Incidence Of Coronary Disease Research Articles

MAXIMAL EXERCISE CAPACITY IS INVERSELY RELATED TO INCIDENT PERIPHERAL ARTERY DISEASE

BACKGROUND Maximal exercise capacity (EC) is a strong, independent predictor of incident coronary and cerebrovascular disease. However, less is known about the relationship between EC and incident peripheral artery disease (PAD). Using data from the Henry Ford Exercise Testing (FIT) Project, we evaluated the relationship between EC and incident PAD. We hypothesized that EC, measured in metabolic equivalents of task (METs), is inversely related to incident PAD. METHODS We assessed 41,268 patients (age = 55±12 yrs, 49% female, and 64% white) who completed a clinically indicated exercise stress test between January 1991 and June 2009 at a Henry Ford Health facility. Patients with established PAD at the time of testing were excluded. METs were estimated from peak treadmill speed and grade and standardized to the equivalent of a 50-year-old male to account for differences in absolute risk for a given MET level by age and sex. METs were categorized as <6, 6-9, 10-11, and >12. ICD9 codes 440.XX and 443.9 were used to identify first incidence of PAD from the test date through June 2010. Multivariable Cox regression was used to relate METs to incident PAD. Patients were censored at the date of death or last clinic visit. RESULTS During a median follow-up of 7.1 years (IQR 4.2-11.1 yrs) there were 2,596 (6%) incident diagnoses of PAD. In the adjusted analysis, each 1 MET increase in maximal EC was associated with a 7% lower risk of PAD (aHR=0.93 [0.91, 0.94]). There was a graded, inverse risk of incident PAD by MET category (see Table). A significant interaction was noted for race (overall p=.04; white [HR=0.93 (0.92, 0.95)] vs black [HR=0.91 (0.88, 0.93)], p=.02; white vs other [HR=0.97 (0.87, 1.07)], p=0.47), but not for sex (p=.79). CONCLUSION In a diverse cohort that completed a clinically indicated exercise stress test, higher EC measured in METs, is independently and inversely associated with a lower risk of incident PAD.

Abstract 12532: Maximal Exercise Capacity is Inversely Related to Incident Peripheral Artery Disease: Data From the Henry Ford Exercise Testing (FIT) Project

Introduction: Maximal exercise capacity (EC) is a strong, independent predictor of incident coronary and cerebrovascular disease. However, less is known about the relationship between EC and incident peripheral artery disease (PAD). Using data from the Henry Ford Exercise Testing (FIT) Project, we evaluated the relationship between EC and incident PAD. Hypothesis: EC, measured in metabolic equivalents of task (METs), is inversely related to incident PAD. Methods: We assessed 41,268 patients (age= 55±12 yrs, 49% female, and 64% white) who completed a clinically indicated exercise stress test between January 1991 and June 2009 at a Henry Ford Health facility. Patients with established PAD at the time of testing were excluded. METs were estimated from peak treadmill speed and grade and standardized to the equivalent of a 50-year-old male to account for differences in absolute risk for a given MET level by age and sex. METs were categorized as <6, 6-9, 10-11, and > 12. ICD9 codes 440.XX and 443.9 were used to identify first incidence of PAD from the test date through June 2010. Multivariable Cox regression was used to relate METs to incident PAD. Patients were censored at the date of death or last clinic visit. Results: During a median follow-up of 7.1 years (IQR 4.2-11.1 yrs) there were 2,596 (6%) incident diagnoses of PAD. In the adjusted analysis, each 1 MET increase in maximal EC was associated with a 7% lower risk of PAD (aHR=0.93 [0.91, 0.94]). There was a graded, inverse risk of incident PAD by MET category (see Table). A significant interaction was noted for race (overall p=.04; white [HR=0.93 (0.92, 0.95)] vs black [HR=0.91 (0.88, 0.93)], p=.02; white vs other [HR=0.97 (0.87, 1.07)], p=0.47), but not for sex (p=.79). Conclusion: In a diverse cohort that completed a clinically indicated exercise stress test, higher EC measured in METs, is independently and inversely associated with a lower risk of incident PAD.

Abstract 14707: Telehealth Usage for Outpatient Cardiology Evaluations During the COVID-19 Pandemic

Introduction: The use of telehealth for cardiac services rapidly expanded during the pandemic, but little is known about the factors driving use of telehealth versus traditional in-person outpatient evaluation. Research Question: What factors are associated with telehealth use for patients with symptoms of cardiovascular disease referred for outpatient cardiology evaluation during the COVID-19 pandemic? Methods: In a large, integrated healthcare system caring for >4.5M patients, we identified those aged >18 years without prior cardiology diagnoses or visits who were evaluated for symptoms of incident heart failure, coronary disease, or arrhythmias before (Jan 2018-Dec 2019) and during the pandemic (June 2020-May 2022) periods. We categorized patients based on initial cardiology visit type: telehealth (video or telephone) or in-person. We compared unadjusted demographic, socioeconomic (SES), and clinical characteristics between visit types, and examined multivariable associations using Cox regression. Results: Only 146 (2.2%) of 6376 pre-pandemic patients versus 4074 (69%; 1213 telephone, 2861 video) of 5898 pandemic patients had an initial cardiology telehealth visit. In the pandemic period, compared to those with in-person visits, patients with video visits were more likely to be younger (58 vs 64 yrs; p<0.01), female (49% vs 45%; p<0.01), and to be linked to a facility with parking fees (11% vs 7%; p<0.01). Telephone visits had the highest proportion of patients with low SES, low internet usage, and a higher comorbidity burden. In adjusted models, these relationships were generally upheld ( Figure ), and the later year of the pandemic (2022) were strongly associated with increased in-person visits. Conclusions: Many patient and system level factors were associated with telehealth use during the COVID-19 pandemic. Future studies should examine the relationship between clinical outcomes and visit type, as telehealth has become part of routine care.

Lp(a) and evolution of left anterior descending velocity reserve in stable coronary artery disease: Is there anything beyond dobutamine stress echo outcome?

Abstract Funding Acknowledgements Type of funding sources: None. Background Elevated Lp(a) is related with premature and accelerated atherosclerosis, thus confering increased risk for incident chronic coronary disease (CAD) and adverse outcome. Dobutamine stress echo (DSE) and coronary flow reserve (CFR) are both related with incident CAD and outcome as well. Purpose Aim of the study was to evaluate the potential relationship between Lp(a) and DSE outcome/left anterior descending (LAD) based CFR in chronic CAD. Methods 132 consecutive pts (age 59±11years, 18 females, 33 diabetics) with stable CAD were studied by DSE with a concomitant evaluation of LAD CFR. Lp(a) distribution was positive skewed (median 18.6 mg/dL) and it was then normalized by log transformation (logLpa: 2.9±1.1). High and low Lpa groups (LpaH/LpaL: 30/92) were defined using the conventional cut off 50 mg/dL. Sixty-eight/132 pts had a follow up DSE with concomitant revaluation of CFR at 98±74 months. Absolute and % changes (%d) of LAD CFR were estimated. Results LpaH and LpaL groups had similar baseline: CFR (2.4±0.5 vs 2.4±0.6), %dCFR (0.33±0.7 vs 0.35±0.8), creatinine (0.98±0.18 vs 1.0±0.26), HbA1c (5.3±0.9 vs 5.3±1.0) and high sensitivity C reactive protein (2.8±2.7 vs 2.6±2.8mg/L). LpaH had lower baseline LDL (93±31 vs 111±50 p = 0.04). LpaH and LpaL groups had also similar hemodynamic burden at DSE and incidence of positive DSE. LpaH nondiabetics had a trend for more nonLAD distribution of ischemia (odds ratio=1.8, p = 0.07) with a greater incidence of previous revascularization (odds ratio=2.3, p = 0.03). Further clustering based on optimal CAD treatment achieved at baseline (guidelines achieved optimal resting heart rate and LDL) did not change the findings. However, improvement in %d LAD CFR during follow up was inversely related with logLpa (figure: R2=0.09 p = 0.05). A similar trend for %d LAD CFR and logLpa was evident for a follow up period shorter than 100 months. Conclusion In chronic CAD, high Lpa levels in the absence of diabetes are related with greater incidence of DSE ischemia. Despite similar CFR baseline values between conventionally defined high and low Lpa groups, the evolution of LADCFR during long term follow up is affected consistently on time by the baseline logLpa. These findings support a potential role of Lpa on ischemic burden and microvascular function in the time domain of CAD.

PD20-10 ETHNIC DISPARITIES IN CLINICAL PRESENTATION AND SURGICAL OUTCOMES FOR HISPANIC PATIENTS WITH LOCALIZED RENAL MASSES

You have accessJournal of UrologyCME1 Apr 2023PD20-10 ETHNIC DISPARITIES IN CLINICAL PRESENTATION AND SURGICAL OUTCOMES FOR HISPANIC PATIENTS WITH LOCALIZED RENAL MASSES Teona Iarajuli, Jennifer Nguyen, Ruth Sanchez De La Rosa, Tanner Corse, Jacquelyn Roth, Hunter Halsey, Martin Malik, Fahad Sheckley, Suzannah Sorin, Simon Gelman, Mubashir Billah, Gregory Lovallo, Ravi Munver, Mutahar Ahmed, and Michael Stifelman Teona IarajuliTeona Iarajuli More articles by this author , Jennifer NguyenJennifer Nguyen More articles by this author , Ruth Sanchez De La RosaRuth Sanchez De La Rosa More articles by this author , Tanner CorseTanner Corse More articles by this author , Jacquelyn RothJacquelyn Roth More articles by this author , Hunter HalseyHunter Halsey More articles by this author , Martin MalikMartin Malik More articles by this author , Fahad SheckleyFahad Sheckley More articles by this author , Suzannah SorinSuzannah Sorin More articles by this author , Simon GelmanSimon Gelman More articles by this author , Mubashir BillahMubashir Billah More articles by this author , Gregory LovalloGregory Lovallo More articles by this author , Ravi MunverRavi Munver More articles by this author , Mutahar AhmedMutahar Ahmed More articles by this author , and Michael StifelmanMichael Stifelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003286.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aim to determine if Hispanic patients differed in clinical presentation and surgical management of renal masses compared to Non-Hispanic Caucasian patients in our Northern New Jersey catchment area. METHODS: We utilized an IRB-approved renal mass database including 1017 patients who underwent partial or radical nephrectomy at our institution between May 2017 and April 2022. We evaluated 1017 patients who identified as either “Hispanic” or “Non-Hispanic Caucasian.” Continuous data was analyzed using the Wilcoxon Rank Sum test. Categorical data was analyzed using Chi-Squared and Fisher's Exact Tests where appropriate. RESULTS: 134 patients (13.18%) self-identified as Hispanic and 883 (86.82%) identified as Non-Hispanic Caucasian (Table 1). In terms of presentation, Hispanic patients were significantly younger on average (56.95 vs 63.92, p=0.0000), more likely to be female (48.51% vs 33.64%, p=0.0001), and less likely to have a history of tobacco use (29.10% vs 43.57%, p=0.018). Hispanic patients had lower incidences of coronary vascular disease (1.491% vs 6.0%, p=0.0315) and chronic kidney disease prior to undergoing surgery (16.39% vs 24.47%, p=0.0158). There was no significant difference in rates of undergoing radical nephrectomy between the two groups (29.66% vs 24.5%, p=0.6212). There was no significant difference in changes from baseline preoperative eGFR (-11.99 vs -13.31 mL/min/1.73 m2, p=0.6012). Additionally, there was no significant difference in the rate of major complications (1.63% vs 2.29%, p=1.0), readmissions (6.67% vs 4.96%, p=0.4328), or mortality (2.99% vs 2.27%, p=1.000). CONCLUSIONS: In our Northern New Jersey population, we found that Hispanic patients presented with renal masses at younger ages with less comorbidities and less prior tobacco use in comparison to Non-Hispanic Caucasian patients. We did not identify significant differences in surgical management, perioperative or long-term outcomes between these cohorts. Our findings suggest that high volume, quaternary medical centers may reduce inequalities in access to care for patients from ethnic minorities. Source of Funding: No funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e588 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Teona Iarajuli More articles by this author Jennifer Nguyen More articles by this author Ruth Sanchez De La Rosa More articles by this author Tanner Corse More articles by this author Jacquelyn Roth More articles by this author Hunter Halsey More articles by this author Martin Malik More articles by this author Fahad Sheckley More articles by this author Suzannah Sorin More articles by this author Simon Gelman More articles by this author Mubashir Billah More articles by this author Gregory Lovallo More articles by this author Ravi Munver More articles by this author Mutahar Ahmed More articles by this author Michael Stifelman More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract P413: Prevalence and Significance of Poor R-Wave Progression on Electrocardiography

Background: The QRS pattern on the electrocardiogram (ECG) has an expected progressively increasing amplitude of the R waves in the anterior leads. Poor R wave progression (low R wave amplitude of < 3 mm in V3) is commonly reported, however its clinical significance is unknown. It may be related to underlying cardiac pathology, body habitus, metabolic abnormalities or ECG lead placement errors. Studying the prevalence and significance of these findings in different genders and races will also shed some light on their clinical utility and applicability. Our objective is to assess the epidemiology and clinical significance of “Poor or Abnormal R-Wave Progression” as reported on routine ECGs. Methods: A database of ECGs performed at the University of South Alabama Medical Center ECG database (Intellispace and/or Cerner) was downloaded and compiled into searchable PDF format. ECGs were searched for patients with “Abnormal or Poor R Wave Progression”. Available clinical data on patients with these ECG findings were analyzed and reported as absolute numbers and percentages. Results: The total number of ECG with “Poor R-Wave Progression” were 318. Out of these, 209 (66%) were females and 109 (34%) males; 209 (66%) were black, 105 (33%) were white and 4 (1%) other races. There were 143 (45%) black females, 65 (20%) white females, 66 (21%) black males and 40 (13%) white males. There were 234 (74%) patients < 60 years of age while 85 (26%) were 60 years of age or older. There were 233 (73%) with hypertension. Only 198 (62%) had echocardiograms, with an average ejection fraction (EF) of 52%. Out of these 49 ((25%) had mild to moderate decrease in EF ( > 30 - 50%) while 28 (14%) had severely decreased EF of 30% or less. There were 81 (41%) with wall motion abnormalities concerning for coronary disease, while 95 (48%) had diastolic dysfunction. Discussion: Poor R-wave progression is a commonly reported finding on ECG. It is more prevalent in females, which may be due to improper lead placement or chest size. However, its higher prevalence in blacks may be indicative of higher incidence of heart failure, coronary disease and hypertension. It is more frequent in younger patients who may be more obese, but also carry multiple risk factors for cardiac disease. Poor R wave progression showed strong correlation with any degree of heart failure and with wall motion abnormalities on echocardiogram concerning for coronary disease. Therefore this finding should trigger a diagnostic cascade with echocardiography and/or stress testing, depending on the clinical scenario, in order to identify potentially serious underlying cardiac pathology which may be amenable to therapy.

Prognostic cut-off values of caffeine and cardiovascular events in a cohort of unselected men and women from general population

Abstract Background Several studies focused on the effect of caffeine on the cardiovascular (CV) system and on CV outcome, with fairly contrasting results. Dietary caffeine is usually taken into consideration as a continuous variable, but researcher would prefer to use cut-off values more useful in clinical setting. Purpose The present study is aimed at defining in epidemiological setting and in population-based context the cut-off values of caffeine, if any, having a CV prognostic values, to confirm them in men and women of general population, and to establish whether caffeine of food origin contained in multiple sources used in everyday life. Methods The study cohort was represented by 1,668 unselected men and women aged 59.6±17.1 years living in an area in North-East Italy and sharing homogeneous lifestyle, randomly taken from general population. Multivariate dichotomic Cox regression models having fatal and morbid CV event as dependent variables, adjusted for age, sex, basal heart rate, body mass index, LDLC, individualized FEV1, β-blocking therapy, ethanol intake, diabetes mellitus, arterial hypertension, smoking, smoking, blood pressure were preliminarily used to search for an association between caffeine as a continuous variable and incident CV event. Prognostic cut-off values, identified by means of receiver operating curves (ROC) and able to discriminate between subjects doomed to develop the CV event, were then used as independent predictors to divide people into those <cut-off>cut-off in further multivariate Cox models adjusted for the confounders listed above. Results Daily intake of caffeine over a specific cut-off determined via the ROC curve analysis are associated to lower incidence of CV events in a 20-year follow-up period. This cut-off corresponds, for each events, to an interval between two groups of quintiles of caffeine intake. The cerebrovascular events and those due to heart failure and arrhythmias were reduced also in multivariate models adjusted for confounders. On the contrary, intake of caffeine over the cut-off was only apparently associated to lower incidence of coronary disease, but this unadjusted crude association was wales and not confirmed after adjustment. Conclusions In men but not in women, higher voluntary daily consumption of caffeine from any source reduces significantly and to a considerable extent, in a long follow-up, the incidence of cerebrovascular events, heart failure and arrhythmias. To have preventive effects on events the consumption of caffeine must be higher than a cut-off that corresponds to 280, 230 and 280 mg/day respectively, cut-off values always falling between the third and fourth quintile of caffeine consumption. No prognostic cut-off can be identified in women and in any sex in the case of coronary events. Specific studies will be mandatory to understand the reason of this sex-specific difference. Funding Acknowledgement Type of funding sources: None.

Elevated lipoprotein (a) levels and risk of peripheral artery disease outcomes: A systematic review

Despite strong association of elevated lipoprotein (a) (Lp(a)) levels with incident coronary and cerebrovascular disease, data for incident peripheral artery disease (PAD) are less robust. The main objective of the present systematic review was to analyze the association between elevated Lp(a) levels and PAD outcomes. This systematic review was performed according to PRISMA guidelines. A literature search was performed to detect randomized clinical trials or observational studies with a cohort design that evaluated the association between Lp(a) levels and PAD outcomes. Fifteen studies including 493,650 subjects were identified and considered eligible for this systematic review. This systematic review showed that the vast majority of the studies reported a significant association between elevated Lp(a) levels and the risk of PAD outcomes. The elevated Lp(a) levels were associated with a higher risk of incident claudication (RR: 1.20), PAD progression (HR: 1.41), restenosis (HR: 6.10), death and hospitalization related to PAD (HR: 1.37), limb amputation (HR: 22.75), and lower limb revascularization (HR: 1.29 and 2.90). In addition, the presence of elevated Lp(a) values were associated with a higher risk of combined PAD outcomes, with HRs in a range between 1.14 and 2.80, despite adjusting for traditional risk factors. Heterogeneity of results can be explained by different patient populations studied and varying Lp(a) cut-off points of Lp(a) analyzed. This systematic review suggests that evidence is available to support an independent positive association between Lp(a) levels and the risk of future PAD outcomes. PROSPERO Registration No.: 289253.

Gender based lung cancer risks for symptomatic coronary artery disease patients undergone cardiac CT.

We estimate the lifetime attributable risk (LAR) of lung cancer incidence in symptomatic Coronary Artery Disease (CAD) patients receiving enhanced Coronary Computed Tomography Angiography (CCTA) and the unenhanced Computed Tomography Calcium Scoring (CTCS) examination. Retrospective analysis has been made of CCTA and CTCS data collected for 87 confirmed CAD adult patients. Patient effective dose (E) and organ doses (ODs) were calculated using CT-EXPO. Statistical correlation and the differences between E and ODs in enhanced CCTA and unenhanced CTCS were calculated using the Pearson coefficient and Wilcoxon unpaired t-test. Following BEIR VII report guidance, organ-specific LARs for the cohort were estimated using the organ-equivalent dose-to-risk conversion factor for numbers of cases per 100,000 patients exposed to low doses of 0.1 Gy. Significant statistical difference (p<0.0001) is found between E obtained for CTCS and that of CCTA. The scan length was found to be greater in CCTA (17.5 ± 2.9 cm) compared to that for CTCS (15 ± 2 cm). More elevated values of dose were noted for the esophagus (4.2 ± 2.15 mSv) and thymus (9.6 ± 2.54 mSv) for both CTCS and CCTA. CTCS organ doses were lower than that of CCTA. Per 100,000 patients, female cumulative doses are seen to give rise to greater lung cancer LARs compared to that for males, albeit with risk varying significantly, noticeably greater for females, younger patients and combined CCTA and CTCS scans. While scan parameters and tube-modulation methods clearly contribute to patient dose, mAs offers by far the greater contribution.

Sleep Apnea and Cardiovascular Disease.

Obstructive sleep apnea (OSA) is associated with incident coronary and cerebral vascular disease. The mechanisms underlying this association are thought to include increased sympathetic nervous system activity, oxidative stress, and systemic inflammation, with these effects mediated in part by elevated blood pressure and impaired glucose metabolism. In observational studies, OSA treatment with positive airway pressure (PAP) is associated with a reduction in cardiovascular disease risk. The aim of this review is to evaluate evidence from recent clinical trials that tested the impact of OSA treatment on major cardiovascular disease outcomes. Multicenter randomized trials have demonstrated a significant, albeit modest, reduction in blood pressure with OSA treatment. Treatment of OSA has generally not demonstrated improvement in type 2 diabetes mellitus, although limited evidence suggests that treatment may be effective in the prediabetic period. However, recent randomized trials of PAP treatment for OSA failed to demonstrate a reduction in incident or recurrent cardiovascular disease events. This may reflect the enrollment of a mostly non-sleepy study sample, as recent evidence suggests that sleepiness is a predictor of adverse cardiovascular outcomes from OSA. PAP treatment of OSA lowers blood pressure and may improve glucose metabolism; however, randomized clinical trials do not indicate a reduction in cardiovascular risk with treatment of minimally symptomatic OSA patients.

DNA methylation biomarkers of myocardial infarction and cardiovascular disease

BackgroundThe epigenetic landscape underlying cardiovascular disease (CVD) is not completely understood and the clinical value of the identified biomarkers is still limited. We aimed to identify differentially methylated loci associated with acute myocardial infarction (AMI) and assess their validity as predictive and causal biomarkers.ResultsWe designed a case–control, two-stage, epigenome-wide association study on AMI (ndiscovery = 391, nvalidation = 204). DNA methylation was assessed using the Infinium MethylationEPIC BeadChip. We performed a fixed-effects meta-analysis of the two samples. 34 CpGs were associated with AMI. Only 12 of them were available in two independent cohort studies (n ~ 1800 and n ~ 2500) with incident coronary and cardiovascular disease (CHD and CVD, respectively). The Infinium HumanMethylation450 BeadChip was used in those two studies. Four of the 12 CpGs were validated in association with incident CHD: AHRR-mapping cg05575921, PTCD2-mapping cg25769469, intergenic cg21566642 and MPO-mapping cg04988978. We then assessed whether methylation risk scores based on those CpGs improved the predictive capacity of the Framingham risk function, but they did not. Finally, we aimed to study the causality of those associations using a Mendelian randomization approach but only one of the CpGs had a genetic influence and therefore the results were not conclusive.ConclusionsWe have identified 34 CpGs related to AMI. These loci highlight the relevance of smoking, lipid metabolism, and inflammation in the biological mechanisms related to AMI. Four were additionally associated with incident CHD and CVD but did not provide additional predictive information.

Lung Transplant Outcomes with Concomitant Heart Donation

<h3>Purpose</h3> Concomitant heart and lung donation may adversely affect outcomes in lung transplant recipients. In this study we characterized donor characteristics and examined the outcomes of lung transplantation from donors with concomitant heart donation. <h3>Methods</h3> This retrospective cohort study used the UNOS SRTR database and identified donors as lung only (LO) or heart and lung (HL) donors. Recipients from 5/01/05-03/31/19 were identified and compared. Redo and multi-organ transplants were excluded. Characteristics and outcomes were compared using the Kruskal-Wallis and chi-square tests. Survival was analyzed with Kaplan-Meier analysis and Cox proportional-hazard (CPH) model. <h3>Results</h3> We identified 24,393 lung transplant recipients. 6,412 were in the HL group and 17,981 in the LO donor group. HL recipients were older, male, and had shorter waitlist times (Table, p<0.01 for all). HL donors were younger and had a significantly lower incidence of coronary disease, smoking, diabetes, and hypertension (Table, p<0.01 for all). HL recipients were more likely to be single lung transplants, have shorter ischemic times, and have shorter length of stay (Table, p<0.01 for all). No significant difference in survival was noted with unadjusted analysis (p=0.09), or with the CPH (HL hazard ratio 0.956, 95% confidence interval 0.91-1.00, p=0.06). <h3>Conclusion</h3> No survival difference was noted in recipients of LO and HL donors. Given comparable survival outcomes HL donors should be viewed as equivalent to LO donors. Further investigation should be directed into the reasons behind increased use of single lung transplantation of HL donors and whether both lungs are utilized.

Usefulness of Coronary Computed Tomographic Angiography to Evaluate Coronary Artery Disease in Radiotherapy-Treated Breast Cancer Survivors

Breast cancer is the most commonly diagnosed cancer in women and radiotherapy is a widely used treatment approach. However, there is an increased risk of coronary artery disease and cardiac death in women treated with radiotherapy. The present study was undertaken to clarify the relation between radiotherapy and coronary disease in women with previous breast irradiation using coronary computed tomographic angiography (CCTA). We conducted a retrospective analysis of women with a history of right or left-sided breast cancer (RBC; LBC) treated with radiotherapy who subsequently underwent CCTA. RBC patients who had reduced radiation doses to the myocardium served as controls. Patients (n = 6,593) with a history of nonmetastatic breast cancer treated with radiotherapy were screened for completion of CCTA; 49 LBC and 45 RBC women were identified. Age and risk factor matched patients with LBC had higher rates of coronary disease compared with RBC patients; left anterior descending (LAD) coronary artery (76% vs 31% [p < 0.001]), left circumflex (33% vs. 6.7% [p = 0.004]), and right coronary artery (37% vs 13% [p = 0.018]). Mean LAD radiation dose and mean heart dose strongly correlated with coronary disease, with a 21% higher incidence of disease in the LAD per Gy for mean LAD dose and a 95% higher incidence of disease in the LAD per Gy for mean heart dose. In conclusion, LBC patients treated with radiotherapy have a significantly higher incidence of coronary disease when compared with a matched group of patients treated for RBC. Radiation doses correlated with the incidence of coronary disease.

State of the coronary arteries and assessment of the role of hormone replacement therapy in patients with coronary heart disease against the background of primary manifest hypothyroidism

Aim To study features of coronary damage and incidence of different types of acute coronary syndrome (ACS) in history associated with primary symptomatic hypothyroidism in patients with ischemic heart disease (IHD) and possible associations of replacement hormonal therapy with lipidogram indexes.Material and methods This retrospective study included 344 patients with IHD and functional class I-III stable angina (ССS, 1976). Of them 100 patients had primary symptomatic hypothyroidism and 244 had no hypothyroidism. Coronary angiography was performed for all patients included into this study. Routine laboratory, instrumental and clinical indexes were analyzed. Hypothyroidism was confirmed by levels of thyrotropic hormone, free triiodothyronine, and thyroxine. Comparative analysis was performed for the incidence of ACS types in history, types of coronary injury, and laboratory, instrumental and clinical indexes with assessment of potential interrelations. Statistically significant results were reported. Type of data distribution was evaluated with the Kolmogorov-Smirnov test. Quantitative data with normal (Gaussian) distribution were presented as mean (M) and standard deviation (SD). Data with attributes of non-normal distribution were presented as median (Me) with maximum and minimum values (min; max). Statistical significance of differences between means was assessed with the Mann-Whitney test. Logistic regression analysis was used in parallel for evaluating dependence of a quantitative variable on values of two or more quantitative or qualitative variables (factors). Significance level for testing of statistical hypotheses was р&lt;0.05.Results Incidence of ST segment elevation ACS (STEACS) was significantly higher in IHD patients with hypothyroidism than in the group without hypothyroidism (61.6 and 35.6 %, р=0.03) and also with three-vessel coronary artery disease (60.6 and 30.6 %, р=0.001). In the IHD group with hypothyroidism, levels of total cholesterol, triglycerides, and low- and very low-density lipoproteins were significantly increased compared to the respective values in patients without hypothyroidism (р&lt;0.0001). An inverse correlation was found between lipidogram indexes and L-thyroxine (р&lt;0.0001).Conclusion The incidence of STEACS associated with primary symptomatic hypothyroidism in history was significantly higher in the patient group with IHD on the background of primary symptomatic hypothyroidism compared to the comparison group. Also, the incidence of three-vessel coronary disease was significantly greater than in the IHD patient group without hypothyroidism. A significant association was found between the replacement hormonal therapy and the best lipidogram indexes. The authors suggested that the key factor for prevention of adverse cardiovascular events in IHD with hypothyroidism is achieving control of clinical manifestations of hypothyroidism with replacement hormonal therapy.

Clinical Characteristics and Outcomes of 74 Patients With Severe or Critical COVID-19

BackgroundThe outbreak of the coronavirus disease (COVID-19) has led to a major concern and caused a pandemic globally. The goal of this study was to clarify the clinical characteristics of recovery and death in patients with severe or critical COVID-19.Materials and MethodsIn this retrospective single-center study, clinical data were collected from 74 severe or critical COVID-19 patients in Wuhan Fourth Hospital between Jan. 25th and Feb. 26th, 2020. All patients were divided into a recovery group or a death group according to clinical outcomes, and the differences between the groups were compared.ResultsOf the 74 patients enrolled in the study, 48 (64.9%) were severe cases and 26 (35.1%) were critical cases. Sixty (81.1%) patients were recovered and 14 (18.9%) died. Compared with recovery patients, patients in the death group were older, and had higher incidences of hypertension, coronary disease and dyspnea at admission. Laboratory tests for lactate dehydrogenase, creatine kinase, myoglobin, brain natriuretic peptide and D-dimer indicated higher levels in the death group. The PaO2:FiO2 ratio and minimum SpO2 were lower in the death group, and a higher proportion of these patients received noninvasive mechanical ventilation, invasive mechanical ventilation and extracorporeal membrane oxygenation treatment.ConclusionsElderly patients with comorbidities are at higher risk of severe COVID-19 or death. Patients with a low blood gas index and poor coagulation function at admission had a high mortality rate. For such patients, comprehensive treatment should be performed as soon as possible to improve the prognosis and reduce mortality.

Expert consensus on blood pressure management in hypertensive disorders of pregnancy (2019)

Objective: To compare the incidence of coronary microvascular disease (CMVD) between patients with non-obstructive and obstructive coronary arteries. Methods: We retrospectively analyzed 97 patients with angina pectoris, who underwent the absolute quantitative PET examination of myocardial perfusion and coronary anatomy examination within 90 days. All patients were divided into two groups: non-obstructive group (72 cases, no stenosis ≥50% in all three coronary arteries) and obstructive group (25 cases, at least one coronary stenosis ≥50%; and at least one coronary stenosis<50%). Quantitative parameters derived from PET including rest myocardial blood flow (RMBF), stress myocardial blood flow (SMBF), coronary flow reserve (CFR) and cardiovascular risk factors were compared between the two groups. CMVD was defined as CFR<2.90 and SMBF<2.17 ml·min(-1)·g(-1). Results: Incidence of CMVD was significant higher in the non-obstructive coronary arteries of the obstructive group than in the non-obstructive coronary arteries of non-obstructive group (47.1% (16/34) vs. 25.5% (55/216), χ(2)=6.738, P=0.009) while incidence of CMVD was similar between non-obstructive and obstructive patients ((44% (11/25) vs. 33.3% (24/72), χ(2)=0.915, P=0.339). RMBF ((0.83±0.14) ml·min(-1)·g(-1) vs. (0.82±0.17) ml·min(-1)·g(-1)), SMBF ((2.13±0.60) ml·min(-1)·g(-1) vs. (1.91±0.50) ml·min(-1)·g(-1)) and CFR (2.59±0.66 vs. 2.36±0.47) were similar between the two groups (all P>0.05). Conclusions: CMVD can occur in non-obstructive coronary arteries in both patients with non-occlusive coronary arteries and patients with obstructive coronary arteries. Prevalence of CMVD is significantly higher in patients with obstructive coronary arteries than in patients with non-obstructive coronary arteries. The CMVD severity is similar between the two groups.目的： 比较非阻塞及阻塞性冠状动脉（冠脉）疾病患者的冠脉微血管疾病（CMVD）发生情况。 方法： 回顾性分析2015年12月至2019年12月在山西医科大学附属第一医院成功完成(13)N-氨水正电子发射计算机断层显像（PET）心肌血流绝对定量检查并在PET检查90 d内完成冠脉造影或CTA的97例疑诊CMVD患者，根据造影及CTA结果将患者分为非阻塞组（72例，3支冠脉均不存在狭窄≥50%的病变）和阻塞组（25例，至少存在1支冠脉狭窄≥50%，且至少存在1支冠脉狭窄<50%），以冠脉血流储备（CFR）<2.90且负荷心肌血流量（SMBF）<2.17 ml·min(-1)·g(-1)为CMVD的判定标准，从血管及患者层面分析两组患者非阻塞性冠脉的CMVD发生情况，并比较两组间发生CMVD的冠脉支配区的静息心肌血流量（RMBF）、SMBF及CFR。 结果： 在血管层面，阻塞组非阻塞性冠脉存在CMVD的比例高于非阻塞组[47.1%（16/34）比25.5%（55/216），χ(2)=6.738，P=0.009]。在患者层面，两组发生CMVD的比例差异无统计学意义[（44%（11/25）比33.3%（24/72），χ(2)=0.915，P=0.339]。两组间发生CMVD的冠脉支配区的RMBF[（0.83±0.14）ml·min(-1)·g(-1)比（0.82±0.17）ml·min(-1)·g(-1)]、SMBF[（2.13±0.60）ml·min(-1)·g(-1)比（1.91±0.50）ml·min(-1)·g(-1)]及CFR（2.59±0.66比2.36±0.47）比较，差异均无统计学意义（P>0.05）。 结论： 非阻塞与阻塞性冠脉疾病患者的非阻塞性冠脉均可存在CMVD，后者的CMVD检出率更高，两者CMVD的严重程度基本一致。.

Relationship between Hemoglobin A1c Level and Severity of Coronary Artery Disease Among The Hospitalized Patients with Acute Coronary Syndrome

Background : Diabetes mellitus is one of the important risk factors for coronary artery disease. The hemoglobin A1c is used for evaluating glycemic control in diabetic patients. Here, we conducted the study to evaluate the relationship between HbA1c level and severity of coronary artery disease among the hospitalized patients with ACS.&#x0D; Materials &amp; Methods : This cross sectional study was conducted in the department of Cardiology, Ibrahim Cardiac Hospital &amp; Research Institute, Dhaka, Bangladesh from September 2015 to December 2015. Total of one hundred patients were studied and they were grouped on the basis of their glycaemic status. One hundred patients with acute coronary syndrome were enrolled in this study. Out of them fifty were diabetic (HbA1c&gt;6.5%) and rest of were nondiabetics (HbA1c&lt;6.5%) ( group-A and B).&#x0D; Results: Out of one hundred patients fifty eight were male and fourty two were female. Mean age of patients in group-A was 58.54±10.22 years and mean age of patients in group-B was 54.52±13.69 years. Mean age of male and female was 57.72±11.48 years and 54.0±13.08 years respectively. Mean HbA1c of patients in group-A was 11.43±1.43% and group-B was 6.34±0.915%. 38% of group-A and 22% of group-B had triple vessel disease, 26% of group-A and 20% of group- B had double vessel disease and 28% of group-A and 18% of group-B had single vessel disease, and 8% of group-A and 40% of group-B had normal coronary arteries. 48% patients of age group 46-50 in group-A had more incidence in coronary artery disease than other age group which was statistically significant ( p=0.035). 61-75 years age group in group-B patients had coronary artery disease than other age groups which was statistically not significant(p=0.084). Patients of group-A was significantly relation with coronary artery disease (p&gt;.001) and six times greater coronary artery disease than patients of group-B (OR= 6.15, 95% CI for OR =2.074 -18.289).&#x0D; Conclusions: In this way the importance of appropriate glycaemic control has been emphasized in diabetic patients. This study showed the relation between HbA1c levels and the severity of CAD in patient with type-II diabetes mellitus .Our findings demonstrate that elevated HbA1c level was risk factor for severity of coronary artery disease in ACS patients.&#x0D; Bangladesh Heart Journal 2018; 33(2) : 80-84

Lipoprotein Particle Profiles, Standard Lipids, and Peripheral Artery Disease Incidence

Despite strong and consistent prospective associations of elevated low-density lipoprotein (LDL) cholesterol concentration with incident coronary and cerebrovascular disease, data for incident peripheral artery disease (PAD) are less robust. Atherogenic dyslipidemia characterized by increased small LDL particle (LDL-P) concentration, rather than total LDL cholesterol content, along with elevated triglyceride-rich lipoproteins and low high-density lipoprotein (HDL) cholesterol (HDL-C), may be the primary lipid driver of PAD risk. The study population was a prospective cohort study of 27 888 women ≥45 years old free of cardiovascular disease at baseline and followed for a median of 15.1 years. We tested whether standard lipid concentrations, as well as nuclear magnetic resonance spectroscopy-derived lipoprotein measures, were associated with incident symptomatic PAD (n=110) defined as claudication and/or revascularization. In age-adjusted analyses, while LDL cholesterol was not associated with incident PAD, we found significant associations for increased total and small LDL-P concentrations, triglycerides, and concentrations of very LDL (VLDL) particle (VLDL-P) subclasses, increased total cholesterol (TC):HDL-C, low HDL-C, and low HDL particle (HDL-P) concentration (all P for extreme tertile comparisons <0.05). Findings persisted in multivariable-adjusted models comparing extreme tertiles for elevated total LDL-P (adjusted hazard ratio [HRadj] 2.03; 95% CI, 1.14-3.59), small LDL-P (HRadj 2.17; 95% CI, 1.10-4.27), very large VLDL-P (HRadj 1.68; 95% CI, 1.06-2.66), medium VLDL-P (HRadj 1.98; 95% CI, 1.15-3.41), and TC:HDL-C (HRadj, 3.11; 95% CI, 1.67-5.81). HDL was inversely associated with risk; HRadj for extreme tertiles of HDL-C and HDL-P concentration were 0.30 ( P trend < 0.0001) and 0.29 ( P trend < 0.0001), respectively. These components of atherogenic dyslipidemia, including small LDL-P, medium and very large VLDL-P, TC:HDL-C, HDL-C, and HDL-P, were more strongly associated with incident PAD than incident coronary and cerebrovascular disease. Finally, the addition of LDL-P and HDL-P concentration to TC:HDL-C measures identified women at heightened PAD risk. In this prospective study, nuclear magnetic resonance-derived measures of LDL-P, but not LDL cholesterol, were associated with incident PAD. Other features of atherogenic dyslipidemia, including elevations in TC:HDL-C, elevations in triglyceride-rich lipoproteins, and low standard and nuclear magnetic resonance-derived measures of HDL, were significant risk determinants. These data help clarify prior inconsistencies and may elucidate a unique lipoprotein signature for PAD compared to coronary and cerebrovascular disease. URL: https://www.clinicaltrials.gov/ . Unique Identifier: NCT00000479.

Ascending Aorta Aneurysm: What is the Risk of Replacing the Aortic Root?

Background: In mildly dilated aortic root, the cost-benefit of replacing of the sinuses of Valsalva with reimplantation of thecoronary arteries or preserving them is still a matter of debate.Objective: The goal of this study was to analyze the postoperative and long-term morbidity and mortality of patients undergoingaortic root replacement versus aortic root surgery with sinuses of Valsalva preservation.Methods: Between 2002 and 2016, 426 patients underwent replacement of the ascending aorta. After excluding patients undergoingurgent procedures, genetic aortic diseases (except for bicuspid aortic valve), reoperations and surgery of the aortic arch,the cohort was made up of 259 patients. In 99 of them (38.2%) the ascending aorta was replaced, preserving the aortic root;these patients were compared with the remaining 160 (61.8%) patients who underwent replacement of the sinuses of Valsalva.Results: Patients undergoing preservation of the aortic root were older, had higher percentage of female sex, higher EuroSCOREand with greater incidence of bicuspid aortic valve and coronary artery disease. Cardiopulmonary bypass time was longer inthe group undergoing aortic root replacement. There were no significant differences in in-hospital mortality between bothgroups (1% in the group with preservation of the aortic root vs. 3.1% for replacement of the sinuses of Valsalva, p=0.272).Multivariate analysis showed that cardiopulmonary bypass was a predictor of in-hospital mortality. Survival at 8 years wassimilar in both groups. There were no new operations due to complications in the aorta during follow-up. At multivariateanalysis, age and mitral valve disease were identified as predictors of long-term mortality.Conclusion: Replacement of the ascending aorta, either replacing the aortic root or preserving the sinuses of Valsalva, is asafe procedure, with low in-hospital mortality. Preservation of the sinuses of Valsalva is not associated with greater rate ofevents or mortality at the long-term.

Gender differences confirmed in cardiac surgery patients in cardiac rehabilitation

The leading cause of death in Europe is cardiovascular diseases (CVD), it causes 4 million deaths a year. Lithuania is classified as a high risk group of CVD. Many studies have shown that there are gender related differences in the way cardiac symptoms and diseases are perceived the incidence and course of coronary disease, cardiac treatments, and cardiac surgery. One hundred and twenty-five patients after cardiac surgery: valve surgery 37.8% ( n = 48), coronary artery bypass graft surgery (CABG) 52.8% ( n = 67), combined 9.4% ( n = 10) undergoing exercise training inpatient CR were studied in order to evaluate the effect of a CR programme on the quality of life. Functional capacity was assessed by a 6 minutes walking test and quality of life was assess by using the Short-Form (36) General Health Survey (assess patient's health and emotional well-being) scale from 1 to 100, on admission and at the end of 3 weeks programme. In the study participated 89 men (71.2%) and 36 women (28.8%). Men average age was 62.53 ± 1.85; women - 67.78 ± 1.6 ( P = 0.017). The prevalence of risk factors was not statistically significantly different between men and women ( P > 0.05). The physical capacity according to 6MWT was statistically significantly lower in women before and after CR (before 341.2 ± 24.1 vs. 246.2 ± 21.2 m., P = 0,004 after 417,1 ±13.29 vs. 341.2 ± 24.1, P = 0.009). Results of SF-36 general health assessment (45.9 ± 1.9% vs. 47.41 ± 3.5%) and emotional well-being (59.17 ± 2.81% vs. 62.4 ± 2.9%) at the beginning of CR did not differ (> 0.05). After CR women rated their general health (45.72 ± 2.36% vs. 54.4 ± 2.77%, P = 0.037) and emotional well-being (82.35 ± 2.65% vs. 71.2 ± 2.57%, P = 0.012) statistically significantly higher. In the female group, general health and emotional well-being assessment after CR were better evaluated, although women were older and their physical capacity was lower.