Michael Miller, Deepak L Bhatt, Eliot A Brinton, Terry A Jacobson, Ph Gabriel Steg, Armando Lira Pineda, Steven B Ketchum, Ralph T Doyle, Jean-Claude Tardif, Christie M Ballantyne
Abstract Introduction Metabolic Syndrome (MetSyn) is associated with high risk of cardiovascular (CV) events, irrespective of statin therapy. In the overall REDUCE-IT study of statin-treated patients, icosapent ethyl (IPE) reduced the risk of the primary composite endpoint (CV death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina requiring hospitalization) and the key secondary composite endpoint (CV death, nonfatal myocardial infarction, or nonfatal stroke). Methods REDUCE-IT was an international, double-blind trial that randomized 8179 high CV risk statin-treated patients with controlled low density lipoprotein cholesterol (LDL-C), and elevated triglycerides, to IPE 4 grams/day or placebo. The current study evaluated the prespecified patient subgroup with a history of MetSyn, but without diabetes at baseline. Results Among patients with MetSyn but without diabetes at baseline (n=2866), the majority (99.8%) of this subgroup were secondary prevention patients. IPE use was associated with a 29% relative risk reduction for the first occurrence of the primary composite endpoint (hazard ratio [HR], 0.71 [95% CI, 0.59-0.84]; P <0.0001, absolute risk reduction [ARR]=5.9%; number needed to treat [NNT]=17) and 41% reduction in total (first plus subsequent) events (rate ratio [RR], 0.59 [95% CI, 0.48-0.72]; P <0.0001) compared with placebo. The risk for the key secondary composite endpoint was reduced by 20% (P=0.05) and a 27% reduction in fatal/nonfatal MI (P=0.03), 47% reduction in urgent/emergent revascularization (P <0.0001) and 58% reduction in hospitalization for unstable angina (P <0.0001). Non-statistically significant reductions were observed in cardiac arrest (44%) and sudden cardiac death (34%). Conclusion(s) In statin-treated patients with a history of MetSyn, IPE significantly reduced the risk of first and total CV events in REDUCE-IT. The large relative and absolute risk reductions observed supports IPE as a potential therapeutic consideration for patients with MetSyn at high CV risk.
{"title":"Effectiveness of Icosapent Ethyl on First and Total Cardiovascular Events in Patients with Metabolic Syndrome, but without Diabetes: REDUCE-IT MetSyn","authors":"Michael Miller, Deepak L Bhatt, Eliot A Brinton, Terry A Jacobson, Ph Gabriel Steg, Armando Lira Pineda, Steven B Ketchum, Ralph T Doyle, Jean-Claude Tardif, Christie M Ballantyne","doi":"10.1093/ehjopen/oead114","DOIUrl":"https://doi.org/10.1093/ehjopen/oead114","url":null,"abstract":"Abstract Introduction Metabolic Syndrome (MetSyn) is associated with high risk of cardiovascular (CV) events, irrespective of statin therapy. In the overall REDUCE-IT study of statin-treated patients, icosapent ethyl (IPE) reduced the risk of the primary composite endpoint (CV death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina requiring hospitalization) and the key secondary composite endpoint (CV death, nonfatal myocardial infarction, or nonfatal stroke). Methods REDUCE-IT was an international, double-blind trial that randomized 8179 high CV risk statin-treated patients with controlled low density lipoprotein cholesterol (LDL-C), and elevated triglycerides, to IPE 4 grams/day or placebo. The current study evaluated the prespecified patient subgroup with a history of MetSyn, but without diabetes at baseline. Results Among patients with MetSyn but without diabetes at baseline (n=2866), the majority (99.8%) of this subgroup were secondary prevention patients. IPE use was associated with a 29% relative risk reduction for the first occurrence of the primary composite endpoint (hazard ratio [HR], 0.71 [95% CI, 0.59-0.84]; P &lt;0.0001, absolute risk reduction [ARR]=5.9%; number needed to treat [NNT]=17) and 41% reduction in total (first plus subsequent) events (rate ratio [RR], 0.59 [95% CI, 0.48-0.72]; P &lt;0.0001) compared with placebo. The risk for the key secondary composite endpoint was reduced by 20% (P=0.05) and a 27% reduction in fatal/nonfatal MI (P=0.03), 47% reduction in urgent/emergent revascularization (P &lt;0.0001) and 58% reduction in hospitalization for unstable angina (P &lt;0.0001). Non-statistically significant reductions were observed in cardiac arrest (44%) and sudden cardiac death (34%). Conclusion(s) In statin-treated patients with a history of MetSyn, IPE significantly reduced the risk of first and total CV events in REDUCE-IT. The large relative and absolute risk reductions observed supports IPE as a potential therapeutic consideration for patients with MetSyn at high CV risk.","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135037976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Aims To develop an artificial intelligence (AI)-model which enables fully automated accurate quantification of coronary artery calcium (CAC), using deep learning (DL) on electrocardiogram (ECG)-gated non-contrast cardiac computed tomography (gated CCT) images. Methods and Results Retrospectively, 560 gated CCT images (including 60 synthetic images) performed at our institution were used to train AI-model, which can automatically divide heart region into 5 areas belonging to left main (LM), left anterior descending (LAD), circumflex (LCX), right coronary artery (RCA), and other. Total and vessel-specific CAC score (CACS) in each scan were manually evaluated. AI-model was trained with novel Heart-labeling method via DL according to the manual-derived results. Then, another 409 gated CCT images obtained in our institution were used for model validation. The performance of present AI-model was tested using another external cohort of 400 gated CCT images of Stanford Center for Artificial Intelligence of Medical Imaging by comparing with the ground truth. The overall accuracy of the AI-model for total CACS classification was excellent with Cohen’s kappa of k=0.89 and 0.95 (validation and test, respectively), which surpasses previous research of k=0.89. Bland-Altman analysis showed little difference in individual total and vessel-specific CACS between AI-derived CACS and ground truth in test cohort (mean difference [95% confidence interval] were 1.5 [-42.6, 45.6], -1.5 [-100.5, 97.5], 6.6 [-60.2, 73.5], 0.96 [-59.2, 61.1], and 7.6[-134.1, 149.2] for LM, LAD, LCX, RCA, and total CACS, respectively). Conclusion Present Heart-labeling method provides a further improvement in fully automated, total and vessel-specific CAC quantification on gated CCT.
{"title":"Fully Automated Coronary Artery Calcium Quantification on ECG-gated Non-contrast Cardiac CT Using Deep-learning with Novel Heart-labeling Method","authors":"Daigo Takahashi, Shinichiro Fujimoto, Yui O Nozaki, Ayako Kudo, Yuko O Kawaguchi, Kazuhisa Takamura, Makoto Hiki, Eisuke Sato, Nobuo Tomizawa, Hiroyuki Daida, Tohru Minamino","doi":"10.1093/ehjopen/oead113","DOIUrl":"https://doi.org/10.1093/ehjopen/oead113","url":null,"abstract":"Abstract Aims To develop an artificial intelligence (AI)-model which enables fully automated accurate quantification of coronary artery calcium (CAC), using deep learning (DL) on electrocardiogram (ECG)-gated non-contrast cardiac computed tomography (gated CCT) images. Methods and Results Retrospectively, 560 gated CCT images (including 60 synthetic images) performed at our institution were used to train AI-model, which can automatically divide heart region into 5 areas belonging to left main (LM), left anterior descending (LAD), circumflex (LCX), right coronary artery (RCA), and other. Total and vessel-specific CAC score (CACS) in each scan were manually evaluated. AI-model was trained with novel Heart-labeling method via DL according to the manual-derived results. Then, another 409 gated CCT images obtained in our institution were used for model validation. The performance of present AI-model was tested using another external cohort of 400 gated CCT images of Stanford Center for Artificial Intelligence of Medical Imaging by comparing with the ground truth. The overall accuracy of the AI-model for total CACS classification was excellent with Cohen’s kappa of k=0.89 and 0.95 (validation and test, respectively), which surpasses previous research of k=0.89. Bland-Altman analysis showed little difference in individual total and vessel-specific CACS between AI-derived CACS and ground truth in test cohort (mean difference [95% confidence interval] were 1.5 [-42.6, 45.6], -1.5 [-100.5, 97.5], 6.6 [-60.2, 73.5], 0.96 [-59.2, 61.1], and 7.6[-134.1, 149.2] for LM, LAD, LCX, RCA, and total CACS, respectively). Conclusion Present Heart-labeling method provides a further improvement in fully automated, total and vessel-specific CAC quantification on gated CCT.","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135430752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Henrik Almroth, Lars O Karlsson, Carl-Johan Carlhäll, Emmanouil Charitakis
Abstract Aims Atrial fibrillation (AF) hemodynamics is less well studied due to challenges explained by the nature of AF. Until now, no randomized data have been available. This study evaluated hemodynamic variables after AF induction in a randomized setting. Methods and Results Forty-two patients with AF who had been referred for ablation to the University Hospital, Linköping, Sweden, and had no arrhythmias during the four-day screening period were randomized to AF induction versus control (2:1). AF was induced by burst pacing after baseline intracardiac pressure measurements. Pressure changes in the right and left atrium (RA and LA), right ventricle (RV), and systolic and diastolic blood pressures (SBP and DBP) were evaluated 30 minutes after AF induction compared to the control group. Eleven women and 31 men (median age 60) with similar baseline characteristics were included (intervention n=27, control group n=15). After 30 minutes in AF, the RV end-diastolic pressure (RVEDP) and RV systolic pressure (RVSP) were significantly reduced compared with baseline and between randomization groups (RVEDP: P=0.016; RVSP: P=0.001). AF induction increased DBP in the intervention group compared to the control group (P=0.02), unlike reactions in SBP (P=0.178). RA and LA mean pressure (RAm and LAm) responses did not differ significantly between groups (RAm: P=0.307 LAm: P=0.784). Conclusions Induced AF increased DBP, decreased RVEDP, and RVSP. Our results allow us to understand some paroxysmal AF hemodynamics, which provides a hemodynamical rationale to support rhythm regulatory strategies to improve symptoms and outcomes. Trial registration number (clinicaltrials.gov): No NCT01553045 https://clinicaltrials.gov/ct2/show/NCT01553045?term=NCT01553045&rank=1
心房颤动(AF)的血流动力学研究较少，这是由于房颤的性质所带来的挑战。到目前为止，还没有随机数据。本研究在随机设置中评估房颤诱导后的血流动力学变量。方法和结果42例转诊至瑞典Linköping大学医院接受消融术治疗的房颤患者，在4天的筛查期间无心律失常，随机分为房颤诱导组和对照组(2:1)。房颤是在基线心内压测量后由爆发性起搏引起的。在房颤诱导30分钟后，与对照组比较，评估左、右心房(RA和LA)、右心室(RV)、收缩压和舒张压(SBP和DBP)的压力变化。纳入基线特征相似的11名女性和31名男性(中位年龄60岁)(干预组n=27，对照组n=15)。房颤30分钟后，左室舒张末压(RVEDP)和右室收缩压(RVSP)较基线和随机分组间显著降低(RVEDP: P=0.016;RVSP: P = 0.001)。与对照组相比，AF诱导干预组舒张压升高(P=0.02)，与收缩压升高(P=0.178)不同。RA和LA的平均压力(RAm和LAm)反应在组间无显著差异(RAm: P=0.307 LAm: P=0.784)。结论AF诱发DBP升高，RVEDP和RVSP降低。我们的研究结果使我们能够理解一些阵发性房颤的血流动力学，这为支持心律调节策略以改善症状和结果提供了血流动力学基础。试验注册号(clinicaltrials.gov): No NCT01553045 https://clinicaltrials.gov/ct2/show/NCT01553045?term=NCT01553045&rank=1
{"title":"Hemodynamic changes after atrial fibrillation initiation in patients eligible for catheter ablation: A randomized controlled study","authors":"Henrik Almroth, Lars O Karlsson, Carl-Johan Carlhäll, Emmanouil Charitakis","doi":"10.1093/ehjopen/oead112","DOIUrl":"https://doi.org/10.1093/ehjopen/oead112","url":null,"abstract":"Abstract Aims Atrial fibrillation (AF) hemodynamics is less well studied due to challenges explained by the nature of AF. Until now, no randomized data have been available. This study evaluated hemodynamic variables after AF induction in a randomized setting. Methods and Results Forty-two patients with AF who had been referred for ablation to the University Hospital, Linköping, Sweden, and had no arrhythmias during the four-day screening period were randomized to AF induction versus control (2:1). AF was induced by burst pacing after baseline intracardiac pressure measurements. Pressure changes in the right and left atrium (RA and LA), right ventricle (RV), and systolic and diastolic blood pressures (SBP and DBP) were evaluated 30 minutes after AF induction compared to the control group. Eleven women and 31 men (median age 60) with similar baseline characteristics were included (intervention n=27, control group n=15). After 30 minutes in AF, the RV end-diastolic pressure (RVEDP) and RV systolic pressure (RVSP) were significantly reduced compared with baseline and between randomization groups (RVEDP: P=0.016; RVSP: P=0.001). AF induction increased DBP in the intervention group compared to the control group (P=0.02), unlike reactions in SBP (P=0.178). RA and LA mean pressure (RAm and LAm) responses did not differ significantly between groups (RAm: P=0.307 LAm: P=0.784). Conclusions Induced AF increased DBP, decreased RVEDP, and RVSP. Our results allow us to understand some paroxysmal AF hemodynamics, which provides a hemodynamical rationale to support rhythm regulatory strategies to improve symptoms and outcomes. Trial registration number (clinicaltrials.gov): No NCT01553045 https://clinicaltrials.gov/ct2/show/NCT01553045?term=NCT01553045&rank=1","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135976540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-30eCollection Date: 2023-09-01DOI: 10.1093/ehjopen/oead090
Anantharaman Ramasamy, Hessam Sokooti, Xiaotong Zhang, Evangelia Tzorovili, Retesh Bajaj, Pieter Kitslaar, Alexander Broersen, Rajiv Amersey, Ajay Jain, Mick Ozkor, Johan H C Reiber, Jouke Dijkstra, Patrick W Serruys, James C Moon, Anthony Mathur, Andreas Baumbach, Ryo Torii, Francesca Pugliese, Christos V Bourantas
Aims: Coronary computed tomography angiography (CCTA) is inferior to intravascular imaging in detecting plaque morphology and quantifying plaque burden. We aim to, for the first time, train a deep-learning (DL) methodology for accurate plaque quantification and characterization in CCTA using near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS).
Methods and results: Seventy patients were prospectively recruited who underwent CCTA and NIRS-IVUS imaging. Corresponding cross sections were matched using an in-house developed software, and the estimations of NIRS-IVUS for the lumen, vessel wall borders, and plaque composition were used to train a convolutional neural network in 138 vessels. The performance was evaluated in 48 vessels and compared against the estimations of NIRS-IVUS and the conventional CCTA expert analysis. Sixty-four patients (186 vessels, 22 012 matched cross sections) were included. Deep-learning methodology provided estimations that were closer to NIRS-IVUS compared with the conventional approach for the total atheroma volume (ΔDL-NIRS-IVUS: -37.8 ± 89.0 vs. ΔConv-NIRS-IVUS: 243.3 ± 183.7 mm3, variance ratio: 4.262, P < 0.001) and percentage atheroma volume (-3.34 ± 5.77 vs. 17.20 ± 7.20%, variance ratio: 1.578, P < 0.001). The DL methodology detected lesions more accurately than the conventional approach (Area under the curve (AUC): 0.77 vs. 0.67, P < 0.001) and quantified minimum lumen area (ΔDL-NIRS-IVUS: -0.35 ± 1.81 vs. ΔConv-NIRS-IVUS: 1.37 ± 2.32 mm2, variance ratio: 1.634, P < 0.001), maximum plaque burden (4.33 ± 11.83% vs. 5.77 ± 16.58%, variance ratio: 2.071, P = 0.004), and calcific burden (-51.2 ± 115.1 vs. -54.3 ± 144.4, variance ratio: 2.308, P < 0.001) more accurately than conventional approach. The DL methodology was able to segment a vessel on CCTA in 0.3 s.
Conclusions: The DL methodology developed for CCTA analysis from co-registered NIRS-IVUS and CCTA data enables rapid and accurate assessment of lesion morphology and is superior to expert analysts (Clinicaltrials.gov: NCT03556644).
{"title":"Novel near-infrared spectroscopy-intravascular ultrasound-based deep-learning methodology for accurate coronary computed tomography plaque quantification and characterization.","authors":"Anantharaman Ramasamy, Hessam Sokooti, Xiaotong Zhang, Evangelia Tzorovili, Retesh Bajaj, Pieter Kitslaar, Alexander Broersen, Rajiv Amersey, Ajay Jain, Mick Ozkor, Johan H C Reiber, Jouke Dijkstra, Patrick W Serruys, James C Moon, Anthony Mathur, Andreas Baumbach, Ryo Torii, Francesca Pugliese, Christos V Bourantas","doi":"10.1093/ehjopen/oead090","DOIUrl":"10.1093/ehjopen/oead090","url":null,"abstract":"<p><strong>Aims: </strong>Coronary computed tomography angiography (CCTA) is inferior to intravascular imaging in detecting plaque morphology and quantifying plaque burden. We aim to, for the first time, train a deep-learning (DL) methodology for accurate plaque quantification and characterization in CCTA using near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS).</p><p><strong>Methods and results: </strong>Seventy patients were prospectively recruited who underwent CCTA and NIRS-IVUS imaging. Corresponding cross sections were matched using an in-house developed software, and the estimations of NIRS-IVUS for the lumen, vessel wall borders, and plaque composition were used to train a convolutional neural network in 138 vessels. The performance was evaluated in 48 vessels and compared against the estimations of NIRS-IVUS and the conventional CCTA expert analysis. Sixty-four patients (186 vessels, 22 012 matched cross sections) were included. Deep-learning methodology provided estimations that were closer to NIRS-IVUS compared with the conventional approach for the total atheroma volume (Δ<sub>DL-NIRS-IVUS</sub>: -37.8 ± 89.0 vs. Δ<sub>Conv-NIRS-IVUS</sub>: 243.3 ± 183.7 mm3, variance ratio: 4.262, <i>P</i> < 0.001) and percentage atheroma volume (-3.34 ± 5.77 vs. 17.20 ± 7.20%, variance ratio: 1.578, <i>P</i> < 0.001). The DL methodology detected lesions more accurately than the conventional approach (Area under the curve (AUC): 0.77 vs. 0.67, <i>P</i> < 0.001) and quantified minimum lumen area (Δ<sub>DL-NIRS-IVUS</sub>: -0.35 ± 1.81 vs. Δ<sub>Conv-NIRS-IVUS</sub>: 1.37 ± 2.32 mm<sup>2</sup>, variance ratio: 1.634, <i>P</i> < 0.001), maximum plaque burden (4.33 ± 11.83% vs. 5.77 ± 16.58%, variance ratio: 2.071, <i>P</i> = 0.004), and calcific burden (-51.2 ± 115.1 vs. -54.3 ± 144.4, variance ratio: 2.308, <i>P</i> < 0.001) more accurately than conventional approach. The DL methodology was able to segment a vessel on CCTA in 0.3 s.</p><p><strong>Conclusions: </strong>The DL methodology developed for CCTA analysis from co-registered NIRS-IVUS and CCTA data enables rapid and accurate assessment of lesion morphology and is superior to expert analysts (Clinicaltrials.gov: NCT03556644).</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10615127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71430401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-26eCollection Date: 2023-09-01DOI: 10.1093/ehjopen/oead105
[This corrects the article DOI: 10.1093/ehjopen/oead079.].
[这更正了文章DOI:10.1093/ehjopen/oaed079.]。
{"title":"Corrigendum to: Aortic flow is associated with aging and exercise capacity.","authors":"","doi":"10.1093/ehjopen/oead105","DOIUrl":"https://doi.org/10.1093/ehjopen/oead105","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ehjopen/oead079.].</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71416342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-17eCollection Date: 2023-11-01DOI: 10.1093/ehjopen/oead108
Kazutoshi Hirose, Koki Nakanishi, Marco R Di Tullio, Shunichi Homma, Naoko Sawada, Yuriko Yoshida, Megumi Hirokawa, Katsuhiro Koyama, Koichi Kimura, Tomoko Nakao, Masao Daimon, Hiroyuki Morita, Makoto Kurano, Issei Komuro
Aims: Emerging evidence suggests an association between non-alcoholic fatty liver disease (NAFLD) and heart failure (HF). We investigated the relationship between NAFLD and left ventricular (LV) functional remodelling in a general population sample without overt cardiac and liver disease.
Methods and results: We included 481 individuals without significant alcohol consumption who voluntarily underwent an extensive cardiovascular health check. The fatty liver index (FLI) was calculated for each participant, and NAFLD was defined as FLI ≥ 60. All participants underwent 2D transthoracic echocardiography; LV global longitudinal strain (LVGLS) was assessed with speckle-tracking analysis. Univariable and multivariable linear regression models were constructed to investigate the possible association between NAFLD and LVGLS. Seventy-one (14.8%) participants were diagnosed with NAFLD. Individuals with NAFLD exhibited larger LV size and LV mass index than those without NAFLD, although left atrial size and E/e' ratio did not differ between groups. Left ventricular global longitudinal strain was significantly reduced in participants with vs. without NAFLD (17.1% ± 2.4% vs. 19.5% ± 3.1%, respectively; P < 0.001). The NAFLD group had a significantly higher frequency of abnormal LVGLS (<16%) than the non-NAFLD group (31.0% vs. 10.7%, respectively; P < 0.001). Multivariable linear regression analysis demonstrated that higher FLI score was significantly associated with impaired LVGLS independent of age, sex, conventional cardiovascular risk factors, and echocardiographic parameters (standardized β -0.11, P = 0.031).
Conclusion: In the general population without overt cardiac and liver disease, the presence of NAFLD was significantly associated with subclinical LV dysfunction, which may partly explain the elevated risk of HF in individuals with NAFLD.
{"title":"Association between non-alcoholic fatty liver disease and subclinical left ventricular dysfunction in the general population.","authors":"Kazutoshi Hirose, Koki Nakanishi, Marco R Di Tullio, Shunichi Homma, Naoko Sawada, Yuriko Yoshida, Megumi Hirokawa, Katsuhiro Koyama, Koichi Kimura, Tomoko Nakao, Masao Daimon, Hiroyuki Morita, Makoto Kurano, Issei Komuro","doi":"10.1093/ehjopen/oead108","DOIUrl":"10.1093/ehjopen/oead108","url":null,"abstract":"<p><strong>Aims: </strong>Emerging evidence suggests an association between non-alcoholic fatty liver disease (NAFLD) and heart failure (HF). We investigated the relationship between NAFLD and left ventricular (LV) functional remodelling in a general population sample without overt cardiac and liver disease.</p><p><strong>Methods and results: </strong>We included 481 individuals without significant alcohol consumption who voluntarily underwent an extensive cardiovascular health check. The fatty liver index (FLI) was calculated for each participant, and NAFLD was defined as FLI ≥ 60. All participants underwent 2D transthoracic echocardiography; LV global longitudinal strain (LVGLS) was assessed with speckle-tracking analysis. Univariable and multivariable linear regression models were constructed to investigate the possible association between NAFLD and LVGLS. Seventy-one (14.8%) participants were diagnosed with NAFLD. Individuals with NAFLD exhibited larger LV size and LV mass index than those without NAFLD, although left atrial size and <i>E</i>/<i>e</i>' ratio did not differ between groups. Left ventricular global longitudinal strain was significantly reduced in participants with vs. without NAFLD (17.1% ± 2.4% vs. 19.5% ± 3.1%, respectively; <i>P</i> < 0.001). The NAFLD group had a significantly higher frequency of abnormal LVGLS (<16%) than the non-NAFLD group (31.0% vs. 10.7%, respectively; <i>P</i> < 0.001). Multivariable linear regression analysis demonstrated that higher FLI score was significantly associated with impaired LVGLS independent of age, sex, conventional cardiovascular risk factors, and echocardiographic parameters (standardized <i>β</i> -0.11, <i>P</i> = 0.031).</p><p><strong>Conclusion: </strong>In the general population without overt cardiac and liver disease, the presence of NAFLD was significantly associated with subclinical LV dysfunction, which may partly explain the elevated risk of HF in individuals with NAFLD.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10630098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71523932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David Ferreira, Jack Hardy, Will Meere, Lloyd Butel-Simoes, Michael McGee, Nicholas Whitehead, Paul Healey, Tom Ford, Christopher Oldmeadow, John Attia, Bradley Wilsmore, Nicholas Collins, Andrew Boyle
Abstract Introduction Cardiac catheterisation procedures are typically performed with local anaesthetic and proceduralist guided sedation. Various fasting regimens are routinely implemented prior to these procedures, noting an absence of prospective evidence, aiming to reduce aspiration risk. However, there are additional risks from fasting including patient discomfort, intravascular volume depletion, stimulus for neuro-cardiogenic syncope, glycaemic outcomes, and unnecessary fasting for delayed/cancelled procedures. Methods and Analysis This is an investigator-initiated, multicentre, randomised trial with a prospective, open-label, blinded endpoint (PROBE) assessment based in New South Wales, Australia. Patients will be randomised 1:1 to fasting (6 hours solid food, and 2 hours clear liquids) or to no fasting requirements. The primary outcome will be a composite of hypotension, hyperglycaemia, hypoglycaemia, and aspiration pneumonia. Secondary outcomes will include patient satisfaction, contrast induced nephropathy, new intensive care admission, new non-invasive or invasive ventilation requirement post procedure, and 30-day mortality and readmission. Ethics and Dissemination Ethics approval is confirmed via the Hunter New England Research Ethics Committee. The trial has been registered on the Australia New Zealand Clinical Trials Registry (ACTRN12622001455752). De-identified patient level data will be available to researchers who provide sound analysis proposals.
{"title":"Safety and Care OF no Fasting prior to catheterisation laboratory procedures: a non-inferiority randomised control trial protocol (SCOFF Trial).","authors":"David Ferreira, Jack Hardy, Will Meere, Lloyd Butel-Simoes, Michael McGee, Nicholas Whitehead, Paul Healey, Tom Ford, Christopher Oldmeadow, John Attia, Bradley Wilsmore, Nicholas Collins, Andrew Boyle","doi":"10.1093/ehjopen/oead111","DOIUrl":"https://doi.org/10.1093/ehjopen/oead111","url":null,"abstract":"Abstract Introduction Cardiac catheterisation procedures are typically performed with local anaesthetic and proceduralist guided sedation. Various fasting regimens are routinely implemented prior to these procedures, noting an absence of prospective evidence, aiming to reduce aspiration risk. However, there are additional risks from fasting including patient discomfort, intravascular volume depletion, stimulus for neuro-cardiogenic syncope, glycaemic outcomes, and unnecessary fasting for delayed/cancelled procedures. Methods and Analysis This is an investigator-initiated, multicentre, randomised trial with a prospective, open-label, blinded endpoint (PROBE) assessment based in New South Wales, Australia. Patients will be randomised 1:1 to fasting (6 hours solid food, and 2 hours clear liquids) or to no fasting requirements. The primary outcome will be a composite of hypotension, hyperglycaemia, hypoglycaemia, and aspiration pneumonia. Secondary outcomes will include patient satisfaction, contrast induced nephropathy, new intensive care admission, new non-invasive or invasive ventilation requirement post procedure, and 30-day mortality and readmission. Ethics and Dissemination Ethics approval is confirmed via the Hunter New England Research Ethics Committee. The trial has been registered on the Australia New Zealand Clinical Trials Registry (ACTRN12622001455752). De-identified patient level data will be available to researchers who provide sound analysis proposals.","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135994620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-17eCollection Date: 2023-09-01DOI: 10.1093/ehjopen/oead097
Maria Lorenza Muiesan, Giacomo Buso, Claudia Agabiti Rosei
We
{"title":"Authors' response to comment on: Less sodium and more potassium to reduce cardiovascular risk and the PURE study.","authors":"Maria Lorenza Muiesan, Giacomo Buso, Claudia Agabiti Rosei","doi":"10.1093/ehjopen/oead097","DOIUrl":"https://doi.org/10.1093/ehjopen/oead097","url":null,"abstract":"We","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/37/67/oead097.PMC10584076.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49686562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sven Svedmyr, Jan Hedner, Sebastien Bailly, Francesco Fanfulla, Holger Hein, Carolina Lombardi, Ondrej Ludka, Stefan Mihaicuta, Gianfranco Parati, Athanasia Pataka, Sophia Schiza, Sezai Tasbakan, Dries Testelmans, Ding Zou, Ludger Grote, Steiropoulos P, Verbraecken J, Petiet E, Georgia Trakada, Fietze I, Penzel T, Ondrej Ludka, Bouloukaki I, Schiza S, McNicholas W T, Ryan S, Riha R L, Kvamme J A, Grote L, Hedner J, Zou D, Katrien Hertegonne, Dirk Pevernagie, Bailly S, Pépin J L, Tamisier R, Hein H, Basoglu O K, Tasbakan M S, Buskova J, Joppa P, Staats R, Dries Testelmans, Haralampos Gouveris, Ludwig K, Lombardi C, Parati G, Bonsignore M R, Francesco Fanfulla, Drummond M, van Zeller M, Randerath W, Marcel Treml, Dogas Z, Pecotic R, Pataka A, Anttalainen U, Saaresranta T, Sliwinski P
Abstract Introduction We analysed longitudinal blood pressure data from hypertensive Obstructive Sleep Apnea (OSA) patients from the European Sleep Apnea Database (ESADA) cohort. The study investigated the interaction between positive airway pressure (PAP) induced blood pressure (BP) change and antihypertensive treatment (AHT). Methods Hypertensive patients with AHT (monotherapy/dual therapy n = 1283/652, mean age 59.6 ± 10.7/60.6 ± 10.3 yrs, Body Mass Index (BMI) 34.2 ± 6.5/34.8 ± 7.0 kg/m2, Apnea Hypopnea Index (AHI) 46 ± 25/46 ± 24 n/h, proportion female 29%/26%, respectively) started PAP treatment. Office BP at baseline and follow up 2-36 months were assessed. The interaction between AHT drug classes and PAP on BP was quantified and the influence of age, gender, BMI, comorbidities, BP at baseline and study site were evaluated. Results Following PAP treatment (5.6 ± 1.6/5.7 ± 1.9 hrs/day), systolic BP was reduced by -3.9 ± 15.5/-2.8 ± 17.7 mmHg in mono/dual AHT, and diastolic BP by -3.0 ± 9.8/-2.7 ± 10.8 mmHg, respectively, all p < 0.0001. Systolic and diastolic BP control was improved following PAP treatment (38/35% to 54/46% and 67/67% to 79/74%, mono/dual AHT respectively). PAP treatment duration predicted a larger BP improvement in the mono therapy group. Intake of Renin-Angiotensin-Blockers (ACEI/ARB) alone or in any AHT combination was associated with better BP control. AHT dependent BP improvement was independent of confounders. Conclusion In this pan-European OSA patient cohort, BP control improved following initiation of PAP. Duration of PAP treatment was associated with a favourable effect on BP. Our study suggests that ACEI/ARB, alone or in combination with other drug classes, provides a particularly strong reduction of BP and better BP control when combined with PAP in OSA.
{"title":"Blood pressure control in hypertensive sleep apnea patients of the ESADA cohort-effects of PAP and antihypertensive medication","authors":"Sven Svedmyr, Jan Hedner, Sebastien Bailly, Francesco Fanfulla, Holger Hein, Carolina Lombardi, Ondrej Ludka, Stefan Mihaicuta, Gianfranco Parati, Athanasia Pataka, Sophia Schiza, Sezai Tasbakan, Dries Testelmans, Ding Zou, Ludger Grote, Steiropoulos P, Verbraecken J, Petiet E, Georgia Trakada, Fietze I, Penzel T, Ondrej Ludka, Bouloukaki I, Schiza S, McNicholas W T, Ryan S, Riha R L, Kvamme J A, Grote L, Hedner J, Zou D, Katrien Hertegonne, Dirk Pevernagie, Bailly S, Pépin J L, Tamisier R, Hein H, Basoglu O K, Tasbakan M S, Buskova J, Joppa P, Staats R, Dries Testelmans, Haralampos Gouveris, Ludwig K, Lombardi C, Parati G, Bonsignore M R, Francesco Fanfulla, Drummond M, van Zeller M, Randerath W, Marcel Treml, Dogas Z, Pecotic R, Pataka A, Anttalainen U, Saaresranta T, Sliwinski P","doi":"10.1093/ehjopen/oead109","DOIUrl":"https://doi.org/10.1093/ehjopen/oead109","url":null,"abstract":"Abstract Introduction We analysed longitudinal blood pressure data from hypertensive Obstructive Sleep Apnea (OSA) patients from the European Sleep Apnea Database (ESADA) cohort. The study investigated the interaction between positive airway pressure (PAP) induced blood pressure (BP) change and antihypertensive treatment (AHT). Methods Hypertensive patients with AHT (monotherapy/dual therapy n = 1283/652, mean age 59.6 ± 10.7/60.6 ± 10.3 yrs, Body Mass Index (BMI) 34.2 ± 6.5/34.8 ± 7.0 kg/m2, Apnea Hypopnea Index (AHI) 46 ± 25/46 ± 24 n/h, proportion female 29%/26%, respectively) started PAP treatment. Office BP at baseline and follow up 2-36 months were assessed. The interaction between AHT drug classes and PAP on BP was quantified and the influence of age, gender, BMI, comorbidities, BP at baseline and study site were evaluated. Results Following PAP treatment (5.6 ± 1.6/5.7 ± 1.9 hrs/day), systolic BP was reduced by -3.9 ± 15.5/-2.8 ± 17.7 mmHg in mono/dual AHT, and diastolic BP by -3.0 ± 9.8/-2.7 ± 10.8 mmHg, respectively, all p &lt; 0.0001. Systolic and diastolic BP control was improved following PAP treatment (38/35% to 54/46% and 67/67% to 79/74%, mono/dual AHT respectively). PAP treatment duration predicted a larger BP improvement in the mono therapy group. Intake of Renin-Angiotensin-Blockers (ACEI/ARB) alone or in any AHT combination was associated with better BP control. AHT dependent BP improvement was independent of confounders. Conclusion In this pan-European OSA patient cohort, BP control improved following initiation of PAP. Duration of PAP treatment was associated with a favourable effect on BP. Our study suggests that ACEI/ARB, alone or in combination with other drug classes, provides a particularly strong reduction of BP and better BP control when combined with PAP in OSA.","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135993807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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