Average Left Ventricular Ejection Fraction Research Articles

Left bundle branch area pacing in the setting of cardiac amyloidosis: a case series

Abstract Background Cardiac amyloidosis (CA) is a highly prevalent cause of congestive heart failure. It often requires cardiac pacing due atrioventricular conduction (AV) system disorders, often with cardiac resynchronization (CRT) to prevent development/deterioration of left ventricular (LV) dysfunction. Left bundle branch area pacing (LBBAP) is an emerging alternative to CRT, offering a strict physiological LV activation and very limited use of iodinated contrast. The feasibility of LBBAP in CA is considered limited due to the presence of septal pseudohypertrophy which theoretically limits left-sided conduction system engagement. Purpose To evaluate the feasibility and effectiveness of LBBAP in cardiac amyloidosis. Methods Consecutive patients with CA (both light-chain -AL- or wild-type transtiretin -wtATTr) with a pacing indication for AV conduction disorders were enrolled. Patients underwent baseline echocardiographic examination. LBBAP was achieved by means of stylet-driven leads advanced transeptally (right ventricle (RV) to LV) via dedicated delivery systems, with continuous monitoring of 12-lead electrocardiographic morphology and impedance until a typical QRS morphology in V1 was obtained (usually rSr’ or Sr’). Standard measures for left bundle (LB) capture were used (stimulus to peak R in V6 – S-RV6, V6-V1 interpeak interval, presence of transition in these measures during threshold testing, presence of fascicular signal during spontaneous QRS). Results Between January 2022 and June 2023, among 63 patients undergoing LBBAP, 7 patients (11%) had CA, 2 AL (28%) and 5 (72%) wtATTR. Patients were prevalently old (78±7 y) males (6, 85%); LV mean septal thickness was 17±2 mm (min 16, max 20 mm) and mean LV ejection fraction (LVEF) was 45±6%. Indications were PR prolongation in 3, bradycardic atrial fibrillation and LB branch block (LBBB) in 2, primary LBBB in 1 and chronic RV pacing in 1. Baseline QRS duration was 145±47 ms (QRS<120 ms: 97±15 ms, QRS>120 ms: 182±13 ms). LBBAP success was 100%. Fascicular electrograms were observed in ¾ of patients without LBBB; S-RV6 interval was 74 ±11 ms (³70 ms in 3), RV6-RV1 interpeak interval was 47±9 ms (³ 30 ms in 6 patients). DQRS in baseline broad QRS was -52 ms and +32 ms in narrow. No complications were observed. Over a short follow up of 6 months, an increase in average LVEF was observed (LVEF at 6 months: 51±3%, p<0.05). Conclusions In patients with CA, LBBAP is easily achievable with stylet-driven systems with frequent selective engagement of conduction system. QRS narrowing in baseline broad QRS is significant while QRS broadening in baseline narrow QRS is limited. Early results regarding follow-up of surrogate endpoint such as LVEF are promising.

Computed tomography as a predictive tool for ventricular tachycardia

Abstract Background Sudden cardiac death is the main cause of mortality worldwide. It is often linked with ventricular tachycardia (VT). To prevent VT, high-risk patients are typically equipped with intracardiac defibrillators (ICDs). Currently, left ventricular ejection fraction (LVEF) is the standard for determining a patient's risk level. Objective We hypothesized that the use of imaging software analyzing cardiac CT-scans could enhance the detection of patients with an increased risk of VT. Methods and Results In this study, 132 patients with ischemic cardiomyopathy (average age 66.2±11.4 years, with an average LVEF of 36.6±10.3%), all with implanted cardiac devices, underwent CT scans. We developed software to automatically analyze the heart's wall tissue thickness, cardiac fat, and calcification levels (Figure.1.A). A viable cardiac wall thickness of less than 3mm typically indicates a ventricular wall predominantly composed of scar tissue with minimal viable tissue remaining. In contrast, a viable wall thickness of less than 5mm includes regions with more viable tissue and therfore represents the total scar. Over an average follow-up of 6.6 years (79.8 ± 30.5 months) via live telemedicine, we observed that patients with VT had a significant difference in wall thickness ratio (3mm/5mm; no VT 0.31±0.18 vs, VT 0.44±0.18, p<0.01)) and higher calcification (0.10±0.38ml vs. 0.47±1.57ml, p=0.039). The amount of cardiac fat did not significantly differ between the no VT and VT groups (1.14±1.38ml vs.1.21±1.01ml, p=0.771). Logistic regression determined a critical cutoff for wall thickness at a ratio of 0.3 for 3mm and 5mm thickness. Kaplan Meyer analysis contrasted this wall thickness ratio of 0.3 (figure.1.B) against the established LVEF threshold of 35% (figure.1.C) for predicting VT-free survival, revealing a notable disparity favoring wall thickness ratio (p<0.01) over LVEF (p=0.77). Conclusions The findings suggest that a higher proportion of regions of thin viable tissue or dense scar in the total scar is a more effective predictor of VT-free survival than LVEF, potentially improving the identification of patients at risk for sudden cardiac death.Figure. 1

WEARABLE CARDIOVERTER DEFIBRILLATOR IN PATIENT WITH TRANSIENT RISK OF SUDDEN CARDIAC DEATH : SINGLE CENTRE EXPERIENCE

Abstract Background Cardiovascular disease is still the first cause of death, with sudden cardiac death ( SCD) as a first presentation in 25% of cases, related to coronary artery disease. Implantable cardioverter defibrillator (ICD) demontrated a reduction of SCD in high risk patients with good functional status. However the risk of SCD should be transient, so the use of a wearable cardioverter defibrillator (WCD) is considered in current guidelines and in clinical practice. The purpose of this study was to investigate the safety and the adherence to WCD in a real world population; moreover we reviewed the rate of ICD implantation after WCD use. Methods We considered consecutively 96 patients discharged from Piacenza cardiology department for potentially transient high risk of SCD, weared a WCD from August 2017 to June 2023. The patients were discharged in high risk mode of SCD with WCD protection and followed through remote monitoring or outpatient.A clinical and echocardiographic evalutation was performed at baseline and repeated at the end of the WCD use period. Results Out of 95 patients , with average age 66,0 ±11,1 years old and baseline average left ventricular ejection fraction (LVEF) 28,6±7,5, 81,2% were males, 72,9% suffered from arterial hypertension, 26% diabetes mellitus, 13,5% peripheral vascular disease, 14,6% chronic renal failure, 4,1% previous stroke.66% of these patients weared WCD for severe systolic disfunction in ischemic cardiac disease after recent myocardial infarction, after percutaneous coronary intervention or coronary artery bypass graft, 4% after removal of an infected ICD, 6% whilst awaiting completion of diagnostic tests (chanalopathies/right arrhythmogenic ventricular cardiomyopathy), 24% newly diagnosed cardiomyopathy. The average wearing time of WCD was 22,7±3,1 hours daily. We received these events: 1 sustained ventricular tachicardia, 2 non sustained ventricular tachicardia, 5 atrial fibrillation with 3 T wave oversensing. One patient recedived inappropriate shock. One death was detected due to severe heart failure. After 56,0±37,8 days of average wearing time 52% of patients were scheduled for ICD implantation. Conclusions In our experience we may consider that WCD use is effective, safe and with a good adherence in all patients. The WCD allows saving resources preventing inapprpriate ICD implantation in patient with transient SCD risk.

Risk Factors for Delayed Atrioventricular Block after Aortic Valve Surgery: A Retrospective Study

Objective: This study aimed to examine the potential factors that contribute to the occurrence of delayed high-grade atrioventricular block (DHAVB) following transcatheter aortic valve replacement (TAVR). Methods: A retrospective analysis was conducted on the clinical data of 115 patients who underwent TAVR at Jiaozhou Central Hospital of Qingdao Hospital between January 2018, and June 2023. A follow-up period of 30 days post-operation was observed for all patients. The patients were categorized into two groups on the basis of the occurrence of DHAVB: DHAVB group (n = 35) and control group (n = 80). The general clinical data preoperative and postoperative heart disease characteristics of the groups were compared. The risk factors associated with DHAVB after TAVR were analyzed. Results: The mean systolic blood pressure (SBP) level of the DHAVB group significantly increased compared with that of the control group, whereas the heart rate (HR) level significantly reduced (p < 0.05). The average preoperative left ventricular ejection fraction (LVEF) was significantly lower in the DHAVB group than in the control group (p < 0.05). The control group exhibited a significantly higher prevalence of preoperative QRS wave broadening, severe calcification of the aortic valve, and right bundle branch block than the control group (p < 0.05). Spearman's correlation and logistic regression analyses identified increased SBP, decreased HR, diminished LVEF, the presence of preoperative and postoperative right bundle branch block, and thickened interventricular septum were as risk factors for DHAVB in patients undergoing TAVR (p < 0.05). Conclusion: Close surveillance of blood pressure, heart rate, and cardiac function is recommended for individuals undergoing TAVR. Pre-operative and post-operative electrocardiography and echocardiography are valuable tools in identifying potential risk factors for DHAVB, offering a solid foundation for effective patient prognostic management.

Transcatheter Aortic Valve Replacement Improves Quality of Life and Ventricular Function With Low-Flow/Low-Gradient Aortic Stenosis

BackgroundD2 aortic stenosis (AS) is the highest risk AS subtype with worse operative and mortality outcomes. This study aimed to investigate the quality of life (QoL) and left ventricular ejection fraction (LVEF) in patients with classic (D2 subtype) low-flow/low-gradient AS who underwent transcatheter aortic valve replacement (TAVR). MethodsIn total, 634 patients with severe AS underwent TAVR at our institution from 2014 to 2020, of whom 76 met criteria for classic D2 AS with reduced LVEF. Echocardiographic and clinical outcomes including mortality, stroke, pacemaker placement (PPM), and readmission at baseline were compared with those at 30 days and 1 year. QoL data were extracted from the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). ResultsThe average baseline Society of Thoracic Surgeons risk score for patients with D2 AS was 7.66 ± 6.76. Patients with D2 AS reported improved QoL post-TAVR. The average baseline KCCQ-12 score was 39.5 ± 20, with improvement to 68.9 ± 20.6 at 30 days (P < .01) and 74.9 ± 17.5 at 1 year (P < .01). Mortality was 0% at 30 days and 18.4% at 1 year. The average baseline LVEF was 36.1 ± 9.4. Left ventricular function improved to 43.5 ± 12.9 (P < .001) at 30 days and 46.3 ± 11.2 (P = .03) at 1 year. Complications post-TAVR at 30 days included stroke (1.3%) and PPM (11.8%). Patients with D2 AS exhibited higher baseline conduction defects including atrial fibrillation and higher postoperative PPM than those with other subtypes. ConclusionsPatients with D2 AS had significantly improved LVEF and QoL following TAVR at 30 days and 1 year. Postoperative rates of new PPM were higher than other subtypes, while stroke, dialysis, and mortality were lower than expected, supporting the benefit of TAVR in this high-risk group.

The register of patients suffering from heart failure in St. Petersburg ”persona-chf”: interim results

The prevalence of heart failure is becoming global, and the number of patients is steadily increasing annually. The assessment of the number of patients suffering from heart failure in St. Petersburg, as well as their characteristics, is one of the most important tasks for which the Saint Petersburg Register of Patients Suffering from Chronic Heart Failure, PERSONA-CHF, was developed and initiated. Data analysis was performed for the period from February to May 2023. A total of 158 people comprised the sample. The Hospital for War Veterans (Saint Petersburg) participated in the pilot project. The average age of the patients was 81. 14 ± 11. 39 years. The number of points based on the assessment scale of the patient’s clinical condition was 6. 4 ± 2. 6. The average left ventricular ejection fraction was 59. 1% ± 11. 1%. Moreover, 70% of patients had a left ventricular ejection fraction of 50%, and in 23. 4% of patients, it was even higher than 65%. Comorbid pathologies prevailed: hypertension, 93%; coronary heart disease, 79. 1%; chronic kidney disease, 46. 8%; atrial fibrillation, 32. 9%; anemia, 31. 6%; and diabetes mellitus, 24. 7%. A high percentage of the presence of comorbid pathology leads to the need to modify therapy and use modern groups of drugs. Beta-blockers were most often prescribed (86. 7%), diuretics (75. 3%), mineralocorticoid receptor antagonists (62%), angiotensin-converting enzyme inhibitors (61. 4%), and angiotensin II receptor blockers (39. 2%). The appointment of modern groups of drugs, such as angiotensin receptor-non-lysine inhibitor and sodium-glucose cotransporter inhibitor 2-type, was 5. 1%. Attention was drawn to the lack of continuity in the provision of medical care and low compliance of patients with modern quadrotherapy, given its high cost for the patient. In general, the efficiency of the PERSONA-CHF registry platform is quite good and allows us to more accurately understand the epidemiological aspects of heart failure, the solution of which will make it possible to improve the quality of medical care, identify the need for necessary medicines, and reduce mortality and mortality rates. However, a much larger set of patients and a different profile of medical institutions are required for the most complete understanding of the problem of heart failure in Saint Petersburg, since the Hospital for War Veterans reflects only a small sample of patients, mainly of senile age, and several comorbid pathologies. In addition, this register requires further improvement to increase the number of connected medical organizations, expand the number of analyzed parameters, automate the process, and possibly connect artificial intelligence for data analysis.

Catheter ablation of typical atrial flutter improves cardiac chamber size and function.

Cavo-tricuspid isthmus (CTI) dependent atrial flutter (AFL) is one of the most common atrial arrhythmias involving the right atrium (RA) for which radiofrequency catheter ablation has been widely used as a therapy of choice. However, there is limited data on the effect of this intervention on cardiac size and function. A retrospective study was conducted on 468 patients who underwent ablation for CTI dependent typical AFL at a single institution between 2010 and 2019. After excluding patients with congenital or rheumatic heart disease, heart transplant recipients, or those without baseline echocardiogram, a total of 130 patients were included in the analysis. Echocardiographic data were analyzed at baseline before ablation, and at early follow-up within 1-year postablation. Follow-up echocardiographic data was available for 55 patients. Of the 55 patients with CTI-AFL, the mean age was 64.2 ± 14.8 years old with 14.5% (n = 8) female. The average left ventricular ejection fraction (LVEF) significantly improved on follow-up echo (40.2 ± 16.9 to 50.4 ± 14.9%, p < .0001), of which 50% of patients had an improvement in LVEF of at least 10%. There was a significant reduction in left atrial volume index (82.74 ± 28.5 to 72.96 ± 28 mL/m2 , p = .008) and RA volume index (70.62 ± 25.6 to 64.15 ± 31 mL/m2 , p = .046), and a significant improvement in left atrial reservoir strain (13.04 ± 6.8 to 19.10 ± 7.7, p < .0001). Patients who underwent CTI dependent AFL ablation showed an improvement in cardiac size and function at follow-up evaluation. While long-term results are still unknown, these findings indicate that restoration of sinus rhythm in patients with typical AFL is associated with improvement in atrial size and left ventricular function.

Time for a new destination: foregoing surgical sympathectomy after successful stellate ganglion block in patients with refractory ventricular tachycardia

Abstract Background Electrical storm (ES) is defined as &amp;gt;3 episodes of sustained ventricular arrhythmias in 24 hours and is associated with increased mortality. ES portends a poor prognosis with limited effective treatment options. Stellate ganglion block (STGB) can be used in patients with ES for temporary control of VT. When STGB is successful, patients can be referred for surgical sympathectomy for longer term management. We postulated that STGB can be used as a bridge to other treatments for refractory VT. Purpose To evaluate the efficacy of STGB as a bridge to interventions other than surgical sympathectomy in patients with refractory VT. Additionally, we assessed STGB as an adjunctive therapy to medical optimization when the cause for ES is temporary (e.g., QT prolonging medications, acute ischemia) foregoing the need for long term interventions. Methods This is a single center retrospective study. We enrolled 12 consecutive patients admitted from July 2018 to September 2022 for ES that received a STGB. The primary clinical outcome was cessation of VT for 24 hours beginning 1 hour after STGB was performed. Secondary clinical outcome of the study was freedom from VT until discharge after STGB. Primary safety outcomes were major procedural complications or death within 48 hours after STGB. Results Sixty-seven percent of the patients were male, with a mean age of 58 years and an average left ventricular ejection fraction of 32%. Two-thirds of the patients had ischemic VT of which half were status post CABG and the other half were status post PCI. In the first 24 hours after STGB, 91% of patients were without recurrent VT. Fifty percent of patients did not have recurrent VT from 24 hours after SGB was performed until discharge. Three patients were referred for catheter ablation. No patients received surgical sympathectomy. There were no major complications or deaths within 48 hours of STGB. Conclusion STGB is a safe and effective procedure that can be utilized as a bridge to VT interventions other than surgical sympathectomy. For patients with ES, STGB is also effective at temporarily suppressing VT allowing time for medical optimization and the withdrawal of provoking agents which perpetuate ES. Further research is necessary to determine optimal timing and patient selection for STGB when used as a bridge for alternative VT therapies.Clinical Impact of VT after STGBElectrical Storm Characteristics

Efficacy of bariatric intervention as a bridge to cardiac transplant.

Many patients with heart failure (HF) are denied cardiac transplants due to inability to meet transplantation body mass index (BMI) criteria. Bariatric intervention, including surgery, medication, and weight loss guidance, may help patients lose weight and become eligible for transplantation. We aim to contribute to the literature on the safety and efficacy of bariatric intervention on patients with obesity and HF who are awaiting cardiac transplantation. University hospital, United States. This was a mixed retrospective/prospective study. Eighteen patients with HF and BMI >35 kg/m2 were reviewed. Patients were divided based on whether they underwent bariatric surgery or nonsurgical intervention and whether they had left ventricular assist devices or other advanced heart failure therapy including inotropic support, guideline-directed medical therapy, and/or temporary mechanical circulatory support. Weight, BMI, and left ventricular ejection fraction (LVEF) were collected before bariatric intervention and 6 months after bariatric intervention. No patients were lost to follow-up. Bariatric surgery led to statistically significant decreases in weight and BMI when compared with nonsurgical patients. At 6 months after intervention, surgical patients lost an average of 18.6 kg and decreased their BMI by 6.4 kg/m2 while nonsurgical patients lost 1.9 kg and decreased their BMI by .7 kg/m2. After bariatric intervention, surgical patients had an average LVEF increase of 5.9% and nonsurgical patients had an average decrease of 5.9%, although these findings lacked statistical significance. Our study suggests that bariatric intervention among patients with HF and obesity is a safe and effective method of weight and BMI reduction.

Relationships between Heart Chamber Morphology or Function and Respiratory Parameters in Patients with HFrEF and Various Types of Sleep-Disordered Breathing.

Sleep-disordered breathing (SDB), i.e., central sleep apnea (CSA) and obstructive sleep apnea (OSA), affects the prognosis of patients with heart failure with reduced ejection fraction (HFrEF). The study assessed the relationships between heart chamber size or function and respiratory parameters in patients with HFrEF and various types of SDB. The 84 participants were patients aged 68.3 ± 8.4 years (80% men) with an average left ventricular ejection fraction (LVEF) of 25.5 ± 6.85% who qualified for cardioverter-defibrillator implantation with or without cardiac resynchronization therapy. SDB, defined by an apnea-hypopnea index (AHI) ≥ five events/hour, was diagnosed in 76 patients (90.5%); SDB was severe in 31 (36.9%), moderate in 26 (31.0%), and mild in 19 (22.6%). CSA was the most common type of SDB (64 patients, 76.2%). A direct proportional relationship existed only in the CSA group between LVEF or stroke volume (SV) and AHI (p = 0.02 and p = 0.07), and between LVEF or SV and the percentage of total sleep time spent with hemoglobin oxygen saturation < 90% (p = 0.06 and p = 0.07). In contrast, the OSA group was the only group in which right ventricle size showed a positive relationship with AHI (for basal linear dimension [RVD1] p = 0.06), mean duration of the respiratory event (for RVD1 p = 0.03, for proximal outflow diameter [RVOT proximal] p = 0.009), and maximum duration of respiratory event (for RVD1 p = 0.049, for RVOT proximal p = 0.006). We concluded that in HFrEF patients, SDB severity is related to LV systolic function and SV only in CSA, whereas RV size correlates primarily with apnea/hypopnea episode duration in OSA.

Cardiac Muscle Injury and Echocardiographic Plus Electrocardiographic Findings in Patients With 2019 Novel Coronavirus (COVID-19): A Retrospective Cohort Study

BackgroundMyocardial injury has been described in coronavirus-2019 (COVID-19). Few studies have reported cardiovascular imaging data with transthoracic echocardiography (TTE) and electrocardiography (ECG) findings in COVID-19 patients, and their correlation with mortality. MethodsWe conducted a retrospective cohort study that included COVID-19 patients from March 2020 through February 2021 who had TTE and ECG during hospital admission. Myocardial injury was defined by an elevated high-sensitivity troponin T level > 20 ng/L. Bivariate analysis was used to compare patients with myocardial injury and those without. Multivariate logistic regression analysis was performed to identify the variables associated with mortality. ResultsA total of 438 patients were included. The mean age was 62.1 ± 14.9 years, and 58.9% were male. A total of 149 patients died, with a mortality rate of 34%. A total of 260 patients (59.4%) had myocardial injury. The average left ventricular ejection fraction was 59.8% ± 11.2%, with 30 patients (6.8%) having an ejection fraction of < 40%. Patients with myocardial injury had higher mortality than those without (P < 0.05, χ2 test). A multiple regression analysis model indicated that age, race and/or ethnicity, the development of acute respiratory distress syndrome, shock, the need for vasopressors, mechanical ventilation, and hemodialysis were the variables significantly associated with mortality. ConclusionCOVID-19 patients with myocardial injury had higher mortality than those without. Age, race and/or ethnicity, acute respiratory distress syndrome, shock, the need for vasopressors, mechanical ventilation, and hemodialysis were the clinical variables associated with mortality. The TEE and ECG variables studied were not significantly associated with mortality.

Association of leadless pacing with ventricular and valvular function.

Traditional transvenous pacemakers are associated with worsening tricuspid valve function due to lead-related leaflet impingement, as well as ventricular dysfunction related to electromechanical dyssynchrony from chronic right ventricular (RV) pacing. The association of leadless pacing with ventricular and valvular function has not been well established. We aimed to assess the association of leadless pacemaker placement with changes in valvular regurgitation and ventricular function. Echocardiographic features before and after leadless pacemaker implant were analyzed in consecutive patients who received a leadless pacemaker with pre- and postprocedure echocardiography at Duke University Hospital between November 2014 and November 2019. Valvular regurgitation was graded ordinally from 0 (none) to 3 (severe). Among 54 patients, the mean age was mean age was 70.1 ± 14.3 years, 24 (44%) were women, and the most frequent primary pacing indication was complete heart block in 24 (44%). The median RV pacing burden was 45.4 (interquartile range [IQR] 3.5-97.0). On echocardiogram performed 8.9 months (IQR 4.5-14.5) after implant, there was no change in the average severity of tricuspid regurgitation (mean change 0.07 ± 1.15, p = .64) from pre-procedure echocardiogram. We observed a decrease in the average left ventricular ejection fraction (LVEF) (52.3 ± 9.3 to 47.9 ± 12.1, p = .0019) and tricuspid annular plane systolic excursion (TAPSE) (1.8 ± 0.6 to 1.6 ± 0.4, p = .0437). Thirteen patients (24%) had absolute drop in LVEF of ≥10%. We did not observe short term worsening valvular function in patients with leadless pacemakers. However, consistent with the pathophysiologic impact of RV pacing, leadless pacing was associated with a reduction in biventricular function.

Inferior vena cava diameter and risk of acute decompensated heart failure rehospitalisations

ObjectivesInferior vena cava (IVC) diameter may be a surrogate for volume status in acute decompensated heart failure (ADHF). The utility of IVC diameter measurement is under studied. The aim of...

The Comparison of Clinical Characteristics of Acute Decompensated Heart Failure Patients between JCARE-CARD Japan and dr. Kariadi Hospital Registry

Background: _Heart failure (HF) is a major public health problem due to the high prevalence, poor prognosis, and huge costs contributed by frequent hospital admissions and prolonged care. Clinical characteristics of patients with HF might differ among different regions and races and low socioeconomic status was associated with increased incidence of heart failure. Indonesia dan Japan are both Asian countries with different race and socioeconomic status. No previous study has examined the difference of clinical characteristics between Indonesia dan Japanese HF patients.Objective: To investigate HF patients demographic and clinical characteristics in Indonesia and compare with Japanese registryMethods: In this retrospective observational study, patients presenting with acute decompensated heart failure (ADHF) at dr. Kariadi Hospital (RSDK) were consecutively recruited during 2014-2015 hospitalization period. Baseline data including demographic, clinical characteristics, laboratory data on admission, medication use before hospitalization, and length of stay during hospitalization were collected from medical record using the form of the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). The descriptive analysis was performed to compare those HF characteristics.Results: A total of 246 ADHF patients in RSDK registry were included with average age of responden was 56.4 years-old and 57.3% were male. Etiology was predominantly ischemic heart disease (IHD) in 60.6%, average left ventricular ejection fraction 40.1% and length of hospital stay was 8.8 days. Compared to Japanese registry, the characteristics of clinical status and laboratory data on admission were almost similar between studies except for higher prevalence of ischemic heart disease, renal dysfunction and dyslipidemia but lower prior stroke in RSDK study. The average length of stay at hospital was longer in Japanese registry (8.8 days vs. 33.9 days).Conclusion: Ischaemic heart disease and renal dysfunction more prevalent in RSDK registry, but prior stroke and length of stay at hospital higher in Japanese registry of hospitalized ADHF patients.

Performance of the 2-minute stand up test and the association with peak oxygen consumption in cardiopathes

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Fundo de amparo a pesquisa do estado da Bahia. Introduction The two minute sit-to-stand test (STST) quantifies the getting up and sitting down movement in 2 minutes. Its use has not yet been well established in patients with heart disease. Purpose To develop and validate an equation to estimate peak oxygen uptake (peak VO2) based on performance in STST. Methods Cross-sectional study with patients over 18 years with heart disease referred to a cardiovascular rehabilitation program, who were submitted to STST and Cardiopulmonary Exercise Test. Pearson's correlation analysis, multiple linear regression and ROC curve were used for statistical analysis. The association between determined and estimated peak VO2 was evaluated by the Bland-Altman analysis. p &amp;lt;0.05 was adopted as statistically significant. Results 158 participants were included, with a mean age of 60±14 years, 75.3% male, 75.6% with coronary artery disease and 24.4% with chronic heart failure. The average left ventricular ejection fraction was 57±16 %. The tests resulted in mean peak VO2 of 19.2±6.4 mL.kg-1.min-1, and mean STST performance was 32±12 repetitions. There was a correlation between peak VO2 and STST (r=0.65; R2=0.57; p&amp;lt;0.001). Performance on STST ≥ 32 was the best cutoff point to predict peak VO2 ≥ 20mL-kg-1min-1 (AUC = 0.80; 95%CI 0.74-0.87; p&amp;lt;0.001), sensitivity 71% (CI95 %; 0.58-0.81) and specificity 81% (95% CI; 0.69-0.89). The resulting equation was: peak VO2 = 21.4 - (0.16*age) + (0.26* STST) - (3.1*sex); male=0, female=1. The peak VO2 estimated by the equation (19.3±5.1 mL-kg-1min-1) was not different (p&amp;gt;0.05) from the peak VO2 determined (19.71±6.8 mL-kg-1min-1). Conclusions STST was moderately correlated with peak VO2. The validated equation accurately estimated the peak VO2. The STST is useful in the assessment of patients with heart disease, helping to estimate peak VO2 and identify patients with peak peak VO2peak ≥ 20mL-kg-1min-1.

Left bundle branch area pacing in mildly reduced heart failure: A systematic literature review and meta-analysis.

Cardiac resynchronization therapy (CRT) strategy for heart failure with mildly reduced ejection fraction (HFmrEF) is controversial. Left bundle branch area pacing (LBBAP) is an emerging pacing modality and an alternative option to CRT. This analysis aimed to perform a systematic review of the literature and meta-analysis on the impact of the LBBAP strategy in HFmrEF, with left ventricular ejection fraction (LVEF) between 35% and 50%.PubMed, Embase, and Cochrane Library were searched for full-text articles on LBBAP from inception to July 17, 2022. The outcomes of interest were QRS duration and LVEF at baseline and follow-up in mid-range heart failure. Data were extracted and summarized. A random-effect model incorporating the potential heterogeneity was used to synthesize the results.Out of 1065 articles, 8 met the inclusion criteria for 211 mid-range heart failure patients with an implant LBBAP across the 16 centers. The average implant success rate with lumenless pacing lead use was 91.3%, and 19 complications were reported among all 211 enrolled patients. During the average follow-up of 9.1 months, the average LVEF was 39.8% at baseline and 50.5% at follow-up (MD: 10.90%, 95% CI: 6.56-15.23,p < .01). Average QRS duration was 152.6 msat baseline and 119.3 msat follow-up (MD: -34.51 ms, 95% CI: -60.00 to -9.02, p < .01).LBBAP could significantly reduce QRS duration and improve systolic function in a patient with LVEF between 35% and 50%. Application of LBBAP as a CRT strategy for HFmrEF may be a viable option.

CE-452779-4 DOFETILIDE FOR TREATMENT OF PREMATURE VENTRICULAR COMPLEXES AND VENTRICULAR TACHYCARDIA

Dofetilide is a class III antiarrhythmic agent approved for the treatment of atrial fibrillation and atrial flutter. Given the efficacy of other class III agents, it is used off-label for the treatment of premature ventricular complexes (PVCs) and ventricular tachycardia (VT), however its ability to suppress recurrent ventricular arrhythmia has not been well examined. In this study, we examined the use of dofetilide for the treatment of PVCs and VT. This was a single-center retrospective cohort study of patients admitted to the University of Michigan between 2015 and 2020 for dofetilide initiation. In patients for whom dofetilide was initiated for PVCs, VT or both, additional descriptive information was collected until date of last clinical follow-up. Successful PVC suppression was defined as 80% reduction in PVC burden compared to pre-dofetilide initiation. A total of 50 patients were admitted for dofetilide initiation for treatment of PVCs (18), VT (27) or both (5). Average left-ventricular ejection fraction was 32.0 +/- 17.2% with 32.7% of patients having ischemic cardiomyopathy and 67.3% of patients having non ischemic cardiomyopathy. A majority (90%) of patients in the cohort had an internal cardioverter defibrillator (ICD). Prior to dofetilide initiation, 40% of patients had undergone ventricular ablations. Previous antiarrhythmic treatments included amiodarone (54.0%), sotalol (28%) and mexilitine (36.0%). Dofetilide was stopped in 8 patients (16%) during index hospitalization for QT prolongation with 3 patients experiencing Torsades de Pointes. In an additional 24 patients, dofetilide was discontinued at a median of 3.3 months for inefficacy (50%) or QT prolongation (50%). Median follow was 36.3 months (range of 3.9 months to 84.8 months). Dofetilide dosing was 500 (35.7%), 250 (45.2%), 125 (19.1%) micrograms. In patients treated for PVCs, PVC frequency decreased from an average of 21.7% to 9.0% (p<.001) with 35.7% of patients meeting criteria for successful suppression. In patients with VT, 80.0% had recurrent ICD shocks after dofetilide (average 1.6 shocks/year of follow-up). 7 patients died over the follow-up period. Treatment with dofetilide was associated with a decrease in PVCs, however clinically significant suppression occurred in a minority of patients. Dofetilide failed to suppress ICD shocks in a majority of patients and was associated with significant toxicities requiring discontinuation in 40% of patients during the follow-up period.

Natriuresis as a Way to Assess the Effectiveness of Diuretic Therapy for Acute Decompensated Heart Failure: Data from a Pilot Study

Aim. To analyze the clinical significance of the sodium level in a single urine test obtained 2 hours after the first dose of a loop diuretic was administered in patients with acute decompensation of chronic heart failure (ADHF).Material and methods. An observational study was conducted on the basis of a rapid-care hospital. The concentration of sodium in urine analysis obtained 2 hours after intravenous administration of the first dose of loop diuretic and natriuresis for the first day of hospitalization were evaluated. The development of resistance to diuretics was taken as the primary endpoint (the need to increase the daily dose of furosemide by more than 2 times compared to the initial one or the addition of another class of diuretic drugs).Results. 25 patients with ADHF were included. The average age of patients was 69.0±14.8 years, 16 (64%) of them were men. The average left ventricular ejection fraction was 49.0±13.5%. The level of the N‐terminal fragment of the brain natriuretic peptide (NT-proBNP) was 3416 (2128; 5781) pg/ml. The average sodium concentration in the urine analysis obtained 2 hours after the start of treatment was 100.6±41.0 mmol / l. The concentration of sodium in urine for the first day was 102.2±39.0 mmol/l. 2 hours after the start of treatment, the sodium concentration in a single urine test was less than 50 mmol/l in 5 (20%) patients. Upon further observation, oligoanuria (defined as diuresis of less than 400 ml within 24 hours) developed in 2 of them. Oligoanuria was not detected among patients whose sodium concentration was more than 50 mmol/l. The need for escalation (any increase in the dose of a loop diuretic and/or the addition of another class of diuretic drugs) arose in 7 (28%) patients; at the same time, we diagnosed the development of resistance to diuretics in 5 (20%) of them. Resistance to diuretics was more common among patients with a sodium concentration in a single urine test obtained 2 hours after the start of furosemide administration, less than 50 mmol/l (p=0.037); when dividing the recruited patient population into subgroups with a sodium concentration in a single urine test ≥50 mmol/l and &lt;50 mmol/l there was no significant difference in the need for any escalation of diuretic therapy [3 (60%) vs 4 (20%), p=0.07].Conclusion. Resistance to diuretics is more common among patients with a sodium concentration in a single urine test obtained 2 hours after the first dose of furosemide, less than 50 mmol / l. Evaluation of natriuresis allows to identify insufficient effectiveness of diuretic therapy already at the beginning of treatment.

Unmasking left ventricular systolic dysfunction in masked hypertension: looking at myocardial strain. A review and meta-analysis.

A growing body of evidence supports the view that masked hypertension (MH) (i.e. normal office and elevated out-of-office BP) is a blood pressure (BP) phenotype associated with increased risk of subclinical organ damage, cardiovascular disease and death as compared to true normotension. Whether left ventricular (LV) systolic function is impaired in individuals with MH is still a poorly defined topic. Therefore, we aimed to provide a new piece of information on LV systolic dysfunction in the untreated MH setting, focusing on speckle tracking echocardiography (STE) studies investigating LV global longitudinal strain (GLS), a more sensitive index of systolic function than conventional LV ejection fraction (LVEF). A computerized search was performed using Pub-Med, OVID, EMBASE and Cochrane library databases from inception until June 30, 2022. Full articles reporting data on LV GLS in MH, as assessed by ambulatory BP monitoring (ABPM), and normotensive controls were considered suitable for the purposes of review and meta-analysis. A total of 329 untreated individuals with MH and 376 normotensive controls were included in six studies. While pooled average LVEF was not different between groups [64.5 ± 1.5 and 64.5 ± 1.3%, respectively, standard means difference (SMD): -0.002 ± 0.08, confidence interval (CI): 0.15/-0.15, P = 0.98), LV GLS was worse in MH patients than in normotensive counterparts (-18.5 ± 0.70 vs. -20.0 ± 0.34%, SMD: 0.68 ± 0.28, CI: 0.12/1.24, P < 0.01). Our findings suggest that early changes in LV systolic function not detectable by conventional echocardiography in the MH setting can be unmasked by STE and that its implementation of STE in current practice may improve the detection of subclinical organ damage of adverse prognostic significance.

Validation of the Meta-Analysis Global Group in Chronic Heart Failure risk score for the prediction of 1-year mortality in a Chinese cohort.

The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score was developed in 2013 to predict survival in heart failure (HF) patients. However, it has yet to be validated in a Chinese population. Our study aimed to investigate the ability of the score to predict 1-year mortality in a Chinese population. Consecutive patients with HF were retrospectively selected from the inpatient electronic medical records of the cardiology department in a regional hospital in China. A total integer score was calculated for each enrolled patient based on the value of each risk factor in the MAGGIC scoring system. Each enrolled patient was followed for at least 1 year. The observational endpoint of this study was all-cause mortality. The predictive ability of the MAGGIC score was assessed by comparing observed and predicted mortality within 1 year. Between January 2018 and December 2020, a total of 635 patients were included in the study: 57 (9.0%) of whom died within 1 year after discharge. The average age of all patients was 74.6 ± 11.2 years, 264 of them (41.6%) were male, and the average left ventricular ejection fraction was 50.7% ± 13.2%. The area under the receiver operating characteristic curve was 0.840 (95% confidence interval: 0.779, 0.901), which indicated a fair discriminatory ability of the score. The Hosmer-Lemeshow test result ( χ2 = 12.902, degree of freedom = 8, P = 0.115) indicated that the MAGGIC score had good calibration. The decision curve analysis showed that the MAGGIC score yielded a good clinical net benefit and net reduction in interventions. This validation of the MAGGIC score showed that it has a good ability to predict 1-year mortality in Chinese patients with HF after discharge. Due to regional and inter-hospital differences, external validation studies need to be further confirmed in other centers.