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MONDAY NEWS TIP
Abstract 661
Embargoed for 12 PM CT/1 PM ET, Monday, Nov. 14, 2016
Emmi Helle, M.D., Ph.D., M.Sc. (Economics), Stanford University, Stanford, California, [email protected]
Session Assignment
LI.RFO.39 - Preventive Pediatric Cardiology Issues
(Presentation #: 66 ; Speaking Time: 11/14/2016 12:00:00 PM - 11/14/2016 12:05:00 PM)
Abstract Title
First Trimester Elevated Serum Glucose Values Are Associated With Congenital Heart Disease in the
Offspring
Author Block Emmi Helle, Stanford Univ Sch of Med, Stanford, CA; Preston S Biegley, Geisinger Health System,
Danville, PA; Joshua W Knowles, Stanford Univ Sch of Med, Stanford, CA; Joseph B Leader, Sarah A Pendergrass,
Geisinger Health System, Danville, PA; Gary Reaven, Stanford Univ Sch of Med, Stanford, CA; Marylyn D Ritchie,
Geisinger Health System, Danville, PA; Gary M Shaw, Wei Yang, James R Priest, Stanford Univ Sch of Med,
Stanford, CA
Disclosure Block: E. Helle: None. P.S. Biegley: None. J.W. Knowles: None. J.B. Leader: None. S.A. Pendergrass:
None. G. Reaven: None. M.D. Ritchie: None. G.M. Shaw: None. W. Yang: None. J.R. Priest: None.
Abstract Content
Introduction: Maternal diabetes mellitus (DM) during pregnancy is a well known and prevalent risk factor for
congenital heart disease (CHD) in offspring. In mothers without DM, we recently observed an association between
elevated serum glucose values measured in the second trimester and the risk for CHDs in offspring.
Hypothesis: As cardiac development largely occurs during weeks 4-12 of gestation, we hypothesized that
measurements of glucose metabolism during early pregnancy, i.e., well before the second trimester, would be
associated with risk for CHD.
Methods: We performed a multi-institutional retrospective case-control study from a population-based cohort of
19,107 pregnant women from Stanford Healthcare and Geisinger Health System comparing liveborn infants with
CHD to infants without CHD (Table 1). Multivariable logistic regression analysis was used to investigate the
association between 1) mother’s plasma glucose values from 4 weeks prior to conception to 15 weeks and 2) the
1hour glucose tolerance test value (OGTT) and risk for CHD the offspring. The model was adjusted for known
maternal risk factors for CHD (maternal age, pregestational DM, prepregnancy BMI).
Results: Early pregnancy plasma glucose values were significantly higher in mothers who delivered offspring with
any CHD relative to mothers of infants without CHD (aOR 1.08; 95% CI 1.02-1.13; Table 2). The OGTT did not
reach statistical significance between these groups (aOR 1.69; 95%CI 0.9-2.91).
Conclusions: For the first time we show random first trimester plasma glucose measured during early pregnancy is
associated with risk for CHD in offspring, and furthermore are more strongly correlated with risk than abnormal
OGTT (which is currently used to risk-stratify patients for echocardiographic screening). Though these conclusions
are limited by the sampling bias inherent in retrospective studies, they support prospective investigation of first
trimester glucose metabolites in the risk for CHD.
Abstract 661 cont.
MONDAY NEWS TIP
Abstract M2164
Embargoed for 2 PM CT/3 PM ET, Monday, Nov. 14, 2016
Bryan P. Yan, M.B.B.S., The Chinese University of Hong Kong, Hong Kong, China, (011) 852 2632 3593,
[email protected]
Session Assignment
HT.APS.P197 - Emerging Technologies: Digital health tools
(Presentation #: M2164 ; Speaking Time: 11/14/2016 2:00:00 PM - 11/14/2016 3:15:00 PM)
Abstract Title
Validation of a Novel Contact-free Atrial Fibrillation Screening Method Using an Iphone Camera to Detect
Facial Pulsatile Photoplethysmographic Signals
Author Block Bryan P Yan, Stephen Chan, William H Lai, Brian HW Lau, Eric KM Lam, Angie KW Yip, Nadia
LY Tai, Oscar CM Ng, Hailey LH Chan, The Chinese Univ of Hong Kong, Hong Kong, Hong Kong; Yukkee C Poh,
Ming Zher Poh, Cardiio Inc., Cambridge, MA
Disclosure Block: B.P. Yan: None. S. Chan: None. W.H. Lai: None. B.H. Lau: None. E.K. Lam: None. A.K. Yip:
None. N.L. Tai: None. O.C. Ng: None. H.L. Chan: None. Y.C. Poh: Ownership Interest; Significant; Co-founder of
Cardiio. M. Poh: Ownership Interest; Significant; Co-founder/CEO of Cardiio.
Abstract Content
Introduction: We aimed to evaluate a novel method of atrial fibrillation (AF) screening using an iPhone
camera to detect and analyze photoplethysmographic (PPG) signals from the face without physical contact
by extracting subtle beat-to-beat variations of skin color that reflects the cardiac pulsatile signal similar to
heart rate fluctuations.
Methods and Results: Facial PPG signal was obtained from 85 hospital in-patients (mean 71.6±13.3
years, 67% male) by having the patients face the front camera of an iPhone 6S before a 12-lead ECG was
recorded. Backdrop and background light intensity was standardized during signal acquisition. Three
successive recordings of 20 seconds (total 60 seconds) were acquired per patient and analyzed for heart
rate regularity by Cardiio Rhythm (Cardiio Inc., Cambridge, MA), a smartphone application. Pulse
irregularity in 1 or more of 3 PPG recordings was considered a positive AF screening result. Atrial
fibrillation was present in 25 out of the 85 patients (29.4%) based on the 12-lead ECG. The smartphone
application demonstrated high sensitivity (0.926, 95% confidence interval (CI) 0.766-0.979) and specificity
(0.948%, 95%CI 0.859-0.982) in discriminating an irregular pulse during AF from sinus rhythm compared to
12-lead ECG. The positive and negative likelihood ratios were 17.901 (5.917-54.161) and 0.078 (0.0210.297), respectively. Conclusions: Our results demonstrated that detection of facial PPG signal to
determine pulse irregularity due to AF is feasible. The Cardiio Rhythm smartphone application showed high
sensitivity and specificity with low negative likelihood ratio for AF; and the convenience of a contact-free
approach is suitable for large-scale community AF screening.
MONDAY NEWS TIP
Abstract 711
Embargoed for 3 PM CT/4 PM ET, Monday, Nov. 14, 2016
(Scientific Presentation 3:10 PM CT, Monday, Nov. 14, 2016)
Peter Okin, M.D., Weill Cornell Medicine, New York, New York, (212) 746-4688, [email protected]
Session Assignment
HY.RFO.13 - Hypertension: Clinical II
(Presentation #: 711; Speaking Time: 11/14/2016 3:10:00 PM - 11/14/2016 3:15:00 PM)
Abstract Title
The Relationship of All-Cause Mortality to Average On-Treatment Systolic Blood Pressure is Significantly Related to
Baseline Systolic Blood Pressure: Implications for Interpretation of the SPRINT Study
Author Block Peter M Okin, Weill Cornell Medical Coll, New York, NY; Sverre E Kjeldsen, Univ of Oslo, Oslo, Norway;
Richard B Devereux, Weill Cornell Medical Coll, New York, NY
Disclosure Block: P.M. Okin: None. S.E. Kjeldsen: Honoraria; Modest; Bayer, MSD, Takeda. Consultant/Advisory Board;
Modest; Bayer, Takeda. R.B. Devereux: None.
Abstract Content
Background: The SPRINT study demonstrated that targeting systolic blood pressure (SBP) <120 mm Hg was associated with
lower cardiovascular event and mortality rates. However, in the LIFE study, a lower achieved SBP (<130 mm Hg) was
associated with increased mortality. Mean baseline SBP in SPRINT was 140 and a third of the population had a baseline SBP
≤132, raising the question of whether the lower baseline SBP in SPRINT could in part account for these differences.
Methods: All-cause mortality in relation to tertiles of on-treatment average SBP achieved was examined in patients with
baseline SBP ≤ or > 25th percentile value of 164 mm Hg during 4.8±0.9 years follow-up in 7998 non-diabetic hypertensive
patients with ECG left ventricular hypertrophy randomly assigned to losartan- or atenolol-based treatment. Average ontreatment SBP <142 (lowest tertile) and average SBP 142 to <152 (middle tertile) were compared with average SBP ≥152
(highest tertile and reference group).
Results: In the overall population, there was a highly significant interaction between baseline SBP ≤164 and average ontreatment SBP <142 in Cox analysis (χ2=15.48, p<0.001). Among patients with baseline SBP >164, in multivariate Cox
analyses adjusting for other potential predictors of mortality and a propensity score for having baseline SBP ≤164, compared
with average on-treatment SBP ≥152 an average on-treatment SBP <142 was associated with 32% increased risk of mortality
(HR 1.32, 95% CI 1.01-1.65), whereas average SBP of 142 to <152 was associated with 24% lower mortality risk (HR 0.76,
95% CI 0.59-0.98). In contrast, in parallel Cox analyses among patients with baseline SBP ≤164, both an average on-treatment
SBP <142 (HR 0.60, 95% CI 0.36-0.99) and average SBP of 142 to <152 (HR 0.51, 95% CI 0.30-0.89) were associated with
statistically significant lower risks of mortality compared with average SBP ≥152.
Conclusions: All-cause mortality risk associated with achievement of an average SBP <142 is strongly related to baseline SBP
level in LIFE. These findings suggest that the lower mortality associated with a lower targeted SBP in SPRINT may not be
applicable to patients with considerably higher baseline SBP than SPRINT patients. Further study is necessary to better
understand these findings.
MONDAY NEWS TIP
Abstract 710
Embargoed for 3 PM CT/4 PM ET, Monday, Nov. 14, 2016
Teemu Niiranen, M.D., Ph.D., Framingham Heart Study, Framingham, MA, (617) 314-3060; [email protected].
Session Assignment
HY.RFO.13 - Hypertension: Clinical II
(Presentation #: 710; Speaking Time: 11/14/2016 3:00:00 PM - 11/14/2016 3:05:00 PM)
Abstract Title
Parental Age of Hypertension Onset and Risk of Hypertension in the Offspring: The Framingham Heart Study
Author Block Teemu J. Niiranen, Boston Univ Sch of Med, Framingham, MA; Elizabeth L. McCabe, Boston Univ
Sch of Public Health, Boston, MA; Martin G. Larson, Ramachandran S. Vasan, Boston Univ Sch of Med,
Framingham, MA; Susan Cheng, Brigham and Women's Hosp, Boston, MA
Disclosure Block: T.J. Niiranen: None. E.L. McCabe: None. M.G. Larson: None. R.S. Vasan: None. S. Cheng:
None.
Abstract Content
Introduction: Parental hypertension (HTN) is known to predict HTN in offspring. However, the relative impact of
objectively diagnosed early- vs. late-onset parental HTN on risk of HTN in the community is unknown.
Hypothesis: We hypothesized that parental early- vs. late-onset HTN is associated with a substantially greater risk of
HTN in offspring.
Methods: We analyzed serially collected blood pressure data in the Original cohort (since 1948) and in the Offspring
cohort (since 1971) of Framingham Heart Study participants. We identified 1635 non-hypertensive Offspring (32±9
years, 54% women) with longitudinal blood pressure data available for both parents. We defined HTN onset as blood
pressure ≥140/90 mmHg or taking antihypertensive medication at ≥2 consecutive exams, and early-onset HTN as
onset age <55 years. We analyzed the risk for HTN in Offspring in relation to their parental HTN status: (1) no
parents with HTN (N=107); (2) ≥1 parent with late-onset HTN (N=480); (3) 1 parent with early-onset HTN (N=721);
and, (4) both parents with early-onset HTN (N=327).
Results: Incident HTN was most common in Offspring whose both parents had early-onset HTN (Figure, log-rank
p<0.0001). Incidence rates for HTN per 1000 person-years increased across the 4 groups: 5.9 in group 1, 8.3 in group
2, 11.0 in group 3, and 18.9 in group 4. In a multivariable-adjusted discrete logistic model, Offspring HTN risk
increased from group 1 (referent) to group 2 (hazard ratio [HR] 1.50, 95% confidence interval [CI] 0.85-2.68), and
from group 3 (HR 2.04, 95% CI 1.18-3.54) to group 4 (HR 3.45, 95% CI 1.93-6.14). In 463 Offspring who developed
HTN, a 10-year lower parental age of HTN onset was associated with a 1.28-fold (95% CI 1.02-1.61) greater odds of
early-onset HTN.
Conclusions: Early-onset and not late-onset HTN in parents is a strong risk factor for HTN in offspring. It may be
important to differentiate between early- and late-onset parental HTN when estimating an individual’s HTN risk.
Abstract 710 continued