To evaluate the Vall d’Hebron-Risk-Score (VH-RS) to stratify the risk of patients with stable ischemic cardiomyopathy (ICM), and assess whether hemoglobin (Hb) and estimated glomerular filtration ...rate (eGFR) provide additional information to the VH-RS.
We analysed 673 consecutive patients with ICM who underwent gated SPECT. According to VH-RS, we stratified patients into 4-risk-levels: very-low-risk (VLR), low-risk (LR), moderate-risk (MR), and high-risk (HRi). We considered as MACEs: non-fatal myocardial infarction (MI), heart failure hospitalization (HF), coronary revascularization (CR), and cardiac death (CD). Also the cardiac-resynchronization-therapy (CRT), and the implantable-cardioverter-defibrillator (ICD) were investigated. During the follow-up (4.8 ± 2.7 years), 379 patients had MACEs (0.18/patient/year). There were no patients in VLR and LR. All patients were reclassified in 3-risk-levels (MRi = 48; HRi = 121; VHRivery high risk = 504). Most patients with MACEs were in VHRi level (test-for-trend: MACEs ≥ 1 without CRT/ICD, P < .001; combined non-fatal MI, CD and CR, P < .001; MACEs ≥ 1 with CRT/ICD, P < .001). The Hb and eGFR values do not properly improve the risk stratification obtained by the VH-RS (global-NRInet-reclassification-improvement was: (MACEs ≥ 1 without CRT/ICD: − 10.6%; non-fatal MI, CD and CR: − 9.08%; and MACEs ≥ 1 with CRT/ICD: − 8.85%).
VH-RS is effective in evaluating risk of patients with stable ICM. In our population, adding Hb and eGFR variables do not improve the performance of the VH-RS.
Atrial fibrillation (AF) remain a prevalent undiagnosed condition frequently encountered in primary care.
We aimed to find the parameters that optimize the diagnostic accuracy of pulse palpation to ...detect AF. We also aimed to create a simple algorithm for selecting which individuals would benefit from pulse palpation and, if positive, receive an ECG to detect AF.
Nurses from four Cardiology outpatient clinics palpated 7,844 pulses according to a randomized list of arterial territories and durations of measure and immediately followed by a 12-lead ECG, which we used as the reference standard. We calculated the sensitivity and specificity of the palpation parameters. We also assessed whether diagnostic accuracy depended on the nurse's experience or on a list of clinical factors of the patients. With this information, we estimated the positive predictive values and false omission rates according to very few clinical factors readily available in primary care (age, sex, and diagnosis of heart failure) and used them to create the algorithm.
The parameters associated with the highest diagnostic accuracy were palpation of the radial artery and classifying as irregular those palpations in which the nurse was uncertain about pulse regularity or unable to palpate pulse (sensitivity = 79%; specificity = 86%). Specificity decreased with age. Neither the nurse's experience nor any investigated clinical factor influenced diagnostic accuracy. We provide the algorithm to select the ≥40 years old individuals that would benefit from a pulse palpation screening: a) do nothing in <60 years old individuals without heart failure; b) do ECG in ≥70 years old individuals with heart failure; c) do radial pulse palpation in the remaining individuals and do ECG if the pulse is irregular or you are uncertain about its regularity or unable to palpate it.
Opportunistic screening for AF using optimal pulse palpation in candidate individuals according to a simple algorithm may have high effectiveness in detecting AF in primary care.
We sought to determine, using advanced echocardiography, the prevalence and type of cardiovascular sequelae after COVID19 infection with marked elevation of cardiovascular biomarkers (CVB), and their ...prognostic implications.
All patients admitted from March 1st to May 25th, 2020 to a tertiary referral hospital were included. Those with cardiovascular diseases or dead during admission were excluded. Patients with hs-TnI > 45 ng/L, NT-proBNP>300 pg/mL, and D-dimer >8000 ng/mL were matched with COVID controls (three biomarkers within the normal range) based on intensive care requirements and age, and separately analyzed.
From 2025 patients, 80 patients with significantly elevated CVB and 29 controls were finally included. No differences in baseline characteristics were observed among groups, but elevated CVB patients were sicker. Follow-up echocardiograms showed no differences among groups regarding LVEF and only slight differences between groups within the normal range. Hs-TnI patients had lower myocardial work and longitudinal strain. The presence of an abnormal echocardiogram was more frequent in the elevated CVB group compared to controls (23.8 vs 10.3%, P = 0.123) but mainly associated with mild abnormalities in deformation parameters. Management did not change in any case and no major cardiovascular events except deep vein thrombosis occurred after a median follow-up of 7 months.
Minimal abnormalities in cardiac structure and function are observed in COVID19 survivors without previous cardiovascular diseases who presented a significant CVB rise at admission, with no impact on patient management or short-term prognosis. These results do not support a routine screening program after discharge in this population.
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•Previously healthy COVID19 survivors have a low prevalence of echocardiographic abnormalities.•Abnormalities are only borderline and mainly in myocardial deformation parameters.•Male patients, with hsTnI >45 ng/l or admitted to ICU have more abnormal findings.•Abnormalities correlate with excellent prognosis and no change in management.•Our data do not support routine echocardiographic screening of COVID19 survivors.
Aims
Studies in cardiogenic shock (CS) often have a heterogeneous population of patients, including those with acute myocardial infarction and acute decompensated heart failure (ADHF‐CS). The ...therapeutic profile of milrinone may benefit patients with ADHF‐CS. We compared the outcomes and haemodynamic trends in ADHF‐CS receiving either milrinone or dobutamine.
Methods and results
Patients presenting with ADHF‐CS (from 2014 to 2020) treated with a single inodilator (milrinone or dobutamine) were included in this study. Clinical characteristics, outcomes, and haemodynamic parameters were collected. The primary endpoint was 30 day mortality, with censoring at the time of transplant or left ventricular assist device implantation. A total of 573 patients were included, of which 366 (63.9%) received milrinone and 207 (36.1%) received dobutamine. Patients receiving milrinone were younger, had better kidney function, and lower lactate at admission. In addition, patients receiving milrinone received mechanical ventilation or vasopressors less frequently, whereas a pulmonary artery catheter was more frequently used. Milrinone use was associated with a lower adjusted risk of 30 day mortality (hazard ratio = 0.52, 95% confidence interval 0.35–0.77). After propensity‐matching, the use of milrinone remained associated with a lower mortality (hazard ratio = 0.51, 95% confidence interval 0.27–0.96). These findings were associated with improved pulmonary artery compliance, stroke volume, and right ventricular stroke work index.
Conclusions
The use of milrinone compared with dobutamine in patients with ADHF‐CS is associated with lower 30 day mortality and improved haemodynamics. These findings warrant further study in future randomized controlled trials.
Percutaneous mitral paravalvular leak (PVL) closure techniques are an effective and safe alternative to surgical treatment, but data regarding long-term outcomes are scarce. We aim to describe the ...impact of successful percutaneous mitral PVL closure on long-term outcomes.
All consecutive patients in whom a first-attempt percutaneous mitral PVL closure was performed in a single tertiary centre between January 2010 and October 2021 were included. Clinical variables, procedural details, and procedural success were collected. Patients were classified based on procedural success, defined as no more than mild residual leak. All-cause mortality was the primary endpoint. Cardiovascular death and heart failure hospitalizations (HFHs) were key secondary endpoints.
Ninety patients (median age 72.5 years 66.0-78.4; median EuroSCORE-II 8.2 5.3-12.46) were included. Although reduction of at least 1 degree in PVL severity was achieved in 82 (91.1%), procedural success was achieved in 47 (52.2%). Chronic kidney disease, previous surgery for PVL, and the presence of multiple jets were independently associated with procedural failure. After a median follow-up of 3.2 (1.2-5.2) years, mortality rate was higher in the procedural failure group (27.3 per 100 patients-years) compared with the group with successful closure (8.2 per 100 patient-years). Procedural failure was associated with all-cause death (adjusted hazard ratio aHR, 2.59; 95% confidence interval CI, 1.41-4.78), cardiovascular death (aHR, 3.53; 95% CI, 1.67-7.49) and HFH (aHR, 3.27; 95% CI,1.72-6.20).
A successful reduction in PVL to mild or absent is associated with improved rates of all-cause death, cardiovascular death, and HFHs.
Les techniques de fermeture de fuites paravalvulaires (FPV) mitrales par voie percutanée sont une alternative efficace et sûre au traitement chirurgical, mais les données quant aux résultats à long terme sont rares. Nous avons pour objectif de décrire les répercussions de la fermeture des FPV mitrales par voie percutanée sur les résultats à long terme.
Tous les patients consécutifs chez lesquels une première tentative de fermeture des FPV mitrales par voie percutanée a été effectuée dans un seul centre de soins tertiaires entre janvier 2010 et octobre 2021 ont été sélectionnés. Nous avons collecté les variables cliniques, les détails des interventions chirurgicales et la réussite des interventions chirurgicales. Nous avons classifié les patients selon la réussite des interventions chirurgicales, qui a été définie par une fuite résiduelle tout au plus légère. La mortalité toutes causes confondues était le critère de jugement principal. Le décès d’origine cardiovasculaire et les hospitalisations en raison d’insuffisance cardiaque (HIC) étaient les principaux critères secondaires.
Nous avons sélectionné 90 patients (âge médian de 72,5 ans 66,0-78,4 ; EuroSCORE-II médian 8,2 5,3-12,46). Bien que la réduction de la gravité des FPV d’au moins 1 degré fût obtenue chez 82 patients (91,1 %), la réussite des interventions chirurgicales était obtenue chez 47 patients (52,2 %). La néphropathie chronique, l’intervention chirurgicale antérieure des FPV et la présence de multiples jets étaient indépendamment associées à l’échec des interventions chirurgicales. Après un suivi médian de 3,2 (1,2-5,2) ans, le taux de mortalité était plus élevé dans le groupe dont les interventions chirurgicales avaient échoué (27,3 par 100 années-patients) que dans le groupe dont les fermetures étaient réussies (8,2 par 100 années-patients). L’échec des interventions chirurgicales était associé au décès toutes causes confondues (rapport de risque ajusté RRa, 2,59 ; intervalle de confiance IC à 95 %, 1.41-4.78), le décès d’origine cardiovasculaire (RRa, 3,53 ; IC à 95 %, 1,67-7,49) et l’HIC (RRa, 3,27 ; IC à 95 %,1,72-6,20).
La réussite de la réduction des FPV de légères à absentes est associée à l’amélioration des taux de décès toutes causes confondues, de décès d’origine cardiovasculaire et d’HIC.
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Kidney disease (KD) in patients with acute myocardial infarction (AMI) is associated with major cardiovascular events (MACE). We sought to compare the long-term variation in KD in patients with AMI ...versus controls and its value as a risk factor for MACE in patients with AMI. A cohort of 300 outpatients with AMI, recruited between 2014 and 2016 in Barcelona, Spain, were compared with a control cohort matched 1:1 based on age and several risk factors for developing KD. Annual estimated glomerular filtration rate (eGFR) using MDRD-4 formula and albuminuria were collected and patients were followed up for the occurrence of MACE (death, heart failure hospitalization, AMI, or stroke). After a median follow-up of 5.3 years, the decline in eGFR was more pronounced in patients with AMI (−1.15 ml/min/1.73 m2/ per year in patients with AMI vs −0.81 ml/min/1.73 m2 per year in controls, p = 0.018 between the ß coefficients of both regression slopes). In patients with AMI, those with the greatest eGFR decline during follow-up had more MACE (hazard ratio HR for first vs fourth quartiles = 3.33, p <0.001). In multivariate analysis, after excluding patients with baseline KD, a newly diagnosed eGFR <60 ml/min/1.73 m2 during follow-up was associated with MACE (HR = 3.21, p <0.001), as well as new onset albuminuria >30 mg/g (HR = 6.93, p <0.001) and the combination of both (HR 5.63, p <0.001). In conclusion, the decline in eGFR after AMI is more pronounced than in the general population. A longitudinal drop in eGFR and newly diagnosed albuminuria during follow-up are associated with MACE and can be useful tools to reclassify the risk profile after AMI.
Cardiogenic shock (CS) is a significant complication of Takotsubo syndrome (TTS), contributing to heightened mortality and morbidity. Despite this, the Society for Cardiovascular Angiography and ...Interventions (SCAI) staging system for CS severity lacks validation in patients with TTS and CS. This study aimed to characterize a patient cohort with TTS using the SCAI staging system and assess its utility in cases of TTS complicated by CS.
From a TTS national registry, 1591 consecutive patients were initially enrolled and stratified into 5 SCAI stages (A through E). Primary outcome was all-cause in-hospital mortality; secondary end points were TTS-related in-hospital complications and 1-year all-cause mortality. After exclusions, the final cohort comprised 1163 patients, mean age 71.0±11.8 years, and 87% were female. Patients were categorized across SCAI shock stages as follows: A 72.1%, B 12.2%, C 11.2%, D 2.7%, and E 1.8%. Significant variations in baseline demographics, comorbidities, clinical presentations, and in-hospital courses were observed across SCAI shock stages. After multivariable adjustment, each higher SCAI shock stage showed a significant association with increased in-hospital mortality (adjusted odds ratio: 1.77-29.31) compared with SCAI shock stage A. Higher SCAI shock stages were also associated with increased 1-year mortality.
In a large multicenter patient cohort with TTS, the functional SCAI shock stage classification effectively stratified mortality risk, revealing a continuum of escalating shock severity with higher stages correlating with increased in-hospital mortality. This study highlights the applicability and prognostic value of the SCAI staging system in TTS-related CS.
Predicted Heart Mass: A Tale of 2 Ventricles Ródenas-Alesina, Eduard; Foroutan, Farid; Fan, Chun-Po ...
Circulation. Heart failure,
09/2023, Letnik:
16, Številka:
9
Journal Article
Recenzirano
Odprti dostop
BACKGROUND: Total predicted heart mass (PHM) is the recommended metric to assess donor-recipient size matching in patients undergoing heart transplantation. Separately measuring right ventricular ...(RV) and left ventricular (LV) PHM may improve risk prediction of 1-year graft failure. METHODS: Adult heart transplant recipients from the UNOS database from 2000 to 2018 were included in the study. LV and RV PHM were modeled as restricted cubic splines. The association with 1-year graft failure was determined using adjusted Cox regression. The risk reclassification of using both LV and RV PHM versus total PHM was assessed using the net reclassification index. RESULTS: A total of 34 976 recipients were included. We observed a U -shaped association between total PHM and 1-year graft failure, such that risk increased for hearts undersized by >15% and those oversized by more than 27%. Graft failure incrementally increased when LV PHM was undersized by more than 5% and when RV was oversized by >20%. There was 1.5-fold greater risk of graft failure for an LV undersized by >26% or an RV oversized by more than 40%. Using LV and RV PHM risk-assessment separately led to a net reclassification index=8.5% (95% CI, 5.3%–11.7%, nonevent net reclassification index=9.1%, event net reclassification index=−0.6%). CONCLUSIONS: The association between donor-recipient PHM match and the risk of graft failure after heart transplantation can be further understood as risk attributable to LV undersizing and RV oversizing. Assessing LV and RV PHM separately instead of total PHM could further refine the methods used to match donors and recipients for heart transplantation, minimize the risk of 1-year graft failure, and increase the use of donor organs.
