bluuebunny/crossref_metadata_2025 huggingface dataset:
P6157Indexed coronary volume - A potential novel low-dose CCTA derived predictor for cardiovascular events
Authors: Benetos G , Goncalves M , Von Felten E , Rampidis G , Clerc O , Benz D , Gebhard K , Fuchs T , Pazhenkottil A , Kaufmann P , Buechel R , Graeni C
Published: October 2019

Background

Coronary computed tomography angiography (CCTA) provides incremental prognostic information over traditional risk factors in patients with suspected coronary artery disease. However, little is known about the long-term predictive performance of CCTA-derived coronary volumes and mid-diastolic left ventricular (LV) mass.

Purpose

To assess long-term prognostic value of coronary volumes and mid-diastolic LV mass as novel potential imaging predictors derived from low-dose prospectively ECG-triggered CCTA.

Methods

Consecutive patients with suspected or known coronary artery disease, referred for low-dose CCTA, were included. Patients with previous revascularization were excluded. The following parameters were evaluated: calcium score, segment involvement score (SIS: 1 point for each coronary segment with presence of plaque), coronary volume, mid-diastolic LV mass and coronary volume indexed to LV mass. Major adverse cardiovascular events (MACE) were defined as all-cause death, non-fatal myocardial infarction and revascularization (PCI or CABG). The association between CCTA measures and the occurrence of events was quantified using cox regression hazard and Kaplan Meier analysis.

Results

A total of 147 consecutive patients were included in the study. Of them, 93 (63.3%) were male and 79 (53.7%) hat one or more traditional cardiovascular risk factors. There was a weak but statistical significant inverse correlation between indexed coronary volume and both calcium score (R=-0.3, p=0.01) and SIS (R=-0.24, p=0.005). After a median follow-up of 5.8 years 30 MACE occurred in 25 patients, including 3 deaths, 26 revascularizations and 1 non-fatal myocardial infarction. In univariate cox regression hazard analysis calcium score (HR=12.69, 95% CI 2.99–53.83, p<0.001), SIS (HR=1.66, 95% CI 1.43–1.94, p<0.001), LV mass (HR=1.02, 95% CI 1.01–1.03, p=0.007) and indexed coronary volume (HR=0.89, 95% 0.82–0.96, p=0.004) were associated with outcome. In multivariate analysis, indexed coronary volume, remained an independent predictor for MACE when adjusted for traditional risk factors and SIS (HR=0.93, 95% CI 0.87–1.00, p=0.05), while LV mass did not reach statistical significance (p=0.46). By ROC curve analysis, a value of 21.85 mm3/gr was defined as optimal cutoff for indexed coronary volume. In Kaplan Meier plots, patients with low indexed coronary volume (<21.85 mm3/gr) showed higher event rates (log rank p<0.001) compared to high indexed coronary volume (≥21.85 mm3/gr).

Conclusions

Indexed coronary volume, derived from low-dose CCTA, independently predicts cardiovascular events. Larger studies are mandated to confirm the predictive value of this potential new biomarker.
P6170Incremental value of on-site computed tomography-derived fractional flow reserve for the diagnosis and management strategy of obstructive coronary artery disease in the randomized CRESCENT trials
Authors: Nous F , Budde R , Lubbers M , Yamasaki Y , Musters P , Bruning T , Akkerhuis J , Kofflard M , Kietselaer B , Galema T , Nieman K
Published: October 2019

Background

Coronary computed tomography angiography (CCTA) accurately rules out coronary artery disease (CAD), but has a limited ability to predict hemodynamically significant CAD. Implementing on-site computed tomography-derived fractional flow reserve (CT-FFR) could improve the clinical value and efficiency of cardiac CT in the diagnostic work-up of patients with stable angina.

Purpose

To determine the impact of on-site CT-FFR on diagnostic effectiveness, management strategy and downstream invasive coronary angiography (ICA) in patients with suspected CAD.

Methods

196 patients (59.1±9.6 years, 47% women) with suspected CAD underwent a CCTA in the CRESCENT I and II trials. On-site CT-FFR analysis was performed in all patients with at least one ≥50% stenosis on CCTA (N=53). We assessed the effect of adding CT-FFR analysis to CCTA in terms of 1) diagnostic effectiveness, i.e. the number of additional tests required to determine the final diagnosis; 2) reclassification of the initial management strategy; 3) ICA efficiency, i.e. ICA rate without ≥50% CAD.

Results

CT-FFR was calculated in 42/53 (79%) of the eligible patients as it could not be calculated in patients with suspected coronary total occlusion (N=7), severe coronary calcification (N=2), severe CT artefacts (N=1) or missing CT images (N=1). CT-FFR ≤0.80 was present in 27/196 (14%) patients, including 8/196 (4%) patients with high-risk ischemia (CT-FFR ≤0.80 in all three vessels, left main or proximal left anterior descending coronary artery). The final diagnosis was achieved with CT-FFR in an additional 30/196 (15%) patients compared to CT alone (p<0.0001), and rendered 42/56 (75%) of additional tests unnecessary (p<0.0001). The initial management strategy was reclassified in 30/196 patients (15%, p<0.0001); 24/196 (12%) patients were reclassified to optimal medical therapy and 6/196 (3%) patients were reclassified directly to ICA including 4/8 (50%) patients with high-risk CAD on ICA. CT-FFR would result in 6/32 (19%, p=0.012) ICA cancellations in which none of the patients had high-risk CAD. The rate of ICA without ≥50% stenosis would decrease from 22% (7/32) to 11% (3/27) (p=0.012).

Conclusion

Implementation of CT-FFR has the potential for improved diagnostic effectiveness. Functional reclassification of CAD provides more efficient ICA referral in patients with suspected CAD compared to CTA alone.

Acknowledgement/Funding

Dutch Heart Foundation [NHS 2014T061 and NHS 2013T071]
P6173Plaque characteristics on coronary CT angiography in case of discordance between fractional flow reserve (FFR) and instantaneous wave-free ratio (IFR)
Authors: Aoshima C , Fujimoto S , Kawaguchi Y , Dohi T , Kato E , Takamura K , Kamo Y , Hiki M , Kato Y , Okai I , Okazaki S , Kumamaru K , Daida H
Published: October 2019

Background

The usefulness of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) evaluation has been confirmed in the determination of revascularization of coronary artery disease. When FFR≤0.8 and iFR≤0.89 were regarded as the criteria for positivity, the discordance was noted in approximately 20%, but this cause has not been well established.

Purpose

The purpose of this study was to investigate the patient background and features on coronary CT angiography (CCTA) showing the discordance between FFR≤0.8 and iFR≤0.89.

Methods

The subjects were consecutive 85 cases with 108 vessels in which stenosis of 30–90% was detected at one vessel of at least 2mm or more in the major epicardial vessels and FFR and iFR was performed within subsequent 90 days, among suspected cases of coronary arterial diseases which underwent CCTA. The factors showing the discordance between FFR and iFR (patient background, coronary artery calcification score, high risk plaque features on CCTA (positive remodeling, low attenuation plaque), plaque characteristics by a plaque analysis software using a new algorithm called labeling method (vessel volume, plaque volume, lumen volume, plaque length, maximum plaque burden, necrotic core area, fibrous area and calcium area) were evaluated using logistic regression analysis on per-patient and per-vessel basis.

Results

There were no significant both FFR and iFR positive definite factors on per-patient basis. The lumen volume/vessel volume (OR: 0.93, 95% CI: 0.88–0.98, P=0.0032) (OR: 0.90, 95% CI: 0.85–0.95, P<0.0001),minimum lumen area (MLA) (OR: 0.59, 95% CI: 0.41–0.85, P=0.0006) (OR: 0.64, 95% CI: 0.44–0.92, P=0.0047), the plaque volume/vessel volume (OR: 1.05, 95% CI: 1.01–1.10, P=0.0114) (OR: 1.09, 95% CI: 1.04–1.15, P=0.0002) and maximum plaque burden (OR: 1.08, 95% CI: 1.01–1.15, P=0.0095) (OR: 1.06, 95% CI: 1.00–1.13, P=0.0406) were significant both FFR and iFR positive definite factors on per-vessels basis. Discordance between FFR≤0.8 and iFR≤0.89 was observed in 23 vessels (21.3%) of 19 patients. In FFR positive and iFR negative group (15 vessels, 13.9%), positive remodeling (PR) (OR: 4.38, 95% CI: 1.13–17.00, P=0.0294) was only significant predictor. In FFR negative and iFR positive group, there was no significant predictors.

Conclusions

In both FFR and iFR, only lumen volume /vessel volume, MLA, plaque volume/vessel volume and plaque burden were significant positive definite factors. As for the discordance between FFR and iFR, PR is significant predictor in FFR positive and iFR negative group.
P6182Combination of a new iterative reconstruction technique with low tube voltage and high tube current has important role of detection of late enhancement on 320 slice CT
Authors: Goto H , Takaoka H , Sakai T , Ochi S , Wakabayashi S , Ishikawa K , Kanaeda T , Ueda M , Funabashi N , Sano K , Kobayashi Y
Published: October 2019

Background

New iterative reconstruction tecniques, including Adaptive Iterative Dose Reduction 3D (AIDR 3D) and Forward Projected Model-based Iterative Reconstruction SoluTion (FIRST), have been recently available on new generation 320 slice CT, and they can provide high-quality CT images.

Purpose

The aim of this study was to evaluate the diagnostic performance of detection of abnormal late enhancement (LE) in left ventricular (LV) myocardium (LVM) using 320-slice CT with new iterative reconstruction techiniques, AIDR 3D (Figure A) and FIRST (Figure B).

Methods

A total of 100 patients who were suspected of having various myocardial diseases and underwent late phase acquisition both on cardiac CT and CMR within 3 months were analyzed. The first 50 consecutive patients (Group 1) underwent 320-slice CT with AIDR 3D, 120 Kv tube voltage, 519±71 mA tube current. The next 50 consecutive patients (Group 2) underwent 320-slice CT with FIRST, 80 or 100Kv tube voltage, 803±20 mA tube current. We compared diagnostic accuracy of CT for detection of LE in LVM against that of CMR (the gold standard) in between the 2 groups.

Results

On patient-by-patient analysis, sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and overall accuracy for detection of LE on CT vs CMR were 87, 95, 96, 82, and 90% in Group 1, and 97, 83, 91, 88, and 90% in Group 2. There were no significant difference of diagnostic accuracy on patient-by-patient analysis in between the 2 groups (Figure C). However, on a segment-by-segment analysis (using 17 American Heart Association LV segment model), these values for detection of LE on CT vs CMR were 60, 95, 73, 91, and 88% in Group 1, and 85, 95, 86, 95, and 93% in Group 2. Sensitivity, PPV, NPV and overall accuracy were significantly higher in Group 2 than in Group 1 (all P<0.01) (Figure D).

Conclusions

Diagnostic accuracy of detection of LE in LVM on CT combining low tube voltage and high tube current acquisition on a new generation 320-slice CT with FIRST was superior to 320-slice CT with AIDR 3D.

Acknowledgement/Funding

TSUCHIYA MEMORIAL MEDICAL FOUNDATION
P6199Lipoprotein(a) and risk of chronic kidney disease among 4,235 Japanese hospitalized patients
Authors: Tada H , Yamagami K , Nishikawa T , Nohara A , Kawashiri M , Takamura M
Published: October 2019

Background

Lipoprotein (a) [Lp(a)] has been shown to be associated with the development of chronic kidney disease (CKD) among various ethnicities. In addition, recent Mendelian randomization studies have suggested that Lp(a) seems to be causally associated with CKD. However, few data exist regarding this issue among Japanese population.

Purpose

We aimed to investigate the association between serum Lp(a) and the CKD among Japanese population.

Methods

We retrospectively investigated 6,130 subjects whose serum Lp(a) had been measured for any reason (e.g. any operations which needs bed rest for a long duration, risk factors for atherosclerosis such as hypertension or diabetes) at our University Hospital from April 2004 to March 2014. We excluded 1,895 subjects due to the lack clinical data. We assessed their Lp(a), LDL cholesterol, HDL cholesterol, triglycerides, presence of hypertension, diabetes, chronic kidney disease, smoking, body mass index, presence of coronary artery disease (CAD), and presence of CKD (stage 3 or greater).

Results

When the study subjects were divided into 5 groups based on their CKD stage, there was a significant trend among their serum Lp(a) levels (P-trend = 2.7×10–13). Under these conditions, multiple regression analysis showed that Lp(a) was significantly associated with CKD [odds ratio (OR): 1.12, 95% confidence interval (CI): 1.08–1.17; p=1.3×10–7: per 10mg/dL)., independent of other classical risk factors, including age, gender, body mass index, hypertension, diabetes, smoking, LDL cholesterol and triglycerides. Under these conditions, Lp(a) was significantly associated with CAD [OR: 1.11, 95% CI: 1.06–1.16; p=1.7×10–6: per 10mg/dL), independent of the presence of CKD.

Conclusion

Serum Lp(a) was associated with the development of CKD independent of other classical risk factors among Japanese population as well.
P6205Increase in EPA/AA Ratio Predicts Improvement in Endothelial Function in Purified Eicosapentaenoic Acid-Treated Patients
Authors: Fukumoto K , Takemoto Y , Yoshikawa J , Norioka N , Iguchi T , Yoshiyama M , Shuto T
Published: October 2019

Background

Omega-3 polyunsaturated fatty acids (n-3 PUFAs) are well-known for preventing cardiovascular disease. Among n-3 PUFAs, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) play key roles in preventing cardiovascular diseases. However, the effects of n-3 PUFAs have been examined under conditions of simultaneous administration of EPA and DHA in the majority of clinical investigations and the effect of purified EPA is still controversial. EPA has been reported to improve endothelial dysfunction. Although several mechanisms underlying the effects of EPA on endothelial function have been demonstrated such as the modulation of lipid metabolism including increases in high-density lipoprotein (HDL) and/or decreases in triglyceride (TG) levels, decreases in cytokine production, and inhibition of inflammatory processes, the main mechanisms ameliorating endothelial function have not been fully determined.

Purpose

We sought to clarify the main factors associated with EPA administration that led to improved endothelial function.

Methods

Fifty-one consecutive patients with hypertriglyceridemia (mean ± SD age, 60±13 years) with no evidence of coronary artery disease (CAD) were prospectively enrolled and administered purified EPA (1800 mg/day). Forty-eight patients who were not administered EPA were enrolled as age- and sex-matched controls. Clinical variables such as body mass index, HbA1c, fasting glucose level, HDL, low-density lipoprotein, TG, systolic blood pressure, diastolic blood pressure, heart rate, interleukin-6, baseline diameter of the brachial artery, intima-media thickness of the brachial artery, and flow-mediated dilation (FMD) were examined before and after 6 months of treatment. Univariate and multivariate regression analyses were performed to examine the associations between FMD changes and clinical variables.

Results

FMD was significantly improved from 4.16% ± 1.88% to 6.30% ± 2.24% (p<0.0001) in the EPA group. The change in FMD was positively correlated with the change in EPA/arachidonic acid (AA) ratio (r=0.34, p=0.014). The multivariate regression analysis showed that the change in EPA/AA ratio alone was significantly associated with the change in FMD (p=0.010).

Conclusions

EPA treatment improves endothelial dysfunction in patients with hypertriglyceridemia without evidence of CAD. The change in FMD was associated with the change in EPA/AA ratio alone. These finding suggest that a direct effect of EPA on the endothelium may be the predominant factor ameliorating endothelial function.

Acknowledgement/Funding

This study was supported, in part, by a Grant-in-Aid for Scientific Research from the Ministry of Education, Science and Culture of Japan (15K08649).
P6217Managed Care after Acute Myocardial Infarction (MC-AMI) reduces MACE by 45% in 3-month follow-up - results form Poland's National Health Fund program of post-MI care. A single center analysis
Authors: Kulach A , Wita K , Wita M , Wybraniec M , Wilkosz K , Polak M , Matla M , Maciejewski Ł , Skowerski T , Fluder J , Kalanska-Lukasik B , Gomulka S , Szydlo K
Published: October 2019

Background

Despite progress in the medical and interventional treatment of acute myocardial infarction (AMI) and low in-hospital mortality related to AMI, a post-discharge prognosis in MI survivors is still unacceptable. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawal) is a program introduced by Poland's National Health Fund aiming at comprehensive care for patients with AMI to improve long-term prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), outpatient follow-up, and prevention of SCD.

Aims

To assess the effect of MC-AMI on major adverse cardiovascular events (MACE) in a 3-month follow-up.

Methods

In this single-center, retrospective observational study we enrolled 1211 patients, and compared them to 1130 subjects in the control group. After 1:1 propensity score matching two groups of 529 subjects each were compared. Cox regression was performed to assess the effect of MC-AMI and other variables on MACE.

Results

MC-AMI has been proved to reduce MACE rate by 45% in a 3-month observation. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with the occurrence MACE at 3 months (HR 0.476, 95% CI 0.283–0.799, p<0.005). Besides, older age, male sex (HR 2.0), history of unstable angina (HR 3.15), peripheral artery disease (HR 2.17), peri-MI atrial fibrillation (HR 1.87) and diabetes (HR 1.5), were significantly associated with the primary endpoint.

Comparison of study endpoints between KO Total, n (%) MC-AMI group, n (%) Control Group, n (%) RR 95% CI NNT P n=1058 n=529 n=529 All-cause mortality 19 (1.8%) 7 (1.3%) 12 (2.3%) 0.583 0.232–1.470 105.8 0.247 Hospitalization for HF 31 (2.9%) 12 (2.3%) 19 (3.6%) 0.632 0.310–1.288 75.6 0.202 Myocardial infarction 25 (2.4%) 9 (1.7%) 16 (3.0%) 0.563 0.251–1.262 75.6 0.157 MACE 73 (6.9%) 26 (4.9%)# 47 (8.9%) 0.553 0.348–0.879 25.2 0.012 *Two-tailed Pearson's Chi-square test; MACE, Major Adverse Cardiovascular Events. #Number of patients with at least one MACE; in 2 patients 2 endpoints occurred. This explains why the total number of MACE is lower than the sum of all endpoints.

MC-AMI vs. control - MACE in 3 months up

Conclusions

MC-AMI is the first program of a comprehensive. Participation in MC-AMI – a first comprehensive in-hospital and post-discharge care for AMI patients for AMI patients improves prognosis and reduces MACE rate by 45% as soon as in 3 months.
P6218Greater burden of risk factors and need of cardiac rehabilitation in elderly patients with lower educational attainment
Authors: Kjesbu I , Mikkelsen N , Sibilitz K , Wilhelm M , Gil C P , Iliou M C , Zeymer U , Meindersma E P , Ardissino D , Van Der Velde A E , Van't Hof A W J , De Kluiver E P , Prescott E
Published: October 2019

Background

A socioeconomic gap in cardiac rehabilitation (CR) has been described in younger populations but whether this is also true in the ageing population is unknown.

Purpose

To describe if poorer education is a predictor for exercise capacity, comorbidity, lifestyle- and risk factors and medical treatment at baseline in CR in an elderly population.

Methods

The observational EU-CaRE study is a European prospective study with eight participating CR centers in seven countries (Denmark, France, Germany, the Netherlands, Italy, Spain and Switzerland). Patients aged 65 or older with CHD or valve surgery participating in CR were consecutively included. Educational attainment was divided into basic, intermediate and high

Results

A total of 1626 patients were included. Educational attainment differed across centers (p<0.001). The groups differed little regarding index event, comorbidity and medical treatment. However, patients with only basic education had more diabetes, higher BMI, less physical activity, lower exercise capacity and higher scores for depression (PHQ 9) and anxiety (GAD). Differences were not affected by adjustment for age, gender and country.

Demographics and risk factor control N=1626 High (N=388) Intermediate (N=788) Basic (N=460) p-value* DEMOGRAPHICS Age (yrs), median (IQR) 72 (68, 76) 71 (68, 75) 74 (70, 78) <0.001 Men 330 (86.8%) 603 (79.3%) 291 (67.4%) <0.001 RISK FACTORS p-value** LDL >1.8 mmol/l*** 255 (66.1%) 518 (66.8%) 293 (63.7%) 0.060 Systolic BP >140 mmHg 85 (22.0%) 179 (23.1%) 100 (21.7%) 0.601 Smoker 26 (6.8%) 80 (10.3%) 46 (10.0%) 0.214 Moderate exercise <4days/week 179 (46.4%) 340 (43.9%) 271 (58.9%) 0.024 BMI >27 kg/m2 133 (35.5%) 389 (50.2%) 255 (55.4%) <0.001 VO2 peak <80% of predicted 220 (57.0%) 443 (57.2%) 252 (54.8%) 0.037 HbA1c >48mmol/mol*** 115 (29.8%) 264 (34.1%) 230 (50.0%) <0.001 Diet score, mean (SD) 6.50 (2.28) 5.93 (2.47) 7.32 (2.35) <0.001 GAD score, median (IQR) 2.0 (0.0,4.0) 2.0 (0.0,5.0) 3.5 (0.0,7.0) 0.051 PHQ-9 score, median (IQR) 4.0 (1.0,7.0) 4.0 (1.0,7.0) 6.0 (2.0,10.0) 0.020 Abbreviations: IQR, interquartile range; SD, standard deviation; ACS, acute coronary syndrome; CAD, coronary artery disease. *Adjusted for center. **Adjusted for center, age, gender. ***Only for ischemic heart disease patients.

Conclusions

The results emphasize the need of CR in this patient-group and that a targeted CR approach should be considered to achieve equal health opportunities also in the elderly.

Acknowledgement/Funding

Horizon2020
P6223Relationship between platelet indices and future cardiovascular events: results from a population-based cohort study
Authors: Ricci F , Patti G , Di Martino G , Renda G , Hamrefors V , Melander O , Sutton R , Gallina S , Engstrom G , De Caterina R , Fedorowski A
Published: October 2019

Background

Studies evaluating the relationship between platelet indices and cardiovascular outcome yielded conflicting results. In particular, the evidence from large, population-based, prospective studies with extended follow-up duration is scarce.

Purpose

We investigated the incidence of major adverse events in relation to baseline values of platelet count, mean platelet volume (MPV) and platelet distribution width (PDW) in the prospective cohort of the Malmö Diet and Cancer Study.

Methods

A total of 30,314 middle-aged individuals (mean age 57±8 years; 40% men) were overall included and followed up for a median of 16 years (in total, 468,490 person-years). The following outcome measures were considered: all-cause death, myocardial infarction (MI) and ischemic stroke.

Results

There was no relationship between increase in MPV or PDW values and adverse events during follow-up. In particular, the incidence of all-cause death, MI and stroke in patients in the 4thquartile of MPV was 19.8% (vs. 20.7% in the 1stquartile; p=0.08), 8.5% (vs. 8.2%; p=0.78) and 7.9% (vs. 7.1%; p=0.09), respectively. The rates of all-cause death, MI and stroke in patients in the 4thquartile of PDW were 20.1% (vs. 20.7% in the 1stquartile; p=0.16), 8.7% (vs. 8.1%; p=0.30) and 8.1% (vs. 7.2%; p=0.09), respectively. There was a significant rise in mortality by platelet count increase (log-rank p<0.001). In multivariable analysis, patients in the 4thquartile of platelet count (>264 x 109/L) showed a significantly higher incidence of all-cause death (HR 1.17, 95% CI 1.07–1.28; p=0.001), MI (HR 1.24, 95% CI 1.08–1.43; p=0.003) and stroke (HR 1.20, 95% CI 1.04–1.39; p=0.014) vs the 1stquartile. The higher mortality in the 4thquartile of platelet count was independent of the history of previous stroke, was significant in patients without prior MI (HR 1.18, 95% CI 1.08–1.29; p<0.001) and non-significant in those with prior MI (HR 0.86, 95% CI 0.56–1.33; p=0.51). The risk of MI in the 4thquartile of platelet count was higher regardless of the history of previous MI (p for interaction=0.11). The risk of stroke in the 4thquartile of platelet count was higher regardless of the history of previous stroke (p for interaction=0.15).

Conclusions

In this population-based, prospective, cohort study there was no difference in the incidence of adverse events across various strata of baseline platelet morphology. However, patients with highest platelet count at baseline showed a significantly higher risk of all-cause death, MI and stroke. Whether or not these individuals should be targeted by more aggressive primary prophylactic measures including antiplatelet treatment, remains to be proven.
P6229Potato consumption is associated with total and cause-specific mortality: a population-based cohort study and pooling of prospective studies with 73,717 participants
Authors: Mazidi M , Mikhailidis D P , Katsiki N , Pella D , Banach M
Published: October 2019

Background

The long-term effect of potato consumption on mortality and cardiometabolic risk factors is still largely unknown.

Purpose

Using the National Health and Nutrition Examination Surveys (NHANES) 1999–2010, we evaluated the long-term impact of potato intake on total and cause-specific (cardiovascular disease [CVD],cerebrovascular disease and cancer] mortality, and the results were next validated in the systematic review and meta-analysis of cohort studies investigating pooled associations of potato consumption with all-cause and cause-specific death.

Methods

Vital status through December 31, 2011 was ascertained. Cox proportional hazards were applied to determine the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of mortality for each quartile of the potato intake, with the lowest quartile (Q1 – with the lowest intake) used as reference. We used adjusted Cox regression to determine the risk ratio (RR) and 95% CI, as well as random effects models and generic inverse variance methods to synthesize quantitative and pooled data, followed by a leave-one-out method for sensitivity analysis.

Results

Among the 24,856 participants included, 3433 deaths occurred during the mean follow-up of 6.4 years. In multivariate adjusted Cox models, total (42%), CVD (65%), cerebrovascular (26%) and cancer (52%) mortality risk was greater in individuals with higher potato consumption than those with the lowest intake (p<0.001 for all comparisons). However this link disappeared after adjustment for confounding factors (see Table below). Results from pooling current prospective studies with 73,717 participants revealed a non-significant association between total (RR: 1.25, 0.98–1.60, p=0.066), CVD (RR: 0.99, 0.90–1.08, p=0.845) and stroke mortality (RR: 0.94, 0.85–1.03, p=0.214) with potato consumption. Individuals with a higher potato intake had a less favorable profile of cardiometabolic factors, including greater WC (97.2 vs. 99.5 cm, p<0.001) and a less favorable profile of systolic and diastolic blood pressure, levels of triglycerides (TGs), high-density lipoprotein-cholesterol (HDL-C) and TG/HDL-C ratio (p<0.001 for all comparisons).

HRs for mortality across potato intake.

Conclusions

Our results highlighted the neutral effect of potato intake on long-term mortalities; whereas potato consumption was adversely related to cardiometabolic risk factors. These findings should be taken into consideration for public health strategies, establishing the position for potatoes in the food pyramid.

Acknowledgement/Funding

None
P6230Gender disparities in serum uric acid levels associated increased cardiovascular risk. The Czech Post-MONICA study
Authors: Krajcoviechova A , Bruthans J , Wohlfahrt P , Sulc P , Cifkova R
Published: October 2019

Background

Recent European Society of Hypertension (ESH) guidelines have implemented serum uric acid (SUA) levels as cardiovascular (CV) risk factor and recommend routine SUA levels measurement in hypertensive patients. However, what is the appropriate SUA level threshold and whether all patients with so called asymptomatic hyperuricemia should be treated remain unclear.

Objective

To evaluate longitudinal trends and determinants of mean serum uric acid (SUA) levels in two representative Czech population surveys (2006–09 and 2015–18) and to determine the SUA levels associated with increased 10-year risk of cardiovascular (CV) death.

Methods

Two independent cross-sectional surveys of major CV risk factors were performed in the Czech Republic in 2006–09 and 2015–18; 1% percent random samples aged 25–64 years stratified by age and gender were examined. The number of participants was 3612 in 2006–09, and 2621 in 2015–18. Ten-year risk of CV death was categorized using the SCORE algorithm as low (<1%), intermediate (1% to <5%), high (≥5% to 10%), and very high (≥10%).

Results

Final analyses included 3542 individuals (48.2% men; mean age 47.1±11.3) in 2006–09, and 2304 individuals (47.4% men; mean age 47.9±10.9) in 2015–18. Over the past decade, there was a highly significant increase in SUA levels (μmol/l) from 344.6±81.1 to 374.4±73.3 in men, and from 250.1±73.8 to 278.9±66.1 in women. In gender-specific multivariate linear regression analyses conducted in the 2015–18 survey, SUA levels increased with use of diuretics, an increase in waist-to-height ratio, serum triglycerides, and aspartate aminotransferase, and a decrease in estimated glomerular filtration rate in both genders, whereas in men SUA levels increased also with an increase in quartiles of alcohol intake and gamma-glutamyl transferase, and a decrease in glycated haemoglobin. When analysing pooled data of the two surveys, mean SUA levels increased with each increase in 10-year CV risk category in women (P<0.001), but not in men (P=0.21). In receiver operating characteristic (ROC) curve analysis, the cut-off value of SUA levels discriminating between low/intermediate and high/very high CV risk category in women was 306 μmol/l (sensitivity 53%; specificity 82%; area under the ROC curve 0.713 [95% CI 0.683–0.743]).

Conclusions

Over the past decade, there was a significant increase in uricemia in the Czech adult population. However, increasing SUA levels were associated with increased 10-year CV death risk only in women. The SUA levels associated with high/very high CV risk were substantially lower in Czech women than the currently used cut-off values for hyperuricemia.

Acknowledgement/Funding

Grant number 15-27109A from Czech health research council
P6232Exploring the bottom of J-shaped curve association between serum uric acid and cardiovascular risks: description using a large Japanese general population
Authors: Kawasoe S , Kubozono T , Ojima S , Miyahara H , Maenohara S , Ohishi M
Published: October 2019

Background

The J-shaped association between serum uric acid (SUA) and cardiovascular risks is known. However, the bottom of the J-shaped curve has not been elucidated because of the lack of epidemiological knowledge about hypouricemia.

Purpose

To explore the SUA levels related to the most preferable cardiovascular risks using data from a Japanese general population.

Methods

Data from 246,923 individuals (111,117 men and 135,806 women) who underwent routine health checkups between January 2001 and December 2015 were analyzed. The participants were divided into quartiles according to their SUA levels, and patients with hypouricemia (SUA level <2.0 mg/dL) were subdivided into two groups according to their distributions. We compared their characteristics, including their cardiovascular risks.

Results

The prevalence of hypouricemia was 0.46% overall, 0.21% for men, and 0.66% for women (P<0.001). The subjects with hypouricemia were divided into two groups according to SUA level: a lower hypouricemia group (0.4–1.1 mg/dL, which included a peak at 0.7–0.8 mg/dL) and a higher hypouricemia group (1.4–2.0 mg/dL). The two groups exhibited significanly different characteristics in several variables: body mass index and triglyceride in men, and age, body mass index, triglyceride, low-density lipoprotein cholesterol, and renal function in women. Furthermore, several cardiovascular risk factors showed the most preferable values in subjects with SUA 1.4–2.0 mg/dL (Figure).

Conclusions

There were two independent distributions in subjects with SUA ≤2.0 mg/dL. The individuals with SUA 1.4–2.0 mg/dL exhibited the most preferable values for several cardiovascular risk factors, suggesting an association with the bottom of the J-shaped curve between SUA and cardiovascular risks.
P6235Normal Body Mass index (BMI) can rule out metabolic syndrome
Authors: Kobo O , Karban A M I R , Leiba R , Avizohar O
Published: October 2019

Objective

To assess whether BMI can be used as a simple and reliable survey test for metabolic syndrome.

Methods

Observational, cohort study, among patients who visited Periodic Examinations Institute [PEI]. We analysed the correlation between obesity indices and presence of metabolic syndrome. We identified the ideal value of BMI for identification of patients at risk for MS. We also described the correlation between different BMI values and its' negative predictive value for metabolic syndrome.

Results

During study years, 23,993 patients visited the PEI, 12.5% of them fulfilled the criteria for metabolic syndrome. Women with metabolic syndrome had higher proportion of obesity, when compared to men (89.9% vs 52.6%, p<0.0001). Normal BMI had very high negative predictive value to rule out metabolic syndrome among men and women (98% and 96% respectively).Using ROC curve, we found BMI 27 to be the ideal value for identification of metabolic syndrome for the entire cohort (AUC 0.767, 95% CI 0.758–0.775, p<0.0001), for men (AUC 0.726, CI [0.715–0.738], p<0.0001) and for women (AUC 0.843, CI [0.831–0.855], p<0.0001). BMI below 30, provide negative predictive value of 91.1% to rule out metabolic syndrome.

Conclusions

BMI as single survey measurement of obesity offers high negative predictive value for metabolic syndrome and can be used by physician and patients for this purpose.
P6237Clinical utility of echocardiographic left-ventricular ejection fraction monitoring for cardiotoxicity risk assessment in patients with HER2+ early breast cancer undergoing trastuzumab-based therapy
Authors: Posch F , Glantschnig T , Firla S , Smolle M , Balic M , Moik F , Stoeger H , Zirlik A , Pichler M , Rainer P
Published: October 2019

Background

Monitoring left-ventricular ejection fraction (LVEF) is a routinely-practiced strategy to survey patients with breast cancer (BC) towards cardiotoxic treatment effects. However, whether the LVEF as a single measurement or as a trajectory over time is truly sufficient to identify patients at high risk for cardiotoxicity is currently debated.

Purpose

To quantify the prognostic impact of LVEF and its change over time for predicting cardiotoxicity in women with HER2+ early BC.

Methods

We analyzed 1,136 echocardiography reports from 185 HER2+ early BC patients treated with trastuzumab ± chemoimmunoendocrine therapy in the neoadjuvant/adjuvant setting (Table 1). Cardiotoxicity was defined as a 10% decline in LVEF below 50%.

Results

Median baseline LVEF was 64% (25th-75th percentile: 60–69). Nineteen patients (10%) experienced cardiotoxicity (asymptomatic n=12, symptomatic n=7, during treatment n=19, treatment modification/termination n=14), Median time to cardiotoxicity was 6.7 months, and median LVEF decline in patients with cardiotoxicity was 18%. One-year cardiotoxicity risk was 7.6% in the 35 patients with a baseline LVEF≥60% and 24.5% in the 150 patients with a baseline LVEF<60% (Hazard Ratio (HR)=3.45, 95% CI: 1.35–8.75, Figure 1). During treatment, LVEF declined significantly faster in patients who developed cardiotoxicity than in patients without cardiotoxicity (1.3%/month vs. 0.1%/month, p<0.0001). A higher rate of LVEF decrease predicted for higher cardiotoxicity risk (HR per 0.1%/month higher LVEF decrease/month=2.50, 95% CI: 1.31–4.76, p=0.005), and cardiotoxicity risk increased by a factor of 1.7 per 5% absolute LVEF decline from baseline to first follow-up (HR=1.70, 95% CI: 1.30–2.38, p<0.0001). Thirty-six patients (19%) developed an LVEF decline of at least 5% from baseline to first follow-up (“early LVEF decline”). One-year cardiotoxicity risk was 6.8% in those without early LVEF decline and a baseline LVEF≥60% (n=117), 15.7% in those without an early LVEF decline and a baseline LVEF<60% (n=65), and 66.7% in those with an early LVEF decline and a baseline LVEF<60% (n=3), respectively (log-rank p<0.0001).

Table 1. Baseline characteristics Age (years, median [IQR]) 55 [49–65] Estrogen receptor positive (n, %) 124 (67%) Neoadjuvant setting (n, %) 103 (56%)

Figure 1. Risk of Cardiotoxicity.

Conclusion

Both a single LVEF measurement and the rate of LVEF decrease strongly predict cardiotoxicity in early BC patients undergoing HER2-targeted therapy. Routine LVEF monitoring identifies individuals at high risk of cardiotoxicity that may benefit from more sensitive screening techniques such as strain imaging.
P6240The impact of stress myocardial blood flow as a very strong predictor for all-cause mortality, cardiovascular mortality and adverse cardiac and cerebrovascular event in hemodialysis population
Authors: Umemoto N , Ooshima S , Katou M , Kajiura H , Inoue S , Iio Y , Itou R , Sakakibara T , Ishii H , Shimizu K , Murohara T
Published: October 2019

Background

In the clinical setting, ischemic heart disease (IHD) is a major problem not only in general patients but also in regular hemodialysis (HD) patients. 13ammonia positron emission tomography (13NH3PET) is an established and excellent diagnostic device for IHD. Although coronary flow reserve is the most important index in IHD diagnosis, there are limited data about stress myocardial blood flow (MBF). We investigated the prognosis predictability of stress MBF in all-cause mortality, cardiovascular (CV) mortality and adverse cardiac and cerebrovascular event (MACCE).

Methods and results

A total 438 of HD patients who undergone 13NH3PET for suspected IHD were enrolled. 29 cases were excluded due to revascularization therapy in 60 days. In total we collected 409 eligible cases. All patients were undergone13NH3PET at Nagoya Radiological Diagnosis Foundation. Patients were divided into two group according to the median value of stress MBF levels; low stress MBF group (<2.12) and high stress MBF group (≥2.12). We followed up them up to 4.2 years (median 2.4 years) and collected their data. We evaluated their all-cause mortality, CV mortality and MACCE. Kaplan-Meyer analysis shows that intergroup difference in all-cause mortality (log rank p=0.001, hazard ratio [HR] 0.411, 95% confident interval [CI] 0.261–0.632), CV mortality (log rank p=0.002, HR 0.324, 95% CI 0.157–0.625) and MACCE (log rank p<0.001, HR 0.465, 95% CI 0.324–0.657). Multiple cox analysis that include established risk factors shows CFR is an independent risk factor for all-cause mortality (HR 0.261, 95% CI 0.154–0.442), CV mortality (HR 0.172, 95% CI 0.079–0.374) and MACCE (HR 0.329, 95% CI 0.213–0.503). As a result of the incremental value with C-index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) when CFR added into a model with established risk factors, each indicator shows adding stress MBF on established risk factors improve the predictability in all-cause mortality, CV mortality and MACCE (all-cause mortality; NRI 0.642, p<0.001, IDI 0.091, p<0.001, CV mortality NRI 0.809, p<0.001, IDI 0.116, p<0.001, MACCE; NRI 0.646, p<0.001, IDI 0.072, p<0.001).

Conclusion

Considering prognosis of HD population, stress MBF is an important and independent predictor for all-cause mortality, CV mortality and MACCE. As a result of our investigation, stress MBF is one of most strong predictors in HD population.
P6248High use of direct oral anticoagulants in elderly patients with non valvular atrial fibrillation: results of REFLEJA study
Authors: Torres Llergo J , Fernandez Olmo M R , Carrillo Bailen M , Puentes Chiachio M , Martin Toro M , Herruzo Rojas M , Fernandez Guerrero J C
Published: October 2019

Background

Older patients with atrial fibrillation (AF) have a higher thromboembolic and hemorrhagic risk, however oral anticoagulation (OAC) continues to be underutilized.

Purpose

To analyze the use of direct oral anticoagulant (DOAC) in patients older than 80 years.

Methods

The REFLEJA study is a single-centre prospective observational registry including 1039 consecutive outpatients with nonvalvular AF.

Results

Among ≥80 years patients (n=376) there were more women (57.7% vs 41.5%; p<0.001), permanent AF (66.5 vs 42%; <0.001), heart failure (HF) (29.8 vs 20.2%, p<0.001) and vascular disease (19.7 vs 12.8%, p=0.003), although without differences in bleeding (5.9 vs 3,8%, p=0.12) and previous strokes (9.3 vs 7.1%, p=0.20). Despite a higher CHA2DS2-VASc score (4.4±1.1 VS 2.9±1.6, p<0.001), HASBLED score >2 (34.6 vs. 23.7%; p<0.001) and chronic kidney disease (CKD) (51.5 vs. 22.6%, p<0.001), total use of OAC was higher among those older (94.9% vs 90%, p=0.005). There were no differences in the prescription of DOAC (64.1% vs 69.3%, p=0.08), although lower doses (45.8 vs. 12.2%, p<0.005) were more frecuent among older patients. In multivariate analysis, HF (OR 0.60, CI 0.40–0.90; p=0.013) and CKD (OR 0.55, CI 0.41–0.76; p<0.001) were independent risk factors for the prescription of DOAC, but not age ≥80 years (OR 1.16, CI 0.58–2.31, P=0.67).

Baseline characteristics Total <80 years ≥80 years p value Hypertension (%) 81.5 77.9 88 <0.001 Diabetes mellitus (%) 26.3 25.7 26.7 0.71 Malignancy (%) 6.6 6.5 6.9 0.78 Coronary artery disease (%) 12.1 10.8 14.4 0.08 Anemia (%) 16.3 12.5 23.2 <0.001 DOAC (%) 67.6 69.3 64.1 0.08 Low doses DOAC (%) 15.9 12.2 45.8 <0.001 CHA2DS2-VASc score 3.4±1.6 2.9±1.6 4.4±1.1 <0.001 HAS-BLED score 1.2±0.8 1.1±0.8 1.4±0.7 <0.001 Glomerular filtration rate (ml/min) 70.9±24.9 76.2±23.1 61.5±25 <0.001 Antiarrhythmic treatment (%) 7.3 9.6 3.1 0.005 Permanent AF 50.5 41.7 66.2 <0.001 DOAC: direct oral anticoagulants; HAS-BLED score: without INR lability; AF: atrial fibrillation.

Conclusion

The proportion of elderly anticoagulated patients in our environment is very high and advanced age was not associated with a lower use of DOAC.
P6249Markers of early myocardial damage in steinert's disease
Authors: Kounka Z , Roque Rodriguez B , Lezcano Gort L E , Romero Castro M J , Chipayo Gonzales D A , Perez Espejo P , Chamorro Fernandez A I , Gomez Barrado J J , Marcos Gomez G , Mogollon Jimenez M V , Ortiz Cortes C , Sanchez Calderon P , Porras Ramos M Y , Vega Fernandez J M
Published: October 2019

Introduction

Myotonic dystrophy type 1 (DM 1), also known as Steinert's disease (SD), is the most common muscular dystrophy in adults. It is characterized by multisystemic involvement and the cardiac affectation is the second leading cause of death after the respiratory one.

Purpose

The objective of our work was to study the cardiac involvement by transthoracic echocardiography (TTE) including systolic function, diastolic function and myocardial deformation with global longitudinal strain (GLS) by speckle tracking and trough biomarkers of myocardial damage with high-sensitive cardiac troponin T (hs-cTnT) and NT-proBNP.

Methods

24 patients affected by SD were included. The TTE machine used has software to perform GLS with reference values: −20±2%. The normal values of hs-cTnT and NT-proBNP of our central laboratory are: <14 ng/L and 0–250 pg/ml, respectively.

Results

The mean age of patients was 52,08±12,14 years and the average age of diagnosis was 31,42 years. There was no gender predilection (12 women, 12 men).

In the TTE 55% of patients had a GLS <−18% with a global average of −17,72±4,02%. The 50% of patients with LVEF >50% had a GLS <−18% and the 27,77% had a GLS between −18 and −20%. The diastolic dysfunction assessed by pulsed wave doppler and tissue doppler imaging was present in 26.82%.

The 95,83% of the patients had levels of hs-cTnT≥14 ng/L with median of 34,93 ng/L (minimum 3,96 and maximum 429), however only 30,4% of these had values of NT-proBNP above 250 pg/ml with a median of 71,83 pg/ml (minimum 9,37 and maximum 8771).

Conclusions

According to our experience GLS and hs-cTnT could be markers of early myocardial damage in patients with SD. We therefore need to develop protocols for the follow-up including these markers in the usual cardiac assessment.
P6250Mentalplus digital game usefulness in cognitive dysfunction evaluation compared to neuropsychological testing batteries in a hypertensive treated population
Authors: Pereira V , Valentin L
Published: October 2019

Introduction

Cognitive dysfunction has been a time-consuming evaluation when full neuropsychology battery is performed, what is the most used method up to nowadays. The time is a limitation besides the necessity of a specific professional to apply it. Both reasons limit the clinical use and even research widespread of cognitive dysfunction evaluation in a variety of diseases that we suppose that might be linked to cognitive dysfunction in its lifetime evolution.

Purpose

The purpose of this study is to evaluate the correlation between a digital game named Mentalplus and a usual neuropsychology battery to cognitive dysfunction evaluation in a hypertensive medically treated and followed group.

Methods

A 163 hypertensive and followed by cardiologists group was evaluated for cognitive dysfunction by two means: A standard neuropsychology battery that spent around two hours and was performed by neuropsychologists. Then, Mentalplus digital game was applied, for 25 minutes. The Mentalplus digital game was developed to evaluate some cognitive functions like selective and alternate attention, short and long term memory, inhibitory control, language, visuoconstruction, executive function. Spearman test was used to calculate the correlations between specific validated tests with each Mentalplus phase. Staticisticists used IBM-SPSS. The significance level was 5%.

Results

41.7% male, mean age of 51.1±16.2 SD years, mean arterial pressure of 93.1±8.7 SD mmHg in use of up to 3 blood pressure medications. Concerning to cognitive evaluation by both methods, the main findings were strong correlations related to functions below: short term memory, comparing VLT-A-1 and Mentalplus phase developed to evaluate that function: (r=0.563, p<0.005); Long term memory, comparing Rey-figure-long term memory and Mentalplus (r=0.887, p<0.005); Attention and Visuoconstruction, comparing Rey-figure copy and Mentalplus: (r=0.929, p<0.005) and Stroop-C and Mentalplus: (r=0.941, p<0.005); Selective attention, comparing TMT-A and Mentalplus phase: (r=0.889, p<0.005); Alternate attention, comparing STOOP-B and TMT-B and Mentalplus phase is similar (r=0>0.98, p<0.005); Inhibitory control, comparing Rey-Figure immediate memory and Mentalplus phase (r=0.969, p<0.005).

MentalPlus Short Term Memory - Part I

Conclusion

Mentalplus phases present a strong correlation with specific validated neuropsychologic tests usually performed in a normal evaluation battery. It opens a useful way to evaluate the cognitive function in a hypertensive treated group during the lifelong time, to follow cognitive dysfunction during treatment with less time consuming and more convenience for the patients.

Acknowledgement/Funding

FAPESP