Risultati per: Sindromi coronariche acute

Circulation, Volume 146, Issue Suppl_1, Page A11578-A11578, November 8, 2022. Introduction:Chest pain is a common reason for emergency room visits. Acute coronary syndrome (ACS) remains a high mortality etiology of chest pain. Spontaneous coronary artery dissection (SCAD) is a rare cause of ACS in the general population, but a relatively common cause of ACS in young women.Case:Patient is a 29-year-old female with history of anxiety and fibroids that presented with chest pain. She described the chest pain as sharp, substernal, non-radiating that lasted for 10 minutes after eating dinner. The pain improved with leaning forward and resolved when lying on her stomach. She had a second episode of chest pain after 2 hours with similar characteristics which lasted 10 minutes. She was 4 months post-partum. She reported having a sore throat 4 days prior to the presentation. Troponin peaked at 0.173. ECG showed diffuse ST-elevation and PR depression in V3-V6 I II III aVF. TTE showed LVEF 65% and no wall motion abnormalities. CTA coronary showed 50-60% narrowing of mid LAD. Cardiac MR showed mild hypokinesis of mid-anteroseptal wall with associated subendocardial to midmyocardial delayed enhancement with focal elevations in myocardial native T1 and T2, and LVEF 53%. Coronary catheterization showed 50-60% stenosis in the mid-LAD distal to the first diagonal artery, there was no improvement in the stenosis after administration of intra-coronary nitroglycerin, there were no septals noted to arise from this area, consistent with diagnosis of SCAD (figure 1).Diagnosis:On initial evaluation, the etiology of her chest pain appeared to be myopericarditis. However, using CTA coronary, cardiac MR and coronary catheterization findings, the pain was more consistent with type 1 NSTEMI in the setting of SCAD. Patient was started on IV heparin, metoprolol tartrate, and aspirin.Conclusions:SCAD is a life-threating and often missed etiology of ACS. It requires a high index of suspicion and should be in the differential diagnosis in young women presenting with chest pain.

Circulation, Volume 146, Issue Suppl_1, Page A10933-A10933, November 8, 2022. Introduction:Feasibility of automated volume-derived cardiac functional evaluation has successfully been demonstrated using cardiovascular magnetic resonance (CMR) imaging. Notwithstanding, strain assessment has proven incremental value for cardiovascular risk stratification. Since introduction of deformation imaging to clinical practice has been complicated by time-consuming post-processing, we sought to investigate automation respectively.Methods:CMR data (n=1095 patients) from two prospectively recruited acute myocardial infarction (AMI) populations with ST-elevation (STEMI) (AIDA STEMI n=759) and non-STEMI (TATORT-NSTEMI n=336) were analysed fully automated and manually on conventional cine sequences. LV function assessment included global longitudinal, circumferential, and radial strains (GLS/GCS/GRS). Agreements were assessed between automated and manual strain assessments. The former were assessed for major adverse cardiac event (MACE) prediction within 12 months following AMI.Results:Manual and automated derived GLS showed the best and excellent agreement with an intraclass correlation coefficient (ICC) of 0.81. Agreement was good for GCS and poor for GRS. Amongst automated analyses, GLS (HR 1.12, 95% CI 1.08-1.16, p

Circulation, Volume 146, Issue Suppl_1, Page A10049-A10049, November 8, 2022. Introduction:Telemedicine offers considerable opportunities to bring high-quality cardiovascular care. Its role in the ischemic-heart disease continuum in patients with acute coronary syndromes (ACS) has not been previously evaluated.Hypothesis:Virtual visits (VV) can be used as an alternative to in-person (IV) follow-up office visits in patients with ACS.Methods:418 patients undergoing angiography for ACS (104 STEMI/314 NSTEMI) were randomized to follow-up via VV (n=208) using a free patient commercial platform or IV (n=210) between February and December 2020. Primary endpoints included major adverse cardiovascular events (MACE) at 1,6 and12 months and 1-year all-cause mortality. Secondary endpoints included 1-year adherence to guideline based-medical therapy including LDL-c < 70 mg/dl, dual antiplatelet therapy, beta-blockers, ACE/ARB/ARNI, Aldosterone antagonists for patients with EF

Circulation, Volume 146, Issue Suppl_1, Page A13185-A13185, November 8, 2022. Introduction:Hematopoietic stem cell transplantation (HSCT) is associated with various cardiovascular (CV) complications. Due to the lack of recent large cohort studies, the incidence and clinical determinants of acute HSCT-related CV events are ill-defined.Methods:We conducted a multi-center observational study (University of Michigan and Rush University) of adult (≥18 years) patients who underwent autologous or allogeneic HSCT for malignant or non-malignant bone marrow disorders from 2005-2021. Data on demographics, pre-HSCT clinical characteristics, imaging, laboratory findings, and acute (

Circulation, Volume 146, Issue Suppl_1, Page A10073-A10073, November 8, 2022. Introduction:With the increasing burden of Acute Myocardial Infarction(AMI) on Medicare, there is a paucity of information on the incidence of Acute Ischemic Stroke(AIS) in those patients and their risk factors.Methods:Patients with a principal diagnosis of AMI covered by Medicare from the 2019 National Inpatient Sample were extracted. Multiple variable regression allowed us to estimate the adjusted odds ratio (aOR) of AIS among patients while acknowledging various possible factors.Results:A total of 378,390 cases of AMI covered by Medicare were found, amongst which 6110 patients,1.6%, also experienced AIS. The mean age of AIS cases was 75.34 years, while it was 74.31 years in non-AIS patients. Patients with AMI are more likely to have a diagnosis of AIS during their hospitalization if they are females (aOR 1.195, 95% CI 1.134-1.260, p

Circulation, Volume 146, Issue Suppl_1, Page A13194-A13194, November 8, 2022. SARS-CoV2 (CoV2) infection causes both acute and long-term health effects via damaging multiple organs including lung. The endothelial dysfunction associated with the infection may contribute to pathogenesis of acute COVID-19 and long COVID. However, the mechanisms underlying the endothelial dysfunction remain elusive. Development of mouse models for these diseases will help us better dissect these mechanisms and facilitate the development of therapeutics for treatment of the disease. Previously, we developed an acute COVID model by infecting human ACE2 transgenic (K18) mice with a lethal CoV2 dose. K18 mice developed severe COVID-19, including progressive body weight loss and fatality at days 7 post infection (DPI), severe lung interstitial inflammation, edema, hemorrhage, perivascular inflammation, systemic lymphocytopenia, and eosinopenia. We detected CoV2 in capillary endothelial cells, activation and adhesion of platelets and immune cells to the vascular wall of the alveolar septa, and increased complement deposition in the lungs in this model. These results indicate that CoV2 infection and infection-mediated immune activation caused endothelial dysfunction, which contributes to the pathogenesis of severe COVID-19. To further develop a model for long COVID, we infected K18 mice with sub lethal CoV2 dose, monitored the body weight and survival rate and characterized the lung and brain histological changes at 21 and 45 DPI. The infected mice progressively lost body weights from 5 to 7 DPI and started to rebound from 8 DPI and then returned to baseline at 13 DPI. Mice had extensive patchy inflammation in the lungs associated with collagen deposition and smooth muscle action expression. We also found moderate levels of total viral RNA in the lung but not brain while viral subgenomic RNA (a correlate of viral replication) was undetectable in lung or brain by qRT-PCR assay. Fluorescence staining showed co-localization of CoV2 spike protein and CD206 in lungs, suggesting macrophage engulfment CoV2 at late time points. Together, we have successfully established long-term COVID mouse models, which will be useful tools for further defining the role of endothelial dysfunction in pathogeneses of CoV2-related acute and long COVID.

Circulation, Volume 146, Issue Suppl_1, Page A12760-A12760, November 8, 2022. Introduction:Post-acute sequelae of COVID-19 (PASC) is a novel clinical syndrome. We have previously reported that PASC patients can develop postural orthostatic tachycardia syndrome (POTS) and that COVID-19 induce microvascular endothelial dysfunction in acutely ill, hospitalized patients, that persist up to four months post discharge. Whether microvascular endothelial dysfunction contributes to POTS pathophysiology in PASC remains unclear.Hypothesis:Patients with PACS combined with POTS have impaired microvascular endothelial function.Methods:PASC patients (n=44) with mild SARS-CoV-2 infection (not hospitalized) were recruited from the post-COVID multidisciplinary clinic at Karolinska University Hospital. PASC diagnosis was based on the WHO PASC criteria. POTS was diagnosed in 21 patients (PASC + POTS) while 23 had a negative head-up tilt test (PASC – POTS). Age- and gender-matched healthy subjects (n=15) served as controls. Microvascular endothelial function was quantified as reactive hyperemia index (RHI) determined from the changes in pulse amplitude tonometry before and after a 5 min episode of arterial occlusion. Stress-perfusion cardiac magnetic resonance imaging (cMRI) with adenosine was performed in a subset of patients.Results:Mean age was 42±11 years and 95 % were women among PACS patients. Time from COVID-19 symptom onset to study inclusion was 18±3 months. RHI was significantly lower in PASC + POTS than in healthy controls and PASC – POTS (Figure 1). The prevalence of cardiac microvascular dysfunction on cMRI did not differ between the PASC groups (8% in PASC + POTS vs. 13% in PASC – POTS, p=1.00). All subjects with microvascular dysfunction on cMRI except one had a RHI below the cutoff (1.67) indicating microvascular dysfunction.Conclusions:Microvascular endothelial dysfunction is common in patients with PACS-associated POTS and may cause stress-induced myocardial ischemia up to 18 months after a mild primary infection.

Circulation, Volume 146, Issue Suppl_1, Page A15021-A15021, November 8, 2022. Introduction:CCL5 or RANTES is a chemokine that mediates chemotaxis and activation of T cells, monocytes, granulocytes, mast cells and dendritic cells. It is involved in the pathogenesis of several diseases including atherosclerosis but little is known about its role at the acute phase of myocardial infarction (MI).Hypothesis:We questioned whether the serum level of RANTES might be a marker of the severity of acute MI.Methods:We prospectively enrolled 251 consecutive STEMI patients who underwent PCI into a prospective cohort. Blood samples were collected at 5 time points: admission, 4, 24, 48 hours and 1 month after admission (H4, H24, H48, M1). RANTES serum levels were assessed using an ELISA assay. Patients underwent cardiac magnetic resonance imaging at one month. Clinical outcomes were prospectively recorded over 12 months.Results:Mean age of the study population was 59±12 years and 54.6% patients exhibited anterior MI. Serum RANTES level raised from 12.6 [7.6-20.8] ng/mL at H0 to 13.9 [7.6-20.8] ng/mL at H4 and decreased gradually until 1 month at 9.3 [4.9-13.6] ng/mL (Kruskal-Wallis test, p

Circulation, Volume 146, Issue Suppl_1, Page A14520-A14520, November 8, 2022. Introduction:While implicated in both cardiac and renal dysfunction, it remains unclear if myeloperoxidase (MPO) plays a role in the development of acute cardiorenal syndrome (CRS). We developed an assay to quantify MPO inhibitory capacity (MIC) to assess a plasma sample’s capacity to inhibit MPO activity.Hypothesis:We hypothesized that unopposed MPO activity (less inhibition) contributes to development of acute CRS and greater MPO inhibition leads to improved clinical outcomes.Methods:90 paired samples of acute heart failure (AHF) patients were collected at enrollment and between 24-96 hours follow-up. Diluted samples were supplemented with 100 ng/mL exogenous MPO and allowed to equilibrate for 1 hour at room temperature. Equal parts sample and Amplex UltraRed Reagent were incubated for 30 minutes, and fluorescence was read. 59 patients had long-term follow-up data for time to readmission survival analysis, censored for loss to follow up, death, or transplantation.Results:Patients with CRS have higher rather than lower MIC compared to that in uncomplicated patients (50% vs 34%, p=0.048). Serial MIC measurements during hospitalization revealed that patients with persistently low MIC experienced better outcomes (median time to readmission 575 days vs 104 days, p=0.023, Figure).Conclusions:Contrary to our original hypothesis, we observed acute CRS patients had higher rather than lower MIC, and that persistently low MIC experienced better long-term outcomes. These results imply that in patients experiencing acute CRS, there is a circulating MPO inhibitory component that has not been previously accounted for, and that unopposed MPO activity was not associated with CRS or poor outcomes.

Circulation, Volume 146, Issue Suppl_1, Page A11529-A11529, November 8, 2022. Introduction:Little research has focused on the acute coronary syndrome (ACS) symptom knowledge, attitudes, and beliefs of younger individuals and those without diagnosed heart disease, even though most ACS events are first-time events, and ACS rates are increasing in the young.Purpose:To identify predictors of ACS symptom knowledge, attitudes, and beliefs in younger people without diagnosed heart disease.Methods:Participants were recruited from social media platforms in fall 2020 and completed an online survey including the ACS Response Index instrument. Multiple linear regressions were run to model ACS symptom knowledge, attitudes, and beliefs as a function of selected demographic and clinical variables that have documented or theoretical importance.Results:A typical participant from the sample (n=765) was 36.4 years old (SD = 16.7), a woman (n=573; 74.9%), white (n=686; 89.7%), and non-Hispanic/Latino (n=706; 92.3%). Hispanic/Latino participants had lower ACS symptom knowledge and attitude scores than non-Hispanic/Latino participants, (β = -.26,t(757) = -7.79,p= .000; β = -1.32,t(755) = -2.86,p= .000, respectively), and white participants had substantially higher ACS symptom attitude scores than non-white, (β = 1.21,t(755) = 3.35,p= .001). Men had lower knowledge scores than women, (β = -6.48,t(757) = -4.41,p= .000). Additionally, participants who reported being taught by a healthcare professional about signs and symptoms of ACS had substantially higher symptom knowledge and attitude scores compared to those who had not, (β = 3.70,t(757) = 3.01,p= .003; β = 2.15,t(755) = 11.68,p= .000, respectively) and so did those who reported exposure to information about these symptoms in the media compared to those who did not, (β = 6.68,t(757) = 4.37,p= .003; β = 1.07,t(755) = 4.58,p= .000, respectively). Other variables, such as use of avoidance coping, self-perceived risk of heart disease, nicotine use, and self-perceived health, also predicted knowledge, attitude, and/or belief scores.Conclusions:Gender, race, and previous exposure to information about ACS symptoms were particularly important predictors of ACS symptom knowledge and attitudes, though others were significant. Additional research is needed in more diverse samples.

Circulation, Volume 146, Issue Suppl_1, Page A13402-A13402, November 8, 2022. Background:Racial differences in outcomes of STEMI patients continue to persist. Our study aimed to assess the difference in the incidence of acute kidney injury (AKI) post percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI), stratified by race into African Americans (AA) vs Caucasians.Methods:All STEMI patients who underwent PCI at the Cleveland Clinic main campus between January 1, 2011, to July 15, 2019, were included in our study. Patients were categorized into two groups depending on a diagnosis of the presence or absence of AKI post PCI. AKI was defined as >0.3mg/dl rise in post PCI creatinine from pre-procedure value. Relative risk of developing AKI depending on race was calculated with the help of a two by two table.Results:Overall, 1847 patients were admitted to our hospital with a STEMI and underwent PCI during the study period. Of these, 267 (15%) developed AKI post PCI. 19% of AA patients developed AKI compared to 13% of Caucasian. Comparison of baseline characteristics amongst patients who developed AKI revealed that AA patients with AKI were younger than their Caucasian counterparts (median age 63 vs 68, p=0.006), but were more likely to having smoking history (52% vs 35%, p=0.014). Upon analyzing the association between race and AKI, AA patients were 48% more likely to develop AKI post PCI compared to Caucasian patients (RR of 1.48, 95% CI 1.17-1.86, p=0.0015). This difference was observed in spite of no significant differences in radial access, contrast dose, or mechanical circulatory support use between the two races.Conclusion:African Americans STEMI patients are almost 50% more likely than Caucasians to develop AKI post PCI. Developing race-specific process measures and further optimization of procedural characteristics may be necessary to improve the outcomes of AA STEMI patients.

Circulation, Volume 146, Issue Suppl_1, Page A10194-A10194, November 8, 2022. Introduction:Acute pericarditis has not been linked to long-term heart-specific morbidity in breast cancer patients. Carcinomatous pericardial involvement has been detected at autopsy in 10-20% of breast cancer patients. In clinical practice, when it comes to primarily echocardiographically-diagnosed pericardial diseases: pericardial effusion, cardiac tamponade, and pericardial constriction have all been reported in breast cancer patients. Acute pericarditis is primarily a clinical non-imaging bedside diagnosis derived from the combination of chest pain, pericardial rub, and typical electrocardiographic changes, irrespective of the presence or absence of pericardial fluid on imaging. It can be the initial clinical manifestation of a malignancy.Methods:The Myocardial Infarction Data Acquisition System (MIDAS) database is an ongoing, longitudinal, and validated database that comprises discharge data, along with demographics, comorbidities, and length of hospital stay; for all patients with cardiovascular diseases admitted to every non-federal acute care hospital in the state of New Jersey. We searched for the diagnosis of acute pericarditis (ICD-9 codes 420.0, 420.90, 420.91, and 420.99), in first hospital admissions of female patients with breast cancer (ICD-9 codes 174.0-174.9) between January 1995 to December 2015. Controls were female breast cancer patients without the diagnosis of acute pericarditis.Results:There were 60,435 female patients with breast cancer. Of those, 253 (0.4%) were also diagnosed with acute pericarditis on the same admission as the first breast cancer diagnosis, or later. Analysis for comorbidities showed that 116 (45.8%) of the 253 patients with acute pericarditis had admissions for heart failure, as opposed to 26.4% (15,895 out of 60,182) of breast cancer patients without acute pericarditis (p < 0.00001).Conclusions:Since New Jersey has a diverse population that resembles the profile of the United States in age, gender, and race/ethnicity; our findings could also be generalized to other geographic areas, and may help with future clinical guidelines. Although it is rare, acute pericarditis in breast cancer patients can indicate long-term cardiovascular morbidity.

Circulation, Volume 146, Issue Suppl_1, Page A10987-A10987, November 8, 2022. Introduction:Female patients are significantly more likely than male patients to experience symptoms of depression and anxiety post-acute coronary syndrome (ACS), correlated with higher rates of cardiovascular morbidity and mortality. Yet, it is unclear if all female patients are impacted broadly or if specific subgroups of female patients are at elevated risk. We aimed to identify the cardiovascular and psychosocial variables correlated with increased depression and anxiety symptoms immediately post-ACS as well as at 3 and 6-month follow-up.Hypothesis:There is a combination of cardiovascular and psychosocial factors associated with elevated depressive/anxious symptoms (Hospital Anxiety and Depression Scale (HADS) score ≥8 on the depression/anxiety subscales) in female patients post-ACS.Methods:This was a prospective multi-center questionnaire-based clinical research study featuring data from 6 sites across Canada using a logistic regression model to delineate multivariate strength of association. Baseline visit (within 72 hours of ACS) included HADS and a sociodemographic questionnaire. Follow-up visits (3 and 6-months) include HADS, Cardiac Anxiety Questionnaire, new health events, mortality, Short Form-12 Health Survey, and Somatic Symptom Scale-8.Results:A total of 245 patients were included in analysis (Table 1). HADS-A≥8 was associated with increased health anxiety at baseline (OR6.56; p

Circulation, Volume 146, Issue Suppl_1, Page A11654-A11654, November 8, 2022. Introduction:Cardiac rehabilitation (CR) improves outcomes after acute myocardial infarction (AMI). The Bundled Payments for Care Improvement Advanced (BPCI-A) program holds participating hospitals accountable for all costs incurred within 90 days of discharge. There is concern that this financial incentive will lead participants to cut back on high-value care, including CR, in order to meet cost targets. We examined whether patients discharged from BPCI-A participating hospitals after an AMI had lower CR utilization compared to non-participating hospitals.Methods:We included patients from a 100% sample of fee-for-service Medicare beneficiaries discharged home after a hospitalization for AMI during a baseline period (January 1, 2016 to December 31, 2017) or an intervention period (October 1, 2018 to September 30, 2019). Our exposure was discharge from a hospital participating in BPCI-A. Our outcomes were the proportion attending ≥1 CR session and the mean number of CR sessions attended within 90 days of discharge. We adjusted for hospital, market, and patient level factors, including medical comorbidities. We performed difference-in-change analyses for both outcomes using linear mixed effects models, before and after adjustment for all confounders.Results:The baseline period included 50,274 discharges, with 33.7% from BPCI-A participating hospitals. The intervention period included 27,268 discharges, with 32.9% from participating hospitals. Overall, CR use was 11.3% in the baseline period and 11.7% in the intervention period. There were no differential changes between BPCI-participating and nonparticipating hospitals for either outcome over time (Table).Conclusions:Among Medicare patients discharged after an AMI, CR utilization was low, and we observed no difference in utilization associated with hospital participation in BPCI-A.

Circulation, Volume 146, Issue Suppl_1, Page A10412-A10412, November 8, 2022. Introduction:Malnutrition has been associated with inferior outcomes in patients admitted with acute myocardial infarction (AMI). However, there is a lack of data to assess if the degree of malnutrition correlates with outcome severity.Methods:We used Nationwide Readmission Database (NRD) for 2016-2019 in our cross-sectional study. First, we extracted all cases older than 18-years that include a primary diagnosis of AMI. Appropriate survey and domain analyses were applied to obtain national estimates using SAS 9.4.Results:We identified 2,280,393 discharges for AMI. Malnutrition was present in 4% of the study cohort (or 89,490 cases). Half of the patients with malnutrition (or 44,919) had moderate to severe malnutrition. The other 44,371 (or 50%) had a milder degree of malnutrition. Patients with malnutrition were younger than those without malnutrition (mean age 72-years vs. 75-years, p

Circulation, Volume 146, Issue Suppl_1, Page A15115-A15115, November 8, 2022. Introduction:Myocarditis contributes to the global burden of cardiovascular disease primarily through sudden death and dilated cardiomyopathy. We aimed to study patient characteristics, national readmission rates and predictors for patients admitted for acute myocarditis utilizing a nationally representative cohort of patients from the National Readmission Database.Methods:We utilized the National Readmission Database 2018 to identify the hospitalized adults with a primary diagnosis of acute myocarditis. We included subjects who were readmitted within 90 days after index admission. We excluded subjects with elective and traumatic admissions. We utilized a multivariate cox regression model to identify independent predictors of readmission.Results:During the study period, 3,524 hospitalized patients who had a primary diagnosis of acute myocarditis were discharged alive. Within 90 days of discharge, 356 (10.1%) subjects were readmitted. The top three causes of readmission were heart failure (37.1%), sepsis (16.1%) and ventricular tachycardia (10.6%). The in-hospital mortality rate (5.5 vs. 2.6%, p