bluuebunny/crossref_metadata_2025 huggingface dataset:
P4357Implementation of interactive mixed reality display of three-dimensional echocardiography during percutaneous structural interventions
Authors: Kasprzak J D , Kierepka M , Peruga J Z , Dudek D , Machura B , Stanuch M , Zlahoda-Huzior A , Kasprzak J I , Sorysz D , Wdowiak-Okrojek K , Lipiec P
Published: October 2019

Background

Three-dimensional (3D) echocardiographic data acquired from transesophageal (TEE) window are commonly used in planning and during percutaneous structural cardiac interventions (PSCI).

Purpose

We hypothesized that innovative, interactive mixed reality display can be integrated with procedural PSCI workflow to improve perception and interpretation of 3D data representing cardiac anatomy.

Methods

3D TEE datasets were acquired before, during and after the completion of PSCI in 8 patients (occluders: 2 atrial appendage, 2 patent foramen ovale and 3 atrial septal implantations and percutaneous mitral commissurotomy). 30 Carthesian DICOM files were used to test the feasibility of mixed reality with commercially available head-mounted device (overlying hologram of 3D TEE data onto real-world view) as display for the interventional or imaging operator. Dedicated software was used for files conversion and 3D rendering of data to display device (in 1 case real-time Wi-Fi streaming from echocardiograph) and spatial manipulation of hologram during PSCI. Custom viewer was used to perform volume rendering and adjustment (cropping, transparency and shading control).

Results

Pre- and intraprocedural 3D TEE was performed in all 8 patients (5 women, age 40–83). Thirty selected 3DTEE datasets were successfully transferred and displayed in mixed reality head-mounted device as a holographic image overlying the real world view. The analysis was performed both before and during the procedure and compared with flatscreen 2-D display of the echocardiograph. In one case, real-time data transfer was successfully implemented during mitral balloon commissurotomy. The quality of visualization was judged as good without diagnostic content loss in all (100%) datasets. Both target structures and additional anatomical details were clearly presented including fenestrations of atrial septal defect, prominent Eustachian valve and earlier cardiac implants. Volume rendered views were touchlessly manipulated and displayed with a selection of intensity windows, transfer functions, and filters. Detail display was judged comparable to current 2-D volume-rendering on commercial workstations and touchless user interface - comfortable for optimization of views during PSCI.

Conclusions

Mixed reality display using a commercially available head-mounted device can be successfully integrated with preparation and execution of PSCI. The benefits of this solution include touchless image control and unobstructed real world viewing facilitating intraprocedural use, thus showing superiority over virtual or enhanced reality solutions. Expected progress includes integration of color flow data and optimization of real-time streaming option.
P4363The predictive capacity of two- and three-dimensional echocardiography detected right ventricular strain in disease severity of pre-capillary pulmonary hypertension
Authors: Liu B , Wu W , Liu Z , Wang H , He J , Xiong C
Published: October 2019

Background

Pulmonary hypertension (PH) patients have poor prognosis due to progressive right ventricular (RV) dysfunction. As a low-cost and non-invasive tool, echocardiography is by far the most widely used technique to investigate the RV structure and function in PH patients. Recent studies showed that RV longitudinal strain (RVLS) measured by two- or three-dimensional echocardiography (2DE, 3DE) was correlated with RV function parameters and have the potential to predict the prognosis of PH patients. However, few studies have compared the value of 2DE- and 3DE- RVLS to predict disease severity of pre-capillary PH patients. Therefore, our study aims to compare the capacity of RVLS assessed by 3DE and 2DE in predicting disease severity of pre-capillary PH patients.

Methods

We consecutively enrolled 57 patients (18 males and 39 females, 35±13 years) with pre-capillary PH diagnosed by right heart catheterization in our center. Standard transthoracic echocardiography was performed in all participants. 2DE- RVLS were obtained from speckle-tracking analyses using GE EchoPAC version 201; while 3DE- RVLS were analyzed by TomTec 4D RV-Function 2.0. On the basis of the risk assessment strategy of 2015 ESC Guidelines for the diagnosis and treatment of pulmonary hypertension, all the participants were classified into low risk or intermediate-high risk groups. Linear regression analyses were performed to evaluate the correlations between RVLS and peak oxygen consumption (PVO2). In addition, receive operating characteristic curves (ROC) were used to compare the predictive values of 2DE- and 3DE-RVLS and identify the optimal cut points for the detection of low risk based on the risk assessment strategy of 2015 ESC Guidelines.

Results

Linear regression analyses showed a significant correlation between PVO2 and 2DE- RVLS (r=−0.484, P<0.001), while a relatively weaker correlation was observed between PVO2 and 3DE- RVLS (r=−0.299, P=0.024). ROC curve showed 2DE-RVEF had a better capacity to classify pre-capillary PH patients into low or intermediate-high risk groups (2DE- vs 3DE-: AUC=0.78, P=0.003 vs AUC=0.69, P=0.044). Optimal cut-offs found 2DE-RVEF <−13.85% had a 73.3% sensibility and 75.0% specificity to predict low risk.

Conclusions

Both two- and three-dimensional echocardiography detected RVLS had the potential to evaluate disease severity of pre-capillary PH patients, but the former may have a better predictive capacity.
P4370Doppler echocardiography, RV Strain and 3D RV Imaging in diagnosis of Acute mountain sickness
Authors: Amuthan V , Ananth R V A , Thinlas T , Chosdol R , Rabgais L , Vivek R
Published: October 2019

Introduction

Right Ventricular (RV) strain and 3D RV ejection fraction sensitivity and specificity has made it a practical and reliable test to detect Acute mountain sickness. All previous studies have been done mainly using M Mode and 2D Echo. Hence it was conceived that 3D Echocardiography would be a better option. Regardless of the type of Acute Mountain Sickness (AMS), the echocardiographic evidence is always the same: Severe Pulmonary hypertension. The visual analysis of these abnormalities requires a trained operator. This operator-dependence has promoted the search for a semiautomatic method to reduce limitations of Echocardiography and improve test accuracy

Purpose

The purpose was to study AMS by 3D Echocardiography

Methods and results

Two dimensional echocardiography with RV strain analysis by speckle tracking echocardiography along with 3D RV ejection fraction was done in nine patients with AMS who were tourists on unplanned, unacclimatized assent to Pangong lake, situated near Leh-Ladakh in the Himalayas, approximately at the height of 4350 meters above sea level and six highlanders, living in Leh-Ladakh. Figure 1A shows the map of the Pangong Lake, B. Shows features of Acute Pulmonary Edema in the Chest X-ray from a patient with AMS, C. Shows the TAPSE (Tricuspid Annular Plane Systolic Excursion) D. Shows the Speckle tracking derived RV Free Wall strain (From a software made for LV) and E: Methodology to derive 3D RV Ejection Fraction. 3D Echocardiographic Equipment with LV strain (which was modified to derive RV Free wall strain) and 3D RV Ejection Fraction software was used for acquisition of images and offline analysis was done. TAPSE, FAC, RV Free wall strain and 3D RV EF were consistently lower in patients with AMS than in persons living in high altitude (High landers). TR peak gradient, RV EDV index, RV ESV index were elevated in AMS patients compared to High landers. Table 1.

Table 1 Age Sex M/F 3D RV EF% TAPSE (mm) FAC TRP E/e' RVFW Strain RV EDVI (ml/m2) RV ESVI (ml/m2) AMS (9) 40.2±2.3 5/4 36±3.2 16±1.7 38.2±2.7 49.2±7.6 5.4±1.2 14±1.9 55±3.7 35±2.4 High Landers (6) 53.6±3.7 5/1 45±2.3 20±2.7 46.9±4.7 26.52±6.7 7±1.7 28±2.2 52±4.1 29±2.8 RV: Right Ventricle; EF: Ejection Fraction; TAPSE: Tricuspid Annular Plane Systolic Excursion; FAC: Fractional Area Change; TRP: Tricuspid Regurgitation Peak gradient; E: Mitral E Velocity; e' Medial mitral Tissue doppler e velocity; FW: Free Wall; EDVI: End Diastolic Volume Index; ESV: End systolic volume index.

Figure 1

Conclusion

Strain or myocardial deformation analysis based on two-dimensional (2D) speckle tracking and 3D RV ejection fraction is feasible even in the remote altitudes apart from standard M Mode and Doppler measurements and allow accurate quantification in analysis of acute mountain sickness.
P4372Left atrial strain: a potential marker of early diastolic dysfunction in patients with Marfan syndrome
Authors: Garcia-Izquierdo Jaen E , Mingo Santos S , Torres Sanabria M , Monivas Palomero V , Moreno Casado S , Navarro Rico S , Martin Lopez C E , Martinez Lopez D , Mitroi C , Gonzalez Mirelis J , Cavero Gibanel M A , Forteza Gil A
Published: October 2019

Background/Introduction

Previous studies using conventional echocardiographic measurements have reported subclinical left diastolic dysfunction in patients with Marfan syndrome (MFS). Left atrial strain (LAS) has been shown to be an accurate predictor of left ventricular diastolic dysfunction. However, there is no evidence regarding the use of LAS in MFS.

Purpose

To assess feasibility of LAS and compare LAS derived measurements along with traditional diastolic parameters in MFS patients vs healthy controls.

Methods

46 MFS patients (normal LV ejection fraction, no previous cardiovascular surgery, no significant valvular regurgitation) vs. 20 healthy controls (age and sex-matched). We performed LAS analysis using 2D speckle-tracking (QLAB 10, Philips). LA strain was determined as the average value of the longitudinal deformation (7 segments) in the apical 4-chamber view (RR gating).

Results

LAS analysis was feasible in 40 MFS patients (87%). All participants had normal diastolic function according to current guidelines (ASE/EACVI 2016). MFS patients showed lower TDI e' velocities and higher average E/e' ratio, but still within normal range. Similarly, LVEF was normal but slightly reduced in MFS patients. LA strain and strain rate parameters during reservoir and conduit phase were significantly impaired in MFS patients compared to controls.

MFS vs controls MFS patients (n=40) Controls (n=20) p MFS patients (n=40) Controls (n=20) p Age 33.8±12.4 34.4±8.3 0.846 Septal e' (cm/s) 9.7±2.5 11.7±2.3 0.006 Male (%) 24 (60%) 12 (60%) 1.000 Average E/e' ratio 6.8±1.5 5.5±1.1 0.002 SBP (mmHg) 120.3±12.4 120.1±9.4 0.969 TR velocity (cm/s) 208.6±21.4 201.6±22.9 0.390 DBP (mmHg) 72.0±10.1 67.1±6.2 0.069 LAVi (ml/m2) 23.5±7.1 25.5±4.8 0.260 Aortic root (mm) 40.3±4.6 31.7±3.7 <0.001 LASr (%) 32.6±8.8 43.0±8.3 <0.001 LVEF (%) 60.9±5.6 64.2±4.2 0.022 LAScd (%) −20.1±8.0 −29.4±5.5 <0.001 E-wave (cm/s) 74.6±16.5 76.7±16.5 0.651 LASct (%) −12.8±6.1 −13.6±5.2 0.622 A-wave (cm/s) 55.2±10.9 52.0±12.8 0.327 LASRr 2.02±0.49 2.31±0.43 0.030 E/A ratio 1.4±0.4 1.5±0.4 0.287 LASRcd −2.22±0.61 −3.07±0.68 <0.001 Lateral e' (cm/s) 13.0±3.6 16.3±3.3 0.002 LASRct −2.24±0.90 −2.35±0.75 0.600 SBP: Systolic blood pressure. DBP: Diastolic blood pressure. LVEF: Left ventricular ejection fraction. LAVi: Left atrial volume index. LAS: Left atrial strain. LASR: Left atrial strain rate. (r): Reservoir. (cd): Conduit. (ct): Contraction.

Example of LA strain and strain rate

Conclusion

MFS patients showed a subtle impairment in diastolic function compared to controls. Although further evidence is needed, LAS derived parameters could be early markers of diastolic dysfunction in this group of patients.

Acknowledgement/Funding

Programa de Actividades de I+D de la Comunidad de Madrid
P4375Value of echocardiography to diagnose coronary arteries patterns in transposition of great arteries
Authors: Galoin Bertail C , Perouse De Montclos T , Bakloul M , Metton O , Mitchell J , Ninet J , Di Filippo S
Published: October 2019

The objective of this study was to evaluate the accuracy of echocardiographic to assess coronary arteries (CA) anatomy in transposition of the great arteries (TGA) and determine impact on outcomes.

Material and methods

Retrospective analysis of data in neonates diagnosed with TGA (isolated or associated with VSD). Preoperative echocardiographic (TTE) coronary artery pattern and surgical intraoperative reports (SURG) were compared. Mismatch between TTE and SURG, and its impact on perioperative outcome were assessed. Coronary patterns were classified in 4 groups: I= normal CA, II= CA with intramural course, III= CA loop, IV= CA loop and intramural segment.

Results

108 neonates who underwent arterial switch operation (ASO) for isolated TGA (67 cases) or TGA+VSD (41) were included in the study: 68 ranged in group I, 7 in group II, 32 in group III and 1 in group IV. Five patients died (4.6%), from coronary cause in 3. Survival rates were 96% at 1-month and 95.2% beyond. Intraoperative complications occurred in 10 cases. TTE and SURG CA diagnosis differed in 19 cases = 17.6% (mismatch). Diagnosis of CA anatomy differed in 4.4%, 42.8%, 37.5% and 100% of respectively groups I, II, III and IV. Mortality was 28.6% in group II (intramural CA) compared to 2.9% in group I, 3.1% in group III and 0% in group IV (p=0.002). Death rates was 15.8% if TTE/SURG mismatch and 2.2% if TTE and SURG were concordant (p=0.0108). Mortality in group II (intramural CA) increased up to 50% in case of mismach TTE/SURG versus 0% if concordance, and was similar in the other groups. Survival rates were 84.2% in TTE misdiagnosed CA anomalies compared to 97.6% if TTE assessment correlated with surgical reports. By multivariate analysis, groups II and III coronary anatomy were risk factors for mismatch between TTE and SURG (respectively p=0.008 and p=0.0005), and mismatch TTE/SURG was the only risk factor for perioperative mortality (p=0.045).

Conclusion

Echocardiography can accurately assess coronary artery anatomy in neonates with TGA. Intramural coronary course is often misdiagnosed. Missed diagnosis of coronary artery anomaly preoperatively may impact on perioperative mortality.
P4384Noninvasive and novel method to evaluate left ventricular contractility using pressure-volume loop area obtained by 3-dimensional speckle tracking echocardiography
Authors: Yoshizane T , Tanaka R , Kawasaki M , Otsuka M , Shoji T , Nagaya M , Hattori K , Yagasaki H , Minatoguchi S , Ono K , Murata I , Deguchi T , Arai M , Noda T , Okura H
Published: October 2019

Introduction

Left ventricular (LV) pressure-volume (P-V) loop area reflects stroke work (SW), but clinical use of this index is limited by the need of invasive pressure measurement. A noninvasive method to obtain LV pressure-strain loop was recently introduced to assess myocardial work (MW). The minimum LV diastolic pressure (mLVP) was reported to have a strong correlation with Tau and we reported that Tau was noninvasively evaluated by speckle tracking echocardiography (STE).

Purpose

We sought to evaluate the impact of preload change by leg lifts on LV SW noninvasively obtained by the novel method and to examine the utility to assess LV contractility by SW and end-diastolic (ED) volume relation (SW-VED).

Methods

Thirty six controls (age 71±10) and 30 patients with heart failure with reduced ejection fraction (EF) <50% (HF) (age 73±6) were enrolled. LV pressure in a cardiac cycle was estimated using systolic blood pressure (SBP), minimum diastolic pressure (mDP) and ED pressure (EDP) by utilizing the profile of an empiric, normalized reference curve. The mDP and EDP were estimated as (Tau − 33.7)/2.06 and as 12.3 − 10.1 x Log (left atrial active emptying function/minimum volume) as we reported. LVSW was obtained by P-V loop by the combination of these pressures and LV volume using 3-D STE.

Results

LVEF and longitudinal strain in HF before leg up by 3D-STE were lower compared to normal (LVEF; normal: 58±5 vs HF: 39±10*% and strain; −12±3 vs −8±3%*, *p<0.05 vs normal). LVEF was increased after leg up by 7±6% in normal and by 8±8% in HF associated with increased LVED volume (normal: 84±24 to 90±24 and HF: 124±36* to 136±42*ml). LV MW and SW in HF before leg up were lower compared to normal (MW: 1790±412 vs 1002±432*mmHg% and SW: 3946±1682 vs 3352±1026mmHgml). LV SW increased after leg up by 26±19% in normal and by 25±20% in HF. LV SW-VED in normal was greater than HF (241±151 vs 90±54*).

Conclusion

LV SW noninvasively obtained by P-V loop area was increased after leg up in both normal and HF but SW-VED in HF was smaller than normal, indicating reduced contractility in HF. This noninvasive method may be a new echocardiographic approach for quantification of LV SW and contractility.
P4386Prognostic value of pressure-strain curve analysis by echocardiography for cardiac death in patients with congestive heart failure
Authors: Manno T , Shimizu M , Ohomri M , Taomoto Y , Kaneda T , Yamakami Y , Iiya M , Shimada H , Isshiki A , Kimura S , Fujii H , Suzuki M , Hirao K
Published: October 2019

Background

Pressure-strain curve analysis (PS-curve) is novel method of echocardiographic evaluation for left ventricular (LV) systolic myocardial work including the effect of blood pressure. However, the prognostic value of PS-curve for prospective cardiac death in patients with congestive heart failure (CHF).

Purpose

To elucidate the prognostic value of PS-curve analysis for cardiac death in patients with CHF.

Methods

We enrolled 63 consecutive sinus-rhythm patients with CHF admission who were evaluated by PS-curve analysis before discharge (76.0±13.3 years, 39 males). Endpoint was set as all cardiac death.

Results

Observation period was median 327 days [25%: 91, 75%: 656 days], and the longest period was 1004 days. Five patients died for cardiac causes. Multivariate Cox regression analysis (stepwise regression) revealed diastolic blood pressure (BP) and global constructive work (GCW) were independent predictors (Hazard ratio: 0.854, 0.996, P value: 0.016, 0.019, respectively). ROC curve analysis demonstrated GCW ≤601 had high diagnostic performance for cardiac death (specificity 0.891, sensitivity 0.800, area under ROC 0.824). Kaplan-Meyer curve analysis indicated the group with GCW ≤601 was worse cardiac prognosis (Logrank P<0.001).

Cox Hazard Regression Analysis Univariate Multivariate (stepwise regression) Hazard Ratio 95% CI P Hazard Ratio 95% CI P BP systole (mmHg) 0.915 0.85–0.99 0.026 BP diastole (mmHg) 0.915 0.84–0.99 0.043 0.854 0.75–0.97 0.016 LVDd (mm) 1.064 1.01–1.12 0.025 NA LVDs (mm) 1.066 1.01–1.12 0.016 LVEF (%) 0.963 0.91–1.02 0.221 LAD (mm) 1.197 1.06–1.36 0.005 GWE 0.937 0.88–0.99 0.041 GWI 0.998 0.99–0.99 0.041 NA GCW 0.998 0.99–0.99 0.037 0.996 0.99–0.99 0.019 GWW 0.996 0.98–1.01 0.502 Considering multicollinearity, we excluded GWI and LVDd (correlation coefficient: GWI and GCW = 0.979, LVDd and LVDs = 0.942).

Conclusion

Pressure-strain curve analysis had powerful predictive value for cardiac death in patients with CHF.
P4390Sex-specific association between secondhand smoke exposure and metabolic syndrome in 118,609 Korean never-smokers verified by both self-reported questionnaire and cotinine
Authors: Kim B J , Kim J H , Kim B S , Kang J H
Published: October 2019

Background

No study has reported the relationship between secondhand smoke (SHS) exposure and metabolic syndrome (MetS) in self-reported never-smokers verified by nicotine metabolite.

Purpose

The aim of this study is to determine the relationship between SHS exposure and MetS in self-reported and cotinine-verified never-smokers.

Methods

A total of 118,609 self-reported and cotinine-verified never-smokers (38,385 men; age 34.8±7.1 years) who participated in Kangbuk Samsung Health Study (KSHS) and Kangbuk Samsung Cohort study (KSCS) between 2011 and 2016 were included. Cotinine-verified never-smoker was defined as individuals having urinary cotinine <50 ng/mL. SHS exposure was defined as having experienced passive smoking indoors at home or the workplace.

Results

The prevalence of SHS exposure in the overall population was 22.6%, with rates of 27.4% for males and 20.3% for females (p<0.001). The overall prevalence of MetS was 6.8%; the prevalence in males was higher than that in females (10.7% versus 4.9%, p<0.001). In both males and females, the prevalence of MetS in group with SHS exposure was higher than that in group without SHS exposure (11.3% versus 10.4%, p=0.010 for males; 5.8% versus 4.6%, p<0.001 for females). However, there was significant gender interaction for the relationships between SHS exposure and MetS (p for interaction=0.010). A multivariate regression model was adjusted for the baseline variables including age, body mass index, frequency of alcohol drinking and vigorous exercise, blood urea nitrogen, creatinine, uric acid, total cholesterol, LDL cholesterol, and hsCRP. The results showed that SHS exposure only in females was associated with MetS (odds ratio [95% confidence interval], 1.17 [1.06, 1.29] for females; 1.02 [0.94, 1.11] for males). In particular, females with SHS exposure of ≥1 hours/day, ≥3 times/week, and ≥10 years increased the prevalence of MetS compared to those without SHS exposure (1.21 [1.02, 1.45], 1.30 [1.14, 1.49], and 1.12 [0.99, 1.28], respectively.

Conclusions

This study showed that the SHS exposure in females was significantly associated with MetS in self-reported never-smokers with low urinary cotinine levels (<50 ng/mL), suggesting that more active anti-smoking programs in the home and public are needed to reduce the risk of MetS.
P4392A systematic review and meta-analysis of the cardiovascular effects of e-cigarette
Authors: Antonopoulos A S , Skotsimara G , Oikonomou E , Ioakeimidis N , Mistakidi C V , Georgakopoulos C , Galiatsatos N , Charalampous G , Vlachopoulos C , Tousoulis D
Published: October 2019

Background

Electronic cigarette (EC) is marketed as a safe alternative to tobacco smoking, but EC cardiovascular effects remains largely unknown.

Purpose

To systematically review and meta-analyse published literature to investigate the cardiovascular effects and associated risk from EC use.

Methods

We searched PubMed from January 2000 until November 2017 for published studies assessing the cardiovascular effects of EC. For each eligible study we used the mean difference (MD) with 95% confidence intervals (CIs) for SBP, DBP and HR. The pooled MDs for each outcome of interest were calculated by using a fixed effects model. The presence of heterogeneity among studies was evaluated by the I2 statistic.

Results

We report conflicting evidence on the effects of EC on heart rate and blood pressure, which is mainly based on non-randomized clinical studies of moderate quality. In a meta-analysis of 14 studies (n=441 participants), that despite the negative effects of EC on heart rate (pooled MD=2.27, 95% CI: 1.64 to 2.89, p<0.001), diastolic (DBP, pooled MD=2.01mmHg, 95% CI: 0.62 to 3.39, p=0.004) and systolic blood pressure (SBP, pooled MD=2.02mmHg, 95% CI: 0.07 to 3.97, p=0.042), benefits may be observed in terms of blood pressure regulation when switching from tobacco smoking to EC (SBP pooled MD=−7.00, 95% CI: −9.63 to −4.37, p<0.001; DBP pooled MD=−3.65, 95% CI: −5.71 to −1.59, p=0.001). Evidence suggests that EC negatively affects endothelial function, arterial stiffness and the long-term risk for coronary events, but these findings are derived from single study reports and have not been confirmed in additional studies.

Conclusions

We report adverse effects of EC use on heart rate and blood pressure. Unless supported by stronger evidence, EC should not be labelled as cardiovascular safe products. Future studies should delineate whether EC use is less hazardous to cardiovascular health than conventional cigarette smoking.
P4395Arterial hypertension and anxiety level in Bukovinian region of Ukraine: obvious problem, which we ignore
Authors: Shorikova D , Shorikov E , Shorikov P
Published: October 2019

The hypothesis that symptoms of anxiety and depression contribute to the development of arterial hypertension (AH) has been controversial. Mermerelis A. (2016) in pilot study found the association of anxiety disoders with resistant hypertension. Since 2013 social-and-psychological situation, which had developed in Ukraine after beginning of military conflict on the East of the country, has led to the destruction of public consciousness and vital orientation of millions people. Psychoemotional overstrain and psychic disadaptation induced the increasing of level cardiovascular diseases (CVD). But till now, the psychological factor we don't include in the management of hypertensive patient.

Materials and methods

The prospective study included 596 patients (375 women and 220 men), treated with arterial hypertension in University Clinic, Military Hospital and Cardiological Ambulance of Bukovinian Region. The exclusion criterias were concominant CVD and other somatical diseases in decompensation. Also we didn't include patients with psychiatry disoders. For psychometric screening hospital anxiety and depression scale HADS-A and HADS-D was used. Considering that the data obtained are characterized by asymptomatic normal distribution the Mantel-Henzel factor of disagreement or odds ratio were used.

Results

The study under the scheme “case-control” showed that in women OR index stresses significant interrelation of anxiety and level of blood pressure (BP).

Thus, the subclinical anxiety at AH 1 degree was according to OR = 1.6 [CI95% - 0.96–2.54). This shows possible association of anxiety and AH at the lower border of the confidential interval. At resistance AH - OR was 3.26 [CI95% - 1.78–5.92], p<0.001. Clinical anxiety is associated with AH due to the index OR in the form of linear dependence, “p” is of high degree of reliability.

In men subclinical anxiety is also associated with AH, however “p” value shows reliability only in an estimation of resistance AH at OR 3.45 [CI95% - 1.33–9.57].

The most significant association, both subclinical and clinical anxiety, was noticed at resistance AH both in women 3.1 [CI95% - 1.17–5.2] and men 4.8 [CI95% - 1.93–12.3].

Estimating the value of the relation of chances by association of anxiety and degree of AH in women, it is possible to notice complete comorbidity of anxiety level and arterial hypertension irrespective of their forms and degree. In men association of anxiety level and various clinical degrees of arterial hypertension has its own features, reaching maximum in patients with AH 3 degree and resistance AH.

Conclusions

In both women and men clinical form of anxiety often associated with AH 3 degree and resistance AH, so it is necessary to introduce the parameter of the presence of anxiety-depressive syndrome in patients with AH in subclinical and clinical forms.
P4398Potentially modifiable clinical and psychosocial factors associated with recurrent cardiovascular events in an outpatient coronary population
Authors: Sverre E , Peersen K , Weedon-Fekjar H , Perk J , Gjertsen E , Husebye E , Otterstad J E , Gullestad L , Dammen T , Munkhaugen J
Published: October 2019

Background

Regular assessment and management of lifestyle, biological and psychosocial factors are recommended in coronary patients. The relative importance of these factors on risk of recurrent cardiovascular (CV) events in the outpatient coronary population is not well known.

Purpose

To estimate the relative effect of potentially modifiable risk factors on recurrent CV events in coronary patients from routine clinical practice.

Methods

A prospective cohort multicenter study from Norway included 1127 (21% women, 83% participation rate) consecutive patients aged 18–80 years 2–36 (mean 16) months after myocardial infarction and/or a coronary revascularization procedure. Thirty percent had at least one coronary event prior to the index event. The primary composite endpoint of recurrent major adverse CV events (MACE): myocardial infarction, revascularization, stroke, heart failure or cardiovascular death was obtained from the hospital records. Cox proportional hazard models stratified for 1 vs. 2+ previous coronary events were performed with model 1 adjusting for age and model 2 with add-on for coronary risk factors and CV comorbidity.

Results

At baseline 99% used platelet inhibition, 93% were taking antihypertensive agents and statins, and 45% had participated in cardiac rehabilitation (CR). During follow-up of mean 4.2 (SD 0.3) years, a total of 355 MACE occurred in 240 patients corresponding to a MACE risk of 31.5%. In model 1, smoking, insufficient physical activity, diabetes, not taking statin therapy, no participation in CR, peripheral artery disease (PAD), previous stroke, kidney failure and higher anxiety and depression scores were significantly associated with recurrent MACE (Table). In model 2, smoking, no physical activity, not taking statin, PAD, kidney failure, anxiety and depression remained significant.

Conclusions

Coronary patients in routine clinical practice were at significant risk of recurrent MACE, particularly in the presence of CV comorbidity. Not taking statin therapy, insufficient physical activity, smoking, anxiety and depression were the major potentially modifiable factors contributing to CV risk. Preventive efforts that target these factors are required to further reduce CV risk in the coronary population.

Acknowledgement/Funding

Grants from the Norwegian ExtraFoundation for Health and Rehabilitation and Vestre Viken Trust
P4399Low social support and risk of myocardial infarction in general population in Russia/Siberia: gender disparities. WHO epidemiological program MONICA-psychosocial study
Authors: Gafarov V , Gromova E , Panov D , Gagulin I , Gafarova A , Krymov E
Published: October 2019

Aim

To determine the gender differences in the effect of social support on risk of myocardial infarction (MI) in an open population 25–64 years in Russia/Siberia.

Methods

Under the third screening of WHO program MONICA-Psychosocial a random representative sample of both gender aged 25- 64 years in Novosibirsk was examined in 1994 (n=1346, males 48.8%, mean age 44,9±0,4 years). Indices of close contacts (ICC) and social relations (SNI) were evaluated at the baseline by Berkman-Syme test. New-onset MI incidences were identified over 16-years (1994–2010yy) of follow-up in the cohort.

Results

The prevalence of low ICC levels was higher in men compared to women (63.9% and 57.1%, respectively); the prevalence of low SNI levels was higher in women compared to men (77.7% and 43%, respectively). The risk of MI over 16 years of follow-up was 5.2-fold higher in men (95% CI 1.947–19.383; p<0.05) and4.9-fold higher in women (1.108–21.762; p<0.05) with low ICC. Low SNI increases risk of MI in 3.1 times in men (1.138–9.247; p<0.05) and in 2.9 times in women (95% CI 1.040–8.208; p<0.05). After adjustment for social variables multivariate model showed significant results in higher risk of MI in those males who are living alone with manual occupational status and in women with low educational degree.

Conclusions

Social support is a protective factor for MI incidence both in men and women. Better social gradient improves this influence. Family status and occupation are stronger to be attributable to risk in males while level of degree in females with low social support.
P4403Sleep quality is associated with visit-to-visit blood pressure variability in elderly people
Authors: Sasaki N , Ozono R , Maeda R , Kihara Y
Published: October 2019

Background

The proportion of people suffering from poor sleep quality increases with age. Several studies reported that poor sleep quality is involved in elevation of blood pressure (BP) level and the development of hypertension. However, it is unclear whether sleep quality is associated with visit-to-visit BP variability, which is related to the incident cardiovascular disease independent of mean BP.

Purpose

In this study, we investigated the association between sleep quality and visit-to-visit BP variability in elderly people.

Methods

This is an observational study involving 3313 participants without atrial fibrillation, aged 68 years or older, who underwent assessment of sleep quality at general health examination between October 2014 and September 2015, and had more than four visits during the first 3 years following the assessment. Of these, 1951 participants (59%) had hypertension, 488 (17%) had diabetes, 432 (13%) had dyslipidemia, and 333 (10%) were on treatment for, or with a history of, cardiac disease. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), which yields seven component scores (0, 1, 2, or 3 is given for each component). A sum of the seven scores was used to calculate the global PSQI score which ranged from 0 to 21. Higher scores indicated poorer sleep quality. Visit-to-visit BP variability for each individual was evaluated by coefficient of variation (CV, defined as standard deviation/mean).

Results

The mean global PSQI score was 5.2±3.2. The mean CV of SBP and CV of DBP was 6.9±3.0, and 8.0±3.5, respectively. The global PSQI score was significantly associated with CV of SBP (ρ= 0.039, P=0.025), and CV of DBP (ρ= 0.039, P=0.024) in Spearman's rank correlation coefficient test. Multiple regression analyses showed that the global PSQI score was a significant contributor to CV of SBP, and CV of DBP, after adjusting for variables with P values <0.1 in Spearman's test (Table).

Table 1. Multiple regression analysis for blood pressure variability (n=3313) Variables CV of SBP CV of DBP β P β P Age 0.131 <0.001 0.140 <0.001 Female −0.017 0.338 0.023 0.186 Hypertension 0.037 0.032 0.031 0.073 Cardiac disease 0.045 0.009 0.038 0.030 Global PSQI score 0.035 0.042 0.047 0.007

Conclusion

Sleep quality is associated with visit-to-visit BP variability in elderly people.
P4419The association between ECG voltage and left-ventricular mass, sex, body size and the distance between the heart and chest wall in college athletes
Authors: Hedman K , Moneghetti K J , Hsu D , Christle J W , Haddad F , Froelicher V F
Published: October 2019

Background

The ECG is widely used in pre-participation evaluation (PPE) of athletes (ATH). While it is assumed that greater than normal QRS voltages reflect physiologically increased left ventricular mass (LVM), this has not been adequately demonstrated in ATH.

Purpose

To examine the relation between QRS voltage on surface ECG and LVM and explore if the distance from the chest wall to mid-LV (CWLVdis) affects QRS voltage in ATH.

Methods

We examined digitized ECG data and echocardiograms in college ATH, obtained as part of routine PPE in years 2010–16. ECG parameters included R and S-wave voltage components of the Sokolow-Lyon (S-L) and Cornell criteria for LV hypertrophy (i.e. SV1 + RV5-V6 and RaVL + SV3, respectively). Transthoracic 2D echocardiography was used to determine LVM (area-length method) and the CWLVdis (detailed in Fig1A). S-L positive (SV1 + RV5-V6 >35 mV or RaVL >11 mV) ATH were compared to S-L negative by t-test, and univariate correlation and multivariable regression analysis was used to explore independent effects of body characteristics, sex, LVM and CWLVdis on QRS voltage.

Results

Included were 227 ATH (age 18.6±0.7 yr; 85% male; 60%/33% Caucasian/Afro-american). Of these, 66% played American football, 18% volleyball and 16% basketball.

Overall, mean LVM was 174±37 g (range 96–284 g), and BSA-indexed LVM was 78±12 g/m2 (range 49–108 g/m2). Mean CWLVdis was 8.5±1.1 cm (range 5.6–11.3 cm) and was greater in males (p<0.001, Fig1B).

Forty-six ATH (24%, all male) were S-L positive and no ATH were positive according to Cornell criteria. S-L positive ATH had lower BMI (25.3±3.5 vs 26.9±4.9, p=0.012), greater absolute LVM (189.1±31.3 vs. 170.1±37.4 g, p=0.002) and greater BSA-indexed LVM (85.3±10.3 vs. 76.6±11.7 g/m2, p<0.001) than S-L negative ATH. The CWLVdis was similar between S-L positive and negative ATH (8.4±1.2 vs. 8.6±1.1, respectively, p=0.213).

CWLVdis was more strongly correlated to body mass (r=0.73, p<0.001, Fig. 1C) than to height (r=0.34, p<0.001). LVM correlated weakly to ECG voltage as combined in the S-L or Cornell criteria (Fig. 1C). CWLVdis was weakly correlated with R in aVL, V5 and V6 (r=0.21, 0.16 and 0.16, all p<0.02).

In multivariate analysis, male sex (β=0.31), LVM (β=0.45) and body mass index (β=-0.37) were independently associated with the S-L summed voltage (R2 0.26, p<0.001). For Cornell summed voltage, only sex was an independent predictor (β=0.48, R2 0.22, p<001).

Figure 1

Conclusion

The R and S wave ECG amplitudes used in the two most common ECG criteria for LV hypertrophy were weakly related in the highest to lowest order to sex, LVM, body size and the distance from the LV to the chest wall in our college ATH.
P4421Increased circulating levels of VCAM-1 correlate with left atrial remodeling in highly trained athletes
Authors: Gabrielli L , Garcia L , Fernandez R , Vega J , Ocaranza M P , Contreras F , Salinas M , Chiong M , Jalil J , Munoz M , Yanez F , Lavandero S , Castro P , Sitges M
Published: October 2019

Introduction

Reports have shown increased risk of atrial fibrillation (AF) in athletes. Vascular cell adhesion molecule-1 (VCAM1) is associated with new onset AF in general population. VCAM1 and its relation with left atrial (LA) remodeling have not been investigated in athletes.

Purpose

To study VCAM1 and LA remodeling in marathon runners.

Methods

Study of 36 male marathon runners in the training period previous to race (42 km) and 18 sedentary controls with no risk factors. Athletes were divided in two groups according to highest training intensity reached (group 1, >100 km/week; group 2, 50–100 km/week). Previous to race in all subjects, VCAM1 serum levels were measured by ELISA and an echocardiogram was performed. In athletes, VCAM1 was measured immediately post-race. Wilcoxon and Spearman were used.

Results

See table. Group 1 showed a significant increment in VCAM1 post-race (651±350 to 905±373 ng/mL; p=0.002) as compared to group 2 with no increment (533±133 to 651±138 ng/mL; p=0.117). In athletes, a moderate correlation between LA volume and VCAM1 was found (rho: 0.483; p=0.007).

Baseline characteristics Group 1 (n=18) Group 2 (n=18) Controls (n=18) p value Age (years) 37±6 38±5 36±4 0.373 Heart rate (bpm) 53±8 57±7 69±6 * 0.001 Body surface area (m2) 1.8±0.1 1.8±0.1 1.9±0.1 0.075 LV diastolic diameter (mm) 49±5 48±5 46±4 0.404 LV systolic diameter (mm) 29±5 30±5 30±4 0.879 Septal wall (mm) 9.1±1.2† 8.2±1.1 8.1±0.8 0.005 Posterior wall (mm) 9.3±2.1† 8.5±1.2 7.6±0.8 0.001 Ejection fraction (%) 55±3 55±6 57±4 0.110 LV mass index (g/m2) 106±27† 78±18 58±11 0.001 LA volume (mL/m2) 42±8† 30±11 25±9 0.001 E wave (cm/sec) 78±13 84±12 77±15 0.217 A wave (cm/sec) 50±12 53±10 48±16 0.438 DT (msec) 233±65 229±65 221±66 0.184 VCAM1 (ng/mL) 651±350† 533±133 440±98 0.022 Mean ± SD. *p<0.05 vs group 1 and 2 post Kruskall-Wallis; †p<0.05 vs other groups post Kruskall-Wallis. LV, left ventricle; LA, left atrium; DT, deceleration time.

Conclusions

Most trained athletes had increased levels of VCAM1 as compared to controls and less trained athletes. They also showed an increment post-effort. VCAM1 is related to LA remodeling in athletes. VCAM1 could be a potential biomarker of AF in athletes which should be confirmed.

Acknowledgement/Funding

FONDECYT 1170963 (LG); FONDAP 15130011 (LG,SL)
P4424Detailed characterization of atrial remodeling induced by exercise training in a rodent model of exercise-induced cardiac hypertrophy
Authors: Olah A , Urban E , Barta B A , Sayour A A , Ruppert M , Virag-Tulassay E , Merkely B , Radovits T
Published: October 2019

Introduction

Atrial fibrillation and heart failure share common risk factors and frequently coexist as atrial fibrillation leads to impaired myocardial function. Although regular exercise training is associated with cardiovascular benefits, the increased risk of atrial arrhythmias has been observed, with differences regarding prevalence between genders. While multiple mechanisms are likely, the atrial alterations induced by long-term physical exercise still need to be elucidated.

Purpose

We aimed at investigating exercise-induced atrial remodeling in a rat model of athlete's heart and determining sex-specific differences.

Methods

Age-matched young adult rats were divided into female exercised (FEx), female control (FCo), male exercised (MEx) and male control (MCo) groups. After exercised animals completed a 12-week-long swim training protocol, echocardiography was used to describe atrial alterations. In vivo electrophysiologic investigation was performed by programmed stimulation with an octapolar catheter inserted into the right atrium and atrial gene expression analysis was carried out.

Results

Post-mortem atrial weight data revealed marked atrial hypertrophy (atrial weight to tibial length: 18.6±2.7g/cm FEx, 10.3±1.0g/cm FCo, 23.7±2.2g/cm MEx, 15.8±1.9g/cm MCo pex<0.01), while echocardiography data showed slight atrial dilatation and improved contraction in both exercised groups. Exercise training was associated with bradycardia, P-wave enlargement and prolonged right atrial effective refractory period (RAERP: 45.7±4.3ms FEx, 40.2±5.9ms, FCo, 49.8±4.2ms MEx, 43.1±4.6ms MCo pex<0.01). Sinus node recovery time (SNRT) did not differ between groups and we could not induce significant number of arrhytmias by programmed stimulation (double extrastimulation, burst pacing) in any groups. We found increased atrial gene expression of antioxidant enzymes (e.g. NADPH oxidase 2, superoxide dismutase 2) in both genders. Despite the marked atrial hypertrophy, no gene expression alteration was found regarding markers that describe pathological remodeling (atrial natriuretic factor), proinflammatoric (tumor necrosis factor-α) and profibrotic [e.g. transforming growth factor-β (TGF-β), matrix metalloproteinase-2 (MMP-2)] processes. While exercise training did not affect on the expression of profibrotic markers, female gender was associated with lower TGF-β and MMP-2 expression. We found altered expression of ion channels participating in atrial depolarization and repolarization.

Conclusions

Our data suggests that long-term exercise-induced atrial hypertrophy is not associated with harmful electrical remodeling and no inflammatory or profibrotic response was observed in the atrium of exercised rats.

Acknowledgement/Funding

NKFIH (K 120277), ÚNKP-17-4 (to A.O.), STIA-KF-17 (to A.O.)
P4433Equal cardiovascular risk in patients with diabetes mellitus versus rheumatoid arthritis?
Authors: Loegstrup B B , Ellingsen T , Pedersen A B , Darvalics B , Botker H E , Maeng M
Published: October 2019

Purpose

To examine whether the risk of cardiovascular disease (heart failure (HF), ischemic heart disease (IHD), myocardial infarction (MI), and coronary revascularization) in patients with rheumatoid arthritis (RA) is comparable to the risk in patients with diabetes mellitus (DM) and general population.

Methods

The study included the entire Danish population encompassing about 5.7 million inhabitants. Through individual record linkage of nationwide administrative health registries, the authors identified subjects who developed RA and DM and compared these to a matched general population. The cohorts were followed from 1 January 1995 until December 2016.

Results

The study population consisted of a cohort of 15,491 RA patients, 309,698 DM patients, and a general population cohort of 77,455 subjects matched by age, sex, and year of diagnosis with the RA cohort.

Cumulative incidence for HF, IHD, MI, PCI (percutaneous coronary intervention) and CABG (coronary artery bypass grafting) are shown in figure 1.

The adjusted hazard ratio (HR) for diagnosis of HF within the 10-year observational period for RA (1.46; 95% CI 1.34–1.59) and DM (1.86; 95% CI 1.78–1.95) were increased compared to the general population. Comparing the risk of HF within the follow-up period a 21% relative risk (HR 0.79, 95% CI 0.73–0.85) reduction of HF in RA compared to DM patients was observed.

The HR for IHD development during the follow-up period for RA (1.36; 95% CI 1.25–1.48) and DM (1.64; 95% CI 1.58–1.72) were increased compared to control group. Comparing the risk of IHD within the follow-up period a 17% relative risk (HR 0.83, 95% CI 0.77–0.89) reduction for IHD development in RA compared to DM patients. The HR for MI was increased both in RA (1.48; 95% CI 1.34–1.63) and DM (1.57; 95% CI 1.49–1.65) compared to the control group, without any statistical difference within RA and DM. According to the coronary revascularization, comparable increased numbers of PCI were observed in RA (1.37; 95% CI 1.22–1.54) and DM (1.50; 95% CI 1.41–1.59) patients compared to control subjects. Interestingly, the HR of coronary by-pass grafting (CABG) for RA (1.20; 95% CI 0.98–1.49) and DM (1.99; 95% CI 1.80–2.19) resulting in an adjusted 39% relative risk (0.61 95% CI 0.50–0.74) reduction for CABG in RA compared to DM patients.

Figure 1

Conclusions

Patients with RA are at increased risk of cardiovascular disease when compared to the general population although slightly lower than observed among patients with DM. Revascularization with CABG was only increased among DM patients, which likely reflects physician compliance to guidelines recommending CABG in case of multivessel disease among DM patients. Patients with RA should be considered for prophylactic strategies in the same way as recommended for patients with DM.
P4436Impaired myocardial healing in patients with diabetes after ST-Elevation Myocardial Infarction
Authors: Wamil M , Borlotti A , Banerjee A , Gaughran L , De Maria G L , Banning A P , Kharbanda R , Choudhury R P , Channon K M
Published: October 2019

Background

Diabetes mellitus (DM) significantly increases mortality following myocardial infarction (MI). The underlying mechanism explaining this adverse prognosis is not completely understood.

Purpose

This study sought to investigate the characteristics of myocardial healing after MI in DM patients.

Methods

62 recruited ST-elevation myocardial infarction (STEMI) patients (21 with DM and 41 controls) underwent acute (1–3 days post-STEMI) and 6 months (6M) follow-up cardiac magnetic resonance scans (CMR). Control cases were matched for the peak troponin levels and area at risk on the acute CMR scans. Blood samples were obtained 6, 24, 48 hours and 6 months after STEMI.

Results

Despite similar severity of the initial ischaemic injury, DM patients had lower myocardial salvage index (MSI) and as a result larger final infarct size at 6 months. Further segment-based analysis of the acute CMR scans showed significantly prolonged T1-mapping values in all segments including non-ischaemic myocardium in DM patients and poorer recovery of the late gadolinium enhancement (LGE) of the infarcted segments in that group. Additionally, DM patients had higher monocyte counts 24 hours post-MI (1.2±0.4x109/μl DM vs 0.88±0.3 x109/μl control, p=0.001). We found that HbA1C correlated with monocyte count measured 24 hours after STEMI (r=0.577, p=0.006, n=21). HbA1C also predicted myocardial salvage index (MSI) at 6M post STEMI in the DM patients (r=0.891, p=0.017, n=13).

Conclusions

DM patients presenting with STEMI have increased peripheral blood monocytosis and larger final infarct size compared with STEMI patients without DM. Poorly controlled DM predisposes to adverse cardiac remodelling after STEMI.

Acknowledgement/Funding

OHSRC Research Grant, National Institute for Health Research (NIHR), British Heart Foundation Centre of Excellence Oxford