Incidence Of Cardiac Complications Research Articles

Pharmacogenetic features of tramadol metabolism affecting the quality of postoperative analgesia in vascular surgery

BACKGROUND: The issue of the efficacy and safety of medications employed for postoperative analgesia has not been resolved to date. Insufficient analgesia constitutes one of the primary risk factors for developing cardiovascular complications postoperatively. Tramadol is a medication that is frequently used for postoperative pain relief following minor and moderately traumatic operations. The biotransformation of this drug is considerably slowed by the presence of CYP2D6 gene polymorphisms G1846A and C100T, which play a significant role in its metabolism. In such patients, a decrease in the quality of postoperative analgesia can be anticipated, which will consequently lead to an increase in cardiac complications. AIM: To assess the efficacy of a postoperative analgesia regimen based on tramadol and the incidence of cardiac complications during vascular operations depending on the presence/absence of polymorphisms of the CYP2D6 gene polymorphisms, an isoenzyme of cytochrome P-450. MATERIALS AND METHODS: An examination of 109 patients undergoing planned vascular surgery was conducted. The frequency of occurrence of polymorphisms G1846A and C100T of the CYP2D6 gene was determined. All patients were assessed for the severity of postoperative pain syndrome during activity and at rest using a visual analog scale on the first day following surgery. Cardiovascular complications that arose while the patients were in the hospital were documented. To assess the autonomic nervous system, patients underwent cardiointervalography. RESULTS: Polymorphism G1846A was detected in 28 (25.7%), while C100T was detected in four (3.7%) patients. Patients without polymorphisms were included in group 1 (n=77). Patients with polymorphisms were assigned to group 2 (n=32). Pain syndrome at rest and during activity was higher in group 2 patients (p 0.05). The tension index before surgery did not differ between the groups; however, it was greater in group 2 patients after surgery (p 0.001). Cardiac complications were identified in 9.1% of group 1 and 18.8% of group 2 patients (p=0.20). CONCLUSION: The frequency of polymorphisms G1846A and C100T of the CYP2D6 gene in patients who underwent vascular surgery was 29.4%. Such patients experienced pain syndrome of greater severity. The patient groups did not exhibit any significant differences in the frequency of cardiac complications.

Initial blood pressure and adverse cardiac events following acute ischaemic stroke: An individual patient data pooled analysis from the VISTA database.

Adverse cardiac events following ischaemic stroke (stroke-heart syndrome, SHS) pose a clinical challenge. We investigated the association between initial blood pressure at stroke presentation and the risk of SHS. We utilised data from the Virtual International Stroke Trials Archive (VISTA). We defined SHS as the incidence of cardiac complications within 30 days post-ischaemic stroke. These presentations included acute coronary syndrome encompassing myocardial injury, heart failure/left ventricular dysfunction, atrial fibrillation/flutter, other arrhythmia/electrocardiogram abnormalities, and cardiorespiratory arrest. Using Cox proportional hazards models, we assessed the risk trajectories for developing SHS and its presentations associated with initial blood pressure. We also explored the risk trajectories for 90-day mortality related to initial blood pressure. From 16,095 patients with acute ischaemic stroke, 14,965 (mean age 69 ± 12 years; 55% male) were analysed. Of these, 1774 (11.8%) developed SHS. The risk of SHS and initial blood pressure showed a U-shaped relationship. The lowest blood pressures (⩽130 mmHg systolic and ⩽55 mmHg diastolic) were associated with the highest risks (adjusted hazard ratio [95%confidence interval]: 1.40 [1.21-1.63]; p < 0.001, 1.71 [1.39-2.10]; p < 0.001, respectively, compared to referential blood pressure range).Cardiorespiratory arrest posed the greatest risk at higher blood pressure levels (2.34 [1.16-4.73]; p = 0.017 for systolic blood pressure >190 mmHg), whereas other presentations exhibited the highest risk at lower pressures. The 90-day mortality risk also followed a U-shaped distribution, with greater risks observed at high blood pressure thresholds. There is a U-shaped relationship between initial blood pressure at ischaemic stroke presentation and the risk of subsequent SHS.

The impact of goal-directed fluid therapy on postoperative pulmonary complications in patients undergoing thoracic surgery: a systematic review and meta-analysis.

Pulmonary complications after thoracic surgery are common and associated with significant morbidity and high cost of care. Goal-directed fluid therapy (GDFT) could reduce the incidence of postoperative pulmonary complications (PPCs) and facilitate recovery in patients undergoing major abdominal surgery. However, whether GDFT could reduce the incidence of PPCs in patients undergoing thoracic surgery was unclear. The present meta-analysis was designed to assess the impact of Goal-directed Fluid Therapy on PPCs in patients undergoing thoracic surgery. Randomized controlled trials (RCTs) comparing GDFT with other conventional fluid management strategies in adult patients undergoing thoracic surgery were identified. Databases searched included PubMed, Web of Science, Embase, and Cochrane Library databases. Review Manager 5.4 (The Cochrane Collaboration, Oxford, UK) software was used for statistical analysis. Heterogeneity was analyzed using I2 statistics, and a standardized mean difference with 95% CI and P value was used to calculate the treatment effect for outcome variables. The primary study outcomes were the incidence of PPCs. Secondary outcomes were the total volume infused, the length of hospitalization, the incidence of cardiac complications, and the incidence of renal dysfunction. Subgroup analysis was planned to verify the definite role of GDFT. A total of 6 RCTs consisting of 680 patients were included in this meta-analysis, which revealed that GDFT did not reduce the incidence of PPCs in patients undergoing thoracic surgery (RR, 0.57; 95% CI 0.29-1.14). However, GDFT decreased the total intra-operative fluid input (MD, - 244.40ml; 95% CI - 397.06 to - 91.74). There was no statistical difference in the duration of hospitalization (MD; - 1.31, 95% CI - 3.00 to 0.38), incidence of renal dysfunction (RR, 0.62; 95% CI 0.29-1.35), and incidence of cardiac complications (RR, 0.62; 95% CI 0.27-1.40). The results of this meta-analysis indicate that GDFT did not reduce the postoperative incidence of pulmonary complications in individuals undergoing thoracic surgery. However, considering the small number of contributing studies, these results should be interpreted with caution.

A plenary survey on the Incidence of cardiac complications amongst transfusion-dependent thalassemia patients

A plenary survey on the Incidence of cardiac complications amongst transfusion-dependent thalassemia patients

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

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

Postoperative Intensive Care Management of Aortic Repair.

Vascular surgery patients have multiple comorbidities and are at high risk for perioperative complications. Aortic repair surgery has greatly evolved in recent years, with an increasing predominance of endovascular techniques (EVAR). The incidence of cardiac complications is significantly reduced with endovascular repair, but high-risk patients require postoperative ST-segment monitoring. Open aortic repair may portend a prohibitive risk of respiratory complications that could be a contraindication for surgery. This risk is greatly reduced in the case of an endovascular approach, and general anesthesia should be avoided whenever possible in the case of endovascular repair. Preoperative renal function and postoperative kidney injury are powerful determinants of short- and long-term outcome, so that preoperative risk stratification and secondary prevention are critical tasks. Intraoperative renal protection with selective renal and distal aortic perfusion is essential during open repair. EVAR has lower rates of postoperative renal failure compared to open repair, with approximately half the risk for acute kidney injury (AKI) and one-third of the risk of hemodialysis requirement. Spinal cord ischemia used to be the most distinctive and feared complication of aortic repair. The risk has significantly decreased since the beginning of aortic surgery, with advances in surgical technique and spinal protection protocols, and is lower with endovascular repair. Endovascular repair avoids extensive aortic dissection and aortic cross-clamping and is generally associated with reduced blood loss and less coagulopathy. The intensive care physician must be aware that aortic repair surgery has an impact on every organ system, and the importance of early recognition of organ failure cannot be overemphasized.

Low Risk of Cardiac Complications in Collegiate Athletes After Asymptomatic or Mild COVID-19 Infection.

The objective of this study was to determine the utility of "standard" cardiac screening with EKG, echocardiography, and serum troponin T (hs-Tn T) testing after COVID infection in competitive college athletes. Prospective cohort study. Tertiary cardiology clinic, university training room. Sixty-five Division 1 athletes recovered from COVID-19 and 465 controls. All COVID-recovered athletes underwent cardiac screening on return to campus in fall 2020. Controls were screened if indicated by preparticipation examination. Students cleared for sports participation were followed for the development of cardiac complications. Incidence of cardiac complications after COVID infection. Infected athletes experienced mild (26/65), moderate (8/65), or no (31/65) COVID symptoms. No athletes had severe symptoms. Men were more likely to have been asymptomatic (20/31), and women were more likely to have had moderate (7/8) symptoms (P = 0.015). All athletes, except 2 with anosmia, were asymptomatic at the time of cardiac testing. One athlete had persistently elevated hs-Tn T but no evidence of myocarditis on cardiac MRI. All other cardiac testing was negative. No athletes were diagnosed with myocarditis (95% CI: 0%-5.5%). All athletes were cleared for athletic participation. None suffered complications over the next 9 months. After COVID-19 infection, no college athletes with mild, moderate, or no symptoms had signs of myocarditis, and all returned to play without cardiac complication. These findings support consensus opinion recommendations that college-age athletes who recovered from COVID-19 and who experienced mild or no symptoms may return to play without cardiac testing.

Association of abdominal obesity with the development of fatal and non-fatal cardiovascular events in a cohort of rural residents of the Kyrgyz Republic: gender and ethnic characteristics

Objective . To study the relationship of abdominal obesity (AO) with the development of fatal and non-fatal cardiovascular events among residents of the Chui region of the Kyrgyz Republic, taking into account gender and ethnicity. Design and methods . This study was carried out as part of the international epidemiological study “Interepid”. The total follow-up period was 7 years. Life status at the end of the follow-up was monitored in 1096 respondents out of 1341 initial cohorts (response 82,1%). Cases of fatal and non-fatal cardiovascular events were included as endpoints in the analysis. The frequency of events was assessed using methods of analysis of survival (Cox proportional hazard regression model, parametric survival models, Kaplan–Meier survival analysis). Results . 181 cases of fatal and non-fatal cardiovascular events (16,44%) were registered during the follow-up. A significant effect of AO on the incidence of cardiac complications in the analyzed cohort was demonstrated. Thus, in respondents with AO, the total frequency of cardiovascular events reached 21,31% and was significantly higher than in those without AO (10,69%, p &lt; 0,0001). An increase in the frequency of events in the presence of AO was recorded in all analyzed subgroups (men, women, Russians, Kyrgyz). The construction of a Cox regression model with a logistic regression analysis made it possible to confirm the independent role of AO in the development of fatal and non-fatal cardiovascular events, which was most pronounced in women and respondents of the Kyrgyz ethnic group. At the same time, on average for the cohort, an increase in waist circumference value by 1 cm is accompanied by an increase in cardiovascular risk by 1,9%. Conclusions . The presence of AO is an independent risk factor for the development of fatal and non-fatal cardiovascular events in the analyzed cohort of residents of the Chui region, mostly among women and respondents of the Kyrgyz ethnic group.

Changes of Electrocardiogram and Myocardial Enzymes in Patients with Intracerebral Hemorrhage.

Purpose Cardiac complications are common in patients with spontaneous intracerebral hemorrhage (ICH). The present study is aimed at observing the incidence of cardiac complications after ICH, so as at improving the understanding of the relationship between cardiac complications and ICH. Methods This is a retrospective study on analyzing electrocardiogram (ECG) and serum myocardial enzyme of 208 patients with ICH admitted to a tertiary hospital from 2018 to 2019. For each patient, demographics, medical history, clinical presentation, ECG, serum myocardial enzyme, and head CT on admission were reviewed. Mortality was noted. Results Among the 208 patients, 145 (69.71%) had one or more ECG abnormalities. The top three abnormalities were corrected QT interval (QTc) prolongation 52 (25%), ST depression 48 (23.08%), and T wave inversion 38 (18.27%). One hundred and thirty-nine patients (66.83%) had increased serum levels of at least one kind of myocardial enzyme, which were high-sensitive cardiac troponin T (hs-cTnT) 79 (37.98%), lactic dehydrogenase (LDH) 80 (38.46%), creatine kinase (CK) 57 (27.40%), and creatine kinase-myocardial subfraction (CKMB) 57 (27.40%). The logistic regression analysis showed the following: secondary intraventricular hemorrhage (SIVH) (odds ratio (OR) 5.32; 95% confidence interval (CI) 2.55–11.08; p < 0.001) and hematoma volume > 30 ml (OR 3.81; 95% CI 1.86–7.81; p < 0.001) were independent predictive factors of QTc prolongation; thalamus location (OR 5.79; 95% CI 1.94–17.28; p < 0.05), hematoma volume > 30 ml (OR 24.187; 95% CI 3.14-186.33; p < 0.05), insular involvement (OR 19.08; 95% CI 5.77-63.07; p < 0.001), and SIVH (OR 2.62; 95% CI 1.69-5.86; p < 0.05) were independent predictive factors of ST depression; insular involvement (OR 2.90; 95% CI 1.12–7.50; p < 0.05) and hematoma volume > 30 ml (OR 1.98; 95% CI 1.06–3.70; p < 0.05) were independent predictive factors of increase of CK; Glasgow Coma Scale (GCS) (OR 0.86; 95% CI 0.78–0.98; p < 0.05) and insular involvement (OR 5.56; 95% CI 1.98–15.62; p < 0.05) were independent predictive factors of increase of CKMB; SIVH (OR 2.05; 95% CI 1.07–3.92; p < 0.05) was independent predictive factor of increase of LDH; age (OR 1.03; 95% CI 1.01–1.06; p < 0.05), blood glucose on admission (OR 1.10; 95% CI 1.01–1.20; p < 0.05), and history of antiplatelet drug use (OR 3.50; 95% CI 1.01–12.12; p < 0.05) were independent predictive factors of hs-cTnT. All the injury indexes were not related to in-hospital mortality. Conclusion The study suggests that insular involvement, hematoma volume > 30 ml, and SIVH are the strongest risk factors for ECG abnormalities and elevated myocardial enzymes after ICH followed which are the risk factors such as GCS, age, admission blood glucose, and ICH location in the thalamus.

Роль та місце кардіопротекції з використанням сучасних інфузійних препаратів у періопераційному періоді

Кардіальні ускладнення не тільки є найчастішою причиною післяопераційної летальності, але й істотно збільшують тривалість і вартість лікування, створюють передумови для розвитку поліорганної недостатності. Саме профілактика й своєчасне адекватне лікування кардіальних ускладнень при позасерцевих оперативних втручаннях є важливим тактичним і стратегічним завданням лікаря-анестезіолога. Можливості радикально знизити ризик ускладнень досить обмежені. Лікарські засоби, до складу яких входять амінокислоти L-аргінін та L-карнітин, можуть бути ефективно використані як кардіо- та ендотеліопротективні препарати. Упровадження таких підходів у клінічну практику в найближчому майбутньому буде мати велике значення для підвищення ефективності та безпечності періопераційної інфузійної терапії пацієнтів із супутніми серцево-судинними захворюваннями.

Abstract 10937: Incidence of Cardiac Complications During Index Hospitalisation with COVID-19 in Australia: AUS-COVID Study

Introduction: Cardiac complications of COVID-19 include acute cardiac injury, myopericarditis, cardiomyopathy and arrhythmias. This study aimed to describe the incidence of cardiac complications in patients admitted to hospital with COVID-19 in Australia. Methods: AUS-COVID is a multicentre observational cohort study across 21 Australian hospitals including all index hospitalisations with laboratory-proven COVID-19 in patients aged 18 years or older. All consecutive patients entered in the AUS-COVID Registry by 28 th January 2021 were included in the present study. Results: Six hundred and forty-four hospitalised patients (62.5 ± 20.1 years old, 51.1% male) with COVID-19 were enrolled in the study. Overall in-hospital mortality was 14.3%. Twenty (3.6%) patients developed new atrial fibrillation or flutter during admission and 9 (1.6%) patients were diagnosed with new heart failure or cardiomyopathy. Three (0.5%) patients developed high grade atrioventricular (AV) block. Two (0.3%) patients were clinically diagnosed with pericarditis or myopericarditis. Among the 295 (45.8%) patients with at least one troponin measurement, 99 (33.6%) had a peak troponin above the upper limit of normal (ULN). In-hospital mortality was higher in patients with raised troponin (32.3% vs 6.1%, p&lt;.001). New onset atrial fibrillation or flutter (6.4% vs 1.0%, p=.001) and troponin elevation above the ULN (50.3% vs 16.4%, p&lt;.001) were more common in patients 65 years and older. There was no significant difference in the rate of cardiac complications between males and females. Conclusions: Among patients with COVID-19 requiring hospitalisation in Australia, troponin elevation was common but clinical cardiac sequelae were uncommon. The incidence of atrial arrhythmias and troponin elevation was greatest in patients 65 years and older. Trial registration: AUS-COVID. ACTRN12620000486921. http://www.anzctr.org.au/

Abstract 10829: Biradial Access Results in Lower Contrast Use and Fewer Complications Than Transfemoral Access in Alcohol Septal Ablation

Introduction: Transradial cardiac catheterization has equivalent efficacy, reduced vascular complications, and is more comfortable and convenient for patients than transfemoral catheterization. The biradial approach for alcohol septal ablation (ASA) has not been well studied. Since 2013, the biradial approach has become the standard approach for alcohol septal ablation at MUSC. This project tested the hypothesis that the biradial approach is equally efficacious and results in fewer complications than the transfemoral approach in ASA. Methods: In this study 274 consecutive patients were retrospectively analyzed from the MUSC alcohol septal ablation database (137= biradial approach, 137=femoral approach) and the changes in left ventricular outflow tract gradient (LVOTG), amount of contrast, fluoroscopy time, and complications were recorded. Groups were not significantly different in pre-ASA LVOTG (p=0.88 and 0.06 for resting and provoked LVOTG respectively). Results: The procedures were equally efficacious at reducing LVOTG with a mean reduction of resting LVOTG of 91.24% (SEM=1.21) in biradial access and 92.37% (SEM=1.14) in femoral access (p=0.5), and a mean reduction of provoked LVOTG of 80.31% (SEM=1.90) in biradial access and 82.17% (SEM=1.74) in femoral access (p=.47). The biradial approach was associated with significantly less contrast use than the femoral approach (mean of 98.1 ccs, SEM of 3.60, and 110.89 ccs, SEM of 4.84, respectively; p=.035). There were statistically significant differences in fluoroscopy time and incidence of complications between the procedures (fluoroscopy time mean of 17.42 min. (SEM=0.93) biradial and 13 min. (SEM=0.72) femoral; (p= 0.00028). Incidence of cardiac complications of .13 biradial and .23 femoral; (p= 0.04)). Conclusions: In this largest study to date, the transradial approach is equally efficacious and is associated with significantly lower contrast use, and fewer complications, albeit with increased fluoroscopy time, than the transfemoral approach in ASA.

P056 Acute rheumatic fever: still a hot topic

Abstract Background Acute rheumatic fever (ARF) still a very common condition and constitutes a real public health problem in the developing countries including Algeria. The objective is to assess the epidemiological and clinical profile and the disease course of ARF in our region and estimate the incidence of cardiac complications. Method The authors report the results of a retrospective study of 52 cases of ARF in children, hospitalized and treated at the Sainte Therese Clinic of the CHU Annaba for a period of 6 years. The diagnosis was made according to Jones criteria. Information was obtained from hospital records. Results The disease mainly concerned the age group of 4–10 years (52%), the sex ratio was 0.86 (28 girls, and 24 boys). The maximum number of hospitalizations is observed during the rainfall period (October-March). 54% of patients had untreated angina. Clinically, fever was noted in 23 patients, polyarthritis in third of cases and a heart murmur in half of patients. Doppler-coupled echocardiography founded carditis in 73% of patients: Endocarditis was noted in all of these cases and the mitral insufficiency was the dominant anatomo-clinical form. The number of infra-clinical carditis was considerable (10/38 cases of carditis). Biologically, accelerated ESR (&amp;gt; 50 mm/H1) was observed in 65% of cases, high CRP level and hyper leucocytosis were noted in 38 and 31 patients, respectively. ASLOs were high in 85% of cases. The outcomes were favorable in the majority of cases. Nevertheless 5 relapses were recorded, including 3 complicated by severe carditis. Conclusion ARF still frequent in our region. Cardiac complications are always frequent and constitute a major factor of morbidity. Our results illustrate the absolute need for a rigorous application of the national prevention program, the main objective of which is to reduce the prevalence of rheumatic heart disease.

Secondary prevention of cerebrovascular events in patients with “asymptomatic” atherosclerotic stenosis of the vertebral arteries and unfavorable prognostic factors of chronic cerebral ischemia

Abstract Aim To evaluate the three-year results of endovascular interventions in patients with “asymptomatic” atherosclerotic stenosis of the vertebral arteries as a method of secondary prevention of cerebrovascular events. Material and methods The patients were randomized into 2 groups: in group I (n=60), secondary prevention of cerebrovascular events were carried out in a combined strategy - stenting of the vertebral arteries in combination with medication therapy, and in group II (n=60) - only medication therapy. Long-term follow-up were planned in 12, 24 and 36 months. Inclusion criteria: patients with “asymptomatic” stenosis of the vertebral arteries 50–95%; the diameter of the vertebral arteries is not less than 3.0 and not more than 5 mm; the presence of not gross cerebral and focal symptoms corresponding to the initial (asymptomatic) stage of encephalopathy (according to E.V. Schmidt); the presence of at least one factor for an unfavorable prognosis of chronic cerebral ischemia: arrhythmia, total cholesterol level more than 6.0 mmol / l, open Willis circle, arterial hypertension, bilateral lesion of the vertebral arteries, low-density lipoprotein level more than 3.5 mmol / l, combined lesion of the vertebral and carotid arteries, calcification of the vertebral arteries, a coronary heart disease in anamnesis. Primary endpoints: the total incidence of cardiovascular events. Results In all patients from group I, stenting of the vertebral arteries was performed without the use of embolic protection devices. The total incidence of major cerebral complications by the end of the study was 5.9% in group I and 25.0% in group II (χ2=4.825; p=0.023). In group I by the end of the study, the total incidence of stroke was 2.9%, and in group II it reached 30.5%. The total frequency of transient ischemic attack was 5.8 and 8.3%, respectively (χ2=4.135; p=0.042). The incidence of cardiac complications was 8.8 and 27.8%, respectively, in groups I and II (χ2=4.154; p=0.042). The survival rate, free from major cerebral complications, as well as cardiac complications, was significantly higher in patients who received combined treatment (vertebral artery stenting in combination with drug therapy). The survival rate of patients from group I, free from restenosis, was 94.12±4.03%. In general, restenosis in 6.45% of patients in the combination treatment group, however, restenosis itself did not affect the incidence of major cerebral complications in the long-term period (χ2=0.6911; p=0.4057). Conclusion In patients with “assymptomatic” atherosclerotic lesions of the vertebral arteries and with factors of poor prognosis of cerebral artery diseases, secondary prevention of cerebrovascular events is advisable to carry out a combined method, including stenting of the vertebral arteries, in combination with drug therapy. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Russian academic excellence project 5-100

Splenectomy Is a Risk Factor for Cardiac Complications in TM

The use of splenectomy for thalassemia major (TM) is restricted over concerns of its long-term outcome. The aim of this retrospective cohort study was to assess the incidence of cardiac complications (CC) in a large multicentric cohort of splenectomized TM patients.We considered 360 TM patients (177 males, mean age 36.59±7.11 years) who performed the splenectomy between 1966 and 2010 (mean age at splenectomy 13.75±8.06 years) and an equal number of TM patients with the spleen, matched by age and sex. Both groups of patients were consecutively enrolled in the Myocardial Iron Overload in Thalssemia (MIOT) Network and were followed-up until October 2016. For each splenectomized patient, the years at risk were calculated from the date of splenectomy until the date of completion of the study, death, or diagnosis of a CC, whichever occurred first. For each non-splenectomized patient the same time at risk of the correspondent splenectomized patient was used. In case of death or CC, the time at risk was the difference between the date of death or CC and the date of transplantation of the matched patient. The cumulative incidence was used to assess the absolute risk of CC over different periods of time.Among the splenectomized patients, 62 CC were recorded (32 arrhythmias, 25 heart failure, 4 pulmonary hyperthension, and 2 thromboembolic events). The cumulative incidence of CC was 5.79% at 10 years from splenectomy, 12.29% at 20 years from splenectomy, 22.42% at 30 years from splenectomy, and 35.95% at 40 years from splenectomy.Among the TM patients with the spleen, 28 CC were recorded (8 supraventricular, arrhythmias, 14 heart failure, 3 pulmonary hyperthension, and 3 thromboembolic events). In this cohort of patients, the cumulative incidence of CC was 0.92% after 10 years, 5.68% after 20 years, 12.78% after 30 years, and 25.65% after 40 years.The cumulative incidence of CC in both groups is shown in the figure: it was higher in splenectomized patients, with a statistically significant difference (P=0.0008).In conclusion, in the present study we showed for the first time that thalassemic splenectomized patients had a significant higher incidence of cardiac complications. The pathophysiologic mechanisms are multiple: splenectomy leads to increased platelet activation and red cell microparticles, upregulating vascular adhesion molecules and promoting thrombosis, causes increased scavenging of nitric oxide contributing to pulmonary vasculopathy and development of pulmonary hypertension, and predisposes patients to infections increasing the risk of myocarditis that can result in heart failure and arrhythmia. [Display omitted] DisclosuresPepe:Chiesi Farmaceutici and ApoPharma Inc.: Other: Alessia Pepe is the PI of the MIOT project, that receives no profit support from Chiesi Farmaceutici S.p.A. and ApoPharma Inc.

New-onset atrial arrhythmias associated with mortality in black and white patients hospitalized with COVID-19.

BackgroundSpecific details about cardiovascular complications, especially arrhythmias, related to the coronavirus disease of 2019 (COVID‐19) are not well described.ObjectiveWe sought to evaluate the incidence and predictive factors of cardiovascular complications and new‐onset arrhythmias in Black and White hospitalized COVID‐19 patients and determine the impact of new‐onset arrhythmia on outcomes.MethodsWe collected and analyzed baseline demographic and clinical data from COVID‐19 patients hospitalized at the Tulane Medical Center in New Orleans, Louisiana, between March 1 and May 1, 2020.ResultsAmong 310 hospitalized COVID‐19 patients, the mean age was 61.4 ± 16.5 years, with 58,7% females, and 67% Black patients. Black patients were more likely to be younger, have diabetes and obesity. The incidence of cardiac complications was 20%, with 9% of patients having new‐onset arrhythmia. There was no significant difference in cardiovascular outcomes between Black and White patients. A multivariate analysis determined age ≥60 years to be a predictor of new‐onset arrhythmia (OR = 7.36, 95% CI [1.95;27.76], p = .003). D‐dimer levels positively correlated with cardiac and new‐onset arrhythmic event. New onset atrial arrhythmias predicted in‐hospital mortality (OR = 2.99 95% CI [1.35;6.63], p = .007), a longer intensive care unit length of stay (mean of 6.14 days, 95% CI [2.51;9.77], p = .001) and mechanical ventilation duration(mean of 9.08 days, 95% CI [3.75;14.40], p = .001).ConclusionOur results indicate that new onset atrial arrhythmias are commonly encountered in COVID‐19 patients and can predict in‐hospital mortality. Early elevation in D‐dimer in COVID‐19 patients is a significant predictor of new onset arrhythmias. Our finding suggest continuous rhythm monitoring should be adopted in this patient population during hospitalization to better risk stratify hospitalized patients and prompt earlier intervention.

Cardiac complications in patients hospitalised with COVID-19.

Aims:To determine the frequency and pattern of cardiac complications in patients hospitalised with coronavirus disease (COVID-19).Methods and results:CAPACITY-COVID is an international patient registry established to determine the role of cardiovascular disease in the COVID-19 pandemic. In this registry, data generated during routine clinical practice are collected in a standardised manner for patients with a (highly suspected) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requiring hospitalisation. For the current analysis, consecutive patients with laboratory confirmed COVID-19 registered between 28 March and 3 July 2020 were included. Patients were followed for the occurrence of cardiac complications and pulmonary embolism from admission to discharge. In total, 3011 patients were included, of which 1890 (62.8%) were men. The median age was 67 years (interquartile range 56–76); 937 (31.0%) patients had a history of cardiac disease, with pre-existent coronary artery disease being most common (n=463, 15.4%). During hospitalisation, 595 (19.8%) patients died, including 16 patients (2.7%) with cardiac causes. Cardiac complications were diagnosed in 349 (11.6%) patients, with atrial fibrillation (n=142, 4.7%) being most common. The incidence of other cardiac complications was 1.8% for heart failure (n=55), 0.5% for acute coronary syndrome (n=15), 0.5% for ventricular arrhythmia (n=14), 0.1% for bacterial endocarditis (n=4) and myocarditis (n=3), respectively, and 0.03% for pericarditis (n=1). Pulmonary embolism was diagnosed in 198 (6.6%) patients.Conclusion:This large study among 3011 hospitalised patients with COVID-19 shows that the incidence of cardiac complications during hospital admission is low, despite a frequent history of cardiovascular disease. Long-term cardiac outcomes and the role of pre-existing cardiovascular disease in COVID-19 outcome warrants further investigation.

Cardiovascular disease and its management in children and adults undergoing hematopoietic stem cell transplantation.

Hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for many malignancies, hemoglobinopathies, metabolic diseases, bone marrow failure syndromes, and primary immune deficiencies. Despite the significant improvement in survival afforded by HSCT, the therapy is associated with major short and long-term morbidity and mortality. Cardiovascular complications such as cardiomyopathy, arrhythmias, pulmonary hypertension, and pericardial effusions are increasingly recognized as potential outcomes following HSCT. The incidence of cardiac complications is related to various factors such as age, co-morbid medical conditions, whether patients received cardiotoxic chemotherapy prior to HSCT, the type of HSCT (autologous versus allogeneic), and the specific conditioning regimen. Thus, the cardiovascular evaluation has become a core component of the pre-transplant assessment, however, the practice differs from center to center as national guidelines and contemporary high-quality studies are lacking. We review the incidence of cardiotoxicity in pediatric and adult HSCT, potential mechanisms of injury, and effects on long-term outcomes. We also discuss the possible therapeutic approaches when disease arises, as well as the indications and need for surveillance before, during, and after transplantation.

The Atrial fibrillation Better Care (ABC) pathway is associated to a lower incidence of cardiac complications in patients with atrial fibrillation: a report from the ATHERO-AF study

Abstract Background The integrated management of atrial fibrillation (AF) patients according to the Atrial fibrillation Better Care (ABC, A, Avoid stroke with anticoagulation; B, better symptom management; C, Cardiovascular and comorbidity risk management) pathway has associated with a reduced incidence of thromboembolic events and mortality. However, whether this approach also results in a lower rate of cardiac complications is unknown. Purpose To investigate the rate of major adverse cardiovascular events (MACE) in AF patients according to compliance with the ABC pathway. Methods This prospective single-center cohort study included 1157 patients with nonvalvular AF from the ATHERO-AF study. The A, B, and C groups were defined as follows: “A” by a Time in Therapeutic Range ≥70% in vitamin K antagonists-treated patients or appropriate dose for patients on direct oral anticoagulants; “B” by a European Heart Rhythm Association (EHRA) symptom scale I-II (vs. III-IV), and “C” as optimized cardiovascular comorbidity management (i.e. use of ACE inhibitors in heart failure patients, blood pressure &amp;lt;140/90, use of statins and beta blockers in patients with prior ischemic heart disease). The primary end point was a composite of MACE including fatal/non-fatal myocardial infarction, coronary revascularization and cardiovascular death (progressive heart failure, sudden cardiac death and procedure-related death). Results Overall, 458 (39.6%) patients were optimally managed according to the ABC (ABC-compliant group), while the remaining 729 patients presented at least one uncontrolled component (ABC non-compliant group). During a mean follow up of 35 months, (2688 patient-years), 64 MACE were recorded 2.38%/year. Kaplan Meier curve analysis showed a significant higher rate of MACE in ABC non-compliant group compared to the ABC-compliant (54 and 10 MACE in each group, respectively, log-rank test p=0.006, figure). The risk of MACE increased by the number of uncontrolled ABC components: Hazard ratio HR) for 1 component 1.697, 95% Confidence Interval 95% CI 0.814–3.537, p=0.158; HR for 2 components 4.157, 95% CI 1.994–8.665, p&amp;lt;0.001); HR for 3 components 5.100, 95% CI 1.596–16.295, p=0.006. ABC non-compliant group remained associated with an increased risk of MACE using Cox proportional hazard regression analysis (HR 2.175, 95% CI 1.098–4.309, p=0.026) after adjustment for CHA2DS2VASc score, antiplatelet drugs and digoxin use. Conclusion The majority of AF patients is not currently optimally managed. An integrated care ABC approach is associated with a reduced risk of MACE in the AF population. Figure 1. Kaplan-Meier curves Funding Acknowledgement Type of funding source: None

Feasibility and safety of an enhanced recovery protocol (ERP) for upper GI surgery in elderly patients (≥ 75 years) in a high-volume surgical center

Enhanced recovery protocols (ERP) have demonstrated their efficacy after esophagectomy and gastrectomy but little is known about their feasibility and safety in elderly patients. Patients submitted to Ivor-Lewis esophagectomy or gastrectomy for cancer between January 2016 and June 2019 were divided into three age groups: young-age group, YG (≤ 65years, n = 130); middle-age group, MG (66-74years, n = 101); old-age group, OG (≥ 75years, n = 74). The groups were compared for adherence to our ERP, morbidity and mortality rates. After esophagectomy, adherence to ERP was comparable between the three groups, overall morbidity was higher in OG, without statistically significant difference, while the incidence of cardiac complications was significantly higher in OG (p = 0.02). After gastrectomy, OG presented a lower adherence to urinary catheter removal and to early mobilization. No difference in overall morbidity rate was observed (p = 0.13). The median length of stay was comparable both after esophagectomy (p = 0.075) and gastrectomy (p = 0.07). Multivariable analysis showed that age ≥ 75years was not associated with a higher risk of ERP failure either after esophagectomy (p = 0.59) or after gastrectomy (p = 0.83). After esophagectomy, the risk of failure of the ERP program was higher for patients with ASA grade 3-4 (p = 0.03) and for those with postoperative complications (p < 0.001) while after gastrectomy only postoperative complications were associated to higher risk of ERP failure (p < 0.001). In our series, adherence to ERP protocol of patients ≥ 75years old was similar to that of younger patients after esophagectomy and gastrectomy, without a significant increase in morbi-mortality rates.