Platelet-to-Lymphocyte Ratio (PLR) as a Predictor of In-Hospital Mortality in Patients with First-Ever Acute Ischemic Stroke: A cross-sectional study from Ecuador
A main concern in developing countries is in-hospital mortality from acute ischemic stroke (AIS) as access to thrombectomy or fibrinolytics is limited. Platelet-to-lymphocyte ratio (PLR) has been recommended as an inflammatory marker correlated with poor outcomes in AIS. Thus, Mautong H, presented a session held at the American Heart Association (AHA) from 16-18 November 2024, in Chicago, Illinois to assess the value of PLR as a predictor of in-hospital mortality in first-ever AIS.
The records of 293 patients were assessed with a first-ever AIS from a third-level hospital in Ecuador from 2016-2022. Immunocompromised patients who had active infections, autoimmune diseases, or malignancies were excluded. The PLR was estimated by dividing platelet by lymphocyte count. Participants were categorised into low or high PLR groups based on the median. Univariate and multivariate logistic analyses were used to analyse predictors of in-hospital mortality. A ROC curve evaluation was performed to recognize the optimal cutoff value of PLR for predicting the outcome.
140 patients were eligible for the study. Most patients were male (67.1%) and the median age was 63 years. The median length of hospitalization was 11 days (6-19), and 35% of patients needed ICU admission. In-hospital mortality was 20%. Deceased patients were substantially older and showed greater rates of ICU admission and NIHSS as compared to survivors. A high PLR was correlated with an elevated risk of in-hospital mortality (OR =8.30; p= 0.001) in the univariate model. Following adjusting for potential confounders, only high PLR (OR =6.02; p= 0.022), ICU admission, and NIHSS remained statistically substantial. The ROC curve exhibited that the optimal cutoff value of PLR for predicting in-hospital mortality was 159.44, with an AUC of 0.799 (Sensitivity: 85.7%, Specificity:77.7%).
The findings recommend that PLR is an independent predictor for in-hospital mortality in patients with a first-ever AIS. This biomarker could be useful in developing countries where stroke mortality is yet high.
Worse Cardiac Structure and Function is Associated with Decline in Multiple Domains of Cognitive Function: The Atherosclerosis Risk in Communities (ARIC) Study
Cognitive impairment is cross-sectionally correlated with worse cardiac structure/function. But, limited data exist concerning cardiac structure/function and longitudinal changes in cognitive function. Dehghan A, presented a session held at the American Heart Association (AHA) from 16-18 November 2024, in Chicago, Illinois aimed to assess the correlation of cardiac structure and function with longitudinal changes in cognitive performance in late life.
Between HF- and dementia-free participants in the community-based ARIC study who attended the 5th study visit (V5; 2011-2013), gone through protocol echocardiography, and completed a neurocognitive test battery at both V5 and study Visit 6 (V6; 2015-17). A multivariable linear regression was used to evaluate correlations of cardiac structure and function measures with changes in both domain-specific and global cognitive scores between V5 and V6. The neuropsychological test battery comprised of 10 neuropsychological tests that covered 3 domains of cognitive function: memory, executive functioning, and language.
Between 2,988 included participants, mean age was 74±5 years, 60% were female, 20% reported Black race, and mean LVEF was 66±6%. Across a mean of 4.9±0.6 years (the V5 to V6 interval), raw scores decreased for all neuropsychological tests. In fully adjusted models, worse diastolic function (larger LAVi) and LV remodelling (greater LV mass index) were correlated with reduction in executive function. Lower LVEF was correlated with reduction in language function, although worse LV longitudinal strain – a more sensitive measure of systolic dysfunction – was correlated with reduction in executive function, language function, and global cognition performance (all p<0.05; Table).
Subclinical LV remodelling and dysfunction is correlated with higher reductions in cognitive function across 5 years in late life. Differential correlations were observed using cognitive domains, with executive function reduction most uniformly correlated with impairments in cardiac structure/function.
Plant-Based Diet and All-Cause and Cause-Specific Mortality among Patients with Cardiovascular Disease: A Population-Based Cohort Study
Wan X, presented a session held at the American Heart Association (AHA) from 16-18 November 2024, in Chicago, Illinois. This study explored the association between plant-based dietary patterns and all-cause and cause-specific mortality in patients with cardiovascular disease (CVD). Using the UK Biobank dataset, 10,841 participants with baseline CVD were followed over a median of 11.3 years. Three plant-based diet indexes were constructed from web-based 24-hour dietary recall questionnaires: an overall plant-based diet index (PDI), a healthy PDI (hPDI), and an unhealthy PDI (uPDI).
Participants were classified into tertiles based on adherence to PDI, hPDI, and uPDI. Mortality outcomes, including all-cause, CVD-specific, and cancer-specific deaths, were documented using the national death registry. Adjustments were made for potential confounders, including demographics, lifestyle factors, and clinical characteristics.
During follow-up, 1,275 deaths were recorded. Higher adherence to PDI was negatively associated with all-cause mortality (HR<sub>T3vsT1</sub>: 0.81, 95% CI: 0.70–0.94, Ptrend = 0.005) and CVD mortality (HR<sub>T3vsT1</sub>: 0.78, 95% CI: 0.61–0.99, Ptrend = 0.040). Conversely, stronger adherence to uPDI was linked to increased all-cause mortality (HR<sub>T3vsT1</sub>: 1.33, 95% CI: 1.16–1.53, Ptrend < 0.001) and both CVD and cancer mortality. Mediation analysis revealed that CRP levels explained 6.2%, 4.0%, and 5.1% of the relationship between uPDI and all-cause, CVD, and cancer mortality, respectively. No significant association was observed between hPDI and any mortality outcomes.
The findings suggest that adherence to PDI reduces mortality risks, likely due to its emphasis on nutrient-dense, minimally processed plant foods. In contrast, the positive correlation between uPDI and mortality might result from the inflammatory impact of unhealthy plant-based foods, as indicated by elevated CRP levels.
Among patients with CVD, adherence to PDI was associated with reduced risks of all-cause and CVD mortality, whereas uPDI was linked to higher mortality rates, mediated partly by CRP levels. These findings underscore the importance of promoting healthy plant-based dietary patterns and limiting the consumption of unhealthy plant-based foods in dietary guidelines.
Accelerometer-Measured Sedentary Behavior and Future Cardiovascular Disease
Ajufo E, presented a session held at the American Heart Association (AHA) from 16-18 November 2024, in Chicago, Illinois. This study investigated the relationship between sedentary behavior and cardiovascular (CV) outcomes, distinct from insufficient physical activity, using accelerometer data from 89,530 participants in the UK Biobank. Participants (mean age 62 ± 8 years, 56.4% women) wore accelerometers for one week to measure sedentary time and moderate-to-vigorous physical activity (MVPA).
Sedentary behavior was quantified in hours/day, with participants grouped into quartiles. The second quartile (8.2–9.4 hours/day) served as the referent group. Sedentary time exceeding 10.6 hours/day (top quartile) was examined for potential threshold effects and interaction with MVPA.
Participants reported a median sedentary time of 9.4 hours/day (quartile-1: 8.2, quartile-3: 10.6). Sedentary time >10.6 hours/day was associated with a 45% higher risk of HF (HR: 1.45, 95% CI: 1.28–1.65) and a 62% higher risk of CV mortality (HR: 1.62, 95% CI: 1.34–1.96). Additionally, sedentary behavior exhibited a linear association with incident AF (HR: 1.11, 95% CI: 1.01–1.21) and MI (HR: 1.15, 95% CI: 1.00–1.32). These associations persisted after adjusting for MVPA and among individuals both above and below the guideline-recommended activity threshold.
The data indicate that sedentary behavior independently increases the risk of adverse CV outcomes, particularly HF and CV mortality, regardless of MVPA levels. The findings suggest a threshold effect for HF and CV mortality at >10.6 hours/day of sedentary time, while associations with AF and MI followed an approximately linear trend.
The study underscores the significant and distinct role of sedentary behavior in CV risk. While MVPA is critical for cardiovascular health, these results highlight that reducing sedentary time, especially beyond 10.6 hours/day, is essential to mitigate risks of HF and CV mortality. The persistence of associations despite MVPA adjustments suggests that sedentary behavior is an independent and modifiable risk factor.
Sedentary behavior exceeding 10.6 hours/day is independently associated with increased risks of HF, CV mortality, AF, and MI. These findings highlight the need for public health strategies that address both physical activity promotion and sedentary behavior reduction to improve cardiovascular outcomes.
Efficacy and Safety of Coronary Sinus Reducer for Refractory Angina: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Refractory angina severely affects patients’ quality of life around the world. Among the new treatment methods, the coronary sinus reducer (CSR) is one of the most thoroughly researched. Amin A M, presented a session held at the American Heart Association (AHA) from 16th -18th November 2024, in Chicago, Illinois that investigated the efficacy and safety of CSR for refractory angina.
A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted from PubMed, Web of Science, Scopus, Embase, and Cochrane searches until May 2024. Dichotomous data were pooled using risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), using (R version 4.3).
With the inclusion of three RCTs, our cohort comprised a total of 180 patients. Compared to the control group, after six months, CSR was significantly associated with decreased mean change of Canadian cardiovascular society (CCS) class (MD: -0.54 with 95% CI [-0.80, -0.27], P< 0.01), an increased number of patients in the CCS class I (RR: 2.29 with 95% CI [1.14, 4.61], P= 0.02), a decreased number of patients in the CCS class III (RR: 0.53 with 95% CI [0.32, 0.87], P= 0.01), and increased exercise time (MD: 50.46 with 95% CI [9.47, 91.45], P= 0.02). However, there was no significant difference between CSR and the control group in CCS class II, class IV, across all Seattle Angina Questionnaire (SAQ) domains, the incidence of any serious adverse events (RR: 3.44 with 95% CI [0.82, 14.42], P= 0.09), stroke (RR: 2.13 with 95% CI [0.20, 22.88], P= 0.53), and all-cause mortality (RR: 1.06 with 95% CI [0.07, 16.59], P= 0.97).
CSR has been shown to reduce angina severity by lowering CCS class scores and increasing exercise time. Large-scale RCTs are needed to confirm its effectiveness in patients with refractory angina.
Optimal Timing for Coronary Artery Bypass Grafting in NSTEMI Patients: A Retrospective Cohort Analysis of In-Hospital Mortality and Stroke Prevalence Over 2017 to 2021
Recent studies suggest performing CABG within 24 hours of acute myocardial infarction increases mortality risk, but the ideal timing beyond the first day is unclear. Tran VN, presented a session held at the American Heart Association (AHA) from 16th -18th November 2024, in Chicago, Illinois that evaluated an optimal timing of CABG in NSTEMI patients using the large National Inpatient Sample (NIS) database over a 5-year period.
This retrospective cohort study analyzed survey-weighted NIS data over 2017-2021, including adult-age admissions with NSTEMI as the principal diagnosis who underwent CABG without prior transfer from another hospital. Patients were categorized into eight groups based on days from admission to CABG (0, 1, 2, 3, 4, 5, 6, and ≥7 days). Baseline characteristics were compared across groups. Multivariate regression analysis adjusted for multiple confounders to assess the association between Time-to-CABG and in-hospital mortality and stroke prevalence.
In-Hospital Mortality: The adjusted odds ratios (OR) were less than one for groups 1 through 7 compared to group 0, indicating that immediate CABG (day 0) is associated with higher mortality risk. While the reduced odds in the day 1 group were not statistically significant, substantial and statistically significant reductions in mortality were observed between days 2 and 5 (OR: 0.624 – 0.609; p<0.05). After day 5, the OR for mortality trended up, reaching 0.667 (p<0.05) on day 6 and 0.692 (p<0.05) for surgeries performed on day 7 or later.
Stroke Prevalence: The adjusted ORs for stroke prevalence were significantly lower for groups 1 through 7 compared to the CABG within 24-hour group (all p-values <0.05). The lowest ORs were observed between days 2 and 4 (OR: 0.654 and 0.542, p<0.05, respectively). After day 4, the ORs increased, reaching 0.672 (p<0.05) for surgeries performed on day 5 and 0.609 (p<0.05) on day 7 and beyond.
The mortality risk in NSTEMI patients remained higher if CABG was performed in the first 48 hours of admission (end of day 1) compared to later. This risk also increased if CABG was done after day 5. Combined with the possible risk of stroke being increased from day 5, we suggest the optimal time-to-CABG is between admission day 2 and day 4 in NSTEMI patients. Future prospective studies are warranted to confirm these findings and guide clinical practice.
Childhood Oral Health Associates with the Incidence of Ischemic Heart Disease, Myocardial Infarction and Ischemic Stroke in Adulthood
Cardiovascular disease (CVD) remains a significant contributor to years of life lost globally. Identifying risk factors and implementing prevention strategies remain crucial. In adults, oral diseases have been linked to increased risks of CVD, including ischemic heart disease (IHD), myocardial infarction (MI), and ischemic stroke (IS). However, the impact of childhood oral health on adult CVD risk has been less studied, leaving a potential avenue for early detection of high-risk individuals unexplored. The hypothesis suggests that poor childhood oral health may be associated with an increased risk of IHD, MI, and IS in adulthood. Nygaard N presented a session held at the American Heart Association (AHA) from 16th to 18th November 2024 in Chicago, Illinoi. This study utilized data from nationwide Danish registries, including the National Child Odontology Register, National Patient Register, and Central Person Register, to track individuals born between 1963 and 1972. Follow-up began in 1995 or when participants turned 30, ending in 2018 when they were aged 46–56. Childhood oral health was assessed based on the highest recorded levels of dental caries and gingivitis, and its association with IHD, MI, and IS in adulthood was analyzed using Cox-proportional hazards models. Educational attainment between ages 25 and 30 was used for stratification. The study included 569,057 individuals (51.2% male, 48.8% female). Results showed that females with high levels of childhood caries had a 26% higher incidence of IHD (hazard ratio [HR]: 1.17–1.86) compared to those with low-level caries, while males showed a 19% increase (HR: 1.08–1.40). Severe childhood caries was associated with a 58% increased risk of MI in females (HR: 1.19–2.09) and 19% in males (HR: 1.01–1.42). Similarly, IS incidence being 45% higher in females (HR: 1.19–1.78) and 52% higher in males (HR: 1.27–1.81). Childhood gingivitis was associated with a 52% increased MI risk in females (HR: 1.19–1.94) and a 32% higher IS risk in males (HR: 1.15–1.52).
Findings suggest that poor oral health during childhood is linked to a higher incidence of IHD, MI, and IS in adulthood, highlighting a potential strategy for early identification and prevention of CVD in high-risk populations.
Global Burden and Trend of Cardiomyopathy and Myocarditis in G20 Countries from 1990-2021: A secondary analysis from the Global Burden of Disease Study 2021
Cardiomyopathy (CM) and myocarditis rank as the fifth leading causes of death and disability among cardiovascular disease (CVD)-related deaths in G20 countries. Despite their growing impact, there remains a significant lack of consistent data across these nations. This study is the first to estimate the burden of these cardiac conditions over the past three decades, including the first two years of the COVID-19 pandemic, underscoring the pressing need for improved surveillance and targeted healthcare strategies to address these critical health challenges. Saravanabavanandan R, presented a session held at the American Heart Association (AHA) from 16th to 18th November 2024 in Chicago, Illinoi.
Between 1990 and 2021, prevalence increased by 64% (95% UI: 53–75%), incidence by 57% (47–68%), and deaths by 37% (26–49%). Japan reported the highest age-standardized incidence rate (ASIR) of 19.84 (16.38–24.21) cases per 100,000, closely followed by Sweden at 19.74 cases per 100,000. Latvia recorded the highest age-standardized mortality rate (ASMR) at 27.95 (23.89–31.99) cases per 100,000, with Russia next at 26.3 cases per 100,000 in 2021. The highest YLD rate (ASYLDR) was observed in Poland at 16.13 (11.05–22.86), followed by Sweden at 15.67 cases per 100,000 in 2021.
The highest incidence occurred in the 70–74 age group, with 76,173 cases (46,415–113,840). The greatest number of deaths occurred in the 80–84 age group, at 31,289 (27,390–33,741), and the highest DALYs were recorded in the 55–59 age group at 750,723 (680,540–814,890). Gender-specific trends revealed a total percentage change in incidence of 55% in males and 61% in females. Deaths increased by 57% in males and 16% in females, while YLDs rose by 67% in males and 54% in females between 1990 and 2021.
Deaths from CM and myocarditis accounted for 2.04% of CVD deaths in G20 countries in 2021, emphasizing the need for targeted education, screening, and cross-border collaboration to mitigate their impact and enhance public health.
Predicting 30-Day and 1-Year Mortality in Heart Failure with Preserved Ejection Fraction (HFpEF) using Electronic Health Record Data
Shin I, presented a session held at the American Heart Association (AHA) from 16-18 November 2024, in Chicago, Illinois. This study aimed to develop and compare models for predicting 30-day and 1-year mortality in patients with heart failure with preserved ejection fraction (HFpEF) using electronic health record (EHR) data. Data from the MIMIC-IV database (2008–2019) were utilized, including demographics, vital signs, prior diagnoses, and laboratory results for patients aged ≥18 years admitted with a primary diagnosis of HFpEF (ICD-9 and ICD-10 codes). The dataset was divided into 70% training and 30% test subsets.
Prediction models were developed using traditional regression methods and machine learning (ML) techniques, with preprocessing steps such as data imputation and oversampling. Elastic Net and Lasso Regression models focused on interpretability, while Random Forest and HistGradient Boosting Classifier targeted non-linear interactions.
Among 3910 HFpEF hospitalisations, 30-day mortality was 6.3%, and 1-year mortality was 29.2%. Lasso and Elastic Net Regression models achieved superior performance for 30-day mortality predictions, each with an AUC of 0.79. For 1-year mortality, Random Forest and HistGradient Boosting Classifier demonstrated AUCs of 0.78. Across all metrics, Elastic Net and Lasso models provided a balanced trade-off between sensitivity, specificity, and AUC, enhancing their clinical utility. SHAP analysis identified age, NT-proBNP, sodium levels, WBC, and platelet counts as significant predictors influencing model outputs.
EHR-derived models showed comparable performance to registry-based or trial-derived models, particularly for short- and long-term mortality predictions in HFpEF. Elastic Net and Lasso Regression were clinically advantageous due to their interpretability and balanced metrics. The integration of ML techniques provided complementary insights but requires further evaluation for routine clinical use.
EHR-based prediction models effectively forecast 30-day and 1-year mortality in HFpEF patients, with Elastic Net and Lasso Regression providing clinically implementable solutions. Future work should focus on integrating these tools into practice while exploring additional endpoints to optimize patient outcomes.
The Effects on Mortality of Statin Therapy in Patients with Heart Failure with Preserved Ejection Fraction (HFpEF): An Updated Systematic Review and Meta-Analysis
Statins have demonstrated benefits in improving outcomes for patients with heart failure with reduced ejection fraction (HFrEF). However, their effects on patients with heart failure with preserved ejection fraction (HFpEF) remain unclear. This study aimed to perform an updated systematic review and propensity score (PS) meta-analysis comparing the impact of statin therapy versus no statin therapy in this population. Coan A presented a session held at the American Heart Association (AHA) from 16th to 18th November 2024 in Chicago, Illinoi.
A comprehensive search was conducted in PubMed, Embase, and Cochrane Library databases to identify studies evaluating the effects of statins in HFpEF patients. The primary outcome was all-cause mortality, while secondary outcomes included cardiovascular (CV) mortality and heart failure (HF) hospitalization. A subgroup analysis was performed for the primary outcome, distinguishing studies using PS adjustments from those without baseline covariate adjustments.
Meta-analysis included 17 studies with a total of 43,911 HFpEF patients, of whom 19,142 (43.59%) were on statin therapy. The mean age was 66.95 years, with an average follow-up of 3.08 years. Statin therapy was significantly associated with reductions in all-cause mortality (HR 0.68; 95% CI 0.62–0.76; p<0.01) and HF hospitalization (HR 0.75; 95% CI 0.69–0.81; p<0.01). However, there was no significant impact on CV mortality (HR 0.84; 95% CI 0.70–1.00; p=0.05). Subgroup analysis confirmed the benefits of statins on all-cause mortality in PS-adjusted studies (HR 0.78; 95% CI 0.74–0.83; p<0.01), with a significant difference (p<0.01) between PS and non-PS results.
This meta-analysis highlights that statin therapy in HFpEF is associated with reduced all-cause mortality and HF hospitalization, with findings reinforced by PS analysis. However, the benefits of statins do not extend to CV mortality in this patient population.
