Average LVEF Research Articles

Early Improvement in Cardiac Function and Dyssynchrony After Physiological Upgrading in Pacing-Induced Cardiomyopathy.

Interventricular dyssynchrony derived from the classic non-physiological stimulation (n-PS) of the right ventricle (RV) is a known cause of left ventricular dysfunction (LVDys). This was a prospective descriptive single-center study. We analyzed patients who develop LVDys with n-PS, and the results after upgrading to conduction system pacing (CSP). Ultra-high frequency electrocardiogram (UHF-ECG) was performed pre and post-implantation of the last patients included. ECG recordings in 16 frequency bands (150-1000Hz) were used to create maps of ventricular depolarization. The maximum time difference between the centers of mass of the complex UHF QRS of leads V1-V6 (electrical dyssynchrony [DYS-e] 16) and V1-V8 (DYS-e 18) defined ventricular dyssynchrony. Data were expressed as mean ± standard deviation. 27 patients were upgraded to CSP from January 2022 to January 2024 after developing LVDys. Permanent His bundle pacing (p-HBP) was achieved in 63% (n=17); in the other 10 patients left bundle branch area pacing (LBBAp) was performed. The average baseline LVEF improved from 34.5% (27-42) to 47.6% (38.2-57), p < 0.001. Telediastolic left ventricle diameter as well as QRS width also decreased. Thresholds remained stable at 6-month follow-up. The last eight patients included were studied in terms of ventricular synchrony parameters by UHF-ECG (VDI Technologies), both His bundle pacing (HBP) and the LBBAp achieved significant improvement with respect to baseline parameters. LVEF improved in patients with previous n-PS-induced cardiomyopathy after upgrading to CSP. LVDys due to dyssynchronopathy is frequent and probably underdiagnosed. UHF-ECG provides useful new information about ventricular activation and will likely improve patient selection for cardiac resynchronization therapy (CRT).

Predictive Factors of the No Reflow Phenomenon during ST-Elevation Myocardial Infarction: Case Reports and Literature Review

The no-reflow phenomenon, defined as inadequate myocardial perfusion despite successful coronary recanalization, remains a significant complication following primary angioplasty for STEMI. This retrospective study analyzes 10 clinical cases, highlighting predictive factors such as high thrombotic burden (70% of cases), significant comorbidities (diabetes 50%, hypertension 40%, smoking 60%), persistent left ventricular dysfunction (average LVEF 40%), and prolonged revascularization delays (&gt;6 hours in 50% of cases). The observations emphasize the central role of microvascular dysfunction and the complexity of no-reflow pathophysiology. Compared to the existing literature, our findings underscore the importance of targeted preventive strategies and innovative therapeutic approaches to improve clinical outcomes. Prospective validation in larger cohorts is needed to confirm these results.

Abstract 4118122: Effect of Beta Blockers on Exercise Capacity, Diastolic Function, and Quality of Life in Patients with Heart Failure with Preserved Ejection Fraction

Introduction: In recent landmark HFpEF trials, 75-80% of patients are taking beta blockers (BB) without clear evidence of clinical or symptomatic benefit. Patients with HFpEF commonly have comorbidities that have been classically managed with BB (AF, CAD, HTN), though the utility of this medication class for these conditions is being reconsidered. It remains unclear what impact BB use, in patients with HFpEF, has on exercise capacity, diastolic function, and quality of life. Hypothesis: We hypothesized that BB use is associated with worse exercise capacity, diastolic function, and quality of life in HFpEF patients. Methods: This retrospective cohort study was completed using deidentified patient data from the INDIE-HFpEF and RELAX clinical trials (two trials of HFpEF patients). Patients were divided into two groups based on BB use at trial enrollment. The primary outcomes were exercise capacity, diastolic function, and quality of life at baseline evaluation. A multivariate logistic regression model was used to assess for statistically significant differences after controlling for potentially confounding variables including age, sex, BMI, AF, prior MI, COPD, DM, HTN, serum creatinine, and NYHA functional class. Results: A total of 320 patients were included in this analysis, with 230 on BB (72%). Baseline demographics are shown in Table 1. Patients studied were older (68 years old), white (90%), obese (average BMI 34 kg/m 2 ) individuals with an average LVEF of 61%. Outcomes and multivariate linear regression results are shown in Table 2. After controlling for potential confounding variables, there were no differences in baseline exercise capacity [peak VO2 (mL/kg/min): 12.1 vs 13.2, P=0.233], diastolic function [average E/e’: 14 vs 12, P=0.125; LAVI (mL/m 2 ): 42 vs 37, P = 0.665; peak TR velocity (m/s): 2.8 vs 2.7, P = 0.165; PASP (mmHg): 41 vs 36, P = 0.357], quality of life [KCCQ: 54 vs 58, P = 0.206; MLHFQ 43 vs 46, P = 0.762], or NT-proBNP (633 vs 342; pg/mL, P = 0.208) in HFpEF patients on BB compared to those not on BB. Conclusion: There was no association with BB use and worse exercise capacity, diastolic function, or quality of life in HFpEF patients. This may be due to heterogenous treatment effects, with differing impact of BB based upon the underlying pathophysiology of unique HFpEF phenotypes. To definitively determine the impact of BB use in patients with HFpEF, both on clinical outcomes and symptoms, randomized controlled trials are necessary.

Non-invasive imaging to guide percutaneous coronary revascularization in chronic total occlusion: a systematic review and meta-analysis

Abstract Background and aims Whether recanalization of coronary chronic total occlusions (CTO) leads to improved patient outcomes is uncertain. We set out to investigate the use of noninvasive imaging modalities to guide patient selection for percutaneous recanalization of coronary chronic total occlusions (CTO-PCI) and its association with outcomes. Methods Systematic review and meta-analysis of studies involving patients undergoing CTO-PCI to detail use of preprocedural non-invasive imaging, change in clinical endpoints and the occurrence of clinical events in these patient cohorts. PubMed and Embase, the Cochrane Database of Systematic Reviews, the PROSPERO database and the Clinical Trials Registry were searched for relevant randomized and observational studies up to May 2023. This study is registered with PROSPERO. The study primary endpoint was a composite of all-cause death and nonfatal myocardial infarction (MI), with a secondary composite endpoint of cardiovascular death, nonfatal MI and target vessel revascularization (TVR). Additional endpoints were individual components of the composite endpoints along with changes in angina burden, LV ejection fraction, ischemic burden, and infarct extent after PCI. Results Of 1264 publications retrieved, 31 studies (26 observational and 5 randomized) were finally included for a total of 7260 patients. Guidance to CTO-PCI varied greatly among included studies, with only a minority implementing routine preprocedural inducible ischemia and myocardial viability assessment. At a median of 3.1 years (range 1-5 years), the primary endpoint occurred at a rate of 3.1 events per 100 patient-years (95%CI: 2.4-3.7). When non-invasive imaging was used to guide CTO-PCI, patients with myocardial ischemia and/or viability, a reduced risk for the primary endpoint was observed (OR 0.3 95%CI 0.2-0.5) compared to CTO-PCI without evidence of myocardial ischemia and/or viability. CTO-PCI was associated with improvements in SAQ summary score, LVEF, reduction of ischemic burden, improvement in myocardial perfusion (all P-values &amp;lt; 0.01), with no change in the burden of myocardial scarring. At meta-regression analysis, a greater improvement in LVEF was observed in studies enrolling patients with lower average baseline LVEF (≤ 45%) (R2 = 63%, p &amp;lt; 0.0001). Conclusions CTO-PCI led to a significant improvement in symptom status (reduction of chest pain) and LV ejection fraction. CTO-PCI guided by the presence of ischemia and/or viability was associated with improved patient outcomes compared with CTO-PCI in the absence of ischemia and/viability, or in patients where non-invasive imaging testing was not performed. Future randomized clinical trials testing whether ischemia and viability-guided CTO-PCI improves clinical outcomes are lacking and warranted.PRISMA Flow diagramGraphical abstract

Pulsed-field ablation for atrial fibrillation without the use of fluoroscopy.

Pulsed-field ablation (PFA) and fluoroless ablation (FA) are emerging techniques in contemporary in electrophysiology. With widespread use of 3D electroanatomic mapping systems and advanced intracardiac echo (ICE) imaging, fluoroless ablation has become more widely adopted. However, with the importance of tissue contact for lesion durability, initial PFA has been used with fluoroscopic guidance, but both ICE and electroanatomic mapping make fluoroless PFA feasible. The objective of this study is to demonstrate that PFA can be done safely and effectively without fluoroscopy. At a single center, consecutive patients undergoing ablation with a pentaspline PFA catheter using a fluoroless approach are described. The standard 3D anatomic map settings were adjusted with changes in interior and exterior projection, respiratory compensation, and interpolation. In addition, projection map lesions were used to confirm adequate circumferential ablation lesions. ICE was used extensively for wire guidance and evaluation of contact with tissue. Beginning on March 15, 2024, 50 consecutive subjects (19 female/31 male) aged 68.0 (± 13.7) underwent PFA ablation. The average CHA2DS2-VA2Sc score was 3.0 (± 1.9). The average LVEF was 57.3% (± 10.0) and the average LA size was 3.9cm (± 1.2). Projection lesions were placed with every application of PFA. An average of 41.7 (± 8.5) PFA applications were placed. In 100% (50/50) of subjects, acute isolation of the pulmonary veins was achieved. Eighteen subjects also underwent concomitant posterior wall isolation and in 100% of these subjects, posterior isolation was achieved. There were zero complications in this cohort. In 50/50 subjects (100%), fluoroscopy was not used. In comparison to the control cohort, the LA dwell time of the ablation catheter was similar (p = 0.34). In comparison to the traditional PFA with fluoroscopy, this proof-of-concept study shows fluoroless PFA ablation can be performed safely and with similar acute success rates as with use of fluoroscopy.

Cardioneural ablation-the first case series without the use of fluoroscopy.

Cardioneural ablation (CNA) and fluoroless ablation (FA) are emerging procedures and movements in contemporary in electrophysiology. Ablation of ganglionated plexus (GP) inputs in the atrium has been successfully targeted as a treatment for symptomatic bradyarrhythmias due to increased parasympathetic tone. As most of these patients are young, avoidance of ionizing radiation is of critical importance to limit potential long term deleterious effects. With widespread use of 3D electroanatomic mapping systems and advanced intracardiac echo (ICE) imaging, fluoroless ablation has become more widely adopted. However, fluoroless CNA has not been widely performed. The objective of this study is to demonstrate that CNA can be done safely and effectively without fluoroscopy. At a single-center, consecutive patients undergoing CNA with a fluoroless approach are described. GP mapping and ablation were performed in both atria. From the right atrium (RA), the right atrium-superior vena cava (RA-SVC GP), the posteromedial ganglionated plexus (PMLGP), which can be accessed from the right atrium-coronary sinus ostium, and the Vein of Marshall GP (VOM-GP) were evaluated. From the left atrium (LA), the superior left atrial ganglionated plexus (LSGP), the left inferior ganglionated plexus (LIGP), the right anterior ganglionated plexus (RAGP), and the right inferior ganglionated plexus (RIGP) were targeted. Over the study period, beginning on January 31, 2021, 30 consecutive subjects (15 females/15 males) aged 42.9 ± 13.6years underwent GP ablation. The average subject had 9.5 (± 9.2) episodes of syncope prior to ablation. The average CHADS2-VA2SC score was zero. The average LVEF was 64.8% (± 4.9). Two of the subjects had concomitant ablations, six failed prior medical therapy, and one had a prior pacemaker placed. All of the procedures were done without fluoroscopy. The average follow-up was 604 (± 366) days. There were 8 patients that did not improve symptomatically postfirst ablation. Four of the eight underwent repeat ablation and have subsequently improved. 26/30 patients symptomatically improved after the 1st or 2nd ablation. There were no complications noted. In comparison to the traditional CNA with fluoroscopy, this proof of concept study reveals fluoroless GP ablation can be performed safely. In addition, the durability and success rate are comparable to other studies of CNA. Given the young age of the cohort and the longitudinal risks of ionizing radiation, fluoroless CNA is a feasible procedure for this patient population.

Long-term results following off-pump coronary-artery bypass grafting in left ventricular dysfunction

Severe left ventricular (LV) dysfunction is an independent risk factor for early and long-term mortality after coronary-artery bypass grafting (CABG). Off-pump CABG (OPCAB) significantly reduces the early incidence of major complications in high-risk patients. Moreover, bilateral internal thoracic artery (BITA) grafting after CABG is associated with improved long-term outcomes. We aimed to evaluate the impact of multivessel OPCAB with BITA grafting for complete revascularization on postoperative and long-term outcomes in patients with low LV ejection fraction (EF). We included 121 patients with EF ≤ 30.0% who underwent isolated multivessel OPCAB (average LVEF, 24.8%) between April 2007 and December 2019. Sixty-six patients received BITA grafts, while 55 had single internal thoracic artery (SITA) grafts. We conducted multivariate analyses to examine the correlation between perioperative data and late mortality rate. The early mortality rate was 1.65%. After excluding in-hospital mortality cases, we performed long-term follow-up of 119 patients. Early postoperative echocardiography showed significant LVEF improvement in 89 (75.2%) patients. However, LVEF remained ≤ 30.0% in 30 (24.8%) patients. We recorded 15 and 30 cases of cardiac death and cardiac events, respectively, during the long-term follow-up period. Postoperative LVEF ≤ 30.0% (P < 0.01) and no use of BITA grafting (P = 0.03) were significant predictors of cardiac death and events; moreover, hemodialysis was a significant predictor of all-cause mortality rather than cardiac death. Multivessel OPCAB in patients with severe LV dysfunction was associated with acceptable in-hospital mortality and early postoperative improvement in LV function. Additionally, OPCAB with BITA grafting may provide long-term benefits with respect to cardiac death and events. However, the long-term benefits were significantly limited in patients without early postoperative improvement in LV function and patients with chronic hemodialysis.Clinical registration number: 5590 (14/5/2020 Tokyo Women’s Medical University).

New onset heart failure with reduced ejection fraction management: single center, real-life Tunisian experience

BackgroundHeart failure (HF) is a serious and frequent pathology. It represents a major public health problem. We have few data about this pathology in our country. The aim of our study is to determine the epidemiological, clinical, therapeutic, and prognostic characteristics of new-onset HF with reduced left ventricular ejection fraction (HFrEF) and to study the degree of conformity of the management of HF with international recommendations.ResultsOur study population includes 210 patients hospitalized for HFrEF newly diagnosed. The average age of our patients was 64 ± 12 years. A male predominance was noted with a sex ratio of 2.8. The main etiology of HF was ischemic heart disease noted in 97 patients (46.2%). The average LVEF is 33 ± 6%. The triple combination (angiotensin-converting enzyme inhibitors + beta blockers + Mineralocorticoid Receptor Antagonists) was prescribed in 75 patients (35.7%). The quadruple combination (angiotensin-converting enzyme inhibitors + beta blockers + Mineralocorticoid Receptor Antagonists + Sodium-Glucose Co-Transporter 2 inhibitors) was prescribed in 17 patients (8.1%). Myocardial revascularization was indicated in 97 patients (46.6%) and valve surgery was indicated in 49 patients (23.3%). Hospital mortality was 3.8% and at 1 year 18.1%. Among the 192 patients followed during the first year after discharge from hospital, 81 patients had to be re-hospitalized, i.e., a 1-year rehospitalization rate of 42.2%.ConclusionsOur study highlighted the epidemiological and clinical features of HF in a Tunisian care center, revealing our patient management deficiency. This pushes us to have a new Tunisian register to enable a better statistical analysis and lead to more relevant conclusions.

ASSESSMENT OF THE PHYSICAL CAPABILITIES OF HEART FAILURES AFTER CARDIOVASCULAR REHABILITATION: ABOUT 125 CASES FROM FEBRUARY 2021 TO DECEMBER 2022

Objective: The objective of this work was to evaluate the effects of cardiac rehabilitation on the physical abilities of patients with heart failure, to compare the parameters of the stress test, the 6-min walk test and cardiac ultrasound before and after cardiac rehabilitation. Design and method: This is a descriptive and analytical cross-sectional study with retrospective and prospective data collection which took place from February 1, 2021 to December 31, 2022. Patients with heart failure of all etiologies combined who received an outpatient cardiovascular rehabilitation program. Data were collected on a pre-established survey form and included anamnestic, clinical, paraclinical and 6-min walk test data. Informed consent was obtained. Data analysis was performed with SPSS version 18 software. Any difference less than 0.05 was considered statistically significant. Results: During this study, the frequency of rehabilitated heart failure patients out of the total number of rehabilitated patients for all etiologies was 45.59%. The average age was 57.97 with extremes at 41 and 74 years. The most represented age group was that of 61 to 70 years (35.5%). The predominance was male with a sex ratio of 2.1. The cardiovascular risk factors found were dominated by dyslipidemia (80.6%), physical inactivity (71%), high blood pressure (41.90%) and diabetes (38.70%). The level of cardiovascular risk was high in 48.39% and very high in 35.48% of cases. Coronary disease was the main etiology of heart failure with 80.65% of cases. Systolic blood pressure increased from 126.87 to 126.42 mmhg (p = 0.91), diastolic blood pressure from 78.74 to 74.48 mmhg (p = 0.090) and resting heart rate from 79.23 bpm to 67.06 bpm (p = 0.000). The average LVEF increased from 38.75 to 45.26% (p = 0.001), the number of METS from 4.42 to 7.48 (p = 0.000), as well as the 06-minute walk test from 328 m to 470 m (p = 0.000). No deaths or rehospitalizations were observed during the study. Conclusions: The study shows that cardiovascular rehabilitation is beneficial in heart failure patients with a marked improvement in symptoms, physical capacity and quality of life.

PO-05-035 FASCICULAR SUBSTRATE MODIFICATION TO TREAT HUMAN VENTRICULAR FIBRILLATION: A MULTICENTER STUDY

Purkinje fibers play an important role in initiation and maintenance of ventricular fibrillation (VF). Fascicular substrate modification approaches have been suggested to treat recurrent VF in isolated case reports and small case series. To investigate the outcomes of catheter-based fascicular substrate modification to treat recurrent VF. Out of 2,212 consecutive patients with ventricular arrhythmia undergoing catheter ablation at our centers, 18 (0.81%) underwent fascicular substrate modification by targeting with short (<20 s) RF lesions in the most distal segment of the Purkinje fibers as identified with high-density mapping during sinus rhythm. Demographic, clinical, and follow-up characteristics were prospectively collected in our institutional database. A total of 18 patients (mean age: 56±3.8 years, female: 4, 22%) were included in the study. Of those, 11 (61.1%) had idiopathic VF (normal heart VF), 3 (16.7%) had non-ischemic cardiomyopathy and 4 (22.2%) had mixed cardiomyopathy. Average LVEF was 42.5%. Patients had failed ≥2 antiarrhythmic drugs pre-ablation. At baseline, all patients had inducible VF and non-inducibility of VF at the end of the procedure was achieved in 16 (88.9%) patients. In select patients, remapping revealed elimination of the targeted Purkinje potentials. At the end of the procedure, no patient demonstrated new evidence of fascicular block or bundle branch block. VF initiation and final lesion sets are shown in figure 1. There were no procedure-related complications. After a median follow-up of 24 months, 16 (88.9%) patients were arrhythmia-free on- or off-drugs; 11/11 (100%) patients with normal heart VF vs 5/7 (71.4%) with underlying cardiomyopathy (p=0.06). Catheter ablation of human VF with distal fascicular substrate modification is feasible, safe and appears highly effective with high rates of acute VF non-inducibility and long-term freedom from recurrent VF.

Fifth decennium after the arterial switch operation for transposition of the great arteries

BackgroundFrom 1977 onwards, patients with both simple and complex transposition of the great arteries (TGA) have been treated with the arterial switch operation (ASO) in the Wilhelmina Children's Hospital/University Medical Center Utrecht the Netherlands. In this study, we compared mortality and morbidity between two patient groups: A. operated before and B. after 1991, specifically focusing on late ventricular function and reinterventions. MethodsA single institution retrospective cohort study was performed on patients who had an ASO for either simple or complex TGA. Data were collected from medical records. The entire patient cohort (n = 283) was divided in a group with more than 30 years of follow-up (A) and a group with less than 30 years of follow-up (B). Clinical and standardized echocardiographic follow-up was evaluated. ResultsGroup A consisted of 79 patients, of whom follow-up was available in 59 patients (median follow-up 34.8 years, IQR 33.0–36.9). Group B consisted of 204 patients, of whom 195 long-term survivors (median follow-up 14.9 years, IQR 10.0–21.2). Early survival was best in group B (A: 67.8% vs. B: 96.6%, p < 0.001), whereas late mortality (in total 1.8%) was similar for both groups. Reinterventions, corrected for follow-up time, were more frequent in group A (p = 0.005). In total 65 patients (25.1%) required 105 late reinterventions including 4 late aortic valve replacements. The mode of reinterventions has shifted over time, from surgical to more catheter-based (p = 0.03). The vast majority of patients functioned in NYHA class I. In contrast to the recent cohort, who have a normal average LVEF (%), the average LVEF in the oldest cohort was in the bottom percentile of normal range. ConclusionThe majority of patients in their fifth decade after ASO are in functional class I. Early outcome improved showing reduced mortality and need for reoperation. However, a trend towards reduced left ventricular function and late aortic valve replacements justify further research.

Evaluating Cardiotoxicity in Breast Cancer Patients Treated with HER2 Inhibitors: Could a Combination of Radionuclide Ventriculography and Cardiac Biomarkers Predict the Cardiac Impact?

(1) Background: The aim of our study was to determine whether monitoring cardiac function through RNV and cardiac biomarkers could predict the cardiac impact of combined therapy with trastuzumab, pertuzumab and docetaxel, which are regularly used nowadays to treat HER2-positive breast cancer. (2) Methods: This prospective monocentric study included 22 patients, diagnosed with HER2-positive breast cancer, who had their LVEFs and cardiac biomarkers evaluated both at the beginning of their treatment and after 6 months. Among all of the enrolled patients, two blood specimens were collected to assess circulating cardiac biomarkers. RNV was performed in each patient after "in vivo" radiolabeling of the erythrocytes. The obtained results were then statistically correlated. (3) Results: The average LVEF decrease between the two time points was approximately 4%. Of the five biomarkers we considered in this paper, only NT-proBNP correlated with the LVEF values obtained both in the baseline study and after 6 months of follow-up (r = -0.615 for T0 and r = -0.751 for T1, respectively). ST2/IL-33R proved statistically significant at the T1 time point (r = -0.547). (4) Conclusions: A combination of LVEF, NT-proBNP and ST2/IL-33R assessment may be useful for early detection of cardiac impairment in breast cancer patients treated with trastuzumab, pertuzumab and docetaxel.

Abstract 14784: Outcomes Associated With Implementation of an Intravenous Sotalol Initiation Protocol

Introduction: Oral sotalol initiation frequently requires a multi-day hospitalization for electrocardiographic monitoring. A one-day intravenous (IV) sotalol loading protocol was approved by the FDA in March 2020, but limited data on its clinical use currently exists. The aim of this study was to describe the outcomes of implementation of the IV sotalol initiation protocol within an integrated health system. Methods: An IV sotalol loading protocol was started in August 2021 for adult patients who were candidates for oral sotalol and had a creatinine clearance (CrCl) &gt; 30 mL/min. Patients with a heart rate &lt; 60 bpm or QTc &gt; 450 ms (500 ms for those with widened QRS) were excluded. Patients with persistent atrial arrhythmias were cardioverted prior to drug infusion. IV sotalol infusion was administered in the Cardiac Recovery and Observation Unit with one-on-one nursing and was stopped for a heart rate &lt; 50 bpm or QTc &gt; 500 ms (550 ms for those with widened QRS). Patients were admitted for monitoring post-infusion and received two oral sotalol doses prior to discharge. Serial EKGs were performed according to protocol. Expected length of stay (LOS) with oral initiation was calculated for the same patients using CrCl. Results: A total of 27 patients (average age 66 years, 26% women) underwent IV sotalol initiation. Average LVEF was 52% and average CrCl was 91.4 ± 24.8 mL/min. Primary indication was atrial arrhythmia for 74% and ventricular arrhythmia for 26%. Sotalol loading was successfully completed in 21 (78%) patients. Adverse events interrupting sotalol load included bradycardia (5 patients, 19%) and QT prolongation (2 patients, 7%). No patients developed sustained ventricular arrhythmias. LOS for patients completing IV load was 2.3 days shorter (mean 1.0 vs 3.3, p&lt;0.001) compared to expected LOS with oral load. Conclusions: A one-day IV sotalol loading protocol is a safe alternative to a multi-day oral sotalol initiation protocol and significantly shortens hospital LOS, potentially leading to significant cost savings.

Abstract 9694: Incidence and Outcomes of Hospitalized Patients With Torsades de Pointes

Introduction: TdP is a polymorphic VT that occurs with prolonged QT interval and can cause sudden cardiac death. Trends in incidence and outcomes of TdP during the COVID-19 pandemic are not well-established. We aim to report incidence of intrahospital TdP and VT, baseline characteristics of patients with TdP, and trends in post-TdP recovery and mortality before and during the COVID-19 pandemic. Methods: Patients with diagnoses of VT and TdP from 2016-2020 at our institution were included. The diagnosis was confirmed after analysis of the patients’ ECGs. Demographics, medical history, and hospital course data were collected. Chi-square/Fisher’s exact, one-way ANOVA, and logistic regression analyses were conducted. Results: Seventy-four patients were included in the analysis. Average age was 60 ± 17, and 57% were male. Fifty-two (70%) patients were in the ICU at time of TdP. Co-morbidities included hypertension (53%), atrial fibrillation/flutter (41%), diabetes mellitus (34%), CAD (26%), and CKD (22%). Average LVEF was 39 ± 19%. Forty-two (57%) underwent emergent defibrillation, 19 (26%) required transvenous pacing, and 7 (10%) were administered isoproterenol for acute management of TdP. Median recovery time of QTc interval to &lt;500ms was 3 days. Twenty-two (30%) received an ICD. Follow-up device check data was available for 15 patients; 4 had at least 1 episode of NSVT. Fifteen (20%) patients died during their admissions. The proportion of patients with VT that had TdP increased in 2020 compared to prior years (p&lt;0.001). However, the proportion of patients with TdP that died during admission was not significantly different across 2016-2020. Conclusions: The proportion of patients with TdP relative to those with VT increased significantly in 2020, concurrent with the first wave of the COVID-19 pandemic. The absolute number of hospitalized patients with TdP did not change from 2016-2020. Mortality rate in patients with TdP did not differ significantly from 2016-2020.

Effect of exercise-based cardiac rehabilitation on the ischemic threshold in patients with high-risk ischemic heart disease

Abstract Introduction Coronary artery disease is a complex condition and is not always resolved after an interventional or surgical procedure, due to the remaining obstructions in the coronary tree or the severity of the atherosclerosis, leaving anginal symptoms, ischemic threshold (IU) in the exercise, decreased cardiorespiratory fitness, and poor quality of life (QoL). Exercise-based cardiac rehabilitation programs (Ex-CRP) usually develop ischemic preconditioning mechanisms thanks to their direct anti-inflammatory, antioxidant, antithrombotic and coronary neovascularization effects, thus improving coronary reserve flow. We hypothesize that an Ex-CRP is capable of favorably impacting the UI in these patients. Therefore, the objective of this study is to evaluate the effects of an Ex-CRP on the UI in patients with high-risk ischemic heart disease. Methods Quasi-experimental study with 121 patients with ischemic threshold due to high-risk ischemic heart disease (with perfusion defects in nuclear medicine, complex coronary anatomy or partially revascularized) and presence of ischemic threshold in the exercise test. An Ex-CRP of 4–6 weeks duration was performed, consisting of supervised and monitored training concurrent with 30-minute aerobic exercise sessions at 70% of heart rate reserve, 3 times per week, supplemented with resistance exercise. and an educational understanding program for the control of risk factors and nutritional and psycho-emotional care. At the end of the program, a stress test was performed to compare the post-intervention effects and ischemic threshold was defined as the presence of angina or electrocardiographic changes of ischemia with negative ST-segment depression in 2 consecutive beats more than 80 ms from the J point. and in more than two contiguous leads. Results The 121 patients with ischemic threshold were 61±10 years old and 75% were male. On the other hand, 29.7% had a diagnosis of heart failure and an average LVEF of 53.1±12.9%. After Ex-CRP, an improvement was found in calculated VO2p (24.7±7.8 vs 34.23±7.5; p=0.000), METs at maximum effort from 7.06±2.15 to 9.78±1.14 (p&amp;lt;0.0001) and submaximal load in watts from 44±21.32 to 61±24.49; p&amp;lt;0.0001. 40.5% of the patients who were admitted with UI resolved it (absence of post-intervention ischemic diagnosis) after Ex-CRP and the remaining percentage with UI (59.5%) displaced it by 2.62 METs (p&amp;lt;0.0001). With this, the cardiovascular risk calculated by the Duke Score also decreased from −7 to −2 (p&amp;lt;0.0001), and the myocardial efficiency index improved from 8 to 6 (p&amp;lt;0.0001), strength (79±15 to 92±8%; p&amp;lt;0.0001) and QoL (65±17 vs 82±12; p&amp;lt;0.0001). Conclusions Ex-CRP had a significant effect on the resolution or displacement of the UI in patients with high-risk ischemic heart disease. In addition, it improved muscle strength, quality of life, myocardial efficiency, and reduced the cardiovascular risk index calculated by the Duke score. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Centro de Estudios e Investigaciόn FISICOL. Cúcuta, ColombiaCardioFit. CDMX, México

What is the clinical benefit of left main coronary artery treatment by percutaneous coronary intervention?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The treatment of choice of left main coronary artery (LMCA) disease has been subject to intense debate and investigation in the last decade. More recent studies showed benefit of percutaneous coronary intervention (PCI) in patients with less complex coronary anatomy. Although it is not the standard treatment, the use of this technique has been increasing. Objectives Characterize the patient population undergoing LMCA PCI and analyze its clinical benefit. Also, try to identify patient profiles according to the composite outcome (angor, heart failure symptoms (HF), myocardial infarction (MI) or death) in short and medium term (30 days (D) and 180D). Methods Observational and retrospective study of patients submitted to LMCA PCI, between 1 January 2019 and 31 December 2020. A descriptive analysis was carried out. Chi-Square test was used for categorical variables and the T-Student test for numerical variables, with a significance level of 95%. CHIAD algorithm was applied to identify patient profiles – composite outcome was the dependent variable (fixed 15 parent nodes and 5 children nodes). For statistical analysis, SPSS 24.0 was used. Results N120 patients, mean age of 70,4 years (standard deviation of 10.8), 76% were male. 81.7% had multivessel disease, with LMCA-anterior descendig artery injury being the most frequent (31.7%). The average LVEF was 49%. The complication rate was 15.8%, most vessel dissections. The most serious complications (cardio-respiratory arrest and cardiogenic shock) occurred in 0.8% of cases. The composite outcome occurred in 25,2% (30D) and 13,3% (180D), regardless of past medical history and number/type of vessels affected. The presence of angor was 9.9% (30D) and 1.3% (180D); HF symptoms in 13.5% (30D) and 4.8% (180D); MI in 2.7% (30D) and 1.2% (180D) and mortality in 2.7% (30D) and 2.4% (180D). In a logic of dependence and profiles, patients with LVEF [45-55%] (95.6%-p=0.003) who treated the lesions in first intention (AdHoc) (100%-p=0.009) presented fewer occurrences at 30D. Patients with occurrences at 30D (65.2%-p=0.001) or without PV of LVEF (66.7%-p = 0.016) and dyslipidemia (53.8%-p = 0.027) were those with most occurrences at 180D. Conclusion This analysis highlights the experience of the angiography laboratory. The majority of patients experienced evident clinical improvement and recovered in shortand medium term. The rate of serious events was low. The analysis suggests that the greatest benefit were found in the profile of patients with LVEF [45-55%] with an AdHoc approach.

PO-678-04 LUMENLESS VERSUS STYLET-DRIVEN LEADS FOR LEFT BUNDLE BRANCH AREA PACING - THRESHOLDS CHANGE IN EARLY FOLLOW-UP

In recent years, catheters have been developed to deliver both lumenless and stylet-driven leads for conduction system pacing (CSP), although there is a paucity of data regarding comparative lead performance for left bundle branch area pacing (LBBAP). To describe lead thresholds at baseline and early follow-up for lumenless versus stylet-driven leads utilized for LBBAP. Patients undergoing LBBAP between May 2018- October 2021 were prospectively studied at a single center. Pacing thresholds at baseline and 3-month follow-up were studied with respect to output voltage (V) and pulse width (ms). A total of 69 patients were analyzed: 46 with lumenless leads (Medtronic SureScan 3830) and 23 stylet-driven leads (19 Boston Scientific Ingevity or Ingevity+ and 4 Biotronic Solia). Baseline characteristics included median age 78 years, 48% female, 62% African American, 36% with cardiomyopathy, 32% history of coronary artery disease, 42% with atrial fibrillation, average LVEF 51% ± 18%, and 18 (26%) received cardiac resynchronization therapy (CRT) devices. Mean baseline QRS width was 138 ± 46 ms: 38% narrow, 10% LBBB, 22% RBBB, 4% IVCD, and 26% chronically RV paced. At baseline, mean pacing voltage threshold was similar for lumenless (0.57 V ± 0.18 V) and stylet-driven leads (0.65 V ± 0.28 V) (p=0.21). Pulse width was also similar (0.42 ms ± 0.09 ms lumenless versus 0.49 ms ± 0.17 ms stylet-driven, p=0.11). At 3-month follow-up visit, however, pacing voltage thresholds were higher for stylet-driven leads (0.99 V ± 0.40 V versus 0.76 V ± 0.19 V for lumenless leads, p=0.04) with a higher rise in voltage (0.38 V ± 0.23 V increase versus 0.19 V ± 0.24 V, p=0.01). 100% of procedures were acutely successful and there were no lead revisions required in either group. The use of stylet-driven leads was associated with a small rise in voltage output at 3 months. Close monitoring of pacing thresholds should be considered in patients undergoing LBBAP, particularly early post procedure. Confirming these findings and understanding their clinical significance will need to be assessed in a larger study and longer-term follow-up.

Red cell distribution width as a predictor of impaired exercise capacity in patients with heart failure

Aim To test a hypothesis that increased values of red cell distribution width (RDW) in patients with chronic heart failure (CHF) can be related with low exercise tolerance.Material and methods 102 patients were evaluated who had CHF with mid-range and reduced left ventricular ejection fraction (LV EF) without anemia (72% men, mean age 66±10.2 years). Cardiopulmonary stress test (CPST), echocardiography, 6‑min walk test (6MWT), blood count, and measurements of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and serum iron were performed.Results The average LV EF was 39±8.7 %; the peak oxygen consumption (VO2peak) was 13.7±4.8 ml /kg /min; and the median NT-pro-BNP was 595.3 pg /ml (Q1-3 1443-2401). RDW variables, including the RDW coefficient of variation (RDW-CV) and RDW standard deviation (RDW-SD), were not significantly related with serum iron or hemoglobin concentrations. A one-factor linear regression analysis showed a significant correlation of VO2peak with RDW-SD (р=0.039). A multivariate linear regression analysis with adjustments for LV EF, hemoglobin concentration, and age did not reveal any significant correlation of VO2peak with RDW variables. The distance covered in the 6MWT was significantly associated with RDW-CV both in the one-factor analysis and with adjustments for LV EF, hemoglobin and serum iron concentrations, and age.Conclusion This study showed that high RDW values in CHF patients without anemia predicted low exercise tolerance regardless of the age, LV systolic function, and hemoglobin and serum iron concentrations. A 16% increase in RDW-CV significantly decreased the likelihood of covering a distance longer than 360 m during 6 min.

Heart Rate and Left Ventricular Ejection Fraction in Dilated Cardiomyopathy: How Much We Have to Low?

<h3>Purpose</h3> An elevated heart rate (HR) is associated with an increased risk of death and cardiac transplant in children with dilated cardiomyopathy (DCM). Whether HR is a biologic marker to address therapy is poorly investigated in pediatric age. <b>Aim</b> The purpose of this study is to investigate the relationship between HR and LVEF improvement in a pediatric population of patients affected by DCM with reduced LVEF and treated with carvedilol. <h3>Methods</h3> A retrospective analysis has been conducted on all children (aged < 18 years) followed by HF Unit in Bambino Gesù Children Hospital from 2013 with a diagnosis of DCM and reduced LVEF (LVEF < 40%) treated by HRR strategy with high dosage of carvedilol. Echocardiographic data on left ventricular function and dimension have been collected. We analysed the relationship between HRR and left ventricular remodelling: LVEF, end-diastolic (LVEDd) and end-systolic left ventricular diameters (LVESd) before and after HRR treatment. The relation between change in HR, LVEF, LVEDs and LVESd were determined using regression analysis. <h3>Results</h3> 65 patients have been selected (M: 38; age 8.7+/- 8.9). The average LVEF was 32+/-9.4 before treatment. All patients were treated with anti HF therapy, including beta-blocker, carvedilol, up titrated to the maximal tolerated dose. We observed a statistically significant relationship between change in HR and change in LVEF (R 0.40; p = 0.001). In particular a HRR of > 20% from basal HR value was related with an improvement > of 25% in LVEF. The magnitude of LVEF improvement was enhanced by a major reduction in HR. <h3>Conclusion</h3> This study provide evidence that heart rate reduction is safe in children. There is a strong correlation with LVEF improvement in children affected by DCM.

Early To Bed, Early To Rise: LVAD Patients And Sleep Patterns

Early To Bed, Early To Rise: LVAD Patients And Sleep Patterns