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Background: A significant portion of cryptogenic stroke is hypothesized to be secondary to cardiac embolism. However, transthoracic echocardiogram is usually delayed after stroke, and more detailed cardiac imaging is not routinely done. Aims: This study aimed to determine whether non–ECG-gated cardiac CT angiography (cCTA) during hyperacute stroke would provide diagnostic quality images and act as an adjunct modality of cardiac imaging to detect sources of emboli. Methods: In this single-center prospective cohort study, modified Code Stroke imaging was implemented with a 64-slice CT scanner, where the longitudinal axis of CT angiography was extended from the carina to the diaphragm. The primary outcomes of image quality, recruitment feasibility, impact on hyperacute time metrics, and additional radiation dose were assessed. Secondary outcomes consisted of detection of high-risk cardiac sources of embolism, mediastinal or lung pathology, and impact on etiologic classification. Results: One hundred and twenty eligible patients were enrolled, of which 105 (87.5%) had good/moderate quality images for motion artifact and 119 (99.2%) for contrast opacification. Total CT time, door-to-needle time, and door-to-groin puncture time were unchanged with the addition of cCTA. Eighty-nine patients received a final diagnosis of ischemic stroke, of which 12/89 (13.5%) had high-risk cardioembolic findings on cCTA. Incidental findings, such as pulmonary embolism (PE) (7/89, 7.9%) and malignancy (6/89, 6.7%), were observed. cCTA led to changes in management for 19/120 (15.8%) of all patients, and reclassification of stroke etiology for 8/89 (9%) of patients. Conclusions: Non–ECG-gated cCTA can be feasibly incorporated into Code Stroke and provide diagnostic quality images without delays in hyperacute time metrics. It can detect high-risk cardiac sources, and other findings impacting patient care. This may help reclassify a subset of cryptogenic stroke cases and improve secondary prevention. [ABSTRACT FROM AUTHOR]

Introduction: Severe aortic stenosis (AS) can lead to degradation of high molecular weight (HMW) von Willebrand factor (VWF) which can result in haemostatic abnormalities. While studies have explored changes in VWF profiles before and after surgical aortic valve replacement (SAVR), the longer‐term changes in VWF profiles pre‐ and post‐transcatheter aortic valve implantation (TAVI) are less understood. Aim: Our primary objective was to identify differences in VWF multimer profiles and VWF function pre‐TAVI and 1‐month post‐TAVI. Our secondary objective was to correlate VWF markers with measures of AS severity. Methods: Adult patients with severe AS referred for TAVI at our institution were prospectively enrolled in this cohort study. Blood samples were collected for plasma analysis at three time points for all patients: 1 day pre‐TAVI, 3 days post‐TAVI, and 1‐month post‐TAVI. VWF antigen, activity, propeptide, collagen binding, multimers, and factor VIII coagulant activity were determined at each time point. Correlations between VWF parameters and severity of AS were assessed. Results: Twenty participants (15 males, five females) with severe AS were recruited for the study. There was a significant increase in HMW VWF between pre‐procedure and 1‐month post‐TAVI (p <.05). There was a transient increase in VWF antigen levels and activity at 3‐days post TAVI that decreased to pre‐TAVI levels at 1‐month. There were no statistically significant correlations between VWF markers and AS severity. Conclusions: This is the first study to elucidate longer‐term (>1 week) improvements in HMW VWF after a TAVI procedure in severe AS patients. [ABSTRACT FROM AUTHOR]

Purpose: Cardiac resynchronization therapy (CRT) has been shown to improve left atrial function; however the effect on reverse electrical remodeling has been poorly evaluated. We hypothesized that CRT might induce reverse atrial electrical remodeling manifesting in the surface ECG as a shortening in P-wave duration.Methods: Patients with CRT and more than 92% biventricular pacing at minimum follow-up of 1 year were included in the analysis. Those with prior history of atrial fibrillation (AF) were excluded. Data were recorded for clinical, echocardiographic and ECG variables prior to implant and at least 12 months post implantation. Semiautomatic calipers and scanned ECGs at 300 DPI maximized × 8 were used to measure P-wave duration and diagnose advanced interatrial block (aIAB) during sinus rhythm. The occurrence of AF was assessed through analyses of intracardiac electrograms and clinical presentations.Results: 41 patients were included in the study with mean age of 67.4 ±9.6 years, 71% were male, left atrial diameter 41.1 ± 8.5 mm and LV EF 28.5 ± 6.5%. Over a mean follow up of 55 months, a significant reduction in P-wave duration (142.7 ms vs. 133.1 ms; p < 0.001) was noted. The presence of aIAB was significantly reduced (36% vs. 17%; p = 0.03). The incidence of new onset AF was 36%. Time to AF onset after CRT implantation was not influenced by a reduction in P-wave duration.Conclusion: CRT induces atrial reverse electrical remodeling manifested as a reduction in P-wave duration. Larger studies are needed to determine the impact on AF incidence after CRT implantation. [ABSTRACT FROM AUTHOR]

Background: Although detection of elevated right ventricular systolic pressure (RVSP) on routine echocardiography is common, its clinical significance is underappreciated. The recent change in the hemodynamic definition of pulmonary hypertension (PH) lowering the threshold from mean pulmonary arterial pressure ≥ 25 mm Hg to > 20 mm Hg further clouds the picture., Methods: A retrospective cohort study was performed on residents of the South East Local Health Integration Network (population 495,000), Ontario, Canada, who underwent transthoracic echocardiography at the Kingston Health Sciences Centre between February 19, 2013, and December 31, 2016. The index echocardiography from 9291 unique patients was obtained., Results: A total of 2049 patients (22.1%) had an RVSP ≥ 40 mm Hg, 2040 patients (22.0%) had an RVSP ≥ 30 and < 40 mm Hg, but only 284 patients (3.1%) had a clinical diagnosis of PH. Although patients with an RVSP ≥ 40 mm Hg had the highest Charlson Comorbidity Index (CCI) (1.81 ± 0.05) and number of hospitalizations 1 year before the echocardiography (1.24 ± 0.03), patients with RVSP between 30 and 40 mm Hg also had significantly higher CCI (1.19 ± 0.04) and hospitalization (0.87 ± 0.03) compared with the CCI (0.84 ± 0.03) and hospitalization (0.65 ± 0.02) of patients with RVSP < 30 mm Hg ( P < 0.0001)., Conclusion: Despite the finding that an elevated RVSP ≥ 30 mm Hg is common and predicts adverse outcomes, most patients with elevated RVSP are not reported as having PH or investigated. The significance of the elevated RVSP is underappreciated., (© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc.)