bluuebunny/crossref_metadata_2025 huggingface dataset:
Sex- and age-related differences of HRQOL change in cardiac rehabilitation
Authors: Jellestad L , Auschra B , Von Kanel R , Euler S , Hermann M
Published: October 2022

Introduction

Health-related quality of life (HRQOL) has emerged as a valid and disease-specific outcome measure in cardiac patients. Cardiac rehabilitation (CR), a core component of secondary prevention, not only improves cardiovascular outcomes, but also HRQOL. Unfortunately, CR is still underutilized, especially among women and older patients. Aim of this study was to highlight age- and sex-specific effects of CR on HRQOL.

Method

A sample of 8286 patients (mean age 69.2±11.47 years; men 67.8±11.29, women 72.2±11.25) was analyzed. Patients were prospectively asessed from 2012 to 2018 in six Swiss CR clinics. HRQOL was measured at CR entry and discharge using the MacNew Heart Disease questionnaire. In multivariate analyses, we estimated sex- and age-specific changes in HRQOL during CR, adjusting for clinical characteristics.

Results

Women scored lower in any subdomain of HRQOL on admission to CR (social M = 5.05 (SD = 1.3); emotional M = 5.06±1.17; physical M = 4.36±1.72), compared to men (social M = 5.2±1.23); emotional M = 5.35±1.1; physical M = 4.43±1.76). Women showed greater improvement of social (F=10.98, p<0.001), emotional (F=17.73, p<0.001) and physical HRQOL (F=9.47, p=0.002). In a subgroup of elderly patients (>76 years) female sex predicted higher changes in emotional (F=10.878, p<0.001), but not in social (F=1.424, p=0.232) and physical HRQOL (F=2.272, p=0.132).

Conclusion

Women report poorer HRQOL in all subdomains at CR entry compared to men, but in turn particularly benefit from CR in this regard. In older patients, this is particularly true for emotional HRQOL. Our results indicate that sex- and age-specific needs of cardiac patients should be considered during CR.

Funding Acknowledgement

Type of funding sources: None.
Diagnostic yield of cardiac magnetic resonance in athletes with and without features of the athlete's heart and suspected structural heart disease
Authors: Malek L , Milosz-Wieczorek B , Marczak M
Published: October 2022

Background

Cardiac magnetic resonance (CMR) is a second-line imaging test in cardiology. Balanced enlargement of heart chambers called athlete's heart (AH) is a part of physiological adaptation to regular physical activity.

Purpose

The aim of the study was to evaluate the diagnostic utility of CMR in athletes with suspected structural heart disease (SHD) and to analyse the relation between the presences of AH and SHD.

Methods

This retrospective, single centre study included consecutive 154 athletes (57 non-amateur, all sports categories, 87% male, mean age 34±12 years) referred for CMR because of suspected SHD. The suspicion was based on existing guidelines including electrocardiographic and/or echocardiographic changes suggestive of abnormality but without a formal diagnosis. AH was defined as a balanced enlargement of most heart chambers above the reference values in adults with or without mild left ventricular hypertrophy.

Results

CMR permitted to establish a new diagnosis in 66 patients (42%). The main diagnoses included myocardial fibrosis typical for prior myocarditis (n=21), hypertrophic cardiomyopathy (n=17, including 6 apical forms), other cardiomyopathies (n=10) and prior myocardial infarction (n=6). The presence of pathologic LGE was found in 41 patients (27%) and was non-significantly higher in athletes without AH (32% vs. 19%, p=0.08). Junction-point LGE was more prevalent in patients with AH phenotype (22% vs. 9%, p=0.02). Patients without AH tended to be more likely diagnosed with an SHD than those with AH (49% vs. 32%, p=0.05). This was mainly caused by a trend towards a higher prevalence of non-apical hypertrophic cardiomyopathy and prior myocardial infarction in this group.

Conclusions

The inclusion of CMR into the diagnostic process leads to a new diagnosis in many athletes with suspicion of SHD and equivocal routine tests. Athletes with AH pattern are equally likely to be diagnosed with SHD in comparison to those without AH phenotype. It shows that the development of AH and SHD can occur in parallel, which makes differential diagnosis in this group of patients more challenging.

Funding Acknowledgement

Type of funding sources: None.
The impact of elite endurance activity on cardiac remodelling in asians: an echocardiographic case control study
Authors: Tan V , Koh X H , Tan F , Hazli H , Ling L H , Yeo T J
Published: October 2022

Background

Prolonged endurance training results in physiological changes to elite athletes' hearts. These changes include thickened left ventricular (LV) walls and dilated left and right ventricles that may overlap with those from pathological conditions such as hypertrophic cardiomyopathy, dilated cardiomyopathy and arrhythmogenic cardiomyopathy. While reference ranges for elite black and white athletes have been published to facilitate differentiation of physiology from pathology, data on Asian athletes remains scarce. With increasing Asian representation in international sport, it is important to ascertain the extent of physiological cardiac remodelling in Asian athletes.

Purpose

This study aimed to compare echocardiographic parameters of elite endurance athletes (EAs) and non-endurance controls and describe reference ranges in this population of Asian athletes.

Methods

Consecutive elite athletes engaging in endurance sport were identified from the Singapore Sports Cardiology Registry from January to October 2018. Controls were obtained from 3 sources: (a) skill-based athletes from the Singapore Sports Cardiology Registry, (b) healthy non-athletic volunteers from a national atrial fibrillation registry, and (c) healthy non-athletic volunteers from a national heart failure registry. All participants underwent resting two-dimensional, M-mode and Doppler transthoracic echocardiography and findings from EA were compared with controls.

Results

165 participants (55 EAs, 110 controls) were analysed (median age 29 years, male gender n=95; 58%, Chinese ethnicity n=55 for EAs; 100%) Baseline characteristics between both groups were comparable (Table 1). EAs had larger LV wall thickness (9.2 vs. 8.1 mm, p<0.001), LV cavity size (50.7 vs. 48.2 mm, p<0.001), LV mass index (98.4 vs. 73.8 g/m2, p<0.001), aortic root diameter at sinus of Valsalva (30.6 vs. 28.9 mm, p<0.01), right ventricular dimensions and biatrial volumes compared to controls (Table 2). Similar results were noted after indexing to body surface area. These associations also persisted after adjusting for age.

Conclusion(s)

Endurance activity in elite Singaporean Chinese athletes was associated with significant structural and functional cardiac remodeling compared to controls. Reference ranges for echocardiographic parameters in this population were described, allowing for more accuracy when differentiating physiology from pathology in Asian athletes.

Funding Acknowledgement

Type of funding sources: None.
Why does CRT work better in women?
Authors: Lorente Ros A , Monteagudo J M , Calvi V , Sancho-Tello M J , Maass A H , Van Erven L , Ellery S , Nurnberg M , Voros G , Vernooy K , Quesada A , Martinez J G , Nof E , Tolosana J M , Zamorano Gomez J L
Published: October 2022

Introduction

It has been recently postulated that cardiac resynchronization therapy (CRT) might have a higher efficacy in women, with a greater reverse cardiac remodeling in this population. The reasons for these differences are not yet completely understood. We aimed to detect sex differences in the degree of ventricular asynchrony (VA) and mitral regurgitation (MR) in patients undergoing CRT implantation.

Methods

We analyzed baseline characteristics of a prospective international clinical trial that compared CRT response rate in a HF population with a comparable distribution of men and women (BIOWOMEN). A total of 408 patients were analyzed. The degree of mitral regurgitation and intra and inter-ventricular asynchrony was assessed by independent echocardiographers in a core lab. Inter-ventricular asynchrony was defined as an interventricular mechanical delay greater than 40ms and intra-ventricular asynchrony as differences greater than 50ms among regional pre-ejection periods. Multivariable logistic regression was performed using commercial data analysis software.

Results

As expected, ventricular asynchrony was dependent on QRS duration and the presence of LBBB (p<0.01). Baseline QRS duration was significantly shorter in women than men (155.85±19.0 in women vs 160.4±21.6, p=0.02). However, for a similar QRS duration, there were no differences in asynchrony parameters between the two groups (p=0.43; Figure 1). Female sex was associated with a significantly higher proportion of mitral regurgitation for a given QRS duration, which was independent of the etiology (p=0.05).

Conclusions

In our analysis, for a given QRS duration there was not a higher degree of asynchrony in women with HF. However, female sex was associated with a significantly higher proportion of mitral regurgitation for a given QRS duration irrespective of baseline HF etiology. Further investigations are needed to establish a possible link between these findings and better CRT outcomes in women.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): BIOTRONIK SE & Co. KG
Relation between sex and mortality after myocardial infarction in high-income and middle-income European countries
Authors: Cenko E , Bergami M , Yoon J , Van Der Schaar M , Manfrini O , Gale C , Vasiljevic Z , Stankovic G , Vavlukis M , Kedev S , Milicic D , Dorobantu M , Badimon L , Bugiardini R
Published: October 2022

Background

The relationship between female sex and cardiovascular mortality in myocardial infarction (MI) is controversial. Most available data are from high-income countries (HIC) where baseline risk is lower and revascularization procedures are more likely, so the generalizability to other populations is unclear.

Purpose

The main goal of this study was to unravel the relation between patient-specific revascularization through percutaneous coronary intervention (PCI) and mortality among women and men.

Methods

Data were drawn from the ISACS-Archives (NCT04008173) which includes a large cohort of patients enrolled in 6 European HIC (Croatia, Italy, Lithuania, Hungary, Romania, and United Kingdom) and 7 middle-income countries (MIC; Bosnia & Herzegovina, Kosovo, Macedonia, Moldova, Montenegro, and Serbia). Participants were stratified by MI subtypes: STEMI and NSTEMI. The primary outcome was 30-day mortality. To yield unbiased sex estimates of the effects of MI on mortality we modeled covariates and outcomes by propensity score-based analytic methods. We calculated the women to men risk ratios (RRs) using weighting with estimates compared by test of interaction on the log scale.

Results

The cohort consisted of 22,087 patients with MI (30.2% women). Patient outcomes varied according to the subtype of MI. Females was associated with a greater excess risk of 30-day mortality in STEMI (RR: 1.94; 95% CI: 1.71–2.21) compared with NSTEMI (RR: 1.12; 95% CI: 0.95–1.50; P interaction <0.001). Coronary revascularization reduced the incidence of death among women and men in the overall population. Despite this, the primary outcome of 30-day mortality remained higher in women than men with STEMI (RR: 2.38; 95% CI: 2.00–2.82) whereas it was comparable across sexes in patients with NSTEMI (RR: 1.21; 95% CI: 0.79–1.83; P interaction=0.002). Sex differences in mortality from STEMI were more significant in MIC compared with HIC (RRs: 2.30; 95% CI: 1.98–2.68 vs. 1.36; 95% CI: 1.05–1.75; P interaction <0.001). The sex gap in mortality was mitigated by the use of revascularization therapy (RRs: 2.05; 95% CI: 1.68–2.50 in MIC vs. 2.17; 95% CI: 1.48–3.18 in HIC; P interaction=0.40)

Conclusion

Women presenting with STEMI have worse early mortality rates than their male counterparts in both HIC and MIC even in patients undergoing revascularization. By contrast, sex differences are attenuated or no longer apparent in NSTEMI. With no information on the type of MI on admission, sex differences in early outcomes are difficult to be fully understood.

Funding Acknowledgement

Type of funding sources: None.
Artificial intelligence-based risk stratification of atrial fibrillation among women with peripartum cardiomyopathy compared to other cardiomyopathies
Authors: Morales-Lara A C , Johnson P W , Douglass E J , O'Sullivan S , Yamani M H , Noseworthy P A , Carter R E , Adedinsewo D A
Published: October 2022

Background

Atrial fibrillation (AF) is diagnosed in up to 50% of patients with heart failure. However, the prevalence of AF among patients with peripartum cardiomyopathy (PPCM) ranges from only 2–10%, with the lowest rates in Black women. An artificial intelligence enhanced electrocardiogram (AI-ECG) has previously been shown to be effective in detecting AF while in sinus rhythm, and for AF risk prediction in a population-based study.

Purpose

Our objective was to evaluate the use of an AI-ECG for AF risk stratification among women of reproductive age (18 to 49 years) with PPCM compared to other forms of cardiomyopathy.

Methods

We identified 59 reproductive age women with a diagnosis of PPCM between January 2007, and October 2018 and included matched controls in a 3:1 fashion. Matching was performed based on sex, age, race, and left ventricular ejection fraction. We excluded patients with a diagnosis of AF prior to cardiomyopathy diagnosis date. AI-ECG prediction probabilities were generated for ECGs performed within a 30-day window prior to the patient's first cardiomyopathy diagnosis date for the entire study cohort.

Results

A total of 236 patients were included in the final analysis (59 cases, 177 controls). Overall, the median age at cardiomyopathy diagnosis was 31.7 years (IQR: 18.5, 49.4), 76.3% were White, 8.5% were Black, and 15.3% represented other or unknown race. Over the period studied, 3.4% of women with PPCM developed AF compared to 5.6% of women with other cardiomyopathies. The frequency of positive AI-ECG predictions for AF was more common among women with other cardiomyopathies (40.7%) compared to women with PPCM (20.3%). The predicted odds ratio for AF development following a cardiomyopathy diagnosis based on AI-ECG results was 0.37 (95% CI: 0.18, 0.73) for PPCM compared to other cardiomyopathies (p=0.006).

Conclusion

We demonstrated that an AI-ECG model for AF prediction may play a potential role in arrhythmia risk stratification/prediction among young women with PPCM who have a demonstrable lower risk for AF compared to women with other cardiomyopathies. Mechanisms for lower AF risk among patients with PPCM remain unknown. Further studies evaluating mechanistic pathways will be essential.

Funding Acknowledgement

Type of funding sources: None.
Associations of comorbidity patterns and in-hospital outcomes in Chinese young females (<55 years) presenting with ST-segment elevation myocardial infarction: a nationwide registry study
Authors: A G , Zhao L , Li Z , Liu H , Li Y , Zhou X , Yang Q
Published: October 2022

Background

Recent evidence demonstrated an increasing trend for acute myocardial infarction (MI) incidence in young females globally. Identification of distinct clinical comorbidity patterns in this population may allow more precise therapy and improvement in clinical care.

Purpose

This study was designed to identify specific comorbidity patterns and to examine their associations with in-hospital outcomes in female ST-Segment Elevation Myocardial Infarction (STEMI) patients under 55 years of age based on the China Chest Pain Center (CCPC) Database.

Methods

From March 7, 2017, to December 29, a total of 267,405 STEMI patients (66,568 females, 24.9%) were admitted to CCPC. Comorbidity patterns were derived among 6,024 female patients (48.5±5.6 years old) under 55 years of age, using hierarchical clustering applied to 15 medical conditions/histories. The study outcome was defined as the composite of in-hospital adverse events (death, new-onset/worsening heart failure, mechanical complications, recurrent MI, and cerebral ischemic stroke). Associations between multimorbidity patterns and clinical outcomes were evaluated by multivariable-adjusted logistic regression models.

Results

Three comorbidity patterns were derived based on hierarchical clustering, including P1 (histories of hypertension, cerebrovascular disease, heart failure and coronary artery disease), P2 (histories peripheral arterial disease, atrial fibrillation, thyroid dysfunction, anemia, chronic kidney disease, cerebrovascular disease and peptic ulcer) and P3 (obesity, histories of hyperlipidemia, diabetes and smoking, family history of cardiovascular diseases). After adjustment for age, admission levels of systolic blood pressure and heart rate, receiving reperfusion treatment or not, and medical therapies in-hospital (antiplatelet drugs, statins, β-blockers and anticoagulants), compared with participants without multimorbidity, P1 (odds ratios [OR] = 1.60, 95% confidence interval [CI]: 1.26 to 2.04) and P3 (OR = 1.45, 95% CI: 1.10 to1.92) demonstrated relatively higher risks for in-hospital composite outcomes. Compared with patients without comorbidity patterns, the clustering of the above comorbidity patterns dose-dependently augmented the risks for in-hospital composite outcomes, from any one pattern (OR = 1.49, 95% CI: 1.23 to1.81), to any two patterns (OR = 2.46, 95% CI: 1.82 to 3.34) and to three patterns (OR = 4.51, 95% CI: 1.12 to 18.16).

Conclusion

In a nationwide STEMI registry, our results provided the proof-of-concept evidence that specific comorbidity patterns of young female STEMI were associated with differential in-hospital outcomes. Further work is needed to validate the utility and values in decision making of these multimorbidity patterns for appropriate management strategies in young female STEMI patients.

Funding Acknowledgement

Type of funding sources: None.
Characterizing left ventricular stiffness in women with signs and symptoms of ischemia with no obstructive coronary arteries
Authors: Wei J , Samuels B , Oneglia A , Tjoe B , Gomez J M D , Manchanda A S , Samuel T J , Azarbal B , Kwan A C , Anderson R D , Petersen J W , Berman D S , Pepine C J , Bairey Merz C N , Nelson M D
Published: October 2022

Background

Women with signs and symptoms of ischemia and no obstructive coronary arteries (INOCA) have evidence of diastolic dysfunction and are at increased risk of developing heart failure with preserved ejection fraction (HFpEF). However, mechanisms contributing to HFpEF development are poorly understood and often attributed to underlying cardiovascular risk factors.

Purpose

To compare clinical, invasive, and imaging parameters in women with suspected INOCA and various degrees of left ventricular (LV) stiffness (as measured by invasive end-diastolic pressure [EDP]/end diastolic volume [EDV]).

Methods

Women with suspected INOCA underwent invasive LV pressure-volume loop analysis at rest and coronary function testing with a Doppler wire in the left anterior descending artery. Intracoronary vasoactive substances (adenosine, acetylcholine, nitroglycerin) were infused into the left main artery, as published. Rest and adenosine stress cardiac magnetic resonance (CMR) imaging was performed to evaluate LV function, structure, perfusion, and fibrosis. Women in different tertiles of EDP/EDV ratio were compared using t-tests.

Results

A total of 62 women with complete invasive data were included; 2 did not complete CMR. Compared to the lower EDP/EDV tertile, women in the upper tertile were older, had higher ejection fraction, higher mass/volume ratio, worse diastolic function, greater aortic stiffness and worse coronary microvascular function (Table 1). Traditional cardiovascular risk factors were not significantly different.

Conclusion

Among women with INOCA, older age, coronary microvascular dysfunction, and aortic stiffness were related to greater LV stiffness at rest. Those with the highest EDP/EDV ratio had hyperdynamic LV systolic function and the smallest LV size. More work is needed to understand contribution of coronary microvascular dysfunction to HFpEF progression.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): National Institutes of HealthErika Glazer Women's Heart Health Project
Evaluation of cardiovascular disease in the turner syndrome population in Northern Ireland
Authors: Kearney A , MacElhatton D , McManus J , Muir A
Published: October 2022

Background

There is higher frequency of both congenital heart disease and acquired cardiovascular conditions in patients with Turner syndrome. It is associated with increased early morbidity and mortality compared with the general population related mainly to cardiovascular complications.

Purpose

We sought to ascertain the prevalence and outcomes of cardiac abnormalities in patients with Turner syndrome in Northern Ireland.

Methods

Patients with Turner Syndrome who attended cardiology or gynaecology clinics in the Belfast Health and Social Care Trust were identified and demographic and clinical data were obtained.

Results

165 patients who had undergone cardiovascular assessment and imaging were identified. The mean age was 38±13 years. Hypercholesterolaemia was present in 49.7%, hypertension in 21% and diabetes mellitus in 15.2%. Patients with these cardiovascular risk factors were older compared to those without (Table 1). Ischaemic heart disease was present in 2.4%. Cardiac structural abnormalities were present in 52 patients (31.5%) and bicuspid aortic valve was the most common abnormality (23.6%). 9.1% of patients had a history of cardiothoracic surgery or catheter intervention and 1 patient had a previous Type A aortic dissection surgically repaired. The variety and frequency of cardiac structural abnormalities are listed in Table 2.

Conclusion

The prevalence of structural cardiac abnormalities and cardiovascular risk factors in Turner patients greatly exceeds that of the general population. This highlights the need for screening with cross sectional cardiac imaging plus early identification and management of cardiovascular risk factors.

Funding Acknowledgement

Type of funding sources: None.
Determinants of death from malformations of the circulatory system
Authors: Salim T , De Andrade T M , Klein C H , Moraes de Oliveira G M
Published: October 2022

Background

Congenital malformations (CMs) were the second cause of death in infants under the age of 1 year in North America and Europe in 2017, behind perinatal causes.Of the CMs, those of the circulatory system (MCSs) were the most lethal. Studies in Brazil, North America and England have reported higher mortality from MCS in the presence of prematurity, non-white skin color of the newborn, asphyxia, low birthweigth, advanced maternal age, and low maternal education level. The magnitudes of those associations vary. Those studies have investigated neither the risk of death from MCS, with control of the mediation provoked by those and other variables, nor the construction of a model to explain the relationship between variables and deaths.

Objective

To assess the associations of maternal geographic and socioeconomic factors, as well as gestational and birth factors, with deaths from MCSs in the first year of life in Brazil from 2006 to 2016, and to build an explanatory model of the relationship between variables and death.

Methods

Study of the Brazilian databases Information System on Live Births and Mortality Information System, which were linked by deterministic relationship and submitted to the cohort strategy. Crude and controlled relative risks were estimated. Acyclic graphs directed the creation of explanatory models of the relationship between maternal and fetal variables and the risks of death from MCSs and all causes.

Results

The deterministic linkage of 32,011,727 live birth certificates and 266,215 deaths yielded 248,027 linked pairs. Low birth weight (RR=14.38), asphyxia in the first (RR=5.95) and fifth minute (RR=11.86), maternal age ≥35 years (RR=1.66), male sex (RR=1.13), residing in the West-Central Brazil (RR=1.22) and small number of prenatal visits (RR=2.24) increased the risk of death from MCSs. Prematurity and multiple-gestation pregnancy had effects on death mediated by low birth weight and asphyxia regardless of the cause of death. Maternal education level and skin color did not increase the risk of death from MCS but influenced deaths from other causes.

Conclusion

The explanatory model of the relation of maternal geographic and socioeconomic, gestational and birth factors with deaths in the first year of life in Brazil from 2006 to 2016 showed that the small number of prenatal visits, male sex, low birthweigth, and presence of asphyxia in the first and fifth minutes are variables with a direct effect on the risk of death regardless of the cause of death. Deaths from MCSs in the West-Central regions and maternal age ≥35 years pose a higher risk of death, but this effect was not evidenced for other causes of death. Better gestational care with an adequate number of prenatal visits would enable the early diagnosis of MCSs with proper life support and treatment.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Federal University of Rio de Janeiro
Prevalence of attention deficit/hyperactivity disorder (ADHD) in congenital heart diseases (CHD), a systematic review and meta-analysis
Authors: Tarek Hasan M , Shaban Abdelgalil M , A Elbadawy M , Mahmoud Elrosasy A , Elkhadragy A , K Awad A
Published: October 2022

Introduction

Neuropsychiatric disorders are well-established in patients with congenital heart defects (CHD); moreover, patients with CHD have higher three to four times risk for inattention and hyperactivity. Several published studies have investigated the prevalence of attention deficit/hyperactivity disorder (ADHD) among patients with CHD, thus we conducted our meta-analysis in an attempt to further investigate the role of CHD in increasing the incidence of ADHD.

Methods

Electronic databases were systematically searched to identify any observational or interventional studies that compared the effects of congenital heart disease on the incidence or progression of ADHD. Pooled mean difference (MD) and their 95% confidence intervals (CI) were calculated using inverse variance and fixed effect models

Results

We identified eight studies with 120187 patients with a mean age of 15.8 years. Patients with CHD compared to healthy population have statistically significant higher scores in ADHD inattention subscale, ADHD hyperactivity-impulsivity subscale, ADHD combined scale (Fig. 1) with MD of 0.25 [95% CI 0.13, 0.37, p<0.0001], 0.16 [95% CI 0.04, 0.28, p=0.008], 0.23 [95% CI 0.11, 0.35, p=0.0002], respectively. Furthermore, ADHD index T score (Fig. 2) for both self-reported and informant report showed a statistically significant increase in CHD with MD of 0.42 [95% CI 0.26, 0.58, p<0.00001] and 0.86 [95% CI 0.52, 1.19, p<0.00001].

Conclusion

CHD showed an associated increased risk for the development of ADHD which was confirmed with several ADHD scales.

Funding Acknowledgement

Type of funding sources: None.
Genetic background of pediatric PAH in Spain and its clinical implications: data from the REHIPED Spanish Registry
Authors: Cruz Utrilla A , Gallego N , Tenorio-Castano J , Guillen I , Torrent-Vernetta A , Moya A , Labrandero C , Garrido-Lestache E , Moreno A , Escribano-Subias P , Del Cerro M J
Published: October 2022

Background

The genetic background of pulmonary arterial hypertension (PAH) in the Spanish pediatric population could be different from the genetic background described in other countries. Besides, clinical implications of a positive genetic result in the PAH pediatric population are not fully understood yet, and could result in the “reclassification” of patients from one PAH group to another type among the current pediatric classification.

Material and methods

Patients under 19 years at diagnosis included in the REHIPED registry from January 2011 to December 2021 were included. Clinical variables and genetical results were recorded. Succesive NGS panels involving up to 35 genes were used. After the results of the genetic testing, we analyzed differences in survival, and if patients “moved” to another category in the current Nice classification.

Results

In the selected cohort of 98 patients (56.1% female), median age at diagnosis was 7.1 years (IQr 1.5–14.7), and ethnicity as follows: Caucasian (81.6%), Romani (8.2%), others (10.2%) (Table 1). Before the genetic testing, patients had been classified as Idiopathic (53.1%), Congenital Heart Disease-PAH (30.6%), Heritable (5.1%), Pulmonary veno-oclusive disease (PVOD) 6.1%, and Multisystemic disorder associated with PAH (5.1%). Pathogenic or likely pathogenic variants were found in 44 of the screened patients (44.9%): BMPR2 (12 cases), EIF2AK4 (9), TBX4 (n=4), MECP2 (n=3), KCNK3 (n=2), FOXF1 (n=2), NFU1 (N=4), ACVRL1 (n=1), BMPR1B (n=1), CLBCI (n=1), GBE1 (n=1), GDF2 (n=1), SOX17 (n=1), VHL (n=1), and digenic pathogenic variant in ABCC8/SMAD1 (n=1). After genetic analysis, 28 patients (28.6%) were “reclassified” (Fig. 1, panel A), with HPAH, PVOD and multisystemic disorders increasing up to 18.4%, 8.2%, and 12.2%, respectively. Worse Survival from death or lung transplantation was observed in heritable PVOD and multisystemic disorders (Fig. 1, panel B).

Conclusions

The Spanish pediatric PAH population showed higher prevalence of EIF2AK4 than other pediatric registries. Genetic testing resulted in the “reclassification” of a significant number of patients.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Rio Hortega grant from the Spanish Ministry of Science and Innovation (Instituto de Salud Carlos III).
Cardiac arrest on persons under the age of 20, from 1996 to 2019
Authors: Andrade T M A , Marques M L C , Guerra S A G , Salim T R , Oliveira G M M
Published: October 2022

Introduction

Cardiopulmonary arrest (CPA), in pediatrics, has high mortality and severe neurological sequelae. Information on the causes and mechanisms of death in children under 20 can provide theoretical support for improving health in childhood and adolescence.

Objectives

To carry out a population analysis of mortality rates (MR) from basic and multiple causes of death, in children under 20 years of age, of both sexes, from 1996 to 2019, and to identify the frequency of description of CPA in death certificates (DC) of these individuals and their places of occurrence, to promote strategies to improve the prevention of deaths.

Method

An ecological time-series study, from 1996 to 2019, of children deaths under 20 years of age, in which MR and we evaluated proportional mortality (PM) due to underlying cause of death. We analyzed the percentage of CPA description in the DC (any lines) and the place of occurrence. Also, we described MR per 100,000 inhabitants and PM due to underlying cause of death under 20 years of age, by sex, and age group. The percentages of death from underlying causes were calculated when CRP was described in any line of parts I and II of the DC, by age groups, and the percentages of death from underlying causes, according to their place of occurrence.

Results

In Brazil, from 1996 to 2019, there were 2,151,716 deaths in children under 20 years of age, with a TxM of 134.38 per 100,000 inhabitants, with higher death rates among male neonates. Two hundred forty-nine thousand three hundred thirty-four had CPA described in any DC line, corresponding to 11.6% of these deaths. We defined four patterns for the underlying cause of death when CPA in the death sequence. In the neonatal period, perinatal causes; in children under five years, respiratory system diseases; 5 to 14 years, neoplastic and hematological; and in adolescents aged 15 to 19, external causes. The central place of occurrence of these deaths was in the hospital.

Conclusion

The highest MR of underlying causes of death, in those under 20 years of age, in Brazil, from 1996 to 2019, was due to perinatal and external causes. When we evaluated multiple causes of death, the leading underlying causes of CPA were respiratory, hematological, and neoplastic diseases, with higher in-hospital mortality. It is crucial to understand deaths sequence events and implement teaching strategies to pediatric cardiopulmonary resuscitation.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): CAPES
Cardiac findings in multisystem inflammatory syndrome in children (MIS-C) – single institution experience
Authors: Smajlovic E , Grahic-Mujcinovic O
Published: October 2022

Background

Multisystem inflammatory syndrome in children (MIS-C), associated with coronavirus disease 2019 (COVID-19) is a rare but serious condition, affecting children mostly after acute SARS CoV2 infection. MIS-C presents with fever, laboratory evidence of inflammation, and multiorgan dysfunction, including heart.

Purpose

We analized the degree of cardiac involvement and clinical outcomes of MIS-C patients hospitalized in Pediatric department of Cantonal hospital Zenica, to compare with previously reported findings.

Methods

Cardiac testing results in pediatric patients hospitalized with MIS-C from November 2020. until March 2022. were retrospectively analized. For this study, MIS-C patients with positive cardiac testing were defined as having an abnormality of one or more of the following on admission: cardiac biomarkers, electrocardiogram, and/or echocardiogram.

Results

Cardiac abnormal findings were present in almost all of our ten patients with MIS-C, but the extent of cardial injury was lower than we expected it to be. Abnormal EKG was found in 80% patients with the most common electrocardiography findings: low voltage (50%) and T wave abnormality (70%). Echocardiography abnormalities were present in 80% patients mostly including valvular regurgitation (mitral, pulmonal), and rarely pericardial effusion or left ventricular diastolic disfunction (20%). Elevated cardiac biomarkers were seen in 70% patients. By the time of hospital discharge or short time follow-up all cardiological findings were diminished. Six months follow-up found no cardiac sequellae and 24h electrocardiogram with heart rate variability parametres found no disturbancies outside physiological or underlying chronic disease.

Conclusion

While most patients in our study had evidence of abnormal cardiac testing on hospital admission, all cardiac findings were normal by hospital discharge. Cardiologic findings were representative for subacute myocardial injury with good clinical outcome and no sequellae. The degree of cardiac involvement was mild compared with previous reports.

Funding Acknowledgement

Type of funding sources: None.
Long term outcomes in different aetiologies of perioperative myocardial infarction/injury after noncardiac surgery
Authors: Puelacher C , Gualandro D , Glarner N , Lurati Buse G , Lampart A , Bolliger D , Grossenbacher M , Steiner L , Burri K , Biner L , Caramelli B , Cardozo F A , Osswald S , Mueller C
Published: October 2022

Background

Perioperative myocardial infarction/injury (PMI) occurring in the first 48h following noncardiac surgery is a frequent cardiac complication. Better understanding of the underlying aetiologies is urgently needed.

Aim

To explore the association of different aetiologies of PMI with long term outcomes.

Methods

In this prospective multicenter observational study, PMI aetiology was centrally adjudicated and hierarchically classified by two independent physicians based on all information obtained during clinically-indicated PMI work-up including cardiac imaging among consecutive high-risk patients undergoing major noncardiac surgery. PMI aetiology was classified into “extracardiac” if caused by a primarily extracardiac disease such as severe sepsis or pulmonary embolism; and “cardiac”, further subtyped into type 1 myocardial infarction (T1MI), tachyarrhythmia, acute heart failure (AHF), or likely type 2 myocardial infarction (lT2MI). Major adverse cardiac events (MACE) including T1MI, AHF (both only from day 3 to avoid inclusion bias), life-threatening arrhythmia, and cardiovascular death as well as all-cause death were assessed during 365-days follow-up.

Results

PMI occurred in 1016/7754 patients (13.1%). At least one MACE occurred in 684/7754 patients (8.8%) and 818/7754 patients died (10.5%) within 365 days. MACE and all-cause death occurred in 51% (95% CI 31–60) and 38% (95% CI 29–47), 41% (95% CI 28–51) and 27% (95% CI 16–34), 57% (95% CI 41–69) and 40% (95% CI 25–53), 64% (95% CI 45–76) and 49% (95% CI 30–62), as well as 25% (95% CI 22–28%) and 17% (95% CI 14–20) of patients with extracardiac PMI, T1MI, tachyarrhythmia, AHF, and lT2MI, respectively. These associations were confirmed in multivariable analysis.

Conclusion

At 365 days, most PMI aetiologies have unacceptably high rates of MACE and all-cause death, highlighting the urgent need for more intensive treatments.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Swiss National Science FoundationRoche Diagnostics
Performance of Society of Thoracic Surgeons and EuroSCORE II pre-surgical mortality risk score for cardiac surgery in a large majority-minority population
Authors: Seto B K , Tsai P , Seto T B
Published: October 2022

Background

Pre-surgical mortality risk scores are important tools for pre-operative assessment. The Society of Thoracic Surgeons (STS) and EuroSCORE II (ES) scores were derived from predominantly white populations; their utility in minority populations is understudied.

Purpose

To compare the performance of STS and ES in a large majority-majority population.

Methods

We used cardiac surgery registry data from a tertiary care, 500-bed, university-affiliated hospital. For each patient, STS and ES risk of mortality were calculated. We measured model performance by discrimination (ROC-AUC) and calibration (O/E ratios). We compared performance by racial subgroups, and explored differences in risk stratification by race and risk category by measuring risk reclassification if ES were used instead of STS.

Results

From 2009–20, 4061 patients underwent CABG (68%), valve (18%), or CABG/valve (7%) surgery. Of these, 51% were Asian (n=2076), 24% Native Hawaiian and other Pacific Islander (NHPI) (n=977), 23% White (n=919) and 3% Other (n=79). Overall, STS underestimated (O/E: 1.09) and ES overestimated (O/E: 0.55) mortality risk. STS had better discrimination (ROC-AUC: 0.83 vs 0.77). STS model calibration was better among Asians (O/E: 1.03) than NHPI (O/E: 1.22) and Whites (O/E: 1.14). ES calibration was poor overall (Asian O/E: 0.58, NHPI O/E: 0.54, White O/E: 0.50). Discrimination was similar in STS (Asian AUC: 0.83, NHPI AUC: 0.85, White AUC: 0.86) and ES (Asian AUC: 0.77, NHPI AUC: 0.77, White AUC: 0.81), although it did perform better for White patients. Of patients defined as Low Risk by STS, 31% were reclassified as Intermediate or High Risk by ES. Of patients defined as High Risk by STS, 27% were downgraded to Intermediate or Low Risk by ES. This differed by race. For Asians, 28% at Low Risk and 31% at High Risk by STS were reclassified when using ES. For NHPI, 36% at Low Risk and 22% of High Risk by STS were reclassified by ES. For Whites, 31% at Low Risk and 19% of High Risk by STS were reclassified by ES.

Conclusion

The choice of pre-surgical risk score can impact estimates of pre-cardiac surgery risk of mortality. While STS performs better than ES in our majority minority population, there are significant differences by race.

Funding Acknowledgement

Type of funding sources: None.
Sacubitril valsartan in aged patients with heart failure and reduced ejection fraction: a safe and beneficial therapy
Authors: Romero Otero J M , Cortes Garcia M , Rodriguez Lopez C , Balaguer German J , Esteban Chapel J A , Nieto Roca L , Martinez Milla J , Taibo Urquia M , Pello Lazaro A M , Tunon Fernandez J
Published: October 2022

Background

Heart failure (HF) constitutes a prevalent diagnosis in aged patients. During the last decades, several therapies have demonstrated clinical benefits among patients with HF and left ventricular systolic disfunction (LVSD), including novel angiotensin receptor-neprylisin inhibitors (ARNI). Nevertheless, these findings remain unclear in the elderly.

Purpose

The objective of this study is the evaluation of ARNI treatment in aged patients with HF and reduced left ventricular ejection fraction (LVEF)..

Methods

Patients were prospectively recruited from January 2016 to December 2020. Subjects LVSD (defined by LVEF below 40%), aged ≥75 years and indication for ARNI were included. Clinical, electrocardiographic and echocardiographic variables were collected.

Results

A total of 616 patients were included in the present study. Median age was 83.3 years old (standard deviation, SD, ± 5.1) and 65.6% were male. 81.2% had hypertension, 35.4% diabetes, and 57.1% dyslipemia. Chronic kidney disease was present in up to 53.6% of the patients; 17.8% suffered from chronic lung disease and 16.2% from cerebrovascular disease. At baseline, the mean LVEF was 29.3% (SD ± 7.7%), being the ischemic disease the most common etiology, with 46.6% of the cases. 60.0% of the patients had sinus rhythm on ECG at inclusion. Nearly 45.0% of the patients had been hospitalized before the recruitment due to heart failure. 77% of the patients had BB in their treatment; 55% had ACEIs / ARBs; 40% had MRA; 4% had iSGLT2. The percentage of patients with ARNI was 14.3%. The median follow-up was 35 months; in this time, 50.2% died; cardiovascular events (dead for any cause or new admission secondary to heart failure) were reported in 62.2% of the patients. A multivariate survival study was performed, using Cox regression. It showed that the use of ARNI in this population represent a powerful protective factor against mortality (HR 0.268; 95% CI 0.162–0.443).

Conclusion

In our study, it has been shown that ARNI improved survival in aged subjects with HF and LVSD. However, this drug is underuse in this population. This may be related to frailty, greater comorbidity and the polypharmacy that lead to lesser accomplishment of clinical guidelines recommendations. However, it would be recommendable to confirm our findings with further studies.

Funding Acknowledgement

Type of funding sources: None.
Trans-catheter mitral valve repair in the elderly and very elderly patients with focus on postprocedural safety and 1-year effectiveness
Authors: Mahnkopf C , Schnupp S , Amami M , Mady H , Salloum B , Ajmi I
Published: October 2022

Background and objectives

Symptomatic mitral regurgitation (MR) is associated with a high mortality rate and high heart failure-related hospitalization. Symptomatic therapy in the elderly and very elderly patients remains weak in controlling severe MR with an elevated morbidity and mortality rate. Patients with an increased risk of surgical repair of the MR seemed to benefit from MitraClip procedures. Therefore, we thought to analyze the postprocedural safety and success of the MitraClip in octogenarians and older patients.

Methods

Elderly and very elderly patients with severe and symptomatic MR were presented and evaluated in the heart team. Patients with high surgical risks underwent MitraClip (Abbot, USA) procedure in our center. Post-procedural transthoracic echocardiography (TTE) procedure was performed to determine the MR grade and exclude procedure-related complications.

Results

Two hundred eleven consecutive patients, older than 80 years (83.75±2.95, 106 Men (83.5±3.06) and 105 Women (84.01±2.83)), who received MitraClip between May 2015 and May 2020 were enrolled. The baseline characteristics are presented in table 1. Procedural success, defined as reducing the MR to grad I-II, was achieved in 93% of the patients (3.11±0.34 vs. 1.25±0.46, P=0.002). All patients improved in the New York Heart Association functional class (3.04±0.40 vs. 1.92±0.76) one year after the intervention. No procedure-related death was registered. 81% (n=168) survival rate was achieved one year after the intervention. No clip embolization was detected in 3 months echocardiography control, Table 2.

Conclusions

Our preliminary results indicate that MitraClip is a safe and effective therapeutic option in elderly and very elderly patients with severe MR and high surgical risks. Therefore, this therapy should be considered despite age and comorbidities for effective symptomatic treatment in this particular cohort.

Funding Acknowledgement

Type of funding sources: None.
Impact of dementia and drug compliance on patients with acute myocardial infarction
Authors: Lee W , Kang S H , Kim S H , Chae I H
Published: October 2022

Background

There has been a worrying rise in the number of people with dementia, especially with many of them also suffering from acute myocardial infarction (AMI), a disease with a high mortality rate.

Purpose

We evaluated the impact of dementia on the mortality of patients with AMI and how drug compliance affects this relationship.

Methods

The data were derived from National Health Insurance Service-Senior. The total number of patients diagnosed with AMI for the first time between 2007 and 2013 was 16,835, among whom 2,021 had dementia. Medication possession ratio (MPR) was used to assess medication adherence.

Results

AMI patients with dementia had unfavorable baseline characteristics; they had significantly higher risk of all-cause mortality (Hazard ratio [HR]: 2.49; 95% confidence interval (CI): 2.34–2.66; P<0.001) and lower MPR (aspirin: 21.9% vs. 42.8%; P<0.001). AMI patients were stratified by presence of dementia and medication adherence, and the survival rate was the highest among those with no dementia and good adherence. followed by those with no dementia and poor adherence, those with dementia and good adherence, and those with dementia and poor adherence. The multivariable analysis revealed that dementia (HR: 1.64; 95% CI: 1.53–1.75; P<0.001) and poor adherence to medication (HR: 1.60; 95% CI: 1.49–1.71; P<0.001) had a significant association with all-cause mortality in AMI patients.

Conclusions

AMI patients with dementia have a higher mortality rate. Patients with dementia have poorer medication adherence than those without, negatively affecting their prognosis.

Funding Acknowledgement

Type of funding sources: None.
Efficacy of cryoballoon ablation for atrial fibrillation in a geriatric population
Authors: Boehmer A A , Rothe M , Nussbaum E , Zezyk C , Dobre B C , Kaess B , Ehrlich J R
Published: October 2022

Background

Cryoballoon pulmonary vein isolation (cryoPVI) is well-established for paroxysmal atrial fibrillation (AF) but its value in persistent AF is less clear. In particular, its efficacy in cardiogeriatric patients (≥75 years) is unknown. Age represents an important modifier of AF progression and is a risk-factor for AF recurrence.

Methods

We conducted a prospective, single-center study to analyze efficacy and safety of cryoPVI in cardiogeriatric patients stratified according to AF entity. Maximum follow-up was 24 months. Efficacy endpoint was symptomatic AF relapse after 90-day blanking period.

Results

We included 668 patients. Of these 218 were ≥75 years old. Paroxysmal AF was present in 400 and persistent AF in 268 patients. By means of cox-regression analysis we found age as the only independent factor influencing AF recurrence in the overall cohort (P=0.034). This effect was carried by patients with persistent AF (P=0.006). At 24 months, the recurrence rate was highest in patients with persistent AF and age ≥75 years (57%; P=0.0004).

Conclusion

Cardiogeriatric patients with persistent AF undergoing cryoPVI had higher rates of AF recurrence compared to elderly patients with paroxysmal AF or younger patients. Against this background we assume, that pulmonary-vein dependent AF may be less frequently encountered among patients ≥75 years with persistent AF.

Funding Acknowledgement

Type of funding sources: None.