scholarly journals Prevalence and Clinical Characteristics of Patients with Pause-Dependent Atrioventricular Block

2022 ◽  
Vol 11 (2) ◽  
pp. 449
Author(s):  
Sok-Sithikun Bun ◽  
Florian Asarisi ◽  
Nathan Heme ◽  
Fabien Squara ◽  
Didier Scarlatti ◽  
...  
Keyword(s):  
Atrioventricular Block ◽  
Clinical Characteristics ◽  
Conduction Block ◽  
Premature Ventricular Contraction ◽  
Underlying Mechanism ◽  
Left Ventricular ◽  
University Hospital ◽  
Left Ventricular Ejection ◽  
High Grade ◽  
Ventricular Ejection Fraction

Background: In patients with complete atrioventricular block (AVB), the prevalence and clinical characteristics of patients with pause-dependent AVB (PD-AVB) is not known. Our objective was to assess the prevalence of PD-AVB in a population of patients with complete (or high-grade) AVB. Methods: Twelve-lead electrocardiogram (ECG) and/or telemonitoring from patients admitted (from September 2020 to November 2021) for complete (or high-degree) AVB were prospectively collected at the University Hospital of Nice. The ECG tracings were analyzed by an electrophysiologist to determine the underlying mechanism of PD-AVB. Results: 100 patients were admitted for complete (or high-grade) AVB (men 55%; 82 ± 12 years). Arterial hypertension was present in 68% of the patients. Baseline QRS width was 117 ± 32 ms, and mean left ventricular ejection fraction was 56 ± 7%. Fourteen patients (14%) with PD-AVB were identified, and presented similar clinical characteristics in comparison with patients without PD-AVB, except for syncope (which was present in 86% versus 51% in the non-PD-AVB patients, p = 0.01). PD-AVB sequence was induced by: Premature atrial contraction (8/14), premature ventricular contraction (5/14), His extrasystole (1/14), conduction block in a branch (1/14), and atrial tachycardia termination (1/14). All patients with PD-AVB received a dual-chamber pacemaker during hospitalization. Conclusion: The prevalence of PD-AVB was 14%, and may be underestimated. PD-AVB episodes were more likely associated with syncope in comparison with patients without PD-AVB.

Prevalence and clinical characteristics of patients presenting with phase 4 atrioventricular block

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
S-S Bun ◽  
N Heme ◽  
F Asarisi ◽  
F Squara ◽  
D Scarlatti ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Atrioventricular Block ◽  
Conduction Block ◽  
Premature Ventricular Contraction ◽  
Left Ventricular ◽  
University Hospital ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Conduction Disorders ◽  
High Degree

Abstract Funding Acknowledgements Type of funding sources: None. Background The prevalence of phase 4 atrioventricular block (4AVB) is not known. Objective To assess the exact prevalence of 4AVB in a population of patients with high-degree AVB. Methods All the ECG from patients admitted for high-degree AVB (2 to 1 and complete) were collected at the University Hospital of Nice. The ECG tracings (12-lead surface and telemonitoring during hospitalization) were reviewed by an electrophysiologist. Results From Sept 2019 to Sept 2020, 65 patients were admitted for high-degree AVB. 8 patients (12 %) with 4AVB were identified (3 men; 88 ± 5 years). Arterial hypertension was present in 7/8 (87 %), and a syncopal episode - 4AVB-related - was noticed in 6/8 patients (75 %), mean left ventricular ejection fraction 54 ± 13 %. Baseline QRS width and corrected QT intervals were respectively 131 ± 30 ms and 469 ± 34 ms). 4AVB sequence was induced by a: premature atrial contraction (5/8), premature ventricular contraction (1/8), conduction block in a branch (1/8), sinus rhythm acceleration (1/8). All patients received a dual-chamber pacemaker during hospitalization. Conclusion The exact prevalence of 4AVB is not rare (12 %), and may be underestimated. 4AVB is usually observed in an elderly population, treated for arterial hypertension, and with baseline conduction disorders. Abstract Figure. Phase 4 AVB induced by PAC

P6209Relationship between skin autofluorescence levels and clinical outcomes in heart failure patients undergoing cardiac rehabilitation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Kunimoto ◽  
K Shimada ◽  
M Yokoyama ◽  
A Honzawa ◽  
M Yamada ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Rehabilitation ◽  
Cox Regression ◽  
Left Ventricular ◽  
University Hospital ◽  
Left Ventricular Ejection ◽  
Skin Autofluorescence ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

Abstract Background Advanced glycation end-products, indicated by skin autofluorescence (SAF) levels, could be prognostic predictors of all-cause and cardiovascular mortality in patients with diabetes mellitus (DM) and renal disease. However, the clinical usefulness of SAF levels in patients with heart failure (HF) who underwent cardiac rehabilitation (CR) remains unclear. Purpose The purpose of this study was to investigate the prognostic value of SAF levels in patients with HF who underwent CR. Methods This study enrolled 204 consecutive patients with HF who had undergone CR at our university hospital between November 2015 and October 2017. Clinical characteristics and anthropometric data were collected at the beginning of CR. SAF levels were noninvasively measured with an autofluorescence reader. The major adverse cardiovascular event (MACE) was a composite of all-cause mortality and unplanned hospitalization for HF. Follow-up data concerning primary endpoints were collected until November 2018. Results Patients' mean age was 68.1 years, and 61% were males. Patients were divided into two groups according to the median SAF levels (high and low SAF groups). Patients in the high SAF group were significantly older, had a higher prevalence of chronic kidney disease, and histories of coronary artery bypass surgery; however, there were no significant between-group differences in sex, prevalence of DM, left ventricular ejection fraction, and physical function. During a median follow-up period of 623 days, 25 patients experienced all-cause mortality and 34 were hospitalized for HF. Kaplan–Meier analysis showed that patients in the high SAF group had a higher incidence of MACE (log-rank P<0.05), whereas when patients were divided into two groups according to the median hemoglobin A1c level, no significant between-group difference was observed for the incidence of MACE (Figure). After adjusting for confounding factors, Cox regression multivariate analysis revealed that SAF levels were independently associated with the incidence of MACE (hazard ratio: 1.74, 95% confidence interval: 1.12–2.65, P<0.05). Figure 1 Conclusion SAF levels were significantly associated with the incidence of MACE in patients with HF and may be useful for risk stratification in patients with HF who undergo CR.

scholarly journals Heart failure with preserved systolic function: prevalence and clinical features in a cohort of patients admitted to internal medicine units. The study PRESYF-HF Tuscany

2016 ◽  
Vol 68 (3) ◽  
Author(s):  
Paolo Biagi ◽  
Luigi Abate ◽  
Massimo Alessandri ◽  
Salvatore Bocchini ◽  
Valerio Verdiani ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Heart Failure ◽  
Clinical Characteristics ◽  
Systolic Function ◽  
The Elderly ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Study Cohort ◽  
Correct Identification ◽  
Ventricular Ejection Fraction

Background. There is uncertainty about the prevalence and clinical characteristics of heart failure (HF) patients with preserved systolic function (PRESYF). Aim. To analyze the prevalence and clinical characteristics of patients with PRESYF in an unselected cohort of subjects consecutively hospitalized for HF. Methods. The study cohort included 338 patients consecutively admitted for HF at 24 Internal Medicine units homogeneously settled in Tuscany area (Italy). We did not have any criteria for exclusion. All patients had an echocardiographic measure of left ventricular ejection fraction (LVEF) within 72 hours from hospital admission. Patients with LVEF &gt; 50% were considered to have PRESYF. Results. The patients with PRESYF were 112 (33,1%), those with depressed systolic function (DESYF) 226 (66,9%). In the group PRESYF were prevalent female sex, hypertensive etiology, and elevated BMI. The distribution for classes of age shows a great frequency of PRESYF in the elderly. Conclusion. About one third of patients admitted for HF have a PRESYF. They are different compared to those with DESYF. A correct identification of this form of HF may be important in clinical practice for more targeted therapeutic options and for prognostic implications.

scholarly journals Amiodarone-Induced Thyrotoxicosis Is a Predictor of Adverse Cardiovascular Outcome

2009 ◽  
Vol 94 (1) ◽  
pp. 109-114 ◽  
Author(s):  
Kai-Hang Yiu ◽  
Man-Hong Jim ◽  
Chung-Wah Siu ◽  
Chi-Ho Lee ◽  
Michele Yuen ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Cardiovascular Events ◽  
Ventricular Arrhythmias ◽  
Clinical Characteristics ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Left Ventricular Ejection ◽  
Amiodarone Therapy ◽  
Ventricular Ejection Fraction ◽  
Increased Risk

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 &lt; 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 &lt; 0.01) and left ventricular ejection fraction less than 45% (hazard ratio 2.52; confidence interval 1.43–4.42; P &lt; 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.

scholarly journals ACUTE MYOCARDIAL INFARCTION

2018 ◽  
Vol 25 (08) ◽  
pp. 223-1228
Author(s):  
Gul Hassan Brohi ◽  
Shahzeb Rasool Memon ◽  
Muhammad Yaqoob Shahani ◽  
Samreen Memon ◽  
Umbreen Bano
Keyword(s):  
Case Series ◽  
Left Ventricular ◽  
University Hospital ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Aspiration Thrombectomy ◽  
Ventricular Ejection Fraction ◽  
Subtle Change ◽  
Case Series Study ◽  
Primary Stenting

Objectives: To evaluate the effects of aspiration thrombectomy (AT) using anAspiration Catheter (INVATEC SPA DIVER C.E. MAX, Italy) in patients with acute myocardialinfarction (AMI). Study Design: Cross sectional and Case series study. Setting: Departmentof Cardiology, Liaquat University Hospital, Hyderabad. Period: January 2012 to December2013. Methodology and Results: Measurement of left ventricular ejection fraction (LVEF) byechocardiography was obtained before (acute LVEF) percutaneous coronary intervention (PCI)and 1 week after (late LVEF) the procedure. Most of the patients with full restoration of STsegment elevation following PCI were higher in the aspiration Catheter control group (90 vs68%, P < 0.01), (86 vs 62%, P < 0.01) and (90 vs 64%, P < 0.01) respectively. Minimal changein LVEF was observed in patients between the Aspiration Catheter group and control group at1 week post procedure. Conclusion: Combination of AT using Aspiration Catheter (INVATECSPA DIVER C.E. MAX) with primary stenting can better outcome, while left ventricle (LV) functionhad subtle change in AMI when compared to primary stenting after balloon predilation withoutthrombectomy.

scholarly journals Estimation of possible candidates for ivabradine in rural Japan and investigation of their clinical characteristics

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Saito ◽  
M Kinoshita ◽  
H Nakagawa ◽  
T Sumimoto
Keyword(s):  
Ejection Fraction ◽  
Clinical Characteristics ◽  
Sinus Node ◽  
Stable Condition ◽  
Left Atrial Volume ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Abstract Background In Japan, ivabradine is indicated in patients with heart failure (HF) with sinus rhythm and a resting heart rate (HR) ≥75/min under standard treatment. Particularly, it is effective for HF with reduced left ventricular ejection fraction (LVEF). However, elderly people have a higher incidence of atrial fibrillation than young people, and their sinus node function is further deteriorated, resulting in a lower intrinsic HR. In addition, Japan is an ultra-aging society, especially in the countryside; therefore, the target patients for ivabradine may be limited in these regions. Purpose We sought to estimate the possible candidates for ivabradine and investigate their clinical characteristics in our hospital located in rural Japan. Method and results We retrospectively studied 14733 consecutive patients who were suspected heart disease who underwent echocardiography between January 2006 and October 2018 in Kitaishikai Hospital located in Ozu city (Proportion of the population aged ≥65 years: 34%, in 2015) and did not take ivabradine treatment. Of these, 187 patients with hemodynamically stable condition whose E/A ratio was measured and met the criteria of LVEF &lt;40% and HR ≥75 /min were confirmed. Of these, 153 patients reached HR &lt;75 /min with additional intensive medication within one year after the index echocardiography (Controlled group; mean HR: 82 to 62/min). The remaining 34 patients with uncontrolled HR (Uncontrolled group; mean HR: 84 to 82/min) were considered possible candidates for ivabradine (34/14733: 0.23%, 2.6 patients per year; median age, 74 years; male, 56%; median LVEF, 32%; ischemic cardiomyopathy, 53%). In the comparison of clinical and echocardiographic parameters in these two groups, Uncontrolled group had a significantly smaller left ventricular diastolic volume index (71 [59–85] vs 82 [66–109] /ml/m2, p=0.02), left ventricular systolic volume index (50 [39–59] vs 59 [42–80] / ml/m2, p=0.04), stroke volume index (22 [18–26] vs 26 [20–32] /ml/m2, p=0.02), left atrial volume index (47 [40–64] vs 59 [45–71] /ml/m2, p=0.02), and more hemodialysis (12 vs 3%, p=0.04) than Controlled group. However, the discrimination ability of these parameters for identifying Uncontrolled group was modest (Figure). Conclusion In rural Japan, possible candidates for ivabradine may be rare, so daily attention should be paid. Patients with reduced ejection fraction, small left ventricle, and hemodialysis may be the possible targets for this therapy. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Study protocol for the PURSUIT-HFpEF study: a Prospective, Multicenter, Observational Study of Patients with Heart Failure with Preserved Ejection Fraction

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038294
Author(s):  
Shinichiro Suna ◽  
Shungo Hikoso ◽  
Takahisa Yamada ◽  
Masaaki Uematsu ◽  
Yoshio Yasumura ◽  
...  
Keyword(s):  
Heart Failure ◽  
Observational Study ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Left Ventricular ◽  
University Hospital ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction

IntroductionNeither the pathophysiology nor an effective treatment for heart failure with preserved ejection fraction (HFpEF) has been elucidated to date. The purpose of this ongoing study is to elucidate the pathophysiology and prognostic factors for patients with HFpEF admitted to participating institutes. We also aim to obtain insights into the development of new diagnostic and treatment methods by analysing patient background factors, clinical data and follow-up information.Methods and analysisThis study is a prospective, multicentre, observational study of patients aged ≥20 years admitted due to acute decompensated heart failure with preserved left ventricular ejection fraction (≥50%) and elevated N-terminal-pro brain natriuretic peptide (NT-proBNP) (≥400 pg/mL). The study began in June 2016, with the participation of Osaka University Hospital and 31 affiliated facilities. We will collect data on history in detail, accompanying diseases, quality of life, frailty score, medication history, and laboratory and echocardiographic data. We will follow-up each patient for 5 years, and collect outcome data on mortality, cause of death, and the number and cause of hospitalisation. The target number of registered cases is 1500 cases in 5 years.Ethics and disseminationThe protocol was approved by the Institutional Review Board (IRB) of Osaka University Hospital on 24 February 2016 (ID: 15471), and by the IRBs of the all participating facilities. The findings will be disseminated through peer-reviewed publications and conference presentations.

Trastuzumab-mediated cardiac dysfunction (CDx) outside of clinical trials: Single Asian center experience

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20732-e20732
Author(s):  
J. Park ◽  
S. Han ◽  
D. Oh ◽  
J. Kim ◽  
H. Lee ◽  
...  
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Left Ventricular ◽  
University Hospital ◽  
Left Ventricular Ejection ◽  
Her2 Positive ◽  
Converting Enzyme Inhibitors ◽  
Ventricular Ejection Fraction ◽  
Lower Baseline

e20732 Background: Trastuzumab is an effective drug for the treatment of HER2 positive breast cancer (BC) and CDx has been reported as a major toxicity. The purpose of our study was to investigate the trastuzumab mediated CDx in practice setting and the treatment outcome at single Asian center. Methods: We retrospectively analyzed 181 HER2-overexpressing BC patients (pts) who were treated with trastuzumab containing regimen between January 2005 and December 2007 at Seoul National University Hospital. We investigated the incidence of CDx and the degree of reversibility using echocardiography (EchoCG) and identify the risk factors to predict CDx. Results: Among 181 patients (pts), 112 were treated for palliative purpose and 139 had previously received anthracycline-based chemotherapy. Baseline EchoCG results were available in 129 pts (median age 47; range 25–79) and median left ventricular ejection fraction (LVEF) was 59% (range 45–70). Median follow-up duration was 21 months. LVEF decreased more than 5% points in 37 out of 129 (28.6%). According to the national cancer institute common terminology criteria for adverse events, grade (G) 2 and G 3/4 CDx developed in 4 (3.1%) and 8 (6.2%) pts respectively. Seven pts experienced symptomatic heart failure (HF). 3 among 5 pts who experienced discontinuation of trastuzumab could resume trastuzumab after median 146 (range 94–163) days of discontinuation. Median LVEF was 54% (range 45–63) at baseline in pts who experienced G2–4 CDx and deceased to 45% (range 30–49) after median 175 (range 65–415) days of trastuzumab treatment. HF treatment was initiated in 9 pts. 4 pts received angiotensin converting enzyme inhibitors (ACEI), 3 pts angiotensin receptor blockers (ARB) and 2 pts ACEI or ARB with diuretics. Occurrence of CDx (G2–4) was associated with higher anthracycline cumulative doses (p=0.039) and lower baseline LVEF (p=0.003). The incidence of symptomatic HF was related with past medical history such as hypertension (p=0.019) and lower baseline LVEF (p=0.005). Among the pts who had G2–4 CDx, LVEF was restored to 54% (range 40–59) which was similar to baseline at median 187 (range 56–477) days after the diagnosis of CDx. Conclusions: The majority pts with trastuzumab-mediated CDx were asymptomatic and LVEF could be reversible. No significant financial relationships to disclose.

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