Update on long-term cardiovascular risk after pre-eclampsia: a systematic review and meta-analysis

BACKGROUND/INTRODUCTION

There is a need for further studies on the cardiovascular risk of women experiencing pre-eclampsia (PE).

PURPOSE

To update the literature regarding the association between a history of PE and subsequent cardiovascular diseases, including cardiovascular death, coronary heart diseases, heart failure, and stroke, focusing on the trend in the effect size (ES) estimates over time.

METHODS AND RESULTS

Following PRISMA guidelines, from inception to May 2023, we performed a systematic review of PubMed, MEDLINE, Scopus, and EMBASE. Randomized, cohort, or case-control studies in English were included if fulfiling the following criteria:(i) The association between PE and subsequent cardiovascular disease was adjusted for clinically relevant variables, (ii) the presence of a control group, and (iii) at least 1 year of follow-up. Pooled adjusted ESs and 95% confidence intervals (CIs) were used as effect estimates and calculated with a random-effect model. Twenty-two studies met the inclusion criteria. PE was associated with a higher risk of cardiovascular death (ES 2.08, 95% CI 1.70-2.54, I2 56%, P < 0.00001), coronary artery diseases (ES 2.04, 95% CI 1.76-2.38, I2 87%, P < 0.00001), heart failure (ES 2.47, 95% CI 1.89-3.22, I2 83%, P < 0.00001), and stroke (ES 1.75, 95% CI 1.52-2.02, I2 72%, P < 0.00001) after adjusting for potential confounders. This risk is evident in the first 1-to-3 years of follow-up and remains significant until 39 years of follow-up.

CONCLUSIONS

Compared to women who experienced a normal pregnancy, those suffering from PE have about double the risk of lifetime cardiovascular disease.

One-Month Dual Antiplatelet Therapy in Patients With Chronic and Acute Coronary Syndromes Treated With Bioresorbable Polymer Everolimus-Eluting Stents

There is a paucity of data regarding the safety of a 1-month dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) in patients at high bleeding risk (HBR) presenting with acute coronary syndromes (ACS). We aimed to compare the clinical outcomes of patients at HBR with chronic coronary syndrome (CCS) or ACS treated with PCI using bioresorbable polymer everolimus-eluting stent (BP-EES) followed by 1-month DAPT. Patients at HBR who underwent PCI with BP-EES were prospectively enrolled in 10 Italian centers. All patients were treated with 1-month DAPT. In case of need for anticoagulation, patients received an oral anticoagulant in addition to a P2Y12 inhibitor for 1 month, followed by oral anticoagulation only after that. The primary end point was a composite of cardiac death, myocardial infarction, or definite/probable stent thrombosis at 12 months. Overall, 263 patients (59.4%) with CCS and 180 patients (40.6%) with ACS were enrolled. No significant difference was evident between patients with CCS and ACS for the primary end point (4.3% vs 5.6%, respectively, p = 0.497) and for each isolated component. The risk for Bleeding Academic Research Consortium (BARC) type 1 to 5 or type 3 to 5 bleedings was also similar between patients with CCS and ACS (4.3% vs 5.2%, p = 0.677, and 1.6% vs 2.9%, p = 0.351, respectively). In conclusion, among HBR patients with ACS who underwent PCI with BP-EES, a 1-month DAPT strategy is associated with a similar risk of ischemic and bleeding events compared with those with CCS.

365 ANALYSIS OF PIVOT POINTS AND SLOW CONDUCTION AREAS IN PATIENTS UNDERGOING ATRIAL FIBRILLATION ABLATION

Introduction

Little is known about progression of atrial fibrillation (AF) from paroxysmal to persistent form. Electrical remodeling may play a pivotal role in the arrhythmia transition. The aim of the study was the characterization of the atrial electrical substrate in patients suffering from AF.

Methods

Twenty-seven patients were included in the study (14 with paroxysmal AF and 13 with persistent AF). Two simultaneous electroanatomical maps of the left atrium were collected using PentaRay catheter using the parallel mapping feature [first map during sinus rhythm and a second one with an extrastimulus from coronary sinus (CS)]. We analyzed the propagation of the wavefront and we identified zones of abnormal conduction: slow conduction (SC) corridors and pivot points (PP). SC corridors were defined by the slowing of conduction velocity; pivot points were zones in which propagation pattern changed the direction of 90° or more. Maximum delay between the recording dipoles located at the extremities of the PentaRay splines was calculated. At each of these sites, EGMs were collected and analyzed in terms of amplitude and duration. We checked if areas of abnormal conduction during sinus rhythm were present or they disappeared by delivering an extrastimulus from the coronary sinus.

Results

The average number of collected EGMs per map was 4790 ± 1333 (PAF 4829 ± 1407; PsAF 4745 ± 1402).

Total abnormal conduction areas in the 27 patients were 62, 65% of which were slow conduction. Pivot points and slow conduction manifested a trend to cluster in some areas: both of them were mostly present at the ostia of pulmonary veins, in a specific segment between LAA ostium and mitral annulus and in the posterior wall. During sinus rhythm, pivot points were 29, while pacing from distal CS catheter the same zones showed normal conduction in 14 cases: they were still present in 60% in PAF group and 50% in PsAF. Slow conduction corridors, instead, show a trend to remain while pacing from CS: 76% in the first group and 78% in the second one.

Conclusions

SC corridors are fixed alterations of atrial substrate, while pivot sites may be more dynamic entities: both of them may have a key role in remodeling atrial structures and atrial fibrillation progression and maintenance. These may represent future targets for AF therapy and prevention.

539 GOING BEYOND CRT NON-RESPONSE: ECHO-GUIDED LEFT BUNDLE-BRANCH PACING

We present the case of a 56-year-old man affected by heart failure (HF) with reduced ejection fraction (HFrEF) and permanent atrial fibrillation, who previously underwent a CRT-D implant with left ventricular stimulation delivered by an epicardial pacing lead due to an unfavourable CS anatomy. We upgraded this system to left bundle branch pacing. The LBB lead was connected to the atrial plug in of the device in order to deliver multisite left ventricular pacing. The device was programmed in DDDR mode and the delay between the two LV pacing sites was chosen (modifying atrioventricular delay) after multimodality assessment (both electrocardiographic and echocardiographic) to obtain the best resynchronization and systolic performance.