Quality of Beverage Intake and Cardiometabolic and Kidney Outcomes: Insights From the STANISLAS Cohort

Background and Aims: Beverages are an important aspect of diet, and their quality can possibly affect health. The Healthy Beverage Index (HBI) has been developed to take into account these effects. This study aimed to highlight the relationships between health and beverage quality by assessing the association of the HBI and its components with kidney and cardiometabolic (CM) outcomes in an initially healthy population-based familial cohort.Methods: This study included 1,271 participants from the STANISLAS cohort. The HBI, which includes 10 components of habitual beverage consumption, was calculated. Associations of the HBI and its components with estimated glomerular filtration rate (eGFR), albuminuria, hypertriglyceridemic waist (HTG waist), metabolic syndrome (MetS), carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (cIMT), and left ventricular mass (LV mass) were analyzed using multivariable linear or logistic regression models.Results: The median HBI score was 89.7 (78.6–95) out of 100 points. While the overall HBI score was not significantly associated with any of the studied outcomes, individual HBI components were found differently associated with the outcomes. cfPWV and cIMT were lower in participants who did not meet the full-fat milk criteria (p = 0.03 and 0.001, respectively). In men, higher cfPWV was observed for the “low Fat milk” (p = 0.06) and “alcohol” (p = 0.03) non-adherence criteria. Odds of HTG waist were higher with the non-adherence to sugar-sweetened beverages criteria (p < 0.001). eGFR was marginally higher with non-adherence to the coffee/tea criteria (p = 0.047).Conclusions: In this initially healthy population, HBI components were differently associated with kidney and cardiometabolic outcomes, despite a good overall HBI score. Our results highlight specific impacts of different beverage types and suggest that beverages could have an impact on kidney and cardiometabolic health.

Association of Aortic Distensibility and Left Ventricular Function in Patients With Stenotic Bicuspid Aortic Valve and Preserved Ejection Fraction: A CMR study

To determine the relationship between aortic distensibility and left ventricular (LV) remodeling, myocardial strain and blood biomarkers in patients with stenotic bicuspid aortic valve (BAV) and preserved ejection fraction (EF) by cardiovascular magnetic resonance (CMR). 43 stenotic BAV patients were prospectively selected for 3.0T CMR. Patients were divided into LV remodeling group (LV mass /volume ≥ 1.15, n=21) and non-remodeling group (LV mass/volume < 1.15, n=22). Clinical characteristics, biochemical data including cardiac troponin T(cTNT), N-terminal pro-B type natriuretic peptide (NT-proBNP) and creatine kinase isoenzyme were noted. Distensibility of middle ascending aorta (mid-AA) and proximal descending aorta, LV structural and functional parameters, global and regional myocardial strain were measured. Compared to non-remodeling group, LV remodeling group had significantly decreased LV global strain (radial: 26.04±8.70 % vs. 32.92±7.81 %, P=0.009; circumferential: -17.20±3.38 % vs. -19.65±2.34 %, P=0.008; longitudinal: -9.13±2.34 % vs. -11.63±1.99 %, P＜0.001), while radial and circumferential strain were significantly reduced at the base (radial: 28.52±9.47 % vs. 39.65±10.33 %, P=0.001; circumferential: -14.45±2.97 % vs. -17.22±2.38 %, P=0.002), longitudinal strain was significantly reduced at all regions (basal: -5.79±3.43 % vs. -8.65±2.42 %, P=0.003; mid: -8.62±2.21 % vs. -11.33±2.58 %, P=0.001; apical : -12.79±2.49 % vs. -15.04±2.20 %, P=0.003). In addition, mid-AA distensibility was independently associated with LV remodeling (β=-0.282, P=0.003), and it was also significantly correlated with LV global strain (radial: r=0.392, P=0.009; circumferential: r=-0.348, P=0.022; longitudinal: r=-0.333, P=0.029), cTNT (r=-0.333, P=0.029) and NT-proBNP (r= -0.440, P=0.003). In this cohort with stenotic BAV and preserved EF, mid-AA distensibility is found significantly associated with LV dysfunction, which may be an important factor for predicting adverse cardiovascular events and a potential therapeutic target to prevent heart failure.

665 Longitudinal strain impairment in organic mitral regurgitation: look beyond the valve

Aims Global longitudinal strain (GLS) is a hallmark of cardiac damage in mitral regurgitation (MR). GLS &gt; −18% in patients with severe organic MR (OMR) and normal LV ejection fraction (LVEF) is an independent predictor of postoperative LV dysfunction. While it is known that GLS is impaired in less than severe functional ischaemic MR (FMR), the value of GLS in less than severe OMR is not known. We aimed to determine prevalence and determinants of any GLS impairment in OMR, in comparison to FMR. Methods We retrospectively evaluated 51 consecutive patients (33 OMR and 18 FMR) with mild-to-moderate, moderate and moderate-to-severe MR (Table*). Overall, GLS was higher in OMR than FMR (17.9±4.5 vs. 10.3±5.3, P&lt;0.001), with rate of impairment of 45% in OMR and 89% in FMR (P= 0.0024). Results However, no significant difference was found in GLS between mild-to-moderate, moderate and moderate-to-severe MR patients within OMR (17.7±4.7 vs. 16.9±3.9 vs. 22.4±3, respectively, P&gt;0.05), as well as FMR (9.8±6.6 vs. 10.7±5.3 vs. 10.4±5.3, respectively, P&gt;0.05) groups. GLS correlated directly with left ventricular (LV) ejection fraction (EF) in both OMR (r=0.69, P&lt;0.001) and FMR (r=0.90, P&lt;0.001), and inversely with LV mass indexed for body surface area (LVMi) in both OMR (r = −0.50, P=0.005) and FMR (r = −0.48, P=0.042). While correlation with LVEF was better for FMR than OMR (Z − 1.95, P=0.026), correlation with LVMi was similar for OMR and FMR groups (Z − 0.082, P&gt;0.05). Conclusions In patients with OMR, GLS may be reduced, despite normal LVEF, in less than severe MR. Prevalence and degree of GLS impairment in OMR is less than in FMR. In OMR, as well as in FMR, GLS impairment is independent of entity of MR, but rather correlates with LVMi, maybe reflecting impact of myocardial fibrosis derived by increased LVMi on GLS.

Cardiac Remodeling and Disease Progression in Patients With Repaired Coarctation of Aorta and Aortic Stenosis

Background: Valvulo-arterial impedance (Zva) is used for assessment of left ventricular (LV) global pressure load in patients with aortic stenosis (AS) and impaired arterial compliance. Because patients with repaired coarctation of aorta (COA) have impaired arterial compliance, we hypothesized that COA patients with greater than or equal to moderate AS (AS-COA group) will have higher Zva, symptomatic progression, and cardiovascular events, as compared to non-COA patients with similar AS severity (AS group). Methods: Propensity matching (1:1) of 71 AS-COA and 71 AS patients based on age, sex, body mass index, and aortic valve mean gradient (cohort 1). Of 172 patients, 117 patients (AS-COA [n=62]; AS [n=55]) underwent aortic valve replacement, cohort 2. Cohort 1 was used to assess the relationship between preoperative Zva, cardiac remodeling, and symptomatic progression, while cohort 2 was used to assess the relationship between postoperative Zva, LV mass index regression (reduction in LV mass index after aortic valve replacement), and cardiovascular events. Results: The AS-COA group had higher Zva (4.2±0.6 versus 3.5±0.4 mm Hg/mL·m 2 , P <0.001), more advanced cardiac remodeling, and higher 5-year incidence of symptomatic progression (85% versus 51%, P <0.001). Preoperative Zva was independently associated with cardiac remodeling (r=0.66, P <0.001) and symptomatic progression (hazard ratio, 1.06 [1.02–1.10], per mm Hg/mL·m 2 increase in Zva). The AS-COA group had higher postoperative Zva (3.3±0.5 versus 2.4±0.4 mm Hg/mL·m 2 , P <0.001), less robust LV mass index regression at 1-year post–aortic valve replacement, and higher 5-year incidence of cardiovascular events. Postoperative Zva was independently associated with LV mass index regression (r=−0.46, P <0.001) and cardiovascular events (hazard ratio, 1.06 [1.02–1.10], per mm Hg/mL·m 2 increase in Zva). Conclusions: Adults with AS-COA had higher LV global pressure load, cardiac remodeling, symptomatic progression, and cardiovascular events as compared to non-COA patients with similar severity of AS. Zva can identify patients at risk for adverse outcomes, and perhaps should be used for risk stratification with regards to timing of aortic valve replacement.

484 Echocardiographic patterns in patients with apolipoprotein AI amyloidosis

Aims Hereditary amyloidosis are rare diseases characterized by extracellular deposition of insoluble fibril proteins in target organs disrupting their structure and function. The APOA1 gene encodes the precursor of apolipoprotein AI (ApoAI), whose mature form is the major component of high-density lipoproteins. There are some clusters of ApoAI amyloidosis (AApoAI) worldwide, including in the Lombardy and Veneto regions. Patients with AApoAI often present with chronic kidney disease, liver and spleen enlargement, with occasional involvement of the heart, peripheral nervous system, and other organs. Patterns of cardiac disease in AApoAI have never been systematically investigated. Methods and results We examined all patients with an established diagnosis of AApoAI referred to a dedicated outpatient clinic in Brescia from 2010 to 2020. The cardiac screening included a transthoracic echocardiogram with 2D speckle-tracking analysis. One-hundred and eighty-nine patients were evaluated [n = 102 (54%) men, median age 55 years (interquartile range 42–67)]. Renal disease was present in 39% and liver disease in 31%. Almost all patients were in sinus rhythm (96%). Median left ventricular ejection fraction (LVEF) was 60% (55–66), and just 2% of patients had LVEF &lt;50%. Diastolic function was preserved, with E/e′ ratio of 7 (6–10). Overall, patients did not display a prominent LV hypertrophy, with median interventricular septal thickness of 11 mm (9–12), a posterior wall thickness of 9 mm (8–11), and a LV mass index of 92 g/m2 (74–111). Global longitudinal strain [−19% (−21 to − 17)], and the mass to strain ratio (MSR) [10.0 (6.8–12.1)] were within normal limits. Ten percent of patients displayed apical sparing, and 19% had a ‘granular sparkling’ appearance of the interventricular septum, which are both echocardiographic red flags of cardiac amyloidosis. Right ventricular (RV) function was preserved [median tricuspid annular plane systolic excursion of 23 mm (20–26)], with a borderline RV free wall thickness [6 mm (5–8)]. A pericardial effusion was present in 11%. Moderate to severe mitral, aortic or tricuspid regurgitation or aortic stenosis were found in 11%, 4%, 6% and no patients, respectively. We found moderately strong correlations between age and several echocardiographic findings, namely: IVS (P &lt; 0.001, r = 0.484), LVMI (P &lt; 0.001, r = 0.459), E/e′ (P &lt; 0.001, r = 0.501), and RV free wall thickness (P &lt; 0.001, r = 0.459). Absolute GLS tended to decrease with age (P &lt; 0.001, r = 0.380), and MSR to increase (P &lt; 0.001, r = 0.357). Conclusions In the largest series of patients with AApoAI so far, minor signs of cardiac disease emerged from transthoracic echocardiography. Nonetheless, some red flags of cardiac amyloidosis were found in some patients. Furthermore, the correlations between age and echocardiographic findings suggested a progressive increase in wall thickness, a decline in systolic and diastolic function, and a greater uncoupling between LV mass and contractility over time.

Impact of BMI z-score On Left Ventricular Mechanics in a Pediatric Population

Background: Adolescent weight disorders ranging from anorexia nervosa (AN) to obesity (OB) can impact the heart by causing opposite alterations in its morphology, suggesting a direct impact of BMI on the heart. Cardiac function is relatively preserved as assessed by standard ultrasound methods. However, few studies have used speckle-tracking echocardiography (STE), which can detect subtle alterations of left ventricular (LV) function by evaluating deformations. The aim of this study was to assess the link between BMI z-score of female adolescents and myocardial function. Methods: Ninety-one female adolescents comprising 26 AN patient (age 14.6 ± 1.9 y), 28 OB patients (age 13.2 ± 1.4 y), and 37 controls (age 14.0 ± 2.0 y) underwent STE to assess LV morphology and myocardial regional deformations. Findings: The BMI z-score of our population ranged from −4.6 to 5.2. LV morphological remodeling was significantly and positively correlated with BMI z-score (R² = 0.456, p < 0.0001 for LV mass). Global longitudinal strain (LS) and regional LS recorded at the mid and apical levels were significantly correlated with BMI z-score (R² = 0.196, p = 0.0001 and R² = 0.274, p < 0.0001 respectively for apical and medial LS). Circumferential strains and twisting mechanics were not correlated with BMI z-score. Fibrinogen and SBP were the main variables explaining the alteration of longitudinal strains. Conclusion: A impact of BMI z-score on LV mechanics was observed especially on medial and apical LS. Neither circumferential nor twisting mechanics were altered by BMI z-score in female adolescents.

Association between Coronary Artery Disease and Left Ventricle Remodeling Parameters in Hypertensive Patients: A Cross-Sectional Study in a Limited Resource Setting

BACKGROUND: Coronary artery disease (CAD) and hypertension are related with left ventricle (LV) remodeling, however evidence about association between CAD and remodeling in hypertensive patient is still limited, especially in limited resource setting like Indonesia. AIM: Evaluating impact of CAD on LV remodeling within hypertensive patients at tertiary referral hospital, Hasan Sadikin General Hospital Bandung, Indonesia. METHOD: Cross-sectional study involving 120 hypertensive patients who visited cardiology outpatient clinic from September-December 2019 and underwent transthoracic echocardiography examination for any medical indications. LV remodeling parameters, such as mass (LV Mass Index [LVMi]), volume (end-diastolic volume/body surface area [BSA]), and relative wall thickness (RWT), were compared between CAD and non-CAD groups. RESULTS: There were 108 patients to be analyzed, 12 patients were excluded due to technical difficulty (n = 9) and non-cooperative during interview (n = 3). Mean (standard deviation) age of patients was 56.9 (±11.8) years, 50 (46.3%) patients were male, and median (interquartile range) hypertension duration was 3 (±4.40) years. CAD was found in 40 (37.0%) patients. In the adjusted analysis, patients with CAD had average 27.75 g/m2 higher LVMi (95% confined interval [CI] 2.03; 53.47; p = 0.035) and 16.20 ml/m2 higher LV end-diastolic volume/BSA (95% CI 4.14; 28.25; p = 0.009) compared to those without. This was independent of age, duration of hypertension, consumption of antihypertensive therapy, and type-2 diabetes mellitus, but disappeared after heart failure (HF) was included in the study. CAD and non-CAD groups were not different, respectively, to RWT. CONCLUSION: In hypertensive patients, CAD was independently associated with higher LV mass and volume. These associations, however, were largely explained by the presence of HF. CAD did not associate with RWT.

Long-Term Cardiac Effects of Successful Non-Myeloablative HLA-Matched Sibling Transplants in Sickle Cell Disease

INTRODUCTION Cardiopulmonary complications lead to early mortality in adults with sickle cell disease (SCD). We previously showed in a small single-center study that cardiac morphology improves by one year after successful non-myeloablative hematopoietic stem cell transplantation (HSCT). Since cardiac outcomes following HSCT are not well-described, we sought to extend our results to a larger group of SCD patients from the National Institutes of Health (NIH) and University of Illinois Chicago (UIC). METHODS The majority of patients received alemtuzumab, 300cGy total body irradiation, and sirolimus; 21 also received pentostatin and cyclophosphamide preconditioning. An echocardiogram (echo) and routine laboratory testing were done at baseline before HSCT and at 1 and 2 year time points. Patients with an echo at least one year following HSCT were included. A generalized estimating equation regression model approach was used to evaluate echo and laboratory changes from baseline adjusting for age, gender, and site. A more stringent p-value threshold of 0.005 was used for significance given the large number of outcomes tested. The reported p values compare baseline vs 1 year and 1 year vs 2 year changes. RESULTS The study population consisted of 88 patients (69 NIH, 19 UIC) who had stable engraftment and were free of dialysis or chronic transfusion therapy. Mean + SD age of patients was 31.5 ± 10.5 years and 36 (41%) are female. Hemoglobin improved significantly in the first year (baseline 8.9 ± 1.5 g/dl, 1 year 12.9 ± 2.3, p &lt; 0.0001), and continued to improve at 2 years (13.6 ± 2.0, p&lt;0.0001). Laboratory results showed improvements in LDH, total bilirubin, and absolute reticulocyte count within the first year after HSCT (data not shown). Body surface area (BSA) was noted to increase significantly in the first year after HSCT (baseline 1.8 ± 0.2 m 2, 1 year 1.9 ± 0.2, p = 0.0002) and then stabilized in the second year (1.9 ± 0.3, p=0.9). Diastolic blood pressure was 66 ± 12 mmHg at baseline and closely followed the BSA, increasing in the first year (73 ± 11, p &lt; 0.0001) and then remaining unchanged in the second year (74 ± 11, p=0.36). Systolic blood pressure (baseline 118 ± 15 mmHg) did not change significantly. The left ventricular size, as measured by the left ventricular end-diastolic volume index (LVEDVI) was elevated at baseline (82.6 ± 21.5 ml/m2), decreased dramatically at 1 year (69.0 ± 14.7, p &lt; 0.0001), and continued to improve significantly at 2 years (63.1 ± 15.0, p &lt; 0.0001, Figure). LV mass index, which is closely related to volume changes, did not change in the first year (baseline 84.9 ± 23.7 g/m 2, 1 year 85.1 ± 20.9, p= 0.72); however, it improved significantly by 2 years (79.2 ± 17.7, p=0.0003). The left atrial size, as measured by the left atrial volume index, also decreased in the first year (baseline 41.4 ± 12.8 ml/m2, 1 year 28.9 ± 8.7, p &lt; 0.0001) with no change in the second year (27.9 ± 8.2, p=0.05). Diastolic filling parameters, which are independent risk markers of mortality, were seen to parallel the volume changes with baseline E/A ratio decreasing in the first year after HSCT (baseline 1.6 ± 0.6, 1 year 1.4 ± 0.4, p &lt; 0.0001) and then remaining unchanged at 2 years (1.4 ± 0.5, p=0.09). Tricuspid regurgitation velocity (TRV), which is also a well-known early mortality risk marker in SCD, decreased significantly in the first year (baseline 2.5 ± 0.4 m/s, 1 year 2.4 ± 0.3, p = 0.002), and suggested a trend towards improvement at 2 years (2.3 ± 0.3, p=0.01). In 37 patients with a high-risk TRV ≥2.5 m/s, there was a significant decrease in the first year (baseline 2.9 ± 0.3, 1 year 2.5 ± 0.3, p &lt; 0.0001) and then no change at 2 years (2.4 ± 0.3, p=0.05) CONCLUSION Our findings from two independent centers demonstrate significant improvements in cardiac size, mass, diastolic function, and TRV after non-myeloablative HSCT. Volume overload secondary to anemia is responsible for cardiac remodeling in SCD, and as the anemia resolves and high flow rates decrease following HSCT, many of the cardiac changes also reverse. LV volume decreased significantly in the first year, and these improvements, along with decreased LV mass index, continued in the second year. 55% of patients with a high-risk TRV normalized their TRV at 2 years. As diastolic dysfunction and TRV have both been associated with early mortality in adults with SCD, our results suggest that successful HSCT may impact survival. A larger multi-center study with longer follow-up is indicated. Figure 1 Figure 1. Disclosures Rondelli: Vertex: Membership on an entity's Board of Directors or advisory committees. Saraf: Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding.

Effect of remote ischaemic conditioning on infarct size and remodelling in ST-segment elevation myocardial infarction patients: the CONDI-2/ERIC-PPCI CMR substudy

The effect of limb remote ischaemic conditioning (RIC) on myocardial infarct (MI) size and left ventricular ejection fraction (LVEF) was investigated in a pre-planned cardiovascular magnetic resonance (CMR) substudy of the CONDI-2/ERIC-PPCI trial. This single-blind multi-centre trial (7 sites in UK and Denmark) included 169 ST-segment elevation myocardial infarction (STEMI) patients who were already randomised to either control (n = 89) or limb RIC (n = 80) (4 × 5 min cycles of arm cuff inflations/deflations) prior to primary percutaneous coronary intervention. CMR was performed acutely and at 6 months. The primary endpoint was MI size on the 6 month CMR scan, expressed as median and interquartile range. In 110 patients with 6-month CMR data, limb RIC did not reduce MI size [RIC: 13.0 (5.1–17.1)% of LV mass; control: 11.1 (7.0–17.8)% of LV mass, P = 0.39], or LVEF, when compared to control. In 162 patients with acute CMR data, limb RIC had no effect on acute MI size, microvascular obstruction and LVEF when compared to control. In a subgroup of anterior STEMI patients, RIC was associated with lower incidence of microvascular obstruction and higher LVEF on the acute scan when compared with control, but this was not associated with an improvement in LVEF at 6 months. In summary, in this pre-planned CMR substudy of the CONDI-2/ERIC-PPCI trial, there was no evidence that limb RIC reduced MI size or improved LVEF at 6 months by CMR, findings which are consistent with the neutral effects of limb RIC on clinical outcomes reported in the main CONDI-2/ERIC-PPCI trial.

Left ventricular apical mass after myocardial infarction—not always a thrombus: a diagnostic dilemma

Myxomas arising from the left ventricle (LV) are extremely rare and can be easily mistaken for a thrombus. We report a case of a 35-year-old man who presented with an acute cerebrovascular accident, having had a prior history of an anterior wall myocardial infarction 2 years back with an echocardiographic evaluation showing mild LV systolic dysfunction. His present prothrombotic workup revealed hyperhomocystinaemia and elevated levels of factor VIII. Present echocardiography revealed a mass arising from a scarred LV wall. Considering the possibility of a thrombus, he was initially started on parenteral anticoagulation. Unfortunately, consequent echocardiogram evaluation showed no reduction in size of the LV mass hence surgical removal was done. Histopathological evaluation unveiled the mass to be a myxoma.