Cardiology

Hamadeh, A., N. H. Patel and J. W. Choi (2020). “Pulmonary Artery Pseudoaneurysm Associated With Abandoned Epicardial Defibrillator Patch.” Am J Cardiol 128: 161-162.

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We describe an 84-year-old man who presented with hemoptysis and acute blood loss anemia due to a pulmonary artery pseudoaneurysm (PAP). The etiology of his PAP was thought to be an abandoned epicardial defibrillator patch that was implanted at age 55. To our knowledge, PAP has never been reported as a possible complication of an abandoned epicardial defibrillator patch.

Gupta, S., S. S. Hayek, W. Wang, L. Chan, K. S. Mathews, M. L. Melamed, S. K. Brenner, A. Leonberg-Yoo, E. J. Schenck, J. Radbel, J. Reiser, A. Bansal, A. Srivastava, Y. Zhou, A. Sutherland, A. Green, A. M. Shehata, N. Goyal, A. Vijayan, J. C. Q. Velez, S. Shaefi, C. R. Parikh, J. Arunthamakun, A. M. Athavale, A. N. Friedman, S. A. P. Short, Z. A. Kibbelaar, S. Abu Omar, A. J. Admon, J. P. Donnelly, H. B. Gershengorn, M. A. Hernán, M. W. Semler and D. E. Leaf (2020). “Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US.” JAMA Intern Med 2020 Jul 15;e203596. [Epub ahead of print.].

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IMPORTANCE: The US is currently an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, yet few national data are available on patient characteristics, treatment, and outcomes of critical illness from COVID-19. OBJECTIVES: To assess factors associated with death and to examine interhospital variation in treatment and outcomes for patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study assessed 2215 adults with laboratory-confirmed COVID-19 who were admitted to intensive care units (ICUs) at 65 hospitals across the US from March 4 to April 4, 2020. EXPOSURES: Patient-level data, including demographics, comorbidities, and organ dysfunction, and hospital characteristics, including number of ICU beds. MAIN OUTCOMES AND MEASURES: The primary outcome was 28-day in-hospital mortality. Multilevel logistic regression was used to evaluate factors associated with death and to examine interhospital variation in treatment and outcomes. RESULTS: A total of 2215 patients (mean [SD] age, 60.5 [14.5] years; 1436 [64.8%] male; 1738 [78.5%] with at least 1 chronic comorbidity) were included in the study. At 28 days after ICU admission, 784 patients (35.4%) had died, 824 (37.2%) were discharged, and 607 (27.4%) remained hospitalized. At the end of study follow-up (median, 16 days; interquartile range, 8-28 days), 875 patients (39.5%) had died, 1203 (54.3%) were discharged, and 137 (6.2%) remained hospitalized. Factors independently associated with death included older age (≥80 vs <40 years of age: odds ratio [OR], 11.15; 95% CI, 6.19-20.06), male sex (OR, 1.50; 95% CI, 1.19-1.90), higher body mass index (≥40 vs <25: OR, 1.51; 95% CI, 1.01-2.25), coronary artery disease (OR, 1.47; 95% CI, 1.07-2.02), active cancer (OR, 2.15; 95% CI, 1.35-3.43), and the presence of hypoxemia (Pao2:Fio2<100 vs ≥300 mm Hg: OR, 2.94; 95% CI, 2.11-4.08), liver dysfunction (liver Sequential Organ Failure Assessment score of 2 vs 0: OR, 2.61; 95% CI, 1.30-5.25), and kidney dysfunction (renal Sequential Organ Failure Assessment score of 4 vs 0: OR, 2.43; 95% CI, 1.46-4.05) at ICU admission. Patients admitted to hospitals with fewer ICU beds had a higher risk of death (<50 vs ≥100 ICU beds: OR, 3.28; 95% CI, 2.16-4.99). Hospitals varied considerably in the risk-adjusted proportion of patients who died (range, 6.6%-80.8%) and in the percentage of patients who received hydroxychloroquine, tocilizumab, and other treatments and supportive therapies. CONCLUSIONS AND RELEVANCE: This study identified demographic, clinical, and hospital-level risk factors that may be associated with death in critically ill patients with COVID-19 and can facilitate the identification of medications and supportive therapies to improve outcomes.

Guerrero-Miranda, C. Y. and S. A. Hall (2020). “Rethinking the Future with Evolving Technology: It’s Time to Empower Change in Heart Transplantation.” Am J Transplant 2020 Jul 27. [Epub ahead of print.].

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According to the National Institutes of Health (NIH) Biomarker Definition Working Group, biomarkers are characteristics objectively measured and indicators of a physiologic or pathologic process. In 1847, the first cancer biomarker was discovered when the Bence Jones proteins were found in the urine of patients with Multiple Myeloma; since then, biomarkers have played a crucial role in modern medicine. An ideal biomarker should be non-invasive, low cost, quantifiable, consistent across ethnic and gender groups, and reflect correlation in different diseases or conditions.

Whisenant, B., S. R. Kapadia, M. F. Eleid, S. K. Kodali, J. M. McCabe, A. Krishnaswamy, M. Morse, R. W. Smalling, M. Reisman, M. Mack, W. W. O’Neill, V. N. Bapat, M. B. Leon, C. S. Rihal, R. R. Makkar and M. Guerrero (2020). “One-Year Outcomes of Mitral Valve-in-Valve Using the SAPIEN 3 Transcatheter Heart Valve.” JAMA Cardiol Jul 29. [Epub ahead of print.].

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IMPORTANCE: Bioprosthetic mitral valves are implanted with increasing frequency but inevitably degenerate, leading to heart failure. Reoperation is associated with high morbidity and mortality. Transcatheter mitral valve-in-valve (MViV) using balloon-expandable transcatheter valves has emerged as an alternative for high-surgical risk patients. OBJECTIVE: To assess contemporary outcomes of SAPIEN 3 (Edwards Lifesciences) MViV replacement. DESIGN, SETTING, AND PARTICIPANTS: In this registry-based prospective cohort study of SAPIEN 3 MViV, patients entered in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry from June 2015 to July 2019 were analyzed. US Centers for Medicare and Medicaid linkage ensured comprehensive collection of death and stroke data. EXPOSURES: Mitral valve-in-valve for degenerated bioprosthetic mitral valves. MAIN OUTCOMES AND MEASURES: The primary efficacy end point was 1-year mortality. The primary safety end point was procedural technical success as defined by the Mitral Valve Academic Research Consortium criteria. Secondary end points included 30-day mortality, New York Heart Association-defined heart failure, and mitral valve performance. RESULTS: A total of 1529 patients (mean [SD] age, 73.3 [11.84] years; 904 women [59.1%]) underwent transseptal or transapical MViV implant at 295 hospitals between June 2015 and July 2019. The mean (SD) Society of Thoracic Surgeons predicted risk of mortality was 11.1% (8.7%). Procedural technical success was achieved for 1480 of 1529 patients (96.8%). All-cause mortality was 5.4% at 30 days and 16.7% at 1 year. Transseptal access was associated with lower 1-year all-cause mortality than transapical access (15.8% vs 21.7%; P = .03). Transcatheter MViV led to early, sustained, and clinically meaningful improvements in heart failure (class III/IV New York Heart Association heart failure of 87.1% at baseline vs 9.7% at 1 year). The mean (SD) mitral valve gradient at 1 year was 7 (2.89) mm Hg. CONCLUSIONS AND RELEVANCE: Transcatheter MViV using the SAPIEN 3 transcatheter heart valve is associated with high technical success, low 30-day and 1-year mortality, significant improvement of heart failure symptoms, and sustained valve performance. Transseptal MViV should be considered an option for most patients with failed surgical bioprosthetic valves and favorable anatomy.

Singhania, N., S. Bansal, D. P. Nimmatoori, A. A. Ejaz, P. A. McCullough and G. Singhania (2020). “Current Overview on Hypercoagulability in COVID-19.” Am J Cardiovasc Drugs Aug 4;1-11. [Epub ahead of print.]. 1-11.

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The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has brought many unique pathologies, such as coagulopathy, prompting a desperate need for effective management. COVID-19-associated coagulopathy (CAC) can cause various thromboembolic complications, especially in critically ill patients. The pathogenesis is likely due to endothelial injury, immobilization, and an increase in circulating prothrombotic factors. Data on treatment are limited, although prophylactic anticoagulation is advised in all hospitalized patients. Herein, we have comprehensively reviewed the current literature available on CAC and highlight the pathogenesis, clinical features, and management of CAC.