Prevalence Of Cardiac Disease Research Articles

Age, sex, and inflammatory markers predict chronic conditions, cardiac disease, and mortality among captive western lowland gorillas (Gorilla gorilla gorilla).

In humans, inflammatory markers predict health risks. As great apes experience many similar conditions, measuring inflammation may provide valuable health information. We examined four serum inflammatory markers in zoo-housed gorillas (n = 48): albumin, CRP, IL-6, and TNF-α. We first analyzed age- and sex-associated patterns, then used multimodel inference to evaluate models with age, sex, and inflammatory markers as predictors of all-cause morbidity, cardiac disease, and mortality. Older gorillas had lower albumin and higher IL-6, and males had higher albumin, lower CRP, and lower TNF-α. All-cause morbidity was best predicted by age, sex, and TNF-α, but the second model containing only age and sex was equivalent. Cardiac disease was best predicted by TNF-α alongside age and sex, with lower levels associated with increased risk. When outliers were removed, the model with TNF-α was second to the model containing only age and sex. Finally, mortality risk was best predicted by the model with only age and sex. Other models containing individual inflammatory markers were within top model sets for each health outcome. Our results indicate that age and sex are robust for predicting all-cause morbidity and mortality risk in gorillas; while models which include individual inflammatory markers also predict risk, they may not improve predictions over age and sex alone. However, given the prevalence of cardiac disease in great apes, these results suggest that TNF-α warrants further investigation. With their potential to provide valuable health information, data on inflammatory markers may contribute to the care and management of gorillas in human care.

Cardiac effects of drugs used for induction of labour and prevention and treatment of postpartum haemorrhage

Pregnancy presents significant stresses to a woman's body from the physiological changes to the cardiovascular system, fluid shifts at the time of delivery and the risk of major haemorrhage in the peri-partum period. Medications used routinely in daily obstetric practice may have potent vasoactive effects. While most parturients are considered to be healthy and can withstand these significant physiological challenges, as the prevalence of cardiac disease among pregnant women increases it is important to consider the additional impact these medications may have in order to minimise the risk of cardiovascular instability and decompensation. This article will review drugs used in the induction of labour and the management of post-partum haemorrhage, and their relevance for women with cardiac disease.

Interest of the evaluation of the LV area in the evaluation of the TID in MPS through IQ SPECT

Abstract Funding Acknowledgements Type of funding sources: None. Objectives To the determine the value as ischemic indicator of measurement of left ventricular areas under stress and rest conditions in the evaluation of the transient ischemic dilation. Methodology This quantitative, observational and cross sectional study included patient undergoing myocardial perfusion SPECT/CT (MPS). Protocol 2-day exercise stress/rest, radiotracers tetrofosmin/MIBI Tc-99m, IQ- SPECT (smartzoom collimators, 17 slices, 20-sec/slice), with/without CT-based attenuation correction (NC and AC, respectively) and processing with Cedars-Sinai QPS software. A descriptive statistical analysis was performed to evaluate patient conditions; MPS results, left ventricular parameters (volume of cavity and area), transient dilation and area dilation ratios. An agreement analysis according by Blend-Altman plots and correlation analysis was realized between TID y LV areas ratios. An univariate analysis by chi square test was used to determine whether there is a statistically significant difference between the frequecies of results of precited factors and TID Results 99 patiens with MPS were included. They were categorized in two groups as 87.87% with normal TID (values : 0.9-1.26) and 12.13% with TID > 1.25 . The mean age was 62,11 ± 10.29 years old and male were 70,1%. The prevalence of clinical conditions were 62.1% of arterial hypertension , 19.5% of type-2 diabetes mellitus and 72.4% dyslipidemia. The prevalence of cardiac disease were 60.9% ischemic cardiac disease, 17.2% cardiac rhythm alterations, 27.6% of cardiac valve disease, 13.8% myocardial hypertrophy and 4.6% dilated cardiomyopathy. There were no statistically significant differences of precited parameters between the two groups. There are 9.19% mild and 2.29% moderate ischemics MPS results in the normal TID group and 36.36% mild ischemic MPS result in the TID > 1.25 group. (p < 0.05) In the normal TID group the stress /rest area ratios were 1.016 ± 0.13 for NC studies and 1.016 ± 0.12 for AC studies (p > 0.05). In the TID > 1.25 group the stress /rest area ratios were 1.13 ± 0.05 for NC studies and 1.12 ± 0.08 for AC studies (p > 0.05) The normal values limits 1.016 ± 0.26 for NC studies and 1.016 ± 0.24 for AC studies. The agreement using the Bland-Altman method showed that the mean difference between TID and stress/rest ratios by NC and AC studies was 0.02 ± 0.08 (-0.13 to 0.18; 95% confidence interval) and 4.04% within the 95% confidence interval. Pearson correlation coefficient obtained between TID and area ratios was 0.69 in the NC studies and 0.91 in AC studies. This is consistent with the recommendations for studies with detectors SMARTZOOM would advise the use of AC determinations. Conclusions The presence of left ventricular areas within normal values in patients with TID visualized in MPS suggests the existence of endocardial ischemia and no ventricular dilation. The joint assessment of these parameters adds value in those situations.

Pre-surgical Prediction of Ischemic Mitral Regurgitation Recurrence Using In Vivo Mitral Valve Leaflet Strains.

Ischemic mitral regurgitation (IMR) is a prevalent cardiac disease associated with substantial morbidity and mortality. Contemporary surgical treatments continue to have limited long-term success, in part due to the complex and multi-factorial nature of IMR. There is thus a need to better understand IMR etiology to guide optimal patient specific treatments. Herein, we applied our finite element-based shape-matching technique to non-invasively estimate peak systolic leaflet strains in human mitral valves (MVs) from in-vivo 3D echocardiographic images taken immediately prior to and post-annuloplasty repair. From a total of 21 MVs, we found statistically significant differences in pre-surgical MV size, shape, and deformation patterns between the with and without IMR recurrence patient groups at 6 months post-surgery. Recurrent MVs had significantly less compressive circumferential strains in the anterior commissure region compared to the recurrent MVs (p=0.0223) and were significantly larger. A logistic regression analysis revealed that average pre-surgical circumferential leaflet strain in the Carpentier A1 region independently predicted 6-month recurrence of IMR (optimal cutoff value -18%, p=0.0362). Collectively, these results suggest greater disease progression in the recurrent group and underscore the highly patient-specific nature of IMR. Importantly, the ability to identify such factors pre-surgically could be used to guide optimal treatment methods to reduce post-surgical IMR recurrence.

ONE YEAR REVIEW OF PATIENTS ADMITTED WITH CARDIAC DISEASES IN PREGNANCY IN A TERTIARY CARE HOSPITAL OF PESHAWAR

Objective: To identify the frequency and type of cardiac diseases in pregnant women and their fetal and maternal outcome. Methodology: This observational study was carried out in Unit A, Department of Gynecology and Obstetrics, Lady Reading Hospital, Peshawar from mid January 2019 to mid January 2020. After informed written consent, using non probability consecutive sampling all pregnant women presenting with cardiac diseases were included in this study. Age, parity, mode of delivery, and period of gestation were recorded. Cardiac disease was diagnosed on the basis of symptoms, ECG and echocardiography. Types of different cardiac lesions and maternal risk were noted according to Modified World Health Organization classification of maternal cardiovascular risk. Maternal and fetal outcomes were measured in terms of mortality. Data was analyzed using SPSS version 20. Results: In one year, a total of 10263 pregnant ladies were admitted and among them 43 (0.42%) patients had cardiac disease. It was observed that 79.1% (n=35) were diagnosed for 1st time during pregnancy. Most frequent cardiac disorder was cardiomyopathy, found in 27.9% (n=12) of patients, followed by congenital heart disease in 18.6% (n=8), in the form of mitral and aortic stenosis. Maternal and fetal mortality was 4.7% (n=2) and 9.3% (n=4), respectively. Conclusion: There is a small proportion of pregnant patients with cardiac disease among all pregnancies. Most of the patients were multiparous and cardiomyopathy was found to be the most prevalent cardiac disease.

Prevalence of heart disease in patients with mitochondrial abnormalities on skeletal muscle biopsy.

ObjectiveMitochondrial DNA mutations are associated with an increased risk of heart disease. Whether an increased prevalence of cardiovascular disease is present in patients presenting with mitochondrial abnormalities on skeletal muscle biopsy remains unknown. This study was designed to determine the prevalence of cardiac conduction disease and structural heart disease in patients presenting with mitochondrial abnormalities on skeletal muscle biopsy.MethodsThis is a retrospective cohort study of 103 patients with mitochondrial abnormalities on skeletal muscle biopsy who were referred for evaluation of muscle weakness at a single tertiary care referral center from 2012 to 2018. Of these patients, 59 (57.3%) had an electrocardiogram available and were evaluated for the presence of conduction disease. An echocardiogram was available in 43 patients (42%) who were evaluated for the presence of structural heart disease. The prevalence of cardiac disease was compared to control cohort populations (Framingham and the Atherosclerosis Risk in Communities, ARIC cohorts).ResultsMitochondrial abnormalities associated with cardiac conduction disease (defined as QRS duration ≥ 120 msec) were present in 8.9%, versus 2.0% (p < 0.001) in the Framingham population and 2.6% (p = 0.003) in the ARIC cohort. LV systolic dysfunction (LVEF ≤ 50%) was present in 11.6%, versus 3.6% (p < 0.01) in the Framingham and 3% (p < 0.01) in the ARIC populations. Left ventricular hypertrophy was present in 28.6%, versus 13.6% (p < 0.02) in the Framingham and 10.4% (p < 0.001) in the ARIC populations.InterpretationGiven the increased prevalence of cardiovascular disease, patients with mitochondrial abnormalities on skeletal muscle biopsy should undergo routine cardiac screening with physical exam, electrocardiography, and cardiac imaging.

Circular RNA POSTN Promotes Myocardial Infarction-Induced Myocardial Injury and Cardiac Remodeling by Regulating miR-96-5p/BNIP3 Axis

Myocardial infarction (MI) is the most prevalent cardiac disease with high mortality, leading to severe heart injury. Circular RNAs (circRNAs) are a new type of regulatory RNAs and participate in multiple pathological cardiac progressions. However, the role of circRNAs Postn (circPostn) in MI modulation remains unclear. Here, we aimed to explore the effect of circPostn on MI-induced myocardial injury and cardiac remodeling. We identified that the expression of circPostn was elevated in the plasma of MI patients, MI mouse model, and hypoxia and reoxygenation (H/R)-treated human cardiomyocytes. The depletion of circPostn significantly attenuated MI-related myocardium injury and reduced the infarct size in MI mouse model. The circPostn knockdown obviously enhanced left ventricular ejection fraction (LVEF) and left ventricular fraction shortening (LVFS) and inhibited left ventricular anterior wall thickness at diastole (LVAWd) and left ventricular posterior wall thickness at diastole (LVPWd). The depletion of circPostn was able to decrease MI-induced expression of collagen 1α1 and collagen 3α1 in the ventricular tissues of mice. The protein expression of collagen and α-smooth muscle actin (SMA) was up-regulated in MI mice and was inhibited by circPostn knockdown. Meanwhile, the expression of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) was repressed by circPostn depletion in the ventricular tissues of MI mice. Besides, the circPostn depletion attenuated cardiomyocyte apoptosis in mice. Mechanically, circPostn served as a miR-96-5p sponge and miR-96-5p-targeted BNIP3 in human cardiomyocytes, in which circPostn up-regulated BNIP3 expression by targeting miR-96-5p. circPostn promoted H/R-induced cardiomyocyte injury by modulating miR-96-5p/BNIP3 axis. Thus, we conclude that circPostn contributes to MI-induced myocardial injury and cardiac remodeling by regulating miR-96-5p/BNIP3 axis. Our finding provides new insight into the mechanism by which circPostn regulates MI-related cardiac dysfunction. circPostn, miR-96-5p, and BNIP3 are potential targets for the treatment of MI-caused heart injury.

COVID-19 and the cardiovascular system in pregnancy

Pregnancy and coronavirus disease-2019 (COVID-19) share several common features which makes differentiation between the 2 difficult. Both are multisystem disorders, may present with breathlessness, are associated with hypercoagulability and frequently cause significant anxiety in both the patient and those around them. Pregnancy represents a state of partial immune suppression, with pregnant women more vulnerable to viral infections. However, these concerns have not been borne out in clinical practice and have not stood up to epidemiological scrutiny. From limited data available on COVID-19 in pregnancy, the outcomes are mostly favourable. While cardiac disease and hypertension are independent predictors of hospital admission with COVID-19 in pregnancy, the prevalence of cardiac disease in the pregnant COVID-19 population is low. Pregnant women are younger, and asymptomatic SARSCoV-2 infection and favourable outcomes are reported in those below 55 years of age. Indeed, large numbers of asymptomatic cases have been reported in pregnancy, suggesting that pregnant patients with more severe disease courses may be over-represented in the current literature, particularly the early case reports and case series. Cardiovascular involvement in pregnancy includes new-onset hypertension, myocarditis, cardiomyopathy, pulmonary embolism and a pre-eclampsia-like syndrome.

Cardiac findings in pediatric patients with spinal muscular atrophy types 2 and 3.

It is unclear whether the heart is affected in pediatric patients with milder forms of spinal muscular atrophy (SMA). Therefore, we aimed to determine the presence of any cardiac abnormalities in these patients. We conducted a cross-sectional study of children and adolescents with SMA types 2 and 3 between July 2018 and July 2019. All patients underwent a comprehensive cardiac evaluation, including history-taking, physical examination, electrocardiography, echocardiography, measurement of cardiac biomarkers (cardiac troponin T [cTnT] and N-terminal pro-brain natriuretic peptide [NT-proBNP]), and 24-hour Holter monitoring. In total, 42 patients were enrolled (27 and 15 with SMA type 2 and 3, respectively). No patient had structural heart disease, except for one with mitral valve prolapse. None had signs of ventricular dysfunction on echocardiography. Both cTnT and NT-proBNP levels were normal in all patients. Electrocardiography showed sinus tachycardia in seven patients (16.7%), and prolonged P-R interval in one (2.4%). Holter monitoring detected benign ventricular arrhythmias in two patients (4.8%), and rare supraventricular premature beats in one. The mean 24-hour heart rate was elevated in six patients (14.3%), whereas both the minimum 24-hour heart rate and the maximum R-R interval were increased in 23 (54.8%). The prevalence of cardiac disease in pediatric patients with SMA types 2 and 3 is low; however, these patients may have increased resting heart rates. A complete cardiac history and physical examination are a useful screen. Additional cardiac investigations may be performed as needed.

The Role of Proteostasis Derailment in Cardiac Diseases

The incidence and prevalence of cardiac diseases, which are the main cause of death worldwide, are likely to increase because of population ageing and changes in lifestyle. Prevailing theories about the mechanisms of cardiac disease onset feature the gradual derailment of cellular protein homeostasis (proteostasis) and loss of the protein quality control as central factors. In the heart, loss of protein patency, due to flaws in design (genetically) or environmentally-induced wear and tear, may overwhelm protein quality control, thereby triggering derailment of proteostasis and contributing to cardiac disease onset.

Coronavirus 2019 Disease (COVID-19), Systemic Inflammation, and Cardiovascular Disease.

Acute respiratory failure associated with the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide and presents critical challenges for the public health and medical communities The World Health Organization (WHO) has declared SARS-CoV-2 a public health emergency of international concern, with a global estimate of over 7 million human infections and more than 400000 deaths worldwide as of June 12, 2020 A 2020 report by the China Medical Treatment Expert Group for Coronavirus disease 2010 (COVID-19) (2) showed that the clinical spectrum of the viral infection is dominated by fever (up to 88 7% of patients during hospitalization) and cough (67 8% of patients) followed by symptoms such as headache, fatigue, or shortness of breath

Duchenne and Becker muscular dystrophy carriers: Evidence of cardiomyopathy by exercise and cardiac MRI testing

BackgroundVaried detection methods have resulted in conflicting reports on the prevalence of cardiac disease in Duchenne and Becker muscular dystrophy carriers (MDC). MethodsWe performed a prospective cohort study of 77 genetically-confirmed MDC mothers, 22 non-carrier mothers, and 25 controls. All participants underwent Cardiopulmonary Exercise Testing (CPET) and Cardiac Magnetic Resonance imaging (CMR). Results25% of carriers had ventricular ectopy in recovery of exercise (RecVE) as compared to 1 non-carrier and no controls (p = .003). No difference in age or maximal oxygen consumption was noted. 11 carriers had abnormal (<55%) left ventricular ejection fraction by CMR. Evidence of late gadolinium enhancement (LGE) was noted in 48% of MDC, 1 non-carrier patient and no control subjects (p < .0001). Subset analysis of LGE+ and LGE- subjects revealed differences in age (44.1 v 38.6 yrs.; p = .005), presence of RecVE, (38.9% v 10.5%, p = .004), and high serum creatine kinase (CK) (> 289 U/l; 52.8% v 31.6%, p = .065). ConclusionWe describe the prevalence of disease using CPET and CMR in genetically-proven MDC. 49% of carriers had fibrosis, opposed to 5% of non-carriers, highlighting the importance of genetic testing in this population. Despite cardiomyopathy, functional assessment by treadmill was normal, illustrating the discrepancy in cardiac and skeletal muscle impacts. Age, RecVE and serum CK appear to have an important role in predicting cardiomyopathy. Serum CK levels suggest that a systemic higher global disease severity and not tissue heterogeneity may be the etiology for greater cardiac disease and relatively spared skeletal muscle disease in this population.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT02972580?term=mendell&cond=Duchenne+Muscular+Dystrophy&rank=5; ClinicalTrials.gov Identifier: NCT02972580

DUCHENNE AND BECKER MUSCULAR DYSTROPHY CARRIERS: EVIDENCE OF CARDIOMYOPATHY BY EXERCISE AND CARDIAC MAGNETIC RESONANCE IMAGING

Lack of defined parameters and varied detection methods have resulted in a broad range of predictions on the prevalence of cardiac disease in carriers of Duchenne and Becker muscular dystrophy (DMD and BMD). Prior studies have been small retrospective samples without genotype confirmation. No study

Central and peripheral pulse wave velocity and subclinical myocardial stress and damage in older adults.

BackgroundArterial stiffness independently predicts cardiovascular disease. However, few studies have evaluated the associations of central and peripheral pulse wave velocity (PWV) with biomarkers of both myocardial stress (natriuretic peptide [NT-proBNP]) and damage (high-sensitivity cardiac troponin-T [hs-cTnT]) among persons without cardiac disease.MethodsWe examined 3,348 participants (67–90 years) without prevalent cardiac disease in the Atherosclerosis Risk in Communities (ARIC) Study (2011–13). The cross-sectional associations of PWV quartiles for central arterial segments (carotid-femoral, heart-carotid, heart-femoral) and peripheral artery (femoral-ankle) with NT-proBNP and hs-cTnT were evaluated accounting for potential confounders.ResultsMost PWV measures demonstrated J- or U-shaped associations with the two cardiac biomarkers. The highest (Q4) vs. second lowest (Q2) quartile of central PWV measures (carotid-femoral, heart-carotid, heart-femoral PWV) were associated with higher levels of NT-proBNP independently of demographic characteristics. The associations were less evident for hs-cTnT. These associations were attenuated after adjusting for traditional cardiovascular risk factors, but the heart-carotid PWV-NT-proBNP relationship remained borderline significant (difference in log-NT-proBNP = 0.08 [-0.01, 0.17] in Q4 vs. Q2, p = 0.07). Peripheral PWV demonstrated inverse associations. Higher values of NT-proBNP were seen in the lowest vs. second lowest quartile of all PWV measures.ConclusionsCentral stiffness measures showed stronger associations with cardiac biomarkers (particularly NT-proBNP) than peripheral measures among older adults without cardiac disease. Our findings are consistent with the concept of ventricular-vascular coupling and suggest that central rather than peripheral arterial hemodynamics are more closely related to myocardial stress rather than damage.

Cardiac disease in mucopolysaccharidosis type III.

Mucopolysaccharidosis type III (MPS III; Sanfilippo disease) is primarily characterized by neurocognitive decline with limited somatic disease. Only few reports addressed cardiac disease (CD) in MPS III. We investigated the prevalence of CD in a relatively large cohort of patients. In this cross-sectional study, extensive echocardiographic studies were performed in 30 MPS III patients (16 patients <18 years), all without clinical symptoms of CD. Results were compared to data from matched controls. The mean global longitudinal strain on speckle-tracking echocardiography (STE) was impaired in both pediatric and adult patients vs controls (resp. -18.4% vs -20.7%; mean difference 2.25, 95% CI 0.61-3.89, P = 0.009 and -16.9% vs -19.5%; mean difference 2.64, 95% CI 0.78-4.49, P = 0.007), indicating early systolic dysfunction. Left ventricle ejection fraction (LVEF) was normal in pediatric patients and (slightly) impaired in adult patients vs controls (48.7% vs 55.8%, P = 0.002). Tissue Doppler imaging (TDI) showed significantly slower early diastolic velocities (e') compared to controls indicative for diastolic dysfunction. Furthermore, mitral and aortic valve abnormalities were prevalent (43% and 33% of patients, respectively). Finally, 15.6% of the patients had a first-degree atrioventricular block on electrocardiography (ECG). The impaired STE reveals early, subclinical LV dysfunction which is supported by results of TDI. In addition, mild valvular disease and ECG abnormalities are prevalent. The lowered LVEF in adult patients suggests that the LV dysfunction is progressive, and may ultimately lead to clinical myocardial disease when patients live longer due to an effective disease-modifying treatment of which a number of options are now in clinical trials.

Risk factors and prevalence of cardiac diseases in Egyptian pediatric patients with end-stage renal disease on regular hemodialysis

Cardiac disease is a significant cause of morbidity and mortality in children with end-stage renal disease (ESRD). The aim of this work was to study the risk factors and prevalence of cardiac diseases in Egyptian pediatric patients with ESRD under regular hemodialysis (HD). Sixty-six children with ESRD on regular HD were included and subjected to history, clinical, laboratory, chest X-rays (CXR), ECG, and two-dimensional echocardiographic study to measure different echocardiographic parameters focusing on the left ventricular ejection fraction. Ninety-two percent of the patients had a cardiovascular risk factor (62.1% hypertension, 37.9% anemia, 12.1% body mass index >95th percentile, 63% serum phosphorus >5.5 mg/dL, and 57.5% calcium-phosphorus product ≥55 mg2/dL2). A diagnosis of cardiac disease was reported in 16 (24.2%) of all studied patients, the diagnostic methods used were CXR in 39 (59 %), echocardiograms in 23 (34.8%), and electrocardiograms in 21 (31.8%), left ventricular hypertrophy/ enlargement was reported in 12 (75%) of cardiac patients, congestive heart failure/pulmonary edema in 11 (68.8%) of cardiac patients, cardiomyopathy in one (6.3%) of cardiac patients and decreased left ventricular function in one (6.3%) of cardiac patients. Ninety-two percent of patients had cardiovascular risk factors. Diagnosis of cardiac disease was reported in about a quarter of all studied patients. An echocardiography reported the left ventricular dysfunction in 12 (75%) of cardiac dialysis patients. The present study stresses the importance of echocardiography as the gold standard for the diagnosis of cardiac disease in pediatric patients under maintenance HD as a high-risk population for cardiac diseases.

Editors' note: Atrial fibrillation detected after stroke is related to a low risk of ischemic stroke recurrence

In “Atrial fibrillation detected after stroke is related to a low risk of ischemic stroke recurrence,” Sposato et al. discussed the prevalence of cardiac disease in patients with atrial fibrillation diagnosed prior to ischemic stroke, patients with atrial fibrillation diagnosed after ischemic stroke, and patients with normal sinus rhythm. Patients with atrial fibrillation diagnosed after stroke had a similar prevalence of myocardial infarction and coronary artery disease compared to patients in normal sinus rhythm, but were slightly more likely to have congestive heart failure. In response, Dr. Boylan notes that neurogenic cardiac disease, such as Takotsubo cardiomyopathy, may be underappreciated, and postulated that some patients may be more susceptible to neurocardiogenic problems. Sposato et al. agree with Dr. Boylan that there can be neurogenic causes for a variety of cardiac problems, but note that, in their study, heart failure was diagnosed before the stroke. In “Atrial fibrillation detected after stroke is related to a low risk of ischemic stroke recurrence,” Sposato et al. discussed the prevalence of cardiac disease in patients with atrial fibrillation diagnosed prior to ischemic stroke, patients with atrial fibrillation diagnosed after ischemic stroke, and patients with normal sinus rhythm. Patients with atrial fibrillation diagnosed after stroke had a similar prevalence of myocardial infarction and coronary artery disease compared to patients in normal sinus rhythm, but were slightly more likely to have congestive heart failure.

Abstract P048: Segment-Specific Pulse Wave Velocity and Subclinical Cardiac Overload and Damage in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Pulse wave velocity (PWV) independently predicts cardiovascular disease. However, few studies simultaneously explored the associations of segment-specific PWV measures with markers of both cardiac overload (natriuretic peptide [NT-proBNP]) and damage (high-sensitivity cardiac troponin T [hs-cTnT]) among adults without cardiac disease. Methods: We examined 2,845 whites and blacks (67-90 years) without clinical history of cardiac disease during ARIC visit 5 (2011-13). The association of PWV quartiles (cf [carotid-femoral], hc [heart-carotid], hf [heart-femoral], ha [heart-ankle], ba [brachial-ankle], and fa [femoral-ankle]) with log-transformed NT-proBNP and hs-cTnT was evaluated using linear and logistic regression models to adjust for potential confounders. Results: Most PWV measures demonstrated J- or U-shaped associations with NTpro-BNP and hs-cTnT [Figure]. The highest vs. the second lowest quartile of central PWV measures (cfPWV, hfPWV, and hcPWV) was associated with higher levels of NT-proBNP independently of demographic characteristics. The associations were weaker for hs-cTnT. These associations were attenuated after further adjustment, but hcPWV and NT-proBNP remained borderline significant (p=0.069). haPWV, baPWV, and faPWV including peripheral elements had less evident positive associations after adjusting for traditional risk. Conclusion: The positive associations between PWV and cardiac biomarkers were stronger for central vs. peripheral arterial stiffness and for NT-proBNP vs. hs-cTnT among older adults without prevalent cardiac disease. Our findings indicate the relative importance of central arterial stiffness behind subclinical cardiac overload.

Suppression of Arrhythmia by Enhancing Mitochondrial Ca2+ Uptake in Catecholaminergic Ventricular Tachycardia Models

Cardiovascular disease-related deaths frequently arise from arrhythmias, but treatment options are limited due to perilous side effects of commonly used antiarrhythmic drugs. Cardiac rhythmicity strongly depends on cardiomyocyte Ca2+ handling and prevalent cardiac diseases are causally associated with perturbations in intracellular Ca2+ handling. Therefore, intracellular Ca2+ transporters are lead candidate structures for novel and safer antiarrhythmic therapies. Mitochondria and mitochondrial Ca2+ transport proteins are important regulators of cardiac Ca2+ handling. Here we evaluated the potential of pharmacological activation of mitochondrial Ca2+ uptake for the treatment of cardiac arrhythmia. To this aim,we tested substances that enhance mitochondrial Ca2+ uptake for their ability to suppress arrhythmia in a murine model for ryanodine receptor 2 (RyR2)-mediated catecholaminergic polymorphic ventricular tachycardia (CPVT) in vitro and in vivo and in induced pluripotent stem cell-derived cardiomyocytes from a CPVT patient. In freshly isolated cardiomyocytes of RyR2R4496C/WT mice efsevin, a synthetic agonist of the voltage-dependent anion channel 2 (VDAC2) in the outer mitochondrial membrane, prevented the formation of diastolic Ca2+ waves and spontaneous action potentials. The antiarrhythmic effect of efsevin was abolished by blockade of the mitochondrial Ca2+ uniporter (MCU), but could be reproduced using the natural MCU activator kaempferol. Both mitochondrial Ca2+ uptake enhancers (MiCUps), efsevin and kaempferol, significantly reduced episodes of stress-induced ventricular tachycardia in RyR2R4496C/WT mice in vivo and abolished diastolic, arrhythmogenic Ca2+ events in human iPSC-derived cardiomyocytes.

An evaluation of cardiac murmurs in new-born

Background: Congenital heart disease (CHD) is defined as a structural abnormality of the heart or intrathoracic great vessels that is actually or potentially of functional significance. The aim of the study is to assess the prevalence of congenital heart disease in new-borns with cardiac murmurs and to study the spectrum of cardiac diseases in new-borns with cardiac murmur.Methods: All the new-borns with cardiac murmurs were evaluated with ECG, Chest X ray and ECHO. They were classified into normal, mild, moderate and severe heart disease.Results: Of the 3375 babies analysed, 80 babies had murmur. ECHO could not be done in 8 babies. Of the 72 babies, 75% of new-borns with murmur had cardiac disease. The prevalence of cardiac disease in this population is 16 per 1000 new-borns. The prevalence of cardiac disease in new-borns with murmur is 750 in 1000 new-borns .94.5% had acyanotic heart disease and 5.5% had cyanotic heart disease. VSD was the most common lesion. 13.9% had severe heart disease, 20.8% had moderate heart disease and 40.3% had mild cardiac disease. There was good correlation between the degree of murmur and the severity of the cardiac disease. Chest X ray contributed only 12.5% to diagnosis of cardiac disease and ECG contributed only 5.3% to the diagnosis. If both ECG and Chest X ray were abnormal,there was 100% association with significant cardiac disease. No correlation was found between gestational age and birth weight and severity of heart Disease.Conclusions: Present study has proved that any murmur in newborn requires evaluation with ECHO as 75% of new-borns with audible murmur had cardiac disease of which 34.7% was moderate to severe heart disease. Abnormal ECG and Chest X ray was 100% associated with severe heart disease.