Frequency Of Cardiovascular Complications Research Articles

CARDIOVASCULAR COMPLICATIONS IN PATIENTS ON RENAL REPLACEMENT THERAPY

Introduction. A progressive decrease in the rate of glomerular filtration is an independent risk factor for cardiovascular complications, as well as a marker of an unfavorable prognosis of cardiovascular diseases. Cardiovascular complications arising against the background of end-stage renal failure are the main cause of mortality in patients undergoing renal replacement therapy.
 The aim of the study was to determine the features and prevalence of cardiovascular complications in patients undergoing renal replacement therapy.
 Materials and methods. A retrospective study was conducted of 114 medical records of nephrology patients who were treated in the center of nephrology and dialysis of Poltava Regional Clinical Hospital n.a. M.V. Sklifosovsky. Patients were divided into three groups: two experimental and one control group. The first experimental group consisted of 44 (38.6%) patients who were on RRT by the method of programmed hemodialysis. The second experimental group consisted of 21 (18.4%) patients who were also undergoing RRT, but by the method of peritoneal dialysis. The control group consisted of 49 (43.0%) patients with CKD stages I-II. Analysis of laboratory data of traditional risk factors for cardiovascular complications (lipidogram), as well as non-traditional ones (level of calcium and phosphorus) was carried out. The frequency of cardiovascular complications in patients on renal replacement therapy was studied.
 Results. A statistically significant difference was found between the indicators of the atherogenicity index in the groups GD1 with CG1 (р=0.001) and GD2 with CG2 (р=0.031), PD1 and CG1 (р=0.005) and PD2 with CG2 (р=0.027). When analyzing the correlations between indicators of mineral metabolism in the experimental and control groups, it was found that weak and medium inverse correlations were observed in the experimental groups (GD1: -0.4703, GD2: -0.3219, PD1: -0,2146, PD2: -0.2784, respectively), while in the control groups a direct weak correlation was found (CG1 0.1975, CG2 0.2031, respectively). Chronic heart failure was detected in 75.0% of patients in the GD1 group, in 66.6% – in GD2, and in 100.0% of PD1 and PD2 patients. Valve calcification was observed in 35.0%, 29.1%, 33.3%, and 20.0%, respectively.
 Conclusions. Studying the features of cardiovascular complications, control of risk factors, which in any case occur in patients on dialysis therapy, is one of the main directions of controlling the underlying disease, reducing the risk of dangerous cardiovascular complications, prolonging life expectancy and its quality.

Autosomal Dominant Polycystic Kidney Disease: Extrarenal Involvement.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disorder, but kidneys are not the only organs involved in this systemic disorder. Individuals with the condition may display additional manifestations beyond the renal system, involving the liver, pancreas, and brain in the context of cystic manifestations, while involving the vascular system, gastrointestinal tract, bones, and cardiac valves in the context of non-cystic manifestations. Despite kidney involvement remaining the main feature of the disease, thanks to longer survival, early diagnosis, and better management of kidney-related problems, a new wave of complications must be faced by clinicians who treated patients with ADPKD. Involvement of the liver represents the most prevalent extrarenal manifestation and has growing importance in the symptom burden and quality of life. Vascular abnormalities are a key factor for patients' life expectancy and there is still debate whether to screen or not to screen all patients. Arterial hypertension is often the earliest onset symptom among ADPKD patients, leading to frequent cardiovascular complications. Although cardiac valvular abnormalities are a frequent complication, they rarely lead to relevant problems in the clinical history of polycystic patients. One of the newest relevant aspects concerns bone disorders that can exert a considerable influence on the clinical course of these patients. This review aims to provide the "state of the art" among the extrarenal manifestation of ADPKD.

Multiplex analysis of post-Covid cardiorenal complications in patients with type 1 and type 2 diabetes mellitus according to the mobile diagnostic and treatment center (Diamobil)

BACKGROUND: Patients with diabetes mellitus (DM) are at risk for a higher incidence and severity of COVID-19, as well as its adverse outcomes, including post-Covid syndrome.AIM: to assess the incidence of cardiorenal complications in patients with type 1 and type 2 diabetes (T1DM/T2DM) who have had COVID-19, and to analyze the structure and severity of disorders according to examination data at the Diamobil mobile medical diagnostic and treatment center.MATERIALS AND METHODS: a cohort of T1DM and T2DM patients examined in Diamobil (n=318), with a confirmed anamnesis of COVID-19 (n=236). The time interval between COVID-19 and the visit to Diamobil was 8.7/8.2 months for T1DM/T2DM. The parameters of the last visit before COVID-19 recorded in the Federal Register of Diabetes (FRD) were used as initial data.RESULTS: Clinical characteristics of patients with T1DM/T2DM: age — 49.2/64.5 years, duration of DM — 22/11 years, proportion of women — 64/73%, respectively. After analysis the data from visits before and after COVID-19 there weren’t statistically significant differences in HbA1c levels for both types of DM (before 9.0/8.3%; after 8.4/8.2%, respectively), there was the intensification of glucose lowering therapy (the proportion of patients with T2DM on 2 and 3 component therapy increased by 4.3% and 1.6%, the proportion of patients on insulin therapy by 16%). After COVID-19, there was a statistically significant decrease in glomerular filtration rate (GFR) in T1DM from 88.1 to 62 ml/min/1.73 m2; with T2DM from 74.7 to 54.1 ml/min/1.73 m2. When assessing acute diabetic complications, there was an increase in the frequency of coma in T1DM by 1.5 times, severe hypoglycemia in T1DM by 3 times, and in T2DM by 1.7 times. Analysis of the frequency of cardiorenal complications before and after COVID-19 showed a total increase of 8.5% in T1DM, by 13.2% in T2DM, of which myocardial infarction, ischemic heart disease, and CHF increased in T1DM in the range from 1.5 to 5 times, with T2DM by 1.3 times, the frequency of CKD with T1DM by 1.5 times, with T2DM by 5.6 times.CONCLUSION: There was a decline of kidney filtration function (decrease in GFR) and an increase in the frequency of cardiovascular complications in both types of diabetes in post-Covid period while patients achieved a stable HbA1c levels by intensifying therapy during the COVID-19 infection. This fact reflects combined damage to the kidney and cardiovascular system as a part of the post-Covid syndrome and determines a key set of measures for the development of preventive strategies.

Latin-American Registry of Cardiovascular Disease and COVID-19: Final Results.

Socioeconomic factors contribute to a more severe impact of COVID-19 in Latin American and Caribbean (LA&C) countries than in developed countries. Patients with a severe or critical illness can develop respiratory and cardiovascular complications. To describe a LA&C population with COVID-19 to provide information related to this disease, in-hospital cardiovascular complications, and in-hospital mortality. The CARDIO COVID-19-20 Registry is an observational, multicenter, prospective, and hospital-based registry of patients with confirmed COVID-19 infection that required in-hospital treatment in LA&C. Enrollment of patients started on May 01, 2020, and ended on June 30, 2021. The CARDIO COVID-19-20 Registry included 3260 patients from 44 institutions of 14 LA&C countries. 63.2% patients were male and median age was 61.0 years old. Most common comorbidities were overweight/obesity (49.7%), hypertension (49.0%), and diabetes mellitus (26.7%). Most frequent cardiovascular complications during hospitalization or reported at discharge were cardiac arrhythmia (9.1%), decompensated heart failure (8.5%), and pulmonary embolism (3.9%). The number of patients admitted to the Intensive Care Unit (ICU) was 1745 (53.5%), and median length of their stay at the ICU was 10.0 days. Support required in ICU included invasive mechanical ventilation (34.2%), vasopressors (27.6%), inotropics (10.3%), and vasodilators (3.7%). Rehospitalization after 30-day post discharge was 7.3%. In-hospital mortality and 30-day post discharge were 25.5% and 2.6%, respectively. According to our findings, more than half of the LA&C population with COVID-19 assessed required management in ICU, with higher requirement of invasive mechanical ventilation and vasoactive support, resulting in a high in-hospital mortality and a considerable high 30-day post discharge rehospitalization and mortality.

Effectiveness of beta-blockers in the therapy of arterial hypertension

Recently, the interest of the cardiology community has been focused on the results of the latest studies on the use of vasodilating β-blockers in patients with arterial hypertension. A review of these studies demonstrates a number of advantages over conventional cardioselective drugs (without vasodilator properties). The positive features of vasodilating β-adrenoblockers are proven metabolic neutrality, proportional reduction of central and peripheral blood pressure, minimal effect on bronchial patency, the absence of negative effect on erectile function, reduction in the frequency of cardiovascular complications in patients with arterial hypertension.

Cardiovascular Effects of Excess Growth Hormone: How Real is the Threat?

Patients with acromegaly carry a high risk of developing cardiovascular diseases (CVD). In fact, CVD is the leading cause of mortality among this group of patients. The most frequent cardiovascular complications are heart failure (HF), valvular disease, hypertension, arrhythmias, and coronary artery disease (CAD). The pathophysiology centers on the family of growth hormone (GH). These hormones are involved in normal cardiac development and function; however, excess of insulin-like growth factor-1 (IGF-1), the principally active hormone, can also cause negative effects on the cardiovascular system. HF in acromegaly usually presents with biventricular enlargement and diastolic dysfunction and is strongly associated with the duration of GH excess rather than the degree of hormone elevation. There is a high prevalence of valvular disease affecting aortic and mitral valves among patients with longer disease duration. The development of hypertension in acromegaly may be attributed to the effects of chronic GH/IGF-1 excess on different organ systems, which act via several mechanisms. The aspect of arrhythmia and CAD complicating acromegaly are currently not fully understood.

Pathophysiological basis of sarcopenia— a chronic complication of diabetes

The review considers the problem of sarcopenia, a muscle weakness and loss of mass, quality and strength of skeletal muscles, which often accompanies type 2 diabetes, especially in the elderly. Recently, sarcopenia has been considered as one of the complications of diabetes, which is associated with an increase in the frequency of cardiovascular complications, the need for hospitalization, and patient mortality. The molecular mechanisms of muscle atrophy in sarcopenia are associated with a violation of the anabolic-catabolic balance in muscles and their energy supply, fatty infiltration and shifts in proteostasis (decreasing the synthesis of muscle proteins and increasing their degradation), mitochondrial dysfunction. Insulin resistance, oxidative stress, accumulation of abdominal and ectopic fat, local inflammation play a key role in the pathogenesis of both sarcopenia and dysmetabolic diabetic complications, i.e., there is a bidirectional relationship between these pathological conditions, which mutually reinforce each other’s negative consequences. According to clinical observations, the risk of sarcopenia in patients with diabetes is 3–4 times higher than in people without diabetes, while the presence of sarcopenia increases the risk of reduced work capacity, disability, mortality, and worsening of diabetes control. These data indicate the feasibility of screening for signs of sarcopenia in patients with type 2 diabetes, especially in the older age group, using dynamic tests, as well as bone monitoring, to prevent the risk of falls and fractures. Antidiabetic therapy for such patients should include drugs that help preserve muscle and bone tissue (have an anabolic effect), do not increase the risk of hypoglycemia and gastrointestinal disorders. According to the literature, the safest preparations include the biguanide metformin, dipeptidyl peptidase inhibitors, and insulin. Sulfonylurea derivatives, thiazolidinediones, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors are not recommended, as they can cause undesirable effects in weakened elderly people. Timely diagnosis of sarcopenia is important to prevent the deterioration of muscle function (through the rehabilitation of the musculoskeletal system using adaptive physical exercises and diet modification) and to improve the quality of life of patients with type 2 diabetes. In turn, improving the prevention and treatment of diabetes in the early stages can also help prevent the development of sarcopenia and its complications.

Abstract P2082: Igfbp-3 Activates Pro-survival Pathways To Mitigate Anthracycline-induced Cardiomyocyte Injury

Rationale: Anthracyclines such as doxorubicin are among the most effective chemotherapeutic agents; however, their use leads to frequent cardiovascular complications, including heart failure, due to the activation of multiple cardiomyocyte injury pathways. Insulin-like growth factor binding protein-3 (IGFBP3) is strongly upregulated in cardiomyocytes after administration of doxorubicin. However, its role in doxorubicin-induced cardiomyocyte apoptosis and survival remains controversial. Methods and Results: We demonstrate that IGFBP3 is strongly induced by doxorubicin in neonatal ventricular myocytes (NRVMs) 12 hours after doxorubicin treatment by RT-PCR (4.2 fold vs. control, n=3, P<0.05) and Western blot. Adenoviral overexpression of IGFBP3 in NRVMs leads to a significant reduction of phosphorylated H2A histone (γH2AX) after doxorubicin treatment, a hallmark of DNA double-strand breaks (DSBs), as well as topoisomerase IIβ, a key mediator of doxorubicin induced DNA DSBs. Conversely, silencing of IGFBP3 with siRNA leads to a significant increase of γH2AX expression in NRVMs. Adenoviral shRNA silencing of IGFBP3 in human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) further demonstrates a 44% and 52% decrease in contraction magnitude and velocity in response to doxorubicin compared with scramble shRNA (scramble shRNA, n=5, shIGFBP3, n=3, P<0.05). Immunofluorescent imaging and cell fractionation assays conducted in NRVMs indicate that doxorubicin initiates IGFBP3 nuclear translocation, suggesting an active role in the cardiomyocyte response to doxorubicin-induced cell injury. Next generation sequencing of hiPSC-CMs treated with doxorubicin reveals that overexpression of IGFBP3 leads to upregulation of cardiomyocyte survival pathways, including TNF receptors without cytoplasmic death domain (TNFRSF10C and D), BCL2 family gene BCL2L1, the p53 target ACER2, the p53 co-factor FBXW7, the β-catenin mediator TBX3 and the ataxia telangiectasia mutated (ATM) activator ZNF423. Conclusion: Our findings indicate that IGFBP3 is strongly induced in cardiomyocytes by doxorubicin treatment. Overexpression of IGFBP3 attenuates doxorubicin induced DNA DSBs and promotes pro-survival signaling pathways.

P306 COVID–19 RELATED PERICARDITIS. CLINICAL IMPLICATIONS AND ROLE OF CARDIAC REHABILITATION IN SUBSEQUENT LONG–COVID SYNDROME

Acute pericarditis is considered one of the cardiovascular complications of COVID–19.Aim of the StudyThe aim was to evaluate the prevalence and clinical implications of acute pericarditis diagnosed through the presence of pericardial effusion in patients with COVID–19.MethodsThe investigation is a retrospective observational study enrolling patients admitted to ICU of Madonna del Soccorso Hospital (San Benedetto del Tronto, Italy) because of a SARS–Cov2 induced severe acute respiratory syndrome. N.170 patients, admitted from 1st april 2020 to 30th april 2021, were enrolled. All patients presented a variable picture of bilateral ground glass opacifications at HR– Chest CT. Some patients underwent oro–tracheal intubation+invasive ventilation. All patients underwent cardiological consultation including a transthoracic bedside echocardiogram, using ultrasound E9–GE machine (Boston, MA, USA). Demographic, laboratory and clinical data were collected for all enrolled patients.The diagnosis of acute pericarditis was defined by different degrees of pericardial effusion. All patient were divided in two groups: 1) pericarditis group (A); 2) pericarditis–free group (B).ResultsOf 170 enrolled patient, 51 were females (30%) and 119 were males (70%). Median age for all patients was 67,6 + 13,3 (females: 70,5 + 16,2; males: 66,4 + 11,7). Of 170, n. 60 patients had a diagnosis of acute pericarditis (32,2%) and were included into Group A [age 69,2 + 12,6; 39 (65%) males aged 69,3 + 10,6, 21 (35%) females aged 69,1 + 16,0]. Of 60, only 6 had a pericardial effusion >10 mm (10%); the remaining group A–patients (90%) had a mild pericardial effusion (<10 mm). No patient had tamponade picture. Group B (pericarditis–free) included 110 patients, aged 66,7 + 13,7, 80 (72,7%) males aged 65,0 + 12,1, 30 (27,3%) females aged 71,4 + 16,6. Group A–patients had more days of intubation and a prolonged hospital stay compared with group B, with a significant difference (p < 0.02 and p < 0,03 rispectively). N. 21 of 60 group A patients underwent a 7 weeks of CARDIAC REHABILITATION (CR) because of a LONG–COVID picture. In these patient a 6MWT was performed before and after CR. A significant increase of the walked distance after CR was found (from 352 + 21 to 498 + 31 – p < 0.03 – delta=41%).ConclusionPericarditis is a frequent cardiovascular complication of COVID–19 (32,2% in our study) with clinical and prognostic implications. CR is essential for long–term recovery in these patients.

STUDY OF LONG-TERM CLINICAL AND PATHOGENETIC EFFECTS OF FAVIPIRAVIR-BASED ANTI-VIRAL DRUG IN PATIENTS WITH METABOLIC SYNDROME IN POST-COVID PERIOD

The article presents modern scientific data on long-term clinical and pathogenetic effects of the antiviral drug Areplivir (Favipiravir) in patients with metabolic syndrome in the post-COVID period.The aim of the article is to study long-term cytokine-mediated (IL-6/sIL6r and LIF/sLIFr) pathogenetic effects of the favipiravir (Areplivir®) based drug on the incidence of complications in patients with metabolic syndrome in the post-COVID period.Material and methods. With the approval of the local ethics committee at the N.P. Ogarevs Mordovia State University (Protocol No. 5 dated May 17, 2020) “An open prospective comparative study of the Areplivir® (Favipiravir) drug effectiveness in reducing the risk of complications in the post-COVID period in patients with metabolic syndrome” in the Republic of Mordovia was carried out.The study included 190 metabolic syndrome patients who received the outpatient treatment for COVID-19 at Saransk polyclinics from February 2021 to March 2021. The case of COVID-19 was diagnosed in accordance with the current Temporary Guidelines for the prevention, diagnosis and treatment of the new coronavirus infection.Results. The analysis of the metabolic syndrome patients’ follow-up within 1 year after undergoing COVID-19, revealed significant differences in the incidence of complications depending on the intake of the favipiravir based drug. The patients who were administrated with favipiravir at the early stage of infection, were characterized by lower serum levels of four members of the interleukin 6 family – IL-6 (IL-6, sIL6r and LIF, sLIFr) 10, 30 and 180 days after a clinical and laboratory recovery (p&lt;0.001). The average statistical changes in the IL-6 /sIL6r system of the group administrated with favipiravir, were 90%, and they were higher than in the group not administrated with antiviral drugs. In the group of the patients administrated with favipiravir, there was a significant (p&lt;0.001) positive dynamic of the sLIFr indicator, while in the comparison group, there was an increase in this indicator.A protective effect of the early favipiravir use was characterized by a decrease in the frequency of cardiovascular complications, a 2.66-fold decrease in the risk of a stroke and the ACS in the post-COVID period.Conclusion. The areplivir therapy in the acute period of coronavirus infection made it possible to timely reduce the viral load. It helps to correct the pro-inflammatory vector of the immune response at the post-COVID stage and, accordingly, reduces the risk of progression of atherosclerosis, transient cerebrovascular accidents with a cognitive decline, an endothelial dysfunction, and can be considered a secondary prevention of life-threatening cardiovascular complications.

669 COVID-19-related acute pericarditis. A retrospective observational study

AimsAcute pericarditis is considered one of the cardiovascular complications of COVID-19. The published data suggest that the diagnosis of acute pericarditis in patients with COVID-19 infection may be more frequent than usually diagnosed and as a consequence, undertreated. The proposed investigation is a retrospective observational study in which 170 patients, admitted to an Intensive Care Unit because of a COVID-19 diagnosis, were analysed. All patients underwent cardiological evaluation including a bedside echocardiogram. The aim of the study was to evaluate the prevalence and clinical implications of acute pericarditis diagnosed through the presence of pericardial effusion.Methods and resultsThe proposed investigation is a retrospective observational study enrolling patients admitted to Intensive Care Unit of Madonna del Soccorso Hospital (San Benedetto del Tronto, Italy) because of a SARS-CoV-2 induced severe acute respiratory syndrome. No. 170 patients, admitted from 1 April 2020 to 30 April 2021, were enrolled. All patients presented a variable picture of bilateral interstitial pneumonia characterized by ground glass opacifications at HR-Chest CT. Some patients underwent oro-tracheal intubation and invasive ventilation. All patients underwent cardiological consultation including a transthoracic bedside echocardiogram, using ultrasound E9-GE machine (Boston, MA, USA). Demographic, laboratory and clinical data were collected for all enrolled patients (Table 1). The diagnosis of acute pericarditis was defined by: (i) different degree of pericardial effusion; (ii) C-reactive proteine elevation. All patients were divided in two groups: (1) pericarditis group (a); (2) pericarditis-free group (b). Of 170 enrolled patient, 51 were females (30%) and 119 were males (70%). Median age for all patients was 67.6 ± 13.3 [females: 70.5 (±16.2); males: 66.4 (±11.7)]. Of 170, n. 60 patients had a diagnosis of acute pericarditis (32.2%). Group A (patient with acute pericarditis) consisted of 60 patients, age 69.2 (±12.6), 39 (65%) male [age 69.3 (±10.6)], 21 (35%) female [age 69.1 (±16.0)]. Of 60, only 6 had a pericardial effusion >10 mm (10%); the remaining group A-patients (90%) had a mild pericardial effusion (<10 mm). No patient had tamponade picture. Group B (pericarditis-free patients) included 110 patients, age 66.7 (±13.7), 80 (72.7%) males [age 65.0 (±12.1)], 30 (27.3%) females [age 71.4 (±16.6)]. Group A-patients (with pericarditis) had more days of intubation and a prolonged global hospital stay compared with group B (pericarditis-free). Other demographic, clinical and laboratory parameters were similar between the two groups.ConclusionsPericarditis is a frequent cardiovascular complication of COVID-19 (32.2% in our study). It may have clinical and prognostic implications.

294. Surveillance for Potential Post-Acute COVID-19 Syndrome Medical Complications in the Emergency Department (ED) – A Retrospective Longitudinal Study of ED Patients Who Had Evidence of SARS-CoV-2 Infection Versus Those Who Did Not

BackgroundAs the COVID-19 pandemic continues, growing attention has been placed on whether patients previously infected with SARS-CoV-2 have an increased risk of developing and/or exacerbating medical complications. Our study aimed to determine whether individuals with previous evidence of SARS-CoV-2 infection prior to their current emergency department (ED) visit were more likely to present with specific clinical sign/symptoms, laboratory markers, and/or clinical complications. MethodsA COVID-19 seroprevalence study was conducted at Johns Hopkins Hospital ED (JHH ED) from March 16 to May 31, 2020. Evidence of ever having SARS-CoV-2 infection (PCR positive or IgG Ab positive) was found in 268 ED patients at this time (i.e. infected and/or previously infected). These patients were matched 1:2 to controls, by date, to other patients who attended the JHHED. Clinical signs/symptoms, laboratory markers, and/or clinical complications associated with ED visits and/or hospitalizations at JHH within 6 months after their initial ED visit was abstracted through chart review for these 804 patients. Cox proportional hazards regression analyses were performed.ResultsAmong 804 ED patients analyzed, 50% were female, 56% Black race, and 15% Hispanic with a mean age of 47 years. 323 (40%) patients had at least 1 subsequent ED visit and additional 70 (9%) had been admitted to JHH. After controlling for race and ethnicity, patients with evidence of current or prior COVID-19 infection were more likely to require supplemental oxygen [hazards ratio (HR) =2.53; p=0.005] and have a cardiovascular complication [HR =2.13; p=0.008] during the subsequent ED visit than the non-infected patients. ConclusionOur findings demonstrate that those previously infected with SARS-CoV-2 have an increased frequency of cardiovascular complications and need for supplemental oxygen in ED visits in the months after their initial SARS-CoV-2 infection was detected. EDs could serve as a critical surveillance site for monitoring post-acute COVID-19 syndrome complications. Disclosures Richard E. Rothman, PhD, MD, Chem bio (Grant/Research Support)

Frequency of Cardiovascular Complications in Coronavirus-19 infected Patients during the second wave in a tertiary care Hospital of Lahore, Pakistan

Coronavirus 2019 (COVID-19) affects the cardiorespiratory systems by causing inflammation of the circulatory systems, hence, causing more cardiac complications in COVID-19 patients Objective: To observe the frequency of cardiac complications in COVID-19 patients during the second wave Methods: 235 COVID-19 patients presenting with cardiac complication to the Cardiology Department of Mayo Hospital, Lahore during 6 month periods of second wave of COVID-19 were included. Data regarding the medical history, age, gender was taken and the observed cardiac complication were noted Results: There were 76.6% male patients and 23.4% female patients. 56.2 % patients were already hypertensive, 37.9% were diabetic, 18.3% had familial history of cardiac diseases. The cardiovascular manifestations observed were, myocardial infarction (57.82%), 7.3% had angina, 21.3% had acute coronary syndrome and 12.3% had non ST elevation myocardial infarction. Conclusions: Our study suggests that there is a prevalence of cardiovascular diseases in COVID-patients which is a major concern as they are at increased risk for severe infection.

Pulse wave velocity is decreased in acromegaly compared to non-acromegaly study participants with similar cardiovascular risk profile

ObjectiveAcromegaly patients were reported to have an increased arterial stiffness that could contribute to the frequent cardiovascular complications in this population. The chronic excess of GH and IGF-1 may lead to arterial stiffening via different mechanisms, including hypertension, impaired glucose tolerance and dyslipidemia, however, it is not known whether the activation of GH/IGF-1 axis might influence arterial stiffening independently of cardiovascular risk factors. The objective of this prospective case-control study was to compare arterial stiffness assessed with pulse-wave velocity (PWV) in acromegaly versus non-acromegaly group with similar cardiovascular risk profile. DesignThis prospective case-control study included 27 patients with active acromegaly, who underwent the assessment of clinical, physiological, biochemical parameters and the evaluation of PWV with applanation tonometry. We used “The epidemiology of cardiovascular disease in different regions of the Russian Federation” study database (n = 522) to establish a non-acromegaly control group with similar cardiovascular risk profile (n = 54). Non-acromegaly control participants underwent the same assessment as acromegaly patients except for the measurement of serum GH and IGF-1 levels. We compared PWV in acromegaly patients to the general non-acromegaly cohort and its subset, matched with acromegaly patients for cardiovascular risk factors. We also investigated the associations of PWV with clinical, physiological and biochemical parameters in acromegaly and non-acromegaly group using correlation and regression analysis with adjustment for age and sex. ResultsAcromegaly patients had lower PWV (6.70 (5.75–7.65) m/s) compared to unmatched non-acromegaly control cohort (7.50 (6.70–8.57) m/s, p = 0.01) and to the non-acromegaly control group matched for cardiovascular risk factors (7.45 (6.73–8.60), p < 0.01). In non-acromegaly control group PWV was associated with BMI (ρ = 0.40, p < 0.01; β = 0.09, p < 0.01), obesity (r = 0.46, p < 0.01; β = 1.36, p < 0.01), systolic blood pressure (ρ = 0.60, p < 0.01; β = 0.05, p < 0.01), diastolic blood pressure (ρ = 0.62, p < 0.01; β = 0.07, p < 0.01), triglycerides (ρ = 0.55, p < 0.01; β = 0.58, p = 0.04), glucose (ρ = 0.54, p < 0.01; β = 0.70, p < 0.01) and diabetes (r = 0.40, p < 0.01; β = 1.10, p = 0.03), while in acromegaly group PWV was associated with IGF-1 expressed in mcg/ml (ρ = −0.49, p ≤0.01; β = −0.002, p ≤0.01) and in percentage of the upper limit of the normal (ρ = −0.47, p = 0.01; β = −0.005, p ≤0.01) as well as with diuretics treatment (β = −1.17, p = 0.03). ConclusionsPWV is decreased in acromegaly patients compared to non-acromegaly control participants with similar cardiovascular risk profile. Future studies need to explore the role of GH/IGF-1 axis in the regulation of arterial wall properties and the reliability of PWV as a prognostic marker of cardiovascular complications in acromegaly.

Abstract 15681: Reduced Left Atrial Strain is Associated With the Development of Atrial Arrhythmias in Hospitalized Patients With COVID-19

Introduction: Coronavirus Disease 2019 (COVID-19) is a pandemic with frequent cardiovascular (CV) complications, including cardiac arrhythmias. However, little is known about contributing factors to the development of new atrial tachyarrhythmias (ATs) in the inpatient setting. Left atrial strain (LAS) is a novel transthoracic echocardiography (TTE) measure of LA myocardial deformation and predicts arrhythmias. We aimed to compare clinical and echocardiographic variables including LAS in hospitalized patients with COVID-19 who developed new ATs compared to matched controls without arrhythmias. Methods: We retrospectively studied 42 patients hospitalized with COVID-19 who underwent clinical TTE. During admission, 20 patients without prior arrhythmia developed new ATs (including sustained atrial fibrillation/flutter/tachycardia, and undifferentiated supraventricular tachycardia) (cases) and were compared to 22 age and sex-matched COVID-19 patients without arrhythmias (controls). TTEs were analyzed for reservoir (peak longitudinal) LAS using 2D-speckle tracking and LA ejection fraction (LAEF) offline using TomTec software. Comparisons were made using Chi-square and t-tests as appropriate. Results: Mean age was 65±14 years, and 40% were women. There were no significant differences in CV risk factors, BMI, troponin or peak inflammatory markers between cases and controls. LAS was overall lower than normal and significantly lower in cases compared to controls (23.5±7.5% vs 31.0±6.0% respectively, P =0.001; Fig 1). There were no significant differences in left ventricular (LV) ejection fraction (LVEF), LV global longitudinal strain (GLS), LAEF, shock or death. Conclusions: COVID-19 patients who developed new ATs have lower LAS on TTE than patients without atrial arrhythmias. LAS may be a sensitive marker for identifying patients with COVID-19 at risk for ATs compared to LVEF, LV GLS, and LAEF. Larger confirmatory studies are warranted.

Carfilzomib-Induced Hypertension Is Mediated By Ion Channel Dysregulation in the Kidneys; The Potent Role of AMP-Activated Kinase α

Introduction: Carfilzomib (Cfz), an irreversible proteasome inhibitor (PI), is an approved agent against relapsed/refractory multiple myeloma (R/R MM). Cfz is associated with high incidence of cardiovascular adverse effects. Hypertension stands as the most frequent cardiovascular complication of Cfz. Even though thrombotic microangiopathy (TMA) is inculpated of Cfz's hypertensive phenotype, its exact pathophysiology is still elusive. In our previous work, we showed that Cfz establishes cardiotoxicity in vivo in a Protein Phosphatase 2A (PP2A)-AMP-activated kinase α (AMPKα)-dependent manner (Efentakis P et al. Blood. 2019;133(7):710-723) but does not lead to a permanent vascular deficit, indicating that hypertension is not vascular derived [Efentakis P et al. IJMS 2020;21(15):E5185]. Taking under consideration that renal homeostasis plays an important role in blood pressure regulation we sought to (i) characterize the dose-dependent manifestation of Cfz-induced hypertension; (ii) investigate the molecular signaling of Cfz in the kidneys by proteomic and immunoblotting analyses and (iii) study the renal ion channels regulation. Methods: Forty C57Bl/6 mice (12-14 weeks of age) were randomly assigned to: (i) Acute Protocol: a. Control [Normal Saline (N/S) 0.9%] and b. Cfz (8mg/kg) for two days and (ii) Sub-acute Protocol: a) Control (N/S 0.9%,) and b) Cfz (8mg/kg) for seven days. Intraperitoneal administration of N/S 0.9% and Cfz was performed at two consecutive and on alternate days for the acute and sub-acute protocols respectively. At baseline and endpoint of the experiments, systolic (SBP) and diastolic blood pressure (DBP) were measured, and subsequently mice were sacrificed for the collection of blood and renal samples. Blood samples were collected in citrate buffer for hematological/coagulation profiling [prothrombin time (PT) and INR estimation] and for cleaved Von Willebrand Factor (cl. VWF) immunoblotting assessment as well as for blood testing of white blood cells (WBCs) and platelets. Renal samples underwent histological proteomic and molecular analyses. Results: SBP and DBP were found to be elevated in Cfz group only in the sub-acute protocol compared to control (SBP: 78.5±2.0 vs 68.2±0.7, p&amp;lt;0.01 and DBP: 104.1±2.3 vs 97.4±2.4, p&amp;lt;0.05, respectively). Neutrophil count in the whole blood was elevated both in the acute and sub-acute protocols, while platelet count was decreased in the acute protocol and restored after sub-acute Cfz administration. Mice presented a thrombotic phenotype characterized by increased PT and INR and decreased cl. VWF after acute Cfz treatment, and a hemorrhagic phenotype with restored cl. VWF after sub-acute Cfz administration. However, the presence of TMA was not confirmed by histological evaluation of the kidneys in any of the protocols. Nonetheless histological evaluation of the kidneys revealed inflammation of the perirenal adipose tissue only in the sub-acute protocol. Proteomic analysis presented that proteasome regulation, metabolism and transport of organic anion processes are affected by Cfz administration. Molecular analysis of the renal tissue showed that Cfz induced an increase in the inducible nitric oxide synthase (iNOS) and microtubule-associated proteins 1A/1B light chain 3B (LC3-B) expression and a decreased AMPKα phosphorylation. Moreover, RT-PCR analysis of the renal samples revealed that collecting duct ion channels epithelial Na+ channel (ENaC), Na+/K+/ATPase and urea transporter 1 (UTA-1) mRNA levels were increased in Cfz group. Conclusion: Sub-acute Cfz treatment establishes a renal-derived hypertensive phenotype and a circulating inflammatory phenotype as indicated by the increased neutrophil and WBCs count in the blood. TMA does not seem to be implicated with the observed phenotype in vivo as investigated molecularly and histologically. Cfz-induced dephosphorylation of AMPKα and the subsequent dysregulation of the collecting duct renal ion channel homeostasis is found to be responsible for the observed effect. Therefore, Cfz seems to induce hypertension by a dysregulation of water-ion re-absorbance leading to increased cardiac preload. The latter comes in agreement with clinical data showing that some Cfz-treated patients present with fluid retention, which can be attributed to the aforementioned renal effects of the drug. Disclosures Efentakis: Amgen: Research Funding. Kastritis:Amgen: Consultancy, Honoraria, Research Funding; Genesis Pharma: Consultancy, Honoraria; Takeda: Consultancy, Honoraria; Janssen: Consultancy, Honoraria, Research Funding; Pfizer: Consultancy, Honoraria. Dimopoulos:BMS: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Personal fees; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Personal fees, Research Funding, Speakers Bureau; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Personal fees, Speakers Bureau; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Personal fees, Research Funding, Speakers Bureau; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Personal fees, Research Funding, Speakers Bureau. Andreadou:Amgen: Research Funding. Terpos:Amgen: Honoraria, Research Funding; Genesis pharma SA: Honoraria, Other: travel expenses , Research Funding; Janssen: Honoraria, Research Funding; Takeda: Honoraria, Other: travel expenses , Research Funding; Celgene: Honoraria; Sanofi: Honoraria; BMS: Honoraria.

Peculiarities of clinical and metabolic profile of patients with coronary artery disease associated with type 2 diabetes mellitus (retrospective analysis)

Coronary artery disease (CAD) is one of the most common reasons of disability and mortality. Diabetes mellitus occurs in 30% of patients with IHD and aggravates the course of the underlying disease, worsens the prognosis and quality of life. However, the clinical features of this comorbidity are not fully understood.Aim of the study: to determine the effect of type 2 diabetes mellitus on the clinical and metabolic features of patients with coronary artery disease.Materials and methods. Retrospective analysis of 256 medical records of inpatients with CAD (males – 106, females – 150, age – 66 (59; 71) years) was performed. The patients were divided into two groups: Group 1 (main) – 213 patients with CAD with type 2 DM; Group 2 (comparison) – 43 patients with isolated CAD. Statistical processing was carried out using Statistica 13.0 software package.Results. It was found that the course of CAD in diabetic patients is associated with higher frequency of cardiovascular complications (arrhythmias, atherothrombotic events). It has been found, that in patients with CAD associated with type 2 DM, body mass index (by 9.39 %), levels of systolic (by 9.28%) and diastolic (by 9.09 %) blood pressure, glucose (by 53.92 %), glycated hemoglobin (by 45.81 %), total cholesterol (by 11.13 %), triglycerides (by 18.86 %) exceeded the corresponding indicators in patients with isolated CAD (P < 0.05). Multicomponent metabolic syndrome was reported in 89 % of patients with type 2 DM. In patients with CAD, associated with type 2 DM, if compared to CAD patients without DM, the ejection fraction of the left ventricle (EF LV) was significantly lower by 15.22 %, and the mean pulmonary artery pressure (mPAP) was significantly higher by 29.41 %. The frequency of LV systolic dysfunction (χ2 = 2.75; df = 1; P < 0.05) and an increase of mPAP (χ2 = 2.87; df = 1; P < 0.05) in patients with CAD and type 2 DM was also significantly higher. The calculation of the relative risk allowed to establish the interrelationship between type 2 DM with the risk of developing of LV systolic dysfunction (RR = 2.238; CI 1.322–3.788; P < 0.05) and increased mPAP (RR = 3.337; CI 1.293–8.615; P < 0.05). Concentric left ventricular hypertrophy (77 %) was predominant in patients with CAD and type 2 DM, and in patients with isolated coronary heart disease a concentric LV remodeling (69 %) was dominating.Conclusions. Concomitant diabetes mellitus affects negatively the course of CAD by increasing the frequency of arrhythmias and atherothrombotic events. In patients with CAD and type 2 DM a multicomponent metabolic syndrome prevails, that is characterized by proatherogenic changes in the lipid profile, higher degree of hypertension and obesity. The intensity of cardiac remodeling in patients with CAD was higher in the presence of type 2 DM, which is confirmed by the formation of a prognostically unfavorable type of LV remodeling on the background of the LV systolic function decrease and significant mPAP increase.

Effect of Yoga Therapy on Disease Activity, Inflammatory Markers, and Heart Rate Variability in Patients with Rheumatoid Arthritis.

Background: Rheumatoid arthritis (RA) is an immune-mediated inflammatory disease. Antirheumatoid treatment reduces disease activity and inflammation, but not all patients respond to treatment. Autonomic dysfunction is common in RA leading to frequent cardiovascular complications. Yoga therapy may be useful in these patients, but there are little data on the effect of yoga on disease activity, inflammatory markers, and heart rate variability (HRV). Objectives: This study assessed the effect of 12-week yoga therapy on disease activity, inflammatory markers, and HRV in patients with RA. Materials and Methods: This randomized control trial was conducted on newly diagnosed RA patients attending outpatient services at the Department of Clinical Immunology, JIPMER. One hundred and sixty-six participants were randomized into two groups: the control group (CG) (n = 83) and yoga group (YG) (n = 83). Yoga therapy was administered to participants in the YG for 12 weeks, along with standard medical treatment. The CG received only standard medical treatment. Primary outcomes were disease activity score 28, interleukin-1α (IL-1α), IL-6, tumor necrosis factor-α (TNF-α), cortisol, and HRV parameters. All parameters were measured at baseline and after 12 weeks. Results: Disease activity significantly decreased in both groups after 12 weeks, but it was reduced more in YG, which was statistically significant (p < 0.05). In both YG and CG, IL-1α, IL-6, TNF-α, and cortisol decreased after 12 weeks, but IL-1α and cortisol decreased more significantly in YG than in CG. Low-frequency component expressed as normalized unit (LFnu) and the low-frequency/high-frequency (LF-HF) ratio decreased significantly, and total power and HF component expressed as normalized unit (HFnu) increased significantly in the YG compared with CG. Conclusion: Twelve-week yoga therapy, if given along with standard medical treatment, significantly reduces disease activity and improves sympathovagal balance in RA patients.

Frequency of the Cardiovascular Complications during the Chronic Renal Insufficiency with the Service of Nephrology of the National Hospital Donka

Introduction: Cardiovascular disease has become a major concern for the nephrologist as it is the leading cause of morbidity and mortality in patients with chronic kidney disease, and affects all stages of the disease, including the earliest stages of the disease. The goal of this work was to determine the frequency of cardiovascular complications during chronic kidney failure. Patients and methods: This was a six-month, descriptive cross-sectional study from March 01 to August 31, 2018. It covered all patients with chronic kidney disease hospitalized in the ward during the study period. Included were all chronic kidney failure patients with at least one cardiac and/or vascular complication diagnosed either on clinical examination, and/or paraclinical examination (Electrocardiogram or cardiac ultrasound, vessel echodoppler, scan). Results: During the study period, 84 out of 378 patients or 22.22% had at least one cardiovascular complication. Cardiovascular complications were hypertrophy of the left ventricle with 49/84 (44 at Electrocardiogram and 5 at cardiac echodoppler), valvulopathy with 33.33%, stroke with 50% of cases, obliterating arterial disease of the lower limbs 25%, hypokinetic dilated cardiomyopathy with 9/36 cases and pericarditis with 2/36. Conclusion: Cardiovascular complications affect both sexes and all ages. They were dominated by enlarged left ventricle, valvulopathy and dilated cardiomyopathy.

Transfemoral extraction of pacemaker and implantable cardioverter defibrillator leads using Needle’s Eye Snare: a single-center experience of more than 900 leads

The femoral approach with the Needle's Eye Snare (NES) is often used for bailout after failure of the superior approach for transvenous lead extraction (TLE). The safety and efficacy of the NES as a first-line tool for TLE remain unclear. The medical records of patients who underwent TLE via the femoral approach utilizing the NES from May 2014 to June 2019 in Peking University People's Hospital were retrospectively reviewed. Nine hundred and eighty-five leads were extracted in 492 patients (369 men; mean age 72.8 ± 29.0years). The median (range) number of leads extracted per patient was 2 (1-6). The mean indwelling time of all extracted leads was 112.6 ± 52.0months. The complete procedure success rate, clinical success rate, and failure rate were 94.1% (463/492), 97.8% (481/492), and 1.1% (11/492), respectively. Major complications including death occurred in nine patients (1.9%), of whom eight developed cardiac tamponade. Among these eight patients, emergency pericardiocentesis followed by rescue surgical repair if necessary was successful in 6 (75.0%) and failed in 2 (25.0%). No significant differences were found in the clinical success rate or major complications rate between patients with pacemakers and implantable cardioverter defibrillators, or between patients with infected and uninfected leads. A femoral approach with the NES is safe and effective for TLE of both pacing and defibrillator leads and could be considered a first-line approach. Cardiac tamponade was the most frequent cardiovascular complication. A strategy of emergency pericardiocentesis followed by a rescue surgical approach seems to be reasonable technique to treat a cardiac tamponade.