Prognostic impact of left ventricular thrombus resolution after myocardial infarction on cardiovascular events and mortality

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Hofer ◽  
P Sulzgruber ◽  
N Kazem ◽  
P Horvath ◽  
R Schweitzer ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Left Ventricular ◽  
Prognostic Impact ◽  
Coronary Syndrome ◽  
Ventricular Thrombus ◽  
All Cause Mortality ◽  
Vulnerable Patient ◽  
Vulnerable Patient Population

Abstract Background Left ventricular thrombus (LVT) is a rare but dreaded complication during the acute phase of acute coronary syndrome (ACS). Incidence rates differ among the observational studies from 1.6% up to 39.0% indicating that many LVT cases might remain undetected. While the prognosis of patients presenting with LVT after ACS has been controversially discussed, it seems intuitive that individuals in whom the thrombus remains have an increased risk for cardiovascular events and mortality. However, profound data on long-term outcome of this highly vulnerable patient population are not available in current literature. Therefore, we aimed to investigate the impact of LVT resolution on patient's outcome from a long-term perspective. Methods We collected data of patients with acute coronary syndrome (n=2011) who underwent treatment between 01/2016 and 09/2019. Patients with a confirmed LVT were included in this analysis. Repeated echocardiographic data, treatment management and clinical outcomes were collected during follow-up. All-cause mortality and major adverse cardiac events (MACE), defined as nonfatal stroke, nonfatal myocardial infarction, nonfatal systemic embolism and cardiovascular death were chosen as primary and secondary endpoint. Results Among 2011 patients with ACS, 52 patients (2.6%) developed left ventricular thrombosis (median age: 63±13). 80.5% of LVT patients presented with STEMI. Out of those 52 patients with LVT, 6 died before hospital discharge and 3 did not receive follow-up imaging. In total 13 patients (24%) died. Mean time to thrombus resolution was 23±31 weeks. Mean follow-up time was 98±69.6 weeks. 43 patients received oral anticoagulation including 7 patients (16%) receiving novel oral anticoagulants (NOACs) and 32 patients (84%) Vitamin K antagonists (VKA). All patients developed LVT after anterior wall infarction. From the time of hospital admission all patients were followed prospectively until the primary endpoint was reached. Thrombus resolution was observed in 27 patients (62.8). As expected, thrombus resolution was associated with a significant lower risk of MACE with a crude hazard ratio (HR) of 3.89 (95% CI 1.30–11.65; P=0.015) and mortality with a crude HR of 5.59 (95% CI 1.07–29.07; P=0.041). Notably, the prognostic impact remained stable after comprehensive adjustment for potential confounders with an adjusted HR of 5.38 for MACE and an adjusted HR of 6.10 for overall mortality. Conclusion Present data clearly highlighted the prognostic potential of thrombus resolution on both MACE and all-cause mortality in individuals presenting with LVT after ACS. Therefore, thrombus resolution might be considered for risk stratification and an intensified anti-thrombotic approach should be taken into account in this highly vulnerable patient population. Survival curves Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of Vienna

scholarly journals Long-term injury after Takotsubo syndrome (stress cardiomyopathy)

2020 ◽  
Vol 22 (Supplement_E) ◽  
pp. E73-E78
Author(s):  
Gloria Vassiliki’ Coutsoumbas ◽  
Pamela Gallo ◽  
Silvia Zagnoni ◽  
Giuseppe Di Pasquale
Keyword(s):  
Cardiovascular Events ◽  
Recovery Period ◽  
Physical Stress ◽  
Left Ventricular ◽  
Major Adverse Cardiovascular Events ◽  
Takotsubo Syndrome ◽  
Severe Left Ventricular Dysfunction ◽  
Coronary Syndrome

Abstract Takotsubo syndrome is a clinical condition characterized by transient impairment of left ventricular contractility, in association with symptoms, increase in indices of myocardial necrosis, as well as electrocardiographic changes, but without a coronary culprit lesion, and often after a significant psychological or physical stress. Albeit very similar to acute coronary syndrome (ACS) as far as presentation and clinical course, Takotsubo syndrome was considered, up until recently, a condition with very favourable long-term prognosis, in view of the frequent complete functional recovery. More recently, several retrospective observational studies as well as registers, unexpectedly called attention to a significant incidence of major adverse cardiovascular events, not limited to the recovery period but also during the long-term follow-up, in a way very similar to the outcome of patients after ACS. Several negative prognostic factors have been isolated, such as physical stress as trigger of the condition, the presence of severe left ventricular dysfunction, and the consequent cardiogenic shock during the acute phase. These factors are able to classify better the patient’s prognosis, both in the short- and long-term, and identify patients requiring a more stringent clinical follow-up, considering the higher likelihood of adverse cardiovascular events.

scholarly journals Nurse-based secondary preventive follow-up by telephone reduced recurrence of cardiovascular events: a randomised controlled trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anna-Lotta Irewall ◽  
Anders Ulvenstam ◽  
Anna Graipe ◽  
Joachim Ögren ◽  
Thomas Mooe
Keyword(s):  
Randomised Controlled Trial ◽  
Primary Endpoint ◽  
Cardiovascular Events ◽  
Controlled Trial ◽  
Control Group ◽  
Coronary Syndrome ◽  
Secondary Endpoints ◽  
Randomised Controlled

AbstractEnhanced follow-up is needed to improve the results of secondary preventive care in patients with established cardiovascular disease. We examined the effect of long-term, nurse-based, secondary preventive follow-up by telephone on the recurrence of cardiovascular events. Open, randomised, controlled trial with two parallel groups. Between 1 January 2010 and 31 December 2014, consecutive patients (n = 1890) admitted to hospital due to stroke, transient ischaemic attack (TIA), or acute coronary syndrome (ACS) were included. Participants were randomised (1:1) to nurse-based telephone follow-up (intervention, n = 944) or usual care (control, n = 946) and followed until 31 December 2017. The primary endpoint was a composite of stroke, myocardial infarction, cardiac revascularisation, and cardiovascular death. The individual components of the primary endpoint, TIA, and all-cause mortality were analysed as secondary endpoints. The assessment of outcome events was blinded to study group assignment. After a mean follow-up of 4.5 years, 22.7% (n = 214) of patients in the intervention group and 27.1% (n = 256) in the control group reached the primary composite endpoint (HR 0.81, 95% CI 0.68–0.97; ARR 4.4%, 95% CI 0.5–8.3). Secondary endpoints did not differ significantly between groups. Nurse-based secondary preventive follow-up by telephone reduced the recurrence of cardiovascular events during long-term follow-up.

scholarly journals A Novel Clinical and Stress Cardiac Magnetic Resonance (C-CMR-10) Score to Predict Long-Term All-Cause Mortality in Patients with Known or Suspected Chronic Coronary Syndrome

2020 ◽  
Vol 9 (6) ◽  
pp. 1957
Author(s):  
Victor Marcos-Garces ◽  
Jose Gavara ◽  
Jose V Monmeneu ◽  
Maria P Lopez-Lereu ◽  
Nerea Perez ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Coronary Syndrome ◽  
Stress Cardiac Magnetic Resonance ◽  
All Cause Mortality ◽  
Male Sex

Vasodilator stress cardiac magnetic resonance (stressCMR) has shown robust diagnostic and prognostic value in patients with known or suspected chronic coronary syndrome (CCS). However, it is unknown whether integration of stressCMR with clinical variables in a simple clinical-imaging score can straightforwardly predict all-cause mortality in this population. We included 6187 patients in a large registry that underwent stressCMR for known or suspected CCS. Several clinical and stressCMR variables were collected, such as left ventricular ejection fraction (LVEF) and ischemic burden (number of segments with stress-induced perfusion defects (PD)). During a median follow-up of 5.56 years, we registered 682 (11%) all-cause deaths. The only independent predictors of all-cause mortality in multivariable analysis were age, male sex, diabetes mellitus (DM), LVEF and ischemic burden. Based on the weight of the chi-square increase at each step of the multivariable analysis, we created a simple clinical-stressCMR (C-CMR-10) score that included these variables (age ≥ 65 years = 3 points, LVEF ≤ 50% = 3 points, DM = 2 points, male sex = 1 point, and ischemic burden > 5 segments = 1 point). This 0 to 10 points C-CMR-10 score showed good performance to predict all-cause annualized mortality rate ranging from 0.29%/year (score = 0) to >4.6%/year (score ≥ 7). The goodness of the model and of the C-CMR-10 score was separately confirmed in 2 internal cohorts (n > 3000 each). We conclude that a novel and simple clinical-stressCMR score, which includes clinical and stressCMR variables, can provide robust prediction of the risk of long-term all-cause mortality in a population of patients with known or suspected CCS.

scholarly journals Predicting the development of adverse events in patients with acute coronary syndrome including genetics in the long-term follow-up

Kardiologiia ◽  
2020 ◽  
Vol 60 (4) ◽  
pp. 77-85
Author(s):  
E. A. Shmidt ◽  
S. A. Berns ◽  
A. V. Ponasenko ◽  
A. V. Klimenkova ◽  
S. A. Tumanova ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Signs ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Long Term Follow Up

Aim To study a relationship of several factors (clinical and genetical markers) with unfavorable outcomes in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in long-term follow-up.Material and methods This full-design, prospective study included 415 patients with NSTE-ACS. 266 patients were evaluated for the presence of multifocal atherosclerosis (MFA). Typing of polymorphic variants rs1041981 LTA, rs1800629 TNF, rs4986790, and rs498679 TLR4, and also rs3024491 and rs1800872 IL10 was performed. Follow-up period lasted for 67±4 months. By the end of this period, information about clinical outcomes for 396 patients became available.Results During the entire follow-up period, unfavorable outcomes were observed in 239 (57.5 %) patients with NSTE-ACS. The following clinical signs were associated with unfavorable outcomes: history of myocardial infarction, age >56 years, left ventricular ejection fraction (LV EF) ≤50 % and GRACE score ≥100, significant stenosis of brachiocephalic arteries, MFA, carriage of genotype А / А rs1041981 LTA (OR, 6.1; р=0.02) and allele А (OR, 1.9; р=0.01). According to results of a multifactorial analysis, the most significant predictors included LV EF <50 %, MFA, and carriage of genotype А / А rs1041981 LTA.Conclusion Stratification of patients with NSTE-ACS into groups of high or low risk for having an unfavorable outcome within the next 6 years is possible using the prognostic model developed and presented in this study. The model includes the following signs: LV EF <50 %, MFA, and carriage of genotype А / А rs1041981 LTA.

scholarly journals Malnutrition Affects Cholesterol Paradox in Coronary Artery Disease: a 41,229 Chinese Cohort Study

2021 ◽  
Author(s):  
Bo Wang ◽  
Jin Liu ◽  
Shiqun Chen ◽  
Ming Ying ◽  
Guanzhong Chen ◽  
...  
Keyword(s):  
Cox Regression ◽  
Cox Model ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
Chinese Cohort ◽  
Artery Disease

Abstract Background: Several studies found that baseline low LDL-C concentration was associated with poor prognosis in patients with acute coronary syndrome (ACS), which was called “cholesterol paradox”. Low LDL-C concentration may reflect underlying malnutrition, which was strongly associated with increased mortality. We objected to investigate the cholesterol paradox in patients with CAD and the effects of malnutrition.Method: A total of 41,229 CAD patients admitted to Guangdong Provincial People's Hospital in China were included in this study from January 2007 to December 2018, and divided into two groups (LDL-C < 1.8 mmol/L, n=4,863; LDL-C ≥ 1.8 mmol/L, n = 36,366). We used Kaplan-Meier method and Cox regression analyses to assess the association between LDL-C levels and long-term all-cause mortality and the effect of malnutrition. Result: In this real-world cohort (mean age 62.94 years; 74.94% male), there were 5257 incidents of all-cause death during a median follow-up of 5.20 years [Inter-quartile range (IQR): 3.05-7.78 years]. Kaplan–Meier analysis showed that low LDL-C levels were associated with worse prognosis. After adjusting for baseline confounders (e.g., age, sex and comorbidities, etc.), multivariate Cox regression analysis revealed that low LDL-C level (<1.8mmol/L) was not significantly associated with all-cause mortality (adjusted HR, 1.04; 95% CI, 0.96-1.24). After adjustment of nutritional status, risk of all-cause mortality of patients with low LDL-C level decreased (adjusted HR, 0.90; 95% CI, 0.83-0.98). In the final multivariate Cox model, low LDL-C level was related to better prognosis (adjusted HR, 0.91; 95% CI, 0.84-0.99).Conclusion: Our results demonstrate that the cholesterol paradox persisted in CAD patients, but disappeared after accounting for the effects of malnutrition.

scholarly journals Atrial Fibrillation Is Associated with Increased Mortality in Patients Presenting with Ventricular Tachyarrhythmias

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Michael Behnes ◽  
Jonas Rusnak ◽  
Gabriel Taton ◽  
Tobias Schupp ◽  
Linda Reiser ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cox Regression ◽  
Ventricular Tachyarrhythmia ◽  
Prognostic Impact ◽  
Ventricular Tachyarrhythmias ◽  
Lv Dysfunction ◽  
Kaplan Meier ◽  
All Cause Mortality

Abstract Heterogenous data about the prognostic impact of atrial fibrillation (AF) in patients with ventricular tachyarrhythmias exist. Therefore, this study evaluates this impact of AF in patients presenting with ventricular tachyarrhythmias. 1,993 consecutive patients presenting with ventricular tachyarrhythmias (i.e. ventricular tachycardia and fibrillation (VT, VF)) on admission at one institution were included (from 2002 until 2016). All medical data of index and follow-up hospitalizations were collected during the complete follow-up period for each patient. Statistics comprised univariable Kaplan-Meier and multivariable Cox regression analyses in the unmatched consecutive cohort and after propensity-score matching for harmonization. The primary prognostic endpoint was long-term all-cause mortality at 2.5 years. AF was present in 31% of patients presenting with index ventricular tachyarrhythmias on admission (70% paroxysmal, 9% persistent, 21% permanent). VT was more common (67% versus 59%; p = 0.001) than VF (33% versus 41%; p = 0.001) in AF compared to non-AF patients. Long-term all-cause mortality at 2.5 years occurred more often in AF compared to non-AF patients (mortality rates 40% versus 24%, log rank p = 0.001; HR = 1.825; 95% CI 1.548–2.153; p = 0.001), which may be attributed to higher rates of all-cause mortality at 30 days, in-hospital mortality and mortality after discharge (p < 0.05) (secondary endpoints). Mortality differences were observed irrespective of index ventricular tachyarrhythmia (VT or VF), LV dysfunction or presence of an ICD. In conclusion, this study identifies AF as an independent predictor of death in patients presenting consecutively with ventricular tachyarrhythmias.

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