New-onset Heart Research Articles

Fragmented QRS predicted major adverse cardiovascular events in patients with coronary artery disease and percutaneous coronary intervention, 10-years of follow-up.

Aim Identifying high-risk groups in patient with coronary artery disease (CAD) is critical for predicting future adverse events. fQRS has been shown to be related to major cardiovascular adverse events (MACE) in patients with CAD. However, predictive value of fQRS for more than 5 yrs has not been evaluated. This study examined the predictive value of fQRS in patients with CAD and percutaneous coronary intervention during a 10‑yrs period.Material and methods Patients with CAD and percutaneous coronary intervention between March 2007 and May 2009 were included the study. An electrocardiogram was recorded following percutaneous coronary intervention and analyzed for the presence of fQRS. The fQRS pattern was defined as an additional spike inside the QRS complexes of at least two consecutive leads. Patients were followed for 10 yrs. A MACE was all-cause mortality or new-onset decompensated heart failure. Patients were divided into two groups according to presence or absence of MACE, and their clinical variables were compared.Results Of 1261 patients included in the study, MACE developed in 374 (29.6 %). MACE (+) patients were older (p<0.001), more likely to have diabetes mellitus (p=0.003), fQRS (p<0.001), and ST-elevated myocardial infarction (STEMI) (p<0.001). Multivariable Cox regression analysis revealed that age (p<0.001), STEMI (p=0.001), fQRS (p=0.017), and elevated serum creatinine (p=0.001) were independent predictors of MACE.Conclusion The presence of fQRS predicted MACE during 10 yrs of follow-up of patients with CAD and percutaneous coronary intervention.

Plasma carbohydrate antigen-125 for prediction of atrial fibrillation recurrence after radiofrequency catheter ablation

BackgroundElevated plasma carbohydrate antigen-125 (CA-125) levels are strongly associated with new-onset atrial fibrillation (AF) and heart failure, but the relationship between plasma CA-125 level and AF recurrence following radiofrequency catheter ablation (RFCA) remains poorly investigated. We aimed to assess whether elevated CA-125 levels are related to long-term AF recurrence following RFCA.MethodsPreoperative CA-125 levels were determined in AF patients undergoing initial RFCA. Multivariate-adjusted Cox models were constructed to determine the relationship between CA-125 levels and AF recurrence. Multivariate logistic regression analyses were performed to determine predictors of AF recurrence.ResultsOf the 353 enrolled patients, 85 patients (24.1%) had AF recurrence at the 12-month follow-up. These patients had significantly higher baseline CA-125 levels than those without AF recurrence [(18.71 ± 12.63) vs. (11.27 ± 5.40) U/mL, P < 0.001]. The incidence of AF recurrence across quartiles 1–4 of CA-125 was 11.5%, 13.3%, 21.6% and 50.0%, respectively (P-trend < 0.001). The adjusted hazard ratios (aHRs) for AF recurrence across quartiles 1–4 of CA-125 were 1.00 (reference), 1.085 (95% CI, 0.468–2.520), 1.866 (95% CI, 0.867–4.019), and 4.246 (95% CI, 2.113–8.533), respectively (P-trend < 0.001). A similar effect was obtained when CA-125 was studied as continuous data (aHR per unit increase in LnCA-125, 3.225, 95% CI, 2.258–4.606; P < 0.001). When a predefined CA-125 cut-off of 13.75 U/mL was established, patients with CA-125 ≥ 13.75 U/mL had a higher risk of recurrent AF than those with CA-125 < 13.75 U/mL (aHR, 3.540, 95% CI, 2.268–5.525, P < 0.001). Multivariate analysis revealed CA-125, high-sensitivity C-reactive protein, and left atrium anteroposterior diameter as independent risk factors for AF recurrence.ConclusionsElevated preoperative CA-125 levels are related to a higher risk of AF recurrence and can independently predict AF recurrence following RFCA.

Abstract P202: Serum Values of Branched-chain Amino Acids Predict High Triglycerides Among People Free of Diabetes. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Introduction: Branched-chain amino acids (isoleucine, leucine, and valine) are associated with new-onset diabetes and incident coronary heart disease and stroke. However, the impact of elevated serum branched-chain amino acids on lipids and lipoproteins remains a matter of investigation. Hypothesis: branched-chain amino acids are independent predictors of dyslipidemia among people free of diabetes. Methods: We tested this hypothesis among 5060 men and women aged 35 to 74 years-old enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) with a 4-year follow-up. The variable of exposure was serum branched-chain amino acids measured in serum by proton nuclear magnetic resonance (1H NMR) spectroscopy at (LabCorp; Raleigh, NC). The outcome variables were LDL-C greater than 130 mg/dl; HDL-C lower than 40 mg/dl; triglycerides higher than 150 mg/ dl during the reappraisal examination. We excluded participants with any type of dyslipidemia at time of baseline, people who sustained a cardiovascular event, and those receiving lipid-lowering therapy or who had a diagnosis of diabetes. The definition of diabetes was self-reported or use of medicines for diabetes or plasma fasting glucose greater than 126 mg/Dl or 2-hour load plasma glucose greater than 200 mg/dl or glycated hemoglobin greater than 6.5 %. We applied Poisson regression to determine prevalence ratios for dyslipidemia according to a 1-standard deviation of branched-chain amino acids. The final model included age, sex, race, body mass index, waist circumference, a 4-year weight change, insulin resistance (measured by the product of fasting plasma glucose * serum insulin divided by 405), and glycated hemoglobin. Results: During the 4-year follow-up, 1373 participants met the criteria of study (median age 47 years; 67% women, 59% white), and 736 (53.6%) developed new-onset dyslipidemia: high triglycerides (120; 8.7%), low HDL-C (332; 24.2%), or high LDL-C (284; 20.7%) The combination of incident high triglycerides and low HDL-C was observed in 44 (3.2%) of participants. After the full adjustment for the covariates, the prevalence ratios (and 95% Confidence Interval) of new-onset dyslipidemia for 1-Standard Deviation (1-SD) of serum branched-chain amino acids were for high triglycerides = 1.25 (1.04 to 1.50), low-HDL-C = 1.08 (0.98 to 1.20), and for high LDL-C = 1.02 (0.91-1.14). The association between 1-SD of branched-chain amino acids and high triglycerides was present for women [1.27 (1.02 to 1.58), but not for men [1.18 (0.90 to 1.53)]. Analyzing separately for the amino acid, the prevalence ratio for high triglycerides for 1-SD of leucine was 1.34 (1.13 to 1.62); for 1-SD of isoleucine was 1.07 (0.90 to 1.28), and for 1-SD of valine was 1.16 (0.96 to 1.38). Conclusion: Serum values of branched chain amino acids are associated with incident hypertriglyceridemia among people free of diabetes.

New-onset congestive heart failure (CHF) and cardiovascular disease (CVD) in older colorectal cancer (CRC) survivors: A population-based study.

10011 Background: CRC is primarily a disease of the elderly. The high burden of pre-existing comorbidities alone or in concert with cancer treatment place the older patients with CRC at increased risk of new-onset morbidities, specifically, CVD and CHF. However, the magnitude of risk of new-onset morbidity, and its association with pre-existing comorbidities or treatment remain unknown. Methods: Using SEER-Medicare data, we evaluated individuals diagnosed with incident stage I-III CRC at age ≥66y between 1/1/2000 and 12/31/2011 who had survived ≥2y after diagnosis (n = 57,256; 77% with colon cancer). We compared these to an age, sex-, and race-frequency matched comparison group of non-cancer Medicare patients (n = 104,731). We evaluated new-onset CHF and CVD using competing risk cumulative incidence functions and multivariable Cox regression models. Results: The median age at diagnosis was 77y (66-106y); 45% males; and 85% non-Hispanic white. Median follow-up was 8y (2-14y) from diagnosis of CRC. Treatment included surgery for 99%, chemotherapy for 31%, and radiation for 12%. New-onset morbidity: The 10y cumulative incidence of new-onset CHF and CVD were 43.6% and 58.9%, respectively. After controlling for pre-cancer comorbidities, CRC survivors were at increased risk of new-onset CHF (HR 1.29) and CVD (HR 1.74) (all p &lt; 0.001) compared to controls. Patients receiving radiation (HR 1.29) or 5-FU+oxaliplatin (HR 1.09) were at increased risk of CVD compared to those without those therapies (p &lt; 0.001). Pre-existing diabetes (HR 1.16) and CHF (HR 1.21) independently increased the risk of CVD (p &lt; 0.001). While 5FU+oxaliplatin did not increase the risk of CHF independently (HR 0.97), diabetic patients treated with 5-FU+oxaliplatin were at 1.71-fold increased risk of developing CHF (p &lt; 0.001) when compared with those without pre-existing diabetes. Conclusions: Older CRC survivors are at increased of developing CHF and CVD. Monitoring survivors with a history of exposure to 5FU+oxaliplatin or radiation, and improving management of pre-existing comorbidities may reduce the burden of long-term morbidity for older CRC survivors.

Significance of estimated glomerular filtration rate in predicting brain or heart attacks in obese and non-obese populations.

The Japanese Specific Health Checkup mainly focuses on metabolic syndrome for preventing cardiovascular events. Subjects are stratified by measuring waist circumference, body mass index, blood pressure, triglycerides, and fasting plasma glucose. However, estimated glomerular filtration rate (eGFR) is not considered essential. A longitudinal cohort study assessed the association of eGFR with new-onset brain or heart attacks in a large Japanese nationwide Specific Health Checkup database. A total of 109,349 Japanese subjects (mean age 63.2 years, 39.5 % men) were examined for the events 2 years later. The odds ratios were calculated for new events in the total and subgroup populations divided by BMI < or ≥25 kg/m(2), obese and non-obese, respectively. Obese subjects were more often male and had proteinuria (dipstick test ≥1+), lower eGFR, and higher systolic and diastolic BP, fasting plasma glucose, hemoglobin A1c, and triglycerides (TG). Rates of new-onset brain or heart attacks were 3.1 and 4.0 % in the groups of non-obese and obese subjects, respectively. In the total population, eGFR as well as higher BMI (≥25 kg/m(2)), higher BP (high-normal hypertension or greater), higher TG (≥150 mg/dl), and proteinuria were significant risk factors for developing brain or heart attacks. The eGFR was significant in non-obese subjects, but not in the obese. As the ultimate aim of 'Specific Health Checkup' is to prevent cardiovascular events, our study suggests that eGFR should be evaluated in non-obese subjects.

Differentiation between active myocarditis and dilative cardiomyopathy in new-onset systolic heart failure: Potential role of T1 and T2 mapping cardiovascular magnetic resonance

Background There is an overlapping phenotype in patients with newonset systolic heart failure due to myocarditis and dilative cardiomyopathy (DCM). Differentiation between both etiologies has important therapeutic and prognostic implications and is currently based on endomyocardial biopsy (EMB). In contrast, current cardiovascular magnetic resonance (CMR) techniques are of limited value in these patients with predominantly diffuse myocardial injury. This study evaluated the performance of quantitative T1- and T2-mapping CMR to differentiate between active myocarditis and DCM in patients with new-onset systolic heart failure. Methods This study included 26 patients with new-onset systolic heart failure and reduced left ventricular (LV) ejection fraction (32 ± 12 %), who underwent EMB and CMR at 1.5 Tesla. The protocol included conventional sequences (T2w-STIR), Early- (T1w-TSE) and Late-GadoliniumEnhancement (PSIR). Furthermore, T1 quantification was performed using the modified Look-Locker inversionrecovery (MOLLI) sequence before (native) and 15 minutes after administration of 0.075 mmol/kg GadoliniumBOPTA. T2 quantification was performed using a freebreathing, navigator-gated multi-echo sequence. Native T1, post-contrast T1, extracellular volume (ECV) and T2 maps were calculated with a dedicated plug-in written for the OsiriX software. Results EMB revealed variants of active myocarditis in 13 (50 %) and DCM in the remaining 13 (50 %) patients. The ROC areas-under-the-curve (AUC) to discriminate between both etiologies was 0.54 (p = 0.77) for Early-GadoliniumEnhancement, 0.63 (p = 0.23) for Late-GadoliniumEnhancement, 0.68 (p = 0.11) for T2w-STIR, 0.66 (p = 0.17) for native global myocardial T1, 0.72 (p = 0.05) for post-contrast global myocardial T1, 0.61 (p = 0.36) for global myocardial ECV and 0.74 (p < 0.05) for global myocardial T2. Sensitivity and specificity were 50 % and 83 % to discriminate between myocarditis and DCM using global myocardial T2 (optimal cut-off ≥ 60 ms). Conclusions Assessing myocardial inflammation by T2-mapping CMR could be helpful to discriminate between active myocarditis and DCM in patients with new-onset systolic heart failure. T2-mapping CMR appears to be superior compared to conventional techniques but also to T1-mapping CMR in this context. Funding

Remote Stab Wound Resulting in AV Fistula and High-Output Heart Failure.

A 54-year-old African American male with no medical history presented to an urgent care clinic with signs and symptoms of new-onset congestive heart failure. There was an initial concern for congestive heart failure secondary to an ischemic etiology as an echocardiogram revealed a depressed ejection fraction. However, a left heart cardiac catheterization did not demonstrate any significant coronary disease. As a loud bruit was auscultated over the right base of the patient's neck, he underwent a carotid duplex ultrasound revealing a fistula between the right common carotid artery (CCA) and the right internal jugular vein (IJV). A diagnosis of high-output heart failure secondary to a large arteriovenous (AV) fistula was made, and the patient underwent ligation and repair of the fistula with resolution of symptoms of congestive heart failure.

TCT-377 Impact of New-Onset Acute Heart Failure in Patients with Acute Myocardial infarction Underwent Successful Revascularization

TCT-377 Impact of New-Onset Acute Heart Failure in Patients with Acute Myocardial infarction Underwent Successful Revascularization

QTc Prolongation and Family History of Sudden Death in a Patient with Desmin Cardiomyopathy

This case report describes a pregnant female patient who presented with new-onset congestive heart failure symptoms and prolonged QTc, with strong family history of sudden death. Endomyocardial biopsy and genetic testing revealed myocardial desmin accumulation and a previously described mutation in the DES (desmin) gene, as well as variants in two LQT genes, SCN5A and KCNH2. The case highlights the phenotypic variability for a particular desmin genotype, and the possible interaction of desminopathy with LQT variants not independently associated with large differences in current properties or QT prolongation from wild type.

To Perform Thrombolysis or Not: A Case of Acute Pancreatitis Presenting with Chest Pain and Transient Left Bundle Branch Block

A suspected case of acute coronary syndrome presented with new-onset left bundle branch and first-degree heart blocks. The decision to thrombolyse was reverted as ECG changes proved to be transient within fifteen minutes of presentation. Later on the patient was diagnosed with acute pancreatitis based on laboratory results of serum amylase, confirmed on radiological investigations.

Electrocardiographic Strain Pattern and Prediction of New-Onset Congestive Heart Failure in Hypertensive Patients: The Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) Study

Electrocardiographic Strain Pattern and Prediction of New-Onset Congestive Heart Failure in Hypertensive Patients: The Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) Study

Can electrocardiographic strain predict new-onset congestive heart failure in patients with hypertension?

Can electrocardiographic strain predict new-onset congestive heart failure in patients with hypertension?

Severely Depressed Left Ventricular Function in Young Patients with New-onset Congestive Heart Failure

Severely Depressed Left Ventricular Function in Young Patients with New-onset Congestive Heart Failure