Hydration status, BMI and troponin as factors of an impaired exercise tolerance in women over 40 with arterial hypertension

Purpose The aim was to identify factors influencing maximal oxygen uptake (VO2max) and early identification of hypertensive women at risk of heart failure (HF). Methods The 185 consecutive females with controlled hypertension were divided according VO2max quartiles. The patients underwent echocardiography, non-invasive body mass analysis, spiroergometry and hemodynamic parameters. Regression analyses determined predictors of the lowest VO2max (quartile 1: VO2max <17 ml/kg/min). Results Females with the worst oxygen consumption had significantly higher level of high sensitive cardiac Troponin T (hs-cTnT) [p=0.001], higher values of the left atrial (LA) volume, late diastolic mitral annulus velocity (A'), ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion (E/E') [p=0.0003, p=0.02, p=0.04; respectively] and lower E' [p=0.001] compared to controls. Women with the worst exercise capacity had higher body mass index (BMI) and fat content (kg and %) [p<0.0001], higher fat free mass (FFM) (kg) [p<0.0001], higher total body water content (TBW) [p=0.0002] as well as extracellular body water content (ECW) [p<0.0001] and intracellular body water content (ICW) [p=0.005], ECW/TBW x 100% [p<0.0001] and metabolic age [p<0.0001] compared to counterparts. In a multiple logistic regression model independently associated with VO2max were: ECW/TBW x 100% (OR 4.45, 95% CI: 1.77–11.21; p=0.002) Figure 1, BMI (OR 7.11, 95% CI: 2.01–25.11; p=0.002) Figure 2 and hs-cTnT level (OR 2.69, 95% CI: 1.23–5.91; p=0.013). Conclusions High-sensitivity cardiac troponin may serve as early biomarker of heart failure in hypertensive women. Hydration status should be considered in overall hypertensive women care. There is an importance of body mass compartments analysis in early identification of hypertensive females at risk of heart failure. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Project is financed by the Polish National Agency for Academic Exchange under the Foreign Promotion Programme. Figure 1 Figure 2

PUFA Supplementation and Heart Failure: Effects on Fibrosis and Cardiac Remodeling

Heart failure (HF) characterized by cardiac remodeling is a condition in which inflammation and fibrosis play a key role. Dietary supplementation with n-3 polyunsaturated fatty acids (PUFAs) seems to produce good results. In fact, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have anti-inflammatory and antioxidant properties and different cardioprotective mechanisms. In particular, following their interaction with the nuclear factor erythropoietin 2 related factor 2 (NRF2), the free fatty acid receptor 4 (Ffar4) receptor, or the G-protein coupled receptor 120 (GPR120) fibroblast receptors, they inhibit cardiac fibrosis and protect the heart from HF onset. Furthermore, n-3 PUFAs increase the left ventricular ejection fraction (LVEF), reduce global longitudinal deformation, E/e ratio (early ventricular filling and early mitral annulus velocity), soluble interleukin-1 receptor-like 1 (sST2) and high-sensitive C Reactive protein (hsCRP) levels, and increase flow-mediated dilation. Moreover, lower levels of brain natriuretic peptide (BNP) and serum norepinephrine (sNE) are reported and have a positive effect on cardiac hemodynamics. In addition, they reduce cardiac remodeling and inflammation by protecting patients from HF onset after myocardial infarction (MI). The positive effects of PUFA supplementation are associated with treatment duration and a daily dosage of 1–2 g. Therefore, both the European Society of Cardiology (ESC) and the American College of Cardiology/American Heart Association (ACC/AHA) define dietary supplementation with n-3 PUFAs as an effective therapy for reducing the risk of hospitalization and death in HF patients. In this review, we seek to highlight the most recent studies related to the effect of PUFA supplementation in HF. For that purpose, a PubMed literature survey was conducted with a focus on various in vitro and in vivo studies and clinical trials from 2015 to 2021.

Factors and Prognostic Significance of Impaired Exercise Tolerance in Women over 40 with Arterial Hypertension

The aim of this study was to identify factors influencing maximal oxygen uptake (VO2max) and early identification of the profile of hypertensive women in the perimenopausal period at risk of heart failure. This study included 185 female patients. Regression analyses determined predictors of the lowest VO2max (quartile 1: VO2max < 17 mL/kg/min). Females with the lowest oxygen consumption had a significantly higher level of high sensitive cardiac Troponin T (hs-cTnT) (p = 0.001), higher values of the left atrial (LA) volume, late diastolic mitral annulus velocity (A′), E/E′ (p = 0.0003, p = 0.02, p = 0.04; respectively), higher BMI and fat content (kg and %) (p < 0.0001), higher fat free mass (FFM) (kg) (p < 0.0001), total body water content (TBW) (p = 0.0002) as well as extracellular body water content (ECW) (p < 0.0001) and intracellular body water content (ICW) (p = 0.005), ECW/TBW × 100% (p < 0.0001) and metabolic age (p < 0.0001) and lower E′ (p = 0.001) compared to controls. In a multiple logistic regression model independently associated with VO2max were: ECW/TBW × 100% (OR 4.45, 95% CI: 1.77–11.21; p = 0.002), BMI (OR 7.11, 95% CI: 2.01–25.11; p = 0.002) and hs-cTnT level (OR 2.69, 95% CI: 1.23–5.91; p = 0.013). High-sensitivity cardiac troponin may serve as an early biomarker of heart failure in hypertensive women. Hydration status should be considered in overall hypertensive women care. There is an importance of body mass compartments analysis in the early identification of hypertensive females at risk of heart failure. Optimization and personalization of body structure may be a preventive method for this disease. ClinicalTrials.gov Identifier: NCT04802369.

The Incremental Prognostic Value of E/(e’×s’) Ratio in Non-ST-Segment Elevated Acute Coronary Syndrome

It has been shown that the E/(e’×s’) index, which associates a marker of diastolic function (E/e’, early transmitral/diastolic mitral annulus velocity ratio) and a parameter that explores LV systolic performance (s’, systolic mitral annulus velocity), is a good predictor of outcome in acute anterior myocardial infarction. There are no studies that have investigated the prognostic value of E/(e’×s’) in a non-ST-segment elevated acute coronary syndrome (NSTE-ACS) population. Echocardiography was performed in 307 consecutive hospitalized patients with NSTE-ACS and succesful percutaneous coronary intervention, before discharge and six weeks after. The primary endpoint consisted of cardiac death or readmission due to re-infarction or heart failure. During the follow-up period (25.4 ± 3 months), cardiac events occurred in 106 patients (34.5%). Receiver operating characteristic (ROC) analysis identified E/(e’×s’) at discharge as the best independent predictor of composite outcome. The optimal cut-off value was 1.63 (74% sensitivity, 67% specificity). By multivariate Cox regression analysis, E/(e’×s’) was the only independent predictor of cardiac events. Kaplan–Meier analysis identified that patients with an initial E/(e’×s’) > 1.63 that worsened after six weeks presented the worst prognosis regarding composite outcome, readmission, and cardiac death (all p < 0.001). In conclusion, in NSTE-ACS, E/(e’×s’) is a powerful predictor of clinical outcome, particularly if it is accompanied by worsening after 6-weeks.

Analysis of Risk Factors for Changes in The Doppler Echocardiographic Indexes of Patients With Gout

Objective: The analysis of risk factors for changes in the Doppler echocardiographic indexes of patients with gout with different serum uric acid (SUA) levels were explored to provide clinical evidence for the early diagnosis and treatment of abnormal heart function in this patients.Methods: We obtained information of 227 patients with primary gout (intermittent period), the left ventricular structure and functional index were measured using echocardiography and multivariate logistics regression was used to analyze the risk factors related to changes in heart function in patients with gout.Results: Logistic regression analysis showed that the course of disease and cystatin C (Cys-C) were risk factors for the increase of left atrial volume index (LAVI) (OR=1.14, 105.47; 95% CI, 1.01-1.28, 1.18-9468.03). Age, body mass index (BMI), course of disease, and diabetes were risk factors for the increase of the ratio of diastolic peak early transmission flow velocity to peak early diastolic mitral annulus velocity (E/Em) (OR=1.04, 1.17, 1.14, 4.82; 95% CI, 1.01-1.08, 1.03-1.33, 1.02-1.27, 1.07-21.71). However, the percentage of neutrophils percentage (NE%) and lymphocytes percentage (LY%) might reduce the risk of left ventricular wall thickening, whereas HGB might reduce the risk of increasing E/Em (OR=0.80, 0.75, 0.94; 95% CI, 0.66-0.96, 0.60-0.93, 0.89-1.00).Conclusion: Our findings suggest that BMI, course of disease, diabetes, and Cys-C are risk factors for decreased left ventricular function. Furthermore, HGB, NE%, and LY% appear to have a weak protective effect for the remodeling of left ventricular structure and function.

Correlation Between Thyroid Autoantibodies and Cardiovascular Disease in Patients With Stages 3-5 Chronic Kidney Disease

Background: Chronic kidney disease (CKD) interacts with thyroid disease and cardiovascular disease (CVD). Our research aimed to analyze the correlation between echocardiographic parameters E / A, E / E ', E' / A ', LVEF and thyroid autoantibodies, and evaluate the role of thyroid autoimmunity in the development of CVD in patients with stages 3-5 CKD.Methods: The patients who were diagnosed as stages 3-5 CKD in our department from January 2015 to May 2019 were recruited. We collected the routine medical history, general clinical data, and laboratory test index of patients. Echocardiography is performed by a trained echocardiographer to measure mitral valve blood flow velocity (E) in early diastole and Mitral valve flow velocity (A), E / A ratio, mitral annulus velocity (E ') in early diastole, mitral annulus velocity (A') in end-diastole, E / E 'ratio, and E' / A ' ratio. The SPSS 22.0 statistical software was used to analyze the data.Results: A total of 1164 patients with stages 3-5 CKD were included. Thyroglobulin antibody (TGAb) was negatively correlated with eGFR (r = -0.287, P <0.05). Thyrotropin receptor antibody (TRAb) was significantly positively correlated with CRP (r = 0.206, P <0.001). The titers of TPOAb and TGAb in male diabetic patients were higher (r = 0.137, P = 0.023; r = 0.159, P = 0.011). In female patients, both TPOAb and TGAb are significantly negatively correlated with HGB (r = -0.213, P = 0.018; r = -0.188, P = 0.019). The E / E’ of patients with TPOAb positive was higher (r = 0.181, P ＜ 0.001). The LVEF in patients with TPOAb positive were higher (r = 0.159, P = 0.007). In addition, LVEF was significantly negatively correlated with TRAb (r = -0.112, P = 0.026).Conclusion: The prevalence of AITD in stages 3-5 CKD gradually increases with the decline of renal function, and the titers of TPOAb and TGAb also gradually increase. In patients with stages 3-5 CKD, AITD may accelerate the incidence of CVD in CKD patients by affecting TG levels, accelerating the occurrence of anemia, and promoting the micro-inflammation. Female patients with high titers of TPOAb and TGAb should be paid more attention. The average E/E' of patients with stage 5 CKD was 16. Women with low FT3 and TPOAb positive maybe more likely to develop diastolic heart failure.

In-hospital changes of echocardiographic parameters and their relationship with the procollagen I C-terminal propeptide in patients with myocardial infarction and preserved left ventricle systolic function

Aim. To study the changes of echocardiographic parameters and their relationship with the procollagen I C-terminal propeptide (PICP) during hospitalization of patients with ST-segment elevation myocardial infarction (STEMI) and preserved left ventricular (LV) systolic function.Material and methods. A total of 120 (100%) patients hospitalized with STEMI were examined. Upon admission, all patients underwent standard examinations to verify myocardial infarction (MI), including coronary angiography and, if necessary, coronary stent implantation. The mean values of LV ejection fraction (LVEF) were 40-49% in 3 patients (2,5%), <40% — in 31 patients (26%), LVEF was. We also analyzed patients with LVEF ≥50%, n=86 (71,6%); mean age was 57,8 years. During the hospitalization, all patients received standard therapy; on the 1st and 12th day of MI, the PICP levels in venous blood serum was determined by enzyme-linked immunosorbent assay. In order to compare PICP values, a control group of healthy volunteers n=20 (100%) was formed, which were comparable by gender and age. In this group, the concentration of PICP was 179,2 [163.5; 194.9] ng/ml.Results. By the 12th day, a significant decrease in the following parameters of the transmitral flow was revealed: DT (p=0,049), dE (0,012), Em (0,029), Em/ Am (p=0,000), Em/PICP (p=0,001). This indicates diastolic function deterioration. At the same time, by the end of hospitalization, systolic function deterioration was recorded in 15,1% of cases. Initially, a higher PICP on the 1st day relative to the control group tended to decrease the concentration by the 12th day, but the differences did not reach statistical significance (p=0,466). Correlation analysis showed a relationship between PICP and echocardiography (Tei index, p=0,026, and mitral annulus velocity, p=0,049).Conclusion. At the hospital stage of treatment of patients with STEMI and preserved LVEF, a negative changes of echocardiography parameters characterizing diastolic dysfunction was revealed. Positive correlation was established between the concentration of PICP with mitral annulus velocity and the Tei index, indicating an association between the myocardial fibrosis and diastolic dysfunction.

P666 left ventricular filling pressure using E/E" ratio as a useful marker for predicting periprocedural myocardial injury following percutaneous coronary intervention in diabetic patients

Background Identification of patients with risk of myocardial injury during PCI would allow targeted novel therapies capable of limiting the extent of this injury or reducing its patients number.CK-MB, Troponin-T and I have enabled the quantification of previously undetectable myocardial injury that can also be CMRI visualized.Elevated LV filling pressures are associated with adverse remodeling, HF, and worse survival.E" velocity (unlike others) appears to be relatively independent of preload, especially if myocardial relaxation decreased.In addition, early transmitral flow velocity /early diastolic mitral annulus velocity(E/E") ratio has recently been shown as the most accurate noninvasive predictor of high LV filling pressure.Purpose: evaluate the reliability and adverse outcome of high E/E" in predicting periprocedural myocardial injury. Methods 60 adult diabetic patients with troponin negative CAD admitted for PCI were studied,then analyzed on the basis of post PCI troponin level:(positive and negative group).E/E" ratio was measured and compared with both groups. Results 24 patients developed high troponin after PCI specially if PCI complicated or number of DES increased (p. value &lt;0.001&0.027 respectively).Septal E" velocity was improved after PCI(p. value 0.031).E/E" ratio was high in troponin positive group as. Average e/e" ratio can differentiate between patient"s with troponin negative and positive values (predict periprocedural myocardial injury) with high p. value &lt;0.0001,with cuttof value &gt;10.7, with sensitivity and specificity(79.17% and 87.11%) respectively. Positive and negative predictive value for average e/e" ratio was (79.2 and 86.1) respectively. Conclusions E/E" ratio can provide useful information on LV filling pressure and can be used as a reliable biomarker for early prediction of periprocedural myocardial injury. But, further studies on a larger number of patients are needed for reliability. Limitations small sample size and pre-defined set of study parameters. E/E" ratio and troponin Negative troponin Positive troponin p. value Mean± SD Median(iqr) Mean± SD Median(iqr) EF Biplane 55.8 ± 6.6 56(50:61.5) 53.8 ± 6.5 51(50:59.5) 0.289 LAV index 30.7 ± 4.6 29.5(28:35.5) 31.6 ± 3.6 33(28:35) 0.675 Average E/E" Post 9.1 ± 7.1 7.3(6.5:9.3) 15.9 ± 8.5 14.2(11.1:18.7) &lt;0.001 Lateral E/E" Post 9 ± 6 7(6:9) 15 ± 7 13(11- 18) &lt;0.001 Septal E/E" Post 10 ± 9 8(7:10) 17 ± 11 15(11:20) &lt;0.001 comparison between focused echocardiographic variables & troponin post PCI

P246 Exercise E/e refines diagnosis of diastolic impairment in patients with chronic kidney disease

Background Diastolic dysfunction is common in chronic kidney disease (CKD) patients and is associated with reduced exercise capacity. The ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e’) correlates with invasively measured left ventricular pressures, both at rest and during exercise. The aim of our study was to evaluate the relationship of resting and exercise E/e’ to exercise capacity in patients with stage 3 and 4 CKD. Methods CKD patients were prospectively recruited. All patients were required to be in sinus rhythm, without previous cardiac disease and with normal LVEF. The E/e’ ratio was assessed at rest and patients were stratified into 3 groups based on conventional clinical classifications (normal: ≤8, indeterminate: 8-14, raised: &gt;14). Patients then underwent a symptom limited exercise stress echocardiogram whereby patients with resting E/e’ &lt;14 additionally had post exercise E/e’ measured. Exercise capacity was assessed as metabolic equivalents (METs). A raised exercise E/e’ was defined as exercise E/e’ of ≥13. Lastly, we grouped patients based on abnormalities of baseline and exercise E/e’ (resting E/e’&lt;14 & exercise E/e’&lt;13, resting E/e’&lt;14 & exercise E/e ≥13, resting E/e’ ≥14) and the relationship to METs achieved was evaluated. Results The cohort consisted of 156 CKD patients (62.8 ± 10.6 yrs, male 62%). 85% had hypertension and 39% had diabetes mellitus. 52/156 (34%) CKD patients had resting E/e’ of ≥14. Of the 104/156 (66%) CKD patients with normal/indeterminate resting E/e’, 66/104(63%) had normal exercise E/e’ &lt;13 whilst 38/104(37%) had exercise E/e’ ≥13. Patients with resting E/e" & raised exercise E/e’ ≥13 achieved significantly lower METs compared to CKD patients with resting E/e’ &lt;14 & exercise E/e’ &lt;13 (5.0 ± 2.2 vs 8.8 ± 2.5, p&lt; 0.01). Of note, METs achieved in this group were comparable to that achieved by CKD patients with raised resting E/e’ ≥ 14 (5.0 ± 2.2 METs vs 5.3 ± 2.6 METs, p = 0.55). Conclusion In CKD patients with normal/indeterminate resting E/e’, there is utility in performing exercise E/e’, which was increased in 37% of patients. Raised exercise E/e’ is associated with poorer exercise capacity and is a potential tool to refine diastolic abnormalities in patients with CKD. Group Total (n,%) METs Achieved Exercise Duration (minutes) Resting E/e’ ≤ 14 & Exercise E/e’ ≤ 13 66/156 (42%) 8.8 ± 2.5 8.4 ± 3.1 Resting E/e’ ≤ 14 & Exercise E/e’ ≥ 13 38/156 (24%) 5.0 ± 2.2 6.0 ± 3.1 Resting E/e’ ≥ 14 52/156 (34%) 5.3 ± 2.6 5.6 ± 2.2

Cardiotoxicity evaluation in pediatric patients with acute lymphoblastic leukemia – results of prospective study

Aim: The chemotherapy protocol for acute lymphoblastic leukemia (ALL) uses low doses of anthracyclines (AC), generally associated with subclinical cardiotoxicity. The aim of our study was to evaluate the serum biomarkers and echocardiography parameters in children with ALL treated with AC in order to determine the most useful element for early detection of cardiotoxicity.Material and methods: In this prospective study, troponin I (TnI) and heart-type fatty acid binding protein (HFABP) were assessed five times during the first year after the onset of ALL. Serial Tissue Doppler Imaging and conventional cardiac echography were performed by two pediatric cardiologists (intraclass correlation coefficient over 0.85 for all measurements) in three periods during the study protocol.Results: We evaluated 48 children with ALL. TnI increased during therapy, without returning to baseline values one year after diagnosis. HFABP did not show significant changes during the study protocol. Left ventricle outflow tract time-velocity integral and peak systolic septal mitral annulus velocity decreased during chemotherapy and returned to baseline levels at one year after diagnosis, while peak systolic tricuspid annulus velocity and excursion, maintained a descending tendency. Early filling transmitral flow velocity and E/A ratio were also transiently influenced by chemotherapy.Conclusions: The study showed signs of transient cardiotoxicity in the left ventricle and diastolic parameters after chemotherapy, compared to right ventricle parameters which maintained low values even one year after diagnosis. TnI proved to be directly proportional to chemotherapy doses but HFABP was not useful in this setting