Ischemic Cardiomyopathy Group Research Articles

Differences in T cell-associated serum markers between ischemic cardiomyopathy and dilated cardiomyopathy.

Ischemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM) have similar clinical manifestations but differ in pathogenesis. We aimed to identify T cell-associated serum markers that can be used to distinguish between ICM and DCM. We identified differentially expressed genes (DEGs) with transcriptome sequencing data in GSE116250, and then conducted enrichment analysis of DEGs in the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) databases. Protein-protein interaction (PPI) networks were used to analyze the relationship between T cells-related genes and identify hub genes. Enzyme-linked immunosorbent assay (ELISA) kits were used to detect T cell-associated proteins in serum, and receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficacy of these serum markers. Using the limma package and Venn plots, we found that the non-failing donors (NFD) and DCM groups shared many of the same DEGs and DEGs-enriched functions compared to the ICM group, which were involved in T cell activation and differentiation, among other functions. Subsequently, the immune cell score showed no difference between NFD and DCM, but they were significantly different from ICM patients in CD8 T cells CD4 T cells memory resting and activated, T cells follicular helper, and M1 macrophage. After analyzing T cell-associated DEGs, it was found that 4 DEGs encoding secreted proteins were highly expressed in the ICM group compared with the NFD and DCM groups, namely chemokine (C-C motif) ligand 21 (CCL21), interleukin (IL)-1β, lymphocyte-activation gene 3 (LAG3), and vascular cell adhesion molecule-1 (VCAM-1). Importantly, the serum levels of CCL21, IL-1β, LAG3, and VCAM-1 in ICM patients were all significantly higher than those in DCM patients. The ROC curves showed that the area under the curve (AUC) values of serum CCL21, IL-1β, LAG3, and VCAM-1 were 0.775, 0.868, 0.934, and 0.903, respectively. We have identified four T cell-associated serum markers, CCL21, IL-1β, LAG3, and VCAM-1, as potential diagnostic serum markers that differentiate ICM from DCM.

Comparative Analysis of Mitochondria Surrounding the Intercalated Discs in Heart Diseases-An Ultrastructural Pilot Study.

Mitochondria play a crucial role in adapting to fluctuating energy demands, particularly in various heart diseases. This study investigates mitochondrial morphology near intercalated discs in left ventricular (LV) heart tissues, comparing samples from patients with sinus rhythm (SR), atrial fibrillation (AF), dilated cardiomyopathy (DCM), and ischemic cardiomyopathy (ICM). Transmission electron microscopy was used to analyze mitochondria within 0-3.5 μm and 3.5-7 μm of intercalated discs in 9 SR, 10 AF, 9 DCM, and 8 ICM patient samples. Parameters included mean size in µm2 and elongation, count, percental mitochondrial area in the measuring frame, and a conglomeration score. AF patients exhibited higher counts of small mitochondria in the LV myocardium, resembling SR. DCM and ICM groups had fewer, larger, and often hydropic mitochondria. Accumulation rates and percental mitochondrial area were similar across groups. Significant positive correlations existed between other defects/size and hydropic mitochondria and between count/area and conglomeration score, while negative correlations between count and size/other defects and between hydropic mitochondria and count could be seen as well. Mitochondrial parameters in the LV myocardium of AF patients were similar to those of SR patients, while DCM and ICM displayed distinct changes, including a decrease in number, an increase in size, and compromised mitochondrial morphology. Further research is needed to fully elucidate the pathophysiological role of mitochondrial morphology in different heart diseases, providing deeper insights into potential therapeutic targets and interventions.

Two-Year Outcomes of Primary Prophylactic Use of Defibrillators for Ischemic and Non-Ischemic Cardiomyopathy - Propensity Score-Matched Analysis From the Nippon Storm Study.

In 2016, the DANISH study reported negative results regarding the efficacy of implantable cardioverter-defibrillators (ICDs) in patients with non-ischemic cardiomyopathy (NICM) and reduced left ventricular ejection fraction (LVEF). In this study we determined the efficacy of using ICDs for primary prophylaxis in patients with NICM.Methods and Results: We selected 1,274 patients with underlying cardiac disease who were enrolled in the Nippon Storm Study. We analyzed the data of 451 patients with LVEF ≤35% due to NICM or ischemic cardiomyopathy (ICM) who underwent ICD implantation for primary prophylaxis (men, 78%; age, 65±12 years; LVEF, 25±6.4%; cardiac resynchronization therapy, 73%; ICM, 33%). After propensity score matching, we compared the baseline covariates between groups: NICM (132 patients) and ICM (132 patients). The 2-year appropriate ICD therapy risks were 27.7% and 12.2% in the NICM and ICM groups, respectively (hazard ratio, 0.390 [95% confidence interval, 0.218-0.701]; P=0.002). This subanalysis of propensity score-matched patients from the Nippon Storm Study revealed that the risk of appropriate ICD therapy was significantly higher in patients with NICM than in those with ICM.

Long-term post-transplantation outcomes in patients with hypertrophic cardiomyopathy: Single-center 35-year experience.

Heart transplantation (HT) is the only option for most patients with end-stage heart failure and hypertrophic cardiomyopathy (HCM) who fail medical therapy. Data on the long-term outcomes post-transplant in HCM individuals remain scarce. We analyzed data of 319 adult patients who underwent HT between 1984 and 2019. Patients were followed for cardiac allograft rejection, cardiac allograft vasculopathy (CAV), death, or re-transplantation. Outcomes of 24 patients with HCM, 160 with ischemic, and 135 with dilated cardiomyopathy were compared. During a mean follow-up of 11.6±7.2 (max 27.8), 16.7±8.2 (max 32.7), and 16.1±9.7 (max 34.6) years after HT in hypertrophic, ischemic, and dilated cardiomyopathy groups, respectively: 10-year survival rate was 67%, 62%, 69%, respectively (p=.04). Post-transplantation, HCM individuals more often than the other two studied groups required prolonged inotropic support (37%, 12%, 17%, respectively, p=.02), temporary mechanical circulatory support (45%, 13%, 14%, respectively, p<.01), and renal replacement therapy immediately post-HT (55%, 19%, 24%, respectively, p<.01). No significant inter-group differences were noted in the 10-year freedom from acute allograft rejection (38%, 46%, 43%, respectively, p=.38) or 10-year freedom from CAV (88%, 78%, 81%, respectively, p=.57). The long-term post-transplant prognosis of adult patients with hypertrophic cardiomyopathy is favorable despite more challenging immediate post-HT course.

Two-year outcomes of primary prophylactic use of defibrillators with ischemic and non-ischemic cardiomyopathy: propensity score-matched analysis from NIPPON STORM Study

Abstract Background In 2016, the DANISH study showed negative results regarding the efficacy of implantable cardioverter defibrillators (ICDs) for patients with non-ischemic cardiomyopathy (NICM) and reduced left ventricular ejection fraction (LVEF). Thus, the ESC guidelines downgraded the indication for primary ICD prophylaxis for NICM patients with reduced LVEF from Class I to IIa. However, the change might be felt somewhat improper in the real wolrd ICD therapy and decided to use the Nippon storm study, a prospective registry study in Japan, to determine whether the DANISH results are of equal value in the clinical setting. Objective To determine the efficacy of ICDs as primary prevention in patients with NICM, the incidence of ICD appropriate therapy in patients with NICM was compared with that in patients with ischemic cardiomyopathy (ICM) for which primary ICD efficacy is generally recognized as a Class I indication. Methods We selected 1274 patients with underlying cardiac disease from a total of 1548 patients enrolled in the Nippon storm study. We analyzed data of 451 patients with LVEF ≤35% owing to NICM or ICM who underwent ICD implantation of primary prophylaxis (men, 78%; age, 65±12 years; LVEF, 25±1.4%; cardiac resynchronization therapy, 20%; ICM, 33%). All patients were followed up for at least 2 years. Patient selection was performed by employing the propensity score matching method with a digit-matching algorithm for clinical factors, ie, age, sex, cardiac resynchronization therapy with a defibrillator, LVEF. After all propensity score matches had been performed, we compared baseline covariates between the 2 groups: 132 patients with NICM and 132 with ICM. The cumulative incidences of ICD therapies (including both anti-tachycardia pacing and shock therapies) were calculated using competing risk analysis, because death is a competing risk for loss to follow-up. Results In the matched cohort, the 2-year appropriate ICD therapy risks were 27.7% and 12.2% in NICM and ICM groups, respectively (HR = 0.390 [95% CI, 0.218–0.701; P = 0.002) (Figure A). Two-year appropriate ATP therapy risks were 25.5% and 11.4% in NICM and ICM groups, respectively (HR = 0.417 [95% CI, 0.226– 0.776; P = .005]) (Figure B), and appropriate shock therapy risks were 6.3% and 1.6% in NICM and ICM groups, respectively (HR = 0.230 [95% CI, 0.049–1.085; P = .063]) (Figure C). Conclusion The present subanalysis of the Nippon Storm Study revealed that the risk for appropriate ICD therapy was significantly higher in the patients with NICM than in those with ICM based on our propensity score–matching method.

Abstract 15327: Clinical Outcomes of Methamphetamine-Associated Cardiomyopathy Compared to Ischemic Cardiomyopathy: A Single Institution Retrospective Longitudinal Study

Background: Methamphetamine-associated cardiomyopathy (MAC) leads to significant morbidity and mortality. The benefit of implantable cardioverter-defibrillator (ICD) in this population is poorly characterized. Aims: To evaluate ICD use and outcomes in patients with MAC compared to ischemic cardiomyopathy (ICM). Methods: Electronic health record (EHR) was queried for all heart failure hospitalizations using ICD-9 codes between 2011 and 2019. Patients with an EF ≤ 35% were included. The MAC cohort was derived from this population and defined by ICD-9 code or positive urine toxicology and compared to ICM cohort. Baseline characteristics and outcomes were extracted from the EHR. MACE was defined as death, ventricular tachycardia, cardiac arrest, rehospitalization, atrial fibrillation (AF) or stroke. Results: The study included 294 patients in the MAC group and 373 patients in the ICM group. MAC patients were younger (56 vs 61 years, p&lt;0.001) compared to ICM (table 1). Readmission rates for heart failure at one year were similar (13% vs 11.2%, p=ns). Significantly fewer patients with MAC had ICD for primary prevention (15.0% vs 27.9%, p&lt;0.001). Mortality and AF were lower in MAC compared to ICM, however VT (2.38% vs 5.09%, p=0.072) and cardiac arrest (6.1% vs 7.8%, p=0.408) were similar between the two groups. MACE outcomes were worse in the ICM cohort (38.3% vs 21.1%, p=0.012) than MAC. In the MAC cohort, ICD presence was associated with 56.82% incidence of MACE compared to 40.00% without ICD (OR = 1.97, CI 1.032-3.77, p = 0.040) mainly due to higher AF hospitalization (22% vs 8%, p=0.01). Conclusion: ICM patients had higher mortality and atrial fibrillation compared to MAC. ICD implantation for primary prevention was not associated with reduced mortality, however this cohort had higher AF hospitalization. We need further studies to assess the benefit of ICD in MAC.

Different expression and prognostic value of troponin in ischemic cardiomyopathy and non-ischemic dilated cardiomyopathy

BackgroundEarly risk stratification of patients with ischemic cardiomyopathy (ICM) and non-ischemic dilated cardiomyopathy (NIDCM) may be beneficial for therapies.MethodsWe retrospectively enrolled all patients admitted for acute heart failure (HF) between January 2019 and December 2021 in Zhongshan Hospital Fudan University, dividing them according to etiology (ICM or NIDCM). Cardiac troponin T (TNT) concentration was compared between two groups. Risk factors for positive TNT and in-hospital all-cause mortality were investigated with regression analysis.ResultsA total of 1525 HF patients were enrolled, including 571 ICM and 954 NIDCM. The TNT positive patients were not different between the two groups (41.3% in ICM group vs. 37.8% in NIDCM group, P = 0.215). However, the TNT value in ICM group were significantly higher than that in NIDCM group (0.025 (0.015–0.053) vs. 0.020 (0.014–0.041), P = 0.001). NT-proBNP was independently associated with TNT in both ICM and NIDCM group. Although the in-hospital all-cause mortality did not show much difference between the two groups (1.1% vs. 1.9%, P = 0.204), the NIDCM diagnosis was associated with reduced risk of mortality after multiple adjustments (OR 0.169, 95% CI 0.040–0.718, P = 0.016). Other independent risk factors included the level of NT-proBNP (OR 8.260, 95% CI 3.168–21.533, P < 0.001), TNT (OR 8.118, 95% CI 3.205–20.562, P < 0.001), and anemia (OR 0.954, 95% CI 0.931–0.978, P < 0.001). The predictive value of TNT and NT-proBNP for all-cause mortality was similar. However, the best cutoff values of TNT for mortality were different between ICM and NIDCM groups, which were 0.113 ng/mL and 0.048 ng/mL, respectively.ConclusionThe TNT level was higher in ICM patient than that in NIDCM patients. TNT was an independent risk factor for in-hospital all-cause mortality for both ICM and NIDCM patients, although the best cutoff value was higher in ICM patients.

Prognostic value of myocardial scar burden using cardiac magnetic resonance in ischemic and non-ischemic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Myocardium is a unique muscle type designed to perform a specific function; conducting electrical activity to both ventricle simultaneously to contract and relax in a synchronized manner. Therefore, evaluation of the myocardial muscle function only using left ventricular ejection fraction (LVEF) would be inaccurate. However, assessment of the myocardium on the tissue level, is expected to provide more precise data regarding the ability to conduct, contract and relax properly. Purpose is to evaluate the prognostic value of myocardial scar using CMR on the clinical outcome in patients with ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM). Methods 154 patients with either ICM or NICM underwent CMR (using 1.5T) for assessment of LVEF, detection and quantification of any myocardial scar by calculating the percentage (%) of scar mass to the whole myocardial mass (using manual quantification of scarred tissue in each myocardial segment, summed and divided by the total myocardial mass). Patients were followed up for at least 6 months for any cardiac events. These events were scaled according to severity from 1 (asymptomatic) to 7 (most severe), including; no symptoms, mild non-acute chest pain, mild dyspnoea (NYHA I-II), hospital admission due to decompensated heart failure, syncope, documented ventricular arrhythmia and sudden cardiac arrest/death, respectively. Statistical correlation between the amount of scarred myocardium in both ICM (group I) and NICM (group II) patients and the severity of the clinical events during the period of the follow up was performed. The study included 154 patients, 56% were males, mean age of 61 years with minimal follow up duration of 6 months. Patients were divided into: group I with ICM (58%) and group II with NICM (42%). Clinical presentation was ranging from eventless (10%), chest pain (18%), heart failure (15%), hospitalization (35%), syncope (1%), ventricular tachycardia (&amp;lt;1%) and up to cardiac arrest (&amp;lt;1%). Direct relationship was observed between scar size and event severity in the two groups (P value &amp;lt; 0.001). However, inverted relationship between LVEF and event severity in group I (P value of &amp;lt; 0.001) was detected but not in group II (P value 0.128), as shown in figure 1. Low EF was mainly linked with hospitalization in both ICM and NICM. It was observed that serious cardiac events were less detected in patient with mean scar mass &amp;lt; 5.4–8.4% . However, patients who have experienced sudden cardiac arrest have a mean scar mass of 15.9 % and patients with ventricular tachycardia with mean of 9.8%. Conclusion The amount of scarred myocardium is found to be directly linked to the severity of the clinical event in both ICM and NICM. Therefore, quantification of myocardial scar could be used as a predictor for cardiac events, hospitalization and sudden cardiac death.

Preinterventional quantification of dense scar or borderline zone in patients undergoing ventricular tachycardia ablation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction This study sought to examine the prognostic role of quantifying areas of interest in preinterventional cardiac magnetic resonance (CMR) in patients with structural heart disease (SHD) referred for ablation of ventricular tachycardia (VT). Background The role of preinterventional CMR for the identification of scar areas, borderline zones and reentry channels in the ventricles has been well established. Whether the burden of dense scar or borderline tissue has a prognostic impact on the acute and the long-term ablation outcome in SHD patients is disputed. Methods and results We investigated 185 patients with SHD undergoing preinterventional CMR prior to VT-ablation. 38 patients were excluded because of poor imaging quality, leaving a cohort of 147 patients with positive late enhancement (LGE) imaging (mean age 62 years, 47% non-ischemic cardiomyopathy, mean left ventricle ejection fraction 38%, 96% with implanted ICD). The cohort was divided in ischemic (ICM) and non-ischemic (NICM) cardiomyopathy group and the results regarding burden of overall scar tissue, dense scar, borderline zone, as well as clinical and procedural characteristics, acute and long-term results of the two groups were compared. The ICM patients had more advanced NYHA stadium (p = 0.046), reduced left ventricular ejection fraction (LV-EF, p &amp;lt;0.001) and higher left ventricular enddiastolic volume (LVEDV, p &amp;lt;0.001). The NICM patients were more often under antiarrhythmic therapy (p = 0.005) and underwent more frequently epicardial ablation (p &amp;lt;0.001). Although the overall scar burden war higher in ICM patients (p &amp;lt;0.001), the groups showed no significant difference in borderline zone burden (p = 0.580). Furthermore, the two groups had similar results in number of inducible VTs (p = 0.054) and VT inducibility at the end of the procedure (p = 0.121). Nevertheless, the NICM group underwent overall more ablation procedures during the 19-month follow up (p = 0.023). Both groups showed similar results regarding assist device implantation, heart transplantation or death until the end of the follow up (p = 0.192). Conclusion While quantification of the scar tissue and the borderline zone is feasible in ICD patients with SHD, the scar or the borderline zone burden were not predictive of the VT ablation outcome.

Prevalence, hematological parameters, and coagulation profiles: Cardiovascular diseases statistics in the Asir region, Saudi Arabia.

To determine the prevalence of cardiovascular disease (CVD) types in the Asir region of Saudi Arabia and the importance of hematological testing for CVD patients in the context of disease management. This retrospective study comprised 416 CVD patients, and samples were divided based the type of CVD. The Mann Whitney U test was used to compare patients' hematological markers and coagulation profiles to those of healthy controls. The rate of ischemic heart disease (IHD) was 80.7% that of other CVDs, and the rate of ST-elevation myocardial infarction (STEMI) was 37.3% the rate of CVD. Significant differences were observed in the hematological and coagulation parameters of CVD patients compared to the control group. White blood cells (WBC) were significantly higher in STEMI, non-ST-elevation myocardial infarction (NSTEMI), unstable angina (UA), and heart failure (HF) groups. Red blood cells (RBC) were significantly lower in STEMI, NSTEMI, UA, chronic coronary syndrome (CCS), HF, dilated cardiomyopathy (DCM), and ischemic cardiomyopathy (ICM). Red distribution width (RDW) was significantly greater in the HF, DCM, and ICM groups. Prothrombin time (PT) was significantly higher in the STEMI, HF, and DCM groups. ST-elevation myocardial infarction has a higher prevalence rate among CVD patients in the Asir region. Both coagulation and hematological indicators have high potential utility as CVD diagnostic and prognostic markers.

Heart transplantation in the era of corona virus disease 2019: Impact of the pandemic on donors, recipients and outcome.

Since March 2020, the COVID-19 pandemic has tremendously impacted health care all around the globe. We analyzed the impact of the pandemic on donors, recipients, and outcome of heart transplantation (HTx). Between 2010 and early 2022, a total of n=235 patients underwent HTx in our department. Patients were assigned to the study groups regarding the date of the performed HTx. Group 1 (09/2010 to 02/2020): n=160, Group 2 (03/2020 to 02/2022): n=75. Since the pandemic, the etiology of heart failure in the recipients has shifted from dilated (Group 1: 53.8%, Group 2: 32.0%) to ischemic cardiomyopathy (Group 1: 39.4%, Group 2: 50.7%, p<.01). The percentage of high urgency status of the recipients dropped from 50.0% to 36.0% (p=.05), and the use of left ventricular assist (LVAD) support from 56.9% to just 37.3% (p<.01). Meanwhile, the waiting time for the recipients also decreased by about 40% (p=.05). Since the pandemic, donors were 2- times more likely to have been previously resuscitated (Group 1: 21.3%, Group 2: 45.3% (p<.01), and drug abuse increased by more than 3-times (p<.01), indicating acceptance of more marginal donors. Surprisingly, the incidence of postoperative severe primary graft dysfunction requiring extracorporeal life support decreased from 33.1% to 19.4% (p=.04) since the pandemic. The COVID-19 pandemic affected both donors and recipients of HTX but not the postoperative outcome. Donors nowadays are more likely to suffer from ischemic heart disease and are less likely to be on the high-urgency waitlist and on LVAD support. Simultaneously, an increasing number of marginal donors are accepted, leading to shorter waiting times.

Which Type of Cardiomyopathy (Ischemic or Dilated) can be Attributed to more Alteration in Right Ventricular Dysfunction?

Background: There are few studies in the literature comparing the RV function of the two entities of dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM). The aim of this study was to compare RV dysfunction among patients with ICM or DCM. Methods: The study population consisted of 287 consecutive patients with heart failure referred for pre-CRT echocardiography evaluation at the Tehran Heart Center between January 2005 and December 2010. A complete transthoracic echocardiographic examination, which included 2-dimensional and Doppler echocardiography with color flow mapping were performed using standard techniques. For assessing RV function, the two parameters of the tricuspid annular plane systolic excursion (TAPSE) and right ventricular peak mean systolic tissue velocity (RVSM) were measured. Results: Comparing RV function on TAPSE measurement between the ischemic and dilated cardiomyopathy groups showed no significant differences between them that the mean of TAPSE was 15.05 ± 4.65 mm and 15.64 ± 4.90 mm, respectively. With respect to assessing RV function using peak mean systolic RVSM measurement, this parameter in the ischemic and dilated cardiomyopathy were also similar (3.795 ± 2.050 cm/s versus 4.551 ± 2.753 cm/s, p = 0.176). Conclusion: There is no difference with regard to RV functional state between ICM and DCM.

Screening and identification of hub genes for ischemic cardiomyopathy and construction and validation of a clinical prognosis model using bioinformatics analysis.

Myocardial ischemia and hypoxia may result in myocardial cell necrosis, scar formation, and hyperplasia. We aim to explore the differentially expressed genes (DEGs) in ischemic cardiomyopathy (ICM), construct and identify a clinical prognosis model using bioinformatics methods, so as to screen potential biomarkers of ICM to provide a basis for the early diagnosis and treatment of ICM. Based on the National Center for Biotechnology Information (NCBI) Gene Expression Omnibus (GEO) database, R language was used to screen DEGs in healthy myocardial (n=5) and ICM myocardial tissues (n=12). DEGs were analyzed by Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and protein-protein interaction (PPI). Receiver operating characteristic (ROC) curves were drawn to verify the target genes. A total of 259 genes with significantly changed fold change (FC) values were obtained through conditional screening, including up-regulated genes and down-regulated genes. The first two hub genes [interleukin-6 (IL-6) and Ras homologous gene family member A (RHOA)] with the largest degree value among the above up-regulated and down-regulated genes were selected and their expression values were combined in the gene chip to draw the ROC curve based on the pROC package of R language. The area under the ROC curve (AUC) values of IL-6 and RHOA were 0.956 and 0.995, respectively. The expression levels of Sqstm1, Nos2, IL-6, RHOA, and Zfp36 genes in the ICM group are lower than those in the blank control group and the difference was statistically significant (P<0.05). RHOA and Stat3 were identified as the key genes controlling the occurrence and development of ICM. ICM is closely related to the changes of extracellular matrix (ECM) and oxidoreductase activity. The IL-6 and RHOA are expected to become potential targets for ICM treatment.

The value of CMR Left ventricular strain analysis in evaluating ICM.

The purpose of this article is to investigate the value of cardiac magnetic resonance imaging (CMR) derived left ventricular strain parameters in evaluation of ischemic cardiomyopathy (ICM). Thirty-one ICM patients and nineteen non-cardiomyopathy (non-CM) patients who performed CMR examinations during the same period were selected for this retrospective study. The basic clinical data, CMR left ventricular function parameters, left ventricular strain parameters were compared among the left ventricular ejection fraction (LVEF) preserved ICM group, the LVEF impaired ICM group and the non-CM group. The differences of MyoGCS (-21.9 ± 1.9 vs. -18.9 ± 2.7 P<0.001), MyoGLS (-20.8 ± 2.3 vs. -17.0 ± 2.9 P<0.001) and EndoGLS (-22.2 ± 3.1 vs. -17.6 ± 3.7 P<0.001) between LVEF preserved ICM group and non-CM group were statistically significant, while the differences of left heart function parameters between the two groups were not statistically significant (P > 0.05). The left ventricular strain analysis can be used to assess cardiac functional and morphological alterations in ICM patients prior to changes of left ventricular function parameters, which has high clinical significance.

Levosimendan Administration May Provide More Benefit for Survival in Patients with Non-Ischemic Cardiomyopathy Experiencing Acute Decompensated Heart Failure.

Background: Acute decompensated heart failure (ADHF) is a life-threatening condition with a high mortality rate. Levosimendan is an effective inotropic agent used to maintain cardiac output and a long-lasting effect. However, only few studies have compared the clinical outcomes, after levosimendan therapy, among etiologies of ADHF. Methods: Between July 2014 and December 2019, 184 patients received levosimendan therapy for ADHF at our hospital. A total of 143 patients had ischemic cardiomyopathy (ICM), and 41 patients had non-ICM (NICM). Data on comorbidities, echocardiographic findings, laboratory findings, use of mechanical devices, consumption of other inotropic or vasopressor agents, frequency of HF hospitalization, cardiovascular (CV) mortality, and all-cause mortality were compared between the ICM and NICM groups. Results: Patients with ICM were older with higher prevalence of diabetes mellitus when compared to patients with NICM. Patients with NICM had a poorer left ventricular ejection fraction (LVEF) and higher left ventricular end-systolic volume when compared to patients with ICM. At the 30 day follow-up period, a lower CV mortality (ICM vs. NICM: 20.9% vs. 5.1%; log-rank p = 0.033) and lower all-cause mortality (ICM vs. NICM: 28.7% vs. 9.8%; log-rank p = 0.018) was observed in the NICM patients. A significantly lower all-cause mortality was noted at 180 day (ICM vs. NICM: 39.2% vs. 22.0%; log-rank p = 0.043) and 1 year (ICM vs. NICM: 41.3% vs. 24.4%; log-rank p = 0.046) follow up in the NICM subgroup. NICM (hazard ratio (HR): 0.303, 95% confidence interval (CI): 0.108–0.845; p = 0.023) and ECMO use (HR: 2.550, 95% CI: 1.385–4.693; p = 0.003) were significant predictors of 30 day all-cause mortality. Conclusions: In our study on levosimendan use for ADHF patients, better clinical outcomes were noted in the NICM population when compared to the ICM population. In the patients with cardiogenic shock or ventilator use, significantly lower incidence of 30 day mortality presented in the NICM population when compared with the ICM population.

Comparison Of LVAD Outcomes In Patients With Non-ischemic Cardiomyopathy And Ischemic Cardiomyopathy: Insight From National Readmission Database

Background : Left ventricular assist device (LVAD) therapy remains a well-established therapy as either bridge to heart transplant or as a destination therapy for non-transplant candidates. Data related to the characteristics of readmissions by heart failure etiology (ischemic vs non-ischemic) after left ventricular assist device (LVAD) implantation is limited. We sought to compare readmissions between LVAD patients with non-ischemic cardiomyopathy (NICM) versus ischemic cardiomyopathy (ICM). Methods We identified patients from the Nationwide Readmission Database (NRD) who underwent LVAD placement between 2014-2017 using ICD-9 and 10 codes. Patients were classified into 2 groups based on the etiology of heart failure whether NICM or ICM. Outcomes were all-cause and cause-specific 30-day readmissions. Multivariable regression was conducted for 30 days readmission adjusting for patient demographics, hospital characteristics, and Elixhauser Comorbidity Index. Results We identified 7,001 recipients, 3292 having NICM as etiology of end-stage heart failure, and 3709 ICM. 28% of NICM and 30% of ICM LVAD recipients were readmitted within 30 days. NICM group was younger with more female patients compared with the ICM group (Table 1). For NICM versus ICM LVAD recipients; LOS of the index admission was 45 vs 39 days, P <0.001, cost of index admission was 995,739 ±38,692 vs 918,877 ±33,899 $, p=0.01, LOS of first readmission was 10.8±0.75 vs 11.3±0.75 days, p=0.67, cost of first readmission was 135,223 ±13,590 vs 117,270 ±10,115$,p=0.26. The most common cause of readmissions for NICM vs ICM were (ventricle tachycardia: 32 vs 25%, P=0.05), (Coagulation disorders: 21 vs 14%, P=0.001), (GI bleed: 15 vs 23%, P = 0.013), (acute heart failure: 29 VS 27%, P >0.05), (Atrial fibrillation/flutter: 40 Vs 37%, P >0.05), (AKI: 25 vs 24%, P >0.05) and (Infections: 12 vs 14%, P>0.05). ICM LVAD recipients have similar odds of 30-day readmission compared to NICM (OR=1.08, P=0.4). Renal failure patients have higher odds of 30-day readmission compared to non-renal failure (OR=1.23, P=0.005). Conclusion : Despite similar 30-day readmissions between patients with ICM vs NICM, post LVAD implantation, there are significant differences in the causes of readmissions. Further studies to explore these differences may help tailor preventive efforts aimed at preventing readmissions based on etiology of cardiomyopathy. : Left ventricular assist device (LVAD) therapy remains a well-established therapy as either bridge to heart transplant or as a destination therapy for non-transplant candidates. Data related to the characteristics of readmissions by heart failure etiology (ischemic vs non-ischemic) after left ventricular assist device (LVAD) implantation is limited. We sought to compare readmissions between LVAD patients with non-ischemic cardiomyopathy (NICM) versus ischemic cardiomyopathy (ICM). We identified patients from the Nationwide Readmission Database (NRD) who underwent LVAD placement between 2014-2017 using ICD-9 and 10 codes. Patients were classified into 2 groups based on the etiology of heart failure whether NICM or ICM. Outcomes were all-cause and cause-specific 30-day readmissions. Multivariable regression was conducted for 30 days readmission adjusting for patient demographics, hospital characteristics, and Elixhauser Comorbidity Index. We identified 7,001 recipients, 3292 having NICM as etiology of end-stage heart failure, and 3709 ICM. 28% of NICM and 30% of ICM LVAD recipients were readmitted within 30 days. NICM group was younger with more female patients compared with the ICM group (Table 1). For NICM versus ICM LVAD recipients; LOS of the index admission was 45 vs 39 days, P <0.001, cost of index admission was 995,739 ±38,692 vs 918,877 ±33,899 $, p=0.01, LOS of first readmission was 10.8±0.75 vs 11.3±0.75 days, p=0.67, cost of first readmission was 135,223 ±13,590 vs 117,270 ±10,115$,p=0.26. The most common cause of readmissions for NICM vs ICM were (ventricle tachycardia: 32 vs 25%, P=0.05), (Coagulation disorders: 21 vs 14%, P=0.001), (GI bleed: 15 vs 23%, P = 0.013), (acute heart failure: 29 VS 27%, P >0.05), (Atrial fibrillation/flutter: 40 Vs 37%, P >0.05), (AKI: 25 vs 24%, P >0.05) and (Infections: 12 vs 14%, P>0.05). ICM LVAD recipients have similar odds of 30-day readmission compared to NICM (OR=1.08, P=0.4). Renal failure patients have higher odds of 30-day readmission compared to non-renal failure (OR=1.23, P=0.005). : Despite similar 30-day readmissions between patients with ICM vs NICM, post LVAD implantation, there are significant differences in the causes of readmissions. Further studies to explore these differences may help tailor preventive efforts aimed at preventing readmissions based on etiology of cardiomyopathy.

Ischemic Cardiomyopathy versus Non-Ischemic Dilated Cardiomyopathy in Patients with Reduced Ejection Fraction- Clinical Characteristics and Prognosis Depending on Heart Failure Etiology (Data from European Society of Cardiology Heart Failure Registries).

Simple SummaryGiven the high morbidity and mortality linked with heart failure and the need for disease-specific treatment, there is international agreement that there is a significant need for well-planned, large-scale databases showing the true course of heart failure. We present a study based on data from the European Society of Cardiology Heart Failure registries designed to evaluate the prevalence, clinical characteristics, management and outcomes of patients with two main etiologies of heart failure: reduced left ventricular ejection fraction-ischemic cardiomyopathy (ICM) and non-ischemic dilated cardiomyopathy (NIDCM). Our findings show that the patients with ICM were older and had more comorbidities. In contrast, the patients with NIDCM had worse systolic heart function. Apart from the more frequent use of aldosterone antagonists in the NIDCM group, there were no other differences as regards the use of heart failure guideline-recommended medications, implantable cardioverter defibrillators or cardiac resynchronization therapy. One-year prognosis was worse in the ICM patients than in the NIDCM patients. Moreover, ICM etiology itself was associated with a worse one-year outcome.Personalized management involving heart failure (HF) etiology is crucial for better prognoses for HF patients. This study aimed to compare patients with ischemic cardiomyopathy (ICM) and patients with non-ischemic dilated cardiomyopathy (NIDCM) in terms of baseline characteristics and prognosis. We assessed 895 patients with HF with reduced left ventricular ejection fraction participating in the Polish part of the European Society of Cardiology (ESC)-HF registries. ICM was present in 583 patients (65%), NIDCM in 312 patients (35%). The ICM patients were older (p < 0.001) and had more comorbidities. The NIDCM patients more frequently had atrial fibrillation (p = 0.04) and lower LVEF (p = 0.01); therefore, they were treated more often with anticoagulants (p = 0.01) and digitalis (p < 0.001). The NIDCM patients were prescribed aldosterone antagonists more often (p = 0.01). There were no other differences as regards the use of HF guideline-recommended medications, implantable cardioverter defibrillators or cardiac resynchronization therapy. The ICM patients were more likely to be treated with statins (p < 0.001) and antiplatelet agents (p < 0.001). All-cause death, as well as all-cause death and readmissions for HF at 12 months, occurred more often in the ICM group compared with the NIDCM group (15.9% vs. 10%, p = 0.016; and 40.9% vs. 28.6%, p = 0.00089, respectively). ICM etiology was an independent predictor of the composite endpoint in the total cohort (p = 0.003). The ICM patients were older and had more comorbidities, whereas the NIDCM patients had lower LVEF. One-year prognosis was worse in the ICM patients than in the NIDCM patients. ICM etiology was independently associated with a worse one-year outcome.

Abstract 13470: Update on Lipid Profiles and Lipid Modifying Therapies in Heart Transplant Recipients, a Single Center Experience

Introduction: Statin use after heart transplant (HT) has been shown to reduce rates of CAV and improve morbidity and mortality regardless of lipid profile. However, drug-drug interactions (DDIs) between statins and immunosuppressive therapies limit their use, particularly at higher doses. Recently, non-statin lipid modifying therapies have also been used in the HT population, despite a lack of outcome trials. Objective: We sought to examine current trends in lipid profiles and lipid-lowering therapy use in the HT population. Methods: We performed a retrospective chart review of 198 HT recipients (average age 53.6 years, 139 males, 59 females) transplanted between 4/8/2016 and 3/24/2020 at a single center. Of those patients, 82 underwent HT for ischemic cardiomyopathy (ICM), and 116 underwent HT for nonischemic cardiomyopathy (NICM). Lipid panels and medications were collected pre-transplant, immediately post-transplant, and 1-year post-transplant. Most recent values were also collected. At each point the 2018 lipid guidelines were used to determine the recommended intensity of statin each patient should ideally be on if they were not transplant patients. Results: Median cholesterol, triglyceride, HDL, and LDL values were reasonably well-controlled post HT. Despite high overall rates of statin use, our data suggest that most HT recipients are on lower than guideline-recommended statin doses due to DDI, particularly in the ICM group. The proportion of patients on non-statin lipid modifying therapies increased over time. Conclusions: There is emerging evidence that non-statin therapies added to statins can further reduce atherothrombotic events in non-transplant patients. These therapies may offer options for additional lipid control in transplant recipients whose statin use is limited by DDIs. However, the pathophysiology of CAV and atherosclerosis are different, and outcome trials of non-statin lipid therapies in HT patients are urgently needed.

Abstract 11018: Prognosis Difference of Disproportional Mr According to Disease Etiology

Introduction: After concept of disproportional MR (mitral regurgitation) is raised, investigators focused on whether disproportional MR could predict prognosis of secondary MR. But subgroup analysis of secondary MR according to etiology is limited until now. Hypothesis: We assessed the hypothesis that prognosis of disproportional MR is different according to etiology. Methods: We collected total 395 patients with severe secondary MR with reduced ejection fraction from January 2000 to October 2020 in one medical center, in South Korea. Only patients with DCMP (dilated cardiomyopathy) or ICMP (ischemic cardiomyopathy) were included. Criteria of disproportional MR was over 0.17 of RV (regurgitant volume)/EDV(end diastolic volume) in this study. We analyzed 1) the prognosis of disproportional MR according to etiologies and compared 2) predictive performance for mortality of disproportional MR with other MR measurements, RV and EROA (effective regurgitant orifice area), in each group. Results: In analysis based on etiology, disproportional group showed significantly higher all death risk (HR 10.08, 95% CI [1.237 - 82.07], p value = 0.031) in only DCMP group. There was no meaningful difference of mortality in ICMP group according to disproportionality (HR 1.265, 95% CI [0.556 - 2.882], p value = 0.575) (figure 1). When compare predictive performance of MR measurements for mortality, RV/EDV has highest value of C index than other methods in DCMP group and not in ICMP (figure 2). Conclusions: In conclusion, prognostic implication of disproportional MR was different according to disease etiology.

Comparable Efficacy in Ischemic and Non-Ischemic ICD Recipients for the Primary Prevention of Sudden Cardiac Death.

(1) Background: In patients suffering from heart failure, the main causes of death are either hemodynamic failure, or ventricular arrhythmias. The only tool to significantly reduce arrhythmic sudden death is the implantable cardioverter defibrillator (ICD), but not all patients benefit to the same extent from these devices. (2) Methods: The primary outcome of this single-center study was defined as cardiovascular death in patients with ischemic and non-ischemic heart failure who have benefited from ICD therapy. The secondary outcomes were death from any cause, sudden cardiac death, ICD-related therapies (appropriate antitachycardia pacing or shock therapy for ventricular tachycardia or fibrillation) and recurrences of ventricular tachyarrhythmias. (3) Results: A total of 403 consecutive ICD recipients—symptomatic heart failure patients with ICD for the primary prevention of sudden cardiac death—were included retrospectively: 59% ischemic cardiomyopathy (ICMP) and 41% non-ischemic cardiomyopathy (NICMP) patients. Within a median follow-up period of 36 months, the incidence of cardiovascular mortality was not significantly different in patients with NICMP and ICMP: the primary outcome had occurred in 9 patients (5.4%) in the NICMP group and in 14 patients (5.9%) in the ICMP group (hazard ratio 1; 95% confidence interval (CI) 0.45 to 2.28; p = 0.97). All-cause mortality occurred in 14 of 166 patients (8.4%) in the NICMP group and 18 of 237 patients (7.6%) in the ICMP group. Sudden cardiac death occurred in two patients (1.2%) in the NICMP group and in four patients (1.7%) in the ICMP group (hazard ratio 0.71; 95% CI, 0.13 to 3.88; p = 0.69). The rate of appropriate device therapies was comparable in both groups. (4) Conclusions: In this study, ICD implantation for primary prevention of sudden cardiac death in patients with symptomatic systolic heart failure was associated with similar rates of cardiovascular and all-cause mortality in patients with ischemic heart disease, and in patients with heart failure from other causes. NICMP and ICMP showed comparable rates of recurrent ventricular tachyarrhythmias and appropriate ICD therapies.