Search

Introduction: The efficiency of drug-coated balloon (DCB) percutaneous coronary intervention (PCI) has been shown for in-stent restenosis (ISR) and native small-vessel disease, with available data showing similar outcomes in both chronic kidney disease (CKD) and non-CKD patients1. The aim is to compare the incidence of target lesion restenosis at follow-up (FUP) coronary angiography in patients with and without CKD receiving DCB PCI. Patients and Methods: The registry included patients undergoing a DCB PCI at the University Hospital Centre Zagreb from February 2011 to January 2023 (n=652). Patient demographics, comorbidities, pharmacotherapy, as well as data on the initial and FUP coronary angiography/PCI was collected. Chronic kidney disease was defined as estimated glomerular filtration rate < 45 ml/ min/1.73m2. A FUP angiography was performed in 49% of patients (n=317), with a median FUP of 6 (interquartile range 3 - 18) months, without difference between groups. Results: Data is shown in Table 1. The cohort was 75% male, mean age 65 ± 10 years. CKD was present in 9% (n=57) of patients and was associated with a higher incidence of arterial hypertension, diabetes mellitus, atrial fibrillation, as well as peripheral artery disease. The age difference was noted between groups, with CKD patients being older on average. At initial PCI, more CKD patients had multivessel coronary disease, with a higher rate of ISR as the indication for DCB, that was not statistically significant (CKD vs non-CKD: 46% vs 34%, p=0.075). After DCB, no difference was noted between groups in regards to the need for a bail-out PCI (9% VS 6%, P=0.375). FUP was performed in an equal percentage of patients in both groups (48% vs 51%, p=0.769), with no differences seen in the incidence of restenosis (17% vs. 18%, p=0.998), the need for target lesion PCI (17% vs. 13%, p=0.533), or the use of anti-anginal drugs. Conclusion: The findings of our single-centre analysis show that patients with CKD do not have a higher risk of target lesion restenosis after DCB PCI, when compared to the non-CKD group, which is in accordance with currently available evidence2. [ABSTRACT FROM AUTHOR]

Introduction: Influenza affects millions worldwide every year. Although most cases are mild, severe complications can occur, including myocarditis1. Extracorporeal membrane oxygenation (ECMO) is a treatment option for patients with severe respiratory and/or cardiac failure. We present a case report of a patient with influenza-induced myocarditis and subsequent heart failure treated successfully with ECMO. Case report: 21-years-old male with no known history of medical illness presented to the Emergency Department at University Hospital Centre with fever, cough, and shortness of breath starting three weeks earlier. Chest X-ray showed pneumonia, PCR was COVID-19 negative but influenza positive. 12- lead electrocardiogram showed diffuse ST-segment elevation, cardiac biomarkers were elevated, and echocardiography verified reduced left ventricular ejection fraction (LVEF) of 44% with pericardial effusion. Patient was diagnosed with acute myopericarditis and pneumonia, admitted to hospital and started on broad-spectrum antibiotics. Four days later patient’s respiratory distress worsened requiring intubation and mechanical ventilation. Hemodynamic status deteriorated requiring noradrenaline and dobutamine support. Bedside echocardiogram showed akinesia of inferolateral and anterolateral wall with severely reduced LVEF. Due to escalation of support and hemodynamic instability, decision was made to initiate veno-arterial (V-A) ECMO support. During the procedure patient had cardiac arrest and was successfully resuscitated two times. Two days later, patient was transported to University Hospital Centre Zagreb. Echocardiography showed LVEF of 20% while the chest X-ray showed signs of severe congestion interpreted as ECMO lung oedema. Due to that, an immediate implantation of Impella was performed. However, as soon as Impella established adequate cardiac output, a severe case of Harlequin syndrome developed which required conversion of ECMO configuration to V-A-V that stabilized the situation and enabled conversion into V-V ECMO two days later. Following further stabilization, VV ECMO was removed two days later, Impella the following day, and patient was extubated. Cardiac recuperation was dramatic and cardiac MRI showed an LVEF of 57%. Patient was discharged home after 24 days. Conclusion: This case highlights the appropriate use of different mechanical circulatory support modalities guided by different imaging modalities for bridging a case of severe influenza-induced myocarditis from a cardiac arrest situation to successful hospital discharge. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) is related to higher rates of complications after coronary revascularization. ¹ The efficiency of drug-coated balloon (DCB) percutaneous coronary intervention (PCI) has been shown for in-stent restenosis (ISR) and native small-vessel disease, however data on outcomes in DM is scarce.² The aim is to compare the incidence of target lesion restenosis at follow-up (FUP) coronary angiography in patients with and without DM receiving DCB PCI. Patients and Methods: The registry included patients undergoing a DCB PCI at the University Hospital Centre Zagreb from February 2011 to January 2022 (n=645). Patient demographics, comorbidities, pharmacotherapy, as well as data on the initial and FUP coronary angiography/PCI was collected. An FUP angiography was performed in 47% of patients (n=295), with a median FUP of 29 (interquartile range 8-41) months. Results: Data is shown in Table 1. The cohort was 75% male, mean age 65 ± 10 years. DM was present in 35% (n=223) of patients, equally in both sexes, and was associated with a history of myocardial infarction, PCI, coronary artery bypass grafting, stroke, as well as arterial hypertension, and renal insufficiency. No age difference was noted between groups. At initial PCI, more DM patients had multivessel coronary disease and ISR as the indication for DCB (DM vs non-DM: 41% vs 31%, p=0.023). After DCB, no group difference was noted in regard to the need for a bail-out PCI. FUP was performed in an equal percentage of patients in both groups (50% vs 45%, p=0.256), with no differences seen in the incidence of restenosis (18% vs. 17%, p=0.965), the need for target lesion PCI (15% vs. 12%, p=0.491), or the use of anti-anginal drugs. Conclusion: The findings of our single-centre analysis show that although DM is related to more advanced comorbidities it does not increase the risk of target lesion restenosis after DCB PCI. DCB PCI should be considered as a therapeutic option in candidate patients regardless of DM status. [ABSTRACT FROM AUTHOR]

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely used in refractory cardiogenic shock and cardiac arrest but is characterized by increased left ventricular (LV) afterload and consequent development of pulmonary oedema (ECMO lungs). The ProtekSoloTM (LivaNova, IT) cannula is inserted via the right femoral vein to the left atrium, by a trans-septal puncture (under the guidance of transesophageal echocardiography and fluoroscopy). This bypasses the LV by draining blood from the left atrium to a paracorporeal pump (eg Rotaflow pump (Maquet, DE)) and returning it via a femoral artery cannula, thus providing direct unloading of LV. We aimed to demonstrate our experience with the paracorporeal LV assist device using the ProtekSolo cannula and Rotaflow pump (PSp-LVAD). Patients and Methods: 7 adult patients underwent PSp-LVAD placement in UHC Zagreb from January to December 2020. We divided the patients in two groups: those who required PSp-LVAD to treat ECMO lungs (n=4) and those who received PSp-LVAD implantation prior to developing ECMO lungs (n=3). In addition to the description of the treated patients, we also assessed 30-day all-cause mortality. Results: The baseline characteristics of patients are shown in Table 1. All patients were male, mean age 56±9.3 years. 57.1% of patients underwent PSp-LVAD placement due to worsening of chronic heart failure and 42.9% due to acute coronary syndrome. Concurrent infection was present in 57.1% of patients. 71.4% were first on VA-ECMO support, of those 80% developed ECMO lungs. Laboratory tests (Figure 1) show improvement in kidney and liver function after PSp-LVAD placement. Outcomes are shown in Table 2; patients in prophylactic group have lower observed 30-day mortality rate (33% vs 75%) and longer VA-ECMO support duration due to lower mortality. Besides 2 patients who are still in active treatment, all others died during initial hospitalization due to infective complications, predominantly those that had a concurrent infection upon institution of the PSp-LVAD. Conclusion: Pulmonary edema (ECMO lungs) due to increased LV afterload is a major complication of VA-ECMO. Prophylactic LV unloading by PSp-LVAD seems associated with lower 30-days mortality. [ABSTRACT FROM AUTHOR]

Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients during cardiac arrest and cardiogenic shock and is associated with increased survival rate. Since mortality on ECMO is still rather high, SAVE (Survival after Veno-Arterial ECMO) score can be used to predict survival from refractory cardiogenic shock requiring ECMO. Patients and Methods: We performed a retrospective analysis of 121 patients (78% male) who underwent VA-ECMO implantation in our Department from January 2011 till November 2020 (Figure 1 and Table 1). Results: Median age was 58 years with 21% of patients older then 65 years. Median of ECMO duration was 6 days. The most common causes of cardiogenic shock were acute myocardial infarction and cardiomyopathy (53% and 37%, respectively) (Figure 2), and 37% patients were implanted during cardiopulmonary resuscitation (eCPR). Overall survival on ECMO support was 59%, but in patients after CPR only 34%. Furthermore, of all patients, 34% were successfuly weaned and the rest who survived continued on advanced heart failure therapies (Figure 3), but overall survival in follow-up was only 26%. Median SAVE score was -8 with significantly less negative values in patients younger than 65 and treated after 2015. Also, patients treated before 2015 had significantly higher values of creatinine, free hemoglobine and international normalized ratio (INR) and their survival rate was only 39%, in comparison to those who were implanted after 2015 whose survival rate was 62%. [ABSTRACT FROM AUTHOR]

Background: Decrease in platelet count following the induction with polyclonal anti-thymocyte globulin (ATG) is deemed as an adverse event, while decrease in lymphocyte count represents a therapeutic goal1. Still, the effect on platelets may represent an important part of ATG anti-rejection mechanisms. Patients and Methods: This was a retrospective single-center study of consecutive HTx (heart transplantation) patients (pts) from February 2010 to February 2018 in University Hospital Centre Zagreb. All pts received rATG (Thymoglobulin®) 1.5 mg/kg daily during the first 5 days. Complete blood count with differential was assessed on days 0, 7 and 14 after HTx. The incidence of cellular-mediated rejection (ACR) was monitored for two years after HTx. ACR was classified according to ISHLT classification from 1990 and expressed as ACR of grade 1B or higher (≥1B). Results: A total of 159 pts were transplanted. Median age was 55 years (IQR, 47-62 years), 76% were male. A total of 27 pts (17 %) experienced ACR ≥1B during 24 months. Pts with ACR of grade ≥1B had higher platelet count on day 7 (145 vs 104 x 103/μL, p<0.001). They also had higher the absolute lymphocyte count (ALC) on the same day, but this did not reach statistical significance (162 vs 130 x 103/μL, p=0.19) and there was no correlation between ALC and platelet counts on day 7 (Pearson's correlation coefficient was 0.064, p=0.459). Conversely, more rejection was observed in pts with higher ALC on day 14 (326 vs 190 x 103/μL, p=0.035), with a trend towards statistical significance in the relationship with higher platelet count (210 vs 199 x 103/μL, P=0.076). In the univariate analysis, higher platelet count on day 7, younger recipient age and negative pre-transplant Cytomegalovirus (CMV) IgG serology were found as predictors of the ACR ≥1B in the first 2 years after HTx (Table 1). In multivariable model, platelet count on day 7 and pre-transplant CMV serostatus were independent predictors of rejection. ROC analysis of the aforementioned model showed a satisfying AUC of 0.75. Conclusion: Decrease in platelet count following the induction with rATG is strongly related to less graft rejection that is independent from the lymphodepleting effect. This indicates the importance of platelet involvement in anti-rejection mechanisms of ATG induction, and consequently a possible rationale for targeting platelets in future immunosuppressive regimens. [ABSTRACT FROM AUTHOR]

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Current guidelines recommend genetic counselling and testing in patients with familial non-ischemic idiopathic cardiomyopathies with hypertrophic, dilated, restrictive or arrhythmogenic phenotype. We aimed to investigate genotype features of patients with non-ischemic cardiomyopathies in advanced stage of heart failure in University Hospital Centre Zagreb. Methods: Genetic testing (single variant and multiple variant testing) was performed in part using the in-house genetics laboratory, and also in a collaborating genetics laboratory in Helsinki, Finland (Blueprint Genetics). Pathogenic and likely pathogenic variants that established a molecular diagnosis were confirmed by Sanger sequencing. Results: From September 2016 to December 2020, we have performed genetic testing in 66 patients. Of this number, 14 patients (8 males, 41.5±14.3 years) had advanced heart failure as evidenced by either having undergone heart transplantation, mechanical circulatory support implantation, or were currently listed for heart transplantation. Before genetic testing, clinically observed phenotypes indicated dilated cardiomyopathy in 6 patients, restrictive cardiomyopathy in 6 patients, and arrhythmogenic cardiomyopathy in 2 patients. Diagnostic yield of the performed genetic tests was relatively high, only one test did not identify any mutations, and 4/14 identified mutations that can currently be classified only as variants of uncertain significance. Pathogenic and likely pathogenic mutations predominantly affected genes coding proteins of the sarcomere, cellular and nuclear membrane, or pathologic protein such as transthyretin (Table 1). Genetic testing lead to change in the clinically determined diagnosis in 4/14 patients. Results of genetic testing in this group of patients warranted further family clinical screening in all of the patients, and family genetic screening in 5 eligible patients. Conclusion: Genetic testing in our advanced heart failure population yields important information on etiology of the diseases, and indicates further family screening. [ABSTRACT FROM AUTHOR]

Introduction: Dual antiplatelet therapy (DAPT) represents one of the pillars in the treatment of acute coronary syndromes (ACS)1. In the past the most commonly used combination of antiplatelet drugs has been acetylsalicylic acid (ASA) and clopidogrel. Clopidogrel had a high incidence rate of high residual platelet reactivity and has, in recent years, been replaced with ticagrelor, a more potent platelet inhibitor with a more uniformed response across the patient population. The effect of high dose atorvastatin on platelet reactivity mediated by ASA and clopidogrel is well researched, however no studies have been published analyzing this effect when clopidogrel is substituted with ticagrelor. Purpose: To investigate if high dose atorvastatin modifies PF mediated by DAPT in patient with ACS as measured by platelet function tests (PFTs). Patients and Methods: We analyzed clinical characteristics and PF in patients presenting with ACS at the Department of Cardiovascular Diseases at the University Hospital Centre Zagreb from December 2015 to February 2018. Primary endpoint was PF after treatment with DAPT and/or high dose atorvastatin. We analyzed PF using the Multiplate platelet function analyzer. PFTs were performed 18-24 hours after therapy initiation. None of the patients were taking statins before the index event. Results: There were 35 patients with a mean (SD) age of 61.6 (12.2) years in the atorvastatin group and 29 patients with a mean (SD) of 62.6 (9.6) years in the no-atorvastatin group. Both groups were identical in all the baseline parameters except history of hyperlipidemia (34.5% vs 65.7%, P=0.023). There were no significant differences between the two groups in PF analyzed with PFTs (Figure 1). The difference in residual platelet reactivity remained non-significant even after adjusting for sex, age and hyperlipidemia as the only co-variate that was significantly different between the group (P=0.432). Conclusion: In this pilot study on a limited sample we found no difference in residual PF in patients on DAPT weather they are on treatment with high dose atorvastatin or not. These results show that the pleiotropic effects of atorvastatin on platelet reactivity are not significant in patients taking DAPT with ticagrelor and ASA. [ABSTRACT FROM AUTHOR]