B-type Natriuretic Peptide Levels Research Articles

Atrial cardiomyopathy markers predict ischemic cerebrovascular events independent of atrial fibrillation in patients with acute myocardial infarction.

Contemporary data on atrial cardiomyopathy (ACM) markers and ischemic cerebrovascular events (ICVE) in patients with acute myocardial infarction (AMI) is lacking. We aimed to examine whether ACM markers predict ICVE among AMI patients. A total of 4,206 AMI cases diagnosed in clinical examinations between January 2016 and June 2021 were assessed for markers of ACM including B-type natriuretic peptide (BNP), P-wave terminal force in ECG lead V1 (PTFV1), and left atrium diameter (LAD). Left atrial enlargement (LAE) and abnormal PTFV1 were defined by previously published cut-off points. The primary outcome was incident ICVE composed of ischemic stroke (IS) and transient ischemic attack (TIA). Receiver operating curve analyses were used to compare the predictive performance of the CHA2DS2-VASc score combined with ACM markers to the CHA2DS2-VASc score alone. During a median follow-up of 44.0 months, 229 (5.44%) ICVE occurred. Of these, 156 individuals developed IS and the remaining 73 cases were diagnosed with TIAs. The ICVE group showed larger PTFV1 and increased LAD as well as elevated BNP levels at baseline. In the multivariate analysis, we found significant associations with ICVE for PTFV1 (HR per 1,000 μV*ms, 1.143; 95% CI, 1.093-1.196), LAD (HR per millimeter, 1.148; 95% CI, 1.107-1.190), but not BNP after adjusting for known ICVE risk factors and interim atrial fibrillation (AF). The addition of abnormal PTFV1 and LAE improved the predictive accuracy of the CHA2DS2-VASc score with C-statistic increasing from 0.708 to 0.761 (p < 0.001). Atrial cardiomyopathy markers including PTFV1 and LAD were associated with incident ICVE independent of well-established risk factors and AF occurrence. The addition of ACM markers with CHA2DS2-VASc score may well discriminate individuals at high risk of ICVE in AMI patients.

364 The neuropeptide B type natriuretic peptide (BNP) induces limited activation of human monocyte-derived Langerhans cells

B type natriuretic peptide (BNP) has emerged as a central signaling molecule in itch transduction, first identified in this context as a neurotransmitter in the central nervous system, but lately also in the epidermal compartment as a paracrine mediator. Pruritus is the most common symptom in dermatology and is especially common in chronic inflammatory skin diseases such as atopic dermatitis, prurigo nodularis and psoriasis, where BNP levels have also been reported to be increased. Its action on nerves is increasingly well documented, but little is known about its effect on the immune cells in the skin.

Left bundle branch area pacing: A promising modality for cardiac resynchronization therapy.

Cardiac resynchronization therapy (CRT) is recognized as the first-line management for patients with heart failure (HF) and conduction disorders. As a conventional mode for delivering CRT, biventricular pacing (BVP) improves cardiac function and reduces HF hospitalizations and mortality, but there are still limitations given the high incidence of a lack of response rates. Alternative pacing methods are needed either for primary or rescue therapy. In recent years, conduction system pacing (CSP) has emerged as a more physiological pacing modality for simultaneous stimulation of the ventricles, including His bundle pacing (HBP) and left bundle branch pacing (LBBP). CSP activates the His-Purkinje system, allowing normal ventricular stimulation. However, HBP is technically challenging with a relatively low success rate, high pacing threshold, and failure to correct distal conduction abnormalities. Therefore, LBBP stands out as a novel ideal physiological pacing modality for CRT. Several non-randomized studies compared the feasibility and safety of LBBP with BVP and concluded that LBBP is superior to BVP for delivering CRT with a narrower QRS and greater improvements in left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) functional class. Concurrently, some studies showed lower and stable pacing thresholds and greater improvement of B-type natriuretic peptide (BNP) levels, as well as better mechanical synchronization and efficiency. LBBP ensures better ventricular electromechanical resynchronization than BVP. In this review, we discuss current knowledge of LBBP, compare LBBP with BVP, and explore the potential of LBBP to serve as an alternative primary therapy to realize cardiac resynchronization.

Abstract 12730: Comparisons of Health Outcomes Between Baby Boomers and Silent Generation Among Older Adults With Heart Failure

Background: Heart failure (HF) is a clinical syndrome of aging. Many studies compare older (≥65 years) and younger (&lt; 65 years) participants’ HF experiences as younger patients’ HF etiology and psychobehavioral factors are distinct from older patients. Yet, best practice geriatric HF management necessitates understanding of the differences present among older generations. Objective: To compare health outcomes (cardiac event-free survival and quality of life [QoL]) in older adults with HF by generational cohort including baby boomers and silent generation. Method: This 2-year longitudinal study of 497 patients with HF (male 61%, age 65±9 years, NYHA III/IV: 34%) included cardiac event data (i.e., HF readmission and cardiac death) collected from patient interview, hospital database and death certificate. QoL was measured using the Minnesota Living with Heart Failure. We collected demographic (e.g., gender, race), clinical (e.g., comorbidities), and psychobehavioral (e.g., depressive symptoms, anxiety, HF knowledge, self-care) factors as covariates. We conducted Chi-squares, t-tests, linear and Cox regression for data analysis. Results: Two fifths of the participants (39.63%) were baby boomers. Baby boomers had more depressive symptoms, higher levels of anxiety, lower levels of B-type natriuretic peptide, and higher number living in the same house than those in the silent generation (all P &lt;.05). Lower percentages of baby boomers were Whites and unemployed compared to the silent generation cohort ( P &lt;.05). There were no differences in other covariates between the two cohorts. Baby boomers had significantly worse QoL than patients in the silent generation ( P &lt;.001). Before and after adjusting for covariates, generation cohort was a significant predictor of cardiac event-free survival (HR=1.46-1.47, both P &lt;.05). Conclusion: Baby boomers with HF had better cardiac event-free survival, but more depressive symptoms, higher levels of anxiety, and worse QoL compared to older adults in the silent generation. In the US, baby boomers are the largest generational cohort in 2022 and are approaching their late 50s and mid-70s. As this group continues to age with increasing rates of HF, practice and research will benefit from continued focus on their needs.

Abstract 9792: Persistent Hypochloremia is Associated With Adverse Prognosis in Patients With Heart Failure

Introduction: Prognostic impact of persistent hypochloremia has been unclear in patients with heart failure (HF). Methods &amp; Results: We recruited data of patients who were hospitalized for HF at least twice repetitively at our hospital from 2010 to 2021 (n = 309). Patients were divided into four groups based on the absence/presence of hypochloremia (&lt; 98 mmoL/L) at discharge from 1st and 2nd hospitalization: Group A (patients without hypochloremia at 1st and 2nd hospitalization, n = 238), Group B (those with hypochloremia at 1st hospitalization and without hypochloremia at 2nd hospitalization, n = 25), Group C (those without hypochloremia at 1st hospitalization and with hypochloremia at 2nd hospitalization, n = 32), and Group D (those with hypochloremia at 1st and 2nd hospitalization, persistent hypochloremia, n = 14). We compared patients’ characteristics and prognosis after 2nd discharge. Group D showed highest age (Group D vs. Group A, B, and C; 75.5, 73.0, 63.0, and 74.5 years, respectively, P = 0.037) and highest prevalence of atrial fibrillation (92.9%, 46.6%, 44.0%, and 50.0%, P = 0.009) among the four groups. Levels of B-type natriuretic peptide were comparable among the four groups. In the Kaplan-Meier analysis, all-cause mortality and cardiac mortality were highest in the Group D compared to other groups (Figure, log-rank P &lt; 0.001). The multivariable Cox proportional hazard analysis revealed that persistent hypochloremia was independently associated with all-cause mortality (hazard ratio 3.235, P &lt; 0.001) and cardiac mortality (hazard ratio 3.069, P = 0.004). Conclusions: Persistent hypochloremia predicts poor prognosis in patients with HF.

Abstract 9789: Geriatric Nutritional Risk Index Predicts Bleeding Event in Patients With Heart Failure

Introduction: The relationship between malnutrition and bleeding event has been unclear in patients with heart failure (HF). Method and Results: We evaluated the nutritional status of patients with HF (n = 2,044) using Geriatric Nutritional Risk Index (GNRI). The primary endpoint was composite bleeding event of hemorrhagic stroke or gastrointestinal bleeding. According to the survival classification and regression tree analysis, the accurate cut-off point of GNRI for predicting the primary endpoint was 106.2. We divided patients into two groups based on GNRI levels: the High GNRI group (GNRI ≥ 106.2, n = 606, 29.6%) and the Low GNRI group (GNRI &lt; 106.2, n = 1,438, 70.4%), and compared patients’ characteristics and prognosis between the two groups. The Low GNRI group showed higher age (72.0 vs. 63.0 years, P &lt; 0.001) and lower prevalence of male sex (56.9% vs. 64.5%, P = 0.001) than the High GNRI group. There were no differences in use of antiplatelet agents and anticoagulants between the groups. In laboratory data, levels of B-type natriuretic peptide were higher in the Low GNRI group (321.1 vs. 111.6 pg/mL, P &lt; 0.001). Left ventricular ejection fraction was comparable between the groups. The Kaplan-Meier analysis demonstrated that bleeding event rates were higher in the Low GNRI group than in the High GNRI group (Figure, log-rank P &lt; 0.001). The multivariable Cox proportional hazard analysis revealed that the Low GNRI was independently associated with bleeding events (hazard ratio 1.795, P = 0.047). Conclusions: Malnutrition assessed by GNRI predicts bleeding events in patients with HF.

Abstract 9543: Cilostazol Improves Symptom Scores and Lowers NT-proBNP in HFpEF Preliminary Results From the CLIP-HFpEF N-of-1 Study

Introduction: Although heart failure (HF) with preserved ejection fraction (HFpEF) is increasingly common, targeted HFpEF therapies remain limited. Current evidence-based treatment options are modestly effective and provide limited symptom relief. Hypothesis: Cilostazol, a generic and oral phosphodiesterase type 3 (PDE-3) inhibitor, rapidly improves HF symptoms and serum N-terminal pro B-type natriuretic peptide (NT-proBNP) levels in HFpEF patients with an ejection fraction of 50% or higher. Methods: A prospective, double-blind, n-of-1 study with three crossovers with unblinding at the 1-month endpoint was designed. Stable outpatients with HFpEF received either placebo twice daily or Cilostazol 100mg twice daily for one week followed by three weekly crossovers. HF symptoms were assessed each week using the Kansas City Heart Failure Questionnaire (KCCQ-12) and NT-proBNP levels were measured at the end of weeks one and four. Results: Preliminary data from the initial 11 participants are presented (six men and five women, mean age 67±13 years). The mean KCCQ-12 score was eight points higher with Cilostazol than placebo (47±12 vs. 39±12; p&lt;0.05) (Figure 1A). Median NT-proBNP levels were lowered by 22% with Cilostazol compared to placebo (412 [293-1066] pg/dL vs. 659 [323-897] pg/dL; p&lt;0.05) (Figure 1B). Conclusions: In this preliminary analysis of CLIP-HFpEF, treatment with Cilostazol led to a rapid alleviation of HF symptoms and a decline in NT-proBNP levels when compared to placebo. The results of CLIP-HFpEF suggest a marked benefit of Cilostazol in HFpEF patients. Further studies are needed to elucidate the mechanism and long-term clinical benefits of Cilostazol in patients with HFpEF.

Abstract 13978: Biologic versus Imaging Markers Predicting Readmission and Death in Heart Failure With Preserved Ejection Fraction

Introduction: Increased B-type Natriuretic Peptide (NT-proBNP) levels have been associated with adverse outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Global longitudinal strain (GLS) and wall stress (WS) are frequently reported to be abnormal in these patients as well, but studies examining how structural changes in those with HFpEF affect morbidity and mortality have been scarce. Hypothesis: NT-proBNP is a stronger predictor of death and heart failure readmissions in HFpEF patients when compared to GLS and WS. Methods: We conducted a retrospective study of 237 patients admitted with acute decompensated heart failure, all with EF &gt; 50. Average age was 78 + 11, 69% of patients were female, and average BMI was 29 + 13. GLS was measured using speckled tracing echocardiography and WS was calculated from systolic blood pressure, end-systolic left ventricular (LV) dimension, and end-systolic posterior wall thickness. Results: During a follow-up period of 2 years, 55 patients died and 55 were readmitted with the diagnosis of acute decompensated heart failure. Mean NT-proBNP among all patients was 9982 + 16268, mean GLS -17.84 + 4.52, and mean WS was 52.27 + 25.23. 129 patients had an abnormal or borderline GLS of &gt;-18, whereas nearly all patients (230) had an abnormal WS of &lt;109. (See table for results.) Conclusion: GLS and WS are reduced in a significant proportion of HFpEF patients. However, our data suggests that compared to echocardiographic indices of LV systolic function, biomarkers have a stronger short-term prognostic value.

Remote dielectric sensing and lung ultrasound to assess pulmonary congestion.

We investigated the agreement between remote dielectric sensing (ReDS) system, which is a recently introduced non-invasive technology to quantify the degree of pulmonary congestion, and lung ultrasound (LUS), which is a gold standard to assess the existence of severe pulmonary congestion. Consecutive patients who were hospitalized to examine the cause of heart failure and treat their heart failure in our institute were prospectively included. They received LUS and simultaneous ReDS measurements. Three or more B-lines at each LUS zone was assigned to B-profile positive, indicating the existence of significant pulmonary congestion. ReDS values ≥ 35% were defined as significant pulmonary congestion. A total of 19 heart failure patients were included (77years, 13 men). Plasma B-type natriuretic peptide level was 131 (36, 416) pg/ml. Three patients had B-profile, indicating significant pulmonary congestion, and two of them had ≥ 35% of ReDS (sensitivity 66.7%, specificity 87.5%, and negative predictive value 93.3%). Most of the patients (79%) had lower B-lines below 3 and did not satisfy the criteria of B-profile, irrespective of wide ranges of ReDS values. ReDS system had as acceptable predictability as LUS in assessing the existence of significant pulmonary congestion. ReDS would be recommended to rule out significant pulmonary congestion or quantify the degree of less significant pulmonary congestion.

Clinical efficacy of Qili Qiangxin Capsule combined with exercise rehabilitation in the treatment of chronic heart failure

ObjectiveTo investigate the effect of Qili Qiangxin Capsule combined with cardiac exercise rehabilitation on patients with chronic heart failure (CHF). MethodsA total of 93 CHF patients admitted to Shanghai's Putuo District Central Hospital from March 2021 to December 2021 were included in the study and were randomly divided into the control group (46 cases) and the intervention group (47 cases). The control group received routine treatment, and the intervention group was treated with Qili Qiangxin Capsule as well as cardiac exercise rehabilitation that was routine for patients with CHF. The total effective rate, 6-min walking distance, left ventricular ejection fraction, B-type natriuretic peptide (BNP) level, left ventricular end-systolic diameter, and left ventricular end-diastolic diameter were compared in terms of the two groups. ResultsAfter three months of treatment, when compared with the control group, the total effective rate of the treatment on the patients in the intervention group increased significantly (87.23% vs 63.04%; P < 0.05). The 6-minute walking distance, BNP level, and the left ventricular end-diastolic diameter improved more drastically in the intervention group than in the control group, and the differences were statistically significant (P < 0.05). There was no significant difference in the other indicators before and after treatment (P > 0.05). ConclusionQili Qiangxin Capsule combined with cardiac exercise rehabilitation can significantly improve cardiac and motor function in patients with CHF.

Rett syndrome with atrial tachycardia in a girl.

Rett syndrome with atrial tachycardia in a girl.

Sacubitril/valsartan treatment: effect on left ventricular remodelling and fibrosis assessed by novel heart failure biomarkers

Abstract Background In patients with heart failure and reduced ejection fraction (HFrEF), treatment with sacubitril-valsartan (SAC/VAL) reduces N-terminal B-type natriuretic peptide (NT-proBNP) levels and appears to have a beneficial effect on ventricular remodelling (VR), although the mechanism of this effect has yet to be established. ST2 is a novel biomarker reflecting inflammation and haemodynamic stress, closely related to the pathophysiology of heart failure (HF), fibrosis and VR. Several studies have shown that elevated levels of ST2 are associated with increased risk of developing HF and worse prognosis, being an independent predictor of adverse clinical outcomes, and even establishing a correlation with clinical changes and NT-proBNP levels. Purpose To evaluate the effect of SAC/VAL treatment on left ventricular remodelling and fibrosis in patients with HFrEF by monitoring ST2 and NTproBNP levels during follow-up. Methods Prospective single-centre, open-label, single-group, prospective study including patients with HFrEF and NYHA functional class II–IV, under follow-up in our HF Unit from April 2018 to July 2020 with a 12-month follow-up for each patient. Biomarker measurements and echocardiography were performed at baseline, 6 and 12 months after initiation of SAC/VAL treatment. In addition, cardiac magnetic resonance imaging (CMRI) was performed at baseline and after 12 months of treatment. Results 68 patients were included (mean age 65.63±11.78 years; 29.4% female). Baseline characteristics are shown in table 1. The mean baseline NT-proBNP and ST2s concentration was 2238.24±2148.65 pg/mL and 42.31±28.38 ng/mL respectively, with a statistically significant reduction after 12 months with SAC/VAL (NTproBNP 701.65±778.13 pg/mL and ST2 30.22±9.70 ng/mL; p&amp;lt;0.01 in both cases). In addition, there was an improvement in left ventricular ejection fraction (LVEF) on echocardiography from 31.01±5.65% at baseline to 45.03±9.45% at 12 months (p&amp;lt;0.01). We also observed a statistically significant reduction in left ventricular end-diastolic and end-systolic diameter at 12 months from baseline (60.86±4.99 mm and 57.35±5.36 mm, p&amp;lt;0.01; 40.70±3.76 mm and 37.23±4.37 mm, p&amp;lt;0.01). These data suggesting reverse remodelling were also confirmed with CMRI, finding improved LVEF (32.90±6.65% vs 46.22±11.1%, p&amp;lt;0.01) and reduced end-diastolic (192.06±60.63 and 160.73±49.68, p&amp;lt;0.01) and end-systolic (125.28±52.07 and 90.74±41.79, p&amp;lt;0.01) volumes. During follow-up there were no alterations in renal function (creatinine 0.98±0.28 mg/dL at baseline, 1.03±0.32 mg/dL at 12 months, p=0.04) or potassium levels (4.50±0.40 mEq/L at baseline, 4.76±0.38 mEq/L at 12 months, p=0.22). Conclusion SAC/VAL treatment is associated with a reduction in NT-proBNP and ST2 concentrations which seems to support its beneficial effect on ventricular remodelling, allowing its monitoring to assess the evolution and prognosis of HF patients. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Novartis

Long COVID syndrome: a case-control study

Abstract Background Cardiovascular complications are rapidly emerging as a major threat in COVID-19 infection. Nonetheless, the mechanisms underlying the disproportionate effect of SARS-CoV-2 infection on patients with cardiovascular comorbidities remain incompletely understood. Purpose To assess whether COVID-19 infection has an adverse clinical outcome at medium-term follow-up. Methods A case-control study was performed. Cases were subjects who were diagnosed with COVID-19 infection following nasopharyhngeal swabbing. Controls were age- and gender-matched subjects who were not found to be infected with COVID-19 following swabbing and were negative on testing for COVID-19 IgG antibodies. All participants were submitted a standardised questionnaire regarding past medical history. Baseline blood investigations were taken including N-terminal pro–B-type natriuretic peptide (NT-proBNP) and troponin levels. High-sensitivity C-reactive protein (hsCRP) was taken as marker of inflammation and von Willebrand factor (vWF) was taken as marker of endothelial dysfunction. Results 270 subjects were recruited, comprising 174 cases and 96 controls. Of the latter, 21 were found to be COVID-19 IgG positive and were excluded from the analysis. Hence, the study cohort comprised 174 cases and 75 controls. The mean age of the participants was 46.1±13.8 years. The median follow-up was of 173.5 days (IQR 129–193.25 days). There was no statistically significant difference in the baseline demographics between cases and controls with regards age, gender as well as cardiovascular risk factors and underlying medical conditions. Regarding symptomatology at follow-up, there was a statistically significant difference between the groups in deterioration in general condition (p&amp;lt;0.001), shortness of breath (SOB) (p=0.008), fatigue (p=0.044), arthralgia (p&amp;lt;0.001), abnormal taste (p&amp;lt;0.001) and anosmia (p&amp;lt;0.001), all being more frequent in subjects with prior COVID-19 infection. At follow-up, the blood investigations showed that only hsCRP was statistically significantly higher in the cases as compared to the controls (p=0.03, Figure 1). Correlation analysis consequently revealed a negative correlation in both troponin (p=0.013, r=−0.19) and vWF levels (p=0.026, r=−0.169) with time. Finally, the association between the cases experiencing dyspnoea and the blood investigations at follow-up was assessed. Multivariate analysis revealed that COVID-19 positive cases experiencing dyspnoea have significantly higher white cell count (WCC) (OR 1.22, 95% CI 1.02–1.46, p=0.029) and troponin levels (OR 1.15, 95% CI 1.02–1.29, p=0.015) and lower haemoglobin levels at follow-up (OR 0.66, 95% CI 0.5–0.86, p&amp;lt;0.002), Figure 2. Conclusion Patients previously infected with COVID-19 have persistent symptomatology at medium-term follow-up. The role of troponin, together with markers of inflammation and endothelial dysfunction at long-term follow-up merit further investigation. Funding Acknowledgement Type of funding sources: None.

Clinical characteristics, patient selection and clinical outcomes of tafamidis treatment in transthyretin amyloidosis cardiomyopathy

Abstract Background Tafamidis is a stabilizer of transthyretin, specifically designed to decrease or prevent amyloidogenesis, and improves prognosis in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). However, clinical coarse, selection of appropriate patients and monitoring therapeutic effect of tafamidis remained unclear. Purpose The aim of this study was to clarify the patients' characteristics, clinical coarse, and clinical outcomes of tafamidis in patients with ATTR-CM and to evaluate prognostic factors and changes in clinical data over time. Methods We evaluated consecutive 180 patients with ATTR-CM considering tafamids treatment. A total of 107 patients had tafamidis treatment (tafamidis treatment group) and 65 patients did not treat with tafamidis (treatment naïve group). The remaining 8 patients were preclinical. Clinical data were obtained at the consideration of tafamidis treatment. We divided the following the cut-off values of high-sensitivity cardiac troponin T (hs-cTnT); &amp;gt;0.05 ng/mL, B-type natriuretic peptide (BNP); &amp;gt;250 pg/ml, and estimated glomerular filtration rate (eGFR); &amp;lt;45 mL/min/1.73 m2 and calculated the score by adding 1 point if increased or decreased by more than the cut-off value. We divided patients into a low score group (0–1 point) and high score group (2–3 points). Results All of study patients in the tafamidis treatment group were wild-type ATTR-CM. Compared to tafamidis treatment group, tafamidis naïve group were significantly older (75.6±5.3 vs. 82.8±4.6 years; p&amp;lt;0.01), female dominant (8% vs. 28%; p&amp;lt;0.01), increased BNP levels (median 209 vs 306 pg/ml; p&amp;lt;0.01), and lower haemoglobin levels (14.1±1.8 vs. 12.4±1.8 g/dl; p&amp;lt;0.01). Tafamidis treatment group was significantly favourable clinical outcomes competed to treatment naïve group (p&amp;lt;0.05; log rank test). According to multivariate logistic regression analysis, prior heart failure hospitalization (hazard ratio [HR]: 5.93, 95% confidence interval [CI]: 1.25–28.03, p=0.03) and high score group (HR: 1.56, 95% CI: 0.37–7.25; &amp;lt;0.01) were the significant poor prognostic factors in tafamids treatment group. Among tafamidis treatment group, Hs-cTnT levels were significantly decreased after 12 months tafamidis treatment (0.055 [0.037–0.082] vs. 0.044 [0.033–0.077]; p&amp;lt;0.01) instead of no significant differences in BNP and significant decline of eGFR levels. There were no significant changes over time in the echocardiographic parameters after 12 months, and native T1 and extracellular volume fraction obtained by cardiac magnetic resonance in a limited number of patients. Conclusion The prognosis of ATTR-CM patients treated with tafamidis was favorable compared to tafamidis naïve group. Patient stratification combined with biomarkers predicted favorable prognosis in patients with tafamidis treatment. Hs-cTnT may be a useful maker for evaluating the therapeutic effect by tafamidis. Funding Acknowledgement Type of funding sources: None.

Impact of atrial fibrillation on outcome of percutaneous mitral valve repair (PMVR) procedure

Abstract Background Limited evidence exists regarding the impact of atrial fibrillation (AF) on outcomes after percutaneous mitral valve repair (PMVR). The aim of the present study was to compare 1-year clinical outcomes following PMVR in patients with and without AF. Methods 426 patients with PMVR for severe MR were included in the COburg MItraclip (COMI) registry between 2016 and 2021. Patients were divided into an AF group (group A, n=284) and a non-AF group (group B, n=142). Clinical profiles, PMVR procedure characteristics and the clinical follow-up were compared between the two groups. Results Patients with AF were older (79.3±6.3 [AF] vs. 77.8±8 years [non-AF], p=0.03), had higher N-terminal B-type natriuretic peptide levels (NT-pro BNP: 5675±5544.2 vs 8516±11184.5, p=0.004), more often a coronary artery disease (62% vs 38%, p=0.03) and had a lower stroke risk (CHA2DS2-VASc score: 4.6±1.2 vs 4.9±1.3, p=0.01). There were no significant differences between groups with regard to the gender, logistic Euroscore or prevalence of chronic heart failure, hypertension, diabetes mellitus or severe mitral regurgitation. Acute procedural success (post-procedural 2. MR, 95.1% vs. 94.4%; p=0.76) and procedure-related major complications were similar. There were no significant differences in 1-year MACCE (death, MI, stroke, bleeding), health-related quality of life or clinical improvement. Conclusion In patients with mitral regurgitation who underwent PMVR, AF is common and appears not to have a relevant negative impact on the clinical outcome at 1 year compared to patients with sinus rhythm. Funding Acknowledgement Type of funding sources: None.

Tayside Screening For Cardiac Events (TASCFORCE) study: a prospective cardiovascular risk screening study

PurposeRisk factor-based models struggle to accurately predict the development of cardiovascular disease (CVD) at the level of the individual. Ways of identifying people with low predicted risk who will develop...

Effects of DPP4 Inhibitor in Platelet Reactivity and Other Cardiac Risk Markers in Patients with Type 2 Diabetes and Acute Myocardial Infarction.

Background: The management of acute myocardial infarction (AMI) presents several challenges in patients with diabetes, among them the higher rate of recurrent thrombotic events, hyperglycemia and risk of subsequent heart failure (HF). The objective of our study was to evaluate effects of DPP-4 inhibitors (DPP-4i) on platelet reactivity (main objective) and cardiac risk markers. Methods: We performed a single-center double-blind randomized trial. A total of 70 patients with type 2 diabetes (T2DM) with AMI Killip ≤2 on dual-antiplatelet therapy (aspirin plus clopidogrel) were randomized to receive sitagliptin 100 mg or saxagliptin 5 mg daily or matching placebo. Platelet reactivity was assessed at baseline, 4 days (primary endpoint) and 30 days (secondary endpoint) after randomization, using VerifyNow Aspirin™ assay, expressed as aspirin reaction units (ARUs); B-type natriuretic peptide (BNP) in pg/mL was assessed at baseline and 30 days after (secondary endpoint). Results: Mean age was 62.6 ± 8.8 years, 45 (64.3%) male, and 52 (74.3%) of patients presented with ST-segment elevation MI. For primary endpoint, there were no differences in mean platelet reactivity (p = 0.51) between the DPP-4i (8.00 {−65.00; 63.00}) and placebo (−14.00 {−77.00; 52.00}) groups, as well in mean BNP levels (p = 0.14) between DPP-4i (−36.00 {−110.00; 15.00}) and placebo (−13.00 {−50.00; 27.00}). There was no difference between groups in cardiac adverse events. Conclusions: DPP4 inhibitor did not reduce platelet aggregation among patients with type 2 diabetes hospitalized with AMI. Moreover, the use of DPP-4i did not show an increase in BNP levels or in the incidence of cardiac adverse events. These findings suggests that DPP-4i could be an option for management of T2DM patients with acute MI.

Long-term outcomes of papillary muscle relocation anteriorly for functional mitral regurgitation.

This study aimed to evaluate the outcomes of the patients who underwent restrictive annuloplasty (RA) plus papillary muscle relocation anteriorly (PMR-A) with the risk factors in mitral valve repair for functional mitral regurgitation (FMR). Eighty-six patients underwent mitral valve repair with RA for FMR. Thirty-five of them received additional bilateral papillary muscle relocation for severe leaflet tethering. The papillary muscles were relocated posteriorly (PMR-P) early in the study. Then, in the later period, the technique was modified to PMR-A, in which the papillary muscles were relocated anteriorly for 24 cases. The survival of the patients undergoing RA + PMR-A was examined retrospectively, adjusting for differences in patient background. Twenty-three deaths were observed during the follow-up period out of the 86 cases. Independent preoperative risk factors for survival were left ventricular ejection fraction, patient age and B-type natriuretic peptide (BNP) level. Among the patients with BNP <1000 pg/ml, 5-year survival after RA plus PMR-A was 84.7%, while RA alone was 78.6% and RA + PMR-P 57.1%. Cox proportional hazards regression adjusted for the preoperative risk factors showed a significantly higher hazard ratio of RA + PMR-P to RA + PMR-A (12.77, P = 0.011), while the hazard ratio of RA alone to RA + PMR-A was not significantly different. Furthermore, reverse remodelling of the left ventricle was observed for 3 years only in RA + PMR-A. Long-term survival for patients who underwent RA plus bilateral PMR-A was promising. Patients with significantly higher BNP had lower survival after valve repair for FMR.

Monitoring for atrial fibrillation prior to patent foramen ovale closure after cryptogenic stroke.

Patients who had a cryptogenic stroke (CS) suspected to be causally related to a patent foramen ovale (PFO) are candidates for percutaneous PFO closure. In such patients, it is important to screen for atrial fibrillation (AF). Limited guidance is available regarding AF monitoring strategies in CS patients with PFO addressing optimal monitoring technology and duration. To provide a narrative review of cardiac rhythm monitoring in CS patients considered for PFO closure, including current practices, stroke recurrences after CS, findings from monitoring studies in CS patients, and predictors for AF detection published in the literature. To propose a personalized strategy for cardiac monitoring in CS patients, accounting for aspects predicting AF detection. AF detection in CS patients is predicted by age, left atrial enlargement, prolonged PR interval, frequent premature atrial contractions, interatrial conduction block, diabetes, prior brain infarctions, leukoaraiosis, elevated B-type natriuretic peptide (BNP)/N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and a family history of AF, as well as composed scores (e.g. CHA2DS2-VASc, atrial fibrillation in embolic stroke of undetermined source (AF-ESUS)). The causal role of the PFO may be accounted for by the risk of paradoxical embolism (RoPE) score and/or the PFO-Associated Stroke Causal Likelihood (PASCAL) classification. A personalized approach to AF detection in CS patients is proposed, accounting for the likelihood of AF detection and aimed at obtaining sufficient confidence regarding the absence of AF in patients considered for PFO closure. In addition, the impact of high-risk PFO features on the monitoring strategy is discussed.

Failure to use health services by people with Chagas disease: Multilevel analysis of endemic area in Brazil.

This study aimed to assess the prevalence of non-use of health services in the last year by people with Chagas disease (CD) in an endemic area in Brazil and the contextual and individual factors associated with this non-use. This is a multilevel study that considered contextual and individual data. Contextual data were collected from official publicly accessible databases of the Brazilian government, at the municipal level. The individual data came from the first follow-up of a Brazilian cohort that assessed patients with CD in 21 municipalities in endemic area for the disease. The sample consisted of 1,160 individuals with CD. The dependent variable “use of health services in the last year” was categorized as yes vs. no. The analysis was performed using Poisson regression with robust variance. The prevalence of non-use of health services in the last year was 23.5% (IC95%: 21.1–25.9). The contextual factor “larger population” (PR: 1.6; 95% CI = 1.2–2.0) and individual factors related to the lower severity of the disease as a functional class without limitations (PR: 1.6; 95% CI = 1.2–2.1) and unaltered N-terminal pro b-type natriuretic peptide levels (PR: 2.2; 95% CI = 1.3–3.6) increased the prevalence of non-use of the health service in the last year by people with CD. The results of this study showed that individual determinants are not isolated protagonists of the non-use of health services in the last year by people with CD, which reinforces the need for public policies that consider the contextual determinants of the use of health services by populations affected by the disease.