bluuebunny/crossref_metadata_2025 huggingface dataset:
The comparison of clinical features and clinical outcomes in stroke patients with atrial fibrillation and non-atrial fibrillation: a hospital-based stroke registry in Indonesia
Authors: Karunawan N H , Pinzon R T , Siswanto B B
Published: October 2021

Background

Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia associated with stroke. Based on the National Health Survey (Riskesdas) the prevalence of stroke in Indonesia increased from 7% in 2013 to 10.9% in 2018. Understanding the clinical features and clinical outcomes differences between AF and non-AF in stroke can help the clinician for further management.

Purpose

To compare the clinical features and clinical outcomes of stroke patients with AF and non-AF by using the data from the Bethesda Stroke Registry in Indonesia.

Methods

This cross-sectional study was based on a stroke registry, data were collected using the electronic medical record in our hospital. All patients ≥18 years of age, who developed stroke between January 1, 2011, and December 31, 2018, were included in this study. Data about clinical features and clinical outcomes were collected. The clinical outcomes included mortality, prolonged hospitalization (LOS >6 days), and disability was evaluated using the modified Rankin scale (MRS). The statistical measures calculated were Chi-square-test and Fischer's exact test.

Results

Data of the total 8447 patients enrolled in the registry, data of 8248 patients who fulfilled inclusion criteria were analyzed, and AF was seen in 226 (2.7%) stroke patents. Comparing with non-AF patients, AF patients were older (47.8% vs 26.0%), higher proportion on of women (48.2% vs39.9%), higher prevalence of ischemic heart disease (16.4% vs 4.7%), loss of consciousness (37.6% vs 23.2%), aphasia (29.6% vs 13.6%) mortality (20.8% vs 10.6%), prolonged hospitalizaton (10.24 [1–80] vs 7.18 [1–73]), worse disability (67.3% vs 43.2%), p<0.05. Comparing with AF patients, non-AF patients had a significantly higher prevalence of hypertension (52.9% vs 40.3%) and diabetes mellitus (33.5% vs 32.7%), p<0.05. Stroke patients with AF was significantly associated with higher in-hospital mortality (RR: 1.19, 95% CI: 1.05–1.35, p<0.001), worse disability (RR: 1.16, 95% CI: 1.11–1.22, p<0.001), and prolonged hospital stay RR: 1.39, 95% CI: 1.22–1.59, p<0.001) than in stroke patents with non-AF.

Conclusions

AF in stroke affected the poor outcomes by contributing to higher in-hospital mortality, prolonged hospitalization, and worse disability. Older age, Women and IHD were more strongly associated with Stroke n AF than non AF

Funding Acknowledgement

Type of funding sources: None.
Prediction of the functional significance of the left main stenosis using frequency domain optical coherence tomography
Authors: Vlad D , Bouki P , Nakas A , Diamantakis E , Kotsakis A , Baroutsi K , Toutouzas K
Published: October 2021

Background

Frequency domain optical coherence tomography (FD-OCT) has been used for the assessment of non-ostial left main coronary artery stenosis (LM). However, no study has evaluated the use of this imaging technique for the prediction of functional significance of LM lesions determined by the fractional flow reserve (FFR).

Purpose

The aim of this study was to assess the safety and diagnostic efficacy of FD-OCT in identifying functional severity of the LM stenosis determined by (FFR).

Methods

One hundred one patients with LM lesion (20–70% diameter stenosis angiographically) underwent FFR measurement and FD-OCT imaging of the LM. The following parameters were measured by FD-OCT in the LM: reference lumen area (RLA), reference lumen diameter (RLD), minimum lumen area (MLA), minimum lumen diameter (MLD), % lumen area stenosis, % diameter stenosis.

Results

The LM lesions were visible and measurable by FD-OCT in 88/101 (87.1%) patients. However lesions with ostial location were analyzable by FD-OCT only in 17/30 (56.4%) patients (Figure 1). FFR at maximum hyperemia was ≤0.80 in 39/88 (44.3%) patients. FFR values were correlated significantly with FD-OCT derived LM lumen parameters. Receiver operating characteristic curves showed that an MLA cutoff value of 5,38 mm2 had the highest sensitivity and specificity of 82% and 81% respectively (Figure 2A), followed by an MLD of 2.43 mm (sensitivity 77%, specificity 72%) (Figure 2B) and an %AS of 60% (sensitivity 72%, specificity 72%) (Figure 2C) for predicting FFR ≤0.80.

Conclusions

FD-OCT is safe and feasible imaging technique for the assessment of a LM stenosis except the ostial LM lesions which are analyzable in half of the cases. An FD-OCT derived MLA of ≤5.38 mm2 strongly predicts the functional severity of a LM lesion.

Funding Acknowledgement

Type of funding sources: None. Angiography and OCT image of LM stenosisROC curves of MLA, MLD and AS
Extracardiac coronary steal induced by upper limb hyperemia: a feature of internal mammary artery arteriogenesis
Authors: Bigler M R , Buffle E , Stoller M , Grossenbacher R , Tschannen C , Seiler C
Published: October 2021

Introduction

Function of naturally existing internal mammary artery (IMA)-to-coronary artery anastomoses has been shown by augmented blood supply to the coronary collateral circulation in response to IMA occlusion. Theoretically, this functional connection is invertible and can cause coronary steal, the verification of whose hypothesis would provide alternate proof to the mentioned functional evidence.

Method

This was a prospective observational study including 40 patients with chronic coronary syndrome and IMA occlusion, and 40 propensity score matched controls (placebo group) without IMA occlusion. Primary study endpoint was the inter-group difference in coronary collateral function (i.e., collateral flow index, CFI) as obtained at 30, 45 and 60 seconds following a proximal coronary artery balloon occlusion. CFI is the ratio between simultaneous mean coronary occlusive pressure divided by mean aortic pressure both subtracted by central venous pressure. To provoke a steal phenomenon, upper limb hyperemia was induced by upper arm blood pressure cuff deflation following a 5-minute supra-systolic inflation ipsilateral to the sensor-wired coronary artery with release immediately after the first CFI measurement.

Results

Between the first and the second CFI-measurement, CFI change (i.e., CFI@45s minus CFI@30s) was absent in the verum group while there was CFI recruitment in the placebo group: 0.000±0.023 and +0.009±0.013, respectively; p=0.032.

Conclusion

Among patients with artificial IMA occlusion, induction of ipsilateral upper limb hyperemia provokes extracardiac coronary steal as expressed by temporarily absent collateral recruitment as it normally takes place without upper limb hyperemia.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Swiss National Sciences Foundation
Comparison of cardiovascular outcomes of moderate to severely calcific de novo coronary lesion preparation for stent implantation using rotational atherectomy in conjunction with cutting balloon versu
Authors: Gedela M G , Giustino G G , Kyaw H K , Johal G J , Hooda A H , Sartori S S , Qiu H Q , Mehran R M , Kini A K , Sharma S S
Published: October 2021

Background

Previous studies showed the combined rotational atherectomy (RA) and cutting balloon angioplasty (CBA) strategy was associated with favourable cardiovascular outcomes compared to RA and plain balloon angioplasty (PBA) for adequate lesion preparation before stent implantation in moderate to severely calcified coronary lesions. However, these studies were limited by small sample size.

Purpose

To assess clinical outcomes in a large group of patients with moderate to severely calcified de novo severe coronary artery stenoses using RA followed by CBA (RA+CBA) compared to RA followed by PBA (RA+PBA) before 2.5–3.5 mm diameter stent implantation.

Methods

We conducted a retrospective analysis of 1852 patients with moderate to severely calcified de novo severe coronary artery stenosis who underwent RA+CBA (n=372) or RA+PBA (n=1480) before 2.5–3.5 mm stent implantation. Death, myocardial infarction (MI), target vessel revascularization (TVR), stent thrombosis (ST), and major adverse cardiovascular events (MACE) were calculated at 1-year. Standard multivariable covariate adjusted hazard ratios (HR) were performed.

Results

At 1-year follow-up, the unadjusted MACE [HR: 1.58 (1.14–2.21); p=0.007] was significant in RA+CBA group compared to RA+PBA group, even after adjusted for multiple variables [HR: 1.61 (1.11–2.35); p=0.013] (Figure 1A). This was mainly driven by TVR [Unadjusted HR: 1.76 (1.16–2.68); p=0.008 and adjusted HR: 1.64 (1.01–2.67); p=0.045] (Figure 1B). However, other adjusted outcomes including death [HR: 1.25 (0.63–2.50); p=0.521], MI [HR: 1.71 (0.77–3.77); p=0.188], and ST [HR: 2.11 (0.64–6.95); p=0.221] were not significant between both groups. There was no significant difference in complications including coronary artery dissection, side branch closure, coronary perforation, slow flow/no flow, abrupt vessel closure, post procedure MI, blood transfusion or bleeding in between the two groups.

Conclusion

In moderate to severely calcific de novo severe coronary artery stenosis lesion preparation before 2.5–3.5 mm stent implantation, RA+CBA strategy is associated with a higher risk of major adverse cardiovascular events compared to RA+PBA strategy at 1-year follow-up.

Funding Acknowledgement

Type of funding sources: None. Figure 1
Usefulness of pulmonary vein flow as a predictor of long-term mortality after MitraClip implantation
Authors: Salinas Gallegos A , Pozo Osinalde E , Gordillo X , Jimenez Quevedo P , Mahia P , Marcos-Alberca P , Tirado G , Perez De Isla L , Macaya C , Perez-Villacastin J , Fernandez-Ortiz A , Nombela-Franco L , De Agustin J A
Published: October 2021

Background

Severe mitral regurgitation (MR) is a common valvular heart disease that has an unfavorable prognosis. Percutaneous mitral valve (MV) repair has become an effective therapeutic alternative to MV surgery in high-risk surgical patients with moderate to severe MR. Pulsed Doppler evaluation of pulmonary venous (PV) flow is widely used to aid in the assessment of grading the severity of MR and it has been recently investigated in patients who underwent MitraClip placement.

Purpose

The purpose of this study is to evaluate the usefulness of pulmonary vein flow as a predictor of long-term mortality after MitraClip implantation.

Methods

This is a single-center, retrospective study in which, between 2010 and 2020, we enrolled 88 consecutive patients who underwent percutaneous MV repair with the MitraClip system, afferent to our tertiary university hospital, eligibility evaluation by TEE. All patients had moderate to severe (3+) or severe (4+) primary or secondary MR. We excluded patients with re-do MitraClip procedure (n=1), no medical record (n=2), no or insufficient PV flow record (n=20). We analyzed the MR and PV flow parameters, such as systolic/diastolic velocity time integral (VTIs/VTId) and maximum velocity (VmaxS/VmaxD) ratios,before and immediately after the procedure.

Results

65 patients (35% women) with a median age of 76.2 ± years (10.4 years). Average follow-up 13 months (1–28). In survivors the ratio of VTIs/VTId post was higher than in the deceased (1.14±0.60 vs 0.56±0.21; p=0.039). Same results were found considering post-procedure VmaxS/VmaxD ratio, with greater values among the survivors compared with patients who died during the follow up (1.17±0.44 vs 0.65±0.09; p<0.001). The ROC curve of the post procedure VTIs/VTId ratio to predict mortality had an area under the curve of 0.82, while for the post VmaxS/VmaxD ratio it was 0.94.

Conclusion

VTIs/VTId and the VmaxS/VmaxD ratio in PV flow after the procedure appeared as potential parameters to predict long-term mortality in patients who receive MitraClip implants

Funding Acknowledgement

Type of funding sources: None. Figure 1. ROC curve VTIs/VTId ratio for survival.Figure 2. ROC curve VmaxS/VmaxD ratio for survival.
CHA2DS2-VASc below 3 predicts low one-year ischemic stroke risk in postoperative atrial fibrillation after CABG
Authors: Taha A , Nielsen S , Franzen S , Rezk M , Ahlsson A , Friberg L , Bjorck S , Jeppsson A , Bergfeldt L
Published: October 2021

Background

Ischemic stroke prevention is a major goal in patients with atrial fibrillation (AF). Neither the optimal risk assessment method, nor the risk-benefit-ratio of long-term use of oral anticoagulation (OAC) is, however, known in patients with new-onset AF (POAF) after cardiac surgery.

Purpose

To explore the feasibility of using the CHA2DS2-VASc scoring system in predicting the one-year ischemic stroke risk in patients with POAF after coronary artery bypass grafting (CABG).

Methods

All patients in Sweden with POAF after isolated CABG 2007–2017, with at least one year of follow-up, and without oral anticoagulation (OAC), were included in this observational, registry-based cohort study. POAF was defined as any new-onset AF during the index hospitalization for CABG. Primary endpoint was the one-year ischemic stroke risk at each step of the CHA2DS2-VASc score in POAF patients with at least one-year follow-up.

Results

Out of 6368 POAF patients without OAC neither at hospital discharge nor before the occurrence of events, 4467 (70.1%) had at least one year follow-up with altogether 124 ischemic strokes within one year from discharge. The one-year risk for ischemic stroke was <1% for a CHA2DS2-VASc score <3, 1–2% for a CHA2DS2-VASc score 3, and >2% for a CHA2DS2-VASc score ≥4. The area under the receiver-operating-characteristic curve for predicting ischemic stroke was 0.67 (95% CI 0.64–0-69).

Conclusions

The CHA2DS2-VASc score was suitable for predicting low risk for ischemic stroke during the first year after hospital discharge in patients with POAF after CABG. A risk <1% considered low was, however, observed at a considerably higher score than in patients with non-surgical/non-valvular AF described in previous studies.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish Heart-Lung Foundation (grant 20150587 and 20180560 to Anders Jeppsson)Region Västra Götaland (grant VGFOUREG-847811 to Anders Jeppsson and grant VGFOUREG-648981 to Amar Taha) Event rates during one year
Insulin resistance-related differences in the relationship between left ventricular hypertrophy and cardiorespiratory fitness in asymptomatic newly diagnosed hypertensive Black sub-Saharan Africans
Authors: Kianu Phanzu B , Nkodila Natuhoyila A , Kokusa Zamani R , Limbole Baliko E , Kintoki Vita E , Longo-Mbenza B , Mbuyamba Kabangu J R , Masolo Muze B
Published: October 2021

Background

Left ventricular hypertrophy (LVH) is associated with impaired cardiorespiratory fitness (CRF), a surrogate marker of poor outcome. Insulin resistance (IR) plays a central role in all stages of cardiovascular disease continuum.

Purpose

This study evaluates IR-related differences in the relationship between left ventricular mass (LVM) and CRF in asymptomatic newly diagnosed hypertensive patients.

Methods

In this cross-sectional observational study, 126 asymptomatic newly diagnosed hypertensive participants (50.5±9.5 years) underwent comprehensive resting transthoracic echocardiographic examination and maximal incremental cardiopulmonary exercise test (CPET). CRF was estimated in peak oxygen uptake (VO2 peak). CPET results were compared between participants with and without LVH. Multivariate analysis examined the influence of IR on the observed differences.

Results

Those with LVH had lower VO2 peak (15.7±5.5 mL min–1 kg–1 vs. 18.4±3.7 mL min–1 kg–1; p=0.001) than those without LVH. In patients with IR, LVM (r=−0.261, p=0.012), LVM indexed to body surface area (LVMIbsa; r=−0.229, p=0.027), and LVM indexed to height to an allometric power of 2.7 (LVMIh2.7; r=−0.351, p=0.001), and VO2 peak were negatively correlated. In hypertensive patients without IR, these same parameters and VO2 peak have no significant correlation. Body mass index (BMI), LVM, and LVMIbsa emerged as independent determinants of VO2 peak, explaining 46.9% of its variability (overall p=0.001) in IR participants, a relationship not found in participants without IR.

Conclusions

IR may participate in the deterioration of CRF associated with LVH. Targeting IR in hypertensive patients with LVH could improve prognosis.

Funding Acknowledgement

Type of funding sources: None.
A new invasive method to assess pulse wave velocity during cardiac catheterization
Authors: Scalia A , Ghafari C , Carlier S G
Published: October 2021

Pulse wave velocity (PWV) is an independent cardiovascular risk factor (CVRF), and there are multiple ways to measure it with more or less accuracy.

We sought to easily develop an invasive gold standard axial PWV during cardiac catheterization between ascending aorta (AAo) and tibial artery (TIB) or humeral artery (HUM). Aorto-humeral PWV is not a usual measurement site because of its difficulty to estimate it non-invasively. Axial PWV demonstrates a greater correlation with CVRF, with carotid-femoral PWV the common way to estimate it non-invasively in hypertensive patients and others.

Methods

26 patients were enrolled for AAo-TIB PWV measurements and 50 for AAo-HUM. A cuff connected to the hemodynamic Phillips workstation of the cathlab was placed around the right leg, at mid-calf, and was inflated to superimpose TIB pulsatile blood pressure waves on AAo blood pressure recorded with a fluid filled diagnostic 5 Fr or interventional 6 Fr catheter left at the end of the diagnostic coronary angiography in the ascending aorta. The distance between AAo and TIB was estimated by the distance between axillary and iliac crest, added with the distance between iliac crest and mid-calf. PWV was then calculated from the length estimated between AAo and mid-calf, and the time delay between AAo and TIB pulses (see figure) by gating to the R-wave of the ECG (upper trace) for both measurements, using a dedicated software written in MatLab®. For AAo=HUM PWV, in 50 patients the pressure of the catheter was sequencially recorded in the AoAsc then pulled back in the humeral artery. Both recordings were matched off-line based on the R top of the ECG recorded and the delay between the rise of the 2 pressure curves in the same MatLab® software.

Results

Mean age of our patients is 62,7±9,2 years. 82% had chronic hypertension and 33% had diabetes mellitus. 4 patients (15%) had clinical peripheral artery disease and only one had a stenting on femoral artery. No patients had previous vascular bypass.

Aorto-tibial PWV showed an average PWV at 8.4±1.4 m/s. Aorto-humeral PWV showed an average PWV at 7.2±1.8 m/s. The PWV tended to be 0,6 m/s lower in patients with ≤2 cardiovascular risk factors versus >3.

Conclusion

We describe a simple and accurate PWV gold standard that can be recorded in any patient admitted for a coronary angiography. Aorto-tibial PWV is easier to obtain. Adding this parameter in the global assessment of patients with hypertension or other CVD will refine their CVRF profile.

Funding Acknowledgement

Type of funding sources: None.
Proportion of patients taking indapamide developing severe hypokalaemia
Authors: Lin Z , Tang V , Tsoi M F , Cheung B M Y
Published: October 2021

Introduction

Diuretics are commonly used for the treatment of hypertension. Yet, hypokalaemia is a well-recognized adverse effect.

Purpose

To evaluate the proportion of patients taking indapamide who developed severe hypokalaemia, defined as requiring hospitalisation. Indapamide was by far the most commonly used diuretic for hypertension in Hong Kong.

Methods

We searched the Hong Kong Hospital Authority Clinical Data Analysis and Reporting System, which is a territory-wide database of computerised medical records. All hypertensive patients prescribed indapamide monotherapy in 2007–2016 and all admissions due to hypokalaemia in 2007–2018 were traced. Factors associated with hospitalisation were studied using multivariable logistic regression.

Results

During the study period, 62,881 patients were started on indapamide and 509 (0.81%) were hospitalised for hypokalaemia. 59% of these hospitalisations occurred within 16 weeks. Female sex (OR = 1.73; 95% CI, 1.43–2.09) and immediate-release formulation (OR = 1.44; 95% CI, 1.16–1.78) were associated with hospitalisation. In the multivariable model, advanced age was not a significant predictor. There were no deaths during hospitalisation and the median length of hospital stay was one day.

Conclusions

In this large population-based study with 147614 person-years of follow-up, severe hypokalaemia requiring hospitalisation was uncommon among hypertensive patients on indapamide. Half of these occurred during the first 16 weeks. Female sex and the immediate release formulation increased the risk. We conclude that using indapamide to treat hypertension is safe, even in the elderly, especially if the sustained release formulation is used and electrolytes are monitored periodically.

Funding Acknowledgement

Type of funding sources: None.
Association between body mass index and the risk of atrial fibrillation and ischemic stroke according to age: a nationwide population-based cohort study
Authors: Ahn H J , Lee S R , Choi E K , Han K D , Kwon S I , Oh S , Lip G Y H
Published: October 2021

Background

Atrial fibrillation (AF) and ischemic stroke (IS) are two significant cardiovascular diseases that confer an enormous healthcare burden. A limited study comprehensively evaluated the association between full ranges of body mass index (BMI), including underweight, and AF or IS risks, especially in the different age subgroups.

Purpose

We investigated the association between BMI and AF and IS incidence according to the Korean population's age groups.

Methods

This was a nationwide population-based cohort study using data from the Korea National Health Insurance Service, including 9 194 477 healthy adults who underwent a medical examination in 2009. We stratified the study population into three age subgroups: age 20–39 (young, 33.1%), age 40–64 (middle-aged, 56.3%), and age over 65 years (elderly, 10.6%). In each age group, the individuals were categorized based on BMI (kg/m2) into underweight (<18.5), normal (18.5 to <23), overweight (23 to <25), obese I (25 to <30), and obese II (≥30). The first occurrences of AF and IS were followed up until December 31, 2018. According to BMI in each age group, the risks of AF and IS were analyzed by Cox proportional hazards regression with 95% confidence intervals (CI) by adjusting age, sex, lifestyle behaviors, and comorbidities.

Results

Overall, both underweight and higher BMI were associated with an increased risk of AF and stroke across all age groups. The increased risk of AF for patients with obese II was slightly accentuated compared to patients with normal BMI in the young population than elderly population (hazard ratio [HR] 1.78, 95% CI 1.63–1.94 for age 20–39 years; HR 1.55, 95% CI 1.48–1.61 for age ≥65 years, respectively). For underweight individuals, however, the increased risk of AF became more prominent in the elderly: HR and 95% CI was 1.12 (1.07–1.17) in the age over 65 years old, and 1.05 (0.94–1.16) in the age 20–39. Regarding IS, the young group presented a considerable increment in the magnitude of HRs in both underweight and higher BMI groups. However, the association between the BMI and stroke risk became attenuated in the elderly: HRs and 95% CI in underweight and obese II individuals were 1.10 (0.93–1.30) and 2.223 (1.99–2.49) in the age 20–39 group, whereas 0.97 (0.93–1.01) and 1.03 (0.98–1.08) in the age over 65 years old.

Conclusions

Underweight as well as obesity was associated with increased risks of AF and IS in the general population. In both AF and IS, the gradient of risks according to BMI was apparent at young ages; thus, maintaining normal body weight should be warranted in early life. An interplay of several factors other than BMI may contribute to ischemic stroke in the old ages, requiring integrated risk management in older patients.

Funding Acknowledgement

Type of funding sources: None.
Coronary artery calcium in patients with atrial fibrillation undergoing catheter ablation – an opportunity to personalize cardiovascular and thromboembolic risk management
Authors: Fernandes S , Ladeiras-Lopes R , Faria R , Ferreira W , Carvalho M , Almeida J , Fonseca P , Oliveira M , Goncalves H , Ferreira N , Primo J , Fontes-Carvalho R
Published: October 2021

Introduction

There is a well-established association between atrial fibrillation (AF) and coronary artery disease (CAD). Coronary artery calcium score (CACS) is a helpful tool to refine cardiovascular risk stratification and guide strategies of cardiovascular (CV) primary prevention.

Purpose

To evaluate the prevalence and clinical implications of CACS in terms of CV and thromboembolic risk stratification and preventive therapies, in patients with AF and atrial flutter (AFL) undergoing catheter ablation.

Methods

Cross-sectional study including patients with AF/AFL undergoing multidetector computed tomography (MDCT) for ablation procedure planning from 2017 to 2019. Baseline clinical and demographical data were collected. CV and thromboembolic risks were evaluated based on the SCORE (Systematic Coronary Risk Evaluation) system and CHA2DS2-VASc score. CACS was assessed in patients without history of coronary artery disease using the Agatston method.

Results

A total of 474 patients were included (441 with AF and 33 with AFL, mean age of 58±10 years, 62% male). Excluding those over 70 years of age (n=50, 11%), most patients had low (n=69, 22%) or moderate (n=188, 60%) CV risk and 277 (64%) patients had a CHA2DS2-VASc score ≥1 (male) or ≥2 (female). Overall, 265 patients (65%) were under chronic anticoagulation and 157 (39%) were under statin therapy. CAC was present in 254 (54%) patients and showed a multivessel distribution in 62% of the cases. The left main stem was affected in 81 (17%) patients and the left anterior descending artery in 211 (45%). Incorporating CACS>100 as a variable in CHA2DS2-VASc score (vascular disease parameter in patients without history of vascular disease) would have resulted in a significant score reclassification (n=87, 20%) and identification of new potential candidates for anticoagulation (n=12, 3%). Additional, anticoagulation would be indicated as a class IA recommendation in more 26 (6%) patients. Twenty three percent of patients with zero calcium were taking statins, and only 7% of patients with a CACS >300 were on high-intensity statin therapy. According to the recommendations and based on their CACS and current therapy, 103 (25%) patients would be candidates for statin therapy and 69 (17%) patients would be candidates for changes in the current statin therapy intensity (Table 1).

Conclusion

In our study, more than half of the patients undergoing MDCT before AF/AFL catheter ablation had coronary calcium above zero. Our findings suggest that an opportunistic evaluation of CACS can be clinically valuable in thromboembolic risk stratification and management of preventive pharmacological strategies such as anticoagulation and statins.

Funding Acknowledgement

Type of funding sources: None.
Inhibition of myeloid differentiation factor 2 by MAC28 suppresses reactive oxygen species, inflammation and improves mitochondrial function, leading to improved cardiac function in prediabetic rats
Authors: Sumneang N , Thun Oo T , Singhanat K , Maneechote C , Arunsak B , Nawara W , Jaiwongkam T , Pratchayasakul W , Apaijai N , Liang G , Chattipakorn S C , Chattipakorn N
Published: October 2021

Background

Chronic inflammation involves in the left ventricular (LV) dysfunction in high-fat diet (HFD)-induced prediabetes, along with cardiac mitochondrial dysfunction. This involved an activation of myeloid differentiation factor 2 (MD2)/toll-like receptor 4 (TLR4) by lipopolysaccharide, leading to inflammatory cytokines production in the heart. MAC28 is a novel MD2 inhibitor, which had been shown to provide effects against LPS-induced cytokine secretion from macrophages. However, the potential benefits of MAC28 on the LV function and its underlying mechanisms in HFD-induced prediabetic rats are unknown.

Purpose

We tested the hypothesis that MAC28 improves LV function in prediabetic rats by reducing cardiac oxidative stress, inflammation, and cardiac mitochondrial dysfunction.

Methods

Male Wistar rats were fed either a normal diet (ND, n=8) or HFD (n=24) for 16 weeks. At week 12, HFD-fed rats developed prediabetes and LV dysfunction. At this time, these HFD-fed rats were divided into 3 treatment groups (n=8/group): 1) vehicle (HFDV; 1% Na-carboxymethyl cellulose; p.o.); 2) MAC28 (40 mg/kg; p.o.); 3) metformin (300 mg/kg; p.o.; a positive control), the ND-fed rats received a vehicle (NDV). Rats were received their treatment for 4 weeks. Then, LV function and heart rate variability (HRV) were examined, and the heart was removed to determinecardiac malondialdehyde (MDA), cardiac inflammation (TNF-α) and mitochondrial function.

Results

HFD-induced prediabetes, together with depressed HRV and %LV ejection fraction (LVEF) (Fig. 1A). Moreover, cardiac oxidative stress and inflammation overproduction, and cardiac mitochondrial dysfunction was also observed, shown by elevated cardiac MDA, cardiac TNF-α protein levels, and mitochondrial ROS levels, mitochondrial depolarization and swelling (Fig. 1B). Notably, treatment with MAC28 effectively improved HRV and %LVEF and HRV (Fig. 1A), compared to HFDV group. Moreover, MAC28 significantly reduced cardiac MDA levels, cardiac TNF-α protein levels and cardiac mitochondrial dysfunction in HFD-induced prediabetic rats (Fig. 1B). These beneficial effects were also observed in metformin-treated rats (Fig. 1A, B).

Conclusion

MAC28 exerts cardioprotection in prediabetic rats by reducing cardiac oxidative stress, inflammation, and mitochondrial dysfunction, leading to restoring LV function.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Thailand Science Research and Innovation
More than the half number of the severe CAD patients without features of metabolic syndrome had hyperlipoprotein(a)-emia
Authors: Kasahara T , Endou S , Osaki S , Kawatani S , Amisaki R , Sasaki N , Mizuta E , Adachi M , Ohtahara A
Published: October 2021

Background

It was reported that insulin suppresses apolipoprotein(a) synthesis in primary cultures of cynomolgus monkey hepatocytes (Neele DM. Diabetologia 1999). Therefore, there is a possibility that inverse association exists between lipoprotein(a); Lp(a) and metabolic syndrome (Mets) with insulin resistance/ hyperinsulinemia for the coronary atherosclerosis.

Purpose

The purpose is to examine the association between Lp(a) and Mets on the CAD patients.

Method

847 male subjects with angiographically demonstrated CAD were enrolled. The subjects were divided into the five groups according to the scored numbers by the counting of Mets components shown below (presence 1, absence 0); 1. BMI ≥25kg/m2, 2. comorbidity of hypertension, 3. triglyceride ≥150mg/dL and/or HDL cholesterol <40mg/dL, 4. fasting plasma glucose ≥110mg/dL and/or comorbidity of diabetes mellitus (Group 0; without any Mets components, Group 4; with all Mets component). The insulin levels (μU/mL) and the prevalence of hyperLp(a)-emia (≥30 mg/dL) were compared between in Group 0 and in Group 4. The blood samples for laboratory tests were collected after an over night fast.

Result

As the scored numbers increased, the insulin levels increased (Group 0; 5.1 μU/mL versus Group 4; 11.4 μU/mL: p<0.0001) and the prevalence of hyperlipoprotein(a)-emia decreased (Group 0; 41.6% versus Group 4; 21.4%: p<0.01). The prevalence of hyperLp(a)-emia increased as the severity of coronary atherosclerosis aggravated (Figure 1; one vessel disease 21.5%, two vessel disease 27.0% three vessel disease 32.1%: one vessel disease versus three vessel disease p<0.01). Especially to limited the three vessel disease subjects (Figure 2), the prevalence of hyperlipoprotein(a)-emia in Group 0 was markedly high (56.7%).

Conclusion

More than the half number of severe CAD patients without features of Mets had hyperLp(a)-emia.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
Association between air pollution and case-specific mortality in north-eastern part of Poland. Case crossover study with 4,500,000 person-years of follow-up
Authors: Kuzma L , Kurasz A , Dabrowski E J , Swieczkowski M , Dobrzycki S , Bachorzewska-Gajewska H
Published: October 2021

Background

Recent studies have reported associations between air pollution and daily mortality. The majority of them are conducted in highly polluted areas. Taking into consideration the scarce number of surveys from cities with moderate air quality we decided to conduct a study in this type of region.

Purpose

To assess the short-term impact of air pollution on cardiovascular (CVD), coronary artery-related (CAD), and cerebrovascular-related (CbVD) mortality.

Methods

The analysis with almost 4,500,000 person-years of follow-up with a time-stratified case-crossover design was performed. Results are reported as odds ratio (OR) associated with an increase in interquartile range (IQR).

Results

The analysed region was inhabited by almost 500,000 residents. From 2008 to 2017 in Bialystok, Lomza, and Suwalki we recorded 49,573 deaths – 34,005, 8,082, 7,486, respectively. The median daily concentrations of PM10 (23.8 μg/m3, IQR=16.9) was the highest in Lomza, Median daily concentration of PM2.5 was the highest in Bialystok (16.2 μg/m3, IQR=15.9). In the case of Suwalki, daily median PM2.5 concentration was 9.8 μg/m3 (IQR=8.7), and PM10 – 18.0 μg/m3 (IQR=14.3). The IQR increase in PM2.5 (OR 1.036, 95% CI 1.016–1.056, P<0.001) and PM10 concentration (OR 1.034, 95% CI 1.015–1.053, P<0.001) was associated with increased CVD mortality on lag 0 and this effect persisted on following days. The effects of PMs were more expressed in association with CAD-related mortality (OR for PM2.5 = 1.045, 95% CI 1.012–1.080, P=0.008), (OR for PM10 = 1.044, 95% CI 1.010–1.078, P=0.011) and CbVD mortality (OR for PM2.5 = 1.046, 95% CI 1.013–1.080, P=0.006), (OR=1.041 for PM10, 95% CI 1.002–1.082, P=0.038). Additionally, IQR increase in NO2 concentration was associated with increased CAD-related mortality at lag 0–1 (OR=1.055, 95% CI 1.004–1.108, P=0.032). The highest OR for PMs was noted in Suwalki compared to Bialystok and Lomza. The trend was noted regardless of the cause of death from lag 0 to lag 0–3. In a comparison of seasons, we noted higher CVD mortality OR in the cold season for PM10 in Suwalki (P=0.047) and Bialystok (p=0.001). However, the impact of NO2 (P=0.02) and PM10 (P=0.03) on CAD related mortality was higher in the warm season.

Conclusions

The impact of air pollution on CVD mortality is also observed in moderately polluted areas. PMs and NO2 had the greatest impact on CAD-related mortality. Differences in effect size and seasonality may depend on the source of air pollution.

Funding Acknowledgement

Type of funding sources: None.
Impact of cardiovascular disease and diabetes on cerebral cognition in older adults: the role of routine echocardiography in a primary care setting of Northern Sweden
Authors: Saha S K , Kiotsekoglou A
Published: October 2021

Background

Older adulthood is often associated with type 2 diabetes (DM), and cardiovascular comorbidities (CVD), such as hypertension, atrial fibrillation (AF) with or without heart failure (HF). A combination of the illnesses may contribute to the decline in cerebral cognition. It is, however, not known whether there exists an association between cognitive function and cardiovascular diseases and co-existing DM in a community setting equipped with outpatient echocardiography services.

Subjects and methods

One hundred and thirty peri-octogenarians (79±11 years,), divided into four groups (Controls, CVD-DM, CVD+DM, and DM-CVD), matched for age, and gender, participated in the study to undergo a routine standard Doppler echocardiography, measures of which included left ventricular (LV) ejection fraction, left atrial (LA) size, pulmonary artery systolic pressure (PASP), and LV diastolic indices such as E/A-wave velocity ratio. Routine biochemistry included glomerular filtration rate and NT-proBNP, in addition to plasma glucose and HbA1c. Cognition was measured using a Mini-Mental State Examination (MMSE) score. In the CVD-DM group 14 out of 47 had AF+HF, In the CVD+DM 7 out of 24 had AF+HF (Chi sq p for trend = 0.9): i.e., a total of 30% had a combined co morbidity of DM+AF+HF. All of them had SGLT2 inhibitors alone or in combination of GLP1-RA. In the CVD group 27 out of 47 had AFIB, while in the DM+CVD group 11 of 24 had AFIB (Ci Sq p for trend=0.8)

Results

Mean ± SD of MMSE scores, LVEF%, PASP (mmHg), E/A ratio, and LA size (mm) in the Controls were respectively 27±3, 58±10, 22±5, and 34±9. MMSE scores did not differ. LVEF was significantly lower, and PASP higher in CVD with or without DM (all p<0.05). LA was not only larger in these groups, LA size and PASP could predict MMSE at an adjusted R2 value of 0.6 (p<0.05). E/A ratio and NT-proBNP contributed, albeit non significantly (p=0.06, Figure 1). When controlled for background AF and HF, DM and CVD equipoised MMSE score (p=NS).

Conclusion

In this community-based cross-sectional study, cerebral cognition, as assessed by MMSE scoring, was found to be preserved in DM with or without co-existing CVD, compared with age-matched Controls. DM and CVD equally contributed to the level of cognition. Whether the newest anti hyperglycemic agents preserve cognition beyond impacting a favorable cardiac outcome is a matter to be resolved by larger, multinational trails. Routine echocardiography in primary care plays a vital role to monitor cardiac function in an increasingly older adults faced with a significant disease burden (DM+AF+HF+CAD) with risk for impaired cognition.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Novo Nordisk Figure 1
Distribution and prevalence of cardiovascular risk factors in a aging population of thalassemia patients: looking at the heart of the problem
Authors: Ajassa M , Barbero U , Longo F , Piga A , Gaglioti C M , De Benedictis M , Ferrero G B
Published: October 2021

Background

β-thalassemia major is a hereditary genetic disease hindered by many comorbidities due to transfusion-related iron. Since the introduction of chelation therapy life expectancy of these patients has increased from the 16 years of 1964 to 50 years today, with a marked improvement in the quality of life. Iron-related heart disease is still a leading complication but diabetes mellitus and hypogonadism may impact the cardiovascular risk in these patients, with an expected change in heart involvement with this unprecedentedly seen aging of these patients.

Target

This study aims to evaluate the distribution and prevalence of cardiovascular risk factors in a population of thalassemia major patients, and their relationship with observed cardiovascular events and potential modifying factors.

Methods and results

One-hundred fifty-nine patients older than 18 years of age with clinical and molecular diagnosis of β-thalassemia major and at least 15 years of follow-up were included in this study. Mean age was 40.9±8.4 years. Low serum lipid levels with low HDL levels were noted, with 17.6% having diabetes mellitus and 62% with hypogonadism; Splenectomy was reported in 70%. During the observed period 3.8% of patients had at least one episode of heart failure, 35.9% showed early signs of heart failure, 22% received diagnosis of diastolic dysfunction, 38% had a left ventricular ejection fraction <55% and 21.4% showed supraventricular arrhythmias. Cardiovascular risk was then assessed using two algorithms (CUORE and Pooled Cohort Risk Equation - PCRE) and was generally low but despite that patients with hypogonadism (who showed lower cardiac T2* value than those without; p<0.001) showed a statistically significant correlation with the occurrence of cardiovascular events.

Discussion

The β-thalassemia population has a relatively low mean age, but shows a particular metabolic profile in association with numerous comorbidities: an increased prevalence of diabetes mellitus, low HDL values and frequent hypogonadism which tends to be associated with increased iron deposition in myocardium. The cardiovascular risk estimated by specific algorithms (CUORE and PCRE) was generally low, mainly due to the young age of the cohort, but the prevalence of cardiac events was not negligible.

Conclusions

The chronic accumulation of iron in the heart and the specific metabolic profile, particularly observed in patients with hypogonadism, allows us to define Major Thalassemia patients as a population at high cardiovascular risk from many points of view (iron-related myopathy, atherosclerosis and arrhythmias), which requires a specific follow-up program, to prevent and to identify early signs of these serious complications.

Funding Acknowledgement

Type of funding sources: None.
Serial measurement of global longitudinal strain among women with breast cancer treated with proton radiation therapy
Authors: Hassan M , Awadalla M , Tan T C , Scherrer-Crosbie M , Zhang L , Zlotoff D A , Bany Bakar R , Hickey S B , Patel S A , Januzzi J L , Passeri J J , Keane F , Jimenez R , MacDonald S M , Neilan T G
Published: October 2021

Background

Conventional photon radiotherapy (RT) for breast cancer is associated with reduction in global longitudinal strain (GLS), an increase in both troponin and N-terminal pro-B type natriuretic peptide (NT-proBNP), and incident heart failure. The cardiac radiation exposure with proton-RT is reduced and, thus may be associated with less cardiotoxicity.

Objectives

To test the effect of proton-RT on GLS, troponin and NT-proBNP.

Methods

A prospective observational single center study of 69 women being treated with proton-RT for breast cancer. Serial measurements of GLS, high-sensitivity cardiac troponin-I (hs-cTnI), and NT-proBNP were performed at pre-specified intervals (pre proton-RT, 4 weeks after completion of proton-RT and again at 2 months post proton-RT).

Results

The mean age was 46±11 years, BMI was 25.6±5.2 kg/m2, 32% had hypertension and mean radiation dose to the heart and left ventricle (LV) were 0.44 Gy and 0.12 Gy respectively. There was no change in LV ejection fraction (pre proton-RT vs. 4-weeks post proton-RT vs. 2 months post proton-RT, 65±5 vs. 66±5 vs. 64±4%, p=0.15), global GLS (−21.7±2.7 vs. −22.7±2.3 vs. −22.8±2.1%, p=0.24) or segmental GLS from pre-to post proton-RT. Similarly, there was no change in hs-cTnI or NT-proBNP with proton-RT. However, post proton-RT, we found that patients with a history of hypertension had lower GLS when compared to women without hypertension (−21.3±3.5 vs. −24.0±2.4%, p=0.006).

Conclusion

Proton-RT did not impact LV function, or associate with an increase in biomarkers. These data support the potential cardiac benefits of proton-RT compared to conventional RT.

Funding Acknowledgement

Type of funding sources: None.
The prevalence of statin intolerance worldwide: a systematic review and meta-analysis with 4,143,517 patients
Authors: Bytyci I , Bajraktari G , Sahebkar A , Penson P E , Rysz R , Banach M Y
Published: October 2021

Background

The efficacy of statins in the prevention and treatment of cardiovascular disease is well established. Despite their large benefit, statin intolerance (SI) is still an important clinical challenge. In this meta-analysis, we aimed to estimate the overall prevalence of SI, the prevalence based on different diagnostic criteria and different disease settings.

Methods

We searched all electronic databases until the end of March 2021 for studies that reported the prevalence of SI. The primary endpoint was overall prevalence and prevalence based on different diagnostic criteria (National Lipid Association/NLA, International Lipid Expert Panel/ILEP and European Atherosclerosis Society/EAS). The secondary endpoint was the SI prevalence in the groups of patients with different diseases' settings. A random-effects model was applied to estimate the overall pooled prevalence.

Results

One hundred and seventy-six studies (112 RCTs; 64 cohort studies) with 4,143,517 patients were included in the analysis. The overall SI prevalence was 9.1% (8.1 to 10%). The prevalence based on NLA criteria was similar compared to ILEP and EAS (7.0, 6.7, 5.9%, respectively; p>0.05). The prevalence of SI in RCTs studies was significantly lower in comparison to the cohort studies (4.9 vs. 17%; p<0.001). The SI prevalence in patients both in primary and secondary prevention was much higher (18%; mainly due to dominant cohort studies) than in the separate analysis of those in primary and secondary prevention (8.2, 9.1%, respectively; p<0.05). In the subgroup analysis based on different disease in the primary prevention: familial hypercholesterolemia, hypercholesterolemia, dyslipidemia and diabetes mellites, the prevalence was 9, 12, 13 and 6%, respectively) and in the secondary prevention: stable coronary artery disease, acute coronary syndrome and myocardial infarction – 8, 13, and 13%; respectively (Figure 1).

Conclusions

Based on the data from analysis of over 4 million patients, the overall SI prevalence is low, and even lower based on the recognized international definitions. These results support the concept that complete intolerance might be often overestimated and highlight the need for very careful examination of patients with statin intolerance.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Prevalence of statin intolerance
Impact of DAPT duration on clinical outcome after stent implantation for coronary bifurcation lesions: multicentre experience
Authors: Jariwala P , Jadhav K , Jadhav K
Published: October 2021

Background

The period of dual antiplatelet therapy (DAPT) following acute coronary syndrome (ACS) or stable coronary artery disease (SCAD) that is managed with coronary stenting is still under consideration. In real-world registries, the association between length of DAPT, bifurcation intervention and its effect on clinical outcome has been poorly studied. In sequential all-comer patients treated with stenting of coronary artery bifurcation lesions we examined the effect of DAPT length on clinical results including our single centre registry.

Methods

Responses were extracted from January 2017 to December 2018 on 536 consecutive patients who had PCI on coronary bifurcation at three centres in India. The primary endpoint of the analysis was the cumulative incidence of major adverse cardiac cerebrovascular events (MACCE), identified as a composite of cardiac death, non-fatal myocardial infarction (MI), target vessel revascularization (TVR) and stroke during follow-up; the secondary objectives were the single occurrence of any of the aforementioned incidents. 496 patients (92.5 percent) had data on the length of DAPT. Group 1) DAPT<6-months (n=174); group 2) DAPT>6-months but <12-months (n=162); group 3) DAPT >12-months (n=160).

Results

In 490 (98.8 percent) patients with an 18-month median (CI: 12–28) follow-up was concluded. MACCE developed more often in the 18 Group 1 patients (10.3%) than in Group 2 and 3 versus 14 [8.6%] and 8 [5%], HR: 0.76, 95% CI: 0.67- 0.92, p<0.001), respectively. After correction for clinical and angiographic features this disparity persisted (HR: 0.68, 95% CI: 0.68–0.79, p<0.001). At Kaplan-Meier analysis, in patients who received DAPT with less than 6 months (p<0.001) the freedom from MACCE survival was substantially lower.

Conclusions

In a real-world registry of hospitalized patients with DES-PCI for coronary artery bifurcation stenosis, short DAPT length (<6 months) is correlated with a considerably higher risk of MACCE relative to longer DAPT.

Funding Acknowledgement

Type of funding sources: None.