High Risk Of Cardiac Complications Research Articles

Perioperative complications and in-hospital mortality in radical cystectomy patients with heart-valve replacement

PurposeTo assess in-hospital mortality and complication rates after radical cystectomy (RC) in patients with history of heart-valve replacement. Materials and methodsUsing the National Inpatient Sample (2000–2019), non-metastatic bladder cancer patients undergoing RC were stratified according to history of heart-valve replacement. Regression models (RM) predicted hospital outcomes. ResultsOf 25,535 RC patients, 250 (1.0%) harbored history of heart-valve replacement. Heart-valve replacement patients were older (median 74 vs. 70 years), more frequently male (87.2 vs. 80.6%), and more frequently had Charlson comorbidity index ≥3 (26.8 vs. 18.9%). In RC patients with history of heart-valve replacement vs. others, 62 vs. 2634 (24.8 vs. 10.4%) experienced cardiac complications, 28 vs. 3092 (11.2 vs. 12.2%) intraoperative complications, 11 vs. 1046 (4.4 vs. 4.1%) infections, <11 vs. 594 (<4.4 vs. 2.3%) perioperative bleeding, <11 vs. 699 (<4.4 vs. 2.8%) vascular complications, 74 vs. 6225 (29.6 vs. 24.7%) received blood transfusions, 37 vs. 3054 (14.8 vs. 12.1%) critical care therapy (CCT), and in-hospital mortality was recorded in <11 vs. 463 (<4.4 vs. 1.8%) patients. In multivariable RM, history of heart-valve replacement independently predicted cardiac complications (odds ratio 2.20, 95% confidence interval 1.62–2.99; p < 0.001). Conversely, no statically significant association was recorded between history of heart-valve replacement and length of stay, estimated hospital cost, intraoperative complications, perioperative bleeding, vascular complications, infections, blood transfusions, CCT use, and in-hospital mortality. ConclusionsRadical cystectomy patients with history of heart-valve replacement exhibited a 2.2-fold higher risk of cardiac complications, but no other complications, including no significantly higher in-hospital mortality.

Management of Ptosis in Kearns-Sayre Syndrome: A Case Report and Literature Review.

Kearns-Sayre syndrome (KSS) is a rare mitochondrial disease that affects young adults, due to a deletion of mitochondrial DNA and characterized by the triad: age of onset lower than 20 years, chronic progressive external ophthalmoplegia, and an atypical pigmentary retinopathy. It is also characterized by other endocrine, neurological, and especially cardiac impairment with a very high risk of cardiac complications during surgical procedures under all types of anesthesia. We report a case of KSS revealed by severe bilateral ptosis and confirmed by a muscle biopsy with "ragged red fibers." The ptosis was surgically managed by cautious Frontal suspension under local anesthesia "Frontal nerve block." Through this case, we discuss challenges in the management of KSS patients.

Role of feature tracking cardiac magnetic resonance imaging in early detection of cardiac dysfunction in β-thalassemia patients recovered from COVID-19: A cross-sectional study.

β-Thalassemia patients may have cardiac complications due to iron overload, which puts them at higher risk of cardiac complications induced by coronavirus disease 2019 (COVID-19) compared with the normal population. The present study aims to evaluate early cardiovascular complications following iron overload in β-thalassemia patients who had early recovery from COVID-19 by cardiac magnetic resonance imaging (MRI) and feature-tracking technique. Thirty-two confirmed COVID-19-recovered β-thalassemia cases were evaluated within 3 weeks to 3 months after a positive reverse-transcriptase polymerase chain reactionCOVID-19 test. Both the heart and liver of all patients were examined using cardiac MRI. We analyzed 32 patients with mean age of 32.84 ± 6.45 years at baseline. Left ventricular global strain values were significantly associated with myocardial T2*. A cut-off value of -15.08% for global longitudinal strain (GLS) with sensitivity and specificity of 90% and 61.1% (p = 0.017), 32.33% for global radial strain (GRS) with sensitivity and specificity of 80% and 94.4% (p = 0.001) and -16.21 for global circumferential strain(GCS), with sensitivity and specificity of 80% and 89.9% (p = 0.013) may indicate cardiac iron overload. GLS, GRS, and GCS were significantly decreased in patients with myocardial T2* <20 ms (iron overload), while no significant change was observed in the right and left ventricular ejection fraction (RV- and LVEF). Cardiac MRI feature-tracking may be helpful in the early detection of cardiac complications resulting from iron overload in β-thalassemia patients who had early recovery from COVID-19.

Management of Patients with Ischemic Heart Disease in Spine Surgery.

In ischemic heart disease (IHD), the myocardium does not receive enough blood and oxygen. Although the IHD-related mortality rate is decreasing, the risk remains and is a major predictor of cardiac complications following noncardiac surgery. Given the increase in the older population, the number of patients with spinal diseases requiring surgery is increasing. Among these patients, those with underlying IHD or a high risk of cardiac complications before and after surgery are also increasing. Given that cardiac complications following spinal surgery are associated with delayed patient recovery and even death, spinal surgeons should be knowledgeable about overall patient management, including medication therapy in those at high risk of developing perioperative cardiac complications for successful patient care. Before surgery, the underlying medical conditions of patients should be evaluated. Patients with a history of myocardial infarction should be checked for a history of surgical treatments, and the anticoagulant dose should be controlled depending on the surgery type. In addition, the functional status of patients must be examined before surgery. Functional status can be assessed according to the metabolic equivalent of task (MET). More preoperative cardiac examinations are needed for patients who are unable to perform four METs in daily because of the high risk of postoperative cardiac complications. Patients with a history of IHD require appropriate preoperative management and further postoperative evaluation. When considering surgery, spinal surgeons should be knowledgeable about patient care before and after surgery.

Cardiopulmonary complications following COVID-19 vaccinations: a systematic review and meta-analysis

Clinical trials of COVID-19 vaccines were insufficient to detect uncommon adverse outcomes that are crucial for risk-benefit analyses and informing clinical practice post-vaccination. As a result, the detection of infrequent adverse events has become a global research priority. The current study aims to estimate the rate of cardiopulmonary complications associated with COVID-19 vaccination.Two databases and one search engine were explored to identify English language-related studies published up to January 2023.The literature search turned up a total of 3974 relevant studies. Of them, 37 articles matched the inclusion criteria. The mean age of patients was 26.4 years, and about 77% of them were male. The most common reported consequence was inflammatory heart disease (myo-peri-cariditis) (77%), followed by pulmonary embolism (17%), and myocardial infarction (5%). The majority of complications were reported following mRNA COVID-19 vaccinations, particularly following the administration of the second dose. Pfizer has a slightly higher risk of cardiac complications following vaccination (4.1 per 100000 persons) than Moderna (3.7 per 100,000 persons). Although cardiopulmonary complications associated with COVID-19 vaccinations are uncommon, they can be life-threatening. Therefore, more large-scale observational studies and review articles of those studies are strongly recommended.

PO-03-238 CARDIAC ARRHYTHMIA IN THE PATIENT ON RITUXIMAB. A PHARMACOVIGILANCE STUDY FROM 2010-2022 FAERS DATABASE

Rituximab is a commonly used monoclonal antibody in most hematological diseases. Cardiac arrhythmia is one of the most common causes of morbidity and mortality in a hematological patient, given the increased cell turnover and electrolyte imbalance, especially after the treatment. Therefore, we explore potential arrhythmic complications related to the most commonly used drug. Given the high risk of cardiac complications in the age group between 65 and 85, we sought to study Rituximab’s arrhythmic complications and outcomes in this patient population. We conducted a retrospective analysis of all reported cases of arrhythmic complication in patients using Rituximab, utilizing data reported to the FDA and registered in the FDA Adverse Event Reporting System (FAERS) database over the past 12 years. We included patients between the 65 to 85 age group; these cases were identified and classified using the Medical Dictionary for Regulatory Activities (MedDRA) terminology. A total of 28,595 patients aged 65 to 85 were reported to use Rituximab from 2010 to 2022. Among 2797 patients with cardiac complications, 31% (n=883) developed cardiac arrhythmias. 70% (n=619) of the reported cases were hospitalized, and 24% (n=149) died. Most deaths were in males, 60% (n=88) Fig.2. Commonly reported arrhythmia is shown in Fig1. The most frequently reported arrhythmia was atrial fibrillation at 72% (n=635), with a mortality rate of 16%. Furthermore, even incidence of ventricular arrhythmia was low at 6% (n=50), the mortality rate was high at 36%. Despite the relatively lower number (3%) of the total reported cases, the development of arrhythmia in patients using Rituximab was associated with increased hospitalization and mortality. Physicians should be aware of cardiological and rhythmic disorders for a commonly used medication like Rituximab. This might help with the early reorganization of the arrhythmia and finally improve the overall outcomes.

Labile plasma iron and echocardiographic parameters are associated with cardiac events in β-thalassemic patients.

Notwithstanding the improvement in therapies, patients affected by thalassemia major (TM) and intermedia (TI) are still at high risk of cardiac complications. This study aimed at evaluating the incidence and predictive factors for developing cardiac events in adult β-TM and TI patients. Data on diagnosis and clinical history were collected retrospectively; prospective data on new-onset cardiac failure and arrhythmias, echocardiographic parameters, biochemical variables including non-transferrin-bound iron (NTBI) and labile plasma iron (LPI), magnetic resonance imaging (MRI) T2* measurement of hepatic and cardiac iron deposits, and iron chelation therapy were recorded during a 6-year follow-up. Thirty-seven patients, 29 TM and 8 TI, were included. At baseline, 8 TM patients and 1 TI patient had previously experienced a cardiac event (mainly heart failure). All patients were on chelation therapy and only 3 TM patients had mild-to-severe cardiac siderosis. During follow-up, 11 patients (29.7%) experienced a new cardiac event. The occurrence of cardiac events was correlated to high LPI levels (OR 12.0, 95% CI 1.56-92.3, p .017), low mean pre-transfusion haemoglobin (OR 0.21, 95% C.I. 0.051-0.761, p .21) and echocardiographic parameters suggestive of myocardial hypertrophy. Multivariate analysis disclosed high LPI and left ventricle mass index (LVMI) as independent variables significantly associated with cardiac events. Cardiac iron deposits measured by MRI T2* failed to predict cardiac events. LPI, Hb levels and echocardiographic parameters assessing cardiac remodelling are associated with cardiac events in adult TM and TI patients. LPI might represent both a prognostic marker and a potential target for novel treatment strategies. Further studies are warranted to confirm our findings on larger populations.

Incidence of New-Onset Cardiac Complications among requiring Invasive Mechanical Ventilation: Findings from a Retrospective Cohort Study

Background: COVID-19 patients are prone to develop many systemic complications including cardiac complications. Objective: This study aimed to determine the overall incidence of new-onset cardiac complications among patients admitted to COVID ICU and the possible role of cardiac complications in deciding the length of hospital or ICU stay and ICU mortality. Methods: A retrospective observational study was conducted among critically ill COVID-19 patients admitted to the ICU of Aga Khan University Hospital in Karachi, Pakistan from June 2020 to May 2021. Medical Records of 159 adult COVID-ICU patients with no prior history of cardiac illness admitted between June 2020 till May 2021, were analyzed. Results: The median age of COVID-ICU patients was 58 years (IQR =17 years). 48.4% (n=77) of all COVID-ICU patients developed one or more new cardiac events, with an incidence density of 92.9/1000 patient-days of COVID-ICU stays. Non-ST elevation myocardial infarction, ECG changes, and cardiac arrhythmias were identified as the most common cardiac complications. The study found a significantly higher frequency of cardiac events among patients having Diabetes Mellitus and Septic Shock. The study also found significant differences in ICU and hospital mortality among COVID-ICU patients with and without cardiac complications. Conclusion: The incidence of cardiac complications is considerably high among COVID-ICU patients and is relatively higher among patients having Diabetes Mellitus and septic shock. Patients with cardiac complications showed considerably higher ICU and hospital mortality. Early identification of patients at higher risk of cardiac complications is crucial for better management of critically ill COVID-19 patients.

S770 Risk of Cardiovascular, Thrombotic and Renal Complications After COVID-19 in Patients With Inflammatory Bowel Disease: A Propensity-Matched Cohort Study

Introduction: Studies have demonstrated that patients with Coronavirus disease 2019 (COVID-19) are at an increased risk of incident cardiovascular disease (CVD) including cerebrovascular disease, dysrhythmias, ischemic heart disease, myocarditis, pericarditis, heart failure and thromboembolic disease. Renal complications are also frequently reported in patients with COVID-19. Little is known regarding the short and long-term risk of COVID-19 related complications in patients with inflammatory bowel disease (IBD) Methods: We compared the 1 year risk of cardiac complications (arrhythmias, heart failure, myocarditis and pericarditis), venous thromboembolism (VTE), peripheral artery disease (PAD), ischemic stroke and acute kidney injury (AKI) in patients between IBD and non-IBD cohort after COVID-19 using TriNetX, a multi-institutional database. Sub-group analysis was performed based on vaccination status, disease activity and IBD medications. Active disease was defined as patients requiring IV or PO steroids or initiation of new biologic agent within 6 months prior to diagnosis of COVID-19. Patients with stable disease were steroid free or were not initiated on new biologic for at least 1 year prior to diagnosis of COVID-19. 1:1 propensity-score matching was performed for age, gender, race, ethnicity and all major risk factors of COVID-19 between all cohorts. Adjusted odds ratios (aOR) with 95% confidence interval (CI) were calculated. Results: The IBD cohort (n = 8,773) had an increased risk for cardiac complications (aOR 1.52, 95% CI 1.33 – 1.73), VTE (1.77, 1.53-2.04), ischemic stroke (2.04, 1.74 – 2.38), AKI (1.34, 1.14 – 1.58) and PAD (1.70, 1.34 – 2.15) after COVID-19 compared to non-IBD cohort. There was no difference between the vaccinated IBD cohort (≥2 vaccine doses) and vaccinated non-IBD cohort for composite outcome of CVD, VTE and AKI (aOR 1.28, 95% CI 0.52 – 3.15). Patients with active disease and COVID19 infection had a higher risk for cardiac complications, VTE and AKI (Figure). There was no difference in the risk of CVD, VTE or AKI in IBD patients on tumor necrosis factor inhibitor (TNFi), immunomodulators, non-TNFi and chronic prednisone compared to patients on 5-aminosalicyclic acid (5-ASA) (Table). Conclusion: Patients with IBD who are unvaccinated or with active disease are at an increased risk for CVD, thrombotic and renal complications after COVID-19. These patients may benefit from close follow up and aggressive CVD risk factor modification.Figure 1.: 1 year risk of CVD, thrombotic and renal complications in IBD patients after COVID-19 based on disease activity. Table 1. - Risk of CVD, thrombotic and renal complications after COVID-19 in IBD patients on TNFi, non-TNFi, chronic steroids and immunomodulators compared to 5-ASA Complication IBD medication (%) OR 95% CI TNFi 5-ASA Composite 10.79 10.83 0.99 0.64 – 1.52 Cardiac complication 8.36 7.52 1.12 0.70 – 1.77 VTE 4.60 3.72 1.24 0.70 – 2.22 Ischemic stroke 4.87 4.15 1.18 0.68 – 2.04 PAD 2.33 1.56 1.5 0.67 – 3.38 AKI 2.86 3.17 0.89 0.46 – 1.74 Immunomodulators 5-ASA Composite 14.14 14.06 1 0.68 – 1.47 Cardiac complication 8.50 11.30 0.72 0.48 – 1.08 VTE 6.90 6.50 1.06 0.71 – 1.60 Ischemic stroke 6.45 4.81 1.36 0.87 – 2.12 PAD 2.48 2.13 1.17 0.62 – 2.18 AKI 5.93 4.74 1.26 0.80 – 1.98 Non-TNFi 5-ASA Composite 12.50 12.50 1 0.55 – 1.79 Cardiac complication 8.15 11.62 0.67 0.36 – 1.24 VTE 4.74 3.86 1.24 0.54 – 2.81 Ischemic stroke 3.44 5.28 0.64 0.28 – 1.45 PAD 3.24 3.24 1 0.41 – 2.45 AKI 4.61 3.49 1.33 0.57 – 3.09 Steroid 5-ASA Composite 17.4 14.9 1.20 0.91 – 1.58 Cardiac complication 12.9 12.4 1.04 0.80 – 1.137 VTE 7.6 7.2 1.05 0.79 – 1.40 Ischemic stroke 7.9 6.07 1.33 0.99 – 1.78 PAD 2.3 2.1 1.09 0.69 – 1.74 AKI 7.01 5.97 1.18 0.87 – 1.61

Comprehensive geriatric assessment for older orthopedic patients and analysis of risk factors for postoperative complications

BackgroundThe comprehensive geriatric assessment (CGA) has been proposed as a supplementary tool to reduce perioperative complications of geriatric patients, however there is no universally accepted standardization of CGA for orthopedic surgery. In this study, a novel CGA strategy was applied to evaluate the conditions of older patients undergoing orthopedic surgery from a broad view and to identify potential risk factors for postoperative complications.MethodsA prospective cohort study was conducted from March 2019 to December 2020.The study enrolled patients (age > 75 years) for elective or confined orthopedic surgery. All patients were treated by a multidisciplinary team. A structured CGA was conducted to identify high-risk older patients and to facilitate coordinated multidisciplinary team care by a geriatric team. The basic patient characteristics, CGA results, postoperative complication and mortality rates were collected. Multivariate logistic regression analysis was used to identify risk factors for postoperative complications.ResultsA total of 214 patients with an age of 81.07 ± 4.78 (range, 75–100) years were prospectively enrolled in this study. In total, 66 (30.8%) complications were registered, including one death from myocardial infarction (mortality rate, 0.5%). Poor Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) were accompanied by frailty, worse perioperative risk, pain, and nutritional status. Poor ADL was also associated with higher risks of falling, polypharmacy, and cardiac and respiration complications. Poor IADL was associated with a higher risk of cardiac and respiration complications. Higher stroke risk was accompanied by higher risks of cardiac complications, delirium, and hemorrhage. Worse American Society of Anesthesiologists (ASA) score was associated with worse ADL, IADL, frailty, and higher delirium risk. Multivariate logistic regression analysis showed that spinal fusion (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.65 to 0.83; p = 0.0214), blood loss(OR, 1.68; 95% CI, 1.31 to 2.01; p = 0.0168), ADL (severe dysfunction or worse) (OR, 1.45; 95% CI, 1.16 to 1.81; p = 0.0413), IADL (serious dependence) (OR, 1.08; 95% CI, 1.33 to 1.63; p = 0.0436), renal function (chronic kidney disease (CKD) ≥ stage 3a) (OR, 2.01; 95% CI, 1.54 to 2.55; p = 0.0133), and malnutrition(OR, 2.11; 95% CI, 1.74 to 2.56; p = 0.0101) were independent risk factors for postoperative complications.ConclusionThe CGA process reduces patient mortality and increases safety in older orthopedic surgery patients. Spinal fusion, blood loss, ADL (severe dysfunction or worse), IADL (serious dependence), renal function (CKD ≥ stage 3a) and nutrition mini nutritional assessment (MNA) (malnourished) were independent risk factors of postoperative complications following orthopaedic surgery in older patients.

Cardiac Complications After 3-Column Osteotomy for Adult Spinal Deformity Patients With Formal Cardiac Clearance: Identifying Key Risk Factors and Threshold Cutoffs Via Recursive Partitioning Analysis.

Despite formal cardiac clearance, a subset of 3-column osteotomy (3CO) patients still experience cardiac complications (CCs). To define the incidence and risk factors for CC in 3CO patients who had formal cardiac clearance and assess the utility of the Revised Cardiac Risk Index (RCRI) and preoperative metabolic equivalent (MET) functional ability in predicting perioperative CC. Patients with adult spinal deformity (ASD) who underwent 3CO deformity correction from 2006 to 2019 were retrospectively reviewed. Multivariate and recursive partitioning analyses were performed to assess risk factors. A total of 390 patients with ASD were included. The mean age was 64.6 years, and 60.3% were female. The CC rate was 9.7%. Patients with CCs were older ( P &lt; .001), had an increased history of heart disease ( P = .001), and higher blood loss ( P = .045). RCRI score ( P = .646) or MET functional ability ( P = .493) were not associated with CC. On multivariate analysis, age ( P &lt; .001), blood loss ( P = .008), and prior spinal fusion ( P = .025) were independent risk factors for CC. Patients age older than 81 years had a significantly higher CC rate than those younger than 81 years. In patients age 81 years and younger, if blood loss was &gt;3900 mL, CC rate was significantly higher. Among patients age 81 years and younger and with &gt;3900 mL blood loss, CC rate is significantly higher in patients with ejection fraction (EF) ≤54.5%. RCRI and MET functional ability are limited risk assessment tools in ASD 3CO patients with formal cardiac clearance. Patients older than 81 years are at high risk for CC. In younger patients, cardiac EF and blood loss are significant components to risk stratify for CC.

Dynamika pokaznykiv yakosty zhyttia u khvorykh na infarkt miokarda z krytychnoiu ishemiieiu nyzhnikh kintsivok pid vplyvom kompleksnoho likuvannia z vykorystanniam arhinin-karnitynovoi sumishi ta standartnoho protokolnoho likuvannia

Introduction. The presence of critical lower extremity ischemia (CLEI) in patients with acute coronary syndrome (ACS) limits the possibility of early invasive interventions and determines the tactics of medical preparation for surgery and prevention of complications. The aim of the study. To assess the dynamics of life quality using the EQ-5D-5L questionnaire in patients with myocardial infarction (MI) in combination with obliterative atherosclerosis of the main vessels at the stage of critical lower extremity ischemia and high risk of cardiac complications in the inpatient phase of treatment under the influence of metabolic therapy. Materials and methods. 67 patients with ACS (MI) in combination with CLEI due to stenotic atherosclerosis of the iliac-femoral arterial segment were examined: 35 patients of the main group who underwent emergency balloon angioplasty and infarct-dependent coronary artery stenting in addition with L-arginine/L-carnitine complex (“TIVOR-L”; “Yuri-Pharm”; in the form of intravenous infusions for seven days of 100.0 ml once / day). 32 patients in the comparison group received only standard protocol treatment. All patients, in addition to general clinical, laboratory and instrumental methods, were additionally assessed for quality of life according to the EQ-5D-5L questionnaire. Statistical processing of indicators was performed by the method of variation statistics. Samples were checked for normality of data distribution according to the test of S. Shapiro – M. Wilk, parametric (t-test, Student’s test) methods were used. Confidence interval (CI) and relative risk (RR) were used to more accurately assess the accuracy. Results. In patients of both groups, the severity of the clinical condition did not differ significantly and was due to typical manifestations of ACS and CLEI. In patients of the main group, the use of intravenous infusions of arginine-carnitine mixture against the background of the standard protocol treatment program led to the elimination of anginal syndrome in all patients and reduced functional class of acute heart failure. When evaluating the effectiveness of the proposed combination treatment and its subjective perception by patients, it was found that initially patients of both groups evaluated their quality of life with similar relatively low scores: an average of 26.14 ± 10.15 and 25.68 ± 9.74 points (p-value more than 0.05). We note a significantly higher assessment of quality of life in patients after a course of comprehensive treatment, whose quality of life index improved by an average of 160.9 % and reached the level of 86.5 ± 8.3 points. During the standard treatment program in patients with ACS in combination with CLEI there was a significant improvement in well-being, the total quality of life index increased by 40.2 %. Сonclusions. Patients in the experimental group with acute coronary syndrome and critical lower extremity ischemia who received arginine-carnitine mixture in addition to complex standard protocol drug treatment had significantly reduced feelings of chest pain/discomfort and anxiety / depression and tended to increase motor activity.

Antipsychotic drugs and QT interval prolongation

Prolongation of myocardial repolarization, i.e. lengthening of the QTc interval on surface electrocardiogram (ECG), with increased risk of cardiac arrhythmias, has been recognized as a side effect of many drugs. Most first and second generation antipsychotic drugs can cause dose-related prolongation of QTc, although there are important differences in the potency of individual agents. ECGs in 46 patients suffering from schizophrenic disorder and treated with different antipsychotic drugs one week after the admission to the psychiatric hospital were analyzed in this prospective observational study. Hearth rate, QT interval and QTc interval were assessed. The average daily dose of prescribed antipsychotic drugs was calculated. Average QTc interval was 417 msec, only 3 out of 46 (6,5%) patients had QTc over 450 msec and only one patient (2,2%) had QTc over 500 msec. No differences in QTc interval between patients who were treated either with first or second generation antipsychotic drug or with combination of both were found. Female participants had significantly longer OTc interval than male participants (p &lt; 0,05). Results raise the question of the clinical relevance of a single ECG for diagnostics of cardiac complications in schizophrenia patients and suggest the need to conduct ECG monitoring in patients with high risk for cardiac complications during antipsychotic treatment.

Acute Coronary Syndrome without ST Elevation: is The Level of Ultrasensitive Troponin T Correlated to the Severity of Coronary Involvement?

Introduction: Acute coronary syndromes without ST segment elevation are heterogeneous entities. Troponins contribute to the early identification of patients at high risk for cardiac complications. The objective of this work is to study the severity of coronary artery disease according to the ultrasensitive troponin T (T us) level. Methods: We have performed a descriptive retrospective of patients hospitalized in the cardiology department of CHU Mohammed VI in Marrakech, between January 2018 and February 2022 for acute coronary syndromes without ST segment elevation. Patients were divided into two groups according to the rate of troponin Tus. Results: 50 patients were included, comprising 35 men and 15 women. Group 1, made of 20 patients whose ultrasensitive troponin T level is less than 4 times normal, group 2, whose troponin T level is more than 4 times normal, made of 30 patients. Demographic analysis shows that there is no significant difference between the two groups in terms of average age and sex. Hypertension is slightly more common in Group 1 (45% vs. 43.3%). De novo angor was more frequent in group 1 compared to group 2 (10% vs 6.7%;p=0.01). At electrocardiogram, subendocardial lesions are more in Group 2 (15% vs. 43.3%; p=0.0006). Group 1 had angiographical coronaries more frequently normal or non-significant coronary involvement compared to group 2 (40% vs 6.67%; p&lt;0.001). Tritroncular lesions are more frequently found in Group 2 (33.3% vs. 5%;p=0.02). Monotroncular and bi-roncular lesions are recorded identically in both groups. Ischemic recurrences are more common in Group 2 (35% vs. 46.6%;p=0.02). Conclusion: Stable Troponin US levels are associated with the degree of coronary involvement, and frailty measurements were significantly associated with the severity of coronary lesions, this could help to identify patients who are at a high risk of death. These findings may help clinicians guide further diagnostic assessment.

The Epidemiology and Mechanisms of Lifetime Cardiopulmonary Morbidities Associated With Pre-Pregnancy Obesity and Excessive Gestational Weight Gain.

Obesity has reached pandemic proportions in the last few decades. The global increase in obesity has contributed to an increase in the number of pregnant women with pre-pregnancy obesity or with excessive gestational weight gain. Obesity during pregnancy is associated with higher incidence of maternal co-morbidities such as gestational diabetes and hypertension. Both obesity during pregnancy and its associated complications are not only associated with immediate adverse outcomes for the mother and their newborns during the perinatal period but, more importantly, are linked with long-term morbidities in the offsprings. Neonates born to women with obesity are at higher risk for cardiac complications including cardiac malformations, and non-structural cardiac issues such as changes in the microvasculature, e.g., elevated systolic blood pressure, and overt systemic hypertension. Pulmonary diseases associated with maternal obesity include respiratory distress syndrome, asthma during childhood and adolescence, and adulthood diseases, such as chronic obstructive pulmonary disease. Sequelae of short-term complications compound long-term outcomes such as long-term obesity, hypertension later in life, and metabolic complications including insulin resistance and dyslipidemia. Multiple mechanisms have been proposed to explain these adverse outcomes and are related to the emerging knowledge of pathophysiology of obesity in adults. The best investigated ones include the role of obesity-mediated metabolic alterations and systemic inflammation. There is emerging evidence linking metabolic and immune derangements to altered biome, and alteration in epigenetics as one of the intermediary mechanisms underlying the adverse outcomes. These are initiated as part of fetal adaptation to obesity during pregnancy which are compounded by rapid weight gain during infancy and early childhood, a known complication of obesity during pregnancy. This newer evidence points toward the role of specific nutrients and changes in biome that may potentially modify the adverse outcomes observed in the offsprings of women with obesity.

Elevated Serum HE4 Concentrations and Risk of Cardiac Complications among Hospitalized Patients with Burns.

The decrease in effective blood volume after burns is closely related to abnormal heart function. To investigate whether serum human epididymis protein 4 (HE4), an indicator of early renal injury, contributes to increased risk of cardiac complications in patients with burns. Within 24 hours after hospital admission, clinical condition assessment and biochemical testing in patients with burns were performed. Multivariate analysis was performed by evaluating the relationship between serum HE4 levels and risk of cardiac complications (cardiac insufficiency, arrhythmia, and myocardial infarction) during hospitalization. The number (percentage) of cardiac complications in all included patients with burns was 80 (15.6%). The results of sensitivity analysis suggest that elevated serum HE4 levels were related to higher risk of cardiac complications in patients with sepsis (OR = 2.1; 95% CI, 1.19-3.17; P <.001) and in patients without sepsis (OR = 2.29; 95% CI, 1.33-4.71l; P = .005), respectively, after adjustments for clinical confounding factors were made. Sepsis did not have a modification effect on the association between serum and cardiac complications among these patients. Also, the results of ROC curve analysis showed that serum HE4 levels have good predictive value for predicting cardiac complications in patients with burns (AUC = 0.708; 95% CI, 0.61-0.81; P <.001). In the current study, we identified that elevated HE4 levels contributed to increased risk of cardiac complications in the hospital in patients with burns. This novel finding suggests that burn patients with serum HE4 may provide the opportunity to predict cardiac complications before hospital admission.

Prediction model of Graves' disease in general clinical practice based on complete blood count and biochemistry profile.

Although untreated Graves' disease (GD) is associated with a higher risk of cardiac complications and mortality, there is no well-established way to predict the onset of thyrotoxicosis in clinical practice. The aim of this study was to identify important variables that will make it possible to predict GD and thyrotoxicosis (GD + painless thyroiditis (PT)) by using a machine-learning-based model based on complete blood count and standard biochemistry profile data. We identified 19,335 newly diagnosed GD patients, 3,267 PT patients, and 4,159 subjects without any thyroid disease. We built a GD prediction model based on information obtained from subjects regarding sex, age, a complete blood count, and a standard biochemistry profile. We built the model in the training set and evaluated the performance of the model in the test set by using the artificial intelligence software Prediction One. Our machine learning-based model showed high discriminative ability to predict GD in the test set (area under the curve [AUC] 0.99). The main contributing factors to predict GD included age and serum creatinine, total cholesterol, alkaline phosphatase, and total protein levels. We still found high discriminative ability even when we restricted the variables to these five most contributory factors in our prediction model (AUC 0.97) built by using artificial intelligence software showed high GD prediction ability based on information regarding only five factors.

Cyanocobalamin prevents cardiomyopathy in type 1 diabetes by modulating oxidative stress and DNMT-SOCS1/3-IGF-1 signaling

Patients with long-standing diabetes have a high risk for cardiac complications that is exacerbated by increased reactive oxygen species (ROS) production. We found that feeding cyanocobalamin (B12), a scavenger of superoxide, not only prevented but reversed signs of cardiomyopathy in type 1 diabetic Elmo1H/HIns2Akita/+ mice. ROS reductions in plasma and hearts were comparable to those in mice treated with other antioxidants, N-acetyl-L-cysteine or tempol, but B12 produced better cardioprotective effects. Diabetes markedly decreased plasma insulin-like growth factor (IGF)-1 levels, while B12, but not N-acetyl-L-cysteine nor tempol, restored them. B12 activated hepatic IGF-1 production via normalization of S-adenosylmethionine levels, DNA methyltransferase (DNMT)-1/3a/3b mRNA, and DNA methylation of promoters for suppressor of cytokine signaling (SOCS)-1/3. Reductions of cardiac IGF-1 mRNA and phosphorylated IGF-1 receptors were also restored. Thus, B12 is a promising option for preventing diabetic cardiomyopathy via ROS reduction and IGF-1 retrieval through DNMT-SOCS1/3 signaling.

Surgical treatment of patients with abdominal aortic aneurysm and ischaemic heart disease

Presented herein are the results of treatment of 137 patients with infrarenal aneurysms of the abdominal portion of the aorta in a combination with ischaemic heart disease. Severity of lesions to the coronary bed and the risk of cardiac complications were assessed according to the SYNTAX score. Depending on severity of angina pectoris and the clinical course of infrarenal aortic aneurysms, we used different tactical approaches to operative treatment of patients. In a low risk of coronary complications, we performed isolated prosthetic repair or endoprosthetic reconstruction of the abdominal aorta. In patients with haemodynamically significant lesions of the coronary bed and positive non-invasive tests, the first stage consisted in coronary artery bypass grafting or stenting of coronary arteries taking into account the risk of cardiac complications according to the SYNTAX Score. The second stage consisted in prosthetic repair or endoprosthetic reconstruction of the abdominal aorta. The terms of the second stage differed and were determined by the course of abdominal aortic aneurysms. In symptomatic large aneurysms (more than 8 cm), prosthetic repair of the abdominal aorta was carried out within 2 weeks after previous stenting of coronary arteries. Simultaneous myocardial revascularization and abdominal aortic reconstruction were performed only in patients with severe angina pectoris, lesions of the trunk of the left coronary artery, three-vessel lesions of the coronary bed, high risk of cardiac complications according to the SYNTAX Score and a complicated or symptomatic course of an infrarenal aortic aneurysm. During implantation of stent grafts into the abdominal aorta there were neither lethal outcomes nor cardiac complications. In open operations, the 30-day mortality rate amounted to 2.2%, with the 5-year survival rate of 92%.

Risk of cardiovascular events in patients with atrial fibrillation and cancer. Data from the ATHERO-AF cohort

Abstract Background Patients with non valvular atrial fibrillation (AF) and cancer represent a high-risk subgroup of patients in whom the management of oral anticoagulation may be challenging. The relationship between cancer type and the risk of cardiovascular events (CVEs) in patients with AF is unclear. Purpose To investigate the incidence of CVEs in patients with AF and cancer according to cancer type. Methods Prospective cohort study including 2,092 consecutive AF patients on vitamin K antagonists. Principal endpoint was the occurrence of CVEs including fatal/non-fatal myocardial infarction and ischemic stroke and cardiovascular death. We also performed a subgroup analysis of cardiac and thromboembolic events separately. Patients with cancer were divided in subgroups based on cancer site as follows: group 1 gastrointestinal tract; group 2 respiratory tract; group 3 genitourinary tract; group 4 other sites. Results Mean age was 73.7±9.1 years and 42.1% were woman; 367 (17.5%) had cancer, of these 21% gastro-intestinal, 10% respiratory, 28% genito-urinary and 41% had other localization. Patients with cancer were older than those without but with similar clinical characteristics. During a mean follow up of 35.9±28.0 months (6264.5 patient-years), 203 CVEs occurred (3.24%/year, 95% CI 2.81–3.72) of whom 86 were cardiac ischemia (1.37%/year, 95% CI 1.10–1.69), 70 thromboembolic events (1.12%/year, 95% CI 0.87–1.41) and 47 cardiovascular deaths (0.75%/year, 95% CI 0.55–0.99). The incidence of CVEs for AF patients with and without cancer was respectively (n=45, 3.78%, 95% CI 2.76–5.06) and (n=158, 3.11%/year, 95% CI 2.65–3.64). In particular, compared to patients without cancer, a higher incidence rate of CVEs was found in patients with gastrointestinal tract cancer (5.61%/year, 95% CI 2.90–9.79, p=0.046), and in patients with respiratory tract cancer (6.15%/year, 95% CI 2.66–12.1, p=0.055), while no difference was found in patients with genito-urinary tract cancer (2.24%/year, 95% CI 0.97–4.41, p=0.362) and other site cancer (3.11%/year, 95% CI 2.65–3.64, p=0.512). Cox regression multivariate analysis showed that factors associated with cardiac events were COPD, dyslipidemia, TTR &amp;lt;70%, PPI drugs and gastrointestinal cancer (figure). Conversely, CHA2DS2VASc score and respiratory cancer were predictors of thromboembolic events. Conclusions Our findings suggest an association between cancer type and specific ischemic complications in AF patients. In particular, we found a higher risk of cardiac complications in patients with gastrointestinal cancer and of thromboembolic events in patients with respiratory cancer. These associations need to be confirmed in larger studies. Funding Acknowledgement Type of funding source: None