Determination of the prevalence and predictors of ventricular thrombus with assessment of the risk of systemic embolization to the CNS in patients after acute myocardial infarction using magnetic resonance imaging, echocardiography and cardiac markers - a prospective, unicentric, observational study

BACKGROUND

Left ventricular thrombus (LVT) formation is one of the well-known and serious complications of acute myocardial infarction (AMI) due to the risk of systemic arterial embolization (SE). To diagnose LVT, echocardiography (TTE) is used. Late gadolinium-enhanced cardiovascular magnetic resonance (DE-CMR) is the gold standard for diagnosing LVT.

OBJECTIVES

The aim of this observational study was to determine the role of transthoracic echocardiography and cardiac markers in predicting the occurrence of LVT compared with a reference cardiac imaging (DE-CMR) and to determine the risk of systemic embolization to the CNS using brain MRA.

METHODS

Seventy patients after MI managed by percutaneous coronary intervention (localization: 92.9% anterior wall, 7% other; median age 58.7 years) were initially examined by transthoracic echocardiography (TTE, n=69) with a focus on LVT detection. Patients were then referred for DE-CMR (n=55). Laboratory determination of cardiac markers (Troponin T and NTproBNP) was carried out in all. Brain MRA was performed 1 year apart (n=51).

RESULTS

The prevalence of LVT detected by echocardiography: (n=11/69, i.e. 15.9%); by DE-CMR: (n=9/55, i.e. 16.7%). Statistically significant parameters to predict the occurrence of LVT after AMI (cut off value): (a) detected by echocardiography: anamnestic data - delay (≥ 5 hours), echocardiographic parameters - left atrial volume index (LAVI≥ 32 mL/m2), LV EF Simpson biplane and estimated (≤ 42%), tissue Doppler determination of septal A wave velocity (≤ 7.5cm/s); (b) detected by DE-CMR: anamnestic data - delay (≥ 13 hours), DE-CMR parameters - left ventricular end-diastolic diameter (≥ 54mm). The value of cardiac markers (Troponin T and NTproBNP in ng/L) in LVT detected by echocardiography did not reach statistical significance. In LVT detected by DE-CMR, NTproBNP was statistically significantly increased at 1 month after AMI onset (no optimal cut-off value could be determined). There was no statistically significant association between the LVT detection (both modalities) and the occurrence of clinically manifest and silent cardioembolic events.

CONCLUSION

Our study confirmed a relatively high prevalence of LVT in the high-risk group of patients with anterior wall STEMI. Due to the low prevalence of thromboembolic complications, no significant association between the LVT detection and the occurrence of a cardioembolic event was demonstrated.

Inquiry into the Temperature Changes of Rock Massif Used in Energy Production in Relation to Season

This research was undertaken to perform and evaluate the temperature measurement in the ground utilized as an energy source with the goal to determine whether significant temperature variations occur in the subsurface during the heating season. The research infrastructure situated on our University campus was used to assess any variations. The observations were made at the so called "Small Research Polygon" that consists of 8 monitoring boreholes (Borehole Heat Exchangers) situated around a borehole used as an energy source. During the heating season, a series of monthly measurements are made in the monitoring boreholes using a distributed temperature system (DTS). Raman back-scattered light is analysed using Optical Frequency Time Domain Reflectometry (OTDR). Our results indicate that no noticeable changes in temperature occur during the heating season. We have observed an influence of long-term variations of the atmospheric conditions up to the depth of a conventional BHE (≈100 m). The resulting uncertainty in related design input parameters (ground thermal conductivity) was evaluated by using a heat production simulation. Production data during one heating season at our research facilities were evaluated against the design of the system. It is possible to construct smaller geothermal installations with appropriate BHE design that will have a minimal impact on the temperature of the surrounding rock mass and the system performance.

Cardiac device-related infective endocarditis in the Czech Republic: prospective data from the ESC EORP EURO-ENDO registry

AIM

Understanding cardiac electronic device infective endocarditis epidemiology is essential for the management of this serious complication. Only monocentric and limited data have been published regarding patients in the Czech republic so far. The aim of this study was to describe the current profile, microbiology and clinical characteristics of this population.

PATIENTS AND METHODS

National data from the prospective ESC-EORP EURO-ENDO registry were collected. 57 consecutive patients with a diagnosis of cardiac device-related infective endocarditis (CDRIE) from 11 Czech centres were included.

RESULTS

Staphylococcus spp. was responsible for 43.9% of isolates, whereas Culture negative endocarditis was documented in 26.3% episodes. The most frequent complications under therapy were acute renal failure (17.5%), septic shock and heart failure (both 10.5%). Extraction of device was performed in 75.4% of all patients, and the 1-year mortality was 22.5%.

CONCLUSIONS

The high proportion of culture-negative endocarditis is alarming and warrants further investigation. Cardiac device related infective endocarditis is a serious complication with a high 1-year mortality in a highly polymorbid spectrum of patients.

Essential role of PET-CT in the management of patients with severe infectious complication CIEDS: multicentre study

Background

With the increasing number of implanted cardiac pacemakers, ICDs and CRTs, the number of serious infectious complications of these procedures increases significantly, especially in the longer term from the primary implantation. The systematic solution is in most cases endovasal extraction of these systems.

Methods

In a multicenter, prospective, randomized, controlled trial evaluating the benefit of CIEDS infection management in 277 patients, a conventional approach using blood cultures, microbiological examinations and TEE versus innovative management of these patients using PET-CT was compared. PET-CT examination is able to differentiate very well the infection of the implant pocket (Figure A) against bacterial endocarditis (Figure B). Thanks to this, it is possible to individualize the management of the patient and to shorten the dates of hospitalization, resp. time to re-implantation of the new system in patients without the presence of bacterial endocarditis.

Results

The results of the multicentre study are summarized in Table 1.

Conclusions

A comprehensive examination of patients with CDRIE using PET-CT significantly shortens hospital stay, time of antibiotic therapy and, as a consequence, leads to a lower incidence of serious complications of extraction procedures.

PET-CT in CDRIE patients

Funding Acknowledgement

Type of funding source: None

P3709Risk of recurrent cerebral ischemia in young patients with cryptogenic ischemic stroke and patent foramen ovale

Background

The cause of ischemic stroke (IS) remains often unclear in young patients. Relevant structural heart abnormities with known embolic potential may represent cause of IS also in young population. A persistent foramen ovale (PFO) is a known risk factor for paradoxical embolism, including ischemic stroke (IS).

Aims

The aims of our prospective study were to assess the rates of recurrent ischemic stroke events in young IS patients with PFO during a 35-month follow-up period (FUP) on effective antiplatelet therapy (OAT) and to evaluate a potential relationship with the presence of PFO on transesophageal echocardiography (TEE).

Methods

The study set consisted of young acute IS patients <50 years enrolled in the prospective HISTORY (Heart and Ischemic STrOke Relationship studY) study, NCT01541163). In all patients, the brain ischemia was confirmed on CT or MRI. Admission ECG, serum specific cardiac markers, transesophageal echocardiography, 24-hour and 3-week ECG-Holter were performed in all patients.

Results

Out of 980 patients enrolled in the HISTORY study, 260 patients were younger than 50 years and 185 (56% males, mean age 41±8 years) patients were classified as cryptogenic IS in ASCOD classification. PFO was diagnosed in 60 patients (32%). Six new clinically apparent recurrent ischemic brain events were recorded during a 35-month FUP. No significant difference was found in the presence of IS recurrence between patient group with PFO and without PFO (2 [3.2% patients with PFO] versus 4 [3.2% without PFO] of young IS patients, P=0.99).

Conclusion

The presence of PFO was not associated with a higher risk of new brain ischemic lesions in young patients with with cryptogenic ischemic stroke during a 35-month follow-up period. Number of recurrent clinical IS is relatively small, thus achieved results may be not so robust.

Acknowledgement/Funding

Grant support IGA MZ CR NT/14288-3, AZV MZ CR 17-30101A, IGA LF UP Olomouc (2016-2018), FNOL SUG No. 87-85