization (HR 0.25, 95% CI 0.13-0.51) predicted MACE. PC reduction correlated with a lower MACE occurrence (adjusted HR 0.27, 95%CI 0.14-0.54) and lower risk of all-cause hospitalization (adjusted HR 0.36, 95%CI 0.19-0.68) in the multivariable Cox-regression analysis. Conclusion: PC change during hospitalization can be a substantial independent predictor of long-term prognosis of ACS patients.

Baseline and admission characteristics Characteristic Statistic Overall, N = 252 Negative Platelet Difference, N = 98 Postive Platelet Difference, N = 154 p-value Age, years median (IQR) 60 (53, 72) 62 (55, 74) 60 (53, 72) 0.2 Hypertension n(%) 147(58.3%) 58(59.2%) 89(57.8%) >0.9 Diabetes n(%) 71(28.2%) 27(27.6%) 44(28.6%) >0.9 Cardiovascualr Disease (CVD) n(%) 100(39.7%) 43(43.9%) 57(37.0%) 0.3 Primary Coronary Intervention (PCI) treatment n(%) 200(79.4%) 71(72.4%) 129(83.8%) 0.045 Number of vessels n 0.6 1 n(%) 107(59.1%) 38(59.4%) 69(59.0%) ≥2 n(%) 68(37.6%) 25(39.1%) 43(36.8%) Platelets at admission, K/μL mean(SD) 257179(71031) 237020(62555) 270006(73282) 0.001 Platelets at dischage, K/μL mean(SD) 250952(70263) 279153(75159) 233006(60698) <0.001

Abstract Figure. MACE univariate / multivariate analysis
Exercise end-tidal carbon dioxide pressure: a new prognostic marker after acute myocardial infarction?
Authors: Ferreira J , Rio P , Castelo A , Cardoso I , Silva S , Ferreira RC
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Although several cardiopulmonary exercise testing (CPET) parameters have already proved to predict prognosis, there is increasing interest in finding variables that do not require maximal effort. End-tidal carbon dioxide pressure (PETCO2), an indirect indicator of cardiac output, is one of such variables. Studies in heart failure populations already suggest its role as a prognostic factor. However, data concerning other populations are still scarce.

Purpose

To assess the association between exercise PETCO2, cardiac biomarkers and systolic function following acute myocardial infarction (AMI) and to evaluate its potential prognostic role in this population.

Methods

A retrospective single-centre analysis was conducted including patients who underwent symptom-limited CPET early after AMI. We assessed PETCO2 at baseline (PETCO2-B), at anaerobic threshold (PETCO2-AT) and at peak exercise and calculated the difference between PETCO2-AT and PETCO2-B (PETCO2-difference). We analysed their association with B-natriuretic peptide (BNP), maximal troponin after AMI as well as with left ventricular ejection fraction (LVEF) 1 year after.

Results

We included 40 patients with a mean age of 56 years (87.5% male), assessed with CPET a median of 3 months after AMI (80% of which were ST-elevation myocardial infarctions). Average respiratory exchange ratio was 1,1 with 48% of patients not reaching maximal effort. Mean PETCO2-AT was 37mmHg, with a mean increase from baseline of 6mmHg (PETCO2-difference). There was a significant positive correlation between all the PETCO2 variables measured and BNP values at time of AMI and on follow-up (best correlation for PETCO2-AT with BNP at AMI hospitalization, r = 0.608, p < 0.001). Maximal troponin was not correlated with PETCO2. Both PETCO2-AT and PETCO2-difference were significantly and positively correlated with LVEF 1-year post-AMI (r = 0.421, p = 0.040 and r = 0.511, p = 0.011, respectively).

Conclusion

PETCO2-AT and PETCO2-difference are both correlated with BNP, an established prognostic marker, and with medium-term systolic function after AMI, suggesting their potential prognostic role in this population. Further studies with larger samples are required to confirm the results of this pilot study and assess PETCO2 as a definite predictor of prognosis after AMI.
Factors affecting the prognosis of patient with ST elevation myocardial infarction and massive thrombosis of infart related coronaty artery
Authors: Leonova I , Boldueva S , Maznev D
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Manual thrombaspiration (MT) is aimed at achieving optimal myocardial perfusion and improving prognosis in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary interventions.

Purpose. To study the factors influencing the prognosis of the disease in patients with STEMI and massive thrombosis of an infarction-associated artery, who underwent percutaneous coronary intervention in combination with MT.

Materials and methods. 2-year dynamic follow-up of two groups of patients with STEMI: 175 patients undergoing percutaneous coronary intervention with MT and 175 patients with percutaneous coronary intervention without MT.

Results. As a result of the logistic regression analysis by a step-by-step method of including factors (107 indicators in total) that affect the likelihood of developing major adverse coronary event (MACE), the parameters independently influencing the risk of their development were: age of patients over 65 years old (OR 1.9), history of coronary heart disease and MI (OR 3.35), diabetes mellitus (OR 2.54), ischemia time more than 180 minutes (OR 5.43), multivessel coronary artery disease (OR 2.16), absence of myocardial perfusion - MBG grade 0 (OR 39 , 82), the ratio of neutrophils to lymphocytes is more than 3 (OR 11.05). In addition, it was found that with LV ejection fraction at discharge ≤ 42%, the risk of developing BCCS after 48 months. follow-up in both groups was 17.7 times higher (p = 0.00001, OR: 17.7 CI 95%), and in patients in the MTA (+) group with LV EDV of more than 160 ml at discharge from the hospital, the risk of developing MACE after 48 months observation was 7.9 times higher (p = 0.006).

Conclusion. A retrospective analysis of the data obtained showed that all patients with STEMI and massive thrombosis of an infarction-associated coronary artery who died of cardiac causes had predictors of unfavorable outcome, most of which were determined already in the first hours of myocardial infarction.
Types of remodeling and assessment of myocardial diastolic function in patients with ACS and CCS
Authors: Maslovskyi VI , Mezhiievska IA
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Objective

to study the features of the structural and functional condition of the myocardium in patients with various forms of coronary artery disease.

Methods. 165 patients with various forms of coronary artery disease were examined. On average, patients NSTEMI - 90, NSTE-ACS - 25, STEMI - 25, chronic coronary syndrome (CCS) - 25. Features of  structural and functional condition of the myocardium were determined by echocardiography in M-, B,  and D-modes.

All of research corresponding to the principles of the Declaration of Helsinki of the World Medical  Association.

Results. Evaluation of the nature of structural-geometric remodeling of the left ventricle (Fig. 1) revealed the predominance of normal geometry in patients with NSTEMI in comparison with STEMI (8 (8.9%) vs. 2 (8.0%), p= 0.06), and in the group with NSTE-ACS in comparison with STEMI (0 (0) vs. 2  (8.0%), p = 0.02). Concentric remodeling was significantly more common in the group of patients with NSTEMI compared with STEMI (23 (25.6%) vs. 2 (8.0%), p = 0.06), and in the group with NSTE-ACS compared with STEMI (9 ( 36.0%) vs. 2 (8.0%), p = 0.02).

Analysis of the nature of diastolic transmitral blood flow revealed the following changes

normal type - 5 vs. 0 in the groups of NSTE-ACS and STEMI, respectively (p = 0.02), the type of relaxation disorder - 58 against 19 in the groups NSTEMI and NSTE-ACS, respectively (p = 0.02), 58 vs. 13 in the NSTEMI and STEMI groups, respectively (p = 0.03), 19 vs. 13 in the NSTE-ACS and STEMI groups, respectively (p <0.0001), 19 vs. 16 in the NSTE-ACS and CCS groups, respectively (p= 0.04), by type of pseudonormalization - 23 against 1 in the groups NSTEMI and NSTE-ACS, respectively (p =0.02), 23 against 12 in the groups NSTEMI and STEMI, respectively (p = 0.03), 1 against 12 in the groups NSTE-ACS and STEMI, respectively (p <0.0001), 1 vs. 6 in the groups NSTE-ACS and CCS, respectively (p = 0.04).

Conclusions. The highest degree of concentric remodeling was found in patients with NSTE-ACS, concentric hypertrophy in the CCS group, excentric hypertrophy in the STEMI group. Changes in transmitral blood flow by type of relaxation disorder prevailed in the NSTE-ACS group, by type of pseudonormalization in STEMI patients. In patients with NSTEMI, transmitral blood flow prevailed as a type of relaxation disorder.

Abstract Figure. Fig. 1
Analysis of exercise capacity, quality of life and leisure sports in patients with a Fontan circulation
Authors: Niemann A , Rinne K , Uebing A , Voges I
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction: Despite the improvement in survival, patients with a Fontan circulation are exposed to numerous complications as well as a reduced exercise capacity and quality of life. 

Purpose

To assess the influence of the type of single ventricle (right vs. left) and the amount of sporting activity on exercise capacity and health related quality of life (HRQol) in a large group of Fontan patients.

Methods

Retrospective analysis of standardised cardiopulmonary exercise tests (CPET) performed on a treadmill between 2014 and 2019. Questionnaires to measure HRQol and sporting activity were sent to study participants.

Results

79 patients were enrolled in this study (female, n = 31). 56 of them had a systemic right ventricle (SRV), 20 had a systemic left ventricle (SLV) and 3 had diverse anatomies. Median age at CPET was 12.2 years (range 6.2-34.4 years). The results for important exercise parameters were as follows: peak oxygen uptake (VO2max) 30.7 ± 6.2 ml/kg/min, oxygen uptake at anaerobic threshold (VO2-VAT) 24.7 ± 5.8 ml/kg/min, peak oxygen pulse 8.2 ± 3.4 mlO2/beat and VE/VCO2 slope 39.8 ± 9.1. There was no significant difference in VO2max, VO2-VAT, peak oxygen pulse and VE/CO2 slope between SRV and SLV patients: VO2max 30.2 ± 5.6 vs. 32.8 ± 7.5 ml/kg/min, p = 0.14; VO2-AT 24.4 ± 5.3 vs.25.7 ± 7.3 ml/kg/min, p = 0.53; peak oxygen pulse 7.8 ± 3.2 vs. 9.5 ± 3.9 mlO2/beat, p = 0.06; VE/CO2 slope 41.1 ± 9.6 vs. 36.9 ± 6.8, p = 0.10. Analyses of the questionnaires revealed that most of the patients do leisure sports (n = 60, 76%) with nearly half of them more than two hours per week (n = 26, 33%).

In a subgroup analysis of patients under 18 years (n = 51, 65%) we found that nearly all of them participate in school sports (n = 50) and have a good subjective healthiness (n = 47). VO2-VAT and VO2max correlated positively with subjective healthiness (VO2-VAT r = 0.32, p < 0.05; VO2max r = 0.35, p < 0.05) as well as with the amount of leisure sports activity (hours/week) (VO2-VAT r = 0.37, p < 0.01; VO2max r = 0.50, p < 0.01).

Conclusions

By analysing a large group of patients in Fontan circulation we could demonstrate that there is no difference in exercise capacity between SRV and SLV patients. Furthermore, most of the patients participate in leisure sports and have a good subjective healthiness. In a subgroup of paediatric patients, we were able to show that a better exercise capacity is associated with increased leisure sports activity and a better subjective healthiness.
Impact of grip strength and balance function on the exercise capacity in pulmonary hypertension
Authors: Okamura M , Konishi M , Saigusa Y , Ando S , Nakayama M , Komura N , Sugano T , Tamaura K , Nakamura T
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

【Background】

Patients with pulmonary hypertension (PH) suffer from poor exercise capacity due to impaired oxygenation or reduced cardiac output. However, the relationship between exercise capacity and physical functions remains unclear.

【Purpose】

The purpose of this study is to investigate the relationship between exercise capacity and physical functions in pulmonary hypertension.

【Methods】

From February 2018 to June 2020, 94 patients (61.3 ± 14.7 years old, 69.1% females) with group 1/3/4/5 PH underwent cardiac catheterization, 6-minute walking distance (6MWD), and physical function measurements simultaneously. The physical functions was measured using muscle strength (grip strength, knee extension muscle strength), balance function (one leg standing time), and short physical performance battery (SPPB). Exercise capacity was measured by 6MWD. 

【Results】

The study cohort consists of 22/8/60/4 (23.4%/8.5%/63.8%/4.3%) patients with group 1/3/4/5 PH, respectively. The average age of each group was 50.7/64.7/63.1/66.0 years old, respectively. A total of 194 measurements of physical functions were evaluated from 94 patients and employed in multivariate logistic regression analysis using adaptive-LASSO methods with the 6MWD (476.2 ± 107.5m) as a dependent variable. WHO functional class (class II: standardized β=-0.35, 95% confidence interval (CI) [-0.54 - -0.16], p < 0.001), class III: β=-0.60, 95%CI [-0.90 - -0.30], p < 0.001), mixed venous oxygen saturation (SvO2: β=0.11, 95%CI [0.03 - 0.19], p = 0.008), pulmonary vascular resistance (PVR: β=-0.16, 95%CI [-0.25 - -0.07], p < 0.001), grip strength (β=0.20, 95%CI [0.09 - 0.31], p < 0.001), one leg standing time (β=0.10, 95%CI [0.00 - 0.20], p = 0.049) , and 4m gait speed test (β=-0.28, 95%CI [-0.36 - -0.19], p < 0.001) were associated with 6MWD.

【Conclusions】

Grip strength and balance function, as well as SvO2 and PVR, were associated with the exercise capacity in pulmonary hypertension.
Predictive value of 24-hour ambulatory blood pressure monitoring for cardiovascular events
Authors: Intan-Goey V , Scherrenberg M , Falter M , Kaihara T , Dendale P
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Hypertension is one of the most important cardiovascular risk factors. Twenty-four-hour ambulatory blood pressure (BP) monitoring remains the gold standard to diagnose hypertension. However, it is still unclear whether different time periods of measurement differ in their predictive value for cardiovascular events.

Purpose

To investigate whether different time periods of home BP monitoring can be used as a predictor of cardiovascular events and mortality.

Methods

In this retrospective study, we included patients who had a 24-hour BP measurement between May 2015 and March 2016. Follow-up data were collected up to a maximum of 67 months. BP measurements were taken every 15 minutes from 9 AM until 9 PM and subdivided into 4 time periods, each consisting of 3 hours of measurements. Correlation of BP with major adverse cardiovascular event (MACE) defined as cardiovascular hospitalization and all-cause mortality was examined using a Cox-regression model, which was adjusted for possible confounding factors.

Results

A total of 301 patients were included for analysis with mean follow-up of 1830,4 days ± 229. The mean age was 64.3 ± 15.2 and 52.8% of patients were female. Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) for the 4 time periods were respectively 135,3 ± 16/ 82,6 ± 13,2mmHg, 132,3 ± 15,5/ 79,7 ± 12,7mmHg, 135,3 ± 15,5/ 81,7 ± 12,3mmHg and 136,4 ± 16,4 mmHg/ 81,6 ± 12,1mmHg. MACE occurred in 66 (21.9%) patients. The multivariable Cox proportional hazard risk model revealed that SBP between 12 and 3PM (HR 0.966 95% CI (0.945-0.989)) and the DBP between 6 and 9PM (HR 0.935 95% CI (0.898-0.973)) were associated with a reduced risk for MACE. Furthermore, the SBP between 6 and 9PM (HR 1.044 95% CI (1.021-1.068)) and the DBP between 3 and 6PM (HR 1.05 95% CI (1.013-1.089)) were associated with an increased risk for MACE.

Conclusions

The risk of cardiovascular events is higher in patients with a high SBP between 6 and 9PM and high DBP between 3 and 6PM. Lower risk is seen when the SBP is high between 12 and 3PM and the DBP is high between 6 and 9PM. These results might be explained by the circadian rhythm of BP. Further study is needed to confirm this time dependent predictive value of BP measurements.
The impact of renal denervation treatment on left ventricular remodeling in patients with resistant hypertension
Authors: Moiseeva A , Caraus A , Ciobanu A , Moscalu V , Abras M , Surev A
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Agency for Research an Development

OnBehalf

HIPERDIAB

Background

Increased blood pressure is considered the major determinant for structural alterations of the left ventricle resulting in increased myocardial mass and pathological remodeling. Renal denervation is a novel treatment for hypertensive patients with promising results on blood pressure levels.

Purpose

Evaluation of impact of renal denervation treatment on indices of left ventricular remodeling in patients with resistant hypertension.

Methods

75 patients with resistant hypertension  after a 3-week standardized treatment with Losartan 100 mg, Amlodipine 10 mg and Indapamid 1,5 mg were randomly assigned into three equal groups, depending on medication supplemented to previously administered: IM group -  Moxonidine, IIB group - Bisoprolol and IIID group – renal artery denervation (RDN). Patients were assessed by echocardiographic exam at baseline and 6 months follow-up. Renal denervation was performed with a Symplicity Spyral catheter.

Results

Increased at the baseline in all three groups (170,96 ± 11,69 g/m2  in IM versus 156,5 ± 11,08 g/m2  in IIB and 164,94 ± 9,61 g/m2  in IIID groups) left ventricular mass index at 6 months of evaluation noted a statistically authentic reduction in all three groups, the group of patients treated with Moxonidine and RDN having a comparable and superior effect to the group treated with Bisoprolol (159,02 ± 10,34 g/m2 versus 150,5 ± 10,51 g/m2 and 149,15 ± 9,31 g/m2 in IM, IIB and IIID groups, p > 0,05).

Simultaniously with the regression of left ventricular myocardial hypertrophy all three treatment regimens induced the improvement of its geometry, renal denervation group demonstrated a superior effect in ameliorating of this parameter (Tab.).

Conclusion

The data obtained confirmed the benefit of RDN treatment in patients with resistant hypertension in inducing reverse-remodeling of the LV, the beneficial effect being superior to both pharmacotherapeutic regimens.

Geometric pattern of the left ventricle Group IM Group IIB Group IIID χ2 p baseline Concentric remodeling 5 (20%) 5 (20%) 4 (16%) 0,71 > 0,05 Concentric hypertrophy 13 (52%) 15 (60%) 14 (56%) Excentric hypertrophy 7 (28%) 5 (20%) 7 (28%) Normal geometry - - - 6 months Concentric remodeling 3 (12%) 7 (28%) 7 (28%) 4,61 < 0,05 Concentric hypertrophy 13 (52%) 13 (52%) 10 (40%) Excentric hypertrophy 8 (32%) 5 (20%) 5 (20%) Normal geometry 1 (4%) - 3 (12%)
Acute dental periapical abscess and new-onset atrial fibrillation: A nationwide, population-based cohort study
Authors: Hassan A , Lip G , Bisson A , Herbert J , Bodin A , Fauchier L , Harris R
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

There are limited data on whether there is an association between hospitalisation with dental periapical abscess and new-onset atrial fibrillation (AF) which is independent of main cardiovascular risk factors.

Purpose

To investigate whether there is an association between hospitalisation with dental periapical abscess and new-onset AF.

Methods

A retrospective cohort study from a national database of patients hospitalised in 2013 (3.4 million patients) with at least five years of follow up, unless deceased. International Classification of Diseases (ICD) codes were used to compare the risk of developing new-onset AF for adults with and without dental periapical abscesses using univariate and multivariable analysis and hazard ratios (HR).

Results

In total, 4,693 patients classified as having dental periapical abscess, 435 (9.27%) developed AF, compared to 326,241 (10.69%) without dental periapical abscess over a mean follow-up of 4.8 ± 1.7 years.  Multivariable analysis indicated that dental periapical abscess acted as an independent predictor for new onset AF (p < 0.01).

Conclusions

An increased risk of new onset AF was identified for individuals hospitalised with dental periapical abscess. Careful follow up of patients with severe, acute dental periapical infections are needed for incident AF, as well as investigations of possible mechanisms linking these conditions.

Predictors of new-onset AF during FU Univariate analysis Multivariate analysis HR, 95%CI P HR, 95%CI P Age, years 1.077 (1.076-1.077) <0.0001 1.076 (1.075-1.076) <0.0001 Gender (male) 1.640 (1.629-1.651) <0.0001 1.0498 (1.487-1.509) <0.0001 Hypertension 2.849 (2.829-2.869) <0.0001 1.114 (1.487-1.509) <0.0001 Diabetes mellitus 1.951 (1.935-1.968) <0.0001 1.106 (1.096-1.116) <0.0001 Heart failure 3.893 (3.857-3.930) <0.0001 1.434 (1.416-1.452) <0.0001 Ischaemic stroke 2.289 (2.23902.340) <0.0001 1.140 (1.114-1.165) <0.0001 smoker 0.903 (0.891-0.917) <0.0001 1.052 (1.036-1.069) <0.0001 Liver disease 1.141 (1.119-1.164) <0.0001 1.082 (1.059-1.105) <0.0001 Previous myocardial infarction 2.128 (2.082-2.176) <0.0001 0.903 (0.880-0.926) <0.0001 Inflammatory disease 1.036 (1.020-1.052) <0.0001 0.978 (0.964-0.994) 0.005 Cognitive impairment 2.368 (2.326-2.410) <0.0001 0.821 (0.807-0.836) <0.0001 Illicit drug use 0.288 (0.263-0.317) <0.0001 0.940 (0.855-1032) 0.19 Dental periapical abscess 0.855 (0.778- 0.939) 0.001 1.107 (1.008-1.216) 0.03 At least 5 years of follow-up (mean follow-up 4.8 ± 1.7 years).

Abstract Figure. Flow Chart of the study patients
Impact of Proteinuria and Low eGFR on Lifetime Risk of Cardiovascular Disease Death: A Pooled Analysis of Data From the Evidence for Cardiovascular Prevention From Observational Cohorts in Japan Study
Authors: Imai Y , Sakurai M , Nakagawa H , Hirata A , Murakami Y , Kiyohara Y , Ninomiya T , Ishikawa S , Saitoh S , Irie F , Sairenchi T , Kiyama M , Miura K , Ueshima H , Okamura T
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): H20–Junkankitou [Seishuu]–Ippan–013; H23–Junkankitou [Seishuu]–Ippan–005; H26-Junkankitou [Seisaku]-Ippan-001; H29–Junkankitou–Ippan–003 and 20FA1002

OnBehalf

EPOCH-JAPAN

Introduction

Absolute risk of Lifetime risk (LTR) is useful estimate for risk communication compared with short term risk or relative risk especially for young people. Proteinuria is leading cause of end-stage kidney disease (ESKD) and independent risk factor for cardiovascular disease (CVD). Although nonproteinuric renal disease is global burden of ESKD, it has been poorly focused. To date, there have been no reports of impact of proteinuria and low eGFR on LTR with the outcome of CVD death in Asian population.

Purpose

We aimed to estimate LTR of CVD death stratified by the status of proteinuria and low eGFR.

Methods

We used modified Kaplan-Meier approach to estimate the remaining lifetime risk of cardiovascular death based on EPOCH-JAPAN(Evidence for Cardiovascular Prevention From Observational Cohorts in Japan) database. LTR was estimated at each index age starting from 40 years for those with proteinuria and without proteinuria stratified by low eGFR, which is defined as eGFR <60 ml/min/1.73 m². Participants were classified into three groups, which were those with proteinuria (Proteinuria (+)), those without proteinuria with low eGFR (Proteinuria (-)/Low eGFR (+)), those without proteinuria without low eGFR (Proteinuria (-)/Low eGFR (-)).

Results

A total of 47,292 participants from 9 cohorts was included in the analysis. Mean follow-up period was 14.6 years with 690,463 person years and total CVD death was 1,075 in men and 1,193 in women. The LTRs at the index age of 40 years were as follows: 17.7% (95% confidence interval: 15.4 – 19.0%) in Proteinuria (-)/Low eGFR (-) group, 26.2% (20.2 – 31.1%) in Proteinuria (-)/low eGFR (+) group, 24.5% (15.1 – 29.3%) in Proteinuria (+) group for men; 15.3%(13.7 – 16.5%), 29.9%(14.7 – 46.8%) , 28.3%(19.4 – 34.7%) for women.

Conclusions

We observed that those without proteinuria with low eGFR have equivalently high LTR with those with proteinuria. These results indicate that even in the absence of proteinuria, low eGFR has high impact on LTR. Lifestyle modification from young age is necessary to prevent from renal dysfunction.
Identifying the prevalence of undiagnosed cardiovascular disease risk factors in healthy Indians
Authors: Thanvi S , Thakkar P
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

 

Cardiovascular disease (CVD) including heart disease and stroke, is the leading cause of death globally and in India. 

The importance of primary prevention, defined as interventions designed to modify adverse risk factors with the goal of preventing an initial CVD event has been established beyond doubt by several population based studies in healthy individuals.

While there have been many studies defining the high prevalence in CVD risk factors in Indian population, this study sought to determine the prevalence of undiagnosed modifiable CVD risk factors in healthy individuals. 

Methods

The  cross sectional, analytical study was carried out at the hospitals, from 1st April 2015 to 31st dec 2017. Subjects between 18 - 70 years of age who were healthy and were undergoing health checkup were included in the study. A total of 5000 patients were screened, those having existing CVD risk factors were excluded from the study. 

This study was approved by the institutional ethics committee of the hospital. Written informed consent was obtained from all subjects. The data collection record sheet was prepared based on validated and standardized questionnaires which was used to enter all data. 

Physical examination for vitals and BMI was done by qualified physicians. Blood investigations were done for diabetes and dyslipidemia and thyroid dysfunction. ACC/AHA criteria was used for diagnosis of  hypertension, ADA criteria for diabetes. Joint British society 3 risk score and ASCVD risk score was calculated using standard calculators.

Results

At screening, 4998 participants aged ≥18 years were approached to participate in study. The study population included 2705 men (68.1%) and 1265 women (31.9%) with a mean age of 68± 18.8 years. The most prevalent risk factor was overweight and obesity (71.2%).

The prevalence of undiagnosed HTN was 73.3%, undiagnosed pre-diabetes was 24.9% and undiagnosed diabetes was 28.3%. Out of total, 44.3% subjects had high level of low-density lipoprotein and 36.6% subjects had low level of high-density lipoprotein, 20.1% subjects had high level of very-low density lipoprotein (VLDL) and 17.3% subjects had high level of triglyceride.

Tobacco smoking was present in 7.7% of the population. The risk estimation predicted 29.1% of the study participants to have more than 10% risk of heart attack/stroke risk at 10 years.

Conclusion

Our study reveals a fairly good snapshot of CVDs risk factors in healthy general population. Increased prevalence of high BMI, undiagnosed HTN, diabetes, dyslipidemia was present in our study population. 

The population had significantly high predicted risk of heart attack/stroke. These findings warrant the need of community based life style modifications, regular health checkup for healthy population for early detection and modification of CVD risk factors.
Systematic review and network meta-analysis of randomised controlled trials of interventions for depressive symptoms in patients with coronary artery disease
Authors: Doyle F , Freedland KE , Carney RM , De Jonge P , Dickens C , Pedersen S , Sorensen J , Dempster M
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Objective

Depression is common in patients with coronary artery disease (CAD) and is associated with poor outcomes. Although different treatments are available, it is unclear which are best or most acceptable to patients, so we conducted a network meta-analysis of evidence from randomized controlled trials (RCTs) of different depression treatments to ascertain relative efficacy.

Methods

We searched for systematic reviews of RCTs of depression treatments in CAD and updated these with a comprehensive search for recent individual RCTs. RCTs comparing depression treatments (pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) were included. Primary outcomes were acceptability (dropout rate) and change in depressive symptoms 8-weeks post-treatment commencement. Change in 26-week depression and mortality were secondary outcomes. Frequentist, random effects network meta-analysis synthesized the evidence. GRADE was used to assess evidence quality.

Results

Thirty-three RCTs (7240 participants) provided analysable data. All treatments were equally acceptable. At 8-weeks, combination therapy (1 study), exercise (1 study), and antidepressants (10 studies) yielded the strongest effects versus comparators. At 26-weeks, antidepressants were consistently effective, but psychotherapy was only effective versus usual care. There were no differences in treatment groups for mortality.  GRADE ratings ranged from very low to low.

Conclusions

All treatments were equally acceptable, while antidepressants appeared to have the most robust evidence base for post-CAD depression. The evidence base was limited and biased; conclusions based on this literature should be drawn cautiously and considered to be tentative. Rigorous, multi-arm intervention trials, including trials of combination therapies and exercise, are urgently needed.
A diet-related microsimulation modelling approach in the context of cardiovascular disease prevention: the ATTICA and GREECS epidemiological studies
Authors: Kouvari M , Tsiampalis T , Chrysohoou C , Notara V , Georgousopoulou E , Skoumas J , Pitsavos C , Panagiotakos DB
Published: May 2021

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): The ATTICA study is supported by research grants from the Hellenic Cardiology Society [HCS2002] and the Hellenic Atherosclerosis Society [HAS2003].

Background/Introduction: Among all behaviors, nutrition makes the largest contribution to cardiovascular disease (CVD) morbidity across Europe. Purpose: The aim of the present work was to quantify the changes in 10-year CVD onset or recurrence or mortality, in relation to transitioning from low to higher level of adherence to Mediterranean diet. Methods: An individual-level microsimulation was created based on ATTICA (2002-2012, n = 3042 subjects free-of-CVD) and GREECS (2004-2014, n = 2172 patients with acute coronary syndrome (ACS)) studies (in total n = 5214). Eight scenarios regarding the proportion of participants and the size of improvement of level of adherence to Mediterranean diet were compared in terms of relative change in CVD incidence and mortality, as well as, the number of preventable CVD events and deaths. Results: Improving the level of adherence to the Mediterranean diet, even in 10% of the population, a significant relative percentage reduction was observed in the 10-year risk for CVD onset, recurrence and mortality, with the observed reductions being higher among women. In particular, at least 851 first CVD events, 374 recurrent CVD events and 205 CVD deaths per 100,000 of population could be averted or delayed. Additionally, Mediterranean diet clustering revealed that high consumption of fruits, vegetables, whole wheat products and legumes was more important than low consumption of meat and full fat dairy products against CVD. Conclusion: This microsimulation process confirms the added value of Mediterranean diet in primary and secondary CVD prevention having great achievements even with small modifications on a population basis, while challenges the orientation of a Mediterranean-diet intervention giving higher weights to plant-based part.
Moderate and vigorous physical activity levels are associated with circulating CD34+ progenitor cells which are predictive of all-cause and cardiovascular mortality
Authors: Ross M , Muggeridge D , Dodd J
Published: May 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Edinburgh Napier University Research Excellence Grant

Background

Circulating progenitor cells (CPCs) play an important role in vascular repair and may influence cardiovascular (CV) health and longevity. Physical activity is known to promote vascular health and may do so by modulating CPC counts.

Purpose

The primary aims of this study were to evaluate the association of CPCs with mortality and explore the association between physical activity (PA) and CPCs.

Methods

We studied 1,751 individuals from the Framingham Offspring cohort (66 ± 9 years, 54% female). CPCs (CD34+, CD34 + CD133+, CD34 + CD133 + KDR+) were measured from blood samples by flow cytometry. Multivariable cox regression analyses were performed to investigate the relationship of CPCs with future CV event, mortality, and all-cause mortality. Multivariate regression analyses were performed to determine the relationship between self-reported PA and CPC counts.

Results

Following adjustment for standard risk factors, there was an inverse association between CD34+ CPCs and all-cause mortality (hazard ratio (HR) per unit increase in CD34+, 0.79; 95% CI 0.64 – 0.98). CD34 + CD133+ CPCs were inversely associated with CV mortality (HR 0.63, 95% CI 0.44 – 0.91, P = 0.013). Associations of CD34+ and CD34 + CD133+ with mortality were strongest in participants with pre-existing CVD. PA was associated with CD34+ CPCs only in CVD participants. This relationship was maintained after adjustment for confounding variables.

Conclusions

Higher number of CD34+ and CD34+ CD133+ CPCs were inversely associated with all-cause and CV mortality. These associations were strongest in participants already diagnosed with CVD. PA is independently associated with CD34+ CPCs in individuals with CVD only, suggestive of greater benefit for this population group.
Correlation of STOP-bang obstructive sleep apnoea screening tool to apnoea-hypopnea index in a general cardiology population
Authors: Mannion J , Binalialsharabi W , Caples N , Rogan M , Foley S , Owens P
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

The link between obstructive sleep apnoea (OSA) and cardiovascular disease is well known. Prevalence can be very high in this population, sharing many pathophysiological drivers in addition to being a risk factor. More concerning however is the increasing number of patients with undiagnosed OSA, who are at higher risk of long-term complications such as coronary artery disease, hypertension, atrial fibrillation, heart failure or stroke. There are several OSA screening tools available to clinicians, with variable sensitivities and specificities depending on patient demographics.

Predictive efficacy of the STOP-Bang screening tool in a general cardiology population with mixed cardiovascular disease has not been established.

Proposal

To identify the correlation between the STOP-Bang assessment score (1-8) and real-world Apnoea-Hypopnoea Index (AHI) in a general cardiology clinic population.

Methods

250 successive patients in a general cardiology clinic were asked to complete a STOP-Bang assessment. Of those, 50 patients with a variety of STOP-Bang scores were randomly selected to undergo sleep studies. A STOP-Bang value of ≥ 5 was taken as high-risk for moderate-severe OSA. Statistical linear regression analysis was performed in IBM SPSS version 26.

Results

Of n = 50 patients, mean STOP-Bang score =3.7 (SD +/-2.17) with mean AHI =15.8, (SD +/- 14.3). See Table 1 for categories 1-8. N = 44 (88%) had AHI ≥ 5 (At least mild OSA). N = 18 (36%) had an AHI ≥ 15 (Moderate-severe OSA). N = 29 (58%) had symptoms such as sleepiness, loud snoring or witnessed apnoea. Correlation between STOP-Bang score and AHI was high, with an  R value of 0.704, R2 = 0.496 (p < 0.01). A STOP-Bang score increase of 1 corresponded with a mean AHI rise of 4.648. When taking a STOP-Bang value of ≥ 5 as "positive", we demonstrated a sensitivity of 83.33% (95% C.I. 58.58-96.42) and specificity of 93.94% (95% C.I. 79.77-99.26%) for moderate-severe OSA (AHI ≥ 15). 

Conclusion

We discovered a very high number of patients with undiagnosed OSA of at least mild severity. We found a strong correlation between STOP-Bang score and real-world AHI in a general cardiology population with mixed cardiovascular disease with 5 as an acceptable screening score for moderate-severe OSA.

Table 1 STOP-Bang Value 1 2 3 4 5 6 7 8 Patients (N=) 12 5 7 9 5 5 5 2 AHI (Mean) 6.67 6.62 9.97 11.95 24.44 22.20 39.54 35.25 Standard Deviation (±) 3.29 2.74 3.45 4.63 12.87 5.69 27.2 6.72 Summary of mean apnoea-hypopnoea index and standard deviation for each STOP-Bang patient category.

Abstract Figure 1
Ttrimetyllysine and risk of new-onset atrial fibrillation in two large norwegian cohorts
Authors: Svenningsson MM , Dhar I , Svingen GFT , Pedersen EKR , Nilsen D , Ueland PM , Ulvik A , Tell GS , Bjoernestad E , Nygaard OK
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background/Aim

Increased plasma trimetyllysine (TML), a methylated amino acid, has recently been linked to higher risk of acute myocardial infarction (AMI). TML is also a precursor of trimethylamine-N oxide (TMAO), which has been linked to increased cardiovascular risk, including that of  atrial fibrillation (AF). We investigated the association between TML and new-onset AF in two large Norwegian cohorts.

Methods

The primary cohort consisted of 6396 participants in the community-based Hordaland Health Study (HUSK). The validation cohort consited of 2027 patients who underwent coronary angiography due to suspected stable angina pectoris in the Western Norway Coronary Angiography Cohort (WECAC). Information on new-onset AF was obtained by linking patient data to Norwegian public health registries. Risk associations were explored by Cox regression.

Results

During median (25th-75th percentile) follow-up of 10.9 (10.6-11.3) and 7.0 (6.3-8.6) years, 560 (8.8%) patients in the HUSK and 210 (10.4%) in the WECAC was diagnosed with AF.

In the HUSK, the age and gender adjusted HR (95 % CI) for the 4th vs. 1st plasma TML quartiles 1.84 (1.37-2.48) p < 0.001. In multivariable models the association was only slightly attenuated. Correspondingsly, the age and gender adjusted HR (95% CI) for the 4th vs. 1st TML quartiles in the WECAC was 1.48 (0.96-2.27) p = 0.07.

Testing for collinearity between TMAO and TML revealed variance inflation factors between 1.0-1.1 in HUSK and WECAC, thus ruling out collinearity.

Conclusion

Plasma TML was associated with new-onset AF among subjects from the general population, and the relationship was independent from established AF risk factors. A similar trend was also seen in patients with suspected stable angina pectoris, strengthening our findings, which motivate further studies to explore potential pathophysiological relationships between one-carbon metabolism and cardiac arrhythmias
Lower perception of pharmacological treatment increases risk of non-adherence to medication
Authors: Graversen CB , Valentin JB , Larsen ML , Riahi S , Holmberg T , Zinckernagel L , Johnsen SP
Published: May 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation

Background

A large proportion of patients fail to reach optimal adherence to medication following incident ischemic heart disease (IHD) despite amble evidence of the beneficial effect of medication. Non-adherence to medication increases risk of disease-related adverse outcomes but none has explored how perception about pharmacological treatment detail on non-adherence using register-based follow-up data.

Purpose

To investigate the association between patients’ perception of pharmacological treatment and risk of non-initiation and non-adherence to medication in a population with incident IHD.

Methods

This cohort study followed 871 patients until 365 days after incident IHD. The study combined patient-reported survey data on perception about pharmacological treatment (categorised by ‘To a high level’, ‘To some level’, and ‘To a lesser level’) with register-based data on reimbursed prescription of cardiovascular medication (antithrombotics, statins, ACE-inhibitors/angiotensin receptor blockers, and β-blockers). Non-initiation was defined as no pick-up of medication in the first 180 days following incident IHD and analysed by Poisson regression. Two different measures evaluated non-adherence in patients initiating treatment: 1) proportion of days covered (PDC) analysed by Poisson regression, and 2) risk of discontinuation analysed by Cox proportional hazard regression. All analyses were adjusted for confounding variables (age, sex, ethnicity, income, educational level, civil status, occupation, charlson comorbidity index, supportive relatives, and individual consultation in medication) identified by directed acyclic graph and obtained from national registers and the survey. Item non-response was handled by multiple imputation and item consistency was evaluated by McDonalds omega.

Results

Lower perceptions about pharmacological treatment was associated with increased risk of non-initiation and non-adherence to medication irrespectively of drug class and adherence measure in the multiple adjusted analyses (please see figure illustrating results on antithrombotics). A dose-response relationship was observed both at 180- and 365-days of follow-up, but the steepest decline in adherence differed when comparing the two adherence measures (results not shown). Moderate internal consistency was found for the summed measure of perception (McDonalds omega = 0.67).

Conclusion

Lower perception of pharmacological treatment was associated with subsequent non-initiation and non-adherence to medication, irrespectively of measurement method and drug class.

Abstract Figure. Figre: Multiple adjusted analyses
Role of post-acute myocardial infarction clinic in secondary prevention
Authors: Dev D , Dutta SD , El-Din MO
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

There is a 5% increased risk of death from cardiovascular causes following acute myocardial infarction[1]. One of the critical factors to improve long-term prognosis is evidence-based medication, but the limiting factors are adherence and optimal up-titration. Studies have shown one of the ways to improve this is early follow up[2]. Post-acute myocardial infarction(AMI) clinics help bridge this gap[3].

Purpose

We realised that the follow-up time for our patients was 257 days. So we created a dedicated post-AMI clinic. We wanted to reduce wait times, improve patient compliance, optimise medication, and manage risk factors.

Methods

We collected retrospective data from our post-AMI clinic between august to december 2020 for 52 patients who had a myocardial infarction.

Results

In 52 patients seen, post-AMI clinic reduced follow up time from 257 to 65 days. In the post-AMI clinic, we picked up the new diagnosis of diabetes in 5.8% of patients. Most medicines required optimisation as depicted in Table 1 and Histogram 1.

Conclusions

Overall, Significant number of patients in post-AMI clinic had early follow up, secondary prevention optimisation. This project demonstrates how Post-AMI clinics are important part of secondary prevention. They should be part of routine post-AMI care in all hospitals.

Table 1 Age 20-40 40-60 60-80 80-100 2 20 24 6 Lesion LAD Cx RCA >1 lesion 23 4 16 9 Meds Optsd B-Blocker ACE-i/ARB Statins DAPt 5(10.8%) 29(55.8%) 8(15.4%) 1(1.9%) Referred to Diabetes Heart failure Need ongoing review 5 2 5 Meds = Medication, Optsd= Optimised, B-Blocker = Beta blocker, ACE-i = Angiotensin converting enzyme inhibitors. ARB= Angiotensin receptor blockers, DAPT = Dual anti-platelet therapy

Abstract Figure. Histogram 1
Evaluation of secondary prevention in Egyptian patients after primary percutaneous coronary intervention
Authors: Thabet NAGWA , Dina LABIB , Samir AHMED , Hosny M , Hassan AHMED , Hekal SOHA , Ibrahim AYMAN , Mansour HOSSAM , Zain-Eldin Hafez M , Farrag AZZA , El-Guindy AHMED
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Effective secondary prevention after acute coronary syndromes is critical to reducing the risk of a subsequent cardiovascular event.  Adherence to secondary prevention is disappointingly low worldwide, with no data in Upper Egypt. 

Purpose and methods

 We sought to determine the prevalence of adherence to secondary preventive among patients who underwent primary percutaneous coronary intervention (PPCI) in a tertiary centre in Upper Egypt from 2014-2016 (n = 468).

Results

 Our cohort included 468 patients, mean age  at STEMI was 55.7 ± 11.2 years; 79% males. Smoking, diabetes mellitus (DM), dyslipidemia, obesity and hypertension were 62%, 42%, 39%, 38% and 34% respectively. Median follow-up duration (IQR) was 703 (613-830) days. Table 1 shows the prevalence of adherence secondary prevention. Re-myocardial infarction, unstable angina, repeated hospital admission was 4.9%, 5.1%, 14% respectively.  Revascularizations were 8.1% and total ischemic complications  were 18%. The major adverse cardiac events MACEs were 24%. DM and hypertension were significant predictors of MACEs on univariable and multivariable analysis (multivariable ORs [95% CIs]: 1.685 [1.002 -2.833] and 1.764 [1.033-3.012], respectively). 

Conclusion

 Adherence to secondary prevention after PPCI is sub-optimal in Upper Egypt. We need to raise the standard of preventive cardiology care through more effective primary and secondary prevention programs, to reduce morbidity and mortality.

Risk factor Target level Number (%) Diabetes HbA1c <7% 280(62) Blood pressure <140/90 295(63) Smoking cessation in smokers Complete cessation 122 (43) Smoking status No smoking 301(65) Physical activity Walking at least 30 minutes 5 days/week 301(60) Body mass index <25 kg/m2 101(22) Waist circumference <102 cm in males, <88 cm in females 164(36) Diet Low salt and fat, adequate fruits and vegetables 268 (57) Lipids LDL < 70 gm/dL 93(26)