Abbreviations and Acronyms

ASCVD: atherosclerotic cardiovascular disease
CAC: coronary artery calcium
LDL-C: low-density lipoprotein cholesterol
mAb: monoclonal antibody
PCSK9: proprotein convertase subtilisin/kexin type 9

Introduction

Cardiovascular disease is the leading cause of death in women in the United States and world-wide. Reducing patients’ lifetime exposure to low-density lipoprotein cholesterol (LDL-C) lowers their risk of atherosclerotic cardiovascular disease (ASCVD), as multiple clinical trials and meta-analyses have shown.¹ Every 1.0-mmol/L (38.7-mg/dL) reduction in LDL-C is associated with a 23% relative risk reduction in major ASCVD events.² Abundant clinical trial evidence has led to statins becoming the cornerstone of

Abstract

Background:

High-sensitivity troponin I, cardiac form (hs-cTnI) accelerates the assessment of acute coronary syndrome. Little has been documented about its performance, how it relates to different types of myocardial injury, and its impact on morbidity and mortality. This study sought to expand understanding of hs-cTnI by characterizing types of myocardial injury, the impact of comorbidities, and 30-day outcomes.

Methods:

The study retrospectively evaluated 1,975 patients with hs-cTnI levels obtained in the emergency department or inpatient setting from June to September 2020. Troponin was considered elevated if it was higher than the 99th percentile for either sex. Charts were reviewed to determine the presence of myocardial injury. Troponin elevation was adjusted for demographics, comorbidities, and kidney dysfunction. Thirty-day mortality and readmission rates were calculated.

Results:

Of 1,975 patients, 468 (24%) had elevated hs-cTnI, and 330 (17%) had at least 1 type of myocardial injury, type 2 myocardial infarction being the most frequent. Sensitivity and specificity using the 99th percentile as a cutoff were 99% and 92%, respectively. The average maximum hs-cTnI level was significantly higher for type 1 myocardial infarction (P < .001). Being male, Black, non-Hispanic, and a hospital inpatient were all associated with higher initial and peak hs-cTnI levels (P < .001). Elevated hs-cTnI level, age, heart disease, kidney dysfunction, and inpatient status were predictive of 30-day mortality on multivariate analysis.

Conclusion:

Elevated hs-cTnI levels in emergency department and inpatient settings occurs most commonly because of type 2 myocardial infarction. Maximum hs-cTnI level is associated with the patient's particular type of myocardial injury, certain demographics, and cardiovascular comorbidities, and it may be a predictor of 30-day outcomes.

Abstract

Background

Updated recommendations for the treatment of heart failure with reduced ejection fraction (HFrEF) include sodium-glucose cotransporter 2 (SGLT2) inhibitors and other long-established HFrEF therapies. These drugs’ mechanisms of action have yet to be fully clarified.

Objective

This study evaluated the effects of SGLT2 inhibitors on the modulation of autonomic function at 1 month beyond conventional HF therapy.

Methods

This single-center, observational, prospective study was conducted from January 2020 to December 2022. Patients with type 2 diabetes who had ischemic HFrEF and met the study criteria were considered for SGLT2 inhibitor treatment with empagliflozin or dapagliflozin. Changes in the circadian index were used as the primary outcome to assess the early effects of SGLT2 inhibitors on autonomic function. Changes in functional effort capacity and laboratory findings were also evaluated. Participants’ circadian index was measured by a 24-hour rhythm Holter monitoring recorder (BTL-08 Holter H100). A symptom-limited treadmill test assessed patients’ effort capacities. Tests were repeated after 1 month of therapy.

Results

The mean (SD) age of the 151 participants was 56.95 (7.29) years; their mean (SD) left ventricular EF was 35.69% (7.10%), and 95 participants were men (62.9%). From baseline to 1 month, mean (SD) daytime heart rate (80.63 [9.17] vs 77.67 [8.04] beats per minute; P = .004) and nighttime heart rate (76.83 [11.34] vs 73.81 [10.25] beats per minute; P = .03) decreased significantly. Variation in the circadian indexes (mean [SD], 1.04 [0.02] vs 1.10 [0.04]; P < .001) was statistically significant, favoring increased modulation of autonomic function. The increases in exercise duration (mean [SD], 8.88 [3.69] minutes and median [IQR], 8.81 [5.76-12.13] minutes vs 9.72 [3.14] and 9.59 [7.24-12.22] minutes; P = .04) and exercise capacity (mean [SD], 203.38 [65.18] m and median [IQR], 119.22 [149.43-259.15] m vs 335.61 [51.39] and 325.79 [293.59-376.91] m; P < .001] were also significant.

Conclusion

The use of SGLT2 inhibitors during early treatment can favorably affect both autonomic dysfunction and functional effort capacity of patients with type 2 diabetes with ischemic HFrEF.

Abbreviations and Acronyms

ICD: implantable cardioverter-defibrillator
S-ICD: subcutaneous implantable cardioverter-defibrillator
TV-ICD: transvenous implantable cardioverter-defibrillator

Introduction

Implantable cardioverter-defibrillators (ICDs) have demonstrated remarkable effectiveness in preventing sudden cardiac death in patients who are at high risk of ventricular arrhythmias.¹ Transvenous ICDs (TV-ICDs) have been the standard design for decades, but they may cause major device-related complications in up to 3% of recipients.² These complications, such as pneumothorax or cardiac perforation with tamponade, are primarily related to the leads and can occur during implantation; in addition, long-term complications, including lead endocarditis or malfunction, may appear. The subcutaneous ICD (S-ICD)

Abstract

Idiopathic dilatation of the right atrium is a rare condition with an unknown etiology. It is characterized by a significant enlargement of the right atrium without the presence of other valvopathies, intracardiac shunts, or pulmonary hypertension. This report presents the case of a 50-year-old woman with a significantly enlarged right atrium that was identified at birth; however, a definitive diagnosis was made later in life. The patient did not have any genetic diseases. Through the help of regular follow-up, anticoagulant therapy, previous radio-frequency ablation, and antiarrhythmic medications, she was able to carry a pregnancy to full term and live a regular life.

Risk Factors for Development of Stroke in Patients With Continuous-Flow Left Ventricular Assist Device Support as Destination Therapy

Ioana B. FloreaMD, MPHS,

Nadia H. BakirMD,

Meghan O. KellyMD,

Joel D. SchillingMD, PhD,

Gregory A. EwaldMD,

Akinobu ItohMD, PhD,

Marc R. MoonMD,

Spencer J. MelbyMD,

Ralph J. Damiano JrMD,

Kunal D. KotkarMD, and

Muhammad F. MasoodMD