Introduction: An 85-year-old man presented to the hospital with acute on chronic diastolic heart failure secondary to transthyretin cardiac amyloidosis. He has a known history of grade III diastolic dysfunction with NYHA Class IIIb symptoms. His past medical history includes paroxysmal atrial fibrillation on Sotalol, hypertension, Type 2 diabetes mellitus, chronic kidney disease stage 3B, hypothyroidism, restrictive cardiomyopathy with heart failure with reduced ejection fraction, and prior triple vessel coronary artery bypass graft. On Presentation: Initial clinical findings including vitals, labs, and imaging are summarized in Figure 1 He was initially treated with intravenous furosemide but had limited response. It was noted that during atrial fibrillation his symptoms worsened, likely due to loss of atrial kick. His home sotalol was changed to amiodarone to improve rhythm control, but this resulted in bradycardia, further contributing to symptoms. Hypothesis: Given his restrictive cardiomyopathy, we suspected a fixed stroke volume and heart rate dependency for cardiac output (CO). Thus, we proceeded with right heart catheterization to better assess his volume status and hemodynamics. Methods: A pulmonary artery catheter was placed for pressure and CO measurements, along with a temporary right atrial pacemaker wire. Pulmonary artery and pulmonary capillary wedge pressures, along with thermodilution CO, were recorded at baseline and during atrial pacing at multiple rates to assess hemodynamic changes. Results: Hemodynamic parameters at baseline and during atrial pacing are shown in Figure 2 . Gradual increases in atrial pacing led to reductions in pulmonary artery and wedge pressures, while cardiac output remained stable. These findings suggest that in restrictive physiology with chronotropic incompetence, modest atrial pacing may lower filling pressures as a result of shortened diastolic filling time, without compromising cardiac output. Conclusion: Current treatment of advanced diastolic heart failure ( Figure 3 ) focuses primarily on preload reduction. We propose atrial pacing to shorten diastolic filling time as an alternate approach to lower left ventricular filling pressures. Further studies are warranted to explore device-based therapy for these patients.

Abstract Introduction Anthracyclines (AC) are essential in cancer therapy but significantly increase the risk of cardiotoxicity, particularly heart failure. Preclinical studies suggest that sacubitril/valsartan (S/V) may mitigate doxorubicin-induced cardiotoxicity through various molecular mechanisms. Purpose We aim to assess the impact of S/V on cardiovascular outcomes in cancer patients undergoing AC therapy using the TriNetX global health research network. Methods A retrospective cohort study was conducted using the TriNetX Network in patients with cancer under AC therapy, comparing S/V treatment with no treatment after a chemotherapy session. Propensity Score Matching (PSM) at a 1:1 ratio was used for balancing the confounders between S/V users and non-users, accounting for demographics, medical conditions, medications, and psychosocial covariates. The primary outcomes included BNP, troponin, echocardiographic parameters, and chronic heart failure, while the secondary outcomes - mortality and Intensive Care Unit admission - were analyzed at 5 years follow-up. Cumulative incidence for binary endpoints calculated using Cox Proportional-Hazard methods was reported as Hazard Ratio (HR) and 95% Confidence Interval (95%CI), and continuous endpoints in mean and standard deviation (SD). All analyses were calculated using TriNexT software. Results After PSM, 1,231 cancer patients treated with AC received S/V, while 1,231 did not. At baseline, the S/V group BNP levels (1,347 ± 3,790 vs. 1,166 ± 6,667 pg/mL; p = 0.76) and troponin levels (2.47 ± 20.7 vs. 0.16 ± 0.69 ng/mL; p = 0.38). At 5 years, S/V groups non-S/V had no significant difference in BNP (p = 0.95; Table 1) and troponin levels (p = 0.57; Table 1). The echocardiographic outcome was similar between the groups. Both systolic and diastolic chronic heart failure were higher in the intervention group: HR 38.71 ([95% CI: 25.26-59.31]), and HR 7.71 ([95% CI: 5.03-11.81]), respectively. However, mortality rates in 5 years were lower in the S/V group, with a HR 0.843 ([95% CI: 0.71–0.99]; p= 0.04; Fig.1), and ICU admission was not statistically significant. Conclusion Sacubitril/Valsartan showed no significant impact on BNP, troponin, or echocardiographic parameters in cancer patients receiving anthracycline therapy but was associated with reduced 5-year all-cause mortality, suggesting potential long-term benefits.

Abstract High output heart failure (HOHF) is a rare, but known, complication of arteriovenous fistulas (AVF) in hemodialysis patients. This can be secondary to longstanding AVF. We present a case of HOHF in a patient with an AVF who presented with altered mental status (AMS). 72-year-old female with history of autosomal polycystic kidney disease status post left arm AVF 10 years prior, kidney transplant and chronic diastolic heart failure with preserved left ventricular (LV) ejection fraction presented with AMS and hypertensive emergency. She was in acute on chronic heart failure exacerbation with evidence of severe anasarca and subcutaneous edema with small bilateral pleural effusions on computed tomography imaging. MRI of the brain revealed findings concerning for posterior reversible encephalopathy syndrome. She was started on intravenous diuretic therapy. Despite this, she had minimal urine output and her kidney function worsened. Her pulmonary artery systolic pressure (PASP) was 61 mmHg on echocardiogram that showed dilated RA and severely dilated RV with hypokinesis of RV free wall suggesting RV failure. Previous echocardiogram 3 years ago showed normal RA, RV and PASP of 40mmHg. Her course was complicated due to acute hypoxic respiratory failure. It was determined that she had RV failure of unclear etiology. She became progressively lethargic in the setting of respiratory failure warranting ICU level of care. Right heart catheterization was performed. She had a pulmonary capillary wedge pressure of 17 mmHg before occlusion of AVF with a transpulmonary gradient that indicated precapillary disease. After occlusion of AVF at bedside, wedge pressure decreased to 12 mmHg with improvement in cardiac output. It was hypothesized that her new onset RV failure and pulmonary hypertension (PH) was related to increased flow through the AV fistula resulting in HOHF. Transplant surgery team was consulted for ligation of AVF with placement of tunneled dialysis catheter. Her mental status and volume status gradually improved following ligation. High flow AVF should be suspected as the cause of new onset heart failure, RV failure and PH in those who are resistant to diuretic therapy and have chronic AVF with high flows. Our patient had a high flow AVF (defined as flow greater than 20% of cardiac output) that was suspected to be the cause of her new RV failure and PH. Diagnosis can be made by obtaining hemodynamic parameters by right heart catheterization before and after occlusion of the fistula. This is managed by ligation of the fistula.

Abstract We report the case of a 62-year-old male with a complex medical history, including chronic diastolic heart failure, hypertension, history of supraventricular tachycardia status post-ablation, hyperlipidemia, and renal cell carcinoma status post-partial nephrectomy, who presented to an outside hospital with new-onset atrial fibrillation with rapid ventricular response following syncopal episodes. Imaging and further workup revealed multiple metastatic lesions within the brain and osseous lesions in the spine, as well as pulmonary nodules consistent with non-small cell lung cancer (NSCLC), favoring adenocarcinoma. During hospitalization, the clinical status of the patient deteriorated with tachycardia and tachypnea, requiring an increasing amount of supplemental oxygen. Prior to transfer to the medical intensive care unit, the patient also complained of chest pain. A chest computed tomography (CT) demonstrated a large pericardial effusion, and the presence of recurrent bradycardia, syncopal episodes triggered by coughing or deep breathing, and pulsus paradoxus prompted an urgent bedside point-of-care ultrasound (POCUS) echocardiogram. Findings included an enlarged pericardial effusion with worsening tricuspid and mitral inflow Dopplers, indicative of increased pericardial pressure. The patient subsequently experienced further hemodynamic deterioration with cardiac tamponade, and an emergent catheter-guided pericardiocentesis, under ultrasound guidance, was performed. The decision to use a thoracentesis catheter kit was made for various reasons, including the lack of immediately available pericardiocentesis kit as well as plans to leave the catheter in place to redrain the effusion due to its rapid progression. Proper placement and improvement in pericardial effusion was confirmed via improvement in vital signs, bedside POCUS, and follow-up CT. Despite initial stabilization, follow-up evaluation in the cardiac catheterization lab revealed that the catheter had migrated into the left pleural space, raising suspicion for a pericardiopleural fistula. This fistula likely contributed to abnormal fluid communication between the pericardial and pleural spaces, complicating management and perpetuating hemodynamic instability. This case underscores the rare complication of pericardiopleural fistula formation following pericardiocentesis, a complication that poses significant management challenges. In this case, the risk was exacerbated by the stiffer thoracentesis catheter being left in the pericardial space. It highlights the importance of vigilant monitoring, including imaging follow-up, after pericardiocentesis, particularly in high-risk individuals. Careful procedural techniques and early recognition of catheter migration are critical to minimize the risk of this severe complication.

Abstract Introduction: Myelodysplastic syndromes (MDS) refer to disorders originating from clonal stem cells, marked by ineffective hemopoiesis and cytopenias. Patients with MDS have a higher incidence of cardiovascular mortality, with heart failure playing a significant role. This has been linked to persistent anemia, excess iron accumulation and a systemic inflammatory state. Patients with MDS have significantly higher rates of infectious events, with pneumonia (PNA) and sepsis being the most common infections. The influence of systolic heart failure (SHF) or diastolic heart failure (DHF) on the risk of infections in patients with MDS is unclear. We evaluated whether chronic SHF or DHF, as well as acute SHF or DHF in concomitance with MDS, affected the rates of PNA, septic shock and overall mortality. Method: A retrospective study identified patients with MDS using specific ICD 10 codes (D46.9, D46A-C and D46.22) from the National Inpatient Sample 2019-2021. Patients with acute and chronic SHF or DHF were obtained using particular ICD 10 codes (I50.2 - I50.4). The incidence rates of PNA, septic shock and overall mortality were compared between MDS patients with each of these types of HFs versus those without any HF using multivariate logistic regression adjusting for demographic characteristics, hospital-related factors, and common comorbidities. Results: A total of 223,975 patients were identified with MDS. Patients with MDS who had chronic SHF (n=11,505) showed increased rates of PNA (OR:1.4, p<0.001) and septic shock (OR: 1.4, p <0.001) but no significant difference in overall mortality (p=0.603) compared to those without any HF. Patients with MDS and acute SHF (n=12,560) had enhanced rates of PNA (OR: 1.4, p<0.001), septic shock (OR: 1.9, p<0.001), and overall mortality (OR:1.6, p<0.001) versus those without any HF. Patients with MDS and chronic DHF (n=18,990) had no difference in rates of PNA (p=0.2), septic shock (p=0.16), or overall mortality (p=0.1). Acute DHF (n=16,700) led to a greater incidence of PNA (OR: 1.5, p<0.001) and overall mortality (OR: 1.2, p<0.001), but no significant difference in the incidence of septic shock (p=0.07) in patients with MDS. Conclusion: Acute SHF was associated with significantly elevated rates of PNA and septic shock in patients with MDS, whereas acute DHF was linked to an increased incidence of PNA. Chronic SHF demonstrated higher occurrences of both PNA and septic shock. Furthermore, acute SHF and DHF correlated with increased mortality rates. Consequently, fostering early collaboration between hematology specialists and those in cardio-oncology is essential for effectively managing patients who have both MDS and HF. This would enable the implementation of timely preventive measures and therapeutic interventions, leading to more comprehensive care strategies that may improve clinical outcomes for these patients. Citation Format: Karnav Modi, Himil Mahadevia, Simran Chandra, Ibrahim Khamees, Parth Sharma, Deepthi Vodnala, Taiyeb Khumri. Effect of heart failure on incidence rates of pneumonia, septic shock and overall mortality in patients with myelodysplastic syndrome [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 790.

Clarification of the presence of diastolic dysfunction, as a possible onset of chronic heart failure (CHF) with preserved LV ejection fraction, is strategic in determining the management tactics and prognosis of patients with HIV infection. It is known that chronic heart failure in HIV-infected people develops in 16–54 % of cases, accompanying the development of multiple pathologies of the myocardium and endothelium [1]. Currently, modern ultrasound equipment, if equipped with a speckle tracking option, provides ample opportunities for diagnosing CHF with preserved ejection fraction, however, this technology is not yet available in all medical institutions, so it is necessary to search for other opportunities for accurate diagnosis of CHF with preserved ejection fraction ejectionThe purpose of this work was to substantiate the use of the Tei index as an optimal and accessible indicator for diagnosing diastolic dysfunction and CHF in people with HIV infection. In a large hospital, a group of 240 patients infected with the human immunodeficiency virus (HIV) was studied over a period of four years. The study was of a one-stage, screening, clinical nature. The Tei index is also found in the literature under the name “myocardial performance index” [2]. The clinical significance of determining the Tei index in determining diastolic dysfunction in patients with HIV infection is higher than the ratio E/e’≥13, which makes this indicator recommended for echocardiography in this cohort of patients as an early marker of diastolic dysfunction and CHF.In HIV-infected patients, an increase in the Tei index of more than 0.41 is associated with the development of left ventricular diastolic dysfunction, hypertrophy, increased volume of the left atrium, pulmonary arterial hypertension, anemia and chronic kidney disease. In patients with HIV infection, with an increase in the Tei Index ≥0.41, the likelihood of developing CHF increases 10.6 times, severe CHF with NT-proBNP≥1500 pg/ml increases 8 times, anemia increases 5.75 times, 3.73 times – coronary artery disease, 3.09 times – chronic kidney disease; 2.86 times for ventricular arrhythmias and 2.29 times for pulmonary arterial hypertension.

Background: Previous studies have shown poor outcomes in Polycythemia vera (PV) patients (pts) with comorbid heart failure (HF). Given lack of data, we studied the role of systolic heart failure (SHF), and diastolic heart failure (DHF), with and without acute exacerbation in PV pts from a national database. Methods: Using National Inpatient Sample 2019-21, we identified all pts with PV. They were further reclassified into 4 different study populations depending on type of HF. This included MM pts with and without acute SHF, chronic SHF, acute DHF, and chronic DHF. In each study population, we excluded those with any other type of comorbid HF. Outcomes were compared using Pearson’s chi-square test and multivariate regression analysis. Results: 65780 had PV. Among them 5.2% (n=3425) had only acute SHF, 4.2% (n=2750) had chronic SHF, 6.6% (n=4315) had acute DHF, and 5.9% (n=3895) had chronic DHF. Those with acute SHF had significantly higher odds of mortality (adjusted odds ratio (aOR) 1.7, p=0.002), cardiogenic shock (CS) (aOR 6.6, p<0.001), acute myocardial infarction (MI) (aOR 4.2, p<0.001), and similar odds of cardiac arrest (CA) (aOR 1.6, p=0.116). Those with chronic SHF had similar odds of mortality (aOR 0.8, p=0.237), CS (aOR 1.3, p=0.472), acute MI (aOR 0.7, p=0.07) and CA (aOR 0.7, p=0.455). Similarly, those with acute DHF had similar odds of mortality (aOR 0.9, p=0.5), CS (aOR 1.1, p=0.745), acute MI (aOR 1.3, p=0.069) and CA (aOR 0.9, p=0.878). Those with chronic DHF also had similar odds of mortality (aOR 0.9, p=0.444), and CA (aOR 1.4, p=0.301), and lower odds of CS (aOR 0.3, p=0.039), and acute MI (aOR 0.6, p=0.001). Please refer Table 1 for rates of complication (Pearson’s chi-square). Conclusion: Among different types of HF in PV pts, acute SHF is associated with higher odds of mortality and even significantly higher odds of cardiac complication like CS (560%), acute MI (320%). All other types of HF including chronic SHF, acute DHF and chronic DHF showed similar odds of mortality and similar or even lower (for chronic DHF) odds of cardiac complications. This data helps guide timing for cardiology consultation and need for care escalation depending on HF type in PV.

With the increasing amount of elective spine fusion patients presenting with cardiac disease and congestive heart failure, it is becoming difficult to assess when it is safe to proceed with surgery. Assessing the severity of heart failure (HF) through ejection fraction may provide insight into patients' short- and long-term risks. The purpose of this study was to assess the severity of HF on perioperative outcomes of spine fusion surgery patients. This was a retrospective cohort study of the PearlDiver database. We enrolled 670,526 patients undergoing spine fusion surgery. Thirty-day and 90-day complication rates, discharge destination, length of stay (LOS), physician reimbursement, and hospital costs. Patients undergoing elective spine fusion surgery were isolated and stratified by preoperative HF with preserved ejection fraction (P-EF) or reduced ejection fraction (R-EF) (International Classification of Diseases-9: 428.32 [chronic diastolic HF] and 428.22 [chronic systolic HF]). Means comparison tests (Chi-squared and independent samples t-tests, as appropriate) compared differences in demographics, diagnoses, comorbidities, procedural characteristics, LOS, 30-day and 90-day complication outcomes, and total hospital charges between those diagnosed with P-EF and those not R-EF. Binary logistic regression assessed the odds of complication associated with HF, controlling for levels fused (odds ratio [OR] [95% confidence interval]). Statistical significance was set at P < 0.05. Totally 670,526 elective spine fusion patients were included. Four thousand and seventy-seven were diagnosed with P-EF and 2758 R-EF. Overall, P-EF patients presented with higher rates of morbid obesity, chronic kidney disease, chronic obstructive pulmonary disease, diabetes mellitus, and hypertension (all P < 0.001). In relation to No-HF, P-EF patients had higher rates of 30-day major complications including pulmonary embolism, pneumonia, cerebrovascular accident (CVA), myocardial infarctions (MI), sepsis, and death (all P < 0.001). Furthermore, P-EF was associated significantly with increased odds of pneumonia (OR: 2.07 [1.64-2.56], P < 0.001) and sepsis (OR: 2.09 [1.62-2.66], P < 0.001). Relative to No-HF, R-EF was associated with significantly higher odds of MI (OR: 3.66 [2.34-5.47]), CVA (OR: 2.70 [1.67-4.15]), and pneumonia (OR: 1.85 [1.40-2.40]) (all P < 0.001) postoperative within 30 days. Adjusting for prior history of MI, CAD, and the presence of a pacemaker R-EF was a significant predictor of an MI 30 days postoperatively (OR: 2.2 [1.14-4.32], P = 0.021). Further adjusting for history of CABG or stent placement, R-EF was associated with higher odds of CVA (OR: 2.11 [1.09-4.19], P = 0.028) and MI (OR: 2.27 [1.20-4.43], P = 0.013). When evaluating the severity of HF before spine surgery, R-EF was associated with a higher risk of major complications, especially the occurrence of a myocardial infarction 30 days postoperatively. During preoperative risk assessment, congestive HF should be considered thoroughly when thinking of postoperative outcomes with emphasis on R-EF.

This case describes an 84-year-old female with chronic diastolic heart failure, coronary artery disease status post coronary artery bypass and percutaneous coronary intervention, hypertension, diabetes mellitus and chronic kidney disease stage III, who presented with progressive dyspnea found to have severe aortic stenosis demonstrated by echocardiogram (aortic valve area, .06 ^cm2; mean gradient, 42 mm Hg). She was evaluated by the Heart Team and deemed to be a candidate for a transfemoral transcatheter aortic valve replacement (TAVR) after computed tomography angiography (CTA) evaluation. During insertion of the valve sheath through the external iliac, intimal “snowplowing” occurred resulting in complete occlusion of the iliac artery. The intima was successfully milked back into anatomical position using a “reverse snowplow” technique. Extravasation was managed with covered stents. The patient recovered over several days and was discharged home on post-procedure day 7. When appropriate, Endovascular management of vascular complications avoids the morbidity associated with open repair. Pre-operative evaluation is imperative in identifying anatomical features that pose a risk to vascular complications. This patient had an increased risk with an elevated iliofemoral tortuosity score, however, had minimal calcification and no acute angulation in the iliofemoral arterial system. This case highlights the complexity of vascular complication management and difficulty faced in identifying patients who are at risk for these types of complications.

Background. Chronic heart failure (CHF) is the most common outcome of cardiovascular disease, of hypertension disease (HD). Beta-blockers contribute to the correction of hypertension, reduce heart remodeling, slow the progression of CHF. At the same time, bisoprolol and nebivolol differing pharmacochemical properties can have a multidirectional effect on the regulatory-adaptive status (RAS).&#x0D; Aim. To determine the effect of bisoprolol or nebivolol therapy on the RAS of patients with diastolic CHF on the background of HD III stage.&#x0D; Material and methods. The study involved 68 patients with diastolic CHF who were randomized into two groups for treatment with bisoprolol or nebivolol. As part of the combination therapy, patients were administered quinapril was prescribed (13.52.5 mg/day, n=34 and 12.82.8 mg/day, n=34), and if indicated, acetylsalicylic acid, atorvastatin. Initially and after 24 weeks of therapy were carried out: quantitative assessment of RAS, echocardiography, treadmill test, six-minute walking test, subjective assessment of quality of life, determination of the level of N-terminal propeptide of brain natriuretic hormone in blood plasma, daily monitoring of blood pressure.&#x0D; Results. Both schemes of combined therapy comparably improved the structural and functional state of the heart, controlled arterial hypertension. In comparison with bisoprolol, nebivolol differed positive impact on RAS, more increased tolerance to physical activity and improved quality of life.&#x0D; Conclusion. In patients with diastolic CHF and HD III stage, the use of nebivolol in combination therapy may be preferable due to the positive effect on RAS, in comparison with bisoprolol.

Introduction: There is currently strong evidence of the adverse effects of anemia on the prognosis of heart failure with reduced ejection fraction. Unfortunately, the data on the effects of anemia on a large sample of patients with diastolic heart failure (DHF) is lacking. In this study, we aimed to evaluate the effect of iron deficiency anemia on DHF readmission rates and its corresponding causes and burdens on the healthcare system. Methods: We utilized 2018 Nationwide readmission data and included patients aged ≥18 years with ICD-10 CM code indicating acute or acute chronic diastolic heart failure and iron deficiency anemia was included in the study. The primary outcome is 30-day readmission rates. Secondary outcomes were mortality rates, common causes of readmission, and healthcare utilization. Independent predictors for readmission were identified using cox regression analysis. Results: The total number of admissions in our study was 795,777. The mean age was 74.4 years (SD=13.7), and 63.54% were females. The 30-day readmission rate in patients with diastolic heart failure and iron deficiency anemia was 18.32 % vs. 16.01% in patients without anemia. The mortality rate at index admission and readmission was 3.62 % (2601) and 5.82 % (737), respectively. The most common cause of readmission was hypertensive heart and kidney disease with heart failure (17.74%). The independent predictors of readmission were age&lt;85 years, household income &lt;59000$/per year, Medicare and Medicaid insurance, higher Elixhauser comorbidities score, longer Length of stay during the index admission, discharge to a nursing home, hospital located in a large metropolitan area. The financial burden on healthcare for all the readmission was $837 million for 2018. Conclusion: The 30-day readmission rate in patients with diastolic heart failure and iron deficiency anemia is 18.32% in the year 2018. The mortality rate increased from 3.62 % to 5.82 % with readmission. The financial burden for readmission during that year was $837 million. Future studies are warranted to treat iron deficiency anemia to prevent readmissions in diastolic heart failure.

BACKGROUNDThere are rising numbers of patients who have heart failure with preserved ejection fraction (HFpEF). Poorly understood pathophysiology of heart failure with preserved and reduced ejection fraction and due to a sparsity of studies, the management of HFpEF is challenging.AIMTo determine the hospital readmission rate within 30 d of acute or acute on chronic heart failure with preserved ejection fraction and its effect on mortality and burden on health care in the United States.METHODSWe performed a retrospective study using the Agency for Health-care Research and Quality Health-care Cost and Utilization Project, Nationwide Readmissions Database for the year 2017. We collected data on hospital readmissions of 60514 adults hospitalized for acute or acute on chronic HFpEF. The primary outcome was the rate of all-cause readmission within 30 d of discharge. Secondary outcomes were cause of readmission, mortality rate in readmitted and index patients, length of stay, total hospitalization costs and charges. Independent risk factors for readmission were identified using Cox regression analysis. RESULTSThe thirty day readmission rate was 21%. Approximately 9.17% of readmissions were in the setting of acute on chronic diastolic heart failure. Hypertensive chronic kidney disease with heart failure (1245; 9.7%) was the most common readmission diagnosis. Readmitted patients had higher in-hospital mortality (7.9% vs 2.9%, P = 0.000). Our study showed that Medicaid insurance, higher Charlson co-morbidity score, patient admitted to a teaching hospital and longer hospital stay were significant variables associated with higher readmission rates. Lower readmission rate was found in residents of small metropolitan or micropolitan areas, older age, female gender, and private insurance or no insurance were associated with lower risk of readmission.CONCLUSIONWe found that patients hospitalized for acute or acute on chronic HFpEF, the thirty day readmission rate was 21%. Readmission cases had a higher mortality rate and increased healthcare resource utilization. The most common cause of readmission was cardio-renal syndrome.

PO-712-03 RATE OF 30-DAY READMISSION AND ECONOMIC BURDEN IN PATIENTS WITH SICK SINUS SYNDROME WITH COEXISTING CHRONIC DIASTOLIC HEART FAILURE WHO UNDERWENT PACEMAKER INSERTION

Reverse Septal Contour On Cardiac Magnetic Resonance Imaging- A Mimicker Of Hypertrophic Cardiomyopathy In Transthyretin Cardiac Amyloidosis

Pulmonary Hypertension and Diastolic Heart Failure in an Adolescent African-American Cantú Syndrome Patient

Background: Acute diastolic heart failure (DHF) is a common but poorly studied diagnosis in hospitalized nonagenarians. Objective: To identify predictors of 30-day readmission in nonagenarians hospitalized with acute DHF. Methods: We queried National Readmission Database (NRD) of years 2016-2018 for patients aged 90 or above admitted with acute or acute on chronic DHF. ICD-10 was used to identify diagnoses. We excluded patients discharged in December and those who died in index admission. Univariate regression was performed on each variable. Variables with p value of &lt; 0.2 were included in our multivariate regression model (figure 1). Results: From a total of 45393 index admissions, 43646 (96.2%) survived to discharge. A total of 7437 (16.4%) patients had a 30-day readmission. Mean cost of readmission was 43265 USD per patient. Significant predictors of 30-day readmission were chronic ischemic heart disease (OR=1.11, 95%CI [1.01-1.22], P=0.023), chronic kidney disease stage 3 or above (OR=1.19, 95%CI [1.07-1.34], P=0.002), complicated diabetes (OR=1.22, 95%CI [1.07-1.38], P=0.003), and length of stay (LOS) &gt; 2 days (OR=1.20, 95% CI [1.09-1.32], P=0.000). Female sex (OR=0.90, 95% CI [0.83-0.99], P=0.030) and palliative care visit (OR=0.27, 95% CI [0.21-0.34], P=0.000) were associated with lower odds of readmission. Conclusion: In nonagenarians hospitalized with acute DHF, 30-day readmission is common and costly. Chronic comorbidities and LOS &gt;2 days were predictors of readmission. Palliative care visit was strongly associated with lower risk of readmission. Further strategies need to be developed to improve the quality of care and prevent readmission in this age group.

Abstract Introduction The incidence of heart failure has exponentially increased over the last few decades and acute decompensated diastolic heart failure is one of the leading causes of hospitalization and readmission. Cardiac amyloidosis is one of the rapidly progressing heart conditions. It occurs due to amorphous proteinaceous material called amyloid into the extracellular space of the heart. The infiltration of the heart from amyloid protein has a broad spectrum of presentation, including diastolic heart failure. Purpose Heart failure due to amyloidosis is characterized by diastolic dysfunction resulting from restrictive cardiomyopathy. The outcomes of hospitalized patient with acute decompensated diastolic heart failure in amyloidosis patients compared to those without amyloidosis is not well defined. Methods We conducted a retrospective cohort study by utilizing the National Inpatient sample database from 2017. Using International Classification of disease (ICD)-10 codes, patients with the diagnosis of acute and acute on chronic diastolic heart failure were enrolled in the study. They were further stratified based on the presence of amyloidosis. The primary outcome was to measure in-hospital mortality, while secondary outcomes included development of acute kidney injury (AKI), Acute respiratory failure (ARF), shock and arrhythmias. Results Out of the 915,694 patients with Acute Decompensated diastolic heart failure, about 2270 had amyloidosis as secondary diagnosis. 6.1% of ADHF and amyloidosis died in hospital, compared to 4.2% in those without amyloidosis (aOR=1.35 CI=0.89–2.05, p=0.197). On multivariate analysis, patients with Amyloidosis had increased odds of developing AKI (aOR=1.40 CI 1.13–1.72, p=0.001), Cardiogenic shock (aOR=2.67 CI 1.56–4.55, p&amp;lt;0.001) and arrhythmias (aOR=1.34, CI 1.10–1.64, p=0.004). The incidence of ARF was however lower in patients without amyloidosis compared to those with it (aOR=0.60, CI 0.47–0.75, p&amp;lt;0.001). Conclusion Amyloidosis is one of the underappreciated and underdiagnosed causes of heart failure. Our study shows an increased risk of complications in acute decompensated heart failure with the presence of amyloidosis. Thus, physicians must be aware of this clinical entity for early diagnosis as patients with advanced disease are likely to have poor prognoses. Funding Acknowledgement Type of funding sources: None.

COVID-19 INFECTION IN A PATIENT WITH HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY

Objective. Compare the eff ect of combination therapy with nebivolol or carvedilol on the functional state of patients with chronic heart failure (CHF) and preserved ejection fraction (pEF) of the left ventricle (LV). Material and methods. The study involved 80 patients with diastolic CHF, who were randomized into two groups. In group I was appointed of nebivolol (7.7 ± 2.4 mg/day, n = 40), in group II — carvedilol (30.5 ± 8.7 mg/day, n = 40). As part of the combination therapy, quinapril was prescribed (13.7 ± 2.7 mg/day, n = 40 and 13.5 ± 2.6 mg/day, n = 40), and if indicated — atorvastatin (15.3 ± 4.6 mg/day, n = 17 and 16.2 ± 5.2 mg/day, n = 17) and acetylsalicylic acid in the intestinal soluble shell (96.4 ± 13.4 mg/day, n = 14 and 93.8 ± 13.3 mg/day, n = 13), respectively. Initially and after 6 months of therapy were carried out: quantitative assessment of regulatory-adaptive status (RAS) (by means of a sample of cardiac-respiratory synchronism), echocardioscopy, treadmill test, test with a six-minute walk, subjective assessment of quality of life, determination of the level of the N-terminal fragment of the brain natriuretic peptide in blood plasma, daily monitoring of blood pressure. Results. Both schemes of combined therapy comparably improved the structural and functional state of the heart, controlled arterial hypertension. In comparison with carvedilol, nebivolol diff ered positive eff ect on the RAS, more increased tolerance to physical activity and improved quality of life. Conclusion. In patients with CHF pEF LV in combination therapy, the use of nebivolol, in comparison with carvedilol, may be preferable due to the more pronounced positive eff ect on the functional state.

Relevance. Cardiotrophin-1 (CT-1) is a member of interleukin-6 (IL-6) superfamily and is associated with cardiovascular pathology. The production of CT-1 increases in response to myocardial wall stretching and increase in its rigidity and is also modulated by a wide range of neurohormones and peptides, which allows to monitor CT-1 as a marker of biomechanical stress. However, the prognostic significance of CT-1 in patients with diastolic heart failure with hypertrophic cardiomyopathy (HCM) remains poorly understood.Objective. To study the blood serum cardiotrophin-1 contents and their relationships with NT-proBNP in patients with obstructive hypertrophic cardiomyopathy and in patients with severe left ventricular (LV) dysfunction.Material and Methods. The study comprised a total of 76 patients with obstructive HCM and 31 patients with severe LV dysfunction. The group of patients with HCM comprised patients with obstructive form; the group of patients with severe LV dysfunction included patients with the third type of post-infarction LV remodeling and ejection fraction (EF) of less than 30%. The determination of cardiotrophin-1 and highly sensitive C-reactive protein was carried out by the enzyme immunoassay. The study of NT-proBNP content in blood serum was performed by multiplex immunoassay using the FLEXMAP 3D Luminex Corporation system.Results. The content of cardiotrophin-1 in the blood serum of patients with obstructive HCM was higher than in the group of patients with severe LV dysfunction. The study of NT-proBNP concentrations in the blood serum showed increases in the content in both groups of patients. The median concentrations of NT-proBNP and C-reactive protein in patients with severe LV dysfunction were increased compared to the median concentration in patients with obstructive HCM.Conclusion. The study showed an increase in cardiotrophin-1 content in the blood serum in patients with obstructive HCM with chronic diastolic heart failure. The increase in cardiotrophin-1 content was directly associated with the increase in NTproBNP level in patients with obstructive HCM with chronic diastolic heart failure.