Independent Predictor Of Cardiovascular Events Research Articles

Analysis of long-term prognosis and risk factors in patients with dilated cardiomyopathy

Objective: To investigate the risk factors and long-term prognosis of major adverse cardiovascular events(MACEs) in patients with dilated cardiomyopathy (DCM). Methods: This study was a single-center retrospective cohort study. Clinical information from 300 patients with DCM hospitalized in Peking Union Medical College Hospital from April 2013 to April 2023 was collected. Based on echocardiography results, the patients were divided into two groups: isolated DCM and DCM with left ventricular non-compaction cardiomyopathy (LVNC). The MACEs, including major heart failure events, severe ventricular arrhythmias, and cardiovascular death, were recorded by outpatient or telephone follow-up. Univariate and multivariate Cox proportional hazard regression models were used to analyze the risk factors affecting the prognosis of patients with DCM. Kaplan-Meier curve and log-rank were used for survival analysis to compare the difference in the incidence of cardiovascular events between the two groups. Results: The included 300 DCM patients were (47.8±16.8) years old, with 197 males (65.7%), of which 237 (79.0%) were isolated DCM and 63 (21.0%) were DCM with LVNC. The follow-up time was 4.0 (1.9, 6.2) years. A total of 142 (47.3%) MACEs occurred, including 117 (39.0%) major heart failure events, 20 (6.7%) severe ventricular arrhythmia events, and 53 (17.7%) cardiovascular death events. Multivariate Cox proportional hazard regression analysis showed that increased left ventricular end-diastolic diameter (HR=1.21, 95%CI: 1.01-1.44, P=0.042), moderate or severe mitral regurgitation (HR=1.71, 95%CI: 1.19-2.47, P=0.004), increased ln (N-terminal pro-B-type natriuretic peptide) (HR=1.30, 95%CI: 1.10-1.54, P=0.002) were independent risk factors for dverse cardiovascular events in DCM patients, and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNI) treatment (HR=0.45, 95%CI: 0.26-0.78, P=0.004) was independent protective factor. Kaplan-Meier survival analysis found no significant difference in the risk of MACEs between isolated DCM and DCM with LVNC (P=0.22). Similarly, there were no significant differences in the incidence of major heart failure, severe ventricular arrhythmia, and cardiovascular death between the two groups (all P>0.05). Conclusion: An increase in left ventricular end-diastolic diameter, moderate or severe mitral regurgitation, elevated N-terminal pro-B-type natriuretic peptide, and non use of ACEI/ARB/ARNI are independent predictors of cardiovascular events in DCM patients. There was no significant risk of MACEs in patients with isolated DCM and DCM with LVNC, and suggested that LVNC may be a unique phenotype and should be accurately managed in combination with genetic background.

Subclinical Hypothyroidism Predicted Adverse Cardiovascular Events in Patients with Ejection Fraction Preserved Heart Failure.

Subclinical hypothyroidism (SH) increases the risk of cardiovascular events, however the influence of SH on prognosis of ejection fraction preserved heart failure (HFpEF) is not fully understood. In this prospective observational study, patients with HFpEF were divided into euthyroidism group (n = 413) and SH group (n = 79). Patients were followed up for at least 30 months to examine the association between SH and cardiovascular events in patients with HFpEF. The primary end point was composite cardiovascular events (cardiovascular death and re-hospitalization). The patients underwent flow-mediated dilation (FMD) measurement by ultrasound in order to value endothelial function. The rate of composite cardiovascular events was higher in SH group than in euthyroidism group (54.49% and 26.36%, respectively; p < 0.001). The higher risk of cardiovascular events in SH group was primarily due to a higher risk of re-hospitalization compared to euthyroidism group (45.56% and 20.58%, respectively; p < 0.001). The rate of cardiovascular death was higher in SH group than in euthyroidism group (13.92% and 5.81%, respectively; p = 0.017). Cox proportional hazards regression showed that SH (hazard ratios [HR] 1.921, 95% confidence interval [CI] 1.139-3.240), level of TSH (HR 1.025, 95% CI 1.010-1.054), age (HR 1.017, 95% CI 1.002-1.034), LVEF (HR 0.975, 95% CI 0.953-0.996), atrial fibrillation (HR 1.581, 95% CI 1.083-2.307), eGFR (HR 0.987, 95% CI 0.978-0.997), and NYHA cardiac function (HR 2.342, 95% CI 1.649-3.326) were independent predictors of cardiovascular events in patients with HFpEF (all P < 0.05). Subclinical hypothyroidism was associated with increased cardiovascular events and death in patients with HFpEF.

Characteristics of pulmonary artery strain assessed by cardiovascular magnetic resonance imaging and associations with metabolomic pathways in human ageing.

Pulmonary artery (PA) strain is associated with structural and functional alterations of the vessel and is an independent predictor of cardiovascular events. The relationship of PA strain to metabolomics in participants without cardiovascular disease is unknown. In the current study, community-based older adults, without known cardiovascular disease, underwent simultaneous cine cardiovascular magnetic resonance (CMR) imaging, clinical examination, and serum sampling. PA global longitudinal strain (GLS) analysis was performed by tracking the change in distance from the PA bifurcation to the pulmonary annular centroid, using standard cine CMR images. Circulating metabolites were measured by cross-sectional targeted metabolomics analysis. Among n = 170 adults (mean age 71 ± 6.3 years old; 79 women), mean values of PA GLS were 16.2 ± 4.4%. PA GLS was significantly associated with age (β = -0.13, P = 0.017), heart rate (β = -0.08, P = 0.001), dyslipidemia (β = -2.37, P = 0.005), and cardiovascular risk factors (β = -2.49, P = 0.001). Alanine (β = -0.007, P = 0.01) and proline (β = -0.0009, P = 0.042) were significantly associated with PA GLS after adjustment for clinical risk factors. Medium and long-chain acylcarnitines were significantly associated with PA GLS (C12, P = 0.027; C12-OH/C10-DC, P = 0.018; C14:2, P = 0.036; C14:1, P = 0.006; C14, P = 0.006; C14-OH/C12-DC, P = 0.027; C16:3, P = 0.019; C16:2, P = 0.006; C16:1, P = 0.001; C16:2-OH, P = 0.016; C16:1-OH/C14:1-DC, P = 0.028; C18:1-OH/C16:1-DC, P = 0.032). By conventional CMR, PA GLS was associated with aging and vascular risk factors among a contemporary cohort of older adults. Metabolic pathways involved in PA stiffness may include gluconeogenesis, collagen synthesis, and fatty acid oxidation.

MPAP/CO Slope and Oxygen Uptake Add Prognostic Value in Aortic Stenosis.

Recent guidelines redefined exercise pulmonary hypertension as a mean pulmonary artery pressure/cardiac output (mPAP/CO) slope >3 mm Hg·L-1·min-1. A peak systolic pulmonary artery pressure >60 mm Hg during exercise has been associated with an increased risk of cardiovascular death, heart failure rehospitalization, and aortic valve replacement in aortic valve stenosis. The prognostic value of the mPAP/CO slope in aortic valve stenosis remains unknown. In this prospective cohort study, consecutive patients (n=143; age, 73±11 years) with an aortic valve area ≤1.5 cm2 underwent cardiopulmonary exercise testing with echocardiography. They were subsequently evaluated for the occurrence of cardiovascular events (ie, cardiovascular death, heart failure hospitalization, new-onset atrial fibrillation, and aortic valve replacement) during a follow-up period of 1 year. Findings were externally validated (validation cohort, n=141). One cardiovascular death, 32 aortic valve replacements, 9 new-onset atrial fibrillation episodes, and 4 heart failure hospitalizations occurred in the derivation cohort, whereas 5 cardiovascular deaths, 32 aortic valve replacements, 1 new-onset atrial fibrillation episode, and 10 heart failure hospitalizations were observed in the validation cohort. Peak aortic velocity (odds ratio [OR] per SD, 1.48; P=0.036), indexed left atrial volume (OR per SD, 2.15; P=0.001), E/e' at rest (OR per SD, 1.61; P=0.012), mPAP/CO slope (OR per SD, 2.01; P=0.002), and age-, sex-, and height-based predicted peak exercise oxygen uptake (OR per SD, 0.59; P=0.007) were independently associated with cardiovascular events at 1 year, whereas peak systolic pulmonary artery pressure was not (OR per SD, 1.28; P=0.219). Peak Vo2 (percent) and mPAP/CO slope provided incremental prognostic value in addition to indexed left atrial volume and aortic valve area (P<0.001). These results were confirmed in the validation cohort. In moderate and severe aortic valve stenosis, mPAP/CO slope and percent-predicted peak Vo2 were independent predictors of cardiovascular events, whereas peak systolic pulmonary artery pressure was not. In addition to aortic valve area and indexed left atrial volume, percent-predicted peak Vo2 and mPAP/CO slope cumulatively improved risk stratification.

Association between high plasma levels of legumain and cardiovascular events in patients undergoing coronary angiography.

Degradation of vascular extracellular matrix is important in atherosclerosis. Cysteine protease legumain is upregulated in atherosclerotic plaques. We recently reported that plasma legumain levels are high in patients with complex coronary lesions. This study investigated the association between legumain levels and cardiovascular events in 372 patients undergoing coronary angiography. Patients with acute coronary syndrome were excluded. Of the 372 patients, 225 had coronary artery disease (CAD). During a mean follow-up of 7.0 ± 4.3 years, cardiovascular events occured in 62 patients. Compared with 310 patients without events, 62 with events tended to have higher prevalence of complex lesions (15% vs. 10%). Notably, patients with events had higher legumain levels (median 5.51 vs. 4.90 ng/mL, P < 0.01) than those without events. A Kaplan-Meier analysis showed lower event-free survival in patients with legumain > 5.0 ng/mL than in those with ≤ 5.0 ng/mL (P < 0.01). In multivariate Cox regression analysis, legumain level was an independent predictor of cardiovascular events. The hazard ratio for legumain > 5.0 ng/mL for cardiovascular events was 2.18 (95%CI = 1.27-3.77, P < 0.01). Only among 225 patients with CAD, patients with events had higher legumain levels (5.49 vs. 4.73 ng/mL) than without events (P < 0.02). Legumain level was also a predictor of cardiovascular events in patients with CAD. Thus, high plasma legumain levels were associated with an increased risk of cardiovascular events in patients undergoing coronary angiography and those with stable CAD.

High plasma levels of endosialin and cardiovascular events in patients undergoing coronary angiography.

Endosialin, also known as tumor endothelial marker-1, is a transmembrane glycoprotein that plays a role in inflammation and tumor progression. Endosialin is upregulated in atherosclerotic lesions. To elucidate the association between blood endosialin levels and cardiovascular events, we measured plasma endosialin levels in 389 patients undergoing coronary angiography who were followed up for a mean follow-up of 6.4 ± 4.2 years for cardiovascular events (cardiovascular death, myocardial infarction, unstable angina, heart failure, stroke, or need for coronary revascularization). Of the 389 patients, 223 had coronary artery disease (CAD). No significant difference was found in plasma endosialin levels between patients with and without CAD (median 0.92 vs. 0.92 ng/mL). During the follow-up, cardiovascular events occurred in 62 patients. Compared with patients without events, those with events had higher endosialin levels (1.12 vs. 0.89 ng/mL), and more often had endosialin level of > 1.1 ng/mL (53% vs. 31%) (P < 0.01). A Kaplan-Meier analysis showed lower event-free survival in patients with endosialin > 1.1 ng/mL than those with ≤ 1.1 ng/mL (P < 0.01). In a multivariate Cox regression analysis, endosialin > 1.1 ng/mL was an independent predictor of cardiovascular events (hazard ratio = 2.00; 95%CI = 1.21-3.32; P < 0.01). Thus, high plasma endosialin levels were associated with an increased risk of cardiovascular events in patients undergoing coronary angiography.

Cross-sectional association between blood cholesterol and calcium levels in genetically diverse strains of mice.

Genetically diverse outbred mice allow for the study of genetic variation in the context of high dietary and environmental control. Using a machine learning approach, we investigated clinical and morphometric factors that associate with serum cholesterol levels in 840 genetically unique Diversity Outbred mice of both sexes (n = 417 male and 423 female), and on both acontrol chow (% kcals in diet: protein 22%, carbohydrate 62%, fat 16%,no cholesterol) and high fat high sucrose (%kcals in diet: protein 15%, carbohydrate 41%, fat 45%, 0.05% cholesterol). We find expected elevations of cholesterol in male mice, as well as in mice with elevated serum triglycerides and/or fed a high fat high sucrose diet. The third strongest predictor was serum calcium which correlated with serum cholesterol across both diets and sexes (r = 0.39-0.48) in both Diversity Outbred (P = 3.0 × 10-43 ) and BXD (P = 0.005) mice. This is in-line with several human cohort studies which show associations between calcium and cholesterol, and calcium as an independent predictor of cardiovascular events.

Abstract 16712: Cardio-Ankle Vascular Index as an Independent Predictor of Cardiovascular Events in Patients With and Without Previous Cardiovascular Disease: A Systematic Review and Meta-Analysis

Background: Large artery stiffness predicts the risk of major adverse cardiovascular events (MACE). However, most data to date are related to carotid-femoral pulse wave velocity. Data about the prognostic value of cardio-ankle vascular index (CAVI), a less blood pressure-dependent marker, are limited, especially among individuals without prior cardiovascular disease (primary prevention). Hypothesis: Higher baseline CAVI is associated with incident MACE and all-cause death. Methods: PubMed, Scopus, and Web of Science were searched up to 29 April 2023 for longitudinal studies reporting the association of CAVI with incident fatal and nonfatal cardiovascular events. Risk of bias was assessed using the MINORS tool. Pooled hazard ratios were calculated separately based on use of CAVI as a categorical or continuous variable. Subgroup analysis focused on studies of patients without prior cardiovascular disease. Results: We included 21 studies (37,658 participants; mean age range 52-75 years; 53.9% males). Median study follow-up duration was 5 years (IQR 4.4-6; range 2-12.4). Despite variations in multivariable models, studies reported adjustments for conventional risk factors. Higher CAVI was associated with risk of MACE among all studies (categorical HR=1.45 [1.23-1.70], I 2 =51%; continuous HR=1.24 [1.15-1.33], I 2 =18%) and in primary prevention studies (categorical HR=1.48 [1.12-1.96], I 2 =67%; continuous HR=1.22 [1.12-.33], I 2 =25%). While CAVI was associated with all-cause mortality in the overall analysis (HR=1.34; 95% CI: 1.09-1.63, I 2 =41%), primary prevention studies did not show a significant association (HR=1.09; 95% CI: 0.9-1.32 I 2 =15%). Conclusion: CAVI holds promise as an independent predictor for MACE, including individuals without established cardiovascular disease. Further epidemiological studies are needed to better understand its prognostic role, normative values in different groups, and its role in primary prevention strategies.

Low Plasma Levels of Soluble Endoglin and Cardiovascular Events in Patients Undergoing Coronary Angiography.

TGF-β is recognized as playing a protective role against atherosclerosis. Endoglin is a receptor for TGF-β, and its expression is upregulated in atherosclerotic plaques. Endoglin is secreted from the cell membrane into the circulation as a soluble form (sEng). We previously reported that plasma sEng levels were low in patients with coronary artery disease (CAD). However, the prognostic value of sEng levels has not been clarified. We investigated the association between plasma sEng levels and cardiovascular events in 403 patients who had an elective coronary angiography and were then followed up. Cardiovascular events were defined as cardiovascular death, myocardial infarction, unstable angina, heart failure, stroke, or coronary revascularization. Of the 403 patients, 209 (52%) had CAD. Plasma sEng levels were lower in patients with CAD than in those without CAD (median 4.26 vs. 4.41 ng/mL, p < 0.025). During a mean follow-up period of 7.5 ± 4.5 years, cardiovascular events occurred in 79 patients. Compared with 324 patients without events, 79 with events had lower sEng levels (3.95 vs. 4.39 ng/mL) and more often had an sEng level < 3.9 ng/mL (47% vs. 28%) (p < 0.02). A Kaplan-Meier analysis showed lower event-free survival in patients with sEng < 3.9 ng/mL than in those with ≥3.9 ng/mL (p < 0.02). In a multivariate Cox proportional hazards analysis, the sEng level (<3.9 ng/mL) was an independent predictor of cardiovascular events (hazard ratio: 1.59; 95%CI: 1.01-2.49). Furthermore, only among the 209 patients with CAD, the sEng level was also a predictor of further cardiovascular events (hazard ratio: 2.07; 95%CI: 1.24-3.45). Thus, low plasma sEng levels were found to be associated with an increased risk of cardiovascular events in patients with CAD and patients undergoing coronary angiography.

Coronary Artery Calcium Identified on Non-Gated Chest CT Scans: A Wasted Opportunity for Preventive Cardiological Care

Coronary artery calcium (CAC) evaluated on dedicated cardiac computed tomography (CT) is an independent predictor of cardiovascular events. This study aimed to evaluate the correlation between CAC detected on non-gated standard chest CT and coronary lesions on coronary angiography (CAG) and determine its impact on prognosis. Consecutive patients who underwent CAG due to acute coronary syndrome and had prior non-contrasted non-gated chest CT were included and retrospectively evaluated. Coronary artery calcium was evaluated by quantitative (Agatston score) and qualitative (visual assessment) assessment. A total of 114 patients were included in this study. The mean time difference between chest CT and CAG was 23 months. Coronary artery calcium was visually classified as mild, moderate, and severe in 31%, 33%, and 16% of patients, respectively. Moderate or severe CAC was an independent predictor of significant lesions on CAG (OR 22; 95% CI 8-61; p<0.001) and all-cause mortality (OR 4; 95% CI 2-9; p=0.001). Quantitative CAC evaluation accurately predicted significant lesions on CAG (AUC 0.81; p<0.001). While significant CAC was identified in 80% of chest CTs, formal reporting was 25%. Coronary artery calcium evaluation with chest CT was feasible and strongly associated with severity of coronary disease on CAG and mortality. Although the identification of CAC on chest CT represents a unique opportunity for cardiovascular risk stratification for preventive care, CAC underreporting is frequent.

The combination of CYP2C19 polymorphism and inflammatory cell ratios in prognosis cardiac adverse events after acute coronary syndrome

BackgroundCYP2C19 gene polymorphism combination with inflammatory cell ratios was significant in the prognosis of coronary heart disease. Materials and methodsA cross-sectional analysis study, with 6 months follow-up on 142 patients with acute coronary syndrome. Patients were analyzed for CYP2C19 gene polymorphisms by real-time polymerase chain reaction (PCR) and complete blood count to determine inflammatory cell ratios and recorded cardiovascular events (CEs) after following up to 6 months. ResultsFor 90-day CEs, CYP2C19 gene polymorphism (Hazard Ratio (HR): 1.965, 95 % Confidence Interval (CI): 1.012–3.814), the combination of a neutrophil and lymphocyte ratio (NLR) ≥ 2.982 (HR: 13.001, 95 % CI: 1.37–97.304) or a platelet to lymphocyte ratio (PLR) ≥ 162.42 (HR: 2.878, 95 % CI: 1.212–6.835) was independent predictors of CEs. For 180-day CEs, CYP2C19 gene polymorphism combination with NLR ≥3.02 (HR: 13.946, 95 % CI: 1.833–106.121) or PLR ≥160.38 (HR: 5.349, 95 % CI: 1.379–20.745) or monocyte to lymphocyte ratio (MLR) ≥ 0.3 (HR: 4.699, 95 % CI: 1.032–31.393) were independent predictors of CEs. ConclusionNLR, PLR or MLR combined with CYP2C19 gene polymorphism were stronger independent predictors of cardiovascular events in patients with acute coronary syndromes compared to CYP2C19 gene polymorphism and inflammatory cell ratios separately. CYP2C19 polymorphism and high NLR was the strongest predictor of both CEs at 90 days and 180 days.

Gamma-glutamyl transferase to high-density lipoprotein cholesterol ratio is a more powerful marker than TyG index for predicting metabolic syndrome in patients with type 2 diabetes mellitus.

The prevalence of metabolic syndrome (MetS) is increasing globally and has become a global and national public health problem that cannot be ignored as an independent predictor of cardiovascular events, cancer and all-cause mortality. γ-glutamyl transferase (GGT) and high-density lipoprotein cholesterol (HDL-C) are associated with insulin resistance, dyslipidemia and oxidative stress. This study was designed to explore the relationship and predictive performance between γ-glutamyl transferase high-density lipoprotein cholesterol ratio (GGT/HDL-C) and MetS. This was a cross-sectional study. MetS was diagnosed from biochemical and anthropometric data in subjects with T2DM. Multivariate logistic regression was used to analyses the relationship between GGT/HDL-C ratio, TyG index and HOMA-IR and MetS in subjects with T2DM. Receiver operating characteristic (ROC) curve was drawn and the areas under the curve (AUC) were used to assess the ability of these indexes in screening MetS in subjects with T2DM. Statistical differences between the AUC values of these indexes were compared. In addition, we performed subgroup analyses and interactions. 769 (70.55%) patients with T2DM were defined as having MetS. patients with MetS had higher anthropometric values and biochemical indicators compared to those without MetS. Multivariate logistic regression analysis of GGT/HDL-C ratio was an independent risk factor for MetS (Per 1 SD increase, OR = 2.49, 95% CI: 1.51, 4.10). According to ROC curve analysis, the value of GGT/HDL-C ratio in predicting MetS in subjects with T2DM was superior to that of TyG index and HOMA-IR. The best cut-off value for GGT/HDL-C prediction was 19.94. GGT/HDL-C ratio may be an important predictor of MetS in subjects with T2DM, and its predictive power is stronger than that of TyG index and HOMA-IR. The risk of MetS in subjects with T2DM is increased in the presence of a higher GGT/HDL-C ratio.

EXPRESSION OF DE NOVO CERAMIDE SYNTHESIS IN LOCAL HEART FAT DEPO IN PATIENTS WITH CARDIOVASCULAR DISEASES

Introduction. Ceramides are bioactive lipids that are not only structural components of cell membranes, but also second messengers in the transmission of cell signals. Ceramides are associated with risk factors for cardiovascular disease, may be independent predictors of cardiovascular events and proatherogenic mediators. However, due attention has not been paid to the problem of ceramide accumulation in the adipose tissue (AT) of the heart, while the accumulation of ceramides in adipocytes of epicardial and perivascular AT in coronary heart disease (CHD) is of particular interest, since they are localized in close proximity to the coronary vessels and the focus of the lesion. Objective: to evaluate the expression of de novo ceramide biosynthesis enzymes in the adipose tissue of the heart of various locations in patients with coronary heart disease and acquired heart defects. Materials and methods. The study included 30 patients with CAD, the comparison group consisted of 30 patients with acquired valvular disease (aortic stenosis/insufficiency) without CAD. During the operation, biopsies of subcutaneous, epicardial, perivascular adipose tissue (VT) (SAT, EAT, PVAT, respectively) were obtained. Expression of genes encoding de novo ceramide synthesis enzymes (subunits of C1 and C2 serine palmitoyltransferases: SPTLC1, SPTLC2; ceramide synthase 1-6: CERS1-6; dihydroceramide desaturase: DEGS1) was assessed by real-time quantitative polymerase chain reaction (qPCR) with primers synthesized by Evrogen (Moscow, Russia) on the ViiA 7 Real-Time PCR System (Applied Biosystems, Foster City, California, USA). Statistical analysis of the results was performed using GraphPad Prism 8 (GraphPad Software). Results. Patients with CAD were characterized by higher levels of SPTLC1 mRNA in subcutaneous and epicardial VT and SPTLC2 mRNA in EAT. DEGS1 expression was maximal in SVT and EAT. The expression of ceramide synthase genes in VT of patients with coronary artery disease had tissue-specific features. Expression of the CERS1 gene, encoding the enzyme ceramide synthase-1, which produces ceramides with a fatty acid residue in its composition of 18 carbon atoms (C18), expression of CERS5 and CERS6, encoding ceramide synthase-5 and -6, synthesizing ceramides C14-C16 was maximum in epicardial adipocytes. At the same time, CERS5 expression was higher than CERS6 expression. Gene expression of CERS2, encoding the enzyme ceramide synthase-2, which produces long-chain ceramides and attaches C20–C24 fatty acyl-CoA to the sphingoid base in ceramide, was maximal in subcutaneous adipocytes. While perivascular VT was characterized by a higher expression of the CERS4 and CERS3 genes, which synthesize very long chain ceramides C26 and higher. In the group of patients with valvular disease, VT samples did not differ in terms of SPTLC1, SPTLC2, CERS1, CERS2, CERS5, and CERS6 mRNA levels. However, high expression of CERS4 and DEGS1 was observed in EAT, while CERS3 and CERS4 were expressed in PVAT. When comparing the level of expression of genes for ceramide synthesis enzymes between the two studied groups, it was found that in patients with IHD, the mRNA level of SPTLC1 in SAT and EAT, SPTLC2 in EAT, CERS2 in all types of AT, CERS4 and CERS5 in EAT, DEGS1 in SAT and EAT was higher in compared with patients with valvular heart disease. Conclusion. Regional fat depots of the heart differed in the level of expression of de novo ceramide biosynthesis enzymes. The results obtained indicate the activation of ceramide synthesis along this pathway in adipocytes of predominantly epicardial localization in coronarogenic pathology, which may contribute to the accumulation of long-chain ceramides in the VT of this localization.

Assessment of Cardiovascular Risk and Arterial Stiffness in Patients With Human Immunodeficiency Virus.

Several studies suggest that patients infected with the human immunodeficiency virus (HIV) under highly active antiretroviral therapy (HAART) have a higher cardiovascular risk than the general population. Arterial stiffness is an independent predictor of cardiovascular events and can be measured through carotid-femoral pulse wave velocity (PWV). The objectives of this study were to characterize a sample of HIV-infected patients under HAART regarding cardiovascular risk, compare PWV values of this group with those of uninfected controls,and investigate predictors of PWV in the HIV-infected group. PWV was measured, and data was collected from a sample of 125 HIV-infected patients under HAART. PWV measurements in the study group were compared with those in a control group of 250 subjects similar in sex, age, prevalence of hypertension, and type 2 diabetes mellitus (DM). A linear regression model was constructed to identify predictors of PWV in the HIV-infected group. In the HIV-infected group, composed mostly of men, the mean age and respective standard deviation were 48.6 ± 11.6 years. In this group, 112 individuals (89.6%) presented moderate to very high cardiovascular risk. Significant differences were found in median PWV between HIV-infected and control groups (8.56 vs. 8.00 m/s,p= .002). Age, peripheral systolic blood pressure, presence of DM, amount of alcohol consumed, and current CD4+T cell count were independent predictors of PWV in the HIV-infected group. Conclusions: The HIV-infected group showed higher cardiovascular risk and arterial stiffness measurements than the general population. PWV may be an important predictor of subclinical cardiovascular disease in HIV-infected patients.

Diastolic dysfunction is an independent predictor for cardiovascular events after an acute kidney injury

Background and aimAcute kidney injury (AKI) conditions several short- and long-term complications. The aim of the present study was to analyse the impact of cardiac function and structure in the cardiovascular prognosis after an in-hospital AKI episode. Material and methodsThis is an observational retrospective cohorts study including all in-hospital AKI episodes in 2013 and 2014 in our centre. At baseline, epidemiological values, comorbidities and echocardiography parameters were collected. During a follow-up of 49 ± 28 months, cardiovascular events (CVE) were collected, and associated factors were analysed. Results1255 patients were included (55% male, age 75 ± 13 years). Of the 676 (54%) that had a previous echocardiogram, 46% had left ventricular hypertrophy, 38% pulmonary hypertension, 38% diastolic dysfunction and 22% systolic dysfunction. During the follow-up, 484 (39%) developed a CVE. Associated factors to VCE were male sex, age, diabetes mellitus, hypertension, dyslipidemia, coronary heart disease, heart failure, atrial fibrillation, neoplasia and chronic kidney disease (also, glomerular filtration rate at baseline and after the AKI episode). Survival curves demonstrated that all the echocardiographic parameters were associated to CVE. An adjusted Cox regression model showed that age (HR 1.017), diabetes (HR 1.576) and diastolic dysfunction (HR 1.358) were independent predictors for CVE. ConclusionDiastolic dysfunction is an independent predictor for long-term cardiovascular events after an in-hospital acute kidney injury episode.

Determinants of short-term blood pressure variability – the value of arterial stiffness

Abstract. Increased blood pressure variability is a significant parameter that affects the prognosis in patients with arterial hypertension, and is an independent predictor of cardiovascular events and mortality. The arterial elasticity is an important factor in maintaining a constant average blood pressure for adequate blood supply to inner organs against the background of dynamic blood pressure fluctuations. A decrease in the elastic properties of the arteries, and therefore, an increase in the arterial stiffness can be one of the potential mechanisms for the blood pressure variability violation. Objective. The aim of the study was to evaluate the possible relationships between arterial stiffness indicators and blood pressure variability indices in patients with hypertension based on the results of ambulatory blood pressure monitoring. Patients and methods. The results of ambulatory blood pressure monitoring of 172 patients with hypertension were analyzed. Arterial stiffness was assessed using the ambulatory arterial stiffness index - symmetric and asymmetric. SD, SDw, CV, SV, ARV, and BPVR indices were calculated to assess blood pressure variability. Analysis of the obtained results was carried out using Microsoft Excel 2010 and the STATISTICA version 10.0 software. Differences between groups were assessed by the Mann-Whitney method, correlations among blood pressure variability indices and ambulatory arterial stiffness indices were evaluated using Spearman`s rank correlation analysis. Significance was set at p ˂ 0.05. The results. Awake asymmetric ambulatory arterial stiffness index was significantly higher than asleep one, no statistically significant difference between asleep and 24-hour asymmetric ambulatory arterial stiffness index was established. The asleep symmetric ambulatory arterial stiffness index did not significantly differ from the awake one and was significantly higher than the 24-hour one. In comparison with asymmetric, for symmetric ambulatory arterial stiffness index statistically significant relationships were established for a greater number of blood pressure variability indices. In all statistically significant cases, the direction of the established relationship with arterial stiffness was only direct for the systolic blood pressure variability indices. Variability of diastolic blood pressure had a clear inverse relationship with arterial stiffness. Conclusions. The presence of pathogenetic interrelationships between arterial stiffness and blood pressure variability have been proven in the present study. The obtained results allow to state that arterial elasticity is an important component of blood pressure variability.

Coronary artery calcium identified on non-gated chest CT scans - A wasted opportunity to avoid the tragedy

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Coronary artery calcium (CAC) is an independent predictor of cardiovascular events. While it is traditionally performed utilizing gating with specific acquisition parameters, CAC can be identified in non-gated standard chest computed tomography (CT). This study aimed to assess CAC on chest CTs, evaluating its correlation with coronary lesions on coronary angiography (CAG) and prognosis. Methods We retrospectively reviewed patients (pts) who underwent CAG due to acute coronary syndrome (ACS) who had undergone a prior non-gated non-contrast chest CT. CAC was qualitatively evaluated by visual assessment (mild/moderate/severe) and quantitatively assessed using Agatson score and stratified by terciles. Evaluation was performed by an investigator blinded to CAG report. Results We included 114 pts after reviewing 1000 CAGs: 67% male, mean age 68 years, 78% hypertension, 62% dyslipidemia, 38% chronic kidney disease, 38% diabetes. The mean time difference between CT and CAG was 23 months. CAG was performed due to unstable angina in 33% of pts, NSTEMI in 52% and STEMI in 16%. Significant lesions were found in 57% (69% performed PCI and 17% surgical revascularization). CAC was visual classified as mild, moderate and severe in 31%, 33% and 16% of pts, respectively. Moderate or severe CAC was an independent predictor of significant lesions on CAG [OR 22, 95%CI 8–61, p&amp;lt;0.001] and all-cause mortality [OR 4, 95%CI 2–9, p = 0.001]. Pts with severe CAC had higher peak troponin than those with mild/moderate CAC (1780 vs 315 ng/L, p = 0.024). Quantitative CAC score accurately predicted significant lesions (AUC 0.81, p&amp;lt;0.001; figure 1A), with higher scores in this subgroup (1308 vs 120, p&amp;lt;0.001) and strongly correlated with SYNTAX score (p&amp;lt;0.001). Survival analysis stratified by severity of CAC assessment is shown in figure 1B and 1C. The most severely calcified artery in the CT often matched the culprit vessel of future ACS, with 79%, 60% and 50% concordance for left anterior descending, circumflex, and right coronary artery, respectively. While significant CAC was identified in 80% of CTs, formal reporting was as low as 25%, even with severe CAC, where only 2/18 reports mentioned it. Furthermore, only 62% pts were on statin therapy at the time of CAG. Conclusion CAC evaluation in chest CTs was feasible and strongly associated with the extent/severity of coronary artery disease on CAG, as well as mortality. Notwithstanding, CAC underreporting was frequent and statin therapy underused, suggesting a simple and common opportunity for preventive care.

ASSOCIATION OF MORTALITY OUTCOMES WITH ARTERIAL PARAMETERS DERIVED FROM THE 24-HOUR AMBULATORY BLOOD PRESSURE MONITORING

Objective: Arterial stiffness, as a subclinical target organ damage, was an independent predictor of cardiovascular events. Parameters calculated from the 24-hour ambulatory blood pressure monitoring (ABPM), such as ambulatory arterial stiffness index (AASI), symmetrical AASI (sAASI), the 24-hour pulse pressure (PP) and its components expressed as elastic PP (elPP) and stiffening PP (stPP), can be used to indirectly assess arterial stiffness. Up to now, few studies have compared the associations of health outcomes with these parameters. Design and method: Out-patients who completed 24-hour ABPM (Mobil-O-Graph, Germany) at Ruijin Hospital (Shanghai, China) from 2017 to 2020 were recruited. All-cause and cardiovascular mortality (ICD10 codes I00-I99) was ascertained according to the death registry in Shanghai Municipal Center for Disease Control and Prevention. Standardized hazard ratios (HR) and 95% confidence intervals were computed with Cox regression models and adjusted for 24-hour mean arterial blood pressure and other confounders. Results: Among the 29,519 participants (mean age 52.9 years, 46.8% males) followed up for a median of 2.8 years, 244 participants died, and 78 died from cardiovascular events. In unadjusted analyses, all studied ambulatory arterial parameters were all associated with all-cause (HR, 1.41-1.87; P&lt;0.001) and cardiovascular (HR, 1.55-2.17; P&lt;0.001) mortality. After multivariable adjustment, AASI, the 24-hour PP, elPP and stPP remained significantly associated with all-cause (HR, 1.18-1.35; P&lt;0.014) and cardiovascular (HR, 1.28-1.38; P&lt;0.048) mortality, while the associations became non-significant for stPP in relation to cardiovascular death, and for sAASI with all-cause and cardiovascular outcomes. Conclusions: Arterial parameters derived from the 24-hour ABPM were independently associated with mortality outcomes, with some differences in the associations among different parameters.

Relationship Between Endothelial Dysfunction and the Outcomes After Atrial Fibrillation Ablation.

Background Endothelial dysfunction (ED) is associated with cardiovascular events in patients with atrial fibrillation (AF). However, the utility of ED as a prognostic marker after AF ablation supplementary to the CHA2DS2-VASc score is unclear. This study aimed to investigate the relationship between ED and 5-year cardiovascular events in patients undergoing AF ablation. Methods and Results We conducted a prospective cohort study of patients who underwent a first-time AF ablation and for whom the endothelial function was assessed by the peripheral vascular reactive hyperemia index (RHI) before ablation. We defined ED as an RHI of <2.1. Cardiovascular events included strokes, heart failure requiring hospitalization, arteriosclerotic disease requiring treatment, venous thromboses, and ventricular arrhythmias or sudden cardiac death. We compared the 5-year incidence of cardiovascular events after AF ablation between those with and without ED. Among the 1040 patients who were enrolled, 829 (79.7%) had ED, and the RHI value was found to be associated with the CHA2DS2-VASc score (P=0.004). The 5-year incidence of cardiovascular events was higher among patients with ED than those without ED (98 [11.8%] versus 13 [6.2%]; log-rank P=0.014). We found ED to be an independent predictor of cardiovascular events after AF ablation (hazard ratio [HR], 1.91 [95% CI, 1.04-3.50]; P=0.036) along with a CHA2DS2-VASc score of ≥2 (≥3 for women) (HR, 3.68 [95% CI, 1.89-7.15]; P<0.001). Conclusions The prevalence of ED among patients with AF was high. Assessing the endothelial function could enable the risk stratification of cardiovascular events after AF ablation.

Implications of the Mitral Leaflet Coaptation Pattern on Clinical Outcomes in Patients With Functional Mitral Regurgitation

The classification of secondary mitral regurgitation (MR) is based on atrial functional MR (AFMR) or ventricular functional MR (VFMR) and volume changes, but the mitral leaflet coaptation angle also contributes to the MR mechanism. The clinical implications of the coaptation angle on cardiovascular (CV) outcomes have not been well evaluated. A total of 469 consecutive patients (265 AFMR vs 204 VFMR) with more than moderate MR were evaluated for the occurrence of heart failure, mitral valve operations, and CV death. The coaptation angle was assessed by measuring the internal angle between both leaflets at mid-systole using the apical 3-chamber view. A coaptation angle ≥130° was classified as leaflet flattening, and an angle <130° was classified as leaflet tethering. AFMR and VFMR were associated with higher frequencies of leaflet flattening and tethering, respectively. AFMR was more likely to be associated with older age, atrial fibrillation, and preserved ejection fraction, all of which were related to leaflet flattening. During a follow-up of 2.3years, 83 patients had heart failure (17.7%), 21 patients underwent mitral valve operations (4.5%), and 34 patients died (7%). Compared with leaflet tethering, leaflet flattening was more significantly related to CV events, whereas CV event rates were less markedly different in A/VFMR. Irrespective of A/VFMR, leaflet flattening and atrial fibrillation were associated with a higher frequency of CV events. Adjusted analysis showed that leaflet flattening remained an independent predictor of CV events (hazard ratio 3.5, 95% confidence interval 1.11 to 4.88, p=0.003), whereas A/VFMR did not. In conclusion, the leaflet coaptation angle in patients with functional MR could provide risk stratification superior to that of A/VFMR. Leaflet flattening appears to be associated with unfavorable clinical outcomes.