Peripheral Arterial Embolism Research Articles

Novel radiopaque ethanol injection: physicochemical properties, animal experiments, and clinical application in vascular malformations

BackgroundDespite the efficacy of absolute ethanol (EtOH), its radiolucency introduces several risks in interventional therapy for treating vascular malformations. This study aims to develop a novel radiopaque ethanol injection (REI) to address this issue.MethodsIopromide is mixed with ethanol to achieve radiopacity and improve the physicochemical properties of the solution. Overall, 82 male New Zealand white rabbits are selected for in vivo radiopacity testing, peripheral vein sclerosis [animals were divided into the following 5 groups (n = 6): negative control (NC, saline, 0.250 ml/kg), positive control (EtOH, 0.250 ml/kg), low-dose REI (L-D REI, 0.125 ml/kg), moderate-dose REI (M-D REI, 0.250 ml/kg), and high-dose REI (H-D REI 0.375 ml/kg)], pharmacokinetic analyses (the blood sample was harvested before injection, 5 min, 10 min, 20 min, 40 min, 1 h, 2 h, 4 h, and 8 h after injection in peripheral vein sclerosis experiment), peripheral artery embolization [animals were divided into the following 5 groups (n = 3): NC (saline, 0.250 ml/kg), positive control (EtOH, 0.250 ml/kg), L-D REI (0.125 ml/kg), M-D REI (0.250 ml/kg), and H-D REI (0.375 ml/kg)], kidney transcatheter arterial embolization [animals were divided into the following 4 groups (n = 3): positive control (EtOH, 0.250 ml/kg), L-D REI (0.125 ml/kg), M-D REI (0.250 ml/kg), and H-D REI (0.375 ml/kg); each healthy kidney was injected with saline as negative control], and biosafety evaluations [animals were divided into the following 5 groups (n = 3): NC (0.250 ml/kg), high-dose EtOH (0.375 ml/kg), L-D REI (0.125 ml/kg), M-D REI (0.250 ml/kg), and H-D REI (0.375 ml/kg)]. Then, a prospective cohort study involving 6 patients with peripheral venous malformations (VMs) is performed to explore the clinical safety and effectiveness of REI. From Jun 1, 2023 to August 31, 2023, 6 patients [age: (33.3 ± 17.2) years] with lingual VMs received sclerotherapy of REI and 2-month follow-up. Adverse events and serious adverse events were evaluated, whereas the efficacy of REI was determined by both the traceability of the REI under DSA throughout the entire injection and the therapeutic effect 2 months after a single injection.ResultsThe REI contains 81.4% ethanol (v/v) and 111.3 mg/ml iodine, which can be traced throughout the injection in the animals and patients. The REI also exerts a similar effect as EtOH on peripheral venous sclerosis, peripheral arterial embolization, and renal embolization. Furthermore, the REI can be metabolized at a similar rate compared to EtOH and Ultravist® and did not cause injury to the animals’ heart, liver, spleen, lungs, kidneys and brain. No REI-related adverse effects have occurred during sclerotherapy of VMs, and 4/6 patients (66.7%) have achieved complete response at follow-up.ConclusionIn conclusion, REI is safe, exerts therapeutic effects, and compensates for the radiolucency of EtOH in treating VMs.Trial registrationThe clinical trial was registered as No. ChiCTR2300071751 on May 24 2023.

Risk of death and thromboembolic events in patients with supraventricular arrhythmias admitted to the emergency department

Abstract Background Few data are available on the risk of death and thromboembolism in patients with supraventricular tachycardia (SVT). Purpose To assess the risk of adverse events in SVT patients admitted to the emergency department (ED). Methods Retrospective study utilizing a global federated health research network (TriNetX). Based on the ICD codes recorded at the ED admission, patients were categorized in: SVT (I41.1), atrial fibrillation (AF, I48.0,1,2,91), atrial flutter (I48.3,4,92), and a control group with palpitations (R00.2) without arrhythmias (CTRL). Primary outcome was the 1-year risk of a composite of all-cause death and thromboembolism (ischemic stroke, transient ischemic attack, and peripheral arterial embolism). Secondary outcomes were the 1-year risk of each component of the composite outcome. Cox-regression analysis was used to produce hazard ratios (HRs) and 95% confidence intervals (CI) after 1:1 propensity score matching (PSM). The exploratory analysis was performed to assess the risk of first episode of thromboembolism. Other sensitivity analyses were performed to validate the results of the main analysis in patients ≥65 years, with multimorbidity, and not on oral anticoagulation (OAC). Results We identified 37,793 SVT patients (58.5±19.2 years, 55.8% females), 239,490 AF patients (70±19.2 years, 47.3% females), 20,674 atrial flutter patients (68.6±15.1, 15.1% females), and 89,152 CTRL (43.5±17.8 years, 60.1% females). Before PSM, in SVT patients the mean age and the prevalence of cardiovascular risk factors was lower than AF and atrial flutter patients but higher than CTRL. After PSM, no difference was found among the three groups. After PSM, the risk of composite outcome in SVT patients was higher compared to CTRL (HR 2.80, 95%CI 2.61-3.00), similar to atrial flutter patients (HR 0.98, 95%CI 0.94-1.03), and a lower compared to AF patients (HR 0.85, 95%CI 0.82-0.88) (Figure 1). These results were consistent also for the secondary outcomes, for the risk of the first thromboembolic event (Figure 2), and in all the sensitivity analyses. Conclusion SVT patients have a risk of death and thromboembolism comparable to those with atrial flutter, but lower than AF. Further studies are needed to evaluate the possible beneficial effect of OAC in this clinical context.Figure 1Figure 2

Five-Year Trends of Vascular Disease-Related Amputations in Romania: A Retrospective Database Study.

Background/Objectives: Lower extremity amputations (LEAs) are a burdensome complication of peripheral artery disease (PAD) and/or arterial embolism and thrombosis (AET). We assessed the trends in PAD- and/or AET-related LEAs in Romania. Methods: This retrospective study (2015-2019) analyzed data on minor and major LEAs in hospitalized patients recorded in the National School for Public Health, Management, and Health Education database. The absolute numbers and incidences of LEAs were analyzed by diagnosis type, year, age, sex, and amputation level. Results: Of 38,590 vascular disease-related amputations recorded nationwide, 36,162 were in PAD and 2428 in AET patients. The average LEA incidence in the general population was 34.73 (minimum: 31.96 in 2015; maximum: 36.57 in 2019). The average incidence of major amputations, amputations above the knee, hip amputations, amputations below the knee, and minor amputations was 16.21 (15.62 in 2015; 16.84 in 2018), 13.76 (13.33 in 2015; 14.28 in 2018), 0.29 (0.22 in 2017; 0.35 in 2019), 2.15 (2.00 in 2015; 2.28 in 2019), and 18.52 (16.34 in 2015; 20.12 in 2019), respectively. Yearly PAD- and/or AET-related amputations were significantly higher in men versus women. The overall number of LEAs increased with age, particularly in patients ≥ 70 years. The increase in the total number of amputations was mainly due to a constant rise in minor amputations for both groups, regardless of gender. Conclusions: PAD- and/or AET-related LEAs in Romania increased from 2015 to 2019, with men having a greater incidence than women. Raising awareness and effective management strategies are needed to prevent LEAs.

Early Mortality, Cardiovascular, and Renal Diseases in Women's Lives Following Hypertensive Disorders of Pregnancy: The Prospective Nationwide Study CONCEPTION.

We aimed to evaluate the impact of hypertensive disorders of pregnancy occurrence, recurrence, onset time, and severity on mortality and on a wide range of cardiovascular outcomes in France. CONCEPTION (Cohort of Cardiovascular Diseases in Pregnancy) is a French nationwide prospective cohort using data from the National Health Data System. We included all women in CONCEPTION with no history of a cardiovascular event who delivered in France for the first time between 2010 and 2018 (N=2 819 655). Hypertensive disorders of pregnancy and cardiovascular outcomes during the study follow-up were identified using algorithms combining International Classification of Diseases, Tenth Revision (ICD-10) coded diagnoses during hospitalization and purchases of medication between 2010 and 2021. We fitted Cox models with time-varying exposure to assess the associations of hypertensive disorders of pregnancy with mortality and cardiovascular events. Women with gestational hypertension had a 1.25- to 2-fold higher risk of stroke, acute coronary syndrome, peripheral arterial disease, pulmonary embolism, and chronic kidney disease, and a 2- to 4-fold higher risk of rhythm and conduction disorder and heart failure. Women with preeclampsia had a 1.35- to 2-fold higher risk of rhythm or conduction disorder and pulmonary embolism during follow-up; a 2- to 4-fold higher risk of stroke, acute coronary syndrome, and peripheral arterial disease; and a 7- to 9-fold higher risk of heart failure and chronic kidney disease. They were 1.8 times more likely to die and 4.4 times more likely to die of cardiovascular causes. Hypertensive disorders of pregnancy drastically increase the risk of mortality, cardiovascular, and renal events early after pregnancy. Recurrent, severe, and early-onset preeclampsia further increases this risk.

Rapidly developing massive thromboembolism and death due to anticoagulant dose reduction in a patient with atrial fibrillation: case Report

Atrial fibrillation is one of the cardiac arrhythmias that can cause fatal complications. Patients diagnosed with atrial fibrillation face complications such as ischemic stroke, peripheral vascular embolism and pulmonary embolism if they are not under regular and strict treatment follow-up. In this case, in a 73-year-old woman with atrial fibrillation who was not receiving regular treatment, sudden onset of leg pain followed by rapid onset of dyspnea was clinically suggestive of acute peripheral arterial embolism followed by massive pulmonary embolism. The patient was tachypneic and confused at the time of presentation to the emergency department. After intubation with sedation and analgesia, radiologic imaging was obtained for possible complications secondary to atrial fibrillation. As a result, the patient had an embolus starting from the level of the abdominal aorta, extending to the right renal artery and spreading to the entire right iliac artery. The lung tissue showed bilateral acute lung injury without pulmonary embolism. In this case, we wanted to emphasize the importance of the subject by sharing the rapidly developing embolism and death process with the reduction of the anticoagulant dose used in the treatment of atrial fibrillation.

Impact of atrial fibrillation on mortality and non-fatal cardiovascular outcomes in 152 638 patients admitted with congestive cardiac failure: a statewide population-linkage study

Abstract Background Congestive cardiac failure (CCF) and atrial fibrillation (AF) frequently co-exist, cause and exacerbate each other. Prior studies on the impact of AF in CCF patients yielded mixed findings. Purpose This study aims to examine the impact of AF on long-term outcomes including MACE (major adverse cardiovascular events defined as all-cause mortality and major cardiovascular outcomes including myocardial infarction, ischaemic stroke, CCF or revascularization) and other non-fatal vascular or bleeding outcomes in patients admitted with CCF. Methods Hospitalised patients in New South Wales (NSW), the largest state of Australia, from 1 July 2003 to 31 March 2021 with a primary diagnosis of CCF were identified from the statewide Admitted-Patient-Data-Collection database, stratified by AF (Prior-AF or New-AF during index CCF admission) and No-AF status, with follow-up until 31 March 2022. A linkage look-back to year-2001 was performed to identify prior-AF history. In addition to MACE, non-fatal outcomes assessed included recurrent admission with AF, haemorrhagic stroke, peripheral arterial thromboembolism, pulmonary embolism, and bleeding. Multivariable Cox regression was performed to assess the impact of AF on MACE. To account for the competing risk of death and assess the impact of AF on non-fatal cardiovascular outcomes, Fine-Gray competing risk analysis was performed. Results The cohort comprised 152 638 admitted CCF patients (median age: 80.4 years; 51.4% males): New-AF, n=16 371 (10.7%); Prior-AF, n=56 546 (37.0%) (Table 1). During a median follow-up of 2.5 years, compared to No-AF CCF patients, those with New-AF or Prior-AF had significantly higher rates of MACE (New-AF: 81.7% vs Prior-AF: 86.3% vs No-AF: 78.5%) driven by all-cause mortality (New-AF: 71.6% vs Prior-AF: 76.5% vs No-AF: 66.2%) (both logrank P<0.001). However, after adjusting for differences in baseline characteristics and admission year-groups, New-AF and Prior-AF status had differential impact on MACE compared to No-AF patients (adjusted hazard ratio [aHR]=0.93, 95% confidence interval [CI]=0.91-0.94; aHR=1.14, 95%CI=1.13-1.16 respectively; both P<0.001). Results were similar for all-cause death (aHR=0.94 and aHR=1.16 respectively; both P<0.001). Competing risk analyses showed that rehospitalisation for ischaemic stroke, AF, haemorrhagic stroke, peripheral arterial thromboembolism and bleeding were significantly higher in CCF patients with New-AF and Prior-AF (P<0.001), after adjusting for age, sex, referral source, year-groups, intensive-care-unit admission and Charlson comorbidities index (Table 2). Conclusion This study shows that AF status has a differential impact on clinical outcomes in patients admitted with CCF. Drivers behind this difference in outcomes require further study and strategies should be developed to minimise the risk of adverse clinical outcomes in this vulnerable group of patients.Table 1.Baseline characteristicsTable 2.Non-fatal CV outcomes

A patient with acute myocardial infarction with acute lower extremity arterial embolization underwent amputation under general anesthesia.

Acute peripheral and coronary artery embolism are common complications of diabetes mellitus and greatly affect the clinical outcome of patients with diabetes; however, there are few reports about the symptoms and prognosis of patients with acute myocardial infarction (AMI) and concurrent acute lower extremity arterial embolism (ALEAE). A 44-year-old man with a history of 4 years of type 1 diabetes was admitted to hospital after suddenly experiencing severe pain in his right lower limb and feeling tightness in the left anterior chest area. Ultrasonography revealed distal occlusion of the right superficial femoral artery, and an electrocardiogram showed acute anterior interstitial myocardial infarction. After conservative treatment for 2 days, the patient had severe necrosis of the lower limbs and secondary injury of multiple organs. Haemodialysis and heparin anticoagulant therapy were performed before amputation. Twelve days after the operation, the patient's condition was stable, and he was transferred out of the intensive care unit. If patients with ALEAE miss the opportunity for early treatment, even with AMI, emergency amputation under general anaesthesia is the right strategy to save lives.

Shaggy aorta-An autopsy analysis.

Shaggy aorta is defined as "very extensive atheromatous disease with diffuse ulcers associated with soft, loosely held debris and a paucity of actual thrombus" and often results in visceral or peripheral arterial embolization (shaggy aorta syndrome). Most of the studies are clinico-radiological with hardly any assessment of the pathological features. We present an autopsy analysis of shaggy aorta. A retrospective study of autopsied cases of shaggy aorta over 15 years was conducted. The involvement of the various segments of the aorta (ascending, transverse, thoracic, and abdominal) was correlated with the clinical manifestations and cardiac/extra-cardiac findings at autopsy. The mortality was categorized as those related to shaggy aorta (Group I), related to cardiac diseases (Group II), and those unrelated to cardiovascular diseases (Group III). Nil. In a span of 15 years, there were 76 cases of shaggy aorta affecting predominantly males (85.5%) and patients in the sixth decades of life (mean age of 64.5 years). The important associated cardiovascular risk factors included hypertension, tobacco use, and diabetes mellitus. Predominant involvement of the entire aorta and arch + descending aorta was seen in 39.5% and 35.5% of the cases, respectively. Regardless of extreme severity, only half of the patients (37 cases, 48. 7%) had clinical presentation due to shaggy aorta. The occurrence of shaggy aorta may be more common than expected, and it would be important to keep this possibility in mind even in asymptomatic elderly patients with cardiovascular risk factors since aorto-arterial manipulations and anti-coagulant therapy can prove detrimental in such patients.

Kawasaki disease complicated by peripheral artery thrombosis: a case report and literature review

BackgroundPeripheral gangrene is rarely documented as a possible complication of Kawasaki disease (KD). There are many causes of peripheral gangrene, and the common cause is in situ thrombosis or embolism. Most cases are reported to have regrettable outcomes (amputation or necrotic shedding). Herein, we report the successful management of KD complicated by peripheral artery thrombosis in an older Chinese boy, and a review of all cases of peripheral gangrene in KD in the literature.Case presentationWe found that most of the children with this complication were under 1 year old, had a heavy inflammatory response combined with the use of cortisol and immunoglobulin, and most children had coronary artery lesions. In addition, Peripheral gangrene mainly occurred in the subacute or chronic stage, and the prognosis is poor.ConclusionsIn the presence of high risk factors, we consider it is necessary to monitor coagulation function and administer prophylactic anticoagulation therapy. When peripheral artery thrombosis or embolism occur, heparin and prostaglandins can be used for treatment.

Efficacy and Safety of Left Atrial Appendage Occlusion in Mild Mitral Stenosis Patients with High Bleeding Risk.

Atrial fibrillation (AF) is highly prevalent in patients with mitral stenosis (MS), but the efficacy of left atrial appendage occlusion (LAAO) in these patients remains unclear.The aim of this study was to evaluate the efficacy and safety of LAAO in patients with MS complicated by AF at high risk of bleeding.We recruited patients from September 2015 to September 2018. We compared the 3-year outcomes of LAAO in 21 patients with AF complicated by MS and 42 sex- and age-matched patients with AF without MS.The MS group had more cases of peripheral arterial embolism (28.6% versus 2.4%, P = 0.004), more spontaneous echo contrast (47.6% versus 9.5%, P = 0.001), a larger LAA orifice diameter (P < 0.01), and a slower LAA flow (P < 0.05) than the Non-MS group. The mean size of the selected occluder device was bigger for patients with MS than for patients with Non-MS (29.2 ± 3.7 versus 26.9 ± 3.1 mm, P = 0.014). In the first 45 follow-up days, 2 (9.5%) patients with MS had device-related thrombi (DRT); one of them had transient ischemic attack 24 hours postoperatively. From 45 days to 6 months, one patient in each group had DRT. After 6 months, two patients in the Non-MS group still had residual leaks; one of them had a stroke, with a small DRT. The proportion of dual antiplatelet therapy was higher in the Non-MS group than in the MS group (33.3% versus 4.8%, P = 0.012), but this population had an increased bleeding risk.LAAO is relatively effective and safe for preventing embolic events in patients with MS complicated by AF, at high risk of bleeding.

Abstract No. 292 Balloon embolization devices deliver more rapid, complete, and lasting artery occlusion

Peripheral artery embolization procedures are performed for a variety of clinical indications including stopping life-threatening bleeding, reducing blood flow to cancerous tumors, and diverting blood away from arterial aneurysms, arteriovenous fistulas, and other vascular malformations. Typically, these procedures involve the implantation of coils or porous vascular plugs to slow blood flow and stimulate the formation of thrombus to achieve complete blood vessel occlusion. These devices often require substantial time to achieve complete occlusion, and can be susceptible to vessel recanalization, all of which can reduce the overall effectiveness of the treatment.

Acute on Chronic Limb Ischemia Treatment: Case Series

ABSTRACT&#x0D; &#x0D; BACKGROUND: Acute on chronic limb ischemia is a condition caused by acute disruption in chronic vessel disease. The major cause is peripheral arterial disease or embolism. Treating the acute phase while considering the origin of disease is important to treat acute on chronic limb ischemia.&#x0D; CASE DESCRIPTION: 3 cases were described on this serial case report. The first and second case represent acute on chronic limb ischemia conditions with history of intermittent claudication (IC) and signs of acute limb ischemia (ALI) upon arrival. They were both treated with surgical intervention for ALI. Despite of adequate surgical intervention, both cases showed suboptimal limb recovery. Both patients were referred for further evaluation of chronic vessel disease with angiography. Third case represent chronic limb ischemia as end point of treatment from the first and second case. Patient with worsening IC despite adequate medical and exercise treatment underwent angiography examination. Angiography result found two sites of total occlusion of right common iliac artery and superficial femoral artery. Angioplasty and primary stenting were done on common iliac artery. Drug coated balloon and stenting was also performed on superficial femoral artery.&#x0D; CONCLUSION: Patients with acute on chronic limb ischemia need to be treated during acute phase and the remaining chronic vessel disease. Consideration and care should be taken when managing similar cases for optimal treatment.&#x0D; &#x0D; KEYWORDS: Acute on chronic limb ischemia, Thrombectomy, Angioplasty, Drug-coated Balloon.

A Case of Acute Necrotizing Esophagitis With Effective Steroid Therapy for Stenosis Prevention.

An 80-year-old man with a complaint of hematemesis was taken to our emergency department. Blood tests showed decreased hemoglobin, 12.6 g/dL (normal range, 13.7–16.8 g/dL), and increased D-dimer, 9.0 μg/mL (normal range, <1 μg/mL). Contrast-enhanced computed tomography revealed the edematous thickening of the entire esophageal wall and a peripheral pulmonary artery embolism. Esophagogastroduodenoscopy (EGD) showed a black appearance of the entire esophageal mucosa and easy bleeding only by passing of the scope (Figure A). Acute necrotizing esophagitis complicated by pulmonary embolism was diagnosed. The patient was treated with proton pomp inhibitor. On day 9, EGD and esophageal transit with gastrografin showed ameliorated bleeding tendency of the mucosa with moderate stenosis in the lower esophagus (Figure B and Figure C). Prednisolone (30 mg) was initiated orally in accordance with the preventative treatment for stenosis in corrosive esophagitis and circumferential endoscopic submucosal dissection for esophageal carcinoma. Prednisolone was tapered off and discontinued after 6 weeks. On day 16, EGD revealed improved stenosis. Six months after discharge, EGD showed a recovered normal esophageal mucosa with only a residual upper-esophagus ring-shaped scar (Figure D). Stenosis can also occur as an acute necrotizing esophagitis complication, and early steroid therapy is a possible treatment option.

Nursing Care of Patients with Peripheral Arterial Embolization and Interventional Thrombolysis under Electron Microscope

Nursing Care of Patients with Peripheral Arterial Embolization and Interventional Thrombolysis under Electron Microscope

Peripheral arterial embolization and limb ischemia complicating septic internal jugular vein thrombosis: a case report of Lemierre’s syndrome

Purpose: Septic thrombophlebitis of the internal jugular vein is a life-threatening complication of venous thrombosis. While heparin is frequently added to antimicrobial therapy, its usefulness in patients with Lemierre’s syndrome is controversial. In this case report, we demonstrate that delayed use of intravenous heparin may be associated with septic embolization of peripheral arteries. Limb ischemia has rarely been reported in patients with Lemierre’s syndrome.&#x0D; Case presentation: Lemierre’s syndrome is a complex and unusual clinical entity, characterized by septic thrombophlebitis of the internal jugular vein and accompanied by sepsis. We present an unusual case of a young female with Lemierre’s syndrome who developed peripheral arterial embolization and Streptococcus pyogenes sepsis, complicating septic internal jugular vein thrombosis. The patient was initially treated with antibiotics without therapeutic heparin. The patient developed digital gangrene in all four extremities, septic meningitis, and a severe fungal infection; she died 6 weeks after admission secondary to multisystem organ failure. We discuss the importance of rapid diagnosis of disease extent in directing heparin treatment in patients with Lemierre’s syndrome.&#x0D; Conclusion: It may be advisable to treat Lemierre’s syndrome with anticoagulation in the acute setting.

Abstract 10074: Cardiovascular Outcomes in Patients with Concurrent Atrial Fibrillation and Myeloproliferative Neoplasms

Introduction: Myeloproliferative neoplasms (MPNs), including polycythemia vera (PV), essential thrombocytosis (ET) and myelofibrosis (MF), are clonal stem cell neoplasms. Therapy is instituted to prevent thrombosis, a leading cause of morbidity/mortality in this population. Atrial fibrillation (AF) is also associated with increased risk of thromboembolism. Risk scores, including CHA 2 DS 2 VASC, are used to determine benefit of anticoagulation (AC) but have not been validated in patients with MPN. Methods: This is a single-center, retrospective cohort study of patients with concurrent MPN and AF from 2000 to 2020 (n = 142; 62 ET, 54 PV, 26 MF). Outcomes included composite of arterial thrombotic events (ATE; MI, ischemic stroke, or peripheral arterial embolism) and cardiovascular (CV) death, bleeding requiring hospitalization, and all-cause mortality (ACM). Results: AC was used in 69% of all MPN patients (73% of ET/ PV, 50% of MF). CHA 2 DS 2 VASC scores were significantly higher in patients with ET/PV compared with MF (4 ± 2 vs 3 ± 1, p = 0.0019). After median follow-up (FU) of 49 months (IQR 18, 86) the composite outcome occurred in 39% of patients with MPN (ET/PV 36%, MF 50%). Bleeding occurred in 30% of patients (ET/PV 29%, MF 30%) and ACM in 45% of all patients (ET/PV 40%, MF 83%). Patients with MF had worse composite-free survival (log-rank p = 0.0043, Fig-A) and no difference in bleed-free survival (Fig-B) compared with ET/PV patients. After multivariable logistic regression including CHA 2 DS 2 VASC, age, sex, MF, AC, CAD, hypertension, diabetes, prior stroke, aspirin use, MPN treatment and FU time as co-variables, MF was associated with the composite (aOR 4.1, 95% CI 1.2-14.9), CHA 2 DS 2 VASC was not (aOR 1.3, 95% CI 0.8-2.1). Conclusions: Patients with MPN and AF have high rates of adverse outcomes with MF having worse composite-free survival compared to ET/PV. Traditional risk scores may underperform in this patient population underscoring the need for further investigation.

Embolization with MVP (Micro Vascular Plug\xae): experience on 104 patients in emergent and elective scenarios

AimTo describe a 3 years experience of peripheral arterial embolization with Micro Vascular Plug (MVP) (Medtronic, USA).Materials and methodsThe following parameters were investigated: type of vascular injury, anticoagulation therapy at time of procedure, anatomical district, caliper of the target artery, course of the landing zone, additional embolics, technical and clinical success, device related clinical complications. Technical success was defined as complete embolization without deployment of additional embolics after MVP release. Primary clinical success was considered as hemodynamic stability in emergency setting and resolution of the underlying vascular pathology in elective cases; secondary clinical success was considered clinical success after a second embolization session.Results116 MVP have been released in 104 patients (67 males and 37 females; mean age 61.3 years). The pullback release technique was adopted in each case. 85 patients were treated in emergent settings while in 19 patients the procedure was scheduled. The overall technical success was 75%. Primary clinical success was 96.1%, secondary clinical success 3% and clinical failure 0.9%. No statistical differences in terms of effectiveness were observed among patients assuming anticoagulation (p-value = 0.6). A straight and longer landing zone were statistically associated with higher technical success compared to curved and shorter ones, (p-values < 0.001 and = 0.048 respectively). MVP-3 and MVP-5 were the most frequently adopted models in this sample, in 29.8% and 49% of the patients respectively. No clinically adverse events directly related to MVP occurred; in 3 cases device migration was registered without clinical complications.ConclusionMVP is a safe and effective embolic agent. While eventual concomitant anticoagulation therapy did not influence the technical outcome, straight course and length of the landing zone are essential parameters to evaluate before deployment.

Anticoagulation versus placebo for heart failure in sinus rhythm.

People with chronic heart failure (HF) are at risk of thromboembolic events, including stroke, pulmonary embolism, and peripheral arterial embolism; coronary ischaemic events also contribute to the progression of HF. The use of long-term oral anticoagulation is established in certain populations, including people with HF and atrial fibrillation (AF), but there is wide variation in the indications and use of oral anticoagulation in the broader HF population. To determine whether long-term oral anticoagulation reduces total deaths and stroke in people with heart failure in sinus rhythm. We updated the searches in CENTRAL, MEDLINE, and Embase in March 2020.We screened reference lists of papers and abstracts from national and international cardiovascular meetings to identify unpublished studies. We contacted relevant authors to obtain further data. We did not apply any language restrictions. Randomised controlled trials (RCT) comparing oral anticoagulants with placebo or no treatment in adults with HF, with treatment duration of at least one month.We made inclusion decisions in duplicate, and resolved any disagreements between review authors by discussion, or a third party. Two review authors independently assessed trials for inclusion, and assessed the risks and benefits of antithrombotic therapy by calculating odds ratio (OR), accompanied by the 95% confidence intervals (CI). We identified three RCTs (5498 participants). One RCT compared warfarin, aspirin, and no antithrombotic therapy, the second compared warfarin with placebo in participants with idiopathic dilated cardiomyopathy, and the third compared rivaroxaban with placebo in participants with HF and coronary artery disease. We pooled data from the studies that compared warfarin with a placebo or no treatment. We are uncertain if there is an effect onall-cause death (OR 0.66, 95% CI 0.36 to 1.18; 2 studies, 324 participants; low-certainty evidence); warfarin mayincreasethe risk of major bleeding events (OR 5.98, 95% CI 1.71 to 20.93, NNTH 17). 2 studies, 324 participants; low-certainty evidence). None of the studies reported stroke as an individual outcome. Rivaroxabanmakes little to no difference to all-cause death compared with placebo (OR 0.99, 95% CI 0.87 to 1.13; 1 study, 5022 participants; high-certainty evidence). Rivaroxaban probably reduces the risk of stroke compared to placebo (OR0.67, 95% CI0.47 to 0.95; NNTB 101; 1 study, 5022 participants; moderate-certainty evidence), and probably increases the risk of major bleeding events (OR1.65, 95% CI1.17 to 2.33; NNTH 79; 1 study, 5008 participants; moderate-certainty evidence). Based on the three RCTs, there is noevidence that oral anticoagulant therapy modifies mortalityin people with HF in sinus rhythm. The evidence is uncertain if warfarin has any effect on all-cause death compared to placebo or no treatment, but it may increase the risk of major bleeding events.There is no evidence of a differencein the effect ofrivaroxabanon all-cause death compared to placebo. It probably reducesthe risk of stroke, but probably increases the risk of major bleedings. The available evidence does not support the routine use of anticoagulation in people with HF who remain in sinus rhythm.

LV twist predicts prognosis in children and adolescents with non-compaction cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Background Left ventricular non-compaction cardiomyopathy (LVNC) is associated with poor clinical outcome in childhood, with heart failure, arrhythmias, and embolic events as main clinical manifestations. LV twist has recently been demonstrated having good predictive value in diagnosing LVNC in young patients. However, how LV twist may influence long-term clinical outcome of LVNC children and adolescents is still unknown. The aim of this study was to analyse a set of echocardiographic parameters to find imaging predictors of worse clinical outcomes in a long-term follow-up of LVNC children and young patients. Methods Children and adolescents, followed from May 2012 to June 2020, were enrolled in a retrospective study. All patients underwent 2-dimensional speckle tracking echocardiography and cardiovascular magnetic resonance imaging (1.5 Tesla) at our Institution’s first evaluation. Death, heart failure hospitalization, aborted sudden cardiac death, ventricular arrhythmias (sustained and non-sustained ventricular tachycardia), and embolisms (i.e. stroke, peripheral arterial embolism and/or pulmonary thromboembolism) were registered and referred to as major adverse cardiovascular events (MACEs). Results Recruited for the study were 47 children (mean age: 11.1± 5; age range: 0–18 years). Twenty-three patients fulfilled the cardiovascular magnetic resonance imaging diagnostic criteria for LVNC (LVNC group), while the remaining 24 did not and were included in the LV hypertrabeculation group (LVHT). They were followed for 4.9 ± 1.0 years, and MACEs were registered. Thirteen children (56% of LVNC, 28% of total) had at least one MACE. Global longitudinal, circumferential and radial strains (GLS, GCS, GRS), LV twist and LVEF resulted being significantly reduced in children with MACEs at follow-up. A multivariable analysis was performed by combining four parameters: LV ejection fraction, GLS, GCS, LV twist. These independent variables were chosen according to univariable analyses and clinical relevance. The results from the analysis demonstrated that LV twist was the only independent predictor (P = 0.033, coeff. B 0.726) of worse clinical outcomes in young patients with LVNC. Conclusions LV twist is a promising tool to stratify and predict prognosis in LVNC young patients. Our findings show the importance of LV twist assessment to detect the severity of LVNC and to plan for early clinical intervention.

Incidence of thromboembolism in patients with melanoma on immune checkpoint inhibitor therapy and its adverse association with survival

BackgroundThromboembolism (TE) in cancer significantly contributes to morbidity and mortality. Little is known about the incidence of arterial TE (ATE) and venous TE (VTE) in patients with melanoma on immune...