569 Association between periodontal disease, coronary calcium score and markers of subclinical atherosclerosis in patients with unstable angina-a CT-based sub-study from the ATHERODENT clinical trial

Abstract Funding Acknowledgements PlaqueImage financed by the National Authority of Scientific Research and Innovation and the Romanian Ministry of European Funding Background The relationship between periodontal disease (PD) and chronic inflammation is well established. PD leads to increased cardiovascular risk and favours development of acute coronary syndromes; however, the association between PD and markers of subclinical atherosclerosis has not been elucidated so far. Purpose To evaluate the interrelation between severity of PD, coronary calcium, subclinical atherosclerosis and plaque vulnerability in patients with unstable angina, who underwent coronary computed tomography angiography (CCTA). Methods Fifty-two patients with unstable angina were enrolled in the ATHERODENT clinical trial (NCT03395041). All patients underwent: (1) complex dental examination for assessment of periodontal status, expressed by the total periodontal index (PI) evaluating the following indices: gingival index, plaque index, tantrum index, furcation index, mobility, loss of attachment, pocket depth and papillary bleeding index, (2) CCTA for analysis of morphology, composition and vulnerability features of the culprit plaques causing myocardial schema. For each patient, coronary calcium score, body mass index, neck circumference, abdominal circumference and Intima-media thickness of the carotid artery were calculated. According to the median value of the total PI (set by 22) the study population was divided into two groups: group 1 included 26 patients with low PI (normal gum or gingivitis) and group 2 included 26 patients with high PI (periodontitis and severe PD). Results In patients with high PI the plaque volume (p = 0.019) and the non-calcified volume (p = 0.002) were more increased compared with patients with low PI. In patients with high risk features in the culprit coronary plaques (positive remodelling, low density atheroma, spotty calcification and napkin ring sign) the severity of PD was more expressed compared with those with low risk plaques (28.20+/-13.34 vs. 18.71+/-11.31, p = 0.001). From all PI indices, loss of gingival attachments (3.6 +/-2.91 vs. 1.66 +/- 1.8, p = 0.009) and papillary bleeding index (4.5 +/-3.06 vs. 2.04+/-1.96, p = 0.002) were significantly correlated with the plaque vulnerability. there was no significant correlation between PI and the markers of subclinical atherosclerosis expressed by the neck circumference, abdominal circumference and IMT of the carotid artery. However, total PI presented significantly correlation with the total coronary artery calcium score (r = 0.45, p = 0.0008). A higher calcium score was identified in patients with high PI compared with those with low PI (505.29 +/-478.64 vs. 93.82+/-233.0, p = 0.0001). Conclusions In patients with vulnerable coronary plaques, subclinical atherosclerosis is not correlated with PI. However, the severity of PD is directly associated with the total calcium score and with a more vulnerable phenotype of the atheromatous coronary plaques. </jats:sec

Edge computing in space: Field programmable gate array-based solutions for spectral and probabilistic analysis of time series

This paper addresses the problem of performing time series analysis on-board a spacecraft, where the number of constraints is much bigger than for applications running in regular (i.e., ground-based) environments. An objective of modern spacecraft technologies designed for space exploration is to perform on-board data processing tasks, in order to increase the amount of data available for scientific analysis. Field Programmable Gate Array (FPGA) devices are considered as good candidates for hardware implementations of such systems. In order to optimize the usage of on-board resources, FPGAs share their resources between several digital signal processing (DSP) algorithms. In this paper, we describe the design and implementation of such an optimized design where two DSP algorithms are implemented on the same FPGA: (1) the power spectral density and (2) the multiscale probability distribution functions. The entire implementation process is described in detail, including a discussion about the main architectural choices. The proposed solutions focus on optimization of area, speed, and power. The tests performed, on both synthetic and real data, demonstrate the feasibility of our approach and constitute the first step toward porting the design on space-grade FPGAs

Heart failure in Europe: Guideline-directed medical therapy use and decision making in chronic and acute, pre-existing and de novo, heart failure with reduced, mildly reduced, and preserved ejection fraction – the ESC EORP Heart Failure III Registry

Aims We analysed baseline characteristics and guideline-directed medical therapy (GDMT) use and decisions in theEuropean Society of Cardiology (ESC) Heart Failure (HF) III Registry. Methods and results Between1November 2018and31December 2020,10162 patients with acute HF (AHF, 39%, age 70 [62-79],36% women) or outpatient visit for HF (61%, age 66 [58-75], 33% women), with HF with reduced (HFrEF, 57%),mildly reduced (HFmrEF,17%) or preserved (HFpEF, 26%) ejection fraction were enrolled from 220 centres in 41European or ESC-affiliated countries. With AHF, 97% were hospitalized, 2.2% received intravenous treatment in theemergency department, and 0.9% received intravenous treatment in an outpatient clinic. AHF was seen by most bya general cardiologist (51%) and outpatient HF most by a HF specialist (48%). A majority had been hospitalized forHF before, but 26% of AHF and 6.1% of outpatient HF had de novo HF. Baseline use, initiation and discontinuation ofGDMT varied according to AHF versus outpatient HF, de novo versus pre-existing HF, and by ejection fraction. Afterthe AHF event or outpatient HF visit, use of any renin-angiotensin system inhibitor, angiotensin receptor-neprilysininhibitor, beta-blocker, mineralocorticoid receptor antagonist and loop diuretics was 89%, 29%, 92%, 78%, and 85%in HFrEF; 89%, 9.7%, 90%, 64%, and 81% in HFmrEF; and 77%, 3.1%, 80%, 48%, and 80% in HFpEF. ConclusionUse and initiation of GDMT was high in cardiology centres in Europe, compared to previous reports from cohortsand registries including more primary care and general medicine and regions more local or outside of Europe andESC-affiliated countries....................................

Use of cardiac imaging in chronic coronary syndromes: the EURECA Imaging registry.

Abstract Background The prospective, multicentre EURECA registry assessed the use of imaging and adoption of the European Society of Cardiology (ESC) Guidelines (GL) in patients with chronic coronary syndromes (CCS). Methods Between May 2019 and March 2020, 5156 patients were recruited in 73 centres from 24 ESC member countries. The adoption of GL recommendations was evaluated according to clinical presentation and pre-test probability (PTP) of obstructive coronary artery disease (CAD). Results The mean age of the population was 64 ± 11 years, 60% of patients were males, 42% had PTP &amp;gt;15%, 27% had previous CAD, and ejection fraction was &amp;lt;50% in 5%. Exercise ECG was performed in 32% of patients, stress imaging as the first choice in 40%, and computed tomography coronary angiography (CTCA) in 22%. Invasive coronary angiography (ICA) was the first or downstream test in 17% and 11%, respectively. Obstructive CAD was documented in 24% of patients, inducible ischaemia in 19%, and 13% of patients underwent revascularization. In 44% of patients, the overall diagnostic process did not adopt the GL. In these patients, referral to stress imaging (21% vs. 58%; P &amp;lt; 0.001) or CTCA (17% vs. 30%; P &amp;lt; 0.001) was less frequent, while exercise ECG (43% vs. 22%; P &amp;lt; 0.001) and ICA (48% vs. 15%; P &amp;lt; 0.001) were more frequently performed. The adoption of GL was associated with fewer ICA, higher proportion of diagnosis of obstructive CAD (60% vs. 39%, P &amp;lt; 0.001) and revascularization (54% vs. 37%, P &amp;lt; 0.001), higher quality of life, fewer additional testing, and longer times to late revascularization. Conclusions In patients with CCS, current clinical practice does not adopt GL recommendations on the use of diagnostic tests in a significant proportion of patients. When the diagnostic approach adopts GL recommendations, invasive procedures are less frequently used and the diagnostic yield and therapeutic utility are superior. </jats:sec