Background and Aim: Left atrial stiffness (LASt) is an important marker of cardiac function, especially in patients with heart failure (HF); it explains symptoms on the basis of pressure transfer to the pulmonary circulation. The aim of this study was to evaluate the relationship between LASt and cardiac events (CE) in HF patients with reduced to mid-range ejection fraction. Methods: The study included 215 consecutive ambulatory HF patients with ejection fraction (EF) < 50% (162 HF reduced EF and 53 HF mid-range EF) of mean age 66 ± 11 years and 24.4% females. Peak LA strain (PALS) was measured by speckle tracking echocardiography and E/e’ recorded from the apical four-chamber view. Non-invasive LASt was calculated using the equation: LASt = E/e’ ratio/PALS. Documented cardiac events (CE) were HF hospitalization and cardiac death. Results: During a median follow up of 41 ± 34 months, 65 patients (30%) had CE. In multivariate analysis model, only raised LV filling pressure (E/e’) (OR = 0.292, (95% CI 0.099 to 0.859), p = 0.02), peak pulmonary artery pressure (PAP) (OR = 1.050 (1.009 to 1.094), p = 0.01), PALS (OR = 0.932 (0.873 to 0.994), p = 0.02) and LASt (OR = 3.781 (1.144 to 5.122), p = 0.001) independently predicted CE. LASt ≥ 0.76% was the most powerful predictor of CE, with 80% sensitivity and 73% specificity (AUC 0.82, CI = 0.73 to 0.87, p < 0.001) followed by PALS ≤ 16%, with 74% sensitivity and 72% specificity (AUC 0.77, CI = 0.71 to 0.84, p < 0.001). These results were consistent irrespective of EF (p < 0.05). Conclusion: In this cohort of ambulatory HFrEF and HFmrEF patients, LASt proved the most powerful predictor of clinical outcome.

Background and Aim: Arterial wall shear strain (WSS) has been proposed to impact the features of atherosclerotic plaques. The aim of this meta-analysis was to assess the impact of different types of WSS on plaque features in coronary artery disease (CAD). Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar, and the Cochrane Central Registry, from 1989 up to January 2020 and selected clinical trials and observational studies which assessed the relationship between WSS, measured by intravascular ultrasound (IVUS), and plaque morphology in patients with CAD. Results: In four studies, a total of 72 patients with 13,098 coronary artery segments were recruited, with mean age 57.5 ± 9.5 years. The pooled analysis showed that low WSS was associated with larger baseline lumen area (WMD 2.55 [1.34 to 3.76, p < 0.001]), smaller plaque area (WMD −1.16 [−1.84 to −0.49, p = 0.0007]), lower plaque burden (WMD −12.7 [−21.4 to −4.01, p = 0.04]), and lower necrotic core area (WMD −0.32 [−0.78 to 0.14, p = 0.04]). Low WSS also had smaller fibrous area (WMD −0.79 [−1.88 to 0.30, p = 0.02]) and smaller fibro-fatty area (WMD −0.22 [−0.57 to 0.13, p = 0.02]), compared with high WSS, but the dense calcium score was similar between the two groups (WMD −0.17 [−0.47 to 0.13, p = 0.26]). No differences were found between intermediate and high WSS. Conclusions: High WSS is associated with signs of plaque instability such as higher necrotic core, higher calcium score, and higher plaque burden compared with low WSS. These findings highlight the role of IVUS in assessing plaque vulnerability.

Background and Aim: Coronary calcification has been described as a manifestation of subclinical atherosclerosis. However, its predictors are not well established. The aim of this study was to evaluate the relationship between coronary artery calcium score (CACs) evaluated by multi-detector computed tomography (MDCT) and atherosclerotic cardiovascular disease (CVD) risk factors in symptomatic patients in three European countries. Method: We retrospectively analyzed 550 patients (age 62.7 ± 12 year, 47.5% females) who presented with atypical chest pain in Germany, Denmark, and Sweden. The demographic indices, CVD risk factors, and CACs were analyzed. The CV risk factors were classified as low (no risk factors), intermediate (1–2 risk factors), and high (≥3 risk factors). Patients were geographically classified into: Gr. I–German (n = 344), Gr. II–Danish (n = 84), and Gr. III–Swedish (n = 122) patients. Results: In the cohort as a whole, the mean CACs was 270.3 ± 72, and the intermediate risk was more prevalent than low and high-risk (p < 0.05 for all). Among the CVD risk profile, arterial hypertension (AH) was the most prevalent, followed by hypercholesterolemia, obesity, smoking, and diabetes (53, 38.2, 23.7, 17.6, and 10.5%; p < 0.05 for all). The German population was younger and had less CVD risk factors compared to the Danish and Swedish populations (p < 0.05, for all). CACSs adjusted to age and sex was lowest in Swedish patients, followed by German patients, and highest in Danish patients (p < 0.05). The CACs modestly correlated with age (r_pb = 0.52, p < 0.001), sex (r_pb = 0.48, p < 0.001), and extent of risk (r_pb = 0.35, p = 0.001). On multivariate regression analysis, hypercholesterolemia β = 185.1 (63.11 to 307.1), the extent of risk adjusted for age and sex β 3.741 (2.566 to 4.916; p < 0.001), and AH, β = 142.6 (11.25 to 274.1; p = 0.03) independently correlated with CACs. Furthermore, hypercholesterolemia was the only risk factor, consistently associated with CACs across all three countries. Conclusions: In symptomatic European patients, hypercholesterolemia is the main player in coronary calcium formation.