Comparison between PtCO2 and PaCO2 and Derived Parameters in Heart Failure Patients during Exercise: A Preliminary Study

Evaluation of arterial carbon dioxide pressure (PaCO2) and dead space to tidal volume ratio (VD/VT) during exercise is important for the identification of exercise limitation causes in heart failure (HF). However, repeated sampling of arterial or arterialized ear lobe capillary blood may be clumsy. The aim of our study was to estimate PaCO2 by means of a non-invasive technique, transcutaneous PCO2 (PtCO2), and to verify the correlation between PtCO2 and PaCO2 and between their derived parameters, such as VD/VT, during exercise in HF patients. 29 cardiopulmonary exercise tests (CPET) performed on a bike with a ramp protocol aimed at achieving maximal effort in ≈10 min were analyzed. PaCO2 and PtCO2 values were collected at rest and every 2 min during active pedaling. The uncertainty of PCO2 and VD/VT measurements were determined by analyzing the error between the two methods. The accuracy of PtCO2 measurements vs. PaCO2 decreases towards the end of exercise. Therefore, a correction to PtCO2 that keeps into account the time of the measurement was implemented with a multiple regression model. PtCO2 and VD/VT changes at 6, 8 and 10 min vs. 2 min data were evaluated before and after PtCO2 correction. PtCO2 overestimates PaCO2 for high timestamps (median error 2.45, IQR −0.635–5.405, at 10 min vs. 2 min, p-value = 0.011), while the error is negligible after correction (median error 0.50, IQR = −2.21–3.19, p-value > 0.05). The correction allows removing differences also in PCO2 and VD/VT changes. In HF patients PtCO2 is a reliable PaCO2 estimation at rest and at low exercise intensity. At high exercise intensity the overall response appears delayed but reproducible and the error can be overcome by mathematical modeling allowing an accurate estimation by PtCO2 of PaCO2 and VD/VT.

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Association between self-care and prognosis in 1123 patients with chronic heart failure

European Heart Journal ◽

10.1093/ehjci/ehaa946.1041 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

E Calero ◽

E Hidalgo ◽

R Marin ◽

L Rosenfeld ◽

I Fernandez ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Acute Heart Failure ◽

Nyha Class ◽

Self Care ◽

P Value ◽

Funding Source ◽

Class Iii ◽

Cox Models ◽

Lower Tertile

Abstract Background Self-care is a crucial factor in the education of patients with heart failure (HF) and directly impacts in the progression of the disease. However, little is published about its major clinical implications as admission or mortality in patients with HF. Aims and methods The aim of the study was to analyze time to admission due to acute heart failure and mortality associated with poor self-care in patients with chronic HF. We prospectively recruited consecutive patients with stable chronic HF referred to a nurse-led HF programme. Selfcare was evaluated at baseline with the 9 item European Heart Failure Self-Care Behavior Scale. Scores were standardized and reversed from 0 (worst selfcare) to 100 (better self care). For the purpose of this study we analyzed the associations of worse self-care (defined as scores below the lower tertile of the scale) with demographic, disease-related (clinical) and psychosocial factors in all patients at baseline. Results We included 1123 patients, mean age 72±11, 639 (60%) were male, mean LVEF 45±17 and 454 (40,4%) were in NYHA class III or IV. Mean score of the 9-item ESCBE was 69±28. Score below 55 (lower tertile) defined impaired selfcare behaviour. Those patients with worse self-care had more ischaemic heart disease, more COPD, and they achieved less distance in the 6 minute walking test. Regarding psychosocial items patients in lower tertile of self-care needed a caregiver more frequently, they present more cognitive impairment, depressive symptoms and worse score in terms of health self-perception. Multivariate Cox Models showed that a score below 55 points in 9-item ESCBE was independently associated with higher readmission due to acute heart failure [HR 1.26 (1.02–1.57), p value=0.034] and with mortality [HR 1.24 CI95% (1.02–1.50), p value=0.028] Conclusion Poor self-care measured with the modified 9-item ESCBE was associated with higher risk of admission due to acute decompensation and higher risk of mortality in patients with chronic heart failure. These results highlight the importance of assessing self-care and provide measures to improve them. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Hospital Univesitario de Bellvitge

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Clinical significance of Q waves in ischemic cardiomyopathy

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.340 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

E Rodenas Alesina ◽

P Jordan ◽

L Herrador ◽

C Espinet-Coll ◽

N Pizzi ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Primary Endpoint ◽

Ischemic Cardiomyopathy ◽

Cox Regression ◽

Cox Model ◽

Cardiovascular Death ◽

P Value ◽

Heart Failure Hospitalization ◽

Total Cohort

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): CIBER-CV AIMS The scintigraphic translation of Q waves in patients with ischemic cardiomyopathy and LVEF < 40% has not yet been assessed. The aim of this study was to explore the relationship between Q waves and necrotic tissue and to analyze their impact in prognosis. METHODS AND RESULTS A retrospective study enrolling 487 consecutive patients (67,0 [57,4 – 75,4] years), with ischemic cardiomyopathy, LVEF <40% and narrow QRS who underwent stress-rest SPECT was conducted. Patients with Q waves (320 patients [65,7%]) had less comorbidity and ischemia, but more necrosis. Q waves correlated poorly with lack of viability (AUC = 0,63) and were independently associated with the subendocardial extent of the necrosis. After a follow-up of 5,07 years, the primary outcome (cardiovascular death, heart failure hospitalization or myocardial infarction) occurred in 192 (39,4%) patients, without differences between groups in multivariate analysis. After accounting for non-cardiovascular death as a competitive risk, the interaction between >10% of ischemia and revascularization remained in Cox model both in the total cohort (aHR= 0,46 [0,24 – 0,86]), and in patients with Q waves (aHR = 0,27 [0,11–0,69]). CONCLUSION Patients with ischemic cardiomyopathy with Q waves have larger subendocardial scarring and more transmural necrosis, although correlation between Q waves and transmural scarring is poor. Revascularization if >10% ischemia is present is associated with a better prognosis. Ischemia burden should be assessed and accordingly treated in these patients, and no differences in management should be made in the presence of Q waves. Table 1. Cox proportional hazards model Total cohort (N = 471) Patients with Q waves (N = 315) aHR p-value 95% CI aHR p-value 95% CI Age (per year) 1,02 0,007 1,01 - 1,04 n.s. Diabetes mellitus 1,35 0,047 1,00 - 1,81 1,54 0,016 1,09 - 2,20 eGFR < 60 ml/min 1,59 0,005 1,15 - 2,21 1,96 <0,001 1,36 - 2,82 Previous HF hospitalization 1,71 0,002 1,23 - 2,38 1,76 0,007 1,17 - 2,64 Previous PCI 1,32 0,069 0,98 - 1,78 n.s. Previous CABG n.s. 1,77 0,009 1,15 - 2,72 Angina or dyspnea 1,68 0,001 1,24 - 2,28 1,71 0,004 1,19 - 2,46 Indexed TDV (per quartile) 1,16 0,047 1,02 - 1,33 n.s. Revascularization*ischemia > 10% 0,46 0,015 0,24 - 0,86 0,27 0,006 0,11 - 0,69 Cox regression for the primary endpoint (cardiovascular death, heart failure hospitalization or myocardial infarction), accounting for non-cardiovascular death as a competitive risk. Abstract Figure. Survival for the primary endpoint

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Factors associated with successful return to work in young heart failure and ischaemic heart disease patients following index hospital admission

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.312 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

HV Thakkar ◽

L Hollingsworth ◽

JA Enright ◽

S Sanderson ◽

RJ Macfadyen ◽

...

Keyword(s):

Heart Failure ◽

Return To Work ◽

Decompensated Heart Failure ◽

Individual Factors ◽

P Value ◽

Complex Interplay ◽

Coronary Syndrome ◽

Funding Sources ◽

Financial Benefits ◽

The Individual

Abstract Funding Acknowledgements Type of funding sources: None. Background Factors influencing return to remunerated work following an acute cardiac illness are poorly defined. We wished to compare the factors in our cohorts following first presentation of acute coronary syndrome(ACS) and decompensated heart failure(HF). Methods Prospectively identified subjects, aged 18-65years, from a rehabilitation population for ACS and HF during 2018-2019 underwent a survey. Results Of 133cases meeting inclusion criteria, 84 completed the survey(41 HF, 80% male, mean age 55years; 43 ACS, 86% male, mean age 57years). Socio-economic indexes for Areas(SIEFA) index were similar for HF(900) & ACS(909) groups, which represents 11th and 14th percentile for Australia respectively. Cardiovascular risk factors were similar except hypercholesterolemia(37% v 60%; p = 0.029) was more common in ACS. Many subjects did not continue beyond Yr12, (54% HF v 30% ACS; p = 0.029). A majority of ACS cases returned to work as compared with HF(70% v 44%; p = 0.017)(Figure). On multivariate analysis, male gender[p = 0.031;OR 13.71 (1.28-147.36)]; access to financial benefits[p < 0.001;OR 22.75 (4.31-119.99)] and a desire to return to work [p = 0.014;OR 12.1 (1.67-87.82)] were associated with successful return to work (Table). Limitations Our study has small numbers so will be difficult to generalise to a wider population. We do show a signal towards the complex interplay of the social and individual factors in determining return to work. Further larger studies are required to tease out the differences between the individual factors to help predict return to work in the Australian context. Conclusion Successful return to work for patients with first presentation of ACS or HF could not be reliably predicted. Patients with ACS returned to work more often than HF. In HF patients who do n to return to work, recurrent symptoms, individual motivation, social support and access to financial benefits have a complex interplay. Predictors of return to work Predictor P value OR (95% CI) Diagnosis (heart failure) 0.095 0.29 (0.07, 1.24) Gender (male) 0.031 13.71 (1.28, 147.36) Access to benefit (none) <0.001 22.75 (4.31, 119.99) Desire to RTW (yes) 0.014 12.1 (1.67, 87.82) Abstract Figure. Rates of return to work in the 2 groups

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Detrimental immediate and long-term clinical effects of right ventricular pacing in patients with myocardial fibrosis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.304 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

C Saunderson ◽

MF Paton ◽

LAE Brown ◽

J Gierula ◽

PG Chew ◽

...

Keyword(s):

Heart Failure ◽

Right Ventricular ◽

Pacemaker Implantation ◽

Mechanical Dyssynchrony ◽

Volume Index ◽

Lv Function ◽

P Value ◽

Rv Pacing ◽

Dyssynchrony Index

Abstract Funding Acknowledgements Type of funding sources: None. Background Long-term right ventricular (RV) pacing leads to heart failure or a decline in left ventricular (LV) function in up to a fifth of patients. Objectives We aimed to establish whether patients with focal fibrosis detected on late gadolinium enhancement cardiovascular magnetic resonance (CMR) have deterioration in LV function after RV pacing. Methods We recruited 110 patients (84 in final analysis) into two observational CMR studies. Patients (n = 34) with a dual chamber device and preserved atrioventricular (AV) conduction underwent CMR in two asynchronous pacing modes (AOO & DOO) to compare intrinsic conduction with RV pacing. Patients (n = 50) with high-grade AV block underwent CMR before and 6 months after pacemaker implantation to investigate the long-term effects of RV pacing. Results: The three key findings were 1) Initiation of RV pacing in patients with fibrosis, compared to those without, was associated with greater immediate changes in both LV end-systolic volume index (LVESVi) (5.3 ± 3.5 vs 2.1 ± 2.4 mL/m2; p < 0.01) and LV ejection fraction (LVEF) (-5.7 ± 3.4% vs -3.2 ± 2.6%; p = 0.02); 2) Long-term RV pacing in patients with fibrosis, compared to those without, was associated with greater changes in LVESVi (8.0 ± 10.4 vs -0.6 ± 7.3 mL/m2; p = 0.008) and LVEF (-12.3 ± 7.9 vs -6.7 ± 6.2%; p = 0.012); 3) Patients with fibrosis did not experience an improvement in quality of life, biomarkers or functional class after pacemaker implantation. Conclusions Fibrosis detected on CMR is associated with immediate and long-term deterioration in LV function following RV pacing and could be used to identify those at risk of heart failure prior to pacemaker implantation. Characteristics before and after pacing Study 1 No fibrosis (n = 16) Fibrosis (n = 18) AOO DOO p-value AOO DOO p-value LVEDVi - mL/m² 66 ± 13 66 ± 12 0.67 78 ± 14 79 ± 13 0.34 LVESVi - mL/m² 30 ± 10 32 ± 9 0.003 38 ± 11 43 ± 12 <0.001 LVEF - % 56 ± 6 53 ± 5 <0.001 52 ± 8 47 ± 9 <0.001 Mechanical Dyssynchrony index - ms 61 ± 17 71 ± 25 0.07 81 ± 18 89 ± 21 0.04 Study 2 No fibrosis (n = 19) Fibrosis (n = 31) Pre-PPM Post-PPM p-value Pre-PPM Post-PPM p-value LVEDVi -mL/m² 88 ± 21 73 ± 14 <0.001 90 ± 18 83 ± 21 0.007 LVESVi -mL/m² 35 ± 9 34 ± 9 0.71 41 ± 14 49 ± 21 0.001 LVEF - % 60 ± 5 54 ± 7 <0.001 56 ± 8 43 ± 12 <0.001 Mechanical Dyssynchrony index - ms 70 ± 29 81 ± 22 0.15 84 ± 30 98 ± 31 0.03 Abstract Figure. Mechanism for heart failure after pacing

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Factors determining symptoms in heart failure: comparison of fast and slow exercise tests.

Heart ◽

10.1136/hrt.55.5.439 ◽

1986 ◽

Vol 55 (5) ◽

pp. 439-445 ◽

Cited By ~ 102

Author(s):

D P Lipkin ◽

R Canepa-Anson ◽

M R Stephens ◽

P A Poole-Wilson

Keyword(s):

Heart Failure ◽

Exercise Tests

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Cardiopulmonary fitness is related to disease severity in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458515581437 ◽

2015 ◽

Vol 22 (2) ◽

pp. 231-238 ◽

Cited By ~ 14

Author(s):

Martin Heine ◽

Inez Wens ◽

Martin Langeskov-Christensen ◽

Olaf Verschuren ◽

Bert O Eijnde ◽

...

Keyword(s):

Disease Severity ◽

Close Relation ◽

Progressive Increase ◽

Peak Oxygen Uptake ◽

Multiple Regression Model ◽

Exercise Tests ◽

Cardiopulmonary Fitness ◽

Disability Status ◽

Related Quality ◽

Health Related

Background: In persons with MS (pwMS), a lower cardiopulmonary fitness has been associated with a higher risk for secondary disorders, decreased functional capacity, symptom worsening and reduced health-related quality of life. Objective: To investigate the association between disease severity and cardiopulmonary fitness. Methods: Data from cardiopulmonary exercise tests, previously conducted in three different countries, were pooled. The association between disease severity (Expanded Disability Status Scale (EDSS)) and cardiopulmonary fitness (peak oxygen uptake (VO2peak)) was adjusted for age, sex and the country of origin. Results: The combined sample comprised 116 ambulant pwMS having a mean (± SD) EDSS score of 2.7 ± 1.3. There was a significant correlation ( r = -0.418, p < .01) between VO2peak and EDSS. A multiple regression model (R2 = 0.520, p < .01) was constructed to describe VO2peak (mL∙kg−1∙min−1); VO2peak = 36.622 − 5.433 (Sex (1=men)) – 0.124 (Age) − 2.082 (EDSS) + 2.737 (Belgium) + 8.674 (Denmark). Conclusion: There was a significant association between disease severity and cardiopulmonary fitness. The close relation between cardiopulmonary fitness and chronic conditions associated with physical inactivity, suggest a progressive increase in risk of secondary health conditions in pwMS

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Toward a predictive theoretical model for osmolality rise with non-humidified incubation: a randomized, multivariate response-surface study

Human Reproduction ◽

10.1093/humrep/deab015 ◽

2021 ◽

Author(s):

Steven F Mullen

Keyword(s):

Mathematical Model ◽

Response Surface ◽

Surface Area ◽

Embryo Culture ◽

Culture Medium ◽

Conflicts Of Interest ◽

Volume Ratio ◽

P Value ◽

Cook Medical ◽

Over Time

Abstract STUDY QUESTION What factors associated with embryo culture techniques contribute to the rate of medium osmolality change over time in an embryo culture incubator without added humidity? SUMMARY ANSWER The surface area-to-volume ratio of culture medium (surface area of the medium exposed to an oil overlay), as well as the density and height of the overlaying oil, all interact in a quantitative way to affect the osmolality rise over time. WHAT IS KNOWN ALREADY Factors such as medium volume, different oil types, and associated properties, individually, can affect osmolality change during non-humidified incubation. STUDY DESIGN, SIZE, DURATION Several experimental designs were used, including simple single-factor completely randomized designs, as well as a multi-factor response surface design. Randomization was performed at one or more levels for each experiment. Osmolality measurements were performed over 7 days, with up to 8 independent osmolality measurements performed per treatment group over that time. For the multi-factor study, 107 independent combinations of factor levels were assessed to develop the mathematical model. PARTICIPANTS/MATERIALS, SETTING, METHODS This study was conducted in a research laboratory setting. Commercially available embryo culture medium and oil was used. A MINC incubator without water for humidification was used for the incubation. Osmolality was measured with a vapor pressure osmometer after calibration. Viscometry and density were conducted using a rheometer, and volumetric flasks with an analytical balance, respectively. Data analyses were conducted with several commercially available software programs. MAIN RESULTS AND THE ROLE OF CHANCE Preliminary experiments showed that the surface area-to-volume ratio of the culture medium, oil density, and oil thickness above the medium all contributed significantly (P < 0.05) to the rise in osmolality. A multi-factor experiment showed that a combination of these variables, in the form of a truncated cubic polynomial, was able to predict the rise in osmolality, with these three variables interacting in the model (P < 0.05). Repeatability, as measured by the response of identical treatments performed independently, was high, with osmolality values being ± 2 of the average in most instances. In the final mathematical model, the terms of the equation were significant predictors of the outcome, with all P-values being significant, and only one P-value > 0.0001. LIMITATIONS, REASONS FOR CAUTION Although the range of values for the variables were selected to encompass values that are expected to be encountered in usual embryo culture conditions, variables outside of the range used may not result in accurate model predictions. Although the use of a single incubator type and medium type is not expected to affect the conclusions, that remains an uncertainty. WIDER IMPLICATIONS OF THE FINDINGS Using this predictive model will help to determine if one should be cautious in using a specific system and will provide guidance on how a system may be modified to provide improved stability during embryo culture. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by Cook Medical. The author is a Team Lead and Senior Scientist at Cook Medical. The author has no other conflicts of interest to declare TRIAL REGISTRATION NUMBER N/A.

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Comparison of lung bedside ultrasound and BNP in the diagnosis of acute heart failure in the emergency department

Journal of Research in Clinical Medicine ◽

10.34172/jrcm.2020.050 ◽

2020 ◽

Vol 8 (1) ◽

pp. 50-50

Author(s):

Seyed Hossein Ojaghi Haghighi ◽

Neda Hamed ◽

Shiva Ebrahimi ◽

Jafar Ghobadi ◽

Hoorolnesa Ameli

Keyword(s):

Heart Failure ◽

Emergency Room ◽

Pulmonary Edema ◽

Acute Heart Failure ◽

Lung Ultrasound ◽

P Value ◽

Ultrasound Evaluation ◽

Ultrasound Findings ◽

Medical Advances ◽

B Lines

Introduction: Congestive heart failure is heart muscle failure that causes pulmonary congestion and eventually pulmonary edema, which despite recent medical advances, is still a progressive syndrome with high mortality, the prevalence of which has increased in recent decades. Therefore, in this study we compared lung ultrasound findings in acute heart failure patients with the BNP. Methods: This study was performed in the emergency room of Imam Reza hospital in Tabriz. For patients entering the emergency room after taking a history, both standard gold (BNP) tests and beside ultrasound of the lung were performed. Ultrasound was performed at the same time as obtaining blood sample to ensure that the ultrasound specialist did not know the result of diagnosis. During the ultrasound, if there were multiple B-Lines that were at least 3 mm apart, patient was diagnosed with pulmonary edema due to heart failure. Results: Number of participants in this study was 108 people, 54.6% of whom were men and the rest were women. The correlation coefficient between width and number of kerley lines was 0.79, between NT-pro BNP and width of kerley lines was 0.65 and between NT-pro BNP and number of kerley lines was 0.77, which indicates a significant positive correlation (P value <0.001). Conclusion: The results of present study showed that in patients with acute heart failure, the number and width of kerley lines in pulmonary ultrasound evaluation increase rapidly. There is also a high correlation between number and length of kerley lines with NT-pro BNP serum values.

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Abstract P392: The Effect Of Cell Sex On Magnetic Nanoparticle Uptake Of Human Induced Pluripotent Stem Cell-derived Cardiomyocytes

Circulation Research ◽

10.1161/res.129.suppl_1.p392 ◽

2021 ◽

Vol 129 (Suppl_1) ◽

Author(s):

Morteza Mahmoudi ◽

Vahid Serpooshan ◽

Phillip C Yang ◽

Mahyar Heydarpour

Keyword(s):

Heart Failure ◽

Actin Filaments ◽

Electromechanical Coupling ◽

Critical Role ◽

Induced Pluripotent Stem Cell ◽

Patient Specific ◽

P Value ◽

Male And Female ◽

Cell Therapies ◽

Human Cardiomyocytes

Introduction: It is well understood that the occurrence, progress, and treatment of heart failure, which is a leading cause of death worldwide, is sex-specific. Over the past decade, the majority of efforts in myocardial regeneration have been centered on cell-based cardiac repair. A promising cell source for these efforts is patient-specific human cardiomyocytes (CMs) differentiated from human inducible pluripotent stem cells (hiPSCs). However, successful use of hiPSC-CMs faces a major limitation, the poor engraftment and electromechanical coupling of transplanted cells with the host myocardial tissue. Magnetic nanoparticles (NPs) demonstrate great potential to address this challenge for treating heart failure via cell therapies. In particular, superparamagnetic iron oxide NPs (SPIONs) have been used to label hiPSC-CMs and, with the aid of external magnetic field, improve their engraftment and electromechanical coupling in the heart tissue. However, the critical role of cell sex in the uptake and labeling efficacy of NPs has not been evaluated. Hypothesis: Significant differences in the molecular and structural (e.g., actin structures and distribution) characteristics of male and female hiPSC-CMs affect their labeling efficacy with SPIONs. Methods and Results: To test our hypothesis, we first performed RNA-Seq analysis on three male and three female (healthy) hiPSC-CM lines. The normalized outcomes were analyzed by edgeR package. We next calculated gene-expression differential between male and female CMs. The results revealed 58 genes with significant differences between the male and female cells (p-value < 0.01). The highest observed sex-specific variation in genes was related to tophit gene (MEG3: logFC = 7.32, P-value = 5.63e -06 ), which is the maternally expressed imprinted gene with a great role in cardiac angiogenesis. Among the identified genes, a number of those were related to the cellular cytoskeletal structures including actin. We probed possible structural differences between actin filaments organization and distribution of male and female hiPSC-CMs using the stochastic optical reconstruction microscopy (STORM) technique. The results demonstrated substantial differences in organization, distribution, and morphology of actin filaments between male and female CMs. Incubation of SPIONs with male and female hiPSC-CMs revealed higher uptake of NPs (~ 3 folds) in female cells as compared to the male cells. The significant differences in the uptake of SPIONs by male vs. female cells could be attributed to the distinct organization, distribution, and morphology of actin in male vs. female cells. Conclusions: Our results indicate that male and female hiPSCs-CMs respond differently to the labeling SPIONs.

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Abstract 17356: Gender Differences in Clinical Presentation and Outcomes of Patients With Acute Myocardial Infarction and Spontaneous Coronary Artery Dissection: A Nationwide Inpatient Sample Matched Analysis

Circulation ◽

10.1161/circ.138.suppl_1.17356 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Setri Fugar ◽

Juliet A Yirerong ◽

Alfred Solomon ◽

Ahmed A Kolkailah ◽

Tauseef Akthar ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Gender Differences ◽

Clinical Presentation ◽

Artery Dissection ◽

P Value ◽

Spontaneous Coronary Artery Dissection ◽

Coronary Artery Dissection ◽

Men And Women ◽

Significant Difference

Introduction: Spontaneous Coronary Artery Dissection (SCAD) is reported to occur predominantly in young women. Gender differences in the clinical presentation and outcomes of patients with SCAD have not been studied on a population level. We sought to compare the in-hospital outcomes of men and women presenting with acute myocardial infarction (AMI) and SCAD. Methods: We identified patients from the National Inpatient Sample (NIS) between 2005 and 2015 who presented with primary diagnoses of AMI and SCAD. We identified SCAD with ICD-9 code 414.12. A 1:1 propensity-matched cohort was created to examine the outcomes between men and women. Primary endpoint was in-hospital mortality. Secondary endpoints included in-hospital cardiac and non-cardiac complications. Results: Of the 6617 (32017 weighted national estimates) patients with SCAD over the study period, majority were males 3667 (55.4%). Males were younger than females (60.32 yr vs. 61.59 yr) and presented more often with ST-elevation myocardial infarction (STEMI) (53.0% vs. 45.9% P=<0.001). Propensity matching yielded 2366 males and 2366 females. In the matched group, there was no significant difference in in-hospital mortality between males and females (OR 1.20 95% CI -0.93-1.54). With regards to in-hospital complications, ventricular tachycardia (V-Tach) was significantly less frequent in females as compared to males (8.0% vs. 10.1% OR 0.76 p-value 0.003). There was no significant difference between females and males in the frequency of other complications, including intracranial hemorrhage (0.2% vs 0.2% OR 1.45 p-value 0.50), GI bleed (1.8% vs 1.3% OR 1.35 p-value 0.13), cardiogenic shock (9.8% vs 9.7% OR 1.01 p-value 0.86), acute heart failure (3% vs 2.6% OR 1.18 p-value 0.26), ventricular fibrillation(vfib) (5.6% vs 6.0% OR 0.928 p-value 0.48) or stroke ( 1.5% vs 1.0% OR 1.535 p-value 0.06) Conclusion: In our large population-based analysis, compared to females, males were more likely to present with STEMI as compared to females. With the except of V-Tach, which was higher in males, there were no significant gender differences in hospital outcomes namely inpatient mortality, cardiogenic, Vfib or acute heart failure.

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