Risk Of Adverse Cardiac Events Research Articles

Serum homocysteine relates to elevated lipid level, inflammation and major adverse cardiac event risk in acute myocardial infarction patients.

Aim: This study aimed to evaluate association of homocysteine (Hcy) with major adverse cardiac event (MACE) risk in acute myocardial infarction (AMI). Methods: Serum Hcy data from 196 AMI and 20 angina pectoris patients were retrieved from ahospital's electronic system. AMI patients attended a median of 21.2-month follow-up. Results: Hcy waselevated in AMI patients compared with angina pectoris patients (p=0.020). In AMI patients, Hcy was positively related to total cholesterol, low-density lipoprotein cholesterol, C-reactive protein, infarct size, TNF-α and IL-6, while inversely linked with IL-10 (all p<0.05). Hcy was independently associated with high MACE risk in AMI patients (p=0.024). Conclusion: Serum Hcy correlates with elevated lipid levels, inflammation, infarct size and MACE risk in AMI patients.

Circulating tumor necrosis factor-α, interleukin-1β, and interleukin-17A estimates increased major adverse cardiac event risk in acute myocardial infarction patients.

Inflammatory cytokines are implicated in the development of atherosclerosis and cardiomyocyte injury during acute myocardial infarction (AMI). This study aimed to investigate the correlation of eight common inflammatory cytokines with major adverse cardiac event (MACE) risk and further establish a prognostic model in AMI patients. Serum samples of 210 AMI patients and 20 angina pectoris patients were, respectively, collected at admission, to detect tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-17A, vascular cell adhesion molecule-1 (VCAM-1), and intercellular adhesion molecule 1 (ICAM-1) via enzyme-linked immunosorbent assay. TNF-α, IL-6, IL-8, IL-17A, VCAM-1, and ICAM-1 were elevated (all p < 0.050); IL-10 (p=0.009) was declined; IL-1β (p=0.086) was not varied in AMI patients compared with angina pectoris patients. TNF-α (p=0.008), IL-17A (p=0.003), and VCAM-1 (p=0.014) were elevated in patients with MACE occurrence compared to patients without MACE occurrence; meanwhile, they possessed a relatively good value for identifying MACE risk via receiver-operating characteristic (ROC) analysis. Subsequent multivariate logistic regression analysis revealed that the independent risk factors for MACE contained TNF-α (odds ratio (OR)=1.038, p < 0.001), IL-1β (OR=1.705, p=0.044), IL-17A (OR=1.021, p=0.009), history of diabetes mellitus (OR=4.188, p=0.013), history of coronary heart disease (OR=3.287, p=0.042), and symptom-to-balloon time (OR=1.064, p=0.030), whose combination disclosed a satisfying prognostic value for MACE risk (area under the curve: 0.877, 95% CI: 0.817-0.936). Elevated levels of serum TNF-α, IL-1β, and IL-17A independently correlated with MACE risk in AMI patients, which perhaps provide novel auxiliary for AMI prognostic prediction.

Clinical Outcome of Revascularization Deferral With Instantaneous Wave-Free Ratio and Fractional Flow Reserve: A 5-Year Follow-Up Substudy From the iFR-SWEDEHEART Trial.

Background Although physiology-based assessment of coronary artery stenosis using instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) are established methods of guiding coronary revascularization, its clinical outcome in long-term deferral needs further evaluation, especially with acute coronary syndrome as a clinical presentation. The aim was to evaluate the long-term clinical outcome of deferral of revascularization based on iFR or FFR. Methods and Results This is a substudy of the iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trial, where patients deferred from revascularization from each study arm were selected. Nine hundred eight patients deferred from coronary revascularization with iFR (n=473) and FFR (n=435) were followed for 5 years. The national quality registry, SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies), was used for patient data collection and clinical follow-up. The end point was major adverse cardiac events and their individual components all-cause death, cardiovascular death, noncardiovascular death, nonfatal myocardial infarction, and unplanned revascularization. No significant difference was found in major adverse cardiac events (iFR 18.6% versus FFR 16.8%; adjusted hazard ratio, 1.08 [95% CI, 0.79-1.48]; P=0.63) or their individual components. Conclusions No differences in clinical outcomes after 5-year follow-up were noted when comparing iFR versus FFR as methods for deferral of coronary revascularization in patients presenting with stable angina pectoris and acute coronary syndrome. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02166736.

HEAR SCORE: A Proposal to Use Only Anamnestic and EKG Data to Evaluate Patients with Very Low Risk Chest Pain

Chest pain in a common symptom in patients attending Emergency Department worldwide and can be related to an extensive variety of disorders, so it represents a diagnostic and logistic challenge for Emergency physicians. The aim of this study is to identify a subgroup of patients with a low pre-test probability of major adverse cardiac events, for which there is no need of troponin testing, to avoid potential harm from false-positive testing and long length stay in ED. We retrospectively analyzed data of patients that attended ED of Siena complaining chest pain from January 2019 to August 2021. We used a modified HEART score, only evaluating history, EKG, age and risk factors. A 0-1 HEAR score was considered at very low risk for adverse cardiac events. Sensitivity, specificity, PPV, NPV and incidence of adverse cardiac events were calculated. The accuracy of HEAR score was evaluated with ROC curve. The correlation of adverse cardiac events with HEAR score 0-1 was evaluated with Fisher test. In this study, we included 2046 patients, of which 279 were classified at very low risk. The incidence of adverse cardiac events in this population was 0.36%. Sensibility was 97.5%, sensitivity 61%, PPV 36.8%, NPV 99.1%. The AUC for global accuracy of HEAR score was 0.945. Chi-square's P value for the association between adverse cardiac events and HEAR score 0-1 was <0.001. The draft presented in this study answers to the necessity to make a personalized path for patients attending ED with chest pain. The choice to avoid troponin testing may appear risky, but data from this study and from other similar show that a careful evaluation of clinical data and EKG allows to correctly discriminate which patients will not have adverse cardiac events, reducing the length of stay in ED.

Procena kardijalnog rizika u elektivnoj otvorenoj reparaciji aneurizme abdominalne aorte

When indicated, patients with abdominal aortic aneurysm are referred for elective abdominal aortic surgery. Abdominal aortic aneurysm open repair is associated with a high risk for the development of cardiovascular morbidity and mortality. Cardiac risk assessment in abdominal aortic surgery includes evaluation of the likelihood of adverse cardiac events during surgery and/or in the postoperative period. Overall cardiac risk is assessed individually for the patient, taking into account the patient's general condition, cardiac function, patient functional capacity, comorbidity status, and vascular surgery risk. Cardiac morbidity and mortality are several times higher in emergency procedures than in elective abdominal aortic procedures, as well as in surgical procedures compared to endovascular procedures, especially in cases with suprarenal clamping of the aorta. Patients with ischemic heart disease and heart failure are at high risk for adverse cardiac events. Pathophysiologic mechanisms activated intraoperatively by aortic clamping and unclamping, hemodynamic fluctuations, blood loss, coagulopathy, and ischemia-reperfusion injury influence the potential development of perioperative infarction, heart failure, and cardiac arrest in high-risk patients. Assessment of perioperative cardiac function and cardiac risk using leading recommendations and scoring systems before surgery may change the approach to management of high-risk patients with multiple comorbidities and significantly reduce the incidence of perioperative morbidity and mortality.

Clinical Practice Guidelines for the Use of Electroconvulsive Therapy.

Clinical Practice Guidelines for the Use of Electroconvulsive Therapy.

Pathogenic roles of neutrophil-derived alarmins (S100A8/A9) in heart failure: From molecular mechanisms to therapeutic insights.

An excessive neutrophil count is recognized as a valuable predictor of inflammation and is associated with a higher risk of adverse cardiac events in patients with heart failure. Our understanding of the effectors used by neutrophils to inflict proinflammatory actions needs to be advanced. Recently, emerging evidence has demonstrated a causative role of neutrophil-derived alarmins (i.e. S100A8/A9) in aggravating cardiac injuries by induction of inflammation. In parallel with the neutrophil count, high circulating levels of S100A8/A9 proteins powerfully predict mortality in patients with heart failure. As such, a deeper understanding of the biological functions of neutrophil-derived S100A8/A9 proteins would offer novel therapeutic insights. Here, the basic biology of S100A8/A9 proteins and their pleiotropic roles in cardiovascular diseases are discussed, focusing on heart failure. We also consider the evidence that therapeutic targeting of S100A8/A9 proteins by the humanized vaccine, antibodies or inhibitors is able to town down inflammatory injuries.

Current Evidence and Future Perspective for Coronary Bifurcation Stenting.

Coronary bifurcation lesions account for 15%-20% of all percutaneous coronary interven tions and are associated with greater procedural complexity and consequently at higher risk for cardiac adverse events. Early clinical trials in the interventional approach to bifurcation lesions supported provisional stenting. However, the most recent randomized studies have indicated potentially superior results using a double-kissing crush technique, particularly for unprotected distal left main bifurcation lesions. Moreover, many operators recently favor double-kissing mini-culotte, nanocrush, and double-kissing nanocrush stenting techniques for bifurcation lesions. In this review, we describe the traditional and novel bifurcation stenting techniques and the current evidence for each and review general principles for bifurcation percutaneous coronary intervention.

Cardiac and Kidney Adverse Effects of HIF Prolyl-Hydroxylase Inhibitors for Anemia in Patients With CKD Not Receiving Dialysis: A Systematic Review and Meta-analysis

Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) are novel, orally administered agents for anemia management in chronic kidney disease (CKD). We evaluated the cardiac and kidney-related adverse effects of HIF-PHIs among patients with CKD and anemia. Systematic review and meta-analysis of randomized controlled trials (RCTs). Patients with anemia and CKD not receiving maintenance dialysis. RCTs comparing HIF-PHIs to placebo or an erythropoiesis-stimulating agent (ESA) with primary outcomes of cardiac and kidney-related adverse events (AEs). Two independent reviewers evaluated RCTs for eligibility and extracted relevant data. Dichotomous variables were pooled using the Mantel-Haenszel method and presented as risk ratios (RRs). Subgroup analyses evaluated different intervention times and HIF-PHIs, as well as phase 2 versus phase 3 trials. The certainty of findings was rated according to GRADE criteria. Twenty-three studies with 15,144 participants were included. No significant difference in the risk of cardiac AEs was observed between the HIF-PHIs group and the placebo (RR, 1.02 [95% CI, 0.89-1.16]; moderate certainty) or ESA (RR, 1.06 [95% CI, 0.98-1.14]; low certainty) groups. No significant difference in the risk of kidney-related AEs was observed between the HIF-PHIs group and the placebo (RR, 1.09 [95% CI, 0.98-1.20]; moderate certainty) or ESA (RR, 1.00 [95% CI, 0.94-1.06]; low certainty) groups. The occurrence of hypertension and hyperkalemia was higher in the HIF-PHIs group than in the placebo group (RRs of 1.35 [95% CI, 1.14-1.60] and 1.25 [95% CI, 1.03-1.51], respectively; both findings had high certainty). The occurrence of hypertension was lower in the HIF-PHIs group than in the ESA group (RR, 0.89 [95% CI, 0.81-0.98]; moderate certainty). The reporting criteria of cardiac and kidney-related AEs and dosage of HIF-PHIs were inconsistent across trials. The occurrence of cardiac or kidney-related AEs in the HIF-PHI groups were not different compared with placebo or ESA groups. Registered at PROSPERO with registration number CRD42021228243.

Abstract 13607: Myocardial Tissue Characterization by Contrast-Enhanced Cardiac Magnetic Resonance Imaging in Patients With Combined Diabetes Mellitus and Obstructive Sleep Apnea

Introduction: Overlap of type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) increases the risk of heart failure possibly mediated by myocardial fibrosis. Hypothesis: T2DM+OSA overlap increases myocardial fibrosis. Methods: This was a prospective study where 141 participants (Control: 28; T2DM only: 27; OSA only: 29; T2DM+OSA: 57) underwent a sleep study and cardiac magnetic resonance. The measures of interest were LV and RV extracellular volume (ECV), native T1 and cardiomyocyte size (tau). Differences were tested with Kruskal-Wallis. The groups 'T2DM only' and 'OSA only' were combined (Control; T2DM or OSA; T2DM+OSA) for trend analysis with Jonckheere-Terpstra test. Results: Groups had similar sex [Control (males): 54%; T2DM: 44%; OSA only: 52%; T2DM+OSA: 65%; p=0.31)]; OSA and OSA+T2DM participants were older (46± 15; 51±7.8; 53±10; 56±9.1* # years; respectively p=0.001; *p&lt;0.05 vs. control, # p&lt;0.05 vs. T2DM only) and had higher BMI (29.8±6.3; 31±4.8; 34±6.3*; 35.2±6.6* # kg/m 2 , respectively p=0.001). LV ECV increased progressively with highest values among subjects with T2DM and OSA (0.25±0.02%; 0.27±0.03%; 0.28±0.04%; 0.31±0.05%; respectively, p=0.001; p for trend&lt;0.001). LV native T1 was similar across groups (995±91 ms; 986±112 ms; OSA: 977±132 ms; 1041±128 ms; respectively, p=0.39; p for trend=0.14), and the T2DM+OSA group had a marginally higher LV tau (0.15±0.04 s; 0.13±0.05 s; 0.12±0.04 s; 0.17±0.06 s; respectively, p= 0.05; p for trend=0.59). RV ECV (0.40±0.06%; 0.41±0.05%; 0.40±0.04%; 0.42±0.05%; respectively, p=0.70; p for trend=0.27) and RV native T1 (1105±164 ms; 1083±124 ms; 1063±189 ms; 1092±148 ms; p=0.85; p for trend=0.85) were similar. RV tau was similar but with a positive trend towards T2DM+OSA (0.087±0.029 s; 0.094±0.023 s; 0.990±0.033 s; 0.115±0.045 s; p= 0.17, p= 0.03). Conclusions: The overlap of T2DM and OSA has an incremental adverse effect on the LV ECV and may explain the increased risk of adverse cardiac events.

Abstract 11088: Childbirth Related Complications in Women With Hypertrophic Cardiomyopathy

Background. Women with hypertrophic cardiomyopathy (HCM) have higher risk of adverse cardiac events and obstetrics complications with labor and delivery (L&amp;D). Data on HCM and peripartum complications are still scarce. We aimed to examine the maternal cardiovascular and obstetric outcomes of L&amp;D in women with HCM in the United States. Methods. We identified 1,1655 mothers with HCM (age 29.5±6.2 years, 48% Caucasians) admitted to a hospital for childbirth from 2003-2018 according to Nationwide Inpatient Sample database. Results. Mode of delivery was Cesarean section (CS) in [702 (61%)] and mean length of stay was 5.5±6 days. There were two maternal deaths and a low rate of major adverse cardiac events (MACE) including cardiac arrest [n=11 (0.9%)], cardiogenic shock [n=10 (0.8%)], and ventricular tachycardia [n=35 (3%)]. Cardiopulmonary resuscitation, mechanical circulatory support, and temporary venous pacemaker rates were low at 0.75%, 0.4%, and 0.4% respectively. There was an increased rate of ARDS [n=45 (3.9%)], deep veins thrombosis [n=8 (0.7%)] and acute renal failure [n=14 (1.2%)]. Obstetric complications included abruption placenta [n=36 (3.14%)], preterm labor [n=193 (16.8%)], premature rupture of membranes [n=32 (2.8%)], pre-eclampsia/eclampsia [n=166 (14.37%)] and gestational hypertension [n=57 (4.9%)]. Post-partum hemorrhage occurred in [n=26 (2.2%)] of deliveries and maternal blood transfusion was needed in [n=77(6.7%)] of patients. Fetal distress, abnormal fetal heart rate and fetal growth retardation occurred in 5.5%, 9.8% and 1.3%, respectively. Conclusions. We were able to identify that there has been an increase in the number HCM over the past decade, however, there has been a decrease in maternal and fetal complications.

Abstract 14174: Abnormal Exercise Electrocardiography With Normal Stress Echocardiography is Associated With Increased Subclinical Coronary Atherosclerosis: Insights From the Project Baseline Health Study

Introduction Patients with an abnormal (positive) exercise electrocardiography (ECG), but normal stress echocardiography (+ECG/-Echo) have more adverse cardiac events than patients with a negative ECG and normal stress Echo (-ECG/-Echo). However, it is unclear if ECG/Echo discordance is associated with a greater burden of concurrent subclinical coronary atherosclerosis. Methods In the Project Baseline Health Study (PBHS), participants underwent stress Echo and a coronary artery calcium (CAC) scan. For this PBHS substudy, participants with no known coronary artery disease (CAD) were analyzed by stress result: -ECG/-Echo, +ECG/-Echo, or +Echo (with or without +ECG). Patients with a submaximal stress test, uninterpretable ECG, resting wall motion abnormality, and/or baseline ejection fraction &lt;50% were excluded. Clinical characteristics, exercise performance, and CAC results were compared between the -ECG/-Echo and +ECG/-Echo groups using the chi-squared test and Student’s t-test for categorical and continuous variables, respectively. ANOVA or Kruskal-Wallis test was used, as appropriate, to compare all 3 groups. Results Among 1466 participants, 1357 (92.6%) had a -ECG/-Echo; 85 (5.8%) had a +ECG/-Echo; and 24 (1.6%) had a +Echo. Compared to the -ECG/-Echo group, participants in the +ECG/-Echo group were older with shorter exercise duration, but younger with fewer risk factors than participants with a +Echo. The median 10-year ASCVD risk score was 2% for -ECG/-Echo, 3% for +ECG/-Echo, and 10% for +Echo (p&lt;0.001). Greater abnormalities by exercise stress Echo were associated with an increased burden of concurrent coronary atherosclerosis as assessed by CAC score and CAC volume (Table). Conclusions Individuals with positive exercise ECG, even with normal stress Echo, have a higher burden of subclinical coronary atherosclerosis than those with -ECG/-Echo, which may explain the increased risk for adverse cardiac events in the +ECG/-Echo population.

Evolving concepts of the vulnerable atherosclerotic plaque and the vulnerable patient: implications for patient care and future research.

Understanding the natural history of coronary artery atherosclerosis is necessary to determine prognosis and prescribe effective therapies. Traditional management of coronary artery disease has focused on the treatment of flow-limiting anatomical obstructions that lead to ischaemia. In most scenarios, revascularization of these atherosclerotic plaques has not substantially improved freedom from death or myocardial infarction, questioning the utility of contemporary revascularization strategies to improve prognosis. Advances in non-invasive and invasive imaging techniques have helped to identify the characteristics of obstructive and non-obstructive plaques that are precursors for plaque progression and future acute coronary syndromes as well as cardiac death. These 'vulnerable plaques' develop as a consequence of systemic inflammation and are prone to inducing thrombosis. Vulnerable plaques most commonly have a large plaque burden with a well-formed necrotic core and thin fibrous cap and are metabolically active. Perivascular adipose tissue might, in some patients, be used as a surrogate for coronary inflammation and predict future risk of adverse cardiac events. Vulnerable plaques can be identified in their quiescent state, offering the potential for therapeutic passivation. In this Review, we describe the biological and compositional features of vulnerable plaques, the non-invasive and invasive diagnostic modalities to characterize vulnerable plaques, the prognostic utility of identifying vulnerable plaques, and the future studies needed to explore the value of intensified pharmacological and focal treatments of vulnerable plaques.

New Insights into Intravascular Imaging of Coronary Bifurcation Lesions and Left Main Stenosis: What Have We Accomplished?

Coronary bifurcation lesions (CBL) are one of the most challenging lesions to treat in interventional cardiology. Intravascular imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT) is paramount for the assessment of lesion characteristics and suboptimal stent results and to improve the outcome of percutaneous coronary intervention (PCI). After upgrading the use of IVUS and OCT by the American College of Cardiology/American Heart Association guidelines, their use has increased. Likewise, there has been significant improvement in image quality and the profile of system (ie, IVUS catheter size). The main indication for the use of IVUS includes: assessment of lesion characteristics, optimization of stent deployment, optimal stent expansion, exclusion of plaque burden &gt;50%, and edge dissection. Intravascular imaging plays a significant role in the assessment and treatment of left main (LM) coronary artery stenosis and CBL. In particular, the use of intravascular imaging for alleviating mechanical issues during stenting and managing stent thrombosis has significantly increased. Overall, a compelling body of evidence has shown that the use of IVUS or OCT during PCI leads to optimal stenting results and mitigates the risk of adverse cardiac events. However, to date, the American College of Cardiology/American Heart Association Guidelines have assigned a Class IIb recommendation for IVUS or OCT, while the European Society of Cardiology Guidelines upgraded it to the Class IIa recommendation. This review summarized the role of IVUS and OCT for the assessment of stenosis and stent optimization in patients with CBL and LM stenosis. In addition, we discuss new insights into the role of IVUS- and OCT-guided stenting in patients with CBL and LM stenosis provided by the ongoing randomized trials.

Coronary lithotripsy for the treatment of underexpanded stents: the international & multicentre CRUNCH registry.

Stent underexpansion increases the risk of cardiac adverse events. At present, there are limited options to treat refractory stent underexpansion. In this context, the intravascular lithotripsy (IVL) system might be a safe and effective strategy. We aimed to evaluate the safety and efficacy of IVL in addressing resistant stent underexpansion due to heavy underlying calcification. This was an international multicentre registry including patients receiving IVL therapy to treat stent underexpansion from December 2017 to August 2020. Angiographic and intracoronary imaging data were collected. The efficacy endpoint was device success (technical success with a final percentage diameter stenosis <50%). The safety endpoint was in-hospital major adverse cardiac events (MACE). Seventy patients were included, the mean age was 73±9.2 years and 76% were male. The median time from stent implantation to IVL therapy was 49 days (0-2,537). Adjuvant treatment with non-compliant balloon dilatations pre- and post-IVL was performed in 72.3% and 76.8% of patients, respectively, and additional stenting was performed in 22.4%. Device success was 92.3%. Minimum lumen diameter increased from 1.49±0.73 mm to 2.41±0.67 mm (p<0.001) and stent expansion increased by 124.93±138.19% (p=0.016). No IVL-related procedural complications or MACE were observed. The use of bailout IVL therapy directly after stenting and the presence of ostial underexpanded lesions negatively predicted lumen diameter gain. Coronary lithotripsy is safe and effective in increasing lumen and stent dimensions in underexpanded stents secondary to heavily calcified lesions.

Prognostic Role of Cardiac Troponin I after Percutaneous Coronary Intervention in Stable Coronary Disease

Cardiac troponin I is a highly sensitive and specific marker of myocardial necrosis. In addition to the strong diagnostic role of cardiac troponin I its prognostic value has become increasingly well established for patients presenting with acute coronary syndrome. However, there have been conflicting reports on the value of troponin in the setting of PCI is stable and unstable coronary disease.&#x0D; Objective: To assess the role of cardiac troponin I in predicting outcome after PCI.&#x0D; Methods and results: CTnl was measured immediately before and at 8 hrs and at chest pain after PCI in 80 consecutive patients with stable coronary artery disease. Twenty of them with post procedural CTnl level 50.4 ng/ml were excluded because of the inability to do repeat estimation of CTnl at chest pain. Among the rest sixty patients, thirty had post procedural troponin &lt;0.4 ng/ml were considered as group I and thirty had post procedural rise of CTnI &gt;0.4 ng/ml were considered as group II. CTnl level, 0.4 ng/ml was consider as cut off value for grouping patients was based on ACC/ AHA/ ISCAI 2005 guide line definition of peri procedural myocardial infarction. The study end point was the following adverse cardiac events-recurrent angina, cardiogenic shock, significant arrythmias, congestive heart failure, Q wave MI, repeat PCI/ CABG, death during hospital stay and at 30 days follow up. In this study base line parameters like age, sex, BMI, risk factors, anginal class, base line ECG and LVEF showed no statistically significant difference between the two groups. Angiographic parameters such as types of lesion and procedural complications shows statistically significant difference between two groups. In-hospital adverse cardiac events after the procedure was significantly higher in group II than group 1 (P&lt;0.01). The mean duration of post procedural hospital stay was also significantly higher in group II than group 1 (P&lt;0.01). At 30 days follow up there has no incremental risk of adverse cardiac events.&#x0D; Conclusion: CTnl rise at peri procedural myocardial infarction level was observed in 37.5% of this study patient. This level of CTnl was significantly predictive of an increased risk of adverse cardiac events at hospital follow up.&#x0D; Central Medical College Journal Vol 5 No 2 Jul 2021 PP 106-115

Cardiology co-management of rheumatoid arthritis patients with coronary artery disease as an intervention reduces hospitalization rates and adverse event occurrence.

IntroductionRheumatoid arthritis (RA) is a systemic autoimmune disease with important cardiovascular (CV) implications. CV disease represents over half of RA patient deaths and causes significant morbidity. CV manifestations in RA can be complex, raising concerns for adequate patient management and provider-dependent roles.MethodsThis is a retrospective study of patients diagnosed with RA and coronary artery disease (CAD). Patients were identified and filtered via EPIC Database search engine. Parameters were set from January 1, 2014, to December 31, 2020. Inclusion criteria consisted of patients who met diagnostic criteria for both RA and CAD. A total of 399 patients met criteria.ResultsOf the 399 identified patients, 272 were female (68.2%) and 127 were male (31.8%) with a median age of 73 (range 26–98). The population was further divided into two groups: those with established cardiology care versus those without. Patients without cardiology follow-up experienced significantly more hospitalizations (RR 1.63 95% CI 1.12, 2.38), higher rates of adverse events including myocardial infarction (MI) (RR 4.82 95% CI 1.94, 11.98), heart failure (HF) (OR 15.81 95% CI 3.54, 70.52), and stroke (RR 2.55 95% CI 1.29, 5.03). Patients not followed by cardiology also had numerical increases in CV death (4 deaths compared to none in those with cardiology follow) and all-cause mortality (HR 1.03 95% CI 0.63, 1.67).ConclusionPatients with regular cardiology follow-up demonstrated fewer cardiac-related adverse events. This suggests that co-management may have a role in adverse cardiac event risk reduction and should therefore be an early consideration. Key Points• Rheumatoid arthritis patients demonstrate higher rates of coronary disease compared to the general population. Traditional cardiac risk factors may not be entirely responsible for this phenomenon• Hospitalization rates and adverse event occurrence are significantly higher in patients with single-provider care (rheumatology only) compared to dual provider care (rheumatology and cardiology)• Cardiology co-management should be an early consideration in the management of RA patients• Early screening, risk stratification of coronary disease, and utilization of appropriate treatment algorithms are important to decrease morbidity and mortalitySupplementary InformationThe online version contains supplementary material available at 10.1007/s10067-022-06335-4.

Abstract OEC103: ATP-dependent Citrate Lyase Drives Metabolic Remodeling In The Heart During Cancer

Cardiovascular diseases and cancer are the leading causes of death worldwide. Recurrent mutations of metabolic enzymes in cancer cells provide benefits for tumor growth, while creating a systemic metabolic phenotype and increasing the risk for adverse cardiac events. We recently showed that tumors producing the oncometabolite D-2-hydroxyglutarate increase ATP citrate lyase activity and histone acetylation in the heart. How cancer cells drive metabolic remodeling in the heart, and whether ATP citrate lyase is critical for cardiac adaptation during cancer, remains poorly understood. We co-cultured wildtype adult mouse ventricular cardiomyocytes with colorectal cancer cells overexpressing ATP citrate lyase. Co-culture of cardiomyocytes with colorectal cancer cells was associated with reduced expression of ATP citrate lyase, pyruvate dehydrogenase, and mitochondrial complex I, suggesting that the cancer cell environment impaired mitochondrial function in vitro. In vitro modulation of ATP citrate lyase activity abrogated the metabolic alterations in cultured cardiomyocytes indicating that ATP citrate lyase drives remodeling during cancer. Accordingly, we created mice lacking ATP citrate lyase in the heart using CRISPR-Cas 9 genomic knockout. Loss of ATP citrate lyase leads to left ventricular systolic dysfunction and causes global gene and protein expression changes in the heart. Targeted mass spectrometry-based metabolomics and lipidomics showed decreased acetyl-CoA and succinyl-CoA levels in isolated cardiomyocytes, while the abundance of cholesterol esters increased. In vivo [ 18 F]-FDG-positron emission tomography revealed that animals lacking ATP citrate lyase increased plasma glucose uptake compared to animals with cardiac ATP citrate lyase expression. These findings are consistent with maladaptive metabolic remodeling and impaired oxidative metabolism during heart failure. Manipulating the activity of ATP citrate lyase using BMS303141 (0.5 μM) in ex vivo perfused wildtype rat hearts caused a rapid decline in cardiac power and increased utilization of glucose confirming our in vivo mouse studies. Conversely, inhibition of ATP citrate lyase during oncometabolic stress via D-2-hydroxyglutarate improved cardiac contractile function via redirection of Krebs cycle flux and provision of ATP levels. Together these data demonstrate that ATP citrate lyase regulates oxidative metabolism and structural remodeling in the heart and creates a targetable metabolic liability during cancer.

Study of cardiovascular dysfunction in chronic liver disease in a tertiary care hospital in eastern India

Background: Chronic liver disease (CLD) exhibits characteristic hemodynamic changes along with pathological changes in the myocardium. Compensated by the decreased systemic vascular resistance, overt heart failure is usually not seen, and thus cardiac pathology is frequently overlooked. Aims and Objectives: The objectives of the study were to study the presence, types, and severity of cardiovascular (CV) dysfunction in patients of CLD. Materials and Methods: An observational cross-sectional study on 50 patients of CLD at Calcutta National Medical College and Hospital, with all relevant investigations. Results: Out of a sample of 50 patients, of which 14.3% were mild, 34.3% moderate and 51.4% severe CLD (by Child-Pugh Class), 28.6% had a high normal heart rate (90 to 100/min), 45.7% had increased stroke volume index, and 42.9% increased cardiac index, reflecting hyperdynamic circulation. In 42% cases, left ventricular ejection fraction was increased more than 65%, reflecting hyperdynamic circulation, but decreased &lt;55% in 23% cases, which may be an indicator of cirrhotic cardiomyopathy. Ejection fraction is significantly (P=0.016) increased after paracentesis in 33.3% patients, reflecting the mechanical effect of ascites on cardiac function. Diastolic dysfunction was present in 60% (P=0.012) and left ventricular mass index was increased in 45.7% cases. All the parameters correlated with increasing Child-Pugh Class severity of CLD. Conclusion: A high level of awareness is needed to take into account the presence of CV dysfunction and cirrhotic cardiomyopathy in patients of CLD and predict the risk of adverse cardiac events. Specific treatment modalities need further study to improve prognosis in these patients.

In-hospital Outcome and Angiographic Profile of Elderly Patients with Non ST-Segment Elevation Myocardial Infraction

Background: Non ST - segment elevation myocardial infarction is heterogeneous in its presentation and is a major life-threatening cause of emergency medical care and hospitalization. Patients with non ST-segment elevation myocardial infarction are at risk for adverse cardiac events and if associated with increased age, it become a strong predictor of adverse cardiac events in patients with non ST-segment elevation myocardial infarction. Objective: To find out in - hospital outcome and severity of coronary artery disease of older patient with non - ST segment elevation myocardial infarction. Methods: This was a descriptive cross sectional study. The study was carried out in the department of cardiology, National Heart Foundation Hospital and Research Institute from June 2011 to May 2012. Patients of non ST - segment elevation myocardial infarction admitted at National Heart Foundation &amp; Research Institute who fulfill the inclusion criteria were the study population. Patients were recruited by nonrandom sampling. One hundred and thirty four patients were recruited in this study. Data were prospectively collected in a pre - designed data collection form and analyzed by using SPSS - 16 software. Results: In this study patients had a greater prevalence of hypertension, diabetes mellitus. Chest pain and shortness of breath were common presentations observed in study patient during admission. They had a lower left ventricular ejection fraction than their younger counter parts. Older group was associated with an increased risk of triple vessel disease. In-hospital complications were significantly higher in older patients. Duration of hospital stay was longer in older patients. Conclusion: Older patients with non- ST segment myocardial infarction strongly predicts adverse inhospital outcome and severe coronary artery disease profile. Older patients should alert physicians to an increased risk of morbidity and mortality, which may in turn support more judicious treatment including appropriate utilization of cardiovascular diagnostic tests and therapeutics used in current cardiovascular care to optimize outcomes in these high-risk patients. Bangladesh Heart Journal 2022; 37(1): 52-58