Post-myocardial Infarction Patients Research Articles

Dairy products and kidney function decline after myocardial infarction: A prospective analysis in the Alpha Omega Cohort

Population-based studies have shown both beneficial and neutral associations between dairy consumption and kidney function outcomes. We investigated the association between dairy products and kidney function decline in drug-treated post-myocardial infarction (MI) patients. We analysed data of 2169 post-MI patients (aged 60-80 years, 81% male) of the Alpha Omega Cohort. Dietary data were collected at baseline (2002-2006) using a validated 203-item food frequency questionnaire. The 2021 Chronic Kidney Disease Epidemiology (CKD-EPI) equation was used to estimate 40-months change in creatinine-cystatin C based glomerular filtration rate (eGFRcr-cysC, mL/min per 1.73m2). Beta coefficients and 95% confidence intervals (CIs) for dairy products in relation to annual eGFRcr-cysC change were obtained from multivariable linear regression, adjusted for age, sex, energy intake, and other lifestyle and dietary factors. Baseline energy-adjusted median intakes were 64g/day for total milk, 20g/day for hard cheeses, 18g/day for plain yogurt, and 70g/day for dairy desserts. Mean±SD eGFRcr-cysC was 84±20 (13% with CKD), and annual eGFRcr-cysC change was-1.71±3.85. In multivariable models, high vs. low intakes of total milk, cheese, and dairy desserts were not associated with annual eGFRcr-cysC change (βtotal milk:-0.21 [-0.60; 0.19], βcheese:-0.08 [-0.52; 0.36], βdairy desserts:-0.24 [-0.72; 0.24]). High vs. low intake of yogurt was adversely associated with annual eGFRcr-cysC change (βtotal yogurt:-0.50 [-0.91;-0.09]), but subsequent spline analyses showed no clear dose-response association. Intakes of milk, cheese or dairy desserts were not associated with a delayed kidney function decline after MI. The observed adverse association for yogurt should be interpreted with caution. Our findings require confirmation in other cohorts of coronary heart disease patients.

Non-revascularized chronic total occlusion is associated with worse outcomes in post-MI drug-refractory electrical storm patients treated by catheter ablation

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Outcomes in post-myocardial infarction (MI) patients which are referred for catheter ablation (CA) for drug-refractory electrical storm (ES) are influenced both by patient characteristics and procedural results. Previous data has shown higher risk for the first incident ES episode in the presence of non-revascularized chronic total occlusions (nCTOs). However, the prognostic effect of nCTOs in post-ES ablation patients is relatively unknown. Purpose We evaluated the impact of the presence of nCTO on all-cause mortality and sustained VT recurrence rate after CA for ES in post-MI patients. Methods In this single centre retrospective longitudinal study, we included consecutive post-MI patients referred for CA for drug-refractory ES. The median follow-up interval was 34.36 (7.25-63.65) months. CA outcome was defined by the absence or presence of residual sustained monomorphic VT at end-procedural programmed ventricular stimulation (PVS). Coronary angiography was performed prior to ablation in all patients. Results Sixty-four patients were included (85.9% (n = 55) males, age 62.64 ± 11.13 years). The mean left ventricular ejection fraction (LVEF) was 31.41 ± 10.99. There were 18.8% (n = 12) patients with nCTOs. Residual sustained monomorphic VT inducibility was documented in 28.1% (n = 18) cases. There were 29.7% (n = 19) deaths and sustained VT recurrences, respectively, during the monitored interval. Nine out of twelve (75%) nCTO patients died during follow-up. The presence of a nCTO induced a borderline significant higher risk of sustained VT recurrence during follow-up (HR 2.527, CI.95% 0.992 – 6.435, p = 0.052) in univariable Cox regression. In addition to age and residual sustained monomorphic VT at PVS, a multivariable Cox regression model identified the presence of nCTO as an independent predictor for all-cause mortality (HR 3.194, CI 95% 1.212-8.420, p = 0.019) (Figure 1). Conclusion(s) The presence of a nCTO in post-MI patients may be associated with higher all-cause mortality and sustained VT recurrences after ablation for drug-refractory electrical storm.

P252 THE TREATMENT WITH BETA–BLOCKERS AFTER MYOCARDIAL INFARCTION WITHOUT REDUCED EJECTION FRACTION (REBOOT) TRIAL, 2023 UPDATES

Abstract Introduction The role of beta blockers (BB) post–myocardial infarction (MI) in patients without reduced ejection fraction in the era of invasive management is controversial results from observational studies have led to opposite results. Methods REBOOT is an independent multinational pragmatic, controlled, randomized, open–label, with blinded endpoint adjudication clinical trial. The study is testing the benefits of BB maintenance therapy in post–MI patients (either with or without ST segment elevation) discharged with LVEF >40%. Patients ≥18 years old undergoing invasive management during admission and without history of heart failure (HF) are eligible to participate. At discharge, they are 1:1 randomized to either receive BB (agent and dose chosen by the treating physician) or no BB therapy. The primary endpoint is a composite of all–cause death, nonfatal re–MI, or heart failure hospitalization over a minimum follow–up period of 2.75 years (minimum 2 years, maximum 3 years). Events are adjudicated by a blinded committee. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC) is the sponsor of the trial and the coordinator of Spanish Centers while Istituto di Ricerche Farmacologiche Mario Negri IRCCS coordinates the Italian participating network. Hospital admission for COVID–19 were also recorded since June 2020. Results The study is currently ongoing and 29 Italian centers are still actively recruiting. A sample size of 8468 pts (728 events) was estimated to provide a power of 85% to detect a RRR of 20% (incidence of primary endpoint in control 10%) and assuming 5% withdrawals. More than 75 Spanish and 35 Italian centers recruited patients. The first patients have been included in Spain in October 2018, in Italy in January 2019. On December 31st 2022, the number of enrolled patients by Italian centers was 1685. The top three Italian enrollers at the moment are: Ospedale G. da Saliceto –Piacenza (483 pts), Ospedale S. Luigi Gonzaga – Orbassano (183 pts) and A.O San’Anna and San Sebastiano – Caserta (170 pts). The patient enrollment rate was almost stable during all the study periods with a slight decrease during COVID pandemic outbreaks. The Italian REBOOT Network goal is to include 1800 patients by April 2023. The first results will become available by the end of 2025. Conclusion The REBOOT, with other ongoing trials, will provide robust evidence to guide the prescription of BB to patients discharged after MI without reduced LVEF.

The let-7b-5p, miR-326, and miR-125a-3p are associated with left ventricular systolic dysfunction in post-myocardial infarction.

Acute ST-elevation myocardial infarction (STEMI) can lead to adverse cardiac remodeling, resulting in left ventricular systolic dysfunction (LVSd) and heart failure. Epigenetic regulators, such as microRNAs, may be involved in the physiopathology of LVSd. This study explored microRNAs in peripheral blood mononuclear cells (PBMC) of post-myocardial infarction patients with LVSd. Post-STEMI patients were grouped as having (LVSd, n = 9) or not LVSd (non-LVSd, n = 16). The expression of 61 microRNAs was analyzed in PBMC by RT-qPCR and the differentially expressed microRNAs were identified. Principal Component Analysis stratified the microRNAs based on the development of dysfunction. Predictive variables of LVSd were investigated through logistic regression analysis. A system biology approach was used to explore the regulatory molecular network of the disease and an enrichment analysis was performed. The let-7b-5p (AUC: 0.807; 95% CI: 0.63-0.98; p = 0.013), miR-125a-3p (AUC: 0.800; 95% CI: 0.61-0.99; p = 0.036) and miR-326 (AUC: 0.783; 95% CI: 0.54-1.00; p = 0.028) were upregulated in LVSd (p < 0.05) and discriminated LVSd from non-LVSd. Multivariate logistic regression analysis showed let-7b-5p (OR: 16.00; 95% CI: 1.54-166.05; p = 0.020) and miR-326 (OR: 28.00; 95% CI: 2.42-323.70; p = 0.008) as predictors of LVSd. The enrichment analysis revealed association of the targets of these three microRNAs with immunological response, cell-cell adhesion, and cardiac changes. LVSd alters the expression of let-7b-5p, miR-326, and miR-125a-3p in PBMC from post-STEMI, indicating their potential involvement in the cardiac dysfunction physiopathology and highlighting these miRNAs as possible LVSd biomarkers.

Effects of quercetin supplementation on endothelial dysfunction biomarkers and depression in post-myocardial infarction patients: A double-blind, placebo-controlled, randomized clinical trial

Endothelial dysfunction and depression are highly prevalent in patients who have experienced a myocardial infarction (MI). Epidemiological studies have pointed out that a diet rich in flavonoids, e.g., quercetin, can prevent the development of these biological phenomena. Therefore, we aimed to investigate the effects of quercetin supplementation on the levels of intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1) and on depression in post-MI subjects. Eighty-eight post-MI patients who had experienced their first MI (body mass index ≤35kg/m2, age 30-65 years) were recruited from the Rasool-e-Akram and Afshar Hospitals, Iran, and included in this randomized, placebo-controlled, double-blind parallel study. The participants were randomly assigned to receive a daily dose of 500mg quercetin (n=44) or placebo (n=44) for 8 weeks. Serum concentrations of ICAM-1 and VCAM-1 were quantified by ELISA and depression levels were assessed using the Beck's Depression Inventory (BDI-II) questionnaire at baseline and at 8-week follow-up. Seventy-six participants completed the study, but the intention-to-treat (ITT) analysis was conducted for all 88 participants who were randomized into the intervention groups. No significant changes in serum concentrations of ICAM-1 or VCAM-1 (P=0.21 and P=0.80, respectively) were observed after 8 weeks of quercetin supplementation versus placebo. In addition, depression levels did not differ significantly between the quercetin and placebo groups. Our findings demonstrated that in post-MI patients, daily supplementation with quercetin (500mg/day) for 8 weeks did not affect endothelial dysfunction biomarkers and depression levels. This trial was registered at IRCT.ir as IRCT20190428043405N1.

The development and randomised feasibility trial of a Nurse-led lifestyle modification follow-up programme among post-myocardial infarction patients.

Cardiovascular disease is the most often occurring disease in India accounting for 24.8% of deaths. Myocardial infarction contributes to this. A higher risk of cardiovascular disease exists due to comorbidities or the unawareness of existing illness among the Indian population. There is a shortage of published research on cardiovascular disease and a lack of standard cardiac rehabilitation programmes in India. Our study aims to develop a Nurse-led lifestyle modification follow-up programme, to assess and compare the effectiveness of the programme on health outcomes and quality of life among post-myocardial infarction patients. A two arm, single-blinded, randomised feasibility trial was conducted by developing a Nurse-led lifestyle modification follow-up programme. The interventional programme was based on the information-motivation-behavioural skill model and included health education, an educational booklet, and telephone follow-up. For feasibility testing of intervention, 12 patients were randomly allocated (n = 6/group). Patients in the control group were provided with routine care, while the intervention group was given routine care along with a Nurse-led lifestyle modification follow-up programme. It was possible to use this tool. In addition to determining the tool's feasibility for use we found that the intervention group showed a significant improvement in systolic blood pressure (BP) (p = 0.001), diastolic BP (p = 0.016), Body Mass Index (BMI) (p = 0.004), and quality of life in all the subscales - physical, emotional and social (p < 0.001) after 12 weeks of discharge. Findings from this study will help to reinforce designing a cost-effective care delivery system in the care of post-myocardial infarction patients. This programme is a novel approach to improve preventive, curative and rehabilitative services for the post-myocardial infarction patients in India.

Commentary: The development and randomised feasibility trial of a Nurse-led lifestyle modification follow-up programme among post-myocardial infarction patients.

Commentary: The development and randomised feasibility trial of a Nurse-led lifestyle modification follow-up programme among post-myocardial infarction patients.

Intensive nurse-led follow-up in primary care to improve self-management and compliance behaviour after myocardial infarction.

To assess the effects of intensive follow-up by primary care nurses on cardiovascular disease self-management and compliance behaviours after myocardial infarction. Although cardiovascular disease prevention and cardiac rehabilitation take place in hospital settings, a nurse-led approach is necessary in primary care during the first few months after a myocardial infarction. Therefore, it is important to assess self-management of cardiovascular disease and levels of compliance with the prescribed diet, physical activity, and medication. The study used a multicentre, quasi-experimental, pre-post design without a control group. Patients with acute coronary syndrome from 40 healthcare facilities were included in the study. A total of 212 patients participated in a programme including 11 interventions during the first 12-18 months after myocardial infarction. The following Nursing Outcomes Classification (NOC) outcomes were assessed at baseline and at the end of the intervention: Self-management: Cardiac Disease (1617) and Compliance Behaviour: Prescribed Diet (1622), Compliance Behaviour: Prescribed Activity (1632), and Compliance Behaviour: Prescribed Medication (1623). Marjory Gordon's functional health patterns and a self-care notebook were used in each intervention. Pre-post intervention means were compared using Student's t-tests for related samples. The results of the study are reported in compliance with the TREND Statement. A total of 132 patients completed the intervention. The indicators for each NOC outcome and the variations in scores before and after the intensive follow-up showed a statistically significant improvement (p-value = 0.000). Compliance Behaviour: Prescribed Diet (pre = 3.7; post = 4.1); Compliance Behaviour: Prescribed Activity (pre = 3.9; post = 4.3); Compliance Behaviour: Prescribed Medication (pre = 3.9; post = 4.7). Intensive, immediate follow-up after myocardial infarction improves compliance behaviours and self-management of heart disease. A combined self-care and family care approach should be encouraged to empower post-myocardial infarction patients. To facilitate patients' self-efficacy, the use of health education tools such as a cardiovascular self-care notebook can also be helpful. This study highlights the benefits of intensive, protocolised, comprehensive patient follow-up in primary care during the first few months after an acute myocardial infarction (AMI). Primary care nurses train patients in cardiovascular self-care. Patients were not involved in either the design or the carrying out of the study. However, at the end of the study, they participated in an evaluation process about the utility of the research study and their satisfaction with it. This process was carried out using an ad hoc survey consisting of 10 questions assessing the nursing care and follow-up inputs that were received.

Wearable cardioverter defibrillator for preventing sudden cardiac death in patients at risk: An updated systematic review of comparative effectiveness and safety.

To synthesise the available evidence of wearable cardioverter defibrillator (WCD) therapy as an add-on measure to optimal medical therapy (OMT) or as a replacement of hospital stay. An update systematic review (SR) of comparative effectiveness and safety of WCD therapy was conducted. We included randomised controlled trials (RCT), prospective comparative studies and prospective uncontrolled studies with at least 100 patients. A narrative synthesis of the evidence was conducted. One RCT (n = 2348) and further eleven observational studies (n = 5345) fulfilled our inclusion criteria. In the only available RCT, the use of the WCD was not statistically associated with a clinical benefit on arrhythmic mortality in post-myocardial infarction (MI) patients with an ejection fraction of ≤35%. The compliance with WCD therapy was low in the RCT and high in observational studies, with ten observational studies reporting on a daily wear time between 20 and 23.5 h. The range of percentage of patients receiving at least one appropriate shock was 1-4.8% and the rate of first shock success was reported to be 100% in three studies. Serious adverse events (SAEs) such as inappropriate shocks occurred rarely, with between 0% and 2% of patients being inappropriately shocked within ten observational studies. In one of the observational studies, two patients (2%) were allergic to nickel developing skin rash and false alarms occurred in 58 patients (57%) in this study. Another registry study (n = 448) reported milder AEs, such as dermatitis and pressure marks, occurring in 0.9% and 0.2% of enrolled patients, respectively. The only available RCT failed to show superiority of add-on use of WCD in post MI patients. Observational evidence shows that the compliance with WCD is good, but the evidence is afflicted with selection bias and the inclusion of diverse mixed patient populations diluting the ability to draw indication-specific conclusions on the utility of the device. More comparative data is needed to justify continuing or expanding use of WCD therapy.

Heart failure with preserved ejection fraction in post myocardial infarction patients: a myocardial magnetic resonance (MR) tissue tracking study.

This study aimed to explore the value of cardiac magnetic resonance tissue tracking (CMR-TT) technology in evaluating heart failure with preserved ejection fraction (HFpEF) in patients with chronic myocardial infarction (CMI). Between June 2016 and March 2022, we included a consecutive series of 92 patients with CMI and 40 healthy controls in this retrospective study. The CMI patients enrolled were divided into different subgroups [HFpEF-CMI group (n=54) and non- heart failure (HF)-CMI group (n=38)] according to the Heart Failure Association (HFA)-PEFF (step 1: P, pre-test assessment; step 2: E, echocardiography and natriuretic peptide score; step 3: F1, functional testing; step 4: F2, final aetiology) diagnostic algorithm. CMR scan was performed at the First Hospital of China Medical University. Quantitative measurements of myocardial damage, such as myocardial strain parameters of both ventricles derived by CMR-TT and infarct size and transmurality by late gadolinium enhancement (LGE), were assessed. One-way analysis of variance, independent samples t-test, and rank sum test were used to compare myocardial impairment among groups. Pearson or Spearman correlation coefficient was used to measure correlations between left ventricular (LV) strains and clinical and functional parameters. Logistic regression analysis and receiver operating characteristic (ROC) curve were performed to identify the best parameter for diagnosing HFpEF-CMI. HFpEF-CMI patients demonstrated significantly impaired LV strains and strain rates in all of the three directions (radial, circumferential and longitudinal) compared to non-HF-CMI patients and healthy controls (P<0.001 for all), whereas only global longitudinal strain (GLS) was significantly impaired in HFpEF-CMI patients vs. controls for right ventricular strain parameters (P<0.001). LV strains showed moderate correlation with N-terminal pro-brain natriuretic peptide (radial, circumferential and longitudinal strain, R=-0.401, R=0.408, R=0.407, respectively, P<0.001 for all). LV strains in the three directions (radial, circumferential and longitudinal) [area under ROC curve (AUC) =0.707, 95% confidence interval (CI): 0.603-0.797; AUC =0.708, 95% CI: 0.604-0.798; AUC =0.731, 95% CI: 0.628-0.818; respectively, P<0.01 for all] were discriminators for HFpEF-CMI and non-HF-CMI. LV strains and myocardial infarction volume were independent factors in multi-logistic regression analysis after adjusting for body mass index, age, and sex (P<0.05 for all). CMR-TT provides clinicians with useful additional imaging parameters to facilitate the assessment of CMI patients with HFpEF. LV strain parameters can detect early cardiac insufficiency in patients with HFpEF-CMI and have potential value for discriminating between HFpEF and non-HF patients post-CMI.

Non-erythropoiesis stimulating agent, non-iron therapies for the management of anemia: A scoping review.

Non-erythropoiesis stimulating agent, non-iron therapies for the management of anemia: A scoping review.

The effect of individualized education on stylistic changesamong M.I. patients

Life is a precious, Lord -given gift to mankind. Pulse rate represents life &amp; lack of it pronounces death. The heart pumps blood throughout the body from conception till the death. A heart is essential to sustain life.A true experimental, posttest research design was adopted. A sample of 60 post M I patients were selected by using non-probability convenient sampling technique, 30 in each experimental and control group. The mean knowledge level score and standard deviation of the experimental group was 21.86 (SD=2.20) higher than mean (10.57) and standard deviation (SD=3.49) of the control group and „t‟ value 14.72.Two mean „t‟ for independent samples showed a significant difference in the post test knowledge score on stylistic changesamong experimental and control group at 0.05 level. This finding indicated that the individualized education was highly effective. : Individualized education on the stylistic changeswas highly effective, eminent and cost-effective intervention for improving the knowledge and creating awareness among post myocardial infarction patients about the stylistic changesand helped them to adopt a healthy lifestyle post myocardial infarction.

The Trends of Pharmacological Therapy in one Month Post Myocardial Infarction Patients

Guideline recommended treatment has an important impact on the mortality and morbidity of post myocardial infarction patients. Objective: To assess the frequency of appropriate drug with its appropriate dosage of guideline recommended pharmacological therapy, prescribed by physician, in patients with Myocardial Infarction (MI). The cross sectional study conducted at National Institute of Cardiovascular Disease, Karachi from 1st January 2020 to 30th June 2020. Methods: Total 160 patients who came to hospital for follow-up after one month of Myocardial infarction were included in the study. Prescription was considered appropriate if the patient has taken at-least 5 out of 6 medications. At least 5 out of 6 along with its goal dose was considered as appropriate dosage. Descriptive statistics were calculated. Stratification was done. Chi-square test was applied post stratification and p-value ≤ 0.05 was considered as significant. Results: There were 103 male and 57 female patients. The mean age was 53.36 ± 8.10 years. Number of drugs used was found appropriate in 96.3% patients but the doses of drugs used was found appropriate in only 5.6% patients. Conclusions: The present study revealed that the majority of the physicians prescribed the recommended number of the drugs used; however, the doses of drugs used were not always according to the guidelines. It is important for cardiology physicians to understand the importance of guideline recommended pharmacological intervention among patients with a one-month history of MI.

Old but not Vain : Two Cases of Refractory Polymorphic Ventricular Tachycardia associated with Coronary Artery Disease successfully treated with Quinidine

Post myocardial infarct polymorphic Ventricular Tachycardia (VT) triggered by injured Purkinje fibres can cause VT storms that are refractory to various treatment even after successful reperfusion or revascularization. We reported such recurrent polymorphic VT in two post myocardial infarct patients after Percutaneous Coronary Intervention. Both of them responded readily to Quinidine. We also discussed the pathophysiology of this arrhythmia and the treatment option of it, namely catheter ablation and antiarrhythmics

Effect of candesartan treatment on echocardiographic indices of cardiac remodeling in post-myocardial infarction patients.

Myocardial infarction has unfavorable effect on structural and functional properties of the myocardium, referred to as cardiac remodeling. Left ventricular mass, left ventricular mass index, and relative wall thickness are important predictors of cardiac remodeling. In this study, we investigated the effect of candesartan treatment in comparison with zofenopril treatment on echocardiographic indices of cardiac remodeling in post myocardial infarction patients. In this prospective study, patients who underwent successful percutaneous coronary intervention were randomly assigned to a candesartan or zofenopril treatment. After randomization, echocardiographic indices of cardiac remodeling including left ventricular mass, left ventricular mass index, and relative wall thickness were evaluated before the start of treatment along with 1- and 6-month follow-ups. According to our study, candesartan group showed significant reduction of estimated left ventricular mass and left ventricular mass index at 6-month follow-up visit compared to baseline values (199.53±38.51 g vs. 212.69±40.82 g; 99.05 g/m2 (90.00-116.5) vs. 106.0 g/m2 (96.0∼123.00), p<0.05, respectively). This trend was also observed in zofenopril group during the 6-month period (201.22±40.07 g vs. 207.52±41.61 g; 101.0 g/m2 (92.25-111.75.0) vs. 104.50 g/m2 (95.0∼116.75), p<0.05, respectively). Although both classes of drugs had favorable effects on post-myocardial infarction cardiac remodeling, the absolute benefit was more prominent in candesartan group as compared to zofenopril group (p<0.05). Our results suggest that candesartan treatment following myocardial infarction may potentially be useful in terms of improving post-myocardial infarction cardiac remodeling.

A Study To Assess The Effectiveness Of Individualized Education On Lifestyle Modification Among Post-Myocardial Infarction Patients In Gknm Hospital, Coimbatore

A Study To Assess The Effectiveness Of Individualized Education On Lifestyle Modification Among Post-Myocardial Infarction Patients In Gknm Hospital, Coimbatore

Importance of Right Ventricular Mapping and Ablation for Ventricular Tachycardia in Postinfarction Patients.

The characteristics of patients with post-myocardial infarction (PMI) ventricular tachycardia (VT) who require right ventricular (RV) ablation are underreported. The aims of this study were to examine the characteristics and outcomes of patients undergoing PMI VT ablation who have target sites in the right ventricle and to compare patient and VT characteristics between patients with free wall vs septal RV target sites. Consecutive patients undergoing ablation for PMI VT with target sites located within the right ventricle were included. Patients were stratified on the basis of the presence of free wall vs septal RV target sites. Among 277 consecutive patient undergoing PMI VT ablation, 30 (11%) had RV target sites (mean age 68.71 ± 9.5 years, 29 men [97%], mean left ventricular ejection fraction [LVEF] 28.7% ± 16.7%). Twenty patients had only septal VTs, and 10 patients had only free wall VTs. Fifty-seven VTs with RV targets (1.9 ± 1.4 per patient, mean cycle length 338± 90ms, 53 left bundle branch, 36 superior axis) were induced. Patients with RV free wall VTs had greater rates of RV dysfunction (80% vs 30%; P=0.023) but had greater LVEFs (38.3% ± 21.06% vs 23.9% ± 11.93%; P=0.02). Overa mean follow-up period of 3.4 ± 3.2 years, patients with RV septal target sites had worse survival free of VT, transplantation, or left ventricular assist device placement after ablation (log-rank P< 0.05). The arrhythmogenic substrate in PMI patients often involves the right ventricle, including the septum and free wall. The presence of RV dysfunction and greater LVEF were associated with the presence of RV free wall target sites. Patients with only RV septal target sites had worse postablation outcomes.

Ischaemic Supraventricular Tachycardia: A Rare Case Report

The incidence of supraventricular arrhythmias other than Atrial Fibrillation (AF) and atrial flutter in postmyocardial Infarction (MI) patients is usually rare. The incidence of in-hospital AF after MI ranges from 5%-18%. Paroxysmal Supraventricular Tachycardia (PSVT) occurs in less than 10% of patients after an acute MI. Herein, the authors presented a case of a 47-year-old male presented to the Casualty Department with chief complaints of palpitations for the past six hours. The Electrocardiogram (ECG) revealed Supraventricular Tachycardia (SVT), and immediate pharmacological cardioversion was performed. Coronary Angiogram (CAG) was conducted, which revealed double vessel disease with critical lesions in the proximal Right Coronary Artery (RCA) and mid Left Circumflex (LCX). Percutaneous coronary intervention was performed for both lesions. The patient was discharged in a stable condition. Prompt and immediate diagnosis of arrhythmias is crucial, especially in patients with MI, to reduce mortality and morbidity.

The Effect of Protease-Activated Receptor-1 (PAR-1) Inhibition on Endothelial-Related Biomarkers in Patients with Coronary Artery Disease.

Vorapaxar has been shown to reduce cardiovascular mortality in post-myocardial infarction (MI) patients. Pharmacodynamic biomarker research related to protease-activated receptor-1 (PAR-1) inhibition with vorapaxar in humans has short follow-up (FU) duration and is mainly focused on platelets rather than endothelial cells. This article assesses systemic changes in endothelial-related biomarkers during vorapaxar treatment compared with placebo at 30 days' FU and beyond, in patients with coronary heart disease. Local substudy patients in Norway were included consecutively from two randomized controlled trials; post-MI subjects from TRA2P-TIMI 50 and non-ST-segment elevation MI (NSTEMI) patients from TRACER. Aliquots of citrated blood were stored at -80°C. Angiopoietin-2, angiopoietin-like 4, vascular endothelial growth factor, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, E-selectin, von Willebrand factor, thrombomodulin, and plasminogen activator inhibitor-1 and -2 were measured at 1-month FU and at study completion (median 2.3 years for pooled patients). A total of 265 consecutive patients (age median 62.0, males 83%) were included. Biomarkers were available at both FUs in 221 subjects. In the total population, angiopoietin-2 increased in patients on vorapaxar as compared with placebo at 1-month FU (p = 0.034). Angiopoietin-like 4 increased (p = 0.028) and plasminogen activator inhibitor-2 decreased (p = 0.025) in favor of vorapaxar at final FU. In post-MI subjects, a short-term increase in E-selectin favoring vorapaxar was observed, p = 0.029. Also, a short-term increase in von Willebrand factor (p = 0.032) favoring vorapaxar was noted in NSTEMI patients. Significant endothelial biomarker changes during PAR-1 inhibition were observed in post-MI and NSTEMI patients.

Ventricular bigeminy characterization in 24-h Holter monitoring from Andersen-Tawil patients: An initial proof of concept versus patients with ischemic heart disease

AimTo characterize ventricular bigeminy from 24-h Holter recordings of Andersen-Tawil syndrome (ATS) patients, a first comparison with a large database of post-myocardial infarction (post-MI) patients with frequent premature ventricular complexes (PVC) was performed. MethodsBaseline Holter recordings from 6 ATS1 patients and 618 post-MI patients were analyzed to assess total number of PVC, quantification of coupling intervals (CI), total number of bigeminy episodes, and percentage of PVC in bigeminy. ResultsA non-significant difference in total number of PVCs, mean CI and CI standard deviation was found. The median number of episodes of bigeminy (1038 vs 1; p = 0.004) and of PVC in bigeminy (51.1 vs 0.1%; p = 0.002) was significantly higher in ATS1 patients. Having ≥42 episodes of bigeminy or ≥ 36.1% of PVC in bigeminy distinguish PVC from ATS from post-MI patients with a sensitivity and specificity >80%. ConclusionIn this first approach, patients with ATS had a characteristic burden of episodes of ventricular bigeminy, compared with post-MI patients.