Prevalence Of Cardiovascular Comorbidities Research Articles

Prevalence of cardiovascular complications and factors associated with higher case-fatality rate among hospitalized patients with sarcoidosis

Abstract Background Cardiovascular (CV) involvement is a serious complication of sarcoidosis with exaggerated morbidity and mortality. However, the prevalence of CV comorbidities and their case-fatality rate have not been established among hospitalized patients with sarcoidosis. Methods Using the National Inpatient Sample (NIS) database, hospitalized patients with a diagnosis of sarcoidosis were identified. The prevalence of each CV comorbidity and the associated case-fatality rate was determined among this population of patients. Results Data of 406,315 admission cases with a diagnosis of sarcoidosis was analyzed from 2016 to 2020. Of this, 13,950 patients (3.4%) had AMI (STEMI: 0.3% and NSTEMI: 2.3%), 121,515 patients (30%) had HF (HFrEF: 8% and HFpEF: 13%), 7,470 patients (1.8%) had CVA, 8,825 patients had sarcoid myocarditis (2.2%), 8,965 patients (5.6%) had PVD, 71,815 patients had Afib (17.7%), 46,775 patients (11.5%) had cardiorenal syndrome, and 3,905 patients (1%) developed cardiac arrest. Case-Fatality rate was the highest for sarcoidosis patients who developed cardiac arrest (61.4%), followed by STEMI (11.6%), NSTEMI (7.7%), and cardiac tamponade (7.8%). Increasing age (2% for each year), male gender (14% more than females), and black race (25%) but not economic status was associated with increased odds of death among patients with sarcoidosis. While PCI was associated with a lower mortality rate (aOR: 0.4, 95%CI:0.2-0.7, P=0.005), revascularization with CABG (aOR: 0.3, 95% CI: 0.1-1.2, P=0.08) did not reduce the mortality rate. Conclusion Atrial fibrillation, heart failure (HFpEF > HFrEF), and cardiorenal syndrome are the most common cardiovascular complications among hospitalized patents with sarcoidosis. However, case-fatality rate is significantly higher for other less prevalent cardiovascular comorbidities of sarcoidosis, which include cardiac arrest, acute myocardial infarction (STEMI > NSTEMI), and cardiac tamponade.

Prevalence of cardiovascular comorbidities among hospitalized patients with hypertrophic cardiomyopathy and factors associated with a higher case-fatality rate

Abstract Background Hypertrophic cardiomyopathy (HCM) is proven to be a catalyst for sudden cardiac death among affected population. However, the prevalence of cardiovascular comorbidities (CVC) and their association with in-hospital mortality has not been established among hospitalized patients with HCM. Methods National Inpatient Sample (NIS) database was queried from 2016 to 2020 to identify hospitalized patients with a diagnosis of HCM. The prevalence of CVC and case-fatality rate was determined for this patient population using univariate analysis and multivariate logistic regression. Results Weighted data was analyzed for a total of 278,995 admission cases with HCM. Crude in-hospital mortality rate increased from 16.4% to 22.9% during the study period. Atrial fibrillation (42.1%), HFpEF (28.1%), and cardiorenal syndrome (16.6%) were the most common CVC among hospitalized patients with HCM. The case-fatality rate was the highest among HCM patients hospitalized due to cardiac arrest (41%) followed by cardiac tamponade (13.7%) and STEMI (10.2%). Increasing age (aOR: 1.02, 95%CI: 1.02-1.03, p<0.0001), Asian/Pacific Islander race (aOR: 1.7, 95%CI: 1.1-2.4-, p=0.007), cerebrovascular accident (aOR: 2.3, 95%CI: 1.7-3.01, p<0.0001), NSTEMI (aOR: 1.8, 95%CI: 1.3-2.4, p<0.0001), peripheral vascular diseases (aOR: 1.3, 95%CI: 1.03-1.6, p=0.03), cardiorenal syndrome (aOR: 1.4, 95%CI: 1.2-1.8, p<0.0001), and cardiac arrest (aOR: 26.6, 95%CI: 20.9-33.9, p<0.0001). Among HCM patients with acute myocardial infarction requiring revascularization procedures, in-hospital mortality rate was significantly lower among those undergoing PCI than CABG (8.5% vs. 37.5%, p=0.008 for STEMI and 1.8% vs. 4.9%, p=0.04 for NSTEMI). Conclusions Mortality rate among hospitalized patients with HCM has been slightly on the rise over the last half century. Although aging population might be a contributing factor, comorbid end-organ damages including CVA, NSTEMI, and cardiorenal syndrome have demonstrated substantial association with in-hospital mortality in addition to cardiac arrest. For HCM patients requiring revascularization procedures, PCI seems to be associated with a lower mortality rate than its competitor CABG.

Changes at Presentation in Patients With Early Rheumatoid Arthritis: A 24-Year Study of the Early Undifferentiated Polyarthritis (EUPA) Cohort.

To analyze changes in baseline characteristics of patients with very early rheumatoid arthritis (RA) over 24 years in the Early Undifferentiated Polyarthritis (EUPA) cohort. Consecutive patients with recent-onset polyarthritis fulfilling RA classification criteria recruited in EUPA were assessed at baseline. Three successive periods were defined: (1) prior to the general availability of biologics (1998-2004; 245 patients), (2) prior to the implantation of the 2010 classification criteria (2005-2010; 266 patients), and (3) the most recent decade (2011-2022; 329 patients). At baseline, demographics, BMI, swollen and tender joint counts, proportion fulfilling 2010 American College of Rheumatology/European Alliance of Associations for Rheumatology criteria, modified Health Assessment Questionnaire, shared epitope status, patient-reported outcomes except pain, and patient global assessment of disease activity remained stable over the 3 periods. Despite a marked decrease in active smoking (22.2% to 12.1%), prevalence of cardiovascular comorbidities and prior cancer increased. Although duration of symptoms increased from a median of 2.9 to 4.1 months, decreases were seen in seropositivity (53.9% to 42.2%) and C-reactive protein beginning in the 2005-2010 period. A large decrease in erosive status (Sharp/van der Heijde erosion score ≥ 5; 18.3% to 9.4%) was only observed after 2011; this decrease occurred mostly in seronegative patients. Use of disease-modifying antirheumatic drugs prior to inclusion remained low and stable (25.7%), but use of oral corticosteroids increased (18% to 33.4%). Baseline characteristics of patients with RA evolved since 2005 toward less seropositivity and lower blood inflammation but with more comorbidities. Milder erosive damage at baseline became evident only since 2011, mostly in seronegative patients. These changes at baseline, before any intervention, suggest ongoing secular trends that may favorably affect outcomes in patients with early RA.

The Outcomes of Colorectal Endoscopic Submucosal Dissection in Patients with Chronic Kidney Disease: A Honam Association for the Study of Intestinal Disease (HASID) Multicenter Study.

Colorectal neoplasms are prevalent in patients with chronic kidney disease (CKD); however, the safety and efficacy of colorectal endoscopic submucosal dissection (ESD) are not well understood. This retrospective analysis included ESD procedures performed in 1266 patients with CKD across five tertiary medical institutions from January 2015 to December 2020. Patients were categorized based on their estimated glomerular filtration rate (eGFR), which ranged from CKD1 to CKD5 (including those on dialysis). We found that en bloc resection rates remained high across all CKD stages, affirming the procedural efficacy of ESD. Notably, the prevalence of cardiovascular comorbidities, such as ischemic heart disease and diabetes mellitus, significantly increased with an advancing CKD stage, with a corresponding increase in the Charlson Comorbidity Index, highlighting the complexity of managing these patients. Despite these challenges, the complete resection rate was lower in the CKD5 group (50%) than in the CKD1 group (83.4%); however, procedural complications, such as perforation and bleeding, did not significantly differ among the groups. The predictive models for complete resection and major complications showed no significant changes with a decreasing eGFR. These findings underscore that ESD is a feasible and safe treatment for colorectal neoplasms in patients with CKD, successfully balancing the inherent procedural risks with clinical benefits.

Abstract PO1-04-13: CARDIAC-STAR: Prevalence of Cardiovascular Comorbidities in Hormone Receptor Positive Human Epidermal Growth Factor Negative metaStatic breasT cAnceR

Abstract BACKGROUND: Baseline cardiovascular (CV) comorbidities can impact treatment decisions for patients (pts) with metastatic breast cancer (mBC). There is limited data on the prevalence of CV comorbidities at the time of hormone receptor positive human epidermal growth factor negative (HR+/HER2-) mBC diagnosis. The primary objective of this study is to describe the prevalence of pre-existing CV comorbidities in women and men with newly diagnosed HR+/HER2- mBC. A secondary objective is to describe the first documented cancer treatment for patients with or without CV comorbidities. METHODS: Women and men ≥18 years of age with newly diagnosed HR+/HER2- mBC from 01/2016 to 12/2021 were included in this retrospective, observational study using the Merative™ Marketscan® Commercial and Medicare Databases which is nationally representative. Evidence of mBC was defined as having two or more claims containing one or more diagnosis code for BC at least 30 days apart and at least two secondary malignancy diagnosis codes. Previously published claims-based algorithms were used to identify the HR+/HER2- molecular subtype. The index date is defined as the date of first mBC diagnosis. Patients had a 1-year pre-index period for observation of CV comorbidities and a 6-month post-index period for first documented cancer treatmen RESULTS: We identified 5,452 pts with HR+/HER2- mBC, 99% of whom were female, with a median age of 58 years (yrs) (IQR 13), and 83% having a health plan from an employer; i.e., are still employed. At mBC diagnosis, 3,335 pts (61.2%) had at least one pre-existing CV comorbidity (see Table). The most reported CV comorbidities were hypertension (50.7%), hyperlipidemia (33.7%), and diabetes (19.2%). The median age of pts with or without a CV comorbidity was 61 and 52 yrs, respectively; 16.2% with CV comorbidities were ≥75 yrs. Additional data, including first documented treatment, will be presented at the meeting. CONCLUSIONS: The prevalence of CV comorbidities in pts with HR+/HER2- mBC is often underrecognized. In this analysis, more than half of pts had at least one CV comorbidity by mBC diagnosis. CV comorbidities may impact treatment decisions in the HR+/HER2- mBC population, particularly in older pts. Table Citation Format: Susan Dent, Avirup Guha, Heather Moore, Rachael McCaleb, Irene Arias, Stella Stergiopoulos, Benjamin Li, Doris Makari, Michael Fradley. CARDIAC-STAR: Prevalence of Cardiovascular Comorbidities in Hormone Receptor Positive Human Epidermal Growth Factor Negative metaStatic breasT cAnceR [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-04-13.

Prevalence of Cardiovascular Comorbidities in Patients with Rheumatoid Arthritis.

Background and Objectives: The risk of developing cardiovascular diseases (CVD) in patients suffering from rheumatoid arthritis (RA) is two times higher compared to the general population. The objective of this retrospective study was to determine which cardiovascular complications can appear in men vs. women with rheumatoid arthritis. Early diagnosis and initiation of therapeutic measures to reduce the progression rate of rheumatoid arthritis, while also maintaining an active lifestyle, are the most important problems in young patients. Materials and Methods: We included a number of 200 patients, divided into two groups according to gender (124 women and 76 men) with rheumatoid arthritis, presenting various stages of disease concomitant with cardiovascular complications. We assessed traditional and non-traditional risk factors, as well as electrocardiographic and echocardiographic findings in both groups. Results: All patients presented an atherogenic coefficient over two, indicating a significant risk of atherogenesis. Men had elevated levels of total cholesterol compared with women (≥200 mg/dL; 77.6%-men vs. 25.8%-women, p < 0.001). The participants presented cardiac arrhythmias, especially in the active stage of RA. Women had an increased risk of atrial fibrillation by 2.308 times compared to men (p = 0.020). One of the most important complications found in young women was pulmonary arterial hypertension (p = 0.007). Conclusions: In daily clinical practice, the screening of RA is carried out in sufficiently. This disease is often undiagnosed, and the risk factors remain unassessed. As a result, RA patients continue to present an increased risk of developing CVD.

SEX DIFFERENCES IN SHORT-TERM BP VARIABILITY AMONG PATIENTS UNDERGOING PERITONEAL DIALYSIS

Objective: The present study aimed to explore potential differences in short-term blood pressure (BP) variability between men and women with end-stage kidney disease undergoing peritoneal dialysis (PD). Design and method: In this comparative study, 48 male PD patients from Northern Greece were matched for age and history of heart failure with 48 female patients in a 1:1 ratio. All patients underwent 24-hour ambulatory BP monitoring with the oscillometric device Mobil-O-Graph (IEM, Stolberg, Germany). Short-term BP variability was assessed with the calculation of standard deviation (SD), coefficient of variation (CV) and average real variability (ARV) of systolic and diastolic BP during the 24-hour, daytime and nighttime periods. Results: Age, the duration of PD therapy and the prevalence of cardiovascular comorbidities were similar in men and women. During the 24-hour period, SD (13.4±3.8 vs. 14.6±3.1 mmHg, P = 0.091), CV (0.10±0.03% vs. 0.12±0.2%, P&lt;0.05) and ARV (10.7±3.1 vs. 11.9±2.6 mmHg, P&lt;0.05) of systolic BP were significantly lower in men than in women. Similarly, the variability of diastolic BP over the 24-hour period was numerically lower in men as compared with women (SD: 10.3±2.4 vs. 10.9±2.2 mmHg, P = 0.218; CV: 0.12±0.03% vs. 0.14±0.03%, P&lt;0.05; ARV: 8.4±2.0 vs. 9.0±1.9 mmHg, P = 0.136). These sex differences in indices of short-term BP variability were consistent during both daytime and nighttime periods. Conclusions: The present study shows that among patients undergoing PD, SD, CV and ARV of systolic and diastolic BP are lower in men than in women. Longitudinal studies are needed to explore whether these sex-related differences in short-term BP variability are prognostically informative in the PD population.

Presence of Permanent Pacemakers: Implications for Elderly Patients Presenting with Traumatic Injuries

BackgroundThe presence of permanent pacemakers (PPM) is common among the elderly population. Trauma literature has shown that the inability to augment cardiac output by at least 30% after injury portends...

Cardiovascular Diseases in COPD: From Diagnosis and Prevalence to Therapy.

Chronic obstructive pulmonary disease (COPD) is considered one of the leading causes of mortality. Cardiovascular comorbidities are diagnosed often in COPD patients, not only because of the common risk factors these two diseases share, but also because of the systemic inflammation which characterizes COPD and has deleterious effects in the cardiovascular system. The comorbid cardiovascular diseases in COPD result in several difficulties in the holistic treatment of these patients and affect outcomes such as morbidity and mortality. Several studies have reported that mortality from cardiovascular causes is common among COPD patients, while the risk for acute cardiovascular events increases during COPD exacerbations and remains high for a long time even after recovery. In this review, we focus on the prevalence of cardiovascular comorbidities in COPD patients, presenting the evidence regarding the interaction of the pathophysiological pathways which characterize each disease. Furthermore, we summarize information regarding the effects of cardiovascular treatment on COPD outcomes and vice versa. Finally, we present the current evidence regarding the impact of cardiovascular comorbidities on exacerbations, quality of life and survival of COPD patients.

PREVALENCE OF CARDIOVASCULAR COMORBIDITIES IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN SUBURBAN AREAS OF SOUTH-WEST INDIA

Objective: Chronic obstructive pulmonary disease (COPD) is the vital cause of morbidity and mortality in Western world, though it has become an increasing cause of mortality in India also in the past decade. Another concern is that COPD patients use medications that stimulate the cardiovascular system, including anticholinergic agents and sympathomimetic medications to study the prevalence of cardiovascular comorbidities in patients with COPD. Methods: It was a prospective observational study, which was conducted on inpatient subjects diagnosed to have COPD based on GOLD guidelines 2020, for a period of 1 year in tertiary care hospital. Results: The most of the patients were in 60–80 year age group (70%) and majority was males (87%). All the males (n=87) were smokers (62 ex-smokers and 25 present smokers) while all females (n=13) were non-smokers. The mean BMI for patients with CVD was 25.85±4.19 kg/m2 while for patients without CVD, mean BMI was 27.46±3.98 kg/m2. About 63.2% of the males (n=87) had some cardiovascular comorbidity as compared to 38.5% of females (n=13). The prevalence of cardiovascular comorbidities in subjects with COPD was 60% in the present study. This was significantly higher in patients with COPD as compared to the reported prevalence value in the general population of comparable age group. The prevalence of associated cardiovascular abnormality in COPD patients with increased PCV (Packed cell volume), leukocytosis, and neutrophilia are 56.3%, 65%, and 60%, respectively. The most common cardiovascular comorbidity in subjects with COPD was ischemic heart disease (21%), followed by heart failure (20%), stroke (5%), arrhythmias (3%), and LVH (3%).

Results After Left Ventricular Assist Device Implantation in Patients with Status Post Transcatheter Edge-to-Edge Repair

Purpose Transcatheter edge-to-edge repair (TEER) represents a valid therapeutic option for symptomatic heart failure (HF) patients with secondary mitral regurgitation (SMR). However, based on the progression of the underlying cardiomyopathy, consecutive LVAD implantation may become necessary. The prognostic impact of TEER prior to LVAD implantation remains unknown. Methods 125 consecutive patients with advanced HF underwent LVAD implantation at our institution between 2014 and 2020. Out of 67 patients with preexisting moderate to severe SMR, 21 patients underwent TEER prior to LVAD implantation (study group) and were compared to the remaining 46 patients (control group). Clinical baseline and follow-up parameters such as re-hospitalization rates, adverse events and all-cause mortality after 12 months were retrospectively analyzed. Results Predominantly male patients (81.6%) were mainly treated with the Medtronic HVAD device (73.1%). Prevalence of cardiovascular comorbidities was similar, although patients in the study group were older (64.0 vs. 56.0 years, p=0.002) and more likely to undergo destination LVAD therapy (61.9% vs. 28.2%, p=0.009). Severity of LV dysfunction (study vs. control group: LVEF 20.0% vs. 18.0%, p=0.178; LVEDD: 67.6 mm vs. 70.5 mm p=0.316) was similar, but patients in the study group had increased transmitral pressure gradients (9.5/3.0mmHg vs. 5.0/2.0 mmHg, p=0.001) and more severe impairment of RV function (TAPSE: 12.5mm vs. 16.0mm, p=0.033). Despite a lower frequency of preoperative short-term circulatory support devices within the study group (0% vs. 67.4%, p=0.003), periprocedural outcome, including the need for temporary RVAD implantation (28.2% vs. 9.5%, p=0.119) was similar. We found no perioperative complications associated with preceded TEER. Re-hospitalization rate during the first postoperative year was increased within the study group compared to the control group (100% vs. 69.6%, p=0.004). Furthermore, 1-year survival was impaired in the study group (42.8% vs. 71.7%; p=0.023). Conclusion LVAD implantation after TEER is feasible and safe. However, 1-year outcome among LVAD recipients with prior TEER is poor. Further studies are needed, to compare TEER against early LVAD implantation in patients at advanced heart failure stages and concomitant relevant SMR. Transcatheter edge-to-edge repair (TEER) represents a valid therapeutic option for symptomatic heart failure (HF) patients with secondary mitral regurgitation (SMR). However, based on the progression of the underlying cardiomyopathy, consecutive LVAD implantation may become necessary. The prognostic impact of TEER prior to LVAD implantation remains unknown. 125 consecutive patients with advanced HF underwent LVAD implantation at our institution between 2014 and 2020. Out of 67 patients with preexisting moderate to severe SMR, 21 patients underwent TEER prior to LVAD implantation (study group) and were compared to the remaining 46 patients (control group). Clinical baseline and follow-up parameters such as re-hospitalization rates, adverse events and all-cause mortality after 12 months were retrospectively analyzed. Predominantly male patients (81.6%) were mainly treated with the Medtronic HVAD device (73.1%). Prevalence of cardiovascular comorbidities was similar, although patients in the study group were older (64.0 vs. 56.0 years, p=0.002) and more likely to undergo destination LVAD therapy (61.9% vs. 28.2%, p=0.009). Severity of LV dysfunction (study vs. control group: LVEF 20.0% vs. 18.0%, p=0.178; LVEDD: 67.6 mm vs. 70.5 mm p=0.316) was similar, but patients in the study group had increased transmitral pressure gradients (9.5/3.0mmHg vs. 5.0/2.0 mmHg, p=0.001) and more severe impairment of RV function (TAPSE: 12.5mm vs. 16.0mm, p=0.033). Despite a lower frequency of preoperative short-term circulatory support devices within the study group (0% vs. 67.4%, p=0.003), periprocedural outcome, including the need for temporary RVAD implantation (28.2% vs. 9.5%, p=0.119) was similar. We found no perioperative complications associated with preceded TEER. Re-hospitalization rate during the first postoperative year was increased within the study group compared to the control group (100% vs. 69.6%, p=0.004). Furthermore, 1-year survival was impaired in the study group (42.8% vs. 71.7%; p=0.023). LVAD implantation after TEER is feasible and safe. However, 1-year outcome among LVAD recipients with prior TEER is poor. Further studies are needed, to compare TEER against early LVAD implantation in patients at advanced heart failure stages and concomitant relevant SMR.

Preliminary results of the "DUO" observational study: Quality of life assessment and cross-sectional follow-up of prostate cancer patients treated with degarelix.

62 Background: The use of androgen deprivation therapy (ADT), has increased over time in the treatment of prostate cancer (PCa). ATD is accompanied by side effects, some of which may increase the cardiovascular (CV) risk. The aim of this study was to evaluate the prevalence of cardiovascular risks and quality of life at the initiation of degarelix, a GnRH antagonist, and 6 months later, in patients with advanced hormone-sensitive PCa. Methods: The DUO study is a PASS, pharmaco-epidemiologic, longitudinal, multicenter observational study. It prospectively enrolled PCa patients during the first 6 months of treatment with degarelix. cohort to describe the prevalence of real-life cardiovascular co-morbidities in. The study was carried out in 46 French urology centers. At D0 and M6, the prevalence of CV, osteoporotic, metabolic, mood disorder, geriatric and sexual morbidity and risk factors were recorded using validated tools and questionnaires. EQ-5D questionnaire measured quality of life. The evolution of the disease (PSA levels) and the tolerance of the treatments were also reported. Results: A total of 124 patients with advanced hormone-dependent PCa (of whom 26.6% were metastatic) were included. At D0 57.7% of patients had a CV morbidity and CV risk factors. Metabolic co-morbidities were also present in 60.6% of patients, osteoporotic risk factors in 34%, sexual disorders in 58%, and mood disorders in 36%. ONCO-G8 score ≤ 14 was observed in 45.6% of patients aged ≥ 70 years. The percentage of patients with CV co-morbidities remained stable (56.7%). The rates of osteoporotic, metabolic, sexual, and mood-related morbidity and risk factors also remained unaltered. Likewise, quality of life remained stable between D0 and M6 (Scores: 0.765 and 0.813 respectively). At the same time, the median PSA rate decreased by -98.4% from D0 (p &lt; 0.001). 42 adverse events (AEs) were reported in 22 patients: degarelix-related AEs were reported in 4.4% of patients. Conclusions: The results of the DUO study showed high prevalence of CV co-morbidity and risk factors in patients with advanced PCa. It also showed no significant increase in CV co-morbidities and risk-factors during the first 6 months of treatment with degarelix as it was observed for osteoporotic, metabolic, sexual, and mood-related disorders. The GnRH antagonist was well tolerated without major impact on quality of life. Assessment of multiple co-morbidities at the initiation and during ADT is mandatory for the optimal management of patients.

Abstract WMP97: Differences Between Atrial Fibrillation Detected Before And After Stroke And Tia: A Systematic Review &amp; Meta-analysis

Background and Purpose: Recent evidence suggests that patients with atrial fibrillation (AF) detected after stroke ( AFDAS ) may have a lower prevalence of cardiovascular comorbidities and lower risk of stroke recurrence than AF known before stroke ( KAF ). We performed a systematic search and meta-analysis to compare the characteristics of AFDAS and KAF. Methods: We searched PubMed, Scopus, and EMBASE for articles reporting differences between AFDAS and KAF until 30-June-2021. We performed random- or fixed-effects meta-analyses to evaluate differences between AFDAS and KAF in demographic factors, vascular risk factors, prevalent vascular comorbidities, structural heart disease, stroke severity, insular cortex involvement, stroke recurrence, and death. Results: We included 21 studies comprising 22,566 patients with ischemic stroke or transient ischemic attack. Patients with AFDAS had a lower CHA2DS2-VASc score (standardized mean difference [ SMD ] -0.47, 95% confidence interval [ 95% CI ] -0.60, -0.34), and lower prevalence of vascular comorbidities including coronary artery disease (odds ratio [ OR ] 0.50, 95%CI 0.42, 0.61), congestive heart failure (OR 0.37, 95% CI 0.31, 0.44), peripheral artery disease (OR 0.44, 95%CI 0.29, 0.68), and previous stroke (RD 0.38, 95% CI 0.25, 0.58). Patients with AFDAS had a higher left ventricular ejection fraction (SMD 0.25, 95% CI 0.20, 0.30) and smaller mean atrial diameter (SMD -0.65, 95% CI -0.99, -0.31) than those with KAF. There were no differences in age, sex, stroke severity, or death rates between AFDAS and KAF. There were not enough studies to report differences in insular cortex involvement between AF types. Conclusions: We found significant differences in the prevalence of vascular comorbidities, structural heart disease, and stroke recurrence rates between AFDAS and KAF, suggesting that they constitute different clinical entities within the AF spectrum.

Abstract 10392: Association of Frailty with Incident Heart Failure with Preserved and Reduced Ejection Fraction in Late Life: The Aric Study

Introduction: The incidence and prevalence of both frailty and heart failure (HF) are greatest in late life, and both have been associated with inflammation and markers of myocardial injury. While frailty is cross-sectionally associated with HF, the association of frailty with incident HF, and HF with preserved (HFpEF) or reduced ejection fraction (HFrEF) is unclear. Methods: Among 5,517 participants in the Atherosclerosis Risk in Communities study with frailty assessment and free of HF at Visit 5 (2011-2013), frailty was ascertained using information on weight loss, low grip strength, exhaustion, low energy expenditure and slow gait. Frail was defined as the presence of &gt; 3 frailty components, pre-frail as 1-2 components, and robust as 0 components. HF was ascertained through adjudication of hospitalizations with related ICD codes. Multivariable Cox proportional hazard models were used to evaluate the association of frailty status at Visit 5 with incident HF overall, HFpEF (LVEF ≥50%), and HFrEF (LVEF &lt;50%). Models were adjusted for age, race, gender, BMI, GFR, and history of stroke, MI, atrial fibrillation, hypertension and diabetes mellitus. Results: Mean age was 75 +/- 5 years, 58% were female, and 22% were Black. Forty-six percent were classified as robust, 48% as pre-frail, and 6% frail. Frail participants were older and had a higher prevalence of cardiovascular co-morbidities. Over a median follow-up of 7.1 (IQR 5.5-7.8) years, 525 participants developed incident HF (249 HFpEF, 209 HFrEF, 67 HF with unknown LVEF). Both pre-frailty and frailty were associated with heightened risk of incident HF compared to robust participants (Figure). The magnitude of risk associated with frailty status was similar for both HFpEF and HFrEF. Conclusions: Pre-frailty and frailty are both associated with heightened risk of incident HF in late life, independent of traditional cardiovascular risk factors. These associations are similar in magnitude for HFpEF and HFrEF.

Exploring the relation between mortality and left ventricular structure and function in stable hemodialysis treated patients, a longitudinal multicenter cohort study

Left ventricular (LV) structure and function anomalies are frequent during the CKD continuum and are associated with increased risk of mortality. Cross section and longitudinal ultrasound data are available for advanced CKD and transition to ESKD. Less information is available about LV changes during stable, long-term hemodialysis (HD) treatment. All stable HD patients from 9 HD centers (1034 patients, 671 males, age 58.71 ± 12.94 years) have been enrolled in January 2015. The cohort was followed-up for 4 years, kidney transplantation or death. Yearly, two-dimensional and M-mode continuous and Pulse Doppler echocardiography were performed. During the follow-up, the prevalence of cardiovascular comorbidities significantly increased (p < 0.0001), coronary artery disease (CAD) from 73.5 to 88.8%, peripheral artery disease (PAD) from 29 to 40.9%, cerebral vascular disease (CVD) from 20.4 to 30.8%, heart valves calcification (VC) from 65.6 to 89.3% and left ventricular hypertrophy (LVH) from 67.6 to 76.5%. The mortality risk increased with the presence of CAD (1.59-fold), PAD (1.61-fold), CVD (1.59-fold), and VC (1.77-fold). Mortality risk was increased in those with LVEF < 50% (LVEF 40–49% 1.5-fold and LVEF < 40% 2.3 fold). Among the survivors of the first year, LVEF varied (> 5% decrease, > 5% increase and ± 5% variations). More than 5% increase of LVEF was associated with higher mortality risk (crude 1.5-fold, adjusted 1.43-fold) compared to stationary EF (p = 0.001). Cardiovascular disease progresses during stable long-term HD therapy and increases mortality risk. HF becomes highly prevalent but only HF with decreased LVEF < 50% is associated with increased risk of mortality.

Abstract 15754: Coronary Calcification is Associated With Prior GnRH Agonist Therapy in Men With Recurrent Prostate Cancer Undergoing PET/CT Imaging

Background: Gonadotropin releasing hormone (GnRH) agonist therapy is associated with major adverse cardiovascular (CV) events in men with prostate cancer. The effect of GnRH agonists on vascular calcification is not known. Methods: Consecutive patients who underwent 18F-fluciclovine positron emission tomography (PET) /computed tomography (CT) at our institution for recurrent prostate cancer were retrospectively identified. Clinical and demographic data were obtained from the medical record. Patients without available data on prior prostate cancer therapies received were excluded (n=25). Coronary calcification was qualitatively assessed on non-gated CT scans using a published scoring system. The association of prior GnRH agonist therapy with coronary calcification was evaluated using stratified odds ratio (OR) analysis in a 2x2 contingency table. Results: Among 186 men included, median age was 69.0 years (IQR 64.3, 74.5) and CV comorbidities were common (72% hypertension, 68% hyperlipidemia, 43% current or former smoking, and 21% diabetes mellitus). 55 patients (30%) received prior hormone therapy, 50 of whom received a GnRH agonist either as single- or multi-agent therapy. Men with prior GnRH agonists were older than those without prior GnRH agonists (71.4 vs. 68.4 years, p=0.025). There were no significant differences in prevalence of CV comorbidities between the two groups. Men with at least mild coronary calcification were more likely to have received prior GnRH agonist therapy (OR=3.0, 95% CI 1.2-7.1, p=0.015 by Fisher’s exact test), with a stronger association seen in younger men (OR=3.9, age &lt;69 years) than in older men (OR=1.8, age ≥69). Conclusions: Coronary calcification is associated with prior GnRH agonist therapy in men with recurrent prostate cancer undergoing PET/CT imaging. The utility of vascular protective therapies including aspirin and statin to mitigate the adverse CV effects of GnRH agonists requires further study.

Characteristics and outcome of a first acute myocardial infarction in patients with ankylosing spondylitis

ObjectivesTo study clinical characteristics, mortality, and secondary prevention, after a first incident acute myocardial infarction (AMI) in patients with ankylosing spondylitis (AS) compared with the general population.MethodsIn total, 292 subjects with AS and a first AMI between Jan 2006 and Dec 2014 were identified using the Swedish national patient register. Each subject was matched with up to 5 general population comparators per AS-patient (n = 1276). Follow-up started at the date of admission for AMI and extended until death or 365 days of follow-up. Cox regression was used to assess mortality in two time intervals: days 0–30 and days 31–365. For a subgroup with available data, clinical presentation at admission, course, treatment for AMI, and secondary prevention were compared.ResultsDuring the 365-day follow-up, 56/292 (19%) AS patients and 184/1276 (14%) comparators died. There were no difference in mortality due to cardiovascular-related causes, although the overall mortality day 31–365 was increased among patients with AS compared with comparators (HR [95% CI] = 2.0 [1.3;3.0]). At admission, AS patients had a higher prevalence of cardiovascular comorbidities compared with comparators. At discharge, patients with AS were less often prescribed lipid-lowering drugs and non-aspirin antiplatelet therapy.ConclusionsPatients with AS tend to have a higher comorbidity burden at admission for first AMI. The mortality after a first AMI due to cardiovascular-related causes does not seem to be elevated, despite an increased overall mortality during days 31–365 among patients with AS compared with the general population.Key Points• The all-cause mortality after a first AMI was higher in patients with AS.• Mortality after a first AMI due to CVD-related causes does not seem to be elevated for patients with AS.• In patients with AS suffering a first AMI, more attention should be given to other comorbidities causing an excess in mortality.

Left atrial appendage closure in patients with chronic kidney disease: results from the German multicentre LAARGE registry

ObjectivesChronic kidney disease (CKD) is associated with an increased complication rate after cardiac interventions. Although CKD has a high prevalence among atrial fibrillation patients, the impact of CKD on periprocedural complications and the outcome after an interventional left atrial appendage closure (LAAC) is unclear. The present study, therefore, aimed to investigate whether CKD influences the procedure’s effectiveness and safety.MethodsLAARGE is a prospective, non-randomised registry. LAAC was conducted with different standard commercial devices, and the follow-up period was one year. CKD was defined by an eGFR < 60 mL/min/1.73 m2, and subgroups were further analysed (i.e. eGFR < 15, 15–29, and 30–59 mL/min/1.73 m2, respectively).ResultsTwo hundred ninety-nine of 623 patients (48.0%) revealed a CKD. The prevalence of cardiovascular comorbidity, CHA2DS2-VASc score (4.9 vs. 4.2), and HAS-BLED score (4.3 vs. 3.5) was significantly higher in CKD patients (each p < 0.001). Implantation success was similarly high across all GFR groups (97.9%). Periprocedural MACCE (0.7 vs. 0.3%), and other major complications (4.7 vs. 3.7%) were comparably infrequent. Survival free of stroke was significantly lower among CKD patients within 1 year (82.0 vs. 93.0%; p < 0.001; consistent after adjustment for confounding factors), without significant accentuation in advanced CKD (i.e. eGFR < 30 mL/min/1.73 m2; p > 0.05 vs. eGFR 30–59 mL/min/1.73 m2). Non-fatal strokes were absolutely infrequent during follow-up (0 vs. 1.1%). Severe non-fatal bleedings were observed only among CKD patients (1.4 vs. 0%; p = 0.021).ConclusionsDespite an increased cardiovascular risk profile of CKD patients, device implantation was safe, and LAAC was associated with effective stroke prevention across all CKD stages.

Left atrial appendage closure in patients with a reduced left ventricular ejection fraction: results from the multicenter German LAARGE registry

BackgroundInterventional left atrial appendage closure (LAAC) effectively prevents thromboembolic events in atrial fibrillation patients. Impaired left ventricular ejection fraction (LVEF) increases not only the thromboembolic risk but also the complication rates of cardiac interventions. The LAAC procedure’s benefit in patients with an impaired LVEF, therefore, has yet to be investigated.MethodsLAARGE is a prospective, non-randomized registry depicting the clinical reality of LAAC in Germany. Procedure was conducted with different standard commercial devices, and follow-up period was one year. In the sense of an as-treated analysis, patients with started procedure and documented LVEF were selected from the whole database.Results619 patients from 37 centers were categorized into one of three groups: LVEF > 55% (56%), 36–55% (36%), and ≤ 35% (8%). Prevalence of cardiovascular comorbidity increased with LVEF reduction (p < 0.001 for trend). CHA2DS2-VASc score was 4.3, 4.8, and 5.1 (p < 0.001), and HAS-BLED score was 3.7, 4.1, and 4.2 (p < 0.001). Implantation success was consistently high (97.9%), rates of intra-hospital MACCE (0.5%), and other major complications (4.2%) were low (each p = NS). Kaplan–Meier estimation showed a decrease in survival free of stroke with LVEF reduction during one-year follow-up (89.3 vs. 87.0 vs. 79.8%; p = 0.067), a trend which was no longer evident after adjustment for relevant confounding factors. Rates of non-fatal strokes (0.4 vs. 1.1 vs. 0%) and severe bleedings (0.7 vs. 0.0 vs. 3.1%) were consistently low across all groups (each p = NS).ConclusionsLVEF reduction neither influenced the procedural success nor the effectiveness and safety of stroke prevention by LAAC.Trial RegistrationClinicalTrials.gov Identifier: NCT02230748Graphic abstract

Impact of cardiovascular risk factors on incidence and severity of Retinal Vein Occlusion.

Retinal Vein Occlusion (RVO) is a thrombotic process affecting retinal veins. The purpose of this research is to study demographic characteristics and prevalence of cardiovascular comorbidities among subjects affected by RVO. In addition, authors explore the role of each variable in determining occlusion type and severity. This was a prospective observational study recruiting subjects affected by RVO and secondary macular edema. Exclusion criteria included pre-existing macular edema, recent ocular surgery (<6 months), pregnancy, diagnosis other than RVO, diabetes mellitus type I, any systemic pathology that significantly reduced life expectancy. Each participant was studied through a comprehensive medical history, cardiovascular assessment, blood testing, ocular exam, and macular OCT imaging. A total of 145 eyes, 145 participants, thereof 80 males (55%) and 65 females. (45%) Mean age: 62.5 ± 14.3 SD. 61 eyes (42%) were affected by CRVO and 84 eyes (58%) by BRVO. No statistically significant differences were noted between genders. Hypertension was very prevalent (63%). Dyslipidemia was more associated with BRVO (p = 0.044). Subjects with hypertension had a mean central macular thickness (CMT) of 643 µm against a mean of 489 µm of those without hypertension. (p < 0.05). No other variable was associated with macular edema severity. Older age and hypertension are strong risk factors for RVO. Dyslipidemia was strongly associated with BRVO. (p=0.044) Hypertension was not only associated with RVO incidence, but also with its severity. In fact, hypertensive subjects had significantly worse macular edema.