Search Results for: Linee Guida per le cure post-parto

Circulation, Volume 150, Issue Suppl_1, Page A4148154-A4148154, November 12, 2024. Background:The AngioVac mechanical aspiration system has recently emerged in the literature for its use in the percutaneous debulking of intracardiac vegetations and masses. However, description of gender-related outcomes and analysis has remained sparse. We present our unique experience with the AngioVac system in men compared to women with tricuspid valve infective endocarditis (TVIE) and high or prohibitive operative risk.Methods:We performed a retrospective, in-hospital analysis comparing all men and women who underwent percutaneous AngioVac vegetation debulking in the setting of TVIE from January 2017 to December 2023 at a large academic tertiary care hospital.Results:Of the 62 patients who underwent AngioVac debulking between January 2017 and December 2023, 32 (51.6%) were women with a mean age of 35.921 +/- 9.976 years. The mean length of the vegetation was 19.581 +/- 7.478 mm and time (days) to blood culture clearance was 8.667 +/- 7.799. Of the 62 patients, 30 (48.4%) were men with a mean age of 41.711 +/- 13.627 years. The mean length of the vegetation was 21.759 +/- 7.836 mm, and time (days) to blood culture clearance was 6.188 +/- 3.692. During their index admission, between both men and women, there was no difference in time (days) from procedure to blood culture clearance (P-value: 0.239, 95% CI: -6.717 – 1.758). There was no difference in the risk of stroke (P-value 0.489, 95% CI: 0.00 – 5.852), systemic embolism (P-value: 0.577, 95% CI: 0.124 – 164.863), vascular access bleeding (OR: 0.966, 95% CI: 0.011 – 78.416), or blood transfusion requirement (P-value 0.799, 95% CI: 0.270 – 2.622). There was no difference in risk of recurrent endocarditis (P-value: 0.712, 95% CI: 0.265 – 9.147) or worsening tricuspid regurgitation post-procedure (P-value: 0.470, 95% CI: 0.075 – 3.113). Finally, there was no difference in the length of hospital stay (days) between both groups (P-value: 0.990, 95% CI: -11.748 – 11.605), and there was no difference in in-hospital mortality post-procedure (P-value: 0.354, 95% CI: 0.384 – 218.472). Notably, neither of the two groups required surgical or percutaneous tricuspid valve replacement.Conclusion:This retrospective, comparative analysis adds to the growing literature that Angiovac debulking may be a safe and effective long-term alternative to cardiac surgery in both men and women with TVIE and elevated perioperative risk.

Circulation, Volume 150, Issue Suppl_1, Page A4134796-A4134796, November 12, 2024. Introduction:Over 6 million patients (pts) present to US emergency departments annually with chest pain (CP), of which the majority are found to have no serious disease. Evaluation of these pts results in substantial costs for unnecessary hospitalization and extensive testing. We evaluated the utility of early discharge of selected low-risk (LR) CP pts from a chest pain unit (CPU) in which no predischarge testing or risk scores were used.Methods:This retrospective study analyzed 1,037 consecutive LR CP pts from a prospectively recorded database. LR was based on normal examination, stable hemodynamics, normal electrocardiograms (ECG), and negative cardiac troponin I, without pre-discharge functional or anatomic cardiac testing or risk scores. We assessed demographics, comorbidities, medications, and major cardiac events at 30 d and 6 mos post-discharge.Results:The study group of 1037 pts comprised 26% of the 4010 pts admitted to the CPU during the study interval from May 2005 to March 2015. Mean patient age was 55 yrs, 56% (n=575) were women, and comorbid conditions were frequent: hypertension (64.1%), dyslipidemia (46.1%), diabetes (25.7%), documented coronary artery disease (19.3%), previous revascularization (20.6%), previous myocardial infarction (10.1%). Length of stay (LOS) in the CPU to discharge was 10.4 hrs. Women received more discharge cardiac medications than men: antiplatelet agents, statins, beta blockers, ACE inhibitors, angiotensin II blockers, calcium channel blockers, and nitrates (p=0.0002 – 0.04).Follow-up (F/U) at 30 d was 91% (n=948) complete and revealed 0.3% (n=3) cardiac deaths, 0.6% (n=6) acute coronary syndromes (ACS), and 6.2% (n= 64) receiving revascularization. F/U at 6 mos was 90% (n=936) complete and total cumulative cardiac deaths were 0.9% (n=9), 0.7% (n=7) ACS and 6.3% (n=65) revascularization.Discussion:Cardiac events at both 30 d and 6 mos were very low and did not differ in men and women (P=0.8). LOS in CPU was minimized and patient safety was maintained. These selected LR pts remained at reduced risk for cardiac events despite a high rate of comorbidities. Early discharge of selected LR CP pts based on history, examination, ECG, and biomarker evaluation was safe and effective.Conclusion:This approach in selected LR pts has the potential to reduce unnecessary diagnostic testing and CPU LOS. This strategy could lead to substantial savings in healthcare costs without compromising patient safety.

Circulation, Volume 150, Issue Suppl_1, Page A4135531-A4135531, November 12, 2024. Introduction:Mitochondrial abnormalities are a characteristic of heart failure leading to energy deprivation and disease worsening. The mitochondrial deubiquitinating enzyme USP30, removes ubiquitin and represses PINK1/PARKIN-mediated mitophagy leading to accumulation of dysfunctional mitochondria. In this study we investigated the role of MTX652, a clinical stage USP30 inhibitor, in a mouse model of cardiac hypertrophy using transverse aortic constriction (TAC).Hypothesis:Inhibition of USP30 will promote mitophagy resulting in clearance of dysfunctional mitochondria and improved cellular health leading to cardioprotective effects.Aims:To determine if MTX652 can protect from TAC induced cardiac hypertrophy and remodelling.Methods:Male C57BL/6 mice, 8 weeks old, were subjected to sham surgeries or TAC using a 26G needle to induce cardiac pressure overload. MTX652 (1.5 or 5 mg/kg,n=12-13) or vehicle (n=11) was administered orally, twice daily, starting 2 days post-surgery. Captopril (30 mg/kg/d,n=13) was also included as a positive control. After 4 weeks, echocardiography assessed left ventricle (LV) function and morphology. Cell based assays assessed MTX652 target engagement and TOM20 ubiquitinationin vitro.Results:LV hypertrophy and wall thickening was observed in TAC animals. Treatment with MTX652 decreased systolic LV volume (1.5 mg/kg p

Circulation, Volume 150, Issue Suppl_1, Page A4142700-A4142700, November 12, 2024. Background:New onset left bundle branch block (LBBB) is the most common complication following transcatheter aortic valve replacement (TAVR), occurring in up to 35% of cases. Previous case studies have shown that in some patients with new onset LBBB, the QRS duration is positively correlated with the preceding RR interval. This unique phenomenon, known as inverse decremental conduction (IDC) or Yan conduction, prompted us to investigate its clinical features and implications.Methods:We reviewed 12-lead ECGs and available in-patient telemetry for patients with new onset LBBB within 14 days following any types of cardiac surgery from 2018 to 2023 at two medical centers. Patients with ≥3 different degrees of LBBB in response to different preceding RR on 12-lead ECGs or on telemetry were included in the analysis.Results:A total of 22 patients (19 males) with a mean age of 75±8 years were identified to exhibit varying degrees of LBBB, with QRS duration that was positively correlated to the preceding RR interval within a certain range of heart rates. Among these patients, 17 had undergone TAVR, while the remaining 5 underwent surgical aortic valve replacement (AVR) and/or mitral valve replacement. 13 of the 22 patients were in sinus rhythm with premature atrial beats or sinus arrhythmias, while the remaining 9 patients were in atrial fibrillation.Figure 1shows the typical manifestations ofIDCin the left bundle on ECG in a patient post TAVR, with a positive correlation between QRS duration and the preceding RR (r = 0.87, p < 0.01).IDCin the left bundle in patients with new-onset LBBB occurred within three days following cardiac surgeries in 20 of the 22 patients, while the remaining 2 patients exhibitedIDCin the left bundle > 7 days after the surgeries.IDCin the left bundle is a temporary phenomenon, commonly lasting

Circulation, Volume 150, Issue Suppl_1, Page A4140310-A4140310, November 12, 2024. Introduction:Acute myocardial infarction (MI) induces splenic remodeling and rapid mobilization of immune cells from the spleen to the injured myocardium. Activation of this “cardio-splenic” axis contributes to adverse cardiac remodeling and the development of chronic heart failure. B cells account for the majority of splenic immune cells, but their potential role within the cardio-splenic axis of heart failure remains incompletely explored. In this study, we provide evidence indicating that B cells play an essential role within the cardio-splenic axis via MHC II-mediated antigen presentation.Methods and Results:MI was induced in mice via permanent ligation of the left anterior descending coronary artery. Four weeks following MI or sham surgery, splenic B cells were isolated and transferred into healthy wild-type mice. Eight weeks after adoptive transfer, we assessed cardiac remodeling of recipient mice using echocardiography, gravimetric analysis, and histology. We found that the adoptive transfer of splenic B cells from post-MI mice was sufficient to induce adverse cardiac remodeling in recipient mice (Figure 1). Adoptively transferred splenic B cells were identified in the blood, spleen, and heart of recipient mice 8 weeks post-adoptive transfer. Single cell RNA sequencing (scRNAseq) of splenic B cells was then performed in mice following MI. Biological pathway analyses revealed dysregulation of signaling pathways related to antigen processing and presentation in post-MI mice, suggesting splenic B cells were modulating adverse cardiac remodeling via major histocompatibility complex class II (MHC II)-mediated antigen presentation (Figure 2). Therefore, we developed transgenic mice with B cell-specific MHC II deletion and repeated our adoptive transfer studies. The adoptive transfer of splenic B cells deficient in MHC II from post-MI mice did not induce adverse cardiac remodeling in naïve recipients (Figure 3). Transcriptomic analyses of peripheral blood B cells were also performed in post-MI human patients and healthy control patients, and showed similar dysregulation of antigen processing and presentation in B cells in both acute and chronic phases of MI.Conclusions:Following MI, splenic B cells recirculate along the cardio-splenic axis and contribute to adverse cardiac remodeling via MHC II-mediated antigen presentation. Our results thus point towards MHC II-mediated signaling in B cells as a novel and specific therapeutic target in heart failure.

Circulation, Volume 150, Issue Suppl_1, Page A4140419-A4140419, November 12, 2024. Cardiac fibrosis is a pathological hallmark of almost all forms of heart disease, characterized by excessive deposition of extracellular matrix (ECM) proteins by activated fibroblasts, leading to cardiomyocyte hypertrophy, arrhythmias, and heart failure. Current treatments, predominantly pharmacological, target signaling pathways involved in fibroblast activation but often come with side effects such as cardiac toxicities. There is a critical need for therapies that specifically target activated cardiac fibroblasts to mitigate these adverse effects.Recent advances have shown that chimeric antigen receptor (CAR)-T cells targeting fibroblast activation protein (FAP), expressed by activated fibroblasts, can significantly reduce fibrosis and improve cardiac function in mouse models. However, CAR-T cell therapies face challenges such as the requirement for large quantities of healthy primary immune cells, lengthy process, and the high cost of personalized treatments. To address these issues, we propose an innovative strategy using off-the-shelf CAR-neutrophils derived from human pluripotent stem cells (hPSCs).We hypothesize that hPSC-derived CAR-neutrophils engineered to target FAP will effectively reduce cardiac fibrosis and improve cardiac function post-injury due to their potent cytotoxic effects and ability to infiltrate infarct regions. To test this hypothesis, anti-FAP CAR hPSCs were generated by CRISPR/Cas9 genome editing and differentiated into neutrophils. The differentiated anti-FAP CAR hPSC-neutrophils exhibited molecular characteristics comparable to unmodified hPSC-neutrophils. We also established an in vitro cardiac fibrosis model utilizing a previously reported protocol for the generation of hPSC-derived epicardial fibroblasts. Importantly, our anti-FAP hPSC-neutrophils exhibited significant cytotoxicity against activated epicardial fibroblasts, while unmodified hPSC-neutrophils showed no/minimal killing efficiency.This study suggests a proof-of-concept therapeutic approach against cardiac fibrosis utilizing FAP-targeting CAR-neutrophils. This strategy can potentially be adapted to treat fibrosis in other organs, thereby having a broad and significant impact on the treatment of various fibrotic diseases, ultimately contributing to longer, healthier human lives.

Circulation, Volume 150, Issue Suppl_1, Page A4145167-A4145167, November 12, 2024. Background:Cardiogenic shock (CS) and cardiac arrest (CA) are serious complications in ST-elevation myocardial infarction (STEMI) patients, with lack of long-term data according to their timing of occurrence.Objective:This study sought to determine the incidence and the relationship between timing of occurrence and prognostic impact of CS and CA following STEMI in the long-term follow-up.Methods:We conducted a retrospective analysis of consecutive STEMI patients treated from 2004 to 2017. Patients were divided into four groups based on the occurrence of neither CA nor CS, CA only, CS only, and both CA and CS (CA-CS-, CA+, CS+ and CA+CS+, respectively). Adjusted Cox regression analysis was used to assess the independent association between the CS and CA categories and mortality. The timing of their occurrence was evaluated according to initial cardiac catheterization as pre-, during- or post-procedure.Results:A total of 1,603 STEMI patients were followed for a median of 3.6 years. CA and CS occurred in the 12.2% and 15.9% of patients, and both impacted long-term mortality [adjusted HR 2.59 (95%CI 1.53-4.41), p

Circulation, Volume 150, Issue Suppl_1, Page A4117180-A4117180, November 12, 2024. Introduction:Patients receiving renin-angiotensin-aldosterone system inhibitors (RAASi) are at increased risk of developing hyperkalemia (HK). Sodium zirconium cyclosilicate (SZC) is used to treat HK, but the impact of duration of SZC on healthcare resource utilization (HRU) in RAASi users is unknown. The GALVANIZE Outcome study compared HK-related HRU among RAASi users between long-term and short-term SZC users.Methods:Adults with ≥1 outpatient prescription for SZC (index date) and ≥1 RAASi prescription spanning the index date were identified from a large US insurance claims database (7/2018-12/2022) and were stratified based on duration of SZC use. Long-term SZC users ( >90 days) and short-term SZC users (≤30 days) were exactly and propensity score matched on key baseline characteristics. Rates of HK-related hospitalizations or emergency department (ED) visits, HK-related ED visits, and HK-related hospitalizations were compared during follow-up from index to the earliest of 6 months post-index, end of data availability, other potassium binder use, or re-initiation of SZC post-discontinuation.Results:Among 1,586 matched pairs, the mean age was 65.5 years, 41.0% of patients were female, and most patients had any stage chronic kidney disease (91.9%), hypertension (90.8%), and diabetes (73.4%). Also, 30.0% of patients had heart failure. The most used RAASi therapies at index were angiotensin-converting enzyme inhibitors (57.3%) and angiotensin-receptor blockers (56.3%). Patients with long-term SZC use had a 44% lower rate of HK-related hospitalizations or ED visits, a 41% lower rate of HK-related hospitalizations and a 52% lower rate of HK-related ED visits than patients with short-term SZC use during follow-up (all p

Circulation, Volume 150, Issue Suppl_1, Page A4142032-A4142032, November 12, 2024. Introduction:. The hospital discharge process is non-standardized and contributes to post-discharge adverse events, re-hospitalization and high cost. To address this, we developed the Re-Engineered Discharge (RED) program designed to provide high quality discharge education, shown to lower readmission rates and improve patient satisfaction. Integrating digital technologies could facilitate its implementation into hospital workflow.Methods:We designed “MayaRED”, a digital conversational agent that simulates face-to-face human interactions through personalized, conversational dialogue to deliver discharge education. MayaRED employs the “teach-back” method to document patient understanding. Upon completion, a report documents what was taught by MayaRED and understood by the patient. Participants were asked to complete a survey regarding their perceptions of the acceptability and usefulness of MayaRED. Participants were matched to controls subjects to evaluate the comparative effectiveness.Results:HF patients (N=18) using MayaRED averaged 69 years, 13,003 pg/ml pro-BNP, 42% ejection fraction and 3 mg/dl creatinine were compared to 17 matched controls. On a 1 to 7 point Likert scale (1=strongly disagree; 7=strongly agree), patients using MayaRED reported that they had “their questions answered” (mean 6.47 vs. 4.76; P

Circulation, Volume 150, Issue Suppl_1, Page A4142875-A4142875, November 12, 2024. Background:Cardiovascular diseases, the leading cause of mortality with 17.9 million deaths annually (WHO), often necessitate heart transplants for end-stage organ failure. However, donor heart demand far exceeds supply. Traditional organ preservation methods like static cold storage (SCS) offer a limited 4-6 hour window, while machine perfusion (MP) extends this by circulating an oxygen-rich solution but faces challenges with nutrient depletion and metabolic imbalances. Our “partial freezing” method offers a novel approach to organ preservation using cryoprotectants (CPAs), by achieving a stable frozen state while maintaining an unfrozen fraction to limit ice damage and dehydrationHypothesis:Partial freezing (PF) method can effectively extend the storage duration of rodent hearts while maintaining their viability and function.Methods:The PF of the heart entails six major steps: (1) Procuring hearts (N=3) from adult male Lewis rats (2) Preloading of CPAs (DMSO, glycerol, raffinose, mannitol, and proline) during hypothermic Langendorff mode perfusion for 30 min (3) Freezing the hearts at a controlled rate of 0.3°C/min to -6°C (4) Storage at -6°C for 18 hours (5) Gradual thawing and unloading of CPAs (6) Recovery of hearts during NMP (normothermic machine perfusion) with antioxidant-supplemented Tyrode solution, followed by viability assessment using metabolic, hemodynamic, and molecular parameters. Two control groups were also included in the study: (1) Fresh hearts (N=3) functionally recovered in Tyrode solution, and (2) SCS hearts (N=3), perfused with cold University of Wisconsin (UW) solution and stored in the UW solution for 18 hours at 4°C, then recovered in same solution as the PF hearts.Results:NMP assessments revealed promising outcomes for PF hearts, with histology, TTC (Triphenyltetrazolium chloride) and Connexin-43 immunostaining profiles comparable to fresh controls and superior to SCS hearts. Although PF hearts exhibited lower beating rates, they demonstrated comparable metabolic parameters (lactate and oxygen consumption) and tissue edema compared to fresh controls, indicating preserved cardiac performance post-recovery.Conclusion:Our study shows the potential of the PF method to extend storage to 18 hours while maintaining viability and molecular function similar to fresh controls and superior to SCS hearts. This exploratory study suggests PF as a promising method to extend heart preservation times, addressing current limitations.

Circulation, Volume 150, Issue Suppl_1, Page A4138268-A4138268, November 12, 2024. Background:Treatment of left ventricular outflow tract (LVOT) obstruction involves a combination of negative inotropic agents. However, these therapies have limitations which may result in insufficient control of symptoms, leading to more invasive options such as surgical septal myectomy or septal alcohol ablation. Mavacamten, a cardiac myosin inhibitor, is currently approved for the treatment of patients with symptomatic obstructive hypertrophic cardiomyopathy (HCM). We present a case of a patient treated with mavacamten in addition to β-blockers (BB) for management of post-TAVR LVOT obstruction.Case:A 76 year old female with a past medical history of hypertension, severe aortic stenosis, and coronary artery disease underwent a Medtronic Evolut TAVR in March 2022. Her TTE post TAVR showed LVOT peak gradient greater than 100 mm Hg, LVEF 75% and severe eccentric mitral regurgitation secondary to systolic anterior motion (SAM) of the mitral valve (MV). After multidisciplinary discussion, the patient was discharged on maximally tolerated BB therapy. Follow up TTE showed persistent obstruction and gradients, so diltiazem was added to her regimen. Her subsequent TTE showed a peak LVOT > 100 mmHg at rest, and severe MR. Given persistent findings, she was started on mavacamten, continued on metoprolol, and tapered off of diltiazem. Her TTE two months after initiation of mavacamten revealed resolution of LVOT gradients, reduction of MR to mild and normal LV and TAVR function. She tolerated the therapy well and endorsed ongoing symptomatic improvement on subsequent follow up.Discussion:With the increasing use of TAVR therapy, there has been a corresponding rise in cases of post-TAVR obstruction that must be managed. As demonstrated by this case, management with BB therapy alone may be suboptimal. Although mavacamten is currently approved in patients with HCM, the obstruction in post-TAVR patients is functionally similar. Thus, this medication was trialed as a supplemental treatment in this patient and yielded positive results. This case highlights the potential benefit of extending use of mavacamten alongside β-blocker therapy for this patient population and suggests the need for future studies.

Circulation, Volume 150, Issue Suppl_1, Page A4141547-A4141547, November 12, 2024. Introduction:Branched chain amino acids (BCAAs) are essential amino acids that are elevated in the failing heart and that have been linked with cardiovascular disease risk. Yet, it remains unclear how BCAAs influence the heart after injury. In this study, we examined in mice whether dietary alterations of BCAA levels influences cardiac structure and function after myocardial infarction (MI).Methods and Results:To assess whether altering dietary BCAA levels would impact circulating BCAA concentrations, mice were fed a low (1/3×), normal (1×), or high (2×) BCAA diet over a 7-day period. The low and high BCAA diets were matched for macronutrient content, nitrogen content, and caloric density. We found that mice fed the low BCAA diet had >2-fold lower circulating BCAA concentrations when compared with normal and high BCAA diet feeding strategies (n=8/group; p

Circulation, Volume 150, Issue Suppl_1, Page A4139107-A4139107, November 12, 2024. Background:Given its chronicity and high hospitalization burden, heart failure (HF) requires close coordinated care. Health Information Exchange (HIE) systems can improve care by enabling seamless information sharing between healthcare providers and patients. We evaluated whether hospitals that have invested in more comprehensive HIE access for patients have better risk-standardized post-discharge outcomes after HF hospitalization.Methods:We defined a range of contemporary HIE services at all US acute care hospitals using the American Hospital Association (AHA) Information Technology (IT) Annual Survey (2022). HIE services included mobile access to health records, the ability to import, export, and update health records online, and the option to share patient-generated data with the health system, representing health measurements and data generated from smart devices (A). We identified each hospital’s corresponding 30-day excess days in acute care (EDAC) for HF – a risk-standardized metric of all acute care needs in the post-hospitalization period from the Centers for Medicare&Medicaid Services Quality Report (2019-2022) and examined the association between HIE services and 30-day EDAC for HF using multivariable linear regression.Results:There were 2,581 US hospitals (22% rural, 9% teaching, with a median bedsize of 162 [IQR 76, 307]) in the AHA-IT survey, with a median EDAC of 5.9 (IQR -8.6, 20.9) days for HF. The vast majority (99%) of hospitals had online health record portals, but access to specific HIE services varied widely across hospitals (B): 84% offered access via mobile application, 86% allowed data import, 55% data export to other health systems, and 77% online data updates, with fewer than half (47%) allowing patients to share patient-generated health data. After accounting for differences in hospital characteristics, only hospitals with HIE configured to enable patients to share their personal health data directly with the health system had significantly lower risk-standardized 30-day EDAC for HF (-3.9, 95% CI -1.04, -3.48) (C).Conclusions:Hospitals with HIE services that include the sharing of patient-generated data have significantly better risk-standardized post-hospitalization outcomes for HF. There is a need to evaluate the role of broader access to bidirectional data sharing as a strategy to enhance care and outcomes at hospitals treating patients with ongoing post-discharge needs.

Circulation, Volume 150, Issue Suppl_1, Page A4147807-A4147807, November 12, 2024. Introduction:Peak oxygen uptake (VO2peak), standardized to total body mass (ml/kg/min) is a predictor of morbidity and mortality in cardiovascular disease patients. However, subsets of individuals undergoing exercise based cardiac rehabilitation (CR) show no improvement or reduction in VO2peak despite improvement in other functional measures.Hypothesis:Change in peak VO2post-CR, adjusted for lean mass rather than total mass better reflects peak VO2improvements.Aim: To assess the influence of CR on lean mass and the effect of lean mass compared to total body mass changes on peak VO2following CR.Methods:This observational cohort study included adults >18 years old who completed CR between 2015-2022 at Mayo Clinic, Rochester. All patients completed both dual energy X-ray absorptiometry (DXA) and cardiopulmonary exercise testing (CPET) for measurement of body composition (total mass and lean mass) and VO2peak pre- and post-CR. Improvement in VO2peak was defined as >% increase. Paired t-tests, one-way ANOVA, and descriptive statistics were performed.Results:Of 145 subjects, 81% were male and 63% Caucasian with a mean (SD) age of 62.8±12.6 years, BMI of 30.3±5.7, and 33.4±8.2 of 36 prescribed (92.8%) CR sessions completed. Pre-CR, patients demonstrated absolute VO2peak of 1,997.0±693.5 mL/min, relative of 22.1±6.2 mL/kg/min, and relative to lean mass of 35.2±9.6 mL/kg lean/min. After CR, patients demonstrated 1.2±3.1 kg reduction in total mass (p

Circulation, Volume 150, Issue Suppl_1, Page A4137644-A4137644, November 12, 2024. Background:Use of hematopoietic stem cell transplantation (HSCT) continues to rise in the United States, particularly in older age groups; however, HSCT is associated with various cardiovascular complications including heart failure (HF). We sought to examine whether prolonged QTc prior to HSCT was associated with the risk of HF post-HSCT.Methods:We used data from the Cardiovascular Registry in Bone Marrow Transplantation (CARE-BMT) study, a multicenter observational study of adult patients (aged ≥18 years) who underwent autologous/allogeneic HSCT for malignant or nonmalignant bone marrow disorders at the University of Michigan Health System (UMHS) and Rush University Medical Center (RUMC) between 2008-2019. In this analysis, only patients from the UMHS site were included (n=2,435). Baseline electrocardiogram (EKG) data were recorded prior to transplant (median (IQR) 14 (3, 30) days). QTc prolongation was defined per CTCAE grading criteria as Normal (480ms). The primary outcome was new-onset HF defined as a diagnosis documented by health care providers after the date of hospitalization for HSCT. Analyses were conducted using a Fine-Gray model adjusted for the pre-HSCT CARE-BMT cardiovascular risk score.Results:Of the 2,435 patients (mean age at HSCT 55±13.4 years; 59.7% male; 90.5% White), 534 (21.9%) had long QTc pre-HSCT. Of those, 440 were Grade 1 and 94 were Grade ≥2. In all, 138 HF events occurred over median period of 2.3 (1.0-5.3) years. The 5-year cumulative incidence of HF was 5.0% in patients with normal QTc, 8.4% in patients with Grade 1 QTc prolongation, and 19.0% in patients with Grade ≥2 QTc prolongation (Figure). Patients with Grade 1 and Grade ≥2 prolongation had a 1.57 (95% CI: 1.05, 2.33) and 2.71 (95% CI: 1.51, 4.86) times higher risk of HF, respectively, compared to those with normal QTc.Conclusions:In this contemporary cohort of adult HSCT patients, those with QTc prolongation prior to HSCT had a higher incidence of HF compared to normal QTc, with greater degree of prolongation associated with higher risk. These findings highlight the importance of accounting for the QTc as part of the pre-transplant cardiovascular evaluation

Circulation, Volume 150, Issue Suppl_1, Page A4142080-A4142080, November 12, 2024. Case Presentation:A 27-year-old-male without any known medical history presented after witnessed sudden cardiac arrest. Initial rhythm in the field was ventricular fibrillation. He underwent CPR with three rounds of external defibrillation with 200 J and after return of spontaneous circulation (ROSC) was transferred to our facility. He was initially normotensive, bradycardic, hypothermic to 35.6°C and hypoxic requiring non-rebreather mask. He was intubated for airway protection. Post ROSC 12-lead surface ECG revealed sinus rhythm with a prolonged QT interval and left ventricular hypertrophy. Initial high-sensitivity Troponin I was elevated to 83 pg/ml that peaked to 4631 pg/m. On transthoracic echocardiogram, ejection fraction was 55-60% with moderate concentric left ventricular hypertrophy and an interventricular septum end diastolic thickness of 1.3 cm as well as normal left ventricular outflow tract pressure gradient. Coronary angiogram was notable for prominent myocardial bridge (MB) of the middle left anterior descending (LAD) artery without any evidence of atherosclerotic disease. Cardiac magnetic resonance imaging (CMR) showed asymmetric left ventricular hypertrophy with reverse septal curvature variant and evidence of patchy late gadolinium enhancement. A dual-chamber implantable cardioverter defibrillator was placed for secondary prevention of ventricular arrhythmias and sudden cardiac death. Metoprolol tartrate was started for management of hypertrophic cardiomyopathy (HCM) and MB. At follow-up visit he was asymptomatic and genetic testing was positive for heterozygous gene mutation in MYBPC3.Discussion:MBs have been recognized as a common congenital anomaly of the epicardial coronary arteries, with a higher prevalence reported in patients with HCM. We present a unique clinical scenario of a young patient with asymmetric HCM, patchy late gadolinium enhancement on CMR and evidence of prominent MB of the LAD artery. Hemodynamically significant MBs have been implicated in the degree of fibrosis in HCM which is significant due to the correlation between extent of fibrosis and adverse cardiac remodeling, and the consequent predisposition to arrhythmogenesis. However, the existing literature is inconclusive regarding the exact association between MBs and cardiovascular mortality in HCM. Here, we highlight the potentially increased risk of sudden cardiac arrest conferred by MB in HCM and the need for further studies to delineate this association.