Cardiology Center Research Articles

Experience of home monitoring of children with complex CHD during the COVID-19 pandemic: lessons learnt.

The COVID-19 pandemic presented unique challenges to global healthcare. Face-to-face outpatient care was dramatically reduced. This study implemented a remote consultation service via a mobile app (Pexip) to monitor patients with major CHD. Study design was quasi-experimental and prospective. Remote consultations were carried out at a tertiary paediatric cardiology centre in Northern Ireland. Children with major CHD aged 0-16years in Northern Ireland. The intervention was a Pexip-enabled remote consultation. Primary outcome measures included the number of attendances to hospital both initiated and avoided via remote consultation. Remote consultations were conducted by doctor and/or cardiac specialist nurse or by specialist nurse alone (52% vs. 48%). In the study, 32 patients enrolled; three were non-responders and a further two excluded. There were 201 remote consultations delivered (mean = 7.4). There were 12 admissions to hospital resulting from the remote consultation; the commonest indication was abnormal oxygen saturations (42%). There were 38 hospital attendances avoided, predominantly related to infant feeding and medication advice (both 42%). A significant number of unnecessary hospital attendances were avoided (n = 38). Remote consultation technology proved a user-friendly and valuable adjunct to the provision of ongoing specialist patient care in challenging circumstances. There was a reduction in parental anxiety, and both parents and clinicians found this initiative beneficial to patient care. There was prompt identification of unwell children on remote consultations.

Predictive strength of inflammatory scores for in-hospital mortality in infective endocarditis.

Inflammatory markers have been proposed as prognostic tools for predicting in-hospital mortality in infective endocarditis (IE). Nonetheless, it is unclear whether these markers provide additional prognostic value over established indicators. This study compared nine different inflammation scores to assess their effectiveness in enhancing the prediction of in-hospital mortality. Patients with IE diagnosed between 2017 and 2023 at two cardiology centers in Istanbul were included in this study. Pre-treatment inflammatory markers were obtained from the hospital electronic database system. In-hospital mortality prognostication was assessed using Cox proportional hazards models. Atotal of 122 patients who were diagnosed with IE were included in the analysis. Overall, 38patients died during the hospital stay. The patients were categorized into two groups based on their mortality status. The prognostic nutritional index (PNI), platelet-to-lymphocyte ratio (PLR), and modified Glasgow prognostic score (mGPS) were identified as statistically significant predictors of in-hospital mortality. Based on the results of Cox regression analysis, the PNI (hazard ratio [HR]: 0.921, 95%confidence interval [CI]: 0.853-0.994, p = 0.035) emerged as the only independent predictor of in-hospital mortality of IE patients. Nine inflammatory scores were evaluated in this study. The PNI, PLR, and mGPS were statistically significant predictors of in-hospital mortality in patients with IE. The PNI was identified as the optimal score.

Prenatal Diagnosis of Congenital Heart Disease in Liveborn Infants in the New England Region.

Prenatal diagnosis of congenital heart disease requiring early cardiac catheterization or surgical intervention enables optimal delivery planning for appropriate postnatal cardiovascular intervention and care. This allows for improved morbidity and mortality. Prior national data reported prenatal diagnosis rates of 32% for congenital heart disease requiring intervention in infants in the first 6months of life in the New England region. With improved technology, access to care and changes to the obstetrical ultrasound guidelines for mid trimester fetal study, it is expected that diagnostic rates should improve. The New England Congenital Cardiology Association (NECCA) conducted a quality improvement study to determine the rates of prenatal detection in the current era with the hypothesis that there has been improvement in detection rates in this region. Ten of fourteen medical centers delivering pediatric cardiology care in New England contributed prenatal diagnosis data for 286 infants born at the participating centers during a one year period. The overall prenatal detection rate was 68%. Detection rates ranged from 39 to 90%. When fetal echocardiogram was performed at a pediatric cardiology center, the detection rate was 95% with only 7 moderate (7/195; 3.6%) and 3 severe (3/195; 1.5%) diagnostic discrepancies. Prenatal diagnostic rate and accuracy are high among pediatric cardiology centers in the New England region, and much improved over historical data. To improve fetal detection of congenital heart disease further, future work is needed to better determine the etiology of missed prenatal diagnoses and efforts should be focused on increasing appropriate referrals to pediatric cardiology centers for fetal evaluation.

Incidence and Predictors of Clinical Outcomes in Real-Life Patients With Atrial Fibrillation Treated With Oral Factor Xa Inhibitors: The Follow-Up Results of the ANATOLIA-AF Study.

The main objective of this study is to determine the incidence and predictors of clinical outcomes in patients with AF treated with factor Xa inhibitors in a real-world setting. The present study was a multicentre and observational study that included patients with AF who were treated with factor Xa inhibitors. The primary outcome was the composite of ischemic stroke, TIA, systemic embolism, major bleeding, and all-cause mortality. A total of 1162 patients from 26 cardiology centers were included in this study, with a median age of 72 years. During the median 12-month follow-up period, the primary outcome occurred in 195 patients (16.8%). Treatment with rivaroxaban compared with apixaban and edoxaban showed a lower rate of ischemic stroke, TIA, and/or systemic embolism (2.2% vs. 4.7% vs. 6.5%, respectively, p = 0.014). The major bleeding rate was similar between all three factor Xa inhibitors. The all-cause mortality rate in the rivaroxaban group was lower compared with the apixaban and edoxaban groups (9.8% vs. 15.1% vs. 12.4%, respectively, p = 0.042). Overall, the frequency of primary outcome was 13.8%, 19.6%, and 20.6% for patients treated with rivaroxaban, apixaban, and edoxaban, respectively (p = 0.019). Older age, male sex, low body weight, high bleeding risk, heart failure, hypertension, liver failure, and treatment with apixaban 2.5 mg b.i.d. were independently associated with the development of primary outcome. The follow-up data from the ANATOLIA-AF study provides detailed data about the incidence and independent predictors of adverse clinical outcomes in patients with AF treated with factor Xa inhibitor treatment.

Prevalence of valvular heart disease in the echocardiography laboratory of the National Cardiology Center of Nouakchott-Mauritania

Prevalence of valvular heart disease in the echocardiography laboratory of the National Cardiology Center of Nouakchott-Mauritania

Endothelial dysfunction in patients exposed to cardiovascular risk factors

Introduction: Cardiovascular diseases are the leading cause of death globally. 90% of them derive from cardiovascular risk factors, the modification of which makes it possible to reverse their harmful consequences. Objective: Identify the presence of endothelial dysfunction in patients exposed to classic cardiovascular risk factors.Method: An observational, descriptive study of case series was carried out with a sample n=106 of patients exposed to classic cardiovascular risk factors, during the period January 2022 to January 2024, treated in a specialized cardiological prevention clinic, at the Cardiology Center. and Cardiovascular Surgery, “Saturnino Lora” Provincial Hospital, Santiago de Cuba. Results: The most altered endothelial function was vasomotor, the highest proportion was found in the group of sick patients, reaching 88.68%. The second most altered function of the vascular endothelium was the inflammatory response, which generally reached proportions of 79.24 and 76.42%. The increase in the intima-media thickness of the carotid artery above 0.8 mm has a strong association with the appearance of CVD (p=0.000; V=0.531), followed by the us CRP value (p=0.001 ; V=0.333).Conclusions: It is concluded that there is an association between the presence of a dysfunctional vascular endothelium and the appearance of cardiovascular disease, determined predominantly by an alteration of vasomotor function and the inflammatory response.

A Comprehensive Approach to the Treatment of Ischemic Heart Disease in Patients with Cardiorenal Metabolic Syndrome

Ischemic heart disease (IHD) remains the leading cause of mortality and disability due to cardiovascular diseases. IHD often manifests itself as stenosing atherosclerosis of the coronary arteries, which can be treated surgically or interventionally. However, chronic coronary syndromes with intact coronary vessels are a serious problem for modern medicine. Coronary microvascular dysfunction is accompanied by impaired coronary blood flow reserve, which leads to myocardial ischemia and angina pectoris, despite the absence of significant coronary artery stenosis. The objective: to study the mechanisms of myocardial ischemia in patients with coronary artery disease and cardiorenal metabolic (CRM) syndrome and to analyze the effectiveness of different treatment approaches depending on the identified mechanisms. Materials and methods. The study included 104 patients with CRM syndrome who underwent examination at the State Institution “The Scientific and Practical Medical Center of Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine” during 2023. Various forms of CHD were detected in the patients. Exercise stress tests were used to diagnose myocardial ischemia. Patients with confirmed stenosing atherosclerosis by percutaneous coronary angiography received appropriate interventional treatment. Microvascular angina was suspected in 21 patients without significant coronary artery lesions. The coronary blood flow reserve index was determined by echocardiography with intravenous administration of dipyridamole. Results. It was determined that of 21 patients with microvascular angina who received a comprehensive treatment including nicorandil, 20 (95.2%) persons were free of ischemic symptoms after 4 weeks. One patient had a decrease in complaints, but discomfort during exercise continued, which was successfully corrected after increasing the dose of nicorandil. Of 83 participants with CRM syndrome, CHD, and stenosing atherosclerosis who underwent coronary angiography, 74 (89.1%) patients had no ischemic symptoms and negative exercise test results after 28 days. In 9 cases ischemia persisted and a positive/doubtful exercise stress test was found. These patients were additionally prescribed nicorandil at a dose of 10 mg 2 times a day, which led to the disappearance of symptoms of angina pectoris and negative results of the exercise test at an additional re-examination after 7 days. Conclusions. In patients with CRM syndrome, the causes of ischemic heart disease were stenosing atherosclerosis (71.2%), microvascular angina (20.2%) and their combination (8.6%). Interventional treatment and nicorandil are effective in the treatment of coronary artery disease with different mechanisms, especially in cases of their combination.

A Tale of Two Conditions: Pediatric Brugada Syndrome Unveiled-Navigating the Challenges of Coexisting Arrhythmia and Fever-Induced ECG Pattern.

Brugada syndrome (BrS) is an inherited channelopathy characterized by right precordial ST-segment elevation. This study investigates the clinical and genetic characteristics of children with BrS in Hong Kong. A retrospective review was conducted at the only tertiary pediatric cardiology center in Hong Kong from 2002 to 2022, including all pediatric BrS patients under 18 years old. The diagnosis of BrS was established with a type 1 ECG pattern detected spontaneously or induced by flecainide, excluding secondary causes. Eight probands of mean age 10 years old were identified. Male dominance was observed (6 boys vs. 2 girls). The mean follow-up duration was 4.6 years (Median 3.5 years). Patients had type 1 ECG pattern either spontaneously (n = 4) or provoked by flecainide (n = 4). Fever was present in seven patients at the initial presentation, and two patients experienced aborted cardiac arrest and one had symptomatic ventricular tachycardia. All symptomatic patients received implantable cardioverter-defibrillator placement. Five asymptomatic patients (62.5%) were diagnosed with BrS through ECG during febrile illness, and they remained asymptomatic following conservative management involving strict fever control and medication avoidance. Two patients with mixed phenotype (one with long QT syndrome and another with ectopic atrial tachycardia) required antiarrhythmics and one patient received transcatheter ablation for atrial tachycardia to achieve optimal arrhythmia control. Fever plays a significant role in unmasking BrS in children. Asymptomatic children with BrS managed conservatively have a favorable prognosis. Difficult arrhythmia control was found in patients with mixed phenotype.

Factors influencing the return to the professional activity in patients hospitalized for myocardial infarction: a single centre experience - pilot study.

Cardiovascular diseases, with myocardial infarction (MI) on the leading position, remain a serious health care issue and socio-economic burden. Nevertheless, factors influencing the return of patients to the professional activity are not fully understood. Cardiac rehabilitation may have a positive impact on the return to professional activity after MI. However, no study among participants in the comprehensive care after myocardial infarction (CCMI) model (in Polish: "KOS-zawał") evaluated this issue so far. The aim of the study was to evaluate factors influencing the return to work and duration of the sick leave after MI among patients who participated in the CCMI in a single reference cardiology centre in Poland. In total, 144 patients were screened retrospectively. Out of them, 105 were included in the analysis. All patients were treated with direct percutaneous coronary intervention according to current European Society of Cardiology guidelines and participated in cardiac rehabilitation within the CCMI program, therefore had been provided optimal and modern therapeutic approach. Data was collected based on patients' medical records and information furnished by the insurer. Out of 105 patients analysed, 93 (88,6%) returned to work. A positive predictor of returning to work was male sex. Predictors of a prolonged return to work were older age and female sex. Completing rehabilitation, anthropometric factors, biochemical factors or results of post-MI echocardiographic examination did not influence the return to professional activity. A relatively large percentage of patients after MI and in the CCMI program returns to professional activity. Main factors of prolonged sick leave are older age and female sex. Med Pr Work Health Saf. 2024;75(6):501-510.

Current state of neurodevelopmental and psychosocial care practices for paediatric patients with ventricular assist devices: an Advanced Cardiac Therapies Improving Outcomes Network and Cardiac Neurodevelopmental Outcome Collaborative collaborative survey.

Paediatric patients with heart failure requiring ventricular assist devices are at heightened risk of neurologic injury and psychosocial adjustment challenges, resulting in a need for neurodevelopmental and psychosocial support following device placement. Through a descriptive survey developed in collaboration by the Advanced Cardiac Therapies Improving Outcomes Network and the Cardiac Neurodevelopmental Outcome Collaborative, the present study aimed to characterise current neurodevelopmental and psychosocial care practices for paediatric patients with ventricular assist devices. Members of both learning networks developed a 25-item electronic survey assessing neurodevelopmental and psychosocial care practices specific to paediatric ventricular assist device patients. The survey was sent to Advanced Cardiac Therapies Improving Outcomes Network site primary investigators and co-primary investigators via email. Of the 63 eligible sites contacted, responses were received from 24 unique North and South American cardiology centres. Access to neurodevelopmental providers, referral practices, and family neurodevelopmental education varied across sites. Inpatient neurodevelopmental care consults were available at many centres, as were inpatient family support services. Over half of heart centres had outpatient neurodevelopmental testing and individual psychotherapy services available to patients with ventricular assist devices, though few centres had outpatient group psychotherapy (12.5%) or parent support groups (16.7%) available. Barriers to inpatient and outpatient neurodevelopmental care included limited access to neurodevelopmental providers and parent/provider focus on the child's medical status. Paediatric patients with ventricular assist devices often have access to neurodevelopmental providers in the inpatient setting, though supports vary by centre. Strengthening family neurodevelopmental education, referral processes, and family-centred psychosocial services may improve current neurodevelopmental/psychosocial care for paediatric ventricular assist device patients.

Left atrial shape and function after endovascular and surgery atrial septal defects correction in children

Introduction. Atrial septal defects (ASD) are one of the most common congenital heart defects, accounting for about 10–15% of all congenital heart defects. Currently, endovascular treatments for ASD are considered the method of choice in most patients with secondary ASD. ASD occluders, after fixation on the atrial septum, close the shunt, eliminating the intercameral communication. However, these devices increase the stiffness of the septum, limit its mobility and presumably disrupt the mechanical function of the left atrium (LA).Aim: To study the effect of surgical and endovascular correction on the size, shape and function of the left atrium and left ventricle in children.Material and Methods. We retrospectively studied sequential echocardiograms of patients who underwent endovascular and surgical treatment of ASD in the period from 2006 to 2016 at the cardiology center in Tomsk, Russia. 756 patients with ASD were examined, 564 of them before and after endovascular closure and 192 after surgical correction. The duration of follow-up ranged from 1 day to 10 years, with an average of 3.6 years in the group receiving hardware treatment and 4.2 years in the group undergoing surgery. The control group consisted of 3393 healthy patients of the same age group. Echocardiographic images were obtained using an iE33 ultrasound scanner, Philips Ultrasound. Standard echo indicators of heart sizes and volumes were evaluated, including taking into account the body surface area and deviations of the studied parameters as a percentage of the predicted norm.Results. 15 days after ASD closure, both groups showed a significant increase in the volume of the left ventricle and a decrease in the right chambers. During follow-up in the group receiving the devices, left atrial shape index (LASI) was significantly reduced, while in patients undergoing surgery, there was no significant increase in LASI. A change in the shape of the left atrium and a decrease in its volume were combined with a change in the effort in the left atrium (LAEF), determined by the Manning method.Discussion. The study showed that both endovascular and surgical methods are effective in correcting ASD and lead to favorable results with respect to left atrial function. However, there is still uncertainty about the long-term effects after implanted devices used in endovascular procedures. Although these devices offer a minimally invasive solution, there is a problem associated with increased stiffness and limited mobility of the partition. Such changes can potentially alter the normal dynamics of atrial filling and contraction, affecting the overall function of the left atrium over time.Conclusion. Endovascular correction of ASD in 35% of children was accompanied by a change in the shape of the left atrium a decrease in sphericity and an increase in ellipsoid. Changes in the shape of the left atrium persisted in 22% of patients after transcatheter correction in the long term. These changes were not accompanied by any disorders of contractility and volume of the heart chambers. In the group of children after surgical correction of ASD, the contractility and volume of the heart chambers did not significantly differ from those in the device group.

Doses from ionising radiation in paediatric cardiac catheterisations in Norway 1975–2021

Pediatric patients with congenital heart disease often undergo cardiac catheterization procedures and are exposed to considerable ionizing radiation early in life. This study aimed to develop a method for estimating the dose area product (PKA) from pediatric cardiac catheterization procedures (1975-1989) at a national centre for pediatric cardiology and to evaluate trends in PKAand exposure parameters until 2021. Data from 2200 catheterization procedures on 1685 patients (1975-1989) and 4184 procedures on 2139 patients (2000-2021) under 18 years of age were retrospectively collected. PKAvalues were missing for 1975-1989 but available from 2000 onward. The missing PKAwas estimated from air kerma and beam area, based on exposure records and input from clinicians working at that time. PKAtrends were analysed over time and age. There was a 71% reduction in median PKAfrom the period 1975-1989 (median 6.63 Gy cm2) to 2011-2021 (1.91 Gy cm2). The PKAincreases significantly (p=0.0001) with patient age, which was associated with body weight. Approximately 80% of the total PKAwas from cine acquisition in 1975-1989, while 20% was from fluoroscopy. The PKAestimate during 1975-1989 was considerably impacted by the assumptions of missing parameters such as tube filtration, focus-to-heart distance, beam area, and number of cine series. The decreasing trend in PKAvalues was attributed to advancements in both technologies and clinical practices. The high contribution of cine acquisition to the total dose during 1975-1989 was due to factors such as a high frame rate, multiple acquisitions, and high tube current. The estimated PKAvalues for the period 1975-1989 are of importance for the dose reconstruction and risk assessments in the EU epidemiology project Health Effects of Cardiac Fluoroscopy and Modern Radiotherapy in Pediatrics (HARMONIC).&#xD.

Contemporary Outcomes of TAVR Using a Balloon-Expandable Valve in Patients With Severe Mitral Stenosis: Insights From the Transcatheter Valve Therapies Registry.

While initial data for transcatheter aortic valve replacement (TAVR) in aortic stenosis patients with mitral stenosis (MS) suggested a poor short-term prognosis, outcomes for contemporary balloon-expandable valves remain unknown. The aim of this retrospective multicenter registry study was to compare the potential impact of MS on TAVR outcomes with balloon-expandable valves. Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry and Centers for Medicare & Medicaid Services claims data were used to obtain a cohort of 327 925 patients who underwent TAVR with current balloon-expandable valves (SAPIEN 3, SAPIEN 3 Ultra, or SAPIEN 3 Ultra Resilia) between June 2015 and December 2022 across 791 sites. Severe MS (defined as >10 mm Hg mean gradient or <1.5 cm2 area) was compared with mild or less MS (defined as <5 mm Hg mean gradient and >2 cm2 area) using propensity matching to minimize confounding variables. Patients with severe MS (n=8500; 2.6%) had a higher number of comorbid conditions, Society of Thoracic Surgeons risk scores, and were more often women than patients with mild or less MS at the time of index TAVR. While patients with severe MS had worse outcomes at 30 days, when propensity-matched, patients exhibited similar 30-day rates of death (3.2% versus 3.0%), stroke (2.4% versus 2.2%), major vascular complications (1.6% versus 1.6%), device implant success (98.9% versus 99.2%), and new dialysis (0.7% versus 0.5%), with higher rates of pacemaker implantation (11.3% versus 9.4%; P<0.001). By 1 year, there was no difference in the change in the KCCQ (Kansas City Cardiomyopathy Questionnaire) overall score from baseline to 1 year (30.7±27.0 versus 31.9±27.0; P=0.07). By 3 years, an increase in the mortality rate (45.1% versus 40.9%; P<0.001) of patients with severe MS was observed. MS in isolation is not associated with worsened short-term outcomes among patients undergoing contemporary TAVR with balloon-expandable valves.

Percutaneous circulatory assistance in an interventional cardiology centre without on-site cardiac surgery.

Percutaneous extracorporeal membrane oxygenation (ECMO) has been developed thanks to the progress in the field of cannulation, but still justifies the presence of an on-site cardiac resuscitation department. Corsica is a French island without an on-site cardiac surgery department. To evaluate the percutaneous ECMO programme in Corsica. All patients who received ECMO at the Bastia Hospital Centre between 01 January 2016 and 30 April 2022 were included. ECMO was implanted in 39 patients. The mean age was 52.7years, with male predominance (84.6%). The majority of veno-arterial ECMOs were placed in the coronary angiography laboratory, whereas venovenous ECMOs were preferentially placed in the medical intensive care unit. Twenty patients (51.3%) were medically transferred to other referral centres after canulation. Percutaneous vascular cannulation was performed with ultrasound guidance in all cases (100%), and was successfully performed without immediate complications in all patients except two (who presented an immediate complication during cannulation), which is similar to large trials, despite the absence of on-site cardiac surgery. The use of ultrasound guidance (and sometimes fluoroscopy guidance) during cannulation and the experience of the medical team facilitated control over correct positioning of the cannulas and decreased implantation failure, without the need for a surgical approach. Percutaneous ECMO by trained interventional cardiologists without a surgical approach appears to be safe. Widespread use of percutaneous cannulation without cardiac surgery would increase survival for some patients who are far from these centres.

Lipoprotein(a) as an Independent Predictor of Elevated SYNTAX Score.

Background/Objectives: Increased lipoprotein(a) [Lp(a)] level is associated with elevated possibility of atherosclerosis progression. SYNTAX score enables to grade the anatomy of coronary arteries. To identify the impact of increased Lp(a) level on SYNTAX score in individuals with acute myocardial infarction (AMI). Methods: In our analysis, we enrolled 173 consecutive adult patients hospitalized for AMI in a tertiary cardiology center from December 2022 to August 2023. Patient characteristics were compared for patients with SYNTAX score ≥ 23 (64 patients) and SYNTAX score < 23 (109 patients). The SYNTAX score was estimated based on the results of coronary angiography. Logistic regression analyses were performed to evaluate the factors associated with SYNTAX score. Results: Individuals with the SYNTAX score ≥ 23 were more likely to have arterial hypertension, diabetes mellitus, significant stenosis in the left main coronary artery, and higher Lp(a) levels than those with SYNTAX < 23 (all p < 0.05). On univariate analysis, age (OR 1.05, 95% CI 1.02-1.08, p = 0.001), Lp(a) levels (OR 1.04, 95% CI 1.01-1.06, p = 0.001), and arterial hypertension (OR 2.69, 95% CI 1.26-5.74, p = 0.011) were associated with SYNTAX score ≥ 23. Multivariable determinants of SYNTAX score ≥ 23 were as follows: Lp(a) levels (OR 1.03, 95% CI 1.01-1.08, p = 0.029), and age (OR 1.04, 95% CI 1.01-1.07, p = 0.005). The cut-off value for Lp(a) 166.16 nmol/L identifies patients with SYNTAX score ≥ 23 with 97% sensitivity and 44% specificity (area under curve 0.78, p < 0.001). Conclusions: Elevated Lp(a) concentration is associated with a higher SYNTAX score. A cut-off value of Lp(a) above 166.16 nmol/L allows us to identify subjects with SYNTAX score ≥ 23 with good specificity and sensitivity.

The use of four-pillar regimen for heart failure management: results from the Jordanian Heart Failure Registry (JoHFR).

Heart failure (HF) is a complex cardiovascular disease. Effective management typically involves four main medications: angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, angiotensin receptor-neprilysin inhibitors, and mineralocorticoid receptor antagonists, along with sodium-glucose co-transporter-2 inhibitors (SGLT2i). The primary objective of this article is to assess and identify the utilization of four-pillar regimen for HF managment and explore the characteristics of the patients being on the four-pillar regimen in Jordan. Data from the Jordanian HF registry (JoHFR) was analyzed, encompassing records of HF patients treated in various cardiology centers from 2021 to 2023. The medical records of 2,151 patients with HF who were admitted to cardiology centers throughout Jordan were collected. Males comprised 58.0% of the included patients. Moreover, 71.0% of patients had chronic HF, whereas the rest, 29.0%, had acute HF. Of these, only 0.6% received the complete four-pillar treatment of HF. Beta-blockers were the most frequently used medication, prescribed to 74% of patients, while SGLT2i were the least common, used by only 9%. Notably, patients with type 2 diabetes were more likely to be on the four-pillar regimen (P-value = 0.016). Additionally, patients with a glomerular filtration rate (GFR) below 60 were more likely to be treated using the four-pillar (P-values = 0.044). The analysis revealed no significant difference in mortality rates between the two groups (P-value = 0.475). Our study demonstrated an overall low utilization of the four-pillar regimen for HF treatment in Jordan with several patients' characteristics associated with it. This highlight the need for enhanced collaborative effort and governmental initiatives to address the challenges of the low utilization of these medications.

Lymphatic Disorder Management in Pediatric Patients With Congenital Heart Disease in European Pediatric Cardiology Centers: Current Status, Disparities, and Future Considerations.

Lymphatic disorders such as protein-losing enteropathy, plastic bronchitis, and chylothorax are important complications of the Fontan circulation and ultimately result in an increased risk of early death. Several European centers are now performing lymphatic procedures. The aim of this study is to map the extent of these lymphatic disorders and treatments provided across European pediatric cardiology centers. A survey was circulated to 49 European pediatric cardiology centers consisting of 37 questions including a mix of binary, categorical, and continuous variables. Thirty-one centers (63%) participated in the study, performing a median of 250 (interquartile range, 178 - 313) cardiopulmonary bypass procedures per year. Chylothorax emerged as the most prevalent lymphatic disorderfollowed by protein-losing enteropathy and plastic bronchitis. The most common diagnostic investigation method was noncontrast magnetic resonance lymphangiography (52%). Eleven centers (35%) conducted lymphatic interventions with a median of 3 (interquartile range, 1 - 4) procedures per year and 12 (interquartile range, 5 - 15) interventions in total per center. This study confirms the rarity of and variation in treatment approaches for lymphatic disorders across Europe. With at least 11 centers offering lymphatic interventions, the adoption of these procedures is on the rise in Europe. To improve the quality of care and treatment outcomes for these complex patients, it is crucial to consider evidence-based lymphatic diagnostics, interventional lymphatic procedures, and the centralization of services in Europe.

Sinus node dysfunction in children: different aetiologies, similar clinical course in two-centre experience.

This study aims to evaluate the clinical characteristics and outcomes of children diagnosed with sinus node dysfunction. This was a retrospective review of patients diagnosed with sinus node dysfunction in two tertiary paediatric cardiology centres in Turkey from January 2011 to June 2022. In all, 77 patients (50, 64.9% males) were included, with a mean age of 8.2 ± 6.3 years and a mean weight of 28.2 ± 18.8 kg. While age-incompatible bradycardia and pauses were the most common rhythm disturbances, syncope, presyncope, and dizziness (n:33, 43%) were the most frequent initial symptoms. Structural heart disease was present in 58 (75.3%) of the 77 patients, 47 (61%) of whom were congenital. The most commonly associated CHDs were transposition of the great arteries (n:8), atrial septal defect (n:7), and atrioventricular septal defect (n:5). Seven of them also had left atrial isomerism. The remaining 19 patients were isolated. Four patients had SCN5A mutation (two of them were siblings) and two of them had Emery-Dreifuss muscular dystrophy. Although sinus node dysfunction is rare in children, it has been diagnosed with increasing frequency with structural heart disease, especially in patients who have undergone corrective cardiac surgery related to atrial tissue. Since sinus node dysfunction can occur at any time postoperatively, these patients should be kept under constant control. If symptomatic sinus node dysfunction is confirmed, permanent pacing is an effective therapeutic modality.

Reliability, internal consistency, and validity of the World Health Organization disability assessment schedule (WHODAS) 2.0 among adults with heart failure

BackgroundHeart failure (HF) imposes significant disability. The World Health Organization Disability Assessment Schedule (WHODAS) 2.0 is a generic instrument that measures disability. Although it has been used in HF, no previous study has investigated its measurement properties in this group. ObjectiveTo assess the test-retest reliability, internal consistency, convergent, and discriminant validity of WHODAS 2.0 in individuals with HF. MethodsWe conducted a cross-sectional study that included individuals with HF treated at the outpatient cardiology center. Data included sociodemographic and clinical (e.g., New York Heart Association - NYHA) characteristics, estimated functional capacity (Duke Activity Status Index - DASI), quality of life (Minnesota Living with Heart Failure Questionnaire - MLHFQ), and disability (the WHODAS 2.0 36-item version). We assessed associations, using Pearson's correlation coefficient or the Kruskal-Wallis test, between the WHODAS 2.0 scores and the MLHFQ, DASI, and NYHA. The WHODAS 2.0 results were collected again seven days after the initial assessment for reliability (intraclass correlation coefficient - ICC). ResultsParticipants were 100 people with HF (M age = 57.8 ± 14 years, 57 % men), of whom 84 % were literate. The WHODAS 2.0 was reliable (ICC = 0.789) and had good internal consistency (Cronbach's alpha >0.7 in all domains). Convergent validity was observed through moderate correlations with DASI and MLHFQ and discriminant validity with statistically different results according to NYHA classes. ConclusionWHODAS 2.0 is a reliable, consistent, and valid instrument for measuring disability in individuals with HF. Further research is needed to evaluate other properties, such as its responsiveness to interventions.

Abstract 4134778: Myocardial Recovery and Survival after Weaning of Left Ventricular Assist Device Therapy in Patients with Toxic and non-Toxic Cardiomyopathy, A Canadian Experience

Left ventricular assist devices (LVAD) are increasingly used in refractory heart failure, mainly as a bridge to transplant or as destination therapy. LVAD unloading of the left ventricle (LV) can also promote myocardial recovery leading to improvement of the LV systolic function, allowing LVAD explantation. However, parameters associated with LVAD weaning and long-term outcomes are not well documented. The aim of this study was to assess the clinical and echocardiographic characteristics of weaned patients and to evaluate their event-free survival post-explantation. We conducted a single-center retrospective study recruiting patients who underwent a second or third generation LVAD implantation at a Canadian cardiology center between November 2009 and October 2021. A total of 98 patients underwent LVAD implantation during this period. All patients were on guideline-directed medical therapy (GDMT). Fourteen patients (14%) had significant LV recovery and were explanted/decommissioned after a median support time of 309 days (range 55-595 days). Toxic cardiomyopathy, defined as abuse of amphetamines (n=2), energy drinks (n=2) or multiple substances (n=6), was the most likely diagnosis in 10 of the weaned patients (71%). The LVEF was significantly higher and the left ventricular end-diastolic diameter (LVEDD) was significantly lower in weaned patients compared to unweaned patients after 3 months of support. Myocardial recovery manifested as pump thrombosis in 4 of the weaned patients (29%). Prior to explantation, 12 patients had a decrease in GDMT doses to minimize post explantation vasoplegia. After explantation, median follow-up time was 40 months (range 8-109 months) and the majority of patients were anticoagulated for 3 months. At last follow up, the LVEF was 44±6% and no patient had a LVEF below 35%. All patients were NYHA I or II and no death, heart transplant, or mechanical support initiation occurred. LVAD therapy can induce LV reverse remodeling leading to myocardial recovery in a significant proportion of patients, especially young patients with toxic and non-ischemic cardiomyopathies. Early reverse remodeling with decreasing LVEDD and improving LVEF at 3 months following implantation is associated with successful weaning. Pump thrombosis seems to be associated with LV reverse remodeling and weaning of mechanical support in certain patients. Weaned patients maintain satisfactory LVEF recovery after explantation and have good long-term event-free survival.