What is the Diagnosis?

Patient from the male gender, 60 years of age, referred for ablation for symptomatic ventricular arrhythmia despite treatment with amiodarone. Patient with chronic dilated cardiomyopathy post-myocarditis with optimized therapy and functional class II.

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The Assessment of Ventricular Arrhythmia Indicators Based on Electrocardiography in Patients With Differentiated Thyroid Cancer Followed Up With Levothyroxine Suppression

Angiology ◽

10.1177/0003319721993343 ◽

2021 ◽

pp. 000331972199334

Author(s):

Sema Hepsen ◽

Davut Sakiz ◽

Hilal Erken Pamukcu ◽

Ismail Emre Arslan ◽

Hakan Duger ◽

...

Keyword(s):

Regression Analysis ◽

Thyroid Cancer ◽

Ventricular Arrhythmia ◽

Differentiated Thyroid Cancer ◽

Linear Regression Analysis ◽

Male Gender ◽

Qtc Interval ◽

Inclusion Criteria ◽

Raising Awareness ◽

Number Of Patients

Levothyroxine suppression therapy (LST) can cause some unfavorable effects on the cardiovascular system in patients with differentiated thyroid cancer (DTC). The aim of this study was to evaluate ventricular arrhythmia predictors based on electrocardiography (ECG) in patients with DTC with LST. The ECG parameters including QT, corrected QT (QTc), Tp-e intervals, Tp-e/QT, and Tp-e/QTC ratios of 265 patients with DTC who met the inclusion criteria were compared with 100 controls. No difference was observed in the number of patients with DTC and controls with prolonged and borderline QTc interval ( P = .273). Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were significantly higher in patients ( P = .002, P = .02, P = .003; respectively). Linear regression analysis suggested that male gender was a predictor of higher Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios (β = 4.322, R 2 = 0.024, P = .042; β = 0.016, R 2 = 0.048, P = .005; β = 0.015, R 2 = 0.044, P = .006, respectively). A higher serum fT4 level was found to be associated with a higher Tp-e/QT ratio (β = 0.018, R 2 = 0.089, P = .007). Ventricular arrhythmia indicators were found to be higher in patients with DTC with LST. Defining ventricular arrhythmia predictors through ECG, an easily accessible cardiac diagnostic tool, can be potentially useful in raising awareness of the possible cardiac harm of LST.

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A simple nomogram to predict contrast-induced acute kidney injury in patients with congestive heart failure undergoing coronary angiography

European Heart Journal ◽

10.1093/ehjci/ehaa946.2554 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Lei ◽

Y He ◽

Z Guo ◽

B Liu ◽

J Liu ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Acute Kidney Injury ◽

Coronary Angiography ◽

Prediction Models ◽

Validation Cohort ◽

Kidney Injury ◽

Class Ii ◽

Functional Class ◽

Killip Class

Abstract Background Patients with congestive heart failure (CHF) are vulnerable to contrast-induced acute kidney injury (CI-AKI), but few prediction models are currently available. Objectives We aimed to establish a simple nomogram for CI-AKI risk assessment for patients with CHF undergoing coronary angiography. Methods A total of 1876 consecutive patients with CHF (defined as New York Heart Association functional class II-IV or Killip class II-IV) were enrolled and randomly (2:1) assigned to a development cohort and a validation cohort. The endpoint was CI-AKI defined as serum creatinine elevation of ≥0.3 mg/dL or 50% from baseline within the first 48–72 hours following the procedure. Predictors for the nomogram were selected by multivariable logistic regression with a stepwise approach. The discriminative power was assessed using the area under the receiver operating characteristic (ROC) curve and was compared with the classic Mehran score in the validation cohort. Calibration was assessed using the Hosmer–Lemeshow test and 1000 bootstrap samples. Results The incidence of CI-AKI was 9.06% (n=170) in the total sample, 8.64% (n=109) in the development cohort and 9.92% (n=61) in the validation cohort (p=0.367). The simple nomogram including four predictors (age, intra-aortic balloon pump, acute myocardial infarction and chronic kidney disease) demonstrated a similar predictive power as the Mehran score (area under the curve: 0.80 vs 0.75, p=0.061), as well as a well-fitted calibration curve. Conclusions The present simple nomogram including four predictors is a simple and reliable tool to identify CHF patients at risk of CI-AKI, whereas further external validations are needed. Figure 1 Funding Acknowledgement Type of funding source: None

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Abstract 12621: Gender Differences Among Implantable Cardioverter Defibrillators Recipients in the Setting of Primary Prevention

Circulation ◽

10.1161/circ.132.suppl_3.12621 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Eloi Marijon ◽

Rui Providencia ◽

Pascal Defaye ◽

Didier Klug ◽

Daniel Gras ◽

...

Keyword(s):

Primary Prevention ◽

Dilated Cardiomyopathy ◽

Specific Interaction ◽

Severe Heart Failure ◽

Real Life ◽

Functional Class ◽

Cardiac Resynchronization ◽

Implantable Cardioverter Defibrillators ◽

Icd Implantation ◽

Cardioverter Defibrillators

Background: Data regarding sex specificities in the use, benefits and complications of implantable cardioverter-defibrillators (ICDs) in primary prevention in the real-world European setting are sparse. Methods: Using a large multicentric cohort of consecutive patients referred for ICD implantation for primary prevention (2002-2012), in the setting of coronary artery disease or dilated cardiomyopathy, we examined potential sex differences in subjects’ characteristics and outcomes. Results: Of 5,539 patients, only 837 (15.1%) were women and 53.8% received cardiac resynchronization therapy (CRT-D). Compared to men, women presented a significantly higher proportion of dilated cardiomyopathy (60.2% vs. 36.2%, P120ms: 74.6% vs. 68.5%, P=0.003), higher New York Heart Association functional class (2.5±0.7 vs. 2.4±0.7, P=0.003) and lower prevalence of atrial fibrillation (18.7% vs. 24.9%, P<0.001). During a 16,786 patient-years follow-up, overall, fewer appropriate therapies were observed in women (HR = 0.59, CI95% 0.45-0.76; P<0.001). By contrast, no sex-specific interaction was observed for inappropriate shocks (OR for women = 1.00, 95%CI 0.74-1.35, P=0.997) and mortality (HR = 0.87; 95%CI 0.66-1.15, P=0.324), with similar patterns of cause of deaths. Conclusion: In our real life registry, women account for the minority of ICD recipients. While female ICD recipients present with features of more severe heart failure in the setting of primary prevention of sudden cardiac death, we observed they have a 40% lower incidence of appropriate therapies.

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Long-Term Safety, Efficacy And Survival Outcomes Of Pulmonary Arterial Hypertension In WHO Functional Class II Patients Treated With Bosentan

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a3835 ◽

2012 ◽

Author(s):

Gerald Simonneau ◽

Nazzareno Galie ◽

Marius M. Hoeper ◽

Andjela Kusic-Pajic ◽

Jean-Christophe Lemarie ◽

...

Keyword(s):

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Class Ii ◽

Functional Class ◽

Survival Outcomes ◽

Pulmonary Arterial

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Sustained paradoxical vasodilation during orthostasis in heart failure: a factor in the edema pathogenesis?

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1994.267.2.h443 ◽

1994 ◽

Vol 267 (2) ◽

pp. H443-H448 ◽

Cited By ~ 1

Author(s):

H. Wroblewski

Keyword(s):

Heart Failure ◽

Blood Flow ◽

Dilated Cardiomyopathy ◽

Regional Blood Flow ◽

Functional Class ◽

Idiopathic Dilated Cardiomyopathy ◽

Pathophysiological Mechanism ◽

Class Iii ◽

Control Subjects ◽

Subcutaneous Blood Flow

Baroreceptor-induced peripheral reflex vasoconstriction during upright posture is an important edema-prevention mechanism in humans. Congestive heart failure (CHF) has been associated with blunted baroreceptor control of regional blood flow during short-term head-up tilt. The effect of prolonged unloading of baroreceptors on subcutaneous blood flow of the calf was investigated in 12 healthy subjects and in 13 patients with severe idiopathic dilated cardiomyopathy (New York Heart Association functional class III or IV). The subjects were studied both supine and sitting for 3-h periods. When sitting, subcutaneous vascular resistance decreased -26 +/- 19% in CHF patients and increased 90 +/- 69% in control subjects (P < 0.0001). The corresponding subcutaneous blood flow increased 43 +/- 29% in patients with CHF compared with the decrease of -42 +/- 17% in control subjects (P < 0.0001). I conclude that patients with CHF secondary to idiopathic dilated cardiomyopathy have an abnormal baroreceptor-mediated peripheral vasodilation during orthostatic stress that is sustained for hours. This extended paradoxical vasodilation may participate as an additional pathophysiological mechanism contributing to lower extremity edema in patients with CHF.

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Abstract 17492: Extent and Pattern of Late Gadolinium Enhancement Predict Arrhythmic Events in Patients With Nonischemic Dilated Cardiomyopathy

Circulation ◽

10.1161/circ.132.suppl_3.17492 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Dong Geum Shin ◽

Hye-Jeong Lee ◽

Junbeom Park ◽

Young Jin Kim ◽

Jae-Sun Uhm ◽

...

Keyword(s):

Late Gadolinium Enhancement ◽

Ventricular Arrhythmia ◽

Dilated Cardiomyopathy ◽

Cardiac Death ◽

Primary Outcome ◽

Multivariable Analysis ◽

Gadolinium Enhancement ◽

Nonischemic Dilated Cardiomyopathy ◽

The Impact

Background: Late gadolinium enhancement (LGE) by cardiac MR (CMR) has been related to adverse clinical outcomes in patients with nonischemic dilated cardiomyopathy (NIDC). But, a statistically significant association between LGE and arrhythmic risk in NIDC has not been demonstrated consistently. This study evaluated the impact of the presence, location and pattern of LGE on arrhythmic risk prediction in NICM. Methods: This study included 365 patients (54±15years) with NICM who underwent CMR. The extent, location and pattern of LGE were categorized. We analyzed for the primary outcome of ventricular arrhythmia (VA) including sustained or nonsustained ventricular tachycardia (VT), appropriate implantable cardioverter-defibrillator (ICD) intervention and ventricular fibrillation (VF). Cardiac death and hospitalization for heart failure (HF) were evaluated as secondary outcomes. Results: LGE was seen in 267 (73 %) patients. During median follow-up of 44±36 months, patients with LGE had higher incidence of cardiac death (15 % vs. 2 %, p<0.001), hospitalization for HF (40 % vs. 15 %, p<0.001) and VA (14% vs. 6%, p=0.03). In multivariable analysis, the presence of LGE (HR 2.78; 95% CI 1.10-7.02; p=0.03) was the independent predictor of arrhythmias. Patients with extensive LGE had higher VA (32% vs. 10%, p<0.001) with lower cumulative survival free of VA than those without extensive LGE (p=0.001). The frequent LGE location was as follows: LV septum 64%, LV-RV junction 42% and inferior 10%. VA was lower in patients with than without localized LGE limited to LV-RV junction (21% vs. 46%, p=0.005). Interestingly, while the incidence of ventricular arrhythmia was higher in patients with transmural LGE (29% vs. 10%, p=0.003), it was lower in those with patch LGE (2% vs. 16%, p=0.02) than the other patients. Conclusions: In patients with NICM, the LGE was an independent prognostic predictor of VA. Extensive LGE and specific location of LGE was related with the arrhythmic events.

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Abstract 3005: Surgical Treatment of Severe Right Ventricular Cardiomyopathy

Circulation ◽

10.1161/circ.116.suppl_16.ii_672-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Juan Chachques ◽

Thomas Lavergne ◽

Robert Frank ◽

Francoise Hidden-Lucet ◽

Guy Fontaine ◽

...

Keyword(s):

Right Ventricular ◽

Class Ii ◽

Functional Class ◽

Long Term Results ◽

Lv Function ◽

Safe Alternative ◽

Long Term Study ◽

Dynamic Cardiomyoplasty

Objective: Chronically depressed right ventricular (RV) function presents an unresolved therapeutic challenge. Despite recent advances in medical and surgical therapies, prognosis remains poor and patient’s quality of life and mortality are frequently unacceptable. The aim of this work is to present the surgical technique and long-term results of RV dynamic cardiomyoplasty applied in patients with RV failure due to isolated RV cardiomyopathies. Methods: Twelve consecutive patients (8 males, 4 females), mean age 37±9 years, were enrolled. All pts had predominant RV dysfunction, associated with tricuspid regurgitation in 11 cases. Etiology of RV failure was arrhythmogenic cardiomyopathy (8 cases), Uhl’s disease (2 cases) and ischemic (2 cases). Patients were in preoperative NYHA FC III. Mean pre-operative EF measured by isotopic technique, was 20 ± 4.2 % for the RV and 37 ± 8 % for the LV. Right ventricular dynamic cardiomyoplasty consists in wrapping the RV free wall with the left Latissimus Dorsi Muscle (LDM) flap. The distal part of the LDM is fixed to the diaphragm and then electrostimulated in synchrony with cardiac function. Eleven patients required associated tricuspid valve surgery (10 annuloplasty rings and 1 valve replacement). In 6 pts an ICD was implanted prior to surgery. Results: Nine patients are alive (mean follow-up: 10 ± 3.5 years), seven in NYHA functional class I and two in class II. Three deaths occurred: one patient died postoperatively due to infection, one patient died at day 45 due to gastroenteric complication and one patient died at year 7 due to stroke, while in functional class II. At long term follow-up, mean RVEF is 32 ± 6 % and LVEF is 51 ± 9 %. Conclusions: The results of this long-term study demonstrate hemodynamic and functional improvements following RV cardiomyoplasty with no long-term malignant arrhythmias and RV dysfunction related deaths. The effects of RV cardiomyoplasty can be related to chronic systolic compression and diastolic dilatation restriction (positive remodeling), which may reduce tension and excitability of myocardial fibers. This study suggests that cardiomyoplasty is a safe alternative or long-term bridge to heart transplantation in these patients with relatively preserved LV function.

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