Impaired Endothelial Glycocalyx Predicts Adverse Outcome in Subjects Without Overt Cardiovascular Disease: a 6-Year Follow-up Study

We investigated whether disturbance of glycocalyx integrity is related with increased cardiovascular risk. In 600 healthy subjects, we measured perfused boundary region (PBR), a marker of glycocalyx integrity, in sublingual microvessels with diameter ranging 5-25 µm using a dedicated camera (Sideview Darkfield Imaging). Increased PBR indicates reduced glycocalyx thickness. We prospectively monitored the occurrence of cardiovascular events (MACE-death, myocardial infarction, and stroke) during a 6-year follow-up. Fifty-seven MACE were documented. Increased values of PBR5-25 predicted higher risk for MACE in a model including sex, age, hyperlipidemia, diabetes, hypertension, smoking, family history of coronary disease, treatment with ACEi/ARBs, or lipid-lowering agents (hazard ratio (HR), 6.44, p = 0.011; net reclassification improvement (NRI), 28%; C-statistic: 0.761). PBR5-25 was an independent and additive predictor of outcome when added in a model including the European Heart SCORE, diabetes, family history of CAD, and medication (HR, 4.71; NRI: 39.7%, C-statistic from 0.653 to 0.693; p < 0.01).Glycocalyx integrity is an independent and additive predictor to risk factors for MACE at 6-year follow-up in individuals without cardiovascular disease. ClinicalTrials.govIdentifier:NCT04646252. PBR5-25 was an independent and additive predictor of adverse cardiovascular events in a model including the European Heart SCORE, diabetes, family history of coronary disease, and medication (HR: 4.71, NRI: 39.7%, C-statistic from 0.653 to 0.693; p < 0.01, NRI:37.9%).

Beat-to-beat P-wave analysis outperforms conventional P-wave indices in identifying patients with a history of paroxysmal atrial fibrillation, during sinus rhythm

Introduction

Atrial fibrillation (AF) is the most common arrhythmia and is associated with high risk of morbidity and mortality. In many patients, AF is of episodic character (paroxysmal AF – PAF), which makes the identification of these patients during sinus rhythm (SR) challenging.

Purpose

The aim of the present study is to compare the performance of beat-to-beat P-wave analysis with P-wave indices used as predictors of PAF, such as P-wave duration, area, voltage, axis, terminal force in V1, inter-atrial block or orthogonal type, in identifying patients with history of PAF during sinus rhythm.

Methods

Standard 12-lead ECG and 10-minute orthogonal ECG recordings were obtained from 40 consecutive patients with short history of PAF under no antiarrhythmic medication and 60 age- and sex- matched healthy controls. The P-waves on the 10-minute recordings were analyzed on a beat-to-beat basis and classified as belonging to a primary or secondary morphology according to previous study. Wavelet transform used to further analyze P-wave orthogonal signals of main morphology on a beat-to-beat basis.

Results

38 out of 327 studied features were found to differ significantly among the two groups. These features were tested for their diagnostic ability and receiver operating characteristic curves were ploted. Only 3 of them performed adequetly, with an area under curve (AUC) above 0.65; Two of them came from morphology analysis (percentage of beats following main morphology in axis X and Y) and one from wavelet analysis (max energy in high frequency zone -Y axis). Among standard P-wave indices, P-wave area in lead II was the one with the highest AUC (0.64).

Conclusion

Novel indices derived from beat-to-beat analysis outperform stadard P-wave markers in identifying patients with PAF history during sinus rhythm.

Funding Acknowledgement

Type of funding sources: None. ROC curves of most significant featuresAUC characteristics of P-wave indices

The effect of one year treatment with GLP1-RA, SGLT2i and their combination on plasma levels of oxidative and antioxidative biomarkers

Background/Introduction

Biomarkers of oxidative stress burden are found increased in Type-2 diabetes mellitus (T2DM) patients. An imbalance between oxidative and antioxidative plasma factors is implicated in the pathway of cardiovascular disease in diabetics. Novel antidiabetic agents with cardioprotective effects are glucagon like peptide-1 receptor agonists (GLP1-RA) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i).

Purpose

We investigated the effect of liraglutide (GLP1-RA),empagliflozin (SGLT-2i) and their combination on plasma levels of oxidative and antioxidative factors.

Methods

A hundred-sixty T2DM patients were randomly assigned and received: a) insulin (n=40), b) liraglutide (n=40), c) empagliflozin (n=40) and d) the combination liraglutide and empagliflozin (n=40) for 1 year. We measured at baseline and after 1 year of treatment the following antioxidative markers: a) Reducing Power (RP), b) 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid (ABTS), c) Total Antioxidant Capacity (TAC) and also Thiobarbituric acid reactive substances (TBARS) as a marker of oxidative burden.

Results

After 1 year of treatment all subjects achieved successful glycemic regulation, as estimated by Hemoglobin A1c (HbA1c) levels (8±0.5 vs 6.65±0.5, p&lt;0.05). Patients on the combination GLP1-RA + SGLT2i displayed greater reduction of TBARS (8.66±0.42 μmol/l vs 7.92±0.35 μmol/l, p&lt;0.05) and increase of ABTS (17.49 ±0.63 mmol/l vs 19.14 ±0.64 mmol/l, p&lt;0.05) compared with insulin-treated participants (8.85±0.41 μmol/l vs 8.83±0.44 μmol/l and 17.07 ±0.58 mmol/l vs 17.22 ±0.49 mmol/l, p=NS respectively). Patients treated on GLP1-RA or SGLT2i separately showed the same improving trend with the combination group in the abovementioned biomarkers but the changes were not so prominent. In the insulin group worsening of TAC was also noticed (0.92±0.02 mmol/l vs 0.89±0.01 mmol/l, p&lt;0.05). In the other biomarkers nonsignificant changes were observed for all groups. Furthermore the absolute change of HbA1c was correlated with the relative change of TBARS (r=0.419, p&lt;0.05)

Conclusion

One year treatment with the GLP1-RA liraglutide and SGLT2i empagliflozin resulted in improvement of plasma levels of oxidative and antioxidative biomarkers compared to administration of insulin and the changes were more outstanding in patients that received the combination of GLP1-RA and SGLT2i, despite similar glycemic regulation in all participants. Thus the favorable cardiovascular effects of these novel factors may be partly explained by alterations in equilibrium between oxidative and antioxidative circulating biomarkers.

Funding Acknowledgement

Type of funding sources: None.

P-wave beat-to-beat morphology analysis outperforms conventional P-wave indices in detecting patients with paroxysmal atrial fibrillation

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) - the most common sustained cardiac arrhythmia - while not a life-threatening condition itself, leads to an increased risk of stroke and high rates of mortality. Early detection and diagnosis of AF is a critical issue for all health stakeholders.

Purpose

The aim of this study is to compare the performance of standard P-wave indices with beat-to-beat P-wave morphological variability parameters in identifying patients with history of Paroxysmal Atrial Fibrillation (PAF).

Methods

Three-dimensional 1000Hz ECG digital recordings of 10 minutes duration were obtained from a total of 39 PAF patients and 60 healthy individuals. Following artifacts and ectopic beats removal, P‑wave morphology analysis was performed based on the dynamic application of the k‑means clustering process and main and secondary P-wave morphologies were identified. The percentage of P-waves following the main or the secondary morphology in each lead was calculated, as well as established indices such as Advanced Interatrial Block, P-wave duration, axis and area, P-wave Terminal Force in lead V1 and Orthogonal Leads Type 1, 2 or 3.

Results

9 out of 24 parameters studied, were found to be significantly different between the two groups. 7 of these indices were derived from morphology analysis and 2 from P-wave area. Logistic regression revealed that the percentage of P-waves allocated to main morphology in X axis performed better than all other indices in identifying patients with PAF history from healthy volunteers in terms of total accuracy and F1 measure.

Conclusion

P-wave beat-to-beat morphology analysis can identify PAF patients during normal sinus rhythm more efficiently than standard P-wave indices. Abstract Figure.

Effects of anti-inflammatory treatment and surgical intervention on endothelial glycocalyx, peripheral and coronary microcirculation and myocardial deformation in inflammatory bowel disease patients

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): EOMIFNE (Hellenic Society of IBD study)

Introduction

IBD alter gastrointestinal physiology and mucosal immunity through a complex inflammatory process which leads to significant arterial endothelial dysfunction and modification of cardiac structure and function. This study is performed to test the hypothesis that treatment with TNF-a inhibitor or surgical intervention improves cardiovascular function through anti-inflammatory mechanisms.

Methods

57 IBD patients (45 CD and 12 UC, 40 ± 8 years, 57% male) were examined at baseline and 4 months after pharmaceutical (antiTNF-a) or surgical intervention. Subjects with a history of established cardiovascular risk factors were excluded.

We measured a) carotid-femoral pulse wave velocity (PWV - Complior SP ALAM) and augmentation index (AI), b) flow mediated dilatation (FMD) of the brachial artery), c) perfused boundary region (PBR) of the sublingual arterial microvessels, d) LV longitudinal strain (GLS) and (PWV/GLS) as a marker of ventricular-arterial coupling, e) peak LV twisting, peak twisting velocity (pTwVel) and peak untwisting velocity (pUtwVel) using speckle tracking echocardiography, f) mitral annulus velocities by tissue doppler imaging (S’ and E’) and mitral inflow velocity (E), g) coronary flow reserve (CFR) by Doppler echocardiography, h) C-reactive protein (CRP), white blood cells (WBC).

IBD severity was quantified using Mayo score and Harvey-Bradshaw Index (HBI) for UC and CD respectively.

Results

At baseline, the disease severity score and the WBC values were significantly correlated with peripheral PWV (r = 0.3, p &lt; 0.05 and r = 0.364, p &lt; 0.05), while central arterial AI was associated with median arterial pressure (r = 0.479, p &lt; 0.05), lateral and septal mitral E’ velocity (r=-0.651, p &lt; 0.05 and r=-0.587, p &lt; 0.05). Four months after treatment, there was a reduction of CRP (13 ± 2.8 mg/L vs 3.9 ± 1.2 mg/L, p &lt; 0.05), CFR (2.5 ± 0.08 vs 3.1 ± 0.11, p &lt; 0.05) and PBR5-25 (2.27 ± 0.06 vs 2.09 ± 0.05 μm, p &lt; 0.05) more significantly in pharmaceutical group (p &lt; 0.05 vs p = 0.23). Moreover, there was an improvement of GLS (-18.6 ± 0.37 vs -20 ± 0.34, p &lt; 0.05), LS-4ch (-18.3 ± 0.47 vs -19.3 ± 0.41, p &lt; 0.05), GcircS (-18.1 ± 0.7 vs -20.1 ± 0.9, p &lt; 0.05) and FMD (7.2%±0.6 vs 11.8%±1.4, p &lt; 0.05). Moreover, there was an overall improvement of PWV/GLS (-0.49 ± 0.02 vs -0.43 ± 0.02, p &lt; 0.05). It was greater after with anti-TNFa therapy compared to surgery (p &lt; 0.05 vs p = 0.1) and particular for the GLS component (p &lt; 0.05 vs p = 0.07). The difference in PBR5-25 was significantly correlated with the difference in GLS (r=-0.403, p &lt; 0.05) and PWV/GLS (r = 0.421, p &lt; 0.05).

Conclusion

IBD severity is associated with vascular and diastolic dysfunction, with significant improvement after anti-inflammatory treatment. Systemic anti-TNFa inhibition leads to significant improvement in myocardial deformation, endothelial and coronary microcirculatory function compared with local intestinal surgical intervention, possibly through a systemic reduction of excess inflammatory burden.

The effects of empagliflozin on arterial stiffness, endothelial function and ventriculoarterial coupling in type 2 diabetes mellitus: 1 year follow up

Introduction

Sodium glucose cotransporters inhibitors (SGLT2i) are currently used in the treatment of patients with type 2 diabetes mellitus (T2DM) who pose high cardiovascular risk. However their effects on arterial stiffness, endothelial function and ventriculoarterial coupling have not been described.

Methods

We recruited 120 patients with T2DM. They received either the SGLT2i empagliflozin (n=60) or insulin (n=60). We measured at baseline and after 1 year of treatment: 1) Perfused Boundary Region (PBR 5–25μm) to evaluate endothelial glycocalyx integrity via Glycocheck, 2) Pulse wave Velocity (PWVc-f), 3)central systolic blood pressure (cSBP), 4) central Pulse Pressure (cPP) via Complior,5) the ratio PWV/GLS by echocardiography to assess ventriculoarterial coupling (VA coupling).

Results

The patients were matched for age, gender, smoking, hypertension and hyperlipidemia (p=NS). Hemoglobin A1c was deteriorated in both groups (8.1% vs 8.2%, p=NS). The baseline measurements of aforementioned markers did not differ between the 2 groups (p=NS). PWV was correlated with cSBP (r=0.4.p&lt;0.05) and cPP (r=0.35, p&lt;0.05) for all participants at baseline. After 1 year of treatment both groups achieved significant reduction of HbA1c. Patients treated with insulin showed an increase of PWV in contrary with empagliflogin group (11.4±0.5 to 12.6±0.4 vs 11.7±0.5 to 10.9±0.4, correspondingly, p&lt;0.05). cSBP declined considerably in empagliflozin group (135±10 to 129±10 vs 134±9 to 136±9 respectively, p&lt;0.05) and cPP remained approximately steady (47±8 to 48±8 vs 49±6 to 55±6 respectively, p&lt;0.05) compared with insulin group. PBR dropped in SGLT2i group (2.20±0.2 to 1.98±0.2, p&lt;0.05) whereas PBR fluctuated at the same level in insulin group (2.18±0.2 to 2.15±0.3, p=NS).PWV/GLS fell in both groups but the reduction was more prominent in empagliflozin group (−0.72±0.1 to −0.67±0.1 vs −0.72±0.1 to −0.60±0.1 respectively, p&lt;0.05).

Conclusion

1 year treatment with empagliflozin resulted in improved markers of arterial stiffness, ventriculoarterial coupling and endothelial function, independently of glycemic control.

Funding Acknowledgement

Type of funding source: None

Effects of electronic cigarette on platelet and vascular function after one month of use

Background and aims

Smoking is a major factor that contributes to the development of cardiovascular disease. Smoking cessation delays progress of coronary artery disease. Electronic cigarette is proposed as a bridge to smoking cessation. We examined its effects on platelet function after 1 month of use compared to tobacco smoking.

Patients and methods

40 current smokers (mean age 48 years±5) without cardiovascular disease were randomized to smoke either a conventional cigarette (conv-cig) or an electronic cigarette (e-cig) (electronic cigarette fluid with nicotine concentration of 12 mg/dL) for one month. All subjects smoked an electronic cigarette with nicotine concentration 12 mg/dL for one month. Measurements were performed at baseline and after one month of smoking the conventional or electronic cigarette. We measured a) perfused boundary region (PBR) of the sublingual arterial micro vessels (range 5–25 micrometers), a marker inversely related with glycocalyx thickness, b) pulse wave velocity (PWV), central systolic blood pressure (cSBP) and augmentation index (AIx), c) platelet function by two different methods, namely the novel Platelet Function Analyzer PFA-100 and the traditional Light Transmission Aggregometry (LTA) d) the exhaled CO level (parts per million-ppm) as a smoking status marker; and e) the plasma malondialdehyde (MDA) levels, as an oxidative stress burden index.

Results

After 1 month of electronic smoking, we did not observe any significant change in platelet function and arterial stiffness (p&gt;0.05 for all markers) with the exception of a reduction of MDA (1.22±0.1 vs 1.09±0.1 μmol/L, p=0.03) and exhaled CO; 14.9±0.7 vs 5.9±0.7 ppm, p&lt;0.001. Conversely, after continuation of conventional cigarette smoking for a month, platelet function was further impaired as assessed by PFA [125,5±31,1 vs 152,35±51,4 U, p=0.047) and by LTA (epinephrine as stimulator) [59,8%±16,1 vs 35,6%±19.1, p&lt;0.001] and markers of arterial stiffness were deteriorated, as assessed by PWV (9,5±2,8 vs 10,3±2,9, p=0,028) and by Aixc (8,36±35,9 vs 30,4±21,6, p=0,004).

Conclusions

Electronic Cigarette smoking has a neutral effect on platelet function and arterial stiffness markers compared to conventional tobacco smoking which further deteriorates platelet and vascular function during one moth of use.

Funding Acknowledgement

Type of funding source: None

Endothelial and Cardiac Dysfunction in Inflammatory Bowel Diseases: Does Treatment Modify the Inflammatory Load on Arterial and Cardiac Structure and Function?

Inflammatory bowel diseases (IBD), largely represented by Crohn's disease (CD) and ulcerative colitis (UC), alter gastrointestinal physiology and mucosal immunity through a complex inflammatory process. These diseases can lead to significant arterial endothelial dysfunction. There is also evidence linking IBD with a modification of cardiac structure and function. A growing body of research has associated IBD with an acceleration of arterial stiffness and atherosclerosis and an increased risk of cardiovascular (CV) morbidity and mortality. The focus of this review is two-fold. Firstly, the literature on IBD in relation to CV dysfunction was evaluated (mainly based on 25 relevant surveys carried out between 2005 and 2018). The vast majority of these studies support a significant association of IBD with a deterioration in CV function. Secondly, the literature available regarding the effect of IBD treatment on CV dysfunction was considered based on studies published between 2007 and 2018. This literature search suggests that IBD treatment may have the potential to ameliorate CV dysfunction resulting in CV benefits. This review will analyse the literature as well as consider emerging research perspectives regarding how IBD treatment could improve CV dysfunction.

P357 Remote ischemic post-conditioning may prevent cardiac remodeling within two years of STEMI by cardioprotective microRNA upregulation

Background

Remote ischemic post-conditioning attenuates ischemia-reperfusion injury in patients with STEMI. However, its biochemical mechanisms, including micro-RNA expression, and effects on cardiac remodeling have not been defined.

Methods

We examined 80 patients with STEMI and 20 healthy controls. All patients had been evaluated by cardiac echocardiography. The conditioning protocol utilised a single ischemic stimulus by brachial cuff inflation of both arms at 200mmHg for 5 minutes, while 20 patients underwent a sham conditioning procedure by way of cuff inflation omission after its placement. Blood samples were taken before and after the conditioning protocol; thus, the expression of microRNA-144,-150,-499 (cardioprotective action), -21, and -208 (remodeling stimuli) was quantified at baseline and after the ischemic conditioning procedure, by polymerase chain reaction. Additionally, cardiac remodeling was evaluated by repeat echocardiography after a 2-year follow-up period, in 40 patients.

Results

Our conditioning protocol resulted in a statistically significant increase in miR-144,-150, -499, -21, and -208 expression (55.9 vs 7.4/U6sn, p &lt; 0.001; 3.4 vs 1.8/U6sn, p &lt; 0.05, p = 0.01; 3.5 vs 1.6/U6sn, p &lt; 0.001; 2.1 vs 1.2/U6sn; 2.4 vs 1.9/U6sn) compared to baseline; none of the aforementioned measurements was affected by the sham procedure. Furthermore, both left-ventricular end-diastolic (LVEDV) and end-systolic volume (LVESV) were decreased after the 2-year follow-up period (from 99.3 ± 6.7 to 85.9 ± 5.7, p= 0.004, and from 55.3± 6.1 to 48.6± 5.2, p= 0.04, respectively). In addition, the increase in mir-144 and mir-499 was significantly correlated with a decrease in LVESV (r=-0.355, p &lt; 0.05; r=-0.368, p &lt; 0.05, respectively), while the increase in mir-499 was also significantly correlated with a decrease in LVEDV (r=-0.374, p &lt; 0.05) at follow-up.

Conclusion

Remote ischemic conditioning may prevent adverse myocardial remodelling within 2 years of the index ischemic event, likely by up-regulation of cardio-protective microRNAs expression.

P1588 micro rna expression profiling may predict cardiac remodeling after stemi

Background

MicroRNAs have been recognised as important modulators of cardiovascular function. However, their profiling in ischemic heart disease and contribution to cardiac remodeling has not been defined.

Methods

We examined 40 patients with STEMI and 20 healthy controls. MicroRNA expression profiling was carried out within 48 hours of the index ischemic event, measuring the expression of microRNA-144,-150,-499 (cardioprotective action), -21, and -208 (remodeling stimuli). In addition, every patient was evaluated by echocardiography, which was repeated after a 2-year follow-up period.

Results

Left-ventricular end-systolic volume (LVESV) and left-ventricular end-diastolic volume (LVEDV) decreased (from 57.7± 6.3 to 48.6± 5.2, p &lt; 0.05 and from 102.1± 7.1 to 85.9 ± 5.7, p &lt; 0.05, respectively) while the ratio of early mitral inflow velocity to mitral annular early diastolic velocity (E/e’) did not change (from 9.32± 0.6 to 9.56± 0.8, p= NS). Mir-208 and -499 expression within 48 hours of STEMI (1.91± 0.43/U6sn and 1.7± 0.48/U6sn respectively) were significantly positively correlated with a reduction in LVESV, LVEDV, and E/e’. In specific, mir-208 expression was associated with an absolute (r= -0.41, p &lt; 0.05) and a percent reduction (r=-0.45, p= 0.03) in LVEDV and an absolute reduction in E/E’ (r= 0.46, p &lt; 0.05), while mir-499 was associated with an absolute (r= -0.4, p &lt; 0.05) and percent reduction (p= -0.38, p &lt; 0.05) in LVESV. Mir-499 median value (1.78[1.292.01]) predicted reverse remodelling (LVESV reduction by &gt;15%) with satisfactory specificity (0.82).

Conclusion

Mir- 208 and -499 expression may contribute to cardiac remodeling after STEMI, while mir-499 could be used as a prognostic marker of reverse remodeling.

P831 Anti-inflammatory treatment improves endothelial glycocalyx, peripheral and coronary microcirculatory function and myocardial deformation in inflammatory bowel disease patients

Funding Acknowledgements

Hellenic Society of IBD study (EOMIFNE)

Introduction

Inflammatory bowel diseases (IBD) alter gastrointestinal physiology and mucosal immunity through a complex inflammatory process. The extensive inflammation leads to significant arterial endothelial dysfunction as well as modification of cardiac structure and function. This study is performed to test the hypothesis that treatment with TNF-a inhibitor or surgical intervention in the IBD population improves cardiovascular function through anti-inflammatory mechanisms.

Methods

Thirty-seven IBD patients (28 CD and 9 UC, 39 ± 12 years, 62% male) were examined at baseline and 4 months after pharmaceutical (TNF-a inhibitor) (16 patients) or surgical intervention (21 patients). Subjects with a history of established cardiovascular risk factors were excluded.

We measured a) carotid-femoral pulse wave velocity (PWV - Complior SP ALAM), central systolic blood pressure (cSBP) and augmentation index (AI), b) flow mediated dilatation (FMD) of the brachial artery), c) perfused boundary region(PBR) of the sublingual arterial microvessels using Sideview Darkfield imaging, d) LV longitudinal strain (GLS), strain rate (GLSR) and (PWV/GLS) as a marker of ventricular-arterial coupling, e) peak LV twisting, peak twisting velocity (pTwVel) and peak untwisting velocity (pUtwVel) using speckle tracking echocardiography, f) mitral annulus velocities by tissue doppler imaging (S’ and E’) and mitral inflow velocity (E), g) coronary flow reserve (CFR) by Doppler echocardiography, h) C-reactive protein (CRP), white blood cells (WBC).

IBD severity was quantified using Mayo score and Harvey-Bradshaw Index (HBI) for UC and CD respectively, and correlated with the cardiovascular disease markers.

Results

At baseline, the disease severity score was significantly correlated with markers of diastolic dysfunction (lateral mitral E’ velocity r=-0.352, p &lt; 0.05, UntwVelE r = 0.389, p &lt; 0.05), while the WBC values were negatively associated with lateral mitral E’ velocity: r=-0.5, p &lt; 0.05 and CFRvti (r=-0.332, p = 0.05). Four months after anti-inflammatory treatment, there was a reduction of CRP (15.5 ± 4.7 mg/L vs 5.1 ± 2.1 mg/L, p &lt; 0.05) and WBC values (8.6 ± 0.6 vs 6.6 ± 0.7 x 103, p = 0.06). Moreover, post-treatment, there was a significant reduction of central arterial AI (3.58 ± 4.13 vs 0 ± 4.96, p &lt; 0.05), PBR10-19 (2.47 ± 0.09 vs 2.24 ± 0.08 μm, p &lt; 0.05) and PBR5-25 (2.31 ± 0.08 vs 2.14 ± 0.06 μm, p = 0.05) and increase of FMD (7.6%±0.7 vs 12.2%±1.7, p &lt; 0.05), CFR (2.6 ± 0.1 vs 3.2 ± 0.14, p &lt; 0.05), GLS (-18.7 ± 0.46 vs -20 ± 0.49, p &lt; 0.05) and PWV/GLS (-0,48 ± 0.027 vs -0,42 ± 0.028, p &lt; 0.05). No difference in the examined markers was observed between patients treated with anti-TNFa or surgery (p = NS).

Conclusion

IBD severity is associated with vascular and diastolic dysfunction. Anti-TNFa inhibition treatment or surgical intervention in IBD lead to improved myocardial deformation, endothelial and coronary microcirculatory function possibly through the reduction of excess inflammatory burden.

P4445Effects of interleukin 17A inhibition on myocardial deformation and vascular function in psoriasis:one year follow-up

Background

Interleukin (IL)-17A activity is implicated in the clinical course of psoriasis. We investigated the effects of IL-17A inhibition on vascular and left ventricular (LV) function in psoriasis patients.

Methods

One hundred psoriasis patients received either an anti-IL-17A agent (secukinumab n=50), or cyclosporine treatment (n=50). At baseline and after 4 and 12 months of treatment, we measured (1) LV global longitudinal strain (GLS), strain rate (GLSR), strain rate at early diastole (GLSRE), twisting (LVtwist), (2) coronary flow reserve (CFR), (3) pulse wave velocity (PWV), (4) malondialdehyde (MDA) and protein carbonyl (PC) as markers of oxidative stress, (5) psoriasis severity and extent assessed by Psoriasis Area and Severity Index (PASI).

Results

Compared to treatment with cyclosporine, anti IL-17A treatment resulted in greater improvement in GLS (GLS: −16.7±3 at baseline vs −18.3±2.8 at 4 months vs −19±3 at 12 months post treatment with anti-IL-17 respectively, p=0.02, GLS: −16.8±2.9 at baseline vs −17.2±2.7 at 4 months vs −17.1±2.9 at 12 months post treatment with cyclosporine respectively, p=0.2), GLSR (−0.9±0.3 at baseline vs −1.08±0.3 at 4 months vs −1.11±0.2 at 12 months post treatment with anti-IL-17 respectively, p=0.02, −0.9±0.2 at baseline vs −0.95±0.2 at 4 months vs −0.96±0.2 at 12 months post treatment with cyclosporine respectively, p=0.5) GLSRE and LV twist (13.7±5.1 at baseline vs 18.1±6 at 4 months vs 17.8±5.6 at 12 months post treatment with anti-IL-17 respectively, p=0.001, 13±5.3 at baseline vs 13.8±5.6 at 4 months vs 15.5±5.3 at 12 months post treatment with cyclosporine respectively, p=0.6).Treatment with anti-IL-17A also resulted in greater improvement of CFR compared to cyclosporine treatment (2.6±0.3 at baseline vs 3±0.3 at 4 months vs 3.1±0.3 at 12 months post treatment with anti-IL-17 respectively, p=0.01, 2.7±0.4 at baseline vs 2.8±0.3 at 4 months vs 2.7±0.3 at 12 months post treatment with cyclosporine respectively, p=0.5) and PWV decreased after treatment with anti-IL-17 (10.2±1.8 at baseline vs 9.3±1.5 at 4 months vs 9.7±1.8 at 12 months post treatment with anti-IL-17 respectively, p=0.04, whereas higher values of PWV were observed after cyclosporine treatment (9.7±1.9 at baseline vs 10.8±1.7 at 4 months vs 11.2±2 at 12 months post treatment with cyclosporine respectively, p=0.02). PASI score was similarly improved after treatment with either anti-IL-17A or cyclosporine. Markers of oxidative stress were reduced after treatment with anti-IL-17A, in contrast to elevation of oxidative stress markers after treatment with cyclosporine. Changes of myocardial deformation markers and CFR after treatment with anti-IL-17A correlated with concomitant reduction of oxidative stress.

Conclusions

In psoriasis patients, inhibition of IL-17A results in a greater improvement of vascular and myocardial function compared with cyclosporine treatment.

P4435Effects of interleukin 6 inhibitor tocilizumab on endothelial glycocalyx, vascular and myocardial function compared to prednisolone

Background/Introduction

Tocilizumab, a humanised monoclonal antibody against the human interleukin-6 receptor, is used for the treatment of rheumatoid arthritis (RA).

Purpose

We investigated the effects of tocilizumab on arterial function, LV myocardial deformation and endothelial glycocalyx in RA patients.

Methods

80 patients with rheumatoid arthritis were randomized to tocilizumab (n=40) or prednisolone (n=40) for 3 months. At baseline and after 3-month treatment we assessed: a) carotid-femoral pulse wave velocity (PWV-Complior SP ALAM), b) LV longitudinal strain (GLS), systolic (LongSr) and diastolic (LongSrE) strain rate using speckle tracking echocardiography, c) perfused boundary region (PBR) of the sublingual arterial microvessels (ranged from 5–25μm) using Sideview Darkfield imaging (Microscan, Glycocheck). Increased PBR is considered an accurate index of reduced endothelial glucocalyx thickness, d) flow mediated dilatation (FMD) of the brachial artery after and percentage difference of FMD (FMD%) after hyperemia, e) coronary flow reserve (CFR) of the LAD using Doppler echocardiography, and f) malondialdehyde (MDA), protein carbonyls (PCs) and C-reactive protein (CRP) plasma levels.

Results

At baseline, all patients had similar disease activity score and markers of vascular and myocardial function. Compared to baseline, all patients had reduced CRP post treatment, while MDA and PCs levels were reduced only after tocilizumab treatment (p<0.05). The percent decrease of MDA was correlated with percent increase of GLS (p<0.001). Compared to baseline, tocilizumab-treated patients reduced PWV (11±3% vs. 10.3±2m/sec) and PBR (2.11±0.2 vs. 1.95±0.18μm) (Figure 1) and increased GLS (−16.1±2.9 vs. −17.6±2.5%), CFR (2.73±0.8 vs. 3.06±1), and FMD% (5.9±2.9 vs. 11.6±3.6) (p<0.05 for all comparisons). No significant changes were observed among prednisolone-treated patients.

Figure 1

Conclusions

IL-6 inhibition improves endothelial function and oxidative stress resulting to improved vascular function and LV myocardial deformation.

Reliability of MRI-derived cortical and subcortical morphometric measures: effects of pulse sequence, voxel geometry, and parallel imaging

Advances in magnetic resonance imaging (MRI) have contributed greatly to the study of neurodegenerative processes, psychiatric disorders, and normal human development, but the effect of such improvements on the reliability of downstream morphometric measures has not been extensively studied. We examined how MRI-derived neurostructural measures are affected by three technological advancements: parallel acceleration, increased spatial resolution, and the use of a high bandwidth multiecho sequence. Test-retest data were collected from 11 healthy participants during 2 imaging sessions occurring approximately 2 weeks apart. We acquired 4 T1-weighted MP-RAGE sequences during each session: a non-accelerated anisotropic sequence (MPR), a non-accelerated isotropic sequence (ISO), an accelerated isotropic sequence (ISH), and an accelerated isotropic high bandwidth multiecho sequence (MEM). Cortical thickness and volumetric measures were computed for each sequence to assess test-retest reliability and measurement bias. Reliability was extremely high for most measures and similar across imaging parameters. Significant measurement bias was observed, however, between MPR and all isotropic sequences for all cortical regions and some subcortical structures. These results suggest that these improvements in MRI acquisition technology do not compromise data reproducibility, but that consistency should be maintained in choosing imaging parameters for structural MRI studies.

Variable precision registration via wavelets: optimal spatial scales for inter-subject registration of functional MRI

The detection of significantly activated brain regions in multi-subject functional magnetic resonance imaging (fMRI) studies almost invariably entails the coregistration of individual subjects' data in a standard space. Here, we investigate how sensitivity to detect loci of generic activation in such studies may be conditioned by the precision of anatomical registration. We describe a novel algorithm, implemented in the wavelet domain, for inhomogeneous deformation of individual images to match a template. The algorithm matches anatomical features in a coarse-to-fine fashion, first minimising a cost function in terms of relatively coarse spatial features and then proceeding iteratively to match the images in terms of progressively more detailed anatomical features. Applying the method to data acquired from two groups of 12 healthy volunteers (with mean age 27 and 70 years, respectively), during performance of a paired associate learning task, we show that geometrical overlap between template and individual images is monotonically improved, compared to an affine transform, by additional inhomogeneous deformations informed by more detailed features. Likewise, sensitivity to detect activated voxels can be substantially improved, by a factor of 4 or more, if wavelet-mediated deformations informed by medium-sized anatomical features are applied in addition to a preliminary affine transform. However, sensitivity to detect activated voxels was reduced by "over-registering" data or matching anatomical features at the finest scales of the wavelet transform. The benefits of variable precision registration are particularly salient for data acquired in older subjects, which showed evidence of greater inter-subject anatomic variability and generally required more extensive local deformation to achieve a satisfactory match to the template image. We conclude that major benefits in sensitivity to detect functional activation in multi-subject fMRI studies can be attained with an inhomogeneous deformation applied over appropriate spatial scales.

32-channel 3 Tesla receive-only phased-array head coil with soccer-ball element geometry

A 32-channel 3T receive-only phased-array head coil was developed for human brain imaging. The helmet-shaped array was designed to closely fit the head with individual overlapping circular elements arranged in patterns of hexagonal and pentagonal symmetry similar to that of a soccer ball. The signal-to-noise ratio (SNR) and noise amplification (g-factor) in accelerated imaging applications were quantitatively evaluated in phantom and human images and compared with commercially available head coils. The 32-channel coil showed SNR gains of up to 3.5-fold in the cortex and 1.4-fold in the corpus callosum compared to a (larger) commercial eight-channel head coil. The experimentally measured g-factor performance of the helmet array showed significant improvement compared to the eight-channel array (peak g-factor 59% and 26% of the eight-channel values for four- and fivefold acceleration). The performance of the arrays is demonstrated in high-resolution and highly accelerated brain images.

3T phased array MRI improves the presurgical evaluation in focal epilepsies: A prospective study

BACKGROUND

Although detection of concordant lesions on MRI significantly improves postsurgical outcomes in focal epilepsy (FE), many conventional MR studies remain negative. The authors evaluated the role of phased array surface coil studies performed at 3 Tesla (3T PA MRI).

METHODS

Forty patients with medically intractable focal epilepsies were prospectively imaged with 3T PA-MRI including high matrix TSE T2, fluid attenuated inversion recovery, and magnetization prepared rapid gradient echo. All patients were considered candidates for epilepsy surgery. 3T PA-MRIs were reviewed by a neuroradiologist experienced in epilepsy imaging with access to clinical information. Findings were compared to reports of prior standard 1.5T MRI epilepsy studies performed at tertiary care centers.

RESULTS

Experienced, unblinded review of 3T PA-MRI studies yielded additional diagnostic information in 48% (19/40) compared to routine clinical reads at 1.5T. In 37.5% (15/40), this additional information motivated a change in clinical management. In the subgroup of patients with prior 1.5T MRIs interpreted as normal, 3T PA-MRI resulted in the detection of a new lesion in 65% (15/23). In the subgroup of 15 patients with known lesions, 3T PA-MRI better defined the lesion in 33% (5/15).

CONCLUSION

Phased array surface coil studies performed at 3 Tesla read by an experienced unblinded neuroradiologist can improve the presurgical evaluation of patients with focal epilepsy when compared to routine clinical 1.5T studies read at tertiary care centers.

Nonstationary noise estimation in functional MRI

An important issue in functional MRI analysis is accurate characterisation of the noise processes present in the data. Whilst conventional fMRI noise representations often assume stationarity (or time-invariance) in the noise generating sources, such approaches may serve to suppress important dynamic information about brain function. As an alternative to these fixed temporal assumptions, we present in this paper two time-varying procedures for examining nonstationary noise structure in fMRI data. In the first procedure, we approximate nonstationary behaviour by means of a collection of simple but numerous time-varying parametric models. This is accomplished through the derivation of a locally parametric AutoRegressive (AR) plus drift model which tracks temporal covariance by allowing the model parameters to evolve over time. Before exploring time variation in these parameters, window-widths (bandwidths) that are well suited to the latent time-varying noise structure must be determined. To do this, we employ a bandwidth selection mechanism based on Stein's Unbiased Risk Estimator (SURE) criterion. In the second procedure, we describe the fMRI noise using a nonparametric method based on Functional Data Analysis (FDA). This process generates well-conditioned nonstationary covariance estimates that reflect temporal continuity in the underlying data structure whilst penalizing effective model dimension. We demonstrate both methods on simulated data and investigate the presence of nonstationary noise in resting fMRI data using the whitening capabilities of the locally parametric procedure. We evaluate the comparative behaviour of the stationary and nonstationary AR-based methods on data acquired at 1.5, 3 and 7 T magnetic field strengths and show that incorporation of time variation in the AR parameters leads to an overall decrease in the level of residual structure in the data. The FDA noise modelling technique is formulated within an activation mapping procedure and compared to the SPM (Statistical Parametric Mapping) toolbox on a cognitive face recognition task. Both the SPM and FDA methods show good sensitivity on this task, but we find that inclusion of the nonstationary FDA noise model seems to improve detection power in important task-related medial temporal regions.

Comparison of physiological noise at 1.5 T, 3 T and 7 T and optimization of fMRI acquisition parameters

Previous studies have shown that under some conditions, noise fluctuations in an fMRI time-course are dominated by physiological modulations of the image intensity with secondary contributions from thermal image noise and that these two sources scale differently with signal intensity, susceptibility weighting (TE) and field strength. The SNR of the fMRI time-course was found to be near its asymptotic limit for moderate spatial resolution measurements at 3 T with only marginal gains expected from acquisition at higher field strengths. In this study, we investigate the amplitude of image intensity fluctuations in the fMRI time-course at magnetic field strengths of 1.5 T, 3 T, and 7 T as a function of image resolution, flip angle and TE. The time-course SNR was a similar function of the image SNR regardless of whether the image SNR was modulated by flip angle, image resolution, or field strength. For spatial resolutions typical of those currently used in fMRI (e.g., 3 x 3 x 3 mm(3)), increases in image SNR obtained from 7 T acquisition produced only modest increases in time-course SNR. At this spatial resolution, the ratio of physiological noise to thermal image noise was 0.61, 0.89, and 2.23 for 1.5 T, 3 T, and 7 T. At a resolution of 1 x 1 x 3 mm(3), however, the physiological to thermal noise ratio was 0.34, 0.57, and 0.91 for 1.5 T, 3 T and 7 T for TE near T2*. Thus, by reducing the signal strength using higher image resolution, the ratio of physiologic to image noise could be reduced to a regime where increased sensitivity afforded by higher field strength still translated to improved SNR in the fMRI time-series.

Eight-channel phased array coil and detunable TEM volume coil for 7 T brain imaging

An eight-channel receive-only brain coil and table-top detunable volume transmit coil were developed and tested at 7 T for human imaging. Optimization of this device required attention to sources of interaction between the array elements, between the transmit and receive coils and minimization of common mode currents on the coaxial cables. Circular receive coils (85 mm dia.) were designed on a flexible former to fit tightly around the head and within a 270-mm diameter TEM transmit volume coil. In the near cortex, the array provided a fivefold increase in SNR compared to a TEM transmit-receive coil, a gain larger than that seen in comparable coils at 3 T. The higher SNR gain is likely due to strong dielectric effects, which cause the volume coil to perform poorly in the cortex compared to centrally. The sensitivity and coverage of the array is demonstrated with high-resolution images of the brain cortex.