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Individuals with established cardiovascular disease or a high burden of cardiovascular risk factors may be particularly vulnerable to develop complications from coronavirus disease 2019 (COVID-19). We conducted a prospective cohort study at a tertiary care center to identify risk factors for in-hospital mortality and major adverse cardiovascular events (MACE; a composite of myocardial infarction, stroke, new acute decompensated heart failure, venous thromboembolism, ventricular or atrial arrhythmia, pericardial effusion, or aborted cardiac arrest) among consecutively hospitalized adults with COVID-19, using multivariable binary logistic regression analysis. The study population comprised 586 COVID-19 positive patients. Median age was 67 (IQR: 55 to 80) years, 47.4% were female, and 36.7% had cardiovascular disease. Considering risk factors, 60.2% had hypertension, 39.8% diabetes, and 38.6% hyperlipidemia. Eighty-two individuals (14.0%) died in-hospital, and 135 (23.0%) experienced MACE. In a model adjusted for demographic characteristics, clinical presentation, and laboratory findings, age (odds ratio [OR], 1.28 per 5 years; 95% confidence interval [CI], 1.13 to 1.45), previous ventricular arrhythmia (OR, 18.97; 95% CI, 3.68 to 97.88), use of P2Y12-inhibitors (OR, 7.91; 95% CI, 1.64 to 38.17), higher C-reactive protein (OR, 1.81: 95% CI, 1.18 to 2.78), lower albumin (OR, 0.64: 95% CI, 0.47 to 0.86), and higher troponin T (OR, 1.84; 95% CI, 1.39 to 2.46) were associated with mortality (p

Transesophageal echocardiography (TEE) has been extensively used historically for Transcatheter aortic valve implantation (TAVI) but focus is shifting from routine use of TEE and general anesthesia to "as needed" use. We evaluated patients who had TAVI in our institution from September 2012 to February 2017. Decision for implantation and use of TEE during procedure was made by the structural heart team on a case-to-case basis, based on FDA approved indications. Data including procedural details, length of stay and rehospitalizations were obtained from all patients. TAVI was performed on 178 patients during the study period of which 104 of 178 had TEE during TAVI. Baseline characteristics were fairly comparable in both groups. Similar proportion of self-expanding and balloon expanding valves were deployed. Patients in TEE group had longer overall procedure time (107 minute vs 83 minute, p = 0.0002) and longer length of stay (5.01days vs 2.49days, p < 0.0001). Echocardiographic study postprocedure showed similar incidence of paravalvular leak and similar gradients and velocities across aortic valve. Rates of 30-day readmissions were similar in both groups. In conclusion, in this single-center retrospective analysis-TAVI without the 'routine use' of TEE was comparable with those done with TEE guidance in terms of periprocedural complications and 30-day readmissions. Overall procedure length and length of stay was predictably higher in the TEE group.

Background Previous studies reported that nearly 50% of patients hospitalized with decompensated heart failure (HF) have preserved left ventricular ejection fraction (EF). Objective We aimed to look at the efficacy of remote hemodynamic monitoring in our center using CardioMEMSTMHF system in reducing the hospital and clinic encounters in patients with HF with reduced EF (HFrEF) versus HF with preserved EF (HFpEF). Methods We performed a retrospective analysis of 106 sequential patients who received CardioMEMS device from April 2015 to January 2018. We divided these patients into two groups based on the EF. We collected data on the number of HF admissions, total hospital admissions, and clinic visits 1-year prior and 1-year after the device implantation. Time to death (in years) were calculated post-implant in all patients. Results Our study showed a significant reduction in HF admissions per year from 4.01 ± 7.56 to 0.88 ± 1.34 (p = 0.0353), total admission per year from 4.87 ± 7.96 to 2.00 ± 2.35 (p = 0.0110) and clinic visits per year from 7.07 ± 9.45 to 5.20 ± 3.27 (p = 0.0071) in patients with HFrEF. There was an overall decrease in the hospital and clinic encounters in patients with HFpEF, but it was not statistically significant. However, there was no significant difference in the outcomes in patients with HFrEF versus HFpEF post-implant ( Table 1 ). Time to death in years in HFrEF cohort post-implant was 0.98 ± 0.54and in the HFpEF post-implant was 0.65 ± 0.75and this was not statistically significant. Conclusion There was a statistically significant reduction in total admissions, HF admissions and clinic visits per year in patients with HFrEF post-implant. But there was no significant difference in these clinical outcomes compared to patients with HFrEF versus HFpEF post-implant.

Background CardioMEMSTMpulmonary artery pressure sensor had shown decreased rates of heart failure (HF) hospitalizations and quality of life compared to standard of care alone in the CHAMPION trial. Objective With our growing HF population, requiring CardioMEMSTM implant in our center based on the FDA approved indication, we aimed to look at the differences in HF admissions, total hospital admissions, clinic visits in all patients. We also aimed to evaluate if there was a difference in these outcomes between first 53 and second 53 patients with increasing operator and HF team experience. Time to death post-implant was also assessed. Methods We performed a retrospective analysis of 106 sequential patients who received the implant. We collected data on number of HF admissions, total hospital admissions, and clinic visits 1-year prior and 1-year post-implant. Time to death (in years) were calculated post-implant in all patients. We labeled first 53 cohort as patients who received implant before Aug 2016 and second 53 cohort who received implant after Aug 2016. Results Our study showed a significant reduction in HF admissions, total admissions and clinic visits per year in all patients who received the implant ( Table 1 ). However, further analysis did not show a significant difference in these outcomes in the first 53 patients cohort versus second 53 patients cohort despite the HF population requiring the implant are growing ( Table 2 ). The second 53 patients showed significant reduction in each individual outcome. There was no statistically significant difference in post-implant death comparing these two groups. Overall there was a significant mean (%) reduction in each clinical outcome in all patients and comparing first 53 patients versus second 53 patients. Conclusion A significant reduction in HF admissions, total admissions and clinic visits per year in all patients who received the implant, especially in the second 53 patients. However, considering post-implant results, there were no significant differences in outcomes compared to the patients who received the implant before Aug 2016 versus after Aug 2016 and our results were sustainable.