Prognostic implications of serial high-sensitivity cardiac troponin testing among patients with COVID-19:A Danish nationwide registry-based cohort study

BACKGROUND: Although troponin elevation is associated with worse outcomes among patients with coronavirus disease 2019 (COVID-19), prognostic implications of serial troponin testing are lacking. We investigated the association between serial troponin measurements and adverse COVID-19 outcomes. METHODS: Using Danish registries, we identified COVID-19 patients with a high-sensitivity troponin measurement followed by a second measurement within 1–24 h. All measurements during follow-up were also utilized in subsequent time-varying analyses. We assessed all-cause mortality associated with the absence/presence of myocardial injury (≥1 troponin measurement >99th percentile upper reference limit) and absence/presence of dynamic troponin changes (>20% relative change if first measurement elevated, >50% relative change if first measurement normal). RESULTS: Of 346 included COVID-19 patients, 56% had myocardial injury. Overall, 20% had dynamic troponin changes. In multivariable Cox regression models, myocardial injury was associated with all-cause mortality (HR = 2.56, 95%CI = 1.46–4.51), as were dynamic troponin changes (HR = 1.66, 95%CI = 1.04–2.64). We observed a low incidence of myocardial infarction (4%) and invasive coronary procedures (4%) among patients with myocardial injury. CONCLUSIONS: Myocardial injury and dynamic troponin changes determined using serial high-sensitivity troponin testing were associated with poor prognosis among patients with COVID-19. The risk of developing myocardial infarction requiring invasive management during COVID-19 hospitalization was low

Obesity, metabolic syndrome and cardiovascular prognosis: from the Partners coronary computed tomography angiography registry

Objective: To investigate the relationship among body mass index (BMI), cardiometabolic risk and coronary artery disease (CAD) among patients undergoing coronary computed tomography angiography (CTA). Methods: Retrospective cohort study of 1118 patients, who underwent coronary CTA at two centers from September 2004 to October 2011. Coronary CTA were categorized as normal, nonobstructive CAD ( 4. Association of BMI with cardiovascular prognosis was evaluated using multivariable fractional polynomial models. Results: Mean age of the cohort was 57 ± 13 years with median follow-up of 3.2 years. Increasing BMI was associated with MetS (OR 1.28 per 1 kg/m2, p 25 kg/m2. Within each BMI category, metabolically unhealthy patients had greater extent of CAD, as measured by CCTA, compared to metabolically healthy patients

Modeling the Cost and Health Impacts of Diagnostic Strategies in Patients with Suspected Transthyretin Cardiac Amyloidosis

Background Transthyretin cardiac amyloidosis (ATTR‐CMP) is an increasingly recognized and treatable cause of heart failure with preserved ejection fraction. Multimodality cardiac imaging is recommended for ATTR‐CMP diagnosis, but its cost‐effectiveness in current clinical practice has not been well studied. Methods and Results Using a microsimulation model, we compared the cost‐effectiveness of a combination of strategies involving 99mtechnetium pyrophosphate (PYP), cardiac magnetic resonance imaging, and endomyocardial biopsy for the diagnosis of ATTR‐CMP. We developed a decision analytic model to project health care costs and lifetime quality‐adjusted life years for symptomatic, older patients who present with congestive heart failure, with an increased left ventricular wall thickness and a 13% prevalence of ATTR‐CMP. Rates of clinical events, costs, and quality‐of‐life values were estimated from published literature. The analysis was conducted from a US health care system perspective with health and cost outcomes discounted annually at 3%. In the base‐case scenario, using a fixed tafamidis price of $16 000 annually (previously identified cost‐effective price), total health care costs per person were lowest for the PYP‐only strategy ($209 415) and highest for endomyocardial biopsy strategy ($215 881). Of the 7 strategies examined, the PYP‐only strategy had the highest net monetary benefit using a willingness‐to‐pay threshold of$100 000/quality‐adjusted life year. Results were sensitive to variations in model inputs for PYP and cardiac magnetic resonance imaging specificity, cost of tafamidis, and willingness‐to‐pay thresholds. Conclusions Our model‐based analyses showed that a PYP‐only strategy to diagnose ATTR‐CMP is the most cost‐effective strategy, at willingness‐to‐pay threshold of $100 000/quality‐adjusted life year. At higher threshold ($150 000/quality‐adjusted life year), sequential tests involving PYP and cardiac magnetic resonance imaging may be considered cost effective

Changes in F18-flurodeoxyglucose uptake on serial cardiac positron emission tomography and left ventricular ejection fraction in patients with cardiac sarcoidosis

lntroduction: Cardiac positron emission tomography (PET) using F18-fluorodeoxyglucose (FDG) has been used to diagnose and monitor cardiac sarcoidosis (CS). It is not yet known whether a reduction in myocardial inflammation, as measured by FDG uptake, is associated with improvement in LV ejection fraction (EF). Methods: For 23 patients with CS (83% diagnosed by biopsy, 17% clinically) followed by a-total of 90 serial PET exams (median 4 per patient), two physicians blinded to EF quantified the maximum standardized uptake value (SUV) and volume of FDG to assess lhe intensity and extent of FDG uptake on each study. Using gated rubidium rest perfusion images, EF was measured by a physician blind to all clinical and FDG data. To account for clustering and differences in scan frequency, a mixed effects model was used to evaluate the relationship between FDG uptake and changes in EF on interval scans. Results : Among 23 patients with serial PETexams (mean age 49,74% male, mean baseline EF 43± 13%) the median time between the first and last scan was 2.0 years. Overall, 91% were treated with corticosteroids, 78% with ACE/ARB, 83% with beta-blockers and 83% had ICDs. Mixed modeling demonstrated a significant inverse linear relationship with an expected increase in EF'of 7.9% per SUV reduction of 10 g/mL (p≤ 0.008) and an increase of 3.8% per SUV volume reduction of 100 cm3 (p≤ 0.022). Conclusions: In a longitudinal cohort of CS patients, a reduction in the intensity and extent of myocardial inflammation on FDG PET is associated with improvement in EF. These data suggest serial PETscanning may help guide titration of immunosuppressive therapy to prevent heart failure in CS.Apresentado no Scientific Sessions and Resuscitation Science Symposium of the American Heart Association, realizado em 16-17 de novembro de 2013 em Dallas, TX