Prevalence Of Cardiac Events Research Articles

Holter Electrocardiographic Approach to Predicting Outcomes of Pediatric Patients With Long QT Syndrome.

This study was performed to clarify the clinical findings of pediatric patients diagnosed with long QT syndrome (LQTS) through electrocardiographic screening programs and to predict their outcome using Holter electrocardiographic approaches.Methods and Results: This retrospective study included pediatric patients with a Schwartz score of ≥3.5 who visited the National Hospital Organization Kagoshima Medical Center between April 2005 and March 2019. Resting 12-lead and Holter electrocardiograms were recorded at every visit. The maximum resting QTc and maximum Holter QTc values among all recordings were used for statistical analyses. To test the prognostic value of QTc for the appearance of cardiac events after the first hospital visit, receiver operating characteristic curves were used to calculate the area under the curve (AUC). Among 207 patients, 181 (87%) were diagnosed through screening programs. The prevalence of cardiac events after the first hospital visit was 4% (8/207). Among QTc at diagnosis, maximum resting QTc, and maximum Holter QTc, only maximum Holter QTc value was a predictor (P=0.02) of cardiac events after the hospital visit in multivariate regression analysis. The AUC of the maximum Holter QTc was significantly superior to that of maximum resting QTc. The maximum Holter QTc value can be used to predict the appearance of symptoms in pediatric patients with LQTS.

Long-term clinical course of patients with catecholaminergic polymorphic ventricular tachycardia: A more than 10-year follow-up cohort study

ABSTRACT Background: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited disorder characterized by ventricular arrhythmias induced by physical or emotional stress. Currently, there are limited data available on the long-term prognosis of CPVT. Methods and Results: In this study, which included both retrospective and prospective components, 12 patients with CPVT (7 males and 5 females) under 18 years old were enrolled to gather and evaluate demographic, clinical, and genetic data. The mean age at diagnosis onset was 7.0 ± 3.1 years. All patients experienced syncope. The mean follow-up duration was 20.1 years. During the follow-up period, all patients experienced at least one episode of supraventricular tachycardia (SVT). Despite beta-blocker therapy, nine patients experienced syncope (75%), and four patients were noncompliant with their treatment. An implantable cardiac defibrillator (ICD) implantation was performed in 10 patients (83%), and among those 5 (50%) experienced appropriate shocks. Inappropriate shocks were observed in all patients with an ICD. The left cardiac sympathetic denervation was performed in 6 patients (50%). One patient died during the follow-up period. Genetic testing was performed in eight patients, five of whom had RYR2 mutations, one patient had mutations in CASQ2, one in TECRL, and one was gene-elusive. Conclusions: The prevalence of cardiac events, even after the initiation of beta-blocker therapy, was found to be distressingly high during long-term follow-up. SVT, such as atrial fibrillation, were found to be more common than previously thought. Combination therapy with a beta-blocker and an IC antiarrhythmic drug shows promise. An individualized approach to the selection of treatment strategies is essential.

P165 CARDIOVASCULAR RISK FACTORS AND HYPOGONADISM INFLUENCE ON CARDIAC OUTCOMES IN AN AGING POPULATION OF BETA–THALASSEMIA PATIENTS: LOOKING AT THE HEART OF THE PROBLEM

Abstract Background β–thalassemia major (β–TM) is a hereditary genetic disease hindered by many comorbidities due to transfusion–related iron. Despite iron chelation therapy increased the life expectancy up to 50 years today, Iron–related heart disease is still a leading complication, with an expected change in cardiac disease drivers with the ageing of these patients. This study aims to evaluate the distribution and prevalence of cardiovascular risk factors in a population of thalassemia major patients, and their relationship with observed cardiovascular events and potential modifying factors. Methods and Results One–hundred fifty–nine β–TM patients older than 18 years of age were included in this study. Mean age was 40.9 ± 8.4 years. Low serum lipid levels with low HDL levels were noted, with 28% having diabetes mellitus and 62% with hypogonadism; Splenectomy was reported in 70%. During the observed period, 3.8% of patients had at least one episode of heart failure, 35.9% showed early signs of heart failure, 22% received a diagnosis of diastolic dysfunction, 38% had a left ventricular ejection fraction <55%, and 21.4% showed supraventricular arrhythmias. Cardiovascular risk was then assessed using two algorithms (CUORE and Pooled Cohort Risk Equation – PCRE) and was generally low despite the high burden of cardiac–related events. Patients with hypogonadism (who showed lower cardiac T2* value than those without; p < 0.001) showed a statistically significant correlation with the occurrence of cardiovascular events. Discussion The β–TM population has a relatively low mean age, but shows a particular metabolic profile associated with numerous comorbidities: an increased prevalence of diabetes mellitus, low HDL values and frequent hypogonadism, which tends to be associated with increased iron deposition in the myocardium. The cardiovascular risk estimated by specific algorithms (CUORE and PCRE) was generally low, probably due to the young age of the cohort and derivation pitfalls when applied to this specific population, but the prevalence of cardiac events was not negligible. Conclusions The chronic accumulation of iron in the heart and the specific metabolic profile, mainly observed in patients with hypogonadism, allows us to define β–TM as a condition with high cardiovascular risk from many points of view (iron–related myopathy, atherosclerosis and arrhythmias), which requires better stratification tools and specific follow–up program.

Distribution and prevalence of cardiovascular risk factors in a aging population of thalassemia patients: looking at the heart of the problem

Abstract Background β-thalassemia major is a hereditary genetic disease hindered by many comorbidities due to transfusion-related iron. Since the introduction of chelation therapy life expectancy of these patients has increased from the 16 years of 1964 to 50 years today, with a marked improvement in the quality of life. Iron-related heart disease is still a leading complication but diabetes mellitus and hypogonadism may impact the cardiovascular risk in these patients, with an expected change in heart involvement with this unprecedentedly seen aging of these patients. Target This study aims to evaluate the distribution and prevalence of cardiovascular risk factors in a population of thalassemia major patients, and their relationship with observed cardiovascular events and potential modifying factors. Methods and results One-hundred fifty-nine patients older than 18 years of age with clinical and molecular diagnosis of β-thalassemia major and at least 15 years of follow-up were included in this study. Mean age was 40.9±8.4 years. Low serum lipid levels with low HDL levels were noted, with 17.6% having diabetes mellitus and 62% with hypogonadism; Splenectomy was reported in 70%. During the observed period 3.8% of patients had at least one episode of heart failure, 35.9% showed early signs of heart failure, 22% received diagnosis of diastolic dysfunction, 38% had a left ventricular ejection fraction <55% and 21.4% showed supraventricular arrhythmias. Cardiovascular risk was then assessed using two algorithms (CUORE and Pooled Cohort Risk Equation - PCRE) and was generally low but despite that patients with hypogonadism (who showed lower cardiac T2* value than those without; p<0.001) showed a statistically significant correlation with the occurrence of cardiovascular events. Discussion The β-thalassemia population has a relatively low mean age, but shows a particular metabolic profile in association with numerous comorbidities: an increased prevalence of diabetes mellitus, low HDL values and frequent hypogonadism which tends to be associated with increased iron deposition in myocardium. The cardiovascular risk estimated by specific algorithms (CUORE and PCRE) was generally low, mainly due to the young age of the cohort, but the prevalence of cardiac events was not negligible. Conclusions The chronic accumulation of iron in the heart and the specific metabolic profile, particularly observed in patients with hypogonadism, allows us to define Major Thalassemia patients as a population at high cardiovascular risk from many points of view (iron-related myopathy, atherosclerosis and arrhythmias), which requires a specific follow-up program, to prevent and to identify early signs of these serious complications. Funding Acknowledgement Type of funding sources: None.

Abstract 16197: Influence of Coronary Artery Disease on the Prognosis of a Positive Stress Echocardiogram in Patients With Advanced Liver Disease

Background: Cardiac complications are the leading cause of mortality after orthotopic liver transplantation (OLT). In the general population, a positive dobutamine stress echocardiogram (DSE) in the absence of coronary artery disease (CAD) still identifies a high risk group whose outcome is similar to those with positive DSE and CAD. DSE is widely employed as a screening method prior to OLT but less is known about the prognostic impact of a positive DSE in the end stage liver disease (ESLD) population and whether CAD also influences their outcome. We investigated the prognostic impact of a positive DSE and clinical factors including CAD in patients with ESLD. Methods: Follow-up data was obtained in 61 liver transplant candidates with positive DSE and coronary angiography for cardiovascular events including angina requiring revascularization, heart failure, infarction, and cardiac death. Event free survival was compared between patients with (22 patients >70% stenosis) and without (39 patients) obstructive CAD and Cox regression was used to identify factors associated with events. Results: Over a mean follow-up of 27 + 28 months, 21 % (8/39) of patients with positive DSE and no CAD had events compared with 46% (10/22) of patients with positive DSE and CAD, p = 0.04. At one year of follow-up, cardiac death had occurred in 8% (3/39) of patients with positive DSE and no CAD, and in 9% (2/22) of those with positive DSE and CAD. Overall, event free survival was significantly better in those without CAD (p = 0.014). Beta blocker use (HR: 4.1, 95% CI: 1.7 - 9.9, p-value = 0.010), CAD (HR: 4.4 95% CI: 1.8- 10.8, p-value = 0.008), and non-alcoholic steatohepatitis (NASH) (HR: 4.9, 95% CI: 2.0 - 11.7, p-value = 0.04) were independently associated with cardiac events. Conclusion: ESLD patients with a positive DSE and no CAD had a one year cardiac mortality that was similar to patients that had a positive DSE and CAD. However, the overall prevalence of cardiac events and the event free survival was significantly worse in the CAD group. Thus, ESLD patients with a positive DSE are at increased risk and the presence of CAD further increases their risk. In addition to CAD, beta blocker use and NASH were independently associated with cardiac events.

Clinical importance of late gadolinium enhancement at right ventricular insertion points in otherwise normal hearts.

Late gadolinium enhancement (LGE) has an established prognostic value in otherwise normal hearts, when detected with a subepicardial or intramyocardial pattern; nevertheless, the clinical relevance of isolated right ventricular insertion point (RVIP) LGE is yet to be defined. From a retrospectively identified cohort of 2000 consecutive patients undergoing CMR, we selected 420 patients according to study's inclusion and exclusion criteria (270 males, mean age 38 ± 17years) with apparently normal hearts: besides 36 patients with non-ischemic pattern LGE (other-LGE group), we found isolated RVIP-LGE in 44 patients and absence of LGE (no-LGE group) in 340 patients. Clinical follow-up was performed for a median of approximately 6years. Primary composite endpoint included cardiac death, resuscitated cardiac arrest, and appropriate implantable cardiac defibrillator shock. Prevalence of cardiac events was significantly lower in RVIP-LGE than in the other-LGE group (p = 0.006). Kaplan Meier curve analysis demonstrated no significant differences between patients with RVIP-LGE and no-LGE for the primary endpoint. On contrast, patients with other-LGE had worse prognosis than those with RVIP-LGE or no-LGE (p < 0.0001). RVIP-LGE in subjects without additional evidence of cardiac damage does not convey worse prognosis when compared to subjects without LGE and it should not be considered a marker of disease. Its diagnostic and prognostic significance is to be considered irrelevant.

Abstract P004: Shift-working Firefighters Have Poorer Heart Health Than They Think: An Intervention Opportunity

Background: As an occupational sub-group, career firefighters experience a disproportionately higher prevalence of cardiac events and risk factors than the general population. The pervasive nature of poor cardiovascular health (CVH) in this population might belie an occupational norm. Underestimation of poor health could be a barrier to the adoption of health-enhancing behaviors. Methods: Baseline data from a sample of 478 male firefighters from five different fire houses were used to examine the relationship between objective and perceived health. Objective CVH was defined as meeting the American Heart Association ideal recommendations for the following six, CVH metrics: tobacco use (non-smoker), body mass index (≤24.9 kg/m 2 ), physical activity (≥75 min/wk vigorous or ≥150 min/wk moderate activity), fruit and vegetable intake (≥4.5 cups/d), blood pressure (&lt;120/80 mm Hg) and total lipids (&lt;200 mg/dL). Firefighters rated their perceived health as excellent, average, fair or poor. The proportion of firefighters meeting the ideal status for each CVH metric, and total CVH metrics achieved, was generated. A chi-square test of independence examined differences between the binary ideal CVH metrics (0-3 versus 4-6 ideal CVH metrics) and perceived excellent/average health. Results: The mean age of the sample was 38.2 years (SD=9.9), 89% (413/478) were Caucasian, 73% (334/478) were married, 67% (290/478) had an annual income of at least $75,000, and 90% (410/478) had attended college. Three-quarters (76%; 225/478) of the sample met the ideal recommendations for tobacco use, 20% (93/478) for body mass index, 0% for physical activity, 36% (174/478) for fruit and vegetable intake, 39% (184/478) for blood pressure, and 88% (345/478) for lipids. Overall, none of the firefighters sampled had ideal status on all 6 CVH metrics considered. Ninety-two percent (426/478) of the sample rated their health as average to excellent, although only 10% (47/478) of the sample had ideal status for 4-6 of the CVH metrics; 90% (431/478) had ideal status for 0-3 metrics (X 2 = 4.54; p=.03). Conclusion: The CVH status of firefighters is poor, but firefighters with poor heart health inaccurately perceive their health as average or better. Addressing this misperception gap will be necessary to optimize responses to CVH interventions delivered to this population.

Quantitative assessment of tissue prolapse on optical coherence tomography and its relation to underlying plaque morphologies and clinical outcome in patients with elective stent implantation

BackgroundTissue prolapse (TP) is sometimes observed after percutaneous coronary intervention (PCI), but its clinical significance remains unclear. We investigated the relationship between TP volume on optical coherence tomography (OCT) after PCI and underlying plaque morphologies and the impact of TP on clinical outcomes. MethodsWe investigated 178 native coronary lesions with normal pre-PCI creatine kinase-myocardial band (CK-MB) values (154 lesions with stable angina; 24 with unstable angina). TP was defined as tissue extrusion from stent struts throughout the stented segments. All lesions were divided into tertiles according to TP volume. The differences in plaque morphologies and 9-month clinical outcomes were evaluated. ResultsTP volume was correlated with lipid arc (r=0.374, p<0.0001) and fibrous cap thickness (r=−0.254, p=0.001) at the culprit sites. The frequency of thin-cap fibroatheroma (TCFA) was higher in the largest TP tertile (≥1.38mm3) (p=0.015). In multivariate analysis, right coronary artery lesion (odds ratio [OR]: 2.779; p=0.005), lesion length (OR: 1.047; p=0.003), and TCFA (OR: 2.430; p=0.022) were related to the largest TP tertile. Lesions with post-PCI CK-MB elevation (>upper reference limit) had larger TP volume than those without (1.28 [0.48 to 3.97] vs. 0.70 [0.16 to 1.64] mm3, p=0.007). The prevalence of cardiac events during the 9-month follow-up was not significantly different according to TP volume. ConclusionsTP volume on OCT was related to plaque morphologies and instability, and post-PCI myocardial injury, but not to worse 9-month outcomes.

Significance of Coronary Calcification for Prediction of Coronary Artery Disease and Cardiac Events Based on 64-Slice Coronary Computed Tomography Angiography

This work aims to validate the clinical significance of coronary artery calcium score (CACS) in predicting coronary artery disease (CAD) and cardiac events in 100 symptomatic patients (aged 37–87 years, mean 62.5, 81 males) that were followed up for a mean of 5 years. Our results showed that patients with CAD and cardiac events had significantly higher CACS than those without CAD and cardiac events, respectively. The corresponding data were 1450.42 ± 3471.24 versus 130 ± 188.29 (P < 0.001) for CAD, and 1558.67 ± 513.29 versus 400.46 ± 104.47 (P = 0.031) for cardiac events. Of 72 patients with CAD, cardiac events were found in 56 (77.7%) patients. The prevalence of cardiac events in our cohort was 13.3% for calcium score 0, 50% for score 11–100, 56% for score 101–400, 68.7% for score 401–1,000, and 75.0% for score >1000. Increased CACS (>100) was also associated with an increased frequency of multi-vessel disease. Nonetheless, 3 (20%) out of 15 patients with zero CACS had single-vessel disease. Significant correlation (P < 0.001) was observed between CACS and CAD on a vessel-based analysis for coronary arteries. It is concluded that CACS is significantly correlated with CAD and cardiac events.

Echocardiographic evaluation in patients with autosomal dominant polycystic kidney disease and end-stage renal disease.

Cardiovascular abnormalities have been considered important extrarenal manifestations of autosomal dominant polycystic kidney disease (ADPKD). However, little is known about their prevalence in patients with ADPKD undergoing hemodialysis (HD). To investigate whether cardiac abnormalities are more prevalent in these patients, clinical and echocardiographic manifestations of cardiovascular disease were evaluated in a group of 32 patients with ADPKD and a matched control group of 32 patients without diabetes treated by chronic HD for more than 6 months. Predialysis systolic and diastolic blood pressure (BP), prevalence of hypertension, and number of patients requiring antihypertensive medications were lower in the ADPKD group than controls. There was no difference in the prevalence of cardiac events, including cardiac failure, ischemic heart disease, and arrhythmia. Systolic dysfunction, diastolic patterns, and left ventricular hypertrophy were similar in the two groups. In patients with ADPKD, simple regression analysis showed left ventricular mass (LVM) index was correlated with hemoglobin level and predialytic systolic and diastolic BPs. In multiple regression analysis, predialysis systolic BP was the only independent variable linked to LVM index. The prevalence of aortic, mitral, and tricuspid valve disease did not differ between groups. In conclusion, the occurrence of cardiovascular complications in patients with ADPKD is similar to that of HD patients with other primary renal diseases, although hypertension is less prevalent.

Resting gated pool ejection fraction: A poor predictor of perioperative myocardial infarction in patients undergoing vascular surgery for infrainguinal bypass grafting

Ventricular ejection fraction is widely regarded as a prognostic indicator of perioperative myocardial infarction. To evaluate this premise the prevalence of perioperative myocardial infarction or cardiac death was analyzed in relation to preoperative resting gated pool ejection fraction in 85 patients undergoing vascular surgery for infrainguinal bypass grafting. Patients were divided into three groups on the basis of ejection fraction. Group I consisted of 50 patients with ejection fractions of 56% to 92%. Nine (18%) perioperative myocardial infarctions occurred in group I, and there were no cardiac deaths. Group II consisted of 20 patients with ejection fractions of 37% to 55%. Three. (15%) myocardial infarctions occurred in this group, and there were no cardiac deaths. Group III included 15 patients with ejection fractions of 20% to 35%. Three (20%) cardiac events occurred in group III including one nonfatal myocardial infarction and two (13%) cardiac deaths. Statistical analysis showed no significant difference in prevalence of cardiac events between any group. These results suggest that resting ejection fraction is a poor predictor of perioperative myocardial infarction in patients undergoing vascular surgery. Patients with normal ejection fractions, but underlying coronary artery disease, are still at significant risk for a perioperative cardiac event.

Resting gated pool ejection fraction: a poor predictor of perioperative myocardial infarction in patients undergoing vascular surgery for infrainguinal bypass grafting.

Ventricular ejection fraction is widely regarded as a prognostic indicator of perioperative myocardial infarction. To evaluate this premise the prevalence of perioperative myocardial infarction or cardiac death was analyzed in relation to preoperative resting gated pool ejection fraction in 85 patients undergoing vascular surgery for infrainguinal bypass grafting. Patients were divided into three groups on the basis of ejection fraction. Group I consisted of 50 patients with ejection fractions of 56% to 92%. Nine (18%) perioperative myocardial infarctions occurred in group I, and there were no cardiac deaths. Group II consisted of 20 patients with ejection fractions of 37% to 55%. Three (15%) myocardial infarctions occurred in this group, and there were no cardiac deaths. Group III included 15 patients with ejection fractions of 20% to 35%. Three (20%) cardiac events occurred in group III including one nonfatal myocardial infarction and two (13%) cardiac deaths. Statistical analysis showed no significant difference in prevalence of cardiac events between any group. These results suggest that resting ejection fraction is a poor predictor of perioperative myocardial infarction in patients undergoing vascular surgery. Patients with normal ejection fractions, but underlying coronary artery disease, are still at significant risk for a perioperative cardiac event.

Prognostic significance of normal quantitative planar thallium-201 stress scintigraphy in patients with chest pain

The prognostic significance of normal quantitative planar thallium-201 stress scintigraphy was evaluated in patients with a chest pain syndrome. The prevalence of cardiac events during follow-up was related to the pretest (that is, before stress scintigraphy) likelihood of coronary artery disease determined on the basis of symptoms, age, sex and stress electrocardiography. In a consecutive series of 344 patients who had adequate thallium-201 stress scintigrams, 95 had unequivocally normal studies by quantitative analysis. The pretest likelihood of coronary artery disease in the 95 patients had a bimodal distribution. During a mean follow-up period of 22 +/- 3 months, no patient died. Three patients (3%) had a cardiac event: two of these patients (pretest likelihood of coronary artery disease 54 and 94%) had a nonfatal myocardial infarction 8 and 22 months, respectively, after stress scintigraphy, and one patient (pretest likelihood 98%) underwent percutaneous transluminal coronary angioplasty 16 months after stress scintigraphy for persisting anginal complaints. Three patients were lost to follow-up; all three had a low pretest likelihood of coronary artery disease. It is concluded that patients with chest pain and normal findings on quantitative thallium-201 scintigraphy have an excellent prognosis. Cardiac events are rare (infarction rate 1% per year) and occur in patients with a moderate to high pretest likelihood of coronary artery disease.