Marker Of Cardiovascular Events Research Articles

Elasticity and Lipids Changes in Children with Type I Diabetes Mellitus Compared with Controls and the Effect of Lipids on Elasticity in Diabetic Children

Abstract Background Increased atrial elasticity is a marker of cardiovascular events. This study aimed to compare the parameters of elasticity and lipids in children with type 1 diabetes mellitus (TIDM) compared with controls and the effect of lipids on elasticity in children with diabetes. Method This case-control study was performed in 186 children aged 6 to 18 years. The aortic diameter was obtained from 3 cm above the aortic valve using M mode and was calculated as the distance between the medial edge of the anterior and posterior walls of the aorta at systole and diastole. AoS and AoD were recorded when the aortic wall was fully open. The parameters of aortic elasticity, aortic stiffness beta index, aortic tension, and elastic modulus of pressure were measured. Cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein were measured. For data analysis, SPSS 20 considers the applicable error to be 0.05. Results The participants were matched by sex and age. The right CHO, LDL, HDL, and MPI lipids, systolic, diastolic, and aortic systolic blood pressure were different among patients. The analysis also showed that ASβI (MWU = 1582.50, p < 0.001) and PSEM (MWU = 1381.00 and p < 0.001) were higher when AS (MWU = 1204 and p < 0.001) and AoD (MWU = 1672.00 and p < 0.001) and AoD (MWU = 1672.00 and p < 0.001) were lower in patients than in controls. No lipid profiles were significantly correlated with stiffness parameters before and after controlling for age. Conclusion It was concluded that lipid profiles were different, and ASβI and PSEM were lower when AoS and AoD were higher in children with diabetes. None of the lipid profiles were significantly correlated with stiffness parameters before and after controlling for age.

Predicting the incidence of chronic kidney disease in patients with myocardial infarction and acute kidney injury

Aim. To estimate the incidence of chronic kidney disease (CKD) and develop a calculator to estimate the CKD probability in patients with myocardial infarction (MI) and acute kidney injury (AKI).Material and methods. A total of 193 patients with MI aged 34-79 years were examined: 123 patients with MI and signs of AKI, 70 patients without AKI. In all patients, the levels of C-reactive protein, troponin I, N-terminal pro-brain natriuretic peptide (NT-proBNP), microalbuminuria (MA), creatinine, and glomerular filtration rate (GFR) were determined. In the presence of AKI criteria on the 3rd day and at discharge, the level of kidney injury molecule-1 (KIM-1) molecule and interleukin-18 was examined in the urine. Six months after discharge, GFR was assessed over time. Patients of both groups underwent coronary angiography with stenting of infarct-related artery.Results. The GFR at admission in patients with AKI was lower than in the group without AKI with normal creatinine levels. Following correlations between AKI and markers of cardiovascular events were revealed: KIM-1 and NT-proBNP (r=0,29 p=0,031), GFR and NT-proBNP (r=-0,22 p=0,015), NT-proBNP and IL-18 (r=0,18 p=0,045), MA with troponin I and CRP (r=0,20 p=0,048 and r=0,29 p=0,001). After six months, persistent renal function decline was more frequently diagnosed in patients with acute MI and AKI on index hospitalization. An equation for a multifactorial model for CKD risk was created: P(CKD)=exp(z)/(1+exp(z)), z=-1,113092e+01 — 4,082006e-02 * troponin I + 8,553826e-04 * NT-proBNP (discharge) + 1,620188e-01 * age + 3,411724e-02 * systolic blood pressure -7,753111e-03 * MA. ROC analysis revealed the most reliable sensitivity of 83% and specificity of 88,2% for the threshold value of CKD probability of 86,1%.Conclusion. Patients with MI and AKI have a significant risk of CKD within 6 months after ACS. The created mathematical model and calculator determine the likelihood of CKD.

Abstract 444: Effectiveness Of The Ratio Of L-cysteine To L-glutathione In Serum For Prediction Of Cardiovascular Events

Background: Aminothiols play an important role in the antioxidant defense system and the profile may be a predictor of prognosis and cardiovascular events. Methods: Two hundred sixty-two patients (202 men, 60 women, age 65 ± 13 years) undergoing coronary catheterization were followed up to 10 years. The patients were divided equally into two groups according to the median ratio of total L-cysteine to total L-glutathione (tCys/tGSH) in serum at enrollment. Results: During 5.5 ± 3.2 years, 31 patients (12%) died, of whom 20 (8%) had cardiovascular death and 32 (12%) had MACE. In addition, 29 (11%) were hospitalized for heart failure. Log-rank test showed that the high group (tCys/tGSH>=80.70) had a higher mortality from all causes (Fig.A, p=0.025) than the low group (tCys/tGSH<80.70). Univariate COX regression analysis showed that tCys/tGSH was a predictive marker of death, cardiovascular death, MACE, and heart failure (p<0.001, all), but these aminothiol alone did not predict any of these endpoints. After adjustment for age, sex, body mass index, coronary risk factors, renal function, and log-transformed brain natriuretic peptide, tCys/tGSH had predictive value for death (p=0.007), cardiovascular death (p=0.019), and heart failure (p=0.004). The adjusted hazard ratio for heart failure in the high tCys/tGSH group versus the low tCys/tGSH group was 3.071 (95% confidence interval: 1.186-7.952), p=0.021. tCys/tGSH ratio can be substituted by the GSH index obtained from the approximation curve (Fig.B, GSH index=142.7255*tGSH -0.777682 ). GSH index was also a prognostic biomarker, but we found tCys information was necessary to predict heart failure and was lost in GSH index. In addition, γ-glutamyl transpeptidase (GGT), which is responsible for extracellular catabolism of GSH to Cys, was a prognostic factor. Conclusions: Our results suggest that tCys and tGSH can be a useful marker of cardiovascular events by ratioing and may be an indicator of GGT activity.

Abstract 13679: Arterial Stiffness and Carotid Intima-Media Thickness Progression Preceding Worsening Left Ventricular Hypertrophy and Diastolic Dysfunction in Youth: A Temporal Causal Longitudinal Study

Introduction: Left ventricular hypertrophy (LVH) is a marker of cardiovascular events and is driven by ventriculo-vascular interactions with stiffening arteries. But longitudinal relations of left ventricle with aorta is uncharacterized in youth. Hypothesis: Aortic stiffening, measured as change in carotid-femoral pulse wave velocity (cfPWV), and arterial thickening measured as change in carotid intima-media thickness (cIMT) each independently predicts and precedes changes in LVH indices even after adjustment for BP. Methods: From the Avon Longitudinal Study of Parents and Children, UK birth cohort, 1856 adolescents (1011 females) were assessed at mean age 17.7 years and followed for 7 years. Vicorder measured cfPWV and ultrasound measured cIMT were grouped in tertiles as low (reference), moderate, and high. Echocardiography measured cardiac abnormalities are left ventricular mass indexed for height 2.7 (LVMI 2.7 ) ≥51g/m 2.7 as LVH; relative wall thickness ≥44 as hiRWT; LV diastolic function E/A as ≥1.5 (LVDD); and LV filling pressure E/e’ ≥8 as hiLVFP. Data were analysed with generalized logit mixed-effect model and cross-lagged structural equation path model adjusting for cardiometabolic and lifestyle factors. Results: Over follow-up, LVH prevalence increased from 3.6% to 7.2% and LVDD from 11.1 to 16.3%. High cfPWV progression was associated with worsening LVH [Odds ratio 1.23 (1.13 - 1.35); p<0.001] and worsening hiLVFP [1.14 (1.13 - 1.14); p<0.0001]. Likewise, high cIMT progression was associated with worsening LVH [1.27 (1.26 - 1.27); p<0.0001] and worsening hiLVFP [1.17 (1.07 - 1.28); p<0.001]. Neither cfPWV nor cIMT progression was associated with worsening hiRWT nor LVDD. In cross-lagged models, higher baseline cfPWV was associated with future LVMI 2.7 (β=0.06, SE, 5.14, p=0.035), RWT, LVDF, and LVFP. However, baseline LVMI 2.7 , RWT, LVDF, and LVFP were not associated with follow-up cfPWV. Baseline cIMT was not associated with follow-up cardiac indices and vice versa . Conclusions: Youth aortic stiffness progression temporally preceded and may causally associate with worsening LVH and hiLVFP but not hiRWT. Mechanistic delineation of coupling in ventriculo-vascular remodeling and consequent physiologic dysfunction is warranted.

Intima-Media Thickness in Women with the History of Hypertensive Disorders of Pregnancy as a Risk Marker of the Occurrence of Cardiovascular Pathology in Advanced Reproductive and Perimenopausal Age

Over the past twenty years, it has been proven that a history of preeclampsia entails a 4-fold risk of hypertension, coronary heart disease, stroke, type 2 diabetes, metabolic syndrome in the affected women at the age of 50-55 years. Evaluation of intima-media thickness (IMT) has diagnostic value for the assessment of remodeling and atherosclerotic vascular lesions and practical importance as a predictor of vascular accidents in patients with hypertension and atherosclerosis.
 The aim. To evaluate the IMT as an integrative biomarker of the occurrence of cardiovascular pathology in women with hypertensive disorders of pregnancy in their advanced reproductive age and in perimenopausal age.
 Materials and methods. We studied 51 women at the age of 48-55 years with the history of severe preeclampsia. The women were asked to fill out a questionnaire in which they indicated the presence of a diagnosis of hypertension, angina pectoris at the time of filling the questionnaire. The diagnosis of hypertension and angina attacks as well as other descriptions of the disease were taken away from the results of the women’s questionnaire. The investigators were not given copies of medical records. The control group consisted of 20 women aged 48-55 who had no history of preeclampsia or any other hypertensive disorders of pregnancy. Ultrasound imaging of the carotid arteries was performed according to the recommendations of the American Society of Echocardiography 2020 in women of both groups using SonoAce-8000 Ex scanner (Medison, South Korea) with a linear sensor UST5524 with a frequency of 7 MHz. IMT less than 0.7 mm was taken as a normal value for women.
 Results. It was revealed that almost every fourth woman at the age of 48-55 with the history of preeclampsia had signs of early angina attacks, and 30% suffered from hypertension. A threatening fact is that almost 6% of women at the age of 48-55 had the history of vascular thrombosis which is a manifestation of early atherosclerotic vascular lesions in the group of women with gestational hypertensive disorders. It is noteworthy that 21 (41.2%) women with the history of severe preeclampsia felt healthy and did not have any complaints. Importantly, among the women surveyed who had no health complaints, 66.6% (14 of 21) had IMT 0.85±0.01 mm. This accounts for about one third (27.4%) among 51 patients. This category of women is at high risk of developing cardiovascular complications in the future and require further monitoring and detailed examination. Thrombotic complications (dynamic bowel obstruction, mesenteric vascular thrombosis) were observed in 3 (5.9 %) women at the age of 48-55 with the history of severe preeclampsia.
 Conclusions. Examinations of women with the history of preeclampsia revealed that women at the age of 48-55 had increased IMT. It should be noted that increased IMT was found both in women with cardiovascular pathology (hypertension, thrombosis, angina attacks) and in asymptomatic patients. Taking into account that increased IMT is one of the characteristics of target organ damage in patients with hypertension and the marker of cardiovascular events in asymptomatic patients, it is important to include this examination in follow-up for women with the history of severe preeclampsia in order to avoid the development of early severe cardiovascular pathologies.

Variation in heart rate range by 24-h Holter monitoring predicts heart failure in patients with atrial fibrillation.

The analysis of heart rate (HR) changes, such as the HR variability or HR turbulence, has been reported as a marker of cardiovascular events during sinus rhythm; however, those relationships during atrial fibrillation (AF) remain controversial, and those parameters are not commonly used in AF patients. We sought to investigate the relationship between a simple index focused on the HR and heart failure (HF) events in patients with permanent AF. We enrolled 198 patients with permanent AF and evaluated the HR range, defined as the maximum HR minus the minimum HR on 24-h Holter electrocardiogram recordings. The patients were divided into two groups, i.e., the larger (n=101) and smaller (n=97) HR range (HRR) groups, determined by the median value. The HF events were defined as hospitalizations for HF or urgent hospital visits due to exacerbations of one's HF status. The observation period of this study was set at 5years from registration. The median age was 73 (68-77) years, and 29% were female. The median HRR was 84 (63-118) beats per minutes (bpm). During the observational period of 1825days (median), HF events occurred in 37 (0.047 per patient-year) patients. In a log-rank test, the larger HRR group had more frequent HF events than the smaller HRR group (P=0.0078). In the adjusted Cox proportional hazards model using the significantly different factors from the univariate analysis (Model 1) and factors and medications associated with HF (Model 2), the larger HRR group had a higher prevalence of HF events than the smaller HRR group for both models [Model 1, adjusted hazard ratio=3.21, 95% confidence interval (CI) 1.593-6.708, P=0.0009; Model 2, adjusted hazard ratio=3.12, 95% CI 1.522-6.685, P=0.002]. When analysed using the time-dependent Cox proportional hazards model, the HRR was associated with HF with a statistically significant difference in both the univariate and multivariate analyses [hazard ratio=1.01, 95% CI 1.006-1.020, P=0.0002; Model 1, adjusted hazard ratio=1.02, 95% CI 1.011-1.027, P<0.0001; Model 2, adjusted hazard ratio=1.01, 95% CI 1.008-1.021, P=0.0003). There was no significant difference in the chronotropic medications between the two groups. In patients with permanent AF, a larger HRR was associated with HF events.

IDF21-0263 The association of plasma NT-proBNP level and progression of diabetic nephropathy

Background: Diabetic nephropathy (DN) is one of the most serious microvascular complications in patients with diabetes. Natriuretic peptides are synthesized and released from the atrial and ventricular myocardium. In response to cardiomyocyte stimulation, such as, ischemic injury, pressure overload, and volume overload, the precursor pro-brain natriuretic peptide (BNP) is divided into the hormonally active BNP and inactive N-terminal (NT)-proBNP. NT-proBNP has already been proved to be a marker for cardiovascular events and/or mortality in patients with diabetes, and patients undergoing peritoneal dialysis/hemodialysis.

Layer-specific regional circumferential strain as prognostic marker of cardiovascular events

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Left ventricular (LV) circumferential strain (Ecc) is an accurate indicator of regional myocardial function. Recent studies have emphasized the potential superiority of regional Ecc, particularly using the layer-specific strain. To date, no studies have assessed the prognostic value of layer-specific regional Ecc in the general population. PURPOSE This study aimed to investigate the prognostic value of the layer-specific regional Ecc for predicting the incident of heart failure (HF) and coronary heart disease (CHD) in a population without a history of cardiovascular disease at baseline. METHODS Data from participants in the Multi-Ethnic Study of Atherosclerosis (MESA) who underwent tagged magnetic resonance imaging for strain determination were analyzed. Using −17% and −10% as Ecc cut-offs, each segment was rated from 0–2 points according to the Ecc value of each layer. The endo-Ecc, mid-Ecc, and epi-Ecc values from the 16-segment model were used to calculate three indexes: Endo-MyoHealth, Mid-MyoHealth, and Epi-MyoHealth, respectively, which were defined as a percentage of good LV regional function. The Intramyocardial-MyoHealth index was the sum of these three MyoHealth indexes. Cox proportional hazard models were used to evaluate the association between each MyoHealth index and incident HF and hard CHD. RESULTS Among the 1,506 participants (63.3 ± 9.4 years, 54.6% men), 122 cases of hard CHD and 91 cases of HF were observed (median [IQR] follow-up 15.9 [12.9-16.6] years). After adjustment, Mid-, Epi-, and Intramyocardial-MyoHealth index values &amp;lt;50% were independently associated with HF (adjusted HR 1.43; 95% CI [1.08-2.87], p = 0.004; HR 1.80; 95% CI [1.12-3.07], p &amp;lt; 0.001; and HR 2.01; 95% CI [1.19-3.20], p &amp;lt; 0.001). After adjustment, Endo-, Mid-, Epi-, and Intramyocardial-MyoHealth &amp;lt;50% were also independently associated with hard CHD (adjusted HR 1.31; 95% CI [1.03-1.51], p = 0.04; HR 1.79; 95% CI [1.26-2.57], p &amp;lt; 0.001; HR 2.03; 95% CI [1.45-3.40], p &amp;lt; 0.001; and HR 2.28; 95% CI [1.51-3.53], p &amp;lt; 0.001). CONCLUSIONS Layer-specific regional Ecc, assessed via MyoHealth indexes, provides a robust, independent predictive value for incident HF and hard CHD in asymptomatic participants without any history of previous clinical cardiovascular disease. Unique identifier Clinical.gov : NCT00005487. Abstract Figure. Abstract Figure. Kaplan Meier curves

Is fruit intake associated with common carotid intima-media thickness?

Abstract Background Common carotid intima-media thickness (ccIMT) is an established risk marker for cardiovascular events, including myocardial infarction and stroke, which are of high public health relevance. While a higher fruit intake is generally considered beneficial for cardiovascular health, recent studies have shown that a fruit intake of &amp;gt; 2 portions per day may be harmful. Therefore, we tested if there is an association between categories of fruit intake and mean ccIMT. Methods We conducted an exploratory, non-prespecified, cross-sectional analysis of baseline values of 167 mostly middle-aged participants of a controlled lifestyle intervention, recruited from the general population in rural northwest Germany (male: n = 58; female: n = 109). Fruit intake was classified into low (&amp;lt;1 portion of fruit/day), intermediate (1-2 portions of fruit/day), and high (&amp;gt;2 portions of fruit/day). Mean ccIMT was measured in accordance with the Mannheim consensus. Between-group differences in mean ccIMT were assessed with analysis of covariance. Results Mean age was 57.3 ± 0.7 years (mean ± SEM). Mean fruit intake was 1.6 ± 0.1 portions/day. Average mean ccIMT was 0.679 ± 0.010 mm. There was a significant difference in mean ccIMT between subjects with low (0.676 ± 0.020 mm; n = 50), intermediate (0.653 ± 0.014 mm; n = 72), and high fruit intake (0.724 ± 0.019 mm; n = 45; p = 0.016). But this difference was attenuated when adjusting for age, sex, and homocysteine (p = 0.418). Conclusions We found only a non-significant association between consuming &amp;gt;2 portions of fruit per day and ccIMT. Thus, our study could not confirm a negative effect of fruit intake on ccIMT. Age, sex, and homocysteine may confound this association. Key messages Current recommendations of 2 portions of fruit per day seem adequate and do not negatively influence carotid intima-media thickness. Future studies should address confounding of the association between fruit intake and cardiovascular risk markers.

Growth differentiation factor-15 and plasminogen activator inhibitor-1 are possible predictors of cardiovascular events in atrial fibrillation patients after elective PCI

Abstract Introduction Patients (pts) with AF (atrial fibrillation), undergoing elective PCI (percutaneous coronary intervention), receiving combined antithrombotic therapy (AT) have high risk of stroke/systemic embolism, coronary events and bleedings. Minimizing the duration of combined AT is the main way to improve the safety of treatment. However, due to the high risk of thrombotic events, patient stratification is necessary. Biomarkers of high risk cardiovascular events (CVE) could be the rational reason to prolong combined AT for some pts. The search for them is relevant. There is data on relationship between growth differentiation factor-15 (GDF-15) level, plasminogen activator inhibitor-1 (PAI-1) level and adverse CVE. Purpose To investigate the prognostic value of GDF-15 and PAI-1 levels in AF pts after elective PCI during 1 year follow up. Methods 150 pts (104 males), aged 70.8±8.5 years, with AF after elective PCI were enrolled in the prospective study. All pts received direct oral anticoagulants and double (89.3%) or single (10.7%) antiplatelet therapy. Median duration of follow up period was 11.5 months [IQR 8.0; 12.0]. Efficacy endpoint of the study was the sum of CVE: ACS (acute coronary syndrome), ischemic stroke (IS), VTE (venous thrombotic events), cardiovascular death and need for unplanned PCI. Plasma samples for GDF-15 and PAI-1 were taken before PCI and analyzed using ELISA. Results AF pts receiving combined AT demonstrated high thrombotic risk (CHA2DS2-VASc, Med 5 [IQR 4; 6]), high rate of comorbidity (index Charlson, Med 7 [IQR 5; 9]). Frequency of CVE during follow up period was 16% (ACS 2; fatal IS 2; VTE 2, include 1 fatal pulmonary embolism; cardiovascular death 2; pts needed an unplanned PCI 16). Median GDF-15 level was 1270 pg/ml [IQR 953; 1778]. Median PAI-1 level was 10.15 U/ml [6,3; 17,0]. By linear correlation analysis (r=0.24; p=0.0037) and by regression model (F-ratio 157.4, p&amp;lt;0.0001) GFD-15 and PAI-1 are exhibited a relation. According to ROC analysis GDF-15 level &amp;gt;1191 pg/ml (sensitivity 83.0, specifity 50.0) and PAI-1 level &amp;gt;13.2 U/ml (sensitivity 58.3, specifity 68.6) increases the probability of the development of CVE (AUC=0.647, p=0.0076, CI 0.565–0.723; AUC=0.652, p=0.0135, CI 0.569–0.728 respectively). Kaplan-Meier curves demonstrated significant difference in CVE free survival between the patients with GDF-15 level &amp;gt; and ≤1191 pg/ml (75.9% and 94.0% respectively, p=0.0032 [HR 4.36, CI 1.50–7.48]); and with PAI-1 level &amp;gt; and ≤13.2 U/ml (74% and 89% respectively, p=0.0112 [HR 2.73, CI 1.28–6.98]). The multivariable Cox regression model demonstrated that GDF-15 (p=0.0363) and PAI-1 (p=0.0074), were independently associated with an increased risk of CVE (op=0.0022). Conclusions GDF-15 and PAI-1 are correlated, and they are new markers of CVE in AF pts after elective PCI. Funding Acknowledgement Type of funding sources: None.

Prognostic value of diastolic function parameters in significant aortic regurgitation. The role of the left atrial strain

Abstract Background The management of patients with asymptomatic significant aortic regurgitation (sAR) is often challenging and appropriate timing of aortic valve surgery remains controversial. There are no strong indicators to recommend early surgery in patients with sAR, however delaying the time for the intervention could bring potential negative consequences, such as the risk of permanent left ventricular (LV) dysfunction. The prognostic value of diastolic parameters has been demonstrated in several cardiac diseases. In particular, left atrial (LA) function has been shown to be an important determinant of morbimortality. Purpose The purpose of this study was to analyze the prognostic significance of diastolic function parameters, included LA strain, in asymptomatic patients with sAR and to evaluate whether these parameters could help to identify patients at high risk of adverse events that could benefit from early cardiac surgery. Methods From February 2013 to November 2019 consecutive asymptomatic patients with chronic sAR evaluated in the Heart Valve Clinic with a comprehensive transthoracic echocardiogram (TTE) were included. Combined clinical endpoint included hospital admission due to heart failure, cardiovascular mortality, or indication for aortic valve surgery. Results A total of 126 patients were included. During a mean follow up of 33±19 month, 25 (19.8%) patients reached the combined end-point. In a sub-group of 57 patients with TTE performed in the Philips stations, LA auto-strain analysis was obtained (figure 1). Univariate analysis showed that LV volumes, LVEF, E wave, E/e' ratio, LA volume and LA reservoir strain (LASr) were significant predictors of events, whereas LA diameter, and LV diastolic diameters were not. Multivariate model 1 that tested all echocardiographic variables statistically significant in the univariate model showed that the LVEDV and E/e' ratio, were significant predictors of events. In the subgroup of patients with LA auto-strain analyzed, a second multivariable model was built, including the previous significant variables for the first model (LVEDV and E/e' ratio), as well as the LA volume and LASr. It showed that LVEDV and LASr were the most significant predictors of cardiovascular events (figure 2). Conclusions In this population of asymptomatic patients with sAR and normal LV systolic function, baseline diastolic parameters were prognostic markers of cardiovascular events; among them, LA reservoir strain played a strong independent predictor role. In addition, our results also showed that LV volumes had greater prognostic value that LV diameters in patients with asymptomatic sAR. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Growth differentiation factor 15 and the risk of cardiovascular events in patients with atrial fibrillation after elective percutaneous coronary intervention

Aim. To study the predictive value of growth differentiation factor 15 (GDF-15) in patients with atrial fibrillation (AF) after elective percutaneous coronary intervention (PCI).Material and methods. The study included 150 patients (men, 69,3%) with AF receiving direct oral anticoagulants in combination with two (89,3%) or one antiplatelet agent (10,7%) after elective PCI. Median age was 71,0 [interquartile range, 66,0; 77,0] years. The median follow-up was 11,5 months [interquartile range, 8,0; 12,0]. The efficacy endpoint was the sum of cardiovascular events (CVEs), including cardiovascular death, ischemic stroke, venous thromboembolism, peripheral arterial thrombosis, acute coronary syndrome, and the need for emergency PCI. The safety endpoint was considered to be BARC type 2-5 bleeding. Prior to PCI, blood plasma samples were taken from patients to determine GDF-15 and D-dimer by enzyme immunoassay.Results. The incidence of CVEs was 16%. The incidence of BARC type 2-5 bleeding was 24,7%. The median GDF-15 level was 1270,0 pg/ml [953,0; 1778,0]. According to multiple regression, the GDF-15 level is associated with D-dimer (t=3,20; p=0,0018), diabetes (t=3,97; p=0,0001) and SYNTAX score II (t=4,77; p&lt;0,0001). In patients with single-vessel coronary artery disease, the GDF-15 level was significantly lower than in patients with three-vessel disease (p=0,0119). According to the ROC analysis, a GDF-15 &gt;1191 pg/ml (p=0,0076) increases the likelihood of CVE (area under the curve, 0,647; confidence interval (CI), 0,5650,723). According to Kaplan-Meier survival curves, significant differences were found in terms of absence of CVEs during the follow-up period between the groups of patients with a GDF-15 &gt;1191 and those with GDF-15 &lt;1191 pg/ml (76% vs 94%, p=0,0032; relative risk, 4,36; CI 1,50-7,48). The relationship of GDF-15 level with BARC type 2-5 bleeding was not revealed.Conclusion. GDF-15 is a novel marker of CVE in AF patients after elective PCI.

Estimated pulse wave velocity (ePWV) as a potential gatekeeper for MRI-assessed PWV: a linear and deep neural network based approach in 2254 participants of the Netherlands Epidemiology of Obesity study

Pulse wave velocity (PWV) assessed by magnetic resonance imaging (MRI) is a prognostic marker for cardiovascular events. Prediction modelling could enable indirect PWV assessment based on clinical and anthropometric data. The aim was to calculate estimated-PWV (ePWV) based on clinical and anthropometric measures using linear ridge regression as well as a Deep Neural Network (DNN) and to determine the cut-off which provides optimal discriminative performance between lower and higher PWV values. In total 2254 participants from the Netherlands Epidemiology of Obesity study were included (age 45–65 years, 51% male). Both a basic and expanded prediction model were developed. PWV was estimated using linear ridge regression and DNN. External validation was performed in 114 participants (age 30–70 years, 54% female). Performance was compared between models and estimation accuracy was evaluated by ROC-curves. A cut-off for optimal discriminative performance was determined using Youden’s index. The basic ridge regression model provided an adjusted R2 of 0.33 and bias of < 0.001, the expanded model did not add predictive performance. Basic and expanded DNN models showed similar model performance. Optimal discriminative performance was found for PWV < 6.7 m/s. In external validation expanded ridge regression provided the best performance of the four models (adjusted R2: 0.29). All models showed good discriminative performance for PWV < 6.7 m/s (AUC range 0.81–0.89). ePWV showed good discriminative performance with regard to differentiating individuals with lower PWV values (< 6.7 m/s) from those with higher values, and could function as gatekeeper in selecting patients who benefit from further MRI-based PWV assessment.

Echocardiographic assessment of left ventricular mass index and function in hypertensive patients with preserved ejection fraction

Background: The aim of the present study is to detect left ventricular (LV) mass and to find out sub clinical LV diastolic dysfunction in hypertensive patients with preserved LV ejection fraction (EF) using echocardiographic parameters.Methods: 96 patients with hypertension were randomly selected irrespective of their sex, race and risk factor and enrolled into this study. Left ventricular mass index (LVMI) and geometrical pattern LV structure were measured. Sub clinical diastolic dysfunction was also assessed by tissue Doppler.Results: Out of 96 patients, 24 had ECG evidence of LV hypertrophy (LVH) 66 were having increased LVMI (154±20), rest 30 had normal LVMI (108±12). They were divided by LV geometrical pattern into concentric LVH (40), eccentric LVH (26), concentric remodeling (19) and normal (11). Diastolic dysfunction in these patients were assessed by E/E´ measurement which was abnormally increased in 42 out of 66 patients with increased LVMI (20±3.4) and 16 out of 30 patients with normal LVMI.Conclusions: Echocardiographic examination help us to find out LVH precisely by calculating LVMI. It also reveals structural changes like concentric LVH, eccentric LVH, concentric remodeling. A significant number of patients with hypertension with normal LV ejection fraction has sub clinical LV diastolic dysfunction which was detected by tissue Doppler imaging (E/E′). The increase in LVMI with or without concentric LVH is an independent risk factor and prognostic marker for cardio vascular events that occur in hypertensive patients. In this study we infer that patients with increase in LVMI with concentric LVH pattern with normal ejection fraction needs more aggressive treatment and regular follow up to prevent cardiovascular complications.

28. USEFULNESS OF NEUTROPHIL-TO-LYMPHOCYTE RATIO (NLR) AS A PREDICTOR FOR LEFT VENTRICULAR HYPERTROPHY (LVH) IN PATIENTS WITH HYPERTENSION: A SYSTEMATIC REVIEW AND META-ANALYSES

Background: Left ventricular hypertrophy (LVH) is a common pathological change in hypertension, which is a marker for cardiovascular events and mortality. Inflammation as well as ischemia play significant roles and are the leading pathways in left ventricular remodeling. Thus, neutrophil-to-lymphocyte ratio (NLR), an inflammatory marker, was suggested to be predictive of LVH in hypertensive patients. Objective: Our aim was to review all studies that assessed the value of NLR in predicting LVH in hypertension. Methods: We performed a systematic literature search on the topic from several electronic databases (PubMed, Europe PMC, ProQuest, EBSCOhost, and Google Scholar) from inception to January 2021. The standardized mean difference (SMD) with 95% confidence interval (CI) were estimated and pooled to investigate the effect sizes. Results: Meta-analysis of two studies showed that increase in NLR was associated with higher risk of developing LVH in patients with hypertension (SMD = 0.68, 95% confidence interval [CI] = 0.12–1.25, Z = 2.36, P = 0.02) compared with control group. Additionally, further subgroup analyses of LVH categorization stratified by Ganau's classification showed significant higher NLR value in eccentric LVH subgroup (SMD = 1.22, 95% CI = 0.08–2.36, Z = 2.11, P = 0.04) although no significant difference was observed in other three subgroups. Conclusion: In this current meta-analysis, we concluded that NLR is a reliable and inexpensive biomarker to help determine risk of developing LVH in patients with hypertension.

Abstract 12991: Growth Differentiation Factor-15 is a New Predictor of Cardiovascular Events in Atrial Fibrillation Patients After Elective Percutaneous Coronary Intervention

Introduction: Patients (pts) with AF, undergoing elective PCI, receiving multicomponent antithrombotic therapy (MAT) have high risk of stroke/systemic embolism and coronary events. There is no biochemical markers associated with negative prognosis in AF pts after elective PCI. Growth differentiation factor-15 (GDF-15) has demonstrated strong relationship with adverse prognosis in pts with cardiovascular disease. Purpose: To investigate the prognostic value of GDF-15 level in AF pts after elective PCI. Methods: 150 pts (104 males), aged 70.8±8.5 years, with AF after elective PCI were enrolled in the prospective study. All pts received DOACs and double (89.3%) or single (10.7%) antiplatelet therapy. Median duration of follow up period was 11.5 months [IQR 8.0; 12.0]. Efficacy endpoint of the study was the sum of cardiovascular events (CVE): ACS, ischemic stroke (IS), VTE, cardiovascular death and need for unplanned PCI. Plasma samples for GDF-15 were analyzed using ELISA. Results: AF pts receiving MAT demonstrated high thrombotic risk (CHA 2 DS 2 -VASc, Med 5 [IQR 4; 6]), high rate of comorbidity (index Charlson, Med 7 [IQR 5; 9]). Frequency of CVE during follow up period was 16% (ACS 2; fatal IS 2; VTE 2, include 1 fatal pulmonary embolism; cardiovascular death 2; pts needed an unplanned PCI 16). Median GDF-15 level was 1270 pg/ml [IQR 953; 1778]. According to multiple regression analysis GDF-15 level was associated with the D-dimer (t=3.20; p=0.0018), diabetes mellitus (t=3.97; p=0.0001) and clinical and angiographic Syntax II score (t=4.77; p&lt;0.0001). In pts with only coronary artery disease, the level of GDF-15 was significantly lower than in pts with atherosclerotic lesion of 3 vascular pools (p=0,0119). According to ROC analysis GDF-15 level &gt; 1191 pg / ml (sensitivity 83.0, specifity 50.0) increase the probability of the development of CVE (AUC=0.647, p=0.0076, 95% CI 0.565–0.723). Kaplan-Meier curves demonstrated significant difference in CVE free survival between the patients with GDF-15 level &gt; and ≤ 1191 pg/ml (75.9% and 94.0% respectively, log-rank test p = 0.0032, [HR 4.36, CI 1.50-7.48]). Conclusions: GDF-15 is a possible marker of CVE determining prognosis in AF pts after elective PCI. The results could be used to individualize the duration of MAT.

IMPACT OF INTER-ARM BLOOD PRESSURE DIFFERENCE ON CARDIOVASCULAR RISK ESTIMATION IN PRIMARY CARE

Objective:The Inter-arm blood Pressure difference Individual Patient Data (INTERPRESS-IPD) Collaboration recently demonstrated, based on data from over 57,000 records, that an inter-arm difference in systolic blood pressure (IAD) is an independent risk marker for cardiovascular events after adjustme

Predictors of unfavorable course of acute myocarditis with reduced left ventricular ejection fraction

Early prediction of myocarditis clinical course still remains one of the actual tasks of cardiological science, which has a significant practical value. The purpose of the study was to determine the predictors of unfavorable course of myocarditis with reduced ejection fraction (EF) of the left ventricle (LV) on the basis of follow-up during 24 months. The study included 90 patients with acute myocarditis and reduced LV EF, who were examined in the first month after the disease onset, after 6, 12 and 24 months of follow-up. All patients underwent for echocardiography, Holter monitoring of the electrocardiogram and cardiac magnetic resonance imaging. Statistical processing of the results was performed using the Excel XP software (Місrosoft Office, USA) and Statistica for Windows v. 6.0 (Statsoft, USA). It was found that restoration of cardiac contractility in patients with myocarditis and reduced LV EF began with an increase in the index of LV longitudinal global systolic strain, which occurred 6 months after the debut of the disease and was associated with a decrease in the number of LV segments affected by the inflammatory process, and a significant increase of LV EF and a decrease of LV end-diastolic volume were observed only 1 year after the disease onset. The predictors of cardiovascular events in patients with acute myocarditis during the next 24 months from the onset of the disease, were detected in the 1st month from the debut of the disease and included following pathological changes: value of the LV EF ≤ 30%; reduction of LV longitudinal global systolic strain ≤ 7.0%; evidence of non-sustained ventricular tachycardia, presence of inflammatory changes in ≥6 LV segments, presence of delayed enhancement in ≥ 5 LV segments. Prospects for further research are the creation of registries of patients with myocarditis on the basis of multicenter clinical trial results on a large number of patients surveyed in order to improve diagnosis, prediction of clinical course and identification of early diagnostic markers of cardiovascular events and quantitative risk assessment of their development.

Liquid Biopsy of Extracellular Microvesicles Predicts Future Major Ischemic Events in Genetically Characterized Familial Hypercholesterolemia Patients

Objective- Circulating microvesicles (cMVs) exert regulatory roles in atherothrombosis. Patients with familial hypercholesterolemia (FH) that are at high risk for premature cardiovascular events (CVEs) have previously shown high levels of cMVs related to disease severity. However, much remains unknown about their value as markers of CVE. We sought to investigate the prognostic cMV signature for future major CVE presentation in patients with FH. Approach and Results- Liquid biopsies from genetically characterized patients with FH from the SAFEHEART (Spanish Familial Hypercholesterolemia Cohort Study)-cohort without clinical manifestation of disease at entry that were going to suffer a CVE within a mean period of 3.3±2.6 years postsampling (CVE, N=92) and from age/cardiovascular risk factor/treatment-matched patients with FH that did not suffer an event within the same time-period (non-CVE, N=48) were investigated. cMVs were phenotyped by flow cytometry to identify activated parental cells. Patients with CVE had higher number of overall procoagulant annexin V+-cMVs than non-CVE ( P<0.05). Pan-leukocyte-derived and neutrophil-derived cMVs, as well as activated platelet-derived cMVs, were significantly higher in patients with CVE. Baseline number of cMVs derived from lymphocytes, neutrophils, and activated platelets were positively associated with mortality at follow-up ( P<0.05). Patient-risk calculated by classical cardiovascular risk-factor scores did not correlate with cMVs. Inclusion of the cMV signature into the SAFEHEART risk model for patients with FH for the prediction of ischemic events increased the area under the curve from 0.603±0.050 to 0.768±0.042 ( P<0.005). Conclusions- Patients with FH who are going to suffer a CVE within a mean period of 3.3 years, despite being treated according to guidelines, have ongoing innate immune cell and platelet activation. The proposed cMV signature is a prognostic marker for accelerated atherosclerosis and clinical event presentation in patients with FH.

ANRIL as a genetic marker for cardiovascular events in renal transplant patients

ANRIL as a genetic marker for cardiovascular events in renal transplant patients