C47 CORO–CT PLAQUE ANALYSIS IN ASSESSMENT OF CARDIOVASCULAR RISK

Background

Computed tomographic (CT) coronary angiography represents a non–invasive approach to assess plaque characteristics that provides information to change treatment of coronary artery disease (CAD) and to asses risk stratification.

Purpose

Analyze the differences in plaque composition between patients with different plaque features: soft unstable plaques, hard stable plaques and no plaques; identify whether there is a relationship between the plaque density and the pericoronary fat attenuation index (pFAI). Materials and methods: 372 patients retrospectively analyzed who underwent CTCA for exclusion of CAD. They were divided into three groups: 37 (10%) patients with high attenuated plaques (> 60HU), 137 (37%)with low attenuated plaques (<29 HU and a volume of at least 15 mm3 and/or 30–59 HU with a volume greater than 52 mm3) and 198 (53%) patients without significant CAD. For each patients we collected clinical, radiological and follow–up data.

Results and Discussion

Low–attenuated plaques are significantly associated with older age, male sex, dyslipidemia and diabetes mellitus (p < 0.001). Higher values of pFAI were more present in patients with soft plaques than in those with stable plaques and without plaques (p = 0.005). It was also found that soft plaques were present in more CA segments compared to stable plaques. Overall volume of soft plaque appears greater than hard plaques and mainly localized in the anterior descendant coronary artery with higher stenosis values (p < 0.001). Presence of plaques with soft or high–risk features predisposes significantly and independently (p < 0.001) to a composite outcome (death, in–hospital admissions for percutaneous angioplasty or by–pass procedures) at the follow up.

Conclusions

Coronary plaque analysis showed a good correlation between high–risk plaques and pFAI, supporting the hypothesis that the presence of high–risk plaques can be correlated to inflammatory burden. Furthermore, the presence of high risk plaques predispose to death or hospitalization for coronary intervention.

The impact of the italian law mandating an automatic external defibrillation in all sports venues on sudden cardiac arrest survival

Funding Acknowledgements

Type of funding sources: None.

Introduction

The chances of surviving a sport-related cardiac arrest depend strictly on resuscitation efforts. Since 2015, all Italian recreational and competitive sport venues must be equipped with automated external defibrillators (AEDs), and trained staff must be present during competitions. The aim of the study was to evaluate the incidence and survival rates of cardiac arrests in sport Venues in the Lombardia region of Italy before and after 2015.

Methods

We collected retrospectively data regarding all sudden cardiac arrests of presumed cardiac origin that involved both athletes and non-athletes (coaches, referees, spectators, etc.) and which occurred in sports venues of the Lombardia region in the period 2015-2019 versus those that occurred in the period 2011-2014, when automatic external defibrillators were not mandatory yet. All cases have been gathered thanks to the database built by the regional territorial emergency service (AREU) of the Lombardia region and consulting the news reported by the local and national press.

Results

Between 2015 and 2019, the incidence of cardiac arrest of presumed cardiac origin which affected athletes in sports venues of the Lombardia region was 0.19 per 100,000 inhabitants/year, versus 0.28 per 100,000 inhabitants/year in the period 2011-2014 (p<0.005). The average age of the victims was 49.9 years in 2015-2019 and 52 years in 2011-2014 (p=0.96). After the enactment of the "compulsory AED law", the proportion of cardiac arrests treated with onsite AEDs increased from 15% to 42.1% (p<0.001) and the return of spontaneous circulation (successful resuscitation) increased from 67% to 80% (p<0.05). The association between mandatory presence of AEDs in sports venues and resuscitation success in terms of ROSC was found significant (p<0.05).

Conclusions

Cardiac arrest in sports venues is a rare event and involves mainly male athletes older than 30 years old. A nationwide law mandating the presence of AEDs in all sport venues significantly increased the proportion of individuals suffering cardiac arrest who received defibrillation before the emergency medical system arrival and favorably influenced survival rates.

Prognostic role of left ventricular late gadolinium enhancement (LV-LGE) in patients who received implantable cardioverter defibrillator (ICD) for secondary prevention

Introduction

LV myocardial fibrosis detected as LGE on cardiac magnetic resonance (CMR) is a predictor of arrhythmic risk in primary prevention both in ischaemic and non-ischaemic cardiomyopathy. However, we still do not know the prognostic role of LV-LGE in patients who suffered cardiac arrest (CA).

Purpose

To evaluate the prognostic role of CMR, and in particular of LV-LGE suggesting myocardial scar, in predicting appropriate ICD interventions in secondary prevention patients.

Methods

Ninety-seven consecutive patients 1) aged ≥14 years 2) hospitalized for CA because of ventricular arrhythmias from 2009/01/01 3) who underwent/undergoing a CMR within one month from the event 4) who received/receiving an ICD for secondary prevention and 5) with at least 1 year-follow-up, were enrolled for this multicentric study.

Results

97 patients (68 males, 70%), mean age 46±16 years, were enrolled. Seventy-six percent of patients received bystander cardiopulmonary resuscitation (CPR) and ventricular fibrillation (VF) was the first rhythm in 86% of cases. ST elevation was present in 18% of cases at the admission; however, angiography was found negative in 80% of patients. Myocardial oedema and LGE were identified in 26% and 64% of patients respectively. A diagnosis was made in 83.5% of cases, while in the remaining 16.5% CA was considered idiopathic. During a four-year-follow-up, 25% of patients had appropriate ICD therapy (10% of which ATP only). A significant correlation between LGE and appropriate ICD intervention was not found (p=0.89).

Conclusions

One fourth of patients who received ICD for secondary prevention had appropriate ICD therapy during a four-year-follow-up. In this setting, LV-LGE does not provide a prognostic value.

Funding Acknowledgement

Type of funding source: None