MO429: The Association of Circulating Monocytes Subsets, NK Cells and Lymphocyte Subpopulations With Conventional and Novel Deformation Indices of Left Ventricular Function in CKD Patients With No Established Cardiovascular Disease

BACKGROUND AND AIMS

Cardiovascular disease (CVD) and chronic kidney disease (CKD) are closely interrelated. Adverse immune responses have been implicated in the pathogenesis of both CVD and CKD [1, 2]. Monocyte subsets are key in atherogenesis and the inflammatory cascade occurring in heart failure [1, 2]. Likewise, the role of lymphocyte subpopulations including natural killer (NK) cells and CD4 + CD25 + regulatory T cells (Tregs) in the modulation of inflammation and immunity and subsequent cardiovascular implications have received increasing attention [2]. The implication of immune cells subsets in the abnormal myocardial remodeling as universally occurs in CKD patients even without overt CVD, remains to be clarified [3]. The aim of our study was to investigate potential correlations between blood levels of specific immune cells subsets with conventional and novel deformation-related indices of LV function in a cohort of patients with CKD without established CVD.

METHOD

A total of 35 stable CKD patients (mean age 66 ±12.2 years, 57% males, 20% diabetics) without established CVD were included in the study. Exclusion criteria included the history of malignancy, autoimmune disease and active or chronic infections. The peripheral blood immune cell subsets CD14++CD16-, CD14++CD16 + and CD14 + CD16++ percentage and absolute number of cells out of the total monocytes and NK cells (CD3 + CD16 + 56+), CD3-CD19 + B lymphocytes, CD3 + CD4 + T cells, CD3 + CD8 + T cells and Tregs (CD4 + CD25 + FoxP3+) absolute values and percentage out of the total lymphocytes were measured by flow cytometry. Simultaneously, conventional [left atrial volume index (LAVI), LV mass index (LVMI), LV end-diastolic volume (LVEDV), E/E’] and novel 2D speckle tracking (2DST) echocardiographic indices of LV function [global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), TWIST and UNTWIST] were assessed.

RESULTS

The mean estimated glomerular filtration rate (eGFR) was 28 ±15 mL/min/1.73 m2 (CKD-EPI) and the mean 24-h proteinuria was 2457 ±2399 mg. The percentage of total blood lymphocytes, as well as both percentage and absolute counts of CD4 + T-cells, were positively correlated with the eGFR (P < 0.05 and < 0.01 respectively) whereas. In addition, both NK cells percentage (P < 0.05) and absolute values (P < 0.01) showed a negative association with proteinuria. Regarding classical indices of LV function, NK counts were negatively associated with LVEDV (P < 0.05). An increased percentage of intermediate CD14++CD16 + monocytes was positively associated with the GRS (P < 0.005). Furthermore, the percentage of T-cells and CD8 + T-cells were positively associated with LV TWIST whereas a positive association was found between the percentage of CD8 + T-cells and more negative values of LV UNTWIST (P < 0.05). No specific significant correlations were observed between the rest immune cells subpopulations with either the classical or the novel indices of LV dysfunction.

CONCLUSION

The results of our study suggest that alterations of immune cells subsets correlate with subclinical markers of LV dysfunction in CKD patients without established CVD. The significance of the implication of the cellular arm of the immune system in the pathophysiological pathways of specific CVD phenotypes in CKD and the utility of immune cells subsets as tools to identify CKD patients who are at the highest risk for developing complications shall be elucidated by future research.

Current videofluoroscopy practice in the United Kingdom: A survey of imaging professionals

INTRODUCTION

Videofluoroscopy (VFSS) is a frequently used radiological investigation for dysphagia and is conducted within a radiology setting by speech and language therapists (SLTs) working alongside imaging personnel (radiologists and/or radiographers). Previous surveys of SLT practice have reported variability in VFSS protocols and procedures. The aim of this study was to explore current clinical practice for VFSS from the perspective of imaging personnel engaged in VFSS within the United Kingdom.

METHODS

A comprehensive online survey enabled exploration of current practices of imaging professionals. Target participants were diagnostic imaging personnel (radiographers and radiologists) with experience of working in VFSS clinics. Descriptive statistics describe and summarise the data alongside inferential statistics where appropriate.

RESULTS

54 survey participants represented 40 unique acute healthcare organisations in the UK, in addition to two respondents from the Republic of Ireland. The survey demonstrated high variance in clinical practice across all stages of the VFSS procedure. Clinicians were not always compliant with current UK guidelines and the roles and responsibilities of different professionals working within the clinics were often not clearly defined.

CONCLUSION

Further research is required to develop new international, interprofessional VFSS guidelines to standardise service delivery for VFSS, improving diagnostic accuracy, efficiency and patient experience.

IMPLICATIONS FOR PRACTICE

In the absence of VFSS guidelines for imaging personnel, practitioners should familiarise themselves with the UK Royal College of Speech and Language Therapists VFSS Position paper; IR (ME)R guidelines and DRLs for the client groups with which they work to guide clinics and improve practice. Clinicians should revisit protocols and clinical governance regarding safe practice in order to improve the quality of care within the VFSS clinic.

Anticholinergic burden and cognitive functions in schizophrenia: a systematic literature review

Background

Cognitive dysfunction in schizophrenia forms the key cause of the disease's disability, leading in serious functional implications at the individual level and socioeconomic effects at global level. Dopaminergic-cholinergic balance is considered essential to cognitive function in schizophrenia while patients are often treated with many drugs with anticholinergic activity. This study aims to examine the association between high anticholinergic burden medication and cognitive function in schizophrenia patients.

Methods

A systematic review was performed on English language research studies published on PubMed from inception to December 2019 focusing on the effect of anticholinergic loads on cognitive domains in schizophrenia. No restrictions on study designs, age or geographical distribution were applied. Two researchers performed independently the screening and shortlisting of the eligible articles. A narrative synthesis of the main characteristics and the findings of included studies was reported.

Results

In total, fourteen articles of varying methodological design met the inclusion criteria. Three of them found significant improvement in cognition after anticholinergic discontinuation without adverse effects. Eleven studies found a significant association between high anticholinergic burden and cognitive impairment (e.g. verbal memory, information processing speed and working memory). However, the magnitude of the association in the largest study is statistically significant but of dubious clinical significance.

Conclusions

Medication with increased anticholinergic load has been found in most of the studies to affect the cognitive functions of people with schizophrenia. However, the lack of clinical and methodological homogeneity of selected studies, limit our interpretation and conclusions.

Key messages

There is some evidence indicating a negative effect of anticholinergic drug treatment on cognitive function of schizophrenia patients. Well-designed large prospective studies and randomized clinical trials are required to examine the effect of anticholinergic drug treatment in the cognition of schizophrenia patients.