Amiodarone-Induced Thyrotoxicosis Is a Predictor of Adverse Cardiovascular Outcome

Abstract Background: Amiodarone-induced thyrotoxicosis (AIT) is a clinical condition that is notoriously difficult to manage; the relative risk of adverse cardiovascular events in these patients compared with euthyroid patients is largely unknown. Objective: We compared the clinical characteristics and major adverse cardiovascular events (MACE) in AIT and euthyroid patients. Method: Patients at a tertiary referral center who had been prescribed amiodarone for at least 3 months were retrospectively analyzed. Baseline clinical characteristics, laboratory parameters, and outcome events were evaluated. MACE was defined as cardiovascular mortality, myocardial infarction, stroke and heart failure, or ventricular arrhythmias that required hospitalization. Results: A total of 354 patients (61.8 ± 14.1 yr; 64.7% male) with a mean follow-up of 48.6 ± 26.7 months were studied. AIT, euthyroid status, and amiodarone-induced hypothyroidism were identified in 57 (16.1%), 224 (63.3%), and 73 (20.6%) patients, respectively. No differences in baseline clinical characteristics were observed between AIT and euthyroid patients. Nonetheless AIT patients demonstrated a higher MACE rate (31.6 vs. 10.7%, P < 0.01), mostly driven by a higher rate of ventricular arrhythmias that required admission (7.0 vs. 1.3%, P = 0.03). Cox-regression multivariate analysis revealed that AIT (hazard ratio 2.68; confidence interval 1.53–4.68; P < 0.01) and left ventricular ejection fraction less than 45% (hazard ratio 2.52; confidence interval 1.43–4.42; P < 0.01) were independent predictors of MACE. Conclusion: In patients prescribed long-term amiodarone therapy, occurrence of AIT is associated with a 2.7-fold increased risk of MACE. Regular and close biochemical surveillance is thus advisable to identify and treat this high-risk group of patients.

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Cardiac rhythm disorders

10.1093/med/9780198726012.003.0063 ◽

2016 ◽

Author(s):

Kristina H. Haugaa ◽

Francesco Faletra ◽

João L. Cavalcante

Keyword(s):

Left Atrial ◽

Ventricular Arrhythmias ◽

Cardiac Rhythm ◽

Left Atrial Appendage ◽

Left Ventricular ◽

Atrial Appendage ◽

Left Ventricular Ejection ◽

Prognostic Information ◽

Ventricular Ejection Fraction ◽

Increased Risk

Cardiac rhythm disorders require diagnostic, prognostic, and guidance of therapeutic procedures by echocardiography. The most common sustained cardiac arrhythmia is atrial fibrillation (AF) leading to an increased risk for mortality, heart failure, and thromboembolic events. Echocardiography is performed to assess the aetiology of AF which most commonly is associated with diseases leading to enlarged atria. Furthermore, echocardiography is crucial to evaluate thromboembolic risk by assessing the morphology and function of the left atrial appendage among other parameters. Non-invasive imaging modalities including two-dimensional transthoracic (TTE) and transoesophageal echocardiography (TOE) with three-dimensional imaging are often indicated. Finally, TOE can help in the preprocedural planning and providing guidance for interventions such as pulmonary vein ablation and percutaneous left atrial appendage closure. In patients with ventricular arrhythmias, TTE is the first-line diagnostic tool for assessing the aetiology of ventricular arrhythmias. Ischaemic heart disease, either acute or chronic fibrosis, is the most common causes of ventricular tachycardias. Left ventricular ejection fraction remains the most important parameter for indication of an implantable cardioverter defibrillator for primary prevention therapy, although newer strain echocardiographic measures may add incremental prognostic information.

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P2609H2FPEF score as a prognostic value in HFpEF patients

European Heart Journal ◽

10.1093/eurheartj/ehz748.0933 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D Sueta ◽

T Nishihara ◽

E Yamamoto ◽

K Tsujita

Keyword(s):

Confidence Interval ◽

Cardiovascular Events ◽

Left Ventricular ◽

Hazard Ratio ◽

Left Ventricular Ejection ◽

Rank Test ◽

Characteristic Analysis ◽

Simple Method ◽

Log Rank Test ◽

Cerebrovascular Events

Abstract Background The H2FPEF score is recognized as a simple method to diagnose heart failure (HF) with preserved left ventricular ejection fraction (HFpEF). Purpose We investigated the value of the H2FPEF score in predicting subsequent cardiovascular events in HFpEF patients. Methods This study was a retrospective, single-center, observational study. We calculated the H2FPEF scores for 404 consecutive HFpEF patients. Subjects were subdivided into low- (0–3), intermediate- (4–6), and high-score (7–9) groups and followed for 50-months. The primary and secondary endpoints were composite cardiovascular/ cerebrovascular events (cardiovascular death, non-fatal myocardial infarction, unstable angina pectoris, hospitalization for HF decompensation and non-fatal stroke) occurrence and HF-related events (hospitalization for HF decompensation) occurrence at 50-months, respectively. Results Kaplan–Meier analyses demonstrated a significantly higher incidence of cardiovascular/cerebrovascular events in proportion to a higher H2FPEF score (log-rank test, P=0.005). The HF-related event rate was higher in proportion to the H2FPEF score (log-rank test, P<0.001). Multivariate Cox hazard analyses identified the H2FPEF score (per 1 point) as an independent predictor of cardiovascular and HF-related events (Table, hazard ratio, 1.179; 95% confidence interval, 1.066–1.305; P=0.001 and hazard ratio, 1.288; 95% confidence interval, 1.134–1.463; P=0.001, respectively). Receiver operating characteristic analysis showed that the H2FPEF significantly predicted cardiovascular events (Figure A, AUC 0.626, 95% CI 0.557–0.693; P<0.001) and HF-related events (Figure B, AUC 0.680, 95% CI 0.600–0.759; P<0.001). The cutoff H2FPEF score was 5.5 for the identification of cardiovascular and HF-related events. Conclusion The H2FPEF score is a potentially useful marker for the prediction of cardiovascular and HF-related events in HFpEF patients.

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Abstract 12842: Both Hyponatremia and Elevated Plasma Renin Activity Are Independent and Additive Cardiovascular Risk Factors in Patients With Angiographically Proven Coronary Artery Disease (CAD): The Intermountain Heart Collaborative Study

Circulation ◽

10.1161/circ.130.suppl_2.12842 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Tami L Bair ◽

Jeffrey L Anderson ◽

Heidi T May ◽

Benjamin D Horne ◽

Joseph B Muhlestein

Keyword(s):

Plasma Renin Activity ◽

Cardiovascular Events ◽

Collaborative Study ◽

Plasma Renin ◽

Left Ventricular ◽

Renin Activity ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Low Sodium ◽

Increased Risk

Background: Several studies have documented an increased risk of future major adverse cardiovascular events (MACE) among CAD patients with elevated baseline plasma renin activity (PRA). One of the proposed mechanisms of elevated PRA is sodium depletion - hyponatremia. However, the relationship between PRA and hyponatremia is not well defined. Methods: A total of 1,781 pts with angiographic CAD (>50% stenosis) enrolled in the Intermountain Heart Collaborative Study were evaluated. Pts were excluded if they had a history of myocardial infarction (MI), heart failure (HF), left ventricular ejection fraction (EF) <45% or were discharged on beta blocker therapy. Baseline sodium levels were stratified between low (<135 mm/L) and normal (≥135 mm/L), and PRA between elevated (>2.3 ng/ml/h) and low (≤2.3 ng/ml/h) risk categories. The independent associations between these categories and MACE (death, MI, HF hospitalization, stroke and new onset renal failure) at five years were determined by multivariable Cox hazard regression analysis. Results: The mean pt age was 65.5 years; most pts were men (73.2%) and hypertensive (70.4%). Overall, PRA was elevated in 940 (52.8%) of the pts and sodium was low in 42 (2.4%) of the pts. The prevalence of elevated PRA was greater among pts with low sodium (66.7% versus 52.4% [p=0.07]). Five-year incidence of MACE was higher among pts with low sodium (61.9% versus 40.7%, p=0.006) and also among those with elevated PRA (43.7% versus 38.3%, p=0.02). After adjustment for baseline characteristics, among pts with low sodium, elevated PRA did not predict an increase in MACE (adjusted hazard ratio (HR)=0.72, p=0.53). However, among those with normal sodium, elevated PRA trended toward an association with MACE (HR=1.14, p=0.08). Conclusion: Among stable pts with angiographically documented CAD, both hyponatremia and elevated PRA are independently associated with future adverse cardiovascular events, although much of the adverse effect of elevated PRA may be explained by the concomitant presence of hyponatremia. The underlying physiology of these findings and its potential implications to future medical management of these pts deserves further study.

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P263 Characterisation of patients with acute myocardial infarction complicated by left ventricular thrombus

European Heart Journal ◽

10.1093/ehjci/ehz872.087 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

Author(s):

A S T Leow ◽

C H Sia ◽

B Y Q Tan ◽

R Kaur ◽

H W Sim ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Clinical Characteristics ◽

Thrombus Formation ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Limited Data ◽

Ventricular Ejection Fraction ◽

Increased Risk ◽

All Cause Mortality

Abstract Funding Acknowledgements None Background/Introduction Left ventricular (LV) thrombus is a widely recognized complication of acute myocardial infarction (AMI). Limited data are available from South East Asian patients with this post-infarction complication nor on whether patients with non-ST segment elevation myocardial infarction (NSTEMI) or STEMI with associated LV thrombosis exhibit differing clinical characteristics and/or outcomes. Left Ventricular Ejection Fraction (LVEF) ≤ 40% is a recognized predictor of LV thrombus formation, but there is limited data on LV thrombus patients with EF > 40% or in NSTEMI patients. Purpose This study aims to investigate and compare the clinical characteristics, treatment and outcomes of post-AMI patients with LV thrombus formation, with a particular emphasis on those with EF ≤ 40% and in NSTEMI patients. Methods Among 5829 consecutive echocardiogram results containing the keyword "thrombus" from August 2006 to September 2017, we identified 289 post-AMI patients with acute LV thrombus formation. Demographics, treatment and outcome measures were analysed. Results Cardiovascular risk factors such as dyslipidaemia (54.0%) and hypertension (50.5%) were commonly present in post-AMI patients with LV thrombus. Mean LVEF was 33.0 ± 10.4%. The majority (68.0%) of patients received triple therapy and 59.5% achieved thrombus resolution. NSTEMI patients had greater number of co-morbidities including heart failure (p < 0.01), documented history of ischaemic heart disease preceding the AMI leading to thrombus formation (p < 0.01) and lower LVEF (28.3 ± 9.3% vs. 34.8 ± 10.3% , p < 0.01) compared with STEMI cases. On multivariate analysis, having a lower EF was a significant independent predictor of stroke (HR 0.96, 95% CI 0.93-1.00, p = 0.03) and all-cause mortality (HR 0.95, 95% CI 0.92-0.99, p < 0.01). The categories of STEMI and NSTEMI did not predict thrombus resolution, stroke events or all-cause mortality after adjustment. Conclusion(s) Post-AMI LV thrombus patients with NSTEMI and STEMI differed in terms of their co-morbidities in their demographics and co-morbidities but it was a lower EF that was associated with an increased risk of stroke and all-cause mortality. Further studies on this topic are required.

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

PLoS ONE ◽

10.1371/journal.pone.0258525 ◽

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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Abstract 2026: Atrial Fibrillation Predicts Ventricular Arrhythmogenicity In Heart Failure

Circulation ◽

10.1161/circ.116.suppl_16.ii_438-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Kristina Lemola ◽

Razi Khan ◽

Stanley Nattel ◽

Sakari Lemola ◽

Peter G Guerra ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Primary Prevention ◽

Cox Regression ◽

Left Ventricular ◽

Hazard Ratio ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Increased Risk ◽

N 93

Background: Atrial fibrillation (AF) is associated with appropriate ICD discharges in patients with primary prevention indications. We explored potential effect modifiers impacting on ventricular arrhythmogenic risk associated with AF. Methods and Results: A retrospective cohort study was conducted on 215 consecutive patients with ICDs for primary prevention having a left ventricular ejection fraction (LVEF) < <26>35% and followed for 1.3±0.7 years. Mean age was 61.0±0.7 years and 17% were women. Cox regression models were explored in subgroups of patients stratified by demographic parameters, prior medical and surgical history, physical exam features, laboratory findings, and results of diagnostic tests. Appropriate ICD discharges were received by 10% of patients. AF was associated with a 3.5 fold increased risk [95% CI (1,5, 8.1), P=0.005]. Effect modifiers for the relationship between AF and appropriate ICD discharges included QRS duration and QTc. In patients with a QRS>130 msec (N=93), 6 of 33 (18%) patients with AF received appropriate ICD discharges versus 2 of 60 (3%) without AF (P=0.03). In this subgroup, AF was associated with a hazard ratio of 5.1 (P=0.049). Among individuals with a QTc >440 msec (N=93), 6 of 32 (19%) AF patients received appropriate ICD discharges versus 1 of 61 (2%) without AF (P=0.01). AF was associated with a hazard ratio of 10.3 (P=0.031). Five of 28 patients (18%) with both prolonged QRS and QTc duration (N=77) that also having AF received appropriate ICD discharges compared to 0 of 49 of patients without AF (P=0.005). After adjusting for medical therapy, AF independently predicted appropriate ICD discharges in subgroups with and without QRS and QTc increase. Conclusion: AF portends increased risk for ventricular tachyarrhythmias in patients with heart failure, particularly when associated with conduction and/or repolarization abnormalities. This finding may reflect common depolarization and repolarization defects associated with the arrhythmic milieu contributing to AF and ventricular arrhythmias, or adverse consequences of AF on the complex neurohumoral/electrophysiological substrate underlying ventricular arrhythmogenesis in heart failure.

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Efficacy of Vitamin D on Chronic Heart Failure Among Adults

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000487 ◽

2020 ◽

Vol 90 (1-2) ◽

pp. 49-58 ◽

Cited By ~ 1

Author(s):

Wang Chunbin ◽

Wang Han ◽

Cai Lin

Keyword(s):

Heart Failure ◽

Vitamin D ◽

Chronic Heart Failure ◽

Left Ventricular Ejection Fraction ◽

Confidence Interval ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Controlled Trials ◽

Ventricular Ejection Fraction ◽

Randomized Controlled

Abstract. Vitamin D deficiency commonly occurs in chronic heart failure. Whether additional vitamin D supplementation can be beneficial to adults with chronic heart failure remains unclear. We conducted a meta-analysis to derive a more precise estimation. PubMed, Embase, and Cochrane databases were searched on September 8, 2016. Seven randomized controlled trials that investigated the effects of vitamin D on cardiovascular outcomes in adults with chronic heart failure, and comprised 592 patients, were included in the analysis. Compared to placebo, vitamin D, at doses ranging from 2,000 IU/day to 50,000 IU/week, could not improve left ventricular ejection fraction (Weighted mean difference, WMD = 3.31, 95% confidence interval, CL = −0.93 to 7.55, P < 0.001, I2 = 92.1%); it also exerts no beneficial effects on the 6 minute walk distance (WMD = 18.84, 95% CL = −24.85 to 62.52, P = 0.276, I2 = 22.4%) and natriuretic peptide (Standardized mean difference, SMD = −0.39, 95% confidence interval CL = −0.48 to 0.69, P < 0.001, I2 = 92.4%). However, a dose-response analysis from two studies demonstrated an improved left ventricular ejection fraction with vitamin D at a dose of 4,000 IU/day (WMD = 6.58, 95% confidence interval CL = −4.04 to 9.13, P = 0.134, I2 = 55.4%). The results showed that high dose vitamin D treatment could potentially benefit adults with chronic heart failure, but more randomized controlled trials are required to confirm this result.

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An Unusual Association: Right Atrial Myxoma and Severe Left Ventricular Dysfunction. Case Report and Review of the Literature

The Heart Surgery Forum ◽

10.1532/hsf98.2014420 ◽

2015 ◽

Vol 17 (6) ◽

pp. 285

Author(s):

Lucian Florin Dorobantu ◽

Ovidiu Chioncel ◽

Alexandra Pasare ◽

Dorin Lucian Usurelu ◽

Ioan Serban Bubenek-Turconi ◽

...

Keyword(s):

Ejection Fraction ◽

Ventricular Dysfunction ◽

Left Ventricular Systolic Dysfunction ◽

Left Ventricular ◽

Right Atrial ◽

Left Ventricular Ejection ◽

Cardiac Tumors ◽

Severe Left Ventricular Dysfunction ◽

Ventricular Ejection Fraction ◽

Increased Risk

Myxomas comprise 50% of all benign cardiac tumors in adults, with the right atrium as their second most frequent site of origin. Surgical resection is the only effective therapeutic option for patients with these tumors. The association between right atrial myxomas and severe left ventricular systolic dysfunction is extremely rare and makes treatment even more challenging. This was the case for our patient, a 47-year-old male with a right atrial mass and a severely impaired left ventricular function, with a 20% ejection fraction. Global enlargement of the heart was also noted, with moderate right ventricular dysfunction. The tumor was successfully excised using the on-pump beating heart technique, with an immediate postoperative improvement of the left ventricular ejection fraction to 35%. The technique proved useful, with no increased risk to the patient.

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Sex differences in transaortic flow rate and association with all-cause mortality in patients with severe aortic stenosis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab045 ◽

2021 ◽

Author(s):

Sahrai Saeed ◽

Anastasia Vamvakidou ◽

Spyridon Zidros ◽

George Papasozomenos ◽

Vegard Lysne ◽

...

Keyword(s):

Sex Differences ◽

Aortic Stenosis ◽

Flow Rate ◽

Cox Regression ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Cox Regression Analysis ◽

Increased Risk ◽

All Cause Mortality

Abstract Aims It is not known whether transaortic flow rate (FR) in aortic stenosis (AS) differs between men and women, and whether the commonly used cut-off of 200 mL/s is prognostic in females. We aimed to explore sex differences in the determinants of FR, and determine the best sex-specific cut-offs for prediction of all-cause mortality. Methods and results Between 2010 and 2017, a total of 1564 symptomatic patients (mean age 76 ± 13 years, 51% men) with severe AS were prospectively included. Mean follow-up was 35 ± 22 months. The prevalence of cardiovascular disease was significantly higher in men than women (63% vs. 42%, P < 0.001). Men had higher left ventricular mass and lower left ventricular ejection fraction compared to women (both P < 0.001). Men were more likely to undergo an aortic valve intervention (AVI) (54% vs. 45%, P = 0.001), while the death rates were similar (42.0% in men and 40.6% in women, P = 0.580). A total of 779 (49.8%) patients underwent an AVI in which 145 (18.6%) died. In a multivariate Cox regression analysis, each 10 mL/s decrease in FR was associated with a 7% increase in hazard ratio (HR) for all-cause mortality (HR 1.07; 95% CI 1.03–1.11, P < 0.001). The best cut-off value of FR for prediction of all-cause mortality was 179 mL/s in women and 209 mL/s in men. Conclusion Transaortic FR was lower in women than men. In the group undergoing AVI, lower FR was associated with increased risk of all-cause mortality, and the optimal cut-off for prediction of all-cause mortality was lower in women than men.

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Temporal trends in outcome and patient characteristics in dilated cardiomyopathy, data from the Swedish Heart Failure Registry 2003–2015

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02124-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Helen Sjöland ◽

Jonas Silverdal ◽

Entela Bollano ◽

Aldina Pivodic ◽

Ulf Dahlström ◽

...

Keyword(s):

Heart Failure ◽

Dilated Cardiomyopathy ◽

Temporal Trends ◽

Physical Symptoms ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Continuous Change ◽

Ventricular Ejection Fraction ◽

Increased Risk ◽

Over Time

Abstract Background Temporal trends in clinical composition and outcome in dilated cardiomyopathy (DCM) are largely unknown, despite considerable advances in heart failure management. We set out to study clinical characteristics and prognosis over time in DCM in Sweden during 2003–2015. Methods DCM patients (n = 7873) from the Swedish Heart Failure Registry were divided into three calendar periods of inclusion, 2003–2007 (Period 1, n = 2029), 2008–2011 (Period 2, n = 3363), 2012–2015 (Period 3, n = 2481). The primary outcome was the composite of all-cause death, transplantation and hospitalization during 1 year after inclusion into the registry. Results Over the three calendar periods patients were older (p = 0.022), the proportion of females increased (mean 22.5%, 26.4%, 27.6%, p = 0.0001), left ventricular ejection fraction was higher (p = 0.0014), and symptoms by New York Heart Association less severe (p < 0.0001). Device (implantable cardioverter defibrillator and/or cardiac resynchronization) therapy increased by 30% over time (mean 11.6%, 12.3%, 15.1%, p < 0.0001). The event rates for mortality, and hospitalization were consistently decreasing over calendar periods (p < 0.0001 for all), whereas transplantation rate was stable. More advanced physical symptoms correlated with an increased risk of a composite outcome over time (p = 0.0043). Conclusions From 2003 until 2015, we observed declining mortality and hospitalizations in DCM, paralleled by a continuous change in both demographic profile and therapy in the DCM population in Sweden, towards a less affected phenotype.

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