Occurrence Of Major Cardiovascular Events Research Articles

Effectiveness of polypill for primary and secondary prevention of cardiovascular disease: a pragmatic cluster-randomised controlled trial (PolyPars)

BackgroundWe aimed to investigate the effectiveness of fixed-dose combination therapy (polypill) for primary and secondary prevention of major cardiovascular diseases in a typical rural setting.MethodsThe PolyPars Study is a two-arm...

Comparative efficacy and acceptability of different exercise patterns for reducing cardiovascular events in pre-diabetes: protocol for a systematic review and network meta-analysis of randomised controlled trials

IntroductionExercise has been used to reverse dysglycaemic states in patients with pre-diabetes. Systematic reviews show that exercise is an effective way to reduce the incidence of diabetes, but there is...

Major cardiovascular events in patients with cardiovascular monosodium urate deposits in atherosclerotic plaques.

To determine the association of cardiovascular atherosclerotic plaque monosodium urate deposits with the occurrence of major cardiovascular events in gout and hyperuricemia patients. This retrospective cohort study included patients with clinically suspicion of gout, who performed a dual energy computed tomography of the affected limb and thorax between June 1st, 2012 and December 5th, 2019. Clinical and laboratory parameters were retrieved from patientś charts. Established cardiovascular risk factors were evaluated. Medical history review identified the presence of major adverse cardiac events with a median follow up time of 33 months (range 0-108 months) after the performed computed tomography scan. Full data sets were available for 189 patients: 131 (69.3%) gout patients, 40 (21.2%) hyperuricemia patients, and 18 (9.5%) controls. Patients with cardiovascular monosodium urate deposits (n = 85/189, 45%) revealed increased serum acute phase reactants, uric acid levels and calcium scores in computed tomography compared with patients without cardiovascular monosodium urate deposits. Major adverse cardiac events were observed in 35 patients (18.5%) with a higher prevalence in those patients revealing cardiovascular monosodium urate deposits (n = 22/85, 25.9%) compared with those without cardiovascular monosodium urate deposits (n = 13/104, 12.5%, OR 2.4, p= 0.018). This is the first study demonstrating the higher hazard of major adverse cardiac events in patients with dual energy computed tomography-verified cardiovascular monosodium urate deposits. The higher prevalence of cardiac events in patients with cardiovascular monosodium urate deposits may facilitate risk stratification of gout patients, as classical cardiovascular risk scores or laboratory markers fail in their proper identification.

Clinical Characteristics and Temporal Profile of Patients Referred to a Cardiac Centre for Stress Electrocardiography (ECG) in Southern Nigeria

Background: The stress electrocardiographic (ECG), is a dependable method for evaluating cardiovascular health and examining potential heart conditions like myocardial ischemia and arrhythmia. EST is rare in cardiac settings with limited data on diagnosis in the developing worlds. Our main goal was to determine the clinical characteristics of patients referred to our cardiac center. Methods: A retrospective cross-sectional study of adult patients aged (>18 years old) with low or intermediate pretest symptoms referred for EST to GoodHeart Medical consultant hospital between October 2019 and January 2023. Data included medication, smoking, alcohol, medical history, and symptoms. Results: In a study with 102 subjects (mean age: 49±16 years), 57.8% were aged 41-60, and 72.5% were males. Routine medical fitness and chest pain were common indications for EST. 80% of subjects with positive arrhythmia and 50% with positive ischemia had chest pain. None of the patient presenting for routine medical fitness had arrhythmia while 14.3% had ischemia. Arrhythmia correlated significantly with chest pain. Among those with positive ischemia, 71.4% were hypertensive and 64.2% were obese; none smoked or consumed alcohol. For positive arrhythmia cases, 70% were hypertensive and 80% were obese; 40%, 20%, and 10% smoked, consumed alcohol, and were diabetic, respectively. Conclusion: Majority of subjects that underwent the EST has normal result and the few that had positive ischemia 13.7% were referred for angiography and angioplasty while subject with positive arrhythmia 9.8% were recommended for Holter ECG and electrophysiology studies. The occurrence of major cardiovascular events was rare.

Prediction of adverse cardiovascular events in children using artificial intelligence-based electrocardiogram

BackgroundConvolutional neural networks (CNNs) have emerged as a novel method for evaluating heart failure (HF) in adult electrocardiograms (ECGs). However, such CNNs are not applicable to pediatric HF, where abnormal anatomy of congenital heart defects plays an important role. ECG-based CNNs reflecting neurohormonal activation (NHA) may be a useful marker of pediatric HF. This study aimed to develop and validate an ECG-derived marker of pediatric HF that reflects the risk of future cardiovascular events. MethodsBased on 21,378 ECGs from 8324 children, a CNN was trained using B-type natriuretic peptide (BNP) and the occurrence of major adverse cardiovascular events (MACEs). The output of the model, or the electrical heart failure indicator (EHFI), was compared with the BNP regarding its ability to predict MACEs in 813 ECGs from 295 children. ResultsEHFI achieved a better area under the curve than BNP in predicting MACEs within 180 days (0.826 versus 0.691, p = 0.03). On Cox univariable analyses, both EHFI and BNP were significantly associated with MACE (log10 EHFI: hazard ratio [HR] = 16.5, p < 0.005 and log10 BNP: HR = 4.4, p < 0.005). The time-dependent average precisions of EHFI in predicting MACEs were 32.4%–67.9% and 1.6–7.5-fold higher than those of BNP in the early period. Additionally, the MACE rate increased monotonically with EHFI, whereas the rate peaked at approximately 100 pg/mL of BNP and decreased in the higher range. ConclusionsECG-derived CNN is a novel marker of HF with different prognostic potential from BNP. CNN-based ECG analysis may provide a new guide for assessing pediatric HF.

Influenza vaccination and major cardiovascular risk: a systematic review and meta-analysis of clinical trials studies

Cardiovascular events remain a substantial global health concern, necessitating innovative strategies for prevention. This study aims to assess the potential impact of influenza vaccination on major cardiovascular events. A search of the medical English literature was conducted using PubMed/MEDLINE, EMBASE, and the Cochrane CENTRAL up to 1 August 2023. Meta-analysis and stratified analyses were performed to investigate specific outcomes, including myocardial infarction (MI), cardiovascular death, and stroke. Pooled relative risks (RR) along with their 95% confidence intervals (CI) were calculated to evaluate the associations. A comprehensive analysis was conducted on a total of 9059 patients, with 4529 patients receiving the influenza vaccine and 4530 patients receiving a placebo. Among patients who received the influenza vaccine, a notable reduction in the occurrence of major cardiovascular events was observed, with 517 cases compared to 621 cases in the placebo group (RR 0.70; 95% CI 0.55–0.91). The stratified analysis revealed a decreased risk of MI in vaccinated patients (RR 0.74; 95% CI 0.56–0.97) and a significant reduction in cardiovascular death events (RR 0.67; 95% CI 0.45–0.98). This study provides compelling evidence that influenza vaccination is associated with a decreased risk of major cardiovascular events, particularly myocardial infarction, and cardiovascular death. These findings highlight the potential of influenza vaccination as an adjunctive strategy in cardiovascular disease prevention. Further research and exploration of underlying mechanisms are warranted to elucidate the observed beneficial effects.

Predictors of major adverse cardiovascular events in patients with severe aortic stenosis awaiting aortic valve replacement

Abstract Background Severe aortic stenosis (AS) is a progressive disease associated with an increased risk of heart failure (HF) and mortality if left untreated. Aortic valve replacement (AVR) is the treatment of choice. However, it is not always immediately available, and some patients have experienced major cardiovascular events (MACE) while waiting for AVR. The identification of reliable predictors of MACE can help clinicians risk-stratify severe AS patients and tailor their management to prevent adverse outcomes. Purpose We aimed to evaluate predictors of MACE in real-world patients with severe AS who are waiting for AVR. Methods We conducted a prospective registry of consecutive patients discussed in the Heart Team meeting of a single centre, between January 2018 and June 2021. All patients with severe AS were included. For each patient we recorded demographic data, blood test results, echocardiogram parameters, and MACEs (a composite of death, HF hospitalization, non-fatal acute myocardial infarction, and non-fatal stroke). MACEs were recorded until the patient underwent AVR. The median follow-up time was 187 days (IQR 59-352). Results Overall, 235 patients were included (mean age 76.7±10.7 years, 48.1% male). Previous HF hospitalization (HR 2.77, 95% CI 1.66 – 4.62), HF symptoms with New York Heart Association (NHYA) class ≥3 (HR 2.64, 95% CI 1.58–4.39), and the presence of left ventricular dysfunction (HR 2.86, 95% CI 1.71–4.78) were independent predictors of MACE (Figure 1). The presence of pulmonary hypertension (HR 2.16, 95CI 1.27–3.66), but not right ventricular dysfunction (HR 2.34, 95CI 0.45–12.08, p=0.31), was associated with MACE until AVR. Concomitant moderate to severe tricuspid regurgitation (HR 10.88, 95CI 1.41–83.94) and moderate to severe mitral regurgitation (HR 5.91, 95CI 1.50–23.34) were associated with a worse prognosis, even when adjusted for other relevant MACE predictors. Laboratory data such as serum creatinine, haemoglobin, and NT-proBNP levels were not associated with the occurrence of MACE in this population (HR 1.00). Past medical history of hypertension, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease were not associated with MACE. Age was a limited predictor of MACE (HR 1.03, 95CI 1.00 – 1.06, p=0.04). Conclusion Previous HF hospitalization, NYHA class ≥3 symptoms, left ventricular dysfunction, and pulmonary hypertension were independent predictors of MACE in patients with severe AS awaiting AVR. Additionally, concomitant moderate to severe tricuspid and mitral regurgitation were also associated with worse prognosis. These findings may help identify those at high risk of MACE who would benefit most from early intervention and close monitoring.

Comparison of pulse wave velocity and hypertensive response to exercise in predicting incidence of resistant hypertension

Abstract Background Resistant hypertension (RH) is strongly associated with occurrence of major cardiovascular events and death. Hypertensive response to exercise (HRE) and arterial stiffness estimated by peripheral pulse wave velocity (PWV) are surrogate markers of incident hypertension, whereas their role in predicting RH development remains uncertain. Purpose Explore the predictive role of PWV and HRE in incident RH. Methods A Comparison of HRE and PWV in predicting development of RH was performed in retrospective study with a cohort of 198 patients with known coronary artery disease (CAD). The patients performed two Bruce protocol stress tests (STs) between 01/2009 and 12/2022. The first ST was used to assess HRE and estimated PWV (ePWV) in predicting occurrence of apparent treatment-resistant hypertension (aTRH). ePWV was calculated using age and blood pressure, as previously described (1). HRE response was defined either as systolic BP (SBP) &amp;gt; 210 mmHg or difference between peak and baseline &amp;gt; 60mmHg for men (&amp;gt;190 mmHg or 50 mmHg in women) (2). aTRH was defined as resting SBP above 140mmHg in the last ST despite simultaneous use of ≥3 different antihypertensive agents. The average time between STs was 4±3 years. The incidence of major adverse cardiovascular events (MACE: cardiovascular death, myocardial infarction, heart failure and stroke) were analyzed during the follow-up period of 10±3 years. Logistic and Cox regression models were used in time-to-event analysis. Data presented as: mean ± standard deviation; 95% confidence interval (CI) for odds ratios (OR); significance between groups p&amp;lt;0.05. Results The incidence of aTRH between STs was 15% (n=30), with 48% of them (n=14) receiving ≥4 or more antihypertensive drugs. aTRH vs non-aTRH were similar at baseline for sex (89% male, p=0.67), hypertension (HT, 62%,p=0.08), dyslipidemia (79%, p=0.86), smoke (46%, p=0.50), chronic kidney disease (13%, p=0.39), myocardial infarction (75%, p=0.39), heart failure (4.5%, p=0.40), but not for body mass index (30±3 vs 28±3 kg/m2, p=0.012) and diabetes (60.0 vs 28.6%, p=0.003) that were higher in the aTRH group. The average ePWV was 9.3±1.6 m/s (9.14±1.5 vs 10.2±1.7 m/s, non-aTRH vs aTRH p=0.001); 22.6% patients had HRE (20.4% vs 36.0%, non-aTRH vs aTRH, p=0.084). In contrast to HRE (adjusted OR=1.34, CI 0.4-4.3, p=0.62), ePWV was correlated with aTRH (adjusted OR=2.0, CI 1.1-4.1, p=0.024) after adjusting for age, comorbidities and anti-HT drugs, with an area under the ROC curve of 0.7 (CI 0.6-0.8). Both aTHR (OR=2.6, CI 1.2-5.8, p=0.017) and ePWV (adjusted OR=1.3, CI 1.2-5.8, p=0.024) were associated with MACE. Conclusion ePWV is a simple and robust marker that outperforms HRE in predicting aTRH and MACE in CAD patients. Higher ePWV values were independently associated with the incidence of aTRH. This study strengthens the importance of developing new strategies to control arterial stiffness in the treatment of RH and prevention of MACE.

GLP1 receptor agonists exhibit antioxidant and anti-inflammatory properties in human heart tissue via the canonical GLP1 receptor expression through a AMPK-mediated pathway

Abstract Background Clinical research has demonstrated that glucagon-like peptide-1 receptor (GLP1R) agonists (GLP1RA) can decrease the occurrence of major cardiovascular events in diabetic patients, regardless of their glycemic control. However, a significant challenge in understanding the positive effects of GLP1RA has been the lack of knowledge regarding the specific cellular types that express GLP1R. Despite the established cardiovascular benefits of GLP1RA, previous studies have been unable to confirm the expression of GLP1R in the heart. Aim The study aimed to investigate the expression and function of GLP1R in heart tissue. Methods We collected human cardiac tissue samples from 30 patients who underwent left ventricle (LV) biopsies (n=21) or right atrial (RA) appendage closure (n=9) at a university hospital. Gene expression levels were assessed using RT-qPCR, protein levels by Western blot analysis, in situ tissue localization of proteins by immunofluorescence (IF) staining, and the level of oxidative stress using dihydroethidium. Results LV biopsies and RA appendages showed a substantial heterogeneity in GLP1R mRNA levels. GLP1R mRNA levels exhibited a positive correlation with IL1B, IL6, TNFα, CCL2, CD68, ACE1, AT1R, and VCAM1 mRNA levels, but a negative correlation with NOS3 mRNA levels. High GLP1R expression in both RA appendages and LV biopsies was associated with increased oxidative stress levels, which were mitigated by the antioxidant N-acetylcysteine (NAC), NADPH oxidase inhibitor (VAS-2870), ACE inhibitor (perindoprilat), AT1R antagonist (losartan), TNF-α receptor neutralizing antibody (infliximab) and by GLP1R agonists (liraglutide and semaglutide) with inhibitory effects amounting to about 50-60 %. Exendin, a GLP1R antagonist reversed the effect of liraglutide and semaglutide which accounted for a receptor-mediated antioxidant effect. H-89, a PKA inhibitor equally reversed liraglutide and semaglutide effect on ROS generation suggesting a canonical GLP1R mediated effect involving the AMPK pathway. Conclusion These findings indicate that human cardiac GLP1R expression levels are correlated to low-grade inflammation and endothelial dysfunction. Increased expression levels of GLP1R were associated with higher levels of oxidative stress sensitive to GLP1RA in a canonical GLP1R AMPK-mediated manner. Therefore, the cardiovascular beneficial effects of GLP1RA might be attributable to their antioxidant and anti-inflammatory properties, specifically within the cardiac system.

Pulse wave velocity has an additive prognostic value to SCORE2 in apparently healthy subjects at 6 years of follow up

Abstract Backround/Aim: Arterial stiffness is involved in the clinical course of atherogenesis. The purpose of this study was to investigate whether altered arterial wall properties of confers predictively and additively to estimation of cardiovascular risk. Methods Pulse wave velocity carotid-femoral (PWVc-f), the gold standard method to assess arterial stiffness, was measured non-invasively by Complior device. Increased PWV(c-f), especially above 10 m/s, indicates increased arterial stiffness. We measured baseline PWV(c-f) in 747 apparently healthy subjects (51.99±13.41 years old, 43.8% males), without established cardiovascular disease and calculated SCORE2 in each subject according to ESC guidelines.We prospectively monitored the occurrence of major cardiovascular events (MACEs-death, myocardial infarction, stroke) during a 6-year follow-up period using electronic records and clinic visits. Results Fifty-seven MACEs were documented during follow-up. In univariate analysis, subjects with increased PWV were found to exert greater risk for MACEs (hazard ratio (HR):1.12, 95%CI: 1.09-1.15, p&amp;lt;0.001). PWV remained a significant predictor for MACEs in a model including sex, age, hyperlipidemia, diabetes, hypertension, current smoking, family history of coronary artery disease and treatment with ACEi/ARBs or lipid lowering agents after using backward elimination (HR:1.13; 95% CI: 1.08-1.18, p&amp;lt;0.001). PWV was an independent and additive predictor of outcome when added in a model including solely SCORE2 (HR:1.10; 95% CI: 1.07-1.14,p&amp;lt;0.001; Chi-square change:20.08, p&amp;lt;0.001; C-statistic increase from 0.592 to 0.685) and also in a model encompassing risk factors not included in SCORE2, namely diabetes (HR:1.07; 95% CI: 1.04-1.11,p&amp;lt;0.001; Chi-square change: 43.12, p&amp;lt;0.001; C-statistic increase from 0.613 to 0.698). The HR of PWV for the prediction of MACE remained similar in subjects younger or older than the age of 50 years (p&amp;gt;0.05). Conclusion Arterial stiffness is an independent and additive predictor to conventional risk factors and SCORE2 for adverse outcome at 6 years follow-up.

The Systemic Inflammation Index Predicts Poor Clinical Prognosis in Patients with Initially Diagnosed Acute Coronary Syndrome Undergoing Primary Coronary Angiography.

Systemic inflammation index (SII: neutrophil count * platelet count/lymphocyte count) is a new inflammatory marker that can reflect the degree of systemic inflammatory response after coronary artery disease (CAD). However, the predictive value of the SII for clinical prognosis in patients with initially diagnosed acute coronary syndrome (ACS) has yet to be thoroughly studied. Patients with initially diagnosed ACS who underwent primary coronary angiography in our hospital from January 2019 to April 2021 were included in this study. 757 patients with ACS who underwent primary coronary angiography were enrolled. According to the baseline SII level, the patients were divided into a high SII group and a low SII group. The primary endpoint was major cardiovascular events (MACEs), defined as cardiac death, non-fatal myocardial infarction (MI), and non-fatal stroke. At a median follow-up of 33.9 months, 140 (18.5%) MACEs were recorded. Receiver operating characteristic (ROC) curve analysis showed that SII's best cut-off value for predicting MACEs was 713.9*109/L. Kaplan-Meier survival curve analysis showed that the survival rate of the low SII group was higher than the high SII group (P<0.001). Compared with the low SII group, the risk of MACEs was significantly increased in the high SII group (89 cases (33.3%) vs.51 patients (10.4%), P<0.001). Univariate and multivariate Cox regression analysis manifested that high SII level was independently associated with the occurrence of MACEs in patients with ACS undergoing primary coronary angiography (adjusted hazard ratio [HR]: 2.915, 95% confidence interval (CI%): 1.830-4.641, P<0.001). Adding SII to the conventional risk factor model improved the predictive value of MACEs. This study showed that elevated SII was associated with adverse cardiovascular prognosis in patients with ACS undergoing primary coronary angiography, making SII a valuable predictor of poor prognosis in patients with ACS undergoing primary coronary angiography.

The new score predicts 1-year poor outcome in patients with successful percutaneous coronary intervention: Naples prognostic score

Aims: This study investigated the relationship between Naples prognostic score (NPS) and 1-year poor clinical outcomes in patients presenting with non-ST-segment elevation myocardial infarction (NSTEMI).&#x0D; Methods: The study included 121 patients who had NSTEMI and received successful PCI treatment. The researchers calculated NPS using the neutrophil/lymphocyte ratio, lymphocyte/monocyte ratio, serum albumin level, and total cholesterol. The patients were divided into two groups based on their NPS scores: those with scores of 0.1 and 2 and those with scores of 3 and 4. The study compared the occurrence of major cardiovascular events (MACE) such as 1-year all-cause mortality, 1-year nonfatal recurrent MI, and stroke between the two groups.&#x0D; Results: Patients with high NPS scores were observed to have significantly higher all-cause mortality than those with low NPS scores (23.9% vs. 9.3%, p=0.029). When the MACEs of the patients were compared, significantly higher MACE was observed in the high NPS group (39.1% vs. 18.7%, p=0.013).&#x0D; In multivariate logistic regression analysis, creatinine (OR:4,914, CI 95%: 1.310-18,433, p=0.018) and NPS 3-4 (OR:2.565, CI 95%: 1.093-6.017, p=0.030) were independent predictors of MACE.&#x0D; Conclusion: Composite MACEs of non-fatal recurrent MI, cerebrovascular accident, and all-cause death were higher at one year in patients with high NPS who underwent successful percutaneous intervention. High NPS is an indicator of MACE.

Low-density lipoprotein cholesterol reduction with immediate combination therapy of statin and ezetimibe compared to statin monotherapy after percutaneous coronary intervention.

Current guidelines recommend astepwise initiation of lipid-lowering therapy after percutaneous coronary interventions (PCI) in treatment-naïve individuals. Patients might benefit from an earlier and stronger low-density lipoprotein-cholesterol (LDL-C) reduction through upfront combination therapies. This retrospective study included patients without previous lipid-lowering therapy undergoing acute or elective PCI with stent implantation between January 2016 and December 2019. Patients initiated on statin monotherapy vs. acombination of statin and ezetimibe were compared. The primary endpoint was an LDL‑C reduction into the target range of < 55 mg/dL at 3 months. The secondary endpoint was the occurrence of major cardiovascular events (MACE). Atotal of 204 lipid-lowering therapy naive patients were included, of whom 157 (77.0%) received statin monotherapy and 47(23.0%) combination therapy. Median LDL‑C levels were higher in patients initiated on combination therapy vs. monotherapy (140 mg/dL, interquartile range, IQR, 123-167 mg/dL vs. 102 mg/dL, IQR 80-136 mg/dL, p < 0.001). The LDL‑C reduction was greater in patients treated with combination therapy vs. statin monotherapy (-73 mg/dL, -52.1% vs. -43 mg/dL, -42.2%, p < 0.001). While the primary endpoint was similar between groups (44.7% vs. 36.1%, p = 0.275), combination therapy significantly increased the proportion of patients achieving the treatment target in the presence of an admission LDL-C > 120 mg/dL (46.2% vs. 26.2%, p = 0.031). The rates of MACE were similar between the two groups (10.6% vs. 17.8%, p = 0.237) at amedian follow-up of 2.2 years, IQR 1.46-3.10 years. Immediate initiation of high-intensity statin and ezetimibe treatment might be considered as the default strategy in treatment-naïve patients with high admission LDL‑C undergoing PCI.

Left ventricular myocardial work for the prediction of postoperative outcomes in patients with bicuspid aortic stenosis.

Chronic elevation of left ventricular (LV) afterload contributes to adverse LV remodeling and myocardial impairment in bicuspid aortic valve (BAV) patients with severe aortic stenosis (AS). Incorporating LV afterload into global longitudinal strain (GLS) analysis, myocardial work facilitates early detection of LV dysfunction. The present study was to evaluate myocardial work in BAV patients with severe AS undergoing surgical aortic valve replacement (SAVR) and to evaluate its prognostic impact on early postoperative outcomes. Between January 2021 and March 2022, BAV patients with severe AS scheduled for SAVR were included and underwent comprehensive transthoracic echocardiography. Quantification of LV myocardial work was performed to obtain LV global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). Clinical outcome was defined as a composite of major cardiovascular events including mortality, myocardial infarction, stroke, acute kidney injury, low cardiac output syndrome and vascular complications during hospitalization or within 30 days after operation. Among 103 BAV patients with severe AS undergoing SAVR (mean age of 65 ± 9 years, 57.3% male), 22 experienced postoperative major cardiovascular events. BAV patients with major cardiovascular events demonstrated lower LV GWI (P < 0.001) and GCW (P = 0.002) along with elder age (P = 0.030), decreased LVGLS (P = 0.026) and right ventricular longitudinal strain (P = 0.019), and higher prevalence of abnormal average E/e' ratio (P = 0.029) than those without major events. Decreased LV GWI and GCW was independently associated with the occurrence of major cardiovascular events (P < 0.01 for adjusted OR). Multivariable logistic regression model including LV GWI demonstrated superior power than the model including LVGLS and yielded best discrimination for BAV patients with and without major cardiovascular events during early postoperative period. Echocardiography-based LV myocardial work overcomes the limitations of LVGLS and presents as a promising novel index for the early detection of functional myocardial damage and the optimization of intervention timing among BAV patients with severe AS.

Influence of pre-peritoneal vs. epidural levobupivacaine infusion on troponin I and BNP as predictors of cardiac injury in cancer patients undergoing major upper abdominal operations: A randomized controlled clinical trial

ABSTRACT Background Cancer patients undergoing major noncardiac surgery are more likely to experience perioperative morbidity and mortality due to myocardial damage. Methods Comparative study enrolled 80 patients with upper abdominal malignancies subjected to major abdominal surgeries. Of them, seventy-two patients were eligible and randomly assigned into two groups; Epidural catheter group (n = 37), received thoracic epidural infusion of levobupivacaine, and pre-peritoneal catheter group (n = 35), received preperitoneal infusion of levobupivacaine postoperatively. Primary endpoint was pain severity by NRS immediately after recovery, at 2, 4, 6, 12, 24, 36, and 48 hours. Secondary endpoints were: (1) Patient`s hemodynamics monitored for postoperative 48 hours. (2) Myocardial injury, confirmed by troponin I & BNP levels preoperatively and on postoperative day 1 and 2 (3) Time of first analgesic demand and total postoperative 48 h morphine consumption. (4) Cardiovascular side effects; hypotension, bradycardia & arrhythmia. (5) Morphine side effects; PONV Results NRS scores showed non-significant reduction at most study times between both groups with significant reduction in the ECI group at 6-, 12-, and 24-hour than other group. First analgesic demand was earlier in PCI group than ECI without significant difference, while total 48 h morphine consumption showed a significant reduction in ECI group than PCI group. Hemodynamics were comparable in both groups. Cardiac enzymes, Troponin I and BNP, showed non-significant differences over study time between both groups. Postoperative complications, PONV, were similar in both groups without any significance, but with more cases of hypotension and bradycardia in epidural group. No cases of myocardial injury or heart failure were reported. Conclusions Preperitoneal analgesia is an effective analgesic method comparable to epidural analgesia limiting the occurrence of major cardiovascular events in cancer patients undergoing major abdominal surgeries and can be utilized when epidural analgesia is not desired or forbidden.

1362-P: The Long-Term Cardiovascular Effects of Metformin on Patients with Newly Diagnosed Type 2 Diabetes

Objective: Metformin is the first pharmacological option for preventing and treating type 2 diabetes. However, the use of this drug in preventing cardiovascular disease associated with the development of newly diagnosed type 2 diabetes is unclear. We aimed to examine whether the metformin reduced the incidence of major cardiovascular events over a 20-year follow-up of patients with newly diagnosed type 2 diabetes. Research Design and Methods: We conducted a retrospective observational cohort study of 48,338 patients with type 2 diabetes from Anhui Provincial Hospital between January 1, 2000, and June 30, 2021. Data were collected for patients with newly diagnosed T2D (within 6 months) who did not have prior cardiovascular disease and took metformin at baseline were compared with those who did not using. The primary outcome was the first occurrence of major cardiovascular events including coronary heart disease (CHD), stroke, and hospitalization due to heart failure (HF). The multivariate Cox proportional hazards regression with inverse probability of treatment weighting. Propensity score matching (PSM) was conducted for reducing the biases of baseline characteristics. Results: After matching, newly diagnosed T2D patients who used metformin, compared with those who did not use, had significantly lower risk of HF (HR 0.51, 95% CI 0.28 to 0.93) and CHD (HR 0.37, 95% CI 0.13 to 1.09). No difference in the risk incident stroke (HR 0.89, 95% CI 0.68 to 1.17) was observed. In both the original and PSM groups, use of metformin can reduce the risk of CHD events from newly diagnosed T2D patients (adjusted HR 0.74; 95% CI 0.69-0.87; P = 0.029). Conclusions: In the present retrospective study, metformin use may be beneficial for preventing CHD and HF in newly diagnosed T2D patients. Further randomized controlled trials are needed to confirm these findings. Disclosure T.Yue: None. X.Wang: None. M.Zhao: None. J.Weng: None. S.Luo: None. X.Zheng: None.

Prognostic significance of calibrated integrated backscatter in patients submitted to transcatheter aortic valve implantation

Abstract Funding Acknowledgements Type of funding sources: None. Background There is a reported association between calibrated integrated backscatter (cIB) and myocardial fibrosis, mostly noted in cardiomyopathies and aortic stenosis cases. But whether this measure of myocardial ultrasound reflectivity could help predict outcomes in patients submitted to transcatheter aortic valve implantation has not been previously tested. Purpose To demonstrate whether cIB may help differentiate patients undergoing transcatheter aortic valve implantation (TAVI) at risk of major cardiovascular events. Methods Consecutive patients submitted to transfemoral TAVI between October 2020 and December 2021 were routinely imaged by echocardiography in the five days peri-procedure. Calibrated integrated backscatter was obtained from the parasternal long-axis view (PLAX) by subtracting pericardial cIB intensity from myocardial septal and posterior wall average cIB. Patients with poor PLAX views were excluded from the study. All measurements of cIB were performed at end-diastole. The primary endpoint was the occurrence of major cardiovascular events at one year of follow-up. Results A total of 184 patients underwent a TAVI procedure during the study period. Of these, 159 had a reasonable acoustic window for cIB measurement and were included in the study. Patient mean age was 81.1±6.1 years, and 58% were female. At baseline, 81% of patients had preserved left ventricle function, the mean aortic mean gradient was 44.8±15.1 mmHg, and the mean Euroscore II was 5.55±3.75. No significant association was found between cIB and TAVI-related major acute complications (21.02±10.4 vs 19.8±7.1 dB, p = 0.544). There was also no significant correlation of cIB with major cardiovascular events (19.71±7.25 vs 20.39±10.47 dB, p = 0.478) or with valve safety (19.59±7.07 vs 18.84±10.32 dB, p = 0.709), defined accordingly to the Valve Academic Research Consortium-2 consensus, at one-year follow-up. There was, however, a positive association between cIB and all-cause mortality (19.24±7.06 vs 22.92±9.36, p = 0.021) at one-year follow-up, with deaths occurring due to multiple causes, mainly cardiovascular, infectious, and neoplastic. Measured cIB was also significantly higher in patients with a pre-TAVI estimated glomerular filtration rate of less than 30 mL/min/1.73m2 (22.42±7.17 vs 19.56±6.88 dB, p = 0.043). Conclusion Higher cIB was not associated with a higher risk of major cardiovascular events or with valve safety in patients submitted to TAVI, but it can potentially have prognostic value in differentiating patients at increased risk of all-cause mortality.

#3018 CARDIOVASCULAR DISEASE AND DETECTION OF CLONAL HEMATOPOIESIS OF INDETERMINATE POTENTIAL IN THE CHRONIC KIDNEY DISEASE POPULATION

Abstract Background and Aims Cardiovascular disease (CVD) is the main cause of morbidity and mortality in patients with chronic kidney disease (CKD). Novel determination of clonal expansion of hematopoietic stem cells carrying mutations in certain genes is called Clonal hematopoiesis of indeterminate potential (CHIP), it is well known the association with an increased risk of hematologic malignancies but in general population, CHIP has been associated with increased mortality and increased cardiovascular risk. The aim of our study was to analyze the influence of CHIP on the risk of CVD and heart disease in the population with CKD. Method 128 patients with different degrees of CKD were roll in our prospective study in between September 1, 2020 and January 31, 2021. All of them have followed up in Nephrology clinics and any patient have previous cardiovascular pathology. For detection of silent heart disease was realized measurement of troponin I and NT-Pro-BNP in the blood using a microparticle chemiluminescence assay and the degree of coronary calcification was calculated by the computed tomography (CT): Agatston method. All the patients were prospectively followed up for 18 months, recording the occurrence of major cardiovascular events. For detection of CHIP massive sequencing was performed with Ion Chef System On-demand technology using Ion AmpliSeqTM Kit for Chef DL8. The data analysis was done with the Torrent SuiteTM software and Varsome software, following the criteria of the American College of Medical Genetics (ACMG). Results 36.7% of the patients presented CHIP (pathogenic and probably pathogenic mutations) and 24.2% (only pathogenic mutations). TET2 was the most frequently affected gene (21.1%). The percentage of patients with CHIP MPL gene mutation was 12,5%, DNMT3 7%, JAK 1,6% and ASXL1 0,8%. 9 patients developed major cardiovascular events (MACE). Using univariate Cox regression analysis, the presence of MACE was related to global coronary calcification (OR 1.001, 95% CI 1.001-1.001, p = &amp;lt; 0.001), NT-ProBNP (OR 1.090, 95% CI 1.050-1.132, p = &amp;lt; 0.001) but there was no relation to smoking (OR 2.796, 95% CI 0.750-10.415, p = 0.125). Patients with CHIP did not have a higher risk of MACE, although patients with DNMT3A mutations did have a higher risk (HR 6.637, 95% CI 1.443-30.533, p = 0.015) independently of other variables. Using multivariate logistic regression analysis, the presence of CHIP was not related to coronary calcification (OR 0.387, 95% CI 0.142-1.058, p = 0.387), nor was it related to troponin I or NT-Pro-BNP. Conclusion The presence of CHIP was not associated with a greater risk of silent heart disease or cardiovascular events, although DNMT3a mutations, analyzed independently, were associated with a greater number of cardiovascular events in our CKD population.

Subclinical coronary atherosclerosis, detected by computer tomography with coronary calcium score, and the occurrence of major cardiovascular events at 5 years of follow-up in a cohort of patients with systemic sclerosis

BackgroundSpreading data describe cardiovascular disease (CVD) as a growing cause of hospitalization in systemic sclerosis (SSc) patients. Although interstitial lung disease and pulmonary arterial hypertension (PAH) remain the principal causes of mortality, the presence of CVD has been shown to further increase mortality in SSc patients. Few and contrasting data are available on cardiovascular impairment, particularly of subclinical coronary arteries disease, in SSc patients. The aims of this study were: 1) to determine the demographic, clinical, and cardiovascular differences between the groups of SSc patients with and without subclinical coronary atherosclerosis (SCA) assessed by coronary calcium score; 2) to verify the performance of cardiovascular risk scores in SSc for detection of SCA major cardiovascular events (MCVE); 3) to evaluate the risk factors associated to MCVE in 5 years of follow-up in this study group of patients. MethodsSixty-seven SSc patients were enrolled in this study. SCA was assessed using quantification of coronary calcium score by computerized tomography, reported as Agatson. Evaluation of common cardiovascular risk scores, carotid plaques by Doppler ultrasonography, the history of peripheral artery disease (PAD), lipid profiles, and clinical and laboratiristic characteristics of SSc were assessed at baseline visits for each patient. Factors associated with the presence of SCA were assessed by multivariate logistic analysis. A five years prospective study was performed for the evaluation of MCVE occurrence and its possible predictors. ResultsThe prevalence of SCA was 42% (Agatston scores of 266.04 ± 455.9 units) in our group of SSc patients. Patients with SCA were principally older (p = 0.0001) and had higher rates of CENP-B antibodies (57% vs 26%; p = 0.009), pulmonary arterial hypertension (PAH) (25% vs 3%; p = 0.008), dysphagia (86% vs 61%; p = 0.027), and users of statins (36% vs 8%; p = 0.004), carotid plaque (82% vs 13%; p = 0.0001), PAD (79% vs 18%; p = 0.0001), and metabolic syndrome (25% vs 0%; p = 0.002) than patients without SCA. Metabolic syndrome (OR: 8.2, p = 0.0001), presence of a PAD (OR: 5.98, p = 0.031), and carotid plaque (OR: 5.49, p = 0.010) were the main factors associated with SCA in SSc patients, by multivariate regression analysis. MCVE occurred in 7 patients. By multivariate COX regression analysis unique predictor of MCVE in 5 years of follow-up in our SSc patients was the presence of PAH (HR: 10.33, p = 0.009). Of note, the contemporary presence of PAH and SCA (defined as "not pure" pattern of PAH) was observed in 71% of patients with the occurrence of MCVE ConclusionThis study evidenced the high presence of the new “not pure” pattern of PAH, which could worsen the outcome in SSc in a medium-term (5 years) observation period. Furthermore, our data confirmed a higher cardiovascular impairment in SSc due to the presence of both SCA, mainly associated with typical cardiovascular risk factors, and PAH, life-threatening complications of SSc, that is the principal cause of the occurrence of MCVE in our SSc patients. A careful assessment of cardiovascular involvement in SSc and a more aggressive therapeutic strategy for preventing CAD and treating PAH should be highly suggested to reduce MCVE in SSc patients.

Major Cardiovascular Events After Spontaneous Intracerebral Hemorrhage by Hematoma Location

Survivors of spontaneous (ie, nontraumatic and with no known structural cause) intracerebral hemorrhage (ICH) have an increased risk of major cardiovascular events (MACEs), including recurrent ICH, ischemic stroke (IS), and myocardial infarction (MI). Only limited data are available from large, unselected population studies assessing the risk of MACEs according to index hematoma location. To examine the risk of MACEs (ie, the composite of ICH, IS, spontaneous intracranial extra-axial hemorrhage, MI, systemic embolism, or vascular death) after ICH based on ICH location (lobar vs nonlobar). This cohort study identified 2819 patients in southern Denmark (population of 1.2 million) 50 years or older hospitalized with first-ever spontaneous ICH from January 1, 2009, to December 31, 2018. Intracerebral hemorrhage was categorized as lobar or nonlobar, and the cohorts were linked to registry data until the end of 2018 to identify the occurrence of MACEs and separately recurrent ICH, IS, and MI. Outcome events were validated using medical records. Associations were adjusted for potential confounders using inverse probability weighting. Location of ICH (lobar vs nonlobar). The main outcomes were MACEs and separately recurrent ICH, IS, and MI. Crude absolute event rates per 100 person-years and adjusted hazard ratios (aHRs) with 95% CIs were calculated. Data were analyzed from February to September 2022. Compared with patients with nonlobar ICH (n = 1255; 680 [54.2%] men and 575 [45.8%] women; mean [SD] age, 73.5 [11.4] years), those with lobar ICH (n = 1034; 495 [47.9%] men and 539 [52.1%] women, mean [SD] age, 75.2 [10.7] years) had higher rates of MACEs per 100 person-years (10.84 [95% CI, 9.51-12.37] vs 7.91 [95% CI, 6.93-9.03]; aHR, 1.26; 95% CI, 1.10-1.44) and recurrent ICH (3.74 [95% CI, 3.01-4.66] vs 1.24 [95% CI, 0.89-1.73]; aHR, 2.63; 95% CI, 1.97-3.49) but not IS (1.45 [95% CI, 1.02-2.06] vs 1.77 [95% CI, 1.34-2.34]; aHR, 0.81; 95% CI, 0.60-1.10) or MI (0.42 [95% CI, 0.22-0.81] vs 0.64 [95% CI, 0.40-1.01]; aHR, 0.64; 95% CI, 0.38-1.09). In this cohort study, spontaneous lobar ICH was associated with a higher rate of subsequent MACEs than nonlobar ICH, primarily due to a higher rate of recurrent ICH. This study highlights the importance of secondary ICH prevention strategies in patients with lobar ICH.