Background:Atrioventricular node ablation (AVNA) is an effective rate-control strategy for patients with AF refractory to medical therapy. However, data on long-term survival outcomes and prognostic factors in this population remain limited. Thus, we aimed to evaluate long-term mortality in patients with refractory AF who underwent AVNA in a single country. Methods:We conducted a nationwide retrospective cohort study including all patients who underwent AVNA followed by permanent pacing (n=435) in Estonia from 2012 to 2022. The primary endpoint was all-cause mortality. Comparisons were made between CRT and right ventricular (RV) pacing, AVNA timing (≤6 months and later following device implantation) and by patient sex. Results:Acute success was achieved in 418 (96.1%); mean age was 73.2 ± 10.2 years and 56.5% were female. Median follow-up was 4.2 years (range 2 days to 12.9 years), with median survival of 7.8 years. No significant survival difference was observed between CRT and RV pacing overall nor in ad hoc AVNA and pacemaker implantation cases. Among CRT recipients, early AVNA (≤6 months post-implantation) significantly reduced mortality risk compared with later AVNA (HR 0.48; 95% CI [0.24-0.96]; p=0.038). In RV-paced patients, timing showed no survival impact, but renal function independently predicted mortality (p<0.001). Survival was similar between sexes. Conclusion:In this 10-year nationwide cohort, AVNA with permanent pacing resulted in survival comparable to local population norms. CRT provided no universal survival benefit over RV pacing, but early AVNA was associated with significantly improved outcomes in CRT recipients.

Central blood pressure (BP) and arterial stiffness are independent predictors of cardiovascular risk. Clinically, peripheral BP is commonly measured, yet, it may exhibit inverse changes relative to central BP in response to alterations in heart rate (HR). In patients with sick sinus syndrome (SSS), pacemakers are used to alleviate symptoms of bradycardia, however, an optimal pacemaker base rate (PBR) strategy remains unclear. Of note, no studies have explored the long-term effects of different PBR strategies on central haemodynamic parameters. To evaluate the effect of three different PBR strategies on central BP parameters via pulse wave analysis (PWA) and pulse wave velocity (PWV) in a randomised single-centre cross-over study. Patients with hypertension and a dual-chamber permanent cardiac pacemaker implanted due to SSS with preserved atrioventricular conduction (atrial pacing >95% and ventricular pacing <1%) were included in the study. Following data collection and randomization, patients had their PBR set to either 55 or 75 bpm for two months. Then, after a two-week wash-out period with patients' pre-study PBR, a second two-month period with alternate settings (those initially at 55 bpm were adjusted to 75 bpm, and vice versa) followed. A non-invasive oscillometric cuff-based device (Sphygmocor XCEL, AtCor Medical) was used for PWA to derive central aortic pressures and applanation tonometry to measure arterial stiffness (PWV) prior to randomisation, after the two-month study period, at the end of the wash-out period, and upon conclusion of the study. Measurements taken at baseline with a PBR of 65 bpm were used to form the mid HR group, whilst measurements taken at 55 and 75 bpm were used for low and high HR groups, respectively. Twenty-two patients with a mean age of 75 (±4) years, a BMI of 30 (±5) kg/m² who were predominantly female (73%) were included in the study. Table 1 describes haemodynamic measurements in study groups. Briefly, there were no statistically significant differences in peripheral systolic BPs (Figure 1A) between study groups (p=0.15). Central systolic BPs (Figure 1B) decreased significantly with increasing pacemaker base rates (p=0.04). Central pulse pressure (Figure 1C) also decreased significantly with increasing HRs (p<0.01). No significant inter-group differences were seen when comparing arterial stiffness (PWV, Figure 1D, p=0.08). Lastly, in a linear regression analysis, baseline PWV was not associated with the degree of changes seen in central BP or PP (p=0.84 and p=0.25, respectively). In older SSS patients with hypertension, opting for a higher anti-bradycardia PBR can enhance central BP control without increasing arterial stiffness. As central BP is independently associated with cardiovascular risk, future studies exploring effects of different PBR strategies on cardiovascular events and mortality are warranted.Figure 1 Table 1

BACKGROUND:We aimed to investigate metabolomic alterations in peripheral artery disease (PAD) by analyzing blood from the femoral artery and vein, assessing metabolite release/uptake in chronically ischemic lower limbs (PAD group) and nonischemic limbs (controls), and evaluating the representativeness of upper-limb venous samples. METHODS:In this exploratory case-control study, 24 patients with PAD (Fontaine IIb and III) and 18 control subjects with stable angina were enrolled. Blood was drawn from the femoral artery and vein, and the antecubital fossa. Metabolomic profiling of serum samples was performed using liquid chromatography and tandem mass spectrometry. We analyzed 560 metabolites, including amino acids and derivatives, acylcarnitines, ceramides, phosphatidylcholines, tri- and diglycerides, cholesteryl esters, sphingomyelins, and fatty acids, as well as 52 metabolic ratios/sums across various biochemical classes. RESULTS:Femoral arteriovenous (AV) concentration differences with in-group significance in at least one group and between-group significance was observed for 47 metabolites and five metabolic sums. Among these, eight metabolic variables in antecubital vein samples were significant. Correlation between AV differences and antecubital vein samples was weak. CONCLUSION:Using the femoral AV concentration differences of metabolites, we identified significant local metabolomic shifts in the PAD group. Most of these changes were not revealed using traditional upper-limb venous blood sampling. Further study of AV differences could improve the understanding of the pathophysiology of PAD.

OBJECTIVE:The clinical efficacy of remote ischaemic preconditioning (RIPC) remains unclear. This pilot study, a substudy of a randomised controlled trial, tested whether repeated RIPC reduces arterial stiffness, end organ damage, and oxidative stress in patients with intermittent claudication (IC). METHODS:In a single centre, randomised, sham controlled, double blind trial, 42 males with Fontaine stage IIa or IIb IC were allocated at a ratio of 1:1 to receive RIPC or sham using an automated device for 28 days in an outpatient setting (ClinicalTrials.gov ID NCT05084066). Secondary outcomes included changes in augmentation index (AIx), heart rate corrected AIx, carotid-femoral pulse wave velocity (cf-PWV), and biomarkers for cardiac (high sensitivity troponin T [hs-TnT], N-terminal pro B-type natriuretic peptide [NT-proBNP]), renal (creatinine, urea, cystatin C, β2 microglobulin, neutrophil gelatinase associated lipocalin, kidney injury molecule 1), and oxidative stress (high sensitivity C reactive protein, interleukin-6, interleukin-18, myeloperoxidase, adiponectin, oxidised low density lipoprotein). RESULTS:Data from 41 patients (RIPC n = 23, sham n = 18) aged 64.9 ± 7.4 years were analysed. The median change in cf-PWV was 0.2 m/s (interquartile range [IQR] -0.6, 0.6) in the RIPC group vs. 0.2 m/s (IQR -0.3, 0.8) in the sham group (p = .54). The median change in hs-TnT was 0 ng/L (IQR -1, 2) in the RIPC group vs. 1 ng/L (IQR -1, 2) in the sham group (p = .54). NT-proBNP showed a median change of -7 ng/L (IQR -32, 18) in the RIPC group vs. 6 ng/L (IQR -14, 35) in the sham group (p = .14). No statistically significant differences were observed between groups for arterial stiffness, oxidative stress, or renal biomarkers. CONCLUSION:Repeated RIPC did not significantly alter arterial stiffness, end organ damage, or oxidative stress biomarkers compared with sham treatment. It is possible that patients with IC already experience repeated RIPC from their ischaemic legs, thereby attenuating any additional effects from arm induced RIPC.

Aim. Chronic kidney disease (CKD) and diabetes mellitus (DM) contribute significantly to cardiovascular disease (CVD) and mortality, with prevalence increasing. The evolving demographic of myocardial infarction (MI) patients, influenced by sedentary lifestyles and advanced medical care, lacks understanding regarding the interplay of CKD, DM, age, and post-MI mortality. This study aims to address this gap by evaluating the long-term impact of CKD and DM on post-MI mortality across age groups. Methods. A retrospective cohort study utilized data from the Estonian Myocardial Infarction Registry (EMIR), Estonian Population Register (EPR), and six major hospitals in Estonia, covering AMI hospitalizations from 2012 to 2019. Statistical analyses included Cox proportional hazards regression models and Kaplan-Meier's curves. Results. Analysis of 17,085 MI patients revealed age-dependent associations between renal function and mortality. In patients <65 years, even minor decreases in renal function increased both short-term (HR 2.79, 95% CI 1.71-4.55) and long-term (HR 1.24, 95% CI 1.05-1.47) mortality. Mortality significantly increased in patients >80 years only below an estimated glomerular filtration rate (eGFR) of 44 ml/min/1.73 m(2). Newly diagnosed DM patients exhibited higher mortality rates (average HR 1.53, 95% CI 1.45-1.62), while pre-DM did not significantly differ from non-DM patients across all age groups. The DM-renal failure interaction did not significantly influence mortality. Conclusions. An age-dependent association between eGFR and post-MI outcomes emphasizes the need for personalized therapeutic approaches considering age-specific eGFR thresholds and comorbidities to optimize patient management.

BACKGROUND:Carotid-femoral pulse wave velocity (cfPWV) and central pulse pressure (PP) are recognised as significant indicators of vascular health and predictors of cardiovascular outcomes. In this study, associations between central hemodynamics and left ventricular (LV) echocardiographic parameters were investigated in subjects with heart failure with reduced ejection fraction (HFrEF), comparing the results to healthy individuals. METHODS AND RESULTS:This cross-sectional prospective controlled study included 50 subjects with HFrEF [mean LV ejection fraction (EF) 26 ± 6.5%] and 30 healthy controls (mean LVEF 65.9 ± 5.3%). Pulse wave analysis (PWA) and carotid-femoral pulse wave velocity (cfPWV) were used to measure central hemodynamics and arterial stiffness. The HFrEF group displayed higher cfPWV (8.2 vs. 7.2 m/s, p = 0.007) and lower central (111.3 vs. 121.7 mmHg, p = 0.001) and peripheral (120.1 vs. 131.5 mmHg, p = 0.002) systolic blood pressure. Central pulse pressure (PP) was comparable between the two groups (37.6 vs. 40.4 mmHg, p = 0.169). In the HFrEF group, cfPWV significantly correlated with left ventricular end-diastolic volume (LVEDV) index (mL/m2) and LVEF, with LVEDV index being a significant independent predictor of cfPWV (R2 = 0.42, p = 0.003). Central PP was significantly associated with heart rate, LVEF and LVEDV index, with the latter being a significant independent predictor of central PP (R2 = 0.41, p < 0.001). These correlations were not observed in healthy controls. CONCLUSIONS:Significant associations between central hemodynamic measures and LV echocardiographic parameters were identified, suggesting the potential to use PWA and cfPWV as possible tools for managing HFrEF.

OBJECTIVE:Remote ischaemic preconditioning (RIPC) is a promising non-invasive strategy in which brief episodes of ischaemia and reperfusion can increase skeletal muscle resistance to ischaemia and improve mobility. This study aimed to determine whether 28 consecutive days of RIPC improved intermittent claudication (IC) symptoms compared with sham intervention. METHODS:This single centre, parallel, randomised, sham controlled, double blind trial was conducted from January 2022 to April 2023 in outpatient settings. Forty two patients with stable IC Fontaine stage IIa or IIb were randomised to RIPC or sham for 28 days. The pre-specified primary outcome was a change in the maximum walking distance (MWD) after 28 days measured with a treadmill test. A > 10% change in MWD was considered clinically significant. Change in intermittent claudication distance (ICD), time to relief from claudication (TRC), and health related quality of life (HRQoL) measured with the VascuQoL-6 questionnaire were the secondary outcomes (ClinicalTrials.gov ID: NCT05084066). RESULTS:Forty one men (RIPC = 23, sham = 18) aged 64.9 ± 7.4 years were analysed. A change of > 10% in MWD occurred in 14 patients in the RIPC group vs. eight patients in the sham group (relative risk 1.37, 95% confidence interval 0.74 - 2.25; p = .35). Changes in ICD, TRC, and HRQoL between the groups were not statistically significant. CONCLUSION:In this trial, RIPC did not significantly improve MWD, ICD, or TRC compared with treatment with a sham device.

Resistance exercise has been shown to have a beneficial effect on muscular strength, bone mineral density, and body composition. Nevertheless, there is less evidence to demonstrate a protective effect of resistance exercise on cardiovascular health, particularly on blood pressure (BP) and cardiac function in competitive powerlifting athletes. PURPOSE: To evaluate the effect of 12-week strength training program (STP) on arterial stiffness, blood pressure and cardiac function in well-trained powerlifting athletes. METHODS: 19 well-trained male powerlifters (28.2 ± 6.1 yrs; 179.2 ± 5.9 cm¸ 99.9 ± 16.5 kg; BMI 31.2 ± 5.1) exercised for 12 weeks, 4 days per week with an intensity of 60-90% assessed from 1 RM and 90-120 min per session. Before the STP, there was an 8-week off-season period, where systematic strength training sessions and competitions were not allowed. Brachial BP was measured using standard protocol (OMRON M4-I, Omron Healthcare Europe BV, Netherlands); carotid-femoral pulse wave velocity (cfPWV) and central blood pressure were measured by applanation tonometry using the SphygmoCor device (AtCor Medical, Sydney, Australia), and an echocardiographic examination (Sonos7500, Philips Medical Systems, Inc., Highland Heights, OH, USA) was performed. All the measurements were performed at baseline and after 12-week STP. RESULTS: Subjects’ mean brachial and central systolic BP decreased significantly after the training period (132.3 ± 8.8 vs 124.3 ± 8.7 mmHg, p < 0.01 and 110.1 ± 7.7 vs 104.5 ± 8.7 mmHg, p < 0.01, respectively). There were no significant differences after the training period in cfPWV. Echocardiographic parameters showed that strength training significantly improved systolic tricuspid annular velocity (p < 0.01) and mitral E/e’ ratio (p < 0.05). CONCLUSION: 12-week strength training program had a beneficial effect on brachial and central systolic blood pressure and improved left and right ventricular cardiac function in male well-trained powerlifting athletes. There was no effect of strength training on arterial stiffness. Study was supported by Institutional Research Fundings No. IUT 02-7 and PRG435.

Abstract Background Prevalence of diabetes (DM) is rapidly increasing. With high rate of concomitant chronic kidney disease (CKD) in the elderly population the risk of cardiovascular (CV) complications is very high. Purpose Aim of our study was to evaluate the effect of DM status and CKD on mortality among elderly patients after acute myocardial infarction (AMI). Methods EMIR is an ongoing nationwide registry recording data from all patients in Estonia diagnosed with AMI (ICD-10 I21-I22). The study included all patients aged > 65 years who were hospitalized with the first AMI from 2012 to 2019. Data on glycated haemoglobin (HbA1c) in the time frame of 30 days prior to 7 days after admission, estimated glomerular filtration (eGFR) and creatinine levels within 24 hours of admission were obtained from the hospitals’ databases. Mortality data was acquired by linking the database to the Estonian population register. Follow up period lasted until the end of 2021. Prediabetes was defined as HbA1c ≥ 5,7 – 6,4 %, new DM as HbA1c ≥ 6,5 % without previous DM diagnosis. Information about previous DM diagnosis was acquired from EMIR. Statistical analysis was done using Cox proportional hazards regression model adjusted for age, sex, DM status and renal function. Results A total of 8902 patients (50.5 % women) were identified. Among female patients there was a larger proportion of diabetics and patients with lower eGFR (Table 1). We found that 30 day, 1-year and long – term (median 5.5 years) mortality was higher for both newly diagnosed (30 days: HR 1.6 (95 % CI 1.14 – 2.23); 1–year: HR 1.57 (95 % CI 1.25 – 1.99); long–term: HR 1.53 (95 % CI 1.29 – 1.81)) and known DM (30 days: HR 1.39 (95 % CI 1.19 – 1.61); 1–year: HR 1.28 (95 % CI 1.15 – 1.42); long–term: HR 1.47 (95 % CI 1.37 – 1.58)) patients. Prediabetes did not increase post MI mortality. In all follow up periods mortality increased progressively in accordance with declining renal function from eGFR below 59 ml/min/1.73m2 (Figure 1). Conclusions Our study suggests that newly diagnosed and known DM status and CKD have a considerable effect on elderly patients’ mortality after AMI, both in short and long term. Timely diagnosis and treatment of DM and CKD and meticulous secondary prevention can add to lowering mortality after AMI. However, our data also indicates that a more lenient medical management of prediabetes and mild CKD would be adequate for the elderly AMI patients in the current polypharmacotherapy era.Table 1.Figure 1.

Remote ischemic preconditioning (RIPC) has demonstrated protective effects in patients with lower extremity arterial disease (LEAD) undergoing digital subtraction angiography (DSA) and/or percutaneous transluminal angioplasty (PTA). This study aimed to investigate the impact of RIPC on the metabolomical profile of LEAD patients undergoing these procedures and to elucidate its potential underlying mechanisms. A total of 100 LEAD patients were enrolled and randomly assigned to either the RIPC group (n = 46) or the sham group (n = 54). Blood samples were drawn before and 24 h after intervention. Targeted metabolomics analysis was performed using the AbsoluteIDQ p180 Kit, and changes in metabolite concentrations were compared between the groups. The RIPC group demonstrated significantly different dynamics in nine metabolites compared to the sham group, which generally showed a decrease in metabolite concentrations. The impacted metabolites included glutamate, taurine, the arginine-dimethyl-amide-to-arginine ratio, lysoPC a C24:0, lysoPC a C28:0, lysoPC a C26:1, PC aa C38:1, PC ae C30:2, and PC ae C44:3. RIPC exhibited a 'stabilization' effect, maintaining metabolite levels amidst ischemia-reperfusion injuries, suggesting its role in enhancing metabolic control. This may improve outcomes for LEAD patients. However, additional studies are needed to definitively establish causal relationships among these metabolic changes.

Background and Aims: Remote ischemic preconditioning (RIPC) is a procedure that aims to reduce ischemia-reperfusion injury to ischemia-sensitive organs. Metabolomics is a novel method to explain the effects of RIPC and draw conclusions about its usefulness in clinical practice. This study assesses whether preoperative RIPC affects metabolome after vascular surgery and if these metabolomic changes correlate with heart and kidney injury markers. Methods: A randomized-controlled, double-blinded trial was carried out in the Tartu University Hospital. Patients undergoing elective vascular surgery were recruited. RIPC consisting of four cycles of 5 minutes of ischemia followed by 5 minutes of reperfusion, was applied before the surgery. Blood samples were collected preoperatively and approximately 24 hours postoperatively. The metabolome was analyzed with the AbsoluteIDQ p180 Kit. Results: Final analysis included 45 patients from the RIPC and 47 from the sham group. Mean age was 67 (± 9) and 66 (± 10) years in the RIPC and sham groups, respectively (p=0.577). RIPC did not cause significant changes in metabolites 24 hours after surgery. Positive linear correlation of change in the kynurenine/tryptophan ratio with change in hs-troponin T (r = 0.570, p ˂0.001), NT-proBNP (r = 0.552, p ˂0.001), cystatin C (r = 0.534, p <0.001) and beta-2-microglobulin (r = 0.504, p ˂0.001) were detected only in the RIPC group. Conclusions: RIPC did not provoke significant changes in metabolome 24 hours after vascular surgery. The positive linear correlation between the kynurenine/tryptophan ratio and heart and kidney injury markers suggests that the Kynurenine-Tryptophan pathway can play a role in RIPC-associated cardio- and renoprotective effects.

Background Routine oral anticoagulation (OAC) is recommended for almost all high-risk patients with atrial fibrillation, yet registries show that OACs are still underused. Our aim was to study the lifeday coverage (LDC) of OAC prescriptions and its relationship with one-year mortality rates of AF patients aged ≥ 65 in Estonia for the years 2019 and 2020. Methods Medical data for AF patients aged ≥ 65 years from 2018 and alive as of 01.01.2019 (cohort I) and new AF documentation from 2019 and alive as of 01.01.2020 (cohort II) was obtained from the Health Insurance Fund’s electronic database. The data was linked to the nationwide Estonian Medical Prescription Centre’s database of prescribed OACs. For LDC analysis, daily doses of guideline-recommended OACs were used. The patients were categorized into three LDC groups: 0%, 1–79%, and ≥ 80%. The data was linked to the Estonian Causes of Death Registry to establish the date of death and mortality rate for the whole Estonian population aged ≥ 65. Results There were 34,018 patients in cohort I and 9,175 patients with new AF documentation (cohort II), previously not included in cohort I. Of the patients, 77.7% and 68.6% had at least one prescription of OAC in cohorts I and II respectively. 57.4% in cohort I and 44.5% in cohort II had an LDC of ≥ 80%. The relative survival estimates at 1 year for LDC lifeday coverage groups 0%, 1–79%, and ≥ 80% were 91.2%, 98.2%, and 98.5% (cohort I), and 91.9%, 95.2%, and 97.6% (cohort II), respectively. Conclusions Despite clear indications for OAC use, LDC is still insufficient and anticoagulation is underused for stroke prevention in Estonia. Further education of the medical community and patients is needed to achieve higher lifeday coverage of prescribed OACs.

Background: remote ischemic preconditioning (RIPC) is a phenomenon in which short episodes of ischemia are applied to distant organs to prepare target organs for more prolonged ischemia and to induce protection against ischemia-reperfusion injury. This study aims to evaluate whether preoperatively performed RIPC affects the metabolome and to assess whether metabolomic changes correlate with heart and kidney injury markers after vascular surgery. Methods: a randomized sham-controlled, double-blinded trial was conducted at Tartu University Hospital. Patients undergoing elective open vascular surgery were recruited and RIPC was applied before operation. Blood was collected preoperatively and 24 h postoperatively. The metabolome was analyzed using the AbsoluteIDQ p180 Kit. Results: final analysis included 45 patients from the RIPC group and 47 from the sham group. RIPC did not significantly alter metabolites 24 h postoperatively. There was positive correlation of change in the kynurenine/tryptophan ratio with change in hs-troponin T (r = 0.570, p < 0.001), NT-proBNP (r = 0.552, p < 0.001), cystatin C (r = 0.534, p < 0.001) and beta-2-microglobulin (r = 0.504, p < 0.001) only in the RIPC group. Conclusions: preoperative RIPC did not significantly affect the metabolome 24 h after vascular surgery. The positive linear correlation of kynurenine/tryptophan ratio with heart and kidney injury markers suggests that the kynurenine–tryptophan pathway can play a role in RIPC-associated cardio- and nephroprotective effects.

Aims Describe the characteristics, management and outcomes of hospitalized ST-segment elevation myocardial infarction (STEMI) patients according to national ongoing myocardial infarction registries in Estonia, Hungary, Norway, and Sweden. Methods and results Country-level aggregated data was used to study baseline characteristics, use of in-hospital procedures, medications at discharge, in-hospital complications, 30-day and 1-year mortality for all patients admitted with STEMI during 2014-2017 using data from EMIR (Estonia; n = 4584), HUMIR (Hungary; n = 23 685), NORMI (Norway; n= 12 414, data for 2013-2016), and SWEDEHEART (Sweden; n = 23 342). Estonia and Hungary had a higher proportion of women, patients with hypertension, diabetes, and peripheral artery disease compared to Norway and Sweden. Rates of reperfusion varied from 75.7% in Estonia to 84.0% in Sweden. Rates of recommendation of discharge medications were generally high and similar. However, Estonia demonstrated the lowest rates of dual antiplatelet therapy (78.1%) and statins (86.5%). Norway had the lowest rates of beta-blockers (80.5%) and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (61.5%). The 30-day mortality rates ranged between 9.9% and 13.4% remaining lowest in Sweden. One-year mortality rates ranged from 14.8% in Sweden and 16.0% in Norway to 20.6% in Hungary and 21.1% in Estonia. Age-adjusted lethality rates were highest for Hungary and lowest for Sweden. Conclusion This inter-country comparison of data from four national ongoing European registries provides new insights into the risk factors, management and outcomes of patients with STEMI. There are several possible reasons for the findings, including coverage of the registries and variability of baseline-characteristics' definitions that need to be further explored.

Aims Data on how differences in risk factors, treatments, and outcomes differ between sexes in European countries are scarce. We aimed to study sex-related differences regarding baseline characteristics, in-hospital managements, and mortality of ST-elevation myocardial infarction (STEMI) patients in different European countries.Methods and results Patients over the age of 18 with STEMI who were treated in hospitals in 2014-17 and registered in one of the national myocardial infarction registers in Estonia (n = 5817), Hungary (n = 30 787), Norway (n = 33 054), and Sweden (n = 49 533) were included. Cardiovascular risk factors, hospital treatment, and recommendation of discharge medications were obtained from the infarction registries. The primary outcome was mortality, in-hospital, after 30 days and after 1 year. Logistic and cox regression models were used to study the associations of sex and outcomes in the respective countries. Women were older than men (70-78 and 62-68 years, respectively) and received coronary angiography, percutaneous coronary intervention, left ventricular ejection fraction assessment, and evidence-based drugs to a lesser extent than men, in all countries. The crude mortality in-hospital rates (10.9-15.9 and 6.5-8.9%, respectively) at 30 days (13.0-19.9 and 8.2-10.9%, respectively) and at 1 year (20.3-28.1 and 12.4-17.2%, respectively) after hospitalization were higher in women than in men. In all countries, the sex-specific differences in mortality were attenuated in the adjusted analysis for 1-year mortality.Conclusion Despite improved awareness of the sex-specific inequalities on managing patients with acute myocardial infarction in Europe, country-level data from this study show that women still receive less guideline-recommended management.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice. The pathogenesis of AF is linked to inflammatory reaction and oxidative stress, which leads to fibrosis of the atria and progression of the disease. The purpose of this study was to define the role of several biomarkers of inflammation, fibrosis, and oxidative stress (OxS). We included 75 patients with paroxysmal/persistent AF, who were admitted for electrical cardioversion or pulmonary vein isolation (PVI). High-sensitivity C-reactive protein (hsCRP), galectin-3 (Gal-3), myeloperoxidase (MPO), oxidized low-density lipoprotein (oxLDL), and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured before the procedures. We compared the results with those of 75 healthy age-, sex-, and blood pressure-matched individuals. The patients were followed up for 1 year after the intervention to establish the recurrence of AF and its association with the measured markers. Patients with AF had higher MPO (52.6 vs. 36.2 ng/ml, p < 0.001) and NT-proBNP (209.0 vs. 28.0 pg/ml, p < 0.001) compared to healthy subjects. Also, they showed significantly higher levels of hsCRP (1.5 vs. 1.1 mg/l, p=0.001) and Gal-3 (11.4 vs. 9.7 mg/l, p=0.003), while there was no difference found in oxLDL (71.5 vs. 71.7 U/l, p=0.449). MPO (OR=1.012, p=0.014), hsCRP (OR=1.265, p=0.026), and weight (OR=1.029, p=0.013) were independently associated with AF in a multivariable logistic regression analysis. Patients with successful maintenance of sinus rhythm (SR) for one year had lower baseline MPO (40.5 vs. 84.3 ng/ml, p=0.005) and NT-proBNP (127.5 vs. 694.0 pg/ml, p < 0.001) compared to patients with recurrent AF episodes, but there was no difference in hsCRP, Gal-3, or oxLDL between them. MPO (OR=0.985, p=0.010) was independently associated with AF recurrence during the follow-up period when adjusted for cofounders. Patients with AF had increased markers of inflammation and fibrosis, while there was no increase detected in the OxS marker oxLDL. MPO was independently associated with AF in a multivariate model. Inflammatory and fibrotic mechanisms are important factors in electrical and structural remodelling progress in the atria of patients with AF.

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Estonian Research Council Introduction High rates of adherence to myocardial infarction (MI) secondary prevention medications have been reported by several studies in Europe. However, results derived from unselected populations registry based data is scarce. Purpose Aim of our study was to analyse adherence to guideline recommended medications for secondary prevention of MI of unselected patient population in Estonia in 2017-2018 and compare the results with data from 2004-2005. Methods Population studied in 2004-2005 was based on Estonian Health Insurance Fund"s (EHIF) database and in 2017-2018 on Estonian Myocardial Infarction Registry (EMIR). EMIR is an ongoing registry recording data from all patients in Estonia diagnosed with MI (ICD-10 I21 – I22). Patients hospitalised due to MI and survived > 30 days formed the study population. By linking to EHIF"s prescription database medication adherence for angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB), statins, beta blockers (BB) and P2Y12 inhibitors clopidogrel and ticagrelor was assessed during one year follow-up period from first hospitalisation during period studied (at least one reimbursed prescription for the drug group during follow-up period). Results 4900 and 5067 index episodes were defined in 2004-2005 and 2017-2018, respectively. Mean age in the study population was 64.7 (+/- 11.5) and 66.5 (+/- 12.1) for men and 72.7 +/- 9.9 and 76.4 +/- 10.9 for women in 2004-2005 and 2017-2018. Rates of medication adherence among patients who survived > 30 days are presented in the Table. Conclusion Adherence to guideline recommended medication for secondary prevention of MI in Estonia has improved considerably over 13 years. Based on our data there is room for advancement, especially among women and the elderly. Rates of medication adherence.2004-20052017-2018p value (comparison between studies)MEN (n = 2365)WOMEN (n = 1660)TOTAL (n = 4025)MEN (n = 2704)WOMEN (n = 1668)TOTAL (n = 4372)BB, No. (%)1907 (80.6)1344 (81.0)3251 (81.0)2265 (84.0)1385 (83.0)3650 (83.5)0.001ACE/ARB, No. (%)1780 (75.3)1317 (79.3)3097 (76.9)1817 (67.2)1070 (64.1)2887 (66.0)< 0.001Statins, No. (%)946 (40.0)826 (50.0)*1772 (44.0)1910 (70.6)1020 (61.2)*2930 (67.0)< 0.001Statin + ACE/ARB + BB, No. (%)999 (42.2)647 (39.0)1646 (40.9)1336 (49.4)686 (41.1)*2022 (46.2)< 0.001None of the above medications, No. (%)130 (5.5)96 (6.0)226 (5.6)214 (7.9)148 (9.0)362 (8.3)< 0.001P2Y12 inhibitorsNANANA2194 (81.1)1147 (69.0)*3341 (76.4)NABB, beta-blockers; ACE/ARB, angiotensin converting enzyme inhibitors/angiotensin II receptor blockers. NA, not available *P < 0.01 for comparison between men and women with Pearson"s χ2 test. Pearson"s χ2 test used for comparison between studies.

Abstract Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and beta blockers (BBs) are the drugs of choice for rate or rhythm control in these patients. The purpose of this study was to describe differences in arterial stiffness (AS), central blood pressure (cBP), and the role of BBs on cBP in patients with AF compared to healthy individuals. The authors included 76 patients with paroxysmal/persistent AF. Carotid‐femoral pulse wave velocity (PWV) and cBP were measured and compared with data from 75 healthy individuals. Patients with AF had higher PWV (8.0 m/s vs. 7.2 m/s, p < .001), central systolic blood pressure (cSBP) (118 mm Hg vs. 114 mm Hg, p = .033), central pulse pressure (cPP) (39 mm Hg vs. 37 mm Hg, p = .035) and lower pulse pressure amplification (PPA) (1.24 vs. 1.30, p = .015), without differences in peripheral blood pressure (pBP) and heart rate (HR). AF patients had significantly increased PWV (β= 0.500, p = .010, adjusted R² = 0.37) after adjustment for confounding factors. The use of BBs significantly reduced PPA (β = ‐0.059, p = .017, adjusted R² = 0.30). AF patients have higher PWV, cSBP, cPP, and lower PPA, compared to healthy patients. These findings support the role of AS in the development of AF. Use of BBs is related to a potential adverse effect on cBP.

There is no clear understanding about the effect of intensive physical load on arterial stiffness and related biomarkers. The aim of this study was to evaluate the effect of half-marathon running on arterial stiffness and blood biomarkers during post-competitive recovery period in competitive and recreational male athletes. Eleven high-level long-distance runners (27.1 ± 4.8 yrs) and seven recreational athletes (34.3 ± 6.1 yrs), who participated in a half-marathon run were examined. Blood biomarkers and arterial stiffness (SphygmoCor 7.1) were measured at baseline and at 18 to 22 hours after the competition. There were no statistically significant changes between the groups in augmentation index (AIx, AIx@75) or pulse wave velocities at carotid-femoral segment (cfPWV) during recovery period. Between-group comparison did not reveal significant differences in blood pressure and arterial stiffness values at baseline and during recovery period. The change of cfPWV (difference between cfPWV at baseline and cfPWV during post-competitive recovery period) was significantly dependent on race time and sports level of the athlete (high-level or recreational). A significant increase was found in hsCRP, creatine kinase and LDH activity during the post-race period in both groups. No significant changes were found in oxidative stress markers in the groups after the race except for higher diene conjugates level in recreational athletes in comparison with the high-level group during recovery period. Our study results showed that half-marathon competition did not cause any significant changes in arterial stiffness parameters during the recovery period. However, the change in cfPWV was independently associated with half-marathon race time and the athlete's level of training revealing a mild increase of arterial stiffness in high-level athletes and athletes with a faster race time.

OBJECTIVE:Diagnostic digital subtraction angiography (DSA) and DSA with percutaneous transluminal angioplasty (DSA-PTA) are common procedures for diagnosing and treating symptomatic lower extremity arterial disease (LEAD). However, organ damage following DSA and DSA-PTA is often underrecognised and hence undiagnosed. To reduce the risk induced by invasive procedures in symptomatic LEAD patients, the method of remote ischemic preconditioning (RIPC) has been suggested. The aim of the current study was to assess the effect of RIPC intervention on the organ damage markers profile, oxidative stress, and inflammation biomarkers in LEAD patients undergoing DSA and DSA-PTA procedure.METHODS:The RIPC intervention was performed by inflating a standard blood pressure cuff on the patient's upper arm to 200 mmHg for 5 minutes four times with 5-minute perfusion between each cycle. The sham intervention was performed similarly, but the cuff was inflated to 20 mmHg. Changes in the cardiac and renal damage biomarkers' profile, oxidative stress, and inflammation biomarkers were recorded before and 24 hours after DSA or DSA-PTA.RESULTS:A total of 111 (RIPC 54, sham 57) patients with symptomatic LEAD scheduled for endovascular procedure were randomised, and 102 patients (RIPC 47, sham 55) completed the study protocol. RIPC significantly limited the increase of adiponectine levels after DSA and DSA-PTA, compared to sham intervention (p = 0.020), but CK-MB levels were markedly lower in the sham group (p = 0.047) after procedure. There was no significant difference between the RIPC and the sham group in mean changes in hs-troponin-T (p = 0.25), NT-proBNP (p = 0.24), creatinine (p = 0.76), eGFR (p = 0.61), urea (p = 0.95), beta-2-microglobuline (p = 0.34), or cystatine C (p = 0.24) levels.CONCLUSION:In this controlled clinical study, RIPC failed to improve the profile of renal and cardiac biomarkers in patients with LEAD periprocedurally. RIPC significantly limits the rise in adiponectin levels and may influence the decrease of CK-MB levels 24 hours after endovascular procedure.