bluuebunny/crossref_metadata_2025 huggingface dataset:
Beta-receptor desensitization after a multistage ultralong distance exercise in the desert?
Authors: Chague F , Carre F , Gudjoncik A , Richard C , Compagnon F , Ganancia O , Pasquereau V , Zeller M , Cottin Y
Published: October 2021

Background

Although cardiac function has been largely investigated during ultra-endurance exercise, few studies addressed to multi-stage endurance race.

Methods

Serial echocardiographic assessment of cardiac function was performed in male healthy subjects during the 2014 Marathon des Sables before the race (T1), at the second (T2) and fifth (T3) arrival (236 km) then after 48h recovery. Analysis were performed by 2 sonographers blind for the results of the other and the time of measure.

Results

Among the 20 athletes, 18 completed the study (mean age 42.4, median 42). RR intervals and (Left ventricular End Diastolic Volume (Simpson) (LVEDV) changed during the race and were correlated (r2 = 0.539, p<0.001); afterload approched by Left Ventricular Meridional Wall Stress (LVMWS) did not change. LV Global Longitudinal Peak Strain (PS) and subepicardial (Epi) PS did not vary. Subendocardial (Endo) LV.PS was lower at T2 /T1, concomitant to a (non-significant) drop in LVEDV; LV strain rate (SR) was lower at T4. RR and LVEDV were higher at T3 than at T2, and higher at T4 compared to T1 and T2. As preload conditions changed during the race, we studied the response of PS and SR to the change in preload (Starling mechanism). EndoPS/LVEDV, LVPS/LVEDV and SR/LVEDV did not change during the race but were lower after recovery.

Conclusions

48h after a multistage ultralong duration exercise, we observed a drop in heart rate and contractility response to preload. The evolution of these parameters could be explained by a beta-receptors desensitization. These data need to be confirmed by other studies.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): CHU Dijon Bourgogne ARS Bourgogne Franche Comté Evolution of parameters
Effect of endothelial nitric oxide synthase gene polymorphism on cardiovascular death and nonfatal myocardial infarction in Japanese general population
Authors: Saito Y , Otaki Y , Watanabe T , Wanezaki M , Kutsuzawa D , Tamura H , Kato S , Nishiyama S , Arimoto T , Takahashi H , Watanabe M
Published: October 2021

Introduction

Single nucleotide polymorphisms (SNP) of endothelial nitric oxide synthase (NOS3) have been reported to be associated with diabetes mellitus and myocardial infarction. However, few reports have prospectively investigated the effects of NOS3 SNP on cardiovascular death and nonfatal myocardial infarction.

Purpose

The purpose of this study was to investigate the impact of NOS3 SNP on cardiovascular death and the development of nonfatal myocardial infarction.

Methods

This prospective cohort study included 2,752 subjects (aged ≥40) who participated in a community based health checkup. We genotyped two SNPs within NOS3 (rs1808593, rs1799983). All subjects were prospectively followed during the median follow-up period of 15.4 years with the end point of cardiovascular death and nonfatal myocardial infarction.

Results

The homozygous G-allele (GG), heterozygous (GT), and homozygous T-allele (TT) carriers of rs1808593 were identified in 60 (2%), 706 (26%), and 1,986 (72%) subjects, respectively. Kaplan-Meier analysis demonstrated that homozygous G-allele carriers of rs1808593 had the greater risk than those without. Multivariate Cox proportional hazard regression analysis revealed that the homozygous G allele of rs1808593 was associated with cardiovascular death and the development of nonfatal myocardial infarction after adjusting for confounding risk factors.

Conclusions

NOS3 gene polymorphism could be a genetic risk factor for cardiovascular death and nonfatal myocardial infarction in the Japanese general population.

Funding Acknowledgement

Type of funding sources: None. Figure 1
High risk characteristics in patients with hypertrophic cardiomiyopathy for predicting cardiovascular events
Authors: Keskin B , Arslan S A , Uzunhasan I U
Published: October 2021

Aim

Sudden cardiac death is the most feared complication of hypertrophic cardiomyopathy due to its tendency to appear in young asymptomatic patients. Although intracardiac defibrillators proved to be most efficient treatment, the selection of patients for primary prevention is controversial due to lack of randomized trials. Current risk algorithms fail to determine all high risk patients. In this study, we aimed to evaluate high risk factors to predict cardiovascular events in our hypertrophic cardiomyopathy population.

Method

A total of 254 patients who fulfill the criteria of hypertrophic cardiomyopathy by echocardiography between 2011 and 2020 were retrospectively included in the study. Data on recent comprehensive vital clinical and survival status were obtained up to 30th January 2020, by hospital visit or from hospital system. The primary endpoints were described as all-cause mortality, myocardial infarction, cerebrovascular events, appropriate ICD therapy interventions.

Results

The median follow up in this study was 54.5 months. During follow up 18 (%7.1) all-cause mortality, 4 (%1.6) myocardial infarction, 12 (%4.7) cerebrovascular events, 19 appropriate ICD interventions, 83 (%32.7) hospitalization due to cardiovascular cause were encountered. Median time of the primary end points was 37.5 months. The incidence of ischemic heart disease, atrial fibrillation, syncope, nonsustained ventricular tachycardia were higher in primary end points group. The outcomes and predictors of our study are given in Tables 1 and 2.

Conclusion

In our study, the primary outcome was observed more frequently in high-risk patients according to the ESC algorithm, but primary outcomes were also observed in a significant portion of low and intermediate risk patients.Therefore, current risk algorithms for sudden cardiac death still have certain limitations in predicting clinical outcomes and new algorithms with high sensitivity and specificity are needed.

Funding Acknowledgement

Type of funding sources: None. Table 1Table 2
Type 2 diabetes significantly modulates the power of lipoprotein(a) to predict cardiovascular events and mortality in young coronary artery disease patients
Authors: Mader A , Maechler M , Larcher B , Sprenger L , Mutschlechner B , Benda M , Leiherer A , Muendlein A , Vonbank A , Drexel H , Saely C H
Published: October 2021

Lipoprotein(a) [Lp(a)] is an important cardiovascular risk factor especially in young individuals.

The purpose of this study was to investigate whether Lp(a) has the power to predict cardiovascular events in young coronary artery disease (CAD) patients with type 2 diabetes (T2DM).

Lp(a) was measured in a cohort of 731 patients with angiographically proven CAD who were aged <65 years. Vascular events were recorded over a mean follow-up of 6.6±3.2 years.

At baseline, 216 patients had T2DM, and 515 did not have diabetes. During follow-up, 30.2% of our patients suffered cardiovascular events. Lp(a) proved to be a strong and independent predictor of vascular events in the total study cohort (standardized adjusted HR=1.30 [1.07–1.56]; p=0.007). In subgroup analyses by diabetes status, Lp(a) significantly predicted vascular events in non-diabetic patients (standardized adjusted HR= 1.39 [1.12–1.74]; p=0.003) but not in diabetic patients (standardized adjusted HR=0.93 [0.63–1.38]; p=0.731). An interaction term Lp(a) x T2DM was significant (p=0.002), indicating that T2DM significantly modulated the power of Lp(a) to predict cardiovascular events.

We conclude that Lp(a) significantly modulates the power of Lp(a) to predict cardiovascular events in CAD patients <65 years.

Funding Acknowledgement

Type of funding sources: None.
Cardiac troponin as major mortality risk factor in SARS-CoV-2 infection
Authors: Gonzalez Leal A , Antonana Ugalde S , Arteagoitia Bolumburu A , Monteagudo Ruiz J M , Martinez Moya R R , Ortega Perez R , Rivas Garcia S , Sanroman Guerrero M A , Lorente Ros A , Rincon Diaz L M , Zamorano Gomez J L
Published: October 2021

Background

The COVID-19 pandemic has collapsed the health system, making it necessary to identify factors that help to predict and stratify the risk of patients on admission. Many factors have been used in clinical practice, but the scientific evidence available to date is limited.

Purpose

The objective of this study was to identify clinical and analytical predictors of 30-day mortality in SARS-CoV- 2 infection.

Methods

A total of 1708 consecutive patients hospitalized in our centre between 18th and 23rd March 2020 and 22nd August and 9th January 2021 with a confirmed microbiological diagnosis of COVID-19 by PCR were prospectively included. Cox regression analysis was performed to assess whether sex and race, smoking habit, chronic kidney disease, D-dimer, heart disease (defined as a history of acute myocardial infarction, heart failure, atrial fibrillation) and troponin at admission (cTnI levels greater than the 99th percentile of a healthy population) were related to the 30-day mortality of these patients.

Results

Baseline characteristic are shown in the table 1. Median hospital length of stay was 9 days (IQR 5 to 16). A total of 338 patients (19.8%) died within 30 days and 153 (9.0%) were admitted to the ICU. Furthermore, 52.1% of patients developed ARDS and 9.3% required non-invasive ventilation. A troponin at admission greater than the 99th percentile of a healthy population (HR 1.9, 95% CI 1.4–2.5, p<0.001) and a Charlson Comorbidity Index above 4 (HR 2.6, 95% CI 1.9–3.6, p<0.001) were independent predictors of 30-day mortality in patients admitted due to COVID- 19 infection.

Conclusions

At admission time, troponin values and patient comorbidity (Charlson Comorbidity Index ≥4) can be useful as prognostic markers of SARS-CoV-2 infection.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Hospital Ramon y Cajal
Remnant cholesterol in patients with established cardiovascular disease predicts cardiovascular events both among patients with type 2 diabetes and among non-diabetic subjects
Authors: Mader A , Sprenger L , Vonbank A , Larcher B , Maechler M , Mutschlechner B , Benda M , Leiherer A , Muendlein A , Drexel H , Saely C H
Published: October 2021

Remnant cholesterol, which is calculated as total cholesterol minus LDL cholesterol minus HDL cholesterol has attracted interest as a marker of cardiovascular event risk.

The purpose of this study was to investiage whether remnant cholesterol has the power to predict cardiovascular events in patients with established cardiovascular disease.

We enrolled 1822 consecutive patients with established cardiovascular disease, including 1472 with angiographically proven stable CAD, 350 with sonographically proven peripheral artery disease. Prospectively, cardiovascular events were recorded over a mean follow-up period of 6.2±3.2 years.

At baseline, remnant cholesterol was significantly higher in patients with T2DM (n=608) than in non-diabetic subjects (27±25 vs. 21±21 mg/dl; p<0.001). During follow-up, 584 of our patients suffered cardiovascular events; the event rate was significantly higher in patients with T2DM than in non-diabetic subjects (45.4 vs. 32.2%; p<0.001). Remnant cholesterol in Cox regression models adjusting for age, sex, hypertension, smoking, body mass index and LDL cholesterol independently predicted cardiovascular events in the total study population (standardized adjusted HR 1.15 [1.07–1.23]; p<0.001), and in patients with T2DM as well as in non-diabetic subjects (standardized adjusted HRs 1.17 [1.03–1.34]; p=0.013 and 1.12 [1.01–1.23]; p=0.028, respectively).

From our data we conclude that remnant cholesterol in patients with established cardiovascular disease predicts cardiovascular events both among patients with T2DM and among non-diabetic subjects.

Funding Acknowledgement

Type of funding sources: None.
Residual cardiovascular risk of patients with dyslipidemia receiving multifactorial cardiovascular prevention therapy
Authors: Barkas F , Anastasiou G , Adamidis P , Koutsogianni A D , Liamis G , Elisaf M , Liberopoulos E
Published: October 2021

Background

Few studies have reported on the incidence and risk factors of cardiovascular disease (CVD) in patients with dyslipidemia receiving multifactorial treatment.

Purpose

To record CVD incidence and risk factors in patients with dyslipidemia receiving multifactorial CVD prevention therapy.

Methods

This was a retrospective observational study including consecutive adult patients with dyslipidemia who were followed for ≥3 years at the outpatient Lipid Clinic of our University General Hospital. We recorded CVD incidence and compared it with ATTICA study, an epidemiological prospective cohort assessing the 10-year cardiovascular risk in a representative sample of the general population in Greece. Factors that were significantly associated with incident CVD were additionally identified.

Results

A total of 1,334 individuals were included and followed-up for 6 (4–10) years. Lipid-lowering treatment was overall prescribed to 94% of study participants, while 70% were on antihypertensive and 20% on glucose-lowering therapy. During follow-up, 95 subjects (7%) developed CVD events. Despite higher baseline cardiovascular risk, CVD incidence rate in this study was lower compared with ATTICA (10.4 vs 15.7/1,000 person-years, respectively). Diabetes (HR: 2.09, 95% CI: 1.18–3.70, p<0.001), established CVD at baseline (HR: 2.04, 95% CI: 1.21–3.43, p<0.001), smoking (HR: 1.82, 95% CI: 1.17–2.84, p<0.001) and age (HR: 1.07, 95% CI: 1.4–1.9, p<0.001) were independently associated with incident CVD.

Conclusions

CVD incidence rate of high-risk dyslipidemic patients receiving multifactorial treatment was lower compared with general population. Diabetes, smoking, age, and baseline CVD remain the residual CVD risk factors in dyslipidemic patients receiving prevention therapy.

Funding Acknowledgement

Type of funding sources: None.
Key aspects of statin intolerance leading to treatment discontinuation: a patient perspective
Authors: Catapano A L , Wiklund O , Bushnell D M , Martin M L , Sidelnikov E , Vrablik M
Published: October 2021

Background and aims

Statins are the standard of care for patients with dyslipidemia, but some patients develop intolerance to treatment. The experience of statin intolerant (SI) patients is poorly understood. The objective of this study was to identify key aspects of SI that may be associated with treatment discontinuation.

Methods

Using a previously created questionnaire, we conducted a pilot cross-sectional survey to identify items important for describing patient-centric aspects of SI. The study recruited adult (18+) patients with a history of statin-associated side effects from 9 clinics in 6 countries (France, Italy, Norway, Spain, Sweden, and the United Kingdom), who had received statin treatment within the previous two years.

Results

We surveyed 104 patients (mean age 61.5 SD=11.2 years, 63.5% men, 50% currently on statins). Patients most frequently reported muscle-related symptoms: pain (90.9%), cramps (63.7%), and stiffness (58.2%). Using a 0–10 point scale, significant differences were found between those continuing versus discontinuing their statins for being bothered by side effects (7.5 vs 9.2, p=0.001), for an inability to tolerate side effects (6.7 vs 9.0, p<0.001), and those having too much side effects interference with their daily life (5.7 vs 8.6, p<0.001; see figure). For patients whose doctors worked on adjusting statin regimen, 67% stayed on treatment; for those whose doctors did not, only 10% continued treatment.

Conclusions

Results of this pilot survey suggest patients who experience greater side effects severity and interference with daily activity, along with lower efforts by clinicians to work with adjusting their statin regimen, are at greater risk for discontinuing treatment. A wider survey and larger study population is needed to confirm the results of this pilot study.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): This study was sponsored by Amgen Inc.
Liver steatosis, metabolically healthy obesity and ten-year cardiovascular disease risk: results from a population based cohort study
Authors: Kouvari M , Chrysohoou C , Georgousopoulou E , Skoumas J , Pitsavos C , Panagiotakos D B , Mantzoros C S
Published: October 2021

Background/Introduction

Inclusion of non-alcoholic fatty liver disease (NAFLD) as a component of metabolic syndrome (MetS) and/or a criterion for defining metabolically healthy vs. unhealthy obese (MHO vs MUO) status remains to be decided.

Purpose

The present work evaluated the role of NAFLD at baseline in the transition of MHO to MUO status, and its role in predicting cardiovascular disease (CVD) incidence ten years later.

Methods

A prospective longitudinal study was performed between 2001 and 2012 studying 1,514 (49·8%) men and 1,528 (50.2%) women (>18 years old) free of CVD at baseline and residing in the greater Athens area, Greece. Follow-up assessment of first fatal/non fatal CVD event (2011–2012) was achieved in n=2,020 participants (n=317 cases). Healthy metabolic status was defined as absence of all NCEP ATP III (2005) metabolic syndrome components. NAFLD was defined according to validated liver steatosis indices.

Results

Among obese participants, MHO prevalence was 9.8% (n=277). Only half of the MHO subjects retained their metabolically healthy status one decade later. NAFLD was an important predictor of this transition; MHO participants with NAFLD at baseline had about two times higher odds to develop unhealthy metabolic status compared with their non-NAFLD counterparts. Subsequently, MHO status accompanied by NAFLD was associated with increased CVD risk (Hazard Ratio=2.90 95%Confidence Interval (1.35, 5.40)) in contrast to their non-NAFLD MHO counterparts. C-statistics revealed that NAFLD significantly increased the discriminative ability of the standardly defined metabolic status (p for C-index change=0.002), yet in the total sample its contribution to the model seemed to be similar with the common metric of central obesity i.e. waist circumference (CNAFLD=0.711 vs. Cwc=0.710). When the analysis was restricted to the obese subset, it was revealed that the discriminative ability of the model adjusted for NAFLD was significantly higher compared with the one adjusted for waist circumference (CNAFLD=0.719 vs. Cwc=0.702).

Conclusions

Taking under consideration NAFLD – via validated indices – in the clinical assessment of an apparently healthy obese individual contributes to better defining future risk of conversion to metabolically unhealthy obesity and future cardiometabolic risk.

Funding Acknowledgement

Type of funding sources: None.
Early results on the efficacy and acceptability of a cardiac rehabilitation programme that transitioned to a fully virtual platform with adoption of wearable technology for covid era
Authors: Connolly S B , Jones J L , Jennings C , Neubeck L , Wood D A
Published: October 2021

Background/Introduction

Cardiaovascular prevention/rehabilitation programmes continue to reduce cardiovascular mortality even with contemporary treatment. During covid the majority of face-to-face programmes were suspended but these services have never been more crucial as control of cardiovascular risk factors can mitigate the morbidity/mortality risk from covid. Programmes must now however be delivered in a way that reduces patient exposure. Here we describe how we rapidly transitioned our previously fully face to face cardiovascular prevention/programme to a completely virtual platform adopting Fitbit as wearable technology.

Methods

The previously face-to-face initial assessment (IA) conducted by the multidisciplinary team (MDT) – nurse, dietician and physiotherapist is now delivered via video/phone as per patient preference. Patients are provided with equipment kits (tape measures, blood pressure monitors (BP), Fitbit smartwatches and Fibricheck app as required.

The virtual IA includes assessment of: Smoking habit, blood pressure (BP), heart rate, lipid profile and HbA1c (taken in community phlebotomy hub), cardioprotective medications, weight, BMI, waist circumference, Mediterranean Diet Score, functional capacity via the Duke Activity Status Index, habitual activity levels, risk stratification for exercise, hospital anxiety and depression scores (HADS) and quality of life (QOL). Patients receive education and tailored advice with SMART goals as well as a written care plan.

The subsequent 12 programme is comprised of

Results

Between April and November 2020 n=262 had a virtual IA (94% of those offered and n=114 (95% of those offered) attended an end of programme assessment. 64% were male and the mean age was 64.1 years. Acceptance of the Fitbit device was 72% of those offered. Table 1 below shows the main clinical and patient-reported outcomes in those attending both an IA and EOP with the data for the same 6 months the year prior (face to face programme) also for comparison. Programme satisfaction ratings were high with 85% rating the programme as excellent or very good.

Conclusions

Transitioning a previously fully face to face cardiac rehabilitation programme to a wholly virtual platform was feasible and acceptable to patients. Early data analysis would suggest that the virtual programme achieves similar clinical and patient reported outcomes.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Funded under Transformation Funding Programme, Department of Health, Northern Ireland Table 1
Rehabilitation in post-COVID patients. A single center experience
Authors: Villani G Q , Villani M , Halasz G , Rosi A , Piepoli M F
Published: October 2021

The COVID 19 disease is frequently associated with significant disability related to intensive care unit-acquired weakness, decontitioning, myopathies and neuropathies. However there are no data on the results of a specific rehabilitative treatment in this group of patients.

The aim of our work was to evaluate the effectiveness f a personalized rehabilitative therapy in group of post-COVID patients (A, 47 patients, average age 65.3±11.6 y, 27 M,) comparing the results with a group of post-cardiosurgical patients COVID 19 negative (B, 47 patients, average age 63.5±10.3 y, 29 M) evaluating the degree of clinical complexity (Rehabilitation Complexity Scale, RCS-E V13) and the degree of autonomy recovery (Six-minute walking test SMWT, Barthel Index, BI) pre and post-treatment.

In Group A patients the Rehabilitation program is associated with a significant improvement in autonomy recovery (BI admission 29.7±20 vs discharge 72.7±28.6 p<0.005, SMWT admission 146±25 vs 318±18 m, p<0.005) and in clinical complexity (RCS admission 10.9±1.1 vs discharge 5.3, p<0.05).

At admission the comparison between Group A vs B has show:

1. a reduced pre-rehabilitation hospital stay (days) in Group Vs A (B 8.2±2 vs 31±5 0.005)

2. a similar degrre of clinical complexity (RCS scale A 10.9±1.1 vs 1.6±11.2 p ns)

3. a greater loss autonomy in post-COVID patients (BI scale A 29.7±20 vs B 47.7±19, p 0.05; SMWT A 145±25 m vs B 255±18 m, p 0.05)

After a similar period of rehabilitation (A 29.7±12.8 days vs B 29.6±10 days, p ns) we observed in both Groups:

1. a reduction of clinical complexity ((RCS scale A 5.3±2 vs 6.6±2 p ns

2. an improvement of degree of autonomy recovery ((BI scale A 72.7±28 vs B 47.7±19, p ns; SMWT A 385±18 m vs B 410±25m, p ns)

Conclusions

Post-COVID patients show a greater loss of autonomy than post-cardiosurgery patients. Rehabilitative treatment has proven effective in ensuring adequate functional recovery with similar results to those obtained in the population of cardiological subjects COVID 19 negative.

Funding Acknowledgement

Type of funding sources: None.
SLCO1B1 and ABCB1 genetic variations – possible players in management of dyslipidemia: CoLaus (PsyCoLaus) study
Authors: Chekanova V , Marques-Vidal P
Published: October 2021

Aims

To find genetic markers associated with response to statins in a general population.

Methods

Data from baseline (2003–2006), first (2009–2012) and second (2014–2017) follow-ups of a population-based, prospective cohort study in Lausanne, Switzerland. Management of dyslipidemia was assessed according to the Swiss GSLA or European ESC/EAS guidelines based on LDL-cholesterol levels. The associations between 51 SNPs and dyslipidemia control using statins was performed.

Results

617, 844 and 798 participants of the baseline, first and second follow-ups (UPs) were included. Prevalence of adequately managed dyslipidemia was 70%, 68.5% and 83.6% at baseline, first and second FUs, respectively. Out of the 51 SNPs, most statistically significant (p<0.05) associations with dyslipidemia control were found for SNPs related with SLCO1B1 (Solute Carrier Organic Anion Transporter Family Member 1B1) and ABCB1 (ATP Binding Cassette Subfamily B Member1), see Table. Still, most associations failed to replicate within survey periods or guidelines.

Conclusion

SLCO1B1 and ABCB1 polymorphisms might interact with response to statins. The use of genetic markers to guide statin prescription is not recommended, but for the future studies the impact of SLCO1B1 and ABCB1 in statin therapy should be further explored investigated.

Funding Acknowledgement

Type of funding sources: None. Table 1. SNPs and dyslipidemia: their association
Population genomic screening of all young adults in Australia to detect familial hypercholesterolemia: a cost-effectiveness analysis
Authors: Ademi Z , Marquina C , Lacaze P , Tiller J , Riaz M , Sturm A C , Nelson M , Ference B A , Pang J , Watts G F , Nicholls S J , Zoungas S , Liew D , McNeil J
Published: October 2021

Background

Heterozygous familial hypercholesterolemia (FH) is a highly-penetrant, autosomal dominant monogenic disorder that causes elevated plasma low-density cholesterol (LDL-C) levels and risk of premature coronary heart disease (CHD). To date, the cost-effectiveness of the emerging strategy of genomic screening of adult populations for FH has not been investigated.

Purpose

To assess the impact and cost-effectiveness of offering population genomic screening to all young adults in Australia to detect heterozygous familial hypercholesterolemia (FH).

Methods

We designed a decision analysis model to compare the current standard of care for heterozygous FH diagnosis in Australia (opportunistic cholesterol screening and genetic cascade testing) with population genomic screening of adults aged 18–40 years to detect pathogenic variants in the LDLR/APOB/PCSK9 genes. The model captured morbidity/mortality due to coronary heart disease (CHD) over a lifetime horizon, from a healthcare perspective. Risk of CHD, treatment effects, prevalence, and healthcare costs were estimated from published studies. Outcomes included quality adjusted life years (QALYs), costs and incremental cost-effectiveness ratio (ICER), discounted 5% annually. Sensitivity analyses were undertaken to explore the impact of key input parameters on the robustness of the model. The model structure was designed to be transferable to countries with different healthcare systems.

Results

Over the lifetime of the population (4,167,768 men; 4,129,961 women), the model estimated a gain of 62,722 years of life lived and 73,959 QALYs due to CHD prevention. Population genomic screening for FH would be cost-effective from a healthcare perspective if the cost per test was ≤AU$300 (∼US$233) which would yield an ICER AU$28,000 cost-saving.

Conclusion

Based on our model, offering population genomic screening to all young adults to detect FH could be cost-effective in the Australian healthcare system, at testing costs that are currently feasible.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): This work was supported by the Australian National Heart Foundation and Monash University Faculty of Medicine, Nursing and Health Sciences Results from scenario analysesResults from Monte Carlo simulations
Increasing prevalence of diabetic peripheral angiopathy and complications in hospitalized patients in the United States
Authors: Jiang D , Kuchta K , Amundson J , Tafur A , Morcos O , Lind B , Qamar A , Lee C J
Published: October 2021

Objectives

We aim to assess prevalence of diabetes related peripheral arterial disease and associated outcomes in hospitalized patients in the United States.

Methods

Trends in hospitalizations in diabetic patients with PAD were determined using the 2003–2017 National Inpatient Sample database. Hospital outcomes including diabetic ulcer incidence, amputations, and revascularizations were analyzed.

Results

The analysis included 10,303,673 hospitalizations in diabetic patients with PAD (DMPAD) during the study period. Prevalence of PAD among patients with diabetes increased over time (p<0.001). The prevalence of foot ulcers in diabetics have also increased over time (p<0.001). The incidence of amputations in patients with diabetes showed a decreasing trend with increasing prevalence of revascularizations from 2003 to 2009. Since 2010 however, rising rates of amputations, both minor and major are seen, especially in younger populations (age 18–49). Hospital costs for amputations have increased ($6.6 billion in 2003 vs $ 14.8 billion in 2017) as well as the costs for revascularization (6.1 billion in 2003 vs $13 billion in 2017) during the study period (p<0.001).

Conclusions

In this analysis of patients with DMPAD, an alarming rate of disease prevalence and in-hospital limb outcomes, including costs, are realized in the current era.

Funding Acknowledgement

Type of funding sources: None.
Mild cognitive impairment in middle-aged adults with coronary microvascular dysfunction
Authors: Nowroozpoor A , Sharp E , Gordon R , Malicki C , Hwang U , Dziura J , D'Onofrio' G , Safdar B
Published: October 2021

Introduction

Coronary microvascular dysfunction (CMD) may be a manifestation of systemic small vessel disease, including the brain. The prevalence of cognitive impairment in CMD patients is poorly understood.

Purpose

To assess the prevalence of cognitive impairment in patients with CMD.

Methods

Between April 2018-March 2020, we enrolled patients with chest discomfort who were admitted to a chest pain observation unit and underwent 3D cardiac positron emission tomography/computed tomography (PET/CT). Exclusions included myocardial infarction, hypertensive urgency, and heart failure. Patients were categorized as 1) Normal: coronary flow reserve (CFR) ≥2.5 without perfusion defect or calcification, 2) Possible CMD: CFR 2–2.5 without perfusion defects or calcification, 3) CMD: CFR <2 without perfusion defects or calcification and 4) coronary artery disease (CAD/CALC): any CFR with perfusion defects or calcifications. We assessed cognitive function with the Montreal Cognitive Assessment (MoCA) and used <23 as the cutoff for impaired cognition. We added 1 point to the total score for those with 12 years of education or less. Odds ratios of cognitive impairment in each group were calculated with the normal group as reference, adjusting for age, sex, and race.

Results

Of 111 patients consented, 109 patients had complete data for analysis. (Table 1) Mean age was 57 years (± 11), 68% were female, and 49% were non-White. All 11 patients with CMD were females, with a mean age of 59 years (±12). The majority (72%) of CMD patients had cognitive impairment on the MoCA compared to 25% of patients with normal flows (unadjusted OR: 8.00 [95% CI 1.70–37.67]), even after adjustment for age, sex, and race (OR: 37.23 (95% CI 2.01–677.05). MoCA scores did not differ significantly between the normal and the CAD/CALC group (unadjusted OR: 0.95 [95% CI 0.30–3.070]), or the possible CMD group (1.44 [95% CI 0.50–4.14]). Additionally, non-White patients were more likely to demonstrate cognitive impairment on MoCA than White patients (OR: 9.47 [95% CI 3.48–25.81]). There was no significant nonparametric correlation between CFR and the MoCA score (r=0.05, p=0.6).

Conclusion

Patients with CMD are more likely to have cognitive impairment, supporting the need to further investigate the heart-brain connection in systemic small vessel disease.

FUNDunding Acknowledgement

Type of funding sources: None.
Laboratory indicators of inflammation and systolic function of the left and right ventricles in patients with cardiovascular disease who have undergone COVID-19-associated pneumonia
Authors: Musikhina N , Petelina T , Yaroslavskaya E , Krinochkin D , Shirokov N , Osokina N , Gorbatenko E
Published: October 2021

Introduction

It is currently unknown what effect SARS-CoV-2 infection has on the parameters of aseptic inflammation in patients with cardiovascular diseases (CVD) in the long-term follow-up period and whether there is a relationship between the prolonged inflammatory response and the indicators of the global longitudinal strain, as the earliest marker of systolic dysfunction of left and right ventricles.

Purpose

To study the dynamics of markers of the inflammatory response and to assess the potential relationship of biomarkers of inflammation with parameters of left and right ventricular systolic function in patients with CVD who underwent COVID-19-associated pneumonia at the reference point 3 months after hospitalization.

Methods

The study included 63 patients (mean age 49.0±16.0 years) within “One-year Cardiac Follow-up of COVID-19 Pneumonia”. Group 1 (n=26) included patients without a history of CVD, group 2 (n=37) - patients with CVD. Three months after discharge from the hospital, patients came for a visit, where blood sampling and echocardiography with speckle tracking analysis were performed.

Results

At the stage of hospitalization, according to the computed tomography data, there were no differences in the volume of lung lesions in the groups. Patients with CVD had a higher level of highly sensitive C-reactive protein (CRP) upon admission to the hospital (group 1 – 33.12 [4.70–45.00] mg/l; group 2 – 47.16 [7.75–76.40] mg/L, p=0.039).

Naturally, in the general group after 3 months, the indicators reflecting the inflammatory response significantly decreased: CRP from 26.10 [5.02–57.5] mg/L to 1.86 [0.76–3.43] mg/L, p<0.001; neutrophil-lymphocyte ratio (NLR), from 2.05 [1.08–2.94] to 1.54 [1.27–1.90], p=0.009; coefficient of large platelets, M±SD from 34.30±6.74 to 23.60±6.59, p<0.001. There were no differences between the groups in the dynamics of inflammation biomarkers.

In group 1, there were no laboratory biomarkers associated with the parameters of myocardial systolic function. In group 2 negative relationship was recorded between the global longitudinal strain of the left ventricle and the CRP level c (r=−0.388; p=0.037) and with the platelet-lymphocyte ratio (PLR) (r=−0.383; p=0.040); endocardial global longitudinal strain of the right ventricle with CRP level (r=−0.386; p=0.039).

Conclusions

In patients who underwent COVID-19-associated pneumonia, after 3 months, the dynamics of laboratory markers of the inflammatory response did not depend on the presence of concomitant cardiac pathology, but only in patients with CVD there was a negative relationship between indicators of systolic function of the left and right ventricles and biomarkers of the inflammatory response.

Funding Acknowledgement

Type of funding sources: None.
Long-term mortality in women with myocardial infarction who underwent PCI using radial versus femoral access
Authors: Kanic V , Naji F H , Kompara G
Published: October 2021

Background

Radial artery approach (RA) has become the recommended vascular access for percutaneous coronary intervention (PCI). In particular, women are at higher risk of bleeding after PCI. RA reduces the risk of bleeding. However, data on the association between RA and mortality after MI in women undergoing PCI are sparse and long-term data are lacking.

Purpose

The aim of our study was to assess whether RA per se is associated with long-term mortality in women with MI who underwent PCI at our center.

Methods

We retrospectively studied 1528 consecutive female patients with MI who underwent PCI between January 2011 and December 2017. RA was performed in 573 (37.5%) patients. Long-term all-cause mortality was observed in the RA and femoral access (FA) groups. The median follow-up time was 3.0 (25th, 75th percentile; 1, 5) years. Data were analyzed using descriptive statistics.

Results

RA patients had significantly lower long-term unadjusted mortality [107 (18.7%) patients died in the RA group compared to 311 (32.6%) patients in the FA group; p<0.0001] (Figure 1). After adjusting for confounders, the RA patients still had more than a 20% lower mortality risk than the FA patients (adjusted HR: 0.78; 95% CI: 0.62 to 0.99; p=0.042) (Figure 2). Age, diabetes, hypertension, renal function, ST-elevation MI, TIMI flow after PCI, dual antiplatelet therapy, and bleeding additionally predicted mortality.

Conclusion

RA independently provided a lower long-term all-cause mortality risk in women with MI (ST-elevation MI and non-ST-elevation MI) who underwent PCI. This finding suggests that RA should be preferred in daily practice whenever possible. From a clinical perspective, it is irrelevant whether RA per se is associated with a better outcome or whether the better outcome is related to fewer bleeding events and lower rates of other complications due to RA. This is especially true for patients at higher risk of bleeding (women, elderly patients, underweight patients, and patients with renal dysfunction).

Funding Acknowledgement

Type of funding sources: None. Figure 1. Unadjusted long-term mortalityFigure 2. Adjusted long-term mortality
Simplified echocardiographic screening criteria for rheumatic heart disease
Authors: Kotit S
Published: October 2021

Introduction

Rheumatic Heart Disease (RHD) remains a major health problem in many low and middle-income countries. The paucity of systematic screening studies and differences in the diagnostic criteria might underestimate greatly the reported prevalence rates.

The standardized WHF criteria is the gold standard for the echocardiographic diagnosis of RHD. Keeping in mind the setting and the implementation of screening programs which require screening of large groups of individuals with limited resources, we have developed a simplified protocol for the swift recognition of RHD features (Image 1).

Purpose

Validation of a simplified protocol for the echocardiographic diagnosis of RHD in endemic areas based on screening and follow-up of a large sample of school children in comparison with the WHF criteria.

Methods

A systematic cross-sectional echocardiographic screening was performed in 3062 randomly selected schoolchildren, aged 5 to 15 years. Follow-up of 72 children with a definite or possible diagnosis of RHD together with a control group of 80 healthy children was carried over 48 to 60 months. The diagnosis of RHD was based on the current WHF criteria and compared to the simplified protocol (Image 2).

Results

Based on the WHF criteria 60 children were diagnosed with definite RHD (19.6/1000) vs 75 (24.5/1000) and 35 with possible disease (11.4 per 1000) versus 41 (13.4/1000) with the simplified criteria.

No significant differences were found in progression or regression rates between both criteria.

The appearance of isolated structural changes in 7 controls (8.8%) would lead to borderline diagnosis in the simplified criteria.

Conclusion

There is no significant difference in progression and regression rates between both criteria.

Importantly, the simplified criteria would diagnose 7 children from the control group as possible RHD, which could show the accuracy of the criteria in diagnosing subtle valvular lesions.

Funding Acknowledgement

Type of funding sources: None. Image 1. Simplified RHD criteriaImage 2. Progress of RHD based on criteria
Cognitive dysfunction among patients referred for transcatheter aortic valve implantation: results of the Montreal Cognitive Assessment and clinical impact at 6 months
Authors: Monnin C , Besutti M , Ecarnot F , Guillon B , Chatot M , Chopard R , Yahia M , Meneveau N , Schiele F
Published: October 2021

Background

Detection of Cognitive Dysfunction (CD) is not routinely performed among patients undergoing Transcatheter Aortic Valve Implantation (TAVI). We sought to determine whether CD has an impact on the clinical course of these patients, during hospitalization at the time of TAVI and up to 6 months afterwards.

Methods

The MoCA was performed before TAVI by an experienced operator in an unselected population of patients referred for TAVI. CD was defined according to the MoCA score: No CD if score ≥26, mild CD if score 18–25, moderate if 10–17 and severe if <10. Multivariate Cox logistic regression analysis was used to determine the impact of CD on procedural success of TAVI, length of stay, 6 month survival, re-admission, and change in clinical status (changes in NYHA class and/or functional status).

Results

MoCA was performed in 83 consecutive patients. TAVI was performed using femoral access and local anesthesia in all patients. There were no procedural deaths, and 2 deaths at 6 months. The median age was 85 years, and median Euroscore I was 11.62. The median MOCA score was 22, CD was excluded in 17 (20%), mild in 50 (60%), moderate in 15 (18%) and severe in one patient. No difference was observed in rate of procedural success, 6 month mortality, re-admission, degree of dyspnea by NYHA between the different cognitive groups. Length of stay after the TAVI procedure was lower in patients without CD, compared to those with CD at any level: 3±1 days versus 4.3±1 days, p=0.045, and p=0.02 by multivariate analysis (figure).

Conclusion

Among patients referred for TAVI, mild or moderate CD was observed in 80% of patients. Patients without CD had a shorter length of stay at the time of TAVI, but CD was not associated with worse prognosis or clinical status at 6 months.

Funding Acknowledgement

Type of funding sources: None.
Antithrombotic therapy and bleeding complications in patients with atrial fibrillation and active cancer
Authors: Chu G , Van Rein N , Huisman M V , Pedersen L , Cannegieter S C , Klok F A , Sorensen H T
Published: October 2021

Background

Little is known about the extent to which an active cancer diagnosis increases bleeding and thromboembolic risks in atrial fibrillation (AF) patients. Data on major bleeding rates per antithrombotic management strategy are lacking in AF patients with active cancer.

Purpose

To examine the incidence rates of major bleeding per antithrombotic treatment in AF patients with active cancer and to examine whether cancer type impacts major bleeding and thromboembolic risks.

Methods

We used Danish population-based health care databases to conduct this cohort study. We included all incident AF (including atrial flutter) patients aged ≥50 years between January 1st 1995 and December 31st 2016, out of whom we identified AF patients who subsequently developed cancer. We used International Classification of Diseases 10th Revision codes to identify data on cancer type and outcomes (i.e. major bleeding, arterial and venous thromboembolism). We used Anatomical Therapeutic Chemical codes to provide information on antithrombotic treatment (e.g. no anticoagulant treatment, platelet inhibitors, vitamin K antagonists, direct oral anticoagulants, or a combination of antithrombotic drugs) which was evaluated as a time-dependent variable. The follow-up started from the incident cancer diagnosis until the occurrence of an outcome, death or the end of the two year follow-up. Incidence rates per 100 patient-years and adjusted hazard ratios were computed.

Results

22,996 AF patients with a subsequent incident cancer diagnosis were included in the study. These patients had higher major bleeding and thromboembolic risk compared to those without cancer, with adjusted HRs of 2.11 (1.99–2.23) and 1.36 (1.27–1.44), respectively (Figure 1). Highest bleeding risk was observed for intracranial and respiratory cancer, while haematological and respiratory cancer were associated with highest thromboembolic risk. Bleeding risk increased with increasing number of antithrombotic drugs and was higher in AF patients with active cancer compared to those without, across all exposure categories (Figure 2).

Conclusions

Patients with AF and active cancer are at increased risk of major bleeding and thromboembolisms than those without cancer. Treatment with dual or triple antithrombotic therapy in AF patients with active cancer showed very high bleeding rates.

Funding Acknowledgement

Type of funding sources: None.
Impact of cardio-oncology strategies in the management of breast cancer patients
Authors: Karmous R , Bennour E , Kammoun I , Sghaier A , Chaieb W , Bayar F , Lassoued A , Cherif N , Ben Halima A , Addad F , Mejri N , Boussen H , Marrakchi S , Kachboura S
Published: October 2021

Background

Cardio-oncology has arisen as one of the most rapidly expanding fields of cardiovascular medicine. The accumulated evidence on the possibilities of early diagnosis of cardiotoxicity provided by imaging techniques as well as on the benefits of preventive and therapeutic interventions is also increasing.

Objective

This study reported our echocardiography lab's initial experience of a cardio-oncology follow-up program.

Methods

We prospectively studied the outcomes of 107 patients diagnosed with breast cancer who attended our follow-up program between 2017 and 2020. An echocardiographic monitoring were realised according to the chemotherapy protocol. Cancer therapy-related cardiac dysfunction (CTRCD) is defined, according to the european society of cardiology (ESC) guidelines of 2016, as a drop of left ventricular ejection fraction (LVEF) by >10 percentage points from baseline to a value <50%. A new entity named subclinical systolic dysfunction, is defined by a drop of global longitudinal strain (GLS) by >15% from baseline, however, LVEF remains >50%. The diagnosis should be confirmed by a second echocardiogram after 2–3 weeks.

Results

We enrolled 107 patients diagnosed with breast cancer and receiving anthracycline and/or trastuzumab. 27 patients were excluded for many reasons: 17 patients were lost to follow-up, 10 patients had an inadequate echo-imaging (8 had a follow-up without measurement of GLS and 2 patients were poorly echogenic). Only eighty patients were finally retained. The average age of our patients was 49.9±10.8 years. The mean left ventricular ejection fraction (LVEF) was at 64±4.4%. The incidence of CTRCD was 6%. the mean delay of diagnosis from the onset of chemotherapy was 174 days. It was reversible in 60% of cases after the initiation of a cardioprotective treatment which allowed the anti-cancer treatment pursuit. The incidence of subclinical cardiac dysfunction was 25%. The mean delay between the initiation of anti-cancer treatment and the diagnosis was 314.5 days. A cardioprotective treatment with Bblockers and angiotensin-converting enzyme (ACE) inhibitors was prescribed and all these patients recovered a normal GLS with a mean delay of three months and pursuied their chemotherapy.

Conclusion

We showed that timely cardiovascular evaluation, intervention and close monitoring in the context of a structured service allowed the majority of patients (99%) to pursue their anti-cancer treatment and to avoid the evolution to CTRCD in patients diagnosed with subclinical cardiac dysfunction.

Funding Acknowledgement

Type of funding sources: None. Treated subclinical cardiac dysfunction