Post‐discharge arrhythmic risk stratification of patients with acute myocarditis and life‐threatening ventricular tachyarrhythmias

2021 ◽  
Author(s):  
Piero Gentile ◽  
Marco Merlo ◽  
Giovanni Peretto ◽  
Enrico Ammirati ◽  
Simone Sala ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Acute Myocarditis ◽  
Ventricular Tachyarrhythmias ◽  
Post Discharge ◽  
Life Threatening

scholarly journals P1736Two-step risk stratification of life-threatening ventricular tachyarrhythmias in patients with dilated cardiomyopathy

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii377-iii378
Author(s):  
TG. Vaikhanskaya ◽  
VC. Barsukevich ◽  
OP. Melnikova ◽  
AV. Frolov
Keyword(s):  
Risk Stratification ◽  
Dilated Cardiomyopathy ◽  
Ventricular Tachyarrhythmias ◽  
Life Threatening

Risk stratification personalised model for prediction of life-threatening ventricular tachyarrhythmias in patients with chronic heart failure

2017 ◽  
pp. 682-688 ◽  
Author(s):  
Alexander Vladimirovich Frolov ◽  
Tatjana Gennadjevna Vaikhanskaya ◽  
Olga Petrovna Melnikova ◽  
Anatoly Pavlovich Vorobiev ◽  
Ludmila Michajlovna Guel
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Risk Stratification ◽  
Ventricular Tachyarrhythmias ◽  
Life Threatening

scholarly journals Myocardial electrical instability score: clinical and prognostic significance

2019 ◽  
pp. 55-61 ◽  
Author(s):  
A. V. Frolov ◽  
T. G. Vaykhanskaya ◽  
O. P. Melnikova ◽  
A. P. Vorobev ◽  
A. G. Mrochek
Keyword(s):  
Risk Stratification ◽  
Qt Interval ◽  
Prognostic Significance ◽  
Ventricular Tachyarrhythmias ◽  
T Wave ◽  
Fragmented Qrs ◽  
Electrical Instability ◽  
Life Threatening ◽  
Rate Deceleration ◽  
The Individual

Aim. To develop and test a risk-stratification model for patients with coronary artery disease (CAD) and non-ischemic pathologies based on a computer analysis of electrical instability ECG markers.Material and methods. In the period from 2011 to 2018, the study included 1014 patients with CAD and non-ischemic pathologies. Depending on ventricular arrhythmia status, the analyzed cohort was divided into 3 groups: 1) 644 patients without lifethreatening ventricular tachyarrhythmias (-VTA), mean age 51,7±16,1 years; 2) 280 patients with clinically significant ventricular arrhythmias (+csVA): ventricular extrasystoles (VES) >1500/24 h, coupled VES >50/24 h or unstable ventricular tachycardia (uVT), mean age 46,7±14,0 years; 3) 90 patients with life-threatening ventricular tachyarrhythmias (+VTA): persistent VT (pVT), successful cardiopulmonary resuscitation (CPR), appropriate discharges by implanted cardioverter defibrillator (CVD), sudden cardiac death (SCD), mean age 46,8±12,7 years.Using the Intekard 7.3 software, ECG markers of myocardial electrical instability were analyzed: T wave alternation, QT interval and dispersion, fragmented QRS, spatial QRS-T angle, turbulence onset and slope, and heart rate deceleration/acceleration.Results. Statistically significant differences were found between the values of T wave alternation, QT interval, fragmented QRS and QRS-T angle in groups 1 and 3 (-VTA) and (+VTA), p<0,005.Personalized model was formed for predicting the risk of life-threatening VTA (primary endpoints: pVT, appropriate CVD discharges, CPR, SCD) in patients with CAD and non-ischemic pathologies (cardiomyopathy, channelopathy) in 5 years follow-up. Integral score of myocardial electrical instability is proposed as new quantitative parameter for risk stratification (sensitivity 75%, specificity 78%, accuracy 77%).Conclusion. The myocardial electrical instability score provides the individual assessment of the dynamic SCD risk. The Intekard 7.3 software is a simple, economic and accessible ECG tool for arrhythmia monitoring.

scholarly journals Risk stratification in cardiogenic shock: a focus on the available evidence

2021 ◽  
Author(s):  
C. Sciaccaluga ◽  
G. E. Mandoli ◽  
N. Ghionzoli ◽  
F. Anselmi ◽  
C. Sorini Dini ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Cardiogenic Shock ◽  
Clinical Syndrome ◽  
Diagnostic Assessment ◽  
Prognostic Scores ◽  
Current Evidence ◽  
Efficient Resource ◽  
Threatening Condition ◽  
Life Threatening ◽  
Future Direction

AbstractCardiogenic shock is a clinical syndrome which is defined as the presence of primary cardiac disorder that results in hypotension together with signs of organ hypoperfusion in the state of normovolaemia or hypervolaemia. It represents a complex life-threatening condition, characterized by a high mortality rate, that requires urgent diagnostic assessment as well as treatment; therefore, it is of paramount important to advocate for a thorough risk stratification. In fact, the early identification of patients that could benefit the most from more aggressive and invasive approaches could facilitate a more efficient resource allocation. This review attempts to critically analyse the current evidence on prognosis in cardiogenic shock, focusing in particular on clinical, laboratoristic and echocardiographic prognostic parameters. Furthermore, it focuses also on the available prognostic scores, highlighting the strengths and the possible pitfalls. Finally, it provides insights into future direction that could be followed in order to ameliorate risk stratification in this delicate subset of patients.

scholarly journals Cardiac MRI and Myocardial Injury in COVID-19: Diagnosis, Risk Stratification and Prognosis

Diagnostics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 130
Author(s):  
Saagar K. Sanghvi ◽  
Logan S. Schwarzman ◽  
Noreen T. Nazir
Keyword(s):  
Risk Stratification ◽  
Myocardial Injury ◽  
Cardiac Tissue ◽  
Contractile Function ◽  
Imaging Modality ◽  
Acute Myocarditis ◽  
Myocardial Inflammation ◽  
Critical Data ◽  
Non Invasive ◽  
Risk Of Exposure

Myocardial injury is a common complication of the COVID-19 illness and is associated with a worsened prognosis. Systemic hyperinflammation seen in the advanced stage of COVID-19 likely contributes to myocardial injury. Cardiac magnetic resonance imaging (CMR) is the preferred imaging modality for non-invasive evaluation in acute myocarditis, enabling risk stratification and prognostication. Modified scanning protocols in the pandemic setting reduce risk of exposure while providing critical data regarding cardiac tissue inflammation and fibrosis, chamber remodeling, and contractile function. The growing use of CMR in clinical practice to assess myocardial injury will improve understanding of the acute and chronic sequelae of myocardial inflammation from various pathological etiologies.

Abstract 363: Chest Pain Observation Unit: Does Post-Discharge Stress Testing Influence Physician Management Decisions?

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Yasser Khalil ◽  
Martin E Matsumura ◽  
Maida Abdul-Latif ◽  
Prasant Pandey ◽  
Melvin Schwartz
Keyword(s):  
Chest Pain ◽  
Risk Stratification ◽  
Stress Testing ◽  
Stress Test ◽  
Multivariate Regression Analysis ◽  
The United States ◽  
Observation Unit ◽  
Management Decisions ◽  
Post Discharge ◽  
Effective Manner

Background: Chest pain (CP) accounts for approximately 6 million emergency visits per year in the United States. There is growing interest in strategies to effectively risk stratify pts for coronary artery disease (CAD) related events in a cost-effective manner. The use of chest pain observation units followed by early stress testing is frequently employed in these pts. However the utility of stress testing in this population is not well defined, and the effect of stress test results on subsequent management decisions is a topic of controversy. In the present study we examined the relationship of stress myocardial perfusion imaging (MPI) results to physician decisions regarding ccath in a single community teaching hospital. Methods: Retrospective study of 426 pts undergoing a chest pain observation strategy over a 24 month period. Pt eligible for the program had CP deemed possibly related to CAD but no diagnostic ECG changes and negative TnI measurements x2. All pts underwent outpt. stress MPI within 72 hours of discharge. Pts saw a cardiologist the day of stress MPI who reviewed the CP history, MPI results, and made decisions regarding further risk stratification. Demographic and medical history was collected from the pts chest pain observation unit record. Multivariate regression analysis was used to determine significant independent variables related to physician decisions regarding further risk stratification. Results: Of 426 pts who underwent outpt stress MPI, 71(16.7%) were positive for ischemia, and 16 (22.5% of +MPI) underwent cath with reperfusion performed in 8 (5PCI, 3 CABG, 11.3% of +MPI). Of the 355 pts with negative stress MPI, 5(1.4% of -MPI) underwent cath with reperfusion performed in 2 (2PCI, 0 CABG, 0.5% of -MPI). A MLR model suggested only stress MPI results were independently predictive of the use of ccath for risk stratification. Conclusion: Stress MPI was an important factor in physician decision-making regarding the need for ccath in pts managed in a chest pain observation unit. The rate of +MPI and subsequent use of ccath in our institution supports MPI as an appropriate step in risk stratification of low to moderate risk CP pts triaged through a CP observation unit.

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