Funding Acknowledgements Type of funding sources: None. Introduction Since mitral regurgitation (MR) is a very common finding in patients with hypertrophic cardiomyopathy (HCM), the evaluation of the mitral valve anatomy and the degree of MR is of utmost importance in this population. However, data regarding the prognostic value of different degrees of MR in HCM remains scarce. Purpose The aim of this study was to determine whether the presence of a higher degree of MR affects: 1) long term prognosis; 2) clinical and echocardiographic presentation of HCM patients. Material and Methods We included prospectively 102 patients, diagnosed with primary asymmetric HCM. The degree of MR was determined echocardiographicaly according to current recommendations of the American Association of Echocardiography. According to the MR severity, patients were divided into 2 groups: Group 1 (n = 52) with no/trace or mild MR and Group 2 with moderate or moderate to severe MR. All patients had clinical and echocardiographic examination, 24-hour Holter ECG and NT pro BNP analysis performed. The primary outcome was a composite of: 1) HCM related death or sudden death; 2) hospitalization due to acute heart failure; 3) sustained ventricular tachycardia; 4) ischemic stroke. Results Patients with higher MR degree had more frequent chest pain (p = 0.039), syncope (p = 0.041) and NYHA II functional class (p < 0.001). Group 2 patients had mostly obstructive form of HCM (p < 0.001) with more frequent presence of previous atrial fibrillation (AF) (p = 0.032), as well as the new onset of AF (p = 0.014) compared to patients in Group 1. Patients with higher MR degree had significantly more SAM (p < 0.001) resulting in a more frequent eccentric MR jet (p < 0.001), along with calcified mitral annulus (p = 0.007), enlarged left atrial volume index (p < 0.001), and elevated right ventricular pressure (p = 0.001). As a result of higher MR grade, Group 2 had higher E/e" values (p < 0.001), elevated LV filling pressure (lateral E/e’ >10), as well as higher levels of NT pro BNP (p = 0.001). By Kaplan-Meier analysis we demonstrated that the event free survival rate during follow up of median 75 (IQR 48-103) months was significantly higher in Group 1 compared to the Group 2 (79% vs. 46%, p < 0.001), Figure 1. After adjustment for relevant confounders, moderate/moderate to severe MR remained as an independent predictor of adverse outcome (hazard ratio 2.58, 95% CI: 1.08-6.13, p < 0.001). Conclusion Presence of moderate, or moderate to severe MR was associated with poor long-term outcome of HCM patients. These results indicate the importance of an adequate MR assessment and detailed evaluation of the mitral valve anatomy in the prediction of complications and adequate treatment of patients with HCM. Abstract Figure.
Funding Acknowledgements Type of funding sources: None. Background Widespread awareness of modifiable cardiovascular risk factors (MCRF) may be fundamental to reduce the burden of cardiovascular diseases (CVD). However, the lack of doctor-patient communication (DPC) about personal cardiovascular risk (pCVR) could affect prevention achievement. Purpose To assess the frequency of DPC about pCVR as potential target for preventive strategy improvement in a very high risk country. Methods The pilot study included convenience sample of 795 adults from Serbia divided in two groups, depending on the presence of at least one of five MCRF (hypertension, hyperlipidemia, diabetes mellitus, obesity, smoking). They were compared according to demographics (age, gender, education, incomes, place of residence), awareness of MCRF as contributing factors to CVD, interest in pCVR, preferable source of information about pCVR and frequency of DPC about pCVR. The data were collected by voluntary filling of survey with multiple choice questions from April 1st to June 30th 2022. Results There were significantly more respondents with MCRF (75% vs 25%, p<0.01). Those with MCRF were older (50±14 vs 39±11, p<0.01), less educated (49% vs 22% with only high school or less, p<0.01) and had lower incomes (53% vs 40% with less than average incomes, p<0.01). No significant difference was observed according to gender (43% vs 38% of males, p>0.05) and place of residence (85% vs 90% from urban area, p>0.05). The majority in both groups showed high awareness of MCRF as contributing factors to CVD (95% vs 96% for hypertension, 95% vs 95% for hyperlipidemia, 89% vs 85% for diabetes mellitus, 93% vs 91% for obesity, 83% vs 84% for smoking; p>0.05). Both groups were very interested in pCVR (89% vs 89%, p>0.05) and opted for their doctors as the most preferable source of information about pCVR (89% vs 91%, p>0.05). On contrary, only the minority in both groups had DPC about their pCVR, although it was higher in the group with MCRF (34% vs 14%, p<0.01) and increased proportionally to the number of present MCRF. Conclusions The study showed high awareness of MCRF and high interest in pCVR, independently of MCRF presence or demographic characteristics. Despite that, there is a notable lack of DPC about pCVR. Since doctors have been chosen as the most desirable source of information, they should make efforts to discuss pCVR with patients, as this may be the crucial part of the preventive strategy.
compared to CRUSADE (AUC 0.76), that is mantained when we compared the risk status of the two scores (AUC 0.78 vs. 0.72). For an ATRIA>2.5pts we have a sensitivity (S) of 74% and specificity (E) of 75% for HE vs. S of 71% and E of 68.8% with CRUSADE>28.5pts. Conclusion:The ATRIA bleeding score proved to be useful for stratifying the risk of HE in P undergoing PCI. The comparison with the CRUSADE score, currently validated for this type of population, allowed us to verify that the ATRIA bleeding is superior in its performance. Its use in clinical practice may allow a better stratification and a more individualized approach to hemorrhagic risk. Having a pre-procedure Hgb of less than 11 g/L had the major impact on choice of stent used during PCI (OR: 0.51; 95% CI: 0.45 to 0.57; p<0.001). Within the HBR patient, having 3 or more HBR criteria was associated with less likelihood to receive DES than patients with one or two risk factors (OR: 0.50; 95% CI: 0.44 to 0.57; p<0.001). When we looked into the trends of DES use on HBR population, there was slow increase then slowed down around 2006 when FDA has released stent thrombosis alert. With the development of second generation DES, there was increase again of DES in HBR population. P5122 | BEDSIDE Conclusions:Presence of HBR has a significant impact upon the decision to use DES. The optimal treatment of patients with at least one HBR risk factor needs to be further explored. Background: Bleeding events in relation to primary percutaneous coronary intervention (pPCI) in ST-segment elevation Myocardial Infarction (STEMI) has been shown to have a strong association to short-and long-term mortality. However, arterial access, anticoagulation and antiplatelet strategies vary between studies and new regimens have evolved. Purpose: To investigate incidences and predictors of serious in hospital bleeding events in a contemporary STEMI population consisting of the DANAMI-3 patient population. P5123 | BEDSIDE Incidences and predictors of serious bleeding events in a contemporary STEMI population. A DANAMI-3 substudy Methods:The Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction (DANAMI-3) aimed to improve outcome in STEMI patients by different revascularization strategies. This nationwide all-comer study included 2217 STEMI patients with symptom duration under 12 hours. In this substudy, hospital charts from admission and until discharge, were read in order to detect in hospital bleeding episodes. Bleeding events were assessed using TIMI criteria. Results: Pre-hospital antithrombotic medication consisted of 10.000 units unfractionated heparin in 96% of patients, and a similar proportion received 300 mg aspirin in combination with loading of either Clopidogrel, Ticagrelor or Prasugrel before arrival in the cath.lab. A total of 76% received additional bivalirudin and/or glycoprotein inhibitor (GPI) (19%) during and after pPCI. Access site was femoral in 94%. In hospital non-CABG related TIMI major bleeding occurred in 16 (0.7%...
a canine model with MI, with higher T2 values in the infarct. We investigated its reproducibility in the clinical setting using native T1-and T2-mapping CMR in ST-segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PPCI). Methods: We included STEMI patients with CMR performed at median of 3 (2-4) days, and excluded those with late microvascular obstruction, intramyocardial haemorrhage or >75% transmural extent of infarct. One short-axis slice per patient of native T1-mapping by Modified Look-Locker Inversion sequence, T2-mapping, and late gadolinium enhancement (LGE) images were analysed. Manual ROIs were drawn in the infarcted, salvaged and remote myocardium using CVI42 (Figure 1). Results: Out of 48 STEMI patients, 15 met the inclusion criteria. Majority (13/15) were males with median age of 56 (42-67) years old. Median MI size was 19 (10-28)% of the left ventricle (%LV) and area-at-risk was 39 (31-53)%LV. T2 values in the infarcted and salvaged myocardium were higher than remote myocardium (T2infarct: 64±5ms versus T2remote: 48±3ms, P<0.001; T2salvage 62±7ms versus T2remote: 48±3ms; P<0.001). However, there was no difference between T2infarct and T2salvage (P=0.45). A similar pattern was observed with native T1 mapping (T1infarct: 1284±81ms versus T1remote: 993±49ms; P<0.001; T1salvage 1235±61ms versus T1remote: 993±49ms, P<0.001, T1infarct versus T1salvage; P=0.38). Conclusion: Native T1 and T2-mapping CMR were unable to distinguish between infarcted and salvaged myocardium in reperfused STEMI patients. LGE remains the gold standard for identifying infarcted myocardium, whereas T1 and T2-mapping remain the reference to detect oedema-based area-at-risk.
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