bluuebunny/crossref_metadata_2025 huggingface dataset:
Metabolic changes following transcatheter bariatric embolotherapy for weight loss in obesity: secondary outcomes from a prospective RCT
Authors: Fried M , Reddy V.Y , Neuzil P , Rosen R , Sramkova P , Kipshidze N , Kipshidze N
Published: November 2020

Background/Introduction

Obesity and its comorbid conditions (i.e. type II diabetes mellitus, atrial fibrillation, coronary artery disease, hypertension, etc...) is a growing burden globally, however, the current treatments (i.e. bariatric surgery, intragasrtic balloons and/or pharmaceutical therapy) pose substantial risks or are contraindicated for various populations. Transcatheter bariatric embolotherapy of left gastric artery by reducing “hunger” hormones from the gastric fundus is a procedure for weight loss that has been growing in prominence over the last several years, however, to date no randomized-controlled trial has been conducted until our study. We studied TBE in a double-blind, sham procedure, first in human RCT of patients (pts) with obesity.

Purpose

The purpose of this study was to assess the safety and efficacy of TBE for weight loss in obese patients as well as to evaluate metabolic changes.

Methods

After IV propofol, eligible pts (age 21–60; BMI 35–50 kg/m2) were randomized 1:1 to Sham (skin nick & 1 hr wait) or TBE. All pts received Lifestyle Therapy (behavioral and diet education). Study staff following the pts were also blinded to treatment. Blood samples for gastrointestinal hormones were collected in EDTA tubes containing a protease inhibitor cocktail and frozen per local laboratory standards. All collected samples were assessed together in two batches at the end of the study. The hormones analyzed included ghrelin, GIP, GLP-1, Visfatin, resistin, PAI-1 (total), Leptin, and C-Peptide. An Oral Glucose Tolerance Test (OGTT) and a diabetes assay was performed at baseline and at 6- and 12-months post-intervention. Note, while diabetes was an exclusion criterion for this study, pre-diabetes was not.

Results

44 pts were enrolled, of which 40 pts were randomized equally to the groups, with no major complications in either group. TBE demonstrated superior weight loss over the control group at 6- and 12-months post-intervention in both intention-to-treat and per-protocol analyses. At 6 and 12 months, the TBE group demonstrated a clinically meaningful decrease in glucose 1-hour post-fasting by OGTT. GIP levels in the TBE group increased at a mean of 21%, indicative of an improvement in pre-diabetic milieu. Circulating plasma visfatin levels decreased 20% at 6 months and 26% at 12 months in the TBE group indicating a decrease in body fat. C-Peptide levels were noticeably increased in the TBE group at 6 months possibly indicating improvements in insulin sensitivity and beta-cell function.

Conclusion(s)

TBE is safe and results in clinically significant weight loss and demonstrated a positive effect on glucose homeostasis in pre-diabetic patients.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Endobar Solutions, LLC
Dyspnea on exertion is an independent predictor of mortality in patients with no baseline cardiovascular or respiratory disorders
Authors: Poosala A , Sydo N , Allison T.G
Published: November 2020

Background

Dyspnea on exertion (DOE) is defined as a subjective experience of breathing discomfort that consists of qualitatively distinct sensations (Effort/work of breathing, Chest tightness, Air hunger) that vary in intensity elicited by physical activity. Although DOE is a common presenting symptom in patients pertaining to cardiovascular and respiratory disorders, its prognostic importance in patients with no prior cardiovascular (CV) or respiratory disorders is unclear.

Purpose

The purpose of this study is to determine the prognostic significance of dyspnea on exertion (DOE) in patients with no prior diagnosis of CV or respiratory disorders.

Methods

We reviewed the Mayo Integrated Stress Center database for the period September 1993 through November 2010. Residents of Minnesota with no known heart disorders and no known history of COPD or other respiratory disorders were included in the study. Patients with abnormal ECG findings were excluded to rule out possible undiagnosed CV disorders. Limiting symptoms of DOE with reduced exercise capacity (FAC<90%). Our primary outcome was mortality which was adjusted for age, sex, smoking history, diabetes, hypertension, obesity, negative chronotropic medications. Statistical analysis was performed to evaluate hazard ratio using Cox regression models in SAS Studio.

Results

A total of 101,455 exercise tests were reviewed to identify 18960 patients (female = 6755, 35.6%) who met the study criteria. Mean age at the time of referral was 51.2±10 years (mean ± SD) and mean follow-up was 12±10 years (mean ± SD). There were 1331 (7%) deaths from all causes, out of which 368 (27.6%) deaths are from DOE patients, and there were 428 (2.2%) deaths from cardiac causes, out of which 141 (32.9%) deaths are from DOE patients. We found that DOE was an independent predictor of mortality from all causes with hazard ratio [95% CI] = 1.690 [1.488–1.918], p≤0.0001, and from cardiac causes with hazard ratio [95% CI] = 1.997 [1.613–2.473], p≤0.0001. Product-limit survival estimates of patients with and without DOE are shown in Figure 1.

Conclusion

Based on our study findings, we conclude that dyspnea on exertion is an independent predictor of mortality in patients with no baseline CV or respiratory disorders. Patients presenting with dyspnea alone as a presenting compliant should be evaluated thoroughly and treated accordingly to reduce the associated mortality outcomes.

Figure 1. Kaplan-Meier Plot

Funding Acknowledgement

Type of funding source: None
Is there a gender difference in endothelial response on exercise training in heart failure patients with preserved ejection fraction?
Authors: Deljanin Ilic M , Ilic S , Simonovic D , Kocic G , Pavlovic R , Petrovic D , Saric S , Mitic V
Published: November 2020

Purpose

To examine the reaction of endothelium, assess through changes of circulating blood markers of endothelial function: the stable end products of nitric oxide (NOx), S – nitrosothiols (RSNO – reservoir for bioavailable nitric oxide), dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) that promotes exercise training in female and male patients (pts) with heart failure with preserved ejection fraction (HFpEF).

Methods

A total of 78 pts with HFpEF were enrolled in the study: 43 male (M group) and 35 female (F group). In all pts, before and after a short-term supervised 3 weeks exercise training at residential center values of NOx, RSNO, ADMA and SDMA were determined and exercise test was performed.

Results

After 3 weeks of exercise training NOx increased significantly in both groups: in M group (from 34.4±7.5 to 42.3±9.5 μmol/l, P<0.001), and in F group (from 31.3±6.8 to 41.5±7.2 μmol/l, P<0.001), as well as RSNO: In M group RSNO increased from 3.6±1.7 to 4.6±1.9 μmol/l (P<0.05) and in F group from 3.1±1.5 to 4.2±2.2 μmol/l (P<0,05). Increase in NOX and RSNO after exercise training was higher in F than in M group: NOx 32,6% vs 22,9%; RSNO 35,1% vs 27%. Value of ADMA as well of SDMA decreased in both groups after 3 weeks: ADMA in M group from 0.315±0.09 to 0.278±0.12 μmol/l (by 11.7%; ns), and in F group from 0.342±0.08 to 0.297±0.13 μmol/l (by 13.1%; ns); SDMA in M group from 0.269±0.08 to 0.234±0.09 μmol/l (by 13%; ns), and in F group from 0.285±0.09 to 0.245±0.10 μmol/l (by 14%; ns). After 3 weeks, level and duration of exercise test were significantly higher in M (both P<0,001), as well as, in F group (both P<0.001), compared to baseline values.

Conclusions

There was no gender difference in the way of endothelial response on exercise training in pts with HFpEF. Exercise training induced favorable modification of endothelial function, expressed through significant increased of NOx, RSNO and decreased of ADMA, SDMA in male as well as in female pts. Those positive changes in endothelial function were associated with significant improvement in exercise capacity. Some higher percentage of NOx and RSNO increase in women suggests that they have more pronounced benefit of exercise training than men.

Funding Acknowledgement

Type of funding source: None
Quality of life in heart failure patients undergoing hybrid comprehensive telerehabilitation versus usual care results of TELEREH-HF randomized clinical trial
Authors: Piotrowicz E , Mierzynska A , Pencina M , Opolski G , Zareba W , Banach M , Kowalik I , Orzechowski P , Szalewska D , Pluta S , Irzmanski R , Glowczynska R , Kalarus Z , Jaworska I , Piotrowicz R
Published: November 2020

Background

Heart failure (HF) is a clinical syndrome associated with physical capacity impairment and poor quality of life (QoL). The hybrid comprehensive telerehabilitation (HCTR) consisting of telecare, telerehabilitation and homemonitoring of implantable devices might be an option to improve QoL. Purpose to investigate the influence of HCTR on various facets of QoL in HF pts in comparison to usual care (UC).

Methods

The present analysis formed part of TELEREH-HF multicenter, randomized trial that enrolled 850 HF pts (NYHA I-III, LVEF≤40%). Patients were randomized 1:1 to HCTR plus UC or UC. Patients underwent either an HCTR (1 week in hospital and 8 weeks at home) or UC with observation. The psychology telecare had a form of supportive psychotherapy via phone. The Short Form 36 Questionnaire was used to assess QoL. Measurements were made before and after intervention/observation.

Results

HCTR group showed significant improvement in overall QoL, physical domain, and 4 areas of QoL (physical functioning [PF], role functioning related to physical state, general health, vitality). A significant positive change in QoL in UC group was observed in vitality and social functioning. There were significant differences in QoL after intervention/observation between groups. Results showed higher improvement in HCTR for overall QoL, physical domain and 3 areas of QoL (PF, role functioning related to physical state and bodily pain [BP]), Table 1.

Conclusion

In comparison to UC, HCTR resulted in significant improvement in overall QoL, physical domain and 3 specific areas of QoL: PF, role functioning related to physical state and BP.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Centre for Research and Development, Warsaw, Poland
Effects of cardiac rehabilitation on quality of life and exercise capacity in patients with coronary artery disease: do women benefit equally?
Authors: Deljanin Ilic M , Stojanovic M , Igrutinovic Novakovic J , Vukovic A , Igic I , Ilic S
Published: November 2020

Background

Quality of life is an important factor in the etiology and prognosis of coronary artery disease (CAD) as well as to evaluate effects of different interventions in cardiovascular diseases. Improvement in quality of life (QOL) is an important goal for patients (pts) participating in cardiac rehabilitation (CR).

Purpose

To examine whether women and men benefit equally from comprehensive CR in terms of QOL and exercise tolerance in pts with CAD.

Methods

We enrolled 1362 CAD patients (mean age 60.4±9.5 years). All patients participated in a comprehensive three weeks CR program at residential center and in all pts before and after CR exercise test was performed. Psychological dimensions were assessed at baseline and post-CR by validated questionnaire Short-Form 36 Health Status Survey (SF-36). All data were analyzed based on gender.

Results

Women participate in CR in lower percentage than man: 336 (24.7%) women vs 1026 (75.3%) men. Out of 1362 CAD pts, SF-36 was performed in 119 pts (75.6% men and 23.5% women). Before CR, physical function (PF), fatigue (F) and social functioning (SF) were significantly higher in men than in women (P<0.001; <0.05 and <0.01). After CR, scores of all domains of the SF-36 were significantly improved in all 119 pts (P<0.001). However, compared to the baseline, and based on gender, women had greater improvement than men in PF: 36.6%vs 11.4%, physical limitation (PL): 119.6 vs 52.2%, emotional well-being (EWB): 12.9% vs 7.5%, SF: 23% vs 4.9%, body pain (BP): 16.4%vs 4.9%, F: 14.3%vs 10.9% and health change (HC): 34%vs 17.9%. At the end of stationary CR there was no significant difference in domains of the SF-36 between men and women. At baseline men had significantly higher level and duration of exercise test than women (both P<0.001). After CR, level and duration of exercise test increased significantly in 1026 men ( by 12% and by 16.5%; both P<0,001), and 336 women (by 18% and by 21%; both P<0.001), and it was still higher in men than women after CR (both P<0.001).

Conclusions

Study demonstrated that women are generally less participate in CR than men. Results indicated that CR improve QOL in CAD pts, especially in women, which was expressed through higher improvement in PF, PL, EWB, SF,BP, F and HC than in men. Those positive changes in QOL were associated with significant improvement in exercise capacity in men as well as in women. CR needs to improve in referral and participation of women.

Funding Acknowledgement

Type of funding source: None
Quality indicators of a cardiac rehabilitation program in women with coronary heart disease
Authors: Juanes Dominguez I , Tojal Sierra L , Fernandez De Leceta Z , Saez De Buruaga E , Garcia S , Torres M , Etxebarria S , Pasalodos L.M , Alonso A.M , Bello M.C
Published: November 2020

Introduction

Cardiac rehabilitation programs (CRP) are well known to improve functional status and prognosis after a cardiovascular event. This programs are class IA recommendation. However, many studies have demonstrated that women are less likely to stick to a CRP.

Purpose

To compare baseline characteristics between men and women participating in a cardiac rehabilitation program and to determine whether there are gender differences in the benefits obtained after the program.

Methods

Using data from our Department of CRP, we analysed a total of 1091 patients referred between 2015 and 2018 to our center CRP after a cardiovascular diagnosis. Clinical, analytical and echocardiographic outcomes were collected. We defined benefit as the achievement of the target levels established for each cardiovascular risk factor (CVRF) as well as improvement in the exercise capacity. This capacity was evaluated with exercise tests and maximum O2 uptake at the beginning and at the end of the CPR.

Results

Between 2015 and 2018, 189 (17.3%) of them women with a mean age of 62 years were enrolled in the CRP. There were no significant gender differences in mean age or incidence of CVRF. Likewise, there weren't differences in cardiovascular diagnosis, risk stratification, left ventricular ejection fraction or exercise test performed before the program.

In the results after CRP there were no important gender differences in the percentage of patients who achieved the quality indicators described as HbA1c <7.0%, systolic arterial pressure <140 mmHg, diastolic arterial pressure <90 mmHg. Percentage of LDL cholesterol <70 mg/dl was significantly higher in male patients. Both in men and women an improvement of the second exercise test result was observed.

Conclusions

1. Men and women who suffer from a coronary heart disease have similar clinical characteristics.

2. Among patients with coronary heart disease who attended a cardiac rehabilitation program there were no significant gender differences in the benefits obtained after the program.

Funding Acknowledgement

Type of funding source: None
Implementation study of CT calcium score in patients with atypical angina pectoris and non-specific thoracic complaints in primary care: rationale, objectives, and design of the CONCRETE study
Authors: Koopman M.Y , Martens S.M.P , Willemsen R.T.A , Van Bruggen R , Dinant G.J , Van Der Harst P , Doggen C , Oudkerk M , Van Ooijen P , Gratama J.W , Braam R , Vliegenthart R
Published: November 2020

Background

Identifying and excluding coronary artery diseases (CAD) in patients with atypical angina pectoris (AP) and non-specific thoracic complaints is a challenge for general practitioners (GPs). It is unclear what the best diagnostic and prognostic strategy is for these patients in primary care. Computed Tomography coronary calcium scoring (CT CCS) has a high sensitivity for early diagnosis and exclusion of CAD. However, CT CCS has not been tested in a primary care setting. In the CONCRETE study, the impact of direct access of GPs to CT CCS on management and diagnosis will be investigated. CONCRETE is the abbreviation for “COroNary Calcium scoring as fiRst-linE Test to dEtect and exclude coronary artery disease in GPs patients with stable chest pain.” Currently, we present the rationale, objectives and design of this study.

Purpose

The purpose of CONCRETE is to study the implementation of CT CCS in primary care, and determine the effects on GP office level. The primary objective is to determine the increase in detection/treatment rate of CAD in GP offices with CT CCS, compared to GP offices with standard of care.

Methods

CONCRETE is an implementation study with a cluster randomized design, in which direct access to CT CCS in a group of 40 GP offices is compared to the standard of care in a control group of 40 GP offices. In both arms, inclusion of 800 patients with atypical angina pectoris and non-specific thoracic complaints is intended.

Results

Recruitment of GP offices and participants started in January 2019. First results will be presented.

Conclusion

CONCRETE will determine whether access to CT CCS will lead to earlier and more effective detection or exclusion of CAD in GP patients with atypical angina pectoris and non-specific thoracic complaints, in comparison to the standard of care. Implementation of the study findings could initiate a change in the (Dutch) GP healthcare policy, for these patients in primary care.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Dutch Heart Foundation
Traditional cardiovascular risk factors and glomerular filtration rate in patients with rheumatoid arthritis
Authors: Madrakhimov S.B , Shukurov U.M , Ubaydullaev S.A
Published: November 2020

The leading cause of premature death in rheumatoid arthritis (RA) is cardiovascular complications associated with vascular atherosclerosis. Even a slight decrease in glomerular filtration rate (GFR) is an important independent risk factor for cardiovascular complications.

The purpose of the study: to determine GFR in patients with RA, to identify the relationship between GFR and traditional risk factors for the development of cardiovascular complications.

Methods

The study included 58 patients with RA aged 21 to 60 years, who do not have concomitant kidney diseases, arterial hypertension (AH) of stage III, and diseases accompanied by the development of secondary nephropathy. GFR was calculated using the CKD-EPI formula. All patients were evaluated for traditional cardiovascular risk factors: hypertension, dyslipidemia, a complicated hereditary history of early development of cardiovascular diseases, overweight, and smoking. The European SCORE scale and the Reynolds Risk Score (RRS) predictive scale in the EULAR modification were used to assess the total risk of cardiovascular complications.

Results

Women predominated among the patients – 61 (86.6%). The mean age of patients is 45 years. Seropositive patients with rheumatoid factor prevailed, with moderate and high activity of the process, III x-ray stage according to Steinbroker. In 36 (62%) patients, GFR was in the range from 60 to 89 ml/min/1.73m2, in 38% of patients-more than 90 ml/min/1,73m2. The average GFR in patients with RA was 88.43±16.13 ml/min/1.73m2, in the comparison group-83.54±15.22 ml/min/1.73m2 (p=0.063). Arterial hypertension was diagnosed in 40 (68.9%) patients with RA: 70.2% of women and 55.3% of men. The level of total cholesterol in patients with RA is significantly higher than in the comparison group (p<0.001), even in patients younger than 40 years, the level of total cholesterol is higher than in those without arthritis (5±1.15 and 4.14±0.21 mmol/l, p=0.027). The average value of the SCORE scale in RA patients and in the comparison group is generally comparable, and when compared by age periods. In patients younger than 40 years who suffer from hypertension, GFR is lower than in patients of the same age, but without hypertension: 86 [79; 101.5] and 104.5 [101; 112] ml/min/1.73m2, respectively, p=0.043. Relationships between GFR and traditional cardiovascular risk factors were identified: body mass index (r=−0.414; p<0.001), total cholesterol levels (r=−0.402; p<0.001), low-density lipoproteins (r=−0.331; p=0.013), triglycerides (r=−0.283, p=0.028), systolic BP (r=−0.257; p=0.027), diastolic BP (r=−0.255; p=0.029) at the time of the study, the value of the Score scale (r=−0.529; p<0.001) and RRS (r=−0.341; p=0.031).

Conclusion

Most patients with rheumatoid arthritis showed a decrease in glomerular filtration rate, and GFR is associated with traditional risk factors for cardiovascular events.

Funding Acknowledgement

Type of funding source: None
Cardio-pulmonary-exercise testing, stress-induced right ventricular diastolic dysfunction and exercise capacity in non-severe chronic obstructive pulmonary disease
Authors: Cherneva Z , Denchev S.D , Cherneva R.C.H
Published: November 2020

Background

Data regarding echocardiographic structural and functional abnormalities in right ventricular diastolic dysfunction (RVDD), cardio-pulmonary exercise testing (CPET) abnormalities and their association with exercise capacity among non-severe chronic obstructive pulmonary disease (COPD) patients without pulmonary arterial hypertension (PAH) at rest is limited.

Purpose

The aim of the study was to find echocardiographic parameters of the right ventricle that may be predictors for stress RVDD in non-severe COPD patients without PAH and to determine their correlation with the 6-minute walking test (6-MWT).

Methods

We applied a ramp protocol of CPET in 104 patients. Dynamic hyperinflation (ICdyn) was measured. Emphysema was evaluated by Goddard score. Echocardiography was performed before and 1–2 minutes after peak CPET. Stress RVDD was assumed if peak E/e'>6.0. Exercise capacity was evaluated by the 6-MWT. ROC analysis detected the best cut-off values of the RV echocardiographic predictors for stress RVDD. Multivariate analysis with covariates left ventricle (LV) (LV E/A at rest; LV E/e' at rest; stress LV E/A; stress LV E/e'), lung function (FEV1), ICdyn, Goddard score, age, sex, and BMI was performed. A p-value <0.05 was accepted of statistical significance.

Results

78% of the patients had stress RVDD. RV wall thickness (RVWT), right atrial volume index (RAVI) and exercise systolic PAH were significantly higher in COPD patients with stress RVDD. After multivariable regression analysis RAVI and rest RV E/e' ratio >5.1 remained independent predictors for stress RVDD; RAVI and RVWT were independent predictors for diminished exercise capacity (6-MWT).

Conclusion

There is a high prevalence of stress induced RVDD in non-severe COPD patients without PAH at rest. RAVI and rest RV E/e'>5.1 are the best predictors for stress E/e' >6; RAVI and RVWT are associated with decrements in exercise capacity.

Funding Acknowledgement

Type of funding source: None
Inhibition of interleukin-6 by tocilizumab improves endothelial glycocalyx and myocardial work index in patients with rheumatoid arthritis
Authors: Ikonomidis I , Pavlidis G , Katsimbri P , Thymis J , Birba D , Kostelli G , Katogiannis K , Makavos G , Andreadou I , Frogoudaki A , Vrettou A.R , Boumpas D , Iliodromitis E
Published: November 2020

Background/Introduction

Tocilizumab, an interleukin-6 receptor blocker is used for the treatment of rheumatoid arthritis (RA).

Purpose

We investigated the effects of tocilizumab on endothelial glycocalyx and myocardial function in patients with RA.

Methods

Eighty patients with RA (age: 64±9 years) were randomized to tocilizumab (n=40) or prednisolone (n=40)for 3 months. We measured at baseline and 3 months post-treatment: a) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced glycocalyx thickness), b) pulse wave velocity (PWV-Complior), central systolic blood pressure (cSBP) and augmentation index (AI), c) global LV longitudinal strain (GLS), longitudinal systolic (LongSr) and diastolic (LongSrE) strain rate, d) global myocardial work index (GWI), global constructive (GCW) and global wasted work (GWW) using speckle tracking imaging.

Results

At baseline, all patients had similar disease activity score and markers of vascular and myocardial function. Compared with baseline, patients under tocilizumab had reduced PBR (2.14±0.2 vs. 1.97±0.2μm), PWV (11±3 vs. 10.3±2m/s), cSBP (134±18 vs. 129±16mmHg) and LongSrE (0.91±0.3 vs. 1±0.3 1/s) at 3 months (p<0.05). There were no statistically significant differences in the above measured markers in patients under prednisolone (p>0.05) (Table). Compared with prednisolone, tocilizumab treatment achieved a greater increase of GLS (8.5% vs. 2.4%), GWI (12.2% vs. 2.7%), GCW (10.3% vs. 5.9%) and a greater reduction of GWW (−30% vs. −13%) (p<0.05 for all comparisons), despite a similar reduction in C-reactive protein post-treatment. The percent decrease of PBR was associated with the percent decrease of cSBP (r=0.46), PWV (r=0.37) and reversely related with the percent improvement of GLS (r=−0.43) and GWI (r=−0.39) (p<0.05).

Conclusions

IL-6 inhibition by tocilizumab improves endothelial and vascular function leading to a greater increase of effective myocardial work compared to prednisolone in patients with RA.

Funding Acknowledgement

Type of funding source: None
Coronary vasomotor dysfunction is associated with worse outcomes in patients with inflammatory disease
Authors: Weber B , Brown J.M , Divakaran S , Stevens E , Hainer J , Bibbo C , Taqueti V , Blankstein R , Dorbala S , Massarotti E , Costenbader K , Liao K , Dicarli M
Published: November 2020

Background

Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriasis (PsO) are common inflammatory conditions with excess cardiovascular (CV) risk compared to the general population. This excess CV risk is associated with traditional risk factors, glucocorticoid treatment, and systemic inflammation. Systemic inflammation perturbs endothelial function and has been linked to coronary vasomotor dysfunction. It is not clear if coronary vasomotor dysfunction would be associated with worse clinical outcomes in systemic autoimmune inflammatory conditions.

Purpose

We tested the hypothesis that impaired coronary flow reserve (CFR), which in the absence of flow-limiting obstructive coronary artery disease (CAD) reflects vasomotor dysfunction, among patients with SLE, RA, and PsO is associated with worse clinical outcomes.

Methods

We included patients with RA, SLE, and PsO who underwent clinically indicated rest/stress myocardial perfusion positron emission tomography (PET) at a large academic medical center from 2006 to 2019. Patients with an abnormal myocardial perfusion study (summed stress score >3) or left ventricular ejection fraction <40% were excluded. CFR was calculated as the ratio of myocardial blood flow (MBF, ml/min/g) at peak stress compared to the MBF at rest and adjusted for baseline heart rate and blood pressure.

Results

Among the 175 patients (median age 65.1 years, 80% female) in the cohort, 24% had SLE, 35% PsO, and 41% RA. There was no difference in mean CFR between patients with RA, SLE, or PsO. Over a median follow-up of 8.5 years after PET, there were 47 deaths. Patients in the lowest and middle tertile (CFR <2.18) had a higher all-cause mortality when compared with the highest (Figure 1), and this association remained significant after adjusting for age and a composite clinical score incorporating sex, symptoms, and CV risk factors (lowest vs. highest tertile: HR 2.8; 95% confidence interval 1.2–6.5; p=0.01). CV risk factors such as diabetes, hypertension, obesity, tobacco use, and a family history of CAD were not significantly different across CFR tertiles, suggesting that inflammatory-disease specific risk factors may contribute to coronary vasomotor dysfunction.

Conclusions

In patients with systemic inflammatory disease, coronary vasomotor dysfunction was associated with worse outcomes independent of traditional CV risk factors and may have utility as a marker of CV risk among patients with inflammatory disease.

Figure 1

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. 5T32HL094301-02 NIH T32 Training Grant, “Noninvasive Cardiovascular Imaging Research Training Program”
Sex difference in left ventricular global longitudinal strain in patients with systemic sclerosis: association with outcomes
Authors: Gegenava T , Leeuwen N , Wijngaarden S , Vries-Bouwstra J , Cassani D , Tanner F , Jordan S , Distler O , Bax J.J , Delgado V , Ajmone-Marsan N
Published: November 2020

Background

Cardiac involvement is an important cause of hospitalization and mortality in patients with systemic sclerosis (SSc). Advanced echocardiographic measures such as global longitudinal strain (GLS) have already demonstrated to help identifying cardiac involvement and improve risk-stratification in these patients. However, possible sex differences in echocardiographic parameters including GLS have not been explored so far.

Purpose

To compare standard and advanced (GLS) echocardiographic parameters between male and female patients with SSc and evaluate their association with cardiovascular outcomes.

Methods

A total of 408 patients (345 females, 54±14 years old and 63 males 51±13 years old) were included in the study. The study endpoint was all-cause mortality combined with hospitalisations for heart failure, myocardial infarction, coronary interventions, device implantations, arrhythmias, cerebral infarction and peripheral ischemic disease.

Results

Males and females were comparable in terms of cardiovascular risk-factors and comorbidities but showed differences in terms of disease characteristics: greater modified rodnan skin score and higher creatine phosphokinase was observed in males as compared to females, although high NT-proBNP and deteriorated glomerular filtration rate was more prevalent in females. By standard echocardiography, male SSc patients were characterised by greater left ventricular (LV) volumes, but no difference was observed in LV ejection fraction. By advanced echocardiographic analysis, LV GLS was more preserved in female patients (−21% (IQR: −22% to −20%) as compared to males (−20% (IQR −21% to −19%), p<0.001. After median follow-up of 39 months (IQR: 22–66), the combined endpoint occurred in 84 patients, males were affected significantly more frequently as compared to females (20 (32%) vs. 64 (19%), p=0.017). Kaplan-Meier survival analysis showed that impaired LV GLS (based on median value −20%) was associated with higher cumulative rates of all-cause mortality both in males and females with SSc (females: Chi-Square = 80.307 Log Rank <0.001; males: Chi-Square = 4.493 Log Rank = 0.034) (Fig. 1). In univariate cox regression analyses, LV GLS was also significantly associated with the endpoint both in males and females (in males HR: 1.291, 95% CI: 1.033–1.612, p=0.025, in females HR: 1.386, 95% CI: 1.290–1.491, p<0.001).

Conclusions

Our study shows that among patients with SSc, LV GLS is more impaired in males as compared to females but in both groups is associated with higher prevalence of death and cardiovascular hospitalization.

Funding Acknowledgement

Type of funding source: None
Malnutrition and biological frailty are independent and complementary predictors of one-year mortality in women after primary angioplasty for ST-segment elevation myocardial infarction
Authors: Arroyo-Espliguero R , Viana-Llamas M.C , Silva-Obregon A , Estrella-Alonso A , Marian-Crespo C , Saboya-Sanchez S , Tirado-Fernandez M.A , Ruiz De Santaquiteria Torres V , Uribe-Heredia G , Castillo-Sandoval A , Garcia-Magallon B , Arriero-Fernandez N , Perez-Sanchez A , Eguileor-Marin Z , Toran-Martinez C
Published: November 2020

Background

Malnutrition and sarcopenia are common features of frailty. Prevalence of frailty among ST-segment elevation myocardial infarction (STEMI) patients is higher in women than men.

Purpose

Assess gender-based differences in the impact of nutritional risk index (NRI) and frailty in one-year mortality rate among STEMI patients following primary angioplasty (PA).

Methods

Cohort of 321 consecutive patients (64 years [54–75]; 22.4% women) admitted to a general ICU after PA for STEMI. NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (actual body weight [kg]/ideal weight [kg]). Vulnerable and moderate to severe NRI patients were those with Clinical Frailty Scale (CFS)≥4 and NRI<97.5, respectively. We used Kaplan-Meier survival model.

Results

Baseline and mortality variables of 4 groups (NRI-/CFS-; NRI+/CFS-; NRI+/CFS- and NRI+/CFS+) are depicted in the Table. Prevalence of malnutrition, frailty or both were significantly greater in women (34.3%, 10% y 21.4%, respectively) than in men (28.9%, 2.8% y 6.0%, respectively; P<0.001). Women had greater mortality rate (20.8% vs. 5.2%: OR 4.78, 95% CI, 2.15–10.60, P<0.001), mainly from cardiogenic shock (P=0.003). Combination of malnutrition and frailty significantly decreased cumulative one-year survival in women (46.7% vs. 73.3% in men, P<0.001)

Conclusion

Among STEMI patients undergoing PA, the prevalence of malnutrition and frailty are significantly higher in women than in men. NRI and frailty had an independent and complementary prognostic impact in women with STEMI.

Kaplan-Meier and Cox survival curves

Funding Acknowledgement

Type of funding source: None
The effect of maternal age on the neonatal electrocardiogram – results from a large, prospective population study
Authors: Paerregaard M , Pihl C , Pietersen A , Iversen K.K , Bundgaard H , Christensen A.H
Published: November 2020

Background

Congenital heart diseases (CHDs) are the most common type of birth defects and account for a significant proportion of infant mortality. Previous studies have shown an increased prevalence of CHD among children born of women ≥35 years. During the last decades women in the Western world have been giving birth at an increasing age. This might affect the newborns cardiac electrical system.

Purpose

To investigate the effect of maternal age on the newborns electrocardiogram (ECG).

Methods

Electrocardiograms from 17,489 newborns (aged 0–30 days) consecutively included in a large, prospective general population study were analyzed. All tracings were acquired digitally and ECG intervals, amplitudes, axis, etc. were automatically analyzed with extensive manual validation.

Results

Among the 17,489 newborns the median age was 11 days and 52% were boys. The median maternal age was 31 years (range 16–54 years). Dividing the mothers into four age quartiles we had 840 ECG's from newborns with a maternal age between 15–24 years, 12,072 between 25–34 years, 4,525 between 35–44 years, and 52 between 45–54 years. Comparing the youngest and oldest mothers we found the ECG parameters (median values, age group 15–24 vs. 45–54 years) neonatal heart rate (143 vs. 147 beats per minute), PR-interval (98 vs. 96 ms), QRS-duration (54 vs. 56 ms), QT (274 vs. 277 ms), QTcB (419 vs. 423 ms), QRS axis (115 vs. 112 degrees), max V1 R-amplitude (1257 vs. 966μV), max V6 R-amplitude (825 vs. 937μV), max V1 S-amplitude (634 vs. 649 μV) and max V6 S-amplitude (654 vs. 615 μV) were not affected by maternal age (all p>0.05). The same was found when only analyzing the subgroup of newborns aged 0–7 days (all parameters p>0.05).

Conclusion

We provide data from a large general population study including a wide range of maternal ages. Our findings indicate that maternal age does not affect the newborns hearts electrical system.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): This work was supported by the Danish Children Heart Foundation, Snedkermester Sophus Jacobsen and wife Astrid Jacobsen's foundation (Grant 19-R112-A5248-26048), the Research Council at Herlev-Gentofte Hospital and Toyota-Fonden, Denmark.
Natural history of the electrical axis during the first four weeks of life
Authors: Paerregaard M , Kock J , Pihl C , Pietersen A , Iversen K.K , Bundgaard H , Christensen A
Published: November 2020

Background

The QRS axis represents the sum of the amplitudes and orientation of the ventricular depolarization. In newborns, the QRS axis is generally directed downward and to the right and left axis deviation (LAD) may be associated with heart disease. Accurate interpretation of abnormalities in the QRS axis may facilitate early diagnosis of heart diseases in newborns.

Purpose

To describe the evolution of the QRS axis during the first four weeks of life and provide updated, digitalized, normal values from healthy newborns.

Methods

Electrocardiograms from 12,317 newborns (age 0–28 days) included in a regional, prospective, general population study from 2016–2018 were analyzed. Electrocardiograms were obtained and analyzed with a computerized algorithm with manual validation. The algorithm calculated the QRS mean axis using the net amplitudes of three leads I, II, and III. The four main QRS axis classifications were: “adult normal” axis (+1° to +90°), left axis deviation (LAD, 0° to −90°), right axis deviation (RAD, +91° to +180°), and extreme axis deviation (EAD, +181° to +270°). Echocardiograms were performed according to standard guidelines. Only newborns with an echocardiography excluding structural heart disease were included.

Results

Electrocardiograms from 12,317 newborns with a median age at examination of 12 days (52% boys) were included. The median QRS axis was 119° at the ages 0–7 days and shifted leftwards to 102° at the ages 22–28 days (p<0.001). We found that girls had significant less pronounced right axis deviation than boys (111° vs 117°, p<0.001) and that increasing gestational age was associated with more pronounced right axis deviation (104° vs 116°, p<0.05). Infant size did not affect the axis (p>0.05). Only 0.5% had LAD (0° to −90°) and 1.1% had an axis within the interval +240° to +30° indicating that a QRS axis in this expanded interval is unusual in healthy newborns.

Conclusion

The QRS axis showed a gradual leftward-shift during the first four weeks of life and was affected by sex and gestation age but unaffected by infant size. LAD occurred in only 0.5% of the newborns. Our data serve as updated reference values, which may facilitate clinical handling of newborns.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): This work was supported by the Danish Children Heart Foundation, Snedkermester Sophus Jacobsen and wife Astrid Jacobsen's foundation (Grant 19-R112-A5248-26048), the Research Council at Herlev-Gentofte Hospital and Toyota-Fonden, Denmark.
Impact of the period of the day on mortality and major cardiovascular complications after vascular surgeries
Authors: Cardozo F.A.M , Artioli T , Caramelli B , Calderaro D , Yu P.C , Rojas M.C.E , Casella I.B , De Luccia N , Gualandro D.M
Published: November 2020

Introduction

Patients submitted to arterial vascular surgeries are at a high risk of postoperative cardiac and non-cardiac complications, therefore developing strategies to lower perioperative complications is essential to optimize outcomes for this subgroup. Recent studies have suggested that the period of the day in which surgeries are performed may influence postoperative major cardiovascular complications but there is still no evidence of this association in vascular surgeries.

Purpose

Our goal is to evaluate whether the period of the day in which surgeries are performed may influence mortality and cardiovascular outcomes in patients undergoing non-cardiac vascular procedures.

Methods

Patients who underwent non-cardiac vascular surgeries between 2012 and 2018 were prospectively included at our cohort. For this analysis, subjects were categorized into two groups: those who underwent surgery in the morning (7am - 12am) and those who underwent surgery in the afternoon/night (12:01pm - 6:59am). The primary endpoints were to compare the incidence of major adverse cardiac events (MACE - acute myocardial infarction, acute heart failure, arrhythmias, and cardiovascular death) and total mortality between morning and afternoon/night surgeries within 30 days and one year. The secondary endpoint was the incidence of perioperative myocardial injury (PMI) in both groups. PMI was defined as an absolute elevation of high-sensitivity cardiac troponin T (hs-cTnT) concentrations ≥14ng/L. Multivariable analysis using Cox proportional regression (with Hazard Ratio – HR and Confidence Interval – 95% CI) was performed to adjust for confounding variables, including emergency and urgent surgeries.

Results

Of 1267 patients included, 1002 (79.1%) underwent vascular surgery in the morning and 265 (20.9%) in the afternoon/night. After adjusting for confounding variables, the incidence of MACE at 30 days was higher among those who underwent surgery in the afternoon/night period (37.4% vs 20.4% – HR 1.43, 95% CI: 1.10–1.85; p=0.008). Mortality rates were also elevated in the afternoon/night group (21.5% vs 9.9%, HR 1.59, 95% CI: 1.10–2.29; p=0.013). After one-year of follow-up the worst outcomes persisted in patients operated in the afternoon/night: higher incidence of MACE (37.7% vs 21.2%, HR 1.37, 95% CI: 1.06–1.78; p=0.017) and mortality (35.8% vs 17.6%, HR 1.72, 95% CI 1.31–2.27; p<0.001). There was no significant difference in the incidence of PMI between groups (p=0.8).

Conclusions

In this group of patients, being operated in the afternoon/night period was independently associated with increased mortality rates and incidence of MACE.

Mortality and MACE at one year

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): FAPESP - Fundação de Amparo a Pesquisa do Estado de São Paulo
The impact of bariatric surgery on framingham risk score
Authors: Ho A.K.H , O'Boyle C.J , Shabana H , Lee K.J
Published: November 2020

Introduction

Although morbid obesity is strongly associated with cardiovascular disease (CVD) risk, relatively little research has been performed to evaluate the long-term effect of bariatric surgery (BS) on CVD risk reduction.

Purpose

To evaluate the 2-year effects of laparoscopic gastric bypass (LGBYP) & laparoscopic sleeve gastrectomy (LSG) on blood pressure, lipid profile, diabetic profile and Framingham risk score (FRS).

Methods

It was a retrospective review of patients undergoing BS between January 2009–2017. Body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), lipid & diabetic profile were recorded preoperatively & 2-year postoperatively.

Results

Of 416 patients, 77% (320) were females, 88% (365) were non-smokers & mean (sd) age was 48 (11) years. 69% (286) underwent LGBYP. 27% (114) were diabetic, 78% (324) were hyperlipidaemic and 65% (269) were hypertensive. The mean SBP & DBP decreased progressively while mean high-density-lipoprotein (HDL) & total-cholesterol (TC) increased progressively (table 1). LGBYP has a greater reduction in DBP than LSG (p<0.001, t-test). 10-year CVD risk reduced by 37% at 2-year, with a greater effect in LGBYP than LSG (40% vs 28%, p<0.001, t-test).

Conclusion

The 10-year risk of CVD reduced by 37% 2-years after bariatric surgery, with a greater risk reduction in LGBYP compared to LSG.

Funding Acknowledgement

Type of funding source: None
Frailty and multimorbidity as mortality risk indicators in older men
Authors: Strandberg T
Published: November 2020

Background

Multimorbidity and frailty are frequent in ageing populations – also among cardiovascular patients – but their independent relationships to prognosis are poorly recognized.

Purpose

To compare effects of frailty and multimorbidity to mortality risk in old age and also relate them to cardiovascular risk in midlife.

Methods

Caucasian men with similar socioeconomic status (born 1919–1934, original n=3490) of an ongoing longitudinal cohort study have been followed-up since midlife in the 1960s (mean age 42 years), whereupon their combined cardiovascular risk (using Keys' risk index) was determined. In the year 2000, multimorbidity (at least 2 of the following: coronary artery disease, stroke, peripheral artery disease, heart failure, chronic pulmonary disease, diabetes, cancer, musculoskeletal disease) and phenotypic frailty status were determined in 1259 men (67% of survivors, mean age 74 years). Eighteen-year mortality was established from national registers and Cox regression (hazard ratio [HR] with 95% confidence interval [CI]) was used to find independent predictors. Various frailty/multimorbidity combinations were also related to cardiovascular risk index in midlife. In the present analyses we excluded men with phenotypic prefrailty (n=641) and the final analytic sample consisted of 618 men.

Results

Of the men 385 had neither multimorbidity nor frailty, 98 and 60 men had multimorbidity or frailty only, respectively, and 75 men had frailty + multimorbidity. Eighteen-year cumulative mortality in various groups is shown in the Figure (log-rank P value between groups <0.001). In age-adjusted Cox analyses (not frail-not multimorbid group as reference), frailty alone was significantly associated with similar mortality risk (HR 1.74, 95% CI 1.25–2.43) as multimorbidity alone (HR 1.65, 95% CI 1.27–2.16). Combination of frailty+multimorbidity was a strong prognostic sign (HR 3.15, 95% CI 2.37–4.21). As compared to not frail-not multimorbid group, combined cardiovascular risk index in healthy midlife was higher in men with multimorbidity (P=0.002), frailty (P=0.04), and frailty + multimorbidity (P=0.001) in old age.

Conclusions

Frailty phenotype without multimorbidity in older men indicated similar mortality risk as multimorbidity and was also associated with higher cardiovascular risk in midlife. Recognition of frailty would thus help assessment of prognosis in addition to multimorbidity. We also suggest that development of frailty should be included as an important outcome in prevention trials of cardiovascular diseases.

Total mortality during follow-up

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Helsinki University Hospital