Predictors of mortality and burden of arrhythmias in endstage heart failure.

BACKGROUND: Heart failure (HF) is a significant cause of morbidity and mortality in the United States, contributing to approximately 1 in 8 deaths. Individuals with end-stage HF (eHF) experience debilitating symptoms leading to poor quality of life (QoL). METHODS: We used the ICD-10 code for eHF (I5084) from the National Inpatient Sample (NIS) (2016-2020) to identify all patients with eHF. We used a multivariable logistic regression model to adjust for confounders and estimate the mortality probability in each arrhythmia cohort. Our primary outcome was in-hospital mortality risk in each group. A p-value of 0.05 was deemed significant. RESULTS: There were 22,703 hospitalizations with eHF (mean age 67 years ±16). Men represented 66.5 % (15,091) of the population. In this cohort, 59 % (13,018) were Caucasians, 27.2 % (6,017) were Blacks, 8.7 % (1,924) were Hispanics, and 2.9 % (505) were Asians. Of these individuals, 50.4 % (11,434) had atrial fibrillation (AFIB). The majority of the arrhythmia subgroups had independent associations with mortality, with adjusted odds ratio (aOR) for VFIB 5.8 (4.6-7.1), AFIB 4.3 (3.9-4.5), SVT 1.9 (1.6-2.4), and VT 1.2 (1.1-1.4), p < 0.0001, each. CONCLUSION: This analysis revealed that approximately half of the hospitalized population with end-stage heart failure are burdened with atrial fibrillation. Ventricular and atrial fibrillation, supraventricular tachycardia, and ventricular tachycardia each carried an independent mortality risk, with ventricular fibrillation having the highest risk.

Isolated primary cardiac angiosarcoma.

Cardiac angiosarcoma (CAS) is the most prevalent malignant primary cardiac tumor in adults, often affecting young males. We present a case of this rare entity in a young female, highlighting the multidisciplinary team's role and multimodality imaging in the diagnosis and management.

The role of coronary computed tomography angiography in pregnancy-associated myocardial infarction.

Background: Pregnancy-associated coronary artery dissection is one of the critical causes of myocardial infarction in young females. The challenges in the diagnosis and follow-up of pregnancy-associated myocardial infarction prompted us to highlight the potential role of coronary computed angiography in managing this life-threatening medical condition. Case Summary: We describe a case of a 29-year-old female with sudden onset chest discomfort one-week postpartum. She presented to the hospital with an ST-elevation myocardial infarction and was urgently taken to the cath lab for PCI and stent placement. Thirteen months later, with intermittent chest discomfort, an coronary computed tomography was done, demonstrating evidence of SCAD and aneurysm formation in the left main coronary artery and left circumflex coronary artery. Repeat cardiac catheterization confirmed the same diagnosis. Given her refractory chest discomfort and the chance of aneurysm rupture decision was made to proceed with a three-vessel CABG. At 3-month and 1-year followup visits, the patient is doing well and remains pain-free. Conclusion: In this case presentation, we aim to highlight the potential role of Coronary Computed tomography angiography in the diagnosis and follow-up of pregnancy-associated spontaneous coronary artery dissection, given the high accuracy and non invasiveness of this diagnostic modality in the context of the high prevalence of spontaneous coronary artery dissection in symptomatic or asymptomatic pregnancy-associated myocardial infarction.

Cardiac amyloidosis: diagnostic challenges and recent advancement in the treatment of transthyretin amyloidosis (ATTR).

ATTR-CA is an under-reported cause of congestive heart failure (CHF) and cardiac arrhythmias. Heightened clinical suspicion along with a multimodal investigative approach is often required in diagnosing this potentially fatal condition. Tafamidis and inotersen have shown promising results in terms of progression-free survival by ameliorating CHF symptoms and peripheral neuropathies in clinical trials. In this case series of five patients, we present three wild-type cardiac amyloidosis (ATTRwt-CA), one familial cardiac amyloidosis (ATTRm-CA) and one primary cardiac (AL-CA). The diagnostic modality was different for each patient. ATTRwt-CA, ATTRm-CA and AL-CA patients received tafamidis, inotersen and chemotherapy with bone marrow stem-cell transplantation, respectively.

Complicated Spontaneous Coronary Artery Dissection (SCAD) Culminating in Aneurysm Formation: Coronary Artery Bypass Graft Surgery Is Preferable Over Percutaneous Coronary Intervention in Peripartum SCAD.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), most frequently occurring in young females of reproductive age, and has a high mortality rate. Currently, no guidelines are available to direct treatment. We report a case of a 29-year-old female with complications of SCAD treated with coronary artery bypass graft (CABG), resulting in a better outcome as compared to that of percutaneous coronary intervention (PCI). Our patient presented with class IV angina one-year post-PCI following postpartum SCAD. Left heart catheterization (LHC) reported SCAD involving the ostium of the left circumflex (LCX) and then cutting off the left marginal artery, which was followed by a 2.5 x 28 mm Synergy drug-eluting stent (Boston Scientific, Marlborough, MA) x1 in the lateral branch of the bifurcating marginal system with good coronary stent results. Repeat LHC one-year after the SCAD was significant for a large aneurysm in the distal left main coronary artery (LCA) extending into the LCX with evidence of a residual large false lumen (0.41 sq cm), as compared to the narrow segment of the true lumen (0.15 sq cm). Compared to the distal LCA area (0.49 sq cm), the true lumen of the LCA had severe stenosis. The patient underwent three-vessel CABG (left internal mammary artery (LIMA)-> left anterior descending artery (LAD), right internal mammary artery (RIMA)->first obtuse marginal (OM1), saphenous vein graft (SVG)->second obtuse marginal (OM2)) with sternal plating. The patient was doing well three months post-CABG with complete resolution of the pain, which was unattainable by PCI. Our report suggests that CABG may be preferable over PCI in the peripartum SCAD to avoid complications or sudden cardiac death from the extension of the dissection and aneurysm formation.