Introduction: Cardiac power (CP) integrates echocardiographic and clinical parameters of hemodynamics, but the prognostic value of CP in the general population remains to be established. Hypothesis: This study investigates the association between CP and incident heart failure (HF) and cardiovascular (CV) mortality in the general population Methods: A total of 4,022 participants without known HF from a general population cohort study was included in the study. CP was calculated by cardiac output x mean blood pressure x 0.222. CP was expressed in W/100 g of LV myocardium. The composite outcome was incident HF or CV death. Cox regression models were used to determine the association of cardiac power with the risk of the composite outcome. Cumulative incidence curves were constructed to visualize the risk of outcome throughout the follow-up period, while accounting for non-cardiovascular death as a competing event. The association was additionally explored in a restricted cubic spline model. Results: During a median follow-up of 3.5 years (IQR 2.6;4.4 years), 134 (3.3%) participants reached the composite outcome. The risk of the composite outcome was significantly increased in those with CP <0.84 W/100 g throughout the follow-up period, while accounting for non-cardiovascular death as a competing event. We found significant interaction between LVEF and CP (p interaction <0.001). When stratifying the population according to LVEF, CP had no prognostic value in LVEF >50% (p=0.74) but in individuals with LVEF < 50%, CP remained an independent prognostic marker after multivariable adjustment (HR 1.20 per 0.1 W/100 g decrease in cardiac power (95% CI: 1.04-1.37, p=0.01) (Figure 1). Conclusion: CP was associated with incident HF and CV death in the general population, however, LVEF significantly modified the relationship between CP and the composite outcome. CP was only independently associated with incident HF and cardiovascular death in participants with LVEF<50%.

BACKGROUND:Early recognition of cardiac dysfunction in patients with chronic obstructive pulmonary disease (COPD) may prevent future cardiac impairment and improve prognosis. Quantitative assessment of subsegmental and segmental vessel volume by Computed Tomographic (CT) imaging can provide a surrogate of pulmonary vascular remodeling. We aimed to examine the relationship between lung segmental- and subsegmental vessel volume, and echocardiographic measures of cardiac structure and function in patients with COPD. METHODS:We studied 205 participants with COPD, included in a large cohort study of cardiovascular disease in COPD patients. Participants had an available CT scan and echocardiogram. Artificial intelligence (AI) algorithms calculated the subsegmental vessel fraction as the vascular volume in vessels below 10 mm2 in cross-sectional area, indexed to total intrapulmonary vessel volume. Linear regressions were conducted, and standardized ß-coefficients were calculated. Scatterplots were created to visualize the continuous correlations between the vessel fractions and echocardiographic parameters. RESULTS:We found that lower subsegmental vessel fraction and higher segmental vessel volume were correlated with higher left ventricular (LV) mass, LV diastolic dysfunction, and inferior vena cava (IVC) dilatation. Subsegmental vessel fraction was correlated with right ventricular (RV) remodeling, while segmental vessel fraction was correlated with higher pulmonary pressure. Measures of LV mass and right atrial pressure displayed the strongest correlations with pulmonary vasculature measures. CONCLUSION:Pulmonary vascular remodeling in patients with COPD, may negatively affect cardiac structure and function. AI-identified remodeling in pulmonary vasculature may provide a tool for early identification of COPD patients at higher risk for cardiac impairment.

Introduction: The long-term prognostic value of C-reactive protein (CRP) in patients with myocardial infarction (MI) is unknown. Purpose: To assess the association between the first CRP measured during hospitalization and long-term mortality in patients with MI. Methods: Using Danish nationwide registries, we identified patients with a first diagnosis of MI from 2012 through 2020 who underwent a CRP measurement during index hospitalization. The primary outcome was death from any cause. The association between CRP levels and death was examined stratifying the patients into quartiles of CRP concentrations. Absolute and relative risks (RR) for death at days 0-30 and 31-365 were calculated through multivariable Cox regression with average treatment effect modeling. Models were standardized for demographic and clinical features, including high-sensitivity troponin (hsTn). Results: We included 36,021 patients with MI and a CRP measurement within 24 hours before or after the time of admission. Median age was 69.7 years and 35.2 % were women. Median CRP in the entire cohort was 4.9 mg/l, and quartile (Q) intervals were: Q1: <3 mg/l, Q2: 3 to <5 mg/l, Q3: 5 to <17 mg/l, and Q4: >=17 mg/l. CRP was significantly and nonlinearly associated with the primary outcome (p<0.001). At 0-30 days, 2694 patients had died, and another 2566 had died between days 31-365. Figure 1 shows the Kaplan Meier curves. The standardized absolute risk of death at both 0-30 and 31-365 days was lowest among patients in Q1 (0-30 days: 4.1%, 31-365 days: 4.8%) and highest among patients in Q4 (0-30 days: 12.1%, 31-365 days: 10.6%). The standardized RR of death compared with Q1 were: 0-30 days 1.01 (95% CI 0.84;1.71), 1.45 (1.26;1.63) and 2.96 (2.61;3.29) in Q2, Q3 and Q4 and at days 31-365, the RR were 1.18 (1.02;1.34), 1.61 (1.42;1.79) and 2.19 (1.95;2.42), respectively. Conclusion: In patients with MI, higher CRP levels were significantly associated with a higher risk of death, independently of hsTn concentrations.