Risultati per: Sindromi coronariche acute

Circulation, Volume 146, Issue Suppl_1, Page A12725-A12725, November 8, 2022. Introduction:Low serum albumin is a marker of protein malnutrition and is commonly associated with worse outcomes in various clinical settings. Furthermore, significant overlap exists between malnutrition and sarcopenia, which can be an independent predictor of worse outcomes.Hypothesis:We assessed the hypothesis that the presence of sarcopenia with low albumin (SLA) would lead to synergistically worse outcomes in patients with acute decompensated heart failure (ADHF).Methods:Patients hospitalized for ADHF from 2017 to 2019 with computed tomography of the abdomen/pelvis within 30 days and albumin level within 24 hours before discharge were studied (n=181). Given the high prevalence of hypoalbuminemia, low albumin was defined as the lower fiftieth percentile. Semi-automatic measurements of skeletal muscle area were made at L3 (Figure 1A) and adjusted using height squared to obtain skeletal muscle index (SMI). Sarcopenia was defined as the lowest sex-stratified SMI tertile.Results:The prevalence of sarcopenia alone was 11.6%, low albumin alone 28.7%, and SLA 20.4%. The groups had similar demographics but differed in BMI (lowest in sarcopenia alone, p

Circulation, Volume 146, Issue Suppl_1, Page A11658-A11658, November 8, 2022. Arthropod and insect bites/stings have been associated with the development of Acute Coronary Syndrome (ACS) in prior case reports. In this systematic analysis, we review 57 reported cases of ACS in patients that were exposed to arthropods, bee stings or insect bites, and provide a summary of these findings in Table 1. We then discuss Kounis Syndrome Type 1 or Type 2 as the proposed mechanism by which myocardial ischemia develops in this subset of patients, and the implications of this diagnosis on management. Kounis Syndrome Type 1 develops due to mast cell activation and histamine release provoking vasospasms and inducing myocardia injury in the absence of underlying coronary artery disease, as demonstrated in Figure 1A. Kounis Syndrome Type 2 develops due to inflammation induced plaque rupture and subsequent thrombus formation, as demonstrated in Figure 1B. In general, Kounis Syndrome should be suspected in patient’s presenting with the appropriate exposure, an allergic or anaphylactic response and/or unremarkable coronary angiogram (specific to Type 1). Once suspected, the use of coronary artery vasodilators, antihistamines, steroids and possibly Epinephrine should be considered in management. In this review, it was discovered that approximately 50% of cases received management consistent with Kounis Syndrome (targeted to allergic/anaphylactic symptoms) with appropriate clinical response, yet only 12% received the formal diagnosis, indicating this condition is underdiagnosed. Furthermore, 40% of patients that underwent coronary angiogram did not have CAD, indicating a possible Type 1 (vasospastic) etiology of ACS that may benefit from more targeted therapy.

Circulation, Volume 146, Issue Suppl_1, Page A15293-A15293, November 8, 2022. Hypothesis:Introduction. Acute critically ill patients experience a rapid decline in plasma free thyroid hormone levels (free triiodothyronine (FT3) and free levothyroxine (FT4)), with a marked elevation of reverse T3, recognized as the euthyroid sick syndrome (ESS) or low-T3 syndrome. The ESS is also often associated with depressed myocardial function, sometimes referred to as the ‘stunned myocardium. The role of thyroid hormone levels in patients with cardiogenic shock complicated myocardial infarction has not been shownMethods:The purpose of the study was to assess the impact of thyroid hormone levels on hospital mortality in patients with infarction related cardiogenic shock. Thyroid hormone levels were measured from routine blood specimens and analyzed initial and up to 96 hours.Results:We identified 40 patients with infarction related cardiogenic shock treated at our university hospital. Majority of the CS-patients had on admission reduced TSH levels of 1,42 ± 0,22mU/l. Nevertheless, in-hospital mortality rate was higher in patients with lower admission TSH levels and levels over time. In addition, FT3 in CS-survivors showed a flat slope from normal levels. Non-survivor had a trend towards lower levels after 72 and 96 hours. When we analyzed for low T3 syndrome (i.e. FT3 >3,1pmol/l) we saw a 3x times higher mortality rate compared to CS patients with normal levels. In contrast, FT4 levels of non survivors were significantly elevated compared to surviving CS patients. After 96 hours both groups had similar levels. Predictors of hospital death in CS patients were low TSH levels, low T3 syndrome and elevated FT4.Conclusions:Thyroid hormone level on admission and over time (i.e. low TSH, low T3 and elevated FT4) are predictors of in-hospital death in patients with infarction related cardiogenic shock. Interestingly TSH stays almost stable over time whereas FT3 and FT4 declines over time. Further studies have to show if administration of thyroid hormone might be beneficial in patients with infarction related cardiogenic shock.

Circulation, Volume 146, Issue Suppl_1, Page A9689-A9689, November 8, 2022. Objectives:To compare the efficacy peripheral intravenous (IV), central IV, and intracoronary (IC) administration of epinephrine in acute myocardial infarction (AMI) patients with cardiac arrest in the cath lab.Methods:Prospective, two-center cohort pilot study of AMI patients with cardiac arrest in the cath lab. Patients who received mechanical circulatory support, primary fibrinolysis, anti-arrhythmic/vasopressors prior to cardiac arrest, or those with prior CAD or a cardiac arrest that lasted < 60 seconds were excluded. Outcomes included return of spontaneous circulation (ROSC), stent thrombosis, and survival-to-discharge with a favorable neurological outcome.Results:158 patients were enrolled (Table 1). After adjusting for age and initial cardiac rhythm, the peripheral IV route had 5.5-fold lower odds (OR: 0.18, 95% CI: 0.07-0.49,p= 0.0007) of achieving ROSC compared with the central IV route, while the IC route had a similar odds compared to the central IV route (p= 0.9516). Among those who achieved ROSC, the IC route had a higher odds for stent thrombosis compared to the central IV route (OR: 5.7, 95% CI: 1.9-17.2,p= 0.0022), but not the peripheral IV route (p= 0.1277). The adjusted odds of achieving survival-to-discharge with a favorable neurological outcome were higher in the IC route compared to the peripheral IV route (OR: 7.8, 95% CI: 2.2 – 27.0,p= 0.0013), and similar in the IC and central IV routes (p= 0.0585) (Table 2).Conclusions:Epinephrine administration via central IV has a higher odds achieving ROSC than via peripheral IV and a lower odds of stent thrombosis than via the IC route in patients with AMI who suffer from cardiac arrest during PCI.

Circulation, Volume 146, Issue Suppl_1, Page A14701-A14701, November 8, 2022. Backgrounds:Although the mortality rates for AMI have declined, the mortality rate for AMI with out-of-hospital cardiac arrest (OHCA) remains high. It has been supposed that CTO (chronic total occlusion) in non-infarct related artery is associated with OHCA patients. However, the detailed angiographic and prognostic comparison between OHCA patients and non-OHCA patients stratified by Killip classification has not been well evaluated.Methods:Among 5662 AMI patients (5420 non-OHCA patients and 242 OHCA patient) who underwent emergency coronary angiography between 2013 and 2020 were enrolled from Mie ACS registry. Difference of culprit lesion and non-infarct related CTO lesion were analyzed between with and without OHCA. They were further stratified using Killip classification.Results:In-hospital mortality for AMI patients with OHCA was 31.4%, significantly higher than the 5.5% for AMI patients with non-OHCA (p

Circulation, Volume 146, Issue Suppl_1, Page A13180-A13180, November 8, 2022. Background:The impact of mechanical left ventricular (LV) unloading before reperfusion on myocardial energetics in acute myocardial infarction (AMI) is unknown. We hypothesized that LV unloading reduces anaerobic glycolysis in models of ischemia reperfusion injury (IRI).Methods:Myocardial ischemia was induced by percutaneous occlusion of the left anterior descending (LAD) artery for 90 minutes in adult swine. In Groups A and B, an additional 120 minutes of LAD occlusion without reperfusion was performed in the presence or absence of a trans-valvular pump (TVP). In Group C and D, an additional 120 minutes of reperfusion was performed in the presence or absence TVP (Fig. 1A). Untargeted Metabolomics was performed on the tissues from the infarct zones.Results:Compared to Group A, infarct size normalized to the area at risk (IS/AAR) was significantly smaller with LV unloading after ischemia alone (Group B; Fig 1B) and reperfusion (Group D; Fig 1B). Principal component analysis analysis of 800 metabolites identified 5 distinct clusters corresponding to the 4 study groups and sham controls (Fig 1C). LV unloading without reperfusion reduced lactate by 30±4% (p

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 A12075-A12075, November 8, 2022. Introduction:Acute decompensation is associated with increased long-term mortality in patients with heart failure (HF). Biomarkers of acute HF that are dynamic during decongestion may provide physiologic insight for this observation. We hypothesized that long-noncoding RNAs (lncRNAs) and mRNAs in extracellular vesicles (EVs) not only mark different types of HF, but also may be dynamically altered with decongestion across physiologically important pathways.Methods:RNA sequencing was performed on plasma-derived EVs in acute HF patients (7 HFpEF; 7 HFrEF) at hospital admission (V1) and at discharge (V2) along with 9 controls without HF. Differential expression analysis was performed using DESeq2 across groups and time-points. Transcripts were prioritized by fold change (±1.5) and statistical significance (

Circulation, Volume 146, Issue Suppl_1, Page A12816-A12816, November 8, 2022. Introduction:High-sensitivity cardiac troponin (hs-cTn) laboratory assays are used to rule out myocardial infarction (MI) on presentation, but prolonged result turn-around times can delay patient management.Hypothesis:Our aim was to identify patients at low risk of index MI using a rapid, point of care (POC), whole blood hs-cTnI assay at presentation, with potential early patient discharge, with99% for index MI, was derived (SEIGE) and validated using plasma (SAMIE). Event adjudications were established using hs-cTnI assay results from usual clinical care. The primary outcome was MI at 30-days.Results:1086 patients (8.1% MI) were enrolled in a US derivation cohort (SEIGE) and 1486 (5.5% MI) in an Australian validation cohort (SAMIE). A derivation whole blood POC hs-cTnI concentration of

Circulation, Volume 146, Issue Suppl_1, Page A12101-A12101, November 8, 2022. Introduction:COVID-19 infection has increased the risk of thrombosis, and the pandemic has impacted the utilization of healthcare services.Hypothesis:The study aims to investigate the consequences of the COVID-19 pandemic on the incidence of hospitalization for acute myocardial infarction (IH-AMI) and out-of-hospital cardiovascular deaths rate (OH-CVD).Methods:The analysis was done on data collected in the National Database of Death Records, the National Health Information System, and the Information System of Infectious Diseases. Incidence and number of deaths were expressed per 100 000 inhabitants. For comparison of time periods incidence rate ratio was applied. Over-mortality was described as a change in % against the reference period 2016-2019.Results:The population for the analysis consisted of 50,745 AMI cases and 204,392 OH-deaths from any cause. In the pandemic year (vs. 2016-2019 period), there was a significant decrease in AMI hospitalizations with an incidence rate ratio of 0.949 (0.911;0.989) for acute STEMI and 0.949 (0.911;0.989) for NSTEMI, respectively. A significant relationship was found between the decrease in acute STEMI hospitalizations and the number of COVID-infected patients. The risk of OH-CVD increased significantly in 2020 compared to the mean death rates in 2016-2019. The analysis of over-mortality against the reference period 2016-2019 shows the increase of OH-CVD associated with the decrease in hospitalization for acute STEMI significantly related to the number of COVID19 cases (Figure).Conclusions:The COVID-19 pandemic significantly affected the number of IH-AMI while increasing the incidence of OH-CVD. These changes were directly impacted by the number of infected in the population. It is, therefore, necessary to focus efforts on informing the population about the safety of hospitalization and ensuring full availability of health care services even in pandemic times.

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 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 A15122-A15122, November 8, 2022. Introduction:Despite well-established device selection algorithms, there remain wide variations in mechanical circulatory support (MCS) device utilization in patients with cardiogenic shock complicating acute myocardial infarction (AMI-CS). Further, there are limited national-level data on the contemporary practices of MCS device use.Methods:To evaluate national utilization patterns of MCS devices, we identified adult admissions ( >18 years) with AMI-CS from the HCUP-NIS data (2005-2017). Use of MCS devices including intraaortic balloon pump (IABP), percutaneous left ventricular assist devices (pLVAD) (Impella/Tandem Heart), and extracorporeal membrane oxygenation (ECMO) during hospitalization was identified. We evaluated trends in the initial MCS device used (IABP alone, pLVAD alone, or ≥2 MCS devices), device escalation, bridging to durable LVAD/heart transplantation, and predictors of in-hospital mortality and device escalation.Results:Among a total of 327,283 AMI-CS admissions in this 13-year period, 132,146 (40.2%) had an MCS device with information on timing of placement. IABP, pLVAD, ≥2 MCS, and ECMO devices were used as initial device in 120,928 (92.0%), 8,202 (6.2%), 2,305 (1.7%), and 711 (0.1%) admissions, respectively. Most admissions were maintained on initiated MCS device with 1-1.5% being escalated (IABP to pLVAD/ECMO, pLVAD to ECMO). The median time to escalation across all devices categories was 2 (IQR 1-4) days. Urban, medium, and large-sized hospitals, and acute multiorgan failure were significant independent predictors of MCS escalation. In admissions receiving MCS, escalation of MCS device was associated with higher in-hospital mortality (adjusted OR 1.56, 95% CI 1.38-1.75;p

Circulation, Volume 146, Issue Suppl_1, Page A10186-A10186, November 8, 2022. Objective:The fluctuations of blood pressure in the acute stage of stroke are associated with neurological deterioration and poor prognosis. Although continuous monitoring of blood pressure changes becomes possible with the emergence of wearable blood pressure monitoring equipment, the accuracy of the equipment is still in doubt. Here, the accuracy of the optoelectronic-based wearable device for blood pressure monitoring in hospitalized patients with acute stroke were investigated and verified.Methods:Thirty-five acute stroke patients in the Department of Neurology of a teaching hospital were recruited. With the blood pressure values measured by bedside ECG monitor as the gold standard, wearables devices (wearable wrist watch) and bedside ECG monitors were monitored sequentially the same upper limb at the same time and recorded every 2 hours during the first 24 hours of admission. Receiver operating characteristic (ROC) curves were employed to determine the optimal cut off points and tests of sensitivity, specificity, kappa coefficients were conducted.Results:The average age of participants (male 17, female 18) was 61.91 ±8.72 years. 414 groups of blood pressure values were measured and ranged from 74/41 to 221/124 mmHg. The kappa value of systolic blood pressure (SBP) measured by wearable wrist watch and bedside ECG monitor was 0.768, with 89.1% sensitivity and 87.7% specificity (Table 1-A). And the kappa value of diastolic blood pressure (DBP) was 0.648, with 94.6% sensitivity and 67.9% specificity (Table 1-B). The area under ROC curve for SBP diagnosis and DBP diagnosis of wearable wrist watches were 0.941(p< 0.001, Figure 1-A) and 0.939 (p< 0.001, Figure 1-B) respectively. There was no significant difference in SBP and DBP between these two methods (p >0.05, Table 3).Conclusions:The accuracy of wearable wrist watch for measuring patient blood pressure with acute stroke is good enough for ambulatory blood pressure monitoring of acute stroke patients.

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 A10445-A10445, November 8, 2022. Background:The purpose of this study is to evaluate the role of viability on PET-MRI to predict improvement of echocardiographic findings such as regional wall motion index and left ventricular ejection fraction after successful percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI).Method:A total of 154 patients with AMI who was performed cardiac PET/MRI within 7 days after PCI were enrolled were enrolled. We performed TTE twice before and after in We performed TTE twice before and after PCI in 103 patients. We categorized these patients according to presence of viability on PET-MRI: group A (N=53, patients with viability on PET-MRI) and group B (N=50, patients without viability on PET-MRI) and compared. The primary end point is improvement of regional wall motion abnormality (RWMA) on TTE.Results:Clinical and angiographic findings were similar between the two groups during follow-up of 11months. Among 53 patients in group A, 30 patients (56.6%) showed the result of slight improvement of RWMA on TTE and among them 13 patients (24.5%) showed result of disappeared RWMA on TTE. In contrast, among 50 patients in group B, 22 patients (44%) showed the result of slight improvement and among them, only 4 patients (8%) showed result of disappeared RWMA on TTE. The proportion of patients who showed slight improvement of RWMA between two groups are not statistically significant (p=0.201). But, the proportion of patients who showed disappeared RWMA between two groups are statistically significant (p=0.024).Conclusions:PET/MRI is useful tool to detect viability in patients with AMI. It seems to be predictable to improve cardiac function for the patients with viability on PET-MRI.