Prior History Of Heart Disease Research Articles

Case report: heart failure related to intravitreal injection of anti-VEGF

BackgroundIntravitreal injection of anti-vascular endothelial growth factor is considered the first-line treatment for polypoidal choroidal vasculopathy. It has potential risks for circulatory system, which should be particularly carefully evaluated in older patients. In this case study, we aim to discuss the potential impact of this treatment regimen on cardiac health.Case presentationThis case report describes an elderly patient with no prior history of heart disease who exhibited unexpected heart enlargement and dysfunction. Throughout the patient’s hospital stay, various potential causes were investigated, leading to the hypothesis that a 10-year history of intravitreal injections of anti-vascular endothelial growth factor could be related to the observed clinical manifestations. The patient was advised to discontinue this treatment, and after a 2-month follow-up period, there was a gradual improvement in the patient’s cardiac structure and function.ConclusionThis manuscript highlights the importance of conducting cardiac examinations before and after anti-vascular endothelial growth factor treatment, especially for individuals at risk of heart diseases like the elderly. It emphasizes the need to carefully weigh the benefits and risks of treatment regimens to ensure optimal therapeutic outcomes.

A CASE REPORT OF HEART FAILURE WITH IMPAIRED EJECTION FRACTION DUE TO DILATED CARDIOMYOPATHY IN A YOUNG PATIENT

Abstract A 30–year–old female, with no prior history of heart disease sought medical treatment for increasing shortness of breath, oedema in the lower limbs, abdominal enlargement from seven days. She had was adopted, was a smoker, no use of illicit drugs. Her heart rate was 90 per minute, she had bilateral pitting oedema to mid–shin, her blood pressure was 100/70mm Hg, there were no signs of jugular venous hypertension, the pulmonary and cardiac auscultations were normal. She had ascites and her liver was palpable 3cm below the right costal margin. Her ECG had shown sinus rhythm, heart rate of 92bm, PR interval of 160ms, left bundle branch block (QRS duration of 130ms). Her echocardiogram showed severe global left ventricular dysfunction with left ventricular (LV) ejection fraction (EF) 18% using the apical biplane Simpson’s rule, GLS WAS –4.3%, her right ventricle was dilated and impaired (TAPSE 1,6cm). Her BNP was 2393,90pg/ml. To exclude coronary artery disease, especially congenital coronary artery disease a coronary CT angiography (CTA) was performed. The coronary CTA scan showed normal findings. Cardiac MRI showed severe impairment of both left and right ventricular systolic function with a pattern of gadolinium enhancement negative for necrosis or fibrosis. The patient, after being initially treated with large doses of diuretics and levosimendan, was promptly treated with sacubitril valsartan, empaglifozin, bisoprolol, spironolactone plus vericiguat with rapid titration to maximal tolerated dose. About 1 week later her symptoms began to subside and the patient was discharged in a stable condition. She was referred for consideration of cardiac transplantation and cardiac resynchronisation therapy defibrillator; blood samples for genetic pathology research were taken. A program of serial echocardiograms was introduced, every 30 days, and was observed after 2 months. At follow up our patient had an impressive improvement in terms of improved quality of life, NYHA functional class (from III to I), and performance capacity. A new echocardiographic assessment had shown an LVEF of42% with GLS of–12%. Conclusions: Four pillars of heart failure therapy and vericiguat addiction with rapid titration represents a safe and effective strategy for the treatment of cardiac decompensation with reduced FE. Basal / 60 day EF % 18 /42 GLS % –4.3/ –12.0 E/A 5 /2,1 BNP pg/ml 2393.90 / 889.90 TAPSE cm/s 1.6 / 2.1

Cardiac structure, function, and coronary anatomy 10 years after isolated contemporary adjuvant radiotherapy in breast cancer patients with low cardiovascular baseline risk.

The effects of isolated contemporary low-dose breast cancer (BC) radiotherapy (RT) on the heart remain poorly understood. This study aims to assess the long-term impacts of BC-RT on cardiac structure and function. Seventy-six women (62 ± 7 years) without history of prior heart disease, who had undergone RT for either first left (n = 36) or right (n = 40) BC, without additional medical oncology therapy apart from hormonal treatment 11 ± 1 years earlier, underwent transthoracic echocardiography, cardiac magnetic resonance imaging (CMR), computed tomography coronary angiography (CTCA), NT-proBNP, and a 6-min walk test (6MWT). They were compared with 54 age-matched healthy female controls. By CTCA, 68% of BC patients exhibited no or very mild coronary disease, while only 11% had moderate stenosis (50-69%) and 3% had significant stenosis (>70%). Despite slightly reduced regional echocardiographic midventricular strains, BC patients exhibited similar global left and right ventricular volumes, ejection fractions, and global strains by echocardiography and CMR as controls. Mitral E/e' ratios were slightly higher, and mitral deceleration times were slightly lower, but NT-proBNP was similar to controls. Also, 6MWT was normal. None had late gadolinium enhancement, and extracellular volume fraction was similar in BC (28 ± 3 vs. 29 ± 3, P = 0.15) and controls. No differences were observed relative to dose or side of RT. Aside from minor alterations of regional strains and diastolic parameters, women who received isolated RT for BC had low prevalence of coronary disease, normal global systolic function, NT-proBNP, and exercise capacity and showed no structural changes by CMR, refuting significant long-term cardiotoxicity in such low-risk patients.

Influence of sarcomeric protein mutations on myocardial function in a 3D-disease model of human iPSC-derived bioartificial cardiac tissue

Abstract Background Peripartum cardiomyopathy (PPCM) is a rare type of cardiomyopathy that occurs in women without prior history of heart disease at later stages of pregnancy or several months after childbirth (1). The disease is characterized by lowered left ventricular ejection fraction (LVEF<45%) and can lead to heart failure if left untreated (1). Approximately 20% of PPCM patients harbor sarcomeric mutations, from which titin truncating variants (TTNtv-s) have the highest pathogenic potential (2). However, the role of such genetic defects of the contractile apparatus on PPCM pathogenesis is not well understood. Purpose The study aims to establish an in vitro 3D disease model of PPCM to elucidate the role of sarcomeric mutations, including titin mutations, in its etiology. We hypothesize, that the disease phenotype can be uncovered in vitro via the stimulation of PPCM patient-derived Bioartificial Cardiac Tissues (BCTs), utilizing pregnancy-related factors in our custom-made bioreactors (3). Methods We selected three patients carrying previously unstudied mutations in the TTN gene for the study. The iPSC reprogramming was performed using a commercial, Sendai virus-based kit. Pluripotency was confirmed via flow cytometry and immunofluorescence stainings. The presence of mutations was confirmed by exome sequencing. Cardiomyocyte differentiation (4) and BCT generation (3) were carried out via established protocols. Following maturation, BCTs were stimulated with the pregnancy-related factors, and tissue forces were measured in the bioreactors. These forces include intrinsically generated (spontaneous) and electrically induced (paced) contraction forces (mN), as well as passive forces, which correlate with tissue stiffness. Results We successfully generated two clonal induced pluripotent stem cell (iPSC) lines from each patient. We confirmed that all of the cell lines were >90% positive for pluripotency markers. After differentiation, CMs contracted spontaneously from day 7 onwards and were >95% positive for cardiac markers (SA, MF20, cTnT). The BCTs remodeled and started contracting on days 1-2 after generation, similarly to wild-type tissues in the baseline conditions. Prolactin treatment of Patient A, harboring a missense mutation in titin, did not show significant functional effects. We confirmed, that patients B and C harbor TTNtvs, and tissues from these patients show a trend of altered stiffness after stimulation with repeated mechanical stretch cycles or β-adrenergic agonist isoprenaline. Further analysis of the underlying mechanisms investigating metabolic changes, signaling pathways, and transcriptomics are ongoing. Conclusion The established iPSC and tissue engineering technologies offer a valuable tool for the development of an iPS-CM-based 3D in vitro disease model for PPCM, which can be used for risk stratification of individual and combined sarcomeric mutations and the development of tailored therapeutic strategies.

Cancer Therapy-Related Cardiotoxicity: A Comprehensive Retrospective Analysis at Najran Cancer Center, Saudi Arabia.

Background Cardiotoxicity, produced as an adverse effect of anticancer therapy, is a common issue during cancer treatment. Acute coronary syndrome, myocarditis, arrhythmias, or heart failure can all be symptoms of this issue.Little is known about its occurrence among Saudi Arabian cancer patients. This study aims to investigate factors linked to anticancer therapy-related cardiotoxicity. Methods A retrospective study was conducted from April 2020 to May 2022 at the King Khalid Hospital, Najran, Saudi Arabia. The study included adult cancer patients receiving anticancer therapy, regardless of their cardiovascular disease history. Univariate analysis was used to investigate factors associated with the occurrence of cardiotoxicity related to anticancer therapy. Results Of 78 patients receiving anticancer therapy, cardiotoxicity occurred in 12 (15.4%) patients. The mean age was 56.5 ± 13.4 years, with 33.3% aged over 65 years. Comorbidities included hypertension (44; 56.4%), diabetes (41; 52.6%), dyslipidemia (13; 16.7%), smoking (16; 20.5%), heart disease (6; 7.7%), trastuzumab use (9; 11.5%), and chronic kidney disease (2; 2.6%). The most common cancers were breast cancer and gastrointestinal cancer (27.6% each). Monoclonal anticancer agents 35 (46.1%) and alkylating agents 29 (38.2%) were commonly used chemotherapies. Cardiac protective agents were used in 16 (21.1%) of patients, with angiotensin-converting enzyme (ACE) inhibitors 15 (19.7%)and statins (13; 17.1%) being the most prescribed. Baseline ejection fraction (EF) was normal in 69 (90.8%) of cases. The follow-up duration was 1.93 ± 1.90 years. A drop in EF occurred in five (6.6%) of cases. Dyslipidemia (OR: 0.12; 95% CI: 0.03-0.47, p=0.002), previous heart disease (OR: 0.14; 95% CI: 0.02-0.81, p=0.029), and impaired baseline EF (p=0.029) were associated with increased risk of cardiotoxicity. Statin (OR: 0.22; 95% CI: 0.05 to 0.84, p=0.028) and antiplatelet agents (OR: 0.19; 95% CI: 0.03 to 1.01, p=0.051) were protective agents against cardiac toxicity. Conclusion Effective anti-cancer therapy may be accompanied by an increased risk of cardiotoxicity. In this study, a history of prior heart disease, dyslipidemia, low baseline ejection fraction, and the administration of multiple anticancer therapy agents was associated with cardiotoxicity. Proactive management strategies aimed at mitigating the potential cardiotoxic effects of anti-cancer therapies are crucial.

Study of Risk Factors for Acute Myocardial Infarction in Western Maharashtra: A Case-Control Study

Introduction: Myocardial infarction (MI) is one of the leading causes of mortality in India. The associated risk factors vary with respect to geographical and cultural difference in patients of MI. Objective: To study the association between known risk factors and MI in patients visiting tertiary rural health care center. Method: The study design was Unmatched Case Control type. Patients of age 18 or above diagnosed of AMI were included as cases. Patients of age 18 or above without prior history of heart disease were included as controls. Pregnant women and patients with coexisting cardiogenic shock, any significant chronic medical illness was excluded. The history of hypertension, Diabetes, family history of CHD, stress in past 1 year, history of alcohol intake, History of tobacco addiction, type of activity at work were recorded. The comparison of case and controls were done using Chi squared test, Fisher's Exact Test and Odds ratio, wherever applicable. A one sided “p” value of <0.05 was considered significant. Results: Of the 230 study participants included in the study, 100(43.5 %) were cases and 130 (56.5%) were Control, respectively. Except for history of stress, there was no statistical difference between number of cases and controls. Conclusion: The known risk factors of MI were not found associated with the disease. There is a need for conduct of study with larger sample size for confirmation of the study results.

Subclinical Myocardial Fibrosis in Systemic Lupus Erythematosus as Assessed by Pulse-Cancellation Echocardiography: A Pilot Study.

The aim of this study was to examine whether scar imaging echocardiography with ultrasound multi-pulse scheme (eSCAR) can detect subclinical myocardial involvement in systemic lupus erythematosus (SLE). We consecutively recruited SLE patients and controls matched for age, sex, and cardiovascular risk factors. Participants with cardiac symptoms or a prior history of heart disease were excluded. All participants underwent eSCAR and speckle tracking echocardiography (STE) with global longitudinal strain (GLS) assessment. SLE patients were assessed for disease activity and were followed up for 12 months. Myocardial scars by eSCAR were observed in 19% of SLE patients, almost exclusively localized at the inferoseptal myocardial segments, and in none of the controls. GLS was significantly lower in most myocardial segments of SLE patients compared with the controls, especially in the inferoseptal segments. eSCAR-positive SLE patients received a higher cumulative and current dose of prednisone, and had significantly higher levels of anti-dsDNA antibodies (p = 0.037). eSCAR-positive patients were at higher risk of having SLE flares over follow-up (hazard ratio: 4.91; 95% CI 1.43–16.83; p = 0.0001). We identified inferoseptal myocardial scars by eSCAR in about one-fifth of SLE patients. Subclinical myocardial involvement was associated with glucocorticoid use and anti-dsDNA antibodies.

Congested Heart Failure in Small Breeds Dogs

Mitral valve disease, commonly known as MVD, is the most common heart disease in dogs, accounting for nearly 75% of all dogs affected. The characteristic of this predominant disease includes collagen degradation, elastic fiber fragmentation and proteoglycan accumulation, leading to deterioration of the mitral valve and ultimately, congestive heart failure (CHF). Treatment to reverse or even delay the damaging effects of MVD has not yet been discovered due to a lack of awareness of the underlying processes. Furthermore, this disease in dogs has many similarities with the human MVD and may potentially serve as a translational model for studying MVD further. Therefore, it is imperative to identify the causes and underlying mechanisms associated with canine MVD in order to treat these patients more efficiently at the earliest detectable stage. MicroRNAs (miRNAs) are small, 21‐25 nucleotides in length, non‐coding RNAs that can down‐regulate the expression of protein coding genes by binding to the 3’UTR sites in their messenger RNAs (mRNA), causing either degradation or gene silencing. Prior studies have shown that one miRNA may regulate multiple mRNAs, subsequently effecting the downstream levels of gene expression. Furthermore, if miRNAs prove to be a useful biomarker of heart disease, not only may they serve as detectors of early disease onset, but they may also be useful as therapeutic agents. Given this recent data, we propose to test the hypothesis that circulating miRNAs may be useful biomarkers for detection of CHF, secondary to MVD. Liquid biopsies (blood samples) were collected in EDTA tubes from 7 healthy dogs with no prior history of heart disease and 7 dogs being treated for CHF secondary to MVD. Total serum RNA was isolated using miRNeasy Serum/Plasma Kit (Qiagen). Isolated RNA was then reverse transcribed using miScript II RT Kit (Qiagen) and lastly, miRNA was quantified using miScript SYBR Green PCR Kit, along with miScript miRNA PCR Arrays (Qiagen).

Resting heart rate and risk of left and right heart failure in 0.5 million Chinese adults

ObjectivesTo compare the shape and strength of the associations of resting heart rate (RHR) with incident heart failure (HF) and pulmonary heart disease (PHD) in Chinese adults.MethodsThe prospective China Kadoorie...

Mediating effect of physical activity on association between sedentary leisure-time and obesity indexes among hypertensive individuals

Objective: To explore the mediating effect of physical activity on association between sedentary leisure-time and obesity indexes among hypertensive individuals. Methods: After excluding of those with a prior history of heart disease, stroke and cancer, a total of 20 178 hypertensive participants in the China Kadooire Biobank (CKB) study from Wuzhong district of Suzhou city were included. Mediating effect analysis was used to analyze the mediating effect of physical activity (PA) on correlation between sedentary leisure-time and body fat percentage (BFP), waist circumference (WC) and body mass index (BMI). Results: After adjusted for age, gender, smoking status, alcohol consumption, education levels, intake frequencies of meat and intake frequencies of fresh fruit, sedentary leisure-time (SLT) was negatively correlated with PA (β=-0.246, P<0.001), but positively associated with BFP (β=0.061, P<0.001), WC (β=0.087, P<0.001) and BMI (β=0.071, P<0.001). After including the mediator variable PA, the direct effect of SLT on obesity index was still significant. PA was negatively correlated with BFP, WC and BMI (β=-0.052, -0.083 and -0.028, respectively, P<0.001). Analysis of mediating effect indicated that the association of SLT with BFP, WC and BMI were partly mediated by PA, the proportion of mediating effect was 20.820%, 23.421% and 9.915%. Stratified by gender, PA had mediating effect on SLT and all obesity indexes in women, while only on SLT and BFP and WC in men. Conclusions: There is a significant mediating effect of PA on correlation between SLT and obesity indexes among hypertensive individuals. Hypertensive patients should increase the level of physical activity and reduce sedentary behavior to achieve a profounder healthy effect.

C74. Post covid-19 cardiomyopathy in an adolescent patient: a case report

Abstract Background Myocardial injury caused by viral myocarditis may occur during COVID-19 infections. This condition may lead to cardiomyopathy as the chronic sequela. We report a case of an adolescent COVID-19 survivor without underlying heart disease presented with dilated cardiomyopathy. Case Summary A 16-year-old male patient was referred to Cardiology Outpatient Clinic, Indonesian Army Central Hospital Gatot Soebroto. The patient presented with a chief complaint of fatigue and just recovered from mild to moderate COVID-19 one month before the visit. There was no prior history of heart disease. Physical examination was within normal limit, but laboratory findings showed highly elevated NT-proBNP (7705 pg/mL) and D-dimer (1850 ng/mL). ECG revealed normal sinus rhythm with poor R wave progression. Echocardiography detected all chamber dilatation, eccentric left ventricular hypertrophy, global hypokinetic, moderate mitral regurgitation, and reduced ejection fraction (22%). The patient was diagnosed with new-onset dilated cardiomyopathy as a COVID-19 sequela and we initiated treatment with ARB (candesartan), beta-blocker (bisoprolol), diuretics (furosemide and spironolactone), rivaroxaban, and trimetazidine. During a follow-up visit three months later, the patient’s recovery was stable. Discussion The occurrence of new-onset cardiomyopathy in our previously healthy young patient highlights the possible mechanism of COVID-19 as a single cause of myocardial injury without underlying heart disease. Comprehensive evaluation and optimal treatment should be taken during hospitalization and post-discharge period to prevent further complications. Additional examinations such as cardiac magnetic resonance and endomyocardial biopsy should be done to provide definitive confirmation.

C74. Post covid-19 cardiomyopathy in an adolescent patient: a case report

BackgroundMyocardial injury caused by viral myocarditis may occur during COVID-19 infections. This condition may lead to cardiomyopathy as the chronic sequela. We report a case of an adolescent COVID-19 survivor without underlying heart disease presented with dilated cardiomyopathy. Case SummaryA 16-year-old male patient was referred to Cardiology Outpatient Clinic, Indonesian Army Central Hospital Gatot Soebroto. The patient presented with a chief complaint of fatigue and just recovered from mild to moderate COVID-19 one month before the visit. There was no prior history of heart disease. Physical examination was within normal limit, but laboratory findings showed highly elevated NT-proBNP (7705 pg/mL) and D-dimer (1850 ng/mL). ECG revealed normal sinus rhythm with poor R wave progression. Echocardiography detected all chamber dilatation, eccentric left ventricular hypertrophy, global hypokinetic, moderate mitral regurgitation, and reduced ejection fraction (22%). The patient was diagnosed with new-onset dilated cardiomyopathy as a COVID-19 sequela and we initiated treatment with ARB (candesartan), beta-blocker (bisoprolol), diuretics (furosemide and spironolactone), rivaroxaban, and trimetazidine. During a follow-up visit three months later, the patient’s recovery was stable.Discussion The occurrence of new-onset cardiomyopathy in our previously healthy young patient highlights the possible mechanism of COVID-19 as a single cause of myocardial injury without underlying heart disease. Comprehensive evaluation and optimal treatment should be taken during hospitalization and post-discharge period to prevent further complications. Additional examinations such as cardiac magnetic resonance and endomyocardial biopsy should be done to provide definitive confirmation.

Cardiac Risk Stratification in Liver Transplantation: Results of a Tiered Assessment Protocol Based on Traditional Cardiovascular Risk Factors.

Coronary artery disease (CAD) confers increased perioperative risk in patients undergoing liver transplantation (LT). Although routine screening for CAD is recommended, there are limited data on the effectiveness of screening strategies. We evaluated the safety and efficacy of a 3-tiered cardiac risk-assessment protocol that stratifies patients based on age and traditional cardiac risk factors. We peformed a single-center, prospective, observational study of consecutive adult patients undergoing LT assessment (2010-2017). Patients were stratified into low-risk (LR), intermediate-risk (IR), or high-risk (HR) cardiac groups and received standardized investigations with selective use of transthoracic echocardiography (TTE), dobutamine stress echocardiography (DSE), computed tomography coronary angiography (CTCA), and coronary angiography (CA). Primary outcomes were cardiac events (CEs) and cardiovascular death up to 30 days after LT. Overall, 569 patients were included, with 76 patients identified as LR, 256 as IR, and 237 as HR. Cardiac risk factors included diabetes mellitus (26.0%), smoking history (47.3%), hypertension (17.8%), hypercholesterolemia (7.2%), family (17.0%) or prior history of heart disease (6.0%), and obesity (27.6%). Of the patients, 42.0% had ≥2 risk factors. Overall compliance with the protocol was 90.3%. Abnormal findings on TTE, DSE, and CTCA were documented in 3, 23, and 44 patients, respectively, and 12 patients were not listed for transplantation following cardiac assessment (1 LR, 2 IR, and 9 HR). Moderate or severe CAD was identified in 25.4% of HR patients on CTCA following a normal DSE. CEs were recorded in 7 patients (1.2%), with 2 cardiovascular deaths (0.4%). Cardiac risk stratification based on traditional cardiac risk factors with the selective use of DSE, CTCA, and CA is a safe and feasible approach that results in a low perioperative cardiac event rate.

Heartbeat: sudden cardiac death risk predicted by simple ECG measures

Sudden cardiac death (SCD) accounts for 10%–20% of all deaths in high-income countries, with about 50% of victims having no prior history of heart disease. Currently, primary prevention of SCD...

Sudden Death in a Middle-Aged Gentleman

A sudden unexpected death in a healthy individual often leads to panic within a community and it’s frequently associated with malicious mischief. Suicide, infections, genetic or congenital abnormalities may well lead to sudden deaths. All these possibilities are vital in determining the cause of death and facilitate investigation, hence must be considered judiciously. Here, we report a case of a 49-year-old gentleman without underlying medical illness or prior history of heart disease found dead in his home by his wife. Postmortem and histopathology findings determined the cause of death. External examination revealed no obvious injuries whereas 50% narrowing was disclosed in the left anterior descending artery at internal examination. Histology finding showed fibro-fatty replacement of the right ventricle myocardium. Toxicological analyses were unrewarding. It was concluded that the cause of death was arrhythmogenic right ventricular dysplasia. In conclusion, the findings of the forensic autopsy and histopathology facilitated the investigation and established the cause of death. The cause of death attributed to arrhythmogenic right ventricular dysplasia (ARVD). This case demonstrates ARVD can have a late presentation and it should always be borne in mind as a potential cause of death, necessitating this case report.

420O - Role of cardioprotective therapies for prevention of cardiotoxicity in breast cancer: A systematic review and meta-analysis

BackgroundCardiotoxicity is a well-recognized adverse outcome following adjuvant breast cancer treatment including anthracyclines, trastuzumab, and chest radiation. Its prevention remains an important challenge in clinical practice. We aimed to determine the effectiveness of prophylactic cardioprotective agents in preventing treatment-related cardiotoxicity in women with breast cancer. MethodsA systematic review of published literature was conducted by searching PubMed, EMBASE and EBSCO host databases. Studies where prophylactic intervention was given to breast cancer patients without a prior history of heart disease were included. The outcomes of interest were preservation of left ventricular ejection fraction (LVEF), or development of cardiac events. Mean differences (MD) in LVEF, and relative risks (RR) of cardiac events, were evaluated using random-effects models. ResultsThirteen randomized controlled trials (RCTs), which used prophylactic beta-blockers, dexrazoxane, angiotensin receptor blockers, angiotensin converting enzyme (ACE) inhibitors or other pharmacologic agents were included. Overall, the use of prophylactic cardioprotective agents resulted in a statistically significant smaller LVEF decline compared to use of placebo (MD = 2.42%, 95% confidence interval (CI): 0.59%-4.24%). While there were 52 cardiac events in the intervention arm (n = 405) compared to 79 in the control arm (n = 396), use of prophylactic cardioprotective agents did not significantly protect against incident cardiac events (RR = 0.63, 95%CI: 0.33-1.22). ConclusionsIn breast cancer patients without a history of heart disease, use of cardioprotective agents appear to confer only a very marginal protection against LVEF decline, falling below the ideal 10% cardioprotection. However, given the sample number of RCTs in this area, more studies are needed to substantiate the effectiveness of prophylactic cardioprotective agents in prevention of cardiotoxicity in women with breast cancer. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

TCAS-ASSOCIATED WITH PERSISTENT WIDE COMPLEX VENTRICULAR TACHYCARDIA

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Amitriptyline is a tricyclic antidepressant (TCA) that has been used for over 50 years. TCAs are notorious for cardiotoxicity and neurotoxicity, and it is widely used medication for suicide. The incidence of ventricular tachycardia (VT) and ventricular fibrillation (VF) is approximately 4% in TCA overdose patients. It is mostly noted in patients with severe acidosis, hypotension, and prolonged QRS duration. Here, we present a patient with prolonged wide-complex ventricular tachycardia secondary to amitriptyline overdose. CASE PRESENTATION: A 50 year old female with history of Ehlers-Danlos syndrome and fibromyalgia was brought to the ED by her husband because of a reported seizure at home. Pertinent home medications included Amitriptyline, fentanyl patch, and hydromorphone. Patient denied any prior history of heart disease or neurological problems. On arrival to the ED, Glasgow Coma Scale was 3. Pertinent vital signs were blood pressure of 61/35 mmHg. The patient was emergently intubated. ECG on admission showed slow wide complex VT (80 bpm with QRS duration 217 msec. Admission labs showed elevated anion gap metabolic acidosis. Lactic acid was 20.0 mmol/L. ABG post intubation showed pH 7.17, pCO2 44, pO2 240 with base excess of -12. Urine toxicology demonstrated TCAs and opiates. Naloxone 4 mg IV was given twice with no improvement in symptoms. Repeat ECG 2 hours later showed wide complex ventricular tachycardia 158 bpm with QRS prolongation 178 msec. This was initially thought to be sinus tachycardia with prolonged QRS complex. ICU was consulted and the patient was immediately cardioverted upon arrival to the MICU. Sinus rhythm was achieved, but the patient remained tachycardic. EEG was obtained which confirmed 7 left and 5 right mid-temporal lobe seizures. Patient was started on bicarbonate gtt and Ativan gtt. ECG and ABG were obtained every 4 hours. Her QRS duration normalized and the acidosis has resolved after 12 hours. Brain MRI with and without contrast did not show any acute intracranial pathology. The patient was discharged home safely after a 7-day hospitalization. DISCUSSION: TCAs have been used for over 50 years for the treatment of depression and neuropathic pain. It has many side effects including cardiotoxic and neurotoxic adverse outcomes. The severity of cardiotoxic effects are also imperative to recognize; particularly, it is important to suspect TCA toxicity in a patient with persistent wide complex ventricular tachycardia. Patients with VT secondary to TCA overdose, should promptly treated with the ACLS protocol. These patients should be closely monitored in the ICU and should receive sodium bicarbonate gtt, ABG, and EKG every four hours. CONCLUSIONS: Early recognition and aggressive intervention is warranted in patients presenting with TCA overdose in order to improve patient outcomes. Reference #1: Goldberg RJ, Capone RJ, Hunt JD. Cardiac complications following tricyclic antidepressant overdose. Issues for monitoring policy. JAMA 1985; 254:1772. Reference #2: Khandker Mohammad Nurus Sabah, Abdul Wadud Chowdhury, Mohammad Shahidul Islam, Bishnu Pada Saha, Syed Rezwan Kabir, and Shamima Kawser. Amitriptyline-induced ventricular tachycardia: a case report. BME Res Notes. 2017;10:286. https://doi.org/10.1186/s13104-017-2615-8 DISCLOSURES: No relevant relationships by Abdisamad Ibrahim, source=Web Response No relevant relationships by Mohamed Labedi, source=Web Response No relevant relationships by Ruby Maini, source=Web Response No relevant relationships by Nitin Tandan, source=Web Response

Increased aortic stiffness in adults with chronic indeterminate Chagas disease.

An ever-increasing number of patients with chronic indeterminate Chagas disease are diagnosed with early vascular and cardiac abnormalities, as cardiovascular imaging becomes more sensitive. However, the currently available information on aortic stiffness (a prognostic marker for adverse cardiovascular outcomes) in these patients is scarce. In this study, we consecutively recruited 21 asymptomatic Bolivian adult patients with chronic indeterminate Chagas disease and 14 Bolivian adults, who were seronegative for Trypanosoma cruzi infection. No participants had a prior history of heart disease, hypertension, diabetes, chronic kidney disease or atrial fibrillation. Carotid-femoral pulse wave velocity (cf-PWV), carotid-radial PWV (cr-PWV), carotid intima-media thickness and conventional echocardiographic measurements were recorded in all participants. Patients with chronic indeterminate Chagas disease had significantly higher cf-PWV (7.9±1.3 vs. 6.4±1.1 m/s, p = 0.003) and greater HOMA-estimated insulin resistance than subjects without Chagas disease. The two groups did not significantly differ in terms of age, sex, smoking, adiposity measures, blood pressure, plasma lipids, fasting glucose levels as well as cr-PWV, carotid intima-media thickness measurements, left ventricular mass and function. Presence of chronic indeterminate Chagas disease was significantly associated with increasing cf-PWV values (β coefficient: 1.31, 95% coefficient interval 0.44 to 2.18, p = 0.005), even after adjustment for age, sex, heart rate, systolic blood pressure and insulin resistance. In conclusion, asymptomatic Bolivian adult patients with chronic indeterminate Chagas disease have an early and marked increase in aortic stiffness, as measured by cf-PWV, when compared to Bolivian adults who were seronegative for Trypanosoma cruzi infection.

Predicting Long-Term Mortality, Morbidity, and Survival Outcomes Following a Cardiac Event: A Cardiac Rehabilitation Study.

Background:Cardiac rehabilitation (CR) has been shown to decrease mortality and morbidity but estimations vary. While there is significant literature supporting short-term benefits, there is not a similarly body of research as to long-term (LT) benefits. Low participation rates in CR are due to several causes and evidence demonstrating positive LT outcomes could be a catalyst to increased participation rates.Objective:To predict LT mortality, readmission, and survival benefits associated with CR participation in a nationally certified program.Methods:Investigators collected mortality and hospital readmission data in a retrospective study to examine a cohort of cardiac patients following a myocardial infarction (MI), MI/percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) up to 14 years ago. Hospital electronic medical record (EMR; n = 207) were used to measure hospital readmission outcome and State Health Department records (n = 361) for mortality and survival outcomes. Participation in CR, age, gender prior history of cardiac event, and diagnosis were used to predict readmission, mortality, and survival.Results:Approximately half (52.1%) the sample participated in CR. Participants included 72% males, average age 68 years (38-91 years), and were predominantly Non-Hispanic white. CR participants attended an average of 20 sessions. CR group differed in diagnoses MI (58.5%), CABG (57.4%) and in prior history of heart disease (25.4%) from the non-cardiac rehabilitation (NCR) group (83.2%, 25.4%, 42.2%, respectively) (P < .05). After controlling for the covariates in logistic regression analyses, the CR group independently predicted lower all-cause mortality (odds ratio, OR = 0.22, 95% CI 0.12 to 0.39) and decreased hospital readmissions (OR = 0.48, 95% CI 0.24 to 0.96). After controlling for the covariates in survival analysis, the CR group significantly contributed to decreased likelihood of death hazard (hazard ratio = 0.36, 95% CI 0.24 to 0.54). Median survivor time for the participants was 5.91 years, SD = 3.81 years.Conclusions:Participation in CR for middle age and elderly patients is associated with increased survival, a marked decrease in all-cause mortality, and a decrease in cardiovascular-related hospital readmission. A referral to a nationally certified outpatient CR program prior to hospital discharge and early enrollment may improve LT outcomes.

Starry Heart Valve: A Story Behind CAT Scratch

SESSION TITLE: Bacterial Infections 1 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Bartonella species are zoonotic bacterial pathogens in humans. B.quintana and B.henselae are the most common agents causing human infections. B.henselae infection is associated with exposure to cats and their fleas; endocarditis may occur in patients with known valvular disease. CASE PRESENTATION: A 62-year-old female, with no prior history of heart disease, presented with 10 days of bilateral leg swelling, malaise and exertional dyspnea. She lived with her 4 cats. Examination was notable for bilateral pitting edema extending to her waist with visible scratch marks on her abdomen and lower extremities. Laboratory data revealed new pancytopenia and an elevated serum creatinine (2.1 mg/dl). She was started on clindamycin for cellulitis. Blood cultures were negative. Transthoracic echocardiogram, obtained to evaluate the severe edema, showed an aortic valve vegetation measuring 2.7 cm x 1.3 cm with aortic insufficiency. The lesion was confirmed with a transesophageal study. The patient was deemed to have culture negative endocarditis; antibiotics were changed to vancomycin, ceftriaxone and doxycycline. B.henselae and B.quintana IgG titers were positive with the titer of > 1:1024. She underwent an aortic valve replacement. PCR of the heart valve tissue was positive for Bartonella. The bacterial colonies were strongly positive by Warthin Starry stain and demonstrated strong reactivity with a Bartonella immunostain. Vancomycin and ceftriaxone were discontinued; she was transitioned to doxycycline 100 mg twice daily with rifampin 300 mg twice daily for six weeks followed by doxycycline monotherapy for 6 months. DISCUSSION: Patients with Bartonella endocarditis generally present with subacute, nonspecific symptoms including fever, fatigue, weakness, and weight loss, like our patient. Our patient’s exposure to her four cats, with frequent scratches on her thighs and lower abdomen, and a culture-negative valuvular vegetation, raised the suspicion of Bartonella endocarditis. There are several methods to confirm the presence of Bartonella infection including tissue cell culture, Warthin-Starry staining of the resected valve, immuno histologic methods, serologic testing, and PCR amplification using valve specimens. If Bartonella is proven, treatment with 6 weeks of doxycycline along with 2 weeks of gentamycin and rifampin is recommended. However, there are no set guidelines defining optimal duration of therapy. Anecdotal evidences support extended doxycycline therapy for 3-6 months to prevent potential dissemination. CONCLUSIONS: Clinicians should suspect Bartonella endocarditis in patients with culture-negative endocarditis who have had extensive contact to cats. Reference #1: Chomel B et al: Fatal Case of Endocarditis Associated with Bartonella henselae Type I Infection in a Domestic Cat. Journal Of Clinical Microbiology; Nov. 2003, p. 5337-5339 Reference #2: Drancourt M et al: Bartonella (rochalimaea) quintana endocarditis in three homeless men. N Engl J Med 1995;332: 419-23 DISCLOSURE: The following authors have nothing to disclose: Thushara Paul, Siddhant Datta No Product/Research Disclosure Information