bluuebunny/crossref_metadata_2025 huggingface dataset:
“Target Heart Rate” calculated aiming at zero overlap of mitral E and A waves is useful for prediction of long-term outcome for patients with heart failure and reduced ejection fraction
Authors: Yumita Y , Nagatomo Y , Takei M , Saji M , Goda A , Kohno T , Nakano S , Nishihata Y , Ikegami Y , Shiraishi Y , Kohsaka S , Yoshikawa T ,   WET-HF
Published: October 2021

Background

Lower heart rate (HR) is associated with more favourable long-term outcome in patients with heart failure with reduced ejection fraction (HFrEF). However, an optimal threshold of HR remains unclear. Targeted HR (THR), defined by echocardiographic deceleration time (DCT) to eliminated overlap of E and A waves, may aid in risk stratification of HFrEF patients.

Purpose

In this study, we aimed to clarify the impact of on long-term clinical outcome in patients with HFrEF.

Methods

In the multicenter WET-HF registry, 4000 consecutive patients hospitalized for acute decompensated HF (ADHF) were registered between 2006 and 2017. Among them, the patients with EF ≥40% or a history of atrial fibrillation were excluded. THR was calculated based on their DCT value measured in compensated HF phase during the index admission. The following formula was applied; THR (bpm)=93 - 0.13 × deceleration time (DCT, msec). A total of 876 patients with HFrEF were included in the present analysis (age: 72 [60–81], male: 69%) and the patients were divided into the 2 groups of HR at discharge ≤ THR (L group) and > THR (H group). The primary endpoint (PE) was defined as the composite of all-cause death and ADHF re-admission.

Results

Compared to the H group, the L group showed higher prevalence of males (74% vs. 66%, P=0.025) with higher body mass index (BMI, 23.2 vs. 22.2, P=0.016), hemoglobin (Hb, 12.9 vs. 12.4, P=0.031), albumin (Alb, 3.7 vs. 3.6, P=0.039) and larger left atrial diameter (LAD, 44 mm vs. 41 mm, P=0.002) and tricuspid regurgitation pressure gradient (TRPG, 29 mmHg vs. 27 mmHg, P=0.012). Age, estimated glomerular filtration rate (eGFR), LVEF (29% vs. 30%, P=NS) and E/e' (17.7 vs. 16.8, P=NS) were similar for both groups. At discharge, HR was lower in L group (66 [60–71] bpm vs. 80 [74–86] bpm, P<0.001), albeit there were no significant differences in b-blocker prescription (90% vs. 85%, P=0.069) or its dose (3.75 [1.25–7.25] mg vs. 2.5 [1.25–5] mg, P=0.11).

In the survival analysis, the L group showed a significantly lower rate of PE (P=0.03), whereas there was no significant difference in the incidence of PE between the patients with HR at discharge ≥70 bpm and <70 bpm (P=NS).

Multivariate Cox hazard analysis showed that HR at discharge ≤ THR was an independent predictor of PE (hazard ratio 0.67 [0.46–0.97], P=0.037), even after adjusting for confounding factors including age, sex, BMI, Hb, Alb, and b-blocker prescription, whereas HR at discharge <70 bpm was not (hazard ratio 0.94 [0.65–1.33], P=0.71).

Conclusion

THR was associated with long-term outcomes in patients with HFrEF after acute decompensation, suggesting that it may aid in tailored treatment for HR reduction in these patients.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
Eco color doppler evaluation of renal hemodynamic in the prognosis of acute heart failuree
Authors: Turrini F , Galassi M , Sacchi A , Ricco' B , Messora R , Bertolotti M , Pinelli G ,   VERDETA' group (VEnous Renal Doppler Evaluation of acute hearT fAilure
Published: October 2021

Background

Elevation of right atrial pressure is a typical feature of acute heart failure (AHF), it is transmitted to renal veins leading to persistent kidney congestion. We aimed to evaluate the role of Doppler ultrasound in monitoring kidney congestion during diuretic therapy.

Methods

71 patients (26 F - mean age 80.8±8.2 - mean EF 0.40±13.2) admitted for AHF underwent cardiac and renal Echo Doppler examination at day 1–3–5 of Hospital stay. Parameters of arterial and venous flow within cortical right kidney were recorded. Venous Doppler Profile (VDP) was classified as: continuous (C), pulsatile (P), biphasic (B) or monophasic (M) according to the growing degree of derangement. Arterial resistive index (RI) >0.8 was considered elevated. Correlation between renal hemodynamic changes and clinical outcome (Death and cardiovascular (CV) hospitalization) at 60 days was sought.

Outcome

VDP derangement (M or B) was detected in 57 patients (80.3%) at day 1 and in 36 at day 5 (52.2%, p <0.05). RI was elevated in 43 patients (61.4%) at day 1 and in 28 patients at day 5 (43.8%, p<0.05). Patients with deranged VDP on admission, had higher pulmonary artery sistolic pressure (PASP) (53±10 vs 39±17 mmHg, p<0.05) but similar EF, BNP and GFR values. Patients with elevated RI on admission exhibited lower GFR (47.6±23.8 vs 60.7±19.1 ml/min/1.73 m2, p<0.05) but similar EF, BNP and PASP values. At day 5, 41 (57.7%) patients had VDP improved of at least one class or continuous VDP (Table 1).

After 60 days, 13 (18.3%) patients died and 8 (11.3%) had a CV hospitalization. Kaplan Meier analysis found a significant better outcome in those patients whose VDP did improve after diuretic therapy (Log Rank test p<0.05 – Figure 1).

Conclusions

Most patients admitted with AHF present deranged VDP. Diuretic treatment lead to VDP improvement and to renal RI decrease. In this perspective study, for the first time VDP improvement after endovenous diuretic treatment resulted associated to reduced risk of death and CV Hospitalization.

Evaluation of VDP could become a useful tool in monitoring the efficacy of diuretic treatment in AHF.

Funding Acknowledgement

Type of funding sources: None. Table 1. Patients characteristics and VDPFigure 1. Kaplan-Meier estimate curve
Discordance in prognostic ability between physician assessed NYHA classification and self-reported health status in patients with acute heart failure
Authors: Belkin M , Wussler D , Kozhuharov N , Strebel I , Walter J , Michou E , Goudev A , Menosi Gualandro D , Maeder M , Kobza R , Rickli H , Breidthardt T , Muenzel T , Erne P , Mueller C ,   Cardiovascular Research Institute Basel
Published: October 2021

Background

Especially in patients with acute heart failure (AHF) the NYHA classification remains of uncertain representation of patients' actual health state. Alternatively, patient's subjective well-being, in terms of health-related quality of life (HRQL), showed to have an excellent prognostic ability in out clinic patients with chronic heart failure.

Objectives

It is unknown whether HRQL instruments can assess a more reliable prognostication in patients hospitalized due to AHF than the NYHA classification.

Methods

Goal Directed Afterload Reduction in Acute Congestive Cardiac Decompensation Study (GALACTIC) was a multicenter, randomized, open-label blinded-end-point trial that emphasized early intensive and sustained vasodilation in adult patients hospitalized due to AHF with NYHA functional class III/IV, however provided neutral findings. HRQL was assessed by the generic EQ-5D-3L which is a 3-leveled 5-item instrument and the disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ). Unadjusted and adjusted Cox regression models were performed after patients were grouped into low (EQ-5D −0.074<0.25; KCCQ 0<25), moderately low (0.25<0.5; 25<50), moderately high (0.5<0.75; 50<75) and high HRQL (0.75–1.0; 75–100).

Results

781 patients were enrolled in 10 centres in 5 countries over 2 continents among which 536 (69%) patientshad completed theEQ-5D and 419 (54%) the KCCQ shortly after admission. Within 180 days of follow-up69 (13%) and 54 (13%) patients died and 151 (28%) and 122 (29%) died or were rehospitalized due to AHF, respectively. Cumulative incidence as well as HRs in patients grouped according to NYHA (n=536) indicated a comparable or significantly lower risk in patients with NYHA IV: e.g. for the combined outcome HR 1.07 (95% CI 0.777–1.473) and aHR 0.463 (95% CI 0.245–0.875). Whereas HRs in patients grouped according to both, EQ-5D (n=536) and KCCQ (n=419), increased from the group with highest to the group with the lowest HRQL: e.g. aHR for moderately high 1.11 (95% CI 0.718–1.715), for moderately low 1.721 (95% CI 1.102–2.688) and for low EQ-5D index 1.891 (95% CI 1.136–3.149) referenced to high HRQL (EQ-5D index 0.75–1.0).

Conclusions

These findings corroborate and extend previous work suggesting that NYHA classification poorly discriminates AHF patients' prognosis and challenge its' extensive application. HRQL might be a possible alternative to easily assess these patients' heath state.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, the Swiss Heart Foundation A. 180-day mortality; B. composite outcome
Natriuretic peptide dynamics with remote pulmonary artery pressure monitoring
Authors: Casquete D , Codina P , Domingo M , Santiago E , Cediel G , Spitaleri G , Zamora E , Santesmases J , Boldo M , Rivas C , Gonzalez B , Velayos P , Pulido A , Lupon J , Bayes-Genis A
Published: October 2021

Background

Real-life clinical practice has confirmed the value of pulmonary artery (PA) pressure-guided therapy in patients with heart failure (HF) and history of repeated HF hospitalizations (HFH), to greater extent to that reported in the pivotal clinical trial CHAMPION-HF. The value of hemodynamic monitoring in a population of patients with HF and elevated natriuretic peptides, but without recent HFH, is unknown.

Objective

To assess N-terminal-pro-brain natriuretic peptide (NTproBNP) dynamics before and 6 months after PA pressure sensor implantation.

Methods

Ten patients managed in a multidisciplinary HF clinic implanted with the CardioMEMS PA pressure sensor were consecutively included from June 2019 to July 2020. Mean age was 63.1±23.5 years, 30% were women, 40% had HF with reduced EF (EF <40%). NTproBNP was measured at baseline and six months after sensor implantation. Wilcoxon matched-pairs signed-rank test was used to compare NTproBNP values at baseline and at 6 months. Fractional polynomial fit plot was used to represent changes in mean PA pressure over time. Linear regression was used to predict the change in NTproBNP based on the change in PA pressures.

Results

Mean daily pressure transmission rate was 92.4±5.1%. During the six-month study period 90% of patients had a change in medication related to PA pressure, with an average of 0.21 [0.17–0.66] changes per patient per month. Mean PA pressure at baseline was 28.5±9.5 mmHg, and decreased by 5.5 mmHg at 6 months (p=0.01) (Figure 1). NTproBNP was also significantly lower six months post CardioMEMS implantation; decreasing from 1696 pg/ml [976–2930] at baseline to 1046 pg/ml [616–2076] after six months (p=0.04) (Figure 2). There was a weak correlation between the change in NTproBNP and the change in mean PA pressure (R2=0.22, p=0.17).

Conclusions

NTproBNP values were significantly lower 6-months following implantation of a PA pressure sensor to guide HF management. Mean PA pressures were also significantly reduced.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitari Germans Trias i Pujol Figure 1. Change in mean PA pressure over time.Figure 2. Change in NTproBNP after PAP monitoring.
Temporal characteristics of duration of daily activity before and after heart failure hospitalizations in a large real-world population of patients with cardiovascular implanted electronic devices
Authors: Sarkar S , Koehler J
Published: October 2021

Background

Diagnostic parameters measured in implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy defibrillators (CRTD) have been shown to change before and after heart failure (HF) events with fluid overload.

Purpose

We investigated the temporal characteristics of device measured daily activity duration before and after HF events in a large real-world cohort of patients with ICD/CRTD devices.

Methods

We linked a de-identified database of aggregated electronic health record (EHR) data (2007–2017) to a manufacturer's device database with continuous diagnostic monitoring data. Patients with ICD/CRTD implants with HF diagnostic feature were included for this study. Device accumulates the total number of active minutes during a 24-hour period with an active minute defined as total number of accelerometer fluctuations reaching a threshold during the minute. HF event was defined as an inpatient, emergency department, or observation unit stay in a hospital with primary diagnosis of HF and intravenous diuretics administration. Temporal ensemble average of daily duration of activity in the 60 days pre and post HF events were compared between HF events with and without readmission within 60 days and with periods with no HF events during follow-up.

Results

A total of 17,886 patients with 1.8±1.2 years of follow-up met inclusion criteria. The average age of patients was 66.6±12.3 years, with 72% being males, and 51% with ICD devices. The average daily duration of activity in HF events with and without readmission and with no events is shown in Figure. A total of 1174 patients had 1425 HF events with no readmission for HF within 60 days and 282 patients had 295 HF events which were followed by readmission for HF within 60 days. A total of 17,839 patients had no HF events over 86,858 follow-up months. The 7-day average activity duration decreased by >10 minutes in a large proportion of patients in the 30-day period before HF event compared to 30-day periods with no events (43% vs 34%; Odds Ratio: 1.52; p<0.001). A 7-day average activity duration increase of >10 minutes from admission to 30 days after admission happens in a smaller proportion of HF events with versus without HF readmission within 60 days of index admission (24% vs 31%; Odds Ratio: 0.7; p<0.001).

Conclusions

In a large real-world population of patients with ICD/CRTD devices, the average daily activity duration reduces before HF events. Re-admissions are more likely in patients with smaller increase in activity duration post discharge.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Medtronic Plc
Efficacy of intravenous ferric carboxymaltose in patients with acute heart failure and iron deficiency with and without anaemia: a subgroup analysis of AFFIRM-AHF
Authors: Filippatos G , Ponikowski P , Farmakis D , Metra M , Ruschitzka F , Van Der Meer P , Kirwan B.-A , MacDougall I C , Fabien V , Waechter S , Butler J , Anker S D , Jankowska E A ,   the AFFIRM-AHF investigators
Published: October 2021

Background

Iron deficiency is associated with increased morbidity and mortality in patients with acute heart failure (HF), even in the absence of anaemia.

Purpose

This prespecified subanalysis of the AFFIRM-AHF trial investigated the effects of ferric carboxymaltose (FCM) on recurrent HF hospitalisations and cardiovascular (CV) mortality in patients with and without anaemia defined as baseline haemoglobin (Hb) <12 g/dL, ≥12 g/dL.

Methods

In total, 1108 patients (558 FCM, 550 placebo) were included in the modified intention-to-treat AFFIRM-AHF analysis. The primary outcome was a composite of total HF hospitalisations and CV death, evaluated up to 52 weeks post-randomisation.

Results

Of the 1108 patients, 228 and 329 in the FCM group and 236 and 314 in the placebo group had Hb <12 g/dL and ≥12 g/dL at baseline, respectively. For patients with a baseline Hb ≥12 g/dL, the total number of HF hospitalisations and CV death was 156 and 201 in the FCM and placebo groups, respectively, with a rate ratio (95% confidence interval) of 0.67 (0.48–0.93; p=0.016). For patients with Hb <12 g/dL, this was 136 and 171 in the FCM and placebo groups, respectively (0.97 [0.66–1.41; p=0.862]). This treatment effect was consistent for all secondary outcomes in patients in the FCM group vs placebo, for both Hb subgroups (Figure).

Conclusion

Iron deficiency treatment with FCM following acute HF reduced the risk of HF hospitalisations and CV death, irrespective of Hb level at baseline.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Vifor Pharma Ltd. Figure 1
Association between the triglyceride-glucose index and a procoagulant state in coronary artery disease
Authors: Kosuta D , Novakovic M , Bozic Mijovski M , Fras Z , Jug B
Published: October 2021

Background

Metabolic risk factors and a procoagulant state represent major drivers of atherothrombosis. In terms of metabolic risk factors, the triglyceride-glucose (TyG) index has recently emerged as a marker of metabolic syndrome and an independent predictor of cardiovascular outcomes in patients with coronary artery disease (CAD). In terms of a procoagulant state, previous research suggests that CAD is associated with increased coagulation and impaired fibrinolytic activity, which may contribute to atherothrombotic events. We hypothesized that metabolic risk, as determined by TyG index, may be an important driver of hemostatic derangements in patients with CAD.

Purpose

We sought to establish a possible association between the overall hemostatic, coagulation and fibrinolytic potentials (OHP, OCP and OFP), and the TyG Index in patients with CAD.

Methods

Consecutive patients after a recent myocardial infarction (within 90 days from inclusion) had fasting blood samples withdrawn. OHP, OCP and OFP were determined with a previously validated method, using thrombin and recombinant tissue-type plasminogen activator, by absorbance measurements at 405 nm in 1 minute intervals for 40 minutes. Areas under the curve were constructed for OHP and OCP with the obtained measurements, OFP was calculated as the difference between the two aforementioned areas: OFP = [(OHP – OCP) / OCP] x 100 (%). Baseline data, cardiovascular risk factor profile and standard laboratory tests were collected. TyG index was calculated using the previously validated formula: TyG index = ln [triglyceride (mg/dL) x glucose (mg/dL) / 2]. Proportions were compared using the chi-squared test, linear regression models were constructed for the multivariate analysis.

Results

We included 117 patients (mean age 56±10 years, 20% women). Arterial hypertension was present in 86 (73.5%), diabetes mellitus in 10 (8.5%), dyslipidemia in 75 (64.1%), family history in 46 (39.3%) patients; 54 (46.2%) were active smokers (within 2 years). Median OHP was 8.0 (interquartile range [IQR] 2.9), OCP was 22.6 (IQR 6.2), OFP was 66.0 (IQR 11)%. The TyG index was a strong univariate predictor of OCP (Beta 2.26 [0.282–4.242] p=0.026), and retained its statistical significance after multivariate adjustment for sex, age and traditional risk factors (R2 0.23; ANOVA for regression p<0.001; Beta 1.98 [0.13–3.84], p=0.036).

Conclusion

The TyG index, a marker of metabolic syndrome, is an independent predictor of a procoagulant state in CAD, as determined by the OCP. Our findings suggests that the metabolic syndrome may be an important driver of atherothrombotic risk in patients with CAD.

Funding Acknowledgement

Type of funding sources: None. Correlation between TyG index and OCP
Application of enhanced external counterpulsation in treating patients with stable ischemic heart disease
Authors: Karaganov K , Lishuta A , Belenkov Y
Published: October 2021

Introduction

Currently, enhanced external counterpulsation (EECP) is one of the safest non-invasive treatments for patients with coronary artery disease (CAD). In combination with traditional drug therapy, EECP can significantly improve the quality of life of patients by increasing coronary perfusion, improving myocardial contractile function, and improving endothelial function.

Aim

To study the effect of EECP on clinical status, quality of life (QL) and structural-functional state of blood vessels in patients with stable coronary artery disease.

Materials and methods

In the present study 67 CAD patients were included (average age 65.7±5.66 years; men 71.9%, angina pectoris of functional class II-III (FC)). All patients were on optimal medical therapy (ACE inhibitors, beta-blockers, antiplatelet agents, statins, nitrates), which remained unchanged during the follow-up. Patients were given a course of EECP (35 procedures 220–280 mmHg.art.). Test 6-minute walk (T6MW), QL (Minnesota Satisfaction Questionnaire (MSQ)), echocardiography (ejection fraction of the left ventricle (LVEF)) were performed at baseline and after 6 months. In addition, all the patients underwent laser photoplethysmography (Stiffness index (SI, m/s), phase shift (PS m/s) occlusion index (OI), nail fold videocapillaroscopy (capillary density at rest, after reactive hyperemia and venous occlusion (CDr, CDrh, CDvo, respectively, cap/mm2) and applanation tonometry (central aortic systolic pressure (CASP), (radial augmentation index (RAI)) in order to assess structural and functional characteristics of blood vessels.

Results

In six months after EECP, significant improvement in patient's condition was found. T6MW distance (212±32 vs 251±29 m, p<0.05), QL MSQ (20.1±6.2 vs 41,6±7,1, p<0.05) and LVEF (40.9±7,6% vs 45.2±10.1%, p<0.05) increased significantly.

Stiffness of large vessels was found to be decreased. CASP, RAI and SI decreased significantly, (CASP: 131±15.8 vs 129±14.8 mmHg, p<0.05), (RAI: 97.2±25.1 vs 97±21.6%, p<0.05), (SI: 8.9±1.5 vs 8.8±,1.6 m/s, p<0.05), Functional characteristics of large blood vessels significantly improved (PS (5.6±1.2 vs 6.8±1.4 m/s, p<0.05).

Microcirculation - Reflection index (106.7 vs 95.3%, p<0.05) and OI (1.5±0.3 vs 1.66±0.26, p<0.05) for all. Increase CDrest (44±12.2–44.6±11.5 capillaries, p>0.05), in samples with CDrh (45±14 vs 57±16 capillaries, p<0.05) and CDvo (55±15–56 vs 4±14.2 capillaries, p<0.05).

Conclusion

ECCP treatment of patients with stable CAD, in addition to optimal drug therapy, led to an increase in load tolerance and improvement of the QL, myocardial contractile function, accompanied by improvement of the structural and functional state of large vessels and microcirculatory bed.

Funding Acknowledgement

Type of funding sources: None.
COVID-19 patients with coronary artery disease have a higher mortality risk: a meta-analysis
Authors: Zuin M , Rigatelli G , Zuliani G , Roncon L
Published: October 2021

Background

The prevalence and prognostic implications of coronary artery disease (CAD) in patients infected by the novel coronavirus 2019 disease (COVID-19) remain unclear.

Purposes

We conducted a systematic review and meta-analysis to investigate the prevalence and mortality risk in COVID-19 patients with pre-existing CAD. PRISMA. guidelines were followed in abstracting data and assessing validity. We searched Medline, Scopus and Web of Science to locate all articles published up to December 8, 2020 reporting data of COVID-19 survivors and non-survivors with pre-existing CAD. Data were pooled using the Mantel-Haenszel random effects models with odds ratio (OR) as the effect measure with the related 95% confidence interval (CI). Statistical heterogeneity between groups was measured using the Higgins I2 statistic.

Results

Twenty-four studies, enrolling 22744 patients [mean age 58.2 and 70.9 years for survivors and non-survivors (p<0.0001), respectively], met the inclusion criteria and were included into the final analysis. The pooled prevalence of pre-existing CAD in COVID-19 patients was 11.5% (95% CI 0.097–0.136) and resulted significantly higher in non-survivors compared to survivors (16.7% vs 7.1%, respectively, p<0.0001). A random-effect model confirmed a significant higher risk of death in COVID- 19 patients with pre-existing CAD in the short-term period (OR 2.96, 95% CI 2.18–4.03, p<0.0001, I2=79%) (Figure 1). A meta-regression, using age as moderator, did not identify any statistical significance (Coeff: −0.046, 95% CI −0.101–0.009, p=0.104). The Egger's regression test (t=0.596; p=0.06) confirmed that there were not statistically evidences of publication bias

Conclusions

Pre-existing CAD in COVID-19 patients significantly increased the risk of death during the infection.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Forest plot investigating the COVID-19 patients mortality risk in relation to pre-existing coronary artery disease.
Prognostic utility of fibrinogen in patients with coronary artery disease and prediabetes or diabetes following percutaneous coronary intervention: five-year findings from a large single-center cohort
Authors: Yuan D S , Jiang P , Jia S D , Zhang C , Liu Y , Zhao X Y , Yang Y J , Gao R L , Xu B , Gao Z , Yuan J Q
Published: October 2021

Background

The prognosis for patients with coronary artery disease (CAD) remains unfavorable despite advances in treatment. Fibrinogen (FIB) is an independent risk factor for mortality and cardiovascular events in general population. However, the relationship between FIB and long-term mortality among CAD patients undergoing PCI is less investigated, especially in individuals concomitated with diabetes mellitus (DM) and prediabetes (Pre-DM).

Methods

6140 patients with CAD undergoing PCI were consecutively enrolled in our study and subsequently divided into three groups according to FIB levels (FIB-L, FIB-M, FIB-H). These patients were further grouped by glycemic metabolism state [normoglycemia (NG), Pre-DM, DM]. The primary endpoint was all-cause mortality. The secondary endpoint was cardiac mortality.

Results

FIB was positively associated with hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) both in CAD patients with and without DM. During a median follow-up time of 5.1 years, elevated FIB was significantly associated with long-term mortality from all-cause (adjusted HR: 1.86; 95% CI: 1.28–2.69; P=0.001) and cardiac specific (adjusted HR: 1.82; 95% CI: 1.15–2.89; P=0.011). Similarly, patients with DM but not Pre-DM had increased risk of all-cause and cardiac mortality (all P<0.05). When grouped by both FIB levels and glycemic metabolism state, diabetic patients with medium and high FIB levels had higher risk of mortality [(adjusted HR: 2.57; 95% CI: 1.12–5.89), (adjusted HR: 3.04; 95% CI: 1.35–6.82), all P<0.05]. Notably, prediabetic patients with high FIB also had higher mortality risk (adjusted HR: 2.27; 95% CI: 1.01–5.12).

Conclusion

FIB was strongly associated with long-term all-cause and cardiac mortality among CAD patients undergoing PCI, especially in persons concomitated with DM and Pre-DM, indicating FIB test may help identify high-risk individuals in this specific patient population.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Key Research and Development Program of China (No. 2016YFC1301300, 2016YFC1301301); National Natural Science Foundation of China (No. 81770365)
Gender differences in characteristics, treatment and outcomes in ST elevation myocardial infarction patients in four European countries
Authors: Hellgren T , Blondal M , Ainla T , Jortveit J , Eha J , Loiveke P , Marandi T , Saar A , Veldre G , Lewinter C , Halvorsen S , Ferenci T , Andreka P , Janosi A , Edfors R
Published: October 2021

Introduction

Women receive less evidence-based care than men and have higher mortality after myocardial infarctions than men. But it is not known how the gender difference in risk factors, treatments and outcomes differs between European countries.

Purpose

In order to investigate the gender differences in European countries with different economic predispositions we aimed to describe and compare baseline characteristics, in-hospital management, medications at discharge and death outcomes of man and woman ST-elevation infarction (STEMI) patients following routine clinical practice in Sweden, Norway, Hungary and Estonia.

Methods

The study population is patients over the age of 18 with STEMI who were treated in hospital 2014–2017 (for Norway between 2013–2016) and registered in one of the national myocardial infarction registers. Patients with non-ST elevation infarction and unstable angina were excluded. Risk factors, hospital treatment, and prescription medications were obtained from the national myocardial infarction registries from each country. Mortality in-hospital, after 30 days and after 1 year, was obtained from national death registers.

Results

Women were on average older, had more comorbidities and higher mortality in hospital, after 30 days and one year after hospitalization. Women received coronary angiography, percutaneous coronary intervention, left ventricular ejection fraction assessment and evidence-based drugs to a lesser extent than men.

Conclusions

The study illustrates that there are differences in characteristics, management, treatments and outcomes between men and women in all of the studied countries no matter economic predispositions. Generally, women are treated with guideline recommended therapy to a lesser extent than men in the studied countries.

Funding Acknowledgement

Type of funding sources: None.
Variation in in-hospital mortality and its association with procedure-related bleeding complications: a report from nationwide percutaneous coronary intervention registry in japan
Authors: Sawayama Y , Yamaji K , Kohsaka S , Yamamoto T , Higo Y , Numasawa Y , Inohara T , Ishii H , Amano T , Ikari Y , Nakagawa Y
Published: October 2021

Background

Large-scale registries have demonstrated that in-hospital mortality after percutaneous coronary intervention (PCI) varies widely across institutions; however, the underlying reasons are not fully understood. Bleeding has been regarded as one of the most serious PCI-related complications associated with increase in mortality. To date, reducing bleeding complications have tended to be addressed, though appropriate care for patients who developed bleeding complications may be also important. Therefore, we sought to investigate which was more involved in the inter-institutional variations in in-hospital mortality.

Methods

We analyzed 388,866 procedures at 718 hospitals performed from 2017 to 2018, using data from a representative nationwide PCI registry in Japan. A bleeding complication was defined as post-procedural bleeding that required a blood transfusion. We first divided the hospitals into quintiles according to their risk-adjusted in-hospital mortality (very low, low, medium, high, and very high). Then, the bleeding complication rate and in-hospital mortality rate among patients who developed bleeding complications were calculated for each quintile.

Results

In total, 4,048 (1.04%) in-hospital deaths and 1,535 (0.39%) bleeding complications occurred. In-hospital mortality varied widely from 0.22% to 2.46% in very-low- to very-high-mortality hospitals. The bleeding complication rate also increased modestly from 0.27% to 0.57% (odds ratio, 1.95; 95% confidence interval, 1.58–2.39). However, the mortality rate among patients who developed bleeding complications markedly increased by quintile; the mortality rate of very-high-morality hospitals was 6-fold higher than that of very-low-mortality hospitals (29.0% vs. 4.8%, respectively; odds ratio, 12.2; 95% confidence interval, 6.9–21.7).

Conclusions

Wide variation in in-hospital mortality was observed within the Japanese nationwide PCI registry, and this variation was largely driven by differences in mortality among patients with bleeding complications, rather than crude incidence of bleeding complications. These results underscore the importance of efforts toward reducing not only bleeding complications but also, even more importantly, mortality once bleeding has occurred.

Funding Acknowledgement

Type of funding sources: None.
Declines in in- and out-of-hospital coronary mortality from 2000 to 2016: results from the French MONICA registries
Authors: Gbokou S , Biasch K , Dallongeville J , Huo Yung Kai S , Montaye M , Amouyel P , Meirhaeghe A , Ferrieres J , Moitry M
Published: October 2021

Background

In the past decades, improvements in the management of acute coronary events (ACE) have dramatically reduced in-hospital Coronary Heart Disease (CHD) mortality. Little is known on recent evolutions in out-of-hospital mortality and its contribution to overall ACE mortality.

Purpose

To estimate trends of in- and out-of-hospital ACE mortality rates from 2000 to 2016 and their respective contribution to total CHD mortality.

Methods

Using data from the three CHD MONICA registries, all fatal myocardial infarctions, coronary deaths and sudden deaths occurring between January 1st, 2000 and December 31st, 2016 in patients age 35 to 74 were recorded. Age-standardized mortality rates (SMRs) were estimated by gender and calendar year. Crude mortality rates (CMRs) were estimated by 20-years age group. Trends were expressed as annual percentage changes (APCs).

Results

During the study period, 20,822 fatal events were recorded, of which 69.4% took place out-of hospital (Figure 1). Almost 90% of out-of-hospital deaths occurred at home. Standardized ACE mortality rates decreased more steeply in women as compared to men, with an APC of −4.4%, versus −3.5% in men. Decreases in ACE mortality were more pronounced inside than outside the hospital (APC: −4.6% versus −3.1% in men; −5.9% versus −3.7% in women), with an increase in the contribution of out-of-hospital mortality to overall ACE mortality from 64.7% to 71.1% in men, and from 64.4% to 71.4% in women. Decreases in CMRs were more pronounced for people age 55–74 compared to those age 35–54. In the 55–74 age group, in-hospital SMRs decreased more steeply inside than outside the hospital (APC −5.2% versus −3.6% in men; −6.3% versus −3.9% in women, Figure 2). This was not observed among the youngest subjects, in whom the decreases for in- and out-of-hospital CMRs were similar (APC −1.5% versus −1.6% in men; −3.6% versus −3.1% in women).

Conclusions

Over the study period, out-of-hospital mortality accounted for more than two-thirds of overall ACE mortality. Declines were more pronounced for in-hospital mortality than for out-of hospital, except in the youngest subjects, in whom they were similar. These results highlight the need to strengthen primary prevention.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): - Santé Publique France (SPF) - Institut national de la santé et de la recherche médicale (Inserm)
Trends in cardiovascular mortality of cancer patients in the US over two decades 1999–2019
Authors: Kobo O , Khattak S , Lopez-Mattei J , Van Spall H , Graham M , Cheng R , Osman M , Sun L , Ullah W , Fischman D , Roguin A , Mohamed O M , Mamas M A
Published: October 2021

Background

Cancer is the second most common cause of death globally after cardiovascular (CV) disease. The present study sought to compare the trends in CV mortality between patients with and without cancer in the US over two decades (1999 to 2019), stratified by sociodemographic factors such as age, sex and geographical location.

Methods

In this retrospective study, the number of deaths, crude- and age-adjusted mortality rates between January 1, 1999, and December 31, 2019, were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) data set

Results

We examined a total of 53,422,612 deaths between 1999 and 2019; of which 33.4% were defined as CV mortality and 25.6% had malignancy. During this period, among patients with cancer, the age-adjusted mortality rate dropped by 52%. (Vs, 38% in patients with no malignancy). CV mortality was highest in patients with gastrointestinal and prostate malignancy where CV mortality accounts together for over 40% of all CV mortality in patients with cancer in 1999 and 33.6% in 2019. The age-adjusted CV mortality rate (per 100,000 people) of patients with GI and prostate cancer nearly halved over twenty years from 2.7 to 1.0 and 2.5 to 1.0.

The CV age-adjusted mortality rate dropped more significantly among patients with gastrointestinal, breast, and prostate malignancy than among patients with hematological malignancy (59–63% vs. 41%. We observed that crude CV mortality rates amongst patients with cancer declined over the study period in all age groups but was more prominent among patients over 65 years old than those aged 55–64 and under 55 (51%-55% Vs. 41%, 25%, respectively).Similar reductions in mortality in men and women (54% and 53% reduction) were observed

During the study period the decline in cardiovascular mortality was more prominent in metro areas which led to lower age adjusted CV mortality in Metro compared to non-Metro areas (5.7–6.3 vs 7.2). The decline in age adjusted CV mortality in patients with cancer differed significantly in different states

Conclusions

In our temporal analysis we show a 50% decline in CV mortality in the US over two decades in both male and female patients with cancer, that has exceeded the reduction in CV mortality seen in the non-cancer population. The greatest reductions in CV mortality were observed in patients with GI, breast and prostate malignancies, those residing in metro areas and in patients aged 65 and over.

Funding Acknowledgement

Type of funding sources: None. CV death among cancer patients
Cardiac and other presentation and clinical outcomes of COVID-19 pandemic among different ethnic and religious populations in the city of Jerusalem
Authors: Asher E , Samuel T , Yagel O , Wolak A , Farkash R , Durst R , Ben-Chetrit E , Helviz I , Tvito A , Nir-Paz R , Amir O , Glikson M
Published: October 2021

Background

The COVID-19 pandemic is an ongoing global pandemic. Jerusalem with its 919,400 inhabitants has a wide variety of populations, of which 62% are Jews (36% ultra-orthodox; 64% non-ultraorthodox) and 38% Arabs which were largely affected by the pandemic.

Objectives

The aim of our study was to understand the different presentations, course and clinical outcomes in these different ethnical and cultural groups in Jerusalem in the COVID-19 pandemic.

Methods

We performed a cohort study of all COVID-19 patients admitted between March 9 - July 16, 2020 to the two university medical centers in Jerusalem. Demographic data, presenting symptoms, comorbid conditions, medications, physical examination, laboratory and imaging data as well as outcome at 30-day were systematically recorded. Patients were divided according to their religion and ethnicity into 3 main groups: 1) Ultra-Orthodox Jews; 2) other (non-Ultra-Orthodox) Jews and 3) Arabs.

Results

Six hundred and two patients comprised the study population. Of them the 361 (60%) were Ultra-Orthodox Jews; 166 (27.5%) non-Ultra-Orthodox Jews and 75 (12.5%) Arabs. The Arab patients were younger than the Ultra-Orthodox Jews and the non-Ultra-Orthodox Jews (51±18 year-old vs. 57±21 and 59±19, respectively, p<0.01), but suffered from significantly more co-morbidities. Fever, cough, dyspnea and fatigue, were more prominent, as presenting symptoms, in the Jewish patients as compared with the Arab patients. Moreover, hemodynamic shock, ischemic ECG changes and pathological chest x-ray were all more frequent in the Ultra-Orthodox patients as compared the other groups of patients. Being an Ultra-Orthodox was independently associated with significantly higher rate of Major Adverse Cardiovascular Events (MACE) [OR=1.96; 95% CI (1.03–3.71), p<0.05]. Age was the only independent risk factor associated with increased mortality rate [OR=1.10; 95% CI (1.07–1.13), p<0.001].

Conclusions

The COVID-19 first phase in Jerusalem, affected different ethnical and cultural groups differently, with the Ultra-Orthodox Jews mostly affected by admission rates, presenting symptoms clinical course and MACE (Acute coronary syndrome, shock, cerebrovascular event or venous thromboembolism). It is conceivable that vulnerable populations need special attention and health planning in time of pandemic, to prevent rapid distribution and severe morbidity.

Funding Acknowledgement

Type of funding sources: None.
Correlation of stress testing with anatomically significant coronary artery disease in the contemporary patient population
Authors: Choudhary J , Biondi-Zoccai G , Mukherjee D , Bashir R , Lakhter V , Chatterjee S
Published: October 2021

Background

The purpose of this study was to determine the accuracy and validity of stress testing compared to anatomic correlation at the level of individual coronary arteries.

Methods

PubMed, Embase, and the Cochrane Library were used to identify studies published between 2000 and 2020 comparing physiologic stress tests such as SPECT, PET, and echocardiography to an anatomical reference standard (CT coronary angiography or invasive coronary angiography) on a per-vessel level, and pooled analyses were conducted.

Results

Forty-one studies reporting ischemia at the level of at least one coronary artery were identified (N=4,778). For LAD, pooled sensitivity (sens) was 74% (95% CI: 69%-77%), specificity (spec) – 82% (95% CI: 79%-84%), positive likelihood ratio (LR) – 4.02 (95% CI: 3.42–4.73), negative LR – 0.32 (95% CI: 0.28–0.37), and DOR – 12.46 (95% CI: 9.58–16.20). For LCX, sens – 64% (95% CI: 59%-69%), spec – 86% (95% CI: 83%-89%), positive LR – 4.69 (95% CI: 3.84–5.74), negative LR – 0.41 (95% CI: 0.36–0.47), and DOR – 11.35 (95% CI: 8.61–14.96). Similarly, for RCA, sens – 71% (95% CI: 66%-75%), spec – 84% (95% CI: 81%-87%), positive LR – 4.42 (95% CI: 3.65–5.36), negative LR – 0.35 (95% CI: 0.30–0.40), and DOR – 12.64 (95% CI: 9.59–16.65). LAD ischemia was more significantly correlated with significant stenosis, and LCX was the least (p<0.001).

Conclusion

There appears to be only modest correlation of physiologic ischemia with anatomically significant coronary artery disease, and this varies according to specific coronary artery territory.

Funding Acknowledgement

Type of funding sources: None.
Gamma glutamyl transferase and its fractions to predict coronary artery calcium and outcome in the general population
Authors: Chiappino S , Aimo A , Musetti V , Masotti S , Paolicchi A , Franzini M , Della Latta D , Ripoli A , Martini N , Susini C , Piagneri V , Storti S , Passino C , Emdin M
Published: October 2021

Background

Gamma glutamyl transferase (GGT) is a risk factor for plaque destabilization, particularly its fraction with the highest molecular weight (big-GGT, b-GGT). We explored the interplay between GGT, computed tomography (CT) findings that predict cardiovascular risk (coronary artery calcium [CAC] and epicardial fat volume [EFV]), and 10-year outcome.

Methods

Between May 2010 and October 2011, subjects aged between 45 and 75 years living in a city of Tuscany (Italy) and free from known cardiovascular disease were invited to participate to a screening including a CT scan.

Results

A subgroup of study participants (n=898, 65%) had total GGT and GGT fractions quantified (median age 65 years [25th-75th percentile: 55–70 yrs], 46% males, median 10-year risk of myocardial infarction or death based on the Framingham score 6% [2–11%]). GGT predicted CAC (Exp(B) 0.099, p=0.002) and EFV (Exp(B) 0.102, p=0.003) in a model including age, gender, diabetes, current or previous smoking status, low-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and aspirin therapy. Over 10.3 years (9.6–10.8), 74 individuals died (8%), and 36 (4%) experienced the composite of cardiovascular death or coronary revascularization. The risk of all-cause death and the composite endpoint increased quite steeply with GGT values, with thresholds of 19 UI and 20 IU, respectively (Figure). GGT predicted both endpoints independently from the Framingham 10-year risk (hazard ratio [HR] 1.01, 95% CI 1.01–1.02, p=0.004, and HR 1.01, 95% CI 1.01–1.02, p=0.002, respectively), as well as a model including CT findings. bGGT had the highest area under the curve value to predict the composite endpoint (0.586).

Conclusions

In a general population setting, plasma GGT independently predicts CAC and EFV, and the risk of all-cause death or a composite cardiovascular endpoint.

Funding Acknowledgement

Type of funding sources: None.
The triglyceride/HDL cholesterol ratio and TyG index to predict coronary artery calcium, epicardial fat and outcome in the general population
Authors: Chiappino S , Aimo A , Neglia D , Martini N , Della Latta D , Susini C , Piagneri V , Storti S , Passino C , Emdin M
Published: October 2021

Background

The ratio between triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) and the triglyceride-glucose (TyG) index predict the severity of coronary atherosclerosis and outcome in patients with chronic coronary syndrome. We investigated the relationship between TG/HDL-C and TyG and coronary artery calcium (CAC), the volume of the pro-atherogenic epicardial fat, and survival in a primary prevention setting.

Methods

Between May 2010 and October 2011, subjects aged between 45 and 75 years living in Montignoso (Tuscany, Italy) and free from known cardiovascular disease were invited to participate to a screening including a computed tomography (CT) scan.

Results

Study participants (n=1,382) were aged 61 years (interquartile interval 54–68), 45% were men, and their 10-year risk of death or myocardial infarction based on the Framingham risk score was 5% (2–10%). CAC and epicardial fat volume (EFV) increased significantly across quartiles of TG/HDL-C and TyG. The TG/HDL-C and TyG displayed weak correlations with CAC and stronger correlations with EFV. The TG/HDL-C and TyG did not predict CAC independently from other baseline variables, while they both independently predicted EFV. Over 10 years (9.5–10.5), 103 individuals died (8%), and 36 patients experienced the composite endpoint of cardiovascular death or urgent revascularization during 10.1 years (9.6–10.6). The risk of all-cause death and the composite cardiovascular endpoint increased with TG/HDL-C and TyG. TG/HDL-C and TyG were univariable predictors of all-cause death and the composite cardiovascular endpoint. Nonetheless, TG/HDL-C and TyG lost their prognostic value for the composite cardiovascular endpoint when adjusting for CAC.

Conclusions

In subjects from the general population, the TG/HDL-C and TyG predict CAC and EFV. TG/HDL-C and TyG are also predictive of cardiovascular death or urgent coronary revascularization, although not independently from CAC.

Funding Acknowledgement

Type of funding sources: None.