bluuebunny/crossref_metadata_2025 huggingface dataset:
Resynchronization of the left atrium may play an important role in cardiac resynchronization therapy
Authors: Hammersboen L E R , Aalen J , Puvrez A , Larsen C K , Remme E W , Donal E , Duchenne J , Voigt J U , Galli E , Khan F H , Sletten O J , Penicka M , Stugaard M , Smiseth O A
Published: October 2022

Introduction

Left atrial (LA) dyssynchrony is a predictor of response to cardiac resynchronization therapy (CRT). It is unknown, however, if LA resynchronization contributes to response to CRT. We hypothesize that there is a relationship between correction of LA dyssynchrony and response to CRT.

Purpose

To investigate the association between LA resynchronization and response to CRT.

Methods

In a prospective study of 171 heart failure patients with LBBB, myocardial strain was measured by speckle-tracking echocardiography, before and 6 months after CRT. As indicated by the white arrows in Figure 1, LA dyssynchrony was measured as the time delay between onset systolic stretch of the interatrial septum and the LA lateral wall. Response to CRT was defined as at least 15% reduction in left ventricular (LV) end systolic volume at 6 months follow up.

Results

119 (70%) patients responded to CRT. The panels in Figure 1 shows LA strain traces in a representative LBBB patient that did respond (upper panels), and a patient that did not respond (lower panels). The white arrows in the left panels indicate that both the responder and the non-responder had marked LA dyssynchrony before CRT (198 and 171 ms, respectively). However, after 6 months with CRT, there was recovery of LA synchrony only in the responder (time delay −40 ms), and still marked LA dyssynchrony of 191 ms in the non-responder (right panels).

Figure 2 confirms similar results for the whole study population: CRT response was associated with marked reduction of LA dyssynchrony (p=0.0001). In the CRT non-responders there was, however, only a modest, non-significant reduction of LA dyssynchrony.

Conclusions

Positive CRT response was associated with resynchronization of the left atrium. These findings suggest LA resynchronization as a potential additional target for CRT.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Institute for Surgical Research, Oslo University HospitalThe Intervention Centre, Oslo University Hospital
Heart rate reserve complements regional wall motion abnormality for predicting outcome in hypertensives during stress echocardiography
Authors: Peteiro Vazquez J C , Ciampi Q , Zagatina A , Cortigiani L , Arbucci R , Saad A K , Celeutkiene J , Citro R , Rodriguez-Zanella H , Gaibazzi N , Djordjevic-Dikic A , Boshchenko A , Wierbowska-Drabik K , Bartolacelli Y , Picano E
Published: October 2022

Background

Stress echocardiography (SE) was recently upgraded to include imaging-independent heart rate reserve (HRR) which assesses cardiac sympathetic balance and is simply based on one-lead electrocardiogram present in the echo monitor. The value of HRR for risk stratification of hypertensive patients remains undetermined.

Aim

To assess the prognostic value of SE with HRR in hypertensive patients in a prospective, large scale, multicenter, international, effectiveness study.

Methods

From July 2016 to December 2020, we enrolled 2747 hypertensives (age 66±10 years, 1599 males, 58.2%; ejection fraction 61±8%) referred from 12 certified laboratories. All patients underwent clinically indicated SE. The employed stress modality was exercise (n=754) or pharmacological stress (n=1993). Exercise modality was either semi-supine bike (n=674) or treadmill (n=80). Pharmacological stress was either vasodilator (n=1695, 1661 with dipyridamole and 34 with adenosine) or dobutamine (n=298). SE response included the evaluation of regional wall motion abnormality (RWMA) and non-imaging HRR (peak/rest heart rate), with stress-specific cutoff values abnormal response <1.80 for exercise or dobutamine, <1.22 for dipyridamole or adenosine. All-cause death was the only end-point.

Results

Rate of abnormal results was 17% for RWMA and 40% for HRR. During a median follow-up of 624 days (interquartile range: 380–1037 days), 60 deaths occurred. Global X2 was 25.0 considering clinical and resting echocardiographic variables, with no change after stress-induced RWMA and a significant increase after HRR (Figure 1). Annual mortality rate was 0.7% person/year for patients (n=1496) with normal HRR and absence of stress-induced RMWA, 0.4% for patients (n=151) with RWMA and normal HRR, up to 2.1% person/year for patients (n=1101) with abnormal HRR with (n=321) or without (n=780) RWMA. At multivariable analysis, only age (HR: 1.070, 95% CI: 1.039–1.101, p<0.001) and abnormal HRR 2.651 (HR: 2.651, 95% CI: 1.550–4.543, p<0.001) showed independent value in predicting survival.

Conclusion

SE with either exercise or pharmacological stress allows an effective prediction of survival in hypertensive patients with chronic coronary syndromes, but only when the conventional criterion of RWMA is complemented with imaging-independent HRR.

Funding Acknowledgement

Type of funding sources: None.
Left atrial volume, function and B-lines at rest and during vasodilator stress echocardiography
Authors: Prota C , Ciampi Q , Cortigiani L , Campagnano E , Wierzbowska-Drabik K , Kasprzak J D , Djordjevic-Dikic A , Merli E , Arbucci R , Gaibazzi N , D'Andrea A , Citro R , Villari B , Picano E
Published: October 2022

Background

Left atrial volume index (LAVi), left atrial reservoir function assessed with global peak amplitude longitudinal strain (PALS), and B-lines at lung ultrasound are supplementary markers of left ventricular filling pressures.

Aim

To assess the relationship between LAVi, PALS and B-lines at rest and peak vasodilator stress.

Methods

A comprehensive dipyridamole stress echo was completed in 266 patients (187 male, 71%, age 65±10 years) with chronic coronary syndromes. LAVi was measured with the biplane disk summation method. PALS was measured from a single vendor with 2-dimensional speckle tracking echocardiography and expressed in % values as the mean of the 12 atrial segments from 4- and 2-chamber values. B-lines were assessed with the simplified 4-site scan in the third intercostal space, with global score from 0 to 40, and considered significant with global score ≥2 units.

Results

During dipyridamole, LAVi decreased (rest= 26±14 ml/m2 vs stress= 24±12 ml/m2, p<0.001), PALS increased (rest= 33±8 vs stress= 38±10%, p<0.001), and B-lines were more frequent (rest= 0.4, median interquartile range 0–30, vs stress= 0.7, median interquartile range 0–30, units, p<0.001). There was a significant, linear, inverse correlation between LAVi and PALS both at rest (r=−0.301, p<0.001) and at peak stress (r=−0.279, p<0.001, see figure). At group analysis, peak B-lines were directly correlated with peak LAVi (r=0.151, p=0.017) and inversely correlated with peak PALS (r=−0.234, p<0.001). At individual patient analysis, 4/93 patients (4.3%) showed stress B-lines (black dots in figure) with normal LAVi (<34 ml/m2) and preserved PALS (>42%).

Conclusion

Vasodilator stress echocardiography with combined assessment of left atrial volume, function and pulmonary congestion is feasible with high success rate in patients with chronic coronary syndromes. Pulmonary congestion is more frequent with dilated left atrium with reduced atrial contractile reserve, but it may occur in a minority of patients with normal LAVi and normal PALS.

Funding Acknowledgement

Type of funding sources: None.
Prognostic power of a new index of right ventricle-pulmonary artery coupling based on right ventricular volumes in patients with secondary tricuspid regurgitation
Authors: Cascella A , Gavazzoni M , Muraru D , Heilbron F , Caravita S , Tomaselli M , Parati G , Badano L P
Published: October 2022

Background

Although echocardiographic surrogates of right ventricular -arterial coupling (RVAC) have been reported to be associated with outcome in patients with moderate or severe secondary tricuspid regurgitation (STR), pulmonary artery systolic pressure (SPAP) is difficult to be estimated using echocardiography in patients with severe STR.

Purpose

Accordingly, we evaluated the predictive power of indexes of RVAC obtained using RV volumes measured using three-dimensional echocardiography (3DE).

Methods

We prospectively enrolled 180 patients with moderate or severe STR and complete two-dimensional, Doppler and 3DE data. The composite endpoint of death for any cause and heart failure hospitalization was used as primary outcome.

Results

After a median follow up of 24 months (IQR: 2–48), 72 patients (40%) reached the primary endpoint. Most of the echocardiographic parameters of RV function were associated with outcomes. Among the different parameters of RVAC, the receiver operating curve (ROC) analysis selected the ratio between (RV stroke volume [SV]-RegVol)/ RV End-systolic volume (ESV) (i.e. the RV forward SV/ESV) as the best predictor of the combined endpoint (AUC 0.80 [IC 95% 0.73–087]), with a threshold value of 0.49.

Event-free survival of patients with RV forward SV/ESV higher and lower 0.49 has been performed (Figure 1).

Multivariable Cox proportional hazards models were constructed (Figure 2). Adding sequentially the 3D-RVEF, TAPSE/SPAP and the forward RV SV/RV ESV on top of a basal model made of TR severity, New York Heart Association (NYHA) functional class and tricuspid anulus plane systolic excursion (TAPSE), the χ2 of the model increased from 40 to 43 (p=0.13) by adding 3D RVEF, from 43 to 46 (p=0.04) by adding TAPSE/SPAP, and from 46 to 51 (p=0.02) by adding RV forward SV/ESV. Severe TR (HR 3.53 [CI 95%: 1.84–6.78], p<0.001) and RV forward SV/ESV <0.49 (HR 2.45 [CI 95% 1.16–5.18], p=0.02) were the only parameters independently associated with outcome.

Conclusions

The RV forward SV/ESV is an index of RVAC obtained by 3DE which is independent from SPAP and it is strongly associated with the occurrence of death or heart failure hospitalization in patients with STR.

Funding Acknowledgement

Type of funding sources: None.
Tricuspid valve geometry alterations in different aetiologies of functional regurgitation: 3D echocardiography study
Authors: Krivickiene A , Verikas D , Kreckauskiene R , Gujyte G , Vaskelyte J J , Ereminiene E
Published: October 2022

Introduction

Evaluation of tricuspid annulus (TA) has many challenges due to its complex three-dimensional shape. The 3D-echocardiography is a gold standard method for accurate assessment of tricuspid valve (TV). Studies investigating TV geometry in different aetiologies of tricuspid regurgitation (TR) are still scarce.

Aim

The aim was to clarify the TV geometry characteristics in different aetiologies of functional TR (FTR).

Methods

Prospective observational cohort study enrolled 107 patients with functional moderate or severe TR and 10 healthy controls. FTR patients were divided into two groups according to the different aetiology of FTR: 1. TR caused by dominant left-sided valvular pathology (LSVP) – 68 patients (pts); 2. TR caused by precapillary pulmonary hypertension (PH) (invasively measured pulmonary capillary wedge pressure <15 mmHg) – 39 pts. Pts with ischemic heart disease (assessed by coronary angiography) were excluded from the analysis. The 3D-transthoracic echocardiography was performed and included the following parameters: the systolic and diastolic 4-chambers (septal–lateral), 2-chambers (anterior–posterior), major axis TA diameters, TA area, perimeter, leaflets tenting height and volume. All parameters have been indexed to body surface area. The 3D TV analysis was made using 4D Auto TVQ quantification software package (GE Healthcare, USA). The statistical analysis was performed using SPSS statistical software.

Results

Study cohort included 66% females; mean age was 65±11 years. TR severity, measured quantitatively, did not differ between FTR groups (ERA – 32±18 in LSVP vs 35±18 mm2 in PH group, p=0.219). The distribution of echocardiography parameters in study groups are shown in Table 1. All the 3D TV parameters were increased in both FTR groups when compared to controls. Precapillary PH was associated with larger leaflets tenting height, volume, and more increased indices of TA systolic and diastolic septal-lateral and major axis diameters. LVSP aetiology was associated with higher TA sphericity index.

Conclusions

Tricuspid valvular geometry differs between different aetiologies of functional TR. The implementation of 3D echocardiography is useful in the determination of TV geometry changes and might provide valuable tools in the evaluation of patients with functional TR.

Funding Acknowledgement

Type of funding sources: None.
Low major bleeding, pump thrombosis and death rates in continuous flow left ventricular assist devices patients with good anticoagulation control
Authors: Janssen E , Van Rein N , Den Exter P L , Palmen M , Beeres S L M A , Jukema J W , Tops L F
Published: October 2022

Background

Continuous-flow left ventricular assist device (CF-LVAD) patients require anticoagulation with vitamin K antagonists (VKAs). Good versus suboptimal anticoagulation control expressed as high versus low time in target range (TTR) of international normalized ratio results in less clinical events in atrial fibrillation patients. However, data in CF-LVAD patients are lacking.

Purpose

To study the association between TTR and clinical events in patients with CF-LVAD as destination therapy.

Methods

Single-centre cohort study in patients receiving CF-LVAD between 2010–2021. Patients were followed from start of VKAs until outcome or end of follow-up. Outcomes were combined major adverse events, thromboembolisms, major bleedings, neurologic events and all-cause mortality. The TTR (low vs. high; <50% vs. >50%) was calculated during the overall study period and over 1-month periods by the Rosendaal-method. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by Cox regression with time-dependent covariables, adjusted for confounding.

Results

74 patients were included; median age 63 years [interquartile range 58–68], 77% males and 60%ischemic heart failure. During 191 years follow-up, 39 combined major adverse events, 14 thromboembolisms, 21 major bleeding, 22 neurologic events and 38 deaths occurred. For 1-month periods, high TTR was associated with less combined major adverse events (HR 0.3 95% CI 0.2–0.7), major bleeding (HR 0.4 95% CI 0.2–1.1), thromboembolism (HR 0.3 95% CI 0.1–1.3) and death (HR 0.2 95% CI 0.1–0.5) (Table 1). Results considering the overall study period were similar.

Conclusion

Good anticoagulation compared with suboptimal control during 1-month and the overall study period in CF-LVAD patients with destination therapy is associated with lower rates of combined major adverse events, major bleedings, pump thrombosis and death.

Funding Acknowledgement

Type of funding sources: None.
4D strain analysis in murine echocardiography facilitates quantification of myocardial infarction
Authors: Schreiber C , Ballmann F S , Mehrkens D , Geissen S
Published: October 2022

Introduction and rationale

Myocardial infarction (MI) can be surgically induced in mice. Accurate measurement of infarction size (IS) is regularly used as an experimental readout. Established methods for IS consist of macroscopic or histological staining of the left ventricle (LV). These methods do not allow for further molecular analysis and do not characterize the functional state of the LV. Echocardiographic analysis of the LV is often performed in MI studies, yet most studies rely on 2D-B-Mode or M-Mode imaging. Here, the extent of the infarction can easily be misjudged. Therefore, we wanted to develop a new strategy to reliably estimate IS in echocardiography.

Methods and results

Echocardiography was performed at baseline conditions and 7 days after MI induction using a Vevo 3100 sonography device with a MX550S transducer (slice thickness for 4D datasets: 150μm). For 4D strain analysis, a custom-made software tool was used to trace the endocardial surface of the LV. The method was checked for inter-observer reliability which was excellent for volumetry and estimation of systolic function (correlation of ejection fraction between observers: r=0.9414, p<0.0001). Surface area strain was computed and the area that displayed a surface area strain >−10% was considered infarcted. IS measured by 4D surface area strain was correlated with ejection fraction (r=−0.510, p=0.002) and IS estimated by triphenyl tetrazolium chloride staining (r=0.582, p=0.005).

Conclusion

4D strain analysis based estimation of IS is a reliable method for functional and morphological characterization of infarcted hearts. Other than established IS measurements, it allows for additional molecular analyses within the same individuum and can be used to monitor growth or reduction of the akinetic area over time. It therefore emerges as a powerful tool for murine MI studies.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): DFG - GRK 2407 (360043781)
Outcomes of patients after repeat heart transplantation – insights from the UNOS database
Authors: Kampaktsis P , Doulamis I , Tzani A , Ruck J , Zhou A , Shah M , Kilic A , Kourek C , Briasoulis A
Published: October 2022

Background

Cardiac graft failure may require repeat heart transplantation (HTx). Outcomes of patients that undergo repeat HTx have not been well described.

Methods

We compared patients that received repeat HTx with patients that received initial HTx by inquiring the United Network for Organ Sharing database between 2015–2021. The primary endpoint was all-cause mortality.

Results

A total of 19,805 HTx patients were included in the study. Patients that underwent repeat HTx (n=578, 3%) were younger (43.8±15.3 vs. 53.7±12.7 years, p<0.001) with lower body mass index (26.8±5.3 vs. 27.6±4.9 kg/m2, p<0.001) and worse renal function (Cr 1.8±1.4 vs. 1.4±0.9 mg/dl). Patients with repeat HTx had increased risk for 1-year mortality (hazard ratio 1.49 [1.16–1.90], p=0.002) compared to patients with initial HTx after adjusting for age, ethnicity, use of left ventricular assist device, UNOS recipient status, diabetes, ischemic time, donor age and predicted heart mass mismatch (Figure 1). Results did not change with the new allocation system (10/2018).

Conclusion

Repeat HTx occurred in 3% of a contemporary UNOS cohort and carried an increased and independent risk for mortality.

Funding Acknowledgement

Type of funding sources: None.
ADONHERS (Aged DONor HEart Rescue by Stress echo) protocol for heart donation from marginal donor hearts: monocentric retrospective study on recipients survival after 10-year follow-up
Authors: Mandoli G E , Barilli M , Soviero D , Ghionzoli N , Maccherini M , Bernazzali S , Natali B , Cavigli L , D'Ascenzi F , Focardi M , Pastore M C , Valente S , Cameli M
Published: October 2022

Purpose

Amelioration of therapies and increased survival in heart failure (HF) is leading to a growing number of patients affected by advanced HF, with an overall 1-year prognosis ranging from 25 to 75%. The gold standard treatment for end stage HF is heart transplantation (Htx), but lack of organs donors remains an important limitation. Marginal hearts can potentially improve and be utilized after a re-evaluation by “aggressive” assessment of donor left ventricular dysfunction, with an important increase of utilization rates (from 38–59%) in the latest years. In our study we analysed if recipients of marginal donor hearts, selected by dipyridamole stress echocardiography, had different outcome compared to recipients with acceptable donor hearts.

Methods

Data collected from 2006 and 2014 of patients who received orthotopic Htx were retrospectively analysed. Clinical, laboratory and instrumental features were evaluated and patients with homogenous baseline characteristics were selected to reduce biases among the two groups. Dipyridamole stress echo was performed on donors >55 years old or <55 with comorbidities/mildly dysfunctional left ventricle.

Results

Twenty-two recipients were included (eleven patients with a marginal donor heart, group 1, and eleven with acceptable donor heart, group 2). Mean donors age was 41±23, 45±29 years for group 1 vs 36±12 for group 2. The average follow-up was 113 months. Age, cardiovascular risk and morpho-functional characteristics of the left ventricle were comparable between the two population (P>0.05) (see Table 1). Left atrial size was significantly higher in marginal hearts (Optimal: p=0.007; Marginal: p=0.003). Optimal donors showed a higher impact of CAV (p=0.019) together with more elevated values of cholesterol and triglycerides (p=0.048 and p=0.012 respectively). No rejection differences were found between the two groups. Four patients deceased, 3 had received a standard donor heart and 1 was from the marginal donor group, with and overall median time to death of 124 months.

Conclusions

No mortality difference was detected among the two heart donor groups with a lower incidence of CAD in the marginal heart donor population. Our study shows how Htx from selected marginal donor heart can implement shortage of organs without difference in survival with acceptable donor hearts.

Funding Acknowledgement

Type of funding sources: None.
Monitoring of the lung fluid status in hospitalized COVID-19 patients for predicts outcome. Results of the IMPEDANCE-Corona Trial
Authors: Kleiner Shochat M , Mohsen J , Abu Rumi M , Hellou E , Abolil M , Singer C , Kazatsker M , Kobo O , Roguin A , Meisel S
Published: October 2022

Introduction

Prediction of the clinical deterioration in hospitalized COVOD-19 patients is an unmet goal.

Aim

To assess monitoring of lung fluid status of hospitalized COVID-19 patients as a tool to predict clinical respiratory deterioration and prognosis.

Methods

The present study population comprised 51 patients hospitalized in our medical center with COVID-19 infection. The lung fluid status of patients was monitored by repeat measurements the lung impedance (LI). The LI technique was found to be a very effective tool for monitoring and guiding the treatment of a heart failure patients. Decreasing LI reflects lung fluid accumulation. Clinical and laboratory parameters, chest X-ray (CXR) and LI level were recorded during hospitalization.

Results

Of the 51 patients hospitalized for COVID-19 infection (37 men and 14 women, 55.7±12.6 years old), 46 were discharged after successful treatment (Group 1) and 5 (9.8%) died during hospitalization (Group 2). The LI kinetics during hospitalization demonstrated a different pattern between groups (Figure 1, p<0.01). In group 1 patients, a small LI decrease (−3.5±4.3%, p=0.7) during the first 4 days (median = 2.2 days, [Q1–3: 1–3.7 days]) of hospitalization was noted. Following this, LI increased progressively until discharge (+20.3±12.3%, p<0.01). Among group 2 patients, LI decreased progressively during hospitalization. Mechanical ventilation was initiated at the eighth day [median = 8, Q1–3: 4–12 days] when LI decreased by 18.2±3.8% in comparison with the admission level (p<0.01). Deaths occurred at 12.4±2.7 days (median = 12 days) after admission. Multivariate Cox regression analysis of clinical, laboratory and CXR variance has shown that the degree of LI decrease during hospitalization is the most reliable predictor of death (hazard ratio: 1.36 [1.04–1.79], p<0.04).

Conclusions

The combination of progressively decreasing LI after 4 days of hospitalization for COVID-19 infection and an LI decrease >15% is the most reliable predictor of death.

Funding Acknowledgement

Type of funding sources: None.
COVID-19 pandemic impact on heart failure epidemiology and outcomes in Poland. National database study
Authors: Zaleska-Kociecka M , Celinska-Spodar M , Podwojcic K , Maluchnik M , Walkiewicz D , Hryniewiecki T , Leszek P
Published: October 2022

Background

COVID-19 pandemic negatively affected patients' will to seek urgent medical treatment as well as and health service performance.

Purpose

The aim was to evaluate the impact of COVID-19 pandemic outbreak at the beginning of 2020 on heart failure epidemiology and outcomes in Poland.

Methods

The study is based on the Nationwide Polish Ministry of Health Registry, an administrative nation-wide database covering all heart failure patients in Poland who were beneficiaries of the public health sector between 2013 and 2021.

Results

After COVID-19 outbreak in 2020, significantly fewer patients presented to health service due to HF than in previous years (Fig. 1). Compared to 2019, the number of HF hospitalisations declined by 21% and outpatient visits by 10% in 2020.

Simultaneously, for the first time in the last decade, the trend in heart failure prevalence went down dropping by 3.7% (Fig. 1). The trend was driven by the greater reduction in ischaemic vs non-ischaemic HF prevalence (4.7% vs 1.3%)

The longstanding downtrend in heart failure incidence accelerated markedly in 2020, decreasing by 20% between 2019 and 2020, compared to average fall of 8% in the previous decade (ranging between 4.1–12.9%). Likely, the drop was mainly attributable to the decline in the ischaemic HF incidence (23% vs 15.3% drop in nonischemic HF).

The average in-hospital mortality due to HF in 2020 was higher compared to 2019 (12.9% vs 11.02%). As many as 1.18% of patients died on the day of admission in 2020, contrary to 0.94% in 2019 which accounts to 25% increase. Monthly distribution of in-hospital mortality aligned with peaks of COVID-19 waves (Fig. 2).

Conclusion

The study shows unfavorable changes in HF epidemiology and outcomes due to the pandemic. The drop in prevalence and incidence seems to be associated with lower patient influx to the health service. It is unknown whether patient non-occurrence resulted from patients' actions or preoccupation of the health service with the pandemic. At the same time, a marked rise in in-hospital mortality was noted, with an over 25% increase in the number of deaths on the day of admission that could potentially reflect a more advanced disease state.

Funding Acknowledgement

Type of funding sources: None.
Effectiveness of a disease management program in heart failure is influenced by patient's prior hospitalisation
Authors: Huynh Q , Marwick T H
Published: October 2022

Background

Hospitalization due to heart failure (HF) is a strong predictor of adverse outcomes. This study sought to what extent previous HF admissions may affect the success of a disease management program (DMP).

Methods

We prospectively enrolled 1363 consecutive HF patients, who were followed for 3 months post-discharge. Of these, 431 (31%) received a DMP (1-month duration, including post-discharge home visits, medication reconciliation, exercise guidance and early clinical review). Study outcomes were all-cause readmission or death at 30- and 90-day post-discharge. Previous HF admissions were collected from medical records.

Results

Of 1363 HF patients, death or readmission occurred in 386 (28%) at 30-day and 556 (41%) at 90-day post-discharge. Compared to 765 patients without any previous admission, the 143 patients with a previous HF admission in >12 months had similar risks of readmission or death at 30-day and 23% higher risks at 90-day. The 420 patients who had a previous HF admission in ≤12 months had higher risks of the composite outcome both at 30-day (RR=1.47 [1.23–1.76]) and 90-day (RR=1.49 [1.30–1.69]). DMP was not associated with any reductions in adverse outcomes at 30-day and 90-day among patients with a previous HF admission in ≤12 months, but was significantly associated with up to a 75% reduction in risks at 30-day and a 50% reduction in risks at 90-day among those without an admission in ≤12 months. These findings were independent of all other factors.

Conclusion

Higher levels of attention should be focused on HF patients with a recent prior HF admission who have higher risks of post-discharge adverse outcomes and appear to be non-responsive to a DMP to reduce readmission.

Funding Acknowledgement

Type of funding sources: None.
Influence of the SGLT2 inhibitor empagliflozin on post myocardial infarction rat hearts
Authors: Damatto F C , Paschoareli G L , Rosa C M , Gomes M J , Pagan L U , Damatto R L , Rodrigues E A , Pontes T H , Reyes D R A , Cezar M D M , Oliveira L R S , Zornoff L A M , Rego A B G C , Okoshi M P , Okoshi K
Published: October 2022

Studies have shown that inhibition of the sodium glucose transporter protein 2 (SGLT2) reduces cardiovascular death in patients with heart failure and reduced ejection fraction. However, the mechanisms involved in the benefits of SGLT2 inhibitors are poorly understood.

Objective

To evaluate the effects of empagliflozin (EMP) on normal and post-myocardial infarction (MI) rat hearts.

Methods

Male Wistar rats (n=80) were assigned into four groups: Sham; Sham treated with EMP (Sham-EMP); myocardial infarction (MI); and MI treated with EMP (MI-EMP). EMP added to rat chow (5 mg/kg/day) was initiated 10 days after MI induction and maintained for 12 weeks. Echocardiogram was performed at the end of the experimental period. Markers of oxidative stress, energy metabolism, and respiratory complex activity were analyzed in left ventricular myocardium. Statistical analysis: ANOVA.

Results

Histological evaluation showed that EMP did not change infarct size. Cardiac structural and functional parameters did not differ between MI-EMP and MI groups. Myocardial oxidative stress, evaluated by lipid hydroperoxide concentration, was lower in MI-EMP than MI group (Sham 143±26; Sham-EMP 123±20; MI 183±29; MI-EMP 137±11 nmol/g tissue). Glutathione peroxidase was lower in the infarcted groups and did not differ between MI-EMP and MI (Sham 37.6±6.14; Sham-EMP 40.8±10.1; MI 27.7±6.61; MI-EMP 26.5±6.80 μmol/g tissue). Activity of the energy metabolism enzymes lactate dehydrogenase (Sham 45.2±6.65; Sham-EMP 41.1±9.33; MI 58.4±14.4; MI-EMP 55.7±10.1 nmol/mg protein) and citrate synthase (Sham 30.4±4.25; Sham-EMP 37.2±4.85; MI 45.8±8.47; MI-EMP 46.5±9.95 nmol/mg protein) was higher, and β-hydroxyacyl-CoA dehydrogenase (Sham 24.0±3.12; Sham-EMP 20.4±4.84; MI 16.9±4.81; MI-EMP 14.4±4.58 nmol/mg protein) lower in the infarcted groups with no differences between MI-EMP and MI. Respiratory complexes I and II, and ATP synthase did not differ between the infarcted groups.

Conclusion

Empagliflozin reduces myocardial oxidative stress independent of changes in antioxidant enzymes activity, energy metabolism, and respiratory complex activity in the myocardium of infarcted rats.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Fapesp, CNPq
A segment-to-segment agreement between findings of Cardiac Computed Tomography Angiography and invasive coronary artery angiography
Authors: Ziubryte G , Ivanova O I , Jarusevicius G J
Published: October 2022

Introduction

Increasing prevalence of ischaemic heart disease (IHD) requires reliable, convenient, and non-invasive screening methods for detection of IHD in early phases. Currently cardiac computed tomography angiography (CCTA) for evaluation for anatomy and in some cases, physiology using non-invasive methods are the method of choice low to moderate IHD patients. Unfortunately, sometimes it seems, that results of CCTA disagree with invasive coronary artery angiography (ICA) results. There was no systemic analysis of segment-to-segment stenosis significance comparison between these two methods (CCTA vs ICA). Therefore, this study aimed to investigate segment-to-segment coronary artery stenosis significance agreement between CCTA, and ICA was performed.

Methods

In total, 100 patients who underwent CCTA and a diagnostic ICA between June 2021 and December 2021 were prospectively included into this single centre study. For all patients CCTA were performed and for who's with indication for treatment by CCTA, ICA was performed. For all included patients both CCTA and ICA were performed. For coronary artery evaluation 15-segment scheme were chosen in both CCTA and ICA. Coronary arteries were evaluated as follows: right coronary artery (RCA) was divided into 4 segments (S1-S4), left main (S5), left anterior descending (LAD) (S6, S7, S8), first and second diagonals (S9 and S10) and left circumflex (LCx) (S11, S13) and its marginal branches (S12, S14, S15). Segment-to-segment evaluation was performed. The statistical analysis was performed using SPSS 28.0.1.0 statistical analyses package. The chosen level of significance was p<0.05.

Results

RCA showed following results: S1 (r=−0.02, p=0.87), S2 (r=0.38, p<0.001), S3 (r=0.09, p=0.38) S4 (r=0.30, p=0.002). In LM weak positive correlation was found S5 (r=0.21, p=0.04). In LAD and its diagonal branches following results were found: S6 (r=0.30, p=0.002), S7 (r=0,15, p=0.14), S8 (r=0.28, p=0.004), S9 (r=−0.05, p=0.66), S10 (r=−0.04, p=0.64). Analysis of LCx and its marginal branches revealed S11 (r=0.23, p=0.02), S12 (r=0.22, p=0.03), S13 (r=0.19, p=0.06), S14 (r=0.06, p=0.57), and S15 (r=0.27, p=0.008). Negative non-significant correlations were found in proximal RCA and diagonal branches. That means that in those segments CCTA found more significant lesions, than it was found during ICA. Other segments showed weak positive correlations. The greatest correlations were found in very proximal parts of LAD and LCx.

Conclusions

The greatest correlations were found in very proximal parts of LAD and LCx in addition to middle RCA segment. Nevertheless, all these correlations were weak. This study failed to show relaible agreement between CCTA and ICA.

Funding Acknowledgement

Type of funding sources: None.
Diagnostic accuracy of angiography-based vessel fractional flow reserve after chronic coronary total occlusion recanalization
Authors: Scoccia A , Scarparo P , Neleman T , Wilschut J , Den Dekker W , Zijlstra F , Van Mieghem N , Daemen J , Diletti R
Published: October 2022

Background

Angiography-Based Vessel FFR (vFFR) demonstrated a strong correlation with invasive fractional flow reserve (FFR) in both a pre- and post-percutaneous coronary intervention (PCI) setting. However, the role of vFFR and its correlation with post-PCI FFR in chronic coronary occlusion (CTO) has not been evaluated yet. We sought to investigate the diagnostic performance of post-PCI vFFR with post-PCI FFR as a reference in patients undergoing successful CTO PCI.

Methods

Between March 2016 and September 2019, a total of 80 patients from the FFR-SEARCH and FFR REACT studies underwent successful CTO recanalization [1,2]). A total of 50 patients (median age 66 (IQR: 56–74) years, 76% were male) were eligible for the analysis. Median FFR was 0.89 (IQR: 0.84–0.94) while median vFFR was 0.91 (IQR: 0.85–0.94). Suboptimal physiological results, defined as FFR and vFFR <0.90, were identified in 26 (52%) and in 21 (42%) patients, respectively. A strong correlation (r=0.79) was found between vFFR and FFR with a mean bias of 0.013±0.051. Receiver-operating characteristics curve analysis revealed an excellent accuracy of vFFR in predicting FFR <0.90 (AUC: 0.97; 95% CI: 0.93–1.00).

Conclusion

vFFR shows a good agreement with FFR and a high diagnostic accuracy for FFR ≤0.90 in patients undergoing successful PCI of a CTO lesion.

Funding Acknowledgement

Type of funding sources: None.
Influence of sex on results and consequences of coronary fractional flow reserve in clinical practice: results of a prospective large-scale multicenter registry
Authors: Troebs M , Marwan M , Gaede L , Moellmann H , Giesler T , Rittger H , Rudolph T , Pauschinger M , Moshage W , Brueck M , Achenbach S
Published: October 2022

Background

Measurement of fractional flow reserve (FFR) is clinically indicated in order to assess the hemodynamic relevance of coronary artery lesions and determine the need for revascularization. Preliminary data sugest that there may be significant differences regarding use and outcome of FFR measurements in men versus women.

Purpose

We therefore analyzed the influence of sex on FFR values and treatment consequences in a large-scale, prospective multicenter registry of consecutive patients undergoing clinically indicated FFR measurements in the setting of chronic or acute coronary syndromes.

Methods

In a large, multicenter prospective registry of patients undergoing FFR, the relationship of stenosis degree to FFR, the influence of FFR on revascularization decisions were compared between male and female patients. (clinicaltrials.gov NCT03055910)

Results

A cohort of 2000 patients from 8 centers was evaluated (73% male, 27% female, median age 69±10 years, 15% acute coronary syndromes). The median number of interrogated lesions was 2 in male and 2 in female patients. A total of 2958 lesions were interrogated by FFR (2156 male, 802 female; 67 LM, 1722 LAD, 646 LCX, 523 RCA). Median stenosis degree was 60% (IQR 50%-70%) in male and, identically, 60% (IQR 50%-70%) in female patients. All the same, median measured FFR values were 0.86 (IQR 0.81–0.92) in male and 0.89 (IQR 0.84–0.93) in female patients (p<0.001). Of all lesions interrrogated, 488/2156 (23%) in men and only 100/802 (12%) in women displayed an FFR value ≤0.80 (p<0.001). The median stenosis degree of lesions with an FFR value ≤0.80 was 70% (IQR 60–80%) in men and 70% (IQR 65–84%) in women (n.s.). In multivariable analysis, stenosis degree, lesion location in LAD, ACS culprit lesion, and male sex were independent predictors of an FFR value ≤0.80. The overall rate of revascularization was 24% in men and 14% in women (p<0.001), driven by lower FFR values in men. In lesions with FFR values ≤0.80, revascularization rate was 94% both in men and in women (n.s.).

Conclusion

Female sex is independently associated with higher FFR values when used to determine the hemodynamic relevance of coronary lesions in the setting of chronic or acute coronary syndromes. Independent of stenosis degree, FFR measurements are significantly less frequently followed by revascularization in women.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): St. Jude Medical
Evaluating systemic immune-inflammation index for in-hospital and long-term mortality in elderly non-ST elevation myocardial infarction patients
Authors: Orhan A L , Saylik F , Cicek V , Akbulut T , Selcuk M , Cinar T
Published: October 2022

Introduction

This investigation aimed to evaluate the predictive value of systemic immune-inflammation index (SII) for in-hospital and long-term mortality in elderly patients with non-ST elevation myocardial infarction (NSTEMI).

Methods

In this retrospective investigation, 314 consecutive elderly patients who were diagnosed with NSTEMI in a tertiary center were included. The SII was computed as neutrophils x platelets/lymphocytes. Based on the increased SII values, we classified the research sample into three tertile groups as T1, T2, and T3. The in-hospital and long-term mortality were defined as the primary outcomes.

Results

Patients in the T3 group had lower chances to survive both in the in-hospital and long-term periods as compared to those in the T2 and T1 groups. The SII was independently related with in-hospital (HR: 1.001, 95% CI: 1.000–1.1003, p=0.038) and long-term mortality (HR: 1.004, 95% CI: 1.002–1.006, p<0.001) according to the multivariable Cox regression models. To predict long-term mortality, the optimal value of the SII was >2174 with 80% sensitivity and 85.4% specificity. When the AUC values of the SII, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) were assessed to predict long-term mortality, the SII had the greatest value (AUC: 0.862), followed by the NLR (AUC: 0.731) and the PLR (AUC: 0.698). Additionally, combining SII with the traditional risk factors and the Charlson Comorbidity Index revealed a significant improvement in C-statistics.

Conclusion

This might be the first investigation to demonstrate that the SII was independently linked with in-hospital and long-term mortality in elderly NSTEMI patients.

Funding Acknowledgement

Type of funding sources: None.
Decreased peroxisome proliferator-activated receptor gamma expression levels in pericoronary adipose tissue adjacent to atherosclerotic plaque compared to lesion-free coronary arteries
Authors: Marketou M , Kontaraki J , Kalogerakos P , Plevritaki A , Fragkiadakis K , Maragkoudakis S , Zervakis S , Kampanieris E , Savva E , Tsiavos A , Lazopoulos G , Kochiadakis G
Published: October 2022

Background

Pericoronary adipose tissue (PCAT) regulates arterial homeostasis, is considered to act in paracrine manner, and plays a role in the pathogenesis of atherosclerosis. The nuclear receptor Peroxisome Proliferator-Activated receptor gamma (PPARγ) is a key regulator of adipogenesis, and alterations of its function are associated with different pathological processes related to metabolic syndrome and inflammatory response.

Purpose

To investigate whether the PCAT surrounding coronary occlusive atherosclerotic lesions shows specific PPARγ expression pattern compared to PCAT surrounding plaque-free segments

Methods

We enrolled 47 patients (32 men, aged 68±12 years old) with 3-vessel coronary artery disease (CAD) who underwent elective coronary bypass surgery. A control group of 10 age- and sex-matched patients with severe valvular disease who underwent aortic or mitral valve replacement was also included (8 men, aged 67±15 years old). PCAT samples were received from all participants. In patients with CAD, the PCAT was harvested from two sites: adjacent to an occlusive atherosclerotic coronary lesion, and a plaque-free segment. PPARγ expression levels in PCAT cells were quantified by real-time reverse transcription polymerase chain reaction.

Results

PCAT analysis showed a significant downregulation of PPARγ expression levels in CAD compared to non-CAD patients (45±19 versus 93±15, p=0.01). In addition, PPARγ levels showed significantly lower expression in PCAT from around atherosclerotic plaque compared to lesion-free sites (31±12 versus 45±19, p=0.04). Notably, the expression of PPARγ from atherosclerotic plaque showed robust negative correlations with BMI (r=−0.47, p=0.001).

Conclusions

PPARγ in PCAT surrounding coronary occlusive atherosclerotic lesions are significantly downregulated and their levels are associated with patients' BMI. Our study opens new perspectives in the pathophysiologic role of PCAT in atherosclerotic complications of diabetes and should be further investigated.

Funding Acknowledgement

Type of funding sources: None.
Heterogeneous carotid plaque is associated with cardiovascular events after percutaneous coronary intervention
Authors: Tobe A , Tanaka A , Furusawa K , Shirai Y , Funakubo H , Otsuka S , Kubota Y , Kunieda T , Yoshioka N , Sato S , Kudo N , Ishii H , Murohara T
Published: October 2022

Background

The relationship between carotid artery ultrasound findings and clinical outcomes in percutaneous coronary intervention (PCI) patients has not been fully elucidated.

Purpose

To investigate the relationship between carotid artery ultrasound findings and cardiovascular risks in PCI patients.

Methods

This was a single-center retrospective study investigating 691 patients who underwent PCI and carotid ultrasound testing. Maximum carotid intima-media thickness (CIMT) was defined as the greatest CIMT at the maximally thick point among the common carotid artery, carotid bulb, and internal carotid artery. A carotid plaque was defined as vessel wall thickening with a CIMT ≥1.5 mm. The characteristics of carotid plaque (heterogeneity, calcification, or irregular/ulcerated surface) were evaluated visually. Patients were divided into those with and without heterogeneous carotid plaque (maximum CIMT ≥1.5 mm and heterogeneous texture). The endpoint was the incidence of a major adverse cardiovascular event (MACE) defined as a composite of cardiovascular death, myocardial infarction, and ischemic stroke.

Results

Among 691 patients, 312 were categorized as having a heterogeneous plaque. Patients with heterogeneous plaques were at a higher risk of MACE than those without (p=0.002). A heterogeneous plaque was independently associated with MACE after adjusting for covariates (hazard ratio [HR], 1.80; 95% confidence interval [CI], 1.06–3.04; p=0.03). Calcified or irregular/ulcerated plaques were correlated with a higher incidence of MACE but both were not independently associated with MACE (HR, 1.37; 95% CI, 0.70–2.67, p=0.36 and HR, 1.13; 95% CI, 0.66–1.93; p=0.66, respectively).

Conclusions

The presence of a heterogeneous carotid plaque in patients who underwent PCI predicted future cardiovascular events. These patients may require more aggressive medical therapy and careful follow-up.

Funding Acknowledgement

Type of funding sources: None.
Trajectories and determinants of left ventricular ejection fraction after first myocardial infarction in current era of primary coronary interventions
Authors: Jenca D , Melenovsky V , Sramko M , Kotrc M , Zelizko M , Mrazkova J , Pitha J , Adamkova V , Kautzner J , Wohlfahrt P
Published: October 2022

Background

Left ventricular ejection fraction (EF) is an independent predictor of adverse outcomes after myocardial infarction (MI). However, contemporary data from the PCI era of MI therapy on trajectories and determinants of EF are scarce.

Purpose

The present study aimed to describe the epidemiology of systolic dysfunction and EF recovery among consecutive patients hospitalized for their first MI.

Methods

Data from a single-centre prospectively-designed AMBITION registry of consecutive patients hospitalized for MI between years 2017 and 2021 at a large tertiary cardiology centre were utilized.

Results

Out of 1593 patients in the registry, 1065 were hospitalized for MI type I and had no previous history of heart failure (HF) or coronary artery disease. Revascularisation was performed in 93.5% of patients: 901 (84.6%) underwent PCI, 89 (8.4%) CABG and 6 (0.6%) both. At discharge, EF<40% was present in 238 (22.3%), EF 40–50% in 326 (30.6%) and EF >50% in 501 (47.0%), respectively. Patients with EF<40% were more often those who suffered subacute and anterior STEMI, had higher heart rate at admission and higher maximal troponin level, and more often HF signs requiring intravenous diuretic therapy (Table 1). In the multivariate Cox analysis, EF<40%, together with age, glomerular filtration rate, glycemia level, clinical signs of HF, and atrial fibrillation were associated with increased mortality risk. Among subjects with EF<40%, the control follow-up EF determined on a median 153 days (IQR 101–407) after discharge was available in 166 patients. Among these, systolic function recovered to EF>50% in 38 (22.9%) and improved to EF 40–50% in 45 (27.1%). Improvement in systolic function to EF>40% was predicted by lower severity of coronary artery atherosclerosis (GENSINI score), by higher discharge EF, by the lower leukocyte count, the absence of atrial fibrillation during MI hospitalization and glycemia level (Table 2). Recovery of systolic function was associated with lower mortality risk (log-rank p=0.012).

Conclusion

In the current era of primary coronary intervention, only 22% of patients after the first MI have EF below 40%. Of them, EF improves in 50%, and full recovery is observed in 23% of patients. Severity or coronary atherosclerosis, inflammatory response to MI, atrial fibrillation and glucose metabolism may all affect EF recovery. These observations provide novel therapeutic targets for EF recovery.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health, Czech Republic