Persistent Left Ventricular Dysfunction Research Articles

The Role of Global Longitudinal Strain in the Follow-Up of Asymptomatic Patients with Chronic Primary Mitral Regurgitation.

Background/Objectives: In patients with chronic primary mitral regurgitation (MR), postoperative persistent left ventricular (LV) dysfunction underlines the lack of a sensitive parameter that can identify subclinical LV dysfunction and optimize the timing of intervention. Left ventricular global longitudinal strain (LV-GLS) is a measure of the longitudinal left ventricular systolic function, with prognostic significance. Its role in the follow-up of asymptomatic patients with MR is, however, poorly defined. The aim of this study was to assess the relative changes in LV-GLS in a cohort of MR patients and to correlate these changes with the need for intervention during a follow-up period. Methods: We conducted a prospective study on a cohort of 218 patients, divided into three subgroups according to MR severity (mild, moderate, severe). LV-GLS was measured at baseline and every six months during a median follow-up period of 30 months. The composite endpoint was the occurrence of heart failure symptoms, hospitalization for heart failure, LVEF < 60%, LVEDD > 45 mm, new onset atrial fibrillation, or cardiovascular death. Results: Patients with moderate and severe MR had a significantly lower GLS at baseline than those with mild MR (19.5% and 19.1% versus 22.3%, p < 0.01) despite a normal LVEF in all subgroups. The relative decrease in LV-GLS occurred earlier (at 12 months vs. 24 months) and was more evident in patients with moderate and severe MR (13.6% and 14.5%, respectively) versus patients with mild MR (6.72%). The baseline LV-GLS being under 18% and a relative decrease of over 10% in GLS were independent predictors of a composite outcome (HR = 1.59, CI 95% 1.17-2.86; HR = 1.74, CI 95% 1.2-2.91, p < 0.01). Conclusions: LV-GLS is a valuable monitoring tool for asymptomatic MR patients, a relative decrease > 10% in GLS may be predictive for the need for valve intervention.

Bromocriptine treatment and outcomes in peripartum cardiomyopathy: the EORP PPCM registry.

Peripartum cardiomyopathy (PPCM) remains a serious threat to maternal health around the world. While bromocriptine, in addition to standard treatment for heart failure, presents a promising pathophysiology-based disease-specific treatment option in PPCM, the evidence regarding its efficacy remains limited. This study aimed to determine whether bromocriptine treatment is associated with improved maternal outcomes in PPCM. PPCM patients from the EORP PPCM registry with available follow-up were included. The main exposure of this exploratory non-randomized analysis was bromocriptine treatment, and the main outcome was a composite endpoint of maternal outcome (death or hospital readmission within the first 6 months after diagnosis, or persistent severe left ventricular dysfunction [left ventricular ejection fraction <35%] at 6-month follow-up). Inverse probability weighting was used to minimize the effects of confounding by indication. Multiple imputation was used to account for missing data. Among 552 patients with PPCM, 85 were treated with bromocriptine (15%). The primary endpoint was available in 491 patients (89%) and occurred in 18 out of 82 patients treated with bromocriptine in addition to standard of care (22%) and in 136 out of 409 patients treated with standard of care (33%) (p=0.044). In complete case analysis, bromocriptine treatment was associated with reduced adverse maternal outcome (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.10-0.83, p=0.021). This association remained after applying multiple imputation and methods to correct for confounding by indication (inverse probability weighted model on imputed data OR 0.39, 95% CI 0.19-0.81, p=0.011). Thrombo-embolic events were observed in 5.9% of the patients in the bromocriptine group versus 5.6% in the standard of care group (p=0.900). Among women with PPCM, bromocriptine treatment in addition to standard of care was associated with better maternal outcomes after 6 months.

Social Vulnerability May Underlie Racial Disparities in Peripartum Cardiomyopathy Outcomes.

Black patients have disproportionately more cases of peripartum cardiomyopathy (PPCM) and more severe disease. To better understand these disparities, we examined the geographic distribution of patients with PPCM by race and evaluated associations between race and social vulnerability. We hypothesized that Black patients with PPCM are more likely than White patients to live in socially vulnerable communities. A retrospective cohort study of patients with PPCM defined by the National Institutes of Health, National Heart, Lung, and Blood Institute was conducted at a single center from January 2000 to November 2017. The US census tract for each patient was identified, and social vulnerability was assessed using the Centers for Disease Control and Prevention Social Vulnerability Index (SVI). Higher SVI values represent a more vulnerable community. SVI and select subcomponents were compared by self-reported race. Among 90 patients with PPCM (47 White, 43 Black), the ejection fraction at diagnosis was similar between groups, although Black patients were more likely to have an ejection fraction of ≤40% at 6 to 12 months postpartum. Black race was associated with living in areas of greater social vulnerability; mean SVI was significantly higher among Black individuals than among White individuals (.56 versus .33, P=.0003). Black patients lived in areas with more people living in poverty, higher unemployment, and more single-parent households. Black patients with PPCM were more likely to have persistent left ventricular dysfunction and live in areas of greater social vulnerability. Strategies to achieve equitable social determinants of health are needed to improve health outcomes in Black patients with PPCM.

Diagnosis and management of peripartum cardiomyopathy and recurrence risk

Peripartum cardiomyopathy (PPCM) is a rare, but serious condition, with a non-negligible risk of adverse events. Several risk factors for PPCM have been individuated over the years, including Afro-American ethnicity, preeclampsia, advanced maternal age, genetic predisposition, multiparity, twin pregnancy, obesity, smoking and diabetes. However, PPCM pathophysiology is still poorly understood, thus making it challenging to develop disease specific therapies. At present, Bromocriptine is the only targeted drug, but further evidence is needed to establish indication and timing of administration. Therefore, these patients are mainly treated following general heart failure guidelines. Even though in most patients left ventricular ejection fraction recovers during follow-up, cases of persistent left ventricular dysfunction are not uncommon. Moreover, all patients detain a certain risk of recurrence after subsequent pregnancies, which is difficult to estimate due to the dearth of long-term prospective data.In this manuscript, we aim to provide an updated review of current evidence about PPCM pathophysiology, diagnosis, treatment and recurrence risk. In addition, we discuss the gaps in knowledge that should be addressed by future research.

THE INTELLIGENT USE OF ADRENALINE

Abstract Case Report A 52–year–old patient experienced anterior and inferior ST–elevation myocardial infarction, leading to cardiogenic shock necessitating invasive hemodynamic and pharmacological support. During angiography, an intra–aortic balloon pump (IABP) was inserted, and a norepinephrine infusion along with dobutamine was initiated, showing partial clinical and laboratory improvement. Critical disease in all three vessels was detected, prompting angioplasty with stenting of the right coronary artery and left anterior descending artery. Echocardiography revealed severe reduction in left ventricular systolic function (ejection fraction 10%). Despite revascularization and intensive support, the patient‘s hemodynamic status deteriorated (SCAI D), necessitating the addition of adrenaline (0.03 μg/kg/min) to the ongoing dobutamine infusion, suspending noradrenaline. Subsequent days showed gradual improvement, allowing for withdrawal from amine support and discontinuation of the IABP. Follow–up included a cardiac MRI displaying severe systolic dysfunction (EF 21%), extensive ischemic–pattern delayed enhancement across three–vessel distribution. Given the persistent severe left ventricular dysfunction, the patient underwent subcutaneous defibrillator implantation for primary prevention after optimizing anti–remodeling therapy. Despite optimized medical therapy and cycles of levosimendan, the patient experienced heart failure exacerbation, requiring hospitalization (INTERMACS 3). Considering the clinical condition and absence of contraindications, the patient was listed for heart transplantation. Due to refractory hemodynamic instability despite inotropic agents, a left ventricular assist device was implanted as a bridge to transplantation. Roughly 6 months later, the patient successfully underwent heart transplantation without acute complications. Conclusions Very low doses of adrenaline demonstrate increased sensitivity to β2 receptors over α receptors, thereby enhancing mean arterial pressure and peripheral perfusion. At the cardiac level, it induces an increase in both heart rate and coronary blood flow, while peripherally reducing resistances, predominantly due to the prevalence of β2 receptors in skeletal muscle. This improvement contributes to the enhancement of ventricular–arterial coupling. In conditions characterized by a primary pump deficit, such as cardiogenic shock, the use of low–dose adrenaline emerges as a valid therapeutic option.

Outcomes of subsequent pregnancy in women with peripartum cardiomyopathy: a systematic review and meta-analysis

IntroductionThe primary concern for women who have experienced peripartum cardiomyopathy (PPCM) is the safety of a subsequent pregnancy (SSP). To maximie decision-making, facilitate effective patient counselling, and ultimately improve maternal...

Influence of Obstructive Apnea Index on Persistent Left Ventricular Dysfunction in Patients with ST-Segment Elevation Myocardial Infarction.

Background: We retrospectively investigated the effects of the severity and classification of sleep-disordered breathing (SDB) on left ventricular (LV) function in patients with ST-segment elevation myocardial infarction (STEMI). Methods: A total of 115 patients with STEMIs underwent a sleep study using a multichannel frontopolar electroencephalography recording device (Sleep Profiler) one week after STEMI onset. We evaluated LV global longitudinal strain (LV-GLS) using two-dimensional echocardiography at one week and seven months. Patients were classified as no SDB (AHI < 5 events/h), obstructive SDB (over 50% of apnea events are obstructive), and central SDB (over 50% of apnea events are central). Due to the device's limitations in distinguishing obstructive from central hypopnea, SDB classification was based on apnea index percentages. Results: The obstructive apnea index (OAI) was significantly associated with LV-GLS at one week (r = 0.24, p = 0.027) and seven months (r = 0.21, p = 0.020). No such correlations were found for the central apnea index and SDB classification. Multivariable regression analysis showed that the OAI was independently associated with LV-GLS at one week (β = 0.24, p = 0.002) and seven months (β = 0.20, p = 0.008). Conclusions: OAI is associated with persistent LV dysfunction assessed by LV-GLS in STEMI.

Cardiac MRI six months after the onset of multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19: A retrospective follow-up study.

In 2020, reports revealed cases called multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19 or multisystem inflammatory syndrome in children. A small proportion of patients suffer from persistent left ventricular dysfunction at discharge. The primary aim was to investigate if myocardial impairment persists during follow-up in these patients. Children fulfilling the criteria for multisystem inflammatory syndrome in children with cardiac involvement hospitalized between December 2020 and February 2022 were included in this retrospective single centre study. Cardiac MRI was performed six months after the onset of symptoms to evaluate possible persistent myocardial damage. Fifteen patients (80% male) with a median age of 8 years (interquartile range 4.5 - 13.5 years) were included. Upon admission, eight patients (53%) presented with reduced left ventricular function, with a median left ventricular ejection fraction of 54% (interquartile range 49.5%-61.5%) on transthoracic echocardiography. Elevated levels of cardiac-specific markers were found in 14 patients (93%). Cardiac MRI was performed in 12 patients at a median of 190.5 days after the onset of symptoms. Nine patients (75%) had normal left ventricular function, with a median left ventricular ejection fraction of 59.45%, while the remaining patients showed mildly to moderately reduced values. None of the patients showed signs of late gadolinium enhancement, indicating the absence of persistent myocardial scarring. During a follow-up of 6.2 months, mild to moderate cardiac impairment was revealed in 25% of patients evaluated by cardiac MRI. Although a majority of patients do not show signs of cardiac impairment, close follow-ups should be performed in a proportion of patients.

Contemporary Outcomes of Children With Acute Fulminant Myocarditis Supported With Peripheral Extracorporeal Membrane Oxygenation.

Despite extracorporeal membrane oxygenation (ECMO) utilization in nearly 20% of cases, there are limited data in children with acute fulminant myocarditis (AFM) requiring ECMO. Herein we identify risk factors for death or heart transplant (HT) in children with AFM supported with ECMO, describe our experience with left atrial (LA) decompression, and depict long-term outcomes of survivors. We performed a retrospective cohort of patients <18 years with AFM (≤14 days of symptoms, rapid cardiogenic shock, and normal left ventricular [LV] size on presentation) supported with ECMO admitted to a single intensive care unit from 1997 to 2021. Among 28 patients (median age 9 years), 21 (75%) survived to discharge without HT. Patients were supported on ECMO for a median of 6 days. Three patients were bridged to HT with durable ventricular assist devices (VAD). Four patients died, two of whom were supported with VAD. At presentation, seven (25%) patients had high grade or complete atrioventricular block and eight (29%) had ventricular tachycardia. Before ECMO cannulation, 21 (75%) patients received CPR. The death/HT group had higher peak troponin levels (12.5 vs . 1.0 ng/ml, p = 0.02) and initial mean LA or pulmonary capillary wedge pressure (27 vs . 18 mm Hg, p = 0.03). Left atrial decompression was performed in 22 patients (79%). Twenty-two (79%) had acute myocarditis on endomyocardial biopsy. Among transplant-free survivors, 18 (86%) had normalization in LV function (median 7 days); the remaining three patients had persistent mild LV dysfunction at last follow-up (median 842 days). Transplant-free survival of pediatric patients with AFM supported on ECMO was 75% and associated with lower initial LA pressure and lower peak troponin. Recovery in ventricular function among survivors was rapid and durable.

Socio-economic factors determine maternal and neonatal outcomes in women with peripartum cardiomyopathy: A study of the ESC EORP PPCM registry

BackgroundPeripartum cardiomyopathy (PPCM) is a global disease with substantial morbidity and mortality. The aim of this study was to analyze to what extent socioeconomic factors were associated with maternal and neonatal outcomes. MethodsIn 2011, >100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global PPCM registry, under the auspices of the ESC EORP Programme. We investigated the characteristics and outcomes of women with PPCM and their babies according to individual and country-level sociodemographic factors (Gini index coefficient [GINI index], health expenditure [HE] and human developmental index [HDI]). Results739 women from 49 countries (Europe [33%], Africa [29%], Asia-Pacific [15%], Middle East [22%]) were enrolled. Low HDI was associated with greater left ventricular (LV) dilatation at time of diagnosis. However, baseline LV ejection fraction did not differ according to sociodemographic factors. Countries with low HE prescribed guideline-directed heart failure therapy less frequently. Six-month mortality was higher in countries with low HE; and LV non-recovery in those with low HDI, low HE and lower levels of education. Maternal outcome (death, re-hospitalization, or persistent LV dysfunction) was independently associated with income. Neonatal death was significantly more common in countries with low HE and low HDI, but was not influenced by maternal income or education attainment. ConclusionsMaternal and neonatal outcomes depend on country-specific socioeconomic characteristics. Attempts should therefore be made to allocate adequate resources to health and education, to improve maternal and fetal outcomes in PPCM.

Iron Status and Short-Term Recovery after Non-Severe Acute Myocarditis: A Prospective Observational Study.

Pathomechanisms responsible for recovery from acute myocarditis (MCD) or progression to non-ischemic cardiomyopathy have not been comprehensively investigated. Iron, positioned at the crossroads of inflammation and the energy metabolism of cardiomyocytes, may contribute to the pathophysiology of inflammatory myocardial disease. The aim of this study was to evaluate whether systemic iron parameters are related to myocardial dysfunction in MCD patients. We prospectively enrolled 42 consecutive patients hospitalized for MCD. Their iron status and their clinical, laboratory, and echocardiographic indices were assessed during hospitalization and during ambulatory visits six weeks after discharge. A control group comprising healthy volunteers was recruited. The MCD patients had higher serum ferritin and hepcidin and lower serum iron concentration and transferrin saturation (TSAT) than the healthy controls (all p < 0.01). Six weeks after discharge, the iron status of the MCD patients was already comparable to that of the control group. During hospitalization, lower serum iron and TSAT correlated with higher NT-proBNP (both p < 0.05). In-hospital lower serum iron and TSAT correlated with both a lower left ventricular ejection fraction (LVEF) and worse left ventricular global longitudinal strain at follow-up visits (all p < 0.05). In conclusion, in patients with acute MCD, iron status is altered and normalizes within six weeks. Low serum iron and TSAT are related to greater in-hospital neurohormonal activation and subtle persistent left ventricular dysfunction.

Streptococcus mutans endocarditis resulting in severe aortic and mitral valve dysfunctionand congestive heart failure.

A patient in his 40s with no known cardiac history presented to the emergency department with midsternal chest pain worse on inspiration for the past 1 week. He also complains of recent weight loss, dry coughand night sweats during this time. He describes significant dental pain as well. Electrocardiogram showed no acute ischemic changes. Transesophageal echocardiography showed a nodular echodensity affecting the mitral valve with severe regurgitation, and echodensity affecting the aortic valve with severe regurgitation. Blood cultures grew Streptococcus mutans in multiple samples. He was treated with intravenous antibiotics and had a mechanical aortic and mitral valve replacement. He continued to have persistent left and right ventricular dysfunction several months later despite medical and surgical treatment.

Abstract 15528: Indeterminate Cardiomyopathy in a Patient With Birt Hogg Dubé Syndrome and a Clinical Diagnosis of Scleroderma and Prior Atrial Tachy Arrhythmias: A Diagnostic and Therapeutic Dilemma

Birt Hogg Dubé (BHD) syndrome, tachycardia induced cardiomyopathy and scleroderma are three well defined diagnoses. A link between them has not been reported. We present a diagnostic and treatment challenge, of a patient with BHD, clinical scleroderma and prior tachycardia induced cardiomyopathy with persistent left ventricular dysfunction despite restoration of sinus rhythm. Mr. X medical history includes recurrent bilateral pneumothoraces and bullectomy, with a cystic lung disease. He was diagnosed with BHD syndrome in 2018. He was diagnosed clinically with scleroderma with myositis based on symptoms and clinical signs with paucity of inflammation on muscle biopsy and negative biomarkers. There has been a limited response to immunosuppressants. In 2020 he presented with symptomatic paroxysmal atrial fibrillation. CMRI showed biventricular dilatation with increased volumes with LVEF of 40%, ​RVEF of 25% in sinus bradycardia. LGE showed subendocardial signal in ​​the basal and mid segment of the lateral and posterolateral walls with small foci of myocardial ​​​signal at the basal and mid inferior RV-LV hinge points. A bespoke CRT-D (secondary to cavity size) was inserted following documented broad complex tachycardia, given the history of reduced ejection fraction despite medical therapy. Right and left heart catheterisations were normal. Endomyocardial biopsy showed no pathological features and no fibrosis or evidence of infiltrative disease. Genotype results are pending. BHD is a genetic disorder, affecting folliculin protein, associated with cystic lesions of the lung, kidney, and skin with an increased risk of renal cell carcinoma (1). There is no known link of BHD syndrome with cardiomyopathy. Studies have demonstrated folliculin has a role in cardiomyocyte generation (2). Given the cardiac biopsy result, not in keeping with scleroderma or tachycardia induced cardiomyopathy, he may have an independent cardiomyopathy, or a first case of cardiomyopathy secondary to BHD. Our challenge continues to be optimising available therapies ensuring the best quality of life, whilst balancing the potential need for cardiac transplant with lifelong immunosuppressant therapy in a condition which has a seven-fold increased risk of renal cancer.

Cardiac Assessment in Children with MIS-C: Late Magnetic Resonance Imaging Features.

Multisystem Inflammatory Syndrome (MIS-C) is a new entity that emerges 2–4 weeks after the SARS-CoV-2 infection in children. MIS-C can affect all systems, the most severe of which is cardiac involvement. The duration of the cardiac symptoms is still uncertain and may be persistent or prolonged. The American College of Rheumatology Clinical Guidelines recommends cardiac magnetic resonance imaging (MRI) 2–6 months after the diagnosis of MIS-C in patients presenting with significant transient left ventricular (LV) dysfunction in the acute phase of illness (LV ejection fraction 50%) or persistent LV dysfunction. There are a few studies investigating cardiac MRI findings in MIS-C patients. In this study, we aimed to evaluate cardiac MRI findings, at the earliest 3 months after diagnosis, and compare these findings with the echocardiograms in children with MIS-C. A retrospective study including 34 MIS-C patients was conducted at a tertiary-level University Hospital between June 2020 and July 2021. Centers for Disease Control and Prevention criteria were used in the diagnosis of MIS-C. Cardiac MRI was performed at least 3 months after MIS-C diagnosis. The study included 17 (50%) boys and 17 (50%) girls with a mean age of 9.31 ± 4.72 years. Initial echocardiographic evaluation revealed cardiac abnormality in 13 (38.2) patients; 4 (11.8%) pericardial effusion, 4 (11.8%) left ventricular ejection fraction (LVEF) < 55%, and 5 (14.7%) coronary artery dilatation. Echocardiography showed normal LV systolic function in all patients during follow-up; coronary dilatation persisted in 2 of 5 (40%) patients at the 6th-month visit. Cardiac MRI was performed in 31 (91.2%) patients, and myocardial hyperemia was not detected in any patients (T1 relaxation time was < 1044 ms in all children). However, 9 (29%) patients’ MRI showed isolated elevated T2 levels, and 19 (61.3%) revealed at least one of the following findings: pericardial effusion, right ventricular dysfunction, or LVEF abnormality. In patients with MIS-C, a high rate of cardiac involvement, particularly pericardial effusion was determined by cardiac MRI performed at the earliest 2–6 months after diagnosis. Even if echocardiography does not reveal any abnormality in the initial phase, cardiac MRI should be suggested in MIS-C patients in the late period. This is the first study reporting cardiac MRI findings in the late period of MIS-C patients.

Predictors of Left Ventricular Dysfunction after Percutaneous Primary Coronary Intervention in Acute Anterior Myocardial Infarction

Background: Primary percutaneous coronary intervention (PCI) has revolutionized the outcome and management of acute myocardial infarction. However, the occurrence of left ventricular dysfunction remains relatively common event following acute myocardial infarction and in associated with an adverse prognosis in these patients. this work aimed to investigate to the left ventricular dysfunction predictors following PCI for anterior myocardial infarction (AMI) using different parameters: Tissue Doppler imaging (TDI), Biomarkers (Troponin, CK-MB) and Echocardiography&#x0D; Methods: This research was conducted prospectively on 50 patients aged from 40 to 70 years old, presenting by first anterior myocardial infarction and treated with PCI. All cases were subjected to full history, full clinical examination, laboratory investigations, resting 12 leads electrocardiography, two dimensions echocardiography and tissue doppler imaging.&#x0D; Results: Highly statistically significant between EF baseline with EF on discharge and EF on discharge with after 3 months p-value was &lt;0.001. Pre balloon dilatation, S wave of tissue Doppler imaging on discharge and S wave tissue Doppler imaging after 3 months were predictors for left ventricular systolic function.&#x0D; Conclusions: Persistent LV dysfunction following successful primary PCI is infrequent and is related to poor clinical outcomes at 3 months clinical follow-up. Tissue Doppler on discharge and after three months after myocardial infarction are independent predictors of LV dysfunction after anterior STEMI and can be used to predict occurrence of LV remodelling after 6 months.

Contemporary Outcomes of Pediatric Patients with Acute Fulminant Myocarditis Supported with Extracorporeal Membrane Oxygenation

<h3>Purpose</h3> Despite extracorporeal membrane oxygenation (ECMO) utilization in up to 20% of cases, there are limited outcome data in pediatric patients with acute fulminant myocarditis (AFM) requiring mechanical circulatory support. <h3>Methods</h3> Retrospective cohort of patients <18 years with AFM admitted to a single center cardiac ICU and supported with ECMO from 1997-2021. Patients had ≤14 days of symptoms, rapid cardiogenic shock, and normal LV size. We compared clinical variables in patients who survived to discharge without heart transplant (HT) to those who did not. In addition, we assessed long-term LV function in survivors. <h3>Results</h3> Among 29 patients (median age 9 years; IQR 3,14), 22 (76%) survived to discharge without HT. Patients were supported on ECMO for a median of 6 days (IQR 5,8). Three patients were bridged to HT with durable ventricular assist devices (VAD). Four patients died, 2 of whom were supported with VAD. At presentation, 7 patients (24%) had high grade or complete atrioventricular block and 8 (28%) had ventricular tachycardia. CPR prior to ECMO occurred in 22 (76%) including all patients in the death/HT group. The death/HT group had higher peak troponin levels (12.5 vs 0.9 ng/mL, p=0.01). All patients underwent cardiac catheterization. Initial LA pressure was higher in the death/HT group (27 vs 18 mmHg, p=0.02) and LA decompression was performed in 23 patients (79%). Twenty-two (76%) had biopsy findings consistent with AFM. Among transplant-free survivors, 19 (86%) had normalization in LV function (median 16 days from presentation, IQR 9,449); the remaining 3 patients had persistent mild LV dysfunction at last follow up. Nine patients underwent cardiac MRI (median 752 days post-diagnosis), among whom 4 exhibited late gadolinium enhancement. <h3>Conclusion</h3> Transplant-free survival of pediatric patients with AFM supported on ECMO was 76% and associated with lower initial LA pressure. Recovery of ventricular function among survivors was rapid and durable.

Outcomes of Percutaneous Coronary Intervention in the Young

Background: The incidence of coronary artery disease in the young is constantly rising. Understanding the outcomes of percutaneous coronary intervention (PCI) in young adults is necessary. This study aims to assess the procedural outcomes, inhospital and 1 year clinical outcomes of PCI in the young (<40-year-old). Methods: This is a prospective, observational study carried out in the Department of Cardiology at Nizam's Institute of Medical Sciences. The study included all subjects ≤40 years of age and has undergone PCI from January 1, 2019 to December 31, 2019 in our institute. Results: The study included 207 patients with a mean age of 36.01 ± 3.72 years and 72.46% males. Acute coronary syndrome was seen in 79.2% patients with ST elevation myocardial infarction (STEMI) being the most common. The median time interval of presentation in STEMI was 12–48 h (73%). Major adverse cardiac events (MACE) over 1-year were seen in 3.8% patients. Severe left ventricular (LV) dysfunction at presentation was an independent factor for acute (P = 0.04) and 1-year mortality (P = 0.0058). It was also associated with angina and chronic heart failure (CHF). Slow flow was significantly associated with mortality (P = 0.0254) and adverse 1 year outcomes. It was significantly associated with persistent LV dysfunction and recurrent CHF. Conclusion: Success rate after PCI is high in the young. 1 year outcome is very good with low mortality and MACE events. Severe LV dysfunction and slow flow are independent predictors of poor prognosis at 1 year.

Abstract 14375: Maternal Outcomes in Subsequent Pregnancies After Peripartum Cardiomyopathy

Introduction: Peripartum cardiomyopathy (PPCM) is a rare cardiomyopathy associated with pregnancy and has a high maternal morbidity and mortality during both index and subsequent pregnancies. Data to help guide women with subsequent pregnancies is sparse. The purpose of this large retrospective study is to perform a comparative analysis of maternal outcomes in women with recovered left ventricular ejection fraction (LVEF) and persistent left ventricular (LV) dysfunction during subsequent pregnancies after PPCM. Methods: We identified 46 patients who had a subsequent pregnancy and an echocardiogram prior to their subsequent pregnancy in our registry of 121 patients with PPCM. Data in the registry was gathered by retrospective chart review. LVEF recovery was defined as improvement to &gt;50%. We divided patients into a recovered group (RG) (n=16) and non-recovered group (NRG) (n=30). Results: Total maternal mortality among women with PPCM and subsequent pregnancy was 19%. Mortality in the RG was 22% compared to 25% in the NRG. Mortality among African Americans (AA) was 83% when compared to other ethnic groups (17%). Discussion: Maternal mortality related to PPCM in the US ranges from 7% to 20%. In our study, we found that the risk of maternal mortality among women who had one or more subsequent pregnancies was 19%. It is well known that women with non-recovered LV function before subsequent pregnancy carries a worse maternal outcome when compared to women who enter the subsequent pregnancy with recovered LV function. Our findings reaffirm this, as we found that mortality rate in the NRG was higher when compared to the RG. Our findings also align with previous studies in that, AA women had a higher mortality rate when compared to other ethnic groups. Conclusion: Recovery of LVEF predicts a better prognosis but is not an absolute protection from the risk of mortality and/or recurrent PPCM. Hence close monitoring of LVEF with serial echocardiograms is still indicated during a subsequent pregnancy. African ethnicity carries a worse maternal prognosis.

Long-Term Survival in Patients with or without Implantable Cardioverter Defibrillator after Transcatheter Aortic Valve Implantation

Patients with symptomatic aortic stenosis (AS) can have concomitant systolic heart failure (HF) that persists even after correction of afterload by transcatheter aortic valve implantation (TAVI). These patients qualify as potential candidates for prophylactic therapy with an implantable cardioverter defibrillator (ICD). We compared survival between patients with or without an ICD after successful TAVI. This retrospective study analyzed Kaplan-Meier survival data during a follow-up period of three years in two populations: (a) patients with a left ventricular ejection fraction (LVEF) ≤ 35% before TAVI (overall population); (b) patients with additionally documented LVEF ≤ 35% 3 months after TAVI (persistent LV dysfunction subpopulation). In the overall population, 53 patients with and 193 patients without an ICD had similar baseline characteristics and procedural success rates, and HF medication at discharge was comparable. Three-year mortality rates were 26.4% for patients with an ICD and 24.4% for patients without an ICD (p = 0.758). Cardiovascular death rates were similar between groups (p = 0.914), and deaths were most often attributed to worsening of HF. Survival rates in patients with persistent LV dysfunction with an ICD (n = 24) or without an ICD (n = 59) were similar between groups (p = 0.872), with cardiovascular deaths mostly qualified as worsening HF and none as sudden cardiac death. Patients of the overall study population with biventricular pacing devices showed only a tendency to have better outcomes (p = 0.298). ICD therapy in elderly patients with AS and LV dysfunction undergoing TAVI did not demonstrate a survival benefit during a 3-year follow-up period.

Off-Pump HeartMate 3® LVAD Implantation via Left Thoracotomy to Descending Aorta: Transition from Transaxillary Impella 5.0® LVAD

A 62-year-old man with a prior history of Coronary Artery Bypass Grafting (CABG) presented in cardiogenic shock. A percutaneous left femoral Impella CP® Left Ventricular Assist Device (LVAD) was placed with modest improvement in hemodynamics. The LVAD was upgraded to an open right transaxillary Impella 5.0® with hemodynamic stabilization. Cardiacfunction was assessed with serial echocardiography demonstrating persistent severe left ventricular dysfunction. In view of previous CABG with patent Left Internal Mammary Artery (LIMA) graft the decision was made to place a HeartMate 3® LVAD via left thoracotomy with LV apical inflow and descending aortic outflow. This approach was completed without the need for Cardiopulmonary Bypass (CPB). The postoperative course was uneventful and discharge to a rehabilitation center occurred on the ninth postoperative day.