Award-winning Posters from ISCP 2023 28th Annual Scientific Meeting
Award Winner
Assessment of Direct Oral Anticoagulant Use and Clinical Outcomes among Patients with Renal Impairment at Faculty of Medicine Siriraj Hospital, Mahidol University
1. Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand; Division of Nephrology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 3. Department of Pharmacy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Citation: European Cardiology Review 2024;19(Suppl 2):2. DOI: https://doi.org/10.15420/ecr.2024.19.PO1
Objectives: The primary objective of this study was to assess an optimal dose of direct oral anticoagulants (DOACs), complied with prescribing information using the Cockcroft and Gault (C-G) equation in patients with renal impairment. The secondary objective was to evaluate the consistency between the prescribed dose and the prescribing information. Clinical outcomes, including recurrence of stroke, venous thromboembolism (VTE), and bleeding, were also evaluated.
Materials and methods: This retrospective study included patients with renal impairment who received their first DOACs between 1 January 2019, and 31 December 2020, at Siriraj Hospital. The included patients were monitored for 1 year.
Results: There were 148 patients in the study with 899 prescriptions for
DOACs. Edoxaban was the most frequently prescribed appropriate dose (87.70%), followed by rivaroxaban (84.51%), apixaban (53.72%) and dabigatran (40.00%). When dabigatran and apixaban dosages were adjusted using the CKD-EPI equation, the appropriate dosing frequency increased. Bleeding was reported in one patient receiving dabigatran, one patient receiving apixaban, and two patients receiving rivaroxaban. Recurrent stroke was identified twice in one patient who received rivaroxaban.
Conclusion: This study shows the consistency of dosage adjustment of DOACs according to the prescribing information in patients with renal impairment. Clinical impacts of DOACs dosing in practice are further needed to support appropriate dose adjustment in the Thai population.
Award Winner
The Impact on Efficacy and Safety of Patients Receiving Oral Anticoagulant Medication (Warfarin) during the COVID-19 Pandemic
1. Department of Pharmacy, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand; 2. Department of Pharmacy, Chum Phuang Hospital, Nakhon Ratchasima, Thailand; 3. Department of Pharmacy, Buriram Hospital, Buriram, Thailand; 4. Department of Cardiology, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand; 5. Department of Pharmacy, Prapokklao Hospital, Chanthaburi, Thailand; 6. Department of Pharmacy, Khonburi Hospital, Nakhon Ratchasima, Thailand
Citation: European Cardiology Review 2024;19(Suppl 2):3. DOI: https://doi.org/10.15420/ecr.2024.19.PO2
In April 2020, the government announced a lockdown during the COVID-19 pandemic. Most patients with chronic diseases had their appointment postponed. However, individuals who were taking warfarin, due to uncertainty about the efficacy and safety of the drug, were an exception. This study was conducted to measure the effects of such circumstances.
Objectives: To compare the time in therapeutic range (TTR) and the incidence of severe bleeding before and during the COVID-19 pandemic.
Materials and methods: An observational study was conducted in patients receiving warfarin pre-epidemic period (October 2019 to March 2020) at the 9th Health Area Network Hospital, had at least 2 INR (International Normalized Ratio), and received a consistent warfarin dosage. Subsequently, follow-up INR levels and incidents of severe bleeding during the COVID-19 period (April to August 2020).
Results: There were 1,175 eligible patients with total 7,504 follow-up times
in this study. A significantly decreased in TTR during the pandemic was observed (70.00 ± 29.22% and 59.03 ± 35.22%; p< 0.001). The number of major bleeding events was significantly increased (0/100 person-years and 1.08/100 person-years; p<0.001). It was observed that INR >4.5 increased from 60 times (1.37%) to 88 times (2.66%). Additionally, the number of warfarin dose adjustments significantly increased (0 time and 492 times). Meanwhile, the interval between appointments decreased (36.20 ± 8.48 days and 31.99 ± 9.95 days).
Conclusion: The efficacy of warfarin use has decreased compared to before the outbreak and more serious bleeding complications were identified. The follow-up period was more frequent than usual. This could be out-of-range INR values, necessitating more frequent warfarin adjustment appointments. However, further studies should be conducted on factors which influence TTR, such as gender, age range, and concomitant medications. This will help in considering the possibility of postponing appointments with drug efficacy.
Award Winner
Actual Condition of Transthyretin Amyloid Cardiac Amyloidosis:
Single Centre Experience
Shunsuke Kiuchi, Shinji Hisatake, Yoshiki Murakami and Takanori Ikeda
Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
Citation: European Cardiology Review 2024;19(Suppl 2):4. DOI: https://doi.org/10.15420/ecr.2024.19.PO3
Objectives: Transthyretin amyloid cardiomyopathy (ATTR-CA) was a rare disease; however, since the approval of tafamidis meglumine, ATTR-CA has been reported in many institutions in Japan. It is effective to start administration of tafamidis meglumine early, and early diagnosis and treatment of ATTR-CA are required. Pyrophosphate scintigraphy (Tc-PYP) is effective for the diagnosis of ATTR-CA. We examined the characteristics of Tc-PYP positive patients at our institution.
Materials and methods: A total of 76 patients who underwent Tc-PYP from February 2020 to December 2022 were investigated. We divided them into Tc-PYP positive and Tc-PYP negative groups, and compared between groups. Evaluated factors were age, gender, medical history, blood examination, chest X-ray, 12-lead ECG and echocardiography.
Results: Nine of the 76 patients were Tc-PYP positive (11.8%), and eight patients were diagnosed with ATTR-CA by myocardial or skin (fat) biopsy. The other positive patient died from a cerebral haemorrhage before biopsy. Cerebral haemorrhage is an amyloid-related disease, and Tc-PYP
positive patients were considered ATTR-CA patients. In blood examinations, troponin I levels were significantly higher in the positive group (0.945 in positive group versus 0.077 in the negative group, p<0.001). ECG showed few patients with low voltage in either group (one patient in each group, no difference), and left ventricular hypertrophy was observed more frequently in the negative group (11% in the positive group versus 46% in the negative group, p=0.046). In addition, in the positive group, the left ventricular posterior wall thickness was significantly thickened (15.5 mm in the positive group versus 12.5 mm in the negative group, p=0.003). In contrast, there was no difference in septal wall thickness (16.1 mm in the positive group vs 13.7 mm in the negative group, p=0.084).
Conclusion: ATTR-CA is not uncommon, and Tc-PYP should be performed in cases of heart failure with left ventricular hypertrophy of unknown cause. Tc-PYP may be particularly useful for troponin I-positive patients who have left ventricular hypertrophy (particularly of the posterior wall), however do not show hypertensive changes on ECG.
Award Winner
The Impact of Renin–Angiotensin System Inhibitor Use on Clinical Outcomes by GRACE Score in ST-elevation MI Patients Undergoing Successful Percutaneous Coronary Intervention with Drug-eluting Stents
Byoung Geol Choi,1 Seung-Woon Rha,1 Se Yeon Choi,1 Jinah Cha,1 Sujin Hyun,1 Woo Jin Ahn,2 Soohyung Park,1 Cheol Ung Choi,1 Myung Ho Jeong,3 and the KAMIR Investigators
1. Cardiology, Korea University Guro Hospital, Seoul, South Korea; 2. Department of Medicine, Tongyeong Detention Center, Korea Correctional Service, Ministry of Justice, Tongyeong, South Korea; 3. Cardiology, Chonnam National University Hospital, Gwangju, South Korea
Citation: European Cardiology Review 2024;19(Suppl 2):5. DOI: https://doi.org/10.15420/ecr.2024.19.PO4
Objectives: In patients with ST-elevation MI (STEMI), optimal medical treatment (OMT), such as β-blockers, statins and renin–angiotensin system (RAS) inhibitors, is emphasised to prevent recurrent cardiovascular events. The purpose of study was to evaluate the long-term clinical outcomes of RAS inhibitors by assessing the 6-month risk of death in each individual STEMI survivor.
Materials and methods: In total, 13,104 patients were enrolled in the Korean AMI registry, and 5,261 patients with STEMI had undergone clinical follow-ups. The 6-month mortality risk assessment, the GRACE score, was calculated, and the cut-off for the low-risk death group was 100 points or less. There were 2,387 patients in the GRACE ≤100 group and 2,874 patients in the GRACE >100 group. To adjust for confounding variables, propensity score matching (PSM) analysis was performed according to the
uses of RAS inhibitors in each group.
Results: Compared to the GRACE >100 groups, the GRACE <100 groups had a significantly lower mortality rate (p<0.001) of 0.4% versus 2.7% at 6 months, 0.6% versus. 4.1% at 1 year, and 1.2% versus 9.1% at 3 years after PSM analysis. In the GRACE <100 group, the use of RAS inhibitors did not make a difference in all clinical outcomes up to 3 years. In the GRACE >100 groups, the use of RAS inhibitors reduced cardiac death up to 3 years: 6 months (1.3% versus 3.8%, p<0.001), 1 year (2.0% versus 4.8%, p<0.001), 3 years (4.9% versus 8.3%, p<0.001).
Conclusion: Our results suggest that recommendations, such as the use of the GRACE score, are needed for clinicians to rule out OMT in clinical practice.
The
Effects of
Co-injecting
Award Winner
Human iPSC-Derived Cardiomyocytes/ Pre-epicardial Cells into Cryoinjured Rat Hearts
Fatin Fazrina Roslan,1 Yuexin Yu,1,2,3 Nurul Ain Nasim Mohd Yusof,4 Nor Azlina Khalil,1 Zhikun Guo,2,3 Jer Ping Ooi1 and Jun Jie Tan1
1. USM-ALPS Laboratory for Heart Research, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Malaysia;
2. Henan Key Laboratory of Cardiac Remodeling and Transplantation, Zhengzhou Seventh People’s Hospital, Henan, China
3. Henan Key Laboratory of Medical Tissue Regeneration, Xinxiang Medical University, Henan, China
4. Institute for Medical Research, National Institute of Health Malaysia, Selangor, Malaysia
Citation: European Cardiology Review 2024;19(Suppl 2):6. DOI: https://doi.org/10.15420/ecr.2024.19.PO5
Objectives: Previously, pre-epicardial cells derived from human-induced pluripotent stem cells successfully recapitulated important developmental effects, including the induction of cardiomyocyte proliferation and compaction in vitro. In this study, we tested the use of pre-epicardial cells (PECs) in cardiomyocyte (CM) therapy for cryoinjured rat hearts.
Materials and methods: Adult male Sprague Dawley rats (250–300g) were administered cyclosporin 3 days prior to surgery. All rats were intubated and underwent thoracotomy under general anaesthesia. Hearts were cryoinjured using a liquid nitrogen-cooled vanadium cryoprobe twice, with 30 seconds for each application. After 10 minutes, CMs (1×106) were injected perpendicularly into the affected ventricular area, towards the infarct border region, both with and without PECs (1×106). Shamoperated and untreated groups (PBS-treated) served as controls. Cardiac haemodynamics were measured using the Millar Pressure Volume System
after 4 weeks. Differences between groups were determined using ANOVA and considered significant when p<0.05.
Results: The preliminary results showed that cryoinjury reduced the left ventricular ejection fraction to 48.2 ± 4.6% (n=5), compared to 77.7 ± 4.8% in the sham group (n=4, p=0.0065). CM and CM/PEC treatment improved the LVEF to 57.85 ± 5.8% and 57.5 ± 4.1% (n=6), respectively, but the difference was not significant compared to the untreated group after 4 weeks. Resting end-systolic elastance (Ees), which measures load-independent cardiac contractility, was improved in the CM-treated group (0.8 ± 0.4 mmHg/ml versus 0.3 ± 0.1 mmHg/ml in the untreated group, p=0.01). No significant difference was observed between the CM and CM/PEC groups.
Conclusion: Further in-depth assessments are required to examine the effects of pre-epicardial cells in cardiomyocyte therapy in vivo.
