bluuebunny/crossref_metadata_2025 huggingface dataset:
Ambulatory blood pressure variability measures in hypertensive patients according to non-alcoholic fatty liver disease state
Authors: Kakouri N , Konstantinidis D , Siafi E , Tatakis F , Polyzos D , Drogkaris S , Koskinas J , Thomopoulos C , Tsioufis K
Published: October 2021

Background

Nonalcoholic fatty liver disease (NAFLD) represents the most frequent cause of chronic hepatic disease and independently determines hypertension and future cardiovascular events. Increased blood pressure variability (BPV) assessed by 24-hour blood pressure (BP) monitoring including mean arterial morning surge have been also associated with increased rates of cardiovascular events.

Purpose

To compare different BPV measures in hypertensive patients with and without NAFLD.

Methods

Consecutive newly diagnosed untreated hypertensive patients without history of cardiovascular disease underwent clinic and ambulatory BP measurements. NAFLD was diagnosed by liver ultrasound to separate patients into those with and without NAFLD. BPV was derived by assessment of standard deviation (SD) of systolic and diastolic BP (24-h, daytime and nighttime), average real variability (ARV) of systolic and diastolic BP, coefficient of variation (CV) of systolic BP (24-h, daytime), weighted SD (wSD) of systolic BP (24-h, daytime), maximum BP and mean arterial morning surge.

Results

Among 146 hypertensive patients (mean age 57±11 years, 64 men, 24-h mean systolic/diastolic BP 140±10/84±9 mmHg) those with NAFLD (n=76) compared to the non-NAFLD group (n=70) were younger (54.7±10.1 vs 58.6±11.2 years, respectively, p=0.03), male gender was more prevalent (42 vs 22 respectively, p=0.004), and body mass index was more increased (33.2±4.1 vs 27.0±3.5 kg/m2, p<0.001). Moreover, NAFLD patients compared to those without NAFLD were characterized by higher levels of mean arterial pressure morning surge (12.4±8.9 vs 8.7±8.5 mmHg, p=0.03), but the remaining BPV measures were not different between the two groups. NAFLD was a determinant of both diastolic BP ARV (B=0.34, p=0.007) and mean arterial morning surge (B=0.47, p=0.006) after adjustment.

Conclusions

Mean arterial pressure morning surge was significantly higher in hypertensive patients with NAFLD compared to their non-NAFLD counterparts, while whole day BPV measures were not increased in NAFLD except for ARV of diastolic BP. Our findings may partially explain the increased cardiovascular risk of comorbid NAFLD in hypertension.

Funding Acknowledgement

Type of funding sources: None.
Cumulative prognostic effect of diabetes and myocardial injury in patients attended in the emergency room
Authors: Del Moral Ronda V , Sanchez Gimenez R , Lal-Trehan Estrada N , Bonet Pineda G , Carrasquer Cucarella A , Peiro Ibanez O M , Fort Gallifa I , Bardaji Ruiz A
Published: October 2021

Background

Diabetes and myocardial injury are clinical conditions associated with cardiovascular events and increased mortality during follow-up. It is not known to what extent both conditions enhance their prognostic effect in patients seen in the emergency room with cardiac troponin determination.

Purpose

This study aims to evaluate the prognostic implication of diabetes and myocardial injury in patients attended in the emergency room with cardiac troponin determination.

Methods

Retrospective observational cohorts study, in which all the patients attended the emergency room from January 2012 and December 2013 with a troponin determination. The sample was categorized according to the diabetes mellitus condition and myocardial injury (troponin below 99 th), studying four groups: non-diabetic without myocardial injury (G1), diabetic without myocardial injury (G2), non-diabetic with myocardial injury (G3), and diabetic with myocardial injury (G4). Baseline clinic characteristics and prognostic data were studied with a four years follow-up.

Results

A total of 3622 patients were studied; 924 (25'55%) diabetics. Three hundred seventy-one diabetic patients (40% of all diabetic patients) had an elevated troponin determination, while six hundred seventy-eights non-diabetic patients had elevated troponin (25'13% from all non-diabetics). Diabetic patients were significantly older (mean age 74 vs. 67 years). They had more frequently history of hypertension (81'9% vs 53'2%), acute myocardial infarction (31'6% vs 15'8%), heart failure (11'1% vs 5'7%), peripheral vascular disease (11'1% vs 5'2%), cerebrovascular disease (11'4% vs 6'6%), chronic pulmonary disease (23'3% vs 16'2%) and renal impairment (16'8% vs 5'2%). At four years of follow-up, G2, G3 and G4 had higher mortality than G1 (HR (95IC): 1,352 (1,080–1,693), 2,896 (2,896–3,477), and 3,441 (2,809–4,216), respectively). A multivariate competing risk model was used to obtain the HRs for readmission for myocardial infarction and heart failure between G2, G3 and G4 in relation to G1 (HR (IC 95%) 2,511 (1,592–3,96), 2,682 (1,739–4,138) and 5,036 (3,221–7,876), respectively for myocardial infarction, and 2,663 (1,825–3,886), 2,562 (1,753–3,744) and 4,292 (2,936–6,274) respectively for heart failure).

Conclusions

Both conditions, myocardial injury, and diabetes have a prognostic impact at a long-term follow-up with a cumulative effect, being the troponin elevation, a better prognostic marker of death risk, and similar to diabetes history for the risk of myocardial infarction and heart failure.

Funding Acknowledgement

Type of funding sources: None. ICC hospitalization cumulativeincidenceIAM cumulative incidence
Sex differences in the effect of family stress on risk of myocardial infarction and stroke in population 25–64 years: WHO program MONICA-psychosocial
Authors: Gafarov V , Gromova E , Panov D , Gagulin I , Gafarova A
Published: October 2021

Purpose

To determine the influence of family stress on the risk of cardiovascular diseases (myocardial infarction and stroke) in an open population aged 25–64 years in Russia / Siberia.

Methods

Within the framework of the III screening of WHO's MONICA-psychosocial program, a random representative sample of the population of both sexes of 25–64 years of Novosibirsk in 1994 (men n=657, mean age 44,3±0,4y, response 82.1%; women: n=689, mean age 45,4±0,4y, response 72.5%) was examined. The screening included: socio-demographic data, the definition of the family stress. New-onset cases of MI and stroke in women - 15 and 35 cases and in men - 30 and 22 cases, respectively detected in the cohort over follow-up period in frame of budgetary theme # AAAA-A17–117112850280–2.

Results

In the open population aged of 25–64 years the prevalence of high family stress was higher in men (31.5%) than women (20.9%). The risk of myocardial infarction in men and women experiencing stressful situations in the family was 5.9 and 5.58-fold higher, respectively over 16-year period. The most significant risk factors for the development of myocardial infarction were divorce (HR = 3.9) and widowhood (HR = 6.3). The risk of developing a stroke was 3.45-fold higher in men and 3.52-fold higher in women with family stress. The risk of developing stroke was higher among those with high school and elementary education levels, both in men (HR = 3.9 and HR = 6.3) and women (HR = 2.87 and HR = 3.33).

Conclusion

Stress in the family is more common in men within the working-age population. Family stress increases the risk of developing both myocardial infarction and stroke among men and women.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): This survey was performed within the framework of the budgetary theme NIITPM - branch of the ICG SB RAS Reg. No. AAAA-A17-117112850280-2, Gov.Task No. 0324-2018-0001.
Patient reported health status and cardiovascular risk factors in a remote area of South America: a cross-sectional study
Authors: Holm A E , Gomes L , Lima K O , Matos L O , Wegener A , Vieira I V M , Souza R M , Marinho C R F , Biering-Soerensen T , Silvestre O M , Brainin P
Published: October 2021

Background

Several studies have indicated that self-perception of health is related to cardiovascular disease. Despite cardiovascular disease is the leading cause of mortality in South America, the relationship between patient reported health and cardiovascular risk is sparsely explored, specifically in indigenous areas.

Purpose

We assessed if self-rated health is associated with cardiovascular risk factors in a remote area in South America.

Methods

We included participants by cluster-randomization of community health care clinics from June to December 2020. Sociodemographic variables and information on cardiovascular risk factors were collected by questionnaires and physical examination. All participants rated their present health status according to the validated EQ5D-VAS instrument, ranging from 0 (worst) to 100 (best).

Results

A total of 492 participants (mean age 41±15 years; 38% men) were included. The mean value of self-rated health was 80 (range 0 to 100) and the prevalence of cardiovascular risk factors were: Hypertension (19%), hypercholesterolemia (15%), smoking (37%), low intake of vegetables (defined as <3 times per week; 54%), no sport activity (62%), diabetes (6%) and obesity (24%). In logistic regression models adjusted for sex, age and socioeconomic status, higher self-rated health was significantly associated with lower risk of hypertension, hypercholesterolemia, smoking, obesity and greater vegetable intake (P<0.05; Figure 1). No association was found with sport activity or diabetes. The total number of cardiovascular risk factors increased with lower self-rated health (beta = 0.100 [0.04 to 0.15], P<0.001 per 10 decrease in self-reported health).

Conclusion

Self-rated health was significantly associated with a greater burden of cardiovascular risk factors and may influence ideal cardiovascular health. Future studies should assess if patient reported health status constitutes an independent risk factor for heart disease in this specific population, and studies elucidating gaps on self-perception of cardiovascular health are encouraged.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Independent Research Fund Denmark
Long-term benefits of cardiac rehabilitation after incomplete percutaneous revascularization
Authors: Otte Alba C , Romero Reyes M J , Padilla Escamez A , Rufian Andujar S , Molano Casimiro F J
Published: October 2021

Background

Incomplete revascularization versus complete revascularization in patients undergoing percutaneous coronary intervention (PCI) is associated with higher risk of mortality and major adverse cardiac events. Cardiac rehabilitation (CR) is one of the most important evidence-based interventions for secondary prevention after ischemic heart disease. However, it has been less studied in patients with incomplete PCI.

Purpose

The aim of our study was to evaluate the effects of CR on long-term clinical outcomes after incomplete PCI.

Methods

Unicentric, descriptive and analitical study. We included 285 patients who underwent incomplete PCI at our hospital from 2004 to 2011. We compared those who participated in a CR program with those who refused to. We analyzed events occurring during a median follow-up of 11 years.

Results

This study included 285 patients, 121 (42.5%) participated in the CR program. Attending to baseline characteristics, there were significant differences in prevalence of male gender (88.4% vs 67.7%, p=0.000) and DM (69.4% vs 51.8%, p=0.003), which were more prevalent in CR group; they were also significantly younger (58.81 vs 66.34 years, p=0.000). Acute myocardial infarction (AMI) was the most common indication for PCI in those who attended CR, whereas in the other group it was unstable angina.

Using univariate logistic analysis, CR participation was found to be associated with significantly reduced heart failure readmissions (14.2% vs 31.7%; OR 0.356; IC95% 0.193- 0.656; p=0.001), all-cause mortality (21.5% vs 56.7%; OR 0.209; IC95% 0.123- 0.356; p=0.000) and cardiovascular mortality (5.8% vs 26.8%; OR 0.167; IC95% 0.072- 0.387; p 0.000). No significant differences were observed in re-AMI (20.8% vs 26.4%, p=0.280) nor incidence of stroke (5.8% vs 9.8%, p=0.226) during the follow-up.

The multivariate regression showed as well that CR was associated with a lower rate of all-cause and cardiovascular mortality and heart failure readmissions. Other predictors of clinical outcomes were NYHA stage, age >65 years and LVEF <40%.

Conclusion

CR is an excellent strategy for reducing hospital readmissions and mortality during long-term follow-up in patients with incomplete PCI.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitario de Valme, Sevilla, Spain Baseline characteristics
Characterisation of ventricular premature beats during exercise testing in masters athletes
Authors: Duncan E , Fyyaz S , Papatheodorou S , Merghani A , Papadakis M , Sharma S
Published: October 2021

Background

Exercise induced ventricular premature beats (VPBs) are associated with an adverse outcome in patients with cardiac disease and the general population. The incidence and significance of exercise induced VPBs in masters athletes remains unknown.

Methods

237 masters athletes (54.6±8 years of age, 42% male) and 50 controls of similar age and sex were assessed with a 12-lead ECG, echocardiogram, cardiopulmonary exercise test, 24-hour holter, cardiovascular magnetic resonance imaging and a CT coronary angiogram. Athletes had participated in endurance exercise for a meanof 32±12 years.

Results

Athletes achieved a higher VO2 max (43.2 ml/min/kg vs 28 ml/min/kg) compared with controls and on average weighed 12kg less (63kg vs 75kg).

VPBs were common in master athletes during exercise but are no more common than in age matched sedentary controls (39.3% vs 33.3% >1 VPB, and 8.9% vs 5.9% complex or frequent VPBs). There were no sex differences in terms of VPB number (40% vs 39%) or complex morphology (10% vs 8%) between male and female athletes.

Athletes demonstrating complex ectopy during ETT had similar age (54.8±9 and 54.6±8), years of competition (34±9 and 32±12), VO2 max (40±6 and 43±7ml/min/kg), left ventricular mass (142±36g and 148±35g), end diastolic volume (160±35ml and 157±32ml) and incidence of late gadolinium enhancement (14% and 10%) compared with athletes who did not reveal complex VPBs.

Conclusion

VPBs are common during exercise testing in both masters athletes and sedentary age matched controls. Exercise-induced complex ectopy in an asymptomatic, low risk masters athlete represents a poor marker of significant structural heart disease.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Cardiac Risk in the Young
Benefits from optimised antihypertensive and statin treatment in high risk people
Authors: Wu R , Rison S , Raisi-Estabragh Z , Dostal I , Carvalho C , Robson J , Mihaylova B
Published: October 2021

Background

Hypertension and hypercholesterolaemia are major modifiable risk factors for cardiovascular diseases (CVD) with available effective and low-cost treatments. However, their suboptimal treatment remains widespread. We characterise treatment gaps in a large urban population and quantify the potential long-term health and economic impact with optimised use.

Methods

We studied 1 million UK urban residents served by 123 primary care practices in 2019. We categorised antihypertensive treatment in adults with diagnosed hypertension, and statin treatment in adults with diagnosed CVD, into optimal, suboptimal and not treated following UK clinical guidelines. A long-term CVD model was used to project cardiovascular events avoided, years of life and quality-adjusted life years (QALYs) gained, and healthcare costs saved with optimised treatments for individual patients accounting for their socio-demographic characteristics and risk factors.

Results

21,954 (24%, mean age 59 years; 49% female) of the 91,828 adults with hypertension were either suboptimally treated (20%) or untreated (4%) and 9,062 (38%, mean age 69 years; 43% female) of the 23,723 adults with CVD were either suboptimally treated (24%) or untreated (14%). Per 1000 patients (95% CI) optimised over lifespan, hypertension treatment would prevent 154 (72–230) major vascular events (MVEs, including heart attack, stroke or arterial revascularisation) and 69 (28–103) vascular deaths, and gain 769 (436–1038) QALYs for those sub-optimally treated, and prevent 138 (68–201) MVEs and 50 (21–76) vascular deaths, and gain 674 (386–920) QALYs for those not treated; statin treatment would prevent 68 (46–88) MVEs and 17 (12–21) vascular deaths, and gain 145 (113–178) QALYs for those sub-optimally treated, and prevent 260 (190–319) MVEs and 55 (40–68) vascular deaths, and gain 535 (412–651) QALYs for those not treated (Figure). Hospital cost savings net of medication costs were about £1100 per person over their remaining lifespan.

Conclusion

Optimising preventive cardiovascular treatments in UK primary care is likely to cost-effectively reduce cardiovascular risk and improve life expectancy, while reducing population inequalities.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Barts Charity, British Heart Foundation, and Health Data Research UK Predicted benefits from optimisation
Effect of body mass index on cardiac injury/cardiovascular outcomes in coronavirus disease 2019: a systematic review and meta-analysis
Authors: Ashraf M , Zlochiver V , Rawala M S , Dahar M , Robinson J , Jan M F
Published: October 2021

Coronavirus disease 2019 has affected millions of people worldwide. Its clinical spectrum ranges from completely asymptomatic to significant respiratory and non-respiratory symptoms leading to critical illness, including death. We aimed to study the effects of body mass index (BMI) on cardiovascular and other critical illness outcomes in these patients in the USA. We conducted a systematic search of three databases for the period of November 2019 to August 2020 and selected 37 studies for analysis. One study showed a non-significant difference in cardiac injury among BMI groups, but there is a paucity of data on cardiovascular outcomes among different BMI groups; hence, meta-analysis was not done for cardiovascular outcomes. Both high BMI and cardiac injury are independent predictors of poor outcomes in these patients. Pooled analysis showed obesity as a significant risk factor for intensive care unit admission (OR=1.547, CI=1.208–1.981, P=0.001) and intubation /mechanical ventilation (OR=1.744, CI=1.363–2.231 P=0.000). Therefore, BMI should be considered an important part of risk stratification, and vaccination should be prioritized for obese patients when it becomes widely available.

Funding Acknowledgement

Type of funding sources: None. Risk of intubation
CHLD score, a new score based on traditional risk factor evaluation and long-term cardiovascular outcomes in patients with systemic sclerosis
Authors: Wybraniec M , Gieszczyk-Strozik K , Widuchowska M , Kotyla P , Brzezinska-Wcislo L , Kucharz E , Mizia-Stec K
Published: October 2021

Purpose

The aim of the study was to assess the predictors of major adverse cardiovascular events (MACE) in patients with systemic sclerosis (SSc) without pulmonary arterial hypertension.

Methods

The study comprised 68 patients with SSc who were followed up for the median time of 97 (74.5; 105) months. The main exclusion criteria involved tricuspid regurgitation maximal velocity >2.8 m/s and structural heart disease. At baseline the patients underwent clinical assessment of cardiovascular risk factors, 6-minute walk test, transthoracic echocardiography and biomarker testing for fetuin-A, growth differentiation factor 15 (GDF-15) and N-terminal pro-B-type natriuretic peptide. The primary composite endpoint was onset of MACE defined as death, myocardial infarction, myocardial revascularization and hospitalization for heart failure. The follow-up consisted of outpatient visits at 1 year intervals and telephone interview every 6 months.

Results

The baseline analysis revealed that chronic kidney disease (HR 28.13, 95% CI: 4.84–163.38), lung fibrosis on high resolution computed tomography (HR 4.36, 95% CI: 1.04–18.26) and GDF-15 concentration (unit HR 1.0006, 95% CI: 1.0002–1.0010) were independent predictors of MACE occurrence. CHLD score was formulated which assigned 1 point for the presence of arterial hypertension, hyperlipidaemia, diabetes mellitus and chronic kidney disease. After inclusion of CHLD score in Cox proportional model, it remained the only independent predictor of MACE onset (unit HR per 1 point 3.46; 95% CI: 2.06–5.82, p<0.0001). Receiver operating curve (ROC) analysis (Figure 1) showed that CHLD score accurately predicted MACE (AUC 0.839; 95% CI: 0.745–0.932, p<0.0001) and death (AUC 0.914, 95% CI: 0.849–0.978, p<0.0001) on follow-up.

Conclusion

Joint assessment of traditional risk factors in the form of CHLD score may serve as a reliable predictor of long-term outcome in patients with SSc without pulmonary arterial hypertension.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland Figure 1
Clinical phenotypes of cardiac sarcoidosis by latent class analysis
Authors: Dai Q , Bose B , Li P , Liu B , Jin L , Laidlaw D
Published: October 2021

Background

Sarcoidosis is a systemic granulomatous disease with cardiac involvement reported in 20–27% of patients [1]. Cardiac sarcoidosis (CS) can lead to atrial or ventricular arrhythmias, various conduction system disorders, heart failure or sudden cardiac death, depending on the location of myocardial involvement [2]. Previous studies have investigated the possible types of CS based on the distribution of myocardial involvement on imaging as well as the role of genetic factors [3,4]. However, there are no studies describing the clinical heterogeneity of CS patients.

Purpose

In order to determine if clinical clusters exist in CS, we carried out a latent class analysis (LCA) to explore potential phenotypes in a large sample of CS patients from the National Inpatient Sample (NIS).

Methods

We identified 848 patients with a diagnosis of CS from the NIS in 2016–2018. A LCA was performed based on comorbidities. Utilizing the Bayesian information criterion and Akaike's information criterion we divided our study population into 3 cohorts. We subsequently applied the LCA model for our study population to fit each patient into one of the 3 cohorts. Finally, we compared the clinical outcomes among the 3 groups.

Results

Following LCA, patients in cohort 3 were strongly associated with a cardiometabolic syndrome profile with the highest prevalence of congestive heart failure (CHF, 95.1%), chronic kidney disease (CKD, 69.7%), diabetes mellitus (68.9%), hyperlipidemia (52.5%) and obesity (45.1%). Patients in cohort 2 had an intermediate prevalence of cardiometabolic syndrome with a universal diagnosis of hypertension (100%) but with the lowest number of CHF (32.5%) patients and none with CKD. Finally, patients in cohort 1 had the least comorbidities in comparison to the other groups but there was a higher prevalence of CHF (71.7%). There was no significant difference in mortality among the 3 groups, but acute respiratory failure was the highest in cohort 3. However, ventricular arrhythmias were more prevalent in cohort 1 patients (Table).

Conclusion

We identified 3 different types of CS based on their clinical phenotype. The clinical outcomes varied among the cohorts with ventricular arrhythmias being the most prevalent in patients with the least cardiometabolic comorbidities.

Funding Acknowledgement

Type of funding sources: None.
The female gender as a risk factor of contrast-induced acute kidney injury in patients with chronic coronary syndromes
Authors: Mironova O , Isaev G O , Perekosova O I , Fomin V V
Published: October 2021

Background

The female gender is a well known risk factor of acute kidney injury that is included in many score widely used by cardiologists for assessment of the risk of contrast-induced acute kidney injury (CI-AKI). The exact influence of gender in patients with chronic coronary syndromes requiring intraarterial contrast media administration remains to be established.

Purpose

The aim of our study was to assess the influence of gender on the risk of the development of CI-AKI in patients with chronic coronary syndromes, receiving optimal medical treatment and with indications for percutaneous coronary interventions (PCI).

Methods

1023 patients with chronic coronary syndromes and indications to PCI were included in the prospective cohort clinical study. The CI-AKI was defined as a rise in serum creatinine equal to or more than 25% from baseline. Preventive measures included the administration of 0,9% saline with intravenous infusion speed of 1 ml/kg/h (0,5 ml/kg/h for patients with heart failure) before and after the procedure. The contrast media used were either iodixanol or iopromide, which are both known to cause less adverse events than high-osmolar contrast media.

Results

The CI-AKI developed in 132 patients (12,9%). The number of male patients was higher than the female ones (741 and 282, 72,4% and 27,6% respectively). The 95% confidence interval of the means was −0,004 to 0,0088. The F test was performed to compare variances: F was 1,297, DFn 281, Dfd 740, the p value was statistically significant. The CI-AKI developed in 45 females (16% of all the female patients) and 87 males (11,7% of all the male patients). Female patients were more likely to be enrolled in the study in older age (presented in population pyramid). This fact is likely to be due to the menopause and natural history of chronic coronary syndromes in female gender.

Conclusion

The female gender is a significant risk factor of the CI-AKI development in patients with chronic coronary syndromes undergoing percutaneous interventions. Women need to be screened and monitored more closely before any contrast media administration in catheterisation laboratory.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Sechenov University
Does transition through menopause affect cardiovascular disease risk factors? Results from a population-based cohort (CoLaus study)
Authors: Raguindin P F , Cardona I , Muka T , Lambrinoudaki I , Gebhard C , Franco O H , Marques-Vidal P , Glisic M
Published: October 2021

Introduction

Menopause has been associated with adverse cardiovascular disease (CVD) risk profile, yet it is unclear whether the changes in CVD risk factors differ by reproductive stage independently of underlying aging trajectories. We examined whether reproductive stages are differently associated with changes in cardiovascular risk factors.

Methods

This is a prospective population-based cohort study. We used data from women at baseline and follow-up (mean 5.5 years). We classified women into (i) premenopausal, (ii) menopausal transition, (iii) early (≤5 years), and (iv) late (>5 years) postmenopausal by comparing their menstruation status at baseline and follow-up. In the cross-sectional analysis, we compared CVD risk factors at baseline across different reproductive stages using multivariable linear regression models. In the longitudinal analysis, we used multivariable linear mixed models. We used premenopausal women as a reference category and adjusted our analyses for age, medications, hormone replacement therapy, lifestyle, body mass index (BMI) at baseline and follow-up.

Results

We used the data from 2,558 women aged 35–75 years. At baseline, compared to premenopausal women, (i) transition and early postmenopausal groups had higher HDL, (ii) early- and late postmenopausal women had higher BMI, total cholesterol, adiponectin, and interleukin-6 levels, and (iii) all other women groups had higher diastolic blood pressure and glucose levels, while no differences were observed in the other CVD risk factors. At follow-up, women across the four reproductive categories showed an increase in BMI, total cholesterol, triglycerides, and fasting glucose compared to baseline. However, linear mixed models showed that, the changes in CVD risk factors were not significantly different in the other three menopausal categories compared to premenopausal women. When using age as a predictor variable and adjusting for menopause status, most of the CVD risk factors increased, while interleukin 6 and interleukin 1b decreased with advancing age. The estimates did not change when the analyses were restricted to women who did not report hormone therapy-use.

Conclusion

The current study suggests that women have a worsening of cardiovascular risk profile as they age, and although menopausal women may have higher levels of cardiovascular risk factors compared to premenopausal women at any given time, the five year changes in cardiovascular risk factors may not depend on menopausal status per se. More studies are still needed to disentangle the contribution of age and menopause in postmenopausal CVD risk, and other pathways not explored in this study.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): COLAUS was supported by a research grants from GlaxoSmithKline and the Swiss National Science Foundation and
Spontaneous Coronary Artery Dissection (SCAD) and a family history of aortic artery dissection, a case series
Authors: McGrath-Cadell L , Hesselson S , Tarr I , Iismaa S E , Bax M , Junday K , Dunwoodie S E , Fatkin D , Kovacic J , Muller D W M , Giannoulatou E , Graham R M
Published: October 2021

Background/Introduction

SCAD typically affects women in their fifth or sixth decade with a paucity of cardiovascular risk factors.(1) It is caused by a coronary artery intramural haematoma with or without intimal tear. Resultant luminal occlusion manifests as myocardial ischaemia/infarction or death.

There are two published sporadic cases of SCAD who developed iatrogenic aortic dissection with coronary angiography.(2, 3) We are not aware of any SCAD cases with intercurrent or historical spontaneous aortic dissection. There is a published SCAD case with a familial history of aortic dissection, in her mother.(4) None of these cases reported a connective tissue disorder.

Methods

We searched our database of 338 SCAD cases, recruited via social media or cardiologist referral, for cases with a family history of aortic dissection. SCAD diagnosis was confirmed by review of coronary angiogram images by an expert interventional cardiologist blinded to the genetic analysis.

Genomic DNA was extracted from buccal cells collected using a cheek swab or mouthwash sample. Whole genome sequencing was performed using the Illumina HiSeq X Ten platform with 30x coverage.

These data are being analysed for rare variants in genes associated with familial aortopathies or connective tissue disorders (e.g. FBN1, COL3A1, TGFbR-1/2, SMAD3), as well as for novel gene associations with aortic dissection and/or SCAD.

Results

We identified 12 cases with a first- or second-degree relative with aortic dissection. Of these SCAD cases, 11 were female whereas 10 of 12 relatives with aortic dissection were male. In one instance, a maternal uncle, but not the index SCAD case, had Marfan's syndrome.

Whole genome sequencing has been performed on the 12 SCAD cases, 2 living relatives with aortic dissection and 2 relatives linking the SCAD and aortic dissection cases.

Conclusions

Coronary and aortic dissections have serious consequences and in some families there may be a genetic association between the two conditions. Early identification of variant carriers is critical for disease prevention.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): This work was supported in part by grants from the Cardiac Society of Australia and New Zealand, the National Health and Medical Research Council, Australia (APP1161200), the St Vincent's Clinic Foundation, the Catholic Archdiocese of Sydney, Perpetual Philanthropy, NSW Health and SCAD Research Inc. LMC is funded by a University Postgraduate Scholarship through University of NSW and a grant from the Avant Foundation.
Management and outcome of non-ST-elevation acute coronary syndromes in the elderly admitted to spoke hospitals with no cath-lab facility
Authors: Mantovani F , Guerri E , Manca F , Calzolari M , Colaiori I , Musto D'amore S , Pignatelli G , Guiducci V , Navazio A
Published: October 2021

Background

Current guidelines recommend an early invasive strategy in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). However, the role of an invasive strategy in elderly patients remains controversial and may be difficult to achieve in spoke hospitals with no cath-lab facility.

Purpose

We aimed to analyze characteristics and outcomes of patients ≥80 years with NSTE-ACS admitted to spoke hospitals.

Methods

Observational retrospective study of all consecutive NSTE-ACS patients admitted to two spoke hospitals, where a service strategy (same-day transfer between spoke hospital and hub center with a cath-lab facility to perform coronary angiography) was available.

Results

From 2013 to 2017, 639 patients were admitted for NSTE-ACS in a spoke hospital of our provincial cardiology network; of these, 181 (28%) were ≥80 years (median 84, IQR 82–89). In the elderly conservative strategy was chosen in 76 patients (42%). When the invasive strategy was chosen, 104 patients (93%) were managed with a Service strategy with no major adverse event observed during the back transfer from the invasive center to the referring spoke center, whereas the rest of the patients (8, 7%) were transferred from the spoke hospital to the hub center and completed their hospital stay without returning to the spoke center. Of patients initially managed with the service strategy, a shift of strategy after the invasive procedure was necessary for 11 (10%) and the patients remained in the hub center. The median time to access to cath-lab was 50 hours (IQR 25–87), with 73 patients (70%) reaching the invasive procedure <72 h from the hospital admission and 23 (22%) <24 h.

Conservative strategy was associated with older age, known previous CAD, clinical presentation with symptoms of LV dysfunction, lower EF, renal failure, higher GRACE score, presence of PAD, and atrial fibrillation (all p<0.03; Table).

At 1-year follow-up, the overall survival was significantly higher in patients treated with invasive strategy compared to patients managed conservatively (94%±2 vs. 54%±6, p<0.001; HR: 10.4 [4.7–27.5] p<0.001; Figure), even after adjustment for age, serum creatinine, known previous CAD and EF (adjusted HR: 2.0 [1.0–4.0]; p<0.001).

Conclusion

An invasive strategy may confer a survival benefits in the elderly with NSTE-ACS. When the invasive strategy is chosen, the same-day transfer between spoke hospital and hub center with the cath-lab facility (service strategy) is safe and granted the access to cath-lab in a timely fashion even in the elderly.

Funding Acknowledgement

Type of funding sources: None. Table 1Figure 1
Percutaneous transluminal angioplasty associated with a comparable risk of mortality in old patients with severe lower extremities arterial disease
Authors: Liu C W , Su M I
Published: October 2021

Background

Percutaneous transluminal angioplasty (PTA) improves limb salvage rates in patients with severe lower extremity arterial disease (LEAD). It remains unknown whether PTA can be safely performed to the older LEAD patients.

Purpose

We investigated the effect of age ≥85 vs <85 years on prognoses in LEAD patients.

Methods

We analyzed 222 LEAD patients from our previous retrospective cohort study between 2013 and 2018. All patients received percutaneous transluminal angioplasty. Study outcomes were in-hospital mortality and 1-year all-cause mortality and major adverse limb events (MALEs).

Results

The study included 222 patients aged 74±11 years (54% male), and 12.6% had acute limb ischemia. The older group had significantly higher rates of in-hospital (17.8 vs. 5.1%, P=0.009) and all-cause mortality (37.8% vs. 19.2%, P=0.016), but MALEs were not different significantly (8.9% vs. 16.9%, P=0.247). In multivariate logistic regression analyses, age ≥85 years was not associated with the increased risks of the study outcomes after we adjusted for potential confounders. The risk factors associated with 1-year all-cause mortality was the presence of acute limb ischemia (adjusted HR: 2.978, 95% CI: 1.502–5.905, P=0.002) and Rutherfold stages (adjusted HR: 2.135, 95% CI: 1.248–3.652, P=0.005).

Conclusion

Compared with the patients aged less than 85 years, the LEAD patients aged more than 85 years had favorable risks of mortality after receiving PTA, and the incident MALEs were not significantly different.

Funding Acknowledgement

Type of funding sources: None. Study outcomes in LEAD patients
Invasive management in elderly patients with non-ST elevation myocardial infarction is beneficial regardless of frailty status
Authors: Fishman B , Sharon A , Itelman E , Tsur A M , Fefer P , Barbash I M , Segev A , Matetzky S , Guetta V , Grossman E , Maor E
Published: October 2021

Introduction

Elderly patients are underrepresented in clinical trials evaluating the management of non-ST elevation myocardial infarction (NSTEMI) patients. Moreover, frailty status is often not reported in these trials.

Purpose

To evaluate the association of invasive management with outcome among elderly (≥80) patients presenting with NSTEMI by frailty status.

Methods

Retrospective cohort of consecutive elderly patients who were hospitalized with NSTEMI as a primary clinical diagnosis between 2008 to 2019. Primary outcome was all-cause mortality. Frailty status was estimated as a continuous variable as well as categorized to low, medium, and high. Cox regression models were applied with stratification by frailty status. Additional sensitivity analyses were conducted including propensity score matching (PSM) and inverse probability treatment weighting (IPTW) models.

Results

Study population included 2,317 patients with median age of 86 years (IQR 83–90) of whom 1,243 (54%) were men. Patients who were managed invasively (n=581 [25%]) were less likely to be frail (7% vs. 44%, p<.001). During the follow up (median of 19 months, [IQR 4–41]), 1,599 (69%) patients died. Kaplan Meier survival curves (Figure 1) show that the cumulative probability of death at 19 months was 50% among patients who were managed conservatively compared with 21% among invasively managed patients (p Log rank <.001). In the multivariable Cox model, invasive approach was associated with a significant 39% decrease in the risk of death (95% CI 0.53–0.71). The benefit of invasive approach was consistent among low, medium, and high frailty subgroups with adjusted HRs of 0.74 [0.58–0.93], 0.65 [0.50–0.85] and 0.52 [0.34–0.78], respectively; p for interaction NS). Results were consistent with PSM and IPTW analyses (HR of 0.6 [0.50–0.71] and 0.67 [0.55–0.82], respectively). Additional sensitivity analysis addressing potential immortal time bias and residual confounding yielded similar results.

Conclusions

Invasive approach is associated with improved survival among elderly patients with NSTEMI irrespective of frailty status. Our results support and extend recent ESC recommendations for the management of elderly patients with NSTEMI

Funding Acknowledgement

Type of funding sources: None. Figure 1
Prediction of radiation-related cardiotoxicity using F-18 FDG PET in non-small-cell lung cancer
Authors: Cho S G , Kim Y H , Park H J , Park K S , Kim J H , Ahn S J , Bom H S
Published: October 2021

Background

Radiation-related cardiotoxicity has been refocused nowadays as the follow-up was increased amomg the patients with advanced lung cancer. The early recognition of the occult cardiotoxicity enables the early intervention preventing clinically significant cardiac events or worsening of severity.

Purpose

We aim to search whether the F-18 fluorodeoxyglucose positron emission tomography (FDG PET) performed immediately after radiotherapy could predict the late cardiac events.

Methods

We retrospectively enrolled 133 patients with locally advanced, unresectable stage III NSCLC who underwent F-18 fluorodeoxyglucose positron emission tomography (FDG PET) immediately after CCRT for the response evaluation and survived at least for 6 months. Heart was recontoured according to the RTOG 0617 secondary analysis atlas for the dose volume analysis. Standardized uptake values (SUV) of the left ventricular myocardium were measured on FDG PET images. The patients were regularly followed up for the disease progression and complications. The primary end-point was the cardiac events grade ≥2 based on the Common Terminology Criteria for Adverse Events (version 5.0).

Results

FDG PET was performed at median interval of 11 days after CCRT. Fourty-two patients experienced cardiotoxicity during a median follow-up of 47 months (range, 12 – 123 months). In univariable analysis, mean heart dose, maximum SUV of the left ventricle (LV SUVmax), white blood cell count, and diabetes were associated with the risk of cardiotoxicity. In multivariable analysis, only higher mean heart dose (>11.1 Gy, hazard ratio 3.930 [95% confidence interval 1.933–7.988]; p=0.0002) and higher LV SUVmax (>12.84, 2.189 [1.162–4.124]; p=0.0152) were independently associated with increased risk of cardiotoxicity. In subgroup analyses, LV SUVmax remained predictive of cardiotoxicity among those with higher mean heart dose, but not among those with lower mean heart dose.

Conclusion

Early FDG PET after CCRT for NSCLC could predict the late cardiac events, especially in patients with high dose cardiac irradiation.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by a grant of the Basic Science Research Program through the National Research Foundation funded by the Ministry of Education, Republic of Korea (Principal Investigator: Sang-Geon Cho)
Incident cardiovascular events among healthy subjects are associated with increased risk of subsequent cancer diagnosis
Authors: Fardman A , Tiosano S , Kaplan A , Kalstein M , Moshkovits Y , Segev S , Klempfner R , Segev A , Grossman E , Maor E
Published: October 2021

Introduction

While Cardiovascular disease (CVD) and cancer share common risk factors, data on the temporal association between the occurrence of CVD and cancer is limited.

Purpose

This study investigated the association between incident CVD events future cancer among apparently healthy subjects.

Methods

We evaluated asymptomatic self-referred adults who participated in a screening program. All subjects were free of CVD and cancer at baseline. CVD was defined as the composite of acute coronary syndrome, percutaneous coronary intervention, or stroke. Study endpoint was the development of cancer during follow up. Cancer and mortality data were available for all subjects from national registries. Cox regression models were applied with CVD as a time-dependent covariate and death as a competing risk event.

Results

Final study population included 26,574 subjects. Median age was 46 years (Interquartile range [IQR] 40–53) and 69% were men. During median follow up time of 10 years (IQR 3–16) 2,463 (9%) subjects developed CVD, 2,040 (8%) developed cancer and 869 (3%) died. Most common cancer types were prostate among men (N=406, 2.2%) and breast among women (N=283, 3.4%). Compared with patients who were free of CVD and cancer during follow up, risk of death was 5, 34 and 54 times higher for patients who developed CVD event, cancer, or both during follow up, respectively (p <.001 for all). Time dependent survival analysis showed that subjects who developed CVD during follow up were 50% more likely to develop cancer in a univariate model (95% Confidence Interval [CI] 1.3–1.7, p<.001). Interaction analysis demonstrated that the association of incident CVD with the risk of future cancer diagnosis was age dependent such that in younger subjects (≤52 years; N=19,052) incident CVD was associated with a significant 30% increased risk of subsequent cancer diagnosis (95% CI 1.03–1.67, p=.027) while in older subjects incident CVD was not associated with increased risk of cancer in the multivariable model (p for interaction =.018).

Conclusion

Incident CVD is independently associated with increased risk of subsequent cancer diagnosis among young adults. Active cancer surveillance should be considered among young patients recovering from a CVD event.

Funding Acknowledgement

Type of funding sources: None.
Effect of the number of parity on right heart chamber quantification
Authors: Keskin M , Borklu E B , Dogan S , Ozturk B , Tenekecioglu E , Keser N , Orhan A L
Published: October 2021

Introduction

Pregnancy is a process that causes several physiological changes including all systems as well as cardiovascular system. Ventricular hypertrophy and dilation of cardiac chambers are seen as a result of these changes. Although there are studies about pregnancy-related changes in echocardiographic examination; there is no data about the long-term effects of parity on these alterations. Therefore, we have evaluated the long-term effect of pregnancy on right ventricular (RV) dilation and RV hypertrophy and their relation to the parity number.

Methods

This prospective study included a total of 600 women (200 consecutive women who had no parity, 200 women who had a parity number of 1 to 4 and 200 women who had a parity number of more than 4). Right chambers' measurements were compared between the groups.

Results

In echocardiographic analysis, RV and right atrial dimensions and areas and RV wall thickness were higher in parous women. On the other hand, RV systolic function parameters were significantly lower in parous women. These significant changes showed a gradual increase or decrease by increasing parity number. By multivariate hierarchical logistic regression analysis, the 4 independent factors that increased the risk of RV dilation were age (OR: 1.16 CI: 1.10 – 1.20), body mass index (OR: 1.05, CI: 1.02 to 1.08), smoking (OR: 1.87, CI: 1.28 to 4.02), and giving a birth (OR: 3.94 CI: 1.82 – 8.81). There were also independent relationship between the number of parity and RV hypertrophy even after adjustment for several confounders.

Conclusion

Pregnancy-related physiological changes mostly resolve after delivery. This study about long-term effects of pregnancy on RV has demonstrated that there is a significant relation between the number of parity and either RV dilation or RV hypertrophy. Each parity had also additive effect on these changes.

Funding Acknowledgement

Type of funding sources: None.