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Background. The prevalence of nonalcoholic fatty liver disease (NAFLD) has been increasing. This study aimed to evaluate the prevalence of NAFLD, as diagnosed by ultrasound, in patients with acute coronary syndrome (ACS) and to assess whether NAFLD is associated with the severity of coronary obstruction as diagnosed by coronary angiography. Methods. We performed a prospective single-center study in patients hospitalized due to acute coronary syndrome who underwent diagnostic coronary angiography. Consecutive patients who presented to the emergency room were diagnosed with acute coronary syndrome and were included. All patients underwent ultrasonography of the upper abdomen to determine the presence or absence of NAFLD; NAFLD severity was graded from 0 to 3 based on a previously validated scale. All patients underwent diagnostic coronary angiography in the same hospital, with the same team of interventional cardiologists, who were blinded to the patients’ clinical and ultrasonographic data. CAD was then angiographically graded from none to severe based on well-established angiographic criteria. Results. This study included 139 patients, of whom 83 (59.7%) were male, with a mean age of 59.7 years. Of the included patients, 107 (77%) patients had CAD, 63 (45%) with serious injury. Regarding the presence of NAFLD, 76 (55.2%) had NAFLD including 18 (23.6%) with grade III disease. In severe CAD, 47 (60.5%) are associated with NAFLD, and 15 (83.3%) of the patients had severe CAD and NAFLD grade III. Conclusions. NAFLD is common in patients with ACS. The intensity of NAFLD detected by ultrasonography is strongly associated with the severity of coronary artery obstruction on angiography.

Background: Whether reprogramming of cardiac resynchronization therapy (CRT) to increase electrical synchrony translates into echocardiographic improvement remains unclear. SyncAV is an algorithm that allows fusion of intrinsic conduction with biventricular pacing. We aimed to assess whether reprogramming chronically implanted CRT devices with SyncAV is associated with improved echocardiographic parameters. Methods: Patients at a quaternary center with previously implanted CRT devices with a programmable SyncAV algorithm underwent routine electrocardiography-based SyncAV optimization during regular CJC Open 2 (2020) 62e70

Background Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in heart failure with reduced ejection fraction (HFrEF). CRT efficacy is greater in left bundle branch block (LBBB). This study aimed to determine if strict LBBB criteria predict an improved QRS duration and left ventricular ejection fraction (LVEF) response after CRT. Methods HFrEF patients who received a CRT device at a single quaternary center were included. Patients were divided into three groups based on baseline QRS morphology. Group 1 consisted of patients with strict LBBB. Group 2 had conventional LBBB, and group 3 had non‐LBBB morphology. Outcomes assessed included change in QRS duration after CRT, change in LVEF, and all‐cause mortality. Results In 231 patients, 56% of patients were in group 1, 29% were in group 2, and 15% were in group 3. Patients with strict LBBB had a significant reduction in QRS duration (–20.9 ± 12.4 ms) compared to conventional LBBB (6.7 ± 19.4 ms; P < 0.0001) and non‐LBBB (3.9 ± 29.3 ms; P < 0.0001). Patients with strict LBBB had a significant increase in LVEF (19.5 ± 10.2) compared to conventional LBBB (5.3 ± 12.6; P < 0.0001) and non‐LBBB (–1.3 ± 10.9; P < 0.0001). There was moderate negative correlation between changes in QRS duration and LVEF (correlation coefficient = –0.63, P < 0.0001). Strict LBBB criteria were associated with a significant reduction in mortality compared to conventional LBBB (odds ratio 0.49, 95% confidence interval 0.24 to 0.99; P = 0.046). Conclusions Strict LBBB predicted a reduction in QRS duration and an increase in LVEF compared to conventional LBBB and non‐LBBB morphology in patients with HFrEF who received CRT.

Background/Introduction Non-alcoholic fatty liver disease (NAFLD) has been significantly associated with atherosclerotic disease independent of classical risk factors. However, the role of NAFLD in this context remains unclear. The systemic inflammation described in NAFLD related to liver disease progression may be one factor that can influence the progression and instability of atherosclerotic disease and, consequently, in the clinical characteristics of acute coronary syndrome (ACS). Purpose To assess the potential relationship between NAFLD and ACS severity. Methods We performed a retrospective study in adult patients with ACS who presented to the emergency room of a quaternary care medical centre between March 2015 and March 2016 and selected 99 patients without previously known coronary artery disease or liver disease, without a history of significant alcohol consumption, terminal disease, other acute illness, use of statins, amiodarone, or other steatogenic drugs. The diagnostic criteria for acute myocardial infarction (AMI) with ST-segment elevation (STEMI) were ST elevation ≥1mm in ≥2 contiguous leads (2mm for leads V1 to V3). The acute myocardial infarction without ST-segment elevation (NSTEMI) diagnostic was established in patients who did not meet the criteria for STEMI and who had elevated necrosis markers (creatine kinase-MB isoform and troponin I). Unstable angina (UA) diagnostic was established in patients who did not meet the criteria for STEMI and NSTEMI but had more than three cardiovascular risk factors and typical thoracic pain. The presence of steatosis and its degrees was assessed using ultrasound, and the diagnosis of NAFLD was based on the presence of steatosis and clinical history. Results The diagnosis of UA, NSTEMI and STEMI was established in 40, 33 and 26 patients, respectively, and NAFLD was observed in 30%, 66.6% and 76.9% of these patients. NAFLD patients were 5.8 times more likely to have a diagnosis of AMI than UA (p&lt;0.001), were 7.88 times more likely to have a diagnosis of STEMI than UA (p&lt;0.001) and were 4.7 times more likely to have a diagnosis of NSTEMI than UA (p&lt;0.01). Patients with grades 2 and 3 liver steatosis were 4.2 times more likely to have a diagnosis of AMI than UA (p&lt;0.01) and were 8.2 times more likely to have a diagnosis of STEMI than UA (p&lt;0.01). There was no significant relationship between other variables evaluated and the clinical presentation of ACS. Conclusion(s) In this study, the frequency of AMI presentation in NAFLD patients with ACS was significantly higher than the frequency of UA, suggesting a significant relationship between NAFLD and the severity of ACS, independent of the classic risk factors assessed. The results also suggest that the steatosis degree can proportionally influence this context. Therefore, NAFLD could be considered a potential risk marker for coronary atherosclerotic disease progression and instability. FUNDunding Acknowledgement Type of funding sources: None.