scholarly journals Outcomes After PCI in Patients with LV Dysfunction

2017 ◽  
Vol 02 (02) ◽  
pp. 005-010
Author(s):  
M Ravikiran ◽  
G. Indrani
Keyword(s):  
Subgroup Analysis ◽  
Previous History ◽  
Chronic Stable Angina ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Lv Function ◽  
Coronary Syndrome ◽  
Lv Dysfunction ◽  
Significant Difference

AbstractBackground: Coronary artery disease (CAD) is the most common cause of left ventricular dysfunction. Percutaneous coronary intervention (PCI) in patient with LV dysfunction is a high risk procedure and may be associated with adverse outcomes. We observed for outcomes after PCI in the elective and acute coronary syndrome setting in patient with LV dysfunction.Methods: A prospective single center study was performed in 836 patients with and without LV dysfunction who underwent PCI with a follow up period of 1 year for MACCE.Results: A total of 836 patients were studied. 329 (39.4%) patients have LV dysfunction (LVD) and 507 (60.6%) patients have good LV function (GLV). Among the patients with LVD, 160 (48.6%) has mild, 89 (27.1%) has moderate, 80 (24.3%) has severe LVD. Mean age was 56.5±12.5 years in patients with GLV and 58.8±10 years in LVD patients (p=0.003). Number of males were 259 (78.7%) in LVD and 364 (71.7%) in GLV group. Hypertension and diabetes were present in 237(72%) vs 368(72.5%), 168 (51%) vs 286 (56.4%) in LVD and GLV groups respectively (p=0.8, 0.1). There was no difference in the previous history of CABG (5.2% vs 3.4%, p=0.2) and PCI (19.5% vs 16.4%, p=0.3) in both groups. 174 (52.9%) patients with LVD and 409 (80.7%) patients with GLV has chronic stable angina. Multivessel PCI was done in 79 (24%) patients with LVD and 110 (21.7%) patients with GLV (p=0.4). Major adverse cardiovascular and cerebrovascular events (MACCE) occurred in 3 patients with mild, 5 patients with moderate, 6 patients with severe LVD during the follow up of 1 year. There was no difference in outcomes between the LVD and GLV group at one year (p=0.2), but when a subgroup analysis was made among patients with LV dysfunction there was a significant occurrence of MACCE in patients with severe LV dysfunction when compared with mild LVD (p=0.05).Conclusion: There was no significant difference between the occurrence of MACCE in patients with LV dysfunction and without LV dysfunction who underwent PCI. But when a subgroup analysis was done there was a significant occurrence of MACCE in patients with severe LV dysfunction (p=0.05) when compared to mild LVD.

scholarly journals Is Normal Coronary Arteries on Coronary Angiogram Truly Benign?

2017 ◽  
Vol 02 (04) ◽  
pp. 077-081
Author(s):  
Indrani Garre ◽  
Raju Nallagasu ◽  
Lalita Nemani ◽  
Sreebhushanraju Devaraju ◽  
Narendrakumar V. ◽  
...  
Keyword(s):  
Coronary Arteries ◽  
Statistical Significance ◽  
Chronic Stable Angina ◽  
Binary Logistic Regression ◽  
Standard Test ◽  
Left Ventricular ◽  
Normal Coronary Arteries ◽  
Coronary Syndrome ◽  
Lv Dysfunction

Abstract Background Heart disease is the leading cause of death in the world, and coronary angiography (CAG) is the standard test for detection of critical diseases. Nearly 25% patients undergoing angiography are found to have normal coronary arteries (NCAs). Recent publications say that the follow-up of the NCA patients is not benign. Aim The main objective of this study is to know outcomes of patients diagnosed with normal coronaries on conventional angiograms. Methods This is a single-center observational study. The authors collected the data of patients who came for CAG to their institute from January 1 to December 31, 2014. They included the patients who have normal coronaries in this study. The indication to do the CAG is chest pain (angina) for evaluation. The authors contacted every patient telephonically to know the outcomes after 2 years of CAG. The telephonic data were collected either from patients or from attendants by asking the questionnaire about the present status of patients. Results The authors collected the data of 1,526 patients who underwent the CAG during study period. Out of 1,526 patients, 201 patients with mean age of 52.45 ± 10.7 years met the inclusion criteria; 108 (53.73%) were hypertensives and 57 (28.36%) were diabetic. Acute coronary syndrome (ACS) was the presenting symptom in 28 (13.9%) of patients; the remaining patients presented with chronic stable angina (CSA). Left ventricular (LV) dysfunction was present in 15 (7.5%) of patients. At the 2-year follow-up, 12 (5.9%) patients were symptomatic, and out of them, 7 died (mortality 3.5%).The binary logistic regression showed that only blood urea (BU) was determinant factor for mortality (p = 0.022). Even LV dysfunction (p = 0.39) was not a contributor for mortality. A subanalysis of gender also showed similar findings (male, p = 0.02; female, p = 0.05). Conclusion In angina patients with NCA on CAG, the BU showed statistical significance for morality. This is true even on further sex-based analysis (male, p = 0.02; female, p = 0.05). This study helps understand that even the people with normal coronaries, they may have the symptomatic outcomes, not only because of coronaries and also with other associated diseases.

scholarly journals A Left sided site of origin is associated with adverse cardiovascular outcomes in patients with LV dysfunction undergoing PVC ablation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
D Penela ◽  
J Fernandez-Armentas ◽  
J Acosta ◽  
F Bisbal ◽  
B Jauregui ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Transplantation ◽  
Systolic Dysfunction ◽  
Previous History ◽  
Left Ventricular ◽  
Cardiovascular Outcomes ◽  
Adverse Outcomes ◽  
Cardiac Mortality ◽  
Lv Dysfunction

Abstract Funding Acknowledgements Type of funding sources: None. Background Epidemiological studies suggested that premature ventricular complexes (PVCs) are associated with cardiac mortality. But data are still inconclusive. Aim This study sought to analyze predictors of adverse outcomes in a population of patients with left ventricular (LV) systolic dysfunction who underwent PVC ablation. Methods 135 consecutive patients [100 (74%) men, 59 +12 y.o.] with LV systolic dysfunction [LV ejection fraction (LVEF) <50%] and frequent PVCs who underwent PVC ablation were included in a multicenter prospective international register. Patients were followed-up at 6 and 12 months and annually thereafter. The last evaluation performed was considered the long-term follow-up (LTFUP) evaluation. Cardiac mortality and/or cardiac transplantation and/or admission for heart failure was considered the primary endpoint. Results 82 (61%) patients had a left-sided PVC’s site of origin (LS-SOO), 51 (38%) had a right-sided SOO (RS-SOO) whereas SOO could not be determined in 2 (1%) patients. LS-SOO patients were older (61 ± 11 vs 52 ± 10, p < 0.001) more frequently men [71 (87%) vs 27 (53%), p < 0.001] with previous history of atrial fibrillation (AF) [14 (15%) vs 0, p = 0.001] and with a previously diagnosed structural heart disease (SHD) [43 (52%) vs 6 (11%), p < 0.001]. After a mean follow-up of 39 ± 21 months (range 24-94 months) there was a significant reduction in the PVC burden from 24 ± 13% at baseline to 4 ± 6% at LTFUP, p < 0.001; LVEF improved from 33 ± 8% at baseline to 41 ± 13% at LTFUP (p < 0.001) and NYHA class from 2.1 ± 0.6% to 1.4 ± 0.6% (p < 0.001); BNP levels decreased from 237 ± 231 pg/mL to 137 ± 185 pg/mL (p = 0.001). The primary end-point was reached in 10% patients (7 cardiac deaths, 1 cardiac transplantation and 5 heart failure admisions), 14,8% in LS-SOO and 1,9% in RS-SOO patients, log rank = 0.05 (Figure 1). Conclusions Among patients with LV dysfunction who underwent PVC ablation, those with LS-SOO were older and more frequently had AF and SHD. LS-SOO was associated with adverse cardiovascular outcomes. These findings suggest that PVCs with LS and RS-SOO should be considered as two different clinicals entities, with different prognostic values. Abstract Figure 1

scholarly journals Advanced cardiac magnetic resonance imaging in takotsubo cardiomyopathy

2020 ◽  
Vol 93 (1115) ◽  
pp. 20200514
Author(s):  
Vineeta Ojha ◽  
Rishabh Khurana ◽  
Kartik P Ganga ◽  
Sanjeev Kumar
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Takotsubo Cardiomyopathy ◽  
Left Ventricular ◽  
Diagnostic Modality ◽  
Coronary Syndrome ◽  
Lv Dysfunction ◽  
Reversible Condition

Takotsubo cardiomyopathy (TC) is a reversible condition in which there is transient left ventricular (LV) dysfunction characterised most commonly by basal hyperkinesis and mid-apical LV ballooning and hypokinesia. It is said to be triggered by stress and mimics, such as acute coronary syndrome (ACS) clinically. Diagnosis is usually suspected on echocardiography due to the characteristic contraction pattern in a patient with symptoms and signs of ACS but normal coronary arteries on catheter angiography. Cardiac magnetic resonance (CMR), with its latest advancements, is the diagnostic modality of choice for diagnosis, prognosis and follow-up of patients. The advances in CMR (including T1, T2, ECV mapping and threshold-based late gadolinium enhancement (LGE) measurements have revolutionised the role of CMR in tissue characterisation and prognostication in patients with TC. In this review, we highlight the current role of CMR in management of TC and enumerate the CMR findings in TC as well the current advances in the field of CMR, which could help in prognosticating these patients.

scholarly journals P1265 A home for two: a case of a twin pregnancy complicated by twin-to-twin transfusion in a woman with a repaired total anomalous pulmonary venous connection

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R Di Cosola ◽  
A M Colli ◽  
C Bonanomi ◽  
M Schiavone ◽  
E Gherbesi ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Twin Pregnancy ◽  
Left Ventricular ◽  
Functional Class ◽  
World Health ◽  
Lv Function ◽  
Class Iii ◽  
Lv Dysfunction ◽  
Anomalous Pulmonary Venous Connection

Abstract BACKGROUND Total anomalous pulmonary venous connection (TAPVC) is a rare correctable congenital heart lesion. According to the modified World Health Organization classification (mWHO) of maternal cardiovascular risk, pregnant patients with successfully repaired TAPVC are at low cardiovascular risk (mWHO class I), but the risk rises to mWHO class III if left ventricular (LV) impairment and ventricular arrhythmias are present. CASE SUMMARY A 34 years old woman with corrected supracardiac TAPVC, pregnant with a spontaneous monochorionic diamniotic twin pregnancy (TP) complicated by twin-to-twin transfusion syndrome (TTTS) was referred to the cardiologist in preparation for fetoscopic laser coagulation (FLC). She was born with a TAPVC to the innominate vein associated with an atrial septal defect (ASD), repaired at the age of 3 months by anastomosing the PVC to the posterolateral wall of the left atrium and closure of the ASD with a pericardial patch. At follow up a few years later she developed asymptomatic mild LV dysfunction and alternating brady and tachyarrhythmias including non-sustained ventricular tachycardias (NSVT). At 17th weeks of gestation she presented mild dyspnoea (NYHA functional class II) and an alternance of sinus bradycardia, atrial fibrillation and NSVT. 2D echocardiography showed moderate LV dilatation and dysfunction (LVEF 47%). She was treated with loop-diuretics, but refused antiarrhythmic and anticoagulant therapy. At 19th weeks, TTTS was diagnosed and successful FLC of placental anastomoses was carried out. Symptomatic worsening of LV function and functional class developed in the ensuing weeks (NYHA III, LVEF 40%). Induction of foetal lung maturity with maternal administration of steroids was carried out at 28 weeks but stopped because of spontaneous preterm labour. After delivery, the arrhythmic burden increased to the point of requiring admission to the intensive care unit (ICU) where pacemaker implant was indicated, but refused by the patient. Diuretics and ACE-inhibitors were titrated, but no beta-blockers nor other antiarrhythmics could be started due to intermittent av block. At discharge, the patient was asymptomatic at rest and there were no clinical signs of heart failure. At 17 months of follow-up, she was still asymptomatic, though LV function remained poor. The 2 newborns were discharged after a stormy 4 months in the neonatal ICU and are still being treated for bronchopulmonary dysplasia and the sequels of intraventricular haemorrages. DISCUSSION We are not aware of other described twin pregnancies in repaired TAPVC with residual LV dysfunction and arrhythmia. As the haemodynamic load of twin pregnancy is more severe and the twin pregnancy itself at high risk both for prematurity and maternal cardiac deterioration, evaluation by a Specialist Multidisciplinary referral Unit should occur before conception especially in mNYHA class III and higher, as per current guidelines. Abstract P1265 Figure. Image 1

scholarly journals 1228 New predictors of sudden cardiac death in hypertrophic cardiomyopathy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D M Adamczak ◽  
A Rogala ◽  
M Antoniak ◽  
Z Oko-Sarnowska
Keyword(s):  
Risk Factors ◽  
Hypertrophic Cardiomyopathy ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Volume Index ◽  
Lv Function ◽  
Icd Implantation ◽  
Significant Difference

Abstract BACKGROUND Hypertrophic cardiomyopathy (HCM) is a heart disease characterized by hypertrophy of the left ventricular myocardium. HCM is the most common cause of sudden cardiac death (SCD) in young people and competitive athletes due to fatal ventricular arrhythmias. However, in most patients, HCM has a benign course. That is why it is of utmost importance to properly evaluate patients and identify those who would benefit from a cardioverter-defibrillator (ICD) implantation. The HCM SCD-Risk Calculator is a useful tool for estimating the risk of SCD. The parameters included in the model at evaluation are: age, maximum left ventricular (LV) wall thickness, left atrial (LA) dimension, maximum gradient in left ventricular outflow tract, family history of SCD, non-sustained ventricular tachycardia (nsVT) and unexplained syncope. Nevertheless, there is potential to improve and optimize the effectiveness of this tool in clinical practice. Therefore, the following new risk factors are proposed: LV global longitudinal strain (GLS), LV average strain (ASI) and LA volume index (LAVI). GLS and ASI are sensitive and noninvasive methods of assessing LV function. LAVI more accurately characterizes the size of the left atrium in comparison to the LA dimension. METHODS 252 HCM patients (aged 20-88 years, of which 49,6% were men) treated in our Department from 2005 to 2018, were examined. The follow-up period was 0-13 years (average: 3.8 years). SCD was defined as sudden cardiac arrest (SCA) or an appropriate ICD intervention. All patients underwent an echocardiographic examination. The medical and family histories were collected and ICD examinations were performed. RESULTS 76 patients underwent an ICD implantation during the follow-up period. 20 patients have reached an SCD end-point. 1 patient died due to SCA and 19 had an appropriate ICD intervention. There were statistically significant differences of GLS and ASI values between SCD and non-SCD groups; p = 0.026389 and p = 0.006208, respectively. The average GLS in the SCD group was -12.4% ± 3.4%, and -15.1% ± 3.5% in the non-SCD group. The average ASI values were -9.9% ± 3.8% and -12.4% ± 3.5%, respectively. There was a statistically significant difference between LAVI values in SCD and non-SCD groups; p = 0.005343. The median LAVI value in the SCD group was 45.7 ml/m2 and 37.6 ml/m2 in the non-SCD group. The ROC curves showed the following cut-off points for GLS, ASI and LAVI: -13.8%, -13.7% and 41 ml/m2, respectively. Cox’s proportional hazards model for the parameters used in the Calculator was at the borderline of significance; p = 0.04385. The model with new variables (GLS and LAVI instead of LA dimension) was significant; p = 0.00094. The important factors were LAVI; p = 0.000075 and nsVT; p = 0.012267. CONCLUSIONS The proposed new SCD risk factors were statistically significant in the study population and should be taken into account when considering ICD implantation.

Predictors and outcome of contrast-induced acute kidney injury in older patients presenting with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Bugani ◽  
E Tonet ◽  
R Pavasini ◽  
M Serenelli ◽  
D Mele ◽  
...  
Keyword(s):  
Older Patients ◽  
Adverse Outcome ◽  
Kidney Injury ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome

Abstract Background The number of older patients presenting with acute coronary syndrome (ACS) is increasing. Routine percutaneous coronary intervention (PCI) is performed in order to improve outcome, but comorbidities associated with aging lead to a higher risk of treatment complications. Contrast-induced acute kidney injury (CI-AKI) represents potential harm in older and frail patients, but its impact on long term prognosis is not clear. Purpose To evaluate occurrence, predictors, and impact on long term outcome of CI-AKI in elderly patients presenting with ACS. Methods A prospective cohort of 392 older (≥70 years) ACS patients who underwent coronary angiography was enrolled. CI-AKI was defined as a serum creatinine increase at least ≥0.3 mg/dl in 48 h or at least ≥50% in 7 days. According to our department protocol, prophylactic hydration was performed to all patients with isotonic saline, given intravenously at a rate of 1 ml/kg body weight/h (0.5 ml/kg for patients with left ventricular ejection fraction <35%) for 12 h before (unless for emergent patients) and 24 h after PCI. Median follow up was 4 [3.0–4.1] years. Long term adverse outcomes include all-cause mortality and any hospitalization for cardiovascular causes (ACS, heart failure, arrhythmia, cerebrovascular accident). Results CI-AKI was observed in 72 patients (18.4%). Among patients who developed or not CI-AKI, no difference was found between clinical presentation (Non-ST segment elevation myocardial infarction (NSTEMI) vs. STEMI), left ventricular ejection fraction and multivessel coronary disease. Estimated glomerular filtration rate (odd ratio (OR) 3.59, confidence interval (CI) 1.79–7.20, p<0.001), contrast media volume (OR 1.006, CI 1.002–1.009, P=0.001), white blood cells (OR 1.18, CI 1.10–1.27, p<0.001), haemoglobin level (OR 0.81, CI 0.70–0.94, p=0.005) and chronic obstructive pulmonary disease (OR=5.37, CI 2.24–12.90, p<0.001) were independent predictors for CI-AKI. Patients with CI-AKI presented increased mortality rate both at 30-days (2.7% vs 0%, p=0.038) and at 4-years follow-up (all cause death 23.6 vs. 11.6%, p=0.013) (Figure 1: long term adverse outcomes). Multivariable Cox proportional hazards analysis revealed that diabetes (hazard ratio, HR 1.99, CI 1.33–2.97, p=0.001), atrial fibrillation (HR 2.49, CI 1.59–3.91, p<0.001), Killip class >1 (HR 2.20, CI 1.32–3.67, p=0.003) and haemoglobin level (HR 0.84, CI 0.76–0.92, p<0.001) were independently associated with adverse outcome, while CI-AKI represent a risk factor only at univariate analysis. Conclusions CI-AKI is a common complication among older adults undergoing coronary angiography for ACS. Patients who developed CI-AKI had worse outcome at long term follow-up. Actually, the occurrence of CI-AKI was not identified as an independent predictor for long-term adverse outcome, while it may represent a marker of severity of comorbidity and consequent poor prognosis, rather than a causal agent itself. Figure 1. Kaplan-Maier Curve Funding Acknowledgement Type of funding source: None

scholarly journals 761 Echocardiographic evaluation in patients recovered from COVID-19

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Alberto Michielon ◽  
Priscilla Tifi ◽  
Maddalena Piro ◽  
Massimo Volpe ◽  
Roberto Ricci ◽  
...  
Keyword(s):  
Heart Disease ◽  
Healthy Volunteers ◽  
Left Ventricular ◽  
Hospitalized Patients ◽  
Lv Function ◽  
P Value ◽  
Free Wall ◽  
Significant Difference ◽  
Rv Function

Abstract Aims COVID-19 has a wide spectrum of clinical presentation, from severe forms that require hospitalization to less severe forms that can be managed at home. An acute myocardial involvement was demonstrated in a large proportion of patients admitted for COVID-19 and may persist in the long term. We evaluated the possible cardiac involvement using echocardiography, comprehensive of right and left ventricular strain, in patients who recovered from SARS-CoV-2 infection (hospitalized or home-treated) comparing them with a population of healthy volunteers. Methods and results Forty-one patients with COVID-19, of which fifteen hospitalized, with no prior heart disease, were compared with 13 healthy volunteers. COVID-19 diagnosis was made by a positive molecular swab. Patients with history of pre-existing heart disease were excluded. The median time from infection to outpatient follow-up was 5.9 months. Numerous echocardiographic parameters were compared by unpaired t-test including left ventricular EF, left ventricular GLS, RV free wall strain, FAC, TAPSE, PAPS, TAPSE/PAPS ratio, RA area, and RV thickness. There was a significant difference in RV free wall strain between hospitalized patients and control (−14.6 ± 2.8% vs. −22 ± 0.7%; P-value 0.03) and between hospitalized and home-treated patients (−14.6 ± 2.8% vs. −19.8 ± 0.9%; P-value 0.03), the difference was not significant between control and home-treated patients (−22 ± 0.7% vs. −19.8 ± 0.8%; P-value 0.09). Between hospitalized and not hospitalized group there was a significant reduction in FAC (38.5 ± 3.2% vs. 44.7 ± 1.3%; P-value 0.03) with an increase of RV end diastolic area (19.9 ± 1.3 cm2 vs. 16.8 ± 0.7 cm2; P-value 0.037) and also of end systolic right atrium area (18.2 ± 1.3 cm2 vs. 15.4 ± 0.5 cm2; P-value 0.01). No difference was observed between hospitalized and home-treated patients in TAPSE (22.38 ± 1.26 mm vs. 23.02 ± 0.68 mm; P-value 0.6) and PAPS (24.3 ± 1.6 mmHg vs. 20.2 ± 1.4 mmHg; P-value 0.07) but there was a borderline significant decrease in right ventricular coupling evaluated with TAPSE/PAPS ratio (0.97 ± 0.08 mm/mmHg vs. 1.29 ± 0.10 mm/mmHg; P-value 0.056) and a significant increase in RV thickness in hospitalized patients (5.32 ± 0.45 mm vs. 3.69 ± 0.24 mm; P-value 0.0014). No significant differences were found between hospitalized and not hospitalized group in left ventricular EF (57.8 ± 1.9% vs. 59.9 ± 1.0%; P-value 0.3) and left ventricular GLS (−15.2 ± 0.6% vs. −16.4 ± 0.4%; P-value 0.1). Conclusions Patients hospitalized for COVID-19 showed a dysfunction in RV parameters at 6 months follow-up compared to non-hospitalized patients. No difference in RV function was found between home treated patients and healthy volunteers. No significant differences in LV function were found among the three groups. These preliminary data confirm a decrease in RV function in more severe COVID-19 infection requiring hospital admission, possibly related to increased pulmonary afterload.

scholarly journals Left Ventricular Dysfunction in Arrhythmogenic Cardiomyopathy: Association With Exercise Exposure, Genetic Basis, and Prognosis

2021 ◽  
Author(s):  
Øyvind H. Lie ◽  
Monica Chivulescu ◽  
Christine Rootwelt‐Norberg ◽  
Margareth Ribe ◽  
Martin Prøven Bogsrud ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Ventricular Tachyarrhythmia ◽  
Left Ventricular ◽  
Exercise Intolerance ◽  
Lv Function ◽  
Arrhythmogenic Cardiomyopathy ◽  
Lv Dysfunction ◽  
The Impact

Background Arrhythmogenic cardiomyopathy (AC) is characterized by biventricular dysfunction, exercise intolerance, and high risk of ventricular tachyarrhythmias and sudden death. Predisposing factors for left ventricular (LV) disease manifestation and its prognostic implication in AC are poorly described. We aimed to assess the associations of exercise exposure and genotype with LV dysfunction in AC, and to explore the impact of LV disease progression on adverse arrhythmic outcome. Methods and Results We included 168 patients with AC (50% probands, 45% women, 40±16 years old) with 715 echocardiographic exams (4.1±1.7 exams/patient, follow‐up 7.6 [interquartile range (IQR), 5.4–10.9] years) and complete exercise and genetic data in a longitudinal study. LV function by global longitudinal strain was −18.8% [IQR, −19.2% to −18.3%] at presentation and was worse in patients with greater exercise exposure (global longitudinal strain worsening, 0.09% [IQR, 0.01%–0.17%] per 5 MET‐hours/week, P =0.02). LV function by global longitudinal strain worsened, with 0.08% [IQR, 0.05%–0.12%] per year; ( P <0.001), and progression was most evident in patients with desmoplakin genotype ( P for interaction <0.001). Deterioration of LV function predicted incident ventricular tachyarrhythmia (aborted cardiac arrest, sustained ventricular tachycardia, or implantable cardioverter defibrillator shock) (adjusted odds ratio, 1.1 [IQR, 1.0–1.3] per 1% worsening by global longitudinal strain; P =0.02, adjusted for time and previous arrhythmic events). Conclusions Greater exercise exposure was associated with worse LV function at first visit of patients with AC but did not significantly affect the rate of LV progression during follow‐up. Progression of LV dysfunction was most pronounced in patients with desmoplakin genotypes. Deterioration of LV function during follow‐up predicted subsequent ventricular tachyarrhythmia and should be considered in risk stratification.

scholarly journals Heart failure in survivors of out-of-hospital cardiac arrest – factors associated with reduced systolic ventricular function at follow-up

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H.S.Z Bahrami ◽  
J Kjaergaard ◽  
J.H Thomsen ◽  
F Lippert ◽  
L Koeber ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Left Ventricular ◽  
Lv Function ◽  
Funding Source ◽  
Factors Associated ◽  
Lv Dysfunction ◽  
Hospital Cardiac Arrest

Abstract Background Survival after out-of-hospital cardiac arrest (OHCA) has increased in recent years but is still only 10%. Little is known about the association between post-resuscitation comorbidity and heart failure after discharge from the initial OHCA-admission. Purpose In OHCA-survivors we aimed to describe predictors of left ventricular (LV) dysfunction, defined as LV ejection fraction (LVEF) &lt;40%, at follow-up. Methods A consecutive cohort of OHCA-patients with cardiac cause from 2007 to 2011 without a pre-OHCA congestive heart failure diagnosis (according to the Danish National Patient Registry, which holds data on all Danish citizens) were retrospectively examined. Logistic regression analyses were used to assess factors associated with LV dysfunction (LVEF &lt;40%) at follow-up after a median of 6 months. Follow-up was not performed systematically in the OHCA-survivors and data from follow-up was assessed by reading of patient charts. Results A total of 365 OHCA-survivors with a mean age of 61 years were discharged alive from hospital. LVEF &lt;40% at hospital discharge was seen in 54% (n=184, 7% missing), and at follow-up after a median of 6 months 19% (n=69) of the total OHCA-cohort of survivors still had LV dysfunction. Factors associated with LV dysfunction at follow-up were chronic ischemic heart disease (IHD) prior to OHCA (odds ratio (OR) = 2.9 (95% CI: 1.2 – 7.1)) and ST-elevation myocardial infarction (STEMI) as cause of OHCA (OR = 2.9 (1.4–6.0)), whereas age, gender, high comorbidity burden prior to OHCA or pre-hospital circumstances (including shockable cardiac arrest rhythm) were not. Conclusion More than half of OHCA-survivors with LVEF &lt;40% at hospital discharge improved LV function and LV dysfunction at follow-up after a median of 6 months after discharge was present in 1 in 5 (19%) of the cohort. Chronic IHD and STEMI were the only factors significantly associated with LV dysfunction at follow-up. A systematic follow-up including echocardiography in the outpatient clinic for OHCA-survivors is recommended especially in patients with reduced LV function at discharge and in STEMI-patients in order to assess the appropriateness of heart failure medication and an implantable cardiac defibrillator. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Danish Foundation Trygfonden

scholarly journals Bone marrow mesenchymal stem cells transfer in patients with ST-segment elevation myocardial infarction: single-blind, multicenter, randomized controlled trial

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Runfeng Zhang ◽  
Jiang Yu ◽  
Ningkun Zhang ◽  
Wensong Li ◽  
Jisheng Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
General Hospital ◽  
Myocardial Viability ◽  
Controlled Trial ◽  
Left Ventricular ◽  
Control Group ◽  
Lv Function ◽  
St Segment Elevation ◽  
Significant Difference

Abstract Objective Our aim was to evaluate the efficacy and safety of intracoronary autologous bone marrow mesenchymal stem cell (BM-MSC) transplantation in patients with ST-segment elevation myocardial infarction (STEMI). Methods In this randomized, single-blind, controlled trial, patients with STEMI (aged 39–76 years) were enrolled at 6 centers in Beijing (The People’s Liberation Army Navy General Hospital, Beijing Armed Police General Hospital, Chinese People’s Liberation Army General Hospital, Beijing Huaxin Hospital, Beijing Tongren Hospital, Beijing Chaoyang Hospital West Hospital). All patients underwent optimum medical treatment and percutaneous coronary intervention and were randomly assigned in a 1:1 ratio to BM-MSC group or control group. The primary endpoint was the change of myocardial viability at the 6th month’s follow-up and left ventricular (LV) function at the 12th month’s follow-up. The secondary endpoints were the incidence of cardiovascular event, total mortality, and adverse event during the 12 months’ follow-up. The myocardial viability assessed by single-photon emission computed tomography (SPECT). The left ventricular ejection fraction (LVEF) was used to assess LV function. All patients underwent dynamic ECG and laboratory evaluations. This trial is registered with ClinicalTrails.gov, number NCT04421274. Results Between March 2008 and July 2010, 43 patients who had underwent optimum medical treatment and successful percutaneous coronary intervention were randomly assigned to BM-MSC group (n = 21) or control group (n = 22) and followed-up for 12 months. At the 6th month’s follow-up, there was no significant improvement in myocardial activity in the BM-MSC group before and after transplantation. Meanwhile, there was no statistically significant difference between the two groups in the change of myocardial perfusion defect index (p = 0.37) and myocardial metabolic defect index (p = 0.90). The LVEF increased from baseline to 12 months in the BM-MSC group and control group (mean baseline-adjusted BM-MSC treatment differences in LVEF 4.8% (SD 9.0) and mean baseline-adjusted control group treatment differences in LVEF 5.8% (SD 6.04)). However, there was no statistically significant difference between the two groups in the change of the LVEF (p = 0.23). We noticed that during the 12 months’ follow-up, except for one death and one coronary microvascular embolism in the BM-MSC group, no other events occurred and alanine transaminase (ALT) and C-reactive protein (CRP) in BM-MSC group were significantly lower than that in the control group. Conclusions The present study may have many methodological limitations, and within those limitations, we did not identify that intracoronary transfer of autologous BM-MSCs could largely promote the recovery of LV function and myocardial viability after acute myocardial infarction.

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