Increased Levels of VCAM-1 in Patients with High Cardiovascular Risk and Obstructive Sleep Apnea Syndrome.

(1) Background: Although obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity, the link between OSA and cardiovascular disease (CVD) is not completely elucidated. Thus, we aim to assess cardiovascular risk (CVR) using SCORE 2 and SCORE 2 for older persons (SCORE 2OP), and to evaluate the association between the endothelial biomarkers VCAM-1, ICAM-1, epicardial fat, and sleep study parameters in order to improve current clinical practices and better understand the short-and long-term CVRs in OSA patients. (2) Methods: 80 OSA patients and 37 healthy volunteers were enrolled in the study. SCORE2 and SCORE 2 OP regional risk charts (validated algorithms to predict the 10-year risk of first-onset CVD) were used for the analysis of CVR. Two-dimensional echocardiography was performed on all patients and epicardial fat thickness was measured. VCAM-1 and ICAM-1 serum levels were assessed in all patients. (3) Results: OSA patients were classified as being at high CVR, regardless of the type of score achieved. Increased EFT was observed in the OSA group. VCAM-1 was associated with a high CVR in OSA patients, but no significant correlation was observed between adhesion molecules and epicardial fat thickness. (4) Conclusions: OSA patients have a high CVR according to the SCORE 2 and SCORE 2OP risk scores. VCAM-1 may be associated with a high CVR in OSA patients. Extending conventional risk stratification scores by adding other potential biomarkers improves the risk stratification and guide treatment eligibility for CVD prevention in the OSA population.

Global work index by non-invasive pressure-strain loops: a novel parameter to assess left ventricular performance in the early stages of heart failure with preserved or mid-range ejection fraction after acute myocardial infarction.

AIM: To determine the relationship between myocardial work (MW) indices derived from non-invasive pressure-strain loops (PSL) and established parameters of left ventricular (LV) performance in patients with acute myocardial infarction (AMI) and heart failure (HF) with preserved or mid-range ejection fraction (HFpEF/HFmrEF). MATERIAL AND METHODS: Speckle-tracking echocardiography (STE) was used to determine MW indices and global longitudinal strain (GLS) in the first 24-48 hours after admission in patients with AMI, HF symptoms, NT-proBNP >300 pg/mL and left ventricular ejection fraction (LVEF) >40%. MW was calculated by using PSL, which combine strain and non-invasive blood pressure measurement. Global MW index (GWI) was defined as the work inside the area of the PSL. RESULTS: Forty-nine patients (mean age 68±13 years) fulfilled the inclusion criteria. Both GWI (1057±338 mmHg%) and GLS (-10.4±3.3%) were reduced in the majority of the patients. However, a proportion of patients with abnormal GLS showed normal GWI. There was a strong inverse relationship between GWI and GLS (r=-0.81). GWI demonstrated a strong relationship with LVEF (r=0.69) and a moderate correlation to NT-proBNP (n=-0.29). NT-proBNP showed a tendency to higher values in patients with more reduced GWI (820 [590-2550] vs 707 [460-1335], p=0.17). Out of the diastolic dysfunction parameters, GWI showed moderate correlations to LA volume index (r-0.29), E/A (r=-0.23) and E/e' (r=-0.39), which were also significantly more impaired in patients with more reduced GWI. CONCLUSION: Non-invasive PSL might bring further information to LVEF and GLS in patients AMI at the early stages of HFpEF/HFmrEF, since LV performance depends on both contractile properties and variations in load in the ischemic segments.

Understanding the role of echocardiography in remodeling after acute myocardial infarction and development of heart failure with preserved ejection fraction.

Despite the use of reperfusion therapies in the last decades, acute myocardial infarction further remains one of the most frequent causes of mortality. This is mainly caused by changes in the ventricular architecture leading to ventricular remodeling, followed by progressive development of heart failure. Transthoracic echocardiography is a non-invasive instrument which can provide information about the extent of the ischemic process and its consequences but can also predict the outcomes after myocardial infarction. Although standard echocardiographic parameters are currently used for risk stratification of these patients, they might not truly reflect left ventricular systolic dysfunction in acute myocardial infarct patients, since the detection of subtle changes in the myocardial function is beyond their limits. The aim of this review is to underline the use of advanced echocardiographic parameters in identifying patients at risk for developing post-acute myocardial infarction heart failure and subsequent adverse events. Advanced echocardiographic parameters derived from speckle tracking echocardiography provide a detailed assessment on the global and regional left ventricular deformation. Therefore, speckle tracking echocardiography has a major role in predicting the prognosis of acute myocardial infarction patients and particularly in the development ofsubsequent heart failure, which might be prevented with early initiation of adequate therapy.