Major Cause Of Cardiovascular Morbidity Research Articles

Left Atrial Enlargement as a Predictor of Atrial Fibrillation in Rheumatic Mitral Valve Disease: An Echocardiography-based Retrospective Cross-sectional Study.

Rheumatic heart disease is a major cause of cardiovascular morbidity and mortality in developing nations and is a leading cause of hospital admission due to cardiac problems in our country. This study will evaluate the association between left atrial size and the occurrence of atrial fibrillation and describe the clinical characteristics along with complications related to Rheumatic Mitral valve disease. A retrospective cross-sectional study was conducted at a tertiary care center from January 2018 to December 2019. Reports of 207 patients admitted to medical and/or surgical wards with echocardiographic diagnosis of rheumatic mitral valve disease with or without atrial fibrillation were reviewed. Data were collected, entered, and analyzed using the Statistical Package for the Social Science version 25.0. Among 207 patients, atrial fibrillation was present in 90 (43.5%) patients. Atrial fibrillation was higher in patients with mixed mitral valvular lesions compared to isolated mitral stenosis or mitral regurgitation. Univariate and multivariate analysis revealed left atrial size [aOR=1.067, 95% CI: 1.023 - 1.113, P= 0.002] and age [aOR = 1.073, 95% CI: 1.042 - 1.105, P<0.001] as an independent predictor of atrial fibrillation. Larger left atrium was an independent predictor of atrial fibrillation. Besides this, atrial fibrillation was associated with increasing age, mixed mitral valvular lesion, and moderately reduced left ventricular ejection fraction, but not associated with gender and mitral stenosis severity. Left atrial clot was significantly higher in patients with atrial fibrillation than in sinus rhythm.

Anticoagulation in the Management of Acute Pulmonary Embolism—A Review

AbstractVenous thromboembolism (VTE) is a very frequent cardiovascular entity that encompasses deep vein thrombosis and pulmonary embolism (PE). This last entity represents a major cause of cardiovascular morbidity and mortality. The incidence of PE and the rate of PE-related morbidity significantly increase with age, race, and underlying medical conditions, such as malignancy. Given the recent advances in diagnostic strategies and algorithms, patients can be risk assessed and treated promptly to avoid disease progression. Anticoagulation is the mainstay of treatment for acute PE that is not hemodynamically unstable. Direct oral anticoagulants, such as apixaban, rivaroxaban, or edoxaban, are currently the preferred agents for the treatment of patients who present with acute PE or for long-term treatment. Treatment duration should be continued for at least 3 months, and all patients should be assessed for extended duration of therapy based on the precipitating factors that led to the development of the VTE. Novel anticoagulant agents targeting factor XI/XIa are currently being investigated in phases 2 and 3 clinical trials, representing an attractive option in anticoagulation therapies in patients with VTE. For hemodynamically unstable patients, systemic thrombolysis is the treatment of choice, and it may also be of benefit—in reduced dose—for patients with intermediate to high risk who are at risk of hemodynamic collapse.

Unraveling the role of miRNAs as biomarkers in Chagas cardiomyopathy: Insights into molecular pathophysiology.

Chagas cardiomyopathy (ChCM) is a severe form of Chagas disease and a major cause of cardiovascular morbidity and mortality. The dysregulation of the immune response leads to cardiac remodeling and functional disruptions, resulting in life-threatening complications. Conventional diagnostic methods have limitations, and therapeutic response evaluation is challenging. MicroRNAs (miRNAs), important regulators of gene expression, show potential as biomarkers for diagnosis and prognosis. This review aims to summarize experimental findings on miRNA expression in ChCM and explore the potential of these miRNAs as biomarkers of Chagas disease. The search was conducted in the US National Library of Medicine MEDLINE/PubMed public database using the terms "Chagas cardiomyopathy" OR "Chagas disease" AND "microRNA" OR "miRNA" OR "miR." Additionally, bioinformatics analysis was performed to investigate miRNA-target interactions and explore enrichment pathways of gene ontology biological processes and molecular functions. The miR-21, miR-146b, miR-146a, and miR-155 consistently exhibited up-regulation, whereas miR-145 was down-regulated in ChCM. These specific miRNAs have been linked to fibrosis, immune response, and inflammatory processes in heart tissue. Moreover, the findings from various studies indicate that these miRNAs have the potential as biomarkers for the disease and could be targeted in therapeutic strategies for ChCM. In this review, we point out miR-21, miR-146b, miR-146a, miR-155, and miR-145-5p role in the complex mechanisms of ChCM. These miRNAs have been shown as potential biomarkers for precise diagnosis, reliable prognostic evaluation, and effective treatment strategies in the ChCM.

Abstract 17986: Impact of Race and Socioeconomic Factors on Hypertensive Emergency

Background: Hypertensive emergency, defined as a blood pressure ≥ 180/110mmHg with target organ damage, is a major cause of cardiovascular morbidity and mortality. There is a lack of data on the impact of race and socioeconomic factors on hypertensive emergency incidence and outcomes. Thus, we investigated these associations in a diverse population at a large tertiary-care academic medical center. Methods: Utilizing the Patient Cohort Explorer Epic electronic health records system at the University of Mississippi Medical Center from 1/1/2013 to 7/31/2021, we identified patients diagnosed with hypertensive emergency. Sociodemographic factors related to hypertension and patient status (alive/deceased) were also examined. Descriptive statistics were used to examine differences in means across groups. Results: 2,483 patients diagnosed with hypertensive emergency were included in this analysis. Among these patients, the mean (SD) age was 52 (17) years, 49% were women, and 82.2% were Black. Nearly half (44.4%) of those diagnosed with hypertensive emergency were uninsured, 46.7% had Medicaid or Medicare, and 7.9% had private insurance. Black patients with hypertensive emergency were significantly younger compared with White patients (51 vs 57 years, p&lt;0.001). There was no significant correlation between race and insurance status in this population. Over the 8-year period, 14.1% were deceased at the time of analysis. Conclusions: Among patients admitted to a large academic medical center with hypertensive emergency, most were Black individuals with Medicaid or lacking health insurance. Black individuals present at significantly younger ages compared to White patients. Our findings are much different than data published from the Nationwide Readmissions Database reporting a mean age of 66 years and nearly 90% insured rate in patients with hypertensive emergency. Further, race was not reported in that analysis. Our findings suggest that hypertensive emergency disproportionately affects minority and underserved populations. Further work is needed to characterize risk factors and improve outcomes for this high-risk population.

Abstract 15965: Electrocardiogram-Based Artificial Intelligence Predicts Incident Heart Failure

Introduction: Heart failure (HF) is a major cause of cardiovascular morbidity. Efficient and accurate prediction of incident heart failure episodes may enable preventive efforts. Methods: Using raw 12-lead ECG waveforms, we developed a convolutional neural network to predict HF admissions (Electrocardiogram to Heart Failure, “ECG2HF”). ECG2HF was developed in 91,573 individuals in Massachusetts General Hospital (MGH), and validated in three independent test sets: MGH, Brigham and Women’s Hospital (BWH), and the UK Biobank, among individuals without a prior HF episode. HF events were identified using a validated natural language processing model (MGH and BWH), and inpatient diagnosis codes (UK Biobank). Discrimination was quantified using time-dependent average precision (AP) and area under the receiver operating characteristic curve (AUROC). Among individuals with available data, we compared ECG2HF to the Pooled Cohort Equations for Heart Failure (PCE-HF). Results: The test sets comprised MGH (15,695 individuals, age 55±17, 51% women), BWH (52,124 individuals, age 55±17, 59% women), and UK Biobank (42,135 individuals, age 65±8, 52% women). ECG2HF consistently discriminated incident HF events (MGH 10-year AP: 0.17 [95% CI 0.15-0.20], 10-year AUROC 0.88 [0.86-0.89]; BWH: 0.15 [0.14-0.17], 0.87 [0.85-0.88]; UK Biobank 3-year AP 0.036 [0.024-0.057], 3-year AUROC 0.73 [0.68-0.77]). ECG2HF risk consistently stratified longitudinal HF incidence. Compared to PCE-HF, discrimination using ECG2HF was favorable in MGH/BWH (improvement in AP 0.07 [-0.11-0.14], improvement in AUROC 0.13 [0.088-0.18]), and UK Biobank (improvement in AP 0.016 [0.0060-0.033], improvement in AUROC -0.0093 [-0.062-0.044]). Conclusions: Artificial intelligence-enabled analysis of the 12-lead ECG may facilitate identification of individuals at risk for HF to enable early treatment to reduce HF-related morbidity.

Allogeneic Adipose-Derived Mesenchymal Stem Cell Transplantation Alleviates Atherosclerotic Plaque by Inhibiting Ox-LDL Uptake, Inflammatory Reaction and Endothelial Damage in Rabbits.

Atherosclerosis (AS) is a chronic inflammatory disease of arteries fueled by lipids. It is a major cause of cardiovascular morbidity and mortality. Mesenchymal stem cells have been used for the treatment of atherosclerotic lesions. Adipose-derived stem cells (ADSCs) have been shown to regulate the activation state of macrophages and exhibit anti-inflammatory capabilities. However, the effect of allogeneic ADSCs in the treatment of AS have not been investigated. In this study, the early treatment effect and preliminary mechanism analysis of allogeneic rabbit ADSCs intravenous transplantation were investigated in a high-fat diet rabbit model. The polarization mechanism of rabbit ADSCs on the macrophage was further analyzed in vitro. Compared with the model group, blood lipid levels declined, the plaque area, oxidized low-density lipoprotein (ox-LDL) uptake, scavenger receptor A1 and cluster of differentiation (CD) 36 levels were all significantly reduced, and the accumulation of inflammatory M1 macrophages, apoptosis, interleukin (IL)-6 and tumor necrosis factor (TNF)-α expression were decreased. The endothelial cells (CD31), M2 macrophages, IL-10 and the transforming growth factor (TGF)-β levels increased. In vitro, ADSCs can promote the M1 macrophage phenotypic switch toward the M2 macrophage through their secreted exosomes, and the main mechanism includes increasing arginase 1 expression and IL-10 secretion, declining inducible nitric oxide synthase (iNOS) expression and TNF-α secretion, and activating the STAT6 pathway. Therefore, allogeneic rabbit ADSC transplantation can transmigrate to the aortic atherosclerotic plaques and show a good effect in lowering blood lipids and alleviating atherosclerotic plaque in the early stage of AS by inhibiting ox-LDL uptake, inflammatory response, and endothelial damage.

Systolic myocardial function measured by echocardiographic speckle-tracking and peak oxygen consumption in pediatric childhood cancer survivors-a PACCS study.

Cancer therapy-related cardiotoxicity is a major cause of cardiovascular morbidity in childhood cancer survivors. The aims of this study were to investigate systolic myocardial function and its association to cardiorespiratory fitness in pediatric childhood cancer survivors. In this sub-study of the international study "Physical Activity and fitness in Childhood Cancer Survivors" (PACCS), echocardiographic measures of left ventricular global longitudinal strain (LV-GLS) and right ventricular longitudinal strain (RV-LS) were measured in 128 childhood cancer survivors aged 9-18 years and in 23 age- and sex-matched controls. Cardiorespiratory fitness was measured as peak oxygen consumption achieved on treadmill and correlated to myocardial function. Mean LV-GLS was reduced in the childhood cancer survivors compared to the controls, -19.7% [95% confidence interval (CI) -20.1% to -19.3%] vs. -21.3% (95% CI: -22.2% to -20.3%) (p = 0.004), however, mainly within normal range. Only 13% of the childhood cancer survivors had reduced LV longitudinal strain z-score. Mean RV-LS was similar in the childhood cancer survivors and the controls, -23.2% (95% CI: -23.7% to -22.6%) vs. -23.3% (95% CI: -24.6% to -22.0%) (p = 0.8). In the childhood cancer survivors, lower myocardial function was associated with lower peak oxygen consumption [correlation coefficient (r) = -0.3 for LV-GLS]. Higher doses of anthracyclines (r = 0.5 for LV-GLS and 0.2 for RV-LS) and increasing time after treatment (r = 0.3 for LV-GLS and 0.2 for RV-LS) were associated with lower myocardial function. Left ventricular function, but not right ventricular function, was reduced in pediatric childhood cancer survivors compared to controls, and a lower left ventricular myocardial function was associated with lower peak oxygen consumption. Furthermore, higher anthracycline doses and increasing time after treatment were associated with lower myocardial function, implying that long-term follow-up is important in this population at risk.

Efficacy and safety of renal denervation in resistant hypertension: two years follow-up

Hypertension remains a major cause of cardiovascular morbidity and mortality globally. Difficulties faced by clinicians to obtain adequate blood pressure control in patients with resistant hypertension have led to the development of alternative device-based treatment methods, one of which is renal artery denervation. In the current paper, the results of the study carried out in the Hypertension Department of the Institute of Cardiology regarding the evaluation of the effectiveness and safety of renal artery denervation in patients with resistant HTN two years post-procedural are presented.

Association Of Heart Rate At Hospital Discharge And Rehospitalization Of Patients With Heart Failure And Reduced Ejection Fraction.

One of the major causes of cardiovascular morbidity and mortality is heart failure. The study aims to assess the effect of heart rate on the incidence of rehospitalization in patients with heart failure and reduced ejection fraction. It is a cross-sectional, analytical research conducted over six months, from June to December 2022, at the cardiology department of a tertiary care hospital. Patients who satisfied the modified Framingham heart failure criteria at admission and were discharged with an initial diagnosis of heart failure and those readmitted within 6 months or less of their discharge were included in the study. Pregnant women, patients diagnosed with cognitive impairment, and patients who had contraindications for taking any of the beta-blockers, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker /angiotensin receptor -neprilysin inhibitor, Sodium-Glucose co-transport inhibitor, and mineralocorticoid inhibitors were excluded from the study. A total of 77 patients were included in the study. At discharge, approximately 71 patients had a heart rate of less than 70 beats/min and had no readmissions whereas, 6 patients had a heart rate of greater than 70 beats/min with 5 patients requiring readmission in the following 6 months. This relationship was statistically significant with a p-value of 0.000. According to the study, heart rate is a significant factor in the rehospitalization of individuals with heart failure and a low ejection fraction. At discharge, if the heart rate is not optimized then the rate of readmissions is increased.

Atherosclerotic plaque composition and specific endovascular considerations in the end stage renal disease patients: a narrative review.

Vascular calcification (VC) and resulting vascular disease is one of the major causes of cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD). CKD itself is increasingly recognized as a risk factor for cardiac and peripheral arterial disease (PAD). This paper examines the atherosclerotic plaque composition and specific endovascular considerations in the end stage renal disease (ESRD) patients. The literature was reviewed regarding the current status of medical and interventional management arteriosclerotic disease in patients with CKD. Lastly, three representative cases displaying typical endovascular treatment options are provided. A literature search was performed in PubMed covering publications up to September 2021 as well as discussion with experts in the field. The high prevalence of atherosclerotic lesions in patients with chronic renal failure and high (re-)stenosis cause problems in the medium and long term as vascular calcium load represents one of the most widely encountered predictors of failure of endovascular treatment of PAD and future cardiovascular events (e.g., coronary calcium score). Patients with CKD also suffer from a greater risk for major vascular adverse events in general and worse revascularization outcomes following peripheral vascular intervention. A correlation between calcium burden and drug-coated balloon (DCB) performance has been established for PAD necessitating the need for different tools to cope with vascular calcium such as endoprosthesis or braided stents. Patients with CKD are at a higher risk of developing contrast-induced nephropathy (CIN). In addition to recommendations such as the administration of intravenous fluids, carbon dioxide (CO2) angiography is one option to potentially provide an effective and safe alternative both to iodine-based contrast media allergy and to the use of iodine-based contrast media in patients with CKD. Management and endovascular procedures of patients with ESRD are complex. In the course of time, new endovascular therapy methods have been developed such as directional atherectomy (DA) and the so-called "pave-and-crack" technique to deal with high vascular calcium burden. Besides interventional therapy, vascular patients with CKD benefit from aggressive medical management.

Ambulatory Blood Pressure Monitoring Section in Normotensive Type 2 Diabetes Mellitus: An Observational Study

Introduction: Hypertension (HTN) is a major cause of cardiovascular morbidity and mortality, particularly in diabetic people. Because HTN and Type 2 Diabetes Mellitus (T2DM) frequently co-exist, HTN is a significant risk factor for chronic problems masked HTN affects around a one third of T2DM patients who have normal Blood Pressure (BP) readings in the clinic. T2DM patients frequently have normal office BP (BP) and no nocturnal BP falling. The non dipping BP pattern raises the risk of cardiovascular events and damage to target organs. Multiple BP recordings can be obtained with Ambulatory BP Monitoring (ABPM). By providing variability of BP, and diurnal variation in BP, it assists the treating physician in the diagnosis and management of HTN. Aim: To elucidate the prevalence of non dipping pattern in T2DM and the characteristics of diabetics who have non dipping pattern using ambulatory monitoring. Materials and Methods: This was an observational study carried out in the Department of Medicine at JIPMER, Pondicherry, India. Between January 2016 and December 2017, 110 patients with T2DM were visited to Medicine Outpatient Department and the Diabetic Clinic. Out of 110, a total of 62 patients, with an average age of 46.67 years, were included in the study. Sun Tech Oscar 2’ 24 hourR ABPM system was used for the study of ambulatory BP of patients, at specified times. Results: Sixty-two normotensive T2DM patients, mean age of 46.67 years were analysed in the 24 months. A total of 62 patients, the non dipping pattern was seen in 47 (76%) of the 62 individuals evaluated for ABPM, while the dipping pattern was seen in 15 (24%) of the normotensive T2DM patients. A non dipping pattern was associated with a higher Body Mass Index (BMI) (p-value=0.03). A non dipping habit was also substantially associated with high PPBS values (p-value=0.02). Conclusion: Patients with a history of HTN and smoking had a higher chance of non dipping patterns, which may lead to endorgan damage and future cardiovascular events. ABPM can be used as a screening tool to predict cardiovascular events in T2DM.

Sodium Glucose Co-Transporter-2 (SGLT 2) Inhibitor as A Therapy For Heart Failure With Low Ejection Fraction (HFrEF)

Heart failure is a major cause of cardiovascular morbidity and mortality worldwide despite advances in prevention and management. Recent clinical trial findings have shown that sodium-glucose co-transporter 2 inhibitor (SGLT2i) produces effects other than lowering blood glucose levels, i.e., exhibits beneficial cardiovascular effects. The purpose of this paper is to determine the role of SGLT2i in heart failure patients with low ejection fraction (HFrEF) so that it can be used as a guide for future management. This study is a narrative review by searching on Google Scholar through several keywords. The period including articles obtained is articles from 2014 to 2022. The diuretic effect of SGLT2i can cause an increase in cardiac preload. The reduction in cardiac afterload likely occurs through a decrease in blood pressure and arterial stiffness resulting in increased endocardial blood flow. SGLT2i has a beneficial effect on the heart remodeling process. SGLT2i can prevent heart failure by increasing the production of ATP from the oxidation of ketone bodiesSGLT2i in heart failure patients can reduce blood pressure, maintain a decrease in eGFR and reduce the risk of acute kidney injury (AKI) in patients. SGLT2i is very effective in the treatment of HFrEF patients. Because of these advantages, further research is needed in Indonesia in order to determine the effectiveness and impact of giving SGLT2i to HFrEF patients in Indonesia.

Cardiac Acetylation in Metabolic Diseases.

Lysine acetylation is a highly conserved mechanism that affects several biological processes such as cell growth, metabolism, enzymatic activity, subcellular localization of proteins, gene transcription or chromatin structure. This post-translational modification, mainly regulated by lysine acetyltransferase (KAT) and lysine deacetylase (KDAC) enzymes, can occur on histone or non-histone proteins. Several studies have demonstrated that dysregulated acetylation is involved in cardiac dysfunction, associated with metabolic disorder or heart failure. Since the prevalence of obesity, type 2 diabetes or heart failure rises and represents a major cause of cardiovascular morbidity and mortality worldwide, cardiac acetylation may constitute a crucial pathway that could contribute to disease development. In this review, we summarize the mechanisms involved in the regulation of cardiac acetylation and its roles in physiological conditions. In addition, we highlight the effects of cardiac acetylation in physiopathology, with a focus on obesity, type 2 diabetes and heart failure. This review sheds light on the major role of acetylation in cardiovascular diseases and emphasizes KATs and KDACs as potential therapeutic targets for heart failure.

Endothelial reactive oxygen-forming NADPH oxidase 5 is a possible player in diabetic aortic aneurysm but not atherosclerosis

Atherosclerosis and its complications are major causes of cardiovascular morbidity and death. Apart from risk factors such as hypercholesterolemia and inflammation, the causal molecular mechanisms are unknown. One proposed causal mechanism involves elevated levels of reactive oxygen species (ROS). Indeed, early expression of the ROS forming NADPH oxidase type 5 (Nox5) in vascular endothelial cells correlates with atherosclerosis and aortic aneurysm. Here we test the pro-atherogenic Nox5 hypothesis using mouse models. Because Nox5 is missing from the mouse genome, a knock-in mouse model expressing human Nox5 in its physiological location of endothelial cells (eNOX5ki/ki) was tested as a possible new humanised mouse atherosclerosis model. However, whether just on a high cholesterol diet or by crossing in aortic atherosclerosis-prone ApoE−/− mice with and without induction of diabetes, Nox5 neither induced on its own nor aggravated aortic atherosclerosis. Surprisingly, however, diabetic ApoE−/− x eNOX5ki/ki mice developed aortic aneurysms more than twice as often correlating with lower vascular collagens, as assessed by trichrome staining, without changes in inflammatory gene expression, suggesting that endothelial Nox5 directly affects extracellular matrix remodelling associated with aneurysm formation in diabetes. Thus Nox5-derived reactive oxygen species are not a new independent mechanism of atherosclerosis but may enhance the frequency of abdominal aortic aneurysms in the context of diabetes. Together with similar clinical findings, our preclinical target validation opens up a first-in-class mechanism-based approach to treat or even prevent abdominal aortic aneurysms.

Correlation between obstructive sleep apnea and ventricular function: a cross-sectional hospital-based study

Background Obstructive sleep apnoea (OSA) is a major cause of cardiovascular morbidity and mortality worldwide. Previous studies showed high prevalence of OSA in heart failure. We aimed to evaluate the association of OSA with cardiac dysfunction and the importance of myocardial performance index (Tei) in identifying cardiac dysfunction. Methods Participants with OSA and sinus rhythm were included, while participants with arrhythmia, debilitating disease, or significant valvular heart disease were excluded. Thirty participants were enrolled, consecutively allocated in a single group, and underwent nocturnal polysomnography, electrocardiogram, and transthoracic echocardiography. Results The prevalence of hypertension, diabetes, and smoking in the study population was 50%, 30%, and 23.3%, respectively. The mean body mass index and apnoea-hypopnoea index (AHI) of the study population was 40.11 ± 7.5 kg/m2 and22.12 ± 13.54 events/h, respectively. There were statistically significant differences between mild, moderate, and severe OSA regarding the left ventricular end diastolic diameter, left ventricular end systolic diameter, ejection fraction, and fractional shortening (p = 0.006, p = 0.002, p = 0.014 and p = 0.011),respectively. There were statistically significant regular positive correlations between the AHI and the right and left Tei (r = 0.447, p = 0.001 and r = 0.391, p = 0.003),respectively. Conclusions The prevalence of OSA was more in patients with comorbidities especially hypertension and diabetes. OSA was significantly associated with ventricular remodelling and cardiac dysfunction. A significant regular positive correlation was observed between the severity of OSA and worsening cardiac function as measured by Tei. Echocardiographic evaluation of the right and left ventricles and the right and left Tei could be considered as potentially valid, reproducible, and clinically applicable non-invasive methods for estimation of ventricular global function in patients with OSA.

3D-PRINTING FOR ABLATION PLANNING IN PATIENTS UNDERGOING ATRIAL FIBRILLATION ABLATION (3D-GALA TRIAL)

Objective: Atrial fibrillation (AF) remains one of the major causes of cardiovascular morbidity. Ablation techniques are becoming more appealing after latest results of andomised trials showing the overall clinical benefit. On the other hand imaging techniques and the frontier application of 3D printing are emerging as valuable ally for cardiac procedures. However, no andomised trial has directly assessed the impact of preprocedural imaging and especially 3D printing guidance for AF ablation. The present study is designed to investigate for the first time the effect of 3D-printing of the heart on the safety and effectiveness of the ablation procedure. Design and method: The 3D-GALA trial is a andomised, open- label, controlled, multicentre clinical trial of 2 parallel groups designed to enrol a total of 100 patients undergoing ablation using cryo-balloon for paroxysmal and persistent AF. Patients will be andomised with a patient allocation ratio of 1: 1 to preprocedural MRI scan of the heart and 3D printing of left atrium and pulmonary veins and cryoablation versus standard cryoablation without imaging. Patients will be followed up to 6 months after the index procedure Results: The primary outcome measure is the reduction of radiation dose and contrast amount during pulmonary veins isolation. Secondary endpoints will include the percentage of atrial fibrillation relapse at 24h-Holter electrocardiogram monitoring at 6 months after initial treatment. Conclusions: To our knowledge, the 3D-GALA trial will be the first study to provide evidence about the clinical impact of preprocedural imaging and 3D printing before cryoablation.

Development of a polygenic risk score to improve detection of peripheral artery disease.

Peripheral artery disease (PAD) is a major cause of cardiovascular morbidity and mortality, yet timely diagnosis is elusive. Larger genome-wide association studies (GWAS) have now provided the ability to evaluate whether genetic data, in the form of genome-wide polygenic risk scores (PRS), can help improve our ability to identify patients at high risk of having PAD. Using summary statistic data from the largest PAD GWAS from the Million Veteran Program, we developed PRSs with genome data from UK Biobank. We then evaluated the clinical utility of adding the best-performing PRS to a PAD clinical risk score. A total of 487,320 participants (5759 PAD cases) were included in our final genetic analysis. Compared to participants in the lowest 10% of PRS, those in the highest decile had 3.1 higher odds of having PAD (95% CI, 3.06-3.21). Additionally, a PAD PRS was associated with increased risk of having coronary artery disease, congestive heart failure, and cerebrovascular disease. The PRS significantly improved a clinical risk model (Net Reclassification Index = 0.07, p < 0.001), with most of the performance seen in downgrading risk of controls. Combining clinical and genetic data to detect risk of PAD resulted in a model with an area under the curve of 0.76 (95% CI, 0.75-0.77). We demonstrate that a genome-wide PRS can discriminate risk of PAD and other cardiovascular diseases. Adding a PAD PRS to clinical risk models may help improve detection of prevalent, but undiagnosed disease.

Exercise capacity assessed with the one-minute sit-to-stand test (1-min STST) is associated with echocardiographic findings in patients with heart failure with preserved ejection fraction (HFpEF)

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart failure with preserved ejection fraction (HFpEF) is a major cause of cardiovascular morbidity and mortality (1). Non-invasive imaging, particularly echocardiography, plays a central role in the evaluation of HFpEF patients. Numerous prognostic markers for mortality have been identified in patients with HFpEF, including right ventricular tricuspid annular plane systolic excursion (TAPSE) and estimated systolic pulmonary artery pressure (ePASP) [(2) (3) (4)]. ePASP is calculated with Doppler measurement of peak tricuspid regurgitation velocity (TRV). Despite those markers, precise risk stratification remains challenging. Recently the one-minute sit-to-stand-test (1-min STST), a quick and objective test of functional capacity that can be potentially used for risk stratification, has attracted the interest of researchers. In this test, participants are encouraged to stand up and sit down from a chair as quickly and as many times as possible within one minute. The 1-min STST provides valuable information on the ability to perform daily life activities in HFpEF patients and adds to our options of diagnostic tests in HFpEF. Purpose The aim of this investigation was to prospectively examine whether 1-min STST results correlate with transthoracic echocardiographic parameters in a group of HFpEF patients. Patient and methods 32 HFpEF patients [59% New York Heart Association (NYHA) Class III, 63% female, age (mean ± standard deviation) 70 ± 11 years and 66% atrial fibrillation] were prospectively studied. Functional performance was examined with the 1-min STST. Echocardiographic estimations of pulmonary artery pressure and additional parameters (TRV and systolic function measured by echocardiography) as well as clinical characteristics were obtained. Results Mean 1-min STST repetitions were 16.41 ± 6.7. Twelve (38%) of the 32 HFpEF patients had moderate to severe mitral regurgitation and 29 (91%) had moderate or more tricuspid regurgitation. Mean left ventricular ejection fraction (LVEF) was 52.57 ± 1.74 % and mean ePASP was 65.81 ± 23.17 mmHg. 10 (32%) patients were in NYHA class I or II, 22 (69%) in NYHA class III or IV. There was a significant inverse association between higher NYHA class and the 1-min STST (t = 2.6, p = 0.012). The following additional parameters correlated significantly with the 1-min STST: ePASP (r = -0.545, p = 0.001), TRV (r = -0.598, p &amp;lt; 0.001) and the ratio of TAPSE/ePASP (r = 0.767, p = 0.001) (see table 1). Interestingly, the decline in oxygen saturation during the 1-min STST showed significant correlation with ePASP (r = -0.559, p &amp;lt; 0.001) and TRV (r = 0.540, p = 0.002). Conclusion Our investigation shows a direct linear correlation between ePASP, TRV and TAPSE/ePASP measured by echocardiography and measurements of functional capacity derived by the 1-min STST. Thus, the current results emphasize the role of the 1-min STST as an additional diagnostic tool in patients with HFpEF. Abstract Figure.

The pathophysiology of RHD and outstanding gaps

Rheumatic heart disease (RHD) is the major cause of cardiovascular morbidity and mortality in children and young adults in low- and middle-income countries. Acute rheumatic fever (ARF) is characterised by multiorgan inflammatory symptoms initiated through cross reaction of immune responses (IRs) to group A streptococcus (GAS) proteins to host proteins. Recurrence of these IRs targeting the heart valves may lead to permanent damage, a sequela which is termed RHD. Preliminary studies suggested genetic associations in RF reactions, but that other host factors are also involved, leaving the determinants of RHD progression incompletely understood. Previous clinical and recent epidemiological studies support differential clinical phenotypes, with varying history from different settings. This review summarises the protein-centric biomolecular changes in RHD and highlights outstanding molecular gaps where urgent focus is required to improve our understanding RHD pathophysiology. Numerous studies have confirmed alterations in the expression of structural and immune response proteins, but the modifications giving rise to neo-epitopes and their involvement in RHD have not been established. As RHD is associated with poor living conditions, identification of other factors driving inflammation to enhance RHD progression is necessary to advance our knowledge and improve patient management. Furthermore, biomarkers for early identification, disease stratification, and alternative therapeutic strategies are necessary to improve treatment and prevention strategies in order to reduce the burden of RHD. Relevance: Despite the explosion of scientific innovation over the last few decades, fundamental scientific studies to understand the pathophysiological mechanisms of RHD remain in their infancy and the determinants of RHD progression thus remain uncertain. Moreover, inconsistency in natural history and phenotypic presentations are seen between Africans and other cohorts in which preliminary studies were conducted, implying that differences in genetic complexity and environmental factors may be responsible for the differential disease progression rates.

Mid and long-term follow-up of 50 pediatric cardiac Chadians operated in France from 2003 to 2012.

Introductioncardiac valvular diseases (CVDs) are the major cause of cardiovascular morbidity and mortality globally, with predominance of rheumatic heart disease (RHD) in developing countries. Congenital heart defects (CHD) diagnoses are delayed due to socioeconomic factors. This study aims to evaluate the post-operative surgical outcomes of CHD and valvular RHD.Methodsthis study is conducted with 50 patients from Chad, operated on between 2003 and 2012. Post-operative outcomes are evaluated from 2010 to 2012.Resultswith the follow-up of 19 RHD patients who underwent plasty, 8 (42.1%) had no complications, 4 (21%) presented with mild regurgitation, 7 (36.8%) required re-operation due to 6 mitral stenosis (MS) cases (mitral surface range from 0.7 to 1.2 cm2) and 1 severe mitral regurgitation (MR) case. While those patients with valve replacement, 2 (50%) had no complications, 1 (25%) had mild regurgitation and 1 (25%) patient died. Two patients with aortic regurgitation (AR) that underwent annuloplasty presented with severe regurgitation. Regarding AR with valve replacement, 3 (60%) had no complications, and 2 (40%) had mild regurgitation. Among the tricuspid regurgitation (TR) patients who had plasty, 6 (85.7%) had no complications, and 1 (14.3%) had severe regurgitation. The surgical repair was curative in all CHD patients. The loss to follow-up rate was 13/50 (26%).Conclusionthe annuloplasty on rheumatic valve disease (MR and AR) has proven to be disappointing. Plasty is debated without justified indication for AR. The outcomes of CHD, mitral and aortic valve replacement are successful.