Prognostic role of global work index in asymptomatic patients with aortic stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Ilardi ◽  
A Postolache ◽  
R Dulgheru ◽  
S Marchetta ◽  
M Cicenia ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Control Group ◽  
Funding Source ◽  
Cardiac Damage ◽  
Asymptomatic Patients ◽  
Work Index ◽  
Advanced Stages ◽  
Global Work

Abstract Background In asymptomatic patients with aortic stenosis (AS), the optimal timing for intervention is still challenging. Previous studies demonstrated that advanced stages of cardiac damage are associated with excess mortality. The role of myocardial work to identify cardiac dysfunction in AS and to predict prognosis has not been investigated. Purpose We aimed to evaluate the modification of myocardial work indices related to AS stages and their prognostic value. Methods This study analysed clinical, echocardiographic and outcome data of 170 patients with asymptomatic AS (aortic valve area ≤1.5 cm2) and preserved ejection fraction (LVEF ≥50%). Exclusion criteria were: significant associated cardiac valve lesion, left bundle branch block and suboptimal quality of speckle-tracking image analysis. The control group included 50 patients matched for age and sex. Global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) were estimated by LV pressure-strain loops. In AS group, LV pressure was evaluated by adding trans-aortic mean gradient to systolic blood pressure. The following staging classification was used: no cardiac damage associated with the valve stenosis (Stage 0), left ventricular damage (Stage 1), left atrial or mitral valve damage (Stage 2), pulmonary hypertension or tricuspid valve damage (Stage 3), or right ventricular damage or subclinical heart failure (Stage 4). Results While global longitudinal strain was significantly lower in AS than in control group (18.7±2.8 vs 20.7±2.1%, p<0.001), increased values of GCW and GWI (respectively 2948±598 vs 2360±353 mmHg%, and 2528±521 vs 2005±302 mmHg%, p<0.001) were observed in patients with AS. Besides, GWW was significantly increased in AS vs controls (139±90 vs 90±49 mmHg%, p=0.001), with no changes in terms of GWE (95±4 vs 96±2%, p=0.110). When patients were stratified according the stages of cardiac damage, MW indices didn't different significantly, except for the GWI, which was significantly lower in Stage 3 to 4 compared to Stage 0 and Stage 2 (2268±469 vs 2623±503 vs 2610±503 mmHg% respectively, p=0.025). During a mean follow up of 27 months (IQ range 12–48 mo), 18 patients had a CV death. The best GWI value associated with outcome was 1866 mmHg% (sensitivity 45%, specificity 96%, AUC= 0.701, p=0.01). The presence of a GWI at baseline lower than 1866 mmHg% was associated with a higher rate of CV events at 4-year follow-up (57% vs 7%, log-rank p<0.001). On multivariable Cox-regression analysis, BNP values (P=0.014) and GWI <1866 mmHg% (P=0.033) emerged as independently associated with CV death. Conclusion In asymptomatic patients with AS, advanced stages of cardiac damage are characterized by reduced values of GWI, that are associated with increased mortality. Thus, the evaluation of MW indices may allow a better phenotyping of asymptomatic patients at higher risk of developing cardiovascular events during follow-up. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Cardiopath PhD program

The vegf-a gene polymorphism in prognosis of outcomes in patients with stemi

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Kutya ◽  
Y Hilova ◽  
J Rodionova ◽  
M Kopytsya ◽  
O Petyunina
Keyword(s):  
Gene Polymorphism ◽  
Cardiovascular Death ◽  
Adverse Outcomes ◽  
Public Institution ◽  
Control Group ◽  
Case Group ◽  
Funding Source ◽  
Polymerase Chain

Abstract   One of the promising parameter for the prognosis in patients with STEMI can be suggested the VEGF-A gene polymorphism. Purpose Estimate the role of the VEGF-A gene polymorphism in the prediction of outcomes in patients with STEMI. Methods The study involved 135 STEMI patients (80.7% male and 19.3% female) with an average age of 59.21±8.92 years. Control group of 30 healthy volunteers included. Patients were divided into two groups: the first one – “case” group, those who reached the end point, and the second group – “control”, those who did not reached. The combined endpoint included cardiovascular death, recurrent myocardial infarction, the occurrence / progression of heart failure that required hospitalization. The study of the VEGF-A gene polymorphism (rs 2010963) was carried out by polymerase chain reaction (PCR). Follow-up period was 6 month. VEGF-A level was measured by ELISA. Results The patients from the “case” group had significantly elevated VEGF-A levels compared to controls (217.40 [102.54–473.78] pg/ml; 311.45 [204.20–680.86] pg/ml; p=0.046). Multivariate linear regression analyses demonstrated that polymorphism G634C (rs2010963) of VEGF-A gene (G634C+C634C) – β=0.8079, CI [1.1907 to 5.6490] p=0.0465; and LVEF <50.60% – β=0.0488 CI [0.9179 to 0.9882], p=0.0096 are significantly associated with negative outcomes (combined endpoints). Conclusions STEMI patients with G634C+C634C polymorphism G634C (rs2010963) of VEGF-A gene, and with LVEF <50.60% have greater chances for adverse outcomes. Further investigations of the VEGF-A gene polymorphism are the perspective direction in the development of prevention and treatment of STEMI. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): GI “L.T. Malaya Therapy National Institute NAMSU”

scholarly journals Subclinical Myocardial Dysfunction in Patients with Persistent Dyspnea One Year after COVID-19

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 57
Author(s):  
Maria-Luiza Luchian ◽  
Andreea Motoc ◽  
Stijn Lochy ◽  
Julien Magne ◽  
Dries Belsack ◽  
...  
Keyword(s):  
Cardiac Dysfunction ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Asymptomatic Patients ◽  
Work Index ◽  
Constructive Work ◽  
Echocardiographic Parameters ◽  
Global Work ◽  
One Year

Long coronavirus disease 2019 (COVID-19) was described in patients recovering from COVID-19, with dyspnea being a frequent symptom. Data regarding the potential mechanisms of long COVID remain scarce. We investigated the presence of subclinical cardiac dysfunction, assessed by transthoracic echocardiography (TTE), in recovered COVID-19 patients with or without dyspnea, after exclusion of previous cardiopulmonary diseases. A total of 310 consecutive COVID-19 patients were prospectively included. Of those, 66 patients (mean age 51.3 ± 11.1 years, almost 60% males) without known cardiopulmonary diseases underwent one-year follow-up consisting of clinical evaluation, spirometry, chest computed tomography, and TTE. From there, 23 (34.8%) patients reported dyspnea. Left ventricle (LV) ejection fraction was not significantly different between patients with or without dyspnea (55.7 ± 4.6 versus (vs.) 57.6 ± 4.5, p = 0.131). Patients with dyspnea presented lower LV global longitudinal strain, global constructive work (GCW), and global work index (GWI) compared to asymptomatic patients (−19.9 ± 2.1 vs. −21.3 ± 2.3 p = 0.039; 2183.7 ± 487.9 vs. 2483.1 ± 422.4, p = 0.024; 1960.0 ± 396.2 vs. 2221.1 ± 407.9, p = 0.030). GCW and GWI were inversely and independently associated with dyspnea (p = 0.035, OR 0.998, 95% CI 0.997–1.000; p = 0.040, OR 0.998, 95% CI 0.997–1.000). Persistent dyspnea one-year after COVID-19 was present in more than a third of the recovered patients. GCW and GWI were the only echocardiographic parameters independently associated with symptoms, suggesting a decrease in myocardial performance and subclinical cardiac dysfunction.

scholarly journals Patients with recurrent syncope and implantable loop recorder exhibit better survival than the control group without implantable loop recorder

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Perings ◽  
C Wolff ◽  
A Wilk ◽  
A Witthohn ◽  
R Voss ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Control Group ◽  
Funding Source ◽  
Implantable Loop Recorder ◽  
Loop Recorder ◽  
Cardiac Device ◽  
Unexplained Syncope ◽  
Care Costs

Abstract Introduction In 30% of patients with syncope, the underlying cause remains unexplained after clinical investigations. Unexplained syncope tends to recur, significantly impacting patients' quality of life of patients and mortality. Thus, there is a need for timely and more accurate diagnosis to initiate treatment. Dedicated care pathways are recommended by ESC guidelines. Purpose Patients with recurrent syncope were followed over time and patient outcomes with ILR were compared to patients with the same syncope burden, age, gender and mortality risk score who did not receive an ILR. Method A representative database of 4.9 million patients insured by German company statuary health insurances (BKK) was analysed over a time period of 10 years, 2007–17. Patients with recurrent syncope (two times ICD-10 GM diagnosis codes R55), age between 45–84 and no diagnosis code for the syncope were included in the analysis and followed for at least 2 years. Patients with ILR were matched to patients without ILR based on age, gender and Charlson Comorbidity index (CCI) using mahalanobis distances. The index event was the device implant in the ILR group and the second syncope event in the control group. Life expectancy, syncope hospitalisations, fall related injuries, health care costs, diagnoses and treatment rates were compared between the groups. Results A total of 412 patients with ILR for recurrent unexplained syncope were matched to the control group. Overall mean age was 68, mean was CCI 2.7, 42% were females. The risk of death was 2.35 times higher in the control group during follow up as shown in Figure 1 (p-value logrank test <0.0001). Cardiovascular related diagnosis and treatment rates were higher in the ILR group with 69% of patients having a cardiology diagnosis compared to 41% in the control group. Over a quarter (27%) of ILR patients received an implantable cardiac device compared to 5% in the control group. Ablation rates were 7% in the ILR group compared to 0% in the control group. Median health care costs were € 3,847 higher in the ILR group including the costs of the ILR implant, follow up and higher rates of cardiac treatments. These extra costs appear moderate given the substantially higher mortality risk in the control group. Conclusion This study of patients with recurrent unexplained syncope shows a remarkable difference in life expectancy in patients with ILR compared to a matched control group. Two large claim data analysis have recently shown higher rates of cardiovascular death as well as all-cause mortality in patients with unexplained syncope. A more vigilant cardiac workup might be needed to identify a possible underlying cardiac condition. Higher rates of cardiac device therapy in the ILR group were likely to play an important role for their better life expectancy. Cardiac therapies such as pacemakers, defibrillators and ablation have also been shown to significantly improve patients' quality of life. Life Expectancy Comparison Funding Acknowledgement Type of funding source: Private company. Main funding source(s): The data analysis was funded by Medtronic

The role of stress testing in evaluation of asymptomatic patients with aortic stenosis

2013 ◽  
Vol 28 (5) ◽  
pp. 531-539 ◽  
Author(s):  
Patrizio Lancellotti ◽  
Julien Magne ◽  
Luc A. Piérard
Keyword(s):  
Aortic Stenosis ◽  
Stress Testing ◽  
Asymptomatic Patients

scholarly journals Cardiologic evaluation of patients undergoing chemoterapy

2015 ◽  
Vol 82 (2) ◽  
Author(s):  
Barbara Bordoni ◽  
Stefano Urbinati ◽  
Alicia Tosoni ◽  
Graziana Labanti ◽  
Alba Brandes
Keyword(s):  
Ventricular Dysfunction ◽  
Troponin I ◽  
Coronary Spasm ◽  
Left Ventricular ◽  
Cardiac Damage ◽  
Common Risk Factors ◽  
Selection For ◽  
Chemotherapy Cardiotoxicity

Life expectancy in patients affected by cancer has recently increased because of early diagnosis and actual therapies. In recent years, Oncology and Cardiology developed a tight relationship because of common risk factors (i.e. obesity, smoking, alcool intake, etc…), and for preventing the prothrombotic status due to cancer and the potential cardiotoxicity of chemotherapy. Cardiotoxicity incidence is reported from 1% up to 70% in retrospective analyses of drug protocols, mainly representing by left ventricular dysfunction (both reversible or irreversible), but also by arrhythmias, hypertension, atrioventricular block, coronary spasm, and arterial or venous thromboembolism. The early detection of the chemoterapy induced cardiotoxicity is now mandatory and can be obtained through a proper patients selection for different treatments and a strict monitoring during the follow-up period. The role of biomarkers of early cardiac damage, mainly, troponin I and brain natriuretic peptide-BNP, has been recently challenged, and algorithms are currently available. In the present paper, we propose how to perform a cardiological evaluation of patients undergoing chemoterapy tailored by the known adverse effects of the drugs.

Abstract 15165: Routine Ambulatory Heart Rhythm Monitoring in Patients With Transthyretin Cardiac Amyloidosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Zack Dale ◽  
Lana Rashdan ◽  
Pranav Chandrashekar ◽  
Miriam Elman ◽  
Stephen B Heitner ◽  
...  
Keyword(s):  
Cardiac Amyloidosis ◽  
Ambulatory Monitoring ◽  
Heart Rhythm ◽  
High Rate ◽  
Routine Practice ◽  
Cardiovascular Implantable Electronic Devices ◽  
Asymptomatic Patients ◽  
Atrial Fibrillation And Flutter

Introduction: Atrial fibrillation and flutter (AF/AFL) are common with transthyretin cardiac amyloidosis (ATTR-CM). These patients have higher risk for thromboembolism. Detection of AF/AFL may thus be especially important, but the role of routine ambulatory monitoring in asymptomatic patients is unclear. Methods: A single center observational study of patients seen at our Amyloidosis Center with wild-type or hereditary ATTR-CM diagnosed between 2005-2019. Records were reviewed to see if AF/AFL was present at baseline. In those without known AF/AFL, ambulatory monitor (duration 2-30 days) was done every 6 months when feasible as part of our routine practice. Patients with cardiovascular implantable electronic devices (CIED) instead had routine device interrogations. Results: Ninety-four patients with ATTR-CM (mean age 71.4±11.4 years, 88.3% male) had mean follow-up 2.2±1.9 years (200 patient-years). AF/AFL was seen in 62 patients (66.0%): 35 (56.5%) by symptoms, 18 (29.0%) incidentally by monitor or CIED, and 9 in whom method of AF/AFL diagnosis was unknown. Forty-one patients (66.1%) had AF/AFL before ATTR-CM diagnosis by of median 26.3 (IQR 4.3-40.9) months. New AF/AFL was diagnosed in 21/53 remaining patients with known ATTR-CM - 11 (52.4%) were incidentally diagnosed (Figure 1). Median time between ATTR-CM and AF/AFL diagnoses was 10.3 (IQR 7.0-25.8) months and 5.9 (IQR 2.2-22.3) months in symptomatic versus incidentally diagnosed patients (Mann-Whitney U=35, p=0.14). Anticoagulation (AC) was started in 9/11 (81.8%) due to incidental AF/AFL. One patient had AC for prior DVT; the other had no AC per patient preference. No strokes occurred in patients on AC. Conclusions: We found a high rate of incidentally diagnosed AF/AFL in patients with ATTR-CM. Detection of AF/AFL led to change in therapy. This finding affirms a need for routine ambulatory monitoring in asymptomatic patients with ATTR-CM. Optimal duration of monitoring needs further investigation.

A Group-Based Walking Study to Enhance Physical Activity Among Older Adults: The Role of Social Engagement

2020 ◽  
pp. 016402752096361
Author(s):  
Yujun Liu ◽  
Margie E. Lachman
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Social Engagement ◽  
Treatment Condition ◽  
Social Comparisons ◽  
Text Messages ◽  
Control Group ◽  
Group Members

Objectives. The aim of this study was to explore social engagement and social comparisons as mechanisms to increase physical activity among older adults. Methods. Participants (N = 60, mean age = 65.7) were randomly assigned to one of two conditions. Participants in the treatment condition used the application to track their daily walking steps and interact via text messages with their group members for 4 weeks. Participants in the control group used the application only to track their own walking steps. Outcome variables included mean weekly steps, exercise self-efficacy, and social engagement. Results. The results revealed that participants in the experimental condition significantly increased their mean weekly steps and social engagement from the pretest to the posttest whereas the control group did not. These effects were maintained at the 1-month follow up. Discussion. The study expands our understanding of the motivational role of social engagement and social comparison in increasing PA among older adults.

The GLP-1 receptor agonist Semaglutide decreases vascular inflammation in a rabbit model of advanced atherosclerosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Kildevang Jensen ◽  
C Grandjean Poulsen ◽  
T Binderup ◽  
S Bentsen ◽  
B Follin ◽  
...  
Keyword(s):  
Molecular Imaging ◽  
Receptor Agonist ◽  
Vascular Inflammation ◽  
Rabbit Model ◽  
Public Institution ◽  
Ct Scans ◽  
Control Group ◽  
Funding Source ◽  
Pet Ct

Abstract Introduction Atherosclerosis is one of the most common inflammatory disorders leading to cardiovascular disease. Incretin therapies such as Glucagon like peptide 1 (GLP-1) receptor agonists has demonstrated efficacy in reducing major adverse cardiovascular events among high risk populations, possibly due to a reduction in vascular inflammation. Positron emission tomography (PET) is a promising modality in the study of atherosclerosis since it has the ability to evaluate physiological processes in vivo. The somatostaton receptor 2 (SSTR2) targeting tracer [64Cu]Cu-DOTA-TATE (DOTATATE) has high specificity for activated macrophages, which are one on the key instigators of atherosclerosis. Two other radiotracers, more commonly used to study atherosclerosis are Na[18F]F (NaF) a radiotracer used for detection of vascular microcalcifications, and [18F]FDG (FDG) used for visualization of inflammatory metabolic activity. Purpose The purpose of this study was to evaluate the anti-atherosclerotic and anti-inflammatory effects of the GLP-1 receptor agonist Semaglutide, using molecular imaging with DOTATATE, NaF and FDG, in a rabbit model of advanced atherosclerosis. Methods A total of 23 female New Zealand White rabbits were fed a high cholesterol diet for 4 months and endothelial denudation of the aorta was performed twice (Fig 1A). The animals underwent baseline PET/CT scans using DOTATATE and FDG. They were then randomly allocated to an intervention group (n=12) or control group (n=11) receiving bi- weekly subcutaneous injections of either Semaglutide in a dose escalating regimen up to 44 μg/kg/week, or placebo (n=11). The intervention period was 16 weeks for both groups. At follow-up, the animals underwent PET/CT scans with DOTATATE, FDG and NaF. Regions of interest were drawn on all CT scans of the aorta from the right renal artery to the iliac bifurcation, and SUVmax was measured from the superimposed PET scans. Data are presented as means ± SEM. Results SUVmax for FDG and DOTATATE were similar in the 2 groups at baseline (DOTATATE: 7.59±0.48 vs 6.69±0.28, P=0.13 and FDG: 2.63±0.12 vs 2.86±0.19 P=0.29). At follow-up, the Semaglutide group had a significantly lower uptake of both DOTATATE and FDG, although the largest difference was observed for DOTATATE (DOTATATE: 5.83±0.24 vs 7.10±0.33, P=0.001 and FDG: 2.49±0.13 vs 2.99±0.15, P=0.034) (Fig 1BC). Microcalcifications visualized using NaF PET, showed no difference at follow-up between the Semaglutide and the control group (4.15±0.30 vs 3.92±0.34, P=0.62) (Fig 1D). Increase in body weight was significantly attenuated in the Semaglutide group compared to the control group at follow-up (0.25±3.29% vs 10.68±3.01%, P=0.0016). Conclusions Semaglutide decreases vascular uptake of the SSTR2 tracer, DOTATATE, and FDG but not NaF. This supports the hypothesis that Semaglutide reduces inflammation by means of decreased macrophage activity and metabolism in the arterial wall. Figure 1 Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark

Short term chronic toxicity of tributyltin on the testes of adult albino rats and the possible protective role of omega-3

2020 ◽  
pp. 096032712094745
Author(s):  
Marwa G Ahmed ◽  
Mona El-Demerdash Ibrahim ◽  
Hoda R El Sayed ◽  
Samah M Ahmed
Keyword(s):  
Treated Group ◽  
Toxic Effects ◽  
Cellular Damage ◽  
Antioxidant Defenses ◽  
Control Group ◽  
Albino Rats ◽  
Omega 3 ◽  
Group I

The declining rate of male fertility is a growing concern. Tributyltin (TBT) is a well-known endocrine disruptor (ED), that induces imposex in female gastropods and is widely used in various industrial applications. The aim of this study was to evaluate the toxic effects of TBT on the testes of adult albino rats and the possible role of omega-3. Forty two adult male albino rats were divided into five groups; control group (Group I) and four experimental groups: omega-3 treated group, TBT treated group, TBT & omega-3 treated group and follow up group. At the end of the study, the rats were subjected to biochemical, histological, immunohistochemical staining for Ki-67 and seminal examinations. Our results clarfied that TBT induced a significant decrease in testosterone, FSH, LH and serum glutathione peroxidase levels and a significant increase in the serum Malondialdehyde as compared to the control group. Tributyltin induced disorganization and shrinkage of seminiferous tubules, apoptosis, cellular damage and marked reduction in the germinal epithelium. A significant decrease in the cell proliferation and arrested spermatogenesis were also detected. Seminal analysis of TBT group showed a significant affection of all parameters as compared to other groups. Omega-3 ameliorated all of these hazardous effects. Follow up group still showed toxic effects. In conclusion, TBT has a toxic effect on the testis. Increased testicular oxidative stress, cellular damage and arrest of spermatogenesis with attenuation in antioxidant defenses are all contributing factors. Omega-3 can protect against TBT induced reproductive toxicity.

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