Pacific Clinics

Background/introductionSince the development of heart failure in PLN-associated cardiomyopathy is highly variable, accurate risk prediction in phospholamban (PLN) p.(Arg14del)-positive individuals is essential to identify patients who may benefit from and rely on future (gene) therapies. Vectorcardiographic data may improve heart failure predictions as it holds information on ventricular depolarization and repolarization patterns which are likely altered in this genetic variant due to fibrosis and fibrofatty replacement.PurposeTo assess the prognostic value of vectorcardiograic data using repeated measurements for predicting heart failure in PLN p.(Arg14del)-positive individuals.Methods/ResultsData were collected of 417 PLN p.(Arg14del)-positive individuals (mean age 44.3 ± 16 years, 45.6% male) with no history of heart failure. During a median follow-up of 6 years (Interquartile range 3.1-10.7 years) after first cardiological investigation, 61 (14.6%) carriers experienced a heart failure composite endpoint, consisting of heart failure hospitalization, left ventricular assist device implantation, heart transplantation and heart failure related death. Vectorcardiographic data was derived from 12-lead ECG and four vector parameters over time were included in a multivariable Cox regression model: spatial QRS amplitude, spatial T wave amplitude, QRS-T angle, and vector gradient. After backward selection two parameters remained significantly associated with heart failure events: spatial T wave amplitude (p-value = 0.002) and QRS-T angle (p-value < 0.001). These variables were then used in a joint model with repeated vector measurements to provide individualized risk predictions (Figure 1). The model yielded a C-statistic of 0.86 (95% confidence interval [CI], 0.85 – 0.87) after 10-fold cross validation in the training set and 0.86 (95% CI, 0.83-0.89) in the test set.ConclusionVectorcardiographic data over time holds important prognostic information that can predict heart failure in phospholamban p.(Arg14del)-positive individuals. These results may identify individuals at highest risk for heart failure.Figure 1.Example individual trajectory

BackgroundThe LoDoCo2 (Low‐Dose Colchicine 2) trial showed that colchicine reduced the risk for cardiovascular events in patients with chronic coronary syndrome. Current guidelines recommend colchicine use in selected high‐risk patients. The aim of this secondary analysis was to explore the relative and absolute benefits of colchicine according to baseline risk.MethodsThe LoDoCo2 trial randomized 5522 patients to colchicine 0.5 mg or placebo. The primary end point was a composite of cardiovascular death, spontaneous myocardial infarction, ischemic stroke, or ischemia‐driven coronary revascularization. First, a LoDoCo2 risk score was developed by Cox regression to identify high‐risk features for the primary end point. Second, the Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention was applied to explore robustness of findings.ResultsIn the LoDoCo2 risk score, high‐risk features were age ≥75, diabetes, and current smoker. In high‐risk (≥1 high‐risk feature), compared with low‐risk (0 high‐risk features) patients, colchicine was associated with consistent relative (high risk: hazard ratio [HR], 0.72 [95% CI, 0.56–0.94] versus low risk: HR, 0.67 [95% CI, 0.52–0.88]; P for interaction=0.73) and absolute benefits (high risk: HR, −1.33 [95% CI, −2.38 to −0.27] versus low risk: HR, −0.93 [95% CI −1.57 to −0.30] events per 100 person‐years). Using the Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention, consistent relative and absolute benefits were found in high‐, intermediate‐, and low‐risk patients.ConclusionsIn patients with chronic coronary syndrome, the relative and absolute benefits of colchicine were consistent in those at high, intermediate, and low risk for cardiovascular events. These findings support the use of colchicine across the spectrum of baseline risk.RegistrationURL: https://www.anzctr.org.au; Unique identifier: 12614000093684.

Abstract Background / Introduction The optimal vascular access site for percutaneous coronary interventions (PCI) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) remains uncertain. While observational data favor trans-radial access (TRA) due to lower complication rates and mortality, trans-femoral (TFA) PCI offers advantages such as shorter access and procedure times, along with quicker escalation to mechanical circulatory support (MCS). Purpose In this study, we aimed to investigate factors associated with a transfemoral approach and compare mortality rates between TRA and TFA in AMI-CS patients undergoing PCI. Methods Data from a nationwide registry of AMI-CS patients undergoing PCI (2017-2021) were analyzed. We compared patient demographics, procedural details, and outcomes between TRA and TFA groups. Logistic regression identified access site factors and radial-to-femoral cross-over predictors. Propensity score matched (PSM) analysis examined the impact of access site on mortality. Results Of 1562 patients, 45% underwent TRA PCI, with an increasing trend over time. TFA patients were more often female, had a history of coronary artery bypass grafting (CABG), lower blood pressure, higher resuscitation and intubation rates, and elevated lactate levels. After PSM, 30-day mortality was lower in TRA (33% vs. 46%, p &amp;lt;0.001). Predictors for cross-over included left coronary artery interventions, multivessel PCI, and MCS initiation. Conclusion Significant differences exist between TRA and TFA PCI in AMI-CS. TFA was more common in patients with worse hemodynamics and was associated with higher 30-day mortality compared to TRA. TRA should be the default access, given its feasibility and favorable outcomes in many patients.Baseline characteristicsPredictors for femoral access

Cardiovascular inflammation and vascular endothelial dysfunction are involved in chronic heart failure (CHF), and cellular adhesion molecules are considered to play a key role in these mechanisms. We evaluated temporal patterns of 12 blood biomarkers of cell adhesion in patients with CHF. In 263 ambulant patients, serial, tri-monthly blood samples were collected during a median follow-up of 2.2 (1.4–2.5) years. The primary endpoint (PE) was a composite of cardiovascular mortality, HF hospitalization, heart transplantation and implantation of a left ventricular assist device and was reached in 70 patients. We selected the baseline blood samples in all patients, the two samples closest to a PE, or, for event-free patients, the last sample available. In these 567 samples, associations between biomarkers and PE were investigated by joint modelling. The median age was 68 (59–76) years, with 72% men and 74% New York Heart Association class I–II. Repeatedly measured levels of Complement component C1q receptor (C1qR), Cadherin 5 (CDH5), Chitinase-3-like protein 1 (CHI3L1), Ephrin type-B receptor 4 (EPHB4), Intercellular adhesion molecule-2 (ICAM-2) and Junctional adhesion molecule A (JAM-A) were independently associated with the PE. Their rates of change also predicted clinical outcome. Level of CHI3L1 was numerically the strongest predictor with a hazard ratio (HR) (95% confidence interval) of 2.27 (1.66–3.16) per SD difference in level, followed by JAM-A (2.10, 1.42–3.23) and C1qR (1.90, 1.36–2.72), adjusted for clinical characteristics. In conclusion, temporal patterns of C1qR, CDH5, CHI3L1, EPHB4, ICAM2 and JAM-A are strongly and independently associated with clinical outcome in CHF patients.

Abstract: In the last years an alarming increase has taken place in the number of suicides in children and teenagers, being a daily reality in the panorama of the USA, especially in the case of Latino immigrants. In the current study, a survey about the perceived risk factors for suicide was established between risk population. The sample was composed of 593 children and adolescents aged between 11 and 18 years, most Latino ethnicity, belonging to "Latina Youth Program" (LYP), a program of suicide prevention in risk population, developed by Pacifics Clinics, an organization that operates in Los Angeles, California. They interviewed the participants about the factors they considered risk for suicidal behavior. Participants were randomly selected in 2003, 2005 and 2008. The factors most commonly identified risk were the regulation of emotions (96.57%), poor family communication, poor school performance, the influence of the peer group (89.67%, 82. 73% and 41.57% respectively). The found trend is towards an increase in the perception of risk factors detected in any case up to ten risk factors for suicide. The higher quantity of variables impede the precise determination of the (s) reason (s) that might end in this fatidical conclusion, being the most common a panorama in which converge multitude of variables, crucial to settling objectives in interventions. Attribution of risk factors for suicide in children and adolescents in the Latino immigrant community: a sample of Southern California Resumen: En los últimos años se ha producido un incremento alarmante en el número de suicidios en niños y adolescentes, siendo una realidad cotidiana en el panorama de los EEUU, especialmente en el caso de inmigrantes latinos. En el presente estudio, se estableció un sondeo en población de riesgo acerca de los factores de riesgo de suicidio percibidos. La muestra quedó conformada por 593 niños y adolescentes de edades comprendidas entre los 11 y los 18 años, la mayoría de etnia latina, pertenecientes a “Latina Youth Program” (LYP), un programa de prevención del suicidio en población de riesgo, desarrollado por Pacifics Clinics, una organización que desarrolla su actividad en Los Ángeles, California. Se entrevistó a los participantes acerca de los factores que ellos consideraban de riesgo para la conducta suicida. Los participantes fueron seleccionados aleatoriamente en los años 2003, 2005 y 2008. Los factores de riesgo más comúnmente señalados fueron la regulación de emociones (96.57%), la pobre comunicación familiar, bajo rendimiento escolar, la influencia del grupo de iguales (89.67%, 82. 73% y 41.57% respectivamente). La tendencia encontrada apunta hacia un aumento en la percepción de factores de riesgo, detectándose en cualquier caso hasta diez factores de riesgo de suicidio. La cantidad de variables puestas en juego complejizan la determinación precisa de la(s) causa(s) que podrían desembocar en este fatídico desenlace, siendo lo más común un panorama en el que confluyen multitud de variables, cruciales para asentar objetivos en las intervenciones.