bluuebunny/crossref_metadata_2025 huggingface dataset:
Nighttime blood pressure reductions after radiofrequency renal denervation through 24 months in patients with uncontrolled hypertension: pooled analysis from the SPYRAL HTN trials
Authors: Kario K , Mahfoud F , Townsend R R , Kandzari D E , Weber M A , Schmieder R E , Tsioufis K , Fahy M , Boehm M
Published: October 2024

Introduction

Studies have shown that elevated nighttime and early morning systolic blood pressure (SBP) are associated with the highest risk for cardiovascular (CV) events. Radiofrequency renal denervation (RF RDN) is an interventional therapy to reduce BP in patients with uncontrolled hypertension (HTN). Although sustained, durable reductions in office and 24-h ambulatory systolic BP (SBP) after RDN have been observed, whether the therapy produces similar, durable nighttime and early morning SBP reductions requires further evaluation.

Objective

To assess whether RF RDN significantly reduces nighttime SBP through long-term follow-up, in addition to other times of the day.

Methods

We pooled data from patients with uncontrolled HTN undergoing RF RDN using the latest-generation Symplicity SpyralTM multi-electrode catheter from the published SPYRAL HTN-OFF and -ON MED clinical trials. Office and 24-h ambulatory SBP were evaluated from baseline through 24 months. We also assessed BP changes during specific, diurnal time ranges including nighttime (1am-6am), early morning (7am-9am), and daytime (9am-9pm). The number of antihypertensive drugs and drug burden (determined by number of classes and prescribed dosage) from urine and plasma drug testing were tabulated from baseline through 24 months.

Results

Outcomes from 388 patients undergoing RF RDN were pooled for this analysis. Patients were on average 54±10yrs old, 26.8% female, mean BMI was 31.3±6.0, 45.1% with >10yrs diagnosis of hypertension, 7.7% with type 2 diabetes, 9.8% with obstructive sleep apnea, 47.7% with a history of smoking. The baseline nighttime SBP was 139±11mmHg, morning SBP was 154±15mmHg, and daytime SBP was 156±9mmHg. At baseline, 92.5% of patients had nocturnal hypertension (BP ≥120/70 mmHg) and took 1.0±1.2 antihypertensive drugs.

12 months after RF RDN, 30.6% of patients no longer had nocturnal hypertension (p<0.0001). The mean nighttime SBP change at 12 months was -10.8±15.4mmHg, morning changed was -12.8±20.4mmHg, and daytime changed was -12.2±13.6mmHg (Figure). The mean 24-h ambulatory SBP change at 12 months was -11.9±12.4mmHg, and the office SBP change was -17.7±15.4mmHg . Patients took 1.8±1.1 antihypertensive drugs at 12 months. Results from 24 months, not currently available, will also be presented for the first time.

Conclusions

In this pooled cohort of RDN patients with uncontrolled hypertension, nocturnal hypertension was highly prevalent. Clinically meaningful reductions at 12 months throughout the 24-hr circadian cycle, including at nighttime and early morning SBP, are consistent with the "always on" effect of RDN. Results from 24 months will also be presented for the first time at ESC. As an adjunctive therapy to pharmacotherapy, RDN may help to reduce CV risk by lowering nighttime and morning SBP.
Carotid-Femoral pulse wave velocity progression in hypertensive patients is associated with subsequent cardiovascular outcomes
Authors: Maloberti A , Rebora P , Occhino G , Andreano A , Intravaia R C M , Tognola C , Toscani G , Peraro G , Morelli M , Pezzoli S , Cavalieri D'oro L , Russo A , Giannattasio C
Published: October 2024

Background

Arterial stiffness (Pulse Wave Velocity - PWV) is associated with CV events and mortality. However, little is known on the relationship of its progression (ΔPWV) over time with CV outcomes.

Purpose

The aim of our study was to evaluate the relationship between PWV progression and all-cause mortality and CV events in hypertensive subjects.

Methods

We enrolled 402 consecutive hypertensive outpatients. At baseline anamnestic, clinical, BP, laboratory data and PWV were assessed. We performed a PWV follow-up examination at a median time of 3.7±0.5 years. Patients were subsequently followed for a median time of 10.1 (IQR 9.5 -10.5) years recording all-cause mortality and CV events.

Results

At baseline the mean age was 53.2±13.0 years, SBP and DBP were 141.8±17.5 and 86.8±10.5 mmHg and PWV was 8.5±1.9 m/s. Despite an improvement in BP control (- 9.2±19.5 and -8.0±12.3 for SBP and DBP respectively), at follow-up the population showed a PWV increase (ΔPWV +0.6±1.9 m/s). Progressors (ΔPWV ≥ 0.5 m/s, 204 patients, 50.7%) had a significantly lower survival probability and higher cumulative incidence of composite events, while no differences were seen for CV events (unadjusted analysis). At cox multivariable analysis neither ΔPWV ≥ 0.5 m/s (progressors) nor ΔPWV (as a spline function) were associated with CV events and with all-cause mortality.

However, the association with survival probability and cumulative incidence of CV events, as a composite outcome, was significant (HR = 2.32, 95% CI: 1.33 – 4.04, p=0.003).

Conclusions

In conclusion, our study shows that PWV progression of at least 0.5 m/s is frequent in hypertensive patients and that it is associated with a significantly higher risk of developing CV events or dying (composite outcome).
High physical activity relates to higher risk of incident carotid plaque components
Authors: Zuo L , Kavousi M , Voortman T , Ikram M K , Bos D
Published: October 2024

Background

The rupture of carotid atherosclerotic plaque, primarily driven by plaque components, is among the leading causes of ischemic stroke. Although physical activity (PA) stands as a major modifiable target for prevention of atherosclerotic diseases, recent studies suggested a potential adverse impact of high-volume PA on atherosclerotic plaque burden in athletes. Data remains scarce from the community-dwelling population regarding to the impact of PA on the longitudinal change of carotid plaque components.

Objectives

To assess the association between PA and the incidence of carotid plaque components and explore whether the association of PA with stroke and all-cause mortality differs by the presence of plaque components.

Methods

Between 2007 and 2012, in a community- dwelling cohort in Netherlands, 1327 stroke-free persons (mean ± standard deviation age 72 ± 9 years, 45% women) with carotid atherosclerosis (carotid intima-media thickness > 2.5 mm) were invited for magnetic resonance imaging (MRI) to assess carotid plaque components. From these, 696 persons (1267 carotid arteries) underwent a follow-up MRI between 2014 and 2017 (median between-scan interval 6 years). Carotid plaque components included calcification, intraplaque hemorrhage (IPH), and lipid-rich necrotic core (LRNC). The volume of moderate, vigorous and total PA (unit: metabolic equivalent task hour, MET-h) was assessed using LASA Physical Activity Questionnaires around the time of the first MRI scan. Participants were followed for the occurrence of stroke or all-cause mortality until December 31, 2019. Generalized estimation equation and Cox regression models were used in the analyses, with adjustments for plaque size and other cardiovascular risk factors.

Results

Compared to lowest quintile PA group, participants in the highest quintile total PA group had a higher risk of new onset of plaque components, odds ratio (95%CI) 2.69 (1.21; 5.94) for calcification, 1.35 (0.82; 2.24) for LRNC and 1.93 (1.12; 3.34) for IPH (Figure 1). Similar associations were observed for vigorous PA but not for moderate PA. Over a median follow-up of 9.5 years, 118 persons suffered a stroke and 298 died. As shown in table 1, baseline IPH, rather than LRNC or calcification, modulated the associations of PA with stroke and all-cause mortality (P-interaction <0.05): higher total PA was associated with a lower risk of stroke among IPH-free persons, with the hazard ratio (95% CI) of 0.929 (0.867; 0.996) per 10 MET-h/week increase; no associations between PA and stroke were found among those with IPH. Similar associations were found between vigorous PA and all-cause mortality.

Conclusions

Among the middle-aged and elderly with subclinical atherosclerosis, high level PA, especially high vigorous PA, may lead to an unstable carotid plaque. The beneficial effect of PA on stroke and all-cause mortality is only among persons with a stable carotid plaque profile, especially without IPH.
The impact of pre-myocardial infarction exercise frequency on prognosis in acute myocardial infarction patients
Authors: Gu T S , Hu S T , Zhang Y K , Jiang C , Zhang J K , Wu X , Liu X , Liu T , Chen K Y
Published: October 2024

Background

Acute myocardial infarction (AMI) is a critical cardiovascular event often associated with significant morbidity and mortality. Despite the acknowledgment of regular physical activity as vital for cardiovascular health, its influence on post-AMI prognosis in patients with varying pre-AMI exercise frequencies remains to be fully explored.

Purpose

This study aimed to investigate the outcomes of AMI patients based on their exercise frequency prior to the occurrence of AMI, comparing those with regular exercise (once or more per week) versus those with infrequent or no exercise.

Methods

This study included acute myocardial infarction cohorts from 71 secondary or tertiary hospitals between January 1, 2010 and June 30, 2023. Inclusion criteria comprised AMI patients evaluated for exercise frequency using the Community Health Questionnaire before hospitalization. The primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), net adverse clinical events (NACE), and all-cause mortality, with secondary outcomes comprising the individual components of MACCE and NACE. Propensity score matching (PSM) was employed to adjust for differences in clinical characteristics between the two groups. Multivariable Cox regression and robust multivariable Cox regression were conducted before and after PSM to evaluate the impact of exercise frequency on outcomes.

Results

The final study population consisted of 77,427 participants (42.1% in the High-frequency exercise group). The median follow-up duration was 1595 days, the mean age was 66.03±11.82 years, 65.6% were male. Compared to individuals with infrequent exercise before AMI, those with regular exercise exhibited significantly lower risks of MACCE [aHR 0.93 (0.91-0.96), p<0.001], NACE [aHR 0.91 (0.89-0.93), p<0.001], and all-cause mortality [aHR 0.90 (0.87-0.92), p<0.001]. However, regular exercise before AMI was associated with an increased risk of coronary revascularization [aHR 1.12 (1.07-1.17), p<0.001]. These findings remained consistent in the robust multivariate Cox regression analysis conducted after adjusting for differences between the two groups with PSM (Figure 1). After PSM, survival analysis indicated that the incidence of primary outcomes was lower in individuals with high exercise frequency before AMI compared to those with low exercise frequency before AMI, with all-cause mortality rates of 23.1% vs. 35.4%, MACCE rates of 26.4% vs. 36.2%, and NACE rates of 36.9% vs. 36.2%, all with log-rank p-values <0.001.

Conclusions

This study underscores the protective role of regular physical activity prior to AMI in reducing adverse post-AMI outcomes. Promoting pre-AMI physical activity can be a key element in preventive cardiology, potentially improving prognosis and decreasing the likelihood of cardiovascular events post-AMI.Figure 1
GJA4 gene inhibition may represent a potential target for novel antithrombotic therapies
Authors: Sa D , Mendonca M I , Sousa F , Abreu G , Rodrigues M , Henriques E , Freitas S , Borges S , Guerra G , Ornelas I , Drumond A , Sousa A C , Palma Dos Reis R
Published: October 2024

The GJA4 gene encodes a protein called connexin 37, a component of gap junctions in vascular endothelial cells, crucial in regulating endothelial function and influencing inflammation, platelet adhesion and thrombus formation. This gene deletion in mice diminished thrombus formation in vitro in human blood. In these circumstances, connexin inhibition with pharmacological agents may represent potential avenues for developing novel antithrombotic agents.

Aim

To investigate whether the GJA4 rs618675 T>C variant is a risk factor for progressing atherosclerosis and cardiovascular (CV) events in an asymptomatic free of apparent CAD from a Portuguese population.

Methods

A prospective study was performed with 1421 individuals without apparent CV disease (73.6% male, aged 52.2±8.3 years) followed during an extended period of 7.2±5.1 years). GJA4 rs618675 T>C variant was genotyped by TaqMan real-time PCR technique (Applied Biosystems). Conventional, anthropometric, biochemical and clinical risk factors were studied. Bivariate analysis and multivariate Cox regression adjusted for age, gender, traditional risk factors, biochemical markers, and the genotypes under study was performed to determine which variables were, significantly and independently, associated with CV events. Kaplan-Meier's estimate assessed the prognosis.

Results

Bivariate analysis showed that 50.6% of wild genotype (TT) carriers had CV events vs. 66.2% without events. Of the risk genotype (CC) carriers, 10.1% had CV events, and 3.4% did not. After the Kaplan-Meier analysis, the TT carriers had 90% CV event-free survival time and the CC risk carriers had only 64% of event-free survival. Finally, after adjustment, CC genotype remained in the equation with an HR of 3.1 (p=0.003) and CT heterozygous with HR of 1.6 (p=0.043), together with Hypertension (HR 3.0; p<0.0001), Smoking habits (HR 2.3; p=0.001) and Diabetes (HR 1.9; p=0.015).

Conclusion: The CC risk genotype of the GJA4 rs618675 represented an independent risk factor for progressing atherosclerosis and CV events in a Portuguese Population. Thrombus formation often begins with the adhesion of platelets to the endothelium, and connexin 37 may influence this process. The inhibition of connexin 37 emerges as a promising candidate for future cardiovascular prevention as well as for the development of new antithrombotic drugs.
Validation of digital cardiovascular risk score (DiCAVA) in the United States All of Us dataset
Authors: Yao Z , Dolezalova N , Aral M , Albrecht G , Irving B , Blaha M J
Published: October 2024

Introduction

The cardiovascular disease (CVD) risk score DiCAVA was developed in 2021 using UK Biobank data with the aim to be used for population health screening by deriving its predictions only from variables readily available to every individual, omitting difficult-to-obtain measurements such as blood pressure and invasive blood tests for metrics like cholesterol or HbA1c, which are commonly used in clinical CVD risk assessment tools. The original set of variables was reduced to 30 in the DiCAVA Lite score to further improve usability in a digital solution accessible to the general population, while maintaining its discrimination ability.

Purpose

Like many countries, the US has a large burden of CVD and would benefit from easily accessible screening tools. However, to ensure generalisability of the UK-developed score, it is necessary to evaluate its performance in a population where the score is intended to be used.

Methods

Data from a large real-world modern observational study in the US, All of Us, was used to evaluate discrimination and calibration metrics of the risk score. Participants with pre-existing CVD and without available electronic health records were excluded from the study. Variables from the All of Us dataset were matched to the original variables and any missing values were imputed using multiple imputation.

Results

216,985 participants with a median follow-up time of 3.44 years were included in the study. The median age was 51 years and 63% of the population were female. Discrimination ability in the All of Us dataset (C-index 0.76) slightly surpassed the discrimination achieved at training with UK Biobank (C-index 0.73), and that of Framingham risk score calculated for the All of Us population (C-index 0.72), demonstrating the score’s usability in the US. The score showed very good discrimination in both males (C-index 0.74) and females (C-index 0.77), all ethnic groups and age groups, with the exception of the population over 65 years of age, where the C-index dropped to 0.65 as expected (similar to that observed in the UK Biobank). Calibration of the original model was assessed at 3 years and showed under-estimation of the predicted risk (calibration-in-the-large of 2.37%). Following re-calibration, the algorithm demonstrated excellent results with the average predicted 3-year risk showing 0.59% difference from the observed CVD rate (calibration plot in Figure).

Conclusions

Overall, the DiCAVA Lite score has shown very good discrimination in the US, showing its generalisability in different demographic populations. Its re-calibrated form is now validated for use in the US population and because of its ability to be utilised outside clinical settings, it can be deployed widely in the general population as an initial screening tool and potentially boost awareness of cardiovascular health in an effort to drive preventative care of CVD.Re-calibration of the DiCAVA Lite score
Evaluating myocardial involvement in patients with multiple myeloma at different stages a cardiac MR T1 mapping study
Authors: Guo P , Chen W , Wang Y U , Shi M , Gao F
Published: October 2024

Background

At present, the International criteria for diagnosis multiple myeloma（MM） do not specifically highlight the use of cardiac magnetic resonance (CMR) to detect abnormal myocardial infiltration in patients at different clinical stages of MM. Extracellular volume fraction (ECV) based on CMR T1 mapping indicates expansion of the extracellular space or deposition of material in infiltrative heart diseases.

Purpose

To detect whether myocardial involvement in patients with MM at different clinical stages based on CMR T1 mapping.

Methods

A cohort consisting of 20 patients with diagnosed MM and 15 sex- and age-matched controls (Cs) were recruited for this study. All participants underwent CMR examination to obtain native T1 and ECV. The patients with MM were stratified into three groups based on the International Staging System (ISS): Stage I (n=5), Stage II (n=7), and Stage III (n=8). Cardiac amyloidosis (CA) is diagnosed based on the patient's clinical presentation and tissue biopsy. The baseline biochemical indices were collected before CMR examination.

Result

Among patients with MM, there were a total of 9 patients diagnosed with CA, comprising 3 patients in stage II and 6 patients in stage III. The ECV in stage III patients (45.13±11.89%) was significantly higher compared to that in stage I (26.65±4.22%), stage II (34.09±8.90%), and controls (25.40±2.52%) (p < 0.05). Furthermore, the ECV in stage II patients (34.09±8.90%) was higher compared to controls (25.40±2.52%), though not significantly different from stage I patients (26.65±4.22%). Correlation analysis revealed a positive correlation between brain natriuretic peptide (BNP) levels and ECV (r=0.606, p=0.013). Receiver operating characteristic (ROC) curve analysis demonstrated that ECV had good predictive value for CA, with an area under the curve (AUC) of 0.898 (p < 0.01), and the optimal cutoff value for ECV was determined to be 33.7%.

Conclusions

ECV derived from CRM T1 mapping holds promise for identifying amyloid accumulation, which deteriorates progressively with the advancement of disease stages in patients with MM. It is recommended that patients diagnosed with Stage II and Stage III MM should undergo CMR to facilitate the early detection of myocardial infiltrative damage.
OSTEO18, a novel urinary proteomic signature, associated with osteoporosis in heart transplant recipients
Authors: Yu Y L , Huang Q F , An D W , Raad J , Martens D S , Latosinska A , Stolarz-Skrzypek K , Van Cleemput J , Feng Y Q , Mischak H , Allegaert K , Verhamme P , Janssens S , Nawrot T S , Staessen J A
Published: October 2024

Background

Immunosuppressive treatment in heart transplant (HTx) recipient causes osteoporosis. The urinary proteomic profile (UPP) includes peptide fragments derived from the bone extracellular matrix.

Purpose

Study aims were to develop and validate a multidimensional UPP biomarker for osteoporosis in HTx patients from single sequenced urinary peptides identifying the parent proteins.

Methods

A single-center HTx cohort was analyzed. Urine samples were measured by capillary electrophoresis coupled with mass spectrometry. Cases with osteoporosis and matching controls were randomly selected from all available 389 patients. In derivation case-control dataset, 1576 sequenced peptides detectable in ≥30% of patients. Applying statistical analysis on these, an 18-peptide multidimensional osteoporosis UPP biomarker (OSTEO18) was generated by support vector modeling. The 2 replication datasets included 118 and 94 patients. For further validation, the whole cohort was analyzed. Statistical methods included logistic regression and receiver operating characteristic curve (ROC) analysis.

Results

In derivation dataset, the AUC, sensitivity and specificity of OSTEO18 were 0.83 (95% CI: 0.76-0.90), 74.3% and 87.1%, respectively. In replication datasets, results were confirmatory. In the whole cohort (154 osteoporotic patients [39.6%]), the ORs for osteoporosis increased (p < 0.0001) across OSTEO18 quartiles from 0.39 (95% CI: 0.25-0.61) to 3.14 (2.08-4.75). With full adjustment for known osteoporosis risk factors, OSTEO18 improved AUC from 0.708 to 0.786 (p = 0.0003) for OSTEO18 categorized (optimized threshold: 0.095) and to 0.784 (p = 0.0004) for OSTEO18 as continuously distributed classifier.

Conclusion

OSTEO18 is a clinically meaningful novel biomarker indicative of osteoporosis in HTx recipients and is being certified as in-vitro diagnostic.
ABO blood groups and platelet reactivity in patients with coronary artery disease undergoing percutaneous coronary intervention treated with clopidogrel
Authors: Liu M L , Li J W , Yan K L , Yuan J Q , Zhao X Y
Published: October 2024

Background

The association between ABO blood groups and the risk of thrombosis and bleeding in patients with coronary artery disease has been of interest for many years, but the mechanisms are not fully understood.

Aim

To investigate the relationship between the ABO blood groups and the platelet reactivity in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) treated with clopidogrel.

Methods

We examined 10,724 consecutive PCI patients in China from January 2013 to December 2013.Among them, 6,740 patients had the results of thromborlastogram (TEG) and the ABO blood groups. Low on-treatment platelet reactivity (LTPR) was defined as adenosine diphosphate-induced platelet maximum amplitude of TEG<31mm.

Results

A total of 6,740 PCI patients (mean age, 58.23±10.27; male, 77.6%) treated with clopidogrel were finally enrolled for analysis. There were 2560 (37.98%) patients in LTPR group. In this group, the multivariate logistic regression showed that the blood group A (OR: 0.885, 95%CI 0.789-0.993, p=0.038) was independent protective factor in the A/non-A model (model 1). Then, we further divided the non-A groups into B, O, AB groups to set the model 2. In model 2, compared to A, multivariate logistic regression showed that only the blood group B (OR: 1.157, 95%CI 1.015-1.320, p=0.030) was independent risk predictors for LTPR, representing a higher risk of bleeding.

Conclusions

In the large sample real-world study, we reported the relationship between ABO blood groups and platelet reactivityin PCI patients treated with clopidogrel for the first time. Blood group A was an independent protective factor for LTPR, representing a lower risk of bleeding, whereas blood group B was an independent risk factor for LTPR, representing a higher risk of bleeding. These results provide an interesting perspective on blood groups and individualized antithrombotic therapy in patients with coronary artery disease, and further elucidation of the mechanisms is still needed in the future.
Novel insights of phenylalanine in Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD) and cardiovascular complications
Authors: Liu J , Chen Y , Qian J , Cui R , Demirkan A , Zheng Y
Published: October 2024

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) is linked to cardiovascular risk, necessitating an exploration of potential metabolic contributors, such as amino acids. While amino acids are implicated in metabolic disorders, their specific relationship with MASLD and subsequent cardiovascular complications is not well-defined. We aimed to delineate the association between circulating amino acids and MASLD, identifying amino acids that could potentially link MASLD to cardiovascular issues.

Methods

Utilizing UK Biobank data, we tested the association of ten amino acids with MASLD in a cohort of 72,626 MASLD cases and 128,102 controls. Afterwards, we performed Mendelian Randomization (MR) using genome-wide association study (GWAS) data from 8,434 MASLD cases and 770,180 controls, and GWAS of amino acids including 115,052 participants from UK Biobank. Multiple MR methods, including MR-Egger, Cochran's Q-test, and MR-PRESSO, were applied to assess pleiotropy and heterogeneity. Survival analysis in MASLD patients assessed the link between significant amino acid and incident severe cardiovascular outcomes, including stroke, heart failure, myocardial infarction, and mortality, using three different covariate combinations: Model 1 included age, sex, and fasting time; Model 2 included in addition smoking, alcohol use, education, physical activity, and Model 3 included body mass index (BMI) in addition to model 2.

Results

Nine out of the ten amino acids were statistically significantly associated with MASLD across all three models (p<6.25×10^-3). Among them valine, leucine, isoleucine, total branched-chain amino acids, tyrosine, alanine, and phenylalanine were positively associated with MASLD, while glutamine and glycine were negatively associated with MASLD. The genetic predisposition of MASLD was significantly associated with increased phenylalanine (beta=0.05, p=4.0×10^-4) and tyrosine (beta=0.15, p=2.0×10^-3), suggesting that alterations in these amino acids may result from the progression of MASLD. We also detected heterogeneity (Cochran’s Q-test: p=8.4×10^-9) and pleiotropy (MR-Egger: p=0.02) for tyrosine, but not for phenylalanine. Furthermore, phenylalanine levels in MASLD patients were significantly (p<6.25×10^-3) associated with the incidence of heart failure, stroke, and mortality, but not with myocardial infarction across all three models. We did not identify a significant association between baseline tyrosine levels and any cardiovascular complications or mortality across the three models (Figure 1).

Conclusion

Our findings indicate a strong association between certain amino acids and MASLD, with phenylalanine, in particular, emerging as a potential mediator of cardiovascular risk in MASLD patients. The absence of heterogeneity and pleiotropy for phenylalanine strengthens its candidacy as a biomarker for future cardiovascular complications in MASLD.
Prognostic implications of right and left atrial strain in diabetes mellitus without coronary artery diseases
Authors: Matshela M R
Published: October 2024

Background

2D- speckle-tracking echocardiography (2D-STE) has recently be used to assess subclinical myocardial dysfunction, however its utility in diabetes mellitus (DM) has been specifically focusing on the longitudinal systolic function of the left ventricle (LV).

Aim

To assess the prognostic relation between left (LA) and right (RA) systolic and diastolic strain parameters with clinical outcome in patients with DM.

Methods

Of the initial 1721 diabetic patients screened for this study only 502 consecutive patients with DM were eligible and retrospectively enrolled, and 2D-STE strain parameters assessed on the 2D-TTE images. All patients were prospectively followed for development of new outcome/cardiac events which included hospitalization for acute HF, CVS-related death, new onset AF/AFI, stroke, heart transplantation, or need for ventricular assist device implantation. The 2D-STE analysis was used to measure the peak LA (longitudinal, radial and circumferential) and RA (longitudinal) strain. The long-term outcomes were evaluated for all-cause CVS outcomes and recurrent hospitalization.

Results

For the 502 eligible patients [mean age:58±4; 58 % male sex], 221 reached the combined endpoint. Mean follow-up was 1.1±0.6years. Both LA and RA strain parameters were significantly impaired compared to normal standard references (p<.0001), the RA was more impaired than LA strain parameters. The best performance parameters predictive of CVS (combined outcomes) events were for LA>RA systolic and diastolic strain, global RA systolic and diastolic strain (AUC: 0.74 and 70) and global LA longitudinal systolic and diastolic strain (AUC: 0.86 and 0.77). The strongest association between the degree of atrial myocardial mechanical dysfunction and risk of cardiovascular events was more evident for LA strain (free wall > global strain) and lesser extend to RA strain. More myocardial mechanical strain impairments were demonstrated in those with higher left atrial volume index (LAVI), NYHA ≥II class, significantly impaired diastolic function, lower strain values (LA, LV, RV), and tricuspid annular plane systolic excursion (TAPSE), p<.001). The LA (free wall) strain impairment was the independent predictors of combined outcome (including survival) after multiple adjustments using different models.

Conclusion

Patients with DM, LA strain parameters are stronger predictors of outcome than RA and other conventional parameters and should be included for regular clinical screening DM patients as these parameters provide a stronger prognostic stratification.
Cardiovascular prevention with GLP1 agonists in high or very-high cardiovascular risk irrespective of diabetes
Authors: Del-Cuerpo-Salinas N , Cazorla-Morallon D , Perez-Ferrandiz A , Lopez-Ayala J M , Claramunt-Bayarri A M , Bodi-Beneito C , Monteagudo-Viana M , Frutos-Garcia M A
Published: October 2024

Introduction

Patients with established cardiovascular disease have an increased risk of stroke and myocardial infarction, even in the absence of atrial fibrillation. Several trials have analyzed the effect of glucagon-like peptide-1 receptor (GLP1) agonists in patients with high cardiovascular risk and lately this effect has been studied even in the absence of diabetes.

Methods

A meta-analysis of randomized clinical trials (RCT) comparing GLP1 agonists with placebo was performed. The primary objective of the study was to analyze the composite endpoint of cardiovascular death, non-fatal myocardial infarction and non-fatal stroke (MACE). As secondary objectives, cardiovascular death, non-fatal myocardial infarction and non-fatal stroke have been studied separately. The meta-analysis was performed using the inverse variance method, using the fixed effects model when there was no heterogeneity and the random effects model when heterogeneity is significant. In the case of significant heterogeneity in the primary objective, a stratified analysis with exposure time have been performed to explain this outcome.

Results

A sum of 9 randomized controlled trials were included where a GLP1 agonist such as albiglutide, dulaglutide, exenatide, liraglutide, lixinatide or semaglutide was compared with placebo. 77684 patients were incorporated, while 39497 were treated with a GLP1 agonist. The mean age was of 63.7 years (SD ± 1.97 years), 60080 (77.3%) suffered from diabetes and 60552 (77.9%) from cardiovascular disease.

As showed in figure 1, the GLP1 agonists showed a reduction of 13% of the MACE (RR: 0.87, 95% CI 0.81-0.92; p<0.001). Heterogeneity could be explained by exposure time and concentration in the blood, considering that it disappears within each group when applying this condition.

Treatment with GLP1 agonist also reduced cardiovascular death by 12% (RR: 0.88, 95% CI 0.82-0.94; p<0.001), non-fatal strokes by 14% (RR: 0.86, 95%CI 0.79-0.95; p<0.001) and non-fatal miocardial infarction by 13% (RR: 0.87, 95% CI 0.78-0.97; p<0.001).

Conclusion

Treatment with a GLP1 agonist reduced the incidence of the MACE by 13% and cardiovascular death by 12%, as well as it decreased the incidence of nonfatal stroke by 14% and of nonfatal myocardial infarction by 13% in different RCTs involving patients with high or very-high cardiovascular risk with or without diabetes.
Estimated pulse wave velocity as a forefront indicator of developing metabolic syndrome
Authors: Kim H J , Kim B S , Shin J H
Published: October 2024

Background

The predictive value of estimated pulse wave velocity (ePWV) for the development of metabolic syndrome has not been extensively explored.

Purpose

This study aims to fill this gap by evaluating ePWV as a potential predictor for the development of metabolic syndrome in middle-aged adults.

Methods

Using prospective multi-center cohort database, participants aged between 40 and 69 years without metabolic syndrome at baseline were studied (enrolled from June 2001 to January 2003 and provided follow-up information spanning up to 18 years). ePWV was calculated using specific equations based on age and blood pressure. The primary outcome was the incidence of metabolic syndrome during a median follow-up period of 15.6 years (187 months).

Results

Of the 6,186 participants analyzed, 2,726 (44.1%) developed metabolic syndrome during the follow-up period. ePWV values were categorized into tertiles to assess their predictive value for the development of metabolic syndrome. An ePWV cut-off of 7.407 m/s was identified as a predictor of metabolic syndrome development, with a sensitivity of 0.743 and a specificity of 0.464 (Figure 1). Participants exceeding this cut-off, especially those in the third tertile (8.77–14.63 m/s), had a notably higher risk of developing metabolic syndrome. Specifically, the third tertile exhibited a 52.8% cumulative incidence compared with 30.8% in the first tertile as illustrated by Kaplan–Meier curves (Figure 2). After adjustments, participants exceeding the ePWV cut-off had a 1.425-fold increased independent risk of developing metabolic syndrome (HR, 1.425; 95% confidence interval [CI], 1.281–1.585). Furthermore, those in the third tertile showed an even higher risk with an HR of 1.530 (95% CI, 1.330–1.761) compared to first tertile, even after adjusting for multiple variables.

Conclusions

ePWV is a significant predictor of the development of metabolic syndrome. This finding underscores the potential of ePWV as a cardiometabolic risk assessment tool and can thus provide useful information for primary and primordial prevention strategies.Figure 1Figure 2
Parallel improvement of arterial stiffness with weight loss following intensification of antidiabetic treatment
Authors: Stampouloglou P , Bletsa E , Oikonomou E , Katsarou O , Tsigkou V , Ikonomidis I , Korakas E , Lambadiari V , Tentolouris N , Tousoulis D , Siasos G
Published: October 2024

Background

Arterial stiffness is a marker that can flag increased cardiovascular disease risk in patients with type 2 Diabetes Mellitus (T2DM), while weight management plays a crucial role for the management of glycemic control and prevention of complications in these patients.

Purpose

To investigate the effects of novel antidiabetic agents on arterial stiffness in T2DM patients as well as potential associations with their weight status before and after treatment.

Patients and Methods

We enrolled 118 consecutive patients under stable antidiabetic therapy. According to their physician they start treatment with an additional antidiabetic agent; either dipeptidyl peptidase-4 inhibitor (DPP-4i, n=19), or glucagon like peptide-1 receptor agonist (GLP-1RA, n=50) or sodium/glucose cotransporter-2 inhibitor (SGLT-2i, n=49). Body Mass Index (BMI) along with carotid-femoral pulse wave velocity (PWV) as a biomarker of arterial stiffness were measured at baseline and 3 months after treatment intensification.

Results

There were no differences between the study groups regarding their sex, age and other traditional risk factors or the values of PWV and BMI at baselined (p=NS for all). All groups achieved better glycemic control in terms of HbA1c values between baseline and follow-up; from 7.4±1.2% to 7.4±1.2% in the DPP4i group (p<0.001 for all), from 8.6±0.7% to 6.7±0.8% in the GLP-1RA group (p=0.07) and from 7.7±1.1% to 6.7±0.7% in the SGLT-2i group (p<0.001). PWV showed a decrease from 10.6±2.7 to 9.0±1.6 m/sec (p=0.001) in the DPP4-i group, from 11.2±2.5 to 9.3±2.2 m/sec (p<0.001) in the GLP-1RA group and from 10.7±2.4 to 8.9±2.0 m/sec (p=0.001) in the SGLT-2i group as presented in Figure 1. Regarding BMI, a reduction in the values between groups from baseline to follow-up was also observed; from 27.4±5.3 to 26.1±5.0 kg/m2 for the DPP-4i group, from 33.6±4.9 to 31.5±4.6 kg/m2 for the GLP-1RA group, from 31.8±5.5 to 30.5±5.6 kg/m2 for the SGLT-2i group (p<0.001 for all). Moreover, in the entire study population there was significant correlation between PWV and BMI improvement following treatment initiation (rho=0.247, p=0.007) (Figure 2).

Conclusion

Diabetes mellitus treatment intensification with GLP1-RA or SGLT-2i or DPP4i, ameliorated arteriosclerosis, improved PWV and BMI while there is significant association between BMI and PWV improvement.Changes in PWV values among the groupsCorrelation between deltaBMI & deltaPWV
Environmental noise exposure is associated with one-year survival after a first myocardial infarction
Authors: Plomb M , Bernard N , Maza M , Pujol S , Diallo K , Chague F , Cottin Y , Mauny F , Zeller M
Published: October 2024

Introduction

Although several studies have shown a link between environmental noise exposure and risk of acute Myocardial Infarction (MI), only few studies have investigated its association with prognosis after MI. We aimed was to analyze the relationship between residential environmental noise exposure and one-year prognosis after a first MI.

Methods

This observational, longitudinal study was conducted from data collected by a French observatory (RICO) from 2004 to 2009. The outcome was defined by Major Adverse Cardiovascular Events (MACE). Medical data were collected from patients hospitalized for an acute MI from patients registered in the database between January 1st, 2004, and December 31st, 2008, with the following criteria: first MI, aged 18 years or older, with a valid home address and residing in a French urban unit, and who survived at least 28 days after the acute MI were included in the present study. Environmental noise and air pollutants exposure were considered at the residence of the patients. Noise exposure was quantified for two time periods: daily (LAeq,24h) and at night (Lnight) with an annual average. Two outdoor air pollutants were considered: nitrogen dioxide (NO2) and particulate matter with an aerodynamic diameter ≤ 10 µm (PM10). Air pollution exposure levels within the 30 days preceding a major cardiac event (MACE) were estimated. MACE were defined as cardiac death, re-hospitalisation for heart failure, recurrent MI, emergency revascularization, stroke, angina and or unstable angina

Results

Among the 864 subjects included, most were male (64%), the median age was at 69 y. Nineteen percent (N = 164) presented a MACE during the one year follow-up, and the most frequent were cardiac death (32%). For each 10 dB(A) increase during Lnight , the hazard ratio (HR) of MACE was 1.25 (95% IC 1.09 to 1.43), independently of air pollutants and other confounding. This effect was modified by age and gender. Conclusion and relevance: Our findings suggest for the first time a strong association between noise exposure, in particular during the night, and prognosis at one year after a first MI. If confirmed by larger prospective studies, our study could help to identify original opportunities for environment-based secondary prevention strategies.
Fear of recurrence and its association with mental health outcomes after spontaneous coronary artery dissection (SCAD)
Authors: Clarke S , Murphy B , Le Grande M , Rogerson M , Hesselson S , Iismaa S , Graham R , Hester R , Jackson A
Published: October 2024

Background

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction, predominantly affecting younger women with few traditional cardiac risk factors. The condition is characterised by relatively high rates of recurrence. Recent qualitative studies demonstrate that SCAD survivors often experience fears about the future, particularly relating to SCAD recurrence and death. Research in psycho-oncology demonstrates that experiencing fear of cancer recurrence predicts worse outcomes for mental health and quality of life, an association that is also likely in cardiac patients. To date, no quantitative research has investigated fear of recurrence and its association with mental health in SCAD survivors.

Purpose

The aim of this study was to investigate the prevalence of fears relating to SCAD recurrence and the association of fear of recurrence with mental health outcomes.

Methods

293 SCAD survivors completed an online questionnaire assessing the psychosocial impacts of SCAD. Participants rated whether they experienced these impacts ‘not at all’, ‘a small amount, ‘a moderate amount’ or ‘a large amount’ within the first six months of their SCAD. Items related to fears about the future, recurrence, and death were extracted for analysis. Participants also completed measures of anxiety (Generalised Anxiety Disorder-7), depression (Patient Health Questionnaire-9), distress (Cardiac Distress Inventory - Short Form), and mental health related quality of life (Short Form 12, mental health component).

Results

In the six months following their SCAD, 97.6% of survivors experienced some level of worry about having another SCAD, 95.6% were concerned about triggering another SCAD, 95.6% experienced fear of the future, and 82.6% experienced fear of dying. Reports of experiencing ‘a large amount’ of fear in these areas were 54.6%, 45.1%, 42.7%, and 30.4% respectively. The amount of worry reported about having another SCAD was significantly associated with increased levels of anxiety, depression, and cardiac distress, and reduced mental health quality of life.

Conclusions

Almost all SCAD survivors reported fears, worries, and concerns related to recurrence. Worry about SCAD recurrence was significantly associated with important mental health outcomes. Cardiac health professionals should monitor fears of recurrence in their patients, as a large amount of worry may be indicative of poor mental health, and referral to psychology services may be appropriate.Rates of fears of SCAD recurrence
Prognostic value of diffuse high-risk plaque in patients with acute myocardial infarction: a three-vessel optical coherence tomography study
Authors: Fang C , Zhao J W , Chen Y Z , Cui L N , Guo J Q , Wang Y N , Hou J B , Dai J N , Yu B
Published: October 2024

Background

Existing evidence has identified that high-risk plaque (HRP) characterized by a thin-cap fibroatheroma and/or a minimal lumen area ≤ 3.5 mm² were indicative of future cardiovascular events. Diffuse coronary artery disease also contributes to the poor prognosis.

Purpose

The present study aims to assess the prognostic value of diffuse HRP in patients with acute myocardial infarction (AMI) by using three-vessel optical coherence tomography (OCT).

Methods

A total of 674 patients with AMI who underwent OCT examination of three major epicardial arteries between January 2017 and December 2018 were consecutively studied. Among 2843 nonculprit lesions detected by OCT, 1375 (48.4%) HRPs were identified and divided into diffuse HRP group (lesion length >20mm, n=443) and focal HRP group (lesion length ≤20mm, n=932). Patients were followed up for a median period of 5 years. Major adverse cardiovascular event (MACE) was defined as the composite of cardiac death, nonculprit lesion-related nonfatal myocardial infarction, and unplanned coronary revascularization.

Results

The average age of all enrolled patients is 56.7±11.4 years, with 74.9% of male. As compared with focal HRP group, diffuse HRP group had longer lesion length [25.8(23.0,30.8) mm vs. 13.2(9.8,16.1) mm, P<0.001], longer lipid length [18.6(12.3,24.9) mm vs. 7.0(4.5,10.5) mm, P<0.001], and thinner minimal fibrous cap thickness [73.3(53.3,106.7) μm vs. 93.3(60.0,130.0) μm, P<0.001], whereas mean lipid arc was comparable between the two groups. The prevalence of nonculprit plaque rupture (14.2% vs. 7.8%, P<0.001) was significantly higher in diffuse HRP group than that in the focal HRP group. Nonculprit lesions in diffuse HRP group had higher incidence of macrophage accumulation, microvessels, cholesterol crystals, calcification, and layered plaque phenotype than those in focal HRP group (all P<0.001). The incidence of nonculprit lesion-related MACE was 4.7% in diffuse HRP group and 1.7% in focal HRP group [HR: 3.155, 95% confidence interval: 1.579 to 6.301, P=0.002].

Conclusions

In patients with AMI, diffuse HRP at nonculprit segment has higher levels of plaque vulnerability and is predictive of future adverse cardiovascular events. Further studies are warranted to investigate the individual treatment strategy of diffuse and focal HRP.Figure 1.Nonculprit plaque vulnerabilityFigure 2.MACE
Frailty and anticoagulant prescription in older hospitalized patients with atrial fibrillation: a multi-centred observational study
Authors: Nguyen T , Fujita K , Hilmer S
Published: October 2024

Background

Evidence of the impact of frailty on anticoagulant prescription in older people with atrial fibrillation (AF) is conflicting. Some studies suggested that oral anticoagulants (OACs) were underutilized in older people with frailty while others have not found this.

Aims

The primary aim of this study was to examine the prevalence of frailty in hospitalized older patients with AF and the association between frailty and OAC prescription during admission. The secondary aim was to examine the association between frailty and prescription of rate/rhythm control medications during admission.

Methods

This is a retrospective observational cohort study. Adults aged ≥65 years with AF admitted to six hospitals in Australia between 1 June 2022 and 31 August 2022 were eligible for this study. Frailty was defined by a Frailty Index constructed using information from the electronic medical records. Logistic regression models were applied to examine the association between frailty and the prescriptions of OACs, rate control drugs and rhythm control drugs during admission. Results are presented as odds ratios and 95% confidence intervals.

Results

A total of 685 patients were included in this analysis. They had a mean age of 82.6, and 49.8% were female. Using the cut-off point of 0.25, 42.8% of the patients were identified as being frail. Overall, 75.6% of the patients were prescribed OACs (67.9% in the frail compared to 81.4% in the non-frail, p<0.001), 37.7% received rate control drugs (42.0% in the frail versus 34.4% in the non-frail, p=0.044), while 27.3% received rhythm control drugs (22.9% in the frail compared to 30.6% in the non-frail, p=0.024). The adjusted odds ratios of frailty on prescriptions during admission were 0.53 (95%CI 0.37 – 0.78) for OACs, 1.45 (95%CI 1.05 – 1.99) for rate control drugs, and 0.79 (95%CI 0.55 – 1.13) for rhythm control drugs.

Conclusion

Our study found a high prevalence of frailty in older inpatients with AF and frailty was associated with a reduced likelihood of receiving OACs. Further studies are needed to understand the reasons for under-coagulation in frail patients with AF.Prescriptions of OACs during admission