Exacerbation Of Chronic Heart Failure Research Articles

Necrotizing Fasciitis-Induced Septic Shock due to Aeromonas hydrophila: A Case Report.

Aeromonas hydrophila (A. hydrophila), a Gram-negative bacterium commonly found in aquatic environments, has the capacity to be transmitted to humans through consumption of contaminated fish, water, or seafood. In this study, we present a case report concerning a 77-year-old female patient who experienced an acute exacerbation of chronic heart failure, subsequently developing severe septic shock due to necrotizing fasciitis caused by A. hydrophila. Infections caused by A. hydrophila are more prevalent during warmer months, particularly in regions characterized by dense aquaculture or the presence of natural water bodies. The excessive use of antibiotics in aquaculture has contributed to the emergence of antibiotic-resistant A. hydrophila strains. The proliferation of multidrug-resistant A. hydrophila presents a significant challenge for clinicians. In the context of atypical bacterial infections, the initial empiric therapy typically involves the use of third-generation cephalosporins in conjunction with quinolone antibiotics. In the present case, the patient's successful recovery was achieved through the administration of a combination of cefoperazone/sulbactam and levofloxacin, as determined by sensitivity testing. This case study underscores the critical importance of considering A. hydrophila infection in patients with septic shock who present with necrotizing fasciitis.

Clinical outcomes following shock team implementation for cardiogenic shock: a systematic review

Abstract Background Cardiogenic shock is a critical cardiac condition characterized by low cardiac output leading to end-organ hypoperfusion and associated with high in-hospital mortality rates. It can manifest following acute myocardial infarction or acute exacerbation of chronic heart failure. Despite advancements, mortality rates remain elevated, prompting interest in multidisciplinary approaches to improve outcomes. This manuscript presents a review focused on the concept of a cardiogenic shock team and its potential impact on patient management and outcomes. Methods A comprehensive search was performed on March 19, 2023, covering PubMed, Web of Science, Scopus, Embase, and Cochrane Library. We included primary studies (prospective and retrospective) only and evaluated their quality using the Newcastle–Ottawa Quality Scale. This review was registered in PROSPERO (CRD42023440354). Results Six relevant studies with 2066 cardiogenic shock patients were included, of which 1071 were managed by shock teams and 995 received standard care. Findings from the reviewed studies indicated the favorable outcomes associated with implementing cardiogenic shock teams. Patients managed by these teams exhibited higher 30-day and in-hospital survival rates compared to those without team intervention. The implementation of cardiogenic shock teams was linked to reduced in-hospital and intensive care unit mortality rates. Additionally, shock team involvement was associated with shorter door-to-balloon times. Conclusion The findings suggest that cardiogenic shock teams play a crucial role in improving patient outcomes through earlier detection and timely interventions. Despite challenges in team implementation, their potential to reduce mortality and improve efficiency in patient care warrants further research and greater integration of multidisciplinary strategies into clinical practice.

Influence of Metformin Discontinuation on Readmission Rate in Patients With Acute Heart Failure.

The consequences of discontinuing metformin in patients with heart failure have not been determined. Knowing that acute exacerbation of chronic heart failure contributes to substantial increases in major adverse cardiovascular events (MACE), we proposed a retrospective study to examine whether discontinuing metformin in patients hospitalized with heart failure impacts mortality and readmission rates. We conducted a retrospective analysis of patients admitted with a diagnosis of acute heart failure to hospitals in the HCA Healthcare System from 2020 to 2022. Included patients had a prior diagnosis of diabetes mellitus, acute heart failure, and were taking metformin prior to admission. After applying our exclusion criteria, a total of 7740 patients remained. The primary outcomes were 30-, 60-, and 90-day readmission rates and secondary outcomes were mortality and length of stay. Patients who were discharged without a prescription for metformin (NONDIS-MET) were 4.489 (95% CI 3.673-5.488, p < 0.0001) times more likely to have a MACE outcome in 30 days compared to patients who received a discharge order for metformin (DIS-MET). The findings were similar for 60-day and 90-day readmission rates, with NONDIS-MET patients 3.457 (95% CI 2.893-4.131, p < 0.0001) and 2.992 (95% CI 2.534-3.533 p < 0.0001) times more likely to have a MACE outcome than MET patients, respectively. However, when metformin was continued during the patients' hospital stay (CONT-MET) there was no significant association with MACE outcomes, readmission, or mortality rates. We found that diabetic patients admitted with acute heart failure exacerbations had a higher incidence of major adverse cardiac events and were more likely to be readmitted when they were not prescribed metformin after discharge. Our findings agree with prior work showing the cardioprotective effects of metformin; however, continuing metformin during hospital admission did not affect our patients adverse outcomes.

Xinbao pill attenuated water retention by regulating the CaSR/AQP2 pathway in LAD-induced chronic heart failure rats

BackgroundWater retention is one of the important factors in the development and exacerbation of chronic heart failure (CHF). Xinbao Pill (XBP) is widely used as an adjuvant therapy for CHF. However, the therapeutic effect of XBP on water retention in CHF remains unclear. PurposeOur research was aimed to investigate the effect and mechanism of XBP on water retention in CHF. MethodsMale Sprague-Dawley (SD) rats underwent left anterior descending (LAD) artery ligation to establish the CHF model and were subsequently administrated with different doses of XBP or Qili Qiangxin (QLQX). Cardiac functions were assessed using M-mode echocardiography. Cardiac remodeling and myocardial fibrosis were observed using HE and Masson staining. Additionally, the expression of the CaSR/AQP2 signaling pathway in the renal was detected using western blotting analysis, quantitative PCR analysis, immunofluorescence staining, immunohistochemistry, and co-immunoprecipitation assays. Furthermore, CaSR inhibitor NPS2143 was used to confirm the role of CaSR on the effect of XBP for water retention. ResultsIn the LAD-induced CHF rat model, XBP improved EF (ejection fraction) and LVFS (fractional shortening), and alleviated cardiac fibrosis. Importantly, XBP significantly increased the 24-h urine volume and decreased urinary protein level after CHF. Further mechanism studies showed that XBP treatment could decrease the expression of renal AQP2 at the protein and mRNA levels. Moreover, XBP promoted renal AQP2 ubiquitination by upregulating CaSR and p-p38-MAPK expression. Meanwhile, XBP suppressed the expression of p-CREB to inhibit the mRNA expression of AQP2 in the renal tissue. However, NPS2143 blocked the beneficial effects of XBP on cardiac function and water retention, even stopped the inhibitory effect on AQP2 expression by XBP. ConclusionOur study revealed that XBP improved water retention against CHF via promoting CaSR/p38-MAPK-mediated AQP2 ubiquitination and regulating CaSR/CREB-mediated AQP2 transcription.

High-altitude-induced alterations in intestinal microbiota.

In high-altitude environments characterized by low pressure and oxygen levels, the intestinal microbiota undergoes significant alterations. Whether individuals are subjected to prolonged exposure or acute altitude changes, these conditions lead to shifts in both the diversity and abundance of intestinal microbiota and changes in their composition. While these alterations represent adaptations to high-altitude conditions, they may also pose health risks through certain mechanisms. Changes in the intestinal microbiota induced by high altitudes can compromise the integrity of the intestinal mucosal barrier, resulting in gastrointestinal dysfunction and an increased susceptibility to acute mountain sickness (AMS). Moreover, alterations in the intestinal microbiota have been implicated in the induction or exacerbation of chronic heart failure. Targeted modulation of the intestinal microbiota holds promise in mitigating high-altitude-related cardiac damage. Dietary interventions, such as adopting a high-carbohydrate, high-fiber, low-protein, and low-fat diet, can help regulate the effects of intestinal microbiota and their metabolic byproducts on intestinal health. Additionally, supplementation with probiotics, either through dietary sources or medications, offers a means of modulating the composition of the intestinal microbiota. These interventions may offer beneficial effects in preventing and alleviating AMS following acute exposure to high altitudes.

Association between Psychiatric Disorders and the Incidence of Heart Failure in Women.

Depression and anxiety occur more frequently in women and are associated with an increased risk of cardiovascular disease. Data on the association between these psychiatric conditions and the incidence of acute heart failure (HF) and how they influence heart failure outcomes in women are lacking. We investigated this potential relationship using data from the National Inpatient Sample. We used ICD-10 codes to extract encounters for acute heart failure and/or the acute exacerbation of chronic heart failure, anxiety, and depression from the discharge data of the NIS from 2019 to 2020. We compared baseline characteristics and length of stay (LOS), cost of care (COC) and acute HF by depression/anxiety status for males and females and employed regression models to assess the influence of these psychiatric conditions on the outcomes. There were 6,394,136 encounters involving females, which represented 56.6% of the sample. The prevalence of depression and anxiety were 15.7% and 16.8%, respectively. Among females, the occurrence of acute CHF did not differ by depression or anxiety status. However, Takostubo cardiomyopathy was more prevalent in those with depression (0.3% vs. 0.2%, p = 0.003) and anxiety (0.3% vs. 0.2%, p = 0.03) compared to those without these conditions. Among those with depression, LOS was significantly longer (3 days IQR: 2-6, vs. 3 days IQR:2-5 days, p < 0.001). The COC was USD 1481 more in patients with depression. On the contrary, LOS and COC were significantly lower in those without anxiety. Depression was associated with an increased LOS among both men and women and an increased cost of care among women. Anxiety was associated with a decreased LOS and cost of care among women, which may be related to an increased rate of against medical advice (AMA) discharges among this population. Further research is necessary to identify optimal management strategies for depression and anxiety among patients hospitalized with HF.

Redox state of human serum albumin predicts 1-year prognosis in patients with heart failure: a single center prospective cohort study

Abstract Background As chronic inflammation would be a fundamental underlying mechanism in the pathogenesis in patients with heart failure (HF), oxidative stress has a possibility to closely associate with the prognosis. However, little is known about the association of oxidative stress with the prognosis in HF patients. Purpose In this study, we assessed the association of the fraction of human mercapto-albumin [f(HMA)], an index of the redox state of human serum albumin, with prognosis in patients hospitalized for HF with the aim to find the possible biomarker available on the prediction for adverse events in HF patients. Methods A single-center prospective cohort study was conducted. In the cohort, 290 ambulate patients admitted for acute HF or exacerbation of chronic HF were registered. Of these, 182 who were successfully followed-up patients were analyzed (median age: 79 years, men: 68.3%. median follow-up: 365 days). The primary outcome was a composite of HF rehospitalization and all-cause mortality. The high-performance liquid chromatography postcolumn bromocresol green method was used to part human serum albumin into human nonmercaptalbumin (oxidized form) and human mercaptalbumin (HMA, reduced form). We divided patients into two groups by median f(HMA) level. Kaplan-Meier Curve and the Cox proportional hazards model was used to examine the significance of f(HMA) as a prognostic indicator of HF patients, adjusting for potential confounding factors. Results Median level of f(HMA) was 57.2%. During 50,965 person-days of follow-up, 52 patients (28.6%) were re-hospitalized due to HF exacerbation, and 25 patients (13.7%) died due to cardiac or noncardiac reasons. Log-rank analysis showed that a high f(HMA) group reduced adverse events (Fig. 1). In the Cox proportional hazards model, a high level of f(HMA) was associated with a reduced risk of composite outcomes (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.39-1.07). In the subgroup analysis, high f(HMA) showed an event-reducing effect in HF rehospitalizations (HR 0.53; 95% CI 0.30-0.94), but not in all-cause mortality (HR 0.61; 95%CI 0.27-1.38). Conclusion The findings of this study support that f(HMA) could be a novel prognostic biomarker for HF patients.Fig. 1

Abstract 14956: Outcomes of Leadless Pacemaker Implantation Following Transvenous Lead Removal of Infected Cardiac Implantable Electronic Device: A Systematic Review

Background: The outcomes of leadless pacemaker (LP) implantation after transvenous lead removal (TLR) of infected cardiac implantable electronic devices (CIED) are not well-established. Objective: This study sought to describe the outcomes of LP implantation following TLR of infected CIED. Method: We conducted a literature search using PubMed and Embase for a combination of term including leadless pacemaker implantation, transvenous lead extraction, transvenous lead removal , transvenous lead explant , infected cardiac implantable electronic device . The inclusion criterion was LP implantation after TLR of infected CIED. The exclusion criterion was TLR for non-infectious reason. Study end-points were procedural complications and LP infection. Result: Of 132 publications reviewed, 13 studies with a total of 253 patients (74 ± 14 years of age, 69% males) were included. Amongst, 56.8% had systemic CIED infection and 43.2% had isolated pocket infection. Staphylococcus Aureus was the most common causative organism in 33% of the reported patients. Of 253 patients included, 105 patients (41.5%) underwent concomitant LP implantation during TLR procedure, and 36 patients (14.2%) had transvenous pacing as a bridge from TLR to LP implantation. During the LP implantation, 1 patient (0.4%) had an intra-procedural complication requiring sternotomy. Post-LP implantation, 2 patients (0.8%) developed groin hematoma, 2 patients (0.8%) developed femoral arteriovenous fistula, and 1 patient (0.4%) developed pericardial effusion requiring pericardiocentesis. During a mean follow-up of 11.3 ±10.6 months, 3 patients (1.2%) developed pacemaker syndrome, 1 patient (0.4%) developed acute on chronic heart failure exacerbation, and only 1 patient (0.4%) developed LP-related infection requiring LP retrieval. Conclusion: This study suggests that LP implant is feasible and safe post-removal of infected CIED with cumulative adverse events at 4% and a reinfection rate of 0.4%.

Abstract 16556: Tafamidis: A Game Changer in Transthyretin Cardiomyopathy? A Systematic Review of Efficacy and Safety

Introduction: FDA approval of tafamidis as a treatment for Transthyretin cardiomyopathy (ATTR-CM) was preceded by demonstrating clinical efficacy and safety based on double-blind trials that showed reduction in mortality, and cardiovascular-related hospitalization. We conducted a systematic review to assess the safety and efficacy using present literature. Methods: 7 studies were included in this meta-analysis from PubMed and Embase comparing tafamidis treatment to no tafamidis for ATTR-CM. Mantel-Haenszel method was used to calculate pooled log odds-ratio (OR) for binary outcomes and Hedges’ g using inverse-variance method for continuous outcomes. Results: Tafamidis was associated with decreased odds of mortality (OR 0.55, 95% CI 0.42-0.73, I2=41%, p&lt;0.0001) and reduced CHF exacerbations (OR 0.71, 95% CI 0.51-0.99, I2= 0%, p= 0.04). While, CHR related hospitalizations (OR 0.35, 95% CI 0.07-1.67, I2= 87%, p= 0.19), atrial arrythmias (OR 0.98, 95% CI 0.67-1.42, I2= 0%, p= 0.9), change in left ventricular ejection fraction (OR 0.78, 95% CI -0.32-1.87, I2= 91%, p= 0.16), left ventricular end-diastolic diameter (OR -0.12, 95% CI -0.41-0.18, I2= 0%, p= 0.4), interventricular septal thickness from baseline (OR -0.26, 95% CI 0.56-0.04, I2= 0%, p= 0.08) were not statistically different for tafamidis compared to no tafamidis for ATTR-CM. Conclusion: Tafamidis treatment in ATTR-CM is associated with reduced all-cause mortality and CHF exacerbation. These observations are consistent with the ATTRACT trial supporting the efficacy of tafamidis in the treatment of ATTR-CM.

Abstract 14927: Transcatheter Aortic Valve Implantation Bailout for Severe Aortic Insufficiency Due to Aortic Root Dissection Following Ascending Aortic Aneurysm Repair

Case Presentation: 75-year-old female with history of conservatively managed ascending aortic aneurysm with mild Aortic Insufficiency (AI) and a chronic Type B aortic dissection. Due to rapid aneurysmal expansion she underwent surgical ascending aortic aneurysm repair with a 32-mm Gelweave graft, aortic valve commissuroplasty, and 1-vessel aorta-to-right coronary artery bypass graft. She was discharged 15 days post-op in stable condition. However presented 2 weeks later with new onset dyspnea with minimal exertion, orthopnea, peripheral edema, wide arterial pulse pressure (150/50 mmHg), jugular venous distention. Transthoracic and transesophageal echocardiography showed a new and severe AI, with preserved left ventricular ejection fraction. A computed tomography angiogram (CTA) of the chest showed an acute aortic dissection at the proximal and distal segments of the aortic graft (Figure 1). She underwent a transcatheter aortic valve implantation (TAVI) with a self-expanding bioprosthesis: 27 mm Portico TM valve (St. Jude Medical, St. Paul, MN, USA) anchored at the annular level (annular area 370 mm 2 , perimeter 69 mm with calculated over sizing of 30%) and at the 32 mm Gelweave graft level (42 mm bioprosthesis aortic outflow dimension) without acute complications (Figure 2). She was discharged and remained clinically well without recent readmission for CHF exacerbation. Conclusions: Patient was deemed a poor surgical candidate due to frailty and recent sternotomy. This case demonstrates TAVI as off-label treatment option for severe AI due to aortic root dissection in poor surgical candidates.

THU506 A Not-So-Simple Case Of Hyperparathyroidism

Abstract Disclosure: P.J. Bhatt: None. S. Rabiei: None. V. Kantorovich: None. Multiple endocrine neoplasia 1 (MEN-1) is a rare autosomal dominant disorder caused by an inactivating mutation of the MEN-1 tumor suppressor gene and is associated with tumors of the parathyroid (95%), endocrine pancreas (40-70%) and anterior pituitary (30-40%). Primary hyperparathyroidism is the most frequent and earliest expression of MEN1 syndrome with a typical onset at age 20-25 in inherited cases, reaching 100% penetrance after age 50. Current guidelines recommend genetic testing in all individuals with primary hyperparathyroidism diagnosed at a young age, with multiglandular disease, or with family history of primary hyperparathyroidism. A 58 year old female with a history of L. breast cancer, pulmonary embolisms, DM2, and recurrent nephrolithiasis was diagnosed with primary hyperparathyroidism at age 36 and had a parathyroidectomy with 3.5 gland removal and later a total thyroidectomy. She continued to be symptomatic and was found to have an ectopic parathyroid gland in her chest requiring parathyroid gland reimplantation 18 years later. After 3 years, she was admitted for a CHF exacerbation and a pancreatic tail lesion was incidentally discovered. There was no mention of pancreatic lesions prior to this reading. Family history was pertinent for a father with nephrolithiasis. Her daughter had recurrent nephrolithiasis, hyperparathyroidism and was found to have a MEN 1 variant of uncertain significance, prompting the patient to seek genetic counseling. 22 years after her initial diagnosis of hyperparathyroidism, she tested positive for a likely pathologic heterozygous variant mutation of the MEN1 gene called 1747C&amp;gt;T. At endocrinology follow-up, she was asymptomatic. Labs showed elevated Chromogranin A at 1,799 ng/ dL [&amp;lt;311] and gastrin 174pg/mL [&amp;lt;/=100]. FSH, LH, prolactin, free alpha subunit, cortisol, and IGF-1 were normal. Further imaging confirmed a DOTATATE-avid 1.1cm nodular lesion in the pancreatic tail, concerning for a neuroendocrine tumor. MEN1 gene mutation is associated with MEN1 syndrome, familial isolated hyperparathyroidism and has an autosomal dominant predisposition to thyroid cancer and paraganglioma-pheochromocytoma syndrome. The 1747C&amp;gt;T sequence change creates a premature translational stop signal in the MEN1 gene and disrupts the NLS2 domain of the MEN1 protein, which is important for DNA binding and repression of cell proliferation. Upon diagnosis of multiglandular hyperparathyroidism, the patient should have been sent for genetic testing and instead, became an example of a multisystem failure to identify and provide necessary testing and treatment. Until her variant diagnosis, her pancreatic tumor was not identified as such. The main cause of mortality in MEN-1 patients is malignant spread of neuroendocrine tumors, hence early detection and prompt treatment are of the utmost importance to preserve quality of life and improve survival. Presentation: Thursday, June 15, 2023

Applying the Rome Proposal on Exacerbations of Chronic Obstructive Pulmonary Disease: Does Comorbid Chronic Heart Failure Matter?

Chronic heart failure (CHF) is a common comorbidity among patients with chronic obstructive pulmonary disease (COPD). Both exacerbations of COPD (ECOPDs) and exacerbations of CHF (ECHFs) display worsening of breathlessness at rest (BaR) and breathlessness at physical activity (BaPA). Comorbid CHF may have an impact on the vital signs assessed, when the Rome proposal (adopted by GOLD 2023) is applied on ECOPDs. Thus, the aim of the present study was to investigate the impact of comorbid CHF on ECOPDs severity, particularly focusing on the influence of comorbid CHF on BaR and BaPA. We analysed data on COPD symptoms collected from the telehealth study The eHealth Diary. Patients with COPD (n = 43) and patients with CHF (n = 41) were asked to daily monitor BaR and BaPA, employing a digital pen and scales for BaR and BaPA (from 0 to 10). Twenty-eight patients of the COPD patients presented with comorbid CHF. Totally, 125 exacerbations were analysed. Exacerbations in the group with COPD patients and comorbid CHF were compared to the group with COPD patients without comorbid CHF and the group with CHF patients. Compared with GOLD 2022, the GOLD 2023 (the Rome proposal) significantly downgraded the ECOPD severity. Comorbid CHF did not interfere significantly on the observed difference. Comorbid CHF did not worsen BaR scores, assessed at inclusion and at the symptom peak of the exacerbations. In the present study, we find no evidence that comorbid CHF would interfere significantly with the parameters included in the Rome proposal (GOLD 2023). We conclude that the Rome proposal can be safely applied even on COPD patients with very advanced comorbid CHF.

Investigation of the efficacy of the change ratio of brain natriuretic peptide for predicting the cardiac effects of chemoradiotherapy on esophageal cancer.

The aim of this study was to investigate the effectiveness of brain natriuretic peptide (BNP) as a predictor of radiological effects on the heart. A total of 41 patients with esophageal cancer who underwent chemoradiotherapy (CRT) were retrospectively investigated. The BNP levels were measured on the first day of CRT (pre-CRT) and the last day of CRT (post-CRT), and the median concentration of BNP and dosimetric parameters of the heart were calculated. The change ratio of BNP was calculated as follows: [(BNP post-CRT) - (BNP pre-CRT)]/(BNP pre-CRT). The comparison of BNP pre-CRT with post-CRT was performed using a Wilcoxon signed-rank test. The relationship between dosimetric parameters and change ratio was analyzed using Spearman's correlation coefficient. The median levels of BNP of pre-CRT and post-CRT were 10 and 22 pg/ml, respectively, and the difference was statistically significant (P<0.0001). Significant correlations (all P<0.05) were observed between the change ratio and mean dose, V5, V10, V20, and V30. Of the cohort, 14 patients developed acute-to-subacute cardiac events, such as pericardial effusion, cardiomegaly, acute exacerbation of chronic heart failure, and a decreased ejection fraction. The change ratios of BNP, V5, V10, V20, and V30 were significantly higher in patients who experienced cardiac events compared with those who did not. The results of this study showed that BNP measurement, particularly the change ratio of BNP pre- and post-CRT, may be a useful cardiac event predictor in addition to dosimetric parameters.

A Systematic Review of Short-Term Outcomes of Leadless Pacemaker Implantation After Transvenous Lead Removal of Infected Cardiac Implantable Electronic Device

The outcomes of leadless pacemaker (LP) implantation after transvenous lead removal (TLR) of infected cardiac implantable electronic devices (CIEDs) are not well-established. This study sought to describe the outcomes of LP implantation after TLR of infected CIED. We conducted a literature search using PubMed and Embase for a combination of terms including LP implantation, transvenous lead extraction, TLR, transvenous lead explant, infected CIED, infected pacemaker, and infected implantable cardioverter defibrillator. The inclusion criterion was LP implantation after TLR of infected CIED. The exclusion criterion was TLR for noninfectious reasons. Study end points included procedural complications and LP infection during follow-up. Of 132 publications reviewed, 13 studies with a total of 253 patients (74±14 years of age, 174 [69%] males) were included. The most common indication of the initial device implantations was a high-degree atrioventricular block (n=100 of 253, 39.5%). Of the 253 patients included, 105 patients (41.5%) underwent concomitant LP implantation during the TLR procedure, and 36 patients (14.2%) had temporary transvenous pacing as a bridge from TLR to LP implantation. Of the 148 patients with data on the type of CIED infection, 56.8% had systemic CIED infection and 43.2% had isolated pocket infection. Staphylococcus aureus was the most common causative organism in 33% of the reported patients. The LP was implanted an average of 5.4±10.7 days after TLR of infected CIED. During the LP implantation, 1 patient (0.4%) had unsuccessful implantation because of an intraprocedural complication requiring sternotomy. After LP implantation, 2 patients (0.8%) developed groin hematoma, 2 patients (0.8%) developed femoral arteriovenous fistula, and 1 patient (0.4%) developed pericardial effusion requiring pericardiocentesis. During a mean follow-up of 11.3±10.6 months, 3 patients (1.2%) developed pacemaker syndrome, 1 patient (0.4%) developed acute on chronic heart failure exacerbation, and only 1 patient (0.4%) developed LP-related infection requiring LP retrieval. This study suggests that LP implant is feasible and safe after removal of infected CIED with cumulative adverse events at 4% and a reinfection rate of 0.4%. Large prospective studies are needed to better evaluate the best timing of LP implantation after TLR of an infected CIED.

Management of Cardiogenic Shock: Present and Future.

Management of Cardiogenic Shock: Present and Future.

Influence of prosthesis – patient mismatch on long-term results in patients after aortic valve replacement with a biological prosthesis: retrospective single center study

Background. Despite numerous studies, ambiguity remains at present regarding the impact of prosthesis-patient mismatch (PPM) on long-term outcomes after aortic valve (AV) replacement.&#x0D; Objective. This study evaluates the effect of PPM on long-term results in patients after AV replacement with a biological prosthesis.&#x0D; Material and methods. We retrospectively analyzed the data of 231 patients who underwent AV replacement with a biological prosthesis from 2010 to 2018 at the Penza Federal Center of Cardiovascular Surgery. Patients were implanted with the following biological prostheses: Medtronic Mosaic, Edwards PERIMOUNT, Biocor.&#x0D; Results. Moderate PPM was present in 131 patients (56%), and severe PPM in 1 patient (0.7%). The mean follow-up was 78.832 months. There were no significant differences in hospital mortality in patients with and without PPM, 4 (3%) and 3 (2,9%), respectively, p=0.9. In the long-term period, patients with PPM showed a slower regression of left ventricle (LV) mass and recovery of LV contractile function than patients without PPM, p=0.05. There was no significant difference in survival in the long-term follow-up period between patients with and without PPM long-term survival, 77.7% and 79%, respectively, p=0.6. Also, there were no significant differences in major adverse cardiac events and the freedom from adverse events was 90% and 91%; p=0.7. However, there was a tendency to more frequent hospitalization for chronic heart failure (CHF) exacerbation in the patient group with PPM than in those without PPM, 63.8% and 78%; HR 1.6; 95% CI 0.932.1, p=0.007. There was also a tendency for an increased biological valve structural degeneration in the group with PPM than in the group without PPM 76% and 87%, HR 1.4; 95% CI 1.43.1, p=0.01 According to the Cox regression, the overall postoperative mortality predictors were diabetes mellitus, vascular atherosclerosis HR 5; 95% CI 1.222, p=0.04 and HR 2.9; 95% CI 1.46.6, p=0.01 respectively. Predictors of the risk of hospitalization due to CHF exacerbation were previous myocardial infarction and PPM HR 0.4; 95% CI 0.20.9, p=0.04 and HR 1,5; 95% CI 0.92; p=0.005, respectively PPM HR 2; 95% CI 0.854.1, p=0.01.&#x0D; Conclusion. PPM is a common complication after AV replacement with a biological prosthesis. It is associated with a slower regression of LV mass, an increased risk of structural valve degeneration, and hospitalizations for exacerbated heart failure.

Cardiovascular complications of respiratory viral infections

Despite significant progress in understanding the pathogenesis and treatment of viral diseases, the influenza virus alone causes up to three to five million severe cases and 250-500 thousand deaths annually. However, respiratory viruses can affect not only the respiratory system, but also cause complications in the cardiovascular system. For example, acute coronary syndrome, myocarditis, pericarditis, exacerbation of chronic heart failure, acute heart failure, pulmonary embolism, and arrhythmias. This review provides information on the incidence of cardiovascular complications that occurred in association with acute respiratory viral infections (COVID-19, influenza, respiratory syncytial virus infection, adenovirus, and rhinovirus infections), and the mechanisms of respiratory virus impact on the cardiovascular system. Understanding these mechanisms may allow to predict the potential cardiovascular complications in patients with respiratory infections and take prompt measures to prevent them as soon as possible especially in case of life-threatening events.

PS-R05-8: THREE PATIENTS WITH CHRONIC KIDNEY DISEASE WHEREIN ANGIOTENSIN RECEPTOR NEPRILYSIN INHIBITOR WAS EFFECTIVE AGAINST HEART FAILURE AND HIGH BLOOD PRESSURE

Background: The efficacy and safety of angiotensin receptor neprilysin inhibitor (ARNI) for patients with an estimated glomerular filtration rate (eGFR) &lt; 30 mL/min/1.73m2 have not been established. This paper reports three cases of low eGFR wherein ARNI was effective against heart failure and high blood pressure. Case: In case 1 (a woman in her 70 s), eculizumab was used to treat chronic kidney disease (CKD) because of an atypical hemolytic uremic syndrome. Surgery was performed for the exacerbation of chronic heart failure due to worsening mitral regurgitation. The postoperative course was stable. However, from the third disease day, her kidney failure exacerbated (eGFR decline from 16 to 10 mL/min/1.73 m2), heart failure flared up again (B-type natriuretic peptide [BNP] elevated from 500 to 1200 pg/mL), hemodialysis was performed, carperitide was added, and the diuretic stage was started. However, the drug could not be discontinued, and ARNI was initiated (50 mg once twice a day). Consequently, the eGFR was recovered (elevated from 10 to 18 mL/min/1.73 m2), the urine output was increased, and the heart failure was recovered (BNP declined from 1200 to 250 pg/mL). In case 2 (a man in his 80 s), CKD exacerbation due to diabetic nephropathy (eGFR of 18 mL/min/1.73 m2) led to heart failure, and hemodialysis therapy and ARNI (50 mg once two times a day) were initiated. Good diuresis became available, and hemodialysis could be withdrawn (BNP declined from 120 to 70 pg/mL, and the bodyweight from 95 to 75 kg). Since then, the urine output has been maintained, and peritoneal dialysis has been initiated and continued. In case 3 (a man in his 70 s), in whom 6 months had elapsed since the initiation of hemodialysis therapy for CKD caused by diabetic nephropathy, the dry weight was appropriate, but the blood pressure tended to increase (from 140/80 to 186/96 mmHg). Moreover, BNP levels had increased (BNP elevation from 70 to 180 pg/mL). When telmisartan 40 mg once a day was changed to ARNI (100 mg once a day) as an antihypertensive agent, the blood pressure was stabilized (from 186/96 to 140/80 mmHg), and the BNP decreased (BNP declined from 180 to 20 pg/mL). No adverse events were observed in all three cases. Discussion: These cases suggest that ARNI not only has diuretic effects but decreases blood pressure and BNP in patients with CKD, including those requiring dialysis. ARNI may be used relatively safely even in patients with reduced kidney function.

For patients with heart failure on a beta-blocker, is it safe to continue beta-blockers during a hospital admission for a CHF exacerbation?

University of Colorado Family Medicine Residency, Denver, CO The corresponding author is Henry Colangelo; [email protected]. The authors declare no conflicts of interest.

Single-Center Study in Lithuania to Evaluate the Role of Transthoracic Impedance Cardiography in the Diagnosis and Outcome Evaluation of 301 Patients with Chronic Heart Failure Exacerbation.

BACKGROUND Scientific data regarding transthoracic impedance cardiography (ICG) parameters and its utility in patients with heart failure (HF) remains controversial. This study from a single center in Lithuania aimed to evaluate the role of ICG in the diagnosis and outcome evaluation of patients who were admitted to the hospital due to HF exacerbation. MATERIAL AND METHODS The sample consisted of 301 consecutive patients with a previous chronic HF diagnosis (166 men, 135 women) hospitalized for HF flare-ups. ICG data were compared to other noninvasive HF diagnostic tests. Data about patient outcomes were gathered from the Lithuanian Medical Record Database. RESULTS A weak correlation of amino-terminal pro-brain natriuretic peptide (NT-proBNP) with thoracic fluid content (TFC) and thoracic fluid content index (TFCI) was found (r=0.204, P<0.001 and r=0.207, P<0.001, respectively). There was weak to moderate correlation of 6-min walk distance with main ICG data. There was weak correlation between left ventricular ejection fraction (LVEF) with TFCI (r=-0.163, P=0.005), systolic index (r=-0.137, P=0.017), and systolic time ratio (r=0.236, P<0.001). By multivariate Cox proportional analysis, the following parameters were independently associated with cardiac death (P<0.001): NT-proBNP ≥425.5 pmoL/L (hazard ratio (HR), 5.104, 95% confidence interval (CI) 3.326-7.832), TFC ≥36.9 1/kOhm (HR, 4.604, 95% CI 2.701-7.849), LVEF ≤40% (HR, 4.942, 95% CI 2.8256-8.647). CONCLUSIONS The combination of non-invasively measured TFC, LVEF, and NT-proBNP showed great prognostic value for predicting readmissions and cardiac death in patients with HF.