Cardiovascular Medicine

7 pages, 1346 KB

Open AccessArticle

Repolarisation in Patients with Ischaemic and Nonischaemic Cardiomyopathy: Assessment of Parameters of Transmural Dispersion of Repolarisation Using the 65-Lead Surface ECG

by Niederseer David, Valentina A. Rossi, Barbieri Fabian, Christian M. Schmied, Bohm Philipp, Pfeifer Bernhard, Wernly Bernhard, Dichtl Wolfgang, Stuhlinger Markus, Hintringer Florian and Berger Thomas

Cardiovasc. Med. 2020, 23(5), w02129; https://doi.org/10.4414/cvm.2020.02129 - 9 Sep 2020

Abstract

BACKGROUND: Patients with heart failure and reduced ejection fraction (HFrEF) are at-risk for arrhythmic events. The aetiology corresponds to incidence of sudden cardiac death and effectiveness of shock therapy. We aimed to investigate repolarisation patterns in HFrEF patients with ischaemic (ICMP) or nonischaemic dilated cardiomyopathy (DCMP) using high-resolution 65-lead surface electrocardiography. METHODS: Fifty-six patients with heart failure underwent coronary angiography and were treated with optimised heart failure medication. Forty-two patients (13 female, mean age 65.1 ± 10.7 years, left ventricular ejection fraction 22.5 ± 6.5%) were then further stratified according to QRS duration (n = narrow QRS complex <120 ms; w = wide QRS complex >120 ms). Patients were divided into four groups: wICMP, n = 12; nICMP, n = 10; wDCMP: n = 10; nDCMP: n = 10. Using a high-resolution electrocardiogram we estimated measures of parameters of transmural dispersion of repolarisation. RESULTS: At baseline, groups were comparable except for variables related to group distribution. No difference in heart rate or T wave duration could be detected. However, the Tpeak-Tend interval differed significantly between groups (nICMP vs wICMP: p = 0.030; nDCMP vs wDCMP: p <0.001), and also in nICMP vs nDCMP (p = 0.021). If DCMP and ICMP were grouped regardless of QRS width, the Tpeak-Tend interval also differed significantly (p = 0.035). Follow-up of 10 years revealed no difference between Tpeak-Tend interval, QRS-duration or aetiology of heart failure in a combined endpoint of death, ventricular arrhythmia or implantable cardioverter defibrillator therapy. However, there was a significant difference for death between ICMP (n = 4, 19% vs DCMP (n = 0, 0%; p = 0.045). CONCLUSION: ICMP had a longer Tpeak-Tend duration and Tpeak-Ten -integral compared with DCMP despite normal parameters of depolarisation (QRS duration/integral). This may reflect different arrhythmogenic morphological substrates and explain why ventricular tachycardias are more common in ICMP. Full article

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5 pages, 910 KB

Open AccessReview

Cooperation Between Cardiology and Palliative Care: Time to Change the Paradigms of Care After the Publication of the European Association for Palliative Care Position Paper

by Piotr Z. Sobanski and Micha T. Maeder

Cardiovasc. Med. 2020, 23(5), w02125; https://doi.org/10.4414/cvm.2020.02125 - 9 Sep 2020

Abstract

As a result of advances in therapy many people living with heart failure reach both an advanced age and advanced stages of disease. This means, however, that they suffer symptoms and problems that may require an additional layer of care in order for them to be addressed. Involving elements of palliative care and, less frequently specialised palliative care or palliative care teams, can significantly limit the burden of symptoms and give patients and their relatives support in coping with challenging situations. Acknowledging the changing nature of palliative care, – as care appropriate for people living with serious diseases (and not only cancer) at every stage of the disease progression (and not only those of the dying) – can help to set up cooperation between cardiology and palliative care. The focus of modern palliative care, as of modern cardiology, is therefore similar – on saving life in the best possible quality. Screening for unaddressed needs could lead to a standard involvement of palliative care when needed. Palliative care reinforces a holistic understanding of a human being (going beyond seeing an ill “person” just in a patient’s role) and addresses the totality of the individual, respecting their relational existence according to the biopsychosocial-spiritual model. These unaddressed needs of people living with a disease and their families can lie in the physical, psychological, social and spiritual dimensions. Symptom control, support in all these dimensions, aiding in decision making, organising a network of care and, finally, as the person approaches the end of her or his life, care for the dying, can all enrich the quality of life of people living with the disease and their relatives. Support for the family is extended beyond the death of the loved ones in the form of bereavement counselling. Cooperation between cardiology and all other disciplines including palliative care should bear the hallmarks of care in the 21st century: caring for all dimensions of needs, always when they emerge and involving all disciplines needed. Full article

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7 pages, 707 KB

Open AccessArticle

Prognostic Role of Atrial Fibrillation in Acute Coronary Syndromes: A Real-Life, Contemporary Analysis

by Adjibodou Boris, Biasco Luigi, Marcon Serena, Svab Stefano, Chiodini Alessandra, Pasotti Elena, Moccetti Tiziano, Moccetti Marco, Klersy Catherine and Pedrazzini Giovanni

Cardiovasc. Med. 2020, 23(5), w02123; https://doi.org/10.4414/cvm.2020.02123 - 9 Sep 2020

Cited by 2

Abstract

OBJECTIVES: To analyse the impact of atrial fibrillation (AF) on in-hospital mortality and the role of antithrombotic regimens on 1-year outcomes in patients presenting acute coronary syndrome (ACS) and AF over a 4-year period in a Swiss tertiary referral centre. METHODS: Between 2011 and 2014, in-hospital mortality of ACS patients in AF was compared to that observed for ACS patients in sinus rhythm. Major adverse cardiovascular events (MACE) and major bleeding were analysed at 1 year according to the antithrombotic regimen at discharge. RESULTS: Out of the 2234 ACS patients, 187 (8.4%) presented with AF, either at admission (54%) or during the hospital stay (46%). In-hospital mortality was higher in ACS-AF cohort than in ACS patients in sinus rhythm (7.5 vs 4.1%; odds ratio [OR] 1.89, 95% confidence interval [CI] 1.06–3.38; p = 0.039). After adjustment for age and ACS presentation, AF did not appear to represent an independent risk factor for in-hospital mortality in ACS patients (OR 1.44, 95% CI 0.78–2.65; p = 0.25). Through combination of the type of ACS and presence of AF, in-hospital mortality was stratified into four risk categories: low (non-ST-segment elevation myocardial infarction [NSTEMI] without AF); intermediate (NSTEMI with AF; OR 3.25, 95% CI 1.017–9.09]); high (ST-segment-elevation myocardial infarction [STEMI] without AF; OR 5.12, 95% CI 2.93–8.95) and very high risk (STEMI with AF; OR 8.62, 95% CI 3.63–20.48). MACE or major bleedings did not differ according to antithrombotic regimens at discharge. CONCLUSION: AF is common in the ACS setting and associated with increased risk of in-hospital mortality. Although AF did not represent an independent prognosticator in ACS, a progressive increase on in-hospital death was observed when combining type of ACS and presence/ absence of AF. Full article

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Cardiovasc. Med., Volume 23, Issue 5 (09 2020) – 3 articles

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