Risultati per: Short Acting Opioid

Circulation, Volume 148, Issue Suppl_1, Page A16368-A16368, November 6, 2023. Introduction:This case highlights opioid withdrawal-induced Takotsubo cardiomyopathy (TCM) in a patient with pre-existing hypertrophic cardiomyopathy (HCM) and discusses the concurrent management.Clinical Presentation:An 85-year-old female with HCM, depression, and chronic back pain presented with generalized weakness five days after opioid discontinuation. She exhibited elevated troponin levels and ST elevation in anteroseptal leads, concerning for STEMI. Coronary angiogram revealed nonobstructive coronary artery disease. Transthoracic echocardiogram revealed newly reduced EF 45%, hyperdynamic basal left ventricle, and akinetic mid-distal left ventricle, consistent with TCM. Notably, marked basal anteroseptum thickness and systolic anterior mitral valve motion with left ventricular outflow tract obstruction (LVOTO) and a peak gradient of 92 mmHg. Presentation was complicated by hypotension, pulmonary edema and cardiorenal syndrome. β-blocker use initially deferred, opting for phenylephrine and diuresis until stabilization permitted β-blocker introduction.Discussion:We present a unique case of TCM precipitated by opioid withdrawal in a patient with existing HCM. Standard critical care management for TCM involves hemodynamic support until cardiac function recovers, though the use of vasopressors and inotropes remains controversial. Importantly, this case demonstrates severe provoked LVOTO, mimicking acute myocardial ischemia. Recognizing such scenarios is vital, as inappropriate use of vasodilators or inotropes can be fatal. Class I-IIa recommendations endorse β-blockers and vasoconstrictors for severe provoked LVOTO with hypotension and pulmonary edema. Phenylephrine, a selective α-agonist, maintains LVOT turgidity through preload enhancement, while β-blockers facilitate ventricular filling and reduce LVOT pressure gradient. Further research is warranted as current evidence level remains class C.

Circulation, Volume 148, Issue Suppl_1, Page A17780-A17780, November 6, 2023. Introduction:The prevalence of in-hospital ACS has risen from 4% to 10% in Dakar cardiology departments over the past 15 years.Hypothesis:The aim of this study was to describe the epidemiological, clinical profile and short-term prognosis of patients with acute ST Segment Elevation Myocardial Infarction (STEMI) treated by percutaneous coronary intervention (PCI).Methods:This was a single-center descriptive study using prospective data collection from September 2020 to July 2022, including all patients with acute STEMI managed by PCI in with Hôpital Principal Dakar (HPD). The latter is the main military hospital of Senegal.Results:Among the 1146 patients admitted in HPD cardiology department, 156 (13.61%) had STEMI and 92 (58.97%) of them had undergone PCI. The mean age of the patients was 60.04 ± 11 years, with a male predominance (78.26%). Eighty-three patients (90.2%) were seen within the first 12 hours, with an average of 3.26 ± 3 hours. Regarding clinical presentation, almost all patients (98.9%) were in Killip I or II class. Seventy-eight patients (84.8%) had a diagnostic ECG within the first 12 hours of symptoms initiation, with a mean of 3.95 ± 2.95 hours. Thrombolysis was performed in 10.86% of the patients with a success rate of 70%. The radial approach predominated largely (89%) and primary PCI was performed in 71.73% of patients. Overall, PCI with stent implantation, exclusively drug eluting stent (DES), was done in 95.65% of cases with a success rate of 98.91%. Three non-fatal periprocedural complications were reported and in-hospital mortality rate was 4.34%.Conclusions:In Dakar, the prognosis of acute STEMI has been improved since the availability of PCI with routine primary PCI 24/7. However, the intervention delays need to be perfected.

Circulation, Volume 148, Issue Suppl_1, Page A12829-A12829, November 6, 2023. Introduction:Takotsubo syndrome (TTS) is a condition characterized by reversible left ventricular dysfunction with typical regional wall motion abnormalities. Although the presentation mimics acute coronary syndrome (ACS), its exact pathophysiology is not known. Despite the transient nature of cardiac dysfunction in TTS, the prognosis remained uncertain, with mortality rates reportedly comparable to that of ACS. The aim of this study was to compare the outcomes between patients with TS and ACS through a meta-analysis.Methods:We systematically searched various electronic databases including PubMed, Embase, and Cochrane Library to identify relevant studies. The outcomes were pooled using the Hartung-Knapp-Sidik-Jonkman random effects model, and the results were presented as odds ratio (OR) with their corresponding 95% confidence interval (CI).Results:11 studies with 3,455,862 (95,165 TTS and 3,360,697 ACS) patients were included in the final analysis. The risk of in-hospital mortality (OR, 0.61(95%CI: 0.42-0.89), P=0.01), 30-day mortality (OR, 0.62(95%CI: 0.48-0.81), P

Circulation, Volume 148, Issue Suppl_1, Page A15670-A15670, November 6, 2023. Background:Intramural coronary arteries (IMCA) are associated with worse outcomes following arterial switch operations (ASO), though data on the effect of IMCA on longer term coronary complications following ASO remains sparse.Hypothesis:IMCA increases the risk of coronary complications both short and long-term following ASO.Methods:A retrospective cohort study included 393 patients with available data following ASO at a tertiary center (1995-2020). IMCA and Yacoub types were recorded from operative reports. Coronary outcomes included mortality (n=7), coronary reintervention (n=6), abnormal perfusion on stress imaging (n=4) or left ventricular (LV) dysfunction (n=7). Demographic and surgical data was collected. Wilcoxon rank-sum test assessed differences in continuous variables. We performed univariable Cox proportional hazard (PH) regression to examine time-to-event during 4 periods: the entire study period, 1-year, 5-year, and 10-year post-op. Multivariable Cox PH using Schoenfeld residuals with backward elimination was performed for the entire cohort and 1-year post-op.Results:A total of 28/393 (7%) patients had IMCA. During a median follow-up of 10 years (4 – 17), 6% (n=24) had coronary complications. On univariable analyses, IMCA and Yacoub-B were associated with overall coronary complications. At 1-year, IMCA and Yacoub-C were predictive while higher operative weight and male sex were protective of outcomes. At 5- and 10-year post-op, IMCA remained predictive. On multivariate analysis, IMCA was an independent risk factor of coronary complications, hazard ratio of 11.09 (2.98-41.30), p

Circulation, Volume 148, Issue Suppl_1, Page A12085-A12085, November 6, 2023. Introduction:The use of the EHMRG model in the emergency department (ED) has been demonstrated to improve outcomes for patients presenting with acute heart failure (HF). It is unknown if the EHMRG model also correlates with healthcare costs, which has not been examined in other HF risk models.Hypothesis:We hypothesized that patients with higher EHMRG risk scores, i.e., sicker, would have higher costs of care in short-term (30-day) and longer-term (up to 2 year) time horizons.Methods:We examined direct costs of care from a health payer perspective using the original EHMRG derivation cohort of 11,857 patients hospitalized with acute HF in Ontario, Canada (from 2004) and linking to population-based case-costing databases. Costs were stratified by the quintiles of the EHMRG risk score (Q1 = lowest risk, Q5 = highest risk). Costs (in 2021 Canadian dollars) were categorized into hospital, physician, drug, home care, long term care (LTC), and other costs.Results:Patients in the lowest EHMRG risk quintile (Q1), compared to higher quintiles (Q2-Q5) had lower total cost of care in both the short-term ($8,113 vs $9,442, $10,557, $12,078 and $15,005, p

Circulation, Volume 148, Issue Suppl_1, Page A12622-A12622, November 6, 2023. Introduction:Central sleep apnea (CSA) is closely associated with poor prognosis in heart failure (HF) patients. Adaptive servo-ventilation (ASV) was expected as a new treatment for HF patients with CSA. However, the efficacy of ASV is controversial, especially the efficacy of long-term use has remained unclear.Methods:We retrospectively examined all HF patients with CSA treated with ASV seen between May 2008 and November 2022 in our hospital who had not been admitted to the hospital due to worsening HF in the 6 months before initiating ASV therapy. We divided them into 2 groups: (A) non-continues-ASV-treated patients; (B) continues-ASV-treated patients. The outcome was a composite of readmission due to worsening HF and all-cause mortality.Results:During a median follow-up of 10.3 years after leaving the hospital, 11 patients died out of 101 patients. Twenty-two patients (group A) could not continue to use ASV because of its discomfort. Seventy-nine patients (group B) could continue to use the ASV device at night after leaving the hospital over a long period. There were almost no significant differences in the baseline characteristics between the two groups. In group B, during 6-, 12-, and 24-month observations, left ventricular ejection fraction (46.4 +/- 17.9 to 47.1 +/- 15.6, 49.8 +/- 15.8, and 48.2+/- 18.9%, p

Circulation, Volume 148, Issue Suppl_1, Page A14338-A14338, November 6, 2023. Introduction:Congestive heart failure (CHF) and opioid use disorder (OUD) are leading contributors to healthcare utilization in the United States. Little is known about how OUD treatment impacts clinical outcomes in patients with both CHF and OUD. We examined the impact of medication assisted treatment (MAT—buprenorphine and methadone) on outcomes for patients diagnosed with OUD and CHF, and which MAT medication is associated with the fewest cardiac toxicities.Hypothesis:The use of MAT in patients with both CHF and OUD will improve clinical outcomes related to CHF including hospitalizations, emergency room (ER) visits, and mortality.Methods:A retrospective cohort study of patients 18 years or older diagnosed with both CHF and OUD was conducted using Optum’s de-identified Clinformatics® Data Mart Database. Using a multivariate logistic regression model, patients who were prescribed MAT were compared to those who were not. The primary outcomes were CHF hospitalizations, CHF ER visits, all-cause hospitalizations, and mortality.Results:No significant differences in the primary outcomes between the MAT and non-MAT cohorts were observed. A subgroup analysis demonstrated that buprenorphine had a lower risk of mortality compared to methadone (HR 0.72, 95% CI 0.52-1.00, p=0.0482).Conclusions:No significant differences in CHF hospitalizations, CHF ER visits, and all-cause hospitalizations were observed between the MAT and non-MAT cohorts. Buprenorphine was associated with a lower risk of mortality when compared to methadone.

Circulation, Volume 148, Issue Suppl_1, Page A16217-A16217, November 6, 2023. Background:The clinical profile and short-term prognosis of patients with cardiogenic shock (CS) secondary to myocarditis remains poorly defined.Methods:All patients admitted to Cleveland Clinic Cardiac Intensive Care Unit (CICU) between Jan 1st, 2010, to Dec 31st, 2021, with a diagnosis of cardiogenic shock (CS) were retrospectively identified through electronic medical records. Patients were further categorized into those with CS secondary to myocarditis (myocarditis-CS) or other etiologies (non-myocarditis-CS). Only patients with confirmed myocarditis with an endomyocardial biopsy or cardiac MRI were included. Descriptive characteristics and short-term outcomes of this group were explored.Results:A total of 2775 patients were admitted to our CICU with CS of which, 26 patients (1%) had CS secondary to confirmed myocarditis. Compared to patients with non-myocarditis CS, patients with myocarditis-CS were significantly younger (median age of 49 vs 65, p

Circulation, Volume 148, Issue Suppl_1, Page A15043-A15043, November 6, 2023. Background:Anthracyclines are an effective and widely used chemotherapy agent in the treatment of multiple solid organ tumors and hematologic malignancies. The use of anthracyclines as a standard cancer therapy is limited by the potential for the development of cardiac dysfunction, arrhythmias, and clinical heart failure. In recent five years, it was demonstrated that proprotein convertase subtilisin/kexin type 9 (PCSK9), a lipid metabolism-related protein, is a key orchestrator of immune infiltration in myocardial and cancer tissues and could regulate cardiac fibrosis and inflammation. PCSK9 is a protein with key roles in hepatic low density lipoprotein (LDL) homeostasis. PCSK9 systemic levels are associated to HOMA score and high insulin levels. Dapagliflozin exerts systemic ant-inflammatory properties and cardioprotective effects in diabetic and non-diabetic patients.Purpose:We hypothesized that Dapagliflozin, administered during doxorubicin, could reduce PCSK9 systemic levels in preclinical models.Methods:Female C57Bl/6 mice were untreated (Sham, n=6) or treated for 10 days with doxorubicin i.p at 2.17 mg/kg (DOXO, n=6), DAPA at 12 mg/kg (DAPA, n=6) or doxorubicin combined to DAPA (DOXO-DAPA, n=6). After treatments, plasma levels of PCSK9, IL-1β and CRP were analyzed through selective anti-mouse ELISA methods. Myocardial and liver expression of NLRP3-inflammasome and IL-1β were analyzed through ELISA method in tissue lysates after treatments.Results:DAPA associated to DOXO reduces significantly systemic levels of PCSK9 ( -37,5% vs DOXO group, p

Circulation, Volume 148, Issue Suppl_1, Page A16254-A16254, November 6, 2023. Background:The characteristics and outcomes of patients with cardiac amyloidosis who present in cardiogenic shock (CS) remains poorly defined.Methods:All patients admitted to Cleveland Clinic Cardiac Intensive Care Unit (CICU) between Jan 1st, 2010, to Dec 31st, 2021, with a diagnosis of cardiogenic shock (CS) were retrospectively identified through electronic medical records and confirmed via physician chart review. Patients were further categorized into those with CS with cardiac amyloidosis (C-Amyloid) and CS without cardiac amyloidosis. 30-day and 1-year all-cause mortality was compared between the two groups with Kaplan-Meier (KM) estimates.Results:During the study period, a total of 2775 were patients were admitted to our CICU with CS of which, 29 patients (1%) had confirmed cardiac amyloidosis (C-amyloid). Amongst patients with CS and c-amyloid, 18 patients (62%) had TTR amyloid, 8 (28%) had AL amyloid and 3 were undefined. Compared to patients with other forms of CS, patients with C-amyloid were significantly older (median age of 70 vs 65, p=0.024), had lower prevalence of prior myocardial infarction (21% vs 42%, p=0.037) or coronary artery bypass grafting, and a higher prevalence of chronic kidney disease (69% vs 39%, p=0.002). There were no significant differences in the utilization of right heart catheterization, mechanical circulatory support or mechanical ventilation between the two groups. Comparison of survival probabilities revealed that CS patients with amyloid had similar 30-day (17% vs 21%, p=0.56) and 1-year all-cause mortality (38% vs 31%, p=0.6).Conclusion:Amyloid cardiomyopathy is a rare but unique etiology of CS in the CICU. Observed mortality rates are similar to patients with other forms of CS. Given breakthroughs in therapeutics for this condition, the proportion of patients with this clinical entity is expected to rise.

Circulation, Volume 148, Issue Suppl_1, Page A13295-A13295, November 6, 2023. Background:Air pollution is increasingly recognized as an environmental risk factor for mental health. However, data regarding the short-term influence on depressive symptoms are limited. It is known that depressed patients (pts) tend to be less adherent to prescribed medical regimens, including appointments. Therefore, we sought to determine how depression during times of increased particulate matter (PM2.5) and ozone during winter inversion (Nov-Mar) and wildfire seasons (June-Oct) affected pt behavior of attending clinic visit appointments.Methods:Pts (n=142,930) who completed a PHQ-9 as an outpatient between Mar 2003-Apr 2022 and resided on Utah’s Wasatch Front were studied. PHQ-9 results were used to classify depression by no depressive symptoms (10), with further stratification into severe ( >20). A case-crossover design was used with odd ratios computed by Poisson regression.Results:A total of 43% (n=60,724) of pts had depressive symptoms, with 25% (n=15,278) being severe. Depressed pts were younger (37 vs. 45 yrs), female (62% vs. 56%), more often smoked (24% vs. 17%), and had fewer comorbidities. The likelihood of attending clinic visits was decreased when the moving average (mAvg) of PM2.5was increased in the 2 days and week prior among those with depression, particularly when severe (Figure a). Levels of PM2.5on lag day 0 did not affect visit attendance. Increases in ozone were associated with a decrease in clinic attendance (Figure b). Air pollution levels >7 to 28 days prior were not associated with clinic attendance.Conclusion:Short-term increases in air pollution, particularly in average PM2.5during inversion season, in the days and week prior were associated with a decrease in attending clinic visit appointments among depressed pts. These results could have healthcare delivery implications since people with depression were less likely to show up to non-emergent medical visits when the air has been polluted.

Circulation, Volume 148, Issue Suppl_1, Page A13012-A13012, November 6, 2023. Introduction:Patients with end-stage renal disease (ESRD) are predisposed to multiple complications following invasive and non-invasive procedures. With the recent introduction of percutaneous mitral valve repair (PMVR), there needs to be more data on ESRD patients’ outcomes following such procedures. Our analysis aims to bridge data via national hospitalization records.Methods:We used de-identified data of adults(ages 18 and more) undergoing PMVR between 2016-2020 via the National Inpatient Sample. Patients were separated into two groups based on the presence of a diagnosis of ESRD. We excluded all other forms of Chronic kidney disease classifications from our control group. Differences in outcomes were studied via logistic regression models.Results:Between 2016-2020, a total of 24680 procedures of PMVR were performed in the United States that met our selection criteria. Among them, 1655 (6.7%) patients were reported with a diagnosis of ESRD, while 23025 (93.3%) were without any diagnosis of CKD or ESRD. Patients with ESRD consisted of a younger cohort (mean age 68.68 years) compared to the non-ESRD group (mean age 77.39 years, p

Circulation, Volume 148, Issue Suppl_1, Page A13569-A13569, November 6, 2023. Introduction:Heart failure (HF) poses a global health burden, with about 26 million people affected and an estimated health expenditure of US$31 billion worldwide . The outcome of HF patients with reduced ejection fraction (HFrEF) has improved significantly due to the availability of evidence-based therapies. Still, the readmission rates, and subsequent mortality, have remained unchanged in the last two decades. Despite immense positive evidence, < 25% of patients with HFrEF are on the appropriate target doses of medical therapy.Objectives:Impact of intense versus routine outpatient follow-up on clinical outcomes and patient satisfaction in Acute decompensated heart failure (ADHF) patients over a 3-month follow-up.METHODS: This is a prospective open-label randomized study analyzing readmission rates and achieving target doses of GDMT.Results:A total of 226 subjects (Intense smartphone application-based follow-up -112) (routine outpatient follow-up -114) were enrolled in the study. The mean age was 53 and 54 years in intense follow-up and routine follow up, respectively. Both study arms were well-matched and randomized. There was a significant reduction in rehospitalization rate in the intense follow-up arm (28 vs. 57) p - 0.005. Subjects on smartphone application-based follow-up had better drug compliance and a rapid escalation of GDMT to reach target doses.Number of patients on target dose of GDMT at three monthsConclusion:Intense smartphone application based follow-up was feasible and safe for ADHF patients. The incidence of 30-day and three months readmissions improved. They also showed improved BP, HR, and NT Pro-BNP levels. Drug dosages were up-titrated periodically in these subsets of patients based on their cardiac function and laboratory parameters. Newer apps should be designed to incorporate artificial intelligence (AI) with features more likely to improve key patient-reported and clinical outcomes.

Circulation, Volume 148, Issue Suppl_1, Page A15300-A15300, November 6, 2023. Introduction and Hypothesis:Percutaneous coronary intervention (PCI) has tended to be selected for the treatment of acute coronary syndrome with cardiogenic shock because of its ability of earlier and less-invasive therapy, though coronary artery bypass grafting (CABG) can perform complete revascularization. We hypothesized that Impella® support has the potential to make surgical treatment much safer because Impella® can improve hemodynamic state and could have the possibility to mitigate myocardial ischemia by unloading the left ventricle.Methods:The aim of study is to investigate if surgical revascularization is safe and effective treatment by comparing short-term outcome with different revascularization including PCI, CABG, and hybrid therapy (PCI followed by CABG). Of 1102 cardiogenic shock cases with Impella (994 cases in PCI, 48 cases in CABG, and 63 cases in Hybrid therapy) between February 2020 and December 2021 enrolled in the J-PVAD registry, short-term outcomes were compared between 62 propensity-matched cases between PCI (n=31) and CABG (n=31), as well as 68 matched cases between PCI (n=34) and hybrid therapy (n=34).Results:There was no difference in all-cause mortality between the PCI and CABG group as well as PCI and hybrid therapy group. The PCI group had a greater number of NYHA class≦2 at discharge than the CABG group (17 (54.8%) in the PCI group vs 10 (32.2%) in the CABG group, p=0.012). There was no difference in the number of NYHA class≦2 at discharge between the PCI and hybrid therapy group (18 (52.9%) in the PCI group vs 15 (44.1%) in the hybrid therapy group, p=0.12).Conclusions:CABG and hybrid therapy showed acceptable short-term outcome compared to PCI.

Circulation, Volume 148, Issue Suppl_1, Page A391-A391, November 6, 2023. Background:The optimal timing of epinephrine administration after defibrillation in out-of-hospital cardiac arrest (OHCA) patients with shockable rhythm is unknown.Aim:We evaluated the association between defibrillation to epinephrine interval and short-term outcomes.Methods:Between 2011 and 2020, we enrolled 1,259,960 OHCA patients from a nationwide prospective population-based registry in Japan. After applying exclusion criteria, 20,905 patients with shockable rhythm as the first documented rhythm at emergency medical services (EMS) arrival who received epinephrine after defibrillation were eligible for the study. Clinical outcomes included prehospital return of spontaneous circulation (ROSC), survival, and favorable neurological outcome at 30 days. To examine whether each variable predicted a good short-term outcome, multivariable logistic regression models were constructed using age, gender, year, district, origin of cardiac arrest, witnessed arrest, bystander-initiated cardiopulmonary resuscitation, call to EMS arrival interval, EMS arrival to defibrillation interval, and defibrillation to epinephrine interval.Results:At 30 days, 1,618 patients (8%) had a favorable neurological outcome. The defibrillation to epinephrine interval in these patients was significantly shorter than the interval in patients with an unfavorable neurological outcome [8 (5-12) vs 11 (7-16) min; P

Circulation, Volume 148, Issue Suppl_1, Page A16616-A16616, November 6, 2023. Introduction:Short-term variability of repolarization (STV) increases prior to ventricular arrhythmias (VA) both in humans and in animal models of VA, and is therefore a promising tool for real-time monitoring of arrhythmic risk. To integrate this concept in cardiac devices, a method to automatically determine STV on intracardiac electrograms (EGM) was developed. This STV algorithm demonstrated high efficacy in predicting life-threatening VA in animal studies, but still needs to be evaluated on human signals.Objective:To assess the performance of the novel automatic method of STV measurement on human EGMs during sinus rhythm (SR) and pacing.Methods:ECG and EGM signals with a 1 kHz sampling frequency were recorded in 14 dual chamber implantable cardioverter-defibrillator (ICD) patients during implantation (n=4) or replacement (n=10) procedures. Recordings were obtained in SR, atrial pacing at 80 beats per minute (AAI80) and atrioventricular pacing at the same frequency (DDD80). STV was calculated over 31 consecutive beats as Σ