bluuebunny/crossref_metadata_2025 huggingface dataset:
Patent foramen ovale closure: a comparison between two types of devices in a retrospective cohort
Authors: Chatelain Q , Giannakopoulos G , Adamopoulos D , Roffi M , Muller H , Noble S
Published: October 2021

Background

Patent foramen ovale (PFO) closure has been shown to reduce the risk of recurrent stroke in selected patients. Different PFO occluding devices have been validated by the authorities and are used in the clinical practice.

Purpose

The main purpose of this study is to compare the use of two types of devices for PFO closure, the GORE CARDIOFORM Septal occluder and the AMPLATZER occluders (PFO or CRIBIFORM) in terms of major clinical safety and efficacy outcomes.

Methods

In this single-center retrospective study, the final cohort comprised 182 patients who underwent PFO closure between January 2012 and May 2019 (mean age 57±13 years, 34% males). The population was divided in two groups according to the device used (GORE CARDIOFORM Septal occluder [n=66, 36%] or the AMPLATZER occluders [n=116, 64%]). The endpoints assessed at 6 months, were the presence of a significant shunt (at least moderate [10–25 microbubbles] at rest or during the Valsalva manoeuvre), the incidence of supraventricular arrythmias, recurrent stroke, or serious device-related adverse events.

Results

At 6 months, a small percentage of patients with significant residual shunt was found in both the GORE and the AMPLATZER groups (7% vs 14% respectively, p=0.182). The incidence of supraventricular arrythmias was lower in the GORE as compared to the AMPLATZER group (9.1% vs 22.4% respectively, p=0.023). During the 6-month follow-up period there were 3 ischemic strokes, all of them in the AMPLATZER group, but this difference did not reach statistical significance (p=0.188). Finally, no serious device-related adverse events were noted in the total cohort.

Conclusion

PFO closure with a GORE device is related to lower incidence of supraventricular arrythmias at 6 months. The presence of a significant residual shunt and the incidence of recurrent stroke were comparable between both groups.

Funding Acknowledgement

Type of funding sources: None.
Changes in aortic valve hemodynamics and ventricular functional measurements in patients undergoing transcatheter and surgical aortic valve replacement: a head-to-head comparison
Authors: Manla Y , Khalouf A , El Zouhbi A , Lee St John T , Bafadel A , Traina M , Al Badarin F J , Edris A
Published: October 2021

Introduction

Both surgical and transcatheter aortic valve replacement are effective interventions for treatment of patients with severe aortic stenosis. Data from landmark randomized trials have shown comparable improvement in aortic valve hemodynamics and left ventricular remodeling. Whether similar patterns will be observed in real-world practice has not been completely investigated.

Purpose

To compare the impact of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) on short- and intermediate-term changes in aortic valve hemodynamics and left ventricular reverse-remodeling.

Methods

A total of 213 patients with severe AS were referred for TAVR (n=137) or SAVR (n=76) at a single center (August/ 2015-Feb/ 2021). Patient demographics and echocardiographic parameters of aortic valve stenosis severity were collected retrospectively. Changes over-time in aortic valve area, mean gradient, dimensionless index, left ventricular ejection fraction (EF), and ventricular septal thickness were examined using linear mixed models.

Results

Patients undergoing TAVR were older with higher STS risk scores and a greater burden of comorbidities (Table). Over a median follow-up of 13 months (IQR 4–31), both groups experienced a significant reduction in aortic valve mean gradient (25.7 mmHg with TAVR and 18.8 mmHg with SAVR), with no significant between-group difference (P=0.15). Aortic valve dimensionless index significantly increased in TAVR and SAVR groups (0.23 and 0.13, respectively) and was more pronounced in the TAVR group (P=0.01). Similarly, aortic valve area increased significantly in both groups (0.66 cm2 and 0.42 cm2, respectively) without a significant across-group difference (P=0.07). On the other hand, left ventricular ejection fraction did not change significantly over time (−0.61 and 1.15 EF points, respectively) with no significant between-group difference at 12 months (P=0.06). Ventricular septal thickness was significantly reduced in both groups, with no significant between group difference (P=0.4; Figure).

Conclusion

In this real-world experience, both TAVR and SAVR were associated with significant improvement in aortic valve hemodynamic parameters and modest reverse left ventricular remodeling. Furthermore, these changes were comparable with both modalities, adding to available evidence from randomized clinical trials on beneficial effects of both TAVR and SAVR.

Funding Acknowledgement

Type of funding sources: None. Table 1Figure 1
Association of markers of vascular inflammation with blood pressure in midlife: the Hordaland Health Study
Authors: Kringeland E A , Tell G S , Ulvik A , Midtbo H , Igland J , Haugsgjerd T R , Ueland P M , Gerdts E
Published: October 2021

Background

Hypertension is a pro-inflammatory condition. A steeper rise in blood pressure (BP) has been observed in middle-aged women than men. However, sex-specific associations of vascular inflammation with midlife BP has not been much explored.

Purpose

To test the association of markers of vascular inflammation, including neopterin, kynurenin:tryptophan ratio (KTR) and high sensitive C-reactive protein (CRP) with BP.

Methods

Circulating levels of neopterin, KTR and CRP were measured in 2042 women and 1646 men aged 47–49 years from the community-based Hordaland Health study. The associations with systolic and diastolic BP were tested in sex-specific linear regression analyses and adjusted for body mass index, serum total- and high-density lipoprotein cholesterol, triglycerides, creatinine, physical activity, daily smoking and diabetes.

Results

Compared to men, women had lower average BP (124/72 vs. 131/78 mmHg, p<0.001), higher plasma neopterin (7.5 vs 7.0 nmol/l, p<0.001) and comparable plasma KTR and serum CRP (both p>0.05). In multivariable analyses 1) higher neopterin was associated with higher diastolic BP in women, but not in men; 2) higher CRP was associated with higher systolic and diastolic BP in women, but not in men; 3) no association of higher KTR with BP was found in either sex (Table 1). A significant sex-interaction between neopterin and diastolic BP was found.

Conclusion

Among participants in the Hordaland Health study, higher circulating levels of neopterin and CRP with higher BP was found among women only, suggesting that vascular inflammation contributes to BP elevation in middle-aged women.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): University of Bergen
Cardiovascular protection by combination of the selective nonsteroidal MR antagonist finerenone and the SGLT2 inhibitor empagliflozin in a preclinical model of hypertension-induced end-organ damage
Authors: Kolkhof P , Hartmann E , Freyberger A , Pavkovic M , Mathar I , Sandner P , Droebner K , Joseph A , Eitner F , Hueser J
Published: October 2021

Background

The nonsteroidal mineralocorticoid receptor (MR) antagonist finerenone and SGLT2 inhibitors have demonstrated clinical benefits in HFrEF and CKD patients with T2D. Cardiovascular protection with finerenone and the SGLT2 inhibitor empagliflozin in combination in hypertensive cardiorenal disease is unknown.

Purpose

To test the hypothesis that the combination of finerenone with empagliflozin provides cardiovascular protection in preclinical hypertension-induced end-organ damage.

Methods

Cardiovascular morbidity and mortality was studied in hypertensive L-NAME (20 mg/L) treated renin-transgenic (mRen2)27 rats. Rats (10–11 weeks old female, n=13–17/group) were treated once daily orally for up to 7 weeks with placebo, finerenone (1 and 3 mg/kg), empagliflozin (3 and 10 mg/kg), or a combination of the respective low doses. Blood pressure (week 1, 3 and 5), urinary (week 2 and 6) and plasma parameters (week 6 and at the end of the study) were determined during the course of the study, while cardiac histology and left ventricular gene expression analysis were performed after study end.

Results

Empagliflozin induced a strong and dose-dependent increase in urinary glucose excretion which was not influenced by finerenone co-administration in the combination arm. Treatment with 3 mg/kg finerenone and the low dose combination significantly decreased systolic blood pressure (SBP) after 3 and 5 weeks as well as plasma uric acid after 6 weeks. SBP was significantly more reduced in the combination arm vs. the individual monotherapies after 3 weeks. Plasma NT-proBNP was reduced by empagliflozin, finerenone and the combination with similar efficacy. There was a dose-dependent protection from cardiac vasculopathy, cardiac and vascular fibrosis with both agents while low dose combination therapy was more efficient than the respective monotherapy dosages on these cardiac histology parameters. Placebo-treated rats demonstrated a ca. 50% survival rate over the course of 7 weeks while low dose combination provided the most prominent survival benefit (93%).

Conclusion

Non-steroidal MR antagonism by finerenone and SGLT2 inhibition by empagliflozin confer cardiovascular protection in preclinical hypertensive-induced cardiorenal disease. Combination of these two modes of action at low dosages revealed efficacious reduction in blood pressure, cardiac lesions and mortality indicating a strong potential for combined clinical use in cardiorenal patient populations.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): BAYER AG
Echocardiography indices in urbanized representatives of the Shor ethnic group with the presence of arterial hypertension
Authors: Sumin A , Gomozova N S , Shcheglova A V , Arhipov O G
Published: October 2021

In patients with arterial hypertension, the detection of left ventricular hypertrophy has important clinical and prognostic significance. The use of published regulatory “control limits” remains limited and cannot be extended to other racial and ethnic groups. The aim of this study was to compare echocardiography indicators in patients with arterial hypertension from two ethnic groups living in the Gornaya Shoria region.

Methods

The study included patients with arterial hypertension: 58 indigenous and 50 non-indigenous urbanized residents, comparable in age, and divided by ethnicity and gender into 4 groups: men of indigenous nationality (n=20), women of indigenous nationality (n=38), men of non-indigenous nationality (n=15) and women of non-indigenous nationality (n=35). All of them underwent echocardiographic examination.

Results

The body weight and BSA were lower in men and women of Shor ethnicity than in men and women of non-indigenous ethnicity (p=0.0014 and p=0.004). LAi was significantly larger in men of Shor nationality (p=0.049), at the same time, the size of their RA was the smallest (p=0.04). The data of the longitudinal LV systolic function in the form of a systolic excursion of the septum (s'sept) were the highest in Shor men (p=0.004), and the LV performance index was the lowest in them (p=0.012). Also in this group, the minimum isovolumic relaxation time (p=0.03) and the highest rate of early diastolic filling of the LV (p=0.04) were noted. When assessing correlations independent factors associated with pronounced LVH were glucose, DBP, and urea in Shor patients. Non-indigenous nationality independent factors associated with pronounced LVH were waist circumference and DBP.

Conclusion

Echocardiographic examination of patients with hypertension revealed the features of structural and functional indicators in the representatives of the indigenous urbanized population of the Mountain Shoria in comparison with the representatives of the non-indigenous population. This study can be useful in assessing the impact of the development of arterial hypertension, as well as the impact of changing the lifestyle of the Shors when moving to the city from rural areas on ethnic differences in echocardiography.

Funding Acknowledgement

Type of funding sources: None.
Blood pressure changes during the the COVID-19 pandemic and associated lockdown period
Authors: Girerd N , Meune C , Duarte K , Vercamer V , Lopez-Sublet M , Mourad J J
Published: October 2021

Background

Despite widespread investigation into the incidence of acute myocardial infarction during the COVID-19 pandemic and associated lockdown, no study has examined the situation's impact on blood pressure (BP) levels.

Methods

Measurements of BP and heart rate (HR) were obtained from persons living in the Paris urban area using connected home BP monitors (accessible to patients and health providers through a secured server). Three time periods of e-Health recordings were compared: during the pandemic prior to the lockdown, during the lockdown and the same time period in 2019.

Results

A total of 297,089 BP recordings from 2,273 participants (age 56.3±12.8 years, 81.1% male) were made. During confinement, systolic BP gradually decreased by 3 mmHg (−2.4 to −3.9), and diastolic BP, by 1.5 mmHg (−1.4 to −2.2) (all p<0.001); this decrease was greater for participants with higher BP (p<0.0001 each). No significant variation in HR was noted.

Conclusion

Among a very large cohort, we observed a significant decrease in home BP measured with e-Health devices during the first lockdown period. This study emphasizes the research potential of e-Health during the Covid crisis.

Funding Acknowledgement

Type of funding sources: None. Changes in BP during the French Lockdown
Influences of smoking on central blood pressure in hypertensive subjects
Authors: Hayashi K , Takase H , Nakano S , Ohno K , Takayama S , Machii M , Sugiura T , Ohte N , Dohi Y
Published: October 2021

Background/Introduction

Smoking is known to induce systemic vascular damage, leading to cardiovascular diseases. Recent studies demonstrated that central blood pressure has a greater impact on cardiovascular events than brachial blood pressure.

Purpose

We investigated influences of habitual smoking on central systolic blood pressure (CSBP) in hypertensive subjects.

Methods

A total of 5630 subjects (male = 2622, 51.7±12.0 year-old at baseline), who visited our hospital for a physical check-up at least twice during the last 10 years and underwent CSBP measurement at each visit, were enrolled, and they were divided into three groups; normotensive (n=4634), non-treated hypertensive (n=91) and treated hypertensive subjects (n=905). Then, the influences of smoking on the average and yearly changes of CSBP (median follow-up 5 years) were analyzed. Brachial blood pressure (oscillometer) and radial artery pressure waveforms (tonometer) were recorded using an automated device, and the pressure corresponding to the second systolic peak of radial pressure waveforms was taken as CSBP (HEM-9000AI, Omron Healthcare, Kyoto). Hypertension was defined as brachial BP ≥140/90mmHg or the use of antihypertensive medications. A yearly change in CSBP was calculated in each subject by linear regression analysis using longitudinal data.

Results

The average CSBP was higher in habitual smokers than in non-smokers when analyzed in normotensive (109.1±11.7 vs. 107.6±12.8 mmHg, p<0.001) and non-treated hypertensive subjects (150.7±14.8 vs. 142.8±16.7 mmHg, p<0.05), whereas in hypertensive subjects under medication the average CSBP was lower in smokers than in non-smokers (124.6±12.4 vs. 127.8±13.6 mmHg, p<0.01). Smoking status did not affect yearly changes of CSBP in normotensive (habitual smokers vs. non-smokers; 1.38±6.00 vs. 1.44±6.04 mmHg/year), treated hypertensive (−0.16±7.08 vs. −0.66±8.24 mmHg/year), and non-treated hypertensive subjects (4.09±15.1 vs. −0.53±10.3 mmHg/year).

Conclusions

Habitual smoking increases CSBP, however, antihypertensive medications counteract the unfavorable effects of smoking on CSBP. These results imply a new pathway underlying the development of cardiovascular diseases in smokers. Unfavorable changes in the cardiovascular system caused by smoking may quite slowly progress that short period of observation in the present study could not have detected enhanced yearly increases of CSBP by smoking.

Funding Acknowledgement

Type of funding sources: None.
Cardio-ankle vascular index is useful screening method to detect obstructive coronary artery disease in asymptomatic diabetes patients with subclinical atherosclerosis
Authors: Ono T , Miyoshi T , Ueki Y , Kuroda K , Saito E , Tsuji M , Kawamura K , Tokioka K , Ohe T , Kawai Y
Published: October 2021

Background

Patients with diabetes mellitus are at very high risk for obstructive coronary artery disease; however, invasive coronary angiography is not allowed to apply in all patients. Cardio-ankle vascular index (CAVI), a marker of arterial stiffness has been reported to reflect atherosclerotic burden.

Purpose

To assess the diagnostic performance of CAVI vs. coronary calcium score for detecting obstructive coronary artery disease determined by Coronary CT angiography (CCTA) in asymptomatic diabetes patients.

Methods

During May 2015 to December 2019, 816 patients with diabetes mellitus were evaluated. First, intima-media thickness of carotid artery was measured in all subjects. Then, patients with intima-media thickness over 11mm underwent CAVI. Finally, 209 patients who have one or more cardiovascular risk factors other than diabetes mellitus were enrolled (68±11 years, 68% men). Patients were excluded if they had a disorder of the kidney, a prior history of coronary artery revascularization, atrial fibrillation, LV ejection fraction <50%, ABI <0.9 or allergy to contrast. Diagnostic performance of CAVI was evaluated with coronary stenosis >50% by CCTA.

Results

CAVI, Agatston score, and intima-media thickness of carotid artery were 9.2±1.3, 396±621 and 2.0±0.7mm, respectively. CAVI was significantly correlated with age (r=0.530, p<0.001), coronary artery calcification (r=0.182, p=0.008), and intima-media thickness of carotid artery (r=0.195, p=0.005). Among them, 108 patients (48%) had coronary stenosis. CAVI, Agatston score and intima-media thickness of carotid artery in patients with coronary stenosis were higher than that without coronary stenosis, respectively (9.8±1.1 vs 8.5±1.0, p<0.001, 526±676 vs. 255±525, p=0.001, 2.2±0.7 vs. 1.8±0.6, p<0.001). The ROC curve analysis of CAVI for discriminating coronary stenosis showed that the sensitivity 75.0% and specificity 77.2% at the cut off value of 9.23 (AUC=0.812, p<0.001). Contrastingly, diagnostic performance of coronary calcium score and intima-media thickness of carotid artery were less than CAVI (sensitivity: 91.7%, specificity: 56.4%, AUC=0.753, p<0.05 vs. CAVI, sensitivity: 68.5%, specificity: 59.4%, AUC=0.663, p<0.05 vs. CAVI). Multivariate logistic analysis demonstrated that CAVI was significantly associated with coronary stenosis (OR=4.133, p<0.001) after adjustment of conventional risk factors, although coronary calcium score was not correlated with coronary stenosis.

Conclusion

CAVI could be informative to select patients having obstructive coronary artery disease in asymptomatic diabetes patients with thick intima-media thickness.

Funding Acknowledgement

Type of funding sources: None.
Clinical and genetic markers of prehypertension in North-Western Russian population
Authors: Erina A , Usoltsev U , Kolosov N , Solntsev V , Kostareva A , Palotie A , Daly M J , Konradi A , Rotar O , Artomov M
Published: October 2021

Introduction

Prehypertension is a medical classification for patients with above normal blood pressure (BP) but insufficient for confirming hypertension diagnosis. Condition is often asymptomatic as it gradually develops over the years, yet recent meta-analyses suggest that prehypertension is a significant risk factor for stroke and other cardiovascular diseases.

Methods

We analyzed phenotypic data from 879 (age 25–64) individuals without hypertension from a population based-sampling cohort of St. Petersburg region in the North-West of Russia to identify clinical risk factors associated with prehypertension condition. All patients were divided in two groups – optimal BP (systolic BP <120 mmHg and diastolic BP <80; N=426) and prehypertension (systolic BP in range 120–140 mmHg and diastolic BP in range 80–90 and not on antihypertensive therapy; N=453).

Results

Phenotypic analysis with linear regression was corrected for age, sex, smoking status, BMI and levels of LDL and HDL cholesterol (Figure 1). Interestingly, blood level of insulin was significantly associated with prehypertension status along with insulin resistance index, however, presence of diabetes diagnosis in medical history was not significant. Phenotypes associated with prehypertension suggest that prehypertension is often developing along with hyperinsulinemia.

Finally, we estimated polygenic risk scores (PRS) for hypertension using UK biobank GWAS summary statistics and confirmed that prehypertension is more frequent at earlier age in patients with higher genetic susceptibility (Figure 1, Figure 2).

Conclusions

Hyperinsulinemia and genetic susceptibility to hypertension are strong risk factors for prehypertension.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was financially supported by the Ministry of Science and Higher Education of the Russian Federation (Agreement No. 075-15-2020-901) to Al.K. Figure 1. Clinical markers of prehypertensionFigure 2. Genetic markers of prehypertension
The quality of plant-based dietary patterns affects the ten-year cardiovascular disease risk of participants with non-alcoholic fatty liver disease: highlights from a population-based cohort study
Authors: Kouvari M , Tsiampalis T , Chrysohoou C , Georgousopoulou E , Skoumas J , Mantzoros C S , Pitsavos C , Panagiotakos D B
Published: October 2021

Background/Introduction

Some plant-based diets like the Mediterranean diet have been suggested to have a beneficial impact on liver disease. However, the quality of plant-based diets – in general – varies.

Purpose

The association between plant-based diet indices and non-alcoholic fatty liver disease (NAFLD) as well as their interaction on ten-year cardiovascular disease incidence was examined.

Methods

A prospective study was conducted during 2001–2012 studying n=1,514 males and n=1,528 females (aged >18 years old) free of CVD. Healthy metabolic status was defines as absence of all NCEP ATP III (2005) metabolic syndrome components (excluding waist circumference). Follow-up CVD assessment (2011–2012) was achieved in n=2,020 participants (n=317 cases). Overall, healthful and unhealthful plant-based dietary indices (PDI, hPDI and uPDI) were created through a standard procedure; hPDI was principally characterized by increased consumption of fruits/vegetables, whole grains, nuts, legumes, oils, tea/coffee while uPDI was related with increased intake of juices, sweetened beverages, refined grains, potatoes and sweets. NAFLD was defined according to validated liver steatosis indices.

Results

In total, n=707 (35%) participants presented NAFLD at baseline. Ranking from 1st to 3rd PDI tertile, NAFLD prevalence was 40.3%, 35.6% and 30.9%, respectively (p=0.04). Multiadjusted analysis revealed significant inverse associations between PDI and NAFLD prevalence [Odds Ratio (OR) (3rd vs. 1st tertile)=0.60 95% Confidence Interval (95% CI) (0.35, 0.92)] as well as hPDI [OR (3rd vs. 1st tertile) = 0.75 95% CI (0.64, 0.89)]. On the other side, increased uPDI had a positive association with NAFLD prevalence [OR (3rd vs. 1st hPDI tertile) = 1.22 95% CI (1.05, 1.34)]. NAFLD predicted CVD in multi-adjusted model [Hazard Ratio (HR) = 1.35, 95% CI (1.08, 2.10)]. Subgroup analyses according to participants' adherence to overall, healthy and unhealthy plant-based patterns revealed that this observation remained significant in the following cases: participants in the 1st PDI tertile, [HR=1.40, 95% CI (1.15, 2.09)] and participants in the 1st hPDI tertile [HR=1.47, 95% CI (1.22, 2.12)].

Conclusions

Lower adherence to plant-based diet was associated with substantially higher long-term CVD risk for a NAFLD individual. Most importantly, the healthy or unhealthy food choices within this pattern seemed to determine liver steatosis progression and in turn cardiometabolic health.

Funding Acknowledgement

Type of funding sources: None.
Marketing mortality? Healthy vs. unhealthy food in television advertising
Authors: Ikram M I , Hill K H , Williams K
Published: October 2021

Background

Cardiovascular disease has been the leading killer of Americans since the Spanish flu pandemic of 1918, despite recent COVID-19 mortality. During this global pandemic, the social distancing and stay-at-home requests, there was increased television (TV) engagement, and media marketing has become more impactful in modifying consumer behaviors.

Purpose

We evaluated the healthfulness of food marketing in the United States (US), based on TV commercials most frequently aired on American primetime networks during the COVID-19 pandemic.

Methods

We reviewed a total of 104 TV commercials between 2020–2021 on network and cable programs dividing them into 4 categories: 1) fast-food chains, 2) brand-recognized individual items, 3) grocery chains, and 4) home-delivery meals. The food items displayed in each commercial were recorded and scored based on the previously validated healthful versus unhealthful nutrition scoring system (Sajita, et al., JACC 2017), assigning either positive or negative values for each food item in the commercial.

Results

We found that 58% of the commercials advertised food from fast-food chains (mean score = −2.82, indicating an average of nearly 3 more unhealthy items than healthy items per commercial), 27% were brand-recognized individual items (−0.86), 9% were grocery chains (−0.90), and 6% were for home-delivery meals (−0.33), with significant differences noted between fast-food and individual items, home deliveries and grocery chains (each p<0.0001).

Conclusions

This study demonstrated that commercial TV in the US routinely promotes the consumption of foods that are known in published medical literature to be unhealthy, particularly those underpinning cardiovascular disease and its risk factors. In order to prevent an increase in cardiovascular mortality during and after this global pandemic, we suggest regulation and or legislation to curtail the frequency and/or content of these commercials, and consider a ban on such advertising to children, similar to that previously employed in Canada and the European Union.

Funding Acknowledgement

Type of funding sources: None.
Combined cardiac risk factors predict COVID-19 related mortality and the need for mechanical ventilation in Coptic Clergy
Authors: Henein M Y , Bytyci I , Nicoll R , Sheneuda R , Ayad S , Cameli M , Vancheri F
Published: October 2021

Background and aims

The clinical adverse events of COVID-19 among clergy worldwide have been found higher than among ordinary communities, probably because of the nature of their work. The aim of this study, was to assess the impact of cardiac risk factors on COVID-19-related mortality and the need for mechanical ventilation in Coptic clergy.

Methods

Of 1576 Coptic clergy participating in the COVID-19-Clergy study, serving in Egypt, USA and Europe, 213 had the infection and were included in this analysis. Based on the presence of systemic arterial hypertension (AH), participants were divided into two groups: Group-I, Clergy with AH (n=77) and Group-II, without AH (n=136).Participants' demographic indices, cardiovascular risk factors, COVID-19 management details and related mortality were assessed.

Results

Clergy with AH were older (p<0.001), more obese (p=0.04), had frequent type 2 diabetes (DM) (p=0.001), dyslipidemia (p=0.001) and coronary heart disease (CHD) (p=0.04) compared to those without AH. COVID-19 treatment at home, hospital or in intensive care did not differ between the patient groups (p>0.05 for all). Clergy serving in Northern and Southern Egypt had a higher mortality rate compared to those from Europe and the USA combined (5.22%, 6.38%, 0%; p=0.001). The impact of AH on mortality was significant only in Southern Egypt (10% vs. 3.7%; p=0.01) but not in Northern Egypt (4.88% vs. 5.81%; p=0.43).

In multivariate analysis, CHD OR 1.607 [(0.982 to 3.051); p=0.02] and obesity, OR 3.403 [(1.902 to 4.694); p=0.04]predicted COVID-19 related mortality. A model combining cardiac risk factors (systolic blood pressure (SBP) ≥160 mmHg, DM, obesity, dyslipidemia and history of CHD), was the most powerful independent predictor of COVID-19-related mortality, OR 4.813 [(2.011 to 7.017); p=0.008]. The same model also proved the best independent multivariate predictor of mechanical ventilation OR 1.444 [(0.949 to 11.88); p=0.001].

Conclusion

In Coptic clergy, the cumulative impact of risk factors is the most powerful predictor of mortality and the need for mechanical ventilation in Coptic clergy.

Funding Acknowledgement

Type of funding sources: None.
Cardiac biomarkers as prognosticators among SARS-CoV-19 patients in a tertiary hospital in Philippines
Authors: Ong R , Chacon C , Javier S
Published: October 2021

Background

There is overwhelming volume of confirmed cases of COVID-19, despite this numerous knowledge gaps remain in the diagnosis, management, and prognostication of this novel coronavirus infection, making prevention and control a challenge.

Methods

This retrospective cohort study included patients with real-time reverse transcriptase polymerase chain reaction (rRT-PCR)-confirmed COVID-19. Binary logistic regression was used to determine the association between the cardiac biomarkers and in-hospital mortality. ROC, AUC, and cutoff analyses were used to determine optimal cutoff values for the cardiac biomarkers.

Results

A total of 90 subjects with a complete panel of cardiac biomarkers out of the 224 rRT-PCR confirmed cases were included. The median age was 57 years (IQR, 47–67 years), majority were males. Sixty-six (77.6%) subjects survived while 19 (22.4%) expired. The most common presenting symptom was fever (75.6%), and the most common comorbidity was hypertension (67.8%). Spearman rho correlation analysis showed moderate positive association of high sensitivity troponin I (hsTnI) with in-hospital mortality (R, 0.434, p = <0.001). Multivariate binary logistic regression analysis showed that creatine kinase and hsTnI were independently associated with in-hospital mortality (OR, 4.103 [95% CI, 1.241–13.563], p=0.021; and OR, 7.899 [95% CI, 2.430–25.675], p=0.001, respectively). ROC curve analysis showed that hsTnI was a good predictor for in-hospital mortality (AUC, 0.829 [95% CI, 0.735–0.923], p = <0.001) and that creatine kinase was a poor predictor (AUC, 0.677 [95% CI, 0.531–0.823], p=0.018). Optimal cutoff point derived from the ROC curve for hsTnI was 0.010 ng/ml (J, 0.574) with a sensitivity of 84% (TPR, 0.842 [95% CI, 0.604–0.966]), specificity of 73% (TNR, 0.732 [95% CI, 0.614–0.386]), and an adjusted negative predictive value of 99% (Known prevalence*adjusted NPV, 0.989), a positive likelihood ratio of 20% (LR+, 3.147 [95% CI, 2.044–4.844]) and a negative likelihood ratio of 30% (LR−, 0.216 [95% CI, 0.076–0.615]).

Conclusion

High sensitivity troponin I level was a good tool with a very high negative predictive value in significantly predicting in-hospital mortality among rRT-PCR positive COVID-19 patients.

Funding Acknowledgement

Type of funding sources: None. ROC Curve
Higher plasma level of small dense low-density lipoprotein cholesterol in ST-segment-elevation myocardial infarction patients with plaque rupture
Authors: Arai T , Sekimoto T , Mori H , Sakai R , Tanaka H , Oishi Y , Ogura K , Nomura K , Sakai K , Tsujita H , Kondo S , Koba S , Shinke T
Published: October 2021

Aim

The aim of this study was to compare small dense low-density lipoprotein cholesterol (sd-LDL-c) and various lipid markers between patients exhibiting plaque rupture (PR) in the culprit lesions evaluated by optical coherence tomography (OCT) imaging and those without PR in ST-segment elevation myocardial infarction (STEMI) patients.

Methods

We studied consecutive 60 de novo culprit lesions in 60 patients with STEMI who underwent pre-intervention OCT. PR was defined as a plaque containing a cavity that had overlying residual fibrous caps. Plasma sd-LDL-c was measured directly by homogeneous assay at the time of primary percutaneous coronary intervention.

Results

The patients were classified into PR (n=40, 66.7%) or non-PR (n=20, 33.3%). There were no significant differences in low-density lipoprotein cholesterol (LDL-c), non-high-density lipoprotein cholesterol (non-HDL-c) and pre-admission statin therapy between two groups (135.1±38.0 mg/dL vs 129.2±43.8 mg/dL; p=0.35, 157.1±37.4 mg/dL vs 143.0±37.7 mg/dL; p=0.24, 15.0% vs 20.0%; p=0.93). However, sd-LDL-c level was significantly higher in patients with PR than those with non-PR (44.0±18.1 mg/dL vs 28.0±9.3 mg/dL; p=0.0005). On multiple logistic regression analysis, sd-LDL-c was an independent predictor of PR (odds ratio, 1.14 per 1 mg/dL; p=0.0063).

Conclusion

Sd-LDL-c was significantly associated with PR of the culprit lesion in patients with STEMI.

Funding Acknowledgement

Type of funding sources: None.
Specific risk factors profile and abstinence rate of female smokers at high cardiovascular risk from the nationwide smoking cessation services cohort CDT-net
Authors: Allagbe I , Thomas D , Airagnes G , Limosin F , Chague F , Zeller M , Le Faou A L
Published: October 2021

Background

In women, smoking is particularly harmful to the cardiovascular (CV) system, and smoking cessation (SC) is a key issue for CV prevention.

Objectives

From a large nationwide database on subjects who visited SC services between 2001 and 2018, we aimed to describe the profile and abstinence rate among female smokers at high CV risk.

Methods

Observational study from the French CS services cohort CDT-net. Inclusion criteria were age ≥18 years, and ≥1 CV risk factor (i.e. body mass index ≥25 kg/m2, hypercholesterolemia, diabetes, hypertension, history of stroke, myocardial infarction or angina pectoris. Abstinence (≥28 consecutive days) was self-reported, and confirmed by measurement of exhaled carbon monoxide <10 ppm.

Results

Among 37,949 smokers, 16,492 (43.5%) were women. Compared to men, women were 3-y younger (48 vs 51 y, p<0.001) and more educated (≥ Bachelor degree: 55 vs 45%, p<0.001). The burden of CV risk factors was high in women and men: hypercholesterolemia (30% vs 33% p<0.001), hypertension (23% vs 26%, p<0.001) and diabetes (10 vs 13%, p<0.001). Compared to men, women suffered more often from obesity (27 vs 20%, p<0.001), respiratory diseases (COPD: 24% vs 21%, p<0.001; asthma: 16 vs 9%, p<0.001) and anxio-depressive symptoms (37.5 vs 26.5%, p<0.001). Although women were less nicotine dependent than men, their abstinence rate was lower (52 vs 55%, p<0.001).

Conclusion

Female smokers who visited SC services not only presented very high CV risk profile, but also elevated rates of lung diseases and anxio-depressive symptoms. Our findings highlight the need to strengthen CV prevention strategies, through comprehensive gender-tailored SC interventions.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): IReSP and INCa through a call for doctoral grants launched in 2019
Metabolic syndrome is related to vascular structural alterations but not to functional one both in hypertensives and healthy subjects
Authors: Leidi F , Maloberti A , Bombelli M , Monticelli M , Ruzzenenti G , Biolcati M , Giani V , De Chiara B , Grassi G , Giannattasio C
Published: October 2021

Background

Metabolic Syndrome (MS) has been related to an impairment in arterial structural and functional properties with heterogeneous results.

Purpose

In this study we focused on the effects of MS on arterial carotid-femoral Pulse Wave Velocity (PWV) and common carotid Intima Media Thickness (IMT) in two different populations, one of hypertensive patients and one of healthy controls.

Methods

We enrolled 816 consecutive hypertensive (HT) and 536 healthy controls. Vascular structural (IMT) and functional (PWV) properties were evaluated. NCEP-ATP-III criteria were used for diagnosis of MS.

Results

MS was diagnosed in 26.9% and 6.9% in hypertensive and control subjects, respectively. PWV was similar in controls with and without MS (7.7±1.9 vs 7.6±1.1 m/s, p=0.69), while IMT was higher in controls with than those without MS (0.64±0.18 vs 0.57±0.13 mm, p=0.02). Hypertensives with MS were older (57.9±12.2 vs 52.7±14.1 years, p<0.001) and showed higher PWV (9.0±2.3 vs 8.4±2.1 m/s, p=0.001) and IMT (0.72±0.22 vs 0.65±0.17 mm, p<0.001) than those without MS, however at the age-adjusted analysis only the difference in IMT was confirmed (p=0.007). Regression models showed that MS was an independent determinant of IMT in both controls (β=0.08, p=0.03) and hypertensives (β=0.08, p=0.01), but not of PWV either in controls (β=0.006, p=0.886 and β=0.04, p=0.19, respectively).

Conclusions

The main finding of our work is that MS is a significant determinant of IMT while this is not the case for PWV. This result has been confirmed both in hypertensive subjects and in healthy controls.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): ASST Grande Ospedale Metropolitano Niguarda
Effects of physical prehabilitation on markers of endothelial function in patients undergoing elective coronary artery bypass grafting
Authors: Argunova Y , Belik E , Gruzdeva O , Barbarash O
Published: October 2021

Purpose

To evaluate the effects of preoperative exercise training on the perioperative serum levels of asymmetric dimethylarginine (ADMA) and endothelin-1 (ET-1) in patients with stable coronary artery disease (CAD).

Methods

78 male patients with stable coronary artery disease referred to elective on-pump CABG were screened and randomized either to receive prehabilitation, or routine preoperative management without training. Group 1 (n=43, age 61.5 [55; 65] years) patients underwent preoperative exercise training (treadmill sessions at 80% of peak oxygen uptake (VO2peak) intensity for 5–10 days), whereas group 2 (n=35, age 63.0 [56; 66] years) received routine preoperative management without training.

Levels of endothelial function (ADMA and ET-1) were measured using enzyme immunoassay in the preoperative period of CABG before exercise training, the day before surgery, and in the postoperative period on days 5–7.

Logistic regression analysis was used to determine significant risk factors contributing to postoperative complications in the early postoperative period.

Statistical analysis was performed using the Statistica 10.0 software (Statsoft, USA).

Results

Patients from both study groups did not differ in the main preoperative clinical and demographic parameters. They had similar comorbid profile and were also comparable in terms of the intraoperative parameters. No differences in baseline echocardiography and cardiopulmonary exercise testing were reported.

By the end of the exercise training, group 1 patients had a significantly lower level of ADMA than patients from group 2 without prehabilitation (p=0.01). Correlation analysis reported a direct correlation between the levels of ADMA and ET-1 the day before surgery (ρ = 0.28, P=0.04) in the absence of significant intergroup differences in ET-1 levels.

Stepwise logistic regression adjusted for comorbidities (chronic bronchopulmonary disease) and intraoperative risk factors (aortic cross-clamp time) reported a correlation of the pre-existing diabetes with an increased risk of complications in the early postoperative period (OR 12.3, 95% CI [1, 18–127.6], p=0.03). Elevated ET-1 levels also increased the risk of complications (OR 10.7, 95% CI [1.1–105.2], p=0.03), whereas preoperative exercise training reduced the risk of postoperative complications (OR 0.1, 95% CI [0.01–0.82], p=0.02).

Conclusion

Our findings indicate favorable effects of prehabilitation on the improvement of endothelial function and prevention of the complications in the early postoperative period.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Fundamental topic No. 0546-2019-0003
Sex differences in pre-hospital analgesia and outcomes in patients presenting with acute coronary syndromes
Authors: Nan Tie E , Fernando H , Nehme Z , Dinh D , Andrew E , Brennan A , Zaman S , Liew D , Stephenson M , Lefkovits J , Peter K , Duffy S J , Shaw J , Smith K , Stub D
Published: October 2021

Background

Opioid analgesia remains the mainstay of pain management in acute coronary syndromes (ACS). Significant sex differences persist in ACS presentation, management and outcomes, but the impact of sex-differences on pre-hospital pain management of ACS with opioids is unknown. There is increasing awareness of the importance of pre-hospital factors in ACS, as well as emerging concerns with opioid use impairing the gastrointestinal absorption of oral P2Y12 inhibitors.

Purpose

This study examined if sex-differences in pre-hospital pain scores, opioid administration and clinical outcomes exist in ACS patients.

Methods

Patients presenting with ACS via ambulance (2014–2018) that underwent percutaneous coronary intervention (PCI) were prospectively collected via the Victorian Cardiac Outcomes Registry (VCOR), the Melbourne Interventional Group (MIG), and linked to the Ambulance Victoria database. The primary outcome was 30-day major adverse cardiac events (MACE). Secondary outcomes were descriptive analyses of pre-hospital pain score, intravenous morphine equivalent analgesic dosing, plus predictors of MACE and Thrombolysis In Myocardial Infarction (TIMI) 0–1 flow pre-PCI using logistic regression.

Results

10,547 patients were included (female: 2,775 [26.3%]). Opioids were administered to 1,585 (57%) females and 5,068 (65%) males (p<0.001). Adjusted 30-day MACE was similar between opioid groups in both sexes (female: OR 1.21, CI 0.82–1.79, p=0.34; male: OR 0.89, 0.68–1.16, p=0.40). Median pain score at presentation was 6 (IQR 4,8) for both sexes. Median opioid dose was 2.5 mg (IQR 0,10) in females and 5 mg (IQR 0,10) in males (p<0.001), with similar pain relief achieved. Adjusted rates of TIMI 0–1 pre-PCI were higher in patients administered opioids (female: OR 2.83, CI 2.14–3.56, p<0.001; male: OR 2.95, CI 2.49–3.49, p<0.001).

Conclusions

Female patients undergoing PCI received less opioid analgesia, but no sex-differences in pre-hospital pain scores were seen. Opioid administration was associated with impaired antegrade flow in the culprit artery in both sexes, but not short-term MACE. Randomised trials evaluating the clinical implications of opioid administration in ACS with sex subgroup analyses are needed to guide clinical practice.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Melbourne Interventional GroupVictorian Cardiac Outcomes Registry
A 3D-TTE left atrial function study in cardio-oncology patients
Authors: Ferreira V , Cruz Coutinho M , Almeida Morais L , Aguiar Rosa S , Moura Branco L , Galrinho A , Timoteo A T , Branco Mano T , Cardoso I , Castelo A , Garcia Bras P , Oliveira S , Cruz Ferreira R
Published: October 2021

Introduction

Transthoracic Doppler echocardiography (TTE) remains the standard imaging method to evaluate cancer therapeutics-related cardiac dysfunction (CTRCD). 3D-TTE with strain analysis is a novel technique, proved useful for earlier detection of left ventricular (LV) function impairment. However, diastolic and left atrial (LA) function impact is less studied.

Purpose

To assess LA volumetric and LA strain (LAS) features by 3D-TTE in cardio-oncology patients.

Methods

A prospective study of female breast cancer patients (P) submitted to therapy (TH) who underwent serial monitoring by 2D and 3D-TTE. Standard 2D, 3D-TTE and LAS parameters were evaluated, including longitudinal (LALS) and circumferential strain (LACS) during conduit (cd), contraction (ct) and reservoir (r) phases. P were evaluated at T0, T1 and T2 (before, ≥6 and ≥12 months after starting TH). CTRCD was defined as an absolute decrease in 2D LVEF >10% to a value <54% or a relative decrease in 2D GLS >15%, according to literature. P with previous cancer treatment, coronary artery disease, significant valvular disease, and atrial arrhythmias were excluded.

Results

98 P (mean age 54.6±12.0 years-old), mostly treated with anthracyclines (78.6%, cumulative dose 268.2±77.6mg/m2), anti-HER (70.4%) and radiotherapy (80.6%) were included. 2D LV and LA volumes had a significantly raise from baseline to T1 (2D LVEDV 82.2±18.8 vs 91.9±18.8 mL, p=0.019 and LA 43.3±12.9 vs 49.8±13.3 mL, p=0.005). 2D and 3D LVEF were significantly reduced during TH, however remaining within the limits of normality. 2D GLS was also impaired at T1 (−19.9±2.6% vs −18.6±3.1%, p=0.009). During a mean follow-up of 14.1±8.1months, 31 P (31.6%) developed CTRCD. 3D LV and LA volumes also globally increased at T1 comparing to baseline with partially recovery at T2. Maximum LA volume was significantly higher at T1 (39.1±9.3 vs 43.6±10.6 ml, p=0.024). 3D LA ejection fraction (T0 53.7±9.7%, T1 53.4±8.6%, T2 49.9±8.6%, pT0-T2=0.039) and LAS values tended to progressively worse during TH. LA dilation (vol>34ml/m2) at baseline was correlated to dysfunction in contraction phase at T1 (LACSct −19.6±8.6 vs −17.3±4.6%, p=0.024). LACSr has substantially decreased from baseline to T2 (31.4±11.6 vs 27.0±10.4%, p=0.05). In univariate analysis, delta LALSr (T1-T0) was a predictor of CTRCD (mean −5.2% vs 1.9%, p=0.05).

Conclusion

CTRCD was frequent during the earlier phase of breast cancer treatment. LA function was also affected, mirroring LV volumetric and functional changes. Diastolic dysfunction, assessed through LA reservoir strain, was impaired in association with CTRCD. 3D-TTE usefulness in the surveillance and monitoring of CTRCD goes beyond systolic LV function assessment, allowing a detailed LA function analysis.

Funding Acknowledgement

Type of funding sources: None.