Effects of Liraglutide, Empagliflozin and Their Combination on Left Atrial Strain and Arterial Function

Background and Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are cardioprotective drugs. We investigated their effects on left atrial function, a major determinant of cardiac diastolic dysfunction in type 2 diabetes mellitus. We also explored the association of changes in arterial stiffness with those of the LA strain after treatment. Materials and Methods: A total of 200 patients (59.5 ± 9.1 year old, 151 male) with type 2 diabetes mellitus treated with metformin were randomized to insulin (n = 50 served as controls), liraglutide (n = 50), empagliflozin (n = 50) or their combination (liraglutide + empagliflozin) (n = 50). We measured at baseline and 6 months post-treatment: (a) left atrial and global left ventricular longitudinal strain by speckle tracking echocardiography; (b) pulse wave velocity (PWV) and central systolic blood pressure. Results: At baseline, there was a correlation of the LA reservoir strain with PWV (r = -0.209, p = 0.008), central SBP (r = -0.151, p = 0.030), EF (r = 0.214, p = 0.004) and GLS (r = -0.279, p = 0.009). The LA reservoir change 6 months post-treatment was correlated with the PWV change in all groups (r = -0.242, p = 0.028). The LA reservoir change 6 months post-treatment was correlated with the GLS change in all groups (r = -0.322, p = 0.004). Six months after intervention, patients treated with liraglutide, empagliflozin and their combination improved the left atrial reservoir strain (GLP1RA 30.7 ± 9.3 vs. 33.9 ± 9.7%, p = 0.011, SGLT2i 30 ± 8.3 vs. 32.3 ± 7.3%, p = 0.04, GLP1&SGLT2i 29.1 ± 8.7 vs. 31.3 ± 8.2, p = 0.007) compared to those treated with insulin (33 ± 8.3% vs. 32.8 ± 7.4, p = 0.829). Also, patients treated with liraglutide and the combination liraglutide and empagliflozin had improved left atrial conduction strain (p < 0.05). Empagliflozin or the combination liraglutide and empagliflozin showed a greater decrease of PWV and central and brachial systolic blood pressure than insulin or GLP-1RA. (p < 0.05). Conclusions: Impaired aortic elastic properties are associated with a decreased LA strain in type 2 diabetics. Treatment with liraglutide, empagliflozin and their combination for 6 months showed a greater improvement of left atrial function compared to insulin treatment in parallel with the improvement of arterial and myocardial functions.

Endothelial Glycocalyx Integrity in Treatment-Naïve People Living with HIV before and One Year after Antiretroviral Treatment Initiation

Endothelial glycocalyx (EG) derangement has been associated with cardiovascular disease (CVD). Studies on EG integrity among people living with HIV (PLWH), are lacking. We conducted a prospective cohort study among treatment-naïve PLWH who received emtricitabine/tenofovir alafenamide, combined with either an integrase strand transfer inhibitor (INSTI, dolutegravir, raltegravir or elvitegravir/cobicistat), or a protease inhibitor (PI, darunavir/cobicistat). We assessed EG at baseline, 24 (±4) and 48 (±4) weeks, by measuring the perfused boundary region (PBR, inversely proportional to EG thickness), in sublingual microvessels. In total, 66 consecutive PLWH (60 (90.9%) males) with a median age (interquartile range, IQR) of 37 (12) years, were enrolled. In total, 40(60.6%) received INSTI-based regimens. The mean (standard deviation) PBR decreased significantly from 2.17 (0.29) μm at baseline to 2.04 (0.26) μm (p = 0.019), and then to 1.93 (0.3) μm (p < 0.0001) at 24 (±4) and 48 (±4) weeks, respectively. PBR did not differ among treatment groups. PLWH on INSTIs had a significant PBR reduction at 48 (±4) weeks. Smokers and PLWH with low levels of viremia experienced the greatest PBR reduction. This study is the first to report the benefit of antiretroviral treatment on EG improvement in treatment-naïve PLWH and depicts a potential bedside biomarker and therapeutic target for CVD in PLWH.

Additive prognostic value of longitudinal myocardial deformation to SCORE2 in psoriasis

Aims

Psoriasis has been associated with increased cardiovascular (CV) risk. We investigated whether markers of CV function and their change after treatment have a prognostic value for adverse outcomes.

Methods and results

In a prospective study, at baseline and after 6 months of treatment with biological agents, we assessed in 298 psoriasis patients (i) left ventricular global longitudinal strain (GLS) and (ii) carotid-femoral pulse wave velocity (PWV), to evaluate their prognostic value for major adverse cardiovascular events (MACEs), including coronary artery disease, stroke, hospitalization for heart failure, and all-cause death over a 4-year follow-up period. During follow-up, 26 (8.7%) MACEs were recorded. By univariate analysis, decreasing absolute GLS values [hazard ratio (HR): 0.73, P < 0.001], decreasing GLS change after treatment (HR: 0.53, P = 0.008), and increasing PWV values (HR: 1.16, P = 0.049) were associated with adverse outcomes. Baseline GLS and its change post-treatment remained independent predictors of adverse events after adjusting for several confounders (P < 0.05). The addition of baseline GLS and its absolute change post-treatment to SCORE2 increased Harrell's C from 0.882 to 0.941. By multivariable analysis, for each 1% increase in absolute baseline GLS values, the risk of MACE decreased by 33% and for each 1% absolute increase of GLS post-treatment compared with the baseline value, the risk of MACE decreased by 58%.

Conclusion

Global longitudinal strain has an independent and additive prognostic value to SCORE2 for adverse CV events in psoriasis, providing timely decision-making for intensive anti-inflammatory treatment and aggressive modification of risk factors to reduce CV risk.

Four-month treatment with long-acting glucagon-like peptide-1 receptor agonists (GLP-1) or sodium-glucose co-trasporter-2 inhibitors (SGLT-2i) improves vascular function in type 2 diabetes mellitus

Background/Introduction

Patients with type 2 diabetes mellitus (T2DM) and ischemic stroke present impaired markers of vascular and endothelial function. Glucagon-like peptide-1 receptor agonists (GLP-1) and sodium-glucose contrasporter-2 inhibitors (SGLT-2) are novel antidiabetic agents reducing the risk of cardiovascular complications.

Purpose

The aim of the study is to investigate the effect of treatment with GLP-1 or SGLT2 on arterial stiffness and endothelial glycocalyx in patients with T2DM and ischemic stroke.

Methods

We recruited in total 81 patients with T2DM and ischemic stroke who received dulaglutide (n=27), dapagliflozin (n=27) or insulin (n=27). We measured at baseline and at four months post-treatment the: a) Carotid-femoral pulse wave velocity (PWV-Complior; ALAM Medical), b) Augmentation index (Aix), c) Central systolic blood pressure (cSBP), and d) Perfused boundary region (PBR) of the sublingual arterial microvessels(marker of endothelial glycocalyx thickness), e) Left ventricular global longitudinal strain (GLS) using speckle-tracking echocardiography.

Results

At baseline, patients among the three groups had similar age, sex, HbA1c and markers of endothelial and cardiovascular function (p&gt;0.05). Dapagliflozin and dulaglutide showed a greater reduction of PBR, PWV and central SBP than insulin, despite a similar HbA1c reduction (p&lt;0.05). After four months treatment, patients on dapagliflozin and on dulaglutide displayed a greater reduction of PWV (−10% and −8% vs −1%), of cSBP (−9% and −8% vs +1%), of Aix (−65% and −13% vs −3%) and of GLS (+11% and +7% vs +5%) compared to patients on insulin (p&lt;0.05 for all comparisons) (Table 1). PBR values were improved only in patients who received dulaglutide (−4% vs dapagliflozin: −2% vs insulin +1%).

Conclusions

Dulaglutide and dapagliflozin improve cardiovascular function, but only dulaglutide improves endothelial glycocalyx in patients with T2DM and ischemic stroke after four months treatment.

Funding Acknowledgement

Type of funding sources: None.

Endothelial glycocalyx improvement after six months and one-year of antiretroviral therapy in treatment naive patients with human immunodeficiency virus

Background

Chronic inflammation induced by Human Immunodeficiency Virus (HIV) plays a key role in the development of early cardiovascular (CV) disease. The impact of currently recommended first line antiretroviral therapy (ART) on CV risk early after treatment initiation is still under investigation. We aimed to explore any treatment-induced changes in endothelial function through endothelial glycocalyx measurement (EG) in treatment naïve HIV patients' one year post HIV treatment initiation by different ART agents.

Methods

We estimated endothelial function by endothelial glycocalyx integrity measurement in 58 recently diagnosed and treatment naïve HIV patients (mean age=38+10 years, 91% males, 61% smokers) at baseline and at 1-year post ART initiation (integrase or protease inhibitors). Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranged from 5–25 micrometers) using Sideview Darkfield imaging (Microscan, Glycocheck) was measured as a non-invasive accurate index of reduced EG thickness.

Results

From a total population of 54 HIV patients, 35 patients were randomly treated by the newer integrase inhibitor Dolutegravir (Group A, mean age = 37±10 years, 89% males, 54% smokers) while 22 patients by the older protease inhibitor Darunavir/Cobicistat (Group B, mean age = 38±10 years, 95% males, 74% smokers). No differences were found between groups regarding age, weight, lipid profile (LDL-C, HDL-C, triglycerides), office (SBP, DBP) and central (cBP) blood pressure. We found that weight (76±14 vs. 81±16 kg, p&lt;0.001), SBP (125±12 vs. 130±14 mmHg, p=0.003) and cBP (116±12 vs. 121±12 mmHg, p=0.001) were increased in the entire HIV population, at 1 year post-treatment. At 6 months evaluation, PBR5–25 was decreased in the entire HIV population and Group A (2.18±0.3 μm vs. 2.05±0.3 μm, p=0.01 and 2.19±0.3 μm vs. 2.02±0.3 μm, p=0.02, respectively). However, at 1-year post treatment evaluation, PBR5–25 was decreased in all groups, total HIV population, Group A and Group B (2.18±0.3 μm vs. 1.96±0.3 μm, p&lt;0.001, 2.19±0.3 μm vs. 1.93±0.3 μm, p=0.003 and 2.17±0.3 vs. 1.99±0.3, p=0.04, respectively).

Conclusions

Endothelial function, estimated by endothelial glycocalyx integrity, is improved in newly diagnosed and treatment naïve HIV patients, evaluated at 6 and 12 months post-treatment initiation by integrase or protease inhibitors despite weight and blood pressure increase.

Funding Acknowledgement

Type of funding sources: None.

Differences in coronary flow reserve and flow-mediated dilation between plaque psoriasis and psoriatic arthritis

Background/Introduction

Psoriatic disease is associated with increased cardiovascular risk through mechanisms of inflammation and oxidative stress.

Purpose

We aimed to investigate endothelial glycocalyx, coronary microcirculatory function and flow-mediated dilation in patients with plaque psoriasis and psoriatic arthritis.

Methods

In 311 patients (mean age: 52±12 years) with psoriatic disease (185 with plaque psoriasis and 126 with psoriatic arthritis) and 150 controls with similar age, sex and atherosclerotic risk factors, we assessed: (1) Perfused boundary region (PBR) of the sublingual microvessels with a diameter 5–25μm using Sidestream Dark Field camera (Microscan, Glycocheck). Increased PBR indicates impaired glycocalyx integrity. (2) Coronary flow reserve (CFR) in the distal left anterior descending coronary artery, (3) Flow-mediated dilation (FMD) of the brachial artery, and (4) LV global longitudinal strain (GLS) using speckle-tracking echocardiography.

Results

Compared with controls, patients with psoriatic disease had higher PBR (2.14±0.29 versus 1.78±0.25μm, p&lt;0.001) and lower CFR (2.86±0.93 versus 3.39±0.68, p&lt;0.001), FMD (6.97±3.9 versus 9.1±2.1, p&lt;0.001) and GLS (−17.4±3.8 versus −21.9±1.5%, p&lt;0.001). There was not significant difference between the two study groups (plaque psoriasis and psoriatic arthritis) in PBR (2.14±0.28 versus 2.14±0.31μm, p=0.990) and GLS (−17.2±3.9 versus −17.6±3.8%, p=0.297). Patients with psoriatic arthritis had more impaired CFR (2.75±0.85 versus 2.96±0.99, p=0.045) and FMD (5.45±3.2 versus 7.76±4, p=0.003) compared to patients with plaque psoriasis.

Conclusions

Patients with psoriatic disease have impaired endothelial, vascular and myocardial function compared with controls. Coronary microcirculatory function and flow-mediated dilation are more affected in psoriatic arthritis compared with plaque psoriasis.

Funding Acknowledgement

Type of funding sources: None.

The additive predictive value of arterial stiffness for outcome to endothelial glycocalyx and SCORE in middle age individuals: 6 years follow-up

Background/Aim

Arterial stiffness is involved in the clinical course of atherogenesis. We have previously shown that PBR, a marker of glycocalyx integrity is predictor of cardiovascular events in patients without established cardiovascular disease. The purpose of this study was to investigate whether altered arterial properties of the vessels confers predictively and additively to estimation of cardiovascular risk.

Methods

Pulse wave velocity carotid-femoral (PWVc-f), the gold standard method to assess arterial stiffness, was measured non-invasively by Complior device. Increased PWV(c-f), especially above 10 m/s, indicates increased arterial stiffness. We measured baseline PWV(c-f) in 600 apparently healthy subjects (47.61±13.84 years old, 50.1% males), without established cardiovascular disease. We prospectively monitored the occurrence of major cardiovascular events (MACE-death, myocardial infarction, stroke and heart failure hospitalization) during a 6-year follow-up period using electronic records and clinic visits.

Results

Fifty-seven MACEs were documented during follow-up. In univariate analysis, subjects with increased PWV were found to exert greater risk for MACEs (hazard ratio (HR): 1.09, 95% CI: 1.02–1.17, p=0.01). In all subjects, PWV predicted higher risk for MACEs in a model including PBR, sex, age, hyperlipidemia, diabetes, hypertension, current smoking, family history of coronary artery disease and treatment with ACEi/ARBs or lipid lowering agents (HR: 1.12; 95% CI: 1.04–1.17, p=0.029,net reclassification improvement (NRI): 23%; C-statistic: from 0.644 to 0.697). However, only in participants older than 50 years old, PWV was an independent and additive predictor of outcome when added in a model including PBR, SCORE, those risk factors not included in SCORE (diabetes, family history of CAD) and medication (HR: 1.09; 95% CI: 1.02–1.13, NRI: 23.8%, C-statistic increase from 0.703 to 0.762, p&lt;0.01).

Conclusion

Arterial stiffness is an independent and additive predictor to endothelial glycocalyx and SCORE for adverse outcome at 6 years follow-up in individuals over 50 years old.

Funding Acknowledgement

Type of funding sources: None.

Isolated diastolic hypertension is not a benign situation regarding hypertension mediated organ damage in patients with first diagnosed and never treated essential hypertension

Background

Isolated diastolic hypertension (IDH) usually remains untreated as it is considered benign compared to isolated systolic or combined systolic/diastolic hypertension. Hypertension mediated organ damage (HMOD) needs to be assessed in each individual hypertensive patient in order to estimate cardiovascular risk. We aimed to investigate the HMOD differences between first diagnosed and never treated patients with IDH compared to normotensive subjects.

Methods

From 550 first diagnosed and never-treated hypertensive and non-diabetic patients, we studied 81 patients with IDH (mean age = 49±9, 63% males, 26% smokers) and 53 normotensives (mean age = 51±13, 30% males, 28% smokers). Office and ambulatory blood pressure monitoring (24h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia and HMOD [aortic stiffness (PWV), left ventricular diastolic dysfunction (EEa), cardiac mass (LVMI) and cardiac hypertrophy (LVH), coronary arteries microcirculation (CFR), carotid intima-media thickness (cIMT) were estimated in each hypertensive patient as well as normotensive subject.

Results

IDH patients had similar age, BMI, lipid profile, central systolic BP and smoking habit, and increased systolic (139±12 vs. 133±18, p=0.03), diastolic (89±9 vs. 84±9 mmHg, p=0.02) and mean office BP (106±9 vs. 82±9 mmHg, p&lt;0.001) as well as 24h systolic (125±3 vs. 119±6 mmHg, p&lt;0.001) and diastolic ABPM (84±4 vs. 73±4 mmHg, p&lt;0.001) compared to normotensives. Regarding HMOD, IDH patients had LVH in 7/81 (9%). Increased LVMI (79±18 vs. 69±18 g/m2, p=0.01) and IMT (0.9±0.2 vs. 0.8±0.1 mm, p=0.01) but similar PWV, E/Ea and CFR were found compared to normotensives. In multiple regression analysis (age and weight were used as independent variables), LVMI was independently related to office systolic (Beta=0.26, p=0.02) and diastolic BP (Beta=0.28, p=0.01) as well as central diastolic BP (r=0.38, p=0.04) while no relationship was found between LVMI and 24h ABPM.

Conclusions

The presence of HMOD in IDH in first diagnosed and never treated patients with arterial hypertension underscores the need for antihypertensive treatment (life style changes and medication). As HMOD may regress with successful antihypertensive treatment, there is still time for physicians to reduce future CV events in those patients.

Funding Acknowledgement

Type of funding sources: None.

Differences in Left atrial stain, endothelial glycocalyx, arterial elasticity and myocardial efficiency between ESUS, lacunar and atherosclerotic type of stroke

Background and aims

Patients with stroke are at high risk to develop cardiovascular complications. We assessed endothelial glycocalyx, aortic elastic properties, left atrial and ventricular function in patients with lacunar, atherosclerotic and stroke of undetermined source (ESUS).

Patients and methods

In 111 patients (age 57,1±10.6) with acute cerebral stroke (37 lacunar, 36 atherosclerotic and 38 ESUS) and 20 controls with similar risk factors, we measured: (1) perfused boundary region (PBR) of the sublingual arterial microvessels (range 5–25 μm), a marker inversely related with glycocalyx thickness, (2) pulse wave velocity (PWV), central systolic blood pressure (cSBP), and augmentation index (AIx), (3) Left atrial (LA) strain using speckle-tracking imaging, (4) left ventricular global longitudinal strain and (5) left ventricular myocardial work index (GWI), constructive work (GCW), wasted work (GWW) and work efficiency (GWE).

Results

Compared with controls, patients with stroke had higher PWV (11.74±3.18 vs 9.61±1.28 m/sec, p=0.003), PBR (2.16±0.28 vs 1.94±0.20, p=0.029) and central SBP (142±25 vs 121±17 mmHg, p=0.025), while ventricular (−18.31±3.21 vs −20.89±2.45%, p=0.001) and atrial deformation (28.59±6.99 vs 37.05±5.08%, p&lt;0.001) were impaired in patients with stroke (p&lt;0.05). GWI and GCW were similar between two groups and GWW and GWE were worse in patients with stroke (106.98±81.52 vs 68.92±36.52 mmHg%, p=0.022, 94.00±4.51 vs 96.46±1.75%, p=0.007, respectively).

LA reservoir strain and contraction strain were more impaired in patients with thromboembolic strain compared to other 2 stroke types (ESUS 30.55±6.02%, −15.57±3.57%, Lacunar 28.19±6.92%, −13.76±3,74%, atherosclerotic 24.73±7.86%, −12.65±2,53%, p&lt;0.05).

Regarding endothelial glycocalyx, PBR5–25 was similar between all stroke types (ESUS 2.12±0.21 μm, LACUNAR 2.23±0.32 μm, ATHEROSCLEROTIC 2.11±0.30 μm, p&gt;0.05).

PWV was significantly higher in patients with atherosclerotic stroke (13.50±3.83 m/sec, p=0.007), while in patients with lacunar (11.31±3.01 m/sec) and in ESUS patients it was mildly elevated (11.66±2.63 m/sec).

Despite there was no significant difference in GWI, GCW and GWW between patients with different types of stroke, GWE was higher in patients with ESUS (95.41±2.32%) than in patients with lacunar 92.86±6.13%) and atherothrombotic stoke (92.27±6.21%) (p&lt;0.05).

Conclusions

Patients with stroke have impaired atrial strain, endothelial glycocalyx and arterial elasticity, compared with controls. Arterial stiffness and LA deformation are more affected in atherosclerotic stroke, while GWE is preserved in ESUS patients.

Funding Acknowledgement

Type of funding sources: None.

Biologics improve endothelial, vascular and left ventricular myocardial function in patients with psoriatic arthritis

Background/Introduction

Psoriatic arthritis is characterized by systemic inflammation leading to an increased risk of cardiovascular diseases.

Purpose

We aimed to investigate the effects of biologics on endothelial glycocalyx, vascular and left ventricular (LV) myocardial function in patients with psoriatic arthritis.

Methods

One hundred twenty patients (mean age: 51±11 years) with psoriatic arthritis were randomized to receive biologics [n=60; anti-tumor necrosis factor-α (etanercept, adalimumab, infliximab), anti-interleukin (IL)-12/23 (ustekinumab) or anti-IL-17 (secukinumab)] or nonbiologics (n=60; methotrexate or cyclosporine). At baseline and 4 months post-treatment, we measured: (1) Perfused boundary region (PBR) of the sublingual microvessels with a diameter 5–25μm using Sidestream Dark Field camera (Microscan, Glycocheck). Increased PBR indicates impaired glycocalyx integrity. (2) Pulse wave velocity (PWV - Complior; ALAM Medical), (3) Coronary flow reserve (CFR) in the distal left anterior descending coronary artery, (4) Flow-mediated dilation (FMD) of the brachial artery and (5) LV global longitudinal strain (GLS) using speckle-tracking echocardiography.

Results

Compared with baseline, all patients had reduced PWV (11±2.1 versus 10.3±1.5m/s, p=0.001) and increased FMD (5.45±3.2 versus 9.77±4.7, p=0.004) at 4 months. PBR remained unchanged in both study groups (p&gt;0.05). Compared with nonbiologics, biologics resulted in a greater reduction of PWV (−10% versus −4%) and in a greater increase of CFR (+11% versus −1%), FMD (+102% versus +56%) and GLS (+10% versus −2%) (p&gt;0.05 for all comparisons) 4 months post-treatment. In patients treated with biologics, the percent increase of GLS post-treatment was related with the percent reduction of PWV (r=−0.28, p=0.034) and with the percent increase of FMD (r=0.42, p=0.006).

Conclusion

In psoriasis arthritis, biologics confers a greater improvement of endothelial, vascular and LV myocardial function compared with nonbiologics after 4-month treatment.

Funding Acknowledgement

Type of funding sources: None.

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%).

Differences in Left atrial stain, endothelial glycocalyx and arterial elasticity between ESUS, lacunar and atherosclerotic type of stroke

Funding Acknowledgements

Type of funding sources: None.

Background and Aims

Patients with stroke are at high risk to develop cardiovascular complications. We assessed endothelial glycocalyx, aortic elastic properties, left atrial and ventricular function in patients with lacunar, atherosclerotic and stroke of undetermined source (ESUS).

Patients and methods

In 75 patients (age 55.2 ± 10.6) with acute cerebral stroke (25 lacunar, 20 atherosclerotic and 30 ESUS) and 20 controls with similar risk factors, we measured: (1) perfused boundary region (PBR) of the sublingual arterial microvessels (range 5–25 µm), a marker inversely related with glycocalyx thickness, (2) pulse wave velocity (PWV), central systolic blood pressure (cSBP), and augmentation index (AIx), (3) Left atrial (LA) strain using speckle-tracking imaging, and (4) left ventricular global longitudinal strain.

Results

Compared with controls, patients with stroke had higher PWV (11.38 ± 3.62 vs 9.51 ± 1.57 m/sec, p = 0.045), PBR (2.10 ± 0.27 vs 1.94 ± 0.20, p = 0.039) and central SBP (139.64 ± 26.31 vs 116.36 ± 37.23 mmHg, p = 0.039), while ventricular (-17.902 ± 3.77 vs - 19.87 ± 1.17%, p = 0.025) and atrial deformation (24.8 ± 9.99 vs 39.05 ± 2.08%, p &lt; 0.001) were impaired in patients with stroke (p &lt; 0.05).

LA reservoir strain was more reduced in ESUS patients compared to other 2 stroke types (ESUS 21.7 ± 6.6%, Lacunar 25.6 ± 13.2%, atherosclerotic 22.3 ± 7.8%, P &lt; 0.05).

Regarding endothelial glycocalyx, PBR5-9 (the smallest vessels with diameter 5-9 μm) was higher in patients with ESUS than in the other two types of stroke (ESUS 1.22 ± 0.12 μm, LACUNAR 1.19 ± 0.12 μm, ATHEROSCLEROTIC 1.15 ± 0.09 μm, p &lt; 0.05), despite the fact that PBR5-25 was similar between all stroke types (ESUS 2.09 ± 0.23 μm, LACUNAR 2.13 ± 0.33 μm, ATHEROSCLEROTIC 2.09 ± 0.24 μm, p = 0.8).

PWV was significantly higher in patients with atherosclerotic stroke (15.57 ± 5.50 m/sec, p = 0.007), while in patients with lacunar it was mildly elevated (10.53 ± 3.22 m/sec) and in ESUS patients it was moderately increased (11.7 ± 3 m/sec).

Conclusions

Patients with stroke have impaired atrial strain, endothelial glycocalyx and arterial elasticity, compared with controls. Arterial stiffness is more affected in atherosclerotic stroke, while LA deformation and glycocalyx of small size micro vessels are more affected in ESUS patients.

The combination of dulaglutide and dapagliflozin improves arterial stiffness, endothelial glycocalyx and albuminuria vs DPP-4 inhibitors independently of glycemic control

Background

Studies in recent years have shown that dulaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), and dapagliflozin, a sodium-glucose cotransporter-2 inhibitor (SGLT-2i), improve or prevent diabetic nephropathy and macrovascular complications in patients with type 2 diabetes mellitus (T2DM).

Purpose

The aim of this study is to determine whether the combination of dulaglutide and dapagliflozin exerts improves arterial stiffness, endothelial glycocalyx and albuminuria in T2DM compared to dipeptidyl-peptidase 4 inhibitors (DPP-4is).

Methods

Overall 37 patients with T2DM were included in our study. 21 patients were transitioned from DPP-4is to dulaglutide and dapagliflozin (treatment group) and were followed immediately prior (baseline) and 4 months after the initiation of treatment. 16 patients, matched for sex, age and glycemic control, remained on treatment with DPP-4is (control group). In each visit we measured a) Carotid-femoral PWV b) central systolic blood pressure (cSBP) c) perfused boundary region (PBR) of the sublingual arterial microvessels, d) urinary albumin-to-creatinine ratio (UACR), e) glycosylated hemoglobin (HbA1c).

Results

There were no statistically significant differences in cardiovascular markers, UACR and HbA1c at baseline (p&gt;0.05). After 4 months, patients on dulaglutide and dapagliflozin combination improved HbA1c (7.9±1.5% vs 6.59±0.6%, p&lt;0.001), PBR (2.3±0.3 vs. 2.1±0.2 μm, p&lt;0.05), PWV (11.9±0.3.5 vs. 10.9±2.2m/s, p&lt;0.05), cSBP (128.5±23.6 vs. 121.1±15.7 mmHg, p&lt;0.05) and UACR (413.66±352.57 vs. 248.06±203.5 mg/g, p&lt;0.001). There were no statistically significant differences in PBR (2.1±0.3 vs. 2.2±0.3 μm, p&gt;0.05), PWV (10.7±3.4 vs. 12±3.3m/s, p&gt;0.05), cSBP (125.4±21.2 vs. 127±20.1 mmHg, p&gt;0.05) and UACR (240.8±103.6 vs. 204.9±119.6 mg/g), in the control group, despite a statistically significant improvement of HbA1c (8.2±1.9% vs 7.3±1.3%, p&lt;0.01).

Conclusions

The combination of dulaglutide and dapagliflozin improves arterial stiffness, endothelial glycocalyx and albuminuria compared to DPP-4is in patients with T2DM.

Funding Acknowledgement

Type of funding sources: None.

The midterm differential effects of heat-not-burn and conventional cigarettes on coronary flow, vascular function and oxidative stress are independent of nicotine levels

Introduction

Heat-not-burn cigarette (HNBC) constitutes a non-combustible smoke product linked to reduced exposure to carbon monoxide (CO).

Methods

We compared the effects of HNBC to those of tobacco cigarette (TCig) on endothelial and coronary function as well as on nicotine levels, oxidative stress and platelet activation after 1 month of switching to HNBC.

We examined 75 smokers. Of those, 50 were switched to HNBC and 25 continued Tcig for 1 month.

At baseline and at 1 month, we assessed a) coronary flow reserve (CFR) by echocardiography b) flow-mediated dilation (FMD) c) Cotinine blood levels, a stable metabolite of nicotine d) malondialdehyde (MDA), a marker of oxidative stress and thromboxane B2 (TXB2), a marker of platelet activation e) the exhaled CO and the number of cigarettes and/or heat stick of HNBC used. Fagerstrom score, a marker of dependence from smoking habit was also calculated.

Results

Compared to Tcig smoking, switching to HNBC for 1-month improved CO (difference in CO between groups: 10.42 ppm; 95% CI 3.07 to 17.76, p=0.007), FMD (difference in FMD=4.3%; 95% CI: 1.23 to 7.51, p=0.009; and CFR (difference in CFR =0.98; 95% CI: 0.23 to 1.80, p=0.02). MDA and TXB2 concentration significantly decreased in subjects switching to HNBC compared to tobacco smokers (difference MDA=0.38 nmol/L; 95% CI 0.10 to 0.66, p=0.009, 45pg/mL; 95% CI 5.28 to 86.31, p=0.03). None of the aforementioned parameters changed in the control group at 1 month compared to baseline (p&gt;0.05).

Cotinine blood levels were similar between the TC cig and HNBC group both at baseline and after one month of use (p&gt;0.05). However, cotinine blood levels at baseline and 1 month correlated with the number cigarettes used at baseline (r=0.45 p=0.04) or the number of heat sticks used at one month (r=0.50, p=0.03) respectively, Baseline Fagerstrom score was also associated with number of heat sticks used at 1 month (r=0.48, p=0.04) and cotinine levels at baseline and at 1 month (p=0.50, p=0.03 and r=0.57, p=0.01 respectively).

Conclusions

HNBCs exert a less detrimental effect on vascular function platelet activation and oxidative stress than tobacco smoking that is independent of nicotine levels and is linked with the parallel reduction the exhaled of CO.

Funding Acknowledgement

Type of funding sources: None.

Effects of hormone replacement therapy on endothelial function, arterial stiffness and myocardial deformation in women with Turner syndrome

Background/Introduction

Turner syndrome (TS) is associated with increased cardiovascular risk.

Purpose

We investigated whether hormone replacement therapy (HRT) affects endothelial function, arterial stiffness and myocardial deformation in women with TS.

Methods

Twenty-five women with TS were studied in the estrogen phase of the HRT and two months after discontinuation of HRT. The following measurements were made: flow-mediated dilatation (FMD) of the brachial artery, pulse wave velocity (PWV-Complior) and central systolic blood pressure (cSBP), carotid intima-media thickness (cIMT), aortic (Ao) elastic indexes-namely Ao strain, distensibility, stiffness index and pressure strain modulus (Ep)-and left ventricular (LV) global longitudinal strain (GLS) using speckle tracking echocardiography. Ten healthy female of similar age and BMI served as control group.

Results

Compared to controls, women with TS on HRT had higher PWV (9.1±2.4 vs. 7.5±0.5m/s), cSBP (130±15 vs. 121±6mmHg), cIMT (0.66±0.06 vs. 0.55±0.05mm), aortic stiffness index, Ep and LA strain, and lower FMD (7.2±4 vs. 10.5±2.3%), Ao strain, Ao distensibility and GLS (−18.8±2.7 vs. −21.9±1.5%) (P&lt;0.05 for all comparisons). Two months after discontinuation of HRT, all women increased FMD (11.7±6 vs. 7.2±4%) and reduced PWV (7.8±1.7 vs. 9.1±2.4m/s) and cSBP (123±14 vs. 130±15mmHg). There were no statistically significant changes in BMI, cIMT and GLS (P&gt;0.05 for all comparisons). The percent decrease of cSBP was associated with the percent decrease of PWV (r=0.54) and reversely related with the percent increase of FMD (r=−0.57) (P&lt;0.05 for all comparisons).

Conclusion

HRT in women with TS may deteriorate endothelial function contributing to increased arterial stiffness and central arterial blood pressure.

Funding Acknowledgement

Type of funding sources: None.

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.

Apremilast improves endothelial glycocalyx and microvascular perfusion: a possible protective mechanism against COVID-19

Background/Introduction

The phosphodiesterase 4 inhibitor apremilast is an approved treatment option for psoriasis.

Purpose

We aimed to investigate the effects of apremilast on endothelial glycocalyx, vascular and left ventricular (LV) myocardial function in psoriasis.

Methods

Ninety patients with psoriasis were randomized to receive apremilast (n=30), anti-tumor necrosis factor-a (etanercept, n=30), or cyclosporine treatment (n=30). At baseline and 4 months post-treatment, we measured: (1)Perfused boundary region (PBR) of the sublingual microvessels with a diameter 5–25μm using a dedicated camera (Sidestream Dark Field imaging, Microscan, Glycocheck). Increased PBR indicates reduced glycocalyx thickness. Perfused microvascular density (PMD), an index of microvascular perfusion, was also measured. (2)Pulse wave velocity (PWV - Complior; ALAM Medical) and central systolic blood pressure (cSBP), and (3)LV global longitudinal strain (GLS) and percent difference between peak twisting and untwisting at mitral valve opening (%dpTw-UtwMVO) using speckle-tracking echocardiography.

Results

Compared with baseline, PBR20–25 decreased only after apremilast treatment (−13% at 4 months, P&lt;0.05) whereas no statistically significant changes in PBR20–25 were observed after etanercept or cyclosporine. Compared with etanercept and cyclosporine, apremilast resulted in a greater increase of PMD (+12% versus +3% versus +3%) and in a higher reduction of PWV (−10% versus −3% versus +8%) and cSBP (−8% versus −2% versus +7%) at 4 months. Apremilast showed a greater increase of GLS (+12% versus +5% versus +2%) and %dpTw-UtwMVO (+15% versus +3% versus +3%) than etanercept and cyclosporine (P&lt;0.05 for all comparisons). Changes of PBR and PMD post-apremilast treatment correlated with a concomitant reduction of PWV and cSBP (P&lt;0.05).

Conclusions

In psoriasis, apremilast confers a greater improvement of endothelial glycocalyx, microvascular perfusion and LV myocardial function compared with etanercept or cyclosporine treatment. Apremilast restores glycocalyx integrity and thus reduces vascular permeability to pro-inflammatory molecules. This may explain the beneficial effects of apremilast on COVID-19.

Funding Acknowledgement

Type of funding sources: None.

Differences in left atrial stain, endothelial glycocalyx and arterial elasticity between ESUS, lacunar and atherosclerotic type of stroke

Background and purpose

Patients with stroke are at high risk to develop cardiovascular complications. We assessed endothelial glycocalyx, aortic elastic properties, left atrial and ventricular function in patients with lacunar, atherosclerotic and stroke of undetermined source (ESUS).

Methods

In 68 patients (age 56,1±10.9) with acute cerebral stroke (22 lacunar, 19 atherosclerotic and 27 ESUS) and 20 controls with similar risk factors, we measured: (1) perfused boundary region (PBR) of the sublingual arterial microvessels (range 5–25 μm), a marker inversely related with glycocalyx thickness, (2) pulse wave velocity (PWV), central systolic blood pressure (cSBP), and augmentation index (AIx), (3) LA volume and strain using speckle-tracking imaging, and (4) left ventricular global longitudinal strain.

Results

Compared with controls, patients with stroke had higher PWV (11,38±3,62 vs 9,51±1,57 m/sec, p=0,045), PBR (2,10±0,27 vs 1,94±,020, p=0,039) and central SBP (139,64±26,31 vs 116,36±37,23 mmHg, p=0,039), while ventricular (−17,902±3,77 vs −19,87±1,17%, p=0,025) and atrial deformation (24,8±9,99 vs 39,050±2,08%, p&lt;0.001) were impaired in patients with stroke (p&lt;0.05).

LA reservoir strain was more reduced in ESUS patients compared to other 2 stroke types (ESUS 21,7±6,6%, Lacunar 25,6±13,2%, atherosclerotic 22,3±7,8%, P&lt;0.05).

Regarding endothelial glycocalyx, PBR5–9 (the smallest vessels with diameter 5–9 μm) was higher in patients with ESUS than in the other two types of stroke (ESUS 1,22±0,12 μm, LACUNAR 1,19±0,12 μm, ATHEROSCLEROTIC 1,15±0,09 μm, p&lt;0.05), despite the fact that PBR5–25 was similar between all stroke types (ESUS 2,09±0.23 μm, LACUNAR 2,13±0,33 μm, ATHEROSCLEROTIC 2,09±0,24 μm, p=0.8).

PWV was significantly higher in patients with atherosclerotic stroke (15,57±5,50 m/sec, p=0,007), while in patients with lacunar it was mildly elevated (10,53±3,22 m/sec) and in ESUS patients it was moderately increased (11,7±3 m/sec).

Conclusion

Patients with stroke have impaired atrial strain, endothelial glycocalyx and arterial elasticity, compared with controls. Arterial stiffness is more affected in atherosclerotic stroke, while LA deformation and glycocalyx of small size micro vessels are more affected in ESUS patients.

Funding Acknowledgement

Type of funding sources: None.

Endothelial glycocalyx integrity and microvascular perfusion are associated with novel echocardiographic markers and carotid intima-media thickness in patients with psoriasis

Background/Introduction

Psoriasis has been associated with vascular and myocardial dysfunction through mechanisms of inflammation and oxidative stress.

Purpose

We aimed to evaluate sublingual microvascular perfusion and glycocalyx barrier properties in psoriasis patients, as well as their correlation with coronary microcirculatory function and markers of myocardial deformation and atherosclerosis (carotid intima-media thickness, cIMT).

Methods

We examined 297 patients with psoriasis and 150 controls, adjusted for age, sex, and atherosclerotic risk factors. Perfusion boundary region (PBR), a marker of glycocalyx barrier function, was measured non-invasively in sublingual microvessels with a diameter ranging from 5–25μm using a dedicated camera (Sidestream Dark Field imaging, Microscan, GlycoCheck). Increased PBR indicates reduced glycocalyx thickness. Indexes of microvascular perfusion, including red blood cell (RBC) filling percentage and functional microvascular density, were also calculated. We measured coronary flow reserve (CFR), cIMT and markers of myocardial deformation by speckle tracking imaging utilizing echocardiography [peak twisting, the percentage changes between peak twisting, and untwisting at mitral valve opening (%dpTw-UtwMVO), at peak (%dpTw-UtwPEF), and the end of early LV diastolic filling (%dpTw-UtwEDF)].

Results

Psoriasis patients had higher PBR5–25 compared to controls (2.13±0.29 versus 1.78±0.25μm, p&lt;0.05). There was an inverse association of PBR5–25 with perfused microvascular density (r=−0.42, p&lt;0.001) and RBC fraction (r=−0.80, p&lt;0.001). In psoriatic population, PBR5–25 was inversely correlated to CFR (r=−0.30, p=0.045). Increased values of PBR5–9 were associated with reduced untwisting at the end of the mitral inflow E wave (r=−0.24, p=0.006) and reduced %dpTw-UtwMVO (r=−0.35, p&lt;0.001). Furthermore, decreased RBC filling percentage and perfused microvascular density were related to worse LV longitudinal strain and increased cIMT (p&lt;0.05). Finally, a positive correlation between perfused microvascular density and %dpTw-UtwMVO was observed in patients with psoriasis (p&lt;0.05).

Conclusion

Endothelial glycocalyx thickness is reduced in patients with psoriasis and is associated with impaired coronary and myocardial function, and vascular atherosclerosis.

Funding Acknowledgement

Type of funding sources: None.

Effects of hormone replacement therapy on endothelial function, arterial stiffness and myocardial deformation in women with Turner syndrome

OBJECTIVES

Turner syndrome (TS) is associated with increased cardiovascular risk. We investigated whether hormone replacement therapy (HRT) affects endothelial function, arterial stiffness and myocardial deformation in women with TS.

METHODS

Twenty-five women with TS were studied in the estrogen phase of the HRT and two months after discontinuation of HRT. The following measurements were made: flow-mediated dilation (FMD) of the brachial artery, pulse wave velocity (PWV-Complior) and central systolic blood pressure (cSBP), carotid intima-media thickness (cIMT), aortic (Ao) elastic indexes - namely Ao strain, distensibility, stiffness index and pressure strain modulus (Ep) - and left ventricular (LV) global longitudinal strain (GLS) using speckle-tracking echocardiography. Ten healthy female of similar age and BMI served as a control group.

RESULTS

Compared to controls, women with TS on HRT had higher PWV (9.1 ± 2.4 vs. 7.5 ± 0.5 m/s), cSBP (130 ± 15 vs. 121 ± 6 mmHg), cIMT (0.66 ± 0.06 vs. 0.55 ± 0.05 mm), aortic stiffness index, Ep and LA strain, and lower FMD (7.2 ± 4 vs. 10.5 ± 2.3%), Ao strain, Ao distensibility and GLS (-18.8 ± 2.7 vs. -21.9 ± 1.5%) (P < 0.05 for all comparisons). Two months after discontinuation of HRT, all women increased FMD (11.7 ± 6 vs. 7.2 ± 4%) and reduced PWV (7.8 ± 1.7 vs. 9.1 ± 2.4 m/s) and cSBP (123 ± 14 vs. 130 ± 15 mmHg). There were no statistically significant changes in BMI, cIMT and GLS (P > 0.05 for all comparisons). The percentage decrease of cSBP was associated with the percentage decrease of PWV (r = 0.54) and reversely related with the percentage increase of FMD (r = -0.57; P < 0.05 for all comparisons).

CONCLUSIONS

HRT in women with TS may deteriorate endothelial function contributing to increased arterial stiffness and central arterial blood pressure.

Association of endothelial glycocalyx integrity and microvascular perfusion with novel echocardiographic markers and carotid intima-media thickness in patients with psoriasis

Funding Acknowledgements

Type of funding sources: None.

Introduction

Psoriasis has been associated with vascular and myocardial dysfunction through mechanisms of inflammation and oxidative stress.

Purpose

We aimed to evaluate sublingual microvascular perfusion and glycocalyx barrier properties in psoriasis patients, as well as their correlation with coronary microcirculatory function, markers of myocardial deformation and atherosclerosis (carotid intima-media thickness, IMT).

Methods

We examined 241 patients with psoriasis and 160 controls, adjusted for age, sex, BMI, smoking, LV mass, heart rate, hyperlipidemia, and office SBP. Perfusion boundary region (PBR), a marker of glycocalyx barrier function, was measured non-invasively in sublingual microvessels with a diameter ranging from 5-25 µm using a dedicated camera (Side field dark imaging,  Micrsoscan, Nedelrands). Increased PBR indicates reduced glycocalyx thickness. Indexes of microvascular perfusion, including red blood cell (RBC) filling percentage and functional microvascular density, were also calculated. We measured coronary flow reserve (CFR), carotid IMT and markers of myocardial deformation by speckle tracking imaging utilizing echocardiography [peak twisting, the percentage changes between peak twisting, and untwisting at mitral valve opening (%dpTw – UtwMVO), at peak (%dpTw – UtwPEF), and the end of early LV diastolic filling (%dpTw – UtwEDF)].

Results

Psoriasis patients had higher PBR (PBR5-25: 2.131 ± 0.296 vs. 1.769 ± 0.306; PBR5-9: 1.183 ± 0.150 vs. 1.051 ± 0.132; PBR10-19: 2.318 ± 0.581 vs. 1.993 ± 0.365; PBR20-25: 2.650 ± 0.461 vs. 2.269 ± 0.492, all p &lt; 0.05) and impaired LV twisting-untwisting markers compared to controls (pTw: 14.8 ± 7.8 vs. 13.9 ± 3.5; UtwMVO: 10.3 ± 7.3 vs. 9 ± 4.3; %dpTw – UtwMVO: 31 ± 4.1 vs. 38 ± 7; pTwVel: 105 ± 83 vs. 89 ± 21; pUtwVel: -100 ± 53 vs. -93 ± 31, all p &lt; 0.05).

In psoriatic population, levels of PBR5-25 and PBR10-19 were inversely correlated to CFR (r=-0.15 and r=-0.17). The first one was also reversely related to peak LV untwisting at aortic valve closure (r=-0.14). Increased levels of PBR5-9 were associated with reduced untwisting at end of the mitral inflow E wave (UtwEDF, r=-0.13) and reduced percentage difference between peak twisting and untwisting at MVO (%dpTw-UntwMVO) (r=-0.15). Furthermore, decreased RBC filling percentage and perfused microvascular density were related to worse LV longitudinal strain (4-chamber) (r=-0.15), and increased IMT (r=-0.14). Finally, a positive correlation between perfused microvascular density and %dpTw-UntwMVO was observed in patients with psoriasis (r = 0.14). All correlations were statistically significant (p &lt; 0.05).

Conclusion

Endothelial glycocalyx thickness is reduced in patients with psoriasis and is associated with impaired coronary and myocardial function, and vascular atherosclerosis.

Effects of heat-not-burn compared to combustible cigarettes on coronary flow, myocardial work index and vascular function

Funding Acknowledgements

Type of funding sources: None.

Aim/Introduction:

Heat-not-burn cigarette (HNBC) constitutes a non-combustible smoke product.

Purpose

We compare the effects of heat-not-burn and conventional cigarettes on coronary flow, myocardial and vascular function, platelet activation and oxidative stress.

Methods

We compared the effects of HNBC to those of tobacco cigarette (TCig), on arterial stiffness, oxidative stress, and platelet activation, acutely and after 1 month of switching to HNBC, as well as on endothelial, myocardial, and coronary function after 1 month of switching to HNBC. In the acute study, 50 smokers were randomized into smoking a single Tcig or an HNBC and after 60 minutes were crossed over to the alternate smoking (HNBC or Tcig). For the chronic phase, 75 smokers were examined. Of those, 50 were switched to HNBC and 25 continued Tcig for 1 month. Pulse wave velocity (PWV) and biomarkers [malondialdehyde (MDA), protein carbonyls (PC), and thromboxane B2 (TXB2)] were assessed in the acute and chronic study. Myocardial deformation [global longitundinal strain (GLS), myocardial work index (GWI) and wasted myocardial work (GWW)], coronary flow reserve (CFR) by Doppler echocardiography, total arterial compliance (TAC), and flow-mediated dilation (FMD) were additionally assessed in the chronic study.

Results

Compared to baseline, TCig smoking acutely increased exhaled CO, PWV, MDA, and TxB2 (p &lt; 0.05), while no changes were observed after HNBC. Compared to resuming Tcig smoking, switching to HNBC for 1 month improved CO (mean change: -55% vs -2.4%), FMD ( +55% vs +15%), CFR (+46% vs +4%), TAC (+9% vs -0.5%), GLS (+6% vs +1%), GWW (-19% vs +0.5%), MDA (-19% vs 1 %), and TxB2 (-12% vs 4%) (p &lt; 0.05 for all comparisons).

Conclusions

HNBCs exert a less detrimental effect on vascular, cardiac and platelet function than combustible tobacco.

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.

Effects of hormone replacement therapy on arterial stiffness, endothelial function and myocardial deformation in women with Turner syndrome

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction: Turner syndrome (TS) is associated with congenital or acquired cardiovascular diseases.

Purpose

We investigated whether hormone replacement therapy (HRT) affects arterial elastic properties, endothelial function and myocardial deformation in women with TS.

Methods

In 25 women with TS (age: 29 ± 9years) we measured  in the oestrogen phase of HRT cycle and 1 month after discontinuation of HRT: a)Pulse wave velocity (PWV-Complior), central systolic blood pressure (cSBP) and augmentation index (AI) of the aortic pulse wave, b)perfused boundary region (PBR) of the sublingual arterial microvessels, as a marker of endothelial glycocalyx thickness, c)carotid intima-media thickness (cIMT), d)flow-mediated dilatation (FMD) of the brachial artery and percentage difference of FMD (FMD%), and e)global LV longitudinal strain (GLS) and left atrium (LA) strain using speckle tracking echocardiography. Ten healthy subjects of similar sex, age and BMI served as control group.

Results

Compared to controls, women with TS under HRT had higher PWV (9.1 ± 2.4 vs. 7.5 ± 0.5m/s), AI (18 [7 to 27] vs. 5.8 [-10 to 19]%), cSBP (130 ± 15 vs. 121 ± 6mmHg), cIMT (0.66 ± 0.06 vs. 0.55 ± 0.05mm), FMD (7.2 ± 4 vs. 10 ± 2.3%) and lower LA volume index (14.3 ± 4 vs. 24 ± 13 mL/m²) and GLS (-18.8 ± 2.7 vs. -21.9 ± 1.5) (p &lt; 0.05 for all comparisons). PBR was negatively related with FMD% (r=-0.58, p = 0.022) in women with TS under HRT. One month after discontinuation of HRT, all women reduced PWV, AI, cSBP and increased FMD. There were no statistically significant changes in BMI, PBR, cIMT, LA volume index, LA strain and LV GLS (p &gt; 0.05 for all comparisons) (Table). The percent decrease of cSBP was associated with the percent decrease of PWV (r = 0.54) and inversely related with the percent increase of FMD (r=-0.57) (p &lt; 0.05 for all comparisons).

Conclusions

Hormone replacement treatment in women with TS deteriorates arterial stiffness and endothelial function probably due to increased central arterial blood pressure.

Women with Turner syndrome under HRT (n = 25) Women with Turner syndrome one month after discontinuation of HRT (n = 25) p-value PWV, m/s 9.1 ± 2.4 7.8 ± 1.7 0.028 Central SBP, mmHg 130 ± 15 123 ± 14 0.007 PBR, 5-25μm 2.11 ± 0.3 2.12 ± 0.2 0.983 cIMT, mm 0.66 ± 0.06 0.67 ± 0.06 0.947 FMD, % 7.2 ± 4 11.7 ± 6 0.042 LA strain, % 51 ± 12 54 ± 15 0.400 LV GLS, % -18.8 ± 2.7 -19.3 ± 2.3 0.594 Table

Differential effects of heat-not-burn and conventional cigarettes on coronary flow, myocardial and vascular function, platelet activation and oxidative stress

 

Heat-not-burn cigarette (HNBC) constitutes a non-combustible smoke product.

Methods

We compared the effects of HNBC to those of tobacco cigarette (TCig), on arterial stiffness, oxidative stress, and platelet activation, acutely and after 1 month of switching to HNBC, as well as on endothelial, myocardial, and coronary function after 1 month of switching to HNBC. In the acute study, 50 smokers were randomised into smoking a single Tcig or an HNBC and after 60 minutes were crossed over to the alternate smoking (HNBC or Tcig). For the chronic phase, 75 smokers were examined. Of those, 50 were switched to HNBC and 25 continued Tcig for 1 month. Pulse wave velocity (PWV) and biomarkers [malondialdehyde (MDA), protein carbonyls (PC), and thromboxane B2 (TXB2)] were assessed in the acute and chronic study. Myocardial deformation [global longitundinal strain (GLS), myocardial work index (GWI) and wasted myocardial work (GWW)], coronary flow reserve (CFR) by echocardiography, total arterial compliance (TAC), and flow-mediated dilation (FMD) were additionally assessed in the chronic study.

Results

Compared to baseline, TCig smoking acutely increased exhaled CO, PWV, MDA, and TxB2 (p&lt;0.05), while no changes were observed after HNBC. Compared to resuming Tcig smoking, switching to HNBC for 1 month improved CO (mean change: −55% vs −2.4%), FMD (+55% vs +15%), CFR (+46% vs +4%), TAC (+9% vs −0.5%), GLS (+6% vs +1%), GWW (−19% vs +0.5%), MDA (−19% vs 1%), and TxB2 (−12% vs 4%) (p&lt;0.05 for all comparisons).

Conclusions

HNBCs exert a less detrimental effect on vascular, cardiac and platelet function than tobacco

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Hellenic Association of Lipidiology, Atherosclerosis and Vascular disease

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

Inhibition of interleukin-6 by tocilizumab improves endothelial glycocalyx and myocardial work index in patients with rheumatoid arthritis

Background/Introduction

Tocilizumab, an interleukin-6 receptor blocker is used for the treatment of rheumatoid arthritis (RA).

Purpose

We investigated the effects of tocilizumab on endothelial glycocalyx and myocardial function in patients with RA.

Methods

Eighty patients with RA (age: 64±9 years) were randomized to tocilizumab (n=40) or prednisolone (n=40)for 3 months. We measured at baseline and 3 months post-treatment: a) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced glycocalyx thickness), b) pulse wave velocity (PWV-Complior), central systolic blood pressure (cSBP) and augmentation index (AI), c) global LV longitudinal strain (GLS), longitudinal systolic (LongSr) and diastolic (LongSrE) strain rate, d) global myocardial work index (GWI), global constructive (GCW) and global wasted work (GWW) using speckle tracking imaging.

Results

At baseline, all patients had similar disease activity score and markers of vascular and myocardial function. Compared with baseline, patients under tocilizumab had reduced PBR (2.14±0.2 vs. 1.97±0.2μm), PWV (11±3 vs. 10.3±2m/s), cSBP (134±18 vs. 129±16mmHg) and LongSrE (0.91±0.3 vs. 1±0.3 1/s) at 3 months (p&lt;0.05). There were no statistically significant differences in the above measured markers in patients under prednisolone (p&gt;0.05) (Table). Compared with prednisolone, tocilizumab treatment achieved a greater increase of GLS (8.5% vs. 2.4%), GWI (12.2% vs. 2.7%), GCW (10.3% vs. 5.9%) and a greater reduction of GWW (−30% vs. −13%) (p&lt;0.05 for all comparisons), despite a similar reduction in C-reactive protein post-treatment. The percent decrease of PBR was associated with the percent decrease of cSBP (r=0.46), PWV (r=0.37) and reversely related with the percent improvement of GLS (r=−0.43) and GWI (r=−0.39) (p&lt;0.05).

Conclusions

IL-6 inhibition by tocilizumab improves endothelial and vascular function leading to a greater increase of effective myocardial work compared to prednisolone in patients with RA.

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

Impaired longitudinal myocardial deformation, coronary microcirculatory dysfunction and increased intima-media thickness predict adverse cardiovascular events in psoriatic patients:a 4 year follow-up

Introduction

Psoriasis has been associated with vascular and myocardial dysfunction, atherosclerosis and increased cardiovascular risk in the setting of inflammation and oxidative stress. We aimed to evaluate the prognostic value of markers of myocardial deformation, coronary microcirculatory function and systemic inflammation and oxidative stress for future cardiovascular events.

Methods

In 260 psoriasis patients We measured a)left ventricular global longitudinal strain (GLS) by speckle tracking, b) coronary flow reserve (CFR), of the left anterior descending artery by pulse wave echocardiography, c) carotid-femoral pulse wave velocity (PWV), d) carotid intima media thickness (IMT) and e) inflammatory and markers of oxidative stress, namely interleukin-6,-12,-17,TNF-α,fetuin-α and protein carbonyl. Bivariate correlations of these measures with incidence of major cardiovascular events (MACE) defined as acute coronary syndrome, stroke and hospitalization for heart failure were performed.

Results

During a mean 4 year follow-up period (48±11monts) 21 MACEs occurred. By Cox regression analysis Incidence of MACEs were associated with impaired GLS (b=1.05 p=0,01, mean GLS −17.3±4), impaired CFR (b=−0.75, p=0.04, mean CFR 2.68±0.9) fetuin levels (b=0.70. r=0.046, mean fetuin value 45±24ng/ml) and IMT (b=0.79, P=0.015, mean IMT=1.3±0.6cm) after adjusting for age, sex and atheroclerotic risk factors. Among the aforementioned markers, GLS had the strongest value for prediction of MACEs (area under the curve 0.82 p=0.017). A cut-off value of GLS &gt;−16.5% predicted MACEs with a sensitivity 80% and specificity of 82.6%.

Conclusion

Impaired myocardial and vascular function is associated with adverse cardiovascular events in psoriasis. GLS as a marker of subclinical myocardial dysfunction has the strongest predictive value for MACEs incidence during a 4-year follow-up study.

Funding Acknowledgement

Type of funding source: None

Increased arterial stiffness during acute myocardial infarction results in adverse cardiac remodelling: a two year follow-up study

 

Increased arterial stiffness is associated with adverse cardiac events. However, it not clear whether increased arterial stiffness at the early phase of acute myocardial infraction (AMI) is associated with adverse left ventricular remodelling.

Methods

We examined 80 patients with STEMI (53±16 years, 80% male, 42% anterior AMI, LVEF=49±15%) after successful revascularisation by echocardiography 48h after admission and 2 years after the index event. We measured a) left-ventricular end-diastolic (LVEDV) and end-systolic volumes (LVESV) using the Simpson Method b) global longitundinal strain (GLS) by speckle tracking imaging c) carotid-femoral pulse wave velocity (PWV, augmentation index and central Aortic pressures by Complior apparatus d) The ratio of PWV/GLS as a marker of ventricular-arterial interaction.

Results

LVEDV and LVESV were decreased while GLS was improved after the 2-year follow-up period (from 103.3±30 to 89.1±37ml, p=0.004, 58.3±25 to 57.6±25, p=0.05, −16.1±4.7 to 17.5±3.2%, p=0.03 respectively). Baseline PWV, GLS and the ratio PWV/GLS were associated with the percent change of LVESV at 2 years (p=0.033, p=0.04 and p=0.035 respectively) after adjustment for type of MI (anterior vs other location), baseline troponin blood pressure and medication.

Patients with PWV &gt;10.6 m/s (upper tercile) had similar baseline LVESV (56.5±18 to 57.2±24 ml, p=0.8) but higher LVESV at 2 years follow-up (74.4±35 to 55.9±24 ml, p=0.03) resulting in a greater percent increase of LVESV compared to patients with baseline PWV &lt;10.6m/s (+26% vs −5% p=0.012).

Conclusion

Increased arterial stiffness in the early phase of AMI impairs ventricular-arterial coupling resulting in adverse LV remodeling despite successful revascularization.

Funding Acknowledgement

Type of funding source: None

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.

P940Effects of IQOS smoking on vascular function, coronary flow reserve, myocardial deformation and myocardial work index during one month of use

Background

IQOS smoking (heat-no burn smoke product) is proposed to reduce harm compared to conventional smoking. We examined its effects on vascular function, myocardial deformation and ventricular arterial coupling.

Methods

Thirty-seven current smokers (mean age 48±5 years, >20 cigarettes /day) without cardiovascular disease and 20 healthy subjects with similar age sex and risk factors participated in the study. All subjects were instructed to smoke only IQOS for one month. Measurements were performed at baseline and 1 month after smoking IQOS. we measured a) the aortic PWV (PWV) and central aortic systole blood pressure (SBPc) by Complior; b) the exhaled CO level (parts per million-ppm) as a smoking status marker; and c) brachial systolic (SBP)and diastolic (DBP) blood pressure and heart rate (HR) a) flow mediated dilation (FMD) of the brachial artery b) coronary flow reserve (CFR) after adenosine infusion by Doppler echocardiography and c) global longitundinal strain (GLS) peak twisting and untwisting velocity and myocardial work index derived by pressure –myocardial strain loops by speckle tracking imaging PWV to GLS ratio was also used as a marker of ventricular arterial coupling

Results

At baseline exhaled CO, PWV, SBPc, FMD, PWV/GLS ratio, myocardial work index and peak untwisting velocity were higher and CFR was lower in smokers compared to controls (14.9±7 vs. 4.2±1 ppm, p<0.001, 8.7±1.4 vs 10.0±1.6 m/s, p<0.05; 118±16 vs 110±7 mmHg p<0.001, 6.9±2 vs 9.5±2% p<0.001, −0.61±0.21 vs. −0.45±0.11 m/sec%, p<0.001, 1926±284 vs 1826±300 mmHg% p=0.04, −122±36 vs −95±25 deg/sec, p=0.02, 2.5±0.9 vs. 3.1±0.8 p=0.001 respectively). In the chronic phase we observed a significant improvement of FMD, CFR, GLS, PWV/GLS, myocardial work index and peak untwisting velocity compared to baseline (12±2% vs. 6.9±2%, p=0.03; 3.2±0.6 vs. 2.5±0.9 p=0.001; −19.3±2.2% vs. −21.1±2.8%, p=0.001; −0.61±0.21 vs. −0.47±0.12 m/sec% p=0.03; 1926±284 vs 1830±343 mmHg% p=0.03, −122±36 vs −105±25 deg/sec, p=0.03, respectively) in parallel with reduction of the exhaled CO (14.9±7 vs. 6±4.9 ppm, p<0.001). HR remained unchanged throughout the study and there was a borderline reduction of central aortic systolic blood pressure (118±16 vs. 114±19 mmHg, p=0.048).

Conclusions

Replacement of conventional cigarettes with IQOS results in improved LV longitundinal myocardial deformation, LV untwisting and reduced LV myocardial work index possibly linked to the concomitant improvement of aortic elasticity, endothelial and coronary microcirculatory function and ventricular-arterial coupling within 1 month.

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.

Differential effects of inhibition of interleukin 1 and 6 on myocardial, coronary and vascular function

BACKGROUND

Anakinra, an interleukin-1 receptor antagonist and tocilizumab, an interleukin-6 receptor blocker, are used for the treatment of rheumatoid arthritis. We investigated the differential effects of anakinra and tocilizumab on myocardial and vascular function in an atherosclerosis model of patients with rheumatoid arthritis.

METHODS

120 patients with rheumatoid arthritis were randomized to anakinra (n = 40), tocilizumab (n = 40) or prednisolone (n = 40) for 3 months. Primary outcome measure was the change of left ventricular longitudinal strain after 3 months of treatment. Additionally, we measured coronary flow reserve, flow-mediated dilatation of the brachial artery, carotid-femoral pulse wave velocity, malondialdehyde and protein carbonyls as oxidative stress markers and C-reactive protein blood levels at baseline and post-treatment.

RESULTS

At baseline, patients among the three treatment arms had similar age, sex, disease activity score and atherosclerotic risk factors. Compared with baseline, all patients had improved longitudinal strain (- 16% vs. - 17.8%), coronary flow reserve (2.56 vs. 2.9), malondialdehyde (2.0 vs. 1.5 µM/L), protein carbonyls (0.0132 vs. 0.0115 nmol/mg), and C-reactive protein post-treatment. In all patients, the percent decrease of malondialdehyde was correlated with percent increase of longitudinal strain (p < 0.001). Compared with tocilizumab and prednisolone, anakinra treatment resulted in a greater improvement of longitudinal strain (18.7% vs. 9.7% vs. 6%) and coronary flow reserve (29% vs. 13% vs. 1%), while pulse wave velocity and brachial blood pressure were improved only after tocilizumab treatment (11 ± 3 vs. 10.3 ± 2 m/s p < 0.05 for all comparisons).

CONCLUSIONS

Anakinra is associated with an improvement in cardiac function and tocilizumab with improvement in vascular function.

CLINICAL TRIAL REGISTRATION

URL: https:// http://www.clinicaltrials.gov . Unique identifier: NCT03288584.