RankGene is a program for analyzing gene expression data and computing diagnostic genes based on their predictive power in distinguishing between different types of samples. The program integrates ...into one system a variety of popular ranking criteria, ranging from the traditional t-statistic to one-dimensional support vector machines. This flexibility makes RankGene a useful tool in gene expression analysis and feature selection.
Cardiomyopathies are a heterogeneous group of heart muscle diseases and an important cause of heart failure (HF). Current knowledge on incidence, pathophysiology and natural history of HF in ...cardiomyopathies is limited, and distinct features of their therapeutic responses have not been systematically addressed. Therefore, this position paper focuses on epidemiology, pathophysiology, natural history and latest developments in treatment of HF in patients with dilated (DCM), hypertrophic (HCM) and restrictive (RCM) cardiomyopathies. In DCM, HF with reduced ejection fraction (HFrEF) has high incidence and prevalence and represents the most frequent cause of death, despite improvements in treatment. In addition, advanced HF in DCM is one of the leading indications for heart transplantation. In HCM, HF with preserved ejection (HFpEF) affects most patients with obstructive, and ∼10% of patients with non‐obstructive HCM. A timely treatment is important, since development of advanced HF, although rare in HCM, portends a poor prognosis. In RCM, HFpEF is common, while HFrEF occurs later and more frequently in amyloidosis or iron overload/haemochromatosis. Irrespective of RCM aetiology, HF is a harbinger of a poor outcome. Recent advances in our understanding of the mechanisms underlying the development of HF in cardiomyopathies have significant implications for therapeutic decision‐making. In addition, new aetiology‐specific treatment options (e.g. enzyme replacement therapy, transthyretin stabilizers, immunoadsorption, immunotherapy, etc.) have shown a potential to improve outcomes. Still, causative therapies of many cardiomyopathies are lacking, highlighting the need for the development of effective strategies to prevent and treat HF in cardiomyopathies.
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Today's pacemaker patients are of increasing age, with more comorbidities, and with an increased mortality risk, especially ...from non-cardiac causes. On the other hand, the prognosis of patients after cardiac resynchronization therapy (CRT) is improving, due to advances in both the pharmacological treatment of heart failure and the development of pacemaker technology.
Purpose
Our goal was to examine the prognostic significance of the indication for pacemaker therapy on long-term survival after device implantation. Also, we aimed to compare the survival rate of these patients and those with structural heart disease (SHD) and implanted CRT-P.
Methods
This retrospective five-year survival analysis was conducted on all patients who had undergone permanent pacemaker implantation in a tertiary center during three years. The study group was divided into 4 subgroups depending on the indication for pacemaker implantation – patients with atrioventricular (AV) block, with sinus node dysfunction (SND), with permanent atrial fibrillation (AF), and with SHD and an indication for CRT-P implantation. We used patients' medical records to define indications for pacemaker implantation, and to collect data on patients' baseline characteristics. The patients’ survival status was determined on the basis of the recent pacemaker control, or examination at another department of our hospital, covered by a unique information system. For the remaining patients telephone follow-up was performed. To test the significance of the within-group and between-group differences we used t-test, chi square test and Kruskal-Wallis test with Dunn-Bonferroni post hoc analysis.
Results
We analysed 2029 patients who underwent pacemaker primo implantation from October 2014 to October 2017 and met the inclusion criteria: 799 with AV block (61.6% male, mean age 77.2 ± 10.9 years); 446 with SND (58.5% male, mean age 74.9 ± 11.2 years) , 437 with AF (62.6% male, mean age 76.6 ± 9.2 years ), 347 with SHD (76.1% male, mean age 65.4 ± 9.4 years). Patients with SHD were statistically significantly younger than patients from the other groups (p < 0.01). The mean time to fatal outcome was 3.7 ± 1.2 years, and was not significantly different between groups. Five-year survival in total study population was 40.1%, and it was statistically significant different among 4 groups of patients with different indications for pacemaker implantation (p < 0.01). The survival rate was highest in patients with SND, followed by SHD, and by far the lowest in patients with AF.
Conclusion
The indication for implantation of a permanent pacemaker significantly determines the five-year survival of patients with bradycardia, and it is the highest in patients with SND. Patients with SHD and implanted CRT are significantly younger and they have a statistically significantly higher five-year survival rate than both patients with AV block and AF with symptomatic bradycardia.
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Implantable cardiverter defibrillators (ICD) represent the only effective treatment in prevention of sudden cardiac death ...(SCD) in patients with Brugada syndrome (BrS). However, according to current ESC Guidelines, ICD implantation is recommended only in secondary prevention, while it should be considered in patients with a spontaneous diagnostic type I ECG pattern and history of syncope.
Purpose
We aimed to determine the frequency of ventricular tachyarrhythmias during the long-term follow-up among patients with BrS and ICDs implanted in primary or secondary prevention.
Methods
This retrospective, observational study was conducted in a tertiary center among adult patients with BrS that underwent single or dual chamber ICD implantation from January 2008 to December 2017. The study group was devided into subgroups depending on weather the patients at the time of ICD implantation had documented sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) regardless of the ECG type of BrS (group I), had BrS type I and history of syncope (group II) or had BrS type I and were asymptomatic but assessed as in high risk of SCD due to non-sustained VT episodes, younger age or history of SCD in close family members (group III). We used patients medical records for collecting the data about VT and VF episodes during the follow-up period.
Results
In the course of ten-year period, ICDs were implanted in 21 adult patients with BrS (66.7% were male). Mean age at the ICD implantation time was 40.3 ± 14.9 years. We analyzed 8 patients from group I, 7 patients from group II, and 6 patients from group III. Mean follow-up period was 82.5 ± 33.3 months. During the obsereved period, VT/VF episodes were appropriately detected in 7 patients from group I (87.5%), in 3 patients from group II (42.86%) and in one patient from group III (16.67%). Kruskal-Wallis test showed that there was a statistically significant difference in the occurrence of ventricular tachyarrhythmias among at least one pair of observed groups (p = 0.031). Using Dunn-Bonferroni post hoc analysis we found statistically significant difference between the patients with malignant arrhythmias and asymptomatic patients (p = 0.03), but not between the other pairs.
Conclusion
Although asymptomatic patients with BrS are at significantly lower risk of SCD, it is important to identify high-risk patients in the low-risk group. Therefore, creating a tool for calculating the risk of SCD among these patients might be helpfull in everyday clinical practice.
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The European Society of Cardiology’s (ESC) risk calculator for sudden cardiac death (SCD) in patients with hypertrophic ...cardiomyopathies (HCM) is currently a tool that facilitates the decision to implant a cardioverter defibrillator (ICD) in primary prevention, but doubts still exist in everyday clinical practice.
Purpose
We aimed to determine the incidence of life-threatening ventricular arrhythmias
during long-term follow-up in patients with different ESC HCM risk scores for SCD
calculated on ICD implantation in primary prevention.
Methods
This retrospective, observational study was conducted in a tertiary center among
adult patients with HCM and ICD devices (ICD-VR, ICD-DR and CRT-ICD) implanted in
primary prevention from January 2008 to December 2019. The patients followed up for less than one year were excluded from the analysis. Study group was divided into three subgroups, according to the ESC 5 years risk score of SCD and based on it the estimated need for ICD implantation: group A
with risk < 4%, where ICD is generally not indicated; group B with risk 4-6%, where ICD
may be considered; group C with risk ≥6%, where ICD should be considered. Regularly, ICD
was interrogated twice a year, while emergency controls were performed after delivering of
ICD therapy. Follow-up data including information about sustained ventricular tachicardia
(VT) and ventricular fibrillation (VF) episodes were collected from patients medical records.
Results
In the observed period, ICD devices were implanted in 60 adult patients with HCM.
Ten of them had history of sustained ventricular arrhythmias and 3 were lost to follow-up. Therefore, we analysed 47 patients (55.3% male, mean age 51.0 ± 15.7 years), 13 from group
A, 12 from group B and 22 from group C. Mean follow-up period was 80.6 ± 37.9 months.
During the follow-up period ventricular tachyarrhythmias (VT and VF, either in monitoring or
therapy zone) were recorded in one patient from group A (7.7%), in two patients from group
B (16.7%) and in 7 patients from group C (31.8%). Using Kruskal-Wallis analysis of
variance, we did not find a statistically significant difference in the occurrence of ventricular
tachyarrhythmias among the observed groups (p = 0.225).
Conclusions
Patients with HCM and a 5-year risk of SCD ≥ 6% calculated on ICD
implantation had more frequent life-threatening ventricular arrhythmias during long-term
follow-up, but not statistically significant. There should be an individual
approach when deciding on the need for device implantation in all patients with HCM.
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Cardiac implantable electronic devices (CIEDs) are being implanted worldwide in increasing numbers, so the incidence of ...hospitalizations due to their infections is also increasing.
Purpose
The aim of this study was to analyze the incidence of pocket infection related to the CIED procedure, as well as clinical presentation, diagnostic approach and methods of treatment during long-term follow- up on large cohort of patients. Methods: This was a retrospective, observational, single-center study. We enrolled patients who underwent CIED procedure between January 2011 and December 2015. The CIED procedure included implantation and replacement of the device. Pocket infection is defined as an infection limited to the generator pocket and can be presented from redness, swelling, pain to the skin erosion with exposure of the generator and/or leads. It may also be associated with lead infections and systemic CIED infections and/or infective endocarditis. All patients with CIED infection underwent the same diagnostics: complete blood count and inflammatory markers, pocket swab, three sets of blood cultures and echocardiography. Results: During the observed period 5 969 CIED procedures were performed (anti-bradycardia pacemakers 68.6%; ICD 21.4%; CRT-P/D 10.0%; CIED replacement 26.1%). CIED infection was registered in 41 patients (0.68%), most often after the ICD procedure (59.0%). In 22 patients (53.6%) the infection occurred after primo-implantation. The average time from intervention to infection was 17 ± 7.3 months. The mean follow-up was 52.2 ± 13.4 months. The most common manifestations of infection were redness (68.1%) and swelling (56.0%), then the protrusion of the generator or electrode (41.5%). Pacemaker pocket swabs and wound swabs were positive in 61.1% of samples and coagulase negative staphylococcus was found to be the most prevalent cause of infection (64.2%). The hemoculture test was positive in 10 patients, and the isolated causative agent matched the swab finding. The valvular vegetation was found in 4 patients. Pacemaker removal and surgical wound treatment were performed in all patients. Complete removal of all leads was achieved in 32 patients. In all pacemaker dependent patients and patients with ICD implanted in the secondary prevention of sudden cardiac death, reimplantation of the new device was performed in the same hospitalization on the opposite side. The remaining patients were operated on 3 to 4 weeks after the end of treatment. Conclusions: It has been shown that the risk of pocket infection was low in a large number of patients, during long-term follow-up. The risk was higher in patients with ICD devices, and slightly higher after primo-implantation.
Objective Growth differentiation factor-15 (GDF-15) has established promising prognostic value in various cardiovascular diseases, although there is very little information available about it in ...patients with acute heart failure, particularly with regard to long-term outcomes. The aim of our study was to determine the prognostic value of GDF-15 in patients with acute decompensated heart failure (ADHF).
Methods and results A total of 107 consecutive patients (median age 70 interquartile range, IQR: 60-73.5; 36% women), hospitalized for ADHF, were examined. The primary and secondary endpoints were to determine the differences in both mortality and rehospitalization due to heart failure after one year, depending on the GDF-15 plasma level. The control group consisted of 25 healthy people of a similar age. The patients with ADHF had significantly higher level of GDF-15 on admission (median 3481 IQR: 2113-5090), than the subjects in the control group (887.5 (IQR: 763.75-960.25 ng/L). A high GDF-15 level on admission remained a significant predictor for adverse clinical events, shown by a multivariable regression analysis (hazard ratio HR, 3.08; 95% confidence interval CI, 1.06-8.35, P< 0.05), together with left ventricle ejection fraction (P <0.05). Kaplan-Meier curve analysis showed a significantly higher probability of death and HF rehospitalization in patients with higher levels of GDF-15. Patients with both GDF-15 and BNP levels above the median on admission had the highest mortality rate.
Conclusion In patients with ADHF, an elevated GDF-15 value on admission was a strong predictor of an adverse clinical outcome regarding mortality and HF rehospitalization 1-year after the initial hospitalization.
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