Relationship between Cardiovascular Disease Risk and Neck Circumference Shown in the Systematic Coronary Risk Estimation (SCORE) Risk Model

Introduction: The most important way to reduce CVD-related mortality is to apply appropriate treatment according to the risk status of the patients. For this purpose, the SCORE risk model is used in Europe. In addition to these risk models, some anthropometric measurements are known to be associated with CVD risk and risk factors. Objectives: This study aimed to investigate the association of these anthropometric measurements, especially neck circumference (NC), with the SCORE risk chart. Methods: This was planned as a cross-sectional study. The study population were classified according to their SCORE risk values. The relationship of NC and other anthropometric measurements with the total cardiovascular risk indicated by the SCORE risk was investigated. Results: A total of 232 patients were included in the study. The patients participating in the study were analysed in four groups according to the SCORE ten-year total cardiovascular mortality risk. As a result, the NC was statistically significantly lower among the SCORE low and moderate risk group than all other SCORE risk groups (low-high and very high 36(3)–38(4) (IQR) p: 0.026, 36(3)–39(4) (IQR) p < 0.001, 36(3)–40(4) (IQR) p < 0.001), (moderate-high and very high 38(4) vs. 39(4) (IQR) p: 0.02, 38(4) vs. 40(4) (IQR) p < 0.001, 39(4) vs. 40(4) (IQR) p > 0.05). NC was found to have the strongest correlation with SCORE than the other anthropometric measurements. Conclusions: Neck circumference correlates strongly with the SCORE risk model which shows the ten-year cardiovascular mortality risk and can be used in clinical practice to predict CVD risk.

Modified CHA2DS2-VASc can predict mortality in COVID-19 patients admitted to the emergency department

Introduction CHA2DS2-VASc score is used to determine the thromboembolic risk, but its prognostic value has been demonstrated in several cardiovascular (CV) diseases. Except for female gender, many CV risk factors comprising this score are recognized as risk factors for mortality in COVID-19. Cetinak G. et al demonstrated the ability of modified CHA2DS2-VASc (M-CHA2DS2-VASc) to predict mortality in COVID-19, which is based on changing gender criteria from female to male. Purpose To evaluate the prognostic value of a M-CHA2DS2-VASc score to predict pulmonary embolism (PE) and mortality in pts with COVID-19 admitted at the emergency department (ED). Methods Retrospective study of pts admitted to the ED between June 2020-January 2021, who underwent computed tomography pulmonary angiography (CTPA) due to PE suspicion. Pts were stratified into 3 M-CHA2DS2-VASc risk groups: lower (0–1), intermediate (2–3) and high risk (≥4). Kruskal-Wallis and X-square test were used to compare score risk groups. Logistic regression was used to determine predictors of PE and mortality. ROC curve was performed to evaluate the discriminative power of the score. Results We included 300 pts: median age 71 years, 59% male. Hypertension (59%) chronic kidney disease (CKD, 33%), dyslipidemia (32%) and diabetes (28%) were the most common comorbidities. PE was diagnosed in 46 pts (15%). We found no difference in PE incidence according to M-CHA2DS2-VASc groups (p=0.531) and it showed no predictive value for PE (OR: 1.050, p=0.596). The AUC of M-CHA2DS2-VASc was 0.52, suggesting no discriminative power to predict PE. Regarding mortality, M-CHA2DS2-VASc score was higher in non-survivors COVID-19 pts than in survivors [4 (IQR 3–5) vs 2 (1–4), respectively, p&lt;0.001]. A multivariate logistic regression analysis was performed for mortality based on M-CHA2DS2-VASC, troponin, CKD and smoking history, and only M-CHA2DS2-VASc was identified as an independent predictor of mortality (OR: 1.406, p=0.007). Kaplan-Meier showed that M-CHA2DS2-VASc score was associated with mortality: the survival rate was 92%, 80% and 63% in the lower, intermediate and higher M-CHA2DS2VASc score risk group (logrank test p&lt;0.001; Fig. A). Most of the pts in the cohort were hospitalized (83%), but 21 pts (17%) discharged from the ED. Among these pts, 33% (n=17) had low risk, 37% (n=19) intermediate risk and 29% (n=15) high risk for mortality according to the M-CHA2DS2VASc score. The Kaplan-Meier individual survival analysis for hospitalized patients (Fig. B) and for those discharged from the ED (Fig. C) showed that M-CHA2DS2-VASc score had a good discriminative ability to predict short-term mortality for both groups (logrank test p&lt;0.001 and p=0.007, respectively). Conclusion Considering the lack of validated scores to predict mortality in COVID-19 pts, the M-CHA2DS2-VASc might be a simple tool to predict short-term mortality in these pts, irrespectively of the need for hospitalization or not. FUNDunding Acknowledgement Type of funding sources: None.

Analysis of LpA levels in young patients after ACS: getting to know less famous risk factors

Introduction Lipoprotein A (LpA) has been shown to be an emerging risk factor, proposing that values greater than 60 mg/dl increases cardiovascular risk. There are few data about LpA values in young patients who have suffered a major cardiovascular event. Purpose The objective of this work was to describe the LpA values observed in young patients admitted for acute coronary syndrome in our center, and subsequently to compare these values according to the patients' previous cardiovascular risk. Methods This is a descriptive and observational study, in which all male patients under 65 years and women under 70 years who have suffered STEMI or NSTEMI from November 2019 to February 2021 admitted to our center were consecutively included. In addition to LpA values, the following variables were recollected: age, sex, high blood pressure, diabetes mellitus, dyslipidemia, stroke, chronic kidney injury, smoking, alcoholism, toxics, total cholesterol and SCORE risk. Results 159 patients were included. The mean of LpA value was 41,08 mg/dl (standard deviation 38, range 1–155, percentile 25th: 9,7; percentile 50th: 28,8; percentile 75th: 59,1). 24,5% presented levels of LpA greater than 60 mg/dl. The percentage of patients with LpA levels &gt;60 mg was 32,4% in low SCORE group and 22,4% in greater than low SCORE group without significant differences. The table compares the LpA values according to the cardiovascular risk SCORE those patients presented before the acute coronary syndrome (low SCORE vs moderate, high or very high SCORE). As we can see in the table, we found a trend to present higher LpA values in patients with low SCORE risk compared to those with higher than low SCORE risk, without reaching statistical significance. Conclusions In a sample of young patients with acute coronary syndrome, the LpA mean was 41,08 mg/dl. 24,5% of patients had values of LpA greater than 60 mg/dl. No significant differences were found according to the SCORE prior to the event, although there was a non-significant trend towards a higher LpA in patients with low SCORE. FUNDunding Acknowledgement Type of funding sources: None. Table 1. LpA values

Abstract MP15: Arterial Hypertension And Cognitive Disorders: Cerebral Vascular Reserve

The study of functional and restructuring disorders of large and small cerebral vessels that are a target for arterial hypertension (AH) is important for the prognosis of cognitive disorders (CD). The relationship between cerebral vascular reserve and CD in 378 outpatients with controlled AH stage II and low SCORE risk of CVD examined. The median age – 57,3±8,91 years. The average duration of AH was 11,5±6,2 years. SCORE risk of CVD <5 %. All AH patients were examined according to the international recommendations and cognitive functioning was assessed by MoCA scale, blood flow in the middle cerebral artery was investigated by transcranial Doppler (TCD) on the HDI 7, Philips, USA with functional respiratory hypo- and hypercapnic ventilation tests.The integrative index of vasomotor reactivity (IVMR) was calculated for cerebral vascular reserve identification: IVMR=[(V apnea -V hyper )/V 0 ]•100%, V apnea - the average maximum velocity of blood flow after 20s of apnea (cm/s), V hyper - the average maximum velocity of blood flow after 20s of hyperventilation (cm/s), V 0 - the average maximum velocity at rest (cm/s). Non-dementia cognitive disorders were found in 125 (33 %) - 24,32±0,11 points on MOCA scale. The significant decrease in the IVMR was found according to the results of the TCD examination of cerebralvascular reserve testing in patients with AH and CD (44.0±1.2, p<0,001), which indicates the close relationship between the value of IVMR and CD even in patients with controlled AH (rs = +0.54; p<0.001). It is necessary to clarify the cerebral vascular reserve and the vasomotor reactivity index even when controlling AH due to the high risk of the development and progression of cognitive disorders, which worsen the prognosis of cardiovascular events and quality of life.

353 AIR Score Based Management of Appendicitis

Introduction Appendicitis is the most common cause of an acute abdomen. Approximately 7% of the population will be affected at some point. The development of AIR has been developed to aid diagnosis and decreasing the number of negative appendectomies while also safely identifying those who have developed appendicitis. Aim This retrospective audit, which aims to assess the effects of the introduction of AIR score risk on the negative appendicectomy rate of patients admitted to Taranaki Base Hospital. Method All patients under General Surgery receiving open appendicectomy, laparoscopic appendicectomy or diagnostic laparoscopy for evaluation or treatment of appendicitis from January 1st 2017 – December 31st 2018. Results The negative appendicectomy rate dropped 11.1% after introduction of the AIR score, we also noted a decrease in CT scan use. Discussion Our results suggest that the Air score could be used as an adjunct to the clinical diagnosis of acute appendicitis.

Association between cardiovascular mortality and STOP-Bang questionnaire scores in a cohort of hospitalized patients: a prospective study

Objective: Obstructive sleep apnea (OSA) is associated with an increased risk of mortality and cardiometabolic diseases. The STOP-Bang questionnaire is a tool to screen populations at risk of OSA and prioritize complementary studies. Our objective was to evaluate the clinical utility of this questionnaire in identifying patients at an increased risk of mortality after discharge in a cohort of hospitalized patients. Methods: This was a prospective cohort study involving consecutive patients admitted to an internal medicine unit between May and June of 2017 who were reevaluated three years after discharge. At baseline, we collected data on comorbidities (hypertension, obesity, diabetes, and fasting lipid profile) and calculated STOP-Bang scores, defining the risk of OSA (0-2 score, no risk; = 3 score, risk of OSA; and = 5 score, risk of moderate-to-severe OSA), which determined the study groups. We also recorded data regarding all-cause and cardiovascular mortality at the end of the follow-up period. Results: The sample comprised 435 patients. Of those, 352 (80.9%) and 182 (41.8%) had STOP-Bang scores = 3 and = 5, respectively. When compared with the group with STOP-Bang scores of 0-2, the two groups showed higher prevalences of obesity, hypertension, diabetes, and dyslipidemia. Multivariate analysis showed an independent association between cardiovascular mortality and STOP-Bang score = 5 (adjusted hazard ratio = 3.12 [95% CI, 1.39-7.03]; p = 0.01). Additionally, previous coronary heart disease was also associated with cardiovascular mortality. Conclusions: In this cohort of hospitalized patients, STOP-Bang scores = 5 were able to identify patients at an increased risk of cardiovascular mortality three years after discharge.

Absolute and relative risk prediction in cardiovascular primary prevention with a modified SCORE chart incorporating ceramide-phospholipid risk score and diabetes mellitus

Aims A risk score, CERT2, based on distinct ceramide and phosphatidylcholine species has shown robust performance in predicting cardiovascular risk in secondary prevention. Here, our aim was to investigate the predictive value of CERT2 in primary prevention compared to classical lipid biomarkers and its compatibility with clinical characteristics used in the SCORE risk chart. Methods and Results Four ceramides [Cer(d18:1/16:0), Cer(d18:1/18:0), Cer(d18:1/24:0), Cer(d18:1/24:1))] and three phosphatidylcholines [PC(14:0/22:6), PC(16:0/22:5), PC(16:0/16:0)] were analysed by targeted tandem liquid chromatography-mass spectrometry method in FINRISK 2002, which is a population-based risk factor survey investigating men and women aged 25-74 years. Primary prevention subjects (N = 7,324) were followed up for 10 years for the following outcomes: incident coronary heart disease (CHD), cardiovascular disease (CVD), major adverse cardiovascular event (MACE), stroke and heart failure (HF). Hazard ratios per standard deviation obtained from adjusted Cox proportional hazard models were significant for all these endpoints, and the highest for fatal ones, i.e. fatal CHD [1.45 (95% confidence interval 1.07-1.97)], CVD [1.39 (1.06-1.83)] and MACE [1.39 (1.07-1.80)]. The categorical net reclassification improvement was 0.051 for 10-year risk of incident CVD. Incidence of fatal events was over 10-fold more frequent in the highest CERT2 category compared to the lowest risk category and modified SCORE risk charts, utilizing CERT2 and diabetes mellitus, increased granularity of risk assessment compared to a chart utilizing total cholesterol. Conclusion CERT2 is a significant predictor of incident cardiovascular outcomes and risk charts utilizing this score provide an easy tool to estimate relative and absolute risk for incident CVD.