Fylgirit 117 - NBCC 2023

28. nordic-baltic congress of cardiology - june 2023 - Reykjavík

Clinical Cases Presentation


Mesalazine-induced Myocarditis in Adolescents: A Rare but Important Complication to Consider

Loriane Kilaite, Vaidotas Urbonas, Rita Sudikiene

Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania

Mesalazine is a commonly used drug for treating inflammatory bowel disease, but it can also cause rare but serious complications, such as mesalazine-induced myocarditis. This case report describes a 15-year-old boy with ulcerative colitis who was treated with mesalazine, prednisolone, and azathioprine, and subsequently experienced a relapse of symptoms. His mesalazine dose was increased, and he was discharged after 16 days with minimal symptoms. However, he was later admitted to the cardiology department with signs of cardiogenic shock and acute myocarditis.

After eliminating other potential causes of the myocarditis, it was concluded that the mesalazine was likely the cause. The patient's mesalazine treatment was stopped, and his condition partially improved with treatment. It is important to consider rare but potentially dangerous complications when prescribing mesalazine treatment, especially in patients with a history of cardiac disease. The case also highlights the difficulty of differential diagnosis of myocarditis and myopericarditis, and the importance of monitoring patients with both gastrointestinal and cardiac symptoms.

In reviewing the literature, 28 cases of mesalazine-induced myocarditis in children and adolescents have been reported, with most patients experiencing complete recovery after discontinuing mesalazine treatment. Clinicians should be aware of this rare complication when prescribing mesalazine and carefully monitor patients for signs of myocarditis or other cardiac complications.


Mitral and aortic Valve-In-Valve

Malin Flygel,

Haukeland University Hospital, Bergen, Norway

75 year old man. Got implanted a mitral Perimount Magna 26 and aortic Perimount 23 mm in 2009, due to endocarditis with large vegetation's and insufficiencies in both valves.

From 2014 the mitral valve started to degenerate. In 2020 there was a severe stenosis with the need of intervention. The aortic valve only had a moderate stenosis. Due to high surgical risk, the patient was accepted for mitral Valve-in-Valve. The procedure was successful with a Sapien 29 mm. The patient was followed in the outpatient clinic. In 2022 there was a severe stenosis in the aortic valve. There was also a severe tricuspid insufficiency due to a prolapse in the septal leaflet with a dilated right ventricle. The patient was accepted for aortic valve-in-valve with the thought of repairing the tricuspid insufficiency later on if the patient was having symptoms. The valve-in-valve procedure was successful with an Evolute 26 mm.

We know that surgical biological valves degenerate over time, and that some patients will outlive their biological valve and present with the need of reintervention. Guidelines for either surgical or percutaneous treatments have limited data with a 1 C indication for reoperation and IIa/b B for Valve-in-Valve procedures. For patients with high surgical risk percutaneous treatments would be the main option. This is one of few patients with valve-in-valve in both mitral- and aortic position. Done in two different procedures with good results, both with transfemoral access. He will be evaluated for TEER in April.


Barlow`s disease: cause of sudden cardiac death

Emilija Sakavičiūtė, Ieva Merkytė, Giedrė Bakšytė

Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania

Introduction: Barlow's disease is a clinical syndrome characterized by pronounced mitral valve annular dilatation, bileaflet prolapse and excessive myxomatous tissue proliferation of leaflets. Several studies have reported ventricular arrhythmias and sudden cardiac death caused by mitral valve prolapse. Fibrosis of the papillary muscles and inferobasal left ventricular segment, indicating a myocardial stretch by the prolapsed leaflet, is the structural hallmark and is associated with ventricular arrhythmias origin.

Material and methods: 63-year-old man was hospitalized after cardiac arrest caused by ventricular fibrillation. Resuscitation was successful, full consciousness was regained. The patient had a syncope eight years ago, seven years ago mitral and tricuspidal valve prolapses were diagnosed. Searching for causes of sudden death, coronary angiography was performed – no lesions were found. Echocardiography showed thickened and prolapsed mitral leaflets due to diffuse excess of tissue caused by myxomatous degeneration, that caused a severe mitral valve regurgitation - these changes are typical to Barlow`s disease. The patient was presented to the Heart team, and successful mitral valve repair surgery was performed.

Results: Moderate-to-severe mitral regurgitation has been demonstrated to be an independent risk factor of ventricular arrhythmias. Valve leaflet dumping in diastole or traction on papillary muscles could serve as a mechanical trigger for ventricular arrhythmias.

Conclusion: Mitral valve prolapse is a common condition in general population and it is usually asymptomatic if non-severe. Early diagnostic of Barlow's disease, monitoring and timely intervention could be a prevention of sudden cardiac death caused by rare but possible ventricular arrhythmias.


Idiopathic systemic capillary leak syndrome complicated by cardiogenic shock and rhabdomyolysis – a case report

Svenno Saan1, Kairit Palm2

1University of Tartu, Institute of Clinical Medicine, Tartu, Estonia, 2East Tallinn Central Hospital, Tallinn, Estonia

Idiopathic systemic capillary leak syndrome (ISCLS) is a rare and potentially fatal disease that manifests as episodes of hypotension, hypoalbuminemia and hemoconcentration. During ISCLS episodes the vascular endothelium throughout the body becomes dysfunctional so that fluid and proteins from inside the vasculature can escape into the interstitial space. The etiology of ISCLS remains unknown and the diagnosis is mainly based on the combination of hypotension, hypoalbuminemia and hemoconcentration as well as exclusion of other possible causes. Treatment of acute episodes is mainly supportive and consists of maintaining an adequate volume and respiratory status. Regular infusions of intravenous immunoglobulin (IVIG) help decrease the likelihood of future episodes.

Here we demonstrate the case of a 39-year-old man who two months prior had history, laboratory analyses, echocardiographic and magnetic resonance imaging findings concomitant with myocarditis and was therefore treated as such. Now the patient presented with a similar but more life-threatening condition that was complicated by severe shock and rhabdomyolysis. Treatment in the intensive care unit was required, including fluids, inotropic support, IVIG, plasmapheresis and dialysis. Since laboratory analyses showed hypoalbuminemia and hemoconcentration and other diagnoses were excluded, ISCLS became the most plausible explanation. Notably, while most cases of shock during ISCLS episodes represent distributive and hypovolemic types, this patient also had a cardiogenic component. Although not common, severe myocardial dysfunction has previously been described in ISCLS as well. This case highlights the importance of considering the diagnosis of ISCLS in patients with unexplained episodes of cardiogenic shock and myocarditis.


Nursing Program - Oral Abstract Presentation


Advanced heart failure nursing experience at Tartu University Hospital in Estonia

Annika Elmet,

Tartu University Hospital, Tartu, Estonia

Introduction: Systematic advanced heart failure (AHF) program has been developed in Tartu University Hospital over the last 10 years. Nursing is important part of the program to educate patients and their families to ensure the best medical care and treatment compliance.

Material and methods: AHF nursing involves continuous patient care in hospital and outpatient situation.

The main activities are made in nurse-led HF clinic, including regular visits of AHF patients, protocol based post-transplant visits and care of left ventricular assist device (LVAD) patients.

Because of small population, Estonia has agreement with Finland to perform heart transplantation (HTx) surgery and post-operative intensive care in Helsinki University Hospital but pre-operative patient selection, preparation for HTx and post-operative follow up is carried out in Estonia.

The additional challenges of cross-border nursing are effective and clear communication and unified standards of care.

Results: Over the last 10 years 22 LVAD-s has been implanted in two Estonian centers, Tartu University Hospital and North Estonia Medical Centre, and 16 heart transplantation for Estonian patients have been performed in Helsinki University Hospital.

Both the patient and nursing guidelines for pre- and post-transplant patient care are adapted from Finnish guidelines.

Well-functioning patient organization is created for sharing patient experience and providing educational and financial support: https://www.siirdatudsyda.ee

Conclusions: The nurse-led systematic care for AHF patients in hospital and outpatient settings has been well received by the patients and families due to easy access, simple and clear communication. Patient organization has shown to be useful partner of nursing activity.


Perceived social support among percutaneous coronary intervention patients over a six-years follow-up period

Outi Maria Kähkönen1, Kankunen Päivi2, Heikki Miettinen3, Hannu Vähänikkilä4, Leila Paukonen4, Anne Oikarinen4, Terhi Saaranen1

1University of Eastern Finland , Kuopio, Finland, 2University of Eastern Finland, Kuopio, Finland, 3Wellbeing services county of Central Finland, Jyväskylä, Finland, 4University of Oulu, Oulu, Finland

Introduction: Percutaneous coronary intervention (PCI) is a common procedure for treatment coronary heart disease (CHD). CHD with an invasive procedure is often stressful. Thus, the importance of social support is emphasized. Social support consists of three aspects: informational support comprises information and recommendations, emotional support includes listening and encouragement, while functional support consists of concrete assistance. The aim of this study was to investigate social support and associated factors among post-PCI patients over a long-term follow-up period.

Material and methods: In this explanatory and descriptive survey baseline data (n = 416) were collected from Finnish patients in 2013, with follow-up data collected by the same study group in 2019 (n = 154). The research employed the Social Support of Patients with Coronary Heart Disease questionnaire. Data were analysed using descriptive statistics and multivariate methods.

Results: Based on the follow-up results, those who experienced high informational support were younger and physically active. They had lower cholesterol levels and undergone PCI only at the baseline. Higher emotional support was perceived among those with a close personal relationship. Functional support was perceived most among smokers and coronary artery bypass surgery patients.

Conclusion: The results seem that access of social support, especially informational support, should be ensured in the long-term follow-ups among post-PCI patients, because it might be associated with better long-term outcomes. Based on the results, social support should be targeted more elderly people living alone, whose disease has required several invasive procedures and whose risk factors are not at an optimal level.



Co-creation in the development of a digital cardiac rehabilitation programme

Kristin Johnsen Ramstad, Nina Hjertvikrem, Trond Røed Pettersen, Tone Merete Norekvål

Haukeland University Hospital, Bergen, Norway

Introduction: Co-creation and patient involvement is pivotal when developing new digital services. Involving patients mitigate risks related to acceptability and feasibility for patients, as the co-creation process involves end-users in each phase of the design and development process. This study aims to describe experiences from a co-creation process when developing a digital cardiac rehabilitation programme.

Material and methods: In the development of the eCardiacRehab programme, eight patient-representatives, four men and four women (age 39-73) were recruited from the National Association for Heart and Lung Diseases. Six co-creation sessions were conducted from June 2022 to March 2023. The sessions had a structured agenda, lasting for 1-3 hours, with a combination of transcription from audiotapes and field notes.

Results: In the co-creation sessions, perceived engagement was high. Several topics engaged the patient-representatives, and patient-representatives' emphasised that eCardiacRehab should; 1) offer a more personalised intervention with tailored goals and registering activities to motivate patients overcoming their barriers to adherence 2) motivate for exercise and a healthy diet 3) provide patients with digital reminders and motivation to adhere to the programme. In addition, the possibility of peer-support in a digital setting was a challenge raised, as peer-support was an important component in patients' own long-term adherence to life-style changes.

Conclusion: Co-creation allows for development of a more tailored intervention. The patient-representatives had several suggestions for eCardiacRehab. Therefore, it is pivotal to make co-creation sessions a safe platform for sharing, as there is a risk that less positive representatives do not voice their opinion


The launching of a nurse-led acute myocardial infarction secondary prevention program at Tartu University Hospital in Estonia

Annika Elmet, Birgit Nädal, Kristina Sobchenko, Kerit Kalder, Mai Blöndal

Tartu University Hospital, Tartu, Estonia

Introduction: Secondary prevention plays a key role in the prognosis of patients with acute myocardial infarction (AMI).

Material and methods: In 2021 a nurse-led secondary prevention program was launched at Tartu University Hospital in Estonia. It includes a visit to a specially trained nurse who has access to a consulting cardiologist. It targets <75-year old patients 4-6 weeks after an AMI event. The aim is to improve drug adherence, help patients reach their secondary prevention targets (LDL-C <1.4 mmol/l, blood pressure <140/90 mmHg), motivate and help in making lifestyle changes like quit smoking and reduce stress as well as facilitate referral to physical rehabilitation.

Results: In 2022 there were 158 (40% of annual AMI cases under 75-years of age) visits to the nurse-led secondary prevention reception. The mean age 63 years, 74% were men. The rates of cardiovascular risk factors were high: 73% had hypertension, 82% had LDL-C above target value despite aggressive statin-treatment, 24% had diabetes, 35% were smokers (45% during the index event). The patients received advice on the modification of their cardiovascular risk factors, principals of drug treatment, and in up to 75% of cases a change in the hyperlipidaemia treatment was made as decided by the consulting cardiologist.

Conclusions: The nurse-led secondary prevention program has been well received by the patients as well as hospital staff and it could be an example for similar counselling models in other Estonian hospitals. In the future a re-evaluation visit 12 months after the index event is planned.


Attribute development for a discrete choice experiment to elicit patient preferences for a digital cardiac rehabilitation programme: a qualitative study

Nina Hjertvikrem1, Kristin Johnsen Ramstad1, Trond Røed Pettersen1, Janet MacNeil Vroomen2, Tone Merete Norekvål1

1Haukeland University Hospital, Bergen, Norway, 2Amsterdam University Medical Centres, Netherlands

Introduction: A discrete choice experiment is a method to elicit patient preferences. The attribute development is a crucial step, and should be conducted rigorously, based on previous research and qualitative methods. This study aims to develop attributes that elicit patient preferences for a digital cardiac rehabilitation programme.

Material and methods: Four group-meetings were conducted with patient representatives (n=6), three men and three women (age 39–73), recruited from The National Association for Heart and Lung Diseases. The first concerned digital cardiac rehabilitation interventions. The second, addressed topics from literature, developers of the digital interventions and topics from the first meeting. In the third meeting, patient representatives were asked to rank possible attributes before and after a discussion on each of the possible attributes. In the fourth meeting, patient representatives were presented with examples of choice sets with attributes and levels. Relevance and wording of the attributes were discussed.

Results: Twelve attributes were considered important. After ranking and discussion in the third meeting, these attributes were reduced to seven attributes. After the fourth meeting, two more attributes were removed and texts were refined. The final five attributes were: (1) Contact with healthcare personnel during the program; (2) Goal setting and registration of own activities; (3) How to motivate for physical activity; (4) How to motivate for change of diet; (5) How to motivate for medication adherence.

Conclusion: Qualitative methods can increase quality of attributes, in addition to help refining language. Attributes concerning lifestyle factors and contact with healthcare-personnel were important to patients.


The nurse´s role in the cardiac rehabilitation team – data from the Perfect-CR study and SWEDEHEART

Matthias Lidin1, Halldora Ögmundsdottir Michelsen2, Emma Hag 3, Mona Schlyter2, Maria Bäck 4, Emil Hagström 5, Margret Leosdottir 2

1Department of Medicine, Unit of Cardiology, Karolinska Institute, Stockholm, Sweden, 2Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Sweden, 3Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden, 4Department of Medical and Health Sciences, Division of Physiotherapy, Linköping, Sweden, 5Uppsala Clinical Research Centre, Uppsala, Sweden

Background: Secondary prevention after myocardial infarction (MI) should be provided by a multidisciplinary cardiac rehabilitation (CR) team focusing on cardiovascular risk factors, lifestyle, and psychosocial management. We aimed to identify components reflecting the nurse´s role in the CR team associated with risk factor target achievement post-MI.

Methods: Centre-level data (78 CR centres) was used from the Perfect-CR study, in which work routines applied within CR in Sweden (including details on the nurse's role) were surveyed. Patient-level data (7549 post-MI patients) was retrieved from the SWEDEHEART registry. Associations between work routines and target achievement for systolic blood pressure (SBP, <140 mmHg) and low-density lipoprotein-cholesterol (LDL-C, <1.8 mmol/L) at one-year post-MI were assessed using adjusted logistic regression models.

Results: Several work routines related to the nurse's autonomy and role in the team were of significance for achieving targets for SBP and/or LDL-C. These included nurses having delegation to adjust BP medication (odds ratio and 95% confidence interval for SBP 1.28, 1.12-1.47; LDL-C 1.15, 1.02-1.30) and lipid-lowering medication (SBP 1.15, 1.02-1.23; LDL-C 1.17, 1.06-1.30), having protocols for such adjustments (SBP 1.40, 1.24-1.59; LDL-C 1.15, 1.03-1.28), patients having the same nurse throughout follow-up (1.08, 1.04-1.12; LDL-C 1.10, 1.06-1.13), CR nurses meeting the patients during MI hospitalization (SBP 1.03, 1.00-1.07), having multidisciplinary rounds to discuss patient cases during follow-up (LDL-C 1.08, 1.04-1.12), and nurses having education in behavior change techniques (SBP 1.07, 1.03-1.10).

Conclusion: Components reflecting CR nurse autonomy and role in the team are of importance for patients achieving central risk factor targets post-MI.


Perfect health not so perfect after all – the use of generic and disease-specific patient-reported outcomes measures in description of health in 2574 patients following PCI

Tone M Norekvål1, Marjolein Memelink Iversen2, Kjersti Oterhals1, Heather Allore3, Britt Borregaard4, Trond Røed Pettersen1, David R Thompson5, Ann-Dorthe Zwisler4, Kyrre Breivik1

1Haukeland University Hospital, Bergen, Norway, 2Western Norway University of Applied Sciences, Bergen, Norway, 3Yale University, New Haven, USA, 4Odense University Hospital, Odense, Denmark, 5Queens University, Belfast, United Kingdom

Introduction: Patient-reported outcome measurements (PROMs) are crucial to capture patients' health and illness status. Selecting the most suitable PROM to measure the construct of interest is essential. Aims: To determine floor and ceiling effects of a generic health utility instrument in a multicentre cohort of patients after percutaneous coronary intervention (PCI) and further explore those with perfect health scores by using a disease-specific instrument.

Material and Methods: CONCARDPCI was conducted at seven PCI centres in Norway and Denmark (June 2017-May 2020) with serial follow-up measurement. In all, 2574 patients were available for analysis. The generic EQ-5D-5L descriptive system and visual analogue scale, and the disease-specific Myocardial Infarction Dimensional Assessment Scale (MIDAS) comprising 35 items measuring seven areas of health status and daily life challenges scrutinized the aims.

Results: There was a large ceiling effect on the EQ-5D-5L score in patients after PCI with 32% scoring the lowest possible EQ-5D-5L score, suggesting perfect health. Latent class analysis on the MIDAS revealed, however, four classes where 17-46% of the perfect scorers perceived challenges in health, particularly related to symptoms of fatigue, and worries about risk factors and side effects of medication.

Conclusion: To obtain an accurate picture of patients' health status, both generic and disease-specific PROMs are needed to capture distinct problems patients experience after PCI. Caution should be made when using the EQ-5D-5L as the sole measure, particularly in priority settings, due to its potential ceiling effect and the fact that important aspects of patient health may be neglected.


Poster session 1 - Arrythmias and device therapy


Success rate of left bundle branch area pacing in 100 consecutive patients

Jarkko Karvonen, Jouni Kuusisto, Jussi Naukkarinen, Heli Tolppanen, Leena Konkola, Markus Sane

Helsinki University Hospital, Helsinki, Finland

Introduction: Left bundle branch area pacing (LBBAP) is a novel pacing method offering physiological left ventricular activation. LBBAP includes left bundle branch pacing (LBBP) and left ventricular septal pacing (LVS). ECG criteria for LBBP and LVS have been recently published in the MELOS study. When the collection of the data started our center had experience of less than one year in LBBAP procedures.

Materials and methods: We collected the following data from 100 consecutive patients in whom LBBAP was attempted: number of lead implantation attempts, procedure time, V6 R-wave peak time (V6RWPT), and V6-V1 interpeak interval. Using the MELOS study criteria, we classified the paced QRS as LBBAP, His bundle pacing (HBP) or deep septal pacing without conduction system capture (DSP). LBBAP was further divided to LBBP and LVS. Both primary implantations and CRT bailouts were included.

Results: Median number of attempts was 2 (range 1-15) and median procedure time was 1 hour 8 minutes (range 23 minutes – 3 hours 57 minutes). The mean V6RWPT was 77±14 ms and V6-V1 interpeak interval 35±12 ms. Ninety cases were classified as LBBAP, 3 as HBP, and 7 as DSP. Sixty-six cases fulfilled the criteria for LBBP and 24 cases for LVS. Altogether 93% of patients received conduction system pacing (either LBBAP or HBP).

Conclusions: Our results are comparable to the large MELOS study that was conducted in experienced centers. LBBAP is a feasible pacing method even with limited experience.


Deep learning algorithm on single-lead ECG to stratify risk of shockable cardiac arrest among hospitalized patients

Eno-Martin Lotman1, Scott Vinay2, Diogo Santos2, Marek Sirendi2, Marek Rei2, Joshua Oppenheimer2

1North Estonia Medical Centre, Tallinn, Estonia, 2Transformative.ai, London, United Kingdom

Introduction: This work presents a collaboration effort between North Estonia Medical Centre (NEMC) and Transformative.ai in developing a novel deep learning algorithm that uses features derived from ECG lead II to categorize patients as being at low-, moderate, or high-risk of experiencing shockable cardiac arrests (ShCA) within the next 24 hours.

Materials and methods: This retrospective cohort study was based on a dataset drawn from publicly available datasets (CUDB, SDDB, MITDB, and MIMIC). This consists of 7,859 patients, including 160 patients who experienced ShCAs. The machine learning model used an ensemble of sub-models: Long Short-Term Memory (LSTM) and a Gated Recurrent Unit (GRU).

Results: The model presented with satisfactory results. The model was tested on a NEMC patient with acute myocardial infarction who experienced a ShCA event. The point of maximal risk calculated by the model occurred 30 minutes before the arrhythmia. In comparison to the standard-of-care Modified Early Warning Score (MEWS), the precision of MEWS was 18.7% and the precision of CodeRhythm was 85.1% at similar levels of sensitivity. The ECG traces preceding the ShCA event did not exhibit any particular abnormalities, and the imminent arrhythmia was not predicted by clinical staff before the event.

Conclusions: Software that accurately identifies a patient's risk of developing shockable cardiac arrest over the next 24 hours could significantly improve clinical outcomes. We report a preliminary algorithm that has the potential to predict the risk of shockable cardiac arrest. The model will need to be further refined with prospectively collected data.


Impact of cryoablation on the quality of life of patients with atrial fibrillation

Greta Radauskaite, Gediminas Rackauskas, Audrius Aidietis

VUL Santaros Clinic, Vilnius, Lithuania

Introduction: according to the literature, 16-35 percent of patients with atrial fibrillation (FA) experience severe symptoms. Although this is not associated with mortality or stroke risk, it significantly impairs quality of life.

Materials and methods: patients who underwent the cryoablation at Vilnius University Santaros Clinic were followed up for four years. EHRA score was assessed before the procedure, one year and four years after procedure. Statistical analysis was performed using Statistica program (SPSS v.13). Friedman test was used to analyze the difference between variables. A p-value <0,05 was considered significant.

Results: the study involved 94 respondents: 67 men (71 percents) and 27 women (29 percents). Before cryoablation, 44 percents of patients had EHRA II, 56 percents had EHRA III. There were no patients with EHRA I. One year after the procedure, 53 percents of patients had EHRA I, 37 percents EHRA II, 10 percents EHRA III. A statistically significant difference was observed between the rate assessed before the procedure and one year after the procedure, as well as when comparing the rates before the procedure and four years after the procedure ( p<0,000). There was no statistically significant difference comparing EHRA score one year and four years after the cryoablation (p= 0,180).

Conclusions: the cryoablation improves the quality of life in patients with FA. An improvement in EHRA score observed one year after the procedure.


Amiodarone induced thyroid dysfunction

Páll Guðjónsson1, Ari J. Ingolfsson1, Axel F. Sigurdsson2, Þórarinn Guðnason3, Karl Andersen1

1Landspitali University Hospital, Reykjavik, Iceland, 2Hjartamidstodin, Reykjavik, Iceland, 3Læknasetrið, Reykjavik, Iceland

Introduction: Amiodarone causes hypothyroidism in 12-25% of treated patients and amiodarone induced thyrotoxicosis is seen in 1.2%-12%. The purpose of the study was to investigate the prevalence of amiodarone induced thyroid dysfunction in Iceland and the effects of dosage and treatment duration.

Materials and methods: The study population was comprised of all patients that were prescribed amiodarone in Iceland during the calendar year of 2014, a total of 1054 patients. Follow up data was obtained from the national health care records both retrospectively and prospectively for first prescription of amiodarone and signs of thyroid related problems.

Results: Amiodarone induced hypothyroidism (AIH) was seen in 22.2% of patients. 10.7% had overt AIH and 11.6% had subclinical hypothyroidism. Hypothyroidism occurred on average after 3.3 ±0.4 years of treatment. The incidence increased with treatment duration and peaked at 41.8% after 15 years of treatment. The risk did not correlate with dosage.

Amiodarone induced thyrotoxicosis was seen in 10.0% with a mean age of 65.6 years. The mean duration of treatment at diagnosis of thyrotoxicosis was 3.9 ±0.6 years. The risk increased with treatment duration up to 17.6% after 13 years of treatment. Higher dosage of amiodarone increased the risk in a dose dependant manner. It was 5% with <200 mg, 11.8% with 200 mg and 14.1% with >200mg (p<0.01).

Conclusion: In this nationwide study we found that long term users of amiodarone are at a higher risk of amiodarone induced hypothyroidism or thyrotoxicosis than previously described.


Systemic atherosclerosis causes reduced cerebral perfusion

Marianna Gardarsdottir1, Sigurdur Sigurdsson2, Thor Aspelund2, David Otto Arnar1, Vilmundur Gudnason2

1Landspitali, Reykjavik, Iceland, 2Hjartavernd, Kopavogur, Iceland

Introduction: Previous studies have shown lower cerebral perfusion in atrial fibrillation, reduced brain volume and cognitive decline. The effect was more pronounced with permanent atrial fibrillation, independent of stroke. Atherosclerosis has similar effect, making comparison with perfusion in atrial fibrillation, using stiffness of the aorta as an indicator of systemic atherosclerosis, interesting. Increased stiffness reduces deflection of the aortic pressure wave at the cervical interface, causing increased pressure in the brain capillaries with capillary and brain tissue damage.

Materials and methods: To compare the effect of atherosclerosis and atrial fibrillation, aortic stiffness was assessed in 261 individuals in the AGES-Reykjavik Study with a pressure monitor in peripheral arteries and derived pressure, CFPWV, calculated. Cerebral perfusion was measured with magnetic resonance imaging and quantitative images of whole brain and grey and white matter assessed.

Results: Participants (mean age 63±4 years) were divided into two groups by median CFPWV. The group with higher CFPWV had significantly lower cerebral perfusion compared to the group with the lower CFPWV. Whole brain perfusion was 46,1±9,8 ml/100g/min compared to 50.7±9.6 ml/100g/min (p<0.001), grey matter perfusion 51,4±11,2 compared to 56,5±10,9 ml/100g/min (p<0.001) and white matter perfusion 38,8±7,9 compared to 42,6±8,0 ml/100g/min (p<0.001). Higher CFPWV was significantly connected to lower perfusion in whole brain, grey and white matter after correction for age, sex, and heart rate (p<0,05).

Conclusions: Increased stiffness of the aorta is connected to significantly lower cerebral perfusion, independent of other possible confounders. This effect is comparable to the effect atrial fibrillation has on cerebral perfusion.



Poster session 2 - Arrythmias and device therapy / Basic science



Impact of maternal connective tissue disease on conduction abnormalities in the offspring

Sarah Sofie Andersen1, Terese Frellesen Neumann1, Sofie Dannesbo1, Ottilia Birgitta Vøgg2, Anna Axelsson Raja1, Karen Schreiber3, Alex Hørby Christensen2, Kasper Iversen2, Henning Bundgaard1, Anne-Sophie Sillesen2

1Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark, 2Herlev-Gentofte Hospital, Copenhagen University Hospital, Danmark, 3Danish Hospital for Rheumatic Diseases, Sønderborg, Danmark

Introduction: Maternal systemic connective tissue disease (CTD) is known to be associated with an increased risk of congenital heart disease. The most frequently described congenital heart disease for these children is conduction abnormalities and complete heart block. Whether this increased risk also applies to less severe cardiac abnormalities in the offspring is currently unknown.

Material and methods: The study is a part of the Copenhagen Baby Heart Study (CBHS), a population study including more than 25,000 newborns between 2016 and 2018. Included newborns had an electrocardiogram obtained during the first 30 days after birth.

Based on the Danish registries 63 newborns of mothers with CTD was identified in the CBHS cohort. 41 of these children had a valid ECG and was included in this present study.

Cases were matched 1:3 with controls based on sex, gestational age, age and weight, and maternal age. Based on the ECGs obtained in the newborns, the primary end-point is a composite of conduction abnormalities including heart rate, PR-, QRS- and QT-interval.

Results: Data is currently being analyzed and results are expected in May 2023.

Conclusions: It is unclear whether children born to mothers with CTD should have routine systematic cardiac evaluation and whether children born to mothers with subgroups of CTD are at a higher risk of conduction abnormalities. The CBHS provides a unique opportunity for new insights in this field, including whether a routine neonatal ECG should be recommended in this risk group.


Impact of cardiac devices on Quality of Life

Paolo Gatti, Carolin Nymark, Fredrik Gadler

Karolinska Institutet, Stockholm, Sweden

Introduction: The impact of cardiac devices (pacemaker (PM), implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) on health-related quality of life (HRQoL) are lacking.

Methods: Data on devices and the European Quality of Life-5 Dimension (EQ-5D) questionnaire were collected from the Swedish Pacemaker and ICD Registry from January 2019 to February 2022 at device implant and after 1 year.

Results: Of 1,479, 80% had a PM, 10% an ICD, 5% a CRT-P and 6% a CRT-D. Patients with ICD or CRT-D were younger (66 and 70 years) with a lower percentage of females (17% and 23%) compared to PM and CRT-P (78 and 79 years, 38% and 27% females). The EQ-5D-VAS and the EQ-5D index significantly increased after 1 year in patients with PM and CRT-P (mean EQ-5D-VAS variation: 2.8, SD 23 and 5.8, SD 24.9; mean EQ-5D index variation: 0.019, SD 0.114 and 0.051, SD 0.125) while only the EQ-5D index increased in patients with ICD (mean EQ-5D index variation: 0.002, SD 0.104 ). After adjusting for age, sex and HRQoL at baseline, ICD and CRT-D devices were associated with a lower EQ-5D-VAS (-3.4, 95% CI -6.7; -0.1 and -4.8, 95% CI -8.8;-0.7) and EQ-5D index (-0.018, 95% CI -0.035; -0.0003 and -0.025 95% CI 0.046;0.004) at follow-up.

Conclusions: In Swedish patients, cardiac devices improved the quality of life. However, the presence of an implantable defibrillator was associated with lower health status. These findings may help physicians and pacemaker nurses in embracing the patients' perspectives for decision-making.


Reduced liver fat and improved cardiometabolic health in individuals with non alcoholic fatty liver disease after a 12 week digital health program - a feasibility study

Sigríður Björnsdóttir1, Hildigunnur Úlfsdóttir2, Elías Freyr Guðmundsson2, Kolbrún Sveinsdóttir2, Ari Ísberg2, Guðlaug Björnsdóttir3, Sigurður Sigurðsson3, Sæmundur Oddsson2, Vilmundur Guðnason3

1Hjartamidstodin, Kopavogur, Iceland, Kopavogur, Iceland,. 2Sidekick Health, Kopavogur, Iceland, 3Icelandic Heart Association, Kopavogur, Iceland

Introduction: Lifestyle can improve metabolic health. We tested whether a digital health program for non-alcoholic fatty liver disease (NAFLD) is feasible regarding user retention, engagement, satisfaction, and liver- and cardiometabolic markers.

Materials and methods: A prospective single-arm, 12-week study was conducted. Individuals with metabolic derangements were screened for NAFLD. The Sidekick smartphone app delivered the digital health program with lifestyle coaching. Baseline and follow-up measurements included clinical measurements, liver fat content, body composition, and blood tests. The primary outcomes were engagement, retention, and user satisfaction. Secondary outcomes were changes in weight, liver fat, and cardiovascular risk factors.

Results: 38 individuals with NAFLD participated, and 34 (89%) completed the program (active 9/12 weeks). The median age was 59.5 years, and 23 (60.5%) were females. The median number of active days was 81 [IQR 45.75, 84.0]. The median user satisfaction score was 6.3/7. The mean weight loss was 3.5 kg (SD=3.7) (p<0.001) with 5.0% (SD=7.0) reduction in fat mass (p<0.001), the average relative liver fat reduction was 19.3% (SD=23.9) (p<0.001). Systolic blood pressure was reduced by 6.0 mmHg on average (SD=13.5) (p=0.009), diastolic blood pressure by 1.2 mmHg (SD=7.7) (p=0.357), triglyceride levels by 0.1 mmol/L [IQR 0.0;0.5] (p=0.003) and waist circumference by 4.1 cm (SD=5.2) (p<0.001). Those active in-app at least 5 days/week, on average, achieved 3.8 kg (SD=3.7) (p<0.001) more weight loss and 19.3% (SD=23.9) (p=0.011) higher reduction in absolute liver fat percentage, compared to less active.

Conclusions: A digital health program is feasible in NAFLD and may improve cardiometabolic health.



Myocardial stunning model in rats

Ahmed Elmahdy, Aaron Shekka Espinosa, Yalda Kakei, Shafaat Hussain, Tetiana Pylova, Amin Al-Awar, Abhishek Jha, Maryna Krasnikova, Ermir Zulfaj, Amirali Nejat, Axel Andersson, Björn Redfors

Institute of Medicine, Gothenburg, Sweden

Background: Myocardial stunning is a temporary cessation of contractility with absence of irreversible histological damage. Myocardial stunning could be a cardiac response to preserve energy and prolong survival of cardiomyocytes. However, in myocardial infarction, stunning could contribute to acute ischemic heart failure (AIHF).

Methods: The left anterior descending coronary artery (LAD) was ligated in Sprague Dawley rats. Rats were exposed to ischemic preconditioning (IPC) before ligating LAD for 13.5 minutes. IPC was induced by two cycles of 5 min occlusions interposed with two cycles of 5 min reperfusions. Echocardiography (ECHO) confirmed LAD occlusions by showing left ventricular akinesia. ECHO was taken at baseline, 4h, and 48h. The wall motion score index (WMSI) and high-resolution speckle tracking on acquired echocardiograms evaluated heart motion and function. Hearts were collected for TTC staining to determine infarction size.

Results: IPC-13.5 min yielded akinesia at 4h which recovered at 48h as evaluated by WMSI. Speckle tracking showed a significant worsening in ejection fraction and global longitudinal strain at 4h, which had normalized at 48h, indicating recovery. Time to peak of different heart segments showed dyssynchrony at 4h and re-synchrony at 48h. TTC staining showed minimal necrosis.

Conclusion: High resolution imaging showed a human-like course of myocardial stunning after 13.5 min LAD occlusion preceded by IPC. Histology confirmed absence of significant irreversible damage. This study provides a reproducible model of myocardial stunning in rats. The model works as a platform for future studies to understand the underlying mechanisms of myocardial stunning and improve prognosis in AIHF.


Poster session 3 - Imaging / Basic science



Valvular Keloids? Aggressive Scarring Process Leading to Multivalvular Obstruction

Nikhil Kolluri, Awais Malik, Alberto Pochettino, Hayan Jouni

Mayo Clinic, Rochester, USA

Introduction: A 59-year-old female presented to clinic due to progressive dyspnea on exertion over the last 3 months. Past medical history was significant for bicuspid aortic valve status post mechanical aortic valve replacement (AVR) and mitral valve annuloplasty band 2 years prior. Physical examination revealed a 2/6 systolic ejection murmur in the aortic area and a 2/4 diastolic rumble at the apex, elevated JVP, and 2+ lower extremity edema.

Materials and Methods: A retrospective review of the electronic medical record, including patient characteristics, lab work, diagnostic testing, and final clinical diagnosis.

Results: Initial TTE revealed a prosthetic aortic valve gradient of 71 mmHg but assessment of the prosthetic leaflets was difficult to evaluate given image quality, flow acceleration in the left ventricular outflow tract, and a mitral diastolic gradient of 8 mmHg (heart rate 82). Subsequent valve fluoroscopy showed normal bileaflet valve motion. A cardiac CT revealed a distinctive subaortic membrane with associated early closure of the prosthetic aortic valve, significant soft tissue thickening of the AVR and mitral annulopasty band. She was referred for surgery with intraoperative images confirming a subaortic membrane along with exuberant tissue ingrowth of the AVR and MVR. She underwent subaortic membrane resection, septal myectomy, Bentall root replacment, AVR, and mitral vavle replacment.

Conclusions: This is a unique case of multivalvular pathology secondary to a systemic scarring process resulting in distinct fibrotic subaortic membrane, AVR obstruction, and mitral band obstruction. This type of pathologic process can only be treated successfully with repeat surgery.


Non-invasive assessments reveal that &gt; 50 % of newly diagnosed asymptomatic patients with type-2 diabetes mellitus have subclinical atherosclerosis.

Gulia Faizi1, Lotte Grumsen 2, Monija Mrgan 2, Niels Peter Rønnow Sand2, Jeppe Gram2, Jørgen Brodersen Gram 2, Michael Hecht Olsen3

1Hospital of Southwest Denmark, Esbjerg., Esbjerg, Danmark, 2Hospital of Southwest Denmark, Esbjerg., Odense C, Danmark, 3University of Southern Denmark, Odense , Danmark

Introduction: Type-2 diabetes mellitus (T2DM) increases the risk of atherosclerosis and a poor long-term prognosis. We assessed the prevalence of subclinical atherosclerosis in asymptomatic patients with newly diagnosed (<1 year) T2DM by five different non-invasive methods.

Material and methods: Coronary artery calcification (CAC) was assessed by coronary computed tomography angiography, intima media thickness (IMT, >0.9 mm) assessed by carotid ultrasound, arterial stiffness by pulse wave analyses (PWA) and the presence of peripheral artery disease (PAD) by ankle brachial index (index <0.9) and vascular leakage by albumin creatinine ratio (ACR). Advanced plaque analysis including total plaque volume (TPV) and volumes of plaque components (calcified plaque and non-calcified plaque, including low-attenuation [low-density non-calcified plaque (LD-NCP)]) was performed on 88 patients using validated semi-automated software.

Results: 59% of the patients had CAC >0, of which 15% had CAC >400. Patients with CAC >0 was significantly older (61 vs 52 years, p<0.05), were more frequently men (38 vs. 35, p<0.05), had higher PWA (8.9 vs 7.9 m/s, p<0.01) and IMT (0.8 vs 0.7 mm, p=0.01). LD-NCP ratio increased with higher TPV (τ = 0.45, p <0.05). 17 % had IMT < 0.9 mm, of which 88 % had CAC >0. Sign of PAD and increased ACR was present in 8% of the patients of whom all had CAC>0.

Conclusion: More than half of asymptomatic patients with new diagnosis of T2DM present signs of subclinical atherosclerosis. Furthermore, asymptomatic patients with newly diagnosed T2DM had plaque features associated with increased vulnerability.


Incidence rates of cardiovascular disease in Greenland 1994 - 2020

Hjalte Erichsen Larsen1, Uka Wilhjelm Geisler2, Finn Gustafsson3, Michael Lynge Pedersen1, Marit Eika Jørgensen1

1Ilisimatusarfik, University of Greenland , Nuuk, Greenland, 2Queen Ingrid's Hospital, Nuuk, Greenland, 3Rigshospitalet, Copenhagen, Danmark

Introduction: The mortality of cardiovascular disease (CVD) in the Western world has declined since the 1950s, which is attributable to the reduction in risk factors and evolving treatment opportunities. CVD in Greenland has historically been perceived as non-existing, but this may be based on unreliable data. This study aims to estimate the incidence and mortality of CVD in Greenland from 1994-2020, based on registered diagnoses in the Greenland hospital discard register (GHDR) and the Electronic medical record (EMR).

Materials and methods: All registered CVD Diagnosis from 1994 to 2020 was extracted from the GHDR and EMR. Those without a registered address in Greenland or younger than 16 years of age were excluded. The diagnoses were divided into subgroups. Only the earliest diagnosis given to an individual in a subgroup was used. Crude gender-specific incidence rates were calculated using the yearly registered Greenlandic population size.

Results: The overall crude incidence rates of ischaemic heart disease (IHD), stroke, and arrhythmia increased from 1994 to 2020. Incidence rates of IHD, stroke and heart failure increased among men and declined among women.

Conclusions: These preliminary results indicate an increase in the overall incidence rates of IHD, arrhythmia and stroke in Greenland, driven by an increase among men. Possible explanations for the increasing incidences include ageing of the population, increasing prevalence of hypertension, obesity and diabetes, and improved diagnostics and registration of diagnoses. However, this remains to be investigated. Future analyses will be done including age-specific incidence- and mortality rates from CVD in Greenland.



Poster session 4 - Coronary artery disease



A digital health program is feasible for outpatient care in coronary artery disease

Davíð Ottó Arnar1, Sæmundur J Oddsson2, Þrúður Gunnarsdóttir2, Inga V Ólafsdóttir1, María V Gudmundsdóttir1, Kjartan H Loftsson2, Elías Freyr Guðmundsson2, Bylgja Kaernested1, María L Ámundadóttir2, Svala Sigurðardóttir2, Brynjólfur Mogensen1, Berglind Libungan1, Tryggvi Thorgeirsson2

1Landspitali, National University Hospital of Iceland, Reykjavik, Iceland, 2Sidekick Health, Kopavogur, Iceland

Introduction: Lifestyle is important in secondary coronary artery disease (CAD) prevention. We tested whether a CAD-specific digital health program is feasible for outpatient care regarding program retention, satisfaction, and quality of life.

Materials and methods: A four-week CAD program was delivered via a smartphone. CAD patients at the National University Hospital of Iceland were recruited. Participation included watching educational videos, mindfulness exercises, medication reminders, and questionnaires. Stress-, energy levels, and sleep quality were logged on a ten-point scale.

Results: A total of 33 completed the baseline survey, of which 25 registered in the app (76% males, mean age 60 years [SD=10]). A total of 23 participants logged a mission during the 4-week intervention; five were active for a single day. A total of 16 (70%) participants completed the program and both pre-and post-surveys (mean age 60 years [SD=10], range 44-80 years).

On average, participants logged 7.5 missions/day, completing half of the daily missions. Results for average quality of life scores from week one to four were: for energy 5.5[SD=1.8] to 5.8[SD=1.9], p=0.22, for quality of sleep 6.2[SD=2.5] to 5.9[SD=2.4] p=0.20 and for stress 3.3[SD=2.6] to 3.3[SD=2.4] p=0.71.

User satisfaction was reasonable, as 75% of the 16 participants said it was likely that they would recommend the program and that it positively affected their life, well-being, and ability to deal with their disease.

Conclusions: A CAD-specific digital health program is feasible in terms of engagement and user satisfaction. An ongoing RCT study is testing the program further.


Online cognitive behavioral therapy targeting cardiac anxiety following myocardial infarction: rational and design of a randomized control trial

Amanda Johnsson1, Brjánn Ljótsson1, Eva Ólafsdottir2, Björn Liliequist1, Matthias Lidin2, Linnea Maurex2, Elina Rautio2, Helga Skúladóttir1, Frieder Braunschweig 2, Linda Mellbin2, Josefin Särnholm1

1Karolinska Institutet, Stockholm, Sverige, 2Karolinska University Hospital, Stockholm, Sverige

Introduction: Cardiac anxiety following myocardial infarction (MI) is associated with poor quality of life (QoL), a barrier to comply with cardiac rehabilitation and a risk factor for recurrent adverse cardiac events. Today, no intervention exists that directly targets cardiac anxiety in post-MI patients. Online cognitive behavioral therapy (internet-CBT) has shown effective in improving QoL in other cardiac disease. The aim of the study is to evaluate internet-CBT targeting cardiac anxiety in patients following MI to increase QoL and physical activity.

Material and methods: In this randomized control trial (N=100), participants are randomized to internet-CBT or to treatment as usual. Inclusion criteria: MI ≥6 months (type 1 STEMI/NSTEMI); clinically significant cardiac anxiety; and adequate medical treatment. Participants are assessed at baseline, post-CBT and 3 months (3M) post-CBT. The primary endpoint is disease-specific QoL (Seattle Angina Questionnaire) at 3M. Secondary outcomes include cardiac anxiety, physical activity and cardiovascular biomarkers (e.g., LDL, HbA1c). The online treatment lasts eight weeks and is guided by clinical psychologists. Main components are exposure to cardiac related symptoms and reduction of avoidance behaviors. Participants are further evaluated 12 months post-CBT.

Results: Recruitment started in October 2022, 39 participants have been randomized, and 19 have started treatment. Participants have shown high adherence to treatment. Clinical vignettes and patient safety considerations will be presented.

Conclusions: If shown effective, internet-CBT targeting cardiac anxiety may constitute an important addition to cardiac rehabilitation, can be made accessible within the near future and implemented in clinical practice to the benefit of the target population



Early changes in myocardial stunning and biomarkers after ST-elevation myocardial infarction compared to the takotsubo syndrome

Aaron Shekka Espinosa1, Ahmed Elmahdy1, Sandeep Jha2, Angela Poller1, Rickard Zeijlon2, Sigurdur James Thorleifsson2, Emanuele Bobbio2, Carlo Pirazzi2, Thorsteinn Gudmundsson2, Tomas Mellberg2, Andreas Martinsson2, Björn Redfors2

1Göteborgs Universitet, Gothenburg, Sweden, 2Sahlgrenska University Hospital, Gothenburg, Sweden

Background: Takotsubo syndrome (TS) and ST-elevation myocardial infarction (STEMI) are both characterized by myocardial wall dysfunction (myocardial stunning) as well as elevation of cardiac troponins and B-type natriuretic peptides. Whereas STEMI results in variable degrees of necrosis and persistent cardiac dysfunction, TS mostly results in little to no necrosis and full recovery of cardiac function.

Purpose: To compare the time-course of recovery of myocardial stunning and serum biomarker levels during the acute and subacute phases of TS, anterior-STEMI and non-anterior-STEMI.

Method: Patients with TS or STEMI without known pre-existing cardiac dysfunction are enrolled in a prospective multi-centre study. Echocardiography is performed and serum cardiac biomarkers measured within 6h after acute coronary angiography and at six additional timepoints within 30 days. The primary endpoint is the proportion of reversible myocardial akinesia resolved after 72h as determined by echocardiography (Fig.1). Secondary endpoint entails the levels of circulating cardiac biomarkers.

Results: Preliminary results include 155 patients with STEMI (78 anterior and 77 non-anterior) and 32 patients with TS. All groups showed substantial recovery of cardiac function over the course of the study. The proportion of reversible akinesia that had recovered at 72h was similar in patients with TS, anterior-STEMI, and non-anterior STEMI (p=0.8414). Compared to both STEMI groups, the TS group had lower troponin-I/troponin-T ratio and higher levels of NT-proBNP (Fig.2).

Conclusion: Preliminary data suggest that early myocardial functional recovery is more substantial in TS while following a similar time-course to STEMI. Additionally, the troponin-I/troponin-T ratio was significantly higher in STEMI vs TS.


Beating Heart CABG on Intermittent Pump Support

Sushil Kumar Singh, Vivek Tewarson, Sarvesh Kumar, Shobhit Kumar

King George's Medical University, Lucknow, India

INTRODUCTION: Beating heart CABG on intermittent pump support is a more reliable method of coronary revascularization which take the advantage of 'off and on pump CABG' while eliminates the disadvantage of both the technique.

MATERIAL & METHODS: From January 2015 to December 2021 a new technique 'intermittent on pump beating heart CABG' using suction stabilizer was used. Patients were supported by pump intermittently, as and when required ( Group 1, n = 254 ). A retrospective data was collected from our record of the patients who underwent off pump CABG electively by the same surgeon and team ( Group 2, n = 254 ).

RESULTS: Significant advantage was noted in Group 1 patients in terms of number of grafts ( 3.31 ± 1.16 vs 2.30 ± 0.66 ), grafting of lateral vessels ( 316 vs 202 ), mean operating time ( 1.37 ± 0.23 hours vs 2.22 ± 0.45 hours ) and postoperative blood loss ( 406.30 ± 257.90 ml vs 567.41 ± 265.20 ml ). CPB support time was less than 15 minutes in majority of patients ( n = 179, 70.37 % ) with a mean of 16.81 minutes. It was required particularly during grafting of lateral vessels.

CONCLUSIONS: Intermittent on pump CABG technique is promising method of surgical revascularization for all the patients requiring CABG. Ithas shown its superiorityin terms of safety, number of grafts, operating time and better perioperative course.


Decoding the Impact of SIRT1 Gene Variants in Coronary Microvascular Dysfunction following ST-Elevation Myocardial Infarction

Benas Kireilis, Gediminas Jaruševicius, Ali Aldujeli, Ingrida Grabauskyte

Lithuanian University of Health Sciences, Kaunas, Lithuania

Introduction: Coronary microvascular dysfunction (CMD) is a significant risk factor for cardiovascular events, and genetic factors are believed to play a role. This study aims to investigate the association between three common genetic variants of the SIRT1 gene (rs7069102, rs1467568, and rs3758391) and CMD in STEMI patients.

Material and methods: Prospective cohort study was conducted with 200 STEMI patients who underwent primary percutaneous coronary intervention (PCI) followed by a staged PCI 3 months later. A coronary temperature-pressure wire was used to assess presence of CMD. CMD was defined by an index of microvascular resistance ≥25 U and a coronary flow reserve <2.5 U. The variants of interest were detected using blood-direct PCR, and binary logistic regression model was used to identify genes that might be associated with CMD.

Results: Binary logistic regression showed, that SIRT1 (rs1467568) AA (n = 30) versus GG (n = 81) genotype (OR: 2.500; 95% CI: 1.045 – 5.983), AG (n = 89) versus GG genotype (OR: 0.403; 95% CI: 0.180 – 0.900) and AG versus GG+AA (n = 111) (OR: 0.306; 95% CI: 0.145 – 0.647); SIRT1 (rs3758391) CT (n = 84) versus CC (n = 92) (OR:0.423; 95% CI: 0.198 – 0.906) and CT versus CC+TT (n = 116) (OR: 0.402; 95% CI: 0.194 – 0.834) were associated with CMD. SIRT1 (rs7069102) genetic models were not statistically significant to prognose CMD.

Conclusions: Our study provides evidence that genetic variations of the SIRT1 gene, specifically rs1467568 and rs3758391, are associated with CMD in STEMI patients.



“The future of coronary artery revascularization with bioresorbable stents”

Ieva Briede, Andrejs Erglis

MD, Riga, Latvia

Aim of study was to evaluate safety and effectiveness of long, mixed plaque coronary artery treatment strategy with bioresorbable stents. N=60 patients were included in single center randomized treatment strategy concept study with long, mixed plaque coronary artery disease for treatment with bioresorbable or drug-eluting metallic stent. Randomization were 2:1 in favor for bioresorbable stent (N=40 patient in bioresorbable stent group and N=20 patients in DES-metallic group).

All patients had coronary lesions >40 mm in length. IVUS and OCT guidance and cutting balloon plaque pretreatment and post-dilatation was mandatory for procedural coronary treatment strategy.

There are one year clinical follow up for all N=60 patients and two year angiographic follow up for N=55 patients.

Clinical case presentation represents “step by step” coronary artery treatment strategy and 2-year angiographic results after bioresorbable stent implantation, with IVUS and OCT vessel follow-up modalities. Also, there are two-year patient clinical data results (TLF, TVR, stent thrombosis, cardiovascular death).

In conclusion this coronary artery revascularization concept trial showed good clinical and angiographical results for bioresorbable stents in long, mixed plaque lesions in comparing with drug-eluting metallic stents. This strategy is safe and effective in treatment of long coronary lesions.


Poster session 5 - Heart failure


Impact of the COVID-19 pandemic on the incidence and mortality in takotsubo syndrome: a report from Swedish Coronary Angiography and Angioplasty Registry

Elmir Omerovic

Sahlgrenska University Hoispital, Göteborg, Sweden

Purpose: To determine the incidence and outcomes of TS in Sweden before (2015-March 2020) and during (April 2020-December 2022) the pandemic.

Methods: We assessed the incidence rate ratio (IRR) for all patients with TS referred for coronary angiography in Sweden using the nationwide Swedish Coronary Angiography and Angioplasty Registry. IRRs before and during the pandemic were calculated with Poisson regression adjusted for age and sex. We evaluated mortality with multivariable Cox proportional hazards regression, which accounted for clustering of patients within hospitals. The following variables were used for adjustment: age, sex, diabetes, smoking status, hypertension, hyperlipidemia, previous myocardial infarction, and Killip class.

Results: 3,180 patients (2,128 [76.0%] women) hospitalized with TS during the study period; 2,189 (69%) pre-pandemic and 991 (31%) during the pandemic. The average age was 68.3 ± 11.2 years. The median follow-up time was 1250 days (IQR 562-1995). The crude all-cause mortality rate was 2.57% at 30 days and 15.5% after long-term follow-up. The incidence of TS was 11% lower during the pandemic compared with the pre-pandemic period (IRR 0.90, 95% CI 0.83-0.98, P=0.009). We found no difference in 30-day mortality (adjusted HR 1.12, 95% CI 0.69-1.78, P= 0.642) or long-term mortality (adjusted HR 0.96, 95% CI 0.73-1.28, P= 0.816) among patients with TS between the pre-pandemic and pandemic periods.

Conclusions: The incidence of TS was lower during than before the pandemic but mortality was unchanged. The lower incidence of TS could be related to the specific anti-pandemic strategies applied at the national level in Sweden.


Importance of hospital and clinical factors in predicting of 30-day mortality in Takotsubo syndrome: data from the Swedish Coronary Angiography and Angioplasty Registry

Elmir Omerovic

Sahlgrenska University Hoispital, Göteborg, Sweden

Background: Takotsubo syndrome (TS) is an acute heart failure condition that presents with symptoms similar to acute myocardial infarction. Predictors of mortality are not well understood. There is a need to identify high-risk patients and tailor treatment accordingly.

Purpose: The purpose of this study was to assess the importance of various clinical factors in predicting 30-day mortality using a machine-learning algorithm capable of identifying complex relationships between variables.

Methods: We analyzed data from the nationwide Swedish Coronary Angiography and Angioplasty Registry for all TS patients between 2015-2022. Gradient boosting was used to assess the relative importance of variables in predicting 30-day mortality.

Results: Of the 3,180 hospitalized TS patients, 76% were women. The average age was 68.3 ± 11.2 years. The crude all-cause mortality rate was 2.57% at 30 days. The most important variable in predicting 30-day mortality was the hospital where the patient was treated, with a relative importance of 35.5%. This was followed by the clinical presentation for angiography (21.1%), creatinine level (11.9%), Killip class (8.9%), and age at angioplasty (6.5%). Other less important factors included weight, height, and certain medical conditions such as hyperlipidemia, smoking status, and hypertension. Gender and previous stroke history had a low impact on 30-day mortality in TS patients.

Conclusions: The treating hospital was the most important factor in predicting 30-day mortality in TS. Since the level of evidence for recommended treatments of TS is low, our findings highlight the importance of conducting randomized studies in this patient group to improve care.


Pre-implantation central hemodynamic profile of HFrEF patients receiving CRT or ICD: a two-centre controlled study

Anette Caroline Kõre1, Martin Serg1, Priit Pauklin1, Tuuli Teeäär1, Jaan Eha1, Indrek Roose2, Jüri Voitk3, Priit Kampus1

1University of Tartu, Tartu, Estonia, 2Tartu University Hospital, Tartu, Estonia, 3North Estonia Medical Centre, Tallinn, Estonia

INTRODUCTION. Cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) devices play important roles in managing heart failure patients with reduced ejection fraction (HFrEF). Thus far, there have been no studies on non-invasively measured central hemodynamics of these patients. This two-centre study aims to map the central hemodynamic profile of HFrEF patients planned to receive a CRT or ICD device, focusing on pre-implantation central blood pressure and arterial stiffness parameters.

MATERIAL AND METHODS. Fifty HFrEF patients (left ventricular EF ≤ 35%) were recruited from two Estonian tertiary healthcare centres with 25 patients planned for CRT and 25 for ICD implantation. Central blood pressure and carotid-femoral pulse wave velocity (PWV) were measured non-invasively with a cuff-based oscillometric device (SphygmoCor XCEL). These results were compared to 28 controls without heart failure.

RESULTS. Central systolic blood pressure (cSBP) was significantly lower in both HFrEF groups compared to controls (111 vs. 122 mmHg, p = 0.001), while PWV was significantly higher (8.2 vs. 7.3 m/s, p = 0.024). PWV significantly decreased with the worsening of LVEF and end-diastolic volume index in HFrEF groups (p = 0.002 and p = 0.001, respectively). Longer QRS duration correlated with lower cSBP and higher NT-proBNP levels in the CRT group (p = 0.04 and p = 0.028, respectively).

CONCLUSIONS. This study mapped the pre-implantation central hemodynamic parameters of HFrEF patients suitable for CRT or ICD, showing a distinct central hemodynamic profile. These findings enable further exploration of the hemodynamic changes post-implantation, potentially identifying markers for treatment response and optimisation.


Study of novel immunomarkers' expression in left ventricular cardiomyocytes during remodeling in progressing heart failure (HF) of ischemic origin

Milda Kupryte, Vaiva Lesauskaite, Dalia Pangonyte

Institute of Cardiology, Lithuanian university of health sciences, Kaunas, Lithuania

Introduction: Compensatory cardiomyocytes' remodeling is initiated by ischemic injury, which leads to progressing morphofunctional changes in cardiomyocyte's resilience, dedifferentiation, and profibrotic activity affecting hemodynamic function towards HF. Immunomarkers against desmin, osteopontin, gremlin-1 indicating scope of these changes in different stages of ischemic HF may serve as diagnostic targets to monitor progress of HF.

Material and methods: Immunohistochemical reactions with immunomarkers against desmin, osteopontin, and gremlin-1 were performed in middle myocardial segments of left cardiac ventricles from males who died or had transplantation due to ischemic injury, and examined by light microscopy applying semi-quantitative analysis for reaction intensity (0 to 3 points): 1st group – HF, A stage; 2nd group – HF, B stage; 3rd group – HF, C/D stages by ACC/AHA classification; samples of patients who died from non-cardiovascular disorders – control group. Statistical analysis of ANOVA with post-hoc LSD tests was applied, p<0.05.

Results: Cardiomyocytes of 1st group had more intensive immunohistochemical reaction against desmin, osteopontin, and gremlin-1 compared to control group (p<0.001). These reactions were more intensive in 2nd group compared to 1st and control groups (p<0.001), except against desmin (p=0.159). Immunohistochemical reactions against desmin, osteopontin, and gremlin-1 were more intensive in 3rd group compared to 2nd group (p<0.001), and control group (p<0.001).

Conclusions: Changes in osteopontin, gremlin-1, and desmin expression in cardiomyocytes during remodeling are initiated as primary cellular immunoprofile changes in response to ischemic injury before developing HF, and progress by gradual morphofunctional pattern changes in symptomatic HF, presenting novel diagnostic targets for myocardial disease monitoring.



Genetic contribution to end-state Cardiomyopathy requiring heart transplantation

Yuri Kim1,2 Oddný Brattberg Gunnarsdóttir2, Anissa Viveiros3,4, Daniel Quiat5, Daniel Reichart2,6, Jon A.L. Willcox2, Hao Zhang3,, Huachen Chen3,4, Justin J. Curran2, Barbara McDonough1,7, Joshua Gorham2, Steven R. DePalma2,6, Jonathan G. Seidman2*, Christine E. Seidman2,6*, Gavin Oudit3,4*

1Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston MA, USA,2Department of Genetics, Harvard Medical School, Boston, MA, USA, 3Demartment of Medicine, University of Alberta, Edmonton, Alberta, Canada, 4Mazankowski Heart Institute, Edmonton, Alberta, Canada, 5Department of Cardiology, Boston Children's Hospital, Boston, MA, USA,6Department of Medicine I, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany, 7Howard Hughes Medical Institute, Chevy Chase, MD, USA

Introduction: Many cardiovascular disorders propel the development of advanced heart

failure that necessitate cardiac transplantation. When treatable causes are excluded, studies

to define etiologies are often abandoned, resulting in a diagnosis of end-stage idiopathic non-

ischemic cardiomyopathy. We aimed to identify unrecognized causes of end-stage non-ischemic

cardiomyopathy requiring heart transplantation and to compare the prevalence of etiologies

with ambulatory cardiomyopathy cases.

Materials and methods: We performed whole exome and genome sequencing of 122 explanted myocardium from patients (101 adult and 21 pediatric) with idiopathic non-ischemic cardiomyopathy. Data were analyzed for pathogenic/likely pathogenic

variants and nonhuman microbial sequences. The frequency of damaging genetic variants

was compared among cardiomyopathy cohorts with different clinical severity.

Results: Fifty-four samples (44.3%) had pathogenic/likely pathogenic cardiomyopathy gene

variants. The frequency of pathogenic variants was similar in pediatric (42.9%) and adult

(43.6%) samples, but the variant distribution differed (p=8.30e-04). The prevalence of causal

genetic variants was significantly higher in end-stage than in ambulatory dilated

cardiomyopathy cases (p=1.25e-04 for adult and p=0.01 for pediatric). Among remaining

samples with unexplained etiologies, no damaging mitochondrial variants were identified, but

28 samples contained parvovirus genome sequences, including 2 samples with 6 to 9-fold

higher levels than the overall mean levels in other samples.

Conclusions: Pathogenic variants and viral myocarditis were identified in 45.9% of patients

with unexplained non-ischemic end-stage cardiomyopathy. Damaging gene variants are

significantly more frequent among transplant compared to ambulatory non-ischemic

cardiomyopathy patients. Identification of causal variants and cascade genetic testing can

improve risk stratification and interventions in family members.



Poster session 6 - Hypertension


Influence of nebivolol, bisoprolol and carvedilol on the penile hemodynamic in men with arterial hypertension

Gulnara Nur-Mammadova,

Azerbaijan State Advanced Training Institute for Doctors named by A.Aliyev, Baku, Azerbaijan

Introduction: The main object was to study the effect of modern beta-blockers nebivolol (N, carvedilol (C) and bisoprolol (B) on the sexual function in men with essential hypertension (ESH). The state of penile hemodynamic (PH) was investigated for formation of possible beginnings and development of sexual dysfunction.

Material and method: 75 males with ESH on degree I and II aged 35-55 (47,7±0,58) years were a part of the survey. Duration of ESH was 10,1±0,44 year. After four weeks of placebo period patients were randomized into three identical groups with 25 men in each. During two months these patients carried out the monotherapy of one of the researching drugs. The dosage of B - 6,1±0,39 mg daily, N- 6,6±0,4 mg daily, C – 22,5 ±1,02 mg daily. PH was regulated using the Doppler ultrasound method, sexual status was studied by Vasilchenko questionnaire. Statistical analyses included the definition of the t- criterion of Student and U-criterion of Wilkokson.

Results: Therapy of B,N and C significantly decreased arterial blood pressure and heart rate in increase of the systolic blood flow in a.cavernosus right (32,6%; 46,4% p<0,01; 36,6% p<0,01); in a.cavernosus left (35,6%; 36,8%; 48,4% p<0,001); in a.dorsalis penis (44,5%; 34,9%, 35,8% p<0,05). Patients didn't notice any substantial changes in neurohumoral, ejaculation and other characteristics of sexual function during two months of monotherapy with researched drugs.

Conclusion:The monotherapy of all BB concluded in statistical improvement of the penile blood flow and didn't worsen the sexual function in men with ESH for studying period.


Prevalence of apparent treatment-resistant hypertension in Iceland and adherence to clinical practice guidelines

Kristján Harðarson1, Bolli Þórsson2, Vilmundur G Guðnason1, Karl Konráð Andersen1

1Háskóli Íslands, Reykjavik, Iceland, 2Icelandic Heart Association, Iceland

Apparent resistant hypertension (aRHT), defined as uncontrolled hypertension despite use of three or more medications including a thiazide, is associated with adverse patient outcomes. Despite this, the phenomenon has not yet been well characterized. The goal of this study is to assess the prevalence of aRHT in the Icelandic population and adherence to clinical guidelines.

For this study we obtained data from the REFINE (n = 6930, ages 20-73) and AGES (n = 5716, ages 66-96) cohorts. Participants were classified based on hypertension status and medications prescribed at the time of observation. Age standardisation was performed.

The prevalence of aRHT among treated hypertensives was 9.1% (n = 1849) and 15.8% (n = 3660) for the REFINE and AGES cohorts. Prevalence rates were significantly higher in older age brackets, with aRHT cases being virtually absent among participants aged under 40. Where the two cohorts had overlap in age, the prevalence rates were comparible. Of those taking 4 or more medications, 59% were prescribed spironolactone in accordance with guidelines.

The prevalence of aRHT in Iceland is comparable to worldwide estimates. Studies have demonstrated that adding spironolactone to the drug regimen dramatically improves outcomes in these patients and therefore the proportion of Icelandic RHT patients taking the drug ought to be higher. Our study is limited by lack of information on adherence and out-of-office measurements. Previous studies have suggested that as much as half of aRHT cases might be explained by these factors. Our analysis will thus tend to overestimate the true prevalence.


Poster session 7 - Interventional cardiology and cardiovascular surgery


Carotid artery stenting in a patient with high platelet reactivity due to hematologic neoplasm. A case report.

Kristina Lotamõis1, Inger Tark1, Sulev Margus1, Halliki Kõdar2

1East Tallinn Central Hospital, Tallinn, Estonia, 2Tallinn Regional Hospital, Tallinn, Estonia

Introduction: Expanding field of interventional cardiology allows cardiovascular events to also be treated or prevented in complex patients with several co-morbid conditions. Growing evidence supports multidisciplinary teams' approach in these complex cases. Usage of antiplatelet therapy with coronary stenting is well studied and routine platelet reactivity testing (PRT) is not recommended. However, the situation may be different when stents with thicker metal struts and higher radial forces are applied for carotid artery stenting (CAS) in a patient with comorbidity potentially affecting platelet reactivity (PR).

Case presentation: A CAS due to symptomatic carotid stenosis was performed in a patient with concurrent JAK2 mutated myeloproliferative neoplasm (MPN). Before CAS, tests demonstrated high platelet reactivity on clopidogrel and borderline PR on ticagrelor. Postprocedural acute stent thrombosis occurred despite the patient being on dual antiplatelet therapy. It was treated using intravenous thrombolysis with good symptomatic and ultrasound improvement. A hematologist was consulted, and after lowering of the platelet count and adding anticoagulant therapy, the stent remained patent. The patient has had good short-term recovery and is currently managed by a multidisciplinary team involving neurologists, cardiologists, and hematologists.

Conclusions: In the presented case, the high on-treatment PR could have been caused by overproduction of treatment-naive platelets due to MPN. Although the initial stent thrombosis was not prevented, the subsequent multidisciplinary approach demonstrated its value in preventing further complications after CAS in a multimorbid patient. We suggest PRT before CAS and an earlier involvement of multidisciplinary teams and treatment change if high or borderline PR appears.


Long-term outcome after venosus-type atrial septal defect closure

Valtteri Juho Matias Muroke1, Mikko Jalanko1, Jari Haukka2, Vesa Anttila3, Tommi Pätilä4, Juha Sinisalo1

1Helsinki University Hospital, Helsinki, Finland, 2Department of Public Health, University of Helsinki, Finland, 3Department of Cardiothoracic Surgery, Turku University Hospital, Finland, 4Department of Cardiac Surgery, New Children's Hospital, Helsinki University Hospital, Finland

Introduction: Previous studies examining the outcome after the sinus venosus type atrial septal defect (SVASD) closure are limited by a small study population, short follow-up time or a lack of control cohort

Material and methods: This nationwide study enrolled every SVASD closure from the nationwide hospital discharge registry (FHDR) and surgical registries of two tertiary centers from 1969 to 2019. Patients with more complex congenital heart defects were excluded. Five sex and birth-year-matched controls per SVASD patient were gathered from the general population. The incidence of comorbidities were collected from FHDR.

Results: In total, 182 SVASD closures were performed during the study period. The median age at the time of the surgery was 8.3 years (range 0.06-75.7), and the majority (77.5 %, n = 141) were under 18 years old. The median follow-up period was 18 years (range 0.1-53).

There was no difference in mortality during the follow-up (MRR 0.78, 95% CI: 0.30-2.0). The risk for heart surgery was markedly elevated (RR 83.9, 95% CI 19.9-352.6) compared to the general population. In addition, SVASD patients had elevated risk for new-onset atrial fibrillation (RR 4.9, 95% CI: 2.2-10.9), heart failure (RR 4.0, 95% CI: 1.2-13.2), ischemic heart disease (4.3, 95% CI: 1.5-11.7), migraine (RR 3.6, 95% CI: 1.5-9.1) and sick sinus syndrome, II- or III-degree AV-block or pacemaker implantation (RR 11.3, 95% CI: 2.9-43.8).

Conclusion: Patients with SVASD have an excellent prognosis after the surgery. The risk for heart surgery, atrial fibrillation, and heart failure remains elevated in the long-term follow-up.


Intrahospital outcomes of true coronary bifurcation treatment. Latvian Center of Cardiology.

Eva Bolsteina1, Arnis Laduss2, Andrejs Erglis2, Karlis Trusinskis3, Gustavs Latkovskis2, Dace Sondore2, Inga Narbute3, Kristine Dombrovska3, Andis Dombrovskis3, Ieva Briede3, Aigars Lismanis3, Ainars Rudzitis2, Sanda Jegere2, Indulis Kumsars2

1University of Latvia, Faculty of Medicine., Riga, Latvia, 2University of Latvia, Faculty of Medicine, Riga, Latvia,
3Paul Stradins Clinical University Hospital, Latvia Center of Cardiology, Riga, Latvia

Introduction: Approximately 15-20% of percutaneous coronary interventions (PCI) are performed to treat coronary bifurcations. PCI for bifurcation disease is known to be technically challenging and has historically been associated with lower procedural success rates and worse clinical outcomes than non-bifurcation lesions.

Materials and methods: A retrospective analysis of the ongoing Coronary Bifurcation Treatment registry in Latvia Centre of Cardiology (PCI performed from 01.01.2017. to 31.12.2022.). Study population was divided into two groups: provisional single-stenting and systematic double-stenting. Procedural complications rates were compared between groups.

Results: A total 697 patients with true bifurcation were included in this study. 562 patients in 1 stent group and 135 in 2 stent group. Procedural complications were side branch occlusion (1 stent 2.7 % (n=15) vs 2 stent 0.7 % (n=1), p=0.179), main vessel occlusion (1 stent 0.2 % (n=1) vs 2 stent 0 % (n=0), p=0.624) cardiogenic shock (1 stent 0% (n=0) vs 2 stent 0.7 % (n=1), p=0.041. Intrahospital complications were early stent thrombosis (1 stent 0% (n=0) vs 2 stent 0.7 % (n=1), p=0.041, periprocedural myocardial infarction (1 stent 4% (n=22) vs 2 stent 6 % (n=8), p=0.303).

CK-MB levels 24 h after PCI were measured in 221 patients. CK-MB levels more than 3 times above upper normal limit (1 stent 3.8 % (n=7) vs 2 stent 7.9 % (n=3), p = 0.382.

Conclusions: Procedural complication rate in the treatment of true coronary bifurcation lesions was low. There was one case of early stent thrombosis in systematic double stenting technique group.



Indications and outcomes of TAVI (transcatheter aortic valve implantation) in Iceland

Katrín Júníana Lárusdóttir

Háskóli Íslands, Reykjavík, Iceland

Introduction: Surgical aortic valve replacement (SAVR) has been the standard of treatment for aortic stenosis but transcatheter aortic valve implantation (TAVI) is increasingly used as treatment in Iceland and elsewhere. Our objective was to assess the outcome of TAVI in Iceland, focusing on indications, complications and survival.

Material and methods: This retrospective study included all TAVI-procedures performed in Iceland between 1st of January 2012 and 7th of May 2021. Patient characteristics, outcome and complications were registered, and overall survival compared to an age and sex matched Icelandic reference-population. The mean follow-up was 2.7 years.

Results: Altogether 223 TAVI procedures (mean age 82±6 years, 41.5% females), were performed, all with a self-expandable valve. Most patients (81.7%) had symptoms of severe heart failure (NYHA-class III-IV) and median EuroSCORE-II was 4.8 (range: 0.9-32). Echocardiography pre-TAVI showed a mean aortic-valve area of 0.67 cm2 and max aortic-valve gradient of 78 mmHg. One out of four patients (24.6%) needed permanent pacemaker implantation following TAVI. Other complications were mostly vascular-related (11.1%) but cardiac tamponade and stroke was detected in 3.1 and 4.9% of cases, respectively and severe paravalvular aortic valve regurgitation in 0.4% cases. Thirty-day mortality was 1.8% (n=4) with one-year survival of 93.8% (95% CI: 90.6-97.1), but long-term survival of TAVI-patients was similar to the matched reference population (p=0.15).

Conclusions: The outcome of TAVI-procedures in Iceland is good, especially regarding 30-day mortality and long-term survival that was comparable to a reference population, but incidence of major complications was also low.


Percutaneous coronary intervention post transcatheter aortic valve implantation

Monér Alchay, Araz Rawshani, Petur Pétursson, Oskar Angerås

Sahlgrenska University Hospital, Gothenburg, Sweden

Background:  Transcatheter aortic valve implantation (TAVI)is increasing. Roughly half of these patients have coronary artery disease (CAD), making it likely that they will undergo angiography and coronary interventions after TAVI, particularly given that patients referred for TAVI are increasingly younger. We studied the rate of angiography and unplanned PCI after TAVI in these patients.

Methods: In the SwedishTranscatheterCardiacIntervention registry all individuals who underwent a TAVI procedure during 2008-01-01 to 2022-09-27 were included. We retrieved angiography and PCI data (before and after TAVI) from the Swedish Coronary Angiography and Angioplasty Registry. We studied the incidence of angiography and unplanned PCI after TAVI.

Results: During the study period, a total of 9849 patientsunderwent TAVI (mean age 81.1 years), of whom 568 (5.8%) patients had a subsequent angiography (151 (1.5%) had unplanned PCI) during a median follow-up time of 3.5-years. Mean age among those subsequently undergoing angiography was 77.4 years. Age was inversely associated with risk of future unplanned PCI. Baseline angiography and history of previous PCI were significant predictors of unplanned PCI. Hazard ratio for unplanned PCI for those with previous PCI vs. no previous PCI was 2.50 (1.73-3.61). Cumulative incidence of any PCI, angiography and unplanned PCI was inversely associated with degree of CAD.

Conclusions: While more than 50% of patients undergoing TAVI have significant CAD, only a small minority require future PCI, which is predicted primarily by previous PCI.Treating younger patients (with longer remaining life expectancy) with TAVI will inevitably increase the need for PCI post TAVI.


“One-year clinical outcomes of sirolimus-eluting bioresorbable stent implantation. Single centre real-life registry data for N=333 patients”

Ieva Briede, Andrejs Erglis

MD, Riga, Latvia

All patients n=333 in real life registry had PCI following bioresorbable stent implantation. First was analysed hospital outcomes-death, myocardial infarction and stent thrombosis. At one year follow up we analysed all-cause death, cardiovascular death, TLF (target lesion associated myocardial infarction, target lesion revascularization), TLF, stent thrombosis.

Clinical follow-up at one year reached all N=333 (100%) patients. Male population-76% (n=253), female 24% (n=80). Mean age were 59.4 years. Arterial hypertension-91% (n=303), dyslipidaemia-98.8% (n=329),diabetes-17.7% (n=59),previous myocardial infarction 28.5% (n=95), previous PCI was 40.8% (n=136). Stable angina-83.5% (n=278), NSTEMI 5.1% (n=17) and STEMI 5,7% (n=19), unstable angina in 3,6% (n=12). Multi-vessel disease-70.6% (n=235).

LAD was treated in 44.1% (n=147), RCA in 30.3% (n=101),LCX in 15% (n=50)of cases. Elective PCI was 83,5% (n=278). Radial approach-83.8% (n=279) of cases. IVUS used in 18.3% (n=61) and OCT in 14.4% (n=48). Pre-dilatation was done in 99.4% (n=331); with cutting balloon in 76.9% (n=256). Mean stent length was 22.87 ± 11.11 mm and diameter - 3.37 ± 0.9 mm. Post-dilatation was done in 98.5% (n=328) of cases.

No In-hospital death and stent tromdosis were observed. In-hospital myocardial infarction 0.3% (n=1). At one year all-cause death was 2.5 % (n=8), cardiovascular death 1,5% (n=5), TVR 8,7% (n=29). Stent thrombosis 1.2% (n=6). TLF 5.4% (n=18). Discontinuation of dual antiplatelet therapy were observed in 3.9% (n=13) of cases, and in n=5 cases it was ended with stent thrombosis.

Conclusions: Sirolimus-eluting bioresorbable stents showed acceptable efficacy (target lesion failure) and clinical safety results at one-year follow-up in real life registry patients.


Poster session 8 - Myocardial, pericardial and valvular disease


Myocarditis: risk factors for longer hospitalization during Covid-19 pandemic

Monika Biesevičienė1, Gabija Baldauskaitė2, Audronė Vaitiekienė2, Gintarė Šakalytė2, Vaida Mizarienė2, Dainius Karčiauskas2, Rūta Dirsienė2

1Assoc. prof., Kaunas, Lithuania, 2Lithuanian University of Health Sciences, Lithuania

Introduction: Aim of this study was to determine differences of demographic/clinical/echocardiographic and hospitalization features in pts. with myocarditis caused by coronavirus disease/vaccination(group A) or other etiology(group B).

Material/methods: Retrospective study enrolled 55 pts. with myocarditis, myopericarditis, perimyocarditis from 2018 to 2021. We analyzed demographic/clinical/ echocardiographic findings, duration of hospitalization. Differences were assessed using Student‘s T, Mann-Whitney criteria in IBM SPSS Statistics 26.0 program.

Results: The majority of pts.were male(N=49; 89.1%). Myocarditis affected young individuals, the mean age was 34.9 years(SD=12,4). Women(N=6; 10.9%) were statistically significant older than men, respectively 51.7y.(SD=9.5) and 32.8y.(SD=11.1),(p<0.05). Hospitalization of women was longer (median 14 vs.7 bed-days),(p<0.05). Pericardial effusion (respectively median 10 vs.6 bed-days (p<0.05)), moderate mitral valve regurgitation (MR), (median 6 vs.11 bed-days (p<0.05)) were associated with longer hospitalization. 5 pts.(9.1%) had anamnesis of Covid-19; for 7 pts.(12.7%) myocarditis was established after Covid-19 vaccination. There were no statistically significant differences between groups according by gender, age and duration of hospital stay. Group A pts. had statistically significant bigger weight (97.7 kg (SD=18.8)) than group B (84.8 kg (SD=15.1)), (p<0.05). Also, group A had higher body mass index (BMI), although differences were not statistically significant.

Conclusions: A higher rate of myocarditis was observed in young men. More severe course of the disease was observed in women. Longer hospitalization was related to moderate MR and pericardial effusion. There were no differences between groups according to gender, age or duration of hospitalization. Although, there were more pts. with higher weight and BMI in group A than in group B.


Prognostic role of atrial fibrillation in patients with non-compaction cardiomyopathy

Nadiia Rineiska, Svetlana Komissarova, Olga Melnikova, Tatyana Sevruk, Anastasia Efimova

RSPC "Cardiology", Minsk, Republic of Belarus

Objective: to evaluate the prognostic role of AF as a predictor of adverse events and outcomes in a cohort of patients with non-compaction cardiomyopathy (NCCM).

Material and methods: This prospective cohort study included 216 pts with NCCM (m/f – 140/76, median age 39 [30;50] years). The endpoints of the study included progression of CHF to FC III NYHA requiring hospitalization, VT and thromboembolic events (TE).

Results: AF was registered in 54 (23.6%) pts. During the follow-up period (median follow-up 36 [6;72] months) 98 (45.4%) pts with NCCM had adverse events and outcomes: 16 (7.4%) had VT, 12 (5.6%) had SCD with successful resuscitation and ICD implantation, 62 (28.7%) of pts with CHF progressed to FC III-IV NYHA, TE – in 20 (9.3%) pts.

Multivariate analysis showed that the most significant predictors of the risk of CHF progression were: LV EF<50% according to cardiac MRI (HR 8.7; 95% CI 7.6–29.9; p=0.0001), the presence of AF (HR 7.5; 95% CI 1.9–28.9; p=0,0033) and an increase in LAVi>43 ml/m2 (HR 1.04; 95% CI 1.01–1.06, p=0.04); predictors of the TE risk were: LV EF<50% (HR 13.4; 95% CI 2.4–75.2; p=0.003); the presence of AF (HR 11.1; 95% CI 2.8–44.6; p=0.0006) and an increase in LAVi>43 ml/m2 (HR 1.03; 95% CI 1.0–1.05; p=0.03).

Conclusion: The presented study shows that along with the conventional predictor of adverse events risk in pts with NCCM (LV EF<50%) revealed additional predictors (the AF presence and an increase in LAVi>43 ml/m2) can be used to identify high-risk pts with NCCM.


Leaflet mechanical stress distribution in different designs of surgical and transcatheter aortic valve bioprostheses: An in vitro study

Regis RIEU1, Viktoria STANOVA2, Lionel THOLLON1, Philippe PIBAROT2

1Aix-Marseille Universite, Marseille cedex 20, France, 2Laval University, Quebec, Canada

Introduction: Calcified aortic stenosis is a progressive disease that ultimately requires either surgical aortic valve (SAV) replacement or transcatheter heart valve (THV) implantation. Increased mechanical stress is one of the main determinants of the structural valve deterioration. In order to assess the durability, an in-vitro/in-silico method was applied to compare the magnitude, and regional distribution of leaflet mechanical stress.

Material and methods: In-vitro testing was conducted with two different SAVs (St.Jude-Trifecta 25mm and Medtronic-Mosaic 25mm) and two different THVs (Edwards-Sapien3 23mm and Medtronic-Evolut PRO 26mm). A non-contact system based on stereophotogammetry and digital image correlation(DIC) was used to visualize the leaflet motion and perform the three-dimensional analysis. A finite element(FE) model of each valve was developed, and the leaflet deformation obtained from the DIC analysis was applied to the FE model to calculate local leaflet mechanical stress during the diastole.

Results: The maximum leaflet stress for SAV reached 2.03(Trifecta) and 1.31MPa(Mosaic) and for THV 1.40(Sapien3) and 1.07MPa(Evolut PRO). For both SAV and THV, the highest values of leaflet stress were primarily observed in the upper leaflet edge near the commissures and to a lesser extent in the mid-portion of the leaflet body.

Conclusions: The method proposed in the present study provides a useful tool to determine the magnitude and distribution of the leaflet stress. The highest levels of leaflet stress occurred near the commissures. This information may help to predict the durability of a given model and size of bioprosthetic valve in different conditions relevant to the clinical context.


Left ventricular strain on ECG in patients with severe aortic stenosis undergoing Transcatheter Aortic Valve Implantation (TAVI); Insights from TAVI-NOR study

Daanyaal Wasim1, Abukar Mohamed Ali1, Øyvind Bleie1, Svein Rotevatn2, Erik JS Packer1, Sahrai Saeed1

1Haukeland University Hospital, Bergen, Norway, 2Norwegian Registry of Invasive Cardiology, Norway

Introduction: Left ventricular (LV) remodelling and fibrosis affects post-intervention outcome in patients with aortic stenosis (AS). LV strain pattern on ECG (LVS-ECG) is a marker of such changes. We investigate the incidence, predictors and prognostic value of LVS-ECG in patients with severe AS undergoing TAVI at Haukeland University Hospital.

Methods: A total of 600 consecutive patients with complete follow-up were evaluated. Patients with bundle branch block or permanent pacing were excluded, leaving 490 patients eligible. LVS-ECG was defined as down-sloping, convex ST-segment depression with asymmetric T-wave inversion in V5 or V6.

Results: Mean age was 81±6 years, 51% males, with LVS-ECG in 126 (25.7%) patients. Age, hypertension and coronary artery disease had no association with LVS-ECG. In a multivariable-adjusted model, higher mean aortic gradient (OR 1.02; 95% CI:1.01-1.04, p=0.019), increase in LV mass index (per SD, 32g/m2) (OR 1.50; 95 CI:1.18-1.92, p=0.001), LVEF <50% (OR 4.55; 95% CI:2.50-8.30), p<0.001), LVH on ECG (OR 3.19; 95% CI: 1.92-5.29, p<0.001) were independent predictors of LVS-ECG. All-cause mortality was significantly higher in patients with LVS-ECG compared to those without (44.2% vs 54.8%, p=0.041), but in univariate Cox-regression analysis LVS-ECG was not associated with all-cause mortality (HR 1.05; 95% CI:0.79-1.39, p=0.742).

Conclusions: In patients with severe AS undergoing TAVI, severity of aortic stenosis, reduced systolic LV function, higher LV mass and the presence of LVH on ECG were independent predictors of LVS-ECG. LVS-ECG is a simple marker of structural and functional LV remodelling that may contribute to excessive mortality during long-term follow-up after TAVI.


Earlier detection of significant perioperative myocardial injury after cardiac surgery

Zineb Chaabi1, Ola Hammarsten1, Björn Redfors1, Tomas Gudbjartsson2, Anders Jeppsson1

1Sahlgrenska University Hospital, Gothenburg, Sweden, 2Landspitali, Reykjavik, Iceland

Background: Early detection of perioperative myocardial injury (PMI) in cardiac surgery patients increases the possibilities to initiate countermeasures. PMI is most often assessed by troponin measurement the day after surgery. In a recent large study by Deveraux PJ et al. (N Engl J Med 2022) a high-sensitive troponin I (TnI) >5670 ng/L on postoperative day 1 indicated clinically significant PMI. We investigated if TnI measurement already 3h after completed surgery identifies significant PMI, according to Devereaux's definition.

Methods: 200 patients without recent preoperative myocardial infarction that underwent CABG or valve surgery at Sahlgrenska University Hospital, were included in a prospective observational study. High sensitivity TnI was measured 3h and one day after surgery. PMI was defined as TnI > 5670 ng/L. Positive and negative predictive values, sensitivity and specificity, and C-statistics for the 3h measurement were calculated. Correlation was calculated with Spearman's test.

Results: PMI was detected in 29/200 patients (14.5%) day 1 after surgery. Median TnI concentration 3h after surgery was 1900 (IQR 1000-3450) ng/L and 2300 (1300-3950) ng/L on day 1 (p=0.001). The correlation coefficient between 3h and day 1 measurements was 0.73 (p<0.001). The positive and negative predictive values for measurements 3h after surgery were 79% and 92% respectively, and the sensitivity and specificity were 52% and 98% respectively. The area under the ROC-curve was 0.84 (95% CI 0.74-0.96).

Conclusion: High-sensitive TnI measurements three hours after cardiac surgery identifies patients with clinically significant perioperative myocardial injury with acceptable positive and high negative predictive value.



Left ventricular non-compaction in childhood: echocardiographic follow-up and prevalence in first-degree relatives

Thilde Olivia Kock, Marie Børresen, Anne-Sophie Sillesen, Ruth Ottilia Vøgg, Jakob Norsk, Maria Pærregaard, Niels Vejlstrup, Alex Christensen, Kasper Iversen, Henning Bundgaard, Anna Axelsson Raja

Copenhagen University Hospital, Copenhagen, Danmark

Introduction: Left ventricular non-compaction (LVNC) is characterized by excessive trabeculations of the left ventricular (LV) wall. We aimed to compare the development of LV function and morphology in 2-4-year-old children with and without LVNC at birth and describe the prevalence of LVNC in first-degree relatives.

Material and methods: Echocardiography of children with and without LVNC matched 1:4 was performed at 2-4 years, including first-degree relatives. LVNC was defined as a ratio of non-compact to compact myocardium of ≥2 in ≥1 LV segment.

Results: In total, 14 (median age 3 (interquartile range (IQR) 3-4) years, 71% male) of 16 children with LVNC at birth and 56 children without (age 4 (IQR 3-4) years, 71% male), 37 first-degree relatives of children with LVNC (age 31 (IQR 4-38) years, 46% male) and 146 first-degree relatives of children without (age 33 (IQR 11-40) years, 50% male) were included. In children with LVNC, trabeculation (8% vs. 13%, p=0.813) and left ventricular ejection fraction (LVEF) (50% vs. 49%, p=0.908) were unchanged from birth to follow-up but LVEF was lower compared to children without LVNC (49% vs. 60%, p<0.001). In first-degree relatives to children with LVNC, 11 of 37 (30%, 95% confidence interval 15-44%) fulfilled LVNC criteria compared to no relatives to children without LVNC fulfilling criteria (p<0.001).

Conclusions: At 2-4 years, children with LVNC diagnosed at birth persistently had reduced systolic function compared to children without LVNC but showed no progression of LV dysfunction or trabeculation. In first-degree relatives to children with LVNC, 30% fulfilled criteria.


Poster session 9 - Other I


Heart Rhythm Control in Children and Adolescents with Psychiatric Disorders: A Pilot Study on Heart Rate Variability and Medication Use

Kamile Plesnyte Capkauskiene, Loriana Kilaite

Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania

The aim of this ongoing pilot study is to evaluate the heart rhythm control of psychiatric disorders in children and adolescents, with or without medication. Psychiatric disorders are known to affect heart rhythm, which can lead to the prescribing of cardiovascular medication. However, good monitoring and treatment of psychiatric disorders may allow unnecessary cardiologic drugs to be avoided.

We are gathering information on 30 children aged 7 to 17 who have psychiatric illnesses, with a focus on heart rhythm, ECG, 24-hour Holter monitoring, and treatment.

While there is no significant clinical difference between age groups or disorders, individual cases already demonstrate the importance of this study. For example, a 16-year-old female with a moderate depressive episode was referred to a pediatric cardiologist for tachycardia. On examination, her ECG showed a sinus rhythm of 133 beats per minute, while 24-hour Holter monitoring revealed a heart rhythm that varied between 65 and 152 beats per minute. After 6 months of psychotherapy and treatment with sertraline 150 mg/d and quetiapine prolonged release 200 mg/d, her heart rhythm was within the normal range for her age.

Polypharmacy can cause harm, especially in children and adolescents with mental and behavioral issues who are particularly sensitive to medication. Therefore, any medical treatment option should be thoroughly assessed and supported. If heart rate variability could be better distinguished, it would be easier to assess the choice and strategies of both drug and non-drug treatment, as well as predict long-term effects.


Cost analysis of treating cardiovascular diseases in a superspeciality hospital in India

Vijaydeep Siddharth1, Atul Kumar2, I B Singh3, Rajiv Narang3

1All India Institute of Medical Sciences, Delhi, India, 2ESI Corporation, New Delhi, India, 3AIIMS, New Delhi, India

Cardiovascular care is expensive. There is dearth of data regarding cost analysis of treating various diseases including cardiac diseases from developing countries. The study aimed to analyze resource consumption in treating cardiovascular disease patients in a super-specialty hospital. An observational and descriptive study was carried out from April 2017 to June 2018 in Cardio-Thoracic (CT) Centre of All India Institute of Medical Sciences, New Delhi, India. As per WHO common cardiovascular diseases were considered for cost analysis. Medical records of 100 admitted patients (Ward & Cardiac Care Unit) of cardiovascular diseases were studied till discharge and number of patient records for a particular CVD was identified using prevalence-based ratio of admitted CVD patient data. Traditional Costing and Time Driven Activity Based Costing (TDABC) methods were used for cost computation. Per bed per day cost incurred by the hospital for admitted patients in Cardiac Care Unit, adult and pediatric cardiology ward was calculated to be Indian Rupee (INR) 28,144 (US$ 434), INR 22,210 (US$ 342) and INR 18,774 (US$ 289), respectively. Inpatient cost constituted almost 70% of the total cost and equipment cost accounted for more than 50% of the inpatient cost followed by human resource cost (28%). Per patient cost of treating any CVD was computed to be INR 2,47,822 (US$ 3842). Cost of treating Rheumatic Heart Disease was the highest among all CVDs followed by Cardiomyopathy and other CVDs. Cost of treating cardiovascular diseases in India is less than what has been reported in developed countries.


Association between pre-operative prolonged corrected QT interval and all-cause mortality after non-cardiac surgery

Helena Xiang Jóhannsdóttir, Ingibjörg Jóna Guðmundsdóttir, Sigurbergur Kárason, Martin Ingi Sigurðsson

Landspítali, Reykjavik, Iceland

Introduction: Prolonged QTc interval has been linked to risk of arrhythmias and mortality in the general population. Preoperative electrocardiography (ECG) is often obtained for patient-and procedural cardiovascular risk assessment. The aim of this study was to investigate the association of preoperative QTc and all-cause mortality in non-cardiac surgical cohort.

Material and methods: A retrospective study of all patients over 18 years undergoing non-cardiac surgery at Landspitali - the National University Hospital in Iceland between January 2nd 2005 to December 31st 2015, with follow-up through May 20th 2016. Patients were separated into five categories according to their preoperative QTc interval ≤379, 380-439ms (reference group), 440ms-479ms, 480ms-519ms, ≥520ms. Primary outcome was long-term mortality and secondary outcome was 30-day mortality.

Results: A total of 10,209 surgeries for 10,209 individuals were included. Patients with longer QTc interval had a higher comorbidity burden, were more likely to undergo emergency surgery and were often prescribed cardiac medications. After adjustment for confounding variables, the hazard ratio for long-term mortality compared with reference (QTc 380-439ms) was 0.85 [CI: 0.66-1.09] for QTc ≤379, 1.08 [CI: 0.99-1.17] for QTc 440-479ms, 1.26 [CI: 1.10-1.43] for QTc between 480-519ms and 0.97 [CI: 0.78-1.21] for QTc ≥520ms. Compared with reference, only patients with QTc interval between 480-519ms had higher odds-ratio for 30-day mortality.

Conclusions: Preoperative QTc between 480-519ms is associated with both higher long-term and 30-day mortality after non-cardiac surgery. The results suggest that this could reflect an underlying cardiovascular risk.


Autopsy findings of sudden cardiac death victims at premenopausal and postmenopausal age

Mira Anette Emilia Eskuri, Juha Vähätalo, Lasse Pakanen, Lauri Holmström, Tuomas Kenttä, Jani Tikkanen, Juha Perkiömäki, Heikki Veli Huikuri, Matti Juhani Junttila

Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, Oulu, Finland

Background: Majority of the sudden cardiac death (SCD) victims aged ≤50 years are men. Menopause has a substantial role in cardiovascular risk burden among women yet autopsy findings of premenopausal and postmenopausal women has not been studied earlier.

Material and methods: The Fingesture study has systematically collected clinical and autopsy data from SCD victims in Northern Finland between 1998−2017. The cohort consists of 5,869 SCD victims of which 1,238 are women. Women aged ≥52 years were considered as postmenopausal and ≤51 years premenopausal.

Results: Only 7.9% of the female subjects experienced SCD ≤52 years old (P<0.001). On average premenopausal women were 42.4±7.4 and postmenopausal women 72.4±10.5 years old (P<0.001). Premenopausal women had higher BMI (30.2 vs. 28.1, P=0.008) and more abdominal fat (4.0±2.9cm vs. 3.2±1.7cm, P<0.001), yet postmenopausal women had larger heart weight (414±102g vs. 381±130g, P=0.001) and they had more often moderate (50.0% vs. 35.7%, P=0.005) or substantial myocardial fibrosis (8.1% vs. 4.1%, P=0.005). However, almost half of the premenopausal women had scattered myocardial fibrosis which was remarkably more common finding than among postmenopausal women (46.9% vs. 31.4%, P=0.005). Prior myocardial scar was found from 45.7% of the postmenopausal women (P=0.043) and surprisingly from 35.1% of the premenopausal women (P=0.034). Majority of the latter experienced nonischemic SCD (62%, P=0.520).

Conclusion: Premenopausal SCDs are rare. Premenopausal women were more obese and almost half of them had scattered myocardial fibrosis at autopsy. Over one third of premenopausal and almost half of the postmenopausal women had a prior myocardial scar at autopsy.



Increased Cyber Vulnerability and Need for Cyber Risk Transparency in the Informed Consent for Patients with Cardiac Implantable Electronic Devices

Leanne N.S. Torgersen1, Rupert E.D. Whitaker1, Ricardo G. Lugo2, Stefan Sütterlin3, Stefan M. Schulz4

1Tuke Institute, London, United Kingdom, 2Tallinn University of Technology, Estonia, 3Albstadt-Sigmaringen University, Germany, 4Trier University, Germany

Introduction: Cardiac implantable electronic devices (CIEDs) have shown to improve autonomy, quality of life, morbidity and mortality. However, CIEDs possess cyber vulnerabilities. With these exemplary safety concerns, we theorise: 1) Cybersecurity risks are an ambiguous threat to medical institutions, and results in ineffective cyber defense planning, 2) Cyber threats can impair trust in the device, treatment plan and patient-provider relationship; and 3) As CIEDs “go” with the patient and these cyber risks are omnipresent, patients may not be aware of the additional risks they possess.

Material and methods: A literature review was conducted to assess what had been published to date about informing CIED patients about their increased cyber risks within the informed consent.

Results: There were little to no articles discussing the need for informing patients about cyber risks or listing cyber risks in the informed consent. Furthermore, there was no general consensus among hospitals and manufacturers on how to implement emergency measures from a cyber attack. Finally, how well both physiological and privacy risks are presented during the informed consent process to patients remains unknown.

Conclusions: The need to inform CIED patients about their cyber risks was identified and presented in a position paper. Future studies include assessing providers' and patients' cyber risk perceptions and conducting a risk assessment of manufacturer manuals with the goal of developing standardized cyber risk guidelines for CIED informed consents. As the risks from a cyber attack occurring to a CIED increases, so does the need to inform the patients of these risks.


Complex trust-building process as part of the use of technology in digital cardiac rehabilitation

Marjo-Riitta Anttila

Jyväskylän yliopisto, University of Jyväskylä, Finland

Introduction: The development of digital solutions is increasingly important in cardiac rehabilitation. The aim of this qualitative study was to study the experience, attitudes, and behaviors of technology as well as the different meanings that patients gave to the rehabilitation process.

Material and methods: The analyses were based on 39 patients who participated in CR between 2015 and 2018. The intervention lasted 12 months and included three 5-day hybrid rehabilitation sessions with web-based coaching and physical activity monitoring. The material consisted of focus group interviews at the beginning and end of CR. The data was analyzed using Grounded Theory approach, which included open, selective, and theoretical coding.

Results: The results showed a complex trust-building process, which included feeling that one has hit rock bottom, facing and coping with a crosscurrent, understanding their concerns as a peer group, moving toward a healthier lifestyle by using technology, and developing self-awareness. The complex process of trust-building was interactions between emotion, cognition, acceptance, and support processes. Patients' attitudes towards technology included four different groups included feeling like an outsider, being uninterested, reflecting on the benefits, and enthusiastic use. Taken together, these findings point to the significant role of patient education in lifestyle management in promoting trust-building for life change.

Conclusions: The provision of personalized encounters, considering the diversity of the patients as technology users and their different attitudes toward utilizing technology, will enhance trust and promote life change.The digital solutions allowed emotional and cognitive factors to be taken into consideration when implementing the rehabilitation.


Poster session 10 - Other II


Impact of prior use of anthracyclines on cardiac function in patients before undergoing hematopoietic stem cell transplantation

Audrone Vaitiekiene, Migle Kulboke, Monika Bieseviciene, Antanas Jankauskas, Igne Strazdiene, Emilija Lidziute, Darija Jankauskaite, Rolandas Gerbutavicius, Jolanta Justina Vaskelyte, Domas Vaitiekus, Gintare Sakalyte

Lithuanian University of Health Sciences, Kaunas, Lithuania

Introduction: Hematopoietic stem cell transplantation (HSCT) causes different grade cardiac toxicity. It is important to evaluate baseline cardiac function before starting HSCT to stratify patients risk. We aimed to find a relation between left ventricle (LV) and right ventricle (RV) function and prior use of anthracyclines.

Material and Methods: Data of 45 patients undergoing autologous or allogenic HSCT in the Hospital of Lithuanian University of Health Sciences was evaluated (Bioethics approvement No BE-2-96). Cardiovascular magnetic resonance (3T MRI Siemens Magnetom Skyra) was performed before the stem cell mobilisation. Volumetric analysis performed using Medis Suite 3.2. Patients were divided into two groups: first group - with prior chemotheraphy regimens including anthracyclines and the second group - without anthracyclines. SPSS statistics 20 was used (Student t test).

Results: The mean age of patients was 57,2 ± 12,7 years (ranging 18-74). 15 patients (33,3%) were in the first group and 30 (66,7%) in the second. Patients in the first group were younger than in the second - 60,9 ± 6,8 vs 49,8 ± 18 years (difference was statistically significant, p=0,004). In the first group LV ejection fraction (LV EF) was statistically significantly lower than in the second 55,5% ± 9,1 vs 61,3% ± 6,8, p=0,02. RV ejection fraction (RV EF) was lower in the anthracyclines group, but difference was not statistically significant (52,5% ± 6,1 vs 55,4 % ± 5,0, p=0,13)

Conclusions: Patients with prior anthracycline based chemotherapy regimens tend to have lower LV EF compared to chemotherapy without anthracyclines before starting HSCT.


The results of a 10-year longitudinal monitoring of cardiac rehabilitation patients

Maie Ojamaa, Livian Laaneots, Aet Lukmann

Tartu University Hospital, Tartu, Estonia

Background: Coronary artery disease (CAD) is the most common cause of death in Estonia and globally. However, with falling CAD mortality rates, an increasing number of people living with CAD may need longer support to manage their symptoms and prognosis.

Aim of the study was to evaluate the indices of cardiorespiratory reserve and functional capacity of CAD patients before and after a 12-week rehabilitation program and after a 10-year period.

Material and methods. The whole group under study consisted of 45 CR patients ( 73% men, mean age 58.2±9.62 years, 27% female patients, mean age 62.08±7.96 years). Two to four weeks after the revascularization of the myocardium the patients started a CR programme. The patients underwent breath-by-breath bicycle cardiopulmonary testing before and after the 12- week rehabilitation programme, and afterwards once a year within 10 years.

Results. The effects of exercise training on functional capacity demonstrated the increase of VO2 peak of 2.23 ml/kg/min as the result of a 12-week moderate training programme and increase of VO2 peak of 4.72 ml/min/kg as the result of 10 years of regular aerobic exercise. The mean values of VO2 peak before and after the programme are 18.78±4.67 ml/min/kg and 21.01±4.47 ml/min/kg, respectively, and after 10 years of regular exercise 23.50±7.89 ml/min/kg.

Conclusion: Considering the indices of cardiorespiratory reserve and physical performance, it is possible to maintain the same functional level within 10 years, or even to improve it, despite increasing age.


Chronic pain after lung transplantation A nationwide study – short and long term

Jytte Graarup1, Signe West Christensen2, Ida Elisabeth Højskov2

1Department of Heart and Lung Surgery, the Heart Centre, Rigshospitalet, Univer, Copenhagen, Danmark, 2Rigshospitalet, Copenhagen, Danmark

Introduction: Lung transplantation is one type of treatment for patients at end-stage lung disease. After transplantation, patients have a high prevalence of pain that has a high impact on their quality of life.

This study explores i) how many patients who underwent lung transplantation in Denmark are in pain, ii) the scale of their chronic pain, iii) the use of pharmacological and non-pharmacological interventions, and iv) the impact of the chronic pain on their everyday lives in the long and short term.

Material and methods: A cross-sectional survey study design was chosen. The Brief Pain Inventory was used to collect patient data at the annual checkup. The study invited 100 patients who had undergone a lung transplantation between 1992 and 2019 to fill out a questionnaire.

Results: Ninety-nine patients completed the questionnaire, 64% of whom reported living with chronic pain. More than 50% of the participants had received a sternotomy, and >80% had undergone transplantation less than ten years ago. More than 50% reported that the chronic pain was located in the lower part of the body.

Conclusions: Most recipients of a lung transplant in Denmark live with chronic pain. The majority of the chronic pain reported does not seem to be related to the surgical procedure and is located in the lower part of the body. Chronic pain affects physical ability and decreases quality of life.


Health Self-Assessment and Cardiovascular Risk Factors in Population of Latvia. Cross-sectional study.

Iveta Bajare, Vilnis Dzerve, Sanda Jegere, Andrejs Erglis

University of Latvia, Riga, Latvia

Introduction: Cardiovascular diseases (CVD) and cardiovascular risk factors (RF) are leading cause of death globally. Health self-assessment (HSA) is strong predictor of morbidity and mortality of CVD. The aim of the study was to determine correlations of HSA and main RF using data of Population Based Cross-sectional Study of Cardiovascular Risk Factors in Latvia.

Materials and methods: 4070 inhabitants (age 25-74) of Latvia were enrolled in the study out of the initial statistical sample (6000), formed by random selection from the Housing Register of the Central Statistical Bureau (1'209'756 pers.). Data on the socio-economic status, prevalence of arterial blood pressure (BP), low density lipoprotein cholesterol (LDL-C) level, glucose (Glu) level, body mass index (BMI), smoking, health self-assessment was obtained in face-to-face interviews, physical measurements and blood tests. The data were processed using Microsoft Excel and R.

Results: Individuals with normal BP had better HSA (good-61%, fair-34%, poor-5%) than individuals with elevated BP (good-32%, fair-55%, poor-13%); P<0.001. Individuals with normal Glu level had better HSA (good-56%, fair-37%, poor-7%) than individuals with elevated Glu level (good-35%, fair-53%, poor-12%); P<0.001. Individuals with normal BMI <25 had better HSA (good-62%, fair-32%, poor-6%) than individuals with elevated BMI (good-44%, fair-47%, poor-9%); P<0.001. There was no statistically significant difference between individuals with normal and elevated LDL-C level as well as between non-smokers and daily smokers.

Conclusions: A lot of people with CVD RF assess their health inappropriate high. The precisely targeted educational campaigns on RF recognition and significance are needed.




Case report: Atypical developmental delay associated with Ebstein anomaly following early hypoxia or comorbidity

Loriana Kilaitė1, Marius Šukys2, Kamilė Plėšnytė Čapkauskienė1

1Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania, 2Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania

BACKGROUND AND AIM: This case study presents a 9-year-old female patient with Ebstein anomaly and associated psychiatric symptoms. The aim of this report is to illustrate the challenges in diagnosing and providing real-time rehabilitation to complex multidisciplinary patients.

METHOD AND RESULTS: The patient was born through cesarean section due to unstable hemodynamics and received sympathomimetics to stabilize blood flow. Heart ultrasound revealed Ebstein anomaly with an atrial septal defect, right ventricular hypoplasia, and reduced pulmonary blood flow. Infection further complicated the situation after birth. At the age of two, she underwent the Carpantier-DaSilva and bidirectional Glenn procedures, which led to complete AV node block and subsequent implantation of a stimulator. At five years old, the stimulator battery was replaced during an intravenous procedure under full anesthesia. At this time, the patient's parents noted developmental abnormalities and features of autistic behavior. A few months later, the patient was diagnosed with epilepsy, which was controlled by medications. Screening for paraneoplastic process and inborn error of metabolism was negative. At the age of nine, a children and adolescent psychiatrist diagnosed moderate mental impairment and disintegrative disorder in childhood.

CONCLUSIONS: This case highlights the complexity of congenital heart disorders and the potential impact of hypoxia on developmental goals. While parents' negligence may have contributed to the unnoticed developmental delay, even extensive medical testing cannot always provide a clear diagnosis. Proper recording of a patient's developmental process is important for accurate diagnosis and timely intervention.


An acquired fistula between coronary and pulmonary arteries after heart transplantation

Anna Maria Punab1, Märt Elmet2

1University of Tartu, Tartu, Estonia, 2Tartu University Hospital, Heart Clinic, Estonia

Introduction: Coronary artery fistulas (CAF) are rare cardiac malformations with prevalence of ~0.1-0.2% in unselected adult patients undergoing coronary angiography. Most CAFs are congenital and occur due to embryologic arrest leading to additional communications within the heart or major vessels. However, CAF can be acquired after trauma, infection or iatrogenic injury such as cardiac surgery, endomyocardial biopsy or coronary angioplasty. Higher prevalence of CAF has been reported among orthotopic heart transplant (OHT) recipients and is particularly high among paediatric OHT recipients.

Case report: A 20-year-old male patient with Danon disease underwent routine coronary angiography to evaluate for transplant rejection 5 years after OHT due to hypertrophic cardiomyopathy. The surgical procedure and post-transplant course were uncomplicated. On the latest follow-up visit, the patient's cardiac examination was normal and no murmur was present. Coronary angiography showed normal coronary arteries, but also revealed the presence of moderate sized non-cameral coronary artery fistula between the right coronary artery and an artery in the ipsilateral lung field. Echocardiograms performed after transplantation showed normal ejection fraction and normal pulmonary artery pressures. Exercise stress test was performed with normal result. Considering the clinical characteristics of the patient and the lack of any symptoms, conservative management was decided on and he remains on regular follow-up and surveillance.

Conclusions: Although most patients are asymptomatic, CAF can cause serious complications secondary to volume overload or myocardial ischemia due to coronary steal phenomenon. There is limited long-term data on CAF after cardiac transplantation and currently no established recommendations for patient follow-up.


Poster session 11 - Preventive cardiology


Oral anticoagulant use by lifeday coverage and one-year relative survival in atrial fibrillation patients in Estonia 2019 and 2020.

Priit Pauklin1, Toomas Marandi1, Mart Kals1, Tiia Ainla1, Katrin Martinson2, Jaan Eha1, Priit Kampus1

1Tartu University Hospital, Tartu, Estonia, 2Linnamõisa Family Medicine Center, Estonia

Introduction: To study the lifeday coverage (LDC) of oral anticoagulant (OAC) prescriptions and its relationship with one-year mortality rates for atrial fibrillation (AF) patients aged ≥65 in Estonia for the years 2019 and 2020.

Methods: Medical data for AF patients aged ≥ 65 years from 2018 and alive as of 01.01.2019 (cohort I) and from 2019 and alive as of 01.01.2020 (cohort II) was obtained from the Health Insurance Fund's electronic database. The data was linked to the nationwide Estonian Medical Prescription Centre's database of prescribed OACs. For LDC analysis, daily doses of guideline-recommended OACs were used. The patients were categorized into three LDC groups: 0%, 1-79%, ≥80%.

The data was linked to the Estonian Causes of Death Registry to establish the date of death and mortality rate for the whole Estonian population aged ≥65.

Results: There were 34,018 patients in cohort I and 36,038 patients in cohort II. Of the patients, 77.7 % and 81.2% had at least one prescription of OAC and 57.4% in cohort I and 60.7% in cohort II had an LDC of ≥80%. The relative survival estimates at 1 year for LDC lifeday coverage groups 0%, 1-79% and ≥80% were 91.2%, 98.2%, and 98.5% (cohort I) and 93.0%, 96.4%, and 98.4% (cohort II), respectively.

Conclusions: Despite clear indications for OAC use, LDC is still insufficient and anticoagulation is underused for stroke prevention in Estonia. Further education of the medical community and patients is needed to achieve higher lifeday coverage of prescribed OACs.


Peripheral bioimpedance curves – just a heart in a magic mirror or crystal ball for cardiovascular prevention

Kristina Lotamõis1, Tiina Uuetoa2, Andrei Krivošei3, Paul Annus3, Marek Rist3, Sulev Margus1, Mart Min3

1East Tallinn Central Hospital, Tallinn, Estonia, 2Confido Healthcare Center, Tallinn, Estonia, 3Tallinn University of Technology, Tallinn, Estonia

Background: Peripheral electrical bioimpedance (EBI) is a promising method that has potential to replace invasive or burdensome techniques for cardiovascular measurements. Although decades of research and engineering has been done on EBI, several technical, analytical, and interpretative aspects still need to be resolved before the method can be adopted in clinical practice. Our goal was to investigate and improve application of EBI, executing its comparison with other cardiovascular assessment methods on patients ongoing coronary catheterization procedure.

Materials and methods: The data were collected from 41 non-acute patients aged 45-74 years hospitalized for coronary catheterization to East-Tallinn Central Hospital in 2020-2021. The radial EBI curves were registered simultaneously with ECG and contralateral radial and central pressure curves. The Savitzky–Golay filter was applied for signal smoothing. Cardiac waveforms were extracted from the multicomponent signals using Hankel matrix decomposer. After extracting the cardiac component, a period detection algorithm was applied to EBI and blood pressure curves.

Results: We were able to detect seven selected fiducial points on the pressure and EBI curves, but only four of them had good representativeness. Strong positive correlation was found between pulse transit times measured invasively and with EBI.

Discussion: Blood pressure calculations and cardiovascular risk assessments can be based on the EBI derived pulse transit time calculations. Further development of wearable devices will lead to more comprehensive vascular and haemodynamic monitoring of patients.


Expanding access to cardiac rehabilitation: a remote service model for heart disease patients

Mattias Tralla, Maie Ojamaa, Gertu Sõerunurk, Livian Laaneots, Matko Vučica, Aet Lukmann, Svetlana Berjozova

Tartu University Hospital, Tartu, Estonia

Introduction: The "Remote Rehabilitation Service Model for Cardiac Patients" project aimed to address limited access to cardiac rehabilitation (CR) for heart disease patients. CR reduces mortality and healthcare costs and is underutilized in Europe, with average participation rates of under 10% in Estonia.

Materials and Methods: A pilot study, conducted from 01.08.2021 to 31.12.2022, included coronary artery disease (CAD) patients recruited at Tartu University Hospital, Estonia. The multidisciplinary project involved organisational and technological adaptations, rehabilitation material creation, and nurse case manager recruitment. The remote service model was developed using the carepath management platform and pilot-tested with 71 patients (56 male, 15 female).

Results: The project successfully implemented the remote service model, integrating it into workflows and training healthcare professionals. Continuous improvements were made based on feedback. The number of rehabilitation program participants doubled compared to 2019. CAD patients showed a mean increase in peak aerobic capacity (VO2 peak) of 3.7 ml/kg/min during 12 weeks of CR. The graduation rate for remote service model patients was 99%. Moreover, 57.8% of patients lived outside the city centre, suggesting improved inclusion of remotely-located patients.

Conclusions: The innovative remote CR model proved viable, with the potential to improve rehabilitation service access. The CR program positively impacted aerobic functional capacity. The subsequent stage will assess the remote service model's impact and discuss implementation with other healthcare providers and the national health insurance agency.


Is statin lipid-lowering therapy sufficient for LDL-C goal attainment in very high cardiovascular risk Lithuanians?

Gabriele Linkeviciute1, Živile Girkantaite2, Greta Vrublevska2, Egidija Rinkuniene2, Vilma Dženkeviciute2, Jolita Badariene2

1Vilnius University Faculty of Medicine, Vilnius, Lithuania, 2Vilnius University Faculty of Medicine, Lithuania

Introduction: Despite having the highest cardiovascular disease mortality in Europe, Central and Eastern Europe remains a relatively understudied region. Therefore, attention to secondary prevention management is crucial. This analysis describes dyslipidaemia management and achievement of the European Society of Cardiology (ESC)/ European Atherosclerosis Society (EAS) guidelines-recommended low-density lipoprotein cholesterol (LDL-C) goals in Lithuania.

Material and methods: This cross-sectional study included 478 patients after myocardial infarction (369 men (77.19%) and 109 women (22.8%), mean age: 58.6±9.95) examined in the Vilnius University Hospital Santaros Klinikos. Data was collected during a single visit between 2016 and 2022.

Results: Overall, 125 (26.15%) patients achieved risk-based LDL-C goals according to 2016 ESC/EAS guidelines, while only 29 (6.5 %) achieved the updated 2019 ESC/EAS goals. High-intensity LLT was the most prescribed regimen (79.7%; n= 381). 307 patients (64.22 %) received atorvastatin monotherapy and 58 patients (12.13%) rosuvastatin monotherapy. LDL-C goal attainment was higher in patients receiving high-intensity (80.8%; n=101) LLT compared to those receiving moderate-intensity LLT (19.2%; n=24) (p=5.694545e-12). However, there was no statistical significance between patients receiving rosuvastatin and atorvastatin (31%; n=18 and 24.8%; n=102, respectively)(p>0.05).

Conclusions: In Lithuania, only a quarter of patients achieved 2016 risk-based LDL-C goals, and the majority did not meet 2019 ESC/EAS goals. Therefore, there is a significant gap between the recommendations and the actual achievement of LDL-C goals in very high-risk patients, indicating the need for statin combination with non-statin LLT in most of these patients.


Non-participants in cardiac rehabilitation; - why 47% don´t participate in cardiac rehabilitation

Ann Bovin1, Nanna Nørgaard Eg2

1Lillebaelt Hospitals Vejle, Vejle, Danmark, 2Aarhus University Hospital Skejby, Aarhus, Danmark

Introduction: Denmark has monitored participation in cardiac rehabilitation (CR) since 2013. However, has never been able to account for non-participants. Participation has never exceeded 54% according to the national registry.

Material and methods: All patients with a relevant diagnosis of acute myocardial infarction or coronary revascularization between June 2020 and June 2021, residents in the uptake area of Regional Hospital Vejle Denmark, were identified by the Danish National Patient Registry and compared to CR participation registered in the Danish Cardiac Rehabilitation Database (DHRD). Medical files on all non-participants were accessed to determine the reason for non-participation.

Results: 273 patients were identified. Only 146 (54%) participated in CR according to the registry, while 127 were registered as non-participants in CR despite relevant diagnosis, a systematic referral system, and free CR services. 54% of the non-participants participated which weren`t registered in DHRD. 24% had no indication of CR (diagnosis not confirmed). 14% were not considered candidates for CR due to severe comorbidities like bedridden state or dementia. 6% were invited but refused to participate. Only 2% was lost because of screening failure at the hospital and failure to invite screened patients.

Conclusions: Although Denmark has had a nationwide CR registry for a decade, the low participation rates have never been investigated. Our study proves the participation rates misleading due to data collection procedures. This study led to a complete reorganization of CR data collection in Denmark and the transition from 2023 to automatic data collection in CR to overcome validity issues.


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