bluuebunny/crossref_metadata_2025 huggingface dataset:
Distal radial access in the right anatomical snuffbox for coronary angiography and interventions: a prospective observational study
Authors: Chatterjee K , Sahu A , Khanna R , Kumar S , Tewari S , Kapoor A , Goel P K , Garg N ,   Sanjay Gandhi Postgraduate Institute of Medical Sciences
Published: October 2021

Background

Distal radial access in the anatomical snuffbox is a novel technique for vascular access. However, limited clinical data is available, mainly limited to the left distal radial access. In view of the paucity of data on right distal radial access; this study was conducted to assess the feasibility, efficacy and safety of the right distal radial approach as a default access route for transradial catheterization.

Methods

We enrolled 159 consecutive patients with a palpable right distal radial pulse prospectively at a single center. A detailed clinical evaluation, laboratory tests and echocardiographic examination was done. Doppler examination of distal radial artery for its patency and size was done before puncture attempt. The right distal radial artery was punctured using the back wall technique. Primary outcome was successful puncture of distal right radial artery. Secondary outcomes were number of puncture attempts, pain score, radial artery spasm, forearm and distal radial hematoma, proximal and distal radial artery occlusion, bleeding and other vascular complications, access site crossover due to distal radial access failure, contrast volume used, and radiation dose.

Results

Distal radial puncture was successful in 144/159 (90.1%) patients. The mean distal radial artery diameter was 2.2±0.25 mm. Mean pain score by visual analogue scale was 2.36±1.9. There were no bleeding events. Snuffbox hematoma was seen in 11 (7.6%) patients and forearm hematoma occurred in 5 (3.5%) patients. There were 9 (6.3%) cases of radial spasm, 4 (2.8%) cases of radial occlusion at distal access site and 1 (0.7%) forearm radial artery occlusion.

Conclusions

The right distal radial access is a feasible, safe and efficacious alternative approach for coronary angiogram and interventions.

Funding Acknowledgement

Type of funding sources: None.
Gender distribution in patients treated with rotablation – analysis of 5,177 percutaneous coronary interventions based on a large national registry from between 2014 and 2020
Authors: Sabatowski K , Malinowski K P , Reczuch K , Dobrzycki S , Lesiak M , Hawranek M , Gil R J , Witkowski A , Wojakowski W , Lekston A , Gasior M , Wanha W , Legutko J , Bartus S , Januszek R
Published: October 2021

Background

Patients undergoing percutaneous coronary intervention (PCI) procedures using rotational atherectomy (RA) are a special group of patients characterised by the presence of massive calcifications in the coronary arteries. Due to a significant increase regarding the frequency of these procedures in recent years and the distinctiveness of this narrow group of patients among all patients undergoing PCIs, we have characterised the group according to gender.

Aims

The aim of analysis was to assess the gender percentage share in following years and differences between both groups of Polish patients undergoing PCI with rotational RA between 2014 and 2020.

Methods

Based on the Polish National Registry of Percutaneous Coronary Interventions (ORPKI), we analysed 751,113 patients treated with PCI between 2014 and 2020. Then, we extracted 5,177 (0.7%) treated with PCI and RA, 3,552 of them (68.6%) were males. Selected indices among the two groups were compared using the t-test for continuous variables, the χ2 test or the likelihood-ratio test for nominal variables where appropriate. To compare means of samples in the following years, one-way ANOVA test was used.

Results

The results of the study indicate an upward RA tendency in successive years (p<0.001). Moreover, this tendency and its increase was greater between the years 2016–2019 (Fig. 1). Almost twice as many RA procedures pertain to men, while the percentage share did not undergo a significant change in following years (Fig. 2). The mean age was 72±9 years in the overall group. In the total group, there were 2,873 patients (55.49%) with chronic coronary syndrome, 1,033 (19.95%) with unstable angina, 654 (12.63%) with non-ST segment elevation myocardial infarction (NSTEMI) and 494 (9.54%) with ST segment elevation myocardial infarction (STEMI).

Females were significantly older in comparison to males [75.2±8.3 vs. 70.5±9.2, p<0.001], more often diabetics [613 (37.72%) vs. 1,068 (30.07%), p<0.001], less often smokers [173 (10.6%) vs. 635 (17.9%), p<0.001] and were significantly more often treated due to acute coronary syndrome [780 (48.8%) vs. 1,401 (40.5%), p<0.001]. Considering periprocedural complications among females, there were more cardiac arrests [13 (0.8%) vs. 10 (0.28%), p=0.01] and deaths [11 (0.68%) vs. 6 (0.17%), p=0.006] when compared to males.

Conclusion

The percentage of RA among overall PCIs has been still growing in recent years in Poland. The majority of patients treated with RA are men. Gender distribution did not change significantly among patients treated with PCI and RA during the analysed period of time.

Funding Acknowledgement

Type of funding sources: None.
Duration of dual antiplatelet therapy and long-term outcomes following drug-eluting balloon or drug-eluting stents for treatment of in-stent restenosis (DAPT-Dragon Registry)
Authors: Januszek R , Bil J , Figatowski T , Tomasiewicz B , Desperak P , Niezgoda P , Reczuch K , Kubica J , Gil R J , Bartus S , Gasior M , Witkowski A , Jaguszewski M , Wojakowski W , Wanha W
Published: October 2021

Objectives

The aim of the DAPT-DRAGON registry was to asses long-term outcomes and the length of dual antiplatelet therapy (DAPT) in patients treated with percutaneous coronary intervention (PCI) due to drug-eluting stent in stent restenosis (DES-ISR) with drug-eluting balloons (DEB) or thin-DES.

Background

Data regarding the duration of DAPT in patients with DES-ISR treated with PCI is still undergoing research and observation, and the adequate duration of DAPT in this group of patients is not unambiguously sanctioned.

Methods

Overall, 1,367 consecutive patients with DES-ISR who underwent PCI with DEB or DES, were entered into the multi-center DAPT-DRAGON Registry (Fig. 1). The mean age was 66.7±9 years (70.5% males). The median follow-up was 3.3 years. There were 34.1% patients with chronic coronary syndrome, 35.2% with unstable angina, 2.9% with ST segment elevation myocardial infarction and 27.7% with non-ST segment elevation myocardial infarction (MI). We assessed selected study endpoints according to the duration of DAPT (≤3 vs. >3 months and ≤6 vs. >6 months), before and after propensity score matching (PSM): stroke, target lesion revascularization (TLR), target vessel revascularization (TVR), MI, death and device-oriented composite endpoints (DOCE).

Results

Among predictors of increased DOCE rate before PSM, we demonstrated: PCI with DEB vs. DES (p<0.001), recurrent ISR (p=0.002), treatment with glycoprotein IIb/IIIa inhibitor during PCI (p<0.001), lower left ventricle ejection fraction (p=0.004) and extent of stenosis (p<0.001). Pairwise contrast analysis considering type of PCI (thin-DES vs. DEB) and duration of DAPT (≤6 vs. >6 months) before PSM revealed superiority of thin-DES+DAPT >6 months vs. DEB+DAPT >6 months for DOCE (p<0.001), TVR (p=0.02) and TLR (p=0.01). After PSM analysis, the length of DAPT (≤3 vs. >3 months) had no significant influence on assessed long-term outcomes, while the percentage of stroke free survival was significantly lower in the group of patients with DAPT ≤6 months vs. >6 months (p=0.01; Fig. 2).

Conclusions

Long-term treatment with DAPT (>6 months) in patients with DES-ISR with DES implantation is related to better long-term outcomes in terms of lower rate of DOCE, TVR and TLR compared to PCI with DEB. DAPT >6 months is related to a greater rate of strokes, independently of the type of treatment (thin-DES and DEB) compared to DAPT ≤6 months.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
A risk predictive model for coronary perforation in patients undergoing percutaneous coronary intervention – APOLLO-XI score
Authors: Jaspattananon A , Wongpraparut N , Chotinaiwattarakul C , Phankingthongkum R , Tungsubutra W , Chunhamaneewat N , Towashiraporn K , Phichaphop A , Tresukosol D
Published: October 2021

Background

Coronary perforation (CP) is a rare but potentially life-threatening complication of percutaneous coronary intervention (PCI). Although several variables are associated with the risk of coronary perforation, a cumulative risk predictive model has not been established yet.

Purpose

To assess an incidence, risk factors and to develop risk predictive model for coronary perforation following PCI.

Methods

A single center, retrospective study of patients who underwent PCI from March 2010 to December 2019. Multivariate regression analysis was performed to identify independent predictors of CP. A risk predictive model was constructed with incremental weights attributed to each component variable according to their beta coefficients.

Results

10,671 PCI procedures were enrolled. The incidence of CP was 0.94%. Adverse in-hospital outcomes were significant higher in CP group, including death (odds ratio [OR]: 3.58), mechanical circulatory support; including IABP and ECMO (OR: 3.79) and urgent revascularization (OR: 7.35). Multivariable analysis identified seven independent risk factors for CP, which were age (OR: 1.02), insulin-treated diabetes (OR: 2.50), prior CABG (OR: 2.03), hydrophilic guidewire (OR: 1.62), rotational atherectomy (OR: 2.60), excimer laser coronary atherectomy (ELCA) (OR: 3.39) and chronic total occlusion PCI (OR: 4.21). Risk predictive model (APOLLO-XI score) was calculated from the total points of each variables as follows: age (1 point per 10-year increase), hydrophilic guidewire (2 points), prior CABG (3 points), insulin-treated diabetes or rotational atherectomy (4 points), ELCA (5 points) and chronic total occlusion PCI (6 points). Cumulative risk score more than 11 points had increased risk for coronary perforation more than 1%. The validation of the risk predictive model (C-statistic) was 0.75 (95% CI: 0.70–0.80).

Conclusions

Coronary perforation is a rare but lethal complication. Our study demonstrates the risk predictive model which could enhance cardiovascular team to precisely estimate risk of coronary perforation before complex PCI procedure.

Funding Acknowledgement

Type of funding sources: None. Baseline charecteristicsAPOLLO-XI score
Managing bifurcations: are two stents better than one?
Authors: Araujo Leite Medeiros P , Braga C , Campos I , Oliveira C , Pires C , Flores R , Mane F , Silva R , Costa J , Marques J , Braga C
Published: October 2021

Introduction

Bifurcation percutaneous coronary intervention (PCI) is associated with a higher degree of complexity when compared with non-bifurcation procedures. Although 1-stent PCI remains the standard approach for most bifurcation lesions, data is constantly being published on 2-stent PCI.

Aim

To evaluate and compare the characteristics and outcomes of patients that underwent bifurcation PCI with one or two stents.

Methods

Single center, retrospective observational study including all patients who underwent bifurcation PCI between January 2015-December 2018. We defined two groups: 1-stent PCI group (1s-PCI) and 2-stent PCI group (2s-PCI). The 2s-PCI group included PCI patients with all the different techniques used in our center: provisional stenting with 2 stents, Cullote, crushing stent and DK Crush.

Results

1s-PCI group included 376 individuals and 2s-PCI group included 26. Overall baseline clinical characteristics were balanced between groups. There was no statistically significant difference in age (mean 64 vs 66; p=0.388), gender (79% vs 85% males; p=0.622) and comorbidities (hypertension, diabetes mellitus, hypercholesterolemia, chronic kidney disease, smoking and previous history of coronary artery disease). Also, there was no difference in clinical status (NSTEMI 36% vs 38%; stable disease 32% vs 42%; STEMI 28% vs 19%; unstable angina 5% vs 0%; p=0.419). Coronary angiography and lesion distribution were similar in both groups (p=0.367). However, radiation dose (median 90.5 [IQR=79] vs 156 [IQR=84] mGy cm2; p<0,001) and contrast volume (median 150 [IQR=100] vs 156 [IQR=83] ml; p<0,001) were significantly higher in 2s-PCI group. At 12-month follow-up, mortality rate was higher in 1s-PCI group, but without statistical significance (8% vs 4%; p=0.71); the same is true for acute myocardial infarction at 12 months (3% vs 0%; p=0.368). Target-lesion failure was only reported in 4 patients in the 1s-PCI group. Survival tests showed no significant difference between groups (χ2(1,n=402)=0.634; p=0.426).

Conclusion

Individuals that underwent 1s-PCI were overall similar to those who underwent 2s-PCI. Predictably, deploying more than 1 stent required more contrast volume and implied a higher radiation dose. We should note that our studied is greatly limited by the 2s-PCI group size, which may justify the lack of difference in the evaluated outcomes.

Funding Acknowledgement

Type of funding sources: None.
Self-expanding and balloon-expandable transfemoral transcatheter aortic valve replacement: in-hospital outcomes in Germany
Authors: Oettinger V , Zehender M , Bode C , Kaier K , Von Zur Muehlen C , Stachon P
Published: October 2021

Background

The impact of valve type used in transfemoral transcatheter aortic valve replacement (TF-TAVR) on outcomes is currently under discussion.

Purpose

We examine the in-hospital outcomes of balloon-expandable (BE) and self-expanding (SE) valves in a complete national cohort in Germany in 2018.

Methods

All 17,295 patients receiving TF-TAVR with BE (N=9,882) or SE (N=7,413) valves in Germany in 2018 were identified. Outcomes were analyzed for the endpoints in-hospital mortality, major bleeding, stroke, acute kidney injury, postoperative delirium, mechanical ventilation >48h, length of hospital stay, and reimbursement. Since there was no randomization of patients to the two treatment options, logistic or linear regression models were carried out using 22 baseline patient characteristics and center-specific variables as potential confounders. Propensity score methods served as sensitivity analysis.

Results

Both valve types differed significantly in baseline characteristics with higher EuroSCORE (p<0.001), age (p<0.001) and rate of female sex (p<0.001) in patients treated with SE valves. After risk adjustment, there were no marked differences in outcomes for in-hospital mortality (risk adjusted odds ratio (aOR) for SE instead of BE: 0.94 [95% CI 0.76; 1.17], p=0.617), major bleeding (aOR 0.91 [0.73; 1.14], p=0.400), stroke (aOR 1.13 [0.88; 1.46], p=0.347), acute kidney injury (aOR 0.97 [0.85; 1.10], p=0.621), postoperative delirium (aOR 1.09 [0.96; 1.24], p=0.184), mechanical ventilation >48h (aOR 0.98 [0.77; 1.25], p=0.893), length of hospital stay (risk adjusted difference in days of hospitalization: −0.05 [−0.34; 0.25], p=0.762) and reimbursement (−€72 [−€291; €147], p=0.519). Similar results were found using propensity score methods.

Conclusion

Outcomes in contemporary TF-TAVR procedures are broadly equivalent regardless of the valve type used. Major complications rarely occur in both types of valve.

Funding Acknowledgement

Type of funding sources: None. Self- vs balloon-expanding TF-TAVR
Long term follow up of elderly patients treated with self-expanding transcatheter aortic valve implantation; a single center experience
Authors: Rodriguez Nieto J , Delgado Ortega M , Ruiz Ortiz M , Mesa Rubio M D , Perea Armijo J , Piserra Lopez Fernandez De Heredia A , Rodriguez Almodovar A , Esteban Martinez F , Romo Penas E , Suarez De Lezo J , Ojeda Pineda S , Romero Moreno M A , Pan Alvarez Ossorio M
Published: October 2021

Background and aims

The information of long term clinical performance of transcatheter heart valves is limited. Our aim is to assess the clinical outcomes and rate of structural valve deterioration (SVD) in patients after self-expanding transcatheter aortic valve implantation (TAVI) at 10-year follow-up.

Methods

A total of 141 consecutive patients undergoing self-expanding TAVI for native aortic valve stenosis or failed aortic surgical bioprosthesis, between 2008 and 2012 at our institution were included. We considered SVD as defined for the consensus statement from the European Association of Percutaneous Cardiovascular Interventions (European Society of Cardiology/European Association for Cardio-Thoracic Surgery). SVD cumulative incidence was calculated considering death in the absence of valve damage as a competitive risk.

Results

At the time of TAVI mean age was 78±5 years, male 44%. Percutaneous prosthesis implanted were self-expanding in 100% of patients (size: 26 mm in 72%, 29 mm in 28%). Mortality at 1, 5, and 10-year follow-up was 14%, 32%, and 72%, respectively. There was one death due to prosthetic valve endocarditis. Of the total cohort, 11 patients had severe SVD, with a cumulative incidence at 10 years of 8,21 (95% CI 4.09- 14.14%). The rate of SVD at 4, 6, 8, and 10 years was 0%, 1.41%, 2.83%, and 8.21%, respectively (Figure 1 and 2). Of the 11 patients with severe SVD, seven died, two patients had reintervention (both had redo TAVI), and the other two patients remain in close follow-up. In survivors at 10-year follow-up (n=41) the median of mean gradient was 8 mmHg (interquartile Rank 6–13 mmHg) and in 8.4% an prosthetic valve regurgitation ≥moderate was detected. Diabetes, chronic obstructive pulmonary disease, chronic kidney disease, previous stroke and high pulmonary systolic pressure were independent predictors of global mortality. SVD was not associated with any of studied variables (Age, arterial hypertension, obesity, chronic kidney disease, atrial fibrillation, previous aortic bioprosthesis, left ventricle function <50%, prosthetic valve regurgitation, valve size and ballon postdilatation)

Conclusions

A low rate of SVD at 10-year follow-up was observed in this serie of elderly patients with severe aortic stenosis treated with self-expanding TAVI. This study provides insights into the long-term performance of self-expanding TAVI.

Funding Acknowledgement

Type of funding sources: None. Cumulative incidence of SVD and deathSVD with confidence intervals
Mitral regurgitation severity assessment after percutaneous edge-to-edge mitral valve repair: guidelines-recommended integration versus volumetric assessment
Authors: Shekel E , Shuvy M , Danenberg H , Planer D , Gilon D , Leibowitz D , Beeri R
Published: October 2021

Background

Percutaneous edge-to edge mitral valve repair (PMVr) using the MitraClip device is a common method for treating mitral regurgitation (MR) when mitral valve operation is contra-indicated or deemed too risky. The evaluation of residual MR post PMVr is crucial for understanding the benefit and prognostic effect on patients. The common methods used today, based on color flow Doppler and the appearance of the color Doppler jet, may be misguiding because of the multiple jets created by the PMVr technique. Also, flow acceleration induced by the reduced systolic orifice may exaggerate systolic flow acceleration and thus jet area.

Purpose

We hypothesized that the guidelines-recommended method to assess MR may underestimate the effect of PMVr in reducing MR.

Methods

Patients undergoing PMVr in a large-volume PMVr centre were recruited between 2015–2019. Post procedural MR was evaluated using the integrated qualitative approach as recommended by the guidelines. In addition, MR volume for each patient was calculated by subtracting the forward stroke volume (calculated by multiplying LVOT area with the velocity time integral of LVOT systolic flow) from the total stroke volume (using the biplane method of discs), We compared the two methods for concordance.

Results

Overall, 112 cases were enrolled. In 59% of cases, the calculated volumetric residual MR was lower than the MR assessed by the integrated method. In 25.1% of patients the grade of MR was identical in both methods. In 16.2% the MR was more severe when calculated by the volumetric method (p<0.001, Kappa measure of agreement = 0.053–0.074). The reduction in residual MR degree using the volumetric approach was mostly observed in patients classified as “moderate” by the integrated qualitative approach. When considering basic characteristics and cardiac function of the patients, we did not find any sub-group of patients in whom the tendency for this mistake was higher.

Conclusion

Because of multiple jet origins and clip-induced flow acceleration, the integrated method to assess MR severity, based mainly on color Doppler, is not ideal in patients after PMVr. In most cases, MR severity after MitraClip is over-estimated by the integrated, guideline-recommended integrative method when compared with a volumetric method. This is especially relevant for patients classified with “moderate” MR. This study suggests that quantitative methods, not based on colour Doppler, should be used to assess MR severity after PMVr

Funding Acknowledgement

Type of funding sources: None.
Percutaneous left atrial appendage occlusion: impact on left atrial deformation indices
Authors: Dippenaar A , Saaiman J A , Heradien M , Van Der Bijl P
Published: October 2021

Background

Percutaneous left atrial appendage occlusion (LAAO) is an accepted alternative to thromboprophylaxis in atrial fibrillation (AF) patients who are: i) intolerant to oral anticoagulation (OAC) (e.g. life-threatening haemorrhage), ii) non-adherent to OAC, or iii) at a high bleeding risk with OAC. Improvement in LA mechanics was shown post-LAAO in the LAFIT-LARIAT study, using the Lariat device (SentreHEART, Redwood City, CA, USA). No significant change was seen in LA mechanics after LAAO with the Watchman device (Boston Scientific, St. Paul, MN, USA) in the LAFIT-Watchman study. The impact of LAAO with the Amplatz or Amulet device (Abbot Vascular, St. Paul, MN, USA) on LA deformation mechanics, has not been investigated.

Purpose

To evaluate the impact of LAAO with the Amplatz or Amulet device on echocardiographic LA deformation indices.

Methods

All patients undergoing percutaneous LAAO from 2013 to 2021 at a single centre were included from an ongoing clinical registry. LA reservoir, conduit and contractile strain and strain rate were assessed with two-dimensional speckle tracking echocardiography from an apical four-chamber view. Conduit and contractile strain and strain rates were only recorded for patients without AF at the time of echocardiography. Changes in LA deformation indices over time were compared with a linear mixed model.

Results

32 LAAO recipients (mean age 72±12 years, 63% male) were analysed. 5 (16%) patients had AF pre- or post-procedure. After a mean follow-up of 17 months, the mean LA reservoir strain increased from 11.8±7.7% to 12.9±9.1% (P=0.49), the mean LA conduit strain increased from 6.8±6.0% to 8.0±7.4% (P=0.42) and the mean LA contractile strain decreased from 5.7±5.2% to 5.3±5.4% (P=0.77). During the same time interval, the mean LA reservoir strain rate decreased from 0.68±0.44/s to 0.64±0.47/s (P=0.70), the mean LA conduit strain rate increased from −0.52±0.43/s to −0.44±0.32/s (P=0.42) and the mean LA contractile strain rate decreased from −0.77±0.55/s to −0.83±0.53/s (P=0.66).

Conclusions

No statistically significant improvement in LA mechanical function was seen after LAAO with the Amplatz or Amulet device, although a trend towards improved strain was observed for reservoir and conduit strain, with a worsening in contractile strain. Different LAAO devices therefore appear to have divergent effects on LA deformation, the clinical implications of which require further study.

Funding Acknowledgement

Type of funding sources: None.
Pulmonary hypertension is associated with systemic arterial hypertension among patients with normal diastolic function
Authors: Itelman E , Segal M , Kuperstein R , Feinberg M , Segev A , Segal G , Maor E , Grossman E
Published: October 2021

Introduction

The association of pulmonary and systemic arterial hypertension is believed to be mediated through hypertensive left heart disease. The purpose of the current study was to investigate whether pulmonary arterial hypertension (PAH) is associated with systemic arterial hypertension among patients with apparently normal left heart diastolic function.

Methods

Consecutive patients who had echocardiographic evaluation between 2007 and 2019. Patients with disease states that are known to be associated with PAH including diastolic dysfunction were excluded from the analysis. Estimated right ventricular systolic pressure (RVSP) was extracted for all patients from the echocardiographic reports. PAH was defined as estimated RVSP >40 mmHg. Multivariate logistic regression models were applied.

Results

Final study population included 25,916 patients with a median age of 59 (IQR 44–69), of whom 12,501 (48%) were male and 13,265 (51%) had systemic arterial hypertension. Compared with normotensive patients, hypertensive patients were 3.2 times more likely to have PAH (95% CI; 2.91–3.53, p<0.001). A multivariate model adjusted for clinical and echocardiographic parameters that are known to be associated with PAH demonstrated that hypertensive patients are almost 3 times more likely to have PAH (95% CI 2.45–3.15, p<0.001). The association was significant in multiple subgroups but was more significant among women compared with men (OR 3.1 vs. 2.4, p for interaction <0.001).

Conclusions

PAH is associated with systemic arterial hypertension irrespective of left heart disease. The association is more pronounced among women.

Funding Acknowledgement

Type of funding sources: None. Estimated RVSP >40 by Systolic BP
Exercise intensities modulate cognitive function in spontaneously hypertensive rats through oxidative mediated synaptic plasticity in hippocampus
Authors: Lee C C , Wu D Y , Lee T M
Published: October 2021

Background

Oxidative damage in the brain may lead to cognitive impairments. There was considerable debate regarding the beneficial effects of physical exercise on cognitive functions because exercise protocols have varied widely across studies.

Purpose

We investigated whether different exercise intensities alter performance on cognitive tasks.

Methods

The experiment was performed on spontaneously hypertensive rats (6 months at the established phase of hypertension) distributed into 3 groups: sedentary, low-intensity exercise, and high-intensity exercise.

Results

Systolic blood pressure measurements confirmed hypertension in spontaneously hypertensive rats. In comparison to normotensive Wistar-Kyoto rats, sedentary spontaneously hypertensive rats had similar escape latencies and a similar preference for the correct quadrant in the probe trial. Compared to the sedentary group, the low-intensity exercise group had significantly better improvements in spatial memory assessed by Morris water maze. Low-intensity exercise was associated with attenuated reactive oxygen species, as measured by dihydroethidine fluorescence and nitrotyrosine staining in the dentate gyrus of the hippocampus. This was coupled with increased numbers of neurons and dendritic spines as well as a significant upregulation of synaptic density. In contrast, the beneficial effects of low-intensity exercise are abolished in high-intensity exercise as shown by increased free radical levels and an impairment in spatial memory.

Conclusions

We concluded that exercise is an effective strategy to improve spatial memory in spontaneously hypertensive rats even at an established phase of hypertension. Low-intensity exercise exhibited better improvement on cognitive deficits than high-intensity exercise by attenuating free radical levels and improving downstream synaptic plasticity.

Funding Acknowledgement

Type of funding sources: None.
Method for predicting meteopathies in patients with arterial hypertension
Authors: Terentjev K , Andronov S , Lobanov A , Popov A , Grishechkina I , Yakovlev M , Rachin A , Fesyun A , Lebedeva O , Zaichev A ,   the laboratory for studying the mechanisms of action of physical factors
Published: October 2021

Background

Climatotherapy, as part of the spa stage of treatment, with arterial hypertension can give both positive and negative effects in the event of meteopathic reactions. The risk of meteopathies is especially high in patients coming from northern and eastern regions.

Purpose

Was to predict periods of increased risk of meteopathy development.

Methods

The study lasted 22 months, from January 01, 2019 to October 31, 2020 in the city of Gelendzhik (44 ° 36 'north latitude 38 ° 08' east longitude). The source of meteorological data: the site Gismeteo.ru, the Gelendzhik weather station and the ambulance data of the cities of Gelendzhik (12,268 requests) and Novorossiysk (12,226) in total (24,494 requests), the ambulance crews of which serve the area. Nonlinear logit regression using the maximum likelihood method was used to calculate the model.

Results

A prognostic model was built to increase the risk of developing a hypertensive crisis in the studied population; the main indicators of climatic and geomagnetic conditions were used as the studied variables. The sensitivity of the used logistic regression method was 56.0%, and the specificity was 77.3%. The overall accuracy of the model under study was 76.0%. In the winter period, according to the compiled prognostic model, no more than 75.0% of days are accompanied by a low risk of developing hypertension, in the spring period their share decreases to 59.0%, in the summer it is 89.0%, and in the autumn period - 77. 0%.

Conclusion

The developed logistic regression models make it possible to more accurately calculate the individual risks of developing a hypertensive crisis in patients with arterial hypertension and develop an individual treatment strategy.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): state assignment of the Ministry of the Russian Federation
Comparison of a self-automated blood pressure measurement according to the American Heart Association recommendation versus a routine practice, a randomized-controlled trial
Authors: Suntornlekha N , Chai-Adisaksopha C , Jesadaporn P , Mekara W , Kuanprasert S
Published: October 2021

Background

Home blood pressure monitoring is currently a gold standard for guiding an adjustment of antihypertensive medications. According to the American Heart Association (AHA), the self-automated blood pressure (BP) measurement may represent accurate home BP. However, there is a limited data in real-world practice

Objective

To explore the accuracy of a self-automated BP measurement in representing the actual home BP monitoring, in comparison with a single spot-arm automated BP measurement, which is routinely used in the clinical setting.

Methods

We conducted a single center, randomized cross-over trial. At the Cardiology clinic, hypertensive patients aged between 18 and 80 years, who were able to perform self-automated BP measurement, were included in the study. The patients were categorized into two groups using different BP measurement methods: a self-automated BP measurement according to the AHA Recommendation 2017 and a single spot-arm automated BP measurement, and then crossed over to alternative methods. All participants were instructed to rest at least 5 minutes prior to undergo BP measurement in both methods. The data of BP measurements were subsequently compared with the standard home BP monitoring.

Results

Overall, 190 patients underwent randomization. Mean differences of systolic blood pressure (SBP) in the self-automated AHA measurement and the single spot-arm measurement, compared with the standard home BP monitoring, were 3.57 mmHg (95% confidence interval (CI); 1.39 to 5.74 mmHg) and 9.44 mmHg (95% CI; 7.03 to11.86 mmHg), respectively (P<0.001) (table1). Mean differences of diastolic blood pressure (DBP) in the self-automated AHA and the single spot-arm measurements, compared with the standard home BP were −1.51 mmHg (95% CI; −2.76 to −0.25) and 2.69 mmHg (95% CI; 1.07–4.31), respectively (P<0.001) (table 1). White coat hypertension was detected in 7 (3.72%) of patients by AHA measurement and 17 (9.04%) by the single-spot arm measurement (P=0.008).

Conclusion

The self-automated BP measurement according to the AHA Recommendation 2017 was more accurate than the single spot-arm automated BP measurement in representing the actual home BP monitoring and reduced the possibility of the white coat effect.

Funding Acknowledgement

Type of funding sources: None. Table 1
The impact of physical activity on arterial stiffness and inflammation; results from the “Corinthia” study
Authors: Theofilis P , Oikonomou E , Vogiatzi G , Lazaros G , Mystakidi V X , Goliopoulou A , Anastasiou M , Tsalamandris S , Chasikidis C , Papakonstantinou M , Fountoulakis P , Christoforatou E , Siasos G , Tousoulis D
Published: October 2021

Background

Diminished physical activity (PA) is associated with cardiovascular morbidity and mortality. Arterial stiffness and inflammation are associated with atherosclerosis and are established risk factors for cardiovascular disease.

Purpose

We investigated the association of PA status on arterial stiffness and inflammation.

Methods

Classification of PA was performed in 2053 participants of the cross-sectional “Corinthia” study using the International Physical Activity Questionnaire (IPAQ). In accordance with the standard IPAQ scoring procedures, participants were classified into one of the following groups: upper tertile: “vigorous” PA-IPAQ 2, middle tertile: “moderate” PA-IPAQ 1 or lower tertile: “low” PA-IPAQ 0. Arterial stiffness was estimated via carotid-femoral pulse wave velocity (cfPWV) estimation and inflammatory burden was assessed via high sensitivity C reactive protein (hsCRP) measurement.

Results

Participants with low PA had impaired cfPWV values (IPAQ 0: 9.5±3.2 m/s vs. IPAQ 1: 8.7±2.4 m/s vs. IPAQ 2: 8.7±2.2 m/s, p<0.001) (Figure 1, Panel A) while abnormal cfPWV –adjusted for age and blood pressure- were more frequently encountered in low PA individuals (IPAQ 0: 14% vs. IPAQ 1: 7.8% vs. IPAQ 2: 7.3%, p=0.001) (Figure 1, Panel B). Participants characterized as having vigorous physical activity had the lowest inflammatory burden, as estimated by hsCRP (IPAQ 0: 4.8±6.4 g/l vs. IPAQ 1: 4.6±5.2 g/l vs. IPAQ 2: 3.6±4.2 g/l, p=0.001) (Figure 1, Panel C). Importantly, results remained unaffected even after adjustment for confounders (Figure 1, Panel D). A correlation analysis between the total weekly physical activity (expressed as MET minutes/week) and arterial stiffness was performed demonstrating a statistically significant negative correlation was noted (r=−0.120, p<0.001) (Figure 1, Panel E).

Conclusion

A significant association between physical activity, arterial stiffness and inflammation was observed, even after adjusting for known cardiovascular risk factors. Our findings should raise public awareness about the beneficial effects of exercise on cardiovascular health.

Funding Acknowledgement

Type of funding sources: None. Figure 1
Cardiovascular predictors associated with poor short-term prognosis in patients diagnosed with SARS-CoV-2 in Spain
Authors: Esteban-Lucia L , Devesa-Arbiol A , Zambrano Chacon M A , Venegas Rodriguez A M , Gonzalez-Rodriguez M , Maure-Blesa L , Avila-Barahona P , Pello-Lazaro A M , Gonzalez-Lorenzo O , Fernandez-Roblas R , Villar-Alvarez F , Ibanez B , Tunon J , Acena Navarro A , Franco Pelaez J A
Published: October 2021

Background

On January 2020, the first patient with coronavirus 2 (SARS-CoV-2) was detected in Spain. Since then, 3 280 000 cases have been confirmed and 75.305 people have died. We aimed to clarify the epidemiological and clinical characteristics related with poor short-term prognosis in patients diagnosed with SARS-CoV-2.

Methods

Observational, retrospective single-center study including consecutive patients (≥40yo) diagnosed with SARS-CoV-2 through PCR, since March 2nd to 20th 2020 in our center in Spain. The primary endpoint (PE) was the combined of all-cause death or need for orotracheal intubation within the first 30 days of infection symptoms.

Results

704 patients were included (table). A follow-up period of thirty-days was fully completed in 692 of 704 patients (98.3%). At the end of this period, 148 patients (21.4%) met the PE; they were older, more frequently male, obese and smokers. Patients who met the PE had a higher prevalence of hypertension, diabetes, dyslipidemia, ischemic heart disease, heart failure, peripheral and cerebrovascular disease, cancer and lung pathologies. They received more frequently therapies with renin-angiotensin system inhibitors, betablockers, calcium channel blockers and statins, as well as antiplatelet and anticoagulant therapies

Multivariate analysis showed that age (OR 1.99 for every 10 years, 95% CI [1.637–2.4], p<0.001), female sex (OR 0.49, [0.30–0.80], p=0.004), diabetes (OR 2.09, [1.17–3.71], p=0.012), lung disease (OR 1.99, [1.14–3.44], p=0.014) and body mass index (OR 1.33 for each 5 kg/m2 increased, [1.05–1.68], p=0.017) were predictors of the PE. Hypertension was not significantly related to the PE (OR 1.55, [0.93–2.60], p=0.09)

Conclusion

In our group of patients with SARS-CoV-2, age, male sex, diabetes, lung disease and obesity were found to be independent predictors of the combined of all case death or need for orotracheal intubation within the first 30 days of infection symptoms. Larger studies are needed to confirm these results.

Funding Acknowledgement

Type of funding sources: None. Description of studied populationOdds-ratio and CI for the combined PE
Association between ankle-brachial index and cardiovascular mortality in a cohort from the United States of America
Authors: Penson P , Henney N C , Banach M
Published: October 2021

Background

Ankle-brachial index (ABI) is a non-invasive and accessible indicator of peripheral arterial disease (PAD) which shares pathophysiological mechanisms with coronary and cerebral atherosclerosis.

Purpose

This study investigated associations between ABI and cardiovascular (CV) mortality in a longitudinal cohort study.

Methods

Ankle-brachial index was measured in 7571 participants of the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2004. Participant data were linked with National Death Index mortality data until December 2015. Participants were categorised as having low ABI, <0.9, indicative of PAD; or normal ABI 0.9–1.4. Cox Proportional Hazards Regression was used to investigate associations between ABI, CV mortality, adjusting for demographic variables (age, sex, educational status, ethnicity & poverty-income ratio) and traditional CV risk factors (HDL-C, LDL-C, triglycerides, systolic blood pressure, body mass index & diabetes)

Results

Individuals with low ABI were on average older (mean ± SD; 71.1±11.6 v. 59.3±12.8 years) and had higher systolic blood pressure (142.8±24.3 v 131.1±20.8) than those with normal ABI.

Low ABI (<0.9) was associated with increased odds of cardiovascular mortality (Odds Ratio (OR) 3.092, 95% CI 1.81–5.28, p<0.001) after adjustment for all variables. Adjusted survival curves are shown in the figure, below.

In a subgroup analysis of individuals with nominally normal ABI (0.9–1.4), ABI, treated as a linear variable was negatively associated with cardiovascular mortality, OR 0.185 (95% CI 0.051–0.067, per 1 unit change in ABI, P=0.01) after adjustment for demographic variables.

In a subgroup analysis of individuals with low ABI, antihypertensive use was associated with lower odds of CV death (OR 0.246 (95% CI 0.091–0.663, p=0.006) independently of demographic variables, systolic blood pressure, LDL-C and use of statins and antiplatelets.

Conclusion

We have demonstrated strong associations between ABI and CV mortality. Our results suggest that ABI should be investigated as an additional tool in routine CV risk prediction, and highlight the importance of risk-factor management in PAD patients.

Funding Acknowledgement

Type of funding sources: None. Survival curves for low and normal ABI
Change in framingham cardiovascular disease risk between 2003 and 2014 in the hong kong population health survey
Authors: Sung B Y C , Tang E H M , Bedford L , Wong C K H , Tse E T Y , Yu E Y T , Cheung B M Y , Lam C L K
Published: October 2021

Background

The Framingham Risk model estimates a person's 10-year cardiovascular disease (CVD) risk.

Purpose

We aimed to calculate the change in sex-age specific Framingham CVD risk in the Hong Kong Population Health Survey (PHS) 2014/15 in comparison with the survey in 2003–05 (PHS2003/2004 & Heart Health Survey (HHS) 2004/2005).

Methods

Subjects aged 30–74 years from PHS2014/15 (n=1,662, n=4,445,869 after population weighing) and PHS2003/2004 & HHS2004/2005 (n=818, n=3,495,074 after population weighing) with complete data for the calculation of Framingham CVD predicted risk were included. The sex-specific CVD risks of participants were calculated based on their age, total cholesterol and high-density lipoprotein, mean systolic blood pressure, smoking habits, diabetic status, and treatment for hypertension. The mean sex-age specific CVD risks were then calculated, and the differences in CVD risk between the two surveys were analysed using ANOVA.

Results

There was no significant difference in 10-year CVD risks between the 2003–2005 and 2014/15 study populations (10.2% vs. 10.6%, p=0.29). After adjusting to a standard population (US Census 2000), the age-standardized CVD risk was lower in 2014–2015 than in 2003–05 (10.0% vs. 10.7%, p=0.017). More participants aged 65–74 were classified as high risk during 2003/04 (PHS2003/2004 & HHS2004/2005: 66.8% vs. PHS2014/15: 53.1%, p=0.026). This might be due to the decrease in the proportion of smokers among men (2003–2005: 30.5% vs. 24.0% in 2014–15, p<0.001).

Conclusions

Between 2003/04 and 2014/15, there was a small decrease in age-standardized 10-year CVD risk, which might be related to the reduction in smoking. However, more effort in targeting multiple CVD risk factors simultaneously is needed to achieve a greater reduction in CVD risk.

Funding Acknowledgement

Type of funding sources: None.
Circulating trimethyllysine predicts total and cardiovascular mortality in patients with and without coronary heart disease
Authors: Bjornestad E O , Dhar I , Svingen G F T , Svenningsson M M , Pedersen E R , Tell G S , Ueland P M , Orn S , Laaksonen R , Nygaard O
Published: October 2021

Background

The carnitine precursor trimethyllysine (TML) is associated with the microbiota-derived metabolite trimethylamine N-oxide (TMAO) and predicts future cardiovascular events in patients with established coronary heart disease (CHD).

Purpose

To examine circulating TML as a predictor of total and cardiovascular mortality in two independent cohorts of subjects with or without CHD.

Methods

By Cox regression modelling, risk associations were examined in 6393 subjects in the community-based Hordaland Health Study (HUSK). A replication study was performed among 4117 patients undergoing coronary angiography for suspected stable angina pectoris in the Western Norway Coronary Angiography Cohort (WECAC).

Results

During a median follow-up of 10.9 years in the HUSK-cohort, 884 (13.8%) subjects died, of whom 287 from cardiovascular causes. After adjustments for traditional cardiovascular risk factors, the hazard ratio (HR) (95% CI) for total mortality comparing the 4th vs. 1st TML-quartile was 1.66 (1.31–2.10, p<0.001). Particularly strong associations were observed with cardiovascular mortality (HR [95% CI] 2.04 [1.32–3.15, p=0.001]). Corresponding risk estimates in the WECAC-cohort (median follow-up of 10.3 years) were 1.35 (1.10–1.66, p=0.004) for total and 1.45 (1.06–1.98, p=0.02) for cardiovascular mortality. Additional adjustments for plasma TMAO did not materially influence the risk estimates in either cohort, and no effect modification by TMAO was observed.

Conclusions

Circulating TML is associated with increased risk of total and cardiovascular mortality in both subjects with and without CHD.

Funding Acknowledgement

Type of funding sources: None.
Inter-relationships of different electrocardiographic indicators of left ventricular hypertrophy in 25,000 Chinese adults
Authors: Chaikovsky I , Lebedev E , Du H , Chen Y , Ponomarev V , Guo Y , Bian Z , Li L , Chen Z , Clarke R
Published: October 2021

Background

Several electrocardiographic (ECG) indices have previously been proposed to diagnose left ventricular hypertrophy (LVH). Such indices utilize different criteria, including increased QRS voltage, prolonged QRS duration, left axis deviation, and LAFB and LBBB-like patterns in varying combinations. However, the inter-relationships of these different electrocardiographic indices of LVH with each otherare not fully understood.

The purpose of this study is to estimate the relationships between the different LVH indices.

Methods

Electronic tracings of 12-lead ECGs recorded in 24,786 adult participants in the China Kadoorie Biobank recorded in 2014 were accessed to detect presence of LVH. ECG parameters of LVH, including individual and combinations of such parameters (voltage-only criteria such as Sokolov-Lyon, Cornell, Gubner as well as scores such as Romhilt-Estes point score) were estimated using customized computer software (Cardiolyse Oy, Finland) and compared proprietary LVH point score algorithms (Mortara, USA). Relationships between the different indices were assessed using a correlation matrix to explore associations between individual parameters and combined indices of such parameters. The matrices were used to construct heat maps and identify clustering of individual parameters.

Results

Overall, approximately 10% of the population had LVH assessed by Mortara algorithms. This graph shows that along with the free standing peaks, the rest are divided into two clusters of interconnected individual parameters. In the center of the largest cluster is the parameter, reflecting R-peak magnitude in aVL lead. In the center of another cluster was the left ventricular strain pattern, as described in Romhilt-Estes point score system. Overall, the Sokolov-Lyon index and LVH point score in Veritas algorithm had the strongest relationships with each other, but the Gubner and Cornell indices had relatively weak correlations with the other indices (Table 1). The mean correlation coefficient between five combined LVH indices was as follows: Veritas (Mortara) – 0.58, Sokolov-Lyon – 0.56, Romhilt-Estes – 0.45, Gubner – 0,32, Cornell – 0,3.

Conclusions

Parameters such as R-peak magnitude in aVL and left ventricular strain pattern were the most strongly related with each other. Aggregate indices, such as the Sokolov-Lyon index and LVH point score in Veritas algorithm were the most strongly related with all other indices, but the Gubner and Cornell indices were only weakly correlated. The results reinforce the utility of Sokolov-Lyon index and Mortara algorithms as the optimum measures of LVH.

Funding Acknowledgement

Type of funding sources: None.