Effects of high-dose versus standard-dose quadrivalent influenza vaccine among patients with diabetes: A post-hoc analysis of the DANFLU-1 trial

AIM

High-dose quadrivalent influenza vaccine (QIV-HD) has been shown to be more effective than standard-dose (QIV-SD) in reducing influenza infection, but whether diabetes status affects relative vaccine effectiveness (rVE) is unknown. We aimed to assess rVE on change in glycated haemoglobin [HbA1c (∆HbA1c)], incident diabetes, total all-cause hospitalizations (first + recurrent), and a composite of all-cause mortality and hospitalization for pneumonia or influenza.

METHODS

DANFLU-1 was a pragmatic, open-label trial randomizing adults (65-79 years) 1:1 to QIV-HD or QIV-SD during the 2021/22 influenza season. Cox proportional hazards regression was used to estimate rVE against incident diabetes and the composite endpoint, negative binomial regression to estimate rVE against all-cause hospitalizations, and ANCOVA when assessing rVE against ∆HbA1c.

RESULTS

Of the 12 477 participants, 1162 (9.3%) had diabetes at baseline. QIV-HD, compared with QIV-SD, was associated with a reduction in the rate of all-cause hospitalizations irrespective of diabetes [overall: 647 vs. 742 events, incidence rate ratio (IRR): 0.87, 95% CI (0.76-0.99); diabetes: 93 vs. 118 events, IRR: 0.80, 95% CI (0.55-1.15); without diabetes: 554 vs. 624 events, IRR: 0.88, 95% CI (0.76-1.01), pinteraction = 0.62]. Among those with diabetes, QIV-HD was associated with a lower risk of the composite outcome [2 vs. 11 events, HR: 0.18, 95% CI (0.04-0.83)] but had no effect on ∆HbA1c; QIV-HD adjusted mean difference: ∆ + 0.2 mmol/mol, 95% CI (-0.9 to 1.2). QIV-HD did not affect the risk of incident diabetes [HR 1.18, 95% CI (0.94-1.47)].

CONCLUSIONS

In this post-hoc analysis, QIV-HD versus QIV-SD was associated with an increased rVE against the composite of all-cause death and hospitalization for pneumonia/influenza, and the all-cause hospitalization rate irrespective of diabetes status.

Left atrial strain is reduced following trastuzumab in breast cancer patients

BACKGROUND

The effect of trastuzumab therapy on left atrial (LA) function remains largely unknown. Our aim was to assess the changes in LA strain parameters longitudinally in patients treated with trastuzumab.

METHODS

We retrospectively studied 170 patients with stage I-IV HER2+ breast cancer. All patients had baseline echocardiograms and repeat echocardiograms at 3 months and after 1 year. We measured LA strain at all three time points. Changes in LA strain and strain rate (sr) parameters were evaluated using repeated-measures mixed-effects models. The cohort was stratified according to development of cancer therapeutics-related cardiac dysfunction (CTRCD) during follow-up.

RESULTS

The mean age was 52.7 ± 13.8 years, 25.3% had hypertension and 16.0% had metastatic disease. Multiple LA strain parameters (predicted delta value, [95%CI]) showed statistically significant declines in patients who developed CTRCD from baseline to the 3-month follow-up after multivariable adjustment; LA reservoir strain (LAεres ): -4.7%; [-8.1% to -1.3%], p = .007; LA conduit strain (LAεcon ): -2.8%; [-5.3% to -.4%], p = .021); and LAεres sr: -.2/s; [-.3/s to -.09/s], p < .001). In patients who did not develop CTRCD, LA strain parameters declined significantly but to a smaller degree than in the CTRCD group (LAεres : -1.7%; [-3.1% to -.3%], p = .020, LAεcon : -2.2%; [-3.3% to -1.1%], p < .001, and LA booster pump strain : -2.4%; [-3.5% to -1.4%], p < .001). LA strain rates did not decline significantly in the non-CTRCD group.

CONCLUSION

Trastuzumab treatment was associated with declines in LA strain parameters in patients with breast cancer. The largest declines were observed in patients who developed CTRCD during treatment.

Electronically Delivered Nudges to Increase Influenza Vaccination Uptake in Older Adults With Diabetes: A Secondary Analysis of the NUDGE-FLU Trial

Importance

Influenza vaccination is associated with a reduced risk of mortality in patients with diabetes, but vaccination rates remain suboptimal.

Objective

To assess the effect of electronic nudges on influenza vaccination uptake according to diabetes status.

Design, Setting, and Participants

The NUDGE-FLU (Nationwide Utilization of Danish Government Electronic Letter System for Increasing Influenza Vaccine Uptake) trial was a nationwide clinical trial of Danish citizens 65 years or older that randomized participants at the household level to usual care or 9 different electronic nudge letters during the 2022 to 2023 influenza season. End of follow-up was January 1, 2023. This secondary analysis of the NUDGE-FLU trial was performed from May to July 2023.

Intervention

Nine different electronic nudge letters designed to boost influenza vaccination were sent in September to October 2022. Effect modification by diabetes status was assessed in a pooled analysis of all intervention arms vs usual care and for individual letters.

Main Outcomes and Measures

The primary end point was receipt of a seasonal influenza vaccine.

Results

The trial included 964 870 participants (51.5% female; mean [SD] age, 73.8 [6.3] years); 123 974 had diabetes. During follow-up, 83.5% with diabetes vs 80.2% without diabetes received a vaccine (P < .001). In the pooled analysis, nudges improved vaccination uptake in participants without diabetes (80.4% vs 80.0%; difference, 0.37 percentage points; 99.55% CI, 0.08 to 0.66), whereas there was no evidence of effect in those with diabetes (83.4% vs 83.6%; difference, -0.19 percentage points; 99.55% CI, -0.89 to 0.51) (P = .02 for interaction). In the main results of NUDGE-FLU, 2 of the 9 behaviorally designed letters (cardiovascular benefits letter and a repeated letter) significantly increased uptake of influenza vaccination vs usual care; these benefits similarly appeared attenuated in participants with diabetes (cardiovascular gain letter: 83.7% vs 83.6%; difference, 0.04 percentage points; 99.55% CI, -1.52 to 1.60; repeated letter: 83.5% vs 83.6%; difference, -0.15 percentage points; 99.55% CI, -1.71 to 1.41) vs those without diabetes (cardiovascular gain letter: 81.1% vs 80.0%; difference, 1.06 percentage points; 99.55% CI, 0.42 to 1.70; repeated letter: 80.9% vs 80.0%; difference, 0.87 percentage points; 99.55% CI, 0.22 to 1.52) (P = .07 for interaction).

Conclusions and Relevance

In this exploratory subgroup analysis, electronic nudges improved influenza vaccination uptake in persons without diabetes, whereas there was no evidence of an effect in persons with diabetes. Trials are needed to investigate the effect of digital nudges specifically tailored to individuals with diabetes.

Trial Registration

ClinicalTrials.gov Identifier: NCT05542004.

The Effect of Sacubitril/Valsartan on Left Ventricular Myocardial Deformation in Heart Failure with Preserved Ejection Fraction (PARAMOUNT trial)

BACKGROUND

Global longitudinal strain (GLS) and global circumferential strain (GCS) have been shown to be impaired in heart failure with preserved ejection fraction. We sought to assess whether treating patients with heart failure with preserved ejection fraction with sacubitril/valsartan would significantly improve GLS and GCS compared with valsartan alone.

METHODS AND RESULTS

PARAMOUNT (Prospective Comparison of ARNI With ARB on Management of Heart Failure With Preserved Ejection Fraction Trial) was a phase II, randomized, parallel-group, double-blind multicenter trial in 301 patients with New York Heart Association functional class II-III heart failure, a left ventricular ejection fraction of 45%, and an N-terminal pro-B-type natriuretic peptide of ≥400 pg/mL. Participants were randomly assigned (1:1) to sacubitril/valsartan titrated to 200 mg twice daily or valsartan titrated to 160 mg twice daily for 36 weeks. We assessed changes in the GLS and the GCS from baseline to 36 weeks, adjusting for baseline value, in patients with sufficient imaging quality for 2-dimensitonal speckle tracking analysis at both timepoints (n = 60 sacubitril/valsartan, n = 75 valsartan only). GCS was significantly improved at 36 weeks in the sacubitril/valsartan group when compared with the valsartan group (Δ4.42%, 95% confidence interval [CI] 0.67-8.17, P = .021), with no significant difference observed in GLS (Δ0.25%, 95% CI, -1.19 to 1.70, P = .73). Patients with a history of hospitalization for heart failure had a differentially greater improvement in GCS when treated with sacubitril/valsartan.

CONCLUSIONS

In patients with heart failure with preserved ejection fraction, sacubitril/valsartan improved GCS but not GLS when compared with valsartan during a 36-week period. This trial is registered at ClinicalTrials.gov, NCT00887588.

EMERGE: Evaluating the value of Measuring Random Plasma Glucose Values for Managing Hyperglycemia in the Inpatient Setting

IMPORTANCE

A diagnosis of diabetes is considered when a patient has hyperglycemia with a random plasma glucose ≥200 mg/dL. However, in the inpatient setting, hyperglycemia is frequently non-specific, especially among patients who are acutely unwell. As a result, patients with transient hyperglycemia may be incorrectly labeled as having diabetes, leading to unnecessary treatment, and potential harm.

DESIGN, SETTING, AND PARTICIPANTS

We conducted a multicenter cohort study of patients hospitalized at six hospitals in Ontario, Canada, and identified those with a glucose value ≥200 mg/dL (including standing measurements and randomly drawn). We validated a definition for diabetes using manual chart review that included physician notes, pharmacy notes, home medications, and hemoglobin A1C. Among patients with a glucose value ≥200 mg/dL (11.1 mmol/L), we identified patients without diabetes who received a diabetes medication, and the number who experienced hypoglycemia during the same admission.

MAIN OUTCOMES AND MEASURES

To determine the diagnostic value of using random blood glucose to diagnose diabetes in the inpatient setting, and its impact on patient outcomes.

RESULTS

We identified 328,786 hospitalizations from hospital between 2010 and 2020. A blood glucose value of ≥200 mg/dL (11.1 mmol/L) had a positive predictive value of 68% and a negative predictive value of 90% for a diagnosis of diabetes. Of the 76,967 patients with an elevated glucose value reported, 16,787 (21.8%) did not have diabetes, and of these, 5375 (32%) received a diabetes medication. Hypoglycemia was frequently reported among the 5375 patients that received a diabetes medication, with 1406 (26.2%) experiencing hypoglycemia and 405 (7.5%) experiencing severe hypoglycemia.

CONCLUSIONS AND RELEVANCE

Hyperglycemia in hospital is common but does not necessarily indicate a patient has diabetes. Furthermore, it can lead to treatment with diabetes medications with potential harm. Our findings highlight that clinicians should be cautious when responding to elevated random plasma glucose tests in the inpatient setting.

Left atrial coupling index predicts heart failure and atrial fibrillation in the general population

Background

It is well known that left atrial (LA) function and size can provide significant information regarding the risk of atrial fibrillation (AF) and heart failure (HF). The ratio of LA volume index and tissue doppler imaging a' (peak myocardial velocity of the left ventricle in late diastole exposing the atrial contraction) provides the LA volumetric/mechanical coupling index (LACi). LACI is a novel echocardiographic measurement which combines information of LA size and function in one measure with limited previous investigation.

Purpose

The aim of the present study was to investigate the prognostic value of LACi in relation to incident HF and AF in the general population.

Methods

The present study included 4,003 participants from a prospective general population. All participants were examined with echocardiography. Incident HF and AF were investigated as separate outcomes. Exclusion criteria were AF and/or HF at baseline. LACi was calculated as the index of LAVI (left atrial volume index) and peak tissue velocity at late diastole measured with pulsed wave Doppler at the septal base of the left ventricle.

Results

Mean age was 56±17 years, 57% were female, and median LACi was 2.3 [IQR: 1.8, 3.0]. The median follow-up time was 5.4 [IQR: 4.5, 6.3] years. A total of 82 and 164 developed HF and AF during follow-up, respectively. Median LACi was significantly higher among participants developing HF (2.6 [IQR: 2.1, 3.8], P&lt;0.001) and AF (2.8 [IQR: 2.1, 4.1], P&lt;0.001) compared to those who remained event free (2.3 [IQR: 1.8, 3.0]). Multivariable Cox proportional hazard regression models were constructed and adjusted for gender, age, smoking status, hypercholesterolemia, diabetes mellitus, ischaemic heart disease at baseline, hypertension, left ventricular ejection fraction and left ventricular diastolic function (E/e'). LACi was an independent predictor of incident HF and of AF in both univariable and multivariable Cox regression models (Figure 1). LACi remained a significant predictor of both HF and AF in a sensitivity analysis with subgroups in which LAVI was normal and enlarged, respectively (Figure 1).

Conclusion

LACi is an independent predictor of HF and AF in the general population.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): The Danish Heart Foundation and The Metropolitan Region of Denmark.

The association between cholesterol remnants and cardiac structure and function

Background

Cardiac disease is the most common cause of death in Europe and is a rising problem globally. Recently, a causal relationship between ischemic heart disease and cholesterol remnants has been suggested by genetic studies. Additionally, new studies have shown that cholesterol remnants were independently related to later development of ischemic disease in individuals free of known heart disease. Finally, in patients suffering from type 1 diabetes, one study demonstrated an association between cholesterol remnants and cardiac function indicating early signs of cardiac pathology.

Purpose

To investigate whether cholesterol remnants are associated with alterations in cardiac structure and function, as evaluated by sensitive echocardiographic measures, in individuals from the general population without known heart disease.

Methods

The study sample consisted of 3,792 participants from a general population cohort without known heart disease. All participants had blood samples withdrawn for analysis and were examined with comprehensive echocardiography including both conventional measurements and two-dimensional speckle tracking analysis. Cholesterol remnant levels were calculated from lipid analyses in non-fasting venous blood samples using the following formula: cholesterol remnants = total-cholesterol − HDL-cholesterol − LDL-cholesterol.

Results

In multivariable analyses increasing levels of cholesterol remnants were associated with significant alterations in cardiac function, demonstrated as a decrease in left ventricular ejection fraction (β=−0.686, P=0.001), a decrease in E/A ratio (β=−0.109, P&lt;0.001) and a decrease in global longitudinal strain (β=−1.195 P=0.014) (Figure 1). The multivariable model was adjusted for age, sex, body mass index, hypertension, diabetes and smoking status. This association was significantly stronger than the association with cardiac alterations and LDL levels with the most significant difference regarding LVEF (cholesterol remnants: β=−0.158, P&lt;0.001) and (LDL: β=−0.016, P=0.353). Additionally, increasing levels of cholesterol remnants were associated with alterations in cardiac structure (IVSd, LVIDd, LVPWd, LVMi and RWT) in the univariable analysis, but these associations were attenuated after multivariable adjustment.

Conclusion

In a general population sample without known heart disease, alterations in cardiac function expressed as both impaired systolic and impaired diastolic function were present with increasing levels of cholesterol remnants. This association was stronger than the association between the cardiac alterations and LDL-cholesterol levels. The findings support the need for testing treatment options aimed specifically at cholesterol remnants, also in the general population.

Funding Acknowledgement

Type of funding sources: None.

Increased circumferential deformation predicts cardiac events when left ventricular ejection fraction is normal

Background

Recent research suggests that early left ventricular (LV) systolic dysfunction is characterized by compromised longitudinal function and a concomitant augmentation of circumferential deformation expressed as increased global circumferential strain (GCS). It is hypothesized that increased GCS could be used to identify people at higher risk of cardiovascular events when left ventricular ejection fraction (LVEF) is preserved.

Purpose

The present study aimed to investigate whether elevated GCS in individuals with preserved LVEF predicts major adverse cardiovascular events (MACE).

Methods

A total of 2,874 participants from the general population were included in this prospective cohort study. All participants had echocardiography performed and analyzed. Exclusion criteria were HF at baseline, non-sinus rhythm during echocardiography, and inadequate image quality for GCS assessment. Outcome was MACE including incident heart failure, myocardial infarction, and/or cardiovascular death. Absolute values of strain were used. To determine the optimal transition point of a potential effect modification, Cox regression models with different LVEF thresholds were created. The model with the optimal hazard ratio (HR) and P values of the interaction terms and Akaike information criterion was chosen.

Results

Mean age was 53±18 years and 60% were female. Mean LVEF and GCS were 57±6% and 21.6±4.0%, respectively. Median follow-up was 3.5 years [IQR: 2.6; 4.4] and a total of 92 (3.2%) developed MACE. A U-shaped relationship was observed between GCS and MACE. The lowest incidence rate was within the GCS range of 20 to 25% (Figure 1a). A significant interaction (P&lt;0.001) between GCS and LVEF was observed regarding MACE. The optimal transition point for this effect modification was determined to be LVEF=50%. In multivariable Cox regressions (including conventional cardiovascular risk factors and global longitudinal strain (GLS)), increasing GCS was significantly associated with future MACE in participants with LVEF ≥50% (HR=1.09 [95% CI: 1.01; 1.17] per 1% increase, n=2420) while decreasing GCS were associated with a higher risk of MACE in individuals with abnormal LVEF (HR=1.16 [95% CI: 1.04; 1.29] per 1% decrease, n=289) (Figure 1b). A total of 50 (2.1%) developed the MACE amongst the participants with LVEF ≥50%. This group had significantly lower GLS (19.0±2.7% vs 19.9±2.0%, P=0.013) and ratio of peak early transmitral filling velocity to peak early diastolic tissue velocity (E/e') (10.7 [IQR: 7.9; 14.3] vs 6.5 [5.3; 8.4], P&lt;0.001) compared to the participants that did not develop MACE with normal LVEF. Figure 2 illustrates a model of the development of GCS, LVEF, GLS, and E/e' as LV function declines.

Conclusion

In the general population, the prognostic value of GCS is modified by LVEF. In participants with normal LVEF, higher GCS was associated with increased risk of MACE, while the opposite was observed in participants with abnormal LVEF.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The Copenhagen City Heart Study is funded by The Danish Heart FoundationThe Metropolitan Region of Denmark (public funding).

Changes in myocardial tissue velocities over a decade: the Copenhagen City Heart study

Background

The aim of the present study was to investigate the impact of cardiovascular risk factors – age, sex, hypertension, hypercholesterolemia, diabetes, smoking and obesity on Tissue Doppler imaging (TDI) measures of systolic and diastolic tissue velocities in the general population over a 10-year period. Identifying risk factors that are associated with changes in TDI velocities could lead to an improved understanding of the pathophysiology of the deteriorating heart and enable early preventive actions and strategies.

Methods

The study included 1128 members from the general population who participated in both the 4th and 5th Copenhagen City Heart Study. At both examination rounds, the participants underwent echocardiography. The examinations were 10 years apart. Conventional echocardiographic measures of cardiac structure and function and measures of TDI myocardial tissue velocities were obtained.

Results

Average change in s', e' and a' were −0.4±1.1 cm/s, −0.9±1.7 cm/s and 0.5±1.7 cm/s, respectively. After multivariable adjustments, older age (P&lt;0.001) and higher systolic blood pressure (BP) (P=0.029) were found to be associated with a decrease in s' at follow-up. Male sex (P&lt;0.001) was found to be associated with an increase in s'. Older age (P&lt;0.001) and greater number of smoking pack-years (P=0.004) were associated with a decrease in e' at follow-up after multivariable adjustments. In addition, greater BMI (P=0.004) was significantly associated with a decrease in a'. Higher diastolic BP (P=0.004) and male sex (P=0.004) were associated with an increase in a'.

Conclusion

In the general population, overall systolic and diastolic function declined over a 10-year period. Both systolic and diastolic function as assessed by myocardial TDI velocities were affected by multiple conventional cardiovascular risk factors.

Funding Acknowledgement

Type of funding sources: None.

The prognostic value of right ventricular free wall and global longitudinal strain in the general population

Background

Right ventricular free wall (RVFWLS) and global longitudinal strain (RV4CLS) have been shown to be prognostic of adverse events in various patient groups including patients with heart failure (HF).

Purpose

We sought to investigate the prognostic value of RVFWLS and RV4CLS for the development of incident HF in participants from the general population.

Methods

Participants from the echocardiographic substudy of the 5th Copenhagen City Heart Study (2011–2015) without chronic ischemic heart disease or heart failure at baseline were included. RVFWLS and RV4CLS were obtained using two-dimensional speckle-tracking echocardiography from the RV-focused apical 4-chamber view. The primary endpoint was incident HF.

Results

Among 2,804 participants (mean age 55, 42% male), 45 (1.6%) developed HF during a median follow-up of 5.4 years (IQR 4.5–6.3). Both RVFWLS and RV4CLS were associated with increased risk of HF in univariable cox regression analysis (HR 1.07, 95% confidence interval (CI) 1.02–1.12, p=0.003, and HR 1.21, 95% CI 1.11–1.31, p&lt;0.001, respectively). Upon adjustment for age, sex, hypertension, diabetes and body mass index (BMI), both RVFWLS and RV4CLS remained associated with increased risk of incident HF (HR 1.05, 95% CI 1.00–1.11, p=0.038 and HR 1.13, 95% CI 1.04–1.22, p=0.004, respectively).

Conclusion

RVFWLS and RV4CLS were associated with an increased risk of incident HF in participants from the general population independent of age, sex, hypertension, diabetes and BMI.

Funding Acknowledgement

Type of funding sources: None.

The impact of cardiovascular risk factors on left atrial strain over a decade

Background

Peak atrial longitudinal strain (PALS) has previously been shown to predict cardiovascular morbidity and mortality in the general population. However, the impact of cardiovascular risk factors on PALS over a decade in participants from the general population is unknown.

Purpose

The aim of this study was to investigate the impact of cardiovascular risk factors (age, sex, mean arterial pressure (MAP), body mass index (BMI), smoking, total plasma cholesterol, HbA1c, physical activity level, socioeconomic and psychosocial status) on change in PALS over a 10-year period in participants from the general population.

Methods

The present study included a total of 208 (mean age 61±14 years, 60% female) participants from the general population, who underwent a health examination including two-dimensional speckle tracking echocardiography of the left atrium at baseline examination and follow-up examination. The median time between the examinations was 10 years (interquartile range, 10.2–10.7 years). PALS was calculated as the average from the three apical views.

Crude and multivariable linear regression analyses were performed to determine the impact of cardiovascular risk factors on the change in PALS. The multivariable regression model was adjusted for age, sex, MAP, BMI, smoking, total plasma cholesterol, HbA1c, heart rate, eGFR, proBNP and previous ischemic heart disease. All analyses were adjusted for baseline value of PALS (baseline value). Restricted cubic spline curves were constructed to illustrate the relationship between the PALS and continuous cardiovascular risk factors.

Results

During 10-year follow-up, the average decrease in PALS was 4±16%. In the crude regression model increasing age (standardized = −0.27, p&lt;0.001), MAP (standardized = −0.19, p&lt;0.001), BMI (standardized = −0.19, p&lt;0.001), smoking (standardized = −0.12, p=0.013), higher cholesterol levels (standardized = −0.16, p=0.001), and higher levels of HbA1c (standardized = −0.14, p=0.004) were associated with an accelerated decrease in PALS. Relationship between the PALS and significant continuous cardiovascular risk factors are displayed in restricted cubic spline curves (Figure 1).

In the multivariable regression model, age (standardized = −0.19, p=0.001), BMI (standardized = −0.18, p=0.001) and smoking (standardized = −0.15, p=0.003) remained independent predictors of an accelerated decrease in PALS.

Conclusion

In the general population, increasing age, BMI and smoking were independently associated with an accelerated decrease in PALS over a decade.

Funding Acknowledgement

Type of funding sources: None.

The effects of smoking on cardiac structure and function in a general population

Background

Cigarette smoking is the leading preventable cause of death worldwide. Smoking is known to cause coronary artery disease, but studies have also shown that smoking independently is associated with higher risk of heart failure. However, the link between smoking and cardiac structure and function is not yet fully examined.

Purpose

The aim of the study was to investigate the independent effect of cigarette smoking on cardiac structure and function in a general population using echocardiographic measures.

Methods

A prospective cohort of 3,874 participants from a general population free of prevalent heart disease underwent an echocardiographic examination including two-dimensional speckle-tracking analysis. Smoking history was obtained through a self-administered questionnaire, that generated three groups; current smokers (18.6%), former smokers (40.9%) and never smokers (40.5%). Pack-years were estimated from the questionnaire.

Results

After multivariable adjustment for age, sex, body mass index, hypertension, hypercholesterolemia, diabetes and lung function, current smokers had significantly alterations in septal thickness (1.1±0.2 cm, P=0.018) and relative wall thickness (0.4±0.1 cm, P=0.016) compared to never smokers. Furthermore, left ventricular mass index (LVMi) was increased in current smokers compared to never smokers (85.8±19.3 g/cm2, P=0.048). Reduced left ventricle systolic function as assessed by global longitudinal strain (GLS) was evident in current smokers compared to never smokers (19.1±2.3%, P&lt;0.001). Additionally, after multivariable adjustment increasing pack-years was associated with decreases in left ventricular ejection fraction (LVEF) (β=−0.04, P=0.031), E/A ratio (β=−0.06, P&lt;0.001) and GLS (β=−0.04, P=0.008). Comparing cardiac structure and function in never smokers, continuous smokers and former smokers after 10 years, showed that continuous smokers developed increased LVMi (Δ=3.97±17.48 g/cm2, P&lt;0.001) and decreased GLS (Δ=−0.77±3.84%, P=0.04) and LVEF (Δ=−4.23±5.7, P&lt;0.001) compared to never and former smokers.

Conclusion

In a large general population study without known heart disease, current smoking and accumulated pack-years were independently associated with alterations in cardiac structure and reduced systolic function. Furthermore, we found that continuous smokers over a 10-year period developed relatively worse systolic function and increased LV structure alterations compared to never smokers and to participants that stopped smoking during that period.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The Copenhagen City Heart Study is funded by The Danish Heart Foundation andThe Metropolitan Region of Denmark.

Heart failure in COVID-19: the multicentre, multinational PCHF-COVICAV registry

Aims

We assessed the outcome of hospitalized coronavirus disease 2019 (COVID‐19) patients with heart failure (HF) compared with patients with other cardiovascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia). We further wanted to determine the incidence of HF events and its consequences in these patient populations.

Methods and results

International retrospective Postgraduate Course in Heart Failure registry for patients hospitalized with COVID‐19 and CArdioVascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia) was performed in 28 centres from 15 countries (PCHF‐COVICAV). The primary endpoint was in‐hospital mortality. Of 1974 patients hospitalized with COVID‐19, 1282 had cardiovascular disease and/or risk factors (median age: 72 [interquartile range: 62–81] years, 58% male), with HF being present in 256 [20%] patients. Overall in‐hospital mortality was 25% (n = 323/1282 deaths). In‐hospital mortality was higher in patients with a history of HF (36%, n = 92) compared with non‐HF patients (23%, n = 231, odds ratio [OR] 1.93 [95% confidence interval: 1.44–2.59], P < 0.001). After adjusting, HF remained associated with in‐hospital mortality (OR 1.45 [95% confidence interval: 1.01–2.06], P = 0.041). Importantly, 186 of 1282 [15%] patients had an acute HF event during hospitalization (76 [40%] with de novo HF), which was associated with higher in‐hospital mortality (89 [48%] vs. 220 [23%]) than in patients without HF event (OR 3.10 [2.24–4.29], P < 0.001).

Conclusions

Hospitalized COVID‐19 patients with HF are at increased risk for in‐hospital death. In‐hospital worsening of HF or acute HF de novo are common and associated with a further increase in in‐hospital mortality.