Concomitant Cardiac Disease Research Articles

Клінічна характеристика пацієнтів похилого віку з ураженням основного стовбура лівої коронарної артерії

​The​ ​aim – to analyze the clinical features of elderly patients with left main coronary artery disease (CAD).Materials and methods. This prospective cohort study included 124 patients with left main CAD aged 60 to 75 years (elderly age group) and 100 control patients aged 44 to 60 who underwent coronary angiography between September 2021 and July 2024. Demographic data, history of coronary artery disease and associated diseases, laboratory test results, results of echocardiography and coronary angiography were collected and analyzed. Results. Elderly patients were characterized by a significantly higher (p = 0.030) frequency of myocardial infarction, as well as higher (p = 0.035) frequency of previous percutaneous coronary interventions compared to middle-aged patients. Elderly patients also had a significantly higher functional class according to NYHA compared to middle-aged patients (p = 0.0005), significantly higher rate of arterial hypertension (p = 0.012), diabetes mellitus (p = 0.033), cerebrovascular disease (p = 0.009), chronic kidney disease (p = 0.011) and anemia (p = 0.044), compared to middle-aged patients. Moreover, elderly patients were characterized by significantly higher creatinine, LDL and glucose levels.Conclusions. Elderly patients with left main CAD were characterized by a more severe course of the disease, more severe coronary lesions, and a higher frequency of concomitant cardiac and non-cardiac diseases compared to middle-aged patients.

Multimodality Imaging in the Management of Tricuspid Valve Regurgitation.

Approximately 5% of elderly patients suffer from moderate or severe tricuspid valve regurgitation, which is an independent predictor of high morbidity and mortality. Surgical treatment of isolated tricuspid valve regurgitation has been associated with elevated fatality rate, leading to a growing interest in minimal invasive, transcatheter-based therapies such as transcatheter edge-to-edge repair and transcatheter valve replacement. Nevertheless, despite high procedural efficacy and safety of transcatheter-based therapies, a number of challenges limit their rapid adoption in routine clinical practice. In particular, the wide range of transcatheter approaches to address the significant variability in tricuspid valve pathology challenges the reproducibility of clinical outcomes. Multimodality imaging is pivotal for grading the regurgitation severity, determining the underlying pathology, assessing RV function and pulmonary pressures, identifying concomitant cardiac disease, and selecting the most beneficial treatment modality and access. This article reviews the role of different imaging modalities in guiding the management of patients with significant tricuspid valve regurgitation.

Cardiovascular disease assessment and management in liver transplantation.

The prevalence and mortality related to end-stage liver disease (ESLD) continue to rise globally. Liver transplant (LT) recipients continue to be older and have inherently more comorbidities. Among these, cardiac disease is one of the three main causes of morbidity and mortality after LT. Several reasons exist including the high prevalence of associated risk factors, which can also be attributed to the rise in the proportion of patients undergoing LT for metabolic dysfunction-associated steatohepatitis (MASH). Additionally, as people age, the prevalence of now treatable cardiac conditions, including coronary artery disease (CAD), cardiomyopathies, significant valvular heart disease, pulmonary hypertension, and arrhythmias rises, making the need to treat these conditions critical to optimize outcomes. There is an emerging body of literature regarding CAD screening in patients with ESLD, however, there is a paucity of strong evidence to support the guidance regarding the management of cardiac conditions in the pre-LT and perioperative settings. This has resulted in significant variations in assessment strategies and clinical management of cardiac disease in LT candidates between transplant centres, which impacts LT candidacy based on a transplant centre's risk tolerance and comfort level for caring for patients with concomitant cardiac disease. Performing a comprehensive assessment and understanding the potential approaches to the management of ESLD patients with cardiac conditions may increase the acceptance of patients, who appear too complex, but rather require extra evaluation and may be reasonable candidates for LT. The unique physiology of ESLD can profoundly influence preoperative assessment, perioperative management, and outcomes associated with underlying cardiac pathology, and requires a thoughtful multidisciplinary approach. The strategies proposed in this manuscript attempt to review the latest expert experience and opinions and provide guidance to practicing clinicians who assess and treat patients being considered for LT. These topics also highlight the gaps that exist in the comprehensive care of LT patients and the need for future investigations in this field.

Multiple Cardiac Diseases Involving the Aortic Arch: Beating Heart Debranching, and Normothermic Arch Replacement: A Case Series

(1) Background: Conventional open surgery is still the gold standard for aortic arch disease, and despite recent developments in optimizing strategies for neuroprotection, distal organ perfusion, and myocardial protection, aortic arch replacement is still associated with high morbidity and mortality rates. (2) Methods: We present our case series of 12 patients undergoing surgical management of multiple cardiac diseases involving the aortic arch. In this single-center study, we report our initial experience over a five-year period (from December 2018 to October 2023) with the use of a “debranching first” technique for the supra-aortic vessels of a beating heart, followed by the cardiac step addressing proximal diseases, and a final distal step treating the aortic arch. This strategy aims to minimize cardiac, cerebral, and peripheral ischemia. (3) Results: Six patients underwent aortic root replacement with either Bentall (n = 4) or valve-sparing aortic root (David procedure) (n = 2). The mean nasopharyngeal temperature was 34 °C and the mean cardiocirculatory arrest was 14.3 min. The early mortality was 8.3% (1 patient); no patient experienced a permanent neurologic event. (4) Conclusions: In patients with complex aortic disease and concomitant cardiac disease, this approach reduces the need for hypothermia and decreases cardiopulmonary bypass time and myocardial arrest time and therefore could represent a valid surgical option, even in high-risk patients.

Romheld's Gastrocardiac Syndrome, diagnosing a complex of cardiologic and gastroenterologic symptoms


 In clinical practice among cardiac patients, symptoms of palpitations diagnosed as premature beats or episodes of atrial fibrillation (AF) are very frequently reported. One of the most common diseases in the field of gastroenterology is gastroesophageal reflux disease (GERD) . However, it may happen that the coincidence of the above-mentioned disease entities may predispose to the development of arrhythmias. 
 
 
 In this article we describe the case of a 65-year-old man, without previously diagnosed diseases, in whom a clear association of arrhythmias with gastrointestinal complaints was observed. 
 
 
 The presence of a burning sensation in the lower sternal region and typical symptoms resulting from esophagitis aggravated by triggers allows us to suspect esophageal reflux disease. Diagnostic tests performed for concomitant cardiac diseases did not reveal an organic cause of the arrhythmia. The recurrent course of symptoms observed in the present case and the analysis of the cause-effect course made us to diagnose gastrointestinal syndrome, also referred to as Romheld's Syndrome.

Foetomaternal Outcomes in Pregnant Women with Corrected vs Non corrected Heart Disease: A Cross-sectional Analysis at a Tertiary Care Institute of Eastern India

Introduction: Cardiac disease in pregnancy remains a major concern, particularly in developing countries like India. Pregnancy in women with heart disease increases the risk of maternal and foetal complications. Approximately 1% to 4% of pregnant women have concomitant cardiac disease. Aim: To examine the foetomaternal outcomes of pregnant women in the corrected vs. non corrected heart disease groups. Materials and Methods: This was a cross-sectional study conducted in the Department of Obstetrics and Gynaecology at IPGME&R, Kolkata, West Bengal, India, from February 2020 to July 2021. A total of 50 pregnant women were included in the present study, with 25 in the corrected heart disease group and 25 in the non corrected heart disease group. Foetomaternal outcomes, including intrapartum complications, maternal intensive care unit admission, mode of delivery, and foetal complications, were observed. Comparative analyses were conducted using the Student’s t-test and Chi-square test. The p-values <0.05 was considered statistically significant. Results: Data from the present study showed that out of a total of 50 pregnant women with heart disease, the majority (60%) were young (≤25 years). Approximately 48% of women were in their second pregnancy. The most common cardiac lesion in the corrected group was closure of Atrial Septal Defect (ASD) in 8 (16%) cases, while in the non corrected group, the most common was mitral regurgitation in 11 (22%) cases. In the corrected heart disease group, 15 (30%) had a caesarean section and 10 (20%) delivered vaginally, whereas in the non corrected group, 17 (34%) had a caesarean section and 8 (16%) delivered vaginally. Adverse cardiac events occurred in 2 (4%) of the corrected group, whereas 11 (22%) were observed in the non corrected group (p-value=0.0088, significant). Preterm birth and low birth weight babies were more common in the non corrected heart disease group (p-value=0.0449, significant). Conclusion: The study concludes that most women with cardiac disease are young. Compared to the Corrected Group of Heart Disease (CGHD), the non corrected group of pregnant women are more likely to experience severe cardiac complications and require admission to the intensive care unit. The foetomaternal outcome is better in the corrected group. Successful management of pregnant women with heart disease requires a comprehensive multidisciplinary approach to optimise foetomaternal outcomes.

Abstract 15167: The Use of Echocardiography in Patients With Advanced Peripheral Arterial Disease

Introduction: Patients with peripheral arterial disease (PAD) are at high risk of concomitant cardiac diseases. Transthoracic echocardiography (TTE) is a common imaging modality to assess cardiac function and is used as a screening tool, especially for patients with advanced PAD undergoing lower extremity revascularization (LER). The current study evaluates the incidental use of TTE in patients undergoing LER. Hypothesis: Patients with a perioperative TTE have improved outcomes compared to patients who do not undergo TTE. Methods: The electronic records of patients undergoing LER between 2013-2020 were reviewed. All TTE within 6 months of initial LER were captured. Patient characteristics and outcomes were compared between patients who underwent TTE and those who did not. Results: A total of 1,988 patients underwent LER, and 69.3% (N=1,377) had TTE. Patients in the TTE group were more likely to be African American and have diabetes mellitus, chronic kidney disease, and coronary artery disease. Patients with TTE were more likely to be on aspirin and undergo open/hybrid revascularization. There was no significant difference between the 2 groups in perioperative MI, major amputation, or mortality. Furthermore, patients with TTE had higher MALEs. (Table) However, there were no differences in MALE-free survival between the two groups (Figure 1) Conclusion: TTE was obtained in 69.3% of patients with advanced PAD undergoing LER but did not seem to be associated with outcomes in this institutional series. Further research is warranted to identify PAD patients that would benefit from TTE prior to LER.

Safety and Efficacy of Liraglutide, 3.0 mg, Once Daily vs Placebo in Patients With Poor Weight Loss Following Metabolic Surgery

Metabolic surgery leads to weight loss and improved health, but these outcomes are highly variable. Poor weight loss is associated with lower circulating levels of glucagon-like peptide-1 (GLP-1). To assess the efficacy and safety of the GLP-1 receptor agonist, liraglutide, 3.0 mg, on percentage body weight reduction in patients with poor weight loss and suboptimal GLP-1 response after metabolic surgery. The Evaluation of Liraglutide 3.0 mg in Patients With Poor Weight Loss and a Suboptimal Glucagon-Like Peptide-1 Response (BARI-OPTIMISE) randomized placebo-controlled trial recruited adult patients at least 1 year after metabolic surgery who had experienced 20% or less body weight loss from the day of surgery and a suboptimal nutrient-stimulated GLP-1 response from 2 hospitals in London, United Kingdom, between October 2018 and November 2019. Key exclusion criteria were type 1 diabetes; severe concomitant psychiatric, gastrointestinal, cardiac, kidney or metabolic disease; and use of insulin, GLP-1 receptor analogues, and medication that can affect weight. The study period was 24 weeks followed by a 4-week follow-up period. Last participant follow-up was completed in June 2020. All participants and clinical study personnel were blinded to treatment allocation. Of 154 assessed for eligibility, 70 met trial criteria and were included in the study, and 57 completed follow-up. Liraglutide, 3.0 mg, once daily or placebo as an adjunct to lifestyle intervention with a 500-kcal daily energy deficit for 24 weeks, on a 1:1 allocation by computer-generated randomization sequence, stratified by surgery type (Roux-en-Y gastric bypass [RYGB] or sleeve gastrectomy [SG]) and type 2 diabetes status. The primary outcome was change in percentage body weight from baseline to the end of the 24-week study period based on an intention-to-treat analysis. Participant safety was assessed through monitoring of biochemical parameters, including kidney and liver function, physical examination, and assessment for adverse events. A total of 70 participants (mean [SD] age, 47.6 [10.7] years; 52 [74%] female) with a poor weight loss response following RYGB or SG were randomized to receive 3.0-mg liraglutide (n = 35) or placebo (n = 35). All participants received at least 1 dose of the trial drug. Eight participants discontinued treatment (4 per group), and 2 in the 3.0-mg liraglutide group and 1 in the placebo group were lost to follow-up. Due to COVID-19 restrictions, 3 participants in the 3.0-mg liraglutide group and 7 in the placebo group were unable to attend their final in-person assessment. Estimated change in mean (SD) percentage body weight from baseline to week 24 was -8.82 (4.94) with liraglutide, 3.0 mg (n = 31), vs -0.54 (3.32) with placebo (n = 26). The mean difference in percentage body weight change for liraglutide, 3.0 mg, vs placebo was -8.03 (95% CI, -10.39 to -5.66; P < .001). Adverse events, predominantly gastrointestinal, were more frequent with liraglutide, 3.0 mg (28 events [80%]), than placebo (20 events [57%]). There were no serious adverse events and no treatment-related deaths. These findings support the use of adjuvant liraglutide, 3.0 mg, for weight management in patients with poor weight loss and suboptimal GLP-1 response after metabolic surgery. ClinicalTrials.gov Identifier: NCT03341429.

Amsacrine-based induction therapy in AML patients with cardiac comorbidities: a retrospective single-center analysis

Intensive chemotherapy is the backbone of induction treatment in patients with acute myeloid leukemia (AML). However, AML patients with concomitant cardiac disease may not be eligible for anthracycline-based therapies. In a small cohort of patients, we have previously shown that anthracycline-free, amsacrine-based chemotherapy TAA (thioguanine, cytarabine, amsacrine) may be as effective as cytarabine/daunorubicin for induction therapy in these patients. In this systematic retrospective single-center analysis, we documented the outcome of 31 patients with significant cardiac comorbidities including coronary heart disease or cardiomyopathy receiving TAA as induction chemotherapy. Median (range) ejection fraction (EF) was 48% (30–67%) in this cohort. Patients with EF below 30% were considered unfit for intensive induction therapy. Event-free survival (EFS), overall survival (OS), and relapse-free survival (RFS) were 1.61, 5.46, and 13.6 months respectively. Poor outcome was primarily related to a high early mortality rate within the first 30 days of therapy, mainly caused by infectious complications. TAA cannot be recommended as a substitute of standard induction for AML patients with significant concomitant cardiac disease. In the era of novel agents, alternative strategies (e.g., hypomethylating agents plus venetoclax) should be considered when anthracycline-based regimens are not suitable.

Anterior and posterior tracheopexy for severe tracheomalacia.

Congenital tracheomalacia can be the cause of respiratory failure in young children. Although the indication for surgical treatment has already been discussed vigorously, no clear guidelines about the modality are available. Through a sternotomy approach, a combination of posterior pexy and anterior tracheopexy using a tailored ringed polytetrafluoroethylene prosthesis is performed. Patient demographic characteristics, as well as operative details and postoperative outcomes, are included in the analysis. Between 2018 and 2022, 9 children underwent the operation under review. All patients showed severe clinical symptoms of tracheomalacia, which was confirmed on bronchoscopy. The median age was 9months. There was no operative mortality. Eight patients could be weaned from the ventilator. One patient died because of interstitial lung disease with bronchomalacia and concomitant severe cardiac disease. The longest follow-up now is 4years, and shows overall excellent clinical results, without any reintervention. Surgical treatment of tracheomalacia through a combination of posterior and anterior pexy is feasible, with acceptable short- and midterm results.

Surgical myectomy in patients with obstructive hypertrophic cardiomyopathy and concomitant cardiac diseases

Surgical myectomy in patients with obstructive hypertrophic cardiomyopathy and concomitant cardiac diseases

Surgical extraction of cardiac implantable electronic device leads based on a heart team approach

BackgroundAs cardiac implantable electronic devices, such as pacemakers, cardioverter defibrillators, and cardiac resynchronization therapies, have become more popular, device extraction has become more frequent. At our institution, individual treatment strategies are discussed at a heart team meeting. Transvenous lead extraction (TVLE) is a first-line treatment; however, surgical lead extraction (SLE) is sometimes selected as a primary choice to provide optimal treatment and maintain the medical safety policy. This study aimed to investigate the validity of this heart team decision-making. MethodsFrom 2013 to 2021, 384 consecutive patients underwent lead extraction at our institution. ResultsSLE was proposed as the primary intervention for 21 patients who had high risk of bleeding, difficult TVLE conditions, large vegetations, and other concomitant cardiac diseases. Of the 363 TVLE patients, 10 patients required surgical intervention; 5 had TVLE difficulty followed by SLE and 5 had excessive bleeding. SLE was performed in 26 patients, 19 of whom required valve surgery, and 8 required plication of the great veins. In 4 of the 17 hybrid procedures with SLE and TVLE, excessive bleeding occurred due to laceration of the superior vena cava and innominate vein. Operative mortality was not observed in SLE patients but was observed in 1 of the 4 TVLE patients who required emergent open-chest hemostasis. ConclusionsThe heart team discussion was essential to provide optimal treatment and maintain medical safety policies for each patient. SLE should be selected for patients with high risk of TVLE or other cardiac complications such as tricuspid valve incompetence.

Complex High-Risk Indicated Percutaneous Coronary Intervention With Prophylactic Use of the Impella CP Ventricular Assist Device.

Patients with complex coronary artery disease, concomitant cardiac disease, and multiple comorbidities are addressed as complex higher-risk indicated patients (CHIPs). Selecting a revascularization strategy in this population remains challenging. If coronary artery bypass grafting is deemed high risk or patients are considered inoperable, high-risk percutaneous coronary intervention (PCI) with the support of the Impella CP ventricular assist device (Abiomed) may be an attractive alternative. In this retrospective, multicenter study, we included consecutive patients undergoing Impella CP-facilitated complex high-risk PCI. All patients were discussed by the heart team and were declined for surgery. Additionally, periprocedural mechanical circulatory support was deemed necessary. We collected demographic, clinical, and procedural characteristics. Major adverse cardiac event (MACE) and mortality rates up to 30 days were evaluated. A total of 27 patients (median age, 73 ± 9.7 years; 74.1% men) were included in our study. The median SYNTAX score was 32 (range, 8-57) and EuroSCORE was 7.25% (range, 1.33-49.66; ± 12.76%). Periprocedural hemodynamic instability was observed in 1 patient (3.7%). In-hospital combined with 30-day mortality was 7.4% (2/27). No repeat revascularization was necessary. MACE was observed in 10 patients (37.0%). Six patients (22.2%) had a major bleeding complication, of which 2 were related to Impella access site. Median Impella run time was 1.22 hours and there was no significant decrease in kidney function. Median admission time after PCI was 3 days (range, 1-23; ± 4.76). The Impella CP system showed good feasibility and provided adequate hemodynamic support during high-risk PCI in this CHIP population.

Restrictions of VC and DLCO in relation to asbestos-related computed tomographic findings quantified by ICOERD-based parameters

BackgroundEven almost 30 years after the ban on the use of asbestos in Germany, the effects of asbestos are still highly relevant in everyday clinical practice in occupational medicine. The aim of this study was to further investigate the significance of essential parameters of both pulmonary function diagnostics and imaging techniques (low-dose HR-TCT) for the prevention and early detection of asbestos-related morphological and functional lung changes.MethodsData from spirometry, body plethysmography and diffusion capacity, as well as CT images of the thorax, were retrospectively studied from 72 patients examined between 2017 and 2019 at the Institute for Occupational and Maritime Medicine (ZfAM), Hamburg, Germany. The subjects were divided into four subgroups according to the presence of comorbidities (concomitant cardiac diseases, obstructive ventilatory disorder, pulmonary function pattern consistent with emphysema, and no other pulmonary or cardiac diseases). These subgroups were analysed in addition to the overall collective. The CT images were evaluated according to the International Classification of Occupational and Environmental Respiratory Diseases (ICOERD) with radiological expertise. In addition, some asbestos-related parameters were newly quantified, and corresponding scores were defined based on ICOERD. Statistical analysis included the use of correlations and fourfold tables with calculation of Spearman's rho (ρ), Cohen’s κ, and accuracy.ResultsVital capacity (VC) is slightly reduced in the total collective compared to the normal population (mean 92% of predicted value), while diffusion capacity for CO (DLCO) shows predominantly pathological values, mean 70% of the respective predicted value. The CO transfer coefficient (DLCO/VA), which refers to alveolar volume (VA), also shows slightly decreased values (mean 87% pred.). Seventy-nine percent of patients (n = 57) had signs of pulmonary fibrosis on CT scans, and pleural plaques appeared in 58 of 72 patients (81%). Of the newly quantified additional parameters, particularly frequently described findings are subpleural curvilinear lines (SC, n = 39) and parenchymal bands (PB, n = 29). VC correlates well with the expression of pleural plaques (ρ = − 0.273, P < 0.05), and DLCO measures show a better correlation with fibrosis score (ρ = − 0.315, P < 0.01). A third, newly developed score, which includes the extent of pleural plaques and additional subpleural parameters instead of fibrosis parameters, shows significant correlations for both VC and DLCO (ρ = − 0.283, − 0.274, resp.; both P < 0.05).DiscussionThe importance of spirometry (VC) and diffusion capacity measurement (DLCO) as essential diagnostic procedures for the early detection of asbestos-related changes ‒ also including patients with relevant concomitant cardiac or pulmonary diseases ‒ was confirmed. Significant and better correlations between lung function changes (VC and DLCO) and abnormal CT findings are seen when parenchymal bands (PB), subpleural curvilinear lines (SC), and rounded atelectasis (RA) are quantitatively included into the evaluation, in addition to assessing the extent of pleural plaques alone. Therefore, when assessing CT images according to ICOERD, these parameters should also be quantified.

A Case Series of Concomitant Cardiac Electrical Disease among Takotsubo Syndrome Patients and Literature Review.

The pathophysiology of Takotsubo Syndrome (TTS) is not completely understood and the trigger of sudden cardiac death (SCD) in TTS is not clear either. We therefore sought to find an association between TTS and primary electrical diseases. A total of 148 TTS patients were analyzed between 2003 and 2017 in a bi-centric manner. Additionally, a literature review was performed. The patients were included in an ongoing retrospective cohort database. The coexistence of TTS and primary electrical diseases was confirmed in five cases as the following: catecholaminergic polymorphic ventricular tachycardia (CPVT, 18-year-old female) (n = 1), LQTS 1 (72-year-old female and 65-year-old female) (n = 2), LQTS 2 (17-year-old female) (n = 1), and LQTS in the absence of mutations (22-year-old female). Four patients suffered from malignant tachyarrhythmia and recurrent syncope after TTS. Except for the CPVT patient and one LQTS 1 patient, all other cases underwent subcutaneous ICD implantation. An event recorder of the CPVT patient after starting beta-blocker did not detect arrhythmias. The diagnosis of primary electrical disease was in 80% of cases unmasked on a TTS event. This diagnosis triggered a family clinical and genetic screening confirming the diagnosis of primary electrical disease. A subsequent literature review identified five cases as the following: a congenital atrioventricular block (n = 1), a Jervell and Lange-Nielsen Syndrome (n = 1), and a family LQTS in the absence of a mutation (n = 2), LQTS 2 (n = 1). A primary electrical disease should be suspected in young and old TTS patients with a family history of sudden cardiac death. In suspected cases, e.g., ongoing QT interval prolongation, despite recovery of left ventricular ejection fraction a family screening is recommended.

Role of Extra-anatomic Ascending to Descending Bypass in Complex Thoracic Aortic Pathology.

Complex pathology of the distal arch and proximal descending thoracic aorta is usually approached by stent endografting or in situ graft replacement. Oftentimes, these options are not feasible due to unfavorable anatomy, multiple previous procedures, active infection, or presence of concomitant cardiac disease. Thoracic aortic extra-anatomic bypass, as part of an open surgical strategy, is a useful and often the only curative option left for the treatment in these patients. Herein, we describe two cases that illustrate the utility of extra-anatomic thoracic aortic bypass for complex aortic disease.

Incidence, prognosis, and risk factors of sepsis-induced cardiomyopathy.

BACKGROUNDAt present, large-scale studies on the clinical characteristics of sepsis-induced cardiomyopathy (SIC) are lacking. AIMTo investigate the clinical characteristics of SIC.METHODSBased on the analysis of the MIMIC-III public database, we performed a large-scale retrospective study involving sepsis patients who were admitted to the intensive care unit (ICU) and had no concomitant cardiac disease. We used propensity score matching analysis and multivariate logistic regression to ensure the robustness of the results. The primary outcome was hospital mortality, and the secondary outcomes included the number of patients who received mechanical ventilation or renal replacement therapy during their hospital stay, the number of patients administered with vasopressors, the length of ICU stay, and the length of hospital stay.RESULTSIn the present study, after screening 38605 patients, 3530 patients with sepsis were included. A total of 997 patients met the SIC diagnostic criteria, and the incidence of SIC was 28.20% (95% confidence interval [CI]: 26.80%-29.70%). Compared to patients in the non-SIC group, patients in the SIC group were of older age and had a higher Simplified Acute Physiology Score (SAPS)-I score, SAPS-II score, and Elixhauser comorbidity index (ECI). A total of 367 (36.8%) of 997 patients in the SIC group and 818 (32.3%) of 2533 patients in the non-SIC group died in the hospital, which resulted in a significant between-group difference (odds ratios = 1.22, 95%CI: 1.05-1.42; P = 0.011). For the secondary outcomes, more patients in the SIC group received mechanical ventilation and vasopressors. Multivariate logistic regression analysis showed that age, male sex, ECI, hemoglobin level, diabetes, and mechanical ventilation use on the first day of ICU admission were risk factors for SIC.CONCLUSIONCompared with non-SIC patients, hospital mortality is higher in SIC patients.

Prognostic value of myocardial injury biomarker in COVID-19: a systematic review and meta-analysis

Abstract Background An accurate prognostic tool that can help with risk stratification at first admission is crucial in COVID-19 patients, as severe complications and mortality rate can be reduced with prompt treatment and close follow up. The myocardial injury biomarker, Troponin, is reported to be a potential predictor of mortality in COVID-19 cases. Purpose This study aims to investigate the utility of cardiac troponin level as a prognosis tool in COVID-19 patients. Methods On March 12th, 2021, data was collected from PMC, PubMed, Google Scholar, Science Direct, and Scopus, using combination of keywords associated with myocardial injury biomarker, Troponin, and its prognostic value for mortality in COVID-19 patients. Included publications are original clinical trials, limited to those with English manuscripts, and all were reviewed and evaluated by 5 authors to minimise bias. Inclusion criteria for studies are original clinical trials with a study population of adults (≥18 years old) patients with confirmed SARS-CoV-2 infection through PCR. The quality of each studies included was assessed using the Newcastle-Ottawa Scale (NOS) and data synthesis and statistical analysis were carried out using Review Manager software. Results A total of 19 studies consisting of 13,789 COVID-19 patients were included. All 19 studies were good quality according to the NOS. Studies found that myocardial injury, indicated by the elevation of its biomarker, Troponin, is a strong predictor of in-hospital mortality. Furthermore, elevated troponin level itself is an independent marker of mortality, regardless of its concomitant cardiac disease. Meta-analysis of 9 included studies revealed a significant association between elevated cardiac troponin levels and mortality (HR 4.13; 95% CI 3.42 - 5.00; P&amp;lt;0.001). Based on GRADE, the result of this systematic review and meta-analysis proved to be moderate in quality as there are no inconsistency and variability in results and there are no publication biases. Conclusion Cardiac troponin level is found to be a strong predictor of mortality in COVID-19 patients and therefore should be treated both as an evaluation for cardiac involvement and as an important prognostic marker. Patients with elevated troponin levels within admission should be closely monitored and given prompt treatment to decrease mortality. Funding Acknowledgement Type of funding sources: None. Forest plot figure

Ascending Aortoiliac Bypass for One-Stage Repair of Adult Aortic Coarctation With Concomitant Cardiac Lesions.

To evaluate the efficacy and safety of ascending aortoiliac bypass surgery for one-stage repair of adult coarctation of the aorta (CoA) and concomitant cardiac disease. From March 2012 to October 2018, 51 consecutive CoA patients were treated with ascending aorta to bilateral iliac artery bypass concomitant with and cardiac surgerical procedures performed for a variety of reasons. A Y-shaped graft was used for the bypass procedure. We evaluated early outcomes, including postoperative death, systolic blood pressure and differences between upper and lower limb blood pressure. The average age was 41years and 64.7% of patients were men. Simultaneous cardiac procedures included aortic valve replacement, ventricular septal defect repair, Bentall procedures and Wheat procedures. No deaths occurred in the early postoperative period. Three patients had delayed healing at the site of the abdominal lower quadrant incisions. The average systolic pressure in the upper limb and the average difference between the upper- and lower-limb blood pressure decreased significantly after surgery (162.7 ± 13.4mmHg vs 128.4 ± 6.7mmHg, P = .000; 69.6 ± 15.6mmHg vs 8.7 ± 7.6mmHg, P = .000, respectively); The systolic blood pressure in the lower limb increased after bypass surgery (93.1 ± 6.2mmHg vs 119.6 ± 7.7mmHg, P = .000). The follow-up rate was 100%, with an average follow-up time of 61months. Six patients (11.8%) had graft stenosis or occlusion. Three patients (5.9%) underwent endovascular embolectomy. In our small series, ascending aortoiliac bypass for one-stage repair of CoA with concomitant cardiac lesions appears safe and efficacious in effectively reduceing differences between upper and lower limb systolic blood pressure. Further study with larger sample size and longer follow-up is needed.

Coronary artery fistula features associated with clinical symptoms in adults with non coronary artery disease detected with coronary computed tomography angiography

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): National Cardiovascular Center Harapan Kita, Jakarta, Indonesia Background Coronary artery fistula (CAF) is rare coronary artery anomaly (&amp;lt;1% in general population). It is often diagnosed accidentally during coronary angiography. Most of CAF cases have no clinical significance, however, some may present with hemodynamic instabilities, requiring invasive or surgical intervention. Recently, coronary computed tomography angiography (CCTA) has been increasingly used to detect CAF at higher rates. Correlation between CAF and significance of clinical presentation, however, remains unclear. Purpose To evaluate association of CAF features with any symptomatic trends present in non coronary artery disease (CAD) patients. Methods This was a single-center, observational, analytic cross-sectional study. A total 45 cases of CAF with no documented CAD or non-significant stenosis CAD diagnosed by coronary CT angiography were collected from 10,175 consecutive patients in National Cardiovascular Center Harapan Kita spanning 5-years from January 2015 to December 2019. The imaging findings, morphologic features and relevant clinical history were recorded and analyzed. Results The prevalence of CAF determined with CCTA in our study was 0.44%. Among 45 patients with CAF, thirty (67%) were female. Mean age was 49.4 ± 12.9 years. Most common symptoms reported, in decreasing frequency, were chest pain (60%), dyspnea (22.2%), palpitation/arrhythmia (11.2%), syncope (4.4%) and general weakness (2.2%). Most common site of CAF origin was the left anterior descending artery (66.7%), followed by right coronary artery (51.1%). The fistula most commonly terminated in the main pulmonary artery (75.5%). The CAF size, in descending order, were small (35.6%), medium (33.3%), and large (20%). Mixed and multiple CAF were presented in 5 cases (11.1%). Aneurysm formation were identified in 10 cases (22.2%). CAF were mainly associated with congenital atrial and ventricular septal defects (6.7%; 4.4%, respectively). Other coexistent cardiac abnormalities presented with CAF were pulmonary hypertension (8.9%), infective endocarditis (4.4%), and pericardial effusion (2.2%). Large-sized CAF was significantly associated with chest pain and palpitation/arrhythmia (p = 0.017; p = 0.003, respectively). Aneurysm formation revealed to be significantly associated with chest pain and palpitation/arrhythmia (p = 0.044; p = 0.006, respectively) as well. Mixed and multiple CAF were significantly correlated with syncope (p = 0.003). CAF with concomitant cardiac diseases (congenital heart disease, pulmonary hypertension, valvular heart disease) were significantly associated with symptoms of chest pain and palpitation/arrhythmia as compared to isolated CAF only (p = 0.004; p = 0.007, respectively). Conclusion CAF features (large-sized, mixed and multiple, aneurysmal and presence of concomitant cardiac disease) were associated with significant trends of clinical symptoms in adults without CAD.