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Objectives: In this study, the authors sought to assess the relationship between AFF and outcomes, the treatment response to sacubitril/valsartan and first-detected AFF in patients with HFpEF enrolled in the PARAGON-HF trial. Background: Atrial fibrillation and flutter (AFF) are common in heart failure with preserved ejection fraction (HFpEF) and increase the risk of adverse outcomes. Methods: A total of 4,776 patients formed 3 groups: those with AFF according to electrocardiography (ECG) at enrollment (n = 1,552; 33%), those with history of AFF but without AFF on ECG at enrollment (n = 1,005; 21%), and those without history of AFF or AFF on ECG at enrollment (n = 2,219, 46%). We assessed outcomes, treatment response to sacubitril/valsartan in each group, and the risk associated with first-detected AFF in patients without any known AFF. The primary outcome was a composite of total heart failure hospitalizations and cardiovascular death. Results: History of AFF and AFF at enrollment were associated with higher risk of the primary outcome (risk ratio [RR]: 1.36 [95% CI: 1.12-1.65] and RR: 1.31 [1.11-1.54], respectively), than no AFF. Neither history of AFF nor AFF at enrollment modified the treatment effect of sacubitril/valsartan. Post randomization AFF occurred in 12% of patients without previous AFF and was associated with 2.8-fold higher risk of the primary outcome, but it was not influenced by sacubitril/valsartan. Conclusions: History of AFF and AFF on ECG at enrollment were associated with a higher risk of the primary outcome. First-detected AFF was not influenced by sacubitril/valsartan, yet it was associated with increased risk of all subsequent outcomes and may represent a potential target for future HFpEF trials. (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711)

ObjectiveThe objective of this study is to determine associations between anthropometry and echocardiographic measures of cardiac structure and function in Hispanic/Latinos.MethodsA total of 1,824 participants from ECHO-SOL were included. We evaluated associations between echocardiographic measures of left ventricular structure and function and anthropometric measures using multivariable-adjusted linear and logistic regression models adjusting for traditional cardiovascular risk factors.ResultsThe mean age was 56±0.17years, 57% were women. The mean body mass index (BMI) was 30±9.4kgm-2, waist circumference (WC) was 100±18cm, and waist-to-hip ratio (WHR) was 0.93±0.15. Adjusted analysis showed that 5-unit increment in BMI and 5-cm increase in WC was associated with 3.4±0.6 and 1.05±0.05gm-2.7 (p&nbsp

BackgroundInformation regarding the prevalence and determinants of cardiac structure and function (systolic and diastolic) among the various Hispanic background groups in the United States is limited.Methods and resultsThe Echocardiographic Study of Latinos (ECHO-SOL) ancillary study recruited 1,824 participants through a stratified-sampling process representative of the population-based Hispanic Communities Health Study - Study of Latinos (HCHS-SOL) across four sites (Bronx, NY; Chicago, Ill; San Diego, Calif; Miami, Fla). The HCHS-SOL baseline cohort did not include an echo exam. ECHO-SOL added the echocardiographic assessment of cardiac structure and function to an array of existing HCHS-SOL baseline clinical, psychosocial, and socioeconomic data and provides sufficient statistical power for comparisons among the Hispanic subgroups. Standard two-dimensional (2D) echocardiography protocol, including M-mode, spectral, color and tissue Doppler study was performed. The main objectives were to: 1) characterize cardiac structure and function and its determinants among Hispanics and Hispanic subgroups; and 2) determine the contributions of specific psychosocial factors (acculturation and familismo) to cardiac structure and function among Hispanics.ConclusionWe describe the design, methods and rationale of currently the largest and most comprehensive study of cardiac structure and function exclusively among US Hispanics. ECHO-SOL aims to enhance our understanding of Hispanic cardiovascular health as well as help untangle the relative importance of Hispanic subgroup heterogeneity and sociocultural factors on cardiac structure and function.

Yellow rust, caused by Puccinia striiformis f.sp. tritici (PST), is an important disease that threatens wheat production in Pakistan. This study was designed to explore the virulence and simple sequence repeat (SSR) diversity of the Pakistani PST population and the ongoing selective pressures of widely grown wheat cultivars. Analyses of 49 isolates sampled from the North-West Frontier Province of Pakistan led to the identification of 12 distinct pathotypes. The virulence frequencies of v2 (virulent against Yr2), v6, v7, v9, vSU and v27 ranged from 63% to 100%. Virulences v3, v4, v17 and vSD were uncommon, whilst v5, v10, v15, v24, v32 and vSp were not detected. The pathotypes thus described were then classified into 27 distinct genotypes. Bayesian structure analysis clustered these genotypes into five groups (in addition to one hybrid isolate) which represent three distinct lineages of the SSR-based phylogenetic tree. Of the studied isolates, 80%, represented by three predominant pathotypes (P1–P3), belonged to the same characteristic Pakistani lineage, whilst the other isolates were close to either a Mediterranean lineage or a Northern European lineage. Genetic recombination was detected within P2 isolates. Resistance genes postulated in 40 Pakistani wheat cultivars indicated the high frequency of Yr2, Yr6, Yr7, Yr9, Yr27 and YrSU. Only 11 cultivars were found to be resistant to P1–P3. Migration and varietal diversity factors might contribute to maintaining the currently high genetic diversity in Pakistani PST, and have serious regional implications for wheat improvement programmes.