bluuebunny/crossref_metadata_2025 huggingface dataset:
A real-world assessment of the distribution of lipid levels across increasing lipoprotein(a) levels in patients with established cardiovascular disease in the United States
Authors: Fonseca A.F , Lahoz R , Ferber P , Laguna A , Amari D.T , Heo J.H , Ding Y , Studer R
Published: November 2020

Background and purpose

Measurements of lipid levels are frequently used to assess the risk of developing cardiovascular disease (CVD), including future myocardium infarction (MI) and ischemic stroke. Lipoprotein(a) [Lp(a)] has been established as an independent risk factor for developing CVD, however it is not widely measured. This real-world study assessed the distribution of lipid (Total Cholesterol [TC], low-density cholesterol [LDL-C], high-density cholesterol [HDL-C] and Triglycerides [TGs]) levels across different Lp(a) strata of patients with established CVD and at least one Lp(a) assessment.

Methods

This was a descriptive, non-interventional, retrospective cohort study of patients with established CVD and at least one Lp(a) assessment in the Optum® de-identified Electronic Health Record dataset (2007–2019). The index date was defined as the date of the first established CVD (MI, ischemic stroke or peripheral artery disease diagnosis) in the identification period (1/1/2008–30/6/2018) following one-year continuous enrollment. Patients were followed for up to one year, until death or transfer out of the dataset, whichever occurred first.

Results

5,434 patients (55.5% males) with established CVD and at least one Lp(a) assessment having a mean (SD) age of 62.5 (12.6) years were evaluated. During the 12 months pre-index period, 49.9%, 46.1%, 48.1% and 49.8% of these patients had a measurement of TC, LDL-C, HDL-C and TGs, respectively. Overall, the mean (SD) TC, LDL-C, HDL-C and TGs levels were 182.1 (47.0) mg/dL [n=2,712], 102.6 (40.1) mg/dL [n=2,503], 52.7 (16.7) mg/dL [n=2,614], and 140.3 (108.8) mg/dL [n=2,707], respectively. More than half of these patients were treated with at least one lipid lowering drug (includes statins, ezetimibe, fibrates, niacin or PCSK9is) during the pre-index period. The mean (SD) levels of TC, LDL-C, HDL-C and TG in patients with Lp(a) <30 mg/dL, 30–50] mg/dL, 50–70 mg/dL, 70–90 mg/dL and ≥90 mg/dL are presented in Figure 1.

Conclusions

Overall, no trends in the levels of total cholesterol, LDL-C, HDL-C or triglycerides were observed across increasing levels of lipoprotein(a). These findings suggest the measurement of lipoprotein(a) is required to ensure a complete characterization of a patient lipid profile.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Novartis Pharma AG
Usage of a new pharmacological agent of ultra-small phospholipid nanoparticles (micelles) in the treatment of combined hyperlipidemia
Authors: Zubareva M , Kudinov V , Malyshev P , Rozhkova T , Markin S , Kukharchuk V
Published: November 2020

Background and aims

Based on the developed technology of prerparation of ultra small size phospholipid nanoparticles without the use of detergents/surfactants and stabilizers drug preparation, exhibiting hypolipidemic properties has been obtained. Preclinical studies have shown that phospholipid nanoparticles of 20–30 nm (PLN) activate reverse cholesterol transport. PLN is now at the stage of clinical trials (Phase II study completed). The aim of the study was to compare the efficacy, safety and tolerability of PLN relative to placebo in the treatment of combined hyperlipidemia.

Methods

This Phase III, multicenter, 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 (in an aqueous environment is a nanoemulsion with a particle size of 20–30 nm), 500 mg (sachet) orally 2 times a day for 12 weeks. Lipid parameters, safety and tolerability were measured. The data is presented in M (s), Me (lq; hq). Mann-Whitney U Test was to compare the significant difference of groups. 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. Mean total cholesterol, non-high-density lipoprotein cholesterol (non-HDL-C), TG, and apolipoprotein B 100 (apoB) levels at baseline were 5.59 (0.8) mmol/l, 4.51 (0.75) mmol/l, 2.38 (0.6) mmol/l and 114.26 (24.96) mg/dl, respectively (n=100). Mean high-density lipoprotein cholesterol (HDL-C) and Lp(a) levels at baseline were 1.0 (0.25) mmol/l and 21.1 (3.9; 20.3)mg/dl, respectively (n=100). At Week 12, PLT significantly reduced total cholesterol, non-HDL-C levels, TG and apo B compared to placebo (p=0.02, p=0.03, p=0.001 and p=0.02, respectively). At the same time, the mean HDL-C level was significantly increased (p=0.03). The drug was well tolerated and no clinically significant laboratory abnormalities were detected.

Conclusions

This study demonstrates that therapy with PLT is well tolerated in additional beneficial effects on key lipid parameters in patients with moderate combined hyperlipidemia.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Ministry of industry and trade
Clinical outcomes related to fasting plasma glucose variability, history of diabetes mellitus and antidiabetic regimens in patients with atrial fibrillation: a subgroup analysis from the SPORTIF trial
Authors: Proietti M , Gumprecht J , Farcomeni A , Romiti G.F , Lip G.Y.H
Published: November 2020

Introduction

The role of diabetes mellitus in determining of major adverse outcomes in patients with atrial fibrillation (AF) is well-established. Little is known about fasting plasma glucose (FPG) visit-to-visit variability (VVV) and its impact on outcomes.

Aim

To analyse the role of FPG-VVV in determining major adverse outcomes in AF patients. Second, to evaluate the prognostic impact of history of diabetes mellitus and antidiabetic regimens.

Methods

Warfarin-treated patients from the SPORTIF trials were considered for analysis if they had FPG evaluation at baseline and at least 4 determinations throughout follow-up. Standard deviation (SD) of the mean of FPG throughout follow-up was the main measure of VVV, according to its quartiles (SD-Qs). A composite of cardiovascular events and the occurrence of all-cause death was the adverse outcome considered.

Results

Among the 3665 patients originally included, 3415 (93.2%) were included in this analysis. Throughout a mean (±SD) of 577.59 (±122.09) days of follow-up patients in the highest SD-Q (SD-Q4) had the highest rate of the composite outcome and all-cause death [Figure]. A Cox multi-regression analysis confirmed that SD-Q4 had a significant independent association with occurrence of composite outcome (hazard ratio [HR]: 1.61, 95% confidence interval [CI]: 1.10–2.35) [Figure, Upper Panel], with a non-significant trend for all-cause death, [Figure, Lower Panel]. If no significant impact of history of diabetes mellitus was found, there was a significant impact on the composite outcome of the various antidiabetic regimes: there was no difference found in patients treated with oral antidiabetics, compared to no antidiabetic treatment, but those patients treated with insulin (±oral antidiabetics) were independently associated with the occurrence of composite outcome (HR: 2.38, 95% CI: 1.05–5.38) (Table).

Conclusion

In AF patients treated with warfarin, patients with the highest FPG-VVV had an increased rate of outcomes and the largest FPG-VVV being significantly associated with the composite outcome of adverse clinical events. In diabetic patients, use of insulin is independently associated with an increased risk of the composite outcome, reflecting the more severe disease in determining adverse events amongst AF patients.

Major Adverse Outcomes

Funding Acknowledgement

Type of funding source: None
Cardiovascular determinants of exercise capacity in people with type 2 diabetes
Authors: Gulsin G , Henson J , Brady E.M , Sargeant J , Swarbrick D.J , Athithan L , Htike Z.Z , Biglands J.D , Kellman P , Khunti K , Webb D , Davies M.J , Yates T , McCann G.P
Published: November 2020

Background

The determinants of exercise capacity in people with type 2 diabetes (T2D), a group at high risk of heart failure, are unknown.

Purpose

To assess the relationship between subclinical cardiovascular dysfunction and peak VO2 in adults with T2D.

Methods

We enrolled asymptomatic adults with T2D and no prevalent cardiovascular disease. Matched controls were recruited for comparison. Subjects underwent echocardiography, cardiopulmonary exercise testing and adenosine stress cardiac MRI. Multivariable linear regression analysis was undertaken to identify independent associations between measures of cardiovascular structure and function and peak VO2 (Figure 1).

Results

247 adults with T2D (age 52±12y, 55% males, A1c 7.4±1.1%) and 78 controls were included. Subjects with T2D had increased concentric LV remodelling (LV mass/volume 0.84±0.14 vs. 0.76±0.11g/mL, p<0.001), reduced global longitudinal strain (−16.4±2.4 vs. −17.4±1.9%, p<0.001), lower aortic distensibility (2.75 (1.74–4.03) vs. 4.92 (2.65–7.13) mmHg-1x10–3, p<0.001), reduced myocardial perfusion reserve (2.60±1.24 vs. 3.54±1.15, p<0.001), and lower peak VO2 (19.0±5.6 vs. 28.0±9.1mL/kg/min, p<0.001) than controls. In a model containing age, sex, ethnicity, smoking status and systolic blood pressure, aortic distensibility (β=−0.466, p=0.033), E/e' (β=−0.344, p=0.001) and myocardial perfusion reserve (β=0.903, p=0.005) were independently associated with peak VO2 in subjects with T2D (Table 1).

Conclusions

In asymptomatic people with T2D, aortic stiffening, diastolic filling, and myocardial perfusion reserve are key determinants of peak VO2, independent of age, sex, ethnicity, smoking status, or blood pressure.

Figure 1

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): National Institute for Health Research - Career Development Fellowship (G P McCann, CDF-2014-07-045). British Heart Foundation - Clinical Research Training Fellowship (G S Gulsin)
Aortic stiffness and incident diabetes: the hard, bittersweet truth
Authors: Terentes-Printzios D , Ioakeimidis N , Aznaouridis K , Georgakopoulos C , Christopoulou G , Korogiannis L , Gardikioti V , Solomou E , Sigala E , Tousoulis D , Vlachopoulos C
Published: November 2020

Background/Introduction

Aortic stiffness increases with advancing age and is a major risk factor for age-related morbidity and mortality. Aortic stiffness and glycaemic dysregulation are related; however, temporal relationships between aortic stiffness and incidence of diabetes have not been fully delineated.

Purpose

We sought to investigate the role of arterial stiffness in the prediction of incident diabetes.

Methods

376 untreated hypertensive patients (mean age 52.6±12.5 years, 201 males) without known cardiovascular disease and without known history of diabetes, were included in the study. Markers of subclinical organ damage [carotid-femoral pulse wave velocity (PWV) and estimated glomerular filtration rate (eGFR)] were evaluated in all patients. eGFR was estimated using the Cockcroft-Gault formula. Hemoglobin A1c (HbA1c) and blood glucose were measured in venous blood samples. Patients were prospectively followed-up, for incidence of diabetes as defined by the American Diabetes Association criteria.

Results

During a median 13.5 years follow-up, forty-six patients (12.2%) patients were diagnosed with diabetes. In multivariable logistic regression analysis, only higher PWV (Odds Ratio [OR] = 1.271, 95% Confidence intervals [CI]: 1.002–1.612, P=0.048) was associated with higher risk of incident diabetes, which was independent of age, sex, pulse pressure, HbA1c, fasting blood glucose and eGFR. In further analysis, receiver operating characteristic (ROC) curves were generated to evaluate the ability of PWV to discriminate subjects with diabetes. The area under the curve (AUC) and 95% CIs of the ROC curve was AUC=0.66 (95% CI: 0.58–0.74, P=0.001) for PWV (Figure 1).

Conclusions

In our cohort, higher aortic stiffness was associated with higher risk of incident diabetes.

Figure 1. ROC curve for the prediction of diabetes

Funding Acknowledgement

Type of funding source: None
The lower the renal function in patients with chronic renal disease, the greater the improvement in the renal function cardiac rehabilitation provides
Authors: Hama T , Ushijima A , Ikari Y , Kobayashi Y
Published: November 2020

Background

Our previous study suggested that cardiac rehabilitation (CR) resulted in a significant improvement in the renal function in cardiac vascular disease (CVD) patients with chronic renal disease (CKD), using cystatin C. However, whether the difference in the severity of the renal impairment at the beginning of the CR affects the degree of the improvement in the renal function after CR is unknown.

Methods

We studied 203 CVD patients (155 males; 73 y/o) with CKD (15≤estimated glomerular filtration rate based on the serum cystatin C concentration [eGFRcys]<60 ml/min/1.73m2) who participated in our 3-month CR program. The eGFRcys was examined at the beginning and end of the CR. In addition, the patients were divided into 3 groups according to the severity of the renal impairment at the beginning of the CR: CKD G3a group (45≤eGFRcys<60 ml/min/1.73m2, n=122), CKD G3b group (30≤eGFRcys<45 ml/min/1.73m2, n=60), and CKD G4 group (15≤eGFRcys<30 ml/min/1.73m2, n=21). We compared the renal function at the beginning and end of the CR in each of the 3 groups. Moreover, we evaluated the correlation between the eGFRcys at the beginning of the CR and the change in the eGFRcys (%ΔeGFRcys).

Results

In all the study patients, the eGFRcys improved after the CR (45.5 to 47.7 ml/min/1.73m2, p<0.001). In the CKD G3b and G4 groups, the eGFRcys also improved (38.4 to 41.5 ml/min/1.73m2, p=0.001; 23.2 to 28.0 ml/min/1.73m2, p=0.016). However, in the CKD G3a group, the eGFRcys did not improve after the CR (52.9 to 54.2 ml/min/1.73m2, p=0.074) (Figure 1). The univariate analysis results showed that the %ΔeGFRcys was significantly negatively correlated with the eGFRcys at the beginning of the CR (p=0.016, r=−0.26, Figure 2).

Conclusion

The greater the renal dysfunction in the CVD patients with CKD was, the greater the improvement in the renal function after participating in the CR program.

Funding Acknowledgement

Type of funding source: None
Predictors of emergency medical services utilization after different preventive counseling programs in paroxysmal atrial fibrillation patients after catheter ablation
Authors: Pogosova N , Yufereva Y.M , Ovchinnikova A.I , Sokolova O.Y , Davtyan K.V
Published: November 2020

Background

Catheter ablation (CA) is known to reduce atrial fibrillation (AF) burden, but even after CA patients (pts) may remain symptomatic and seek for emergency care.

Purpose

To identify predictors of emergency medical services (EMS) utilization after different preventive counseling programs in paroxysmal AF pts after CA.

Methods

This is a secondary analysis of a randomized controlled trial in AF pts after CA (radiofrequency or cryoballoon) assessing the effects of a long-term preventive counseling program encompassing remote support. Pts were randomized into 3 groups in 1:1:1 ratio. During hospitalization for CA pts from all groups received single-session preventive counseling with focus on their individual cardiovascular risk factors profile. After discharge, pts from Group 1 received remote preventive counseling by phone and pts from Group 2 by email every two weeks for the first 3 months after enrollment (a total of 6 sessions). Group 3 received usual care. At baseline and at 12 months of follow-up, pts underwent assessments of their demographic parameters (age, sex, education level, marital status, and socioeconomic status) and psychological status (stress level using a 10-point visual analogue scale [VAS] and anxiety and depression by the Hospital Anxiety and Depression Scale [HADS]; transthoracic echocardiography, ECG and 24-hour ECG monitoring. A multivariate regression analysis of seeking for EMS was performed with patients' baseline parameters as independent variables.

Results

A total of 135 pts aged 35 to 80 years were enrolled (mean age 57.3±9.1 years, 51.8% men). Over 1 year of follow-up, 53 study participants called the ambulance (which made up for 90 calls) with no significant differences between the study groups. Age (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1–2.9; P=0.010), stress level ≥7 points (OR 3.2, 95% CI 1.4–7.5; P=0.007), left ventricular (LV) ejection fraction ≤62% (OR 2.6, 95% CI 1.1–6.1; P=0.024); and left atrial (LA) diameter ≥42 mm (OR 3.6, 95% CI 1.5–8.5; P=0.003) were independent predictors of an EMS call.

Conclusions

Age, perceived stress level, reduced LV function and LA size were independent predictors of EMS utilization after CA regardless of preventive counseling interventions.

Funding Acknowledgement

Type of funding source: None
Predictors of left ventricular scar at cardiac magnetic resonance in athletes with apparently idiopathic ventricular arrhythmias
Authors: Zorzi A , Crescenzi C , Vessella T , Cipriani A , Panattoni G , De Lazzari M , Perazzolo-Marra M , Sarto P , Corrado D , Calo' L
Published: November 2020

Introduction

In athletes with ventricular arrhythmias (VA) and otherwise unremarkable clinical findings, cardiac magnetic resonance (CMR) may reveal concealed pathological substrates. The aim of this multicentre study was to evaluate which VA characteristics were associated with CMR abnormalities.

Methods

We enrolled a consecutive series of 251 competitive athletes (74% males, mean age 28.5±14.5 years) who underwent CMR for evaluation of VA. We included athletes with >100 premature ventricular beats (PVBs)/24-hour or ≥1 repetitive VA (couplets, triplets or non-sustained ventricular tachycardia) on 12-lead 24-hour ambulatory ECG monitoring and negative family history, electrocardiogram and echocardiogram. Features of VA that were evaluated included number, morphology, repetitivity and response to exercise testing.

Results

Left-ventricular late gadolinium-enhancement (LGE) was documented in 28 (11%) athletes, mostly (N=25) with a subepicardial/midmyocardial (non-ischemic) distribution. On 24-hour ECG monitoring, PVBs with a right-bundle-branch-block and intermediate/superior axis configuration or multiple morphologies were documented in 24/28 (86%) athletes with versus 55/223 (25%) without LGE (p<0.001). More than 2000 PVBs were recorded in 6 (21%) athletes with versus 127 (57%) without positive CMR (p<0.001). At exercise testing, repetitive VA occurred at high work-load in 12 (43%) athletes with versus 26 (12%) without LGE (p<0.001). At multivariable analysis, all three VA features independently correlated with CMR abnormalities.

Conclusions

In athletes with apparently idiopathic VA, simple characteristics such as number and morphology of PVBs on 12-lead 24-hour ambulatory ECG monitoring and response to exercise testing predicted the presence of concealed myocardial abnormalities on CMR. These findings may help cost-effective CMR prescription.

Flow chart

Funding Acknowledgement

Type of funding source: None
Mechanical diversity in the adaptation of left and right ventricular function to long-term exercise: 3D echocardiographic study in a large cohort of competitive athletes
Authors: Fabian A , Lakatos B.K , Tokodi M , Kiss O , Babity M , Bognar C , Sydo N , Csulak E , Vago H , Merkely B , Kovacs A
Published: November 2020

Regular physical exercise results in complex remodelling of the left- (LV) and right ventricle (RV), commonly referred as the athlete's heart. Despite the well-known changes in ventricular volumes and mass, data are scarce regarding ventricular mechanics and its connection to exercise performance.

Accordingly, our aim was to characterize biventricular morphological and functional changes and their association with peak exercise capacity in a large cohort of athletes using three-dimensional (3D) echocardiography.

Competitive athletes of various training regimes (n=525, age: 20±6 years, training: 15±7 hours/week, 30% female) were enrolled, while 73 age- and gender-matched sedentary volunteers served as the control group. Full volume 3D echocardiographic datasets focused on the LV or the RV were acquired for further analysis: LV and RV end-diastolic volume (EDVi), LV mass (Mi) indices and ejection fraction (EF) were quantified. To characterize biventricular mechanics, LV and RV global longitudinal strain (GLS) and global circumferential strain (GCS) were also measured using dedicated software. Athletes also underwent cardiopulmonary exercise testing to determine peak oxygen uptake (VO2/kg).

Athletes had significantly higher LV and RV EDVi (81±13 vs. 64±11 mL/m2; 83±14 vs. 63±11 mL/m2; both p<0.001) and also LVMi (87±15 vs. 65±12 g/m2; p<0.001) compared to controls. LV and RV EF were significantly lower in athletes (57±5 vs. 60±6%; 55±5 vs. 58±5%; both p<0.001). LV GLS (−19.5±2.1 vs. −20.6±2.6%; p<0.001) and also LV GCS (−27.9±3.2 vs. −29.8±4.4%; p<0.001) was lower in athletes compared to controls. In opposed to the LV, RV GLS did not differ between the two groups (−29.3±5.8 vs. −29.5±5.3%; p=NS), however, RVGCS was decreased in athletes compared to controls (−24.4±6.1 vs. −28.6±7.3%; p<0.001). In athletes, ventricular morphology measured by LV and RV EDVi correlated with VO2/kg (both r=0.37; p<0.001), while functional measures, such as lower resting LV GLS (r=0.22; p<0.001) and RV GCS (r=0.14; p<0.01) also showed relationship with better exercise performance.

According to our results, regular physical exercise is associated with significant changes of LV and RV geometry and mechanics. Resting biventricular systolic function of the athlete's heart is characterized by a mild reduction, which is attributable to a lower longitudinal and circumferential shortening on the left side of the heart, while on the right side lower circumferential shortening can be seen along with a maintained longitudinal shortening. Moreover, this mechanical pattern also correlates with exercise performance.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): “National Heart Program” NVKP_16-1-2016-0017; NKFIH K_16 K120277 to BM
Master athletes'ECG and the diagnostic accuracy of contemporary ECG interpretation criteria
Authors: Halasz G , Cattaneo M , Romano S , Biasini V , Villa M , Cassina T , Capelli B
Published: November 2020

Background

Over the last years, several efforts have been made to refine the ECG criteria for interpretation of young (16–35 years) competitive athlete's ECG in order to improve specificity maintaining good sensitivity. However, few data exist about the efficacy of such interpretation criteria in master athletes (over 35 years). We aimed to assess the diagnostic performance of screening based on 2017 International ECG recommendation (2017-International), 2010 European Society of Cardiology recommendation (2010-ESC) and Seattle criteria in a cohort of master athletes competing at regional and national level.

Methods

506 Caucasian master athletes (mean ages 47.9±8.7, 85,6% male, 65% endurance athletes) underwent standardized medical history, physical examination, resting and exercise ECG during their pre-participation screening. ECGs were retrospectively interpreted based on 2010-ESC, Seattle-criteria and 2017-International. For the purpose of the study we included also a transthoracic echocardiography as reference, to calculate the sensibility and specificity, area under the ROC curve (AUC) was estimated as measure of discriminative ability of each ECG criteria. Athletes with abnormalities underwent further examinations according to the European Guidelines.

Results

Twelve athletes (2,3%) were diagnosed with a condition potentially related to SCD (1 hypertrophic cardiomyopathy, 1 Type1 Brugada Syndrome, 4 Chronic Coronary Syndromes, 2 Dilated Cardiomyopathy, 3 Aortic Dilation, 1 Moderate aortic stenosis) during the pre-participation screening. International criteria failed to identify two athletes with DCM and left axis deviation on ECG while no athletes with complete right bundle branch block showed serious structural abnormalities. The most common ECG abnormalities were left axis deviation (7,1%), left atrial enlargement (4,2%) and T wave inversion (3%). 29 athletes (5,7%) exhibited a long QT interval according to 2010-ESC and 1 athlete according to International and Seattle criteria. The false positive ECG rate was 15% for 2017-International based screening, 21,9% for Seattle based screening and 30,40% for 2010-ESC based screening while the diagnostic accuracy for pathologies at risk of SCD was 0,73 (95% CI 0,69–0,77) for 2017 International based screening; 0,81 (95% CI 0,77–0,84) for Seattle Criteria based screening and 0,77 (95% CI 0,73–0,80) for 2010-ESC based screening.

Conclusion

In master athletes the 2017-International ECG criteria showed inferior accuracy compared to the Seattle criteria and 2010-ESC, the least showing a higher false positive rate mostly due to lower cut-off for long QT. Furthermore complete right bundle branch block may be considered a normal finding also in master asymptomatic athletes.

Accuracy of ECG criteria

Funding Acknowledgement

Type of funding source: None
Acute myocardial infarction in several mental illness: a nationwide analysis of prevalence, management strategies and outcomes
Authors: Mohamed M , Rashid M , Farooq S , Siddiqui N , Parwani P , Shiers D , Thamman R , Gulati M , Shoaib A , Chew-Graham C , Mamas M.A
Published: November 2020

Background

Severe mental illness (SMI) is associated with an increased risk of cardiovascular disease and mortality. However, it is unclear whether SMI patients are just as likely to receive guideline-recommended therapy for AMI as those without mental illness.

Purpose

To examine national-level estimates of the prevalence, management strategies and in-hospital clinical outcomes of SMI patients presenting with AMI.

Methods

All AMI hospitalisations from the United States National Inpatient Sample were included, stratified by mental health status in to 5 groups: no-SMI, Schizophrenia, “Other non-organic psychoses” (ONOP), Bipolar Disorder and Major Depression. Multivariable logistic regression modelling was performed to examine the association between SMI subtypes and receipt of invasive management and subsequent in-hospital clinical outcomes, expressed as adjusted odds ratios (aOR) and 95% confidence intervals (CI).

Results

Out of 6,968,777 AMI hospitalisations between 2004 and 2014, a total of 439,544 (6.5%) had an SMI diagnosis. The prevalence of SMI amongst the ACS population doubled over the study period (from 4.5% in 2004 to 9.5% in 2014), primarily due to an increase in Major Depression and Bipolar Disorder diagnoses. All SMI subtypes were less likely to receive coronary angiography and PCI, with the Schizophrenia group being at least odds of either procedure (aOR 0.46 95% CI 0.45, 0.48 and aOR 0.57 95% CI 0.55, 0.59, respectively). Although patients with Schizophrenia and ONOP experienced higher crude rates of in-hospital mortality and stroke compared to those without SMI, only Schizophrenia patients were associated with increased odds of mortality (aOR 1.10 95% CI 1.04, 1.16), while ONOP were the only group at increased odds of stroke (aOR 1.53 95% CI 1.42,1.65) following multivariate adjustment. Patients with ONOP were the only group associated with increased odds of in-hospital bleeding compared to those without SMI (aOR 1.11 95% CI 1.04,1.17).

Conclusion

Patients with SMI are less likely to receive invasive management for AMI, with women and schizophrenia diagnosis being the strongest predictors of conservative management. Schizophrenia and “other non-organic psychoses” are the only SMI subtypes associated with adverse clinical outcomes after AMI. A multidisciplinary approach between psychiatrists and cardiologists could improve outcomes of this high-risk population.

Odds of management and clinical outcomes

Funding Acknowledgement

Type of funding source: None
Survey of cardiovascular disease and risk factor management in patients with rheumatoid arthritis across 5 world regions: results from the SURF-RA
Authors: Semb A.N.N.E , Ikdahl E , Sexton J , Kitas G , Van Riel P , Crowson C , Graham I , Rollefstad S
Published: November 2020

Background

Patients with rheumatoid arthritis (RA) are at high risk for cardiovascular disease (CVD).

Purpose

The aim of this survey was to evaluate updated information on CVD risk factors, comorbidities, RA disease characteristics, RA and CVD preventive medication in patient with RA.

Methods

The audit is termed SUrvey of cardiovascular disease Risk Factors in patients with Rheumatoid Arthritis (SURF-RA) and was performed in 53 centres/19 countries/5 world regions in 2014–2019. SURF-RA have been performed in patients with coronary heart disease, in primary care, and now in patients with stroke, SLE and antiphophlipid syndrome. The survey was approved by the Data Protection Officer (2017/7243) and a GDPR evaluation has been performed (10/10–2018).

Results

Among 14 503 patients with RA in West (n=8 493) and East (n=923) Europe, Latin (n=407) and North (n=4 030) America and Asia (n=650) the mean (SD) age was 59.9 (13.6) years, and 2/3 or more were female (table). RA disease duration was comparable across the world regions, ranging from 9.9 to 12.6 years. The prevalence of atherosclerotic CVD (ASCVD) was lowest in Latin America (2.5%) and highest in East Europe (21.4%), and this pattern was similar regarding familial premature CVD. The mean prevalence (% of each entity) of blood pressure above 140/90 mmHg was 5.3%, of low density lipoprotein cholesterol >2.5 mmol/L: 63.3%. Overall, 29% used antihypertensive medication, lowest in West Europe (17.4%) and highest in East Europe (57.0%), and 26.4% used lipid lowering agent(s), lowest in Asia (7.2%) and highest in North America (31.1%). Body mass index >30 kg/m2 was present in 26.6%, with the smallest waist circumference in Asia [mean (SD): 84.1 (13.6) cm] and highest in East Europe [92.5 (15.5) cm]. The proportion of current smokers was on average: 16.2%, lowest in Asia (7.8%) and highest in East Europe (28.5%).

Conclusion

The high prevalence of CVD risk factors and ASCVD in patients with RA across five world regions shows that there is still an unmet need for vigilance and improved implementation of preventive measures in this high CVD risk patient population.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Lilly
Impaired longitudinal myocardial deformation, coronary microcirculatory dysfunction and increased intima-media thickness predict adverse cardiovascular events in psoriatic patients:a 4 year follow-up
Authors: Ikonomidis I , Makavos G , Rafouli-Stergiou P , Thymis J , Katsanos S , Katogiannis K , Varoudi M , Kapniari E , Theodoropoulos K , Iliodromitis E.K , Efthimiou O , Kazatzoglou A , Kostelli G , Papadavid E
Published: November 2020

Introduction

Psoriasis has been associated with vascular and myocardial dysfunction, atherosclerosis and increased cardiovascular risk in the setting of inflammation and oxidative stress. We aimed to evaluate the prognostic value of markers of myocardial deformation, coronary microcirculatory function and systemic inflammation and oxidative stress for future cardiovascular events.

Methods

In 260 psoriasis patients We measured a)left ventricular global longitudinal strain (GLS) by speckle tracking, b) coronary flow reserve (CFR), of the left anterior descending artery by pulse wave echocardiography, c) carotid-femoral pulse wave velocity (PWV), d) carotid intima media thickness (IMT) and e) inflammatory and markers of oxidative stress, namely interleukin-6,-12,-17,TNF-α,fetuin-α and protein carbonyl. Bivariate correlations of these measures with incidence of major cardiovascular events (MACE) defined as acute coronary syndrome, stroke and hospitalization for heart failure were performed.

Results

During a mean 4 year follow-up period (48±11monts) 21 MACEs occurred. By Cox regression analysis Incidence of MACEs were associated with impaired GLS (b=1.05 p=0,01, mean GLS −17.3±4), impaired CFR (b=−0.75, p=0.04, mean CFR 2.68±0.9) fetuin levels (b=0.70. r=0.046, mean fetuin value 45±24ng/ml) and IMT (b=0.79, P=0.015, mean IMT=1.3±0.6cm) after adjusting for age, sex and atheroclerotic risk factors. Among the aforementioned markers, GLS had the strongest value for prediction of MACEs (area under the curve 0.82 p=0.017). A cut-off value of GLS >−16.5% predicted MACEs with a sensitivity 80% and specificity of 82.6%.

Conclusion

Impaired myocardial and vascular function is associated with adverse cardiovascular events in psoriasis. GLS as a marker of subclinical myocardial dysfunction has the strongest predictive value for MACEs incidence during a 4-year follow-up study.

Funding Acknowledgement

Type of funding source: None
Sex differences in diastolic blood pressure changes with age using 24-hour ABPM in 30,513 patients
Authors: Matangi M , Armstrong D , Cases M , Zhu T , Brouillard D
Published: November 2020

Background

We have previously shown, using 24-hour ABPM monitoring, that diastolic blood pressure (DBP) in a large referral population, containing both males and females, increases until age 42 years, following which DBP falls progressively. This occurs in the hypertensive population some 13 years sooner than previous general population studies. There is conflicting emerging data on sex differences in the lifelong trajectory of both systolic and diastolic blood pressure.

Purpose

To examine sex-specific patterns of diastolic blood pressure throughout the lifespan of patients referred for 24-hour ABPMs.

Methods

Our database was searched for all 24-hour ABPMs. We used the average 24-hour SBP and DBP for this analysis. Scatter grams were produced for age versus systolic BP (SBP) and DBP for both males and females. Second order polynomial regression was performed on the DBP scatter grams for both genders and their inflection points calculated. The inflection point is the age at which the DBP on the polynomial curve where the slope changes from positive to negative. This, inflection point, corresponds to the age at which DBP begins to decrease. The DBP polynomial curves for males and females were then superimposed to show any gender differences.

Results

There were 30,513 24-hour analysable ABPMs over 24 years, representing 97% of all ABPMs. There were 15,913 females aged 60.8±14.6 years (range 15–97 years) and 14,600 males aged 58.8±14.2 years (range 15–100 years). As can be seen from the charts below, in females DBP begins to fall at a very early age of 22.3 years, whereas in males the diastolic BP begins to fall at 46.5 years.

Conclusions

There are significant sex differences in the changes in DBP with increasing age. For the first 35 years DBP is higher in women, thereafter DBP is lower in females and only intersects again much later in life at 95 years. The significance of this sex difference is unclear but may explain the increased prevalence of systolic hypertension in elderly females.

Figure 1

Funding Acknowledgement

Type of funding source: None
Effect of weight loss, exercise and risk factor control in microvascular angina. A randomized controlled pilot trial
Authors: Bove K.B , Nilsson M , Pedersen L.R , Mikkelsen N , Suhrs H.E , Astrup A , Prescott E
Published: November 2020

Background

Coronary microvascular dysfunction (CMD) is a common cause of angina in women and associated with adverse cardiovascular prognosis. Currently, no evidence-based treatment for CMD exists.

Purpose

To examine whether an intervention targeting cardiovascular risk factors is feasible and improves angina symptoms and microvascular function in women with CMD and no obstructive coronary artery disease.

Methods

We randomized 62 women aged 40–75, with body mass index >25 kg/m2, angina symptoms monthly or more and coronary flow velocity reserve (CFVR) <2.5 to a 24-week intervention comprising low energy diet, exercise training, and optimized medical treatment of hypertension, dyslipidemia and diabetes or to usual care. Patients were assessed before randomization and after 24 weeks. The primary outcomes were CFVR assessed by transthoracic Doppler stress-echocardiography and angina burden measured by the Seattle Angina Questionnaire (SAQ). Secondary endpoints were exercise capacity (VO2max), body composition and glycemic control, anxiety and depression symptoms measured by the Hospital Anxiety and Depression Scale (HADS).

Results

Fifty-six participants (90%) completed the study. Median age was 65 years. The intervention group obtained a mean weight loss of 10 kg, mainly (9 kg) from fat tissue (all p<0.0001), increased work load (p<0.01), decreased triglycerides, low density lipoprotein and low plasma cholesterol (all p<0.006). HbA1c in non-diabetes participants also decreased (p<0.05).

There was a clinically relevant improvement in all angina symptoms (9–21-point increase on all SAQ scales (all p<0.01)) as well as in depression score (p=0.008). There was no effect on CFVR or other secondary outcomes.

Conclusion

A major weight loss and intensified risk factor control resulted in significant improvement in angina burden but no improvement of coronary microvascular function among women with microvascular angina.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Unlimited research funding sources from the Capital region of Denmark and Bispebjerg-Frederiksberg Hospital internal funding sources.
Specific sex and gender factors of pericarditis in women
Authors: Cepas Guillen P.L , Martinez-Nadal G , Izquierdo M , Aldea A , Matas A , Lopez-Sobrino T , Lopez-Barbeito B , Andrea R , Miro O
Published: November 2020

Introduction

Pericarditis is relatively common in clinical practice and may present as an isolated disease or as a manifestation of a systemic disease. There is an important sex-gap in the evidence on cardiovascular diseases, whereas it is unclear if there are sex-specific differences in the features of patients with acute pericarditis (AP).

Objective

The aim of this study was to evaluate the presence of specific sex and gender factors of pericarditis in women.

Material and methods

We retrospectively included all consecutive patients admitted with acute pericarditis (AP) in an emergency department (ED) of a tertiary care center between 2008 and 2018. Patients without acute pericarditis diagnosis criteria were excluded. We collected patients' baseline characteristics and management data. Recurrence and complicated related to AP at 30-days and 1-year follow-up were assessed.

Results

A total of 729 patients (mean age 42±17.2 years, 33% females) were analyzed. Women were older than men (47.5 yo vs 40 yo, P<0.001). Univariate analysis showed that women presented more prevalence of obesity (11% vs 5%, P<0.01) and chronic kidney disease (6% vs 3%, P<0.05) with previous autoimmune disease (15% vs 3%, P<0.001), and previous immunosuppressive treatment more frequent (15% vs 7%, P<0.01). Women presented more delayed time between beginnings of symptoms until first medical attendance (70 min vs 41 min, P<0.01). No difference was found either echocardiography findings or blood test values. Autoimmune AP was more prevalent in women than men (9% vs 1%, P<0.001). Hence, corticosteroids treatment was more used in women (12% vs 4,5%, P<0.001). In multivariate analysis, six factors were found as specific gender factors of pericarditis in women: Age (OR: 1.02, 95% CI: 1.01–13.2, P<0.01), obesity (OR: 2.27, 95% CI: 1.15–4.49; P<0,05), smoker (OR: 0.39, 95% CI: 0.25–0.59, P<0.001), previous autoimmune disease (OR: 4,29, 95% CI: 1,77–13,21; P<0,01); electrocardiogram diagnosis criteria (OR: 0,18, 95% CI: 0,6–0,52; P<0,001); Autoimmune etiology (adjusted OR: 11,78, 95% CI: 1,99–69,64; P<0,01). No difference was found in recurrence of AP in 30-days and 1-year follow-up (12% vs 13%, P>0.05; 14% vs 13%. P>0.05; respectively).

Conclusion

In our cohort, women with AP attended ED later than men and were less likely to present with typical AP changes in the electrocardiogram. Moreover, women are more commonly affected by specific forms of pericarditis related to autoimmune disease. However, follow-up did not show differences related to gender.

Funding Acknowledgement

Type of funding source: None
Persistent chest pain at 1-year predicts long-term angina hospitalization in women with and without obstructive coronary artery disease: results from Women's Ischemia Syndrome Evaluation (WISE)
Authors: Quesada O , Wei J , Suppogu N , Cook-Wiens G , Kelsey S.F , Bittner V , Reis S.E , Reichek N , Shaw L.J , Sopko G , Handberg E , Pepine C.J , Baireymerz C.N
Published: November 2020

Background

There is growing evidence that women with ischemia and no obstructive coronary artery disease (INOCA) have an increased risk of major adverse cardiovascular events (MACE). Half of these women continue to experience persistent chest pain (PChP); however longer-term outcomes are unknown.

Purpose

To investigate the relationships between PChP at 1-year with obstructive and nonobstructive coronary artery disease (CAD) and longer-term all-cause mortality, MACE and angina hospitalization in women with suspected myocardial ischemia.

Methods

We studied 673 women with chest pain undergoing coronary angiography for suspected myocardial ischemia in the National Heart, Lung, and Blood Institute Women's Ischemia Syndrome Evaluation (WISE) study. PChP was defined as self-reported continuing chest pain at 1-year, obstructive CAD as >50 stenosis in any coronary artery and non-obstructive CAD was further divided as <20% stenosis and 20–50% stenosis in any coronary artery. The Kaplan-Meier method was used to estimate cumulative incidence rates of all-cause mortality, MACE, and angina hospitalization. Proportional hazards regression estimated adjusted hazard ratios of mortality, MACE and angina hospitalization in relation to PChP at 1-year in obstructive and nonobstructive CAD.

Results

The median age was 58 years, 45% had PChP, and 39% had obstructive CAD with a median follow-up time of 9 years (range 1 to 11) for mortality and 5 years (range 0 to 9) for MACE and anginal hospitalization. There was no difference in mortality or MACE in women with PChP compared to women without PChP in any of the 3 groups (<20%, 20–50%, or >50% CAD), however differences were noted in long-term angina hospitalization (Figure 1). Notably,angina hospitalization rates in women with PChP and nonobstructive CAD were 2.2 times those of women without PChP, and comparable to those of women with obstructive CAD and no PChP (p<0.0001).

Conclusions

Among women undergoing coronary angiography for suspected myocardial ischemia, women with nonobstructive CAD and PChP have rates of angina hospitalization comparable to patients with obstructive CAD without PChP. Thus, PChP increases the hazard of long term anginal hospitalization regardless of the presence or absence of obstructive CAD. Given the economic burden of angina hospitalization, further studies are needed to determine whether aggressive treatment in women with PChP without obstructive CAD changes outcomes and impact on the health care system.

Figure 1

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health (NIH)
The prevalence of Wolff-Parkinson-White syndrome in newborns – results from a large general population study
Authors: Paerregaard M , Kock J , Pihl C , Pietersen A , Iversen K.K , Bundgaard H , Christensen A.H
Published: November 2020

Background

The accessory electrical pathway in Wolff-Parkinson-White (WPW) syndrome predisposes to tachycardia and may increase risk of sudden cardiac death. Studies investigating the prevalence of this condition in newborns are few.

Purpose

To describe the prevalence of WPW syndrome and assess the localization of the accessory pathway and associated structural heart disease in newborns from a large general population study.

Methods

Electrocardiograms (ECG's) and echocardiograms of 17.489 newborns (aged 0–30 days) from a large, prospective general population study were included. WPW cases were identified through manual evaluation of outliers in measurements of PR-interval, QRS-duration, QTcB interval and QRS axis. Newborns suspected for WPW syndrome were offered a secondary echocardiogram and ECG recording. Localization of the accessory pathway was assessed based on a QRS polarity algorithm. The control group consisted of 5,000 randomly selected newborns with a normal echocardiogram.

Results

Among the 17,489 ECG's we manually analyzed 5,166 and found 15 newborns (80% boys) with WPW syndrome (secondary confirmatory ECG's will be available at ESC 2020) consistent with prevalence of WPW syndrome of 0.1%. The median values of the PR-interval, QRS-duration and QTcB in cases and controls were 80 vs 98 ms, 74 vs 56 ms, and 449 vs 420 ms, respectively (all p<0.0001). The accessory electrical pathway was left-sided in 13 (87%) of the newborns. One newborn had moderate mitral regurgitation while all other newborns had structurally normal hearts and no cases of Ebstein's anomaly.

Conclusion

The prevalence of WPW syndrome in our cohort was 0.1%. The syndrome was more frequent in boys, and the accessory pathways were mainly left-sided. All but one of the affected newborns had structurally normal hearts.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): This work was supported by the Danish Children Heart Foundation, Snedkermester Sophus Jacobsen and wife Astrid Jacobsen's foundation (Grant 19-R112-A5248-26048), the Research Council at Herlev-Gentofte Hospital and Toyota-Fonden, Denmark.
The value of coronary artery calcium scores based on non-gated chest CT in predicting perioperative cardiovascular risk in patients with lower-risk lung cancer surgery
Authors: He B , Yang X , Xie M , Shen L
Published: November 2020

Objectives

This study evaluated whether coronary artery calcium scores (CACS) that were measured with non-gated chest CT predicted perioperative cardiovascular events in patients who were undergoing lower-risk lung cancer surgery.

Method

In this retrospective single center study, we evaluated 3112 consecutive lung cancer patients with non-gated chest CT before low-medium risk surgeries in 2017. We measured CACS and assessed clinical risk factors according to the revised cardiac risk index (RCRI) scores and predictable surgery factors. Perioperative cardiovascular events were defined as cardiac death, acute coronary syndrome, pulmonary edema, atrial and ventricular arrhythmia with hemodynamic compromise, and complete heart block during hospitalization.

Result

83 patients (2.7%) had perioperative cardiac events, 71 (85.5%) of them were atrial fibrillation. Coronary calcification CT findings were seen in 761 (24.5%) patients. CACS were associated with incidence of cardiac events (p<0.001). In the receiver-operating characteristic (ROC) curve analysis of CACS for prediction of cardiac events, the cutoff value was 1 (sensitivity, 0.60; specificity, 0.75; area under the curve, 0.680). In the multivariate analysis, CACS >1 (OR=1.75, 95% CI: 1.08–2.84, p=0.023), age (OR=1.06, 95% CI: 1.03–1.10, p<0.001), pulmonary function classification (p<0.001) and thoracotomy (OR=3.06, 95% CI: 1.78–5.26, p<0.001) were predictive of cardiovascular complications.

Conclusion

Predicative value of CACS based on non-gated chest CT is high for perioperative cardiovascular risk in lung cancer patients with lower-risk lung surgery. It may be considered as a valuable tool for preoperative risk assessment in these patients without additional testing.

Funding Acknowledgement

Type of funding source: None