bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of physical activity on all-cause mortality in European patients with atrial fibrillation: a report from the ESC-EHRA EORP AF General Long-Term Registry
Authors: Vitolo M , Proietti M , Harrison S , Kalarus Z , Tavazzi L , Potpara T , Lane D.A , Boriani G , Lip G.Y.H
Published: November 2020

Background

Physical activity (PA) may have a beneficial contribution for outcomes in patients with atrial fibrillation (AF).

Purpose

We aimed to evaluate the impact of self-reported PA in a large contemporary cohort of European AF patients on the risk of all-cause mortality.

Methods

We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Self-reported PA was categorized, on the basis of reported time spent exercising, as follows: i) No PA; ii) Occasional PA; iii) Regular PA; iv) Intense PA. The primary outcome was all-cause death.

Results

Over 11096, a total of 8699 (78.4%) patients (mean age (SD) 69.1 (11.5); 40.7% female) had available data about PA and follow-up observation and were included in the analysis. Of these, 3703 (42.6%) reported no PA, 2829 (32.5%) occasional PA, 1824 (21.0%) regular PA, with only 343 (3.9%) reporting intense PA. With the 4 increasing PA categories, mean age, proportion of female patients, CHA2DS2-VASc and HAS-BLED scores were progressively lower (all p<0.001). Use of vitamin K antagonist (VKA) declined across the classes of PA (53.1% vs. 52.2% vs. 44.5% vs. 33.9%, p<0.001), while use of non-VKA OACs (NOACs) conversely increased. During a mean (SD) 680.6 (171.5) days of follow-up, there were a total of 848 (9.7%) all-cause death events. Based on Kaplan-Meier analysis, there was a progressively lower cumulative risk for all-cause death according to PA categories [Figure]. A multivariable Cox regression analysis, adjusting for CHA2DS2-VASc score, use of OAC at baseline and type of AF, found a lower risk of all-cause death associated with increasing levels of PA (Hazard ratio [HR]: 0.69, 95% confidence interval [CI]: 0.59–0.81 for occasional PA, HR: 0.45, 95% CI: 0.35–0.58 for regular PA, HR: 0.41, 95% CI: 0.23–0.76 for intense PA, when compared to no PA). In a sensitivity analysis, a regular-intense PA was inversely associated with occurrence of cardiovascular (CV) death, after multivariable adjustments for comorbidities (HR: 0.54, 95% CI: 0.37–0.77).

Conclusions

In a large contemporary cohort of European AF patients, self-reported PA was found to be inversely associated with all-cause death and CV death.

Kaplan-Meier Curves

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Since the start of EORP, several companies have supported the programme with unrestricted grants
Ticagrelor could cause central sleep apnea after acute coronary syndrome in patients without left ventricular dysfunction or heart failure
Authors: Meurin P , Ben Driss A , Defrance C , Renaud N , Dumaine R , Weber H , Grosdemouge A , Mouram S , Pericart L , Bonnevie L , Tabet J.Y
Published: November 2020

Background

Although the prevalence of obstructive sleep apnea (OSA) syndrome is high in patients with acute coronary syndrome (ACS), little is known about central sleep apnea (CSA) in these patients, especially if they have no left ventricular dysfunction (indeed, it is well known that heart failure could be a confounding factor as it is an important cause of CSA). Furthermore, central apnea could be promoted by ticagrelor, a relatively new drug, already known to cause dyspnea (which could modify the apneic threshold) in some patients.

Purpose

To investigate the prevalence of central sleep apnea in patients without left ventricular dysfunction after ACS.

Methods

Monocentric prospective survey. All consecutive patients within 365 days after ACS were included if they had (1) left ventricular ejection fraction LVEF >45%, (2) no history of heart failure, (3) systolic arterial pulmonary artery pressure <45 mm Hg, and (4) no history of sleep apnea. After inclusion, patients underwent an overnight sleep study with a portable sleep monitor validated to differentiate central and obstructive apneas. Patients were then classified as “normal” patients if they had an AHI (apnea hypopnea index) <15, “CSA patients” if they had an AHI >15 with a majority of central sleep apneas and “OSA patients” if they had an AHI >15 with a majority of obstructive sleep apneas.

Results

Between January 2018 and January, 2020, we included 115 consecutive patients (age 56.1±10.5, male 84%, mean body mass index 28.4±4.5, LVEF: 56±4%). Sleep study was performed 68±62 days (7–350 days) after ACS on average. All of the patients were receiving a single or (mostly) dual antiplatelet therapy: aspirin (n=114: 99%, ticagrelor (n=80: 69.5%), clopidogrel (n=28: 24%), prasugrel (n=4: 3.5%).

Finally 80 patients were taking ticagrelor, while 35 were not.

A total of 49/115 patients (42.6%) had a clinically significant (moderate to severe) sleep disordered breathing, with an AHI>15: (CSA: n=27/115: 23.5%, OSA:n=22/115: 19%). Among them, 25/115 patients (22%) had a severe (AHI >30) sleep disordered breathing: CSA 12% OSA: 10%.

Among patients receiving ticagrelor, 24/80 (30%) had a CSA with an AHI >15, while, in patients not taking ticagrelor only 3/35 (8.5%) had CSA with an AHI >15 (p=0.04)

Conclusion

As expected, OSA is frequent after ACS, as in all types of coronary artery disease patients. High prevalence of CSA was less expected and seemed to be correlated with ticagrelor administration. This monocentric survey is a preliminary safety signal. Further studies are needed to investigate the exact incidence, the sustainability and the potential consequences of ticagrelor induced central sleep apnea.

Funding Acknowledgement

Type of funding source: None
Effects of CPAP treatment on cardiac structure and function in individuals with obstructive sleep apnea and cardiovascular disease: a prospective 6-month randomised control trial
Authors: Franke K , Loffler K.A , Nicholls S.J , Anderson C.S , Cowan B.R , McEvoy R.D , Young A.A , Verjans J.W
Published: November 2020

Background

Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular events. The influence of continuous positive airway pressure (CPAP) on cardiac function remains uncertain.

Purpose

To prospectively determine the effects of CPAP on cardiovascular function, as measured by cardiac magnetic resonance imaging (CMR) as a sub-study of the international SAVE trial (NCT00738179).

Methods

Participants with OSA and established cardiovascular disease were randomized to CPAP treatment plus usual cardiovascular care or Usual Care alone. Primary outcomes were defined as change in ventricular ejection fraction (EF) and stroke volume (SV) between baseline and 6-month follow-up both groups. Secondary outcomes included other ventricular parameters including volumes, mass, and strain, and atrial parameters.

Results

140 participants were included; mean CPAP adherence in those allocated to receive the treatment was 4.31±2.45 hours per night. Most were male (91%) and had moderate-severe OSA with minimal daytime sleepiness. There were no significant differences in left or right ventricular EF between groups after 6 months of treatment. There was an 8.5 mL increase in LV SV (95% CI; [4.3–12.6], p<0.001) and a 7.7 mL increase in RV SV (95% CI; [3.4–12.0], p<0.001) in the CPAP group compared to Usual Care. CPAP also affected left and right ventricular EDV, RV strain, and atrial parameters.

Conclusions

In the first prospective CMR imaging study of patients with OSA and cardiovascular disease, CPAP treatment did not change EF after 6 months, but did have significant effects on other parameters of cardiac function.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Respironics Foundation; Australian National Health and Medical Research; New Zealand Health Research Council
Relationship between AF-risk, ischemic stroke AF related, and cognitive dysfunction in population older than 65 years-old. MIND-COR study
Authors: Ballesta-Ors J , Muria-Subirats E , Lorman-Carbo B , Panisello-Tafalla A , Clua-Espuny J.L
Published: November 2020

Background

The number of individuals with atrial fibrillation (AF) and cognitive impairment (CI) will increase 150% by 2050.

Purpose

The main objective of this study is to elucidate the relationship between AF-risk, the ischemic stroke, and the cognitive dysfunction.

Methods

Multicenter, longitudinal and retrospective community-based study of cohort ≥65 year-old without AF between 1/1/2013–31/12/2017 conducted by 11 Primary Care teams. Variables: sociodemographic; Charlson, CHA2DS2VASc score, Pfeiffer and NIHSS scores from records database (primary care, specialty clinics and hospitalizations). Kaplan-Meier to evaluate mortality.

Descriptive analysis

Cox regression to create an AF risk score was developed: Q1 (lowest AF-risk)-Q4 (highest AF-risk). Incidence density (ID) rate per 1000/people/years of AF and stroke; and CI prevalence were calculated by risk stratum.

Approved by Ethics Committee of IDIAP Jordi Gol PP15/047.

Results

46706 (women 49%) cases, aged 78.01±11.9 and average follow-up time 4.9±0.7 years. Q4 risk group (Q4) was characterized by women's (85.2%), highest age, AF, stroke, CI and mortality.

1244 AF were diagnosed (ID 10.5/1000/year's IC95% 9.9–11.2). Q3–4 levels included 53.8% of AF in men vs 84.2% in women. 214 strokes were diagnosed and 78.5% happened in Q3–4, especially among women (88.1%). The stroke and AF were diagnosed simultaneously in 9.8% (ID 5.8/1000/year CI95% 3.4–8.1) and showed higher severity (NIHSS 7.25±8.62 vs 4.55±5.74, p=0.002). The cognitive impairment increased from 2.6% (Q1) up to 16.4% (Q4) significantly higher in women (17.6% vs 12.1%)

Conclusions

Differences were found according to gender and risk groups. The risk-based screening could improve the effectiveness of AF screening in primary care.

Funding Acknowledgement

Type of funding source: None
Addition of biomarker high sensitivity troponin I (hSTROPI) to QRISK3 score in predicting significant coronary artery disease (CAD)
Authors: Dasari B.C.A , Oomman A , Govindarajulu P , Narra L , Mao R , Gunasekaran S , Satish S , Showkathali R , Immaneni S , Pramodkumar K.P , Reddy Y.V.C , Nayak R
Published: November 2020

Background

The current models to predict CAD in general population is not universally accepted. Many risk scores do not take into account factors such as south Asian ancestry, type 2 diabetes mellitus or family history of premature CAD. There is still no clarity on the position of biomarkers in addition to traditional risk factors.

Purpose

This study evaluates the role of biomarker hSTROPI in addition to QRISK3 score in predicting significant CAD.

Methods

This observational study included 103 consecutive subjects who had non cardiac pain as per ESC criteria and wanted to assess their future cardiovascular risk and to know the coronary anatomy. None had documented CAD prior. The inclusion criteria consisted of subjects who were >18 years of age asymptomatic or with non-cardiac chest pain and absence of clinical cardiovascular disease. Exclusion criteria were heart failure, chronic kidney disease (CKD) and anemia (hemoglobin <10 gms%). They underwent risk stratification based on QRISK3 score and measurement of hSTROPI. All of them underwent Computerized Tomography coronary angiogram (CTCA). Subjects with more than 50% lesions on CT coronary angiogram were deemed to have significant CAD. We analyzed the impact of hSTROPI in addition to QRISK3 score in picking up significant lesions by CTCA.

Results

The analysis showed sensitivity of QRISK3 >17.5% of 46.43%, specificity of 75.68%, positive predictive value (PPV) of 41.94%, negative predictive value (NPV) of 78.87% and diagnostic accuracy of 67.65%.

hSTROP I >3.5pg/ml showed a sensitivity of 37.93%, specificity of 81.08%, PPV of 44%, NPV of 76.92% and diagnostic accuracy of 68.93%.

When both hSTROPI >3.5pg/ml and QRISK3 >17.5% are combined, the sensitivity was found to be 27.59%, specificity of 91.89%, PPV of 57.14%, NPV of 76.4% and diagnostic accuracy of 73.79%.

In the study population, significant CAD was found in QRISK3 >17.5% in 41.9% and QRISK3<17.5% in 22.2% and (p=0.04).

Significant CAD was found in 44% of population with HSTROPI >3.5 pg/ml and in 23.1% whose HSTROP I <3.5pg/ml (p=0.04).

Significant CAD was found in 57.1% of population with both parameters positive (QRISK3 >17.5% and hSTROPI >3.5 pgm/ml), 23.6% of the population in which both parameters were negative (p=0.009).

Conclusion

Combining QRISK3 score of more than 17.5% and hSTROP I more than 3.5pg/ml have significant association with more than 50% lesion by CTCA with a specificity of 91.89%.

This may be useful in counselling intermediate risk group patients to have aggressive pharmacological primary preventive strategies like high dose statins. This may be a cost effective method of screening south Asian population who have much more risk factors and CAD at much younger age.

Funding Acknowledgement

Type of funding source: None
Association of isolated T inversion and sudden cardiac death – etiology and gender differences
Authors: Haukilahti M.A.E , Holmstrom L , Vahatalo J , Kentta T.V , Pakanen L , Tikkanen J , Perkiomaki J , Rissanen H , Knekt P , Huikuri H.V , Junttila M.J
Published: November 2020

Background

Inferolateral T wave inversion has been associated with increased risk of mortality and sudden cardiac death (SCD) in general population. However, the association between isolated T inversion and SCD is still unclear.

Purpose

The purpose of this study was to examine whether isolated T inversion associates with SCD, and find out possible gender differences.

Methods

FinGesture Study has systematically collected clinical data and medico-legal autopsy data from 5,869 consecutive SCD victims (mean age 64.9±12.4 yrs.) in Northern of Finland between years 1998 and 2017. Previously recorded electrocardiograms (ECG) were available and analyzed in 1,101 subjects. The control group consisted of 7,217 subjects representative of Finnish general population (mean age 51.5±12.4 yrs.). T inversion was interpreted isolated if there was at least two T inversions ≥−0.1 mV in at least two contiguous leads, and there were no ECG signs of left ventricular hypertrophy (LVH) defined by Sokolow-Lyon criteria or bunchle brand block (BBB) attached to it.

Results

In a current study, isolated T inversion was more common finding among SCD victims compared to general population: isolated T inversion in any leads 10.9% vs. 0.9% (SCD vs. general population, p<0.001), laterally 7.7% vs. 0.1% (p<0.001), inferiorly 3.2% vs. 0.5% (p<0.001) and anteriorly 2.9% vs. 0.4% (p<0.001). Particularly, isolated T inversion seemed to assoaciate with ischemic SCD taking into account that 61.5% of the total isolated T inversions were seen in ischemic SCD victims (p=0.018). In addition, 62.1% of the inferior isolated T inversions (p=0.023) and 61.7% of the lateral isolated T inversions (p=0.031) were in ischemic SCD victims versus 37.9% and 38.3% in non-ischemic SCD victims, respectively. The prevalence of isolated T inversion in any lead was also higher among male SCD victims compared to female victims (12.8% vs. 8.2%, p<0.001, respectively). There was no statistically significant difference in the prevalence of LVH and strain changes between the populations. Among bundle branch blocks left BBB was predictably more typical in SCD victims (5.8% vs. 0.5%, p<0.001).

Conclusion

We noticed an association between isolated T inversion and SCD. The association was most prominent in males and in those with ischemic etiology of SCD.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): The Finnish Medical Foundation, Finnish Foundation for Cardiovascular Research
CHA2DS2-VASc and CHADS2 scores for risk stratification of major adverse cardiovascular events in the COMPASS trial
Authors: Sen J , Tonkin A , Varigos J , Fonguh S , Berkowitz S.D , Yusuf S , Verhamme P , Vanassche T , Anand S , Fox K.A.A , Eikelboom J.W , Amerena J
Published: November 2020

Background

The COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial demonstrated that the combination therapy of rivaroxaban and aspirin reduced major adverse cardiovascular events (MACE) compared to aspirin alone in patients with chronic coronary artery disease (CAD) and/or peripheral artery disease (PAD).

Purpose

We assessed whether the CHA2DS2-VASc (congestive heart failure (CHF), hypertension, age ≥75 years, diabetes, stroke/transient ischemic attack (TIA)/thromboembolism, vascular disease, age 65–75 years, and sex category) and CHADS2 (CHF, hypertension, age ≥75 years, diabetes, stroke/TIA) scores used to predict the risk of stroke in patients with atrial fibrillation, can be used identify vascular patients at highest risk of recurrent events who may derive greatest benefits of treatment.

Methods

In COMPASS patients, the predictive accuracy of CHA2DS2-VASc and CHADS2 scores were assessed for MACE, bleeding and net clinical benefit using Cox proportional hazards model. Kaplan-Meier estimates of cumulative risk and absolute risk differences were used to examine the effects of rivaroxaban plus aspirin compared with aspirin alone over 30 months according to risk score categories.

Results

In 27,395 participants with CAD and/or PAD, a high CHA2DS2-VASc score (6–9) was associated with 3 times greater absolute risk of MACE compared to a low score (1–2) (hazard ratio=3.39, 95% CI: 2.54–4.51, p<0.0001). The effects of combination therapy with rivaroxaban and aspirin on MACE, bleeding and net clinical benefit were consistent across CHA2DS2-VASc and CHADS2 score categories, with the greatest benefit in those with the highest risk scores (Figure 1). The greatest reduction in MACE with rivaroxaban and aspirin compared to aspirin only was observed in patients treated for 30 months with highest CHA2DS2-VASc score (6–9) (23 events per 1000 patients prevented) or highest CHADS2 score (3–6) (25 events per 1000 patients prevented). There was increased bleeding in patients with higher CHA2DS2-VASc and CHADS2 scores, but net clinical benefit was preserved across all risk categories and was greatest in those with the highest risk scores.

Conclusion

The CHA2DS2-VASc or CHADS2 scores can be used in patients with chronic CAD and/or PAD to identify patients who are at highest risk of MACE, and therefore likely to achieve the greatest benefit of dual pathway inhibition with the combination of rivaroxaban and aspirin compared with aspirin alone.

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): This study was sponsored by Bayer AG.
Cost-effectiveness of cardiovascular risk classification based on Ankle-Brachial Index test in association to Framingham risk score
Authors: Grasso E , Maloberti A , Cortesi P.A , Micale M , Mazzaglia G , Occhi L , Palazzini M , Peretti A , Cavasin D , Pansera F , De Chiara B , Vallerio P , Mantovani L.G , Giannattasio C
Published: November 2020

Objectives

An individual patient-data meta-analysis conducted on 24,955 men and 23,339 women showed that Ankle-Arm Index (ABI) in combination with FRS classifies female subjects with higher accuracy with no difference for male. The objective of this analysis is assessing the cost-effectiveness of ABI combine with FSR in primary prevention.

Methods

A decisional analytical model was developed to simulate CV risk of asymptomatic female subjects, stratified in 3 CV risk categories. The model compares the primary prevention intervention (treatment of subjects at intermediate and high risk) based on the classification with FRS alone or in association with ABI<0.9 (FRS-ABI). The cost-effectiveness model used 10 years time-horizon and the point of view of the Italian National Health System. Results were presented as incremental cost-effectiveness ratios (ICERs) per QALY gained. Cost and outcomes were discounted at 3%.

Results

FRS-ABI determined a reclassification to higher risks in 7% of the female population, with an increase in costs per patient (€3,373 vs €3,198) but also greater efficacy (8,683 vs 8,689 QALYs) over a 10 years time horizon, with an ICER of €47.065 per QALY gained. While using an ABI<1.10 cut-off we obtained an ICER of €28.688 per QALY gained over 10 years simulation. In the probabilistic sensitivity analysis, the FRS-ABI reported a 50% probability to be cost-effective with ABI<0.9 cut-off and 80% probability with ABI<1.1 at a willingness to pay threshold of €50,000 per QALY.

Conclusions

Our study showed that FRS and ABI combination is a potentially cost-effective CV risk classification approach in female population. Our results can help the healthcare decision makers in implementing better strategies for primary CV diseases prevention in Italy.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): ASST Niguarda Cà Granda Hospital, University of Milano-Bicocca, Milan, Italy
Multi-Ethnic Study of Atherosclerosis (MESA) score compared to the Pooled Cohort Equations (PCE) score for cardiovascular risk assessment
Authors: Shemesh J.S , Koren Morag K.M.N , Segev S.S , Grossman G.E
Published: November 2020

Introduction

The current categorization of cardiovascular (CV) disease based on the Pooled Cohort Equations Risk (PCE) broadened the scope of candidates eligible for statin therapy. Coronary artery calcium score (CCS) identifies those who are most likely to benefit from statin therapy for primary prevention. The Multi-Ethnic Study of Atherosclerosis (MESA) score is the first that includes CCS for CV risk calculation.

Aim

To find whether MESA score can better predicts CV events than the PCE score and better allocates asymptomatic subjects for statin treatment

Methods

632 consecutive subjects free of CV disease, mean age 56±7 years, 84% male, underwent clinical evaluation and CCS measuring. PCE and MESA risk scores were calculated for each subject. Patients were divided according to the 4 PCE categories of 10 years CV risk, and further analyzed according to a higher or lower risk groups than 7.5%, the cutoff above which statin is definitely indicated.

Results

During mean follow-up of 6.5±3.3 years, 54 subjects experienced a first CV event. Those with MESA risk score ≤7.5% had a favorable outcome even when the PCE indicated a risk of >7.5%. The MESA risk improves the discrimination, ROC curves C-statistics increased from 0.653 for the PCE risk to 0.770. 84% (99/118) of those with borderline risk (5 to ≤7.5%) according to the PCE score, were re-allocated by the MESA risk into an higher (>7.5%) or lower risk category (<5%).

Conclusion

The MESA risk score better predicts CV events than the PCE score in asymptomatic, and contributes to better allocate them to statin treatment.

Funding Acknowledgement

Type of funding source: None
Independent relevance of left ventricular hypertrophy for risk of ischaemic heart disease in 25,000 Chinese adults
Authors: Clarke R , Chaikovsky I , Wright N , Du H , Chen Y , Guo Y , Bian Z , Li L , Chen Z
Published: November 2020

Background

The prevalence of left ventricular hypertrophy (LVH) is strongly related with established cardiovascular disease (CVD) risk factors and, hence, there has been some uncertainty about its independent relevance for ischaemic heart disease (IHD) after taking account of such risk factors.

Purpose

To examine the associations of LVH with prevalent and incident cases of IHD after adjustment for established risk factors for CVD in a population-based study of Chinese adults.

Methods

The prospective China Kadoorie Biobank cohort study was conducted in the general population of 5 urban and 5 rural areas in China, with a baseline survey in 2004–2008. A random sample of 24,786 participants had a 12-lead electrocardiogram (ECG) recorded at the second resurvey in 2013–2014. Electronic records of ECG tracings were used to estimate LVH using 5 different criteria (Sokolov, Cornell, Romhilt-Estes, Gubner and Mortara). IHD cases were recorded by linkage to electronic records of hospitalisation, death and disease registries. Cox regression was used to estimate the associations of LVH with prevalent (n=1325) and incident (n=900) cases of IHD after adjustment for age, sex, region, prior vascular disease, smoking, alcohol, SBP, diabetes, lipids and body mass index (BMI).

Results

The overall prevalence of LVH in the population varied depending on the criteria used for detection (Mortara [10%], Sokolov [14%], Cornell [6%], Romhilt-Estes [4%] and Gubner [1%]). The prevalence of LVH (using Sokolov) increased with age and was higher in men than women (20% vs 10%) and linearly with levels of SBP, but also by ∼10-fold between the 10 regions in China. Irrespective of which criteria were used for detection (Table), LVH was strongly associated with both prevalent and incident cases of IHD after adjustment for age, sex, region and established CVD risk factors. Any one measure of LVH was associated with an adjusted OR (95% CI) of 1.30 (1.10, 1.53) for prevalent IHD and 1.40 (1.20, 1.64) for incident IHD, respectively.

Conclusions

Overall, 1 in 10 Chinese adults had LVH, and LVH was associated with 30% higher risk of prevalent IHD and 40% higher risk of IHD independent of established CVD risk factors.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): UK Wellcome Trust
SUPERNOVA phenomenon in unique population exposed to starvation in early life
Authors: Rotar O , Moguchaia E.V , Boiarinova M.A , Kolesova E.P , Erina A.M , Sontsev V.N , Vasilieva E.Y , Konradi A.O , Shlyakhto E.V
Published: November 2020

Background

Modern concept of supernormal vascular aging (SUPERNOVA) can be verified in subjects with exceptionally low arterial stiffness for their age. Among subjects who were exposed to severe famine in the prenatal and early childhood period of life during Leningrad Siege 1941–1944 those who survived now reached advanced age of 75 years or more. As caliris restriction can be associated with slowing of arterial stiffening this group can be expected to have subject with SUPERNOVA phenomenon.

Purpose

The aim of the study was to assess predictors of SUPERNOVA phenomena in survivors of the Leningrad Siege according to different gender.

Design and methods

The arterial stiffness was assessed by SphygmoCor device (carotid-femoral pulse wave velocity (PWV)) in 232 survivors of Leningrad Siege in 2014. Blood pressure (BP) measurement and anthropometry (weight, height, waist circumference) were performed according to standard protocols. Fasting serum lipids and plasma glucose were measured by Hitachi-902. According to The Reference Values for Arterial Stiffness' Collaboration (2010) for Siege survivors group (over 70 years old) the median value (10–90 percentile) of the PWV is 8.0–14.6 m/s. SUPERNOVA phenomenon was determined in case of PWV ≤8.0 m/s. 35 (11,3%) participants had SUPERNOVA phenomenon: 9 males and 26 women, non-SUPERNOVA group of 50 males and 147 females was a control group.

Results

Comparative gender analysis revealed common and distinct predictors of SUPERNOVA presence.

Conclusions

Independently of gender SUPERNOVA phenomenon was observed in subjects with lower BP. In females normal triglycerides levels were associated with low arterial stiffness while in male gender lack of abdominal obesity was also important.

Funding Acknowledgement

Type of funding source: None
Strict compliance with ESC therapeutic guidelines after myocardial infarction treated with invasive strategy correlates with improved 18-month outcomes
Authors: Kasprzak J.D , Jankowski E , Peruga J.Z , Plewka M , Krecki R , Wcislo T , Fiutowski M , Jankowski E , Hudzik B , Gasior M , Gierlotka M
Published: November 2020

Background

Despite improved early outcomes in patients (pts) with acute myocardial infarction (MI) in Poland with prevalent strategy of primary angioplasty by radial access, mid- and long-term outcomes are unsatisfactory.

Objective

We hypothesized that strict implementation of secondary prevention ESC guidelines in post-infarction management may be related with improved mid-term clinical outcomes

Methods

We compared 18-month outcomes of pts treated for MI with primary invasive strategy in a tertiary university hospital (NSTEMI 470/47%, or STEMI 535/53%; N=1005; Gr-L) with similar subset from national databases AMI-PL and PL-ACS (N=117307; NSTEMI 50966/43%, STEMI 64078/57%; Gr-Pol). Females represented 38.5% / 35.7% of Gr-L/Gr-Pol and mean age was 66.1±11.5 vs 65.8±11.9% (NS). The center implemented a strict policy of optimization prognosis-modifying prescriptions at discharge according to ESC guidelines. Endpoints over 18-month follow-up were defined as total mortality and combined clinical endpoint (death, stroke, recurrent MI, recurrent revascularization).

Results

30-days survival was comparable between Gr-L and national cohort. Key medicationrates were significantly higher for Gr-L vs most recent national estimates: renin-angiotensin blockers: 94% vs 79%, statins: 98% vs 75%, beta-blockers 95% vs 85%; ASA: 99% vs 94.5%, P2Y12 inhibitors 100% vs 83%. Rehabilitation was completed in 32% and 51% (after NSTEMI/STEMI) with national average around 20% - all differences p<0.05. Long-term mortality rate (overall 10.6% vs 14.5%, p=0.0005) and composite outcome rate was significantly improved in Gr-L – details shown in the table.

Conclusions

Outcomes of MI patients in primary PCI era are related to optimized medical therapy and rehabilitation planned at discharge. Our study does not prove causality but indicates on strong association of strict compliance with ESC guidelines and improved 18-month outcomes including overall survival.

Funding Acknowledgement

Type of funding source: None
Limited reproducibility of lipoprotein (A) determination in a general clinical setting: a large retrospective study
Authors: Morra S , Vivier R , Vanhaeverbeek M , Brognez M , Van De Borne P
Published: November 2020

Background

Lipoprotein (a) (Lp(a)) is an independent risk factor for cardiovascular disease. Because of the polymorphism of Apolipoproteine-A (Apo A), a component of LP(a) which is under tight genetic control, two main isoforms of Lp(a) exist and are responsible for a wide inter-individual variability. Despite Lp(a) levels are genetically determined, a single measurement during an entire life span may suffice for this purpose. However, this is not unequivocal, since several non genetic factors may be responsible for the natural variability of Lp(a) within individuals.

Aims

To characterize the reproducibility of Lp(a) levels; to determine the influence of several non genetic factors (inflammation, chronic kidney failure, chronic hepatic failure, dysthiroidism, hormonal status, Niacine treatment) on the natural Lp(a) variability within subjects.

Methods

Between 2004 and 2014, 15 815 Lp(a) measurements were performed by immunoturbidimetry in a reference center for 48 belgian laboratories in 11 982 subjects. 2049 individuals underwent 1 to 20 consecutive Lp(a) samplings. Reproducibility of the last Lp(a) measurement was compared to the previous one in term of time. The influence of non genetic factors on Lp(a) natural variability was studied on 300 patients randomly selected.

Results

Higher Lp(a) levels at the first measurement elicited additional Lp(a) determinations in subsequent measurements (p<0.0001). Lp(a) measurement became less reproducible when exceeding ± 35 mg/dL. There is a strong association between two consecutive Lp(a) measurements (r=0.85, p<0.0001). A significant but weak correlation has been found between Lp(a) and CRP levels (r=0.17, p=0.008) and the time intervals between two consecutive measurements (r=0.07, p<0.0001). No correlations have been found between Lp(a) levels and others non genetic factors said above. Niacine treatement and menopause with hormonal therapy replacement are responsible for a reduced median Lp(a) level (p=0.04, p=0.02, respectively).

Conclusion

Lp(a) levels are poorly reproducible when Lp(a) levels are elevated: the higher the Lp(a) levels at the first measurement, the higher the variability between consecutive measurements. Non genetic factors such as inflammation, hormonal status, timing of sampling seem to influence the Lp(a) levels but a causal link cannot be stated.

Funding Acknowledgement

Type of funding source: Public grant(s) – EU funding. Main funding source(s): Fonds Erasme, FNRS_Fonds National pour la Recherche Scientifique
Effectiveness of more strict managements after achievement of standard target value of low-density lipoprotein cholesterol in secondary prevention of Japanese patients
Authors: Endo A , Kagawa Y , Sato H , Morita Y , Kawahara H , Yasuda Y , Ouchi T , Watanabe N , Yamaguchi K , Yoshitomi H , Tanabe K
Published: November 2020

Background

In secondary prevention of coronary artery disease, target value of low-density lipoprotein cholesterol (LDL-C) <100 mg/dL is recommended as standard management in Japanese guideline. The guideline also stated that strict management of LDL-C targeting <70 mg/dL is considered in some high risk patients. However, in Japanese patients, effectiveness of more strict management of LDL-C lowering therapy for prevention of long-term cardiovascular events remains unclear.

Purpose

The purpose of the present study was to evaluate whether the strict management of LDL-C targeting <70 mg/dL was effective to prevent recurrence of long-term coronary events than standard management in patients with previous percutaneous coronary intervention (PCI).

Methods

We investigated 344 patients with previous PCI who underwent late coronary angiography to examine recurrence of cardiac ischemia beyond the early phase of restenosis from January 2007 to August 2019. Patients were stratified into three groups according to achieved LDL-C value; LDL-C <70mg/dL (n=53), 70 to <100mg/dL (n=130) and ≥100mg/dL (n=161). Endpoints of this study were recurrence of cardiac ischemia presenting as acute coronary syndrome (recurrence-ACS) and any late coronary revascularization.

Results

During average 7.1 years follow-up, 200 patients (58%) underwent any late coronary revascularization. In 94 of those patients, recurrence-ACS was observed. The incidence of recurrence-ACS was significantly lower in patients with achieved LDL-C <70mg/dL than in those with LDL-C 70 to <100mg/dL and LDL-C ≥100mg/dL (p=0.009 and p=0.001, respectively), however, there was no difference between patients with LDL-C 70 to <100mg/dL and LDL-C ≥100mg/dL (p=0.140). Any late revascularization was significantly lower in patients with achieved LDL-C <70mg/dL and in those with LDL-C 70 to <100mg/dL than in those with LDL-C ≥100mg/dL (p=0.002 and p<0.001, respectively), however, no difference was found between patients with LDL-C <70mg/dL and LDL-C 70 to <100mg/dL (p=0.119). Moreover, in patients with achieved LDL-C <100mg/dL (n=183), multivariate analysis identified that LDL-C (HR 1.035, p=0.007) and HbA1c (HR 1.338, p=0.001) were independent predictors of recurrence-ACS. In contrast, only using statins (HR 0.461, p=0.009) was an independent predictor of recurrence-ACS in patients with achieved LDL-C ≥100mg/dL.

Conclusions

LDL-C was the important residual risk of recurrence-ACS even after recommended standard LDL-C lowering management had been achieved. More strict management of LDL-C targeting to <70mg/dL should be considered to prevent recurrence-ACS for wider range of Japanese patients in secondary prevention.

Incidence of late coronary events

Funding Acknowledgement

Type of funding source: None
Gender differences in the effects of weight reduction on future blood pressure elevation in the overweight middle-aged population
Authors: Kawasoe S , Kubozono T , Ojima S , Kawabata T , Miyahara H , Tokushige K , Ohishi M
Published: November 2020

Background

The effectiveness of weight loss (WL) to prevent blood pressure (BP) elevation is common knowledge; however, the effect of gender differences on this efficacy is not known. We aimed to investigate whether there were gender differences in the degree of BP increase and the prevalence of hypertension in the future when middle-aged obese participants achieved slight WL.

Methods

We analyzed the annual health checkup data for the general Japanese population collected from January 2001 through December 2015. Middle-aged participants (40–49 years old) with overweight (body mass index [BMI], 25.0–29.9 kg/m2) who had examination data for two follow-up time-points (after 3 and 10 years) were included. The participants with a BMI decrease ≥1.0 kg/m2 in 3 years (WL group) were propensity score (PS)-matched to those with a BMI decrease <1.0 kg/m2 or weight gain (non-WL group) based on the data of the first examination, including age, BMI, smoking and drinking status, eGFR, systolic BP and diastolic BP, and hypertension (defined as SBP ≥140 mmHg and/or DBP ≥90 mmHg). We compared the BMI, systolic BP, and hypertension prevalence after 10 years in both groups.

Results

There were 17,554 individuals, aged 40–49 years, with overweight. After excluding subjects who did not satisfy the inclusion criteria and PS matching, we identified 232 men and 160 women in both WL and non-WL groups. The BMI in the WL group after 3 years was significantly lower than that in the non-WL group (men, 25.2±1.4 kg/m2 vs. 27.1±1.6 kg/m2, P<0.001; women, 24.9±1.4 kg/m2 vs. 27.1±1.5 kg/m2, P<0.001), and the significance persisted even after 10 years among both men and women (men, 25.5±1.8 kg/m2 vs. 26.8±2.1 kg/m2, P<0.001; women, 25.3±2.0 kg/m2 vs. 26.8±2.2 kg/m2, P<0.001). Among women, the systolic BP and hypertension prevalence after 10 years were significantly lower in the WL group than in the non-WL group (systolic BP, 124.8±16.3 mmHg vs. 130.3±19.0 mmHg, P<0.01; hypertension prevalence, 35.0% vs. 48.1%, P<0.05). In contrast, there were no significant differences in the SBP and hypertension prevalence after 10 years among men between the groups (systolic BP, 129.0±17.7 mmHg vs. 129.0±17.5 mmHg, P=0.96; hypertension prevalence, 46.1% vs. 48.7%, P=0.57).

Conclusions

There were gender differences in the effectiveness of WL to prevent future BP elevation in overweight middle-aged participants. WL could prevent future BP elevation and the hypertension onset in women but not in men.

Funding Acknowledgement

Type of funding source: None
RV function in obesity: before and after laparoscopic gastric sleeve
Authors: Iancu M , Badea G , Craciunescu I , Vasile S , Popa O , Alecu L , Tulin A
Published: November 2020

Left ventricular (LV) changes associated with obesity, including LV hypertrophy and impaired LV function, have been shown to be reverted by bariatric surgery. Little is known about the effect of bariatric procedures on right ventricle (RV) function.

Aim

We analyzed RV functional changes, as assessed by echocardiography, after laparoscopic gastric sleeve (LGS) bariatric surgery.

Methods

22 consecutive obese subjects with good acoustic windows (mean age 40.2±6.7 years, 41% men, mean body mass index (BMI) 43.5±6 kg/m2) scheduled for LGS were prospectively studied before and 12 months after surgery.

RV function was assessed by RV Fractional Area Change (FAC), TDI RV free wall S wave (RV S) and free wall RV longitudinal strain (LS) and strain rate (L-SR), calculated by 3D speckle tracking echocardiography (STE). The estimated systolic pulmonary artery pressure (sPAP) was evaluated by tricuspid regurgitation velocity.

Results

Preoperative and postoperative obesity measures, as well as RV function measures significantly improved 12 months postoperatively versus baseline (all p<0.05 vs baseline): BMI decreased from 43.5±2.8 to 30.3±2.9 kg/m2, abdominal circumference from 124.8±4.7 to 98.4±5 cm, RV S changed from 12.8±1.1 to 13.4±1.3 cm/s, FAC from 44.2±3.8 to 52.8±2.8%, 3D LS from 15±1.3% to 17.8±2.2% and 3D L-SR from −1.1±1.4 to −2±0.9 s–1.

Patients had similar sPAP before and after surgery.

Conclusion

By successful weight loss, 12 months after LGS, subclinical RV function parameters improved, in association with favorable metabolic changes. These findings may contribute to the cardioprotective effects of bariatric surgery.

Funding Acknowledgement

Type of funding source: None
Cornell voltage left ventricular hypertrophy predicts all-cause mortality better than Sokolow-Lyon voltage in patients with and without diabetes – data from 183,749 primary care ECGs
Authors: Haxha S , Pedersen-Bjergaard U , Nielsen J.B , Pallisgaard J , Devereux R.B , Okin P.M , Gislason G.H , Torp-Pedersen C , Bang C.N
Published: November 2020

Background

Cornell voltage criteria (CL) and Sokolow-Lyon criteria (SL) for electrocardiographic left ventricular hypertrophy (ECG-LVH) are well known predictors of cardiovascular outcome. However, their predictive value may differ according to patient type and remains to be further tested in diabetic mellitus (DM) patients.

Purpose

The present study aims to determine the prevalence of each ECG-LVH criteria and their respective predictive value in DM patients.

Method

A retrospective cohort study of individuals age >40 years with digital ECGs from primary care were collected during 2001 to 2011. Data on medication, comorbidity, and outcomes were collected from Danish nationwide registries. DM was defined if individuals were prescribed oral antidiabetics or insulin, if they were diagnosed with DM type I or II, or had a HbA1c>48 mmol/l. Cox multivariable analysis was used for estimating hazard ratio (HR) and 95% confidence intervals (95% CI) for all-cause mortality during follow-up of up to 17 years.

Results

Included were 183,749 individuals with a digital ECG collected in primary care. A total of 13,003 (7.1%) individuals had DM, they were older (65.8 vs. 61.3 years), had more myocardial infarction (16.1% vs. 5.2%), stroke (14.4% vs. 6.2%), hypertension (35.1% vs. 13.2%), CL LVH (8.0% vs. 5.6%) and more were males (53.3% vs. 45.3%) compared to the non-DM individuals (all p<0.001). CL identified a larger percentage of LVH in DM compared to non-DM individuals (8.0% vs. 5.6%, p<0.001), whereas SL identified similar percentage LVH in DM and non-DM individuals (8.5% vs. 8.1%, p=0.068). In multivariable adjusted analysis CL LVH remained strongly associated with all-cause mortality [HR 1.45 (95% CI: 1.42–1.48)] compared to SL LVH which found only a modest association [HR 1.06 (95% CI: 1.03–1.10)] (Figure 1). Of note, the association of CL LVH and all-cause mortality was even stronger than DM per se. There was no interaction with DM and either ECG LVH criteria (p>0.45).

Conclusion

Cornell Voltage Left Ventricular Hypertrophy is a strong predictor of mortality in patients with and without diabetes and an independent risk factor compared to hypertension and diabetes. The predictive value was substantially stronger than Sokolow-Lyon Voltage criteria for hypertrophy.

Figure 1. LVH and all-cause mortality

Funding Acknowledgement

Type of funding source: None
The inverse association between lipoprotein(a) levels and metabolic syndorome and its components on coronary artery disease patients
Authors: Kasahara T , Endoh S , Ohtahara A , Kawatani S , Amisaki R , Mizuta E , Adachi M , Osaki S
Published: November 2020

Purpose

Neele DM (Diabetologia 1999) showed that insulin suppressed apolipoprotein(a) synthesis by primary cultures of cynomolgus monkey hepatocytes. Therefore, there is a possibility that inverse association exists between lipoprotein(a) [Lp(a)] and metabolic syndorome (Mets) with insulin resistance/hyperinsulinemia for coronary atherosclerosis. Sung KC (Nutr Metab Cardiovasc Dis 2013) described the inverse association between Lp(a) levels and Mets and its components on an asian occupational cohort. And high levels of Lp(a) were associated with preclinical atherosclerosis, as evaluated by coronary calcium score with cardiac computed tomography. There is no similar examination on coronary artery disease (CAD) patients. The purpose is to examine similar considerations on CAD patients.

Method

610 subjects with angiographically demonstrated CAD were enrolled. The patients who receiving medication for dyslipidemia and Insulin administration were excluded. The blood samples for laboratory tests were collected after an over night fast. Subjects were divided into four groups according to quartiles of Lp(a) levels (mg/dL). Ranges of quartile groups of Lp(a) were Q1: <9.0, Q2: 9.0–<16.0, Q3: 16.0–<30.0, Q4: ≥30.0.

Results

The inverse association Lp(a) levels and Mets and its component. The comparison of Q1 (bottom quartile) versus Q4 (top quartile) was shown below; the comorbidity rate of Mets 19.5% versus 8.0% (p<0.01), BMI (kg/m2) 23.5 versus 22.7 (p<0.05), trigyceride (mg/dL) 144.0 versus 107.5 (p<0.0001), HDL cholesterol (mg/dL) 46.8 versus 50.7 (p<0.05), the comorbidity rate of hypertension 60.4% versus 50.7% (p=0.084), glucose (mg/dL) 107.1 versus 100.6 (p<0.05), insulin (μU/mL) 8.49 versus 5.85 (p<0.0001), HOMA-R 2.26 versus 1.44 (p<0.0001). The mean number of diseased coronary vessel was higher in the Q4 group (2.07) than in the Q1 group (1.87) (p<0.05).

Conclusion

There was the inverse association between Lp(a) levels and Mets and its components on CAD patients. The robust association was found between Lp(a) levels and severity of coronary atherosclerosis despite this inverse correlation.

Funding Acknowledgement

Type of funding source: None
Metabolic syndrome and mortality prediction in the seven countries' study: single or multifactorial
Authors: Parapid B , Danchin N , Bande M , Simic D.V , Kircanski B , Blackburn H , Jacobs D , Menotti A , Adachi H , Kromhout D , Nissinen A , Moschandreas J , Nedeljkovic-Arsenovic O.M.S , Ostojic M.C , Kanjuh V
Published: November 2020

Introduction

The metabolic syndrome (Met Sy) is a known cluster of risk factors (HTA, HLP, DM, BMI) that promotes overall vascular disease, however its real impact on overall, ischemic heart disease (IHD) and cerebrovascular disease (CVD) mortality remains debated.

Material and methods

The Seven Countries Study encompassed 12,763 participants who were healthy men over 40y at baseline and who underwent regular check ups every 5 years throughout over a 4 decades' span. Morbidity and mortality was adjudicated according to valid ICD and LPH coding.

Results

Using the IDF definition of the Metabolic Syndrome, 9,09% of participants were identified. In a multivariate analysis predictors for overall Mt were hypertension (p<0.0001) and BMI (p<0.029), while HLP had a weak prediction value (p=0.083), where as MetSy and DM had not at all. Hypertension (p<0.0001) remained a strong predictor for IHD mortality together with HLP (p<0.0001), while diabetes was of weak predictive value (p=0.065), whereas MetSy failed to. Although HTA was a strong predictor for CVD mortality, so did MetSy (p<0.050), while DM and HLP haven't while BMI had a low impact (p=0.070).

Conclusion

Metabolic syndrome's role in atherosclerotic burden remains important, however whether its power is due to its respective components or their interactions remains to be an issue. The described results belong to an era where both IHD and CVD were considered a “male disease” women were spared of, so, further validation in the described cohorts is needed in an offspring fashion, however hypertension remains the driving force of both overall mortality as well as specific IHD and CVD ones, also previously demonstrated in the very same cohort to be more important in the setting of maternal family history of hypertension, than paternal one.

MetSy in the SCS

Funding Acknowledgement

Type of funding source: None