Biallelic EPCAM deletions induce tissue-specific DNA repair deficiency and cancer predisposition

We report a case of Mismatch Repair Deficiency (MMRD) caused by germline homozygous EPCAM deletion leading to tissue-specific loss of MSH2. Through the use of patient-derived cells and organoid technologies, we performed stepwise in vitro differentiation of colonic and brain organoids from reprogrammed EPCAMdel iPSC derived from patient fibroblasts. Differentiation of iPSC to epithelial-colonic organoids exhibited continuous increased EPCAM expression and hypermethylation of the MSH2 promoter. This was associated with loss of MSH2 expression, increased mutational burden, MMRD signatures and MS-indel accumulation, the hallmarks of MMRD. In contrast, maturation into brain organoids and examination of blood and fibroblasts failed to show similar processes, preserving MMR proficiency. The combined use of iPSC, organoid technologies and functional genomics analyses highlights the potential of cutting-edge cellular and molecular analysis techniques to define processes controlling tumorigenesis and uncovers a new paradigm of tissue-specific MMRD, which affects the clinical management of these patients.

Estimating minimum dietary diversity for children aged 6-23 months: a comparison of agreement and cost of two recall methods in Cambodia and Zambia

OBJECTIVE

To compare the agreement and cost of two recall methods for estimating children's minimum dietary diversity (MDD).

DESIGN

We assessed child's dietary intake on two consecutive days: an observation on day one, followed by two recall methods (list-based recall and multiple-pass recall) administered in random order by different enumerators at two different times on day two. We compared the estimated MDD prevalence using survey-weighted linear probability models following a two one-sided test equivalence testing approach. We also estimated the cost-effectiveness of the two methods.

SETTING

Cambodia (Kampong Thom, Siem Reap, Battambang, and Pursat provinces) and Zambia (Chipata, Katete, Lundazi, Nyimba, and Petauke districts).

PARTICIPANTS

Children aged 6-23 months: 636 in Cambodia and 608 in Zambia.

RESULTS

MDD estimations from both recall methods were equivalent to the observation in Cambodia but not in Zambia. Both methods were equivalent to the observation in capturing most food groups. Both methods were highly sensitive although the multiple-pass method accurately classified a higher proportion of children meeting MDD than the list-based method in both countries. Both methods were highly specific in Cambodia but moderately so in Zambia. Cost-effectiveness was better for the list-based recall method in both countries.

CONCLUSION

The two recall methods estimated MDD and most other infant and young child feeding indicators equivalently in Cambodia but not in Zambia, compared to the observation. The list-based method produced slightly more accurate estimates of MDD at the population level, took less time to administer and was less costly to implement.

Exclusive breastfeeding: Measurement to match the global recommendation

The World Health Organization (WHO) and United Nations Children's Fund (UNICEF) recommend exclusive breastfeeding (EBF) for the first 6 months of life. To estimate the proportion of infants that are exclusively breastfed, many agencies use the point prevalence of EBF among infants currently 0–5.9 months of age, as recommended by WHO and UNICEF. This measure tends to overestimate the percentage of infants that are exclusively breastfed for the entire recommended period. We compared five methods of measuring EBF, using data from three large‐scale cross‐sectional surveys. The five methods were: the WHO/UNICEF recommended method (EBF‐24H); an estimate of EBF for 6 months, using the 24‐h recall among infants 4–5.9 and 6–7.9 months (EBF‐24H‐Pul); a since birth recall (EBF‐SB); an estimate of EBF for 6 months, using the since‐birth recall among infants 4–5.9 and 6–7.9 months (EBF‐SB‐Pul); a retrospective measure of EBF collected from infants 6–11.9 months, based on the age of introduction of liquids and foods (EBF‐AI). EBF‐24H‐Pul and EBF‐SB‐Pul produced lower estimates of EBF than other measures, while also aligning better with the WHO recommendation, but may be difficult to estimate from multipurpose surveys due to sample size limitations. The EBF‐AI method produced estimates between these, aligns well with the WHO recommendation and can be easily collected in large‐scale household surveys. Additional validation of the EBF‐24‐Pul, EBF‐SB‐Pul, and EBF‐AI methods is recommended to understand how accurately they measure EBF for the recommended 6‐month period.

Exclusive breastfeeding infants for the first 6 months of life is recommended by the World Health Organization and UNICEF for the benefits it provides to both the infant and the mother.

The measure currently recommended for global monitoring of exclusive breastfeeding is the prevalence of exclusive breastfeeding among infants less than 6 months, based on a 24‐h recall.

Though this measure is easy to collect in large‐scale household surveys, it is often misinterpreted as the percent of infants who are fed according to the recommendation, resulting in an overestimation.

Other survey‐derived measures of exclusive breastfeeding are available, for example, such as calculating the midpoint prevalence among infants 4–5.9 and 6–7.9 months, a method developed by Pullum and a since birth recall among infants aged 6–11.9 months of age.

These are similarly feasible to collect in household surveys and align better with the practice of exclusive breastfeeding for 6 months as recommended by the WHO.

0243 Relationships Between Pre-Pandemic Trauma and Stress with Sleep During the COVID-19 Pandemic in Young Adults

Introduction

Young adults, particularly those with histories of interpersonal trauma or stress, are more likely to experience to adverse psychosocial outcomes (e.g., depression) during the COVID-19 pandemic, compared to those without these histories. However, few studies have examined sleep and most rely on retrospectively-reported pre-pandemic experiences. We tested whether pre-pandemic trauma and stress were prospectively related to worse ecological momentary assessment (EMA)-reported sleep during the pandemic.

Methods

The sample includes 114 regular drinkers aged 21-30 years from two ongoing studies of alcohol use and sleep who completed a shared assessment battery and a 10-17-day EMA protocol before and during the pandemic (conducted July-November 2020; M=13.9 months after baseline). Participants reported past-month perceived stress (10-item Perceived Stress Scale) and interpersonal traumas (e.g., abuse, conflict), via scores on the “Current Partner” and “Personal” (persons other than spouse/partner) subscales of the Difficult Life Circumstances Scale. The EMA protocol measured daily sleep (total sleep time [TST]; sleep efficiency [SE]), relational stress (1-5 ratings for family, spouse/partner, friends), and alcohol use. Paired t-tests compared pre-pandemic vs. pandemic sleep. Separate linear regressions tested associations between pre-pandemic trauma and stress with average pandemic TST and SE, adjusted for baseline age and sleep, racial identity, assigned sex at birth, time between assessments, and drinking days (averaged across timepoints).

Results

Participants were on average 23.8 years old (61% female; 7% Asian; 39% Black; 1.8% Mixed race; 0.9% Other race; 0.9% Pacific Islander; 55% White). Average TST increased from baseline to pandemic (7.5 vs. 7.8; t(113)=-2.57, p=.01); no change was observed in SE (95% vs. 94%; t(113)=1.01, p=.31). Pre-pandemic perceived stress (B[SE]=-.003[.001], p=.02) and average EMA-reported family stress (B[SE]=-.04[.02], p=.05) predicted worse pandemic SE. No associations emerged with friend or partner stress, trauma, or TST (ps>.11).

Conclusion

Pre-pandemic perceived stress (but not trauma nor relational stress) predicted worse sleep during the pandemic. Perceived stress reflects feeling overwhelmed and difficulty coping, which is relevant given dramatic pandemic-related impacts on daily life. The overall accumulation of stress, versus day-to-day stress in specific relationships, may be most detrimental for sleep during the pandemic. Perceived stress is amenable to evidence-based (and remotely-delivered) interventions, including mindfulness-based stress reduction.

Support (If Any)

R01AA025617 (SLP), R01AA026249 (BPH/SLP), K23HL159293 (KPJ)

HIV Testing Program Activities and Challenges in Four U.S. Urban Areas

The national "Ending the HIV Epidemic: A Plan for America" supports expanded testing in jurisdictions and groups with disproportionate HIV burden. Public health planners benefit from learning HIV testing service (HTS) strengths, challenges, and innovations. We conducted semistructured interviews with 120 HTS staff from local health departments, community-based organizations, and community members in Houston, Texas; Miami, Florida; New Orleans, Louisiana; and Washington, DC. We coded interview transcripts using qualitative methods to identify themes. Program strengths include HIV testing integration with other client services; prioritized testing and tailored incentives; multiple advertising methods; and partnerships among HTS providers. Challenges include stigma, fear, and disparities; funding requirements that create competition between providers; and service accessibility, unnecessary repeat testing, and insufficient innovation. The four jurisdictions addressed some, but not all, of these challenges. Cross-jurisdictional collaboration, together with state and federal partners plus program data may help identify additional strategies for strengthening HTS.

Trajectories of state impulsivity domains before and after alcohol consumption in the naturalistic environment

BACKGROUND AND AIMS

Studies have demonstrated that ecological momentary assessment (EMA) can effectively capture within-person variations in impulsive states and that this relates to alcohol use. The current study aimed to examine the daily trajectories of five facets of impulsivity prior to and following drinking initiation. Additionally, we explored how race, sex, baseline trait impulsivity facets, and ADHD may moderate this relation.

DESIGN AND SETTING

EMA was used to collect real-time data at 6 semi-random time points and self-initiated reports of drinking onset throughout the day over a 10-day period Measurements Five state and trait impulsivity facets were assessed via the UPPS-P. Naturalistic alcohol use, ADHD history, and demographic characteristics were also assessed PARTICIPANTS: Participants were 135 adult drinkers from a larger study examining alcohol response for Black and White adults with and without a history of childhood ADHD FINDINGS: Generalized estimating equations showed that the linear trajectory of negative urgency significantly increased prior to drinking. Following drinking initiation, the linear trajectory of sensation seeking significantly decreased. There was not significant change in the trajectories of positive urgency, lack of premeditation and lack of perseverance before or after drinking initiation. Additionally, race and ADHD history moderated the trajectory of sensation seeking and race moderated the trajectory of lack of planning.

CONCLUSIONS

Findings highlight the possibility of identifying proximal changes in impulsivity facets prior to and after initiation of drinking. Results can be used to inform real-time interventions that target risk periods to ultimately decrease alcohol use.

Saying the unsayable: The online expression of mothers’ anger during a pandemic

This article investigates key triggers for mothers’ anger during the COVID-19 pandemic and some of the positive and negative consequences of its expression online. It uses the UK online parenting forum Mumsnet as a research context and source of data. Our findings support previous research into mothers’ anger during COVID-19 that suggests that the pandemic has both exacerbated longstanding sources of conflict and created new ones within their homes. This anger is frequently repressed because women need to continue to work and cohabit with the colleagues and family members who have caused this anger. However, we also identify a further trigger for mothers’ anger – their frustration at the government's perceived inaction and mis- or even dis-information about the pandemic. This anger can be exacerbated by mainstream media reports and also the sharing of suspicions and complaints on online forums such as Mumsnet. Mumsnet therefore offers a safe space for the venting of women's anger during lockdown, but also a place where feelings of anger can be perpetuated and perhaps even aroused.

Systematic review of metrics used to characterise dietary nutrient supply from household consumption and expenditure surveys

OBJECTIVE

To review existing publications using Household Consumption and Expenditure Survey (HCES) data to estimate household dietary nutrient supply to (1) describe scope of available literature, (2) identify the metrics reported and parameters used to construct these metrics, (3) summarise comparisons between estimates derived from HCES and individual dietary assessment data and (4) explore the demographic and socio-economic sub-groups used to characterise risks of nutrient inadequacy.

DESIGN

This study is a systematic review of publications identified from online databases published between 2000 to 2019 that used HCES food consumption data to estimate household dietary nutrient supply. Further publications were identified by 'snowballing' the references of included database-identified publications.

SETTING

Publications using data from low- and lower-middle income countries.

RESULTS

In total, fifty-eight publications were included. Three metrics were reported that characterised household dietary nutrient supply: apparent nutrient intake per adult-male equivalent per day (n 35), apparent nutrient intake per capita per day (n 24) and nutrient density (n 5). Nutrient intakes were generally overestimated using HCES food consumption data, with several studies finding sizeable discrepancies compared with intake estimates based on individual dietary assessment methods. Sub-group analyses predominantly focused on measuring variation in household dietary nutrient supply according to socio-economic position and geography.

CONCLUSION

HCES data are increasingly being used to assess diets across populations. More research is needed to inform the development of a framework to guide the use of and qualified interpretation of dietary assessments based on these data.

Position specific physical performance and running intensity fluctuations in elite women's football

The purpose of the present study was to investigate the physical performance of elite female football players during match play along with transient alterations in running performance following 1- and 5-min univariate peak periods. 54 elite female players from four top-level Norwegian teams were monitored for one season (n = 393 match observations), and physical performance data collected using STATSport GPS APEX. Results revealed significant differences in physical performance between the positions during full match play, particularly between wide and central players. Both full backs (FBs) and wide midfielders (WMs) covered more total distance (TD), high-speed running distance (HSRD), and sprint distance (SpD) than center backs (CBs) (p < 0.05-0.001), while WMs also covered more HSRD than both central midfielders (CMs) (p < 0.01) and forwards (FWs) (p < 0.05), and more acceleration -and deceleration distance (Acc_dist and Dec_dist ) than both CBs and CMs (p < 0.01-0.001). A similar pattern was observed for the peak period analysis, with FBs and WMs covering more SpD in peak 1 min than CBs and CM (p < 0.001) and more SpD in peak 5-min than CBs, CMs, and FWs (p < 0.001). Irrespective of the variable analyzed, greater distances were covered during the peak 5-min period than in the next-5 and mean 5-min periods (p < 0.001). Significant (p < 0.001), but small to trivial (Cohen's D_z : 0.07-0.20), decreases in distance covered were also observed for each variable following each univariate peak 5-min period. In conclusion, practitioners should account for differences in physical performance when developing training programs for female football players and be aware of transient reductions in physical performance following univariate peak 1- and 5-min periods. Specifically, the very high intensity in 1-min peak periods adds support to the principal of executing speed endurance activities during training to mirror and be prepared for the physical demands of match play.

Prognostic value of layer-specific global longitudinal strain in patients undergoing coronary artery bypass grafting

Background

Recent improvements in speckle tracking echocardiography have made sectionalized quantification of layer-specific global longitudinal strain (GLS) possible. Prior studies have reported prognostic value of GLS in several cardiac diseases, however, the use of layer-specific strain has not been investigated in patients undergoing coronary artery bypass grafting (CABG).

Purpose

To determine the prognostic value of layer-specific GLS for predicting all-cause mortality after CABG.

Methods

In this retrospective cohort study, consecutive patients undergoing isolated CABG between 2006 and 2011 were included. The patients were followed through nation-wide registries for the endpoint of all-cause mortality. Multivariable Cox regression models adjusted for clinical and echocardiographic baseline characteristics were used to assess the association between layer-specific GLS and all-cause mortality. Cumulative survival was stratified by clinical age and gender-dependent cut-off values for the layer-specific GLS, which was obtained from a large healthy population study.

Results

Of 641 patients included (mean age 67 years, 84% male), 70 (10.9%) died during follow-up (median 3.8 years [IQR: 2.7; 4.9 years]). Patients who died during follow-up were significantly older (71 years vs. 67 years, P = &lt;0.001) and had a lower LVEF (46% vs. 51% P = &lt;0.001). Endocardial GLS (GLSendo) (−14.2% vs. −16.3%, P&lt;0.001), whole wall GLS (−12.1% vs. −13.9%, P&lt;0.001), and epicardial GLS (GLSepi) (−10.6% vs. −12.2%, P&lt;0.001) were all reduced in patients who died during follow-up, and patients with GLS below cut-off had a more than two-fold increased risk of all-cause mortality (Figure 1). The risk of dying increased linearly with decreasing absolute GLS for all layers (p&lt;0.0002 for all layers), (Figure 2). In multivariable models, all layer-specific strain parameters remained significantly associated with all-cause mortality; GLSepi: HR=1.14 (1.05–1.23), p=0.002; GLS: HR=1.12 (1.04–1.20), p=0.002; GLSendo: HR=1.09 (1.03–1.16), p=0.003, per 1% absolute decrease. However, only GLSepi remained significantly associated with mortality when also adjusting for echocardiographic parameters (GLSepi: HR=1.12 (1.00–1.25), p=0.049, per 1% absolute decrease) and separately also after adjusting for the EuroScore II (GLSepi: HR=1.09 (1.00–1.18), p=0.043, per 1% absolute decrease).

Conclusion

Layer-specific GLS is an independent prognosticator of all-cause mortality after CABG. In multivariable models, GLSepi provided significant prognostic value after adjusting for echocardiographic parameters and EuroScore II.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Research grant from Herlev & Gentofte University Hospital's internal research funds. Figure 1. Kaplan-Meier survival estimatesFigure 2. Incidence rate of all-cause mortality

Effect of internet-delivered cognitive behavioral therapy on quality of life in patients with symptomatic atrial fibrillation

Background

Many patients with atrial fibrillation (AF) experience severe or disabling symptoms and suffer from impaired quality of life (QoL). AF symptoms are often not sufficiently alleviated by current treatments. Symptom preoccupation (fear of AF episodes, hypervigilance towards cardiac symptoms, worry about complications, avoidance of physical and social activities) plays an important role in AF disability and can be targeted by cognitive behavioural therapy (CBT). This is the first randomized controlled trial (RCT) evaluating internet-delivered CBT in patients with AF.

Methods

We randomized patients to 10 weeks of CBT or routine care with AF-education (EDU) only. Inclusion criteria were ECG documented paroxysmal AF (≥1 episode/month); AF-care according to ESC guidelines; symptoms ≥EHRA IIb. Exclusion criteria were recent or planned ablation and severe medical or psychiatric illness. CBT was delivered over the internet by clinical psychologists. Main components were exposure to cardiac-related physical sensations and reduction of AF-related avoidance behavior. Patients were evaluated at baseline, post-CBT and 3 months (3M) post-CBT. The primary endpoint was AF-specific QoL (AFEQT) at 3M. Secondary endpoints were symptom preoccupation (CAQ), symptom frequency (SCL), symptom severity (SCL), general QoL (WHODAS) and AF-specific healthcare (AFSS) (abbreviations: see table legend). AF burden was measured by 5-day continuous ECG recording. After 3M, patients in the EDU group were offered CBT. The CBT group was further evaluated at 6M and 12M.

Results

127 patients (age 65.4±8.3; 58% female; AF duration 5.6±6.1 years) were randomized to CBT (n=65) or EDU (n=62). CBT significantly improved AF-specific QoL. The AFEQT score was 62.5±16.7 at baseline and increased by 21.0 in the CBT group compared to 6.0 in the EDU group resulting in an 15.0 points improvement (95% CI: 10.1–19.8; P&lt;.001). CBT also significantly improved the secondary outcomes (table). Results were sustained 12 months after treatment (AFEQT; figure). The results from ECG monitoring (AF burden) are currently being analyzed.

Conclusion

Internet delivered CBT significantly improved AF-specific QoL in patients with symptomatic paroxysmal AF already receiving routine AF care. The magnitude of QoL improvement was comparable to that obtained in recent rhythm control trials and the effects were sustained over 12 months. AF-specific CBT delivered via the internet has the potential to improve the well-being of a large group of patients who do not sufficiently improve from current treatment methods. Our data support the integration of psychological evaluation and treatment in a multifactorial approach to AF management.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The study was supported by grants from theSwedish Research Council (2016-01379), RegionStockholm (ALF project). Change in AFEQT score over study periodBetween group improvements

Modeling food fortification contributions to micronutrient requirements in Malawi using Household Consumption and Expenditure Surveys

Large-scale food fortification may be a cost-effective intervention to increase micronutrient supplies in the food system when implemented under appropriate conditions, yet it is unclear if current strategies can equitably benefit populations with the greatest micronutrient needs. This study developed a mathematical modeling framework for comparing fortification scenarios across different contexts. It was applied to model the potential contributions of three fortification vehicles (oil, sugar, and wheat flour) toward meeting dietary micronutrient requirements in Malawi through secondary data analyses of a Household Consumption and Expenditure Survey. We estimated fortification vehicle coverage, micronutrient density of the diet, and apparent intake of nonpregnant, nonlactating women for nine different micronutrients, under three food fortification scenarios and stratified by subpopulations across seasons. Oil and sugar had high coverage and apparent consumption that, when combined, were predicted to improve the vitamin A adequacy of the diet. Wheat flour contributed little to estimated dietary micronutrient supplies due to low apparent consumption. Potential contributions of all fortification vehicles were low in rural populations of the lowest socioeconomic position. While the model predicted large-scale food fortification would contribute to reducing vitamin A inadequacies, other interventions are necessary to meet other micronutrient requirements, especially for the rural poor.

De novo assembly, annotation, and comparative analysis of 26 diverse maize genomes

We report de novo genome assemblies, transcriptomes, annotations, and methylomes for the 26 inbreds that serve as the founders for the maize nested association mapping population. The number of pan-genes in these diverse genomes exceeds 103,000, with approximately a third found across all genotypes. The results demonstrate that the ancient tetraploid character of maize continues to degrade by fractionation to the present day. Excellent contiguity over repeat arrays and complete annotation of centromeres revealed additional variation in major cytological landmarks. We show that combining structural variation with single-nucleotide polymorphisms can improve the power of quantitative mapping studies. We also document variation at the level of DNA methylation and demonstrate that unmethylated regions are enriched for cis-regulatory elements that contribute to phenotypic variation.

Systematic review and network meta-analysis of randomised controlled trials of interventions for depressive symptoms in patients with coronary artery disease

Funding Acknowledgements

Type of funding sources: None.

Objective

Depression is common in patients with coronary artery disease (CAD) and is associated with poor outcomes. Although different treatments are available, it is unclear which are best or most acceptable to patients, so we conducted a network meta-analysis of evidence from randomized controlled trials (RCTs) of different depression treatments to ascertain relative efficacy.

Methods

We searched for systematic reviews of RCTs of depression treatments in CAD and updated these with a comprehensive search for recent individual RCTs. RCTs comparing depression treatments (pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) were included. Primary outcomes were acceptability (dropout rate) and change in depressive symptoms 8-weeks post-treatment commencement. Change in 26-week depression and mortality were secondary outcomes. Frequentist, random effects network meta-analysis synthesized the evidence. GRADE was used to assess evidence quality.

Results

Thirty-three RCTs (7240 participants) provided analysable data. All treatments were equally acceptable. At 8-weeks, combination therapy (1 study), exercise (1 study), and antidepressants (10 studies) yielded the strongest effects versus comparators. At 26-weeks, antidepressants were consistently effective, but psychotherapy was only effective versus usual care. There were no differences in treatment groups for mortality.  GRADE ratings ranged from very low to low.

Conclusions

All treatments were equally acceptable, while antidepressants appeared to have the most robust evidence base for post-CAD depression. The evidence base was limited and biased; conclusions based on this literature should be drawn cautiously and considered to be tentative. Rigorous, multi-arm intervention trials, including trials of combination therapies and exercise, are urgently needed.

083 Circadian Preference is Associated with Impulsivity at Both the Trait and State Level

Introduction

Impulsivity is a multifaceted construct with well-documented risk for substance use problems. A circadian preference towards eveningness has been linked to trait, global impulsivity. Here we extend existing literature by investigating whether eveningness is associated with multiple facets of impulsivity at both trait- and state-level impulsivity. We also examined these associations utilizing daily measures of sleep timing and duration.

Methods

The primary sample included 78 moderate-to-heavy social drinkers (aged 21–35, 100% White men) with circadian preference data (Composite Scale of Morningness: CSM). Five facets of impulsivity were assessed via the UPPS-P, both at baseline (full scale) and up to 6 times per day over 10 days (reduced scale). Daily sleep timing (midsleep) and duration were assessed via self-report over 10 days. Multilevel models were used to examine between- and within-person associations, accounting for covariates and correcting for multiple comparisons.

Results

Between-person models found that eveningness was associated with multiple facets of impulsivity, at trait (lack of perseverance) and state levels (negative urgency, positive urgency, lack of perseverance, and lack of premeditation). However, average midsleep and duration were generally unrelated to impulsivity when accounting for circadian preference. Within-person models in the primary sample largely paralleled the between-person findings. In a larger, more diverse sample (29.1% self-identified as Black, 29.7% female) without CSM data, later midsleep timing was associated with greater mean state-level impulsivity across multiple facets. These effects largely appear to be driven by White women.

Conclusion

A circadian preference for eveningness is strongly associated with multiple facets of impulsivity, at both trait- and state-levels, potentially increasing risk for substance use. This association does not appear to be driven by actual daily sleep timing and/or duration. Future research with objective measures of sleep in larger, more diverse samples will be important to clarify implications for sleep-focused prevention and/or treatment of substance use.

Support (if any)

Supported by grants from NIH (R01AA026249; K01 AA021135), as well as a Foundation Grant from ABMRF/The Foundation for Alcohol Research.

Prognostic utility of early systolic lengthening by speckle tracking in patients undergoing coronary artery bypass graft

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Independent Research Fund Denmark

Background

Early systolic lengthening (ESL), a paradoxical stretch of myocardial fibers, has been linked to myocardial viability and contractile dysfunction. We assessed the long-term prognostic potential of ESL in coronary artery bypass graft (CABG) patients.

Methods

We retrospectively included patients (n = 709; mean age 68 years; 85% men) who underwent speckle tracking echocardiography (median 15 days) prior to CABG. Endpoints were cardiovascular death (CVD) and all-cause mortality. We assessed amplitude of ESL (%), defined as peak positive strain, and duration of ESL (ms), determined as time from Q-wave on the ECG to peak positive strain. We applied Cox proportional hazards models adjusted for the clinical risk tool, EuroSCORE II.

Results

During median follow-up of 3.8 years [IQR 2.7 to 4.9 years], 45 (6%) experienced CVD and 80 (11%) died. In survival analyses adjusted for EuroSCORE II, amplitude of ESL was associated with CVD (HR 1.37 [95%CI 1.13 to 1.66], P = 0.001) and all-cause mortality (HR 1.31 [95%CI 1.13 to 1.54], P = 0.001). Similar findings applied to duration of ESL and CVD (HR 1.17 [95%CI 1.08 to 1.26], P &lt; 0.001) and all-cause mortality (HR 1.14 [95%CI 1.07 to 1.21], P &lt; 0.001). The prognostic value of ESL amplitude was modified by sex (P interaction &lt; 0.05), such that it was greater in women for both endpoints (Figure 1A-B). When adding ESL duration to EuroSCORE II, the net reclassification index improved significantly for both CVD and all-cause mortality.

Conclusions

Assessment of ESL provides independent and incremental prognostic information in addition to the EuroSCORE II for CVD and all-cause mortality in CABG patients. The prognostic value was greater in women.

Abstract Figure. Prognostic value of ESL amplitude by sex

Longitudinal change in cardiac structure and function following acute coronary syndrome stratified by culprit coronary artery lesion site

Funding Acknowledgements

Type of funding sources: None.

Background

Acute coronary syndrome (ACS) has adverse consequences for the myocardium and subsequent cardiac function and structure. No reports exist comparing the differences in impact of culprit coronary artery lesion site on longitudinal remodeling and changes left ventricular structure and function.

Method

A total of 299 ACS patients treated with PCI were included in the present study. All patients had two echocardiographic examinations performed. The first was performed median 2 (IQR: 1; 3) days following PCI, while the second was performed median 240 (IQR: 81; 881) days after the first. Patients were grouped based on culprit coronary artery lesion (left anterior descending artery (LAD), right coronary artery (RCA) and circumflex artery (Cx)). Patients with multiple lesions were excluded from the present study. Univariable linear regression analysis was utilised to assess the association between culprit coronary artery lesion site and longitudinal change in cardiac structure and function.

Results

Mean age was 63 ± 11 years and 77% were male. At follow-up, mean left ventricular ejection fraction was 42 ± 9% and global longitudinal strain (GLS) was -13 ± 4%. Culprit coronary artery lesion was allocated as follows; 168 ACS patients were treated in LAD, 95 patients were treated in RCA, and 36 patients were treated in Cx. In the linear regression analysis, LAD patients displayed a greater improvement in GLS (b =-0.116, p = 0.048) compared to the two other lesion sites. LAD patients had the poorest GLS at both baseline and follow-up echocardiography (Figure). RCA lesions were associated with the largest decrease in left atrial maximum volume (LAVmax) (b = -0.156, p = 0.011) and the largest increase in relative wall thickness (RWT) (b = 0.139, p = 0.030), consequently resulting in an LAVmax smaller and an RWT larger at follow-up than other lesion sites (Figure). Lastly, Cx lesions were significantly associated with the largest decrease in ratio between peak early diastolic transmitral flow velocity and peak early diastolic mitral annular tissue velocity (E/e’) (b = -0.262, P &lt;0.001). Cx lesion patients were observed to have elevated E/e’ at baseline, which generally normalised at follow-up (Figure).

Conclusion

The present study suggests that culprit coronary artery lesion site has a differential impact on cardiac remodeling. This information can potentially aid the clinical understanding of cardiac structure and function following ACS according to coronary artery lesion site.

Abstract Figure

Left ventricular end-diastolic pressure is associated with left atrial functional measures by echocardiography

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation

Background

Assessment of maximal LA volume (LAVmax) is recommended in imaging guidelines but evidence suggests additional value of functional LA measures. How extended measures of LA function associate to left ventricular filling pressure has not been fully explored.

Purpose

To investigate the association between functional LA measures and left ventricular end-diastolic pressure (LVEDP)

Methods

Patients suspected of coronary artery disease referred for angiography had simultaneous left heart catheterization performed for invasive pressure measurements. LVEDP &gt; 12mmHg was considered elevated. LA measurements by echocardiography included: LAVmax, minimal LA volume (LAVmin), total LA emptying fraction (total LAEF), passive LA emptying fraction (passive LAEF), and active LA emptying fraction (active LAEF).

Results

Of 43 patients, 28 (65%) had elevated LVEDP. These patients more frequently had coronary vessel disease (VD) and impaired LA mechanics by all accounts except by LAVmax.

All LA measures except LAVmax were associated with LVEDP in unadjusted linear regression analyses, however, only LA emptying fractions remained associated with LVEDP after adjusting for age and VD (2.6 (1.2-4.0) mmHg increase, p = 0.001, per 5% decrease in total LAEF; 1.4 (0.1-2.8) mmHg increase, p = 0.040, per 5% decrease in active LAEF; 1.8 (0.1-3.4) mmHg increase, p = 0.038, per 5% decrease in passive LAEF).

In logistic regression, passive LAEF was significantly associated with elevated LVEDP (figure), and this was also the case after adjusting for age and VD (OR = 1.11 (1.01-1.21), p = 0.023, per 1% decrease). Similar findings were made in subgroup analyses among patients without dilated LA and patients without conventional indicators of elevated filling pressure.

Conclusion

Left ventricular end-diastolic pressure is significantly associated with LA functional measures but not LA volumes. Additionally, passive LAEF is associated with elevated LVEDP. Future studies examining LA function should include all components of LAEF.

Abstract Figure.

Unsupervised machine learning generated clusters of left ventricular strain curves identifies patients in risk of heart failure and cardiovascular death following acute myocardial infarction

Background

Today myocardial deformation, also known as strain, is assessed by the global longitudinal strain (GLS) which only provides information about the maximal deformation during systole. Hence, a lot of information obtained from different patterns of deformation curves might be undiscovered. Unsupervised Machine leaning (uML) is capable of identifying similar patterns of deformation curves. Identifying different phenotypical patterns from myocardial deformation curves might provide insights into the pathophysiological development of cardiac disease and entail useful prognostic information.

Purpose

To investigate whether uML can group specific patterns of myocardial deformation curves which provide prognostic information on heart failure and/or cardiovascular death (HF/CVD) following ST-segment elevation myocardial infarction (STEMI).

Methods

A total of 319 STEMI patients had an echocardiogram performed at median 2 days after primary percutaneous coronary intervention (pPCI). Speckle tracking echocardiography analysis divided the left ventricle into 18 segments. Standardisation of the cardiac cycle was done using linear interpolation and complete strain data (mean of all segments) as function of time throughout the cardiac cycle was used as input for the uML algorithm. Clusters were identified using a K-means cluster analysis algorithm. Primary endpoint was the composite of heart failure (HF) and/or cardiovascular death (CVD). Median follow-up time was 1423 days (IQR: 91; 1660).

Results

Mean age was 62 years, 75% were male and 130 (41%) suffered incident HF/CVD during follow-up. The uML algorithm grouped patients into three clusters containing 97, 104, and 118 patients respectively. GLS curves of the three clusters are illustrated in the Figure 1. Incidence of HF/CVD increased significantly from cluster 1 through 3 (24% vs. 39% vs. 60%, P&lt;0.001). In multivariable Cox regressions adjusting for the variables in the score risk chart model all three clusters were significantly associated with future HF/CVD (Figure 1). Cluster models provided significant incremental prognostic information when comparing C-statistics (0.64 vs. 0.62, p=0.029)

Conclusion

Unsupervised Machine Learning clusters of left ventricular deformation curves identifies patients in risk of HF/CVD following STEMI treated with pPCI, and provides incremental prognostic information to the score risk chart model.

Figure 1. GLS curves of the three clusters

Funding Acknowledgement

Type of funding source: None

The prognostic value of myocardial deformational patterns is reduced in patients with heart failure

Background

Early systolic lengthening (ESL) and postsystolic shortening are considered highly specific for myocardial ischemia. We aimed to investigate the prognostic potential of both deformational patterns in patients with heart failure (HF) and to determine if a history of ischemic heart disease modified this relationship.

Method

A total of 884 patients with systolic HF (66±12 years, male 73%, mean ejection fraction 28±9%) underwent speckle tracking echocardiography. Of these, 61% suffered from ischemic cardiomyopathy (ICM). Patients were followed for all-cause mortality. We assessed the ESL index: [−100x (peak positive strain/maximal strain)] and the postsystolic index (PSI): [100x (postsystolic strain/maximal strain)]. Both parameters were averaged across 18 myocardial segments.

Results

During a median follow-up of 3.4 years [interquartile range 1.9 to 4.8], 132 patients (15%) died. In multivariable survival analyses adjusted for potential confounders (age, sex, BMI, mean arterial pressure, cholesterol, heart rate, CABG/PCI, left ventricular ejection fraction and mass index, left atrial volume index, tricuspid annular plane systolic excursion, E-wave, E/e', deceleration time, and global longitudinal strain) neither the ESL index (HR 1.02 per 1% increase [0.97 to 1.08], P=0.40) nor PSI (HR 1.00 per 1% increase [0.98 to 1.01], P=0.69) were associated with all-cause mortality. ICM modified the relationship (P interaction unadjusted/adjusted=0.001/0.008; Figure) such that per 1% increase in ESL index in patients with ICM was significantly associated with all-cause mortality (unadjusted: HR 1.09 [1.04 to 1.15], P&lt;0.001 and adjusted: HR 1.06 [1.00 to 1.13], P=0.045) but not in those without (unadjusted: HR 1.02 [1.01 to 1.03], P=0.002 and adjusted: HR 0.99 [0.90 to 1.09], P=0.086). ICM did not modify the relationship between PSI and all-cause mortality (P interaction unadjusted/adjusted=0.15/0.13).

Conclusion

Our results indicate that in this cohort of undifferentiated HF patients with reduced ejection fraction the prognostic value of deformational patterns was reduced. However, the ESL index may provide some information on prognosis in patients with ICM.

ESL and interaction with ICM

Funding Acknowledgement

Type of funding source: None

Right ventricular speckle tracking in patients with heart failure – a comparison of right ventricular measures

Background

RV dysfunction is associated with increased mortality and morbidity in patients with heart failure. Due to the complex shape and position of the RV, assessing RV function from echocardiographic images remains a challenge.

Purpose

We have previously found that global longitudinal strain from 2DSTE is superior to left ventricular ejection fraction (LVEF) in identifying HFrEF patients with high risk of mortality. In this study we wanted to examine RV 2DSTE in patients with HFrEF and compare its prognostic value to conventional RV measures.

Methods and results

Echocardiographic examinations were retrieved from 701 patients with HFrEF. RV estimates were analysed offline, and end point was all-cause mortality. During follow-up (median 39 months) 118 patients (16.8%) died. RV GLS and RV FWS remained associated with mortality after multivariable adjustment, independent of TAPSE (RV GLS: HR 1.07, 95% CI 1.02–1.13, p=0.010, per 1% decrease) (RV FWS: HR 1.05, 95% CI 1.01–1.09, p=0.010, per 1% decrease). This seemed to be caused by significant associations in men as TAPSE remained as the only independent prognosticator in women. All RV estimates provided prognostic information incremental to established risk factors and significantly increased C-statistics (TAPSE: 0.74 to 0.75; RVFAC: 0.74 to 0.75; RVFWS: 0.74 to 0.77; RVGLS: 0.74 to 0.77).

Conclusions

RV strain from 2DSTE was associated with mortality in patients with HFrEF, independent of TAPSE and established risk factors. Our results indicate that RV strain is particularly valuable in male patients, whereas in women TAPSE remains a stronger prognosticator.

RV GLS and the risk of mortality

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): PGJ reports receiving lecture fee from Novo Nordisk.

Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air® App

BACKGROUND

In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently.

METHODS

All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self-assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated.

RESULTS

A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures.

CONCLUSIONS

VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.

0216 Is There a Daily Rhythm in Alcohol Craving and Does It Vary by Circadian Timing?

Introduction

People with later circadian timing tend to consume more alcohol, potentially due to altered rhythms in when and how much they crave alcohol throughout the day. However, whether circadian factors play a role in alcohol craving has received scant attention. Here, we investigated if the daily rhythm of alcohol craving varied by circadian timing in two independent studies of late adolescent and young adult drinkers.

Methods

In Study 1, 32 participants (18–22 years of age; 61% female; 69% White) completed momentary reports of alcohol craving five times a day for 14 days. Participants wore wrist actigraphs and completed two in-lab assessments of dim light melatonin onset (DLMO). Average actigraphically-assessed midpoint of sleep on weekends and average DLMO were used as indicators of circadian timing. In Study 2, 231 participants (21–35 years of age; 28% female; 71% White) completed momentary reports of alcohol craving six times a day for 10 days. Average midpoint of self-reported time-in-bed on weekends was used to estimate circadian timing.

Results

Multilevel cosinor analysis revealed a 24-hour daily rhythm in alcohol craving which was moderated by circadian timing in both studies (p’s&lt;0.05). In both Study 1 and 2, people with later circadian timing had a later timed peak of craving. In Study 1, but not Study 2, later circadian timing predicted a blunted amplitude in craving.

Conclusion

Findings support a daily rhythm in craving that varies by individual differences in circadian timing. Because craving is an important predictor of future alcohol use, the findings implicate circadian factors as a useful area to advance alcohol research and potentially improve interventions.

Support

R21AA023209; R01DA044143; K01AA021135; ABMRF/The Foundation for Alcohol Research.

Effect of sequence depth and length in long-read assembly of the maize inbred NC358

Improvements in long-read data and scaffolding technologies have enabled rapid generation of reference-quality assemblies for complex genomes. Still, an assessment of critical sequence depth and read length is important for allocating limited resources. To this end, we have generated eight assemblies for the complex genome of the maize inbred line NC358 using PacBio datasets ranging from 20 to 75 × genomic depth and with N50 subread lengths of 11-21 kb. Assemblies with ≤30 × depth and N50 subread length of 11 kb are highly fragmented, with even low-copy genic regions showing degradation at 20 × depth. Distinct sequence-quality thresholds are observed for complete assembly of genes, transposable elements, and highly repetitive genomic features such as telomeres, heterochromatic knobs, and centromeres. In addition, we show high-quality optical maps can dramatically improve contiguity in even our most fragmented base assembly. This study provides a useful resource allocation reference to the community as long-read technologies continue to mature.

P1868Risk of arrhythmias after myocardial infarction in patients with left ventricular systolic dysfunction according to mode of revascularization: a CARISMA substudy

Introduction

The CARISMA trial was the first study to use continuous monitoring for documentation of long-term arrhythmias in post-infarction patients with left ventricular dysfunction. During the study duration (2000–2005), primary PCI (pPCI) as treatment of acute myocardial infarction was introduced approximately midway (2002) on the enrolling centres.

Purpose

The aim of this study was to describe the influence of mode of revascularization after myocardial infarction (AMI) on long-term risk of risk of new onset atrial fibrillation, ventricular tachyarrhythmias and brady arrhythmias.

Methods

The study is a sub-study on the CARISMA study population that consisted of patients with AMI and left ventricular ejection fraction ≤40%, which received an implantable loop recorder and was followed for 2 years. After exclusion of 15 patients who refused device implantation and 26 with pre-existing arrhythmias, 268 of the 312 patients were included. Choice of revascularization was made by the treating team independently of the trial and was retrospectively divided into primary percutaneous intervention (pPCI), subacute PCI (24 hours to 2 weeks after AMI), primary thrombolysis or no revascularization.

Endpoints were new-onset of arrhythmias and major cardiovascular events (MACE). The Kaplan-Meier (figure 1) and Mantel-Byar methods were used for time to first event risk analysis.

Results

A total of 77 patients received no revascularization, whereas 49 received thrombolysis only and 142 received PCI. At two-years follow up patients treated with any PCI had a significant lower risk (0.40, n=63) of any arrhythmia compared to patients treated with trombolysis (0.60, n=30) or no revascularization (0.68, n=16) (p<0.001, unadjusted) (figure 1). Risk of MACE was significant higher in patients with any arrhythmia (0.25, n=76) compared to no arrhythmia (0.11, n=93) at two years follow-up (p=0.004, unadjusted).

Figure 1

Conclusion(s)

The long-term risk of new onset arrhythmias after AMI was significantly lower in patients treated with any PCI compared to patients not revascularized or treated with thrombolysis. Risk of MACE was significantly higher in patients with new onset arrhythmias compared to patients with no arrhythmias.

1096Diastolic myocardial dysfunction by tissue doppler imaging predicts outcome following isolated coronary artery bypass grafting

Background

Myocardial tissue velocities by tissue Doppler imaging (TDI) have proven superior predictors of outcome to left ventricular ejection fraction (LVEF) in ischemic heart disease, with early diastolic myocardial relaxation velocity (e') being an early sign of LV dysfunction in the ischemic cascade.

Purpose

We hypothesized that e' predicts outcome after coronary artery bypass grafting (CABG).

Methods

We included patients treated with isolated CABG (n=679). Before surgery, all patients had an echocardiogram performed with TDI to measure tissue velocities: systolic (s'), e' and late diastolic (a'). Endpoint was all-cause mortality retrieved from national registries. We performed Cox regressions and C-statistics. Net reclassification index was used to test improvement of EuroSCOREII.

Results

Of 679 patients, 79 (n=12%) died during follow-up (median: 3.8 years (IQR: 2.8; 5.0y). Follow-up was 100%. Mean age was 68 years, LVEF 50%, and 86% were male. All tissue velocities were univariable predictors of outcome (s': HR=1.46 [1.21; 1.78], p<0.001; e': HR=1.55 [1.33; 1.81], p<0.001; a': HR=1.19 [1.06; 1.33], p=0.004, per 1cm/s decrease for all). Overall, e' provided the highest C-statistics of all the tissue velocities (c-stat=0.69). In multivariable adjustments, e' remained an independent predictor after adjusting for clinical, biochemical and echocardiographic confounders (HR=1.24 [1.03; 1.49], p=0.022, per 1cm/s decrease). LVEF <40% modified the relationship between e' and outcome, so e' did not predict outcome in these patients (p for interaction = 0.013). However, e' was an independent predictor after multivariable adjustments in patients with LVEF >40% (HR=1.39 [1.11; 1.74], p=0.005, per 1cm/s decrease). When split by the median (−4.95cm/s), patients in the lowest group had a 3-fold increased risk of death (HR=3.31 [1.98; 5.56], p<0.001) compared to patients in the highest group (figure).

The e' improved the net reclassification improvement index when added to EuroSCOREII, with a net reclassification of 39%.

Conclusion

After CABG, e' is a strong predictor of all-cause mortality and improves the predictive value of the established prediction model, the EuroSCOREII. We identified a possible effect modifier in LVEF, such that e' was a strong predictor in patients with LVEF >40% and not when LVEF is below 40%.

P4628A multiple biomarker approach for risk assessment after ST-segment elevation myocardial infarction

Background

Several biomarkers independently predict outcome following ST-segment elevation myocardial infarction (STEMI). We hypothesized that combining information from multiple circulating biomarkers with numerous pathophysiological pathways may improve biomarker risk stratification following a STEMI.

Method

This was a prospective study of 735 patients with STEMI treated with primary percutaneous coronary intervention. Seventeen biomarkers were drawn before revascularization, including adrenalin, noradrenalin, C-reactive protein (CRP), neutrophil gelatinase-associated lipocalin (NGAL), pro-atrial natriuretic peptide (pro-ANP), alfa-defensin, adiponectin, troponin I, hemoglobin, thrombocyte, and total leukocyte count. The primary outcome was a composite of cardiovascular death or heart failure (CVD/HF) identified by national registries. In the effort to identify the best model, the population was randomly split into two equally sized groups, a derivation cohort and a validation cohort. We used classification and regression tree (CART) analysis to develop a risk model. The identified risk model was hereafter applied to the whole cohort.

Results

Mean age was 63 years, 74% were male and 33% had hypertension. During a median follow-up time of 5.0 years (3.2; 5.0), we observed 185 primary events. After including all biomarkers in the initial model, the CART analysis created a risk model including pro-ANP, NGAL, and CRP (Figure 1a). The risk of CVD/HF increased incrementally with increasing risk group (Figure 1b). The risk remained significantly higher in groups 3 and 4 after multivariable adjustments (hazard ratio (HR)=3.38 [95% confidence interval (CI): 1.60; 7.16] p=0.001 and HR=6.55 [95% CI: 2.73; 15.76] p<0.001, respectively) when compared with group 1.

Figure 1

Conclusion

We developed a risk model based on multiple biomarkers (NGAL, CRP, and pro-ANP) determined from a CART analysis which may ease risk stratification after STEMI.

Acknowledgement/Funding

Sif Rasmussen received a scholarship grant from Herlev & Gentofte Hospital and the P. Carl Petersens Fond during preparation of this manuscript.

P623Regional Longitudinal Strain for Prediction of Left Ventricular Thrombus Formation following Acute Myocardial Infarction

Background

Left ventricular thrombus (LVT) formation is a dangerous complication to acute myocardial infarction (MI).

Purpose

We hypothesized that regional strain impairment was predictive of LVT formation.

Methods

We included 373 prospectively enrolled patients with ST-segment elevation MI treated with primary percutaneous intervention. All patients had an echocardiogram performed a median of 2 days post-MI. Using logistic regression, we investigated the predictive value of left ventricular (LV) speckle tracking, conventional echocardiographic measures and well-known echocardiographic features of LVT formation including LV smoke, aneurysm and valvular regurgitations.

Results

Overall, the mean age was 62 years, 75% were male, 5% had prior MI, and 48% had anterior infarcts. Mean LVEF was 46% and absolute global longitudinal strain (GLS) was 12%.

Of 373 patients, 31 (8%) developed LVT in follow-up echocardiograms. Patients with LVT more frequently had anterior infarcts, prior MI, lower LVEF, lower e', lower GLS and regional strain, and these were all univariable predictors of LVT formation.

In multivariable analysis (including anterior infarcts, prior MI, LVEF, e'), GLS and regional strain remained independent predictors of LVT formation (GLS: OR: 1.17 [1.00; 1.36], midventricular strain: OR: 1.19 [1.03; 1.38], apical strain: 1.12 [1.00; 1.25], p<0.05 for all) (figure)

In a combined diagnostic model, including anterior infarct, impaired LVEF (<42%) and apical strain (<8%), the sensitivity and negative predictive value was 100%, with a specificity and positive predictive value of 38 and 13%, respectively.

Regional strain and risk of LVT

Conclusion

In MI patients, anterior infarct, LVEF and apical strain were strong predictors of LVT formation. Reduced apical strain indicates a markedly increased LVT risk.

P6399Left atrial function determined by echocardiography predicts incident heart failure in STEMI patients treated with primary percutaneous coronary intervention

Objectives

To assess the comparative effectiveness of LA functional parameters (LAEF and MinLAVI) with that of LA volume index (LAVI) in predicting HF following STEMI.

Background

Heart failure (HF) is common following STEMI. Enlarged left atrial (LA) volume determined by echocardiography is associated with adverse outcome following STEMI. However, whether echocardiographic parameters of LA function, such as the LA emptying fraction (LAEF) and the minimal LA volume index (MinLAVI), are superior to LAVI for predicting prognosis following STEMI is unknown.

Methods

A total of 369 STEMI patients without atrial fibrillation or heart failure treated with primary percutaneous coronary intervention (pPCI) were prospectively enrolled in the period September 2006 to December 2008. Patients underwent echocardiography shortly after STEMI. The maximal and minimal LA volume were measured using the biplane area-length method. LAVI, MinLAVI (minimal LA volume indexed to body surface area) and LAEF [(maximal LA volume − minimal LA volume) / maximal LA volume] were calculated. End-point was incident HF.

Results

During a median follow-up of 66 months (interquartile-range: 50–73 months), 68 patients (18%) were admitted for HF. In univariable analysis, both reduced LAEF and increased MinLAVI were significantly associated with an increased risk of HF (LAEF: HR 1.18, 95% CI 1.08–1.29, per 5% decrease, p<0.001) (MinLAVI: HR 1.35, 95% CI 1.09–1.67, per 5 mL/m2 increase, p=0.006) (Figure). In contrast, LAVI was not significantly associated with the development of HF (HR 1.03, 95% CI 0.87–1.22, per 5 mL/m2 increase, p=0.73) (Figure). Following adjustment for clinical, biochemical and echocardiographic variables, LAEF and MinLAVI remained independent predictors of HF, while the lack of association between LAVI and HF persisted (LAEF: HR 1.14, 95% CI 1.02–1.27, per 5% decrease, p=0.019) (MinLAVI: HR 1.31, 95% CI 1.02–1.69, per 5 mL/m2 increase, p=0.036) (LAVI: HR 1.05, 95% CI 0.86–1.29, per 5 mL/m2 increase, p=0.61). These results were replicated when treating death from all causes as a competing event in competing risk regression.

PY, person-years

Conclusion

In STEMI patients treated with pPCI, LAEF and MinLAVI measured by echocardiography shortly after infarction are superior to LAVI for predicting incident HF.

Prevalence and predictors of weight loss maintenance: a retrospective population-based survey of European adults with overweight and obesity

BACKGROUND

The prevalence of weight loss attempts has increased worldwide, although the extent to which sustained weight loss is achieved is unknown. There is insufficient research into weight loss maintenance (WLM) in individuals with overweight or obesity who have recently lost clinically significant amounts of weight (≥5%), particularly in the European general population. The present study aimed to determine the prevalence and retrospective predictors of WLM in population-based samples of European adults with overweight or obesity who had made a recently completed weight loss attempt.

METHODS

Participants (N = 2000) in UK, Denmark and Portugal completed an online survey about loss and regain in their most recent completed weight loss attempt, features of their attempt (duration, self-weighing, lapses, strategies), as well as loss of control and binge eating. Multiple regression analysis was used to determine factors retrospectively associated with WLM in those who achieved clinically significant weight loss (n = 1272).

RESULTS

Mean (SD) self-reported weight loss was 9% (8%) and mean (SD) regain was 96.3% (9%) of participants' start weight. Twenty-three percent of the total sample had maintained weight loss of ≥5% for at least 1 month. Controlling for weight loss and time since attempt, predictors of better WLM were avoidance of a temporary lapse, infrequent/absent loss of control and binge eating, and use of a greater number of dietary strategies for WLM (r²  = 0.338, P < 0.001).

PRINCIPAL CONCLUSIONS

Factors associated with recent successful WLM indicate the importance of the continued use of dietary and other strategies for WLM, particularly in the face of a lapse, as well as the need to manage dysfunctional eating behaviours.

The potential role of genetic assimilation during maize domestication

Domestication research has largely focused on identification of morphological and genetic differences between extant populations of crops and their wild relatives. Little attention has been paid to the potential effects of environment despite substantial known changes in climate from the time of domestication to modern day. In recent research, the exposure of teosinte (i.e., wild maize) to environments similar to the time of domestication, resulted in a plastic induction of domesticated phenotypes in teosinte. These results suggest that early agriculturalists may have selected for genetic mechanisms that cemented domestication phenotypes initially induced by a plastic response of teosinte to environment, a process known as genetic assimilation. To better understand this phenomenon and the potential role of environment in maize domestication, we examined differential gene expression in maize (Zea mays ssp. mays) and teosinte (Zea mays ssp. parviglumis) between past and present conditions. We identified a gene set of over 2000 loci showing a change in expression across environmental conditions in teosinte and invariance in maize. In fact, overall we observed both greater plasticity in gene expression and more substantial changes in co-expressionnal networks in teosinte across environments when compared to maize. While these results suggest genetic assimilation played at least some role in domestication, genes showing expression patterns consistent with assimilation are not significantly enriched for previously identified domestication candidates, indicating assimilation did not have a genome-wide effect.

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA—disseminated and implemented in over 70 countries globally—is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.

Scaling up strategies of the chronic respiratory disease programme of the European Innovation Partnership on Active and Healthy Ageing (Action Plan B3: Area 5)

Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) focuses on the integrated care of chronic diseases. Area 5 (Care Pathways) was initiated using chronic respiratory diseases as a model. The chronic respiratory disease action plan includes (1) AIRWAYS integrated care pathways (ICPs), (2) the joint initiative between the Reference site MACVIA-LR (Contre les MAladies Chroniques pour un VIeillissement Actif) and ARIA (Allergic Rhinitis and its Impact on Asthma), (3) Commitments for Action to the European Innovation Partnership on Active and Healthy Ageing and the AIRWAYS ICPs network. It is deployed in collaboration with the World Health Organization Global Alliance against Chronic Respiratory Diseases (GARD). The European Innovation Partnership on Active and Healthy Ageing has proposed a 5-step framework for developing an individual scaling up strategy: (1) what to scale up: (1-a) databases of good practices, (1-b) assessment of viability of the scaling up of good practices, (1-c) classification of good practices for local replication and (2) how to scale up: (2-a) facilitating partnerships for scaling up, (2-b) implementation of key success factors and lessons learnt, including emerging technologies for individualised and predictive medicine. This strategy has already been applied to the chronic respiratory disease action plan of the European Innovation Partnership on Active and Healthy Ageing.

An Australian survey of women's use of pregnancy and parenting apps

BACKGROUND

There are now many pregnancy and parenting apps available on the market for both pregnancy and parenting.

AIMS

To investigate how Australian women use pregnancy and parenting apps, their attitudes about the information provided and data privacy and security related to such use, and what features they look for in these apps.

METHODS

An online survey was completed by 410 women who were pregnant or had given birth to at least one child in the past three years, were aged between 18 and 45 and were competent in English.

FINDINGS

The use of pregnancy and parenting apps was common among the respondents. Almost three quarters of respondents had used at least one pregnancy app; half reported using at least one parenting app. Respondents found the apps useful or helpful, particularly for providing information, monitoring foetal or child development and changes in their own bodies and providing reassurance. Yet many users were not actively assessing the validity of the content of these apps or considering issues concerning the security and privacy of the personal information about themselves and their children that these apps collect.

CONCLUSION

Apps are becoming important as a source of information and self-monitoring and for providing reassurance for Australian pregnant women and mothers with young children. Midwives and other healthcare professionals providing care and support for pregnant women and women in the early years of motherhood need to take women's app use into account and recognise both the potential and limitations of these apps.

Establishing a community-wide DNA barcode library as a new tool for arctic research

DNA sequences offer powerful tools for describing the members and interactions of natural communities. In this study, we establish the to-date most comprehensive library of DNA barcodes for a terrestrial site, including all known macroscopic animals and vascular plants of an intensively studied area of the High Arctic, the Zackenberg Valley in Northeast Greenland. To demonstrate its utility, we apply the library to identify nearly 20 000 arthropod individuals from two Malaise traps, each operated for two summers. Drawing on this material, we estimate the coverage of previous morphology-based species inventories, derive a snapshot of faunal turnover in space and time and describe the abundance and phenology of species in the rapidly changing arctic environment. Overall, 403 terrestrial animal and 160 vascular plant species were recorded by morphology-based techniques. DNA barcodes (CO1) offered high resolution in discriminating among the local animal taxa, with 92% of morphologically distinguishable taxa assigned to unique Barcode Index Numbers (BINs) and 93% to monophyletic clusters. For vascular plants, resolution was lower, with 54% of species forming monophyletic clusters based on barcode regions rbcLa and ITS2. Malaise catches revealed 122 BINs not detected by previous sampling and DNA barcoding. The insect community was dominated by a few highly abundant taxa. Even closely related taxa differed in phenology, emphasizing the need for species-level resolution when describing ongoing shifts in arctic communities and ecosystems. The DNA barcode library now established for Zackenberg offers new scope for such explorations, and for the detailed dissection of interspecific interactions throughout the community.