bluuebunny/crossref_metadata_2025 huggingface dataset:
Characteristics of patients with a lipoprotein(a) assessment – a health insurance claims database analysis
Authors: Laufs U , Schorr J , Klebs S
Published: October 2021

Background

Elevated lipoprotein(a) [Lp(a)] has been established as marker of cardiovascular [CV] risk, however, it is not commonly assessed.

Purpose

The aim of the study was to characterize patients who underwent their first Lp(a) testing regarding sociodemographic characteristics and clinical outcomes.

Methods

A retrospective analysis was performed on data from 4 million individual patients in a local database that provides complete, longitudinal, anonymized claims data. The data are representative of the German population in terms of age and gender. Lp(a) billing codes documented in the ambulatory setting were used to identify adult patients in 2015 to 2018 (index quarter defined as the first Lp(a) test in the respective year). These patients must not have had any Lp(a) test in the year prior to the index quarter. Patient data needed to be available for at least 1 year before and 1 year after the Lp(a) test or until death, whichever came first. Patients were followed for a maximum of four years.

Results

Within the four-year period, 36.609 patients (0.83% of the analysis set) had an Lp(a) test, of whom the majority (58%) were women. 50% of the women (median age 49 years) and 32% of the men (median age 56 years) were younger than 50 years.

The most prevalent comorbidities (based on International Classification of Diseases, version 10, German modification) at index were: dyslipidemia (E78) 46%, essential hypertension (I10) 46%, dorsalgia (M54) 25%, overweight/obesity (E66) 18%, chronic ischemic heart disease (I25) 16%, type 2 diabetes mellitus (E11) 15%, other coagulation defects (D68) 14%, depressive episodes (F32) 14%; disorders of refraction and accommodation (H52) 13%, somatoform disorders (F45) 13%, other non-toxic goiter (E04) 13%, other hypothyroidism (E03) 13%, and chronic kidney disease (N18) 11%.

The rates of cardiovascular events and procedures are listed in the table below.

Conclusions

Lp(a) tests are rarely performed in Germany. Women are more often tested than men, and in women this is done at a younger age. The data suggest that CV events/ CV hospitalizations frequently trigger the first Lp(a) assessment. The population tested displayed a high prevalence of cardiovascular comorbidities. The data identify an opportunity to better characterize the CV risk by testing Lp(a) once in a lifetime independent of prior CV events as recommended by current European Society of Cardiology/European Atherosclerosis Society guidelines.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): The analysis has been funded by Novartis Pharma GmbH, Nuremberg.
Comparison of coronary atherosclerotic features in response to achieving LDL-C <55 mg/dl between non-diabetic and diabetic patients: insights from the REASSURE-NIRS registry
Authors: Iwai T , Katoka Y , Murai K , Hosoda H , Honda S , Fujino M , Yoneda S , Otsuka F , Nishihira K , Kanaya T , Asaumi Y , Murata S , Miyamoto Y , Yasuda S , Noguchi T ,   REASSURE-NIRS Registry
Published: October 2021

Introduction

Current ESC guideline recommends achieving LDL-C <1.4 mmol/l in very high-risk subjects. Despite fabvourable anti-atherosclerotic effects of lowering LDL-C, its efficacy is diminished in type 2 diabetic patients. Whether response of coronary atheroma to on-treatment LDL-C <1.4 mmol/l differs in diabetic and non-diabetic subjects has not been elucidated yet.

Methods

The REASSURE-NIRS registry is an on-going multi-center registry to enroll CAD subjects receiving PCI under the guidance of near-infrared spectroscopy/intravascular ultrasound (NIRS/IVUS: DualProTM, Nipro, Tokyo, Japan) imaging. Culprit lesions in 557 CAD patients who already received a statin were evaluated by NIRS/IVUS. Maximum 4-mm-lipid-core burden-index (maxLCBI4mm) and plaque calcification grade at culprit sites were measured. Calcification grade at each 1-mm cross-sectional image was defined as follows: calcium arc 0° = 0, 0–90° = 1, 90–180° = 2, 180–270° = 3, 270–360° = 4. MaxLCBI4mm and the averaged calcification grade were compared in diabetic and non-diabetic subjects stratified according to on-treatment LDL-C level, respectively.

Result

The proportion of diabetic (n=293, HbA1c; 6.9±0.9%) and non-diabetic patients (n=264) with on-treatment LDL-C <1.4 mmol/l was 8.54 and 16.67%, respectivey (p=0.01). In non-diabetic patients, achieving LDL-C <1.4mmol/L was associated with a lower maxLCBI4mm, whereas, in diabetic patients, maxLCBI4mm was numerically smaller under achieving LDL-C <1.4 mmol/l, but this comparison did not meet statistical significance (Figure 1). Furthermore, a greater degree of calcification grade in non-diabetic patients was observed in association with on-treatment LDL-C level (Figure 2). However, plaque calcification at diabetic coronary atheroma was not necessarily induced under achieving stricter LDL-C goal. Subgroup analysis demonstrated that diabetic patients with body mass index ≥25 (odds ratio = 0.15; 95% CI: 0.18–1.19, p=0.04), estimated glomerular filtration rate <60 (mL/min/1.73m2) (odds ratio = 0.31; 95% CI: 0.10–0.90, p=0.03) and non-insulin use (odds ratio = 0.36; 95% CI: 0.14–0.87, p=0.02) benefit from achieving LDL-C <1.4 mmol/l.

Conclusion

Achieving LDL-C <1.4 mmol/l was associated with more stabilized atheroma in non-diabetic patients with CAD, whereas these favourable effects were not observed in diabetic subjects. Our findings suggest the potential need to modify additional atherogenic risks for stabilizing diabetic coronary atheroma under achieving LDL-C <1.4 mmol/l.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
Clinical features of familial hypercholesterolaemia in children and adults – the PMMHRI Registry
Authors: Lewek J , Starostecka E , Konopka A , Sosnowska B , Banach M ,   the PMMHRI Registry
Published: October 2021

Background

Familial hypercholesterolaemia (FH) affects approximately 150,000 people in Poland. However, there are many patients still unaware of this diagnosis. On the other hand, it might lead to early cardiovascular mortality and morbidity due to the lifetime exposure to high levels of LDL-C. Therefore, increased awareness of FH is very important.

Purpose

We aimed to evaluate the clinical features of FH in children and adults based on the preliminary data from the Polish Mother's Memorial Hospital Research Institute (PMMHRI) Registry.

Methods

The registry of children and adults with FH conducted in PMMHRI (2nd largest, supra-regional hospital in Poland) was established to investigate the clinical characteristics, management and clinical outcomes data of FH patients. All consecutive patients with diagnosed (genetically and/or phenotypically) FH were included in the study.

Results

Of 103 patients with FH, there were 16 children aged 9±3 and 87 adults aged 41±16; 59% were female. The diagnosis of FH in adults was late – at the mean age of 41 years. Among children with FH, as compared with adults, the levels of highest TC and LDL-C ever were similar. However, children presented higher mean levels of total cholesterol, LDL-C and HDL-C measured at baseline visit (Table). Interestingly there was no difference in BMI between children and adults (Table). Among adults, chronic coronary syndrome was diagnosed in 11.5% patients, from which 5.7% patients had a history of myocardial infarction and 7% patients required revascularization. The prevalence of chronic coronary disease, peripheral artery disease as well as stroke in family history was definitely higher (in 44 patients – 50%, 17 patients – 20% and 22 patients – 25%, respectively). Most of adult patients at baseline visit were prescribed statins (rosuvastatin or atorvastatin). 14 patients (13.6%) declared statin intolerance, most of them complained of muscle pain, 4.6% patients reported hepatic disturbances. The frequency of statin use in children was lower – 56% children were prescribed statin, 19% declared statin intolerance with muscle pain as the side-effect of treatment. Ezetimibe, as a part of combination therapy, was taken by 29% adult patients. PCSK9 inhibitors were prescribed (within drug program) for 11.5% adult patients. Fibrates were prescribed for 13.7% adult patients, the same was for n-3 fatty acids.

Conclusions

Despite definitely younger age of FH diagnosis children present higher mean levels of LDL cholesterol than adults. Therefore, the lifetime exposure to LDL cholesterol starts at a very young age. As a result, there is a need to the earlier initiation of therapy and strict monitoring of the atherosclerosis progression. On the other hand, late diagnosis of FH in adults is an unmet need, that might be associated with poorer prognosis.

Funding Acknowledgement

Type of funding sources: None.
Association of glycated haemoglobin A1c levels with cardiovascular outcomes in the general population: results from the BiomarCaRE consortium
Authors: Sinning C , Makarova N , Schnabel R , Ojeda F , Felix S B , Koenig W , Peters A , Rathmann W , Brenner H , Kuulasmaa K , Wilsgaard T , Blankenberg S , Soderberg S , Ferrario M M , Thorand B ,   BiomarCaRE
Published: October 2021

Background

Glycated haemoglobin A1c (HbA1c) is used to monitor the quality of diabetes treatment; however, its role in predicting cardiovascular outcomes in the general population remains uncertain.

Purpose

The additional use of glycated haemoglobin A1c (HbA1c) as a biomarker might highlight subjects of the general population with an increased risk for cardiovascular outcomes with cardiovascular disease, cardiovascular mortality or overall-mortality.

Methods

Data from six prospective population-based cohort studies across Europe comprising 36,180 participants were analysed. HbA1c was evaluated in conjunction with classical cardiovascular risk factors (CVRFs) for association with cardiovascular mortality, cardiovascular diseases (CVD), and overall mortality in the study population, in non-diabetic (N=32,477), and diabetic participants (N=3,703).

Results

Kaplan-Meier curves showed higher event rates with increasing continuous log-transformed HbA1c levels. Cox regression analysis revealed significant associations between HbA1c (in mmol/mol) log-transformed divided by interquartile range and the examined outcomes, with a hazard ratio (HR) of 1.12 (95% confidence interval (CI): 1.04–1.20, p=0.0019) for cardiovascular mortality, 1.10 (95% CI: 1.04–1.16, p<0.001) for CVD, and 1.09 (95% CI: 1.05–1.14, p<0.001) for overall mortality per one unit increase.

An increased risk of CVD was observed in subjects without diabetes with increased HbA1c levels (HR 1.09; 95% CI: 1.01–1.16, p=0.021). An HbA1c cut-off value of 39.89 mmol/mol (5.8%), 36.62 mmol/mol (5.5%), and 38.80 mmol/mol (5.7%) for cardiovascular mortality, CVD, and overall mortality, respectively, was determined for selecting individuals at an increased risk.

Conclusion

HbA1c was demonstrated to be an independent prognostic biomarker for all investigated outcomes in the general European population. An approximately linear relationship was observed between an increase of HbA1c levels and the outcomes. Elevated HbA1c levels were also associated with the outcomes in participants without diabetes (i.e. HbA1c levels <6.5% (<48mmol/mol) which underlines the importance of HbA1c levels in the overall population.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union Seventh Framework ProgrammeEuropean Union FP 7 project CHANCES Kaplan-Meier curves for the outcomesPenalised cubic splines HbA1c/time event
Relationship between heart rate variability, low grade inflammation and glycated hemoglobin. A sugary sweet story
Authors: Hadad R , Akobe S F , Weber P , Haugaard S B , Sajadieh A
Published: October 2021

Background

Low grade inflammation (LGI) is significantly associated with microvascular complications in diabetes mellitus (DM). Reduced and impaired Heart rate variability (HRV) is a strong marker of autonomic dysfunction and neuropathy and strongly associated with microvascular disease in DM. New studies and observations indicate that the diabetic neuropathic process starts early during pre-diabetes. On the other hand, HRV and LGI are closely interrelated. Our aim was to evaluate whether LGI or hyperglycemia (i.e. high HbA1c) is associated with the autonomic dysfunction or reduced HRV among people with diabetes and pre-diabetes.

Methods and materials

This study is based on The Copenhagen Holter Study, in which 678 community dwelling subjects aged 55 – 75 years who were free of previous cardiovascular disease, except from well controlled hypertension, and who underwent a 48-hours Holter recording. Analysis of HRV including night-time HRV were available for 653 participants and this population included 133 people with well-controlled and newly recognized T2DM (mean HbA1c 55 mmol/mol (7.2%)) and 386 people with pre-diabetes defined as HbA1c between 39 mmol/mol (5.7%) and 47 mmol/mol (6.4%). We selected high-sensitive CRP, as markers of LGI. As measures of HRV we used the standard deviation of normal-to-normal (N-N) beats (SDNN), the root mean square of N-N beats (RMSSD) which has been acknowledged to be best linked to vagal parasympathetic tone, and the mean time between N-N complexes (meanNN) which represents the average 24-hour heart rate (60.000/meanNN = average 24-hour HR in beats/min)

Results

Measures of HRV were associated with HgbA1c among both people with T2DM and pre-diabetes. Among people with pre-diabetes HbA1c was inversely associated with 24-hour RMSSD (r=−0.11, p=0.03) and night-time SDNN (r=−0,13, p>0.01), while among T2DM HgbA1c was only associated with 24-hour RMSSD (r=−0.21, p=0.02). These association stayed significant when adjusted for sex, age, BMI, smoking, HOMA-ir, hs-CRP and systolic blood pressure in multiple linear regression (Table 1). LGI was only associated with HRV in diabetes. HbA1c was not associated with any measures of HRV or LGI among people with normal glucose metabolism.

Conclusion

HRV is closely and inversely associated with HbA1c in both diabetes and prediabetes, but only in diabetes LGI is associated with HRV. This indicates that the process of autonomic dysfunction/neuropathy starts at an early phase during pre-diabetes and probably provoked by postprandial hyperglycemia, while in diabetes both HbA1c and LGI are associated with HRV showing that LGI is activated later in the disease process probably provoked by long-term postprandial hyperglycemia, indicating treatment of hyperglycemia and postprandial hyperglycemia in the prediabetes state may be helpful.

Funding Acknowledgement

Type of funding sources: None.
Out-of-hospital cardiac arrest and ambient air pollution: a dose-effect relationship and a predictive role in OHCA risk
Authors: Gentile F R , Primi R , Baldi E , Compagnoni S , Mare C , Contri E , Reali F , Bussi D , Facchin F , Currao A , Bendotti S , Savastano S
Published: October 2021

Background

Pollution has been suggested as a precipitating factor for cardiovascular diseases via a series of different mechanisms. However, data about the link between the different air pollutants and the risk of out-of-hospital cardiac arrest (OHCA) are limited and controversial.

Purpose

The primary aim of this study is to examine the impact of short-term exposure to particulate and gaseous pollutants on the incidence of OHCA in a vast metropolitan and rural area that encompasses four provinces of the Po Valley in Northern Italy, one of the most polluted areas in Italy and Europe due to its levels of industrialization and high population density. The secondary aim of this study is to look for a dose-effect curve, which could help predict OHCA incidence based on the concentration of pollutants in a specific area.

Methods

This is a retrospective analysis of prospectively collected data both in the OHCA registry (Lombardia CARe) and in the database of the regional agency for environmental protection (ARPA) of the Lombardy region. All medical OHCAs and the mean daily concentration of pollutants including fine particulate matter (PM10, PM2.5), benzene (C6H6), carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2) and ozone (O3) were considered from January 1st to December 31st, 2019 in the southern part of the Lombardy region (provinces of Pavia, Lodi, Cremona and Mantua; 7863 km2; about 155ehab724.2654 inhabitants). Days were divided into high or low incidence of OHCA according to the median daily incidence. A Probit dose-response analysis and both uni- and multivariable logistic regression models were provided for each pollutant.

Results

The median daily incidence of OHCA was 0.3 cases/100,000 inhabitants. Benzene was the pollutant with the greatest difference between days at high and low incidence of OHCA [0.7 (IQR 0.4–1.2) vs 0.4 (IQR 0.3–0.7), p<0.001], whereas SO2 had the lowest and least significant difference between the two periods [3.2 (IQR 2.8–3.6) vs 3.1 (IQR 2.7–3.5), p=0.046]. O3 showed a countertrend, being significantly higher in the low-incidence period [29.9 (IQR 10.9–61.7) vs 56.1 (IQR 25.5–74.1), p<0.001] as well as temperature [10.1— (IQR 5.2–14.8) vs 15.1 (IQR 8.9–23.3), p<0.001]. By using the Probit regression analysis and after adjusting for temperature, a dose-response relationship was demonstrated for all the tested pollutants.

Conclusions

Our results clarify the link between pollutants and the acute risk of cardiac arrest suggesting the need of both improving the air quality and integrating pollution data in future models.

Funding Acknowledgement

Type of funding sources: None.
Health promoting and risky behaviours of nurses, taking into account “coronary prone behaviour pattern”
Authors: Gieniusz-Wojczyk L , Dabek J , Kulik H
Published: October 2021

Introduction

“Coronary prone behaviour pattern” refers to the way of coping with environmental stressors, otherwise known as a type A behaviour pattern. Stress, unlimited working hours and the shift system are conducive to an “unhealthy life style” conducted by nurses.

The purpose of the study was to evaluate health promoting and risky behaviours of nurses, taking into account the “coronary prone behaviour pattern.”

Material and method

1080 nurses were subject to the analysis, among whom 1052 (97.4%) were women. They were from 23 to 65 years of age, with the average of 44.2 years. Most of them (n=484; 44%) had been working as nurses more than 20 years. The AUDIT-C test was used in the analysis, as well as the menu evaluation scale by Z. Bielińska, the International Physical Activity Questionnaire (IPAQ), the Psychosocial Working Conditions Questionnaire, the COPE Inventory (an inventory developed to assess methods of coping with stress; Mini-COPE) and the A-Framingham scale by Chesney and Rosenman, in the Polish adaptation by Z. Juczyński.

Results

“Coronary prone behaviour pattern” (A Type behaviour pattern) was demonstrated by 333 (30.8%) nurses, B Type – by 272 (25.2%) nurses, while the other group demonstrated the Intermediate Type. The respondents with “coronary prone behaviour pattern” statistically significantly (p=0.003) demonstrated the risk of the problem with alcohol less often in comparison to the other respondents. Additionally, nurses featuring the above-mentioned behaviour pattern ate better (M=16.66; SD=6.66) in comparison to persons with B type behaviour patterns (M=15.49; SD=6.52). As far as the mental and physical well-being is concerned, resulting from stress perceived, persons with A type behaviour patterns had materially (p<0.001) better mental and physical well-being and on average better results in the scope of coping with stress, i.e. Active Coping, Search for Support, Acceptance, Turning to Religion, and Sense of Humour in comparison to nurses demonstrating other behaviour patterns. There were no significant differences between nurses demonstrating different behaviour patterns and the existence of diseases (obesity, hypertension, hypercholesterolemia, diabetes), physical activity and smoking.

Conclusions

A significant group of nurses demonstrated the “coronary prone behaviour pattern” which is unfavourable to health and predisposes to the development of cardiovascular diseases.

The occurrence of “coronary prone behaviour pattern” was associated with health promoting behaviours of nurses being the subject of the analysis, i.e. better mental and physical well-being, better coping with stress and a lower risk of the problem with alcohol and proper nutrition.

Funding Acknowledgement

Type of funding sources: None.
Influence of resistance exercise on cardiac remodeling and soleus muscle of infarcted rats
Authors: Souza L M , Gomes M J , Pagan L U , Rodrigues E A , Pontes T H D , Fernandes A A H , Murata G M , Zornoff L A M , Okoshi K , Okoshi M P
Published: October 2021

Introduction

Resistance exercise (RE) provides several benefits for healthy individuals. However, its effects during heart failure are unclear. The aim of this study was to evaluate the effects of RE on functional capacity, cardiac remodeling, and soleus muscle molecular and biochemical features in rats with myocardial infarction (MI).

Methods

Three months after MI or simulated surgery (Sham), Wistar rats were divided into three groups: Sham (n=14), MI (n=13), and MI subjected to RE (RE-MI, n=14). Exercised rats trained 3 times a week performing four climbs with progressive loads on a ladder over 12 weeks. Functional capacity was assessed by maximum carrying capacity test in the ladder and exercise tolerance test in treadmill. Echocardiogram was performed at the end of the study. Energy metabolism and antioxidant enzyme activities were assessed by spectrophotometry in the soleus muscle. Oxidative stress markers were analyzed in soleus muscle (lipid hydroperoxide) or serum (malondialdehyde and protein carbonylation). Protein expression of insulin type-1 growth factor-like pathway, protein kinase B, and rapamycin target complex was analyzed by Western-blot. Statistical analysis: ANOVA and Bonferroni or Dunn, Student's t and Goodman tests; p<0.05.

Results

Mortality was higher in MI than Sham. Infarction size did not differ between groups. Resistance exercise increased maximum load carrying capacity, without changing functional capacity or cardiac remodeling. Catalase activity was lower in MI than Sham and glutathione peroxidase activity was lower in MI than Sham and RE-MI. Protein carbonylation was higher in RE-MI than MI. Energy metabolism did not differ between groups, except for lower phosphofructokinase activity in RE-MI than MI. Expression of p70s6K, p-FoxO3a, and p-FoxO3a-to-FoxO3a ratio was lower, and p-p70s6K-to-p70s6K ratio was higher in MI than Sham.

Conclusion

The practice of resistance exercise is safe, attenuates mortality, and improves maximum load carrying capacity regardless of changes in cardiac remodeling in infarcted rats. In soleus muscle, resistance exercise preserves phosphofructokinase and antioxidant enzyme activity and expression of the proteins involved in muscle trophism.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): CNPq UNESP
The effects of dual task training on the neurophysiological parameters in cardiac surgery patients: a pilot study
Authors: Tarasova I , Trubnikova O , Kukhareva I , Syrova I , Sosnina A , Kupriyanova D , Nagirnyak O , Barbarash O ,   Study of the mechanisms of cognitive dysfunction in patients with cardiovascular diseases
Published: October 2021

Background

Preventive strategies for postoperative cognitive decline in cardiac patients are being actively developed. The dual task method has demonstrated beneficial potential for treating patients with cognitive impairment.

Purpose

To evaluate the effects of dual task training on the neurophysiological parameters in cardiac surgery patients.

Methods

47 patients who underwent elected coronary artery bypass grafting (CABG) or CABG combined with carotid endarterectomy (CEE) were recruited in a prospective study. Patients who did not undergo any cognitive training were assigned to Group 1 (n=21), whereas those who underwent postoperative cognitive training I (postural training and an open-type task) (n=11) and II (visual-motor response and an open-type task) (n=15) were assigned to Group 2 and Group 3, respectively. Cognitive training was carried out daily, starting from the 4th day of the postoperative period. The average number of trainings was 5 for each training group. All patients underwent extensive neuropsychological testing and electroencephalographic (EEG) studies 3–5 days before and 8–11 days after surgery.

Results

All patients demonstrated an increase of the theta1 and beta1 EEG rhythms power, an increase in theta/alpha EEG index and a decrease in theta/beta activity index in the early postoperative period of cardiac surgery. Importantly, Group 3 patients undergoing cognitive training II showed an improvement in a larger number of indicators related to executive functions and attention than Group 2 patients undergoing training I. The last reported only improved short-term memory and attention.

Conclusion

All patients had similar ischemic brain damage. Those who underwent cognitive training reported improvements in neurodynamics, attention, and memory. The results of the study indicate the need to improve further the approaches to postoperative cognitive training using dual tasks with intensification of the load and individual support for patients undergoing cardiac surgery.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The Russian Foundation for Basic Research
Does coronary calcium score add value to European SCORE in an asymptomatic population?
Authors: Temtem M , Mendonca M I , Soares C , Serrao M , Rodrigues R , Santos M , Sousa J A , Mendonca F , Sousa A C , Rodrigues M , Henriques E , Freitas S , Drumond A , Palma Dos Reis R ,   GENEMACOR study
Published: October 2021

Background

Despite being a controversial subject, multiple guidelines mention the use of Coronary Artery Calcification (CAC) scoring in the cardiovascular risk prediction in the asymptomatic population. Adding CAC score to European SCORE (Systematic Coronary Risk Evaluation) may improve the prediction of MACE (Major Adverse Cardiovascular Events), providing better cardiovascular risk stratification.

Purpose

Our study aims to evaluate the impact of CAC severity in MACE prediction compared with SCORE and estimate the additional value of CAC score in cardiovascular risk stratification in a low- risk region and asymptomatic population.

Methods and results

The study consisted of a prospective registry of 1110 asymptomatic individuals free of known coronary heart disease, enrolled from the GENEMACOR study and referred for computed tomography for the CAC scoring assessment. The mean age was 51.6±8.2 years, and 74.1% were male. This population was followed for a mean of 5.2±3.3 years for the primary endpoint of all-cause of cardiovascular events. The extent of CAC differs significantly between men and women in the same age group. Therefore, the distribution of CAC score by age and gender was done using Hoff's nomogram (a). According to this nomogram, 3 categories were created: low CAC (0≤CAC<100 and P<50); moderate CAC (100≤CAC<400 or P50–75) and high CAC (CAC≥400 or P>75). Through a Cox regression for MACE occurrence, SCORE does not remain in the equation, and the higher severity level of CAC presented a significant risk of MACE occurrence with an HR of 7.943 (95% CI 2.948 – 21.401; p<0.0001). Using the C-index, CAC was superior to SCORE (0.729 vs 0.615; p<0.0001). Adding CAC score to SCORE increased MACE prediction compared to SCORE alone (AUC 0.77 vs 0.615; p=0.003).

Conclusion

Our results point to the importance of the CAC score inclusion in primary prevention to improve cardiovascular risk stratification. CAC score in clinical practice could have a prognostic impact on MACE prediction. Larger prospective multicenter cohorts with longer follow-up should reproduce and validate these findings.

Funding Acknowledgement

Type of funding sources: None. Table 1
The impact of chronic alcohol overuse on right ventricular myocardial strain
Authors: Hamala P , Kasprzak J D K , Wierzbowska-Drabik K W D
Published: October 2021

Background

The mechanisms and detail effects of alcohol cardiac toxicity are not clear.

Purpose

We aimed, to evaluate the relationship between the consumed alcohol dose and severity of right ventricle (RV) myocardial injury in patients overusing alcohol.

Methods

We collected a group of patients chronically overusing alcohol (ALC- alcohol overusers) and matched to them control group of abstainers (CG-control group). Clinical and echocardiography data have been obtained and statistical analysis performed. RV strain data were obtained from free wall (RVGS). Strain data were presented as absolute values.

Results

Group with available and feasible data of RV function consisted of 53 ALC patients, 75% men, 50±12 years old, and 33 controls CG, 69% men. Alcohol unit (AU – 10 gram of pure ethanol) consumed per week (AUW) was 21 (12–44) in ALC and 0 (0–0) in CG, P<0.001. The mean time of alcoholism amounted 20 (10–26) years. RVGS was: 20±7% in ALC vs. 24±3% in CG, P=0.001. In ALC, RV middle segment strain (RVmid) was 22±8% vs. 24±3%, P=0.01 and RV apical segment strain (RVapx) was 17±7 vs. 22±3, P=0.0002, see Table. No significant differences were detected for RV diameter, TAPSE and RVS', see Table. Moreover, univariate analysis showed significant positive correlation between free time (FT- time between last alcohol ingestion and echocardiography examination) and RVGS (rho = 0.36, P=0.01) as well as between FT and global longitudinal left ventricle strain (LVGS) (rho = 0.33, P=0.01), whereas TAPSE and RVS' did not show this relationship (rho = 0.30, P=0.41 and rho = 0.21, P=0.14, respectively). See Figure for RVGS.

Conclusions

Chronic alcohol overuse was associated with significant worsening of RV function expressed by absolute values of RVGS and RV middle and apical segment strains, offering novel quantitative parameter for reflecting early, often subclinical, impairment of RV function. RVGS and LVGS (contrary to TAPSE and RVS') reflected also myocardial function recovery after alcohol intake cessation proportionally to the elapsed abstinence time.

Funding Acknowledgement

Type of funding sources: None. Table 1Figure 1
Sex-based differences in clinical outcomes and resource utilization of type 2 myocardial infarction
Authors: Ariss R W , Elzanaty A M , Minhas A M K , Nazir S , Gul S , Patel N , Ahuja K R , Mochon A , Eltahawy E A
Published: October 2021

Background

Sex-based differences in clinical outcomes have been previously well described in type 1 myocardial infarction (MI). However, type 2 MI is common in contemporary practice with scarce data regarding sex-based differences of clinical outcomes and resource utilization.

Purpose

To examine the association of sex category with clinical outcomes and resource utilization in hospitalizations with type 2 MI.

Methods

The Nationwide Readmission Database 2018 was queried for hospitalizations within the United States with type 2 MI using The International Classification of Diseases, Tenth Revision (ICD-10) diagnosis code I21.A1. Comorbidities and outcomes were identified using the corresponding ICD-10 codes. Complex samples multivariable logistic and linear regression models were used to determine the association between type 2 MI and outcomes (in-hospital mortality, index length of stay [LOS], hospital costs, discharge to nursing facility, and 30-day all-cause readmissions) in females compared to males with type 2 MI.

Results

A total of 252,641 hospitalizations [119,783 (47.4%) females and 132,858 (52.6%) males] were included in this analysis. Females with type 2 MI were more likely to be older (72.8 years vs. 69.7 years; P<0.001), admitted on the weekend (26.5% vs. 25.9%; P=0.02), and have a higher prevalence of chronic pulmonary disease (35.6% vs. 32.0%; P<0.001), obesity (17.9% vs. 15.7%; P<0.001), neurological disorders (22.9% vs. 22.3%; P=0.02), deficiency anemias (7.5% vs. 6.6%; P<0.001), and hypothyroidism (22.1% vs. 10.1%; P<0.001) compared to males with type 2 MI. Female with type 2 MI was associated with lower in-hospital mortality, shorter LOS, less hospital costs, and increased nursing home discharge compared to males with type 2 MI. Females and males with type 2 MI had similar rates of 30-day all-cause readmission [Table 1].

Conclusion

Among type 2 MI hospitalizations, females have lower in-hospital mortality, less hospitalization cost, shorter LOS, but increased rates of nursing home discharge compared to males. Thirty-day all-cause readmission was similar between males and females with type 2 MI.

Funding Acknowledgement

Type of funding sources: None.
Biochemical and cardiovascular predictors of PIMS risk in children after COVID-19 recovery =- the results of the LATE COVID Kids study
Authors: Jatczak-Pawlik I , Lewek J , Czkwianianc E , Zeman K , Jankowski P , Banach M ,   the LATE-COVID-Kids study.
Published: October 2021

Background

Unfortunately, the number of children with the pediatric inflammatory multisystem syndrome (PIMS) associated with previous coronavirus disease has been increasing significantly.

Purpose

The aim of the present study was to characterize biochemical and cardiovascular predictors of PIMS risk in children recovered from COVID-19 based on the data from the LATE-COVID-Kids study (NCT04799444).

Methods

131 consecutive COVID-19 convalescents (mean age: 8.89±4.91; 67 boys and 64 girls) hospitalized for the clinical evaluation after the acute phase of the COVID-19 were classified into two groups related to symptoms: 29 children finally diagnosed with PIMS and 102 children with no-PIMS. All patients had confirmed coronavirus infection based on the positive results of nucleic acid test (RT-PCR - reverse transcriptase-polymerase chain), and they were serologically tested for antibodies against SARS-CoV-2. They had detailed laboratory testing, electrocardiography, and echocardiography.

Results

The time from COVID-19 recovery was from 1 to 10 months (median 4.0 [3.00–5.00] months). Children with PIMS were significantly younger in comparison to those without (6.60±4.50 vs 9.50±4.80 years, respectively; p=0,005). In comparison to non-PIMS group, children with PIMS had higher level of antithrombin III (111±7.23 vs. 104±10.9; p=0.0015), CK-MB (29.0 [18.5–36.0] vs. 21.0 [15.0–30.7]; p=0.03) and heart rate [HR]/min (100 [89.0–112] vs. 90.0 [79.0–100]; p=0.006) but lower PQ interval (120 [110–120] vs. 130 [120–140]; p=0.023) on admission to hospital. Moreover, the immunological parameters: IgA and neutrophils were lower in children with PIMS vs. no-PIMS (0.69 [0.47–0.85] vs. 1.19 [0.71–1.50]; p=0.0001 and 37.4%±13.3 vs. 43.0±11.6; p=0.0045, respectively), but lymphocytes were significantly higher (50.6±13.6 vs. 43.7±10.9; p=0.002). Some acid-base balance parameters were higher in children following PIMS vs. no-PIMS children group: pCO2 (41.30±5.70 vs. 45.0±7.00; p=0.019), pO2 (50.1 [38.4–59.7] vs. 37.8 [27.9–49.9]; p=0.007), and O2Sat (84.2 [69.3–90.6] vs. 64.2 [44.3–82.6]; p=0.004); however, concentration of HCO3- (23.6 [22.2–24.4] vs. 24.3 [22.8–26.2]; p=0.023) was lower in group of PIMS children.

Conclusions

Based on our best knowledge, it is the first data on the possible predictors of PIMS risk in children recovered from COVID-19. We showed that children with PIMS have significantly higher levels of antithrombin III, CK-MB, HR, as well as lymphocytes, pCO2, pO2 and O2Sat on admission to hospital and lower levels of PQ interval, IgA, neutrophils and concentration of HCO3. We continue our research to confirm these results and to create the PIMS SCORE algorithm to allow prediction of children with the risk of PIMS occurrence after COVID-19 recovery.

Funding Acknowledgement

Type of funding sources: None.
Preoperative evaluation of pulmonary hypertension in lung transplant candidates: echocardiography versus right heart catheterization
Authors: Skalsky K , Abu T , Levi A , Bental T , Hirsh R , Samara A , Vaknin-Assa H , Perl L , Codner P , Rosengarten D , Kramer M R , Kornowski R , Hadsai D
Published: October 2021

Background

Right heart catheterization (RHC) and echocardiography are both routinely used for pulmonary hypertension (PH) assessment in LT candidates, although this is not mandatory according to guidelines. We aim to describe the correlation between the pulmonary artery systolic pressure (PASP) measured by echocardiography to that measured by RHC in this population.

Methods

From a retrospective registry of 461 LT candidates, undergoing RHC between 2015–2019, 393 consecutive patients were assessed for the presence of pulmonary hypertension according to two methods – echocardiography and RHC. The primary outcome was the correlation between the estimated PASP measured by echocardiography to that measured by RHC. Secondary outcome was the accuracy of the echocardiographic assessment of PH.

Results

Patients were predominantly males (63.6%) with a mean age of 61.46±8.33y. The two most common etiologies for lung failure were interstitial lung disease or pulmonary fibrosis (52.2%) and chronic obstructive pulmonary disease (30.5%). Estimated PASP as measured by echocardiography was available in 89.31% of the patients, with a mean value of 49.5±20.02 mmHg. Mean PASP measured by RHC was 42.47±17.96 mmHg. The correlation between the two measurements was moderate (Pearson's correlation: r=0.609, p<0.01). The accuracy of the echocardiographic estimation of PASP was poor with >10 mmHg differences between the two values in 79.9% of the patients.

Conclusions

In the pre-surgical evaluation of LT candidates, echocardiographic estimation of PASP has moderate correlation with the PASP measured by RHC and relatively poor accuracy.

Funding Acknowledgement

Type of funding sources: None.
Frailty is associated with impaired cerebral oxygenation recovery during
Authors: Perez-Denia L , Claffey P , Delgado-Ortet M , Byrne L , Kenny R A , Finucane C
Published: October 2021

Frailty is associated with impaired peripheral circulatory responses to standing in older adults. However, little is known about how frailty affects cerebrovascular function during such activities of daily living. Here we investigate the association between frailty and cerebral oxygenation during standing in a large clinical cohort of fallers and fainters.

Participants were recruited from a national Falls and Syncope unit and underwent an active stand test (5–10 minutes lying supine, 3 minutes standing) with concurrent monitoring of continuous blood pressure (BP) and heart rate (HR) and tissue saturation index (TSI) using near-infrared spectroscopy (NIRS). Frailty was measured using a count of deficits (27 morbidities). Robust linear regression was applied to study the association between features of dynamic cerebral oxygenation (changes from baseline at nadir, overshoot, 30s and steady state; and recovery rate) and frailty while correcting for covariates. A p-value <0.05 was considered significant.

Frailty was associated with deficits in TSI at 30s after standing (β: −0.165, CI: (−0.261, −0.069), p=0.005), as well as a lower diastolic BP at 30s (β: −1.346, CI: (−2.287, −0.405), p=0.032) and standing steady-state (β: −1.182, CI: (−2.038, −0.325), p=0.032). When stratified by gender, frailty was associated in women with a lower TSI at overshoot (β: −0.174, CI: (−0.312, −0.037), p=0.043) and 30s (β: −0.216 (−0.344, −0.089), p=0.010), and impaired DBP recovery at overshoot (β: −1.623, CI: (−2.865, −0.391), p=0.045) and attenuated HR response at 30s (β: −0.701, CI: (−1.246, −0.155), p=0.036). No associations were found in men.

Impaired cerebral oxygenation and BP responses to standing are associated with frailty in patients with falls and syncope, with stronger effects in women, suggesting that frailty may increase risk of hypoperfusion and consequent syncope, falls, and brain ageing. Our results demonstrate the clinical utility and feasibility of using NIRS in this context which can be used to further personalise patient management.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Irish Research Council Cerebral oxygenation and frailty
New onset atrial fibrillation and heart failure among patients with multiple myeloma: analysis from a nationwide french medical information database
Authors: Cottin Y , Boulin M , Doisy C , Mounier M , Caillot D , Chretien M L , Bodin A , Herbert J , Bonnotte B , Zeller M , Maynadie M , Fauchier L
Published: October 2021

Background

Over the last decade, new therapies, screening optimization, and cardiovascular management have changed the cardiovascular prognosis of patients with multiple myeloma (MM). Older studies suggested that MM could be associated with increased risk of heart failure (HF). Based on a nationwide hospitalization database, we aimed to assess the risk of hospitalization for Heart failure (HF) and/or Atrial fibrillation (AF).

Methods

From 1st January 2013 to 31st December 2013, 3,381,472 adults (age ≥18 years) were hospitalized for any reason in French hospitals and then had at least 5 years of complete follow-up (or suffered death earlier). We identified 15,774 patients diagnosed with known MM at baseline. The outcome analysis on hospitalization for new onset HF or AF was performed with follow-up (FU) starting at the time of last event. For each patient with MM, a propensity score-matched patient with no MM was selected (1:1) using the one-to-one nearest neighbor method (n=15774 in each group).

Findings

In the propensity-score-matched population, mean±SD FU was 3.7±2.3 years, median (IQR)5.0 (1.3–5.7) years, mean age was 71±12y, and most were female (55%). When compared with patients without MM, MM patients were more likely to have history of HF (16.8% vs. 10.5%, p<0.0001), pulmonary edema (1.5 vs. 0.8%, p<0.0001), or AF (13.4% vs. 9.6%, p<0.0001). At FU, MM patients had a higher risk of all-death (yearly rate 20.02 vs 11.39%/year). Moreover, yearly rates of new onset HF or AF, which were the common CV causes of re-hospitalisation, were higher in the MM group, i.e. respectively for incidence rate, 7.47 vs 5.42%/year (p<0.0001) and 4.57 vs 3.72%/year (p<0.0001). Multivariate analysis showed that MM remained significantly associated with a higher rate of HF and AF (HR (95% CI): 1.343 (1.276–1.413) and 1.196 (1.128–1.269), respectively). Results were similar in sensitivity analysis limited to patients with recent MM (i.e. diagnosed within the 3 previous months).

Interpretation

From a large nationwide hospitalization database, we show that patients with MM had a higher risk of new onset HF and AF. Our findings highlight the key issue of cardiovascular management in patients with MM.

Funding Acknowledgement

Type of funding sources: None.
Is early percutaneous coronary intervention safe in patients ACS and cancer?
Authors: Scarpone M , Bergami M , Cenko E , Vasiljevic Z , Zdravkovic M , Vavlukis M , Kedev S , Milicic D , Manfrini O , Bugiardini R
Published: October 2021

Background

Patients with malignancies may have a high pro-thrombotic status as well as a high risk of hemorrhagic events either due to the tumor or its treatment. For this reason, these patients have always been excluded from randomized clinical trial on percutaneous coronary intervention (PCI).

Aim

To investigate the safety of PCI in patients with malignancies admitted for an AMI.

Methods and results

Retrospective analysis on an international European ACS registry. Primary endpoint: in-hospital mortality. Secondary endpoint: periprocedural-complications. There were 273 patients (35% women) with AMI and malignancies. Colon (19%), prostate (14%), breast (13%), lung (8%) and blood (8%) malignancies were the most frequents type of cancer. Women and men had similar age (68±11.5 vs 69.1±11.5, p=ns). STEMI was in 56% of patients (with no significant gender difference: 51% men vs 65% women, p=0.09). PCI was performed in 64% of patients (with primary PCI in 75% of STEMI). The rate of complications during cardiac catheterization and intervention was 6.5% (2.1% distal embolization, 2.1% no-reflow, 0.7% acute closure, 0.7% dissection, 0.7% perforation, none major bleeding). Nobody among patients that had cardiac catheterization and intervention complications died during hospital stay. In-hospital mortality was 5.9%. The group of patients treated with PCI had a significantly lower rate of death then that of those treated non invasively (1.7% vs 13.1%, p<0.ehab724.28851). Factors associated with lower probability to receive cardiac catheterization were older age (OR: 0.94, 95% CI: 0.92–0.97) and absence of typical chest pain at admission (OR: 0.38; 95% CI: 0.18–0.81), but the type of malignancy and gender were not. On multivariable model, age (OR: 1.1, 95% CI: 1.03–1.17) and PCI (OR: 0.16, 95% CI: 0.04–0.59) were independently associated with the risk of in-hospital death for ACS (increased and decreased risk, respectively).

Conclusion

These preliminary data from real word support the safety use of PCI in patients with malignancies and ACS, which have always been excluded from randomized clinical trial.

Funding Acknowledgement

Type of funding sources: None.
Incidence of maternal and fetal complications in pregnant with mechanical prosthetic cardiac valves: a cohort study
Authors: Youssef G , Hosny M , Ramadan W , Baligh E
Published: October 2021

Background

In developing countries, an unusually large number of women of childbearing age have mechanical valves because rheumatic fever and concomitant valvular heart disease are still common and most severely affect the young. Managing anticoagulation during pregnancy is challenging, and the rate of complications is relatively high.

Purpose

The aim of this study was to detect the incidence of maternal and fetal complications in pregnant women with prosthetic valve in a high-risk pregnancy unit in one of the developing countries.

Methods

This study included 106 pregnant women with prosthetic heart valves on oral anticoagulant therapy. Excluded from the study were patients with low ejection fraction (<50%), patients with other comorbidities that may affect the pregnancy outcomes and patients who were not willing to share their data. Patients were followed up since presentation to the high-risk pregnancy unit till delivery. At each visit, women were clinically assessed for the occurrence of complications (heart failure, infective endocarditis, prosthetic valve dysfunction, systemic emboli, new onset arrhythmia, antepartum hemorrhage, or death). Babies were evaluated by an Obstetrician for intrauterine growth retardation or fetal death, abortion, oligo or polyhydramnios, and congenital heart diseases.

Results

The mean age was 28.5±4.2 years, 58 patients (54.7%) had mitral valve prothesis, 34 (32.1%) had aortic valve prosthesis and 14 patients (13.2%) had double valve prothesis. Fifty-three patients (50%) received warfarin throughout pregnancy and the rest switched to heparin in the first trimester. Cerebrovascular stroke occurred in 4 patients (3.8%), all were on the 1st trimester and all were taking heparins. The mean gestational age at delivery was 36.2±4.8 weeks and the mean fetal birth weight was 2435±791.5 gm. Thirty-three abortions were reported and the mean gestational age for abortion was 13 weeks±6 days while the mean gestational age for intrauterine fetal death was 29±4 weeks, table. Two babies had congenital heart diseases (ventricular septal defect and patent ductus arteriosus) and in both, the mothers were taking warfarin >5 mg/day during the second and third trimesters.

Conclusion

In this tertiary care centre, the incidence of maternal complications was relatively small while the incidence of fetal complications was high, especially in mothers taking higher warfarin doses. Switching to heparin in the first trimester increased the risk of systemic embolization.

Funding Acknowledgement

Type of funding sources: None.