Background: Advancements in cancer treatments for children, adolescents, and young adults (CAYAs) over recent decades have significantly improved their prognosis. However, these advancements have also led to an increased risk of developing various cardiovascular diseases, such as arrhythmias. Atrial fibrillation (AF) the most common arrhythmia in the general population, becomes more prevalent with age (1). The risk of developing AF is elevated in patients with cancer compared to the general population (2). Nevertheless, symptomatic arrhythmias remain uncommon among long-term survivors of childhood cancer (3).

Purpose: The main objective of this study was to explore the rates and risk of arrhythmias in CAYAs with cancer compared to controls.

Method: The Rebuc study is a retrospective matched cohort study that encompasses all young cancer patients (<25 years) in Sweden from 1958 and 2021, with a total of 65,173 individuals matched with 312,935 controls. All individuals with an arrhythmia diagnosis were identified and compared for the following arrhythmias: AF and atrial flutter (ICD-10: I48), supraventricular tachycardia (I47.1), ventricular tachycardia (I47.2), ventricular fibrillation (I49.0), sick sinus syndrome (I49.5), second- and third-degree atrioventricular block (AV-block) (I44.1 and I44.2).

Results: A total of 12,415 individuals with arrhythmias were identified, 2,352 CAYAs (3.6%) and 10,063 controls (3.2%) (Odds Ratio (OR) 1.13 95% CI 1.08-1.18, p<0.0001).

CAYAs had a higher risk of ventricular fibrillation, (OR 1.66 95% CI 1.22-2.27, p= 0.001) and the risk of third-degree AV-block was also 66% higher (OR, 95% CI 1.32-2.07, p<0.0001) compared to controls. CAYAs had no elevated risk for AF but were 1 year younger when diagnosed (60 vs. 61 years, p= 0.03). No significant difference was found in risk for supraventricular and ventricular tachycardias, second-degree AV-block or sick sinus syndrome.

Conclusion: CAYAs have a higher risk for life-threatening arrhythmias such as ventricular fibrillation and third-degree AV-block.

The risk of AF and other supraventricular arrhythmias was similar, but CAYAs experienced AF at a younger age than controls.

Background: The advances in the management of cancer in children, adolescents, and young adults (CAYAs) over recent decades have greatly improved prognosis. However, the risk of long-term complications persists. (1,2) It is known that cancer treatment such as chemotherapy and radiotherapy as well as conventional cardiovascular risk factors increase the risk of ischemic heart disease (IHD). (3)

Purpose: The aim was to study IHD among CAYAs and investigate mortality and revascularization compared to controls.

Method: This study utilizes the Rebuc study, a retrospective matched cohort study that includes all young (<25 years) cancer patients in Sweden between 1958 and 2021, comprising a total of 65,173 CAYAs and 312,935 controls. From the Rebuc study population, 1,486 CAYAs and 6,258 controls with IHD (ICD-10: I20-I25) were identified and compared regarding all-cause mortality, cardiovascular mortality, and revascularization (percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)).

Results: The median age at index was 22 years (IQR 19–23), and at the end of the study 66 years (IQR 59–72). 801 CAYAs (54%) and 3,265 controls (52%) had myocardial infarction (ICD-10: I21)

The risk for all-cause mortality after diagnosis of IHD was 1.26-fold higher for CAYAs (Hazard ratio (HR) 95% CI 1.14-1.40, p<0.0001) and 1.20-fold higher for cardiovascular mortality (HR 95% CI 1.06-1.37, p<0.001) compared to controls. Revascularisation of any kind was registered among 47% of CAYAs and 48% of controls (p = 0.8). PCI was registered among 39% of CAYAs and 42% of controls (p = 0.045), while CABG was registered among 14% of CAYAs and 11% of controls (p = 0.001).

Conclusion: CAYAs with IHD had a higher risk of all-cause and cardiovascular mortality compared to controls. There was no difference regarding revascularization between the groups, however, CABG was more common among CAYAs while PCI was more common among controls.

Background: In recent decades, numerous cohorts have been established to investigate cardiovascular disease (CVD) and mortality among young cancer patients.(1,2) However, these cohorts rarely include young females with cervical cancer, a disease often treated surgically and associated with human papillomavirus (HPV) infection. HPV infections, which can be prevented through vaccination, has also been associated to an elevated risk of CVD. (3)

Purpose: The aim was to study CVD and mortality in young cervical cancer patients.

Method: Using the Rebuc study, which includes all young (<25 years) cancer patients in Sweden from 1958 to 2021. 30,507 individuals aged 15-24 years with cervical cancer (ICD-10 C53) were identified and compared to 152,276 matched controls with regard to CVD (ICD-10 I00–I99 and G45), all-cause mortality, and CV mortality.

Results: The median age at cervical cancer diagnosis was 23 years (IQR 22-24) and the median age at the study’s end was 41 years in both groups (IQR 29-59 vs. 29-60).

CVDs were identified in 5,460 cervical cancer patients (17.9%) and 24,113 controls (15.8%), (Odds ratio (OR) 1.16 95% CI 1.12-1.20 p<0.0001). The risk for ischemic heart disease was 42% higher in cervical cancer patients (OR 95%CI 1.31-1.54, p<0.0001), 54% higher for myocardial infarction (OR 95%CI 1.38-1.72 p<0.0001), 35% higher for heart failure (OR 95% CI1.38-1.72 p<0.0001), and 38% higher risk for cerebrovascular diseases (OR 95%CI 1.26-1.50 p<0.0001) compared to controls.

The risk for all-cause mortality was 64% higher, and the risk for cardiovascular death was 49% higher among females with cervical cancer compared to controls. (Hazard Ratio 95%CI 1.52-1.76; and 1.29-1.70 p <0.0001). Myocardial infarction, sudden cardiac death, and heart failure was the most common cardiovascular causes of death in these young females.

Conclusion: Young females with cervical cancer are at a higher risk of severe CVD and mortality compared to controls. These findings highlight the importance of cardiovascular risk evaluation in cancer patients and contribute to the growing evidence supporting a broad implementation of HPV vaccination programs to reduce the burden of HPV-related diseases.

Background High-sensitive Troponin-T (hsTnT) is often increased in acute illness and may be of prognostic importance in patients with atrial fibrillation (AF). The aim of this study was to analyse the characteristics and data of patients attending the emergency department (ED) with AF to determine whether age-adjusted hsTnT levels can predict mortality. Methods This retrospective, single centre, register-based cohort study included all patients &gt;= 18 years attending the emergency department during 2018 and 2020 with a primary diagnosis at the ED of AF and sampled for hsTnT. Symptoms, comorbidities, lab results, and characteristics were registered. Patients were divided into groups based on hsTnT level (&lt; 15, 15-50, and &gt; 50 ng/L). Primary outcomes: 30-day and 1-year mortality. Results A total of 625 patients were included (median age 72, and 45% female). All-cause mortality was 2% at 30 days and 8% at 1-year. The hazard ratio (HR) for 30-day mortality was 4.17 (95% confidence interval (CI) 0.49-35.79, p = 0.192) for hsTnT 15-50 ng/L and 9.64 (95% CI 0.98-95.30, p = 0.053) for hsTnT &gt; 50 ng/L compared to hsTnT &lt; 15 ng/L when adjusted for age. The HR for 1-year mortality was 4.82 (95% CI 1.81-12.82, p = 0.002) for hsTnT 15-50 ng/L and 9.70 (95% CI 3.27-28.74, p &lt; 0.001) for hsTnT &gt; 50 ng/L compared to hsTnT &lt; 15 ng/L when adjusted for age. Conclusions Elevated hsTnT levels increase the risk for 30-day and 1-year mortality independently of age. Both mild and major elevation of hsTnT levels is associated with increased risk for 1-year mortality regardless of age.

In cardio-oncology, a range of clinical dilemmas can be identified where high-quality evidence for management is still lacking. The aim of this project was to study clinical practices and expert approaches to several clinical cardio-oncological dilemmas regarding prediction, prevention and treatment of cardiovascular disease in adult cancer patients.

Heart failure (HF) patients diagnosed with breast cancer (BC) may have a higher risk of death, and different HFpresentation and treatment than patients without BC.

Methods and results:A total of 14 998 women with incident HF (iHF) or prevalent HF (pHF) enrolled in the Swedish HF Registrywithin and after 1 month since HF diagnosis, respectively, between 2008 and 2013. Patients were linked withthe National Patient-, Cancer-, and Cause-of-Death Registry. Two hundred and ninety-four iHF and 338 pHFpatients with BC were age-matched to 1470 iHF and 1690 pHF patients without BC. Comorbidity and treatmentcharacteristics were compared using the v2 tests for categories. Cox proportional hazard models assessedthe hazard ratio (HR) and 95% confidence intervals (95% CIs) of all-cause and cardiovascular mortality amongHF patients with and without BC. In the pHF group, BC patients had less often myocardial infarction (21.6% vs.28.6%, P < 0.01) and received less often aspirin (47.6% vs. 55.1%, P = 0.01), coronary revascularization (11.8% vs.16.2%, P < 0.01), or device therapy (0.9% vs. 3.0%, P = 0.03). After median follow-up of 2 years, risk of all-causemortality (iHF: HR = 1.04, 95% CI = 0.83–1.29 and pHF: HR = 0.94, 95% CI = 0.79–1.12), cardiovascular mortality(iHF: HR = 0.94, 95% CI = 0.71–1.24 and pHF: HR = 0.89, 95% CI = 0.71–1.10), and HF mortality (iHF: HR = 0.80,95% CI = 0.34–1.90 and pHF: HR = 0.75, 95% CI = 0.43–1.29) were similar for patients with and without BC inthe iHF and pHF groups.

Conclusion: Risk of all-cause and cardiovascular mortality in HF patients did not differ by BC status. Differences in pre-existingmyocardial infarction and HF treatment among pHF patients with and without BC may suggest differences in pathogenesis of HF.  

Aims Patients with advanced heart failure (AdHF) who are ineligible for heart transplantation (HTx) can become candidates for treatment with a left ventricular assist device (LVAD) in some countries, but not others. This reflects the lack of a systematic analysis of the usefulness of LVAD systems in this context, and of their benefits, limitations and cost-effectiveness. The SWEdish evaluation of left Ventricular Assist Device (SweVAD) study is a Phase IV, prospective, 1:1 randomized, non-blinded, multicentre trial that will examine the impact of assignment to mechanical circulatory support with guideline-directed LVAD destination therapy (GD-LVAD-DT) using the HeartMate 3 (HM3) continuous flow pump vs. guideline-directed medical therapy (GDMT) on survival in a population of AdHF patients ineligible for HTx. Methods A total of 80 patients will be recruited to SweVAD at the seven university hospitals in Sweden. The study population will comprise patients with AdHF (New York Heart Association class IIIB-IV, INTERMACS profile 2-6) who display signs of poor prognosis despite GDMT and who are not considered eligible for HTx. Participants will be followed for 2 years or until death occurs. Other endpoints will be determined by blinded adjudication. Patients who remain on study-assigned interventions beyond 2 years will be asked to continue follow-up for outcomes and adverse events for up to 5 years. Conclusion The SweVAD study will compare survival, medium-term benefits, costs and potential hazards between GD-LVAD-DT and GDMT and will provide a valuable reference point to guide destination therapy strategies for patients with AdHF ineligible for HTx.

INTRODUCTION: The HeartMate 3^™ has shown lower rates of adverse events compared to previous devices due to the design and absence of mechanical bearings. For previous devices, sound analysis emerged as a way to assess pump function. The aims of this study were to determine if sound analysis can be applied to the HeartMate 3 in vivo and in vitro and to evaluate an electronic stethoscope.

METHOD: Sound recordings were performed with microphones and clinical accessible electronic stethoscope. The recordings were studied in both the time and the frequency domains. Recordings from four patients were performed to determine if in vivo and in vitro recordings are comparable.

RESULTS: The results show that it is possible to detect sound from HeartMate 3 and the sound spectrum is clear. Pump frequency and frequency of the pulsatile mode are easily determined. Frequency spectra from in vitro and in vivo recordings have the same pattern, and the major proportion (96.7%) of signal power is located at the pump speed frequency ±40 Hz. The recordings from the patients show low inter-individual differences except from location of peaks originating from pump speed and harmonics. Electronic stethoscopes could be used for sound recordings, but the dedicated equipment showed a clearer sound spectrum.

DISCUSSION: The results show that acoustic analysis can also be performed with the HeartMate 3 and that in vivo and in vitro sound spectrum is similar. The frequency spectra are different from previous devices, and methods for assessing pump function or thrombosis need further evaluation.

Progressive multifocal leukoencephalopathy (PML), caused by reactivation of JC-virus is a relatively rare complication seen in patients with compromised immune system. There are no evidence-based treatment available and prognosis is poor. Withdrawal of immunosuppressant can result in further neurological deterioration and for patients with solid organ transplantations, fatal graft rejection. We report a 52-year-old women that presented with seizures within 1 month after heart transplantation. Initial diagnosis was vascular disease. After clinical deterioration 10 months after transplantation, further examinations led to the diagnosis. Minimizing tacrolimus, to a concentration of 2 ng/ml, and extensive physical therapy has improved the physical capacity of the patient. The patient has now been clinically stable for 4 years and extended survival for 5 years. This case adds to the limited adult cases of PML within the population of heart transplant recipients and the need for increased awareness to minimize diagnosis delay.

Mechanical circulatory support technology is continually improving. However, adverse complications do occur with devastating consequences, for example, pump thrombosis that may develop in several parts of the pump system. The aim of this study was to design an experimental clot/thrombosis model to register and analyze acoustic signals from the left ventricular assist device (LVAD) HeartMate II (HMII) (Thoratec Corporation, Inc., Pleasanton, CA, USA) and detect changes in sound signals correlating to clots in the inflow, outflow, and pump housing. Using modern telecom techniques, it was possible to register and analyze the HMII pump-specific acoustic fingerprint in an experimental model of LVAD support using a mock loop. Increase in pump speed significantly (P less than 0.005) changed the acoustic fingerprint at certain frequency (0-23 000 Hz) intervals (regions: R1-3 and peaks: P1,3-4). When the ball valves connected to the tubing were narrowed sequentially by similar to 50% of the inner diameter (to mimic clot in the out-and inflow tubing), the frequency spectrum changed significantly (P less than 0.005) in P1 and P2 and R1 when the outflow tubing was narrowed. This change was not seen to the same extent when the lumen of the ball valve connected to the inflow tube was narrowed by similar to 50%. More significant (P less than 0.005) acoustic changes were detected in P1 and P2 and R1 and R3, with the largest dB figs. in the lower frequency ranges in R1 and P2, when artificial clots and blood clots passed through the pump system. At higher frequencies, a significant change in dB figs. in R3 and P4 was detected when clots passed through the pump system. Acoustic monitoring of pump sounds may become a valuable tool in LVAD surveillance.