Peripheral Blood MicroRNA-21 as a Predictive Biomarker for Heart Failure With Preserved Ejection Fraction in Old Hypertensives

BACKGROUND

Heart failure with preserved ejection fraction (HFpEF) is a major health issue with high morbidity and mortality. The epidemiology and the factors that cause HFpEF have not been fully clarified, while accurate predictive biomarkers are lacking. Our aim was to determine whether levels of microRNA-21 (miR-21) in peripheral blood monocytes, which play a critical role in many pathophysiological pathways of hypertensive heart disease, can predict the occurrence of HFpEF in older hypertensives, as well as the associated mortality and morbidity.

METHODS

We enrolled 151 elderly patients >60 years old with essential hypertension but without HF at baseline. miRs expression levels in peripheral blood mononuclear cells had been quantified by real-time reverse transcription polymerase chain reaction.

RESULTS

During a median follow-up of 8.2 years, 56 patients (37%) had an event. Levels of miR-21 in peripheral mononuclear blood cells proved to be significantly associated with the occurrence of HFpEF. More specifically, the median HFpEF-free period was 110 months for those with miR-21 >2.1 and 114 months for those with miR-21 <2.1. In addition, multivariate analysis showed that miR-21 (hazard ratio 11.14), followed by hemoglobin (Hg) (hazard ratio 0.56 for Hg >13.6 g/dl, a 45% risk reduction), were independent and the most significant predictors of HFpEF events.

CONCLUSIONS

miR-21 levels in peripheral blood monocytes are associated with the development of future HFpEF. Our findings may alter the risk models of HFpEF and support the rationale for further research into the modulation of miRs as biomarkers and treatment targets for HFpEF.

Visceral fat and cardiometabolic future in children and adolescents: a critical update

Cardiovascular disease (CVD) is a process whose pathogenetic mechanisms start very early in life. Recently, the importance of visceral adipose tissue (VAT) has been highlighted in the development of CVD. VAT does not always depend on body mass index (BMI) and has been implicated in unfavorable metabolic activity and cardiovascular adverse events. Abnormally high deposition of VAT is associated with metabolic syndrome, obesity-associated phenotype, and cardiometabolic risk factors. Although the importance of visceral fat has not been studied broadly or extensively in long-term studies in children and adolescents, it appears that it does not have the same behavior as in adults, it is related to the appearance of cardiac risk factors. In adolescents, it plays a role in the pathogenesis of CVD that occur later in adulthood. Excess body weight and adiposity may lead to the development of early myocardial and pathological coronary changes in childhood. The purpose of this review is to summarize the risk factors, the clinical significance, and the prognostic role of visceral obesity in children and adolescents. In addition, extensive reference is made to the most commonly used techniques for the evaluation of VAT in clinical settings. IMPACT: Visceral obesity, plays an important role in cardiovascular health from very early in an individual's life. Visceral adipose tissue (VAT) distribution is not entirely related to body mass index (BMI) and provides additional prognostic information. There is a need to pay more attention to the assessment of VAT in young people, to develop methods that would go beyond the measurement of only BMI in clinical practice and to identify individuals with excess visceral adiposity and perhaps to monitor its changes.

Injecting a ventricular tachycardia into the heart-Α unique case report

INTRODUCTION

A 52-year-old woman presented with a complex ventricular arrhythmia in an intraoperative context, during kyphoplasty for an osteoporotic fracture of a lumbar vertebra. The subject showed no indications of a previous cardiovascular condition.

METHODS AND RESULTS

Causes of arrhythmias associated with the procedure were excluded. Due to her positive family history for dilated cardiomyopathy, upcoming thoughts were made for unmasking a previous asymptomatic cardiomyopathy. Nevertheless, an intracardiac cement embolism was diagnosed and, finally, the patient underwent an open-heart surgery with successful removal of the cardiac cement. Νo new arrhythmia recorded during follow up.

CONCLUSION

To the best of our knowledge, this is the first reported case of ventricular arrhythmogenic presentation of a cardiac cement embolus after a KP procedure.

Hybrid imaging of neuroendocrine tumors in the heart: Union is strength

Cardiac neuroendocrine tumors (NETs) are particularly rare tumors that can lead to a very poor clinical outcome, partly because of metastases but mainly because of manifestations of the hormonal activity they exhibit. Prompt diagnosis is important in order to start the most effective treatment for their removal or management, with the fewest complications. They are often difficult to diagnose, especially in their early stages. One of the reasons for this is that the heart is an organ with a high rate of metabolism and is located in close proximity to other high-metabolism organs. In addition, the anatomic location and their small size render their diagnosis extremely challenging. In recent years, hybrid imaging methods have revolutionized the diagnostic approach to oncology patients and have established a place in the diagnosis of cardiac NETs, because they provide both anatomical and functional information at the same time. Positron emission tomography/computed tomography (PET/CT), PET/magnetic resonance imaging (PET/MRI) and single-photon emission computed tomography/CT (SPECT/CT) are widely used in clinical practice because of the very important metabolic information, the high sensitivity and specificity. However, prospective studies are needed to confirm the true clinical and prognostic value of various hybrid imaging diagnostic techniques in cardiac NETs.

Differences in MicroRNA Expression in Pericoronary Adipose Tissue in Coronary Artery Disease Compared to Severe Valve Dysfunction

Pericoronary adipose tissue (PCAT) is a source of microRNAs (miRs) that act as messengers for intercellular communication. We investigated whether the PCAT surrounding significant coronary atherosclerotic lesions shows specific miR expression patterns compared with PCAT surrounding plaque-free segments. We included 49 patients with 3-vessel coronary artery disease (CAD) and 19 patients with severe valvular disease but no CAD, who underwent elective cardiac surgery. The PCAT was harvested from two sites: adjacent to a significant atherosclerotic coronary lesion and from plaque-free segments. miR-133a, miR-21, miR-26b, miR-9, and miR-143 levels in PCAT cells were quantified by real-time reverse transcription polymerase chain reaction (data expressed as arbitrary units). Expression of miR-133, miR-21, and miR-26b in adipose tissue at a site without atherosclerotic lesion was much lower in patients with CAD than in those without CAD (0.82 ± 1.37 vs 1.86 ± 0.52, P < .001, 0.45 ± 1.3 vs 1.51 ± 1.11, P < .001, 0.3 ± 1.25 vs 1.2 ± 0.73, P = .02, respectively). In addition, miR-133, miR-21, and miR-143 in CAD patients showed significantly greater expression in PCAT from atherosclerotic lesion compared with plaque-free segments (1.32 ± 0.96 vs 0.82 ± 0.37 (P = .011), 0.91 ± 1.7 vs 0.3 ± 1.25 (P = .012), 1.2 ± 1.59 vs 0.43 ± 0.54 (P < .001), respectively). Our findings open new perspectives for the role of PCAT in the pathophysiology of atherosclerosis and should be further investigated.

Decreased peroxisome proliferator-activated receptor gamma expression levels in pericoronary adipose tissue adjacent to atherosclerotic plaque compared to lesion-free coronary arteries

Background

Pericoronary adipose tissue (PCAT) regulates arterial homeostasis, is considered to act in paracrine manner, and plays a role in the pathogenesis of atherosclerosis. The nuclear receptor Peroxisome Proliferator-Activated receptor gamma (PPARγ) is a key regulator of adipogenesis, and alterations of its function are associated with different pathological processes related to metabolic syndrome and inflammatory response.

Purpose

To investigate whether the PCAT surrounding coronary occlusive atherosclerotic lesions shows specific PPARγ expression pattern compared to PCAT surrounding plaque-free segments

Methods

We enrolled 47 patients (32 men, aged 68±12 years old) with 3-vessel coronary artery disease (CAD) who underwent elective coronary bypass surgery. A control group of 10 age- and sex-matched patients with severe valvular disease who underwent aortic or mitral valve replacement was also included (8 men, aged 67±15 years old). PCAT samples were received from all participants. In patients with CAD, the PCAT was harvested from two sites: adjacent to an occlusive atherosclerotic coronary lesion, and a plaque-free segment. PPARγ expression levels in PCAT cells were quantified by real-time reverse transcription polymerase chain reaction.

Results

PCAT analysis showed a significant downregulation of PPARγ expression levels in CAD compared to non-CAD patients (45±19 versus 93±15, p=0.01). In addition, PPARγ levels showed significantly lower expression in PCAT from around atherosclerotic plaque compared to lesion-free sites (31±12 versus 45±19, p=0.04). Notably, the expression of PPARγ from atherosclerotic plaque showed robust negative correlations with BMI (r=−0.47, p=0.001).

Conclusions

PPARγ in PCAT surrounding coronary occlusive atherosclerotic lesions are significantly downregulated and their levels are associated with patients' BMI. Our study opens new perspectives in the pathophysiologic role of PCAT in atherosclerotic complications of diabetes and should be further investigated.

Funding Acknowledgement

Type of funding sources: None.

Detection of left ventricular hypertrophy on the ECG through machine learning with a focus on obesity

Background

Cardiac remodeling, an important aspect of cardiovascular disease (CVD) progression, is emerging as a significant therapeutic target. The electrocardiogram (ECG) is of paramount importance in the initial evaluation of a patient. However, the ECG is not a sensitive method of detecting left ventricular hypertrophy (LVH), and as far as we know, it cannot detect changes in left ventricular geometry (LVG) at early stages, especially before LVH is present. Its sensitivity is particularly low for obese patients.

Purpose

To use a machine learning (ML) classifier to detect abnormal LVG from ECG parameters/markers, even before it becomes LVH, and to propose some indicative markers useful for practitioners. We also looked at the results of our model for obese patients to test the markers in this population.

Methods

We enrolled consecutive subjects, aged 30 years or older (mean age: 61.6±12 years old) with and without essential hypertension and no indications of CVD. All patients underwent a full echocardiographic evaluation and were classified into 2 groups; those with normal geometry (NG) vs. those with concentric remodeling (CR) or LVH defined as concentric hypertrophy (CH) and eccentric hypertrophy (EH). Abnormal LVG was identified as increased relative wall thickness (RWT) and/or left ventricular mass index (LVMi). We analyzed the EKG waveforms deduced to single beat averages for each lead using custom software and extracted 70 markers. We then trained a Random Forest machine learning model to classify subjects with abnormal LVG and calculated SHAP values to perform feature importance and interaction.

Results

After screening 1120 individuals, we enrolled 594 subjects, aged 30 years or older (mean age: 61.6±12 years old). The percentage of women was 56.5%, while 71.3% of all patients were hypertensive. Hypertension, age, body mass index divided by the Sokolow-Lyon voltage (BMI/S-L), QRS-T angle, and QTc duration were among the most important parameters (Figure, left panel) identified by the model as being predictive of abnormal LVG (AUC/ROC = 0.84, sensitivity = 0.94, specificity 0.61). Specifically for obese patients, whose prevalence in our population was 60.3%, our model performed well (sensitivity = 0.71, specificity = 0.92. When we tried our model without the the BMI/S-L parameter, the specificity dropped to 0.88. We also found that a cut-off point of 18 for the BMI/S-L marker predicted the patients who were more probable to have developed abnormal LVG.

Conclusions

This study is the first to demonstrate the promising potential of ML modeling for the efficient and cost-effective diagnostic screening of abnormal LVG and cardiac remodeling through ECG. We found specific clinical and ECG parameters that can predict early pathological changes of LVG in patients without established CVD and detect the population who will benefit from a detailed echocardiographic evaluation.

Funding Acknowledgement

Type of funding sources: None.

Differences in microRNA expression in pericoronary tissue adjacent to atherosclerotic plaque and from lesion-free coronary artery

Background

Pericoronary adipose tissue (PCAT) plays a key role in the pathogenesis of atherosclerosis. PCAT is a source of microRNAs (miRs) that acts as messengers for intercellular communication. In this study, we investigated whether the PCAT surrounding coronary occlusive atherosclerotic lesions shows specific miR expression patterns compared to PCAT surrounding plaque-free segments.

Purpose

To evaluate the expression of miRs that are known to be implicated in the pathophysiology of atherosclerosis.

Methods

We included 49 patients (38 men, age 65±9 years) with 3-vessel coronary artery disease, who underwent elective coronary bypass surgery. The PCAT was harvested from two sites: adjacent to an occlusive atherosclerotic coronary lesion, and a plaque-free segment. miR-133a, miR-21, miR-26b, miR-9 and miR-143 levels in PCAT cells were quantified by real-time reverse transcription polymerase chain reaction.

Results

miR-26b, miR-21 and miR-143 showed significantly greater expression in PCAT samples taken from around atheromatous plaque (154±295 versus 37±96, p=0.014, for miR-26b; 122±265 versus 29±79, p=0.014, for miR-21; and 181±356 versus 31±50, p=0.03, for miR-143) (Figure 1). In addition, the expression of miR-143, miR-26b and miR-21 in PCAT from atherosclerotic plaque showed robust positive correlations with body.mass index (r=0.451, p=0.001, r=0.41, p=0.03 and r=0.416, p=0.003 respectively),

Conclusions

Analysis of PCAT located in proximity to atherosclerotic plaque showed a different pattern of miR expression compared to PCAT in a plaque-free segment. Our findings open new perspectives for the role of PCAT in the pathophysiological mechanisms of atherosclerotic disease and should be further investigated.

Funding Acknowledgement

Type of funding sources: None.

Artificial intelligence-based opportunistic screening for the detection of arterial hypertension through ECG signals

Background

Hypertension is a major risk factor for cardiovascular disease (CVD) which often escapes the diagnosis or should be confirmed by several office visits. The electrocardiogram (ECG) is one of the most widely used diagnostic tools and could be of paramount importance in patients' initial evaluation.

Purpose

To detect whether a person is hypertensive using features from the ECG, as well as basic anthropometric features such as age, sex, and body mass index (BMI).

Methods

We used machine learning (ML) techniques based features derived from the electrocardiogram for detecting hypertension in a population without CVD. We enrolled 1091 subjects who were classified into hypertensive and normotensive group. We trained 3 ML models, specifically logistic regression, k-nearest-neighbors, and random forest (RF), to predict the existence of hypertension in patients based only on a few basic clinical parameters and ECG-derived features. We also calculated Shapley additive explanations (SHAP), a sophisticated feature importance analysis, to interpret each feature's role in the random forest's predictions.

Results

Our RF model was able to distinguish hypertensive from normotensive patients with accuracy 84.2%, specificity 66.7%, sensitivity 91.4%, and area under the receiver-operating curve 0.86. Age, BMI, BMI-adjusted Cornell criteria (BMI multiplied by RaVL+SV3), R wave amplitude in aVL, and BMI-modified Sokolow-Lyon voltage (BMI divided by SV1+RV5), were the most important anthropometric and ECG-derived features in terms of the success of our model. Figure 1 shows the results in detecting hypertension by the Random Forest.

Conclusions

Our ML algorithm is effective in the detection of hypertension in patients using ECG-derived and basic anthropometric criteria. Our findings open new horizon in the detection of many undiagnosed hypertensive individuals who have an increased cardiovascular disease risk.

Funding Acknowledgement

Type of funding sources: None.

Elevated platelet reactivity in patients with uncontrolled hypertension: the effect of CHA2DS2-VASc score

Background

Hypertension is associated with vascular and endothelial dysfunction that may result in a greater propensity for reactive platelets to cause thrombosis.

Purpose

The aim of this study was to evaluate multiple platelet activation pathways in hypertensive patients with different level of blood pressure control and cardiovascular risk factors.

Methods

Thirty nine uncontrolled (office BP &gt;140/90 mmHg and ambulatory daytime BP &gt;135/85 mmHg, 27 males, aged 58±9 years) and 32 well controlled (office BP &lt;140/80 mmHg and ambulatory daytime BP &lt;135/85 mmHg, 21 males, aged 58±8 years) essential hypertensive patients were included in the study. Twenty four healthy individuals (12 males, aged 53±10 years) were served as control group. Blood samples were obtained before and 48 hours after the procedure and platelet aggregation was tested in platelet rich plasma after activation with arachidonic acid (AA), adenosine diphosphate ADP), collagen (Col), epinephrine (Epi) and ristocetin (Risto), by using AggRAM Platelet Aggregation Analyzer.

Results

Hypertensive patients showed elevated platelet reactivity in all platelet activation pathways compared to normotensive group (AA: 88.8±6.8% versus 79.5±7.3%, ADP: 86.8±9.1% versus 71.5±7.7%, Col: 86.5±5.7% versus 73.9±6.7%, Epi: 92.6±5.4% versus 80.5±5.7%, Risto: 93.8±6.8% versus 79.9±6.3%, p&lt;0.05 for all). Col, Epi and Risto platelet activation pathway showed a statistically significant increase in patients with uncontrolled hypertension compared to the group with well controlled hypertension (AA: 88.8±6.1% versus 89.1±4.1%, ADP: 89.8±4.1% versus 87.5±4.7%, Col: 87.5±4.7% versus 81.9±6.7%, Epi: 93.6±4.4% versus 80.1±5.7%, Risto: 94.8±3.8% versus 80.9±4.3%,). Notably, strong correlations were found between the Col platelet pathway activation and Risto platelet pathway activation and CHA2DS2-VASc score (r=0.57, p&lt;0.001 and r=0.61, p&lt;0.001, respectively) in hypertensive patients.

Conclusions

Patients with uncontrolled hypertension showed elevated platelet reactivity. Patients with high CHA2DS2-VASc even without atrial fibrillation carry also a higher risk of thrombosis as indicated by the increased platelet aggregation under certain pathways of activation.

Funding Acknowledgement

Type of funding sources: None.

Usefulness of right ventricular longitudinal systolic strain to predict the progression to heart failure with preserved ejection fraction in hypertensive patients

Background

Accurate assessment of right ventricular (RV) systolic function is important, as it is an established prognostic marker in cardiac diseases. Speckle-tracking echocardiography is a sensitive tool for detection of subclinical left ventricular impairment in essential hypertension.

Purpose

Our aim was to investigate the usefulness of RV longitudinal peak systolic strain (LS) to predict the risk of future development of heart failure with preserved ejection fraction (HFpEF) in patients with essential hypertension

Methods

We performed a retrospective observational study that included 453 patients with essential hypertension (266 males, aged 63±18 years) and 175 normotensives (100 males, aged 66±15 years). Standard echocardiography was performed at the initial visit. 2D speckle tracking echocardiography with evaluation of longitudinal strain in each segment of the RV (basal: RVLS-B; mid: RVLS-M, apical: RVLS-A) and global RV free-wall strain (RVLS-G) were also performed. We studied the cases of new onset HFpEF in hypertensive patients.

Results

The median follow up was 85 months (22–122). RVLS-G, RVLS-B and RVLS-M were significantly impaired in hypertensives compared to controls (RVLS-G: −16.1±9.7 vs −20.0±5.1, RVLS-B: −11.7±3.7 vs −20.6±3.3, RVLS-M:-16.3±5.4 vs −20.7±4.9, p&lt;0.05 for all). No significant difference was detected for the RVLS-A (−20.1±3.8 for hypertensives vs −21.31±6.5 for controls, p=NS). Thirty two hypertensive patients developed HFpEF (7%). A cut-off RVLS-G worse than −17% was significantly associated with new onset HFpEF (p&lt;0.001) in those patients. A multivariate Cox regression analysis showed that RVLS-G had independent significant prognostic value for the risk of HFpEF (HR: 10.5, 95% confidence interval (CI): 7.3–25.4).

Conclusions

Essential hypertension leads to a decrease of RVLS which is strong predictor of a new onset HFpEF. Future studies are needed to assess the significance of these findings and the effect of treatment.

Funding Acknowledgement

Type of funding sources: None.

Right ventricular longitudinal systolic strain can predict new onset heart failure with preserved ejection fraction in hypertensive patients

Funding Acknowledgements

Type of funding sources: None.

Purpose

Accurate assessment of right ventricular (RV) systolic function is important, as it is an established prognostic marker in cardiac diseases. Speckle-tracking echocardiography is a sensitive tool for detection of subclinical left ventricular impairment in essential hypertension. We associated RV function using longitudinal peak systolic strain (GLS) in patients with essential hypertension with the risk of future development of heart failure with preserved ejection fraction (HFpEF).

Methods

 We performed a retrospective observational study that included 458 patients with essential hypertension (266 males, aged 63 ± 18 years) and 179 normotensives (100 males, aged 66 ± 15 years). Standard echocardiography was performed at the initial visit. 2D speckle tracking echocardiography with evaluation of longitudinal strain in each segment of the RV (basal:  RVLS-B; mid: RVLS-M, apical: RVLS-A) and global RV free-wall strain (RVLS-G) were also performed. We studied the cases of new onset HFpEF in hypertensive patients. 

Results

The median follow up was 85 months (22–122). RVLS-G, RVLS-B and RVLS-M were significantly impaired in hypertensives compared to controls (RVLS-G: -16.1 ± 9.7 vs -20.0 ± 5.1, RVLS-B: -11.7 ± 3.7 vs -20.6 ± 3.3, RVLS-M:-16.3 ± 5.4 vs -20.7 ± 4.9, p &lt; 0.05 for all). No significant difference was detected for the RVLS-A (-20.1 ± 3.8 for hypertensives vs -21.31 ± 6.5 for controls, p = NS). Thirty two hypertensive patients developed HFpEF (7 %). A cut-off RVLS-G worse than -17 % was significantly associated with new onset HFpEF (p&lt; 0.001) in those patients. A multivariate Cox regression analysis showed that RVLS-G had independent significant prognostic value for the risk of HFpEF (HR: 10.5, 95% confidence interval (CI): 7.3-25.4). 

Conclusions

Essential hypertension leads to a decrease of RVLS which is strong predictor of a new onset HFpEF. Future studies are needed to assess the significance of these findings and the effects of treatment.

Effects of sodium-glucose cotransporter-2 inhibitors on cardiac structural and electrical remodeling: from myocardial cytology to cardiodiabetology

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have changed the clinical landscape of diabetes mellitus (DM) therapy through their favourable effects on cardiovascular outcomes. Notably, the use of SGLT2i has been linked to cardiovascular benefits regardless of DM status, while their pleiotropic actions remain to be fully elucidated. What we do know is that SGLT2i exert beneficial effects even at the level of the myocardial cell, and that these are linked to an improvement in the energy substrate, resulting in less inflammation and fibrosis. SGLT2i ameliorate myocardial extracellular matrix remodeling, cardiomyocyte stiffness and concentric hypertrophy, achieving beneficial remodeling of the left ventricle with significant implications for the pathogenesis and outcome of heart failure. Most studies show a significant improvement in markers of diastolic dysfunction along with a reduction in left ventricular hypertrophy. In addition to these effects there is electrophysiological remodeling, which explains initial data suggesting that SGLT2i have an antiarrhythmic action against both atrial and ventricular arrhythmias. However, future studies need to clarify not only the exact mechanisms of this beneficial functional, structural, and electrophysiological cardiac remodeling, but also its magnitude, and to determine whether this is a class or a drug effect.

MicroRNA profile analysis in pericoronary adipose tissue of diabetic patients with significant coronary artery disease

Background

Pericoronary adipose tissue (PCAT) regulates arterial homeostasis, is considered to act in paracrine manner,and plays a role in the pathogenesis of atherosclerosis. PCAT may be a source of microRNAs (miRs) that target other tissues and act as messengers for intercellular communication. In this study, we investigated whether the PCAT surrounding coronary occlusive atherosclerotic lesions shows specific miRs expression patterns in patients with diabetes type 2 compared to non-diabetic patients.

Methods

We enrolled 43 patients (29 men, aged 63±12 years old) with 3-vessel coronary artery disease who underwent elective coronary bypass surgery with and without diabetes type 2. The PCAT samples were received from all participants. miR-133a, miR-21, miR-26b, miR-9 and miR-143 expression levels in PCAT cells were quantified by real-time reverse transcription polymerase chain reaction.

Results

Twenty-one patients with diabetic type 2 (14 men, 64±10 years old) and twenty=two non-diabetic patients (15 men, 62±15 years old) were included in the study. PCAT analysis showed a significant upregulation of miR-21 levels in diabetic compared to non-diabetic patients (181±76 versus 21±15, p=0.04). Diabetic patients also revealed a significant increase of miR-26b and miR-143 expression in PCAT samples compared to on-diabetics (33±22 versus 16±13, p=0.02, 93±42 versus 16±23, p=0.01). No significant differences between the two sites were observed in PCAT expression of miR-133a and miR-9 (73±12 versus 130±143, 56±44 versus 34±33, respectively, p =NS for both).

Conclusions

miRs expression in PCAT from diabetic patients with significant coronary disease show a distinct expression profile. Our study opens new perspectives in the pathophysiologic role of PCAT in atherosclerotic complications of diabetes and should be further investigated.

Funding Acknowledgement

Type of funding sources: None.

Long term prognostic value of myocardin expression levels in non-ischemic dilated cardiomyopathy

Background

We The mortality of patients with non-ischemic dilated cardiomyopathy (NIDCM) remains substantial. We evaluated gene expression levels of myocardin, an early cardiac gene, in the peripheral blood cells of NIDCM patients as a prognostic biomarker in their long-term outcome and mortality from congestive HF (CHF).

Methods

We retrospectively analyzed 101 consecutives optimally treated NIDCM patients of Cretan origin who were enrolled from the HF clinic of our hospital from November 2005 to December 2008. Our patient data were either taken from their medical files or recorded during visits to the HF unit or hospitalizations. Follow-up was carried out by telephone interview and by accessing information from general practitioners and cardiologists in private practice.

Results

The median follow up period was 8 years (mean follow-up 7±3.4 years). The overall mortality during follow-up was 61.4%, while mortality due to congestive heart failure (CHF) was 49.5%. Higher CHF and all-cause mortality were observed in patients with myocardin levels &gt;14.26 (p&lt;0.001 for both CHF and all-cause mortality). A multivariate Cox regression analysis showed that myocardin level of expression had independent significant prognostic value for the risk of death from CHF (HR: 14.5, 95% confidence interval (CI): 5.3–39). in those patients.

Conclusions

Peripheral blood cells gene expression of myocardin, an early myocardial marker, may serve as prognostic biomarkers of the long-term outcome of patients with NIDCM. Our findings open new prospects in the risk stratification of these patients.

Funding Acknowledgement

Type of funding sources: None. Figure 1

Right ventricular longitudinal systolic strain as a predictor of new onset heart failure with preserved ejection fraction in hypertensive patients

Purpose

Accurate assessment of right ventricular (RV) systolic function is important, as it is an established prognostic marker in cardiac diseases. Speckle-tracking echocardiography is a sensitive tool for detection of subclinical left ventricular impairment in essential hypertension. We associated RV function using longitudinal peak systolic strain (GLS) in patients with essential hypertension with the risk of future development of heart failure with preserved ejection fraction (HFpEF).

Methods

We performed a retrospective observational study that included 452 patients with essential hypertension (266 males, aged 63±18 years) and 175 normotensives (100 males, aged 66±15 years). Standard echocardiography was performed at the initial visit. 2D speckle tracking echocardiography with evaluation of longitudinal strain in each segment of the RV (basal: RVLS-B; mid: RVLS-M, apical: RVLS-A) and global RV free-wall strain (RVLS-G) were also performed. We studied the cases of new onset HFpEF in hypertensive patients.

Results

The median follow up was 85 months (22–122). RVLS-G, RVLS-B and RVLS-M were significantly impaired in hypertensives compared to controls (RVLS-G: −16.1±9.7 vs −20.0±5.1, RVLS-B: −11.7±3.7 vs −20.6±3.3, RVLS-M: −16.3±5.4 vs −20.7±4.9, p&lt;0.05 for all). No significant difference was detected for the RVLS-A (−20.1±3.8 for hypertensives vs −21.31±6.5 for controls, p=NS). Thirty two hypertensive patients developed HFpEF (7%). A cut-off RVLS-G worse than −17% was significantly associated with new onset HFpEF (p&lt;0.001) in those patients. A multivariate Cox regression analysis showed that RVLS-G had independent significant prognostic value for the risk of HFpEF (HR: 10.5, 95% confidence interval (CI): 7.3–25.4).

Conclusions

Essential hypertension leads to a decrease of RVLS which is strong predictor of a new onset HFpEF. Future studies are needed to assess the significance of these findings and the effects of treatment.

Funding Acknowledgement

Type of funding sources: None.

Differential microRNAs profile analysis in pericoronary adipose tissue adjacent to atherosclerotic plaque

Background

Pericoronary adipose tissue (PCAT) regulates arterial homeostasis, is considered to act in paracrine manner, and plays a role in the pathogenesis of atherosclerosis. PCAT may be a source of microRNAs (miRs) that target other tissues and act as messengers for intercellular communication. In this study, we investigated whether the PCATsurrounding coronary occlusive atherosclerotic lesions shows specific miRs expression patterns compared to PCAT surrounding segments without significant atherosclerosis (plaque-free segments). We evaluated expression of miRs that are known to be implicated in the pathophysiology of atherosclerotic disease.

Methods

We included 40 patients (38 men, aged 62±12 years old) with 3-vessel coronary artery disease who underwent elective coronary bypass surgery. The PCAT was harvested from two sites: adjacent to coronary occlusive atheroscleroticlesion and plaque-free segment. miR-133a, miR-21, miR-26b, miR-9 and miR-143 expression levels in PCAT cells were quantified by real-time reverse transcription polymerase chain reaction.

Results

PCAT analysis revealed a significant downregulation of miR-133a levels in periplaque samples compared to those that were not adjacent to atheroscrerotic plaque (35.4±4.3 versus 87.2±130.5, p=0.03). We also found a significant decrease of miR-143 expression in segments adjacent to plaque compared to those surrounding plaque-free coronary artery (72.6±14.3 versus 213.2±222.5, p=0.01). No significant differences between the two sites were observed in PCAT expression of miR-21, miR-26b, miR-9 (170.7±205 versus 130.9±303.2, 129.8±64.3 versus 200.2±330.6, 40±0.2 versus 30.2±3.6, respectively, p=NS for all).

Conclusions

miR-133a and miR-143 expression in PCAT surrounding coronary occlusive atherosclerotic lesions were significantly downregulated compared to PCAT surrounding segments without significant atherosclerosis. Our study opens new perspectives in the role of PCAT in the pathophysiological mechanisms and the treatment of atherosclerotic disease and should be further investigated.

Funding Acknowledgement

Type of funding sources: None.

Peripheral Blood MicroRNAs as Potential Biomarkers of Myocardial Damage in Acute Viral Myocarditis

Background: microRNAs (miRs) have emerged as important modulators of cardiovascular development and disease. Our aim was to determine whether cardiac-related miRs such as miR-21-5p and miR-1-3p were differentially expressed in acute viral myocarditis and whether any of them was related with the extent of myocardial damage and left ventricular dysfunction. Methods: We enrolled 40 patients with acute viral myocarditis. Blood samples were taken on admission and miRs expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. Results: miR-21-5p, miR-1-3p were significantly elevated in acute myocarditis. miR-21-5p levels showed a strong correlation with global longitudinal strain (r = 0.71, p < 0.01), while miR-1-3p had significant correlations with troponin I (r = 0.79, p < 0.01). Conclusions: The expression of miR-21-5p and miR-1-3p in peripheral blood is increased in acute viral myocarditis, and this increase is correlated with myocardial damage and indicative of left ventricular systolic dysfunction in these patients.

Left ventricular global longitudinal peak strain deterioration in patients undergoing endovascular repair of abdominal aortic aneurysms: the effect of arterial stiffness

Purpose

Invasive abdominal aortic aneurysm (AAA) replacement with an endograft interposes between the normal arterial tree which may acutely reduce overall systemic compliance and increase the input impedance. We evaluated the impact of aortic reconstruction, using currently available grafts and endografts, on pulse wave velocity (pwv) and its effect on early cardiac systolic function indices in these patients.

Methods

A total of 73 men, mean age 70±8 years, were evaluated. Of these, 61 underwent endovascular repair (EVAR) and 12 open repair (OS). All patients underwent an assessment with a standard conventional transthoracic and a two-dimensional speckle tracking echocardiography at baseline, at 1 and 6 months after the intervention. Carotid - femoral (c-f) artery waveforms were measured and pwv was determined in all participants on each follow up visit.

Results

No significant changes in blood pressure were observed during the study period. Notably, our findings revealed a significant reduction in global longitudinal peak strain (GLPS) during the 6 months follow-up (from −19.7±−5.9% at baseline to −17.1±−5.9% at 6 months, p=0.03). C-r pwv showed a significant increase 6 months after the procedure (from 10.7±−2.9 m/sec at baseline to 13.9±3.3 m/sec at 6 months, p&lt;0.001). A significant time effect was found on cf-pwv, which showed an increase at 1 month and remained thereafter (p=0.007). Additionally, a deterioration in GLS values was revealed, with a significant increase at 1 month that persisted 5 months later (p&lt;0.001). No significant group effect was observed between EVAR and open repair (p=0.98) and there was no significant interaction (p=0.96). Notably, the difference of global longitudinal strain (ΔGLS) between baseline and 6 months significantly correlated with the corresponding changes in cf-pwv (r=0.494, p&lt;0.0001).

Conclusions

AAA repair not only leads to an increase in aortic stiffness, as measured by the increase in pwv, but also reduces cardiac systolic function. Our findings highlight the need a more intense cardiac surveillance program after aortic reconstruction. Further studies are needed to investigate how this may translate into long-term manifestations of cardiovascular complications and symptomatology.

Funding Acknowledgement

Type of funding source: None

Association between long non coding RNA levels and hypertension mediated organ damage

Purpose

Long non coding RNAs (lncRNAs) are emerging as important components of regulatory networks underlying cardiovascular development and pathophysiology. They exhibit distinctive roles in modulating tissue-specific epigenomic states that are critical for the transcriptional and epigenetic reprogramming that may underpin cardiovascular disease pathogenesis. We investigated the association between gene expression levels of the lncRNAs CARMEN and FENDRR in peripheral blood mononuclear cells (PBMCs) and asymptomatic hypertension mediated organ damage.

Methods

We included 56 patients with essential hypertension (38 women, mean age 77±8 years). Twenty nine normotensive individuals (14 women, mean age 76±10 years) were also included as controls. PBMCs were isolated and lncRNAs' expression levels were determined by quantitative real-time reverse transcription polymerase chain reaction. Hypertension mediated organ damage (MOD), namely carotid wall thickening, left ventricular hypertrophy, and albuminuria were assessed in all patients.

Results

Hypertensive patients showed significantly higher CARMEN (19.95±5.9 versus 5.69±2.82, p&lt;0.001) and FENDRR (37.7±11.8 versus 10.21±8.02, p&lt;0.001) expression levels compared with controls. Increased CARMEN expression levels in PBMCs showed a significant relationship with the number of organs involved (r=0.49, p=0.001). No significant relationship was revealed for FENDRR levels.

Conclusions

Our data reveal that in essential hypertension, increased CARMEN expression levels in PBMCs could be a marker of subclinical MOD. Further studies are needed to assess their role as potential biomarkers or future therapeutic targets in those patients.

Funding Acknowledgement

Type of funding source: None

MicroRNA-208b gene expression levels as a biomarkers of left ventricular dysfunction in patients with acute myocarditis

Purpose

MicroRNAs (miRs) play a major role in protein regulation by post-transcriptional gene expression and cell to cell interaction. Recently, they have been emerged as important modulators in cardiovascular development and disease. Our aim was to determine whether cardiac related miRs such as miR-208b was differentially expressed in peripheral blood mononuclear cells from patients with acute myocarditis. We also evaluated their expression levels in peripheral blood mononuclear cells in relation with left ventricular global longitudinal peak strain (GLPS) in those patients.

Methods

We assessed the expression levels of miR-208b in 55 patients with acute myocarditis (48 men, mean age 33±10 years) and 22 healthy individuals (18 men, mean age 33±9 years). Blood samples were taken on admission and miR expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. All patients were also underwent an assessment with standard conventional transthoracic and a two-dimensional speckle tracking echocardiography.

Results

GLPS was significantly reduced in the group of myocarditis compared to healthy individuals (from −13.9±10.9% versus −22.2±6.7%, p&lt;0.05). Myocarditis patients showed significantly higher miR-208b (28.8±16.6 versus 6.40±1.1, p&lt;0.001) expression levels compared to control group. miR-208b gene expression levels at baseline revealed a significant negative correlation with GLPS on admission (r=−0.51, p&lt;0.05). This correlation was independent of the patients' clinical parameters.

Conclusions

Our data reveal that miR-208b gene expression levels are upregulated in peripheral blood mononuclear cells from patients with acute myocarditis relative to healthy individuals. In addition, miR-208b levels have a prognostic value in the deterioration of left ventricular GLPS in those patients. Thus, miR-208b may represent a promising biomarkers in myocarditis or a potential therapeutic target in the future.

Funding Acknowledgement

Type of funding source: None

P5562Increased microRNA-21 gene expression levels as a biomarker of myocardial damage in acute myocarditis

Purpose

MicroRNAs (miRs) are implicated in various cardiovascular pathologies and are promising diagnostic and therapeutic targets. miR-21 plays a critical role in the regulation of inflammation and cardiac fibrosis. In this study, we evaluated miR-21 expression levels in peripheral blood mononuclear cells from patients with acute myocarditis compared to healthy individuals and explored their diagnostic potential as predictor of myocardial damage.

Methods

We assessed the expression levels of miR-21 in 55 patients with acute myocarditis (40 men, mean age 30±12 years) and 20 healthy individuals (15 men, mean age 30±9 years). Blood samples were taken on admission and miR-21 expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. Plasma high sensitive troponine (TnI) was measured by immunoassay and a value above the laboratory reference range (11.6 pg/ml) was considered elevated.

Results

Myocarditis patients showed significantly higher troponine levels compared to healthy individuals (256.59±94.9 versus 11.9±9.01, p<0.001). miR-21 expression levels in peripheral blood mononuclear cells were significantly elevated in the myocarditis group compared to the control group (47.01±18.3 versus 3.8±2.2, p=0.02). In addition, miR-21 expression levels in peripheral blood mononuclear cells revealed a significant correlation with troponine levels in those patients (r=0.55, p<0.001)

Conclusions

Our data reveal that miR-21 is upregulated in peripheral blood mononuclear cells from patients with acute myocarditis relative to healthy individuals and is significantly correlated with myocardial damage in those patients. Our findings indicate that miR-21 may be involved in the pathophysiology of myocarditis and represent promising biomarker in the disease.

P5561MicroRNA-208b gene expression levels as a biomarkers of left ventricular dysfunction in patients with acute myocarditis

Purpose

MicroRNAs (miRs) play a major role in protein regulation by post-transcriptional gene expression and cell to cell interaction. Recently, they have been emerged as important modulators in cardiovascular development and disease. Our aim was to determine whether cardiac related miRs such as miR-208b was differentially expressed in peripheral blood mononuclear cells from patients with acute myocarditis. We also evaluated their expression levels in peripheral blood mononuclear cells in relation with left ventricular global longitudinal peak strain (GLPS) in those patients.

Methods

We assessed the expression levels of miR-208b in 45 patients with acute myocarditis (38 men, mean age 31±10 years) and 22 healthy individuals (18 men, mean age 33±9 years). Blood samples were taken on admission and miR expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. All patients were also underwent an assessment with standard conventional transthoracic and a two-dimensional speckle tracking echocardiography.

Results

GLPS was significantly reduced in the group of myocarditis compared to healthy individuals (from −13.7 ± −7.9% versus −22.2±6.7%, p<0.05). Myocarditis patients showed significantly higher miR-208b (28.5±6.6 versus 6.40±1.1, p<0.001) expression levels compared to control group. miR-208b gene expression levels at baseline revealed a significant negative correlation with GLPS on admission (r=−0.51, p<0.05). This correlation was independent of the patients' clinical parameters.

Conclusions

Our data reveal that miR-208b gene expression levels are upregulated in peripheral blood mononuclear cells from patients with acute myocarditis relative to healthy individuals. In addition, miR-208b levels have a prognostic value in the deterioration of left ventricular GLPS in those patients. Thus, miR-208b may represent a promising biomarkers in myocarditis or a potential therapeutic target in the future.

Bicuspid aortic valve endocarditis caused by Gemella sanguinis: Case report and literature review

Gemella species are catalase-negative, facultative anaerobic, Gram-positive cocci, which are part of the human oral microbiome and may occasionally cause systemic infections. Infective endocarditis (IE) has been reported as the most common infection caused by Gemella species. We report the first case of IE due to Gemella sanguinis in Greece, in a patient with bicuspid aortic valve and review the available literature. The patient was successfully treated with antibiotics and aortic valve replacement.