Independent Predictor Of Cardiovascular Events Research Articles

Effects of Hydroxychloroquine on endOthelial function in eLDerly with sleep apnea (HOLD): study protocol for a randomized clinical trial

BackgroundSleep apnea and coronary artery disease are prevalent and relevant diseases. The mechanism by which sleep apnea leads to coronary artery disease remains unclear. Intermittent hypoxia, caused by sleep apnea, leads to inflammation and consequent endothelial dysfunction. Endothelial dysfunction precedes the development of atherosclerotic disease and the occurrence of cardiovascular events. Agents that potentially act to improve endothelial function can help prevent cardiovascular events. Patients using immunomodulators due to rheumatic diseases have a lower prevalence of cardiovascular diseases. However, the potential cardioprotective effect of these drugs in patients without autoimmune diseases is not clear. Hydroxychloroquine (HCQ) is an immunomodulator used to treat rheumatoid arthritis and systemic lupus erythematosus. In addition to its anti-inflammatory properties, HCQ reduces cholesterol and blood glucose levels and has antithrombotic effects. The drug is inexpensive and widely available. Adverse effects of HCQ are rare and occur more frequently with high doses.ObjectiveIn this randomized clinical trial, the effect of HCQ treatment on endothelial function will be tested in seniors with sleep apnea.MethodsWe will recruit participants over the age of 65 and with moderate-severe sleep apnea from an ongoing cohort. We chose to use this sample already evaluated for sleep apnea for reasons of convenience, but also because the elderly with sleep apnea are vulnerable to heart disease. Endothelial function will be assessed by examining flow-mediated dilation of the brachial artery, the gold standard method, considered an independent predictor of cardiovascular events in the general population and by peripheral arterial tonometry, the most recent and most easily obtained method. Hydroxychloroquine will be used at a dose of 400 mg/daily for 8 weeks.DiscussionOur study aims to obtain evidence, albeit preliminary, of the efficacy of hydroxychloroquine in improving endothelial function and reducing cardiovascular risk markers. If the improvement occurs, we plan to design a randomized multicenter clinical trial to confirm the findings.Trial registrationClinicalTrials.gov NCT04161339. Registered on November 2019.

Spironolactone Reduces Aortic Stiffness in Patients With Resistant Hypertension Independent of Blood Pressure Change.

BackgroundAortic stiffness is an independent predictor of cardiovascular events in patients with arterial hypertension. Resistant hypertension is often linked to hyperaldosteronism and associated with adverse outcomes. Spironolactone, a mineralocorticoid receptor antagonist, has been shown to reduce both the arterial blood pressure (BP) and aortic stiffness in resistant hypertension. However, the mechanism of aortic stiffness reduction by spironolactone is not well understood. We hypothesized that spironolactone reduces aortic stiffness in resistant hypertension independently of BP change.Methods and ResultsPatients with uncontrolled BP (≥140/90 mm Hg) despite use of ≥3 antihypertensive medications (including diuretics) were prospectively recruited. Participants were started on spironolactone at 25 mg/d, and increased to 50 mg/d at 4 weeks while other antihypertensive medications were withdrawn to maintain constant mean BP. Phase‐contrast cardiac magnetic resonance imaging of the ascending aorta was performed in 30 participants at baseline and after 6 months of spironolactone treatment to measure aortic pulsatility, distensibility, and pulse wave velocity. Pulse wave velocity decreased (6.3±2.3 m/s to 4.5±1.8 m/s, P<0.001) and pulsatility and distensibility increased (15.9%±5.3% to 22.1%±7.9%, P<0.001; and 0.28%±0.10%/mm Hg to 0.40%±0.14%/mm Hg, P<0.001, respectively) following 6 months of spironolactone.ConclusionsOur results suggest that spironolactone improves aortic properties in resistant hypertension independently of BP, which may support the hypothesis of an effect of aldosterone on the arterial wall. A larger prospective study is needed to confirm our findings.

Arterial Stiffness in Type 1 Diabetes: The Case for the Arterial Wall Itself as a Target Organ.

Arterial stiffness (AS) integrates the cumulative burden of known and unknown cardiovascular risk factors on the elastic wall of large arteries along the lifespan of an individual. As a marker of vascular aging, AS is an independent predictor of cardiovascular events and improves cardiovascular risk prediction when added to the Framingham Risk Score. In addition, AS may affect the microvasculature and promote the development of microvascular complications. Its impact on both the macro- and microvasculature has led to the concept that the arterial wall itself should be considered as a target organ. Here, we review the biological and clinical consequences of AS on the macro- and microvasculature and the measurement of AS in routine clinical practice. We also discuss the pathophysiological mechanisms underpinning AS development using diabetes and, in particular, type 1 diabetes, as a disease model with a high risk of cardiovascular events and microvascular complications that are accelerated by AS.

Hand grip strength and type 2 diabetes are mutually independent predictors of cardiovascular events and of mortality in patients with established cardiovascular disease

Background and Aims: Impaired skeletal muscle function is involved in the pathogenesis of type 2 diabetes (T2DM) as well as of cardiovascular disease (CVD). Hand grip strength (HGS) is a simple, inexpensive and non-invasive diagnostic parameter for muscle function. Its association with cardiovascular events and mortality in patients with established CVD is unclear and is addressed in the present study.

Ameliorative effect of allicin on vascular calcification via inhibiting endoplasmic reticulum stress.

Vascular calcification (VC) is an independent predictor for cardiovascular events and mortality. However, there are currently no effective methods to reverse or prevent it. The present study aimed to determine the ameliorative effect of allicin on VC. VC model of rats was induced by high-dose vitamin D3, which was valued by Alizarin Red staining, calcium contents, and alkaline phosphatase in the aorta. Systolic blood pressure, pulse pressure, and pulse wave velocity were measured to determine aortic stiffness. Protein levels were detected by Western blot. Allicin treatment rescued aortic VC and stiffness. The increased protein levels of RUNX2 and BMP2, two markers of osteoblastic phenotype of vascular smooth muscle cells, in the calcified aorta were attenuated by allicin, whereas the decreased levels of calponin and SM22α induced by calcification were improved. Allicin treatment significantly attenuated the increased protein levels of GRP78, GRP94, and CHOP, which are key markers of endoplasmic reticulum stress, in the calcified aorta. The activation of PERK/eIF2α/ATF4 cascades was also prevented by allicin. Allicin could ameliorate aortic VC and stiffness. The ameliorative effect of allicin on VC might be mediated by inhibiting PERK/eIF2α/ATF4 cascades. Our results might provide a new proof for VC treatment.

Elevated plasma levels of NT-proBNP in ambulatory patients with peripheral arterial disease.

N-terminal pro B-type natriuretic peptide (NT-proBNP), a cardiac disease biomarker, has been demonstrated to be a strong independent predictor of cardiovascular events in patients without heart failure. Patients with peripheral arterial disease (PAD) are at high risk of cardiovascular events and death. In this study, we investigated levels of NT-proBNP in patients with PAD compared to non-PAD controls. A total of 355 patients were recruited from outpatient clinics at a tertiary care hospital network. Plasma NT-proBNP levels were quantified using protein multiplex. There were 279 patients with both clinical and diagnostic features of PAD and 76 control patients without PAD (non-PAD cohort). Compared with non-PAD patients, median (IQR) NT-proBNP levels in PAD patients were significantly higher (225 ng/L (120–363) vs 285 ng/L (188–425), p- value = 0.001, respectively). Regression analysis demonstrated that NT-proBNP remained significantly higher in patients with PAD relative to non-PAD despite adjusting for age, sex, hypercholesterolemia, smoking and hypertension [odds ratio = 1.28 (1.07–1.54), p-value <0.05]. Subgroup analysis showed elevated NT-proBNP levels in patients with PAD regardless of prior history of CHF, CAD, diabetes and hypercholesteremia (p-value <0.05). Finally, spearmen’s correlation analysis demonstrated a negative correlation between NT-proBNP and ABI (ρ = -0.242; p-value < 0.001). In conclusion, our data shows that patients with PAD in an ambulatory care setting have elevated levels of NT-proBNP compared to non-PAD patients in the absence of cardiac symptoms.

Incremental prognostic value of calcified vs non-calcified plaque burden on computed tomography angiography and myocardial perfusion imaging

Abstract Funding Acknowledgements Type of funding sources: None. Background Coronary computed tomography angiography (CCTA) is currently guideline-endorsed for diagnosing suspected coronary artery disease (CAD) in low-intermediate risk patients. Single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has an established role in both the accurate detection of ischemia and identification of patients at high risk of future cardiovascular events. Recent studies have shown that the burden of atherosclerotic plaque is an independent predictor of cardiovascular events, and that this effect depends on the degree of calcification. Purpose To compare the incremental prognostic value of calcified vs non-calcified plaque burden to CCTA anatomic assessment and SPECT physiologic assessment in patients evaluated with both tests. Methods Consecutive patients who underwent clinically indicated CCTA and SPECT myocardial imaging for suspected CAD were included. Ischemia on SPECT was defined as summed difference score &amp;gt; 0 using perfusion graded on a 5-point scale. Anatomically obstructive CAD by CCTA was defined as ≥50% in the left main artery and ≥70% stenosis severity in proximal, mid and distal branches of the left anterior descending, left circumflex and right coronary artery without including side branches. Segment involvement score was defined as the sum of segments with plaque irrespective of the degree of stenosis using an 18-segment coronary artery model. A Hounsfield unit threshold of &amp;gt; =130 was used to classify plaques composition as calcified/mixed (C-SIS) vs non-calcified plaque (NC-SIS). Patients were followed for major adverse cardiovascular events (MACE, inclusive of all-cause death, non-fatal myocardial infarction, and percutaneous coronary intervention or coronary artery bypass grafting 90-days after imaging test.) Results A total of 956 patients were included. (Mean age 61.1 ± 14.2 years, 54% men, 89% hypertension, 81% diabetes, 84% dyslipidemia). Obstructive stenosis (left main ≥ 50%, all other coronary segments ≥ 70%) and ischemia were observed in similar number of patients (14%). After a median follow-up of 31 months, 102 patients (11%, 29.2 events per 1000 person-year) experienced a MACE. In multivariable Cox regression models, C-SIS, but not NC-SIS significantly predicted outcomes and improved risk discrimination in models with CCTA obstructive stenosis (HR 1.14 95% CI 1.08 - 1.20 p= &amp;lt;0.001; Harrel’s C 0.74, p = 0.011) and SPECT ischemia (HR 1.14 95% CI 1.08 - 1.20, p &amp;lt; 0.001; Harrel’s C 0.76, p = 0.015). Conclusion In the current study of high-risk patients with suspected CAD, calcified plaque burden, but not non-calcified plaque incrementally added to measures in predicting incident cardiovascular outcomes

Reservoir-Excess Pressure Parameters Independently Predict Cardiovascular Events in Individuals With Type 2 Diabetes.

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Predictors of cardiovascular events in patients with primary systemic vasculitis: A 5 years prospective observational study

Introduction: Granulomatosis with polyangiitis (GPA) is one of antineutrophil cytoplasmic autoantibody (ANCA) – associated systemic vasculitis and is characterised by inflammation of blood vessels. Systemic vasculitis exhibits an enhanced cardiovascular morbidity and cardiovascular disease (CVD) has become a leading cause of death in this group of patients. Objectives: The aim of the present study was to assess the prevalence of clinical manifestation of atherosclerosis and its relation with classic risk factors for atherosclerosis, echocardiographic parameters and laboratory findings in GPA patients. Patients and methods: The group of consecutive patients with GPA were followed in the study. Results: One hundred six patients with GPA (mean age 50.4 ± 14.9 yrs, 67 female) were prospectively followed for 5.1 ± 1.6 yrs. In 19 patients (18%) cardiovascular disease (9 acute coronary syndromes, 4 symptomatic peripheral vascular diseases and 6 strokes) occurred in association with GPA. In a multivariate model, only age was predictive of cardiovascular events in this group of patients (OR=1.078, 95% CI: 1.025–1.134, p = 0.003). During observation in patients without CVD the level of hs-CRP and D-dimer were significantly reduced on the follow-up visit (p = 0.041, p = 0.0002). On the other hand, in patients with CV events there was no significant differences in both markers’ concentrations despite clinical remission. Conclusions: The age was the only independent predictor of cardiovascular events. Persistent elevation of inflammatory and prothrombotic markers despite clinical remission of the disease could be an indicator of premature atherosclerosis development in patients with systemic vasculitis.

MO754THE INTERRELATIONSHIP BETWEEN FLUID OVERLOAD AND VASCULAR STIFFNESS IN HEMODIALYSIS PATIENTS: A SCOPING REVIEW

Abstract Background and Aims Fluid overload and vascular stiffness are two independent predictors of cardiovascular events in hemodialysis (HD) patients. To date, observational and interventional studies that investigated the effect of inter- and intradialytic fluid overload changes on vascular stiffness in HD patients are very limited. We performed a scoping review to explore existing reports about effects of fluid overload on vascular stiffness in adults receiving HD treatment and to identify knowledge gaps for future research. Method We followed the framework originally developed by Arksey and O’Malley. We searched Medline, Embase, CINAHL, and Cochrane Database of systematic reviews from inception to October 29, 2019. References of review papers were screened for relevant studies not identified from the initial search until saturation is achieved. Results Of 666 eligible studies, nineteen studies met the inclusion criteria. These included clinical observational studies (n=16) and randomized controlled trials (n=3). In general, most of the identified studies had small sample size and short term of follow up. Studies use different definitions of fluid overload and vascular stiffness. Measures of relative fluid overload like the ratio of extracellular fluid/intracellular fluid, fluid overload/extracellular fluid, and/or extracellular fluid/total body fluid were used as a representative of fluid status. Pulse wave velocity and augmentation index were used interchangeably as vascular stiffness measures. The accumulated findings were inconsistent and inconclusive. There was no consensus whether intradialytic fluid volume changes affected vascular stiffness. In the majority of the observational studies, a decrease in pulse wave velocity or augmentation index correlated with a decrease in blood pressure after fluid correction by HD treatment. The randomized clinical trials used different methods and technologies for the correction of fluid overload, thereby, results were conflicting. Conclusion Current literature is insufficient to justify whether fluid overload changes have a direct effect on vascular stiffness in HD patients. The findings were conflicting which limits the comparisons of studies and generalization of findings. These knowledge gaps urge the need for further clinical studies to enhance the understanding and to improve the quality of research in this topic. This includes standardized definitions and methodologies as well as longer term of follow up.

Relationship between heart rhythm turbulence and ventricular arrhythmia in patients with multivessel lesion of coronary arteries

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): MoH Research Grant "Development of methods for differentiated prevention and treatment of potentially dangerous heart rhythm disorders" Prediction of adverse outcomes in patients after myocardial infarction (MI) remains a serious and not completely resolved problem, which pushes researchers to search for new technologies. One of the relatively promising new non-invasive methods for predicting sudden coronary death in patients with coronary heart disease and ventricular arrhythmias (VA) may be an assessment of heart rate turbulence (HRT). Given its important prognostic role, primarily in patients after MI, the aim of this work was to study the relationship between HRT and cardiovascular remodeling in patients with VA with history of MI and multivessel nature of coronary lesions. Materials and research methods 123 patients with history of MI, aged 38 to 76 years (average age 61.0 ± 7.6 years), were included into the study. The multivessel nature of coronary lesions was established based on the results of diagnostic selective coronary angiography. All patients underwent Holter monitoring of the electrocardiogram (HMECG). HRT was determined using two indicators, in accordance with the guidelines: Turbulence Onset (To, %) and Turbulence Slope (Ts, ms/RRi). Results Potentially dangerous ventricular arrhythmias (PDVA) were noted in more than half of the examined patients (n = 67; 54.5%). In analyze of the structure of PDVA, II class of VA, as the highest class, was not observed in any of the examined patients, class III was detected in 35% of cases, IVA – in 37.5%, and IVB – in 27.5%. In assessing the frequency of VAs, according to the Bigger classification, frequent PVC &amp;gt;10 VA/hour was detected in 41.5% of patients. The analysis of the HRT indicators did not reveal a decrease in the mean values both To (-1.2 ± 1.5%) and Ts (3.9 ± 3.1 ms/RRi) indicators in the main group of patients. However, after appropriate separation of the main group, 21.1% of them had disorders of only one (category 1; 15.4%) or both of the HRT indicators (category 2; 5.7%). Category 0 included patients without any disorder of HRT indicators. In analysis of the relationship between the PDVA and the category of HRT reduction, a significant interrelation between them was revealed (Table 1). Result Our study demonstrates presence of strong interrelation between HRT parameters disorder and severity of PDVA. Thus, study of HRT in patients after MI could be a strong and independent predictor of cardiovascular events including sudden cardiac death. Abstract Figure. Tab. 1. Interrelation between HRT and VA

Parathormone levels add prognostic ability to N-terminal pro-brain natriuretic peptide in stable coronary patients.

AimsThere are controversial data on the ability of the components of mineral metabolism (vitamin D, phosphate, parathormone [PTH], fibroblast growth factor‐23 [FGF23], and klotho) to predict cardiovascular events. In addition, it is unknown whether they add any prognostic value to other well‐known biomarkers.Methods and resultsIn 969 stable coronary patients, we determined plasma levels of all the aforementioned components of mineral metabolism with a complete set of clinical and biochemical variables, including N‐terminal pro‐brain natriuretic peptide (NT‐proBNP), high‐sensitivity troponin I (hs‐TnI), and high‐sensitivity C‐reactive protein. Secondary outcomes were ischaemic events (any acute coronary syndrome, stroke, or transient ischaemic attack) and heart failure or death. The primary outcome was a composite of the secondary outcomes. Median follow‐up was 5.39 years. Age was 60 (52–72) years. Median glomerular filtration rate was 80.4 (65.3–93.1) mL/min/1.73 m2. One‐hundred and eighty‐five patients developed the primary outcome. FGF23, PTH, hs‐TnI, and NT‐proBNP were directly related with the primary outcome on univariate Cox analysis, while Klotho and calcidiol were inversely related. On multivariate analysis, only PTH (HR 1.058 [CI 1.021–1.097]; P = 0.002) and NT‐proBNP (HR 1.020 [CI 1.012–1.028]; P < 0.001) were independent predictors of the primary outcome but also for the secondary outcome of heart failure or death (HR 1.066 [CI 1.016–1.119]; P = 0.009 and HR 1.024 [CI 1.014–1.034]; P < 0.001, respectively). PTH was the only biomarker that predicted ischaemic events (HR 1.052 [1.010–1.096]; P = 0.016). Patients were divided in two subgroups according to FGF23 plasma levels. PTH retained its prognostic value only in patients with FGF23 levels above the median (>85.5 RU/mL) (P < 0.001) but not in patients with low FGF23 levels (P = 0.551). There was a significant interaction between FGF23 and PTH (P = 0.002). However, there was no significant interaction between PTH and both klotho and calcidiol levels.ConclusionsParathormone is an independent predictor of cardiovascular events in coronary patients, adding complimentary prognostic information to NT‐proBNP plasma levels. This predictive value is restricted to patients with high FGF23 plasma levels. This should be considered in the design of future studies in this field.

Malnutrition Affects the Outcomes of Patients with Low-Output Heart Failure and Congestion.

This study aimed to investigate the relationship between malnutrition and outcomes in patients with decompensated severe systolic heart failure (HF) focusing on clinical presentations and medication use. This study prospectively enrolled 108 patients admitted for severe systolic HF with a left ventricular (LV) ejection fraction < 35%, low cardiac output, and high LV filling pressure. Five patients died during the index hospitalization, and the remaining 103 patients were followed up for 2 years. The primary endpoints were HF rehospitalization and all-cause mortality. Nutritional risk index (NRI) was calculated as (1.519 × serum albumin, g/L) + (41.7 × body weight/ideal body weight). Forty-four patients reached the study endpoints. An NRI ≤ 93 predicted events. The NRI ≤ 93 group had higher pulmonary artery systolic pressure, more edema over dependent parts, longer hospital stay, and more primary endpoints compared to the NRI > 93 group. The NRI ≤ 93 group received fewer evidence-based medications and more loop diuretics compared to the NRI > 93 group. NRI was an independent predictor of cardiovascular events [hazard ratio 0.902; 95% confidence interval (CI) 0.814-0.982 per 1 point increase; p = 0.012]. Low NRI was associated with a significantly higher use of loop diuretics [odds ratio (OR) 2.75; 95% CI 1.046-5.647; p = 0.004] and significantly lower use of beta blockers (OR 0.541; 95% CI 0.319-0.988; p = 0.002). Malnutrition assessed using the NRI was associated with cardiovascular events in the patients with severe systolic HF with low cardiac output and high LV filling pressure. Low NRI was associated with more diuretic and less beta blocker use.

The Effects of a 11‐Week Resistance Training Program on Arterial Stiffness in Females

Arterial stiffness is an indicator of disease and is an independent predictor of cardiovascular events. There have been inconsistencies from previous investigations examining the effect of resistance training on arterial stiffness in female participants. Objective This study was conducted to examine the effect of two resistance training models on arterial stiffness in females. Hypothesis We tested the hypothesis that 11 weeks of either high-intensity or high-volume resistance training would not increase indices of arterial stiffness in young, healthy females. Methods 24 female, untrained college students aged 18-22 years were randomized into one of three groups: control (CON) group (n = 8), high-intensity resistance exercise (HI) group (n = 8), and high-volume resistance exercise (HV) group (n = 8). Subjects randomized to resistance training groups were required to perform strength training exercises three to five days a week for 11 weeks. The exercise regimen consisted of 2-3 sets of 3-8 repetitions (80-90% of 1-repetition maximum (1 RM)) for the HI group and 3-4 sets of 10-15 repetitions (50%-70% of 1 RM) for the HV group. All subjects were instructed to continue their normal diet and avoid cardiovascular exercise during the study. Results Following the intervention, there was a significant increase in carotid femoral pulse wave velocity (C-F PWV) (6.39±0.73 to 8.4±2.31; P < 0.05) and carotid radial (C-R) PWV (9.77±1.74 to 12.58±2.09; P < 0.05) in the CON group only. Both CON and HI groups had significantly decreased central pulse pressure (cPP) (-15.3±12.4 vs. -13.11±12.0 percent change; P < 0.05), respectively. Both the HI and HV groups increased their maximum squat (36.6±7.9 vs.41.3±31.8 percent change; P < 0.05), bench press (34.4±12.6 vs. 23.4±11.1 percent change; P < 0.05), and seated row (22.0±12.6 vs. 21.9±12.5 percent change; P < 0.05), respectively. Conclusion Our findings support the use of resistance training exercise without undue impact on vascular compliance in healthy, young females.

CAROTID-FEMORAL PULSE WAVE VELOCITY, PULSE WAVE ANALYSIS AND 24-HOUR AMBULATORY BLOOD PRESSURE MEASUREMENT IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Objective: Increased arterial stiffness and arterial hypertension are known risk factors for vascular damage and are an independent predictor of cardiovascular events. Pulse wave analysis of the radial artery (PWA) is a simple method for assessing various hemodynamic parameters in the central aorta. The aim of our study was to investigate the relationship between arterial stiffness measured by carotid femoral pulse wave velocity (cfPWV), PWA parameters and 24-hour ambulatory blood pressure measurement (ABPM) in patients with chronic kidney disease (CKD). Design and method: We conducted a cross-sectional study in a cohort of 87 non-dialysed CKD patients. cfPWV and PWA were investigated non-invasively using applanation tonometry (SphygmoCor®,Atcor, Australia). ABPM was measured with the monitor BR -102 (Schiller, Switzerland). Cardiovascular (CV) risk factors (urinary albumin/creatinine ratio, NT -pro-BNP, troponin I, cystatin C, cholesterol, LDL, HDL, triglycerides, lipoprotein Lp(a)) were measured. The patients were divided into two groups according to the median cfPWV: lower cfPWV group (cfPWV &lt; 11.58m/s, n = 44), higher cfPWV group (cfPWV &gt; 11.58m/s, n = 43). Results: The mean age of the patients was 60 ± 13.4 years, 65.5% were men, 24.1% had diabetes, 43.7% were smokers. Further descriptive data for all patients and both groups are presented in Table 1. With the t-test we found a significant difference between both groups regarding age (P &lt; 0.0001), but not regarding the biochemical CV risk factors. Patients with higher cfPWV had statistically significant higher central aortic systolic pressure (P &lt; 0.0001) and pulse pressure (P &lt; 0.0001), lower subendocardial viability ratio (P = 0.003), higher 24 h systolic ABPM (P &lt; 0.0001) and 24 h pulse pressure (P &lt; 0.0001). Conclusions: The results of our study show that non-dialysis CKD patients with higher cfPWV levels also have higher systolic and pulse pressure (central aorta and 24 h ABPM).

POS-758 IMPACT OF REDUCTION OF ARTERIAL STIFFNESS AFTER KIDNEY TRANSPLANT ON RADIAL ARTERY SYSTOLIC-DIASTOLIC PEAK-TO-PEAK TRANSIT TIME

Chronic kidney disease leads to cumulative vascular damage that increases aortic stiffness, which is an independent predictor of cardiovascular events. Analysis of Digital Volume Pulse recordings has been proposed to assess arterial stiffness. It is proposed that the systolic peak timing (T1) represents the forward-travelling pressure from the ventricle, and the peak diastolic component (T2) arises mainly from the reflected wave pressures from the lower parts of the body. Hence, using height of a subject and the transit time, one could calculate a pulse wave velocity and estimate arterial stiffness.

LEFT VENTRICULAR MASS AND URINARY METABOLOMICS IN YOUNG BLACK AND WHITE ADULTS: THE AFRICAN-PREDICT STUDY

Objective: Increased left ventricular mass is an independent predictor for cardiovascular events, and shown to be higher in black than white populations. To gain a better understanding of early factors contributing to increased left ventricular mass in young black adults, we investigated metabolomic profiles and identified metabolites associated with left ventricular mass index in healthy black and white adults aged 20–30 years. Design and method: We included normotensive black (N = 80) and white (N = 80) participants from the African-PREDICT study, with data on urinary metabolomics and echocardiography. Urinary metabolites were measured using nuclear magnetic resonance spectroscopy, liquid chromatography tandem mass spectrometry and gas chromatography time-of-flight mass spectrometry. Univariate statistical analyses, including independent t-test (adjusted for multiple comparisons), effect size (d &gt; = 0.3) and single regression analyses were used to identify metabolites. Results: When comparing the black and white groups, the black group had lower body weight (p &lt; 0.001) and protein intake (p = 0.014). Central systolic blood pressure was higher in the black group compared to the white group (p &gt; 0.005), whereas left ventricular mass index was similar between the groups (p = 0.97). Three from a total of 192 metabolites were identified to be more abundant (p &lt; 0.046) and inversely associated with left ventricular mass index in the black group only: hydroxyproline (beta = –0.24; p = 0.020), glycine (beta = –0.23; p = 0.025) and trimethylamine (beta = –0.22; p = 0.026). Conclusions: Higher urinary levels of hydroxyproline, glycine and trimethylamine were inversely associated with left ventricular mass index in the black adults only. Hydroxyproline and glycine are important in maintaining healthy collagen turnover and stability in the heart. Our results may reflect an increase in collagen biosynthesis and collagen deposition in the left ventricle due to higher central systolic blood pressure in the black population.

CHANGES IN CAROTID LOCAL STIFFNESS DURING A SIX-YEARS FOLLOW UP IN A GENERAL POPULATION: THE VOBARNO STUDY

Objective: Local carotid stiffness (Carotid PWV) is an independent predictor of cardiovascular events but few data are available on the progression of Carotid stiffness over time. The aim of the present longitudinal study was to analyze the progression of local carotid stiffness over a 6-year period in a general population in Northern Italy (Vobarno Study). Design and method: 123 subjects, age 55 ± 4 years (42% males, hypertension in 43% at baseline visit), underwent a baseline (BL) and a follow up (FU) visit, 6.2 ± 0.5 years apart. In all subjects laboratory examinations, measurements of blood pressure (BP) and of Carotid PWV (using an echotracking approach) were performed at BL and at FU. Progression rate of Carotid PWV (δCarotid_PWV/Year) was defined as (Carotid PWV at FU-Carotid PWV at BL)/years of FU. Results: In the overall population, Carotid PWV increased from 6.39 ± 1.41 at BL to 6.79 ± 1.18 m/s at FU (p &lt; 0.05). δCarotid_PWV/Year was inversely related to BP (mean BP: r = -0.193, p &lt; 0.05; pulse pressure: r = -0.1.81, p &lt; 0.05) and to Carotid PWV at BL (r = -0.669, p &lt; 0.001). No other correlation was observed between δCarotid_PWV/Year and demographic or laboratory parameters at BL. δCarotid_PWV/Year was also related to changes over time in BP values (δSystolicBP: r = 0.291, p &lt; 0.01; δDiastolicBP: r = 0.266, p &lt; 0.01; δMeanBP: r = 0.310, p &lt; 0.0001). At multivariate analysis the variables independently related to the annual progression rate of Carotid PWV were Carotid PWV and mean BP at BL (beta -0.68, p &lt; 0.0001, and beta 0.20, p &lt; 0.05, respectively) and changes in mean BP during follow-up (beta 0.18, p &lt; 0.05). Conclusions: In a general population sample in Northern Italy the main determinants of the increase in local carotid stiffness during a 6 years FU were local carotid stiffness and mean BP at BL and change in mean BP over time.

Arterial Stiffness and Cardiometabolic-Based Chronic Disease: The Kardiovize Study

ObjectiveArterial stiffness (ArSt) describes a loss of arterial wall elasticity and is an independent predictor of cardiovascular events. A cardiometabolic-based chronic disease model integrates concepts of adiposity-based chronic disease (ABCD), dysglycemia-based chronic disease (DBCD), and cardiovascular disease. We assessed if ABCD and DBCD models detect more people with high ArSt compared with traditional adiposity and dysglycemia classifiers using the cardio-ankle vascular index (CAVI). MethodsWe evaluated 2070 subjects aged 25 to 64 years from a random population-based sample. Those with type 1 diabetes were excluded. ABCD and DBCD were defined, and ArSt risk was stratified based on the American Association of Clinical Endocrinologists criteria. ResultsThe highest prevalence of a high CAVI was in stage 2 ABCD (18.5%) and stage 4 DBCD (31.8%), and the lowest prevalence was in stage 0 ABCD (2.2%). In univariate analysis, stage 2 ABCD and all DBCD stages increased the risk of having a high CAVI compared with traditional classifiers. After adjusting for age and gender, only an inverse association between obesity (body mass index ≥30 kg/m2) and CAVI remained significant. Nevertheless, body mass index was responsible for only 0.3% of CAVI variability. ConclusionThe ABCD and DBCD models showed better performance than traditional classifiers to detect subjects with ArSt; however, the variables were not independently associated with age and gender, which might be explained by the complexity and multifactoriality of the relationship of CAVI with the ABCD and DBCD models, mediated by insulin resistance.

Impact of New Grading System and New Hemodynamic Classification on Long-Term Outcome in Patients With Severe Tricuspid Regurgitation.

A new grading of tricuspid regurgitation (TR) beyond severe has been proposed. However, few studies assessing the validity of such a new grading scheme of TR have been conducted. Therefore, we evaluated associations of TR grades beyond severe with patient outcome and hemodynamics. We retrospectively studied patients who underwent 2-dimensional echocardiography and were diagnosed with severe TR between January 2014 and December 2015. According to the vena contracta width of TR (VC), the patients were classified into 2 groups: VC under 14 mm (VC<14 mm) and VC 14 mm or greater (VC≥14 mm). Hemodynamic parameters were estimated by echocardiography and were obtained by right heart catheterization. Cardiovascular events were defined as cardiovascular death or admission for heart failure. A total of 679 patients (mean 72±17 years, 56% women) were included. During follow-up (median, 158 days; range, 29-891), 210 patients experienced cardiovascular events. By multivariate analysis, VC≥14 mm and left ventricular ejection fraction were independent predictors of cardiovascular events (hazard ratio, 1.57 [1.06-2.33]; hazard ratio, 0.99 [0.98-0.99], respectively). Patients with VC≥14 mm had significantly lower cardiac index (median, 1.8 versus 2.1 L/min per m2, P=0.001) and a higher prevalence of right atrial pressure 15 mm Hg (74% versus 60%, P<0.001) on echocardiography. Also, right heart catheterization confirmed higher right atrial pressure in patients with VC≥14 mm than those with VC<14 mm (16±8 versus 12±6 mm Hg, P=0.004). The new subset classification developed by cardiac index and right atrial pressure both on echocardiography predicted cardiovascular events (Log-rank P<0.001). The relationship of VC≥14 mm to adverse outcome and poor hemodynamics showed the clinical relevance and need of a new grading system beyond severe. The new hemodynamic subset classification provides additional prognostic value for cardiovascular events in patients with severe TR.