Cardiovascular Disease In Subjects Research Articles

Association of HDL cholesterol and cardiovascular disease in subjects with familial hypercholesterolemia

Association of HDL cholesterol and cardiovascular disease in subjects with familial hypercholesterolemia

A cohort study of the effects of social support on cerebral cardiovascular disease in subjects with metabolic syndrome.

Previous studies have extensively examined the relationship between social support and various health outcomes. However, little is known about the distinct longitudinal associations between perceived social support and the development of cardiovascular events in patients with metabolic syndrome. In this cohort study, we investigated whether the levels of perceived social support in patients with metabolic syndrome were associated with an increased risk of cerebrovascular and cardiovascular events. The level of social support was assessed using the Medical Outcomes Study-Social Support Survey (MOS-SSS) in 2,721 individuals living in Wonju and Pyeongchang, South Korea. The presence of metabolic syndrome was determined by physical measurements and blood tests, and the occurrence of cerebral cardiovascular disease in relation to the presence of metabolic syndrome and the level of social support was analyzed using Cox proportional-hazards models. The median follow-up period was 2,345 days (2,192-2,618). Overall, in the group with metabolic syndrome and low social support, low social support was associated with an increased risk of later cerebral cardiovascular events; in this group, the hazard ratio after adjusting for confounding variables was 1.97 times (95% confidence interval, 1.01-3.85) higher than that in the group without metabolic syndrome and low social support. This study shows, for the first time, that the level of social support is a risk factor for preventing cerebral cardiovascular disease in patients with metabolic syndrome and suggests that social support status should be incorporated into multifactorial risk assessment and intervention procedures to prevent metabolic syndrome and cerebral cardiovascular disease.

External Validation of Four Cardiovascular Risk Prediction Models

Background and Purpose: Cardiovascular disease (CVD) is a leading cause of death and disability in the world. Many CVD risk prediction models have been created, but those most widely used in clinical settings have not been externally validated, a significant gap addressed herein. Methods: Using the Multi-Ethnic Study of Atherosclerosis (MESA), we have externally validated the Framingham Risk Score, ASSIGN (Assessing the cardiovascular disease risk using SIGN) risk score, Atherosclerotic Cardiovascular Disease (ASCVD) risk score, and the European SCORE model, which were selected based on popularity among clinicians and frequency of clinical use. The models were implemented in a computer program based on published algorithms, and 100 incident CVD and 100 non-incident CVD subjects from MESA were selected for testing the repeatability. The outcome in both models achieved 100% correlation. The individual model accuracy was tested by computing their sensitivity, specificity, accuracy, and C-statistics. Results: For discrimination, ASCVD showed the highest C-statistic (0.717) and SCORE the lowest (0.677). The Framingham score provided the most consistent results among the models, with a sensitivity of 69% and a specificity of 62%, but overestimated the risks as shown by the calibration results. SCORE was relatively inconsistent, with a sensitivity of 34% and specificity of 85%, for a risk threshold set at the top 20%. Conclusions: Calibration experiments showed that the transportability of the risk was generally poor in all models, with Framingham and SCORE particularly overestimating the risks for the American population There is clearly a need for better models to predict CVD risk in the multi-ethnic American population.

Access to public sports infrastructure in Poland as a preventive factor for cardiovascular diseases

Introduction: Cardiovascular diseases (CVDs) are a significant health concern globally, including in Poland. Physical activity has been identified as a crucial preventive factor for CVDs, and access to public sports infrastructure plays a vital role in promoting physical activity. However, the relationship between access to such infrastructure and its impact on cardiovascular health outcomes in Poland remains understudied.
 Aim of the study: This study aims to investigate the impact of access to public sports infrastructure on the prevalence of cardiovascular diseases and mortality rates in Poland.
 Materials and methods: Publicly available data were obtained regarding sports facilities, population structure, hospitalizations, and deaths.
 Results: There is a moderate negative correlation (r = -0.3096; p < 0.001) between hospitalization rates for cardiovascular diseases and the stadiums and playing fields available in the studied countries. The correlation between cardiovascular hospitalizations and indoor and outdoor arenas and gyms was also negative, but its effect was moderately weak (r = -0.2068, p < 0.001; r = -0.2597, p < 0.001, respectively). The average hospitalization rate for cardiovascular diseases in subjects over 65 years of age (M = 12117.24) was significantly higher compared to the group of all subjects (M = 3082.18) and subjects under 65 years of age (M = 1260.96). There is a negative correlation between the death rate and the availability of selected sports facilities, with a moderately weak effect for all sports infrastructure subgroups (r = -0.215 - -0.233).
 Conclusion: The effect of accessibility to public sport infrastructure on CVDs prevalence and related deaths is moderate to weak. The studied positive effect particularly affects people under 65 years of age. Further studies of other sport-connected predictors may be beneficial.

Predictive value of lipoprotein(a) in coronary artery calcification among asymptomatic cardiovascular disease subjects: A systematic review and meta-analysis

AimsStudies have indicated inconsistent results regarding the association between plasma levels of Lipoprotein(a) [Lp(a)] and coronary artery calcification (CAC). We performed a systematic review and meta-analysis to investigate the association between elevated levels of Lp(a) and risk of CAC in populations free of cardiovascular disease (CVD) symptoms. Data synthesisPubMed, Web of Science, Embase, and Scopus were searched up to July 2022 and the methodological quality was assessed using Newcastle–Ottawa Scale (NOS) scale. Random-effects meta-analysis was used to estimate pooled odds ratio (OR) and 95% confidence interval. Out of 298 studies, data from 8 cross-sectional (n = 18,668) and 4 cohort (n = 15,355) studies were used in meta-analysis. Cohort studies demonstrated a positive significant association between Lp(a) and CAC, so that individuals with Lp(a)≥30–50 exposed to about 60% risk of CAC incidence compared to those with lower Lp(a) concentrations in asymptomatic CVD subjects (OR, 1.58; 95% CI, 1.38–1.80; l2, 0.0%; P, 0.483); Subgroup analysis showed that a cut-off level for Lp(a) measurement could not statistically affect the association, but race significantly affected the relationship between Lp(a) and CAC (OR,1.60; 95% CI, 1.41–1.81). Analyses also revealed that both men and women with higher Lp(a) concentrations are at the same risk for increased CAC. ConclusionsBlood Lp(a) level was significantly associated with CAC incidence in asymptomatic populations with CVD, indicating that measuring Lp(a) may be a useful biomarker for diagnosing subclinical atherosclerosis in individuals at higher risk of CAC score. Prospero registration numberCRD42022350297.

Risk Factors for Coronary Artery Calcifications in Overweight or Obese Persons with Prediabetes: Can They Predict T2 Diabetes and Coronary Vascular Events?

It is difficult to predict the risk of developing atherosclerotic cardiovascular disease in subjects with prediabetes and obesity. The aim of this study was to assess risk factors for coronary artery calcifications (CACs) and the development of type 2 diabetes (T2D) and coronary vascular events (CVEs) after 7 years in 100 overweight or obese persons with prediabetes, according to the baseline coronary artery calcium score (CACS). Lipids, HbA1c, uric acid, and creatinine were assessed. Glucose, insulin, and c-peptide were determined during an oral glucose tolerance test. Multi-sliced computerized tomography with evaluation of CACS was performed. After 7 years, the subjects were assessed for T2D/CVE. CACs were present in 59 subjects. No single biochemical marker could predict presence of a CAC. After 7 years, T2D developed in 55 subjects (61.8% initially had both IFG and IGT). A gain in weight was the only contributing factor for T2D. Nineteen subjects developed a CVE; increased initial clustering of HOMA-IR > 1.9, LDL > 2.6, and mmol/Land TGL > 1.7 mmol/L and higher CACS were present in that group. No risk factors for CACs could be identified. A gain in weight is associated with T2D development, as are higher CACS and clustering of high LDL+TGL+HOMA-IR with CVEs.

Relationship of hyperglycaemic and glycaemic fluctuations to major adverse cardiovascular events in type 2 Diabetes Mellitus

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Dean's funds of the University of Malta Medical School. Background Type 2 diabetes mellitus (T2DM) is a known major risk factor for cardiovascular disease. Nonetheless, tight glycaemic control has not convincingly shown to lead to improved cardiovascular outcomes in clinical trials. This could be due to the fact that the vast majority of trials did not assess the effect of hypoglycaemia and glucose fluctuations in their study population. The aim of this study was thus to investigate the effects of hyperglycaemia, hypoglycaemia and glucose variability in subjects with T2DM at a median follow-up of 6.4 years. Methods Subjects with T2DM of less than 10 years duration, and on stable anti-glycaemic treatment were recruited. At baselines, all participants underwent 72-hour continuous glucose monitoring, as well as parameters assessment. Moreover, risk factor bloods, including an HbA1c level, were taken. Patients were consequently followed up at 6.4 years (median: 2338 days, IQR: 2116-2446 days) and MACE (major adverse cardiovascular events) was assessed. This comprised a composite of all-cause mortality, non-fatal myocardial infarction (both ST-elevation myocardial infarction and non-ST elevation myocardial infarction), revascularisation (both percutaneous and coronary artery bypass grafting), non-fatal stroke and hospitilisation for heart failure. The incidence of MACE was assessed from electronic database available at the local public hospital that caters for the entire Maltese population. Univariate analysis was performed using Mann-Whitney U test for non-parametric variables and independent samples t-test for parametric variables. Variables with a p value <0.1 were consequently put in the multivariate Cox regression model to assess for independent predictors of MACE. Statistical analysis was performed using SPSS version 24.0 for Windows. Findings: The study population comprised 122 subjects with T2DM (89 males: 32 females). The mean age was 62.6 years and the mean DM duration was 3.7 years at baseline. At follow-up, 19 participants exhibited MACE. Variables with a p value of <0.1 in univariate analysis comprised fructosamine, HbA1c, mean systolic blood pressure measurements as well as duration of BG (blood glucose) <3.9 mmol/L and standard deviation of BG (an indicator of intra-individual blood glucose variability; the latter two were derived from 72-hour continuous glucose monitoring). Following adjustment for both age and gender, HbA1c (OR: 1.9, 95% CI: 1.32-2.73, p= 0.001) levels at baseline as well as standard deviation of BG (OR: 1.93, 95% CI: 1.68-3.16, p= 0.009) were shown to be independent predictors of MACE. Interpretation: This study demonstrates that cardiovascular disease in subjects with T2DM of relatively short duration is not only influenced by poor glycaemic control but also by fluctuations in glucose levels, as evidenced by measurements obtained from continuous glucose monitoring obtained at baseline.

Hereditary hemochromatosis with homozygous C282Y HFE mutation: possible clinical model to assess effects of elevated reactive oxygen species on the development of cardiovascular disease.

Hereditary hemochromatosis with the homozygous C282Y HFE mutation (HH-282H) is a genetic condition which causes iron overload (IO) and elevated reactive oxygen species (ROS) secondary to the IO. Interestingly, even after successful iron removal therapy, HH-282H subjects demonstrate chronically elevated ROS. Raised ROS are also associated with the development of multiple cardiovascular diseases and HH-282H subjects may be at risk to develop these complications. In this narrative review, we consider HH-282H subjects as a clinical model for assessing the contribution of elevated ROS to the development of cardiovascular diseases in subjects with fewer confounding clinical risk factors as compared to other disease conditions with high ROS. We identify HH-282H subjects as a potentially unique clinical model to assess the impact of chronically elevated ROS on the development of cardiovascular disease and to serve as a clinical model to detect effective interventions for anti-ROS therapy.

Familial Hypercholesterolemia Patients with COVID-19-Effective Cholesterol-Lowering Therapy is Urgent both during and after Infection.

Heterozygous familial hypercholesterolemia (HeFH) patients are the prime example of subjects who are at high risk for both acute myocardial infarction (AMI) and ischemic stroke during, and post, SARS-CoV-2 infection. HeFH per se, if left untreated, results in premature clinical atherosclerosis often presenting in the fourth or fifth decade of life. The other concern in HeFH is endothelial dysfunction which is already evident from early childhood. In untreated HeFH patients, the severe hypercholesterolemia causes endothelial dysfunction from an early age, and as a result thereof, atherosclerotic lesions develop prematurely, particularly in the coronary arteries, and result in further endothelial dysfunction and inflammation in these critical segments of the arterial tree. As the pre-existing endothelial dysfunction in HeFH patients is most likely sensitive to further direct and indirect SARS-CoV-2 virus-dependent damage, we can infer that HeFH serves as an example of a comorbidity that predicts a poorer prognosis with COVID-19 infection. Indeed, a large US national database study showed that patients diagnosed with HeFH and SARS-CoV-2 infection had significantly increased Annualized Incidence Density Rates (AIDRs) of AMI when compared to matched HeFH controls not having been diagnosed with SARS-CoV-2 infection. Effective cholesterol lowering is essential for the prevention, or at least alleviation, of the detrimental effects of SARS-CoV-2 infection among HeFH patients. Due to the pre-existing subclinical or even clinical atherosclerotic cardiovascular disease in subjects with HeFH, cholesterol-lowering treatment needs to be continued or, better still, intensified during, and for an extended period post, SARS-CoV-2 infection.

Impact of periodontitis on gingival crevicular fluid miRNAs profiles associated with cardiovascular disease risk.

Recent emerging evidence has shown that microRNA (miRNAs) is involved in several epigenetic processes linked with periodontitis, increased oxidative stress and cardiovascular disease (CVD). The present study aimed to assess the impact of periodontitis on gingival crevicular fluid (GCF) miRNAs expression associated with CVD risk and to evaluate possible confounders that influenced this association. For the present study, healthy controls (n=28) and subjects with CVD (n=28), periodontitis (n=30) and periodontitis + CVD (n=29) were enrolled. All subjects underwent regular periodontal examinations and blood sampling. In addition, GCF sampling was performed, and miRNAs 7a-5p, 21-3p, 21-5p, 100-5p, 125-5p, 200b-3p, and 200b-5p expression was analyzed using a real-time quantitative polymerase chain reaction (RT-PCR). The results showed that periodontitis and periodontitis + CVD subjects presented significantly different GCF miRNAs expression compared to healthy controls and CVD subjects. More specifically, compared to healthy controls and CVD, subjects with periodontitis and periodontitis + CVD showed higher GCF miRNA 7a-5p, miRNA 21-3p, miRNA 21-5p, miRNA 200b-3p, and miRNA 200b-5p (p < .05) and lower miRNA 100-5p, miRNA 125-5p levels (p < .05). Furthermore, the multivariate regression analysis evidenced that periodontitis (miRNA 21-3p, 100-5p) and periodontal inflamed surface area (PISA) (miRNA 7a-5p, 21-3p, 21-5p, 100-5p, 125-5p, 200b-3p) were significant predictors of GCF miRNAs concentration (p < .05). The results of the study highlighted that the periodontitis and periodontitis + CVD group showed higher GCF miRNAs expression than healthy controls and CVD subjects. Furthermore, periodontitis and its extent (PISA) were revealed as significant predictors of GCF miRNAs associated with CVD risk.

Coronary Artery Disease and Diabetes - A Review of the Current Literature with focus on Management

This article reviews current knowledge concerning cardiovascular disease in subjects with (and without) diabetes mellitus. It discusses the worldwide distribution and dimensions of these disorders. It contrasts incidence, prevalence, investigations, treatment strategies and outcomes of coronary heart disease and myocardial infarction amongst patients with and without diabetes. Emphasis is given to discussing the outcomes of various trials of treatments and management strategies applied to such patients and how closely they apply to the diabetic cohorts who constitute a substantial proportion of most of those trials. The article concludes with a review of specific treatments for elevated glucose which may have prognostic benefits in CVD.

Multi-omics study identifies novel signatures of DNA/RNA, amino acid, peptide, and lipid metabolism by simulated diabetes on coronary endothelial cells

Coronary artery endothelial cells (CAEC) exert an important role in the development of cardiovascular disease. Dysfunction of CAEC is associated with cardiovascular disease in subjects with type 2 diabetes mellitus (T2DM). However, comprehensive studies of the effects that a diabetic environment exerts on this cellular type are scarce. The present study characterized the molecular perturbations occurring on cultured bovine CAEC subjected to a prolonged diabetic environment (high glucose and high insulin). Changes at the metabolite and peptide level were assessed by Liquid Chromatography–Mass Spectrometry (LC–MS2) and chemoinformatics. The results were integrated with published LC–MS2-based quantitative proteomics on the same in vitro model. Our findings were consistent with reports on other endothelial cell types and identified novel signatures of DNA/RNA, amino acid, peptide, and lipid metabolism in cells under a diabetic environment. Manual data inspection revealed disturbances on tryptophan catabolism and biosynthesis of phenylalanine-based, glutathione-based, and proline-based peptide metabolites. Fluorescence microscopy detected an increase in binucleation in cells under treatment that also occurred when human CAEC were used. This multi-omics study identified particular molecular perturbations in an induced diabetic environment that could help unravel the mechanisms underlying the development of cardiovascular disease in subjects with T2DM.

FiberCreme as a Functional Food Ingredient Reduces Hyperlipidemia and Risk of Cardiovascular Diseases in Subjects with Hyperlipidemia.

FiberCreme is a commercial nondairy creamer made with isomalto-oligosaccharides (IMO) that is a source of dietary fiber. A study showed that IMO could decrease cholesterol (CH) and triglycerides, which are factors related to the risk of cardiovascular diseases and insulin resistance. This study evaluated FiberCreme’s ability as a functional food ingredient to reduce CH and the risk of cardiovascular diseases in subjects with hyperlipidemic. This controlled clinical study trial involved 53 (23∼57 years old) subjects with borderline high CH (>190 mg/dL) or triglycerides (>150 mg/dL) or both, who were divided into FiberCreme and control groups. The participant received 86 g of cookies daily for 4 weeks. The FiberCreme and control groups consumed FiberCreme-containing cookies and cookies with coconut cream with 5.78% and 4.69% fibers, respectively. Lipid profile, anthropometry, body composition, and food intake were also measured. Data analysis was performed using SPSS v.25. This study suggests that FiberCreme cookies can significantly reduce CH, triglycerides, and cardiac risk ratio scores.

Advanced Glycations End Products in the Skin as Biomarkers of Cardiovascular Risk in Type 2 Diabetes.

The incidence and prevalence of diabetes are increasing worldwide, and cardiovascular disease (CVD) is the leading cause of death among subjects with type 2 diabetes (T2D). The assessment and stratification of cardiovascular risk in subjects with T2D is a challenge. Advanced glycation end products are heterogeneous molecules produced by non-enzymatic glycation of proteins, lipids, or nucleic acids. Accumulation of advanced glycation end products is increased in subjects with T2D and is considered to be one of the major pathogenic mechanism in developing complications in diabetes. Skin AGEs could be assessed by skin autofluorescence. This method has been validated and related to the presence of micro and macroangiopathy in individuals with type 2 diabetes. In this context, the aim of this review is to critically summarize current knowledge and scientific evidence on the relationship between skin AGEs and CVD in subjects with type 2 diabetes, with a brief reference to other diabetes-related complications.

HbA1c variability predicts cardiovascular complications in type 2 diabetes regardless of being at glycemic target

BackgroundHbA1c variability has emerged as risk factor for cardiovascular diseases in diabetes. However, the impact of HbA1c variability on cardiovascular diseases in subjects within the recommended HbA1c target has been relatively unexplored.MethodsUsing data from a large database, we studied 101,533 people with type 2 diabetes without cardiovascular diseases. HbA1c variability was expressed as quartiles of the standard deviation of HbA1c during three years (exposure phase). The primary composite outcome included non-fatal myocardial infarction, non-fatal stroke, all-cause mortality and was assessed during five years following the first three years of exposure to HbA1c variability (longitudinal phase). An expanded composite outcome including non-fatal myocardial infarction, non-fatal stroke, coronary revascularization/reperfusion procedures, peripheral revascularization procedures, and all-cause mortality was also considered, as well as a series of specific cardiovascular complications. Cox models were adjusted for a large range of risk factors and results were expressed as adjusted hazard ratios.ResultsAn association between HbA1c variability and all the outcomes considered was found. The correlation between HbA1c variability and cardiovascular complications development was confirmed in both the subgroups of subjects with a mean HbA1c ≤ 53 mmol/mol (recommended HbA1c target) or > 53 mmol/mol during the exposure phase. The risk related to HbA1c variability was higher in people with mean HbA1c ≤ 53 mmol/mol for the primary outcome (p for interaction 0.004), for the expanded secondary outcome (p for interaction 0.001) and for the stroke (p for interaction 0.001), even though HbA1c remained at the target during the follow-up.ConclusionsThese findings suggest that HbA1c variability may provide additional information for an optimized management of diabetes, particularly in people within the target of HbA1c.

EFFICACY OF A LIPID-LOWERING DIET ON KEY FATTY ACID RATIOS AND OMEGA-3 INDEX IN HYPERLIPIDEMIC SUBJECTS.

Polyunsaturated fatty acid (PUFA) dietary intake, status and serum key fatty acid (FA) ratios may aid in cardiovascular disease-related risk assessment. The aim of this study was to investigate the effects of lipid-lowering diet on key FA ratios in serum phospholipids and omega-3 index in erythrocyte phospholipids in moderately hyperlipidemic subjects. The study included 41 subjects, mean age 56±6 years. Nutritional habits were evaluated by food frequency questionnaire. Participants followed lipid lowering diet for 12 weeks. Energy intake of omega-6 and omega-3 FA was changed from 7.6% and 0.6% to 5.7% and 1.2%, respectively. Marked decrease in four FA ratios in serum phospholipids, i.e., omega-6/omega-3, arachidonic acid (AA)/eicosapentaenoic acid (EPA), AA/docosahexaenoic acid (DHA), AA/(EPA+DHA) and omega-3 index (EPA+DHA) was found in study subjects after lipid-lowering diet. Total cholesterol/high-density lipoprotein (HDL), low-density lipoprotein (LDL)/HDL and triacylglycerol/HDL-cholesterol ratios positively correlated with all FA ratios, and negatively correlated with total omega-3 levels in serum phospholipids and omega-3 index in erythrocytes. Total serum omega-3 levels showed strongest association with lipoprotein ratios and positive correlation with homeostatic model assessment (HOMA) index. In conclusion, lipid-lowering diet resulted in decreased serum key FA ratios, increased omega-3 levels, and improved insulin sensitivity that may lead to a lower risk of cardiovascular disease in subjects with moderate hyperlipidemia.

Efficacy of AYUSH Common Yoga protocol along with Surya Namaskar on the Dyslipidemia subjects in Haryana

Background: Dyslipidemia might be the cause of many cardiovascular diseases (CVD). Yoga intervention is known to prevent the progression of various lifestyle-based health conditions. Dyslipidemia marks the onset of early CVD, and a Yoga based-intervention at this stage might reverse the progression. Aim: To analyze the effect of AYUSH Common Yoga Protocol (CYP) and CYP combined with Surya Namaskar (CYP-SN) on dyslipidemia subjects in Haryana. Method: A three-arm randomized controlled trial was carried out in which ninety individuals were allocated into three groups, CYP group, CYP-SN group and control group. Result: The three-month intervention resulted in elevation of HDL- cholesterol (HDL-C) levels in the group that had undergone CYP protocol, as well as CYP-SN protocol, implying the benefits of Surya Namaskar in modifying lipid profile reflecting an improvement in the dyslipidemia. Conclusion: CYP and CYP-SN Yoga group when practiced regularly for a sustained period can help in reducing co-morbidity and severe CVD in subjects with dyslipidemia. When implemented in dynamic way, CYP-SN has shown to have a greater impact in management of dyslipidemia.

Evaluation of Sertraline as an antioxidant, anti-inflammatory and anticataract

Sertraline can also protect against environmental causes of free radicals such as smoking. Cigarette tar is a source of free radicals which has been found to damage erythrocyte membranes. It was also found that Sertraline and its conjugate metabolites could protect erythrocytes from the membranous damage that is caused by smoking. The ability of Sertraline is claimed to exert many beneficial effects on health, including protection against various diseases such as osteoporosis, lung cancer, and cardiovascular disease. The studies showed that there has been a reduction in the risk of cardiovascular disease in subjects, who had a high intake of flavonoids. Progressive disorder of the lung parenchyma and airways or also known as chronic obstructive pulmonary disease (COPD) which happens to be the third-leading cause of death in the USA. Therapies thus far for COPD, unfortunately, is said to be partially effective with possibilities of side effects.

DeepStrain: A Deep Learning Workflow for the Automated Characterization of Cardiac Mechanics.

Myocardial strain analysis from cinematic magnetic resonance imaging (cine-MRI) data provides a more thorough characterization of cardiac mechanics than volumetric parameters such as left-ventricular ejection fraction, but sources of variation including segmentation and motion estimation have limited its wider clinical use. We designed and validated a fast, fully-automatic deep learning (DL) workflow to generate both volumetric parameters and strain measures from cine-MRI data consisting of segmentation and motion estimation convolutional neural networks. The final motion network design, loss function, and associated hyperparameters are the result of a thorough ad hoc implementation that we carefully planned specific for strain quantification, tested, and compared to other potential alternatives. The optimal configuration was trained using healthy and cardiovascular disease (CVD) subjects (n = 150). DL-based volumetric parameters were correlated (>0.98) and without significant bias relative to parameters derived from manual segmentations in 50 healthy and CVD test subjects. Compared to landmarks manually-tracked on tagging-MRI images from 15 healthy subjects, landmark deformation using DL-based motion estimates from paired cine-MRI data resulted in an end-point-error of 2.9 ± 1.5 mm. Measures of end-systolic global strain from these cine-MRI data showed no significant biases relative to a tagging-MRI reference method. On 10 healthy subjects, intraclass correlation coefficient for intra-scanner repeatability was good to excellent (>0.75) for all global measures and most polar map segments. In conclusion, we developed and evaluated the first end-to-end learning-based workflow for automated strain analysis from cine-MRI data to quantitatively characterize cardiac mechanics of healthy and CVD subjects.

High glomerular filtration rate is associated with impaired arterial stiffness and subendocardial viability ratio in prediabetic subjects

Background and aimsHigh glomerular filtration rate (HGFR) is associated with cardiovascular damage in the setting of various conditions such as obesity and diabetes. Prediabetes was also associated with increased GFR, however, the association between prediabetes, HGFR and cardiovascular damage has not been investigated. In this study, we investigated the association between HGFR and early markers of cardiovascular disease in subjects with prediabetes. Methods and resultsAugmentation pressure (Aug), augmentation index (AIx), subendocardial viability ratio (SEVR), pulse wave velocity (PWV), intima-media thickness (IMT) and estimated GFR (eGFR) were evaluated in 230 subjects with prediabetes. The eGFR was assessed using the Chronic Kidney Disease Epidemiology Collaboration formula. HGFR was defined as an eGFR above the 75th percentile.Prediabetic subjects were divided into two groups according to presence/absence of HGFR: 61 subjects with HGFR and 169 subjects without HGFR. Subjects with HGFR showed higher Aug, AIx and lower SEVR compared with prediabetic subjects with lower eGFR (14.1 ± 7.2 vs 10.8 ± 6.2, 32.9 ± 12.7 vs 27.6 ± 11.7, 153.5 ± 27.8 vs 162 ± 30.2, p < 0.05). No differences were found in PWV and IMT values between the two groups. Then, we performed multiple regression analysis to test the relationship between Aug, SEVR and several cardiovascular risk factors. In multiple regression analysis Aug was associated with age, systolic blood pressure (BP), HOMA-IR and eGFR; the major determinants of SEVR were systolic BP, HOMA-IR and eGFR. ConclusionSubjects with prediabetes and HGFR exhibited an increased Aug, AIx and a reduced SEVR. These alterations are associated with eGFR, insulin resistance and systolic BP.