Chronic Systolic Heart Failure Patients Research Articles

Does subclinical hypothyroidism affect the prognosis of patients with chronic systolic heart failure: A systematic review and meta-analysis.

Chronic systolic heart failure (CSHF) is a significant health burden with high morbidity and mortality. The role of subclinical hypothyroidism (SCH) in the prognosis of CSHF patients remains a critical area of inquiry. This systematic review and meta-analysis aim to elucidate the impact of SCH on the prognosis of patients with CSHF. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, this meta-analysis employed a comprehensive search strategy across major databases including PubMed, Embase, Web of Science, and the Cochrane Library. The Patient, Intervention, Comparison, Outcome framework guided the inclusion of studies focusing on patients with CSHF, comparing those with and without SCH. Quality assessment was performed using the Newcastle-Ottawa scale. Statistical analyses assessed heterogeneity and publication bias, employing fixed-effect or random-effects models based on heterogeneity levels. From an initial pool of 1439 articles, 8 studies met the stringent inclusion criteria. These studies, conducted across diverse geographical regions, highlighted the relationship between SCH and all-cause mortality, cardiac events, and subgroup differences in CSHF patients. The meta-analysis revealed SCH as a significant risk factor for all-cause mortality (HR = 1.42) and cardiac events (HR = 1.46). Subgroup analysis indicated variability in risk based on region, sample size, age, and follow-up duration. Sensitivity analysis confirmed the stability of these findings, and publication bias assessment indicated symmetric funnel plot and nonsignificant Egger test results. SCH emerges as a predictive factor for all-cause mortality, cardiovascular events, and rehospitalization in CSHF patients. This finding underscores the importance of screening for SCH in CSHF patients, highlighting its potential role in improving patient prognosis.

Not By Choice: Black Patients With Advanced Heart Failure Are Less Likely To Receive A Vad Or Transplant Despite Their Preferences For Care

<h3>Introduction</h3> Heart failure (HF) disproportionately affects marginalized people, including racial and ethnic minorities, and those impacted by social determinants of health (SDoH). Inequities in access to advanced therapies are well documented, though the reasons for such inequities remain uncertain. Potential explanations include access to care, patient preference, and biases in provider decision-making. <h3>Hypothesis</h3> Race and SDoH will impact utilization of advanced therapies, and patient preference for VAD will not modify the effect. <h3>Methods</h3> We performed an observational cohort study of Black and White ambulatory chronic systolic HF patients from 21 implanting VAD centers in The Registry Evaluation for Vital Information for VADs in Ambulatory Life (REVIVAL) study. Patients had ≥1 high-risk feature for death and no contraindication to VAD at enrollment. We performed competing events cause-specific proportional hazard models using multiple imputation for missing data with the primary outcomes of (1) death or (2) durable VAD/urgent transplant (TXP). Candidate variables included demographics (race, gender, age), SDoH (education, income, insurance type, caregiver), and four time-varying variables: clinician-assessed HF severity (INTERMACS Patient Profile), patient-reported quality of life (EuroQoL Visual Analogue Scale), preference for VAD given current health (3-point Likert scale), and "want for any and all life-sustaining therapies" (yes/no). <h3>Results</h3> The study included 377 participants, of whom 100 (26.5%) identified as Black. The primary outcomes of death and VAD/TXP occurred in 14.3% (n=54) and 19.4% (n=73) of patients. Preferences for VAD and life-sustaining therapies by race were similar. There was a non-significant increase in death among Black patients (HR, 95% CI; 1.23, 0.67-2.24), while Black race (0.46, 0.24-0.87) was associated with reduced utilization of VAD/TXP (Table). Preference for VAD or general life-sustaining therapies were not associated with either death or utilization of VAD/TXP. <h3>Conclusions</h3> Among patients receiving care by advanced heart failure cardiologists at VAD centers, there is less utilization of VAD/TXP for Black patients even after adjusting for HF severity, patient-reported QOL, SDoH, and despite similar patient preferences. This residual inequity in VAD and TXP may be a consequence of structural racism or result from provider bias or racism impacting clinician decision-making.

Predictors of Hemodynamic Response to Intra-Aortic Balloon Pump Therapy in Patients With Acute Decompensated Heart Failure and Cardiogenic Shock.

There is renewed interest in intra-aortic balloon pump (IABP) use in chronic systolic heart failure (HF) patients with acute decompensation and cardiogenic shock (CS). We sought to identify predictors of early IABP response to guide optimal use in this population. We retrospectively analyzed records of chronic systolic HF patients presenting to our center between 2011-2018 with acute decompensated HF who received IABP for CS. An IABP responder was defined as having both an early cardiac output (CO) increase and mean pulmonary artery pressure (MPAP) decrease above the cohort median values. During this period, a total of 218 chronic systolic HF patients received IABP for acute decompensation with CS. The average CO increase was 0.57 ± 0.85 L/min and MPAP reduction was 5.1 ± 7.6 mm Hg. Fifty-six patients (25.7%) were identified as IABP responders, with mean CO increase of 1.21 ± 0.87 L/min and MPAP reduction of 12.1 ± 5.9 mm Hg. Systemic vascular resistance (SVR) >1300 dynes/sec/cm-5 (odds ratio [OR], 5.04; 95% confidence interval [CI], 1.86-13.6; P<.01) and moderate-severe mitral regurgitation (OR, 2.42; 95% CI, 1.25-4.66; P<.01) predicted robust hemodynamic response. A subset of chronic systolic HF patients had robust hemodynamic response to IABP with significant CO augmentation and MPAP reduction. Higher SVR and moderate-severe mitral regurgitation predicted early hemodynamic response to IABP.

U-shaped association of sphingosine-1-phosphate level with mortality in chronic systolic heart failure

Abstract Background The immunomodulatory molecule sphingosine-1-phosphate (S1P) has received attention in the cardiovascular field due to its significant cardioprotective effects, as revealed in animal studies. Until now, it has been unclear what is the normal range of S1P in chronic heart failure patients and whether it is related to long term prognosis. Purpose The purpose of our study was to identify the distribution characteristics of S1P in systolic heart failure patients and the prognostic value of S1P for long-term prognosis. Methods We recruited 210 chronic systolic heart failure patients from June 2014 to December 2015. Meanwhile 54 healthy people in the same area were selected as controls. Plasma S1P was measured by mass spectrometry. Patients were grouped according to the baseline S1P level quartiles, and restricted cubic spline plots described a U-shaped association between S1P and all cause death. Cox proportional hazard analysis was used to determine the relationship between category of S1P and all-cause death. Survival curves were using the Kaplan-Meier method and the log-rank test was used for comparison. Results Compared with the control group, the plasma S1P in chronic heart failure patients demonstrated a higher mean level (1.269 μmol/L vs 1.122 μmol/L, P=0.006) and a larger standard deviation (0.441 vs 0.316, P=0.022). After a follow-up period of 31.7±10.3 months, the second quartile (0.967–1.192μml/L) with largely normal S1P levels had the lowest all-cause mortality and either an increase (HR=3.87, 95% CI 1.504–9.960, P=0.005, adjusted HR=3.134, 95% CI 1.211–8.111, P=0.019) or a decrease (HR=3.271, 95% CI 1.277–8.381, P=0.014, adjusted HR=1.90, 95% CI 0.711–5.083, P=0.200) predicted a worse prognosis. Conclusions Plasma S1P levels in systolic heart failure patients are related to the long-term all-cause mortality with a U-shaped correlation. Through restoring abnormal levels to a normal range instead of simply up regulation or down regulation, S1P may have the potential to be a therapeutic target for reducing the risk of death in patients with heart failure in the future. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Technology of the People's Republic of China. Ministry of Finance of the People's Republic of China.

18F-FDG PET/CT brain glucose metabolism as a marker of different types of depression comorbidity in chronic systolic heart failure patients

Abstract Background/Introduction Depression comorbidity is an important issue in heart failure (HF) disease. Results from the recent prospective randomized trial MOOD-HF did not provide a rationale for the indiscriminate use of antidepressants in depressed HF patients. Purpose The study investigated whole-brain and regional-brain glucose metabolism in HF patients with 18F-FDG PET/CT and its association with depression comorbidity. Methods Twenty-nine hospitalized patients with symptomatic systolic HF disease (LVEF&amp;lt;40%), NYHA class II-IV and mean age of 55.5±12.0 years participated in the study. All patients had echocardiography, blood sampling, HF-adapted and psychometric questionnaires before discharge and a brain 18F-FDG PET/CT scan after discharge. Semi-automated PET/CT image analysis was performed on all patients and 30 matched controls. The metabolic index SUVmean was calculated for the whole-brain and three brain regions (prefrontal cortex, amygdala and hippocampus), implicated in depression pathogenesis. A standardized SUVmean was also estimated by dividing depression-related regional-brain SUVmean with the whole-brain SUVmean. Results HF patients had lower average whole-brain SUVmean (3.90±1.49 vs 5.10±1.35, p=0.001), average regional-brain SUVmean (4.57±2.31 vs 9.96±3.58, p&amp;lt;0.001) and average standardized SUVmean (1.28±0.60 vs 2.07±1.32, p&amp;lt;0.001) compared to controls. Whole-brain SUVmean had a statistically significant correlation to patient age (r=−0.39, p=0.031), NYHA class (p=0.027), LVEF in the major group of 21 NYHA III-IV patients (p=0.018), diabetes comorbidity (p=0.001), creatinine levels (r=−0.49, p=0.005) and depression (r=−0.36, p=0.049). Regional-brain SUVmean was correlated to whole-brain SUVmean (r=0.53, p=0.002) and depression (r=0.46, p=0.011). The standardized SUVmean, in particular, was found to be a robust index that could differentiate HF patients with “epiphenomenal” (&amp;gt;0.93) or “real” (≤0.93) depression. Conclusion HF patients with more severe disease showed whole-brain and regional-brain hypometabolism in 18F-FDG PET/CT scan, which is consistent with impaired cerebral perfusion. Depressed HF patients (Beck Depression Inventory score &amp;gt;13) exhibited different metabolic patterns that could be used to differentiate between “epiphenomenal” and “real” depression. Namely, presence of whole-brain hypometabolism suggested “epiphenomenal” depression. Absence of whole-brain hypometabolism suggested “real” depression. When the pattern of whole-brain hypometabolism included significant relative, depression-related regional hypometabolism (standardized SUVmean ≤0.93), “real” depression was the most likely diagnosis. The distinction is important, as different types of comorbid depression suggest different treatment approach. Summarizing figure Funding Acknowledgement Type of funding source: None

Prognostic value of NT-proBNP and best cut-offs for risk prediction in obese patients with chronic systolic heart failure

Abstract Background N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP) is a strong predictor of outcome in chronic systolic heart failure (CHF). Although plasma NT-proBNP has been reported to display an inverse correlation with body-mass-index (BMI), its prognostic value in obese patients has been poorly investigated so far. Objectives To evaluate the prognostic value and the best cut-offs for risk prediction of NT-proBNP in obese individuals from a multinational cohort of patients with systolic CHF. Methods We analyzed data from the BIOS (Biomarkers In Heart Failure Outpatient Study) Consortium. Patients with left ventricular ejection fraction (LVEF) ≤50% were selected and classified as nonobese (BMI &amp;lt;30 kg/m2), mildly obese (BMI 30–35 kg/m2), moderately obese (BMI 35–40 kg/m2), or severely obese (BMI ≥40 kg/m2), according to standard nomenclature. Clinical and bio-humoral data, including NT-proBNP testing, were retrieved, and 5-year cardiac and all-cause mortality status were considered as primary and secondary outcome, respectively. The independent prognostic role of NT-proBNP was evaluated through Cox regression analysis, adjusting the model for age, gender, New York Heart Association class, ischaemic aetiology, LVEF, and estimated glomerular filtration rate (eGFR). Results The study population included 11,574 patients (age 65±12 years, LVEF 30±9%, males 78%). Most of patients were nonobese (n=8,937, 77%), while mildly, moderately, and severely obese patients were 1,887 (16%), 499 (4%), and 251 (3%), respectively. Median values of plasma NT-proBNP were progressively lower from nonobese to mildly, moderately, and severely obese patients (1455 ng/L, 903 ng/L, 767 ng/L, 660 ng/L, respectively) and BMI was predictive of NT-proBNP independently from age, LVEF, and eGFR (r=−0.152, p&amp;lt;0.001). The best NT-proBNP cut-offs to predict 5-year cardiac mortality were significantly lower in mildly [1044 ng/L; AUC 0.663 (Sen 66%; Spe 59%), p&amp;lt;0.001] moderately [736 ng/L; AUC 0.670 (Sen 76%; Spe 52%), p&amp;lt;0.001]), and severely [1060 ng/L; AUC 0.635 (Sen 57%; Spe 69%), p=0.021] obese patients compared to nonobese individuals [2034 ng/L; AUC 0.714 (Sens. 65%; Spec. 66%), p&amp;lt;0.001]. Further, NT-proBNP independently predicted 5-year cardiac death in nonobese, mildly and moderately obese patients (all p&amp;lt;0.001), but not in severely obese patients (p=0.457). Similar findings were observed for the secondary endpoint of 5-year all-cause mortality. Conclusions Compared to nonobese CHF patients, obese patients have lower circulating NT-proBNP levels, which retain independent prognostic significance for cardiac and all-cause mortality across most categories of obesity. BMI-adjusted NT-proBNP cut-offs might be considered for prognostic stratification in obese patients with CHF. Funding Acknowledgement Type of funding source: None

Evaluation of ivabradine in left ventricular dyssynchrony and reverse remodeling in patients with chronic heart failure.

ObjectivesIvabradine is a pharmacological agent used in patients with heart failure and sinus rhythm. Its only known pharmacological effect is to slow the heart rate. In this study, we investigated the impact of ivabradine on dyssynchrony parameters in heart failure patients.MethodsIn this study, we assigned 55 patients taking medication for heart failure to receive ivabradine in addition (Group I). Twenty healthy volunteers comprised Group II. Echocardiographic measurements (dyssynchrony, left ventricular volumes and left ventricular ejection fraction) were taken at baseline, 1 month, and 3 months.ResultsA total of 32 heart failure patients in Group I completed the study. There was significant improvement in dyssynchrony parameters after ivabradine treatment in Group I. Interventricular dyssynchrony (IVD) decreased from 42.0 ± 24.4 milliseconds at baseline to 33.6 ± 20.7 milliseconds at 1 month (P = .001) and to 30.7 ± 19.4 milliseconds at 3 months (P < .001). Septal to posterior wall motion delay decreased from 90.3 ± 21.4 milliseconds to 83.9 ± 26.9 milliseconds (P = .011) at 1 month and to 81.5 ± 27.3 milliseconds at 3 months (P = .001). Septal to lateral Ts delay (Ts‐SL) decreased from 42.7 ± 24.5 milliseconds to 35.8 ± 22.6 milliseconds at 1 month (P < .001) and to 34.8 ± 22.4 milliseconds at 3 months (P = .002). Left ventricular end‐systolic volume (LVESV) decreased from 139.4 ± 42.2 mL to 135.3 ± 39.6 mL at 1 month (P = .006) and to 123.3 ± 39.5 mL at 3 months (P < .001).ConclusionThe addition of ivabradine to heart failure treatment improves cardiac dyssynchrony parameters in chronic systolic heart failure patients with sinus rhythm.

U-shaped association between plasma sphingosine-1-phosphate levels and mortality in patients with chronic systolic heart failure: a prospective cohort study

BackgroundThe endogenous lipid molecule sphingosine-1-phosphate (S1P) has received attention in the cardiovascular field due to its significant cardioprotective effects, as revealed in animal studies. The purpose of our study was to identify the distribution characteristics of S1P in systolic heart failure patients and the prognostic value of S1P for long-term prognosis.MethodsWe recruited 210 chronic systolic heart failure patients from June 2014 to December 2015. Meanwhile 54 healthy people in the same area were selected as controls. Plasma S1P was measured by liquid chromatography-tandem mass spectrometry. Patients were grouped according to the baseline S1P level quartiles, and restricted cubic spline plots described the association between S1P and all-cause death. Cox proportional hazard analysis was used to determine the relationship between category of S1P and all-cause death.ResultsCompared with the control group, the plasma S1P in chronic heart failure patients demonstrated a higher mean level (1.269 μmol/L vs 1.122 μmol/L, P = 0.006) and a larger standard deviation (0.441 vs 0.316, P = 0.022). Based on multivariable Cox regression with restricted cubic spline analysis, a non-linear and U-shaped association between S1P levels and the risk of all-cause death was observed. After a follow-up period of 31.7 ± 10.3 months, the second quartile (0.967–1.192 μml/L) with largely normal S1P levels had the lowest all-cause mortality and either an increase (adjusted HR = 2.368, 95%CI 1.006–5.572, P = 0.048) or a decrease (adjusted HR = 0.041, 95%CI 0.002–0.808, P = 0.036) predicted a worse prognosis. The survival curves showed that patients in the lowest quartile and highest quartile were at a higher risk of death.ConclusionsPlasma S1P levels in systolic heart failure patients are related to the long-term all-cause mortality with a U-shaped correlation.Trial registrationCHiCTR, ChiCTR-ONC-14004463. Registered 20 March 2014.

Predictors of Hemodynamic Response to Intra-Aortic Balloon Pump Therapy in Patients with Acute Decompensated Heart Failure and Cardiogenic Shock

Introduction There is renewed interest in the utility of the intra-aortic balloon pump (IABP) for short-term and durable support in patients with chronic systolic heart failure (HF) who present with acute decompensation and cardiogenic shock (CS). However, the clinical characteristics of IABP-responders and non-responders remain incompletely defined. We sought to identify predictors of early IABP response to guide optimal use of IABP therapy in this population. Methods We retrospectively analyzed the records of chronic systolic HF patients who presented at our institution between 2011-2018 with acute decompensated HF with hemodynamic evidence of CS and underwent IABP placement. IABP-responder was defined as having an immediate increase in cardiac output (CO) and an immediate decrease in mean pulmonary artery pressure (MPAP) above the median values of the cohort. Logistic regression was used to identify predictors of hemodynamic response. Results During the study period, 218 chronic systolic HF patients underwent IABP insertion for acute decompensation with CS. The mean age was 59.4 ±13.4 years, 79.8% were men, and 38.5% had ischemic cardiomyopathy (ICM). The average hemodynamic response to IABP in the whole cohort was a CO increase of 0.57 ±0.85L/min and a MPAP reduction of 5.1 ±7.6mmHg; IABP-responders had a CO increase of 1.21 ±0.87L/min and a MPAP reduction of 12.1 ±5.9mmHg (figure). Univariable predictors of IABP-response were ICM, presence of severe mitral regurgitation, baseline heart rate, elevated MPAP, and elevated systemic vascular resistance (SVR). Following multivariable logistic regression, independent predictors of IABP-response were elevated baseline SVR (OR 2.05, 95% CI 1.01 - 4.17; p=0.047) and elevated MPAP (OR 2.47, 95% CI 1.23 - 5.00; p=0.01). MPAP reduction decreased the odds of death or need for escalation to another short-term circulatory support device while CO increase did not [OR 0.52 (0.28 - 0.97; p=0.04) vs. 0.83 (0.45 - 1.54; p=0.56)]. Conclusions A subset of chronic systolic HF patients had a robust hemodynamic response to IABP insertion with CO augmentation and MPAP reduction. Elevated baseline SVR and MPAP are predictors of robust response following device insertion. These parameters may be used to identify patients who may respond favorably to IABP counterpulsation therapy.

Soluble angiotensin converting enzyme 2 levels in chronic heart failure is associated with decreased exercise capacity and increased oxidative stress-mediated endothelial dysfunction

The aim of this study was to explore the relationship between serum soluble angiotensin converting enzyme 2 (sACE2), parameters of cardiopulmonary exercise testing and plasma asymmetric dimethylarginine (ADMA), a marker of oxidative stress-induced endothelial dysfunction. This has not been previously evaluated. We assessed 50 consecutive ambulatory patients with chronic systolic heart failure and left ventricular ejection fraction (LVEF) ≤45%. Their blood samples were collected for sACE2 and ADMA tests before they underwent symptom-limited cardiopulmonary exercise testing and transthoracic echocardiography. The majority of our study subjects had New York Heart Association functional class II (74%) and III (18%) presentation, and 42% of patients had ischemic etiology. Median sACE2 activity was 10.36 (7.00-14.47) ng/mL and mean ADMA was 0.90 ± 0.22. sACE2 activity was inversely correlated with pVO2 (r = -0.42, P = 0.00283), exercise time (r = -0.35, P = 0.0138) and LVEF (r = -0.548, P < 0.001), and positively correlated with VE/VCO2 slope (r = 0.294, P = 0.0405), ΔDBP (r = 0.315, P = 0.0278), mitral E/Ea ratio (r = 0.442, P = 0.00158) and ADMA levels (r = 0.351, P = 0.0134). Meanwhile, we observed a negative correlation between ADMA and pVO2 (r = -0.424, P = 0.00227) and positive correlations between ADMA and VE/VCO2 slope (r = 0.515, P < 0.001), ΔDBP (r = 0.391, P = 0.00568), mitral E/Ea ratio (r = 0.426, P = 0.00219). In multivariate logistic regression analysis, sACE2 was independently associated with peak oxygen uptake (% predicted) after adjusting for body mass index (BMI) and mitral E/Ea ratio (odds ratio [OR] 0.81 (0.58-0.94), P = 0.041) and associated with oxygen pulse (VO2/HR) (%) after adjusting for age, gender, BMI and mitral E/Ea ratio (OR 0.83 [0.68-0.95], P = 0.025). Therefore in stable chronic systolic heart failure patients, higher sACE2 activity is independently associated with diminished exercise capacity and correlates with elevated systemic oxidative stress-mediated endothelial dysfunction.

Efficacy and safety of levothyroxine (L-T4) replacement on the exercise capability in chronic systolic heart failure patients with subclinical hypothyroidism: Study protocol for a multi-center, open label, randomized, parallel group trial (ThyroHeart-CHF)

BackgroundSubclinical hypothyroidism is a common condition in patients with heart failure and is defined as elevated serum thyroid hormone (TSH) with normal circulating free thyroxine (FT4). Evidence on the effect of thyroid hormone treatment is lacking. We designed a randomized controlled trial to compare the efficacy and safety of thyroid hormone supplementation in patients with chronic heart failure complicated with subclinical hypothyroidism.Methods/designEligible participants were identified from the cardiology units of five study centers based on the following criteria: 18 years or older, systolic heart failure with NewYork Heart Association (NYHA) class II–III, left ventricular ejection fraction ≤ 40%, and subclinical hypothyroidism (TSH > 4.78μIU/ml, < 10 μIU/ml + FT4 level within reference range). Eligible patients will be randomly assigned in a 1:1 manner to receive thyroxine replacement therapy plus standard chronic heart failure (CHF) treatment or only standard CHF therapy. Levothyroxine will be administered at an initial dose of 12.5 μg once daily and will be titrated until TSH is within the normal range. The primary endpoints include the difference in distance of the six-minute walk test between 24 weeks and baseline. The secondary endpoints include differences in plasma NT-proBNP levels and serum lipid profiles, changes in the NYHA classification, cardiovascular death, re-hospitalization, differences in echocardiographic and cardiac magnetic resonance imaging measures, and Minnesota Living With Heart Failure Questionnaire (MLHFQ) results between 24 weeks and baseline.DiscussionThyroHeart-CHF is designed as a prospective, multi-center, randomized, controlled clinical trial to study the efficacy and safety of thyroid hormone supplementation in patients with chronic heart failure complicated with subclinical hypothyroidism. The study findings will have significant implications for discovering the new therapeutic targets and methods of heart failure.Trail RegistrationClinicalTrials.gov, NCT03096613. Registered on 30 March 2017.

P5657Gender differences in the response to spironolactone in chronic systolic heart failure patients: a propensity matched analysis

P5657Gender differences in the response to spironolactone in chronic systolic heart failure patients: a propensity matched analysis

Effects of ivabradine on endothelial function, aortic properties and ventricular-arterial coupling in chronic systolic heart failure patients.

Heart rate (HR) is an important prognostic factor in patients affected by chronic heart failure (CHF); ivabradine has been demonstrated to significantly reduce nonfatal myocardial infarction and hospitalization rate for acute heart failure and to improve left ventricular (LV) reverse remodeling, quality of life, exercise capacity, and arterial elastance (Ea) in these patients. We aimed at evaluating the short-term effects of ivabradine on ventricular-arterial coupling (VAC), aortic stiffness, and endothelial function in stable patients with CHF. We evaluated 30 consecutive CHF patients (LVEF≤ 35%, NYHA class II) with sinus rhythm and HR ≥ 70bpm on optimized pharmacological therapy. All of them underwent both transthoracic echocardiogram to assess aortic elastic properties (aortic distensibility, AD; aortic stiffness index, ASI; systolic aortic strain, SAS) and VAC, and peripheral arterial tonometry to measure endothelial function. Therapy with ivabradine 5mg bid was added and each patient was evaluated with the same examinations after 4months. At the baseline, 73% of patients had impaired VAC and 63% endothelial dysfunction. After 4months, there was a significant improvement in the VAC value (ΔVAC -0.10±0.18, P=.021), mainly linked to Ea (ΔEa -0.40±0.23mm Hg/mL; P=.003). All the parameters of aortic elasticity underwent significant improvement (ΔAD 1.82±1.43cm² × dyn- ¹, P=.004; ΔASI -4.73±6.07, P=.033; ΔSAS -7.98±4.37%, P=.003). Lastly, we also noted a significant improvement of endothelial function (Δ RHI 0.35±0.35; P<.001). At follow-up 40% of patients had impaired VAC (P=.018) and 33% endothelial dysfunction (P=.038). In patients with CHF adding ivabradine on top to the standard optimized medical therapy, when indicated, seems to improve endothelial function, aortic properties, and VAC.

P815Left atrial strain predicts cardiovascular events in chronic systolic heart failure patients treated with cardiac resynchronization therapy

P815Left atrial strain predicts cardiovascular events in chronic systolic heart failure patients treated with cardiac resynchronization therapy

(553) - Implantable Defibrillator Average Heart Rate versus Spot Heart Rate as Determinant for Ivabradine Use Indication in Patient with Systolic Heart Failure

To identify the discrepancy between a spot heart rate and the average heart rate obtained from an implantable cardioverter defibrillator (ICD) as the optimal criteria to qualify for the addition of ivabradine in chronic systolic heart failure patients.

Effects of functional tricuspid regurgitation on renal function and long-term prognosis in patients with heart failure.

Renal dysfunction is common in heart failure. Recent evidence suggests a pivotal role for systemic venous congestion and functional tricuspid regurgitation (FTR) in the pathophysiology of renal dysfunction. We investigated the role of FTR as a determinant of renal dysfunction and a predictor of long-term prognosis in chronic systolic heart failure patients. Four hundred and thirteen consecutive patients (mean age 74.2 ± 11 years) with chronic heart failure and left ventricular ejection fraction below 50% were enrolled. The FTR severity was quantified by transthoracic echocardiography. Renal function was evaluated with the estimated glomerular filtration rate measured by the simplified Modification of Diet in Renal Disease formula. The association between moderate/severe FTR and renal dysfunction, and its impact on heart failure episodes and overall mortality were also assessed. The median follow-up was 36 months (range 1-144 months). Through multivariate analysis, the interaction between moderate/severe FTR with tricuspid annular plane systolic excursion less than 16 mm was found to be an independent determinant of renal dysfunction [odds ratio 1.2, 95% confidence interval (CI) 1.1-1.5, P = 0.04]. Moderate/severe FTR (hazard ratio 1.3, 95% CI 1.2-2.7, P = 0.02) and tricuspid annular plane systolic excursion below 16 mm (hazard ratio 1.2, 95% CI 1.0-3.7, P = 0.01) were significantly related to the heart failure episodes. Moreover, the Kaplan-Meier analysis showed a worse outcome in patients with moderate/severe FTR (log-rank test 8.6, P = 0.003). The combination of significant FTR and right ventricular dysfunction, but not FTR and right ventricular dysfunction alone, is independently associated with renal dysfunction. The presence of significant FTR is related to an excess event rate of heart failure and has significant impact on outcome.

62. Gap in the application of implantable defibrillator and cardiac resynchronization therapy guidelines in heart failure patients

Background and objectives Literature review revealed no studies were done regarding the application of implantable defibrillator and cardiac resynchronization therapy guidelines in Saudi Arabia. Therefore, our aim was to identify the gap in the application of the guidelines for acute on chronic systolic heart failure patients in Saudi Arabia. Design and setting We used data from the heart function assessment registry trial in Saudi Arabia (HEARTS) to explore the rate of device implantation. In consecutive cohort admitted in 18 governmental hospitals with heart failure between October 2009 and December 2010. Results Of 1664 patients with acute on chronic systolic heart failure enrolled in the HEARTS registry, 227 (13.64%) have undergone a past ICD/CRT, 148 (8.9%) patients with ICD and 79 (4.7%) patients with CRT. 1437 (86.36%) patients did not go through an ICD or a CRT. From 71 VT/VF patients who are required to have an ICD only 10 (14%) patients received an ICD therapy. 223 patients have a left bundle branch block and 35 (15.6%) of those patients received an ICD/CRT device. From 831 patients with LVEF Conclusion Since a large number of whom required an ICD/CRT did not receive a device, a gap in the application of ICD/CRT devices had been identified, further studies are required to establish the reason behind this.

PP-166 The Relationship between Carbohydrate Antigen 125 and Left Ventricular Echocardiographic Parameters in Stable Chronic Systolic Heart Failure Patients: A Comparative Study with NT-pro BNP

PP-166 The Relationship between Carbohydrate Antigen 125 and Left Ventricular Echocardiographic Parameters in Stable Chronic Systolic Heart Failure Patients: A Comparative Study with NT-pro BNP

Analysis of etiology and drug use in the chronic systolic heart failure patients in two community health service centers of Pudong district in Shanghai

Objective To investigate the treatment of chronic heart failure in two communities in Pudong and find the deficiency of standardized treatment in community hospital. Methods A retrospective study of all the inpatient, family bed and outpatient with heart failure who visit Hudong and Lujiazui community health Service center was conducted from March 2012 to March 2015 retrospectively. General situation(gender, age, smoking history, drinking history, daily salt intake, concomitant disease), etiology and if have the acute heart failure onset in half a year and what are the incentives, drug treatment and treatment of concomitant hypertension and diabetes mellitus were analyzed by face to face follow up. Results The study included 300 patients, average age was (58±10) years. Daily salt intake of 55.0%(165/300) patients was more than 9 g. Coronary heart disease(45.7%, 137/300), hypertension (30.7%, 92/300)and cardiomyopathy (9.0%, 27/300)were the chief heart failure etiology. 59.3%(178/300)patients had acute heart failure in half a year.Acute blood pressure(20.8%, 37/178), transfusion too fast or too much and infection(14.6%, 26/178)were the chief incentives leading to acute heart failure. 83.3%(250/300)patients used ACEI/ARB, but only 32.0%(80/250)of them applied the target dose. 53.7%(161/300)patients used beta blockers and 98.1%(158/161)of them could not reach the target dose. Tartaric acid metoprolol(51.6%, 83/161), peso parlour(18.6%, 30/161)and carvedilol(14.9%, 24/161)were commonly used drug in clinic. 76.6%(230/300)patients had hypertension and blood pressure was controlled in 82.2%(189/230)of them successfully. 44.0%(132/300)patients had diabetes mellitus and glycosylated hemoglobin(HbA1c)was controlled from 7% to 8% in 23.5%(31/132)of them. Conclusion In the community treatment of heart failure, the drugs recommended by guidelines were low usage and achieved the target dose rarely. Treatment of concomitant diseases was not good. The knowledge of new progress was not enough. Key words: Heart failure, systolic; Community health centers; General practitioner; Standardized treatment

Omecamtiv mecarbil: a new cardiac myosin activator for the treatment of heart failure

Introduction: Current available inotropic agents increase cardiac contractility, but are associated with myocardial ischemia, arrhythmias, and mortality. A novel selective cardiac myosin activator, omecamtiv mecarbil (CK-1827452/ AMG-423) is a small molecule that activates the sarcomere proteins directly, resulting in prolonged systolic ejection time and increased cardiac contractility.Areas covered: This paper discusses the chemistry, pharmacokinetics, clinical efficacy and safety of omecamtiv mecarbil. Omecamtiv mecarbil represents a novel therapeutic approach to directly improve cardiac function and is therefore proposed as a potential new treatment of patients with systolic heart failure. The authors review results of previous studies investigating the effect of omecamtiv mecarbil in heart failure animal models, healthy volunteers, and patients with acute and chronic systolic heart failure.Expert opinion: Results of phase I and phase II studies demonstrate that omecamtiv mecarbil is safe and well tolerated both as an intravenous and oral formulation. In healthy volunteers and chronic systolic heart failure patients, administration of omecamtiv mecarbil resulted in a concentration-dependent increase of left ventricular ejection time, ejection fraction, fractional shortening, and stroke volume. The first results of a double-blind, randomized, placebo-controlled phase IIb dose-finding study with the oral formulation of omecamtiv mecarbil demonstrated beneficial effects on cardiac function and N-terminal pro-brain natriuretic peptide levels. This study will provide essential dosing information for the requisite phase III trials which will investigate whether the beneficial effects of omecamtiv mecarbil translate into improved clinical outcomes.