Cardiovascular Risk Categories Research Articles

Artículo traducido] Realización del examen de calcio en los pacientes con psoriasis severa: evaluación del riesgo y potencial de reclasificación en una población de riesgo cardiovascular bajo

BackgroundPatients with severe psoriasis have an increased cardiovascular (CV) risk and prevalence of subclinical coronary artery disease (CAD). Coronary artery calcium (CAC) testing can detect subclinical CAD and improve cardiovascular risk assessment beyond clinical scores. ObjectivesEvaluate the presence and magnitude of subclinical CAD determined by CAC score among the different ESC/EAS CV risk categories, as well as the potential for risk reclassification, in patients with severe psoriasis from a low CV risk population. MethodsUnicentric cross-sectional study in 111 patients with severe chronic plaque psoriasis from a low CV risk population in the Mediterranean region. Patients were classified into four CV risk categories according to the ESC/EAS guideline recommendations and HeartScore/SCORE calibrated charts. Patients underwent coronary computed tomography to determine their CAC scores. Patients in the moderate-risk category with a CAC score of ≥100 were considered to be reclassified as recommended by the 2019 ESC/EAS guidelines. Reclassification was also considered for patients in the low-risk category with a CAC score>0. ResultsPresence of subclinical CAD was detected in 46 (41.4%) patients. These accounted for 86.2% of patients in high/very-high-risk categories and 25.6% of patients in non-high-risk categories. Fourteen (17.1%) of the patients in non-high-risk categories were reclassifiable due to their CAC score. This percentage was higher (25%) when considering the moderate-risk category alone and lower (13.8%) in the low-risk category. Age was the only variable associated with presence of subclinical CAD and reclassification. ConclusionsOver 40% of patients with severe psoriasis from a low-risk region and up to 25% of those in non-high-risk categories have subclinical CAD. CAC appears to be useful for reclassification purposes in CV risk assessment of patients with severe psoriasis. Further research is required to elucidate how CAC could be implemented in everyday practice at outpatient dermatology clinics dedicated to severe psoriasis.

Biochemical Efficacy of Sodium-Glucose Cotransporter 2 Inhibitors by Cardiovascular Risk Profile and Volume Status in a Real-World Diabetic Population.

Despite large-scale randomized clinical trials (RCTs) highlighting a consistent prognostic benefit of sodium-glucose cotransporter 2 inhibitors (SGLT2is) both in diabetic patients at high cardiovascular risk and in those with heart failure, there is relative paucity of data on their biochemical effects in a real-world setting. We performed a retrospective analysis on consecutive diabetic patients who were prescribed a SGLT2i in a tertiary referral center and completed at least 1 year of treatment. Changes in glycated hemoglobin, weight, and hematocrit were compared across 2 cardiovascular risk categories, defined through the inclusion criteria of 3 large RCTs. Of the 459 patients screened, 312 completed 1 year of treatment (68.0%), 92 interrupted the treatment prematurely (20.0%), and 55 were lost to follow-up (12.0%). The most common cause of drug discontinuation was genital or urinary tract infections (9.4%). At 1 year, reduction in glycated hemoglobin concentration (-0.7 ± 1.5%, P < 0.001) and body weight (2.4 ± 4.6 kg, P < 0.001) was comparable between patients at high versus low cardiovascular risk, while hematocrit increase (2.3 ± 3.3%, P < 0.001) was more marked in patients with high cardiovascular risk and low baseline hematocrit. In a real-world population of diabetic patients, SGLT2is were well-tolerated at 1 year and led to improved glycemic control and weight loss. Hematocrit increase was more consistent in patients with high cardiovascular risk and signs of fluid overload, indicating euvolemic restoration as a potential cardioprotective mechanism mediated by these compounds.

Cardiovascular risks and primary interventions among treated rheumatoid arthritis patients: Experience from a tertiary care centre in Kuala Lumpur, Malaysia

Purpose: To investigate the cardiovascular risk among treated rheumatoid arthritis (RA) patients to predict the factors associated with high cardiovascular risk and to determine the presence of pharmacotherapy primary prevention among treated RA patients with high cardiovascular disease (CVD) risk.Methods: The study was a prospective cross-sectional study on adult patients diagnosed and treated for RA and without established heart disease/stroke. Cardiovascular risk scoring was based on Framingham Cardiovascular Disease 10-year risk prediction model (BMI model) x 1.5 factor while descriptive and inferential analyses were done using SPSS.Results: High CVD risk was defined as FRS-CVD cardiovascular risk categories (&gt;20%) and 55.9% of patients were at high CVD risk. Use of Hydroxychloroquine (OR: 0.44; 95 % CI: 0.21- 0.92; p= 0.028) and COX-2 inhibitors (OR: 0.31; 95% CI:0.10- 0.95; p = 0.039) were found to be significantly associated with high CVD risk among treated RA patients. Significant number of high CVD risk patients did receive pharmacotherapy primary prevention (p = 0.001).Conclusion: Hydroxychloroquine and COX-2 inhibitors are independent negative risk predictors associated with high CVD risk among treated RA patients. Baseline cardiovascular risk data may be useful in rational use of medications to treat RA, considering that cardiovascular related mortality is the leading cause of death in RA.

Cardiovascular disease risk assessment in a rural population (&gt;40 years)

Context: Cardiovascular diseases (CVDs) are the most common cause of death worldwide, although low- and middle-income countries are affected disproportionately. By 2020, it is estimated that there will be around 25 million deaths from Cardiovascular diseases globally,and out of that 19 million would be from middle- and low-income countries. Aims: The aim of this study was to estimate the 10-year risk of cardiovascular events among adults aged ≥40 years in a rural population of Meerut district using the World Health Organization (WHO)/International Society of Hypertension (ISH) risk prediction charts for SEAR-D region. Community based cross-sectional study, which was conducted from january 2021 to december 2021, in the rural areas of Meerut district. Methods and Material: Study was conducted on 397 subjects who were aged ≥40 years. Two sets of the WHO/ISH risk prediction charts, with and without cholesterol, for WHO SEAR-D region were used in this study. Statistical analysis used: SPSS, version 23 was used for data analysis. Results: By using the risk assessment tools, with and without cholesterol, 78.5 and 76.8%, of the population being studied were in the 10-year cardiovascular risk category with &lt;10% risk, whereas 11.2 and 10.4%, were in the cardiovascular risk category of ≥20% risk.

PRESCRIPTIVE APPROPRIATENESS IN PRIMARY CARDIOVASCULAR PREVENTION: DATA FROM NIGUARDA HOSPITAL

Objective: The main cause of waste of health resources is represented by overuse of diagnostic and therapeutic procedures. Given its high prevalence and the importance of identifying hypertensive-mediated organ damage, management of patients with arterial hypertension can lead to a lack of appropriateness. The aim of this study was to evaluate the prescriptive appropriateness of non-invasive diagnostic tests (Echocardiography, Carotid ultrasound, ECG exercise testing, 24 h Ambulatory blood pressure monitoring) in outpatients referring to an ambulatory of primary cardiovascular prevention. Design and method: 559 specialistic ambulatory visits were retrospectively analysed and appropriateness of every prescription was evaluated. An integration of different Italian and European guidelines was used to define appropriateness. Moreover, we evaluated the correlation between prescriptions, appropriateness and clinical characteristics of the population. Results: During the 559 ambulatory visits analysed, 449 prescriptions were made, including 198 echocardiographies, 148 carotid ultrasound, 85 24 h ABPM and 18 ECG exercise testing. The global percentage of appropriate prescriptions was 40.3%. Focusing on each test, appropriateness rate was 49.4% in 24 h ABPM, 43.9% in echocardiography, 38.9% in ECG exercise testing and 30.4% in carotid ultrasound. A significant correlation was identified between the age and cardiovascular risk category of patients and the appropriateness of echocardiography, 24 h ABPM and carotid ultrasound, and a correlation between appropriateness of echocardiography and the duration of hypertension and the presence of valvular heart disease. Conclusions: Our study shows a relevant percentage of inappropriate prescriptions of non-invasive cardiologic exams; moreover, there might be a greater lack of appropriateness in young and low risk patients.

Association of epicardial adipose tissue and coronary artery calcium score in patients with atrial fibrillation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Both coronary artery calcium (CAC) and epicardial adipose tissue (EAT) had been implicated in coronary artery disease (CAD) and risk of future adverse cardiovascular events. There are scarce data regarding the assessment and association of EAT volume and CAC score (CACS) in atrial fibrillation (AF) patients. Purpose To assess the association between EAT volume and the presence and severity of CAC in patients with AF. Methods Retrospective and single-centre study including consecutive patients with AF undergoing contrast-enhanced cardiac computed tomography for catheter ablation planning, from 2017 to 2019. Patients with known history of CAD and moderate to severe valvular heart disease were excluded. Baseline clinical and demographical data were collected, as well as their cardiovascular risk, based on the SCORE (Systematic Coronary Risk Evaluation) system and cardiovascular risk categories. We assessed CACS (Agatston method) and EAT volume and analysed their association. EAT was defined as the adipose tissue accumulated between the visceral pericardium and the myocardium and was semi-automatically reconstructed by manually tracing the pericardium. Patients were split into three groups according to CACS: 0, 1-99 and ≥100. A logistic regression (LR) analysis was performed to explore the relationship between EAT volume and the presence of CAC (CACS&amp;gt;0), adjusted for age, gender, obesity, diabetes mellitus and hypertension. Results A total of 354 patients were included, with a mean age of 56 ± 12 years, 66% male and 21% with persistent AF. A CHA2DS2-VASc score ≥2 was present in 130 (37%) patients and most patients had low to moderate cardiovascular risk (n=213, 82%). More than half of the patients had a CACS&amp;gt;0 (n=185, 52%), of which 63 patients (18%) had a CACS≥100. The mean EAT volume was 79 ± 39 ml. There was a significant association between EAT volume and the presence of CAC: CACS=0 69 ± 34 ml vs CACS 1-99 84 ± 38 ml vs CACS ≥100 95 ± 45 ml (p&amp;lt;0.001) (Fig. 1). After covariate adjustment (LR model R2 = 0.373, p &amp;lt;0.0001), the presence of CAC was not associated with EAT volume (OR 1.00, 95%CI 1.00 - 1.01, p=0.2) or obesity, and only with higher age, male gender, hypertension and diabetes mellitus (Fig. 2). Conclusion In our cohort of patients with AF undergoing catheter ablation we observed an association between EAT and CACS. Nevertheless, EAT volume was not an independent predictor of CACS and only the classical cardiovascular risk factors remained significant.

P348 PRESCRIPTIVE APPROPRIATENESS IN PRIMARY CARDIOVASCULAR PREVENTION: DATA FROM NIGUARDA HOSPITAL

Abstract Background The main cause of waste of health resources is represented by overuse of diagnostic and therapeutic procedures. Given its high prevalence and the importance of identifying hypertensive–mediated organ damage, management of patients with arterial hypertension can lead to a lack of appropriateness. The aim of this study was to evaluate the prescriptive appropriateness of non–invasive diagnostic tests (Echocardiography, Carotid ultrasound, ECG exercise testing, 24h Ambulatory blood pressure monitoring) in outpatients referring to an ambulatory of primary cardiovascular prevention. Methods 559 specialistic ambulatory visits were retrospectively analysed and appropriateness of every prescription was evaluated. An integration of different Italian and European guidelines was used to define appropriateness. Moreover, we evaluated the correlation between prescriptions, appropriateness and clinical characteristics of the population. Results During the 559 ambulatory visits analysed, 449 prescriptions were made, including 198 echocardiographies, 148 carotid ultrasound, 85 24h ABPM and 18 ECG exercise testing. The global percentage of appropriate prescriptions was 40.3%. Focusing on each test, appropriateness rate was 49.4% in 24h ABPM, 43.9% in echocardiography, 38.9% in ECG exercise testing and 30.4% in carotid ultrasound. A significant correlation was identified between the age and cardiovascular risk category of patients and the appropriateness of echocardiography, 24h ABPM and carotid ultrasound, and a correlation between appropriateness of echocardiography and the duration of hypertension and the presence of valvular heart disease. Conclusions Our study shows a relevant percentage of inappropriate prescriptions of non–invasive cardiologic exams; moreover, there might be a greater lack of appropriateness in young and low risk patients.

Comparison of severe maternal morbidity in pregnancy by modified World Health Organization Classification of maternal cardiovascular risk

BackgroundTo compare rates of severe maternal morbidity (SMM) for pregnant patients with a cardiac diagnosis classified by the modified World Health Organization (mWHO) classification to those without a cardiac diagnosis. MethodsThis retrospective study using the 2015-2019 Nationwide Readmissions Database identified hospitalizations, comorbidities, and outcomes using diagnosis and procedure codes. The primary exposure was cardiac diagnosis, classified into low-risk (mWHO class I and II) and moderate-to-high-risk (mWHO class II/III, III, or IV). The primary outcome was SMM or death during the delivery hospitalization; secondary outcomes included cardiac-specific SMM during delivery hospitalizations and readmissions after the delivery hospitalization. ResultsA weighted national estimate of 14,995,122 delivery admissions was identified, including 46,541 (0.31%) with mWHO I-II diagnoses and 37,330 (0.25%) with mWHO II/III-IV diagnoses. Patients with mWHO II/III-IV diagnoses experienced SMM at the highest rates (22.8% vs 1.6% for no diagnosis; with adjusted relative risk (aRR) of 5.67 [95% CI: 5.36-6.00]). The risk of death was also highest for patients with mWHO II/III-IV diagnoses (0.3% vs <0.1% for no diagnosis; aRR 18.07 [95% CI: 12.25-26.66]). Elevated risk of SMM and death persisted to 11 months postpartum for those patients with mWHO II/III-IV diagnoses. ConclusionsIn this nationwide database, SMM is highest among individuals with moderate-to-severe cardiac disease based on mWHO classification. This risk persists in the year postpartum. These results can be used to enhance pregnancy counseling.

Performance of Coronary Artery Calcium Testing in Patients With Severe Psoriasis: Risk Assessment and Reclassification Potential in a Low Cardiovascular Risk Population

BackgroundPatients with severe psoriasis have an increased cardiovascular (CV) risk and prevalence of subclinical coronary artery disease (CAD). Coronary artery calcium (CAC) testing can detect subclinical CAD and improve cardiovascular risk assessment beyond clinical scores. ObjectivesEvaluate the presence and magnitude of subclinical CAD determined by CAC score among the different ESC/EAS CV risk categories, as well as the potential for risk reclassification, in patients with severe psoriasis from a low CV risk population. MethodsUnicentric cross-sectional study in 111 patients with severe chronic plaque psoriasis from a low CV risk population in the Mediterranean region. Patients were classified into four CV risk categories according to the ESC/EAS guideline recommendations and HeartScore/SCORE calibrated charts. Patients underwent coronary computed tomography to determine their CAC scores. Patients in the moderate-risk category with a CAC score of ≥100 were considered to be reclassified as recommended by the 2019 ESC/EAS guidelines. Reclassification was also considered for patients in the low-risk category with a CAC score>0. ResultsPresence of subclinical CAD was detected in 46 (41.4%) patients. These accounted for 86.2% of patients in high/very-high-risk categories and 25.6% of patients in non-high-risk categories. Fourteen (17.1%) of the patients in non-high-risk categories were reclassifiable due to their CAC score. This percentage was higher (25%) when considering the moderate-risk category alone and lower (13.8%) in the low-risk category. Age was the only variable associated with presence of subclinical CAD and reclassification. ConclusionsOver 40% of patients with severe psoriasis from a low-risk region and up to 25% of those in non-high-risk categories have subclinical CAD. CAC appears to be useful for reclassification purposes in CV risk assessment of patients with severe psoriasis. Further research is required to elucidate how CAC could be implemented in everyday practice at outpatient dermatology clinics dedicated to severe psoriasis.

Automatic coronary artery calcium scoring on routine chest computed tomography (CT): comparison of a deep learning algorithm and a dedicated calcium scoring CT.

The aim of this study was to investigate the reliability and accuracy of automatic coronary artery calcium (CAC) scoring and risk classification in non-gated, non-contrast chest computed tomography (CT) of different slice thicknesses using a deep learning algorithm. This retrospective study was performed at 2 tertiary hospitals. Paired, dedicated calcium-scoring CT scans and non-gated, non-contrast chest CT scans taken within a month from the same patients were included. Chest CT images were grouped according to the slice thickness (group A: 1 mm; group B: 3 mm). For internal scans, the CAC score manually measured on dedicated calcium scoring CT images was used as the gold standard. The deep learning algorithm for group A was trained using 150 chest CT scans and tested using 144 scans, and that for group B was trained using 170 chest CT scans and tested using 144 scans. The intraclass correlation coefficient (ICC) was used to evaluate the correlation between the algorithm and the gold standard. Agreement between the deep learning algorithm, the manual results on chest CT, and the gold standard was determined by Bland-Altman analysis. Cardiac risk categories were compared. External validation was performed on 334 paired scans from a different organization. A total of 608 internal paired scans (1 mm: 294; 3 mm: 314) of 406 individuals and 334 external paired scans (1 mm: 117; 3 mm: 117) of 117 individuals were included in the analysis. The ICCs between the deep learning algorithm and the gold standard were excellent in both group A (0.90; 95% CI: 0.85-0.93) and group B (0.94; 95% CI: 0.92-0.96). The Bland-Altman plots showed good agreement in both groups. For the cardiovascular risk category, the deep learning algorithm accurately classified 71% of cases in group A and 81% of cases in group B. The Kappa values for risk classification were 0.72 in group A and 0.82 in group B. External validation yielded equally good results. The automatic calculation of CAC score and cardiovascular risk stratification on non-gated chest CT using a deep learning algorithm was reliable and accurate on both 1 and 3 mm scans. Chest CT with a slice thickness of 3 mm was slightly more accurate in CAC detection and risk classification.

Discrimination is associated with C-reactive protein among young sexual minority men.

This report examines associations between everyday discrimination, microaggressions, and CRP to gain insight on potential mechanisms that may underlie increased CVD risk among sexual minority male young adults. The sample consisted of 60 participants taken from the P18 cohort between the ages of 24 and 28years. Multinomial logistic regression models were used to examine the association between perceived everyday discrimination and LGBQ microaggressions with C-reactive protein cardiovascular risk categories of low-, average-, and high-risk, as defined by the American Heart Association and Centers for Disease Control. Adjustments were made for BMI. Individuals who experienced more everyday discrimination had a higher risk of being classified in the high-risk CRP group compared to the low-risk CRP group (RRR = 3.35, p = 0.02). Interpersonal LGBQ microaggressions were not associated with CRP risk category. Everyday discrimination, but not specific microaggressions based on sexual orientation, were associated with elevated levels of CRP among young sexual minority men (YSMM). Thus, to implement culturally and age-appropriate interventions, further researcher is needed to critically examine the specific types of discrimination and the resultant impact on YSMM's health.

ESC/EAS guidelines for the detection, prevention, and treatment of individuals at risk of a first myocardial infarction: effect of 5 years of updates and the new SCORE2.

The European Society of Cardiology (ESC) has released three consecutive guidelines within 5 years addressing cardiovascular prevention, risk scores, and cholesterol treatment. This study aims to evaluate whether the 2021 ESC guidelines improved the eligibility of individuals for primary prevention statin therapy before their first ST-segment elevation myocardial infarction (STEMI), and for intensive lipid-lowering treatments in secondary prevention. The cardiovascular risk category of 2757 consecutive individuals admitted for a first STEMI was evaluated to assess whether they would have been eligible for primary prevention statins according to 2021 vs. 2019 and 2016 ESC guidelines. Eligibility for intensive lipid-lowering therapy in secondary prevention was assessed according to the real-life follow-up low-density lipoprotein cholesterol (LDL-C) and the expected follow-up LDL-C. More individuals would have been eligible for primary prevention statins according to 2021 and 2019 vs. 2016 guidelines (61.8% vs. 38.7% vs. 23.6%, P&lt;0.01), a finding observed in both men (62.3% vs. 35.0% vs. 24.9%, P&lt;0.01) and women (60.2% vs. 50.7% vs. 19.3%, P=0.18). Only 27% of individuals reached the LDL-C objective of 55mg/L in secondary prevention: using the ESC stepwise approach, 61.7% were eligible for higher doses of statins, 26.2% for ezetimibe, and 12.1% for a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor (PCSK9i). Based on expected LDL-C reductions, eligibility for a PCSK9i in secondary prevention was greater with 2021 vs. 2016 guidelines (44.5% vs. 22.5%, P&lt;0.01). The 2021 ESC guidelines improved the detection and treatment of individuals at risk for a first myocardial infarction. In secondary prevention, 70% of patients kept LDL-C levels above 55mg/dL: increasing the statin dose and adding ezetimibe were the most frequently recommended therapeutic actions.

An automated quantification method for the Agatston coronary artery calcium score on coronary computed tomography angiography.

A coronary artery calcium (CAC) score can provide supplementary information for predicting the risk of cardiovascular disease (CVD). Although CAC is clinically measured with non-contrast cardiac computed tomography (CT), coronary CT angiography (CCTA) may also be used, allowing for the simultaneous evaluation of coronary artery vessels and calcified plaques. This study proposes a method for the automated quantification of the Agatston CAC score from CCTA and compares our method's performance with that of non-contrast cardiac CT. Sixty-two patients were selected from a clinical registry and divided into four CAC categories. They underwent both non-contrast cardiac CT and CCTA. The Agatston CAC score derived from non-contrast cardiac CT (standard Agatston CAC score) was used as the reference standard. Calcifications were automatically identified and quantified using different thresholds after a deep learning-based coronary artery segmentation model pretrained on CCTA images. Comparisons were made between the standard Agatston CAC score and the CCTA-based Agatston CAC score (CCTA-CAC score) on a per-patient and per-vessel basis. Spearman's rank-order correlation coefficient (R) and intra-class correlation (ICC) values were used to calculate the correlation between the two methods. After comparison, the optimal lower threshold in CCTA-CAC score calculations was found to be 650 Hounsfield units (HU). Using this threshold on a per-patient basis, the automatically computed CCTA-CAC score showed a high correlation (R =0.959; P<0.01) and ICC (R =0.8219; P<0.01) with the standard Agatston CAC score. On a per-vessel basis, the standard Agatston CAC score was also highly correlated with the CCTA-CAC score (R =0.889; P<0.01 and ICC =0.717; P<0.01). Of the 62 patients enrolled, 47 (76%) were classified into the same cardiovascular risk category using the CCTA-CAC score quantification method as when the standard Agatston CAC score was used. Agreement within the CAC categories was also good (kappa =0.7560). Fully automated quantification of the Agatston CAC score on CCTA images is feasible and shows a high correlation with the reference standard. This method could simplify the quantification procedure and has the potential to reduce the radiation dose and save time by eliminating the non-contrast cardiac CT stage.

Osteopontin as Candidate Biomarker of Coronary Disease despite Low Cardiovascular Risk: Insights from CAPIRE Study.

Stratification according high cardiovascular (CV) risk categories, still represents a clinical challenge. In this analysis of the CAPIRE study (NCT02157662), we investigate whether inflammation could fit between CV risk factors (RFs) and the presence of coronary artery disease (CAD). In total, 544 patients were included and categorized according with the presence of CAD and CV risk factor burden (low/multiple). The primary endpoint was to verify any independent association of neutrophil-related biomarkers with CAD across CV risk categories. The highest values of osteopontin (OPN) were detected in the low RF group and associated with CAD (23.2 vs. 19.4 ng/mL; p = 0.001), although no correlation with plaque extent and/or composition were observed. Conversely, myeloperoxidase (MPO) and resistin did not differ by CAD presence. Again, OPN was identified as independent variable associated with CAD but only in the low RF group (adjOR 8.42 [95% CI 8.42–46.83]; p-value = 0.015). As an ancillary finding, a correlation linked OPN with the neutrophil degranulation biomarker MPO (r = 0.085; p = 0.048) and resistin (r = 0.177; p = 3.4 × 10−5). In the present study, OPN further strengthens its role as biomarker of CAD, potentially bridging subclinical CV risk with development of atherosclerosis.

Tamil Nadu Pregnancy and Heart Disease Registry (TNPHDR): design and methodology

BackgroundCardiac disease in pregnancy is a major contributor to maternal mortality in high, middle and low-income countries. Availability of data on outcomes of pregnancy in women with heart disease is important for planning resources to reduce maternal mortality. Prospective data on outcomes and risk predictors of mortality in pregnant women with heart disease (PWWHD) from low- and middle-income countries are scarce.MethodsThe Tamil Nadu Pregnancy and Heart Disease Registry (TNPHDR) is a prospective, multicentric and multidisciplinary registry of PWWHD from 29 participating sites including both public and private sectors, across the state of Tamil Nadu in India. The TNPHDR is aimed to provide data on incidence of maternal and fetal outcomes, adverse outcome predictors, applicability of the modified World Health Organization (mWHO) classification of maternal cardiovascular risk and the International risk scoring systems (ZAHARA and CARPREG I & II) in Indian population and identify possible gaps in the existing management of PWWHD. Pregnancy and heart teams will be formed in all participating sites. Baseline demographic, clinical, laboratory and imaging parameters, data on counselling received, antenatal triage and management, peripartum management and postpartum care will be collected from 2500 eligible participants as part of the TNPHDR. Participants will be followed up at one, three and six-months after delivery/termination of pregnancy to document study outcomes. Predictors of maternal and foetal outcome will be identified.DiscussionThe TNPHDR will be the first representative registry from low- and middle-income countries aimed at providing crucial information on pregnancy outcomes and risk predictors in PWWHD. The results of TNPHDR could help to formulate steps for improved care and to generate a customised and practical guideline for managing pregnancy in women with heart disease in limited resource settings.Trial registrationThe TNPHDR is registered under Clinical Trials Registry-India (CTRI/2020/01/022736).

Evaluating coronary artery calcification with low-dose chest CT reconstructed by different kernels

PurposeTo understand the reliability of low-dose chest computed tomography (LDCT) in coronary artery calcification (CAC) assessment and evaluate the performance of different reconstruction kernels against the standard cardiac computed tomography (CaCT) as reference. Materials and methodsPatients from the NELCIN-B3 screening program who underwent CaCT and LDCT scans were analyzed retrospectively. LDCT were reconstructed with smooth, standard, and sharp kernels (Group B1, B2 and B3) to compare against standard CaCT (Group A). The image quality was evaluated by noise value, signal-to-noise ratio (SNR), and contrast to noise ratio (CNR); moreover, radiation dose was recorded for both scans. Coronary artery calcification scores (CACS) were measured with volume, mass and Agatston standards. Agatston score was divided into four cardiovascular risk categories (0, 1–99, 100–399, and >400). The agreement in CACS and risk classification between LDCT and CaCT was analyzed by intra-group correlation coefficient (ICC) and Kappa test. ResultsThe sensitivity of diagnosing CAC with LDCT was 98.5% (330/335) regardless of reconstruction kernels. Group B1 demonstrated the highest agreement in raw CACS (ICC volume 0.932; mass 0.904; Agatston 0.906; all p < 0.001) and risk classification (kappa 0.757, 95% CI 0.70–0.82). Smooth-kernel reconstruction achieved lower image noise, better SNR and CNR than other kernels. The effective radiation dose in of LDCT was 41.2% lower than that of the calcium scan (p < 0.001). ConclusionReconstructing LDCT with a smooth kernel in LDCT could provide a reliable imaging method to detect and quantitatively evaluate CAC, potentially expanding the application of LDCT lung screening to incidental findings of cardiovascular disease.

Impact of cardiovascular risk on the diagnostic accuracy of the ultrasound Halo Score for giant cell arteritis

ObjectiveTo evaluate the impact of cardiovascular risk (CVR) on the diagnostic accuracy of the ultrasonographic (US) Halo Score in patients with suspected giant cell arteritis (GCA).MethodsRetrospective observational study of patients referred to our US fast track clinic with suspected GCA for a 2-year period. The intima-media thickness (IMT) of cranial and extra-cranial arteries and the Halo Score was determined to assess the extent of vascular inflammation. The European Society of Cardiology Guidelines on CV Disease Prevention were used to define different categories of CVR and patients were classified according to the Systemic Coronary Risk Evaluation (SCORE). The gold standard for GCA diagnosis was clinical confirmation after a 6-month follow-up.ResultsOf the 157 patients included, 47 (29.9%) had GCA after a 6-month follow-up. Extra-cranial artery IMT was significantly higher in patients with high/very high CVR than in those with low/moderate CVR, but only among patients without GCA. Non-GCA patients with high/very high CVR had also a significantly higher Halo Score in contrast with low/moderate CVR [9.38 (5.93) vs 6.16 (5.22); p = 0.007]. The area under the ROC curve of the Halo Score to identify GCA was 0.835 (95% CI 0.756–0.914), slightly greater in patients with low/moderate CVR (0.965 [95% CI 0.911–1]) versus patients with high/very high CVR (0.798 [95% CI 0.702–0.895]). A statistically weak positive correlation was found between the Halo Score and the SCORE (r 0.245; c = 0.002).ConclusionsElevated CVR may influence the diagnostic accuracy of the US Halo Score for GCA. Thus, CVR should be taken into consideration in the US screening for GCA.

112 Safety and biochemical efficacy of sodium–glucose cotransporter 2 inhibitors based on cardiovascular risk profile and volume status in a real-world diabetic population

Abstract Aims Sodium–glucose cotransporter 2 inhibitors (SGLT2i) have become a first-line cardiovascular medication. However, their potential side effects still limit a widespread use in real-world clinical practice. Further, there is uncertainty about the mechanisms mediating SGLT2i-associated cardiovascular benefit. Methods We performed a retrospective analysis on consecutive diabetic patients who were prescribed a SGLT2i in a tertiary referral centre. Patients who completed at least 1 year of treatment were included in the data analysis. Changes in glycated haemoglobin, weight and haematocrit were evaluated and compared across two cardiovascular risk categories, defined through the inclusion criteria of three large randomized clinical trials. Additionally, a modified clinical score (mH2FPEF) was applied to detect the probability of heart failure with preserved ejection fraction (HFpEF). Results Of the 459 patients screened from 2015 to 2020, 312 completed 1 year of treatment (68.0%), 92 interrupted the treatment prematurely (20.0%) and 55 were lost to follow-up (12.0%). The most common causes of drug discontinuation were genital or urinary tract infections (9.4%) and poor glycaemic control (5%). At 1 year, a significant reduction in glycated haemoglobin concentration (−0.6 ± 1.4%, P &amp;lt; 0.001) and body weight (2.4 ± 4.6 Kg, P &amp;lt; 0.001) was observed and was comparable between patients at high vs. low cardiovascular risk. Haematocrit increase at 1 year (2.3 ± 3.3%, P &amp;lt; 0.001) was more marked in patients with high cardiovascular risk and low baseline haematocrit. Among patients with no established heart failure (N = 295), 156 (52.9%) had &amp;gt;50% probability of HFpEF (mH2FPEF ≥3). Conclusions In a real-world population of diabetic patients, SGLT2i were well-tolerated at 1 year and led to improved glycaemic control and weight loss. Haematocrit increase was more consistent in patients with high cardiovascular risk and signs of fluid overload, indicating the potentially beneficial role of euvolemic restoration. More than half of these diabetic patients had a high likelihood of unrecognized HFpEF.

Implications of the 2021 ESC cardiovascular risk classification among 283,000 European immigrants living in a low-risk region: a population-based analysis in Catalonia.

The ESC recently classified European countries into 4 cardiovascular risk regions. However, whether Europeans from higher-risk countries living in lower-risk regions may benefit from intensive cardiovascular prevention efforts is unknown. We described the burden of risk factors and cardiovascular disease (CVD) among European-born immigrants living in Catalonia, a low-risk region. A retrospective cohort study of 5.6 million adults of European origin living in Catalonia in 2019, including 282,789 European-born immigrants, was performed. We used the regionwide healthcare database and classified participants into 5 groups: low-, moderate-, high-, and very high-risk, and local-born. Age-standardized prevalence was estimated as of December 31st, 2019 and incidence was computed during 2019 among at-risk individuals. The very high-risk group was the largest immigrant group (N = 136,910; 48.4%), while the high-risk group was the smallest (N = 15,739; 5.6%). These two had the highest burden of coronary heart disease across all groups evaluated, in both men and women. The very high-risk group also had the highest prevalence of hypertension and obesity at young-to-middle age, and the burden of risk factors newly diagnosed during 2019 was highest in high- and very high-risk participants. The mean age at first diagnosis of risk factors and CVD was lower in these groups. In Catalonia, residents born in high- and very-high-risk European countries are at increased risk of coronary heart disease and newly diagnosed risk factors. Low-risk European countries may consider tailored prevention efforts, early screening of risk factors, and adequate healthcare resource planning to better address the health needs of men and women from higher-risk countries.

Cognitive disorders in patients with chronic kidney disease in pre-dialysis period

Objective: to study the cognitive status of patients in the pre-dialysis period depending on the stage of chronic kidney disease (CKD) and the category of cardiovascular risk (CVR). Materials and Methods. We examined 98 patients with CKD in the pre-dialysis period (mean age 47.1±11.2 years). The patients were divided into three groups according to the criteria of CVR stratification. Group 1 consisted of 32 patients with a low or moderate CVR, and CKD stage C1 or C2; Group 2 included 34 patients with a high CVR and CKD stage C3a or C3b; Group 3 comprised 32 patients with a very high CVR and CKD stage C4. We used the SAGE test (Self-Administered Gerocognitive Examination) to evaluate cognitive functions. Results. Cognitive impairment (CI) was detected in 57% of the patients: 37.5% in Group 1, 44.1% in Group 2, and 90.5% in Group 3. Dementia was diagnosed in 19% of patients with CI. A correlation was found between the severity of CI, the degree of decrease in glomerular filtration rate, and the education level of CKD patients in the pre-dialysis period (p≤0.001). We established that the examined subjects with CKD were characterized by memory, constructive, spatial and logical thinking disorders. Conclusion. Chronic kidney disease is an independent risk factor for the development of CI. The latter progressed with both CKD stage and the patient’s CVR category, and was detected in 37.5% of patients with a low or moderate CVR, 44.1% of patients with a high CVR, and 90.5% of patients with a very high CVR.