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Aim & methods: This 6-month prospective, observational, noninterventional, open-label clinical study assessed the effectiveness/safety of trimetazidine in 737 patients with stable angina pectoris and Type 2 diabetes mellitus (OGYI/51534–1/2014). Results: Trimetazidine-based therapy was effective in stable coronary artery disease, with significant improvements from baseline (p < 0.05) in: number of angina attacks/week (2.9 ± 2.4 vs 1.1 ± 1.6), angina severity (Canadian Cardiovascular Society Classification 1.9 ± 0.8 vs 1.2 ± 0.8), exercise capacity (metabolic equivalents 6.1 ± 1.7 vs 6.5 ± 1.7), and exercise-induced myocardial ischemia (min 5.5 ± 2.5 vs 6.5 ± 2.6). Discussion: Trimetazidine treatment significantly (p < 0.05) improved glucose metabolism, lowered HbA1c (7.1 ± 1.1% vs 6.6 ± 1.0%), glucose levels (7.7 ± 2.1 mmol/l vs 6.9 ± 1.6 mmol/l) and decreased arterial stiffness (pulse wave velocity 11.2 ± 2.1 m/s vs 10.4 ± 2.2 m/s). In most patients, the tolerability of trimetazidine was rated as excellent to good, with a low incidence of adverse events.

Recently an expert consensus document advised to standardize user procedures and a new cut-off value for carotid-femoral pulse wave velocity in daily practice. Our aim was to observe aortic pulse wave velocity (PWVao) and augmentation index (AIXao) in two high cardiovascular risk groups: patients with verified coronary artery disease (CAD) or with type 2 diabetes mellitus (T2DM). We also aimed to determine the cut-off values for PWVao, AIXao in CAD and T2DM patients using oscillometric device (Arteriograph). We investigated 186 CAD and 152 T2DM patients. PWVao and AIXao increased significantly in the CAD group compared to the age-, gender-, blood pressure-, and heart rate-matched control group (10.2±2.3 vs. 9.3±1.5 m/s; p<0.001 and 34.9±14.6 vs. 31.9±12.8 %; p<0.05, respectively). When compared to the apparently healthy control subjects, T2DM patients had significantly elevated PWVao (9.7±1.7 vs. 9.3±1.5 m/s; p<0.05, respectively), however the AIXao did not differ significantly. The ROC-curves of CAD and healthy control subjects explored cut-off values of 10.2 m/s for PWVao and 33.23 % for AIXao. Our data provide supporting evidence about impaired arterial stiffness parameters in CAD and T2DM. Our findings encourage the implementation of arterial stiffness measurements by oscillometric method in daily clinical routine.

Introduction According to recent 2021 ESC prevention guidelines arterial stiffness (aortic pulse wave velocity – PWV, augmentation index - Aix) predicts future major adverse cardiovascular events (MACE). Both parameters have a prognostic relevance, however due to the various technical approaches the level of high stiffness values show significant differences and resulting an argue against widespread use. Purpose We evaluated the cut-off PWV and Aix values for MACE prediction using cardiac magnetic resonance imaging (CMR) and oscillometric methods for validating the prognostic value of high stiffness parameters in post-infarcted patients. Methods CMR phase contrast imaging (Siemens Avanto, 1,5 T CMR device) and an invasively validated oscillometric based Arteriograph (AG) method were compared in this 6 years follow-up study, including 49 patients suffered previous ST-elevation myocardial infarction (STEMI). Patients received follow-up for MACE comprising all-cause death, non-fatal MI, ischemic stroke, hospitalization for heart failure and coronary revascularization. Results 49 patients (37 male, average age: 57±8 years) were investigated. An acceptable agreement and significant correlation (Spearman's rho: 0.332, p&lt;0,01) was found between AG and CMR derived PWV values. Bland Altman plot was created to test for methods' agreement. The bias showed that in general the mean difference between the two measures was 3.6 m/s (upper and lower limit of agreement: –0.2 and 7.5 m/s). The coefficient of variation was 43.9%. Totally 51 MACE events occurred during the 6 years follow-up period. Hospitalisation for coronary revascularisation (55%), all-cause death (15%), non-fatal MI (12%), heart failure (12%) exposed the majority of MACE events. Optimized PWV and Aix cut-off values for MACE prediction were calculated (PWVCMR: 6,47 m/s; PWVAG: 9,625 m/s; AixAG: 34,22%) by receiver operating characteristic analysis (Figure 1). Kaplan-Meier analysis in all parameters showed a significantly lower event-free survival in case of high PWV and Aix values (Figure 2). Multivariate Cox regression analysis revealed PWV and Aix as a predictor of MACE (PWVCMR hazard ratio (HR): 1.31 (CI: 1.1–1.7), PWVAG HR: 1.24 (CI: 1.0–1.5), AixAG HR: 1,043 (CI: 1,01–1,08), p&lt;0,05 respectively). Conclusions Arterial stiffness, particularly elevated PWV predicts MACE in postinfarcted patients. Our study showed both CMR and oscillometric techniques are feasible for MACE prediction, however, adjusted cut-off values of PWV are recommended for different methods to improve individual risk stratification. All these findings emphasize the clinical relevance for the future measurement of arterial stiffness might contribute to improved risk stratification after MI, which is crucial for the assessment of prognosis and guidance of secondary prevention treatment. Funding Acknowledgement Type of funding sources: None.

Introduction Increased aortic pulse wave velocity (PWV) as a strong predictor of major advanced cardiovascular events (MACE) has a prognostic relevance in patients after myocardial infarction (MI). Several non-invasive methods have been proposed for the assessment of arterial stiffness, but the PWV values show significant differences according to the applied techniques. Cardiac magnetic resonance imaging (CMR) provides an accurate method to measure PWV and infarct size in patients after MI. Purpose Calculated PWV values of CMR based phase-contrast (PC) and invasively validated oscillometric methods were compared in this prospective observational study. We aimed to evaluate the cut-off PWV values for each method, while MACE predicted and validated the prognostic value of high PWV in post-infarcted patients in a 6-year follow-up. Methods 3D aortic angiography and PC velocity imaging was performed using a Siemens Avanto 1,5 T CMR device. Oscillometric based Arteriograph (AG) was used to assess PWV using direct body surface distance measurements. The comparison between the two techniques was tested. Patients received follow-up for MACE comprising all-cause death, non-fatal MI, ischemic stroke, hospitalization for heart failure and coronary revascularization. Event-free survival was analysed using Kaplan-Meier plots and log-rank tests. Univariable and multivariable Cox regression analysis was performed to identify outcome predictors. Results 75 patients (56 male, 19 female, average age: 56±13 years) referred for CMR were investigated, of whom 50 had coronary artery disease (CAD) including 35 patients with previous MI developing ischaemic late gadolinium enhancement (LGE) pattern. AG and CMR derived PWV values were significantly correlated (rho: 0,343, p&lt;0,05), however absolute PWV values were significantly higher for AG (median (IQR): 10,4 (9,2–11,9) vs. 6,44 (5,64–7,5); p&lt;0,001). Bland Altman analysis showed an acceptable agreement with a mean difference of 3,7 m/s between the two measures. In patients with CAD significantly (p&lt;0,01) higher PWV values were measured by AG and CMR, respectively. During the median follow-up of 6 years, totally 69 MACE events occurred. Optimized PWV cut-off values for MACE prediction were calculated (CMR: 6,47 m/s; AG: 9,625 m/s) by receiver operating characteristic analysis. Kaplan-Meier analysis in both methods showed a significantly lower event-free survival in case of high PWV (p&lt;0,01, respectively). Cox regression analysis revealed PWV for both methods as a predictor of MACE (PWV CMR hazard ratio (HR): 2,6 (confidence interval (CI) 1,3–5,1), PWV AG HR: 3,1 (CI: 1,3–7,1), p&lt;0,005, respectively). Conclusions Our study showed good agreement between the AG and CMR methods for PWV calculation. Both techniques are feasible for MACE prediction in postinfarcted patients. However, different AG and CMR PWV cut-off values were calculated to improve risk stratification. FUNDunding Acknowledgement Type of funding sources: None. Agreement between the two methods Kaplan-Meier event curves for MACE

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Bevezetés: A COPD-s betegek prognózisát rontja a jobbkamra-diszfunkció (JK). Rutinszerűen echokardiográfi át használunk a JK-méret és -funkció megítélésére, ám ennek klinikai értéke COPD-ben nem tisztázott. A szív MR számít referenciamód-szernek, de nincs konszenzus arról, hogy a jobb kamrai volumenhez számítandó-e a trabekulák és a papilláris izmok tér-fogata. Így kutatásunk célja a JK-t jellemző echokardiográfi ás és szív MR-paraméterek közti összefüggések vizsgálata volt COPD-s betegekben. A trabekulák és papilláris izmok beszámításának hatását is tanulmányoztuk a JK-i méret és funkció szív MR-rel mért paramétereire. Betegek és módszerek: 22 fő, GOLD II. és III. stádiumú COPD-s beteget (62±9 év) vizsgáltunk. Echokardiográfi ával határoztuk meg a JK-i végszisztolés (ES) és végdiasztolés (ED) areát és a falvastagságot. A JK-funkciót TAPSE és RVFAC mérésével, valamint a tricuspidalis anuluszon mért szisztolés (S) sebességgel jellemeztük. Szív MR-rel JK-térfogat (MR-tér-fogat), ejekciós frakció (MR-EF) és izomtömeg-index (MR-tömeg-index) meghatározás történt. A manuális kontúrozás során a trabekulák és a papilláris izmok a kamrai volumen részét képezték, majd egy pixelintenzitáson alapuló programmal hozzászámítottuk a kamrai izomtömeghez. Eredmények: A JK-i átmérő és area értékek szignifi kánsan korreláltak az MR-térfogattal, a falvastagság pedig az MR-tömeg-indexszel. Az MR-EF szignifi kánsan korrelált a JK hosszanti átmérőjére normalizált TAPSE és tricuspidalis S-értékekkel, míg az RVFAC-cal nem. A trabekulák és papilláris izmok beszámítása szignifi kánsan csökkentette az MR-térfogatot (ED: -26,5±9,6; ES: -17,3±6,9 ml). Az MR-EF (+3,6±2,6%) és az MR-tömeg-index (ED:+27,8±10,0; ES:+18,1±7,2 g/m 2 ) szignifi kánsan nőtt. Következtetések: Az echokardiográfi a rutinszerűen alkalmazható a JK méretének és funkciójának meghatározására COPD-s betegeknél. A TAPSE és a tricuspidalis S a preferálandó módszerek a JK-funkció megítélésére. A trabekulák és papilláris izmok beszámítása a szív MR-mérések során szignifi kánsan befolyásolja az MR-rel nyert térfogat, tömeg és EF-értékeket.Correlations between echocardiographic and CMR-derived parameters of right ventricular function in COPD Background: In COPD right ventricular (RV) failure is linked to worse outcome. Though echocardiography is the common method for the assessment of RV size and function, its clinical value in COPD is not well defi ned. CMR is the reference technique, but it is not known, if trabeculae and papillary muscles should be included or excluded from the muscles during analysis. Thus we aimed to investigate the correlations between echocardiographic and CMR-derived parameters of the RV size and function in COPD patients. In addition, our aim was to determine the impact of including trabeculae and papillary muscles on RV volumes and function as assessed by CMR. Patients and methods: 22 COPD patients (62±9 years) in stages GOLD II. and III. were involved. RV end-systolic (ES) and end-diastolic (ED) area and RV wall thickness were measured by echocardiograph...