Corneal Biomechanical Changes in Patients with Inherited Retinal Diseases

Purpose

Inherited retinal diseases (IRDs) are a group of degenerative disorders of the retina, that can be potentially associated with changes in the anterior segment, but their prevalence and impact are not known. Exploring these concomitant ophthalmologic changes with biomechanical assessment may help identify other non-retina causes of vision loss in these patients, such as corneal ectasia or susceptibility to glaucoma. This study aimed to measure and compare corneal biomechanics in patients with and without IRDs.

Methods

A total of 77 patients (154 eyes) with IRD were recruited as the study group. The control group consisted of 77 healthy adults (154 eyes) with matched age and sphere equivalents. All participants underwent a comprehensive assessment including corneal tomography (Pentacam®) and biomechanical assessment (Corvis ST®). A total of 4 second-generation biomechanical parameters and 3 indexes were collected: Ambrosio Relational Thickness (ARTh), Deflection Amplitude Ratio Max (DARM), Integrated Radius (IR) and Stiffness Parameter at Applanation (SP-A1), the final deviation value D of the Belin/Ambrosio Enhanced Ectasia Display (BAD-D), Corvis Biomechanical Index (CBI) and Tomographic Biomechanical Index (TBI).

Results

For IRD patients, there was a higher DARM (p < 0.001), lower ARTh (p < 0.001), higher CBI (p < 0.001), higher TBI (p<0.001), and higher BAD-D (p < 0.001) compared to the control group. Regarding discrimination of healthy subjects and IRD patients, ARTh was the most sensitive parameter.

Conclusion

The results showed that IRD patients tend to have softer corneal behaviour, compared to eyes without pathology, which may predispose patients to corneal ectasia or glaucoma development. ARTh could be used to screen IRD patients if a non-retina cause of vision loss is suspected.

Immunohistochemistry-Based Biomarkers and Impact on Outcomes Following Salvage Radiotherapy for Prostate Cancer

PURPOSE/OBJECTIVE(S)

Salvage radiation therapy (SRT) is a mainstay of treatment for prostate cancer patients who experience biochemical relapse following radical prostatectomy. We sought to characterize the prognostic impact of previously identified deleterious molecular phenotypes-loss of PTEN, ERG expression, and p53 mutation- upon survival in patients undergoing SRT.

MATERIALS/METHODS

We analyzed an institutional database of 320 patients treated with SRT for whom prostatectomy tissue was available; tissue microarrays (TMAs) were constructed and used for genetically validated immunohistochemistry assays for PTEN, ERG, and p53. Chi-squared and Mann-Whitney's tests were used to assess association between molecular expression and clinical risk factors for adverse survival. Uni- and multivariate Cox-proportional hazards models were constructed to determine effects on biochemical (bRFS) and metastasis-free survival (MFS), calculated from end of SRT to event.

RESULTS

Loss of PTEN (n = 123, 50%) and ERG expression (n = 118, 39.1%) were common, while p53 overexpression (signifying TP53 missense mutation) was less common (n = 21, 6.6%). On univariate Cox regression, loss of PTEN portended worse bRFS [HR 1.86; 95% CI 1.36-2.57] and MFS [HR 1.89; 1.21-2.94], with homogeneous loss associated with particularly worse MFS [HR 2.47; 1.54-3.95]. Similarly, p53 overexpression predicted worse bRFS [HR 1.95; 1.14-3.32] and MFS [HR 2.79; 1.50-5.19]. ERG expression was associated with only worse MFS [HR 1.6; 1.03-2.48]. On multivariate analysis adjusting for known prognostic features (grade, nodal involvement, pathologic stage, androgen deprivation therapy (ADT), and PSA velocity), homogeneous PTEN loss remained predictive of adverse bRFS [HR 1.73; 1.06-2.82] and MFS [HR 2.35; 1.04-5.34].

CONCLUSION

PTEN loss identified by immunohistochemistry is an independent adverse prognostic factor for both biochemical and metastasis-free survival in prostate cancer patients treated with SRT. Although clinically validated RNA expression assays also exist which are prognostic for outcomes following SRT, stromal contamination in bulk RNA could mask "loss" signals specific to tumor cells, such as PTEN. Further work is necessary to determine the optimal approach to treating patients with poor molecular prognostic features in a salvage setting.

LGE prevalence and patterns in severe aortic stenosis: When "junctional" means the same

BACKGROUND

Left ventricular (LV) remodeling in severe aortic valve stenosis (AS) is a complex process that goes beyond hypertrophic response. Reparative/replacement fibrosis is considered irreversible and has recognized value in both risk stratification and prognosis. Currently, cardiac magnetic resonance (CMR) is the gold-standard imaging technique for fibrosis identification through late gadolinium enhancement (LGE) assessment. However, its prevalence and distribution are quite variable among series. Our goal was to assess LGE prevalence and patterns in severe AS.

METHODOLOGY

Single-center prospective cohort of 140 patients with severe symptomatic high-gradient AS (mean age 72 ± 8 years; mean valvular transaortic gradient 61 ± 18 mmHg; mean LV ejection fraction by echocardiogram 58 ± 9%) undergoing surgical aortic valve replacement. Those with previous myocardial infarction and/or non-ischemic cardiomyopathy were excluded. All patients performed 1.5 T LGE-CMR prior to surgery.

RESULTS

Overall, 103 patients (74%) had non-ischemic LGE (median LGE mass 2.8 g [IQR 0.0-7.8] g), many of them with combined mid-wall and junctional enhancement pattern (36%). LGE was most frequently observed in the mid-basal segments of the interventricular septum. Seventy-four patients (53%) had non-exclusively junctional LGE. Contrary to those with junctional enhancement, patients with non-exclusively junctional LGE had higher LV volumes/mass, worse LV ejection fraction and worse global longitudinal strain.

CONCLUSION

Among patients with severe, symptomatic, high-gradient AS, LGE is frequent, primarily affecting the mid-basal interventricular septum. Contrary to junctional LGE, the presence of non-junctional LGE seems to correlate with adverse markers of LV remodeling.

Case Report: Alternaria alternata keratitis

Background

Alternaria spp are ubiquitous pigmented filamentous fungi that can cause opportunistic human infections. These molds can be found in healthy individuals and the most frequently observed clinical manifestations are skin infections, ocular mycosis, rhinosinusitis, among others. Immunosuppression (both local and systemic) as well as contact or trauma with contaminated matter are important risk and predisposing factors for ocular mycosis. Accurate diagnosis with microscopy and culture is crucial since infections by filamentous fungi are sight-threatening, and clinically indistinguishable from bacterial disease. In general terms, conventional antifungal drugs are effective.

Case Presentation

We report a case of Alternaria alternata keratitis after ocular trauma with biological material in a 44-year-old man's functional single eye, which had a good clinical and functional evolution after topical therapy with voriconazole.

Conclusion

This case accounts the importance of thinking about other etiological diagnoses in infectious keratitis refractory to the established therapy and with a history of trauma with biological material.

Histology-verified myocardial fibrosis and quantification in severe AS patients: correlation with non-invasive LV myocardial tissue assessment

Background

Myocardial fibrosis (MF) is a common finding and a potential adverse prognostic marker in several cardiac diseases, including in severe aortic stenosis (AS). While histological analysis obtained through endomyocardial biopsy remains the gold-standard for MF assessment, non-invasive cardiac imaging may offer surrogate biomarkers for fibrosis. We tried to assess the correlation between MF quantification at histopathology and cardiac magnetic resonance (CMR)-derived tissue characterization data in patients with severe AS.

Methodology

Single-center prospective cohort enrolling 71 patients with severe symptomatic high-gradient AS undergoing surgical aortic valve replacement (SAVR) (mean age 71±9 years; 49% male, mean valvular transaortic gradient 60±20 mmHg; mean left ventricle [LV] ejection fraction 58±9%). Those with past history of myocardial infarction or cardiomyopathy were excluded. All patients underwent pre-operative CMR study with LV tissue characterization and quantification. Normal T1 mapping value was defined as &gt;1021ms as per center protocol. Myocardial tissue was obtained during SAVR either through myocardial biopsy at basal LV septum or harvested from surgical myectomy specimens. Masson's trichrome stain was used for collagen/fibrosis assessment. Automatic quantification was obtained at QuPathTM digital pathology software after applying a dedicated artificial intelligence algorithm on ultra-high-resolution digital slide scanning images.

Results

Histology-confirmed MF was observed in all patients (median percentage of fibrotic myocardial tissue 15% [IQR 9–22%]). Median global T1 mapping and extracellular volume (ECV) percentage was 1048ms (IQR 1027–1078) and 24% (IQR 20–30%), respectively. Late gadolinium enhancement (LGE) with a non-ischemic pattern was present in 42 patients (59%) with a median LGE mass of 5.8g [IQR 1.0–10.2]; median percentage of 3.7% [IQR 0.6–10.4]. While neither T1 mapping (global or basal LV septum), ECV nor LGE had any significant correlation with histology-confirmed MF (Figure 1) the vast majority had significantly elevated global and basal LV septum T1 mapping – 81% and 92%, respectively.

Conclusion

In this single-center prospective study, microscopic MF was present in all patients with severe symptomatic high-gradient AS, was accompanied by elevated T1 mapping values but no correlation was found between myocardial fibrosis at histopathology analysis and CMR-derived LV tissue characterization parameters. This may not only stem from sampling (single point biopsy vs. whole myocardial tissue assessment) but also from distinct evaluation of different types of fibrosis by different methods.

Funding Acknowledgement

Type of funding sources: None.

Left ventricular remodeling in aortic stenosis patients referred for surgical aortic valve replacement

Background

Left ventricular (LV) hypertrophy is a common expected finding in aortic stenosis (AS) patients. Cardiac magnetic resonance (CMR) plays an important role as a non-invasive method for determining LV mass and volume, and to characterize the LV remodeling response in AS.

Aim

To assess the prevalence, to describe the patterns and evolution of LV remodeling (by CMR) in AS patients referred for surgical aortic valve replacement (AVR).

Methods

Single-center prospective cohort of 132 consecutive patients (73 years [68–77 years], 49% men] with severe AS: mean transaortic pressure gradient (AVmean): 61±1.5 mmHg; aortic valve area (AVA): 0.7±0.1 cm2, referred for surgical AVR, with no previous history of ischemic cardiomyopathy. Before surgery, all patients underwent electrocardiogram, complete transthoracic echocardiogram (TTE) and CMR for LV assessment and tissue characterization (mean LV indexed mass [LVMi]: 80.3±26.5 g/m2; mean end-diastolic LV indexed volume [LVEDVi]: 84.4±24.5 mL/m2 and median geometric remodeling ratio [M/V]: 0.95 g/mL [IQR 0. 81–1.08 g/mL]). Patterns of LV remodeling were investigated before and after AVR by CMR measurements of LVMi, LVEDVi and M/V. Besides normal LV ventricular structure, four other patterns were considered: concentric remodeling, concentric hypertrophy, eccentric hypertrophy, and adverse remodeling (Figure 1).

Results

Overall, 43% (n=58) of the patients had concentric hypertrophy, 30% (n=40) concentric remodeling, 22% (n=29) normal ventricular geometry, 4% (n=5) eccentric hypertrophy and in two patients we observed an adverse remodeling pattern. AVR was performed in 80 patients. At the 3rd to 6th month post-AVR assessment, LV remodeling changed to: normal ventricular geometry in 46%, concentric remodeling in 31%, concentric hypertrophy in 19%, eccentric hypertrophy in 3% and adverse remodeling in only one patient (Figure 1).

Conclusions

In this group of patients with severe aortic stenosis, concentric hypertrophy was not the sole pattern of LV remodeling and two out of every five still presented a normal ventricular geometry and mass as assessed by CMR. LV response was dynamic after AVR which stands for complex and multifactorial interaction in these group of patients despite similar valvular pathophysiology and therapeutic intervention.

Funding Acknowledgement

Type of funding sources: None.

Cardiac magnetic resonance patterns of left ventricular hypertrophy in aortic stenosis patients

Background

Left ventricular (LV) hypertrophy is a known compensatory mechanism to pressure overload in aortic stenosis (AS) patients. However, by cardiac magnetic resonance (CMR) different patterns of LV adaptation are seen in this group of patients.

Aim

To describe the patterns of LV adaptation (by CMR) and to analyze its structure and function indexes in AS patients referred for surgical aortic valve replacement (AVR).

Methods

We prospectively studied 134 consecutive patients (age: 73y [IQR 68–77y], 49% men) with severe symptomatic AS - mean transaortic pressure gradient (AVmean): 61±1.5 mmHg; mean aortic valve area: AVA): 0.7±0.1 cm2, referred for surgical AVR with no previous history of ischemic cardiomyopathy or other. All patients underwent electrocardiogram, 2D transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) before surgery for LV assessment and tissue characterization. Five patterns of LV structure were considered: normal ventricular structure (normal LV mass/volume ratio [M/V], normal LVMi and normal indexed LV end-diastolic volume (LVEDVi); concentric remodeling: increased M/V, normal LVMi; concentric hypertrophy: increased M/V and LVMi; eccentric hypertrophy: increased LVMi and LVEDVi, normal M/V and ejection fraction; and adverse remodeling: dilated left ventricle, increased LVMi and normal M/V in the context of an impaired ejection fraction. Echocardiogram and CMR structural and functional indexes were compared between these groups.

Results

At baseline study, at CMR: mean LV indexed mass [LVMi]: 80.3±26.5 g/m2; mean end-diastolic LV indexed volume [LVEDVi]: 84.4±24.5 mL/m2 and median geometric remodeling ratio [M/V]: 0.95 g/mL [IQR 0. 81–1.08 g/mL]. Overall, 22% patients had normal LV structure, 30% concentric remodeling ventricular geometry, and two patients had an adverse remodeling pattern. LV hypertrophy was the most prevalent pattern and occurred in 48% of subjects (concentric 43%; eccentric 4%). In our cohort, the severity of AS (AVmean (p&lt;0.001), LV function (LV ejection fraction [p&lt;0.001] and Global longitudinal strain [p&lt;0.001]), LV loading conditions (indexed left atrial volume [p&lt;0.001] and E/e' ratio [p&lt;0.001]) and NT-proBNP (p&lt;0.001) were related to the pattern of LV structure (Table 1).

Conclusions

In our cohort, AS patients presented several distinct patterns of LV remodeling. Disease severity, functional repercussion and loading conditions are distinct between them.

Funding Acknowledgement

Type of funding sources: None.

Left ventricular reverse remodeling in post operative aortic stenosis patients: prevalence and predictor(s)

Background

In patients with severe aortic stenosis (AS), left ventricular (LV) remodeling is believed to be a compensatory adaptive process which should reverse after aortic valve intervention. However, this is not always the rule and remodeling persistence may negatively impact post-procedural outcomes and survival.

Aim

To assess the prevalence and predictors of morphological LV reverse remodeling in severe symptomatic AS patients after surgical aortic valve replacement (AVR).

Methods

We prospectively studied 75 patients (72y [68–77y], 45% male) with severe symptomatic AS - mean gradient (AVM): 61±17mmHg; mean indexed aortic valve area (AVAi) 0.41±0.10 cm2/m2 with no previous history of ischemic cardiomyopathy, all with high gradient, 4 with low-flow, 81% with hypertension, 27% with type 2 diabetes mellitus and 35% patients with stage 3 chronic kidney disease: median MDR creat clearance: 70.4mL/min [40–102]. All patients performed pre-operative cardiac magnetic resonance (CMR) at a mean period of 3.4 months (0–17 months) before AVR and at the 3–6th months after AVR, for LV reverse remodeling assessment. It was defined as at least the occurrence of one of the following: &gt;15% reduction in LVEDVi; &gt;15% reduction in LVMi by CMR; &gt;10% reduction in geometric remodeling ratio. Clinical, AV severity data, preoperative functional LV and tissue characterization data were analyzed at multivariate regression to predict the occurrence of LV reverse remodeling.

Results

Overall, at pre-operative CMR: mean LV indexed mass (LVMi): 82±28.9 g/m2; mean end-diastolic LV indexed volume (LVEDVi): 87.4±26.6 mL/m2; mean geometric remodeling (LV mass/end-diastolic volume): 0.92±0.2 g/mL. After AVR, at echocardiographic evaluation, no patient had prosthetic obstruction or prosthetic patient mismatch: median LV-Ao gradient 12mmHg [9.1–14 mmHg]; 5 of them had mild paravalvular regurgitation. LV reverse remodeling occurred in 65 patients (88%) (Figure 1A) and these were younger, had significantly smaller preoperative AVAi and higher valvular gradients (Figure 1B). At multivariate analysis, only preoperative AVAi remained an independent predictor (odds ratio 0.85, 95% CI 0.735–0.984, p=0.029).

Conclusions

In this prospective cohort of patients LV reverse remodeling after surgical AVR was highly frequent, occurring in almost nine out of every ten patients.

Funding Acknowledgement

Type of funding sources: None.

Late gadolinium enhancement patterns in severe symptomatic high-gradient aortic stenosis

Background

Left ventricular (LV) remodeling in patients with severe aortic valve stenosis (AS) is a complex process that goes beyond hypertrophic response and may involve reparative/replacement fibrosis. Currently, cardiac magnetic resonance (CMR) is the gold-standard imaging technique for detecting focal myocardial fibrosis through late gadolinium enhancement (LGE). However, myocardial fibrosis prevalence and distribution is quite variable among series. Our goal was to assess LGE prevalence and distribution pattern in severe symptomatic high-gradient AS.

Methodology

Single-center prospective cohort of 132 patients with severe symptomatic high-gradient AS (mean age 73±11 years; 48% male, mean valvular transaortic gradient 60±20 mmHg; mean aortic valve area 0.7±0.2 cm2/m2; mean LV ejection fraction by 2D echocardiogram 58±9%), all with normal flow (except one) undergoing surgical aortic valve replacement. Those with previous history of acute myocardial infarction, ischemic cardiomyopathy or other cardiomyopathy were excluded. All patients performed 1.5T CMR assessment with LV myocardium tissue characterization prior to surgery. Segmental LGE presence was assessed by two independent operators and classified according to the AHA 16 segment model, using 5-standard deviations from remote myocardium as the signal intensity cut-off for LGE identification and quantification.

Results

Overall, 96 patients (74%) had non-ischemic LGE (median LGE mass 3.2 g [IQR 0.2–8.3] g; median percentage of LGE myocardial mass 2.5% [IQR 0.1–6.1]%); 22 patients [17%] with exclusively junctional LGE); in one patient an incidental ischemic scar (subendocardial distribution) was identified. No cases of subepicardial distribution were found. Intramyocardial LGE was most frequently observed in basal and mid-anterior and inferior interventricular septum – see Figure 1. In these segments, LGE was most often junctional at right-ventricular insertion points (54%), followed by mid-wall LGE (32%) or both sites involvement (14%).

Conclusion

LGE is frequent in symptomatic high-gradient AS patients with preserved left ventricular ejection fraction, most often presenting as junctional enhancement in basal/mid-anterior and inferior interventricular septum. Future studies may address whether distinct LGE patterns may impact patient prognosis.

Funding Acknowledgement

Type of funding sources: None.

Acute ST-elevation myocardial infarction: are men and women particular cases of STEMI ?

Funding Acknowledgements

Type of funding sources: None.

Background

ST-segment elevation myocardial infarction (STEMI) has high levels of morbidity and mortality. Multiple risk factors may contribute to clinical outcomes and some studies demonstrate gender-related differences in baseline characteristics and in-hospital management.

Purpose

To access the difference in clinical characteristics and prognostic outcomes between men and women who were admitted in our Cardiac Intensive Care Unit with STEMI diagnosis.

Methods

We retrospectively analyzed 121 non-consecutive patients with STEMI during a mean follow-up period 135 ± 31 weeks.

We accessed baseline characteristics and time course of events (symptom onset-to-door admission; time to first EKG; time to fibrinolytic therapy; door-to-cath lab time and time from fibrinolytic therapy to PCI (for patients transferred from another centers).

Primary endpoint (PE) was a composite of in-hospital cardiovascular death, arrhythmic events or STEMI evolution in Killip-Kimbal III or IV.

Secondary endpoint (SE) was in-hospital major bleeding events, considered intracerebral hemorrhage, cases of hemodynamic compromise or requiring a blood transfusion.

Tertiary endpoint (TE) included admissions to the emergency department or hospitalization by heart failure decompensation, acute or chronic coronary syndromes and all-cause mortality.

Results

Of the 121 patients, 102 were male (84.3%) and 19 (15.7%) female. The mean age was 58.3 ± 12.7 years and women had a superior mean age (69.8 ± 12.2 years) vs. Men mean age 56 ± 11.6 years.

Hypertension was more prevalent in women (84.2% vs. 47.1%, respectively; p 0.003) and also diabetes – 36.8% of women had type 2 diabetes (vs 10.8% of men) and 5.3% of these female patients requires insulin therapy (vs 2% of men; p 0.021).

According to Charlson Comorbidity Index (CCI), women had a higher disease burden with 73.7% of them included into the moderate or severe group of mortality risk, compared to 42.2% of men (p 0.014).

Conversely, less women smoke (31.6% vs. 82.2%; p &lt;0.001) and less frequently chest pain was the onset symptom (78.9% vs. 95.1%; p 0.04).

Time since symptom onset to door admission was estimated on 510 ± 1149 minutes and the mean women delay was superior (557 ± 858 minutes).

Regarding to in-hospital hemorrhagic events (secondary endpoint), female patients had a statistically significant higher risk (22.2% vs. 7.1%, p 0.045), independently of hypertension, diabetes or anticoagulant therapy (r=0.249; ANOVA p-value &lt; 0.005), but it was associated with higher CCI (p 0.033). No other gender differences in outcomes or survival function were observed.

Conclusion

Our study demonstrates gender-related differences among patients with STEMI. Indeed, women were older, had more clinical cardiovascular risk factors and tend to delay hospital admission after symptoms onset. Secondary endpoint was statistically more frequent in women, but no other differences in outcomes were observed.

Comparison of Syngas-Fermenting Clostridia in Stirred-Tank Bioreactors and the Effects of Varying Syngas Impurities

In recent years, syngas fermentation has emerged as a promising means for the production of fuels and platform chemicals, with a variety of acetogens efficiently converting CO-rich gases to ethanol. However, the feasibility of syngas fermentation processes is related to the occurrence of syngas impurities such as NH3, H2S, and NOX. Therefore, the effects of defined additions of NH4+, H2S, and NO3− were studied in autotrophic batch processes with C. autoethanogenum, C. ljungdahlii, and C. ragsdalei while applying continuously gassed stirred-tank bioreactors. Any initial addition of ammonium and nitrate curbed the cell growth of the Clostridia being studied and reduced the final alcohol concentrations. C. ljungdahlii showed the highest tolerance to ammonium and nitrate, whereas C. ragsdalei was even positively influenced by the presence of 0.1 g L−1 H2S. Quantitative goals for the purification of syngas were identified for each of the acetogens studied in the used experimental setup. Syngas purification should in particular focus on the NOX impurities that caused the highest inhibiting effect and maintain the concentrations of NH3 and H2S within an acceptable range (e.g., NH3 < 4560 ppm and H2S < 108 ppm) in order to avoid inhibition through the accumulation of these impurities in the bioreactor.

Continuous sulfide supply enhanced autotrophic production of alcohols with Clostridium ragsdalei

Autotrophic syngas fermentation with clostridia enables the conversion of CO, CO2, and H2 into organic acids and alcohols. The batch process performance of Clostridium ragsdalei was studied in fully controlled and continuously gassed (600 mbar CO, 200 mbar H2, 200 mbar CO2) stirred-tank bioreactors. The final ethanol concentration varied as function of the reaction conditions. Decreasing the pH from pH 6.0-5.5 at a temperature of 37 °C increased the ethanol concentration from 2.33 g L-1 to 3.95 g L-1, whereas lowering the temperature from 37 to 32 °C at constant pH 6.0 resulted in a final ethanol concentration of 5.34 g L-1 after 5 days of batch operation. The sulphur availability was monitored by measuring the cysteine concentration in the medium and the H2S fraction in the exhaust gas. It was found that most of the initially added sulphur was stripped out within the first day of the batch process (first half of the exponential growth phase). A continuous sodium sulfide feed allowed ethanol concentrations to increase more than threefold to 7.67 g L-1 and the alcohol-to-acetate ratio to increase 43-fold to 17.71 g g-1.

Deep learning based classification of left ventricular function from two-dimensional echocardiographic images

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Philips Healthcare

Background. Echocardiographic quantification of left ventricular function (LVF) is mainly based on ejection fraction (EF) measurements, which relies on either manual or automated identification of endocardial boundaries followed by calculation of model-based end-systolic and end-diastolic LV volumes. Recent developments in artificial intelligence resulted in computer algorithms that allow fully automated detection of endocardial boundaries and measurement of LV volumes and EF. However, this methodology is prone to errors and inter-measurement variability. We hypothesized that a fully automated deep learning algorithm could be developed, which would accurately classify LVF while avoiding volume and EF measurements. This study was designed to test the accuracy of this approach.

Methods. Deep learning algorithm was developed (Philips Research) based on convolutional neural network (CNN) that uses as input dynamic sequences of apical 2- and 4-chamber echocardiographic views obtained without ultrasound enhancing agents. We used for CNN development a database of clinical DICOM studies: a training set of 14,427 studies with normal LV function and 6,135 abnormal, and a validation set of 2,898 normal and 1,081 abnormal studies, based on Philips IntelliSpace Cardiovascular (ISCV) codes found (defined by cardiologists) in the patients’ reports. The CNN was trained to automatically classify LVF into 3 categories: (1) normal, (2) mildly-to-moderately or moderately reduced, and (3) moderately-to-severely or severely reduced. In the validation set, the automated classifications were compared to those in the patients’ reports as a reference standard. Accuracy of the automated classification was tested using contingency tables, from which sensitivity, specificity, and negative and positive predictive values (NPV, PPV) and overall accuracy were calculated for each category of LVF. Additionally, the area under ROC curve (AUC) was calculated to assess the diagnostic accuracy of the automated classification for each LVF category.

Results.  Automated classification of LVF showed high levels of diagnostic accuracy in identifying cases with LVF in all 3 categories, reflected by high AUC values: (1) 0.94, (2) 0.87 and (3) 0.97 (Figure), and overall accuracy of 0.84 (Table). 

Conclusions. Deep learning algorithm based on CNN allowed accurate automated classification of LVF, when tested on ∼4,000 clinical studies and compared to ISCV codes found in the patients’ reports. This novel fully-automated methodology may become a useful aid in the interpretation of echocardiographic images by providing the reader with a preliminary assessment of LVF. Abstract Figure.

Risk scores in predicting adverse events after an acute coronary syndrome

Funding Acknowledgements

Type of funding sources: None.

Introduction

ST-segment elevation myocardial infarction (STEMI) is a serious event that usually occur in patients with cardiovascular risk factors and is associated with great morbidity and mortality.

PARIS ischemic risk score and TIMI score were validated to evaluate ischemic risk in STEMI patients who underwent percutaneous coronary intervention (PCI) and to estimate mortality, respectively.

Despite these specific purposes, the usefulness of these scores in predicting adverse cardiovascular events (ACE) is unknown.

Objectives

To assess the prognostic value of PARIS and TIMI scores for cardiovascular events, coronary ischemic events and mortality in patients after STEMI.

Methods

Retrospective single center cohort study enrolled 103 patients with STEMI diagnosis between 2018 and 2019, during a mean follow-up period 30.30 ± 6.46 months and patients were included regardless of the reperfusion strategy.

Primary endpoint (PE) was a composite of acute coronary events (ACE), admissions to the emergency department by heart failure (HF) decompensation or chronic coronary syndrome and HF hospitalization. Secondary endpoint (SE) was ACE. Cardiovascular and non-cardiovascular death was determined.

PARIS ischemic risk score was calculated and patients were stratified into low (0-2), intermediate (3-4) or high (≥ 5) ischemic risk categories. TIMI score was also assessed.

Results

Out of 103 patients with STEMI diagnosis, the median age was 58.15 ± 12.6 years and 85,4% were male. Fifty-seven patients (55.3%) had hypertension, 45 (43.7%) dyslipidemia, 18 (17.5%) diabetes, 17 (15.5%) were obese and seventy-eight patients (75.7%) had history of smoking. Twenty (19.4%) patients had a previous acute coronary syndrome and 15 underwent PCI.

Twenty-five (24.3%) patients were included in low PARIS ischemic risk category, 53 (51.5%) in intermediate risk and 20 (19.4%) in high risk category.

PE occurred in 16 patient (15.5%) and SE in 7 patients (6.8%).

Eight patients died during the follow-up period (7.8%), 4 of cardiovascular causes (50%), 3 of non-cardiovascular causes (37.5%) and 1 of unknown cause.

PARIS ischemic risk score showed prognostic value for PE, with an area under the curve (AUC) of 0.65, 95% confidence interval (CI) 0.506-0.806 and p-value 0.039.

PARIS score also had predictive value for SE (AUC 0.816, 95% CI 0.604-1.000; p 0.004) as well as TIMI score (AUC 0.738, 95% CI 0.560 – 0.917; p 0.032).

Both scores showed a good prognostic value in evaluating all-cause mortality, with a slightly better predictive value for TIMI score (AUC 0.91, 95% CI 0.802 – 1.00) when compared to PARIS score (AUC 0.84, 95% CI 0.685 – 0.987).

Conclusion

This study revealed that PARIS and TIMI scores have a good discriminatory power to predict prognosis in STEMI patients. According to our study results, these scores could be an interesting tool to determine the likelihood of fatal and non-fatal outcomes, including ACS.

A left systolic dysfunction study in a group of breast cancer patients and its clinical impact

Funding Acknowledgements

Type of funding sources: None.

Background

 Cancer therapy-related cardiac dysfunction (CTRCD) is one of the major complications being reported in patients with breast cancer (BC) under chemotherapy, in particular with anthracyclines (A) or trastuzumab (T). CTRCD is defined as a reduction of left ventricular ejection fraction (LVEF) &gt;10% to a value &lt;50% or as a relative reduction of global longitudinal strain (GLS) &gt;15%.

Purpose

We aim to evaluate the frequency of CTRCD and its clinical impact on BC patients.

Methods

 Retrospective study of patients with BC treated with A and/or T between Jan 2017 and Dec 2018 who underwent a  transthoracic echocardiography (TTE) before, during, and after chemotherapy. We analysed their baseline characteristics and outcomes based on the type of treatment received, and focusing specially on parameters of ventricular function.

Results

 We included 128 females with median age of 54 ± 11 years-old, treated with A (78; 60.9%), T (14; 10.9%) or A followed by T (36; 28.1%).

At the end of A therapy, there was a significant decrease in LVEF (64,2 ± 5,4% vs 62.6 ± 5,3%, p &lt; 0.05) and in GLS (-20,7 ± 1.9% vs -18.8 ± 2.2%, p &lt; 0.001) compared to baseline. No change in tricuspid annular systolic velocity (S") (p = 0,842) was observed. At 2 years of follow-up, this group of patients had no significant difference in LVEF (64,58 ± 5,58 vs 62,63 ± 6,48, p = 0,053) but maintained a significant lower GLS (-20,84 ± 2,13 vs -18,51± 2,52, p &lt; 0,001) compared to baseline. A significant decrease in S’ (14,36 ± 2,55 vs 13,25 ± 2,26, p &lt; 0,05) was observed.

During T therapy, there was a significant decrease in LVEF (65,04 ± 5,41 vs 59,30 ± 6,21, p &lt; 0,001), in GLS (-21,21 ± 2,75 vs -17,89 ± 2,77, p &lt; 0,001) and in S’ (14,39 ± 3,05 vs 12,19 ± 1,62, p &lt; 0,001) compared to baseline. At the end of T therapy (with or without A), this group of patients maintained a significant decrease in LVEF (65,11 ± 5,65 vs 61,29 ± 6,39, P &lt; 0,001) and in GLS (-21.41%±2,86 vs -19.54%±3,50, p &lt; 0,01). S’ returned to normal values (p = 0,10). At 2 years of follow-up, this group of patients maintained a significant decrease in LVEF (65,00 ± 5,99 vs 61,18 ± 6,30, p &lt; 0,05) but GLS (p = 0,235) returned to normal values. No change in S’ was observed (p =0,379).

During a mean follow-up of 38 months, 35 (27%) patients developed CTRCD with a higher prevalence in patients who took A followed by T (18; 14%), 9 (7%) presented with clinical heart failure, 1 (1%) needed hospitalization, 5 (4%) needed to temporarily suspend treatment and 3 (2%) needed to definitely stop treatment.

Conclusions

 Treatment with A was associated with a decrease in LV systolic function at the end of therapy. A decrease in right ventricular (RV) systolic function was observed at 2 years of follow-up. Treatment with T was associated with a decrease in RV and LV systolic function during therapy. CTRCD occurred in 27%, mainly on patients with both A and T therapy, a frequency within literature data. CTRCD had clinical impact leading to HF and suspension of chemotherapy.

Cancer therapeutics-related cardiac dysfunction: what is the role of cardioprotective medication?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cancer therapy-related cardiac dysfunction (CTRCD) is one of the major complications being reported in patients with breast cancer (BC) under chemotherapy, in particular with anthracyclines (A) or trastuzumab (T). Guidelines recommend regular left ventricular ejection fraction (LVEF) assessments and CTRCD management with cardioprotective medication (CPM). However, while secondary prevention has already entered clinical practice, primary prevention is still in the research domain.

Purpose

Our aim was to evaluate the role of CPM and the risk of CTRCD in BC patients.

Methods

Retrospective study of BC patients treated with A and/or T between Jan 2017 and Dec 2018 who underwent a transthoracic echocardiography (TTE) before, during, and after chemotherapy. Patients with baseline LVEF &lt;50% were excluded. CTRCD is defined as reduction of EF &gt;10% to a value &lt;50% or as relative reduction of global longitudinal strain (GLS) &gt;15%. As CPM we considered angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blocker (ARB) and beta-blockers (BB).

Results

We included 128 patients, all female with median age of 54 ± 11 years-old, treated with A (78; 60.9%), T (14; 10.9%) or A followed by T (36; 28.1%).

At baseline, mean LVEF was 64,7 ± 5,7% and mean GLS was -20,8 ± 2,3.

During a mean follow-up of 38 months, 35 (27%) patients developed CTRCD with a higher prevalence in patients who took A followed by T (18; 14%), 9 (7%) presented with clinical heart failure, 1 (1%) needed hospitalization, 5 (4%) needed to temporarily suspend treatment and 3 (2%) needed to definitely stop treatment. ACEI/ARB therapy was initiated in 12 (34%) and BB therapy was initiated in 10 (29%). Twenty-one (60%) of CTRCD patients recovered. CPM initiation after CTRCD was not associated with a significant higher rate of cardiac function recovery (p = 0,682).

When comparing patients already medicated with CPM before cancer treatment (39; 30,5%) to those naïve of CPM, the first group presented a lower incidence of CTRCD (7% vs 20%) but it was not statistically significant (p = 0,473).

In patients treated with T or A + T, the group of patients treated with CPM before cancer treatment did not present a significantly lower incidence of CTRCD (p = 0,449) compared to patients CPM naïve. Nonetheless, there was a significant higher LVEF in the TTE during T therapy, after chemotherapy and at 2 years of follow-up (P &lt;0,05) in patients treated with CPM before cancer treatment compared to patients CPM naïve.

In patients treated with A (without T) there was no statistically significant difference between the two groups.

Conclusion

 In our study, pre-treatment with CPM was associated with a significant higher LVEF in patients treated with T but no significant association was found with respect to the occurrence of CTRCD. CPM initiation after CTRCD was not associated with a statistically significant cardiac function recovery.

Characterization of temporal trends of systolic and diastolic indexes over time in breast cancer patients treated with trastuzumab

Funding Acknowledgements

Type of funding sources: None.

Background

Trastuzumab therapy increases survival in patients (pts) with HER2 positive breast cancer, however, it is associated with a risk of cardiotoxicity (CT). Our aim was to: 1) assess the temporal evolution of systolic and diastolic left and right ventricular indexes during and after T therapy and 2) study the incidence of CT in this group.

Methods

Retrospective study of breast cancer pts treated with T in a single center, during 2017 and 2018, who underwent a comprehensive echocardiographic examination before, quarterly, and after conclusion of T therapy. Pts with a baseline left ventricular ejection fraction (EF) &lt;50% were excluded. CT was defined as a reduction of EF &gt;10% to a value &lt;50% or as a relative reduction of global longitudinal strain (GLS) of more than 15%.

Results

We included 50 women with mean age of 56 ± 10 years and mean body mass index (BMI) of 27 ± 5 kg/m2. Thirty-six (72%) patients underwent anthracycline chemotherapy prior to T and 44 (88%) had performed radiotherapy.

During treatment with T there was an increase of indexed left ventricle end-diastolic volume (38.6 ± 7.8 to 46.5 ± 10.3 ml/m2, p&lt;.001) and a reduction of LVEF (65.1 ± 5.4 to 59.3 ± 6.2%, p &lt; 0.001), GLS (-21.2 ± 2.7 to -17.9 ± 2.8%, p&lt;.001) and right ventricle S’ (14.4 ± 13.1 to 12.2 ± 1.6 cm/s, p&lt;.001) compared to baseline. There was no change in diastolic function parameters.

CT occurred in 23 (46%) pts, the majority based on GLS criteria (18; 78%). Heart failure symptoms were reported in 4 (8%) of these pts (1 in the GLS group and 3 in the EF group) and 3 (6%) pts had to permanently suspend therapy with T due to CT.

Patients with CT had a lower BMI (25 ± 4 vs 29 ± 4 kg/m2), but were otherwise similar to pts without CT. No association was found between pre-treatment with anthracyclines or radiotherapy with the risk of CT.

An echocardiographic revaluation at 2 years from treatment with T revealed a tendency for LVEF improvement (58.7 ± 7.1 to 61.2 ± 6.3%, p=.059) and a significative recovery of GLS (-17.4 ± 3.5 to -19.1 ± 3.3%, p=.026). No significative variations were found on right ventricular systolic function indexes or on diastolic parameters.

During a follow-up of 43 (IQR 32–47) months, 7 (14%) pts had tumor relapse and 1 (2%) died. CT was not associated with the composite endpoint of tumor relapse or death (p = 0.585).

Conclusion

T therapy is associated with a significative reduction on left and right ventricle systolic indexes during treatment. Although left ventricle systolic function tends to normalize over time, this does not happen with the right ventricle. CT induced by T had clinical impact leading to overt heart failure in 8% of pts and treatment discontinuation in 6% of pts.  A lower BMI was associated with CT, which may be taken into account when defining the treatment strategy.

Hemorrhagic risk scores in hospitalized patients with acute coronary syndrome: can they (only) predict bleeding events?

Funding Acknowledgements

Type of funding sources: None.

Introduction

Acute coronary syndrome (ACS) is a life-threatening condition and its therapeutic approach increases the risk of important bleeding events which are associated with a worse prognosis. Along with hemorrhagic events, a drop on hemoglobin level not related to bleeding or the development of anemia could have a negative impact on prognosis.

Both CRUSADE and PARIS bleeding risk scores are used to evaluate and to stratify the risk of major bleeding in ACS. However their actual predictive value has been questioned and validity of these scores in predicting in-hospital mortality (IHM) is not established.

Objectives

To evaluate the actual prognostic value of CRUSADE and PARIS bleeding scores in ACS patients during their hospitalization stay.

Methods

Retrospective single center cohort study including 103 hospitalized patients after an acute ST-segment elevation myocardial infarction (STEMI) regardless of its reperfusion strategy.

In-hospital major hemorrhagic events (IHMHE), considered intracerebral hemorrhage, those resulting in hemodynamic compromise or requiring a blood transfusion, were assessed. Data on hemoglobin levels (HL) at hospital admission and at the time of hospital discharge were also collected and a composite endpoint (CE) of IHMHE and a drop in HL  ≥ 3g/dL were elaborated.

Both scores were calculated for each patient, its predictive value and their impact on IHM were determined.

Results

Out of 103 patients enrolled, the median age was 58.15 ± 12.6 years and 85.4% were male.

Two IHMHE occurred, twenty patients (19.4%) had anemia at the time of hospital discharge and 16 of these patients (15.5%) were not anemic at the time of hospital admission. Nine (8.7%) patients had a drop in their HL of at least 3g/dL.

The five bleeding risk categories defined by CRUSADE investigators were used, with 48 (46.6%) patients in the very low risk category, 9 (8.7%) and 6 (5.8%) in the high and very high risk category, respectively.

Hospitalization length stay was 5.6 ± 4.1 days with an overall in-hospital mortality (IHM) of 5.8%.

Receiver operating characteristic curve (ROC) analysis showed that CRUSADE score had an excellent discriminatory power for the CE (AUC 0.927, 95% CI 0.854-1.000) and the PARIS score had an acceptable discriminatory value (AUC 0.775, 95% CI 0.616-0.935).

Both CRUSADE and PARIS bleeding scores also had prognostic value in evaluating IHM (AUC 0.929, 95% CI 0.856-1.000 and AUC 0.788, 95% CI 0.634-0.942, respectively).

No specific and independent predictors of IHMHE were found, neither related to individual characteristics nor to therapeutic approach.  

Conclusion

The presenting study showed that CRUSADE and PARIS scores still have discriminatory power to assess CE and to assess IHM in ACS patients. Their addition to stratification tools could be of interest.

Sweet potato (Ipomea batatas) feed affects intake, digestibility and nitrogen retention of ovine fed with ryegrass hay (Lolium multiflorum Lam)

ABSTRACT This study aimed to evaluate sweet potato feed as an alternative energy supplement for ovine. A latin-square design was used to assess the effects of feeding the animals 0, 0.5, 1 and 1.5% their body weight in sweet potato as well as ryegrass hay (Lolium multiflorum) twice daily, mineral salt and water ad libitum. During this study 8 males were housed in metabolic cages with urine and feces collectors. Each round of experimentation consisted of 14 days adaptation followed by 5 days evaluating the diet, left-overs, feces, and urine to determine intake, digestibility, and nitrogen retention. The results show a linear increase in intake of ryegrass hay, FDN, DM and OM because of the increasing supplementation levels. Similarly, we observed a linear increase in DM and OM intake, as well as in the OM digestibility. Additionally, BP digestibility decreased considering nitrogen excretion. In conclusion, sweet potato feed is a viable alternative for ovine receiving ryegrass hay since it increased DM and OM digestibility, albeit reducing NDF and BP digestibility.

Usability of a telehealth solution based on TV interaction for the elderly: the VITASENIOR-MT case study

Remote monitoring of biometric data in the elderly population is an important asset for improving the quality of life and level of independence of elderly people living alone. However, the design and implementation of health technological solutions often disregard the elderly physiological and psychological abilities, leading to low adoption of these technologies. We evaluate the usability of a remote patient monitoring solution, VITASENIOR-MT, which is based on the interaction with a television set. Twenty senior participants (over 64 years) and a control group of 20 participants underwent systematic tests with the health platform and assessed its usability through several questionnaires. Elderly participants scored high on the usability of the platform, very close to the evaluation of the control group. Sensory, motor and cognitive limitations were the issues that most contributed to the difference in usability assessment between the elderly group and the control group. The solution showed high usability and acceptance regardless of age, digital literacy, education and impairments (sensory, motor and cognitive), which shows its effective viability for use and implementation as a consumer product in the senior market.

Two-dimensional radiographs versus cone-beam computed tomography in planning mini-implant placement: A systematic review

Background

This study aimed to compare two-dimensional radiographs and cone beam computed tomography (CBCT) images for mini-implant planning.

Material and Methods

A search was performed in PubMed, Embase, Web of Science, Cochrane Library and Google Scholar electronic databases according to PIRD strategy, on September 11, 2021. In vivo studies that compared two-dimensional imaging with CBCT for mini-implant planning were selected. The methodological quality of each study was assessed using the QUADAS-2 tool.

Results

The initial search identified 441 papers. Five studies were added following a manual research. Of the total 446 studies, 40 were selected after title evaluation, 29 remained after abstract evaluation, and 11 were left after full-text analysis. Final screening yielded a total of four studies that composed the narrative synthesis of this systematic review. When comparing the imaging systems for palatal mini-implants, lateral radiographs (LRs) showed approximately the same measurements of bone quantity as those of CBCT, hence bearing no influence on placement site selection. In determining image suitability for interradicular mini-implants, two-dimensional radiographs underestimated the available space.

Conclusions

Lateral radiography is sufficient to quantify the available bone for planning mini-implants installed on the palate, in the median region of upper first premolars. CBCT enhances interradicular mini-implant planning by aiding in implantation site selection, and improving the installation success rate.

Key words:Systematic Review, Cone beam computed tomography, Radiography, Orthodontic mini-implant, Dental planning.

STEMI treatment in remote areas – challenges of the only interventional angioplasty center located in an archipelago

Background

In remote islands lack of specialized medical facilities, long distance transfer and emergency medical system organization remains a challenge and fibrinolysis is necessary to achieve revascularization in optimal timing in ST-elevation myocardial infarction (STEMI) patients. Our angioplasty center is the only one located in an archipelago composed of nine islands, six of which do not have hospital facilities and only have small family health care units.

Purpose

To evaluate the reality and outcomes of our interventional angioplasty center and compare cardiovascular outcomes between STEMI patients from the main island and remote islands.

Methods

We retrospectively evaluated 103 patients with STEMI admitted to our center between 2018 and 2019. Patients from the main island where the center is located underwent primary percutaneous coronary intervention (PCI) (group 1, n=55) and patients from remote islands underwent fibrinolytic therapy followed by transference to our center with facilitated or rescue PCI (group 2, n=48). A subanalysis of the far remote islands without hospital facilities was also performed. Primary outcome was defined as cardiovascular death or re-infarction at two years and secondary outcome as intrahospital haemorrhagic complications.

Results

Mean age was 58,15±12,6 years, 85,4% were males and follow up period was 30,30±6,46 months. Seventy-eight patients (75,7%) had history of smoking, 45 (43,7%) dyslipidemia, 20 (19,4%) previous acute coronary syndrome, 18 (17,5%) diabetes and 17 (15,5%) were obese. Troponin I peak was 117,42±129,06 ug/L and 14 (13,6%) were in Killip Class III/IV. Infarct-related artery was the left anterior descending artery in 45 (45,5%) and multivessel disease was present in 38 (38,0%). In group 1 reperfusion after PCI was obtained in 91,5%. In group 2, 73,5% met criteria for reperfusion after fibrinolysis and 23,6% after rescue PCI. Mean time from fibrinolysis to PCI was 558±349 minutes. Rates of successful revascularization did not differ between groups, as well as complete patency of the culprit-vessel defined as thrombolysis in myocardial infarction (TIMI) flow 3 (91,5% vs. 97,2% and 90,0% vs. 93,0% respectively for group 1 and 2). Cardiovascular death at two years occurred in 4 (3,9%) patients and re-infarction in 11 (10,7%) and were similar between groups (3 (5,5%) vs. 1 (2,1%) and 8 (14,5%) vs. 3 (6,3%) respectively) as well as haemorrhagic complications (1 (1,8%) vs. 5 (10,4%) respectively). Nineteen (18,4%) patients were from far remote islands without hospital facilities and when comparing these patients with the others there was also no difference in primary outcome.

Conclusion

Even in remote islands, an organized STEMI network with attempted fibrinolytic treatment and coordinated transference of patients for facilitated or rescue PCI can provide successful revascularization with cardiovascular outcomes similar to those submitted to primary PCI.

Funding Acknowledgement

Type of funding sources: None.

Non-ST elevation myocardial infarction in patients with previous CABG: what is the best treatment option?

Background

Current European Society of Cardiology guidelines recommend an invasive strategy (IS) for the treatment of non-ST elevation myocardial infarction (NSTEMI) patients, but the clinical trials that support this recommendations included only a few patients with previous coronary artery bypass graft (CABG).

Purpose

To characterize NSTEMI patients with previous CABG who underwent medical and invasive management and to evaluate the prognostic impact of the type of strategy used.

Methods

Retrospective analysis of a cohort of patients from a multicenter national registry diagnosed with NSTEMI with a previous history of CABG between 2010 and 2021. Patient's baseline demographics, medical history and in-hospital management data was collected. Outcomes of in-hospital and six months follow-up all-cause mortality were accessed.

Results

A total of 890 patients were included in the analysis. Of these, 470 were medically managed (MM) – this group included 249 patients (53.1%) who underwent coronary angiography but did not perform any further revascularization. The remaining 420 underwent an invasive strategy (IS) and performed additional revascularization, mainly percutaneous (only 1 patient submitted to reCABG). Mean age was similar (MM 72±10 vs IS 71±10 years, p=0.147) and most patients were male (MM 81.5% vs IS 83.8%, p=0.362). MM patients had more chronic kidney disease (16.7% vs 9.9%, p=0.003), peripheral artery disease (20.5% vs 15.0%, p=0.003) and heart failure (20.5% vs 11.9%, p&lt;0.001). Main presenting symptom was chest pain in both groups, however it was more frequent in the IS group (89.4% vs 94.5%, p=0.006) and dyspnea in the MM patients (6.3% vs 3.1%). Mean left ventricle ejection fraction was similar between groups (MM 49±12% vs IS 50±11%, p=0.290). Although the GRACE risk score was available for only 124 patients, high risk patients (GRACE score &gt;140) were equally distributed among the two groups (55.9% vs 48.2%, p=0.395). An IS was associated with significant lower in-hospital mortality (4.5% vs 1.7%, OR 0.37, 95% CI 0.15–0.87, p=0.018). At six months follow-up an IS was also associated with lower mortality (6.6% vs 2.4%, HR 0.18, 95% CI 0.06–0.52, p=0.002), even after adjusting for the baseline differences (HR 0.41, 95% CI 0.20–0.85, p=0.016).

Conclusions

In this cohort of patients with NSTEMI and previous CABG, an IS was linked to better outcomes during hospitalization and during six months follow-up. Randomized clinical trials are needed to address this issue.

Funding Acknowledgement

Type of funding sources: None.