bluuebunny/crossref_metadata_2025 huggingface dataset:
Antithrombotic strategy in patients with atrial fibrillation and acute coronary syndrome
Authors: Almeida I , Santos H , Santos M , Miranda H , Chin J , Sa C , Almeida S , Sousa C , Almeida L ,   Portuguese Registry of Acute Coronary Syndromes
Published: October 2021

Background

Atrial fibrillation (AF) is frequent in patients admitted with acute coronary syndromes (ACS). The development of this arrhythmia occurs in 2–21% of patients with non ST-elevation ACS and 21% of ST-elevation ACS. According with the most recent European guidelines, a short period up to 1 week of triple antithrombotic therapy (TAT) is recommended, followed by dual antithrombotic therapy (DAT) using a NOAC and a single antiplatelet agent, preferably clopidogrel.

Objective

To compare the antithrombotic strategy (DAT vs TAT) used and its prognostic value in patients with AF and ACS.

Methods

Retrospective analysis of patients' data admitted with ACS in a multicentric registry between 10/2010–09/2019. TAT was defined as the prescription of dual antiplatelet therapy and one anticoagulant and DAT as one antiplatelet and one anticoagulant. Survival and rehospitalization were evaluated through Kaplan-Meier curve.

Results

1067 patients were included, mean age 67±14 years, 72.3% male. Patients who developed de novo AF during hospitalization due to ACS were older (75±12 vs 66±14 years, p<0.001) and with higher prevalence of cardiovascular risk factors and cardiovascular disease. AF was more often in patients with ST elevation ACS (53.4%). During hospitalization, AF patients were more often medicated with aspirin, glycoprotein inhibitor, heparin, fondaparinux and vitamin K antagonists. No difference was found regarding P2Y12 inhibitors. AF patients presented more often obstructive coronary disease (normal coronaries 5.4 vs 8.5%, p<0.001) so they were more often submitted to PCI (79.5 vs 70.9%, p<0.001). AF patients presented with higher rates of adverse in-hospital events as re-infarction, heart failure, shock, ventricular arrhythmias, cardiac arrest, stroke, major bleeding and death (p<0.001). At discharge, AF patients were less prescribed with aspirin or ticagrelor, but the rate of clopidogrel prescription was higher, such as vitamin K antagonists or any of the new anticoagulants. In the AF group, 21.5% patients were discharged with TAT and 30.3% with DAT. Concerning patients discharged with TAT, 1-year follow-up revealed no significant differences in mortality (p=0.578), re-admission for cardiovascular causes (p=0.301) and total re-admission rates (p=0.291). Patients discharged with DAT had similar mortality (p=0.623) and re-admission for cardiovascular causes rates (p=0.138), but significant differences were identified regarding total re-admissions (p=0.024).

Conclusions

In patients with ACS and de novo AF, a low percentage of patients was discharged with oral anticoagulation (51.8%). In those whose anticoagulation was initiated, DAT was the preferred strategy. 1-year outcomes were not different between the antithrombotic strategy, except for all cause re-admission.

Funding Acknowledgement

Type of funding sources: None.
Mechanical circulatory support for refractory out-of-hospital cardiac arrest: a nationwide multicentre study
Authors: Moerk S R , Stengaard C , Linde L , Moller J E , Andreasen J B , Laugesen H , Thomassen S A , Freeman P M , Christensen S , Tang M , Gregers E , Kjaergaard J , Hassager C , Eiskjaer H , Terkelsen C J
Published: October 2021

Background

Extracorporeal cardiopulmonary resuscitation (ECPR) has shown potential as a salvage therapy for patients with refractory out-of-hospital cardiac arrest (OHCA). Despite growing interest in and a growing body of literature on ECPR for refractory OHCA, robust evidence on patient eligibility is still lacking.

Purpose

To describe the survival, neurological outcome, and adherence to the national consensus with respect to use of ECPR for OHCA, and to identify factors associated with outcome.

Methods

Retrospective, observational cohort study of patients who underwent ECPR for OHCA at four cardiac arrest centres. Binary logistic regression and Kaplan-Meier survival curves were performed to assess association with 30-day mortality.

Results

A total of 259 patients receiving ECPR for OHCA between July 2011 and December 2020 were included in the study. Thirty-day survival was 26% and a good neurological outcome Cerebral Performance Category (CPC) 1–2 was observed in 94% of patients at discharge. Strict adherence to the national consensus showed a 30-day survival rate of 30%. Adding one or more of the following criteria to the national consensus: signs of life during cardiopulmonary resuscitation (CPR), pre-hospital low-flow <100 minutes, pH >6.8 and lactate <15 mmol/L increased the survival rate to 48%, but would exclude 58% of the survivors from the current cohort. Logistic regression identified initial presenting rhythm with asystole (RR 1.36, 95% CI 1.18–1.57), pulseless electrical activity (PEA) (RR 1.20, 95% CI 1.03–1.41), initial pH <6.8 (RR 1.28, 95% CI 1.12–1.46) and lactate levels >15 mmol/L (RR 1.16, 95% CI 1.16–1.53) as factors associated with increased risk of 30-day mortality. Patients presenting signs of life during CPR had threefold higher survival rate than patients without signs of life (45% versus 13%, p<0.001)

Conclusion

A high survival rate with a good neurological outcome was observed in this population of patients treated with ECPR for OHCA. Signs of life during CPR may aid the decision-making in the selection of appropriate candidates. Stringent patient selection for ECPR may produce higher survival rates but potentially withholds life-saving treatment in a significant proportion of survivors, why optimization of the selection criteria is still necessary.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): This work was supported by the Danish Heart Foundation [20-R142-A9498-22178]; and Health Research Foundation of Central Denmark Region [R64-A3178-B1349] Survival and adherence to consensusSigns of life during CPR
Evaluation of adverse outcomes in patients with Troponinemia without significant coronary artery disease; a proposal application of the ACTION-ICU Score
Authors: Idrovo C P , Vasquez J F V , Navarro A , Medina R I , Carreno M , Giraldo L E , Isaza D
Published: October 2021

Purpose

Elevated troponin in absence of significant coronary artery disease is a frequent situation that is associated with increased mortality. Criteria to estimate complications in these patients are not defined. The aim of this study was to evaluate the predictive capacity of the ACTION-ICU score, a scale designed to predict likelihood of complication requiring ICU care for patients with NSTEMI, to define risk of complications in patients with elevated troponin without significant coronary artery disease.

Methods

A retrospective study of patients with elevated troponin and no significant coronary artery disease were selected to apply the ACTION-ICU Score to predict likelihood of complications. Complications were defined as cardiac arrest development, shock, high-grade atrioventricular block, respiratory failure, stroke, or death during the index hospitalization. ROC Curves were created to determine the predictive power.

Results

1221 patients were screened, of them 181 presented elevated troponin without significant coronary artery disease; age median 65 year (IQR 56–75 years), female 48,1%. Of 181 patients, 73.5% were admitted to ICU based on physician criteria. Only 13.3% of patients presented a complication. A score greater than 5 was present in 33.7% of the patients, of which 5,5% presented a complication. ROC to predict complications was 0,75 (95% CI: 0,65–0,86). Best cut off point was >6 points, sensitivity 70.83%, specificity 72.08%, LR+ 2.54, LR− 0.4.

Conclusions

In patients with elevated troponin and no significant coronary artery disease, the ACTION-ICU Score was a predictive scale for the development of complications with adequate accuracy. The best cut-off point for this classification in patients with elevated troponin in absence of significant coronary artery disease was >6.

Funding Acknowledgement

Type of funding sources: None. ROC Curve of ACTION-ICU score >6 points
Echocardiogram in critically ill patients with COVID-19
Authors: Gomes B F O , Silva T M B , Menezes I R R , Azevedo A S , Peres L S , Pereira D F P , Dutra G P , Paula S A M , Mendes B F S , Nascimento J H P , Cantisano A L , Petriz J L F , Carmo Junior P R , Pereira B B , Oliveira G M M ,   ECOVID Study
Published: October 2021

Background

Describe echocardiographic characteristics in patients admitted to an intensive care unit by COVID-19 and identify clinical and laboratory findings associated with an abnormal echocardiogram and its association with in-hospital mortality.

Methods

Included all patients with RT-PCR-confirmed COVID-19 who underwent echocardiography during hospitalization. Echocardiographic characteristics were assessed in the entire population and subgroups. We also analyzed clinical characteristics associated with an abnormal echocardiogram. An echocardiogram was defined as abnormal when it demonstrates systolic ventricular dysfunction of any degree (left and/or right ventricle) and/or high filling pressures (E/E' ratio>16; SPAP>40mmHg, RAP>15mmHg or diastolic dysfunction ≥ grade 2) and/or moderate to severe pericardial effusion. Clinical variables were also assessed using a classification tree and binary logistic regression was performed with characteristics that showed a statistical significance in univariate analysis. Finally, echocardiographic variables were assessed for in-hospital mortality outcome using the chi-square test.

Results

272 admissions to ICU by COVID-19 were identified. Of these, 159 underwent echocardiography (58.5%). 39 were excluded by incomplete demographic data. 72 echocardiograms (60%) were abnormal according to pre-established criteria. Low occurrence of left and right ventricular systolic dysfunction was observed, as well as 30.8% of the population had a normal diastolic function. In univariate analysis, characteristics associated with abnormal echocardiogram were age, elevated troponin, previous heart failure, and SAPS3 score. In the regression model, troponin was the independent marker of abnormal echocardiography in patients admitted to the intensive care unit by COVID19. This finding was corroborated by the classification tree. The abnormal echocardiogram was not associated with in-hospital mortality (OR 1.60; CI95% 0.75–3.41), but the presence of systolic ventricular dysfunction of any degree was associated with a higher occurrence of this outcome (OR 3.52; CI95% 1.12–11.1).

Conclusions

In intensive care COVID-19 patients, many manifested elevated ventricular filling pressures, but the occurrence of ventricular dysfunction was low. Elevated serum troponin level was the independent marker associated with an abnormal echocardiogram. Systolic ventricular dysfunction was the only echocardiographic variable associated with in-hospital mortality.

Funding Acknowledgement

Type of funding sources: None.
Clinical risk score for individualized risk stratification of patients with clinically suspected myocardial inflammation
Authors: Puntmann V , Carr-White G , Rolf A , Zainal H , Vasquez M , Zhou H , Arcari L , Valbuena S , Hinojar R , Vidalakis E , Kolentinis M , Martin S , Zeiher A , Marber M , Nagel E
Published: October 2021

Objective

To develop a clinical risk score for individualized risk stratification of patients with clinically suspected myocardial inflammation.

Background

Myocardial inflammation is a prominent cause of non-ischaemic dilated cardiomyopathy, heart failure (HF) and sudden cardiac death.

Methods

This is a prospective multicentre longitudinal study of consecutive patients referred to cardiac magnetic resonance (CMR) with clinically suspected myocardial inflammation between October 2011 and December 2019 as a part of standard diagnostic pathway. Patients were followed up from the date of CMR. The outcome endpoints included major adverse cardiovascular event (MACE, cardiovascular mortality, sudden cardiac death, appropriate device discharge); or death or hospitalisation due to HF). A prognostic model was developed using Cox proportional hazards analysis and validated internally and externally.

Results

The final dataset included 722 subjects (50 years (40–61); males 422 (58%)). During a follow-up period of median 19 (15–23) months, there were 64 (9%) MACE and 130 (18%) HF events. Ten predictor variables qualified for entry into the prognostic model: age, sex, hematocrit, C-reactive protein, high-sensitive troponin-T (TNT), left and right ventricular ejection fraction, native T1 and T2, and late gadolinium enhancement (LGE). The final multivariable Cox regression model included native T2 (Figure 1A), TNT and LGE (Figure 1B) for the primary (Chi-square: 102.0, p<0.001) and secondary endpoint (Chi-square: 166.9, p<0.001), respectively. Cross-validation as well as external validation of the secondary models revealed good performance and no healthcare system effect. Based on the MyoRISK Score, patients were classified into three risk groups with respective event rates for MACE of 0%, 6.3% and 25.1%, and HF endpoint of 1.8%, 17.3% and 44.2%. TNT≥7 pg/ml allowed to efficiently preselect patients prior to CMR.

Conclusions

This is the first systematic assessment of outcomes in patients with clinically suspected myocardial inflammation, providing a non-invasive estimation of the probability of adverse events based on a score using readily available clinical parameters.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): DZHK
Artificial intelligence-based stethoscope for the diagnosis of aortic stenosis
Authors: Ghanayim T , Bachner-Hinenzon N , Hanuka D , Adler D , Adawi S , Shiran A
Published: October 2021

Background

Although the stethoscope is used for auscultation in the diagnosis of valvular heart disease for more than 200 years, its diagnostic accuracy is limited and highly dependent on clinical expertise and acoustic range of the human ear.

Purpose

To develop an electronic stethoscope, based on artificial intelligence (AI), for the diagnosis of aortic stenosis (AS).

Methods

We developed an electronic stethoscope (VoqxTM, Sanolla) with subsonic capabilities and acoustic range of 0–2,000 Hz. Using the VoqxTM, we recorded heart sounds from 100 patients referred for echocardiography (derivation group), 50 with moderate or severe AS (aortic valve area (AVA) ≤1.5 cm2) and 50 without valvular disease, using the 5 standard auscultation points. An AI based supervised learning model was applied to the auscultation data from the first 100 patients, to construct a diagnostic algorithm that was then tested on a validation group (50 other patients, 25 with AS and 25 without AS).

Results

The derivation group included 50 patients with AS (age 78±9 years, 28 males, AVA=0.87±0.19 cm2, mean gradient 44±16 mmHg, 39 with severe AS) and 50 without AS (age 58±16 years, 39 males). The AI based algorithm using 1–4 auscultation position (all except the mitral position), correctly identified 47/50 AS patients (sensitivity 94%) and 49/50 patients without AS (specificity 98%), total accuracy 96% (Table).

The algorithm was then applied to the validation group (AS: n=25, age 76±9 years,12 males, AVA=0.88±0.21 cm2, mean gradient 41±15 mmHg, 18 with severe AS; No AS: n=25, age = 59±18 years, 17 males). The algorithm correctly identified 21/25 AS patients (sensitivity 84%) and 24/25 patients without AS (specificity 96%), total accuracy 90% (Table 1).

Conclusion

Our initial findings show that an AI based stethoscope can accurately diagnose AS. AI based electronic auscultation is a promising new tool for automatic diagnosis of valvular heart disease.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Sanolla Company Table 1
Impact of diabetes mellitus on long-term survival after transcatheter mitral valve edge-to-edge repair
Authors: Geyer M , Schmitt V H , Keller K , Born S , Bachmann K , Schnitzler K , Hell M M , Tamm A R , Ruf T F , Kreidel F , Petrescu A , Da Rocha E Silva J G , Schulz E , Munzel T , Von Bardeleben R S
Published: October 2021

Introduction

Diabetes mellitus (DM) represents a notable risk factor after surgical and interventional procedures but data on the influence of DM on long-term survival after Transcatheter Edge-to-edge Repair (TEER) for Mitral valve Regurgitation (MR) are sparse.

Purpose

To compare the outcome of patients with and without DM after TEER.

Methods

Retrospective monocentric assessment of patients after successful treatment of MR by TEER (exclusion of combined forms of transcatheter repair) between 06/2010 and 03/2018. Patients were stratified for DM at baseline and observed regarding mortality during follow-up. Cox regression analyses were performed for survival analyses.

Results

627 patients (47.0% females, 88.2% aged ≥70 years) and among these 174 subjects with DM (27.3%) were included with a median follow-up period of 486 days [IQR 157–916 days]). Within the investigation period, 20 patients (3.2%) were lost to follow-up. Patients with DM more often presented severe comorbidities like obesity (27.3% vs. 9.2%, p<0.001), arterial hypertension (91.4% vs. 83.7%, p=0.013), renal insufficiency (63.8% vs. 43.9%, p<0.001), coronary artery disease (77.0% vs. 59.8%, p<0.001) or peripheral artery disease (14.4% vs. 8.4%, p=0.026) and had a higher median logistic Euroscore I (29.4% [20.0/43.0] vs. 25.0% [16.7/36.6], p=0.001) as well as reduced systolic function (LVEF 35% [30/50] vs. 45% [30/55], p<0.001). No statistical differences in short- and long-term survival were detected between patients with and without DM (in-hospital mortality 1.7 vs. 2.6%, p=0.771; at 30-days 5.0 vs. 6.0%, p=0.842, 1-year 28.7 vs. 25.0%, p=0.419, 3-years 49.2 vs. 44.1%, p=0.554, 5-years 69.0 vs. 68.3%, p=0.497). By calculating cox regression analyses, DM was not predictive for a higher mortality, even after adjustment for other risk factors (HR 1-year 1.17 [95% CI 0.80–1.71], p=0.419; HR long-term 1.13 [95% CI 0.86–1.49], p=0.373) in the total cohort, as well as after stratification for the underlying mitral valve pathology (functional MR: 1-year HR 0.99 [95% CI 0.01–1.62], p=0.969, long-term HR 0.903 [95% CI 0.63–1.29, p=0.571; primary MR: 1-year HR 1.48 [95% CI 0.66–3.35, p=0.344, long-term HR1.66 [95% CI 0.89–3.09], p=0.110).

Conclusions

Even though DM-patients presented with a more vulnerable clinical profile, no relevant differences in short- and long-term mortality after TEER for MR were found. Although being factored in most common risk scores, DM could not be associated with an adverse prognosis after transcatheter therapy of MR.

Funding Acknowledgement

Type of funding sources: None.
Fragmented qrs as a predictor of cardiac events in patients with cardiac sarcoidosis
Authors: Ogura S , Nakamura K , Morita H , Nishii N , Watanabe A , Akagi S , Norihisa T , Yoichi T , Miyoshi T , Ito H ,   Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
Published: October 2021

Background

Multiple spikes within the QRS complex (fragmented QRS [fQRS]) are associated with occurrences of ventricular arrhythmic events (VAEs) in Brugada syndrome and hypertrophic cardiomyopathy. However, association between fQRS and occurrences of VAEs in cardiac sarcoidosis (CS) has not been elucidated.

Purpose

We investigated the association between fQRS and cardiac events in patients with CS.

Methods

We evaluated the association between existence of fQRS (Figure 1A) and cardiac events including VAEs (non-sustained ventricular tachycardia (NSVT), sustained ventricular tachycardia (VT) and ventricular fibrillation (VF)), hospitalization for heart failure and all cause death in 68 patients with CS for 5 years (30 patients with fQRS vs 38 patients without fQRS).

Results

All cardiac events (NSVT, VT, VF, hospitalization for heart failure and all cause death) occurred in 22 patients with fQRS and 18 patients without fQRS (73% vs 47%; P=0.031). Among cardiac events, occurrences of VAEs (NSVT/VT/VF) in patients with baseline fQRS were higher than those in patients without fQRS (VAEs: 70% vs 45%, P=0.037), whereas there were no significant differences in hospitalization for heart failure and all cause death between patients with and without fQRS (hospitalization for heart failure: 6.7% vs 5.3%, P=0.80 and all cause death: 6.7% vs 5.3%, P=0.80). Kaplan-Meier method also showed significant difference in occurrences of VAEs between with and without fQRS (Log rank: P=0.015) (Figure 1B). Multivariable analysis showed that the existence of fQRS in baseline ECG was associated with VAEs (Hazard ratio [HR]: 2.21, 95% confidence interval [CI]:1.15 to 4.25, P=0.017).

Conclusions

fQRS represents a predictor of VAEs in patients with CS.

Funding Acknowledgement

Type of funding sources: None. Figure 1
Role of right ventricular free wall longitudinal strain in prediction outcome in patients with cardiac sarcoidosis
Authors: Albakaa N , Sato K , Iida N , Yamamoto M , Machino T , Ishizu T , Ieda M
Published: October 2021

Introduction

Right ventricular free wall longitudinal strain (RVFWLS) is a sensitive tool for right ventricular (RV) function assessment. Furthermore, it shows incremental prognostic role in various cardiac diseases. RV involvement is frequently observed along with left ventricular (LV) involvement in cardiac sarcoidosis (CS) patients, while its impact on outcome is unclear.

Purpose

The aim of this study is to investigate the association between RV dysfunction detected by RVFWLS and cardiovascular event in patients with CS.

Methods

We retrospectively evaluated 51 patients with CS who were treated with prednisone from 2012 through 2020. Diagnosis of CS was made according to the Japanese Circulation Society diagnostic criteria. We evaluated RVFWLS at baseline using vender-independent software. We considered major adverse cardiovascular event (MACE: ventricular arrhythmia, heart failure hospitalization) to be the primary outcome.

Results

Mean age of the study population was 63±11 years, and 61% were female. At baseline, 25 patients (49%) had reduced left ventricular (LV) ejection fraction (EF) (<50%) and 18 patients (35%) had impaired RVFWLS (<17%). Patients with impaired RVFWLS showed lower LVEF% (42±12% vs. 53±13%, P=0.005) and larger LV end-systolic volume index (54±33 vs. 37±23ml/m2, P=0.04) compared with those with preserved RVFWLS. Impaired RVFWLS patients also showed trend towards higher prevalence of basal interventricular thinning (50 vs. 28%, P=0.12). During a median follow-up of 548 days, eleven patients had MACE. In multivariable Cox-proportional hazards model analysis, RVFWLS was independently associated with MACE (HR 1.28, 95% CI: 1.07–1.10, P=0.009). Kaplan-Meier survival curves showed worse event-free survival in patients with impaired RVFWLS (log-rank test, P=0.001).

Conclusions

In patients with CS, RVFWLS is an independent predictor for MACE. RVFWLS may be valuable in improving risk stratification in CS.

Funding Acknowledgement

Type of funding sources: None. Kaplan-Meier survival curves
Comparison between a novel sirolimus-eluting bioresorbable scaffold with everolimus-eluting metallic stent in patients with coronary artery disease: three-year follow-up from the neovas rct study
Authors: Han Y , Xu K , Xu B , Fu G , Wang X , Li Y , Stone G ,   NeoVas Randomized Controlled Trial Investigators
Published: October 2021

Background

Previous trials and meta-analyses have demonstrated that risk of adverse clinical events, especially thrombosis and target vessel myocardial infarction is increasing between 1 and 3 years after Bioresorbable Scaffolds (BRS) implantation.

Purpose

We sought to evaluate the long-term clinical outcomes of a novel NeoVas BRS in comparison with cobalt chromium everolimus-eluting stent (EES) following implantation in patients with coronary artery disease by 3-year follow-up results from the NeoVas RCT.

Methods

Overall, 560 patients with a single de novo native coronary artery lesion with reference vessel diameter 2.5–3.75 mm and lesion length ≤20 mm were randomized 1:1 to NeoVas BRS vs. cobalt-chromium everolimus-eluting stents (CoCr-EES). Optical coherence tomography (OCT) and fractional flow reserve (FFR) were both performed in a pre-specified subgroup at 3-year follow-up. Clinical outcomes from NeoVas RCT were analyzed by randomized device (intention to treat) cumulative to 3 years.

Results

Over 3 years, the overall target lesion failure (TLF) rate was 6.9% in the NeoVas group and 6.1% in the CoCr-EES group (HR 1.13, 95% CI 0.59 to 2.18; p=0.71). There was no statistically significant difference of the definite or probable stent thrombosis between the NeoVas group and the CoCr-EES group (1.1% vs. 0.7%, HR 1.51, 95% CI 0.26 to 8.73, p=0.64). In a landmark analysis of TLF, we found no difference in rate of late events from 2 to 3 years between two groups. FFR was not significantly different between the two group at 3 years (NeoVas vs. CoCr-EES, 0.89±0.07 vs. 0.90±0.05). NeoVas was largely absorbed (72.26% ± 13.21%) examined by OCT follow-up. Of 55 patients who finished 3-year absorption analysis, NeoVas was totally absorbed in 4 patients.

Conclusions

At the 3-year follow-up in the Neovas RCT trial, overall TLF rates were comparable between Neovas BRS and CoCr-EES, and adverse event rates relating to device safety were not increased with Neovas BRS compared with CoCr-EES up to 3 years after implantation.

Funding Acknowledgement

Type of funding sources: None.
The prognostic potential of growth differentiation factor-15 on bleeding events and patient outcome after cardiac surgery
Authors: Kazem N , Hammer A , Koller L , Hofer F , Steinlechner B , Laufer G , Hengstenberg C , Wojta J , Sulzgruber P , Niessner A
Published: October 2021

Background

GDF-15 (growth/differentiation factor 15) is induced by myocardial stretch, volume overload, inflammation and oxidative stress. Its expression is tightly linked with cardiovascular events as well as the risk for major bleeding and all-cause mortality.

Objective

The objective of the present study was to elucidate the prognostic potential of GDF-15 in patients after cardiac surgery.

Methods

504 patients undergoing elective cardiac valve and/or coronary artery bypass graft surgery were prospectively enrolled. GDF-15 levels were measured prior surgery to evaluate the impact on bleeding events, thromboembolic events and mortality.

Results

Preoperative GDF-15 was associated with the primary endpoint of intra- and postoperative red blood cell transfusion (for bleeding risk factors adjusted [adj] OR [odds ratio] per 1-SD [standard deviation] of 1.62 [95% CI: 1.31–2.00]; p<0.001) and postoperative atrial fibrillation (for atrial fibrillation risk factors adj. OR per 1-SD of 1.49 [95% CI: 1.22–1.81]; p<0.001). Higher concentrations of GDF-15 were observed in patients reaching the secondary endpoint of major or clinically relevant minor bleeding (for bleeding risk factors adj. OR per 1-SD of 1.70 [95% CI: 1.05–2.75]; p=0.030) during the 1stpostoperative year, but not for thromboembolic events. GDF-15 was a predictor for cardiovascular mortality (for comorbidities adj. HR [hazard ratio] per 1-SD of 1.67 [95% CI: 1.23–2.27]; p=0.001) and all-cause mortality (for comorbidities adj. HR per 1-SD of 1.55 [95% CI: 1.19–2.01]; p=0.001). A combined risk model of GDF-15 and EuroSCORE II outperformed the EuroSCORE II alone for long-term survival (c-index: 0.75 [95% CI: 0.70–0.80], p=0.046; net reclassification improvement: 33.6%, p<0.001).

Conclusion

Preoperative GDF-15 concentration is an independent predictor for intra- and postoperative major bleeding, major bleeding during the first year and for long-term cardiovascular or all-cause mortality after cardiac surgery.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Vienna Central illustration
Resistant hypertension improved after 3 months by measuring drug levels to identify non-adherence
Authors: Peeters L E J , Kappers M H W , Hesselink D A , Van Der Net J B , Hartong S C C , Bahmany S , Massey E , Van Dijk L , Van Gelder T , Koch B C P , Versmissen J ,   RHYME-RCT
Published: October 2021

Introduction

Identification of non-adherence to antihypertensive drugs is crucial to improve resistant hypertension (RH). For this therapeutic drug monitoring is the most reliable method.

Purpose

The primary objective of this analysis is to determine whether drug levels measured with a dried blood spot (DBS) method combined with personalized feedback leads to a decrease in prevalence of RH after 3 months due to an increase in adherence.

Methods

This is a multi-centre single-blinded randomized controlled trial (RHYME-RCT, NL6736). Patients went to an eligibility visit, where DBS sampling and a 24-hour ambulatory blood pressure measurement (ABPM) was performed simultaneously. Patients with a daytime systolic blood pressure (SBP) >135 and/or diastolic blood pressure (DBP) >85 mmHg were randomized to standard treatment (control) or intervention. The intervention was performed by the treating physician and included information on drug levels and a personalized feedback conversation based on a feedback tool. The follow-up period was one year and included visits at 3, 6 and 12 months after the eligibility visit. At each visit an ABPM and DBS were performed.

Results

A total of 53 patients (mean age of 59±11 years, 78.7% male) with at least three months of follow-up were included. The prevalence of RH decreased from 100% in both arms to 75.0% in the intervention arm (p=0.014, n=24) and 58.6% in the control arm (p=0.001, n=29). No improvements were seen in adherence rates over time. Furthermore, no significant differences were found after three months between the two groups in the degree of RH (p=0.214), SBP (p=0.551) or adherence (p=0.746).

Conclusion

Measuring blood pressure and drug levels led to a decrease in the prevalence of RH. However, this improvement could not be linked to the actual intervention or improvement of adherence.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ZonMW
Psychological assessment of depression and anxiety in patients with implantable cardioverter-defibrillator: DEFibrillator-related distress and depression survey in Chiba 2
Authors: Kondo Y , Miyazawa K , Nakano M , Kajiyama T , Nakano M , Kobayashi Y
Published: October 2021

Background

Despite the established treatment for life-threatening arrhythmias, the implantable cardioverter-defibrillator (ICD) therapy has emerged as a major determinant of psychological distress. Previous studies have showed several approaches to assess the ICD-specific psychological distress, however, the risk factors affecting psychological functioning are relatively variable across studies, and are not well studied in Japanese population. Therefore, we prospectively investigate the risk factors affecting the psychological functioning and assess the impact of ICD therapy in Japanese patients with ICD.

Methods

We prospectively enrolled consecutive 136 patients in the present study. At the time of ICD implantation and 1 year later, all patients completed the Florida Shock Anxiety Scale (FSAS), which is a tool designed to provide a quantitative measure of ICD shock-related anxiety. In addition, patients were also examined by psychiatrists using two assessment scales, Montgomery-Åsberg Depression Rating Scale (MADRS) and Hospital Anxiety and Depression Scale (HADS).

Results

The FSAS score was significantly correlated with the MADRS and HADS scores (Figure). During 1-year follow-up, 11 patients (8.1%) received ICD therapy. Younger age was significantly associated with the FSAS and MADRS scores at registration, but ICD therapy was the only independent factor associated with the increased risk of the FSAS score at 1 year later (p-value = 0.012).

Conclusions

ICD therapy has a strong impact on psychological distress in time course of ICD implantation. To reduce unnecessary shock therapy and optimal intervention by healthcare professionals may lead to the improvement of ICD-related psychological functioning.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Correlation between MADRS and HADS scoreFigure 2. FSAS, MADRS and HADS scores
Cardiovascular risk prediction in type 2 diabetes: a comparison of 22 risk scores in primary care setting
Authors: Dziopa K D , Asselbergs F W A , Gratton J G , Chaturvedi N C , Schmidt A F S
Published: October 2021

People with type 2 diabetes (T2DM) remain at high risk for cardiovascular disease (CVD) CVD treatment initiation and intensification are guided by risk prediction algorithms. The majority of CVD risk prediction tools have not been validated in T2DM.

We compared the performance of general and diabetes specific cardiovascular risk prediction scores for cardiovascular disease (CVD ie coronary heart disease and stroke), CVD+ (including atrial fibrillation and heart failure), and their individual components, in type 2 diabetes patients (T2DM).

Scores were identified through a systematic review and included irrespective of the type of predicted CVD, or inclusion of T2DM patients. Performance was assessed in a contemporary sample of 203,172 UK T2DM.

We identified 22 scores: 11 derived in the general population, 9 in T2DM patients, and 2 excluded T2DM patients. Over 10 years follow-up, 63,000 events occurred. The RECODE score, derived in people with T2DM, performed best for both CVD (c-statistic 0.731 (0.728,0.734), and CVD+ (0.732 (0.729,0.735)). Calibration slopes (1 indicates perfect calibration) ranged from 0.38 (95% CI 0.37; 0.39) to 1.05 (95% CI 1.03; 1.07). A simple, population specific recalibration process considerably improved performance, now ranging between 0.98 and 1.03. Risk scores performed badly in people with pre-existing CVD (c-statistic ∼0.55).

CVD risk prediction scores performed worse in T2DM than in the general population, irrespective of derivation population, and of original predicted outcome. Scores performed especially poorly in patients with established CVD. A simple population specific recalibration markedly improved score performance and is recommended for future use.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): NPIF programme
Analysis of LpA levels in young patients after ACS: getting to know less famous risk factors
Authors: Luna M , Rodriguez Cordoba A , Rodriguez Capitan J , Martinez Carmona J D , Diaz Exposito A , Marquez Camas P , Garcia Rodriguez L , Palma Marti L , Angullo Gomez M , Doncel Abad M V , Berteli Garcia G , Mendez Natera R , Grande Prada D , Melgar Melgar A , Gomez Doblas J J
Published: October 2021

Introduction

Lipoprotein A (LpA) has been shown to be an emerging risk factor, proposing that values greater than 60 mg/dl increases cardiovascular risk. There are few data about LpA values in young patients who have suffered a major cardiovascular event.

Purpose

The objective of this work was to describe the LpA values observed in young patients admitted for acute coronary syndrome in our center, and subsequently to compare these values according to the patients' previous cardiovascular risk.

Methods

This is a descriptive and observational study, in which all male patients under 65 years and women under 70 years who have suffered STEMI or NSTEMI from November 2019 to February 2021 admitted to our center were consecutively included. In addition to LpA values, the following variables were recollected: age, sex, high blood pressure, diabetes mellitus, dyslipidemia, stroke, chronic kidney injury, smoking, alcoholism, toxics, total cholesterol and SCORE risk.

Results

159 patients were included. The mean of LpA value was 41,08 mg/dl (standard deviation 38, range 1–155, percentile 25th: 9,7; percentile 50th: 28,8; percentile 75th: 59,1). 24,5% presented levels of LpA greater than 60 mg/dl. The percentage of patients with LpA levels >60 mg was 32,4% in low SCORE group and 22,4% in greater than low SCORE group without significant differences.

The table compares the LpA values according to the cardiovascular risk SCORE those patients presented before the acute coronary syndrome (low SCORE vs moderate, high or very high SCORE). As we can see in the table, we found a trend to present higher LpA values in patients with low SCORE risk compared to those with higher than low SCORE risk, without reaching statistical significance.

Conclusions

In a sample of young patients with acute coronary syndrome, the LpA mean was 41,08 mg/dl. 24,5% of patients had values of LpA greater than 60 mg/dl. No significant differences were found according to the SCORE prior to the event, although there was a non-significant trend towards a higher LpA in patients with low SCORE.

Funding Acknowledgement

Type of funding sources: None. Table 1. LpA values
Characteristics and prognosis of patients with elevated triglycerides in acute myocardial infarction: observational data from a large database over a 17 years period
Authors: Zeller M , Chague F , Maza M , Bichat F , Beer J C , Masson D , Cottin Y , Farnier M ,   RICO survey
Published: October 2021

Background and aim

From a large database of a regional registry, we aimed to address the prevalence, characteristics and prognosis of patients with elevated triglycerides (TG) in patients hospitalized for an acute myocardial infarction (MI).

Methods

From the multicenter database (RICO survey), all consecutive patients hospitalized for an acute MI (2001–2017) and alive at discharge were included. Patients with TG >500 mg/dL, lost to follow-up (FU), or under chronic fibrate treatment were excluded. Patients with high TG (>200 mg/dL) on admission were compared to those with TG ≤200 mg/dL. Endpoints were recurrent ischemic events (i.e. recurrent MI, angina, unstable angina, stroke or urgent revascularization (PCI or CABG)) at 1-year FU.

Results

Among the 10667 patients included, 1886 (17.7%) had elevated TG. When compared with patients with TG ≤200 mg/dL, patients with high TG were younger (59 vs 69 y, p<0.001), had a higher BMI (28 vs 26 kg/m2, p<0.001), were more frequently men (77 vs 68%, p<0.001), diabetic (27 vs 21%, p<0.001), and smokers (42 vs 28%, p<0.001). The rate of statin therapy at discharge was similar for the 2 groups (79 vs 77%, p=0.285), as well as SYNTAX score and rate of multivessel disease (p=0.368 and p=0.791). In high TG group, LDL cholesterol was higher (130 vs 120 mg/dL, p<0.001) and HDL-cholesterol was lower (37 vs 46 mg/dL). At 1-Y FU, recurrent ischemic events were more frequent in elevated TG patients (11.2 vs 9.1%, p=0.004). In multivariate logistic regression analysis, high TG (OR (95% CI): 1.356 (1.095–1.679)) remains an independent estimate for recurrent ischemic event, even after adjustment for confounding (GRACE score, diabetes, obesity).

Conclusions

In our large population-based cohort, elevated TG are common in acute MI, and associated with residual risk of recurrent ischemic events, beyond traditional prognostic markers. Our data may help to identify candidates for targeted therapies to reduce recurrent ischemic risk after MI.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Amarin
Sympathetic nerve activity changes following acute exposures to electronic and tobacco cigarette smoking in humans
Authors: Dimitriadis K , Narkiewicz K , Leontsinis I , Konstantinidis D , Mihas C , Andrikou I , Thomopoulos C , Tousoulis D , Tsioufis C
Published: October 2021

Background/Introduction

Tobacco cigarette (TC) smoking acutely increases blood pressure and sympathetic nerve activity, whereas there are scarce data on the impact of electronic cigarette (EC).

Purpose

The aim of the study was to assess the acute effects of TC, EC and sham smoking on blood pressure, heart rate and sympathetic nervous system in healthy subjects.

Methods

We studied 12 normotensive male habitual smokers (mean age 33 years) free of cardiovascular disease. The study design was randomized and placebo controlled with 3 experimental sessions (sham smoking, tobacco cigarette smoking, and e-cigarette smoking) in random order, each session on a separate day. Subjects smoked 2 tobacco cigarettes containing 1.1 mg nicotine or simulate smoking (sham smoking) with the 2 cigarettes separated by 5 minutes. Additionally, participants smoked e-cigarettes for a period of 5 and 30 minutes. In all occasions, sympathetic drive was assessed by muscle sympathetic nerve activity (MSNA) (baroreflex-dependent) and skin sympathetic nerve activity (SSNA) (baroreflex-independent) based on established methodology (microneurography).

Results

After the first and second TC smoking, there was significant increase in mean arterial pressure (MAP) (by 6 and 8 mmHg, respectively, overall p<0.001) and heart rate (by 8 and 12 beats/minute, respectively, overall p<0.001) compared to baseline. Similarly, EC smoking at 5 and 30 minutes compared to baseline was accompanied by augmentation of MAP (by 6 and 10 mmHg, respectively, overall p<0.001) and heart rate (by 5 and 9 beats/minute, respectively, overall p<0.001). Sham smoking was accompanied by a reduction in MAP after the first and second cigarette compared to baseline (by 2 and 4 mmHg, respectively, p=0.001), whereas there was no significant difference in heart rate (p=NS). The first and second TC smoking was characterized by lower muscle MSNA (by 6 and 6 bursts/minute, respectively, overall p<0.001) compared to baseline, whereas SSNA was increased (by 9 and 10 bursts/minute respectively, overall p<0.001). Additionally, EC smoking at 5 and 30 minutes caused a decrease in MSNA (by 8 and 8 bursts/minute, respectively, overall p<0.00) and an augmentation in SSNA (by 7 and 9 bursts per minute, respectively, overall p<0.001) compared to baseline. Sham smoking had no significant effect on MSNA and SSNA (p=NS for both).

Conclusions

Sympathetic, pressor and heart rate unfavorable responses to EC smoking are similar to those elicited by TC in healthy subjects. Our findings provide novel insights into the negative impact of EC on cardiovascular system and support opinions recommending great caution concerning EC use.

Funding Acknowledgement

Type of funding sources: None.
One-year impact of bariatric surgery on echocardiographic markers of vascular disease: results from the prospective FatWest study
Authors: Cramariuc D , Grymyr L M D , Nadirpour S , Nedrebo B G , Kovac N , Gerdts E
Published: October 2021

Background

Aortic root plaque and aortic valve sclerosis (AVS) are known echocardiographic markers of atherosclerosis. Obesity increases the atherothrombotic risk, while large surgical weight loss improves the cardiovascular risk profile. It is unclear whether the severity of vascular disease associated with severe obesity changes after bariatric surgery.

Purpose

To assess the 1-year impact of bariatric surgery on aortic root wall thickness (ART) and AVS.

Methods

91 severely obese patients (43±10 years, preoperative body mass index [BMI] 41.7±4.9 kg/m2, 55% hypertensive, 17% diabetic) underwent echocardiography preoperatively and 14 months after Roux-en-Y bypass surgery in the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study. We measured the end-diastolic maximum ART and categorized AVS as mild, moderate or severe based on combined aortic cusp thickness and hyperechoic valve lesions. Left ventricular (LV) structural remodelling was assessed by LV mass and geometry. In 52 patients with clinical signs of obstructive sleep apnea, preoperative polysomnography data including apnea-hypopnea index and mean nightly oxygen saturation were evaluated.

Results

Preoperatively, 39% had mild-moderate AVS, and an average ART of 4.9±1.7mm (Figures 1–2). Presence of AVS at baseline was associated with higher LV mass, while ART was higher in men, older patients and increased with lower nightly oxygen saturation (r=−0.29, p<0.05). During the first preoperative 14 months, patients experienced a 12.9±3.8kg/m2 BMI and 0.6±1.9mm ART reduction, and AVS prevalence lowered by 45% (Figures 1 and 2). In backward stepwise multivariate regression analyses with adjustment for changes in clinical variables, LV mass and geometry, less ART reduction at 14 months was independently predicted by higher age, higher postoperative BMI and presence of AVS (R2 0.53, all p<0.05). Persistent AVS was associated with higher age and preoperative diabetes (R2 0.24, p<0.05).

Conclusion

In patients undergoing bariatric surgery, a reduction in echocardiographic markers of vascular disease was observed 1 year postoperatively, particularly in younger, non-diabetic patients.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Helse Vest Figure 1Figure 2
Cardiac phenotypes in the acute-phase of microscopic polyangiitis involves dilatation of the left atrium caused by LV diastolic dysfunction
Authors: Kinoshita N , Nawata T , Okuda S , Kubo M , Wada Y , Kobayashi S , Tanaka N , Yano M
Published: October 2021

Background

Microscopic polyangiitis (MPA) is a type of primary systemic vasculitis that affects various organs, especially the lungs and kidneys. However, few reports regarding cardiac features of MPA patients were found.

Purpose

We aim to investigate the echocardiographic parameters of acute-phase MPA.

Methods and results

This single-center retrospective study included 15 patients with MPA (Mean age at 72.2±7.1 years, women 73.3%) who underwent echocardiography within two weeks of commencing steroid therapy for induction or reinduction. The echocardiography parameters of the patients were compared with those of 30 age and sex-matched controls. In the MPA group, the commonly affected organs were kidneys (93.3%) and lungs (46.7%); 5 patients (33.3%) had a history of hypertension, which had a similar frequency as the control group. No significant difference in left ventricular (LV) diameter, LV ejection fraction, e', or inferior vena cava diameter was observed between the two groups. However, the MPA group showed significantly higher left atrial (LA) diameter (p=0.033) and LA volume index (p=0.001), as well as higher early diastolic filling velocity (E-wave, p=0.015; E/A, p=0.043; E/e', p=0.041), diastolic pulmonary venous flow velocity (p=0.013), trans-tricuspid pressure gradient (p=0.019), and shorter deceleration time (p=0.038), associated with mildly thicker ventricular walls of left ventricle (LV) than the control group. Moreover, serum levels of C-reactive protein showed significant correlation between E wave (r=0.58, p=0.023), E/A (r=0.67, p=0.006), and deceleration time (r=−0.69, p=0.005) in the MPA group. These results may indicate that in MPA, increased LV stiffness, rather than impairment of LV relaxation was contributed to LV diastolic function, resulting in LA enlargement.

Conclusion

Patients with acute-phase MPA had LA dilatation associated with LV diastolic dysfunction. This finding indicates the importance of cardiac assessment in patients with MPA.

Funding Acknowledgement

Type of funding sources: None.