bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcatheter mitral valve-in-valve implantation: a 10-year single center experience
Authors: Akodad M , Sathananthan G , Chatfield A G , Trpkov C , Lounes Y , Chuang A , Wood D A , Boone R H , Moss R , Cheung A , Ye J , Blanke P , Leipsic J , Sathananthan J , Webb J G
Published: October 2021

Background

Transcatheter mitral valve-in-valve (TMVIV) appears a reasonable alternative to surgical redo mitral valve replacement in patients with degenerated mitral prosthesis and high surgical risk with favorable early and mid-terms outcomes. Long-term outcomes are limited by high mortality in a comorbid population.

Purpose

We aimed to evaluate early prosthesis hemodynamic performance and late clinical outcomes following TMVIV.

Methods

All patients who underwent TMVIV for degenerated surgical mitral bioprostheses from 2011 to 2020 in our center were included. Prospectively collected demographic, clinical, procedural, and imaging variables were analyzed. Clinical and echocardiographic outcomes were defined according to Mitral Valve Academic Research Consortium (MVARC) definitions and assessed at 30-day and at the latest follow-up available.

Results

A total of 67 patients were included; mean age 76.9±9.6 years, mean STS score 11.0±6.2%, 53.7% male (n=36). Mechanisms of bioprosthetic failure were mitral stenosis (n=32, 47.8%), mitral regurgitation (n=24, 35.8%), and mixed (n=11, 16.4%). Mean time from mitral valve surgery to TMVIV was 10.2±4.3 years. Access was mostly transapical (n=45; 67.2%), followed by transseptal (n=22; 32.8%). Following the first transseptal procedure in 2016; transseptal access accounted for the majority of procedures (22 of 37 cases, 59.4%).

Technical success was achieved in 65 patients (97.0%). Mean hospitalization was 9.2±10.0 days; shorter with the transseptal as opposed to the transapical approach (6.3±8.1 days versus 11.0±10.5 days, p=0.001). At 30-day echographic follow-up, mean mitral valve gradient was 7.3±2.7 and 1 patient (1.9%) had mitral regurgitation >mild.

At 30-day follow-up, 3 patients had died (4.5%); due to left ventricular outflow tract obstruction (1), heart failure (1), and stroke (1). New pacemakers were required in 2 patients (3.0%) and pacemaker lead dislodgement occurred in 1 patient (1.5%), 4 patients (6.2%) were hospitalized for heart failure. At a median follow-up of 3.8 years [1.7–5.1], 29 patients had died (43.3%), valve thrombosis was found in 6 (8.9%) and endocarditis in 4 patients (6.2%). Mitral valve reintervention was performed in 4 patients (6.2%); redo TMVIV due to valve migration in 1 (1.9%), surgical valve replacement in 1 (1.9%), and delayed redilation with a non-compliant balloon due to underexpansion in 2 patients (3.8%).

Conclusion

TMVIV is associated with acceptable 30-day mitral valve hemodynamics. Long-term mortality remains high in this high-surgical risk comorbid group.

Funding Acknowledgement

Type of funding sources: None.
Fluid responsiveness in patients under mechanical ventilation and low tidal volume ventilation through the pulse pressure variation after tidal volume challenge in the post-operative cardiac surgery
Authors: Azevedo D F C , Viera De Melo R M , Cunha A C , Brito L G S , Viana T , Figueiredo C S , Gomes B C S , Bezerra C G , Tamazato A O , Santos Junior R P , Rangel R A , Oliveira F C , Nascimento Junior O R , Da Silva D N V , Passos L C S
Published: October 2021

Background

It is known that in the immediate postoperative period of cardiac surgery, strict control of hemodynamic variables and blood volume is necessary, since there is an imbalance between oxygen supply and consumption. Thus, the present study seeks to validate methods previously used in different clinical situations to predict fluid responsiveness, in the current scenario of the immediate postoperative period of cardiac surgery.

Purpose

To evaluate the influence of “tidal volume challenge” from 6 ml / kg to 8 ml / kg of the predicted body weight (PBW) in conjunction with the end expiratory occlusion test (EEOT) in the variation of pulse pressure to predict fluid responsiveness in the immediate postoperative period of cardiac surgery.

Methodology

This prospective study included 30 patients after cardiac surgery. Hemodynamic and ventilatory parameters were initially recorded in mechanical ventilation at 6 ml/kg and after tidial volume challenge and with the EEOT at 8 ml/kg of predicted body weight (PBW). After recorded the intervention data, there was a return to ventilation at 6 ml/kg and a saline infusion of 500 ml was performed for 15 minutes. Fluid responsiveness was defined for patients who had an increase of 10% or more in velocity time integral (VTI) by echocardiogram after volume expansion compared to baseline value. Multivariate analysis was used to identify independent predictors of fluid response status. Sensitivity and specificity analyzes were performed to determine the predictive precision of each parameter.

Results

The main result of our study is that, when the tidal volume is increased from 6 to 8 ml/kg of PBW, the relative increase in pulse pressure variation (%ΔPPV6–8) predicts with excellent accuracy responsiveness to fluids with cut-off values of 18.3%, with sensitivity of 92.9% and specificity of 84% (P=0.019). Although changing PPV6, EEOT6 and EEOT8 are not reliable in predicting fluid responsiveness, they still require additional calculations. PPV8 also discriminates between responders and non-responders; however, with sensitivity (78.6%) and specificity (66.6%) when the value found in the PPV8 is up 8.5, but without statistical significance (figure).

Conclusion

The challenge of tidal volume and its influence on the ΔPP variation has excellent accuracy to predict fluid responsiveness in the immediate postoperative period of cardiac surgery. EEOT did not present good accuracy to predict fluid responsiveness in patients in the immediate postoperative period of cardiac surgery.

Funding Acknowledgement

Type of funding sources: None.
Off-pump versus on-pump coronary artery bypass grafting: a propensity score-matching analysis of safety and long-term results
Authors: Saraiva F A , Cerqueira R J , Ferreira A F , Moreira R , Amorim M J , Barros A S , Pinho P , Lourenco A P , Leite-Moreira A F
Published: October 2021

Background

The role and the indications for using off-pump coronary artery bypass surgery (OPCAB), instead of the traditional on-pump (ONCAB), is still to be addressed.

Aim

To describe our centre experience and to compare 15-years survival and early safety outcomes between OPCAB and ONCAB.

Methods

Single-centre retrospective cohort including 9-years of isolated first CABG (2005–2013). Multi-vessel disease with at least 2 surgical grafts patients were considered and the first 50 surgeries of each surgeon with each technique were excluded to account for the learning curve effect. Emergent surgeries and on-pump beating heart procedures were also excluded. A propensity-score matching (PSM) analysis was performed to balance groups and both survival and early outcomes comparison was done within the matched cohort using Kaplan-Meier or Cox stratified and paired tests, respectively. The median follow-up was 9 years, maximum 15 years.

Results

From 3012 multi-vessel patients with at least 2 surgical grafts, 2503 were included at the main analysis: 1487 ONCAB and 1016 OPCAB. ONCAB patients presented more frequently 3-vessels disease and left ventricular dysfunction, but received similar number of grafts than OPCAB, who in turn, received more frequently multiple arterial grafts. The surgical completeness of revascularization (CR) was similar, but hybrid procedures were more frequent in OPCAB raising CR rate in this group. After PSM (646 pairs), both groups were similar regarding pre and peri-operative characteristics. The long-term survival was similar (HR stratified by pair: 1.02 (0.81–1.30), but OPCAB evidenced benefits at early term results including bleeding, postoperative atrial fibrillation and stroke incidence.

Conclusion

At our centre, OPCAB performed by experienced surgeons provides rates of complete revascularization and long-term survival similar to ONCAB. In-hospital results favoured OPCAB.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Universidade do Porto/FMUP; Social European Fund; FCT-Fundação para a Ciência e a Tecnologia
Higher levels of serum phosphorus are associated with coronary calcification post heart transplantation
Authors: Ozcan I , Toya T , Corban M T , Ahmad A , Nardi V , Lerman L O , Kushwaha S S , Lerman A
Published: October 2021

Background

A higher serum phosphorus level, although within the normal range has been linked to coronary artery and aortic calcification in the non-transplant population. Coronary calcification is mostly associated with donor-derived lesions, and is uncommon within the first years after heart transplantation.

Purpose

We aimed to investigate the association of phosphorus levels with plaque calcification after heart transplantation.

Methods

A total of 156 patients who underwent virtual histology intravascular ultrasound (VH-IVUS) studies for cardiac allograft vasculopathy (CAV) surveillance and had fasting serum phosphorus levels <4.5 mg/dL, were included in the analyses. IVUS analyses were performed in the proximal left anterior descending artery, and plaque composition of dense calcium (DC) was evaluated using VH-IVUS, and presented as percent DC of total plaque volume. The patients were separated into 3 groups according to tertiles of serum phosphorus levels.

Results

Mean recipient and donor ages were 54±13 and 31±14 years, respectively. Mean serum phosphorus in recipients was 3.5±0.6 mg/dL, with median time after transplantation at the IVUS studies of 6 (3,10) years. There were no significant differences in %DC between phosphorus tertiles in patients who underwent IVUS within 6 years after transplantation (p=0.11, Fig. 1A). However, beyond 6 years after transplantation, we observed an incremental association between phosphorus levels and the extent of calcification (p=0.02, Fig. 1B). In this group, serum phosphorus levels significantly correlated with %DC (standardized β=0.29, P=0.008), and this correlation remained significant after adjustment for donor age, recipient age, and eGFR (standardized β=0.26, P=0.001).

Conclusion

Higher serum phosphorus levels were associated with a level-dependent increase in calcified coronary artery plaque in patients starting 6 years post heart transplant. Long-term exposure to higher serum phosphorus, even within the normal range, might promote plaque calcification after heart transplantation.

Funding Acknowledgement

Type of funding sources: None.
Associations between plasma metabolite profiles and blood pressure: the HELIUS study
Authors: Verhaar B , Mosterd C M , Collard D , Galenkamp H , Van Den Born B J H , Muller M , Nieuwdorp M , Van Raalte D H
Published: October 2021

Background

Blood pressure (BP) is regulated by plasma metabolites from different neurohumoral and cardiometabolic systems. Since there are established differences in hypertension pathogenesis and treatment response between ethnicities, we hypothesized that plasma metabolites may be differently associated with BP across ethnic groups.

Purpose

To investigate associations between plasma metabolite profiles and BP in a multi-ethnic population-based cohort.

Methods

From the Healthy Living In an Urban Setting (HELIUS) study, 369 subjects (mean age 52±11 years, 51%F) of African and non-African descent were included. Office systolic (136±21 mmHg) and diastolic (83±12 mmHg) BP levels were recorded. Plasma metabolites were measured semi-quantitively with LC-MS (Metabolon) from fasting plasma samples. Associations between metabolite profiles and BP were assessed with machine learning prediction models using the XGBoost algorithm with nested cross-validation. Associations between the resulting best predictors and BP were assessed with linear regression models while adjusting for age, sex, estimated glomerular filtration rate and diabetes.

Results

Plasma metabolite profiles explained 14.1% of systolic BP variance and 10.6% of diastolic BP variance. These were attenuated to 3.1% and 1.4% respectively, when using residuals of BP after adjusting for age and sex. Top predictors for both systolic and diastolic BP included N-formylmethionine, several acylcarnitines and polyunsaturated fatty acids such as hexadecadienoate. These metabolites were significantly associated with higher systolic BP with estimates ranging from 3.0 to 4.5 mmHg per 1 SD increase in the adjusted models. Associations with hexadecadienoate, dihomolinoleate and catecholamine metabolites, including vanillactate had significant interactions (p<0.05) with ethnicity, and were only significant in subjects of non-African descent.

Conclusions

Plasma metabolome composition explained a large proportion of BP variance, but this association was attenuated when adjusting for confounders. Polyunsaturated fatty acids and catecholamine metabolites were only associated with BP in the non-African descent subjects. N-formylmethionine was the most consistent predictor for systolic BP across all subgroups. Future studies could focus on translating these findings in vitro in order to decipher the role of N-formylmethionine in BP regulation.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Dutch Heart Foundation, the Netherlands Organization for Health Research and Development, the European Integration Fund and the European Union (Seventh Framework Programme) Explained variances of machine learningLinear regression models
Blood pressure response during treadmill exercise testing and the risk for future cardiovascular events and new-onset hypertension
Authors: Zafrir B , Asaf Y , Aker A , Saliba W
Published: October 2021

Background

Although there is a diminishing role of exercise stress testing (EST) in the diagnostic assessment of coronary heart disease, the physiologic response to exercise may provide valuable prognostic information. We aimed to investigate the association of repeated blood pressure (BP) measurements during EST with long-term risk of myocardial infarction, stroke or death (MACE), as well as the development of new-onset hypertension.

Methods

Retrospective analysis of EST performed between the years 2005–2019 in a single center according to Bruce protocol. Included were patients aged 35–75 years without a history of cardiovascular disease (n=14,792; 48% women). BP was documented at rest, submaximal exercise (Bruce stage-2), peak exercise and recovery (2 minutes). Association of BP measures with study outcomes during a median follow-up of 78 months was investigated.

Results

An increment of 10-mmHg in rest, submaximal, peak and recovery systolic BP was each associated with a significant increase in the hazard ratio (HR) and 95% confidence interval (CI) for MACE: 1.09 (1.04–1.14), 1.06 (1.01–1.10), 1.04 (1.01–1.08), and 1.06 (1.02–1.10), respectively, after adjustment including exercise capacity, medications and resting BP. The association between SBP at submaximal exercise and recovery with MACE had a J-shaped appearance (Figure). Among non-hypertensive patients without BP lowering medications (n=8,529), 13% were diagnosed with new-onset hypertension during follow-up. Excessive systolic BP response to peak exercise (≥190 mmHg in women and ≥210 mmHg in men) was an independent predictor of future hypertension [HR (95% CI)]: 1.87 (1.41–2.48), as were systolic BPs during submaximal exercise [>160 vs. ≤130 mmHg: 2.44 (1.97–3.03)] and recovery [≥140 vs. ≤120 mmHg: 1.65 (1.37–1.98)], showing gradual, incremental association with the risk for developing hypertension.

Conclusions

BP measurement during exercise and recovery phases of treadmill testing provides incremental prognostic information regarding long-term risk for cardiovascular events and the probability for developing future hypertension.

Funding Acknowledgement

Type of funding sources: None.
Tobacco cigarette smoking accelerates impairment of aortic elastic properties in middle-aged patients with high normal blood pressure
Authors: Ioakeimidis N , Dima I , Terentes-Printzios D , Georgakopoulos C , Gardikioti V , Aznaouridis C , Lazaros G , Tsioufis K , Vlachopoulos C
Published: October 2021

Background

The impact of smoking on atherosclerosis progression is greater in patients with arterial hypertension. High blood pressure (BP) is a major determinant of increased aortic stiffness which is an independent predictor of cardiovascular events. Aim of this study was to examine whether there are differences between office BP categorization and aortic stiffness on the basis of smoking status.

Methods

We measured carotid-femoral pulse wave (PWV) in 185 men (mean age: 55±10 years) who were not receiving antihypertensive medications and they had no history of diabetes and cardiovascular disease. The cohort was divided into three groups according to office systolic BP (SBP) and diastolic BP (DBP): normal (SBP <130 and DBP <85 mmHg, n=79), high normal (130≤SBP<140 or DBP 85≤DBP<90mmHg, n=42), and hypertension (SBP≥140 or DBP≥90mmHg, n=64).

Results

The three groups had similar age and metabolic parameters (body mass index, fasting blood glucose and LDL-C). PWV progressively increased from normotensive to high normal BP, and to hypertensive patients (7.8±1.4 vs 8.2±1.4 vs 8.6±1.6 m/s, respectively, overall P<0.01). Then we subdivided the three office BP groups into subgroups according to smoking status. Figure shows PWV of the three groups stratified by smoking status. The three subgroups of smokers had similar tobacco exposure (40 pack-years). There were not statistically significant differences between smokers and non smokers in each office BP category with regard to age and metabolic parameters. In separate analysis, among individuals with either normal BP the association of smoking status with PWV level was not significant. However, in hypertensive patients but also in patients with high normal BP, smoking status was significantly correlated with PWV (all P<0.01). Furthermore, the differences in mean PWV between smokers with high normal BP and patients with hypertension were not statistically significant reflecting a detrimental effect of smoking on aortic stiffness among males with high normal BP.

Conclusion

Smoking has an unfavorable effect on aortic elastic properties in men with high normal BP. The smokers with high normal BP have PWV comparable to that of hypertensive patients. This finding imply that smoking cessation should be a premising non pharmacological intervention in men with high-normal BP and increased aortic stiffness who are considered to be at a higher cardiovascular risk.

Funding Acknowledgement

Type of funding sources: None. Smoking, BP categories and PWV
Effectiveness of bisoprolol versus selective beta-1 blockers in the management of hypertension: a systematic review and meta-analysis of randomized cross-over trials
Authors: Jadhav U , Ray S , Bansal S , Nair T
Published: October 2021

Background

Cross-over trials carry a higher weightage in choosing a therapeutic agent in clinical practice. A meta-analysis of cross-over trials involving the use of bisoprolol in hypertension (HT) would bring about clarity in positioning this drug.

Purpose

The present study aimed to clarify the underlying benefits of bisoprolol in the reduction of blood pressure (BP) in HT patients when compared to selective beta-1 blockers (s-BBs - Atenolol, Betaxolol hydrochloride, Esmolol, Acebutolol hydrochloride, Metoprolol succinate, Nebivolol) by performing a meta-analysis of “cross-over” trials published in literature.

Methods

Systematic search was undertaken in PubMed, Embase, Cochrane Library, Clinicaltrials.gov registry, Surveillance, Epidemiology and End Results Program and 12 pharmacovigilance databases. Randomized, cross-over studies published up to October 2019 which compared bisoprolol with other s-BBs in HT patients were evaluated in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A meta-analysis was performed using random effects model in terms of mean difference (MD) and 95% confidence intervals (95% CI) for BP, heart rate (HR) and lipid profile.

Results

Nine randomized cross-over studies which compared bisoprolol with other s-BBs (atenolol and nebivolol) were included in this meta-analysis. Bisoprolol reported significant reduction of sitting BP [MD: −3.35, 95% CI: −6.75, 0.05; P=0.05] and reduction of diastolic BP [MD: −2.00; 95% CI: −8.04, 4.04; P=0.52, non-significant] among patients with HT when compared to other s-BBs. Heart rate (HR) decreased significantly among HT patients in bisoprolol group treated for 2 w [MD: −6.00; 95% CI: −11.30, −0.70; P=0.03] when compared to those treated with other s-BBs. Analysis of lipid profile showed non-significant reduction of serum cholesterol [MD: −7.74; 95% CI: −17.18, 1.70; P=0.11] and triglyceride [MD: −26.57; 95% CI: −64.34, 11.20; P=0.17] levels in the bisoprolol group compared to other s-BBs. Bisoprolol treatment for 8 w resulted in a slight but statistically significant change in potassium levels [MD: −0.10; 95% CI: −0.16, −0.04; P<0.01] among HT patients.

Conclusion

The results of this meta-analysis reported significant efficacy of bisoprolol on BP and HR in comparison to other s-BBs in a meta-analysis of cross-over trials. Our findings show that use of bisoprolol as a therapeutic option is efficacious and safe compared to other s-BBs in this patient population.

Funding Acknowledgement

Type of funding sources: None.
Prevalence of metabolic syndrome in the United States National Health and Nutrition Examination Survey (nhanes) 2011–2018
Authors: Liang X P , Or C Y , Tsoi M F , Cheung C L , Cheung B M Y ,   Division of Clinical Pharmacology and Therapeutics, Department of Medicine, The University of Hong Kong, Hong Kong
Published: October 2021

Background

Metabolic syndrome (MetS) is a cluster of risk factors presaging the development of cardiovascular disease and diabetes. It is a risk factor for severe coronavirus disease 2019 (COVID-19).

Purpose

To estimate the prevalence of MetS in the US National Health and Nutrition Examination Survey (NHANES) 2011–2018.

Methods

This cohort study included 22370 eligible participants aged ≥20 years from the NHANES 2011–2018. MetS was defined as the presence of at least three of these components: central obesity, reduced high-density lipoprotein, elevated triglycerides, elevated blood pressure and elevated fasting blood glucose. The prevalence of MetS was estimated taking into account the complex sampling. The time trend was evaluated using logistic regression. Annual percentage changes (APC) were measured trend in MetS prevalence.

Results

The prevalence of MetS was 36.2% (95% CI, 32.3–40.3), 34.8% (95% CI, 32.3–37.4), 39.9% (95% CI, 36.6–43.2) and 38.3% (95% CI, 35.3–41.3) in 2011–2, 2013–4, 2015–6, 2017–8, respectively (P for trend = 0.08). Among the MetS components, the prevalence of elevated glucose increased from 48.7% (95% CI, 45.9–51.5) in 2011–2 to 64.3% (95% CI, 61.0–67.4) in 2017–8 [P for trend <0.001; APC=11.7, (95% CI, 3.5–21.0)]. The prevalence of MetS in non-Hispanic Asian increased from 21.8% (95% CI, 16.7–28.0) in 2011–2 to 31.2% (95% CI, 27.4–35.3) in 2017–8 [P for trend <0.001; APC=14.6, (95% CI, 2.5–34.8)].

Conclusions

The prevalence of MetS remained stable during 2011 to 2018. Lifestyle modification is needed, especially among non-Hispanic Asians to prevent the metabolic syndrome and the associated risks of diabetes and cardiovascular disease.

Funding Acknowledgement

Type of funding sources: None.
Evaluation of basic nutritional parameters in older adults treated with percutaneous coronary intervention
Authors: Marti Sanchez D , Duarte Torres J , Marschall A , Biscotti Rodil B , Delgado Calva F , Dejuan Bitria C , Del Castillo Carnevali H , Morales Gallardo M J , Lopez Soberon E , Alvarez Anton S
Published: October 2021

Background

Aging patients are characterized by their variability in terms of biological status and outcomes after invasive procedures. Recently, concepts of comorbidity, frailty, and nutrition have been incorporated into clinical decision-making. Of these, nutrition is the least studied component.

Purpose

To analyze the prevalence and impact of different baseline nutritional disorders on the clinical course in the first year after PCI.

Methods

We conducted a prospective observational study of consecutive patients aged ≥75 years treated by PCI in a tertiary hospital between 2014 and 2017. We evaluated the patients with baseline information on the nutritional parameters of the validated Controlling Nutritional Status (CONUT) score variables: serum albumin, total cholesterol and lymphocyte count. We analyze the prevalence of nutritional disorders, CONUT values (ranging from 0–12, with higher values indicating more severe malnutrition), and their relationship with the 12-months cumulative events rates.

Results

The study population comprised 209 patients (mean age 82±5 years, 40% women). The averaged laboratory values were as follows: serum albumin 3.8±0.5 g/dL, total cholesterol 141±35 mg/dL, lymphocytes 1723±913 per mL, CONUT score 2.8±2.2 points. The table shows the prevalence of each nutritional disorder, and its impact on the incidence of ischemic or hemorrhagic events. Hypoalbuminemia was significantly associated with bleeding and mortality. Notably, low cholesterol was associated with a higher incidence of vascular events in this population, and low LDLc levels did not have a protective effect.

Conclusions

The analysis of simple nutritional parameters is relevant in the prognostic prediction after PCI in the older adult. In particular, hypoalbuminemia and low cholesterol levels were associated with a higher incidence of adverse events. Future studies should assess the role of dietary strategies and supplements in this context.

Funding Acknowledgement

Type of funding sources: None. Nutrition disorders and clinical events
IL6 trans-signalling is associated with a higher risk of cardiovascular events in individuals with diabetes
Authors: Ziegler L , Gigante B
Published: October 2021

Background

Pro-inflammatory interleukin 6 (IL6) trans-signalling is associated with an increased risk of future cardiovascular events (CVE). Diabetes mellitus is a well-known risk factor for CVE but its relation to IL6 trans-signalling is not investigated.

Purpose

We aimed at analysing if the CVE risk associated with IL6 trans-signalling differed between individuals with/without diabetes.

Method

In a prospective cohort of 60-year-old men and women from our city (n=4232), 629 CVE (myocardial infarction, hospitalised angina pectoris and ischemic stroke) occurred during a 20-year follow-up. The risk of CVE associated with IL6 trans-signalling was assessed using the binary/ternary complex ratio (B/T ratio), a novel marker of IL6 trans-signalling derived from the serum molar concentrations of IL6 and the soluble IL6 receptors (sIL6R; sgp130). As a B/T ratio > median, mirroring active IL6 trans-signalling with a relative excess of the active binary IL6 complex in relation to the inactive ternary complex, previously was demonstrated to be associated with an increased CVE risk in this cohort we chose the same cut-off. The CVE risk was assessed by Cox proportional hazards models and described as hazard ratios (HR) with 95% confidence intervals (CI) in individuals with/without diabetes mellitus type 1 or 2 (n=114) defined as either self-reported, or fasting glucose >7.0 mmol/L in the baseline blood test. In the adjusted model, risk estimates were adjusted for the common cardiovascular risk factors. The additive interaction between IL6 trans-signalling and diabetes on the CVE risk was analysed using Cox regression and presented as Synergy index (S) with 95% CI where S > or <1 indicate presence of an interaction.

Result

There was a higher CVE risk associated with IL6 trans-signalling assessed by B/T ratio > median in individuals with diabetes (adjusted HR 3.42; 95% CI 1.60–7.29) compared to participants without (adjusted HR 1.36; 95% CI 1.15–1.60) and the interaction analysis suggested a presence of additive interaction between IL6 trans-signalling and diabetes on the CVE risk (adjusted S=5.23; 95% CI 0.93–29.26) as seen in Figure 1.

Conclusion

Individuals with diabetes mellitus have an increased risk of CVE associated with IL6 trans-signalling possibly in part due to an additive interaction between the two.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): The Stockholm County Council ALF projectStrategic research in Epidemiology at Karolinska Institutet Figure 1
Arterial stiffness and valvular calcifications in aortic stenosis: caught between a rock and a hard place
Authors: Gardikioti V , Terentes-Printzios D , Aznaouridis K , Christoforatou E , Benetos G , Drakopoulou M , Latsios G , Oikonomou E , Siasos G , Toutouzas K , Vavuranakis M , Tsioufis K , Vlachopoulos C
Published: October 2021

Background/Introduction

Arterial stiffness and aortic hemodynamics are independent predictors of adverse cardiovascular events. Indications for transcatheter aortic valve implantation (TAVI) are expanding and aortic valve calcifications (AVC) are an important prognostic factor of the success of TAVI.

Purpose

We sought to investigate the associations between AVC and aortic vascular function/hemodynamics.

Methods

Fifty-two high-risk patients (mean age 80.4±8.5 years, 27 male) with severe symptomatic aortic stenosis undergoing TAVI were included. Arterial stiffness was estimated through carotid-femoral pulse wave velocity (cfPWV) and brachial-ankle pulse wave velocity (baPWV). Aortic hemodynamics (aortic pressures, aortic augmentation index corrected for heart rate [AIx@75]) were also measured. Measurements were conducted prior to the implantation and at discharge. In all patients, a native and contrast-enhanced multislice cardiac computed tomography were performed pre-interventionally. AVC were then graded semi-quantitatively as follows: grade 1 – no calcification; grade 2 – mildly calcified (small isolated spots); grade 3 – moderately calcified (multiple larger spots); grade 4 – severely calcified (extensive calcification of all cusps).

Results

Group 1 (subjects with none/mild AVC, n=29) did not significantly differ in age, gender and body-mass index compared to group 2 (subjects with moderate/severe AVC, n=23). As far as the traditional cardiovascular risk factors were concerned, only hypertension (p=0.008), coronary artery disease (p=0.016), atrial fibrillation (p=0.075) and insulin-dependent diabetes mellitus (p=0.068) were found to be more prevalent in group 2. Group 2 had significantly higher both cfPWV and baPWV (8.3±1.7 vs 7.2±1.2 m/s and 1750±484 cm/s vs. 2101±590 cm/s with p=0.008 and p=0.022 respectively) compared to Group 1 (Figure 1). Even after adjustment for age, gender and systolic blood pressure, aortic stiffness indices were higher in Group 2 compared to Group 1 (p=0.038 and p=0.048, respectively). There was no statistically significant difference in peripheral or aortic pressures as well as in wave reflections indices between the two groups.

Conclusion

Our study shows that in patients with aortic valve stenosis there is a correlation between increased aortic stiffness and a greater extent of damage of aortic valvular leaflets as well as calcifications.

Funding Acknowledgement

Type of funding sources: None. Figure 1. PWV and aortic valve calcifications
SF-12 Physical and Mental Health Scales predict cardiovascular events after hospitalization
Authors: Gascuena R , Diaz Ortiz J , Morales Martinez T , Jimenez Virumbrales D , Gomez Diego J
Published: October 2021

Self perceived physical and mental health are easily scored by validated SF-12 questionnaires (a short form of SF-36). Depression can be also scored by HAD scale. We analysed its usefulness to predict death or cardiovascular events after hospitalization.

Methods

69 consecutive patients (median age 75 (95% CI 33.1–88.9) admitted from a cardiovascular cause performed the SF-12 Physical (PSF) and Mental Health (MSF) questionnaires, and Hospital Anxiety and Depression Scale (HAD) before hospital discharge. Charlson's Comorbidity index and Barthel's modified index for Physical Incapacity were also performed and results adjusted by them and clinical issues (cardiovascular diagnosis, ventricular function, age) and social status. Median follow-up was 506 days (95% CI 490–542). Cox-regression univariate analysis was performed, and data were adjusted by multivariate analysis.

Results

23 patients (33,3%) experienced an event during follow-up (a compound of death, acute coronary syndrome, heart failure, and need for readmission). 85.5% of patients showed a physical SF-12 under poblational mean (PSF 34.55; CI 14.34–55.41), and 59.4% of patients showed a diminished mental SF-12 (MSP 45.69; CI 21.94–66.83).

After adjusting by atrial fibrillation (p=0.21), ventricular disfunction (p=0.14), Charlson's index (p=0.013), Barthel's modified index (p=0.035), and age (p=0.013), both mental SF12 (HR 0.93; CI 0.88–0.98; p=0.004) and Physical SF-12 scales (HR 0.935; CI 0.87–0.98; p=0.0.023), together with HAD depression score (HR 0.85; CI 0.75–0.96; p=0.009) were predictors of new cardiovascular events.

Conclusions

Self perceived physical and mental health scales before hospital discharge predict new clinical cardiovascular events during follow-up. Short form questionnaires (SF-12) and HAD scale are easily performed and can be used for selecting high risk patients beyond clinical characteristics.

Funding Acknowledgement

Type of funding sources: None. Physical SF12 and Event Free Survival
Effect of recreational exercise and fitness on left ventricular torsion and wall mechanics study (FIT-TWIST/Health)
Authors: Zaidi S , Wessly P , Larrauri Reyes M , Hurwitz B , Arenas I , Lamas G , Mihos C
Published: October 2021

Background

Left ventricular (LV) remodeling is associated with elite athletics. This study aimed to assess the effects of recreational exercise on LV remodeling and mechanics in healthy adults.

Methods

A prospective cross-sectional study evaluated 38 healthy adult recreational exercise participants with a Bruce protocol treadmill exercise stress test, and 2D and speckle-tracking echocardiography. Fitness level was stratified by the achieved age- and sex-predicted metabolic equivalents (METS) as average/good (group A, N=20; METS=13.9) and high (group B, N=18; METS=18.2) groups.

Results

Mean age was 33 years, and 58% were female. Participants in Group B used more multi-modality (67 vs 20%; p=0.008) or running (50% vs 15%; p=0.04) exercise regimens, and had larger LV mass (66 vs 56 g/m2; p=0.05) and left atrial volume indices (28 vs 22 ml/m2; p=0.02), when compared with group A. However, all LV strain and torsion mechanics were similar between groups (Figure). Multivariate linear regression analysis revealed independent associations between global longitudinal strain (GLS) and transmitral E-wave (β=−0.57), maximum systolic blood pressure (β=0.32), and LV end-diastolic volume index (β=0.32) (model r=0.72; p<0.001). No correlation between METS achieved and LV parameters was observed.

Conclusion

Recreational exercise and fitness are associated with healthy LV geometry and mechanics in adults. Early diastolic LV filling, LV chamber size, and peak exercise blood pressure are correlated with GLS.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Florida Heart Research Foundation
SARS-CoV2 infection: functional and morphological cardiopulmonary changes in elite handball players
Authors: Fikenzer S , Kogel A , Hepp P , Lavall D , Stoebe S T , Rudolph U , Laufs U , Hagendorff A
Published: October 2021

Background

There is increasing evidence of cardiac involvement in SARS-COV-2 infections. This may not only apply to symptomatic infections but may also affect asymptomatic athletes. This study aimed to characterize the possible acute cardiac involvement of SARS-COV-2 infection in athletes both morphologically and functionally.

Methods and results

Eight elite handball players (27±3.5 y) with past SARS-COV-2 infection were retrospectively analyzed and compared with four uninfected team-mates (22±2.6 y). Athletes were examined 19±7 d after positive PCR-test. Echocardiographic assessment of the global longitudinal strain under resting conditions was not significantly changed after SARS-CoV2 infection (−17.7% vs. −18.1%) but magnetic resonance imaging showed minor signs of acute inflammation/edema in all patients (T2-mapping: +4.1ms) without reaching the Lake-Louis criteria. Spiroergometric analysis showed a significant reduction in VO2max (−292 ml/min, −7.0%), oxygen-pulse (−2.4 ml/beat, −10.4%), and respiratory minute volume (VE) (−18.9 l/min, −13.8%) in athletes with a history of SARS-CoV2 infection (p<0.05, respectively). The parameters were unchanged in the control group.

Conclusion

SARS-CoV2 infection caused functional impairment of cardiopulmonary performance primarily under stress in elite athletes.

It seems reasonable to screen athletes after SARS-CoV2 infection at least with spiroergometry to mark performance limitations and to ensure an optimal return to competition.

Funding Acknowledgement

Type of funding sources: None.
Levels of hypersensitive troponin T in the emergency department as a predictive factor of mortality for hospitalized COVID-19 patients
Authors: Pionnier Y P , Denoel P D , Manara A M , Brousmiche K
Published: October 2021

Background

Coronavirus disease 2019 (COVI-19) has resulted in considerable morbidity ans mortality worldwide since December 2019. Cardiac complications are a common condition among patients with COVID-19. The association between elevated hypersensitivity troponin T in COVID-19 disease and risk of mortality remains unclear but data suggest it could be associated with higher risk of in-hospital mortality.

Purpose

The present study examine the potential association between the level of hypersensitive troponin T (Hs TnT) in emergency department (ED) and mortality among patients hospitalized with COVID-19.

Methods

Consecutive patients admitted in two hospitals from ED with confirmed PCR COVID-19 were included in this retrospective study. The data were collected from October 1, 2020 to December 31, 2020. The demographic characteristics (age and sex), clinical data (symptoms, comorbidities, laboratory findings, treatments, complications, and outcomes), and results of cardiac examinations (cardiac biomarkers and electrocardiogram) were collected in an electronic database. There data were analyzed and the mortality at 1 month was compared for patients with normal or elevated Hs TnT (>14 ng/L).

Results

The study population included 413 hospitalized patients with a confirmed PCR COVID-19. The median age was 82. The comorbidities like cardiovascular diseases, cerebrovascular diseases, pulmonary diseases and renal insufficiency are associated with a significant higher mortality (P<0.05). Clinicals findings like tachypnea (respiratory rate >20/minute) or hypotension (<90 mmHg systolic blood pressure) also result an increased mortality (P<0.05). In this cohort, 90 patients had an analysis of Hs TnT in the ED. The mortality at 1 month was higher in patients with elevated Hs TnT (>14 ng/L) compared to the patients with normal levels of Hs TnT and the correlation was significant (P<0.05). The relative risk of fatal outcome is 3.86 when the troponin level is >14ng/L.

Conclusion

Elevated Hs TnT levels in the emergency department appear to be a predictive factor of mortality at one month for patients with COVID-19 infection requiring admission.

Funding Acknowledgement

Type of funding sources: None.
Social determinants and mortality from cardiovascular disease in Brazil
Authors: Bastos L , Oliveira G M M , Villela P B , Feliciano S C C , Bichara J L P
Published: October 2021

Introduction

Cardiovascular diseases (CVD) are the main cause of death in Brazil and worldwide, with Ischemic Heart Diseases (IHD) of great importance among them. This relevance increases with the aging of the world population and seems to be related to each country's social determinants.

Objectives

To analyze the temporal evolution of mortality rates due to CAD and IHD by sex, age group, Federation Unit (FU), and Geographic Regions (GR) in Brazil, from 1980 to 2019, and the associations with the Municipal Human Development Index (MHDI).

Methods

Ecological study of time series of deaths from CVD and IHD in Brazil. We analyzed the crude and standardized mortality rate by CVD and IHD by sex, age group, FU, and GR between 1980 and 2019 and correlated with the MHDI. Deaths and the population were obtained from DATASUS to estimate mortality rates per 100,000 inhabitants, crude and standardized (direct method with the Brazilian population in 2000). The MHDI for each FU was extracted from the Atlas Brasil website (ATLAS BRASIL, 2017).

Results

Between 1980 and 2019, there were 10,836,004 deaths from CVD and 3,264,828 from IHD in Brazil, 52.86% and 58.39%, respectively, in men. The mortality rate analysis due to CVD and IHD standardized by age showed a downward trend nationwide. The relationship between the variations in these rates between the years 1980 and 2019 and the MHDI 2010 demonstrated a reduction in mortality in UFs with an MHDI above 0.7 (Figures 1 and 2).

Conclusion

The social determinants, represented by the MHDI, correlate with mortality from CVD and IHD in Brazil's UF, where the most developed ones have less mortality from these causes.

Funding Acknowledgement

Type of funding sources: None.
Directly quantified abdominal subcutaneous adipose tissue volume is negatively associated with subclinical coronary artery disease in men with psoriasis
Authors: Teklu M T , Zhou W Z , Kapoor P K , Patel N P , Playford M P P , Sorokin A V S , Dey A K D , Teague H L T , Manyak G A M , Rodante J A R , Keel A K , Chen M Y C , Bluemke D A B , Mehta N N M
Published: October 2021

Background

Psoriasis is a common chronic inflammatory condition associated with an increased risk of obesity and higher coronary atherosclerosis burden by coronary computed tomography angiography (CCTA). Prior studies have shown that the ability to expand subcutaneous adipose tissue (SAT) may serve to identify individuals at a lower risk of atherosclerotic cardiovascular disease. However, the relationship between abdominal SAT and high-risk subclinical coronary artery disease requires exploration.

Purpose

To characterize the relationship between abdominal SAT volume measured on low-dose computed tomography, and coronary artery disease assessed as noncalcified and lipid-rich necrotic core burden by CCTA in psoriasis.

Methods

We performed a cross-sectional study of 232 participants with psoriasis and without known cardiovascular disease. All participants underwent CCTA to characterize coronary artery disease burden and low dose abdominal computed tomography to quantify subcutaneous adipose tissue volumes. Fat depot volumes were first adjusted in a sex specific manner for each participant's body mass index in a linear regression model. The residual values from the sex stratified linear regression models were used for analyses. Coronary artery disease burden was quantified in the three main coronary arteries (QAngio, Medis, The Netherlands) and averaged. Analyses were performed with StataIC 16 (Stata Corp., College Station, TX, USA).

Results

Of the 232 participants, 92 (40%) were women and the average age was 50 years. In women, there was a positive correlation between abdominal SAT and systemic inflammation as assessed by hs-CRP (r=0.30; p=0.004) and GlycA (r=0.29; p=0.007) as well as total cholesterol (r=0.24; p=0.02) and LDL cholesterol (r=0.22; p=0.04). In men, abdominal SAT correlated with hs-CRP (r=0.18; p=0.04) and insulin resistance as assessed by the homeostatic model for insulin resistance (r=0.17; p=0.04). In models fully adjusted for traditional cardiovascular risk factors, abdominal SAT volume negatively associated with noncalcified and lipid-rich necrotic core burden in men (β=−0.17; p=0.03, β=−0.21; p=0.02, respectively), but not women (β=−0.04; p=0.72, β=0.05; p=0.68, respectively) with psoriasis (Table).

Conclusions

In psoriasis, for a given body mass index, abdominal SAT negatively associated with coronary atherosclerosis burden in men. The observed sex-specific effects on subclinical coronary artery disease warrant further study of abdominal SAT in states of chronic inflammation.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Heart, Lung and Blood Institute Intramural Research Program in Bethesda, Maryland
Sex-differences in outcomes after percutaneous coronary intervention of chronic total occlusions: insights from a large single-center registry
Authors: Kumar S , Kyaw H , Giustino G , Sartori S , Sharma S , Kini A , Mehran R
Published: October 2021

Introduction

Patients undergoing PCI of chronic total occlusions (CTO) are at high risk of both periprocedural and post-procedural adverse events. Whether sex-differences in outcomes exist after PCI of CTO remains unclear.

Purpose

We sought to investigate sex-differences in outcomes after CTO-PCI among an unselected real-world cohort of patients.

Methods

In our single-center retrospective study, patients who underwent elective CTO intervention from January 2000 to December 2019 were included. The primary endpoint of interest was major adverse cardiac events (MACE) defined as the composite of death, myocardial infarction (MI), and target vessel revascularization (TVR) at 1 year of follow-up.

Results

A total 1897 patients were included of which 368 were women (19.4%). Women were older (67±11.3 years vs. 62.6±10.9 years) and had a higher prevalence of comorbidities including diabetes and chronic kidney disease. Women had higher rates of procedure-related complications including increased risk of post-procedural bleeding requiring blood transfusion (3.0% vs 1.1%; p=0.007), and acute vessel closure (1.36% vs 0.2%; p=0.009). In multivariable-adjusted models for baseline confounders, female sex was associated with higher risk of MACE and TVR (Table 1).

Conclusion

Gender differences in CTO management are observed, with fewer females going for CTO revascularization in contemporary practice. Female sex is associated with procedural-related complications, higher MACE, and TVR even after successful CTO intervention.

Funding Acknowledgement

Type of funding sources: None.