Background: Traditional Framingham risk factors are highly prevalent in patients with chronic kidney disease (CKD); however, they do not completely account for the accelerated cardiovascular (CV) risk in CKD. Recently global longitudinal strain (GLS) has emerged as a superior method for detecting, often subclinical, left ventricular(LV) systolic dysfunction as compared to ejection fraction(EF). This study aimed to determine the relationship between GLS, traditional risk factors and novel CKD-related risk factors in patients with CKD.Methods: This was a cross sectional study of patients with moderate CKD stages 3 and 4 (n=136). Clinical characteristics, anthropometric, biochemical data including markers of inflammation [C-reactive protein (CRP)], novel uraemic toxins [indoxyl sulphate(IS), p-cresyl sulphate(PCS)], and arterial stiffness [pulse wave velocity (PWV)] were measured. Inducible ischaemia was detected using exercise stress echo. Associations between GLS, traditional risk factors and CKDrelated risk factors were explored using multivariate models.Results: The study population parameters included: mean age 59.4±9.8 years, 58% male, estimated glomerular filtration rate (eGFR) 44.4±10 ml/min/1.73m 2 , GLS -18.3±3.6% and EF 65.8%±7.8%. We demonstrated that GLS correlated with diabetes (r=0.21, p=0.01), history of heart failure (HF) (r=0.20, p=0.01), free IS (r=0.24, p=0.005) free PCS (r=0.23, p=0.007), body mass index (BMI) (r=0.28, p<0.001), and PWV (r=0.24, p=0.009). Following adjustment for demographic, baseline co-morbidities and laboratory parameters, GLS was independently associated with free IS, BMI and arterial stiffness (R 2 for model = 0.30, p<0.0001). Conclusion:In the CKD cohort, LV systolic function, assessed using GLS, was associated with novel uraemic toxins, obesity and arterial stiffness.

Background:Frozen shoulder (FS) is a debilitating musculoskeletal condition with an uncertain etiology and pathogenic mechanism. The aim of this study was to investigate the hypothesis that an alteration in the level of cytokines may disrupt the normal inflammatory and tissue healing process in the shoulder, leading to the development of FS.Materials and Methods:A prospective case–control study was undertaken, analyzing patients undergoing arthroscopic treatment of FS and control patients being treated for subacromial bursitis. Synovial biopsies were taken from all subjects. Synovial RNA levels were analyzed using quantitative polymerase chain reaction (qPCR)Results:Thirteen patients with FS were recruited, four of whom were diagnosed with diabetes mellitus, along with 10 control patients. Cytogenetic analysis using qPCR revealed both fibrogenic cytokine matrix metalloproteinase 3 (MMP 3) (1.98×10 5 vs. 755.0, P=0.068) and inflammatory cytokine interleukin 6 (IL 6) (1679.2 vs. 372.8, P=0.062) to be elevated in FS cases as compared to controls. Comparison between diabetic and non-diabetic patients revealed a decrease in the level of expression of inflammatory cytokine, monocyte colony stimulating factor (M-CSF) (12,496 vs. 305.1, P=0.04) in diabetic FS patients.Conclusions:The results demonstrate that levels of inflammatory and fibrogenic cytokines are elevated in the synovium of patients with FS compared with controls. This indicates that altered levels of inflammatory cytokines may be associated with the pathogenesis of inflammation evolving into fibrosis, which is the characteristic feature of FS. We have also shown the opposite to be the case in patients with diabetic FS.

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ObjectivesRecent technology advances have allowed for heart rhythm monitoring using single-lead ECG monitoring devices, which can be used for early diagnosis of atrial fibrillation (AF). We sought to investigate the AF detection rate using portable ECG devices compared with Holter monitoring.Setting, participants and outcome measuresWe searched the Medline, Embase and Scopus databases (conducted on 8 May 2017) using search terms related to AF screening and included studies with adults aged >18 years using portable ECG devices or Holter monitoring for AF detection. We excluded studies using implantable loop recorders and pacemakers. Using a random-effects model we calculated the overall AF detection rate. Meta-regression analysis was performed to explore potential sources for heterogeneity. Quality of reporting was assessed using the tool developed by Downs and Black.ResultsPortable ECG monitoring was used in 18 studies (n=117 436) and Holter monitoring was used in 36 studies (n=8498). The AF detection rate using portable ECG monitoring was 1.7% (95% CI 1.4 to 2.1), with significant heterogeneity between studies (p<0.001). There was a moderate linear relationship between total monitoring time and AF detection rate (r=0.65, p=0.003), and meta-regression identified total monitoring time (p=0.005) and body mass index (p=0.01) as potential contributors to heterogeneity. The detection rate (4.8%, 95% CI 3.6% to 6.0%) in eight studies (n=10 199), which performed multiple ECG recordings was comparable to that with 24 hours Holter (4.6%, 95% CI 3.5% to 5.7%). Intermittent recordings for 19 min total produced similar AF detection to 24 hours Holter monitoring.ConclusionPortable ECG devices may offer an efficient screening option for AF compared with 24 hours Holter monitoring.PROSPERO registration numberCRD42017061021.

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Aims Although both left atrial (LA) and ventricular (LV) dysfunction has been accepted as an important risk factor of atrial fibrillation (AF), usefulness of LA and LV strain has not been fully compared for prediction of AF. The aims of this study were to clarify the associations of both LA and LV strain with AF and to compare their predictive values in the risk stratification for AF. Methods and results We evaluated 531 consecutive patients (median age 67 years, 56% male), with no history of AF who underwent echocardiography after cryptogenic stroke. Standard echocardiographic parameters were measured, and speckle-tracking was used to measure LA (reservoir, pump, and conduit strain) and LV strain (global longitudinal strain, GLS). The baseline clinical and echocardiographic parameters of the patients who developed AF and those who did not were compared. Median 36 months of follow-up, 61 patients (11%) had newly diagnosed AF. LA pump strain and GLS were significantly and independently associated with AF and provided incremental predictive value over clinical and standard echocardiographic parameters. Areas under the receiver-operating curves for GLS (0.841) were comparable to LA pump (0.825) and reservoir (0.851) strain. However, predictive value of both strains was different between patients with and without LA enlargement at the time of transthoracic echocardiography screening. LA strain was more useful than LV strain in patients with normal LA volumes, while LV strain was more useful than LA strain in patients with abnormal LA volumes. Conclusion Both LA and LV strain are significantly and independently associated with AF and provide incremental predictive value over clinical and standard echocardiographic parameters. However, priorities of strain assessment are different depends on patients’ condition at the time of echocardiography.

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