Funding Acknowledgements Type of funding sources: None. Introduction Heparin-induced thrombocytopenia (HIT) is a rare immune-mediated disorder related to the use of unfractionated heparin and low-molecular-weight heparin. Although thrombocytopenic, HIT is a paradoxical prothrombotic state associated with increased risk of vascular thrombosis and death. Non-heparin anticoagulants, parenteral and oral, are recommended for the treatment of HIT. As heparin is commonly used and thrombocytopenia is frequent in critically ill cardiac patients, HIT constitute a relevant clinical issue in the intensive cardiac care unit. Despite this, the incidence of HIT as well as factors influencing clinical outcomes in acute cardiac patients with HIT are unknown and have not been investigated so far. Purpose The purpose of our study was to evaluate the incidence of HIT in the population of cardiac patients and to determine if any predictor of survival for acute cardiac patients with HIT can be found. Methods We retrospectively collected data of all patients with HIT who were hospitalized in our intensive cardiac care unit in 2016 - 2021. We had used functionalized latex immunoassay to confirm the diagnosis of HIT in all patients. The choice of the non-heparin anticoagulant, oral or parenteral, for the first-line treatment of HIT had been left to clinical judgment of the physician. We performed statistical analysis including clinical and laboratory variables to find the predictors of survival in critically ill cardiac patients with HIT. Results Among 22 483 patients hospitalized in 2016 - 2021 in our department of cardiology 12 were diagnosed with HIT (incidence 1 : 1874). 5 of them were treated with parenteral non-heparin whereas 7 with oral anticoagulant as first-line treatment. 4 patients with HIT died during the index hospitalization. All of them were treated with parenteral non-heparin anticoagulant. 7 of 8 survivors were treated with oral anticoagulant as primary drug. First-line treatment with oral anticoagulant was the predictor of survival (p=0,0152) in our study group. There was no other neither clinical nor laboratory factor influencing outcomes in critically ill cardiac patients with HIT (Table 1). Conclusion First-line treatment with oral anticoagulant was the only one predictor of survival in acute cardiac patients with HIT. Oral anticoagulants may be preferred for the treatment of HIT in this population.
Background Atrial fibrillation (AF) impairs mechanical function of the heart, especially atria and restoration of sinus rhythm (SR) leads to improvement of mechanics. The predicting role of changes in strain parameters for AF recurrence is not established yet. Purpose To analyse changes in left atrial (LA) and left ventricular (LV) mechanical function after conversion to SR and their prognostic values for AF recurrence during 24 months follow-up. Methods Prospective study involved 59 patients after successful electrical cardioversion (EC) because of nonvalvular AF (mean age 65±4 years, 47% female). Speckle tracking analysis (STE) was applied to calculate longitudinal strain of LV and LA before EC and within 24 hours after restoration of SR and additionally total left heart strain (TS) defined as a sum of absolute peak LV and LA strain. We calculated change in strain between AF and SR analyses expressed as delta (Δ). During follow-up we noticed AF recurrence in 42 (71%) patients, most of them (93%) during 1st year after EC. Median time of AF recurrence was 3 months. Results We noticed significant immediate post-EC improvement in peak LA longitudinal strain (PALS) and LV global longitudinal strain (LVGLS) (table). Unlike CHA2DS2-VASc score, strain parameters were predictors of AF recurrence. Every 1% increment in ΔLVGLS was related with 13% increase in AF recurrence risk (p=0.02) and every 1% increment in ΔPALS and ΔTS were related with 9% decrease in AF recurrence risk (p=0.007 and p=0.0014, respectively). Multivariate analysis revealed ΔTS as a strongest predictor with 9% decrease in AF risk per every 1% increment. The criterion of ΔTS ≤7.5% allows to predict AF recurrence with 81% sensitivity and 63% specificity. Conclusions Speckle tracking measurements are able to detect early mechanical changes in LA even within 24 hours of SR and these absolute changes in LVGLS as well as PALS can predict AF recurrence, with optimal stratification by novel parameter - TS. Funding Acknowledgement Type of funding source: None
Funding Acknowledgements Type of funding sources: None. Background The restoration of sinus rhythm (SR) improves the mechanical function of the heart. Purpose To assess left atrial (LA) function before and within 24 hours after successful electrical cardioversion (EC) and its prognostic value for atrial fibrillation (AF) recurrence during 24 months follow-up. Methods Prospective study involved 71 patients with non-valvular AF (mean age 64 ± 13 years, 61% male). All patients underwent echocardiography before and after EC. We analysed standard parameters in two-dimensional echo, pulse-wave Doppler and tissue Doppler echocardiography. Using speckle-tracking method we assessed peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS). Results During follow-up we noticed AF recurrence in 48 (68%) patients. Median time to AF recurrence was 2.4 (IQR 1 to 6.9) months. Left ventricular ejection fraction as well as E/E’ and PALS assessed during AF were statistically insignificant as potential predictors in univariate regression model. Receiver operating characteristic curve analysis revealed that left atrial volume index >37 ml/m² (AUC = 0.811, p < 0.0001), E/A ratio >2.1 (AUC = 0.828, p < 0.0001), A wave ≤0.4 m/s (AUC = 0.662, p = 0.01), mean E/E’ ratio during sinus rhythm >8.5 (AUC = 0.815, p < 0.0001), mean A’ wave of ≤5.5 cm/s (AUC = 0.848, p < 0.0001), PALS-SR ≤14.1% (AUC = 0.767, p < 0.0001), PACS ≤4.3% (AUC = 0.883, p < 0.0001) were the optimal cut-off values for predicting AF recurrence. Conclusions The assessment of LA and diastolic function conducted within 24 hours after successful cardioversion predicts long-term maintenance of sinus rhythm.
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