Impact of diabetes mellitus and triglyceride glucose index on mortality and cardiovascular outcomes in patients with chronic coronary syndrome undergoing coronary computed tomography angiography

Background

There is limited knowledge regarding whether an elevated triglyceride glucose (TyG) index can serve as a prognostic marker for mortality and cardiovascular outcomes, independent of diabetes mellitus (DM) and plaque burden, in patients with chronic coronary syndrome (CCS).

Methods

Patients with CCS (n = 684) were categorized into subgroups based on the presence of DM, and patients without DM were further divided into two groups based on presence or absence of an elevation of TyG index >8.8. Coronary plaque burden was evaluated using coronary computed tomography angiography. Major cardiovascular adverse event (MACE) was defined as a composite event of nonfatal myocardial infarction, unstable angina or unplanned coronary revascularization, stroke, non-cardiovascular mortality and cardiovascular mortality.

Results

Patients without DM exhibited significantly greater plaque and epicardial adipose tissue volumes than those with DM. Multivariable Cox proportional hazards models demonstrated that DM and an elevated TyG index >8.8 were independently associated with the risk of MACE after adjusting for age, sex, and plaque volume. Patients with DM (hazard ratio, 3.74; 95% confidence interval, 1.97-7.08; p < 0.001) and patients without DM with an elevated TyG index (hazard ratio, 1.99; 95% confidence interval, 1.01-3.91; p = 0.045) had an increased risk of MACE.

Conclusion

This study indicates that DM and an elevated TyG index are predictors of MACE, independent of plaque volume, in patients with CCS.

Thoracic Aortic Plaque Burden and Prediction of Cardiovascular Events in Patients Undergoing 320-row Multidetector CT Coronary Angiography

AIM

Wide volume scan (WVS) coronary computed tomography angiography (CCTA) enables aortic arch visualization. This study assessed whether the thoracic aortic plaque burden (TAPB) score can predict major cardiovascular adverse events (MACE) in addition to and independently of other obstructive coronary artery disease (CAD) attributes.

METHODS

This study included patients with suspected CAD who underwent CCTA (n=455). CCTA-WVS was used to assess CAD and the prognostic capacity of TAPB scores. Data analysis included the coronary artery calcification score (CACS), CAD status and extent, and TAPB score, calculated as the sum of plaque thickness and plaque angle at five thoracic aortic segments. The primary endpoint was MACE defined as a composite event comprised of ischemic stroke, acute coronary syndrome, and cardiovascular death.

RESULTS

During a mean follow-up period of 2.8±0.9 years, 40 of 455 (8.8%) patients experienced MACE. In the Cox proportional hazards model adjusted for clinical risks (Suita cardiovascular disease risk score), we identified TAPB score (T3) as a predictor of MACE independent of CACS ＞400 (hazards ratio [HR], 2.91; 95% confidence interval [CI], 1.26-6.72; p=0.012) or obstructive CAD (HR, 2.83; 95% CI, 1.30-6.18; p=0.009). The area under the curve for predicting MACE improved from 0.75 to 0.795 (p value=0.008) when TAPB score was added to CACS ＞400 and obstructive CAD.

CONCLUSIONS

We found that comprehensive non-invasive evaluation of TAPB and CAD has prognostic value in MACE risk stratification for suspected CAD patients undergoing CCTA.

Aortic arch plaque morphology in patients with coronary artery disease undergoing coronary computed tomography angiography with wide-volume scan

BACKGROUND

Wide-volume scanning with 320-row multidetector computed tomography coronary angiography (CTCA-WVS) enables the assessment of the aortic arch plaque (AAP) morphology and coronary arteries without requiring additional contrast volume. This study aimed to investigate the prevalence of AAPs and their association with coronary artery disease (CAD) and major adverse cardiovascular events (MACEs) in patients who underwent CTCA-WVS.

METHODS

This study included 204 patients without known CAD (mean age, 65 years; 53% men) who underwent CTCA-WVS. We evaluated the presence of aortic plaques in the ascending aorta, aortic arch, and thoracic descending aorta using CTCA-WVS. Large aortic plaques were defined as plaques of at least 4 mm in thickness. A complex aortic plaque was defined as a plaque with ulceration or protrusion. MACEs were defined as composite events of cardiovascular (CV) death, nonfatal myocardial infarction, and ischemic stroke.

RESULTS

AAPs and large/complex AAPs were identified in 51% ( n = 105) and 18% ( n = 36) of the study patients, respectively. The prevalence of AAPs with large/complex morphology increased with CAD severity (2.1% in no CAD, 12% in nonobstructive CAD, and 39% in obstructive CAD). The univariate Cox hazard model demonstrated that the predictors associated with MACEs were diabetes, obstructive CAD, and large/complex AAPs. Independent factors associated with large/complex AAPs were male sex [odds ratio (OR), 2.90; P = 0.025], stroke history (OR, 3.48; P = 0.026), obstructive CAD (OR, 3.35; P = 0.011), and thoracic aortic calcification (OR, 1.77; P = 0.005).

CONCLUSION

CTCA-WVS provides a comprehensive assessment of coronary atherosclerosis and thoracic aortic plaques in patients with CAD, which may improve the stratification of patients at risk for CV events.

Verification of the Usefulness of an Assessment and Risk Control Sheet that Promotes Management of Cancer Drug Therapy

Background: Proper management of adverse events is crucial for the safe and effective implementation of anticancer drug treatment. Showa University Hospital uses our interview sheet (assessment and risk control [ARC] sheet) for the accurate evaluation of adverse events. On the day of anticancer drug treatment, a nurse conducts a face-to-face interview. As a feature of the ARC sheet, by separately describing the symptoms the day before treatment and the day of treatment and sharing the information on the medical record, it is possible to clearly determine the status of adverse events. In this study, we hypothesized that the usefulness and points for improvement of the ARC sheet would be clarified by using and evaluating a patient questionnaire.

Methods: This study included 174 patients (144 at Showa University Hospital (Hatanodai Hospital) and 30 at Showa University Koto Toyosu Hospital (Toyosu Hospital) who underwent pre-examination interviews by nurses and received cancer chemotherapy at the outpatient center of Hatanodai and Toyosu Hospital. In the questionnaire survey, the ARC sheet’s content and quality, respondents’ satisfaction, structural strengths, and points for improvement were evaluated on a five-point scale.

Results: The patient questionnaire received responses from 160 participants, including the ARC sheet use group (132 people) and the non-use group (28 people). Unlike the ARC sheet non-use group, the ARC sheet use group recognized that the sheet was useful to understand the adverse events of aphthous ulcers (p = 0.017) and dysgeusia (p = 0.006). In the satisfaction survey questionnaire, there was a high sense of security in the pre-examination interviews by nurses using the ARC sheet.

Conclusions: The ARC sheet is considered an effective tool for comprehensively evaluating adverse events. Pre-examination interviews by nurses using ARC sheets accurately determined the adverse events experienced by patients with anxiety and tension due to confrontation with physicians.

Intraventricular pressure gradient: a promising tool to predict the post-infarction chronic congestive heart failure in rats

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction: Congestive heart failure (CHF), the main reason for morbidity and mortality, is considered a serious consequence of myocardial infarction (MI). The use of left ventricular end-diastolic pressure (LVEDP) as a chief indicator of CHF becomes limited because of the possible impairment of cardiac function and induced aortic valve damage during its recording. Echocardiography is the gold standard approach to diagnose structural myocardial dysfunction. However, its ability to predict chronic CHF following MI is still limited. Recently, intraventricular pressure gradient (IVPG) was presented as a non-invasive, highly sensitive preload-independent diastolic function parameter to assess cardiac function, especially during cardiomyopathy. However, there have not been any investigations demonstrating the feasibility of IVPG in the evaluation of post-infarction chronic CHF.

Purpose

This study aimed to investigate the utility of IVPG to assess the heart function in a rat model with chronic CHF following MI with evaluating its capacity to predict these changes.

Methods

Fifty male rats were included. MI was induced via ligation of the left anterior descending artery (LAD) at the level of the atrioventricular junction (MI animals, n = 35). Sham animals were subjected to the same left thoracotomy procedure without LAD ligation (Sham animals, n = 15). Transthoracic conventional echocardiography and colour M-mode echocardiography (CMME) for IVPG were performed in all animals 6 months post-surgery. The next day, animals were anesthetized, ventilated, and euthanized after the recording of hemodynamics. The heart weight, and lung and liver wet-to-dry weight ratios were recorded. J-tree cluster-analysis was performed based on ten echocardiographic variables indicative of CHF.

Results

Based on the cluster analysis, animals were joined into two clusters; CHF+ (n = 22) and named MI/HF+, and CHF- (n = 28) that was joined from sham (n = 15), and MI/HF- (n = 13). MI/HF+ presented the most severe anatomical and echocardiographic changes indicative of CHF with significant reduction of all IVPG indices and impairment of the hemodynamics. The IVPG indices were significantly (P&lt; 0.0001) correlated with the anatomical and echocardiographic findings, LVDP, LVEDP, HR, -dP/dtmin, and Tau. Meanwhile, LVSP was only significantly correlated with apical IVPG (R = 0.677, P = 0.022). dP/dtmax was significantly correlated with total IVPG, basal IVPG, and apical IVPG (R = 0.797, P = 0.017, R = 0.724, P = 0.003, and R = 0.652, P = 0.026 ; respectively). Moreover, total, basal, mid-to-apical, mid-, and apical IVPG were significant (P&lt; 0.0001) predictors of chronic CHF following MI.

Conclusion

Compared to the structural, and functional indices of conventional echocardiography, IVPG derived from CMME could provide a substantial non-invasive tool to diagnose and predict CHF after long-term MI.

Comment on "An early Miocene extinction in pelagic sharks"

[Figure: see text].

AB0180 A MULTICENTER SELF-CONTROLLED CASE SERIES STUDY INVESTIGATING THE PREVENTIVE EFFECT OF SULFASALAZINE AGAINST PNEUMOCYSTIS PNEUMONIA

Background:

An animal study revealed that sulfasalazine (SSZ) enhances Pneumocystis clearance from the lung by accelerating macrophage activity.[1] Although the preventive effect of SSZ on Pneumocystis pneumonia (PCP) in patients with rheumatoid arthritis (RA) is reported in case-control studies, some important confounders might remain unmeasured and distort the results. [2-3]. The self-controlled case series (SCCS) method involves only cases and controls fixed confounders automatically.[4]

Objectives:

To evaluate the prophylactic effect of SSZ against PCP in patients with RA, controlling unmeasurable confounders by the SCCS method.

Methods:

A retrospective study was conducted at five hospitals. Patients with RA who developed PCP between 2003 and 2019 were included. PCP was defined by the following criteria: (1) detection of Pneumocystis jirovecii in respiratory specimens by polymerase chain reaction; (2) clinical manifestations (pyrexia, dry cough, dyspnea, or hypoxia); (3) diffuse interstitial infiltrate on chest imaging; (4) absence of prophylaxis for PCP. Incidence rate ratio (IRR) for Pneumocystis pneumonia associated with sulfasalazine use was calculated by conditional Poisson regression.

Results:

We identified 48 episodes of PCP in 47 cases. Of these, 15 (31.9%) died. Thirty received SSZ in certain periods of their observations (Table 1). While 46 episodes of PCP developed in the period of 168.9 person-years without SSZ use, only one episode of PCP developed in the period of 103.7 person-years with SSZ use. SSZ use had a decreased risk of PJP (adjusted IRR 0.007, 95% CI <0.001-0.067) after adjusted for age group, the use of glucocorticoid, methotrexate, and tacrolimus, and the use of biologic agent or janus kinase inhibitor (Table 2).

Table 1.

Characteristic of the 47 patients enrolled in the study.

Male/female, n (%)14 (29.8)/33 (70.2)Observational period (years), median (IQR)72.0 (66.3-79.1)Lung disease, n (%)4.7 (1.4-9.5)Use of sulfasalazine, n (%)23 (48.9)Outcome of PCP, death, n (%)30 (63.8)Age at the onset of PCP (years), median (IQR)15 (31.9)

PCP, Pneumocystis pneumonia; IQR, interquartile range.

Table 2.

Unadjusted and adjusted incidence rate ratio for Pneumocystis pneumonia associated with sulfasalazine use.

Observation length (years)Episodes of PCP, n (%)Unadjusted IRR95% CI)Adjusted IRRa(% CI)Use of SSZ103.71 (2.1)0.010 (0.001-0.092)0.007 (<0.001-0.067)No use of SSZ168.947 (97.9)referencereference

IRR, incidence rate ratio; PCP, Pneumocystis pneumonia; SSZ, sulfasalazine.

Conclusion:

Our study demonstrated the preventive effect of SSZ against PCP with confounders controlled by the SCCS.

References:

[1]Wang, J., et al. Immune modulation with sulfasalazine attenuates immunopathogenesis but enhances macrophage- mediated fungal clearance during pneumocystis pneumonia. PLoS Pathog. 2010;19;6(8):e1001058.

[2]Nunokawa, T. et al. Prophylactic effect of sulfasalazine against Pneumocystis pneumonia in patients with rheumatoid arthritis: A nested case-control study. Semin. Arthritis Rheum. 2019;48(4):573-578.

[3]Nunokawa, T., et al. Effect of Sulfasalazine Use on the Presence of Pneumocystis Organisms in the Lung among Patients with Rheumatoid Arthritis: A Test-Negative Design Case-Control Study with PCR Tests. Mod. Rheumatol. 2019;29(3):436-440.

[4]Petersen, I., et al. Self controlled case series methods: an alternative to standard epidemiological study designs. BMJ. 2016;12;354:i4515.

Disclosure of Interests:

None declared

The utility of patent ductus arteriosus closure with hemostatic clip in dogs

This study investigated the utility of patent ductus arteriosus (PDA) closure with hemostatic clip by comparing with traditional PDA closure. Medical records of 51 dogs with surgical closure of PDA were reviewed and retrospective study was conducted. 29 dogs were treated by procedure with hemostatic clip (Group HC), and 22 dogs were treated by surgical ligation (Group SL). Data pertaining to breed, sex, age and body weight at the time of surgery, echocardiographic minimal ductal diameter, duration of surgery, hemostatic clip size, echocardiographic findings, hemor-rhage, residual ductal flow and recanalization were collected from records. The results showed that procedure with hemostatic clip had been selected in lighter dogs than traditional PDA closure. Duration of surgery performed only hemostatic clip technique was significantly shorter than that in group SL. Preoperative LVIDd, E-wave and FS were significantly lower than postoperative ones. As regard all parameters, the differences between pre- and postoperative periods were not significantly different between group HC and group SL. Hemorrhage, residual ductal flow, and recanalization were not significantly different in both groups. The present study showed that procedure with hemostatic clip is beneficial in that it is available in smaller dogs and can make shorter operation duration than traditional PDA closure. Moreover, the procedure is effective for the resolution of volume overload of the left atrium and ventricle in short-term outcome. Complications including hemorrhage, residual ductal flow and recanaliza-tion were not significantly different with both techniques.

Orbital Complexity in Intrinsic Magnetic Topological Insulators MnBi_{4}Te_{7} and MnBi_{6}Te_{10}

Using angle-resolved photoelectron spectroscopy (ARPES), we investigate the surface electronic structure of the magnetic van der Waals compounds MnBi_{4}Te_{7} and MnBi_{6}Te_{10}, the n=1 and 2 members of a modular (Bi_{2}Te_{3})_{n}(MnBi_{2}Te_{4}) series, which have attracted recent interest as intrinsic magnetic topological insulators. Combining circular dichroic, spin-resolved and photon-energy-dependent ARPES measurements with calculations based on density functional theory, we unveil complex momentum-dependent orbital and spin textures in the surface electronic structure and disentangle topological from trivial surface bands. We find that the Dirac-cone dispersion of the topologial surface state is strongly perturbed by hybridization with valence-band states for Bi_{2}Te_{3}-terminated surfaces but remains preserved for MnBi_{2}Te_{4}-terminated surfaces. Our results firmly establish the topologically nontrivial nature of these magnetic van der Waals materials and indicate that the possibility of realizing a quantized anomalous Hall conductivity depends on surface termination.

Reduction of Pneumocystis jirovecii pneumonia and bloodstream infections by trimethoprim-sulfamethoxazole prophylaxis in patients with rheumatic diseases

Objective: Trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis against Pneumocystis jirovecii pneumonia (PJP) is routinely administered to patients with rheumatic diseases in Japan. The present study aimed to evaluate the effect of TMP/SMX prophylaxis on PJP and non-central line-associated bloodstream infections (BSIs) in patients receiving high-dose glucocorticoids for the treatment of rheumatic diseases.Method: This study enrolled patients who were admitted between 1 October 2003 and 31 March 2018 and began high-dose glucocorticoid therapy for rheumatic diseases during hospitalization. The observation period was 4 months from the commencement of high-dose glucocorticoid therapy. The effect of TMP/SMX prophylaxis on PJP and non-central line-associated BSI was analysed.Results: Of the 437 patients included in the study, 376 received TMP/SMX prophylaxis and 61 patients did not. During the observation period, TMP/SMX prophylaxis was discontinued in 76 patients (20.2%). Three PJP cases (0.7%) occurred. Among the 399 patients included in our analysis of non-central line-associated BSI, eight experienced non-central line-associated BSI (2.0%). Among the covariates, TMP/SMX prophylaxis was associated with reduced PJP and non-central line-associated BSI incidence [odds ratio (OR) 0, 95% confidence interval (CI) 0.00-0.38, and OR 0.08, 95% CI 0.01-0.42, respectively].Conclusion: Routine TMP/SMX prophylaxis reduced the incidence of both PJP and BSI in patients with rheumatic diseases undergoing high-dose glucocorticoid therapy.

Levels of phospholipids and triacylglycerol-containing omega 3 fatty acids in myocardial tissue of patients with myocardial infarction: analyzed by a lipidomics profiling method

Objective

According to population-based studies, low omega 3 fatty acid (omega3FA) intake and high levels of serum triacylglycerol (TAG) are associated with cardiovascular diseases. Recent advances in mass spectrometry allow molecular lipid (lipidomics) profiling, which may enhance cardiovascular risk prediction. In this study, we assessed the levels of omega3FA-containing phospholipids (PL) and TAG in myocardial tissues of patients with and without myocardial infarction (MI) using a lipidomics profiling method.

Methods

We performed lipidomics profiling of human left atrial appendage (LAA) tissue of 29 consecutive patients receiving off-pump coronary bypass surgery with standard LAA resection. The patients were divided into the MI group (n=7) and an age- and gender-matched non-MI group (n=7).

Results

Lipidomics profiling revealed that the MI group tended to have low levels of phosphatidylcholines (PC), phosphatidylethanolamine (PE), lysophosphatidylethanolamine (LPE), and plasmalogen, and high levels of TAG species. Individual molecular species containing omega3FA, such as PC (18:0/20:5; 3,200±1,200 vs. 4,500±910 pmol/g tissue, p=0.04) and plasmalogen (18:1/20:5; 57,000±21,000 vs. 91,000±28,000 pmol/g tissue, p=0.02), were significantly lower in the MI group than in the non-MI group.

Conclusions

To our knowledge, this is the first study to determine the levels of omega3FA-containing PL and TAG in myocardial tissue using lipidomics profiling. We discovered that lower levels of omega3FA-containing PL and higher levels of TAG existed in myocardial tissues of patients with MI than in those of patients without MI. Accordingly, the lipidomics profiling method for human myocardial tissue may be useful for developing therapy targets for cardiovascular diseases.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): MEXT/JSPS KAKENHI Grant

Impact of body mass index on the clinical outcomes in heart failure patients undergoing cardiac rehabilitation

Background

Increased body mass index (BMI) has recently shown to have a favorable effect on the prognosis in heart failure (HF) patients. However, the impact of BMI on clinical events and mortality in HF patients who underwent cardiac rehabilitation (CR) remains unclear.

Purpose

This study aimed to investigate whether the obesity paradox is present in HF patients who have undergone CR.

Methods

This study enrolled 238 consecutive HF patients who had undergone CR at our university hospital between November 2015 and October 2017. The clinical characteristics and anthropometric data of these patients, including BMI, were collected at the beginning of the CR. The major adverse cardiovascular event (MACE) was defined as a composite of all-cause mortality and unplanned hospitalization for HF. Follow-up data regarding the primary endpoints were collected until November 2018.

Results

Patients (mean age 68.7 years, male 61%) were divided into four groups as per BMI quartiles. More patients in the highest BMI group were women, were significantly younger, and had a higher prevalence of hypertension, dyslipidemia, and diabetes mellitus; however, no significant differences were observed in the prevalence of chronic kidney disease, left ventricular ejection fraction, and brain natriuretic peptide levels of the four groups. During a median follow-up duration of 583 days, 28 patients experienced all-cause mortality, and 42 were hospitalized for HF. Kaplan–Meier analysis showed that patients in the highest BMI quartiles had lower rates of MACE (Log-rank P&lt;0.05) (Figure 1). After adjusting for confounding factors, Cox regression multivariate analysis revealed that BMI was negatively and independently associated with the incidence of MACE (hazard ratio: 0.89, 95% confidence interval: 0.83–0.96, P&lt;0.05).

Conclusion

Increased BMI was associated with better clinical prognosis even in HF patients who have undergone CR Therefore, BMI assessment may be useful for risk stratification in HF patients who have undergone CR.

Figure 1. Kaplan-Meier survival curve

Funding Acknowledgement

Type of funding source: None

Combined impact of residual inflammatory risk and chronic kidney disease on long-term clinical outcomes in patients undergoing percutaneous coronary intervention

Background

Inflammatory status pre-percutaneous coronary intervention (PCI) and post-PCI has been reported not only associated with poor prognosis, but also to impair renal function. Statins reduce cardiovascular events by lowering lipids and have anti-inflammatory impacts, but residual inflammatory risk (RIR) exists. It remains unclear that the synergistic effect of RIR and chronic kidney disease (CKD) on long-term clinical outcome in stable coronary artery disease (CAD) patients undergoing PCI in statin era.

Aim

The aim of this study was to investigate the long-term combined impact of RIR evaluating hs-CRP at follow-up and CKD among stable CAD patients undergoing PCI in statin era.

Methods

This is a single-center, observational, retrospective cohort study assessing consecutive 2,984 stable CAD patients who underwent first PCI from 2000 to 2016. We analyzed 2,087 patients for whom hs-CRP at follow-up (6–9 months later) was available. High residual inflammatory risk was defined as hs-CRP &gt;0.6 mg/L according to the median value at follow up. Patients were assigned to four groups as Group1 (high RIR and CKD), Group2 (low RIR and CKD), Group3 (high RIR and non-CKD) or Group4 (low RIR and non-CKD). We evaluated all-cause death and major adverse cardiac events (MACE), defined as a composite of cardiovascular (CV) death, non-fatal myocardial infarction (MI) and non-fatal stroke.

Results

Of patients (83% men; mean age 67 years), there were 299 (14.3%) patients in group 1, 201 (9.6%) patients in group 2, 754 (36.1%) patients in group 3, and 833 (39.9%) patients in group 4. The median follow-up period was 5.2 years (IQR, 1.9–9.9 years). In total, 189 (frequency, 16.1%) cases of all-cause death and 128 (11.2%) MACE were identified during follow-up, including 53 (4.6%) CV deaths, 27 (2.4%) MIs and 52 (4.8%) strokes. The rate of all-cause death and MACE in group 1 was significantly higher than other groups (p&lt;0.001, respectively). There was a stepwise increase in the incidence rates of all-cause death and MACE. After adjustment for important covariates, the presence of high RIR and/or CKD were independently associated with higher incidence of MACE and higher all-cause mortality. (shown on figure).

Conclusion

The presence of both high RIR and CKD conferred a synergistic adverse effect on the risk for long-term adverse cardiac events in patients undergoing PCI.

Kaplan-Meier curve

Funding Acknowledgement

Type of funding source: None

Blocking of interleukin-1 suppresses both angiotensin II-induced renal inflammation and hypertension

Background

Clinical hypertension is associated with renal inflammation and elevated circulating levels of proinflammatory cytokines. IL-1 receptor antagonist (IL-1Ra) is one of the most important anti-inflammatory cytokines and plays a crucial role in inflammation. Inhibition of IL-1 may contribute to modulation of the Angiotensin II (AngII)-induced hypertension response. This study aimed to elucidate the effects of IL-1Ra and anti-IL-1beta antibody (01BSUR) on AngII-induced hypertension and renal inflammation.

Methods and results

To determine the contribution of IL-1Ra to AngII-induced renal inflammation, male wild-type (WT) and IL-1Ra-deficient (IL-1Ra−/−) mice were infused with AngII (1000ng/kg/min) using subcutaneous osmotic pumps for 14 days. We checked blood pressure, histological change, and several mRNA expressions 14 days after infusion. Fourteen days after infusion, systolic blood pressure (197±5 vs 169±9 mmHg, p&lt;0.05) in IL-1Ra−/− mice significantly increased compared with WT mice. Furthermore, on day 14 of AngII infusion, plasma IL-6 was 5.9-fold higher in IL-1Ra−/− versus WT mice (p&lt;0.001); renal preproendothelin-1 mRNA expression was also significantly higher in IL-1Ra−/− mice (p&lt;0.05). To examine renal function, we analyzed 24-hour urinary protein excretion and serum levels of blood urea nitrogen, creatinine, and uric acid in IL-1Ra−/− and WT mice. On day 14 of Ang II infusion, all levels increased significantly in IL-1Ra−/− mice compared with WT mice, suggesting that IL-1Ra deficiency reduced renal function following Ang II infusion. In addition, renal histology revealed that glomerular injury (Figure upper panels: PAS staining) and tubulointerstitial fibrosis (Figure lower panels: Elastica Masson staining) increased significantly in Ang II-infused IL-1Ra−/− versus Ang II-infused WT mice. Finally, we administrated 01BSUR to both IL-1Ra−/− and WT mice, and 01BSUR treatment decreased AngII-induced hypertension (162±17 vs 204±6 mmHg, p&lt;0.05) and renal damage (glomerular injury and fibrosis of the tubulointerstitial area) in both IL-1Ra−/− and WT mice compared with IgG2a treatment. These findings suggest that 01BSUR suppresses Ang II-induced inflammation and renal injury.

Conclusions

Inhibition of interleukin-1 by both endogenous IL-1Ra and exogenous 01BSUR decreased AngII-induced hypertension and renal damage in mice, suggesting suppression of IL-1 may provide an additional strategy to protect against renal damage in hypertensive patients.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): JSPS KAKENHI

Roles of Re-entrant cluster glass state and spin-lattice coupling in magneto-dielectric behavior of giant dielectric double perovskite La1.8Pr0.2CoFeO6

La based Co-Fe combined double perovskite (La1.8Pr0.2CoFeO6) was synthesized and the dielectric (zero-field and in-field), magnetic, x-ray absorption and Raman spectroscopy measurements have been investigated for La1.8Pr0.2CoFeO6double perovskite. The existence of re-entrant cluster glass state is observed. The magneto-dielectric (MD) is found in two temperature regions (25-80 K and 125-275 K). It has been demonstrated that the observed MD at low and high temperatures are respectively due to the spin freezing and the spin-lattice coupling. Furthermore, the very large dielectric constant and the low loss suggest that La1.8Pr0.2CoFeO6is very important from the application point of view.

AB1118 OPEN MUSCLE BIOPSY AS A SAFE AND USEFUL MEANS OF DIAGNOSING VASCULITIS: A SINGLE-CENTER EXPERIENCE OF 210 BIOPSY CASES

Background:

We previously reported the utility of open muscle biopsies in diagnosing vasculitis [1]. The number of open muscle biopsies performed at our department has increased to over 200. The purpose of the present study was to evaluate the diagnostic utility of vasculitis and the safety of the open muscle biopsies.

Objectives:

To clarify the diagnostic utility of vasculitis and the safety profile of the open muscle biopsy.

Methods:

We retrospectively examined all cases of open muscle biopsy performed between May 2012 and June 2018 in our department. The biopsy results, the presence or absence of adverse events, and blood test data at the time of the biopsy were extracted from the patients’ electronic medical records.

Results:

Between May 2012 and June 2018, 210 open muscle biopsies were performed, 120 of which were done for vasculitis diagnosis. Diagnostic histopathological findings were obtained in 42 of the 120 cases (35%). The definitive diagnosis in these cases was microscopic polyangiitis (30 cases), eosinophilic granulomatosis with polyangiitis (seven cases), granulomatosis with polyangiitis (one case), polyarteritis nodosa (three cases), and other vasculitis (one case). In 57 cases with myeloperoxidase-anti-neutrophil cytoplasmic antibody (MPO-ANCA) ≥ 10 U/ml, 31 cases (54.3%) showed histopathology of vasculitis. In six cases with protainase-3-ANCA (PR3-ANCA) ≥ 10 U/ml, histopathology of vasculitis was found in one case (16.7%).

In all 210 open muscle biopsy cases, complications included minor wound dehiscence (11 cases) and small subcutaneous hematoma (six cases), which were able to be managed by local treatment. Albumin was significantly lower in the patients with wound dehiscence (mean 3.2 vs 2.7, p = 0.049)

Serious complications included anaphylaxis due to local anesthesia (one case), compartment syndrome due to hematoma (one case), hematoma requiring surgical removal (one case), and arterial hemorrhage requiring surgical intervention (one case). The patients in the latter three hemorrhagic cases were receiving antiplatelet drugs.

Conclusion:

An open muscle biopsy is useful for diagnosing vasculitis, especially for MPO-ANCA-positive anca-associated vasculitis. Its safety profile is acceptable. Serious adverse events are rare, but the procedure should be performed carefully when patients are receiving antiplatelet drugs.

References:

[1]Nunokawa T. et al. The use of muscle biopsy in the diagnosis of systemic vasculitis affecting small to medium-sized vessels: A prospective evaluation in Japan. Scand. J. Rheumatol. 2016;45:210–214

Disclosure of Interests:

None declared

THU0309 UNILATERAL TEMPORAL ARTERY BIOPSY IS SUFFICIENT FOR DIAGNOSING GIANT CELL ARTERITIS IF THE SERUM C-REACTIVE PROTEIN LEVEL IS 10 MG/DL OR HIGHER

Background:

Temporal artery biopsy (TAB) is the gold standard for diagnosing giant cell arteritis (GCA). However, previous studies have reported that the discordance rate of TAB is 3-45%,i.e., in unliteral TAB, GCA may be overlooked in one in five patients, approximately. Evidence as to whether bilateral TAB should be performed initially or one-sided TAB is sufficient for diagnosing GCA is lacking.

Objectives:

To investigate the predictors of patients with GCA in whom one-sided TAB is sufficient.

Methods:

The present study was a cross-sectional, single center study conducted from April 1, 2011 to July 31, 2019 at Tokyo Metropolitan Tama Medical Center. Of all consecutive GCA cases for which bilateral TAB was performed, bilaterally positive cases and unilaterally positive cases were extracted as bilateral positive group (BPG) and unilateral positive group (UPG), respectively. GCA was defined in accordance with the classification criteria of the 1990 American College of Rheumatology, and GCA was diagnosed if no other etiology was found within six months after beginning of high-dose glucocorticoid treatment. Demographic, clinical and laboratory data were obtained from the medical records, and the BPG and the UPG were compared statistically in each variable. Statistical significance was defined asp< 0.05.

Results:

During study, 264 biopsies were performed for 145 cases, who suspected GCA and underwent TAB. The pathological positivity rate was 26.1% (68 / 264 biopsies). Of these, 53 cases had final diagnosis of GCA, in which 43 cases were biopsy proven GCA. Thirty-seven biopsy proven GCA with bilateral TAB were enrolled; 64.9% women; mean (SD) age 75 (8.9) years; median [IQR] TAB length 17.5 [13.0,20.0] mm; headache 54.1%; jaw claudication 45.9%; scalp tenderness 16.2%; temporal artery (TA) tenderness 32.4%; TA engorgement 32.4%; TA pulse abnormality 5.4%; visual symptoms 2.7%; a fever of 38.5°C or higher 40.5%; shoulder girdle pain 48.6%; imaging of aortitis or arteritis 40.5%; median [IQR] white blood cell 9,100 [7200, 12050] /μl; median [IQR] platelet cell 37.5 [27.0, 46.3] ×104/μl; median [IQR] C-reactive protein (CRP) 10.1 [3.9, 16.5] mg/dL; erythrocyte sedimentation rate [IQR] 105 [66, 129] mm/h. Thirty-one in 37 cases were positive bilaterally while 6 in 37 cases were positive unilaterally; and the discordance rate was 16.2%. The median sample length after formalin fixation was 19.0 mm for the BPG and 14.5 mm for the UPG (p= 0.171). The parameters above were compared between UPG and BPG. Of these, only the serum CRP value (mg/dL) differed statistically between groups, and the median value of the two groups was 10.6 and 6.5, respectively (median test:p= 0.031). To predict BPG, in whom unilateral TAB is sufficient for diagnosing GCA, the cut-off value of serum CRP with a specificity of 100% and a sensitivity of 61.3% was set at 9.3 mg/dL (ROC analysis: AUC 0.726).

Conclusion:

When the serum CRP level is 10 mg/dL or higher in GCA suspected patients, an unilateral TAB alone was sufficient for an accurate diagnosis.

References:

[1]Hellmich, B, et al.Ann Rheum Dis2020;79(1):19-30.

[2]Breuer, GS, et al.J Rheumatol. 2009;36(4):794-796.

[3]Czyz CN, et al.Vascular2019;27(4):347-351.

[4]Durling B, et al.Can J Ophthalmol2014;49(2):157-161.

Figure.

Comparison of median CRP levels between unilaterally positive group and bilaterally positive group.

Disclosure of Interests:

None declared

SAT0208 INCIDENCES OF ADVERSE EFFECTS AND DISEASE FLARE DUE TO PNEUMOCYSTIS PNEUMONIA PROPHYLAXIS WITH TRIMETHOPRIM/SULFAMETHOXAZOLE IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS

Background:

Methods of preventing pneumocystis pneumonia (PCP) in systemic lupus erythematosus (SLE) are controversial. Previous studies have verified the efficacy and safety of trimethoprim/sulfamethoxazole (TMP-SMX) in patients with rheumatic diseases1. However, as for SLE, some clinicians advise against prescribing TMP-SMX because sulfa allergy is reportedly more common in SLE than in other rheumatic diseases2, 3. Anecdotally, sulfonamides may also worsen SLE itself, but few data are available on lupus flares related to sulfonamides3.

Objectives:

This study aimed to assess the incidences of adverse effects and disease flare due to PCP prophylaxis with TMP-SMX in SLE patients.

Methods:

SLE patients seen at our hospital between September 2010 and April 2018 who received TMP-SMX as a PCP prophylaxis were enrolled. The clinical manifestations, treatment course, adverse drug reactions, and occurrence of lupus flares were retrospectively assessed from the medical records. The Naranjo adverse drug reaction probability scale4 was used to determine whether the reactions were induced by SMX-TMP. According to the British Isles Lupus Assessment Group (BILAG) 2004 index, a severe flare of lupus was defined as a development of a new grade A manifestation, and a moderate flare as a development of grade B manifestation following grade C, D or E. Two board-certificated rheumatologists reviewed the medical records in a blinded fashion to determine the reason for the flare, with disagreement resolved by consensus.

Results:

In total, 188 SLE patients were enrolled; of these, 117 (62.2%) had no adverse events and were able to continue taking SMX-TMP as needed. Seventy-one patients (37.8%) stopped SMX-TMP due to suspected adverse drug reactions, including fever, rash, liver function disorder, and cytopenia. The Naranjo scale indicated “definite” in 4, “probable” in 39, and “possible” in 28. Eighteen-patients restarted the SMX-TMP and 9 patients could continue the prophylaxis without adverse effects. Five patients were hospitalized to treat the adverse events: 3 with drug rash (concomitant use of hydroxychloroquine in 2), 1 with hypersensitivity (concomitant use of azathioprine) and 1 with hyponatremia, respectively.

Lupus flares occurred in 10 patients (5.3%) within one month after the start of the the SMX-TMP prophylaxis. Macrophage activation syndrome (MAS) or neuropsychiatric SLE occurred in 9 of them. Of 188 cases, 2 patients (1.1%) developed a new onset of MAS during the stable clinical course as the flare, which was considered due to SMX-TMP. Confounding factors, including high disease activity and the reduction of glucocorticoids, were identified in other 8 flares.

Conclusion:

PCP prophylaxis with SMX-TMP was tolerable in most SLE patients. However, a small number of SLE patients developed severe adverse effects or disease flares due to the SMX-TMP.

References:

[1]Park JW, et al. Annals of the Rheumatic Diseases 2018;77:644-649.

[2]Suyama Y, et al. Modern Rheumatology 2016;26:557-61

[3]Petri M, et al. Journal of Rheumatology 1992;19:265-9

[4]Naranjo CA, et al. Clinical Pharmacology and Therapeutics 1981;30:239-45

Disclosure of Interests:

None declared

AB0358 REDUCTION OF WHITE BLOOD CELL COUNT PREDICTS THE EFFICACY OF BARICITINIB, DOES NOT OF TOFACITINIB FOR RHEUMATOID ARTHRITIS

Background:

Pairing Janus kinase (JAK) 1/JAK3 signaling mediates lymphocyte proliferation and differentiation while pairing JAK2/JAK2 signaling is essential in myelopoiesis, erythropoiesis, and platelet production by facilitating signaling mediated by granulocyte-macrophage colony stimulating factor and erythropoietin. Tofacitinib (TOF) preferentially inhibits JAK1 and JAK3, while baricitinib (BAR) inhibits JAK1 and JAK2in vitro(1). However, the difference in the efficacy and the clinical courses between TOF and BAR in patients with rheumatoid arthritis (RA) remains unclear.

Objectives:

The objective of this study was to compare TOF and BAR in efficacy and changes in peripheral blood cell counts. We hypothesized that the efficiency of BAR was related to the decline in the blood cell counts, but that of TOF was not in patients with RA.

Methods:

We conducted a multicenter, 24 week-retrospective observational study. All RA patients received TOF (n = 43) or BAR (n = 26) treatment at Tama-Hokubu Medical Center and Tama Medical Center from December 2013 to March 2019 were included.

Results:

Baseline characteristics were similar between both groups; age 59.1 and 65.0 years old, disease duration 164.1 and 111.7 months, C-reactive protein 1.98 and 2.22 mg/ml, rheumatoid factor positive 76.7 % and 84.0 %, anti-citrullinated peptide antibody positive 78.9 % and 78.8 %, methotrexate combination 81.4 % and 69.2 %, the number of previous treatment of biologic or targeted disease-modifying antirheumatic drugs were 2.7 and 2.8, for TOF and BAR, respectively (mean).

Simplified Disease Activity Index (SDAI) at baseline were similar between the groups (TOF 20.77, BAR 19.15). There was no significant difference in efficacy between the both groups at week 24 (SDAI remission: TOF 3 (7%), BAR 6 (23.1%), p = 0.054, SDAI low disease activity (LDA): TOF 21 (48.8%), BAR 17 (65.4%), p = 0.181).

Among those who achieved SDAI LDA at week 24 in the BAR group, significant decrement of white blood cell (WBC) counts at week 12 and 24 and of neutrophil counts at week 4, 12 and 24 were observed (p < 0.05, Table). These decrements of cell count were not observed in patients who did not achieve LDA or in patients in the TOF group. Platelets and hemoglobin (data not shown) had no significant change in all groups.

Conclusion:

Clinical efficacy of TOF and BAR in RA was comparable in our cohort. A significant decrease of WBCs and neutrophils was associated with LDA achievement at week 24 in the BAR group. This could be explained by the inhibition of myelopoiesis through JAK2 signaling.

References:

[1]Winthrop, K.Nat Rev Rheumatol13,234–243 (2017)

Table 1.

Description of the three clusters

tofacitinibbaricitinibweekLDApnot LDApLDApnot LDApWhite Blood Cells[/µl]06821 ± 24026041 ± 26127994 ± 43097886 ± 251346247 ± 1905.2546465 ± 2440.3446706 ± 2499.0597143 ± 1526.363126480 ± 1949.4975871 ± 2070.2176470 ± 2867.0317383 ± 2963.356246733 ± 2297.8586450 ± 3001.4286418 ± 2875.0246833 ± 1021.454Neutrophils[/µl]04888 ± 23993982 ± 23006221 ± 40856221 ± 408544243 ± 1655.2104298 ± 2100.4614548 ± 2578.0155923 ± 2716.294124261 ± 1843.3243617 ± 1869.2364542 ± 3062.0195429 ± 3055.311244487 ± 2243.6574547 ± 2847.1904225 ± 2900.0084474 ± 1396.207Lymphocytes[/µl]01419 ± 6511305 ± 4891370 ± 4161395 ± 48541515 ± 544.3571502 ± 514.0391730 ± 659.0131530 ± 652.484121537 ± 555.5231327 ± 664.9961569 ± 572.0111453 ± 401.832241511 ± 598.6971143 ± 378.0921792 ± 699.0111836 ± 710.109Platelets[104/µl]026.9 ± 9.123.7 ± 6.630.3 ± 11.226.9 ± 7.4425.5 ± 8.9.29123.8 ± 6.6.94030.5 ± 4.6.94027.3 ± 10.8.7981224.7 ± 7.4.26125.6 ± 7.5.20933.1 ± 8.3.20927.0 ± 9.3.9052426.3 ± 8.1.93023.3 ± 6.1.96133.4 ± 6.9.96133.0 ± 4.4.063

Data are mean ± standard deviation. LDA: patients achieved SDAI LDA at week 24. not LDA: patients did not achieve SDAI LDA at week 24. Shownpvalues were calculated by t-test compared to week 0.

Disclosure of Interests:

None declared