Abstract
Background
Heart failure (HF) admission is a serious event in the follow up of patients with chronic coronary syndromes (CCS). Stratification schemes have been described for predicting this ...end-point but none of them has been externally validated.
Purpose
To develop point-scores for predicting incident HF admission with data from previous studies, to perform an external validation in an independent prospective cohort study, and to compare their discriminative ability for this event.
Methods
We performed a literature review searching for prospective studies including patients with CCS, excluding patients with HF at baseline, with data on HF admission incidence in follow up and predictive variables. If undescribed previously, scores were developed including those variables independently associated with this outcome, and score points were assigned based in the relative magnitude of the coefficients of Cox regression models. The resulting scores were validated and their discriminative ability compared in a prospective, monocentric, 17-years cohort study, that included consecutive outpatients with CCS.
Results
Four studies were included: two post-hoc analysis of clinical trials (CARE and PEACE) and two observational registries (CORONOR and CLARIFY). The validation cohort included 1212 patients (mean age 67±11 years, 74% male) followed for up to 17 years (median 12 years, p25–75 5–15 years), with 171 patients suffering at least one HF admission in follow-up. The proportions of the variables needed for scores calculation available in the database of the study were 75% (6/8), 88% (15/17), 100% (8/8) and 85% (17/20) respectively, for each of these study-derived scores. Discriminative ability for predicting HF admission was statistically significant for all (C-statistic 0.72, 95% CI 0.68–0.75, p<0.0005; 0.72, 95% CI 0.68–0.76, p<0.0005; 0.73, 95% CI 0.69–0.76, p<0.0005; and 0.69, 95% CI 0.65–0.73, p<0.0005 for CARE, PEACE, CORONOR and CLARIFY scores, figure 1) and paired comparison among them were all non-significant except for CORONOR and CLARIFY scores (p=0.03). The CORONOR score (Age each year 2 points, ejection fraction each percentage point −1 point, hypertension 11 points, diabetes 10 points, atrial fibrillation 14 points, body mass index each kg/m2 unit 1 point, symptomatic angina 11 points and multivessel disease 7 points) identified subgroups of patients with 12 years-HF admission free survival probabilities of 97%, 87 and 62% (p<0.0005, first, second and third tertile of the score, figure 2).
Conclusions
All tested scores showed significant discriminative ability for predicting incident HF admission in this independent validation study. Their discriminative ability was similar, except that CORONOR score performed significantly better than CLARIFY score.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The work for this paper was funded by the Andalusian Society of Cardiology through anunconditional grant from Astra Zeneca. ROC curves for HF predictive scoresHF free survival by CORONOR score
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Andalusian Society of Cardiology
Introduction
A new classification of severe tricuspid regurgitation ...(TR) has recently been described that distinguishes three subgroups: severe, massive and torrential. Our objective was to analyse the prevalence of the new categories, describe their baseline characteristics according to severity group and assess their impact on the prognosis in a large series of patients with severe TR of a tertiary care hospital in our area.
Methods
All consecutive patients ≥18 years with severe TR studied with echocardiography in a tertiary care hospital in our area from 01.01.2008 to 12.31.2017 were retrospectively included. Images were analysed off-line to measure the maximum vena contracta (VC) in any echocardiographic plane and severe TR was classified into three groups: severe (VC≥7mm), massive (VC 14–20mm) and torrential (VC≥21mm). Baseline characteristics were analysed in the different subgroups and follow-up events by univariate and multivariate techniques. The combined event of death and heart failure (HF) admission on follow-up was investigated.
Results
A total of 661 patients (69±13 years, 72% women) with severe TR were included. 81.5% (539) presented severe TR, 15.6% (103) massive TR and 2.9% (19) torrential TR. The baseline characteristics were different according to the different subgroups of severity (Table). The 5-year HF-free survival was 42%, 44% and 11% (p<0.0005), for the different subgroups, respectively (Figure). After adjusting for baseline characteristics, the severity of TR assessed by VC was independent predictor of HF-free survival, HR 0.89 95%CI 0.70–1.15 p = 0.39, for massive TR; and HR 2.48 95% CI 1.52–4.05 p<0.0005, for torrential TR considering severe TR as reference.
Conclusions
In this large monocentric study, severe TR measured by VC was the most frequent subgroup, followed by massive and torrential. The prognosis was significantly worse in patients with torrential TR.
Abstract
Background
Obesity is a major medical and public health problem. A high body mass index has been associated with increased mortality and cardiovascular disease morbidity. Obesity in adults ...is related to hypertrophy and left ventricular dilatation. Previous studies have shown that, in Spain, the prevalence of overweight and obesity in childhood is 26% and 12.6% respectively. The association between obesity and left ventricular morphology has been poorly studied in the pediatric population.
Aim
To investigate the relationship between childhood obesity and the dimensions of cardiac structures and systolic function in a Mediterranean pediatric population.
Methods
A random sample of children and adolescents in primary and secondary education was selected, stratified by age, gender and educational centers in a rural town of 2864 inhabitants in southern Spain. Children between 6 and 17 years old were included. A transthoracic echocardiogram was performed for the evaluation of cardiac chambers morphology and systolic function.
Results
A total of 212 children were studied (10.9±3.0 years old and 51.9% males): 106 (50%) were normal weight, 57 (26.9%) were overweight and 49 (23.1%) were obese. Results are shown in the table. Age and sex were similar in the three groups. Overweight and obesity were related to larger values of left ventricle end-diastolic diameter and volume, left atrial volume and right ventricle basal diameter, and lower values of left ventricle ejection fraction.
Normal weight
Overweight
Obese
p
Age
10.9±3.2
10.7±2.7
11.0±2.8
0.79
Male (%)
50.9%
49.1%
57.1%
0.69
End-diastolic left ventricle diameter (mm)
41.1±5.5
42.8±5.4
44.2±5.5
0.003
End-diastolic left ventricle volume (mm)
57.9±18.6
64.3±18.3
78.1±22.4
<0.0005
Interventricular septum (mm)
6.3±1.4
6.7±1.3
7.0±1.7
0.01
Left ventricle mass (g)
69.3±30.1
80.9±30.2
94.8±36.5
<0.0005
Left atrium volume (mm)
19.7±6.8
22.6±6.5
27.9±7.4
0.004
Basal right ventricle diameter (mm)
27.6±4.5
28.0±3.9
30.2±4.2
0.001
Left ventricle ejection fraction (%)
65.7±3.6
63.6±4.7
61.5±4.6
<0.0005
Conclusions
Overweight and obese children have larger cardiac chambers, higher left ventricular mass, and worse systolic function compared with normal weight children of similar age and sex.
Abstract
Background
In the COMPASS trial, low dose rivaroxaban (2.5 mg/12h) on top of aspirin showed a 26% reduction in major cardiovascular events in patients with stable coronary artery disease ...(sCAD). However, information about external applicability of these results is limited. Our objective was to assess potential eligibility for this treatment in a “real world” cohort of Spanish patients with sCAD and to evaluate the incidence of major events in the long-term follow up in this population.
Methods
The CICCOR registry (“Chronic ischemic heart disease in Cordoba”, in Spanish “Cardiopatía isquémica crόnica en Cordoba”) is a prospective, monocentric study. From February 1, 2000 to January 31, 2004, all consecutive patients with sCAD attended at two outpatient cardiology clinics in a city of the south of Spain were included in the study and prospectively followed. The COMPASS inclusion and exclusion criteria were applied to this cohort, and the proportion of patients potentially eligible for this trial was described. The rate of the main COMPASS end-point (the composite of acute myocardial infarction, stroke, or cardiovascular death), as well as mortality rates, were investigated in this subset of patients, and compared with those of sCAD patients included in the aspirin alone group of the COMPASS trial.
Results
From a total population of 1268 patients, 1246 subjects presented enough data to assess eligibility. Among these, 575 patients (46%) had exclusion criteria, and another 229 (18%) did not fulfill the inclusion criteria and were not eligible. The main reasons for exclusion were requirement for dual antiplatelet therapy within 1 year of an acute coronary syndrome or coronary stent implantation (70%), high-bleeding risk (33%), other non-aspirin antiplatelet therapy (13%), atrial fibrillation (12%), anticoagulant use (11%), history of ischemic stroke (5%) and heart failure with severe left ventricular dysfunction (4%). The reason for not fulfilling inclusion criteria was the absence of additional high risk factors in patients younger than 65 years. The potentially eligible population included 442 patients (35% of evaluable patients), with up to 17 years of follow-up (median 9 years, IQR 4–15 years, only 1 patient lost in follow-up, 4174 patients-years of observation). These patients experienced higher primary outcome event rates than coronary patients actually enrolled in the aspirin alone arm of COMPASS (5.1% versus 2.9% per year), and higher rates of cardiovascular (4.0% versus 1.1%) and all-cause mortality (6.3 versus 2.1%, p<0.00005 for all comparisons).
Conclusion
More than one third of “real world” patients with sCAD of this prospective Spanish registry could be potentially eligible for low dose rivaroxaban therapy, according to COMPASS inclusion and exclusion criteria. This population had a higher risk of cardiovascular events and mortality than COMPASS participants with sCAD in the reference aspirin group.
Funding Acknowledgement
Type of funding source: None
Observed cardioembolic risk factors were hypertension (197 of 279 (71%)), diabetes (64 (23%)), congestive heart failure (51 (18%)), a prior cardioembolic event (39 (14%)), atrial enlargement (31 ...(11%)), coronary heart disease (25 (9%)), and left ventricular dysfunction (18 (7%)). ...treatment of patients without contraindications and with only advanced age as a cardioembolic risk factor was left to the responsible physician to decide.
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
The monitoring of the left ventricular ejection fraction (LVEF) is a common practice in patients with breast cancer ...undergoing chemotherapeutic treatment. Although indiscriminate follow-up is not very cost-effective, we don’t have enough data to determine which patients would benefit from it.
Purpose
To analyze if any baseline ventricular function echocardiographic parameter can help to identify the subsequent development of ventricular dysfunction secondary to cardiotoxic drugs (DV-CTOX).
Methods
Retrospective study of patients with breast cancer who have received treatment with anthracyclines with / without adjuvant treatment with immunotherapy and / or radiotherapy. We analyzed baseline and follow-up ventricular function parameters (LVEF estimated by 2D-3D automatic quantification and semi-automatic quantification of global longitudinal strain (GLS)).
Results
We included 93 patients (mean age 59 ± 11 years, 98.9% women). 67% received immunotherapy and 84% radiotherapy. Median follow-up was 6 months. 10 patients (11%) developed DV-CTOX. There were differences in baseline clinical characteristics between patients and those with no DV-CTOX. Regarding echocardiographic parameters we didn’t observe differences between both groups in basline 2D LVEF (65 ± 1% vs 62 ± 14%, p = 0.4), and 3D LVEF (60 ± 7% vs 57 ± 8%, p = 0.4), although the GLS was lower in patients who later developed DV CTOX (GLS 19 ± 3% vs 16 ± 3%, p = 0.03); At follow-up, patients who developed DV-CTOX had worse LVEF estimated by 2D-3D and maintained a worse GLS value (52 ± 7% vs 69 ± 8% p <0.001.49 ± 8% vs 61 ± 4%, p = 0.005 and 14 ± 3% vs 20 ± 4%, p = 0.04 respectively). We used the area under the curve for the use of baseline GLS as a diagnostic method for the early detection of DV-CTOX. It was 0.785 (CI 0.585-0.985 for a p value = 0.047). A baseline GLS cut-off point of 17.5% was determined with a sensitivity of 73% and a specificity of 80%.
Conclusion
The quantification of baseline GLS in patients with breast cancer who are going to start treatment with cardiotoxic drugs could help to discriminate which patients require a closer LVEF monitoring, improving efficiency in the Cardio-Onco-Hematology unit. A value greater than 17.5% in absolute terms of baseline GLS could be an optimal cut-off point that discriminates between patients who will develop DV-CTOX. Abstract Figure. Abstract Figure.
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitario Reina Sofia. Instituto de investigación biomédica Maimonides
Introduction
...Percutaneous closure is nowadays considered the treatment of choice of ostium secundum atrial septal defects (ASD) but complex defects may be a challenging. In the last years, the imaging techniques used for ASD assessment have improved considerably, allowing therapeutic approaches in patients with complex morphological features particularly in those with absence of rims. However, there are no studies about the impact of 3D imaging techniques on transcatheter closure of ASD as compared with 2D imaging along time .
Purpose
To compare the impact of real time 3D Transesophageal echocardiography (3D-RT TEE) and cardiac computed tomography (CCT) on the profile as well as on the success rate of transcatheter closure of complex ASD as compared to 2D imaging.
Methods
We selected 106 adults patients suffering from ASD of complex anatomy (large≥30 mm, multiple, multifenestrated, aneurysmal, or deficiency of posterior or inferior rims) from 1998 to 2020. Along this time, we compared closure success rate, morphological characteristics, and procedure complications after ASD transcatheter closure. We defined closure success rate as a complete closure without complications. In our study, ASD assessment and further intervention was performed by two-dimensional transesophageal echocardiography (2D-TEE) from 1998 to 2007 (n = 66), whereas 3D-RT TEE and CCT was performed from 2008 to 2020 (n= 40).
Results
The type of ASD complexity was different between the two diagnostic approaches. Thus, those patients management by 2D-TEE showed more number in large ASD (40,9%), multiple-ASD (34,8%), fenestrated (10,6%), aneurysmal (7,6%) and with lower ring deficiency (6,1%) as compared to those with 3D-RT TEE and CCT (10%, 25%, 15%, 15%, and 35%, respectively, p < 0,05). Although no significant differences were observed, patients from the 2D group needed a second surgical closure more frequently than those treated with 3D-RT TEE and CCT (12,1% vs 5%, p = 0.31). In our study, there were few complications (10 (9,4%), with no significant differences according to the imaging technic used (2D-TEE group: 3 device embolisms, 2 cardiac tamponade, 2 complications of the femoral access; 3D-RT TEE and CCT group: 2 device embolisms and 1 complication of the femoral access. All of them were resolved intraprocedure. Importantly, closure success was higher in those patients manage by 3D-RT TEE and CCT in comparison to 2D-TEE (88% vs. 67%, respectively, p <0.05).
Conclusion
Transcatheter closure of complex ASD is a secure procedure. However, the use of 3D TEE and cardiac CT improves the success rate of this approach as compared to 2D-TEE and changes the profile of complex ASD treated by transcatheter closure in favor of those with absence of some rims
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