History Of Cardiac Disease Research Articles

Prognostic Impact of Comorbidities on Outcomes of Patients (pts) with Relapsed or Refractory Large B-Cell Lymphoma (r/r LBCL) Treated with Chimeric Antigen Receptor T-Cell Therapy (CART)

Background CAR T-cell therapy is a standard of care for patients with r/r LBL and despite promising responses, outcomes can vary depending on the condition of the patient prior to the infusion. Pre-existing comorbidities as scored by the hematopoietic cell transplantation-specific comorbidity index (HCT-CI) (Sorror, et al. Blood. 2005) have been shown to be associated with morbidities and mortality following transplants. The impact of comorbidities on outcomes of CAR T-cell therapy is not well established. To this end, we sought to develop and validate a CAR T-cell therapy-specific comorbidity index (CT-CI) and examine its prognostic value in predicting survival and toxicity outcomes. Methods Utilizing the cellular therapy registry from the Center for International Blood and Marrow Transplant Research (CIBMTR) adult pts were identified with r/r LBCL receiving commercially available CAR T-cell therapy since FDA approval (2017 and 2018 for axi-cel and tisa-cel, respectively) until December 2020. Each reported individual comorbidity according to the HCT CI was individually assessed on its impact on outcomes after CAR T cell infusion Pts were randomly assigned to training (67% of pts) and validation (33% of pts) cohorts. In the training set, Cox proportional hazard model was used to examine risk factors associated with OS. A stepwise selection method was used to identify the significant covariates affecting OS with a significance level of 0.01. Pairwise interactions between significant factors were tested. Multivariate analysis (MVA) adjusting for the significant covariates was used to develop a weighted score for each comorbidity based on the magnitude of hazard ratios (HRs) for OS. The CT-CI score (the sum of weighted scores of individual comorbidities) was then tested in the validation cohort. Results We identified 1916 pts, median age was 63.6 years (range: 18.5-91), with 24.7% (n=473) ≥70 years of age, and 63.9% males (n=1225). A total 13.8% (n=265) and 24.1% (n=461) of pts had double∖triple hit LBCL and transformed lymphoma, respectively. Of the whole cohort 19.5% (n=373) of pts had Karnofsky performance status (KPS) less than 80, while 43.6% (n=836) had an elevated LDH prior to CT. Incidence of all grade CRS was 75.4% (8.5% grade ≥3 and all grade ICANS was 44.4% (19.5% grade ≥3), respectively. 12-month progression free survival (PFS) was 42.2% (95% CI 39.9-44.5) and 12-month OS was 61.6 (95% CI 59.4-63.9). The primary cause of death was disease progression 73.2% (n=617). Incidence of treatment related mortality (TRM) was 4.3% (95% CI 3.4-5.3). At least 1 comorbidity was recorded for 1321 (68.9%), while 558 (29.1%) had none and 37 (1.9%) did not have reported data. The most commonly reported were history of cardiac disease (11.8%), diabetes requiring non-diet treatment (13.8%), psychiatric disturbance (18.1%), pulmonary disease (moderate- 15.0%, severe- 12.2%) and hepatic disease (mild- 8.2%, moderate∖severe- 2 %). Table 1 shows comorbidities associated with overall mortality on multivariable analysis in the training cohort. Other clinical factors associated with worse OS were lower KPS (<80 vs. 90-100 (HR 1.956, 95%CI 1.577-2.424, p<0.0001, 80-90 vs. 90-100 HR 1.239, 95%CI 1.006-1.527, p=0.0442), and resistant disease or a partial response at time of infusion (resistant disease vs. CR; HR 3.891, 95%CI 1.932-7.836, p<0.0001, PR vs. CR HR 2.789, 95%CI 1.361-5.713, p=0.0051) Higher CT-CI scores were associated with worse 1-year OS in the training, validation, and entire cohorts (0 vs 1 vs 2 vs ≥3) (Table 2). The C-index was 0.56. While KPS and LDH were associated with toxicities, specific comorbidities and the CT-CI were not associated with development or incidence of CRS or ICANS. Conclusion Development of a novel CT-CI has shown that comorbidities are predictive of mortality after CAR T-cell therapy and may influence clinical decisions for treatment selection in high risk pt populations. Further analysis will be presented at the meeting. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Impact of kinesiophobia on initiation of cardiac rehabilitation: a prospective cohort path analysis

ObjectivesTo identify factors associated with kinesiophobia (fear of movement) after cardiac hospitalisation and to assess the impact of kinesiophobia on cardiac rehabilitation (CR) initiation.DesignProspective cohort study.SettingAcademic Medical Centre, Department of...

ODP609 Optimizing Sexual Function and Libido in Men with Androgen Deficiency due to Hypogonadotropic Hypogonadism

Abstract Objective Bolstered by an N-of-1 study design, precision medicine proactively predicts and reverses chronic disease, thereby extending the healthspan. An essential element to this approach is maintaining quality of life despite age. Adult males commonly report a decline in sexual function and libido, which can be triggered by a 1-3% decline in testosterone beginning in their thirties. Our collection, integration, and interpretation of longitudinal data on men revealed symptoms emerging even earlier due to other diagnoses, such as varicocele, depression, or a positive family history of early cardiac disease. In the present study, the efficacy of hormonal optimization to improve sexual function and libido in adult men was investigated. Methods Inclusion criteria for this retrospective chart review were men aged ≥20 years who were active patients for ≥6 months and prescribed hormonal intervention. Clinical encounter notes were reviewed for reported improvement in sexual function and/or libido, which was noted as a binary variable. Exclusion criteria was met if sexual function and libido were never discussed during any encounter. Chi-square tests for independence were performed to assess correlation between improvements in sexual function and Libido. Results 82 patients were eligible for inclusion in this study. Five were never prescribed hormonal intervention and therefore exclude, resulting in a final cohort of 77 patients ranging from 21-90 years (mean=54 years). Patient data was compiled into 6 age groups: 20-29 (8, 10.4%), 30-39 (3, 3.9%), 40-49 (14, 18.2%), 50-59 (29, 37.7%), 60-69 (13, 16.8%), and 70+ (10, 13. 0%). Overall, 84% and 88% of patients reported improvement in sexual function and libido, respectively. Improvements in sexual function and libido were most reported in the 60-69 age group (92% and 93%) and least reported in the 30-39 age group (33% and 67%). Notably, the majority of 11 out of 12 age-outcome groups noted improvement. Improvements in sexual function and libido were significantly correlated, with 71% of all patients reporting improvement in both categories (p &amp;lt; . 001). Discussion Overall, these findings reveal the efficacy of hormonal optimization to improve sexual function and libido in men across age groups. A limitation of this study is sample size, particularly in the 30-39 age group. Repeated analysis with a larger sample would provide deeper insight to this treatment modality. Nevertheless, these results emphasize the importance of the N-of-1 concept, as each patient's baseline hormonal status and physiological response to intervention is unique. Age is just a single variable to consider before hormonal intervention, not the only variable. Importantly, sexual function and libido are among the many aspects that constitute an optimal quality of life. Further investigation is warranted to understand how hormonal optimization impacts other quality of life markers, such as sleep, energy, and cognition, in the adult male population. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Bimaxillary Distalization with Skeletal Anchorage for Management of Severe Skeletal Class III Open Bite Malocclusion.

Adult patients with severe vertical growth pattern, skeletal class III malocclusion and open bite anteriorly are difficult orthodontic cases to treat. An orthognathic surgical treatment plan may benefit adult patients with such types of complex malocclusions, however in certain cases, the patient's medical history may contraindicate the surgical treatment plan. A male patient aged 17 years presented with a prognathic mandible, Angle's class III malocclusion on a class III skeletal base with proclination in upper incisors, retroclination of lower incisors, and reduced facial convexity. Patient gave history of asthma and complex cardiac diseases including arrhythmia, irregular heartbeat, and pacemaker. This case report describes a non-surgical approach of distalization of mandibular and maxillary arches performed with the help of miniplates to achieve an improvement in the facial balance without surgery.

Radiation Dose, Technique and Use of Brain Radiation on Overall Survival in Patients with Limited-Stage Small Cell Lung Cancer

<h3>Purpose/Objective(s)</h3> The standard of care for limited-stage small cell lung cancer (LS-SCLC) currently involves concurrent chemoradiation +/- prophylactic cranial irradiation (PCI). Previous research has presented conflicting data regarding the optimal radiation therapy (RT) technique, RT dosage, and impact of brain RT on long term overall survival (OS). This study aimed to explore prognostic factors of OS in LS-SCLC cancer patients using a population-based cohort. <h3>Materials/Methods</h3> Data on all patients diagnosed with LS-SCLC in Ontario, Canada from 2005-2017 was obtained using the Institute for Clinical Evaluative Sciences (IC/ES) Data and Analytic Services. Eligible patients received curative intent chemoradiation, and OS was estimated from a landmark date of 6 months post-diagnosis to avoid survivor bias. Kaplan-Meier methods and Cox regression were used to estimate OS and explore differences between RT dose (40-49, 50-59, 60+ Gy), RT technique (3DCRT, IMRT, VMAT), and use of brain RT (PCI – 25 Gy, whole brain RT – 20 or 30 Gy, other brain RT, no brain RT). Multivariate analyses adjusted for sex, age, income quintile, Charlson comorbidity index, disease stage, prior history of cardiac disease, brain RT dose, and laterality. <h3>Results</h3> A total of 1360 LS-SCLC patients who received chemoradiation were included. Median OS (95% CI) was 18.1 months (16.6-19.4). Higher RT dose had significantly improved OS when compared to 40-49 Gy on univariate analysis (HR=0.83, 0.71-0.95, 60+ Gy), however, this did not persist when adjusting for other prognostic factors on multivariate analysis (HR=0.90, 0.77-1.06, 60+ Gy). The use of whole brain RT was associated with worse OS on both univariate (HR=1.47, 1.24-1.74) and multivariate (HR=1.42, 1.18-1.70) analyses. OS (95% CI) at 5-years for RT dose were 40-49 Gy: 16% (13-19%), 50-59 Gy: 23% (18-29), and 60+ Gy: 20% (16-25). For RT technique, OS (95% CI) at 5-years were 3DCRT: 19% (13-22), IMRT: 18% (13-23), and VMAT: 12% (4-25). Multivariate analyses demonstrated that male sex (HR=1.36, 1.20-1.55), more advanced stage disease (HR=1.35/1.94/3.08/1.67 for stage 2/3/4/Unknown vs 1), and older age were prognostic for worse OS. <h3>Conclusion</h3> Analyses of population-based data demonstrated that male sex, older age, and more advanced disease stage were notable predictors of OS in LS-SCLC. RT dose, when adjusting for other important prognostic variables did not predict for improved OS. However, use of whole brain RT (versus PCI or no PCI) was associated with worse OS. Use of PCI versus no PCI did not influence survival in this cohort, nor did RT technique.

Case of Mitral Valve Prolapse – Associated Sudden Cardiac Death in Pregnancy

BACKGROUND Mitral valve prolapse (MVP) is a frequent echocardiographic finding that can be accompanied by symptoms ranging from a benign course to occasionally catastrophic complications, such as heart failure, and rarely, sudden cardiac death. Female sex, younger age, physiological or psychological stress, electrical instability, and changes in the structure of the mitral apparatus all seem to be risk factors for fatal ventricular arrhythmias in patients with MVP. We report a case of MVP-related cardiac arrest in a pregnant woman, which is rarely reported. CASE REPORT A 34-year-old woman who had collapsed at home from cardiac arrest was transported to the hospital. She had no history of cardiac diseases and was 8 weeks pregnant. Premature ventricular complexes and sinus tachycardia were observed on the 12-lead electrocardiogram as she arrived at the Emergency Department. The second cardiac arrest she experienced while in the hospital was observed to be from torsades de pointes. Further investigations revealed severe mitral valve regurgitation due to posterior leaflet prolapse and regional hypokinesis of the inferior wall and interventricular septum. CONCLUSIONS Ventricular arrhythmia is a frequent finding of mitral valve regurgitation. However, it rarely results in serious consequences. Malignant arrhythmic mitral valve regurgitation can result in sudden cardiac death; therefore, physicians need to be aware of patients with MVP who exhibit characteristics of a potential high-risk profile in order to avoid tragic outcomes.

Impact of case-mix adjustment on observed variation in the healing of diabetic foot ulcers at 12 weeks using data from the National Diabetes Foot Care Audit of England and Wales: A cohort study.

This cohort study investigates the extent to which variation in ulcer healing between services can be explained by demographic and clinical characteristics. The National Diabetes Foot Care Audit collated data on people with diabetic foot ulcers presenting to specialist services in England and Wales between July 2014 and March 2018. Logistic regression models were created to describe associations between risk factors and a person being alive and ulcer-free 12 weeks from presentation, and to investigate whether variation between 120 participating services persisted after risk factor adjustment. Of 27,030 people with valid outcome data, 12,925 (47.8%) were alive and ulcer-free at 12 weeks, 13,745 (50.9%) had an unhealed ulcer and 360 had died (1.3%). Factors associated with worse outcome were male sex, more severe ulcers, history of cardiac or renal disease and a longer time between first presentation to a non-specialist healthcare professional and first expert assessment. After adjustment for these factors, four services (3.3%) were more than 3SD above and seven services (5.8%) were more than 3SD below the national mean for proportions that were alive and ulcer-free at follow-up. Variation in the healing of diabetic foot ulcers between specialist services in England and Wales persisted after adjusting for demographic characteristics, ulcer severity, smoking, body mass index and co-morbidities. We conclude that other factors contribute to variation in healing of diabetic foot ulcers and include the time to specialist assessment.

Normal indexed values of left atrial volume by age and gender in a population of 250 healthy subjects: a CT-study

Abstract Introduction Left atrial volume (LAV) is predictive of cardiovascular outcomes. Its reference values have been described with 2D-transthoracic echocardiography (TTE) and cardiac MRI but very few data are published regarding cardiac computed tomography angiography (CCTA) values. Recent guidelines have highlighted the role of CT-scan, which is a valuable tool to evaluate cardiac dimensions, by its volumetric approach, with a minimal time acquisition and high reproducibility. Purpose We aimed to provide CCTA normal LAV reference values by age and gender in a population of 250 healthy subjects. Methods We retrospectively included 250 adults (18–74 years) who underwent a retrospectively ECG-gated CCTA in our institution, in order to rule out coronary disease after an episode of chest pain, without any history of cardiac disease or anomaly on the CT-scan. We divided our population in 5 classes of age (&amp;lt;40; 40–49; 50–59; 60–69; ≥70 years) with 1:1 sex ratio. LAV was evaluated at 40% of RR cycle, corresponding to maximal volume, by 2 different methods: semi-automated volumetric approach (3D) and manual area-length (A-L), as recommended for echocardiography and MRI. Results In the overall population, mean LAV was 50.6±12.7 ml/m2 (lower and upper limits 25 and 76 ml/m2 respectively) by 3D method and slightly lower using A-L method (42.8±11.5 ml/m2) (LL and UL 20 and 66 ml/m2 respectively). Normal values were 22–81 ml/m2 (3D) and 17–68 ml/m2 (A-L) in men and 30–70 ml/m2 (3D) and 23–63 ml/m2 (A-L) in women. There was no significant difference across genders, but LAV significantly increased with age by the 2 methods (Table 1). Interobserver agreement was better using 3D than A-L method (Lin's coefficient = 0.89 and 0.67, respectively). Concordance between the 2 methods was good, with overall Pearson's correlation coefficient R = 0.72 (p&amp;lt;0.001) (Figure 1). Conclusion This study is the first to establish normal indexed LAV values by gender and age in a large population of healthy adults with 2 methods, 3D volumetric approach being the most reproducible one. More accurate than TTE and more available than CMR, CCTA may become a reference method to evaluate LAV in various cardiac diseases and normal values definition is thus of importance. Funding Acknowledgement Type of funding sources: None.

S455 Factors Associated With Higher Complication Rates Amongst Patients Requiring Endoscopic Intervention for Esophageal Food Impaction

Introduction: The American Society for Gastrointestinal Endoscopy recommends that endoscopic intervention should occur within 24 hours to minimize complications in patients presenting with food impaction. The aim of our study was to ascertain whether complication rates were higher in patients undergoing endoscopy more than 6 hours after presentation compared to those undergoing intervention within 6 hours and to identify factors associated with patients that develop complications. Methods: The electronic medical record at a single tertiary care center was queried for esophagogastroduodenoscopies (EGD) with food impaction over a ten-year period. Information on patient demographics, medical history, timing of presentation, timing of EGD, procedural and post-procedure complications was obtained. Rates of complications were compared between encounters in which a patient had an EGD within 6 hours from initial presentation versus greater than 6 hours. Data was compared using Fishers Exact test for categorical variables and a two-tailed t-test for continuous variables. (Table) Results: This study received IRB approval. 127 records met the inclusion criteria, with 86 undergoing an EGD within 6 hours. Those undergoing EGD within 6 hours were younger (48.6 vs 60.4, p< .001), and less likely to have heart disease (5.8% vs 17.1%, p=.055). Patients that underwent an EGD within 6 hours had statistically significant fewer post-procedural complications (0% vs 12.2%, p=.0029) and fewer complications overall (3.5% vs 14.6%, p=.057). Amongst the 5 cases where post-procedural complications occurred, average age was 78.4 (range of 68 to 89) and average time from presentation to EGD was 30.7 hours (range 7.5 to 60). Two of the 5 were transferred from an outside facility, 3 of the 5 had heart or lung disease. The only post-procedural complication was aspiration pneumonia in all five patients. Conclusion: The rate of procedural complication was not affected by duration to endoscopy. There is a higher risk of post-procedural complications in elderly patients that received an EGD more than 6 hours after initial presentation. Those patients were more likely to have cardiopulmonary comorbidities and 40% of them were transferred from outside facilities. There should be an effort to reduce delays to endoscopy and to reduce inter-facility transfer time, especially amongst elderly patients with cardiopulmonary comorbidities. Endotracheal intubation for patients undergoing EGD more than 6 hours after presentation may reduce complications. Table 1. - Patient characteristics and outcomes EGD within 6 hours EGD after 6 hours P value Total number of patients 86 41 Average age 48.6 (18.2) 60.4 (17.1) < 0.001 Male gender 64 (74.4) 27 (65.9) .40 On Anticoagulation 0 (0) 4 (9.8) .0098 History of cardiac disease 5 (5.8) 7 (17.1) .055 History of pulmonary disease 8 (9.3) 6 (14.6) .38 Prior food impaction 33 (38.4) 11 (26.8) .24 Procedural complication 3 (3.5) 1 (2.4) 1 Post-procedural complication 0 (0) 5 (12.2) .0029 Any complication 3 (3.5) 6 (14.6) .057

Stroke and intracardiac thrombus: A case series

IntroductionCardioembolism may cause 20%–40% of all ischemic strokes. Up to 22% of cardioembolic strokes are associated with intracardiac thrombi and occur in patients with a high burden of comorbid cardiac disease. Aim and methodsTo describe the in-hospital experience of stroke patients with intracardiac thrombi. A retrospective 1 center study was carried out. Demographic, clinical, stroke, echocardiographic, and outcome data of stroke patients with intracardiac thrombi were extracted. ResultsFrom 2018 to 2019, 530 stroke patients were admitted. Nine (1.7%) had intracardiac thrombi, 100% males with mean age 63.3 years. There were a high prevalence of cardiovascular risk factors, with anterior circulation stroke in 8 (88%) and large vessel occlusion in 8 (88%). Most had major echocardiographic findings and 8 (88%) had a discharge outcome Rankin scale score > 3. ConclusionIntracardiac thrombus is not an uncommon cause of stroke. Cardiac ultrasound is a sensitive diagnostic method and should be sought in older patients with high prevalence of cardiovascular risk factors and history of cardiac disease.

Impact of Heart Disease History on Safety of Telemedicine Cardiac Clearance Appointments.

The objective of this study was to compare complication, readmission, mortality, and cancellation rates between patients who had either an in-person or telemedicine preoperative cardiac clearance visit before spine surgery. A retrospective review was conducted on patients who underwent a spine procedure at a single tertiary academic center from February 1, 2020, to June 30, 2021. Cancellations, inpatient complications, 90-day readmissions, and inpatient and 90-day mortality rates were compared between in-person and telemedicine cardiac clearance visits. Secondary analysis included multiple logistic regression to determine independent predictors of case cancellations and complications. Alpha was set at P < 0.05. A total of 1,331 consecutive patients were included, with 775 patients (58.2%) having an in-person cardiac clearance visit and 556 (41.8%) having telemedicine clearance. Overall, the telemedicine cohort did not have more cancellations, complications, or readmissions. Regardless of the type of clearance, patients with a history of cardiac disease had more inpatient complications (15.8% versus 6.9%, P < 0.001) and higher 90-day mortality rates (2.3% versus 0.4%, P = 0.005). Subgroup analysis of patients with a history of cardiac disease showed that patients who had telemedicine visits had more cancellations (4.6% versus 10.9%, P = 0.036) and higher 90-day mortality rates (1.4% versus 4.4%, P = 0.045). On regression analysis, telemedicine visits were not independent predictors of preoperative cancellation rates (P = 0.173) but did predict greater preoperative cancellations among patients with cardiac history (odds ratio 2.73, P = 0.036). Patients with cardiac disease who undergo preoperative telemedicine visits have greater preoperative surgical cancellation rates and postoperative 90-day mortality rates. Although preoperative telemedicine visits may be appropriate for most patients, a history of cardiac disease should be a contraindication.

Cardiac Status of Patients with Thalassemia Major on Echocardiography

Background: Beta-thalassemia is a common genetic disorder in which red blood cell fail to perform normal function due to alterations in structure of red blood cells. Objective: To determine the cardiac status (mean left ventricular end diastolic diameter, left ventricular end systolic diameter and interventricular septal thickness) of patients with thalassemia major on echocardiography. Study Design: Cross-sectional study. Place and Duration of Study: Department of Pediatric Medicine, GMMMC Hospital, Sukkur from 2nd October 2020 to 1stApril 2021. Methodology: Ninety eight patients of both genders with age 2-18 years having thalassemia major. Thalassemia major were assessed and demographic variables including age, gender, family history of cardiac diseases, socio-economic status, other comorbid condition, duration since diagnosis of thalassemia was determined. All patients were also assessed for cardiac status using echocardiography. Results: Mean age of patients was 7.73±5.01 years. Mean duration since diagnosis of thalassemia was 6.12±4.80 years. There were 65 (66.33%) males and 33 (33.67%) female patients. There were 18 (18.37%) patients having low, 52 (53.06%) middle and 28 (28.57%) high status. Family history of cardiac disease was found in 15 (15.31%) patients. Mean left ventricular end diastolic diameter was 38.42±3.75 mm, left ventricular end systolic diameter was 24.45±2.40 mm and interventricular septal thickness was 6.23±1.45 mm. Conclusion: Left ventricular diastolic dysfunction (LVDD) occurs in all studied patients of thalassemia major. There was no systolic dysfunction and intraventricular septal thickening in thalassemia major patients. Keywords: Left ventricular end diastolic diameter, Left ventricular end systolic Diameter, Interventricular septal thickness, Thalassemia major, Echocardiography.

64-Year-Old Woman With Aphasia and Troponin Elevation

64-Year-Old Woman With Aphasia and Troponin Elevation

Massive Hemorrhage Due to Aortoesoghageal Fistula in an 11-Months-Old Infant: A Case Report

Aortoesophageal Fistula (AEF) with no prior history of cardiac disease or trauma is an uncommon but a mortal cause of Upper Gastro Intestinal Bleeding (UGIB) in children.&#x0D; In pediatric patients, AEF is mainly due to a congenital cardiac or vascular anomaly or foreign body ingestion. There are surgical, endoscopic, and interventional radiological treatment options; however, definitive treatment is surgical intervention. Because of the rapid and devastating course, diagnosis and treatment decision should be made quickly.&#x0D; In this article, we report a case of an 11-months-old infant who presented with hematemesis due to a primary aortoesophageal fistula. The patient was transported to the operating theater for an emergency endoscopy. He suffered massive hematemesis in the operating room and an emergency laparotomy was performed but no source of bleeding was detected. An undiagnosed AEF was found and repaired during a left thoracotomy. Despite massive volume resuscitation, the patient passed away four hours later in the PICU. The etiology of the fistula remains unknown.

The Prognostic Value of Coronary Arteries Calcium Scoring in a Primary Health Care Setting in Riyadh, Saudi Arabia: A Retrospective Cohort Study.

Background/Purpose: Coronary Artery Calcium Scoring (CACS) by CT, the American Atherosclerotic Cardiovascular Disease (ASCVD) Score, and the British Cardiovascular Risk (QRISK2) score are the most frequently used cardiovascular risk stratification scores to predict cardiac outcomes and aid in the decision of implementing preventative and/or interventional measures. The aim of this study is to assess CACS, ASCVD score, QRISK2 score, and their capacity to predict cardiovascular events among family medicine patients in King Faisal Specialist Hospital and Research Centre (KFSH&RC), Riyadh, Saudi Arabia.Methodology: All medical records of patients (18 years and above) who had a CACS done in Family Medicine Clinics at KFSH&RC from January 2010 to March 2018 were reviewed, retrospectively. The study variables included demographics, comorbidities, CACS, ASCVD Score, QRISK2 score, and cardiovascular events.Results: We included 218 patients. Our study population included: 77% men, a mean age of 51 years (SD±8), and a mean BMI of 29 kg/m2 (SD±5). CACS was significantly associated with coronary events (p-value < .05). There was significant association between high CACS (>400) and family history of cardiac disease (p-value = .006), prior cardiovascular events (p-value = .01) and advancing age (p-value < .001). High concordance was found between QRISK2 score and CACS (90.6%), and moderate concordance between ASCVD score and CACS (69.4%). Moderate concordance was found between ASCVD score and QRISK2 score (74.3%). The majority of the subjects (88%) fell into the low-risk group (CACS <100) with (63%) having a CACS of zero.Conclusion: QRISK2 cardiac assessment tool provides better risk assessment and higher concordance with CACS. To improve cost-effectiveness and minimize unnecessary radiation exposure, QRISK2 scoring should be implemented for initial cardiovascular risk stratification prior to ordering the CACS imaging modality.

Cardiac functional and structural abnormalities after adjuvant radiotherapy for breast cancer: Relation to cardiac radiation exposure

Radiation therapy (RXT) is an essential tool in the treatment of breast cancer (BC). However the benefits of this therapy may be counterbalanced by increased cardiovascular morbidity due to radiation-induced late cardiotoxicity. High doses of cardiac radiation leads to diffuse and focal myocardial fibrosis on CMR, but contemporary BC-RXT is less studied. Our objective was to assess the long-term cardiac safety of contemporary RXT for BC. We sought, therefore, to estimate the prevalence of functional and structural myocardial defects in BC survivors treated with RXT 10 years earlier, in direct relation to the radiation dose. In a prospective cross-sectional study, we examined 72 women (61 ± 8 years) treated with adjuvant RXT but without chemotherapy or history of cardiac disease for a left ( n = 34) or right ( n = 38) BC between 2009 and 2013, and compared them to 23 age-matched healthy women (66 ± 10 years). All underwent 3 T cMRI to measure LV volumes and function, global strain, extracellular volume (ECV) and late gadolinium enhancement (LGE). We also compared abnormalities in left and right BC patients and related them to the mean cardiac radiation dose (MHD) measured at the time of RXT ( Fig. 1 ). MHD in BC survivors was 1.57 ± 1.53 Gy (range 0–7.9 Gy). Exposure was significantly ( P < 0.001) higher in left-sided (2.62 ± 1.72 Gy) than in right-sided BC (0.72 ± 0.49 Gy). We did not observe any other difference between patients irradiated on the left and right side, or any significant correlation with MHD. Left ventricular ejection fraction (LVEF) was significantly lower in patients than in controls (62 ± 6% vs. 65 ± 6%, P = 0.006), and there was a trend for lower GLS (−15.6 ± 1.8 vs. −14.7 ± 1.8, P = 0.07). GCS and GRS were not statistically different in BC survivors versus controls. Indexed LV mass was moderately reduced in patients (46 ± 6 vs. 51 ± 9 g/m 2 , P = 0.03), whereas end-diastolic and end-systolic volumes were similar (66.1 ± 10.4 vs. 64.9 ± 11.2 ml/m 2 , P = NS). No patient developed LGE. ECV was similar in RXT-exposed patients (29.4 ± 3.5) and in controls (28.5 ± 3.0, P = NS). Patients with BC treated with adjuvant RXT 10 years ago had a slightly but clinically not relevant lower LVEF and LV mass than controls. No other significant structural abnormalitie was detected, and no association was found between cardiac function and MHD. This suggests that current RXT protocols for BC are safe without long-term cardiac side effects.

Computational modeling identifies the cellular electromechanical effects of disrupted intracellular calcium handling in arrhythmogenic cardiomyopathy patients

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NWO - ZonMw (VIDI grant 016.176.340 to JL) Dutch Heart Foundation (ERA-CVD JTC2018 grant 2018T094; Dr. Dekker Program grant 2015T082 to JL) The Netherlands Cardio Vascular Research Initiative (CVON): the Dutch Heart Foundation, Dutch Federation of University Medical Center, the Netherlands Organization for Health Research and Development and the Royal Netherlands Academy of Sciences (CVON-eDETECT 2015-12 and CVON-PREDICT2 2018-30 to TvV). Background Patients with arrhythmogenic cardiomyopathy (ACM), an inherited progressive cardiac disease, mostly remain asymptomatic until the occurrence of life-threatening arrhythmias. Previous research identified disturbed calcium handling as a potential disease-initiating mechanism [1], but how this translates to arrhythmogenesis and cardiac mechanical dysfunction remains unknown. Purpose To characterize disturbed molecular regulators of intracellular calcium (Ca2+) handling in patients with ACM and predict their effects on action potential (AP), calcium transient (CaT) and tension development in both left and right ventricles (LV, RV) using a computer model of cellular electromechanics. Methods We performed gene expression (qPCR) and protein level (Western blot) analysis using LV and RV tissue samples obtained from 5 ACM patients who underwent heart transplant and 5 controls with no history of cardiac disease. Changes in protein levels were implemented in our recent human electromechanical cardiomyocyte computer model [2]. CaT, AP and tension traces were simulated and compared to control. Clinical data (age, sex, genetics, ECG, echocardiography) were related to the simulation outcome. Results Measured protein levels varied significantly between the 5 patients and between individual LV and RV samples. Exemplary results for one ACM patient are shown in the figure below. In the LV, AP duration was shorter than control (221ms vs. 255ms), CaT peak was increased (0.52µM vs. 0.39µM) but CaT amplitude was reduced due to increased diastolic Ca2+ (0.26µM vs. 0.060µM). Relaxation was also impaired, as shown by a longer CaT and tension duration (965ms vs. 640ms), and an increased diastolic tension (10mN vs. 4.8mN). In the RV, AP duration was shortened, and CaT and tension peak were lower than in the LV (0.37µM and 13.6mN). Diastolic levels were elevated compared to control, and CaT and tension development were prolonged. This can be related to the measured Ca2+ changes: in the LV, a lower activity of the sodium-calcium exchanger (NCX) (22% of control) and SERCA pump (52%) combined with an increased ryanodine receptor (RyR) activity (96%) may impair the extrusion of Ca2+, leading to accumulation of Ca2+ and increased diastolic Ca2+ levels. In the RV, milder changes in NCX (48% of control) and RyR (11%) may explain the larger Ca2+ extrusion, leading to lower CaT peak and diastolic levels. The patient showed a normal LV size, a severely dilated RV, as well as a poor LV fractional shortening suggesting increased ventricular stiffness, in line with the potential impaired relaxation shown by the simulations. Conclusion By integrating protein level data from ACM patients into a computational model of cellular electromechanics, we quantified the electromechanical effects of patient-specific Ca2+ handling changes. Future whole-heart extensions of this work have the potential to identify and understand proarrhythmic mechanisms in ACM patients.

Could Steroids Cause Dysrhythmia in COVID-19 Patients? A Case Report

Aim: Steroid-induced dysrhythmia is a rare but severe side effect.&#x0D; Presentation of Case: After 24-48 hours of corticosteroid administration, bradyarrhythmia was detected in our three COVID-19 patients (a 38 and 67-year-old female and a 57-year-old male) who had no prior medical history of cardiac disease. Bradyarrhythmia improved following discontinuation of corticosteroids.&#x0D; Discussion: Cardiac dysrhythmia is a rare side effect for steroids especially in Iranian patients. Our patients had no prior history of cardiac disease, and sinus bradycardia was observed while receiving intravenous methylprednisolone or dexamethasone&#x0D; Conclusion: This side effect can occur with any corticosteroid, and all patients receiving high doses of corticosteroids, even for a brief period, should be closely monitored.

C45 LATE CARDIAC OUTCOMES IN PATIENTS AFTER COVID–19: A CARDIAC MAGNETIC RESONANCE STUDY

BackgroundMyocardial injury can occur in patients with coronavirus disease (COVID)–19. Cardiac magnetic resonance (CMR) provides information on functional and morphological cardiac parameters, as well myocardial tissue characterization. Actually, there are few data on late cardiac outcomes in patients after COVID–19.Aim of the StudyTo assess late functional, morphological and myocardial tissue parameters in patients positive to COVID–19 Methods 55 patients (age 50±16 yrs, Female n = 17) with a prior diagnosis of COVID 19, without a previous history of cardiac disease were enrolled in the study. Of these, 35 were hospitalized. The time interval between COVID–19 diagnosis and CMR was 418±28 days. Cardiac function and myocardial tissue characterization have been evaluated with the current CMR techniques. In particular, the presence of late gadolinium enhancement (LGE), as a sign of myocarditis outcome has been evaluated.ResultsLGE was present in 19 patients (34.5%). In all cases, LGE was localized at the level of lateral wall of left ventricle within the myocardium or at the subepicardial level (non–ischemic pattern). Left and right ventricular (LV, RV) ejection fraction were within normal values (mean±SD 65±5% and 65±7%, respectively), as well as volumes (LV endiastolic and endsystolic volumes 71±15 and 27±8 ml/m2; RV endiastolic and endsystolic volumes 72±15 and 25±9 ml/m2). In one case, LGE was associated to regional wall hypokinesia. Among the hospitalized patients, the following factors were associated to the presence of LGE: prone position during assisted ventilation, duration of hospitalization. LGE was present in 67% of patients put in prone position, against 33% of patients not pronated (p = 0.009 Fisher‘s exact test). Duration of hospitalization was 9±5 and 16±7 respectively in patients without and with LGE (p = 0.007)ConclusionLGE, as an outcome of myocarditis, is present in a significant number of patients with a history of COVID–19, but it is not associated with dilatation or global and regional dysfunction of left ventricle. LGE is mainly present in pts with more severe clinical presentation of COVID–19

C43 A CASE REPORT OF A GIANT RIGHT CORONARY ARTERY ANEURYSM: ROLE OF CONTRAST ECHOCARDIOGRAPHY

Abstract A giant coronary aneurysm is rare entity and it is defined if the diameter is 4–fold greater the reference vessel diameter or if it is &amp;gt; 20 mm in diameter. We report the case of a 73–years–old man without prior history of cardiac disease, admitted in Emergency Department for abdominal pain with normal ECG. Abdominal CT scan showed no pathological findings. At thoracic level it was reported a suspected pericardial cyst (75x80 mm), with partial compression of right chambers (Fig. 1). Echocardiography confirmed the presence of a giant round cystic–appearance lesion characterized by the presence of an anechoic space with internal echogenic swirling flow pattern at the level of right atrioventricular groove with mild compressive effect on right chambers. (Fig. 2). The color Doppler mode showed a faint signal, without a clear evidence of flow origin. A bubble test with agitated saline contrast medium injected through antecubital vein, shows no evidence of contrast uptake by the mass. In order to better characterize the lesion, we use echocardiographic contrast agent (SonoVue®), which showed a clear pattern of blood flow inside the mass with a probable origin at a very limited region (Fig. 2a–2b). At that level it was also possible to sample an ECG–synchronized systo–diastolic pulse–wave (PW)–Doppler pattern (peak velocity 125 cm/s), typical for a coronary artery flow. According to these echocardiographic findings, we supposed a giant right coronary aneurysm. Coronary Computed Tomography Angiography with 3D reconstruction showed a giant aneurysm of the right coronary artery at mid–level, preceded by a mild aneurysm of the proximal tract and two small aneurysms of the circumflex artery and diffuse atherosclerosis diseases with significant stenosis on mid left anterior descending artery (LAD). The coronary angiography confirmed the presence of the giant aneurysm in mild tract of right coronary artery preceded by a small one in the proximal tract andthe two small aneurysm of the circumflex artery and a critical stenosis of mid tract of LAD. The patient underwent surgical treatment of the aneurysm and coronary artery bypass graft (Fig. 3). Computed Tomography Coronary Angiography is the best method for coronary artery anatomy and coronary abnormalities. In case of giant coronary abnormalities, the use of echo contrast agent provides further important information about perfusion and/or flow assessment and it helped to clarify the diagnosis.