Indonesian Journal of Cardiology

Added Value of CHA2DS2-VASc Score to Safe Contrast Volume for Contrast Induced Nephropathy Prediction after Percutaneous Coronary Intervention

2023-12-02T21:59:13+07:00

Abstract

Background: The CHA2DS2-VASc score is utilized to order the danger of embolization in atrial fibrillation (AF). Also, it has been assessed the worse clinical scenario in acute coronary syndrome patients, regardless of having AF. The study aim was to use CHA2DS2-VASc score added to the safe contrast volume (Volume /CrCl) for contrast-induced nephropathy (CIN) early prediction post PCI.

Patients and Methods: The study included two hundred fifty nine patients who underwent percutaneous coronary intervention . For each patient, The CHA2DS2-VASc score and Volume /CrCl were evaluated. The patients in our study were divided, according to CIN development into two groups. CIN was identified as a rise in serum creatinine >0.5 mg/dl or >25% increase in baseline within48 to 72 hours after PCI. Statistical analysis: the receiver operating characteristic analysis was used to detect the best cut off values to predict CIN, and we concluded the predictors of CIN through multivariate logistic regression analysis. Results: There was a positive correlation between Mehran score and CHA2DS2-VASc score. Independent predictors of CIN were Mehran score, Volume/CrCl ratio>3.2 and CHA2DS2-VASc >3, CHF or EF < 40%, hypotension, anemia, primary PCI and weight. If the patient had (CHA2DS2-VASc score>3 or Volume/CrCl >3.2), as a single predictor, we could predict CIN with (sensitivity 96.97 %, 95% CI 0.71 to 0.82).

Conclusion: The CHA2DS2-VASc score and Volume/CrCl ratio are new predictor of CIN, and we can use the CHA2DS2-VASc score , safe contrast volume for early detection of CIN after PCI.

The Sub-Analysis of HFmrEF and HFrEF Group in CORE-HF Registry : When being Good is Not Enough

2023-12-02T21:59:12+07:00

Background : As the prevalence of heart failure (HF) kept rising each year, the burden caused by it also escalating, especially in terms of economic burden. This is urging the physician to quickly tackle the problem. Although HFrEF medications were developing vastly, the outcome of HF in real world still varies. This indicates another approach is still needed to manage HFrEF/HFmrEF comprehensively. This paper is aimed to give an overview of HFrEF and HFmrEF epidemiological data, based on CORE-HF real world data.

Methods : The CORE-HF is a single-center, prospective-cohort registry, which enrolls all patients with chronic HF, that were recruited consecutively from the outpatient Sebelas Maret HF Clinic. Both enrollment and follow-up have been performed since January 2018 until December 2022. Variables recorded consists of baseline characteristics, risk factors, subjective indicators, objective diagnostic assessments, therapies, and outcomes (readmission and mortality).

Results : The population of this registry was younger (58.7 ± 12.14) compared to other HF registries, with more multi comorbidities. The number of HFrEF patient was higher than HFmrEF (77.7% vs 22.3%), with clinically higher mortality rate (7.2% in the 1^styear and 18.2% in the next year). Although triple therapy initiation and uptitration were excellent in number, the mortality rate during second year of follow-up was higher than other registries. We found non-compliant behavior to be responsible for those results.

Conclusion : Based on CORE-HF sub-analysis of the HFrEF and HFmrEF groups, adherence to HF guidelines is the main but not the only key leading to lower mortality and rehospitalization. Our data provide satisfying low hard outcomes, but solving the non-compliance behavior and optimizing the non-pharmacological approach should be done comprehensively by the HF team.

Usefulness of The CHADS2 and CHA2DS2-VASc Scores in Predicting In-Hospital Mortality in Acute Coronary Syndrome Patients: A Single-Center Retrospective Cohort Study

2023-12-02T21:59:11+07:00

Background

Although the GRACE risk score is widely accepted as an established scoring system to predict in-hospital mortality in acute coronary syndrome (ACS) patients, this scoring system still depends on electrocardiography and laboratory findings to determine the results. Therefore, we aim to retrospectively evaluate the association between the CHADS₂and CHA₂DS₂-VASc score as an anamnesis-only mediated scoring system and in-hospital mortality in hospitalized ACS patients.

Methods

This retrospective cohort study analyzed data of ACS patients from the ACS registry in Dr. Hasan Sadikin Central General Hospital from 2018 to 2021. The outcome of this study was in-hospital mortality. The association between these scoring system and in-hospital mortality were evaluated using binary logistic regression analysis. Receiver operating characteristics (ROC) analysis was also performed to assess the success rate of this scoring system in predicting in-hospital mortality.

Results

A total of 1339 patients were included in this study, and 162 (12.1%) of them died in the hospital. High CHA₂DS₂-VASc score group (cut-off >2) was significantly associated with higher risk of in-hospital mortality before (OR=2.56 [1.75,3.75]; p<0.001) and after adjustment of several confounding factors (OR=3.39 [1.73,6.64]; p<0.001). Meanwhile, the high CHADS₂score (cutoff >2) was only significantly increased the risk of in-hospital mortality in univariate analysis (OR=2.05[1.47,2.87];p<0.001), but was not significantly associated with in-hospital mortality after multivariate analysis (OR=1.31 [0.92,1.86];p=0.129). ROC analysis revealed that predictive accuracy of CHA₂DS₂-VASc score was significantly greater compared to CHADS₂score (AUC: 0.653 vs 0.609, p<0.001). However, the predictive value of CHA₂DS₂-VASc score was significantly lower than the GRACE risk score (AUC: 0.789 vs 0.653, p<0.001).

Conclusion

Our study showed that the CHA₂DS₂-VASc score >2 was significantly and independently associated with higher in-hospital mortality in ACS patients compared to the CHA₂DS₂-VASc score of 1 or lower. Despite its lower predictive accuracy compared to the GRACE risk score, CHA₂DS₂-VASc score can still be used in practical situations as an alternative scoring system in predicting in-hospital mortality in ACS patients, especially in primary health care settings located in rural areas that lack the diagnostic facilities.

Hyperkalemia Mimicking Anteroseptal Myocardial Infarction

2023-12-02T21:59:11+07:00

Background: Hyperkalemia often results in cardiac emergency associated with fatal cardiac arrhythmias. However, the presence of ST segment elevation in hyperkalemia is rare and could potentially subject the patients to unnecessary risk of intervention. Most commonly, ST elevation in hyperkalemia presents in a down-sloping fashion compared to the typical convex or upsloping pattern in myocardial infarction. However, in some cases, the ST elevation morphology can be very identical and difficult to distinguish. Herein, we describe a hyperkalemic patient presenting with non-ischemic ST segment elevation that resolved spontaneously following therapy.

Case illustration: A 77-year-old, bed-ridden, inarticulate woman was admitted to emergency department with acute dyspnea perceived for 1.5 hours. The patient’s past clinical history included craniotomy for subdural hematoma, poorly controlled hypertension, hypertensive heart disease, rheumatoid arthritis, and dementia and was under candesartan, amlodipine, nebivolol, spironolactone, and atorvastatin treatment. The 12-lead electrocardiography (ECG) recording showed wide QRS complex with left bundle branch block pattern, slow atrial fibrillation with total atrioventricular block, ST segment elevation and Q wave in anteroseptal leads, and peaked T wave (Figure 1A). The pattern of ST elevation was indistinguishable from that of myocardial infarction which necessitated further laboratory confirmation. Laboratory results showed severe hyperkalemia (K⁺ 7.93 mmol/L) and normal troponin level (45.0 ng/L). The patient was given serial insulin-based therapy and calcium gluconate immediately. The follow-up ECG pictured normal sinus rhythm with no sign of bundle branch block, resolution of ST segment elevation, and reduction in T wave amplitude (Figure 1B). However, the reduction in potassium level was not significant and the patient also experienced an acute kidney injury. The patient was transferred to intensive care unit and was prepared for hemodialysis.

Conclusion: ST segment elevation is a rare feature of hyperkalemia that could mislead the patient’s treatment. Thorough ECG evaluation is the key to narrow down the differential diagnosis. Every deviant feature should not be interpreted separately. Laboratory tests could help confirm the diagnosis, particularly in patients with atypical presentation and could help avoid unnecessary risk of intervention.