bluuebunny/crossref_metadata_2025 huggingface dataset:
Oncostatin M is associated with adverse left ventricular remodeling in patients with ST-segment elevation myocardial infarction
Authors: Gusakova A M , Kercheva M A , Ryabova T R , Suslova T E , Ryabov V V
Published: October 2021

Introduction

The development of adverse left ventricular remodeling (LVR) after myocardial infarction (MI) remains a significant problem despite current achievements in invasive and pharmacological treatment. A large number of biomarkers are known that reflect various processes and pathophysiological mechanisms of the pathogenesis of MI and the development of adverse cardiovascular events in the post-infarction period. Oncostatin M (OSM) is a cytokine of the interleukin-6 family that is involved in the pathophysiology of cardiovascular diseases and takes part in processes of inflammation, tissue regeneration, cell development and growth.

Purpose

To assess the dynamics of serum levels of OSM and its association with the development of adverse left ventricular remodeling in the long-term post-infarction period in patients with acute primary myocardial infarction with ST-segment elevation (STEMI).

Methods

Subjects were 21 patients (59.2±8.1 y.o.) with STEMI, who underwent percutaneous coronary intervention during the first 24 h of the onset of MI. The serum level of OSM and echocardiography with 2D speckle tracking imaging were assessed at days 1 and 6 months after STEMI. The criterion of adverse LVR is an increased of end-diastolic (EDV) or/and end-systolic (ESV) volume more than 20% from admission to 6 month period.

Results

A significant increase of the serum levels of OSM during the first 24 hours of MI was detected [46.9 (18.9; 75.7)] pg/ml. A decrease of the OSM levels in 6 months after STEMI was revealed [13.1 (6.9; 19.6)] pg/ml (p<0.0005). Correlation analysis showed strong positive association between the values of OSM with Troponin I (R=0.797 p=0.0001) and Nt-proBNP (R=0,713 p=0.0013). The relationship between OSM and Troponin I persisted in the long-term post-infarction period (R=0.751, p=0.0005). An inverse correlation between the OSM, measured at admission to hospital and the left ventricular ejection fraction at day 7 after MI was found (R=−0.63, p=0.023). Logistic regression analysis showed that the values of OSM at day 1 of the MI were associated with development of adverse LVR in the long term after STEMI. OSM level of more than 18.4 pg/ml at a time of admission was associated with the increased of ESV in 6 months after STEMI by more than 20% (p<0.05).

Conclusions

Our study showed the serum levels of OSM statistically significantly decreased in 6 months after STEMI. The content of OSM was positive associated with Troponin I and Nt-proBNP. Elevated levels of OSM were associated with an increase of ESV in 6 months after STEMI. The serum levels of OSM can be used to predict of adverse remodeling in patients undergoing STEMI.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Science
High levels of lipoprotein(a) are associated with the severity of coronary disease in patients with acute myocardial infarction. Data from the RICO survey
Authors: Farnier M , Chague F , Maza M , Bichat F , Beer J C , Masson D , Cottin Y , Zeller M ,   RICO survey
Published: October 2021

Background

High level of lipoprotein(a), Lp(a), is a well-recognized independent risk factor for atherosclerotic cardiovascular disease (ASCVD) including acute myocardial infarction (MI). However, limited data are available on the relationship between coronary artery disease (CAD) burden and Lp(a) levels in patients with acute MI.

Methods

CAD burden was addressed in 1213 consecutive patients hospitalized for an acute MI in 2019–2020 who underwent coronary angiography from the RICO survey. Patients were compared according to Lp(a) levels (Lp(a) <50 mg/dL (normal), ≥50 mg/dL and ≤100 mg/dL (high) and >100 mg/dL (very high)).

Results

The prevalence of high and very high Lp(a) was elevated (13% and 6%, respectively). Median (IQR) age (normal: 68 (58–79)y; high: 70 (61–80)y; very high: 69 (60–78)y, p=0.502) and rate of diabetes (p=0.448) were similar across the 3 groups. When compared with normal Lp(a), patients with very high Lp(a) had more frequently hypertension, were more often under chronic statin therapy and their corrected LDL-cholesterol was lower. There was a gradual increase in prior ASCVD rates across the 3 Lp(a) groups (p=0.001). When compared with patients with high or normal Lp(a), patients with very high Lp(a) levels had elevated SYNTAX score at coronary angiography, (17 (6–25) vs 12 (6–19) and 10 (5–18), p=0.006, respectively), and had more frequently multivessel disease (74% vs 64% and 56%, p=0.003). By multivariate analysis, very high Lp(a) (OR(95% CI): 1.879 (1.065–3.312)) remained associated with high CAD burden, beyond confounding including age, diabetes and dyslipidemia.

Conclusion

Among real world patients hospitalized for an acute MI, high Lp(a) levels are common (≈20%) and independently associated with a severe CAD burden, beyond traditional risk factors, identifying a subset of patients with features of high ASCVD risk.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): CHU Dijon Bourgogne ARS Bourgogne Franche Comté
The relationship between high-sensitivity troponin taken on admission to critical care, regardless of whether there was a clinical indication for testing, and one year mortality
Authors: Hinton J , Augustine M , Gabara L , Mariathas M , Allan R , Borca F , Nicholas Z , Gillett N , Kwok C S , Cook P , Grocott M P W , Mamas M , Curzen N
Published: October 2021

Introduction

High-sensitivity troponin (hs-cTn) assays now form a key component of the diagnostic pathways for patients presenting to emergency medical services with chest pain. However, hs-cTn concentrations above the manufacturer-provided upper limit of normal (ULN) are now frequently reported in patients presenting with conditions not traditionally associated with type 1 myocardial infarction (T1MI). This is particularly true of severe illness states. We investigated the possible association between hs-cTn and 1 year mortality in critical care patients.

Method

Consecutive patients admitted to two adult critical care units (general critical care unit (GCCU) and neuroscience critical care unit (NCCU)) over a six month period had hs-cTnI assay performed on admission, regardless of whether there was a clinical indication, and the results nested unless a clinical request had been made. Comorbidity data, illness severity and critical care outcome were recorded and have been previously reported. One year mortality data were obtained from NHS Digital.

Results

After excluding patients diagnosed with T1MI by the clinical team, there were 1,033 patients remaining. At one year a total of 253 (24.5%) patients had died. The Kaplan-Meier curves in figure 1 demonstrate a positive association between mortality and increasing hs-cTnI concentrations relative to the ULN. Specifically, using the log-rank test, the mortality at one year was significantly higher (p<0.001) in patients with hs-cTnI concentrations above the ULN. Furthermore, on multivariable Cox regression analysis, the log(10) hs-cTnI concentration was independently associated with the hazard of one year mortality (hazard ratio 1.587 (95% confidence interval 1.358–1.856).

Conclusions

These data suggest that admission hs-cTnI is a biomarker for one year mortality in critical care patients. Further work is now required to assess whether any medical intervention can alter this risk.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Beckman Coulter provided the assays for the tests used in this study. They had no other involvement in the study
Statin induced myalgia on high intensity statin in patients with Acute Coronary Syndrome
Authors: Kumar D , Yasin U , Saghir T , Akbar Sial J , Khatti S , Khan K , Khan N , Naeem Mengal M , Qamar N
Published: October 2021

Background

High intensity statins are recommended in patients with acute coronary syndrome. Statins inhibit atherosclerotic plaque formation in the coronary arteries and reducing the burden of ischemic heart disease, therefore decreasing the morbidity and mortality. Muscle symptoms are most common adverse effect of statins. Hence, the aim of this study is to determine the statin induced myalgia by the statin myalgia clinical score.

Purpose

To monitor the Statin induced myalgia on high intensity statin in patients with Acute Coronary Syndrome

Methods

This was an prospective observational study comprised of 418 patients with acute coronary syndrome who were commenced on high intensity statins (Rosuvastatin 20–40mg & Atorvastatin 40–80). These patients were followed at 4 weeks, 8 weeks and 12 weeks subsequently and the clinical myalgia score (SAMS-CI) was calculated at each visit to determine the statin induced myalgia. SAMS-CI was categorized as unlikely (2–6), possible (7–8) and probable (9–11)

Results

From 418 patients, 327 were males and 91 were females. Mean age was 55.6±11.14. Only 19 (7.63±1.8) patients developed muscle symptoms on high intensity statins (Rosuvastatin 20 mg and Atorvastatin 40 mg) on SAMS-CI Score. 5 patients were unlikely to develop myalgia on SAMS-CI and continued with the same dosage without any new symptoms. 6 patients were possible on SAMS-CI, therefore the dosage of these patients were decreased to moderate intensity statin (Rosuvastatin 10mg, Atorvastatin 20 mg), their symptoms were resolved and continued with the moderate intensity statins. Furthermore, Statin was hold in 8 patients in the probable category for 4 weeks until the resolution of symptoms followed by moderate intensity statins.

Conclusion

Statin induced myalgia is more reported in old aged and female patients. Most of the patients can better tolerate the lower range of high intensity statins with the similar benefits and should be prescribed in every patient

Funding Acknowledgement

Type of funding sources: None.
Temporal trends in adverse ischemic events, bleedings, kidney injury and overall mortality for patients with ST-elevation myocardial infarctions and advanced kidney disease
Authors: Schmucker J , Fach A , Osteresch R , Retzlaff T , Mata Marin L A , Garstka D , Hambrecht R , Wienbergen H ,   Bremen STEMI-registry
Published: October 2021

Background

Although the negative effects of advanced chronic kidney disease (CKD) on the pathogenesis and prognosis of coronary artery disease (CAD) has been shown in prior studies, there is few data on the efficacy and safety of modern interventional therapies and medications in patients with advanced CKD. Aim of the present study was to analyse temporal trends in patients with ST-elevation myocardial infarctions (STEMI) and advanced CKD during the last 15 years.

Methods

All STEMI-Patients admitted to a German heart center between 2006–2019 were analysed. Advanced CKD, estimated with the CKD-EPI-equation, was defined as stage ≥G3b (glomerular filtration rate (GFR) <45 ml/min). Cumulative ischemic events at 1 year were defined as a combination of in-stent-thrombosis, myocardial re-infarction and repeat target-lesion-revascularisation

Results

Of a total of 9605 patients, 1013 (10.6%) showed a moderately or severely (G3b-G5) reduced renal function with a mean baseline Serum creatinine of 2.2±4.2 mg/dl and a GFR of 32.3±10 ml/min/1.73 m2. CKD-Patients were less likely to be treated with a primary percutaneous coronary interention (PCI): 84.1 vs. 94.1% (p<0.01) and showed higher all-cause-mortality (44.4 vs. 3.6%, p<0.01) and bleeding-rates (9.4 vs 3.7%, p<0.01) compared to non-CKD-patients at 1 year, while cumulative ischemic events did not differ (6.5 vs. 5.1%, p=0.12). Over time however, patients with advanced CKD were also more likely to be treated with primary PCI (2006–10: 75.8 to 2015–19: 90.1%, p<0.01), ticagrelor/prasugrel (1.7 to 59.6%, p<0.01) and drug eluting stents (DES: 1.3 to 90.7%, p<0.01). After adjustment for confounders (multivariate analysis of outcomes adjusted for age, gender, diabetes and cardiogenic shock) patients with advanced CKD showed a decline in ischemic events at 1 year, however offset by an increase in bleedings (table). Neither overall mortality nor rates of acute kidney injury changed over time (table), despite an increase in amount of contrast media used (132±62 ml to 152±73 ml, p<0.01). In patients with advanced CKD both ticagrelor/prasugrel (OR 0.48, 95% CI 0.2–0.98) and DES (OR 0.38, 95% CI 0.2–0.8) were associated with a decrease in ischemic-events.

Conclusions

This registry data shows, that during the last 15 years STEMI-patients with advanced CKD were more likely to be treated with primary PCI and are in their majority now treated with ticagrelor, prasugrel and modern DES. These changes in therapeutic strategies probably have contributed to the decline in adverse ischemic events, while overall mortality was not affected.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): State of BremenStiftung Bremer Herzen Multivariate outcome analysis over time
TOTAL risk score for predicting safe very early discharge in patients with ST-elevation myocardial infarction (STEMI)
Authors: Garg A , Rao-Melacini P , Quinn R , Ainsworth C , Belley-Cote E , Cairns J , Cantor W , Dzavik V , Gomez R M , Kedev S , Lavi S , Stankovic G , Jolly S
Published: October 2021

Background/Introduction

Previously validated risk scores for identifying low-risk patients after ST-segment elevation myocardial infarction (STEMI) have led to acceptance of the safety and feasibility of discharge after 48–72 hours of hospitalization, reducing hospital length of stay and costs. With ongoing improvements in outcomes, it may be possible to select patients who are safe to discharge very early (24–48 hours) but this has never been evaluated.

Purpose

We sought to develop and validate a novel risk score for identifying low-risk patients suitable for very early discharge (≤48 hours of hospitalization) post-STEMI.

Methods

We derived a novel risk score using data from patients enrolled in the Trial of Routine Aspiration Thrombectomy with PCI versus PCI alone in Patients with STEMI (TOTAL). The TOTAL database was randomly divided into a derivation cohort with 2/3 of the composite events and non-events and remaining 1/3 as the internal validation cohort. Using the derivation cohort, we identified risk factors for cardiovascular death (CV) or non-fatal cardiac arrest by performing a univariate and multivariable stepwise regression analysis of baseline clinical and angiographic characteristics. Each co-variate was assigned an integer score based on regression coefficients and the novel TOTAL risk score was developed by adding points from each risk factor profile. We externally validated the TOTAL score using data from the Radial versus Femoral Access for Coronary Intervention (RIVAL) trial.

Results

The TOTAL derivation cohort included 6331 participants with 287 events (CV death/cardiac arrest). Twelve independent risk-factors associated with risk of CV death and non-fatal cardiac arrest at 1 year were selected and weighted for the TOTAL risk score (Table 1). In the TOTAL validation cohort (n=3166), patients with a TOTAL score of 0–4 points (n=779 (24.6%)) were categorized as very low risk with only a 0.1% risk of CV death/cardiac arrest observed within 24 hours of hospitalization, and no further events observed between 24 hours and 30 days post-STEMI. In the RIVAL validation dataset (n=1451), patients with a TOTAL score of 0–4 points (n=737 (50.7%)) had a 0.3% risk of CV death/cardiac arrest within 24 hours, with no further events observed between 24 hours and 72 hours of hospitalization.

Conclusion

The TOTAL risk score identified a very low risk subset of patients for whom early discharge, 24–48 hours post-STEMI, is likely safe. These findings have the potential to change practice and support early discharge after STEMI.

Funding Acknowledgement

Type of funding sources: None.
Left ventricular unloading before percutaneous coronary intervention is associated with improved survival in patients with acute myocardial infarction complicated by cardiogenic shock
Authors: Miyashita S , Marbach J , Banlengchit R , Kapur N
Published: October 2021

Background

Left ventricular unloading with Impella before percutaneous coronary intervention (PCI) may improve survival outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). However, the optimal timing to initiate Impella remains controversial.

Purpose

We conducted a systematic review and meta-analysis to compare survival outcomes of patients supported with Impella before PCI (pre-PCI) with those supporte after (post-PCI).

Methods

This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines. Multiple databases were searched through March 2021. All studies evaluating the impact of pre-PCI versus post-PCI Impella placement in patients with AMI-CS were included. A composite primary endpoint included in-hospital, 30-day, and 6-month survival rates.

Results

We identified five observational studies comparing outcomes in 432 patients with AMI-CS, including 173 patients treated with Impella pre-PCI and 259 patients post-PCI. In the pooled analysis, patients in the pre-PCI group had significantly lower in-hospital mortality compared to patients in the post-PCI group (RR 0.62, 95% CI: 0.50–0.76, I2=0%). Reduced mortality rate in the pre-PCI group persisted through 30-days (HR 0.61, 95% CI: 0.47–0.80, I2=0%) and at 6-months (HR 0.67, 95% CI: 0.45–0.99, I2=0%). There was no difference in the risk of adverse events including re-infarction, stroke, major bleeding, acute ischemic limb, access site bleeding, and hemolysis.

Conclusion

In a meta-analysis of studies evaluating mortality among AMI-CS patients treated with primary versus bailout left ventricular support, Impella placement prior to PCI was associated with improved survival.

Funding Acknowledgement

Type of funding sources: None. Forest plot for mortality
Prevalence and prognostic implications of moderate or severe mitral regurgitation in patients with bicuspid aortic valve
Authors: Butcher S C , Prevedello F , Kong W K F , Ng A C T , Poh K K , Shanks M , Popescu B A , Fijalkowski M , Selvanayagam J B , Pinto F , Zamorano J L , Pibarot P , Evangelista A , Bax J J , Delgado V ,   The BAV international registry
Published: October 2021

Background

Significant (≥ moderate) mitral regurgitation (MR) could augment the hemodynamic effects of aortic valvular disease in patients with bicuspid aortic valve (BAV), imposing a greater hemodynamic burden on left ventricle and atrium, possibly culminating in a faster onset of left ventricular (LV) dilation and/or symptoms.

Purpose

To determine the prevalence and prognostic implications of significant MR in patients with BAV.

Methods

In this large, multicenter, international registry, a total of 2,932 patients (48±18 years, 71% male) with BAV were identified. All patients were evaluated for the presence of significant primary or secondary MR by transthoracic echocardiography and were followed-up for the endpoint of all-cause mortality and a combined endpoint of all-cause mortality or aortic valve surgery.

Results

Overall, 147 patients (5.0%) had significant primary (1.5%) or secondary (3.5%) MR. Significant MR was associated with all-cause mortality (HR 2.80, 95% CI 1.91 to 4.11, p<0.001, Figure A) and reduced event-free survival (HR 1.97, 95% CI 1.58 to 2.46, p<0.001) on univariable analysis. However, MR was not associated with all-cause mortality (HR 1.33, 95% CI 0.85 to 2.07, p=0.21, Figure B) or event-free survival (HR 1.10, 95% CI 0.85 to 1.42, p=0.46) after multivariable adjustment. Subgroup analyses demonstrated an independent association between significant MR and all-cause mortality for individuals with significant aortic regurgitation (HR 2.04, 95% CI 1.03 to 4.05, p=0.042), although this association was not observed for subgroups with significant aortic stenosis or without significant aortic valve dysfunction.

Conclusions

Significant MR is uncommon in patients with BAV. Following adjustment for confounding variables, significant MR was not associated with event-free or overall survival.

Funding Acknowledgement

Type of funding sources: None. Survival curves for all-cause mortality
Sex-differences in left ventricular remodeling and mechanics after aortic valve surgery in patients with severe aortic valve disease
Authors: Singh G K , Vollema E M , Prihadi E A , Regeer M V , Ewe S H , Ng A C T , Mertens B J A , De Weger A , Ajmone-Marsan N , Bax J J , Delgado V
Published: October 2021

Background

Sex-differences in left ventricular (LV) remodeling in patients with aortic valve disease have been reported. However, sex-differences in LV remodeling and mechanics in response to aortic valve replacement (AVR) remained largely unexplored.

Purpose

The present study aimed to evaluate the sex-differences during the time course of LV remodeling and LV mechanics (by LV global longitudinal strain (GLS)) after aortic valve replacement.

Methods

Patients with severe aortic valve disease (aortic stenosis (AS) or aortic regurgitation (AR)) undergoing AVR with echocardiographic follow-up at 1,2, and/or 5 years were evaluated. LV mass index, LV ejection fraction, LV GLS and stroke volume (SV) were measured. Linear mixed models analyses were used to assess changes in LV mass index, LVEF, LV GLS and SV between time points. The models were corrected for age, LV end-diastolic diameter at baseline and time between echocardiograms.

Results

A total of 211 patients (61±14 years, 61% male) with severe aortic valve disease (AS 63% or AR 39%) were included. Before AVR, men had larger LV mass index and higher SV compared to women. Both men and women had a preserved LV ejection fraction (54±12 and 56±9, P=0.102, respectively), but moderately impaired LV GLS (14.6±4.1 and 16.1±4.1, P=0.009, respectively). After AVR, both groups showed LV mass regression, improvement in LV ejection fraction and LV GLS. LV mass index and SV remained higher in men. During follow-up women showed significantly better LV GLS compared to men (P=0.030, figure 1).

Conclusion

In men and women with severe aortic valve disease undergoing AVR, the time course of changes in LV mass regression, LV ejection fraction, LV GLS and SV are similar. During follow-up LV mass index remained larger in men and women showed significantly better LV GLS.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The department of Cardiology received unrestricted research grants from Abbott Vascular, Bayer, Bioventrix, Biotronik, Boston Scientific, Edwards Lifesciences, GE Healthcare and Medtronic. Victoria Delgado received speaker fees from Abbott Vascular, Edwards Lifesciences, GE Healthcare, MSD and Medtronic. Nina Ajmone Marsan received speakers fees from Abbott Vascular and GE healthcare. Jeroen J Bax received speaker fees from Abbott Vascular. The remaining authors have nothing to disclose.
Percutaneous edge-to-edge therapy with PASCAL or MitraClip: a multicenter propensity score matched comparison
Authors: Markovic S , Felbel D F , Kessler M K , Schneider L M S , Gercek G M , Rudolph V R , Hausleiter J H , Rotblauer W R
Published: October 2021

Background

The MitraClip is the worldwide established transcatheter edge-to-edge repair system with over 100,000 treated patients. The recently approved PASCAL repair system is well adopted in the field of percutaneous mitral regurgitation (MR) treatment with growing acceptance both in mitral and tricuspid valves. The aim of this retrospective multicenter study was to compare the Edwards' PASCAL System with the Abbott MitraClip System in terms of procedural results and short-term outcome.

Methods

We retrospectively evaluated patient data of three high volume German centers that performed percutaneous edge to edge procedures either with the MitraClip or the PASCAL repair system. Primary endpoint was the amount of MR reduction. Secondary endpoints were residual MR at discharge, technical success, device success and 30-day mortality.

Results

Between 2018 and 2020 a total of 412 procedures were performed in the three centers. 216 cases were performed with the MitraClip compared to 196 procedures done with the PASCAL repair system. Patients were male in 55.6% of the cases (50.5% in the MitraClip cohort compared to 61.2% in the PASCAL cohort, p=0.028), mean Logistic Euro-Score II was 4.42 (3.58 in the MitraClip and 3.23 in the PASCAL cohort, p=0.038) and reduced LVEF beyond 45% was seen in 42.6% of the cases (49.5% in the MitraClip compared to 35.3% in the PASCAL cohort, p=0.004). Severe MR at baseline was seen in 98.5% in the MitraClip cohort compared to 98.6% in the PASCAL cohort, p=0.909). Mean number of implanted devices was 1.41±0.56 in the MitraClip cohort and 1.37±0.55 in the PASCAL cohort (p=0.401). Procedures were successfully conducted with both edge-to-edge systems (device success rate 93.2% in the MitraClip cohort and 94.0% in the PASCAL cohort, p=0.775), leading to comparably good results (final MR ≤2 in 94.4% with the MitraClip compared to 95.9% with the PASCAL system, p=0.448) and very good results (final MR ≤1 in 72.6% in the MitraClip compared to 79.5% in the PASCAL cohort, p=0.102).

After propensity score matching for adjustment of major differences among the two treatment strategies (including age, gender, MR etiology, EROA, Severe MR (III and IV), reduced LVEF and Mitral Valve orifice area) the achieved mean MR reduction remains comparable (2.29±0.82 with the MitraClip compared to 2.46±0.82 with the PASCAL system, p=0.191). In multivariate regression analysis STS Score independently correlates with a very good final result while device choice did not show a significant impact in this cohort.

Conclusion

In this retrospective multicenter study both the MitraClip and PASCAL system performed excellent with comparable procedural success rates. Achieved final average reduction of MR Grade was 2.29±0.82 with the MitraClip and 2.46±0.82 with the PASCAL system.

Funding Acknowledgement

Type of funding sources: None.
Potential candidates for transcatheter tricuspid valve interventions after transcatheter aortic valve implantation: predictors and prognosis
Authors: Tomii D , Okuno T O , Praz F P , Heg D H , Wild M W , Lanz J L , Stortecky S S , Windecker S W , Pilgrim T P
Published: October 2021

Background

The importance of concomitant tricuspid regurgitation (TR) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) remains unclear.

Objectives

To document the prevalence of concomitant TR before and after TAVI, to correlate TR severity after TAVI with clinical outcome, to quantify suitability for transcatheter tricuspid valve interventions (TTVI), and to report clinical outcome in patients eligible for TTVI.

Methods

In a prospective TAVI registry, the severity of TR at baseline and after TAVI was retrospectively evaluated.

Results

Among 2,008 eligible patients, 1,659 patients (82.6%) had ≤mild TR, 242 (12.1%) had moderate TR, 57 (2.8%) had severe TR, and 50 (2.5%) had massive TR. More than half of all patients with ≥moderate TR had an improvement of TR severity after TAVI. In contrast to baseline TR, >moderate TR after TAVI was associated with an increased risk of mortality (HRadjusted 1.89; 95% CI 1.03–3.46, HRadjusted 2.11; 95% CI 1.07–4.16, respectively) compared with ≤mild TR. After TAVI, 30 out of 101 patients with baseline ≥severe TR (29.7%) were deemed suitable candidates for TTVI. They had a 2-fold increased risk of mortality between 30 days and 1 year (HRadjusted: 1.97; 95% CI: 1.17–3.31) and a higher risk of persistent heart failure symptoms (RRadjusted: 2.75; 95% CI: 1.75–4.31).

Conclusions

Severity of TR improved in more than half of all patients after TAVI. More than moderate TR after TAVI was associated with a twofold increased risk of death at one year. Xx% of patients with relevant TR are anatomically suitable for TTVI.

Funding Acknowledgement

Type of funding sources: None. Figure 1
Clinical applicability of echocardiographic strict negative criteria for suspected infective endocarditis
Authors: Marcos Garces V , Gabaldon-Perez A , Merenciano-Gonzalez H , Soler M , Lorenzo-Hernandez M , Nunez-Marin G , Bonanad C , De La Espriella R , Chorro F J , Bodi V , Santas E
Published: October 2021

Introduction

Infective endocarditis (IE) is an uncommon but potentially lethal disease that requires a timely diagnosis. Echocardiography has a pivotal role in EI diagnosis, but this may lead to an overuse of this technology in clinical daily practice, and it is unclear which patients can benefit from a follow-up study if the initial transthoracic echocardiogram (TTE) shows no signs of IE. The strict negative criteria (good ultrasound quality and no high-risk features such as significant valvular regurgitations or stenosis, pericardial effusion or intracardiac devices) have been recently proposed to avoid unnecessary follow-up echocardiograms.

Purpose

The objective of this study is to review the contemporary, real-world use of echocardiography in patients with suspected IE and analyze the potential applicability of the strict negative criteria.

Methods

We retrieved all the echocardiograms that were performed in our center for suspected or confirmed IE between January 2014 and December 2018. We defined different groups according to the strict negative criteria and reviewed the electronic clinical history to check if a definitive diagnosis of IE was established or not.

Results

We included a total of 905 TTEs. 451 (49.8%) of them fulfilled the strict negativity criteria (Group 1). In this group, IE was seldom diagnosed (n=4, 0.9%). In 338 (37.4%) patients no signs of IE were evident but they didn't fulfill the strict negative criteria (Group 2). A follow-up echocardiogram and definitive diagnosis of IE were more frequent (n=48, 14.2% and n=20, 5.9%). Finally, in 116 (12.8%) patients the initial TEE showed typical or suggestive signs of IE, in whom the diagnosis was confirmed in 48 (41.4%). The independent predictors of follow-up echocardiography were the previous history of valvular heart disease (HR 2.38 [1.39–3.89], p=0.001) or cancer (HR 0.47 [0.27–0.84], p=0.01), positive blood cultures for Enterococcus (HR 5.01 [2.34–10.73], p<0.001), methicillin-sensitive Staphylococcus aureus (HR 2.8 [1.27–6.17], p=0.011) or Streptococcus (HR 2.36 [1.12–5], p=0.024), and the presence of typical or suggestive signs of infective endocarditis on initial TTE (HR 13.77 [8.6–22.05], p<0.001). A definitive diagnosis of IE was confirmed in a minority of the study population (n=72, 8%). Only one readmission for underdiagnosis of IE during index hospitalization was noted on Group 2.

Conclusions

In a real-life, observational setting only a minority of patients in whom IE was suspected had a definite diagnosis. An initial TTE for suspected IE fulfilling the strict negative criteria predicts both a low probability of requesting a follow-up study and of a definitive diagnosis of IE. Further research should be performed to rationalize echocardiogram requests for suspected IE.

Funding Acknowledgement

Type of funding sources: None.
Coronary microvascular dysfunction in hypertrophic cardiomyopathy – impact from tissue characteristics to clinical manifestations
Authors: Aguiar Rosa S , Thomas B , Fiarresga A , Papoila A , Alves M , Pereira R , Branco G , Cruz I , Baquero L , Cruz Ferreira R , Mota Carmo M , Rocha Lopes L
Published: October 2021

Background

Coronary microvascular dysfunction (CMD) is an important pathophysiological feature in hypertrophic cardiomyopathy (HCM).

Purpose

This study investigated the role of CMD in tissue characteristics, left ventricular (LV) systolic performance and clinical manifestations in HCM.

Methods

This prospective study enrolled patients with HCM without obstructive epicardial coronary artery disease. Each patient underwent cardiovascular magnetic resonance (CMR) including parametric mapping, perfusion imaging during regadenoson-induced hyperemia, late gadolinium enhancement (LGE) and three-dimensional longitudinal, circumferential and radial strains analysis. Electrocardiogram and 24 hours Holter recording were performed to assess arrhythmias.

Results

75P were enrolled, 47 (63%) males, mean age 54.6 (14.8) years; 51 patients (68%) had non obstructive HCM, mean maximum wall thickness (MWT) was 20.2 (4.6)mm, LV ejection fraction 71.6 (8.3)%, ischemic burden 22.5 (16.9)% of LV.

Greater MWT was associated the severity of ischemia (β-estimate: 1.809, 95% CI: 1.073; 2.545; p<0.001).

Ischemic burden was strongly associated with higher values of native T1 (β-estimate: 9.018, 95% CI: 4.721, 13.315; p<0.001).

An association between ischemia and the extent of LGE was found (β-estimate: 2.02, 95% CI: 0.93, 3.10; p<0.001). Ischemia in ≥21% of LV was associated with LGE >15% (AUC 0.766, sensitivity 0.724, specificity 0.659).

In multivariable analysis, in the overall population, MWT and LGE were independently associated with ischemia, however the evidence of association between ischemia and extent of LGE became weaker (β-estimate: 1.070, 95% CI: −0.106; 2.245; p=0.074).

In subgroup analysis, the association between ischemia and LGE remained significant in individuals with MWT 15–20mm, non-obstructive HCM, female and age <40 years.

The severity of ischemia was not associated with markers of LV systolic function, namely LVEF, longitudinal, radial and circumferential strain

A strong evidence of association was found between ischemia and atrial fibrillation/flutter (AF/AFL) (OR: 1.481, 95% CI: 1.020,2.152; p=0.039), but no association was verified with non-sustained ventricular tachycardia.

Conclusion

In HCM, CMD is related to the severity of LV hypertrophy. Ischemia secondary to CMD promotes fibrosis and is associated with an increase in the odds of AF/ALF.

Funding Acknowledgement

Type of funding sources: None.
Genetic regulation of myocardial fibrosis in hypertrophic cardiomyopathy
Authors: Patel V , Syrris P , Coats C , Lucena J , Lara-Pezzi E , Garcia-Pavia P , Elliott P M
Published: October 2021

Background

Myocardial fibrosis is a common feature of hypertrophic cardiomyopathy (HCM) but its pathophysiology has yet to be elucidated.

Purpose

In this study, we used a multiplex approach to examine the genetic regulation of pathways associated with fibrosis in patients undergoing septal myectomy.

Methods

Myocardial tissue was collected at time of surgical intervention. Control biopsy samples were obtained from the left ventricular free wall from structurally normal hearts during autopsy following non-cardiac related death. Tissue was either snap frozen in liquid nitrogen and subsequently stored at −80 degrees or collected in RNA laterTM and frozen 24 hours later at −80 degrees. Total RNA was extracted from HCM tissue samples using the Qiagen RNeasy fibrous tissues mini kit and from control samples using mirVana isolation kit (Ambion), according to the manufacturer's protocol. Quantitative PCR (qPCR) was performed on the extracted RNA using a RT. Profiler™ Human finrosis PCR Array.

Results

The study cohort comprised 22 HCM samples and 5 controls. The relative regulation of genes involved in myocardial fibrosis in patients with HCM compared to controls is shown in figure 1.

In patients with HCM, there was increased expression of genes involved in collagen synthesis. A significant two-fold upregulation in type III procollagen mRNA was observed relative to controls (p=0.013) with a similar trend identified for type I procollagen (1.5 fold up-regulation, p=0.081). The gene expression of MMP3 (−1.5 fold, p=0.029) and MMP8 (−1.8, p=0.002) which are involved in collaged degradation were downregulated in the HCM group.

The gene expression of pro-fibrotic mediators TGF-β2 (4.8 fold, p=0.008) and CCN2 (2.9 fold, p=0.021) was also significantly elevated. Within the HCM group, there was a correlation between the fold regulation of TGF-β1 (r=0.570, p=0.006; r=0.528, p=0.012), TGF-β2 (r=0.569, p=0.006; r=0.514, p=0.014) and TGF-β3 (r=0.738, p<0.001; r=0.496, p=0.019) to gene regulation of type I and III procollagens respectively.

The expression of BMP-7 which has been shown to reduce myocardial fibrosis by antagonising TGF- β mediated endothelial – mesothelial transformation of fibroblasts was also down-regulated in HCM (−3.8, p=0.015).

Conclusions

Genetic expression of procollagen is significantly upregulated in patients with HCM relative to controls. TGF-β and CCN2 mediated signalling appear to be key mediators in promoting collagen expression.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Heart Hospital Charitable Grant, UK Figure 1. Gene expression in HCM
Cerebrovascular events in takotsubo syndrome: short and long-term outcome. Results from a multicenter-prospective registry
Authors: Leopizzi A , Santoro F , Mallardi A , Vitale E , Iacoviello M , Brunetti N D
Published: October 2021

Background

Several studies have shown that Takotsubo syndrome (TTS) secondary to neurological disorders is associated with higher rate of in-hospital complications. Imaging brain studies found that atrophy or damage of some regions and their altered connectivity with other brain regions are typical features of TTS patients.

Aim of the study

To evaluate rates of in hospital and long-term follow up events in TTS patients with history or acute cerebrovascular events (CVE).

Methods

395 consecutive patients were enrolled in a multicenter prospective registry. History, clinical data, echocardiographic parameters and in-hospital and long-term follow up events of all patients were evaluated.

Results

Prevalence of CVE among TTS patients was 9.4% (N=37). Compared to the control group, these patients were older (80±7 vs 71±12 years, p=0.01) and predominantly men (24% vs 9%, p=0.01). No differences in terms of cardiovascular risk factors and left ventricular ejection fraction at admission and discharge were found between the two groups. The prevalence of physical stressors was higher in the CVE group (67% vs 44% p=0.01).

The incidence of in-hospital adverse events was higher in the CVE group (70% vs 29%), mainly driven by higher rates of cardiogenic shock (19 vs 8%, p=0.01) and in-hospital death (19 vs 4%, p=0.01).

At long-term follow-up, patients in the CVE group had higher mortality rates (38% vs 20%, p=0.01).

Patients presenting with acute CVE, 10 out of 37 patients (27%), when compared with chronic CVE had higher in-hospital mortality rates (40% vs 11%, p=0.01).

Conclusion

TTS patients with history or CVE had higher rates of in-hospital events and death at long-term follow-up. Acute CVEs in the setting of TTS are associated with a worse prognosis.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Ospedali Riuniti di Foggia. Università di Foggia
Anti-interleukin 1 agents for the treatment of recurrent pericarditis
Authors: Imazio M , Andreis A , Piroli F , Lazaros G , Lewinter M , Klein A , Brucato A
Published: October 2021

Background

Corticosteroid-dependent and colchicine-resistant recurrent pericarditis (RP) is a challenging management problem, in which conventional anti-inflammatory therapy (nonsteroidal anti-inflammatory drugs, colchicine, corticosteroids) is unable to control the disease. Recent data suggest a potential role for anti-interleukin-1 (IL-1) agents for this condition.

Purpose

This study was designed to assess the safety and efficacy of anti-IL-1 agents in this setting.

Methods

We performed a systematic review and meta-analysis of randomised controlled trials and observational studies assessing pericarditis recurrences and drug-related adverse events in patients receiving anti-IL-1 drugs for pericarditis.

Results

The meta-analysis assessed 7 studies including 397 pooled patients with RP. The median age was 42 years, 60% were women and the aetiology was idiopathic in 87%. After a median follow-up of 14 months (IQR,12–39), patients receiving anti-IL-1 agents (anakinra or rilonacept) had a significantly reduction in pericarditis recurrences (incidence rate ratio 0.06, 95% CI 0.03 to 0.14, see figure), compared with placebo and/or standard medical therapy. Anti-IL-1 agents were associated with increased risk of adverse events compared with placebo (risk ratio (RR) 5.38, 95% CI 2.08 to 13.92): injection-site reactions occurred in 15/41 (36.6%) vs. none (RR 14.98, 95% CI 2.09 to 107.09), infections occurred in 13/51 (25.5%) vs. 3/41 (7.3%; RR 3.65, 95% CI 1.23 to 10.85). Anti-IL-1 agents were not associated with increased risk of severe adverse events.

Conclusions

In patients with RP, anti-IL-1 agents (anakinra and rilonacept) are efficacious for prevention of recurrences, without severe adverse events.

Funding Acknowledgement

Type of funding sources: None.
Echocardiography-computed tomography fusion imaging: a new approach for congenital heart disease
Authors: Fournier E , Batteux C , Mostefa-Kara M , Cohen S , Van Aerschot I , Meliani A , Guirgis L , Sigal-Cinqualbre A , Provost B , Roussin R , Zoghbi J , Belli E , Hascoet S
Published: October 2021

Introduction

Diagnosis, management and surgical decision making in children and adults with congenital heart disease are based on echocardiography. One of the most recent developments in cardiac imaging is “fusion” of different imaging modalities. Our objective was to evaluate the feasibility of imaging fusion between computed tomography (CT) and 3D trans-thoracic echocardiography (TTE) in children and adults with congenital heart disease.

Methods

Fourteen patients with congenital heart disease who had a CT and a 3D TTE (9.5 years [2.7–15.7], 57% male, BSA 0.9 m2 [0.6–1.7]) were prospectively included for their usual monitoring in our center. Congenital heart disease was classified as simple (n=4, 29%), moderate (n=4, 29%) or complex (n=6, 42%). A full-volume 3D heart acquisition on three cycles was performed using a VividTM E95 GE. Image fusion between CT and TTE was done using General Electrics (GE) Fusion Software. Steps required for images importation, for fusion process (alignment, landmarks, superposition), navigation and analysis were described.

Results

Fusion imaging between 3D TTE and CT was successful for all patients and superposition was good with a median scored at 8.5/10. Median total time required to complete the fusion process was 735 seconds [628–1163], without significant difference according to the degree of complexity of the cardiopathy. Landmarks were significantly placed differently from the reference landmarks in complex congenital heart disease. For complex cardiopathy, navigation into the heart at the same time with multiple modalities demonstrate its interest, for diagnosis or for planning surgery.

Conclusion

We have investigated the feasibility and the accuracy of imaging fusion between 3D TTE and CT in a varied population of patients with congenital heart disease, from children to adult. These advances allow simultaneous visualization of intracardiac structures and may help in understanding the complex anatomy of congenital heart disease, without limitations in terms of age, weight or type of congenital heart disease.

Funding Acknowledgement

Type of funding sources: None. Validation of fusion imagingNavigation in fusion imaging
Left ventricular global longitudinal strain is superior to ejection fraction for prognostication in ebstein anomaly
Authors: Devara J , Iftikhar M , Goda A , Shaik L , Katta R , Egbe A , Connolly H
Published: October 2021

Background

Certain factors such as left ventricular (LV) geometry and loading conditions affect the validity and reliability of LV ejection fraction (LVEF) as a true measure of LV contractility. LV global longitudinal strain (LVGLS) is less sensitive to these factors, and it has superior prognostic performance in patients with acquired heart disease. The purpose of this study was to determine the clinical implications of using LVGLS (instead of LVEF) as the measure of LV systolic function in adults with Ebstein anomaly given the inherent abnormalities of LV geometry and preload in this population.

Methods

Retrospective cohort study of 673 adults with Ebstein anomaly (2003–2018). We hypothesized that LVGLS had a stronger correlation with heart failure indices and transplant-free survival compared to LVEF.

Results

Compared to LVEF, LVGLS had stronger correlations with cardiac index (r=0.46 vs r=0.21, p=0.007), glomerular filtration rate (r=0.57 vs r=0.19, p<0.001), and NT-proBNP (r=−0.64 vs r=−0.41, p=0.01). Of 673 patients, 514 (76%) had normal LV systolic function (LVGLSNormal-LVEFNormal), 87 (13%) had subclinical LV dysfunction (LVGLSLow-LVEFNormal) and 66 (10%) had overt LV dysfunction (LVGLSLow-LVEFLow). Compared to the overt LV dysfunction group, the subclinical LV dysfunction group had similar 10-year transplant-free survival (64% vs 63%, p=0.6), but were less likely to be on heart failure therapy (12% vs 82%, p<0.001). LVGLS (but not LVEF) was the independent predictor of transplant-free survival

Conclusions

LVGLS provided more robust risk stratification and prognostication than LVEF in patients with Ebstein anomaly, and patients with low LVGLS had reduced transplant-free survival regardless of LVEF. The use of LVGLS (rather than LVEF) as the measure of LV systolic function has important clinical implications with regards to initiation of medical and surgical therapies.

Funding Acknowledgement

Type of funding sources: None.
Hematologic abnormalities as a marker of cirrhosis after Fontan completion
Authors: Scandinaro A , Haider M , Saef J , Farwati M , Allende D , Ghobrial J , Zahka K , O'Shea R , Fares M
Published: October 2021

Background

More patients with functioning single ventricle are living into adulthood due to improved survival with the Fontan procedure. Therefore, screening and detection of late-stage complications such as Fontan Associated Liver Disease (FALD) has become increasingly important to improve outcomes. The role of hematologic abnormalities as a marker of cirrhosis in this population is evolving.

Purpose

We aimed to evaluate the value of hematologic parameters in predicting the presence of cirrhosis in the context of FALD.

Methods

This was a retrospective study of patients after Fontan completion who underwent liver biopsy between 2007 and 2019 at our institution. Biopsy slides were evaluated for the presence of cirrhosis by a single pathologist. Laboratory testing was recorded within 12 months of the liver biopsy. Univariable analysis was conducted with an alpha level of 0.05 for hypothesis testing.

Results

A total of 31 Fontan patients with liver biopsies were identified, of whom 7 patients were found to have cirrhosis (Table 1). Compared to patients with no cirrhosis on biopsy, cirrhotic patients tended to have lower hematologic counts including absolute lymphocyte count (0.78 vs 1.02, p=0.019), hemoglobin (12.5 vs 15.1, p=0.018), and platelets (131 vs 194, p=0.025). Notably, the MELD-XI score (Model for End-stage Liver Disease excluding INR) as well as its individual components, creatinine and total bilirubin, were not different between the groups.

Conclusion

Our data suggests that hematologic parameters including absolute lymphocyte count might be of value in predicting cirrhosis on liver biopsy following Fontan completion. Further research to validate these findings in other cohorts is warranted.

Funding Acknowledgement

Type of funding sources: None.