History Of Ischemic Heart Disease Research Articles

A Noninvasive Arterial Stiffness Index to Estimate the Severity of Coronary Atherosclerosis in Patients Undergoing Coronary Angiography

The early diagnosis and appropriate treatment of subclinical atherosclerosis before the onset of life-threatening cardiovascular (CV) diseases are major unmet medical needs in current clinical practice. Noninvasive arterial stiffness indices, the arterial velocity–pulse index (AVI) and the arterial pressure–volume index (API) have been associated with CV risks, conventional arterial stiffness indices, and the severity of coronary atherosclerosis. However, few studies have examined the relationship between these indices and the occurrence of CV events. We measured the AVI and API in 113 consecutive patients admitted to Yokohama City University Hospital for cardiac catheterization between June 2015 and March 2016. Patients were followed until September 2022, and the occurrence of CV events was assessed. The mean age was 71.2 ± 10.7 years, and 83 patients (73.5%) were male. In total, 80 patients (70.8%) had hypertension, 87 (77.0%) had dyslipidemia, and 91 (80.5%) had a history of ischemic heart disease (IHD). The mean follow-up duration was 1752 ± 819 days. Patients who received elective percutaneous coronary intervention (PCI) based on the results of coronary angiography (CAG) at the time of enrollment had significantly higher API than those who did not (38.5 ± 12.6, n = 17 vs. 31.3 ± 7.4, n = 96, p = 0.001). The API was independently associated with the risk of elective PCI in multiple logistic regression analysis. In conclusion, the API could be a useful indicator for estimating the need for coronary interventional treatment in patients with a high CV risk.

Unplanned rehospitalisation due to medication harm following an Acute Myocardial Infarction.

Introduction The contribution of medication harm to rehospitalisation and adverse patient outcomes after an acute myocardial infarction (AMI) needs exploration. Rehospitalisation is costly to both patients and the healthcare facility. Following an AMI, patients are at risk of medication harm as they are often older, have multiple comorbidities and polypharmacy. This study aimed to quantify and evaluate medication harm causing unplanned rehospitalisation after an AMI. Methods This was a retrospective cohort study of patients discharged from a quaternary hospital post-AMI. All rehospitalisations within 18 months were identified using medical record review and coding data. The primary outcome measure was medication harm rehospitalisation. Preventability, causality and severity assessments of medication harm were conducted. Results A total of 1564 patients experienced an AMI and 415 (26.5%) were rehospitalised. Eighty-nine patients (5.7% of total population; 6.0% of those discharged) experienced a total of 101 medication harm events. Those with medication harm were older (p=0.007) and had higher rates of heart failure (p=0.005), chronic kidney disease (CKD) (p=0.046), chronic obstructive pulmonary disease (COPD) (p=0.037) and a prior history of ischaemic heart disease (p=0.005). Gastrointestinal (GI) bleeding, acute kidney injury (AKI) and hypotension were the most common medication harm events. Forty percent of events were avoidable and 84% were classed as 'serious'. Furosemide, antiplatelets and angiotensin-converting enzyme inhibitors (ACEi) were the most commonly implicated medications. The median time to medication harm rehospitalisation was 79 days (interquartile range [IQR]: 16-200 days). Conclusion Medication harm causes unplanned rehospitalisation in 5.7% of all AMI patients (1 in 17 patients; 6.0% of those discharged). The majority of harm was serious and occurred within the first 200 days of discharge. This study highlights that measures to attenuate the risk of medication harm rehospitalisation are essential, including post-discharge medication management.

Risk of clinically significant cardiovascular disease associated with postoperative radiotherapy in non-small cell lung cancer patients receiving surgical resection followed by adjuvant chemotherapy: A Korean nationwide cohort study

BackgroundThere are no large-scale datasets that analyze the relationship between postoperative radiotherapy (PORT) and various cardiovascular diseases (CVDs) in patients with locally advanced non-small cell lung cancer (NSCLC). Therefore, we aimed to investigate the incidences of CVDs with PORT using a national population-based database. MethodsPatients diagnosed with NSCLC who underwent curative surgery followed by adjuvant chemotherapy were included from 2007 to 2017. Patients with a prior diagnosis of heart failure (HF), atrial fibrillation (AFib), or heart surgery were excluded. A total of 11,141 patients were included in the final analysis. PORT was used in 1334 patients. Most patients received lobectomy with mediastinal lymph node dissection. ResultsMajor adverse cardiac events mostly occurred within 3–4 years from the diagnosis. After the median follow-up duration of 70.6 months, HF was the most diagnosed disease (5.3 %), followed by AFib (4.5 %), stroke (4.1 %), and pulmonary embolism (3.5 %). All the incidences of clinically significant CVDs did not differ by PORT. This result remained unchanged after the propensity score matching comparison. Age ≥ 65, underlying hypertension, and history of ischemic heart disease were the most related factors to the occurrence of HF and AFib. No significant difference in CVD-free survivals according to PORT status was observed. When stratified by proposed scoring, there were no subgroups showed increased incidence by PORT. ConclusionsThese results suggest that PORT had no significant impact on various CVD occurrences in NSCLC patients without underlying heart disease.

O68: Long term stroke prevention drug therapy following Carotid endarterectomy (CEA) is good, but could be better

Abstract Introduction CEA reduces the risk of future stroke. The benefit is maximised with live-long drug therapy to reduce major adverse cardiovascular events (MACE), including stroke. Studies suggest around half discontinue these drugs within 12 months. We compared the drugs prescribed at CEA with those prescribed several years later. Methods Of 347 patients who underwent CEA between 2010-2019, at late follow-up (9+/-3.1y), 187 (54%) patients were alive. The prescription of generic MACE-reducing drugs (anti-thromboembolic, lipid-lowering, b-blockers and ACE-Inhibitors) and incidence of cardiovascular risk factors (hypertension, diabetes, ischaemic cardiac disease, stroke) at CEA were compared with that at late follow-up. Results At late follow-up, fewer were taking antiplatelet drugs (170v143 p<0.01), but more were formally anticoagulated (4v37 p<0.01). Overall there was no change in anti-thromboembolic prescription rates. Lipid-regulating drugs were equally highly prescribed at CEA and follow-up (169v173), Both B-blocker and ACE-Inhibitor prescriptions rates were low, but had increased by follow-up (46v69 p<0.01; 38v88 p<0.01). More patients were treated for hypertension at follow-up (67v166 p<0.01), but numbers with managed diabetes had not changed at late follow-up. 47 (25%) of patients had a history of ischaemic heart disease at CEA and 24 (14%) had developed new symptoms. There were 22 (12%) new strokes at late follow-up. Discussion Despite a higher than expected prescription rate of MACE-reducing drugs years after CEA, which is tailored to the patient’s changing needs, continued improvement is needed to optimise cardiovascular protection fully.

Incidence, Pattern, Causes, and Outcome of Acute Chest Pain Among Patients Presenting in the Emergency Department of a Tertiary Care Hospital in North India.

Acute chest pain is a common presentation in emergency departments worldwide. Differentiating between cardiac and non-cardiac chest pain is crucial for patient management and resource allocation. This study analyzed 714 patients presenting with acute chest pain in a tertiary care hospital in North India. We investigated demographic characteristics, chief complaints, risk factors, ECG findings, and final diagnoses to identify patterns associated with cardiac (CCP) and non-cardiac chest pain (NCCP). CCP was diagnosed in 53.7% (n=383) and NCCP in 46.3% (n=331). Significant predictors of CCP included age (OR=1.05, p<0.001), smoking (OR=2.22, p<0.001), diabetes (OR=1.57, p=0.003), hypertension (OR=1.82, p<0.001), and family history of ischemic heart disease (IHD) (OR=1.42, p=0.01). Central chest pain was more common in CCP (60% vs. 40%, p<0.001), as were abnormal ECG findings such as ST-segment depression (35% vs. 10%, p<0.001) and elevation (29% vs. 6%, p<0.001). Normal ECG was more prevalent in NCCP (60%, p<0.001). Traditional cardiovascular risk factors remain strongly associated with CCP. Smoking has a particularly high odds ratio, suggesting the need for targeted interventions. ECG findings significantly aid in differentiating CCP from NCCP. This study underscores the importance of a comprehensive approach in evaluating acute chest pain to ensure accurate diagnosis and effective treatment.

Calculated Small Dense Low-Density Lipoprotein Cholesterol Level is A Predominant Predictor for New Onset of Ischemic Heart Disease.

A high level of directly measured small dense low-density lipoprotein cholesterol (sdLDL-C) is a strong risk factor for ischemic heart disease (IHD). However, it remains unclear whether estimated sdLDL-C level is a predictor for IHD. We investigated the associations of new onset of IHD with levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, triglycerides (TG), LDL-C and calculated sdLDL-C by Sampson's equation. After exclusion of subjects with IHD or those with TG ≥ 800 mg/dL, a total of 18,176 subjects (men/women: 11,712/6,464, mean age: 46 years) were recruited among 28,990 Japanese individuals who received annual health checkups. During the 10-year follow-up period, 456 men (3.9%) and 121 women (1.9%) newly developed IHD. Multivariable Cox proportional hazard analyses after adjustment of age, sex, obesity, smoking habit, family history of IHD, estimated glomerular filtration rate, hypertension and diabetes mellitus at baseline showed that the hazard ratio (HR) (1.38 [95% confidence interval: 1.03-1.85]) for new onset of IHD in subjects with the 4th quartile (Q4) of sdLDL-C (≥ 42 mg/dL) was significantly higher than that in subjects with the 1st quartile (Q1) (≤ 24 mg/dL) as the reference, though the adjusted HRs in subjects with Q2-Q4 of TC, HDL-C, non-HDL-C, LDL-C and TG were comparable with those in subjects with Q1 of the respective lipid fractions. The adjusted HR with a restricted cubic spline increased with a higher level of calculated sdLDL-C as a continuous value at baseline. sdLDL-C level calculated by Sampson's equation is a predominant predictor for the development of IHD in a general Japanese population.

Plasma proteomics for prediction of subclinical coronary artery calcifications in primary prevention

Recent developments in high-throughput proteomic technologies enable the discovery of novel biomarkers of coronary atherosclerosis. The aims of this study were to test if plasma protein subsets could detect coronary artery calcifications (CAC) in asymptomatic individuals and if they add predictive value beyond traditional risk factors. Using proximity extension assays, 1,342 plasma proteins were measured in 1,827 individuals from the Impaired Glucose Tolerance and Microbiota (IGTM) study and 883 individuals from the Swedish Cardiopulmonary BioImage Study (SCAPIS) aged 50-64 years without history of ischaemic heart disease and with CAC assessed by computed tomography. After data-driven feature selection, extreme gradient boosting machine learning models were trained on the IGTM cohort to predict the presence of CAC using combinations of proteins and traditional risk factors. The trained models were validated in SCAPIS. The best plasma protein subset (44 proteins) predicted CAC with an area under the curve (AUC) of 0.691 in the validation cohort. However, this was not better than prediction by traditional risk factors alone (AUC = 0.710, P = .17). Adding proteins to traditional risk factors did not improve the predictions (AUC = 0.705, P = .6). Most of these 44 proteins were highly correlated with traditional risk factors. A plasma protein subset that could predict the presence of subclinical CAC was identified but it did not outperform nor improve a model based on traditional risk factors. Thus, support for this targeted proteomics platform to predict subclinical CAC beyond traditional risk factors was not found.

Clinical characteristics of stroke in SARS-CoV-2 infected patients in Japan: A prospective nationwide study

IntroductionWe investigated the clinical characteristics and outcomes of stroke in SARS-CoV-2 infected patients in Japan. MethodsThis prospective, multicenter observational study of stroke in patients with SARS-CoV-2 infection involving 563 primary stroke centers across Japan was conducted between July 2020, and May 2022. We included 159 stroke cases (131 ischemic stroke, 2 transient ischemic attack (TIA), 21 intracranial hemorrhage, and 5 subarachnoid hemorrhage) and collected their clinical characteristics. Ischemic stroke and TIA (n = 133) were analyzed separately. ResultsThe mean age of the 159 patients was 70.6 years, with 66% being men. Poor outcomes (modified Rankin Scale score 5–6) occurred in 40% (63/159) at discharge. Among patients with ischemic stroke and TIA, 30%, 18%, 10%, and 42% had cardioembolism, large-artery atherosclerosis, small-vessel occlusion, and cryptogenic stroke or embolic stroke of undetermined source, respectively. One-third (34%) presented with large vessel occlusion (LVO) of the internal carotid, middle cerebral M1, or basilar arteries. Poor outcomes included age (adjusted odds ratio (aOR): 1.06, 95%CI: 1.01–1.12), ischemic heart disease (IHD) history (aOR: 13.00, 95%CI: 1.51–111.70), moderate to severe pneumonia (aOR: 7.78, 95%CI: 1.18–51.42), an National Institutes of Health Stroke Scale score at baseline (aOR: 1.10, 95%CI: 1.03–1.17), LVO (aOR: 14.88, 95%CI: 2.33–94.97), and log10 D-dimer (aOR: 3.38, 95%CI: 1.01–11.26). ConclusionUpon discharge, 40% of SARS-CoV-2 infected patients with ischemic stroke and TIA had poor outcomes. Poor outcomes were associated with older age, IHD history, moderate to severe pneumonia, higher NIHSS scores, LVO, and higher log10 D-dimer.Registration: UMIN Clinical Trials Registry: https://www.umin.ac.jp/ctr/. Unique identifier: UMIN000041226.

Frequency of Left Bundle Branch Block in Patients with Acute Myocardial Infarction; A Cross-Sectional Study

Background: Cardiovascular disease (CVDs) is important problems in both developing and developed countries. Currently, non-invasive methods for diagnosis of CVD, especially myocardial infarction (MI), is an interesting subject in the cardiology field. Some evidence showed left bundle branch block (LBBB) is more prevalent among patients with MI. Hence, this study aimed to investigate the frequency of LBBB and their contributing factors in patients with MI. Materials and Methods: In this cross-sectional study, 150 patients with ST elevation or non-ST elevation on their admission electrocardiography who referred to Boo-Ali and Amir-Al-Momenin hospitals, Tehran from January 2016 to June 2017 entered the study. Frequency of LBBB and right bundle branch block (RBBB) in participants and the contributing factors were determined. Results: In this study, of 150 cases (mean age: 60.35±12.88 years), 109 (72.7%) were male, and 41 (27.3%) were female. Out of 150 cases, 12 (8%) had LBBB, 5 (3.3%) RBBB, and 133 (89.7%) had not RBBB or LBBB. Contributing factors were family history, hypertension, and history of ischemic heart disease (P&lt;0.05). Conclusion: Eight percent of patients with myocardial infarction would develop LBBB, which is related to hypertension, and self and family history of ischemic heart disease. [GMJ.2019;8:e1576] 

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.

What May Stand Behind Chest Pain: A Case Report on Aortic Dissection

Aortic dissection (AD) is a relatively uncommon, rare disorder and potentially misdiagnosed disease. Early diagnosis and treatment is required for the patient's survival. Aortic dissection can be fatal if misdiagnosed. A 50-year-old adult male presented to emergency with acute chest pain and having a medical history of aortic stenosis post-aortic valve replacement 9 months back and a family history of ischaemic heart disease. Pain was relieved by analgesics. After further investigations by echocardiography and CT Angiography, it was diagnosed as AD Standford type A and DeBakey type 1, in view of the critical nature of illness, patient attenders wanted only medical management. The patient was declared dead after 2 days of diagnosis.

PP90 Artificial Intelligence To Detect Ischemic Heart Disease In Non-traumatic Chest Pain At The Emergency Department – SmartHeart Study

IntroductionAn estimated 17.9 million people died from cardiovascular diseases (CVDs) in 2019, which is 32 percent of all global deaths and 85 percent were due to heart attack and stroke. Chest pain is one of the most common reasons for presenting to the emergency department (ED). It is increasingly recognized that artificial intelligence (AI) will have a significant impact on the practice of medicine in the near future and may help with diagnosis and risk stratification. We aim to estimate a diagnostic prediction of acute myocardial infarction by the development and validation of an AI model.MethodsData on 134 variables of 3,986 consecutive patients who presented to the ED with non-traumatic chest pain were included in the analysis. Using AI tools, a neural network model was developed to establish the risk of acute myocardial infarction (AMI) to achieve n=150 patients over 18 years of age attending the ED.ResultsThe mean age was 65.5 (±13.7) years and 63.6 percent were male. Most (60.1%) patients were admitted to hospital, with only 20.3 percent diagnosed at hospital discharge with ischemic heart disease (IHD). All patients were followed up for two months, and 6.3 percent were readmitted to the ED, but none presented with an episode of IHD. In the data analysis of the entire sample we obtained a probability of diagnosing IHD by the SmartHeart model (S=93.1%, E=47.3%, PPV=31.0%, and NPV=96.4%). When we analyzed the sample of patients with no history of IHD (n=104), the diagnosis accuracy was as follows (S=100%, E=77.5%, PPV=42.8%, and NPV=100%).ConclusionsOur AI model provides information to predict patients who are suffering from acute IHD. AI has been reported to outperform emergency physicians and current risk stratification tools to diagnose IHD, but has rarely been integrated into practice. This study highlights the diagnostic applicability and accuracy of this type of tool and that is why studies should be implemented to see its effectiveness in routine practice in EDs.

Retinal changes and cardiac biomarker assessment in relation to chronic kidney disease: a single centre study

BackgroundThe prevalence of chronic kidney disease (CKD) is rising in Malaysia. Early detection is necessary to prevent disease progression, especially in terms of cardiovascular (CV) risk, the main cause of death in end-stage renal disease (ESRD). Retinal changes have proven to be a good predictor of CKD whereas cardiac biomarkers are useful in cardiovascular risk stratification. We aimed to demonstrate the correlation between retinal changes and cardiac biomarkers with CKD.MethodsThis single-centre cross-sectional study was conducted among patients with CKD stages 3, 4, and 5 (not on dialysis) from the Nephrology Clinic, Universiti Kebangsaan Malaysia Medical Centre. A total of 84 patients were recruited with an even distribution across all three stages. They underwent fundus photography where images were analysed for vessel calibre (central retinal venular equivalent (CRVE), central retinal arterial equivalent (CRAE), and tortuosity indices. Optical coherence tomography was used to measure macular volume. Blood samples were sent for laboratory measurement of high-sensitivity C-reactive protein (hs-CRP) and asymmetric dimethylarginine (ADMA). These parameters were analysed in relation to CKD.ResultsThe mean age was 58.8 ± 11.7 years, with 52.4% male and 47.6% female patients. Among them, 64.3% were diabetics. Retinal vessel tortuosity (r = -0.220, p-value = 0.044) had a negative correlation with the estimated glomerular filtration rate (eGFR). CRVE showed a positive correlation with proteinuria (r = 0.342, p = 0.001) but negative correlation with eGFR (r = -0.236, p = 0.031). Hs-CRP positively correlated with proteinuria (r = 0.313, p = 0.04) and negatively correlated with eGFR (r = -0.370, p = 0.001). Diabetic patients had a higher CRVE compared to non-diabetic patients (p = 0.02). History of ischaemic heart disease was associated with a smaller macula volume (p = 0.038). Male gender (r2 = 0.066, p = 0.031) and HbA1c had a positive influence (r2 = 0.066, p = 0.047) on retinal vessel tortuosity. There was a positive influence of age (r2 = 0.183, p = 0.012) and hs-CRP (r2 = 0.183, p = 0.045) on CRVE. As for macula volume, it negatively correlated with diabetes (r2 = 0.015, p = 0.040) and positively correlated with smoking (r2 = 0.015, p = 0.012).ConclusionOur study showed that eGFR value affects retinal vessel tortuosity, CRVE and hs-CRP. These parameters bear potential to be used as non-invasive tools in assessing CKD. However, only macula volume may be associated with CVD risk among the CKD population.

The Clinical Profile and Hospital-based Outcome of Acute Myocardial Infarction in Elderly Patients More than 60 Years and Patients Younger than 60 Years: A Comparative Study

Background: Acute myocardial infarction refers to a pathological state characterized by the obstruction of blood supply to the myocardium, resulting in the subsequent necrosis of cardiac tissue. It constitutes a significant etiological factor contributing to the development of heart failure and global mortality rates. Objective: The purpose of this study was to conduct a comparative analysis of the clinical characteristics of acute myocardial infarction in old and young individuals who sought medical attention at a tertiary care hospital. Methods: This cross-sectional observational study was done from January 2023 to June 2023 at the Mymensingh Medical College Hospital, Mymensingh, Bangladesh. A total of 100 people were observed in this study. Result: We have two age groups: under 60 (60%) and over 60 (40%). We name them A and B. Group A patients are 86.7% male and 13.3% female. Group A patients are 88.3% Muslim and 7% Hindu. This patient group includes 30% service workers and 20% businesses. The remaining 28.3% were patients from diverse jobs and 1.7% were farmers. With 55% male and 45% female Muslim patients, Group B includes domestic workers (45%) and businessmen (22.5%). Service workers 17%, farmers 2.5%, and other patients 12.5%. Group A had 85% chest pain, 46.7% dyspnea, 90% palpitations, and 86.7% nausea and vomiting. Ischemic chest pain, dyspnea, palpitations, nausea, and vomiting affected 87.5% of Group B.Top MI risk factors. Group A had dyslipidemia (95%), family history of MI (93.3%), sedentary lifestyle (91.7%), smoking (88.3%), hypertension (86.7%), and diabetes (78.3%). The sedentary lifestyle, 100% family history of ischemic heart disease, 97.5% dyslipidemia, and 77.5% diabetes and hypertension characterized Group B. Lastly, our study reports patients' average pulse and blood pressure. In Group A, the average pulse was 81.73 ± 14.60, systolic blood pressure was 129.50 ± 20.28 mmHg, and diastolic blood pressure was 89.41 ± 12.35. Group B had an .......

Risk of myocardial infarction following capecitabine treatment in patients with gastrointestinal cancer - a nationwide registry-based study

Abstract Background Myocardial infarction is a cardiac adverse event associated with fluoropyrimidines such as 5-fluorouracil and its orally available prodrug capecitabine. There are limited data on the incidence, risk, and prognosis of capecitabine associated myocardial infarction. Purpose The aim of this study was to examine the risk of myocardial infarction in patients with gastrointestinal (GI) cancer treated with capecitabine compared with age- and sex-matched population control subjects without cancer (1:2 ratio). Methods Patients with GI cancer treated with capecitabine between 2004-2016 were identified within the Danish National Patient Registry. Those with a history of ischemic heart disease were excluded. Absolute and relative risks of myocardial infarction at 6 months and 1 year were derived from multivariable Cox regression with average treatment effect modeling. Estimates were standardized to the distributions of age, sex, selected comorbidities, and pharmacotherapies of all included subjects. Results A total of 71,460 patients were included in the final analysis of whom 23,820 had GI cancer treated with capecitabine, and 47,640 were population control subjects without cancer. Differences in the prevalences of selected comorbid conditions, including diabetes, hypertension, and other risk factors for coronary artery disease and antianginal medications were not significant (P&amp;gt;0.05 for all). The 6-month absolute risk (AR) of myocardial infarction was significantly higher for capecitabine-treated patients at 0.6% [95% confidence interval (CI): 0.5%-0.7%] versus 0.3% [95% CI: 0.2%-0.3%] in population control subjects, corresponding to a relative risk (RR) of 2.00 [95% CI 1.53-2.48; P &amp;lt;0.001]. The corresponding 1-year ARs were 0.7% [95% CI: 0.6%-0.9%] versus 0.6% [95% CI: 0.5%-0.6%]; RR 1.28 [95% CI 1.03-1.52; P= 0.03]. Six-month and one-year all-cause mortality ARs for patients treated with capecitabine versus controls were 15.2% vs. 0.7% and 29.7% vs. 1.6% respectively. Conclusions The risk of myocardial infarction of capecitabine-treated patients both 6- and 12-month risks were significantly higher compared with population controls. Despite the absolute risk were low, the clinical significance of the differences appears limited in the context of the significant competing risk of death in this population.Risk of Myocardial InfarctionMortality

Effect of sodium-glucose type 2 cotransporter inhibitors on cardiac structure and function in patients with normal ejection fraction

Abstract Introduction Sodium-glucose cotransporter inhibitors (SGLT2i) have proven a reduction in cardiovascular events in diabetic patients with and without heart failure (HF), as well as in non-diabetic patients with heart failure with reduced and preserved ejection fraction (EF). The mechanisms underlying this benefit are not well known, with contradicting data on the changes that SGLT2i produce on cardiac function and structure. Methods Between October 2020 and October 2021, 31 diabetic patients without prior history of SGLT2i use with normal EF (&amp;gt;50%), glycated hemoglobin &amp;lt;6.5%, renal clearance rate of &amp;gt;60 ml/min/1.73 m2 and sinus rhythm were prospectively included. In all of them, SGLT2i were started. At inclusion and 6-months follow-up, different clinical, ECG, analytical and echocardiographic (standard, 3D and speckle tracking) variables were recorded. Results The average age of our population was 66.4 years (±8.4). 90% were male, 71% were hypertensive, 77.4% were dyslipidemic, 22.6% were obese and 87.1% were current or former smokers. 77.4% of patients had a history of ischemic heart disease, and 10% had vascular disease in other territories. At the time of inclusion, 80.6% of the population was treated with ACEI or ARB, 54.8% with beta-blockers, 29% with diuretics, and 93.5% with statins. After an average follow-up period of 6.6 months (±0.8), medication had to be withdrawn in 5 patients (in 3 of them due to repeated genital or urinary infections, and in 2 of them because of patient choice). An average reduction of 0.89 mm (±0.24, p = 0.001) in myocardial thickness was observed, as well as a reduction in the 3D-estimated left ventricle mass of 9.9 g/m2 (±4.5, p = 0.03), and in the E/é ratio of 1.4 (±4.5, p = 0.02). An increase in absolute left ventricle global longitudinal strain (LVGLS) of 0.74 (±0.35, p = 0.05) was observed, as well as an increase in isovolumetric relaxation time (IVRT) of 9.8 ms (±4.8, p = 0.05). An increase in LA strain and indexed volume was noted, although differences did not achieve statistical significance. No relevant differences in LV dimensions and volumes were observed, as well as in the evaluated RV parameters (picture 1). Conclusions It is necessary to understand the mechanism underlying the clinical benefit of these drugs. This will allow us to better understand its effect in patients with HF. Our data shows that the use of SGLT2i is associated with cardiac improvements, both structural (myocardial mass) and functional (IVRT, LVGLS, E/e'), in a population of patients with normal EF.

Sarcoidosis is associated with a higher long-term risk of ischaemic heart disease, venous thromboembolism, and ischaemic stroke: a nationwide study

Abstract Background Sarcoidosis shares a number of pathophysiological mechanisms and risk factors with ischaemic heart disease and thromboembolism. Patients with sarcoidosis are at risk of cardiac involvement with heart failure and arrhythmias, but unlike other inflammatory diseases, such as systemic lupus erythematosus and rheumatoid arthritis, data on the risk of ischaemic heart disease, venous thromboembolism, and ischaemic stroke in patients with sarcoidosis are sparse. This may prevent patients with sarcoidosis from the benefits of screening for these cardiovascular diseases. Purpose To examine the long-term risk of ischaemic heart disease, venous thromboembolism, and ischaemic stroke in patients with sarcoidosis compared to a matched background population. Methods In this Danish nationwide cohort study, all patients &amp;gt;18 years diagnosed with sarcoidosis between 1996-2020 were matched 1:4 by age, sex, and cardiovascular risk factors with individuals from the background population without sarcoidosis. Patients with a history of ischaemic heart disease, venous thromboembolism, and ischaemic stroke were excluded from the sarcoidosis and background population prior to matching. Absolute 10-year risks of outcomes were estimated using the Aalen-Johansen estimator, and rates of outcomes were compared between sarcoidosis patients and the background population using Cox regression. Results We identified 15,454 patients with sarcoidosis and 61,816 matched individuals from the background population (median age 43.8 years, 56% males). The median follow-up was 9.4 years. Absolute 10-year risks of outcomes were as follows: ischaemic heart disease, 5.2% (95% confidence interval [CI], 4.8-5.6%) vs. 3.8% (95% CI, 3.6-4.0%) in the sarcoidosis vs. background population; venous thromboembolism, 3.3% (95% CI, 3.0-3.6%) vs. 1.6% (95% CI, 1.5-1.8%) in the sarcoidosis vs. background population; ischaemic stroke, 2.5% (95% CI, 2.2-2.8%) vs. 2.0 (95% CI, 1.9-2.1%) in the sarcoidosis vs. background population. In multivariable Cox regression analysis, sarcoidosis was associated with an increased risk of ischaemic heart disease (hazard ratio [HR] 1.47 [95% CI, 1.31-1.65]), venous thromboembolism (HR 1.99 [95% CI, 1.70-2.31]), and ischaemic stroke (HR 1.41 [95% CI, 1.21-1.64]) compared with the matched background population (Figure 1). Conclusions In this nationwide cohort study, sarcoidosis was associated with a higher long-term risk of ischaemic heart disease, venous thromboembolism, and ischaemic stroke compared with a matched background population. Although further studies on pathophysiological mechanisms are needed, it may be relevant to screen for cardiovascular diseases in patients with sarcoidosis, as we do in patients with other inflammatory diseases.

Differences in clinical characteristics and outcomes between patients with left ventricular thrombus following non-anterior and anterior ST-elevation myocardial infarction

Abstract Background Left ventricular thrombus (LVT) is a serious complication following ST-elevation myocardial infarction (STEMI), and occurs more frequently in anterior compared to non-anterior myocardial infarction (MI).1 There is limited data on the clinical characteristics and outcomes in patients with LVT following non-anterior MI. Purpose We aimed to describe the clinical characteristics and outcomes of patients with LVT following non-anterior MI, and compare them against patients with LVT associated with anterior MI. Methods We retrospectively studied 217 consecutive patients with post-STEMI LVT from our tertiary centre’s echocardiography database between March 2011 and January 2021. Trans-thoracic echocardiography was performed at day 2 or 3 post-MI. We compared baseline co-morbidities and echocardiographic parameters between patients with LVT following non-anterior versus anterior MI. The Kaplan Meier method with log-rank test was used to compare rates of thrombus resolution, stroke and all-cause mortality between the 2 groups. Multivariable Cox regression models were constructed to correct for potential confounders. Results Mean age of the study population was 56.0 (IQR 48.0, 63.0) years old and 16/217 (7.4%) were female. LVT following non-anterior MI made up 24/217 patients (11.1%), and included lateral (n=3), inferior (n=15), inferoposterior (n=4) and inferolateral (n=2) MI. Patients with LVT associated with non-anterior MI were older and more frequently had a history of ischaemic heart disease (Figure 1). These patients also had a lower median left ventricular ejection fraction (LVEF) of 29% compared to their counterparts with anterior MI (mean LVEF 38%). Rate of anticoagulation was lower in patients with LVT associated with non-anterior MI (75.0% versus 92.2%). There were no differences in rates of thrombus resolution between the 2 groups (Figure 2). Patients with LVT following non-anterior MI had a higher incidence of stroke, however this observation was not present after correction for baseline embolic risk (CHA2DS2-VASc score) and rate of anticoagulation. Mortality rates were similar in patients with LVT following non-anterior MI versus anterior MI, after correction for baseline co-morbidities as well as in-hospital mortality – as this was more likely due to acute MI complications rather than longer term consequences of LVT. Conclusions Patients with LVT following non-anterior MI are older with a greater prevalence of prior ischaemic heart disease. These patients had a greater rate of stroke and mortality, although baseline co-morbidities and less frequent use of anticoagulation may have contributed to these findings. This needs to be clarified in future prospective studies.Figure 1:Baseline characteristicsFigure 2:Outcomes

Epidemiology and prognostic relevance of morphofunctional classification of secondary mitral regurgitation

Abstract Background Mitral regurgitation has traditionally been divided into organic and functional (FMR) due to its different etiology and prognosis. However, FMR is not a homogeneous entity, and may be secondary to annular dilation, ventricular dilation and dysfunction, or posterior leaflet restriction. Purpose Our aim is to assess the epidemiology of these FMR subtypes and their prognostic impact. Methods Patients with FMR from our center who underwent three-dimensional transesophageal echocardiography (3D-TEE) between 2016 and 2020 were retrospectively evaluated. Patients with at least moderate FMR, effective regurgitant orifice (ERO) by 3D-TEE &amp;gt;0.2 cm2 were selected. They were classified according to the predominant mechanism: type 1 or ventricular dysfunction, type 2 or posterior leaflet restriction, and type 3 or annular dilation. 3D-TEE and the closest transthoracic study variables, as well as baseline demographic and clinical characteristics and evolution events, were obtained and statistical analysis was performed according to FMR types. Results 112 patients were included (66.1% male, mean age 72.3 years). 54.5% had previous hospitalization for heart failure and 53.6% had a history of ischemic heart disease. The most frequently identified FMR mechanism was type 1 (61.6%), followed by type 3 (23.2%) and type 2 (15.2%). There were significant differences in epidemiological factors and echocardiographic parameters (Table) between groups. During follow-up, 43.8% died, received a heart transplant or LVAD and 44.6% had any hospitalization for heart failure. There were no significant differences between FMR types in relation to total mortality (p=0.28), mortality due to heart failure (p=0.13), total hospitalizations (p=0.73), or hospitalization for heart failure (p=0.12). Valvular intervention was performed in 54 patients (48.2%), 33 of them percutaneously with a clip, with no differences in FMR subtypes. Conclusions FMR is a heterogeneous entity and different morphotypes with different epidemiology and etiology can be identified. Despite the different mechanism, all subgroups presented a similar unfavorable prognosis and similar intervention rates.

Cardiac troponin is a strong prognostic biomarker for patients admitted with heart failure

Abstract Background Cardiac troponin T (cTnT) and I (cTnI) are strong prognostic biomarkers in several diseases and play a key role in risk stratification of patients admitted with cardiac disease. Though viewed as equals, there are substantial differences in the biology and frequency of elevations among non-cardiac illnesses between cTnT and cTnI. A recent study of all comers with a measurement of cTn showed that the risk of mortality was highest for patients with low grade elevations of cTn, while high concentrations were associated with a paradoxical decrease in the risk. We aimed to investigate whether this pattern exists among patients with heart failure. Purpose To compare the prognostic ability of cTnT and cTnI among patients admitted with heart failure. Methods This nationwide cohort study includes patients admitted with heart failure who had cTn measurements from 2009-2022 using one of five different cTn assays: Roche high-sensitivity cTnT (hs-cTnT), Abbott Alinity high sensitivity cTnI (hs-cTnI), Siemens Vista Hs-cTnI, Siemens Atellica hs-cTnI and Beckman-Coulter hs-cTnI. We selected the peak concentration of cTn on admission and grouped patients into those with measurements of cTnI and those with cTnT. The primary outcome was all-cause mortality. We divided the peak cTn concentrations into groups based on the bands of concentrations of cTn from &amp;lt;1 times the 99th percentile, 1-2, 2-5, 5-100 and &amp;gt;100 times the 99th percentile and compared cumulative mortality using Kaplan-Meier analysis and the risk of mortality for each group using logistic regression for the 30-day mortality. Results A total of 9,344 patients were included in this study with a median age of 75 years (65-83) and 5,613 (60%) were males. Of these, 2,874 (31%) had a history of heart failure and 2,349 (25%) had a history of ischemic heart disease. When grouping for type of cTn used, there were more patients treated using hs-cTnT (n = 7,131 76%) than hs-cTnI (n = 2,213, 24%). The median age of patients treated who had a measurement of cTnI was slightly higher; 77 years (IQR 67-84) vs cTnT 74 years (64-83) p&amp;lt;0.001. Of the 9,344 patients, 1,096 (12%) died within 30 days of admission. Figure 1 shows the absolute risk of 1-year all-cause mortality for each band of cTn concentration for (panel A) hs-cTnI and (panel B) hs-cTnT. This showed an increase in the risk of mortality for patients up to 2-5 times the 99th percentile for cTnI and 5-100 times the 99th percentile for cTnT. Figure 2 shows the risk of 30-day mortality for patients for each concentration of cTn. There was a much higher risk of mortality associated with elevation of cTnT than cTnI for all bands of concentration. Conclusion Though both cTnI and cTnT are strong prognostic markers of mortality among patients admitted with heart failure, cTnT seemed to be the strongest prognostic marker. The risk of mortality increased with concentration of cTnT up to very high concentrations of &amp;gt;5 times the 99th percentile.Figure 1Figure 2