bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of surgical bailout after transcatheter aortic valve replacement in Germany
Authors: Oettinger V , Heidenreich A , Kaier K , Zehender M , Bode C , Duerschmied D , Stachon P , Von Zur Muehlen C
Published: October 2022

Background

Severe complications during transcatheter aortic valve replacement (TAVR) may require a surgical bailout. However, little is known about the outcomes after bailout in Germany.

Methods

All TAVR between 2007 and 2020 were identified using German national electronic health records, with focus on 2018 to 2020. Additionally, those procedures requiring surgical bailout were selected.

Results

A total of 159,643 patients received TAVR. Overall rate of surgical bailout was 2.30% and overall in-hospital mortality 3.85%. In-hospital mortality after surgical bailout was 16.51%. While the annual number of procedures in all TAVR rose steeply (202 to 22,972), the rate of surgical bailout dropped from 27.23 to 0.61% and that of overall mortality from 11.39 to 2.29%. However, mortality in case of surgical bailout remained high with 28.37% in 2020. After risk adjustment, in 2018 to 2020, standardized rates of overall in-hospital mortality and surgical bailout for both balloon-expandable and self-expanding transfemoral TAVR were significantly lower than for transapical TAVR (transapical vs transfemoral balloon-expandable vs self-expanding TAVR: in-hospital mortality: 5.66% [95% CI 4.81%; 6.52%] vs 2.30% [2.03%; 2.57%] vs 2.32% [2.07%; 2.57%]; surgical bailout: 2.33% [1.68%; 2.97%] vs 0.79% [0.60%; 0.98%] vs 0.42% [0.31%; 0.53%]). Main risk factors for surgical bailout were coronary artery disease (risk adjusted OR=1.50 [1.21; 1.85], p<0.001), atrial fibrillation (OR=1.29 [1.07; 1.57], p=0.009), and higher grade heart failure NYHA III/IV (OR=1.26 [1.01; 1.57], p=0.037).

Conclusion

Rates of surgical bailout as well as overall in-hospital mortality after TAVR decrease substantially over the years. However, in the case of surgical bailout, outcomes remain poor with a constantly high in-hospital mortality.

Funding Acknowledgement

Type of funding sources: None.
Readmission after transcatheter aortic valve implantation according to frailty
Authors: Strange J E , Christensen D M , Sindet-Pedersen C , Gislason G , Schou M , Oestergaard L , Butt J H , Graversen P L , Koeber L , Olesen J B , Fosboel E L
Published: October 2022

Background

Readmissions and time spent hospitalized following transcatheter aortic valve implantation (TAVI) are important parameters of patient autonomy, particularly for frail patients with limited life-expectancy. Yet, such data remain scarce.

Purpose

To investigate actual time spent hospitalized the first year after TAVI. Secondly, to investigate time spent hospitalized according to frailty risk.

Methods

Through Danish, nationwide registries, we included all patients undergoing TAVI and alive at discharge between January 2008 and June 2020. From discharge, patients were followed until death, emigration, end of study period, or one year of follow-up, whichever came first. During follow-up, all in-patient hospital admissions were identified according to ICD-10 diagnosis codes. Length of stay was calculated, and cumulative numbers of days hospitalized was presented. Further, the proportion of patients dying within one year of follow-up was calculated.

Using The Hospital Frailty Risk Score, a validated frailty risk assessment tool, patients were categorized as low, intermediate, and high frailty risk. We then evaluated the time spent hospitalized stratified by frailty risk group.

Results

The study population comprised 5,464 patients undergoing first-time TAVI with a median age of 81 years among whom 55.2% were males. After one year, 445 (8.1%) patients had died. In total, 2,452 (44.9%) of TAVI patients survived one year and were never admitted, whereas 3,012 (55.1%) patients were admitted at least once or died within one year of TAVI. Of these, 1,200 (21.9%) patients were admitted for more than two weeks or died within one year of TAVI (Figure 1).

Regarding frailty, 3,296 (60.3%), 1,965 (36.0%), and 203 (3.7%) patients were classified as low, intermediate, and high frailty risk, respectively. In the low frailty risk group, 6.2% of patients died within one year and 50.4% survived one year without a hospital admission. By contrast, 16.7% of patients in the high frailty risk group died within one year and only 24.6% survived one year without a hospital admission. Further, 17.1% of patients in the low frailty risk group were admitted for more than two weeks or died within one year of TAVI compared with 47.3% in the high frailty risk group (Figure 2).

Conclusion

Readmissions in the first year after transcatheter aortic valve implantation were common and time spent hospitalized after transcatheter aortic valve implantation was significant. Our results were clearly related to frailty, which should be considered for future prevention strategies.

Funding Acknowledgement

Type of funding sources: None.
Intravascular lithotripsy to facilitate transfemoral TAVI: a single-center experience
Authors: Steblovnik K , Cercek M , Sustersic M , Terseglav S , Bunc M
Published: October 2022

Introduction

Transfemoral is considered the approach of choice for transcatheter aortic valve implantation (TAVI) and improves clinical outcomes such as death or stroke compared to transaortic or transapical access. Intravascular lithotripsy (IVL) has enabled modification of calcified intimal and medial lesions to increase vascular wall compliance which might facilitate the transfemoral TAVI approach.

Purpose

To present a single-center experience with intravascular lithotripsy facilitating transfemoral TAVI approach.

Methods

A peripheral IVL catheter was used to perform lithotripsy of calcified iliofemoral stenosis. A 0.014" guidewire was used to guide the lithotripsy catheter with a balloon diameter of 5.0 or 6.0 mm. Inflating the balloon with 4–6 atm of pressure enabled apposition with the arterial wall and several cycles of 30 pulses have been performed at various locations of the iliofemoral arteries. IVL was planned in advance as primary strategy in case of ring or as baillout strategy in case of ring or excentric calcified periferial artery stenosis, respectively. The IVL was immediately followed by transfemoral TAVI. Retrograde data were collected for the purpose of this abstract.

Results

From December 2019 to December 2021 433 TAVI procedures were performed in the University Medical Centre Ljubljana. In 13 of the procedures (3%) IVL was used to facilitate the transfemoral approach. The mean minimal diameter of iliofemoral arteries was 5,2 mm with calcifications affecting at least three-quarters of arterial circumference in 92% and circular calcifications in 62% of cases. In all cases, IVL was performed in a common iliac artery or aortic bifurcation, while external iliac (15%) or femoral (8%) arteries were treated less often. A 5 mm IVL balloon was used in 2 (15%), and a 6 mm balloon in 9 (69%) cases, while a combination of 5 and 6 mm balloons was used in 2 (15%) cases. IVL and subsequent TAVI were successful in all the cases. No hospital mortality or major bleeding was observed. One patient needed one unit of blood transfusion due to loss during planned surgical preparation and closure of the puncture site. The puncture site was closed using a 2 Proglide technique and no conversion from percutaneous to surgical puncture site closure was needed. A self-expanding aortic prosthesis (Evolut R, Medtronic) was used in 11 (85%) and a balloon-expandable (Sapien 3, Edwards Lifesciences) in 2 (15%) cases.

Conclusion

In our experience IVL of iliofemoral arteries is a safe and effective method to facilitate transfemoral approach in TAVI, especially in cases of circular calcifications affecting the majority of arterial wall circumference.

Funding Acknowledgement

Type of funding sources: None.
Application of machine learning to identify top determinants of fibrofatty plaque burden by CCTA in humans with psoriasis
Authors: Hong C , Li H , Parel P M , Berg A R , Rodante J , Keel A , Teague H L , Playford M P , Chen M Y , Zhou W , Sorokin A V , Bluemke D A , Mehta N N
Published: October 2022

Introduction

Fibrofatty plaque burden (FFB) is a high-risk, vulnerable plaque feature comprised of an atheromatous core and fibrous cap with increased risk of coronary artery disease (CAD) [1]. Psoriasis (PSO) is a chronic inflammatory disease linked with atherosclerotic risk and premature cardiovascular disease, driven in part by vulnerable plaque rupture [2,3]. Machine learning (ML) previously showed the prognostic value of FFB in predicting 5-year risk of cardiac-related mortality in patients with CAD [4]. Whether ML can predict FFB in psoriasis is understudied.

Purpose

To use ML to identify top determinants of FFB by CCTA in PSO.

Methods

320 consecutive participants with psoriasis were recruited as part of an ongoing cohort study, of whom 307 had FFB analyzed with coronary computed tomography angiography (CCTA) and quantified by QAngio CT (Medis, The Netherlands). 140 out of 182 potential determinants were subjected to ML algorithms analyzed by random forest and validated by 5-fold cross validation to select the top determinants based on R-square criteria. Lipid concentration and size were measured by nuclear magnetic resonance (NMR) and sdLDL-C was calculated by Sampson's formula.

Results

The top 21 determinants of FFB at baseline were grouped into 3 categories: cardiometabolic risk factors (BMI, sex, DBP, mean arterial pressure, exercise, heart rate, glucose, anxiety, psoriasis disease duration), clinical measurements (basophils, platelets, hemoglobin, RBC, alkaline phosphatase, ALT, creatinine, neutrophil-to-lymphocyte ratio), and lipoproteins (LDL particle size, apolipoprotein A1, apolipoprotein B-to-A1 ratio, calculated sdLDL-C).

Conclusion

ML confirmed that FFB strongly correlates with cardiometabolic risk factors, clinical measurements, and lipoproteins. Further investigations into these top determinants of FFB over time may provide insight into potential therapeutic interventions that decrease cardiovascular risk in patients with chronic inflammatory diseases and should be validated in larger studies.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): This study was supported by the National Heart, Lung and Blood Institute (NHLBI) IntramuralResearch Program (ZIA-HL-06193). This research was made possible through the NIH MedicalResearch Scholars Program, a public-private partnership supported jointly by the NIH andcontributions to the Foundation for the NIH from the Doris Duke Charitable Foundation,Genentech, the American Association for Dental Research, the Colgate-Palmolive Company, andother private donors.
Outcomes following patent foramen ovale percutaneous closure according to the delay from last ischemic event
Authors: Guedeney P , Mesnier J , Michel M , Hauguel-Moreau M , Silvain J , Houde C , Alperi A , Panagides V , Collet J P , Wallet T , Rouanet S , Hammoudi N , Rodes-Cabau J , Montalescot G
Published: October 2022

Background

Randomized controlled trials evaluating patent foramen ovale (PFO) percutaneous closure only included patients with recent embolic event. We aimed to evaluate outcomes following percutaneous PFO closure outcomes according to the delay from the last embolic episode.

Methods

This international ambispective cohort included consecutive patients from two centers in France and Canada undergoing PFO percutaneous closure for secondary prevention of paradoxical embolic event. The primary endpoint was the composite of stroke or transient ischemic attack (TIA). Logistic regression model was used to evaluate determinants of late PFO closure procedures.

Results

A total of 1,179 patients (mean age 49±12.7 years; 44.4% female) underwent PFO closure from 2001 to 2021 (Figure 1). The median delay from last embolic event to procedure was 6.0 (3.4–11.2) months. Determinants of late PFO closure procedure were the center (France versus Canada) adjusted Odds Ratio (aOR) 1.65 95% confidence interval (CI) 1.25–2.19, year of procedure (≥2018 versus <2018) aOR 1.43 95% CI 1.08–1.90, female sex aOR 1.63 95% CI 1.28–2.07 and lower RoPE score aOR 1.10 95% CI 1.03–1.19. After a median follow-up of 2.61 (1.13–7.25) years, the incidence rate of first stroke or TIA did not differ between early and late PFO procedures with 0.51 versus 0.29 events per 100 patient-years, respectively, incidence rate ratio 1.74 95% CI 0.66–5.08, p=0.25 (Figure 2). In univariate analysis, late PFO percutaneous closure was not associated with the occurrence of stroke or TIA, with hazard ratio 0.54 95% CI 0.22–1.34 p=0.17.

Conclusion

This analysis provides indirect evidence that delay from last ischemic event does not impact outcomes following PFO percutaneous closure for secondary prevention.

Funding Acknowledgement

Type of funding sources: None.
Clinical impact of peri-device leaks following percutaneous left atrial appendage occlusion: a systematic review and meta-analysis
Authors: Samaras A , Papazoglou A , Balomenakis C , Bekiaridou A , Moysidis D , Patsiou V , Orfanidis A , Feidakis A , Giannakoulas G , Tzikas A
Published: October 2022

Background

Peri-device leaks (PDL) are quite common after left-atrial appendage occlusion (LAAO) given the complex anatomy of LAA and surrounding structures. However, there is uncertainty regarding the prognostic implications of PDL.

Material and methods

Literature search was conducted in MEDLINE (PubMed), EMBASE, Scopus by ELSEVIER and Cochrane Central Register of Controlled Trials (CENTRAL) databases until 12 October 2021. A random-effects meta-analysis was performed to assess the effect of PDL presence on thromboembolism, all-cause mortality and major bleeding occurrence. Sensitivity analyses accounted for: i. the combined AF ablation performance, ii. the anticoagulation strategy followed after LAAO, iii. mean PDL size, and iv. mean female percentage.

Results

Of 699 articles initially retrieved, 46 were deemed eligible for this analysis (9,184 AF patients undergoing LAAO out of whom 1,446 had PDL). PDL presence was significantly associated with elevated odds of thromboembolism (FIgure 1) [pooled odds ratio (pOR) 3.05, 95% confidence interval (CI) 1.94–4.81; I2=37%]; yet PDL was not significantly linked with mortality (pOR=0.86, 95% CI: 0.25–2.95; I2=69%) and major bleeding rates (0.95, 95% CI: 0.27–3.35; I2=72%). AF-ablation did not significantly interact with the prognostic impact of PDL when performed in conjunction with LAAO (p for subgroup= 0.17). Antiplatelet discharge medication affected the prognostic value of PDL (p for subgroup <0.01 and =0.04, respectively). The prognostic significance of mean PDL size [peri-procedural or at 1–3 months or D(mean size)/D(time of follow-up)] on the risk of thromboembolism did not yield any significant association (p values >0.05). Meta-regression analysis of the mean female percentage demonstrated a non-significant trend towards a positive linear correlation between female percentage and risk of thromboembolism (p=0.10) (FIgure 2).

Conclusions

This is the first meta-analysis on the prognostic impact of PDL after LAAO. The findings highlighted a significant association between PDL and thromboembolic events, warranting careful post-LAAO device surveillance.

Funding Acknowledgement

Type of funding sources: None.
Total arterial revascularization is associated with long-term survival benefit in coronary artery bypass grafting: systematic review with meta-analysis
Authors: Ren J , Royse A , Tian D , Royse C , Boggett S , Bellomo R , Gaudino M , Fremes S
Published: October 2022

Importance

Total arterial revascularization (TAR), the complete avoidance of saphenous vein grafting (SVG) in coronary artery bypass grafting (CABG), is advocated based on the superior conduit durability and resistance against atherosclerosis. However, the low adoption rate of TAR indicates a high level of controversy.

Objective

To compare long-term survival between TAR and conventional CABG involving SVG.

Data sources

A comprehensive literature search was conducted through digital databases including MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from the inception to May 2021.

Study selection

The inclusion criteria were randomized clinical trials, or propensity-score balanced or multivariable-adjusted observational studies with a sample size of at least 100 patients in each arm, isolated CABG, comparing TAR (SVG=0) vs. non-TAR (SVG≥1), and inclusion of all-cause mortality.

Data extraction and synthesis

Two reviewers performed independent extraction following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Pooled hazard ratios (HR) and 95% confidence intervals (CI) were estimated with random-effect and fixed-effect models using generic inverse variance weighting. Individual patient time-to-event data were reconstructed to create an overall Kaplan-Meier survival function for matched studies. Sensitivity analyses were performed according to the risk of bias, matching status, and source of HR.

Main outcomes and measures

The primary endpoint was all-cause mortality.

Results

A total of 23 studies (100,314 patients), all with a retrospective observational design, were identified. The weighted mean follow-up time was 8.8 years post-operatively. Total arterial revascularization was associated with greater freedom from all-cause mortality than non-TAR (HR, 0.77, 95% CI, 0.71 to 0.84, p<0.001). There was evidence of low heterogeneity (I2=45%) across studies. Low publication bias was observed. Leave-one-out influence analysis and sensitivity analyses produced consistent results. Cochrane Collaboration signaling domains showed no critical risk of bias.

Conclusions and relevance

This meta-analysis found superior late survival associated with total arterial revascularization. Further randomized clinical trials are needed.

Funding Acknowledgement

Type of funding sources: None.
Impact of surgical left atrial appendage closure during coronary bypass on clinical outcomes and readmissions
Authors: Wu L , Narasimhan B , Yang Z R , Shah A N , Kantharia B K
Published: October 2022

Background

Whether surgical left atrial appendage closure (sLAAC) during coronary artery bypass (CABG)surgery improves post-operative outcome including stroke and atrial fibrillation (AF) occurrence is largely unknown.

Objective

To analyze the impact of concomitant sLAAC during CABG in terms of outcomes and readmissions over the following year.

Methods

We analyzed the Nationwide Readmissions Database (2016–2019) using ICD-10 codes to identify hospitalizations for CABG. Patients were subcategorized based on whether sLAAC was performed or not. Among patients who survived their index admission, we employed propensity matching (1:3) to adjust for age, sex, comorbidities, CHA2DS2-VASc scores, previous AF history, heart failure and hospital characteristics. Primary outcomes included unplanned AF and stroke-related readmissions at 1 year.

Results

A total of 58,311 patients with CABG and sLAAC were identified with 175,940 propensity matched controls. Patients undergoing sLAAC were older with higher CHA2DS2-VASc scores and comorbidity burdens. Confounders were well balanced following propensity matching. Over a mean follow-up of 152 days, sLAAC was associated with higher risk of readmission due to AF at one year (HR 1.71 [1.49–1.96] p<0.001). This association is independent of previous AF history. Lower rates of stroke-related readmission was associated with perfomance of sLAAC (HR 0.80 (0.65–0.97) p=0.026), however the association was not observed when accounting for AF history.

Conclusion

CABG with concomitant sLAAC is maybe associated with lower stroke risk at the cost of higher risk of AF readmissions.

Funding Acknowledgement

Type of funding sources: None.
Large multinational evaluation of time to reintervention in patients undergoing bioprosthetic valve implantation during open heart surgery
Authors: Maller T , Perel N , Simonato M , Harari E , Tager S , Fink D , Jacobson E , Glikson M , Dvir D
Published: October 2022

Introduction

Bioprosthetic valves are increasingly utilized during open heart surgery in favor of mechanical valves. These tissue valves are prone for structural valve degeneration and failure, especially in young patients. Transcatheter aortic valve implantation (TAVI) is an appealing approach in these patients.

Purpose

To describe independent correlates for early need for reintervention.

Method

We used a large multicenter registry of patients (>45 years of age) with failed bioprosthetic surgical valves undergoing TAVI valve-in-valve (VinV) in either aortic or the mitral positions. Early reintervention was (<5 years between open-heart surgery and VinV). Multi-variable properties that were included: patient gender, age at open-heart surgery, valve size, baseline renal failure, position of valve implantation, and bioprosthetic valve label size.

Results

A total of 3,324 patients were included in the study (age at the time of open heart surgery 68.9+7.9 years). Median time to TAVI was 9 years (IQR 6–13 years). A total of 632 (19%) patients experienced early valve degeneration with median time to TAVI of only 3 years [IQR 1–5]. Patients with early degeneration were older than those without early degeneration (mean age at surgery was 72.8±9 years vs. 68.9±8 years; p<0.001). in addition, significant linear relation between older patient age and early valve degeneration (p for trend <0.001). Re-intervention in the mitral position was more common in the group of patients with early degeneration (24.4% vs 18.2% without early degeneration; p<0.001) Patient age and mitral valve position were independently associated with increased rate of early degeneration (OR 1.09 [1.08–1.11], p<0.001; OR 1.62 [1.31–2.01]; p<0.001 respectively).

Conclusions

In this large multicenter analysis of patients undergoing TAVR for failed bioprosthetic valves we identified old patient age and mitral valve (vs. aortic) as independent correlates for early intervention. A discrepancy with known association of young age and rapid bioprosthetic valve degeneration is to be determined.

Funding Acknowledgement

Type of funding sources: None.
Impact of atrial fibrillation on in-hospital outcomes of coronary artery bypass graft surgery: an analysis by propensity score matching
Authors: Rosler A , Constantin G , Nectoux P , Ferreira G , Borges A , Sales M C , Lucchese F A
Published: October 2022

Background/Introduction

Many patients referred for coronary artery bypass graft (CABG) surgery have persistent or permanent atrial fibrillation (AF). Despite the significant occurrence, the impact of this arrythmia on surgical outcomes remains uncertain.

Purpose

To assess the impact of persistent or permanent AF on post-CABG in-hospital outcomes.

Methods

A cohort of 3,124 patients undergoing to isolated CABG between 2010 and 2020 was evaluated. A propensity score pairing was applied, considering persistent or permanent AF as a dependent variable and another 19 baseline characteristics as independent variables in the regression model used to build the propensity score. Pairing was performed at a ratio of 3:1 – Group 1: 324 patients without persistent or permanent AF; Group 2: 108 patients with the documented diagnosis of persistent or permanent AF. The statistical plan also included normality analyses, descriptive and univariate analyses, binary logistic regression, ROC curves and DeLong test to compare de curves. The significance level adopted was 5%. The analyses were performed by the programming language Python.

Results

None of the baseline characteristics evaluated showed a significant difference between the groups, including the EuroScore II (Group 1: 1.54±1.45 vs Group 2: 1.49±1.59; p=0.990). Likewise, none of the analysed surgical characteristics showed a significant difference, indicating a very approximate pattern of complexity of the surgeries. The absence of differences demonstrated a high degree of homogeneity between the groups. The use of pairing by propensity score aimed to form two extremely similar study groups, which differed only in relation to the diagnosis of the arrhythmia under study. Among the outcomes evaluated, AMI (1.5 vs 6.5; p=0.013), MACCE (7.1% vs 14.8%; p=0.015) and death (1.5% vs 6.5%; p=0.013) had significantly higher incidences in Group 2, formed by patients with persistent or permanent AF. From the multivariate analysis, it can be identified that permanent AF was an independent risk predictor for the occurrence of in-hospital death (OR: 5.009; 95% CI 1.433–17.507; p=0.012). Finally, it was also possible to verify that the association of EuroScore II with persistent or permanent AF showed higher predictive accuracy than EuroScore II alone (ESII+FA = AUC 0.852 vs ESII alone = AUC 0.775, p<0,05).

Conclusion(s)

Patients with persistent or permanent AF had significantly higher incidences of AMI, MACCE and in-hospital death. Persistent or permanent AF was characterized as an independent predictor for the occurrence of death and the association with the EuroScore II resulted in a 9.9% increase in the predictive accuracy of the surgical risk score.

Funding Acknowledgement

Type of funding sources: None.
Relationship between Pulse Wave Velocity and Myocardial Work in untreated hypertensive patients with preserved LVEF
Authors: Lofrumento F , Mandraffino G , Trimarchi G , Mancinelli A , Restelli D , De Sarro R , Sinicropi D , Cinquegrani M , Cusma-Piccione M , Manganaro R , Recupero A , Di Bella G , Zito C , Carerj S
Published: October 2022

Introduction

Hemodynamic interaction between left ventricular (LV) and arterial system is a key determinant of cardiovascular performance. The non-invasive carotid-femoral Pulse Wave Velocity (PWV), obtained with applanation tonometry, is considered the most precise way of estimating arterial stiffness. The LV myocardial work (MW), based on non-invasive LV pressure-strain loop (PSL), is a new promising tool to assess LV function.

Purpose

The aim of the study was to evaluate the correlation between PWV and MW parameters in a population of non-hypertensive and newly diagnosed untreated hypertensive people.

Material and methods

50 people (M=30), divided in hypertensive (group 1: n=25, 40±8 years) and non-hypertensive (group 2: n=25, 38±9 years), were prospectively enrolled. All underwent conventional transthoracic echocardiography and at the same day carotid femoral PWV was calculated with applanation tonometry (SphygmoCor® XCEL). MW parameters were obtained using 2D Speckle-tracking technique.

Results

Comparing the two groups, PWV and Global Work Wasted (GWW) were significantly higher in the hypertensives group (9.44±2.4 vs 7.56±1.1; p=0.001 and 130±2.5 vs 80.60±1.5, p=0.002), as shown in Figure 1, whereas Global Work Efficiency (GWE) and Global Work Constructive (GWC) were significantly lower (94±2.5 vs 95.8±1.2, p=0.003 and 2393±20 vs 2166±18, p=0.02). We found a linear and positive correlation of PWV with GWW (r=0.315, p=0.026), as seen in Figure 2, and a linear and negative correlation of PWV with GWE (r=−0.315, p=0.026).

Conclusion

This study highlights the role of PWV and MW evaluation in hypertensives. Higher PWV and GWW could be considered as red flags of myocardial damage suggesting the need of an early appropriate antihypertensive therapy.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): University Ospital G. Martino - Messina
Intracranial carotid arteriosclerosis mediates the association between blood pressure and cerebral small vessel disease: the Rotterdam Study
Authors: Melgarejo J , Vernooij M W , Ikram M A , Zhang Z Y , Bos D
Published: October 2022

Background

Cerebral arteriosclerosis could explain the physiopathological mechanisms linking high blood pressure (BP) and cerebral small vessel disease (CSVD).

Objectives

To test the hypothesis that ICAC mediates the association between BP and CSVD.

Methods

1458 stroke-free participants from the Rotterdam Study underwent nonenhanced computed tomography to quantify ICAC and brain magnetic resonance imaging scans to assess CSVD. ICAC subtypes included atherosclerotic (intimal) and non-atherosclerotic internal elastic lamina (IEL) calcifications. We analyzed systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), and mean arterial pressure (MAP). Mediation analysis included a two way decomposition to compute the natural direct effect (NDE), natural indirect effect (NIE) and percentage of mediation (%) of ICAC on the association between BP and CSVD.

Results

The study population had a mean age of 68.0 years old, and 52% (n=758) of the participants were women. In analyses including participants with predominantly IEL calcification, we observed that larger log-ICAC volume was positively related to a higher pulse pressure (β=0.020; P<0.001), and lower diastolic BP (β=0.024; P=0.001). None of the BP components were associated with log-ICAC volume among participants with predominantly intimal calcifications (β≤0.008; P≥0.060). Among all participants, log-ICAC volume mediated the association of DBP (NIE, 0.003; −14.5%) and PP (NIE,0.003; 16.5%) with log-white matter hyperintensities (log WMH). In participants with IEL calcification, log-ICAC volume mediated the association of DBP with log-WMH (NIE, 0.004, −19.5%); no mediations were observed for intimal ICAC. For Lacunes, in all participants, log-ICAC volume mediated the association of DBP (NIE, −0.015, −40%) and PP (NIE,0.015; 26.9%). In participants with IEL calcification; the NIE was 0.020 (45.8%) for DBP and 0.017 (18.2%) for PP. No interactions were detected.

Conclusions

ICAC mediated the association between BP and CSVD. Non-atherosclerotic IEL calcification, considered a proxy of arterial stiffness, was the main physiopathological mechanism explaining how BP links to CSVD due to cerebral arteriosclerosis.

Funding Acknowledgement

Type of funding sources: None.
Regional inequality of socioeconomic status and the prevalence of hypertension between rural and urban areas
Authors: Cho D , Ha M C , Jo H R , Kang S H
Published: October 2022

Background

Lower socioeconomic status (SES) is associated with greater burdens of cardiovascular disease in a community. The regional disparity of SES may result in an uneven distribution of hypertension (HTN) by a region. This study aims to analyze the regional disparity in the SES and HTN burden between rural and urban areas of the Korea.

Methods

We used data from the Korea National Health and Nutrition Examination Survey (KNHANES) V (2010–2012), VI (2013–2015), and VII (201–2018). We analyzed 11,206 and 1739 subjects from Seoul metropolitan and rural area (Gangwon province), respectively. We compared socioeconomic characteristics, the distribution of HTN between two regions. Finally, we performed a multivariate logistic regression adjusting for traditional CV risk factors and SES status to examine differences in the prevalence of HTN.

Results

Subjects in Gangwon province were older than Seoul (54.6±0.4 vs 49.4±0.2 years old, p<0.001). The proportions of subjects with low economic status and low education level were significantly higher in Gangwon province compared to Seoul (low economic status; 25.6 vs 14.4%, p<0.001, low education level; 35.3 vs 16.5%, p<0.001). Mean systolic blood pressure (SBP) was higher in Gangwon compared to Seoul (121.6±0.4 vs 118.1±0.2 mmHg, p<0.001). In the longitudinal trend from KNHANES V to VII, the difference of SBP between the two regions increased (Figure). The age-matched prevalence of HTN was significantly higher in Gangwon compared to Seoul (23.8 vs 21.6%, p<0.05), and the difference of prevalence of HTN by regions longitudinally increased (Figure). In the univariate analysis, the residency in Gangwon was associated with the presence of HTN (reference: Seoul, OR=1.63; 95% CI: 1.45–1.83). In the multivariate logistic regression model, the residency in Gangwon was not associated, however, low economic status and low education level were significantly associated with the presence of HTN (economic status, OR=1.39; 95% CI: 1.17–1.67, education level, OR=1.88; 95% CI: 1.57–2.24).

Conclusion

The SES status was lower and the prevalence of HTN was higher in Gangwon compared to Seoul. The burden of HTN longitudinally increased in Gangwon, but not in Seoul. The poor SES was significantly associated with HTN. It suggests that the inequalities of SES in Gangwon may contribute to the increasing prevalence of HTN. The regional and individual disparity of SES should be considered in the establishment of public health strategies for HTN.

Funding Acknowledgement

Type of funding sources: None.
Bi-directional relationships of arterial stiffness with hypertension and diabetes mellitus from the early pathophysiological stages: a 16-year prospective observational study
Authors: Nakano H , Shiina K , Takahashi T , Fujii M , Iwasaki Y , Matsumoto C , Yamashina A , Chikamori T , Tomiyama H
Published: October 2022

Background

Hypertension and diabetes mellitus frequently coexist; however, it has not yet been clarified if the bidirectional longitudinal relationships between arterial stiffness and hypertension are independent of those between arterial stiffness and diabetes mellitus.

Methods

In this 16-year prospective observational study, 3960 middle-aged employees of a Japanese company without hypertension/diabetes mellitus at the study baseline underwent annual repeated measurements of the blood pressure, serum glycosylated hemoglobin A1c levels (HbA1c), and brachial-ankle pulse wave velocity (baPWV).

Results

By the end of the study period, 664, 779, 154, and 406 subjects developed hypertension, prehypertension, diabetes mellitus, and prediabetes, respectively. Increased baPWV at the baseline was associated with a significant odds ratio (per 1 standard deviation increase) for new onset of prehypertension/hypertension with (2.45/3.28, P<0.01) or without (2.49/2.76, P<0.01) coexisting prediabetes/diabetes mellitus, but not for new onset of prediabetes/diabetes mellitus without coexisting hypertension. Analyses using the latent growth curve model confirmed the bidirectional relationships between baPWV and hypertension, but no such relationship was observed between baPWV and abnormal glucose metabolism. Moreover, after the adjustments, higher mean blood pressure at baseline accelerated the increases in the baPWV over follow-up (unstandardized coefficient [B] = 0.39, standard error [SE] = 0.05x10–1, P<0.01). Similarly, higher baPWV at baseline accelerated the increases in mean blood pressure over follow-up (B = 0.02x10–1, SE = 0.01x10–1, P<0.01) (Figure 1). On the other hands, higher HbA1c levels at baseline accelerated the increases in the baPWV over follow-up (B = 0.43, SE = 0.05x10–1, P<0.01), but higher baPWV at baseline did not accelerate the increases in HbA1c levels over follow-up (B <0.01, SE <0.01, P=0.52) (Figure 2).

Conclusions

In middle-aged employees of a Japanese company, in contrast to the bidirectional relationships that exist between arterial stiffness and hypertension, increased arterial stiffness preceding the development of diabetes mellitus may represent that associated with the development of hypertension, as it is observed only in cases of diabetes mellitus coexisting with hypertension. Therefore, arterial stiffness may be associated to a greater degree with the development of hypertension than with the development of diabetes mellitus.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Omron Health Care Company (Kyoto, Japan),Teijin Pharma Company (Tokyo, Japan)
Correlation between central aortic stiffness indices and cardiac mechanics in hypertensive patients: new insights from speckle tracking echocardiography imaging
Authors: Marzouk D , Eldeep H , Baghdady Y , Youssef G
Published: October 2022

Background

Left ventricular (LV) and left atrial (LA) mechanics are altered in hypertensive patients. Recent evidence suggests that central aortic pressure, rather than brachial pressure is strongly related to future cardiovascular events. Currently, oscillometric non-invasive devices are considered a reliable method for estimation of central aortic pressure and stiffness indices.

Purpose

To evaluate the relation between central aortic pressure measured using oscillometric non-invasive device and cardiac mechanics assessed by speckle tracking echocardiography (STE).

Methods

Fifty hypertensive patients with apparently structural normal heart were consecutively enrolled. A new oscillometric device was programmed to measure blood pressure over a period of 30 minutes (total of 15 sequential readings) and then data was transferred to a computer-based software where the central aortic pressure and stiffness indices (Augmentation index {AIx} and Pulse wave velocity {PWV}) were automatically calculated. All patients underwent conventional transthoracic echocardiography and STE. STE analysis of LV and LA functions was done using a specific software. LV systolic (global longitudinal strain {GLS}) as well as diastolic (measured at peak mitral filling {E} and at isovolumetric relaxation time {IVRT}) strain/strain rate were measured. LA strain was measured during reservoir (LASr), conduit (LAScd) and contraction (LASct) phases.

Results

The mean age was 45.9±10.6 years and 38% of patients were males. Most of the population was overweight with mean BMI 28±1.9 kg/m2. About 2/3 of population has uncontrolled hypertension (mean brachial systolic and diastolic blood pressure was 139.8±17.5 and 88.4±11.3 mmHg, respectively). The mean central systolic (cSBP) and diastolic blood pressures (cDBP) were elevated (122.2±13.3 and 84.6±10.8 mmHg, respectively). cSBP and cDBP showed significant weak negative correlation with LV diastolic strain rate (Dsr) at peak E (cSBP: r=−0.33, p=0.02; cDBP: r=−0.28, p=0.04). There was no significant correlation between LV GLS and central stiffness indices (p>0.05). cDBP was significantly negatively correlated with LASct (r=−0.3, p=0.03), with no other significant correlation between central stiffness indices and other LA functions (LASr and LAScd) (p>0.05).

Conclusions

Changes in LV diastolic strain/strain rate parameters assessed by STE are related to central aortic pressure particularly cSBP and cDBP in patients with hypertension. This relation was also observed with LA strain parameters namely LASct.

Funding Acknowledgement

Type of funding sources: None.
The music therapy effectiveness in hypertensive patients with acute myocardial infarction after previous coronary artery bypass surgery; 18-year experience of the MUSIC study
Authors: Mitrovic P , Paladin A , Radovanovic M , Radovanovic N , Rajic D , Matic G , Jozic T , Dizdarevic I , Jankovic J , Radovanovic M N
Published: October 2022

Patients who have clinical evidence of hypertension (HT) after coronary artery bypass surgery (CABS) have a poor prognosis in expression of acute myocardial infarction (AMI), as one of the MACE. Unrelieved anxiety can produce an increase in sympathetic nervous system activity leading to an increase in cardiac workload. The purpose of this study was to evaluate the effectiveness of music therapy on prognosis of patients with HT and AMI, after CABS.

Methods

314 patients (males 78.4%, mean age 59.8±1.2 yrs) with AMI after previous CABS have been selected from the patients consecutively submitted from January 2003 to January 2019. HT was registered in 166 (53.0%) pts with AMI after previous CABS. All patients with HT were randomized and divided in 2 groups: Study group of 83 patients treated with music therapy and Control group of 83 patients with no music therapy. Each patient in study group underwent two sessions of medical therapy (12 minutes) in a day. Both groups were similar in baselines, post-AMI characteristics and post-AMI medical therapy. The plasma cytokine and catecholamine were measured in both groups.

Results

In the Study group, heart rate was significantly decreased by music therapy (p=0.0196). In the Control group, there were no significant changes in heart rate. Among cytokines (p=0.0160), plasma interleukin-6 (IL-6) (p=0.0179) in the Study group was significantly lower than those in the Control group, as well as plasma adrenaline (p=0.0162) and noradrenalin (p=0.0218) levels.

Conclusion

This study provides support for the use of musical therapy in patients with HT and AMI after previous CABS. The positive effects of music therapy, in these patients, are probably because of enhanced of parasympathetic activities and reduction of plasma cytokine and catecholamine levels.

Funding Acknowledgement

Type of funding sources: None.
Valsartan reduces arterial stiffness along with level of soluble ST2 independently of blood pressure changes
Authors: Tomasik A , Kozielska E , Kawecki D , Jachec W , Wojciechowska C
Published: October 2022

Introduction

Arterial stiffness is one of end-organ damage signs in patients with arterial hypertension. Carotid femoral pulse wave velocity (cfPWV) is a clinical measure of arterial stiffness and its values above 10 m/sec are associated with increased cardiovascular risk. Soluble ST2 is a cytokine involved in fibrotic processes. There is paucity of data on the association between sST2, arterial stiffness, and effect of valsartan on these parameters.

Objectives

The aim of the study was to assess the effect of valsartan on arterial stiffness and level of soluble ST2 over a 12-month long treatment.

Methods

This was a randomized, blinded, placebo controlled single center study. There was a 24-hour-long wash-out period from angiotensin converting enzyme inhibitors (ACEI) and other than valsartan, angiotensin receptor blockers ARB (previous use of valsartan was an exclusion criterion). Drugs other than ACEI and ARB were allowed in follow-up to control blood pressure. CfPWV was assessed at baseline and at 12 months using applanation tonometry. Soluble ST2 was measured with lateral flow cassette-based immunofluorescent assay. We present the data for 28 placebo patients (Plac) and 60 valsartan patients (Vals).

Results

Patients from both groups have had comparable peripheral and central blood pressures. CfPWV has risen in Plac by 6.2% and has fallen by 6.2% in Vals (P=0.01) over 12 months. Soluble ST2 has risen in Plac by 9.4% and has fallen by 43.3% in Vals (P=0.001) over 12 months.

Conclusion

Valsartan has positive effect on improvement of arterial stiffness. Decrease in soluble ST2 concentration may help explain the alternative mechanism for protective role of valsartan.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Medical University of Silesia
Blood pressure reduction in higher cardiovascular risk patients in the Global SYMPLICITY Registry
Authors: Rodriguez O , Mahfoud F , Schmieder R , Schlaich M , Narkiewicz K , Ruilope L , Williams B , Fahy M , Mancia G , Boehm M
Published: October 2022

Background/Introduction

The Global SYMPLICITY Registry (GSR) was designed to evaluate the safety and efficacy of renal denervation (RDN) in real-world patients. Inclusion and exclusion criteria are limited to allow assessment of the effects of RDN on patients with a wide range of comorbidities. The current analysis examines blood pressure (BP) reduction after RDN in higher cardiovascular risk patients.

Purpose

To evaluate blood pressure reduction after RDN in higher cardiovascular risk patients in GSR.

Methods

GSR is a prospective all-comers registry to evaluate the safety and efficacy of RDN. Patients are enrolled in GSR and receive radiofrequency RDN using the Symplicity Flex or Symplicity Spyral catheter. Office and ambulatory BP are measured at each follow-up (3, 6, 12, 24, and 36 months). In this post-hoc analysis, changes from baseline in office and 24-hour ambulatory systolic blood pressure were assessed in patients at higher cardiovascular risk. Higher risk was defined using baseline office systolic or diastolic BP as well as additional risk factors (Figure 1).

Results

As of March 2021, there were 2621 patients characterized as higher cardiovascular risk in GSR. Baseline characteristics included mean age 60.7±12.1 years, 57.6% male, 37.9% type 2 diabetes, 35.8% hypocholesterolemia, 19.7% eGFR <60 mL/min/1.73 m2, 16.2% left ventricular hypertrophy, 10.2% previous stroke and 9.3% previous myocardial infarction. Baseline office systolic BP (OSBP) was 168.8±22.7 mmHg and baseline ambulatory systolic BP (ASBP) 155.3±18.6 mmHg. Mean OSBP reductions after RDN in this higher risk population ranged from −13.1 mmHg at 3 months to −17.5 mmHg at 24 months and −18.9 mmHg at 36 months, and mean ASBP reductions ranged from −7.8 mmHg at 3 months to −9.8 mmHg at 24 months and −9.3 mmHg at 36 months (Figure).

Conclusions

Higher risk patients in GSR had sustained office and ambulatory systolic BP reductions out to 3 years after catheter-based radiofrequency RDN.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Medtronic
Differences in mitochondrial efficiency and heart function after different modes of exercise training in hypertension
Authors: Dorofeyeva N , Sagach V F
Published: October 2022

Physical exercise is often used for the cardioprotective purpose in hypertension. However, it's not clear whether the mitochondrial efficacy will depend on the intensity and mode of physical exercise. The aim of the work is to investigate the effect of different modes of exercise training on mitochondria function and cardyohemodynamic in hypertension. All experimental procedures were performed in accordance with the European Communities Council Directive of 24 November 1986 (86/609 /EEC). Six-month-old spontaneously hypertensive rats (SHR) and normotensive control–Wistar rats were randomly assigned to 2 different training modes: moderate (20 min) and enhanced (45 min). Swimming training was done five times per week for 5–6 weeks. The functional cardiohemodynamic indicators were registered via microcatheter and Millar Pressure-Volume System. Mitochondrial oxygen consumption registered by Oxygraph. Moderate exercise training mode in SHR had a positive effect on the respiratory chain of mitochondria, respiratory control increased by 25,3%, the mitochondrial membrane potential increased by 47,8%. Moderate exercise training mode protected mitochondrial permeability transition pore (MPTP) formation. The threshold of MPTP opening increased by 1.4 times and the sensitivity of MPTP to inductor Ca2+ decreased. It was shown that end-systolic and end-diastolic pressure of SHR was decreased by 23,8% and 32,7% respectively. Moderate exercise improves end-diastolic heart function in SHR by increasing dP/dtmin and reducing the end-diastolic myocardial stiffness in 8,3 times. Stroke volume increased in 3,3 times, stroke work decreased by 17.2%, which may indicate the heart work efficiency increased after moderate exercise training. The Frank-Starling mechanism efficiency after moderate exercise was increased by 3,7 times. After enhanced exercise mode we didn't observe a protected effect on heart mitochondria and heart function in SHR. The mitochondrial membrane potential didn't increase, mitochondrial respiration in states V2, V3, V4 were significantly decreased. In conclusion, we showed that a moderate mode of exercise in SHR rats increased mitochondrial efficiency and improved heart function. The enhanced mode of exercise was excessive for SHR which was confirmed by suppressing the mitochondrial respiration and end-diastolic function of the heart.

Funding Acknowledgement

Type of funding sources: None.