Effect of ivabradine on ventricular arrhythmias in heart failure patients with reduced ejection fraction

BACKGROUND/INTRODUCTION

Heart failure patients with reduced ejection fraction are at high risk for ventricular arrhythmias and sudden cardiac death. Ivabradine, a specific inhibitor of the If current in the sinoatrial node, provides heart rate reduction in sinus rhythm and angina control in chronic coronary syndromes.

OBJECTIVE

The effect of ivabradine on ventricular arrhythmias in heart failure patients with reduced ejection fraction patients has not been fully elucidated. The aim of this study was to investigate the effect of ivabradine use on life-threatening arrhythmias and long-term mortality in heart failure patients with reduced ejection fraction patients.

METHODS

In this retrospective study, 1,639 patients with heart failure patients with reduced ejection fraction were included. Patients were divided into two groups: ivabradine users and nonusers. Patients presenting with ventricular tachycardia, the presence of ventricular extrasystole, and ventricular tachycardia in 24-h rhythm monitoring, appropriate implantable cardioverter-defibrillator shocks, and long-term mortality outcomes were evaluated according to ivabradine use.

RESULTS

After adjustment for all possible variables, admission with ventricular tachycardia was three times higher in ivabradine nonusers (95% confidence interval 1.5-10.2). The presence of premature ventricular contractions and ventricular tachycardias in 24-h rhythm Holter monitoring was notably higher in ivabradine nonusers. According to the adjusted model for all variables, 4.1 times more appropriate implantable cardioverter-defibrillator shocks were observed in the ivabradine nonusers than the users (95%CI 1.8-9.6). Long-term mortality did not differ between these groups after adjustment for all covariates.

CONCLUSION

The use of ivabradine reduced the appropriate implantable cardioverter-defibrillator discharge in heart failure patients with reduced ejection fraction patients. Ivabradine has potential in the treatment of ventricular arrhythmias in heart failure patients with reduced ejection fraction patients.

Left Ventricular Mass Index Predicts Pacemaker-Induced Cardiomyopathy in Patients with Dual Chamber Permanent Pacemakers Implanted Due to Complete Atrioventricular Block

Background

Pacing-induced cardiomyopathy (PICM) occurs as a result of high-burden right ventricular (RV) pacing, which usually develops in patients with complete atrioventricular (AV) block. There is a paucity of data on the association between PICM and pre-implantation left ventricular mass index (LVMI). Thus, the purpose of this study was to analyze the influence of LVMI on PICM in patients who had dual chamber permanent pacemakers (PPMs) implanted secondary to complete AV block.

Methods

Overall, 577 patients with dual chamber permanent pacemakers (PPMs) were classified into three tertiles according to their pre- implantation LVMI. The average follow-up period was 57 ± 38 months. The baseline characteristics, laboratory and echocardiographic variables were compared between the tertiles. PICM was defined as a ≥ 10% drop in left ventricular ejection fraction (LVEF) from pre-implantation with a resultant LVEF < 50%. PICM occurred in 42 (7.2%) patients. The independent predictors of PICM development, as well as the impact of LVMI on PICM, were investigated.

Results

After controlling for confounding baseline variables, the tertile with the greatest LVMI had a 1.8 times higher risk for the development of long-term PICM compared with the tertile with the lowest LVMI, which was accepted as the reference group. A receiver operating characteristic curve analysis revealed that the best LVMI cut- off value for predicting long-term PICM was 109.8 g/m² with 71% sensitivity and 62% specificity (area under curve: 0.68; 95% confidence interval: 0.60-0.76; p < 0.001).

Conclusions

This investigation revealed that pre-implantation LVMI had a prognostic role in predicting PICM in patients with an implanted dual chamber PPM due to complete AV block.

Can left ventricle mass index predict pacemaker-induced cardiomyopathy in patients with dual chamber permanent pacemakers implanted due to complete atrioventricular block?

Background

Pacing induced cardiomyopathy (PICM) occurs due to high-burden right ventricular pacing. In patients with complete atrioventricular (AV) block, it is presumed to have a higher burden of right ventricular pacing. There is a lack of data regarding the relationship between PICM and pre-implantation left ventricular mass index (LVMI).

Purpose

This study aims to investigate the effect of LVMI on PICM in patients with implanted dual chamber permanent pacemakers (PPM) due to complete AV block.

Methods

PPM implanted 577 patients were divided into three groups according to admission LVMI. Mean duration of follow-up was 57±38 months. The baseline characteristics, laboratory and echocardiographic variables were compared between the groups. The independent predictors of PICM incidence and the effect LVMI on PICM were evaluated.

Results

Age, post-implantation QRS duration, left atrium anteroposterior diameter and LVMI were determined to predict long-term PICM. After adjustment for confounding baseline variables, tertile with highest LVMI had 1.9 times higher rates of long-term PICM compared to tertile with lowest LVMI, which was used as the reference group. A ROC analysis showed that the optimal cut-off value of the LVMI to predict long-term PICM was 109.8 mg/m2 with 71% sensitivity and 62% specificity (AUC: 0.68; 95% CI: 0.60–0.76; p&lt;0.001),

Conclusion

Pre-implantation LVMI plays an important prognostic role in predicting PICM in patients with implanted dual chamber PPM due to complete AV block.

Funding Acknowledgement

Type of funding sources: None.

Cardiac variables associated with atrial fibrillation occurrence and mortality in octogenarians implanted with dual chamber permanent pacemakers

BACKGROUND

There is a dearth of data on the predictors of atrial fibrillation (AF) and the association between AF and long-term mortality in octogenarians with dual-chamber permanent pacemakers (PPM). We investigate the occurrence of AF and whether it is associated with overall mortality among octogenarians with dual-chamber PPM implants.

METHODS

Three hundred and fifty-four patients with PPM implants were divided into two groups based on their long-term survival status. Baseline characteristics, laboratory variables, and echocardiographic variables were then compared between the groups, and independent predictors of the long-term incidence of AF and mortality were determined.

RESULTS

Multivariable Cox regression analysis performed after adjusting for the parameters in univariable analysis revealed that diabetes, urea levels, albumin levels, paced QRS duration, and the frequency of atrial high-rate episodes (AHREs) were independently associated with a long-term risk of AF in octogenarians after having dual chamber PPMs implanted. The left ventricular (LV) ejection fraction, left atrial (LA) anteroposterior diameter, and AHRE + AF (HR 1.498, 95%CI 1.003-2.237, p = 0.048) were independent risk factors for the long-term mortality in octogenarians receiving dual-chamber PPMs implants.

CONCLUSION

The occurrence of AF following dual-chamber PPM implantation is a significant prognostic factor in octogenarian patients.

Prognostic value of serum albumin for long-term mortality in patients with dual-chamber permanent pacemakers

Background: This investigation aims to examine the prognostic utility of albumin concentrations for long-term all-cause mortality in patients undergoing permanent pacemaker implantation. Methods: A total of 1798 patients who received permanent pacemaker implantation were divided into quartiles according to serum albumin concentrations. The significance of albumin in predicting long-term mortality was compared in these quartiles. Results: There was a higher rate of long-term mortality in the Q4 group compared with the Q1-3 groups (49.9 vs 15.8%). The risk of long-term mortality in the Q4 group was 3.6-times higher compared with the Q1-3 groups after adjustment for confounders. Conclusion: Serum albumin level at the time of device implantation has great value when assessing long-term mortality in patients with permanent pacemakers.

Comparative analysis of sequential pot-side-pot and kissing balloon techniques in patients with coronary bifurcation lesions treated with single stent strategy: propensity score analysis

Objectives

It is unknown whether the novel re-POT technique is more effective than commonly preferred kissing balloon inflation (KBI) in patients with non-complex coronary bifurcation lesions (CBL) treated with single-stent strategy. Our aim was to compare the efficacy of re-POT and KBI techniques in one-stent strategy of non-complex CBL.

Methods

283 patients were retrospectively analyzed (re-POT group, n=149; KBI group, n=134). Primary end-points of the study were defined as; in-hospital and 30-day mortality, contrast induced acute kidney injury (CI-AKI), stent thrombosis (ST), side branch (SB) dissection and need for SB stenting. Characteristics of patients at baseline were balanced by using propensity score inverse probability weighting (IPW).

Results

Procedure time (minute, 30.6±8.5 vs 34.3±11.6; p=0.003) and contrast volume (mL, 153.7±42.4 vs 171.1±58.2; p=0.004) were significantly lower in re-POT group. Besides, SB residual stenosis and number of patients with &gt;50% SB residual stenosis remained significantly higher in re-POT group both in general and true bifurcation subgroup analysis (20.3±19.8% vs 16.5±16.4%, p=0.02; 11.9% vs 5.7%, p=0.01 and 24.1±23.2% vs 18.8±18.7%, p=0.03; 17.6% vs 6.6%, p=0.005; respectively). Combined clinical adverse outcomes were similar between groups. (Figure 1) SB dissection (10.2% vs 20.1%, p=0.001) and need for SB stenting (12.6% vs 19%, p=0.04) were reached statistically significance in KBI group after adjustment. (Figure 2)

Conclusions

Re-POT may be a simple and safe technique with a shorter procedure time and lower incidence of adverse events in non-complex CBL treated with single-stent strategy.

Funding Acknowledgement

Type of funding sources: None. Adverse clinical outcomes; weighted

P968Comparison of re-proximal optimizing technique with kissing balloon technique in provisional stenting during primary percutaneous coronary intervention

Background

Re-proximal optimizing technique (rePOT) (POT, side branch inflation and final POT) is a new provisional coronary bifurcation stenting technique which has better results in bench tests in comparison with kissing balloon inflation (KBI) techique. A clinical study showed that rePOT had beneficial effects in terms of strut malapposition, side branch obstruction and stent geometry. But it has not been compared with KBI technique especially in patients with ST segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (p-PCI).

Purpose

The aim of our study is to compare the new rePOT technique with a known and widely used provisional stenting technique in a real-world special patient population in terms of clinical and technical aspects

Methods

51 patients with STEMI who underwent p-PCI and needed provisional side branch stenting were enrolled in a tertiary center. Patients who needed “two stent strategy” at the beginning of procedure were deferred.

Results

Results were shown in Table 1. In-hospital death, contrast induced acute kidney injury, side branch dissection, need for side branch stenting and acute stent thrombosis were lower in rePOT group but there was no statistically significance.

Table 1 rePOT group (n=23) KBI group (n=28) p value Age 51.6±11.7 51.2±9.4 0.87 Male gender 18 (78.3%) 24 (85.7%) 0.16 Diabetes Mellitus 3 (13%) 6 (21.4%) 0.43 Hypertension 5 (21.7%) 5 (17.9%) 0.73 Ejection fraction 46.8±10.6 44.8±8.4 0.43 Killip class>2 1 (4.3%) 4 (14.3%) 0.47 Stent type (DES) 21 (91.3%) 23 (82.1%) 0.34 Side branch dissection 3 (13%) 8 (28.6) 0.18 Side branch stenting 3 (13%) 6 (21.4%) 0.43 In-hospital death 2 (8.7%) 3 (10.7%) 0.81 CI-AKI 3 (13%) 6 (21.4%) 0.43 Acute stent thrombosis 0 2 (7.1%) 0.19 DES: Drug eluting stent; CI-AKI: contrast induced acute kidney injury.

Conclusion

To the best of our knowledge this is the first study which compares the new rePOT technique with KBI in patients with STEMI who underwent p-PCI and needed provisional coronary bifurcation stenting. Although results are similiar in terms of clinical and technical aspects, rePOT may be a useful and user-friendly technique in such a complex and emergent procedure.

Acknowledgement/Funding

None

Serum high-sensitivity C-reactive protein, amyloid associated protein and N-terminal proBNP levels do not predict reversible myocardial ischaemia

AIM

The aim of this study was to detect any relationship between serum high-sensitivity C-reactive protein (hs-CRP), serum amyloid-associated protein (SAA) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and reversible myocardial ischaemia during cardiovascular exercise tests and to determine whether these biomarkers could predict transient myocardial ischaemia.

METHODS

Ninety-six patients (36 women, 60 men, mean age 57 ± 8.5 years) were included in the study. Venous blood samples were taken from patients before and 15 minutes after exercise testing. SAA and hs-CRP were analysed using immunonephelometric assays (Dade-Behring, BN II, Marburg, Germany). NT-proBNP (pg/ml) was determined using the immulite 1 000 chemiluminescence immunoassay system (Siemens Medical Solution Diagnostics, Deerfiled, USA). Forty-eight patients (18 women, 30 men) with positive exercise tests were allocated to the exercise-positive group and 48 (18 women, 30 men) with negative exercise tests were put in the exercise-negative group. Coronary angiography was performed on all patients in the exercise-positive group.

RESULTS

There was no difference between the levels of hs-CRP, SAA and NT-pro-BNP before and after exercise testing in both of the exercise groups.

CONCLUSION

Serum levels of hs-CRP, SAA and NT-proBNP could not predict the occurrence of reversible myocardial ischaemia during exercise. Large-scale clinical studies are needed to clarify the status of hs-CRP, SAA and NT-proBNP with exercise.

Distribution of coagulase-negative staphylococci, including the newly described species Staphylococcus schleiferi, in nosocomial and community acquired urinary tract infections

Four hundred and four coagulase-negative staphylococci were isolated from 4905 urine specimens obtained from 4192 inpatients and outpatients. The distribution of the strains was as follows: 193 Staphylococcus epidermidis (47.8%), 171 Staphylococcus saprophyticus (42.3%), 29 Staphylococcus haemolyticus (7.2%), 5 Staphylococcus warneri (1.2%), 3 Staphylococcus schleiferi (0.7%), 2 Staphylococcus hominis (0.5%) and 1 Staphylococcus simulans (0.2%). All three Staphylococcus schleiferi strains were isolated from inpatients: a 64-year-old female, a 68-year-old male and a 3-month-old male with colony counts of 468,000 cfu/ml, 324,000 cfu/ml and 764,000 cfu/ml respectively. These findings show that among coagulase-negative staphylococci, Staphylococcus schleiferi, a newly described species of coagulase-negative staphylococci not previously reported as a uropathogen, may also cause hospital acquired urinary tract infection.

[Viral encephalitis]

Acute viral and other infectious causes of encephalitis usually produce fever, headache, stiff neck and alterations in consciousness, focal neurologic signs and seizures. A large number of viral and nonviral agents can cause encephalitis. Arthropod-borne viruses peak in summer, the tick-borne infections occur in early summer, enterovirus infections in later summer and mumps in the winter and spring.

[Lyme disease]

Lyme disease, which is caused by the tick-borne spirochete Borrelia burgdorferi, usually begins with a characteristic skin lesion erythema chronicum migrans (ECM), that may be followed by neurological or cardiac abnormalities and is accompanied by malaise, fatigue, fever, myalgia, headache, lymphadenopathy and is often followed by arthritis. The disease takes its name from Lyme, Connecticut, where the full spectrum of illness was first described in 1975. It is known to be a multisystemic infectious disease. Because culture and direct visualisation of spirochetes are often negative in Lyme disease, serological testing has been the only practical laboratory aid in diagnosis and primarily clinical findings.