Significant Predictor Of Cardiovascular Events Research Articles

Predictors of cardiovascular events in patients with heart failure and <i>Pseudomonas aeruginosa</i> pneumonia

Aim. To identify predictors of cardiovascular events (CVEs) in patients with heart failure (HF) and P. aeruginosa pneumonia.Material and methods. The study included 92 patients with HF with mildly reduced or reduced ejection fraction and nosocomial pneumonia. Based on sputum or bronchoalveolar lavage microbiological examination, patients were divided into 2 following groups: group I — 51 patients with HF and P. aeruginosa pneumonia, group II — 41 patients with HF and pneumonia caused by other pathogens (Staphylococcus aureus, Streptococcus pneumoniae). During the hospital stay, the following morbidities were assessed: cardiovascular death, acute coronary syndrome, non-fatal cerebrovascular accident, pulmonary embolism, lower extremity venous thrombosis.Results. CVEs were significantly more often observed in patients with HF and P. aeruginosa pneumonia — 30 (58,8%) than in patients with HF and pneumonia caused by S. aureus or S. pneumoniae — 5 (12,1%). Complete blood count in group I patients revealed a decrease in hemoglobin level to 114 [95; 133] g/l, when compared with patients in group II — 139 [118; 150] g/l (p<0,001) and an increase in white blood cell count (10,2×109/l and 6,96×109/l, respectively (p<0,001)). A biochemical blood test in group I patients revealed a significant increase in C-reactive protein (CRP) of 105 [60; 191] and 18 [14; 55,1] mg/l (p<0,001). Patients with P. aeruginosa pneumonia had more widespread lung involvement than patients with pneumonia of other etiologies.Conclusion. There are following most significant predictors of cardiovascular events in patients with HF and P. aeruginosa pneumonia: decreased LVEF <40% (relative risk (RR) 1,833; 95% confidence interval (CI) 1,188-3,400; p=0,005), white blood cell count >11×109/l (RR 2,412; 95% CI 1,399-4,158; p=0,048), CRP >133 mg/l (RR 3,115; 95% CI 1,611-6,025; p<0,001) and hypoproteinemia <57 g/l (RR 5,225; 95% CI 1,249-21,854; p=0,012).

СТРУКТУРНО-ФУНКЦИОНАЛЬНОЕ СОСТОЯНИЕ СЕРДЦА У ПАЦИЕНТОВ МОЛОДОГО ВОЗРАСТА С ЖЕЛУДОЧКОВОЙ ЭЛЕКТРОКАРДИОСТИМУЛЯЦИЕЙ В ОТДАЛЕННОМ ПОСЛЕОПЕРАЦИОННОМ ПЕРИОДЕ

Aim. To study the structural and functional state of the heart in young patients with ventricular pacing in the long-term postoperative period. Materials and methods. The study included 60 people aged 18 to 35 years (35 men and 25 women) with AV blocks that required the implantation of a permanent pacemaker (PM). The first group consisted of 30 people with permanent PMs implanted after surgical correction of CHD due to postoperative AV blockage. The second group consisted of 30 people with non-surgical AV block. All patients underwent a general clinical examination, echocardiography, and medical documentation was retrospectively studied. The duration of pacing in group 1 was 15.6 (13.1; 18.0) years, in group 2 - 15.7 (13.9; 18.5) years. All patients of both groups at the time of the study were implanted with two-chamber PMs. The median percentage of ventricular stimulation in both groups was 100%.Results. In the study groups, significant differences were revealed in the anteroposterior size of the left atrium (LA): 36.5 (33.5; 39.5) mm and 33.5 (31.0; 36.0) mm (U = 281.0, p = 0.030), suggesting initial changes in LA geometry in patients of group 1. Signs of LV remodeling (concentric and eccentric hypertrophy and concentric remodeling) were detected in 40% (12 people out of 30) of patients in group 1 and in 10% (3 people out of 30) in group 2 (χ2 = 7.20, p = 0.007). In group 1, LV ejection fraction (EF) in B mode was significantly lower than in group 2 and made up 59.0 (52.0; 63.0) % and 61.5 (56.0; 66.0)% (U = 307.5, p = 0.034), respectively. 40% of patients in group 1 and 17% in group 2 had LVEF < 55% (χ2 = 4.02, p = 0.045). LV diastolic dysfunction was detected in 26% of people in group 1; in group 2, no patients with diastolic dysfunction were identified (F = 0.154, p = 0.005).Conclusion. In patients with long-term ventricular stimulation after surgical correction of congenital heart disease, significant structural and functional changes in the heart were revealed (signs of remodeling of the left heart, systolic and diastolic dysfunction of the left ventricle), which appear to be significant predictors of cardiovascular events, including heart failure and mortality. In patients with non-surgical AV block and long-term ventricular pacing no significant impairment of cardiac function was detected.

Opportunistic screening at chest computed tomography: literature review of cardiovascular significance of incidental findings.

Several incidental cardiovascular findings are present in a routine chest computed tomography (CT) scan, many of which do not make it to the final radiology report. However, these findings have important clinical implications, particularly providing prognosis and risk-stratification for future cardiovascular events. The purpose of this article is to review the literature on these incidental cardiovascular findings in a routine chest CT and inform the radiologist on their clinical relevance. A time unlimited review of PubMed and Web of Science was performed by using relevant keywords. Articles in English that involved adults were included. Coronary artery calcification (CAC) is the most common incidental cardiac finding detected in a routine chest CT and is a significant predictor of cardiovascular events. Noncoronary vascular calcifications in chest CT include aortic valve, mitral annulus, and thoracic aortic calcifications (TAC). Among these, aortic valve calcification (AVC) has the strongest association with coronary artery disease and cardiovascular events. Additional cardiac findings such as myocardial scar and left ventricular size and noncardiac findings such as thoracic fat, bone density, hepatic steatosis, and breast artery calcifications can also help in risk stratification and patient management. The radiologist interpreting a routine chest CT should be cognizant of the incidental cardiovascular findings, which helps in the diagnosis and risk-stratification of cardiovascular disease. This will guide appropriate referral and management.

Remodeling and regression of left ventricular hypertrophy in patients with arterial hypertension (literature review)

The article contains literature information concerning the pathogenesis of hypertrophy and remodeling of the left ventricle (LV) of the heart in patients with arterial hypertension (AH), regression of left ventricular hypertrophy (LVH) under the influence of anti-hypertensive treatment. Remodeling of the heart is its structural geometrical changes occurring under the influence of pathological factors: increasing the number of sarcomeres, length and thickness of cardiomyocytes, increasing or decreasing the wall thickness, and enlargement of the ventricular cavity. The renin-angiotensin-aldosterone system (RAAS) plays a central role in the pathogenesis of hypertrophy and remodeling of the myocardium with AH and heart failure. LVH is one of the most significant predictors of cardiovascular events, including myocardial infarction, stroke, life-threatening ventricular arrhythmias, mortality from cardiovascular diseases, and general mortality. Treatment with angiotensin-converting enzyme inhibitors (ACEI), dihydropyridine calcium channel blockers (CCB), АТ ІІ receptor blockers (ARB) promotes reverse development of LVH and regression of the processes of the heart muscle remodeling. ACEIs are found to be more effective in achieving regression of LVH in patients with AH compared to CCB and beta-blockers. An early beginning of anti-hypertensive therapy and attention to metabolic aspects are critically important to avoid irreversible LVH. The ESH/ESC recommendations (2018) indicate that ACEI and ARB are effective for the prevention or regression of LVH in patients with AH, and beta-blockers are less effective than RAAS blockers and CCB.Objective: to systematize literature data about the pathogenesis of the left ventricle remodeling in patients with arterial hypertension, and the role of anti-hypertensive therapy in the regression of left ventricular hypertrophy. Conclusion. Today, the concept about the role of the renin-angiotensin-aldosterone system in the pathogenesis of hypertrophy and remodeling of the left ventricle in patients with arterial hypertension has been formulated. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are the most effective in the prevention or regression of left ventricular hypertrophy in patients with arterial hypertension.

Pathophysiological and Diagnostic Aspects of Sarcopenia in Hemodialysis Patients

Chronic kidney disease and renal replacement therapy, particularly hemodialysis, contribute to the development of negative protein balance and muscle dysfunction in dialysis patients, from the development of protein-energy malnutrition to sarcopenia. Due to multifactorial etiology and complex pathophysiological patterns, sarcopenia has proven to be a significant predictor of cardiovascular events and is associated with a higher risk of overall mortality. Screening methods of chronic kidney patients and patients on hemodialysis who are at higher risk of developing sarcopenia, as well as diagnostic methods for this group of patients are not clearly defined, hence methods used for the general population of elderly patients, especially based on the revised European consensus on definition and diagnosis of sarcopenia of the European Working Group on Sarcopenia in Older People (EWGSOP2), are utilized in this subpopulation as well. Therefore, there is a need to define new biomarkers of sarcopenia such as the existing 24h urine excretion of creatinine, a product of estimated glomerular filtration of cystatin C and creatinine or myostatin and their use in routine work with dialysis patients to identify this condition among them and reduce morbidity and mortality.

Analysis of Extracellular Vesicle-Mediated Vascular Calcification Using In Vitro and In Vivo Models.

Cardiovascular disease is the leading cause of death in the world, and vascular calcification is the most significant predictor of cardiovascular events; however, there are currently no treatment or therapeutic options for vascular calcification. Calcification begins within specialized extracellular vesicles (EVs), which serve as nucleating foci by aggregating calcium and phosphate ions. This protocol describes methods for obtaining and assessing calcification in murine aortas and analyzing the associated extracted EVs. First, gross dissection of the mouse is performed to collect any relevant organs, such as the kidneys, liver, and lungs. Then, the murine aorta is isolated and excised from the aortic root to the femoral artery. Two to three aortas are then pooled and incubated in a digestive solution before undergoing ultracentrifugation to isolate the EVs of interest. Next, the mineralization potential of the EVs is determined through incubation in a high-phosphate solution and measuring the light absorbance at a wavelength of 340 nm. Finally, collagen hydrogels are used to observe the calcified mineral formation and maturation produced by the EVs in vitro.

Central and brachial pulse pressure predicts cardiovascular and renal events in treated hypertensive patients

Purposes Central blood pressure is a stronger predictor of cardiovascular prognosis rather than brachial blood pressure. The reflection wave reaches the abdominal aorta sooner than ascending aorta. Thus, the contribution of central pulse pressure (cPP) to renal events may differ from that of cardiovascular events. Methods The subanalysis of the ABC-J II study was performed. Subjects were 3434 treated hypertensive patients with a mean follow-up of 4.7 years. Left ventricular hypertrophy, an index of cardiovascular risk, correlated with cPP better than central systolic blood pressure in this cohort. The contribution of brachial pulse pressure (bPP) and cPP to cardiovascular and renal events was analysed. Results Cox proportional-hazard analysis revealed that sex (p < 0.001), height (p < 0.05), history of cardiovascular diseases (p < 0.001), number of antihypertensive drugs (p < 0.05), and cPP (p < 0.05) contributed to cardiovascular events. However, Cox proportional-hazard analysis disclosed that baseline serum creatinine (p < 0.001) and bPP (p < 0.05) predicted renal events. After adjusting for the history of cardiovascular diseases, Cox regression demonstrated only sex as a significant predictor of cardiovascular events. After adjusting for baseline serum creatinine, no parameters were shown to predict renal events. Conclusions The present findings support our previous data that the absence of cardiovascular or renal diseases is an important determinant for event-free survival, and suggest that cPP and bPP contribute to cardiovascular and renal events in treated hypertensive patients.

Sarcopenia and echocardiographic parameters for prediction of cardiovascular events and mortality in patients undergoing maintenance hemodialysis.

Sarcopenia is prevalent and is associated with the occurrence of cardiovascular complications in patients undergoing maintenance hemodialysis (MHD). It is unknown how skeletal muscle may be associated with aspects of myocardial structure and function. This study aimed to evaluate the association between sarcopenia and cardiac structure and function in patients undergoing MHD. We also examined the prognostic role of sarcopenia for mortality and cardiovascular events (CVE) in this population. Participants from a single center underwent bioimpedance body composition analysis to measure skeletal muscle and echocardiography to assess myocardial structure and function. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia criteria. The end points were all-cause mortality and CVE. Of the 158 participants, 46 (29.1%) had sarcopenia, 102 (64.6%) had left ventricular diastolic dysfunction (LVDD), and 106 (67.0%) had left ventricular hypertrophy (LVH). Participants with sarcopenia had smaller right ventricular sizes (2.54 ± 0.77 vs 2.76 ± 0.28; P < 0.01), inter-ventricular thickness (1.07 ± 0.19 vs 1.14 ± 0.20; P = 0.039), and left ventricular posterior wall thickness (0.96, 0.89-1.10 vs 1.06, 0.95-1.20; P = 0.018). Skeletal muscle mass was strongly correlated with left ventricular mass (LVM) (r = 0.577; P < 0.0001). Furthermore, the risk of LVDD (OR: 4.92, 95% confidence interval (CI) [1.73-13.95]) and LVH (OR: 4.88, 95% CI [1.08-21.96]) was much higher in the sarcopenic group than in the non-sarcopenic group. During a follow-up period of 18 months, 11 (6.9%) patients died, of which seven died (4.4%) of CVE, and 36 (22.8%) experienced CVE. The presence of sarcopenia (adjusted hazard ratio (HR), 6.59; 95% CI [1.08-39.91]; P = 0.041) and low skeletal muscle index (HR, 3.41; 95% CI [1.01-11.57]; P = 0.049) and handgrip strength (HR, 0.88; 95% CI [0.78-0.99]; P = 0.037) independently predicted death. Sarcopenia was a significant predictor of CVE (HR, 10.96; 95% CI [1.14-105.10]; P = 0.038). Our findings demonstrated that sarcopenia is associated with LVDD and LVH, and is associated with a higher probability of death and CVE.

Endothelial dysfunction predicted cardiovascular events in patients with paroxysmal atrial fibrillation.

To examine the relationship between endothelial dysfunction and adverse cardiovascular events in patients with paroxysmal atrial fibrillation (AF). In this prospective observational study, flow-mediated dilation (FMD) was measured by ultrasound in 291 patients with paroxysmal AF. Then, the patients were divided into low FMD group (n=97, FMD of <5.9%) or high FMD group (n=194, FMD of ≥5.9%). Patients were followed up for at least 30 months. Primary end point was cardiovascular events (stroke, heart failure hospitalization, cardiovascular death, and non-fatal myocardial infarction) and second endpoint was heart failure hospitalization, or stroke. Rate of cardiovascular events was higher in low FMD group compared with high FMD group (37.1% versus 18%, p<0.001). This higher risk of cardiovascular events in patients with low FMD was primarily due to a higher risk of heart failure hospitalization compared with patients with high FMD (19.6% versus 10.8%, p<0.05). There was no significant difference of stroke between both groups. Cox proportional hazards ratio (HR) analysis showed that low FMD (HR: 3.036, 95% CI: [1.546-5.963], CHA2DS2-VASc scores (HR: 1.383, 95% CI: [1.035-1.847]), and left atrial diameter (HR: 1.304, 95% CI: [1.001-1.069]) were independent predictors for composite cardiovascular events. In patients with paroxysmal AF, endothelial dysfunction was associated with composite cardiovascular events. Flow-mediated dilation was a significant predictor of cardiovascular events in patients with paroxysmal AF.

Prevalence of Metabolic Syndrome in Patients with Psoriasis

Introduction: Psoriasis is a multifactorial inflammatory disease of chronicity characterized by well-defined erythematous plaques covered with silvery white scales present particularly over extensor surfaces of extrimities, trunk and scalp associated with a higher cardiovascular risk. Metabolic syndrome is one of the significant predictor of cardiovascular events. Objective: To determine the prevalence of metabolic syndrome in patients with psoriasis. Materials and Methods: This cross-sectional study was conducted in Department of Dermatology &amp; Venereology, Combined Military Hospital (CMH), Dhaka from 01 May 2014 to 30 October 2014. One hundred four confirmed psoriasis patients were selected for this study. Complete history, thorough clinical examination including height, weight, Blood pressure (BP), waist circumference (WC) and relevant investigations were done in all patients. Results: Out of 104 patients of psoriasis, 32(30.8%) patients had metabolic syndrome and 72(69.2%) patients were without metabolic syndrome. In group I (with metabolic syndrome) majority 16(50.0%) patients belonged to age 51-60 years and in group II (without metabolic syndrome) 25(34.7%) patients belonged to age 21-30 years and the difference was significant statistically (p&lt;0.05) between two groups. Among the comorbidities, DM and HTN were found 26(81.3%) &amp; 24(75%) in group I and 4(16.7%) &amp; 18(25%) in group II respectively which was significant statistically (p&lt;0.05) between two groups. Conclusion: Psoriatic patients have a higher prevalence of metabolic syndrome, which can favour cardiovascular events. The dermatologists should be very keen to find out the elements of metabolic syndrome and suggests appropriate measures to reduce cardiovascular morbidity in addition to optimal dermatologic treatment of psoriasis. JAFMC Bangladesh. Vol 17, No 2 (December) 2021: 81-85

Notched P-Wave on Digital Electrocardiogram Predicts Cardiovascular Events in Patients with Cardiovascular Risks: The Japan Morning Surge Home Blood Pressure Study

Background: The relationship between notched P-wave characteristics on digital electrocardiogram (ECG) and long-term cardiovascular events remains unclear. Methods: We enrolled 810 subjects from the Japan Morning Surge Home Blood Pressure study who had one or more cardiovascular risk factors. Twelve-lead electrocardiography was conducted, and the peak-to-peak distance in the M shape was calculated automatically using a 12-lead ECG analysis system. We compared two definitions: P-waves were defined as “notched” if the peak-to-peak distance in the M shape was ≥20 ms or ≥40 ms in lead II. We assessed the left atrial diameter and left ventricular mass index (LVMI) by echocardiography. The primary endpoint was defined as a composite endpoint that combines fatal events (stroke, heart failure, coronary artery disease, and sudden death) and nonfatal events (acute myocardial infarction, angina, congestive heart failure, stroke, and aortic dissection). Results: The mean follow-up period was 101 ± 34 months, during which 85 cardiovascular events occurred. When we defined a notched P-wave as ≥20 ms in the M shape (n = 92), a notched P-wave was a significant predictor of cardiovascular events after adjustment for age, gender, and comorbidity (hazard ratio: 1.83; 95% confidence interval: 1.01–3.31, p = 0.045). When we defined a notched P-wave as ≥40 ms in the M shape (n = 25), the hazard ratio of cardiovascular events in the notched P-wave group was not significant after adjustment for covariates (hazard ratio: 1.52; 95% confidence interval: 0.51–4.53, p = 0.455). The left atrial diameter and LVMI in the patients in the notched P-wave group (peak-to-peak distance of ≥20 ms in the M shape) were significantly higher than those in the control group (left atrial diameter: 38.8 ± 5.9 vs. 36.8 ± 5.0 mm, p = 0.001; LVMI: 103.9 ± 27.7 vs. 96.3 ± 25.7 g/m², p = 0.010). Conclusions: The notched P-wave by digital ECG analysis was associated with cardiovascular events and left atrial enlargement.

Increase of serum cyclophilin C levels in the follow-up of coronary artery disease: A biomarker and possible clinical predictor.

Objective:This study is aimed at investigating the changes in serum CypC levels and their relationship with cardiovascular events at 12 months of follow-up in coronary artery disease (CAD) patients.Methods:The study included a total of 125 subjects (40 patients with acute CAD, 40 patients with chronic CAD, and 45 control volunteers) and we analyzed plasma CypC levels from baseline to 6 and 12 months for a better understanding of its behavior in atherosclerosis.Results:Serum CypC levels were shown to be gradually increased in CAD patients (30.63 pg/mL ± 3.77 at baseline, 38.70 pg/mL ± 6.41 at 6 months [p = 0.25], and 47.27 pg/mL ± 5.65 at 12 months [p = 0.007]). In addition, serum CypC levels during the follow-up were a significant predictor of CAD (c-statistic 0.76 at 6 months and 0.89 at 12 months; p < 0.001). Despite it, there was no significant association between CypC and cardiovascular events, but serum CypC levels tended to be higher in patients suffering cardiovascular events during the follow-up (29.02 pg/mL ± 6.39 vs. 79.96 pg/mL ± 22.18; p = 0.029). In this regard, plasma levels of high-sensitivity C-reactive protein (hsCRP) > 2.3 mg/L plus NT-proBNP > 300 pg/mL together were significant predictors of cardiovascular events during the follow-up in CAD patients with CypC levels >17.5 pg/mL (p = 0.048).Conclusions:Taken together, our results suggest that serum CypC levels increase during the follow-up in CAD patients and could be a novel biomarker with a possible prognostic value in combination with hsCRP and NT-proBNP.

Increase of serum cyclophilin C levels in the follow-up of coronary artery disease: a biomarker and possible clinical predictor

Abstract Background Traditional cardiovascular risk factors and a large number of biomarkers are well known in their association with the diagnosis and prognosis of coronary artery disease (CAD). Cyclophilin C (CypC) is a subfamily of immunophilins that modulates macrophage activation and redox homeostasis. Purpose This study is aimed at investigating the changes in serum CypC levels and their relationship with cardiovascular events at 12 months of follow-up in CAD patients. Methods The study included a total of 125 subjects (40 patients with acute CAD, 40 patients with chronic CAD and 45 control volunteers). We analyzed plasma CypC levels from baseline to 6 and 12 months for a better understanding of its behaviour in atherosclerosis. Results Serum CypC levels were shown to be gradually increased in CAD patients [(30.63 pg/mL ± 3.77 at baseline, 38.70 pg/mL ± 6.41 at 6 months (p=0.25) and 47.27 pg/mL ± 5.65 at 12 months (p=0.007)]. In addition, serum CypC levels during the follow-up were a significant predictor of CAD (c- statistic 0.76 at 6 months and 0.89 at 12 months; p&amp;lt;0.001). Despite it, there was no significant association between CypC and cardiovascular events, but serum CypC levels tended to be higher in patients suffering cardiovascular events during the follow-up (29.02 pg/mL ± 6.39 vs 79.96 pg/mL ± 22.18; p=0.029). In this regard, plasma levels of hsCRP &amp;gt;2.3 mg/L plus NT-proBNP &amp;gt;300pg/mL together were significant predictors of cardiovascular events during the follow-up in CAD patients with CypC levels &amp;gt;17.5 pg/mL (p=0.048). Conclusions Taken together, our results suggest that serum CypC levels increase during the follow-up in CAD patients and could be a novel biomarker with a possible prognostic value in combination with hsCRP and NT-proBNP. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III. Spain

Prognostic value of diastolic function parameters in significant aortic regurgitation. The role of the left atrial strain

Abstract Background The management of patients with asymptomatic significant aortic regurgitation (sAR) is often challenging and appropriate timing of aortic valve surgery remains controversial. There are no strong indicators to recommend early surgery in patients with sAR, however delaying the time for the intervention could bring potential negative consequences, such as the risk of permanent left ventricular (LV) dysfunction. The prognostic value of diastolic parameters has been demonstrated in several cardiac diseases. In particular, left atrial (LA) function has been shown to be an important determinant of morbimortality. Purpose The purpose of this study was to analyze the prognostic significance of diastolic function parameters, included LA strain, in asymptomatic patients with sAR and to evaluate whether these parameters could help to identify patients at high risk of adverse events that could benefit from early cardiac surgery. Methods From February 2013 to November 2019 consecutive asymptomatic patients with chronic sAR evaluated in the Heart Valve Clinic with a comprehensive transthoracic echocardiogram (TTE) were included. Combined clinical endpoint included hospital admission due to heart failure, cardiovascular mortality, or indication for aortic valve surgery. Results A total of 126 patients were included. During a mean follow up of 33±19 month, 25 (19.8%) patients reached the combined end-point. In a sub-group of 57 patients with TTE performed in the Philips stations, LA auto-strain analysis was obtained (figure 1). Univariate analysis showed that LV volumes, LVEF, E wave, E/e' ratio, LA volume and LA reservoir strain (LASr) were significant predictors of events, whereas LA diameter, and LV diastolic diameters were not. Multivariate model 1 that tested all echocardiographic variables statistically significant in the univariate model showed that the LVEDV and E/e' ratio, were significant predictors of events. In the subgroup of patients with LA auto-strain analyzed, a second multivariable model was built, including the previous significant variables for the first model (LVEDV and E/e' ratio), as well as the LA volume and LASr. It showed that LVEDV and LASr were the most significant predictors of cardiovascular events (figure 2). Conclusions In this population of asymptomatic patients with sAR and normal LV systolic function, baseline diastolic parameters were prognostic markers of cardiovascular events; among them, LA reservoir strain played a strong independent predictor role. In addition, our results also showed that LV volumes had greater prognostic value that LV diameters in patients with asymptomatic sAR. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Visit-to-visit variability of blood pressure and cardiovascular events among the working-age population in Japan: findings from the Japan Epidemiology Collaboration on Occupational Health Study.

Increased visit-to-visit variability (VVV) of blood pressure, which is calculated based on several readings, has been suggested to be a significant predictor of cardiovascular events and mortality, independent of mean blood pressure. This study examined associations between the VVV of systolic blood pressure (SBP) measured annually and cardiovascular disease (CVD) events among 72,617 Japanese subjects. Data were obtained from the Japan Epidemiology Collaboration on Occupational Health Study, which is an ongoing epidemiological survey of workers in Japan. VVV was calculated as the coefficient of variation of SBP readings from 2008 to 2011; information on fatal and nonfatal CVD events was collected from registries of specific outcomes between April 2012 and March 2019. A Cox proportional hazards model was applied to investigate associations after adjusting for mean SBP between 2008 and 2011 and covariates. During the 7-year follow-up period, there were 63 CVD fatalities and 314 CVD events (combining fatal and nonfatal events). The results showed that a one-standard deviation increase in VVV was associated with a significant increase in the risk of CVD mortality (hazard ratio [HR] = 1.42; 95% confidence interval [CI] = 1.32-1.54); those in the highest tertile had a 3.20 times (95% CI = 1.26-8.17) higher risk of CVD mortality than those in the lowest tertile. We found less pronounced associations regarding CVD events (HR = 1.08, 95% CI = 1.02-1.15). In conclusion, VVV was significantly associated with CVD mortality in our Japanese working population.

Associations of the nocturnal blood pressure fall and morning surge with cardiovascular events and mortality in individuals with resistant hypertension.

The prognostic importance of the nocturnal blood pressure (BP) fall and early-morning surge were scarcely investigated in patients with resistant hypertension (RHT). We investigated them in a prospective cohort of 1726 RHT individuals. The nocturnal fall and morning surge were calculated from the baseline ambulatory BP monitoring (ABPM) and also as mean cumulative values using all ABPMs performed during follow-up. Dipping patterns (normal, extreme, reduced, and reverse) were defined by classic cut-off values of the night-to-day ratio, while MS (difference between early-morning and night-time BP) was categorized into quartiles and at the extremes of its distribution (5th, 10th, 90th, and 95th percentiles). The primary outcomes were total cardiovascular events (CVEs), major adverse cardiovascular events (MACEs), all-cause and cardiovascular mortalities. Multivariate Cox analyses examined the associations between nocturnal BP fall and morning surge and outcomes. Over a median follow-up of 8.3 years, 417 CVEs occurred (358 MACEs), and 391 individuals died (233 cardiovascular deaths). Reduced and reverse dipping patterns were significant predictors of CVEs and MACEs, with hazard ratios between 1.6 and 2.5, whereas extreme dipping was a protective factor in younger individuals (hazard ratios 0.3--0.4) but a hazardous factor in elderly (hazard ratios 3.7--5.0) and in individuals with previous cardiovascular diseases (hazard ratios 2.6--4.4). No morning surge parameter was predictive of any outcome in fully adjusted analyses. Abnormal dipping patterns but not the early-morning BP surge, were important prognostic markers for future cardiovascular morbidity in RHT patients. The prognosis of extreme dippers depended on age and the presence of cardiovascular diseases.

Serum ceramides and type 2 diabetes are mutually independent predictors of cardiovascular events in patients with peripheral artery disease

Abstract Introduction: Ceramides are enriched in atherosclerotic plaques, and a set of circulating ceramides including Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/24:1), and Cer(d18:1/24:0) has recently emerged as predictors of cardiovascular outcomes in coronary artery disease patients. Hypothesis: We hypothesize that they have the power to predict cardiovascular events in patients with peripheral artery disease (PAD). Methods: We measured the serum concentrations of the above mentioned ceramides in a cohort of 380 patients with sonographically proven PAD, of whom 107 had type 2 diabetes (T2DM). Prospectively, we recorded 221 cardiovascular events over a mean follow-up time of 6.3±2.3 years. Results: Cardiovascular event risk was higher in T2DM patients than in those who did not have diabetes (69 vs. 52%, p=0.001). The ceramides Cer(18:1/16:0) and Cer(18:1/24:1) and the respective ratios Cer(18:1/16:0) / Cer(18:1/24:0) and Cer(18:1/24:1) / Cer(18:1/24:0) were significant predictors of cardiovascular events both univariately and after multivariate adjustment including the presence of T2DM (figure). Conversely, T2DM predicted cardiovascular events independently from the investigated ceramides (adjusted HR 1.76 [1.31-2.35], p<0.001). Conclusions: We conclude that the investigated ceramides and T2DM are mutually independent predictors of cardiovascular events in PAD patients.

Abstract 14614: The Automatically Assessed P-wave Notch Predicts Cardiovascular Events in Patients With Cardiovascular Risks: The Japan Morning Surge Home Blood Pressure (J-HOP) Study

Background: The notched P-wave characteristics is associated with atrial remodeling. However, the relationship between notched P-wave characteristics and long-term cardiovascular events remains unclear. Hypothesis: We hypothesized that the notched P-wave would be associated with cardiovascular events. Methods: We enrolled 810 subjects from the J-HOP Study who had ≥1 of four cardiovascular risk factors. Twelve-lead electrocardiography was conducted, and the peak-to-peak distance in the M-shape was calculated automatically using a 12-lead ECG Analysis system (Fukuda Denshi, Tokyo). We compared two definitions: P waves were defined as "notched" if the peak-to-peak distance in the M-shape was ≥20 msec or ≥40 msec in lead II. The primary endpoints were fatal/nonfatal cardiovascular events: myocardial infarction, stroke, hospitalization for heart failure, and aortic dissection. We assessed the left atrial diameter and left ventricular mass index (LVMI) by echocardiography. Results: The mean follow-up period was 101±34 months, and 85 cardiovascular events occurred. When we defined a notched P wave as ≥20msec in the M shape (n=92), a notched P wave was a significant predictor of cardiovascular events after adjustment for age, gender, and comorbidity (hazard ratio 1.80, 95%CI: 1.06-3.05). When we defined a notched P wave as ≥40msec in the M shape (n=25), the hazard ratio of cardiovascular events in the notched P-wave group was significantly borderline after adjustment for covariates (hazard ratio 2.23, 95%CI: 0.90-5.56). The left atrial diameter and LVMI in the patients in the notched P-wave group (≥20 msec in the M shape) were significantly higher than those in the control group (left atrial dia. 38.8±5.9 vs. 36.8±5.0 mm, p=0.001; LVMI 103.9±27.7 vs. 96.3±25.7 g/m 2 , p=0.010). Conclusion: The automatically assessed notched P wave was associated with cardiovascular events, left atrial enlargement and left ventricular hypertrophy.

Prognostic Value of Psoas Muscle Mass Index in Patients With Non‒ST-Segment‒Elevation Myocardial Infarction: A Prospective Observational Study.

BackgroundMuscle wasting is an important predictor of long‐term outcome in patients with cardiovascular disease, but the prognostic value of muscle wasting in patients with non‒ST‐segment‒elevation myocardial infarction is not established. The aim of this study is to investigate the prognostic value of muscle wasting, defined by psoas muscle mass index (PMI), in patients with non‒ST‐segment‒elevation myocardial infarction.Methods and ResultsA total of 132 consecutive patients with non‒ST‐segment‒elevation myocardial infarction were prospectively enrolled between 2015 and 2018. Primary end point was incidence of cardiovascular events including cardiovascular deaths, non‐fatal myocardial infarction, or non‐fatal stroke. Cross‐sectional area of the psoas muscle at the L3 vertebral level was obtained by computed tomography and PMI was calculated. The median follow‐up period was 2.4 years (interquartile range, 1.1–4.0 years). There were 45 cardiovascular events (34%) during the study periods. The optimal cutoff value of PMI to predict cardiovascular events was 772 mm2/m2, as assessed by receiver operating curve analysis. Patients with reduced PMI (PMI<772 mm2/m2) had significantly higher cardiovascular events than those with preserved PMI (PMI≥772 mm2/m2) (48% versus 21%; log‐rank test P<0.001). Multivariate Cox proportional hazards model revealed that reduced PMI was a statistically significant predictor of cardiovascular events (hazard ratio, 3.30; 95% CI, 1.70–6.40; P<0.001).ConclusionsMuscle wasting defined as PMI is a simple and useful objective marker to predict future cardiovascular outcome in patients with non‒ST‐segment‒elevation myocardial infarction.Registration InformationURL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN000013445.

Higher oxidized high-density lipoprotein to apolipoprotein A-I ratio is associated with high-risk coronary plaque characteristics determined by CT angiography

BackgroundOxidized high-density lipoprotein (oxHDL), unlike native HDL, is characterized by reduced cholesterol efflux capability and anti-inflammatory properties. The ratio of oxHDL to apolipoprotein A-I (oxHDL/apoAI) is a possible marker of dysfunctional HDL. The aim of this study was to evaluate the association between oxHDL/apoAI and coronary plaque characteristics that increase the likelihood of cardiovascular events as determined by coronary computed tomography (CT) angiography. MethodsA total of 297 patients (mean age; 67 years, men; 63%) who underwent coronary CT angiography for suspected stable coronary artery disease (CAD) were included. High-risk plaques (HRP) were defined by three characteristics: positive remodeling; low-density plaques; and spotty calcification. Significant stenosis was defined as a luminal narrowing of >70%. Serum concentrations of oxHDL were measured using an enzyme-linked immunosorbent assay. ResultsPatients with higher oxHDL/ApoAI showed significantly greater prevalence of HRP (p = 0.03) and significant stenosis (p < 0.01) compared with patients with low oxHDL/ ApoAI. The multivariate logistic analysis demonstrated that oxHDL/ApoAI significantly associated with the presence of HRP and significant coronary stenosis (p = 0.01 and < 0.01). In the follow-up study including 243 patients for a median period of 1.8 years, univariate cox regression analysis showed that oxHDL/ApoAI, HRP and significant stenosis were significant predictors of cardiovascular events. ConclusionsA high oxHDL/apoAI was associated with the presence of HRP and significant stenosis determined by coronary CT angiography, which can lead to cardiovascular events in patients with suspected stable CAD.