Left atrial performance during exercise in endurance athletes: the impact of gender

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Simard ◽  
M Sanz-De La Garza ◽  
A Vaquer-Segui ◽  
I Blanco ◽  
S Prat-Gonzalez ◽  
...  
Keyword(s):  
Left Atrial ◽  
Female Athletes ◽  
Premenopausal Women ◽  
Underlying Mechanism ◽  
Cardiopulmonary Exercise Test ◽  
Endurance Athletes ◽  
Funding Source ◽  
Increased Risk ◽  
The Impact ◽  
Conduit Function

Abstract Background High-intensity endurance training is associated with an increased risk of atrial fibrillation (AF) in male athletes while it seems to have a protective effect for the development of atrial arrhythmias in female athletes. Mechanisms underlying this fact are unknown but a differential atrial adaptation to exercise may be involved. Aim To evaluate left atrial (LA) performance during exercise in endurance athletes (EAs) of both sexes. Methods Highly-trained (>10 hours training/week) EAs performed a maximal cardiopulmonary exercise test. LA evaluation was performed at rest and immediately after exercise. LA analysis consisted of standard and speckle-tracking assessment: atrial contractile, reservoir and conduction strain. Results 80 EAs (55% women, 34.8±5.8 years) were enrolled. Baseline LA size and functional parameters were similar in both sexes (Table 1). Compared to men, women achieved a higher predicted VO2max (Δchange+11.9%, p<0.01) but a similar increase of systolic blood pressure (Δ+63 vs +66%, p=0.58). Exercise induced a mild decrease in LA size but of similar amplitude for both sexes. LA strain parameters of EAs improved with exercise, but a significantly greater improvement in LA reservoir and conduit function was noted in women compared to men. In EAs with marked atrial remodelling (LA ≥35ml/m2), the same trend of greater improvement of LA reservoir and conduit function in women persisted. Conclusion In highly-trained EAs, premenopausal women have better LA function profile during exercise compared to men, even when the LA is significantly dilated. This discriminatory LA adaptation in female EAs could at least partly explain the dichotomous relationship between AF and exercise regarding sexes and warrants further studies to clarify the underlying mechanism. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Government of Spain - Plan Nacional I+D, Ministerio de Economia y Competitividad

Comparative data on left atrial appendage occlusion efficacy and clinical outcomes by age group in the Amplatzer™ Amulet™ Occluder Observational Study

EP Europace ◽  
2020 ◽  
Author(s):  
Xavier Freixa ◽  
Boris Schmidt ◽  
Patrizio Mazzone ◽  
Sergio Berti ◽  
Sven Fischer ◽  
...  
Keyword(s):  
Observational Study ◽  
Ischaemic Stroke ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Serious Adverse Events ◽  
Left Atrial Appendage Occlusion ◽  
Increased Risk ◽  
The Impact

Abstract Aims Left atrial appendage occlusion (LAAO) may be considered for patients with non-valvular atrial fibrillation (NVAF) and a relative/formal contraindication to anticoagulation. This study aimed to summarize the impact of aging on LAAO outcomes at short and long-term follow-up. Methods and results We compared subjects aged <70, ≥70 and <80, and ≥80 years old in the prospective, multicentre Amplatzer™ Amulet™ Occluder Observational Study (Abbott, Plymouth, MN, USA). Serious adverse events (SAEs) were reported from implant through a 2-year post-LAAO visit and adjudicated by an independent clinical events committee. Overall, 1088 subjects were prospectively enrolled. There were 265 subjects (24.4%) <70 years old, 491 subjects (45.1%) ≥70 and <80 years old, and 332 subjects (30.5%) ≥80 years old, with the majority (≥80%) being contraindicated to anticoagulation. As expected, CHA2DS2-VASc and HAS-BLED Scores increased with age. Implant success was high (≥98.5%) across all groups, and the proportion of subjects with a procedure- or device-related SAE was similar between groups. At follow-up, the observed ischaemic stroke rate was not significantly different between groups, and corresponding risk reductions were 62, 56, and 85% when compared with predicted rates for subjects <70, ≥70 and <80, and ≥80 years old, respectively. Major bleeding and mortality rates increased with age, while the incidence of device-related thrombus tended to increase with age. Conclusions Despite the increased risk for ischaemic stroke with increasing age in AF patients, LAAO reduced the risk for ischaemic stroke compared with the predicted rate across all age groups without differences in procedural SAEs.

scholarly journals Diet-induced obesity accelerates oral carcinogenesis by recruitment and functional enhancement of myeloid-derived suppressor cells

2021 ◽  
Vol 12 (10) ◽  
Author(s):  
Jianmin Peng ◽  
Qinchao Hu ◽  
Xijuan Chen ◽  
Chunyang Wang ◽  
Jiayu Zhang ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Suppressor Cells ◽  
Underlying Mechanism ◽  
Clinical Samples ◽  
Acid Uptake ◽  
Myeloid Derived Suppressor Cells ◽  
Increased Risk ◽  
The Impact

AbstractAlthough obesity has been associated with an increased risk and aggressiveness of many types of carcinoma, whether it promotes squamous cell carcinoma remains unclear. To reveal the role of obesity in oral squamous cell carcinoma (OSCC) initiation and development, we used 4NQO-induced OSCC model mice to examine the impact of dietary obesity on carcinogenesis. The results showed that high-fat diet (HFD)-induced obesity significantly promoted the incidence of OSCC and altered the local immune microenvironment with the expansion of CD11b+Gr1+ myeloid-derived suppressor cells (MDSCs). The underlying mechanism that induced an immunosuppressive local microenvironment in obesity was the recruitment of MDSCs through the CCL9/CCR1 axis and enhancement of MDSC immunosuppressive function via intracellular fatty acid uptake. Furthermore, clinical samples verified the increase in infiltrated CD33+ (a marker of human MDSCs) cells in obese OSCC patients, and data from the TCGA dataset confirmed that CD33 expression was positively correlated with local adipocytes in OSCC. Survival analysis showed that enrichment of adipocytes and high expression of CD33 were associated with poor prognosis in OSCC patients. Strikingly, depletion of MDSCs significantly ameliorated HFD-promoted carcinogenesis in 4NQO-induced model mice. These findings indicate that obesity is also an important risk factor for OSCC, and cancer immunotherapy, especially targeting MDSCs, may exhibit greater antitumor efficacy in obese patients.

Germline ATM mutations on survival in metastatic pancreatic cancer patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16746-e16746
Author(s):  
Arjan Gower ◽  
Gillian Gresham ◽  
Nanor Haladjian ◽  
John Lee ◽  
Camille Ng ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Metastatic Disease ◽  
Cox Regression ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Underlying Mechanism ◽  
First Line ◽  
Increased Risk ◽  
Atm Protein ◽  
The Impact

e16746 Background: Ataxia telangiectasia mutated (ATM) protein is a DNA damage repair enzyme and regulates normal cell-cycle mechanisms. Germline ATM mutations are associated with increased risk for developing pancreatic cancer (PC), occurring in approximately 2% of PC patients (pts). The role of germline ATM mutations in PC is not well defined. The objective of this study was to compare survival outcomes in patients with germline ATM mutations compared to somatic ATM mutations in PC. Methods: Tumor genomic profiling was completed in 144 PC patients at a single institution in the US, where pts were included in the analysis if they had either germline ATM mutations or somatic ATM mutations. Clinical outcomes were compared between pts with germline ATM mutations and pts with somatic ATM mutations only. Adjusted Cox regression models were fit to evaluate the impact of ATM mutation on overall survival (OS), calculated from treatment (tx) initiation to death, and progression free survival (PFS) calculated from tx initiation to first progression. Results: From 144 PC pts evaluated, 7 pts (4.9%) had germline ATM mutations, all of whom presented with metastatic disease, and 14 pts (9.7%) with somatic ATM mutations only, of whom 10 presented with metastatic disease and 4 who initially presented with locally advanced PC. The majority of pts (15/21), including all 7 pts with germline ATM mutations and 8 with somatic ATM mutations, were treated with first line gemcitabine and abraxane. Median OS was not reached in patients with germline mutations, and 11 months for patients with somatic mutations. Pts with germline ATM mutations had significantly higher OS (HR: 0.12, 95% CI 0.03-0.62, p = 0.01) and PFS (HR:0.26, 95%CI 0.07-0.91, p = 0.04) compared to patients with somatic ATM mutations only after adjusting for age, sex, and first-line tx. Conclusions: Pts with germline ATM mutations may experience greater survival benefit from tx compared to those with only somatic ATM mutations. Further research into the underlying mechanism is warranted.

Impact of body mass index on outcomes in European patients with atrial fibrillation: the ESC EHRA EORP Atrial Fibrillation General Long-Term registry (AFGen LT)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Boriani ◽  
M Proietti ◽  
C Laroche ◽  
L Fauchier ◽  
F Marin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Body Mass ◽  
Large Cohort ◽  
Funding Source ◽  
Increased Risk ◽  
Underweight Patients ◽  
The Impact

Abstract Introduction The impact of body mass index (BMI) on outcomes in patients with atrial fibrillation (AF) has been largely debated. Aims To describe the relationship between BMI categories and clinical outcomes in a large cohort of European AF patients. Methods We included all AF patients with available baseline BMI and creatinine clearance and 1-year follow-up data enrolled in the EORP-AF General Long-Term Registry. Outcomes considered were: i) a composite of any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death; ii) CV death; iii) all-cause death. Results A total of 7,759 patients were included in this analysis. Of these, 55 (0.7%) were underweight, 2,074 (26.7%) were normal weight, 3,170 (40.9%) were overweight, 1,703 (21.9%) were obese and 757 (9.8%) were severe obese. Mean age was progressively lower across the categories (p<0.0001), with proportion of patients aged≥75 years also progressively lower (52.7% in underweight to 19.4% in severe obese patients; p<0.001). Both underweight (41.8%) and severe obese (25.0%) patients were more likely symptomatic (p<0.001). Mean CHA2DS2-VASc score was higher in underweight patients (p=0.0325). Use of any oral anticoagulant therapy was progressively higher across the BMI categories (p<0.001). At 1-year follow-up the rate of all outcomes considered were highest for underweight patients and lowest in severe obese [Figure 1]. On univariate Cox regression analysis, being underweight was consistently associated to a higher risk for all outcomes, while increasing of weight categories was associated with progressively lower risk for adverse outcomes. After full adjustment with clinical and pharmacological characteristics, no effect of higher BMI classes was found for any outcome, but an independent association with an increased risk of CV death and all-cause death was seen for underweight patients (Table 1). Conclusions In a large cohort of European AF patients a progressively lower rate of outcomes was found across increasing BMI classes. After full adjustments, no significant association was found between the higher BMI classes and outcomes. Underweight was associated with an increased risk for CV death and all-cause death. Figure 1. Outcomes at 1-year Follow-up Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Since the start of EORP programme, several companies have supported it with unrestricted grants

Quantitative determination of circulating L-cartinine and its derivates contributes to Heart failure diagnosis, etiology discrimination and clinical prognosis prediction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Z Chen ◽  
D.B Lu ◽  
B.L Qi ◽  
Y Wu ◽  
Y Xia ◽  
...  
Keyword(s):  
Heart Failure ◽  
Serum Creatinine ◽  
Left Atrial ◽  
Acid Metabolism ◽  
Mortality Prediction ◽  
Funding Source ◽  
Clinical Prognosis ◽  
Left Atrial Diameter ◽  
Heart Failure Patients ◽  
The Impact

Abstract Background Despite the latest progress in heart failure therapy, early diagnosis and clinical prognosis prediction are still critical issues nowadays. It has been proved that carnitines play an essential role in fatty acid metabolism. However, it is unclear about the changes and clinical effects of circulating carnitines in heart failure. Objectives This study was designed to clarify the alteration of serum carnitine and its derivates in heart failure patients, and to verify the impact of carnitines on heart failure etiology discrimination and mortality prediction. Methods A total of 161 heart failure patients (Dilated cardiomyopathy: DCM, n=98; ischemia cardiomyopathy: ICM, n=63) and control patients (n=48) were enrolled from Feb to Sep in 2017. Serum L-carnitines were quantitatively measured by liquid chromatography/ mass spectrometry. All patients underwent follow-up (mean 30.8 months). Multi-variable Cox survival was performed to verify the impact of carnitines on heart failure mortality prediction. Results A total of 27 different carnitine derivates were detected. Compared with control group, 26 types of carnitines were increased significantly in heart failure patients. Several circulating carnitines were independent biomarkers for heart failure even adjusted by multi-variable logistic analysis. We also found 7 carnitines were obviously increased in DCM group than those in ICM group. Isobutyryl-L-carnitine and stearoyl-L-carnitine were independently associated with higher probability of DCM than ICM. DCM prediction model established by adding carnitines (isobutyryl-L-carnitine and stearoyl-L-carnitine) to age, serum creatinine and left ventricular ejection fraction,had favorable discrimination (C-index = 0.832, P<0.01, Figure 1A and B) and calibration efficiency (Hosmer-Lemeshow χ2=7.376, P=0.497>0.05). Meanwhile, a total of 43 mortality event occurred, 18 death (31.6%) in ICM group and 25 (27.2%) in DCM group. Independent clinical risk factors for the occurrence of mortality were serum creatinine >2mg/dl, left atrial diameter 0.55mm and N-terminal pro-B-type natriuretic peptide >4000 pg/ml. Using multi-variable COX survival analysis simultaneously adjusted by serum creatinine, left atrial diameter, NT-pro-BNP and age, oleoyl L-carnitine >300nmo/L (HR=2.364, 95% CI: 1.122–4.976, P=0.024) and isovaleryl-L-carnitine <100nmol/L (HR=2.108, 95% CI: 1.091–4.074, P=0.026) were also independently associated with higher mortality. Conclusions As one of critical participants in fatty acid metabolism, L-carnitines alteration not only differentiates DCM patients from ICM ones, but also independently predicts the risk of long-term mortality in heart failure patients. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China, Grant of Shanghai Municipal Commission of Health and Family Planning

scholarly journals Inflammatory Potential of the Diet and Risk of Breast Cancer in the European Investigation Into Cancer and Nutrition (EPIC) Study

2021 ◽  
Author(s):  
Carlota Castro-Espin ◽  
Antonio Agudo ◽  
Catalina Bonet ◽  
Verena Katzke ◽  
Renée Turzanski-Fortner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Physical Activity ◽  
Cox Regression ◽  
Menopausal Status ◽  
Premenopausal Women ◽  
Underlying Mechanism ◽  
Potential Effect ◽  
Inflammatory Score ◽  
Hazard Ratios ◽  
Increased Risk

Abstract The role of chronic inflammation on breast cancer (BC) risk remains unclear beyond as an underlying mechanism of obesity and physical activity. We aimed to evaluate the association between the inflammatory potential of the diet and risk of BC overall, according to menopausal status and tumour subtypes. Within the European Prospective Investigation into Cancer and Nutrition cohort, 318,686 women were followed for 14 years, among whom 13,246 incident BC cases were identified. The inflammatory potential of the diet was characterized by an inflammatory score of the diet (ISD). Multivariable Cox regression models were used to assess the potential effect of the ISD on BC risk by means of hazard ratios (HR) and 95% confidence intervals (CI). ISD was positively associated with BC risk. Each increase of one standard deviation (1-Sd) of the score increased by 4% the risk of BC (HR=1.04; 95% CI: 1.01-1.07). Women in the highest quintile of the ISD (indicating most pro-inflammatory diet) had a 12% increase in risk compared with those in the lowest quintile (HR=1.12; 95% CI: 1.04-1.21) with a significant trend. The association was strongest among premenopausal women, with an 8% increased risk for 1-Sd increase in the score (HR=1.08; 95% CI: 1.01-1.14). The pattern of the association was quite homogeneous by BC subtypes based on hormone receptor status. There were no significant interactions between ISD and body mass index, physical activity or alcohol consumption. Women consuming more pro-inflammatory diets as measured by ISD are at increased risk for BC, especially premenopausal women.

scholarly journals The Impact of Disease Comorbidities in Alzheimer's Disease

2021 ◽  
Vol 13 ◽  
Author(s):  
Jose A. Santiago ◽  
Judith A. Potashkin
Keyword(s):  
Alzheimer’S Disease ◽  
Cardiovascular Disease ◽  
Alzheimer's Disease ◽  
Underlying Mechanism ◽  
Increased Risk ◽  
Wide Range ◽  
Patients With Diabetes ◽  
Different Populations ◽  
Relationship Of ◽  
The Impact

A wide range of comorbid diseases is associated with Alzheimer's disease (AD), the most common neurodegenerative disease worldwide. Evidence from clinical and molecular studies suggest that chronic diseases, including diabetes, cardiovascular disease, depression, and inflammatory bowel disease, may be associated with an increased risk of AD in different populations. Disruption in several shared biological pathways has been proposed as the underlying mechanism for the association between AD and these comorbidities. Notably, inflammation is a common dysregulated pathway shared by most of the comorbidities associated with AD. Some drugs commonly prescribed to patients with diabetes and cardiovascular disease have shown promising results in AD patients. Systems-based biology studies have identified common genetic factors and dysregulated pathways that may explain the relationship of comorbid disorders in AD. Nonetheless, the precise mechanisms for the occurrence of disease comorbidities in AD are not entirely understood. Here, we discuss the impact of the most common comorbidities in the clinical management of AD patients.

Permanent discontinuation of different anticoagulants in patients with atrial fibrillation and the impact on clinical outcome: data from the GARFIELD-AF registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Cools ◽  
D Johnson ◽  
K.S Pieper ◽  
A.J Camm ◽  
J.-P Bassand ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Time Dependent ◽  
Funding Source ◽  
Increased Risk ◽  
History Of ◽  
Baseline Factors ◽  
The Impact

Abstract Background Non-Vitamin K Antagonists (NOAC) are replacing vitamin K Antagonists (VKA) as first line oral anticoagulant therapy (OAC) in patients with non-valvular atrial fibrillation (NVAF). Discontinuation of OAC might put patients at increased risk. It was anticipated that patients who were on NOAC would discontinue OAC less. Purpose We compare the rates and impact on outcome of the discontinuation of NOAC and VKA using data from the GARFIELD-AF registry. Methods Patients included in GARFIELD-AF, had a new diagnosis of NVAF and at least 1 stroke risk factor. In this analysis 26,299 patients (VKA: 13,012; NOAC: 13,287) that received OAC were included. Permanent discontinuation was defined as stopping OAC for at least 7 consecutive days (whether or not restarted during follow-up). Marginal structural Cox proportional hazards models estimated the effect of discontinuation on death, cardiovascular (CV) death, non-haemorrhagic stroke + systemic embolism (NHS+SE), myocardial infarction (MI), or combined endpoints. Adjustments were made for both baseline factors and time dependent variables. Results Of all patients, 15.6% discontinued OAC (VKA: 15.4%; NOAC: 15.8%) over a median follow-up of 181 days (IQR: 359). Most discontinued early (67.0% of patients on VKA and 47.1% of patients on NOAC ≤4 months). Significantly higher discontinuation risk was seen with worsening kidney function, coronary artery disease, history of bleeding (baseline factors), as well as with all types of bleeding (time dependent factors). Lower discontinuation rates were seen with history of stroke/TIA, hypertension, increasing age, permanent AF (all p<0.01). Mean CHA2DS2-VASc score was 3 in all groups. Patients in both treatment arms who discontinued were at increased risk for death, NHS+SE, MI as well as combined endpoints of death/NHS+SE/MI, death/NHS+SE and a trend towards higher CV death (Figure 1). All interaction tests for the interaction of treatment and discontinuation had a p value >0.4. The association between discontinuation and outcomes did not change when a 30 day discontinuation window was used. Conclusion The rate of discontinuation in this study was 15.8% and comparable for VKA and NOAC over a 2-year follow-up. Discontinuation rates were the highest soon after the initiation of treatment. When VKA or NOAC was stopped for ≥7 consecutive days, the risk of NHS+SE, death, MI or any combined endpoints were significantly worse in both treatment arms. These data suggest that discontinuation of anticoagulant treatment with VKA or NOAC should be discouraged. HR of patients who discontinued OAC Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The GARFIELD-AF registry is funded by an unrestricted research grant from Bayer AG.

Hinge point fibrosis in athletes is not associated with structural, functional or electrical consequences: a comparison between young and middle-aged elite endurance athletes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R De Bosscher ◽  
M Claeys ◽  
C Dausin ◽  
K Goetschalckx ◽  
J Bogaert ◽  
...  
Keyword(s):  
Female Athletes ◽  
Maximal Oxygen Consumption ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Endurance Athletes ◽  
Funding Source ◽  
Middle Aged ◽  
National Budget ◽  
Hinge Point ◽  
Wave Inversion

Abstract Background The health benefits of extensive endurance training have been debated due to the report of myocardial fibrosis (MF), arrhythmias and temporary post-race cardiac impairment in middle-aged and veteran athletes. The extent of these changes is unknown in elite young athletes. Purpose To assess the prevalence of MF and its structural, functional and electrical impact in highly trained young endurance athletes (YA, 15–23 years) as compared to middle-aged athletes (MA, 30–50 years). We hypothesised that MF would be more frequent in MA and associated with more structural, functional and electrical abnormalities. Methods We prospectively assessed 197 YA and 34 MA. All had ECG, maximal oxygen consumption (VO2max) testing, cardiac magnetic resonance imaging (CMR), echocardiography and 24h-holter. Indexed left ventricular and right ventricular end diastolic volume (LVEDVi, RVEDVi), ejection fraction (LVEF, RVEF), left ventricular mass (LVMi), and MF defined as delayed gadolinium enhancement were assessed by CMR. LV and RV free wall strain (LVSL, RVfwSL) were assessed by 2D speckle tracking echocardiography. Ventricular premature beats (VPB) and non-sustained ventricular tachycardia (nsVT) were assessed by 24h-holter. Results YA and MA (18±2 vs 38±5 years [p<0.01]; 78% vs 80% male [p=0.99]) with an elite level of fitness (VO2max 61±8 vs 54±10 mL/min/kg [p<0.01]; % predicted VO2max 150±20 vs 158±30 [p=0.02]) had a large variance in LV and RV remodelling (Figure 1). MF was seen in 28 athletes (12.5%) and more prevalent in MA than in YA (23.5 vs 10.5%, p=0.048). MF was limited to the hinge points in all 8 MA with MF and 17 YA. 3 YA had LV lateral wall subepicardial MF. 27 of 187 (14.4%) male athletes had MF compared to 1 of 50 (2%) female athletes (p=0.01). MF+ MA(A) and YA(B) as well as MF− MA(C) and YA(D) had similar structural remodelling (LVEDVi 110±14 vs 118±14 vs 113±19 vs 110±16 mL/m2; RVEDVi 120±14 vs 128±17 vs 117±19 vs 125±23mL/m2; LVMi 77±11 vs 83±14 vs 81±14 vs 77±15g/m2, p>0.05). LVEF, LVSL and RVSL were similar (59±3 vs 58±5 vs 61±6 vs 58±6%; −18.8±2 vs −18.8±2 vs −19.8±2 vs −19.3±2%; −26.3±2.4 vs −24.4±2.4; −26.3±3 vs −25.8±3.5% respectively, p>0.05). LVEF <50% was seen in 19 (8.2%) athletes (0 [0%] vs [5%] 1 vs 1 [3.8%] vs 17 [9.6%]; p=0.51). RVEF was higher in D compared to C without further differences between groups (54±4 vs 54±6 vs 53±6 vs 57±5, p=0.005). RVEF<45% was seen 21 (9.1%) athletes (0 [0%] vs 1 [5%] vs 0 [0%] vs 20 [11.3%]; p=0.14). Abnormal T-wave inversion was similar (12.5 vs 5 vs 7.4 vs 6.2%, p=0.93) as was the prevalence of >100VPB/24h (12.5 vs 5 vs 11.1 vs 5.1%, p=0.42). 2 athletes had nsVT, both in D. All had similar exercise capacity (% predicted VO2max 157±26 vs 152±15 vs 147±24 vs 158±32%; p=0.11). Conclusion Hinge-point fibrosis was more prevalent in MA, possibly due to repeated hemodynamic stress during exercise, but is not associated with structural, functional or electrical consequences. Figure 1. Cardiac remodelling in elite athletes Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fonds voor Wetenschappelijk Onderzoek (FWO)

Stratifying the prognostic capability of cardiovascular magnetic resonance in severe aortic stenosis: a machine learning approach

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Kwak ◽  
R Everett ◽  
T Ko ◽  
H Lee ◽  
W Lee ◽  
...  
Keyword(s):  
Machine Learning ◽  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Aortic Stenosis ◽  
Volume Fraction ◽  
Left Ventricular ◽  
Funding Source ◽  
Ventricular Ejection Fraction ◽  
Increased Risk ◽  
The Impact

Abstract Background Cardiovascular magnetic resonance (CMR) demonstrates promise in improving patient risk stratification in aortic stenosis (AS). We explored whether machine learning might provide further insights into the prognostic capability of CMR parameters. Methods Severe AS patients (n=440) undergoing AVR were prospectively enrolled across 10 international sites, and CMR performed prior to AVR. A machine learning prediction model using a random survival forest (RSF) was trained with 29 variables, including 13 CMR, 4 echocardiography, and 12 clinical parameters, using post-AVR mortality as an outcome. The impact of the important variables on the outcome (partial dependency) was examined. Results The most predictive CMR parameters in the RSF model were the extracellular volume fraction (ECV%), followed by right ventricular ejection fraction (RVEF), late gadolinium enhancement (LGE%), and indexed left ventricular end-diastolic volume (LVEDVi). Regarding the partial effects, the predicted mortality increased strongly once the ECV% exceeded 26.5% (Figure 1A). The LGE% was associated with an increased risk of mortality, which reached a plateau beyond the level of 2% (Figure 1C). There were U-shaped relationships between mortality and both RVEF and LVEDVi, with the lowest mortality seen at RVEF 70% and LVEDVi 68ml/m2 (Figure 1B, D). These trends of predicted outcomes by each variable were verified in the Kaplan-Meier curves and Cox analyses (Table). In both Cox and RSF models, the predictability was substantially increased when these four CMR parameters were added to conventional clinical risk factors. An AS-CMR risk score comprised of these four parameters presented a stepwise increase in mortality with increasing adverse CMR features (p<0.001). Conclusions Our machine learning analysis using RSF has identified ECV%, RVEF, LGE%, and LVEDVi as key prognostic markers in severe AS with a nonlinear influence of each parameter on mortality post-AVR. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported by grants from the Korean Health Technology R & D Project, Ministry of Health, Welfare & Family Affairs, Republic of Korea (HI16C0225 and HI15C0399) and the National Institute for Health Research (NIHR) infrastructure at Leeds.

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