Mortality and Cardiovascular End Points In Relation to the Aortic Pulse Wave Components: An Individual-Participant Meta-Analysis

BACKGROUND

Wave separation analysis enables individualized evaluation of the aortic pulse wave components. Previous studies focused on the pressure height with overall positive but differing results. In the present analysis, we assessed the associations of the pressure of forward and backward (Pfor and Pref) pulse waves with prospective cardiovascular end points, with extended analysis for time to pressure peak (Tfor and Tref).

METHODS

Participants in 3 IDCARS (International Database of Central Arterial Properties for Risk Stratification) cohorts (Argentina, Belgium, and Finland) aged ≥20 years with valid pulse wave analysis and follow-up data were included. Pulse wave analysis was done using the SphygmoCor device, and pulse wave separation was done using the triangular method. The primary end points consisted of cardiovascular mortality and nonfatal cardiovascular and cerebrovascular events. Multivariable-adjusted Cox regression was used to calculate hazard ratios.

RESULTS

A total of 2206 participants (mean age, 57.0 years; 55.0% women) were analyzed. Mean±SDs for Pfor, Pref, Tfor, and Tfor/Tref were 31.0±9.1 mm Hg, 20.8±8.4 mm Hg, 130.8±35.5, and 0.51±0.11, respectively. Over a median follow-up of 4.4 years, 146 (6.6%) participants experienced a primary end point. Every 1 SD increment in Pfor, Tfor, and Tfor/Tref was associated with 27% (95% CI, 1.07-1.49), 25% (95% CI, 1.07-1.45), and 32% (95% CI, 1.12-1.56) higher risk, respectively. Adding Tfor and Tfor/Tref to existing risk models improved model prediction (∆Uno's C, 0.020; P<0.01).

CONCLUSIONS

Pulse wave components were predictive of composite cardiovascular end points, with Tfor/Tref showing significant improvement in risk prediction. Pending further confirmation, the ratio of time to forward and backward pressure peak may be useful to evaluate increased afterload and signify increased cardiovascular risk.

The sodium-chloride difference: A marker of prognosis in patients with acute myocardial infarction

BACKGROUND

The difference between serum sodium and chloride ion concentrations (SCD) may be considered as a surrogate of a strong ion difference and may help to identify patients with a worse prognosis. We aimed to assess SCD as an early prognostic marker among patients with myocardial infarction.

METHODS

Data of 594 consecutive patients with acute myocardial infarction treated with PCI (44.9% STEMI patients; 70.7% males) was analysed for SCD in relation to their 30-day mortality. A restricted cubic spline regression model was used to study the relationship between mortality and SCD. Cox regression models were used to assess the association between SCD and the mortality risk.

RESULTS

Patients with Killip class ≥3 had lower SCD values in comparison to patients with Killip class ≤2: (32.0 [30.0-34.0] vs. 33.0 [31.0-36.0], p = .006). The overall 30-day mortality was 7.7% (n = 46). There was a significant difference in SCD values between survivors and non-survivors groups of patients (median (IQR): (33.0 [31.0-36.0] vs. 31.5 [28.0-34.0] (mmol/L), p = .002). The restricted cubic splines model confirmed a non-linear association between SCD and mortality. Patients with SCD <30 mmol/L (in comparison to SCD ≥30 mmol/L) had an increased mortality risk (unadjusted HR 2.92, 95% CI 1.59-5.36, p = .001; and an adjusted HR 2.30, 95% CI 1.02-5.19, p = .04).

CONCLUSIONS

Low SCD on admission is associated with an increased risk of 30-day mortality in patients with acute myocardial infarction treated with PCI and may serve as a useful prognostic marker for these patients.

Angiotensin-converting enzyme inhibitors and angiotensin-II-receptor antagonists modulate sodium handling based on endogenous lithium clearance

BACKGROUND

Numerous studies based on assessment of lithium clearance demonstrated higher sodium reabsorption in renal proximal tubules in individuals with hypertension, overweight, obesity, metabolic syndrome, or diabetes.

AIMS

We aimed to assess the influence of angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin-II-receptor antagonists (ARB) treatment on sodium handling.

METHODS

In a sample of 351Caucasian subjects without diuretic treatment with prevailing sodium consumption, we studied associations between renal sodium reabsorption in proximal (FPRNa) and distal (FDRNa) tubules assessed by endogenous lithium clearance and daily sodium intake measured by 24-hour excretion of sodium (UNaV), in the context of obesity and long-term treatment with ACE-I or ARB.

RESULTS

In the entire study population, we found a strong negative association between FPRNa and ACE-I/ARB treatment (b = -19.5; SE = 4.9; P <0.001). Subjects with FPRNa above the median value showed a significant adverse association between FPRNa and age (b = -0.06; SE = 0.02; P = 0.003), with no association with ACE-I/ARB treatment (P = 0.68). In contrast, in subjects with FPRNa below the median value, we found a strongly significant adverse relationship between FPRNa and ACE-I/ARB treatment (b = -30.4; SE = 8.60; P <0.001), with no association with age (P = 0.32).

CONCLUSIONS

ACE-I/ARB long-term treatment modulates FPRNa in the group with lower reabsorption, but not in that with higher than median value for the entire study population.

Ambulatory blood pressure monitoring in treated patients with hypertension in the COVID-19 pandemic - The study of European society of hypertension (ESH ABPM COVID-19 study)

PURPOSE

The coronavirus disease 2019 (COVID-19) pandemic and the subsequent lockdown profoundly affected almost all aspects of daily life including health services worldwide. The established risk factors for increased blood pressure (BP) and hypertension may also demonstrate significant changes during the pandemic. This study aims to determine the impact of the COVID-19 pandemic on BP control and BP phenotypes as assessed with 24-hour ambulatory BP monitoring (ABPM).

MATERIALS AND METHODS

This is a multi-centre, observational, retrospective and comparative study involving Excellence Centres of the European Society of Hypertension across Europe. Along with clinical data and office BP, ABPM recordings will be collected in adult patients with treated arterial hypertension. There will be two groups in the study: Group 1 will consist of participants who have undergone two ABPM recordings - the second one occurring during the COVID-19 pandemic, i.e. after March 2020, and the first one 9-15 months prior to the second. Participants in Group 2 will have two repeated ABPM recordings - both performed before the pandemic within a similar 9-15 month interval between the recordings. Within each group, we will analyse and compare BP variables and phenotypes (including averaged daytime and night-time BP, BP variability, dipper and non-dipper status, white-coat and masked hypertension) between the two respective ABPM recordings and compare these changes between the two groups. The target sample size will amount to least 590 participants in each of the study groups, which means a total of at least 2360 ABPM recordings overall.

EXPECTED OUTCOMES

As a result, we expect to identify the impact of a COVID-19 pandemic on blood pressure control and the quality of medical care in order to develop the strategy to control cardiovascular risk factors during unpredictable global events.

Serial echocardiographic evaluation of COVID-19 patients without prior history of structural heart disease: a 1-year follow-up CRACoV-HHS study

Background

It is a well-known fact that COVID-19 affects the cardiovascular system by exacerbating heart failure in patients with preexisting conditions. However, there is a poor insight into the cardiovascular involvement and sequelae in patients without preexisting conditions. The aim of the study is to analyse the influence of COVID-19 on cardiac performance in patients without prior history of structural heart disease. The study is part of the CRACoV project, which includes a prospective design and a 12-month follow-up period.

Material and methods

The study included 229 patients hospitalised with a diagnosis of COVID-19 (median age of 59 years, 81 were women). A standard clinical assessment and laboratory tests were performed in all participants. An extended echocardiographic image acquisition was performed at baseline and at a 3-, 6-, and 12-month follow-up. All analyses were performed off-line. A series of echocardiographic parameters was compared using repeated measures or Friedman analysis of variance.

Results

In all subjects, the left ventricular (LV) ejection fraction at baseline was preserved [63.0%; Q1:Q3 (60.0-66.0)]. Elevated levels of high-sensitivity cardiac troponin T were detected in 21.3% of the patients, and elevated NT-proBNP levels were detected in 55.8%. At the 1-year follow-up, no significant changes were observed in the LV diameter and volume (LV 48.0 ± 5.2 vs. 47.8 ± 4.8 mm, p = 0.08), while a significant improvement of the parameters in the biventricular strain was observed (LV -19.1 ± 3.3% vs. -19.7 ± 2.5%, p = 0.01, and right ventricular -19.9 ± 4.5% vs. -23.2 ± 4.9%, p = 0.002). In addition, a decrease in the LV wall thickness was also observed (interventricular septum 10.4 ± 1.6 vs. 9.7 ± 2.0 mm, p < 0.001; LV posterior wall 9.8 ± 1.4 vs. 9.1 ± 1.5 mm, p < 0.001).

Conclusions

In an acute phase of COVID-19, the elevation of cardiac biomarkers in patients with normal left ventricular ejection fraction is a frequent occurrence; however, it does not translate into clinically significant cardiac dysfunction after 1 year. The serial echocardiographic evaluations conducted in patients without preexisting structural heart disease demonstrate an overall trend towards an improved cardiac function and a reduced myocardial thickening at 1-year follow-up. This suggests that the acute cardiac consequences of COVID-19 are associated with systemic inflammation and haemodynamic stress in patients without preexisting conditions.

Derivation of an Outcome-Driven Threshold for Aortic Pulse Wave Velocity: An Individual-Participant Meta-Analysis

BACKGROUND

Aortic pulse wave velocity (PWV) predicts cardiovascular events (CVEs) and total mortality (TM), but previous studies proposing actionable PWV thresholds have limited generalizability. This individual-participant meta-analysis is aimed at defining, testing calibration, and validating an outcome-driven threshold for PWV, using 2 populations studies, respectively, for derivation IDCARS (International Database of Central Arterial Properties for Risk Stratification) and replication MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease Health Survey - Copenhagen).

METHODS

A risk-carrying PWV threshold for CVE and TM was defined by multivariable Cox regression, using stepwise increasing PWV thresholds and by determining the threshold yielding a 5-year risk equivalent with systolic blood pressure of 140 mm Hg. The predictive performance of the PWV threshold was assessed by computing the integrated discrimination improvement and the net reclassification improvement.

RESULTS

In well-calibrated models in IDCARS, the risk-carrying PWV thresholds converged at 9 m/s (10 m/s considering the anatomic pulse wave travel distance). With full adjustments applied, the threshold predicted CVE (hazard ratio [CI]: 1.68 [1.15-2.45]) and TM (1.61 [1.01-2.55]) in IDCARS and in MONICA (1.40 [1.09-1.79] and 1.55 [1.23-1.95]). In IDCARS and MONICA, the predictive accuracy of the threshold for both end points was ≈0.75. Integrated discrimination improvement was significant for TM in IDCARS and for both TM and CVE in MONICA, whereas net reclassification improvement was not for any outcome.

CONCLUSIONS

PWV integrates multiple risk factors into a single variable and might replace a large panel of traditional risk factors. Exceeding the outcome-driven PWV threshold should motivate clinicians to stringent management of risk factors, in particular hypertension, which over a person's lifetime causes stiffening of the elastic arteries as waypoint to CVE and death.

Short- and long-term survival of patients hospitalized for COVID-19 in relation to cardiovascular risk factors and established cardiovascular disease: the Cor-Cardio study

INTRODUCTION

The clinical presentation of COVID‑19 may range from asymptomatic infection to severe disease. Previous studies reported a relationship between the course of COVID‑19 and a history of cardiovascular (CV) disease (CVD).

OBJECTIVES

We aimed to analyze the influence of CV risk factors, established CVD, and treatment with CV drugs on short- and long‑term survival in patients hospitalized for COVID‑19.

PATIENTS AND METHODS

We retrospectively analyzed data of patients hospitalized in 13 COVID‑19 hospitals in Poland (between March and October 2020). Individual deaths during the follow‑up were recorded until March 2021.

RESULTS

Overall, 2346 patients with COVID‑19 were included (mean age, 61 years; 50.2% women). A total of 341 patients (14.5%) died during the hospitalization, and 95 (4.7%) died during the follow‑up. Independent predictors of in‑hospital death were older age, a history of established CVD, heart failure, and chronic kidney disease (CKD), while treatment with renin‑angiotensin‑aldosterone system blockers or statins was associated with a lower risk of death during hospitalization. Factors that independently predicted death during the follow‑up were older age, a history of established CVD, CKD, and a history of cancer. The presence of CV risk factors did not increase the odds of death either in the hospital or during the follow‑up. Of note, higher systolic blood pressure and oxygen blood saturation on admission were associated with better short- and long‑term prognosis.

CONCLUSION

Established CVD and CKD were the main predictors of mortality during both the hospitalization and the follow‑up in the patients hospitalized for COVID‑19, while the use of CV drugs during the hospitalization was associated with better prognosis. The presence of CV risk factors did not increase the odds of in‑hospital and postdischarge death.

The role of stress hyperglycemia and hyperlactatemia in non-diabetic patients with myocardial infarction treated with percutaneous coronary intervention

BACKGROUND

Stress hyperglycemia and lactates have been used separately as markers of a severe clinical condition and poor outcomes in patients with myocardial infarction (MI). However, the interplay between glucose and lactate metabolism in patients with MI have not been sufficiently studied. The aim in the present study was to examine the relationship of glycemia on admission (AG) and lactate levels and their impact on the outcome in non-diabetic MI patients treated with percutaneous coronary intervention (PCI).

METHODS

A total of 405 consecutive, non-diabetic, MI patients were enrolled in this retrospective, observational, single-center study. Clinical characteristic including glucose and lactate levels on admission and at 30-day mortality were assessed.

RESULTS

Patients with stress hyperglycemia (AG ≥ 7.8 mmol/L, n = 103) had higher GRACE score (median [interquartile range]: 143.4 (115.4-178.9) vs. 129.4 (105.7-154.5), p = 0.002) than normoglycemic patients (AG level < 7.8 mmol/L, n = 302). A positive correlation of AG with lactate level (R = 0.520, p < 0.001) was observed. The coexistence of both hyperglycemia and hyperlactatemia (lactate level ≥ 2.0 mmol/L) was associated with lower survival rate in the Kaplan-Meier estimates (p < 0.001). In multivariable analysis both hyperglycemia and hyperlactatemia were related to a higher risk of death at 30-day follow-up (hazard ratio [HR] 3.21, 95%, confidence interval [CI] 1.04-9.93; p = 0.043 and HR 7.08; 95% CI 1.44-34.93; p = 0.016, respectively) CONCLUSIONS: There is a relationship between hyperglycemia and hyperlactatemia in non-diabetic MI patients treated with PCI. The coexistence of both hyperglycemia and hyperlactatemia is associated with lower survival rate and are independent predictors of 30-day mortality in MI patients and these markers should be evaluated simultaneously.

Neutrophil-activating Peptide 2 as a Novel Modulator of Fibrin Clot Properties in Patients with Atrial Fibrillation

Neutrophil-activating peptide 2 (NAP-2, CXCL7), a platelet-derived neutrophil chemoattractant, is involved in inflammation. We investigated associations between NAP-2 levels, neutrophil extracellular traps (NETs) formation, and fibrin clot properties in atrial fibrillation (AF). We recruited 237 consecutive patients with AF (mean age, 68 ± 11 years; median CHA₂DS₂VASc score of 3 [2-4]) and 30 apparently healthy controls. Plasma NAP-2 concentrations were measured, along with plasma fibrin clot permeability (K_s) and clot lysis time (CLT), thrombin generation, citrullinated histone H3 (citH3), as a marker of NETs formation, and 3-nitrotyrosine reflecting oxidative stress. NAP-2 levels were 89% higher in AF patients than in controls (626 [448-796] vs. 331 [226-430] ng/ml; p < 0.0001). NAP-2 levels were not associated with demographics, CHA₂DS₂-VASc score, or the AF manifestation. Patients with NAP-2 in the top quartile (> 796 ng/ml) were characterized by higher neutrophil count (+ 31.7%), fibrinogen (+ 20.8%), citH3 (+ 86%), and 3-nitrotyrosine (+ 111%) levels, along with 20.2% reduced K_s and 8.4% prolonged CLT as compared to the remaining subjects (all p < 0.05). NAP-2 levels were positively associated with fibrinogen in AF patients (r = 0.41, p = 0.0006) and controls (r = 0.65, p < 0.01), along with citH3 (r = 0.36, p < 0.0001) and 3-nitrotyrosine (r = 0.51, p < 0.0001) in the former group. After adjustment for fibrinogen, higher citH3 (per 1 ng/ml β = -0.046, 95% CI -0.029; -0.064) and NAP-2 (per 100 ng/ml β = -0.21, 95% CI -0.14; -0.28) levels were independently associated with reduced K_s. Elevated NAP-2, associated with increased oxidative stress, has been identified as a novel modulator of prothrombotic plasma fibrin clot properties in patients with AF.

Artificial intelligence guided HRCT assessment predicts the severity of COVID-19 pneumonia based on clinical parameters

BACKGROUND

The purpose of the study was to compare the results of AI (artificial intelligence) analysis of the extent of pulmonary lesions on HRCT (high resolution computed tomography) images in COVID-19 pneumonia, with clinical data including laboratory markers of inflammation, to verify whether AI HRCT assessment can predict the clinical severity of COVID-19 pneumonia.

METHODS

The analyzed group consisted of 388 patients with COVID-19 pneumonia, with automatically analyzed HRCT parameters of volume: AIV (absolute inflammation), AGV (absolute ground glass), ACV (absolute consolidation), PIV (percentage inflammation), PGV (percentage ground glass), PCV (percentage consolidation). Clinical data included: age, sex, admission parameters: respiratory rate, oxygen saturation, CRP (C-reactive protein), IL6 (interleukin 6), IG - immature granulocytes, WBC (white blood count), neutrophil count, lymphocyte count, serum ferritin, LDH (lactate dehydrogenase), NIH (National Institute of Health) severity score; parameters of clinical course: in-hospital death, transfer to the ICU (intensive care unit), length of hospital stay.

RESULTS

The highest correlation coefficients were found for PGV, PIV, with LDH (respectively 0.65, 0.64); PIV, PGV, with oxygen saturation (respectively - 0.53, -0.52); AIV, AGV, with CRP (respectively 0.48, 0.46); AGV, AIV, with ferritin (respectively 0.46, 0.45). Patients with critical pneumonia had significantly lower oxygen saturation, and higher levels of immune-inflammatory biomarkers on admission. The radiological parameters of lung involvement proved to be strong predictors of transfer to the ICU (in particular, PGV ≥ cut-off point 29% with Odds Ratio (OR): 7.53) and in-hospital death (in particular: AIV ≥ cut-off point 831 cm³ with OR: 4.31).

CONCLUSIONS

Automatic analysis of HRCT images by AI may be a valuable method for predicting the severity of COVID-19 pneumonia. The radiological parameters of lung involvement correlate with laboratory markers of inflammation, and are strong predictors of transfer to the ICU and in-hospital death from COVID-19.

TRIAL REGISTRATION

National Center for Research and Development CRACoV-HHS project, contract number SZPITALE-JEDNOIMIENNE/18/2020.

Urinary proteomics combined with home blood pressure telemonitoring for health care reform trial-First progress report

High blood pressure (BP) and type-2 diabetes (T2DM) are forerunners of chronic kidney disease and left ventricular dysfunction. Home BP telemonitoring (HTM) and urinary peptidomic profiling (UPP) are technologies enabling risk stratification and personalized prevention. UPRIGHT-HTM (NCT04299529) is an investigator-initiated, multicenter, open-label, randomized trial with blinded endpoint evaluation designed to assess the efficacy of HTM plus UPP (experimental group) over HTM alone (control group) in guiding treatment in asymptomatic patients, aged 55-75 years, with ≥5 cardiovascular risk factors. From screening onwards, HTM data can be freely accessed by all patients and their caregivers; UPP results are communicated early during follow-up to patients and caregivers in the intervention group, but at trial closure in the control group. From May 2021 until January 2023, 235 patients were screened, of whom 53 were still progressing through the run-in period and 144 were randomized. Both groups had similar characteristics, including average age (62.0 years) and the proportions of African Blacks (81.9%), White Europeans (16.7%), women 56.2%, home (31.2%), and office (50.0%) hypertension, T2DM (36.4%), micro-albuminuria (29.4%), and ECG (9.7%) and echocardiographic (11.5%) left ventricular hypertrophy. Home and office BP were 128.8/79.2 mm Hg and 137.1/82.7 mm Hg, respectively, resulting in a prevalence of white-coat, masked and sustained hypertension of 40.3%, 11.1%, and 25.7%. HTM persisted after randomization (48 681 readings up to 15 January 2023). In conclusion, results predominantly from low-resource sub-Saharan centers proved the feasibility of this multi-ethnic trial. The COVID-19 pandemic caused delays and differential recruitment rates across centers.

Prevalence and clinical implications of atrial fibrillation in patients hospitalized due to COVID-19: Data from a registry in Poland

Background

Atrial fibrillation (AF) is a common arrhythmia with increasing prevalence with respect to age and comorbidities. AF may influence the prognosis in patients hospitalized with Coronavirus disease 2019 (COVID-19). We aimed to assess the prevalence of AF among patients hospitalized due to COVID-19 and the association of AF and in-hospital anticoagulation treatment with prognosis.

Methods and results

We assessed the prevalence of AF among patients hospitalized due to COVID-19 and the association of AF and in-hospital anticoagulation treatment with prognosis. Data of all COVID-19 patients hospitalized in the University Hospital in Krakow, Poland, between March 2020 and April 2021, were analyzed. The following outcomes: short-term (30-days since hospital admission) and long-term (180-days after hospital discharge) mortality, major cardiovascular events (MACEs), pulmonary embolism, and need for red blood cells (RBCs) transfusion, as a surrogate for major bleeding events during hospital stay were assessed. Out of 4,998 hospitalized patients, 609 had AF (535 pre-existing and 74 de novo). Compared to those without AF, patients with AF were older and had more cardiovascular disorders. In adjusted analysis, AF was independently associated with an increased risk of short-term {p = 0.019, Hazard Ratio [(HR)] 1.236; 95% CI: 1.035–1.476} and long-term mortality (Log-rank p &lt; 0.001) as compared to patients without AF. The use of novel oral anticoagulants (NOAC) in AF patients was associated with reduced short-term mortality (HR 0.14; 95% CI: 0.06–0.33, p &lt; 0.001). Moreover, in AF patients, NOAC use was associated with a lower probability of MACEs (Odds Ratio 0.3; 95% CI: 0.10–0.89, p = 0.030) without increase of RBCs transfusion.

Conclusions

AF increases short- and long-term risk of death in patients hospitalized due to COVID-19. However, the use of NOACs in this group may profoundly improve prognosis.

Multiple drug intolerance in patients with arterial hypertension: prevalence and determining factors

INTRODUCTION

One of the reasons for poor medication compliance among patients is the occurrence of adverse drug reactions.

OBJECTIVES

The aim of this study was to determine the prevalence of Multiple Drug Intolerance Syndrome, defined as adverse reactions to 3 or more classes of drug, among patients with arterial hypertension, and to assess the predisposing factors.

PATIENTS AND METHODS

The study population comprised hospitalized patients diagnosed with arterial hypertension as well as patients undergoing chronic treatment in an outpatient hypertension clinic. The authors used a structured proprietary questionnaire, which focused on demographic and clinical data, including current or past history of adverse drug reactions.

RESULTS

The study population comprised 1000 patients, including 560 women.  The mean (SD) age was 62.8 (14.9) years. Eighty patients (8%) suffered from MDIS. Among MDIS patients, as compared to the remaining subjects, there were more women  (71% vs. 55%, P = 0.01). Patients with MDIS had longer history of hypertension (median 15  vs. 10 years, P = 0.01) and were more likely to suffer from respiratory (P = 0.01), gastrointestinal (P = 0.003), rheumatoid (P <0.001) and endocrine (P = 0.01) disorders. The risk of MDIS was highest with the concomitant use of analgesics, followed by beta-blockers, antiplatelet drugs and antibiotics.

CONCLUSIONS

MDIS in patients with hypertension is common and more frequently affects women and patients with a longer known disease duration. Comorbidities increase the risk of MDIS. The risk of MDIS is strongly associated with the use of analgesics, beta-blockers, antiplatelet drugs and antibiotics.

The role of artificial intelligence technology analysis of high-resolution computed tomography images in predicting the severity of COVID-19 pneumonia

INTRODUCTION

High-resolution computed tomography (HRCT) is usually used only for qualitative analysis of COVID-19 pneumonia. However, when coupled with artificial intelligence (AI) it can also automatically provide quantitative data.

OBJECTIVES

The purpose of the study was to analyze the role of automatic assessment of COVID‑19 pneumonia severity on HRCT images by AI technology.

PATIENTS AND METHODS

We retrospectively studied medical records of consecutive patients admitted to the Krakow University Hospital due to COVID‑19. Of the 1729 patients, 804 underwent HRCT with automatic analysis of such radiological parameters as absolute inflammation volume, absolute ground glass volume, absolute consolidation volume (ACV), percentage inflammation volume, percentage ground glass volume, percentage consolidation volume (PCV), and severity of pneumonia classified as none, mild, moderate, or critical.

RESULTS

The automatically assessed radiological parameters correlated with the clinical parameters that reflected the severity of pneumonia (P <0.05). The patients with critical pneumonia, as compared with mild or moderate one, were more frequently men, had significantly lower oxygen saturation, higher respiratory rate, higher levels of inflammatory markers, as well as more common need for mechanical ventilation and admission to the intensive care unit. They were also more likely to die during hospitalization. Notably, as determined by the receiver operating characteristic curve analysis, radiological parameters above or equal to the cutoff points were independently associated with in‑hospital mortality (ACV odds ratio [OR], 4.08; 95% CI, 2.62-6.35; PCV OR, 4.05; 95% CI, 2.60-6.30).

CONCLUSIONS

Using AI to analyze HRCT images is a simple and valuable approach to predict the severity of COVID‑19 pneumonia.

The occurrence of drug-induced side effects in women and men with arterial hypertension and comorbidities

BACKGROUND

Women have been underrepresented in large clinical trials in hypertension, and the incidence of adverse drug reactions by sex has been not sufficiently described.

AIMS

The aim of the study was to determine the prevalence of adverse drug reactions in women and men with arterial hypertension and comorbidities and to assess the specific predisposing factors for adverse drug reactions by sex.

METHODS

The study population comprised consecutive hospitalized patients diagnosed with arterial hypertension and patients treated in an outpatient clinic, whose recruitment started in January 2019 aiming to reach 1000 participants. A structured questionnaire was used to gather the patients' demographic and clinical data and current or past cases of adverse drug reactions.

RESULTS

The study included 560 women and 440 men, with mean (standard deviation) age of 62.84 (14.96) years. Women were older than men, had a longer hypertension history, and suffered less frequently from other cardiovascular diseases. Women reported more frequently adverse drug reactions. The risk of drug-induced side effects in women increased with age (P = 0.03) and with coexistence of any respiratory disease (P = 0.04). In the case of male sex, the risk of adverse drug reactions increased with the occurrence of hypercholesterolemia (P = 0.03), and coexistence of any analyzed metabolic diseases (P = 0.04).

CONCLUSIONS

Adverse drug reactions were reported more frequently by women. Older age and the presence of any respiratory disease increased the risk of adverse drug reactions in women, while in men, the risk was increased mainly by the presence of hypercholesterolemia or other metabolic diseases.

Cardiovascular consequences of aircraft noise exposure

The results from epidemiological studies suggest that environmental noise including aircraft, railway, road traffic, wind turbine, and leisure-related noise is a growing public health concern. According to the WHO, at least 100 million people in the European Union are affected by traffic noise levels above the WHO-recommended thresholds. Environmental noise can adversely affect physical and mental health, as well as wellbeing. Chronic low-level noise exposure typical for most environmental sources is associated with psychophysiological stress causing non-auditory or indirect noise effects leading ultimately to cardiovascular diseases. Among all environmental noise sources, aircraft noise is considered the most annoying, and its leading mechanism of action is autonomic system activation such as increases in heart rate and blood pressure. Previously, we observed that long-term exposure to aircraft noise was associated with increased diastolic blood pressure, arterial stiffness (as assessed by pulse wave velocity), and impaired left ventricular diastolic function. All mentioned above effects are early, subclinical, and potentially reversible changes which preceded late noise effects in the cardiovascular system, that is, established cardiovascular diseases such as myocardial infarction, stroke, and heart failure. However, even a short-term reduction in aircraft noise exposure as observed during the COVID-19 lockdown may reverse these negative effects on arterial stiffness and blood pressure and may decrease the prevalence of insomnia. In this review, we aimed to critically discuss our obtained results considering recent studies on the influence of aircraft noise (and other traffic noises) on cardiovascular diseases in the context of the WHO Environmental Noise Guidelines for the European Region.

Impact of concomitant COVID-19 on the outcome of patients with acute myocardial infarction undergoing coronary artery angiography

Background

The impact of COVID-19 on the outcome of patients with MI has not been studied widely. We aimed to evaluate the relationship between concomitant COVID-19 and the clinical course of patients admitted due to acute myocardial infarction (MI).

Methods

There was a comparison of retrospective data between patients with MI who were qualified for coronary angiography with concomitant COVID-19 and control group of patients treated for MI in the preceding year before the onset of the pandemic. In-hospital clinical data and the incidence of death from any cause on 30 days were obtained.

Results

Data of 39 MI patients with concomitant COVID-19 (COVID-19 MI) and 196 MI patients without COVID-19 in pre-pandemic era (non-COVID-19 MI) were assessed. Compared with non-COVID-19 MI, COVID-19 MI was in a more severe clinical state on admission (lower systolic blood pressure: 128.51 ± 19.76 vs. 141.11 ± 32.47 mmHg, p = 0.024), higher: respiratory rate [median (interquartile range), 16 (14–18) vs. 12 (12–14)/min, p < 0.001], GRACE score (178.50 ± 46.46 vs. 161.23 ± 49.74, p = 0.041), percentage of prolonged (>24 h) time since MI symptoms onset to coronary intervention (35.9 vs. 15.3%; p = 0.004), and cardiovascular drugs were prescribed less frequently (beta-blockers: 64.1 vs. 92.8%, p = 0.009), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers: 61.5 vs. 81.1%, p < 0.001, statins: 71.8 vs. 94.4%, p < 0.001). Concomitant COVID-19 was associated with seven-fold increased risk of 30-day mortality (HR 7.117; 95% CI: 2.79–18.14; p < 0.001).

Conclusion

Patients admitted due to MI with COVID-19 have an increased 30-day mortality. Efforts should be focused on infection prevention and implementation of optimal management to improve the outcomes in those patients.

Impact of Arterial Hypertension and Use of Antihypertensive Pharmacotherapy on Mortality in Patients Hospitalized due to COVID-19: The CRACoV-HHS Study

Cardiovascular diseases including arterial hypertension are common comorbidities among patients hospitalized due to COVID-19. We assessed the influence of preexisting hypertension and its pharmacological treatment on in-hospital mortality in patients hospitalized with COVID-19.

Effects of uric acid-lowering therapy in patients with essential arterial hypertension

OBJECTIVES

Asymptomatic hyperuricemia (AHU) is elevated serum uric acid (UA) without symptoms. This study aimed to determine the effects of AHU treatment with allopurinol on selected hypertension-mediated organ damage (HMOD) indices in patients with uncomplicated essential arterial hypertension (AH).

METHODS

Patients aged 30-70 years with AHU and AH grade 1-2 with adequate blood pressure (BP) control, without previous urate-lowering therapy (ULT), were divided into two groups: (a) ULT (receiving allopurinol) and (b) control (age- and sex-matched patients without ULT). Both received a UA-lowering diet. BP (office, 24 h and central), echocardiographic parameters, carotid intima-media thickness (IMT) and lab tests [high-sensitivity C-reactive protein (hs-CRP)] were measured at baseline and at 6 months follow-up.

RESULTS

Of 100 participants, 87 (44 ULT, 43 controls) completed the study. At 6 months follow-up, there was a greater reduction in serum UA concentration in the ULT group than in the control group. Patients receiving allopurinol had significant reductions in office systolic and diastolic BP, central systolic BP, pulse pressure, IMT (0.773 ± 0.121 vs. 0.752 ± 0.13 mm, P = 0.044) and hs-CRP (3.36 ± 2.73 vs. 2.74 ± 1.91 mg/L, P = 0.028) compared to controls. Multivariate regression analysis revealed the independent relationship between reduction in IMT and UA lowering (P < 0.026).

CONCLUSION

In patients with AH and AHU, treatment with allopurinol leads to improvement in BP control and reduction in HMOD intensity, in particular IMT. The decrease in hs-CRP concentration associated with ULT may have a beneficial effect on a patient's long-term prognosis.

Cardiac biomarkers on admission and in-hospital mortality in COVID-19 patients with or without concomitant heart failure

INTRODUCTION

High-sensitive cardiac troponin (hs-cTnT) and N terminal pro B type natriuretic peptide (NT-proBNP) are known markers of cardiac injury. However, the role of these markers in predicting severity of coronavirus disease (COVID-19) remains to be investigated.    Objectives: To analyze an association between hs-cTnT and NT-proBNP with in-hospital mortality in COVID-19 patients, with emphasis on those with concomitant chronic heart failure (CHF).

PATIENTS AND METHODS

1,729 consecutive patients with COVID-19 were enrolled. Demographic data, laboratory parameters and clinical outcomes (discharged or death) were analyzed. ROC curves and logistic regression analyses for hs-cTnT and NT-proBNP values and the risk of death were performed.

RESULTS

Hs-cTnT was determined in 1,041 patients, while NT-proBNP was assessed in 715. CHF was present in 179 cases (10.4% of the cohort). The median of hs-cTnT, NT-proBNP values and in-hospital mortality were higher in CHF patients in comparison to those without CHF. In patients without CHF, the mortality was highest in those with the 4 th quartile of hs-cTnT or NT-proBNP values. In the ROC analysis, hs-cTnT ≥ 142 ng/ml, and NT-proBNP ≥ 969 pg/ml predicted in-hospital death. In cases without CHF, each 10 ng/L increase in hs-cTnT or 100 pg/mL increase in NT-proBNP was associated with risk of death: OR 1.01 and OR 1.02 (P<0.01), respectively.

CONCLUSION

Hs-cTnT or NT-proBNP predicts in-hospital mortality in COVID-19 patients. Both Hs-cTnT and NT-proBNP should be routinely measured at admission in all patients hospitalized due to COVID-19 for early detection of subjects with an increased risk of in-hospital death, even if they do not have concomitant heart failure.

Prognostic value of acid-base balance parameters obtained from peripheral venous blood sample on admission in patients with myocardial infarction treated with percutaneous coronary intervention

INTRODUCTION

Peripheral venous blood sample may be used to obtain acid-base balance parameters (PVA-BP) measured in rapid point-of-care test analyzers (POCT) on admission to emergency department (ED). Thus, lactates, anion gap (AG) and base excess (BE) may be early prognostic markers in patients with myocardial infarction (MI).

OBJECTIVES

We aimed to confirm the relationship between PVA-BP on admission and the outcome in patients with MI treated by percutaneous coronary intervention (PCI).

PATIENTS AND METHODS

A retrospective, observational analysis of MI patients admitted primarily to ED and secondly transferred to PCI department.

RESULTS

336 patients (41.1% STEMI, 58.9% NSTEMI) were divided according to lactates level: G1:≤2.0 mmol/l (n = 207), G2:>2.0 mmol/l (n = 129). G2 patients had higher values of AG (mean (SD), 9.6 (4.3) vs 6.8 (3.2) mEq/l; P <0.001) and lower BE (median [interquartile range (IQR)], -0.7 [-3.9;0.8] vs 1.0 [-0.2;2.4] mEq/l; P <0.001). In-hospital non-survivors had higher values of lactates (4.0 [2.0;8.7] vs 1.7 [1.3;2.4] mmol/l; P <0.001), AG (10.5 (4.6) vs 7.7 (3.8) mEq/l; P <0.001) and lower BE (-4.8 [-10.6;-1.8] vs 1.5 [-0.8;2.3] mEq/l; P <0.001) compared to survivors. Lactates, AG and BE correlated with GRACE score (r = 0.361; P <0.001, r = 0.158; P = 0.004, r = -0.383; P <0.001, respectively). Only BE independently predicted both 30- and 365-days mortality in whole group (HR 0.79, 95%CI 0.65-0.95; P = 0.01, HR 0.89, 95%CI 0.76-0.99; P = 0.04, respectively) as well as in-hospital mortality among patients without infarct-related out-of-hospital cardiac arrest (OR 0.74, 95%CI 0.57-0.97; P = 0.03).

CONCLUSIONS

In patients admitted to ED with MI treated with PCI the evaluation of PVA-BP assessed in POCT analyzers may be a reliable tool for early risk stratification.

Risk Stratification by Cross-Classification of Central and Brachial Systolic Blood Pressure

BACKGROUND

Whether cardiovascular risk is more tightly associated with central (cSBP) than brachial (bSBP) systolic pressure remains debated, because of their close correlation and uncertain thresholds to differentiate cSBP into normotension versus hypertension.

METHODS

In a person-level meta-analysis of the International Database of Central Arterial Properties for Risk Stratification (n=5576; 54.1% women; mean age 54.2 years), outcome-driven thresholds for cSBP were determined and whether the cross-classification of cSBP and bSBP improved risk stratification was explored. cSBP was tonometrically estimated from the radial pulse wave using SphygmoCor software.

RESULTS

Over 4.1 years (median), 255 composite cardiovascular end points occurred. In multivariable bootstrapped analyses, cSBP thresholds (in mm Hg) of 110.5 (95% CI, 109.1-111.8), 120.2 (119.4-121.0), 130.0 (129.6-130.3), and 149.5 (148.4-150.5) generated 5-year cardiovascular risks equivalent to the American College of Cardiology/American Heart Association bSBP thresholds of 120, 130, 140, and 160. Applying 120/130 mm Hg as cSBP/bSBP thresholds delineated concordant central and brachial normotension (43.1%) and hypertension (48.2%) versus isolated brachial hypertension (5.0%) and isolated central hypertension (3.7%). With concordant normotension as reference, the multivariable hazard ratios for the cardiovascular end point were 1.30 (95% CI, 0.58-2.94) for isolated brachial hypertension, 2.28 (1.21-4.30) for isolated central hypertension, and 2.02 (1.41-2.91) for concordant hypertension. The increased cardiovascular risk associated with isolated central and concordant hypertension was paralleled by cerebrovascular end points with hazard ratios of 3.71 (1.37-10.06) and 2.60 (1.35-5.00), respectively.

CONCLUSIONS

Irrespective of the brachial blood pressure status, central hypertension increased cardiovascular and cerebrovascular risk indicating the importance of controlling central hypertension.

Blood Pressure and Arterial Stiffness in Association With Aircraft Noise Exposure: Long-Term Observation and Potential Effect of COVID-19 Lockdown

Supplemental Digital Content is available in the text.

In a cross-sectional analysis of a case-control study in 2015, we revealed the association between increased arterial stiffness (pulse wave velocity) and aircraft noise exposure. In June 2020, we evaluated the long-term effects, and the impact of a sudden decline in noise exposure during the coronavirus disease 2019 (COVID-19) lockdown, on blood pressure and pulse wave velocity, comparing 74 participants exposed to long-term day-evening-night aircraft noise level >60 dB and 75 unexposed individuals. During the 5-year follow-up, the prevalence of hypertension increased in the exposed (42% versus 59%, P=0.048) but not in the unexposed group. The decline in noise exposure since April 2020 was accompanied with a significant decrease of noise annoyance, 24-hour systolic (121.2 versus 117.9 mm Hg; P=0.034) and diastolic (75.1 versus 72.0 mm Hg; P=0.003) blood pressure, and pulse wave velocity (10.2 versus 8.8 m/s; P=0.001) in the exposed group. Less profound decreases of these parameters were noticed in the unexposed group. Significant between group differences were observed for declines in office and night-time diastolic blood pressure and pulse wave velocity. Importantly, the difference in the reduction of pulse wave velocity between exposed and unexposed participants remained significant after adjustment for covariates (−1.49 versus −0.35 m/s; P=0.017). The observed difference in insomnia prevalence between exposed and unexposed individuals at baseline was no more significant at follow-up. Thus, long-term aircraft noise exposure may increase the prevalence of hypertension and accelerate arterial stiffening. However, even short-term noise reduction, as experienced during the COVID-19 lockdown, may reverse those unfavorable effects.

Ventricular-arterial coupling changes as an early predictor of left ventricular remodelling in atrial fibrillation

Objective

Atrial fibrillation (AF) can be associated with adverse atrial and ventricular remodelling also in the absence of persistently elevated heart rate. Ventricular–arterial coupling (VAC) plays a pivotal role in cardiac and aortic adaptation to pathophysiological conditions. The aim of this study was to investigate changes in conventional and novel VAC indexes in long lasting paroxysmal AF.

Methods

Participants with paroxysmal AF, in sinus rhythm on admission, with preserved left ventricle (LV) systolic function and carotid – femoral pulse wave velocity (PWV) within normal range were carefully selected from consecutive patients admitted to University Hospital in Krakow for scheduled AF ablation. We excluded those with established coronary artery disease, moderate or severe heart valves disease, with uncontrolled hypertension or other comorbidities. The anthropometric and demographic data, medical history, and habits were collected using standardized questionnaire. A total of 51 (mean age 57.7 yrs; 37 men) patients underwent simultaneous echocardiographic and arterial data acquisition. End-systolic pressure was determined from central pulse wave analyses. Arterial elastance (Ea) and LV elastance (Ees) were calculated as end-systolic pressure/stroke volume and end-systolic pressure/end-systolic volume. Two-dimensional speckle tracking was used to derive LV global longitudinal strain (GLS), and then PWV to GLS ratio was calculated.

Results

Patient presented moderate (EHRA class median = 2b) and long-lasting symptoms (median of AF history 3 years). There was an association of Ees (parameter estimate (PE) 0.12; P=0.0004) and VAC (Ea/Ees) (PE=−0.13; P=0.33) with duration of AF history in the univariate linear regression model and this association retain statistically significant in a model including age, sex, history of hypertension and hypercholesterolemia. Longer history of AF was related to lower PWV to GLS ratio, however this association reached statistical significance only among patients with AF lasting more than 3 years (PE=−0.14; P=0.024) and persisted significant after accounting for covariates.

Conclusion

The relationship between AF and LV dysfunction is complex and potentially bi-directional. Paroxysmal AF however, can contribute to abnormality in heart–vessel coupling, even when LV function remained within the normal range, indicating early stage of ventricular remodelling due to arrythmia.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Collegium Medicum, Jagiellonian University, Krakow

Comparison of six risk scores for the prediction of atrial fibrillation recurrence after cryoballoon-based ablation and development of a simplified method, the 0-1-2 PL score

INTRODUCTION

There are several prognostic scores for the assessment of risk of atrial fibrillation (AF) recurrence post ablation procedure. However, the use of these complex scores is difficult and the validation on different populations brought divergent results. Our goal was to compare the performance of these risk scores as the basis for the development of a new, simplified score based only on few universally predictive variables.

METHODS

All cryoballoon-based AF ablations performed in a single-center over a 10-year period were prospectively analyzed with regard to AF recurrence. This served to analyze the performance of APPLE, CAAP-AF, SCALE-CryoAF, MB-LATER, CHADS2, and CHA2DS2-VASc risk scores.

RESULTS

A total of 597 patients, mostly (78.1%) with paroxysmal AF were studied. Analyzed risk scores performed poorer than in the original publications because some risk factors were not predictive of AF recurrence. A simplified score named 0-1-2 PL, composed of just two universally predictive variables, AF type (1 point for Persistent AF) and LA dimension (1 point for LA size >45 mm) was developed. The 0-1-2 PL score stratified patients into low risk (0 points), intermediate risk (1 point), and high risk categories (2 points) which were related to a 2-year risk of AF recurrence of 21%, 37%, and 55%, respectively. This score had C-statistics (0.620) higher/comparable to other investigated much more complex scores.

CONCLUSION

The assessment of risk of AF recurrence at the pre-ablation stage can be simplified without compromising accuracy. This could help to popularize risk assessment and standardization of AF management.

Impact of acute total occlusion of the culprit artery on outcome in NSTEMI based on the results of a large national registry

BACKGROUND

The impact of acute total occlusion (TO) of the culprit artery in non-ST-segment elevation myocardial infarction (NSTEMI) is not fully established. We aimed to evaluate the clinical and angiographic phenotype and outcome of NSTEMI patients with TO (NSTEMI_TO) compared to NSTEMI patients without TO (NSTEMI_NTO) and those with ST-segment elevation and TO (STEMI_TO).

METHODS

Demographic, clinical and procedure-related data of patients with acute myocardial infarction who underwent percutaneous coronary intervention (PCI) between 2014 and 2017 from the Polish National Registry were analysed.

RESULTS

We evaluated 131,729 patients: NSTEMI_NTO (n = 65,206), NSTEMI_TO (n = 16,209) and STEMI_TO (n = 50,314). The NSTEMI_TO group had intermediate results compared to the NSTEMI_NTO and STEMI_TO groups regarding mean age (68.78 ± 11.39 vs 65.98 ± 11.61 vs 64.86 ± 12.04 (years), p < 0.0001), Killip class IV on admission (1.69 vs 2.48 vs 5.03 (%), p < 0.0001), cardiac arrest before admission (2.19 vs 3.09 vs 6.02 (%), p < 0.0001) and death during PCI (0.43 vs 0.97 vs 1.76 (%), p < 0.0001)-for NSTEMI_NTO, NSTEMI_TO and STEMI_TO, respectively. However, we noticed that the NSTEMI_TO group had the longest time from pain to first medical contact (median 4.0 vs 5.0 vs 2.0 (hours), p < 0.0001) and the lowest frequency of TIMI flow grade 3 after PCI (88.61 vs 83.36 vs 95.57 (%), p < 0.0001) and that the left circumflex artery (LCx) was most often the culprit lesion (14.09 vs 35.86 vs 25.42 (%), p < 0.0001).

CONCLUSIONS

The NSTEMI_TO group clearly differed from the NSTEMI_NTO group. NSTEMI_TO appears to be an intermediate condition between NSTEMI_NTO and STEMI_TO, although NSTEMI_TO patients have the longest time delay to and the worst result of PCI, which can be explained by the location of the culprit lesion in the LCx.

Patent foramen ovale and left atrial appendage flow velocity predict atrial fibrillation recurrence post cryoballoon ablation

BACKGROUND

Transesophageal echocardiography (TEE) allows detailed characterization of atrial fibrillation (AF) substrate and could be valuable for predicting pulmonary vein isolation (PVI) procedure outcomes.

AIMS

We aimed to assess the value of TEE-derived left atrial (LA) and LA appendage (LAA) features as prognostic markers for AF recurrence after cryoballoon-based ablation.

METHODS

Patients were enrolled using prospective database of consecutive PVI procedures performed over a 7-year period. Following TEE-derived parameters were investigated: LAA emptying flow velocity (LAA-FV), presence of patent foramen ovale (PFO), LA spontaneous echo contrast and mitral regurgitation. Diagnosis of AF recurrence was based on scheduled and symptoms triggered ECG monitoring. Cox's regression model and Kaplan-Meier survival curves were applied for statistical analysis.

RESULTS

A total of 417 consecutive patients who underwent their first PVI using cryoballoon were analysed (mean age: 59 years). AF recurrence was noted in 25.7 % of patients (median follow-up of 24 months). Four TEE-derived variables had predictive value for AF recurrence: LAA-FV < 45 cm/s, presence of PFO at resting state, LA spontaneous echo contrast and mitral regurgitation. In the multivariable model, apart from the transthoracic echocardiography-derived LA size, two TEE-derived features (LAA-FV < 45 cm/s and presence of PFO) remained as independent predictors.

CONCLUSIONS

This study proposed a novel TEE-derived AF recurrence risk factor - presence of PFO and confirmed the prognostic value of LAA flow velocity in patients undergoing cryoballoon-based AF ablation. These risk factors could be useful in global assessment of AF recurrence risk and potentially helpful in planning the ablation strategy.

Association between cardiovascular disease, cardiovascular drug therapy, and in-hospital outcomes in patients with COVID-19: data from a large single-center registry in Poland

BACKGROUND

COVID-19 recently became one of the leading causes of death worldwide, similar to cardiovascular disease (CVD). Coexisting CVD may influence the prognosis of patients with COVID-19.

AIMS

To analyze the impact of CVD and use of cardiovascular drugs on the in-hospital course and mortality of patients with COVID-19.

METHODS

We retrospectively studied data for consecutive patients admitted to our hospital, with COVID-19 between March 6th and October 15th, 2020.

RESULTS

1729 patients (median (Q1 - Q3) age 63 (50-75) years; women 48.8%) were included. Overall, in-hospital mortality was 12.9%. The most prevalent CVD was arterial hypertension (56.1%), followed by hyperlipidemia (27.4%), diabetes mellitus (DM) (25.7%), coronary artery disease (16.8%), heart failure (HF) (10.3%), atrial fibrillation (13.5%), and stroke (8%). Angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) were used in 25.0% of patients, β-blockers in 40.7%, statins in 15.6%, and antiplatelet therapy in 19.9%. Age over 65 years (odds ratio [OR] 6.4, 95% CI 4.3-9.6), male sex (OR 1.4, 95% CI 1.1-2.0), pre-existing DM (OR 1.5, 95% CI 1.1-2.1), and HF (OR 2.3, 95% CI 1.5-3.5) were independent predictors of in-hospital death, whereas treatment with ACEIs/ARBs (OR 0.4, 95% CI 0.3-0.6), β-blockers (OR 0.6, 95% CI 0.4-0.9), statins (OR 0.5, 95% CI 0.3-0.8), or antiplatelet therapy (OR 0.6, 95% CI 0.4-0.9) was associated with lower risk of death.

CONCLUSION

Among cardiovascular risk factors and diseases, HF and DM appeared to increase in-hospital COVID-19 mortality, whereas the use of cardiovascular drugs was associated with lower mortality.

The relation of nocturnal exposure to aircraft noise and aircraft noise-induced insomnia with blood pressure

INTRODUCTION

Nighttime environmental noise exposure leads to unconscious stress reactions and autonomic arousals. These may disturb overnight sleep and the diurnal blood pressure (BP) profile, contributing to an increased risk of developing hypertension.

OBJECTIVES

This study aimed to investigate the effects of chronic nighttime exposure to aviation noise on sleep disturbances and the relationship with annoyance and the BP profile.

PATIENTS AND METHODS

Based on acoustic maps, we selected 2 groups of normotensive participants: exposed (n = 48; mean age, 50.9 years; 29 women) and unexposed (n = 50; mean age, 49.7 years; 35 women) to nocturnal aircraft noise. We collected anthropometric and demographic data using a standardized questionnaire. Insomnia symptoms were evaluated using the Athens Insomnia Scale (AIS). In both study groups, we performed office BP measurements and 24‑hour ambulatory BP monitoring.

RESULTS

Noise‑exposed participants showed distinctive sleep disturbances, higher AIS scores (4.3 vs 2.3; P = 0.01), and an increased insomnia risk (odds ratio, 2.62; P = 0.046). With increased noise annoyance, a higher AIS score was observed (PANOVA = 0.02). Noise‑exposed individuals had higher diastolic BP at night than those unexposed (64.6 mm Hg vs 61.7 mm Hg; P = 0.03). Insomnia among noise‑exposed participants resulted in higher 24‑hour (115.2 mm Hg vs 122.2 mm Hg; P = 0.03) and nighttime (103.7 mm Hg vs 112.2 mm Hg; P = 0.02) systolic BP. A significant interaction was noted between aircraft noise exposure and the AIS score. The association of the AIS score with 24‑hour systolic BP (P = 0.048) and pulse pressure (P = 0.04) was stronger in the exposed group.

CONCLUSIONS

The study results may indicate different pathomechanisms affecting BP in terms of nighttime noise and noise‑related insomnia.

Patent foramen ovale and left atrial appendage flow velocity predict atrial fibrillation recurrence post cryoballoon ablation

BACKGROUND

Transesophageal echocardiography (TEE) allows detailed characterization of atrial fibrillation (AF) substrate and could be valuable for predicting pulmonary vein isolation (PVI) procedure outcomes.

AIMS

We aimed at assessing the value of TEE-derived left atrial (LA) and LA appendage (LAA) features as prognostic markers for AF recurrence after cryoballoon-based ablation.

METHODS

Patients were enrolled using a prospective database of consecutive PVI procedures performed over a 7-year period. The following TEE-derived parameters were investigated: LAA emptying flow velocity (LAA-FV), the presence of patent foramen ovale (PFO), LA spontaneous echo contrast, and mitral regurgitation. Diagnosis of AF recurrence was based on scheduled and symptoms triggered ECG monitoring. The Cox's regression model and Kaplan-Meier survival curves were applied for statistical analysis.

RESULTS

A total of 417 consecutive patients who underwent their first PVI using cryoballoon were analyzed (mean age: 59 years). AF recurrence was noted in 25.7% of patients (median follow-up of 24 months). Four TEE-derived variables had predictive values for AF recurrence: LAA-FV <45 cm/s, presence of PFO at resting state, LA spontaneous echo contrast, and mitral regurgitation. In the multivariable model, apart from the transthoracic echocardiography-derived LA size, two TEE-derived features (LAA-FV <45 cm/s and the presence of PFO) remained as independent predictors.

CONCLUSIONS

This study proposed a novel TEE-derived AF recurrence risk factor - the presence of PFO - and confirmed the prognostic value of LAA flow velocity in patients undergoing cryoballoon-based AF ablation. These risk factors could be useful in the global assessment of AF recurrence risk and potentially helpful in planning the ablation strategy.

Plasma renin activity, serum aldosterone concentration and selected organ damage indices in essential arterial hypertension

INTRODUCTION

The aim of this study was to assess the relations between plasma renin activity (PRA), serum aldosterone concentration (ALDO) and selected asymptomatic organ damage (AOD) indices in mild primary arterial hypertension (AH).

MATERIAL AND METHODS

We measured PRA, ALDO, and selected AOD indices (carotid-femoral pulse wave velocity (cfPWV), central aortic pulse pressure (cPP), estimated glomerular filtration rate (eGFR)) in 122 patients with untreated AH.

RESULTS

Patients with high PRA (≥ 0.65 ng/ml/h) were characterized by lower plasma sodium and aldosterone to renin ratio (ARR), higher ALDO, but a similar level of AOD indices compared to patients with low PRA. cfPWV (p = 0.04) and cPP (p = 0.019) increased with ARR, while eGFR decreased with ALDO (p = 0.008). Only eGFR was independently correlated with ALDO. In subjects with simultaneously high PRA and ARR values, we found significantly higher cfPWV (p = 0.02) and cPP (p = 0.04) and lower eGFR (p = 0.02) than in those with high PRA but low ARR values.

CONCLUSIONS

Assessment of the influence of the renin-angiotensin-aldosterone system (RAAS) on AOD should include the relationship between renin and aldosterone. The PRA itself has no predictive value for AOD. More advanced arterial stiffness and renal impairment are associated with increased PRA and ARR. The RAAS activity might be useful in AOD prediction and hypertension severity assessment.

Cardiovascular End Points and Mortality Are Not Closer Associated With Central Than Peripheral Pulsatile Blood Pressure Components

Supplemental Digital Content is available in the text.

Pulsatile blood pressure (BP) confers cardiovascular risk. Whether associations of cardiovascular end points are tighter for central systolic BP (cSBP) than peripheral systolic BP (pSBP) or central pulse pressure (cPP) than peripheral pulse pressure (pPP) is uncertain. Among 5608 participants (54.1% women; mean age, 54.2 years) enrolled in nine studies, median follow-up was 4.1 years. cSBP and cPP, estimated tonometrically from the radial waveform, averaged 123.7 and 42.5 mm Hg, and pSBP and pPP 134.1 and 53.9 mm Hg. The primary composite cardiovascular end point occurred in 255 participants (4.5%). Across fourths of the cPP distribution, rates increased exponentially (4.1, 5.0, 7.3, and 22.0 per 1000 person-years) with comparable estimates for cSBP, pSBP, and pPP. The multivariable-adjusted hazard ratios, expressing the risk per 1-SD increment in BP, were 1.50 (95% CI, 1.33–1.70) for cSBP, 1.36 (95% CI, 1.19–1.54) for cPP, 1.49 (95% CI, 1.33–1.67) for pSBP, and 1.34 (95% CI, 1.19–1.51) for pPP (P<0.001). Further adjustment of cSBP and cPP, respectively, for pSBP and pPP, and vice versa, removed the significance of all hazard ratios. Adding cSBP, cPP, pSBP, pPP to a base model including covariables increased the model fit (P<0.001) with generalized R² increments ranging from 0.37% to 0.74% but adding a second BP to a model including already one did not. Analyses of the secondary end points, including total mortality (204 deaths), coronary end points (109) and strokes (89), and various sensitivity analyses produced consistent results. In conclusion, associations of the primary and secondary end points with SBP and pulse pressure were not stronger if BP was measured centrally compared with peripherally.

Selected matrix metalloproteinases activity and hypertension-mediated organ damage in relation to uric acid serum level

BACKGROUND

Atherosclerosis is as a systemic inflammatory disease associated with the activation of many mediators, including matrix metalloproteinases (MMPs), and may be amplified by abnormal high serum uric acid (UA) concentration (hyperuricemia, HU). The aim of the study was to determine the relationship between serum UA concentration and activity of MMPs and their correlation with the hypertension-mediated organ damage (HMOD) intensity.

METHODS

109 patients untreated with antihypertensive, hypolipemic or urate-lowering drugs with diagnosed stage 1-2 essential hypertension were included in this study. In all participants blood pressure (BP) was measured, carotid-femoral pulse wave velocity (PWV), intima-media thickness (IMT), echocardiography and blood tests including UA, lipids and serum concentrations of MMPs (1, 2, 3, 9) were observed. The participants were divided into hyper- and normuricemic groups.

RESULTS

Uric acid concentration in the whole study group positively correlated with some HMOD parameters (IMT, PWV, left ventricular mass index, left atrial dimension). Among the studied metalloproteinases only MMP-3 activity positively correlated with serum UA concentration independently of age, body mass index and serum lipids (R2 = 0.11, p = 0.048). Multivariate regression analysis showed positive association between IMT and BP, UA concentration and MMP-3 activity, independently of waist circumference and serum lipids (R2 = 0.328, p < 0.002). Patients with HU were characterized by higher activity of MMP-3 than those without (19.41 [14.45; 21.74] vs. 13.98 [9.52; 18.97] ng/mL, p = 0.016).

CONCLUSIONS

The present results may support the thesis that UA and the increased by UA activity of MMPs may take part in the development of HMOD, especially IMT.

The relationship between plasma renin activity and serum lipid profiles in patients with primary arterial hypertension

Introduction:

The aim of the study was to evaluate clinical and biochemical differences between patients with low-renin and high-renin primary arterial hypertension (AH), mainly in reference to serum lipids, and to identify factors determining lipid concentrations.

Materials and methods:

In untreated patients with AH stage 1 we measured plasma renin activity (PRA) and subdivided the group into low-renin (PRA < 0.65 ng/mL/h) and high-renin (PRA ⩾ 0.65 ng/mL/h) AH. We compared office and 24-h ambulatory blood pressure, serum aldosterone, lipids and selected biochemical parameters between subgroups. Factors determining lipid concentration in both subgroups were assessed in regression analysis.

Results:

Patients with high-renin hypertension (N = 58) were characterized by higher heart rate (p = 0.04), lower serum sodium (p < 0.01) and aldosterone-to-renin ratio (p < 0.01), and significantly higher serum aldosterone (p = 0.03), albumin (p < 0.01), total protein (p < 0.01), total cholesterol (p = 0.01) and low-density lipoprotein cholesterol (LDL-C) (p = 0.04) than low-renin subjects (N = 39). In univariate linear regression, only PRA in the low-renin group was in a positive relationship with LDL-C (R² = 0.15, β = 1.53 and p = 0.013); this association remained significant after adjustment for age, sex, and serum albumin and aldosterone concentrations.

Conclusions:

Higher serum levels of total and LDL-C characterized high-renin subjects, but the association between LDL-C level and PRA existed only in low-renin primary AH.

The relation between blood pressure components and left atrial volume in the context of left ventricular mass index

Left atrial enlargement (LAE) is a risk factor for cardiovascular complications and death. In hypertensive patients, LAE is usually due to left ventricular (LV) hypertrophy and diastolic dysfunction. We aimed to identify factors associated with LAE in patients with increased and normal left ventricular mass index (LVMI) with reference to pulsatile and steady components of blood pressure (BP).The study was carried out as a cross-sectional observation. In a group of inhabitants of suburban area of Cracow, Poland, we measured office, ambulatory and central BP, carotid-femoral pulse wave velocity (PWV), as well as echocardiographic indices and gathered anthropometric data, information on habits and relevant medical history. Further, with division according to sex-stratified dichotomised LVMI, we performed correlation analysis to identify possibly significant relations between measures of left atrial volume and other studied parameters. We also fitted regression models in order to assess the respective value of steady and pulsatile BP components as factors related to measures of left atrial volume.The mean age of 205 patients (136 females-66%) was 53.6 ± 8.3 years. We found higher values of PWV, office, ambulatory and central BPs in the group of LVMI above median value. This group had also greater left atrial volume index (LAVI), which correlated with LVMI (r = 0.36, P < .001) and ratio of early diastolic mitral peak flow velocity to early diastolic mitral annulus mean velocity in tissue Doppler imaging (E/e') (r = 0.24, P = .04).In the group of LVMI below the median, LAVI correlated with pulsatile and steady BP components. LAVI was independently predicted by mean arterial pressure (MAP) obtained from both ambulatory (MAP24h, β= 0.15; P = .045) and office measurements (MAPoffice, β = 0.35; P = .004), but not by pulse pressure.LV mass and function are the main determinants of LAVI. However, in persons with lower LV mass, LAVI depends on the steady component of blood pressure, but not pulsatile one. Increased LAVI reflects early changes in response to systemic blood pressure elevation.

The effect of antihypertensive treatment on arterial stiffness and serum concentration of selected matrix metalloproteinases

INTRODUCTION

The aim of the study was to assess the arterial stiffness and serum levels of selected metalloproteinases (MMPs) in hypertensive patients and their changes following antihypertensive therapy.

MATERIAL AND METHODS

The study group consisted of 95 patients with essential arterial hypertension (HT) stage 1 or 2 (mean age: 53.1 ±13.0 years). The control group consisted of 31 normotensives of the same age range. Hypertension patients were randomized to one of the following monotherapies for 6 months: quinapril, losartan, amlodipine, hydrochlorothiazide or bisoprolol. Carotid-femoral pulse wave velocity (PWV) was measured using a Complior device. Serum concentrations of MMPs (proMMP-1, MMP-2, MMP-3, MMP-9) and plasma concentration of tissue inhibitor of MMPs (TIMP-1) were measured using ELISA.

RESULTS

Pulse wave velocity and serum concentrations of MMP-2 and MMP-9 were higher in HT patients than in the control group. In HT patients PWV was significantly associated (R² = 0.41) with age (B = 0.408, p = 0.00027), systolic blood pressure (SBP) (B = 0.441, p = 0.0011), and MMP-3 (B = 0.204, p = 0.0459). After 6 months of treatment, regardless of the agent used, we observed a significant decrease of PWV, SBP, MMP-2 and MMP-3 and an increase of TIMP-1 plasma concentration. The decrease of PWV was significantly associated with a decrease of SBP (R² = 0.07, B = 0.260, p = 0.015) only.

CONCLUSIONS

In patients with arterial hypertension, beside age and systolic blood pressure, the determinants of arterial stiffness include serum MMP-3 concentration. For drugs compared in the study with the same hypotensive effect obtained, the arterial stiffness reduction effect is not dependent on the drug used. Systolic blood pressure is one of the independent factors responsible for the reduction of arterial stiffness in the course of antihypertensive treatment.

Echocardiographic assessment of right ventricular function in responders and non-responders to cardiac resynchronization therapy

INTRODUCTION

The aim of this study was to determine whether baseline right ventricular (RV) function assessed by standard echocardiography may indicate patients who will respond to cardiac resynchronization therapy (CRT).

MATERIAL AND METHODS

The data of 57 patients (54 men, 95%), aged 66.4 ±8.7 years with heart failure (HF) having a CRT device implanted were collected. All patients had left ventricular ejection fraction (LVEF) ≤ 35% and QRS complex duration ≥ 120 ms. Echocardiographic examination with tissue Doppler imaging techniques and complex RV evaluation were performed at baseline and three months after CRT onset.

RESULTS

Three months after CRT implantation, patients responding to CRT, defined as a reduction of left ventricle end-systolic volume (LVESV) of at least 10% (n = 34), compared to patients with a reduction of LVESV of less than 10% (n = 23), had at baseline a smaller right atrium diameter (47.85 ±11.33 mm vs. 52.65 ±8.69 mm; p = 0.028), higher TAPSE (14.56 ±2.57 mm vs. 13.04 ±2.93 mm; p = 0.030) and lower grade of tricuspid valve regurgitation (1.82 ±0.97 vs. 2.3 ±0.88; p = 0.033).

CONCLUSIONS

This study showed that there are differences in baseline right ventricular function between responders and non-responders to CRT. Yet in our study, none of the baseline RV parameters provided any value in identifying patients who would respond to CRT.