Risk Of Adverse Cardiac Events Research Articles

Is there an association between coronary artery inflammation and coronary atherosclerotic burden?

As for the coronary artery inflammation and coronary atherosclerotic burden, which are used to assess the risk of adverse cardiac events in patients, it is unclear whether there is any certain correlation between them. Therefore, the purpose of this study was to explore the potential relationship between coronary artery inflammation and coronary atherosclerotic burden. A total of 346 eligible patients underwent assessment of computed tomography (CT) attenuation values of pericoronary adipose tissue (PCAT) in the right coronary artery and Agatston coronary artery calcium (CAC) based on coronary CT angiography. These measurements were utilized to evaluate coronary inflammation and atherosclerotic burden, respectively. Patients with a CAC score of 0 were categorized into groups based on the presence or absence of coronary artery disease (CAD). CAC scores of 10, 100, and 400 were chosen as cutoff values to compare differences in PCAT attenuation values across different CAC scores. When comparing all CAD patients to non-CAD patients, a significantly higher PCAT attenuation was observed in CAD patients (-87.54±9.39 vs. -93.45±7.42 HU, P=0.000). The PCAT attenuation in CAD patients with a CAC score of 0 was significantly higher than that in patients with a CAC score greater than 0 and in non-CAD patients with a CAC score of 0 (-82.63±8.70 vs. -90.38±8.59 vs. -93.45±7.42 HU, P=0.000). The PCAT attenuation values did not exhibit significant differences among different CAC scores (all P>0.05); however, it was highest in CAD patients with a CAC score of 0 (P<0.05). Body mass index, hyperlipidemia, hypertension, and PCAT attenuation were identified as independent risk factors in both CAD patients with a CAC score of 0 and patients with a CAC score greater than 0 (all P<0.05). The results of this study suggest that a direct relationship between coronary inflammation and coronary atherosclerotic burden is not evident. Nonetheless, it is noteworthy that coronary inflammation was most pronounced in CAD patients with a CAC score of 0, while CAC score did not demonstrate an association with inflammation.

Relationship between left-axis deviation and onset of cardiac adverse events in right ventricular pacing.

The electrical axis shows alterations during right ventricular pacing (RVP), including a normal axis and left axis deviation; however, it remains unknown if differences in the electrical axis affect the occurrence of cardiac adverse events. The purpose of this study was to determine whether a left axis deviation increases the incidence of adverse cardiac events compared with a normal axis. This study analysed 156 patients with RVP. The patients were divided into two groups: those with left axis deviation after RVP (LAD group) and those with a normal axis (NA group). The primary composite outcome was the new-onset of atrial fibrillation (AF) and worsening heart failure (HF). The QRS axis of the LAD (n=77) and NA (n=79) groups were-64.5±14.3° and 29.8±36.5°, respectively (P<0.001). The median follow-up was 1100days and, regarding primary composite outcomes (hazard ratio, 1.03; 95% confidence interval, 0.64 to 1.65; P=0.89), 29/77 (37.6%) and 28/79 (35.4%) patients in the LAD and NA groups, respectively, developed AF (hazard ratio, 1.07; 95% confidence interval, 0.64 to 1.81; P=0.77). Furthermore, 8/77 (10.3%) and 12/79 (15.1%) patients in the LAD and NA groups, respectively, experienced worsening HF (hazard ratio, 0.65; 95% confidence interval, 0.26 to 1.60; P=0.35). The risk of cardiac adverse events in patients with RVP (new-onset AF or worsening HF, cardiovascular death, myocardial infarction, and stroke) and overall mortality with LAD is not higher than that with NA.

Cardiac Morphology, Function, and Left Ventricular Geometric Pattern in Patients with Hypertensive Crisis: A Cardiovascular Magnetic Resonance-Based Study.

(1) Background: Altered cardiac morphology and function are associated with increased risks of adverse cardiac events in hypertension. Our study aimed to assess left ventricular (LV) morphology, geometry, and function using cardiovascular magnetic resonance (CMR) imaging in patients with hypertensive crisis. (2) Methods: Patients with hypertensive crisis underwent CMR imaging at 1.5 Tesla to assess cardiac volume, mass, function, and contrasted study. Left ventricular (LV) function and geometry were defined according to the guideline recommendations. Late gadolinium enhancement (LGE) was qualitatively assessed and classified into ischemic and nonischemic patterns. Predictors of LGE was determined using regression analysis. (3) Results: Eighty-two patients with hypertensive crisis (aged 48.5 ± 13.4 years, and 57% males) underwent CMR imaging. Of these patients, seventy-eight percent were hypertensive emergency and twenty-two percent were urgency. Diastolic blood pressure was higher under hypertensive emergency (p = 0.032). Seventy-nine percent (92% of emergency vs. 59% of urgency, respectively; p = 0.003) had left ventricular hypertrophy (LVH). The most prevalent LV geometry was concentric hypertrophy (52%). Asymmetric LVH occurred in 13 (22%) of the participants after excluding ischemic LGE. Impaired systolic function occurred in 46% of patients, and predominantly involved hypertensive emergency. Nonischemic LGE occurred in 75% of contrasted studies (67.2% in emergency versus 44.4% in urgency, respectively; p < 0.001). Creatinine and LV mass were independently associated with nonischemic LGE. (5) Conclusion: LVH, altered geometry, asymmetric LVH, impaired LV systolic function, and LGE are common under hypertensive crisis. LVH and LGE more commonly occurred under hypertensive emergency. Longitudinal studies are required to determine the prognostic implications of asymmetric LVH and LGE in hypertensive crisis.

Meta-analysis of Shugan Jieyu Capsule for depression in patients with coronary heart disease.

Shugan Jieyu Capsule (SGJYC) has been prescribed to treat primary and secondary depression; however, whether it can benefit depression of patients with coronary heart disease (CHD) remains controversial. This meta-analysis aimed to evaluate the efficacy and safety of SGJYC in treating depression in patients with CHD. A total of 644 CHD patients with depression were selected from China National Knowledge Infrastructure, Wanfang, China Biomedical Database, MEDLINE, the Cochrane library from their inceptions until June, 2021. All patients with CHD or coronary artery disease were confirmed to suffer from depression based on recognized criteria. Patients were assigned randomly to receive SGJYC-based regimens or conventional antidepressants alone. Meta-analysis of 6 studies showed that antidepressants (MD, 2.12; 95% confidence interval [CI], 0.73~3.50) or sertraline (MD, 2.15; 95%CI, 0.61~3.68) significantly alleviated depression level compared to SGJYC; however, SGJYC plus antihypertensive drugs (AHD) (MD, -8.33; 95%CI, -13.90 ~ -2.75) significantly improved depression symptoms compared to AHD. A significant difference in risk of adverse cardiac events (risk ratios [RR], 2.72; 95%CI, 1.07~6.94) between SGJYC and sertraline was detected in patients with simple CHD. SGJYC has a poor effect on depressive symptoms, and the effect of combination with AHD is better than AHD but its efficacy and cardiac safety are inferior to antidepressants.

The association between exposure to clozapine, olanzapine, and quetiapine and the outcomes perimyocarditis and heart failure: A population-based cohort study

The risk of cardiac adverse events following clozapine use is debated and is unknown for the chemically related and widely used antipsychotics olanzapine and quetiapine. National Swedish registers were used to identify all patients 16–75 years old with antipsychotic dispensations between 2005 and 2018. The short-term outcome was a diagnosis of perimyocarditis (pericarditis and/or myocarditis) within two months of first dispensation, and the long-term outcome was heart failure (including cardiomyopathy) within three years. Cox regressions with time varying exposure were used to estimate hazard rates (HR) and their 95% confidence intervals (CI). A total of 201,045 individuals were included in the cohort. The risk of developing perimyocarditis during clozapine treatment tripled compared to no antipsychotic treatment (HR 3.4, CI 1.6–7.3), although the absolute rate remained comparably low. The long-term risk of heart failure during clozapine treatment was also elevated (HR 1.3, CI 1.1–1.7). Treatment with either or both olanzapine or quetiapine was not associated with an increased relative risk of perimyocarditis, or heart failure compared to no antipsychotic treatment. Clozapine use is therefore associated with a substantially elevated short-term risk of perimyocarditis and an increased risk of heart failure within three years.

Significance of electrocardiogram abnormalities in children presenting to the emergency department with acute COVID-19 infection

ObjectivesAcute COVID-19 infection may be associated with electrocardiogram (EKG) abnormalities in pediatric patients. We have anecdotally observed EKG abnormalities in patients without MIS-C or significant cardiac disease requiring intervention or further follow-up. Our aim was to determine the incidence of abnormal EKG findings and correlate with evidence of significant cardiac pathology in pediatric patients who present to the emergency department during an acute COVID-19 infection. MethodsWe conducted a retrospective chart review of 209 pediatric patients diagnosed in the emergency department with acute COVID-19 infection and had an EKG during the same encounter; patients with MIS-C were excluded. Primary objectives included determination of the incidence of EKG abnormalities in patients presenting to the emergency department (ED) with acute COVID-19 infection who did not require hospitalization. Secondary objectives included correlation of these findings with other concomitant testing of possible cardiac pathology (echocardiograms, biomarkers), and clinical outcomes. ResultsEKG abnormalities were identified in 84 (40%) patients. Echo was performed in 28 (13.4%) patients; only 1 was abnormal, and considered an incidental finding. The most common EKG abnormality involved nonspecific ST-T wave patterns, suggestive of but not diagnostic for underlying pericardial or myocardial disease. Serum troponin and BNP values were normal in all patients tested, either with a normal or abnormal EKG. A normal EKG had a 100% sensitivity and negative predictive value in predicting a normal echocardiogram. No patients were hospitalized and there was normalization of EKG abnormalities during short-term follow up. ConclusionsDespite a high incidence of abnormal EKG repolarization patterns in pediatric patients presenting with acute (non-MIS-C) COVID-19 infections, these patients generally do not have abnormal cardiac biomarkers or echocardiograms, and the risk for adverse cardiac events is low.

Prognostic value of myocardial strain on cardiac magnetic resonance imaging in patients with non-ischemic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Background Myocardial strain measurements using feature tracking imaging (FTI) on cardiac magnetic resonance (CMR) has emerged as a reliable method for evaluating myocardial function. However, the prognostic value of left ventricular strain measurements on CMR remains unclear in patients with nonischemic cardiomyopathy (NICM). Purpose The purpose of this meta-analysis is to evaluate the association of myocardial strain measurements with adverse outcomes in patients with NICM. Methods A literature search was conducted for studies reporting on the association of left ventricular global longitudinal strain (LVGLS), left ventricular global circumferential strain (LVGCS), and left ventricular global radial strain (LVGRS) using FTI on CMR with cardiovascular outcomes on long term follow-up in patients with NICM. The primary endpoint was major adverse cardiac events (MACE). The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results A total of 6 studies with 1004 participants (251 with MACE and 753 without MACE) met inclusion criteria. Mean follow-up duration was 39 months. Mean ejection fraction was 27%. Baseline LVGLS, LVGCS, and LVGRS were significantly lower in NICM patients who subsequently experienced MACE on follow-up compared to patients without MACE (SMD −0.58, 95% CI −1.01, −0.15; p&amp;lt;0.01; SMD −0.58, 95% CI −0.96, −0.21; p&amp;lt;0.01; SMD −0.43, 95% CI −0.81, −0.05; p = 0.03). Conclusions Myocardial strain measurement using FTI on CMR may represent a useful clinical tool for risk stratification of NICM patients at risk for adverse cardiac events.

Prognostic value of strain echocardiography measurements in patients with non-ischemic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Background Speckle tracking echocardiography has been increasingly used in the evaluation of myocardial function. However, the association of reduced strain measurements with cardiovascular outcomes remains unclear in patients with nonischemic cardiomyopathy (NICM). Purpose The purpose of this meta-analysis is to evaluate the prognostic value of speckle tracking echocardiography in patients with NICM. Methods A literature search was conducted for studies reporting on the association of left ventricular global longitudinal strain (LVGLS), left ventricular global circumferential strain (LVGCS), left ventricular global radial strain (LVGRS), and right ventricular global longitudinal strain (RVGLS) on baseline echocardiography with cardiovascular outcomes on long term follow-up in patients with NICM. The primary endpoint was major adverse cardiac events (MACE). Secondary endpoints included left ventricular reverse remodeling (LVRR) and ventricular arrhythmias (VA). The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results A total of 17 studies with 2375 participants (640 with adverse outcomes and 1735 without adverse outcomes) met inclusion criteria. Mean follow-up duration was 33 months. Mean ejection fraction was 30%. Baseline LVGLS, LVGCS, LVGRS, and RVGLS were significantly lower in NICM patients who subsequently experienced MACE on follow-up compared to patients without MACE (SMD −0.57, 95% CI −0.82, −0.32; p&amp;lt;0.01; SMD −0.54, 95% CI −0.75, −0.33; p&amp;lt;0.01; SMD −0.51, 95% CI −0.7, −0.32; p&amp;lt;0.01; SMD −0.46, 95% CI −0.75, −0.18; p&amp;lt;0.01). Baseline LVGLS was significantly higher in patients who experienced LVRR on follow-up compared to patients without LVRR (SMD 0.36, 95% CI 0.05–0.68; p = 0.02). Baseline LVGLS was significantly lower in NICM patients who experienced VA on follow-up (SMD −1.19, 95% CI −2.12, −0.26, p = 0.01). Conclusions Speckle tracking echocardiography may represent a useful clinical tool for risk stratification of NICM patients at risk for adverse cardiac events and poor treatment response.

Effect of prior statin treatment on the achievement of &amp;lt;55 mg/dL LDL cholesterol threshold in acute coronary syndrome patients undergoing percutaneous coronary intervention

Abstract Funding Acknowledgements Type of funding sources: None. Background Acute coronary syndrome (ACS) patients are associated with a higher risk of adverse cardiac events after percutaneous coronary intervention (PCI). A lower threshold level of low density cholesterol (LDL), less than 50 mg/dL, as recommended by most recent guidelines, has been associated with a lower risk of such events. An early and more pronounced achievement of such target LDL level could confer benefit to this high risk patient category. It is not known whether prior treatment with statins might have such beneficial effect in patients admitted with acute coronary syndromes undergoing PCI. Purpose To study the role of prior statin use in patients admitted with ACS and treated with PCI regarding the achievement of target LDL threshold. Methods We prospectively enrolled 400 consecutive ACS patients who underwent PCI treatment in our hospital. We collected peri- and postprocedural clinical and laboratory data; all patients were followed up and were asked to have their lipid profile measured at 1 month after discharge. Patients were divided in 2 groups: patients who were already on statin treatment on admission (group 1) and those who were not (group 2). Primary endpoint was achievement of target LDL threshold in accordance with current ESC guidelines 1 month after discharge, and secondary endpoint was in-hospital and 30-day occurrence of major adverse events (death, nonfatal myocardial infarction and re-hospitalization). Results Out of 400 patients, 105 of them composed group 1 and 295 patients composed group 2. Mean age was 64.96 +/- 10.26 years. 74.8% were males. 94.8% suffered from arterial hypertension, 41% from diabetes and 56.3% were active smokers. On admission, mean LDL level was 118.15 +/- 42.67 mg/dL in group 1 and 141.66 +/- 44.14 mg/dL in group (p=&amp;lt;0.05). 399 (99.7%) of the patients were discharged on a high intensity dose statin. 30 day clinical follow up was completed in all (n=400) patients and lipid profile was acquired from 379 (94%) patients. Mean LDL level was 83.2 +/- 31.2 mg/dL in group 1 and 86.56 +/- 86.56 mg/dL in group 2. The threshold of &amp;lt;55 mg/dL of target LDL, was achieved in 16.2% of the patients in group 1 and in 10.2% in group 2 (p=0.1). There was no in-hospital death in both groups. 1 patient in each group suffered periprocedural myocardial infarction. At 30-day follow up, secondary endpoint occurred in 15 patients (3.8%) in total cohort. 5 (4.8%) in first group (a composite of 2 deaths and 3 rehospitalizations) and in 10 (3.4%) in second group (a composite of 4 deaths and 6 rehospitalizations). Conclusion In patients with acute coronary syndrome who are treated with PCI, prior treatment with statin, despite a numerically more favorable outcome, has no statistically significant impact on achievement of LDL target threshold in accordance with current guidelines or in in-hospital and 30-day MACE occurrence.

Pertuzumab-mediated Cardiotoxicity: A Single Center Study.

Pertuzumab-mediated Cardiotoxicity: A Single Center Study.&#x0D; Objective: Recent clinical trials have shown that adding pertuzumab to trastuzumab improved the cellular response to therapy and provides a survival benefit compared with trastuzumab alone. However, it has raised concerns about additive risk of cardiotoxicity. Real life data on pertuzumab-induced cardiotoxicity are limited.&#x0D; Materials and Methods: Patients a diagnosis of breast cancer who had been treated trastuzumab plus pertuzumab between January 2017 and June 2022 and had undergone regularly transthoracic echocardiography, as a part of control visits, in our medical center were included. We performed descriptive statistical analysis to evaluate the patients’ characteristics and therapies, which could increase the risk of cardiac adverse events. Cardiotoxicity was evaluated by serial left ventricular ejection fraction (LVEF) measuring by 2D echocardiography at baseline and every three months during pertuzumab therapy and was defined as a decrease in LVEF &gt; 10% to below 55%. &#x0D; Results: There were 118 patients fulfilling the inclusion criteria. The median age of the population was 51 (41-60) years. The median duration of pertuzumab therapy was 15 (9–57) weeks. Pertuzumab therapy was discontinued in two patients because of an allergic reaction and in other two patients due to cardiotoxicity. The reduced LVEF did not recover to baseline values in either patient.&#x0D; Conclusion: The incidence of cardiotoxicity (1.69%) in the current study was no higher than expected for trastuzumab alone. Data from previous studies and the results of this study support that pertuzumab causes no increase in cardiotoxicity. Still, large clinical trials are needed to verify the cardiac safety of pertuzumab in a real-world setting.

Cardiac Magnetic Resonance in myocarditis: besides the diagnosis?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients with acute myocarditis (AM) can be at increased risk of adverse cardiac events after the index episode. Beyond its undoubted role in diagnosis, Cardiac Magnetic Resonance (CMR) can also provide additional prognostic information and contribute to the patients risk stratification. Methods Retrospective study with patients admitted with the clinical suspicion of myocarditis in our center from February/2018 to September/2021, in whom CMR was performed. A total of 48 patients were included and divided into two groups based on the number of segments with late gadolinium enhancement (LGE). The threshold (&amp;gt; or &amp;lt; than 5 segments) was determined according to ROC curve analysis. The primary outcome was a composite of all-cause mortality, heart failure and myocarditis recurrence. Results We included 48 patients (95,8% males; mean age 37,0±16,1 years old), 93,8% presenting with chest pain and 63,2% presenting with st-segment elevation on electrocardiogram. During hospitalization, 3 patients needed ionotropic support, 7 had supraventricular tachycardia, 9 non-sustained ventricular tachycardia, 1 sustained ventricular tachycardia, 1 needed extracorporeal membrane oxygenation and 9 had heart failure. CMR (performed 6 days (median) after admission) showed LGE in 45 patients (93,8%) and mean left ventricular ejection fraction (LVEF) of 55,5±8,7%. Both groups had similar age (35,0±13,7 vs 38,5±17,6 years, p=0,45), cardiovascular risk factors, st-segment elevation at admission (61,9% vs 63,0%, p=0,38), pro-BNP levels at admission [286 (IQR 144-699) mg/dl vs 522 (IQR 222-1253) mg/dl, p = 0,20] and peak C-reactive protein [5,7 (IQR 4-12) vs 5,2 (IQR 2,6-12,5),p=0,77]. Patients with LGE in ≥5 segments (56,3%) had lower LVEF (53,2±9,6 vs 58,2±6,6, p=0,02), had more non-sustained ventricular tachycardia episodes (29,6% vs 4,8%, p=0,03), incidence of heart failure during hospitalization (25,9% VS 9,6%, p=0,19) and higher peak troponin levels [1,54 (IQR0,64-2,45) vs 0,594 (IQR 0,374-1,07), p=0,002]. During a median follow-up of 21,5 (IQR 8–35,2) months, 11 patients (22,9%) experienced the primary outcome (6 for heart failure, 4 for AM recurrence, 1 death). The incidence of the primary endpoint increased by 1,20 (95% CI 1,08-1,60) for each segment involved. Patients with ≥ 5 segments had a higher incidence of this outcome (25,7 vs 5,1 per 100 patient/year, log rank p=0,02). After adjusting for possible cofounders, LGE≥ 5 segments on CMR was an independent predictor of all-cause mortality, heart failure and myocarditis recurrence (HR 7,22, 95% CI 1,33-39,16). Conclusion In this study, LGE involving 5 or more segments by LGE was correlated with adverse cardiovascular events among patients with suspected myocarditis. These data suggest that cardiac resonance imaging might add value to currently existing diagnostic tools for risks assessment in AM.

Abstract 470: Targeting The Local Inflammation In Atherosclerosis Using An Ex-vivo Perfusion System Of Human Coronary Arteries

Atherosclerosis is characterized by the accumulation of lipids, immune cells, and fibrotic tissue in the arterial intima. Although well described as an inflammatory condition, targeting the inflammation component of atherosclerosis while avoiding systemic toxicity remains a clinical challenge. Pro-inflammatory cytokines such as IL-1β and IL-6 have been implicated in atherosclerotic plaque progression and atherothrombotic events. Recent clinical trials have shown promising results targeting these cytokines to reduce the risk of adverse cardiac events in patients, yet systemic toxicity remains a concern. We hypothesize that knocking down the local inflammation using siRNA against IL-1β and/or IL-6 may be a viable therapeutic strategy to treat atherosclerosis. To test our hypothesis, we used an ex-vivo perfusion system of human coronary arteries (hCA) collected from non-transplantable, de-identified hearts ( Fig. A ). Hearts came from donors with or without cardiovascular disease (CVD) risk factors including hypertension, high cholesterol, and diabetes mellitus. hCA isolated from donors with CVD risk factors showed increased IL-1β ( Fig. B ) and IL-6 ( Fig. C ) expression levels assessed by RT-qPCR, compared to controls without risk factors. Perfusion of hCA with media containing TNF-α and IFN-γ increased the expression of both IL-1β and IL-6 ( Fig. D ). Thus, the perfusion system established here will allow us to assess the efficacy of delivering IL-1β and/or IL-6 specific siRNA complexed nanoparticles and will advance the development of novel nanotherapies that target inflammation in atherosclerosis.

Serum Hemoglobin and Potassium Levels in Sudden Cardiac Death at Hemodialysis Center of Aziz Bhatti Hospital Gujrat

Background: Sudden cardiac arrest has become a serious pandemic and a substantial public health burden. Significant morbidity and death are linked to it. Hemodialysis is considerably a heavy burden on cardiac patients. A sudden cardiac arrest is sometimes a disastrous event that happens without warning and is regrettably a significant cardiac disease manifestation in individuals surviving on kidney dialysis. Aim: To determine Serum Hemoglobin and potassium levels in sudden cardiac death patients admitted in hemodialysis center of Aziz Bhatti Shaheed Teaching Hospital Gujrat. Study Design: Cross-Sectional Study Methodology: This research study was conducted at the hemodialysis center of Aziz Bhatti Shaheed Teaching Hospital Gujrat. The Ethics Committee approved to conduct of this descriptive cross-sectional study on 40 (20 males and 20 females) sudden cardiac patients. All information and the goal of the research project were explained to patients or their relatives before the collection of blood serum. Prescription drug lists, smoking histories, and medication or dialysis report data were randomly evaluated. Laboratory results from recent month were collected, together with dialysis run sheets and cardiac arrest data forms. Results: Results of this result study showed that the mean value of age was 50 years with a mean standard deviation of 15.1 (p= &lt;0.001). The mean BMI (kg/m2) was estimated as 26.8 with a mean standard deviation value of 2.6 (p= 0.01). Almost 21.6% of male patients were smokers and overall 36.1% were associated with cardiac arrest due to coronary artery disease. Systolic blood pressure (mmHg) was 165 (95% CI of 117-140) (p= &lt;0.001), diastolic blood pressure (mm Hg) was 89 ( 95% CI of 64-72) (p= &lt;0.001), hemoglobin level was 0.73 (95% CI of 0.70-0.76) (p= &lt;0.001), Hemoglobin A1 c was 6.4% (95% CI of 5.8-7.6) (p= &lt;0.001), Urea was 56 (95% CI of 41-79) (p= &lt;0.001), and estimated glomerulus filtration rate (mL/min per 1.73mm2 ) was 1.16 (1.10-1.22) in sudden cardiac patients with low K (serum &lt;4.0mmole/L). For the sudden cardiac patients with higher K level (serum &gt;4.0mmole/L) showed that there was a significant change in the estimated values i.e. estimated glomerular filtration rate (mL/min per 1.73 mm2) was 0.67 (95% CI of 0.54-0.58) (p=&lt;0.01). The practical implication of this research study suggests that the higher proportion of cardiac patients were reported higher concentration of K level serum. For diagnosis purposes K-level was directly associated with the cardiac disease progression. Conclusion: Hemodialysis patients with sudden cardiac arrest had reported very low concentrations of potassium levels. Dialysate prescriptions should be continuously reviewed and changed, especially after hospitalization in high-risk patients, to lower the risk of adverse cardiac events during hemodialysis. It was suggested that in the high-normal range of serum potassium seems to be safe and is linked to better outcomes. Keywords: Sudden cardiac arrest, Hemodialysis, serum potassium level, Hemoglobin

Residing in a Food Desert and Adverse Cardiovascular Events in US Veterans With Established Cardiovascular Disease

Residents living in a "food desert" are known to be at a higher risk for developing cardiovascular disease (CVD). However, national-level data regarding the influence of residing in a food desert in patients with established CVD is lacking. Data from veterans with established atherosclerotic CVD who received outpatient care in the Veterans Health Administration system between January 2016 and December 2021 were obtained, with follow-up information collected until May 2022 (median follow-up: 4.3 years). A food desert was defined using the United States Department of Agriculture criteria, and census tract data were used to identify Veterans in these areas. All-cause mortality and the occurrence of major adverse cardiovascular events (MACEs; a composite of myocardial infarction/stroke/heart failure/all-cause mortality) were evaluated as the co-primary end points. The relative risk for MACE in food desert areas was evaluated by fitting multivariable Cox models adjusted for age, gender, race, ethnicity, and median household income, with food desert status as the primary exposure. Of the 1,640,346 patients (mean age 72 years, women 2.7%, White 77.7%, Hispanic 3.4%), 25,7814 (15.7%) belonged to the food desert group. Patients residing in food deserts were younger; more likely to be Black (22% vs 13%)or Hispanic (4% vs 3.5%); and had a higher prevalence of diabetes mellitus (52.7% vs 49.8%), chronic kidney disease (31.8% vs 30.4%,) and heart failure (25.6% vs 23.8%). Adjusted for covariates, food desert patients had a higher risk of MACE (hazard ratio 1.040 [1.033 to 1.047]; p <0.001) and all-cause mortality (hazard ratio 1.032 [1.024 to 1.039]; p <0.001). In conclusion, we observed that a large proportion of US veterans with established atherosclerotic CVD reside in food desert census tracts. Adjusting for age, gender, race, and ethnicity, residing in food deserts was associated with a higher risk of adverse cardiac events and all-cause mortality.

Stimulant Use for ADHD in a Cardiac Transplant Recipient: A Case Report

AbstractIntroductionMethylphenidate is a central nervous system stimulant used as first-line treatment for attention-deficit/hyperactivity disorder (ADHD). CNS stimulant use is associated with increased risk of cardiovascular events such as increased resting heart rate and blood pressure, sudden cardiac death, arrhythmia, and stroke. Its safety profile in recipients of cardiovascular transplants is unknown, and more research is warranted to determine the risk of adverse cardiac events due to stimulant medication in this population.MethodsClinical case report, n=1Results/Clinical CaseA 19-year-old female with a history of restrictive cardiomyopathy, cardiac arrest, and orthotopic cardiac transplant has been treated with methylphenidate for ADHD for approximately 2 years without incident. The patient was diagnosed with ADHD between the ages of 8 and 10 and historically was treated with stimulant medication. At age 13, she experienced a cardiac arrest after a volleyball game with 4–6 minutes of pulselessness. She was successfully resuscitated and underwent defibrillator placement. It was concluded that the patient had restrictive cardiomyopathy undetected at birth, leading to the need for orthotopic cardiac transplantation at age 16. After her cardiac arrest, the patient’s memory and cognition worsened, and approximately 1 year after her transplant, she was prescribed amantadine. The patient remained untreated for her ADHD until approximately 1.5 years after her cardiac transplant, at which time she underwent neuropsychological testing that showed findings consistent with attention deficit disorder, and was restarted on stimulant medication. Her transplant cardiologist and psychiatrist have collaborated in her ongoing treatment with methylphenidate 40 mg daily and monitoring symptom response and cardiac stability. Because the patient had previously been stable on stimulant medication for many years, it is reasonable to conclude that stimulant medication did not lead to her cardiac arrest. The patient reports that methylphenidate has been helpful in improving her functioning as a college student, through reduction of her ADHD symptoms. The patient’s blood pressure and heart rate remain within an acceptable range and she has not experienced any adverse cardiac events to date while taking methylphenidate.ConclusionThis case sheds light on the potential to treat cardiac transplant recipients with stimulant medication for ADHD. Although a careful evaluation of risk factors must be undertaken in cooperation with cardiology and other specialists, a role exists for the safe use of stimulant medications in the cardiac transplant population.FundingNo Funding

Identification of High-Risk Coronary Lesions by 3-Vessel Optical Coherence Tomography

BackgroundOptical coherence tomography (OCT) may provide a method for detecting histologically defined high-risk plaques in vivo. ObjectivesThe authors aimed to investigate the prognostic value of OCT for identifying patients and lesions that are at risk for adverse cardiac events. MethodsBetween January 2017 and May 2019, OCT of all the 3 main epicardial arteries was performed in 883 patients with acute myocardial infarction (MI) who were referred for primary percutaneous coronary intervention. The primary endpoint was the composite of cardiac death, nonculprit lesion–related nonfatal MI, and unplanned coronary revascularization. Patients were followed for up to 4 years (median 3.3 years). ResultsThe 4-year cumulative rate of the primary endpoint was 7.2%. In patient-level analysis, thin-cap fibroatheroma (TCFA) (adjusted HR: 3.05; 95% CI: 1.67-5.57) and minimal lumen area (MLA) <3.5 mm2 (adjusted HR: 3.71; 95% CI: 1.22-11.34) were independent predictors of the primary endpoint. In lesion-level analysis, nonculprit lesions responsible for subsequent events were not angiographically severe at baseline (mean diameter stenosis 43.8% ± 13.4%). TCFA (adjusted HR: 8.15; 95% CI: 3.67-18.07) and MLA <3.5 mm2 (adjusted HR: 4.33; 95% CI: 1.81-10.38) were predictive of events arising from each specific lesion. TCFAs with an MLA <3.5 mm2 carried a higher risk and were sufficient for identifying patients at risk for the composite of cardiac death and nonculprit lesion–related nonfatal MI. ConclusionsOCT imaging of angiographically nonobstructive territories in patients with acute MI can aid in identifying patients and lesions at increased risk for adverse cardiac events.

Sclerotherapy of lower limb veins: Indications, contraindications and treatment strategies to prevent complications - A consensus document of the International Union of Phlebology-2023.

Sclerotherapy is a non-invasive procedure commonly used to treat superficial venous disease, vascular malformations and other ectatic vascular lesions. While extremely rare, sclerotherapy may be complicated by serious adverse events. To categorise contraindications to sclerotherapy based on the available scientific evidence. An international, multi-disciplinary panel of phlebologists reviewed the available scientific evidence and developed consensus where evidence was lacking or limited. Absolute Contraindications to sclerotherapy where the risk of harm would outweigh any benefits include known hypersensitivity to sclerosing agents; acute venous thromboembolism (VTE); severe neurological or cardiac adverse events complicating a previous sclerotherapy treatment; severe acute systemic illness or infection; and critical limb ischaemia. Relative Contraindications to sclerotherapy where the potential benefits of the proposed treatment would outweigh the risk of harm or the risks may be mitigated by other measures include pregnancy, postpartum and breastfeeding; hypercoagulable states with risk of VTE; risk of neurological adverse events; risk of cardiac adverse events and poorly controlled chronic systemic illness. Conditions and circumstances where Warnings and Precautions should be considered before proceeding with sclerotherapy include risk of cutaneous necrosis or cosmetic complications such as pigmentation and telangiectatic matting; intake of medications such as the oral contraceptive and other exogenous oestrogens, disulfiram and minocycline; and psychosocial factors and psychiatric comorbidities that may increase the risk of adverse events or compromise optimal treatment outcomes. Sclerotherapy can achieve safe clinical outcomes provided that (1) patient-related risk factors and in particular all material risks are (1a) adequately identified and the risk benefit ratio is clearly and openly discussed with treatment candidates within a reasonable timeframe prior to the actual procedure; (1b) when an individual is not a suitable candidate for the proposed intervention, conservative treatment options including the option of 'no intervention as a treatment option' are discussed; (1c) complex cases are referred for treatment in controlled and standardised settings and by practitioners with more expertise in the field; (1d) only suitable individuals with no absolute contraindications or those with relative contraindications where the benefits outweigh the risks are offered intervention; (1e) if proceeding with intervention, appropriate prophylactic measures and other risk-mitigating strategies are adopted and appropriate follow-up is organised; and (2) procedure-related risk factors are minimised by ensuring the treating physicians (2a) have adequate training in general phlebology with additional training in duplex ultrasound, procedural phlebology and in particular sclerotherapy; (2b) maintain their knowledge and competency over time and (2c) review and optimise their treatment strategies and techniques on a regular basis to keep up with the ongoing progress in medical technology and contemporary scientific evidence.

A novel marker to predict cardiac arrhythmia in epilepsy patients: frontal QRS-T angle.

The most important complication of epilepsy, which is a chronic disorder of the central nervous system, is sudden unexplained death in epilepsy (SUDEP). The causes of SUDEP are complex and multifactorial. Epilepsy patients are at increased risk of cardiovascular events, SUDEP, and ventricular arrhythmias, due to both the disease itself and the effect of antiseizure medications. Previous studies have commonly focused on cardiac repolarization markers in epilepsy patients. This study aimed to investigate frontal QRS-T angle (FTQ angle), a relatively new repolarization parameter, in epilepsy patients. One hundred two epilepsy patients and 86 healthy volunteers as a control group were included in the study. The clinical data of all patients were prospectively recorded during patient visits. All participants underwent 12-lead surface electrocardiography (ECG). SPSS 22 was used to evaluate all data. p<0.05 was considered statistically significant. When the epilepsy patient group and the control group were compared in terms of QRS (89.59±43.63 vs. 80.00±9.82, p=0.050), QT (364.30±36.16 vs. 335.95±35.64, p<0.001), QTc (418.85±27.06 vs. 409.37±26.66, p=0.018) durations, and FTQ angle (46.55±22.06 vs. 20.84±12.70, p<0.001), statistically significant differences were found between the groups. We observed that FTQ angle was significantly higher in individuals exposed to the disease for more than 10 years (39.2±19.0 vs. 54.7±22.5, p<0.001). In addition, according to the multivariate logistic regression analysis, disease duration was an independent predictor of FTQ angle (β=0.263, p=0.009). FTQ angle, a relatively new repolarization parameter, can be used as an inexpensive, easy, reproducible, and reliable ECG marker to predict the risk of adverse cardiac events in epilepsy patients.

Neoadjuvant therapy with vs. without anthracyclines for HER2-positive breast cancer: a systematic review and meta-analysis.

Neoadjuvant therapy has become the standard treatment for early human epidermal growth factor receptor 2 (HER2)-positive breast cancer, with most regimens using a combination of anti-HER2-targeted drugs and chemotherapy. However, the combination of anthracyclines and trastuzumab has high cardiac toxicity, and the efficacy evaluation of targeted therapy with or without anthracyclines is not unified. The purpose of this meta-analysis was to evaluate the relative efficacy and safety of anti-HER2-targeted therapy combined with vs. without anthracyclines neoadjuvant treatment. The following databases: PubMed, Medline, Embase, and Cochrane Library were systematically searched. Study inclusion was determined according to PICOS principles. PICOS: Patients, HER2-positive breast cancer; Intervention, anti-HER2-targeted therapy combined with anthracyclines; Control, without anthracyclines; Outcomes, the percentage of pathologic complete response (pCR), breast-conserving surgery (BCS), and grade 3 or worse adverse events according to CTCAE version 4.03; Studies, randomized controlled trials (RCTs) and retrospective studies. The meta-analysis was performed using RevMan5.3 software, and the odds ratio (OR) with 95% confidence intervals (CIs) was performed. In total, 11 articles involving 1,998 patients were included with 1,155 patients in the anthracycline-containing group and 843 patients in the anthracycline-free group. For efficacy, there was no statistically significant difference in the percentage of pCR (OR 0.95; 95% CI: 0.61-1.48; P=0.83) and BCS (OR 1.18; 95% CI: 0.93-1.49; P=0.17) on anthracycline-free regimens compared with anthracycline-containing regimens. For safety, the combined effect values showed a significantly lower incidence of left ventricular ejection fraction decreases with the anthracycline-free regimen than with the anthracycline-containing regimen (OR 0.50; 95% CI: 0.35-0.71; P=0.0001). Other adverse effects and survival events were generally not statistically different in incidence between the two groups. The subgroup analysis suggested that hormone receptor status might be the source of heterogeneity in this study. Our study demonstrated that the targeted therapy combined with anthracyclines was associated with an increased risk of cardiac adverse events compared with the anthracycline-free group, with no significant difference in the percentage of pCR and BCS. Due to the high heterogeneity of this meta-analysis, more studies with longer follow-up are needed to validate the current findings and to further explore the removal and retention of anthracyclines.

Abstract P3-07-25: Efficacy and safety of neoadjuvant pertuzumab biosimilar TQB2440, trastuzumab and docetaxel in HR negative, HER2 positive breast cancer: a single-arm trial

Abstract Background: Despite that dual anti-HER2 therapy (Trastuzumab and Pertuzumab, TP) is one of the commonly used regimens for neoadjuvant treatment of HER2-positive breast cancer, previous studies showed that its pCR rate rarely exceeds 63%. Additionally, it is associated with higher risk of cardiac adverse events. TQB2440, a biosimilar of pertuzumab, with strong affinity and specificity, can effectively bind with HER2 epitope. In the PDX mouse model, TQB2440 showed promising biological activity and minimal cardiotoxicity. In this study, we designed a single-arm trial of dual anti-HER2 therapy (TQB2440 and trastuzumab, TT) plus docetaxel in neoadjuvant therapy of HER2 positive breast cancer. We aimed to examine the efficacy and safety of TQB2440 and study whether new dual anti-HER2 therapy (TT) can boost pCR rate in the neoadjuvant treatment. The cardiotoxicity and other adverse reactions were closely monitored. Methods: Upon approval by the Medical Ethics Committee of Xijing Hospital, patients with HR negative HER2-positive breast cancer (cT2-3/N0-1/M0) receiving neoadjuvant therapy were enrolled. The patients were treated with docetaxel 75 mg/m2, trastuzumab 8 mg/kg loading, then 6 mg/kg, TQB2440 840 mg loading, then 420 mg, iv, q3w for 4 cycles, with strict monitoring of cardiotoxicity. The primary endpoint was pCR rate, and secondary endpoint was cardiotoxicity. Results: From April 2021 to February 2022, a total of 28 patients were recruited. Among the 28 patients with a median age of 52 (28-74), 12 patients had positive lymph node status. Overall, the pCR rate was 67.9% (19/28). The pCR rate was higher than that in the NeoSphere trial (pCR 63.2%) and the PEONY study (pCR 52.5%). The lymph-positive tumor achieved a higher pCR rate than lymph-negative tumor (70.8% vs 52.3%, p = .019). Multivariate regression analysis showed that for participants aged 50 or above, HER2 3+ (IHC) showed a statistically significant positive influence on pCR rate. The common adverse reactions of grade ≥3 were leukopenia (46.4%), neutropenia (35.7%), asthenia (3.6%), and peripheral sensory neuropathy (2.3%). Left ventricular insufficiency was detected in 1 patient, and no cardiotoxic events higher than grade 2 occurred during the neoadjuvant therapy. There was no treatment-related death. Conclusion: TQB2440 and trastuzumab plus docetaxel is a feasible and effective neoadjuvant therapy for early-stage HR negative HER2-positive breast cancer, showing high pCR rate and acceptable cardiotoxicity. These results support a further random controlled trial testing for dual anti-HER2 therapy using TQB2440 in neoadjuvant or adjuvant therapy of HER2 positive breast cancer. Citation Format: Jiang Wu, Jing Yu, Yuqing Yang, Xinxin Wen, Jixin Yang, Hongliang Wei, Xiaolong Xu, Yike Li, Liu Yang, Dongdong Xu, Lei Wang, Yijia Wang, Wen Ma, Nanlin Li. Efficacy and safety of neoadjuvant pertuzumab biosimilar TQB2440, trastuzumab and docetaxel in HR negative, HER2 positive breast cancer: a single-arm trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-07-25.