Risk Of Cardiac Complications Research Articles

Low Risk of Cardiac Complications during Long-Term Follow-Up of Opioid Dependence

Low Risk of Cardiac Complications during Long-Term Follow-Up of Opioid Dependence

Cardiac complications (arrhythmias and heart failure) in patients with ischemic stroke: A meta-analysis.

In patients with ischemic stroke (pwIS), cardiac complications have been observed in observational studies. We conducted a systematic review and meta-analysis to investigate the arrhythmias and heart failure in pwIS. Up until September 2023, we searched for case-control, cross-sectional, or cohort studies in 4 databases. For case-control/cross-sectional studies, odds ratios (OR) were determined using a random-effects model meta-analysis, while hazard ratios (HR) were calculated for cohort studies, and 95% confidence intervals (CIs) were pooled in the meta-analysis. In the meta-analysis, we incorporated 5 studies: 2 cohort studies, 2 case-control studies, and 1 cross-sectional study. In all, 81,181 controls and 25,544 pwIS were included in this investigation. The combined OR for case-control studies of arrhythmias was estimated to be 1.86 (95% CI: 0.70-4.94, P = .21), HR for cohort studies of arrhythmias to be 4.2 (95% CI: 1.49-12.01, P < .05), and for cohort studies of heart failure to be 2.9 (95% CI: 2.65-3.18, P < .05), suggesting that pwIS may be more likely to experience cardiac complications. Our results revealed that there is a comparatively higher risk of cardiac complications in pwIS; however, more research is needed to evaluate the risk of cardiac complications in pwIS.

Perioperative complications and in-hospital mortality in radical cystectomy patients with heart-valve replacement

PurposeTo assess in-hospital mortality and complication rates after radical cystectomy (RC) in patients with history of heart-valve replacement. Materials and methodsUsing the National Inpatient Sample (2000–2019), non-metastatic bladder cancer patients undergoing RC were stratified according to history of heart-valve replacement. Regression models (RM) predicted hospital outcomes. ResultsOf 25,535 RC patients, 250 (1.0%) harbored history of heart-valve replacement. Heart-valve replacement patients were older (median 74 vs. 70 years), more frequently male (87.2 vs. 80.6%), and more frequently had Charlson comorbidity index ≥3 (26.8 vs. 18.9%). In RC patients with history of heart-valve replacement vs. others, 62 vs. 2634 (24.8 vs. 10.4%) experienced cardiac complications, 28 vs. 3092 (11.2 vs. 12.2%) intraoperative complications, 11 vs. 1046 (4.4 vs. 4.1%) infections, <11 vs. 594 (<4.4 vs. 2.3%) perioperative bleeding, <11 vs. 699 (<4.4 vs. 2.8%) vascular complications, 74 vs. 6225 (29.6 vs. 24.7%) received blood transfusions, 37 vs. 3054 (14.8 vs. 12.1%) critical care therapy (CCT), and in-hospital mortality was recorded in <11 vs. 463 (<4.4 vs. 1.8%) patients. In multivariable RM, history of heart-valve replacement independently predicted cardiac complications (odds ratio 2.20, 95% confidence interval 1.62–2.99; p < 0.001). Conversely, no statically significant association was recorded between history of heart-valve replacement and length of stay, estimated hospital cost, intraoperative complications, perioperative bleeding, vascular complications, infections, blood transfusions, CCT use, and in-hospital mortality. ConclusionsRadical cystectomy patients with history of heart-valve replacement exhibited a 2.2-fold higher risk of cardiac complications, but no other complications, including no significantly higher in-hospital mortality.

Perioperative Complications and In-Hospital Mortality in Partial and Radical Nephrectomy Patients with Heart-Valve Replacement

BackgroundIn-hospital mortality and complication rates after partial and radical nephrectomy in patients with history of heart-valve replacement are unknown.Patients and MethodsRelying on the National Inpatient Sample (2000–2019), kidney cancer patients undergoing partial or radical nephrectomy were stratified according to presence or absence of heart-valve replacement. Multivariable logistic and Poisson regression models addressed adverse hospital outcomes.ResultsOverall, 39,673 patients underwent partial nephrectomy versus 94,890 radical nephrectomy. Of those, 248 (0.6%) and 676 (0.7%) had a history of heart-valve replacement. Heart-valve replacement patients were older (median partial nephrectomy 69 versus 60 years; radical nephrectomy 71 versus 63 years), and more frequently exhibited Charlson comorbidity index ≥ 3 (partial nephrectomy 22 versus 12%; radical nephrectomy 32 versus 23%). In partial nephrectomy patients, history of heart-valve replacement increased the risk of cardiac complications [odds ratio (OR) 4.33; p < 0.001), blood transfusions (OR 2.00; p < 0.001), intraoperative complications (OR 1.53; p = 0.03), and longer hospital stay [rate ratio (RR) 1.25; p < 0.001], but not in-hospital mortality (p = 0.5). In radical nephrectomy patients, history of heart-valve replacement increased risk of postoperative bleeding (OR 4.13; p < 0.001), cardiac complications (OR 2.72; p < 0.001), intraoperative complications (OR 1.53; p < 0.001), blood transfusions (OR 1.27; p = 0.02), and longer hospital stay (RR 1.12; p < 0.001), but not in-hospital mortality (p = 0.5).ConclusionsHistory of heart-valve replacement independently predicted four of twelve adverse outcomes in partial nephrectomy and five of twelve adverse outcomes in radical nephrectomy patients including intraoperative and cardiac complications, blood transfusions, and longer hospital stay. Conversely, no statistically significant differences were observed in in-hospital mortality.

Locoregional Anesthesia Has Lower Risks of Cardiac Complications Than General Anesthesia After Prolonged Endovascular Repair of Abdominal Aortic Aneurysms

ObjectivesWhile general anesthesia is the primary anesthesia in endovascular aneurysm repair (EVAR), some studies suggested locoregional anesthesia could be a feasible alternative for eligible patients. However, most evidence was from retrospective studies and was subjected to an inherent selection bias that general anesthesia is often chosen for more complex and prolonged cases. To mitigate this selection bias, this study aimed to compare 30-day outcomes of prolonged non-emergent intact infrarenal EVAR in patients undergoing locoregional or general anesthesia. In addition, risk factors associated with prolonged operative time in EVAR were identified. Designretrospective large-scale national registry study. SettingAmerican College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) targeted database from 2012-2022 Participants4075 out of 16,438 (24.79%) patients had prolonged EVAR. Among patients with prolonged EVAR, 324 (7.95%) were under locoregional anesthesia. There were 3,751 (92.05%) under general anesthesia, where 955 of them were matched to the locoregional anesthesia cohort. InterventionsPatients undergoing infrarenal EVAR were included. Exclusion criteria included age<18 years, emergency cases, ruptured AAA, and acute intraoperative conversion to open. Only cases with prolonged operative times (>157 minutes) were selected. A 1:3 propensity-score matching was used to address demographics, baseline characteristics, aneurysm diameter, distant aneurysm extent, and concomitant procedures between patients under locoregional and general anesthesia. Thirty-day postoperative outcomes were assessed. Moreover, factors associated with prolonged EVAR were identified by multivariable logistic regression. Measurements and Main ResultsExcept for general anesthesia contraindications, patients undergoing locoregional or general anesthesia exhibited largely similar preoperative characteristics. After propensity-score matching, patients under locoregional and general anesthesia had a lower risk of myocardial infarction (0.93% vs 2.83%, p=0.04) but comparable 30-day mortality (3.72% vs 2.72%, p=0.35) and other complications. Specific concomitant procedures, aneurysm anatomy, and comorbidities associated with prolonged EVAR were identified. ConclusionsLocoregional anesthesia can be a safe and effective alternative to general anesthesia, particularly in EVAR cases with anticipated complexity and prolonged operative times, as it offers the potential benefit of reduced cardiac complications. Risk factors associated with prolonged EVAR can aid in preoperative risk stratification and inform the decision-making process regarding anesthesia choice.

Management of Ptosis in Kearns-Sayre Syndrome: A Case Report and Literature Review.

Kearns-Sayre syndrome (KSS) is a rare mitochondrial disease that affects young adults, due to a deletion of mitochondrial DNA and characterized by the triad: age of onset lower than 20 years, chronic progressive external ophthalmoplegia, and an atypical pigmentary retinopathy. It is also characterized by other endocrine, neurological, and especially cardiac impairment with a very high risk of cardiac complications during surgical procedures under all types of anesthesia. We report a case of KSS revealed by severe bilateral ptosis and confirmed by a muscle biopsy with "ragged red fibers." The ptosis was surgically managed by cautious Frontal suspension under local anesthesia "Frontal nerve block." Through this case, we discuss challenges in the management of KSS patients.

Abstract WP15: Early Neurological Improvement in Ischemic Stroke and Risk of Cardiac Complications

Introduction: Cardiac complications are seen in 15-20% of acute ischemic strokes (AIS). We hypothesized that early neurologic improvement (ENI) with or without revascularization would be associated with lower risk of cardiac complications after AIS. Methods: We retrospectively screened consecutive AIS patients for elevated initial cardiac troponin (cTn) and ≥1 additional cTn within 48h. Minor strokes (NIHSS≤3) or comorbidities impacting cTn were excluded from primary analysis. ENI was defined as ≥4 pt improvement in NIHSS or 24h NIHSS≤ 1. Post-stroke acute myocardial injury (PSAMI) refers to dynamic cTn pattern (rise/fall&gt;20% in serial cTn levels) in the absence of acute atherosclerotic coronary disease or cardiac death. Secondary analysis assessed full range of NIHSS at baseline and at 24h in relation to cardiac outcomes. Results: Of 2,609 patients screened, 165 (ENI=62, no-ENI=103) were included in our primary analysis. (Fig.1). In patients with ENI, a dynamic cTn pattern and PSAMI were present in 55% (n=34) and 34% (n=21) respectively, compared to 45% (n=46) and 24% (n=25) in the no-ENI group ( P =0.20 and P =0.18). Adjusted regression analysis did not show any statistical association of cardiac outcomes with ENI. Secondary analysis including NIHSS≤3, was associated with a 4-fold greater risk of PSAMI in NIHSS &gt;15 at 24h (Fig.1). Analysis of patients intervened with MT or tPA (n=77) also showed no statistical association between ENI and PSAMI (Fig 1.) Conclusion: SENI was not associated with a lower risk of cardiac complications after AIS. NIHSS at 24 hours was a strong predictor of PSAMI. Larger studies should investigate if revascularization decreases risk of PSAMI.

Cumulative effect of chronic dehydration and age on postoperative complications after total shoulder arthroplasty

Dehydration is a modifiable risk factor that should be optimized prior to all surgical procedures. The aim of this study was to determine the effects of dehydration on postoperative complications following total shoulder arthroplasty (TSA). The American College of Surgeons National Surgical Quality Improvement database was queried for all patients who underwent TSA between 2015 and 2019 and a total of 16,993 patients were included in this study. The study population was subsequently classified into 3 categories: 8498 (50.0%) nondehydrated patients with blood urea nitrogen/creatinine (BUN/Cr)<20, 4908 (28.9%) moderately dehydrated patients with 20≤BUN/Cr≤25, and 3587 (21.1%) severely dehydrated patients with 25<BUN/Cr. A subgroup analysis involving only elderly patients aged > 65 years and normalized gender-adjusted Cr values was also performed. Postoperative complications within 30 days of the TSA were collected. Multivariate logistic regression analysis was conducted to explore the correlation between dehydration and postoperative complications. Adjusted multivariate logistic regression analysis showed that the severely dehydrated cohort had a greater risk of postoperative transfusion, mortality, nonhome discharge, and increased length of stay (all P<.05). The moderately dehydrated cohort had a greater risk of wound dehiscence (P=.044). Among the elderly, severely dehydrated patients had a greater risk of cardiac complications, postoperative transfusion, mortality, nonhome discharge, and increased length of stay (all P<.05). Finally, the elderly moderately dehydrated cohort had a greater risk of postoperative transfusion and nonhome discharge (all P<.05). BUN/Cr ratio is an important preoperative diagnostic tool to identify at-risk dehydrated patients. Providers should optimize dehydration to prevent complications, decrease costs, and improve discharge planning.

Application of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy in curative surgery for esophageal cancer: A meta-analysis.

The effectiveness of neoadjuvant therapy in esophageal cancer (EC) treatment is still a subject of debate. To compare the clinical efficacy and toxic side effects between neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemotherapy (nCT) for locally advanced EC (LAEC). A comprehensive search was conducted using multiple databases, including PubMed, EMBASE, MEDLINE, Science Direct, The Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Chinese Science and Technology Journal Database, and Chinese Biomedical Literature Database Article. Studies up to December 2022 comparing nCRT and nCT in patients with EC were selected. The analysis revealed significant differences between nCRT and nCT in terms of disease-free survival. The results indicated that nCRT provided better outcomes in terms of the 3-year overall survival rate (OSR) [odds ratio (OR) = 0.95], complete response rate (OR = 3.15), and R0 clearance rate (CR) (OR = 2.25). However, nCT demonstrated a better 5-year OSR (OR = 1.02) than nCRT. Moreover, when compared to nCRT, nCT showed reduced risks of cardiac complications (OR = 1.15) and pulmonary complications (OR = 1.30). Overall, both nCRT and nCT were effective in terms of survival outcomes for LAEC. However, nCT exhibited better performance in terms of postoperative complications.

The Exploring of Growth Differentiation Factor-15 and H63D Gene Polymorphisms in β-thalassemia Major: Implications for Cardiovascular Risk and Iron Overload

BACKGROUND: β-thalassemia major (βTM) is a genetic disorder characterized by a deficiency in hemoglobin production, ineffective erythropoiesis, chronic hemolysis, lifelong blood transfusions, iron overload, and increased risk of cardiac complications. OBJECTIVE: The study aimed to evaluate the growth differentiation factor-15 (GDF-15) concentration in βTM patients and its correlation with cardiac complications. H63D refers to a specific mutation in the HFE gene, which is associated with hereditary hemochromatosis (HH), a genetic disorder characterized by excessive accumulation of iron in the body. This mutation involves a change of histidine (H) to aspartic acid (D) at position 63 in the HFE protein. This mutation is often only written abbreviated as (H63D). MATERIALS AND METHODS: This case–control study was done on 120 subjects. A total of 60 patient samples were randomly collected from the Genetic Hematology Center at the Babylon Hospital, with an age range of 10–26 years. In addition, 60 samples were collected from healthy children in the same age range as the control group; patients and controls were subdivided into (10–18) and (18–26) year groups. GDF-15 was measured by enzyme-linked immunosorbent assay, and the genotyping of mutation was done by amplification refractory mutation system-polymerase chain reaction technique. RESULTS: The study revealed a significant increase in ferritin (FER) and GDF-15 levels in the patients compared to controls (P &lt; 0.001). GDF-15 showed a direct correlation with age (r = 0.244, P = 0.02) and FER (r = 0.215, P = 0.04). There was a significant difference in H63D mutations between controls and patients (P = 0.044), with a higher proportion of the C-G (heterozygous for the mutant allele) genotype observed in βTM patients (31.67%). Additionally, a notable effect of the H63D mutation on serum ferritin (higher) levels within the βTM group was observed. CONCLUSION: Elevations of the GDF-15 in βTM patients indicate a high risk of cardiovascular complications in patients with βTM. The H63D mutation of the hemostatic iron regulator (HFE) gene is frequently found in βTM. Although a significant effect of the mutation was obtained on serum FER levels, it did not act as a risk factor in βTM patients. However, the frequent presence of the H63D mutation in patients indicated a possible association between single-nucleotide polymorphism and the iron regulation pathway.

Role of feature tracking cardiac magnetic resonance imaging in early detection of cardiac dysfunction in β-thalassemia patients recovered from COVID-19: A cross-sectional study.

β-Thalassemia patients may have cardiac complications due to iron overload, which puts them at higher risk of cardiac complications induced by coronavirus disease 2019 (COVID-19) compared with the normal population. The present study aims to evaluate early cardiovascular complications following iron overload in β-thalassemia patients who had early recovery from COVID-19 by cardiac magnetic resonance imaging (MRI) and feature-tracking technique. Thirty-two confirmed COVID-19-recovered β-thalassemia cases were evaluated within 3 weeks to 3 months after a positive reverse-transcriptase polymerase chain reactionCOVID-19 test. Both the heart and liver of all patients were examined using cardiac MRI. We analyzed 32 patients with mean age of 32.84 ± 6.45 years at baseline. Left ventricular global strain values were significantly associated with myocardial T2*. A cut-off value of -15.08% for global longitudinal strain (GLS) with sensitivity and specificity of 90% and 61.1% (p = 0.017), 32.33% for global radial strain (GRS) with sensitivity and specificity of 80% and 94.4% (p = 0.001) and -16.21 for global circumferential strain(GCS), with sensitivity and specificity of 80% and 89.9% (p = 0.013) may indicate cardiac iron overload. GLS, GRS, and GCS were significantly decreased in patients with myocardial T2* <20 ms (iron overload), while no significant change was observed in the right and left ventricular ejection fraction (RV- and LVEF). Cardiac MRI feature-tracking may be helpful in the early detection of cardiac complications resulting from iron overload in β-thalassemia patients who had early recovery from COVID-19.

Novel Russian guidelines for the assessment and modification of cardiovascular risk in non-cardiac surgery

This year, new domestic recommendations for assessing and correcting the risk of cardiac complications during non-cardiac surgery have been published. These guidelines provide simple and practical key messages to facilitate decision-making in real-life clinical practice. The proposed algorithm for the management of patients before non-cardiac operations, focused on integral risk assessment, assessment of functional status and biomarkers. This review provides a summary of perioperative drug therapy, management of the most common CVDs, and focuses on specific care based on the risk of the patient's preexisting clinical conditions. Finally, the document includes practical recommendations for the management of postoperative complications, and also includes a new section on perioperative myocardial infarction/injury.

Presentation and Outcome of Children with Kawasaki Disease: Experience in A Tertiary Care Hospital in Bangladesh

Background: Kawasaki disease (KD) is an acute difficult-to-diagnose febrile illness in children caused by self limiting vasculitis in medium and small sized arteries.&#x0D; Objetive: This study has been conducted to analyze its presenting symptoms, clinical course, laboratory findings, and therapeutic options in a tertiary hospital in Bangladesh to aid early diagnosis and optimum management.&#x0D; Methods: This is a retrospective study where the medical records of 31 children admitted and diagnosed with Kawasaki Disease (KD) in Evercare Hospital Dhaka between 2009 and 2020, were assessed. Through a structured form, the demographic information, clinical profile, laboratory results, and echocardiographic data were obtained from the hospital records and then entered into a Microsoft Excel sheet. Cleaned and verified data were transferred to SPSS program version 23 and analyzed to obtain descriptive statistics.&#x0D; Results: Out of total 31 patients with KD enrolled, 64.5% of the patients were between six months to five years of age with a median age of three years; 97% had an age below 6 months. Though 68% of patients met all the required criteria for KD, one-third (32%) were diagnosed as incomplete KD with fewer manifestations. Along with high fever in all cases, the most common clinical features were polymorphous rash (90%) and changes in extremities (90%) followed by changes in the lips and oral cavity (77.4%), cervical lymphadenopathy (68%) and conjunctival injection (61%). Common laboratory abnormalities found were anemia (90%), leukocytosis (65%), thrombocytosis especially in the second week (78%), high ESR (100%), and elevated CRP (84%). About 42% of patients had cardiac abnormalities at the onset. Seven children (63.6%) had coronary artery aneurysms (CAA) whereas 18% had coronary dilatations. In subsequent followups, coronary artery changes remained almost the same up to 6-8 weeks. After 3-6 months, 87.5 % of children recovered from cardiac abnormality.&#x0D; Conclusion: A high index of suspicion for KD and an active search for compatible findings in children with unexplained fever can help in early diagnosis. Timely initiation of IVIG treatment is needed to reduce the risk of cardiac complications. Young infants under six months of age need further careful early suspicion and evaluation because of their incomplete presentation and more vulnerability to developing cardiac complications.&#x0D; DS (Child) H J 2022; 38(2): 70-78

Comparison of oral iron chelators in the management of transfusion-dependent β-thalassemia major based on serum ferritin and liver enzymes

Background Excess iron deriving from a chronic transfusion and dietary intake increases the risk for cardiac complications in β-thalassemia major patients. Deferiprone and deferasirox are commonly prescribed to thalassemic patients who are at risk of iron overload. This study aimed to compare the performance and toxicity of deferiprone and deferasirox in β-thalassemia major patients. Methods A cross-sectional observation was performed on 102 patients with β-thalassemia major. Serum ferritin along with total, indirect, and direct bilirubin levels were measured. Levels of liver enzymes, transaminase (ALT), and aspartate transaminase (AST), were also determined. Ferritin correlations with serum ALT, AST, and total bilirubin were constructed based on Spearman’s rank correlation. Statistical differences based on the serum parameters were analyzed between deferiprone and deferasirox groups. The differences of iron chelators’ effects between those receiving short-term (≤7 years) and long-term (&gt;7 years) blood transfusion were also analyzed. Results The averaged levels of bilirubin, ALT, AST, and ferritin were found to be high. Ferritin was positively correlated with ALT (r=0.508 and p&lt;0.001) and AST ((r=0.569; p&lt;0.001). There was no statistical difference in ferritin levels between the deferiprone and deferasirox groups (p=0.776). However, higher total bilirubin and ALT were observed in the deferasirox group than in the deferiprone group (p=0.001 and 0.022, respectively). Total (p&lt;0.001), indirect (p&lt;0.001), and direct bilirubin levels (p=0.015) were significantly higher in patients with long-term transfusions than those receiving short-term transfusions. Higher ferritin was found with a statistical significance of p=0.008 in the long-term transfusions group. Conclusions Ferritin is high in people with transfusion-dependent β-thalassemia major and positively correlated with ALT and AST. Deferasirox might pose a higher risk of developing hepatic injury as compared with deferiprone. Yet, no significant change of deferasirox efficacy (based on ferritin level) was found between those receiving short-term and long-term transfusions.

Management of Patients with Ischemic Heart Disease in Spine Surgery.

In ischemic heart disease (IHD), the myocardium does not receive enough blood and oxygen. Although the IHD-related mortality rate is decreasing, the risk remains and is a major predictor of cardiac complications following noncardiac surgery. Given the increase in the older population, the number of patients with spinal diseases requiring surgery is increasing. Among these patients, those with underlying IHD or a high risk of cardiac complications before and after surgery are also increasing. Given that cardiac complications following spinal surgery are associated with delayed patient recovery and even death, spinal surgeons should be knowledgeable about overall patient management, including medication therapy in those at high risk of developing perioperative cardiac complications for successful patient care. Before surgery, the underlying medical conditions of patients should be evaluated. Patients with a history of myocardial infarction should be checked for a history of surgical treatments, and the anticoagulant dose should be controlled depending on the surgery type. In addition, the functional status of patients must be examined before surgery. Functional status can be assessed according to the metabolic equivalent of task (MET). More preoperative cardiac examinations are needed for patients who are unable to perform four METs in daily because of the high risk of postoperative cardiac complications. Patients with a history of IHD require appropriate preoperative management and further postoperative evaluation. When considering surgery, spinal surgeons should be knowledgeable about patient care before and after surgery.

X-linked Emery-Dreifuss muscular dystrophy is associated with a high risk of malignant ventricular arrhythmia

Abstract Background Emery-Dreifuss muscular dystrophy (EDMD) is caused by variants in EMD (X-linked) and LMNA (autosomal dominant). LMNA variants are known to cause end-stage heart failure (ESHF) and malignant ventricular arrhythmia (MVA) [1], but the risk of cardiac complications in EMD variant-carriers is unknown. Purpose To determine the incidence of MVA and ESHF in EMD variant-carriers. Methods Consecutively referred individuals carrying EMD variants were recruited from 12 cardiomyopathy units in Europe and the USA. The incidence of MVA and ESHF in male and female EMD variant-carriers was determined. Male EMD variant-carriers with a cardiac phenotype at baseline (EMDcardiac) were compared to consecutively recruited male LMNA variant-carriers with a cardiac phenotype (LMNAcardiac). Results Longitudinal follow-up data were available for 38 male and 21 female EMD variant-carriers (mean (SD) ages 33.4 (13.3) and 43.3 (16.8) years, respectively; Table 1). Nine (23.6%) males developed MVA and five (13.2%) developed ESHF during a median follow-up time of 65.0 [24.3, 109.5] months. No female EMD variant-carrier had MVA or ESHF, but nine (42.8%) developed a mild cardiac phenotype at a median [IQR] age of 58.6 [53.2, 60.4] years. Incidence rates for MVA were similar for EMDcardiac and LMNAcardiac (4.8 versus 6.6 per hundred person-years, respectively; log-rank test p = 0.49; Figure 1). Incidence rates for ESHF were 2.4 per hundred person-years for EMDcardiac and 5.9 per hundred person-years for LMNAcardiac (log-rank test p = 0.09; Figure 1). Conclusions Male EMD variant-carriers have a high risk of progressive heart failure and ventricular arrhythmias similar to that of male LMNA variant-carriers. These data suggest that early ICD implantation and heart failure drug therapy should be considered in male EMD variant-carriers with cardiac disease.Table 1Figure 1

C-reactive protein in Stroke-Heart-Syndrome: a propensity-matched analysis of a global federated health network

Abstract Introduction The role of inflammation in the Stroke-Heart-Syndrome is unclear. Purpose To assess the predictive role of C-Reactive Protein (CRP) for early cardiovascular complications in patients with stroke. Methods Electronic medical records from TriNetX, a global federated health research network, were used for this retrospective analysis. Patients with ischemic stroke and CRP levels measured within 24 hours post-stroke, were categorized into three groups: i)&amp;lt;1mg/L, ii)1-3 mg/L and iii)&amp;gt;3mg/L. The primary outcome was a composite outcome of cardiac complications (heart failure (HF), atrial fibrillation (AF), ischemic heart disease, ventricular arrhythmias, and Takotsubo cardiomyopathy) or death at 30 days from the index event. Cox-regression analyses were used to produce hazard ratios (HRs) and 95% confidence intervals (CI) following 1:1 propensity score matching. Results Of the 104,741 patients enrolled, 51% were female and the mean age was 67±2 years. Cardiac complications or death within 30 days occurred in 40.4% patients with CRP&amp;gt;3 mg/L, in 27.6% patients with CRP 1-3 mg/L and in 23.2% patients with CRP&amp;lt;1 mg/L. After propensity score matching, patients with CRP levels of 1-3mg/L and &amp;gt;3mg/L had higher risk of the composite outcome (HR: 1.10, 95%CI: 1.05-1.50;HR: 1.51, 95%CI: 1.45-1.58), death (HR:1.43, 95%CI:1.24-1.64; HR:3.50, 95%CI:3.10-3.96), HF (HR:1.08, 95%CI:1.01-1.16; HR:1.51, 95%CI:1.41-1.61), AF (HR:1.10, 95% CI:1.02-1.18; HR:1.42, 95%CI:1.33-1.52), and ventricular arrhythmias (HR:1.24, 95% CI:1.02-1.52, HR:1.67, 95% CI:1.39-2.01) compared to those with CRP&amp;lt;1 mg/L. Ischemic heart disease was more common only in patients with CRP levels &amp;gt;3mg/L (HR:1.33, 95% CI:1.26-1.40) compared to those with CRP&amp;lt;1mg/L. No association with Takotsubo cardiomyopathy was found. At the sensitivity analysis, these results were also confirmed considering only older patients or excluding those with possible confounding factors. Conclusion CRP levels at the admission for an ischemic stroke predict the 30-day risk of cardiac complications or death.

Abstract 11882: Acute Cardiac Events Among Older Adults Hospitalized With Laboratory-Confirmed Respiratory Syncytial Virus

Introduction: Respiratory syncytial virus (RSV) can cause severe illness among older adults, but potential cardiac complications have not been comprehensively described. We evaluated the frequency and severity of acute cardiac events among older adults hospitalized with laboratory-confirmed RSV to inform recommendations for RSV vaccine candidates in development. Methods: The RSV-Associated Hospitalization Surveillance Network (RSV-NET) abstracted medical record data among all hospitalized patients identified with laboratory-confirmed RSV infection (clinician-ordered testing) in a population-based catchment area of 38 counties in 9 states. Among adults aged ≥50 years hospitalized with RSV during the 2015-16 to 2017-18 RSV seasons, we estimated the period prevalence and 95% confidence interval (CI) of acute cardiac events, identified from the patient’s discharge diagnoses and ICD-10 codes. Multivariable generalized estimating equation models estimated the adjusted risk ratio (aRR) of intensive care unit (ICU) admission and in-hospital death by acute cardiac event status. Results: Among 3959 adults aged ≥50 years hospitalized with RSV (mean age 73 years), 20.8% (CI, 19.5-22.1) experienced an acute cardiac event during hospitalization, most frequently acute heart failure (14.3%; CI, 13.2-15.4; Table). Acute cardiac events were common among adults aged ≥75 years (25.0%; CI, 23.1-27.0) and among those with underlying cardiac disease (30.4%; CI: 28.5-32.3). Compared to patients without an acute cardiac event, those with an acute cardiac event were more likely to experience ICU admission (16.8% vs 27.0%; aRR: 1.7, CI: 1.5-1.9) and in-hospital death (4.1% vs 8.8%; aRR: 2.0, CI: 1.6-2.5). Conclusions: One in 5 older adults hospitalized with RSV experienced an acute cardiac event, which was associated with approximately double the risk of severe outcomes. Adults at greater risk of cardiac complications from RSV may benefit from vaccines when available.

High Plasma Fibrinogen Level Elevates the Risk of Cardiac Complications Following Spontaneous Intracerebral Hemorrhage

Cardiac complications are related to poor prognosis after spontaneous intracerebral hemorrhage (ICH). This study aims to predict the cardiac complications arising from small intracranial hematoma at ultraearly stage. The data of this work were derived from the Risk Stratification and Minimally Invasive Surgery in Acute ICH Patients study (ClinicalTrials.gov Identifier: NCT03862729). This work included patients with ICH but without brain herniation, as confirmed by a brain computed tomography scan within 48hours of symptom onset. Every Patient's information recorded at the emergent department, including clinical, laboratory, electrocardiogram, and medical records, was derived from the electronic data capture. Cardiac complications were defined as the occurrence of myocardial damage, arrhythmias, and ischemic electrocardiogram changes during hospitalization. Variables associated with cardiac complications were filtrated by univariate and multivariate regression analyses. Independent risk factors were used to form the early predictive model. The restricted cubic splines were employed to investigate the nonlinear associations in a more sophisticated and scholarly manner. A total of 587 ICH patients were enrolled in this work, including 72 patients who suffered from cardiac complications after ICH. Out of the 78 variables, 24 were found to be statistically significant in the univariate logistic regression analysis. These significant variables were then subjected to multivariate logistic regression analysis and utilized for constructing risk models. Multivariate logistic regression analysis showed high plasma fibrinogen (FIB) level [odds ratio (OR) per standard deviation (SD) 1.327, 95% confidence intervals (CI) 1.037-1.697; P=0. 024)] and older age (OR per SD 1.777, 95% CI 1.344-2.349; P ＜0.001) were associated with a higher incidence of cardiac complications after ICH. High admission pulse rate (OR 0.620, 95% CI 0.451-0.853; P=0. 003) was considered a protective factor for cardiac complications after ICH. In the restricted cubic spline regression model, FIB and cardiac complications following ICH were positively correlated and almost linearly (P for nonlinearity=0.073). The reference point for FIB in predicting cardiac complications after ICH was 2.64g/L. Emergent factors, including plasma FIB level, age, and pulse rate, might be independently associated with cardiac complications after ICH, which warrants attention in the context of treatment.

SIRT3-dependent mitochondrial redox homeostasis mitigates CHK1 inhibition combined with gemcitabine treatment induced cardiotoxicity in hiPSC-CMs and mice.

Administration of CHK1-targeted anticancer therapies is associated with an increased cumulative risk of cardiac complications, which is further amplified when combined with gemcitabine. However, the underlying mechanisms remain elusive. In this study, we generated hiPSC-CMs and murine models to elucidate the mechanisms underlying CHK1 inhibition combined with gemcitabine-induced cardiotoxicity and identify potential targets for cardioprotection. Mice were intraperitoneally injected with 25mg/kg CHK1 inhibitor AZD7762 and 20mg/kg gemcitabine for 3weeks. hiPSC-CMs and NMCMs were incubated with 0.5uM AZD7762 and 0.1uM gemcitabine for 24h. Both pharmacological inhibition or genetic deletion of CHK1 and administration of gemcitabine induced mtROS overproduction and pyroptosis in cardiomyocytes by disrupting mitochondrial respiration, ultimately causing heart atrophy and cardiac dysfunction in mice. These toxic effects were further exacerbated with combination administration. Using mitochondria-targeting sequence-directed vectors to overexpress CHK1 in cardiomyocyte (CM) mitochondria, we identified the localization of CHK1 in CM mitochondria and its crucial role in maintaining mitochondrial redox homeostasis for the first time. Mitochondrial CHK1 function loss mediated the cardiotoxicity induced by AZD7762 and CHK1-knockout. Mechanistically, mitochondrial CHK1 directly phosphorylates SIRT3 and promotes its expression within mitochondria. On the contrary, both AZD7762 or CHK1-knockout and gemcitabine decreased mitochondrial SIRT3 abundance, thus resulting in respiration dysfunction. Further hiPSC-CMs and mice experiments demonstrated that SIRT3 overexpression maintained mitochondrial function while alleviating CM pyroptosis, and thereby improving mice cardiac function. In summary, our results suggest that targeting SIRT3 could represent a novel therapeutic approach for clinical prevention and treatment of cardiotoxicity induced by CHK1 inhibition and gemcitabine.