Left Ventricular Ejection Fraction Levels Research Articles

Effects of rhBNP on Elderly Emergency Patients with Acute Heart Failure

Objective: To study the effect of re-combinant human brain natriuretic peptide (rhBNP) in older emergency patients with acute heart failure. Patients and Methods: A total of 130 patients were randomly divided into two groups as: rhBNP treatment group and sodium nitroprusside (SNP) treatment group, half by half. The rhBNP was taken once every three days for treatment. But dose was doubled at first time used. In the whole progress, it measured the concentration of rhBNP. Echocardiography examination and 6-minute walk testing (6MWT) were used to evaluate the improvement of heart function after rhBNP treatment, compared with SNP. Results: It taken vital symptoms assessment according to the clinical manifestations, once every four hours in the whole 48 hours emergency treatment procedure. Compared before and after treatment, there were significant improvement about LVEF (left ventricular ejection fraction), 6MWT and proBNP level changes in rhBNP group. Furthermore, it revealed that there were also significant differences in LVEF, 6MWT and proBNP level changes between rhBNP and SNP group. Conclusion: Recombinant human brain natriuretic peptide (rhBNP) could be used to treat old patients with acute heart failure in emergency with meaningful clinical value.

Preoperative Evaluation and Midterm Outcomes after the Surgical Correction of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery in 50 Infants and Children.

Background:Anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) is a rather rare congenital anomaly that has a profound effect on heart function. This study aimed to retrospectively illustrate the perioperative clinical features, therapy experience, and midterm outcomes after surgical correction, and to determine the value of left ventricular ejection fraction (LVEF) and myocardial viability in differentiating critically ill patients among infants and children with ALCAPA.Methods:From April 1999 to March 2013, infants and children patients diagnosed with ALCAPA in Beijing Fuwai Hospital were analyzed. Clinical data of patients were summarized and retrospectively analyzed. All patients were divided into two groups according to LVEF level (Group 1: LVEF >50%, or Group 2: LVEF ≤50%) to compare perioperative and follow-up variables. Effect of myocardial viability evaluated according to myocardial perfusion/18F-fluorodeoxyglucose (FDG) imaging on the clinical variables was also analyzed.Results:A total of 50 patients with ALCAPA (male/female: 29/21; median age: 3.1 years [range: 4 months to 18 years]) were included. Younger age, lower weight, intercoronary collaterals (ICC) dysplasia, ratio of the proximal right coronary artery diameter to the aortic root diameter <0.2, and larger cardiothoracic ratio (CTR) were more frequently found in Group 2 than those in Group 1. Forty-seven patients underwent cardiac surgery. The times of cross-clamp and cardiopulmonary bypass were not different between the two groups; however, the duration of mechanical ventilation and postoperative Intensive Care Unit stay were longer in Group 2 than those in Group 1. Follow-ups were possible in 38 patients (80.9%); median time: 84.5 months (range: 49 months to 216 months). There was one late sudden death with simple ligation of the LCA at 8 months after surgery. No severe complications and reoperation occurred. The relationship of the grades of myocardial viability and clinical features was analyzed in 15 patients with myocardial perfusion/18F-FDG imaging, and the results showed that myocardial viability correlated well with LVEF, CTR, abnormal Q waves, and left ventricular end-diastolic dimension. It was not correlated with age, mitral regurgitation, and ICC. Heart implantation was decided in one patient with little viable myocardium; however, this patient died 2 months after the diagnosis while waiting for transplantation. Two patients with no viable myocardium in the area of aneurysm had aneurysmectomy concomitantly.Conclusions:In infants and children with ALCAPA, heart function and myocardial viability are closely related to clinical features. LVEF and the grades of myocardial viability can differentiate high-risk patients before surgery and in the early stage of recovery after surgery. The area and extent of myocardial infarction are also crucial in making preoperative clinical decisions. However, even in patients with depressed ventricular function and severe myocardial infarction, the midterm follow-up showed satisfactory recovery of cardiac function after the successful restoration of a dual-coronary arterial system.

YIA-CS1-4 - Loss of Inertia Force of Late-systolic Aortic Flow in Patients with Mid-range Left Ventricular Ejection Fraction Deterioration

Background: The upper limit of cut-off value of left ventricular ejection fraction (LVEF) for classifying heart failure with mid-range deterioration of LVEF (HFmrEF) is unclear. Methods: The cardiac functional parameters of study patients (n = 428, LVEF>&=40%) including inertia force of late systolic aortic flow (IFLAF) which was calculated from the LV pressure and dP/dt relation were obtained using a catheter-tipped micro-manometer. We determined a cut-off value of LVEF to divide the patients into 2 groups where they had different cardiac functional backgrounds. We then searched a predictor of future cardiovascular death or hospitalization for HF in each group. In addition, we determined an appropriate upper limit LVEF level of the HFmrEF based on the predictor using ROC analysis. Results: Significant differences in tau, ±dP/dt, and IFLAF were demonstrated between patients with LVEF <60% and >&=60%. In patients with LVEF <60%, a multivariate Cox proportional-hazards model revealed that a loss of IFLAF was a significant predictor of future events (HR: 0.222, 95%CI: 0.049 to 0.996, P=.049). Furthermore, an LVEF <58% was a surrogate indicator for loss of IFLAF and a time-dependent ROC analysis revealed that the IFLAF could be a strong predictor with a high accuracy among patients with LVEF up to 67%. Conclusion: Maintaining systolic function with the existence of IFLAF may be a key issue for preventing HFpEF.

Left ventricular ejection fraction and left atrium diameter related to new-onset atrial fibrillation following acute myocardial infarction: a systematic review and meta-analysis.

BackgroundNew-onset atrial fibrillation (NOAF) occurs frequently in patients with acute myocardial infarction (AMI), and is associated with increased subsequent cardiovascular mortality. However, only a few studies directly evaluated the relationship of left ventricular ejection fraction (LVEF) or left atrium diameter (LAD) and NOAF following AMI.Materials and MethodsMEDLINE®, EMBASE® and the Cochrane Library were carried out to find studies until January 2017. Pooled mean difference (MD) and 95% confidence interval (CI) were calculated to evaluate the value of LVEF and LAD in the prediction of NOAF after AMI. We performed sensitivity analyses to explore the potential sources of heterogeneity. Statistical analyses were carried out using the Revman 5.3.ResultWe included 10 qualifying studies comprising a total of 708 patients with NOAF and 6785 controls. Overall, decreased LVEF and increased LAD levels had a significant positive association with NOAF in patients with AMI. The MD in the LVEF levels between the patients with and those without NOAF was −4.91 units (95% Cl: −5.70 to −4.12), test for overall effect z-score = 12.18 (p < 0.00001, I2 = 35%). Moreover, in a subgroup analysis, the MD for LAD and NOAF was 2.55 units (95% Cl: 1.91 to 3.19), test for overall effect z-score = 7.80 (p < 0.00001, I2 = 57%).ConclusionsOur meta-analysis demonstrated that both decreased LVEF and increased LAD levels were associated with greater risk of NOAF following AMI.

Observational Monitoring of Patients with Aplastic Anemia and Low/Intermediate-1 Risk of Myelodysplastic Syndromes Complicated with Iron Overload

Background: This study focuses on the iron overload (IOL) of patients with transfused aplastic anemia (AA) or a low/intermediate-1 risk of myelodysplastic syndrome (MDS). Methods: Ninety-two AA or MDS patients with IOL were prospectively recruited. Clinical data were collected every 6 months, and organ magnetic resonance imaging T2* values were collected annually. Patients with IOL were chelated. Results: Serum ferritin was correlated with liver T2* and pancreatic T2* in the AA and MDS groups. Transfusion amounts were correlated with serum ferritin values, liver T2*, and pancreatic T2* in the AA group. At the 6-month and 1-year evaluations, patients with sufficient chelation experienced significant decreases in serum ferritin, and those with decreased serum ferritin experienced an obvious increase in hemoglobin. At their 1-year-follow-up, patients with adequate chelation showed significant increases in hepatic T2*, cardiac T2*, and left ventricular ejection fraction (LVEF). Patients with decreased serum ferritin (including those without chelation) experienced an increase in hemoglobin, hepatic T2*, cardiac T2*, and LVEF. Conclusion: The transfusion amount was more reliable at predicting IOL in patients with AA than in those with MDS. Adequate iron chelation can decrease serum ferritin levels and may improve hepatic T2*, cardiac T2*, and LVEF levels. A decrease in serum ferritin, even in the absence of chelation, may also benefit patients.

Diagnostic value of brain natriuretic peptide and β-endorphin plasma concentration changes in patients with acute left heart failure and atrial fibrillation.

Rationale:This study aims to evaluate the diagnostic value of beta-endorphin (β-EP) and brain natriuretic peptid (BNP) plasma concentrations for the early diagnosis of acute left heart failure and atrial fibrillation.Patient concerns:A total of 45 patients were included. These patients comprised 23 male and 22 female patients,and 20 healthy subjects who underwent physical examinations in the Outpatient Department during the same periodwere included and assigned to the control group.Diagnoses:The diagnos stand was that of the Chinese guidelines for the diagnosis and treatment of heart failure.Interventions:Enzyme-linked immunosorbent assay was performed to detect the plasma concentration of β-EP and BNP in the treatment and control groups, and electrocardiogram targeting was performed to determine the left ventricular ejection fraction (LVEF).Outcomes:BNP, β-EP, and LVEF levels were higher in the treatment group (688.01 ± 305.78 ng/L, 394.06 ± 180.97 ng/L, and 70.48 ± 16.62%) compared with the control group (33.90 ± 8.50 ng/L, 76.87 ± 57.21 ng/L, and 32.11 ± 5.25%). The P-values were .015, .019, and .026, respectively, which were <.05. The difference was statistically significant. The BNP and β-EP's 4 correlations (r = 0.895, P <.001), BNP, β-EP, and the combination of BNP and β-EP for acute left heart failure diagnosis in maximizing Youden index sensitivity, specific degree, area under the ROC curve (AUC), and 95% confidence interval (CI) were respectively 93.5%, 81.3%, 0.921, 0.841, 0.921; 80.5%, 78.6%, 0.697, 0.505, 0.697; 94.1%, 83.5%, 0.604 to 0.979, and 0.604. Acute left heart failure in patients with LVEF acuity plasma BNP and β-EP 50% group was obviously lower than that in the LVEF <50% group (P <.01). BNP, β-EP, and LVEF were negatively correlated (r = −0.741, −0.635, P = .013, .018).Lessons:β-EP and BNP have high specificity and sensitivity for detecting early acute left heart failure and atrial fibrillation in patients, which is convenient, easy to perform, and suitable for clinical applications.

Different impact of aortic regurgitation assessed by aortic root angiography after transcatheter aortic valve implantation according to baseline left ventricular ejection fraction and N-terminal pro-B-type natriuretic peptide.

Transcatheter aortic valve implantation (TAVI) is an alternative therapeutic option for severe aortic stenosis. Aortic regurgitation (AR) is commonly observed after TAVI and increases the mortality rate. We hypothesized that the influence of significant AR, defined as that more severe than mild AR, on survival rate after TAVI might differ according to the baseline left ventricular ejection fraction (LVEF) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) level. We categorized 856 patients who underwent transfemoral TAVI into 2 groups according to their baseline LVEF (<40 and ≥40%) and NT-pro BNP levels (≤5000 and >5000pg/mL). Significant AR was observed in 92 patients (11%). Among patients with significant AR, the proportion of patients with CoreValve/EvolutR implantation was higher than that of patients with SAPIEN XT/3 implantation. Kaplan-Meier curves and the log-rank test showed that significant AR was not associated with 1-year mortality in patients with LVEF ≥40% and those with NT-pro BNP level ≤5000pg/mL. On the other hand, it was significantly associated with a higher 1-year mortality in patients with LVEF <40% (p=0.003) and those with NT-pro BNP level >5000pg/mL (p=0.011). Similarly, multivariate Cox regression analysis showed that the presence of AR was significantly associated with a higher 1-year mortality in patients with LVEF <40% [p=0.005, hazard ratio (HR)=3.626] and NT-pro BNP level >5000pg/mL (p=0.004, HR=3.221). However, AR was not significantly associated with a higher 1-year mortality in patients with LVEF ≥40% and NT-pro BNP level ≤5000pg/mL. Thus, the impact of significant AR on mortality after TAVI seems to be considerable in patients with reduced LVEF or high NT-pro BNP levels, but not those with preserved LVEF or low NT-pro BNP levels, suggesting that the influence of AR differs depending on the baseline LVEF and NT-pro BNP level.

Prevalence and clinical impact of iron deficiency and anaemia among outpatients with chronic heart failure: The PrEP Registry

BackgroundIron deficiency (ID) and anaemia are common in heart failure (HF). The prospective, observational PReP registry (Prävalenz des Eisenmangels bei Patienten mit Herzinsuffizienz) studied prevalence and clinical impact of ID and anaemia in HF outpatients attending cardiology practices in Germany.Methods and resultsA total of 42 practices enrolled consecutive patients with chronic HF [left ventricular ejection fraction (LVEF) ≤45%]. ID was defined as serum ferritin <100 µg/l, or serum ferritin ≥100 µg/l/<300 µg/l plus transferrin saturation <20%, and anaemia as haemoglobin <13 g/dl (12 g/dl) in men (women). Exercise capacity was assessed using spiroergometry (69.4%) or 6-min walk test (30.4%). Amongst 1198 PReP-participants [69.0 ± 10.6 years, 25.3% female, New York Heart Association (NYHA) class 2.4 ± 0.5, LVEF 35.3 ± 7.2%], ID was found in 42.5% (previously unknown in all), and anaemia in 18.9% (previously known in 4.8%). ID was associated with female gender, lower body weight and haemoglobin, higher NYHA class and natriuretic peptide (NP) levels (all p < 0.05). ID was also more common in anaemic than non-anaemic patients (p < 0.0001), and 9.8% of PrEP-participants had both, ID and anaemia. On spiroergometry, ID independently predicted maximum exercise capacity even after multivariable adjustment, including anaemia (p = 0.0004). In all PrEP-participants, ID predicted reduced physical performance (adjusted for age, gender, anaemia, serum creatinine, C-reactive protein, LVEF, and NP level).ConclusionsDespite high prevalence, ID was previously unknown in all PrEP-participants, and anaemia was often unappreciated. Given the clinical relevance, treatability, and independent association with reduced physical performance, ID should be considered more in real-world ambulatory healthcare settings and ID-screening be advocated to cardiologists in such populations.

Interleukin-1β levels predict long-term mortality and need for heart transplantation in ambulatory patients affected by idiopathic dilated cardiomyopathy.

AimsThe prognostic stratification of patients with Idiopathic Dilated Cardiomyopathy (iDCM) is a difficult task. Here, we assessed the additive value of the evaluation of biomarkers of inflammasome activation and systemic inflammation for the long-term risk stratification of iDCM patients.Methods and ResultsWe studied 156 ambulatory iDCM patients (mean age 58 years, 77% men, 79% in NYHA class 1-2, median Left Ventricular Ejection Fraction (LVEF) 35%, mean sodium 139 mEq/L, median BNP 189 pg/mL, median IL-1 beta (IL-1β) 1.08 pg/mL, median IL-6 1.7 pg/mL and median IL-10 2.7 pg/mL).During the follow-up period of 89.6 months, 35 patients (22%) died/underwent heart transplantation. Patients who died/underwent heart transplantation were more likely to be male, to be in NYHA class III, to have atrial fibrillation, to have lower LVEF and higher BNP levels. IL-1β, IL-6 and IL-10 levels did not differ significantly between the groups of patients with good or bad prognosis. IL-1β levels did not vary significantly among either the different NYHA classes or the quartiles of LVEF. In a multivariable model, however, IL-1β was a strong and independent predictor of all-cause mortality (HR 1.193, 95% CI 1.056 – 1.349, p=0.005 for log squared transformed values). Other factors associated with the outcome were: male gender, presence of atrial fibrillation and sodium concentration. The estimated time-dependent ROC curve of the multivariable model showed an AUC 0.74 (95% CI 0.65-0.86).ConclusionsSerum levels of IL-1β could be useful to predict the long-term outcome of patients with iDCM.

Current evidence-based therapy does not restore plasma apelin level in phenotypically diverse chronic heart failure patients

Background: Apelin, endogenous peptide acting through its receptor (APJ), is the most potent inotropic agent known to man. Plasma apelin and cardiac APJ mRNA levels rise in early stages of chronic heart failure (CHF) but fall later in decompensated CHF. The effect of current evidence-based management of CHF on plasma apelin level is not known. We estimated change in plasma apelin level in CHF patients of diverse phenotypes treated with standard pharmacotherapy and compared it with the corresponding change in left ventricular ejection fraction (LVEF), plasma brain natriuretic peptide (BNP) level and quality of life (QoL).Methods: With ethical approval and written informed consent, venous blood samples were collected from 39 CHF [dilated cardiomyopathy (DCM) (n=21), restrictive cardiomyopathy (RCM) (n=9) and chronic constrictive pericarditis (CCP) (n=9)] patients and 10 age-matched healthy controls, at baseline and after 12 weeks. Plasma apelin and BNP were estimated by competitive ELISA (RayBiotech Inc.) and an auto-analyzer (Triage, Allere Inc.), respectively. QoL was assessed using Kansas City Cardiomyopathy Questionnaire (KCCQ). Nonparametric tests were applied and p-value &lt;0.05 was considered significant.Results: Low LVEF, KCCQ score and high BNP levels were observed in all CHF patients compared to controls. Plasma apelin level was depressed in RCM and CCP patients compared to controls but not in DCM patients. These parameters did not change in any group after 3 months of standard pharmacotherapy.Conclusions: Current evidence-based management of CHF does not restore the depressed apelin-APJ axis. New drugs are required for specifically modulating this promising therapeutic target in CHF.

NEUROPSYCHOLOGICAL STATUS OF PATIENTS WITH STABLE CORONARY ARTERY DISEASE AND FACTORS AFFECTING IT

The purpose. To assess neuropsychological status of patients with stable coronary artery disease (CAD) and to determine the factors affecting it. Material and methods. 272 male patients aged 45-69 years were included in the study. Neuropsychological status of patients with coronary artery disease was assessed and presented as an integrated index. Results. The integrated index of neuropsychological status was reported to be 2 times less than those in healthy subjects matched for age (0.47 [0.35; 0.59] vs. 0.8 [0.72; 0.87, (p <0.0001)). The most significant factors affecting neuropsychological status of patients with coronary artery disease were as follows: age (p = 0.00271), number of years of education (p = 0.033), left ventricular ejection fraction (LVEF) (p = 0.018), as well as plasma triglyceride levels (TG) (p = 0.003). Conclusion. The integrated approach to the assessment of neuropsychological status in patients with CAD allows not only presenting it as a single index, but also determining the extent to which the index deviate from neuropsychological status of healthy subjects. The factors affecting neuropsychological status in patients with coronary artery disease were as follows: age, number of years of education, LVEF and plasma triglyceride levels.

Observational Study of Magnetic Resonance Imaging Monitoring in Patients with Aplastic Anemia (AA) and Low or Int-1 Risk of Myelodysplastic Syndromes(MDS) Complicated with Iron Overload

▪Objective: To observe the clinical characters and magnetic resonance imaging (MRI) T2* change in patients with aplastic anemia (AA) and low or int-1 risk of myelodysplastic syndromes(MDS) complicated with iron overload.Methods:This is a prospective study. Patients with AA and low and intermediate-1 risk factors of MDS complicated with iron overload were enrolled. Clinical parameters and T2* of liver, heart and pancreas were collected regularly.Results: Of all the 92 recruited patients (54 males and 38 females), the median age was 47.5 (15~18) year-old, median disease duration was 26 (3~407) months. There were 54 AA patients and 38 MDS patients. SF was related to liver T2* and pancreatic T2*(AA group r=-0.476,-0.509, respectively, P<0.05; MDS group r=-0.401, -0.565, respectively, P<0.05) in both groups, but not related to cardiac T2* in either group. SF level was correlated with transfusion amount in AA patients (r=0.403, P<0.05), but not in MDS patients (r=0.234, P>0.05. Of the 20 patients who received iron-chelation therapy, 3 (15%) had diarrheas, 2 (10%) decreased in hemoglobin, 2 (10%) decreased in platelet, 2 (10%) had increased creatinine, 1 (5%) had allergic dermatitis, but the symptoms relieved after drug withdrawal. 2 patients died of bone marrow failure during the follow-up period. 38 patients finished the half-year evaluation. Those (18 cases) who chelated adequately had significant decrease in SF (3354.9±3287.3 vs 2119.3±1742.0 ng/ml, P=0.044). Meanwhile an increase in hemoglobin level (83.5±30.0 vs 96.7±31.6 g/L, P=0.01) was noticed in those with decreased SF. 26 patients finished one year follow-up, those (15 cases) who chelated adequately had significant decrease in SF (3583.9±3543.8 vs 1693.9±1532.5 ng/ml, P=0.006), increase in cardiac T2* (25.0±13.4 vs 32.3±15.7 ms, P=0.015) and left ventricular ejection fraction (LVEF) (63.6±8.6 vs 67.1±5.2 %, P=0.028) , whereas no such changes were found in those did not chelate adequately. No change was found either in chelated or non-chelated groups in hemoglobin, WBC count, platelet count, SGPT, TBil, creatinine level, liver or pancreas T2* value. For those with decreased SF, even without chelation, increase in hemoglobin level (91.1 ±29.9 vs 108.4±31.4 g/L, P=0.046),cardiac T2* (25.5±13.7 vs 33.1±15.9 ms, P=0.014)) and LVEF level (63.6±8.6 vs 67.2±5.4 %, P=0.027) were also documented.Conclusion: SF was related to liver T2* and pancreatic T2* in both AA and MDS groups. SF was relevant to transfusion amount in patients with AA but not MDS. Adequate iron chelation can decrease the SF level, and might bring improvement in cardiac T2* and LVEF level. Decrease of SF even without chelation might also benefit patients. DisclosuresNo relevant conflicts of interest to declare.

Left Ventricular Ejection Fraction Predicts Severity of Posttraumatic Stress Disorder in Patients With Implantable Cardioverter-Defibrillators.

Implantable cardioverter-defibrillators (ICD) have provided effective therapy for fatal arrhythmia. However, ICD patients are known to develop psychological problems, such as posttraumatic stress disorder (PTSD), if they have experienced potentially fatal arrhythmia and ICD shocks. Little is known about the factors influencing PTSD in ICD patients. Echocardiographic cardiac-function parameters might relate to psychological problems, especially PTSD, in ICD patients. A total of 128 outpatients with ICD implantation completed the Impact of Event Scale Revised (IES-R) questionnaire as a measurement of PTSD. Demographic and clinical characteristic data were collected from medical records. The mean age of the ICD patients was 59 ± 16 years; 103 were male; and the mean left ventricular ejection fraction (LVEF) by echocardiography was 52.4% ± 18.3%. In the ICD patients, female sex and impaired LVEF were related to lower IES-R scores or led to PTSD (P = 0.01 and P = 0.03, respectively). Impaired LVEF also worsened 2 symptoms of PTSD, intrusion (P = 0.02) and hyperarousal (P = 0.03). In patients with LVEF <35%, there was a significant negative correlation between LVEF level and IES-R score (P = 0.045). This study showed that LVEF was related to the severity of PTSD, especially in the ICD patients with LVEF of <35%. We should pay more attention to ICD patients with severely impaired left ventricular function to prevent psychological problems.

Prognostic Role of Ventricular Ectopic Beats in Systemic Sclerosis: A Prospective Cohort Study Shows ECG Indexes Predicting the Worse Outcome.

BackgroundArrhythmias are frequent in Systemic Sclerosis (SSc) and portend a bad prognosis, accounting alone for 6% of total deaths. Many of these patients die suddenly, thus prevention and intensified risk-stratification represent unmet medical needs. The major goal of this study was the definition of ECG indexes of poor prognosis.MethodsWe performed a prospective cohort study to define the role of 24h-ECG-Holter as an additional risk-stratification technique in the identification of SSc-patients at high risk of life-threatening arrhythmias and sudden cardiac death (SCD). One-hundred SSc-patients with symptoms and/or signs suggestive of cardiac involvement underwent 24h-ECG-Holter. The primary end-point was a composite of SCD or need for implantable cardioverter defibrillator (ICD).ResultsFifty-six patients (56%) had 24h-ECG-Holter abnormalities and 24(24%) presented frequent ventricular ectopic beats (VEBs). The number of VEBs correlated with high-sensitive cardiac troponin T (hs-cTnT) levels and inversely correlated with left-ventricular ejection fraction (LV-EF) on echocardiography. During a mean follow-up of 23.1±16.0 months, 5 patients died suddenly and two required ICD-implantation. The 7 patients who met the composite end-point had a higher number of VEBs, higher levels of hs-cTnT and NT-proBNP and lower LV-EF (p = 0.001 for all correlations). All these 7 patients had frequent VEBs, while LV-EF was not reduced in all and its range was wide. At ROC curve, VEBs>1190/24h showed 100% of sensitivity and 83% of specificity to predict the primary end-point (AUROC = 0.92,p<0.0001). Patients with VEBS>1190/24h had lower LV-EF and higher hs-cTnT levels and, at multivariate analysis, the presence of increased hs-cTnT and of right bundle branch block on ECG emerged as independent predictors of VEBs>1190/24h. None of demographic or disease-related characteristics emerged as predictors of poor outcome.ConclusionsVEBS>1190/24h identify patients at high risk of life-threatening arrhythmic complications. Thus, 24h-ECG-Holter should be considered a useful additional risk-stratification test to select SSc-patients at high-risk of SCD, in whom an ICD-implantation could represent a potential life-saving intervention.

Carbohydrate-antigen-125 levels predict hospital stay duration and adverse events at long-term follow-up in Takotsubo cardiomyopathy.

The aim of this study is to evaluate the possible role of carbohydrate-antigen(CA)-125 as prognostic marker at short- and long-term follow-up, in subjects with Takotsubo cardiomyopathy (TTC). Sixty-three consecutive subjects with TTC were enrolled in the study and followed for a median 139days. Circulating levels of CA-125, NT-proBNP, and left ventricular ejection fraction (LVEF) were evaluated at admission. Duration of hospital stay, incidence of death, re-hospitalization and recurrence of TTC during follow-up were recorded. The mean hospital stay was 8.3days, adverse events occurred during follow up in 17% of cases. CA-125 levels at admission are inversely related to LVEF (r -0.30, p<0.05) and directly related to hospital stay (r 0.29, p<0.05). CA-125 levels at admission are higher in subjects with adverse events at follow-up (88.9±200.0 vs 20.9±30.0 U/mL, p<0.05). Rates of incidence of adverse events are proportionally increased with CA-125 tertiles (0, 6, 11% respectively, p for trend <0.01), at survival analysis (Log Rank p<0.05) and after correction for age, gender, LVEF and NT-proBNP levels in multivariable Cox analysis (p<0.05). CA-125 levels <10 U/ml are predictors of adverse events at follow up with 91% sensitivity, 52% specificity, 29% positive predictive power, and 96% negative predictive power. Increased CA-125 admission levels are associated with a longer hospital stay, a lower LVEF, and a higher risk of adverse events during follow up. CA-125 might be useful for early risk stratification of subjects with TTC.

Incidence and prognosis of stent thrombosis following percutaneous coronary intervention in Middle Eastern patients: The First Jordanian Percutaneous Coronary Intervention Registry (JoPCR1)

BACKGROUNDThe incidence, risk factors, and outcome of stent thrombosis (ST) after percutaneous coronary intervention (PCI) in Middle Eastern patients are largely unknown.OBJECTIVETo determine the incidence, risk factors and outcome in our population.DESIGNRetrospective study of a prospective multicenter registry of consecutive patients who underwent PCI between January 2013 and February 2014 (JoPCR1).SETTING12 tertiary care centers in Amman and Irbid, Jordan.PATIENTS AND METHODSWe collected clinical baseline and follow-up data.MAIN OUTCOME MEASURESIncidence of stent thrombosis.RESULTSThe mean (standard deviation) age of patients (n=2426) was 59.0 (10.1) years and 20.6% were women. Stents (n=3038) were drug eluting (89.6%), bare metal (9.4%) or bioabsorbable (1.0%). After 1 year, 47 patients (1.97%) had ST, including 44 (94%) definite and 3 (6%) probable ST. Patients who had ST presented with sudden death (n=6; 12.2%) or with a nonfatal event (n=43; 87.8%). Nonfatal events included non-ST-segment elevation acute coronary syndrome (26; 53%), acute ST segment elevation myocardial infarction (n=15; 31%) or heart failure (n=2; 4.1%). ST was associated with significantly higher one-month (22.0% vs. 0.7%) and one-year (12.3% vs. 0.73%) mortality rates compared with patients who did not have ST (P<.001). ST patients were younger (mean age 52.9 years vs. 58.4 years), had heart failure (64% vs. 18%), left ventricular ejection fraction (LVEF) <45% (36% vs. 13%), ST-segment deviation (70% vs. 48%), and elevated cardiac biomarkers blood levels (62% vs. 40%). In the multivariate analysis, the only factor that was significantly associated with ST was the heart failure (OR = 3.5, 95% confidence interval: 1.8, 6.6; P<.0001).CONCLUSIONSThe incidence of ST was not different from that in other regions and was associated with an increased one-year mortality. Younger age, heart failure, low LVEF, ST-segment deviation, and elevated blood levels of cardiac biomarkers were predictors of ST.LIMITATIONSPossible selection bias, recall bias, and missing or incomplete information. The majority of patients were lost to follow up after the 6th month. The registry may not fully represent PCI practice and outcome in all areas in the country or region.

Noninvasive Positive Pressure Ventilation in Chronic Heart Failure.

Instruction and Objectives. Noninvasive positive pressure ventilation (NPPV) alleviates sleep-disordered breathing (SDB) and it may improve cardiac function in SDB patients. Because large randomized controlled trials directly evaluating the impact of NPPV on cardiac function are lacking, we conducted a meta-analysis of published data on effectiveness of NPPV in improving cardiac function in patients with chronic heart failure regardless of SDB presence. Methods. Controlled trials were identified in PubMed, OVID, and EMBASE databases. Both fixed and randomized models were used in meta-analysis with primary outcomes of left ventricular ejection fraction (LVEF). Results. Nineteen studies were included with a total of 843 patients. Compared to standard medical treatment (SMT) plus sham-NPPV or SMT only, NPPV plus SMT was associated with improvement in LVEF (weighted mean difference 5.34, 95% CI, [3.85,6.82]; P < 0.00001) and plasma brain natriuretic peptide (BNP) level (weighted mean difference −117.37, 95% CI, [−227.22, −7.52]; P = 0.04) and no influence on overall mortality (RR 1.00, 95% CI, [0.96,1.04]; P = 0.95). Conclusions. In the present meta-analysis, use of NPPV plus SMT improved LVEF and reduced plasma BNP level but did not improve overall mortality in patients with chronic heart failure.

Prognostic value of high sensitivity troponin T after ST-segment elevation myocardial infarction in the era of cardiac magnetic resonance imaging.

To determine if high sensitivity troponin T (hs-TnT) measurements performed during the 'plateau phase' of troponin release (≥48 h) following ST-segment elevation myocardial infarction (STEMI) can predict major adverse cardiovascular endpoints (MACE), and to evaluate its prognostic value compared with cardiac magnetic resonance imaging (CMRI) parameters. We prospectively recruited 201 first presentation STEMI patients. Serial hs-TnT levels were measured at admission, peak (highest), 24, 48 and 72 h. CMRI and transthoracic echocardiography were performed (4 days median) post-STEMI, evaluating infarct scar characteristics and left ventricular ejection fraction (LVEF). Associations were determined between hs-TnT levels and CMRI parameters early after STEMI with MACE (comprising mortality, re-infarction, new or worsening of heart failure, cerebrovascular accident, and sustained ventricular arrhythmias) at medium-term follow-up. After 602 days (median), 33 (17%) patients had MACE. Upper tertile hs-TnT levels at 48 and 72 h were associated with MACE (Kaplan-Meier P = 0.002 and P = 0.012, respectively). Multivariate Cox analyses, incorporating diabetes, CMRI scar size, LVEF and hs-TnT levels (applied at a single hs-TnT time point) showed that 48 and 72 h hs-TnT levels were independent predictors for MACE (HR = 1.20, P = 0.002, and HR = 1.21, P = 0.035 respectively). Measurement of hs-TnT in the plateau phase after STEMI is an inexpensive method of prognostic risk assessment.

Retrospective analysis of cardiac tolerability of concurrent administration of trastuzumab and anthracycline-based regimen for breast cancer, to address one-year-term issues in LVEF

Patients with HER2-positive breast cancer, who received paclitaxel (P) followed by epirubicin at 75 mg/m2, fluorouracil, and cyclophosphamide (FEC75) and concurrent trastuzumab (Trastuzumab Group) show good cardiac tolerability. We assessed left ventricular ejection fraction (LVEF) of these patients regularly, and compared with that of HER2-negative breast cancer patients who administered P followed by FEC100 (Standard Group), and followed for more one year, and address the longer-term issues in LVEF. We routinely assessed LVEF, at the time of initiation, after P, after FEC, and after 1 year, and compared them between 49 patients in Trastuzumab Group and 45 patients in Standard Group. In Trastuzumab Group, LVEF was reduced from the initial level (63.1%) to 60.4 at ``After FEC'' (p= 0.007), but had recovered to 60.9% at ``After 1 year''. A two-way repeated-measures ANOVA demonstrated a significant decline in LVEF level along the time course (p< 0.002), but there was no interaction revealed between time course of LVEF and treatment with or without trastuzumab (p= 0.834). In addition, there was no significant difference between groups (p= 0.386)CONCLUSIONS: P followed by FEC75 with concurrent trastuzumab could provide enough evidence of cardiac safety.

Abstract 18925: The Serum Level of Mir-30a-3p And Mir-31-5p Can Discriminate Responders From Non-responders to CD34 + Cell Therapy in Patients With Dilated Cardiomyopathy

Introduction: The potential predictive value of specific, circulating miRNAs in blood in patiens with non-ischemic dilated cardiomyopathy (DCM) undergoind CD34+ cell therapy remains undefined. Hypothesis: We assessed the hypothesis that the relative level of specific miRNAs in serum obtained at baseline will discriminate responders from non-responders to stem cell therapy in patients with DCM. Methods: We enrolled 10 consecutive patients with DCM who underwent transendocardial CD34+ cell transplantation between January and December 2013. All patients received 5-day stimulation with G-CSF; CD34+ cells were selected with apheresis and injected transendocardially guided by electroantomical mapping. Patients were followed for 6 months and good clinical response was defined as an increase of left ventricular ejection fraction (LVEF) ≥5%. Before cell therapy, total RNA was isolated from serum with the miRCURY RNA Isolation Biofluids Kit. cDNA synthesis and real-time qPCR were performed using the miRCURY Locked Nucleic Acid and Universal RT microRNA PCR system with The qPCRs were run on a ViiA7 thermocycler. Results: At 6 months after therapy, good clinical response was found in 5 patients (Group A), and 5 patients failed to respond to cell therapy (Group B). The two groups did not differ with regards to age (55±9 years in Group A vs. 57±3 years in Group B; P=0.58), male gender (87% vs. 100%; P=0.34), baseline LVEF (33±5% vs. 28±8%; P=0,28), LVEDD (6.6±0.4 cm vs. 6.9±0.7 cm; P=0.33) or NTproBNP levels (1460±932 pg/mL vs. 4540±3808 pg/mL; P=0.15). When analyzing the pool of miRNAs we found the serum level of miR-30a-3p and miR- 31-5p to be significantly different between two study groups (both had adjusted P values of 0.031). The serum level of miR- 31-5p was higher in the group of responders (log2 fold change of 6.78) while the serum level of miR-30a-3p was higher in the group of non-responders (log2 fold change of 4.98). Conclusions: In patients with DCM undergoing CD34+ cell therapy specific serum miRNAs appear to discriminate clinical responders from non-responders. Therefore, they could be used as a tool when selecting appropriate patients for stem cell therapy.