The Usefulness of 18F-FDG PET to Differentiate Subtypes of Dementia: The Systematic Review and Meta-Analysis

Background and Purpose

Dementia subtypes, including Alzheimer's dementia (AD), dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD), pose diagnostic challenges. This review examines the effectiveness of 18F-Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET) in differentiating these subtypes for precise treatment and management.

Methods

A systematic review following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines was conducted using databases like PubMed and Embase to identify studies on the diagnostic utility of 18F-FDG PET in dementia. The search included studies up to November 16, 2022, focusing on peer-reviewed journals and applying the gold-standard clinical diagnosis for dementia subtypes.

Results

From 12,815 articles, 14 were selected for final analysis. For AD versus FTD, the sensitivity was 0.96 (95% confidence interval [CI], 0.88-0.98) and specificity was 0.84 (95% CI, 0.70-0.92). In the case of AD versus DLB, 18F-FDG PET showed a sensitivity of 0.93 (95% CI 0.88-0.98) and specificity of 0.92 (95% CI, 0.70-0.92). Lastly, when differentiating AD from non-AD dementias, the sensitivity was 0.86 (95% CI, 0.80-0.91) and the specificity was 0.88 (95% CI, 0.80-0.91). The studies mostly used case-control designs with visual and quantitative assessments.

Conclusions

18F-FDG PET exhibits high sensitivity and specificity in differentiating dementia subtypes, particularly AD, FTD, and DLB. This method, while not a standalone diagnostic tool, significantly enhances diagnostic accuracy in uncertain cases, complementing clinical assessments and structural imaging.

Patient Reported Outcomes Following Palliative Whole Brain Radiation Therapy in Patients with Brain Metastasis

PURPOSE/OBJECTIVE(S)

Brain metastases (BM) are a common occurrence in patients with advanced cancers, and extremely challenging to treat, resulting in short survival periods. Consequently, whole brain radiation therapy (WBRT) remains the standard palliative intervention for patients with BM. The present study set to evaluate the efficacy of WBRT by assessing the quality of life (QoL) and survival outcomes in WBRT-treated patients with BM. It was hypothesized that the WBRT would enhance the QoL through alleviation of symptoms and functionality, and prolong patient survival.

MATERIALS/METHODS

This was a prospective, longitudinal, hospital-based single-center study. Consecutive sampling methodology was used to recruit 52 patients with BM undergoing WBRT. Patients were followed up on days 7, 30, 90 and 180 after WBRT. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative care (EORTC QLQ-C15-PAL) was employed to report patient responses in a Likert scale. A descriptive analysis and multi-trait scaling correlation was computed using IBM SPSS Statistics 29.0, 95% confidence interval. The overall survival analysis (Kaplan-Meier) was also performed.

RESULTS

The study cohort was predominantly females (82.7%), and accordingly, 65.4% of the respondents had a breast primary tumor. A Shapiro-Wilk test of normality revealed that the data was not normally distributed (sig. < 0.05), however, statistic values (W) closer to 1 suggested a good fit. A goodness-of-fit test ascertained the assumption, yielding non-significant Chi square Pearson (p = 0.325) and Deviance (p = 1.000) residuals. There was a significant correlation (p < 0.001) between physical functioning and emotional functioning. Median overall survival was 180 days (∼6 months). A total of 20 patients (38%) that survived up to 180 days reported alleviated symptoms and better functioning. A significant improvement in physical functioning (p < 0.001) and emotional functioning (p = 0.031) was reported at 180 days post WBRT, compared to baseline. Similarly, a significant improvement in visual disorders (p = 0.002), motor dysfunction (p = 0.031), and communication deficit (p = 0.001) was also reported. A significant alleviation of pain was reported at day 90 (p = 0.042) by 53% of the patients that survived.

CONCLUSION

WBRT is an effective palliative intervention in patients with BM, resulting in improved QoL and prolonged survival. More than 50% of patients that survived 3 months reported a significant alleviation of pain, and 38% of patients that survived for 6 months reported a significantly improved functioning. This demonstrated the effectiveness of WBRT in palliative care and will add to the body of data on the efficacy of radiotherapy.

Multimodal Biomarkers That Predict the Presence of Gleason Pattern 4: Potential Impact for Active Surveillance

PURPOSE

Latent grade group ≥2 prostate cancer can impact the performance of active surveillance protocols. To date, molecular biomarkers for active surveillance have relied solely on RNA or protein. We trained and independently validated multimodal (mRNA abundance, DNA methylation, and/or DNA copy number) biomarkers that more accurately separate grade group 1 from grade group ≥2 cancers.

MATERIALS AND METHODS

Low- and intermediate-risk prostate cancer patients were assigned to training (n=333) and validation (n=202) cohorts. We profiled the abundance of 342 mRNAs, 100 DNA copy number alteration loci, and 14 hypermethylation sites at 2 locations per tumor. Using the training cohort with cross-validation, we evaluated methods for training classifiers of pathological grade group ≥2 in centrally reviewed radical prostatectomies. We trained 2 distinct classifiers, PRONTO-e and PRONTO-m, and validated them in an independent radical prostatectomy cohort.

RESULTS

PRONTO-e comprises 353 mRNA and copy number alteration features. PRONTO-m includes 94 clinical, mRNAs, copy number alterations, and methylation features at 14 and 12 loci, respectively. In independent validation, PRONTO-e and PRONTO-m predicted grade group ≥2 with respective true-positive rates of 0.81 and 0.76, and false-positive rates of 0.43 and 0.26. Both classifiers were resistant to sampling error and identified more upgrading cases than a well-validated presurgical risk calculator, CAPRA (Cancer of the Prostate Risk Assessment; P < .001).

CONCLUSIONS

Two grade group classifiers with superior accuracy were developed by incorporating RNA and DNA features and validated in an independent cohort. Upon further validation in biopsy samples, classifiers with these performance characteristics could refine selection of men for active surveillance, extending their treatment-free survival and intervals between surveillance.

Resilience in adolescence during the COVID-19 crisis in Canada

BACKGROUND

The COVID-19 pandemic constitutes a social crisis that will have long-term health consequences for much of the global population, especially for adolescents. Adolescents are triply affected as they: 1) are experiencing its immediate, direct effects, 2) will carry forward health habits they develop now into adulthood, and 3) as future parents, will shape the early life health of the next generation. It is therefore imperative to assess how the pandemic is influencing adolescent wellbeing, identify sources of resilience, and outline strategies for attenuating its negative impacts.

METHODS

We report the results of longitudinal analyses of qualitative data from 28 focus group discussions (FGDs) with 39 Canadian adolescents and of cross-sectional analyses of survey data from 482 Canadian adolescents gathered between September 2020 and August 2021. FGD participants and survey respondents reported on their: socio-demographic characteristics; mental health and wellbeing before and during the pandemic; pre- and during-pandemic health behaviours; experiences living through a crisis; current perceptions of their school, work, social, media, and governmental environments; and ideas about pandemic coping and mutual aid. We plotted themes emerging from FGDs along a pandemic timeline, noting socio-demographic variations. Following assessment for internal reliability and dimension reduction, quantitative health/wellbeing indicators were analyzed as functions of composite socio-demographic, health-behavioural, and health-environmental indicators.

RESULTS

Our mixed methods analyses indicate that adolescents faced considerable mental and physical health challenges due to the pandemic, and were generally in poorer health than expected in non-crisis times. Nevertheless, some participants showed significantly better outcomes than others, specifically those who: got more exercise; slept better; were food secure; had clearer routines; spent more time in nature, deep in-person social relationships, and leisure; and spent less time on social media.

CONCLUSIONS

Support for youth during times of crisis is essential to future population health because adolescence is a period in the life course which shapes the health behaviours, socio-economic capacities, and neurophysiology of these future parents/carers and leaders. Efforts to promote resilience in adolescents should leverage the factors identified above: helping them find structure and senses of purpose through strong social connections, well-supported work and leisure environments, and opportunities to engage with nature.

Classification and prediction of cognitive trajectories of cognitively unimpaired individuals

Objectives

Efforts to prevent Alzheimer's disease (AD) would benefit from identifying cognitively unimpaired (CU) individuals who are liable to progress to cognitive impairment. Therefore, we aimed to develop a model to predict cognitive decline among CU individuals in two independent cohorts.

Methods

A total of 407 CU individuals from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and 285 CU individuals from the Samsung Medical Center (SMC) were recruited in this study. We assessed cognitive outcomes by using neuropsychological composite scores in the ADNI and SMC cohorts. We performed latent growth mixture modeling and developed the predictive model.

Results

Growth mixture modeling identified 13.8 and 13.0% of CU individuals in the ADNI and SMC cohorts, respectively, as the "declining group." In the ADNI cohort, multivariable logistic regression modeling showed that increased amyloid-β (Aβ) uptake (β [SE]: 4.852 [0.862], p < 0.001), low baseline cognitive composite scores (β [SE]: -0.274 [0.070], p < 0.001), and reduced hippocampal volume (β [SE]: -0.952 [0.302], p = 0.002) were predictive of cognitive decline. In the SMC cohort, increased Aβ uptake (β [SE]: 2.007 [0.549], p < 0.001) and low baseline cognitive composite scores (β [SE]: -4.464 [0.758], p < 0.001) predicted cognitive decline. Finally, predictive models of cognitive decline showed good to excellent discrimination and calibration capabilities (C-statistic = 0.85 for the ADNI model and 0.94 for the SMC model).

Conclusion

Our study provides novel insights into the cognitive trajectories of CU individuals. Furthermore, the predictive model can facilitate the classification of CU individuals in future primary prevention trials.

Registered reports in forensic science

Research assessing the validity and reliability of many forensic science disciplines has been published; however, the quality of this research varies depending on the methodologies employed. This was a major point of contention with the United States' President's Council of Advisors on Science and Technology, who recognized the existing literature but found the majority lacking because of methodological issues. Questionable scientific methodologies have undermined the forensic science community's ability to defend the scientific foundations and examination protocols used to examine evidence in criminal cases. Such scientific failures have significant legal implications. Registered reports, which strengthen the quality of scientific research and reliability of laboratory protocols, can provide transparency, validity and a stronger scientific foundation for forensic science.

Eye-Tracking Metrics for Figure-Copying Processes in Early- vs. Late-Onset Alzheimer's Disease

Visuospatial dysfunction is a common symptom in patients with Alzheimer's disease (AD). To more focus on copying processes rather than on finally completed figures, we conceptually split the copying processes into three stages: visuoperceptual function, visuoconstructional function, and working memory function. We constructed perceptual and working spaces to investigate the different stages of copying, and then, we compared the number and duration of fixations and saccades and the number of switches across the two spaces. We used eye-tracking glasses to assess eye-tracking metrics in patients with early-onset AD (EOAD), patients with late-onset AD (LOAD), and normal control (NC) participants while they copied the simplified Rey–Osterrieth complex figure test (RCFT). Regarding eye metrics on the perceptual space, the number and duration of fixations were greater in both groups of patients with AD than in the NC participants group (number: EOAD vs. NC: p < 0.001, LOAD vs. NC: p = 0. 003/ duration: EOAD vs. NC: p < 0.001, LOAD vs. NC: p < 0.001). On the working space, the number and duration of fixations were greater in the patients with EOAD than in the patients with LOAD and NC participants (number: EOAD vs. LOAD: p = 0. 007, EOAD vs. NC: p = 0. 001/duration: EOAD vs. LOAD: p = 0. 008, EOAD vs. NC: p = 0. 002). The number of saccades and switching was higher in patients with EOAD than in NC participants (p < 0.001). The eye-tracking metrics from the simplified RCFT correlated with the neuropsychological test scores. Patients with EOAD and LOAD achieved the same level of performance at the simplified and original RCFT scores. However, patients with EOAD than LOAD showed a greater number and duration of fixations on the working space and more frequent switching between the perceptual and working spaces, which may reflect more cognitive efforts to achieve the same level of performance.

Effects of smartphone application-based cognitive training at home on cognition in community-dwelling non-demented elderly individuals: A randomized controlled trial

INTRODUCTION

We investigated whether cognitive function improves in elderly individuals after Application-based Cognitive Training at Home (ACTH) for 12 months.

METHODS

A total of 389 non-demented elderly volunteers aged over 60 years were recruited and randomly assigned to the intervention or control group. The intervention group underwent daily ACTH (with regular feedback from the administrator) and monthly offline cognitive training in groups for 12 months. All participants received a computerized cognitive test battery called Inbrain Cognitive Screening Test (Inbrain-CST) at baseline and 6 and 12 months. The primary outcome was the change in the total composite score of Inbrain-CST, and secondary outcomes included changes in composite scores in five cognitive domains of Inbrain-CST.

RESULTS

The intervention group outperformed the control group in terms of the total score (P = .001) and subscores of language (P < .001) and memory (P < .001) domains at 12 months.

DISCUSSION

ACTH improved global cognition in community-dwelling non-demented elderly individuals.

Longitudinal Amyloid Cognitive Composite in Preclinical Alzheimer's Disease

BACKGROUND

Previous studies have developed several cognitive composites in preclinical AD. However, more sensitive measures to track cognitive changes and therapeutic efficacy in preclinical Alzheimer's disease (AD) are needed considering diverse sociocultural and linguistic backgrounds. This study developed a composite score that can sensitively detect the Aβ-related cognitive trajectory of preclinical AD using Korean data.

METHODS

A total of 196 cognitively normal (CN) participants who underwent amyloid positron emission tomography were followed-up with neuropsychological assessments. We developed the Longitudinal Amyloid cognitive Composite in Preclinical AD (LACPA) using the linear mixed-effects model (LMM) and z-scores. The LMM was also used to investigate the longitudinal sensitivity of LACPA and the association between time-varying brain atrophy and LACPA.

RESULTS

Considering the group-time interaction effects of each subtest, the Seoul Verbal Learning Test-Elderly's version (SVLT-E) immediate recall/delayed recall/recognition, the Korean Trail Making Test B time, and the Korean Mini-Mental State Examination were selected as components of LACPA. LACPA exhibited a significant group-time interaction effect between the Aβ+ and Aβ- groups (t = -3.288, p = 0.001). Associations between time-varying LACPA and brain atrophy were found in the bilateral medial temporal, right lateral parietal, and right lateral frontal regions, and hippocampal volume.

CONCLUSION

LACPA may contribute to reduction in time and financial burden when monitoring Aβ-related cognitive decline and therapeutic efficacy of the disease-modifying agents specifically targeting Aβ in secondary prevention trials.

Antithrombotic strategy in patients with atrial fibrillation and acute coronary syndrome

Background

Atrial fibrillation (AF) is frequent in patients admitted with acute coronary syndromes (ACS). The development of this arrhythmia occurs in 2–21% of patients with non ST-elevation ACS and 21% of ST-elevation ACS. According with the most recent European guidelines, a short period up to 1 week of triple antithrombotic therapy (TAT) is recommended, followed by dual antithrombotic therapy (DAT) using a NOAC and a single antiplatelet agent, preferably clopidogrel.

Objective

To compare the antithrombotic strategy (DAT vs TAT) used and its prognostic value in patients with AF and ACS.

Methods

Retrospective analysis of patients' data admitted with ACS in a multicentric registry between 10/2010–09/2019. TAT was defined as the prescription of dual antiplatelet therapy and one anticoagulant and DAT as one antiplatelet and one anticoagulant. Survival and rehospitalization were evaluated through Kaplan-Meier curve.

Results

1067 patients were included, mean age 67±14 years, 72.3% male. Patients who developed de novo AF during hospitalization due to ACS were older (75±12 vs 66±14 years, p&lt;0.001) and with higher prevalence of cardiovascular risk factors and cardiovascular disease. AF was more often in patients with ST elevation ACS (53.4%). During hospitalization, AF patients were more often medicated with aspirin, glycoprotein inhibitor, heparin, fondaparinux and vitamin K antagonists. No difference was found regarding P2Y12 inhibitors. AF patients presented more often obstructive coronary disease (normal coronaries 5.4 vs 8.5%, p&lt;0.001) so they were more often submitted to PCI (79.5 vs 70.9%, p&lt;0.001). AF patients presented with higher rates of adverse in-hospital events as re-infarction, heart failure, shock, ventricular arrhythmias, cardiac arrest, stroke, major bleeding and death (p&lt;0.001). At discharge, AF patients were less prescribed with aspirin or ticagrelor, but the rate of clopidogrel prescription was higher, such as vitamin K antagonists or any of the new anticoagulants. In the AF group, 21.5% patients were discharged with TAT and 30.3% with DAT. Concerning patients discharged with TAT, 1-year follow-up revealed no significant differences in mortality (p=0.578), re-admission for cardiovascular causes (p=0.301) and total re-admission rates (p=0.291). Patients discharged with DAT had similar mortality (p=0.623) and re-admission for cardiovascular causes rates (p=0.138), but significant differences were identified regarding total re-admissions (p=0.024).

Conclusions

In patients with ACS and de novo AF, a low percentage of patients was discharged with oral anticoagulation (51.8%). In those whose anticoagulation was initiated, DAT was the preferred strategy. 1-year outcomes were not different between the antithrombotic strategy, except for all cause re-admission.

Funding Acknowledgement

Type of funding sources: None.

Multiparametric Magnetic Resonance Imaging in the Diagnosis of Clinically Significant Prostate Cancer: an Updated Systematic Review

There has been growing utilisation of multiparametric magnetic resonance imaging (MPMRI) as a non-invasive tool to diagnose and localise clinically significant prostate cancer (CSPCa). This updated systematic review examines the use of MPMRI in patients with an elevated risk of CSPCa who have had a prior negative transrectal ultrasound systematic biopsy (TRUS-SB) and who were biopsy naïve. MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews were searched for existing systematic reviews published up to September 2020. The literature search of the electronic databases combined disease-specific terms (prostate cancer, prostate carcinoma, etc.) and treatment-specific terms (magnetic resonance, etc.). Studies were included if they were randomised controlled trials (RCTs) comparing MPMRI to template transperineal mapping biopsy (TPMB) or to TRUS-SB. Thirty-six RCTs were eligible. For biopsy-naïve men, accuracy of diagnosis of CSPCa showed sensitivities from 87 to 96% and specificities ranging from 29 to 45%. Meta-analyses for CSPCa showed increased detection favouring MPMRI-targeted biopsy over TRUS-SB by 3% (95% confidence interval 0-7%, P = 0.03) and decreased detection of clinically insignificant prostate cancer (CISPCa) favouring MPMRI by 8% (95% confidence interval -11 to 5%, P < 0.00001). Accuracy of MPMRI for men with prior negative biopsy showed sensitivities of 78-100% and specificities of 30-100%. Meta-analyses comparing MPMRI to TRUS-SB showed increased detection of 5% (95% confidence interval 3-7%, P < 0.0001) with a reduction of CISPCa detection of 7% (95% confidence interval 4-9%, P < 0.00001). The growing acceptance of MPMRI utilisation internationally and the recent publication of several RCTs regarding MPMRI in reducing CISPCa detection rates, particularly in biopsy-naïve men, without loss of sensitivity for CSPCa necessitates the synthesis of updated evidence examining MPMRI in the diagnosis of CSPCa.

Differential effects of risk factors on the cognitive trajectory of early- and late-onset Alzheimer's disease

BACKGROUND

Although few studies have shown that risk factors for Alzheimer's disease (AD) are associated with cognitive decline in AD, not much is known whether the impact of risk factors differs between early-onset AD (EOAD, symptom onset < 65 years of age) versus late-onset AD (LOAD). Therefore, we evaluated whether the impact of Alzheimer's disease (AD) risk factors on cognitive trajectories differ in EOAD and LOAD.

METHODS

We followed-up 193 EOAD and 476 LOAD patients without known autosomal dominant AD mutation for 32.3 ± 23.2 months. Mixed-effects model analyses were performed to evaluate the effects of APOE ε4, low education, hypertension, diabetes, dyslipidemia, and obesity on cognitive trajectories.

RESULTS

APOE ε4 carriers showed slower cognitive decline in general cognitive function, language, and memory domains than APOE ε4 carriers in EOAD but not in LOAD. Although patients with low education showed slower cognitive decline than patients with high education in both EOAD and LOAD, the effect was stronger in EOAD, specifically in frontal-executive function. Patients with hypertension showed faster cognitive decline than did patients without hypertension in frontal-executive and general cognitive function in LOAD but not in EOAD. Patients with obesity showed slower decline in general cognitive function than non-obese patients in EOAD but not in LOAD.

CONCLUSIONS

Known risk factors for AD were associated with slower cognitive decline in EOAD but rapid cognitive decline in LOAD.

Sustained ventricular tachycardia as a predictor of major adverse cardiac events in acute coronary syndrome patients

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

Sustained ventricular tachycardia (VT) is a frequent rhythm disturbance during an ischemic event like acute coronary syndrome (ACS). VT was frequently associated with worse prognosis, then is expected, that its presence is related to a higher incidence of major adverse cardiac events (MACE).

Objective

Evaluate if sustained VT was a predictor of MACE in ACS hospitalized patients.

Methods

Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided into two groups: A – patients without VT, and B – patients that presented VT on the hospitalization. VT was defined as a register or more of the VT with at least 30 seconds. Were excluded patients without a previous cardiovascular history or clinical data. MACE was defined as re-infarction, congestive heart failure, cardiogenic shock, a mechanical complication of myocardial infarction, completed atrioventricular block, sustained ventricular tachycardia, cardiac arrest, stroke and hospitalization death. Univariate logistic regression was performed to assess if VT in ACS patients was a predictor of MACE.

Results

A total of 29851 patients was analyze and 25725 had information regarding VT. From the group of patients that presented VT, 177 (1.1%) had re-infarction, 2415 (14.1%) had congestive heart failure, 816 (5.0%) had atrial fibrillation, 108 (0.7%) had a mechanical complication of myocardial infarction, 442 (2.7%) had completed atrioventricular block, 458 (2.8%) had cardiac arrest, 101 (0.6%) had stroke and 535 (3.3%) died. VT did not predict re-infarction (p = 0.071), mechanical complication of myocardial infarction (p = 0.979) and stroke (p = 0.500) in ACS hospitalized patients. Logistic regression revealed that VT in ACS patients was a predictor of congestive heart failure (odds ratio (OR) 2.304, p &lt; 0.001, confidence interval (CI) 1.742-3.047), atrial fibrillation (OR 2.078, p &lt; 0.001, CI 1.453-2.973), completed atrioventricular block (OR 1.831, p = 0.012, CI 1.145-2.928), cardiac arrest (OR 15.434, p &lt; 0.001, CI 11.429-20.843) and hospitalization death (OR 6.472, p &lt; 0.001, CI 4.484-9.342).

Conclusions

VT in ACS patients predict MACE, namely congestive heart failure, atrial fibrillation, completed atrioventricular block, cardiac rest and hospitalization death.

Was the atrioventricular block similar in anterior and inferior ST-elevation myocardial infarction?

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

The presence of atrioventricular block (AVB) in ST-elevation myocardial infarction (STEMI) is more frequently registered when is identified in the inferior leads. However, AVB maybe occurs in anterior STEMI, yet the AVB and STEMI localization maybe had different implications.

Objective

Evaluate the impact and prognosis of AVB according to the STEMI localization.

Methods

Multicenter retrospective study, based on the Portuguese Registry of Acute Coronary Syndrome between 1/10/2010-3/05/2020. Patients were divided into two groups: A – patients with anterior STEMI, and B – patients with inferior STEMI. Were excluded patients without a previous cardiovascular history or clinical data regarding AVB occurrence. Logistic regression was performed to assess AVB as a prognostic marker in STEMI patients.

Results

From 32157 patients, was identified 462 with AVB, 72 in group A (15.6%) and 390 in group B (84.4%). Both groups were similar regarding gender (p = 0.710), age (p = 0.068), body mass index (p = 0.535), admitly directly to cat lab (p = 0.635), initial symptons until first medical contact (p = 0.561), smoker status (p = 0.483), diabetes mellitus (p = 0.331), coronary artery disease (p = 0.053), previous stroke (p = 0.332),  peripheral artery disease (p = 0.348), chronic kidney disease (p = 0.425), systolic blood pressure (p = 0.057), multivessel diasease (p = 0.235), new-onset of atrial fibrillation (p = 0.582), cardiac arrest (p = 0.062) and stroke complication (p = 0.685). Group B had higher left ventricular ejection fraction (LVEF) &gt;50% (16.9 vs 60.7%, p &lt; 0.001). On the other hand, group A had more arterial hypertension (79.7 vs 66.2%, p = 0.027), dislipidaemia (58.2 vs 54.4%, p = 0.038), heart rate at admission (81 ± 20 vs 59 ± 23, p &lt; 0.001), Killip-Kimball class &gt; I (45.7 vs 29.6%, p = 0.008), sinus rhythm at admission (84.5 vs 72.6%, p = 0.035), heart failure complication (65.3 vs 37.1%, p &lt; 0.001), cardiogenic shock complication (42.3 vs 24.7%, p &lt; 0.001), ACS mechanical complication (8.3 vs 3.1%, p = 0.047), sustained ventricular tachycardia during ACS hospitalization (19.4 vs 8.5%, p = 0.005) and hospitalization death (52.9 vs 44.7%, p &lt; 0.001). Logistic regression revealed that AVB in inferior STEMI was a predictor of new-onset of atrial fibrillation (odds ratio (OR) 3.817, p = 0.038, confidence interval (CI) 1.123-12.975), with a R2 Nagelkerke 24.4. Also, revealed that AVB in anterior STEMI was a predictor of death (OR 0.111, p &lt; 0.001, CI 0.034-0.366), with a R2 Nagelkerke 55.2.

Conclusions

AVB in inferior STEMI was a predictor of new-onset of atrial fibrillation and AVB in anterior STEMI was a predictor of death.

Sustained ventricular tachycardia in acute coronary syndromes the Portuguese experience

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

Acute coronary syndromes (ACS) are frequent and are associated with high levels of comorbidities and complications. Ventricular tachycardia (VT) is one of the most danger and stressful situations in ACS.

Objective

Evaluate predictors of ventricular tachycardia in ACS.

Methods

Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A – patients without VT, and B – patients that presented VT on the hospitalization. VT was defined as a register or more of the VT with at least 30 seconds. Logistic regression was performed to assess predictors of VT in ACS patients.

Results

25361 in group A (98.6%) and 364 in group B (1.4%). Both groups were similar regarding gender, cardiovascular risk factors, except for dyslipidemia (61.7 vs 51.9%, p &lt; 0.001) and ST-segment elevation myocardial infarction (STEMI) location. Group B was elderly (67 ± 14 vs 70 ± 14, p &lt; 0.001), was admitted directly to the cat lab (10.6 vs 20.4%, p &lt; 0.001), had less time since the onset of symptoms until the admission (383 ± 157 vs 349 ± 121, p = 0.003), but presented higher previous history of heart failure (5.9 vs 10.6%, p &lt; 0.001), peripheral vascular disease (5.5 vs 8.4%, p = 0.015), chronic obstructive pulmonary disease (COPD) (4.4 vs 7.9%, p = 0.001) and dementia (1.7 vs 3.2%, p = 0.038). At admission presented higher levels of STEMI (42 vs 67%, p &lt; 0.001), dyspnea (29 vs 18.1%, p &lt; 0.001), syncope (1.3 vs 6.6%, p &lt; 0.001), cardiac arrest (0.4 vs 4.4%, p &lt; 0.001), Killip-Kimball classification &gt; I (14.8 vs 40.5%, p &lt; 0.001) and atrial fibrillation at admission (AF) (7.1 vs 15.3%, p &lt; 0.001). Ivabradine (3.7 vs 7.6%, p &lt; 0.001), aldosterone receptor antagonists (10.2 vs 24%, p &lt; 0.001), diuretic (28 vs 57.2%, p &lt; 0.001), amiodarone (5.6 vs 53.5%, p &lt; 0.001), digoxin (1.4 vs 4.7%, p &lt; 0.001) were more prevalent used in the admission. Group B exhibited higher multivessel disease (MVD) (51.5 vs 61.5%, p &lt; 0.001), culprit as common coronary trunk (CT) (1.7 vs 4.2%, p = 0.024), hybrid revascularization (0.8 vs 2%, p = 0.032) and left ventricular ejection fraction (LVEF)&lt;50% (38.7 vs 71%, p &lt; 0.001). On the other hand, the used of beta block (81.4 vs 62.3%, p &lt; 0.001), angiotensin-converting-enzyme inhibitor (85.5 vs 74.4%, p &lt; 0.001) and calcium channel blockers (10.1 vs 24%, p &lt; 0.001) since had a protect effect. Regarding reinfarction (0.9 vs 2.5%, p = 0.007), de novo heart failure (15.1 vs 50.3%, p &lt; 0.001), atrioventricular block (2.2 vs 17%, p &lt; 0.001), stroke (1.4 vs 4.9%, p &lt; 0.001) and death (3.4 vs 26.9%, p &lt; 0.001), all were higher in Group B. Logistic regression revealed COPD (odds ratio (OR) 1.9, p = 0.010, confidence interval (CI) 1.17-3.10), STEMI (OR 2.73, p &lt; 0.001, CI 2.00-3.73), AF (OR 2.30, p &lt; 0.001, CI 1.52-3.49), MVD (OR 1.44, p = 0.012, CI 1.08-1.92), CT (OR 2.87, p = 0.003, CI 1.45-5.69) and LVEF &lt; 50%  (OR 3.44, p &lt; 0.001, CI 2.52-4.71) as predictors of VT in ACS.

Conclusions

COPD, STEMI, AF, MVD, CT and LVEF &lt; 50% were predictors of VT in ACS.

Atrial Fibrillation in Acute Coronary Syndrome - early onset impact on MACE

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

on behalf of the Investigators of " Portuguese Registry of ACS "

Introduction

Atrial Fibrillation (AF) complicates approximately 10% of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on ACS patients’ (pts) prognosis.

Objective

To evaluate early onset (≤48h) de novo atrial fibrillation (AF) as predictor of major adverse cardiovascular events (MACE) and in-hospital complications.

Methods

Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 8/01/2019. Pts were divided in two groups: A – early onset de novo AF (EOAF), and B – late onset de novo AF (LOAF). Patients without data on previous cardiovascular history or uncompleted clinical data were excluded. Univariate logistic regression was performed to assess if LOAF in ACS was a predictor of MACE or complications.

Results

29851 pts had ACS. EOAF occurred in 584 pts (2.0%) and LOAF in 360 pts (1.2%). EOAF were younger (73 ± 13 vs 77 ± 10, p &lt; 0.001) and smokers (21.3% vs 12.1%, p &lt; 0.001). LOAF had higher rates of diabetes mellitus (40.1% vs 30.2%, p &lt; 0.001), angina (30.8% vs 21.4%, p &lt; 0.001), previous ACS (22.5% vs 15.4%, p = 0.006), previous revascularization (percutaneous coronary intervention 14% vs 9.5%, p = 0.032; coronary artery bypass surgery 8.4% vs 3.9%, p = 0.004). ST-segment elevation myocardial infarction (MI) rates were higher in EOAF (56.8% vs 46.9%, p = 0.003) and were admitted directly to the cath lab more often (21.7% vs 13.4%, p = 0.001). Non-ST elevation MI rates were higher in LOAF (44.2% vs 37.7%, p = 0.048). LOAF times from first symptoms to admission were longer (420min vs 183%, p &lt; 0.001), mean brain natriuretic peptide levels were higher (579 vs 447, p = 0.009) and diuretics usage was more frequent (72.8% vs 54.3%, p &lt; 0.001). EOAF had higher rates of heart failure (32.1% vs 17.2%, p &lt; 0.001), atrioventricular block (10.5% vs 7.8%, p = 0.006) and sustained ventricular tachycardia (8.1% vs 3.1%, p = 0.001). LOAF had higher in-hospital mortality (14.2% vs 9.6%, p = 0.031) and longer hospital stay (12 days vs 7 days, p &lt; 0.001). Logistic regression confirmed that EOAF was predictive of in-hospital heart failure (p &lt; 0.001, OR 2.15) and atrioventricular block (p = 0.008, OR 7.46). Regarding 1 year-follow-up, EOAF had poorer prognosis comparing to LOAF (59.3% vs 73.0%, p = 0.018, OR 1.62, CI 1.09-2.42)

Conclusion

EOAF is predictive of MACE, namely heart failure and atrioventricular block, and is associated to poorer prognosis comparing to LOAF.

Endocardial left ventricular pacing Where are we a systematic review

Funding Acknowledgements

Type of funding sources: None.

Background

Endocardial left ventricular pacing is a technique used in cardiac resynchronization therapy (CRT), when a coronary sinus implant is not possible, conventional CRT was an unsuccess and in CRT nonresponders. We performed a systemic review to evaluate its risks and benefits.

Objective

Review the evidence regarding the efficacy and safety of endocardial left ventricular pacing.

Methods

A systemic research on MEDLINE and PUBMED with the term "endocardial left ventricular pacing", "biventricular pacing" or "endocardial left pacing". 1038 results were identified, however, just publish papers (excluding abstract) with more than 16 patients was admitted in these analyses. Comparisons pre and post CRT regard New York Heart Association (NYHA) functional classification, left ventricular ejection fraction (LVEF) and QRS width was performed. Mean differences (MD) and confidence interval (CI) was used as a measurement of treatment.

Results

Eleven studies were selected, including a total of 560 patients. The studies were performed with different techniques, trans-atrial septal technique, trans-ventricular septal technique and transapical technique. Mean age 66.93 years old, 90.54% male, median ejection fraction of 28.86%, NYHA class of 3.03, QRS width 167,50 mseg. Ischemic etiologic in 43.88%, atrial fibrillation in 45.35% and left bundle branch block in 55.20%. Was reported several complications after the procedure, 8 pocket infection (7 studies), 17 transient ischemic attacks (10 papers), 17 ischemic stroke (all), 35 tromboembolic events (all) and 115 deaths, nevertheless, follow up in the different studies was diverse and heterogeneous. Significant improvement was registered in NYHA class (MD 0.64, CI 0.56-0.72, p &lt; 0.00001, I2 = 89%) (reported in 7 studies), LVEF (MD 6.20, CI 5.09-7.32, p = 0.002, I2 = 69%) %) (reported in 8 studies) and QRS width (MD 31.35, CI 26.11-36.60, p &lt; 0.00001, I2 = 89%) %) (reported in 5 studies), (all p &lt; 0.00001).

Conclusions

Left ventricular endocardial pacing is a feasible alternative to conventional CRT, when the last one is not possible. With clinical, electrocardiogram and echocardiogram improvement in several series. First data regarding this procedure were associated with higher stroke incidence, something contrary to the last study’s results. Nevertheless, at the moment just small series present this technique with heterogenous results and different approaches, being important further investigation.

Cardiac arrest in Acute Coronary Syndrome: predictors and prognosis

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

on behalf of the Investigators of " Portuguese Registry of ACS "

Introduction

Cardiac arrest (CA) is a potential complication of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of CA in the setting of ACS.

Objective

To evaluate predictors and prognosis of CA in the setting of ACS.

Methods

Based on a multicenter retrospective study, data collected between 1/10/2010 and 4/09/2019. Patients (pts) without data on previous cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without CA; GB - pts with CA during hospitalization. Logistic regression and survival analysis was performed.

Results

Between 25718 pts with ACS, CA occurred in 651 (2.5%). GB was younger (65 ± 15 vs 67 ± 14, p &lt; 0.001), had higher rates of smoking (35.8% vs 26.4%, p &lt; 0.001), and lower rates of hypertension (62.3% vs 70.9%, p &lt; 0.001), diabetes (25.7% vs 31.7%, p &lt; 0.001), dyslipidaemia (53.8% vs 61.7%, p &lt; 0.001), previous ACS (17.2% vs 20.6%, p = 0.037) and coronary artery bypass grafting (CABG) (1.9% vs 5.1%, p &lt; 0.001). Both groups were similar regarding previous heart failure (p = 0.450) and chronic kidney disease (p = 0.560). GB had shorter times from first symptoms to admission (158min vs 243min, p &lt; 0.001). GA had higher rate of non-ST-elevation myocardial infarction (MI) (78.6% vs 41.4%, p &lt; 0.001), whether GB had higher rates of ST-elevation myocardial infarction (STEMI) (46.7% vs 18.1%, p &lt; 0.001), namely anterior (54.9% vs 46.9%, p &lt; 0.001). GB had lower blood pressure (BP) (122 ± 33 vs 139 ± 28, p &lt; 0.001), higher heart rate (HR) (83 ± 23 vs 77 ± 19, p &lt; 0.001), presented more frequently in Killip-Kimball class (KKC) ≥2 (37.6% vs 14.6%, p &lt; 0.001), in atrial fibrillation (AF) (13.9% vs 7.0%, p &lt; 0.001) and with right bundle block (10.6% vs 5.3%, p &lt; 0.001). GB had higher rates of common trunk culprit lesion (CL) (3.9% vs 1.6%, p &lt; 0.001), anterior descending coronary CL (49% vs 37%, p &lt; 0.001), 1 vessel lesion (53.4% vs 38.5%, p &lt; 0.001), lower CABG rates (4.3% vs 6.3%, p = 0.042), more left ventricle dysfunction (57.7% vs 38.7%, p &lt; 0.001) and needed more frequently mechanical ventilation (35.3% vs 1.1%, p &lt; 0.001), non-invasive ventilation (6.8% vs 1.6%, p &lt; 0.001) and provisory pacemaker (9.4% vs 1.3%, p &lt; 0.001). Logistic regression confirmed that older age (p &lt; 0.001, OR 1.89, CI 1.35-2.64), higher HR (p &lt; 0.029, OR 1.33, CI 1.03-1.71), lower BP (P &lt; 0.001, OR 2.67, CI 1.94-3.68), KKC ≥2 (p &lt; 0.001, OR 2.35, CI 1.84-3.00), AF at admission (p &lt; 0.001, OR 1.84, CI 1.34-2.51), STEMI (p &lt; 0.001, OR 4.08, CI 3.66-6.77), lower left ventricle function (p = 0.009, OR 1.38, CI 1.08-1.75) were predictors of CA. Event-free survival was higher in GA than GB (92.8% vs 83.3%, OR 1.68, p = 0.008, CI 1.41-2.47).

Conclusion

As expected, CA in the setting of ACS is associated with poorer prognosis. Several characteristics of the pts may help to predict the development of CA during hospitalization, allowing earlier identification and prompt treatment.

Septal vs apical defibrillator electrode placement a systematic review

Funding Acknowledgements

Type of funding sources: None.

Background

The optimal right ventricular defibrillator lead placement is still a debatable matter. We attempt to performed a systemic review to evaluate whether septal and apical placement had significant differences in the follow-up with an indication for implantation of these devices.

Objective

Review the evidence regarding the efficacy and safety of right ventricular apical and septal defibrillator lead placement.

Methods

A systemic research on MEDLINE and PUBMED with the term "septal pacing", "apical pacing" "septal defibrillation" or "apical defibrillation". 309 results were identified, however, after a serious analysis, several articles were excluded. Comparisons between apical and septal placement were performed regarding R wave amplitude, pacing threshold at 0.5 ms, lead impedance, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD) and lead complication that produced lead re-placement. Mean differences (MD) and confidence interval (CI) was used as a measurement of treatment.

Results

Six studies were selected, including a total of 2180 patients. The studies were performed with different techniques, analyses and goals. The studies presented heterogeneous and diverse results, with a varied follow-up period, that resulted in the exclusion of one of the studies. Mean age 64.51 years old, 76.86% male, a median ejection fraction of 27.84%, NYHA class of 2.65, ischemic etiologic in 51.10% and a follow-up period of 26.49 months. Septal defibrillator lead placement was established in 772 patients, while the apical defibrillator lead placement was performed in 1399 patients. No differences regarding the lead performance on apical and septal placement were detected regarding the R-wave (MD -0.36, CI -0.75 - +0.03, p = 0.68, I2 = 0%) (reported in 3 studies) and lead impedance (MD -23.83, CI -51.36 - +3.69, p = 0.003, I2 = 82%) (reported in 3 studies). Pacing threshold seems to be favor a septal defibrillator lead implantation (MD -0.05, CI -0.09 - -0.02, p = 0.12, I2 = 53%) (reported in 3 studies). Concerning echocardiography parameters during the follow up period, LVEF (MD -0.83, CI -3.05 - +1.38, p = 0.10, I2 = 57%) (reported in 3 studies) and LVEDD (MD -0.51, CI -2.13 - +1.10, p = 0.20, I2 = 38%) (reported in 3 studies) were not significant influenced for the defibrillator lead placement. Lead complications that provoke a lead replacement was not significant between the lead placement (MD 1.25, CI 0.53 – 2.94, p = 0.71, I2 = 0%) (reported in 3 studies).

Conclusions

Just pacing threshold proved to improve the septal defibrillator lead placement. Neither the other lead parameters or the echocardiography results during the follow-up were influenced by the lead placement. For a definitive conclusion is important to further investigation.

Prognosis of new-onset of atrial fibrillation in acute coronary syndrome: Portuguese experience

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

Acute coronary syndrome (ACS) and atrial fibrillation (AF) are common diseases in developed countries and in some cases, the first episode of AF can occur during the ACS. A stressful event like an ACS can be a trigger for AF, being important to realize its impact and prognosis in the short and long term.

Objective

Evaluate the impact and prognosis of new-onset AF in ACS.

Methods

Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided into two groups: A – patients without new-onset AF, and B – patients that presented new onset of AF. Were excluded patients without a previous cardiovascular history or clinical data during the admission and the follow-up period. Logistic regression was performed to assess if new-onset AF in ACS was a predictor of major adverse cardiac events and mortality. Kaplan-Meier test was performed to establish the survival rates and re-admission for one year of follow up.

Results

9687 patients suffered ACS and had follow-up at 1 year, 9264 in group A (95.6%) and 423 in group B (4.4%). Both groups were similar regarding dyslipidemia, diabetes mellitus, previous coronary artery disease, multivessel disease after the cardiac catheterization. Group A had more smokers (28.2 vs 17.8%, p &lt; 0.001) and left ventricular ejection fraction (LVEF) &gt;50% (69.2 vs 45.1%, p &lt; 0.001). On the other hand, group B was elderly (67 ± 14 vs 75 ± 12, p &lt; 0.001), female (26.9 vs 34.0%, p &lt; 0.001), arterial hypertension (70.5 vs 77.5%, p = 0.005), was more admitted directly to the cat lab (12.5 vs 17.7%, p = 0.002), ST-segment elevation myocardial infarction (40.2 vs 49.9%, p &lt; 0.001), Killip-Kimball classification &gt; I (12.8 vs 34.8%, p &lt; 0.001) and hybrid revascularization (0.7 vs 2.4%, p = 0.002). Logistic regression revealed that new-onset of AF in ACS patients was a predictor of congestive heart failure (odds ratio (OR) 1.75, p &lt; 0.001, confidence interval (CI) 1.47-2.09), cardiogenic shock (OR 3.08, p &lt; 0.001, CI 2.37-4.01), sustained ventricular tachycardia (OR 2.29, p &lt; 0.001, CI 1.61-3.25) and intrahospital mortality (OR 1.99, p &lt; 0.001, CI 1.51-2.63). Nevertheless, new-onset of AF was not associated with re-infarction (p = 0.361), mechanical complications (p = 0.319), atrioventricular block (p = 0.574), stroke (p = 0.131) and cardiac arrest (p = 0.060) during the hospitalization for ACS. Mortality rates at one year of follow-up showed significant differences, p &lt; 0.001, between the two groups (Figure 1). Similar results were found concerning re-admission for all causes, p = 0.021 (Figure 2), on the other causes, re-admission for cardiovascular causes do not reveal to be significant, p = 0.515.

Conclusions

New-onset of AF in ACS was a predictor of congestive heart failure, cardiogenic shock, sustained ventricular tachycardia and intrahospital mortality. AF was associated with higher mortality rates and re-admission for all causes at one year follow up.

Atrioventricular block in acute coronary syndrome: Portuguese experience

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

The atrioventricular block (AVB) occurrence in acute coronary syndrome (ACS) is a potentially life-threatening complication, that demand a rapid and efficient response regarding reperfusion time and rhythm stabilization.

Objective

Evaluate the impact and prognosis of AVB in ACS patients, as well as predictors of AVB.

Methods

Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-3/05/2020. Patients were divided into two groups: A – patients without AVB, and B – patients that presented AVB. Were excluded patients without a previous cardiovascular history or clinical data regarding AVB occurrence. Logistic regression was performed to assess predictors of AVB in ACS patients.

Results

From 32157 patients, 23774 was included, 23148 in group A (97.4%) and 626 in group B (2.6%). Both groups were similar regarding initial symptons until first medical contact (p = 0.410), smoker status (p = 0.222), arterial hypertension (p = 0.776), diabetes mellitus (p = 0.508), peripheral artery disease (p = 0.479), chronic kidney disease (p = 0.467) and re-infarction during the hospitalization for ACS (p = 0.145). Group A had higher body mass index (27.4 ± 4.4 vs 26.9 ± 4.6, p = 0.005), dislipidaemia (59.6 vs 51.4%, p &lt; 0.001), coronary artery disease (18.9 vs 13.0, p &lt; 0.001), heart rate (78 ± 19 vs 65 ± 25, p &lt; 0.001), systolic blood pressure (139 ± 29 vs 119 ± 32, p &lt; 0.001) and left ventricular ejection fraction (LVEF) &gt;50% (60.1 vs 51.7%, p &lt; 0.001). On the other hand, group B was elderly (66 ± 13 vs 71 ± 13, p &lt; 0.001), female (27.4 vs 32.4%, p &lt; 0.001), previous stroke (6.9 vs 10.9%, p &lt; 0.001), neoplasia (4.9 vs 6.8%, p = 0.031), ST-segment elevation myocardial infarction (46.2 vs 75.4%, p &lt; 0.001), syncope as major symptom (1.3 vs 10.0%, p &lt; 0.001), Killip-Kimball class &gt; I (15.4 vs 31.6%, p &lt; 0.001), multivessel diasease (52.1 vs 61.4%, p &lt; 0.001), heart failure complication (15.5 vs 40.6%, p &lt; 0.001), cardiogenic shock complication (3.8 vs 24.6%, p &lt; 0.001), new-onset of atrial fibrillation (4.2 vs 14.1%, p &lt; 0.001), ACS mechanical complication (0.6 vs 3.2%, p &lt; 0.001), sustained ventricular tachycardia during ACS hospitalization (1.3 vs 10.0%, p &lt; 0.001), cardiac arrest (2.7 vs 13.3%, p &lt; 0.001), stroke complication (0.6 vs 1.9%, p &lt; 0.001) and hospitalization death (3.5 vs 19.0%, p &lt; 0.001). Logistic regression revealed that female gender (odds ratio (OR) 1.422, p = 0.015, confidence interval (CI) 1.072-1.885), age ≥75 years old (OR 1.560, p = 0.002, CI 1.174-2.073), heart rate &lt;60 (OR 6.692, p &lt; 0.001, CI 5.180-8.644) and Killip-Kimball class &gt; I (OR 3.264, p &lt; 0.001, CI 2.446-5.356) were predictors of AVB in ACS patients.

Conclusions

Female gender, age ≥75 years old, heart rate &lt;60 and Killip-Kimball class &gt; I were predictors of AVB in ACS patients.

In-hospital outcomes of sustained ventricular tachycardia in the setting of Acute Coronary Syndrome

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

on behalf of the Investigators of " Portuguese Registry of ACS "

Introduction

Sustained ventricular tachycardia (SVT) complicates up to 20% of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of SVT.

Objective

To evaluate predictors of early onset (&lt;48h) and late onset (≥48h) SVT.

Methods

Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Patients (pts) were divided in two groups (G): A – pts that presented early onset SVT (ESVT), and B – pts that presented late onset SVT (LSVT). Pts without data on previous cardiovascular history or uncompleted clinical data were excluded. Logistic regression was performed to assess predictors of SVT in ACS.

Results

Between 29851 pts with ACS, 364 (1.2%) presented SVT. ESVT – 251 pts (69%); LSVT – 91 pts (25%). LSVT G was older (74 ± 13 vs 68 ± 14, p = 0.003), was admitted directly to cat lab less frequently (10.1% vs 24.8%, p = 0.003), had longer times from first symptoms to admission (440min vs 261 min, p &lt; 0.001) and had higher rates of previous stroke (14.4% vs 6.8%, p = 0.028). LSVT G had higher rates of non-ST-elevation myocardial infarction (MI) (35.2% vs 23.1%, p = 0.025) and lower rates of ST-elevation MI (53.8% vs 71.7%, p = 0.002), although both G were similar regarding MI location (anterior – p = 0.135, inferior – p = 0.097). LSVT G had higher systolic blood pression (130 ± 33 vs 122 ± 33, p = 0.050), presented more frequently in Killip-Kimball class ≥2 (52.5% vs 35.5%, p = 0.005) and with atrial fibrillation (21.2% vs 12.4%, p = 0.045), and had higher brain-natriuretic peptide (1075 vs 329, p &lt; 0.001). LSVT G was treated more frequently with diuretics (80.0% vs 47.8%, p &lt; 0.001), amiodarone (62.2% vs 48.8%, p = 0.029), digoxin (8.9% vs 2.4%, p = 0.013) and levosimendan (11.1% vs 2.8%, p = 0.004). ESVT G had higher rates of performed coronarography (88.4% vs 79.1%, p = 0.028) but lower rate of 3 vessels disease (58.5% vs 70.8%, p = 0.017). LSVT G had higher rates of severe (&lt;30%) left ventricle dysfunction (32.9% vs 15.4%, p &lt; 0.001) and need to non-invasive ventilation (23.1% vs 6.8%, p &lt; 0.001). Regarding in-hospital complications, ESVT G had higher rates of heart failure (34.7% vs 19.1%, p = 0.006), atrioventricular block (15.7% vs 1.1%, p &lt; 0.001), atrial fibrillation (20.4% vs 7.7%, p = 0.006) and major haemorrhage (5.2% vs 0.0%, p = 0.024). LSVT G had higher rates of in-hospital death (44.4% vs 20.9%, p &lt; 0.001) and in-hospital stay (14 days vs 7 days, p &lt; 0.001). The G were similar regarding re-infarction (p = 0.216), shock (p = 0.179), mechanical complications (p = 1.00), cardiac arrest (p = 0.097) and stroke (0.348) rates. Logistic regression confirmed ESVT was predictive in-hospital heart failure (p = 0.010, OR 2.67) and de novo AF (p = 0.001, OR 5.56), whether LSVT was predictive of in-hospital death (p = 0.002, OR 2.70).

Conclusion

LSVT was associated with higher rates of in-hospital complications, but ESVT was associated with higher in-hospital mortality.

Cardiovascular risk factors as predictors of new onset atrial fibrillation during hospitalization for Acute Coronary Syndromes

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

Cardiovascular risk factors (CVRF) are a growing health problem in developed countries, being directly associated with acute coronary syndrome (ACS) occurrence and atrial fibrillation (AF). Nevertheless, new onset of AF in context of ACS is a clinical problem with prognostic and therapeutic implications.

Objective

Evaluate the impact of the CVRF in new onset AF during the hospitalization for ACS.

Methods

Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A – without new onset of AF during the hospitalization for ACS and B – with new onset of AF during the hospitalization for ACS. CVFR was defined by body mass index, diabetes, arterial hypertension, smoking, coronary artery disease, neoplasia, dyslipidemia, chronic kidney disease and peripheral arterial disease. Logistic regression was performed to assess predictors of new onset AF in these patients.

Results

14037 patients were included, 637 in group B (4.8%). Both groups were similar regarding diabetes mellitus (p = 0.116), coronary artery disease (p = 0.264) and neoplasia (p = 0.327). Curiously the group A exhibited higher body mass index (27.5 ± 4.3 vs 27.2 ± 4.4, p &lt; 0.001), smokers (28.1 vs 18.5%, p &lt; 0.001) and dyslipidemia (62.8 vs 56.7%, p &lt; 0.001). On the other hand, group B presented more females (26.4 vs 35.0%, p &lt; 0.001), arterial hypertension (70.0 vs 74.9%, p = 0.002), peripheral arterial disease (5.4 vs 8.4%, p &lt; 0.001) and chronic kidney disease (6.7 vs 9.5%, p &lt; 0.001). Logistic regression revealed that body mass index, smoker status, diabetes, dyslipidemia, coronary artery disease, neoplasia, chronic kidney disease and peripheral arterial disease were not predictors of AF during the hospitalization for ACS. Nonetheless, female gender (odds ratio (OR) 1.23, p = 0.025, confidence interval (CI) 1.03-1.47), obesity (OR 1.39, p = 0.004, CI 1.11-1.74) and arterial hypertension (OR 1.22, p = 0.049, CI 1.01-1.50) were predictors of new onset of AF during hospitalization for ACS. Conclusions: Female gender, obesity and arterial hypertension were predictors of new onset of AF in during hospitalization for ACS.

Acute heart failure: does etiology matter?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients (pts) with acute heart failure (AHF) are a heterogeneous population. The etiology of the heart disfunction may play a role in prognosis. Risk stratification at admission may help predict in-hospital complications and needs.

Objective

To explore predictors of in-hospital mortality (IHM), post discharge early mortality [1-month mortality (1mM)] and late mortality [1-year mortality (1yM)] and early and late readmission, respectively 1-month readmission (1mRA) and 1-year readmission (1yRA), in our center population, using real-life data.

Methods

Based on a single-center retrospective study, data collected from patients (pts) admitted in the Cardiology department with AHF between 2010 and 2017. Pts without data on previous cardiovascular history or uncompleted clinical data were excluded. The pts were divided in 3 groups: ischemic etiology (IE), valvular etiology (VE) and other etiologies (OE), which included hypertensive and idiopathic cardiomyopathies). Statistical analysis used non-parametric tests and Kaplan-Meyer survival analysis.

Results

We included 300 pts admitted with AHF. Mean age was 67.4 ± 12.6 years old and 72.7% were male. 37.7% had previous history of revascularization procedures, 66.9% had hypertension, 41% were diabetic and 38% had dyslipidaemia. The heart failure was of IE in 45%, VE in 22.7% and of OE in 32.3% of the cases.

There were no significant differences between groups regarding body mass index, Killip-Kimball class, systolic blood pressure at admission, blood tests aspects at admission (namely, creatinine, sodium or urea), inotropes’ usage or need of non-invasive or invasive ventilation. However, IE group had higher percentage of males comparing to VE e OE (83.0% vs 55.9% vs 70.1%, respectively, p &lt; 0.001), higher rates of prior revascularization procedures (68.9%, vs 19.1%, vs 7.2%, p &lt; 0.001) and higher rates of traditional cardiovascular risk factors, namely hypertension (74.1% vs 55.9% vs 57.7%, p = 0.014), diabetes mellitus (48.1% vs 27.9% vs 27.8%, p = 0.002) and dyslipidaemia (48.9% vs 30.9% vs 40.2%, p = 0.022). OE group was younger compared to IE and VE (63.9 ± 13.5 vs 68.9 ± 11.1 vs 69.5 ± 13.0 years old, respectively, p = 0.003). VE group had less left ventricle disfunction comparing to IE and VE groups (left ventricle ejection fraction 40.8 ± 14.1 vs 32.2 ± 9.8 vs 31.6 ± 12.8%, respectively, p &lt; 0.001).

The groups showed no significant differences regarding IHM (IE 5.2% vs VE 8.8% vs OE 2.1%, p = 0.146), 1mRA (IE 8.1&, VE 7.4%, OE 3.1%, p = 0.276) or 1yRA (IE 55.6%, VE 54.4%, OE 47.4%, p = 0.449). However, VE group had higher rates of 1mM (VE 13.2% vs IE 8.9% vs OE 3.1%, p = 0.05) and 1yM compared to IE and OE (33.8% vs 30.4% vs 17.5%, respectively, p = 0.34). These aspects are represented in Kaplan Meier survival curves.

Conclusion

In our population, the etiology of heart failure was predictor of early and late post-discharge mortality but not readmission.

Cardiovascular risk factors as predictors of heart failure during hospitalization for Acute Coronary Syndromes

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

Cardiovascular risk factors (CVRF) are a growing health problem in developed countries. These patients have a higher prevalence of acute coronary syndromes (ACS) and as a consequence ACS complication, like heart failure (HF). HF after an ACS is a common complication and CVFR can influence its manifestation.

Objective

Evaluate the impact of the CVRF in HF during the hospitalization for ACS.

Methods

Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A – without new onset of HF during the hospitalization for ACS and B – with new onset of HF during the hospitalization for ACS. CVFR was defined by body mass index, diabetes, arterial hypertension, smoking, neoplasia, dyslipidemia, coronary artery disease, chronic kidney disease and peripheral arterial disease. Logistic regression was performed to assess predictors of new onset HF in these patients.

Results

14717 patients were included, 2287 in group B (15.5%). Both groups were similar regarding body mass index (27.5 ± 4.3 vs 27.2 ± 4.4, p = 0.254). Curiously the group A exhibited higher prevalence of smoking status (29.8 vs 16.6%, p &lt; 0.001). On the other hand, group B presented more females (25.0 vs 35.7%, p &lt; 0.001), arterial hypertension (68.7 vs 78.2%, p &lt; 0.001), diabetes mellitus (28.5 vs 43.1%, p &lt; 0.001), dyslipidemia (62.2 vs 64.3%, p = 0.023), coronary artery disease (19.6 vs 25.6%, p &lt; 0.001), neoplasia (4.4 vs 7.0%, p &lt; 0.001), peripheral arterial disease (5.2 vs 15.8%, p &lt; 0.001) and chronic kidney disease (4.6 vs 10.0%, p &lt; 0.001). Logistic regression revealed that body mass index, diabetes, arterial hypertension, neoplasia and dyslipidemia were not predictors of HF during the hospitalization for ACS. Nevertheless, female gender (odds ratio (OR) 1.37, p &lt; 0.001, confidence interval (CI) 1.22-1.54), chronic kidney disease (OR 1.59, p &lt; 0.001, CI 1.33-1.90) and peripheral arterial disease (OR 1.54, p &lt; 0.001, CI 1.27-1.86) were predictors of new onset of HF during hospitalization for ACS. Curiously, smoking seems to have a protective effect (OR 0.68, p &lt; 0.001, CI 0.59-0.78) in new onset HF in ACS patients.

Conclusions

Chronic kidney disease and peripheral arterial disease were predictors of new onset of HF in during hospitalization for ACS.

Predictors of early and late re-hospitalization and mortality in non-ST elevation myocardial infarction

Funding Acknowledgements

Type of funding sources: None.

Introduction

Regarding prognosis, acute coronary syndromes (ACS) are heterogeneous. Non-ST elevation myocardial infarction (NSTEMI) is a subtype of ACS. In-hospital (IH) and post-hospitalization (PH) risk stratification is crucial.

Objective

To identify predictors of IH and PH mortality (early and late), as well as predictors of early and late re-admission (RA) in our center population suffering NSTEMI, using real-life data.

Methods

Based on a single-center retrospective study, data collected from admissions between 1/01/2018 and 11/12/2019. Patients (pts) who survived the ACS and were discharged from the hospital were included. Concerning prognosis, we assessed 1-month M and RA (1mM and 1mRA), 6-month M and RA (6mM and 6mRA), 1-year M and RA (1yM and 1yRA).

Results

268 pts with ACS, 59.7% were males and mean age was 66.4 ± 12.5 years old. NSTEMI was the diagnosis in 66.4% and ST elevation myocardial infarction (STEMI) in 31%. Mean creatinine was 1.2 ± 1ml/min, mean sodium was 138 ± 3mmol/L, mean blood urea nitrogen (BUN) was 21 ± 12mg/dL and mean haemoglobin (Hb) was 13.6 ± 1.9g/dL. 88.2% of the pts presented in Killip-Kimball class (KKC) 1, 5.7% in KKC 2, 5.7% in KKC 3 and 0.4% in KKC IV; furthermore, 4.1% of the pts presented de novo AF. Concerning coronary artery disease, 250 were submitted to coronary angiography – 18.8% had no lesions or non-significant lesions (stenosis &lt;50%), 34.8% had one significant lesion, 23.2% had 2 significant lesions and 23.2% had 3 or more. Regarding left ventricle (LV) function, 70.5% of the pts had no LV dysfunction, 15.7% had mild LV impairment (LVI), 9.3% moderate LVI and 4.5% had severe LVI. 8.4% of the patients experienced IH complications, such as auriculoventricular block, heart failure, ventricular tachycardia, stroke, cardiorespiratory arrest and major haemorrhage, during hospitalization. 1mM rate was 1.9% and 1yM rate was 7.8%.

KKC (p = 0.001), BUN (p = 0.007), LV function (p= 0.001) and de novo AF (p = 0.46) were predictors of 1mM. Age (p = 0.004), KKC (p = 0.031), BUN (p = 0.002), sodium (p = 0.037), creatinine (p = 0.001), Hb (p = 0.003), LV function (p &lt; 0.001), de novo AF (p &lt; 0.001) and occurrence of IH complications (p &lt; 0.001) were predictors of 1yM. Age (p = 0.010), male gender (p = 0.19), Hb (p = 0.031), de novo AF (p &lt; 0.001) and occurrence of IH complications (p = 0.001) were predictors of 1mRA. Age (p = 0.004), smoking (p = 0.040), hypertension (p = 0.040), glycemia at admission (p = 0.031), Hb (p = 0.004), LV function (p = 0.019), de novo AF (p &lt; 0.001) and occurrence of IH complications (p &lt; 0.001) were predictors of 1yRA.

Conclusion

This study suggests that de novo AF and occurrence of IH complications are very important prognosis factors regarding early and late mortality and readmission rates.

Acute Coronary Syndrome - reinfarction predictors and outcomes

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

on behalf of the Investigators of " Portuguese Registry of ACS "

Introduction

Reinfarction (RI) is a potential complication of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of RI in the setting of ACS.

Objective

To evaluate predictors and prognosis of RI in the setting of ACS.

Methods

Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Patients (pts) without data on previous cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without RI; GB - pts with RI during hospitalization. Logistic regression and survival analysis were performed.

Results

Between 25718 pts with ACS, RI occurred in 223 (0.87%). Regarding epidemiological factors and past history, GB was older (70 ± 12 vs 67 ± 14, p &lt; 0.001), had higher rates of hypertension (77.4% vs 70.6%, p = 0.028), previous stroke (12.1% vs 7.2%, p = 0.005), peripheric arterial disease (10.0% vs 5.5%, p = 0.004) and chronic obstructive pulmonary disease (8.6% vs 4.4%, p = 0.003). GB had higher rates of non-ST-elevation myocardial infarction (MI) (54.3% vs 45.9%, p = 0.012) and GA had higher rates of ST-elevation MI (42.4% vs 35.9%, p = 0.049). The groups were similar regarding blood pressure (p = 0.285), heart rate (p = 0.796) and Killip-Kimball class at admission, but GB had higher levels of brain natriuretic peptide (392 vs 180, p = 0.005). GB had higher rates of multivessel disease (62.8% vs 51.6%, p = 0.002), left ventricle dysfunction (50.0% vs 39.1%, p = 0.002), higher needs of mechanical ventilation (6.3% and vs 1.9%, p &lt; 0.001) non-invasive ventilation (5.4% vs 1.7%, p &lt; 0.001). Logistic regression confirmed that peripheric arterial disease (p = 0.011, OR 1.93, CI 1.17-3.19), multivessel disease (p = 0.003, OR 1.69, CI 1.20-2.39) and lower left ventricle function (p &lt; 0.001, OR 2.42, CI 1.69-3.47) were predictors of RI in the setting of ACS. Event-free survival was similar between groups (p = 0.399).

Conclusion

RI in the setting of ACS was associated multivessel disease and left ventricle disfunction, however, 1-year prognosis was similar to pts who didn’t suffer RI.

Acute heart failure: is ACTION-ICU useful?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients (pts) with acute heart failure (AHF) are a heterogeneous population. Risk stratification at admission may help predict in-hospital complications and needs. ACTION ICU score is validated to estimate the risk of complications requiring ICU care in non-ST elevation acute coronary syndromes.

Objective

To validate ACTION-ICU score in AHF as predictor of in-hospital M (IHM), post discharge early M [1-month mortality (1mM)] and 1-month readmission (1mRA), in our center population, using real-life data.

Methods

Based on a single-center retrospective study, data collected from pts admitted in the Cardiology department with AHF between 2010 and 2017. Pts without data on previous cardiovascular history or uncompleted clinical data were excluded. Statistical analysis used non-parametric tests, logistic regression analysis and ROC curve analysis.

Results

We included 300 pts admitted with AHF. Mean age was 67.4 ± 12.6 years old and 72.7% were male. 37.7% had previous history of revascularization procedures, 66.9% had hypertension, 41% were diabetic and 38% had dyslipidaemia. Mean heart rate was 95.5 ± 27.5bpm, mean systolic blood pressure (SBP) was 131.2 ± 37.0mmHg, mean urea level at admission was 68.8 ± 40.7mg/dL, mean sodium was 137.6 ± 4.7mmol/L, mean glomerular filtration rate (GFR) was 57.1 ± 23.5ml/min. 35.3% were admitted in Killip-Kimball class (KKC) 4. Mean ACTION-ICU score was 10.4 ± 2.3. Inotropes’ usage was necessary in 32.7% of the pts, 11.3% of the pts needed non-invasive ventilation (NIV), 8% needed invasive ventilation (IV). IHM rate was 5% and 1mM was 8%. 6.3% of the pts were readmitted 1 month after discharge.

Older age (p &lt; 0.001), lower SBP (p = 0,035), presenting in KKC 4 (p &lt; 0.001, OR 8.13) and need of inotropes (p &lt; 0.001) were predictors of IHM in our population. Older age (OR 1.06, p = 0.002, CI 1.02-1.10), lower SBP (OR 1.01, p = 0.05, CI 1.00-1.02) and lower left ventricle ejection fraction (LVEF) (OR 1.06, p &lt; 0.001, CI 1.03-1.09) were predictors of need of NIV. None of the studied variables were predictive of need of IV. LVEF (OR 0.924, p &lt; 0.001, CI 0.899-0.949), lower SBP (OR 0.80, p &lt; 0.001, CI 0.971-0.988), higher urea (OR 1.01, p &lt; 0.001, CI 1.005-1.018) and lower sodium (OR 0.92, p = 0.002, CI 0.873-0.971) were predictors inotropes’ usage.

ACTION-ICU was able to predict IHM (OR 1.51, p = 0.02, CI 1.158-1.977), 1mM (OR 1.45, p = 0.002, CI 1.15-1.81) and inotropes’ usage (OR 1.22, p = 0.002, CI 1.08-1.39), but not 1mRA, the need of IV or NIV.

ROC curve analysis revealed ACTION-ICU performs well when predicting IHM (Area under curve (AUC) 0.729, confidence interval (CI) 0.59-0.87), inotropes’ usage (AUC 0.619, CI 0.54-0.70) and 1mM (AUC 0.705, CI 0.58-0.84).

Conclusion

In our population, ACTION-ICU score was able to predict IHM, 1mM and inotropes’s usage.

Acute heart failure: predicting early in-hospital outcomes

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients (P) with acute heart failure (AHF) are a heterogeneous population. Risk stratification at admission may help predict in-hospital complications and needs. The Get With The Guidelines Heart Failure score (GWTG-HF) predicts in-hospital mortality (M) of P admitted with AHF. ACTION ICU score is validated to estimate the risk of complications requiring ICU care in non-ST elevation acute coronary syndromes.

Objective

To validate ACTION-ICU score in AHF and to compare ACTION-ICU to GWTG-HF as predictors of in-hospital M (IHM), early M [1-month mortality (1mM)] and 1-month readmission (1mRA), using real-life data.

Methods

Based on a single-center retrospective study, data collected from P admitted in the Cardiology department with AHF between 2010 and 2017. P without data on previous cardiovascular history or uncompleted clinical data were excluded. Statistical analysis used chi-square, non-parametric tests, logistic regression analysis and ROC curve analysis.

Results

Among the 300 P admitted with AHF included, mean age was 67.4 ± 12.6 years old and 72.7% were male. Systolic blood pressure (SBP) was 131.2 ± 37.0mmHg, glomerular filtration rate (GFR) was 57.1 ± 23.5ml/min. 35.3% were admitted in Killip-Kimball class (KKC) 4. ACTION-ICU score was 10.4 ± 2.3 and GWTG-HF was 41.7 ± 9.6. Inotropes’ usage was necessary in 32.7% of the P, 11.3% of the P needed non-invasive ventilation (NIV), 8% needed invasive ventilation (IV). IHM rate was 5% and 1mM was 8%. 6.3% of the P were readmitted 1 month after discharge.

Older age (p &lt; 0.001), lower SBP (p = 0,035) and need of inotropes (p &lt; 0.001) were predictors of IHM in our population. As expected, patients presenting in KKC 4 had higher IHM (OR 8.13, p &lt; 0.001). Older age (OR 1.06, p = 0.002, CI 1.02-1.10), lower SBP (OR 1.01, p = 0.05, CI 1.00-1.02) and lower left ventricle ejection fraction (LVEF) (OR 1.06, p &lt; 0.001, CI 1.03-1.09) were predictors of need of NIV. None of the variables were predictive of IV. LVEF (OR 0.924, p &lt; 0.001, CI 0.899-0.949), lower SBP (OR 0.80, p &lt; 0.001, CI 0.971-0.988), higher urea (OR 1.01, p &lt; 0.001, CI 1.005-1.018) and lower sodium (OR 0.92, p = 0.002, CI 0.873-0.971) were predictors of inotropes’ usage.

Logistic regression showed that GWTG-HF predicted IHM (OR 1.12, p &lt; 0.001, CI 1.05-1.19), 1mM (OR 1.10, p = 1.10, CI 1.04-1.16) and inotropes’s usage (OR 1.06, p &lt; 0.001, CI 1.03-1.10), however it was not predictive of 1mRA, need of IV or NIV. Similarly, ACTION-ICU predicted IHM (OR 1.51, p = 0.02, CI 1.158-1.977), 1mM (OR 1.45, p = 0.002, CI 1.15-1.81) and inotropes’ usage (OR 1.22, p = 0.002, CI 1.08-1.39), but not 1mRA, the need of IV or NIV. ROC curve analysis revealed that GWTG-HF score performed better than ACTION-ICU regarding IHM (AUC 0.774, CI 0.46-0-90 vs AUC 0.731, CI 0.59-0.88) and 1mM (AUC 0.727, CI 0.60-0.85 vs AUC 0.707, CI 0.58-0.84).

Conclusion

In our population, both scores were able to predict IHM, 1mM and inotropes’s usage.

Acute Coronary Syndrome follow up: Portuguese experience

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

Acute coronary syndrome is a major health problem, with several acute and chronic complications. So, it is imperative identifying factors that can be associated with better and worse prognosis during the follow up these patients.

Objective

Evaluate predictors of mortality, cardiovascular readmission and all causes of readmission at 1 year follow up in ACS patients.

Methods

Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Logistic regression was performed to assess predictors of mortality, cardiovascular readmission and all causes of readmission at 1 year follow up in ACS patients.

Results

1492 patients were included, 141 die during the first year. Age &gt; 75 years old (odds ratio (OR) 2.557, p &lt; 0.001, confidence interval (CI) 1.727-3.785), heart rate &lt; 60 (OR 2.686, p = 0.008, CI 1.296-5.569), cardiogenic shock (OR 6.726, p = 0.012, CI 1.512-29.915), creatinine &gt;2mg/dL (OR 1.956, p = 0.023, CI 1.099-3.480), left ventricular ejection fraction &lt;50% (OR 1.911, p = 0.001, CI 1.284-2.844), nitrate (OR 1.589, p = 0.020, CI 1.074-2.351), ivabradine (OR 1.831, p = 0.011, CI 1.146-2.924), aldosterone antagonists (OR 1.632, p = 0.020, CI 1.079-2.468), diuretic (OR 1.625, p = 0.023, CI 1.069-2.472) and mechanical complication d (OR 55.518, p &lt; 0.001, CI 11.516-267.655) were predictors of mortality of 1 year of follow up. Regarding cardiovascular readmission was registered in 291 patients, of a total 1412. Were predictors of cardiovascular readmission previous history of heart failure (OR 1.467, p = 0.003, CI 1.135-1.895), cardiogenic shock (OR 3.447, p = 0.039, CI 1.068-11.128), acetylsalicylic acid previous to ACS (OR 1.751, p = 0.008, CI 1.285-2.385), multivessel disease (OR 1.667, p = 0.002, CI 1.206-2.306), left ventricular ejection fraction &lt;50% (OR 1.489, p = 0.003, CI 1.145-1.938), nitrate (OR 1.812, p &lt; 0.001, CI 1.403-2.341), aldosterone antagonists (OR 1.572, p = 0.004, CI 1.155-2.140) and sustained ventricular tachycardia (OR 55.518, p &lt; 0.001, CI 11.516-267.655). On the other hand 411 patients was readmitted (all causes), in 1455 patients with follow up. Were predictors of all causes of readmission previous history of heart failure (OR 1.347, p = 0.025, CI 1.039-1.747), previous chronic obstructive pulmonary disease (OR 1.456, p = 0.041, CI 1.016-2.087), atrial fibrillation (OR 1.439, p = 0.027, CI 1.041-1.988), acetylsalicylic acid previous to ACS (OR 1.473, p = 0.001, CI 1.161-1.869), left ventricular ejection fraction &lt;50% (OR 1.456, p = 0.001, CI 1.166-1.819), nitrate (OR 1.478, p &lt; 0.001, CI 1.192-1.831), aldosterone antagonists (OR 1.493, p = 0.003, CI 1.148-1.943) and sustained ventricular tachycardia (OR 3.792, p = 0.004, CI 1.540-9.337). Conclusions: Left ventricular ejection fraction &lt;50%, nitrate as discharge therapeutic and aldosterone antagonists as discharge therapeutic were predictors of mortality, cardiovascular readmission and readmission for all causes at 1 year follow up.

Stroke in acute coronary syndrome: predictors and prognosis

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

on behalf of the Investigators of " Portuguese Registry of ACS "

Introduction

Stroke is a potential complication of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of stroke in the setting of ACS.

Objective

To evaluate predictors and prognosis of stroke in the setting of ACS.

Methods

Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Patients (pts) without data on previous cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without stroke; GB - pts with stroke during hospitalization. Logistic regression was performed to assess predictors of stroke in ACS. Survival analysis was evaluated through Kaplan Meier curve.

Results

Population – 25711 pts with ACS, CA occurred in 154 (0.6%). Regarding epidemiological factors and past history, GB was older (72 ± 12 vs 67 ± 14, p &lt; 0.001), had higher rates of females (53.2% vs 27.5%, p &lt; 0.001), diabetes (43.9% vs 31.5%, p &lt; 0.001), previous stroke (13.3% vs 7.2%, p = 0.004), peripheric arterial disease (9.2% vs 5.5%, p = 0.044) and dementia (6.8% vs 1.7%, p &lt; 0.001), and had lower rates of smoking (16.6% vs 26.7%, p = 0.005), dyslipidaemia (53.5% vs 61.6%, p = 0.047) and previous ACS (12.7% vs 20.6%, p = 0.017. GB had longer times from first symptoms to admission (340min vs 240min, p = 0.011). The groups were similar regarding diagnosis, namely non-ST-elevation myocardial infarction (MI) (p = 0.345) and ST-elevation MI (p = 0.541). GB had higher heart rate (HR) (84 ± 24 vs 77 ± 19, p = 0.001), presented more frequently in Killip-Kimball class (KKC) ≥2 (28.0% vs 15.1%, p &lt; 0.001), in atrial fibrillation (AF) (16.4% vs 7.1%, p &lt; 0.001) and with higher brain-natriuretic peptide levels (545 vs 180, p &lt; 0.001). The groups were similar regarding culprit lesion and number of lesions. GB had more left ventricle (&lt;50%) dysfunction (51.4% vs 39.1%, p &lt; 0.001) and needed more frequently mechanical ventilation (10.4% vs 1.9%, p &lt; 0.001) and provisory pacemaker (8.4% vs 1.5%, p &lt; 0.001).

Logistic regression confirmed that older age (p = 0.018, OR 1.69, CI 1.10-2.60), female gender (p &lt; 0.001, OR 2.09, CI 1.38-3.15), diabetes (p = 0.002, OR 1.91, CI 1.27-2.86), dementia (p = 0.047, OR 2.13, CI 1.01-4.50), AF (p = 0.024, OR 1.87, CI 1.09-3.21) and lower left ventricle function (p = 0.002, OR 2.01, CI 1.29-3.15) were predictors of stroke in the setting of ACS. Event-free survival was higher in GA than GB (79.9% vs 70.5%, OR 1.58, p &lt; 0.001, CI 1.36-1.83).

Conclusion

As expected, stroke in the setting of ACS is associated with poorer prognosis. Several characteristics of the pts may help to predict the occurrence of stroke during hospitalizations, therefore allowing an earlier identification and prompt treatment.

Cardiovascular risk factors as predictors of completed atrioventricular block during hospitalization for Acute Coronary Syndromes

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Portuguese Registry of Acute Coronary Syndromes

Background

The presence of cardiovascular risk factors (CVRF) are directly related to acute coronary syndrome (ACS) occurrence. ACS is a major health problem with multiple complications. Completed atrioventricular block (CAVB) in context of ACS can impact the patient’s prognosis, and is not clarified if its presence can be predicted only by CVFR.

Objective

Evaluate the impact of the CVRF in CAVB during the hospitalization for ACS.

Methods

Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided in two groups: A – without CAVB during the hospitalization for ACS and B – with CAVB during the hospitalization for ACS. CVFR was defined by body mass index, diabetes, arterial hypertension, smoking, coronary artery disease, neoplasia, dyslipidemia, chronic kidney disease and peripheral arterial disease. Logistic regression was performed to assess predictors of CAVB in these patients.

Results

14031 patients were included, 401 in group B (2.9%). Both groups were similar regarding smoking status (p = 0.920), arterial hypertension (p = 0.928), diabetes mellitus (p = 0.249), peripheral arterial disease (p = 0.352) and chronic kidney disease (p = 0.783). Interestingly the group A exhibited higher body mass index (27.4 ± 4.3 vs 26.9 ± 4.5, p &lt; 0.001), dyslipidemia (62.8 vs 53.6%, p &lt; 0.001) and coronary artery disease (20.7 vs 15.0%, p = 0.001). On the other hand, group B presented more females (26.7 vs 31.5%, p = 0.012), mean age (66 ± 13 vs 71 ± 13, p &lt; 0.001) and neoplasia (4.8 vs 7.1%, p = 0.012). Logistic regression revealed that any of the CVRF were a predictor of CAVB during the hospitalization for ACS. Just, age (odds ratio 1.48, p &lt; 0.001, confidence interval 1.16-1.88) has been a predictor of CAVB during hospitalization for ACS.

Conclusions

Any CVFR was a predictor of CAVB in context of ACS. Age was a predictor of CAVB during hospitalization for ACS.

Heart failure in Acute Coronary Syndrome: predictors and prognosis

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

on behalf of the Investigators of " Portuguese Registry of ACS "

Introduction

Heart failure (HF) is a frequent complication of acute coronary syndromes (ACS). Therefore, it is important to access its impact on prognosis and identify patients (pts) with higher risk of HF.

Objective

To evaluate predictors and prognosis of HF in the setting of ACS.

Methods

Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Pts without data on cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without HF; GB - pts with HF during hospitalization.

Results

HF occurred in 4003 (15.6%) out of 25718 pts with ACS. GB was older (74 ± 12 vs 65 ± 13, p &lt; 0.001), had more females (36.3% vs 26.2%, p &lt; 0.001), had higher rates of arterial hypertension (78.4% vs 69.3%, p &lt; 0.001), dyslipidaemia (64.4% vs 61.1%. p &lt; 0.001), previous ACS (25.6% vs 19.7%, p &lt; 0.001,), previous HF (16.4% vs 4.1%, p &lt; 0.001), previous stroke (11.9% vs 6.4%, p &lt; 0.001), chronic kidney disease (CKD) (17.1% vs 5.5%, p &lt; 0.001), chronic obstructive pulmonary disease (COPD) (7.8% vs 3.8%, p &lt; 0.001) and longer times from first symptoms to admission (268min vs 238min, p &lt; 0.001). GA had higher rate of smokers (28.4% vs 16.2%, p &lt; 0.001) and higher rate of non-ST-elevation myocardial infarction (MI) (46.5% vs 43.0%, p &lt; 0.001). GB had higher rates of ST-elevation MI (STEMI) (49.2% vs 41.1%, p &lt; 0.001), namely anterior STEMI (58.1% vs 44.9%, p &lt; 0.001). GB had lower blood pressure (130 ± 32 vs 140 ± 28, p &lt; 0.001), higher heart rate (86 ± 23 vs 76 ± 18, p &lt; 0.001), Killip-Kimball class (KKC) ≥2 (63.2% vs 6.7%, p &lt; 0.001), atrial fibrillation (AF) (15.4% vs 5.7%, p &lt; 0.001), left bundle branch block (7.5% vs 3.1%, p &lt; 0.001) and were previously treated with diuretics (39.1% vs 22.1%, p &lt; 0.001), amiodarone (2.2% vs 1.4%, p &lt; 0.001) and digoxin (2.8% vs 0.7%, p &lt; 0.001). GB had higher rates of multivessel disease (66.0% vs 49.5%, p &lt; 0.001) and planned coronary artery bypass grafting (7.3% vs 6.0%, p &lt; 0.001), reduced left ventricle function (72.3% vs 33.4%, p &lt; 0.001) and needed more frequently mechanical ventilation (8.2% vs 0.9%, p &lt; 0.001), non-invasive ventilation (8.7% vs 0.5%, p &lt; 0.001) and provisory pacemaker (4.5% vs 1.0%, p &lt; 0.001). Logistic regression confirmed females (p &lt; 0.001, OR 1.42, CI 1.29-1.58), diabetes (p &lt; 0.001, OR 1.43, CI 1.30-1.58), previous ACS (p &lt; 0.001, OR 1.27, CI 1.10-1.47), previous stroke (p &lt; 0.001, OR 1.35, CI 1.16-1.57), CKD (p &lt; 0.001, OR 1.76, CI 1.50-2.05), COPD (p &lt; 0.001, OR 2.15, CI 1.82-2.54), previous usage of amiodarone (p = 0.041, OR 1.35, CI 1.01-1.81) and digoxin (p &lt; 0.001, OR 2.30, CI 1.70-3.16), and multivessel disease (p &lt; 0.001, OR 1.64, CI 1.67-2.32) were predictors of HF in the setting of ACS. Event-free survival was higher in GA than GB (79.5% vs 58.1%, OR 2.3, p &lt; 0.001, CI 2.09-2.56).

Conclusion

As expected, HF in the setting of ACS is associated with poorer prognosis. Several features may help predict the HF occurrence during hospitalizations, allowing an earlier treatment.

Cortical neuroanatomical changes related to specific neuropsychological deficits in subcortical vascular cognitive impairment

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Poor performances in neuropsychological tests were associated with cortical atrophy.

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Neural substrates in Aβ (−) SVCI differed from those in ADCI.

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Neural substrate of episodic memory was frontal regions in Aβ (−) SVCI.

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Neural substrates of three neuropsychological tests showed laterality.

Objective

Neuropsychological test-specific neural substrates in subcortical vascular cognitive impairment (SVCI) are expected to differ from those in Alzheimer’s disease-related cognitive impairment (ADCI) but the details are unclear. To determine neural substrates related to cerebral small vessel disease, we investigated the correlations between cognitive dysfunctions measured by standardized neuropsychological tests and cortical thickness in a large sample of participants with amyloid negative (Aβ (−)) SVCI.

Methods

One hundred ninety-eight participants with Aβ (−) SVCI were recruited from the memory clinic between November 2007 to August 2018. To acquire neural substrates, we performed linear regression using the scores of each neuropsychological test as a predictor, cortical thickness as an outcome, and age, sex, education years, intracranial volume and white matter hyperintensity (WMH) as confounders.

Results

Poor performances in each neuropsychological test were associated with cortical atrophy in certain brain regions regardless of WMH. Especially, not the medial temporal but the frontal and posterior cingulate regions with cortical atrophy were mainly associated with memory impairment. Poor performance in animal fluency was more likely to be associated with cortical atrophy in the left hemisphere, while poor performance in the visuospatial memory test was more likely to be associated with cortical atrophy in the right hemisphere.

Conclusions

Our findings suggested that cortical atrophy was an important factor of cognitive impairment in Aβ (−) SVCI regardless of WMH. Furthermore, our findings might give clinicians a better understanding of specific neural substrates of neuropsychological deficits in patients with SVCI.

Norwich COVID-19 testing initiative pilot: evaluating the feasibility of asymptomatic testing on a university campus

Background

There is a high prevalence of COVID-19 in university-age students, who are returning to campuses. There is little evidence regarding the feasibility of universal, asymptomatic testing to help control outbreaks in this population. This study aimed to pilot mass COVID-19 testing on a university research park, to assess the feasibility and acceptability of scaling up testing to all staff and students.

Methods

This was a cross-sectional feasibility study on a university research park in the East of England. All staff and students (5625) were eligible to participate. All participants were offered four PCR swabs, which they self-administered over two weeks. Outcome measures included uptake, drop-out rate, positivity rates, participant acceptability measures, laboratory processing measures, data collection and management measures.

Results

798 (76%) of 1053 who registered provided at least one swab; 687 (86%) provided all four; 792 (99%) of 798 who submitted at least one swab had all negative results and 6 participants had one inconclusive result. There were no positive results. 458 (57%) of 798 participants responded to a post-testing survey, demonstrating a mean acceptability score of 4.51/5, with five being the most positive.

Conclusions

Repeated self-testing for COVID-19 using PCR is feasible and acceptable to a university population.

A Validation Study of the Inbrain CST: a Tablet Computer-based Cognitive Screening Test for Elderly People with Cognitive Impairment

BACKGROUND

Computerized versions of cognitive screening test could have advantages over pencil-and-paper versions by eliminating rater-dependent factors and saving the time required to score the tests and report the results. We developed a computerized cognitive screening test (Inbrain Cognitive Screening Test [Inbrain CST]) that takes about 30 minutes to administer on a touchscreen computer and is composed of neuropsychological tests already shown to be sensitive in detecting early cognitive decline in Alzheimer's disease (AD). The aims of this study were to 1) introduce normative data for Inbrain CST, 2) verify its reliability and validity, 3) assess clinical usefulness, and 4) identify neuroanatomical correlates of Inbrain CST.

METHODS

The Inbrain CST runs on the Microsoft Windows 10 operating system and comprises 7 subtests that encompass 5 cognitive domains: attention, language, visuospatial, memory, and executive functions. First, we recruited 480 cognitively normal elderly people (age 50-90) from communities nationwide to establish normative data for Inbrain CST. Second, we enrolled 97 patients from our dementia clinic (26 with subjective cognitive decline [SCD], 42 with amnestic mild cognitive impairment [aMCI], and 29 with dementia due to AD) and investigated sensitivity and specificity of Inbrain CST for discriminating cognitively impaired patients from those with SCD using receiver operating characteristic (ROC) curve analyses. Third, we compared the Inbrain CST scores with those from another neuropsychological test battery to obtain concurrent validity and assessed test-retest reliability. Finally, magnetic resonance imaging (MRI)-based cortical thickness analyses were performed to provide anatomical substrates for performances on the Inbrain CST.

RESULTS

First, in the normative sample, the total score on the Inbrain CST was significantly affected by age, years of education, and gender. Second, Inbrain CST scores among the three patient groups decreased in the order of SCD, aMCI, and AD dementia, and the ROC curve analysis revealed that Inbrain CST had good discriminative power for differentiating cognitively impaired patients from those with SCD. Third, the Inbrain CST subtests had high concurrent validity and test-retest reliability. Finally, in the cortical thickness analysis, each cognitive domain score and the total score of Inbrain CST showed distinct patterns of anatomical correlates that fit into the previously known brain-behavior relationship.

CONCLUSION

Inbrain CST had good validity, reliability, and clinical usefulness in detecting cognitive impairment in the elderly. Furthermore, it showed neuroanatomical validity through MRI cortical thinning patterns. These results suggest that Inbrain CST is a useful cognitive screening tool with efficiency and validity to detect mild impairments in cognition in clinical settings.

A Comprehensive Evaluation of the Process of Copying a Complex Figure in Early- and Late-Onset Alzheimer Disease: A Quantitative Analysis of Digital Pen Data

Background

The Rey-Osterrieth Complex Figure Test (RCFT) is a neuropsychological test that is widely used to assess visual memory and visuoconstructional deficits in patients with cognitive impairment, including Alzheimer disease (AD). Patients with AD have an increased tendency for exhibiting extraordinary behaviors in the RCFT for selecting the drawing area, organizing the figure, and deciding the order of images, among other activities. However, the conventional scoring system based on pen and paper has a limited ability to reflect these detailed behaviors.

Objective

This study aims to establish a scoring system that addresses not only the spatial arrangement of the finished drawing but also the drawing process of patients with AD by using digital pen data.

Methods

A digital pen and tablet were used to copy complex figures. The stroke patterns and kinetics of normal controls (NCs) and patients with early-onset AD (EOAD) and late-onset AD (LOAD) were analyzed by comparing the pen tip trajectory, spatial arrangement, and similarity of the finished drawings.

Results

Patients with AD copied the figure in a more fragmented way with a longer pause than NCs (EOAD: P=.045; LOAD: P=.01). Patients with AD showed an increased tendency to draw the figures closer toward the target image in comparison with the NCs (EOAD: P=.005; LOAD: P=.01) Patients with AD showed the lower accuracy than NCs (EOAD: P=.004; LOAD: P=.002). Patients with EOAD and LOAD showed similar but slightly different drawing behaviors, especially in space use and in the initial stage of drawing.

Conclusions

The digitalized complex figure test evaluated copying performance quantitatively and further elucidated the patients’ ongoing process during copying. We believe that this novel approach can be used as a digital biomarker of AD. In addition, the repeatability of the test will delineate the process of executive functions and constructional organization abilities with disease progression.