Mm In Women Research Articles

Relationship of Main Pulmonary Artery (Truncus Pulmonalis) Diameter With Hospital Stay and Mortality in Pulmonary Hypertension Patients Admitted to the Emergency Department.

Pulmonary hypertension (PH) is a haemodynamic and pathophysiological disease significantly associated with morbidity and mortality. The increase in pulmonary vascular resistance, high pulmonary artery pressure and wall tension that occurs in PH results in dilatation of the main pulmonary artery (truncus pulmonalis), one of the largest and most important vessels in the body. The aim of this study is to investigate the relationship between the diameter of the truncus pulmonalis and hospitalization, length of hospital stay, and mortality in patients diagnosed with PH. Demographic characteristics, number of Emergency Department (ED) admissions, post-admission status, treatment, truncus pulmonalis diameter, and mortality were evaluated statistically through the patient files of 115 PH patients who presented to the ED of Fırat University Faculty of Medicine,Elazığ, Türkiye, between January 2022 and December 2022. Of the 115 PH patients who came to the ED, 70 (60.8%) were women and 45 (39.2%) were men, with a mean age of 78.77±8.72 years. Fifty-one of these patients were discharged from the ED after treatment, and 64 were hospitalized. The mean length of hospital stay was two (min=0, max=38) days. Thoracic CT scans demonstrated that the mean diameter of the truncus pulmonalis of the patients was 34.874±3.288 mm (35.20±3.6509 mm in women, 34.367±2.5836 mm in men; p₌0.351) and there was no statistically significant relationship with mortality (p=0.496), hospitalization (p=0.806), and length of hospital stay (p=0.416). There was a statistically significant relationship between mortality rate and male gender (p=0.02) and comorbidity (p=0.001). It was determined that there was no statistically significant relationship between the truncus pulmonalis diameter and gender, comorbidity, hospitalization, length of hospital stay, and mortality in this study in which single-centre one-year admissions of PH, which differ in aetiology, epidemiology, and demographic features were examined. However, among the patient demographics, a significant relationship was determined between gender and the number of comorbidities and mortality.

Safe range of femoral neck system insertion and the risk of perforation

BackgroundInternal fixation of the femoral neck carries a risk of perforation due to the presence of the isthmus of the femoral neck. At present, there are few studies on the safe and risk zones of the femoral neck system (FNS) implantation. This study aimed to recommend the safe range of injection of FNS in the lateral wall of the proximal femur, parallel to the axis of the femoral neck, during FNS treatment of femoral neck fracture (FNF).MethodsFemoral computed tomography (CT) data of 80 patients (male: 40; female: 40) who met the inclusion criteria were collected. Mimics 21.0 software was used to complete the modeling. 3-Matic 13.0 software was used to establish the axis of the femoral neck and its vertical plane, perform the cutting of the femoral neck, and project it on the vertical plane of the femoral neck axis. After matching a rectangle for each projection map, all sample sizes (80 cases) were standardized and superimposed to obtain gradient maps of the safe zone (SZ) and dangerous zone (RZ), thereby securing edge key points and safe FNS insertion range.ResultsIn the 80 samples, the mean diameter of the smallest femoral neck section was 33.87 ± 2.32 mm for men and 29.36 ± 1.92 mm for women. All 80 femoral necks had safe and risky areas. The SZ/S × 100% was 77.59 (± 2.22%), and the RS/S × 100% was 22.39% (± 2.22%). The risk area was composed of four parts: (1), (2), (3), and (4), respectively, corresponding to 3.45 ± 1.74%, 5.51 ± 2.63%, 6.22 ± 1.41%, and 7.22 ± 1.39%. Four marginal key points, perforation risk, and safe ranges (SR) of FNS were analyzed on the lateral wall of the femoral neck.ConclusionsThe SR of FNS placement was recommended by digital simulation. In addition, Regions (3) and (4) posed a higher risk of penetrating the cortex. Using the gradient map of RZ for preoperative evaluation is recommended to avoid iatrogenic perforation.

P20.11.A TEMPORAL MUSCLE THICKNESS AS PROGNOSTIC MARKER IN PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA - A VALIDATION STUDY

Abstract BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare, aggressive diffuse large B-cell lymphoma, confined to the central nervous system. Age and performance status are validated prognostic variables in PCNSL. Frailty may also be a factor but is not easily quantified. Temporal muscle thickness (TMT), as parameter of sarcopenia, is believed to reflect frailty, is easily measurable and may be a valuable additional prognostic factor: mean TMT has been described as an independent prognostic factor in PCNSL patients. This study aims to validate these results in a prospective cohort. MATERIAL AND METHODS All patients from a large phase III trial (HOVON 105/ALLG NHL 24; EudraCT 2009-014722-42) of whom baseline axial T1 weighted magnetic resonance images (MRI) were available were included. Sarcopenia is defined as a mean TMT <6.3mm for men and <5.2mm for women, measured on axial T1-weighted MRI. The TMT was measured by a radiologist (RG) with and a neurologist (MvdM) without correction for angulation of images. Sarcopenia, together with known other prognostic factors were analyzed in a Cox-regression analysis for progression-free (PFS) and overall survival (OS) for both investigators. RESULTS TMT measurements were possible in 164/199 trial patients. The median mean TMT was 7.62mm (IQR: 6.58-9.00; measured by RG) and 5.94mm (IQR: 5.09-7.01; measured by MvdM). The mean TMT was not significantly different between those who used dexamethasone, and those who did not. Sarcopenia was present in 75 patients (46%), measured by MvdM without correction for angulation of the images and in 21 patients (13%), measured by RG with correction for angulation of the images. In univariate analyses, age (>60 years-old) and baseline Mini-Mental State Examination-score <27 were significantly associated with adverse PFS and OS. In multivariate analyses, only age remained as independent prognostic factor for adverse PFS and OS. Sarcopenia, as measured by either of the investigators, was not associated with survival. For measurements by RG, presumed to be most accurate, the Hazard Ratio (95% confidence interval) was 0.68 (0.33-1.40), p=0.30 for PFS, and HR (95% CI): 0.97 (0.42-2.20), p=0.93 for OS in the multivariate analysis. CONCLUSION There was a low interobserver agreement between a neurologist and a radiologist regarding TMT measurements, which questions the use of this parameter in daily practice by non-radiologists. Sarcopenia, based on the mean TMT, was not a prognostic factor in PCNSL patients for PFS and OS. The small number of patients with sarcopenia in this series may have influenced results.

Abstract P365: Left Ventricular Hypertrophy In Hypertension-correlation Of Electrocardiography Criteria, Echocardiography And Myocardial Strain Imaging

Background: LVH on ECG has been defined by 37 different criteria with modest degree of differences in accuracy amongst them leading to a lack of consensus. Objectives: Study aims to correlate sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of selected 17 standard ECG criteria in the diagnosis of LVH, correlation with echocardiography and myocardial global longitudinal strain (GLS). Demographics: Average age of the 104 hypertensive individuals included in the study was 61.86 years with 43.3% women. 73% of subjects had LVH on echocardiography with mean LVMI 115.97g/m2 and mean RWT 0.5. Results: Groningen criteria (24.70%) and Cornell voltage criteria (20.98%) had the best sensitivity for LVH detection. Groningen criteria was defined as QV2+R1+RV5+RV6+SV2+SV4+SV5+SV6 >= 49.5 mm in women and R1+RV5+SII+ SV2+SV6 x QRS duration >= 4500mm msec in men. Sensitivity for other criteria were lesser; Peguero Lo presti(PL) 13.58%, Sokolow Lyon index(SL) 11.11% and Cornell voltage product (CVP) 6.17%. Specificity and Positive predictive value (PPV) with Groningen criteria were 90% and 95.6% and with Cornell voltage criteria 100% and 100% respectively. Best sensitivity results were on combining all 17 ECG LVH criteria (39.5%). Addition of Groningen criteria improved the sensitivity of SL+CV+PL from 28.39% to 38.3%. Combination of the commonly used CV+SL+PL criteria yielded better sensitivity (28.39%) as compared to CV (20.98%) alone. Subjects with mild LVH on echo had an average GLS of -15.46+/-2.4% in 75%, subjects with moderate LVH had an average GLS of -14.23+/-2.8% in 71.4% and subjects with severe LVH had an average GLS of -12.6+/-4.9% in 80%. Conclusion: Irrespective of the voltage criteria used, singular or in combination, sensitivity to diagnose LVH proven on echocardiography is low. Novel Groningen criteria was more sensitive than the previously established standard ECG LVH criteria and had the highest association amongst all in patients with reduction in average GLS. Combination of four criteria SL+CV+PL+Groningen had the best sensitivity (38.3%) which improved only by 1.2% if all 17 criteria were combined.

Aortic size distribution among normal, hypertension, bicuspid, and Marfan populations.

Large-scale investigations on ascending aortic diameter, especially in the Asian population, are lacking. Furthermore, relevant evidence regarding the distribution of hypertension (HP), bicuspid aortic valve (BAV), and Marfan syndrome (MFS) is scarce. We aimed to examine the distribution of ascending aortic diameter in these populations in China. The data of a total number of 698 795 individuals who underwent cardiac ultrasound were subjected to retrospective analysis. After screening, 647 087 individuals were included in the final analysis. In the normal population, the mean ascending aortic diameter was 28.1 ± 3.2 mm (27.2 ± 3.1 mm in women vs. 29.0 ± 3.1 mm in men) (P < 0.001). Aortic diameter increased gradually with age (P < 0.001). The prevalence of aortic dilation, aneurysm, and dissection in individuals with HP was 12.83%, 2.70%, and 4.77%, respectively. In individuals with MFS, the corresponding rates were 43.92%, 35.31%, and 26.11%. Notably, although BAV patients had high incidences of aortic dilation (37.00%) and aortic aneurysm (16.46%), the incidence of aortic dissection was relatively low (0.74%). Most cases of aortic dissection occurred at an aortic diameter of less than 55 mm. However, in the overall population, the incidence of aortic dissection significantly increased with the increase in the aortic diameter, revealing the existence of an 'aortic paradox'. (i) The ascending diameter increases with age and is larger in men than in women; (ii) 'Aortic paradox' is explained; (iii) BAV bears a high rate of aortic dilation, but a low incidence of aortic dissection.

Early Relative Growth Rate of Abdominal Aortic Aneurysms and Future Risk of Rupture or Repair

This study aimed to test whether the relative growth rate of subthreshold abdominal aortic aneurysms (AAAs) in the first 24 months of surveillance predicts the risk of future rupture or repair. This was a single centre retrospective observational analysis of all small (< 45 mm diameter) and medium (45 - 54 mm in men, 45 - 50 mm in women) AAAs entered into ultrasound surveillance between January 2002 and December 2019, which received ≥ 24 months of surveillance. Relative growth rates were calculated from measurements taken in the first 24 months of surveillance. The Kaplan-Meier method was used to estimate intervention and rupture free proportions five years following diagnosis for AAAs growing by < 5% and by ≥ 5% in the first 24 months of surveillance. Multivariable Cox regression analysis was used to further analyse this relationship by adjusting for factors found to be significantly associated with outcome in univariable analysis. A total of 556 patients with AAAs (409 men, 147 women) were followed for ≥ 24 months. This included 431 small AAAs. Of these, 109 (25.3%) grew by < 5% in the first 24 months of surveillance and had a cumulative event free proportion of 0.98 ± 0.05 at five years compared with 0.78 ± 0.05 for the ≥ 5% growth group (p < .001). Of 125 medium AAAs, 26 (20.8%) grew by < 5% in the first 24 months of surveillance and had a cumulative event free proportion of 0.73 ± 0.11 at five years compared with 0.29 ± 0.13 for the ≥ 5% growth group (p= .024). Baseline diameter and early relative growth rate were strongly and independently predictive of future intervention or rupture with hazard ratios of 9.16 (95% CI 5.98 - 14.03, p < .001) and 4.46 (95% CI 2.45 - 8.14, p < .001), respectively. The results suggest that slow expansion of small (< 45 mm) AAAs observed over an isolated 24 month period is indicative of a very low risk of rupture or repair in the medium term. Isolated growth rates may be a useful tool with which to triage low risk AAAs and prevent unnecessary surveillance.

Measurement of Clavicular Symmetry in Healthy Subjects Using Tomographic Database of Public Hospitals.

Objective This study aimed to perform an imaging evaluation to prove the existence or not of symmetry between the clavicles of healthy subjects from Curitiba, Paraná, Brazil, and identify potential factors influencing the clavicular length. Method The study analyzed chest computed tomography (CT) scans of 211 patients with no clavicular fracture or malformations (100 women and 111 men). We measured the greatest clavicular diagonal on both sides, and the software automatically generated the maximum distance in millimeters. Relative and absolute frequencies described qualitative variables and mean values; quantitative variables used a 95% confidence interval. Value comparisons employed the student's t-test, and correlations determinations used Pearson's correlation coefficient. The significance level adopted was 5%. Results There was a significant difference between the clavicular length (right clavicle, 143.58 mm; left clavicle, 145.72 mm; p = 0.037), indicating asymmetry. On average, the left clavicle was 3.71 mm larger. Asymmetry was significant for both men and women (p < 0.001). The average difference was 4.13 mm for men and 3.23 mm for women. Seventy-three percent of the sample had < 5 mm of asymmetry, 23.7% had 5 to 10 mm, and 3.3% had > 10 mm of asymmetry. Conclusion The studied population did not present clavicular symmetry. On average, the left clavicle was longer than the right clavicle, with differences of 3.71 mm in the general sample, 3.23 mm in women, and 4.13 mm in men. The only significant factor was gender since men presented longer clavicles and higher differences than women.

Liver Fat Storage Is a Better Predictor of Coronary Artery Disease than Visceral Fat.

Fatty liver is one aspect of metabolic syndrome. The roles and contributions of fatty liver and visceral fat storage to coronary artery disease (CAD) are not clear. This study measured associations among visceral fat storage, fatty liver, insulin resistance, atherosclerosis, and CAD. Patients were divided into three groups: excess visceral fat (visceral fat area >330 ± 99 cm2), non-alcoholic fatty liver disease (NAFLD), and a control group. The definition of fatty liver is liver minus spleen density greater than or equal to -10. We defined early atherosclerosis as intima-media thickness of the common carotid artery >7 mm in men and >0.65 mm in women, measured with Doppler ultrasound. Visceral fat area was defined using CT (>330 ± 99 cm2). Insulin-resistance biomarkers (HOMA), CRP, and oxidant-antioxidant status (MDA-Paraoxonase) were also measured. Patients with high liver or visceral fat showed higher coronary plaque prevalence (50% (p < 0.001), 38% (p < 0.01), respectively vs. 25% in the control group), higher prevalence of coronary stenosis (30% (p < 0.001), 22% (p < 0.01) vs. 11% in the control group), higher intimal thickening (0.98 ± 0.3 (p< 0.01), 0.86 ± 0.1 (p < 0.01) vs. 0.83 ± 0.1 in the control group), higher HOMA (4.0 ± 3.0 (p < 0.005), 3.0 ± 1.0 (p < 0.001) vs. 1.5 ± 1.2 in the control group), and higher triglyceride levels (196.8 ± 103 (p < 0.005), 182.6 ± 90.87 (p < 0.005) vs. 145 ± 60 in the control group). Multiple logistic regression analysis showed that fatty liver predicted CAD (OR 2.7, 95% CI 2.3-4.9, p < 0.001) independently of visceral fat storage (OR 2.01, 95% CI 1.2-2.8, p < 0.001). Liver fat storage is a strong independent risk factor for CAD and carotid atherosclerosis and contributes more than visceral fat storage.

Anatomical and biometric study of the radial artery on human cadavers dissected in the anatomy laboratory.

To study the anatomy and biometry of the radial artery and to report the implications of this study for daily practice in Cardiac Surgery. Radial arteries from 45 human cadavers (28 males and 17 females, average age 79.2 (92) fixed in 10% formalin were dissected. The proximal and distal internal calibers and lengths of these radial arteries were measured. Our results showed the presence of a single radial artery variation in 2.3% of the entire sample (1.1% of the 90 dissected upper limbs). The distance between the epicondyle and the emergence of the radial artery was 32.4 (6.67) mm in men and 30.7 (9.00) mm in women, with an average of 31.8 (7.58) mm. For the right upper limb, the mean proximal internal caliber of the radial artery was 3.16 (0.56) mm and its mean distal internal caliber was 2.62 (0.66) mm. For the left upper limb, the mean proximal internal caliber of the radial artery was 3.17 (0.59) mm and its mean distal internal caliber was 2.64 (0.68) mm. The mean length of the left radial artery was 197.0 (17) mm. The mean length of the right radial artery was 201.0 (33) mm. It is very important to be aware of the possible anatomical variation of the radial artery. Despite its rarity, this knowledge may ensure a better safety and reliability of the harvesting technique for use as a graft.

Pathogenesis and management of abdominal aortic aneurysm.

Abdominal aortic aneurysm (AAA) causes ∼170 000 deaths annually worldwide. Most guidelines recommend asymptomatic small AAAs (30 to <50 mm in women; 30 to <55 mm in men) are monitored by imaging and large asymptomatic, symptomatic, and ruptured AAAs are considered for surgical repair. Advances in AAA repair techniques have occurred, but a remaining priority is therapies to limit AAA growth and rupture. This review outlines research on AAA pathogenesis and therapies to limit AAA growth. Genome-wide association studies have identified novel drug targets, e.g. interleukin-6 blockade. Mendelian randomization analyses suggest that treatments to reduce low-density lipoprotein cholesterol such as proprotein convertase subtilisin/kexin type 9 inhibitors and smoking reduction or cessation are also treatment targets. Thirteen placebo-controlled randomized trials have tested whether a range of antibiotics, blood pressure-lowering drugs, a mast cell stabilizer, an anti-platelet drug, or fenofibrate slow AAA growth. None of these trials have shown convincing evidence of drug efficacy and have been limited by small sample sizes, limited drug adherence, poor participant retention, and over-optimistic AAA growth reduction targets. Data from some large observational cohorts suggest that blood pressure reduction, particularly by angiotensin-converting enzyme inhibitors, could limit aneurysm rupture, but this has not been evaluated in randomized trials. Some observational studies suggest metformin may limit AAA growth, and this is currently being tested in randomized trials. In conclusion, no drug therapy has been shown to convincingly limit AAA growth in randomized controlled trials. Further large prospective studies on other targets are needed.

Investigation of maximum mouth opening in terms of age, weight, height and body mass index in Turkish adult population

ABSTRACT Introduction Maximum mouth opening (MMO) is an important finding in the detection of many diseases and conditions.The aim of this study is to determine the relationship of MMO level with age, gender, weight, height, BMI variables in adult individuals. Materials and Methods A total of 1582 participants, 806 women and 756 men, between the ages of 18–85 were included in the study. MMO, age, gender, weight, height and BMI values of the participants were recorded. Results Among the 1582 participants included in the study, the MMO value of men was 44.2 mm, while it was 40.29 mm in women. The MMO value of men was found to be higher than that of women (p < .05). A correlation was observed between MMO and height (p < .05). Conclusions In the study, a correlation was observed between MMO and height. The MMO value was found to be higher in men.

Associations of alcohol intake with subclinical carotid atherosclerosis in 22,000 Chinese adults

Background and aimsWe investigated the causal relevance of alcohol intake with measures of carotid artery thickness and atherosclerosis in Chinese adults. MethodsThe study included 22,384 adults from the China Kadoorie Biobank, with self-reported alcohol use at baseline and resurvey, carotid artery ultrasound measurements, and genotyping data for ALDH2-rs671 and ADH1B-rs1229984. Associations of carotid intima media thickness (cIMT), any carotid plaque, and total plaque burden (derived from plaque number and size) with self-reported (conventional analyses) and genotype-predicted mean alcohol intake (Mendelian randomization) were assessed using linear and logistic regression models. ResultsOverall 34.2% men and 2.1% women drank alcohol regularly at baseline. Mean cIMT was 0.70 mm in men and 0.64 mm in women, with 39.1% and 26.5% having carotid plaque, respectively. Among men, cIMT was not associated with self-reported or genotype-predicted mean alcohol intake. The risk of plaque increased significantly with self-reported intake among current drinkers (odds ratio 1.42 [95% CI 1.14–1.76] per 280 g/week), with directionally consistent findings with genotype-predicted mean intake (1.21 [0.99–1.49]). Higher alcohol intake was significantly associated with higher carotid plaque burden in both conventional (0.19 [0.10–0.28] mm higher per 280 g/week) and genetic analyses (0.09 [0.02–0.17]). Genetic findings in women suggested the association of genotype-predicted alcohol with carotid plaque burden in men was likely to due to alcohol itself, rather than pleiotropic genotypic effects. ConclusionsHigher alcohol intake was associated with a higher carotid plaque burden, but not with cIMT, providing support for a potential causal association of alcohol intake with carotid atherosclerosis.

Association between sonographic sling location and success of surgery for stress urinary incontinence.

To determine the relationship between the clinical outcome of suburethral sling surgery for stress urinary incontinence and sling location on ultrasound examination. This was a retrospective study of patients diagnosed with stress urinary incontinence who were treated with a suburethral sling by a single surgeon between January 2009 and October 2016. Four-dimensional volumes acquired on transperineal ultrasound at least 3 months postoperatively were analyzed and the gap between the sling and symphysis pubis (sling-pubis gap (SPG)) on Valsalva maneuver was measured. Continence was assessed on a cough stress test at follow-up. A total of 378 patients were included, with a mean follow-up of 14.3 months. The success rate of sling surgery was 89.4%. The mean ± SD SPG on Valsalva maneuver was 12.0 ± 2.5 mm in women who were clinically continent at follow-up and 14.1 ± 2.8 mm in those with failed surgery (P < 0.001). A shorter SPG on transperineal ultrasound imaging after suburethral sling surgery is associated with cure of stress urinary incontinence. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Left atrial strain is associated with atrial fibrillation recurrence after catheter ablation: Data from the ISOLATION registry

Abstract Funding Acknowledgements Type of funding sources: None. Background Catheter ablation (CA) has been established as an effective therapeutic option to achieve rhythm control in patients with atrial fibrillation (AF). However, AF recurrence occurs in approximately 45% of the patients undergoing CA. The association between AF recurrence after CA and left atrial (LA) strain, which is a surrogate marker of LA mechanical dysfunction already appearing before the enlargement of the LA, remains less clear. Aim The purpose of this study was to evaluate the association between LA function assessed by strain echocardiography and AF recurrence after CA. Methods This sub-study of ISOLATION (NCT04342312), involved consecutive patients with paroxysmal or persistent AF scheduled for first cryoballoon or radiofrequency CA. Clinical characteristics and echocardiography examination were collected at baseline visit before CA. Patients were followed for 12 months. Follow-up consisted of outpatient visits and heart rhythm monitoring (48 day Holter, 12-lead electrocardiogram, 7 day photoplethysmography-based rhythm app) at 3, 6, and 12 months. Results We analyzed 312 patients (median age 65, 36% women). More than half (52%; n=162) underwent radiofrequency CA and 84 (27 %) had AF recurrence within one year follow-up. No statistically significant differences in baseline characteristic were observed between patients with and without recurrent AF, expect higher prevalence of persistent AF prior to CA in patients with recurrence of AF (75% vs. 46%, p&amp;lt;0.001). LA reservoir strain (22 [14-33]% vs 29 [19-37]%, p=0.002), LA conduit strain (15 [9.6-19]% vs 17 [12-22]%, p=0.038) and LA contraction strain (7.5 [2.2-15]% vs 12 [5.8-16]%, p&amp;lt;0.001), were significantly lower, and mildly-to-severe LA dilatation (≥39mm in women and ≥41–in men) was more frequently observed (77% vs 64%, p=0.039) in patients with (vs without) recurrence of AF. Based on multiple logistic regression, LA contraction strain was an independent predictor for AF recurrence (OR 0.94, 95%CI 0.90-0.98) in all study group. LA contraction strain of ≤9.4% had a sensitivity of 61% and specificity of 58% for recurrence of AF after CA. In the group with normal LA (&amp;lt;39mm in women and &amp;lt;41–in men), LA reservoir strain was significantly associated with the risk for recurrence of AF (OR 0.94 [0.90–0.99]). Overall, LA reservoir strain of ≤29% in this group had a negative predictive value of 90% and sensitivity of 74% for recurrence of AF after CA (Figure 1). AF type was not predictive in this subgroup. In the group with mildly-to-severe enlarged LA, AF type remained strongly predictive for recurrence of AF (OR 3.38[1.82-6.25]), whereas LA strains did not. Conclusions LA function assessed by LA strain is associated with AF recurrence after CA, even in patients with non-dilated LA. Whether integration of results derived from systematic preprocedural LA strain analysis into patients’ selection strategies may help to identify patients profiting from CA required further study.

Catheter ablation of left atrial tachyarrhythmia: predictors of recurrence after catheter ablation

Abstract Funding Acknowledgements Type of funding sources: None. Background Differently from catheter ablation (CA) of atrial fibrillation (AF), outcome data on CA of atrial re-entrant arrhythmias are scarce. Purpose We sought to evaluate predictors of recurrence at follow up in this setting. Methods We analysed consecutive patients undergoing mapping and CA left atrial tachyarrhythmia. Three-dimensional high-density activation and voltage maps were created for each investigated tachycardia by means of CARTO® system. Left atrial (LA) size was measured as the anteroposterior diameter on parasternal long axis view on transthoracic echocardiogram. Severe LA enlargement was defined for LA diameter &amp;gt;47 mm in women and &amp;gt;52 mm in men in accordance with guidelines. Results Eighty-eight patients were considered (67 ± 9 years old, 45% males) undergoing 94 CA procedures (1.1 ± 0.3 per patient). Most patient had past medical history of pulmonary vein isolation (57%). In the investigated population, 120 tachycardia morphologies were mapped and ablated. Acute procedural success was achieved in 97% of cases without any major complication. After a mean follow-up of 17 ± 11 months, the overall freedom from atrial arrhythmia was 58% and 65% after single and repeat procedures, respectively. Severe LA enlargement was the only variable associated with arrhythmia recurrence at follow-up and it was consistent after single and repeat procedures (Figure 1 A-B). Conclusion CA of complex left atrial tachyarrhythmia is safe and effective, and the mid- and long-term outcome is improved when LA is not severely enlarged. CA of should therefore be considered early in this patient population to achieve better clinical outcome.

Women with large intact abdominal aortic aneurysms remain untreated

ObjectiveA lower elective repair rate among women with abdominal aortic aneurysms (AAAs) has been a consistent finding. Reasons behind this gender gap have not been thoroughly outlined. MethodsThis was a retrospective multicenter cohort study (ClinicalTrials.gov: NCT05346289) at three European vascular centers in Sweden, Austria and Norway. Patients in surveillance with AAAs were consecutively identified starting from January 1, 2014, until reaching a total sample size of 200 women and 200 men. All individuals were followed for 7 years through medical records. Final treatment distributions and the proportion of “truly untreated” (surgically untreated despite reaching guideline-directed thresholds: 50 mm for women and 55 mm for men) were determined. In a complementary analysis, a universal 55-mm threshold was used. Gender-specific primary reasons behind untreated statuses were clarified. Eligibility for endovascular repair among the truly untreated was assessed in a structured computed tomography analysis. ResultsWomen and men had similar median diameters at inclusion (46 mm; P = .54) and at treatment decisions (55 mm; P = .36). After 7 years, the repair rate was lower among women (47% vs 57%). More women were truly untreated (26% vs 8%; P < .001) despite similar mean ages as for male counterparts (79.3 years; P = .16). With the 55-mm threshold, 16% women still classified as truly untreated. Similar reasons for nonintervention were captured for women and men (50% due to comorbidities alone, 36% morphology and comorbidity). The endovascular repair imaging analysis revealed no gender differences. Among truly untreated women, ruptures were common (18%), and mortality was high (86%). ConclusionsSurgical AAA management differed between women and men. Women could be underserved in terms of elective repairs: one in every four women was untreated with over-the-threshold AAAs. The lack of obvious gender differences in eligibility analyses could imply unmeasured discrepancies (eg, in disease extent or patient frailty).

P206 DO WE NEED LOWER CUT–OFFS OF LEFT VENTRICULAR WALL THICKNESS TO SUSPECT CARDIAC TRANSTHYRETIN AMYLOIDOSIS IN WOMEN?

Abstract Background Echocardiographic reference values for interventricular septal (IVS) thickness (upper reference limit [URL] 11.2 mm in women vs. 12.4 mm in men), and posterior wall (PW) thickness (URL 11.5 mm vs. 12.3 mm, respectively) exist. According to a European Society of Cardiology position statement, cardiac amyloidosis (CA) should be suspected when left ventricular (LV) wall thickness is ≥12 mm and at least one red flag is present. Given the normal difference between men and women, a same cut–off might cause a diagnostic delay in women. Methods Consecutive patients diagnosed with amyloid transthyretin (ATTR)–CA at 3 centers were evaluated. Results The cohort included 302 patients (Pisa, n=215; Brescia, n=58; Trieste, n=29). Women (n=49, 16%) were older than men (median age 83 years [interquartile range 80–85] vs. 80 years [76–84], p=0.009), but their survival free from all–cause death (p=0.380) or heart failure (HF) hospitalization (p=0.381) did not differ significantly. N–terminal pro–B–type natriuretic peptide values (p=0.897), the proportion of patients with variant ATTR (p=0.369), the prevalence of hypertension (p=0.659), diabetes (p=0.629), or New York Heart Association class III–IV (p=0.613) were not different. LV ejection fraction was 53% (43–60%) in women vs. 50% (43–65%) in men (p=0.066), and tricuspid annular plane systolic excursion was 16 mm (13–20) in women vs. 16 mm (14–19) in men (p=0.674). Even relative wall thickness (RWT) did not differ significantly (0.61 [0.49–0.98] in women vs. 0.69 [0.57–0.87] in men; p=0.448). Conversely, women had lower IVS (15 mm [14–18] vs. 17 mm [15–20]) and PW thickness (13 mm [12–16] vs. 15 mm [13–17]). These differences disappeared when IVS and PW thicknesses were indexed for height (as m), height2,7, or body surface area: IVS, p=0.150, 0.212, 0.325, respectively; PW, p=0.309, 0.107, 0.743, respectively. Conclusions At the time of diagnosis, women with ATTR–CA are older, but their biventricular function, the pattern of LV remodeling, and final outcome did not differ significantly from men, suggesting a similar disease stage. Even indexed IVS or PW thicknesses are similar, while non–indexed measures may point to a less advanced disease and then be misleading. Indexed measures or sex–specific cut–offs (e.g., 11 mm in women vs. 12 mm in men) to suspect CA might be considered.

Adductor Pollicis Muscle Thickness and Its Relationship with Other Anthropometric Measurements: A Sample of Healthy Turkish Population

Objective: The aim of the authors of this study was to determine the reference values for the Adductor Pollicis Muscle Thickness (APMT) in individuals belonging to a healthy population and to compare these values with other anthropometric measurements. Materials and Methods: In this cross-sectional study, the APMT in the dominant and non-dominant hands of 385 healthy individuals categorized according to age and gender variables were measured with a caliper. Individuals in the “A” category according to the Subjective Global Assessment (SGA) test were included in the study, and anthropometric measurements. Results: In the study, 193 women and 192 men were included, and various anthropometric measurements were taken. The mean APMT values of the dominant and non-dominant hands were 20.87 ± 3.23 mm and 19.28 ± 2.93 mm in men and 16.78 ± 3.10 mm and 15.43 ± 2.92 mm in women, respectively, which indicates that there were significant differences between the members of the two genders and between the members of the same gender (p&amp;lt;0.001). There was a high level of positive correlation between the mean APMT values of the dominant hand and the mid-upper arm circumference (p&amp;lt;0.001). Conclusion: In this study, a high-level and positive correlation was found between APMT values and mid-upper arm circumference (MUAC), mid-upper arm muscle circumference (MUAMC) and mid-upper arm muscle area (AMA) values. APMT measurement emerges as a useful and new anthropometric measurement method in the assessment of the nutritional status of a person.

Oxidative Stress in Postmenopausal Women with or without Obesity.

Oxidative stress, a key mediator of cardiovascular disease, metabolic alterations, and cancer, is independently associated with menopause and obesity. Yet, among postmenopausal women, the correlation between obesity and oxidative stress is poorly examined. Thus, in this study, we compared oxidative stress states in postmenopausal women with or without obesity. Body composition was assessed via DXA, while lipid peroxidation and total hydroperoxides were measured in patient's serum samples via thiobarbituric-acid-reactive substances (TBARS) and derivate-reactive oxygen metabolites (d-ROMs) assays, respectively. Accordingly, 31 postmenopausal women were enrolled: 12 with obesity and 19 of normal weight (mean (SD) age 71.0 (5.7) years). Doubled levels of serum markers of oxidative stress were observed in women with obesity in women with obesity compared to those of normal weight (H2O2: 32.35 (7.3) vs. 18.80 (3.4) mg H2O2/dL; malondialdehyde (MDA): 429.6 (138.1) vs. 155.9 (82.4) mM in women with or without obesity, respectively; p < 0.0001 for both). Correlation analysis showed that both markers of oxidative stress increased with an increasing body mass index (BMI), visceral fat mass, and trunk fat percentage, but not with fasting glucose levels. In conclusion, obesity and visceral fat are associated with a greater increase in oxidative stress in postmenopausal women, possibly increasing cardiometabolic and cancer risks.

Impact of age on glenoid size: three-dimensional computed tomographic analysis of glenoid anatomy

ObjectivePredictors of glenoid size are not fully understood. Reported factors include ethnicity, sex, and height. However, many studies have been conducted with relatively younger age groups on the assumption that no significant change in the size of the glenoid fossa occurs after the termination of bone growth. The purpose of this study was to examine glenoid size in a population representing the age groups eligible for rotator cuff surgery and to identify the influence of age on the size of the glenoid. MethodsThis retrospective review included 380 shoulders in 380 patients (151 females and 229 males; mean age: 67.2 ± 10.1 years; range: 27–89 years) who underwent preoperative three-dimensional computed tomography (3D-CT) evaluation and elective shoulder surgery (open or arthroscopic). The exclusion criteria were: history of prior shoulder surgery or glenoid fractures; history of shoulder instability; patients aged younger than 25 years; and those with advanced glenohumeral osteoarthritis. Anatomic parameters of the glenoid (height and width) were measured using 3D-CT images. A generalized linear model with the gamma distribution (multivariate gamma regression) was used in the analysis with the glenoid size (height or width) as the dependent variable. Initial exploratory models included all independent variables, followed by the stepwise selection of variables based on the P value, variance inflation factor, and Akaike’s information criterion for developing the final models. ResultsThe final analytical model showed that age was a significant predictor in both glenoid height and width. The mean glenoid width was 31.2 mm in men and 26.1 mm in women, and the mean glenoid height was 41.1 mm in men and 38.8 mm in women. Other factors that were significant were sex, body height, and hand dominancy. The analysis models accounted for 65% of the glenoid height (pseudo r-squared = 0.65; likelihood ratio test, P = .011) and 73% of the glenoid width (pseudo r-squared = 0.73; likelihood ratio test, P < .0001). ConclusionThis study showed that predictors of glenoid size (height and width) included age. Other positive predictors were shown to be taller body height, male gender, and dominant hand. The influence of rotator cuff tear was not observed.