bluuebunny/crossref_metadata_2025 huggingface dataset:
P3114Protective effect of SOCS1-based therapy in experimental abdominal aortic aneurysm
Authors: Bernal Uribe S , Lopez-Sanz L , Melgar A , La-Manna S , Jimenez-Castilla L , Prieto I , Martin-Ventura J L , Blanco-Colio L , Gomez-Guerrero C
Published: October 2019

Introduction

Abdominal aortic aneurysm (AAA) is a multifactorial vascular disease characterized by chronic inflammation, oxidative stress and proteolytic activity in the aortic wall, which contribute to extracellular matrix degradation and aortic dilation. Altered expression and activation of Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway have been implicated in several cardiovascular diseases including atherosclerosis and aneurysm formation. Suppressors of cytokine signaling (SOCS) are key negative regulators of JAK/STAT pathway and have been considered an attractive target for therapeutic intervention.

AIM

We hypothesize that SOCS1 protein could influence AAA development by inhibiting JAK activity and, consequently, STAT activation and target gene expression. Therefore, this study investigates the effect of a SOCS1-derived synthetic peptide in a rodent model of AAA and in cultured vascular smooth muscle cells (VSMC).

Methods

Experimental AAA was induced in C57BL/6 mice (males, 12 weeks old) by transient elastase perfusion of the aorta. Mice were randomly divided into control (vehicle, i.p.) and treatment (SOCS1 peptide, 3 mg/kg/day, i.p.) groups. Fourteen days after AAA induction, mice were sacrificed, and aorta segments were collected for histology (n=10/group) and mRNA and protein expression analysis (n=8/group).

Results

Compared to the AAA control group, SOCS1-treated mice exhibited a significant decrease in aortic diameter (68±6% vs. control; p<0.005) and aortic wall thickness, (67±3% vs. control; p<0.001). Histological analyses of aortic tissues showed a higher content of VSMC (α-actin) along with reduced leukocyte infiltration (macrophages, neutrophils and T-cells) and oxidative stress markers (superoxide anion and 8-hydroxyguanosine) in SOCS1-treated mice. SOCS1 therapy also attenuated the gene expression of inflammatory cytokines (CCL2, CCL5, TNF, IFNγ) and matrix metalloproteinases (MMP2, MMP9) in aortic lesions, and altered the expression levels of macrophage M1 (ArgII, iNOS) and M2 (ArgI, CD206) polarization markers. In vitro experiments in murine VSMC revealed that SOCS1 peptide prevented the expression of cytokines and chemokines induced by non-toxic dose of elastase (5 ug/ml, 24 hours). Effects of SOCS1 treatment were accompanied by a reduction in STAT1 and STAT3 phosphorylation and gene expression, both in AAA lesions and cultured VSMC.

Conclusion

Our results suggest that SOCS1 peptide presents protective effects in experimental AAA by suppressing JAK/STAT pathway-mediated inflammation.

Acknowledgement/Funding

MINECO-FEDER (SAF2015-63696-R), ISCII (FIS-FEDER PI17/01495), Spanish Society of Arteriosclerosis.
P3129Rheumatic heart diseases screening in Bornean Malaysia: a pilot echocardiography study
Authors: Foo J H , Chong W L , Azizan Bin Abdullah M O H D , Yen C H , Liew S F , Chu C M , Ma K F , Ng K C , Liew H B
Published: October 2019

Background

Rheumatic heart disease is a major public health issue in developing countries including Malaysia. RHD is a preventable disease. Early detection and appropriate treatment may decrease the disease burden to the society. Rheumatic heart disease screening using portable echocardiography may improve early detection among school children in vulnerable community. This is a pilot study of rheumatic heart disease screening using Vscan among primary school students in the Bornean state of Sabah Malaysia.

Purpose

To evaluate the resources required for RHD screening, prevalence of RHD among school children and awareness among the parents and teachers.

Methods

A cohort of 211 students from a primary school were recruited in 2017–2018. Parental consents were obtained. Seven sessions were conducted at the school. Echocardiography was performed by 2–3 experienced ultrasonographers. Image interpretation as per the 2012 WHF RHD echocardiographic diagnostic criteria.

Results

Of the 211 students, 50% female, age range 7–12 year-old. Ethnic groups include Kadazandusun (87%), Rungus (2.4%), Lundayeh (2%), Chinese (2%). Overall, the average number of student scanned was 4.6 students/device/hour. There was a learning curve observed, whereby initial session only scanned 2 students/device/hour which improved to a maximum of 5.9 students/device/hour. Preliminary findings noted probable RHD among 36% (n=76) of screened subjects. Incidental diagnosis of congenital heart disease among 5 students. The suspected RHD cases were referred for formal echocardiography in the tertiary centre for confirmation. Thus far, 12 students were diagnosed with borderline RHD; the main diagnostic criteria in these cases were at least two morphological features of RHD of the MV without pathological MR or MS. Secondary prophylaxis with antibiotic, dental hygiene and patient education were given.

Conclusion

This is a pilot RHD screening using portable Vscan echocardiography among primary school students in Malaysia. Our study showed it is feasible to conduct RHD screening in the field using portable Vscan. The number of students screened improved with practice. Our preliminary finding suggest RHD is prevalent in this population in Sabah, Malaysia.
P3134Variations in anterior mitral valve leaflet restriction that may lead to the erroneous diagnosis of rheumatic heart disease
Authors: Hunter L D , Monaghan M J , Lloyd G , Snyman H W , Pecoraro A J K , Doubell A F , Herbst P G
Published: October 2019

Introduction

Anterior mitral valve leaflet (AMVL) restriction is a prominent morphological feature of rheumatic heart disease (RHD). The World Heart Federation (WHF) criteria for echocardiographic diagnosis of RHD rely on the use of colloquial terms such as “dog-leg” to define AMVL restriction rather than a strict, reproducible definition. We recognise AMVL restriction when the tip of the leaflet is seen to point away from the interventricular septum and towards the posterior left ventricular (LV) wall at peak diastole in the parasternal long axis (PSLAX) view. This definition however risks inclusion of a finding commonly identified in our high-risk screening program (Echo in Africa- EIA) which demonstrates gradual AMVL bowing (so-called “slow-bow”) from the proximal to mid-leaflet but with free motion ('fluttering') of the tip during diastole. This is in contrast to RHD-related restriction which typically involves the distal AMVL tip only. We propose that the former is a normal variant of the AMVL and is unrelated to the RHD process, provided no concomitant morphological features of RHD are identified.

Purpose

Determine the prevalence of “slow-bow” AMVL restriction between two cohorts of schoolchildren with a documented high-and low-RHD prevalence.

Methods

Retrospective analysis of EIA data obtained from children (aged 13–18) attending two separate South African schools. The high-RHD prevalence school (HR) demonstrated a 0.8% rate of WHF “definite RHD”. The low-RHD prevalence school (LR) demonstrated no cases of WHF “definite RHD”. Cases of AMVL restriction were identified and classified according to the definitions provided above.

Results

A total of 941 screening studies (HR cohort n=577 /LR cohort n=364) were evaluated. 74 cases of AMVL restriction (12.82%, 95%, CI 10.34–15.80) were identified in the HR cohort of which 8 cases demonstrated AMVL-tip restriction (1.39%, 95%, CI 0.70–2.71) and 65 cases demonstrated “slow bow” (11.27%, 95%, CI 8.94–14.11). There were no cases of AMVL-tip restriction observed in the LR-cohort and 35 cases of “slow-bow”(9.62%, 95%, CI 7–13.08).

A. “Slow bow”; B. “Distal tip restriction”.

Conclusion

Our results support the hypothesis that “slow-bow” AMVL restriction is a common variant of the AMVL amongst South African school children and unrelated to the RHD process. Further research is required to investigate the exact mechanism underlying this form of AMVL restriction.

Acknowledgement/Funding

Edwards Lifescience EHM grant
P3137Transvenous lead extraction in patients under 30 years of age results from two high volume European centers
Authors: Jachec W , Polewczyk A , Segreti L , Bongiorni M G , Kutarski A
Published: October 2019

Background

Young patients are a specific group undergoing transvenous leads extraction (TLE) procedures due to different anatomy, intensive connecting tissue scar and earlier calcification.

Aim

Evaluation of results of TLE in young patients compared to adults above 30 years old

Examined Groups and Methods: 3810 patients (mean age at the time of procedure; 65,21±15,84 years old, 1301 female) who underwent TLE procedures in two high volume experienced European centers (Poland and Italy). We compared clinical and procedural factors in two groups of patients: under the age of 30 (n=172) and between 30 and 80 (n=3054) with exclusion 584 patients above 80 years old.

Results

Results are presented in Table 1.

A: p<0,05, AA; p<0,01, AAA; p<0,001, NS

Conclusion

Infective indications are less frequent in very young people. In spite of presence of simple systems in this patients the effectiveness of TLE remains lower- with documented lower rate of procedural and clinical success Young age does not influence on the appearance of major complications and procedure related death, however, the frequency of technical problems is increased due to necessity of extraction older, strongly ingrown, calcified leads. TLE in young patients is usually a big challenge and should be performed by the most experienced operators in high volume centers.
P3391Cholesterol crystals in culprit coronary artery with acute myocardial infarction and their relation to myocardial salvage
Authors: Nunohiro T , Kuwasaki S , Fukushima T , Furudono S , Suenaga H , Takeshita S , Nakashima H
Published: October 2019

The involvement of cholesterol crystals (CCs) in plaque progression and destabilization of atherosclerotic plaques has been recently recognized. However, little is known about CCs and myocardial salvage in the Acute myocardial infarction (AMI) patients. This study aimed to evaluate the association between the existence of CCs at the site of culprit coronary artery and myocardial salvage index (MSI).To investigate, we applied the diagnostic resources of Optical Coherence Tomography (OCT).

Methods

This study included 53 AMI patients (90% with STEMI) who underwent primary PCI within 24h of onset. 53 STEMI patients underwent magnetic resonance imaging (CMR) of 5th days and 3 months after PCI. Infarct size was measured on delayed-enhancement imaging, and area at risk was quantified on T2-weighted imaging. MSI was calculated as [area at risk − infarct size] × 100/area at risk. 3 months CMR with contrast-enhanced imaging of late gadolinium enhancement-LGE. Patients were divided 2 groups according to the existence of CCs at the site of culprit coronary artery.

Results

CCs occurs in 26 of 53 (49%). Acute 5th days risk area (13.5±4.1 vs 12.6±4.9, P=0.48) and 3months infarct size (5.3±3.5 vs 7.0±3.2, P=0.066) were not significant between CCs and no CCs group. But salvage index were significantly lower in patients with CCs group (47.7±17.5% vs 60.1±20.2%, P=0.021)

Conclusion

Salvage index in patients that CCs were found by the OCT analysis, remain low after AMI. This study demonstrates the potential correlation between the myocardial salvage and vulnerable morphological features of culprit lesion to the presence of CCs with AMI patients.
P3395Arrival time at hyperemia of below the ankle as a determinant factor for limb salvage: evaluation by 2 dimension perfusion angiography
Authors: Ikeoka K , Watanabe T , Shinoda Y , Inui H , Fukuoka H , Ueno K , Hoshida S
Published: October 2019

Background

In patients with critical limb ischemia, it is desirable to obtain enough skin perfusion pressure (SPP) levels through revascularization. 2D-perfusion angiography is an emerging technology for the quantification of tissue perfusion consisted of 6 parameters calculated by time-density curve of digital subtraction angiography (DSA).

Purpose

We evaluated the feasibility of 2D-perfusion angiography for below the knee (BTK) endovascular therapy (EVT). We aimed to clarify which angiographical parameters of lower limb are related to SPP after EVT.

Methods

Consecutive 33 limbs (mean age 74.5 years, men 55%), which successfully underwent EVT for isolated BTK lesions, were enrolled in this study. We excluded Rutherford 6 limbs with severe gangrene or tissue loss, consequently 26 limbs were Rutherford 4 or 5 critical limb ischemia. We treated total 47 lesions, including 26 chronic total occlusive lesions. 5Fr guiding sheath was advanced to popliteal artery. DSA images were obtained by mechanical contrast infusion. We quantified indexed blood flow on below the ankle area by using 2D-perfusion angiography, and examined 6 parameters [arrival time (AT), time to peak (TTP), wash-in rate, width, area under the curve and mean transit time (MTT)] from acquired DSA. Hyperemia was induced by 20mg papaverine intra-arterial infusion through the guiding sheath.

Results

The parameters except wash-in rate were significantly shortened after hyperemia induced by intra-arterial papaverine infusion below the ankle region. Dorsal and plantar SPP were significantly correlated with hyperemic AT, hyperemic wash-in rate and AT ratio (hyperemic/rest) of lower ankle regions after EVT. However, only AT ratio was independently associated with dorsal SPP in multivariate analysis (P=0.032). A receiver operating characteristic curve showed hyperemic AT <4.5 seconds and AT ratio <0.49 predicted to obtain SPP levels >50 mmHg after EVT with the area under the curve of 0.71 (95% confidence interval, 0.52–0.90) and 0.73 (95% confidence interval, 0.55–0.90), respectively.

Representative Case of 2D-perfusion

Conclusion

Hyperemic AT <4.5 seconds and AT ratio <0.49 of lower ankle regions may be essential to obtain the sufficient levels of SPP for limb salvage after BTK intervention. 2D perfusion angiography technique at hyperemic condition is feasible and has the potential to monitor lower limb tissue perfusion through EVT and to optimize the interventional treatment.
P3406Validation of atherothrombotic risk score for secondary prevention in patients with acute myocardial infarction: the J-MINUET study
Authors: Hashimoto T , Ako J , Nakao K , Ozaki Y , Kimura K , Noguchi T , Suwa S , Fujimoto K , Nakama Y , Morita T , Shimizu W , Saito Y , Hirohata A , Ogawa H , Ishihara M
Published: October 2019

Background

Thrombolysis in Myocardial Infarction (TIMI) Risk Score for Secondary Prevention and CREDO-Kyoto Thrombotic Risk Score are contemporary secondary prevention risk scoring systems. However, these scoring systems have not been validated in other populations.

Purpose

The aim of this study was to validate of the TIMI Risk Score for Secondary Prevention and CREDO-Kyoto Thrombotic Risk Score in patients in the early phase of acute myocardial infarction (AMI).

Methods

The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective multicenter registry conducted in 28 Japanese medical institutions. We enrolled 3,283 consecutive patients with AMI who were admitted to participating institutions within 48 hours of symptom onset between July 2012 and May 2014. Among them, 3,070 patients were included in this study after excluding 213 patients who died in the hospital. Clinical follow-up data were obtained up to 3 years. The primary endpoint was a composite of all-cause death, non-fatal MI and non-fatal stroke. The patients were stratified by the TIMI Risk Score for Secondary Prevention and CREDO-Kyoto Thrombotic Risk Score.

Results

At the 3-year follow-up, the primary endpoint had occurred in 337 patients (11.0%). All-cause death, non-fatal MI and non-fatal stroke had occurred in 177 (5.8%), 80 (2.6%) and 80 (2.6%) patients, respectively. TIMI Risk Score for Secondary Prevention and CREDO-Kyoto Thrombotic Risk Score showed a graded association with the composite of all-cause death, non-fatal MI and non-fatal stroke at 3 years in the J-MINUET population (Figure).

Validation of atherothrombotic risk

Conclusions

TIMI Risk Score for Secondary Prevention and CREDO-Kyoto Thrombotic Risk Score were shown to be applicable to the patients in the early phase of AMI.
P3411Prevalence and risk factors of multifocal cardiovascular calcification in patients at high cardiovascular risk
Authors: Van 'T Klooster C C , Nathoe H M , Leiner T , Hjortnaes J , Bots M L , Isgum I , Lessmann N , Van Der Graaf Y , Visseren F L J
Published: October 2019

Background

Cardiovascular calcification is associated with a higher risk for cardiovascular disease (CVD). The pathophysiology of calcium deposition is different for arteries and heart valves, and is not yet completely understood.

Purpose

The aim of the present study is to determine the prevalence of coronary artery calcification (CAC), thoracic aorta calcification (TAC) (including ascending aorta, aortic arch, and descending aorta), mitral annulus calcification (MAC), and aortic valve calcification (AVC), and to compare the associations with predetermined cardiovascular risk factors, in patients at high cardiovascular risk.

Methods

Computed tomography imaging was performed in 645 patients with stable CVD or marked risk factors, visualizing heart and thoracic aorta. Prevalence of site-specific and multifocal calcification was determined. To quantify the association of risk factors with cardiovascular calcification per location, ordinal regression analyses were performed. 99% confidence intervals were estimated to account for multiple testing.

Results

Prevalence of CAC, TAC, MAC, and AVC was 82%, 65%, 13%, and 48% respectively. Patients with MAC were most likely to have calcification in other locations simultaneously (Table 1). Age was associated with calcification in all locations (lowest OR 2.18; 99%CI 1.58–3.05 for ascending aorta calcification), and number of packyears with vascular calcification (lowest OR 1.26; 99%CI 1.03–1.54 for CAC). Diabetes mellitus and systolic blood pressure were associated with TAC, whereas waist circumference and male sex were determinants of CAC (Figure 1).

Prevalence of calcification per site Coronary artery calcification (CAC) Mitral annulus calcification (MAC) Aortic valve calcification (AVC) Thoracic aorta calcification (TAC) N=524 N=83 N=306 par N=415 No calcification in other locations (%) 103 (20%) 1 (1%) 7 (2%) 27 (7%) CAC (%) NA 77 (93%) 286 (94%) 373 (90%) MAC (%) 77 (15%) NA 67 (22%) 76 (18%) AVC (%) 286 (55%) 67 (81%) NA 256 (62%) TAC (%) 373 (72%) 76 (92%) 256 (84%) NA Prevalence of calcification is shown for patients with presence of CAC, MAC, AVC, or TAC. For example; 103 (20%) of the patients with CAC have no calcification in other studied locations, and 77 (15%) of the patients with CAC have MAC as well.

Determinants of calcification per site

Conclusion

Arterial and heart valve calcifications are generally multifocal in a population at high vascular risk. Age was the only consistent risk factor. Differences in association with cardiovascular risk factors imply limited influence of atherosclerotic pathways in heart valve calcification compared to vascular calcification, and suggest more pronounced tunica media involvement in TAC than in CAC.
P3422Contrasting the risk for atherosclerotic cardiovascular disease events among individuals with lower extremity peripheral artery disease, coronary heart disease and cerebrovascular disease
Authors: Hubbard D , Colantonio L D , Rosenson R S , Brown T M , Jackson E A , Dai Y , Mues K E , Woodward M , Muntner P M , Farkouh M E
Published: October 2019

Background

Having more vascular conditions, including coronary heart disease (CHD), cerebrovascular disease and lower extremity artery disease (LEAD), may increase the risk for atherosclerosis cardiovascular disease (ASCVD) events. Specific vascular conditions may increase the ASCVD event rate more than others.

Purpose

To compare the risk for future ASCVD events associated with the number and type of vascular conditions among adults with a history of CHD, cerebrovascular disease and/or LEAD.

Methods

We analyzed data from US adults ≥19 years of age with commercial or Medicare health insurance who had a history of CHD, cerebrovascular disease and/or LEAD as of December 31, 2014 (N=901,391). Individuals were followed through December 31, 2016 (median follow-up: 2 years) for ASCVD events, including myocardial infarction, coronary revascularization, stroke, carotid revascularization and lower extremity amputation or revascularization.

Results

Among individuals included in the current analysis (mean age 63 years, 45% female), 70%, 23% and 7% had 1, 2 and 3 vascular conditions, respectively. After adjustment for sociodemographic and cardiovascular risk factors, the hazard ratio for ASCVD among individuals with 2 and 3 versus 1 vascular conditions was 1.88 (1.85, 1.92) and 2.93 (2.86, 3.00), respectively. Among individuals with 1 vascular condition, the rate of ASCVD events per 1,000 person-years was 46.5 (95% CI 44.1, 49.0), 29.6 (95% CI 29.0, 30.1) and 19.9 (95% CI 19.2, 20.8) for those with LEAD, CHD and cerebrovascular disease, respectively. The multivariable-adjusted hazard ratio (95% CI) for ASCVD events comparing individuals with LEAD only and CHD only versus those with cerebrovascular disease only was 1.84 (1.77, 1.92) and 1.12 (1.08, 1.16), respectively. Among individuals with 2 vascular conditions, the ASCVD event rate per 1,000 person-years was higher in those with LEAD and CHD (122.0, 95% CI 112.5, 132.2) and with LEAD and cerebrovascular disease (92.4, 95% CI 79.9, 106.4), versus those with CHD and cerebrovascular disease (59.1, 95% CI 54.8, 63.6). The multivariable-adjusted hazard ratio (95% CI) comparing individuals with LEAD and CHD and those with LEAD and cerebrovascular disease versus those with CHD and cerebrovascular disease was 1.48 (1.44, 1.53) and 1.49 (1.41, 1.58), respectively.

Conclusion

Among adults with vascular disease, having LEAD confers a higher risk for future ASCVD events than CHD or cerebrovascular disease and this group may benefit from more intensive risk reduction treatment.

Acknowledgement/Funding

Amgen Inc.
P3423The contribution of genetics to premature CAD through different degrees of lifestyle factors: a matter of relative significance?
Authors: Sousa J , Mendonca M , Pereira A , Mendonca F , Neto M , Monteiro J , Sousa A C , Rodrigues M , Henriques E , Guerra G , Borges S , Ornelas I , Drumond A , Palma Dos Reis R
Published: October 2019

Introduction

Coronary artery disease (CAD) is a multifactorial process with substantial genetic contribution. However, genetic predisposition among patients with a different number of lifestyle factors and premature CAD, remains a complex and thoroughly unexplored topic.

Objective

To evaluate, in a young population, the importance of conventional risk factors as well as of a genetic risk score in the appearance of CAD.

Methods

A case-control study was conducted with 1075 patients from the GENEMACOR study population, under 50 years-old (555 cases, 86.8% male, mean age 44.1±4.9 years and 520 controls, 86.2% male, mean age 44.3±4.8 years). Univariate analysis addressed the association of different modifiable risk factors with premature CAD. Genetic risk score (GRS) was computed comprising 33 genetic risk variants in a multiplicative method. GRS was evaluated according to the number of traditional risk factors and risk for premature CAD was estimated and its independent predictive value estimated by logistic regression.

Results

72.6% of patients had ≥3 risk factors vs 31.2% of controls (p<0.0001). In comparison with having no risk factors (rf), patients with 1 rf had an OR of 2.79 (1.19–6.53; p=0.015), patients with 2 risk factors had a OR of 6.87 (3.03–15–57, p<0.0001) and patients with 3 modifiable risk factors had a OR of 24.17 (10.87–53.73, p<0.0001) – graph 1. In this young population, mean GRS level was consistently higher among patients with coronary artery disease comparing with a healthy population (0.6±0.6 vs 0.4±0.4, p<0.0001, respectively) – graph 2. GRS in multivariate analysis, proved to be an independent predictor for premature CAD (OR 1.71, CI95% 1.25–2.34, p=0.001).

Conclusion

In our population, GRS was an independent predictor for premature CAD. In young patients with ≥3 risk factors, genetics play a less decisive role in the development of CAD. Even in young patients, modifiable risk factors should be addressed aggressively as they may represent a higher burden than genetic predisposition itself.
P3429A novel prediction model for mortality after cardiac surgery using institutional case volume
Authors: Lee S , Park J B , Cho Y J , Ryu H G , Jang E J
Published: October 2019

Purpose

A number of risk prediction models have been developed to identify short term mortality after cardiovascular surgery. Most models include patient characteristics, laboratory data, and type of surgery, but no consideration for the amount of surgical experience. With numerous reports on the impact of case volume on patient outcome after high risk procedures, we attempted to develop a risk prediction models for in-hospital and 1-year mortality that takes institutional case volume into account.

Methods

We identified adult patients who underwent cardiac surgery from January 2008 to December 2017 from the National Health Insurance Service (NHIS) database by searching for patients with procedure codes of coronary artery bypass grafting, valve surgery, and surgery on thoracic aorta during the hospitalization. Study subjects were randomly assigned to either the derivation cohort or the validation cohort. In-hospital mortality and 1-year mortality data were collected using the NHIS database. Risk prediction models were developed from the derivation cohort using Cox proportional hazards regression. The prediction performances of models were evaluated in the validation cohort.

Results

The models developed in this study demonstrated fair discrimination for derivation cohort (N=22,004, c-statistics, 0.75 for in-hospital mortality; 0.73 for 1-year mortality) and acceptable calibration in the validation cohort. (N=22,003, Hosmer-Lemeshow χ2-test, P=0.08 and 0.16, respectively). Case volume was the key factor of mortality prediction models after cardiac surgery. (50≤ x <100 case per year. 100≤ x <200 case per year, ≥200 case per year are correlated with OR 3.29, 2.49, 1.85 in in-hospital mortality, 2.76, 1.99, 1.69 in 1-year mortality respectively, P value <0.001.)

Annual case volume as risk factor Variables In-hospital mortality 1-year mortality OR (95% CI) p-value OR (95% CI) p-value Annual case-volume (reference: ≥200) – – 100–200 1.69 (1.48, 1.93) <0.001 1.85 (1.58, 2.18) <0.001 50–100 1.99 (1.75, 2.25) <0.001 2.49 (2.15, 2.89) <0.001 <50 2.76 (2.44, 3.11) <0.001 3.29 (2.85, 3.79) <0.001 OR: Odds ratio; CI: confidence interval; Ref: Reference.

Discrimination and calibration

Conclusion

We developed and validated new risk prediction models for in-hospital and 1-year mortality after cardiac surgery using the NHIS database. These models may provide useful guides to predict mortality risks of patients with basic information and without laboratory findings.
P3438Malaria infection and risk of incident heart failure: a nationwide cohort study
Authors: Brainin P , Mohr G H , Modin D , Claggett B , Silvestre O M , Shah A , Hviid L , Pedersen C T , Kober L , Solomon S , Schou M , Gislason G H , Biering-Sorensen T
Published: October 2019

Background

Malaria is a parasitic mosquito-borne infection which affects more than 219 million people worldwide each year. Recent studies have hypothesized that malaria may contribute to functional and structural changes in the myocardium, which can lead to cardiovascular disease. We therefore investigated the risk of heart failure (HF) and other cardiovascular events in individuals with a prior history of malaria infection.

Methods

Danish nationwide registries were used to identify patients with a history of malaria infection between January 1994 and January 2017. Patients with ischemic heart disease or HF at baseline were excluded. The population was sex and age matched with the general population in a ratio of 1:10. Information on cardiovascular risk factors and medication were assessed at time of the malaria diagnosis. Cox proportional hazards models, and a propensity score-matched model, were used to assess the risk of HF, myocardial infarction (MI) and cardiovascular death (CVD).

Results

A total of 3,570 malaria cases were identified (40% had plasmodium falciparum). The median age was 32 years and 57% were male. During a median follow-up time of 11 years [interquartile range 5, 17], 52 cases experienced incident HF (1.5%), 30 MI (0.9%) and 58 suffered from CVD (1.6%). In unadjusted survival analyses, malaria cases had a significantly increased risk of HF (HR 1.34 95% CI 1.01–1.79, P=0.046) but not MI (HR 0.72 95% CI 0.51–1.03, P=0.073) or CVD (HR 1.14 95% CI 0.87–1.49, P=0.34). In multivariable models adjusted for hypertension, diabetes, chronic kidney disease, vascular disease and concomitant pharmacotherapy (lipid lowering/antianginal/diuretics/betablocker), the association with HF remained significant (HR 1.40 95% CI 1.05–1.87, P=0.023). A propensity score-matched model based on 7,152 individuals (1:1 of cases and controls) also yielded a significant association with HF (HR 1.59 95% CI 1.03–2.46, P=0.036).

Forest plot: Malaria and CV events

Conclusion

Our data indicate that individuals with a prior history of a malaria infection may have an increased risk of incident HF but not MI or CVD. This suggests that malaria, on a hypothesis-generating basis, may affect long-term cardiac function.
P3439Causes of death in patients with chronic myocardial injury
Authors: Roos A , Kadesjo E , Sartipy U , Holzmann M J
Published: October 2019

Background/Introduction

Persistently elevated high-sensitivity cardiac troponin T (hs-cTnT) levels above the 99th percentile value indicate ongoing chronic myocardial injury which is associated with a high risk of death, heart failure, and myocardial infarction. No prior studies have thoroughly investigated the causes of death in patients with chronic myocardial injury.

Purpose

To investigate causes of death in patients with chronic myocardial injury.

Methods

In a cohort of 19,460 consecutive patients with chest pain and stable hs-cTnT levels measured concurrently from 2011 to 2014 at the Karolinska university hospital, of whom 1528 (7.9%) had myocardial injury, we included all patients who died during a mean follow-up of 4.0±1.3 years. Incidence rates for cause-specific deaths were calculated within following categories of hs-cTnT levels: <5, 5–9, 10–14, 15–29, 30–49, and ≥50 ng/l. Logistic regression was used to estimate adjusted odds ratios (OR) with 95% confidence intervals (CI) for the association between hs-cTnT levels and the relation between cardiovascular (CV) and non-cardiovascular (non-cardiovascular) causes of death, for patients with hs-cTnT levels of 5–14, and >14 ng/l, respectively using patients with hs-cTnT levels <5 ng/l as referent.

Results

In total, 1577 patients (8.1%) were included, of whom 684 (43%) had chronic myocardial injury (i.e. hs-cTnT >14 ng/l). Higher hs-cTnT levels were associated with higher age at baseline and at death, male sex, kidney dysfunction and comorbidities. The yearly cardiovascular and non-cardiovascular death rates increased with increasing hs-cTnT levels from 0.07% and 0.4% (<5 ng/l), to 17% and 15% (≥50 ng/l), respectively. Corresponding rates for cancer death increased from 0.6% to 4.0%. The proportion of cardiovascular versus non-cardiovascular deaths increased with hs-cTnT levels (figure). Patients with hs-cTnT levels 5–14 ng/l were 87% more likely to die from cardiovascular causes compared with patients with hs-cTnT <5 ng/l (adjusted OR: 1.87, 95% CI: 1.24–2.80), while the risk was doubled in those with chronic myocardial injury (adjusted OR: 2.02, 95% CI: 1.29–3.15). The proportion of patients suffering from cardiovascular death increased with age in both women and men.

Causes of Death

Conclusions

We found a gradual increase in the risk of cardiovascular death with increasing hs-cTnT levels, already below the 99th percentile value. Patients with chronic myocardial injury were twice as likely to die from cardiovascular causes compared with patients with undetectable troponin levels, with almost half of the patients dying cardiovascular death. Chronic myocardial injury is associated with a high risk of cardiovascular death.

Acknowledgement/Funding

None
P3450Aortic stiffness is significantly associated with left ventricular mass in females but not in males: insights from the CORINTHIA study
Authors: Papaioannou T , Oikonomou E , Lazaros G , Christoforatou E , Vogiatzi G , Tsalamandris S , Chasikidis C , Kalambogias A , Mystakidi V.-X , Galiatsatos N , Santouri M , Latsios G , Deftereos S , Tousoulis D
Published: October 2019

Introduction

Arterial stiffening may contribute to the increase of left ventricular mass (LVM) and the development of left ventricular hypertrophy (LVH). Although male gender has been also found to be an independent determinant of LVH, it is unknown if the adverse effect of increased aortic stiffening on LVM differs between males and females.

Aim

To evaluate the association of aortic stiffness as assessed by carotid-to-femoral pulse wave velocity (cf-PWV) with LVM and LVH in a general population and compare these associations between males and females.

Methods

Demographic, laboratory and clinical data of 1686 subjects (693 males and 993 females) from the cross-sectional, observational study “Corinthia” were analyzed. All subjects underwent applanation tonometry and pulse wave analysis for the measurement of cf-PWV and echocardiography examination for the computation of LVM which was adjusted by body surface area providing the LVM index (LVMI). Multivariate linear regression analysis was performed for the determination of independent factors related with LVMI. Receiver operator curve analysis (ROC) was used to compare the ability of cf-PWV to predict LVH, in males and females separately.

Results

In the female population, significant and independent determinants of LVMI were: age (beta=0.243, p<0.001), urea (beta=0.119, p=0.001), hypertension (beta=0.089, p=0.028) and cf-PWV (beta=0.096, p=0.021). In contrast, in the male population, LVMI was independently related with age (beta=0.242, p<0.001), systolic blood pressure (beta=0.095, p=0.027), LDL (beta=-0.087, p=0.047) and creatinine (beta=0.092, p=0.031). ROC analysis showed that cf-PWV is a stronger predictor of LVH in females than in males (figure).

Conclusion

Increased aortic stiffness measured by cf-PWV is significantly related with increased LVMI regardless from age and other risk factors only in females. Moreover cf-PWV was a stronger predictor of left-ventricular hypertrophy in females than males. These findings should be further explored in prospective studies.
P3454Myocardial reverse remodeling occurs to a comparable extent in male and female aortic-banded rats following pressure unloading
Authors: Ruppert M , Korkmaz-Icoz S , Loganathan S , Olah A , Sayour A A , Barta B A , Merkely B , Karck M , Szabo G , Radovits T
Published: October 2019

Background

Sex differences have been intensely investigated during the development of pressure overload (PO; e.g. aortic stenosis, arterial hypertension)-induced left ventricular (LV) myocardial hypertrophy (LVH). However, it is less clear whether sex-related differences also affect the regression of pathological LVH after pressure unloading.

Purpose

Therefore, we investigated the potential influential effect of sex on myocardial reverse remodeling in a relevant rat model of banding and debanding of the abdominal aorta.

Methods

PO of the left ventricle was induced in male (M) and female (F) rats by abdominal aortic banding (AB) for 6 or 12 weeks. Sham operated animals served as controls. Pressure unloading was evoked by removing the aortic constriction at week 6 (debanded). Serial echocardiography was performed to detect temporal alterations in LV morphology and geometry. Furthermore, distinct aspects of LV systolic and diastolic function were assessed by pressure-volume analysis. Structural changes, such as cardiomyocyte hypertrophy and interstitial fibrosis were measured on histological sections. Fetal gene expression (a molecular marker of pathological LVH) was analyzed by quantitative real-time PCR.

Results

In both male and female AB rats, PO induced the development of marked LVH as confirmed by increased LV mass, heart weight-to-tibial length ratio (HW/TL [g/cm]: 0.47±0.01 AB-M vs. 0.36±0.01 Sham-M, p<0.05; 0.36±0.02 AB-F vs. 0.26±0.01 Sham-F, p<0.05) and cardiomyocyte diameter. Similarly, reactivation of fetal gene expression (indicated by increased atrial natriuretic peptide [ANP]) and enhanced interstitial collagen accumulation was also observed in male and female AB groups as well. The extent of myocardial hypertrophy was greater among female AB animals, while fibrosis was more severe in male AB rats. In both genders, LVH was associated with prolonged ventricular relaxation (active relaxation time constant, Tau [ms]: 19.6±0.8 AB-M vs. 13.1±0.4 Sham-M, p<0.05; 15.2±1.3 AB-F vs. 12.2±0.3 Sham-F, p<0.05). However, systolic function was impaired only in males (ejection fraction, [%]: 44.4±2.3 AB-M vs. 57.5±2.1 Sham-M, p<0.05; 49.7±2.2 AB-F vs. 53.4±1.7 Sham-F, n.s.). Contrary to the sex-dependent differences during the development of LVH, removing the aortic constriction resulted in a comparable degree of reverse remodeling on the morphological (decreased LV mass, HW/TL), histological (decreased CD and interstitial fibrosis), molecular (reduced ANP expression) and functional (recovered ejection fraction and Tau) levels in both male and female rats.

Conclusion

Pressure unloading at a relatively early time point leads to myocardial reverse remodeling to a comparable degree in male and female rats.

Acknowledgement/Funding

NVKP-16-1-2016-0017; ÚNKP-18-3-I-SE-9
P3459Research Network in Africa (RNA): gender differences in cardiovascular risk factors and complications in 12 African countries
Authors: Diop I B , Antignac M , Nhavoto C , Sidy Ali A , Balde D , Empana J P , Dzudie A , Thiam S , Cavagna P , Adoubi A , Perier M C , Takombe J L , Ikama M S , Houenassi M D , Jouven X
Published: October 2019

Background

Cardiovascular diseases are rapidly growing epidemic in Sub-Saharan Africa. Unlike other regions of the world, death rates due to hypertension are greater for women than men in Africa. Scarce data were available on factors associated with gender in cardiovascular risk factors and complications in Sub-Saharan Africa.

Purpose

To assess gender differences in cardiovascular risk factors pattern in patients with hypertension in 12 Sub-Saharan countries.

Methods

We conducted a cross-sectional survey in urban clinics of twelve countries in Africa. Data were collected on demographics, treatment and standardized BP measures were made among the hypertensive patients attending the clinics. BP control was defined as BP<140/90 mmHg and hypertension grades were defined according to European Society of Cardiology guidelines. The separate association between women factors and BP control was investigated using Generalized Linear Mixed-Effects Models adjusted on age; A random effect on the country was added (generalized estimated equation models) to account for inter-country variability.

Results

The EIGHT study enrolled 2198 patients with hypertension in 12 sub-Saharan countries between January 2014 and November 2015. The proportion of women (60,2%) was higher than men and varied significantly according to countries (p<0.001), ranged from 33.7% (Guinea) to 71.9% (Gabon). Mean age was 57.7±12.0 years for women and 59.2±11.4 years for men (p<0.001).

Compared to men, women had a higher rate of family cardiovascular background (79% vs 70%, for women and men respectively) (p<0.0001), cardiovascular risk factors (74.3% vs 68.1) (p=0.008), such as obesity (25.8% vs 12.1%) (p<0.0001), sedentary behavior (42.1% vs 35.0%) (p=0,006). BP control didn't differ according to gender, the repartition of grades of hypertension was similar between women and men and proportion of uncontrolled BP was 77.2% in women and 77.8% in men (p=0.4), with same proportion of women and men receiving antihypertensive treatment (96 vs 97.5%) (NS).

However, African women had less cardiovascular complications than men (39% vs 52.4%) (p<0.0001) (OR: 0.50 [CI 95% 0.41–0.61]).

Conclusions

Our study highlighted gender differences in cardiovascular risk factors pattern in Sub-Saharan hypertensive patients. Tailoring medical (public health) programs to improve cardiovascular disease prevention that take into women characteristics may enhance their effectiveness.
P3461Sex-specific pattern of left ventricular hypertrophy and diastolic function in patients with type 2 diabetes mellitus
Authors: Wu M Z , Chen Y , Yu Y J , Tse H F , Yiu K H
Published: October 2019

Background

Few prospective studies have evaluated sex-specific pattern, natural progression of left ventricular (LV) remodeling and diastolic dysfunction in patients with type 2 diabetes (T2DM).

Purpose

The aim of this study was to study the sex-specific prevalence, longitudinal changes of LV remodeling and diastolic dysfunction in patients with T2DM. Further the prognostic value of diastolic function in women and men was also evaluated.

Methods

A total of 386 patients with T2DM (mean age 61±11 years; women, 48.2%) was recruited. Detailed echocardiography was performed and LV geometry, systolic and diastolic function were measured at baseline and follow-up. A major adverse cardiovascular event (MACE) was defined as cardiovascular death, heart failure hospitalization or myocardial infarction. Multivariable cox-regression adjusted for age, hypertension, LVEF and HbA1c was used to assess the association between sex-specific diastolic function and the development of a MACE.

Results

Despite a similar age, prevalence of hypertension and body mass index, women had a higher prevalence of LV hypertrophy and diastolic dysfunction at baseline and follow-up compared with men. A total of 26 patients developed a MACE (4 cardiovascular death, 14 hospitalization for heart failure, 8 myocardial infarction) during follow-up. Women with diastolic dysfunction had a higher incidence of MACE than those with normal diastolic function but this association was neutral in men. Multivariable Cox-regression analysis indicated that diastolic dysfunction was associated with MACE in women (hazard ratio 6.35, 95% confidence interval 1.18–34.19, P<0.05) but not men (hazard ratio 1.85, 95% confidence interval 0.58–5.92, P=0.30).

Conclusions

LV hypertrophy and diastolic dysfunction, both at baseline and follow-up, were more common in women than men. Pre-clinical diastolic dysfunction was independently associated with MACE only in women with T2DM but was neutral in men.
P3463Cardiometabolic risk factors in women with a history of hypertensive disorders of pregnancy
Authors: Chulkov V , Tarasova O , Vereina N , Chulkov V L , Sinitsin S
Published: October 2019

Introduction

A history of hypertensive disorders of pregnancy (HDP) has the unique potential to identify women at higher risk of future maternal cardiovascular disease (CVD), for whom targeted risk-reduction interventions may be particularly helpful.

Purpose

The aim of the study was to assess the factors and biomarkers of cardiometabolic risk in women with a history of hypertensive disorders of pregnancy.

Methods

Cross-sectional study of risk factors and biomarkers of cardiometabolic risk among young women with a history of HDP in comparison with normotensive patients during pregnancy. 117 women were studied: gr. 1 – 33 with a history of HDP, 40 [40–43] years; gr. 2 – 44 without a history of HDP, 39 [32–43] years. The control group consisted of 40 patients, 25 [23–28] years. The time interval after delivery was on average 5 to 19 years. We measured serum glucose, insulin, HOMA-IR, lipids, leptin, adiponectin. Left ventricular mass index (LVMI) was estimated by TTE. Data are presented as M±SD and Me (Q25–Q75).

Results

Women with HDP more often had hypertension (n=27; 82%), obesity (n=20; 39%) and smoking (n=9; 27%), p1–2,3 <0.05. A higher plasma levels of glucose mmol/L (5.5±0.7 vs 5.2±0.6 and 5.1±0.5), leptin ng/ml (42 [30–50] vs 24 [13–32] and 19 [10–29]) and lower plasma levels of adiponectin were observed in gr.1 vs gr. 2 and controls. Mean value of LVMI (g/m2) was statistically higher in women with HDP vs. without HDP and controls (119.9±23.7 vs 85.9±15.2 and 77.6±11.3), p1–2,3 <0.05.

Conclusion

It is shown that in women with a history of HDP subsequent changes in carbohydrate and lipid metabolism in combination with arterial hypertension and abdominal obesity, which constitute a cluster of the metabolic syndrome, are revealed after careful examination. These changes are also accompanied by insulin resistance, hyperinsulinemia, adipokine imbalance and more pronounced target organ damage.
P3466Cardiac output in end-stage liver disease increases with the severity of liver dysfunction
Authors: Koshy A N , Cailes B , Gow P , Testro A , Sajeev J K , Han H , Ko J , Weinberg L , Lim H , Teh A , Farouque O
Published: October 2019

Background

End-stage liver disease is associated with significant systemic and haemodynamic alterations that affect cardiac function. Cirrhotic cardiomyopathy remains an ill-defined entity among cardiologists. Understanding the complex interplay between liver dysfunction and cardiac function can lead to a better understanding of the compensatory mechanisms of the heart in liver failure.

Purpose

To investigate whether severity of liver disease affects baseline cardiac output in a large contemporary cohort of patients undergoing liver transplant work-up.

Methods

Consecutive patients that underwent pre-liver transplant (LT) workup between 2010–2017 were included. All patients underwent a resting echocardiogram. Cardiac output (CO) was prospectively recorded at baseline by pulsed-wave Doppler examination of the left ventricular outflow tract from the apical window and systemic vascular resistance (SVR) was calculated as 80 x (mean arterial pressure (MAP)/CO). Severity of liver disease was characterized by the model of end-stage liver disease (MELD) and Child-Pugh scores.

Results

560 patients were included (mean age 57.5±7.7, 74.8% male). Mean MELD score was 19±7 and Child-Pugh Score was 9±3. There was an inverse linear relationship between the severity of liver disease by the MELD score and baseline SVR (rho 0.40, P<0.001). As SVR reduced, there was also a significant rise in baseline CO with a strong inverse correlation between the two variables (rho 0.86, p<0.001). There was a significant linear correlation between the severity of liver disease and baseline CO with both the scores (MELD Score rho 0.42, p<0.001; Child Pugh rho 0.44, p<0.001) (Figure).

Baseline CO in LT Patients by Severity

Conclusions

Baseline CO increased with the severity of liver dysfunction due to a reduced afterload. A higher resting CO may lead to patients encroaching on their cardiac reserve at rest. This provides a pathophysiological insight suggesting a limited role for beta-blockers, particularly in patients with advanced liver cirrhosis.