Background Echo-derived linear dimensions offer straightforward indices of right ventricular (RV) structure but have not been systematically compared to RV volumes on cardiac magnetic resonance (CMR). Methods Echo and CMR were interpreted among CAD patients imaged via prospective (90%) or retrospective (10%) registries. For echo, American Society of Echocardiography (ASE) recommended RV dimensions were measured in apical 4-chamber (basal RV width, mid RV width, RV length), parasternal long (proximal RV outflow tract [pRVOT]) and short axis (distal RVOT) views. For CMR, RV end-diastolic (RV-EDV) and end-systolic (RV-ESV) volumes were quantified via border planimetry. Results 272 patients underwent echo and CMR within a narrow interval (0.4±1.0 days); complete acquisition of all ASE dimensions was feasible in 98%. All echo dimensions differed between patients with and without RV dilation on CMR (p<0.05). Basal RV width (r=0.70), pRVOT width (r=0.68), and RV length (r=0.61) yielded highest correlations with RV-EDV on CMR; end-systolic dimensions yielded similar correlations (r=0.68, 0.66, 0.65 respectively). In multivariable regression, basal RV width (regression coefficient 1.96 per mm [CI 1.22–2.70], p<0.001), RV length (0.97[0.56–1.37], p<0.001) and pRVOT width (2.62 [1.79–3.44], p<0.001) were independently associated with CMR RV-EDV[r= 0.80]. RV-ESV was similarly associated with echo dimensions (basal RV width; 1.59 per mm [CI 1.06–2.13], p<0.001) | RV length; 1.00 [0.66–1.34], p<0.001) | pRVOT width; 1.80 [1.22–2.39], p<0.001) [r= 0.79]. Conclusions RV linear dimensions provide readily obtainable markers of RV chamber size. Proximal RVOT and basal width are independently associated with CMR volumes, supporting use of multiple linear dimensions when assessing RV size on echo.

Background RV and LV function are closely linked due to a variety of factors, including common coronary blood supply. Altered LV perfusion holds the potential to affect the RV, but links between LV ischemia and RV performance, as well as independent impact of RV dysfunction on effort tolerance are unknown. Methods and Results The population comprised 2051 patients who underwent exercise stress MPI and echo (5.5 ± 7.9 days), among whom 6% had echo-evidenced RV dysfunction. Global summed stress scores were nearly 3-fold higher among patients with RV dysfunction, attributable to increments in inducible and fixed LV perfusion defects (all p≤0.001). Regional inferior and lateral wall ischemia was greater among patients with RV dysfunction (both p<0.01), without difference in corresponding anterior defects (p=0.13). In multivariable analysis, inducible inferior and lateral wall perfusion defects increased the likelihood for RV dysfunction (both p<0.05) independent of LV function, fixed perfusion defects, and PA pressure. Patients with RV dysfunction demonstrated lesser effort tolerance whether measured by exercise duration (6.7±2.8 vs. 7.9±2.9 min, p<0.001) or peak treadmill stage (2.6±0.9 vs. 3.1±1.0, p<0.001), paralleling results among patients with LV dysfunction (7.0±2.9 vs. 8.0±2.9, p<0.001 |2.7±1.0 vs. 3.1±1.0, p<0.001 respectively). Exercise time decreased stepwise in relation to both RV and LV dysfunction (p<0.001), and was associated with each parameter independent of age or medication regimen. Conclusions Among patients with known or suspected CAD, regional LV ischemia involving the inferior and lateral walls confers increased likelihood of RV dysfunction. RV dysfunction impairs exercise tolerance independent of LV dysfunction.

Background There is a lack of evidence regarding the benefits of β-blocker treatment after invasively managed acute myocardial infarction (MI) without reduced left ventricular ejection fraction (LVEF). Methods and results TREatment with Beta-blockers after myOcardial infarction withOut reduced ejection fraction (REBOOT) trial is a pragmatic, controlled, prospective, randomized, open-label blinded endpoint (PROBE design) clinical trial testing the benefits of β-blocker maintenance therapy in patients discharged after MI with or without ST-segment elevation. Patients eligible for participation are those managed invasively during index hospitalization (coronary angiography), with LVEF &gt;40%, and no history of heart failure (HF). At discharge, patients will be randomized 1:1 to β-blocker therapy (agent and dose according to treating physician) or no β-blocker therapy. The primary endpoint is a composite of all-cause death, nonfatal reinfarction, or HF hospitalization over a median follow-up period of 2.75 years (minimum 2 years, maximum 3 years). Key secondary endpoints include the incidence of the individual components of the primary composite endpoint, the incidence of cardiac death, and incidence of malignant ventricular arrhythmias or resuscitated cardiac arrest. The primary endpoint will be analyzed according to the intention-to-treat principle. Conclusion The REBOOT trial will provide robust evidence to guide the prescription of β-blockers to patients discharged after MI without reduced LVEF.

Grasa corporal y edad metabólica como indicadores de inflamación y riesgo cardiovascular Body fat and metabolic age as indicators of inflammation and cardiovascular risk

The main issue in the prevention of myocardial infarction (MI) is to reduce risk factors. Periodontal disease is related to cardiovascular disease and both share risk factors. The purpose of this study is to investigate whether periodontitis can be considered a risk factor for MI and common risk factors in a case–control study and in a prospective follow-up study in patients with MI. The test group (MIG) was made up of 144 males who had MI in the previous 48 h. The control group (CG) was composed of 138 males without MI. Both groups were subdivided according to the presence or absence of stage III and IV of periodontitis. General data; Mediterranean diet and physical activity screening; periodontal data; and biochemical, microbiological and cardiological parameters were recorded. ANOVA, Mann–Whitney U and Kruskal–Wallis statistical tests and binary logistic regression analysis were applied. No differences in anthropometric variables were observed between the four groups. The average weekly exercise hours have a higher value in CG without periodontitis. The number of leukocytes was higher in MIG, the number of monocytes was higher in CG and the number of teeth was lower in MIG with periodontitis. Adherence to the Mediterranean diet was higher in CG. Porphyromonas gingivalis and Tannerella forsythia were higher in CG with periodontitis and in MIG with and without periodontitis. At follow-up, the left ventricular ejection fraction (LVEF) data were better in the non-periodontitis group: 15 patients had Mayor Cardiovascular Adverse Events (MACE), 13 of them had periodontitis and 2 did not show periodontitis. Periodontitis, exercise, diet and smoking are risk factors related to MI. MACE presented in the ‘MI follow-up’ shows periodontitis, weight, exercise hours and dyslipidemia as risk factors. LVEF follow-up values are preserved in patients without periodontitis. Our data suggest that periodontitis can be considered a risk factor for MI and MACE in the studied population.