A 71-year-old man was admitted owing to an episode of retrosternal chest pain. Based on ECG findings and minimal troponin elevation, the patient was initially treated as having an acute coronary syndrome, with subsequent clinical improvement. On the second day of hospitalisation, he complained of progressively worsening dyspnoea, and pulmonary …

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Background: Thyroid hormone has a differential action on healthy and ischemic heart. Triiodothyronine (T3) administration improved postischemic cardiac function while it limited apoptosis in experimentally induced ischemia. Thus, the present study investigated the potential effects of acute liothyronine (LT3) treatment in patients with anterior myocardial infarction.Methods: This study is a pilot, randomized, double-blind, placebo-controlled trial (ThyRepair study). We randomized 52 patients and analyzed data from 37 patients (n = 16 placebo and n = 21 LT3), per prespecified per protocol analysis. We excluded three patients who had died of cardiovascular causes (one in placebo and two in LT3 arm), four with small infarct size below a pre-specified threshold (in the placebo arm), and the rest, who lacked follow-up data. LT3 treatment started after stenting as an intravenous (i.v.) bolus injection of 0.8 mu g/kg of LT3 followed by a constant infusion of 0.113 mu g/kg/h i.v. for 48 hours. All patients had cardiac magnetic resonance (CMR) at hospital discharge and 6 months follow-up. The primary end point was CMR left ventricular (LV) ejection fraction (LVEF) and secondary endpoints were LV volumes, infarct volume (IV), and safety.Results: The CMR LVEF% at 6 months was 53.6 +/- 9.5 for the LT3-treated group and 48.6 +/- 11 for placebo, p = 0.15. Acute LT3 treatment resulted in a significantly lower LV end-diastolic volume index (92.2 +/- 16.8 mL/m(2) vs. 107.5 +/- 22.2, p = 0.022) and LV systolic volume index (47.5 +/- 13.9 mL/m(2) vs. 61.3 +/- 21.7, p = 0.024) at hospital discharge, but not at 6 months. There was no statistically significant difference in CMR IV at hospital discharge between the groups (p = 0.24). CMR IV tended to be lower in the LT3-treated group at 6 months (18.7 +/- 9.5 vs. 25.9 +/- 11.7, in placebo, p = 0.05). Serious, life-threatening events related to LT3 treatment were not observed. A tendency for an increased incidence of atrial fibrillation (AF) was found in the LT3 group during the first 48 hours (19% for T3 group vs. 5% for placebo, p = 0.13).Conclusion: This pilot randomized, placebo-controlled trial study suggests potential favorable effects (acute cardiac dilatation and 6-month IV) as well as potential concerns regarding a higher risk of AF after LT3 administration early after myocardial infarction, which should be tested in a larger scale study.

Objective: Percutaneous coronary interventions create stress and anxiety in patients, which usually affect blood pressure. Safe sedation is considered cornerstone therapy as relieves stress and pain. In chronic heart diseases the patient tries to negotiate the challenges of his illness which often aggravate his anxiety. The patient experiences the inability to manage and respond to others and/or his expectations, and as a result he “hurts” himself mentally. Self-compassion and self-esteem contribute to resilience. Resilience is a protective psychological factor in heart diseases. Purpose: The purpose of the research is the nursing monitoring and recording of the effects of the administered mild sedatives or analgesia during a percutaneous coronary intervention and the patients’ perception of the care provided. Materials & Method: Questionnaires were used, answered by cardiac patients undergoing percutaneous coronary interventions (coronary angiography and angioplasty). The sample of participants is 100 people, where the 50 received midazolam (Dormixal) and fentanyl (Fentanyl) (group 1) five minutes before the examination and the remaining 50 did not (group 2). Blood pressure was measured and recorded before the start of the procedure, during, and at the end of it, in both groups to investigate a possible effect of the treatment. Design and method: During those three periods, there was a significant change in blood pressure (decrease) after the procedure in group 1 (120.76. 10.75 versus 129.86 ± 22.26 in group 2, p = 0.007). In group 1 the self-compassion scale was significantly and negatively correlated with the STAI scale and positively with the Connor scale. Those with a moderate financial level were less resilient while those with a high financial level showed less stress. Results: The majority of studies use these medications based on the adoption of the line “zero pain tolerance” in order to reduce or eliminate it. This difference is indicative of a possible effect of the treatment on the change (reduction) of blood pressure. In addition, it turns out that the higher the self-compassion, the greater the resilience and lower the stress

The majority of studies use these medications based on the adoption of the line "zero pain tolerance" in order to reduce or eliminate it. This difference is indicative of a possible effect of the treatment on the change (reduction) of blood pressure. In addition, it turns out that the higher the self-compassion, the greater the resilience and lower the stress.

Abstract Background Despite the proven benefits of cardiovascular disease medication, adherence to treatment remains poor. Fixed-dose combinations (FDC) have been proposed as a measure to enhance adherence. Objective To assess compliance to treatment with an FDC, consisting of acetylsalicylic acid, atorvastatin and ramipril, and to gauge its impact on cardiovascular risk factors. Methods This was a prospective, multicenter, observational, phase 4 study conducted for 6 months in Greece. 1444 participants (67% males, mean age 63.7 years old) that were prescribed the FDC for primary or secondary prevention were included in the analysis. Descriptive statistical analysis was performed to analyze clinical, sociodemographic and safety parameters. Results Approximately equal number of participants was recruited in the primary and secondary prevention group. The majority of patients were overweight and hypertensive. Dosing compliance was 88.6% at 3 months and 86.8% at 6 months. Adherence to treatment was 99.1% at 3 months and 97.6% at 6 months. Statistically significant changes at 6 months compared to baseline were documented in systolic/diastolic blood pressure of 15.7/7.5 mmHg and LDL-c of 32.6 mg/dl, in both CVD and non-CVD participants and in total population as well. The total 10-year risk for CV events was reduced by 34.1% at 6 months. Only 1.2% of the participants reported an adverse event and 0.8% an adverse event reaction. Conclusions Among patients with or without CVD, the use of acetylsalicylic acid, atorvastatin and ramipril FDC resulted in good medication adherence at 6 months and statistically significant improvements in blood pressure, total cholesterol and LDL levels. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Galenica SA

Left ventricular (LV) aneurysm is a serious mechanical complication following acute myocardial infarction (MI). Approximately 85% of true LV aneurysms are located at the apical and anteroseptal wall. They are associated with increased morbidity and mortality due to complications that can potentially occur, including heart failure, thromboembolism and tachyarrhythmias. As the need for prompt treatment is vital, transthoracic echocardiography, contrast echocardiography, computed tomography (CT) and cardiac magnetic resonance (CMR) are the preferred noninvasive modalities used for the diagnosis. The incidence of LV aneurysm as a complication of acute myocardial infarction has declined, primarily thanks to the advances in percutaneous coronary intervention and early revascularization. We report the case of a large LV apical aneurysm in a patient with a delayed presentation after ST-elevation myocardial infarction during the COVID-19 pandemic. A 60-year-old female with history of previous anterior myocardial infarction with delayed revascularization presented to the emergency department with worsening shortness of breath, orthopnea and marked limitation of physical activity. The transthoracic echocardiogram that was conducted revealed a giant LV aneurysm located at the apex as well as a markedly reduced left ventricular ejection fraction. Contrast echo-cardiography and cardiac CT were used to confirm these findings while CMR also provided accurate measurements of left ventricular volumes and mass. In addition, the extent of myocardial scar tissue and viability of the other regions of left ventricle were identified. The patient underwent a successful left ventricular reconstructive surgery leading to a significant functional status improvement.

Abstract Background/Introduction MINOCA constitutes a clinical entity characterized by heterogeneous and poorly understood pathophysiological substrate, whereas current knowledge leaves significant gaps regarding the identification, risk stratification and therapeutical approach of these patients. Purpose The aim of our study is to investigate the potential role of clinical, hemodynamic, laboratory and imaging parameters in the early identification of true acute myocardial infarction (AMI) among patients with a working diagnosis of MINOCA. Methods Our study population included 62 patients admitted with acute coronary syndrome (ACS) fulfilling the diagnostic criteria of MINOCA. A subsequent cardiac magnetic resonance (CMR) performed at 54 patients demonstrated an ischemic pattern of late gadolinium enhancement (LGE) confirming the diagnosis of true AMI in 15 cases (27.8%). Other findings included Takotsubo syndrome (n=19; 35.2%) and myocarditis (n=4; 7.4%), whereas CMR failed to reveal abnormal findings at 16 cases (29.8%). Results Focusing on the combined population of true AMI and clear CMR groups (n=31; 51.6% male; mean age: 58±12 years old; 42% hypertensives (HTN), 16% with history of diabetes mellitus (DM), 28.6% smokers) no significant difference was observed regarding classic cardiovascular risk factors (HTN, DM, smoking, age, dyslipidemia) except for a tendency of overrepresentation of female sex (r=0.354; p=0.051) in the true AMI group. Coronary angiographic (CA) findings did not differ between the two groups: clear vessels: 16/31 (51.6%); lesions causing ≤50% stenosis: 7/31 (22.6%); bridges: 4/31 (12.9%); spontaneous coronary artery dissection (SCAD): 2/31 (6.5%); slow flow phenomenon or spontaneous epicardial spasm: 2/31 (6.5%). No difference was observed in treatment approach with beta-blockers, renin-angiotensin system blockers, statins or the selection of no, single or dual antiplatelet strategy. Univariate regression analysis demonstrated that CMR derived left-ventricular ejection fraction (CMR-LVEF) (OR, 0.846; CI 95%: 0.742–0.965; p=0.012), as well as admission ECG abnormalities (OR, 0.154; CI 95%: 0.026–0.914; p=0.04), admission (OR, 5.689; CI 95%: 1.374–23.553; p=0.016) and peak troponin levels (OR, 15.874; CI 95%: 2.486–101.367; p=0.003) were the only parameters significantly related to a true AMI. Statistical significance was retained in multivariate models adjusted for age, gender, history of HTN and DM. On the contrary echocardiography derived LVEF failed to predict true AMI. Conclusions These preliminary results further highlight the need of an early CMR evaluation of MINOCA patients. A timely identification of true AMI is expected to improve patient outcomes by guiding the treatment approach. Funding Acknowledgement Type of funding sources: None.

Abstract Background/Introduction Left ventricular mass index (LVMI) has been long established as an index of target organ damage. It has demonstrated a prognostic role in cardiovascular morbidity and mortality assessed using either echocardiography or cardiac magnetic resonance (CMR) under the prism of coronary artery disease, hypertension, diabetes mellitus, chronic kidney disease. On the other hand, it has shown a strong association with indices of sympathetic nervous system (SNS) activity. Purpose The aim of our study is to investigate for potential associations between LVMI and indices of SNS among patients with a working diagnosis of MINOCA. Methods Our study population consists of 50 patients [32% male; mean age: 61±12 years old; 50% hypertensives (HTN), 16% with history of diabetes mellitus (DM), 22% smokers] admitted with acute coronary syndrome (ACS) fulfilling the diagnostic criteria of MINOCA. A subsequent CMR demonstrated an ischemic pattern of late gadolinium enhancement (LGE) in 15 cases (27.8%), findings indicative of Takotsubo syndrome (TTS) in 19 patients (35.2%), whereas failed to reveal any abnormalities in 16 cases (29.8%). LVMI was estimated using left ventricular mass per body surface area (LV mass/BSA) as derived from CMR. SNS activity was assessed using muscle sympathetic nerve activity (MSNA) during the first 30 days of patient discharge. Results Univariate analysis failed to demonstrate an association between LVMI and indices of SNS in the total population. This was found to be driven by the TTS group. However, for all other MINOCA cases (n=31; including both LGE CMR and clear CMR cases) LVMI demonstrated a significant positive association with MSNA measured as bursts/min (OR, 0.558; CI 95%, 0.200–0.915; p=0.004). A multivariate analysis was conducted in the same group in which LVMI retained its statistical significance independently of age, gender, ejection fraction derived from CMR, history of HTN and DM (OR, 0.518; CI 95%, 0.030 - 0.952; p=0.038). TTS group did not show any association between LVMI and MSNA. Conclusions These preliminary results may imply an underlying mechanism of reverse negative feedback on systematic SNS activity after the acute phase of sympathetic overdrive during a TTS event. Further investigation is warranted to confirm our research findings. Funding Acknowledgement Type of funding sources: None.

Prevention -Obesity 915 >1500 MASL, vs 19

The advent of percutaneous coronary intervention (PCI) transformed the treatment of obstructive coronary artery disease (CAD) by creating a less invasive revascularization option to coronary-artery bypass grafting (CABG). 1 Although, randomized controlled clinical trials (RCTs) are the gold standard in medical research, there is not always the possibility to conduct properly designed RCTs. The gap between evidence from RCTs and clinical practice can be filled by epidemiological studies and properly designed registries. 2 The results of the Hellenic Heart Registry on Percutaneous Coronary Interventions (HHR-PCI), a national registry of patients with stable angina or acute coronary syndromes who underwent PCI, were only recently published. 3 The purpose of the current study is to report the experience of a newly formed Catheterization laboratory at a tertiary hospital of Athens and to compare its findings to those reported by the HHR-PCI... (excerpt)