Presence Of Traditional Risk Factors Research Articles

Abstract 16665: Traditional Risk Factors and Acute Coronary Syndrome Free Survival

Introduction: Recent studies claim that the discriminatory power of traditional risk factors (RF) in predicting acute events and mortality from coronary heart disease (CHD) is low. This claim implies a potential misinterpretation, which may negatively affect healthcare organizations Aim: To investigate the association between the four traditional RF, hypertension, current smoking, hypercholesterolemia and diabetes, and the lifetime occurrence of first acute coronary syndrome (ACS) and consequent mortality Methods: We analysed data of 70953 Caucasian patients presenting with first ACS, but without prior CHD enrolled in the ISACS Archives. RF were used to stratify patients into mutually exclusive categories using a balancing strategy by inverse probability weighting. Trends were evaluated by the Pearson's correlation coefficient (r). Primary endpoints were patient’ age at hospital presentation for ACS and rates of all-cause mortality within 30 days after hospital admission Results: For fatal ACS (n=6097), exposure to at least one RF ranged from 77.6% in women to 74.5% in men. The presence of all four RF significantly (P trend<0.001) decreased the age at time of ACS event by nearly half a decade compared with the absence of any RF in both women (from 67.1 to 61.9 years) and men (from 62.8 to 58.9 years). Similar trends were observed for fatal ACS among women (from 73.3 to 67.6 years) and men (from 69.3 to 63.2 years). Current smoking (ORs 4.17 in women; 3.00 in men) and hypercholesterolemia (ORs 1.34 in women; 1.44 in men) were the predominant RFs for premature ACS presentation, with diabetes being the largest for death from premature ACS (ORs 1.50 in women; 1.65 in men). In contrast, there was an inverse association between the presence of RFs and the risk of 30-day mortality. The risk ratios (RR) among individuals with at least one RF vs those with no RFs were 0.72 (95%CI 0.65-0.79) in women and 0.64 (95%CI 0.59-0.70) in men. This association was consistent among patient subgroups Conclusions: In contrast with recent thinking, the presence of traditional RFs is associated with very high lifetime risk of developing ACS and markedly shorter survival. Public health policies should still place significant emphasis on traditional RFs and the lifestyle behaviors causing them

Association of Coronary Artery Disease with Hypertension, Diabetes and Chronic Kidney Disease

Background: It is well known that patients with chronic hypertension (HTN), diabetes mellitus (DM) and kidney disease (CKD) have a strong risk of coronary artery disease. However, the excess risk of coronary artery disease in patients with CKD is only somewhat explained by the presence of traditional risk factors, such as hypertension and diabetes mellitus. Objective: To find out the association between coronary artery diseases who have hypertension, diabetes, and chronic kidney disease. Methodology: This prospective observational study was conducted in a Tertiary medical college Bangladesh, the department of Cardiology, Dhaka Medical College, Bangladesh during the period from July 2021 to June 2022. Total 150 patients with coronary artery disease were included as the study subjects for this study. Results: The majority of patients were above 60 years (49%), and 40-59 years old (37%), followed by 18-39 years (35%). The female patients (n=79) were 65.3%% and male patients (n=42) were 34.7%. Gender, age and DM, P value was significant with hypertension, diabetes mellitus, and chronic kidney disease among coronary artery disease patients. Hypertension and DM also significant with predictors of chronic kidney disease (CKD) on a representative sample of adults. Conclusion: In Bangladesh, coronary artery disease is currently a serious public health issue. The increased rate of CAD is assumed to be caused by rapid lifestyle changes, harmful behaviors like smoking and sedentary behavior, economic development, nutritional variables, and a higher prevalence of hypertension, diabetes, and CKD. To get more granular results, we would advise conducting comparable more experiments with bigger samples in more places.

Features of the myocardial infarction course in convalescents of the new coronavirus infection COVID-19

Acute myocardial injury is one of the possible complications of the new coronavirus infection COVID-19 and can be diagnosed both in the acute phase of the infection, and also after stabilization or clinical improvement of the patient's condition. This review is devoted to the actual problem of the acute myocardial infarction development during the period of COVID-19 convalescence. The pathophysiological mechanisms of acute myocardial infarction during recovery from COVID-19 are diverse. The key role belongs to the state of hypercoagulation and the systemic inflammatory response, which can provoke destabilization and rupture of unstable atherosclerotic cardiac plaques. Type 2 acute myocardial infarction is most often diagnosed in COVID-19 convalescents against the background of intact coronary arteries. In this case, acute myocardial infarction develops due to an imbalance between increased myocardial oxygen demand (increased levels of cytokines in the blood, hypercatecholaminemia, hyperthermia and tachycardia) and a decrease in oxygen supply to cardiomyocytes due to hypoxemia and hypotension. Subclinical myocardial injury may be present despite normal coronary arteries on angiography and intact left ventricular ejection fraction. There is no clear relationship between the development of acute myocardial infarction during the period of COVID-19 convalescence and the severity of the infection, the time from the initial diagnosis, and the presence of traditional risk factors for cardiovascular diseases in the patient. Cardiac complaints in COVID-19 convalescents are often interpreted as a post-COVID syndrome, especially given the absence of a history of coronary heart disease in many patients, which can lead to late diagnosis. Further study of the features of acute myocardial infarction during the period of COVID-19 convalescence is needed.

In RA patients without prevalent CVD, incident CVD is mainly associated with traditional risk factors: A 20-year follow-up in the CARRÉ cohort study

ObjectivesTo extend our investigation of cardiovascular diseases (CVD) in rheumatoid arthritis (RA) patients to a follow up of more than 20 years, with a special focus on patients without prevalent CVD. MethodsThe CARRÉ study is an ongoing prospective cohort study on CV endpoints in RA patients. Results were compared to those of a reference cohort (n = 2484) enriched for type 2 diabetes mellitus (DM). Hazard ratios (HR) for RA and DM patients compared to non-RA/-DM controls were calculated with cox proportional hazard models, and adjusted for baseline SCORE1 (estimated 10-year CVD mortality risk based on CV risk factors). Results238 RA patients, 117 DM patients and 1282 controls, without prevalent CVD at baseline were included. Analysis of events in these patients shows that after adjustment, no relevant ‘RA-specific’ risk remains (HR 1.16; 95%CI 0.88 – 1.53), whereas a ‘DM-specific’ risk is retained (1.73; 1.24 – 2.42). In contrast, adjusted analyses of all cases confirm the presence of an ‘RA-specific’ risk (1.50; 1.19 – 1.89). ConclusionsIn RA patients without prevalent CVD the increased CVD risk is mainly attributable to increased presence of traditional risk factors. After adjustment for these factors, an increased risk attributable to RA only was thus preferentially seen in the patients with prevalent CVD at baseline. As RA treatment has improved, this data suggests that the ‘RA-specific’ effect of inflammation is preferentially seen in patients with prevalent CVD. We suggest that with modern (early) treatment of RA, most of the current increased CVD risk is mediated through traditional risk factors.

On the Natural History of Coronary Artery Disease: A Longitudinal Nationwide Serial Angiography Study.

Background The long-term course of coronary atherosclerosis has not been studied in large nationwide cohorts. Understanding the natural history of coronary atherosclerosis could help identify patients at risk for future coronary events. Methods and Results All coronary artery segments with <50% luminal stenosis in patients with a first-time coronary angiogram between 1989 and 2017 were identified (n=2 661 245 coronary artery segments in 248 736 patients) and followed until a clinically indicated angiography within 15 years was performed or until death or end of follow-up (April 2018) using SCAAR (Swedish Coronary Angiography and Angioplasty Registry). The stenosis progression and incidence rates were 2.6% and 1.45 (95% CI, 1.43-1.46) per 1000 segment-years, respectively. The greatest progression rate occurred in the proximal and middle segments of the left anterior descending artery. Male sex and diabetes were associated with a 2-fold increase in risk, and nearly 70% of new stenoses occurred in patients with baseline single-vessel disease (hazard ratio, 3.86 [95% CI, 3.69-4.04]). Coronary artery segments in patients with no baseline risk factors had a progression rate of 0.6% and incidence rate of 0.36 (95% CI, 0.34-0.39), increasing to 8.1% and 4.01 (95% CI, 3.89-4.14) per 1000 segment-years, respectively, in patients with ≥4 risk factors. The prognostic impact of risk factors on stenosis progression was greatest in younger patients and women. Conclusions Coronary atherosclerosis progressed slowly but more frequently in the left coronary artery in men and in the presence of traditional risk factors. Coronary artery segments in patients without risk factors had little or no risk of stenosis progression, and the relative impact of risk factors appears to be of greater importance in younger patients and women. These findings help in the understanding the long-term course of coronary atherosclerosis.

Influence of specialized medical devices intended for microsurgeries on the dynamic characteristics of the IOP-level, refraction and the ocular surface of ophthalmic surgeons

Most ophthalmic interventions are examples of microinvasive surgery using microscopes of various modifications, which can have a negative impact on the eye condition of ophthalmic surgeons. Thus, presumably, a prolonged and repeated change in the accommodation of surgeons can contribute to a change in the dynamic refraction of the eye; separate articles began to appear describing the development of artifical dry eye syndrome (DES). It seems obvious that systematic work in the operating room and the conduct of microsurgical operations affect the organ of vision of ophthalmic surgeons.Purpose: to determine the degree of influence of equipment intended for microsurgical ophthalmic operations on the dynamic characteristics of the level of intraocular pressure, refraction and the state of the eye surface of ophthalmic surgeons.Materials and Methods. As part of a multicenter analytical scientific cross‑sectional study, data from 48 people (48 eyes, men – 50% and women – 50%) were analyzed. The indicators of total tear production (Schirmer test, I), as well as individual tonometry and refractive index characteristics of volunteers at the beginning and at the end of the surgical day, were studied. Individual risk factors for the development and progression of the dry eye syndrome (age, smoking, use of hormonal systemic drugs, wearing soft contact lenses), as well as instillation of artificial tears, were recorded. Additionally, all subjects completed the Ocular Surface Disease Index (OSDI) questionnaire.Results. After the operation day, which averaged 2.8 ± 0.2 hours, the subjects (mean age – 41.9 ± 1.1 years) had a statistically significant change in the index of tear production (from 11.9 ± 0.9 to 10.8 ± 1.7 mm, p = 0.01; Z = 2.407). A significant decrease in the parameters of the Schirmer test 1 was found in the age group of surgeons under 40 years old (p = 0.018; Z = 2.353), and in persons over 40 years old, there was a tendency for a decrease in tear production parameters, which was not statistically significant (p = 0.213; Z = 1.244). There was a tendency to increase the IOP‑level in surgeons of both age groups (p = 0.314; Z = 1.006 and p = 0.632; Z = 0.407, respectively). In addition, in surgeons older than 40 years, there was a change in accommodation, expressed in an increase in myopic refraction by 0.5 diopters at the end of the surgical day (p = 0.076; Z = 1.771).Conclusions. The use of specialized professional equipment (operating microscope) was found to have a negative effect on total tear production regardless of the presence of traditional risk factors for DES. The severity of violations depended on the age category of the subjects. The data obtained are of particular relevance in the period of development and progression of methods of surgical treatment of ophthalmic diseases and substantiate the need to develop specific preventive measures.

Changing Trend of Risk Factors of Mucormycosis Including Diabetes, Acidosis, and Serum Iron in the Second Wave of COVID-19.

To analyze the clinic-pathological profile of patients presenting with mucormycosis infection to a tertiary care center during the second wave of the COVID-19 pandemic in India. This descriptive cross-sectional study was conducted in a hospital setting from April 2021 to July 2021 and analysis was carried out to find associations between the stratified data and the extent of the disease involvement based on radiological findings. Statistical tests like percentage, average, chi-square test, etc. were used wherever relevant using software called Minitab13. All the 51 patients had involvement of at least one paranasal sinus. The incidence of previously established risk factors was diabetes (66.67%), history of severe COVID-19 disease (5.88%), raised serum iron levels (1.96%), Acidosis (3.92%), steroid administration (62.75%), oxygen administration (25.49%). Elevated serum urea levels (76.47%), alkalosis in 50.98% and hyperglycemia on multiple occasions (41.17%) were observed. The mean days between start of treatment for COVID-19 and appearance of first symptom suggesting mucormycosis were found to be 27.59 days. Only in 5.88% participants mucormycosis preceded COVID-19 infection detection. The current work finds presence of traditional risk factors and associations in significantly lower frequencies than the reviewed literature. However, blood urea was elevated in three fourths of the participants. Larger scale studies in mucormycosis patients are warranted for finding the role of other risk factors including possible role of elevated blood urea and hyperglycemia in the present era.

Relationship between Urinary Norepinephrine, Fibrosis, and Arrhythmias in Chronic Chagas Heart Disease with Preserved or Mildly Reduced Ejection Fraction.

ResumoFundamento:Na cardiomiopatia chagásica crônica (CCC), impõem-se estudos com a proposta de identificar fatores de risco arritmogênicos em pacientes nos quais a disfunção ventricular de moderada a grave não está presente.Objetivos:Verificar a dependência entre arritmias ventriculares frequentes (ARV), fração de ejeção de ventrículo esquerdo (FEVE), extensão da fibrose pela ressonância magnética cardíaca (RMC) e dosagem de norepinefrina urinária (NOREPI) na CCC com FEVE preservada ou minimamente comprometida.Métodos:Foi analisada no Holter a presença de extrassístoles ventriculares >30/hora. Na RMC, avaliou-se a FEVE e a quantificação de massa fibrosada. Foi realizada a dosagem de NOREPI pelo método de Muskiet. A matriz de correlação foi calculada para aferir a capacidade de as variáveis preverem outra sendo considerado significante p<0,05.Resultados:Foram incluídos no estudo 59 pacientes, com idade média de 57,9±10,94 anos. Arritmia ventricular frequente (ARV) foi detectada em 28 pacientes. A variável fibrose mostrou-se inversamente proporcional à fração de ejeção de ventrículo esquerdo (FEVE) (R de −0,61) e à norepinefrina urinária (NOREPI) (R de −0,68), assim como a variável ARV mostrou-se inversamente proporcional à FEVE (R de −0,33) e à NOREPI (R de −0,27). Já a FEVE mostrou-se diretamente proporcional à NOREPI (R de 0,83).Conclusão:Nesta amostra, em pacientes com CCC com FEVE preservada ou discretamente reduzida, observa-se a integridade do sistema nervoso autonômico em corações com pouca fibrose e FEVE mais elevada, apesar da presença de tradicionais fatores de risco para morte súbita cardíaca. Há dependência entre os níveis de NOREPI, FEVE e fibrose miocárdica, mas não com ARV.

MO933: are Chronic Inflammation and CKD-MBD Risk Factors of Mortality in Hemodialysis Patients?

Abstract BACKGROUND AND AIMS Haemodialysis patients are known to be susceptible to a wide range of early and long-term complications such as chronic inflammation, infections, malnutrition, mineral bone disorders (CKD-MBD) and cardiovascular disease that significantly affect the incidence of mortality.The aim of this study is to assess the presence of traditional risk factors for mortality such as diabetes mellitus or cardiovascular disease on one hand and non-traditional risk factors on the other hand (chronic inflammation, CKD-MBD). METHOD We conducted a single-centre study that included 63 CKD G5D patients (haemodialysis for 1–5 years) followed up for 48 months. All patients have been assessed at baseline, regarding cardiovascular disease (medical history, echocardiography and ECG), we performed using standard methods blood biochemistry, complete blood count and markers of inflammation (CRP, IL-6) and markers of CKD-MBD (sKlotho, iPTH, serum calcium and serum phosphorus). RESULTS After 24 months of follow-up, we found a mortality rate of 22.23%, while after 48 months, the mortality rate was of 50.73%. Baseline plasma IL-6 levels showed a strong statistically significant correlation with sKlotho (r = 0.57, P = 0.001), but no statistically significant correlation with other elements of CKD-MBD was present (serum calcium, serum phosphorus and iPTH). sKlotho showed a positive correlation with haemodialysis efficiency (eKTV) (r = 0.26, P = 0.04)., Decreased levels of sKlotho at baseline correlated significantly with the presence of signs of ischaemia on ECG (190.3 versus 381.57 pg/mL; P = 0.028). Inflammation markers (IL-6 and CRP) showed no statistically significant correlation with any of the markers of cardiovascular disease (presence of vascular calcifications and of left ventricular hypertrophy). The level of iPTH at baseline was significantly lower in the group of patients that survived the following 4 years of haemodialysis (428.08 ± 315.39 versus 666.76 ± 484.55 pg/mL, P = 0.029). In a Cox proportion-hazards regression analysis of predicting factors of mortality, only age and not inflammation markers (IL-6 and CRP) showed a statistically significant correlation with 4-year mortality (P = 0.032). Patients with higher levels of sKlotho showed a decreased risk of mortality, however not statistically significant. We found a higher risk of all-cause mortality after 24 months in patients with diabetes mellitus [OR 6.9, 95% confidence interval (95% CI) 1.6924–28.1469; P = 0.007], and after 48 months in patients with a history of cerebro-vascular disease (OR 21.8571, 95% CI 1.2018–397.5026; P = 0.0371) and with left ventricular hypertrophy (OR 2.7259, 95% CI 0.9596–7.7437; P = 0.0598). CONCLUSION In our study, although the inflammation marker IL-6 showed correlations with features of CKD-MBD, it did not lead to an increased mortality, which was influenced rather by traditional risk factors such as age, diabetes mellitus or history of cardiovascular disease, but also by CKD-MBD (iPTH).

ОСОБЕННОСТИ ЛАБОРАТОРНЫХ ПОКАЗАТЕЛЕЙ ВОСПАЛЕНИЯ И ТРОМБОЗА У ПАЦИЕНТОВ С НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИЕЙ SARS-COV-2 И ТРОМБОЭМБОЛИЕЙ ЛЕГОЧНОЙ АРТЕРИИ

Introduction. The COVID-19 pandemic continues with over 600 million cases and over 6 million deaths worldwide according to WHO. The state of hypercoagulation is a key feature of the course of COVID-19 which often leads to the development of serious cardiovascular events and adverse outcomes. There is a higher risk of all-cause mortality in the COVID-19 cohort with thrombotic complications, and mortality among patients with COVID-19 and PE is significantly higher than in patients with either condition alone, indicating a life-threatening additive effect of the combination of COVID-19 and PE. Thus, it is necessary to study further the features of inflammation and thrombosis parameters in patients with COVID-19 given the high prevalence of thrombotic complications among this group of patients. Objective. To define features of inflammation and thrombosis laboratory markers in patients with COVID-19 and pulmonary embolism. Materials and Methods. The study included n = 116 patients with COVID-19 hospitalized in 4-th city clinical hospital of Minsk named after N.E.Sauchenko in whom a thrombotic event – pulmonary embolism (PE) – was developed. The mean age of the patients was 64.7 ± 11.3 years, with 53 (45.7%) male and 63 (54.3%) female patients, respectively. The study group consisted of patients with COVID-19 and confirmed diagnosis of PE (n = 37) and the comparison group consisted of patients with COVID-19 without PE (n = 79). Patients in the groups were comparable by sex, age, presence of traditional risk factors, and COVID-19 severity. The parameters associated with thrombosis were analyzed in general blood count, hemostasiogram, biochemical blood analysis at the moment of confirmation or exclusion of PE using computer tomographic angiography of the pulmonary arteries. Results. Intergroup comparison of laboratory parameters in the group of patients with COVID-19 and confirmed diagnosis of PE in comparison with the group of patients with COVID-19 without PE showed a significantly higher mean group leukocyte count: 10,59 (6,75-12,6)×109/L versus 7,12 (4,50-9,08)×109/L (U = 96,5; p &lt; 0,05); significantly higher mean group level of C-reactive protein: 120.09 (45.08-164.38) mg/L versus 54.89 (31.14-96.86) mg/L (U = 101.0; p &lt; 0.05); group mean fibrinogen and D-dimer were significantly higher: 7.03 (5.89-8.28) g/L versus 5.98 (4.25-6.80) g/L (U = 99.0; p &lt; 0.05) and 2058.5 (826.0-4026.0) ng/mL versus 982.5 (656.5-1936.0) ng/mL (U = 141.5; p &lt; 0.05) respectively. A higher proportion of individuals with increased prothrombin time was identified: 75.5% (n = 28) versus 32.9% (n = 26) (χ2 = 6.31; p &lt; 0.05). In patients with COVID-19 and PE there was a direct moderate relationship between CRP and D-dimer values (ρ = 0.66; p &lt; 0.05), a direct moderate relationship between CRP and fibrinogen values (ρ = 0.61; p &lt; 0.05). Conclusion. Patients with new coronavirus infection COVID-19 and PE had a marked increase of inflammatory and thrombotic markers (leukocyte count, CRP, fibrinogen, D-dimer). The relationship between the values of CRP, fibrinogen, D-dimer indicates the association of inflammation with the thrombosis markers level.

Geometric patterns of the left ventricle in relation to left atrial size among hypertensive patients at a tertiary hospital in South-South Nigeria

Introduction: It is well established that left ventricular hypertrophy (LVH), determined by echocardiography, is a strong predictor of poor prognosis in cardiovascular disorders independent of the presence of traditional risk factors. The left ventricle undergoes morphological as well as functional alterations in its structure that impact adversely on the structure and overall function of the left atrium. The prevalence of left atrial (LA) enlargement in the hypertensive group was found to be 16% and 59% using LA linear diameter and LA maximum volume, respectively. Materials and Methods: The study was carried out on 200 adult hypertensive patients ≥18 years attending consultant cardiology outpatient clinics irrespective of blood pressure control, whether on antihypertensive medications or not. A transthoracic echocardiogram with ECG gating was performed according to established recommendations. Results: This study showed four different geometric patterns of left ventricular (LV) adaptation to chronic hypertension: concentric remodeling (CR) in 31.5%, concentric hypertrophy in 27.5%, eccentric hypertrophy in 12.5%, while 28.5% of the total population had normal LV geometry. LA size was discovered to be highest among patients with concentric patterns of hypertrophy compared to the eccentric geometric pattern. Findings suggest that LV pressure overload is more likely to impact on LA size than volume overload. This may be as a result of increased afterload in the left ventricle, leading to impairment of diastolic filling. Conclusion: Although CR of the LV is the most common type of geometric change among hypertensive patients, patients with dilated left atrium are more likely to have the concentric type of LVH than the eccentric type.

Influence of Personal Respiratory and Visual Protective Equipment on the Development and Progression of Dry Eye Syndrome

Purpose. To study the influence of personal protective equipment (PPE) of the respiratory and visual systems on the development and progression of dry eye syndrome (DES) and its relationship with other risk factors for medical workers.Patients and methods. The data of 243 people (male — 22.2 %, female — 77.8 %) were analyzed as part of a multi-center analytical scientific one-step study. Total tear production (Schirmer I test) was studied at the beginning and the end of the working day in persons used PPE of respiratory system (disposable medical face mask, gauze masks or different types of respirators), as well as PPE of the eyes (protective half-closed/closed glasses or protective screens). Risk factors for the development and progression of DES were registered (age, smoking, systemic hormones intake, soft contact lenses), as well as the use of artificial tears.Results. A decrease in the Schirmer I test score at the end of a 7–8 hour work shift was found by an average of 3 mm (from 13 (9; 16) mm to 10 (6; 15) mm, p &lt; 0.001). Statistically significant changes were typical mainly for medical personnel (p &lt; 0.001) with the maximum severity in persons working in outpatient sector. The presence of at least one DES risk factor was found in 30.5 % of patients, two factors — in 3.0 %, and three or more — in 7.0 %. There was no influence of risk factors on the degree of changes in total tear production. Reduced tear production is typical for some PPE of respiratory system (disposable masks and respirators) and the eye (screens and half-closed glasses) (p &lt; 0.001). In people who do not use PPE of the eye, significant changes were detected only in the presence of risk factors.Conclusion. The negative influence of various PPE of the respiratory system and eye on the total tear production was established. The decrease in the results of the Schirmer I test by the end of the working day was 20–25 % of the basic level, regardless of the presence of traditional risk factors for DES. The severity of changes depended on the type of PPE used. The data obtained are particularly relevant during the new COVID-19 coronavirus pandemic and justify the need to establish specific prophylactic measures. One of the possible methods is the preventive use of artificial tears.

Magnetic resonance imaging effectiveness in adolescent idiopathic scoliosis.

To assess the effectiveness of preoperative magnetic resonance imaging (MRI) in adolescent idiopathic scoliosis (AIS) patients with unremarkable history and physical examination. The imaging data of consecutive patients with presumed AIS treated with a posterior spinal fusion between 2010 and 2016 were reviewed. The presence of traditional risk factors, atypical curve patterns, and its association with relevant abnormalities on MRI were investigated. The number needed to diagnose (NND) and the number needed to misdiagnose (NNM) were calculated to measure MRI effectiveness. A total of 198 consecutive patients were identified and divided according to the presence of MRI findings. Both groups predominantly consisted of females, with a mean age of 15years and right thoracic curvature. Neural axis abnormalities were detected in 25 patients, and the groups had a similar proportion of atypical findings, as curve magnitude, thoracic kyphosis, curve direction, and sex. The NND was 7.9 patients and NNM was 66 patients, meaning that the management was changed before the spine fusion in 12% of patients with neural axis abnormalities. None of the traditional risk factors could predict a higher incidence of neural axis abnormalities in asymptomatic AIS patients. Traditional risk factors may not be predictive of patients with a higher risk of changes in MRI. Both NND and NNM are representations easily understood by clinicians. Using these indexes to define if a patient should be submitted for additional imaging tests may facilitate the decision of using MRI as a preoperative screening tool in AIS patients. Level II.

Acquired Coronary Artery Disease in Patients with Congenital Heart Disease: Issues in Diagnosis and Management

Objective: Acquired coronary artery disease, initially thought to rarely affect survivors of congenital heart disease, is increasingly recognized in this population, as these patients grow in age and numbers in the recent era. This study reports our experience with coronary artery disease in adults with congenital heart disease and discusses treatment issues and the existing literature. Methods: Retrospective review of all charts of adults with congenital heart disease and acquired coronary artery disease was performed. Patients’ clinical characteristics, diagnosis, risk factors, noninvasive and invasive imaging and management data were recorded. Results: Coronary artery disease was diagnosed at 35–70 of age in 17 patients out of a total of 1345 adult congenital heart disease patients followed. Congenital heart disease was moderate or complex in 5 patients (4 repaired Tetralogy of Fallot, 1 repaired ventricular septal defect) and simple unrepaired atrial septal defect diagnosed later in life before or after coronary artery disease identi- fication in 12 patients. Coronary artery disease symptoms were present in 12 patients (8 myocardial infarctions, 4 exercise intolerance), while all patients had 2–3 risk factors for coronary artery disease. Coronary angiography showed 1–3 vessel disease treated with percutaneous coronary intervention in 7 patients, coronary artery bypass graft in 2 patients and both in 2 patients. Patients received appropriate medical therapy and remained stable for 1–17 years, while 2 patients are awaiting surgical pulmonary valve replacement in the near future. Conclusion: Coronary artery disease can develop in adults with congenital heart disease later in life in the presence of traditional risk factors, and prevention, screening and treatment strategies should be applied in this population. Further studies are needed to fully elucidate the extent of this issue in this increasing and ageing population and to determine its optimal medical, interventional and surgical management.

P6602Plasma signature of apoptotic microparticles in acute coronary syndromes is associated with endothelial dysfunction and plaque rupture

Abstract Background Circulating microparticles (MP) are surrogate biomarkers of atherosclerosis and are elevated in acute coronary syndromes (ACS) but its exact biological role remains unknown. Purpose To explore the diagnostic and biological significance of circulating apoptotic MP signature in patients with ACS. Methods We enrolled 122 ACS patients: n=38 with unstable angina (UA), n=49 with STEMI, 35 with NSTEMI. Flow cytometry analysis was used to quantify circulating apoptotic (annexin+) endothelial cell (EMP), red blood cell (RMP) and platelet (PMP) derived microparticles. Endothelial function was estimated with flow mediated dilation (FMD), and inflammatory status with C-reactive protein (hsCRP). Results The association between EMP, RMP and PMP is shown on a cloud plot (A). Using an unbiased approach, we performed hierarchical clustering (A) of the total population of patients with ACS by using the circulating levels of EMP, RMP and PMP (B). Hierachical clustering identified two discreet clusters of patients (Cluster A and B) without any differences in the presence of traditional risk factors (not shown), but significant differences in the distribution of ACS type (C). STEMI subtype (a surrogate for definite plaque rupture) was significantly increased in Cluster B, which also had significantly decreased FMD (D), but not hsCRP (p=NS). Conclusions Apoptotic MP are involved in the pathogenesis of acute coronary syndromes via promotion of endothelial dysfunction and plaque rupture. The diagnostic and/or predictive value of microparticles' profiling for plaque vulnerability should be explored in future studies.

Risk prediction of recurrent venous thrombosis; where are we now and what can we add?

BackgroundSeveral models are available to predict recurrent venous thrombosis (VT) in patients with unprovoked first events. ObjectivesTo validate these prediction models externally. MethodsWithin the MEGA follow‐up study (n = 3750), we externally validated the Vienna and DASH score. These models were validated (a) by using the original study's criteria for patients with unprovoked VT and (b) by using our own criteria for unprovoked VT. In addition, absolute recurrence risks based on individual VT risk factors were calculated. ResultsThe recurrence rate was 5.2 (95% CI, 4.6‐5.9) per 100 patient‐years in those who had a first unprovoked VT according to our definition. For the Vienna model it was 3.4 per 100 patient‐years and for DASH 3.8 per 100 patient‐years. The C‐statistic was 0.62 for Vienna and 0.65 for DASH. The C‐statistic declined to 0.58 for both Vienna and DASH when we used our own definition of “unprovoked VT.” Within the provoked group a strong gradient in risk was found dependent on the presence of traditional risk factors or biomarkers in a patient. ConclusionsThe ability to distinguish patients’ recurrence risks is lower than proposed in the original prediction model studies and dependent on the definition that is used for an unprovoked first event. Furthermore, our results suggest that a more‐refined risk estimation is possible, also in patients with a provoked first event, who are currently all classified as low risk.

Current Treatments and New Developments in the Management of Glucocorticoid-induced Osteoporosis.

Glucocorticoids (GCs) are often used for improvement of quality of life, particularly in the elderly, but long-term GC use may cause harm; bone loss and fractures are among the most devastating side effects. Fracture risk is particularly high in patients with a severe underlying disease with an urgent need for treatment with high-dose GCs. Moreover, it is important to realize that these patients suffer from an augmented background fracture risk as these patients have a high presence of traditional risk factors for osteoporosis, such as high age, low body mass index (BMI), smoking and relatives with osteoporosis or hip fractures. It is thus crucial for prevention of osteoporotic fractures to use the lowest dose of GC for a short period of time to prevent fractures. Another important task is optimal treatment of the underlying disease; for instance, fracture risk is higher in patients with active rheumatoid arthritis than in patients in whom rheumatoid arthritis is in remission. Thus, fracture risk is generally highest in the early phase, when GC dosage and the disease activity of the underlying disease are high. Finally, some of the traditional risk factors can be modulated, e.g., smoking and low BMI. Life-style measures, such as adequate amounts of calcium and vitamin D and exercise therapy are also crucial. In some patients, anti-osteoporotic drugs are also indicated. In general, oral bisphosphonates (BPs) are the first choice, because of their efficacy and safety combined with the low cost of the drug. However, for those patients who do not tolerate oral BPs, alternatives ("second-line therapies") are available: BP intravenously (zoledronic acid), denosumab (Dmab), and teriparatide. Both zoledronic acid and Dmab have been proven to be superior to oral bisphosphonates like risedronate in improvement of bone mineral density. For teriparatide, vertebral fracture reduction has been shown in comparison with alendronate. Thus, to reduce the global burden of GC use and fracture risk, fracture risk management in GC users should involve at least involve life-style measures and the use of the lowest possible dose of GC. In high-risk patients, anti-osteoporotic drugs should be initiated. First choice drugs are oral BPs; however, in those with contraindications and those who do not tolerate oral BPs, second-line therapies should be started. Although this is a reasonable treatment algorithm, an unmet need is that the most pivotal (second-line) drugs are not used in daily clinical practice at the initial phase, usually characterized by high-dose GC and active underlying disease, when they are most needed. In some patients second-line drugs are started later in the disease course, with lower GC dosages and higher disease activity. As this is a paradox, we think it is a challenge for physicians and expert committees to develop an algorithm with clear indications in which specific patient groups second-line anti-osteoporotic drugs should or could be initiated as first-choice treatment.

A Scoring System with High-Resolution Computed Tomography to Predict Drug-Associated Acute Respiratory Distress Syndrome: Development and Internal Validation

Drugs can cause acute respiratory distress syndrome (ARDS). However, there is no established clinical prediction rule for drug-associated ARDS (DARDS). We aimed to develop and validate a scoring system for DARDS prediction. We analysed data collected from a prospective, single-centre, cohort study that included ARDS patients. The ARDS diagnosis was based on the American-European Consensus Conference or Berlin definition. Drug-associated acute lung injury (DALI) was defined as previous exposure to drugs which cause ALI and presence of traditional risk factors for ALI. High-resolution computed tomography (HRCT; indicating extent of lung damage with fibroproliferation), Acute Physiology and Chronic Health Evaluation (APACHE) II, and disseminated intravascular coagulation (DIC; indicating multiorgan failure) scores and PaO2/FiO2 were evaluated for their ability to predict DARDS. Twenty-nine of 229 patients had DARDS. The HRCT, APACHE II, and DIC scores and PaO2/FiO2 were assessed. The model-based predicted probability of DARDS fitted well with the observed data, and discrimination ability, assessed through bootstrap with an area under the receiver-operating curve, improved from 0.816 to 0.875 by adding the HRCT score. A simple clinical scoring system consisting of the APACHE II score, PaO2/FiO2, and DIC and HRCT scores can predict DARDS. This model may facilitate more appropriate clinical decision-making.

Serum nitric oxide metabolites and hard clinical endpoints: a population-based prospective study

Objective. Limited data are available regarding prognostic value of nitric oxide metabolites (NOx) for clinical hard end points. In this study, we defined optimum cut-off values of serum NOx for predicting all-cause and cardiovascular disease (CVD) mortality events and prospectively investigated their hazards in the presence of traditional risk factors. Design. Serum NOx concentrations were measured at baseline (2006–2008) and 3520 adult men and women were followed during 7.7 years for all-cause and cardiovascular disease (CVD) mortality. To determine the optimal cut-off points of serum NOx, the receiver operator characteristic (ROC) curve analysis was used. Multivariate Cox proportional hazard models were used to estimate the hazard ratios (HRs) with 95% confidence intervals (95% CIs) of all-cause and CVD mortality below and above the defined optimal cut-off points of serum NOx. Results. Mean age of participants was 44.5 ± 16.0 years at baseline and 40.2% were male. Median (inter-quartile range) of serum NOx levels was 25.0 µmol/L (19.0–37.0), at baseline. The optimal cut-off points of serum NOx levels for predicting CVD and all-cause mortality were 30.5 and 32.5 µmol/L, respectively. In the presence of age, sex, body mass index, smoking, type 2 diabetes, hypertension, and history of CVD, a significant increased risk of CVD mortality (HR = 1.98, 95% CI = 1.10–3.58) and all-cause mortality (HR = 1.52, 95% CI = 1.05–2.21) was observed for serum NOx values higher than their cut-offs. Conclusion. Serum NOx level may be predictor of CVD mortality and death, in general populations.

PD06-04 IMPACT OF FELLOWSHIP TRAINING ON HOSPITAL DISCHARGE DATA FOR WOMEN UNDERGOING URINARY INCONTINENCE PROCEDURESα

INTRODUCTION AND OBJECTIVES:Urinary incontinence is a prevalent condition that is becoming recognized in more women regardless of the presence of traditional risk factors. Female Pelvic Medicine & Reconstructive Surgery (FPMRS) is a subspecialty of urologists and gynecologists with expertise in the management of pelvic floor disorders, including refractory incontinence. We hypothesized that patients hospitalized after incontinence procedures would have different characteristics based on the level of training of their surgeon. FPMRS surgeons may treat more complex patients in metropolitan areas, and this may be associated with higher costs and length of hospitalization.METHODS:New York State Statewide Planning and Research Cooperative System (SPARCS) inpatient de-identified datasets were queried for women who underwent genitourinary incontinence procedures from 2009 to 2016. Descriptive statistics using chi-square tests were performed to compare FPMRS-trained surgeons to non-FPMRS surgeons. Age, race, leng...