Nguyen, Thach N;
Huynh, Thanh N;
Le, Thoa;
Le, Minh Anh;
Nguyen, Thu Q;
Le, Chuong T;
Nguyen, Nguyet;
Vu, Loc;
Le, Minh H;
Ho, Dung T;
Rigatelli, Gianluca;
Talarico, Ernest;
Zuin, Marco;
Pham, Hung N;
Cao, Thinh;
Nguyen Thuong, Nghia T
Abstract 11983: Prolonged Coronary Arterial Phase and Recurrent Ischemia Are Hallmarks of Repeat Heart Failure and Sudden Cardiac Death in Patient With Dilated Cardiomyopathy and Patent Coronary Arteries an Angiographic and Machine Learning Analysis
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Media type:
E-Article
Title:
Abstract 11983: Prolonged Coronary Arterial Phase and Recurrent Ischemia Are Hallmarks of Repeat Heart Failure and Sudden Cardiac Death in Patient With Dilated Cardiomyopathy and Patent Coronary Arteries an Angiographic and Machine Learning Analysis
Contributor:
Nguyen, Thach N;
Huynh, Thanh N;
Le, Thoa;
Le, Minh Anh;
Nguyen, Thu Q;
Le, Chuong T;
Nguyen, Nguyet;
Vu, Loc;
Le, Minh H;
Ho, Dung T;
Rigatelli, Gianluca;
Talarico, Ernest;
Zuin, Marco;
Pham, Hung N;
Cao, Thinh;
Nguyen Thuong, Nghia T
Description:
<jats:p>
<jats:bold>Introduction:</jats:bold>
Many patients with dilated cardiomyopathy (DilCM) and patent coronary arteries came to emergency room with shortness of breath, chest discomfort, elevated troponin level. Many similar DilCM patients did not. Why?
</jats:p>
<jats:p>
<jats:bold>Hypothesis:</jats:bold>
In DilCM and patent coronary arteries, could the combination of coronary slow flow and ischemia is a predictor of recurrent heart failure (HF) and sudden cardiac death (SCD)?
</jats:p>
<jats:p>
<jats:bold>Methods:</jats:bold>
Patients with DilCM underwent coronary angiography and were enrolled if the coronary arteries were patent. In a new dynamic angiographic technique, contrast was injected until the index coronary artery was completely opacified. Then the manual injection stopped. At this moment, the blood in “white” color moved in, displacing the black contrast. The shape and movement of the blood flow could be clearly analyzed above a background of black contrast. The first study measurement was the arterial phase (AP) which was calculated by visual angiographic assessment and artificial intelligence program (Machine Learning algorithms). The AP was defined as the duration from the entry of blood until all the contrast was cleared from the distal index artery. The second study factor was the series of troponin levels. The patients were followed up for (1) recurrent HF hospitalization, (2) aborted ventricular tachycardia by defibrillator (ICD) and (3) SCD.
</jats:p>
<jats:p>
<jats:bold>Results:</jats:bold>
40 patients with DilCM were enrolled (ejection fraction (EF) averaged 34%) and followed up for 3 years. In 35 DilCM patients, the AP phase was extremely prolonged at 120 frames or 8 seconds compared with 1.56 seconds of historical controls. The results showed:
<jats:bold>Group A</jats:bold>
(5 patients): No prolonged AP, no Ischemia: so no HF admission, no death if on guideline-directed medical therapy (GDMT), 3 patients had EF recovered >50%.
<jats:bold>Group B</jats:bold>
(25 patients): Prolonged AP and No ischemia: rare hospitalization, ICD shock, no death if compliant with GDMT.
<jats:bold>Group C</jats:bold>
(10 patients) Prolonged AP and ischemia: recurrent HF, ICD shocks and 6 SCD
</jats:p>
<jats:p>
<jats:bold>Conclusions:</jats:bold>
In patients with DilCM, prolonged AP and recurrent ischemia were the markers of recurrent HF and SCD. The patients with only prolonged AP were at medium risk and stable if on GDMT. Patients with normal AP without ischemia were at low risk and the EF could recover to normal with GDMT.
</jats:p>