A novel score to predict left ventricular recovery in peripartum cardiomyopathy derived from the ESC EORP Peripartum Cardiomyopathy Registry.

BACKGROUND AND AIMS: There are no established clinical tools to predict left ventricular (LV) recovery in women with peripartum cardiomyopathy (PPCM). Using data from women enrolled in the ESC EORP PPCM Registry, the aim was to derive a prognostic model to predict LV recovery at 6 months and develop the 'ESC EORP PPCM Recovery Score'-a tool for clinicians to estimate the probability of LV recovery. METHODS: From 2012 to 2018, 752 women from 51 countries were enrolled. Eligibility included (i) a peripartum state, (ii) signs or symptoms of heart failure, (iii) LV ejection fraction (LVEF) ≤ 45%, and (iv) exclusion of alternative causes of heart failure. The model was derived using data from participants in the Registry and internally validated using bootstrap methods. The outcome was LV recovery (LVEF ≥50%) at six months. An integer score was created. RESULTS: Overall, 465 women had a 6-month echocardiogram. LV recovery occurred in 216 (46.5%). The final model included baseline LVEF, baseline LV end diastolic diameter, human development index (a summary measure of a country's social and economic development), duration of symptoms, QRS duration and pre-eclampsia. The model was well-calibrated and had good discriminatory ability (C-statistic 0.79, 95% confidence interval [CI] 0.74-0.83). The model was internally validated (optimism-corrected C-statistic 0.78, 95% CI 0.73-0.82). CONCLUSIONS: A model which accurately predicts LV recovery at 6 months in women with PPCM was derived. The corresponding ESC EORP PPCM Recovery Score can be easily applied in clinical practice to predict the probability of LV recovery for an individual in order to guide tailored counselling and treatment.

Peer Support for Type 2 Diabetes Management in Low- and Middle-Income Countries (LMICs): A Scoping Review.

Background: Although there is evidence of peer support in high-income countries, the use of peer support as an intervention for cardiometabolic disease management, including type 2 diabetes (T2DM), in low- and middle-income countries (LMICs), is unclear. Methods: A scoping review methodology was used to search the databases MEDLINE, Embase, Emcare, PsycINFO, LILACS, CDSR, and CENTRAL. Results: Twenty-eight studies were included in this scoping review. Of these, 67% were developed in Asia, 22% in Africa, and 11% in the Americas. The definition of peer support varied; however, peer support offered a social and emotional dimension to help individuals cope with negative emotions and barriers while promoting disease management. Conclusions: Findings from this scopingreview highlight a lack of consistency in defining peer support as a component of CMD management in LMICs. A clear definition of peer support and ongoing program evaluation is recommended for future research.

Cardiovascular drug interventions in the cardio-oncology clinic by a cardiology pharmacist: ICOP-Pharm study.

Background: Cardio-oncology is a rapidly growing field that requires a novel service design to deal with the increasing number of patients. It is reported that the volume of patients at the cardio-oncology clinic in the United Kingdom is 535 patients/5 years and in Canada is 779 patients/7 years. The pharmacist has a role in reducing the consultation time of physicians. Objective: To identify the role of a qualified cardiology pharmacist at the cardio-oncology clinic using a new paradigm based on complementary interventions with the cardiologist for the management of patients with cancer and cardiovascular risk factors and/or cardiovascular diseases (CVRF/CVD). Methods: A prospective observational study was conducted at the cardio-oncology clinic in the Medical City in Baghdad, Iraq between December 2020 and December 2021. Patients with CVRF/CVD were registered. The Iraqi Cardio-Oncology Program-Pharmacist (ICOP-Pharm) paradigm was designed to involve a qualified cardiology pharmacist for initial cardiovascular (CV) drug interventions. Results: Among 333 patients who attended our clinic over the 1-year interval, 200 (60%) CVRF/CVD cases were enrolled in the study, and of them 79 (40%) patients had CV drug interventions. A total of 196 interventions were done, including 147 (75%) cases performed by the cardiology pharmacist, and 92 (63%) of the latter were CV drug initiations. Among the total CVRF/CVD treated initially by the cardiology pharmacist, hypertension 32 (26%) and cancer therapy-related cardiac dysfunction 29 (24%) were the main types. Conclusion: The qualified cardiology pharmacist was responsible for three-quarters of the initial CV drug interventions at the cardio-oncology clinic in a complementary approach to the cardiologist. The role of the cardiology pharmacist in the ICOP-Pharm paradigm may be one of the reasons for the ability of the heart team to manage 3-fold of the patient volume when compared with those in the United Kingdom or Canada.

Global pattern of cardiovascular disease management in patients with cancer and impact of COVID-19 on drug selection: IRAQ-IC-OS survey-based study.

Background: Regional variations in cardiovascular disease (CVD) and CVD management are well known. However, there is limited information on geographical variations in the discipline of Cardio-Oncology, including both the nature of CVD in patients with cancer and its management. Furthermore, during the recent COVID-19 pandemic, CV care for patients was disrupted resulting in an unknown impact on cardio-oncology services. Objective: The aim of this study was to identify the regional variations in the management of CVD among patients with cancer and the impact of the COVID-19 pandemic on the selection of cardiovascular drugs in cardio-oncology. Methods: An online survey was conducted by the Iraq Chapter of the International Cardio-Oncology Society (IC-OS). The survey was shared with cardiologists and oncologists in all seven continents to identify whether regional variations exist in cardio-oncology daily practice. Results: From April to July 2021, 140 participants responded to the survey, including cardiologists (72.9%) and oncologists (27.1%). Most of the respondents were from the Middle East (26.4%), North America (25%), Latin America and the Caribbean (25%), and Europe (20.7%). Baseline CV risk assessment in patients with cancer using the HFA/IC-OS score was reported in 75.7% of respondents (78.4% cardiologists and 68.4% oncologists). Hypertension was the most common CVD treated by the survey respondents globally (52.1%) unlike in Europe where heart failure was the most prominent CVD (51.7%). The blood pressure cutoff value to initiate hypertension management is >140/90 mmHg globally (72.9%), but in North America (48.6%) it was >130/80 mmHg. In the Middle East, 43.2% of respondents do not use cardioprotective medication. During the COVID-19 pandemic, 10.7% of respondents changed their practice, such as switching from prescribing ACEI to ARB. Apixaban is the main anticoagulant used in patients with cancer (32.9%); however, in cancer patients with COVID-19 infection, the majority used enoxaparin (31.4%). Conclusion: More than three-quarters of cardiologists and oncologists responding to the survey are using HFA/IC-OS proformas. The survey showed regional variations in the management of CVD on different continents. The use of cardioprotective agents was limited in some regions including the Middle East. COVID-19 pandemic impacted daily practice on the selection and switching of cardiovascular drugs including ACEI/ARB and the choice of anticoagulants.

Peripartum cardiomyopathy in Iraq: initial registry-based data and 6 month outcomes.

AIMS: This study aimed to evaluate the clinical characteristics, echocardiographic measurements, medical treatment, pregnancy outcomes, and the 6 month follow-up outcomes among patients with peripartum cardiomyopathy (PPCM) in Iraq. METHODS AND RESULTS: Data were collected prospectively at cardio-maternal clinic in Baghdad Heart Center, using case report form for the EORP-PPCM registry from January 2015 to November 2020. Six month follow-up was performed either by attendance of patients or by phone contact. A total of 64 PPCM patients were enrolled with a mean age of 32.1 ± 6.8 years. Diagnosis in 35 (54.7%) women was made in the post-partum period. There was a history of previous PPCM in 9 (14%), coexisting hypertension with the current pregnancy in 30 (51.7%), cholelithiasis in 5 (7.8%), and cancer in 3 (4.7%). Baseline mean left ventricular ejection fraction (LVEF) was 34.7 ± 8.1%, significantly higher than that reported globally (31 ± 10%) (P-value 0.011), and 26 (40.6%) of our patients had LVEF of ≤34%. Baseline mean global longitudinal strain (GLS) for 26 (40.6%) patients was -9.4 ± 4.1%. Baseline mean left ventricular end-diastolic and end-systolic dimensions were 61.2 ± 8.5 and 50.6 ± 10.2 mm, respectively. At 6 month follow-up, 11 (36.7%) women recovered their LVEF, lower than global data (46%) but higher than that in the Middle East (25%) with P-value 0.241 and 0.919, respectively. The mean LVEF was 44.5 ± 11.9%, and the mean GLS for 15 (23.4%) of patients was -13.4 ± 5.3%, including 5 (33.3%) with the range of -18.6% to -17%. Bromocriptine was the least used drug in 4 (8.2%) vs. globally reported (15%) (P-value 0.188). Thrombo-embolic events and maternal death were reported in 2 (4.1%) and 3 (4.7%) cases, respectively, within 6 months. CONCLUSIONS: Around half of our PPCM patients were diagnosed at post-partum period with impaired initial LVEF and GLS, and one-third had early LVEF recovery at 6 month follow-up, higher than that in the Middle East but lower than the globally reported figure in the EORP-PPCM registry. Limited use of bromocriptine might explain the later finding. The co-morbid diseases in our setting were hypertension and cholelithiasis. Interestingly, the comparable ratios of neonatal and maternal mortalities in our study to that of the EORP-PPCM registry were found less than the Middle East figures. Bromocriptine needs to be considered in Middle East countries, including Iraq, which may be the key to improving LVEF recovery and perhaps reducing maternal mortality.

Perceptions of the Cardiologists and Oncologists: Initial Step for Establishing Cardio-Oncology Service.

Background: Over the last years, there was no established cardio-oncology service in Iraq and no firm data about the incidence of cardiovascular disease (CVD) among patients with cancer. As an initial step, we decided to conduct a national cardio-oncology online survey for cardiologists, oncologists, and their residents which would help us to understand the expected prevalence, problems, and readiness for collaboration between the two specialties. Objectives: For evaluating the current national practice in the cardiology and oncology specialty fields and to identify the hidden gaps associated with the development or worsening of CVD among patients with cancer. Methods: An online survey including 19-question for cardiologists/cardiology residents (CCRs) and 30-question for oncologists/oncology residents (OORs) about cardio-oncology service was sent to them including all Iraqi cities using Google document form during December 2020. Results: The total number of responses was 164, mainly 62.2% from CCRs while 37.8% from OORs. Hypertension was the main baseline risk factor (71%). A 77.5% of CCRs prescribe cardiovascular drugs vs. 35.5% by OORs. About 76.5% of CCRs and 79% of OORs are facing difficulties in the management of patients with cancer with established CVD. CVD was the leading cause of both hospitalization (30.7%) and mortality (48.4%). About 62.8% of CCRs and 64.5% of OORs have an interest to work in cardio-oncology service. Conclusion: Based on the perception of cardiologists and oncologists, CVD is the main cause of hospitalization and mortality among patients with cancer. High interest among CCRs and OORs to work in cardio-oncology service. Positive initiatives are available to take the action plan in this emerging field.

Heart disease in pregnancy-clinical pattern and prevalence: initial data from the first cardio-maternal unit in Iraq.

OBJECTIVES: The purpose of this study to determine the clinical pattern and prevalence of heart disease in pregnancy at the first established cardio-maternal unit in Iraq over the last 4 years; since January 2015 till May 2019. Data are presented as number and percentage. RESULTS: A total of 252 pregnant women presented to cardio-maternal unit included in this study. According to the collected data, among the main diagnosis of heart disease during pregnancy was valvular heart disease 34.1%, followed by congenital heart disease 30.5%, cardiomyopathy 29.8%, pulmonary hypertension 4%, and ischemic heart disease 1.6%. Among subtypes of the main heart diseases in pregnant women, the most clinical pattern was: the prosthetic heart valve (26.7%) in valvular heart disease, both atrial septal defect and ventricular septal defect (35%) in congenital heart disease, and peripartum cardiomyopathy (76%) among cardiomyopathies.

Clopidogrel non-responsiveness in patients undergoing percutaneous coronary intervention using the VerifyNow test: frequency and predictors.

OBJECTIVES: Stent thrombosis and death after percutaneous coronary intervention (PCI) can be caused by a phenomenon known as clopidogrel non-responsiveness which has been shown to occur in approximately 5%-44% of patients. We investigated the responsiveness of clopidogrel in an Iraqi series of cases. Our aim was to determine for the first time the frequency and predictors of clopidogrel non-responsiveness among Iraqi patients with ischaemic heart disease undergoing PCI. METHODS: The study was conducted at the Cardiac Catheterization Center, Baghdad Teaching Hospital, Medical City, from January to May 2014, and included patients who presented for PCI. A platelet aggregation test was performed for those patients using the VerifyNow system. RESULTS: A total of 115 patients (mean age: 58.3±10.1 years; male sex: 73.9%) were included in the study. 18.3% of the study population were clopidogrel non-responders, which was comparable with the results of a Chinese study (20.28%, P=0.796) but contrasted with other reports from Jordan, Brazil and Thailand. The major independent predictive factor for non-responsiveness in our report was diabetes mellitus (OR 5.96, 95% CI 2.23 to 13.71; P=0.001), followed by hypertension (OR 4.135, P=0.035), obesity (OR 3.44, P=0.037) and male sex (OR 3.039, P=0.045). Previous use of clopidogrel (OR 0.17, P=0.02) and younger age (OR 0.72, P=0.026) were identified as protective factors. CONCLUSIONS: In this study, 18.3% of patients were non-responders to clopidogrel and the major independent predictive factors for non-responsiveness were diabetes mellitus, hypertension, obesity and male sex.