bluuebunny/crossref_metadata_2025 huggingface dataset:
P3821Resting heart rate in late adolescence and long term risk of cardiomyopathy - A nationwide study of one million Swedish men
Authors: Lindgren M , Robertson J R , Adiels M A , Schaufelberger M S , Aberg M A , Toren K T , Waern M W , Aberg N D , Rosengren A R
Published: October 2019

Background/Introduction

Elevated resting heart rate (RHR) is a known risk factor for HF. Whether elevated RHR is also associated with cardiomyopathy (CM), a common cause of heart failure in the young, is unknown.

Purpose

To investigate the association of resting heart rate (RHR) measured in late adolescence with long term risk of various subtypes of CM with special attention to cardiorespiratory fitness (CRF), an important predictor of RHR and myocardial dysfunction.

Methods

We followed a cohort of Swedish men enrolled for conscription in 1968–2005 (n=1,008,485; mean age=18.3 years) until December 2014. Outcomes of CM were collected from the national inpatient- (IPR), outpatient- (OPR) and cause of death registries and were divided into categories: 1) dilated, 2) hypertrophic, 3) alcohol/drug-induced, and 4) other. Cox proportional hazard models were used to analyze the longitudinal association between RHR and outcomes while adjusting for potential confounders, including body mass index (BMI), arterial blood pressure and cardiorespiratory fitness (CRF). CRF was measured by maximum capacity ergometer testing as part of the enlistment protocol.

Results

During a mean follow up of 34 years, there were 3500 cases of a first hospitalization for CM (mean age at diagnosis, 50.1 years). Comparing the highest with the lowest quintile of the RHR distribution, we found a positive association between RHR and dilated CM (hazard ratio (HR) = 1.58 [confidence interval (CI) = 1.37–1.82]) after adjustment for BMI, age at conscription, conscription year, test center, and baseline comorbidities (diabetes, hypertension, congenital heart disease). There no significant association with alcohol/drug-induced (HR=1.32 [CI=0.94–1.85]) or other categories of CM.

Conclusion

Adolescent RHR is associated with future risk CM, independently of blood pressure, BMI and CRF. The association was driven by dilated CM. These findings are suggestive of a causal pathway between elevated heart rate and adverse cardiac remodeling that warrants further investigation.

Acknowledgement/Funding

The Swedish Heart and Lung Foundation, the Swedish Research Council, the Swedish Council for Health, Working Life and Welfare
P3823Body mass index or waist and hip circumference as predictors of outcome in the UK biobank
Authors: Pellicori P , Stanley B , Iliodromiti S , Celis-Morales C A , Lyall D M , Anderson J , Gray S , Mackay D F , Nelson S M , Welsh P , Pell J P , Gill J M R , Sattar N , Cleland J G F
Published: October 2019

Background

Controversies exist about the relationship between body habitus and mortality, especially for patients with cardiovascular disease.

Purpose

We evaluated the relations between different anthropometric indices and mortality amongst participants with and without cardiovascular (CV) risk factors, or established CV disease (stroke, myocardial infarction and/or heart failure), enrolled in the UK Biobank.

Methods

The UK Biobank is a large prospective study which, between 2006 and 2010, enrolled 502,620 participants aged 38–73 years. Participants filled questionnaires and had a medical history recorded, physical measurements done and biological samples taken. The UK Biobank is routinely linked to national death registries and updated on a quarterly basis. Data on death were coded according to the International Classification of Diseases, 10th Revision (ICD-10). The primary end-point was all-cause mortality (ACM) across three subgroups of men and women: those with, or without, one or more CV risk factors (smoking, diabetes and/or hypertension), and those with CV disease (history of stroke, myocardial infarction and/or heart failure) at recruitment. Presence, or absence, of CV risk factors and diagnoses of CV disease were self-reported by participants at enrolment. Associations between anthropometric indices (body mass index (BMI), waist circumference (WC), waist to hip ratio (WHiR), and waist to height ratio (WHeR)) and the risk of all-cause mortality were analysed using Cox regression models.

Results

After excluding those with history of cancer at baseline (n=45,222), 453,046 participants were included (median age: 58 (interquartile range: 50 - 63) years; 53% women), of whom 150,732 had at least one CV risk factor, and 17,884 established CV disease.

During a median follow-up of 5 years, 6,319 participants died. Baseline BMI had a U-shaped relationship with ACM, with higher nadir-values for those with CV risk factors or CV disease, for both sexes (figure). WC, WHiR and WHeR (measures of central distribution of body fat) had more linear associations with ACM, regardless of CV risk factors, CV disease and sex.

Conclusions

For adults with or without CV risk factors or established CV disease, measures of central distribution of body fat are more strongly and more linearly associated with ACM than BMI. WC, or WHiR, rather than BMI, appear to be more appropriate variables for risk stratification.
P3842One-year efficacy and safety of prasugrel and ticagrelor in patients with Acute Coronary Syndromes: results from a prospective and multicenter ACHILLES Registry
Authors: Esteve Pastor M A , Ruiz-Nodar J M , Rivera-Caravaca J M , Sandin Rollan M , Lozano T , Vicente-Ibarra N , Orenes-Pinero E , Macias-Villanego M J , Pernias-Escrig V , Carrillo-Aleman L , Candela E , Veliz-Martinez A , Tello-Montoliu A , Martinez-Martinez J G , Marin F
Published: October 2019

Background

Prasugrel and Ticagrelor have demonstrated higher efficacy than clopidogrel in their main clinical trials for patients with Acute Coronary Syndrome (ACS). However, the long-term prognosis and different clinical characteristics related with the type of antiplatelet prescription in current clinical practice ACS patients have not been analyzed in depth.

Purpose

The objective of this study was to analyze the clinical profile of ACS and the efficacy and safety of new antiplatelet drugs (NAD) in current clinical practice patients discharged after an ACS.

Methods

We collected data from ACHILLES registry, and observational, prospective and multicenter registry of patients discharged after an ACS. We analyzed baseline characteristics, clinical profile and therapy during ACS admission and compared with the different treatments at discharge. After 1 year of follow-up, ischaemic and major bleeding events were analyzed. Multivariate Cox regression analysis and Kaplan Meier curves were also plotted.

Results

Of 1,717 consecutive patients, 1,294 (75.4%) were discharged with a P2Y12 inhibitor without oral anticoagulation. NAD was indicated in 47%. Patients treated with clopidogrel were elderly (69.1±13.4 vs. 60.4±11.5 years; p<0.001) and with a higher prevalence of cardiovascular risk factors. GRACE and CRUSADE score were higher in the clopidogrel than in NAD group (p<0.001). After 1 year of follow-up, 64 (5.0%/year) patients had a new myocardial infarction, 127 (10.0%/year) had a MACE and 78 (6.1%/year) patients died. Patients treated with clopidogrel had significantly higher annual rate of cardiovascular mortality, MACE and all cause-mortality (all of them p<0.001) without differences in major bleeding (p=0.587) compared with NAD therapy. After multivariate adjustment for the main clinical variables related with adverse prognosis in ACS patients, the discharge with NAD was independently associated with lower risk of all-cause mortality [HR 0.49, 95% CI (0.24–0.99); p=0.043] and lower risk of MACE [HR 0.65, 95% CI (0.43–0.99); p=0.049].

Event Free Survival according NAD Use

Conclusions

In this prospective, observational and current clinical practice ACS registry, the use of NAD was associated with a reduction of adverse events compared with clopidogrel in patients with ACS. NAD prescription at discharge was independently associated with lower all-cause mortality and MACE without differences in bleeding events. However, clopidogrel remained the most common P2Y12 inhibitor employed for ACS, especially in older and high risk population.
P3857Validation of the cardiac damage classification and additional effects of albumin levels in a large cohort of patients undergoing transcatheter aortic valve replacement
Authors: Berkovitch A , Barbash I M , Finkelstein A , Assali A R , Denenberg H , Fefer P , Maor E , Zhitomirsky S , Orvin K , Steinvil A , Barsheset A , Halkin A , Guetta V , Kornowski R , Segev A
Published: October 2019

Background

Risk stratification in patients undergoing transcatheter aortic valve replacement (TAVR) is limited and based on clinical judgment and surgical AVR scoring systems. Recently, extent of cardiac damage using an echocardiographic classification was purposed to assess prognosis of patients undergoing TAVR. We aimed to validate this new scoring system in a real-world cohort and to examine the addition of baseline albumin in risk assessment.

Methods

We investigated 2,608 patients undergoing TAVR. All subjects had an echocardiography test prior to TAVR. Subjects were divided into five groups based on their echocardiography findings: stage 0 – 758 (29%) patients, stage 1 – 769 (30%), stage 2 – 730 (28%), stage 3 – 320 (12%) and stage 4 (1.2%). Patients were further assessed by incorporating baseline albumin.

Results

Mean age of study population was 82±7 years. Kaplan-Meier's survival analysis showed that the cumulative probability of mortality was significantly higher among subjects with increased stage compared to the lower stages (p<0.001). Multivariable analysis demonstrated that each increase in stage was associated with significant increased risk of 1-year mortality (HR 1.37, 95% CI 1.23–1.54, p<0.001). Among patients at increased stage (3–4), incorporation of baseline of albumin identified the highest risk group, such that each 1 decrement in albumin levels was associated with more than triple increase in mortality among patients at stage 3 and 4 (HR 2.77, 95% CI 1.48–5.18, p-value=0.001)[figure]. When added to the scoring risk prediction model, albumin allowed more accurate risk stratification: continuous NRI analysis showed an overall improvement of 11% (95% CI 6%-16%) in the accuracy of classification.

KM according to stage and albumin

Conclusions

Cardiac damage classification is validated in a real-world cohort of patients undergoing TAVR. Incorporation of low baseline albumin may further identify patients at the highest risk group.
P4152Implications of the ACC/AHA risk score for heart failure risk prediction and its comparison with existing heart failure risk prediction models: A prospective population-based cohort study
Authors: Arshi B , Van Den Berge J C , Van Dijk B , Deckers J W , Ikram M A , Kavousi M
Published: October 2019

Background

In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) developed a score for assessment of cardiovascular risk. Due to between study variability in ascertainment and adjudication of heart failure (HF), incident HF was not included as an endpoint in the ACC/AHA risk score.

Purpose

To assess the performance of the ACC/AHA risk score for HF risk prediction in a large population-based cohort and to compare its performance with the existing HF risk prediction models including the Atherosclerosis Risk in Communities (ARIC) model and the Health Aging and Body Composition (Health ABC) model.

Methods

The study included 2743 men and 3646 women from a prospective population-based cohort study. Cox proportional hazards models were fitted using risk factors applied by the ACC/AHA model for cardiovascular risk, the ARIC model and the Health ABC model. Independent relationship of each predictor with 10-year HF incidence was estimated in men and women. Next, N-terminal pro-b-type natriuretic peptide (NT-pro-BNP) was added to the ACC/AHA model.

The performance of all fitted models was evaluated and compared in terms of discrimination, calibration and the Akaike Information Criterion (AIC). In addition, area under the receiver operator characteristic curve (AUC), sensitivity and specificity of each model in predicting 10-year incident of HF was assessed. The incremental value of NT-pro-BNP to the ACC/AHA model, was assessed using the continuous net reclassification improvement index (NRI).

Results

During a median follow-up of 13 years (63127 person-years), 387 HF events in women and 259 in men were recorded. The Optimism-corrected c-statistic for ACC/AHA model was 0.76 (95% confidence interval (CI): 0.73–0.79) for men and 0.76 (95% CI: 0.74–0.79) for women. The ARIC model provided the largest c-statistic for both men [0.82 (95% CI: 0.80–0.84)] and women [95% CI: 0.81 (0.79–0.83)] among the three models. Calibration of the models was reasonable.

Addition of NT-pro-BNP to the ACC/AHA model considerably improved model fitness for men and for women. The AIC improved from 3104.62 to 2976.28 among men and from 5161.63 to 4921.51 among women. The c-statistic also improved to 0.81 (0.78–0.84) in men and 0.79 (0.77–0.81) in women. The continuous NRI for the addition of NT-pro-BNP to the base model was 5.3% (95% CI: −12.3–28.6%) for men and 15.9% (95% CI: 2.7–24.7%) for women.

Conclusions

Compared to HF-specific models, the ACC/AHA model, containing routine clinically available risk factors, had a reasonable performance in prediction of HF risk. Inclusion of NT-pro-BNP in the ACC/AHA model strongly increased the model performance. To achieve a better model performance for 10-year prediction of incident HF, updating the simple ACC/AHA risk score with the addition of NT-pro-BNP is recommended.
P4159Coronary flow capacity guidance optimizes the efficacy of percutaneous coronary intervention in patients with stable lesions: international registry of comprehensive physiologic evaluation
Authors: Hamaya R , Hoshino M , Kanaji Y , Kanno Y , Hada M , Yamaguchi M , Sumino Y , Sugiyama T , Lee J M , Koo B K , Escaned J , Kakuta T
Published: October 2019

Background

Fractional flow reserve (FFR) is the current standard for determining severity of epicardial stenosis and indication for percutaneous coronary intervention (PCI). However in practice, FFR is not enough robust to select lesions that will truly benefit from PCI. Coronary flow capacity (CFC) provides integrated information of coronary flow reserve (CFR) and coronary flow during hyperemia that is useful for identifying flow-limiting stenosis considering both epicardial and microvascular conditions.

Objective

We hypothesized that the effect of FFR-guided PCI would be enhanced by further consideration of CFC. This study aimed to investigate the prognostic effect of PCI according to CFC status of the stable lesions, using pressure-temperature sensor-tipped wire for FFR and CFC evaluation.

Methods

From a global, multicenter registry of comprehensive physiological assessment, a total of 1397 patients (1694 vessels) were enrolled. Three patients/vessels were excluded due to lost follow-up. Low CFC was defined for lesions with reduced CFR and the corresponding inverse of thermodilution-derived mean transit time under hyperemia, which represents hyperemic coronary flow. The effect of FFR-guided PCI on vessel-oriented composite outcomes (VOCO) was assessed by multivariate marginal COX proportional regression model with or without the interaction term between PCI and CFC, using the CFC definition with the CFR threshold of 2.0 (Figure: red + green area showing low CFC). Using the same model, variously defined CFC was tested to determine the optimal thresholds (Figure: red only area ∼ red + green + blue area).

Results

During the 5-year follow-up period, VOCO was identified for a total of 113 vessels. In the multivariate model, the HR of PCI was 0.963 (95% CI: 0.538–1.723). When the interaction was added to the model, the effect of PCI on VOCO incidence was significantly different according to CFC status (p=0.069 for interaction). The optimal criterion of CFC was made where Akaike Information Criterion of the model was minimized (CFR threshold of 2.9 for the CFC definition), where PCI had HR of 0.443 (95% CI: 0.196–0.999) and 1.521 (95% CI: 0.828–2.796) for lesions low and high CFC, respectively. CFR had no significant interaction with PCI (p=0.26).

CFC Map

Conclusion

The effect of PCI on VOCO was significantly different according to CFC status. PCI to lesions with low CFC was prognostically beneficial. Our results suggested the potential of CFC for optimizing PCI benefit in stable lesions after FFR assessment.
P4165Influence of restrictive right ventricular physiology in outcomes after transcatheter pulmonary valve implantation in adult patients
Authors: Gaspar Lopes Francisco A R , Malekzadeh-Milani S , Ladouceur M , Iserin L , Soulat G , Mousseaux E , Legendre A , Boudjemline Y , Karsenty C
Published: October 2019

Background

A restrictive right ventricular (RV) physiology (r-RVP) is present in almost half of the patients with repaired tetralogy of Fallot (ToF), but its effect on later patients' clinical status is controversial.

Purpose

Evaluate the outcomes after transcatheter pulmonary valve implantation (TPVI) in patients with restrictive versus non-restrictive RV.

Methods

Single-center retrospective study of patients who underwent TPVI for pulmonary regurgitation between 2008 and 2017. Electrocardiogram, transthoracic echocardiogram, cardiac magnetic resonance and cardio-pulmonary exercise test were performed previous to TPVI and repeated 12 months after. For statistical analysis restrictive physiology was defined as the presence of end-diastolic forward flow (EDFF) and RVEDVi <150ml/m2.

Results

Fifty-nine patients, 55 with tetralogy of Fallot, were included. R-RVP was present in 23 patients (39.0%). At the baseline, the majority of the patients were symptomatic, in NYHA functional class II–III (n=48, 81.4%) and with reduced cardiopulmonary performance (VO2max = 20.5mL/min/kg), both worse among patients with r-RVP (p=0.018 and p=0.018). During a mean follow-up of 446.4±226.1 days after TPVI one patient died. BNP levels were not significantly different from baseline. Despite self-reported functional capacity and exercise capacity improvement after TPVI (p<0.001), all parameters remained lower in r-RVP group. One year after TPVI, pulmonary and tricuspid regurgitation decrease significantly, as well as RVEDV, in both groups. However, RV systolic function remained unchanged in both groups. Regarding to the dysrhythmic profile, all patients with need for an implantable cardiac defibrillator and seven of the eight patients requiring radiofrequency ablation for sustained supraventricular arrhythmias during follow-up were in the group without r-RVP (p=0.038).

Kaplan-Meier survival curve

Conclusion

TPVI had a positive impact in clinical status in a cohort of patients with predominant PR regardless the presence of restrictive physiology. Moreover, besides higher VO2max and anaerobic threshold in the non-restrictive group, the magnitude of the improvement was not statistically different between the two groups. Nevertheless, in patients without r-RVP, a peculiar caution has to be focused regarding rhythmic issue during follow-up, despite the TPVI.
P4341Sex differences in the U-shaped relationship between physical activity and cardiovascular mortality in the general population
Authors: Takahashi T , Watanabe T , Watanabe M
Published: October 2019

Background

The beneficial effect of moderate physical activity on morbidity and mortality has been observed in the general population. However, sex differences in the impact of physical activity on cardiovascular mortality remain unclear. The aim of this study was to investigate the relationship between physical activity and cardiovascular mortality in the general population.

Methods

This longitudinal cohort study included 1,826 apparently healthy subjects who participated in a community-based health checkup.

Results

There were 97 deaths, including 31 cardiovascular deaths during 10-year follow-up. Subjects were divided into 4 groups based on the quartiles of physical activity (low, mild, moderate and high). There was a U-shaped relationship between physical activity and cardiovascular mortality in male subjects, but not in female subjects. Kaplan-Meier analysis demonstrated that high and low physical activity groups showed higher cardiovascular mortality compared with mild and moderate physical activity groups in male subjects. Cox proportional hazard analysis revealed that low and high physical activities were associated with cardiovascular mortality (hazard ratio 3.59 and 5.11, respectively) in male subjects. In contrast, physical activity was not associated with cardiovascular mortality in female subjects.

Conclusion

We identified a U-shaped relationship between the amount of physical activity and cardiovascular mortality in male subjects, but not in female subjects.
P4356Assessment of global and regional right ventricular systolic function in restrictive pulmonary disease by novel speckle tracking 3D echocardiography comparison with cardiac magnetic resonance imaging
Authors: Tanwar S , Sen N , Jain A , Mehta A , Kalra B , Bansal M
Published: October 2019

Background

Chronic restrictive pulmonary disease may alter right and left ventricular function by changing intrathoracic pressure. Pulmonary hyperinflation may increase right atrial pressure, leading to reduced venous return and subsequent reductions in RV pre-load. In CRPD patients, hyperinflation has been directly correlated with reduced atrial chamber size, global RV dysfunction, and reduced LV filling. Accurate assessment of global and regional right ventricular (RV) systolic function is challenging.

Purpose

The aims of this study were to confirm the reliability and feasibility of a three-dimensional (3D) speckle-tracking echocardiography (STE) system, using comparison with cardiac magnetic resonance imaging (CMR), and to assess the contribution of regional RV function to global function.

Methods

In a retrospective, cross-sectional study setting, RV volumetric data were studied in 200 patients who were referred for both CMR and 3D echocardiography within 1 month. Three-dimensional STE-derived area strain, longitudinal strain, and circumferential strain were assessed as global, inlet, outflow, apical, and septal segments.

Results

136 patients (68%) had adequate 3D echocardiographic data. RV measurements derived from 3D STE and CMR were closely related (RV end-diastolic volume, R2=0.89; RV end-systolic volume, R2=0.82; RV ejection fraction [RVEF], R2=0.68; P<0.003 for all). RVEF and RV end-diastolic volume from 3D STE were slightly but significantly smaller than CMR values (mean differences, −3% and −8 mL for RVEF and RV end-diastolic volume, respectively). Among conventional echocardiographic parameters for RV function (tricuspid annular plane systolic excursion, fractional area change, S' of the tricuspid annulus, RV free wall two-dimensional longitudinal strain), only fractional area change was significantly related to RVEF (r=0.30, P=0.005). Among segmental 3D strain variables, inlet area strain (r=−0.49, P<0.004) and outflow circumferential strain (r=−0.39, P<0.005) were independent factors associated with CMR-derived RVEF.

Conclusions

Severity of restrictive pulmonary disease influences RV systolic dysfunction, which is reflected in speckle tracking 3D echocardiographic parameters. Regional RV wall motion showed that heterogeneous segmental deformations affect global RV function differently; specifically, inlet area strain and outflow circumferential strain.RV volume and RVEF determined by STE were comparable with CMR measurements.
P4364A direct comparison between 2D and 4D deformation imaging in hypertrophic hearts. An agreement of disagreement
Authors: Pagourelias E , Mirea O , Duchenne J , Unlu S , Van Cleemput J , Papadopoulos C E , Bogaert J , Vassilikos V , Voigt J U
Published: October 2019

Background

Previous studies have directly compared 2-dimensional (2D) and 4-dimensional (4D) deformation imaging in normal and ischemic hearts suggesting a moderate agreement prone to technical considerations. However, the level of agreement between 2D and 4D-strain imaging has never been adequately addressed in hypertrophic hearts, nor has it been validated against a “ground truth”.

Purpose

We aimed at directly comparing 4D and 2D global and regional deformation parameters and depict which may best reflect underlying segmental fibrosis in hypertrophic cardiomyopathy (HCM), as defined by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR).

Methods

We included 40 HCM patients (54.1±14.3 years, 82.5% male, maximum wall thickness 19.3±4.8mm) who have consecutively undergone 2D-,4D-speckle tracking echocardiography and CMR. Global and segmental circumferential (CS) and longitudinal (LS) strain have been calculated from 2D acquisitions and 4D full volume data, where additionally radial (RS) and area (AS) strain have been extracted using an 18 segment left ventricle model. Accordingly, segmental fibrosis was defined by LGE in corresponding CMR slices.

Results

Deformation parameters (2D and 4D, global and regional) presented overall poor to moderate agreement (Figure A+B) with regional 4D_LS and 4D_CS values being constantly less negative compared to 2D derivatives (−7.29±6.94% and −8.53±8.8% accordingly). In regional analysis, 720 segments were evaluated of which 134 (19.7%) were enhanced and 95 of them thickened (68.8%) (thickness>12 mm), with segments presenting both characteristics showing the greatest impairment both in 2D and 4D strain values. Among segmental deformation indices, 2D_SLS showed the best area under the curve [(AUC)=0.78, 95% CI (0.75–0.81), p<0.0005] to detect segmental fibrosis, with 2D_SCS and all 4D deformation indices presenting significantly lower AUC (Figure C).

Conclusions

In HCM, 2D and 4D deformation parameters are not interchangeable, showing modest agreement. Thickness and tracking algorithm calculating assumptions seem to induce this variability. Nevertheless, among HCM patients 2D_SLS remains the best strain parameter for tissue characterization and fibrosis detection.

Acknowledgement/Funding

Supported with a scholarship by the Greek State Scholarship Foundation (IKY).
P4377Use of LV Deformation Imaging to predict long term Heart Failure Risk in high risk patients
Authors: Haji K , Marwick T , Neil C , Stewart S , Carrington M , Wright L , Chan Y , Simons K , Wong C
Published: October 2019

Background

The increasing prevalence of heart failure (HF), due to hypertension, ischaemic heart disease, diabetes, obesity, and ageing population demands identification of at-risk subgroup whom we could target on prevention strategies. In a same cohort of patients at risk of HF (70% with CAD), 13% developed new HF hospitalization or death over 4.3 years of follow-up, however, disease management program did not confer any benefit to outcome and LV ejection fraction (EF) was not predictive of progression to HF. Better risk stratification strategies are needed. In this study, we sought whether advanced echo measure on deformation, global longitudinal strain (GLS) would predict HF admission over a long term follow up and thereby define an at-risk group. Aim: To determine which of the LV morphology, function and deformation parameters, best predict new HF admission or HF death in pts at risk but without prior dx of HF.

Method

Echocardiograms (including measurement of LV, size, function, morphology and deformation) were obtained in 431 inpatients (mean age 65±11, 72% male) at risk of HF. LV global longitudinal strain (GLS) and strain rate (GLSR) were measured offline (EchoPac, GE). Long term (9 years) follow up data were obtained via data linkage.

Results

63 pts (15%) reached the end-point of HF admission or HF death. LV deformation showed a univariable association with outcome (Table). In multivariable analysis, including known significant predictors of outcome (age, sex, BMI, diabetes, hypertension), GLS less than 18 remained an independent predictor (Table), in addition to age and DM at baseline. EF and LV mass were not predictors of heart failure.

HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value Age 1.1 (1–1.1) <0.01 1.1 (1–1.1) 0.04 1 (1–1.1) 0.04 Sex 1.0 (0.6–1.7) 0.9 0.8 (0.4–1.8) 0.6 0.8 (0.4–1.8) 0.6 BMI 1.0 (1–1.1) 0.05 1 (0.9–1.1) 0.7 1 (0.9–1.1) 0.7 DM 2.6 (1.6–4.3) <0.01 2.7 (1.4–5.3) <0.01 2.7 (1.4–5.2) 0.04 LVMI 1.0 (1.0–1.0) <0.01 1 (0.9–1.0) 0.7 1 (0.99–1.0) 0.7 Impaired EF, % 1.0 (0.9–1.0) <0.01 1 (0.9–1.0) 0.16 0.97 (0.94–1.0) 0.04 Diastolic dysfunction 2.3 (1.4–3.7) <0.01 0.8 (0.3–1.7) 0.5 0.7 (0.3–1.7) 0.5 GLS 1.3 (1.4–1.2) <0.01 1.1 (1–1.2) 0.07 GLS <18 5.3 (2.8–10.2) <0.01 2.3 (1.1–5.1) 0.04

Conclusion

GLS <18 is independently associated with increasing new onset heart failure admission and HF mortality in patients at risk of HF.
P4379Pathophysiology of left atrial filling in mitral regurgitation. A new volumetric flow rate index describing disturbed left atrial filling behavior in mitral regurgitation by 3D TTE
Authors: Frumkin D , Stangl K , Muegge A , Buck T , Plicht B
Published: October 2019

Background

In chronic mitral regurgitation (MR) the left atrium (LA) is one of the first cardiac structures involved in remodeling by progressive volume overload. Real-time three-dimensional echocardiography is able to monitor volumetric changes of the left atrium during the heart cycle.

Purpose

We hypothesized that chronic volume overload due to MR leads to detectable changes in the LA filling behavior described by mean and maximum filling flow rates and their relation called volumetric flow rate index.

Methods

We prospectively analyzed data of 36 patients in different stages of chronic MR and 13 patients without MR. Transthoracic echocardiography was conducted using the Epiq 7G Ultrasound System. Standard 2D- and 3D apical 4-chamber views were recorded and stored for offline analysis. We generated volume-time-curves by 3D volume analysis to derive mean and maximum volumetric flow rates during LA reservoir, conduit and pump phase. Volumetric flow rate index was calculated as the quotient of mean flow rate/maximum flow rate.

Results

Average MR severity, calculated with the MR Scoring system introduced from Buck et al. and implicated in the ESC Guidelines, was 6.2 points (±2.5) according to Grade I-II. We included 13 patients without MR, 18 with mild MR, 12 patients with moderate MR, 6 patients with severe MR. Left ventricular ejection fraction was similar in the different groups (51,2±12,3%). Maximum and mean flow rate showed no significant correlation with MR severity. Correlation of MR severity with LA dilation (ml/m2 BSA) was r=0.41; p<0.001. Flow rate index showed strong significant correlation with MR severity in left atrial reservoir phase (r=−0.75; p<0.001). There was no statistically relevant difference of volumetric flow rate parameters in left atrial pump and conduit phase.

Line chart

Conclusions

We observed a significant correlation of the volumetric flow rate index to MR severity in the left atrial reservoir phase with stronger correlation than MR severity to left atrial dilation. The results of this work encourage further investigations to establish the presented volumetric flow rate index as a progression marker of MR and to evaluate its prognostic value.
P4383Machine learning approach for prdiction of postinfarction myocardial recovery using echocardiographic myocardial texture
Authors: Michalski B W , Skonieczka S , Strzelecki M , Simiera M , Szymczyk E , Wejner-Mik P , Lipiec P , Wierzbowska-Drabik K , Kasprzak J D
Published: October 2019

Background

Recovery of left ventricular (LV) function has significant prognostic significance after myocardial infarction (MI) but is challenging to predict. We applied machine learning algorithms (ML) to analyze echocardiographic myocardial texture for predicting long-term recovery of left ventricular myocardium

Methods

We used native and contrast-enhanced (Sonovue imaged with Contrast Perfusion Sequence, CPS) myocardial images acquired 7 days after reperfused ST-elevation MI from apical window recorded in 61 pts (19 females, age 59.7±11.9) with first ST-elevation MI treated with successful PCI. A custom software (MaZDa 4.6) was used for texture analysis. 299 image features were calculated for defined regions of interest in each image (9 features from histogram, 6 from gradient matrix, 20 from run length matrix, 220 from co-occurrence matrix, and 44 from wavelet transform). Up to 10 most reproducible parameters were selected based on low variation and, later, Fisher criterion with minimization of classification error along with average correlation coefficient. ML methods used to analyze textures included Multilayer perceptron neural network -MLP, support vector machines -SVM, Adaptive Boosting algorithm AdaBoost and library support vector machine. We defined recovery as: improvement of LV wall motion score index (WMSI), absence of remodeling defined as >8% increase in LV end-diastolic volume (LVEDV) and improvement >5% of LV ejection fraction % after 1 year.

Results

Effectiveness of tested methods was similar for predicting regional and local LV function evolution after one year. Results for native grayscale and red component of CPS myocardial perfusion images were comparable. Percent accuracy of prediction is shown in the table, with best result for WMSI.

Accuracy of 1-yr predictions of LV function change ΔWMSI ΔEF ΔLVEDV native grey contrast red contrast grey native grey contrast red contrast grey native grey contrast red contrast grey Adaptive Boosting 78% 79% 78% 64% 64% 59% 61% 60% 60% Neural network 77% 79% 78% 63% 63% 58% 62% 59% 60% Library support vector machine 77% 79% 78% 63% 65% 64% 61% 60% 58% Support vectro machine 77% 79% 78% 64% 65% 59% 61% 60% 58%

Conclusions

Echocardiographic myocardial texture can be analyzed using machine learning approaches to predict global or regional recovery of myocardial function. Accuracy for predicting regional WMSI improvement was superior to prognosing LVEDV or EF change. Performance of different tools did not differ between native and contrast enhanced images.
P4400Heart rate variability in supporters of the German national football team during FIFA world cup 2018
Authors: Brunner S , Hamm W
Published: October 2019

Objective

It is well known that emotional stress can trigger cardiovascular events. Although several studies have confirmed this relationship during big sport events, the underlying mechanisms are less well understood. Therefore, we aimed to analyse parameters of the cardiac autonomous nervous system during FIFA World Cup 2018.

Methods

We performed a high-resolution digital electrocardiography (ECG) in healthy supporters of the German national football team watching the final group stage match of FIFA World Cup 2018 between Germany and South Korea. As control, ECG recordings were performed watching a group stage match of another group without involvement of the German team (Japan against Poland). We analysed standard parameters of heart rate variability (HRV). Further, we analyzed the number of admissions to Chest Pain Units (CPUs) and Stroke Units (SUs) in Munich at the day of the German match (June 27th, 2018) and at predefined control periods.

Results

All measured HRV parameters (SDNN, RMSSD, LF and HF) were significantly lower during the match involving the German national football team compared to the control match (SDNN: 76.7 (67.4–83.9) versus 82.9 (72.5–96.5) ms, p<0.05; RMSSD: 32.0 (27.7–33.3) versus 41.3 (31.4–49.19 ms, p<0.05; LF: 1442 (1182–1637) versus 2000 (1563–2238) ms2, p<0.05; HF: 206 (158–259) versus 376 (242–417), p<0.05). Regarding the LF/HF ratio, there was no significant difference. The admission rate on CPUs and SUs was numerically higher at the day of the German match compared to the control days and compared to the predefined control period (40.8% higher).

Conclusion

Emotional stress during important football matches results in a dysbalance of the cardiac autonomous nerve system. These findings might provide a link to increased cardiovascular events during emotional stress.
P4406New hypothesis of the insulin resistance development: role of adipose-derived stem cell proliferation and adipogenesis
Authors: Stafeev I , Michurina S , Podkuychenko N , Sklyanik I , Panevina A , Shestakova E , Yah'yaev K , Ratner E , Vorotnikov A , Menshikov M , Yashkov Y , Parfyonova Y E , Shestakova M
Published: October 2019

Background

Obesity, remaining a topical issue of modern medicine, leads to development of latent inflammation and insulin resistance in adipose tissue with subsequent development of type 2 diabetes mellitus (T2DM). Among patients with obesity, patients with obesity and normal glucose tolerance (NGT) are often encountered. In our study we have tested the hypothesis that low proliferative potential of adipose derived stromal cells (ADSC) associates with reduced formation of new fat depots, excess accumulation of fat in the functional adipocytes and their hypertrophy, resulting in fat inflammation and insulin resistance.

Methods

We screened two groups of obese patients with or without T2DM, matched for BMI, age, and duration of obesity to test the hypothesis that hypertrophy and decreased renewal of adipocytes may underlie transition from obesity to T2DM. All patients were matched for carbohydrate metabolism (fasting blood glucose level, glycated hemoglobin, HOMA-IR index and M-index). The subcutaneous and omental fat tissue biopsies were obtained during bariatric surgery from obese individuals with or without T2DM. The morphology and immunophenotype of subcutaneous and omental fat was assessed in frozen tissue sections. ADSC were isolated from both types of fat tissue biopsies and screened for morphology, proliferative potential and inflammatory status.

Results

The non-diabetic patients had normal carbohydratemetabolism andmoderate insulin resistancemeasured byHOMA-IR and hyperinsulinemic clamp (M-index),while T2DM patientswere extremely insulin resistant by both indexes. The average size of diabetic adipocytes was higher than that of non-diabetic in both subcutaneous and omental fat tissues, indicating adipocyte hypertrophy in T2DM. We have shown that ADSC from T2DM patients had significantly higher level of inflammation. According to measurement of p62 expression and LC3 modification we can say that ADSC from T2DM patients have less autophagy level compare with ADSC from NGT patients. Immunohistochemistry have shown that patients with T2DM have much more infiltration of CD68+-cells in subcutaneous and omental adipose tissue and immunophenotype (balance of M1-M2 macrophages) of adipose tissue at this patients shift toward inflammatory state.

Conclusion

These results suggest that decreased proliferation and increased hypertrophy of diabetic ADSC may lead to reduced insulin sensitivity via increased inflammation mediated by M1-macrophages and JNK1/2 pathway.

Acknowledgement/Funding

This work was supported by RSF grant #17-15-01435
P4409Cardiorespiratory fitness is inversely associated with the inflammatory status in the general population
Authors: Lehnert K , Gross S , Baumeister S E , Ewert R , Glaeser S , Nauck M , Felix S B , Doerr M , Bahls M
Published: October 2019

Background/Introduction

Low-grade systemic chronic inflammation is a major risk factor for cardiometabolic diseases. Higher physical activity has athero- and cardioprotective effects, potentially through its anti-inflammatory properties. However, the relation between resting inflammatory status and cardiorespiratory fitness (CRF) in population-based settings remains to be elucidated. While previous research has shown inverse associations between CRF and high-sensitive C-reactive protein (hs-CRP) levels, relations with other inflammatory markers are not yet well examined.

Purpose

We assessed the relation between markers of CRF (i.e. maximal oxygen uptake [VO2peak], oxygen uptake at the anaerobic threshold [VO2@AT], oxygen pulse [O2HRmax] and maximal workload [max. Watt]) and hs-CRP as well as total white blood cell (WBC), monocyte, neutrophil, lymphocyte, eosinophil and basophil counts.

Methods

Data of the population-based cohort Study of Health in Pomerania (SHIP) was used (n=1,481; 51% male; age range 20–81 years). CRF was assessed using standardized cardio-pulmonary exercise testing (CPET) according to a modified Jones protocol. The Dimension Vista 500 analytical system was used to measure hs-CRP concentrations. Fluorescence-activated cell sorting was used to assess total as well as subpopulation WBC count. We excluded subjects with missing data, anti-rheumatic/steroid/anti-inflammatory medication as well as chronic inflammatory and hepatic diseases, gastritis, hepatitis infection, severe renal disease, chronic lung disease, asthma, chronic bronchitis, previous myocardial infarction, left ventricular ejection fraction <40% and previous cancer. Linear regression models, adjusted for age, sex, current smoking and lean-mass, were used to assess the relation between CPET and inflammatory parameters.

Results

A 14 ml/min (95%-confidence interval [CI] −23 to −6, p=0.004) lower VO2peak was associated with a one mg/L higher hs-CRP. A lower VO2peak was also related with a one Gpt/L greater WBC (β: −42. 95% CI: −55 to −27 ml/min, p<0.001) as well as neutrophil (β: −57, 95% CI: −77 to −36 ml/min, p<0.001), lymphocyte (β: −63, 95% CI: −107 to 19 ml/min, p=0.005) and monocyte count (β: −204, 95% CI: −360 to −47 ml/min, p=0.011). No significant associations were found for eosinophil and basophil count. Similar results were found for VO2@AT, O2HRmax and max. Watt.

Conclusion

Results suggest an inverse association between CRF and resting inflammatory status. Our non-significant findings with regards to eosinophils and basophils may be expected since these cell types are generally involved in type 2 immune responses related to allergic skin and airway inflammation as well as immunity against parasites. Overall, our results imply that potential biological mechanisms underlying the athero- and cardioprotective effects of high CRF may be related to lower chronic inflammation in fitter individuals.
P4411Analysis of cardiometabolic traits highlights shared biological pathways
Authors: Timasheva Y , Zudina L , Balkhiyarova Z , Kaakinen M , Munroe P , Prokopenko I
Published: October 2019

Genome-wide association studies (GWAS) have contributed to a major leap forward in the unravelling of the genetic basis of complex disorders, and identified over 900 genetic loci for blood pressure (BP) regulation, 160 for coronary artery disease (CAD) and 140 for type 2 diabetes (T2D). The ubiquitousness of genetic pleiotropy and the fact that cardiovascular diseases, T2D, and other metabolic disorders share a number of risk factors, suggest that these conditions may have common underlying molecular mechanisms. We aimed to dissect shared genetic factors contributing to the comorbidity of these diseases using multi-phenotype approach.

Using summary statistics from published GWAS available in public domain, including those from GWAS consortia DIAGRAM/DIAMANTE (T2D), MAGIC/ENGAGE (glycaemic), ICBP (blood pressure, BP), CARDIOGRAM (cardiovascular), GLGC/ENGAGE (lipids), GIANT (obesity), we analysed 3429 single nucleotide variants (SNVs) associated with 63 cardiometabolic phenotypes (defined as related to T2D, cardiovascular and metabolic disorders).

We identified 301 unique association signals, and found 426 CAD/BP SNVs overlapping with 1194 SNVs reported for other phenotypes and located within 100kb from one another. Further analysis revealed 49 linkage patterns for cardiometabolic phenotypes (D'>0.9, r2>0.8). Specifically, nine SNVs in SH2B3-ATXN2 locus are associated with CAD, systolic and diastolic BP, stroke, ICAM-1 and diabetes; three SNVs in ATP5G1- UBE2Z influence CAD risk, T2D, and anthropometric traits; nine SNVs in TCF7L2 are associated with pulse pressure (PP), body mass index (BMI), glycaemic traits and T2D risk; four SNVs in ADAMTS9 and three in BCL2 are associated with BP traits, T2D, and abdominal obesity; twelve SNVs in IRS1 gene are related to hypertension, T2D risk, glycaemic and lipid traits; ten SNVs in MTNR1B affect PP, T2D susceptibility, and glycaemic traits; six SNVs in KLF14 influence systolic BP, T2D, and high density lipoproteins (HDL) level; nine SNVs in ABO affect CAD, T2D, and stroke susceptibility, as well as lipids and ICAM-1 level; eight SNVs in CDKAL1 are associated with systolic BP, increased T2D risk, and glycaemic traits; two in SLC39A8 affect BP traits, lipid levels, and BMI.

Our results highlight the pathways that influence multiple cardiometabolic phenotypes, including circadian rhythm regulation (MTNR1B), pancreatic islet function and insulin signalling (CDKAL1 and IRS1), appetite control and nutritional regulation (NUCB2 and ATXN2), immune and inflammatory signaling (SH2B3 and SLC39A8), cell cycle regulation and apoptosis (UBE2Z and BCL2), angiogenesis (ADAMTS9), suggesting that similar disease-driving biological processes are implicated in the pathogenesis of these diseases.
P4415Long obstructive sleep apneas as a biomarker of atrial fibrillation
Authors: Allam S , Reddy P , Valladares E , Hammond T , Grbach V , Basrawala H , Patel K , Konecna E , Konecny V , Borok Z , Khoo M , Doshi R , Somers V , Konecny T
Published: October 2019

Background

Even though obstructive sleep apnea (OSA) is strongly associated with atrial fibrillation (AF), the use of traditional OSA scoring by apnea hypopnea index (AHI) did not result in improved arrhythmia outcomes in recent randomized trials. Longer OSA episodes lead to stronger pro-arrhythmic changes, and whether very long OSA episodes are more prevalent in AF patients remains unknown.

Purpose

We hypothesized that AF patients with mild-moderate OSA manifest greater percentage of long (>20s), very long (>30s), and extremely long (>40s) OSA episodes, compared to control OSA patients matched to AHI, age and sex.

Methods

From patients studied with diagnostic polysomnography in our laboratory between 2016 and 2018, we selected 22 patients with mild-moderate untreated OSA of which 11 patients had history of paroxysmal AF and 11 patients did not have any cardiac history. The length, oxygen desaturation, and relationship to neighboring events was manually re-measured in all recorded apnea and hypopnea events.

Results

In the 22 included patients (age 62.5±9.1 years, AHI 12.8±6.1, 40% female) we recorded 1021 apneas: 508 in the AF group and 513 in the control group. AF patients had longer apneas compared to the patients without AF history (mean length 28.7±11.7s vs. 23.3±9.9s; p<0.0001). The proportion of apneas that were long (>20s), very long (>30s), and extremely long (>40s) was greater in the AF group as compared to the control (p=0.0039, p=0.0215, p=0.0104, respectively; see figure). The acute oxygen saturation drops (>2%) during apneas were comparable between the AF group and control groups (p=0.13), but the long (>20s) apneas were prone to greater oxygen desaturations.

Length of Apneas

Conclusions

While traditional scoring of OSA focuses on episodes lasting >10s, our data newly show that longer durations of OSA events are particularly prevalent in AF patients. These results, combined with recent mechanistic studies showing that longer apneas exert greater pro-arrhythmic effect on atrial conduction, suggest that novel scoring of OSA placing more weight on longer apneas should be explored, especially when screening and titrating OSA therapy in patients at risk of AF.