bluuebunny/crossref_metadata_2025 huggingface dataset:
The reveal, reveal 2.0, compera and fphn risk scores in predciting the pah mortality: a single-centre study
Authors: Tanyeri S , Tokgoz H.C , Keskin B , Akbal O.Y , Karagoz A , Hakgor A , Bayram Z , Dogan C , Acar R.D , Kultursay B , Guner Z.E , Tanboga I.H , Ozdemir N , Kaymaz C
Published: November 2020

Aims

Several risk prediction models have been developed for risk assessment at the time of diagnosis and during follow-up in patients (pts) with pulmonary arterial hypertension (PAH). In this single-centre study we aimed to compare baseline REVEAL, REVEAL 2.0, COMPERA and FPHN risk scores in predicting the mortality in pts with PAH.

Methods

Study group comprised of 504 pts (age 54.4±18.9 years, female 64.4%) with PAH out of the overall 852 pts with pulmonary hypertension enrolled fourteen year period. Subgroups of PAH were as follows; IPAH (39%), CHD-PAH (51%), CTD-PAH (7.7%) and other PAH (3.3%). Functional-class (FC), six-minute-walking-distance (6MWD), pericardial effusion (PE), right atrial area (RAA), tricuspid-annular-planary-systolic-excursion (TAPSE) and systolic annular velocity (St), Echo and Catheter pulmonary artery mean presures (PAMP) and N-terminal-pro brain natriuretic-peptide (NT-proBNP) measures were evaluated at baseline and periodical control examinations with 6-months apart. Baseline assessments for REVEAL, REVEAL 2.0, COMPERA and FPHN risk scores were performed in all pts.

Results

In baseline assessment mean FC and 6MWD were 3 (3–4 IQR), and 230±100 m, repectively. Mean PAMP was 51.5±26 mm Hg, and pulmonary vascular resistance was 8.8±6.5 Wood units. Mono, dual and triple combination therapies were noted in 42%, 40%, and 18% of pts. Median follow-up time was (1470 (275–4840 IQR)) and overall all-cause mortality was 32.1%. Using the Cox proportional hazard model, likelihood ratio (LR) of scores and p values were as follows; REVEAL: 95.09 (p<0.001), REVEAL-2: 122.16 (p<0.001), COMPERA: 22.73 (p<0.001) and FPHN: 1.63 (p=0.210). Adding the TAPSE on REVEAL 2.0 score did not increase the LR of REVEAL 2.0.

When comparing the different combinations including REVEAL 2.0, with likelihood ratio test, the LR of REVEAL 2.0 plus TAPSE vs REVEAL 2.0 was 7.32 (p=0.12),

Conclusions

In this single-centre study, REVEAL 2.0 as compared to REVEAL, COMPERA and FPHN models provided the highest prediction for mortality, and adding the TAPSE on the REVEAL 2.0 scoring offered no additional benefit for risk assessment.

Funding Acknowledgement

Type of funding source: None
Patients with blunt traumatic thoracic aortic injury treated with TEVAR present increased flow dynamics alterations and pulse wave velocity: a 4D flow CMR study
Authors: Guala A , Gil Sala D , Ruiz-Munoz A , Garcia Reyes M.E , Dux-Santoy L , Teixido-Tura G , Tello C , Cinque A , Valente F , Lopez Sainz A , Galian Gay L , Ferreira I , Evangelista A , Bellmunt Montoya S , Rodriguez Palomares J.F
Published: November 2020

Background

Thoracic endovascular aortic repair (TEVAR) is widely used for the treatment of blunt traumatic thoracic aortic injuries. Aortic flow dynamics and mechanical implications of this intervention are poorly investigated and may be of particular interest in the long-term follow-up of these mostly young patients.

Purpose

To assess whether the presence of TEVAR in a cohort of otherwise healthy subjects was related to dilation of the proximal aorta or increase in aortic stiffness and flow alterations.

Methods

Nineteen patients who underwent TEVAR implantation after a traumatic injury of the thoracic descending aorta (DAo) (10.0±6.1 years from intervention) and 44 healthy volunteers (HV) underwent 4D flow CMR to compute ascending aorta (AAo) pulse wave velocity (PWV), a marker of aortic stiffness, systolic flow reversal ratio (SFRR), quantifying backward flow during systole and in-plane rotational flow (IRF), measuring in-plane strength of helical flow. IRF and SFRR were assessed at 20 planes between the sinotubular junction and the mid thoracic DAo. Aortic diameters were measured using double-oblique cine CMR.

Results

Patients with TEVAR and HV did not differ in age, sex, body surface area, blood pressure and DAo diameter distal to TEVAR (Table). However, TEVAR patients presented larger diameters at the sinus of Valsalva and AAo, increased AAo PWV and strong flow alterations: IRF was reduced from the distal AAo to the proximal DAo, while SFRR was increased in the whole thoracic aorta (Figure).

Conclusions

In patients with blunt traumatic thoracic aortic injury treated with TEVAR the aorta proximal to TEVAR is dilated, stiffer and present potentially pathogenic flow conditions. Longitudinal studies are needed to assess whether these alterations have prognostic value and may improve clinical prevention and management of these patients.

Figure 1. IRF and SFRR in healthy vs TEVAR

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study has been funded by Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation (PI19/01480). Guala A. received funding from the Spanish Ministry of Science, Innovation and Universities (IJC2018-037349-I).
Predictors of rapid plaque progression: an optical coherence tomography study
Authors: Araki M , Yonetsu T , Kurihara O , Nakajima A , Lee H , Soeda T , Minami Y , Uemura S , Kakuta T , Jang I.K
Published: November 2020

Background

Two patterns of plaque progression have been described: slow linear progression and rapid step-wise progression. The former will cause stable angina when the narrowing reaches a critical threshold, while the latter may lead to acute coronary syndromes or sudden cardiac death.

Purpose

The aim of the study was to identify morphologic predictors for rapid plaque progression.

Methods

Patients who had OCT imaging during the index procedure and follow-up angiography with a minimum of 6-month interval were selected. Non-culprit lesion was defined as a plaque with a diameter stenosis ≥30% on index angiogram. Lesion progression was defined as the decrease of angiographic minimum lumen diameter ≥0.4 mm at follow-up (mean, 7.1 months). Baseline morphological characteristics of the plaques with rapid progression were evaluated by OCT. In a subgroup with follow-up OCT imaging for plaques with progression, morphological changes from baseline to follow-up were assessed.

Results

Among 517 lesions, 50 lesions showed progression. These lesions had a significantly higher prevalence of lipid-rich plaque (76.0% vs. 50.5%), thin-cap fibroatheroma (TCFA) (20.0% vs. 5.8%), layered plaque (60.0% vs. 34.0%), macrophage accumulation (62.0% vs. 42.4%), microvessel (46.0% vs. 29.1%), plaque rupture (12.0% vs. 4.7%), and thrombus (6.0% vs. 1.1%), compared to those without progression. The multivariable analysis identified lipid-rich plaque [odds ratio (OR) 2.17, 95% confidence interval (CI) 1.02–4.62, p=0.045], TCFA (OR 5.85, 95% CI 2.01–17.03, p=0.001), and layered plaque (OR 2.19, 95% CI 1.03–4.17, p=0.040) as predictors of subsequent lesion progression. In a subgroup with follow-up OCT, a new layer was detected in 14/41 (34.1%) plaques.

Conclusions

Lipid-rich plaque, TCFA, and layered plaque were predictors of subsequent rapid plaque progression. A new layer, a signature of rapid progression through plaque disruption and healing, was detected in 1/3 of the cases.

Funding Acknowledgement

Type of funding source: None
Cardiac procedural myocardial injury, infarction and mortality in patients undergoing elective PCI: a pooled analysis of patient-level data
Authors: Silvain J , Zeitouni M , Paradies V , Zheng H , Ndrepepa G , Cavallini C , Feldman D.N , Sharma S.K , Mehilli J , Jaffe A.S , Thygesen K , Montalescot G , Bulluck H , Hausenloy D.J
Published: November 2020

Background

The prognostic implications of cardiac procedural myocardial injury and infarction (MI) in chronic coronary syndrome patients undergoing elective percutaneous coronary intervention (PCI) is still debated.

Objective

To determine the optimal cardiac troponin threshold for identifying prognostically important events.

Methods

Using a pooled dataset of nine registries and one randomized trial, we analysed individual data of 14,433 patients undergoing elective PCI with a normal or moderately elevated baseline pre-PCI cardiac troponin (cTn). A multivariate model was performed to evaluate the associations between post-PCI cTn elevation and 1-year mortality after PCI, including thresholds used by existing procedural myocardial injury definitions (Fourth Universal Definition of MI [UDMI] and Academic Research Consortium 2 [ARC-2] / Society for Cardiovascular Angiography and Interventions (SCAI)). The association between type 4a MI and 1-year mortality was also evaluated.

Results

Procedural myocardial injury defined by the Fourth UDMI occurred in 52.5% of patients and was not associated with 1-year mortality (adjOR 1.27, 95% CI [0.90–1.81] p=0.18). The association between post-PCI cTn elevation and 1-year mortality was significant above a 3-fold increase above the upper reference limit, and was optimal for a 5.2-fold increase which corresponded to an 18.3% rate of event, and an adjOR of 2.03 (95% CI [1.31–3.14], p=0.002) (figure). Procedural myocardial injury defined by the ARC-2/SCAI definition occurred in 1.3% of the patients, had a strong association with 1-year mortality (adjOR 4.15, 95% CI [1.62–10.64], p<0.01) but lacked sensitivity (5.2% sensitivity). Type 4a MI occurred in 12.7% of patients, was strongly associated with 1-year mortality (adjOR 3.18, 95% CI [1.47–6.90], p=0.002), but could only be evaluated in a subset of patients (n=3 084) with available data on new myocardial ischaemia post-PCI.

Conclusions

We have demonstrated that a post-PCI cTn elevation ≥5x the 99th percentile URL in CCS patients with normal baseline cTn, represents the optimal threshold for defining prognostically important or “Major” procedural myocardial injury in the absence of evidence for new myocardial ischaemia. Major procedure related myocardial injury and type 4a MI should be considered as a quality metric and endpoints in clinical trials.

Adjusted OR of mortality at 1 year

Funding Acknowledgement

Type of funding source: None
Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip
Authors: Benito Gonzalez T , Freixa X , Godino C , Taramasso M , Estevez-Loureiro R , Pascual I , Serrador A , Nombela L , Grande D , Cruz I , San Antonio R , Galasso M , Gavazzoni M , Portoles A , Fernandez-Vazquez F
Published: November 2020

Background

Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR.

Methods

We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up.

Results

93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed.

Conclusion

PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort.

Proportion of patients who presented ven

Funding Acknowledgement

Type of funding source: None
Patent foramen ovale screening and prevention of decompression sickness in divers
Authors: Honek J , Tomek A , Sefc L , Horvath M , Fiedler J , Sramek M , Honek T , Januska J , Veselka J
Published: November 2020

Background/Introduction

Patent foramen ovale (PFO) is associated with increased risk of decompression sickness (DCS) due to paradoxical embolization of nitrogen bubbles that form during and after ascent. Screening for PFO using transcranial Doppler ultrasonography (TCD) is currently not recommended for all divers. If a diver is diagnosed with a high-grade PFO and wishes to continue diving there are currently two options to reduce the risk of DCS: catheter-based PFO closure or recommendation of conservative approach to diving. However, to date the evidence for the long-term effectiveness of these measures is limited.

Purpose

This study sought to compare the effectiveness of catheter-based PFO closure and conservative diving in the reduction of DCS incidence in divers with a high-grade PFO.

Methods

A total of 829 consecutive divers (35.4±10.0 yrs, 81.5% males) were screened for PFO between January 2006 and December 2018 by means of TCD. All patients were prospectively included in the study registry. Patients with a high-grade PFO were offered either catheter-based PFO closure (closure group) or advised to dive within the limits of recreational diving (conservative group). A trans-telephonic follow-up was performed at the end of the study. In this study we compared the incidence rate of DCS prior to enrollment and during the follow-up period in the closure and conservative group.

Results

Follow-up was available in 748 (90%) divers. Mean follow-up was 6.5±3.5 years. There were a total of 154 divers with a high-grade PFO that continued diving after the initial screening examination. Fifty-five (36%) of them underwent a catheter-based PFO closure (closure group), the remaining 98 divers were advised to dive within the limits of recreational diving (conservative group). The 55 divers in the closure group performed a total of 63,436 dives (30,684 prior to enrollment and 32,752 during the follow-up). Prior to enrollment there were 108 DCS episodes in 33 divers (incidence rate 3.3/1000 dives) and none during follow-up (p<0.001). The 98 divers in the conservative group performed a total of 48,069 dives (25,328 prior to enrollment and 22,741 during follow-up). There were 91 DCS episodes in 33 divers (incidence rate 3.6/1000 dives) prior to enrollment and 19 episodes in 11 divers (incidence rate 0.75/1000 dives) during follow-up (p<0.001). The incidence rate of DCS was similar for both groups prior to enrollment (p=0.196) but lower in the closure group during the post-interventional follow-up (p<0.001).

Conclusion(s)

In divers with a high-grade PFO both strategies decreased the incidence rate of DCS. Catheter-based PFO closure was more effective than conservative approach. The results also suggest that divers might benefit from screening for PFO.

Funding Acknowledgement

Type of funding source: None
Association between office blood pressure, antihypertensive medication use and male sexual dysfunction: a penile Doppler study
Authors: Ioakeimidis N , Rokkas K , Terentes-Printzios D , Angelis A , Dima I , Gardikioti V , Sigala E , Aznaouridis K , Tousoulis D , Vlachopoulos C
Published: November 2020

Background

Arterial hypertension is associated with an almost two-fold increase in the likelihood of having an abnormal penile blood flow. Recent evidence supports the independent of age and blood pressure (BP) level predictive value of severe penile arterial insufficiency for adverse cardiovascular events.

Purpose

Aim of this study is to quantify the association between BP level and severity of penile vascular disease and to examine the potential for differences in effect of BP lowering medication use on the associations between BP level and penile vascular damage.

Methods

We measured penile peak systolic velocity (PSV) in 356 consecutive men with erectile dysfunction (ED) and without a history of diabetes and cardiovascular disease; The cohort was divided according to office systolic BP (SBP) and diastolic BP in three BP categories: normal (SBP <130 and DBP <85 mmHg, n=117), high normal (130≤SBP<140 or DBP 85≤DBP<90mmHg, n=91), and hypertension (SBP≥140 or DBP≥90mmHg, n=148). 164 (46%) patients of the whole study population were treated with antihypertensive medications. Low PSV values after intracavernous injection of prostanglandin E1 indicate impaired penile blood inflow and severe vasculogenic ED.

Results

Figure shows PSV measurements of the three office BP categories subdivided according to use of antihypertensive therapy. Treated and untreated hypertensive patients had similar mean PSV. Interestingly, the mean PSV of men with high normal BP not receiving antihypertensive drugs was significantly higher compared to PSV of men with high normal BP under therapy and significantly lower compared to PSV of normotensive males without therapy (all P<0.05). Among males not receiving antihypertensive medications there was a progressive decrease in PSV values from normal BP, to high normal BP and to hypertension (P=0.01, after adjustment for age), while among males under antihypertension therapy, the three BP categories had similar PSV level (P=0.54 after adjustment for age) (figure).

Conclusion

The inverse associations observed between hypertension status and penile arterial insufficiency in men not taking antihypertensive medication were attenuated or disappeared among men reporting antihypertensive medication use reflecting a medication effect or structural effects of longstanding hypertension on the penile vasculature.

BP level, hypertension therapy and PSV

Funding Acknowledgement

Type of funding source: None
Assessing the relationship between serum potassium variability and the risk of hyperkalaemia and adverse clinical outcomes
Authors: McEwan P , Badora K , Sugrue D , James G , Hurst M , Hoskin L , Tafesse E
Published: November 2020

Background

Serum potassium (SK+) is a vital electrolyte, which level is maintained by adjusting renal K+ excretion. Variability in SK+ has been linked to increased risk of mortality and other adverse clinical events in patients in intensive care and/or receiving haemodialysis, prompting a similar investigation in cardiovascular patients.

Purpose

To examine the effect of SK+ variability on all-cause mortality (ACM) and the incidence of major adverse cardiovascular events (MACE), comprising arrhythmia, [subsequent records of] HF, myocardial infarction, or stroke, in patients with heart failure (HF) or resistant hypertension (RHTN).

Methods

Patients aged ≥18 years with HF or RHTN were identified from the UK Clinical Practice Research Datalink (CPRD, primary care data) and linked Hospital Episode Statistics (HES, secondary care data). HF and RHTN were defined through READ codes recorded during the study period (2008-June 2018) or the five-year look-back period (2003–2007). Index date was set to 1st January 2008 or initial diagnosis; whichever occurred later. Mean SK+ and variability of measurements (quantified as standard deviation [SD] and each patient categorised as low or highly variable based on the median SD of the cohort), and crude incidence rates of ACM and MACE were estimated over a follow-up period from index date to event or end of follow-up (death, loss to follow-up or end of study, whichever was earlier).

Results

The eligible population included 317,135 RHTN patients and 84,210 HF patients with a mean follow-up of 6.37 (SD 3.06) and 5.01 (SD 3.20) years, respectively. In both cohorts, higher mean SK+ ≥5.0 mmol/L was associated with increased rates of ACM and MACE relative to a mean SK+ of 3.5–5 mmol/L (Table 1). High SK+ variability was associated with increased incidence of adverse outcomes, with rates consistently higher in the high SK+ variability group compared to low-variability patients with the same diagnosis and mean SK+ category (Table 1); all comparisons were statistically significant except for ACM in HF patients with mean SK+ ≥5 mmol/L.

Conclusion

Independently of mean SK+, increased variability in SK+ levels was associated with an increased rate of mortality and MACE in patients with RHTN or HF. Careful SK+ monitoring and management to maintain SK+ concentrations may improve the outcomes of patients with RHTN and HF.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): AstraZeneca
The effects of different preventive counseling programs on anxiety and depression symptoms in patients with paroxysmal atrial fibrillation after catheter ablation
Authors: Pogosova N , Ovchinnikova A.I , Yufereva Y.M , Sokolova O.Y , Davtyan K.V
Published: November 2020

Background

Depression and anxiety are common in patients (pts) with atrial fibrillation (AF). These psychosocial risk factors add to the symptoms burden and further deteriorate the quality of life.

Purpose

To assess the effects of different preventive counseling programs on anxiety and depression symptoms in pts after catheter ablation (CA) performed for paroxysmal AF.

Methods

This is a prospective randomized controlled study with 3 parallel groups of pts with paroxysmal AF after CA (radiofrequency or cryoablation). Pts were randomized into 3 groups in 1:1:1 ratio. During hospitalization for CA pts from all groups received single-session preventive counseling with focus on their individual cardiovascular risk factors profile. After discharge pts from Group 1 received remote preventive counseling by phone and pts from Group 2 – by email every two weeks for the first 3 months after enrollment (a total of 6 sessions). Group 3 received usual care. All pts underwent anxiety and depression assessment using Hospital Anxiety and Depression Scale (HADS) at baseline and at 12 months.

Results

A total of 135 pts aged 35 to 80 years were enrolled (mean age 57.3±9.1 years, 51.8% men). The groups were well balanced according to demographic and clinical features. At 1 year of follow-up there was a significant decrease in anxiety and depression scores as measured by HADS in both intervention groups vs. control (Table).

Conclusions

Preventive counseling followed by 3 months of remote support via phone and email reduced anxiety and depression level in AF pts after CA.

Funding Acknowledgement

Type of funding source: None
Pooled safety and efficacy of inclisiran in patients with statin intolerance (ORION-10 and ORION-11)
Authors: Wright R.S , Kallend D , Raal F.J , Stoekenbroek R , Koenig W , Leiter L.A , Landmesser U , Schwartz G , Wijngaard P.L.J , Kastelein J.J.P , Ray K.K
Published: November 2020

Introduction

Statin-associated side effects prevent a substantial proportion of patients from being adequately treated with statin therapy and achieving adequate LDL-C reductions. Phase 3 trials showed that inclisiran, a new siRNA, durably lowers LDL-C by ≥50% on top of maximally tolerated statin therapy.

Purpose

To evaluate inclisiran's tolerability and LDL-C lowering effects among individuals who were not receiving statin therapy mainly because of statin intolerance.

Methods

The Phase 3 ORION-10 and ORION-11 trials randomized patients with established ASCVD (or risk-equivalents) with LDL-C >70 mg/dl despite maximally tolerated statins to inclisiran or placebo (1:1). Inclisiran sodium 300 mg was administered s.c. at baseline, three months later, then every six months. The primary efficacy endpoints were % change in LDL-C from baseline to Day 510 and time adjusted % change in LDL-C from baseline after Day 90 and up to Day 540. Absolute LDL-C reductions were secondary endpoints. This analysis included individuals who were not on statin therapy at baseline.

Results

The trials included 252 (7.9% of the pooled trial populations; mean age 68; male 62%; lipid-lowering therapy 28%). AE rates and LDL-C reductions are shown in the Table. Overall, 12 (4.7%) patients had myalgia (4.8% in the inclisiran groups, 4.7% in the placebo groups). There were 8 discontinuations in the inclisiran groups (6.5%) and 3 in the placebo groups (2.3%). The placebo-adjusted mean reduction in LDL-C at Day 510 was 45.8%, an absolute reduction of 68.0 mg/dL (p<0.0001).

Conclusion

Among statin intolerant individuals in ORION-10 and 11, inclisiran potently and durably lowered LDL-C with an adverse event profile comparable to placebo. Inclisiran may represent a new and potent therapeutic option for patients with elevated LDL-C unable to tolerate statins.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): The Medicines Company
Epicardial obesity as a significant preclinical predictor of atherosclerosis of brachiocephalic arteries
Authors: Ott A , Chumakova G.A
Published: November 2020

Obesity is one of the significant factors of cardiovascular risk. Nowadays it is understood that it is visceral obesity (VO), which has metabolic activity due to the synthesis of adipokines, that determines cardiometabolic risk. The effect of epicardial obesity (EO), as a variant of VO on the formation of cardiometabolic risk (in particular coronary atherosclerosis) is being actively studied. The role of EO in the development of atherosclerosis of other localizations has been little studied.

Objective

To study the predictor value of EO as well as traditional criteria for obesity: body mass index (BMI) and waist circumference (WC) for the formation of atherosclerosis of brachiocephalic arteries (BCA).

Materials and methods

The study included 140 men 45.2±4.3 years old with arterial hypertension (AH) of the 1–3 degree and the absence of clinical manifestations and anamnesis of atherosclerosis of any localizations with a BMI of 20–35 kg /m2 and abdominal obesity according to WC ≥94 cm. Patients were divided into two groups depending on the thickness of the epicardial adipose tissue (EAT) measured behind the free wall of the right ventricle by echocardiography. Group 1 consisted of 60 patients with epicardial obesity (EAT ≥7 mm), group 2 included patients without epicardial obesity (EAT <7 mm). Subclinical atherosclerosis of BCA was evaluated in all subjects using duplex brachiocephalic arteries (BCA).

Results

When assessing the thickness of the intima-media of the carotid arteries (TIM), a subclinical marker of BCA atherosclerosis, higher average TIM values in group 1 (EAT ≥7 mm) were revealed (1.09±0.34 mm versus 0.74±0, 05 mm in group 2 (EAT <7 mm) (p=0.0001). Prevalence of subclinical BCA atherosclerosis from (20–45%) in group 1 patients was found in 57%, in group 2 only 4% (p=0.01). In the first group, hemodynamically significant asymptomatic BCA stenosis (50–65%) was found in 8% of patients. No hemodynamically significant BCA stenosis was detected in the second group. Using ROC analysis, the threshold value of EAT (9.25 mm) was obtained as a risk factor for hemodynamically significant stenoses of BCA (50% or more) with high prognostic significance (the area under the curve was 0.92). Using multivariate analysis of variance, the effect of various criteria of obesity on the formation of BCA atherosclerosis was studied. As a result of the analysis it was revealed that only EAT (p=0.02) influenced the development of BCA atherosclerosis (TIM more than 1.3 mm). WC and BMI did not affect the development of BCA subclinical atherosclerosis (p=0.21; p=0.24, respectively).

Conclusions

EO (EAT ≥7 mm) is an early marker of BCA subclinical atherosclerosis in contrast to the traditional criteria for obesity (BMI, WC). Patients with EAT of 9.25 mm or more need additional examinations and the appointment of pharmacotherapy aimed at the prevention of secondary complications.

Funding Acknowledgement

Type of funding source: None
Is cardiac troponin elevation following strenuous exercise clinically relevant in healthy subjects?
Authors: Orn S , Melberg T.H , Omland T , Skadberg O , Bjorkavoll-Bergseth M.F , Erevik C.B , Hansen M.W , Auestad B , Bergseth R , Aakre K.M , Kleiven O
Published: November 2020

Background

Exercise causes an increase in cardiac troponin (cTn) levels. Exercise-induced myocardial injury (cTn > the 99th percentile) has been associated with adverse cardiovascular (CV) outcomes in older subjects with CV risk factors. The long-term clinical implications of exercise-induced cardiac troponin elevations in healthy individuals has not been determined.

Purpose

To assess the association between exercise-induced cardiac troponin increase above the 99th percentile and all-cause death, myocardial infarction, revascularization, sudden cardiac arrest, heart failure admission and stroke during 5-years follow-up in a large cohort of healthy recreational athletes.

Methods

1002 healthy subjects that completed a 91-km bike race in 2014 were eligible. Follow-up data was available for 991 subjects (99%). High-sensitivity cardiac troponin I (cTnI) and T (cTnT) were obtained 24h prior to the race, and at 3h and 24h after the race in 2014.

Results

Median age was 46 (25th-75th percentile: 40–53) years at inclusion, and 776 (78%) were male. Race duration was 3.8 (3.4–4.3) hours. At 3-hours following the race 821 (82.8%) of subjects exceeded the sex-specific 99th percentile of the cTnI assay and 910 (91.8%) of the cTnT assay. At 24-hours following the race 168 (17%) of subjects exceeded the sex-specific 99th percentile of the cTnI assay and 263 (27%) of the cTnT assay. During 5 years of follow-up 12 subjects (1.2%) suffered a CV event. Exercise-induced cardiac troponin increase above the 99th percentile was not associated with increased risk of adverse CV events, neither at 3-hours nor at 24-hours following the race (Figure 1). This finding was further supported by no significant relationship between adverse CV events and cTnI or cTnT at any time-point, assessed as continuous variables.

Conclusion

Myocardial injury, defined as a cardiac troponin level above the 99th percentile, occurs frequently following strenuous exercise. In the present study, however, healthy subjects with cardiac troponin increase above the 99th percentile following strenuous exercise were not found to have an increased five-year risk of cardiovascular events. frequent occurrence following strenuous exercise.

Figure 1

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Stavanger University Hospital, Abbott Diagnostics
First-degree atrioventricular block in children and adolescent athletes
Authors: Velasquez Rodriguez J , Gonzalez-Saldivar H , Li X , Bruna-Fernandez V , Valero-Masa M.J , De Hevia M , Diaz-Gonzalez L
Published: November 2020

Introduction

Intense regular training produces cardiac adaptations that manifests in various changes in the electrocardiogram (ECG), with sinus bradycardia being the most common finding. In adults the PR interval may be elongated and according to different series it can occur in 10–33% of cases, in the contrary in children and adolescent athletes the prevalence categorized by age has not been studied.

Purpose

Determine the incidence of first-degree atrioventricular (AV) block in a population of children and adolescent athletes in our environment, categorized by age.

Methods

We performed a cross-sectional study involving children and adolescent athletes between 5 and 16 years old who received a sport medical examination between August 2018 and May 2019. The ECG were obtained and analyzed following international standards, adequate electrode placement was ensured and was interpreted by cardiologists. The PR interval was obtained, considering prolonged if PR>180 milliseconds (ms) in children under 10 years old, PR>190 ms between 10 and 14 and PR>200 ms in those over 14. We categorized our athletes by age into the following four groups corresponding to approximated quartiles: G1 5–8 years, G2 9–11 years, G3 12–13 years, and G4 14–16 years

Results

A total of 6401 subjects were included, mean age was 11.2±2.9 years, 93.7% were male, soccer players (97.2%) and Caucasian (99.2%). They trained a mean of 5.4±2.3 hours a week. 11.4% of the patients had mild (50–59 bpm) or moderate (40–49 bpm) bradycardia, but none had severe bradycardia (<40 bpm). Sixty-one patients (0.96%) had 1st degree AV block and 19 (0.30%) had a PR interval at higher limit of normality. When stratified by age groups, the prevalence of 1st degree AV block was higher in the second quartile (Table 1). We did not find cases of Wenckebach or high-grade AV block (Mobitz II or 3rd degree AV block).

Conclusions

In children and adolescent athletes, the incidence of first-degree AV blockade is low (around 1%) and significantly lower than what is reported in adults. This may be due to a lower vagal tone in this population. If detected it may prompt clinicians to pursue further investigation given the low proportion of 1st degree AV block in children and adolescent athletes.

Figure 1. Sixteen year old patient ECG

Funding Acknowledgement

Type of funding source: None
The impact of sex, gender and healthcare system on quality of care among young adults with acute myocardial infarction
Authors: Raparelli V , Pilote L , Behlouli H , Dziura J , Bueno H , D'Onofrio G , Krumholz H.M , Dreyer R.P
Published: November 2020

Background

The quality of care among young adults with acute myocardial infarction (AMI) may be related to biological sex, psycho-socio-cultural (gender) determinants or healthcare system-level factors.

Purpose

To examine whether sex, gender, and the type of healthcare system influence the quality of AMI care among young adults.

Methods

A total of 4,564 AMI young adults (<55 years) (59% women, 47 years, 66% US) were analyzed from the VIRGO and GENESIS-PRAXY studies consisting of single-payer (Canada, Spain) versus multipayer (US) systems. For each patient treated in each system we calculated a quality of care score (QCS) for pre-AMI (1-year pre admission), in-hospital, and post-AMI (1-year post discharge) phases of care (number of quality indicators received divided by the total number [range=0–100%], with higher scores indicating better quality). Ordinal logistic or linear regression models, and 2-way interactions between sex, gender and healthcare system were tested.

Results

Women in the multipayer system had the highest risk factor burden. Across the phases of care for AMI, 20% of quality indicators were missed in both sexes. High stress, earner status, and social support were associated with a higher QCS in the pre-AMI phase, whereas only employment and earner status were associated with QCS in all other phases. In the pre-AMI phase, women had higher QCS than men, mainly in the single-payer system (adjusted-OR=1.85, 95% CI 1.46,2.35 vs. 1.07, 95% CI 0.84,1.36, P-interaction= 0.002). Regardless of sex, only employment status had a greater effect in the multipayer system (adjusted-OR=0.59, 95% CI 0.44,0.78 vs 1.13, 95% CI 0.89,1.44, P-interaction <0.001). In the in-hospital phase, women had a lower QCS than men, especially in the multipayer system (adjusted-mean-difference: −2.48, 95% CI-3.87, −1.08). Employment was associated with a higher QCS (2.0, 95% CI 0.9–3.17, P-interaction >0.05). Finally, in the post-AMI phase, men and women had a lower QCS, predominantly in the multipayer system. However, primary earners had higher QCS regardless of system.

Conclusion

Sex, gender, and healthcare system affected the quality of care after AMI. Women had a poorer in-hospital than men and both women and men had suboptimal post-discharge care. Being unemployed lowered the quality of care, more so in the multipayer system.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health and Research (CIHR)
Cardiac function in pregnant women with a Fontan circulation following live birth
Authors: Lodge F , Castleman J , Fox C , Morris R.K , Ram C , Clift P , Hudsmith L
Published: November 2020

Background

Fontan circuits are used to palliate congenital heart disease where patients have a single functioning ventricle. The venous return to the heart is redirected to the pulmonary arteries through the use of a conduit, bypassing the heart. Many females with Fontan circuits are now reaching child-bearing age and some desire pregnancy. However, pregnancy in women with Fontan circuits is associated with high complication rates.

Purpose

We compared postnatal cardiac function in women with a Fontan circulation with pre-pregnancy cardiovascular investigations.

Methods

Data were collected from case notes of all women with a Fontan circulation giving birth after 24 weeks of gestation at Birmingham Women's Hospital between 1997 and 2019.

Results

18 women with a median age of 29±6 years were followed up for 8.0±9 years. There were 21 live births at a median gestation of 32±5 weeks, of which 81% were caesarean sections. Three infants (14%) were born before 30 weeks' gestation and only two (10%) at term. Significant dyspnoea complicated 19% of pregnancies and postpartum haemorrhage occurred in 24%.

Pre-pregnancy cardiac magnetic resonance (CMR) data were available for 11 women and post-pregnancy for 14. Post-pregnancy scans were performed a median of 1.5±4.8 years after birth. Ejection fraction was 63.6±5% at baseline and tended to reduce following pregnancy (median −5.0±8%, n=7). Pre-pregnancy peak oxygen consumption (VO2max) was 73±14% of predicted on cardiopulmonary exercise testing. Median change in VO2max was −8±22% post-pregnancy (n=4). There was no change New York Heart Association (NYHA) class or resting saturations after pregnancy.

Conclusions

Preterm delivery and maternal bleeding were prevalent in this cohort. Exercise capacity was moderately impaired and saturations were typically low. Pregnancy does not seem to have longer term impact on oxygen saturations or NYHA class. Larger series are needed to confirm whether pregnancy is detrimental to postpartum systolic function. CMR can give comprehensive assessment of cardiac function before and after pregnancy and provide data to inform the crucial pre-pregnancy counselling for Fontan patients of child-bearing age.

Funding Acknowledgement

Type of funding source: None
Right ventricular function and right heart catheterization as predictors of ECMO requirement in lung transplantation
Authors: Garcia Gomez S , Monivas V , Goicolea J , Oteo J.F , Campo-Canaveral De La Cruz J.L , Crowley Carrasco S , Garcia Gallo C , Romero Roman A , Fernandez-Diaz J.A , Garcia-Touchard A , Cavero Gibanel M.A , Mingo Santos S
Published: November 2020

Introduction

Lung transplantation (LT) often requires extracorporeal life support with extracorporeal membrane oxygenation (ECMO) because of several complications (included acute heart failure) during the intervention. Data on predictors of intraoperative ECMO use in these patients are scarce but it is an interesting topic because ECMO support has been linked to worse outcomes after LT.

Purpose

The main aim of our study is to assess which pre-surgical characteristics of right ventricular (RV) function and data from right heart catheterization (RHC) could help us to anticipate the need of ECMO in LT.

Methods

We conducted a retrospective observational study of all patients who underwent LT at our institution along 2018. We analysed data from echocardiogram (ECO) and RHC. All subjects underwent transthoracic echocardiography (TTE) according to the latest ASE/EACVI guidelines. Strain analysis was carried out by speckle-tracking echocardiography (QLAB 10.7, Philips).

Results

We included all 47 patients who underwent LT from January to December of 2018. They were middle age patients (52±11.8 years old) 51.1% men, 61.7% smokers (other cardiovascular risks: diabetes mellitus (8.5%), hypertension (23.4%) or dyslipidaemia (27.7%)). 24 (51%) of them needed intraoperative ECMO. 21 patients (45%) were evaluated by RHC before LT and ECO quality was good enough to evaluate different data in 41 patients (87%).

Variables related to ECMO requirement vs non-ECMO use were: mean pulmonary artery pressure (23.1±7.3 vs 16.67±4.9 mmHg, p=0.027), mean transpulonary gradient (16.9±6.6 vs 8.9±3.6 mmHg, p=0.027) and diastolic transpulmonary gradient (9.8±8.1 vs 2.3±4.7 mmHg, p=0.002) from RHC and RV mid cavity diameter (3.4±0.8 vs 2.8±0.6 mm, p=0.001) from ECO. Besides this, free-wall RV longitudinal strain (FWRVLS) showed a tendency to be lower in patients who required ECMO (17.3±4.5% in vs 21.4±4.5%, p=0.072).

Conclusion

According to our results, RV mid cavity diameter measured by ECO and mean pulmonary artery pressure, mean and diastolic pulmonary gradients measured by RHC are useful tools to predict which patients could require ECMO during LT. FWRVLS showed an interesting tendency of lower values of it in LT using ECMO. This exploratory finding opens an important investigation line about a parameter which could help us to identify patients with subclinical right ventricle dysfunction.

ROC curve

Funding Acknowledgement

Type of funding source: None
Defining the metabolomic profile associated with early cardiotoxicity in patients with breast cancer treated with anthracyclines
Authors: Cocco D , Ferro E.G , Ricci S , Deidda M , Noto A , Madeddu C , Atzori F , Scartozzi M , Mercuro G , Cadeddu Dessalvi C
Published: November 2020

Background

Anthracycline (ANT) therapy has dramatically improved clinical outcomes for patients with breast cancer, but it causes cardiotoxicity (CTX) in a dose-dependent manner. Current cardiac biomarkers (troponin, brain natriuretic peptide) and 2D echocardiography only detect CTX in advanced and often irreversible stages. Metabolomic analysis may allow early diagnosis of CTX, and prompt initiation of cardio protective therapies.

Purpose

To diagnose early CTX via speckle tracking echocardiography (STE), and to characterize the metabolomic fingerprint of patients affected by ANT-mediated CTX.

Methods

In 2019, patients with breast cancer and normal baseline ejection fraction (EF) were enrolled and longitudinally monitored through clinical assessment, blood sample collection and echocardiography, before initiation of ANT therapy and at 180, 270 and 360 mg/m2 of ANT. CTX, defined as >15% reduction in Global Longitudinal Strain (GLS), was monitored at each ANT dose increment. Unsupervised Principal Component Analysis, supervised Partial Least Square and Partial Least-Square Discriminant Analyses were used to compare the metabolomic profiles of patients who did and did not develop CTX during the study period.

Results

In the study sample (n=33), no patient developed clinical heart failure, but 8 patients (25%) developed CTX by GLS criteria. Patients with CTX had a significant decrease in GLS compared to patients without CTX at 270 mg/m2 (GLS 20.5 vs 17.9, p=0.01) and 360 mg/m2 ANT (GLS 21.6 vs 17.7, p<0.001), but no significant differences in EF or other 2D echocardiographic parameters. The PLS-DA model at 360 mg/m2 ANT (R2=0.92, Q2=0.53, p=0.03) identified a significantly higher prevalence of Krebs cycle intermediates (like fumarate and succinate), and fatty acids (like linoleic acid) in patients with CTX. On the contrary, patients without CTX at 360 mg/m2 ANT had significantly higher levels of cardioprotective metabolites, like tryptophan.

Conclusions

For the first time in a human population of breast cancer patients, we show that early ANT-induced CTX (diagnosed via asymptomatic GLS reduction) is associated with a unique metabolomic profile, which affects molecular pathways of energy production. Notably, CTX damage upregulates similar metabolites to those previously identified in clinical heart failure and in mouse CTX models. Our results suggest that a metabolomic fingerprint can be leveraged to create prediction models to identify patients at higher risk of developing cardiovascular complications from ANT therapy. This, in turn, will allow to personalize both chemotherapy and cardioprotective treatments.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): University of Cagliari
Hypertensive disorders of pregnancy and impact on in-hospital cardio-obstetric outcomes
Authors: Wu P , Chew-Graham C , Maas A , Chappell L , Potts J , Gulati M , Jordan K , Mamas M
Published: November 2020

Introduction

Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity. However, short-term outcomes of HDP subgroups remain unknown.

Methods

Using the United States National Inpatient Sample database, all delivery hospitalizations between 2004 and 2014 with or without HDP (preeclampsia/eclampsia, chronic hypertension, superimposed preeclampsia on chronic hypertension and gestational hypertension) were analysed to examine the association between HDP and adverse in-hospital outcomes.

Results

We identified >44 million delivery hospitalizations, within which the prevalence of HDP increased from 8% to 11% over a decade with increasing comorbidity burden. Women with chronic hypertension have higher risks of myocardial infarction, peripartum cardiomyopathy, arrhythmia and stillbirth compared to women with preeclampsia. Out of all HDP subgroups, the superimposed preeclampsia population had the highest risk of stroke (OR 7.83, 95% CI 6.25, 9.80), myocardial infarction (OR 5.20, 95% CI 3.11, 8.69), peripartum cardiomyopathy (OR 4.37, 95% CI 3.64, 5.26), preterm birth (OR 4.65, 95% CI 4.48, 4.83), placental abruption (OR 2.22, 95% CI 2.09, 2.36), and stillbirth (OR 1.78, 95% CI 1.66, 1.92) compared to women without HDP. In conclusion, we are the first to evaluate chronic SH without superimposed preeclampsia as a distinct subgroup in HDP and show that women with chronic SH are at even higher risk of some adverse outcomes compared to women with preeclampsia.

Conclusion

The chronic hypertension population, with and without superimposed preeclampsia, is a particularly high risk group and may benefit from increased antenatal surveillance and the use of a prognostic risk assessment model incorporating HDP to stratify intrapartum care.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): NIHR