P1868Risk of arrhythmias after myocardial infarction in patients with left ventricular systolic dysfunction according to mode of revascularization: a CARISMA substudy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Thomsen ◽  
S Pedersen ◽  
P K Jacobsen ◽  
H V Huikuri ◽  
P E Bloch Thomsen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Loop Recorder ◽  
Ventricular Ejection Fraction ◽  
New Onset

Abstract Introduction The CARISMA trial was the first study to use continuous monitoring for documentation of long-term arrhythmias in post-infarction patients with left ventricular dysfunction. During the study duration (2000–2005), primary PCI (pPCI) as treatment of acute myocardial infarction was introduced approximately midway (2002) on the enrolling centres. Purpose The aim of this study was to describe the influence of mode of revascularization after myocardial infarction (AMI) on long-term risk of risk of new onset atrial fibrillation, ventricular tachyarrhythmias and brady arrhythmias. Methods The study is a sub-study on the CARISMA study population that consisted of patients with AMI and left ventricular ejection fraction ≤40%, which received an implantable loop recorder and was followed for 2 years. After exclusion of 15 patients who refused device implantation and 26 with pre-existing arrhythmias, 268 of the 312 patients were included. Choice of revascularization was made by the treating team independently of the trial and was retrospectively divided into primary percutaneous intervention (pPCI), subacute PCI (24 hours to 2 weeks after AMI), primary thrombolysis or no revascularization. Endpoints were new-onset of arrhythmias and major cardiovascular events (MACE). The Kaplan-Meier (figure 1) and Mantel-Byar methods were used for time to first event risk analysis. Results A total of 77 patients received no revascularization, whereas 49 received thrombolysis only and 142 received PCI. At two-years follow up patients treated with any PCI had a significant lower risk (0.40, n=63) of any arrhythmia compared to patients treated with trombolysis (0.60, n=30) or no revascularization (0.68, n=16) (p<0.001, unadjusted) (figure 1). Risk of MACE was significant higher in patients with any arrhythmia (0.25, n=76) compared to no arrhythmia (0.11, n=93) at two years follow-up (p=0.004, unadjusted). Figure 1 Conclusion(s) The long-term risk of new onset arrhythmias after AMI was significantly lower in patients treated with any PCI compared to patients not revascularized or treated with thrombolysis. Risk of MACE was significantly higher in patients with new onset arrhythmias compared to patients with no arrhythmias.

Risk of arrhythmias after myocardial infarction in patients with left ventricular systolic dysfunction according to mode of revascularization: a Cardiac Arrhythmias and RIsk Stratification after Myocardial infArction (CARISMA) substudy

EP Europace ◽  
2020 ◽  
Author(s):  
Anna F Thomsen ◽  
Peter Karl Jacobsen ◽  
Lars Køber ◽  
Rikke Moerch Joergensen ◽  
Heikki V Huikuri ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Stratification ◽  
Cardiac Arrhythmias ◽  
Left Ventricular Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Subsequent Risk ◽  
New Onset

Abstract Aims The Cardiac Arrhythmias and RIsk Stratification after Myocardial infArction (CARISMA) study was an observational trial including 312 patients with acute myocardial infarction (MI) and left ventricular ejection fraction (LVEF) &lt;40%. Primary percutaneous intervention (pPCI) was introduced 2 years after start of the enrolment, dividing the population into two groups: pre- and post-pPCI. This substudy sought to describe the influence of the mode of revascularization on long-term risk of new-onset atrial fibrillation (AF), bradyarrhythmia, and ventricular tachycardia and the subsequent risk of relevant major cardiovascular events (MACE). Methods and results The study included the 268 patients without a history of AF. All patients received an implantable cardiac monitor (ICM) and were followed for 2 years. The choice of revascularization was made by the treating team independently of the trial and retrospectively divided into pPCI, subacute PCI, primary thrombolysis, or no revascularization. Endpoints were new-onset arrhythmia and MACE. A total of 77 patients received no revascularization, whereas 49 received thrombolysis only and 142 received any PCI. The adjusted hazard ratio (HR) for developing any arrhythmia and the subsequently risk of MACE were increased in non-revascularized or thrombolysed patients compared with PCI-patients (any arrhythmia, non-revascularization: HR = 1.7, P = 0.01 and thrombolysis: HR = 1.6, P = 0.05; MACE, non-revascularization: HR = 3.1, P = 0.05 and thrombolysis: HR = 3.1, P = 0.08). All HRs were adjusted for significant baseline and clinically considered covariates and stratified for calendar year. Conclusion This study is the first to demonstrate that the long-term risk of arrhythmia documented by an ICM and the subsequent risk of MACE were increased in non-revascularized or thrombolysed patients compared with PCI-patients in a post-MI population with LVEF &lt;40%.

scholarly journals Trimethylamine N-Oxide Was Not Associated With 30-Day Left Ventricular Systolic Dysfunction in Patients With a First Anterior ST-Segment Elevation Myocardial Infarction After Primary Revascularization: A Sub-analysis From an Optical Coherence Tomography Registry

2020 ◽  
Vol 7 ◽  
Author(s):  
Jinying Zhou ◽  
Shiqin Yu ◽  
Yu Tan ◽  
Peng Zhou ◽  
Chen Liu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation

Objective: Left ventricular systolic dysfunction (LVSD) after ST-segment elevation myocardial infarction (STEMI) is associated with poor outcome. Trimethylamine N-oxide (TMAO), a gut metabolite, is linked to cardiovascular diseases but its relationship with LVSD after STEMI remains unclear. The present study therefore aimed to investigate the relationship between TMAO and LVSD at 30 days after a first anterior STEMI.Methods: This was a sub-study from the OCTAMI (Optical Coherence Tomography Examination in Acute Myocardial Infarction) registry. Eligible patients were included in current study if they: (1) presented with a first anterior STEMI; (2) had available baseline TMAO concentration; (3) completed a cardiovascular magnetic resonance examination at 30 days after STEMI. LVSD was defined as left ventricular ejection fraction &lt; 50%. Associations between TMAO and left ventricular ejection fraction, infarct size and left ventricular global strain were examined.Results: In total, 78 patients were included in final analysis. Overall, TMAO was moderately associated with peak cTnI (r = 0.27, p = 0.01), age (r = 0.34, p &lt; 0.01), and estimated glomerular filtration rate (r = −0.30, p &lt; 0.01). At 30-day follow-up, 41 patients were in the LVSD group and 37 in the non-LVSD group. Baseline TMAO levels were not significantly different between the two groups (LVSD vs. non-LVSD: median 1.9 μM, 25−75th percentiles 1.5–3.3 μM vs. median 1.9 μM, 25−75th percentiles 1.5–2.7 μM; p = 0.46). Linear regression analyses showed that TMAO was not associated with left ventricular ejection fraction, infarct size or left ventricular global strain at 30 days (all p &gt; 0.05).Conclusions: TMAO was not significantly correlated with 30-day LVSD in patients with a first anterior STEMI after primary revascularization.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03593928.

scholarly journals Antialdosterone in Acute Myocardial Infarction patients: a Meta-Analysis and Systematic Review

2021 ◽  
Author(s):  
Qiao Chen ◽  
Zhuqing Li ◽  
Die Zhao ◽  
Jie Sun ◽  
Yiling Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ventricular Remodeling ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cochrane Library ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

Abstract Purpose: A comprehensive evaluation of the benefits of mineralocorticoid receptor antagonists (MRA) in acute myocardial infarction (AMI) patients is lacking. We aimed to summarize the evidence on the efficacy and safety of MRA in post-AMI patients.Methods: Articles were identified through PubMed, Embase, Cochrane Library, Ovid (Medline1946-2021) and ClinicalTrials.gov databases from their inception to Dec 31, 2020. Results: MRA reduced the risk of all-cause mortality by 16% (relative ratio(RR) 0.84, 95% confidence interval(CI) (0.76,0.94), P=.002), new or worsening heart failure (HF) 14% (RR 0.86, 95%CI (0.78,0.96), P=.007), death from HF by 22% (RR 0.78, 95%CI (0.62,0.99), P=.04), and cardiovascular death by 16% (RR 0.84, 95%CI (0.74,0.94), P=.003) in post-AMI patients. Meanwhile, all-cause mortality was reduced by 38% (RR 0.62, 95%CI (0.42,0.90), P=.01), 30% (RR 0.70, 95%CI (0.49,1.00), P=.05), and 29% (RR 0.71, 95%CI (0.59,0.86), P=.0004) in ST-elevation myocardial infarction (STEMI) patients and those who initiated MRA treatment within 3 days and (3,7) days, respectively. Post-AMI patients without left ventricular systolic dysfunction (LVSD) treated with MRA improved left ventricular ejection fraction (mean difference[MD] 2.74, 95%CI (2.49,2.99), P<.00001) and reduced left ventricular end-systolic and end-diastolic volume indices (MD -6.23, 95%CI (-10.93,-1.52), P=.009; MD -3.13, 95%CI (-5.79,-0.47), P=.02). The corresponding RR were 1.73 (95%CI (1.44,2.08), P<.00001) for considered common side effects (hyperkalemia and gynecomastia).Conclusion: Our findings suggest that all-cause mortality is lower in STEMI patients and in patients initiating MRA within 7 days, and that post-AMI patients without LVSD have improved left ventricular remodeling and cardiac function.

scholarly journals Antialdosterone in Acute Myocardial Infarction patients: a Meta-Analysis and Systematic Review

2021 ◽  
Author(s):  
Qiao Chen ◽  
Die Zhao ◽  
Jie Sun ◽  
Chengzhi Lu
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ventricular Remodeling ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cochrane Library ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

Abstract We aimed to summarize the evidence on the efficacy and safety of mineralocorticoid receptor antagonists (MRA) in post acute myocardial infarction (AMI) patients. Articles were identified through PubMed, Embase, Cochrane Library, Ovid (Medline1946-2021) and ClinicalTrials.gov databases from their inception to December 31, 2020. MRA reduced the risk of all-cause mortality by 16% (relative ratio (RR) 0.84, 95% confidence interval (CI) (0.76, 0.94), P = 0.002). Meanwhile, all-cause mortality was reduced by 38% (RR 0.62, 95% CI (0.42, 0.90), P = 0.01), 30% (RR 0.70, 95% CI (0.49, 1.00), P = 0.05), and 29% (RR 0.71, 95% CI (0.59, 0.86), P = 0.0004) in ST-elevation myocardial infarction (STEMI) patients and those who initiated MRA treatment within 3 days and (3,7) days, respectively. Post-AMI patients without left ventricular systolic dysfunction (LVSD) treated with MRA improved left ventricular ejection fraction (mean difference [MD] 2.74, 95% CI (2.49, 2.99), P < 0.00001) and reduced left ventricular end-systolic and end-diastolic volume indices (MD -6.23, 95% CI (-10.93, -1.52), P = 0.009; MD -3.13, 95% CI (-5.79, -0.47), P = 0.02). The corresponding RR were 1.73 (95% CI (1.44, 2.08), P < 0.00001) for considered common side effects (hyperkalemia and gynecomastia). Our findings suggest that all-cause mortality is lower in STEMI patients and in patients initiating MRA within 7 days, and that post-AMI patients without LVSD have improved left ventricular remodeling and cardiac function.

Mortality and morbidity reduction after frequent premature ventricular complexes ablation in patients with left ventricular systolic dysfunction

EP Europace ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1079-1087 ◽  
Author(s):  
Antonio Berruezo ◽  
Diego Penela ◽  
Beatriz Jáuregui ◽  
David Soto-Iglesias ◽  
Luis Aguinaga ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Cardiac Transplantation ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Mortality ◽  
Ventricular Ejection Fraction

Aims Ablation of frequent premature ventricular complexes (PVCs) improves left ventricular ejection fraction in patients with left ventricular (LV) systolic dysfunction. This study aims to evaluate the long-term hard outcomes and potential prognostic variables in this population. Methods and results Prospective multicentre study including 101 consecutive patients [56 ± 12 years old, 62 (61%) men] with LV systolic dysfunction and frequent PVCs who underwent PVC ablation before November 2015. The last evaluation performed was considered the long-term follow-up (LTFUP) evaluation. Mean follow-up was 34 ± 16 months (range 24–84 months). Ablation was successful in 95 (94%) patients. There was a significant reduction in the PVC burden from 21 ± 12% at baseline to 3.8 ± 6% at LTFUP, P < 0.001. Left ventricular ejection fraction improved from 32 ± 8% at baseline to 39 ± 12% at LTFUP (P < 0.001) and New York Heart Association class from 2.2 ± 0.6% to 1.3 ± 0.6% (P < 0.001). Brain natriuretic peptide levels decreased from 136 (78–321) to 68 (32–144) pg/mL (P = 0.007). Most of this improvement occurs during the first 6 months after ablation. Persistent abolition of at least 18 points of the baseline PVC burden was independently and inversely associated with the composite endpoint of cardiac mortality, cardiac transplantation, or hospitalization for heart failure during follow-up [hazard ratio 0.18 (0.05–0.66), P = 0.01]. Conclusion In patients with LV systolic dysfunction, ablation of frequent PVCs induces a significant improvement in functional, structural, and neurohormonal status, which persists at LTFUP. A sustained reduction in the baseline PVC burden is associated with a lower risk of cardiac mortality, cardiac transplantation, or hospitalization for heart failure during follow-up.

scholarly journals Aldosterone Blockade in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-18
Author(s):  
Qiao Chen ◽  
Die Zhao ◽  
Jie Sun ◽  
Chengzhi Lu
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Adverse Events ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cochrane Library ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

Background. A comprehensive evaluation of the benefits of mineralocorticoid receptor antagonists (MRA) in acute myocardial infarction (AMI) patients is lacking. Objective. To summarize the evidence on the efficacy and safety of MRA in patients admitted for AMI. Methods. Articles were identified through PubMed, Embase, Cochrane Library, Ovid (Medline1946-2021), and ClinicalTrials.gov databases from their inception to December 31, 2020. Results. 15 articles with a total of 11,861 patients were included. MRA reduced the risk of all-cause mortality by 16% (relative ratio (RR): 0.84; 95% confidence interval (CI) (0.76, 0.94); P = 0.002 ) and the incidence of cardiovascular adverse events by 12% (RR: 0.88, 95% CI (0.83, 0.93), P < 0.00001 ) in post-AMI patients, and further analysis demonstrated that early administration of MRA within 7 days after AMI resulted in a greater reduction in all-cause mortality (RR: 0.72, 95% CI (0.61, 0.85), P < 0.0001 ). Subgroup analyses showed that post-STEMI patients without left ventricular systolic dysfunction (LVSD) treated with MRA had a 36% reduction in all-cause mortality (RR: 0.64, 95% CI (0.46, 0.89), P = 0.007 ) and a 22% reduction in cardiovascular adverse events (RR: 0.78, 95% CI (0.67, 0.91), P = 0.002 ). Meanwhile, post-STEMI patients without LVSD treated with MRA get significant improvements in left ventricular ejection fraction (mean difference (MD): 2.69, 95% CI (2.44, 2.93), P < 0.00001 ), left ventricular end-systolic index (MD: -4.52 ml/m2, 95% CI (-8.21, -0.83), P = 0.02 ), and left ventricular end-diastolic diameter (MD: -0.11 cm, 95% CI (-0.22, 0.00), P = 0.05 ). The corresponding RR were 1.72 (95% CI (1.43, 2.07), P < 0.00001 ) for considered common adverse events (hyperkalemia, gynecomastia, and renal dysfunction). Conclusions. Our findings suggest that MRA treatment reduces all-cause mortality and cardiovascular adverse events in post-AMI patients, which is more significant in patients after STEMI without LVSD. In addition, MRA treatment may exert beneficial effects on the reversal of cardiac remodeling in patients after STEMI without LVSD.

Clinical, Electrocardiographic and Echocardiographic Profile of Ischemic Cardiomyopathy: An analysis of 100 cases.

2021 ◽  
Vol 35 (2) ◽  
pp. 121-127
Author(s):  
Mainul Islam ◽  
M Atahar Ali ◽  
Umme Habiba Ferdaushi ◽  
Shaila Nabi ◽  
Sayeedur Rahman Khan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Data Analysis ◽  
Mitral Regurgitation ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Anterior Myocardial Infarction ◽  
Ventricular Ejection Fraction

Background: Ischemic heart disease (IHD) is one of the leading cause of morbidity and mortality worldwide. Ischemic cardiomyopathy (ICM) is a delayed complication of IHD that arises as dilated cardiomyopathy with depressed ventricular function, which cannot be attributed entirely to coronary artery obstruction or ischemic injury. Objectives: To evaluate the clinical, electrocardiographic and echocardiographic profile of patients presenting with ischemic cardiomyopathy. Methods: In this cross sectional observational study 100 patients of ischemic cardiomyopathy admitted in hospital or visited OPD in NICVD, Dhaka from March’15 to Sept’15 were studied. Enrollment of the patients were done after fulfilling the inclusion and exclusion criteria. Clinical, electrocardiographic and echocardiographic data were collected then data analysis was done. Results: Data analysis of 100 patients was showed age range was 40-80 years and mean age was 61.4±7.9 years. 79% subjects were male. Most common symptoms were dyspnea (93%), chest pain(73%), palpitation (39%) and edema (23%). Most patients were in NYHA functional class lV (43%). 64% cases had history of anterior myocardial infarction (MI), 22% had inferior MI, 25% had H/O PTCA and 7% had CABG. 71% subjects had tachycardia, 65% had lungs basal rales, 56% had systolic blood pressure below 100 mmhg and 25% had edema. ECG findings was as follows sinus rhythm (85%), Sinus tachycardia 71%, AF 15%, LBBB 34%, RBBB 12%, pathological Q in anterior surface 65% and inferior surface 21%, non specific ST-T changes 41% and PVCs was found in 17%.On echocardiography ,anterior wall hypokinesia was seen in 52% and global hypokinesia in 43%. Mean left ventricular ejection fraction (LVEF) was 31±5.9% and mean left ventricular internal diastolic diameter (LVIDd) was 6.5±0.4 cm. (59%) subjects had mitral regurgitation (MR) grade-l and 20% had MR grade-ll. Conclusion: The clinical presentation of ischemic cardiomyopathy varies from patient to patient. Severity of symptoms correlates with severity of left ventricular systolic dysfunction, left ventricular diameter and mitral regurgitation grade . Anterior Myocardial infarction has more chance to develop ischemic cardiomyopathy. Bangladesh Heart Journal 2020; 35(2) : 121-127

scholarly journals Multivessel versus IRA-only PCI in patients with NSTEMI and severe left ventricular systolic dysfunction

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258525
Author(s):  
Myunhee Lee ◽  
Dae-Won Kim ◽  
Mahn-Won Park ◽  
Kyusup Lee ◽  
Sung-Ho Her ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Confidence Interval ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Left Ventricular Ejection ◽  
Ventricular Systolic Dysfunction ◽  
Ventricular Ejection Fraction ◽  
Number Of Patients

Background A substantial number of patients presenting with non-ST-elevation myocardial infarction (NSTEMI) and multivessel disease (MVD) have severe left ventricular systolic dysfunction (LVSD) (left ventricular ejection fraction (LVEF) less than 35%). But data are lacking regarding optimal percutaneous coronary intervention (PCI) strategy for these patients. The aim of this study was to compare the long-term outcomes of IRA (infarct-related artery)-only and multivessel PCI in patients with NSTEMI and MVD complicated by severe LVSD. Methods Among 13,104 patients enrolled in the PCI registry from November 2011 to December 2015, patients with NSTEMI and MVD with severe LVSD who underwent successful PCI were screened. The primary outcome was 3-year major adverse cardiovascular events (MACEs), defined as all-cause death, any myocardial infarction, stroke, and any revascularization. Results Overall, 228 patients were treated with IRA-only PCI (n = 104) or MV-PCI (n = 124). The MACE risk was significantly lower in the MV-PCI group than in the IRA-only PCI group (35.5% vs. 54.8%; hazard ratio [HR] 0.561; 95% confidence interval [CI] 0.378–0.832; p = 0.04). This result was mainly driven by a significantly lower risk of all-cause death (23.4% vs. 41.4%; hazard ratio [HR] 0.503; 95% confidence interval [CI] 0.314–0.806; p = 0.004). The results were consistent after multivariate regression, propensity-score matching, and inverse probability weighting to adjust for baseline differences. Conclusions Among patients with NSTEMI and MVD complicated with severe LVSD, multivessel PCI was associated with a significantly lower MACE risk. The findings may provide valuable information to physicians who are involved in decision-making for these patients.

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