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JACC. Advances Sep 2023
PubMed: 38939475
DOI: 10.1016/j.jacadv.2023.100572 -
JACC. Advances Aug 2023Early coronary occlusion detection by portable personal device with limited number of electrocardiographic (ECG) leads might shorten symptom-to-balloon time in acute...
BACKGROUND
Early coronary occlusion detection by portable personal device with limited number of electrocardiographic (ECG) leads might shorten symptom-to-balloon time in acute coronary syndromes.
OBJECTIVES
The purpose of this study was to compare the accuracy of coronary occlusion detection using vectorcardgiographic analysis of a near-orthogonal 3-lead ECG configuration suitable for credit card-size personal device integration with automated and human 12 lead ECG interpretation.
METHODS
The 12-lead ECGs with 3 additional leads ("abc") using 2 arm and 2 left parasternal electrodes were recorded in 66 patients undergoing percutaneous coronary intervention prior to ("baseline", n = 66), immediately before ("preinflation", n = 66), and after 90-second balloon coronary occlusion ("inflation", n = 120). Performance of computer-measured ST-segment shift on vectorcardgiographic loops constructed from "abc" and 12 leads, standard 12-lead ECG, and consensus human interpretation in coronary occlusion detection were compared in "comparative" and "spot" modes (with/without reference to "baseline") using areas under ROC curves (AUC), reliability, and sensitivity/specificity analysis.
RESULTS
Comparative "abc"-derived ST-segment shift was similar to two 12-lead methods (vector/traditional) in detecting balloon coronary occlusion (AUC = 0.95, 0.96, and 0.97, respectively, = NS). Spot "abc" and 12-lead measurements (AUC = 0.72, 0.77, 0.68, respectively, = NS) demonstrated poorer performance ( < 0.01 vs comparative measurements). Reliability analysis demonstrated comparative automated measurements in "good" agreement with reference (preinflation/inflation), while comparative human interpretation was in "moderate" range. Spot automated and human reading showed "poor" agreement.
CONCLUSIONS
Vectorcardiographic ST-segment analysis using baseline comparison of 3-lead ECG system suitable for credit card-size personal device integration is similar to established 12-lead ECG methods in detecting balloon coronary occlusion.
PubMed: 38939446
DOI: 10.1016/j.jacadv.2023.100454 -
JACC. Advances Aug 2023COVID-19 is known to be associated with acute myocardial infarction (MI).
BACKGROUND
COVID-19 is known to be associated with acute myocardial infarction (MI).
OBJECTIVES
The purpose of this study was to evaluate the outcomes of 30-day readmissions for MI among survivors of COVID-19 hospitalization.
METHODS AND RESULTS
We used the U.S. Nationwide Readmission Database to identify COVID-19 admissions from April 1, 2020, to November 30, 2020, using International Classification of Diseases-10th Revision-Clinical Modification (ICD-10-CM) claims. The primary outcome was 30-day readmission incidence for MI. A total of 521,251 cases of COVID-19 were included, of which 11.6% were readmitted within 30 days of discharge. The 30-day readmission incidence for MI was 0.6%. The 30-day all-cause readmission mortality incidence was 1.3%. Patients readmitted for MI were more frequently males (61.6% vs 38.4%) and had a higher Charlson comorbidity burden score (7 vs 4). The most common diagnosis among 30-day MI readmission was type 2 MI (51.1%), followed by a diagnosis of a type 1 non-ST-segment elevation MI (41.7%). ST-segment elevation MI cases constituted 7.6% of all MI-readmission whereas 0.6% of patients had unstable angina. 30-day MI readmissions with a recurrent diagnosis of COVID-19 had higher readmission mortality and incidence of complications. Conversely, the odds of performing revascularization procedures were lower for MI with recurrent COVID-19. Furthermore, MI readmissions with recurrent COVID-19 had a higher length of stay (7 vs 5 days) and cost of hospitalization ($18,398 vs $16,191) when compared with non-COVID-19 MI readmissions.
CONCLUSIONS
Among survivors of COVID-19 hospitalization, 5.2% of all-cause 30-day readmissions and 12% of all-cause readmission mortality were attributed to MI. MI-related readmissions were a significant source of mortality, morbidity, and resource utilization.
PubMed: 38939438
DOI: 10.1016/j.jacadv.2023.100453 -
JACC. Advances Aug 2023Up to one-half of adults with congenital heart disease (CHD) experience psychological distress, including anxiety.
BACKGROUND
Up to one-half of adults with congenital heart disease (CHD) experience psychological distress, including anxiety.
OBJECTIVES
This paper sought to: 1) assess the contribution of illness perception in explaining anxiety symptoms beyond sociodemographic and medical variables in adults with CHD; and 2) investigate the potential mediating effect of coping style.
METHODS
CHD adult patients were recruited at Montreal Heart Institute between June 2019 and April 2021 for this cross-sectional study. Participants responded to self-reported questionnaires (Hospital Anxiety and Depression Scale, Brief Illness Perception Questionnaire, and Brief COPE). Medical characteristics (CHD complexity, NYHA functional class, and cardiac devices) were collected from medical records. We conducted hierarchical multiple linear regression and mediation analyses.
RESULTS
Of the 223 participants (mean age 46 ± 14 years, 59% women), 15% had clinically significant anxiety symptoms. Medical and sociodemographic variables explained 15% of the variation in anxiety symptoms. Adding illness perception explained an additional 18% of the variation in anxiety. This R change was significant ([1,188] = 49.06, < 0.0001). Illness perception explained more variance (18%) than medical and sociodemographic variables combined. A more threatening perception of illness was associated with greater anxiety symptoms (β = 0.45, < 0.0001). Furthermore, illness perception was associated with coping, which was linked to reduced anxiety symptoms. Coping response style accounted for 20% of the total effect of illness perception on anxiety.
CONCLUSIONS
Illness perception and coping are associated with anxiety in adults with CHD. Future initiatives should assess whether targeting these potentially modifiable factors effectively prevents or mitigates anxious symptoms in adults with CHD.
PubMed: 38939437
DOI: 10.1016/j.jacadv.2023.100425 -
JACC. Advances Feb 2024Treatment with vitamin K antagonists (VKAs) has been linked to worsening of kidney function in patients with atrial fibrillation (AF).
BACKGROUND
Treatment with vitamin K antagonists (VKAs) has been linked to worsening of kidney function in patients with atrial fibrillation (AF).
OBJECTIVES
XARENO (Factor XA-inhibition in RENal patients with non-valvular atrial fibrillation Observational registry; NCT02663076) is a prospective observational study comparing adverse kidney outcomes in patients with AF and advanced chronic kidney disease receiving rivaroxaban or VKA.
METHODS
Patients with AF and an estimated glomerular filtration rate (eGFR) of 15 to 49 mL/min/1.73 m were included. Blinded adjudicated outcome analysis evaluated adverse kidney outcomes (a composite of eGFR decline to <15 mL/min/1.73 m, need for chronic kidney replacement therapy, or development of acute kidney injury). A composite net clinical benefit outcome (stroke or systemic embolism, major bleeding, myocardial infarction, acute coronary syndrome, or cardiovascular death) was also analyzed. HRs with 95% CIs were calculated using propensity score overlap weighting Cox regression.
RESULTS
There were 1,455 patients (764 rivaroxaban; 691 VKA; mean age 78 years; 44% females). The mean eGFR was 37.1 ± 9.0 in those receiving rivaroxaban and 36.4 ± 10.1 mL/min/1.73 m in those receiving VKA. After a median follow-up of 2.1 years, rivaroxaban was associated with less adverse kidney outcomes (HR: 0.62; 95% CI: 0.43-0.88) and all-cause death (HR: 0.76, 95% CI: 0.59-0.98). No significant differences were observed in net clinical benefit.
CONCLUSIONS
In patients with AF and advanced chronic kidney disease, those receiving rivaroxaban had less adverse kidney events and lower all-cause mortality compared to those receiving VKA, supporting the use of rivaroxaban in this high-risk group of patients.
PubMed: 38939389
DOI: 10.1016/j.jacadv.2023.100813 -
JACC. Advances Feb 2024The number of patients with an arterial switch operation (ASO) for transposition of the great arteries (TGA) is steadily growing; limited information is available...
BACKGROUND
The number of patients with an arterial switch operation (ASO) for transposition of the great arteries (TGA) is steadily growing; limited information is available regarding the clinical course in the current era.
OBJECTIVES
The purpose was to describe clinical outcome late after ASO in a national cohort, including survival, rates of (re-)interventions, and clinical events.
METHODS
A total of 1,061 TGA-ASO patients (median age 10.7 years [IQR: 2.0-18.2 years]) from a nationwide prospective registry with a median follow-up of 8.0 years (IQR: 5.4-8.8 years) were included. Using an analysis with age as the primary time scale, cumulative incidence of survival, (re)interventions, and clinical events were determined.
RESULTS
At the age of 35 years, late survival was 93% (95% CI: 88%-98%). The cumulative re-intervention rate at the right ventricular outflow tract and pulmonary branches was 36% (95% CI: 31%-41%). Other cumulative re-intervention rates at 35 years were on the left ventricular outflow tract (neo-aortic root and valve) 16% (95% CI: 10%-22%), aortic arch 9% (95% CI: 5%-13%), and coronary arteries 3% (95% CI: 1%-6%). Furthermore, 11% (95% CI: 6%-16%) of the patients required electrophysiological interventions. Clinical events, including heart failure, endocarditis, and myocardial infarction occurred in 8% (95% CI: 5%-11%). Independent risk factors for any (re-)intervention were TGA morphological subtype (Taussig-Bing double outlet right ventricle [HR: 4.9, 95% CI: 2.9-8.1]) and previous pulmonary artery banding (HR: 1.6, 95% CI: 1.0-2.2).
CONCLUSIONS
TGA-ASO patients have an excellent survival. However, their clinical course is characterized by an ongoing need for (re-)interventions, especially on the right ventricular outflow tract and the left ventricular outflow tract indicating a strict lifelong surveillance, also in adulthood.
PubMed: 38939383
DOI: 10.1016/j.jacadv.2023.100772 -
JACC. Advances Feb 2024Type 2 myocardial infarction (MI) results from coronary supply and demand imbalance and has a poor prognosis. It is crucial to identify potential sex-based differences...
BACKGROUND
Type 2 myocardial infarction (MI) results from coronary supply and demand imbalance and has a poor prognosis. It is crucial to identify potential sex-based differences in the prevalence and nature of coronary artery disease (CAD) within this population.
OBJECTIVES
The purpose of this study was to evaluate sex-based disease differences in type 2 MI among patients evaluated with coronary computed tomography angiography and fractional flow reserve.
METHODS
In a single-center, prospective study, patients with strictly adjudicated type 2 MI underwent coronary computed tomography angiography with fractional flow reserve.
RESULTS
Among 50 study participants enrolled, 50% were women. A similar mix of MI precipitants was present in both sexes. ST-segment depression was more common in women (64% vs 32%), while men were more likely to have T wave inversion (68% vs 36%). Women and men had comparable coronary artery calcium scores (median: 152 [Q1, Q3: 45, 762] vs 234 [Q1, Q3: 56, 422]). Prevalence of any CAD (84% vs 100%), obstructive CAD (24% vs 28%), and hemodynamically significant focal stenosis (20% vs 32%) were similar between sexes. Total plaque volume was similar between sexes, but women had significantly lower levels of low-attenuation plaque (median: 3 [Q1, Q3: 1, 7] vs 9 [Q1, Q3: 3, 14]).
CONCLUSIONS
Among patients with type 2 MI, prevalence of any CAD and obstructive CAD did not differ according to sex. Total plaque volume was similar between sexes, but women had a lower volume of low-attenuation plaque (DEFINing the PrEvalence and Characteristics of Coronary Artery Disease Among Patients With TYPE 2 Myocardial Infarction Using CT-FFR [DEFINE TYPE2MI]; NCT04864119).
PubMed: 38939381
DOI: 10.1016/j.jacadv.2023.100795 -
JACC. Advances Feb 2024
PubMed: 38939380
DOI: 10.1016/j.jacadv.2023.100788 -
JACC. Advances Feb 2024Increased particulate matter <2.5 μm (PM) air pollution is associated with adverse cardiovascular outcomes. However, its impact on patients with prior coronary artery...
BACKGROUND
Increased particulate matter <2.5 μm (PM) air pollution is associated with adverse cardiovascular outcomes. However, its impact on patients with prior coronary artery bypass grafting (CABG) is unknown.
OBJECTIVES
The purpose of this study was to evaluate the association between major adverse cardiovascular events (MACE) (defined as myocardial infarction, stroke, or cardiovascular death) and air pollution after CABG.
METHODS
We linked 26,403 U.S. veterans who underwent CABG (2010-2019) nationally with average annual ambient PM estimates using residential address. Over a 5-year median follow-up period, we identified MACE and fit a multivariable Cox proportional hazard model to determine the risk of MACE as per PM exposure. We also estimated the absolute potential reduction in PM attributable MACE simulating a hypothetical PM lowered to the revised World Health Organization standard of 5 μg/m.
RESULTS
The observed median PM exposure was 7.9 μg/m (IQR: 7.0-8.9 μg/m; 95% of patients were exposed to PM above 5 μg/m). Increased PM exposure was associated with a higher 10-year MACE rate (first tertile 38% vs third tertile 45%; < 0.001). Adjusting for demographic, racial, and clinical characteristics, a 10 μg/m increase in PM resulted in 27% relative risk for MACE (HR: 1.27, 95% CI: 1.10-1.46; < 0.001). Currently, 10% of total MACE is attributable to PM exposure. Reducing maximum PM to 5 μg/m could result in a 7% absolute reduction in 10-year MACE rates.
CONCLUSIONS
In this large nationwide CABG cohort, ambient PM air pollution was strongly associated with adverse 10-year cardiovascular outcomes. Reducing levels to World Health Organization-recommended standards would result in a substantial risk reduction at the population level.
PubMed: 38939372
DOI: 10.1016/j.jacadv.2023.100781 -
ACG Case Reports Journal Jul 2024ST segment elevations (STEs) on an electrocardiogram (EKG) gravitate immediate attention to the heart. However, these EKG changes can sometimes be the result of...
ST segment elevations (STEs) on an electrocardiogram (EKG) gravitate immediate attention to the heart. However, these EKG changes can sometimes be the result of noncardiac pathologies. Here, we present an interesting case of small bowel obstruction (SBO) masquerading as an inferior wall myocardial infarction. A 77-year-old woman with a history of aortic stenosis status postsurgical aortic valve replacement presented with chest pain. Workup revealed elevated high-sensitivity troponins and STE in the inferior leads. She subsequently underwent a left heart catheterization, which showed no critical plaques or stenosis. Persistent abdominal pain prompted further evaluation with a computed tomography scan of the abdomen, which demonstrated evidence of SBO. Conservative treatment with bowel decompression resulted in symptom improvement and complete resolution of the STEs on a follow-up EKG. This case underscores the importance of considering noncardiac etiologies, such as SBO, in the differential diagnosis of STE on EKG for accurate diagnosis and management.
PubMed: 38939350
DOI: 10.14309/crj.0000000000001412