Abstract 17065: Final Results of the AHA Guideline Transformation Optimization Initiative

Background: Although guideline directed care has been shown to improve outcomes of Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) patients, dissemination and implementation of updated guideline recommendations are variable and often delayed. Methods: In 2014, the American Heart Association (AHA) launched the Guideline Transformation Optimization (GTO) initiative, designed to decrease the time to implementation of guideline recommendations by increasing knowledge and awareness for three target audiences: healthcare professionals, patients, and hospital systems. Guideline content was delivered using rapid formats via mobile applications intended for point-of-care provider and patient use, web-based content and media campaigns. The first guidelines to undergo this new organizational paradigm shift were the 2014 NSTE-ACS Guidelines and the 2016 Dual Antiplatelet Therapy Focused Update. We determined the reach to our target audiences and hospital-level achievement of NSTE-ACS quality measures using 2016 data from ACTION Registry-Get-With-The Guidelines. Results: Over 3 years (2014-17), there were 83,000 downloads of the healthcare professional mobile application and 4,365 attendees at 4 AHA professional education webinars. As a result of attending the webinar, 87% of learners said their practice would change. The patient campaign achieved over 2.7 billion media impressions, 32.6 million unique visitors to AHA’s heart attack webpages, and 26.2 million social media engagements. My Cardiac Coach mobile application for NSTE-ACS was downloaded by 8,500 patients. Among the 797 participating AHA “Mission: Lifeline” hospitals, 42 achieved early adopter recognition in 2015, defined as achieving all 5 target quality measures: cardiac rehabilitation referral, ACE/ ARB prescription at discharge, dual antiplatelet prescription, evaluation of left ventricular systolic function and smoking cessation education. Recognition was achieved by 296 hospitals in 2017. Conclusion: Three years after launch of the GTO initiative, AHA was able to meet its 2020 goals of decreasing time to translation of scientific guidelines, increasing provider and patient education and awareness, and increasing guideline adherence in almost 300 U.S. hospitals.

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An Atypical Presentation of Acute Coronary Syndrome

European Cardiology Review ◽

10.15420/ecr.2012.8.1.67 ◽

2012 ◽

Vol 8 (1) ◽

pp. 67

Author(s):

Syed Khurram Mushtaq Gardezi ◽

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Systolic Function ◽

Artery Bypass ◽

Left Ventricular Systolic Function ◽

Regional Wall Motion ◽

Dobutamine Stress ◽

Left Ventricular ◽

Ventricular Systolic Function ◽

Coronary Syndrome

A 61-year-old man was admitted to hospital with severe occipital headache and weakness and numbness of the left arm. His electrocardiograms showed changes hinting at acute coronary syndrome (ACS). However, in view of his clinical presentation, he underwent tests for likely subarachnoid haemorrhage, but this was ruled out. The next day, he was referred to cardiology. A transthoracic echocardiogram showed reduced left ventricular systolic function along with regional wall motion abnormalities involving inferoposterior walls. The patient was treated as per the protocol for ACS. A dobutamine stress echocardiogram confirmed inferior myocardial infarction with evidence of myocardial viability in the affected left ventricular segments. Subsequent investigations confirmed three-vessel coronary artery disease and reduced left ventricular systolic function. The patient underwent successful coronary artery bypass grafting.

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Comparative Characteristics of The Effects of Drug and Mechanical Reperfusion in The Treatment of Acute Coronary Syndrome with ST Elevation in Patients Working in Environmentally Challenging Conditions

Journal of Medical Biomedical And Applied Sciences ◽

10.15520/jmbas.v8i6.234 ◽

2020 ◽

Vol 8 (6) ◽

pp. 479-486

Author(s):

Javadova Tarana Mamedgasanovna ◽

Mammadgasan Mammadguseynovich Agayev

Keyword(s):

Systolic Function ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Coronary Syndrome ◽

Combined Application ◽

St Elevation ◽

Group 2 ◽

Comparison Of The Results ◽

Group 1

Studied clinical and hemodynamic efficacy of complex use heparin,Сyто-Mас, propranolol (obzidan), fosinopril (monopril) with and PCI; PCI conducted separately on hemodynamics on cardiohemodynamics on ekoendotoksikoz (AMP) and the clinical course of patients working in environmentally stressful conditions in the acute phase and follow-up of MI. Comparison of the results of complex mediakamentoz and mechanical revascularization with PCI conducted separately. Investigated 50 patients with STMI in the age of 30 to 70 years (56,7 ± 1,20 years). Of the 50 patients 25 were treated Cyto-Mac, foznopril, propranolol with heparin and PCI (group 1); 25 patients were treated with PCI alone (group 2). In both groups, blood was determined by the degree ekoendotoksikoza (AMP) by EchoCG and Doppler EchoCG studied ESV, EDV, EF, SI, CI , an local contractility violation index of left ventricle (LCVI) , with the aid of restenosis koronorografii. A well established dynamics of systolic and diastolic blood pressure, clinical features of MI during follow-up. Patients treatedheparin,Cуто-мас, propranolol, foznopril and PCIindicators of central hemodynamics stabilizis. The reduced ЕSV,EDV, LCVI and decreased degree ofekoendotoksikoza (АMP), improves left ventricular systolic function of demand , increases PV. However, in this group, one patient on the third day was recorded AHF and one recurrent MI. İn The group spent only 2 PCI in relapse developed MI, 1 - restenosis, 2 -AHF and 1 patients died. The results show that the combined application of drug therapy with PCI provides a positive result in comparsionwiththan separately conducted PCI in ACS with elevation ST.

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Traumatic Takotsubo Cardiomyopathy in a Patient with Extensive Coronary Artery Disease

Case Reports in Emergency Medicine ◽

10.1155/2019/7270426 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Abagayle E. Renko ◽

Warren C. Doyle ◽

Paul W. Sokoloski

Keyword(s):

Takotsubo Cardiomyopathy ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Systolic Function ◽

Point Of Care ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Diagnostic Score ◽

Vehicle Accidents ◽

Artery Disease

Takotsubo Cardiomyopathy (TCM) should be considered in the differential diagnosis for patients with cardiovascular symptoms not only following emotional trauma but also following motor vehicle accidents. A 45-year-old woman presented with chest pain following a motor vehicle accident. While she had an elevated troponin level and an extensive history of cardiac disease, her electrocardiogram was normal. Echocardiogram, however, demonstrated transiently reduced left ventricular systolic function with mid to apical hypokinesis consistent with TCM. We emphasize the use of a diagnostic score and point of care focused cardiac ultrasound (FOCUS) to expedite the recognition, evaluation, and treatment of suspected TCM in an Emergency Department setting.

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Prognostic value of NT-Pro-BNP in prediction of left ventricular systolic function and outcome of patients of acute coronary syndrome

Indian Heart Journal ◽

10.1016/j.ihj.2015.10.058 ◽

2015 ◽

Vol 67 ◽

pp. S23

Author(s):

B.P. Chattopadhyay ◽

R. Ray ◽

H. Rath ◽

S. Singh ◽

S. Chatterjee

Keyword(s):

Acute Coronary Syndrome ◽

Prognostic Value ◽

Systolic Function ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Ventricular Systolic Function ◽

Coronary Syndrome

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Prognostic value of NT-proBNP in patients with chronic coronary syndrome and normal left ventricular systolic function according to glucose status: a prospective cohort study

Cardiovascular Diabetology ◽

10.1186/s12933-021-01271-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Hui-Hui Liu ◽

Ye-Xuan Cao ◽

Jing-Lu Jin ◽

Yuan-Lin Guo ◽

Cheng-Gang Zhu ◽

...

Keyword(s):

Cox Regression ◽

Systolic Function ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Ventricular Systolic Function ◽

Coronary Syndrome ◽

Kaplan Meier ◽

Normal Left Ventricular ◽

Glucose Status

Abstract Background The prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with coronary artery disease (CAD) with different glucose status has not been established. This study sought to evaluate the significance of NT-proBNP in predicting major adverse cardiovascular events (MACEs) in patients with chronic coronary syndrome (CCS) and normal left-ventricular systolic function (LVSF) according to different glucose status, especially in those with abnormal glucose metabolism. Methods A total of 8062 patients with CCS and normal LVSF were consecutively enrolled in this prospective study. Baseline plasma NT-proBNP levels were measured. The follow-up data of all patients were collected. Kaplan-Meier and Cox regression analyses were used to assess the risk of MACEs according to NT-proBNP tertiles stratified by glucose status. Results Over an average follow-up of 59.13 ± 18.23 months, 569 patients (7.1 %) suffered from MACEs, including cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Kaplan-Meier analysis showed that high NT-proBNP levels had a significant association with MACEs in subjects with prediabetes mellitus (pre-DM) or DM, but not in patients with normoglycemia. Multivariate Cox regression analysis revealed that NT-proBNP remained an independent predictor of MACEs in patients with pre-DM [hazard ratio (HR): 2.56, 95% confidence interval (CI): 1.34–4.91] or DM (HR: 2.34, 95% CI: 1.32–4.16). Moreover, adding NT-proBNP to the original Cox model including traditional risk factors significantly increased the C-statistic by 0.035 in pre-DM and DM, respectively. Conclusions The present study indicated that NT-proBNP could well predict worse outcomes in dysglycemic patients with CCS and normal LVSF, suggesting that NT-proBNP may help with risk stratification in this population.

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An Unusual Case of Recurrent Hypersensitivity Reaction Associated with Kounis-Like Acute Coronary Syndrome

Case Reports in Cardiology ◽

10.1155/2017/6421208 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Shanker Kundumadam ◽

Vivek Reddy ◽

Sagar Mallikethi Reddy ◽

Pradeep Kathi ◽

Aiden Abidov

Keyword(s):

Unusual Case ◽

Systolic Function ◽

Artery Bypass ◽

Left Ventricular Systolic Function ◽

Coronary Event ◽

Left Ventricular ◽

Kounis Syndrome ◽

Coronary Syndrome ◽

Mediators Of Inflammation ◽

Coronary Events

There have been multiple reports of allergic reactions associated with acute coronary syndromes. This has been classically described as Kounis syndrome. We present an unusual case of 70-year-old male with multiple prior hypersensitivity reactions and history of coronary artery bypass grafting who presented recurrent episode of severe angioedema and anaphylaxis. He responded to epinephrine but subsequently developed a non-ST elevation myocardial infarction with worsening heart failure. Our case is unique in that, unlike classic Kounis syndrome, the acute coronary event in this case did not present concurrently with the allergic reaction; rather it took nearly 48 hours to present. Subsequent angiogram revealed patent grafts and significant decline in the left ventricular systolic function as compared to his own ECHO a year ago. We postulate that slow mediators of inflammation may play a role in delayed development of acute coronary events with associated LV dysfunction following episodes of angioedema and anaphylaxis.

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Impact of glycemic status on left ventricular systolic function in patients with acute coronary syndrome

THE ULUTAS MEDICAL JOURNAL ◽

10.5455/umj.20150924034203 ◽

2015 ◽

Vol 1 (3) ◽

pp. 58 ◽

Cited By ~ 1

Author(s):

Alaaeldin Amin ◽

Waleed Ammar ◽

Azza Farrag

Keyword(s):

Acute Coronary Syndrome ◽

Systolic Function ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Glycemic Status ◽

Ventricular Systolic Function ◽

Coronary Syndrome

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P6458The prevalence of left ventricular non-compaction in newborns

European Heart Journal ◽

10.1093/eurheartj/ehz746.1050 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M F Borresen ◽

E M Blixenkrone-Moeller ◽

M Tindholdt ◽

R O B Vogg ◽

C Pihl ◽

...

Keyword(s):

Systolic Function ◽

Systolic Dysfunction ◽

Large Population ◽

Heart Association ◽

Left Ventricular Systolic Function ◽

Ventricular Myocardium ◽

Population Based ◽

Left Ventricular ◽

Left Ventricular Myocardium ◽

Developmental Defect

Abstract Background Pronounced trabeculation of the left ventricular myocardium, or non-compaction, may be accompanied by systolic dysfunction in ventricular non-compaction cardiomyopathy (LVNC). It is unclear whether non-compaction represents a fetal development defect or may develop later in life. Previous studies have estimated the prevalence of non-compaction to 0.01–0.31% in adults referred for echocardiography. The prevalences in unselected populations of adults or children are unknown. Purpose To determine the prevalence of non-compaction of the left ventricle in a large population-based cohort of newborns and to assess the relation to left ventricular systolic function. Methods Transthoracic echocardiography was performed according to a standardized protocol in all newborns included in a regional population-based cohort study in 2016–2018. For the present study, the extent of trabeculations were assessed by one of three primary reviewers in apical long-axis views (4-chamber, 5-chamber, and sinus coronarius views), parasternal short (SAX), and long axis (PLAX) views. Based on the presence of pronounced trabeculations, deep intertrabecular recesses and/or an impression of a ratio of >1 of non-compact:compact myocardium (NC:C), the exam was regarded as either possible or not possible non-compaction: In examinations classified as possible non-compaction, an expert reviewer would determine if diagnostic criteria were fulfilled. A ratio of NC:C myocardium ≥2 was considered as non-compaction in accordance with previously suggested criteria. Results As of January 11, 2019, 6,880 neonate echocardiograms (median age 10 days [IQR 5,14], 48.8% females) had been analyzed. In total, 127 (1.8%) were considered as possible non-compaction. Six newborns (median age 14 days [IQR 8,18], 33.3% females) had a ratio of NC:C myocardium ≥2 corresponding to a prevalence of non-compaction of 8.7 per 10,000 newborns (95% CI 0.04–0.19%) (Figure). One of six neonates had a ratio of NC:C myocardium≥2 in more than one segment. Median fractional shortening (FS %), left ventricular end-diastolic (LVIDd) and end-systolic diameter (LVIDs) were 29.5% (IQR 27.0, 31.0), 1.9 cm (IQR 1.8, 2.1) and 1.3 cm (IQR 1.3, 1.5) respectively in the six newborns with non-compaction. The corresponding mean z-scores (standard deviations away from the age-matched reference mean) according to The Boston Children's Hospital z-score Calculator were FS: r=−3.0 (IQR r=−3.8, r=−2.5), LVIDd: r=−1.3 (IQR r=−2.7, r=−0.2), LVIDs: 0.2 (IQR r=−0.1, 1.6). 10-days-old boy with LVNC (FS 22%) Conclusion Echocardiography of an unselected population-based cohort of 6,880 newborns revealed a prevalence of non-compaction of 8.7 per 10,000 newborns. The prevalence is in accordance with previously described prevalences in adults referred for echocardiography and corroborate the view that non-compaction may be a fetal developmental defect. Non-compaction was not associated with left ventricular dilatation but with systolic dysfunction. Acknowledgement/Funding Danish Heart Association, Danish Children's Heart Foundation, Candy's Found., Toyota Found., Herlev-Gentofte Hospital Research Found., Gangsted Found.

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