Funding Acknowledgements Type of funding sources: None. Background Thrombocytopenia post transcatheter aortic valve implantation (TPPT) in its most severe manifestation is an independent predictor of mortality. However, mechanisms that favors TPPT remain unknown. Purpose To establish the prognostic value and risk factors of TPPT in a real-life population of patients treated with transcatheter aortic valve implantation (TAVI) in a tertiary hospital. Methods We analyzed retrospectively clinical, laboratory, echocardiographic and procedure-related variables from 203 consecutive patients, treated with TAVI between January 2019 and October 2021. Results This cohort had mean age of 82,3 ±5,9 years, 56% male, 83% hypertensive, 62% dyslipidemia, 35% diabetic, 20% chronic kidney disease, 22% chronic obstructive pulmonary disease, 32% coronary artery disease, 20% had previous ICP, 38% Atrial Fibrillation (AF), 18% peripheral arterial disease, 12% neurovascular disease, 23% history of cancer, 10% pacemaker carriers. 50% of TAVIs were balloon-expandable and 50% self-expandable. Mean procedure duration was 138 ±109min, size 26,6±3mm, contrast dose 233 ±88mL. During in-hospital stay 192/203 patients had TPPT. Platelets before TAVI, 187.000 (IQR 148.000-222.000) Vs a minimum post-TAVI (PlqMin) of 135.000 (IQR 105.000-164.000); P<0,05. Platelet fall (DeltaPlq) 48.000 ±38.000. We observed a Minimum Kidney clearance (ClMin) 46 ±20,75mL/min/m2, a maximum ultrasensitive Troponin-T (Tr-TusMax) 250 ±450 pg/L, a Maximum C Reactive Protein (PCRMax) 6,68 ±6,4, and a Minimum Hemoglobin (HbMin) 9,8 ±1,7 g/dL. 31/203 (15,3%) patients were exitus at the end of follow-up. We observed a non-lineal statistically significant association between TPPT quartiles and all-cause mortality (P<0,05): 21 exitus occurred in the extreme quartiles (1 and 4) while only 11 at the central ones (2 and 3). DeltaPlq was associated with PCRMax (Pearson 0,25; P<0,001), CliMin (Pearson -0,23; P0,005), HbMin (Pearson -0,27; P 0,001), AF. The only protective factor for DeltaPlq was history of previous ICP. Among exitus patients PlqMin was observed later than in survivors (3,5 vs 2,2 days; P<0,05). TPPT’s quartiles, previous ICP, time to PlqMin, HbMin, PCRMax and Tr-TusMax were the variables found to be independent associated with all-cause mortality (P<0,05). Conclusions The non-linear association between TPPT and mortality, the temporal relation between TPPT and mortality and the linear correlation between TPPT and HbMin and PCRMax suggest that late TPPT may have a mortality prognostic value through an increased risk of low Hb in the context of an increased inflammatory status. The fact that history of ICP was associated with les platelet fall suggests that revascularization, or ICP associated drug therapy, may confer protection against after TAVI mortality.
Funding Acknowledgements Type of funding sources: None. Introduction In several structural arrhythmogenic diseases that comprise intricate endocardial, intramural and epicardial substrates, endocardial ablation of ventricular tachycardia (VT) is not sufficient and epicardial ablation has lately become a complementary and necessary tool. Purpose To evaluate the clinical characteristics of patients (pts) most suitable for first intention epicardial VT ablation. Methods Single-center prospective study of consecutive pts with structural heart disease undergoing first intention epicardial VT mapping between August 2015 and June 2021. Decision for epicardial approach was based on the etiology, VT electrocardiogram (ECG) and cardiac magnetic resonance (CMR) results. Under general anesthesia, subxiphoid access using a Tuhoy needle was done using fluoroscopic guidance and with high-density epicardial mapping was performed. Epicardial ablation was performed if relevant arrhythmogenic findings were locally confirmed. Results First intention epicardial VT ablation was attempted in 18 pts (mean age 59.8±12 years,94% male) of whom 16 had non-ischemic dilated cardiomyopathy (NICM,idiopathic:11; post-myocardis:4; hereditary:1) and 2 had right ventricular arrhythmogenic cardiomyopathy. Mean LVEF was 33% and 79% had a previous ICD (53% in primary prevenon). 69% were referred for ablation due to arrhythmic storm (1pt in cardiogenic shock). Epicardial access was achieved in 17 pts (94%), without acute complications. In 35% pts with NICM the decision for epicardial approach was based on the detection of subepicardial CMR delayed-hyperenhancement and relevant epicardial arrhythmic substrate was confirmed by mapping in all cases. In 3 pts radiofrequency (RF) applicaons were not performed at epicardium, as no abnormal electrograms were locally detected, and an addional endocardial approach was prosecuted. The mean overall procedure and fluoroscopic time were 123 and 28min, respectively, with a mean RF application me of 51min. After the procedure 1pt required pericardial drainage due to inflammatory pericardial effusion. No other acute complications occurred. During a mean follow-up of 2.8±1.8 years, only 3pts (17%) had VT recurrence; 5pts (28%) died due to end-stage heart failure and 2pts (11%) underwent heart transplantation. Conclusion In NICM a first intention epicardial VT ablation performed by experienced operators/centers is efficient, particularly if guided by CMR findings,and presents a safety profile.
Funding Acknowledgements Type of funding sources: None. Introduction Mitral annulus disjunction (MAD) has been proposed as a contributing factor for arrythmias and mitral regurgitation in patients with mitral valve prolapse (MVP), however its clinical relevance is still under investigation. Objective To evaluate the frequency of MAD in MVP patients, to characterize clinically patients with MAD and assess potential markers for events. Methods Single-center retrospective study of consecutive patients with MVP documented in transthoracic echocardiogram between January 2014 and October 2019. MVP was defined according to the 2017 AHA recommendations; MAD was defined as a separation between mitral valve annulus and the left ventricle free wall. Demographic, clinical, echocardiographic, electrocardiographic data were collected. The results were obtained using Chi-square and Mann-Whitney tests; logistic regression was used to find predictors of events. Results 247 patients were included (mean age 62.9 ± 18 years, 61% males), of these 23 (9.3%) had MAD (mean age 56 ± 20 years, 56.5% males). The maximum diameter of MAD was 10 ± 3mm (range 5-18). 21 patients (92.3%) had mitral regurgitation, and it was at least of moderate severity in 65.2% of patients. Most of the patients (91.3, n = 21) were in sinus rhythm (SR). During follow-up (FUP) of 29 ± 19 months, 39% (n = 9) of the patients developed symptoms, 22% (n = 5) had atrial fibrillation (AF), 4.3% (n = 1) had acute aortic syndrome (AAS), 4.3% (n = 1) needed ICD, 22% (n = 5) were submitted to mitral valve intervention, 8.7% (n = 2) were admitted to hospital and 8.7% (n = 2) died. None of the patients presented sustained ventricular arrhythmias (SVA) as assessed in regular Holter monitoring. These patients had more AAS and needed more ICD in FUP compared to patients without MAD (p = 0.007 and p = 0.006, respectively) Mitral cord rupture (p = 0.04), age (p = 0.044), maximum velocity of tricuspid regurgitation (p = 0.04) and IVS thickness (p = 0.017) were associated with AF in MAD patients. in univariate analysis, interventricular septum thickness was a predictor of AF in this subgroup (OR 4.0, 95%CI 1.1-14.3, p = 0-032) The presence of SR was associated with survival (p = 0.03). There were no predictors of hospital admission or mitral intervention. Conclusion Patients with MAD had a relatively benign prognosis with few events during follow-up, although with more AAS and ICD in FUP. In our sample, AF was more common than SVA. Left ventricle hypertrophy was a predictor of AF and sinus rhythm was associated with survival. Larger studies with more patients and other methods of imaging are needed to confirm our results.
Funding Acknowledgements Type of funding sources: None. Introduction Despite being known for more than a century, mitral valve prolapse (MVP) is an entity not fully understood with controversial data regarding the prognosis. Aim To characterize a sample of patients with MVP and to access the frequency of complications associated with MVP (arrhythmias, hospital admissions and death). Methods Single-center retrospective study of consecutive patients with MVP documented in transthoracic echocardiogram between January 2014 and October 2019. MVP was defined as systolic displacement of the mitral leaflet into the left atrium≥ 2 mm from the mitral annular plane. Demographic, clinical, echo, EKG data were collected as well as major adverse events at follow-up. Categorical variables were reported in absolute number and/or % and continuous variables were reported as mean and SD or median and IQR. The results were obtained using Chi-square and ANOVA tests. Results 247 patients were included (mean age 62.9 ± 18 years, 61% male). The mean distance of the MVP was 6mm (IQR 5-9). The posterior mitral valve leaflet (PL) was the most frequently involved (49%), followed by involvement of both leaflets (BL) (27%) and the anterior leaflet (AL) (25%). Patients with MVP of PL were older compared to patients with BL and AL involvement (68 ±15 vs 58 ± 17 vs 59 ± 22 years, respectively, p < 0.001) and had longer QT interval (419 ± 35 vs 403 ± 25 vs 410 ± 34ms, respectively, p = 0.013). 70.4% (174) had significant MR. Mitral annulus disjunction (MAD) was present in 9.3% (n = 23). The mean LVEF was 63% ± 6.3% and LV mass was 124,7 ± 41g/m2. Most of the patients were in sinus rhythm (SR) (78%). 13.3% had hospital admission for cardiovascular cause and 8.5% (n = 21) died. During a mean follow-up of 30 ± 19 months, 25.1% of the patients had de novo atrial fibrillation (AF), 8 patients (3%) were submitted to supraventricular dysrhythmia ablation. 16.2% had premature ectopic ventricular complexes, 2.4% non-sustained VT, 0.4% sustained VT, 0.8% needed ICD, 8.5% had a pacemaker. 25% of the patients underwent mitral valve intervention (23.9% to surgical intervention and 3 to percutaneous). 12% of the patients had a hospital admission for CV cause and 8.5% of the patients died. In multivariate analysis, hospitalization for CV cause (OR 7.27, p = 0.011, CI 95% 1.59- 33.3), higher NYHA class (III-IV) (p = 0.036 OR 5.7 CI95% 1.125-28.84) and the presence of LBBB (p = 0.021 OR = 6.78 CI95% 1.13-28.85) were independent predictors of mortality. MAD was not associated with the outcomes. SR (OR 0.3, p = 0.014, CI95% 0.119-0.786) and prolapse (OR 0.37, p = 0.035, CI95%0.148-0.935) according to the ESC classification (comparing to flail and billowing) predicted survival. Conclusion MVP was traditionally described as a benign entity. However, in our population it was associated with significant mitral regurgitation, some requiring intervention. Besides that, 44% had arrhythmias, with AF occurring in about 25%, hospitalization in 13.3% and cardiovascular death in 8.5%.
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