bluuebunny/crossref_metadata_2025_split huggingface dataset:
IL6 trans-signalling is associated with a higher risk of cardiovascular events in individuals with diabetes
Authors: Ziegler L , Gigante B 
Published: October 2021

Abstract

Background
Pro-inflammatory interleukin 6 (IL6) trans-signalling is associated with an increased risk of future cardiovascular events (CVE). Diabetes mellitus is a well-known risk factor for CVE but its relation to IL6 trans-signalling is not investigated.

Purpose
We aimed at analysing if the CVE risk associated with IL6 trans-signalling differed between individuals with/without diabetes.

Method
In a prospective cohort of 60-year-old men and women from our city (n=4232), 629 CVE (myocardial infarction, hospitalised angina pectoris and ischemic stroke) occurred during a 20-year follow-up. The risk of CVE associated with IL6 trans-signalling was assessed using the binary/ternary complex ratio (B/T ratio), a novel marker of IL6 trans-signalling derived from the serum molar concentrations of IL6 and the soluble IL6 receptors (sIL6R; sgp130). As a B/T ratio &gt; median, mirroring active IL6 trans-signalling with a relative excess of the active binary IL6 complex in relation to the inactive ternary complex, previously was demonstrated to be associated with an increased CVE risk in this cohort we chose the same cut-off. The CVE risk was assessed by Cox proportional hazards models and described as hazard ratios (HR) with 95% confidence intervals (CI) in individuals with/without diabetes mellitus type 1 or 2 (n=114) defined as either self-reported, or fasting glucose &gt;7.0 mmol/L in the baseline blood test. In the adjusted model, risk estimates were adjusted for the common cardiovascular risk factors. The additive interaction between IL6 trans-signalling and diabetes on the CVE risk was analysed using Cox regression and presented as Synergy index (S) with 95% CI where S &gt; or &lt;1 indicate presence of an interaction.

Result
There was a higher CVE risk associated with IL6 trans-signalling assessed by B/T ratio &gt; median in individuals with diabetes (adjusted HR 3.42; 95% CI 1.60–7.29) compared to participants without (adjusted HR 1.36; 95% CI 1.15–1.60) and the interaction analysis suggested a presence of additive interaction between IL6 trans-signalling and diabetes on the CVE risk (adjusted S=5.23; 95% CI 0.93–29.26) as seen in Figure 1.

Conclusion
Individuals with diabetes mellitus have an increased risk of CVE associated with IL6 trans-signalling possibly in part due to an additive interaction between the two.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The Stockholm County Council ALF projectStrategic research in Epidemiology at Karolinska Institutet Figure 1
Arterial stiffness and valvular calcifications in aortic stenosis: caught between a rock and a hard place
Authors: Gardikioti V , Terentes-Printzios D , Aznaouridis K , Christoforatou E , Benetos G , Drakopoulou M , Latsios G , Oikonomou E , Siasos G , Toutouzas K , Vavuranakis M , Tsioufis K , Vlachopoulos C 
Published: October 2021

Abstract

Background/Introduction
Arterial stiffness and aortic hemodynamics are independent predictors of adverse cardiovascular events. Indications for transcatheter aortic valve implantation (TAVI) are expanding and aortic valve calcifications (AVC) are an important prognostic factor of the success of TAVI.

Purpose
We sought to investigate the associations between AVC and aortic vascular function/hemodynamics.

Methods
Fifty-two high-risk patients (mean age 80.4±8.5 years, 27 male) with severe symptomatic aortic stenosis undergoing TAVI were included. Arterial stiffness was estimated through carotid-femoral pulse wave velocity (cfPWV) and brachial-ankle pulse wave velocity (baPWV). Aortic hemodynamics (aortic pressures, aortic augmentation index corrected for heart rate [AIx@75]) were also measured. Measurements were conducted prior to the implantation and at discharge. In all patients, a native and contrast-enhanced multislice cardiac computed tomography were performed pre-interventionally. AVC were then graded semi-quantitatively as follows: grade 1 – no calcification; grade 2 – mildly calcified (small isolated spots); grade 3 – moderately calcified (multiple larger spots); grade 4 – severely calcified (extensive calcification of all cusps).

Results
Group 1 (subjects with none/mild AVC, n=29) did not significantly differ in age, gender and body-mass index compared to group 2 (subjects with moderate/severe AVC, n=23). As far as the traditional cardiovascular risk factors were concerned, only hypertension (p=0.008), coronary artery disease (p=0.016), atrial fibrillation (p=0.075) and insulin-dependent diabetes mellitus (p=0.068) were found to be more prevalent in group 2. Group 2 had significantly higher both cfPWV and baPWV (8.3±1.7 vs 7.2±1.2 m/s and 1750±484 cm/s vs. 2101±590 cm/s with p=0.008 and p=0.022 respectively) compared to Group 1 (Figure 1). Even after adjustment for age, gender and systolic blood pressure, aortic stiffness indices were higher in Group 2 compared to Group 1 (p=0.038 and p=0.048, respectively). There was no statistically significant difference in peripheral or aortic pressures as well as in wave reflections indices between the two groups.

Conclusion
Our study shows that in patients with aortic valve stenosis there is a correlation between increased aortic stiffness and a greater extent of damage of aortic valvular leaflets as well as calcifications.

Funding Acknowledgement
Type of funding sources: None. Figure 1. PWV and aortic valve calcifications
SF-12 Physical and Mental Health Scales predict cardiovascular events after hospitalization
Authors: Gascuena R , Diaz Ortiz J , Morales Martinez T , Jimenez Virumbrales D , Gomez Diego J 
Published: October 2021

Abstract

Self perceived physical and mental health are easily scored by validated SF-12 questionnaires (a short form of SF-36). Depression can be also scored by HAD scale. We analysed its usefulness to predict death or cardiovascular events after hospitalization.

Methods
69 consecutive patients (median age 75 (95% CI 33.1–88.9) admitted from a cardiovascular cause performed the SF-12 Physical (PSF) and Mental Health (MSF) questionnaires, and Hospital Anxiety and Depression Scale (HAD) before hospital discharge. Charlson's Comorbidity index and Barthel's modified index for Physical Incapacity were also performed and results adjusted by them and clinical issues (cardiovascular diagnosis, ventricular function, age) and social status. Median follow-up was 506 days (95% CI 490–542). Cox-regression univariate analysis was performed, and data were adjusted by multivariate analysis.

Results
23 patients (33,3%) experienced an event during follow-up (a compound of death, acute coronary syndrome, heart failure, and need for readmission). 85.5% of patients showed a physical SF-12 under poblational mean (PSF 34.55; CI 14.34–55.41), and 59.4% of patients showed a diminished mental SF-12 (MSP 45.69; CI 21.94–66.83).
After adjusting by atrial fibrillation (p=0.21), ventricular disfunction (p=0.14), Charlson's index (p=0.013), Barthel's modified index (p=0.035), and age (p=0.013), both mental SF12 (HR 0.93; CI 0.88–0.98; p=0.004) and Physical SF-12 scales (HR 0.935; CI 0.87–0.98; p=0.0.023), together with HAD depression score (HR 0.85; CI 0.75–0.96; p=0.009) were predictors of new cardiovascular events.

Conclusions
Self perceived physical and mental health scales before hospital discharge predict new clinical cardiovascular events during follow-up. Short form questionnaires (SF-12) and HAD scale are easily performed and can be used for selecting high risk patients beyond clinical characteristics.

Funding Acknowledgement
Type of funding sources: None. Physical SF12 and Event Free Survival
Effect of recreational exercise and fitness on left ventricular torsion and wall mechanics study (FIT-TWIST/Health)
Authors: Zaidi S , Wessly P , Larrauri Reyes M , Hurwitz B , Arenas I , Lamas G , Mihos C 
Published: October 2021

Abstract

Background
Left ventricular (LV) remodeling is associated with elite athletics. This study aimed to assess the effects of recreational exercise on LV remodeling and mechanics in healthy adults.

Methods
A prospective cross-sectional study evaluated 38 healthy adult recreational exercise participants with a Bruce protocol treadmill exercise stress test, and 2D and speckle-tracking echocardiography. Fitness level was stratified by the achieved age- and sex-predicted metabolic equivalents (METS) as average/good (group A, N=20; METS=13.9) and high (group B, N=18; METS=18.2) groups.

Results
Mean age was 33 years, and 58% were female. Participants in Group B used more multi-modality (67 vs 20%; p=0.008) or running (50% vs 15%; p=0.04) exercise regimens, and had larger LV mass (66 vs 56 g/m2; p=0.05) and left atrial volume indices (28 vs 22 ml/m2; p=0.02), when compared with group A. However, all LV strain and torsion mechanics were similar between groups (Figure). Multivariate linear regression analysis revealed independent associations between global longitudinal strain (GLS) and transmitral E-wave (β=−0.57), maximum systolic blood pressure (β=0.32), and LV end-diastolic volume index (β=0.32) (model r=0.72; p&lt;0.001). No correlation between METS achieved and LV parameters was observed.

Conclusion
Recreational exercise and fitness are associated with healthy LV geometry and mechanics in adults. Early diastolic LV filling, LV chamber size, and peak exercise blood pressure are correlated with GLS.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Florida Heart Research Foundation
SARS-CoV2 infection: functional and morphological cardiopulmonary changes in elite handball players
Authors: Fikenzer S , Kogel A , Hepp P , Lavall D , Stoebe S T , Rudolph U , Laufs U , Hagendorff A 
Published: October 2021

Abstract

Background
There is increasing evidence of cardiac involvement in SARS-COV-2 infections. This may not only apply to symptomatic infections but may also affect asymptomatic athletes. This study aimed to characterize the possible acute cardiac involvement of SARS-COV-2 infection in athletes both morphologically and functionally.

Methods and results
Eight elite handball players (27±3.5 y) with past SARS-COV-2 infection were retrospectively analyzed and compared with four uninfected team-mates (22±2.6 y). Athletes were examined 19±7 d after positive PCR-test. Echocardiographic assessment of the global longitudinal strain under resting conditions was not significantly changed after SARS-CoV2 infection (−17.7% vs. −18.1%) but magnetic resonance imaging showed minor signs of acute inflammation/edema in all patients (T2-mapping: +4.1ms) without reaching the Lake-Louis criteria. Spiroergometric analysis showed a significant reduction in VO2max (−292 ml/min, −7.0%), oxygen-pulse (−2.4 ml/beat, −10.4%), and respiratory minute volume (VE) (−18.9 l/min, −13.8%) in athletes with a history of SARS-CoV2 infection (p&lt;0.05, respectively). The parameters were unchanged in the control group.

Conclusion
SARS-CoV2 infection caused functional impairment of cardiopulmonary performance primarily under stress in elite athletes.
It seems reasonable to screen athletes after SARS-CoV2 infection at least with spiroergometry to mark performance limitations and to ensure an optimal return to competition.

Funding Acknowledgement
Type of funding sources: None.
Levels of hypersensitive troponin T in the emergency department as a predictive factor of mortality for hospitalized COVID-19 patients
Authors: Pionnier Y P , Denoel P D , Manara A M , Brousmiche K 
Published: October 2021

Abstract

Background
Coronavirus disease 2019 (COVI-19) has resulted in considerable morbidity ans mortality worldwide since December 2019. Cardiac complications are a common condition among patients with COVID-19. The association between elevated hypersensitivity troponin T in COVID-19 disease and risk of mortality remains unclear but data suggest it could be associated with higher risk of in-hospital mortality.

Purpose
The present study examine the potential association between the level of hypersensitive troponin T (Hs TnT) in emergency department (ED) and mortality among patients hospitalized with COVID-19.

Methods
Consecutive patients admitted in two hospitals from ED with confirmed PCR COVID-19 were included in this retrospective study. The data were collected from October 1, 2020 to December 31, 2020. The demographic characteristics (age and sex), clinical data (symptoms, comorbidities, laboratory findings, treatments, complications, and outcomes), and results of cardiac examinations (cardiac biomarkers and electrocardiogram) were collected in an electronic database. There data were analyzed and the mortality at 1 month was compared for patients with normal or elevated Hs TnT (&gt;14 ng/L).

Results
The study population included 413 hospitalized patients with a confirmed PCR COVID-19. The median age was 82. The comorbidities like cardiovascular diseases, cerebrovascular diseases, pulmonary diseases and renal insufficiency are associated with a significant higher mortality (P&lt;0.05). Clinicals findings like tachypnea (respiratory rate &gt;20/minute) or hypotension (&lt;90 mmHg systolic blood pressure) also result an increased mortality (P&lt;0.05). In this cohort, 90 patients had an analysis of Hs TnT in the ED. The mortality at 1 month was higher in patients with elevated Hs TnT (&gt;14 ng/L) compared to the patients with normal levels of Hs TnT and the correlation was significant (P&lt;0.05). The relative risk of fatal outcome is 3.86 when the troponin level is &gt;14ng/L.

Conclusion
Elevated Hs TnT levels in the emergency department appear to be a predictive factor of mortality at one month for patients with COVID-19 infection requiring admission.

Funding Acknowledgement
Type of funding sources: None.
Social determinants and mortality from cardiovascular disease in Brazil
Authors: Bastos L , Oliveira G M M , Villela P B , Feliciano S C C , Bichara J L P 
Published: October 2021

Abstract

Introduction
Cardiovascular diseases (CVD) are the main cause of death in Brazil and worldwide, with Ischemic Heart Diseases (IHD) of great importance among them. This relevance increases with the aging of the world population and seems to be related to each country's social determinants.

Objectives
To analyze the temporal evolution of mortality rates due to CAD and IHD by sex, age group, Federation Unit (FU), and Geographic Regions (GR) in Brazil, from 1980 to 2019, and the associations with the Municipal Human Development Index (MHDI).

Methods
Ecological study of time series of deaths from CVD and IHD in Brazil. We analyzed the crude and standardized mortality rate by CVD and IHD by sex, age group, FU, and GR between 1980 and 2019 and correlated with the MHDI. Deaths and the population were obtained from DATASUS to estimate mortality rates per 100,000 inhabitants, crude and standardized (direct method with the Brazilian population in 2000). The MHDI for each FU was extracted from the Atlas Brasil website (ATLAS BRASIL, 2017).

Results
Between 1980 and 2019, there were 10,836,004 deaths from CVD and 3,264,828 from IHD in Brazil, 52.86% and 58.39%, respectively, in men. The mortality rate analysis due to CVD and IHD standardized by age showed a downward trend nationwide. The relationship between the variations in these rates between the years 1980 and 2019 and the MHDI 2010 demonstrated a reduction in mortality in UFs with an MHDI above 0.7 (Figures 1 and 2).

Conclusion
The social determinants, represented by the MHDI, correlate with mortality from CVD and IHD in Brazil's UF, where the most developed ones have less mortality from these causes.

Funding Acknowledgement
Type of funding sources: None.
Directly quantified abdominal subcutaneous adipose tissue volume is negatively associated with subclinical coronary artery disease in men with psoriasis
Authors: Teklu M T , Zhou W Z , Kapoor P K , Patel N P , Playford M P P , Sorokin A V S , Dey A K D , Teague H L T , Manyak G A M , Rodante J A R , Keel A K , Chen M Y C , Bluemke D A B , Mehta N N M 
Published: October 2021

Abstract

Background
Psoriasis is a common chronic inflammatory condition associated with an increased risk of obesity and higher coronary atherosclerosis burden by coronary computed tomography angiography (CCTA). Prior studies have shown that the ability to expand subcutaneous adipose tissue (SAT) may serve to identify individuals at a lower risk of atherosclerotic cardiovascular disease. However, the relationship between abdominal SAT and high-risk subclinical coronary artery disease requires exploration.

Purpose
To characterize the relationship between abdominal SAT volume measured on low-dose computed tomography, and coronary artery disease assessed as noncalcified and lipid-rich necrotic core burden by CCTA in psoriasis.

Methods
We performed a cross-sectional study of 232 participants with psoriasis and without known cardiovascular disease. All participants underwent CCTA to characterize coronary artery disease burden and low dose abdominal computed tomography to quantify subcutaneous adipose tissue volumes. Fat depot volumes were first adjusted in a sex specific manner for each participant's body mass index in a linear regression model. The residual values from the sex stratified linear regression models were used for analyses. Coronary artery disease burden was quantified in the three main coronary arteries (QAngio, Medis, The Netherlands) and averaged. Analyses were performed with StataIC 16 (Stata Corp., College Station, TX, USA).

Results
Of the 232 participants, 92 (40%) were women and the average age was 50 years. In women, there was a positive correlation between abdominal SAT and systemic inflammation as assessed by hs-CRP (r=0.30; p=0.004) and GlycA (r=0.29; p=0.007) as well as total cholesterol (r=0.24; p=0.02) and LDL cholesterol (r=0.22; p=0.04). In men, abdominal SAT correlated with hs-CRP (r=0.18; p=0.04) and insulin resistance as assessed by the homeostatic model for insulin resistance (r=0.17; p=0.04). In models fully adjusted for traditional cardiovascular risk factors, abdominal SAT volume negatively associated with noncalcified and lipid-rich necrotic core burden in men (β=−0.17; p=0.03, β=−0.21; p=0.02, respectively), but not women (β=−0.04; p=0.72, β=0.05; p=0.68, respectively) with psoriasis (Table).

Conclusions
In psoriasis, for a given body mass index, abdominal SAT negatively associated with coronary atherosclerosis burden in men. The observed sex-specific effects on subclinical coronary artery disease warrant further study of abdominal SAT in states of chronic inflammation.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Heart, Lung and Blood Institute Intramural Research Program in Bethesda, Maryland
Sex-differences in outcomes after percutaneous coronary intervention of chronic total occlusions: insights from a large single-center registry
Authors: Kumar S , Kyaw H , Giustino G , Sartori S , Sharma S , Kini A , Mehran R 
Published: October 2021

Abstract

Introduction
Patients undergoing PCI of chronic total occlusions (CTO) are at high risk of both periprocedural and post-procedural adverse events. Whether sex-differences in outcomes exist after PCI of CTO remains unclear.

Purpose
We sought to investigate sex-differences in outcomes after CTO-PCI among an unselected real-world cohort of patients.

Methods
In our single-center retrospective study, patients who underwent elective CTO intervention from January 2000 to December 2019 were included. The primary endpoint of interest was major adverse cardiac events (MACE) defined as the composite of death, myocardial infarction (MI), and target vessel revascularization (TVR) at 1 year of follow-up.

Results
A total 1897 patients were included of which 368 were women (19.4%). Women were older (67±11.3 years vs. 62.6±10.9 years) and had a higher prevalence of comorbidities including diabetes and chronic kidney disease. Women had higher rates of procedure-related complications including increased risk of post-procedural bleeding requiring blood transfusion (3.0% vs 1.1%; p=0.007), and acute vessel closure (1.36% vs 0.2%; p=0.009). In multivariable-adjusted models for baseline confounders, female sex was associated with higher risk of MACE and TVR (Table 1).

Conclusion
Gender differences in CTO management are observed, with fewer females going for CTO revascularization in contemporary practice. Female sex is associated with procedural-related complications, higher MACE, and TVR even after successful CTO intervention.

Funding Acknowledgement
Type of funding sources: None.
Risks of trastuzumab-related cardiotoxicity in breast cancer patients in Taiwan
Authors: Chang W T C , Chen P W C , Lin H W L , Lin H S L , Li Y H L 
Published: October 2021

Abstract

Aims
Despite being an essential therapy for breast cancer, trastuzumab has potential risks of cardiotoxicity. The incidence of trastuzumab-related major adverse cardiac and cerebrovascular event (MACCE) and its predictors remain unknown in Taiwan.

Methods and results
Through a three-hospital retrospective cohort study, we analyzed the incidence of MACCE in 386 breast cancer patients exposure to trastuzumab from 2010 to 2018. To further reconfirm our findings, in a nationwide study using the Taiwanese National Health Insurance Research Database and National Cancer Registry, we identified 13502 women diagnosed with breast cancer who received chemotherapy from 2010 to 2015 and found 6751 women who received initial treatment with trastuzumab. After 1:1 propensity score matching with trastuzumab nonusers, the incidence of MACCE was measured with a median follow-up of 36 months. In the hospital-based study, among 386 patients receiving trastuzumab, the 5-year incidences of MACCE and heart failure (HF) were 5.4% and 2.8%, respectively. In the national cohort, the crude incidences of MACCEs and HF were 4.67% and 3.21%, respectively. After adjustment for age and comorbidities, the hazard ratio of MACCE was 1.485 (95% CI 1.246–1.769). Notably, among the endpoints, only the hazard ratio of HF was significantly higher in patients receiving trastuzumab than in nonusers. In the subgroup analysis, except for patients also using taxanes, those receiving trastuzumab had a higher risk of MACCE than nonusers.

Conclusions
From clinical observations in a nationwide cohort, we found an increased risk of MACCE, especially HF, in patients receiving trastuzumab. Given that its cardiotoxicity is independent of traditional cardiovascular risks, our findings highlight critical concerns regarding the cardiac safety of trastuzumab use.

Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): Chi-Mei Medical Center, National Cheng Kung University Hospital