Presence Of Ischemic Heart Disease Research Articles

Retrospective Evaluation of Risk Factors for Ischemic Heart Disease in Patients with Dermatitis Herpetiformis

Background and Purpose: Some have proposed that the cardiovascular risk among individuals with DH differs from that of the general population. This study aimed to analyze cardiovascular risk factors in DH patients and compare them to a matched control group without DH or celiac disease.
 
 Methods: This was a retrospective hospital-based study involving patients diagnosed with DH, both clinically and histopathologically, along with age- and sex-matched control subjects without the disease. The presence of ischemic heart disease, and the risk factors including laboratory values, treatment and comorbidity histories were evaluated comparatively. (SPSS version 28.0). 
 
 Results: Thirty-five patients with DH and 49 controls were included. No significant difference was found between the DH patients and controls regarding the prevalence of ischemic heart disease (22.9% vs. 14.3%, p:0.312). Diabetes mellitus was significantly higher and HDL cholesterol levels were significantly lower in the DH group (respectively, p: 0.044 and p: 0.018). Celiac autoantibodies, the laboratory values, or treatments did not show any significant correlation with heart disease in DH.
 
 Conclusion: This study revealed that HDL cholesterol were significantly lower in DH patients compared to general population. More research is needed to optimize the cardiovascular health of DH patients.

A case of complex asphyxia sheds light on problems in the classification of asphyxias

Death from positional asphyxia is often an accidental event occurring when the victim’s body assumes a position which can compromise an effective respiration. Its diagnosis is usually not simple, because it needs to know the exact circumstance in which the body was found and the original positioning of all the body segments. In this case, a 41-year-old man with a history of opioid drugs abuse was found dead in a knee-chest position; the head was down on the floor with the face resting on a plastic bag. Pictures of the scene of death was taken while the body was still in its original position. At first, the main suspicion was that of a fatal overdose. Following the autopsy examination, completed by histological and toxicological examinations, the cause of death was determined as postural asphyxia secondary to intoxication by methadone, in the presence of ischemic heart disease. Some features, moreover, were typical of the death in head down position, and the prolonged knee-chest position was also associated with the obstruction of mouth and nose by the plastic bag, which may have contributed to the asphyxiation. These cases of “combined” asphyxia represent a challenge for the current classifications of asphyxia, which are very variable and not standardized, as we observe from a brief review of the literature. The elaboration of new systems of classification for asphyxias, which must be clear, simple and shareable, is necessary to avoid confusion in categorizing cases that present overlapping between several types of asphyxiation modalities.

Abstract 16234: Higher 30-Day Mortality Following Diagnostic Coronary Angiographies Performed at Community versus VA Hospitals Despite Similar Pre-Procedure Mortality Risk

Introduction: Polices to improve access increased referrals to VA community care (VACC), including diagnostic coronary angiography (DCA). Yet, studies showing higher mortality rates following percutaneous coronary intervention at VACC vs VA facilities (VAF), raise concern about VACC quality. Hypothesis: 30-day mortality following DCA would be greater at VACC vs VAF. Methods: We identified outpatient DCAs at VAF and VACC from October 2014-June 2019 (N=75,950) and were matched to balance DCAs on eight characteristics including baseline mortality risk. DCAs with same-day PCI, missing covariates or without a good match were excluded (n=33,060). Primary exposure was DCA at VACC (vs. VAF). We examined weighted characteristics of DCAs and 30-day mortality by VACC status; used weighted logistic regression, adjusting for Veterans’ age, race, rurality, insurance, distance to VAF, Elixhauser mortality risk score and presence of ischemic heart disease, to compare 30-day mortality following DCA at VACC vs VAF. We used instrumental variables analysis to explore any confounders. Results: Among 42,890 DCAs, 27% were at VACC. Weighted characteristics of DCAs were similar by VACC status; were predominantly among male, white race, older aged patients. VACC vs VAF patients had similar mean pre-DCA mortality risk scores (4.7 [SD 9.2]) vs 4.8 [SD 9.2]), respectively (SMD=-0.01). Overall, 30-day mortality was 0.9%; 2.5% at VACC and 0.4% at VAF (SMD=0.18). Overall, predicted probabilities of 30-day mortality were greater in VACC vs VAF (Figure 1).In weighted regression analysis, odds of 30-day mortality were greater in VACC vs VAF (aOR 7.07, 95% CI=4.88, 10.24, p lt0.001). Instrument variable analysis suggested selection on unobserved factors contributed to VACC assignment and mortality. Conclusions: Risk of 30-day mortality was greater following DCAs performed at VACC vs VAF, despite comparable baseline mortality risk. Further research is needed to explain this difference.

Incidence and Predictive Risk Factors for Post-Cataract Surgery Endophthalmitis in Ministry of Health Hospitals from 2012 to 2020

ABSTRACT Purpose Postoperative endophthalmitis is a devastating complication, leading to poor visual prognosis. The purpose of this study is to determine the incidence, risk factors, and visual outcome of post-cataract surgery endophthalmitis in Malaysia over a 9-year period (2012–2020). Methods Data from National Eye Database (NED), involving all patients who have undergone cataract surgery from January 2012 until December 2020 were analyzed. Results Total number of patients who had undergone cataract surgery between the year 2012 till 2020 were 231,281 patients (267,781 eyes). Incidence of POE in this population was 0.08%. Patient aged 70 and above (p-value 0.047), Malay ethnicity (p-value: 0.009), presence of ischemic heart disease, renal failure, diabetic retinopathy, and poorer preoperative vision were shown to have a higher risk of POE. Cataract surgeries done in KK-KKM, duration more than 45 minutes, use of general anaesthesia, and no IOL or ACIOL implantation were significantly more in POE patients. Multivariate analysis revealed Malay ethnicity, presence of ocular comorbidity, poor preoperative vision, ACIOL, and presence of intra-operative complication were predictive factors for POE. Conclusions Incidence of POE is low in the Malaysian population. Surgeons have to be aware that Malay ethnicity, presence of ocular comorbidity, poor preoperative visual acuity, placement of IOL and complicated cataract operation have higher risk of POE.

Vascular Disease Burden, Outcomes and Benefits with Empagliflozin in Heart Failure: Insights From the EMPEROR-Reduced Trial

Presence of ischemic heart disease impacts prognosis in patients affected by heart failure and reduced ejection fraction (HFrEF). It is not well known how the extent of vascular disease impacts prognosis and response to therapy in this setting. In this post hoc analysis of the EMPEROR-Reduced trial, outcomes, and the effect of empagliflozin, were assessed in study participants according to the extent (none vs. mono [1] vs. poly [≥2] vascular bed) of vascular disease. Vascular disease was defined as investigator-reported coronary artery disease (CAD), peripheral artery disease (PAD), and cerebrovascular disease at baseline. Cox proportional-hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Incidence rates are presented per 100 person-years (py) of follow-up. Of the 3,730 study participants enrolled, 1324 (35.5%) had no, 1879 (50.4%) had mono, and 527 (14.1%) had poly-vascular disease. Participants with poly-vascular disease tended to be older, male, and with history of hypertension, diabetes, and smoking. In the placebo arm, a significant higher risk for cardiovascular death existed in those with poly-vascular disease (HR1.57, 95%CI 1.02, 2.44 compared to no vascular disease). In adjusted analysis, the benefit of empagliflozin on cardiovascular death or HF hospitalization, HF hospitalization, cardiovascular death, renal composite endpoint, estimated glomerular filtration slope changes, and health status scores, were seen across the three groups (interaction P>0.05 for all) but were attenuated in those with poly-vascular disease. Adverse events were higher in those with poly-vascular disease but there were no major differences noted between empagliflozin or placebo assignment in the three groups. In patients with HFrEF, the extent of vascular disease is associated with the risk for adverse cardiovascular outcomes. Empagliflozin offers cardiovascular and renal benefits in HFrEF across the extent of vascular disease, but this benefit is attenuated in those with poly-vascular disease.

Coexistence of Metabolic Dysfunction-Associated Fatty Liver Disease and Chronic Kidney Disease Is a More Potent Risk Factor for Ischemic Heart Disease.

Background Metabolic dysfunction-associated fatty liver disease (MAFLD), defined as fatty liver with overweight/obesity, type 2 diabetes, or metabolic abnormalities, is a newly proposed disease. However, it remains unclear whether the coexistence of MAFLD and chronic kidney disease (CKD) is a more potent risk factor for ischemic heart disease (IHD). Methods and Results We investigated the risk of the combination of MAFLD and CKD for development of IHD during a 10-year follow-up period in 28 990 Japanese subjects who received annual health examinations. After exclusion of subjects without data for abdominal ultrasonography or with the presence of IHD at baseline, a total of 14 141 subjects (men/women: 9195/4946; mean age, 48 years) were recruited. During the 10-year period (mean, 6.9 years), 479 subjects (men/women, 397/82) had new onset of IHD. Kaplan-Meier survival curves showed significant differences in rates of the cumulative incidence of IHD in subjects with and those without MAFLD (n=4581) and CKD (n=990; stages 1/2/3/4-5, 198/398/375/19). Multivariable Cox proportional hazard model analyses showed that coexistence of MAFLD and CKD, but not MAFLD or CKD alone, was an independent predictor for development of IHD after adjustment for age, sex, current smoking habit, family history of IHD, overweight/obesity, diabetes, hypertension, and dyslipidemia (hazard ratio, 1.51 [95% CI, 1.02-2.22]). The addition of the combination of MAFLD and CKD to traditional risk factors for IHD significantly improved the discriminatory capability. Conclusions The coexistence of MAFLD and CKD predicts new onset of IHD better than does MAFLD or CKD alone.

Peripheral arterial disease in hemodialysis patients 10 years later

Background and objectivePatients with chronic kidney disease (CKD) on hemodialysis present high cardiovascular comorbidity. Peripheral arterial disease (PAD) is associated with higher mortality and the interest in its early detection and treatment is increasing. The objective of this study is to determine the frequency and severity of symptomatic PAD, and to establish its relationship with mortality in HD patients that have received treated early and compare them with a cohort of our center already reported. Material and methodsRetrospective study on a cohort of incident patients since 2014 and followed up until December 2019. Demographic data, cardiovascular risk, the presence of symptomatic PAD at baseline and during follow-up were collected. Trophic lesions were graded using the Rutherford scale. ResultsInitially, there were 91 patients and 7 cases that were not included in the study were lost to follow-up. Age 64 ± 16 years, men 51.6% (47/91). The percentage of baseline PAD was 10.7% (9/84). During a median follow-up of 35 months (20−57), the diagnosis of PAD increased to 25% (21/84). Half of the patients with PAD 52.38% (11/21) obtained a score greater than 3 in the Rutherford Clinical Classification, which corresponds to severe disease. 13/21 patients required reoperation due to recurrence of symptoms (61.9% of cases with PAD).The development of PAD was significantly associated with: an elevated index of Charlson (3.9±2.1 vs. 7.7 ± 3.5; P = 0.001),being male (19 vs. 2; P = 0.001), diabetic (no: 7; yes: 15; P = 0.001) and with a history of chronic ischemic heart disease (no: 13; yes: 8; P = 0.001), 38.1% (8/21) had ischemic heart disease in patients who developed PAD, while in the absence of PAD the presence of ischemic heart disease was 9.5% (6/63). Furthermore, more than half (66.7% [14/21]) of those who developed PAD were diabetic.Univariate analysis showed that age, C reactive protein, albumin, and number of surgical interventions, but not PAD, were associated with mortality. In the multivariate analysis adjusted for other factors, only C reactive protein was related to overall survival Exp β: 2.17; P = 0.011; CI (1.19–3.97). Regarding cardiovascular mortality, in the multivariate Cox analysis, only PAD was related to mortality of cardiovascular origin Exp β: 1.73; P = 0.006; CI (1.17–2.56). ConclusionsA significant number of patients on hemodialysis develop PAD requiring peripheral vascular surgery. PAD was not associated with overall mortality in our cohort, but it did show an association with cardiovascular mortality. Prospective studies with a larger sample size are necessary. New surgical treatments and Follow-up by vascular surgeons could improve the severity of PAD and the long-term prognosis.

A Retrospective Analysis of Risk Factors for Mortality during Hemodialysis at a General Hospital that Treats Comprehensive Diseases.

Objective We analyzed adverse events retrospectively during a three-year follow-up of patients undergoing hemodialysis at the dialysis center of our general hospital that can treat comprehensive diseases and conducted an exploratory study focusing on the risk factors that determine the prognosis of hemodialysis patients. Methods A total of 132 hemodialysis patients at our dialysis center as of June 2017 were included in the study. Data on event incidence, including death and various clinical indicators, were collected in the electronic medical record for three years until June 2020. Results Between June 2017 and June 2020, 33 of the 132 patients died. The mortality group had a lower body mass index (BMI) and a longer duration of hemodialysis already carried out with more preexisting upper gastrointestinal (GI) bleeding, infections, ischemic heart disease (IHD), and malignancy than the survival group. Furthermore, the mortality group took more warfarin, aspirin, proton pump inhibitors and less H2 blockers than the survival group. Occurrence of upper or lower GI bleeding was similar between the mortality and survival groups. In a univariate analysis for mortality, the odds ratio was significantly higher for a low BMI (<18), long duration of hemodialysis, history of upper GI bleeding, and presence of IHD. Multivariable-adjusted odds ratios for mortality were significantly higher for cases with a history of upper GI bleeding and BMI <18. Conclusion A history of upper GI bleeding and low BMI may be poor prognostic factors of hemodialysis patients. Careful management of upper GI bleeding and a low BMI are required during the initiation of hemodialysis.

The value of cardiopulmonary exercise testing and stress echocardiography in the prediction of all-cause mortality in adults with end-stage renal disease

ABSTRACT We aimed to assess the prognostic utility of different parameters routinely assessed from cardiopulmonary exercise testing (CPET) and exercise echocardiography in adults with end-stage renal disease (ESRD). Forty-two ESRD (37 male) individuals (age: 58 ± 13 years, height: 169.30 ± 8.30 cm, weight: 81 ± 15 kg, body surface area: 1.92 ± 0.20 m2) underwent a maximal/symptom limited CPET, with a full cross-sectional echocardiogram performed at baseline and peak exercise. All participants were prospectively followed over a 10-year period, with all-cause mortality as the primary endpoint. After the follow-up period, a total of 19 participants (45%) died. Left atrial size (4.70 ± 0.70 vs. 3.65 ± 0.50 cm, P < 0.001) and anteroseptal wall thickness (1.28 ± 0.40 vs. 1.06 ± 0.02 cm, P = 0.002) were significantly greater in those that died, while peak heart rate was significantly lower (108 ± 12 vs. 128 ± 14 bpm, P < 0.001). The prevalence of myocardial ischaemia (13 vs. 8 participants, P = 0.03) was significantly greater, while peak VO2 (9.80 ± 2.10 vs. 15.90 ± 4.30 ml·kg−1·min−1, P < 0.001) was significantly lower in those that died. Following multivariate cox regression, myocardial ischaemia (Hazard Ratio 3.08; 95% Confidence Interval 1.09–8.70; P = 0.03) and peak VO2 (HR 0.73; 95% CI 0.64–0.84; P < 0.001) were significant independent predictors of 10-year all-cause mortality. This is the first study to establish peak VO2 as powerful marker of all-cause mortality when assessed with clinical, resting and stress echocardiography parameters in people with ESRD over a 10-year follow up period. This observation indicates that, in clinical practice, CPET and exercise echocardiography may serve as valuable tools for the risk stratification of individuals with ESRD. Highlights We aimed to assess the prognostic utility of cardiopulmonary exercise testing (CPET) and exercise echocardiography in end-stage renal disease (ESRD) with 10-year mortality. Peak aerobic capacity and the presence of ischaemic heart disease were independently associated with all-cause mortality. This observation indicates that, in clinical practice, CPET and exercise echocardiography may serve as valuable tools for the risk stratification of individuals with end-stage renal disease.

Sudden Death in Men Versus Women with Heart Failure.

Sudden cardiac death (SCD) represents the most feared complication of heart failure (HF). This review intends to provide insight on our current knowledge of sex differences in SCD mechanisms, prevention, and management in HF patients. Women with HF present a better prognosis than men and have a lower incidence of SCD, irrespective of the presence of ischemic heart disease and age. The influence of sex hormones, sex differences in intracellular calcium handling, and a differential myocardial remodeling may explain such a gap between men and women. Both HF drugs and ventricular arrhythmias ablation seems also useful for the management of women at risk of SCD, but special care must be taken with the use of antiarrhythmic QT-prolonging drugs. However, implantable cardioverter defibrillator (ICD) use has not been shown to be equally effective in women than men. Sex-specific recommendations regarding SCD in HF are still lacking due to the scarcity of information and the under-representation of women in clinical trials. Further investigation is required to provide specific risk stratification models in women. Cardiac magnetic resonance imaging, genetics development, and personalized medicine will probably play an increasing role in this evaluation.

Impact of Arterial Calcification of the Lower Limbs on Long-Term Clinical Outcomes in Patients on Hemodialysis

Lower limbs' arterial calcification is significantly associated with the clinical severity of lower extremity artery disease (LEAD) in patients undergoing hemodialysis (HD). However, the association between arterial calcification of the lower limbs and long-term clinical outcomes in patients on HD has not been elucidated. Calcification scores of the superficial femoral artery (SFACS) and below-knee arteries (BKACS) were quantitatively evaluated in 97 HD patients who were followed for 10 years. Clinical outcomes, including all-cause and cardiovascular mortality, cardiovascular events, and limb amputation were evaluated. Risk factors for clinical outcomes were evaluated using univariate and multivariate Cox proportional hazard analyses. Furthermore, SFACS and BKACS were divided into three groups (low, middle, and high), and their associations with clinical outcomes were evaluated using Kaplan-Meier analysis. SFACS, BKACS, C-reactive protein, serum albumin, age, diabetes, presence of ischemic heart disease, and critical limb-threatening ischemia were significantly associated with 3-year and 10-year clinical outcomes in the univariate analysis. Multivariate analysis showed that SFACS was an independent factor associated with 10-year cardiovascular events and limb amputations. Kaplan-Meier life table analysis showed that higher SFACS and BKACS levels were significantly associated with cardiovascular events and mortality. In conclusion, long-term clinical outcomes and the risk factors in patients undergoing HD were evaluated. Arterial calcification of the lower limbs was strongly associated with 10-year cardiovascular events and mortality in patients undergoing HD.

Risk factor structure of heart failure in patients with cancer after treatment with anticancer agents’ assessment by big data from a Japanese electronic health record

As the prognosis of cancer patients has been improved, comorbidity of heart failure (HF) in cancer survivors is a serious concern, especially in the aged population. This study aimed to examine the risk factors of HF development after treatment by anticancer agents, using a machine learning-based analysis of a massive dataset obtained from the electronic health record (EHR) in Japan. This retrospective, cohort study, using a dataset from 2008 to 2017 in the Diagnosis Procedure Combination (DPC) database in Japan, enrolled 140,327 patients. The structure of risk factors was determined using multivariable analysis and classification and regression tree (CART) algorithm for time-to-event data. The mean follow-up period was 1.55 years. The prevalence of HF after anticancer agent administration were 4.0%. HF was more prevalent in the older than the younger. As the presence of cardiovascular diseases and various risk factors predicted HF, CART analysis of the risk factors revealed that the risk factor structures complicatedly differed among different age groups. The highest risk combination was hypertension, diabetes mellitus, and atrial fibrillation in the group aged  ≤ 64 years, and the presence of ischemic heart disease was a key in both groups aged 65–74 years and 75 ≤ years. The machine learning-based approach was able to develop complicated HF risk structures in cancer patients after anticancer agents in different age population, of which knowledge would be essential for realizing precision medicine to improve the prognosis of cancer patients.

1283 MEDICATION-RELATED HARM (MRH) IN OLDER PEOPLE AFTER LEAVING HOSPITAL - AN UNDER-REPORTED EGYPTIAN CHALLENGE

Abstract Introduction Ageing is associated with multimorbidity, polypharmacy and medication-related harm (MRH). A 2013 systematic review reported only one study of medication errors (MEs) in older Egyptian patients. Our study investigated MRH (adverse drug reactions (ADR), drug errors, and non-adherence) in older Egyptian adults after hospital-discharge. Methods Between 2018 and 2020, we recruited 400 Egyptian patients, aged ≥60 years on discharge from Geriatrics and Internal Medicine wards from 3 hospitals, and followed them up for 8 weeks. Study procedures adopted a modified PRIME trial methodology (1). Results The average age of study participants was 71 (range 60 to 93, SD +/- 6.29) years with 53% females. In the cohort of 325 patients completing follow up, MRH occurred in 99 patients (incidence of 30.5%), with 5 patients (5.1%) experiencing a fatal MRH. Almost two thirds (65.7%) of MRH events were secondary to ADRs, 2 % related to non-adherence, 18.2 % due to both ADR and non-adherence, and 14% related to MEs. Multivariate logistic regression analysis showed that non-adherence (p-value 0.000, OR- 95% CI: 36.029), inappropriate prescription using Beer’s criteria (p 0.000, OR- 95% CI: 6.589), length of stay &amp;gt;7days (p 0.001, OR- 95% CI: 6.176), presence of Ischaemic Heart Disease (IHD) (p 0.000,OR- 95% CI: 5.695), Platelets count ≤ 245X 109/L (p 0.021, OR- 95% CI: 2.640), and dementia medications (p 0.017, OR- 95% CI: 4.616) were all significantly associated with MRH. Conclusions Medication-related harm in older Egyptian adults is common after hospital discharge. An integrated care pathway is required targeting high-risk older patients. Reference 1. Stevenson J, Parekh N, Ali K et al. Protocol for a Prospective (P) study to develop a model to stratify the risk (RI) of medication (M) related harm in hospitalized elderly (E) patients in the UK (The PRIME study). BMC Geriatrics 2016; 16: 22. https://doi.org/10.1186/s12877-016-0191-8.

A novel scoring system to predict cardiac device implantation in patients presenting with syncope

Abstract Background Cardiac syncope occurs when the heart fails to maintain cardiac output to match cerebral need and can occur due to either mechanical/structural defect of the heart or secondary to an arrhythmia. It has a raised 1-year mortality with some figures estimating this as high as 30%. Implantable loop recorders (ILR) are a useful diagnostic tool in patients presenting with syncope or pre-syncope to ascertain a cardiac cause. A higher number of patients are presenting with advancing age and undergoing ILR implantation. Subsequently, they end up requiring a cardiac implantable electronic device (CIED) implantation, adding to additional costs, exposure to procedural complications and frequent hospitalisations. Purpose To investigate the number of patients undergoing CIED implantation following implantation of ILRs for syncope and identify predictors of CIED implantation in patients presenting with syncope. Methods A retrospective analysis of 736 patients who underwent ILR implantation at our teaching hospital trust between November 2012 to October 2020. Data on demographics, clinical characteristics, pathology results, ECGs, holter findings and CIED implanted was collected using the local electronic patient record system. The data was analysed using SPSS software. Univariable and multivariable regression analysis and ROC curve analysis was carried out to determine prediction model for CIED implantation. Results The mean age of patients who underwent an ILR implantation was 65±19 years. 22% of patients required CIED implantation, 68% of patients did not require a cardiac device and were safely discharged and 10% of patients died during follow up. Age (p&amp;lt;0.001), male sex (p=0.006), impaired left ventricular function (p=0.04) and presence of hypertension (p=0.04) were found to be independent predictors of CIED implantation on univariable and multivariable regression analysis (see Table 1). Conclusions Old age, presence of coronary artery disease, impaired left ventricular function and presence of hypertension are inter-linked and in our study were found to be key predictors of poor prognosis and thus requiring CIED implantation. We propose a scoring system based on age &amp;gt;75, male sex, presence of ischaemic heart disease, heart failure and hypertension as key markers of conduction abnormalities requiring CIED implantation (see fi−ure 1). Funding Acknowledgement Type of funding sources: None.

Particularities of Catheter Ablation in Women with Atrial Fibrillation and Associated Ischemic Heart Disease.

Background: Atrial fibrillation is more common in men, but in the presence of ischemic heart disease, this arrhythmia is more frequent in women. However, like in coronary heart disease, women with atrial fibrillation are suboptimally treated. Methods: To identify particularities of ablation, in women with atrial fibrillation and ischemic heart disease. Results: 29 women and 26 men, with documented ischemic heart disease and atrial fibrillation, who underwent catheter ablation, were admitted in the study. No significant differences were registered regarding the heart rate control treatment. Electrical cardioversion was significantly higher in men, while pharmacological cardioversion was predominantly recommended in women. The ablation was performed later in women, after 2.55 ± 1.84 years versus 1.80 ± 1.05 in men (p = 0.05). The time elapsed until the ablation was performed was statistically correlated with atypical symptomatology and with the number of antiarrhythmics used prior to the ablation. There were no significant differences for the relapse of atrial fibrillation at 3 months. Quality of life at 3 months after ablation was increased in both groups. Conclusion: Catheter ablation is performed much later in women, and the causes responsible for this delay would be more atypical symptoms and a greater number of antiarrhythmics tried before the ablation.

Hormonal characteristics of androgen status and their relationship with the anthropometric and metabolic parameter in men depending on the severity of hypertension

Background. According to the literature data, long-term and poorly controlled hypertension (HTN) leads to target organs damage, and in some cases, to the development of associated diseases, the severity of which in men may be partly due to the characteristics of the androgenic status.The aim: to reveal the features of hormonal indicators of androgen status and their relationship with the anthropometric and metabolic characteristics of the therapeutic clinic male patients, depending on the severity of HTN.Materials and methods. 296 men aged 59,0 [54,0; 65,0] years with confirmed HTN were examined. All study participants in the morning on an empty stomach underwent anthropometry, determination of metabolic and androgenic status, and assessment of comorbid burden. Depending on the severity of hypertension, all patients were divided into two groups (G): G1 (n = 134) – patients with hypertension without a history of coronary artery disease or stroke; G2 (n = 162) – patients with hypertension with a history of ischemic heart disease (IHD) and/or stroke.Results. In male patients of G2 with severe HTN, a decrease in the levels of free testosterone (FT) and, to a greater extent, dehydroepiandrosterone sulfate (DHEA-S), as well as total cholesterol, high and low density lipoproteins, was revealed. The correlation analysis performed revealed statistically significant negative correlations between the levels of total testosterone (TT) and FT with body mass index, the value of the ratio of waist circumference to hips, only the level of FT – with the presence of IHD, chronic heart failure (CHF), disorders of carbohydrate metabolism and abdominal type of fat distribution, and the level of DHEA-S – with the presence of IHD and CHF.Conclusion. A decrease in FT and DHEA-S is associated with early progression of atherosclerosis and the risk of developing HTN-associated cardiovascular events, which can aggravate the course of HTN.

Cardiovascular risk factors in young patients presenting with STEMI in a city of South Europe

Background and Aims : The presence of ischaemic heart disease and Acute Coronary Syndromes (ACS) in young patients are becoming more frequent in our society nowadays. However, there is little information published about this population, especially in the area of South Europe, where we cannot find large series of young patients. Furthermore, there are socio-demographic differences between North and South Europe, which may have an influence over the prevalence of risk factors in this population. Our aim is to describe the prevalence of risk factors in one population of young patients admitted to our hospital with the diagnosis of ST elevation myocardial infarction (STEMI).

1148-P: Risk Factor Control and Risk of Hospitalization for Heart Failure in Diabetic Patients

Both diabetes and ischemic heart disease (IHD) are important risk factors for heart failure hospitalization. We investigated the association between the degree of risk-factor control and risk of heart failure in diabetic patients with and without IHD. A total of 20,9diabetic patients from UK Biobank were included, and matched with 82,582 controls based on age, sex, the presence of IHD, and assessment center. Risk-factor control was evaluated by 3 factors: glycated hemoglobin &amp;lt;53 mol/mol, blood pressure &amp;lt;140/90 mm/Hg and non-HDL-cholesterol &amp;lt;130 mg/dl. The Cox regression model was used to assess the association between the number of risk-factor control and the risk of heart failure. During a mean follow-up of 8.7 years, 1,139 incident heart failure hospitalization were documented. Higher degree of risk-factor control was significantly associated with a lower risk of heart failure in diabetic patients without IHD, but not in diabetic patients with IHD (P-interaction=0.008) . Moreover, as compared with non-diabetic controls, the diabetes-related excess risk of heart failure became diminished when all the three risk factors were under control in diabetic patients without IHD; the hazard ratio for heart failure was 1. (95%, CI, 0.85-1.49) . Our findings highlight the importance of early intervention for controlling cardiovascular risk factors in preventing heart failure, especially before the onset of IHD. Disclosure H.Ma: None. X.Wang: None. Y.Heianza: None. L.Qi: None.

ACHIEVED BLOOD PRESSURE LEVELS, COMORBIDITIES AND ONE YEAR PROGNOSIS OF ANTICOAGULATED PATIENTS WITH ATRIAL FIBRILLATION

The aim of the study was to analyze clinical characteristics of the consecutive sample of patients with atrial fibrillation admitted to Saint Anna University Hospital, ESH Excellence center of hypertension.Consecutive sample of 215 patients with AFib (112 M, 103 F; age 70.5) was enrolled 2017-2019. Data were collected during hospitalization and the patients were followed for one year for the occurrence of death/ischemic events and bleeding. BP was measured in a sitting position using an automatic validated device. In the present analysis we report the associations of mean achieved BP during the year (an average 6,8 BP measurements) with the key ischemic outcomes.Mean CHADSVASC was 3,77 ± 1.8 and HASBLEED 2,91 ± 1,3 with 191 (88.8%) and 127 (59.1%) of patients having CHADSVASC= > 2 and HASBLEED= > 3. Arterial hypertension was the most frequent risk factor in 88.4% (average duration of 17.7 ± 9 years). Previous history of myocardial infarction or stroke, obesity, heart failure and chronic kidney disease were established in 27,9%, 23.3%, 52.6%, 79,5% and 55.8%. OAC therapy was changed in approximately 23% during the year. Average BP values were 136/84.7 mmHg at admission and mean achieved BP during the follow-up were 129.7/81.9 mmHg. The annual event rates for death/ischemic events were 19.1%, for cardiovascular death 7% and for all cause bleeding 20%. Factors, associated with subsequent ischemic events includes higher CHADSVASC (4.2 vs 3.6) and HASBLEED (3.6 vs 2.7), presence of CKD (eGFR Epi < 60 ml/min) and worsening of CKD during the year (-6.7 ml/min vs - 1 ml/min). On treatment SBP> 130 mmHg and < 110 mmHg was associated with death/ischemic events compared with SBP 120-130 mmHg, HR 2.42 (0.9-5.4) and 2.76 (1-7.6) respectively. Similar patterns were observed for DBP with an increased risk at < 70 mmHg HR 1,52 (0.9-2.56) and > 90 mmHg HR 2,31 (1,1-8.1). Factors associated with unfavorable outcomes at low achieved BP < 120/80 were the presence of ischemic heart disease, CKD or heart failure.The presence of comorbidities mediate the effect of blood pressure on prognosis for ischemic complications especially at low achieved levels of BP.

TOTAL DİZ PROTEZİ UYGULANAN HASTALARDA OBESİTE VARLIĞININ İNTRAOPERATİF VE ERKEN POSTOPERATİF (HASTANEDE) KOMPLİKASONLAR ÜZERİNE OLAN ETKİSİ

OBJECTIVE: Due to the increase in both obesity and total knee prosthesis arthroplasty (TKA), the number of TKA applications in obese patients has increased in recent years. However, it is debatable whether obesity is a risk factor for the complications observed in TKA. The aim of this study is to investigate the effect of obesity on intraoperative and early postoperative (in hospital) complications in patients with TKA.MATERIAL AND METHODS: Patients were divided into 2 groups according to body mass index; Group 1: obese patients (Body mass index: BMI&amp;gt; 30 kg/m2), Group 2: non-obese patients (BMI≤30 kg/m2). Patient files were examined from 4 different perspectives (Demographic data, Preoperative features, Intraoperative features, Postoperative features). T-test was used in the analysis of parametric data, and Chi-square test was used in the analysis of non-parametric data. A value of P&amp;lt;0.05 was considered significant.RESULTS: There was no statistically significant difference between the obese and non-obese patients in respect of the length of hospital stay, the operation time, the tourniquet time, the number of blood transfusions, presence of ischemic heart disease, diabetes, ASA scores, local skin complications, and systemic complications such as deep vein thrombosis, sepsis, pulmonary embolism and mortality. However, a statistically significant difference was found in presence of hypertension, hypothyroidism, and obstructive sleep apnea in the obese group.CONCLUSIONS: There is no difference in terms of local and systemic complications in obese and non-obese patients undergoing TKA.