European Society Of Cardiology Research Articles

Cardiovascular disease burden due to productivity losses in European Society of Cardiology countries.

Cardiovascular disease (CVD) is the leading cause of death across Europe. We estimated lost earnings (productivity losses) associated with premature mortality due to CVD, and separately for its main sub-categories of coronary heart disease and cerebrovascular disease, across 54 country members of the European Society of Cardiology (ESC). We used a standardized approach to estimate working years and earnings lost due to premature death resulting from CVD across the 54 ESC member countries in 2018. Our population-based approach was based on national data on the number of deaths, employment rates, and earnings by age group and sex. We discounted future working years and earnings lost to present values using a 3.5% annual rate. In 2018, there were 4.4 million deaths due to CVD across the 54 countries, with 7.1 million working years lost. This represented productivity losses due to premature death of €62 billion in 2018. Deaths due to coronary heart disease accounted for 47% (€29 billion) of all CVD costs, and cerebrovascular disease accounted for 18% (€11 billion). Approximately 60% (€37 billion) of all productivity losses occurred in the 28 European Union member states, despite accounting for only 42% (1.8 million) of deaths and 21% (1.5 million) of working years lost across the 54 countries. Our study provides a snapshot of the economic consequences posed by premature mortality due to CVD across 54 countries in 2018. The considerable variation across countries highlights the potential gains from policies targeting prevention and care of cardiovascular diseases.

Coronary Artery Calcium Score Improves Risk Assessment of Symptomatic Patients in Low-Risk Group Based on Current Guidelines.

The guidelines for evaluation and diagnosis of stable chest pain (SCP) released by American societies in 2021 (2021 GL) and European Society of Cardiology (ESC) in 2019 both recommended the estimation of pretest probability (PTP) by ESC-PTP model. Further risk assessment for the low-risk group according to 2021 GL (ESC-PTP 15%) is important but still remains unclear. Thus, the present study intended to comprehensively investigate the diagnostic and prognostic value of coronary artery calcium score (CACS) in these low-risk patients. From January 2017 to June 2019, we initially enrolled 8265 patients who were referred for CACS and coronary computed tomography angiography (CCTA) for the assessment of SCP. PTP of each patient was estimated by ESC-PTP model. Patients with ESC-PTP 15% were finally included and followed up for major adverse cardiovascular event (MACE) and utilization of invasive procedures until June 2022. The degree of coronary artery disease (CAD) on CCTA was defined as no CAD (0%), nonobstructive CAD (1-49%) and obstructive CAD ( 50%). Multivariate Cox proportional hazards and Logistic regression models were used to calculate adjusted hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs), respectively. A total of 5183 patients with ESC-PTP 15% were identified and 1.6% experienced MACE during the 4-year follow-up. The prevalence of no CAD and obstructive CAD decreased and increased significantly (p 0.0001) in patients with higher CACS, respectively, and 62% had nonobstructive CAD among those with CACS 0, resulting in dramatically increasing ORs for any stenosis 50% and 0% across CACS strata. Higher CACS was also associated with an elevated risk of MACE (adjusted HR of 3.59, 13.47 and 6.58 when comparing CACS = 0-100, CACS 100 and CACS 0 to CACS = 0, respectively) and intensive utilization of invasive procedures. In patients for whom subsequent testing should be deferred according to 2021 GL, high CACS conveyed a significant probability of substantial stenoses and clinical endpoints, respectively. These findings support the potential role of CACS as a further risk assessment tool to improve clinical management in these low-risk patients.

QUANTITATIVE ANALYSES OF THE ESC GUIDELINES ON SPORTS CARDIOLOGY AND EXERCISE

Objective: Exercise and sports are important components of preventing/delaying the development of cardiovascular disease (CVD) as evidenced by reduced all-cause morbidity and mortality. Because of that, the European Society of Cardiology (ESC) published “2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease” (GL-SCE) summarizing recommendations and supporting evidence to ‘prescribe’ various types of exercise and sports regimens that can be used to prevent, delay, or alleviate CVD. Thus we aimed to assess quantitatively the efficacy of the GL-SCE providing help in the sport- /exercise-related treatment decision-making in specific cardiovascular condition Design and method: An analytic study was conducted on the GL-SCE regarding the Classes of Recommendations (CLASS) and the Levels of Evidence (LEVEL) (n = 159). Then LEVEL areas under CLASS were calculated to form a Certainty Index (CI: -1 to +1). Results: The frequency of CLASS I and CLASS III was relatively high in GL-SCE (52.2%) and GL-CS) (in Clinical Settings: 50.7%). Yet, the most frequent LEVEL was C (41.2%–83.8%), indicating only a relatively low quality of scientific evidence in GL-SCE. The GL-SCE showed a relatively high CI (+0.57), 78.4% Certainty, and 21.6% Uncertainty. Conclusions: The GL-SCE provides substantial help in decision-making through the recommendations (CLASS), but the supporting evidence (LEVEL) in most cases is only lower quality, which is well reflected in the newly developed Certainty Index identifying issues that should be clarified and investigated in future studies.

Histopathologic Validation of Stress T1 Mapping in Myocardial Ischemia: Another Step toward Clinical Translation?

Histopathologic Validation of Stress T1 Mapping in Myocardial Ischemia: Another Step toward Clinical Translation?

SEPTAL AND LEFT ATRIAL VOLUME INDEX AS PREDICTORS FOR HFPEF AMONGST TYPE 2 DIABETES MELLITUS PATIENTS

Objective: The aim of this study is to determine the prevalence and determination of risk factors of heart failure with preserved ejection fraction (HFpEF) diagnosed based on the consensus recommendation from the Heart Failure Association (HFA) and European Society of Cardiology (ESC) 2019 in type 2 diabetes mellitus (T2DM) patients in Malaysia. Design and method: We conducted a cross sectional study on patients with T2DM of more than 18 years old that were under Hospital UiTM follow-up from December 2021 until May 2021 (6 month). The participants were chosen via simple random sampling. Data's on demographic data, comorbid profile, symptoms and clinical examination including vitals sign, chemical profile and proceed with echocardiography and NTproBNP test to diagnosed HFpEF. Results: 201 diabetic patients were recruited and screened for HFpEF. 40 patients were confirmed with the diagnosis of HFpEF. Mean age was 61 ± 5.4 years. A significant difference in mean septal e’ was found between diabetic patients with HFpEF (5.5 ± 1.5 cm/s) and non-heart failure subjects (7.6 ± 1.0 cm/s)(p<0.001, 95% CI -2.40,-1.49). There was also significant difference in mean left atrial volume index (LAVI) between diabetic patients with HFpEF (35.5 ± 1.5 ml/m2) and non-heart failure subjects (28.6 ± 1.0 ml/m2)(p<0.001, 95% CI -2.50,-1.33). A stepwise increase in cortisol level corresponding to NTproBNP was observed(p<0.061). Basal septal hypertrophy was seen in 30% of HFpEF diabetic patients (p<0.081). Multiple linear regression analysis revealed septal e’ and LAVI as independent predictors of HFpEF in diabetic patients (r2 = 0.249, p<0.001). Conclusions: One fifth of diabetic population had HFpEF and specific echocardiography parameters including septal e’ and LAVI were predictors for HFpEF. Emerging early imaging and chemical biomarkers for HFpEF such as basal septal hypertrophy and cortisol should be further studied.

LIPOPROTEIN (A): TREATMENT IN THE METABOLIC CONTEXT

Objective: Lipoprotein(a) [Lp(a)] is an independent cardiovascular risk factor but is closely associated with other similar risk factors that are manageable with appropriate treatment and guidance. We aimed to study the impact of using combined therapy for managing Lp(a) levels in patients at high cardiovascular risk but without major adverse cardiovascular events, in primary prevention. Design and method: We conducted a retrospective observational study in 516 patients randomly selected from a group of 1677 patients who attended cardiovascular risk and metabolism consultations between 1995 and 2015. The disorders observed and therapies used were classified into nosological and pharmacological groups, respectively. Cardiovascular risk was calculated based on the Framingham risk score, the European Society of Cardiology's SCORE and the American College of Cardiology's ASCVD Risk Estimator, and changes in patients’ lifestyle were assessed. Results: Significant differences (p<0.001) were found in almost all metabolic variables, except fasting insulin and C-peptide. Lp(a) levels were also significantly reduced (p<0.001). Carotid intima-media thickness improved, decreasing from 2.90 mm to 1.40 mm; however, there was no reduction in the number of cases of vascular stenosis. Of patients with hepatic steatosis (85.5%), 40.7% presented hepatomegaly, but liver function was only altered in a few patients (14.5%). Lipid-lowering therapy, especially statins, significantly decreased Lp(a), benefiting from synergy with other treatments aimed at other metabolic situations associated. Conclusions: Lp(a) is a key overall indicator of vascular risk and should be considered a target in context of combined therapy. Besides a healthy lifestyle, primary prevention should include combined drug therapies to address all cardiovascular risk factors and to delay the atherosclerotic process.

Cardiac Resynchronization Therapy: current guidelines and recent advances beyond drug treatment.

Cardiac resynchronization therapy (CRT) is the therapy of choice for patients with symptomatic systolic heart failure (HF) and left bundle branch block (LBBB), despite optimal medical therapy (OMT). The recently published 2021 European Society of Cardiology (ESC) Guidelines on cardiac pacing and cardiac resynchronization therapy highlight the importance of CRT on top of OMT in HF patients with left ventricular ejection fraction (LVEF) ≤ 35%, sinus rhythm and typical LBBB with QRS duration ≥150ms. In the presence of medically intractable or recurrent after catheter ablation atrial fibrillation (AF), AV nodal ablation as an adjuvant therapy becomes more relevant in patients qualifying for the implantation of a biventricular system. Furthermore, CRT may be considered in cases when increased pacing of the right ventricle is not desirable. However, alternative pacing sites and strategies are currently available, if the CRT is not feasible and effective in patients. However, strategies targeting "multi-sides" or using "multi-leads" have shown superiority over classic CRT. On the other hand, conduction system pacing seems to be a promising technique. Although early results are positive, consistency during the long term is pending. The indication for additional defibrillation therapy (ICD) may occasionally be unnecessary and has to be considered individually. Due to the great development and success of heart failure drug therapy, its positive effect on LV function can lead to enormous improvement. Physicians must await these effects and findings, which hopefully could lead to a relevant LV improvement resulting in a definitive decision against an ICD.

Protocolo terapéutico de la hipertensión esencial

Hypertension (HT) is the main risk factor for disease and death in the world, and properly controlling it reduces the risk of associated morbimortality. Essential HT is the most common form of HT (90%-95%), and genetic as well as environmental factors are implicated in its development. When considering a therapeutic protocol in a hypertensive patient it is important to quantify the vascular risk and define a control target. Following the 2018 recommendations of the European Society of Hypertension and the European Society of Cardiology, in the majority of cases it is indicated to simultaneously commence with lifestyle modifications and pharmacological treatment. The recommendation is to always start treatment with a combined therapy, except in patients with BP close to the target and in patients who are frail or over the age of 80 years. For the majority of patients a combination of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist II (ARA II) with a calcium antagonist or a thiazide will be preferable, although we should always individualize the treatment and control targets according to the patient's profile, while also considering special situations such as heart failure, auricular fibrillation, heart disease, chronic kidney disease or resistant HT.

Thromboelastogram Assessment of Dual Antiplatelet Effect in Cardiac Surgery

The management of patients on dual antiplatelet therapy (DAPT) prior to cardiac surgery is challenging. At least 10% of patients presenting with acute coronary syndromes require coronary artery bypass grafting (CABG). The standard of care is that these patients have received DAPT at presentation. However, preoperative cessation and washout may increase ischaemic events and disrupt hospital bed flow. Further, various guidelines and societies advocate different durations of preoperative DAPT washout: European Society of Cardiology, 3 days, and American College of Cardiology/American Heart Association, 5 days. This study sought to assess whether there was a difference in bleeding outcomes for patients proceeding to CABG earlier than 5 days based on thromboelastogram (TEG) assessment of their response to DAPT.

HIGH BLOOD PRESSURE IN WOMEN ACCORDING TO CARDIOVASCULAR RISK FACTORS AND ANTIHYPERTENSIVE TREATMENT: THE IMPORTANCE OF DETECTION

Objective: To evaluate the relationship between the presence of high blood pressure in a group of Mexican women, according to cardiovascular risk factors and antihypertensive treatment. Design and method: We analyzed the data of 341 women, > 18 years, with multiple risk factors, who attended cardiovascular imaging department. Cardiovascular risk factors and antihypertensive treatment were analyzed. Hypertension was classified according to the European Society of Cardiology (ESC) Guidelines (SBP >140 mmHg and DBP > 90 mmHg). Statistical analysis: SPSS v23; descriptive and comparative analysis with chi-square, confidence level 95%. Results: Mean age 58±15.6; Cardiovascular risk factors: hypertension 201 (58.9%), diabetes126 (37%), 136 (40%) dyslipidemia, tobacco use 97 (27.8%), chronic kidney disease 63 (18.5%); 248 (72.7%) were menopausal. A total of 198 (58.1%) patients with hypertension were on pharmacological treatment: 88 (44.5%) with monotherapy, 85 (42.9%) on dual therapy, and 25 (12.6%) with multiple therapies; (46.4%) were non-controlled. There were 143 (41.9%) patients, that were detected and classified as hypertensive according to European Society of Hypertension guidelines: Grade 1 88 (61.5%), Grade 2, 22 (15.38%), Grade 3, 6 (4.1%). A relationship between hypertensive women, kidney disease (47.6%, p = 0.001), and menopause was found (37.9%, p: 0.039). Conclusions: Hypertension is an important cardiovascular risk factor in women. Most are associated with others risk factors; more than fifty percent were on multiple therapy and uncontrolled. It is necessary to optimize antihypertensive treatment to improve hypertension control, especially in postmenopausal women and with kidney disease. Screening also must be improved to prevent future complications.

Heart Failure Discharge Checklist for Improving Quality of Care

Does evaluating the quality of heart failure (HF) care prior to discharge improve adherence to guideline-recommended care and equitable patient outcomes? A checklist tool was developed and implemented to measure and improve adherence against the 2022 European Society of Cardiology (ESC) Quality Indicators (QIs) for the care and outcomes of adults with heart failure. A retrospective audit was undertaken to evaluate performance against a checklist tool for 50 outpatients at discharge from a single-centre tertiary New Zealand hospital with a nurse practitioner/nurse specialist-led adult heart failure service. Performance measures were achieved for diagnosis of HF type by echocardiogram (ECHO), health practitioner review, and prescription of beta blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors. Rate of mineralocorticoid receptor antagonist prescriptions, screening for iron deficiency, cardiovascular risk assessment, documentation of QRS duration, and consideration of device therapy improved. Adoption of sodium/glucose cotransporter-2 inhibitors was limited by funding in the New Zealand context. Service constraints for repeat ECHO, HF rehabilitation programs, and use of a validated assessment tool to measure quality of life are targets for improvement. Adopting a discharge checklist improved interprofessional consistency in achieving optimal and individualised guideline-recommended care for patients, whilst improving service efficiency.

Evaluation of the guideline-adherence of coronary angiography in patients with suspected chronic coronary syndrome – Results from the German prospective multicentre ENLIGHT-KHK project

With 900'000 coronary angiographies (CA) per year, Germany has the highest annual per capita volume in Europe. Until now there are no prospective clinical data on the degree of guideline-adherence in the use of CA in patients with suspected chronic coronary syndrome (CCS) in Germany. Between January 2019 and August 2021, 458 patients with suspected CCS were recruited in nine German centres. Guideline-adherence was evaluated according to the current European Society of Cardiology and German guidelines. Pre-test probability (PTP) for CAD was determined using age, gender, and a standardized patient questionnaire to identify symptoms. Data on the diagnostic work-up were obtained from health records. Patients were in mean 66.6years old, male in 57.3%, had known CAD in 48.4% and presented with typical, atypical, non-anginal chest pain or dyspnoea in 35.7%, 41.3%, 23.0% and 25.4%, respectively. PTP according to the European guidelines was in mean 24.2% (11.9%-36.5% 95% CI). 20.9% of the patients received guideline-recommended preceding non-invasive image guided testing. The use of CA was adherent to the European and German guideline recommendations in 20.4% and 25.4%, respectively. In multivariate-analysis, arterial hypertension and prior revascularization were predictors of guideline non-adherence. These are the first prospective clinical data which demonstrated an overall low degree of guideline-adherence in the use of CA in patients with suspected CCS in the German health care setting. To improve adherence rates, the availability of and access to non-invasive image guided testing needs to be strengthened. (German Clinical Trials Registry DRKS00015638 - Registration Date: 19.02.2019).

Comparison of four electrocardiographic criteria for the detection of cardiac abnormalities in Singapore athletes.

Sudden cardiac death in athletes is a rare occurrence, the most common cause being hypertrophic cardiomyopathy, which increases the risk of sustained ventricular tachycardia or ventricular fibrillation. Most of these young athletes are asymptomatic prior to the cardiac arrest. Several electrocardiogram criteria such as the European Society of Cardiology group 2 Criteria changes, Seattle Criteria, Refined Criteria, and most recently the 2017 International Criteria, have sought to improve the accuracy of identifying these at-risk athletes during pre-participation screening while minimising unnecessary investigations for the majority of athletes at low risk.We aimed to compare the above four criteria in our Singapore athlete population to identify which criterion performed the best in detecting cardiac abnormalities on echocardiography. Out of 1,515 athletes included in Changi General Hospital, Singapore registry between June 2007 and June 2014, the electrocardiograms of 270 athletes with further cardiac investigations were analysed. We compared the above four electrocardiographic criteria to evaluate which performed best for detecting cardiac abnormalities on echocardiography in our Southeast Asian athlete population. The European Society of Cardiology, Seattle, Refined and 2017 International Criteria had a sensitivity of 20%, 0%, 20% and 5%, respectively; a specificity of 64%, 93%, 84% and 97%, respectively; a positive predictive value of 4%, 0%, 9% and 11%, respectively; and a negative predictive value of 91%, 92%, 93% and 93%, respectively for detecting abnormalities on echocardiography. The latest 2017 International Criteria performed the best as it had the highest specificity and positive predictive value, joint highest negative predictive value, and lowest false positive rate.

Atrial Fibrillation in Endurance Training Athletes: Scoping Review.

Moderate regular physical activity is indicated to avoid atrial fibrillation (AF), whereas athletes should be counseled that long-lasting vigorous sports engagement may cause AF, according to the 2016 European Society of Cardiology (ESC) recommendations for AF treatment. Exercise and AF are complex. To evaluate the relationship between Endurance training and AF, in addition to the starting point/trigger by which Endurance Training causes impairment of cardiac function and AF, considering the time and intensity of Endurance training. We synthesized evidence from articles published in the PubMed, EMBASE, and SciELO databases using their respective Boolean operators. A total of 112 original articles related to AF and endurance athletes published up to the year 2023 were reviewed. Our study verified multiples aspects of the genesis of AF in athletes, such as cardiac adaptations to exercise, disturbances in cardiac injury biomarkers, sex differences in cardiac adaptations and their role in AF risk, and the relationship between body composition (height, weight, and physical fitness) and AF pathogenesis. Variations in cardiac structure (increased atrial thickness and size in addition to myocardial fibrosis) and significant increases in vagal tone (sinus bradycardia and imbalances in sympathetic and parasympathetic activation) shorten the refractory period shortening in athletes, induce the onset of re-entrance mechanisms, and serve as ectopic triggers that can lead to AF.

Differences in treatment strategies for LDL-cholesterol reduction in a university lipid clinic vs. standard care apart from the use of PCSK9 inhibitors

Lipid-lowering therapy (LLT) in patients with cardiovascular disease (CVD) is insufficient despite clear guideline recommendations. Lipid clinics have specialized in patients with dyslipidemia, but the magnitude and reduction of low-density lipoprotein cholesterol (LDL-C) in lipid clinics has not yet been studied in depth. To assess LDL-C reduction in very high-risk CVD patients achieved in a lipid clinic through different forms of LLT in comparison to standard care without the initiation of PSCK9 inhibitors. Data from 96 lipid clinic patients were analyzed retrospectively and compared to 84 standard care patients. Very high-risk patients were defined according to the European Society of Cardiology (ESC). Different combinations of LLT focusing on statins and ezetimibe were investigated. Achievement of LDL-C treatment goals according to ESC guidelines as well as LDL-C reduction were assessed. Baseline and follow-up data of 180 very high-risk CVD patients (mean age 67.7 (±9.8) y; 60.6% male) were used. Achievement of the LDL-C goal in lipid clinic patients increased significantly from 14.6% at baseline to 41.7% at the latest visit (p<0.001) while standard care patients improved from 21.4% to 33.3% (p=0.08). The largest relative LDL-C reduction via an adjustment in LLT was achieved by initiation of high-intensity statins (50.8 ± 4.9%, n=5, p < 0.05). Treatment in a lipid clinic leads to a superior LDL-C goal achievement in very high-risk CVD patients as compared to standard care with the highest reduction under LLT with high-intensity statins and ezetimibe. Referral algorithms have to be established for high-risk patients.

Social media dissemination of a novel digital health approach: a social network analysis of the TeleCheckAF project

Abstract Funding Acknowledgements Type of funding sources: None. Background TeleCheck-AF is a novel remote on-demand mobile health (mHealth) infrastructure supporting teleconsultations. During the COVID-19 pandemic, social media (SoMe) communication on Twitter contributed to the rapid dissemination and implementation of this health care innovation into 41 European hospitals by using the hashtag #TeleCheckAF. Purpose To (1) analyze the SoMe Twitter network behind #TeleCheckAF, (2) describe the communities and behavioral groups within the network and (3) to determine the opinion leaders and influencers. Methods Publicly available data on actors and interactions within the #TeleCheckAF SoMe network was collected by web-scraping from the platform Twitter. This included all public tweets that used the hashtag #TeleCheckAF including their meta-data. Based on this, a node list (Twitter accounts) and an edge list (ties between accounts) as well as a social network were created. The position of an actor in the network and an actor’s opinion leadership was analyzed with the help of centrality measures (i.e. degree centrality, closeness centrality, betweenness centrality). Communities, or groups of nodes that were highly connected to each other, were further assessed by a modularity algorithm. Behavioral groups were analyzed based on participation in the healthcare innovation TeleCheck-AF (active participation) and dissemination of #TeleCheckAF on Twitter. Three behavioral groups were defined: Diffusers (dissemination but no active participation), adopters (no dissemination but active participation) and communicative adopters (dissemination and active participation). Results The network consisted of 413 086 nodes and 636 502 edges. 287 actors within the SoMe Twitter network behind #TeleCheckAF, who were either diffusers, adopters or communicative adopters, were further analyzed. Twenty-two different communities and 20 opinion leaders were identified. Peaks in Twitter activity could be temporally related to (inter-,)national virtual conferences, where results on TeleCheck-AF were presented. Two official European Society of Cardiology (ESC) Twitter handles and two Twitter handles of ESC SoMe supervisors and ESC Journal SoMe editors were among the group of opinion leaders reflecting the effect of the ESC SoMe promotion strategy. Overall, not only professionals directly involved in the TeleCheck-AF project, but also different other stakeholders such as allied health professionals or health technology companies were represented within the network. Conclusion The SoMe network behind #TeleCheckAF showed a wide dissemination involving a broad spectrum of healthcare professionals and was accelerated by the official ESC Twitter handles. Social network analysis created a helpful insight into the mechanisms behind innovation dissemination within social media. Future research could further analyze the difssemination process using e.g. hazard modeling and investigate the evolution of the network and behaviors over time.

Disagreement of ESC guidelines from 2016 and 2021 and HFA-PEFF and H2 FPEF scores in diagnosis of heart failure with preserved ejection fraction in atrial fibrillation patients

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart failure with preserved ejection fraction (HFpEF) frequently coexists with atrial fibrillation (AF). The gold-standard test for HFpEF diagnosis remains invasive assessment of left ventricular end-diastolic pressures but noninvasive diagnostic scoring systems have been developed to aid accurate diagnosis. However, the diagnosis of HFpEF in patients with AF is more difficult because some diagnostic criteria for HFpEF may be associated with AF instead of HFpEF per se. Purpose To compare the guidelines and scoring systems for HFpEF diagnosis in patients with AF, and to indicate the most relevant clinical and echocardiographic parameters supporting the diagnosis of HFpEF in an AF cohort. Methods Consecutive patients with paroxysmal or persistent AF scheduled for catheter ablation were included. Clinical characteristics and transthoracic echocardiography examination was collected at baseline visit. The European Society of Cardiology (ESC) guidelines from 2016 and 2021 as well as scoring systems (HFA-PEFF and H2FPEF scores) were used to diagnose HFpEF. In the H2FPEF score, patients with AF alone, score of 3, were assessed as group with the low risk for HFpEF (instead of intermediate risk according to the H2FPEF score), as all enrolled patients had AF. Multiple logistic regression was performed to find optimal parameters predicting HFpEF, that was defined as diagnosis of HFpEF according to all following scores: ESC guidelines from 2016 and 2021 and high risk in HF2FPEF and HF-PEFF scores. Results We analysed 325 patients (median age 65 [59-72], 36% women). Considerable differences were observed in HFpEF diagnoses when stratifying patients according to ESC 2016 and ESC 2021 guideline definitions; the percentage of HFpEF patients reduced from 55% (n=180) to 28% (n=90). The agreement of HF2PEF score relative to HFA-PEFF score was 46% (n=25/55), 54% (n=115/213) and 35% (n=20/57) of patients regarding low, intermediate and high risk for HFpEF, respectively. Overall, 5.8% of patients (n=19) had HFpEF (Figure 1). These 19 patients were older (median age 70 vs 65, p&amp;lt;0.001), had more often persistent AF (63% vs 30%; p&amp;lt;0.001) and vascular disease (37% vs 14%, p=0.017) as compared to those without HFpEF. Based on multiple logistic regression, higher values of N-terminal-pro hormone BNP (NT-proBNP; OR 1.02, 95CI 1.01-1.03) and LA volume index (LAVI; OR 1.13, 95%CI 1.04-1.23) were independent predictors of having HFpEF in AF population. The NT-proBNP of 45 pmol/L and LAVI of 45ml/kg2 were ideal cutoffs and constructed a model to predict HFpEF which fitted with a concordance index of 0.91 (95% CI 0.87–0.94) (Figure 2). Conclusions The differences in HFpEF definition in the guidelines and various scoring systems lead to considerable difference in stratification of HFpEF in AF patients. In our population, just 5.8% of AF patients were diagnosed with HFpEF regarding ESC guidelines and high risk for HFpEF in scoring systems.

Overview of Cardiac Rehabilitation (OCRE) in European Society of Cardiology (ESC) Member Countries

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite unambiguous guideline recommendations, the implementation of Cardiac Rehabilitation (CR), a cost-effective strategy of secondary prevention with the potential to reduce cardiovascular morbi-mortality, remains heterogeneous, mostly suboptimal, in Europe. A previous "Overview of CR in ESC member countries" (OCRE) analysis reported on diverse national uptake rates and singled out possible common CR provision and quality surrogates contributing to the distinct performances. However, an integrated understanding of the overall status and concomitancy of the provision and quality indicators (or the lack thereof) in each country was still lacking. Purpose The present OCRE analysis aimed to further characterize and compare ESC affiliated national CR settings, by scoring the national overall provision and quality status, and to describe the matching between both. Methods An online survey concerning key CR provision and quality indicators was sent to the network of National CVD Prevention Coordinators of ESC member states, whose answers were supported by published evidence and/or national expert consensuses. To summarize the findings from the OCRE study, we assigned participating countries based on their provision of CR and their CR quality, to three different categories: lacking, average, and good. Provision was rated considering the following indicators: uptake rate, dropout rate, average start time, average duration, and public funding. CR quality was sought by scoring the presence of: guidelines, guidance documents, coordination by cardiology, mandatory rotation in cardiology training, national accreditation, and electronic database registry. Results The data suggested that although provision of CR is at an encouraging level in Europe (Fig.1), it often is of suboptimal quality (Fig.2), signalling the need for improvement in the allocation of human and monetary resources. Conclusions This study provides a comprehensive characterisation of CR in Europe, generating important insights on the current provision and quality of CR in Europe, highlighting its sucesses and shortcomings, and discussing important strategies to overcome current obstacles. Particularly, we consider that European CR programs need to be based upon the same minimal quality standards. However, we acknowledge the differences in economy, culture, religion, health system, climate, and literacy across the different countries. These need to be considered and respected, and a shared CR plan should contemplate the diver sity and promote adjustments for each country while also preventing it from falling short of the common set goals.

Estimation of 10-year risk of fatal and non-fatal cardiovascular disease in a portuguese population

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiovascular disease (CVD) is the most common noncommunicable disease and actually the leading cause of death globally. Hence, it is important to identify individuals who may benefit from CVD preventive strategies. The European Society of Cardiology (ESC) has recently updated the European Systematic Coronary Risk Evaluation (SCORE) to SCORE2 and SCORE2-OP risk prediction algorithms. Those tools were recalibrated to four groups of countries (low, moderate, high and very high CVD risk) based on national CVD mortality rates published by the WHO, with Portugal being now considered a moderate risk country. Purpose To evaluate the application of SCORE2 and SCORE2-OP in a Portuguese population sample. Methods We conducted a cross-sectional study, including individuals aged 40-90 years, without known established Atherosclerotic Cardiovascular Disease, Diabetes mellitus, Chronic Kidney Disease or Familial Hypercholesterolemia. The sample was recruited at a local cardiovascular screening event in Portugal that took place in May 2022. The 10-year fatal and non-fatal CVD risk was calculated using SCORE2 (for individuals aged &amp;lt; 70 years) and SCORE2-OP (for individuals aged ≥ 70 years) tools. Based on CVD risk category, patients were stratified into 3 categories: low to moderate, high and very high risk according to new SCORE algorithms. Primary outcome was the assessment of 10-year risk of fatal and non-fatal CVD with SCORE2 e SCORE2-OP in a local Portuguese population. According to the data distribution, appropriate statistical tests were conducted to compare independent samples. Multivariable linear regression was used to analyze 10-year CVD risk. Results This cohort included 431 individuals. Median age was 71 years (Q1-Q3: 65-75) and 66.8% of individuals were women. Regarding baseline characteristics of the included individuals, 48.1% had hypertension, 38.3% had dyslipidemia, 25.5% were obese and 6.6% were smokers. Based on the SCORE2 model 92 (26.1%) individuals were classified into low to moderate risk, 162 (46.0%) into high risk and 98 (27.8%) into very high-risk category. SCORE2 median was 3.43 % (Q1-Q3: 5.5-8.0 p&amp;lt; 0.01) and SCORE2-OP median was 12.70 % (Q1-Q3: 9.7-12.7). Active smoking was the only independent predictor of 10-years CVD risk both in SCORE2 (RR 3.28, 95% CI: 1.93-4.66, p=0.001) and SCORE2-OP (RR 6.31, 95% CI: 2.67-9.52, p&amp;lt;0.001). Conclusions Most individuals in this sample were stratified into high or very high risk of developing 10-year fatal and non-fatal cardiovascular events. This data is in accordance with the updated risk category of Portugal based on World Health Organization cardiovascular mortality rates. These results not only validate the application of SCORE to the Portuguese setting, but also reinforce how this easily applicable tool can help to identify patients who will benefit from CVD preventive strategies.

Application of european society of cardiology guidelines 2020 on competitive sports eligibility in a large population of subjects with surgically corrected congenital heart disease

Abstract Funding Acknowledgements Type of funding sources: None. Background Congenital heart disease (CHD) affects approximately 0.5-1% of the general population. Thanks to the improvement of medical and surgical techniques, in developed countries 90% of individuals with CHD reach adulthood and, consequently, the demand for participation in sporting activities also increases. Recently, the European Society of Cardiology have given recommendations on participation in recreational and competitive sports (ESC 2020) based on a clinical and functional algorithm. Purpose To show the prevalence of the eligibility for competitive sports proposed by ESC 2020 in a real CHD population and the prevalence of real engagement in physical activity (both competitive and non-competitive). Also, to evaluate the difference in cardiorespiratory fitness (CRF) and the impact of training among different sport eligibility classes. Methods Retrospective study of 401 patients with surgically corrected CHD and followed up with cardiopulmonary exercise test (CPET) performed on treadmill or cycle ergometer until patients’ exhaustion. Subjects were divided in 4 classes according with ESC 2020 guidelines and corresponding to the eligibility for all competitive sport (A), all except endurance specialties (B), only for skill disciplines (C) or not eligible (D). Results Median (IQR) age was 18.0(13.0; 21.5) years; 266 patients (66.3%) were males. 34% were in class D, 13% in class B, 25% in class C and 28% in class A. Within the entire population, 179 subjects (44.6%) carried out structured exercise training, corresponding to 60.7% of subjects in class A, 45.1% of those in class B, 41.7% of those in class C and 41.1% of those in class D. VO2peak/Kg was similar between class A [39.2 (33.6-44.4) mL/Kg/min] and B [37.9 (30.6-42.6) mL/Kg/min], but significantly different between class A vs. class C [33.3 (28.3-41.4) mL/Kg/min p&amp;lt;.0001] and class D [32.2 (27.6-39.3) mL/Kg/min p&amp;lt;.0001]. Also, functional impairment, defined as &amp;lt;85% of the predicted for age and sex, resulted significantly higher in patients in the lower classes of sport eligibility (C and D) than in the higher ones, with a prevalence of impaired CRF of 22.5% in class A, 42.5% in class B, 55.1% in class C and 57.0% in class D (p &amp;lt;.0001). Paired comparison showed significant differences in CRF (VO2peak/Kg) between trained and untrained subjects both within and across ESC 2020 classes, while there was no significant difference between paired groups of different classes who presented the same level of physical activity (Figure 1). Conclusions Subjects in class A had better functional capacity than those in C and D classes, but exercise training (competitive or non-competitive) can have a significant impact on CRF level. Figure 1 shows that trained people in D class had higher CRF than untrained in A class, supporting that functional evaluation and an individualized exercise prescription may recruit functional "reserve" by improving the VO2peak as key prognostic component.