bluuebunny/crossref_metadata_2025 huggingface dataset:
Immediate & medium-term results of balloon dilatation in native coarctation of aorta: a reasonable initial management strategy
Authors: Singal A K , Ramakrishnan S , Kothari S S , Shivdas S , Gupta K , Gupta S K , Sharma S K , Saxena A
Published: October 2021

Background

Coarctation of aorta (CoA) accounts for 5–10% of all congenital heart defects. Despite >20 years of experience with balloon dilatation (BD) as an effective therapy, initial choice of procedure still remains controversial.

Purpose

This study was planned to identify the predictors of success of BD in native CoA and to evaluate immediate & medium-term outcomes of the same.

Methods

This is a retrospective analysis of all BDs done over five years in a tertiary care centre. Success was defined as residual gradient ≤20 mmHg in the absence of a serious or life-threatening complication. In view of the high pre-dilatation gradient in many patients, a strict cut-off of 20 mmHg was not considered to be clinically feasible. Clinically acceptable outcome was thus defined as reduction of gradient to ≤20 mmHg or by ≥50% of baseline, to a final value ≤30 mmHg, in the absence of a serious or life-threatening complication. Repeat intervention on follow-up was considered in patients satisfying any of these criteria: symptoms attributed to CoA, significant residual gradient (>20 mmHg) with diastolic spill on echo, LV dysfunction, or refractory hypertension.

Results

Of the 111 cases analysed, 85 (76.5%) were male. The mean age was 11.79±12.64 years (1 month to 57 years). Bicuspid aortic valve was the most common associated anomaly, present in 42 (38%) patients. The mean gradient fell from 53.15±22.37 mmHg to 14.83±12.24 mmHg. Overall, the procedure was successful in 83 (74.8%) patients, and clinically acceptable outcome was obtained in 97 (87.4%) patients. Success rate and clinically acceptable outcome rate in the <18 years group was 80.7% (67/83) and 92.7% (77/83) respectively. Complications were seen in 9 (8.1%) cases. There was no mortality associated with the procedure. Ascending aortic pressure ≥150 mmHg [OR 27.94; 95% CI 1.30–598.84; p<0.001], and balloon to isthmus ratio <1 [OR 9.70; 95% CI 2.18–43.02; p<0.001] were significant negative predictors for success. At median follow-up of 43.5 months, reintervention free survival rate was 79.5% (62/78) in the overall group, and 81.5% (53/65) in the <18 years age group; with most of the repeat interventions being required within the first-year of the index procedure (14/16, 87.5%).

Conclusion

Immediate and medium-term success rates of BD in CoA are acceptable in majority of children and adolescents. High ascending aorta pressure and inadequate balloon size are important negative predictors of successful dilatation. Considering the economic advantages and reasonable success, balloon dilatation alone can be considered as a first line management option for native coarctation of aorta.

Funding Acknowledgement

Type of funding sources: None.
Heart failure hospitalization in adult patients with congenital heart disease: risk factors for repeated admissions
Authors: Scherrenberg H , De Meester P , Troost E , Santens B , Moons P , Budts W , Van De Bruaene A
Published: October 2021

Background

Heart failure hospitalizations in adult patients with congenital heart disease (ACHD) are increasing and are associated with higher healthcare-related costs. We aimed to evaluate factors that are associated with repeated heart failure hospitalizations and whether heart failure hospitalizations are related to adverse outcome in ACHD patients with heart failure (ACHD-HF).

Methods

Out of 3995 patients under active follow-up in our institution (last visit >2010), 256 patients (mean age 49.5±16.7 years) had ACHD-HF and were included in the study. Medical records were reviewed, including heart failure hospitalization prior and after study inclusion. A combined endpoint of death, ventricular assist device and transplantation was defined.

Results

Overall, 136 ACHD-HF patients (53%) had a prior heart failure hospitalization. Over a mean follow-up of 2.5±2.3 years, 44 patients (17%) had repeated heart failure hospitalizations. Of these, 31 patients (12%) had 1; 9 patients (4%) 2 and 4 patients (2%) 3 repeated heart failure hospitalizations. Patients with repeated heart failure hospitalizations had higher NYHA class (p=0.031), were more likely to have end-organ dysfunction (p=0.025) and more likely to have a prior heart failure hospitalization (p<0.001). In multivariable Cox regression analysis, only end-organ dysfunction (HR 2.431 95% CI 1.516–43.896 p<0.001) was related to repeated hospitalization. Seventy patients (27%) reached the combined endpoint of death, VAD or transplantation (event-rate 11% per year). Repeated heart failure hospitalizations was not related to the combined endpoint in Cox regression analysis.

Conclusions

Heart failure hospitalizations are frequent in ACHD-HF. End-organ dysfunction appears to be a strong determinant of repeated heart failure hospitalizations. Event-rate is high in patients with ACHD-HF, but repeated heart failure hospitalizations were not related to outcome in this short-term follow-up study.

Funding Acknowledgement

Type of funding sources: None. Table 1.1Table 1.2
Early and long term prognostic accuracy of 4 acute pulmonary embolism mortality risk scores
Authors: Oliveira L , Duarte F , Barradas M I , Serena C , Fontes A , Almeida C , Machado C , Dourado R , Monteiro A , Santos E , Pelicano N , Pacheco A , Tavares A , Martins D
Published: October 2021

Background

Acute pulmonary embolism (PE) is a frequent condition associated with significant morbidity and mortality. Multiple scores have been developed and validated to predict 30-day mortality risk, however accurate prognostic assessment remains a challenge in clinical practice.

Purpose

To compare the performance of PESI, simplified PESI, Hestia and Bova scores in predicting in-hospital, 30-day and 1-year mortality risk for acute PE.

Methods

We retrospectively assessed consecutive patients from a single center registry who were hospitalized with acute PE between January 2017 and October 2020. Discriminative power of each score was assessed by receiver operating characteristic curve analysis. Charlson comorbidity index (CCI) was also assessed for comparison.

Results

A total of 131 patients with a mean age of 67.6±15.3 years were included with a mean follow-up of 46.3±17.7 months. Thirty-six patients (27.5%) had a recent hospitalization or major surgery and 26 (19.8%) a medical history of cancer. Besides anticoagulation, 7 patients (5.3%) underwent fibrinolysis. Overall in-hospital mortality was 8.4%, 30-day mortality 12.2% and 1-year mortality 19.8%. All acute PE scores, except Bova score, were significantly higher in those patients who died during hospitalization and on 30-day and 1-year follow-up. CCI was also higher in those patients. Discriminative power for in-hospital mortality was higher for PESI (c-statistic 0.84, 95% CI 0.74–0.93, p=0.002), followed by sPESI (c-statistic 0.77, 95% CI 0.65–0.90, p=0.010) and Hestia (c-statistic 0.77, 95% CI 0.61–0.92, p=0.011). The Bova score showed a poor discriminative power for prediction of in-hospital mortality (c-statistic 0.61, 95% CI 0.43–0.78, p=0.325). For 30-day and 1-year mortality PESI score still maintained the best performance with acceptable discriminative power (c-statistic 0.73, 95% CI 0.61–0.85, p=0.007 for 30-day mortality; c-statistic 0.80, 95% CI 0.71–0.89, p<0.0001 for 1-year mortality). However at longer follow-up CCI had a better performance to predict worse outcomes (c-statistic 0.79, 95% CI 0.65–0.92, p=0.001 for 30-day mortality; c-statistic 0.83, 95% CI 0.74–0.92, p<0.0001 for 1-year mortality).

Conclusions

All scores, except Bova score, showed overall good performance in stratifying mortality for acute PE, however PESI score performed better in this population particularly at shorter follow-up. At longer follow-up, although PESI score maintained an acceptable performance, comorbidities seem to play a bigger role. The different performance of multiple scores highlights the complexity of this condition.

Funding Acknowledgement

Type of funding sources: None. ROC curves for mortality risk scores
Predictors of mortality in patients with intermediate risk pulmonary embolism
Authors: Teterina M , Netylko J E , Shikib S A , Babaeva L A , Pisaryuk A S , Merai I , Kobalava Z H D
Published: October 2021

Introduction

Information about treatment and outcome of patients with pulmonary embolism (PE) intermediate risk remains limited. Little is known about the benefits of reperfusion therapy in patients with intermediate risk PE and evidence of right ventricular dysfunction.

Objective

To evaluate clinical outcomes and predictors of mortality in patients admitted to ICU with pulmonary embolism and intermediate risk.

Methods

In a prospective single-center study 103 normotensive patients with an established diagnosis of pulmonary embolism confirmed by pulmonary CT were included. All patients met intermediate risk criteria according to the European Society of Cardiology guidelines (ESC 2019) for pulmonary embolism using severity index [PESI] with signs of right ventricular dysfunction and elevated cardiac biomarkers.

The average age of patients was 67.6 years (95% CI, 65.1–70.5), 42 (41%) of them were men. Thrombolysis with standard dose of alteplase was performed in 54 (52%) patients. CT scan and echocardiography were done for all patients.

Results

Outcome data were collected for all patients through the 30-day and 180-day follow-up. During 30 days follow up 14 patients died (13,6%, 95% CI, 6,9–20%). The all-cause mortality rate after 180 days was 22,2% (95% CI, 13,5–31%) - 22 patient. In the thrombolysis group only 2 patients died after 180-day follow-up, mortality rate was 4,4% (95% CI, 1,7–10,6%), the mortality rate in patients not treated by thrombolysis was 40% (95% CI, 25,3–54,7%). Thrombolysis was associated with a significant decrease in mortality [OR 0.07 (95% CI, 0.01–0.31)]. In the thrombolysis group 2 patients (4.1%; 95% CI, 1.1–10%) had a non-fatal major bleeding event. The presence of chronic heart failure [OR 6 (95% CI, 1.8–20.2)] and previous stroke [OR 4.3 (95% CI, 0.9–21.1)] were higher among non-survivors when compared to survivors (p≤0.05). TAPSE less than 16 mm was found to be negatively associated with survival [OR 5.5 (95% CI, 0.9–40.3)], p=0.02.

Conclusion

In our study thrombolysis in patients with pulmonary embolism and intermediate-risk was associated with improved prognosis. Predictors of mortality were the presence of CHF, previous stroke and TAPSE of less than 16 mm.

Funding Acknowledgement

Type of funding sources: None. Kaplan-Meier mortality curves. p<0.05
Role of cardiac magnetic resonance in stratifying the prognosis of patients with pulmonary arterial hypertension
Authors: De Lorenzis A , Dardi F , Guarino D , Palazzini M , Magnani I , Zuffa E , Ballerini A , Rotunno M , Manes A , Galie N
Published: October 2021

Background

Pulmonary arterial hypertension (PAH) is a rare disease characterized by a complex remodeling of heart structures. Cardiac magnetic resonance (CMR) is the gold standard for a non-invasive evaluation of right ventricle (RV) volumes and mass.

Purpose

To define the relationship between clinical, functional, biochemical, haemodynamic and CMR parameters and survival in patients with PAH.

Methods

Consecutive patients with PAH referred to our centre underwent clinical, functional, brain natriuretic peptide (BNP) plasma levels, haemodynamic and CMR evaluation. All patients were treated according to current guidelines. Univariate Cox analysis for survival was performed. Parameters with a p-value <0.1 at the univariate analysis were included in the multivariate analysis.

Results

One hundred forty-seven patients with PAH (mean age 49±17 years, 69% female) were included in the study. Etiology of PAH was: idiopathic/heritable (49%), associated with connective tissue disease (19%), congenital heart disease (12%), portal hypertension/HIV infection (12%) and pulmonary veno-occlusive disease (8%). Thirty-six patients died during follow-up. Parameters significantly associated with mortality at the univariate analysis were age [Hazard Ratio (95% Confidence Interval): 1.043 (1.020–1.067); p<0.001], six-minute walk test (6MWT) [HR: 0.995 (0.993–0.998); p<0.001], WHO-functional class [HR: 2.489 (1.025–6.041); p=0.044], idiopathic-heritable-congenital heart disease aetiology [HR: 0.182 (0.085–0.389); p<0.001], connective tissue disease aetiology [HR: 2.274 (1.099–4.704); p=0.027], pulmonary veno-occlusive disease aetiology [HR: 5.864 (2.328–14.773); p<0.001], right atrial pressure [HR: 1.098 (1.032–1.169); p=0.003], pulmonary artery oxygen saturation [HR: 0.947 (0.921–0.975); p<0.001], BNP levels [HR: 2.214 (1.213–4.039); p=0.010], RV wall thickness [HR: 0.633 (0.399–1.006); p=0.053], RV end diastolic volume [HR: 1.012 (1.003–1.021); p=0.007], RV end systolic volume [HR: 1.014 (1.003–1.024); p=0.011]. Parameters independently associated with mortality at the multivariate analysis were age [HR: 1.035 (1.006–1.064); p=0.018], idiopathic-heritable-congenital heart disease aetiology [HR: 0.355 (0.146–0.860); p=0.022], pulmonary veno-occlusive disease aetiology [HR: 3.129 (1.071–9.143); p=0.037], pulmonary artery oxygen saturation [HR: 0.953 (0.919–0.989); p=0.011], RV wall thickness [HR: 0.527 (0.300–0.927); p=0.026], RV end systolic volume [HR: 1.016 (1.003–1.029); p=0.014].

Conclusion

RV wall thickness and RV end-systolic volume are associated with prognosis in patients with PAH independently from clinical and haemodynamic characteristics. These parameters may be used in the overall risk stratification of PAH patients.

Funding Acknowledgement

Type of funding sources: None.
Vitamin D deficiency predicts the no-reflow phenomenon in STEMI patients undergoing primary percutaneous coronary intervention
Authors: Verdoia M , Gioscia R , Viglione F , Rolla R , Viola O , Brancati M F , Solda' P L , Marcolongo M , De Luca G
Published: October 2021

Background

Vitamin D displays a broad spectrum of cardioprotective effects, preventing oxidative stress, inflammation and thrombosis and improving endothelial function.

Previous studies have associated vitamin D deficiency with more extended and severe coronary artery disease (CAD) and worse outcome, and especially among patients with ST-segment elevation myocardial infarction (STEMI). Few data have been reported on the association of vitamin D levels with the features of infarct-related lesions and PCI outcomes.

Aim

We aimed at assessing the relationship between vitamin D and angiographic findings and the procedural results of primary percutaneous coronary intervention (pPCI) in STEMI.

Methods

A consecutive cohort of patients admitted for STEMI treated with pPCI were included. The levels of 25(OH)D were assessed at admission by chemiluminescence immunoassay kit LIAISON® Vitamin D assay. Hypovitaminosis D was defined for 25(OH)D <10 ng/ml.

Results

We included in our study 450 patients, divided according to tertiles values of 25(OH)D. Lower vitamin D was associated to higher use of diuretics (p=0.02), higher levels of white blood cells and glycemia (p<0.001), lower prevalence of lesions on bifurcations (p=0.03) and smaller diameter of the target coronary vessel (p=0.03). Procedural characteristics and pre-procedural TIMI flow were not different according to vitamin D levels, but for a higher rate of slow-flow/no-reflow phenomenon (12.8% vs 8.1% vs 5.3%, p=0.03, adjusted OR [95% CI]=2.6 [1.05–6.6], p=0.04 for I vs III tertile), requiring higher use of adenosine (p=0.006) and glycoprotein IIbIIIa inhibitors (p=0.01).

Conclusion

The present study shows that among patients with STEMI undergoing pPCI, lower levels of vitamin D indepently predict the occurrence of slowflow/no-reflow phenomenon. Future dedicated studies will shed light on the prognostic implications of hypovitaminosis D in these patients and the potential therapeutic perspectives.

Funding Acknowledgement

Type of funding sources: None.
Late outcomes of percutaneous coronary interventions (PCI) and subsequent life-quality in patients younger 40 years of age
Authors: Abdullayev F Z , Babayev N M , Shikhiyeva L S
Published: October 2021

Background

Late results of PCI in patients aged ≤40 years are few presented without differentiation of groups with acute coronary syndrome (ACS) vs. Stable Angina, and age borderlines≤35 years vs. 36–40 years. Health-life quality following PCI in patients ≤40 years of age not studied.

Objective

To analyze predictors of outcomes, and subsequent life-style in patients aged ≤35 vs. 36–40 years underwent PCI according to ACS vs. Stable Angina.

Material

Enrolled 208 consecutive patients with coronary artery disease aged 24–40 years, of them 157 (75.5%) – aged 36–40 years, 51 (24.5%) – ≤35 years. 197 (94.7%) patients underwent revascularization of the myocardium, of them: 165 (79.3%) patients underwent PCI; 32 (15.4%) – CABG. 11 (5.3%) patients abandoned revascularization. Late results of PCI, and subsequent health-life quality studied in 126 (76,4%) of 165 patients on 10–108 months (mean 62,5±2,6).

Results

84 (50.9%) patients underwent PCI according to ACS; 81 (49.1%) – Stable Angina, without any complications. In-hospital, and 30-days mortality 0%.

Actuarial survival on 9 years comprised 99,2%; cardiac mortality – 0,8%; events-free survival on 1–2–3 years comprised 90,5–84,1%-81,7%; on 5–9 years – 79,4%.

Active lifestyle verified in 74,6% patients; sparing lifestyle – in 25,4%; return to work – in 86,5% patients. 88,1% examined preserved family; transitory sexual disorders revealed in 28,6% patients. Regular medication, and dietary regimen followed by 83,3% & 27,8% patients. Continue smoking & abuse energetic drinks 34,1% & 23,8% examined; overweight and obesity persisted in 23,8% & 19% examined patients. 23% patients fall in depression tied with re-MI/ angina; 18,3% – with quarantine (COVID-19); 6,3% examined suffered “panic attack” waiting recurrence of angina. Re-MI/angina revealed in 23% patients; 20,6% examined underwent re-PCI.

Conclusion

Predictors of poor outcomes were: 1) ACS; 2) age in time of PCI ≤35 years; 3) early MI, DM, LVEF ≤35–40%; 4) used stents diameter<28mm.; 5) continued smoking, and abuse of energetic drinks.

Leading independent predictor – aggressively current atherosclerosis & DM in individuals ≤40 years of age leading to rapid dysfunction of stents; in patients with patency stents – lesion of native or “protected” coronary arteries.

Funding Acknowledgement

Type of funding sources: None.
Single antiplatelet therapy versus dual antiplatelet therapy after transcatheter aortic valve replacement: a meta-analysis of randomized controlled trials
Authors: Sayat G , Porciuncula L G , Gerodias A
Published: October 2021

Background

The performance of transcatheter aortic valve replacement (TAVR) has expanded considerably during the past decade. Technological advances and refinement in implantation techniques have resulted in improved procedural outcomes, whereas indications are progressively extending toward lower-risk patients. Ischemic/embolic complications and major bleeding remain important and strongly correlate to mortality. In this regard, the optimal antithrombotic regimen after successful transcatheter aortic valve replacement remains unclear.

Purpose

To compare the efficacy and safety of single antiplatelet therapy (SAPT) versus dual antiplatelet therapy (DAPT) for post Transcatheter Aortic Valve Replacement.

Search strategy

Key Terms: transcatheter aortic valve replacement, transcatheter aortic valve implantation, antiplatelet, single antiplatelet therapy, dual antiplatelet therapy.

Selection criteria

Four randomized, controlled clinical trials comparing single antiplatelet therapy versus dual antiplatelet therapy for post TAVR patients were included in this study.

Method

Extensive search of PubMed, Medline, Cochrane and Ovid was done for articles published until November 20, 2020. Studies were limited to RCTs comparing SAPT and DAPT among patients who underwent TAVR. Outcome measures include: stroke, myocardial infarction, all-cause mortality and major bleeding. Two reviewers independently reviewed the studies. Results were gathered from published articles, journals and clinical trials. Studies were critically appraised with regards to methods of minimizing bias. All four studies included received a quality scale for meta-analysis overall score of not less than B.

Statistical analysis was done using Review manager V5.4.

Main results

Four RCTs with 1086 patients were included in this meta-analysis. Overall, the risk of stroke (OR 0.94 [0.54 −1.64]), myocardial infarction (OR 0.50 [0.18–1.40]), and overall mortality (OR 1.01 [0.65–1.57]) did not differ significantly between DAPT and SAPT. There was noted increased risk of bleeding noted with DAPT, thus favoring SAPT (OR 0.44 [0.30–0.65]).

Author's conclusions

Among patients who underwent TAVR, DAPT compared to SAPT had similar rates of stroke, myocardial infarction and death. Due to lower rates of bleeding, we recommend using single antiplatelet therapy after TAVR.

Funding Acknowledgement

Type of funding sources: None.
The validation of four published algorithms to predict the need for pacemaker implantation after TAVR
Authors: El Garhy M , Owais T , Lapp H , Kuntze T , Lauten P
Published: October 2021

Background

The identification of patients with high risk for PPMI after TAVR might change our decision as regard the type of the prosthesis and allow more patients' acceptance for this complication. Objective: we investigated the predictors of PPMI after TF-TAVR and validated the accuracy of four published algorithms in this group of patients.

Methods and results

We retrospectively examined all patients who were in need for pacemaker implantation during the index hospitalisation after TAVR between 2016 and 2019. We searched for the predictors of the new PPMI after TAVR in this group of patient and compared it with a matched group of patients. Moreover, we tested the accuracy of four published algorithms. The first tested algorithm from Kaneko et al had positive predictive value (PPV), negative predictive value (NPV) and accuracy from 50%, 65% and 60% consecutively. The second tested algorithm from Jilaihawi et al had PPV, NPV and accuracy from 13.6%, 100% and 26.9% consecutively. The third tested algorithm from Maeno et al had PPV, NPV and accuracy from 37%, 56% and 45% consecutively. The forth tested algorithm from Fujiti et al had PPV, NPV and accuracy from 42%, 65% and 50% consecutively. In this study, 3 ECG-predictors (RBBB, the presence of AF and LAHB) and 3 CT-predictors (Aortic valve calcification Volume >500mm3, eccentricity index >0.25, deep valve implantation in relation to the length of membranous septum) were independent predictors of PPMI. Moreover, the rate of preimplantation ballon valivuloplasty was higher in the group with new PPMI. Using these independent predictors, the new 7 points score was developed by assigning 1 point for each one. AUC of the new score in the derivation cohort was 0.809 (95% CI 0.758–0.86), with an optimal cut-off threshold of 4 points. All other scores had AUC from 0.6 or lower. In a validation cohort of 100 patients, the predictive value of the score was confirmed (AUC, 0.72; 95% CI, 0.70–0.87; P<0.001).

Conclusion

The four studied score systems had low accuracy to predict new PPMI after TAVR in our cohort of patients. The new score is more complex but might be more accurate.

Funding Acknowledgement

Type of funding sources: None.
Single centre experience in 1202 biological prosthesis: a comparison between sutured, sutureless and surgical transcatheter aortic valve
Authors: Mariani C , Murana G , Botta L , Gliozzi G , Folesani G , Santamaria V , Tassi S , Di Marco L , Pacini D
Published: October 2021

Background/Introduction

Different types of bio-prosthesis are now available for the treatment of aortic valve disease.

In absence of the “ideal” heart valve prosthesis, the best choice may be customized on the basis of the patient's profile.

Purpose

The aim of this study was to compare results in different subgroups of bio-prosthesis in elderly patients (>75 years old) undergoing conventional or surgical trans-catheter aortic valve replacement (AVR). Primary outcome was all cause mortality, secondary outcomes were: early post-operative complications (stroke, AV-block, acute kidney injury requiring temporary dialysis), freedom from structural vascular disease (SVD) and from re-operation.

Methods

In this retrospective study we analysed 1202 patients over 75 years old, underwent AVR from 2002 to 2018. Inclusion criteria were: age >75 years underwent AVR; we divided our population in 3 groups according to different strategy: primary aortic valve replacement with sutured (group 1, n=1005), sutureless (group 2, n=103) or surgical trans-catheter aortic valve replacement (group 3, n=94). Exclusion criteria: concomitant cardiac procedure other than coronary artery by-pass graft (CABG) or endocarditis.

Patient and disease characteristics are described as numbers and percentages, continuous data were expressed using mean and standard deviation. Differences between groups were evaluated using either Student t-test or Mann-Whitney U test or ANOVA test. Survival curves of the primary outcome and freedom from secondary outcomes were built with the Kaplan-Meier method.

Results

The mean age of the overall population was 80.5±3.6 years with a mean STS score of assessed at 2.79±2.2% (2.27±1.0 for standard AVR, 3.3±2.2% for sutureless and 6.4±4.5 for S-TAVR, p-value<0.001). Early outcomes are depicted in figure 1. The overall 30-day mortality was 2.9%; among the different groups we observed 2.3%, 4.9% and 7.2% for sutured, sutureless and surgical-TAVR, respectively (p-value=0.01). The groups statistically differed also for permanent pacemaker implantation (sutured AVR 2.2%, sutureless AVR 4.9%, TAVR 9.6% (p-value<0.001) and acute renal failure requiring temporary dialysis sutured AVR 3%, Sutureless AVR 1.9% and Surgical TAVR 9.6% (p-value=0.004). The survival rate at follow-up was significantly different among group (log-rank <0.001, figure 2). Instead, freedom from reoperation was similar between cohorts (figure 2.)

Conclusion(s)

The outcomes of surgical AVR in a elderly population could be safely guaranteed with different biological prosthesis and operative techniques. A patient tailored approach should be always advised to improve current available transcatheter options.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
Adipose-derived exosomes impairs endothelial transient receptor potential vanilloid 4 channels and elevates blood pressure in abdominal obesity
Authors: Wan J , Liu S , Yang Y , Wang D , Ran F , Dai X , Zhou P , Wang P
Published: October 2021

Aim

Large epidemiological studies have found that abdominal obesity is a strong risk factor for hypertension. Impaired endothelium-dependent vasodilation is a hallmark of obesity-induced hypertension. Adipose-derived exosomes can regulate distant tissues as novel adipokines, providing a new mechanism for cell-cell interactions. However, the effects of adipose-derived exosomes on obesity-induced hypertension are unknown.

Methods

We extracted three adipose-derived exosomes, including high-fat diet (HFD) mouse serum exosome, adipose tissue exosome, and adipose-derived stem cell exosome, and further explored their effects on endothelium-dependent vasodilation in vivo and in vitro.

Results

Impairment of endothelial transient receptor potential vanilloid 4 (TRPV4) channel activity and vasodilation were observed in the arteries from abdominal obesity patients. Ca2+ influx through TRPV4 channels at myoendothelial projections to smooth muscle cells decreases resting blood pressure in nonobese mice, a response that is diminished in HFD mice. Administration of three exosomes elevated blood pressure by promoting artery endothelial barrier permeability, impairing the expression of adherens junctions, and aggravating inflammatory response in vivo and in vitro, accompanied by TRPV4/Ca2+ pathway inhibition.

Conclusions

Impairment of endothelial TRPV4 channels contributes to obesity-induced hypertension and imply that HFD-induced obesity plays a role in blood pressure by aggravating the artery endothelial barrier injury and inflammatory response via adipose-derived exosomes, at least partially, through inhibiting the TRPV4/Ca2+ pathway.

Funding Acknowledgement

Type of funding sources: None. Main funding source(s): This research was supported by grants from the National Natural Science Foundation of China (81970262) (P.J.W.), Innovation Team Project Department of Education of Sichuan Province (18TD0030) (PJW), Central Funds Guiding the Local Science and Technology Development of Sichuan Province (2020ZYD036, P.W.), and grants from the Scientific Research Fund of Chengdu Medical College (CYZYB20-07) (J.W.).
Transforming growth factor, arterial stiffness and vascular aging in patients with uncontrolled arterial hypertension
Authors: Nebieridze N N , Safronova T , Podzolkov V I
Published: October 2021

Introduction

Arterial stiffness and vascular aging is associated with a risk factors for cardiovascular complications in hypertension. It is known that, transforming growth factor β1 (TGF-β1), a pleiotropic cytokine, enhances proliferation and growth of smooth muscle cells, as well as the accumulation of extracellular matrix, that is, the processes underlying vascular remodeling in hypertension. But still there is no data about influence off TGF-β1 on arterial stiffness and vascular aging.

Purpose

The aim of our study was to identify the relationship between TGF-β1, arterial stiffness and vascular age in patients with uncontrolled arterial hypertension

Materials and methods

The study included 140 patients: 30 people with uncontrolled hypertension (UAH), 80 people with controlled hypertension (CAH) and 30 people in the control group. All patients underwent determination of arterial stiffness, vascular age using cardio-ankle vascular index (CAVI) by means of volumetric sphygmography and TGF-β1 concentration level.

Results

The TGF-β1 level was 19,2 [17,2; 24,7] ng/ml in the CAH group. In the UAH group – 22,6 [20,6; 25,6] ng/ml. In the control group - 17.4 [11,8; 19,3] ng/ml. Value of the CAVI was 9,2 [8,5; 9,9] in UAH group, 7.8 [7,0; 8,5] in CAH group and 7 [6,5; 7,5] in control group. The maximum and minimum values vascular age were observed in the group UAH 71,5 [64; 74] and control group 54 [44; 59], respectively (p<0,05), in the CAH group there was an intermediate value of the vascular age 59 [49; 69] (p<0,05). There was significant difference between vascular and passport age in CAH and UAH groups (p<0,05) and no significant difference between passport and vascular age in control group (p>0,05). The correlation analysis revealed a significant relationship between the TGF-β1 level and CAVI for patients with hypertension (CAH r=0,777; UAH r=0,753; p<0.05). Positive correlation was also revealed between TGF-β1 and vascular age in UAH group (r=0,657) and CAH (r=0,649) p<0,05.

Conclusion

An increase in the concentration of TGF-β1, vascular age and an increase of arterial stiffness were revealed in patients of the UAH group in comparison with the other groups. The relationship between TGF-β1, vascular age and arterial stiffness was also found in patients with arterial hypertension.

Funding Acknowledgement

Type of funding sources: None.
“Stifflammation” in hypertension is a predictor of future cardiovascular hospitalizations
Authors: Terentes-Printzios D , Christopoulou G , Korogiannis L , Ioakeimidis N , Aznaouridis K , Gardikioti V , Dima I , Oikonomou D , Gkini K P , Tsioufis K , Vlachopoulos C
Published: October 2021

Background/Introduction

Hypertension is associated with increased cardiovascular risk, inflammation and arterial stiffness.

Purpose

We sought to investigate the role of inflammation and arterial stiffness in the prognosis of cardiovascular hospitalizations in hypertensive patients over an extended follow-up.

Methods

One hundred and seventy-three patients (mean age 52.5±13.2 years, 57% males) untreated hypertensives at baseline without cardiovascular disease, were included in the study. Arterial stiffness was assessed with carotid-femoral pulse wave velocity (PWV). High-sensitivity C-reactive protein (hsCRP) was measured in venous blood samples. Other markers of subclinical organ damage [left ventricular mass index (LVMI) by echocardiography and estimated glomerular filtration rate (eGFR)] were also evaluated in all patients.

Results

During 13.6±0.4 years of follow-up, forty-four patients (25.4%) patients were admitted in hospital due to cardiovascular causes. In multivariable logistic regression analysis, only higher hsCRP (Odds Ratio [OR] = 3.34, 95% Confidence intervals [CI]: 1.22–9.51, P=0.02) and increased PWV (OR = 1.48, 95% Confidence intervals [CI]: 1.03–2.12, P=0.036) were associated with higher risk of cardiovascular hospitalizations, which was independent of age, gender, systolic blood pressure, LVMI and presence of diabetes. In further analysis, receiver operating characteristic (ROC) curves were generated to evaluate the ability of hsCRP and PWV to discriminate subjects with cardiovascular hospitalization. The area under the curve (AUC) and 95% CIs of the ROC curves were AUC=0.69 (95% CI: 0.59–0.78, p<0.001) for hsCRP and AUC=0.74 (95% CI: 0.65–0.83, P<0.001) for PWV (Figure).

Conclusions

Our study shows the independent complimentary prognostic role of inflammation and arterial stiffness in the prognosis of hypertensives even in studies with extended follow-up.

Funding Acknowledgement

Type of funding sources: None. ROC curves for the prediction of outcome
March, September and December months with the greatest influence of atmospheric pressure on blood pressure in patients with hypertension
Authors: Cieslik-Guerra U I , Kaminski M , Kotas R , Trzos E , Wierzbowska-Drabik K , Bednarkiewicz Z , Rechcinski T , Tylman W , Kasprzak J D , Kurpesa M
Published: October 2021

Objectives

For a long time, science has searched for the relationship between weather and human health. Atmospheric pressure is the most objective weather factor because, regardless of whether the objects are outdoors or indoors, it affects all objects in the same way. In cardiology, we often look for factors that worsen blood pressure control. Could atmospheric pressure be one of them?

The main objective of our research was to assess the relationship between atmospheric pressure and blood pressure in patients with treated hypertension in different months in the moderate climate of Central Poland.

Material and methods

The study group consisted of 4191 patients with arterial hypertension, divided into 2 near equal groups due to a lower or higher average value of atmospheric pressure when blood pressure was recorded. Blood pressure was monitored by a means of 24-h ABPM. Atmospheric pressure was recorded with the frequency of 1 measurement per minute using a meteorological station. The observations were conducted in the years 2009–2019. Comparisons between blood pressure values in the 2 groups were performed using the Mann-Whitney U test.

Results

We observed a significant difference in blood pressure recorded during the periods of lower and higher atmospheric pressure: for systolic blood pressure during the days of September (125.01±14.99 vs 120.14±12.83, p<0.001) and December (124.22±15.45 vs 127.50±14.35, p<0.05), for diastolic pressure during the days of March (72.24±10.92 vs 69.81±9.13, p<0.02) and for diastolic pressure during the nights of March (61.53±8.96 vs 59.58±9.17, p<0.04).

Conclusions

A significant inverse relationship between atmospheric pressure and blood pressure was observed; during March days and nights for diastolic blood pressure and during September and December days for systolic blood pressure.

This finding may be important for the understanding of why during some months the pharmacological control of blood pressure is poor, and of the consequences of this fact.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): own resources
Risk factors in young patients with myocardial infarction: what is different from the general population?
Authors: Wienbergen H , Guenther K , Boakye D , Schmucker J , Mkalaluh S , Retzlaff T , Ruehle S , Osteresch R , Fach A , Ahrens W , Hambrecht R
Published: October 2021

Introduction

Patients that suffer from myocardial infarction (MI) at a younger age are of special medical and socioeconomic interest. Data on risk factors for MI in this patient group are however scarce.

Methods

In this case–control study, clinical characteristics of consecutive patients admitted to hospital with MI at age of ≤45 years were compared to a randomly selected cohort from the general population in the same geographic region in Germany. After 3:1 matching on age and gender and multivariable analyses, independent risk factors for the occurrence of MI at a younger age were analyzed.

Results

522 patients with MI ≤45 years were compared to 1191 matched controls from the general population. The proportion of active smokers was more than 3-fold higher in younger MI-patients compared to the general population (82.4% vs. 24.1%, p<0.01), while the proportion of persons consuming alcohol at least 2 times a week was higher in the general population (19.9% vs. 36.6%, p<0.01). Younger patients with MI were more often obese (median body mass index 28.4 vs. 25.5 kg/m2, p<0.01), had a higher proportion of hypertension (25.1% vs. 0.5%, p<0.01) or diabetes mellitus (11.7% vs. 1.7%, p<0.01) and had more often a family history of the father (22.4% vs. 7.1%, p<0.01) or the mother (7.5% vs. 1.3%, p<0.01) for premature coronary artery disease.

In multivariable analysis, hypertension or diabetes, active smoking, family history and body mass index ≥30 kg/m2 were strong predictors for the occurrence of MI at a younger age, while alcohol consumption was a protective factor (Figure).

Conclusions

This case-control study demonstrates a very strong association of active smoking, metabolic syndrome and family history with the occurrence of MI at a younger age. The contrary is found regarding alcohol consumption.

These data suggest that the risk of young-onset MI goes beyond family history and underline the importance of primary prevention efforts to reduce smoking and metabolic syndrome in children, adolescents and young adults in order to reduce the burden of cardiovascular diseases.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Bremen Heart FoundationLeibniz Institute for Prevention Research and Epidemiology
Should we really avoid fat in diet? The beneficial effects of low carbohydrate diet versus low fat diet on cardiovascular health: a systematic review and meta-analysis
Authors: Ishak A I , Harikrishna A H , Chrysostomou S C , Karpettas N K
Published: October 2021

Background

European Society of Cardiology and the American College of cardiology recommend a diet that is considerably low in fat (<35%) and high in carbohydrates (45–55%) for cardiovascular disease (CVD) prevention. However, recent evidence suggests that low-carbohydrate diets (LCD) can provide similar, if not, better CVD protection.

Design

Systematic review and meta-analysis

Methods

3 databases were screened until 17th of August 2020 for randomized controlled trials (RCTs). Two investigators selected studies, extracted data, and assessed risk of bias. Certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Weighted mean differences and 95% confidence intervals were calculated.

Results

25 trials with a total of 2438 patients were included. LCD resulted in greater reductions in body weight (WMD −1.93 (95% CI −2.69, −1.16) kg; p<0.0001), triglycerides (WMD −26.13 (95% CI −23.45, −14.29) mg/dL; p<0.0001), TNF-alpha (WMD −0.5 (95% CI −0.82, −0.17) pg/mL; p=0.003) and IL-6 (95% CI −2.29, −0.59) pg/mL; p=0.0009) with a greater increase in HDL-C (WMD 3.73 (95% CI 2.92, 4.54) mg/dL; p<0.ehab724.24271) and LDL-C (WMD 5.07 (95% 1.9, 8.23) mg/dL; p=0.002) compared to low fat diet (LFD). There was no statistical difference in systolic (WMD 0.5 (95% CI −1.06, 2.05) mmHg; p=0.53) and diastolic blood pressure reduction (WMD −0.22 (95% CI −1.35, 0.91) mmHg; p=0.70).

Conclusions

Obese patients with other cardiovascular risk factors assigned to an LCD achieved greater reductions in weight loss and triglycerides levels with a greater increase in HDL-C levels and a more pronounced anti-inflammatory state than patients assigned to an LFD. Hence, low carbohydrate diets could be an alternative tool for cardiovascular protection in selected patients.

Funding Acknowledgement

Type of funding sources: None.
A-posteriori protein-rich dietary patterns and their association with ten-year transition to metabolically unhealthy status: highlights from a population-based cohort study
Authors: Kouvari M , Chrysohoou C , Georgousopoulou E , Skoumas J , Pitsavos C , Panagiotakos D B
Published: October 2021

Background/Introduction

The role of dietary protein on cardiometabolic health remains complex influenced by concomitant changes in overall diet composition. The quality of protein sources is currently suggested as more detrimental than the level of consumption itself.

Purpose

The association between different protein-rich dietary patterns and 10-year transition to metabolically unhealthy status in a sample from Greece was evaluated.

Methods

A prospective study was conducted during 2001–2012 studying n=1,514 men and n=1,528 women (>18 years old) free of CVD. Healthy metabolic status was defined as absence of all NCEP ATP III (2005) metabolic syndrome components. Baseline dietary assessment was based on a validated semi-quantitative food frequency questionnaire. Dietary protein was calculated through standardized food database. Follow-up cardiometabolic assessment (2011–2012) was achieved in n=2,020 participants. Protein-rich dietary patterns were derived through factor analysis in the subsample of participants with high daily protein intake (>15% of total energy intake corresponding to the median consumption level). Patterns were named according to food scores that correlated most with the factor (scores>0.5).

Results

Overall, six of ten participants lost their metabolically healthy status within a decade. Multiadjusted analysis revealed an inverse yet non-significant association between total energy-standardized protein intake and transition to metabolically unhealthy status [Odds ratio (OR) (high vs. low protein intake)=0.59, 95% Confidence Interval (95% CI) (0.32, 1.10), p=0.09]. Factor analysis extracted three protein-rich dietary patterns, explained 55% of the total variation in intake. Factor A was characterized by increased consumption of processed meet, unprocessed red meat and eggs, factor B was characterized by increased consumption of nuts and seeds, legumes, whole grain products and fish while factor C was characterized by increased consumption of dairy products, poultry and vegetables. Multiadjusted logistic regression analysis revealed that factor B had the strongest protective effect against 10-year transition to metabolically unhealthy status [ORper 1 point increase in factor B score=0.74, 95% CI (0.60, 0.85), p=0.01] followed by a marginally protective effect of factor C [ORper 1 point increase in factor C score=0.89, 95% CI (0.73, 1.05), p=0.07]. Participants with higher adherence to factor A had an increased likelihood to lose their metabolically healthy status [ORper 1 point increase in factor A score=1.15, 95% CI (1.02, 1.30), p=0.04].

Conclusions

The present work confirms that within an increased level of dietary protein intake, different cardiometabolic outcomes were observed according to the quality of protein food sources consumed.

Funding Acknowledgement

Type of funding sources: None.
Intervention to decrease salt intake inadequacy using a control device to monitor and control salt use when cooking at home – iMC SALT preliminary results
Authors: Goncalves C , Silva-Santos T , Padrao P , Abreu S , Graca P , Oliveira L , Esteves S , Norton P , Moreira P , Pinho O
Published: October 2021

Introduction

Excessive salt intake is one of the greatest risks to public health, making urgent to propose measures to reduce its intake and bring great benefits to reduce cardiovascular diseases risk. In the Portuguese population, the main source of salt consumption is the salt that is added during food preparation and cooking meals.

Purpose

The main aim of this study was to assess whether an intervention using a dosing salt device (Salt Control H) in food preparation and cooking has beneficial effects in salt intake.

Methods

This was a two-arm randomized controlled trial. A total of 88 workers from a public university (50% female; mean age 47.2±11.4 years), were randomly assigned to a intervention (I; n=42) or a control group (C; n=46). The intervention was delivered by health professionals in an occupational medicine setting, asking participants to use a salt control device that delivers the maximum amount of salt to add in food preparation and cooking, according to the number and age of the persons who will consume the meal, during 8 weeks. Primary outcome was the 24-hour urinary sodium excretion (Na24), validated by creatinine coefficient, and secondary outcome was 24-h urinary sodium-to-potassium ratio (Na/K24). Parametric tests were used to assess differences between urinary data stratified by C or I group and Mann-Whitney to evaluate differences between stratified groups according to meet WHO daily recommendations of intake.

Results

At baseline, there was no significant differences in mean Na24 (C: 3145.5±1420.1 and I:3268.7±1159.8 mg/d, p=0.096) and Na/K24 (C: 2.0±0.9 and I: 2.1±0.8 mg/d, p=0.792) between the two groups. After 8 weeks intervention, a Na24 and Na/K24 non statistically significant decrease was observed in the I group (to 3094.1±1391 and 2.0±0.8 mg/d), as opposed to the C group (to 3262.5±1527.0 and 2.2±0.9 mg/d). The proportion of participants from I group that present Na<2000 mg/d increased (from 17 to 29%) as the proportion of participants that present Na/K24 <1 (from 0 to 12%) without significant differences from C group (p=0.214 for Na <2000 mg/d and p=0.383 for Na/K24 <1).

Conclusion

The Salt Control H measurement device showed promising results to increase adherence to daily salt intake recommendations. The device is a useful and practical tool for educating individuals about dietary salt doses to add to meals cooked at home.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fundação para a Ciência e Tecnologia Figure 1