Clinical Cardiovascular Risk Factors Research Articles

Prognostic value of biomarkers of ischaemia in patients with peripheral arterial disease following endovascular revascularisation.

Background: Our aim was to evaluate the prognostic value of detectable high-sensitivity cardiac troponin I (hs-cTnI) and ischaemia-modified albumin (IMA) in predicting all-cause death or non-fatal ischaemic events in patients with PAD after endovascular revascularisation of the lower limbs. Patients and methods: Patients who underwent successful endovascular revascularisation for chronic limb-threatening ischaemia (CLTI) or disabling intermittent claudication (IC) were prospectively included. Pre-procedural levels of hs-cTnI and IMA were measured, and patients were followed for one year for the occurrence of the composite outcome of all-cause death, non-fatal myocardial infarction, new-onset angina, non-fatal ischaemic stroke, transient ischaemic attack, or progression of PAD. Outcomes were evaluated using survival analyses. Results: A total of 487 patients concluded the study, of whom 175 (35.9%) experienced the composite outcome. When considering only the clinical presentation of PAD and biomarker values, in patients with CLTI, hs-cTnI above the limit of detection (LoD) conferred an increased risk of the composite outcome compared to hs-cTnI below theLoD (p=0.004), while for IMA we found no significant difference. Outcomes of patients with CLTI and hs-cTnI or IMA below the LoD did not differ from those of patients with IC (p=0.07 and p=0.462, respectively). When adjusting for clinical characteristics and common cardiovascular risk factors in multivariate Cox survival analysis, neither biomarker improved prognostic performance, however IMA emerged as an independent predictor of the composite outcome in patients with CLTI. Conclusions: In patients with PAD who underwent successful endovascular procedure, neither IMA nor hs-cTnI improved risk stratification beyond clinical determinants. However, detection of IMA was an independent predictor of major cardiovascular events or death in patients with CLTI.

The impact of angiotensin-receptor neprilysin inhibitors on cardiovascular events and solute transport function in peritoneal dialysis patients: a multicenter retrospective controlled study

Background Whether angiotensin receptor-neprilysin inhibitor (ARNI) can reduce the incidence of cardiovascular events and improve peritoneal function in peritoneal dialysis (PD) patients remains unclear. Thus, this study aims to clarify the role of ARNI in PD patients. Methods This was a multicenter retrospective study. A total of 102 patients were enrolled for analysis. Patients who continuously used ARNI for 12 months were assigned to the ARNI group (n = 55), while those who never used ARNI to the control group (n = 47). Clinical indicators and cardiovascular risk factors were analyzed, along with in vitro experiments on neoangiogenesis to investigate the underlying molecular mechanisms of peritoneal protection by ARNI. Results Systolic blood pressure (p = 0.001), diastolic blood pressure (p = 0.001), and left ventricular ejection fraction (p = 0.008) were statistically improved after 12 months of ARNI therapy, whereas these metrics did not change in control patients. The risk factors for the occurrence of cardiac events in PD patients included the use of ARNI [hazard ratio (HR) 0.053; 95% confidence interval (CI), 0.006–0.492] and NT-proBNP level (HR 2.317; 95% CI, 1.179–4.554). Additionally, there was a decrease in 4-hour ratio of creatinine concentration in dialysate to plasma (4h Scr D/P) in the ARNI group (p = 0.020). The in vitro experiments showed that LCZ696, a combination of sacubitril and valsartan, inhibited neoangiogenesis via the VEGFR2/ERK1/2 and Notch1 pathways. Conclusions ARNI may play a protective role in reducing the incidence of cardiovascular events and decreasing solute transport in PD patients.

Are novel ASCVD risk factors more prevalent in young middle eastern women who have classical risk factors

Abstract Introduction Urbanization is an important contributor to atherosclerotic cardiovascular disease (ASCVD) in the Middle East, especially in the younger age groups. There is a scarcity of data on clinical profiles and cardiovascular risk factors (RFs) in urban young women compared with those who reside in rural areas in this region. Purpose To study the demographic and clinical profiles and prevalence of traditional and novel CV RFs in a cohort study of young urban Middle Eastern women compared with those in rural areas. Methods The prevalence of 19 traditional and novel cardiovascular RFs were compared in urban vs. rural young women residents (18-50 years of age), who were enrolled in 12 centers (August 2020 to October 2023). Results Of 627 young women enrolled (mean age 44.2 ± 5.1 years old), 463 (74%) were urban residents and 164 (26%) were rural residents. ASCVD was diagnosed in 32% of urban and 37.3% of rural young women. Table shows the prevalence of traditional and novel, sex-specific RFs with significant differences in the 2 groups. Other RFs with no significant differences included hypertension, diabetes and gestational diabetes, preterm delivery, persistent weight gain after delivery, radiation for breast cancer, and polycystic ovary syndrome. Conclusion In this cohort of Middle Eastern young women, despite heterogeneity, those who were urban residents had worse clinical profiles with higher prevalence of certain classical and sex-specific risk factors.

Abstract P203: Healthy Diet Perception, Cardiovascular Disease, and Risk Factors in Americans

Introduction: Healthy diet perception may influence cardiovascular (CV) outcomes. Misperceptions on the healthfulness of one’s diet can interfere with the precontemplative and contemplative stages of behavioral change if individuals overestimate their diet quality. Using a nationally-representative sample, we explored the prevalence of healthy diet misperception in the general population and in those with CV diseases, as well as whether misperceptions are associated with clinical CV risk factors. Methods: We included adults≥20 years old from the National Health and Nutrition Examination Survey 2017-2020. Using survey data on participants’ perception of their own diet and diet recall data to calculate Healthy Eating Index-2015 (HEI), we divided participants into dietary quantiles. We categorized healthy diet perception (HDP) as overestimated (perceived>HEI quantile), accurate (perceived=HEI quantile), or underestimated (perceived<HEI quantile). We categorized those who self-reported hypertension, coronary heart disease, myocardial infarction, congestive heart failure, and stroke as having CV disease. Clinical CV risk factor measures were body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin A1c, total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). We used multiple logistic regression to measure the association between CV disease and HDP and multiple linear regression for HDP and CV risk factors, stratified by presence of CV disease. Results: Of 7,710 adults, 4,470 (57.5 weighted %) overestimated HDP; 1,924 (25.6 weighted %) underestimated HDP; and 1,316 (16.9 weighted %) correctly estimated HDP. After adjusting for age, sex, and education level, having CV disease was not associated with incorrectly estimating HDP (adjusted OR 1.08; 95% CI 0.93, 1.26) or overestimating HDP (adjusted OR 1.21; 95% CI 1.00, 1.48), compared to correctly estimating HDP. Among those with CV disease, overestimating HDP was associated with higher BMI (adjusted difference 1.9 m/kg 2 ; 95% CI 0.8, 2.9) and lower HDL (adjusted difference -2.8 mg/dL; 95% CI -5.1, -0.5). Among those without CV disease, overestimating HDP was only associated with higher BMI (adjusted difference 1.9; 95% CI 0.8, 2.9) Conclusions: More than half of Americans overestimate their diet quality, and adults with CV disease do not estimate diet quality more accuracy than those without CV disease. Among adults with CV disease, misperceptions in diet quality were associated with worse CV risk factor profiles, highlighting the need to assess and educate patients with CV disease on personal diet quality as part of healthy lifestyle promotion. Among those without CV disease, dietary misperceptions were associated with higher BMI, suggesting that increasing awareness of one's diet is also important in CV disease prevention.

Body Composition Evaluation and Clinical Markers of Cardiometabolic Risk in Patients with Phenylketonuria.

Cardiovascular diseases are the main cause of mortality worldwide. Patients with phenylketonuria (PKU) may be at increased cardiovascular risk. This review provides an overview of clinical and metabolic cardiovascular risk factors, explores the connections between body composition (including fat mass and ectopic fat) and cardiovascular risk, and examines various methods for evaluating body composition. It particularly focuses on nutritional ultrasound, given its emerging availability and practical utility in clinical settings. Possible causes of increased cardiometabolic risk in PKU are also explored, including an increased intake of carbohydrates, chronic exposure to amino acids, and characteristics of microbiota. It is important to evaluate cardiovascular risk factors and body composition in patients with PKU. We suggest systematic monitoring of body composition to develop nutritional management and hydration strategies to optimize performance within the limits of nutritional therapy.

Clinical presentation and cardiovascular risk factors in patients with STEMI due to spontaneous coronary artery dissection (SCAD)

Abstract Background Spontaneous coronary artery dissection (SCAD) may occur in the absence of atherosclerotic and traumatic etiology and can lead to severe clinical manifestations such as ST-segment elevation myocardial infarction (STEMI). Compared to atherosclerotic STEMI, younger patients and females are predominantly affected. Hence, underdiagnosis is an important concern. We therefore systematically analyzed the prevalence of SCAD among a large cohort of young patients presenting with STEMI, as well as risk factors and presenting symptoms. Methods We retrospectively identified a consecutive cohort of 631 patients younger than 55 years who underwent coronary angiography due to STEMI between 01/2005 and 10/2022. Systematic review of coronary angiograms allowed identification of all STEMI caused by SCAD (n=20, 3.2%), including patients previously misdiagnosed as atherosclerotic STEMI. By reviewing medical records, we identified symptoms at presentation and cardiovascular risk factors in patients with SCAD-STEMI. Results Out of the 20 patients <55 years presenting with SCAD-STEMI, 16 (80%) were female, and the mean age was 49.5 years. By far the most common presentation was typical angina (75%, n=15), being reported by all 4 male and 11/16 female patients (100% vs. 69%, respectively). Importantly, three patients presented with cardiac arrest due to malignant ventricular arrhythmia (15%). In 6 patients, symptoms were mild and atypical (nausea/vomiting, n = 3, 15%; atypical chest pain, n = 2, 10%; and diaphoresis, n = 1, 5%). There was no significant difference of symptoms between men and women. 11 patients (55%) were treated by primary PCI, none received emergency coronary artery bypass grafting (CABG). The mean maximum serum creatin kinase (CK) level was 1410 U/l (range 139-86144 U/l). Mean left ventricular ejection fraction (LVEF) was 50% (range 30-60%). Symptoms at presentation did not correlate with maximum CK levels, nor with LVEF. In this caucasian cohort, the most common cardiovascular risk factor was arterial hypertension (n = 12, 60%), followed by smoking (n = 9, 45%). Six patients had hyperlipidemia (30%), and three (15%) were obese. Diabetes and a positive family history for cardiovascular events were rare (n = 2, 10% vs. n = 1, 5%, respectively). Conclusion In this large caucasian cohort of young patients with STEMI, SCAD accounted for 3.2 % of cases. Typical angina was the most common symptom at presentation, but cardiac arrest due to ventricular fibrillation was frequent. Symptoms in men and women were similar and did not correlate with LVEF, nor with maximum CK levels.

GDF-15 is associated with worse ischemic and bleeding outcomes in the acute phase and during follow-up in patients with acute coronary syndrome: insights from the TRACER trial

Abstract Introduction Growth differentiating factor-15 (GDF-15) is a stress responsive cytokine that increases with age. GDF-15 has been associated with mortality, myocardial infarction (MI), heart failure and bleeding in patients with acute coronary syndrome (ACS) and stable coronary artery disease. Purpose The aim of this study was to evaluate the levels of GDF-15 and their associations with risk of cardiovascular events and bleeding in patients with ACS in the acute setting and after one month. Methods Venous blood samples were obtained at the index event in 6800 patients and again after one month in 5313 patients with non-ST-segment elevation ACS (NSTE-ACS) randomized to vorapaxar vs placebo on top of dual antiplatelet treatment in the TRACER study. The GDF-15 level was centrally measured by the ROCHE ELISA assay in stored plasma aliquots. The main cardiovascular (CV) endpoint in this substudy was the composite of CV death, MI and ischemic stroke and main safety endpoint was non-procedural major or minor bleeding according to Thrombolysis in Myocardial Infarction (TIMI) classification. Cox-regression models were used to estimate unadjusted and adjusted associations between log-transformed GDF-15 and outcomes. Adjustments were made for study treatment and well-established clinical CV risk factors. All corresponding models but without the biomarker was fitted and a concordance index (c-index) calculated. A likelihood-ratio test was used to test for differences between the two c-indices. Results Median concentration of GDF-15 at baseline and after one month were 1226 ng/L and 1181 ng/L, respectively. The correlation between GDF-15 concentrations at baseline and after one month was r=0.80 (Figure 1). The levels of GDF-15 were independently associated with older age, presence of diabetes mellitus, renal dysfunction and smoking. GDF-15 levels both at baseline and after one month were independently associated with higher rate of CV death, MI and ischemic stroke and with non-procedural TIMI major or minor bleeding (Figure 2). At baseline the addition of GDF-15 levels to the multivariable model for subsequent CV death, MI or ischemic stroke increased the c-index from 0.656 to 0.668 (P<0.001), and for bleeding from 0.715 to 0.719 (P=0.037). At one month adding GDF-15 levels increased the c-index from 0.711 to 0.722 (P<0.001) for CV death, MI or ischemic stroke and from 0.735 to 0.783 (P<0.001) for bleeding. Conclusions In patients with NSTE-ACS levels of GDF-15 are independently associated with CV death, MI or ischemic stroke and non-procedural bleeding and contribute prognostic information both at the index event and after one month. Levels of GDF-15 remain stable over time and provide similar prognostic information in the acute and follow-up setting.Fig.1 Correlation GDF-15 baseline and 1mFig.2 Non-linear cox-regression

Abstract 14503: Chemokine Ligand 18 (CCL18) is a Long-Term Predictor of All-Cause Mortality, but Did Not Predict CVD Events

Introduction: Chemokines mediate leukocyte recruitment and activation. Chemokine ligand 18 (CCL18) is mainly expressed by a broad range of cells such as monocytes/macrophages and dendritic cells. It is highly expressed in chronic inflammatory diseases, and locally in atherosclerotic plaques, particularly at sites of reduced stability. Circulating CCL18 levels are transiently elevated in patients admitted with unstable angina pectoris, but data on myocardial infarction (MI) are scarce. Aim: To assess the utility of CCL18 as a prognostic marker of CVD in patients hospitalized for chest pain of suspected coronary origin. Methods: The population consisted of 871 consecutive patients (ClinicalTrials.gov Identifier: NCT00521976). Stepwise Cox regression models, applying continuous log e -transformed values, were fitted for each of the biomarkers with all-cause mortality and cardiac death within 24-months and all-cause mortality within median 7 years (y) as the dependent variables, adding an analysis of 1) all-cause mortality or MI, and 2) all-cause mortality or MI or stroke at 7 y follow up (FU). The hazard ratio (HR) (95% CI) was assessed in a univariate and multivariable model, adjusting for traditional clinical cardiovascular risk factors, adding BNP, hsCRP, and TnT. Results: Plasma samples from 849 patients were available. By 24 months FU, 138 (15.8%) patients had died; 86 were cardiac deaths. The univariate analysis showed a positive, significant association between CCL18 and total death [HR 1.55 (95% 1.30-1.83), p=0.000], and for cardiac death [HR 1.32 (95% 1.06-1.64), p=0.013]. Applying multivariable analysis, the associations were no longer significant. At 7 y FU, a total of 332 (38.1%) patients had died. After multivariable adjustment, CLL18 was independently associated with all-cause mortality [HR 1.14 (95% CI, 1.01-1.29), p=0.030], but not for MI (n=203) or stroke (n=55). The positive association between CCL18 and all-cause mortality was lost when combined with CVD events; all-cause mortality or MI (n=404, p=0.75), and all-cause mortality or MI or stroke (n=422, p=0.79). Conclusions: CCL18 predicts long-term all-cause mortality, but had no independent prognostic bearing on short-term cardiac death and CVD events during long-term FU.

Abstract 14288: α1-Antichymotrypsin Complex (SERPINA3) is an Independent Predictor of Long-Term All-Cause Mortality, but Did Not Predict CVD Events

Introduction: SERPINA3 is an acute phase protein triggered by inflammation. It inhibits neutrophil cathepsin which cleaves protease-activated receptor 4 (PAR-4) via a thrombin-independent pathway, and mast cell chymase which mediates the production of angiotensin-II via an ACE-independent pathway. SERPINA3 is upregulated after an acute myocardial infarction (MI), but data on its long-term prognostic value in MI patients are scarce. Aim: To assess the utility of SERPINA3 as a prognostic marker in patients hospitalized for chest pain of suspected coronary origin. Methods: A total of 871 consecutive patients were included (ClinicalTrials.gov Identifier: NCT00521976). Stepwise Cox regression models, applying continuous log e -transformed values, were fitted for each of the biomarkers with all-cause mortality and cardiac death within median 24-months (mo) and all-cause mortality within median 7 years (y) as the dependent variables, adding an analysis of 1) all-cause mortality or MI, and 2) all-cause mortality or MI or stroke at 7 y follow up (FU). The hazard ratio (HR) (95% CI) was assessed in a univariate and multivariable model, adjusting for traditional clinical cardiovascular risk factors, adding BNP, hsCRP, TnT. Results: Plasma samples from 847 patients were available. At 24 mo FU, 138 (15.8%) patients had died, of which 86 were cardiac deaths. The univariate analysis showed a positive, significant association between SERPINA3 and total death [HR 1.42 (95% 1.19-1.68), p =0.000], but was not significant for cardiac death. Associations after multivariable adjustment were statistically non-significant. At 7 y FU, 332 (38.1%) patients had died. After adjustment, SERPINA3 was independently associated with all-cause mortality [HR 1.14 (95% CI, 1.02-1.28), p=0.022], but not for MI (n=203), and stroke (n=55), respectively, and remained essentially unaffected for all-cause mortality or MI combined (n=404) [HR 1.12 (95% CI, 1.01-1.24), p=0.031], slightly weakened when stroke also was added (n=422) [HR 1.10 (95% CI, 1.00-1.22), p=0.060]. Conclusions: SERPINA3 predicts long-term all-cause mortality, but had no prognostic bearing on short-term cardiac death. Introducing non-fatal CVD events during long-term FU did not improve its prognostic value.

Clinical Profile and Cardiovascular Risk Factors Among Hemophilians Followed at University Clinics of Kinshasa

Clinical Profile and Cardiovascular Risk Factors Among Hemophilians Followed at University Clinics of Kinshasa

Pericoronary Adipose Tissue Density, Inflammation, and Subclinical Coronary Artery Disease Among People With HIV in the REPRIEVE Cohort.

Pericoronary adipose tissue (PCAT) may influence plaque development through inflammatory mechanisms. We assessed PCAT density, as a measure of pericoronary inflammation, in relationship to coronary plaque among people with human immunodeficiency virus (HIV [PWH]) and to a matched control population. In this baseline analysis of 727 participants of the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) Mechanistic Substudy, we related computed tomography-derived PCAT density to presence and extent (Leaman score) of coronary artery disease (CAD), noncalcified plaque, coronary artery calcium (CAC), and vulnerable plaque features using multivariable logistic regression analyses. We further compared the PCAT density between PWH and age, sex, body mass index, CAC score, and statin use-matched controls from the community-based Framingham Heart Study (N = 464), adjusting for relevant clinical covariates. Among 727 REPRIEVE participants (age 50.8 ± 5.8 years; 83.6% [608/727] male), PCAT density was higher in those with (vs without) coronary plaque, noncalcified plaque, CAC >0, vulnerable plaque, and high CAD burden (Leaman score >5) (P < .001 for each comparison). PCAT density related to prevalent coronary plaque (adjusted odds ratio [per 10 HU]: 1.44; 95% confidence interval, 1.22-1.70; P < .001), adjusted for clinical cardiovascular risk factors, body mass index, and systemic immune/inflammatory biomarkers. Similarly, PCAT density related to CAC >0, noncalcified plaque, vulnerable plaque, and Leaman score >5 (all P ≤ .002). PCAT density was greater among REPRIEVE participants versus Framingham Heart Study (-88.2 ± 0.5 HU versus -90.6 ± 0.4 HU; P < .001). Among PWH in REPRIEVE, a large primary cardiovascular disease prevention cohort, increased PCAT density independently associated with prevalence and severity of coronary plaque, linking increased coronary inflammation to CAD in PWH.

Coronary plaque burden predicts perioperative cardiovascular events after coronary endarterectomy.

The risk factors of perioperative and long-term cardiovascular events in patients undergoing coronary artery bypass grafting (CABG) with adjunctive coronary endarterectomy (CE) are not well determined. This study evaluated the clinical value of coronary plaque burden, coronary anatomic stenosis, and serum biomarkers for predicting perioperative cardiovascular events after off-pump CABG + CE. This retrospective cohort single-center study enrolled 125 patients undergoing off-pump CABG + CE between February 2018 and September 2021 in China. Coronary plaque burden was reflected by the length of plaque removed by CE. Plaque length-max, which represents the plaque length in patients undergoing single-vessel CE and the maximum plaque length in patients undergoing multivessel CE, was calculated. The primary endpoint was perioperative myocardial infraction (PMI). Plaque length-max was significantly higher in patients with PMI than in those without PMI (2.4 ± 1.5 vs. 1.6 ± 0.9, p = .001). A threshold plaque length-max of 1.15 cm was an independent predictor of PMI (area under the curve: 0.67; sensitivity 87.9%; specificity 59.8%; p = .005). Patients with plaque length-max ≥1.15 had a > 5-fold increase in PMI after adjusting for confounding factors (odds ratio = 5.89; p = .002). Furthermore, interleukin-6 (Beta = .32: p = .028), CD68 (Beta = .34; p = .045), and osteopontin (Beta = .43; p = .008) were significantly correlated with plaque length-max. Plaque length-max was superior to clinical cardiovascular risk factors in predicting PMI occurrence after off-pump CABG + CE, which might be associated with systemic and plaque inflammation state.

Exploring the role of adult attachment, major depression and childhood trauma in arterial stiffness: A preliminary study

ObjectivePrior research indicates a noteworthy and intricate connection between depression and subclinical atherosclerosis. Nevertheless, the biological and psychological mechanisms that underlie this association are not yet fully understood. To address this gap, this exploratory study aimed to examine the relationship between active clinical depression and arterial stiffness (AS), with a particular focus on the potential mediating roles of attachment security and childhood trauma. MethodsIn this cross-sectional study, we examined 38 patients with active major depression free of dyslipidemia, diabetes mellitus, hypertension, and obesity and 32 healthy controls. All participants underwent blood tests, psychometric assessments, and AS measurements using the Mobil-O-Graph arteriograph system. AS severity was evaluated using an augmentation index (AIx) normalized to 75 beats/min. ResultsIn the absence of defined clinical cardiovascular risk factors, there was no significant difference in AIx between individuals with depression and healthy controls (p = .75). Patients with longer intervals between depressive episodes had lower AIx (r = −0.44, p < .01). Insecure attachment and childhood trauma did not significantly associate with AIx in patients. Whereas insecure attachment was positively correlated with AIx only in healthy controls (r = 0.50, p = 01). ConclusionsOur analysis of established risk factors for atherosclerosis revealed that depression and childhood trauma had no significant relationship with AS. However, we did identify a novel finding: insecure attachment was significantly associated with AS severity in healthy adults without defined cardiovascular risk factors for the first time. To our knowledge, this is the first study to demonstrate this relationship.

P233 ACUTE CORONARY SYNDROME AFTER WASP BITE (KOUNIS SYNDROME)

Abstract Kounis syndrome (KS) is defined as an acute coronary syndrome (SCA) associated with an anaphylactic reaction. A 64–year–old sports man with no previous cardiovascular disease arrived at the emergency room of our Hospital for dyspnoea and chest pain arising during physical activity e preceded by a syncopal episode. During the physical activity (cycling) the patient reported that he had felt an insect bite sensation, with no possibility of precisely identify it. Parameters an admission were: BP 85/45 mmHg, HR 70 bpm, on ECG signs of early repolarization (Fig. 1), blood tests rise in hsTNI (328 ng/L), normal D–dimer. The transthoracic echocardiogram showed no motion abnormalities. In the suspicion of KS, therapy was set up only with ASA and statin, avoiding any drug commonly used to treat allergic reactions that could have worsen the hemodynamic and vasomotor situation by further reducing the coronary perfusion. During hospitalization, in consideration of the clinical picture and cardiovascular risk factors (dyslipidemia and previous smoking), was performed coronary angiography, which showed no obstructive lesions, but during the first injection of contrast showed vasospasm of the ostium of the right coronary artery, dominant (Fig. 2 – left), resolved spontaneously (Fig. 2 – right). The post–procedural hsTNI peak (3953 ng/L) and the presence of the European paper wasp i77 antigen to the serological dosage of the allergens supported the pathophysiology of acute coronary syndrome concomitant with allergic reaction and supported the diagnostic hypothesis of KS type I (without underlying coronary artery disease). The patient was discharged with calcium channel blocker therapy, to reduce coronary vasospasm which characterizes KS, and short–term follow–up was planned with blood tests, exercise stress test and cardiological visit which were normal. KS, though rare, is a clinical entity that should not be underestimated, especially in allergic patients with evidence of SCA without coronary occlusions. The data available in the literature are scarce and it is not clear the medium and long term prognosis. It therefore seems reasonable to follow up the patients as outpatient cardiology visits especially in the first months after the event and schedule instrumental tests control.

Increased arterial stiffness and accelerated atherosclerosis in Takayasu arteritis

IntroductionCardiovascular diseases are the leading causes of morbidity and mortality in patients with Takayasu arteritis (TAK). Arterial stiffness and accelerated atherosclerosis have been reported in TAK, however, morphological changes in the arterial wall have not been adequately addressed. Shear wave elastography (SWE) is a new, non-invasive, direct and quantitative method of ultrasonography (US) that evaluates elasticity of biological tissues. MethodsA total of 50 patients with TAK (44F/6 M; mean age: 39.8 ± 8.2 years), 43 with systemic lupus erythematosus (SLE) (38F/5 M; 38.0 ± 7.9 years) and 57 healthy controls (HCs) (50F/7M: 39.5 ± 7.1 years) were studied using carotid B mode US and SWE. Carotid artery intima-media thickness (CCA IMT) and SWE were measured and the atherosclerotic plaques were recorded. Clinical characteristics and cardiovascular risk factors were determined. Intra and inter observer reproducibility was assessed and found good agreement. ResultsThe mean IMT in the right and left carotid arteries was significantly higher only among patients with TAK when compared to SLE and HCs. Carotid artery plaques were significantly increased only in patients with TAK. On the other hand, the mean SWE value was significantly increased among both TAK and SLE patients when compared to HCs, whereas patients with TAK had the highest value. These were also true after adjustments were made for atherosclerotic risk factors and after all those with atherosclerotic plaques were excluded from the analysis. TAK itself, diastolic blood pressure levels and IMT were independently associated with SWE. ConclusionsMarkedly increased CCA IMT and SWE values appear to be uniquely associated with TAK, suggesting that they could be used as diagnostic tools. Arterial stiffness occurs independently from atherosclerosis and is associated with arterial thickening. Further studies should investigate whether CCA SWE values could predict cardiovascular morbidity and mortality. Strong association with premature atherosclerosis could be also considered as a unique feature of TAK.

Clinical parameters and cardiovascular risk factors related to heart failure with preserved ejection fraction: a comparative analysis between HFA-PEFF and H2FPEF Scores

Abstract Background Heart failure with preserved ejection fraction (HFpEF) diagnosis remains challenging, since several mechanisms (diastolic and systolic reserve abnormalities, chronotropic incompetence, ventricular or vascular stiffening, atrial dysfunction, pulmonary hypertension, impaired vasodilation, endothelial dysfunction, energetic abnormalities and autonomic dysfunction) play different roles in HFpEF development. European Society of Cardiology HF guidelines recently suggested a stepwise non-invasive diagnostic approach consisting of three steps: the first is clinical, the second includes echocardiographic and laboratory data (natriuretic peptides), named HFA-PEEF score, and finally, in case of inconclusive findings, diastolic stress echocardiography is recommended. On the other hand, in United States, another multiparametric score, named H2FPEF, has been proposed for HFpEF diagnosis, and including, in addition to echocardiographic parameters, also clinical data; thereby more applicable in the outpatient clinical arena. Purpose Whether there is a clinical overlap between the two scores (HFA-PEEF and H2FPEF) as well as whether the addition of clinical data to the HFA-PEEF could improve its ability to identify different HFpEF phenotypes is still an open issue and these were the aims of our study. Methods HFA-PEEF and H2FPEF scores were systematically applied on 1,156 consecutive subjects with preserved ejection fraction who undergone cardiovascular evaluation at the Cardiovascular Prevention Center of Fondazione Don Gnocchi &amp; University of Parma. All subjects underwent cardiovascular risk assessment followed by echocardiography and cardiopulmonary exercise testing; due to the outpatient (non-acute) setting of the evaluation, natriuretic peptides assay was not performed. Clinical data and cardiovascular risk factors data were compared between different groups of HFpEF risk. Results According to H2FPEF score, low risk (&amp;lt;40%) of HFpEF was found in 659 (57%), moderate in 300 (26%) and high (&amp;gt;75%) in 197 (17%); according to HFA-PEEF score, 675 (58%) had 0 or 1 point, 253 (22%) had 2 points and 230 (20%) had 3 or 4 points (moderate-to-high risk). Patients with higher HFA-PEEF score were older (p&amp;lt;0.001), had higher prevalence of HTN (p&amp;lt;0.001), diabetes (p&amp;lt;0.001), obesity (p&amp;lt;0.001), sedentary lifestyle (p&amp;lt;0.001), AF (p&amp;lt;0.001) and CCS (p&amp;lt;0.001) (figure 1). More specifically, AF was associated to a 6.3-fold higher risk (p&amp;lt;0.001) of high (3–4) HFA-PEEF Score, age &amp;gt;75 years to a 4.6-fold higher risk, HTN to a 3.6-fold higher risk (p&amp;lt;0.001), CCS to a 3.3-fold higher risk (p&amp;lt;0.001), obesity to a 2.2-fold higher risk (p&amp;lt;0.001), diabetes to a 1.9-fold higher risk (p&amp;lt;0.001) and sedentary to a 1.7-fold higher risk (p=0.001). Conclusions Although HFA-PEEF score does not include clinical data, patients with older age, atrial fibrillation, hypertension, hypertensive heart, diabetes, sedentary lifestyle and chronic coronary syndrome show a higher ESC risk of HFpEF. Funding Acknowledgement Type of funding sources: None.

Acute ST-elevation myocardial infarction: are men and women particular cases of STEMI ?

Abstract Funding Acknowledgements Type of funding sources: None. Background ST-segment elevation myocardial infarction (STEMI) has high levels of morbidity and mortality. Multiple risk factors may contribute to clinical outcomes and some studies demonstrate gender-related differences in baseline characteristics and in-hospital management. Purpose To access the difference in clinical characteristics and prognostic outcomes between men and women who were admitted in our Cardiac Intensive Care Unit with STEMI diagnosis. Methods We retrospectively analyzed 121 non-consecutive patients with STEMI during a mean follow-up period 135 ± 31 weeks. We accessed baseline characteristics and time course of events (symptom onset-to-door admission; time to first EKG; time to fibrinolytic therapy; door-to-cath lab time and time from fibrinolytic therapy to PCI (for patients transferred from another centers). Primary endpoint (PE) was a composite of in-hospital cardiovascular death, arrhythmic events or STEMI evolution in Killip-Kimbal III or IV. Secondary endpoint (SE) was in-hospital major bleeding events, considered intracerebral hemorrhage, cases of hemodynamic compromise or requiring a blood transfusion. Tertiary endpoint (TE) included admissions to the emergency department or hospitalization by heart failure decompensation, acute or chronic coronary syndromes and all-cause mortality. Results Of the 121 patients, 102 were male (84.3%) and 19 (15.7%) female. The mean age was 58.3 ± 12.7 years and women had a superior mean age (69.8 ± 12.2 years) vs. Men mean age 56 ± 11.6 years. Hypertension was more prevalent in women (84.2% vs. 47.1%, respectively; p 0.003) and also diabetes – 36.8% of women had type 2 diabetes (vs 10.8% of men) and 5.3% of these female patients requires insulin therapy (vs 2% of men; p 0.021). According to Charlson Comorbidity Index (CCI), women had a higher disease burden with 73.7% of them included into the moderate or severe group of mortality risk, compared to 42.2% of men (p 0.014). Conversely, less women smoke (31.6% vs. 82.2%; p &amp;lt;0.001) and less frequently chest pain was the onset symptom (78.9% vs. 95.1%; p 0.04). Time since symptom onset to door admission was estimated on 510 ± 1149 minutes and the mean women delay was superior (557 ± 858 minutes). Regarding to in-hospital hemorrhagic events (secondary endpoint), female patients had a statistically significant higher risk (22.2% vs. 7.1%, p 0.045), independently of hypertension, diabetes or anticoagulant therapy (r=0.249; ANOVA p-value &amp;lt; 0.005), but it was associated with higher CCI (p 0.033). No other gender differences in outcomes or survival function were observed. Conclusion Our study demonstrates gender-related differences among patients with STEMI. Indeed, women were older, had more clinical cardiovascular risk factors and tend to delay hospital admission after symptoms onset. Secondary endpoint was statistically more frequent in women, but no other differences in outcomes were observed.

ACUTE ST-ELEVATION MYOCARDIAL INFARCTION: ARE MEN AND WOMEN PARTICULAR CASES OF STEMI?

Objective: To access the difference in clinical characteristics and prognostic outcomes between men and women who were admitted in our Cardiac Intensive Care Unit with STEMI diagnosis. Design and method: We retrospectively analyzed 121 patients with STEMI, during a mean follow-up period 135 ± 31 weeks. We accessed baseline characteristics and time course of events. Primary endpoint (PE) was a composite of in-hospital cardiovascular death, arrhythmic events or STEMI evolution in Killip-Kimbal III or IV. Secondary endpoint (SE) was in-hospital major bleeding events and tertiary endpoint (TE) included admissions to the emergency department or hospitalization by heart failure decompensation, acute or chronic coronary syndromes and all-cause mortality. Results: Of the 121 patients, 102 were male (84.3%). The mean age was 58.3 ± 12.7 years and women had a superior mean age (69.8 ± 12.2 years). Hypertension was more prevalent in women (84.2% vs. 47.1%, respectively; p 0.003) and also diabetes – 36.8% of women had type 2 diabetes and 5.3% of these female patients requires insulin therapy (vs 2% of men; p 0.021). According to Charlson Comorbidity Index (CCI), women had a higher disease burden with 73.7% of them included into the moderate or severe group of mortality risk, compared to 42.2% of men (p 0.014). Conversely, less women smoke (31.6% vs. 82.2%; p &lt; 0.001) and less frequently chest pain was the onset symptom (78.9% vs. 95.1%; p 0.04). Time since symptom onset to door admission was estimated on 510 ± 1149 minutes and the mean women delay was superior (557 ± 858 minutes). Regarding to in-hospital hemorrhagic events, female patients had a statistically significant higher risk (22.2% vs. 7.1%, p 0.045), independently of hypertension, diabetes or anticoagulant therapy (r = 0.249; ANOVA p-value &lt; 0.005), but it was associated with higher CCI (p 0.033). No other gender differences in outcomes were observed. Conclusions: Our study demonstrates gender-related differences among patients with STEMI. Indeed, women were older, had more clinical cardiovascular risk factors and tend to delay hospital admission after symptoms onset. Secondary endpoint was statistically more frequent in women, but no other differences in outcomes were observed.

Interconnected Clinical and Social Risk Factors in Breast Cancer and Heart Failure.

Breast cancer and heart failure share several known clinical cardiovascular risk factors, including age, obesity, glucose dysregulation, cholesterol dysregulation, hypertension, atrial fibrillation and inflammation. However, to fully comprehend the complex interplay between risk of breast cancer and heart failure, factors attributed to both biological and social determinants of health must be explored in risk-assessment. There are several social factors that impede implementation of prevention strategies and treatment for breast cancer and heart failure prevention, including socioeconomic status, neighborhood disadvantage, food insecurity, access to healthcare, and social isolation. A comprehensive approach to prevention of both breast cancer and heart failure must include assessment for both traditional clinical risk factors and social determinants of health in patients to address root causes of lifestyle and modifiable risk factors. In this review, we examine clinical and social determinants of health in breast cancer and heart failure that are necessary to consider in the design and implementation of effective prevention strategies that altogether reduce the risk of both chronic diseases

Clinical characteristics and cardiovascular risk factors associated with clinical outcome in hospitalized patients with COVID-19

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a new coronavirus, was originally recognized as a pandemic by the WHO on early, a new coronavirus, was originally recognized as a pandemic by the WHO on early 2020, and has infected over 243 million people worldwide, killing about five million people between then and October 2021. Objectives: We investigated the relationship between clinical characteristics, cardiovascular risk factors and echocardiographic findings and in-hospital outcomes of patients who were admitted for COVID-19. Patients and Methods: A retrospective review of 216 hospitalized patients with COVID-19 who were admitted to Chamran hospital from March 2019 to April 2021 was conducted. Patients’ characteristics cardiovascular risk factors, echocardiographic findings, clinical outcomes (discharge (complete recovery/ partial recovery) and in-hospital mortality) were recorded. To analyze risk factors associated with outcomes in patients with COVID-19, univariate and multivariate ordinal logistic regression models were conducted. Results: The most common underlying diseases in patients were hypertension (HTN) (57.9%) and diabetes mellitus (DM) (37.9%), respectively. Cognitive disorders (20.8%) and mitral regurgitation (MR) were the most complication and echocardiographic finding of the patients. In our study, six variables were found to be associated with patient’s outcomes, including age, body mass index (BMI), DM, chronic pulmonary diseases, number of hospitalization days and number of an intensive care unit (ICU) admission days. Conclusion: Our analysis suggests that age, male gender, BMI, number of hospitalization days and ICU admission, chronic pulmonary disease and diabetes are associated with a higher risk of in-hospital mortality and worst prognosis in patients infected by SARS-CoV-2.