Division Of Cardiology Research Articles

Comparison of Oral Procainamide and Mexiletine Treatment of Recurrent and Refractory Ventricular Tachyarrhythmias

Background: Antiarrhythmic therapy for recurrent ventricular arrhythmias (VAs) in patients having undergone catheter ablation and in whom amiodarone and/or beta-blockers were ineffective or contraindicated is a controversial issue. Purpose: The present study sought to compare the efficacy and tolerability of oral procainamide and mexiletine in patients with recurrent ventricular arrhythmias when the standard therapy strategy failed. Methods: All patients with an implantable cardioverter defibrillator (ICD) treated with oral procainamide or mexiletine for recurrent ventricular tachycardia (VT) or ventricular fibrillation (VF) in two cardiology divisions between January 2010 and January 2020 were enrolled. Patients were divided into group A (oral procainamide) and group B (mexiletine) and the two groups were compared to each other. The primary endpoint was the efficacy of therapy; the secondary endpoint was the discontinuation of therapy. All events that occurred during procainamide or mexiletine treatment were compared with a matched duration period before the initiation of the therapy. Antiarrhythmic therapy was considered effective when a ≥80% reduction of the sustained ventricular arrhythmias burden recorded by the ICD was achieved. Results: A total of 68 consecutive patients (61 males, 89.7%; mean age 74 ± 10 years) were included in this retrospective analysis. After a median follow-up of 19 months, 38 (56%) patients had a significant reduction in the VA burden. After multivariable adjustment, therapy with procainamide was independently associated with an almost 3-fold higher efficacy on VA suppression compared to mexiletine (HR 2.54, 95% CI 1.06–6.14, p = 0.03). Only three patients (9%) treated with procainamide presented severe side effects (dyspnea or hypotension) requiring discontinuation of therapy compared with six patients (18%) treated with mexiletine who interrupted therapy because of severe side effects (p = 0.47). Conclusions: Compared to mexiletine, oral procainamide had a higher efficacy for the treatment of recurrent and refractory VAs, and showed a good profile of tolerability.

Brief Version of Chinese Society of Cardiology Guidelines on the Diagnosis and Treatment of Adult Fulminant Myocarditis

Review Brief Version of Chinese Society of Cardiology Guidelines on the Diagnosis and Treatment of Adult Fulminant Myocarditis Hongyang Shu, Chen Chen, Luyun Wang, Jiangang Jiang and Daowen Wang * Division of Cardiology, Department of Internal Medicine and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China * Correspondence: dwwang@tjh.tjmu.edu.cn Received: 3 April 2024; Revised: 6 June 2024; Accepted: 25 June 2024; Published: 20 August 2024 Abstract: Fulminant myocarditis is an acute and severe diffuse inflammatory disease of the heart with a high mortality rate. Its pathogenesis is driven by overactivation of the innate immunity and inflammatory storms. Based on China’s practical experience, the clinical guidelines for the management of the disease recommend adoption of a “life support-based comprehensive treatment regimen” which comprises mechanical circulatory support and immunomodulatory therapy at optimized doses of glucocorticoids and immunoglobin rather than immunosuppression to improve survival rates and long-term prognosis. The application experience of this treatment regimen in China provides evidence upon which the guidelines are formulated. This regimen emphasizes the importance of early identification, diagnosis, prediction, and treatment in patients with fulminant myocarditis. This is a brief introduction of the guidelines.

ATRIAL FIBRILLATION IN A CIED POPULATION: RESULTS FROM A TELEMONITORING FOLLOW–UP

Abstract Background Telemedicine has emerged as a crucial tool in managing patients with Cardiac Implantable Electronic Devices (CIED), addressing the common challenge of the Atrial Fibrillation (AF) in cardiology. The incidence of AF in CIED recipients varies widely (30–70%), influenced by implant indication, device type, and population characteristics. This study aims to evaluate AF in an unselected, real–world CIED population, considering patients’ characteristics and the remote follow–up. Methods and Results 808 consecutive CIED recipients were evaluated between 2021 and 2023 in two Italian Division of Cardiology by collecting patients’ baseline characteristics and the scheduled remote follow–up data. Mean age was 75.6±12.6 years, 42% were females. 16.7% of the population was working actively and 73% of individuals were assisted by at least one caregiver, reflecting a diminished quality of life (EQ–5D score 8.9±4.3). Over a median follow–up of 20.6 months, 8.9% of patients died. 68.8% of the patients received a pacemaker, 19.3% an ICD and 11.9% a loop recorder. History of AF was present in 40.1% of the population, with a prevalence of permanent AF (46.6%). Ongoing anticoagulant therapy was documented in 303 patients (37.5%), 71% of whom were taking direct oral anticoagulants. Baseline CHA2DS2–VASC score was ≥3 in 79.7%, and the median HAS–BLED score was 1. During the observation period, scheduled remote transmissions revealed 719 AF episodes (15.7 episodes/patient/year), causing 21% of the overall remote alarms. Among patients without AF history, 69 (14.3%) experienced AF episodes (4.8 episodes/patient/year). Notably, 21.8% of the AF episodes lasted less than 10 minutes. Conclusions The wide spreading of heart rhythm monitoring technologies reveals the challenge of the subclinical AF in healthcare systems. This study, encompassing an unselected CIED population of elderly and frail patients with high AF prevalence, highlights AF as a primary cause of remote alerts and a substantial burden in telemonitoring controls. Telemedicine facilitated new AF diagnoses in 14.3% of individuals without a prior AF history and resulted a valuable tool considering the significant cardioembolic risk in these patients. However, the initiation of anticoagulation therapy remains debatable, especially for episodes of brief duration which in our experience exceeded 20% of the cases.

Genetic Testing Resources and Practice Patterns Among Pediatric Cardiomyopathy Programs.

The use of genetic testing has enhanced the diagnostic accuracy of heritable genetic cardiomyopathies. However, it remains unclear how genetic information is interpreted and incorporated into clinical practice for children with cardiomyopathy. The primary aim of this study was to understand how clinical practice differs regarding sequence variant classifications amongst pediatric cardiologists who treat children with cardiomyopathy. A secondary aim was to understand the availability of genetic testing and counseling resources across participating pediatric cardiomyopathy programs. An electronic survey was distributed to pediatric heart failure, cardiomyopathy, or heart transplantation physicians between August and September 2022. A total of 106 individual providers from 68 unique centers responded to the survey. Resources for genetic testing and genetic counseling vary among large pediatric cardiomyopathy programs. A minority of centers reported having a geneticist (N = 16, 23.5%) or a genetic counselor (N = 21, 31%) on faculty within the division of pediatric cardiology. A total of 9 centers reported having both (13%). Few centers (N = 13, 19%) have a formal process in place to re-engage patients who were previously discharged from cardiology follow-up if variant reclassification would alter clinical management. Clinical practice patterns were uniform in response to pathogenic or likely pathogenic variants but were more variable for variants of uncertain significance. Efforts to better incorporate genetic expertise and resources into the clinical practice of pediatric cardiomyopathy may help to standardize the interpretation of genetic information and better inform clinical decision-making surrounding heritable cardiomyopathies.

Identifying pediatric heart murmurs and distinguishing innocent from pathologic using deep learning

ObjectiveTo develop a deep learning algorithm to perform multi-class classification of normal pediatric heart sounds, innocent murmurs, and pathologic murmurs. MethodsWe prospectively enrolled children under age 18 being evaluated by the Division of Pediatric Cardiology. Parents provided consent for a deidentified recording of their child's heart sounds with a digital stethoscope. Innocent murmurs were validated by a pediatric cardiologist and pathologic murmurs were validated by echocardiogram. To augment our collection of normal heart sounds, we utilized a public database of pediatric heart sound recordings (Oliveira, 2022). We propose two novel approaches for this audio classification task. We train a vision transformer on either Markov transition field or Gramian angular field image representations of the frequency spectrum. We benchmark our results against a ResNet-50 CNN trained on spectrogram images. ResultsOur final dataset consisted of 366 normal heart sounds, 175 innocent murmurs, and 216 pathologic murmurs. Innocent murmurs collected include Still's murmur, venous hum, and flow murmurs. Pathologic murmurs included ventricular septal defect, tetralogy of Fallot, aortic regurgitation, aortic stenosis, pulmonary stenosis, mitral regurgitation and stenosis, and tricuspid regurgitation. We find that the Vision Transformer consistently outperforms the ResNet-50 on all three image representations, and that the Gramian angular field is the superior image representation for pediatric heart sounds. We calculated a one-vs-rest multi-class ROC curve for each of the three classes. Our best model achieves an area under the curve (AUC) value of 0.92 ± 0.05, 0.83 ± 0.04, and 0.88 ± 0.04 for identifying normal heart sounds, innocent murmurs, and pathologic murmurs, respectively. ConclusionWe present two novel methods for pediatric heart sound classification, which outperforms the current standard of using a convolutional neural network trained on spectrogram images. To our knowledge, we are the first to demonstrate multi-class classification of pediatric murmurs. Multiclass output affords a more explainable and interpretable model, which can facilitate further model improvement in the downstream model development cycle and enhance clinician trust and therefore adoption.

493 Knowledge of Familial Hypercholesterolemia Among Cardiology Healthcare Providers

OBJECTIVES/GOALS: Familial Hypercholesterolemia (FH) is a common disorder that is vastly underdiagnosed and causes an increased risk for sudden cardiac death. Cardiology providers (CHCPs) are in an ideal position to care for patients with FH. This research aimed to assess the knowledge of CHCPs in the screening, diagnosis, and management of FH. METHODS/STUDY POPULATION: Adaptation of an existing knowledge tool guided survey development. FH knowledge domains included description of FH, prognosis, prevalence, inheritance, diagnostic criteria, and management options. CHCPs were asked to select their provider type (MD, PA, NP, RN) and years in clinical practice (less than 1-5 years, 6-10 years, 11-20 years, and greater than 20 years).Convenience and snowball sampling recruited CHCPs in the Division of Cardiology at Columbia University Irving Medical Center (CUIMC). Descriptive statistical analysis was performed on quantitative survey data using R. Frequency counts of provider type and years in clinical practice were calculated. Comparisons of scores between provider types and years in clinical practice were made using ANOVA. RESULTS/ANTICIPATED RESULTS: 70 surveys were analyzed (30.2% response rate). 50% of CHCPs identified as MDs, 24.2% as RNs, 12.9% as NPs, and 12.9% as PAs. With regards to clinical experience, 21.4% of CHCPs had 1-5 years, 25.7% had 6-10 years, 24.3% had 11-20 years, and 28.6% had greater than 20 years. The average overall score across all CHCPs was 55.4%, with the highest on the description knowledge domain (81.4% correct), followed by management (61.8%), diagnostic criteria (60.6%), inheritance (58.6%), prevalence (44.3%), and prognosis (25.2%). Physicians had the highest average score of 66.0%, followed by NPs (50.3%), PAs (49.7%), and RNs (39.3%). There was no significant difference in scores across experience levels, provider types, and knowledge domains based on experience levels. DISCUSSION/SIGNIFICANCE: CHCPs across all provider types and years of experience had limited FH knowledge. There exists an opportunity to improve CHCPs’ knowledge of FH through education (didactic knowledge) or practice (experiential knowledge). Future interventions should aim to increase didactic and experiential knowledge of CHCPs through a variety of methods.

Dose Selection for Clinical Development in the Treatment of Hypertension: The Aprocitentan Case and Lessons from the Past

Dose selection plays a critical role in the clinical development of a drug. This current review highlights the lessons learned from previous dose finding studies (DFSs) of antihypertensive drugs and from the recent example of aprocitentan, a novel endothelin receptor antagonist for the treatment of resistant hypertension. Based on these, the authors provide 10 key recommendations for an efficient DFS for a new antihypertensive medication. These recommendations respect critical comments repeatedly made by the U.S. Food and Drug Administration (FDA) Division of Cardiology and Nephrology over the last 5 decades and go beyond the more limited recommendations made in the 2016 Committee for Medicinal Products for Human Use (CHMP) guideline on the development of new antihypertensive medications. The added value of a dose-response modelling approach enriches prior regulatory advice on DFSs.

Association between Cardiopulmonary Exercise Test and severity of obstructive sleep apnea syndrome

Review Association between Cardiopulmonary Exercise Test and Severity of Obstructive Sleep Apnea Syndrome Jianyu Wang 1,2, * , Shishi Zhang 2, Luying Jiang 3, Chunran Zhang 3, and Houjuan Zuo 2 1 Tianyou Hospital, Wuhan University of Science and TechnologyWuhan430064China 2 Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan430030China 3 The 3rd Department of Cardiology, The First Affiliated Hospital of The Medical College, Shihezi UniversityShihezi832008China * Correspondence: Wangjianyu1003@163.com Received: 17 April 2023 Accepted: 6 June 2023 Published: 27 December 2023 Abstract: Obstructive sleep apnea syndrome (OSAS) is becoming widespread, especially in people with obesity. As it is usually measured by polysomnography (PSG), the role of cardiopulmonary exercise test (CPET), a new exercise capacity test, has not attracted enough attention in OSAS research. In this article, we explore the relationship between CPET results and patients with OSAS. 68 individuals were recruited and divided into three groups: negative/mild group (n = 22, apnea hypopnea index (AHI) < 15), moderate group (n = 22, 15 ≤ AHI < 30) and severe group (n = 24, AHI ≥ 30). Clinical parameters, cardiopulmonary exercise test (CPET) indexes, and apnea hypopnea index (AHI) were compared among the three groups. A multivariate analysis was carried out to assess which factors determine the index of AHI. The ANOVA analyses were used to evaluate the difference among the three groups. Receiver operating characteristic analyses were chosen to detect the prediction efficiency of the CPET index for AHI. The predictive power of using the CPET index (VO2/kg peak) combined with the body mass index (BMI) of patients in the detection of AHI was significantly better when compared with using the CPET index only. There was a notable correlation between VO2 and the index of AHI (r = 0.249, P = 0.04). Also, the CPET data (VO2/kg peak) combined with the BMI of patients has powerful predictive value for the severity of OSAS in patients. It is expected to be a promising way to predict the severity of OSAS in the future. Our study provides a new strategy for predicting whether a patient is in the early phase OSAS.

Analysis of QRS complex morphology in children and adolescents with obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) leads to many cardiovascular, neurologic, metabolic, and neurocognitive consequences. Conduction deficits, deviations in electrical axis, and changes in QRS morphology reflect the impairments in cardiac muscle activity and underlie the cardiovascular complications of OSAS. Here we aimed to determine the relationship between OSAS and changes in the cardiac conduction system in children and adolescents. During the 6-month duration of the study, all children having the diagnosis of OSAS in Sleep and Disorders Unit following a full-night polysomnography (PSG) were consecutively evaluated. ECGs were performed and analyzed in the Division of Pediatric Cardiology, Department of Pediatrics. The maximum spatial vector size (QRSmax), QRS electrical axis (EA), left and right ventricular hypertrophy, and the presence of fragmented QRS (fQRS) or prolonged R or S wave were examined in detail. A total of 17 boys with OSAS and 13 healthy boys participated in the study. The mean QRSmax and the QRSmax on V5 derivative were significantly lower in the patient group compared to those in the control group (p = 0.011 and p = 0.017, respectively). EA was similar between the two groups. While none of the patients with OSAS nor the control group had left ventricular hypertrophy, only one boy with OSAS had right ventricular hypertrophy according to ECG-derived analysis. The percentage of fQRS or notched R or S waves was significantly higher in patients with OSAS compared to healthy controls (p = 0.035), especially in children below the age of 5years (p = 0.036). Conclusion: This study demonstrated that male children and adolescents with OSAS have a combination of QRS complex changes characterized by low QRS voltages, and increased frequency of fragmented QRS. These findings reflect that the electrical remodeling and structural remodeling of the myocardium are considerably affected by OSAS in children and adolescents, leading to ventricular changes and intraventricular conduction problems. What is Known: • Pediatric obstructive sleep apnea syndrome (OSAS) characterized by recurrent intermittent hypoxemia, hypercapnia, and sleep fragmentation results in sympathetic nervous system activation, increased inflammation, and hypoxic endothelial dysfunction. When left untreated, OSAS leads to many cardiovascular, neurologic, metabolic and neurocognitive consequences, and also to sudden infant death syndrome in young children, probably due to the involvement of the cardiac conduction system. What is New: • This study demonstrated that mean QRSmax was significantly lower in male children and adolescents with OSAS, reflecting the structural and electrical remodeling of the myocardium, and one boy with OSAS had RVH according to ECG-derived analysis. The percentage of fQRS or notched R or S waves was much higher in boys with OSAS, especially in children below the age of five years. These finding showed that myocardium was considerably affected to impair the intraventricular conduction in younger children with OSAS.

Quantification of heart failure decompensation through mixed digital methodology

Abstract Background While natriuretic peptides (NPs) quantification and echocardiographic assessments are recommended for diagnosis of heart failure (HF), yet electrocardiographic determinants of cardiac rhythm alterations predisposing to sudden cardiac death (SCD) are lacking. Premature ventricular contractions (PVCs) are common in HF. In some patients, PVCs are triggered by the same mechanism that gives rise to ventricular tachycardia (VT). Appropriate clinical evaluation is important in these patients. Currently, smartwatches are becoming particularly popular to enhance health monitoring. Purpose The aims of this study were: to evaluate the feasibility and reliability of the clinical use of a smartwatch, to detect main features of QRS-complex (width, voltage), and to correlate PVCs with VT originating in different aetiologies of HF. Methods From November ‘22 to February ’23, 53 patients admitted to the Division of Cardiology of our academic hospital underwent standard ECG and smartwatch-based lead I acquisitions. Concordance between the two technologies was assessed by Cohen κ coefficient. Bland-Altman method for analysis of measurement agreement was used for comparison. Results Clinical characteristics of the subjects included in this study are described in the Table. All patients had diagnosis of acute or chronic HF and had PVCs (N= 47) and/or VT (N=3). Sustained and non-sustained VT were more common in patients with HF and reduced ejection fraction. In 7 cases we detected PVCs with the same standard ECG’s morphology and axis during recording ECG with the smartwatch. The Cohen κ coefficients for the measurement of the voltage and width of QRS complex were 0.833 (95% CI, 0.725-0.936) and 0.869 (95% CI, 0.747- 0.956), respectively; voltage and width of PVCs were 0.860 (95% CI, 0.579-1.00) and 0.822 (95% CI, 0.429-1.00), respectively. Concordance was found between the smartwatch ECG and standard ECG for QRS width (bias, −0.05; SD, 0.395; lower limit, −0.821; and upper limit, 0.727), for QRS voltage (bias, −0.004; SD, 0.034; lower limit, −0.073; and upper limit, 0.062), for PVC width (bias, −0.7; SD, 2.167; lower limit, −4.372; and upper limit, 4.12), PVC voltage (bias, −0.02; SD, 0.07; lower limit, -0.112; and upper limit, 0.162) using the Bland-Altman analysis. Conclusions Smartwatch can accurately measure QRS width and voltage and reproducibly detect PVCs compared with standard ECG. Valid correlation indices and good concordance between the two methods were observed using digitally-assessed lead I. These data could be of great interest due to the widespread diffusion of wearable devices; the smartwatch could be helpful especially when frequent monitoring of VT becomes necessary. Currently available smartwatches display, in this regard, an implementation for PVCs detection.

Physician- and Patient-Elicited Barriers and Facilitators to Implementation of a Machine Learning-Based Screening Tool for Peripheral Arterial Disease: Preimplementation Study With Physician and Patient Stakeholders.

Peripheral arterial disease (PAD) is underdiagnosed, partially due to a high prevalence of atypical symptoms and a lack of physician and patient awareness. Implementing clinical decision support tools powered by machine learning algorithms may help physicians identify high-risk patients for diagnostic workup. This study aims to evaluate barriers and facilitators to the implementation of a novel machine learning-based screening tool for PAD among physician and patient stakeholders using the Consolidated Framework for Implementation Research (CFIR). We performed semistructured interviews with physicians and patients from the Stanford University Department of Primary Care and Population Health, Division of Cardiology, and Division of Vascular Medicine. Participants answered questions regarding their perceptions toward machine learning and clinical decision support for PAD detection. Rapid thematic analysis was performed using templates incorporating codes from CFIR constructs. A total of 12 physicians (6 primary care physicians and 6 cardiovascular specialists) and 14 patients were interviewed. Barriers to implementation arose from 6 CFIR constructs: complexity, evidence strength and quality, relative priority, external policies and incentives, knowledge and beliefs about intervention, and individual identification with the organization. Facilitators arose from 5 CFIR constructs: intervention source, relative advantage, learning climate, patient needs and resources, and knowledge and beliefs about intervention. Physicians felt that a machine learning-powered diagnostic tool for PAD would improve patient care but cited limited time and authority in asking patients to undergo additional screening procedures. Patients were interested in having their physicians use this tool but raised concerns about such technologies replacing human decision-making. Patient- and physician-reported barriers toward the implementation of a machine learning-powered PAD diagnostic tool followed four interdependent themes: (1) low familiarity or urgency in detecting PAD; (2) concerns regarding the reliability of machine learning; (3) differential perceptions of responsibility for PAD care among primary care versus specialty physicians; and (4) patient preference for physicians to remain primary interpreters of health care data. Facilitators followed two interdependent themes: (1) enthusiasm for clinical use of the predictive model and (2) willingness to incorporate machine learning into clinical care. Implementation of machine learning-powered diagnostic tools for PAD should leverage provider support while simultaneously educating stakeholders on the importance of early PAD diagnosis. High predictive validity is necessary for machine learning models but not sufficient for implementation.

Correlation between baseline immature platelets fraction levels and peak troponin in patients with acute myocardial infarction.

Elevated peak cardiac troponin levels have been linked with increased morbidity and mortality in patients with acute myocardial infarction (AMI). Immature Platelets are young and relatively large platelets that are hyper-reactive and pro-thrombotic compared to regular platelets. Increased immature platelet fraction (IPF) has been associated with an elevated risk of thrombotic events. We hypothesize that patients with higher IPF levels during AMI, will experience a more severe infarct, leading to elevated peak troponin levels. Clinical data from patients admitted to the cardiology division between 2018 and 2022, who were diagnosed with AMI and underwent an IPF testing. Univariate and multivariate regression analyses were performed to identify predictors of elevated peak troponin. Among the 277 patients diagnosed with AMI who underwent IPF testing, 113 had (STEMI) and 164 had (NSTEMI). The median value of IPF of 4.2% was used as the threshold for defining elevated IPF. Notably, among STEMI patients, those with IPF ≥ 4.2% had significantly higher peak troponin levels (P = 0.021). Conversely, no significant difference in peak troponin levels was observed among NSTEMI patients (P = 0.348). Multivariate analysis identified patients with STEMI in the higher IPF group as one of the significant predictors for elevated peak troponin levels. This study revealed a correlation between higher baseline IPF levels and increased peak troponin levels specifically in STEMI patients, while no such association was found in NSTEMI patients. Incorporating IPF levels above the median into risk stratification scores for STEMI patients may provide valuable support for adopting a more proactive therapeutic approach.

THU248 Screening For Heart Failure In Patients With Diabetes Mellitus - A SwissDiab Study

Abstract Disclosure: M. Brandle: None. L. Knaus: None. M. Quarella: None. M. Maeder: None. M. Buser: None. F. Renstrom: None. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have been shown to significantly reduce the risk of hospitalization for heart failure (HF) and death from cardiovascular causes in patients with diabetes and HF. Since the diagnosis of HF is challenging, the condition often remains undetected, and the prevalence in diabetes patients is unclear. The aim of this study was to evaluate the prevalence of HF in patients with diabetes enrolled in the Swiss Diabetes Registry (SwissDiab) and the proportion prescribed SGLT2i, to help to determine the need to reinforce clinical treatment guidelines and establish regular screening of HF.SwissDiab is a multicenter longitudinal observational study of outpatients with diabetes in tertiary care. The current study was conducted at the Cantonal Hospital of St.Gallen, Switzerland. All patients with a SwissDiab study visit between 28.09.2020 and 31.03.2022 were screened for HF according to a standardized protocol based on the diagnostic algorithm established by the European Society of Cardiology. Patients with ≥1 risk factor and/or symptoms of HF and a NT-proBNP ≥125 ng/L were referred to the Division of Cardiology for echocardiography and a clinical evaluation of HF, further stratified by HFpEF, HFmrEF, and HFrEF. The study was approved by the regional Ethics Committee East Switzerland (EKOS, PB_2016-01449) and all SwissDiab participants provided written informed consent. Out of 555 patients with diabetes, 530 had data available for analysis: 168 with type 1 diabetes (T1DM); 315 with type 2 diabetes (T2DM), and 47 with other forms of diabetes n=47. The median (IQR) age was 60.9 (49.0-69.0) years, n=162 (30.6%) were females, diabetes duration 14.0 (8.0-21.0) years, HbA1c 7.1 (6.6-7.8)%, low-density lipoprotein cholesterol 2.6 (2.1-3.2) mmol/L, and n=114 (21.5%) were current smokers. In total, HF was present in n=59 (11.1%) (T1DM, n=4 [2.4%]; T2DM, n=50 [15.9%]; other, n=5 [10.6%]) of which 35 (59.3%) were newly diagnosed. 34 of 59 patients presented with HFpEF (57.6%), 7 with HFmrEF (11.9%), and 18 with HFrEF (30.5%). Of the 59 patients with HF, n=19 (32.2%) were prescribed SGLT2i (HFpEF, n=7 [36.8%]; HFmrEF, n=2 [10.5%]; HFrEF, n=10 [52.6%]). Of the 24 patients with a previously known diagnosis of HF, 50% were treated with SGLT2i (2 out of 3 patients with HFmrEF and 10 out of 15 patients with HFrEF). All of the patients with HF that were treated with SGLT2i had T2D.The results indicate that roughly one in ten patients enrolled in SwissDiab have HF, and one in six patients with T2D. Patients with HFrEF (around 30% of cases) primarily have T2D, of which >50% were prescribed SGLT2i, as compared to 32% overall. Presentation: Thursday, June 15, 2023

A retrospective audit of young adults who received permanent pacemakers at a teaching hospital in the Western Cape, South Africa.

While most pacemaker implantations occur in older individuals, younger patients also receive pacemakers. In these, degenerative conduction system disease is less likely to be the cause of atrioventricular block (AVB), with other diseases being more common. There is, however, a paucity of data on this group as well as on younger pacemaker recipients that have undergone pacemaker implantation for reasons other than AVB. The aim of this study was to perform an audit of young adult permanent pacemaker recipients. This was a retrospective record review, conducted in the Division of Cardiology at Tygerberg Hospital, Cape Town, South Africa. We included 169 adult patients between the ages of 18 and 60, who received permanent pacemakers between 2010 and 2020. A subgroup analysis of patients 55 years and younger was also performed. Third degree AVB was the most common indication for pacemaker implantation (n = 115; 68%), followed by high degree AVB (n = 23; 13.6%) and sick sinus syndrome (SSS; n = 14; 8.3%). A specific underlying cause for conduction system abnormalities was found in only 25.4% of patients (n = 43), with most of them being 55 years or younger (n = 32; 30.8% of patients ≤ 55 years). Specific causes that were identified included prosthetic valve implantation and/or valve repair (n = 14; 8.3%), myocardial infarction (n = 6; 3.6%), cardiac sarcoidosis (n = 5; 3.0%), coronary artery bypass grafting (n = 3; 1.8%), cardiomyopathy (n = 2; 1.2%), muscular dystrophy (n = 2; 1.2%), congenital heart disease (ventricular septal defect; atrioventricular septal defect; Tetralogy of Fallot; bicuspid aortic valve; n = 6; 3.6%), acute myocarditis (n = 1; 0.6%), atrial myxoma removal (n = 1; 0.6%), planned AV node ablation (n = 2; 1.2%), and following a previous stab in the chest (n = 1; 0.6%). Given that the mean age of our study population was high, the low number of identified underlying causes in the whole cohort (≤60 years) may reflect some AVB due to age related degeneration of the conductions system in the patients 56 to 60 years age, but also raises the possibility that these patients may be less likely to be extensively investigated for an underlying cause than those ≤55 years, where diseases such as sarcoidosis were more readily confirmed. As access to advanced diagnostic tools improves, the percentage of young pacemaker recipients with an underlying cause identified may increase.

Effect of colchicine on perioperative atrial fibrillation and myocardial injury after non-cardiac surgery in patients undergoing major thoracic surgery (COP-AF): an international randomised trial

Higher levels of inflammatory biomarkers are associated with an increased risk of perioperative atrial fibrillation and myocardial injury after non-cardiac surgery (MINS). Colchicine is an anti-inflammatory drug that might reduce the incidence of these complications. COP-AF was a randomised trial conducted at 45 sites in 11 countries. Patients aged 55 years or older and undergoing major non-cardiac thoracic surgery were randomly assigned (1:1) to receive oral colchicine 0·5 mg twice daily or matching placebo, starting within 4 h before surgery and continuing for 10 days. Randomisation was done with use of a computerised, web-based system, and was stratified by centre. Health-care providers, patients, data collectors, and adjudicators were masked to treatment assignment. The coprimary outcomes were clinically important perioperative atrial fibrillation and MINS during 14 days of follow-up. The main safety outcomes were a composite of sepsis or infection, and non-infectious diarrhoea. The intention-to-treat principle was used for all analyses. This trial is registered with ClinicalTrials.gov, NCT03310125. Between Feb 14, 2018, and June 27, 2023, we enrolled 3209 patients (mean age 68 years [SD 7], 1656 [51·6%] male). Clinically important atrial fibrillation occurred in 103 (6·4%) of 1608 patients assigned to colchicine, and 120 (7·5%) of 1601 patients assigned to placebo (hazard ratio [HR] 0·85, 95% CI 0·65 to 1·10; absolute risk reduction [ARR] 1·1%, 95% CI -0·7 to 2·8; p=0·22). MINS occurred in 295 (18·3%) patients assigned to colchicine and 325 (20·3%) patients assigned to placebo (HR 0·89, 0·76 to 1·05; ARR 2·0%, -0·8 to 4·7; p=0·16). The composite outcome of sepsis or infection occurred in 103 (6·4%) patients in the colchicine group and 83 (5·2%) patients in the placebo group (HR 1·24, 0·93-1·66). Non-infectious diarrhoea was more common in the colchicine group (134 [8·3%] events) than the placebo group (38 [2·4%]; HR 3·64, 2·54-5·22). In patients undergoing major non-cardiac thoracic surgery, administration of colchicine did not significantly reduce the incidence of clinically important atrial fibrillation or MINS but increased the risk of mostly benign non-infectious diarrhoea. Canadian Institutes of Health Research, Accelerating Clinical Trials Consortium, Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario, Population Health Research Institute, Hamilton Health Sciences, Division of Cardiology at McMaster University, Canada; Hanela Foundation, Switzerland; and General Research Fund, Research Grants Council, Hong Kong.

Toward a Roadmap for Best Practices in Pediatric Preventive Cardiology: A Science Advisory From the American Heart Association.

Cardiovascular disease risk factors are highly prevalent among youth in the United States and Canada. Pediatric preventive cardiology programs have independently developed and proliferated to address cardiovascular risk factors in youth, but there is a general lack of clarity on best practices to optimize and sustain desired outcomes. We conducted surveys of pediatric cardiology division directors and pediatric preventive cardiology clinicians across the United States and Canada to describe the current landscape and perspectives on future directions for the field. We summarize the data and conclude with a call to action for various audiences who seek to improve cardiovascular health in youth, reduce the burden of premature cardiovascular disease, and increase healthy longevity. We call on heart centers, hospitals, payers, and policymakers to invest resources in the important work of pediatric preventive cardiology programs. We urge professional societies to advocate for pediatric preventive cardiology and provide opportunities for training and cross-pollination across programs. We encourage researchers to close evidence gaps. Last, we invite pediatric preventive cardiology clinicians to collaborate and innovate to advance the practice of pediatric preventive cardiology.

Comparative effectiveness of Cangrelor in patients with acute coronary syndrome undergoing percutaneous coronary intervention: an observational investigation from the M.O.Ca. registry

Cangrelor, the first intravenous P2Y12 inhibitor (P2Y12-I), has been approved on the basis of three large RCTs from the CHAMPION program which nevertheless have been criticized for the low bleeding risk of the enrolled patients, the large quote of chronic coronary syndromes, and the use of Clopidogrel as control arm even in the setting of acute coronary syndromes (ACS). We sought to investigate, in the setting of ACS, the comparative performance of Cangrelor in terms of in-hospital ischemic and haemorrhagic outcomes compared with the current gold-standard of oral P2Y12-I. The study retrospectively enrolled 686 consecutive patients admitted to the Divisions of Cardiology of Policlinico of Bari and L. Bonomo Hospital of Andria for ACS and treated with percutaneous coronary intervention. The study population was divided according to the P2Y12-I treatment strategy in two groups: patients given an oral P2Y12-I and patients receiving Cangrelor in the cath lab followed by an oral P2Y12-I. Clinical endpoints included death, ischemic and bleeding events occurring during hospital stay. Cangrelor treated patients presented higher clinical risk profile at presentation and faced higher death rate. However, after PS matching, in-hospital mortality resulted comparable between the groups and Cangrelor use was associated with reduced in-hospital definite stent thrombosis (p = 0.03). Data from our real-world registry highlight that, in the setting of ACS, Cangrelor is prevalently used in patients with very challenging clinical presentations. The adjusted analysis provides for the first time promising data on stent thrombosis reduction associated with Cangrelor use.

Initiation of Varenicline in People Hospitalized for Acute Coronary Syndrome Who Smoke.

HomeCirculationVol. 147, No. 25Initiation of Varenicline in People Hospitalized for Acute Coronary Syndrome Who Smoke No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessArticle CommentaryRequest AccessFull TextInitiation of Varenicline in People Hospitalized for Acute Coronary Syndrome Who Smoke Areesha Moiz and Mark J. Eisenberg Areesha MoizAreesha Moiz From the Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada (A.M., M.J.E.). Search for more papers by this author and Mark J. EisenbergMark J. Eisenberg Correspondence to: Mark J. Eisenberg, MD, MPH, Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, 3755 Côte Ste-Catherine Rd, Suite H-421.1, Montreal, Quebec, Canada H3T 1E2. Email E-mail Address: [email protected] https://orcid.org/0000-0002-1296-0661 From the Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada (A.M., M.J.E.). Faculty of Medicine and Health Sciences, Departments of Epidemiology, Biostatistics and Occupational Health, and Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (M.J.E.). Search for more papers by this author Originally published19 Jun 2023https://doi.org/10.1161/CIRCULATIONAHA.123.064257Circulation. 2023;147:1869–1871FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Sources of Funding and Disclosures, see pages 1870–1871.Circulation is available at www.ahajournals.org/journal/circCorrespondence to: Mark J. Eisenberg, MD, MPH, Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, 3755 Côte Ste-Catherine Rd, Suite H-421.1, Montreal, Quebec, Canada H3T 1E2. Email mark.[email protected]ca

Gene Silencing Therapy in Hereditary (Variant) Transthyretin Cardiac Amyloidosis: A Puzzling Case of Decreasing Pyrophosphate Uptake on Scintigraphy.

HomeCirculation: Cardiovascular ImagingAhead of PrintGene Silencing Therapy in Hereditary (Variant) Transthyretin Cardiac Amyloidosis: A Puzzling Case of Decreasing Pyrophosphate Uptake on Scintigraphy No AccessCase ReportRequest AccessAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessCase ReportRequest AccessGene Silencing Therapy in Hereditary (Variant) Transthyretin Cardiac Amyloidosis: A Puzzling Case of Decreasing Pyrophosphate Uptake on Scintigraphy Dia A. Smiley, Andrew J. Einstein, Akiva Mintz, Mrinali Shetty, Nicholas Chan, Stephen T. Helmke, Ketan Bhatia, Kim Goldner, Thomas H. Brannagan, Denisse D. Santana and Mathew S. Maurer Dia A. SmileyDia A. Smiley Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital. (D.A.S., A.J.E., M.S., N.C., S.T.H., D.D.S., M.S.M.) Search for more papers by this author , Andrew J. EinsteinAndrew J. Einstein https://orcid.org/0000-0003-2583-9278 Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital. (D.A.S., A.J.E., M.S., N.C., S.T.H., D.D.S., M.S.M.) Department of Radiology, Columbia University Irving Medical Center, New York-Presbyterian Hospital. (A.J.E., A.M., K.B., K.G.) Search for more papers by this author , Akiva MintzAkiva Mintz Department of Radiology, Columbia University Irving Medical Center, New York-Presbyterian Hospital. (A.J.E., A.M., K.B., K.G.) Search for more papers by this author , Mrinali ShettyMrinali Shetty https://orcid.org/0000-0003-3263-5134 Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital. (D.A.S., A.J.E., M.S., N.C., S.T.H., D.D.S., M.S.M.) Search for more papers by this author , Nicholas ChanNicholas Chan Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital. (D.A.S., A.J.E., M.S., N.C., S.T.H., D.D.S., M.S.M.) Search for more papers by this author , Stephen T. HelmkeStephen T. Helmke https://orcid.org/0000-0003-2764-3009 Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital. (D.A.S., A.J.E., M.S., N.C., S.T.H., D.D.S., M.S.M.) Search for more papers by this author , Ketan BhatiaKetan Bhatia Department of Radiology, Columbia University Irving Medical Center, New York-Presbyterian Hospital. (A.J.E., A.M., K.B., K.G.) Search for more papers by this author , Kim GoldnerKim Goldner Department of Radiology, Columbia University Irving Medical Center, New York-Presbyterian Hospital. (A.J.E., A.M., K.B., K.G.) Search for more papers by this author , Thomas H. BrannaganThomas H. Brannagan https://orcid.org/0000-0002-1812-8331 Department of Neurology, Columbia University Irving Medical Center, New York-Presbyterian Hospital. (T.H.B.) Search for more papers by this author , Denisse D. SantanaDenisse D. Santana Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital. (D.A.S., A.J.E., M.S., N.C., S.T.H., D.D.S., M.S.M.) Search for more papers by this author and Mathew S. MaurerMathew S. Maurer Correspondence to: Mathew S. Maurer, MD, Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 622 W 168th St, PH12 Stem Room 134, New York, NY 10032. Email E-mail Address: [email protected] https://orcid.org/0000-0002-1867-0526 Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital. (D.A.S., A.J.E., M.S., N.C., S.T.H., D.D.S., M.S.M.) Search for more papers by this author Originally published19 Jun 2023https://doi.org/10.1161/CIRCIMAGING.123.015243Circulation: Cardiovascular Imaging. 2023;0:e015243FootnotesFor Sources of Funding and Disclosures, see page xxx.Correspondence to: Mathew S. Maurer, MD, Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital, 622 W 168th St, PH12 Stem Room 134, New York, NY 10032. Email [email protected]columbia.edu Previous Back to top Next FiguresReferencesRelatedDetails Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/CIRCIMAGING.123.015243PMID: 37334703 Originally publishedJune 19, 2023 Keywordspositron emission tomographyprealbumintransthyretinamyloidosiscardiomyopathyPDF download Advertisement SubjectsCardiomyopathyHeart FailureImagingNuclear Cardiology and PET

Mind the gap: Recurrence of ventricular pre-excitation after accessory pathway effective refractory period with short coupled paced stimuli.

Journal of Cardiovascular ElectrophysiologyEarly View EP ROUNDS Mind the gap: Recurrence of ventricular pre-excitation after accessory pathway effective refractory period with short coupled paced stimuli Nathan McConkey DO, Nathan McConkey DO Division of Cardiology, Penn State Hershey Medical Center, Heart and Vascular Institute, Hershey, Pennsylvania, USASearch for more papers by this authorAnkit Maheshwari MD, Corresponding Author Ankit Maheshwari MD [email protected] orcid.org/0000-0002-3096-3372 Division of Cardiology, Penn State Hershey Medical Center, Heart and Vascular Institute, Hershey, Pennsylvania, USA Correspondence Ankit Maheshwari, MD, Division of CardiologyPenn State Hershey Medical Center, Heart and Vascular Institute, 500 University Dr, Hershey, PA 17033, USA. Email: [email protected]Search for more papers by this author Nathan McConkey DO, Nathan McConkey DO Division of Cardiology, Penn State Hershey Medical Center, Heart and Vascular Institute, Hershey, Pennsylvania, USASearch for more papers by this authorAnkit Maheshwari MD, Corresponding Author Ankit Maheshwari MD [email protected] orcid.org/0000-0002-3096-3372 Division of Cardiology, Penn State Hershey Medical Center, Heart and Vascular Institute, Hershey, Pennsylvania, USA Correspondence Ankit Maheshwari, MD, Division of CardiologyPenn State Hershey Medical Center, Heart and Vascular Institute, 500 University Dr, Hershey, PA 17033, USA. Email: [email protected]Search for more papers by this author First published: 14 June 2023 https://doi.org/10.1111/jce.15971 Disclosures: None. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. REFERENCE 1Josephson ME. Josephson's Clinical Cardiac Electrophysiology: Techniques and Interpretations. 5th ed. Wolters Kluwer; 2016. Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation