non-ST Elevation Research Articles

P-718. Getting to the Heart of Respiratory Syncytial Virus Disease Burden

Abstract Background There is increasing evidence that viral respiratory infections are associated with acute cardiovascular events. The majority of studies to date involve SARS-CoV-2 and influenza, whereas data for RSV are limited. Methods We performed an analysis of electronic records from patients with documented RSV hospitalization from a prospective incidence study conducted in Rochester, NY from 2017-2020. Clinical, demographic, medical history, and cardiac risk factor data were collected. Outpatient and hospital encounters were reviewed for cardiovascular events (CVE) 6 months before RSV infection and during “high-risk” and “late-risk” periods, 28 days and 1-5 months, respectively, after RSV for a total of one year of observation. Events of interest were myocardial infarction (MI), new or exacerbation of congestive heart failure (CHF), new atrial fibrillation (Afib) or with rapid ventricular response (RVR), arrhythmias, stroke, and others. Peak cardiac biomarkers (troponin and brain natriuretic peptide [BNP]) were collected. Chart review was conducted by 2 physicians independently and consensus achieved. Cardiac Risk Factors Cardiac Risk factors: HTN, hyperlipidemia, diabetes mellitus, family history of CAD in a first-degree relative, current smoking, BMI>30. Results RSV was diagnosed in 471 hospitalized adults. The median age was 69 years, 59% were female and nearly all had underlying medical conditions (92%) with hypertension and diabetes mellitus most common (Figure 1). Cardiac risk factors are summarized in Table 1. During a high-risk period, 167 patients had 270 CVE (89% within 1 week) and 29 patients died. The most common complications were new or exacerbated CHF (27.5%) and Afib with RVR (12.9%), Figure 2. The rates of CVE during pre-RSV, high-risk, and late-risk periods were 0.34, 6.9, and 0.45 per person-years, respectively. Notably, the Incidence Rate Ratio (IRR) of CVE during the high-risk period was 19.9 (CI 15.5-25.9) compared to the pre-RSV period, p< 0.0001. IRR of CVE during late-risk period was 1.55 (CI 1.1-2.1) compared to pre-RSV period, p=0.003. Increased troponins occurred in 34% and high BNP in 62% of those tested. Total number of Cardiovascular Events (CE) was 270 events in 167 patients. CHF – congestive heart failure new onset or decompensation requiring intervention; STEMI/NSTEMI – ST-Elevation Myocardial Infarction, Non-ST Elevation Myocardial Infarction; Afib/Aflutter – Atrial Fibrillation or Atrial Flutter new onset or with rapid ventricular response requiring intervention; SVT – supraventricular tachycardia requiring intervention; VT/NSVT/PEA – Ventricular Tachycardia, Non-sustained Ventricular Tachycardia, Pulseless Electrical Activity; PE/DVT – Pulmonary embolism, Deep Venous Thrombosis; CVA – Cerebrovascular Accident. Conclusion RSV infection is associated with decompensation of chronic cardiac conditions as well as new CVEs with effects persisting past a traditional 28-day risk period. Prevented CVEs should be assessed in upcoming adult RSV vaccine effectiveness studies. Disclosures Edward E. Walsh, MD, Enanta: Advisor/Consultant|Enanta: Honoraria|GSK: Advisor/Consultant|Janssen: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support Angela R. Branche, MD, Cyanvac: Grant/Research Support|GSK: Advisor/Consultant|Merck: Grant/Research Support|Moderna: Grant/Research Support|Moderna: Honoraria|Novavax: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi: Honoraria|VaxCo: Grant/Research Support Ann R. Falsey, MD, ADMA: Board Member|BioFire Diagnostics: Grant/Research Support|CyanVac: Grant/Research Support|GSK: Advisor/Consultant|GSK: Travel support|Janssen: Grant/Research Support|Moderna: Advisor/Consultant|Moderna: Grant/Research Support|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant|Sanofi Pasteur: Travel support|VaxCo: Grant/Research Support

Early and late outcomes of emergency coronary bypass grafting in non-ST-segment elevation acute myocardial infarction

The majority of patients undergoing emergency coronary artery bypass grafting for non-ST-segment elevation myocardial infarction are of advanced age and have many comorbidities, which pose challenges for operation. This study aimed to determine the early and midterm outcomes of this subgroup. The study conducted a retrospective analysis on 89 patients who experienced non-ST-elevation acute myocardial infarction and underwent emergency coronary artery bypass graft surgery at Hanoi Heart Hospital in Hanoi, Vietnam, between January 1, 2020, and December 31, 2022. The primary outcome variable was in-hospital mortality, and the secondary outcome variable was midterm mortality. The mean age of the cohort was 66.4 years. Female accounted for 31.46%. Over half of patients (53.9%) were operated on within 24 hours from the onset of symptoms. The average European System for Cardiac Operative Risk Evaluation (EuroSCORE II) was 10.55%. The number of coronary bypasses was 3.4. Aortic cross-clamp and cardiopulmonary bypass times were 64.2 and 94.4 minutes. The in-hospital mortality rate was 10.11%. Significant predictors determining in-hospital mortality were the EuroSCORE II score. The mean follow-up time was 28.2±12.2 months. Survival rates at 1 year and 2 years were 97.5% and 96.02%, respectively. Emergency coronary bypass surgery in patients with non-ST segment elevation myocardial infarction had poor early but good midterm outcomes. A high EuroSCORE II score was a predictor of in-hospital mortality.

Impact of Nurse Practitioners on Guideline-Directed Medical Therapy at Discharge on Patients with Recent Acute Coronary Syndrome after Coronary Artery Bypass Graft Surgery

Background: Skills and knowledge of acute care nurse practitioners (ACNPs) are important resources within the healthcare team. Few studies have been conducted on their impact in terms of adherence to guideline-directed medical therapy (GDMT) at the time of discharge. Methods: A retrospective cohort study of 160 patients with a diagnosis of recent acute coronary syndrome (ACS) prior to coronary artery bypass graft surgery in Eastern Canada was conducted. Eighty randomly selected patients in each group were compared, one led by the physicians, and the other with the presence of ACNPs within the team. Results: In the physician-led group, adherence to GDMT at discharge was not reached in 47 patients versus six in the group with ACNPs (58.8% vs. 7.5%; χ2 (1) = 45.58; p = 0.0001). Of the 47 non-adherent patients, 29 suffered a nonST segment elevation myocardial infarction. The main reason for non-adherence in both groups was the omission of dual antiplatelet therapy prescription. Mean length of stay in hours was longer in the physician-led group than in the group with ACNPs (148.1 vs. 127; F (1, 158) = 2.053; p = 0.154). At 30 days, returns to the emergency department (9 vs. 16; χ2 (1) = 2.323, p = 0.127) and readmissions (4 vs. 8; χ2 (1) = 1.441, p = 0.230) for cardiac surgery complications were not statistically different between both groups. Conclusion: On a cardiac surgery unit, the ACNP is a valuable addition with respect to adherence to GDMT at discharge in an ACS population post surgical revascularization.

Newly defined biomarker for the no reflow phenomenon in patients with non-ST elevation acute coronary syndrome; uric acid to creatinine ratio

Background The present study aimed to investigate whether newly defined serum uric acid (SUA) to serum creatinine ratio (SUA/SCr) predicts no-reflow phenomenon (NRP) development in patients with non-ST-elevated acute coronary syndrome (NSTE-ACS). Methods The study group was divided into two groups: those who developed NRP and those who did not. Complete blood counts, SUA, serum creatinine, C-reactive protein (CRP) and albumin were obtained at admission. The SUA/SCr, SUA to albumin ratio (UAR), C-reactive protein to albumin ratio (CAR) and systemic immune inflammation (SII) index values of all patients were calculated and their relationships with NRP were evaluated. Results Patients with NRP had higher mean SUA/SCr ratio (7.19 ± 2.14 vs 5.30 ± 1.70, p < 0.001), mean UAR (1.73 ± 0.69 vs 1.38 ± 0.47, p < 0.001), median CAR (1.73 vs 1.54, p = 0.002), and median SII index (861.9 vs 730.9, p = 0.015) levels than in those who did not develop NRP. According to multivariant analysis models, SUA/SCr ratio, UAR, CAR and SII index were found to be independent predictors of NRP development (p < 0.05 for all) but only the area under the curve (AUC) for SUA/SCr ratio (AUC = 0.73, p < 0.001) was above the 0.70 proficiency level, performing markedly better than the other evaluated parameters. A SUA/SCr ratio ≥5.34 predicted the NRP with 75% sensitivity and 55% specificity. Conclusion SUA/SCr ratio can be used as a reliable marker in prediction the development of NRP in NSTE-ACS patients.

Relationship between ECG-derived T-wave amplitude and T/R ratio and Syntax score in patients with acute non-st segment elevation myocardial infarction.

Our objective was to determine the diagnostic significance of a low T-wave amplitude (TWA) and T/R ratio, defined as the amplitude ratio between the T waves and the R waves, in patients with acute non-ST elevation myocardial infarction (ANSTEMI). Syntax score (SS) shows the extension of coronary artery disease. Previously, low TWA and T/R ratios were demonstrated to be inversely proportional to the risk of sudden cardiac arrest in different cardiac disease conditions. 266 patients were retrospectively included with ANSTEMI between July 2021 and December 2022. SS-1 and SS-2 scores were calculated using the angiographic and clinical data of the patients. The patients were stratified into tertiles based on their median SS-1 scores as lower, moderate, and higher SS-1 tertiles. ECG parameters, including TWAs and T/R ratios in leads II and V5, were measured digitally. TWA and T/R ratios were compared with SSs among the tertiles. TWA and T/R ratios in leads II and V5 were significantly lower across the increasing SS-1 tertiles (p<0.001 for TWA in lead II) (p<0.001 for T/R ratio in lead II) (p=0.014 for TWA in lead V5) (p=0.002 for T/R ratio in lead V5).ROC analysis identified T/R ratios in leads II and V5 of 0.254 (AUC: 0.758, p<0.001) and 0.201 (AUC: 0.635, p<0.015), respectively. A low T/R ratio, particularly in lead II due to its greater AUC, better predicts moderate-to-high SS-1 in patients with ANSTEMI.

Elevated Plasma Nitrate Levels in Patients with Acute Coronary Syndrome.

Acute coronary syndrome (ACS) encompasses a spectrum of coronary artery diseases, including unstable angina, non-ST segment elevation myocardial infarction, and ST-segment elevation MI. At present, ACS is a major cause of mortality and morbidity in the community. The diagnosis of ACS is of critical importance for guiding appropriate therapeutic strategies, although this can be onerous if the standard presenting manifestations are lacking. While high-sensitivity cardiac troponin (hs-cTn) is a proven biomarker of ACS, additional markers to support the clinical diagnosis could be valuable. Since nitrate metabolism is crucial to the vasomotion of coronary arteries, in this study, we compared the plasma nitrate levels in consecutive patients with ACS and healthy volunteers. Systemic hemodynamic parameters were also compared between the groups. The pulse wave velocity of individuals with ACS was higher than that in healthy volunteers, thereby verifying the association between coronary artery disease and a loss of vascular elasticity in the circulatory system. Notably, median plasma nitrate levels were significantly higher in patients with ACS compared to healthy volunteers. Although plasma nitrate levels seem to be higher in patients with ACS, whether this finding is incidental, contributory, or a consequential factor in the pathogenesis of ACS remains to be determined.

Relationship between renal dysfunction, left ventricular diastolic dysfunction and coronary atherosclerosis in patients with non-ST segment elevation acute coronary syndrome

Relationship between renal dysfunction, left ventricular diastolic dysfunction and coronary atherosclerosis in patients with non-ST segment elevation acute coronary syndrome

Typical rise and fall pattern of cardiac Troponin I in diagnosing non-St elevation acute coronary syndrome in patients admitted with chest pain

Typical rise and fall pattern of cardiac Troponin I in diagnosing non-St elevation acute coronary syndrome in patients admitted with chest pain

Elevated miRNA-499 Levels in Early Phase of Non-ST Elevation Acute Coronary Syndromes Predict Increased Long-Term Risk of Major Adverse Cardiac Events.

Background/Objectives: Available data suggest the diagnostic potential of testing microRNAs (miRs) in myocardial infarction, but their prognostic value remains unclear. To evaluate the prognostic value of circulating miRs (miR-1, miR-21, miR-133a, miR-208 and miR-499) for predicting major adverse cardiac events (MACEs), including death, non-fatal myocardial infarction (MI) or cardiovascular rehospitalization, in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS). Methods: Our prospective, single-center, observational study included patients (pts) with NSTE-ACS admitted <24 h after symptoms onset and pts with confirmed stable coronary artery disease (SCAD) as controls. Relative expression of miRs was calculated, and subjects were categorized according to miRs expression on hospital admission into two groups (≤median and >median). Results: Overall, 103 NSTE-ACS (52 NSTEMI/51 UA) and 47 SCAD pts (median age 66 years, 67% male) were included. During the median 895 (581-1134) days of the follow-up, MACE occurred in 75 (50%) patients: 20 (13%) died, 28 (19%) presented with MI, and 65 (43%) were readmitted due to cardiovascular reasons. Incidence of MI, rehospitalization and MACE was significantly higher in pts with elevated (>median) miR-499 [MI: 34.3% vs. 7.3%; HR = 6.0 (2.8-12.7) for rehospitalization; 53.7% vs. 36.2%, HR = 2.3 (1.4-3.8) for MACE; 62.7% vs. 42%, HR = 2.4 (1.5-3.8)] for hospital readmission. In the Cox proportional hazards regression model, miR-499 expression above the median level [HR = 1.8 (1.1-3.1)], high-sensitivity cardiac troponin T [HR = 1.2 (1.02-1.5)], diabetes [HR = 1.7 (1.1-2.8)] and percutaneous intervention during hospital stay [HR = 2.1 (1.1-3.8)] were identified as independent predictors of MACE in long-term observation, even after adjustment for covariates. Conclusions: Elevated miR-499 level on hospital admission in NSTE-ACS is related to an increased rate of MACE in the 2.5-year follow-up.

Association Between Systemic Immune-Inflammation Index and Outcomes of Acute Myocardial Infarction: A Systemic Review and Meta-Analysis.

Objective: To assess the link between systemic immune-inflammation index (SII) and risk of major adverse cardiovascular events (MACE), contrast-induced nephropathy (CIN), and overall mortality in patients with acute myocardial infarction (AMI). Patients and Methods: Electronic search of PubMed, EMBASE, Web of Science, and Scopus databases was done for observational studies with the data on the association of SII and outcomes, such as MACE, and CIN in adult (≥18 y) patients with AMI. A random-effects model was used, and the pooled effect sizes were expressed as relative risk (RR) with corresponding 95% confidence intervals (CI). Subgroup analysis was conducted on the basis of the type of AMI (ST elevation myocardial infarction and non-ST elevation myocardial infarction), sample size (≥500 and <500), and study design. GRADE assessment was used to evaluate the certainty of the evidence. Results: The analysis included 23 studies. Most studies were conducted in China (n = 13), followed by Turkey (n = 10). Majority of the studies (n = 20) had a retrospective cohort design. Patients with high SII had increased risk of MACE (RR 2.95, 95% CI: 1.25, 6.99; n = 5, I2 = 97.5%), overall mortality (RR 2.59, 95% CI: 1.64, 4.07; n = 6, I2 = 58.0%), and CIN (RR 4.58, 95% CI: 3.44, 6.10; n = 4, I2 = 0.0%), compared with patients with lower SII. Egger's test detected publication bias for MACE (p = 0.047) and overall mortality (p = 0.012) but not for CIN. These associations remained valid in subgroup analysis. Conclusion: Findings suggest that higher SII in patients with AMI is associated with increased risks of MACE, CIN, and overall mortality. This underscores SII's potential as a prognostic marker in AMI.

Retrospective Analysis of the Thai Percutaneous Coronary Intervention Registry: Impacts of Center Volume and Operator Experience on Outcomes.

Percutaneous coronary intervention (PCI) outcomes can vary due to various factors, including patient clinical condition, complexity of coronary lesions, expertise of operators, and quality of the PCI center. This study evaluated the influence of PCI center volume and operator experience on patient outcomes after the procedure. Retrospective data on demographic, clinical details, and outcomes for all patients undergoing PCI across 39 hospitals in Thailand from 2018 to 2019 were retrieved. PCI center volume was categorized based on annual number of interventions: low (< 200), intermediate (200-499), and high (≥ 500). Operator experience was assessed by years of practice (low [< 5] and high [≥ 5]) and the number of PCI cases performed annually (low [< 75] and high [≥ 75]). The evaluated PCI outcomes were: PCI failure; procedural complications; PCI-related in-hospital mortality; 1 year post-intervention all-cause mortality. A total of 19,701 patients who underwent PCI were included in the analysis, of whom 17,432 had follow-up data available after 1 year. Of these, 58.1% presented with either ST-elevation or non-ST elevation myocardial infarction/unstable angina, while 41.9% had stable CAD. Nearly half of the patients had triple-vessel or left-main disease, and 8.7% presented with cardiogenic shock. The percent with PCI failure, procedural complications, PCI-related in-hospital death, and 1-year all-cause mortality were 4.9%, 5.1%, 2.7%, and 11.8%, respectively. Despite patients in higher-risk profiles being treated at high-volume PCI centers and by experienced operators, there were no significant differences in PCI failure, PCI-related in-hospital mortality nor 1-year all-cause mortality compared to those treated at low or intermediate volume PCI centers. However, high-volume PCI centers had procedural complications more frequently (4.7%) than did intermediate (3.9%) and low-volume (2.5%) centers (p < 0.001). After adjusting for confounding factors, no significant associations were found between PCI center volume and PCI outcome. Similarly, no significant relationship was found between operator experience and procedural complications, nor 1-year all-cause mortality. Nevertheless, operators with more years of practice were associated with lower PCI-related in-hospital mortality (odds ratio [95% CI] of 0.75 (0.57, 0.98); p < 0.038). Additionally, operators conducting a higher number of PCIs annually tended to have less PCI failures (odds ratio [95% CI] of 0.76 (0.57, 1.01); p = 0.062). A center's PCI volume did not significantly impact PCI outcome. In contrast, operator experience did impact outcomes. This result highlights areas for improvement and can help reform strategies for national PCI systems at both center and operator levels.

Non-ST elevation acute coronary syndrome with multivessel disease: need for randomized trials.

Non-ST elevation acute coronary syndrome with multivessel disease: need for randomized trials.

Challenges in the Management of Dislodged Coronary Stent Embolization: A Case Report

AbstractAlthough device embolization is a rare complication in percutaneous coronary interventions (PCI), its mortality and morbidity are serious complications. With the increasing prevalence of complicated procedures, invasive cardiologists encounter device embolization daily. Different devices and techniques are utilized to retrieve these devices. Most devices used during PCIs are infection stents. More infrequently, the tip of diverting wires, angioplasty balloons, or balloon holders may break and embolize distally into the arteries. A 51-year-old man with non-ST elevation myocardial infarction was presented for restoration of the ring of the stent, which was stripped in the first diagonal ostium, with snare communication. The patient had an anterior myocardial infarction and underwent stent implantation in the left anterior descending artery (LAD) 1 month ago. While the stripped stent was being retracted, the LAD stent had been inserted, causing the stent implanted a month ago to be retracted. Additionally, the dissection was observed in the proximal LAD, and the procedure was terminated by stenting the LAD-Diagonal bifurcation lesion using the mini-crush technique. This case report highlights the importance of constant vigilance that invasive cardiologists must show when removing the embolized device. The maturity of the technique depends on the operator's experience with the methods of use and the material possibilities in the laboratory.

Accuracy of dynamic stress CT myocardial perfusion in patients with suspected non-ST elevation myocardial infarction

Coronary CT angiography (CCTA) and dynamic stress CT myocardial perfusion (CT-MPI) are established modalities in the analysis of patients with chronic coronary syndromes. Their role in patients with suspected non-ST elevation myocardial infarction (NSTEMI) is unknown. CCTA with CT-MPI might assist in the triage of NSTEMI patients to the Cath lab. We investigated the correlation of significant epicardial lesions by CT-MPI in addition to CCTA compared to invasive coronary angiography (ICA) with fractional flow reserve (FFR) in patients with NSTEMI. Twenty NSTEMI patients scheduled for ICA were enrolled in this study with planned ICA. CCTA and CT-MPI was performed pre-ICA. For each coronary artery, the presence or absence of significant lesions was interpreted by CCTA with CT-MPI, using an FFR of ≤ 0.8 or angiographic culprit (stenosis > 90%, suspected plaque rupture) as reference. The main outcome was the per-vessel correlation. Sixteen out of 20 patients had a culprit lesion that required immediate revascularization. CCTA with ≥ 50% stenosis demonstrated a per vessel sensitivity and specificity for the detection of significant stenosis of respectively 100% (95% CI: 86–100%) and 75% (95% CI: 58–88%). CCTA with CT-MPI showed a lower sensitivity 90% (95% CI: 70–99%) but higher specificity of 100% (95% CI: 90–100%). CCTA with CT-MPI exhibits a strong correlation for identifying significant CAD in patients with NSTEMI. Thereby, it might assist in the triage of ICA in NSTEMI patients.

The Prognostic Value of Bendopnea In-Hospital Mortality In Patients With Acute Coronary Syndrome

Background: Bendopnea, also known as flexi-dyspnea, has recently been defined as the development of shortness of breath within 30 seconds by bending forward in patients with systolic and decompensated heart failure. There is no clear data in the literature regarding acute coronary syndrome (ACS) patients and in-hos-pital mortality. This study investigated the effect of the presence of bendopnea on in-hospital mortality in ACS patients. Materials and Methods: A cross-sectional analysis was conducted on patients admitted with ACS (unstable angina and non-ST elevation myocardial infarction (NSTEMI)) between March 2023 and January 2024. The presence of orthopnea, bendopnea, paroxysmal nocturnal dyspnea PND and venous jugular distention (VJD) recorded. Coronary angiography was performed in all patients. A total of 395 patients were enrolled in this study. Results: The patients were divided into 2 groups as living and deceased. The deceased group was significantly older. Bendopnea, PND, and orthopnea were statistically higher in the deceased group. left ventricular ejec-tion fraction(LVEF) was statistically lower, syntax score was statistically higher in the deceased group. Age (%95 CI:1.254-1.627 , OR: 1.411 p:0.001), uric acid (%95 CI: 1.151-1.394 OR: 1.278 p:0.001), bendopnea (%95 CI: 1.285-1.611 OR: 1.452 p: 0.001), syntax score (%95 CI: 1.103-1.358 OR: 1.258 p:0.001) were shown to be independent risk factors for mortality. Conclusions: The presence of bendopnea in patients with ACS may be closely associated with in-hospital mor-tality.

Chest Pain Risk Stratification in the Emergency Department and Prediction of Major Adverse Cardiac Events Using HEART Score

Introduction: Acute coronary syndrome (ACS) should be identified from various cardiac and noncardiac causes of chest pain. Non-ST segment elevation (NSTE-ACS) diagnosis can be done immediately in the case of typical changes in the electrocardiogram (ECG) and/or increased levels of myocardial markers, the absence of such variation does not always exclude NSTE-ACS. NSTE-ACS in its early stages difficult to diagnose. To stratify the risk of chest pain, aid early diagnosis, and prediction of outcome HEART score was designed. Components of the HEART score are history, ECG, age, risk factors, and troponin. The objectives of the study are risk stratification of chest pain in ED, prediction of MACE, validate the HEART Score in risk stratification of chest pain, and deciding on the discharge of patients. Materials and methods: This was a hospital-based, prospective study involving 220 patients who were admitted and discharged according to risk stratification using the HEART score. Patients are followed up over six weeks for prediction of MACE. MACE includes AMI, PCI, CABG, or death. The collected data were analysed with SPSS version 26.0, IBM Corp, Chicago, Illinois, USA. P value ≤.05 is considered as significant. Results: Out of 220 patients, 51 reached MACE. Low-risk HEART scores were seen in 25% of patients and No MACE occurred in these patients. Intermediate risk HEART scores were seen in 53% of patients and MACE occurred in 9.3% of patients. High-risk HEART scores were seen in 22% of patients and MACE occurred in 83% of patients. Conclusion: HEART score is helpful in risk stratification of chest pain in our study. It also aids in early diagnosis of intermediate and high-risk groups. HEART score also helps in decision-making to discharge patients. Thus, HEART score provides a quick and reliable prediction of outcomes in chest pain and should be used in ED.

Diagnostic accuracy of two-dimensional strain imaging echocardiography to detect severity of coronary artery disease in non-ST segment elevation myocardial infarction

Diagnostic accuracy of two-dimensional strain imaging echocardiography to detect severity of coronary artery disease in non-ST segment elevation myocardial infarction

When acute myocardial infarction meets renal abscess: Case report and literature review.

Acute myocardial infarction (AMI) is the leading global cause of death from cardiovascular disease, and the mortality rate increases in the presence of comorbidities such as renal abscess. The treatment of AMI combined with renal abscess is challenging, especially in combination with urinary tract obstruction, as percutaneous coronary intervention (PCI) can lead to progression of the renal abscess and deterioration of renal function. Currently, there is no consensus on the treatment of renal abscess in AMI. We reported a case of a 74-year-old male patient with acute non-ST-segment elevation myocardial infarction combined with urinary tract obstruction. During his hospitalization, the hydronephrosis progressed to a renal abscess, which we punctured and drained. He ultimately underwent twice PCI and surgical relief of the ureteral obstruction shortly thereafter. He was diagnosed with acute non-ST elevation myocardial infarction on admission, unfortunately, his hydronephrosis progressed into a renal abscess after the first PCI, which made further treatment difficult. We performed 2 coronary angiography examinations and implanted a stent in the stenotic coronary artery during the second procedure, which was preceded by an aggressive regimen of antibiotics and puncture and drainage of the renal abscess, which set the stage for the second PCI. We successfully performed coronary revascularisation to treat his coronary artery disease. One month later, his renal abscess drain was removed and the ureteral obstruction was finally resolved after undergoing percutaneous nephrolithotripsy for ureteral stone extraction. The occurrence of renal abscesses is rare and may be unavoidable in those patients with preexisting structural lesions in the urinary tract where coronary angiography will increase the incidence of renal abscesses. Aggressive anti-infective therapy and drainage of pus by puncture will help the renal abscess to heal, and repeat coronary angiography has been shown to be safe in the meantime.

Identification of Pre-Heart Failure in Early Stages: The Role of Six Stages of Heart Failure.

Despite increased availability of effective drug therapy for treatment of heart failure (HF), the morbidity and mortality in chronic heart failure (CHF) are unacceptably high. Therefore, there is an urgent need to ascertain new imaging techniques to identify early sub-clinical forms of cardiac dysfunctions, to guide early relevant treatment. It seems that all the behavioral risk factors-such as tobacco, alcoholism, Western-type diet, sedentary behavior and obesity, emotional disorders, and sleep disorder are associated with early cardiac dysfunction, which may be identified by speckle-tracking echocardiography (STE). Cardiac remodeling can also occur chronologically in association with biological risk factors of CHF, such as diabetes mellitus (DM), hypertension, cardiomyopathy, valvular heart disease, and coronary artery disease (CAD). In these conditions, twisting and untwisting of the heart, cardiac fibrosis, and hypertrophy can be identified early and accurately with 2-Dimentional (2D) and 3D echocardiography (2D echo and 3D echo) with tissue Doppler imaging (TDI), strain imaging via STE, and cardiac magnetic resonance imaging (CMR). Both 2D and 3D echo with STE are also useful in the identification of myocardial damage during chemotherapy and in the presence of risk factors. It is possible that global longitudinal systolic strain (GLS) obtained by STE may be an accurate marker for early identification of the severity of CAD in patients with non-ST segment elevation MI. Left ventricular ejection fraction (LVEF) is not the constant indicator of HF and it is normal in early cardiac dysfunction. In conclusion, this review suggests that GLS can be a useful early diagnostic marker of early or pre-cardiac dysfunction which may be treated by suitable drug therapy of HF along with the causes of HF and adhere to prevention strategies for recurrence. In addition, STE may be a superior clinical tool in the identification of cardiac dysfunction in its early stages compared to ejection fraction (EF) based on conventional echocardiography. Therefore, it is suggested that the chances of either stalling or reversing HF are far better for patients who are identified at an early stage of the disease.

Lorlatinib-associated weight gain and dyslipidaemia: A retrospective analysis and implications for future care

ObjectivesThe objective of our study was to benchmark the incidence and severity of lorlatinib-related weight gain and dyslipidaemia in a real-world context, to guide future therapeutic strategies to mitigate these toxicities. MethodsWe conducted a retrospective, observational analysis of patients with ALK and ROS1-positive NSCLC at a single institution in the UK who were commenced on lorlatinib from 11/2016 to 11/2022. Non-small cell lung cancer (NSCLC) patients prescribed lorlatinib were identified through institutional electronic pharmacy records. Descriptive analyses were conducted. Patients without recorded baseline weight were excluded from the analysis. Changes in weight, body mass index (BMI), triglycerides, and total/low-density lipoprotein (LDL)/high-density lipoprotein (HDL) cholesterol were calculated from serial measurements and graded in accordance with CTCAE v5.0. Results43 patients were evaluated. 81 % of patients developed weight gain on lorlatinib (median: 4.5 kg, 6.5 % increase from baseline); Grade < 1 in 37 % (n = 16/43), Grade 1 in 23 % (n = 10/43), Grade 2 in 12 % (n = 5/43), and Grade ≥ 3 in 9 % (n = 4/43). BMI increase was observed in 79 % of patients. 35 % of patients with healthy baseline BMI moved into overweight/obese categories.Of patients with recorded baseline lipid levels, 91 % developed increase in total cholesterol, and 68 % an increase in triglycerides, respectively. 7 % (n = 1/15) patients with normal baseline total cholesterol developed Grade ≥ 3 elevated cholesterol; no patients with normal baseline triglycerides developed Grade ≥ 3 elevated hypertriglyceridaemia (n = 12). Median time to onset of total cholesterol elevation was 21 days. Lipid-lowering therapy was required in most patients (86 %). One patient developed a non-ST elevation myocardial infarction (NSTEMI) which may have been attributable to lorlatinib. ConclusionWeight gain and dyslipidaemia are commonly observed with lorlatinib, highlighting the need for effective pharmacologic and non-pharmacologic strategies to manage these toxicities. Rates were similar to those reported in the CROWN trial. Given the 60 % 5-year progression-free survival (PFS) demonstrated in CROWN, mitigation of treatment-related toxicities is paramount to minimise impact on patient quality of life (QOL) and cancer-independent morbidity in this subgroup of NSCLC patients with favourable outcomes.