scholarly journals Surgical Treatment of Concomitant Atrial Fibrillation: Focus onto Atrial Contractility

2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Claudia Loardi ◽  
Francesco Alamanni ◽  
Claudia Galli ◽  
Moreno Naliato ◽  
Fabrizio Veglia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Left Ventricular ◽  
Maze Procedure ◽  
Right Atrial ◽  
Lv Function ◽  
Factors Associated ◽  
Procedural Success ◽  
Cox Analysis

Background. Maze procedure aims at restoring sinus rhythm (SR) and atrial contractility (AC). This study evaluated multiple aspects of AC recovery and their relationship with SR regain after ablation.Methods. 122 mitral and fibrillating patients underwent radiofrequency Maze. Rhythm check and echocardiographic control of biatrial contractility were performed at 3, 6, 12, and 24 months postoperatively. A multivariate Cox analysis of risk factors for absence of AC recuperation was applied.Results. At 2-years follow-up, SR was achieved in 79% of patients. SR-AC coexistence increased from 76% until 98%, while biatrial contraction detection augmented from 84 to 98% at late stage. Shorter preoperative arrhythmia duration was the only common predictor of SR-AC restoring, while pulmonary artery pressure (PAP) negatively influenced AC recuperation. Early AC restoration favored future freedom from arrhythmia recurrence. Minor LA dimensions correlated with improved future A/E value and vice versa. Right atrial (RA) contractility restoring favored better left ventricular (LV) performance and volumes.Conclusions. SR and left AC are two interrelated Maze objectives. Factors associated with arrhythmia “chronic state” (PAP and arrhythmia duration) are negative predictors of procedural success. Our results suggest an association between postoperative LA dimensions and “kick” restoring and an influence of RA contraction onto LV function.

Abstract P023: Risk Factors Associated with Progression of Subclinical Diastolic Dysfunction in a Multiethnic Population

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Lili Zhang ◽  
Jian Shan ◽  
Cynthia Taub
Keyword(s):  
Risk Factors ◽  
Renal Disease ◽  
Diastolic Dysfunction ◽  
Significant Risk ◽  
Left Ventricular ◽  
Cumulative Probability ◽  
Factors Associated ◽  
Hispanic Patients ◽  
Multiethnic Population

Background: Subclinical diastolic dysfunction is defined as echocardiographic evidence of left ventricular diastolic dysfunction and normal ejection fraction (EF) without congestive heart failure (HF) symptoms/diagnosis. Our study, for the first time, sought to examine risk factors associated with progression from subclinical diastolic dysfunction to overt HF in a large multiethnic population. Methods: The study population included patients with asymptomatic diastolic dysfunction and EF ≥ 50% assessed by transthoracic echocardiogram between 2003 and 2008 at Montefiore Medical Center, Bronx, NY. Patients with preexisting HF, valvular heart disease or atrial fibrillation prior were excluded. The end point was the development of HF by September 1, 2013. Multivariable adjusted Cox proportional hazards models, determined by stepwise selection method, were performed to examine risk factors associated with the development of HF. All analyses were also performed with adjustment and stratification of race. Results: A total of 7,879 patients, with 21% European Americans (EA), 36% African Americans (AA), 31% Hispanics, and 12% others or unknown, were included in the analysis. Mean follow up time was 6.3 years. Mean age of the cohort was 68±12, with 63% women. The overall cumulative probability of development of HF was 17% (19% in EA, 17% in AA, 19% in Hispanic patients) during the follow up period. In multivariable Cox proportional hazard regression analysis, renal disease (hazard ratio (HR)=1.6, 95% confidence interval (CI) 1.3-2.0, P<0.001) and hemoglobin levels (HR=0.9, 95% CI 0.9-1.0, P=0.001) were significantly associated with the development of HF in overall population. In stratification analysis, age (P=0.012) and hypertension (P=0.007) were independent risk factors for HF in Hispanic patients, but not in EA and AA. Conclusions: In a large multiethnic population with subclinical diastolic dysfunction, renal disease and hemoglobin levels were independently associated with development of HF in overall population.. Age and hypertension were significant risk factors for HF only in Hispanic patients. These results may have important implications in preventing the development of HF from subclinical stage.

scholarly journals P1441 Predictors of systemic embolisms in a large cohort of left ventricular noncompaction patients

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Casas ◽  
G Oristrell ◽  
J Limeres ◽  
R Barriales ◽  
J R Gimeno ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Noncompaction ◽  
Severe Phenotype ◽  
Ventricular Noncompaction ◽  
Increased Risk

Abstract BACKGROUND Left ventricular noncompaction (LVNC) is associated with an increased risk of systemic embolisms (SE). However, incidence and risk factors are not well established. PURPOSE To evaluate the rate of SE in LVNC and describe risk factors. METHODS LNVC patients were included in a multicentric registry. Those with SE were considered for the analysis. RESULTS 514 patients with LVNC from 10 Spanish centres were recruited from 2000 to 2018. During a median follow-up of 4.2 years (IQR 1.9-7.1), 23 patients (4.5%) had a SE. Patients with SE (Table 1) were older at diagnosis, with no differences in gender and had similar cardiovascular risk factors. They were more frequently under oral anticoagulation (OAC). Besides, they had a more reduced LVEF, and more dilated LV and left atrium (LA). Late gadolinium enhancement (LGE) was more frequent, altogether suggesting a more severe phenotype. Patients with SE had non-significantly higher rates of hospitalization for heart failure (33% Vs 24%, p = 0.31) and atrial fibrillation (35% Vs 19%, p = 0.10). In multivariate analysis, only LA diameter was an independent predictor of SE (OR 1.04, p = 0.04). A LA diameter &gt; 45 mm had an independent 3 fold increased risk of SE (OR 3.04, p = 0.02) (Image 1). CONCLUSIONS LVNC carries a moderate mid-term risk of SE, which appears to be irrespective of atrial fibrillation and associated with age, LV dilatation and systolic dysfunction and mainly LA dilatation. This subgroup of patients should be considered for oral anticoagulation in primary prevention. Table 1 Systemic embolisms (n = 23) No systemic embolisms (n = 491) p Men, n (%) 15 (65) 289 (56) 0.52 Median age at diagnosis (IQR) - yr 60 (48-76) 48 (30-64) 0.02 Median follow up (IQR) - yr 5.9 (3.1-7.8) 4.2 (1.8-7.1) 0.18 OAC, n (%) 19 (83) 118 (24) 0.01 LVEF (SD) - % 37 (15) 48 (17) 0.01 LVEDD (SD) - mm 58 (11) 54 (10) 0.04 LA diameter (SD) - mm 46 (9) 39 (9) 0.01 Characteristics of patients with and without systemic embolisms Abstract P1441 Figure. Image 1

scholarly journals Acute kidney injury predicts poor left ventricular function for patients with peripartum cardiomyopathy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiajia Zhu ◽  
Wenxian Liu
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Ventricular Ejection Fraction ◽  
Factors Associated ◽  
Recovery Group

Abstract Background The aim of this study was to explore the risk factors associated with a poor left ventricular (LV) function among patients with peripartum cardiomyopathy (PPCM) and to determine the influence of acute kidney injury (AKI) on the LV function of the patients. Methods Sixty patients with PPCM were recruited between January 2007 and June 2018, among which 11 had AKI. The participants were divided into two groups, the recovery group (32 cases) and the nonrecovery group (28 cases), with their clinical features, echocardiography and electrocardiogram findings, laboratory results, and treatments compared between groups. We further determined the risk factors associated with nonrecovery and the influence posed by AKI on the LV function of the patients. Results Compared with the patients in the recovery group, those in the nonrecovery group had higher proportions of multiparity [78.6% (22/28) vs. 43.8% (14/32)], function class III– IV heart failure [92.9% (26/28) vs. 71.9% (23/32)], and a higher incidence of AKI [35.7% (10/28) vs. 3.1% (1/32)]. Logistic regression analysis showed that having AKI [odds ratio (OR): 10.556; 95% confidence interval (CI) 1.177–94.654; P = 0.035] and left ventricular ejection fraction (LVEF) < 40% [OR: 4.533; 95% CI 1.118–18.382; P = 0.034] were independently associated with nonrecovery of PPCM. Conclusions The prognosis of patients with PPCM and AKI during hospitalization was poor compared to those without AKI; therefore, clinicians should pay more attention to this phenomenon.

scholarly journals Should we keep performing electrical cardioversion in atrial fibrillation/flutter?

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R Menezes Fernandes ◽  
T.F Mota ◽  
H.A Costa ◽  
M Espirito Santo ◽  
D Bento ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Therapeutic Option ◽  
Outpatient Setting ◽  
Left Ventricular ◽  
Electrical Cardioversion ◽  
Lv Function ◽  
Safe Procedure ◽  
Male Predominance

Abstract Introduction Atrial fibrillation (AF) and atrial flutter (AFL) are frequently diagnosed arrhythmias in the outpatient setting or in the Emergency Department. Electrical cardioversion (EC) is a therapeutic option when a rhythm control strategy is pursued. Purpose To evaluate the clinical outcomes of patients with AF/AFL referred to EC and to analyse the procedures' complications. Methods We conducted a retrospective study enrolling patients with AF/AFL referred to EC in our Cardiology Department, from September 2011 to September 2020. Clinical characteristics, echocardiographic studies and follow-up data were analysed. Primary endpoint was the incidence of ischemic stroke during follow-up. Results A total of 719 patients were referred to EC during the 9-year period, with a median age of 67 years-old and 70,4% male predominance. Most patients were cardioverted in an outpatient setting (60,6%) and 21% had AFL. 62,1% had persistent AF/AFL, 19,6% presented with first diagnosed AF/AFL and 17,2% had paroxysmal episodes. EC was successfully performed in 93,2% and 0,3% had major non-fatal immediate complications. Arterial hypertension was present in 57,3% of patients, 20,4% had diabetes, 34,6% were obese, 13,3% mentioned alcohol consumption and 6,3% had sleep apnea. Previous stroke was diagnosed in 6,8% and 19% had ischemic heart disease. Left ventricular (LV) ejection fraction (LVEF) was preserved in 66,7%. Median CHA2DS2-VASc score was 2,0 and 89,8% were anticoagulated (75,7% with non-vitamin K antagonist oral anticoagulants). Antiarrhythmic therapy was prescribed in 85% and 64,5% maintained sinus rhythm one-year after EC. After EC, it was documented complete reversal of LV systolic dysfunction in 46,3% of patients with previously reduced LVEF, confirming the diagnosis of arrhythmia-induced cardiomyopathy (AIC). During a median follow-up of 1355 days, ischemic stroke occurred in 4,8%, but only 5 patients had an embolic event in the first week after EC (0,7% stroke rate at one week, the same at one month). AIC was associated to a lower rate of cardiovascular death (3,8% vs 25,5%; p=0,002), comparing to patients who did not recover LV function. Conclusion EC is a safe procedure, with a very low rate of immediate and embolic complications. AIC was diagnosed in 46,3% of patients with previously reduced LVEF and it was associated with a significantly lower rate of CV death. EC should be considered to relieve patients' symptoms and when there is suspicion of AIC. FUNDunding Acknowledgement Type of funding sources: None.

Abstract 17132: Risk Factors for Anthracycline And/or Herceptin-induced Left Ventricular Systolic Dysfunction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yasmin S Hamirani ◽  
Ali El Sayed ◽  
Patrick Dillon ◽  
Andrew Wong ◽  
Pooja Mehra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Lv Function ◽  
Fisher Exact Test ◽  
Ventricular Systolic Dysfunction ◽  
Exact Test ◽  
The Difference

Introduction: Anthracyclines (ANT) and Herceptin (HER) are known to cause left ventricular (LV) systolic dysfunction and congestive heart failure (CHF). We aimed to identify the clinical risk factors associated with reduced LV function caused by one or both agents. Methods: We retrospectively examined our electronic records for patients that received ANT and/or HER from 2000-2013 and identified 3253 patients. 2704 were excluded for lack of a follow-up EF assessment (2699) or development of CAD (5) after the start of chemotherapy. Of the remaining 216 patients, 27 (12.5%) had a drop in EF after chemotherapy of >10% to below 50% and 185 (86.6%) did not. Kruskal Wallis test and Fisher exact test were utilized to estimate the difference between groups, and logistic regression model was used to predict a fall in EF. Results: More patients with a fall in EF had hypertension (HTN), hyperlipidemia (HL) and CAD (Table). A higher % of patients with a fall in EF received both HER and ANT as compared to ANT alone (36% vs 9.5% p=0.001). Higher use of liposomal doxorubicin was seen in the group with no reduction in EF. The median (IQR) time difference (days) between start of chemotherapy and reduced EF was 213 (76-761) and the doxorubicin dose in this group was 240 (128.5-254) mg/m2. On multivariate analysis hypertension and use of Herceptin remained independent predictors of EF fall. Conclusion: HTN, HL, CAD and concomitant HER use were univariate predictors of EF decline, while only HTN and HER were independent multivariate predictors. Given the prevalence of reduced EF at follow-up, late assessment of EF is indicated to avoid missing chemotherapy-induced cardiotoxicity.

P5555Predictors of systemic embolisms in a large cohort of left ventricular noncompaction patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Casas ◽  
G Oristrell ◽  
J Limeres ◽  
A Sao-Aviles ◽  
R Barriales ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Oral Anticoagulation ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Noncompaction ◽  
Severe Phenotype ◽  
Ventricular Noncompaction ◽  
Increased Risk

Abstract Background Left ventricular noncompaction (LVNC) is associated with an increased risk of systemic embolisms (SE). However, incidence and risk factors are not well established. Purpose To evaluate the rate of SE in LVNC and describe risk factors. Methods LNVC patients were included in a multicentric registry. Those with SE were considered for the analysis. Results 514 patients with LVNC from 10 Spanish centres were recruited from 2000 to 2018. During a median follow-up of 4.2 years (IQR 1.9–7.1), 23 patients (4.5%) had a SE. Patients with SE (Table 1) were older at diagnosis, with no differences in gender and had similar cardiovascular risk factors. They were more frequently under oral anticoagulation (OAC). Besides, they had a more reduced LVEF, and more dilated LV and left atrium (LA). Late gadolinium enhancement (LGE) was more frequent, altogether suggesting a more severe phenotype. Patients with SE had non-significantly higher rates of hospitalization for heart failure (33% vs 24%, p=0.31) and atrial fibrillation (35% vs 19%, p=0.10). In multivariate analysis, only LA diameter was an independent predictor of SE (OR 1.04, p=0.04). A LA diameter>45 mm had an independent 3 fold increased risk of SE (OR 3.04, p=0.02) (Image 1). Table 1 Systemic embolisms (n=23) No systemic embolisms (n=491) p Men, n (%) 15 (65) 289 (56) 0.52 Median age at diagnosis (IQR), yr 60 (48–76) 48 (30–64) 0.02 Median follow up (IQR), yr 5.9 (3.1–7.8) 4.2 (1.8–7.1) 0.18 Hypertension, % 8 (33) 118 (24) 0.31 Diabetes mellitus, % 3 (14) 39 (8) 0.41 OAC, % 19 (83) 118 (24) 0.01 LVEF (SD), % 37 (15) 48 (17) 0.01 LVEDD (SD), mm 58 (11) 54 (10) 0.04 LVESD (SD), mm 45 (13) 38 (11) 0.01 LA diameter (SD), mm 46 (9) 39 (9) 0.01 LVEDV CMR (SD), mL 193 (75) 163 (70) 0.12 LVESV CMR (SD), mL 121 (64) 85 (64) 0.04 LGE, % 9 (40) 88 (18) 0.04 Conclusions LVNC carries a moderate mid-term risk of SE, which appears to be irrespective of atrial fibrillation and associated with age, LV dilatation and systolic dysfunction and mainly LA dilatation. This subgroup of patients should be considered for oral anticoagulation in primary prevention.

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.

scholarly journals Modified Maze Procedure for Atrial Fibrillation as an Adjunct to Elective Cardiac Surgery: Predictors of Mid-Term Recurrence and Echocardiographic Follow-Up

2015 ◽  
Vol 42 (4) ◽  
pp. 341-347 ◽  
Author(s):  
Claudia Loardi ◽  
Francesco Alamanni ◽  
Fabrizio Veglia ◽  
Claudia Galli ◽  
Alessandro Parolari ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Left Ventricular Ejection Fraction ◽  
Sinus Rhythm ◽  
Left Ventricular ◽  
Maze Procedure ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Elective Cardiac Surgery

The radiofrequency maze procedure achieves sinus rhythm in 45%–95% of patients treated for atrial fibrillation. This retrospective study evaluates mid-term results of the radiofrequency maze—performed concomitant to elective cardiac surgery—to determine sinus-rhythm predictive factors, and describes the evolution of patients' echocardiographic variables. From 2003 through 2011, 247 patients (mean age, 64 ± 9.5 yr) with structural heart disease (79.3% mitral disease) and atrial fibrillation underwent a concomitant radiofrequency modified maze procedure. Patients were monitored by 24-hour Holter at 3, 6, 12, and 24 months, then annually. Eighty-four mitral-valve patients underwent regular echocardiographic follow-up. Univariate and multivariate analysis for risk factors of maze failure were identified. The in-hospital mortality rate was 1.2%. During a median follow-up of 39.4 months, the late mortality rate was 3.6%, and pacemaker insertion was necessary in 26 patients (9.4%). Sinus rhythm was present in 63% of patients at the latest follow-up. Predictive factors for atrial fibrillation recurrence were arrhythmia duration (hazard ratio [HR]=1.296, P=0.045) and atrial fibrillation at hospital discharge (HR=2.03, P=0.019). The monopolar device favored maze success (HR=0.191, P &lt;0.0001). Left atrial area and indexed left ventricular end-diastolic volume showed significant decrease both in sinus rhythm and atrial fibrillation patients. Early sinus rhythm conversion was associated with improved left ventricular ejection fraction. Concomitant radiofrequency maze procedure provided remarkable outcomes. Shorter preoperative atrial fibrillation duration, monopolar device use, and prompt treatment of arrhythmia recurrences increase the midterm success rate. Early sinus rhythm restoration seems to result in better left ventricular ejection fraction recovery.

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

Incidence and predictors of mismatch after mechanical mitral valve replacement

2019 ◽  
Vol 27 (7) ◽  
pp. 535-541
Author(s):  
Ashraf AH El Midany ◽  
Ezzeldin A Mostafa ◽  
Tamer Hikal ◽  
Mostafa G Elbarbary ◽  
Ayman Doghish ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Ventricular ◽  
Effective Orifice Area ◽  
Orifice Area ◽  
Patient Prosthesis Mismatch

Background Patient-prosthesis mismatch after mitral valve replacement has an unfavorable postoperative hemodynamic outcome, which underlines the importance of identifying and preventing prosthesis- and patient-related risk factors. This study was conducted to determine the incidence and identify possible predictors of patient-prosthesis mismatch. Methods A prospective study was conducted on 715 patients with a mean age of 42 ± 11 years who underwent mechanical mitral valve replacement between 2013 and 2017. The effective orifice area of the prostheses was estimated by the continuity equation, and a mismatch was defined as an effective orifice area index ≤1.2 cm2·m−2. The mean clinical and echocardiographic follow-up was 26.74 ± 11.58 months. Multivariate regression analysis was performed to identify predictors of patient-prosthesis mismatch. Results Patient-prosthesis mismatch was detected in 382 (53.4%) patients. A small mechanical prosthesis (<27 mm) was inserted in 54.3%. Mortality during follow-up was 9% (65 patients). Patient-prosthesis mismatch was identified in patients with preoperative rheumatic mitral valve pathology, associated tricuspid regurgitation, higher New York Heart Association class, preoperative atrial fibrillation, mitral stenosis, and small preoperative left ventricular dimensions. Multivariate analysis identified mitral stenosis, preoperative atrial fibrillation, and small postoperative left ventricular end-diastolic dimension as risk factors for patient-prosthesis mismatch. Conclusion Patient-prosthesis mismatch is a common sequela after mechanical mitral valve replacement. Identification of predictors of patient-prosthesis mismatch can help so that a preoperative strategy can be implemented to avoid its occurrence.

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