bluuebunny/crossref_metadata_2025 huggingface dataset:
The efficacy of vericiguat on improving quality of life among patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis
Authors: Marino B , Macatiag J.M
Published: October 2021

Background

Heart Failure with Preserved Ejection Fraction remains to be a global health concern since there is no proven effective therapy as of the moment. Data from 2017 have shown that half of the population with heart failure has preserved ejection fraction (HFpEF) and there is an observed increasing trend in numbers. HFpEF carries significant disease burden and greatly affects Quality of Life.

Objective

To determine the efficacy of Vericiguat in improving the quality of life among patients with Heart Failure with preserved Ejection Fraction.

Methodology

A comprehensive literature search was made by the authors for Randomized Controlled Trials comparing the efficacy of Vericiguat with placebo in improving the Quality of Life among patients with HFpEF. Authors were contacted if there were missing data. Two authors independently extracted data and appraised the different studies' characteristics, quality and outcomes. RevMan 5.4 was used for the statistical analysis.

Results

The authors found two RCTs with 1,218 participants. Pooled analysis of the moderate to high quality studies showed no statistically significant mean difference in the different domains of the Kansas City Cardiomyopathy Questionnaire including the Clinical Summary Score, Physical Limitation Score, Total Symptom Score, and Overall Summary Score (1.61 [−1.44, 4.66] p=0.30; 2.22 [−1.16, 5.60] p=0.20; 0.14 [−3.00, 3.29] p=0.93; and 1.35 [−1.65, 4.35] p=0.38, respectively) between Vericiguat and placebo. For the safety and adverse events, there was no statistically significant difference between Vericiguat and placebo with regards to syncope, hypotension and death, with RR of 1.10 [0.06, 18.61] p=0.95; 1.22 [0.70, 2.14] p=0.48 and 1.79 [0.67, 4.75] p=0.24, respectively.

Conclusion

Vericiguat compared to placebo did not significantly improve the Quality of Life among adult patients with Heart Failure with Preserved Ejection Fraction.

Funding Acknowledgement

Type of funding sources: None.
Relationship between venous congestion and systemic hypoperfusion in cardiorenal syndrome
Authors: Scagliola R , Bonino B , Viazzi F , Balbi M , Ameri P
Published: October 2021

Background

Renal impairment takes a relevant role in worsening clinical outcomes and increasing mortality risk in patients with heart failure (HF). In this context, the interplay between venous congestion and systemic perfusion in the pathogenesis of cardiorenal syndrome is currently a matter of extensive debate1.

Purpose

To investigate the relationship between renal function and hemodynamic variables, as the cardiac index and right atrial pressure, in a broad spectrum of HF patients undergoing right heart catheterization, as part of their pulmonary hypertension (PH) diagnostic work-up.

Patients and methods

From 1st September 2005 until 31st October 2019, hemodynamic data from 286 consecutive patients were collected, of whom 267 had available plasmatic creatinine values. The estimated glomerular filtration rate (eGFR) was calculated by using the Chronic Kidney Disease Epidemiology Collaboration formula. The overall study population was stratified in no PH group, pre-capillary PH group and post-capillary PH group, on the basis of the available hemodynamic values of mean pulmonary arterial pressure and pulmonary artery wedge pressure.

Results

Of the overall population, 46.1% of them were male, the mean age at the right heart catheterization was 65.5±13.7 years, and the mean eGFR value was 70.0±0.2 mL/min/1.73 m2. On the basis of hemodynamic parameters, 71 patients constituted the no PH group, 107 the pre-capillary PH group, and 63 the post-capillary PH group. Post-capillary PH patients were significantly older than both no PH and pre-capillary PH subjects (69.4±11.7 years; 61.2±16.7 years and 65.7±12.9 years respectively, p=0.003). eGFR was significantly lower in the post-capillary PH group, compared to both no PH group (63.1±22.8 mL/min/1.73 m2 vs. 73.0±23.9 mL/min/1.73 m2, p=0.029) and pre-capillary PH group (63.1±22.8 mL/min/1.73 m2 vs. 71.6±26.6 mL/min/1.73 m2, p=0.041). In post-capillary PH group, multivariate logistic regression analysis showed a significant correlation between eGFR <60 mL/min/1.73 m2 and both reduced cardiac index (Odds ratio [OR] 0.05, 95% confidence interval [CI] 0.00 to 0.72, p=0.027) and right atrial pressure (OR 0.75, 95% CI 0.57 to 0.99, p=0.039), compared to no PH group and pre-capillary PH group.

Conclusions

A significant association between renal impairment and both low systemic perfusion and venous congestion, was found in patients with post-capillary PH, rather than in other hemodynamic subsets. Further investigations are needed to disentangle the impact of the both sides of circulation on renal function, in different hemodynamic phenotypes.

Funding Acknowledgement

Type of funding sources: None.
Kallistatin/ serpina3c inhibits fibrosis after myocardial infarction by regulating glycolytic pathway
Authors: Ji J.J , Yao Y.U.Y.U
Published: October 2021

Background

Fibrotic remodeling is the main pathological mechanism of heart failure after infarction. Studies have shown that the serine protease inhibitor Kallistatin/Serpina3c could inhibit the progression of myocardial hypertrophy and fibrosis after myocardial infarction, but the specific mechanism is unknown.

Methods and results

We used Serpina3c−/− and C57BL/6 mice to construct a MI model in vivo. TGF-β and hypoxia interfered with cardiac fibroblasts (CFs) to construct a fibrosis model in vitro. RNA-seq assessed the effect of Serpina3c knockout on the transcriptome. CCK-8 and BrdU were used to assess cell proliferation. Western blot and qPCR were used to verify the changes of glycolytic enzymes in the sequencing results. Co-IP was used to verify the interaction between Serpina3c and NR4A1. The results showed that Serpina3c expression decreased in the fibrotic tissue of MI heart and in the fibrosis model in vitro. After Serpina3c knockout, the degree of myocardial infarction fibrosis aggravated, and the proliferation and differentiation of CFs increased. Up-regulation of Serpina3c expression in CFs had the opposite effect, suggesting that Serpina3c had the ability to resist myocardial fibrosis. RNA-Seq results showed that glycolysis-related genes were significantly increased after Serpina3c knockout. Among them, the key enzyme of glycolysis, enolase (ENO1), had the largest change, and at the same time, the glycolysis reaction was enhanced. Inhibition of ENO1 can antagonize the promotion of Serpina3c knockout on the proliferation and differentiation of CFs. Activating the activity of NR4A1 could negatively regulate the expression of ENO1 and then inhibited the proliferation and differentiation of CFs.

Conclusions

Serpina3c inhibited the transcriptional activation of ENO1 by binding to NR4A1, and then reduced the fibrosis after myocardial infarction by inhibiting glycolysis. In short, Serpina3c provides a potential intervention target for the prevention and treatment of heart failure after infarction.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): National Nature Science Foundation of China (No. 81770452) Serpina3c is a key protein in MI.
Impaired health status is independently associated with persistently elevated NT-proBNP levels despite medical therapy for heart failure with reduced ejection fraction
Authors: Chaikijurajai T , Tang W.H.W
Published: October 2021

Background

Impaired health status as measured by standardized tools such as Kansas City Cardiomyopathy Questionnaire (KCCQ), Duke Activity Status Index (DASI) and six-minute walk test (6MWT) has been shown to predict hospitalization and mortality in patients with chronic heart failure. However, prognostic implications of these measurements in response to guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF) remained to be elucidated.

Purpose

We hypothesized that impaired health status were predictive of persistently elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) after 6 and 12 months of therapeutic optimization in HFrEF.

Methods

Data on the GUIDE-IT trial that included protocolized HFrEF drug titration were analyzed. Patients who did not have NT-proBNP at 12 months were excluded. KCCQ overall and clinical summary scores, and DASI scores at baseline and 6 months were calculated. Six-minute walk test (6MWT) distance at baseline were also available. Response to medical therapy was defined as having NT-proBNP at 12 months of less than 1,000 pg/mL. Median value of each measurement was used as a cutoff. Multivariate logistic regression analysis was used to determine independent associations between different QOL scores and NT-proBNP response after adjustment for age, comorbidities, baseline EF, NYHA functional class, and NT-proBNP.

Results

There were 193 (43%) responders. Compared with those who responded to the medical therapy, non-responders were older, and more likely to have comorbidities including coronary artery disease, stroke, PAD, AF, hypertension, COPD, DM, CKD, and dyslipidemia, as well as lower EF, NHYA functional class and higher baseline NT-proBNP. After adjustment for baseline characteristics, lower KCCQ (either overall or summary) scores at baseline and 6 months, and lower DASI scores at 6 months (but not baseline) were independently associated with lower likelihood of response to GDMT (Table). In contrast, baseline 6MWT distance did not predict non-response to GDMT after adjustments.

Conclusions

Only impaired baseline KCCQ scores were predictive of persistently elevated NT-proBNP, while lower KCCQ and DASI scores at 6 month were predictive of persistently elevated NT-proBNP.

Funding Acknowledgement

Type of funding sources: None. Health Status Score below Median and ORs
Ticagrelor monotherapy versus dual anti-platelet therapy in patients undergoing percutaneous coronary intervention: a subgroup analysis of safety in multiple comorbidities
Authors: Patel M M , Zerihun K
Published: October 2021

Background

The TICO trial evaluated the effectiveness of ticagrelor monotherapy after 3 months of dual antiplatelet therapy (DAPT) versus continued DAPT and measured the risk of major bleeding and adverse cardiac/cerebrovascular events at 12 months, however there are certain subgroups such as the elderly that have higher bleeding risks than the average population.

Objective

To determine if specific comorbidities or patient demographics increase the risks of major bleeding or major cardiac/cerebrovascular events in patients receiving ticagrelor monotherapy versus aspirin plus ticagrelor in patients post percutaneous coronary intervention with acute coronary syndrome.

Methods

This was a post-hoc subgroup analysis of multiple cohorts (Age, diabetes, hypertension, chronic kidney disease, and obesity) from the TICO (The ticagrelor monotherapy after 3 months in the patients treated with new generation sirolimus stent for acute coronary syndrome) study. The co-primary outcomes that were measured were major bleeding events and major adverse cardiac and cerebrovascular events.

Results

Compared to DAPT, ticagrelor monotherapy significantly decreases risk of major bleeding events in patients >65 (HR 0.48; 95% CI 0.24–0.95), without diabetes (HR 0.48; 95% CI 0.25–0.94), without CKD (HR 0.48; 95% CI 0.25–0.95), and non-obese (HR 0.49; 95% CI 0.25–0.95). Ticagrelor monotherapy also decreases risk of major cardiac and cerebrovascular events in patients >65 (HR 0.52; 95% CI 0.29–0.95) compared to DAPT.

Conclusion

This post-hoc subgroup analysis reveals that, in certain populations, ticagrelor monotherapy after a three month DAPT course significantly decreases risk of major bleeding events and major cardiac and cerebrovascular outcomes in patients with acute coronary syndrome. This is especially seen in the elderly population where risks of adverse events are higher. Nonetheless, larger studies need to be performed for further analysis.

Funding Acknowledgement

Type of funding sources: None.
Comparative efficacy of fibrinolytics and glycoprotein IIb/IIIa inhibitors in preventing coronary no-reflow: a network meta-analysis
Authors: Hofbauer F , Stibleichinger M , Wendt J , Klappacher G
Published: October 2021

Background

Coronary no-reflow is a potentially lethal complication of percutaneous coronary intervention (PCI). The optimal approach to preserve coronary reflow during primary PCI is still controversial.

Purpose

Therefore, we aimed to compare and rank the adjunctive use of fibrinolytic agents and glycoprotein IIb/IIIa inhibitors by network meta-analysis of randomized controlled trials.

Methods

Pairwise and network meta-analysis were performed using the random-effects model within a frequentist framework. The primary outcome was coronary TIMI flow grade immediately following the intervention.

Results

82 studies with a total of 20666 participants were identified, including 7 multi-arm studies. This enabled 94 pairwise comparisons of 35 different adjunctive anticoagulant regimens, all administered in the context of primary PCI. Overall, risk of bias in these studies was rated moderate, and heterogeneity was low with a global I2 value of 20.8%. The figure shows the ranking of the interventions in relation to no adjunctive treatment (NON) and placebo (PLA). In particular, Tirofiban (TIR) alone or in combination with Adenosin (ADE) Nicorandil (NIC) was effective in preventing coronary no-reflow. The route of its administration, intravenous (IV) vs intracoronary (IC), did not matter much. However, its timing as an early IV injection upstream of primary PCI was not beneficial. Eptifibatide (EPT) given as IC bolus followed by continuous IV infusion had an effect comparable to TIR, as well as, among the fibrinolytics, Pamiteplase (PAM) given IV and Urokinase (URO) given IC.

Conclusions

This comprehensive comparison of fibrinolytics and glycoprotein IIb/IIIa inhibitors demonstrates that TIR, EPT, PAM, and URO can effectively and equally prevent coronary no-reflow in primary PCI.

Funding Acknowledgement

Type of funding sources: None.
Bioabsorbable vascular scaffolds in routine practice: long-term results
Authors: Mori R M , Nunez I N G
Published: October 2021

Background

Recent publications suggest that bioabsorbable vascular scaffolds (BVS) carry an excess of thrombotic complications. Our goal was to describe the results in real life and in the long term, in a series of patients who received a BVS which is currently off the market.

Methods

Two hundred and thirteen consecutive patients who received at least 1 BVS between May 2012 and December 2016 were analyzed. The primary objective was the incidence of the compound event “target vessel failure” that included infarction or target vessel revascularization and cardiac death.

Results

Seventy-five percent of patients were men with a mean age of 61.4 years. They had a high prevalence of dyslipidemia (62.44%) and smoking (65.26%). The most common cause of admission was myocardial infarction without ST elevation (53.52%). A total of 233 coronary lesions were treated, with an average of 1.3±0.3 lesions per patient. The implant was successful in 99.5% of cases. Predilatation was performed in 89.3% and post dilation in 33.5% of cases. The use of intracoronary imaging (Optical Coherence Tomography OCT and/or Intravascular ultrasonography IVUS) to optimize the BVS implant was performed in 86 patients (40.38%). With a mean follow-up of 42.5 months, the incidence of target vessel failure was 6.57% during the first 24 months and 7.98% at the end of the follow-up. Regarding the device, this included 6 cases (2.81%) of thrombosis (definitive, probable or possible) and 10 cases (4.69%) of restenosis. Patients with a history of diabetes mellitus (HR 1.72 95% CI 1.01–2.95 P=0,05) and/or chronic oral anticoagulation (HR 5.71 95% CI 1.12–28.94 P=0.04) had a higher risk of target vessel failure. The use of intracoronary imaging (OCT and/or IVUS) during the BVS implantation had a considerable trend toward significance as a protective factor (HR 0.32 95% CI 0.11–1.03 P=0.06).

Conclusions

In this series of patients; in real life conditions, the incidence of target vessel failure was comparable to that previously described in randomized clinical trials. The events were more frequent during the first 2 years of follow-up, in the presence of greater cardiovascular comorbidity and in the absence of intracoronary imaging during the implantation.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): European Society of Cardiology KM curve for target vessel failure (TVF)Predictor analysis for TVF
The impact of bifurcation lesion in infarct-related artery of NSTE-ACS patients
Authors: Boukerche F , Zouli L , Laredj N
Published: October 2021

Introduction

Angioplasty of bifurcation lesions remains challenging. In most studies, long-term outcomes were less favourable compared to non-bifurcation lesions. Patients with bifurcation lesions were excluded from most of the randomised studies of AMI.

Purpose

The aim of this study was to determine the prognostic impact of bifurcation lesion on three-year outcome in a prospective cohort of NSTE-ACS patients.

Bifurcation lesions (BFLs) remain a challenging lesion subset, often associated with lower success rates than less complex lesions. There are few data regarding the impact of BFLs in the setting of NSTE-ACS.

Methods

Patients admitted for NSTE-ACS and indication for coronary angiography were prospectively evaluated. Patients were divided into 2 groups according to whether infarct-related-artery lesions were vs. were not a bifurcation lesion. Major outcomes were assessed at 3 years.

Results

A total of 296 patients were evaluated: mean age was 62±12 years and 58% were male. The three-year mortality was 12.2% (36 patients) and the three-year MACCE was 26.4% (78 patients). The bifurcation lesion group included 62 patients (20.9%).The three-year mortality and MACCE in the patients of the bifurcation lesion group was significantly higher (19.4% vs. 10.3%; p=0.046) and (45.2% vs. 21.4%; p≤10–3) respectively.

Conclusion

In NSTE-ACS, bifurcation lesions portend worse prognosis. This may guide prognostication and decision making in treatment.

Funding Acknowledgement

Type of funding sources: None. MACCE occurrence: Bifurcation impact
Radioprotection during interventional cardiology procedures
Authors: Noval-Morillas I , Canadas-Pruano D , Izaga E , Gutierrez-Barrios A
Published: October 2021

Background

The use of ionizing radiation during cardiac catheterization interventions adversely impacts both the patients and the medical staff. Traditional radiation protection equipment is only partially effective. The Cathpax® radiation protection cabin (RPC) has demonstrated to significantly reduce radiation exposure in electrophysiological and neuroradiology interventions. Our objective was to analyze whether the Cathpax® RPC reduces radiation dose in coronary and cardiac structural interventions in unselected real-world procedures.

Methods and results

In this non-randomized all-comers prospective study, 119 consecutive cardiac interventional procedures were alternatively divided into two groups: the RPC group (n=59) and the non-RPC group (n=60). No significant changes in patients and procedures characteristics, average contrast volume, air kerma (AK), dose area-product (PDA) and fluoroscopy time between both groups were apparent. In RPC group, the first operator relative radiation exposure was reduced by 78% at the chest and by 70% at the wrist. This effect was consistent during different types of procedures including complex percutaneous interventions and structural procedures.

Conclusions

Our study demonstrates, for the first time, that the Cathpax® cabin significantly and efficiently reduces relative operator radiation exposure during different types of interventional procedures, confirming its feasibility in a real-world setting.

Funding Acknowledgement

Type of funding sources: None.
A comparison of long-term clinical outcomes between PCI and medical therapy in patients with chronic total occlusion in non-Infarct-related arteries after AMI PCI
Authors: Qin Q , Ma J , Ge J
Published: October 2021

Background

Chronic total occlusion (CTO) in a non-infarct-related artery (IRA) is one of the risk factors for mortality after acute myocardial infarction (AMI). However, there are limited data comparing the long-term outcomes of patients underwent successful percutaneous coronary intervention (s-PCI) with patients having medical therapy (MT) in CTO lesion after AMI PCI.

Methods

We retrospectively enrolled 330 patients (n=166 in s-PCI group and n=164 in MT group) with CTO in a non-IRA from a total of 4372 patients who underwent PCI after AMI from July 2011 to July 2019 in our center (Figure 1). Propensity matching (119 matched pairs) was used to adjust for baseline differences. Major adverse cardiovascular and cerebrovascular events (MACCEs) on follow-up were defined as the composite of cardiac death, all cause death, myocardial infarction (MI), stroke and any revascularization. Kaplan-Meier analysis were used to evaluate the long-term outcomes between s-PCI and MT group.

Results

The patients in MT group were older, more likely to be diagnosed as STEMI, had lower eGFR and higher peak troponin T level during AMI compared with s-PCI group. Furthermore, in MT group, the involvement of LAD as IRA (50.6% vs 38.6%, p=0.028) and LCX as CTO vessel (45.1% vs 27.1%, p=0.001) was more frequent than in s-PCI group, and thus the involvement of LAD as CTO vessel was less frequent (28.9% vs 39.8%, p<0.001). During a median follow-up period of 946 days, patients in s-PCI group had significantly lower incidences of cardiac death (3.0% vs 10.4%, p=0.017) and all cause death (5.4% vs 14.0%, p=0.030) when compared with patients in MT group. Moreover, after PSM, patients in s-PCI group still showed lower incidence of cardiac death (2.5% vs 9.2%, p=0.04). The incidence of MI, stroke, revascularization and MACCE showed no significant difference between the two groups both before and after PSM. In multivariate analysis, age (HR 1.06, 95% CI 1.02–1.10, p=0.003) and LVEF<50% (HR 4.71, 95% CI 1.72–12.90, p=0.003) showed significant correlation with long term cardiac death, however, successful CTO PCI showed borderline significance (HR 0.42, 95% CI 0.15–1.16, p=0.095). In subgroup analysis, Kaplan–Meier curve showed s-PCI group had a lower incidence of cardiac death compared with MT in patients with LVEF<50% both before (p=0.011) and after PSM (p=0.045). However, no difference was observed between two groups in patients with LVEF≥50%.

Conclusions

In our center, s-PCI of CTO in non-IRA after AMI PCI showed better long-term cardiac survival as compared with MT. Moreover, patients with low LVEF may be benefit from CTO PCI in non-IRA.

Funding Acknowledgement

Type of funding sources: None. Flow chart of the studyKaplan-Meier analysis between two groups
The bimodal rise and fall acute coronary syndromes curves paralleling COVID-19 outbreaks
Authors: Trabattoni D , Teruzzi G , Ravagnani P M , Santagostino Baldi G , Montorsi P , Calligaris G , Galli S , Bartorelli A L
Published: October 2021

Introduction

Preliminary reports from the early phase of COVID-19 epidemic in Italy reported a dramatic reduction in hospital admission rates for acute coronary syndromes (ACS) coupled with longer times from symptoms onset to hospital presentation.

Purpose

To assess the impact of COVID-19 on hospital admission rates and ACS patterns, as well as time to presentation and clinical outcomes, following the acute pandemic phase in 2020 compared to previous year.

Methods

We conducted a single institution retrospective analysis conducted in a cardiovascular hub serving a large metropolitan area in Italy. Number and monthly distribution of hospital admissions for ACS from January 1 to December 31, 2020 were compared to the respective figures in 2019. Baseline clinical features, time from symptoms onset to hospital admission and main clinical outcomes were collected.

Results

A total of 599 ACS cases were recorded in 2020 vs. 386 cases in 2019, with a net 55% increase. ACS presentation rate in 2020 showed a bimodal pattern, paralleling the most contagious outbreak periods (Figure 1). SARS-CoB-2 nasopharyngeal swab or specific antibody tests were positive in 34 (5.7%) patients. Time from symptoms onset to hospital presentation tended to be longer in 2020 than in 2019, being two-fold longer during the peak epidemic phase (February 21-May 3, 2020; median time 2.0 vs. 5.0 hours, p=0.030). The proportion of late-presenting STEMI (>8 hrs from symptoms onset) was higher in 2020 compared to 2019 (30% vs. 18%, p=0.003),as well as higher was in-hospital mortality (15% in 2020 vs 6% in 2019, p=0.001), partly due to a three-fold increase in cardiogenic shock on ACS presentation.

Conclusions

ACS admission rate significantly increased during the 2020 COVID-19 epidemic outbreak for several reasons only partially explained by a SARS-CoV-2 infection trigger effect on ACS. Longer presentation times and higher rates of cardiogenic shock and mortality were observed, urging the need health-care systems to keep a high priority on cardiovascular emergencies response networks.

Funding Acknowledgement

Type of funding sources: None. Figure 1
Improved cardiac outcomes by early treatment with angiotensin-converting enzyme inhibitors in becker muscular dystrophy
Authors: Motte L , Stalens C , Behin A , Ben Yaou R , Leturcq F , Bassez G , Laforet P , Fontaine B , Ederhy S , Masingue M , Saadi M , Leonard Louis S , Berber N , Duboc D , Wahbi K
Published: October 2021

Background

The latest practice guidelines from the American College of Cardiology/American Heart Association recommend the prescription of an ACE-i for patients presenting with non-ischemic cardiomyopathy when left ventricular ejection fraction (LVEF) falls below 40%.

Objective

To determine if the initiation of treatment with an angiotensin-converting enzyme inhibitor (ACE-i) earlier than recommended by practice guidelines issued by professional societies improves the long-term cardiac outcomes of patients presenting with Becker muscular dystrophy (MD) cardiomyopathy.

Methods

From a multicenter registry of Becker MD, we selected retrospectively patients presenting between January 1990 and April 2019 with a LVEF ≥40 and ≤49%. We used a propensity score analysis to compare the risk of a) hospitalization for management of heart failure (HF), and b) a decrease in LVEF to <35% in patients who received an ACE-i when LVEF fell below 40% (conventional treatment), versus below 50% (early treatment).

Results

From the 183 patients entered in our registry, we identified 85 whose LVEF was between 40 and 49%, 51 of whom received early and 34 received conventional ACE-i treatment. Among patients with early versus conventional treatments, 2 (3.9%) versus 4 (11.8%) were hospitalized for management of HF [hazard ratio (HR) 0.151; 95% confidence interval (CI) 0.028 to 0.822; p=0.029], and 9 (17.6%) versus 10 (29.4%) had a decrease in LVEF below 35% (HR 0.290; 95% CI 0.121 to 0.694; p=0.005).

Conclusions

The long-term cardiac outcome of patients presenting with Becker MD was significantly better when treatment with ACE-i was introduced after a decrease in LVEF below 50%, instead of below 40% as recommended in the current practice guidelines issued by professional societies.

Funding Acknowledgement

Type of funding sources: None. Study EndpointsCardiovascular events during follow-up
The coronary arteries in adults after arterial switch: a systematic review
Authors: Engele L J , Mulder B J M , Schoones J W , Kies P , Egorova A D , Vliegen H W , Hazekamp M G , Bouma B J , Jongbloed M R M
Published: October 2021

Background

Coronary artery status in adults longterm after the arterial switch operation (ASO) is unclear. As a consequence, current follow-up strategies for coronary assessment remain controversial. We conducted a systemic review to provide an overview of coronary complications during adulthood and to evaluate the value of coronary imaging in adults after ASO, in light of current guidelines.

Material and method

Studies describing coronary complications or coronary imaging after ASO in adults were considered eligible for review and analysis. Articles were screened for the inclusion of adult ASO patients and data on coronary complications and findings of coronary imaging were collected. In cohort studies with both adults (≥18 years) and non-adults (<18 years) only outcomes in identifiable adults were analyzed.

Results

A total of 993 adults were followed with a median follow-up of 2.0 years after reaching adulthood. Myocardial ischemia was suspected in 16/192 patients (6.8%). The number of coronary interventions was 4 (0.4%) and coronary death was reported in 4 (0.4%) patients. The following coronary abnormalities were found by routine coronary computer tomography CT (cCT): stenosis (4%), acute angle (40%), kinking (24%) and interaterial course (11%). No coronary events were reported during pregnancy (n=45).

Conclusion

The reported number of coronary interventions (0.4%) and of coronary death (0.4%) during a median follow-up of 2 years in 993 ASO adults is low. Coronary abnormalities including acute angle, kinking and interarterial course were commonly found by cCT. The 2020 European Society of Cardiology (ESC) guidelines state that routine screening for coronary pathologies is questionable. However, based on current findings and in line with the 2018 American ACC/AHA guidelines we suggest a baseline assessment of the coronary arteries in all adult ASO patients. Thereafter, an individualized coronary follow-up strategy, based upon coronary findings, is advisable.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Hartstichting Freedom from coronary complications
Longitudinal changes in aortic distensibility in patients with Marfan syndrome
Authors: Van Andel M M , De Waard V , Timmermans J , Scholte A J H A , Van Den Berg M P , Zwinderman A H , Mulder B J M , Groenink M
Published: October 2021

Background

Patients with Marfan syndrome (MFS) may develop aortic dissection due to progressive dilatation in the entire aorta. Increased aortic stiffness, i.e.a. decreased distensibility has been shown to often precede these dismal sequelae. Therefore, we investigated longitudinal changes in aortic distensibility throughout the entire aorta by means of Cardiac Magnetic Resonance (CMR) imaging in patients with MFS.

Methods

This retrospective study included all MFS patients with four CMR examinations performed between 1996 and 2012. Aortic distensibility was measured and calculated by a single analyst, in the ascending, proximal- and distal descending, and abdominal aorta. Changes in distensibility were studied using linear mixed-effects regression models. Furthermore, we investigated the association between distensibility and age, sex, blood pressure, medication use, FBN1 mutation type, and previous aortic root surgery.

Results

In total, 35 MFS patients (age at inclusion 28 [IQR 23–32] years, 54% male) were included. Mean aortic distensibility was low in the ascending and proximal descending aorta (resp. 3.25±1.87, 3.91±1.73x10–3 mmHg–1) at the first scan. Distensibility decreased significantly over time at level 2, 3, and 4 (resp. p=0.021, p=0.002, p=0.038) (Figure 1). The rate of distensibility loss per year (x10–3 mmHg–1/year) was respectively 0.04 and 0.06 in the proximal- and distal descending aorta.

Men seemed to have a lower but more stable distensibility, whereas women showed a higher distensibility at younger age, but a faster deterioration rate over time (difference in distensibility loss per year between men and women: 0.08, p=0.038). Distensibility did not correlate significantly with medication use, FBN1 mutation type or previous aortic root surgery.

Conclusion

Patients with MFS have low distensibility at all levels of the aorta at young age, which keeps decreasing over time. Men had lower distensibility at younger age than women. Distensibility was stably low in men, while still deteriorating over time in women.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): AMC FoundationHorstingstuit Foundation
Neointimal hyperplasia regression using combined paclitaxel- mediated confocal dual pulse shock wave sonoporation therapy and catheter- based 90Y- mediated brachytherapy
Authors: Mehrad H
Published: October 2021

Background and aims

Intimal hyperplasia refers to proliferation and migration of vascular smooth muscle cells primarily in the tunica intima, resulting in arterial wall thickening and decreased arterial lumen size. Neointimal hyperplasia is the major cause of restenosis after percutaneous carotid interventions such as stenting or angioplasty. The aim of this study was to investigate the effect of combined shock wave enhanced sonoporation therapy and catheter-based 90Y-mediated β-brachytherapy on neointimal hyperplasia regression in an animal model, wherein diagnostic B-mode ultrasound is combined with therapy system, with a goal of increased safety.

Methods

Endothelial balloon catheter denudation of the abdominal aorta of golden Syrian hamsters was performed. Histopathologic evaluation confirmed neointimal hyperplasia formation in all of the hamsters' arteries. The treatment group underwent intravenous lipid-based encapsulated paclitaxel nanoparticles (10mg/kg)-mediated extracorporeal confocal dual pulse low-level focused electrohydraulic shock wave (V=15 kV, F=2 Hz, Impulses = 50 and V=10 kV, F=0.2 Hz, Impulses = 150) enhanced sonoporation therapy accompanied by catheter-based 90Y-mediated β-brachytherapy (90Y, 15 Gy), guided by simultaneous B-mode ultrasound imaging.

Results

B-mode ultrasound guided combined shock wave enhanced sonoporation therapy and β-brachytherapy was feasible and appeared safe for the targeting of stenosis in the aorta artery. Furthermore, pathological results showed a significant reduction in the mean value for smooth muscle hyperplasia cells density, lumen wall thickness and percentage of luminal cross- sectional area of stenosis in the treatment group compared with the other groups (p<0.05).

Conclusions

Enhanced toxicity effect of paclitaxel, induced by enhanced sonoporation effect of shock wave therapy, due to inertial cavitation effect of collapsed capsules and dual pulse system application accompanied by apoptotic effect of brachytherapy, can cause to neointimal hyperplasia regression. Combined shock wave enhanced sonoporation therapy and β-brachytherapy is significantly associated with reduced aorta artery stenosis in hamsters. The mechanism may relate to reduced smooth muscle hyperplasia cells and inflammation in the tunica intima.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Mehrad Research Lab
Association of rs11196288 polymorphism with the development of acute cerebrovascular event
Authors: Chernova A , Nikulina S , Nikulin D
Published: October 2021

Purpose

To study SNP rs11196288 (A> G) with development of Acute Cerebrovascular Event in the patients with cardiovascular pathology and risk factors of its development who are representatives of the east Siberian population.

Material and methods

260 patients with Acute Cerebrovascular Event participated in a research (age [57.0; 51.0–62.0]) and 272 patients of control group (age [55.0; 51.0–62.0].). Among the patients who transferred Acute Cerebrovascular Event, 157 men and 103 women. The control group included 170 men and 102 women. Inspection of the main group included: collecting complaints, anamnesis, clinical examination, computer tomography of a brain, electrocardiography, echo, ultrasonic of arteries, daily monitoring of arterial blood pressure and cardiac rhythm, analysis of a coagulant system of blood. Patients of the main group had the following cardiovascular pathology and risk factors: arterial hypertension, supraventricular tachycardia, dislipidemiya, atherosclerosis brachiocephalic of arteries, disturbances of a system of a hemostasis. The control group is examined within the international HAPIEE project. The molecular and genetic research was conducted by PCR method in real time. Statistical processing of material was carried out with use of set of the Statistica for Windows 7.0, Excel and SPSS 22 application programs.

Results

As a result of the conducted research in one of the analyzed groups and subgroups statistically significant associations of genotypes and alleles of polymorphism of rs11196288 were not revealed (A> G) with Acute Cerebrovascular Event.

Conclusion

SNP rs11196288 (A> G) has no significant effect on development of Acute Cerebrovascular Event in persons of the east Siberian population regardless of the previous cardiovascular pathology and risk factors.

Funding Acknowledgement

Type of funding sources: None.
Haplotype analysis of polymorphic genes of lipid metabolism and its association with an increased risk of the first non-cardioembolic ischemic stroke
Authors: Shishkova V N , Adasheva T V , Stakhovskaya L V
Published: October 2021

Aim

We studied the effect of haplotype variations in lipid metabolism genes on the risk of first non-cardioembolic ischemic stroke in 206 patients and 206 controls.

Material and methods

The alleles frequencies and genotypes assessed for 5 mono-nucleotide polymorphic gene variants (APOB (rs1042031), APOEB (rs676210), APOC-IV (rs1132899), APOE (rs 7412), APOE (rs 429358), LP(a) (rs41267817)) in 206 patients, who had first non-cardioembolic ischemic stroke, and 206 persons with no stroke, comparable with age, gender, place of living and ethnicity. Genotyping of polymorphisms was done with the prepared TaqMan probes. Haplotype analysis was performed using the online tool SNPStat.

Results

Haplotype analysis revealed that CTGATT, CTGACT and CCAGTT, haplotypes of lipid metabolism genes polymorphisms are associated with risk of first non-cardioembolic ischemic stroke after multivariate adjustment.

Conclusions

These results show that haplotype of lipid metabolism genes polymorphisms are signifcantly associated with increased the development of the first non-cardioembolic ischemic stroke In the studied groups.

Funding Acknowledgement

Type of funding sources: None.
Hypercholesterolemia as a factor in the risk stratification of patients with hypertension depending on the ITGA2 gene polymorphism
Authors: Netiazhenko V , Liakhotska A V
Published: October 2021

Mutation C807 in the ITGA2 gene is associated with the risk of early myocardial infarction, ischemic stroke, embolism, thrombosis after angioplasty and stenting of coronary arteries.

Aim

To study the relationship between ITGA2 gene polymorphism and increased risk of CAD in patients with hypertension and hypercholesterolemia

Materials and methods

72 patients were included. Study involved patients with ACS, which developed on the background of hypertension, 32 patients also had coronary angiography and stenting. We used analysis of spontaneous and induced platelet aggregation, polymorphism of C807T of the ITGA2 gene was determined by polymerase chain reaction.

Results

At 82.5% of patients with ACS genotype ITGA 2 C/T was prevalent – 40.3%, T/T – 31.9%. Aggregation capability research in the studied groups has shown that patients of all groups had their degree of spontaneous aggregation significantly exceeding limits of control. Wherein, the highest indices were recorded in the T/T genotype group, which exceeded reference values by 3,02 times. AA-induced aggregation in the group of patients with T/T genotype exceeded indexes of the C/C group by 17.3%, while C/T group's rates-by 16.5% (p<0.05 in both cases). Studying the degree of collagen-induced aggregation, it was noted that the highest rates were recorded in T/T genotype group – 1.68 times higher than control group.

Conclusion

It is found that T allele of ITGA2 carrier is typical for 72.1% of patients with acute coronary syndrome and combined with spontaneous acceleration of platelet aggregation and increases sensitivity of platelets to ADP and collagen. Results allow us to consider the carrier of the T-allele as a marker of predisposition to thrombophilia.

Funding Acknowledgement

Type of funding sources: None.
Efficacy of angiotensin receptor neprilysin inhibitor in Asian patients with refractory hypertension
Authors: Song W E I ,   Dalian medical university
Published: October 2021

Background

Angiotensin receptor neprilysin inhibitor, concomitantly inhibits neprilysin and angiotensin type 1 receptor shown an effect of reducing blood pressure. We aimed to study whether it can be used as an antihypertensive agent in patients with resistant hypertension who has already been treated.

Methods

This is a multiple center prospective study. Thirty-five Chinese patients with refractory hypertension were enrolled. Resistant hypertension was defined as on the basis of improved lifestyle when the application of the three reasonable and tolerable dose of antihypertensive drugs including thiazide diuretics at least four weeks after treatment, the inadequate control of BP is confirmed by ambulatory BP monitoring, or at least four drugs are needed to achieve the BP standard. Refractory hypertensive patient received sacubitil/valsartan 200 mg instead of their angiotensin type 1 receptor blocker while other agents were continued. If blood pressure was uncontrolled, the sacubitil/valsartan dose was increased to 400 mg after 4 weeks. ABPM were evaluated at 8 weeks follow up.

Results

Reductions in office SBP/DBP at week 8 were 37/17 mmHg. the average baseline ABPM were 154/90 mmHg of 24-h, and daytime BP and nighttime BP were 157/92 mmHg and 145/83 mmHg respectively. he average endpoint ABPM were 134/80 mmHg of 24-h, and daytime BP and nighttime BP were 136/82 mmHg and 125/73 mmHg respectively. Reductions in 24-h ABPM at week 8 were 20/9 mmHg while 20/10 mmHg in daytime and 20/9 mmHg in nighttime.

Conclusion

The sacubitil/valsartan provided a strategy therapy for refractory hypertension in Chinese patients in reducing SBP and DBP.

Funding Acknowledgement

Type of funding sources: None.
Assessing the effect of ultra-small phospholipid nanoparticles on biochemical parameters of carbohydrate and fat metabolism in patients with combined hyperlipidemia
Authors: Zubareva M , Kudinov V , Artyushev R , Rozhkova T , Malyshev P , Gornyakova N , Baskaev K , Sharf T , Sergienko I
Published: October 2021

Background and aims

Based on the developed technology of preparation of ultra-small size phospholipid (PL) nanoparticles without the use of detergents/surfactants and stabilizers drug preparation, exhibiting hypolipidemic properties has been obtained. Preclinical and clinical studies have shown that phospholipid nanoparticles of 20–30 nm (PLN) have activated reverse cholesterol transport and reduced non-high-density lipoprotein cholesterol levels. The aim of the study was to compare the effect of PLN relative to placebo on the selected parameters of carbohydrate and fat metabolism in patients with combined hyperlipidemia.

Methods

This Phase III, randomized, double-blind, placebo-controlled, parallel-group study was conducted at 4 centers. The patients (pts) received PLN or placebo (1:1), powder for oral solution preparation (500 mg PL/dose) orally 2 times per day for 12 weeks. Biochemical parameters of carbohydrate and fat metabolism were measured. The data is presented in M (s). Statistical analysis was performed using the Mann-Whitney U-test and the Wilcoxon sign rank test. P-value <0.05 was considered statistically significant.

Results

A total of 100 pts with combined hyperlipidemia were randomized (age 35–70 years, males 58%). The mean age of patients was 56.4 (10.2) years, body-mass index (BMI) – 30.4 kg/m (2). Mean glucose, triglyceride (TG), fasting insulin (INS) and adiponectin (ADN) serum levels at baseline were 5.58 (0.9) mmol/l, 2.38 (0.6) mmol/l, 13.71 (6.03) mU/ml and 7.07 (2.25) μg/ml, respectively. At Week 12, PLN significantly reduced TG and insulin (p=0.03 and p=0.02, respectively). At the same time, the mean adiponectin level was increased (ns). The drug was well tolerated, and no clinically significant laboratory abnormalities were detected.

Conclusions

PLN therapy is well tolerated with a favorable effect on the chosen parameters of carbohydrate and fat metabolism in patients with moderate combined hyperlipidemia.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Ministry of industry and trade, Ministry of Healthcare of the Russian Federation
Results of a hybrid cardiovascular rehabilitation program (in-hospital plus home) in patients with low income
Authors: Garcia Saldivia M , Ilarraza Lomeli H , Rojano Castillo J , Rius Suarez M , Franco M , Villegas D , Negrete D , Guerrero T , Sandoval C , Sanchez Cornejo A , Ruan J
Published: October 2021

Background

One of the main problems facing cardiovascular rehabilitation (CR) is patient care and adherence. However, due to the low level of economic income of the patients who are cared for in our center, the possibility of going to CR in a conventional way is very difficult since they do not have the necessary resources to cover transportation, cost of the sessions, among others.

It has been shown that the greater the number of sessions attended by the patient, the greater the reduction in cardiovascular risk, however the role of a hybrid program with a decreased number of face-to-face sessions has not been established.

Purpose

Present the results of a hybrid training program (in-hospital plus home) in a low-income population. Education through supervised sessions plus home physical training in a patient with bases for exercise can improve their adherence with better results.

Methods

A cohort of patients with heart disease who were referred to the Cardiovascular Rehabilitation program between May 2017 and February 2019 was included. The socioeconomic level was classified into 6 strata according to occupation, income, housing, economic dependents, place of origin and family health status. After risk stratification, the patients participated in a hybrid program that consisted of 6 in-hospital sessions, once a week, in which the training to be carried out at home was prescribed by means of a triptych. An exercise test was performed before and after completing the program, as well as psychological and nutritional intervention. Statistical analysis was performed using SPSS 21.0 software. All p values less than 0.05 were considered significant.

Results

In the study period, of the total number of patients discharged for heart disease from the hospital, 61% were referred to cardiovascular rehabilitation, of which only 45% (n=39) completed the program, the reasons for dropping out were multiple and the lowest socioeconomic level (1) was the most frequent (figure 1). The main referral diagnosis was ischemic heart disease in 82%. The majority of patients were men, 95%. A significant improvement was observed in load METs, maximum heart rate, heart rate recovery (figure 2).

Conclusion

The implementation of a hybrid cardiovascular rehabilitation program (in-hospital + home) was associated with an improvement in the exercise test parameters of patients who successfully completed the program.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2