bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic implications of staging right heart failure in patients with significant tricuspid regurgitation undergoing tricuspid valve surgery
Authors: Galloo X , Stassen J , Butcher S C , Meucci M C , Dietz M F , Mertens B J A , Prihadi E A , Van Der Bijl P , Ajmone Marsan N , Bax J J , Delgado V
Published: October 2021

Introduction

Mortality of tricuspid valve (TV) surgery for severe secondary tricuspid regurgitation (TR) remains relatively high. Current guidelines advise surgery in patients with symptomatic severe TR as a concomitant procedure to left-sided valve surgery. Right ventricular (RV) dysfunction is an important prognostic marker and may appear late in the natural history of TR. How a staging algorithm of right heart failure (RHF) may impact on TV surgery outcomes has not been evaluated.

Purpose

To evaluate the impact of staging RHF on survival of patients with significant TR undergoing TV surgery.

Methods

Patients diagnosed with significant (moderate and severe) TR who subsequently underwent TV surgery, were staged into 4 groups of progressive disease according to the diagnosis of RV dysfunction and the presence of RHF: stage 1, at risk for RHF; stage 2, RV dysfunction without clinical symptoms of RHF; stage 3, RV dysfunction with symptoms of RHF, and stage 4, RV dysfunction with refractory symptoms of RHF (Figure 1). The study endpoint was all-cause mortality.

Results

A total of 279 patients (mean age 64±12 years, 49% male), were included in the analysis, of which 20 patients (7%) were in stage 1, 14 patients (5%) were in stage 2, 141 patients (51%) were in stage 3 and 104 patients (37%) were in stage 4.

The majority of the patients (266 patients, 95%) underwent TV annuloplasty. Most patients had TV surgery concomitant to left-sided valve surgery or coronary artery bypass grafting (254 patients, 91%). In per-group analysis, patients in stage 4 had significantly larger left ventricular (LV) and RV dimensions, lower LV ejection fraction and more severe diastolic dysfunction than patients in other RHF stages.

During a median follow-up of 65 [15 - 106] months after TV surgery, 145 deaths (52%) occurred. The cumulative survival rates were 88%, 77% and 60% at 1 month, 1 year and 5 years, respectively. The Kaplan-Meier curves for overall survival according to RHF stage are shown in Figure 2. Survival rates at 5 years were significantly worse in more advanced stages of RHF: 71% (stage 1 and 2), 66% (stage 3) and 49% (stage 4); log-rank chi-square: 11.302; p=0.004. Right heart failure stage was independently associated with all-cause mortality following adjustment for age, gender, LV ejection fraction, kidney function, TV annulus diameter, concomitant mitral valve surgery and time delay from diagnosis until surgery (p=0.021).

Conclusion

Patients diagnosed with significant TR may benefit from earlier referral for surgical intervention, before presenting with RV dysfunction and before the onset of symptoms of RHF.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Stages of right heart failureFigure 2. Kaplan-Meier curves for overall survival
Diffusion weight magnetic resonance imaging analisys with rapid software appication in symptomatic carotid stenosis revascularization
Authors: Sirignano P , Dezi T , Aloisi F , Pranteda C , Taurino M
Published: October 2021

Objectives

The aim of this study was to evaluate whether the extension of preoperative neuroradiological lesions assessed by magnetic resonance imaging (MRI) with Diffusion Weighted sequences (DWI) and Rapid processing of Perfusion and Diffusion software are potentially related to post-operative neurological outcome in patients with symptomatic carotid stenosis (SCS) treated by carotid endarterectomy (CEA).

Methods

From January 2010 to June 2020, data from 134 consecutive patients affected by SCS, presenting with transient ischemic attack (TIA), and minor or moderate stroke, and submitted to urgent CEA in a single academic center, were prospectively collected and reviewed. All SCS patients underwent independent neurological evaluation, duplex ultrasound scan, computed tomographic angiography, and DW-MRI with RAPID evaluation. RAPID evaluation was performed to assess the volume of acute ischemic brain lesion (IBL); through this method it is possible to obtain the identification of the ischemic core milliliters (mL). According with clinical presentation, and imaging studies analysis CEA endarterectomies were performed within 48 hours, within 14 days or after 14 days from symptoms onset. Outcomes for presented analysis were the post-operative new neurological event, and deathat follow-up. Timing of CEA and IBL volume at RAPID evaluation were considered as risk factor potentially influencing outcomes.

Results

Among all the 134 enrolled patients, 68 patients (50.7%) presented with TIA, 49 (36.6%) with a minor Stroke, and 17 (12.7%) with a moderate Stroke. No intraoperative death occurred in any group. Overall, 6 (4.4%) new neurological events were noted in this series, 1 minor stroke (0.7%), and 5 TIAs (3.7%). One-hundred-fifteen (86%) underwent surgery within 14 days from neurological symptoms onset (Urgent patients – U), and 19 (14%) after 14 days (Delayed patients – D); U patients were also divided in two subgroups U1 47/115 patients (35%) submitted to CEA within 48 hours from symptoms onset, and U2 68/115 patients (51%) after 48 hours. No neurological complications were noted in group D, while 5 new adverse events occurred in U1, and 1 in U2 (p=0.01). Results from MRI with DWI sequences performed in 100/134 patients (74.6%) showed positive preoperative diffusion in 62 patients. The RAPID processing ascribed a 0 value, for punctiform lesions, and a value from 2 to 77 ml for single acute lesions; average volume lesion volume was 8.6 mL. Patients were then divided into two groups according to IBL volume: 84 <10 ml, and 16≥10 mL. Incidence of new neurological events was significantly higher in >10ml group (18.7% vs 3.6%; p=0.02).

Conclusion

Our experience seems to suggest that the optimal time for SCS revascularization is between 48 hours and 14 days. Moreover, IBL volume >10ml might greatly increase risk of postoperative adverse events occurrence.

Funding Acknowledgement

Type of funding sources: None.
Subclinical cardiac organ damage in patients with moderate to severe psoriasis treated with infliximab
Authors: Linde A , Gerdts E , Tveit K S , Kringeland E , Midtbo H
Published: October 2021

Background

Psoriasis is an immune mediated disease that has been associated with elevated risk of cardiovascular (CV) disease. Comorbidities, psoriasis treatment and presence of subclinical cardiac organ damage can modulate CV risk in psoriasis.

Purpose

To assess the prevalence and covariables of subclinical cardiac organ damage in patients with moderate-to-severe psoriasis on infliximab treatment.

Methods

Echocardiography was performed in 53 psoriasis patients (age 47±15 years, 30% women) and 99 control subjects (age 47±11 years, 28% women). Subclinical cardiac organ damage was defined as presence of left ventricular (LV) hypertrophy, concentric LV geometry and/or dilated left atrium. Psoriasis area and severity index (PASI) was used to assess the severity of psoriasis. Hypertension was defined as use of antihypertensive medication/history of hypertension and/or elevated ambulatory blood pressure ≥130/80 mmHg.

Results

Hypertension was the most common comorbidity, present in 66% of patients and 61% of control subjects (p=0.54). Smoking was more prevalent in psoriasis patients than controls (37% vs 17%, p=0.005), while other CV risk factors and antihypertensive treatment did not differ between groups. Subclinical cardiac organ damage was less prevalent in psoriasis patients than controls (51% vs. 73%, p=0.007, Figure). In the total study cohort, having psoriasis was associated with lower prevalence of subclinical cardiac organ damage independent of hypertension, smoking, age and sex (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.13–0.72, p=0.007) in logistic regression analysis. Among psoriasis patients, hypertension was associated with a near seven-fold increased risk of cardiac organ damage (OR 6.88 [95% CI 1.32–35.98], p=0.022) independent of age, sex and body mass index. PASI at start of treatment or current PASI was not associated with presence of subclinical cardiac organ damage.

Conclusion

Psoriasis patients on infliximab treatment had less subclinical cardiac organ damage compared with controls, suggesting that inhibition of CV inflammation may attenuate cardiac organ damage in psoriasis. Hypertension was the strongest covariable for subclinical cardiac organ damage in psoriasis patients.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Western and South-Eastern Regional Health Authorities of Norway and Hjertefondet, University of Bergen.
Psoriasis severity and the risk of left ventricular remodelling in psoriasis patients treated with infliximab
Authors: Linde A , Midtbo H , Gerdts E , Kringeland E , Tveit K S
Published: October 2021

Background

Psoriasis is an immune mediated skin disorder with a great variation in disease severity. Chronic inflammation predisposes to subclinical cardiac damage like left ventricular (LV) remodelling. However, the association of psoriasis severity with LV remodelling is not known.

Purpose

To assess LV remodelling in patients with moderate to severe psoriasis treated with infliximab.

Methods

Psoriasis severity was assessed by the Psoriasis Area Severity Index (PASI) before initiation of treatment with the tumour necrosis factor α inhibitor infliximab in 53 patients (age 47±15 years, 30% women, body mass index (BMI) 29.2±5.5 kg/m2). Echocardiography was preformed after a mean follow-up of 4.9±3.8 years and compared to 99 control subjects (age 47±11 years, 28% women, BMI 29.9±3.9 kg/m2). LV remodelling was assessed from LV relative wall thickness and LV mass index by echocardiography.

Results

Both psoriasis patients and controls had high prevalence of hypertension (66% vs. 61%, p=0.54) and obesity (34% vs. 33% p=0.94). Psoriasis patients were more likely to be smokers than controls (37% vs. 17%, p=0.005), but other cardiovascular risk factors were similarly distributed. Psoriasis patients had higher LV relative wall thickness (0.38±0.09 vs. 0.34±0.07, p=0.001), but lower LV mass index (36.1±9.6 g/m2.7 vs. 40.3±9.8 g/m2.7, p=0.014), compared to controls. Having psoriasis remained associated with higher LV relative wall thickness (β 0.25, p=0.002) and lower LV mass index (β-0.20, p=0.02) in multivariable analyses after adjustment for age, sex, smoking, hypertension and BMI. In psoriasis patients mean PASI decreased from 16.1±11.5 to 0.8±0.8 during infliximab treatment, p<0.001. Higher PASI at start of treatment was associated with a higher LV relative wall thickness at follow-up (Table), but not with higher LV mass index in univariable analyses. After adjusting for sex, age and hypertension, higher PASI at start of treatment (β 0.36, p=0.006) still predicted greater LV relative wall thickness at follow-up in psoriasis patients (Table).

Conclusion

Higher psoriasis severity before infliximab treatment predicted presence of adverse LV remodelling after 4.9 years treatment despite nearly complete clinical remission.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Western and South-Eastern Regional Health Authorities of Norway and Hjertefondet, University of Bergen.
Renin-angiotensin-aldosterone system genotypes and cardiac remodeling response to essential hypertension
Authors: Mocan O , Radulescu D , Buzdugan E , Cozma A , Leucuta D C , Procopciuc L M
Published: October 2021

Background/Introduction

Cardiac remodeling represent a response to uncontrolled essential hypertension (EHT). The morphological response is expressed by left ventricular (LV) mass index values and/or relative wall thickness (RWT) >0.42. Functionally response is expressed by isolated alteration of LV diastolic function (E/A<1).

Purpose

We aimed to establish the association between anatomical and functional adaptation to EHT, with two genetic variants of the renin-angiotensin-aldosterone system (RAAS): M235T-AGT and A3123C-R2 AngII.

Methods

In 139 hypertensive subjects cohort, we determined the M235T-AGT and A3123C-R2 AngII genotypes, using polymerase chain reaction-restriction fragment length polymorphism methods. The relationship between the studied RAAS gene polymorphisms and morphological and functional cardiac remodeling was assessed by multiple logistic regressions.

Results

We found that the C/C, A/C genotypes of the A3123C-R2 AngII polymorphism were statistically significantly associated with RWT<0.42 (p=0.033), so hypertensive patients carrying this genotype had a 2.7-fold increased risk to have a non-concentric type of cardiac response. The association was maintained even after adjustment for confounders - age, body mass index (BMI), systolic blood pressure (BP), and diastolic BP (p=0.008). We found statistically significant associations between LV diastolic dysfunction in hypertensive patients cohort carrying the T/T, M/T genotypes (M235T-AGT polymorphism) (p=0.037). Moreover, the association remained statistically significant even after adjustment for age, BMI, systolic BP, and diastolic BP (p=0.039). We could not identify any statistically significant associations between M235T-AGT, A3123C-R2 AngII polymorphisms, and LV mass index.

Conclusion(s)

Non-concentric type of cardiac response to essential hypertension was associated with A3123C-R2 AngII polymorphism. M235T-AGT polymorphism was found to be statistically significantly associated with alteration of LV diastolic function.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, as part of Doctoral Research Projects (DRP) 2016
Relationship between peripartum maternal cardiac phenotype and maternal outcome in women with hypertensive disorders of pregnancy
Authors: Giorgione V , O'Driscoll J , Di Fabrizio C , Frick A , Cauldwell M , Khalil A , Thilaganathan B
Published: October 2021

Background

Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and neonatal morbidity worldwide.

Purpose

The aim of this study is to assess maternal cardiac function in women affected by HDP in singleton pregnancy and investigate the relationship between abnormal cardiac findings and maternal outcomes.

Methods

In this single-centre prospective longitudinal study, 190 women with a diagnosis of HDP underwent standard trans-thoracic echocardiography (TTE) in the immediate peripartum period from February 2019 to December 2020. Left ventricle morphology (LVM) and diastolic dysfunction (DD) were evaluated according to according to British Society of Echocardiography guidelines. Patients were classified into three groups according to TTE findings: (1) normal LVM and DD, (2) abnormal LVM or abnormal DD, (3) abnormal LVM and abnormal DD. Maternal indices were compared among these groups.

Results

56 (29.5%) patients affected by HDP were included in group 1, 69 (36.3%) in group 2 and 65 (34.2%) in group 3. Gestational age at delivery and birthweight centile were similar among the groups. Women in group 3 were significantly older than group 2 and group 1 (35.1±5.4 years vs 32.6±6.3 vs 33.1±5.8 years years, respectively, p=0.043). Group 2 and 3 showed a higher blood pressure in the first trimester of pregnancy compared to group 1 (mean arterial pressure: 94.3±7.2 mmHg vs 95.5±8.2 mmHg vs 91.6±8.3 mmHg, p=0.024), while no significant difference was found in body mass index among the three groups (group 1: 26.4±5.4, group 2: 28.0±6.4; group 3: 27.7±5.0, p=0.293). HDP women with LVM and DD (group 3) were more likely to be admitted to high dependency unit (35.4%) than women in group 2 and 1 (14.5% and 23.6%, respectively, p=0.019).

Conclusions

Abnormal echocardiographic findings were associated with a worse maternal cardiovascular phenotype that required a closer maternal cardiovascular monitoring in the peripartum period.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Veronica Giorgione and Carolina Di Fabrizio have received funding from European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 765274 (iPLACENTA project).
Suboptimal blood pressure control and associated risk for cardiovascular mortality among stroke survivors in China
Authors: Wang B , Lu J P , Cai J
Published: October 2021

Background

Elevated blood pressure (BP) is associated with substantial morbidity and mortality in stroke survivors. China has approximately 7.5 million stroke survivors, and accounts for one third of stroke mortality worldwide, but little is known about the prevalence and management of elevated BP as well as its effect on cardiovascular death at the national level.

Purpose

We aim to describe the prevalence and treatment of elevated BP and assess the cardiovascular mortality attributable to elevated BP among stroke survivors in China.

Methods

Based on 3 million participants aged 35–75 years from all 31 provinces in mainland China recruited from September 2014 through August 2019, we assessed the prevalence and treatment of elevated BP (systolic BP ≥140mmHg or diastolic BP ≥90mmHg) among those with self-reported stroke. Cardiovascular death was recorded before December 31st 2019. The age- and sex- specific population attributable fractions of cardiovascular death from elevated BP were estimated based on hazard ratios derived by Cox regression analysis.

Results

Among 91,628 stroke survivors, the mean (SD) age was 62 (8) years, 49% were male sex. The median (IQR) stroke duration was 4 (2,7) years. 61.3% of the individuals had elevated BP, and the prevalence increased with age (from 47.6% at 35–44 years of age to 64.7% at 65–75 years of age) and was slightly higher in rural area (63.2%) than urban area (58.8%). 32.7% of the overall population were treated, and 23.4% of those with elevated BP were treated. Among stroke survivors, elevated BP accounted for 26% of cardiovascular death at 35–75 years of age, and about one third at 35–54 years of age. The age- and sex- specific results were shown in the Table.

Conclusions

In this nationwide cohort of stroke survivors from China, over 60% had elevated BP, and about one third were treated. Elevated BP was associated with particularly substantial cardiovascular mortality for young and middle-aged stroke survivors. National strategies targeting elevated BP are required to improve the prognosis of stroke survivors in China.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Key Research and Development Program from the Ministry of Science and Technology of China Age- and sex-specific HRs and PAFs
Sustained strong blood pressure lowering and preserved renal function during 3 year after anatomically optimized distal renal denervation according to the double blind randomized controlled study
Authors: Pekarskiy S , Baev A , Tarasov M , Falkovskaya A , Sitkova E , Zubanova I , Manukyan M , Mordovin V , Popov S
Published: October 2021

Aim

To evaluate long-term safety and efficacy of anatomically optimized distal renal denervation (RDN).

Methods

We assessed major adverse cardiovascular and renal events; changes in BP (office, ambulatory), and renal function (serum creatinine, eGFR) over 3 year follow-up extension of our double blind, randomized controlled study of the efficacy and safety of distal RDN versus conventional main trunk treatment in patients with true resistant hypertension (NCT02667912).

Results

Of 55 randomized patients (28/27, distal/main trunk RDN, respectively), 47 (23/24) were assessed at 1 year, and 39 (21/18) - at 3-year post-procedure. During 3-year follow-up 2 fatal and 2 non-fatal strokes were observed in distal RDN group versus one heart failure death and 2 non-fatal strokes in group of main trunk treatment.

In distal RDN arm BP remained powerfully and significantly lowered both at 1 and 3 years post-procedure: −18.0 (95% CI −27.6; −8.5) and −16.9 (95% CI −27.3; −6.5) mmHg, 24h ambulatory systolic. During 1st year this potent BP lowering effect was accompanied by moderate eGFR decrease: −8.9 (95% CI −14.8; −3.1) ml/min/sq.m, however, this decrease was later reduced to non-significant −6.5 (95% CI −13.2; 0.3) ml/min/sq.m at 3 year post-procedure signaling some improvement in renal function after 1st year despite sustained strong BP lowering.

In group of main trunk intervention BP only moderately decreased at 1 year −12.1 (95% CI −19.2; −5.0) mmHg, in parallel with small non-significant change in eGFR: −1.3 (95% CI −6.6; 4.0) ml/min/sq.m. Subsequently, BP lowering effect weakened and lost significance at 3 years post-procedure: −8.5 (95% CI −19.7; 2.2) mmHg. In contrast, eGFR continued to decline and reached significant −5.0 (95% CI −9.6; −0.3) ml/min/sq.m at the end of the study.

Five patients developed new onset chronic kidney disease after main trunk RDN versus 3 patients – after distal RDN. The number of concomitant antihypertensive medications did not significantly changed in either group.

Conclusion

Our data demonstrate strong long-term BP lowering efficacy of distal RDN and, also, the potential of this procedure to prevent the decline of renal function in patients with resistant hypertension.

Funding Acknowledgement

Type of funding sources: None.
Treatment with a fixed dose combination for cardiovascular disease-more than a health benefit?
Authors: Dima I , Andrikopoulos G , Demerouti E , Giannakoulas G , Kartalis A , Lambropoulos K , Marketou M , Papadopoulos C , Poulimenos L , Stalikas D , Stougiannos P , Tsiafoutis I , Tsioufis K , Vlachopoulos C
Published: October 2021

Background

Despite the proven benefits of cardiovascular disease medication, adherence to treatment remains poor. Fixed-dose combinations (FDC) have been proposed as a measure to enhance adherence.

Objective

To assess compliance to treatment with an FDC, consisting of acetylsalicylic acid, atorvastatin and ramipril, and to gauge its impact on cardiovascular risk factors.

Methods

This was a prospective, multicenter, observational, phase 4 study conducted for 6 months in Greece. 1444 participants (67% males, mean age 63.7 years old) that were prescribed the FDC for primary or secondary prevention were included in the analysis. Descriptive statistical analysis was performed to analyze clinical, sociodemographic and safety parameters.

Results

Approximately equal number of participants was recruited in the primary and secondary prevention group. The majority of patients were overweight and hypertensive. Dosing compliance was 88.6% at 3 months and 86.8% at 6 months. Adherence to treatment was 99.1% at 3 months and 97.6% at 6 months. Statistically significant changes at 6 months compared to baseline were documented in systolic/diastolic blood pressure of 15.7/7.5 mmHg and LDL-c of 32.6 mg/dl, in both CVD and non-CVD participants and in total population as well. The total 10-year risk for CV events was reduced by 34.1% at 6 months. Only 1.2% of the participants reported an adverse event and 0.8% an adverse event reaction.

Conclusions

Among patients with or without CVD, the use of acetylsalicylic acid, atorvastatin and ramipril FDC resulted in good medication adherence at 6 months and statistically significant improvements in blood pressure, total cholesterol and LDL levels.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Galenica SA
Association of daily coffee consumption with cardiovascular health – results from the UK Biobank
Authors: Simon J , Fung K , Raisi-Estabragh Z , Aung N , Khanji M Y , Kolossvary M , Merkely B , Munroe P B , Harvey N C , Piechnik S K , Neubauer S , Petersen S E , Maurovich-Horvat P
Published: October 2021

Background

There are conflicting reports on the association of coffee consumption with cardiovascular (CV) health. The UK Biobank is a prospective cohort study including data for half a million middle-aged individuals.

Purpose

We studied the association of daily coffee consumption with all-cause and CV mortality, and incidence of the major CV diseases in the UK Biobank. In a subgroup of participants who underwent cardiovascular magnetic resonance (CMR), we evaluated the association between regular coffee intake and cardiac structure and function parameters.

Methods

UK Biobank cohort of participants without clinically manifested heart disease at the time of recruitment were included. Regular coffee intake was categorized into 3 groups: zero, light-to-moderate (0.5–3 cups/day) and high (>3 cups/day) coffee drinkers. We estimated association of daily coffee consumption with incident outcomes using multivariable Cox-regression models (median follow-up of 11 years) and, in the subset with CMR data, with left and right ventricular (LV, RV) end-systolic and end-diastolic volumes, LV mass, and LV/RV stroke volume using multivariable linear regression. Models were adjusted for potential confounders and mediators, including: age, sex, non-European ethnicities, body mass index, smoking, physical activity, Townsend deprivation index, alcohol, meat, fruit and vegetable intake, hypertension, diabetes mellitus, and cholesterol level.

Results

We included 468,629 individuals (mean age 56.2±8.1 years, 44.2% male). Among them, 22.1% did not consume coffee on a regular basis, 58.4% had 0.5–3 cups per day and 19.5% had >3 cups per day. After adjustment for potential confounders and mediators, compared to non-coffee drinkers, light-to-moderate coffee drinking was associated with lower risk of all-cause mortality (HR=0.88, p<0.001), CV mortality (HR=0.83, p=0.006), and incident stroke (HR=0.79; p=0.037). CMR data were available in 30,650 participants. In multivariable analysis, compared to non-coffee drinkers, both the light-to-moderate and high coffee consuming categories, were associated with significantly increased LV and RV ventricular end-systolic (β=0.91 and 1.64 for LV and 1.10 and 1.72 for RV), end-diastolic (β=2.21 and 3.28 for LV and 2.24 and 3.35 for RV) and stroke volumes (β=1.31 and 1.64 for LV and 1.15 and 1.63 for RV), as well as greater LV mass (β=0.78 and 1.64; all p<0.001).

Conclusion

In this large study of the UK Biobank population, regular coffee consumption of up to 3 cups per day was associated with favorable cardiovascular outcomes, in particular, decreased all-cause and CV mortality and stroke incidence. Regular coffee consumption was also associated with a pattern of CMR metrics in keeping with the reverse of age-related cardiac alterations.

Funding Acknowledgement

Type of funding sources: None.
Echocardiographic parameters of myocardial work in relation to prolonged strenuous physical exercise
Authors: Erevik C , Kleiven Ø , Froysa V , Bjorkavoll-Bergseth M , Hansen M , Chivulescu M , Klaboe L G , Dejgaard L , Skadberg O , Melberg T , Urheim S , Haugaa K , Edvardsen T , Orn S ,   NEEDED
Published: October 2021

Background

Myocardial work (MW) assessed by echocardiography is a novel measure of left ventricular (LV) function. This measure is load-independent, and therefore a more accurate method for assessing LV function when there are changes in loading conditions. The purpose of this study was to examine alterations in MW parameters, blood pressure (BP) and LV global longitudinal strain (LV GLS) in relation to strenuous exercise, and to compare the response between two different physical stress situations.

Methods

59 healthy recreational athletes were assessed by echocardiography before-, immediately- and 24 hours after two episodes of high-intensity endurance exercise. The first exercise was a cardiopulmonary exercise (CPX) test, which included both a stepwise lactate threshold- and a maximal oxygen uptake test. The second exercise was a 91-km mountain bike leisure sport cycling competition. Global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) were estimated from LV pressure-strain loops, constructed from a combination of LV GLS and non-invasive BP, using commercially available software package (Echopac V.202, GE).

Results

Subjects were 52 (43–59) years old (73% men). The duration of the CPX-test was 43 (40–45) minutes, and the race was 230 (210–245) minutes. The average heart rate during the CPX-test and the race was 144 (140–153) and 154 (148–161) beats per minute (bpm), respectively. The relative changes (percent) in systolic blood pressure (SBP) and LV GLS compared with pre-exercise values are demonstrated in Figure 1a, and GWI and GCW compared with pre-exercise values in Figure 1b. GWI at baseline was 2156 (1899–2400) mmHg% and GCW 2383 (2152–2668) mmHg%. There was a significant reduction in LV GLS (p=0.015), SBP, GWI and GCW following the CPX-test and the race (p<0.001), while there was an increase in heart rate and cardiac output (p<0.001). After the race, there was a significant (p=0.001) increase in GWW, and a reduction (p=0.006) in GWE.

Conclusion

There was a significant reduction in GWI and GCW after both the CPX-test and the race, suggesting that these markers reflect increased myocardial exhaustion following strenuous physical exercise.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by ConocoPhillips and the Simon Fougner Hartmann Trust Figure 1aFigure 1b
Relationship between cardiovascular risk factors and adipocytokines gene expression in local fat depots
Authors: Dyleva Y U A , Gruzdeva O V , Belik E V , Sinitsky M Y U , Sotnikov A V , Barbarash O L
Published: October 2021

In this study we studied the relationships between adipokines (leptin, soluble leptin receptor) in adipose tissue (AT) and cardiovascular disease (CVD) risk factors.

Methods

Fat tissue biopsies were obtained from 134 patients median aged 64.0 (48.0; 68.0) with stable CAD undergoing coronary artery bypass grafting. Traditional cardiovascular risk factors and patient treatment have been recorded. AH was defined as systolic blood pressure >140 mm Hg Art., diastolic blood pressure >90 mm Hg. Dyslipidemia was defined as a previously detected increase in total serum cholesterol (>200 mg/dl), triglycerides (>200 mg/dl), or low-density lipoprotein (LDL) cholesterol (>150 mg/dl) for at least 1 year, or use of lipid-lowering drugs. Smoking was classified as current or former smokers; current smoking status was defined as at least one cigarette daily over the last year. Adipocytes were isolated from subcutaneous (SAT), epicardial (EAT), and perivascular AT (PVAT) samples. Isolated adipocytes were cultured for 24-h after which, Then adipocytes were immediately processed to RNA extraction and determination of adipokines gene expression.

Results

In this study, we showed that men with CAD LEP and LEPR expression were lower in PVAT, whereas only the latter was decreased in SAT. Thus, LEPR expression in local fat depots appeared to differ in men and women, which is consistent with previous reports. Men with CAD showed lower LEP expression than women in EAT, whereas no significant differences were observed in SAT. Patients 51–59 years old were characterized by the lowest LEP expression in SAT and the highest LEP and LEPR expression in EAT and PVAT. Those >60 years presented the highest levels of LEPR in SAT. The presence of dyslipidemia in patients with CAD correlated with decreased LEPR expression in EAT, which is an unfavorable sign and may potentially lead to the development of leptin resistance. In patients with AH, LEP expression in EAT and LEPR expression in SAT and PVAT is increased. AH >20 years was associated with increased LEP in ATs. Smokers with CAD exhibited higher levels of LEP expression in SAT and EAT, and LEPR expression in SAT.

Conclusions

The results of the study indicate a close association of traditional CVD risk factors with adipocytokine imbalance in patients with CAD. The results indicate the potential of the fat depot and leptin and its receptor data as a drug application point. The study of the molecular basis of PVAT and EAT function can provide a more complete understanding of the etiopathogenetic mechanisms of CVD and develop an effective strategy for their prevention and control.

Funding Acknowledgement

Type of funding sources: None.
Predictors of deterioration in cardiorespiratory fitness among healthy adults: the importance of sex and obesity
Authors: Kaplan A , Fardman A , Tiosano S , Segev S , Scheinowitz M , Segev A , Klempfner R , Grossman E , Maor E
Published: October 2021

Introduction

Cardiorespiratory fitness (CRF) is associated with cardiovascular co-morbidities and is a strong predictor of adverse cardiovascular outcomes. However, data on the natural history of cardiorespiratory fitness among healthy subjects is limited.

Purpose

This study investigated what are the predictors of deterioration in CRF over time.

Methods

We investigated 36,239 men and women who were annually screened in a tertiary medical center and completed an exercise stress test in all visits, with a total of 175,596 annual visits. Subjects who failed to complete maximal exercise stress test according to the Bruce protocol at their first baseline visit were excluded. In addition, subjects with less than five visits to the center or those who developed ischemic heart disease during follow-up were excluded. Fitness was categorized into age- and sex-specific quintiles (Q) according to Bruce protocol treadmill time. Change in CRF between the first baseline visit and the fifth visit was used to calculate fitness deterioration. The primary study endpoint was defined as the lower sex-specific quintile of change in metabolic equivalents (METS) between visits 1 and 5. Logistic regression models were applied.

Results

Final study population included 10,841 subjects. The mean age of the study population was 49±10 years, the mean BMI was 26±4, and 8107 (75%) were men. Median METS at baseline were 10.8 (IQR 9–12.6) and 11.1 (IQR 9.4–13) at the first and fifth visit, respectively (p<0.001 for METS between visits). Overall, 2189 (20%) subjects met the study endpoint. CFR deterioration was higher among women as compared to men (p=0.023). Out of obesity, hypertension, fasting blood glucose, LDL, and HDL cholesterol, after adjustments for age, sex, and baseline CFR, only obesity was independently associated with fitness deterioration in the multivariate model (OR=1.4 95% CI 1.2–1.5, p<0.001). The association of obesity with fitness deterioration was modified by sex such that the risk of CRF deterioration was more pronounced in women (OR=1.6 95% CI 1.3–2, p<0.001) than in men (OR=1.3 95% CI 1.1–1.4, p<0.001).

Conclusion

Obesity is an independent predictor of future CRF deterioration. The effect of obesity on future CRF deterioration is more pronounced among women as compared to men.

Funding Acknowledgement

Type of funding sources: None.
The ceramide- and phosphatidylcholine- based Coronary Event Risk Test2 (CERT2) and cardiovascular mortality in men and women with type 2 diabetes
Authors: Leiherer A , Muendlein A , Saely C H , Larcher B , Mader A , Maechler M , Sprenger L , Mutschlechner B , Benda M , Laaksonen R , Laaperi M , Jylha A , Fraunberger P , Drexel H
Published: October 2021

The recently introduced Coronary Event Risk Test version 2 (CERT2) is a validated cardiovascular risk predictor score that uses circulating ceramide and phosphatidylcholine concentrations.

The purpose of this study was to investigate the power of CERT2 to predict cardiovascular mortality in 280 male and 121 female patients with type 2 diabetes (T2DM).

Prospectively, we recorded 55 cardiovascular deaths in men and 19 in women during a mean follow-up time of 7.6±3.6 and 8.1±3.4 years respectively.

Overall, cardiovascular survival decreased with increasing CERT2 risk categories (figure 1). In Cox regression models, CERT2 significantly predicted the incidence of cardiovascular mortality in male patients with T2DM (unadj. HR 1.82 [1.39–2.37] per standard deviation; p<0.001), the unadj. HR in women was 1.36 [0.83–2.22]; p=0.228). After adjustment for age, BMI, current smoking, LDL cholesterol, HDL cholesterol, hypertension, and statin use the HR in men was 1.73 [1.31–2.29]; p<0.001) and 1.40 [083–2.36]; p=0.210 in women. Interaction terms CERT2 x gender were non-significant both in univariate analysis (p=0.354) and after multivariate adjustment (p=0.359).

We conclude that sex does not significantly impact the association of CERT2 with cardiovascular mortality in patients with T2DM.

Funding Acknowledgement

Type of funding sources: None. Figure 1
Is there a different impact of traditional risk factors on calcium score, in an asymptomatic population?
Authors: Temtem M , Serrao M , Mendonca M I , Santos M , Sousa J A , Mendonca F , Sousa A C , Freitas S , Henriques E , Rodrigues M , Borges S , Guerra G , Drumond A , Palma Dos Reis R ,   GENEMACOR study
Published: October 2021

Background

The coronary calcium score has been increasingly used to stratify and predict cardiovascular risk, particularly in low and intermediate-risk persons. Understanding which determinants have more impact on coronary calcium score level, could lead to the development of new stricter preventive measures for reducing coronary artery calcification (CAC) and, consequently, cardiovascular risk.

Purpose

Our study aimed to investigate the impact of the traditional risk factors (TRFs) on the CAC score level and if there is a different association between this TRFs and CAC score degrees, in an asymptomatic population.

Methods

The study cohort comprised 1,122 consecutive asymptomatic individuals without known coronary artery disease (CAD) belonging to the healthy controls of GENEMACOR study and referred for computed tomography for CAC scoring assessment. The traditional risk factors considered were (1) current cigarette smoking, (2) dyslipidemia, (3) diabetes mellitus, (4) hypertension and (5) family history of coronary artery disease. According to the Hoff's nomogram, 3 categories were created: low CAC (0≤CAC<100 and P<50); moderate CAC (100≤CAC<400 or P50–75) and high or severe CAC (CAC≥400 or P>75). We evaluated the association of the different TRFs with these levels of CAC score (Chi-square test). Finally, we performed a logistic regression model adjusted for all significant TRFs selected in the bivariate analyses.

Results

Smoking was significantly associated with high levels of CAC score, 28.4% vs 21.7%; p=0.038 as well as hypertension, 58.8% vs 45.6%; p=0.001, type 2 diabetes 21.1% vs 9.6%; p<0.0001, dyslipidemia, 73.0% vs 66.1%; p=0.057. Family history did not show a significant association with CAC (p=0.717). Then, we constructed a logistic regression model adjusted the significant risk factors in previous analysis. The final multivariate analysis, selected as independent predictors of high CAC: Type 2 diabetes; OR=2.309; 95% CI 1.533–3.479; p<0.0001, hypertension; OR=1.627; 95% CI 1.185–2.233; p=0.003, and smoking, OR=1.565; 95% CI 1.102–2.222; p=0.012.

Conclusions

In this study, well-known and modifiable cardiovascular risk factors are associated with high calcium score levels. However, hypertension and diabetes seem to be preferentially associated with higher CAC scores, while tobacco, although it has a significant association, seems to be not so strong as diabetes and hypertension. This concept may mean that smoking has its primary role in plaque instability and not so much in the growing and calcification of plaques.

Funding Acknowledgement

Type of funding sources: None.
High plasma D-dimer and von Willebrand factor levels are associated with risk of upper gastrointestinal bleeding in patients with chronic coronary syndromes receiving long-term antiplatelet therapy
Authors: Korobkova V , Komarov A L , Shakhmatova O O , Dobrovolsky A B , Novikova E S , Guskova E V , Titaeva E V , Yarovaya E B , Shuleshova A G , Panchenko E P
Published: October 2021

Purpose

Plasma von Willebrand factor (VWF) and D-dimer levels have been proposed as markers of endothelial damage, coagulation activation and subsequent cardiovascular events. Thrombotic and hemorrhagic burdens are closely related. However, the association of coagulation markers with bleeding complications in pts with atherosclerosis remains unclear.

We aimed to assess the predictive value of D-dimer and VWF levels for upper gastrointestinal bleeding (UGIB) in patients with chronic coronary syndromes (CCS) receiving long-term antithrombotic therapy.

Patients and methods

Single center prospective Registry of Long-term AnTithrombotic TherApy (REGATTA-1 NCT04347200) included 934 pts with CCS (78.6% males, age 61±10.7 yrs, 76% after elective PCI). The UGIB annual incidence was 1.9 events per 100 patient-years.

VWF was determined in 28 pts with UGIB and 141 controls, matched for age, sex and main clinical risk factors. D-dimer was determined from 28 and 380 pts respectively

Results

The median for VWF was 139 [interquartile range 107–168]%. The median for D-dimer was 443,8 [interquartile range 272.5–702.4] ng/ml. ROC analysis revealed acceptable discriminatory ability for VWF (cut off >105%; AUC=0.67, 95% CI: 0.59–0.74, p=0.001) and for D-dimer (cut off >928 ng/ml; AUC=0.63, 95% CI: 0.59–0.68, p=0.002). High levels of coagulation markers remained significant in regression model adjuster for ESC panel of UGIB risk factors. OR for D-dimer = 3.4, 95% CI: 1.09–10.66; p=0.03). OR for VWF = 11.74, 95% CI: 1.19–116.18; p=0.03).

Conclusion

VWF and D-dimer should be considered as valuable prognostic biomarkers to improve the prediction of UGIB in addition to well-known scoring systems in CCS patients receiving long-term antithrombotic therapy.

Funding Acknowledgement

Type of funding sources: None.
A novel NKX2–5 double variant corresponds with familial atrial septal defect with arrhythmia in Indonesia
Authors: Rozqie R , Satwiko M G , Anggrahini D W , Hartopo A B , Sadewa A H , Mumpuni H , Dinarti L K
Published: October 2021

Background

The transcription factor NKX2–5 is essential for heart development during embryonic stages. The genetic variant of NKX2–5 is founded in many congenital heart diseases, especially atrial septal defect (ASD). Most of NKX2–5 variants in Asia based on Chinese population are single nucleotide polymorphisms. Whether the same variant of NKX2–5 is also involved in Southeast Asia population is still unknown. Therefore, we investigate the NKX2–5 variant in atrial septal defect population in Indonesia.

Purpose

To investigate the genetic variation of NKX2–5 in ASD in Indonesian population.

Methods

We screened 97 patients with ASD (including 23 familial patients) for sequence variant in NKX2–5. DNA samples were extracted from venous blood samples. The whole two coding exons of the NKX2–5 gene from DNA samples were amplified by multiplex PCR and directly sequenced. Variations were detected by comparison with the standard reference genome. The distribution of genotype frequency in atrial septal disease familial and non-familial were analyzed.

Results

We identified a novel heterozygous DNA sequence double variant (c413 G>A, rs1366528649 and c561 G>C, rs767559311) in exon 2 of NKX2–5 gene was identified only in 3 familial ASD patients. These patients are related to first-degree relatives. Patients with these double variants have septal defects and arrhythmias in young-to middle-aged adults (sinus node dysfunction dan atrial tachycardia). Moreover, one reported single nucleotide polymorphisms (SNPs) (c63 A>G, rs2277923) was detected in 83 patients (85.6%), as 20 patients (87%) were present among the familial group, and 63 patients (85.1%) were found from the non-familial group. The distribution of rs2277923 variation among the familial and non-familial groups was not different. Variation of rs2277923 has 2 genotypes: homozygous AG presented in 42 patients (43.3%) and heterozygous AG shown in 41 patients (42.3%). The distribution of both genotypes is also similar between familial and non-familial groups.

Conclusions

We discovered that the novel NKX2–5 double variants (rs1366528649 and rs767559311) might contribute to familial ASD risk, although the rs2277923 is the most commonly found variant in ASD patients in Indonesia.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dana Masyarakat Faculty of Medicine, Public Health and Nursing UGM fiscal years 2020
How common is undiagnosed prediabetes or type 2 diabetes mellitus in the cardiology ward?
Authors: Stratinaki M , Milaki K , Stavrakis S , Pitarokoilis M , Korela D , Detoraki M , Stavratis S , Katsiavos A , Kafarakis P , Garidas G , Lamprogiannakis E , Foukarakis E
Published: October 2021

Background

Type 2 diabetes mellitus (T2DM) is one of the most important risk as well as prognostic factors in patients with cardiovascular disease. Thus, it is of crucial importance to identify the patients with T2DM or prediabetes and provide them the necessary treatment and follow up.

Purpose

To identify the prevalence of undiagnosed prediabetes or T2DM in the patients admitted to cardiology department of our hospital during one year.

Methods

We retrospectively analyzed the data from the patients admitted to the cardiology department of our hospital (general secondary hospital) for a period of 12 months. We recorded the reason of admission, whether they had been previously diagnosed with T2DM or prediabetes.For those without a known history of T2DM glycosylated hemoglobin (HbA1C) was measured during their hospital stay. If HbA1c was higher than 6.5% the patient was classified as diabetic and if HbA1c was 5.7–6.4% the patient was classified as pre-diabetic.

Results

1524 patients were admitted in the cardiology department during 1 year (612 female, 912 male, mean age 76±12.4 years).Of them, 932 (61.15%) had no history of T2DM or prediabetes. 524 (34.38) were admitted due to acute decompensation of heart failure (ADHF), 206 (13.51%) due to acute coronary syndrome (ACS), 103 (6.75%) due to atrial fibrillation (AF), 87 (5.7%) due to other arrhythmias and 12 (0.78%) for other reasons (including pericarditis, endocarditis etc).229 patients (24.5%) were identified as prediabetics and 329 (35.3%) as diabetics. In terms of the reason of admission, as prediabetics were classified the following number of patients: 124 (23.66%) with ADHF, 42 (20.38%) with ACS, 26 (25.24%) with AF, 35 (40.22%) with other arrhythmias and 2 (16.66%) of those admitted for other reasons. Respetctively, as diabetics were classified 230 (44.8%) patients with ADHF, 74 (32.6% with ACS, 15 (12.7%) with AF, 7 (12.4%) with other arrhythmias) and 3 (9.2%) of those admitted for other reasons.

Conclusions

59.8% of all patients admitted in the cardiology department with no previous history of T2DM was found to have either prediabetes or T2DM. Given the fact that T2DM plays pivotal role in the prognosis of cardiovascular disease as well as the well established benefits of the new antidiabetic drugs especially in patients with heart failure and coronary artery disease, screening of all patients for T2DM could be very helpful in order to identify these patients and offer them suitable and timely treatment.

Funding Acknowledgement

Type of funding sources: None.