Bariatric surgery is associated with lower risk of acute cardiovascular events in patients with obesity and hypertrophic cardiomyopathy

Background Prior studies have suggested causal relationships between obesity and acute cardiovascular events (e.g., acute coronary syndrome, hypertensive crisis, and heart failure exacerbation). It has been known that the risk of cardiovascular events is reduced by bariatric surgery, the most effective method for substantial and sustained weight loss. However, little is known about whether bariatric surgery lowers the risk of acute cardiovascular events in the hypertrophic cardiomyopathy (HCM) population. Purpose To test the hypothesis that patients with obesity and HCM who underwent bariatric surgery have lower risk of developing acute cardiovascular events than those who did not. Methods In this population-based study of adults with obesity and HCM, the bariatric surgery group consisted of patients who underwent bariatric surgery from January 2004 to December 2014, whereas the control group included those who received non-bariatric elective intra-abdominal surgery during the same period. The outcome was an acute cardiovascular event – defined as emergency department (ED) visit or unplanned hospitalization for cardiovascular disease – during a 1-year post-surgery period. We used the SPARCS database, a population-based ED and inpatient database that captures all the ED visits and hospitalizations in New York State. We constructed logistic regression models with generalized estimating equations to compare the risk of the outcome events during sequential 6-month periods. We conducted multivariable analysis, adjusting for age, sex, number of ED visits and hospitalizations for cardiovascular disease within 2 years before the index surgery, and the Elixhauser comorbidity measures. We also performed additional analyses with propensity score (PS)-matching at 2:1 ratio and inverse probability treatment weighting (IPTW) using these variables. Results The analytic cohort consisted of 207 adults with obesity and HCM, including 147 patients who underwent bariatric surgery and 60 who had non-bariatric elective intra-abdominal surgery. In the 7–12 months post-surgery period, the risk of acute cardiovascular event was significantly lower in the bariatric surgery group (adjusted OR 0.23; 95% CI, 0.068–0.71; P=0.01; Figure) compared to the control group. In the PS-matched cohort (n=82 vs. 47), there were no significant differences in the baseline characteristics (P>0.50 for all comparisons). Similar to the main analysis, the PS-matched analysis demonstrated lower risk of the outcome event in the bariatric surgery group in the 7–12 months post-surgery period (OR 0.26; 95% CI, 0.083–0.73; P=0.01). The IPTW analysis also replicated the findings (OR 0.33; 95% CI, 0.16–0.71; P=0.004 during the 7–12 months post-surgery period). Conclusion In this population-based study of 207 adults with obesity and HCM, bariatric surgery was associated with a lower risk of acute cardiovascular events in the 7–12 months post-surgery period in real-world settings. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Health (USA) and American Heart Association

Outcomes of a Cardiac Rehabilitation (CRH) Program after phase II: what about our patients almost 4 years later?

Funding Acknowledgements Type of funding sources: None. INTRODUCTION CRH in patients with ischemic heart disease is recommended by the different clinical practice guidelines with an IA level of evidence, with an important role in reducing cardiovascular mortality and hospital readmissions during follow-up. OBJECTIVE The goal of this study is to show the 4-year clinical results of a population of patients who participated in an CRH program after an Acute Coronary Syndrome (ACS). METHODS Between May/2014 and September/2017, 221 patients who had recently presented an ACS completed the 12 weeks of phase II of the CRH program at our center. In May/2020 we collected epidemiological, clinical and echocardiographic information at the time of the acute cardiovascular event; and we evaluate the current vital status of the patients and the incidence of readmissions for: angina, HF, new ACS, or arrhythmic events. RESULTS Of the 221 patients, 182 were men (82%). The mean age of our population was 58.3 ± 7.8 years. 58% (129 patients) suffered from ST-elevation ACS. The mean time of hospital stay was 6.20 ± 2.9 days. An echocardiogram was performed at discharge, which showed an average LVEF of 56 ± 6%. Eight patients (4%) developed early Ventricular Fibrilation (VF) during the acute phase of ACS. Among the classic CVRF, smoking (79%) was the most prevalent, followed by dyslipidemia (53%) and hypertension (47%). The mean time from hospital discharge to the start of phase II RHC was 42 ± 16 days. The overall incidence of events was 9%: 10 patients suffered reinfarction during follow-up, and 7 were readmitted for unstable angina, all of whom underwent PCI; no patient was admitted for HF; and none of the 8 patients with early VF had a new tachyarrhythmia, registering a single admission for VT during follow-up. None of the patients had sustained ventricular tachyarrhythmias during exercise-training. At the mean 4.5-year follow-up, 218 patients were still alive (98%). CONCLUSION The incidence of CV events in the follow-up of our cohort was low, which can be explained by the fact that it is a young population, with an LVEF at low limits of normality at discharge, which is one of the most important predictors in the prognosis after an ischemic event. As an improvement, we must shorten the time until the start of phase II of the program. CRH shows once again its clinical benefit after an ACS, in consonance with the existing evidence. Abstract Figure. Outcomes of a CRH program.

Acute myocarditis in COVID19 patients. Clinical features, severity and outcomes. Results from Spanish multicenter registry Car-COVID19

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Fundacion del Corazon Introduction COVID19 has emerged as a new disease, spreading around the world, leading to a complete lockdown. It is known that other infectious diseases can affect the heart inducing myocarditis. As a new entity, it was unknown if SARS-COV2 could provoke that cardiovascular manifestation. This national registry was created to describe COVID19 cardiac affection and its severity. Methods and results A multicenter registry was conducted, including 28 centers in Spain. Patients with COVID19 diagnosis presenting an acute cardiovascular event between March 1st and May 30th were included. Eighty-two patients were included. Of them, 9 (14,1%, excluding missing data) presented with acute myocarditis; the rest were diagnosed of acute myocardial infarction or stress cardiomyopathy. Baseline characteristics of these patients are summarised in Table 1. The 83,3% of patients with myocarditis presented with heart failure and 25% simulating an acute coronary syndrome. According to severity, 5 patients (62,5%) were admitted in the Intensive Care Unit, requiring orotracheal intubation 4 patients (57,1%). Left ventricle was affected in 66,7% of patients, whereas the remaining 33,3% presented biventricular failure. Mean left ventricle ejection fraction was 46% [30,0%-52%]. One patient developed refractory cardiogenic shock requiring implantation of both intra-aortic balloon pump and VA- ECMO. Three patients died during hospitalization. Cardiac magnetic resonance was conducted in 2 patients (28,6%), showing oedema and subepicardial enhacement in postero-lateral segments. Cardiac biopsy was performed in one patient showing significant lymphoid infiltration and intersticial oedema. Conclusions Patients with COVID 19 who develop acute myocarditis usually present with heart failure secondary to ventricular failure. This entity has a bad prognosis with high in-hospital mortality rate. Table 1. Baseline characteristics.n (%)Age65,0[47,0-77,0]Sex (female)3 (42,9%)Hypertension3 (42,9%)Dyslipidemia3 (42,9%)Diabetes mellitus2 (28,6%)Chronic coronary disease1 (14,3%)Previous stroke1 (14,3%)Cancer1 (14,3%)

A Significant Addition of Left Ventricular Fractional Shortening to Ejection Fraction correlated with Global Longitudinal Strain Value in Predicting Major Acute Cardiovascular Event in patients with Acute Coronary Syndrome

Background: Global longitudinal strain (GLS) was a proven predictor of systolic function improvement and myocardial remodeling after acute coronary syndrome (ACS) for a residual left ventricular function defined their prognosis. However, not all echocardiography devices are equipped by speckle tracking (STE) as compare to the availability of M-mode modality which capable on assessing fractional shortening (FS) instead. Methods: This study evaluated clinical and echocardiography parameters on myocardial infarction (MI) and non-MI ACS patients. Clinical outcome was defined as composite major acute cardiovascular event (MACE) on 6 months of follow up. Results: Over 145 patients, GLS>-9.4% was found to be an independent predictor of MACE despite of troponin, age, ejection fraction (EF), prior reperfusion and infarct location [(HR 5.89 (1.82-16.51)]. There is negative correlation between FS and GLS (Spearman r -0,717; p<0,01). By using logistic regression analyses, it was found that the addition of FS<25% to biplane Simpson EF<50% could be useful to rule in the presence of GLS>-9.4% (AUC 0.831). Conclusion: GLS had a prognostic value in patients with ACS. Left ventricular conventional M-mode FS in addition to Simpson EF were well correlated with GLS as well they can be considered as an alternative in predicting the incident of MACE in patient with ACS. Keywords: global longitudinal strain, prognostic, fractional shortening, acute coronary syndrome

ANALYSIS OF PATIENTS’ NONADHERENCE TO STATIN THERAPY FROM CARDIOVASCULAR EVENT TO CARDIOVASCULAR REHABILITATION

Numerous studies have pointed to low adherence to statin, which decreases as time period from acute cardiovascular event elapses. The aim was to analyze the cause of not taking statin by patients who were referred to rehabilitation after coronary event. Study population and methods. The research included the total of 573 patients, average age 60.3, while 305 (53.1%) of them were patients who experienced the first cardiovascular event. The stated research was conducted by means of a questionnaire and implied active participation of the researchers in terms of monitoring the possession and use of medication during rehabilitation. On arrival to rehabilitation, 98 (17.1%) patients did not have statin. They stated that they had never used statins before or that they stopped using them shortly after the event. This subgroup had significantly unfavorable values of lipid parameters (p<0.001), abdominal obesity (p<0.01), physical inactivity (p<0.01), more comorbidities (p<0.001), more prescribed medications on daily level (p<0.05), lower education degree level (p<0.01) and lower monthly income (p<0.001). Independent factors for not taking statin were: female gender, low monthly income and large number of comorbidities (R = 0.291, R2 = 0.85, adjusted R2 = 0.80, std. error of the estimate = 0.36151; p < 0.001). The patients themselves stated that the first reason for not taking statin was lack of financial funds (45.9%), while the second reason was normalization of laboratory results (21.4%). Three months after acute coronary event, 17.1% of patients in Serbia stopped taking statin. Lower adherence to statin closely correlates with female gender, low financial income and multiple comorbidities.

Settings and stakeholders

Cardiovascular disease remains a leading cause of death and disability globally, and cardiovascular prevention should take place everywhere. Reducing the burden of cardiovascular disease requires a concerted effort in multiple settings (primary care, acute care, community, and home), and from multiple stakeholders such as government, public health, non-governmental organizations, healthcare, industry, and individuals. Primary care provides the majority of healthcare to populations, and is in an optimal position to screen and assess patients for cardiovascular risk and deliver cardiovascular prevention. Improving screening, risk assessment, and use of evidence-based guidelines requires collaboration between specialist cardiology services and primary care. Nurse-led and multiprofessional teams are effective in delivering prevention across a variety of settings. Prevention should be a priority prior to patient discharge from hospital following an acute cardiovascular event, and should encompass both medications and advice regarding lifestyle behaviours. Secondary prevention through specialized prevention programmes is needed by patients in order to reduce the risk of subsequent events. Cardiac rehabilitation is one of the most effective methods of delivering prevention and improving patient well-being following an acute event or procedure. There is a need to get more patients participating by using alternative methods of delivery and ensuring that women, older patients, and those with low fitness are encouraged and supported to attend. Stakeholders such as government, non-governmental organizations, and industry have important roles to play in improving public health. Healthcare providers should disseminate their research in lay language, and play a role in advising on and supporting public health measures.