An unusual case of peripartum cardiomyopathy manifesting with multiple thrombo-embolic phenomena

Peripartum cardiomyopathy (PPCM) is a rare form of heart failure with a reported incidence of 1 per 3000 to 1 per 4000 live births and a fatality rate of 20%–50%. Onset is usually between the last month of pregnancy and up to 5 months postpartum in previously healthy women. Although viral, autoimmune and idiopathic factors may be contributory, its etiology remains unknown. PPCM initially presents with signs and symptoms of congestive heart failure and rarely with thrombo-embolic complications. We report an unusual case of PPCM in a previously healthy postpartum woman who presented with an acute abdomen due to unrecognized thromboemboli of the abdominal organs. This case illustrates that abdominal pain in PPCM may not always result from hepatic congestion as previously reported, but may occur as a result of thromboemboli to abdominal organs. Further research is needed to determine the true incidence of thromboemboli in PPCM

Impact of smoking in patients undergoing transcatheter aortic valve replacement.

Background: The paradox that smokers have better clinical outcomes in cardiovascular diseases remains controversial. No literature exists studying impact of smoking on outcomes following transcatheter aortic valve replacement (TAVR). Methods: We performed an electronic search of the 2011-2012 National Inpatient Sample (NIS) database to identify all TAVR hospitalizations. Outcomes were measured comparing smokers to non-smokers. Results: A total of 8,345 TAVR hospitalizations were identified with 24% being smokers. Compared to non-smokers, smokers were younger (80.4±8.8 vs. 81.4±9.2 years, P Conclusions: Despite having a higher cardiovascular disease burden, smokers had better outcomes compared to non-smokers. Therefore the smoker\u27s paradox is applicable in the TAVR cohort

Heart Failure and Cognitive Impairment: Clinical Relevance and Therapeutic Considerations

Heart failure (HF) is a devastating condition characterized by poor quality of life, numerous complications, high rate of readmission and increased mortality. HF is the most common cause of hospitalization in the United States especially among people over the age of 64 years. The number of people grappling with the ill effects of HF is on the rise as the number of people living to an old age is also on the increase. Several factors have been attributed to these high readmission and mortality rates among which are; poor adherence with therapy, inability to keep up with clinic appointments and even failure to recognize early symptoms of HF deterioration which may be a result of cognitive impairment. Therefore, this review seeks to compile the most recent information about the links between HF and dementia or cognitive impairment. We also assessed the prognostic consequences of cognitive impairment complicating HF, therapeutic strategies among patients with HF and focus on future areas of research that would reduce the prevalence of cognitive impairment, reduce its severity and also ameliorate the effect of cognitive impairment coexisting with HF

A web-based tool to predict acute kidney injury in patients with ST-elevation myocardial infarction: Development, internal validation and comparison.

In ST-elevation myocardial infarction (STEMI), acute kidney injury (AKI) may increase subsequent morbidity and mortality. Still, it remains difficult to predict AKI risk in these patients. We sought to 1) determine the frequency and clinical outcomes of AKI and, 2) develop, validate and compare a web-based tool for predicting AKI.In a racially diverse series of 1144 consecutive STEMI patients, Stage 1 or greater AKI occurred in 12.9% and was severe (Stage 2-3) in 2.9%. AKI was associated with increased mortality (5.7-fold, unadjusted) and hospital stay (2.5-fold). AKI was associated with systolic dysfunction, increased left ventricular end-diastolic pressures, hypotension and intra-aortic balloon counterpulsation. A computational algorithm (UT-AKI) was derived and internally validated. It showed higher sensitivity and improved overall prediction for AKI (area under the curve 0.76) vs. other published indices. Higher UT-AKI scores were associated with more severe AKI, longer hospital stay and greater hospital mortality.In a large, racially diverse cohort of STEMI patients, Stage 1 or greater AKI was relatively common and was associated with significant morbidity and mortality. A web-accessible, internally validated tool was developed with improved overall value for predicting AKI. By identifying patients at increased risk, this tool may help physicians tailor post-procedural diagnostic and therapeutic strategies after STEMI to reduce AKI and its associated morbidity and mortality

Outcome of Liver Transplant Recipients with Revascularized Coronary Artery Disease: A Comparative Analysis with and Without Cardiovascular Risk Factors

Background Coronary artery disease (CAD) is a significant problem during evaluation for liver transplantation (LT). We aim to assess survival in LT recipients based on presence, severity, extent of CAD, and cardiac events within 90 days of LT. Methods Eighty-seven LT recipients with history of pre-LT angiogram (December 2005 to December 2012) were compared with 2 control groups without prior angiogram, 72 LT recipients matched for cardiovascular risk factors (control group I), and 119 consecutive LT recipients without any CV risk factors (control group II). CAD was assessed by (1) vessel score (≥50% reduction in luminal diameter), and (2) Extent score (Reardon scoring system). Results Of the 87 LT recipients (study group), 58 (66.7%) had none or less than 50% stenosis, 29 (33.3%) had obstructive CAD (≥50% stenosis), 7 (8%) with single-vessel disease, and 22 (25.3%) with multivessel disease. In the study group, irrespective of prerevascularization severity of CAD (P = 0.357), number of segments involved (0, 1-2, \u3e 2 segments, P = 0.304) and extent of CAD based on Reardon score (0, 1-9, \u3e10, P = 0.224), comparable posttransplant survival was noted. Overall, patient survival in the revascularized CAD group was comparable to angiogram group without obstructive CAD, and both control group I and control group II (P = 0.184, Log Rank). Postoperative cardiac events within 90 days of LT predicted poor survival in study group as well as control groups. Conclusions Severity or extent of CAD does not impact post-LT survival, if appropriately revascularized. Early postoperative cardiac events are associated with inferior survival in LT recipients, irrespective of underlying CAD

1273-P: Dysglycemia and Cardiac Autonomic Dysfunction—The Diabetes Prevention Program Outcomes Study (DPPOS)

Introduction: Limited data exist on links between glycemic markers and cardiac autonomic neuropathy (CAN) across the dysglycemia spectrum (including prediabetes and diabetes). We assessed associations of multiple glycemic markers with heart rate (HR) and CAN, measured via heart rate variability (HRV). Methods: This cross-sectional analysis included 2,266 participants who attended a 14-year follow up DPPOS visit. We evaluated associations of glycemic markers (fasting glucose, HbA1c and HOMA-IR) with HR and HRV (standard deviation of all normal-to-normal intervals [SDNN], root mean square of successive differences between normal-to-normal intervals [rMSSD] and QT index [QTI]) measures, using linear regression. Similarly, the relations between glycemic markers and CAN (SDNN ≤17.13 ms, rMSSD ≤24.94 ms or QTI ≥112) were assessed using logistic regression. Results: Participants had 65 years old on average, 68.2% were women, 53.4% were White, and 57.3% had diabetes. Glycemic measures were positively associated with HR and negatively associated with SDNN and rMSSD (Figure 1). Greater HbA1C, FPG and HOMA IR were associated with greater odds of CAN (OR [95% CI] per SD change: 1.34 [1.14, 1.62], 1.27 [1.08, 1.53] and 1.19 [1.02, 1.39], P<0.05). Conclusions: Glucose metabolism is associated with heart rate and risk of cardiac autonomic dysfunction across the spectrum of dysglycemia. Disclosure J. Echouffo Tcheugui: None. X. Liu: None. R.B. Goldberg: None. M. Budoff: Speaker's Bureau; Boehringer-Ingelheim, Lilly Diabetes, AstraZeneca. S. Dagogo-Jack: Consultant; Merck Sharp & Dohme Corp., Medtronic, Bayer Inc. Stock/Shareholder; Aerami. S. Golden: None. U.N. Ibebuogu: None. W.C. Knowler: None. N. White: None. M. Temprosa: None. D. Research Group: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (UDK048489, UDK048339, UDK048377, UDK048349, UDK048381, UDK048468, UDK048434, UDK048485, UDK048375, UDK048514, UDK048437, UDK048413, UDK048411, UDK048406, UDK048380, UDK048397, UDK048412, UDK048404, UDK048387, UDK048407, UDK048443, UDK048400