Risultati per: Sindromi coronariche acute

Circulation, Volume 146, Issue Suppl_1, Page A15591-A15591, November 8, 2022. Introduction:Ryanodine receptor 2 (RyR2) hyperactivity is commonly observed in structural heart diseases that are a result of ischemia or heart failure. It results in abnormal calcium handling and calcium leak that can trigger arrhythmias. Dantrolene, a RyR inhibitor, is used to prevent calcium leak from RyR1 in skeletal muscles.Hypothesis:Suppressing RyR2 hyperactivity with acute dantrolene treatment can reduce arrhythmia burden in human hearts.Methods:Human donor hearts that were not used in transplantation were obtained and 1 cm3cubes were isolated from the left ventricle. Slices at 400 μm thickness were generated from these cubes, pinned and perfused with Tyrode’s solution in a recording tissue chamber. Pseudo-ECGs were recorded with ECG electrodes and the slices were optically mapped to measure conduction velocity (CV), action potential duration (APD) and calcium transient duration (CaTD). After an initial 30 min equilibration period, baseline optical recordings were obtained. Slices were then treated with 1) Isoproterenol (Iso, 250 nM) to stimulate β-adrenergic receptors, 2) Caffeine (200 μM) for RyR2 receptor activation and 3) Dantrolene (10 μM), sequentially. Dual optical recordings, Vm and Ca, were obtained after each treatment.Results:Substrate: Iso reduced APD (425±36 vs 394±43, p=0.03), as expected, and addition of Caffeine restored APD to baseline. More importantly, addition of Dantrolene prolonged APD even further (460±90, p=0.04). CaTD was also similarly reduced by Iso (445±48 vs 387±25, p=0.04) and restored to baseline by Caffeine+Iso. No significant changes in CV were measured under any condition. Trigger: In slices where PVCs were inducible, Caffeine+Iso increased occurrence of PVCs (20 vs 53 PVCs/min) while addition of Dantrolene reduced PVC incidence (18 PVCs/min).Conclusions:Dantrolene treatment, acutely reversed proarrhythmogenic substrate and reduced triggers and could therefore be a suitable approach for anti-arrhythmic therapy in patients with structural heart disease. Additionally, human LV slice preparation is useful in antiarrhythmic drug studies.

Circulation, Volume 146, Issue Suppl_1, Page A12220-A12220, November 8, 2022. Introduction:The clinical significance of right bundle branch block (RBBB) or bifascicular block (BFB) in the setting of ST-elevation myocardial infarction (STEMI) is uncertain. Informed by studies demonstrating higher rates of complete occlusion of the infarct-related artery in patients presenting with RBBB, the latest guidelines on STEMI management suggest patients with persistent ischemic symptoms and RBBB be considered for emergent coronary angiography. However, there has been little study of the prognostic implication of either RBBB or BFB in the setting of undifferentiated acute chest pain, and even less of the degree of ST-elevation in concomitant RBBB.Methods and Results:A total of 7626 patient encounters presenting to the Baylor St. Luke’s Medical Center between July 2018 and July 2020 with a chief complaint of “chest pain” were identified via electronic health record query. Of these encounters, 211 (2.8%) patients were found to have RBBB. Of that cohort, 18 (8.5%) presented with acute coronary syndrome, with STEMI accounting for 6 (2.8%), non-STEMI 9 (4.3%), and unstable angina 3 (1.4%). New or presumed new RBBBs were found in 59 (28%) of total RBBB patients, of which only 5 (8.5%) were found to have acute coronary syndrome and only 2 (3.4%) STEMI specifically. Similarly, 90 (42.7%) patients with chest pain and RBBB were found to have a BFB. New or presumed new BFBs were found in 40 (19%) patients, of which only 4 (10%) were also found to have acute coronary syndrome. No patients with new-onset BFB had STEMI. Furthermore, real-time diagnosis of anterior STEMI was complicated in two patients presenting with acute coronary syndrome by the masking of ST elevation in leads V1-3 by concomitant RBBB.Conclusions:In a large cohort of undifferentiated patients who presented with chest pain and RBBB or BFB (regardless if new or presumed new), only a small fraction had acute coronary syndrome, and even fewer STEMI. These data suggest patients with undifferentiated chest pain and RBBB on ECG with clinical suspicion for acute myocardial infarction and any degree of ST-elevation in leads V1-3 be considered for emergent coronary angiography rather than RBBB or BFB without ST-segment elevation.

Circulation, Volume 146, Issue Suppl_1, Page A11931-A11931, November 8, 2022. Background:Plasma volume status (PVS), a measure of plasma volume, has been evaluated as a prognostic marker for chronic heart failure. However, the significance of PVS in patients with acute decompensated heart failure (ADHF) admitted to the cardiovascular intensive care unit (CICU) remains unclear. Therefore, we examined the relationship between PVS and the long-term mortality.Method:Of 389 consecutive patients admitted to our CICU for ADHF from January 2018 to December 2020, a total of 206 patients (74.9 ± 12.9 years, 64.6% male) were enrolled, excluding those who received red blood cell transfusion, underwent dialysis, were discharged directly from the CICU, or died in the hospital. We measured PVS during the CICU stay and at discharge using the Kaplan-Hakim formula, and examined the association with all-cause mortality during the observation period (1037 days).Result:The group with decreasing PVS at 3 points, at admission to the CICU, at transfer to the GW, and at discharge, had a 3-year mortality rate of 0%. Cut-off values to predict long-term mortality were 10% and 9% for PVS at transfer to the GW and discharge according to ROC curve, respectively. All patients were divided into 2 groups by cut-off values, respectively, and the high PVS group had a significantly higher mortality rate (Figure 1, 2). In COX regression analysis, significant poor prognostic factors were PVS at transfer to the GW (HR=1.086 [1.04-1.13], P

Circulation, Volume 146, Issue Suppl_1, Page A11951-A11951, November 8, 2022. Introduction:Cardiac contractility modulation (CCM) is a medical device therapy whereby non-excitatory electrical simulations are delivered to the myocardium during the absolute refractory period. We previously evaluated the effects of the standard CCM pulse parameters in isolated rabbit ventricular cardiomyocytes and 2D human induced pluripotent stem cell-derived cardiomyocyte (hiPSC-CM) monolayers, on flexible substrate.Hypothesis:In the present study, we sought to extend these results to 3D microphysiological systems to develop a human-based model to evaluate various clinical CCM pulse parameters in vitro.Methods:HiPSC-CMs were studied in conventional 2D monolayer format, on stiff substrate (i.e., glass), and as 3D human engineered cardiac tissues (ECTs). Cardiac contractile properties were evaluated by video-based analysis and custom force analysis. CCM pulses were assessed at varying clinical ‘doses’ using a commercial pulse generator. Robust response was observed at physiological Ca concentrations [1.8 mM] for 3D ECTs.Results:Under standard acute CCM stimulation 3D ECTs displayed enhanced contractile properties including increased peak contraction amplitude (i.e., force), and faster contraction and relaxation kinetics. Moreover, 3D ECTs displayed enhanced contractility in a CCM pulse parameter dependent manner. The observed effects subsided when the acute CCM stimulation was stopped and gradually returned to baseline. Under comparable conditions, conventional 2D monolayer hiPSC-CMs, on stiff substrate, displayed neutral response.Conclusions:These data represent the first study of acute CCM stimulation in a 3D hiPSC-CM model and provides a preclinical model to assess various CCM signals in human cardiac tissues prior to in vivo animal studies.

Circulation, Volume 146, Issue Suppl_1, Page A11885-A11885, November 8, 2022. Background:cardiac magnetic resonance (CMR) is central for diagnosis, follow up and prognostic stratification of acute myocarditis. Late gadolinium enhancement (LGE) extent and persistence at follow-up represents a negative prognostic marker. However, time course of oedema resolution and LGE stabilization and optimal timing to repeat CMR are unclear.Hypothesis:we assessed time course of oedema and LGE evolution to identify optimal timing to repeat CMR in acute myocarditis.Methods:36 acute myocarditis patients (35M, 28,8±10,3 years) underwent CMR at clinical presentation (CMR-1), after 3 months (CMR-2) and after 12-months (CMR-3). We assessed oedema and LGE and measured left ventricular ejection fraction (LVEF) and indexed mass (iLVM). After CMR-3 all patients were followed up yearly with clinical evaluation, Holter ECG and echocardiography.Results:all patients had oedema and LGE at CMR-1. At CMR-2 significant reduction of oedema (T2 positive segments 0,4±0,9 vs 4,1±3,2 p

Circulation, Volume 146, Issue Suppl_1, Page A11248-A11248, November 8, 2022. Introduction:Patients with acute coronary syndromes (ACS) are known to have a higher risk of target vessel revascularization after percutaneous coronary intervention (PCI) and worse long-term prognosis than patients with stable angina. Neoatherosclerosis is one of the significant factors at very late stent thrombosis. And the presence of in-stent neoatherosclerosis is independently associated with major adverse cardiac event. Although many studies have been reported on neoatherosclerosis, few have been reported on short-term in-stent neoatherosclerosis. Moreover, none have evaluated the impact of ACS. We investigated the impact of ACS on in-stent neoatheroscrelosis using Optical Coherence Tomography (OCT) in the present study.Methods:From March 2017 to November 2020, we investigated 102 patients (122 lesions) who had undergone PCI using drug eluting stent during that period and were followed up for OCT within one year. Subjects were categorized as ACS or non-ACS according to clinical findings at the time of target lesion intervention. We used OCT to investigate the presence of early in-stent neoatherosclerosis.Result:ACS group consisted of 21 (20.6%). In patients with ACS, women tended to be more common (38% vs 19%,P=0.0777). There were no differences in age or presence of diabetes or dyslipidemia during treatment. There were also no significant differences in LDL-C levels at the time of PCI (88 (73-114) mg/dL vs 100 (85-124) mg/dL,P=0.319) and when observed by OCT (67 (55-81) mg/dL vs 68 (57-89) mg/dL,P=0.622). The ACS group was significantly more likely to have a previous history of ACS (38% vs 12%,P=0.0104). Stent length was significantly shorter in ACS patients (24 (18-28) mm vs 32 (23-38) mm,P=0.0365). The mean dulation from PCI was 292 days. In-stent neoatherosclerosis was more frequent in the ACS group (31.8 % vs 9.9 %,P=0.014).Conclusion:This observational study using OCT indicates that stenting for ACS lesion is associated with early in-stent neoatherosclerosis.

Circulation, Volume 146, Issue Suppl_1, Page A15637-A15637, November 8, 2022. LongCovid or Post-Acute Sequelae of COVID-19 (PASC) is a diagnosis given to patients who experience a wide range of debilitating chronic symptoms after infection with SARS-CoV-2. The majority of individuals are PCR negative, indicating microbiological recovery. There are currently few LongCovid/PASC blood-based biomarkers. We used fluorescence microcopy to identify unique fibrin/amyloid micro-thrombosis and hyperactivated platelets in individuals with PASC. These fibrin/amyloid microclots may impede blood flow to tissue.Methods:Whole blood was collected in citrate tubes from 30 matched healthy subjects and 30 PASC subjects. Platelet poor plasma (PPP) was prepared by centrifugation and stored at -80 °C. PPP was then exposed to thioflavin T (ThT), a fluorescence marker known to bind to and open hydrophobic areas on damaged amyloidogenic protein. Samples were viewed with fluorescence microscopy using a 63x/1.4 Oil DIC M27 objective (excitation wavelength 450nm-488nm, emission 499nm- 529nm). After a double-trypsin PPP digestion method, proteomic analysis of the PPP samples was performed.Results:Significant microclot load was observed in the PPP of participants with PASC compared to healthy participants (Fig. 1). Proteomic analysis revealed the presence of inflammatory molecules within digested microclots.Conclusion:Preliminary results suggest that the presence of microclots in PPP may be used as a diagnostic biomarker for the PASC. Characterization of inflammatory molecules and antibodies trapped within microclots might provide insight into the pathogenesis of PASC and serve as a basis for novel treatment strategies or preventative medicine.Figure:Representative specimensA)Microclots in healthy plasma.B)Microclots in PASC plasma.

Circulation, Volume 146, Issue Suppl_1, Page A15628-A15628, November 8, 2022. Background:Acute myocardial infarction may concomitantly occur with acute ischemic stroke. The incidence,complications and outcomes of acute Non- ST elevation Myocardial infarction in acute ischemic stroke are not well studied.Methods:We examined hospitalized patients (n = 1,726,265) with acute ischemic stroke that were included in National Inpatient Sample 2016-2019. Acute ischemic stroke and NSTEMI were defined by using International classification of disease (ICD -10). STEMI patients were excluded. Multivariable logistic regression analysis was used to examine association of NSTEMI with outcomes. A subgroup analysis of NSTEMI patients that underwent PCI (with or without angioplasty) was also performed.Results:Of the total stroke patients, 27630 (1.6%) patients (mean age 73.5, 52.2% females) had NSTEMI diagnosed during the hospitalization. Of these, 3890 (6.32%) died in NSTEMI group and 57670 (93.68%) died in non NSTEMI group. The commonest complications in NSTEMI group were cardiogenic shock 25% , cardiac tamponade 13.8% , and septic shock 12.1%. NSTEMI in stroke patients were associated with several complications and mortality (OR 2.73, 95% CI 2.57-2.90, p value

Circulation, Volume 146, Issue Suppl_1, Page A9981-A9981, November 8, 2022. Introduction:Pulmonary embolism (PE) is a major cause of morbidity and mortality accounting for 100,000 deaths per year in the United States and 5-10% of in-hospital deaths. There is sparse comparative data on readmission patterns and healthcare costs in patients who undergo early versus late catheter directed thrombolysis (CDT) for acute PE.Hypothesis:Procedure Day for acute PE may be associated with difference in 30-day readmission rates and healthcare costs.Methods:This study was performed by using National readmission database between January 2016 and November 2019. Patients with acute PE who underwent CDT were identified using the International Classification of Diseases, Tenth Edition (ICD 10) codes. Patients who were

Circulation, Volume 146, Issue Suppl_1, Page A9885-A9885, November 8, 2022. Introduction:Atrial septal defect (ASD) is one of the most common congenital cardiac defects. It can also allow paradoxical emboli to move into the cerebral vasculature leading to Acute Ischemic Stroke (AIS). As there is a lack of adequate information on the additional risk factors for mortality in ASD patients following AIS, we queried the largest inpatient database in the United States for answers.Methods:Patients with ASD were identified among patients of ages 25 and more admitted with a principal diagnosis of AIS ICD-10 code (I63.x) in 2019 from the National Inpatient Sample(NIS). Various patient characteristics and procedures were also studied. A Multivariate regression model adjusting for several factors allowed our study to further evaluate potential risk factors for mortality among ASD patients.Results:Our study found 551,385 cases of AIS, amongst which 19,670 (3.6%) also had a diagnosis of ASD. ASD patients had a higher risk of requiring mechanical thrombectomy (aOR 1.239, 95% CI 1.167- 1.316, p

Circulation, Volume 146, Issue Suppl_1, Page A15415-A15415, November 8, 2022. Background:Use of the Impella 5.5 trans-valvular axial flow pump is increasing among patients with heart failure and cardiogenic shock (HF-CS) as a bridge to advanced therapies or myocardial recovery. The effect of trans-valvular left ventricular (LV) unloading on biventricular hemodynamics remains poorly understood.Methods:Seven patients with HF-CS underwent Impella 5.5 placement. A conductance catheter was placed first in the right ventricle (RV) then the LV to record pre-support pressure-volume loops. After insertion of the Impella 5.5, LV then RV loops were recorded within 15 minutes of device activation. Pulmonary artery catheter indices were recorded before and after Impella 5.5 activation.Results:Compared to baseline values, Impella 5.5 activation significantly decreased LV systolic and diastolic pressures as well as LV dP/dt(max) (Figure and Table). Impella 5.5 also significantly decreased right atrial, pulmonary (systolic/diastolic/mean) and RV diastolic pressures. Both LV and RV pressure-volume area and stroke work were not significantly changed with acute LV unloading.Conclusions:Trans-valvular unloading with an Impella 5.5 decreases biventricular filling pressures and reduces pulmonary pressures. These findings suggest that percutaneous LV unloading in patients with acute decompensated heart failure and cardiogenic shock may improve RV performance.

Circulation, Volume 146, Issue Suppl_1, Page A13636-A13636, November 8, 2022. Introduction:Postoperative acute kidney injury (AKI) is common after vascular surgery and is associated with increased morbidity and mortality.Hypothesis:It is hypothesized that patients with persistent postoperative AKI have increased complications, mortality and hospital cost.Methods:A single center retrospective cohort of patients undergoing non-emergent major vascular surgery (lower extremity bypass, endovascular and open aortic surgery), between 2014-2019 was analyzed. Development of postoperative AKI (defined as > 50% or 0.3 mg/dl increase in serum creatinine relative to reference after surgery and before discharge) was evaluated. Patients were divided into 3 groups: no AKI, non-persistent AKI (< 48 hours) and persistent AKI ( >48 hours). Multivariable regression analyses were then used to evaluate the association between AKI status and postoperative complications, 90-day mortality, and hospital cost.Results:A total of 1,881 patients undergoing 1,980 vascular procedures were included. Thirty five percent of patients developed postoperative AKI. Patients with persistent AKI were more likely to have longer ICU and hospital stays, as well as more mechanical ventilation days. In risk-adjusted logistic regression analysis, persistent AKI was a major predictor of 90-day mortality (OR 4.4, 95% CI 2.5-7.6). Risk-adjusted average cost was higher for patients with any type of AKI. The incremental cost of having any AKI ranged from $5,500-$12,400, even after adjustment for comorbidities and other postoperative complications. The risk-adjusted average cost for patients stratified by type of AKI was higher among patients with persistent AKI compared to those with no or non-persistent AKI (Fig.1).Conclusions:Persistent AKI after vascular surgery is associated with increased complications, mortality and cost. Strategies to prevent and aggressively treat AKI in the perioperative setting are imperative to optimize care for this population.

Circulation, Volume 146, Issue Suppl_1, Page A11880-A11880, November 8, 2022. Introduction:We evaluated differential contribution of the left atrial (LA) function by cardiovascular magnetic resonance (CMR) and left ventricular (LV) fibrosis to pulmonary arterial systolic pressure in hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) and reperfused acute myocardial infarction (AMI).Hypothesis:The differential role of the LA function and LV fibrosis indices for pulmonary pressure elevation would be different in various myocardial diseases and there would be a predictive value in addition to the conventional echocardiographic parameters.Methods:Data of 370 patients with HCM (n=133), DCM (n=114) and reperfused AMI (n=123) who underwent both echocardiography and CMR were comprehensively reviewed. Phasic LA volumes, LA-global longitudinal strain (GLS), LA stiffness index, defined as E/e’/LA-GLS and extracellular volume fraction (ECV) of LV were measured using CMR.Results:E/e’ was correlated with PASP in all groups; however, the predicted value was significantly attenuated after adjusting for LA volume and LA strain in HCM and DCM, but remained significant in AMI. The LA stiffness index was related to PASP in HCM (p=0.01) and DCM (p=0.03) independent of LA volume index and E/e’, but not in AMI. In DCM, ECV was significantly related to PASP (p

Circulation, Volume 146, Issue Suppl_1, Page A11098-A11098, November 8, 2022. Introduction:Severity of end-organ dysfunction correlates with outcomes in acute myocardial infarction-related cardiogenic shock (AMI-CS). The epidemiology of end-organ dysfunction in heart failure-related cardiogenic shock (HF-CS) has not been well described.Methods:Cardiac intensive care unit (CICU) admissions with CS in the Critical Care Cardiology Trials Network Registry (2017-2021) were identified and categorized as AMI-CS and HF-CS (de novoor acute-on-chronic HF). Admissions for each CS sub-type were characterized as having respiratory, kidney, liver, and/or neurologic dysfunction using definitions adapted from the Sequential Organ Failure Assessment score (Fig A). Outcomes were assessed by burden of non-cardiac organ dysfunction: no end-organ dysfunction (NEOD), single system end-organ dysfunction (SEOD), or multi-system end-organ dysfunction (MEOD).Results:A total of 2,911 CS admissions from 35 CICUs were identified, most of which were for HF-CS (71%, N = 2,068). The proportions of patients with NEOD, SEOD, and MEOD were 25%, 36%, 39% for HF-CS vs. 16%, 35%, 49% for AMI-CS (p

Circulation, Volume 146, Issue Suppl_1, Page A11306-A11306, November 8, 2022. Introduction:Adherence is often measured using proportion of days covered (PDC), where the single average PDC that is estimated conceals the heterogeneity of the adherence patterns, each of which may require unique solutions. Novel group-based trajectory methods allow one to distinguish subgroups of adherence patterns. We examined the magnitude of variation in PDC estimates in these subgroups.Methods:We conducted a retrospective cohort study of patients aged ≥65 years who had filled ticagrelor within 7 days post-ACS discharge in Ontario, Canada between 4/2014-3/2018. Longitudinal patterns of adherence were measured using group-based trajectory models over 1 year and compared with traditional adherence metrics using PDC for the entire cohort and for each trajectory group.Results:We identified 9,764 ticagrelor users (mean age 73.6; 65.4% men). Three distinct trajectory patterns of ticagrelor adherence were identified: a consistently adherent, a gradually nonadherent, and a rapidly nonadherent group, comprising 67.8%, 17.1% and 15.1% of the cohort, respectively. The 1-year mean PDC (±SD) was 80.8±29.2 for the whole ticagrelor post-ACS cohort. After differentiating by adherence trajectory group, mean PDC (±SD) was 97.4±4.5 % in the consistently adherent, while it was 69.1±15.6% and 20.2±11.6 over 1 year in the gradually and rapidly non-adherent trajectory groups, respectively.Conclusions:The overall ticagrelor adherence of ~80% 1-year post-ACS instills a false sense of comfort. The 3 distinct trajectory groups revealed divergent patterns not reflected by this overall mean estimate. The two-thirds of patients who were consistently adherent maintained nearly perfect ticagrelor adherence, while the rapidly non-adherent group only took ticagrelor on average for 2.5 months of the year. The trajectory method approach allows us to distinguish adherence subgroups, and better identify patients at risk of nonadherence who need targeted interventions.

Circulation, Volume 146, Issue Suppl_1, Page A227-A227, November 8, 2022. Introduction:Cardiac arrest (CA) survivors have significant impairments and poor functional outcomes at hospital discharge. We assessed if discharge disposition to acute inpatient rehabilitation after CA-related hospitalization is associated with improved functional recovery at 12 months relative to alternative acute care hospital discharge dispositions.Methods:Adults with the return of spontaneous circulation after in-hospital or out-of-hospital CA between 2/1/2016- 1/31/2020 admitted to intensive care units in a single tertiary care center were enrolled in an observational, prospective cohort study. A series of logistic regressions were used to assess acute inpatient rehabilitation associations with good functional recovery patterns, defined as persistent Modified Rankin Score (mRS) 0-2, or absence of any worsening of mRS at 12 months relative to discharge mRS. The model included demographics, individual and structural-level Social Determinants of Health, and pertinent clinical characteristics.Results:Of 201 included patients (24% Hispanic and 19% Black; average age 56±16 years; 40% women), 63% (n=127) reported good functional recovery pattern. Patients who went to acute inpatient rehabilitation were significantly more likely to experience good recovery pattern (54.3% vs 37.8% with poor recovery pattern, p