Clinical Characteristics Of Heart Failure Research Articles

Clinical characteristics of heart failure with reduced ejection fraction patients with rare pathogenic variants in dilated cardiomyopathy-associated genes: A subgroup analysis of the PARADIGM-HF trial.

To evaluate the prevalence of pathogenic variants in genes associated with dilated cardiomyopathy (DCM) in a clinical trial population with heart failure and reduced ejection fraction (HFrEF) and describe the baseline characteristics by variant carrier status. This was a post hoc analysis of the Phase 3 PARADIGM-HF trial. Forty-four genes, divided into three tiers, based on definitive, moderate or limited evidence of association with DCM, were assessed for rare predicted loss-of-function (pLoF) variants, which were prioritized using ClinVar annotations, measures of gene transcriptional output and evolutionary constraint, and pLoF confidence predictions. Prevalence was reported for pLoF variant carriers based on DCM-associated gene tiers. Clinical features were compared between carriers and non-carriers. Of the 1412 HFrEF participants with whole-exome sequence data, 68 (4.8%) had at least one pLoF variant in the 8 tier-1 genes (definitive/strong association with DCM), with Titin being most commonly affected. The prevalence increased to 7.5% when considering all 44 genes. Among patients with idiopathic aetiology, 10.0% (23/229) had tier-1 variants only and 12.6% (29/229) had tier-1, -2 or -3 variants. Compared to non-carriers, tier-1 carriers were younger (4 years; adjusted p-value [padj ] = 4 × 10-3 ), leaner (27.8 kg/m2 vs. 29.4 kg/m2 ; padj = 3.2 × 10-3 ), had lower ejection fraction (27.3% vs. 29.8%; padj = 5.8 × 10-3 ), and less likely to have ischaemic aetiology (37.3% vs. 67.4%; padj = 4 × 10-4 ). Deleterious pLoF variants in genes with definitive/strong association with DCM were identified in ∼5% of HFrEF patients from a PARADIGM-HF trial subset, who were younger, had lower ejection fraction and were less likely to have had an ischaemic aetiology.

Developing and Implementing an mHealth Heart Failure Self-care Program to Reduce Readmissions: Randomized Controlled Trial.

BackgroundPatients admitted with decompensated heart failure (HF) are at risk for hospital readmission and poor quality of life during the discharge period. Lifestyle behavior modifications that promote the self-management of chronic cardiac diseases have been associated with an improved quality of life. However, whether a mobile health (mHealth) program can assist patients in the self-management of HF during the acute posthospital discharge period is unknown.ObjectiveWe aimed to develop an mHealth program designed to enhance patients’ self-management of HF by increasing knowledge, self-efficacy, and symptom detection. We hypothesized that patients hospitalized with HF would be willing to use a feasibly deployed mHealth program after their hospital discharge.MethodsWe employed a patient-centered outcomes research methodology to design a stakeholder-informed mHealth program. Adult patients with HF admitted to a large academic hospital were enrolled and randomized to receive the mHealth intervention versus usual care. Our feasibility outcomes included ease of program deployment, use of the clinical escalation process, duration of participant recruitment, and participant attrition. Surveys assessing the demographics and clinical characteristics of HF were measured at baseline and at 30 and 90 days after discharge.ResultsThe study period was between July 1, 2019, and April 7, 2020. The mean cohort (N=31) age was 60.4 (range 22-85) years. Over half of the participants were men (n=18, 58%) and 77% (n=24) were White. There were no significant differences in baseline measures. We determined that an educational mHealth program tailored for patients with HF is feasibly deployed and acceptable by patients. Though not significant, we found notable trends including a higher mean quality of life at 30 days posthospitalization among program users and a longer duration before rehospitalization, which are suggestive of better HF prognosis.ConclusionsOur mHealth tool should be further assessed in a larger comparative effectiveness trial. Our pilot intervention offers promise as an innovative means to help HF patients lead healthy, independent lives. These preliminary data suggest that patient-centered mHealth tools can enable high-risk patients to play a role in the management of their HF after discharge.Trial RegistrationClinicalTrials.gov NCT03982017; https://clinicaltrials.gov/ct2/show/NCT03982017

Clinical characteristics of heart failure with recovered ejection fraction

Objective: To summarize the clinical characteristics of heart failure patients with recovered ejection fraction (HFrecEF) and identify variables capable of predicting left ventricular ejection fraction (LVEF) recovery. Methods: This case control study included patients with heart failure, who admitted to Department of Cardiology of Beijing Hospital from January 1, 2009 to December 31, 2017. The patients were divided into 3 groups based on the baseline LVEF and changes of LVEF: heart failure with reduced ejection fraction (HFrEF, baseline LVEF≤40%, follow-up LVEF≤40% or follow-up LVEF>40% but LVEF increase<10% from baseline), HFrecEF(baseline LVEF≤40%, follow-up LVEF>40% and increase≥10% from baseline), and heart failure with preserved ejection fraction (HFpEF, baseline LVEF>40%). Clinical data were collected and endpoint events (all-cause death, cardiovascular death and sudden death) were recorded. The Log-rank test was used to evaluate the differences of terminal events in different groups, and Kaplan-Meier survival analysis was performed. Logistic regression equation was used to identify prognostic factors of HFrecEF. Results: A total of 310 patients with heart failure were included. There were 91(29.4%) HFrEF patients, 38(12.3%) HFrecEF patients and 181(58.4%) HFpEF patients. Compared with HFrEF patients and HFpEF patients, HFrecEF patients were featured by younger age, more likely to be female, higher systolic blood pressure, diastolic blood pressure and resting heart rate (all P<0.05). Dilated cardiomyopathies were more common, while old myocardial infarctions were less common in HFrecEF (both P<0.05). During a median follow-up of 36.7(18.0, 63.9) months, Kaplan-Meier survival analysis found that HFrecEF patients had the lowest all-cause mortality (Log-rank P=0.047, HFrecEF vs. HFpEF P=0.017, HFrecEF vs. HFrEF P=0.016, and HFpEF vs. HFrEF P=0.782).The cardiovascular mortality ranged from low to high was in HFrecEF patients, HFpEF patients, and HFrEF patients (Log-rank P<0.001, HFrecEF vs. HFpEF P=0.029, HFrecEF vs. HFrEF P<0.001, HFrEF vs. HFpEF P=0.005). Sudden death rate was similar among the three groups (Log-rank P=0.520). Logistic regression analysis showed that left ventricular end-diastolic diameter (LVEDD)≤55 mm (OR=5.922, 95%CI 1.685-20.812, P=0.006), higher diastolic blood pressure (OR=1.058, 95%CI 1.017-1.100, P=0.005), faster resting heart rate (OR=1.042, 95%CI 1.006-1.080, P=0.024), absence of old myocardial infarction (OR=5.343, 95%CI 1.731-16.488, P=0.004) were independent prognostic factors of LVEF recovery after clinical treatment. Conclusions: Patients with HFrecEF are associated with a better prognosis as compared to patients with HFrEF and HFpEF. LVEDD≤55 mm, higher diastolic blood pressure, faster heart rate,and absence of old myocardial infarction are independent prognostic factors of LVEF recovery after clinical treatment.

S-Nitrosylation of Histone Deacetylase 2 by Neuronal Nitric Oxide Synthase as a Mechanism of Diastolic Dysfunction.

Although the clinical importance of heart failure with preserved ejection fraction has been extensively explored, most therapeutic regimens, including nitric oxide (NO) donors, lack therapeutic benefit. Although the clinical characteristics of heart failure with preserved ejection fraction are somewhat heterogeneous, diastolic dysfunction (DD) is one of the most important features. Here we report that neuronal NO synthase (nNOS) induces DD by S-nitrosylation of HDAC2 (histone deacetylase 2). Two animal models of DD-SAUNA (SAlty drinking water/Unilateral Nephrectomy/Aldosterone) and mild transverse aortic constriction mice-as well as human heart samples from patients with left ventricular hypertrophy were used. Genetically modified mice that were either nNOS-ablated or HDAC2 S-nitrosylation-resistant were also challenged. N(ω)-propyl-L-arginine, an nNOS selective inhibitor, and dimethyl fumarate, an NRF2 (nuclear factor erythroid 2-related factor 2) inducer, were used. Molecular events were further checked in human left ventricle specimens. SAUNA or mild transverse aortic constriction stress impaired diastolic function and exercise tolerance without overt systolic failure. Among the posttranslational modifications tested, S-nitrosylation was most dramatically increased in both models. Utilizing heart samples from both mice and humans, we observed increases in nNOS expression and NO production. N(ω)-propyl-L-arginine alleviated the development of DD in vivo. Similarly, nNOS knockout mice were resistant to SAUNA stress. nNOS-induced S-nitrosylation of HDAC2 was relayed by transnitrosylation of GAPDH. HDAC2 S-nitrosylation was confirmed in both DD mouse and human left ventricular hypertrophy. S-nitrosylation of HDAC2 took place at C262 and C274. When DD was induced, HDAC2 S-nitrosylation was detected in wild-type mouse, but not in HDAC2 knock-in mouse heart that expressed HDAC2 C262A/C274A. In addition, HDAC2 C262A/C274A mice maintained normal diastolic function under DD stimuli. Gene delivery with adenovirus-associated virus 9 (AAV9)-NRF2, a putative denitrosylase of HDAC2, or pharmacological intervention by dimethyl fumarate successfully induced HDAC2 denitrosylation and mitigated DD in vivo. Our observations are the first to demonstrate a new mechanism underlying DD pathophysiology. Our results provide theoretical and experimental evidence to explain the ineffectiveness of conventional NO enhancement trials for improving DD with heart failure symptoms. More important, our results suggest that reduction of NO or denitrosylation of HDAC2 may provide a new therapeutic platform for the treatment of refractory heart failure with preserved ejection fraction.

Analysis of animal models of heart failure based on characteristics of clinical symptoms of traditional Chinese and Western medicine

The incidence of heart failure has increased year by year, with a negative impact on quality of life and life expectancy of patients. Reproduction of animal models that meet the characteristics of clinical symptoms is a prerequisite for conducting experimental studies relating to heart failure. Based on the characteristics of clinical symptoms of heart failure in traditional Chinese medicine(TCM) and Western medicine, the existing common animal models of heart failure were explored, and the clinical anastomosis of the existing animal models was analyzed based on the clinical diagnostic criteria of heart failure in TCM and Western medicine. After analysis and comparison, it can be seen that the existing modeling methods are mostly single-factor animal models, with certain gaps between the characteristics of clinical multi-factors and interactions that jointly lead to heart failure, and the modeling methods were mostly guided by Western medicine, with a lack of TCM pathogenic factors in the model process, which is different from the clinical diagnostic criteria of Chinese and Western medicine for heart failure. In terms of syndrome differentiation, heart failure is classified into heart and lung Qi deficiency syndrome, Qi and Yin deficiency syndrome, heart and kidney Yang deficiency syndrome, Qi deficiency and blood stasis syndrome, Yang deficiency and water flooding syndrome, phlegm-drinking obstructive lung syndrome, Yin and yang exhausted syndrome. The existing animal models mostly confused them, with no effective and recognized method for modeling at present. There are major limitations in studies of Chinese medicine. Therefore, based on clinical characteristics of heart failure in Chinese and Western medicine, this article analyzed the existing animal models, defined their advantages and disadvantages and application prospects, and then suggested further improving the corresponding animal models of heart failure and standardizing the model evaluation, so as to improve the clinical coincidence between animal models and Chinese and Western medicine, make heart failure animal models better serve scientific studies, and promote relevant mechanism studies, pathological change studies and drug screening.

Predominant subtype of heart failure after acute myocardial infarction is heart failure with non-reduced ejection fraction.

AimsPatients who survive acute myocardial infarction (AMI) are at risk of being rehospitalized owing to the occurrence of acute decompensated heart failure (HF). However, the clinical characteristics of HF after AMI, especially the frequency of each HF subtype, are unclear.Methods and resultsWe retrospectively studied 1055 patients with AMI. We excluded 257 patients, who were admitted >48 h after the onset of AMI, died during hospitalization or after discharge, and whose echocardiogram data at index hospitalization and follow‐up data were missing. The remaining 798 patients (mean age: 66.5 ± 11.7 years) were investigated for a mean follow‐up period of 4.9 years. All patients underwent emergency coronary angiography. The mean maximum creatine kinase levels were 2898 ± 2627 IU/L, and mean left ventricular ejection fraction (LVEF) was 58.9 ± 10.2%. Eighty‐one patients (10.2%) were rehospitalized because of unexpected worsening of HF. Echocardiography data were available for 74 of the 81 patients during the acute phase of the second hospitalization, of which 30, 20, and 24 patients (41%, 27%, and 32%, respectively) were diagnosed as having HF with preserved LVEF (LVEF ≥ 50%), HF with mid‐range LVEF (40% ≤ LVEF < 50%), and HF with reduced LVEF (LVEF < 40%), respectively. The ejection fraction during index hospitalization was 58.3 ± 9.7% in the HF with preserved LVEF group, 53.3 ± 10.2% in the HF with mid‐range LVEF group, and 43.3 ± 10.5% in the HF with reduced LVEF group (P < 0.001).ConclusionsThe predominant subtypes of HF after AMI were HF with mid‐range ejection fraction and preserved ejection fraction, or HF with non‐reduced ejection fraction.

Homoarginine supplementation in patients with heart failure with preserved ejection fraction (HFpEF). Protocol of multicentre randomized controlled trial

Background and Aims: L-homoarginine (hArg) is a nonproteinogenic amino acid that recently has been shown to be inversely correlated with adverse cardiovascular outcomes. In particular, low circulating hArg was associated with biochemical and clinical characteristics of heart failure. A clinical trial with hArg supplementation in healthy volunteers demonstrated four- and sevenfold increase of hArg plasma levels after the single oral dose of 125 mg without any adverse effects. We propose a prospective clinical study to assess if hArg supplementation improves outcomes in patients with HFpEF.

Estudio retrospectivo de casos de insuficiencia cardíaca en adultos del 2011 al 2015 en un Hospital Dominicano

Introducción: la insuficiencia cardíaca (IC) es un síndrome caracterizado por un funcionamiento inadecuado de las capacidades cardíacas, que se asocia con discapacidad. Sus múltiples etiologías y factores de riesgo varían geográficamente, por lo que se plantea conocer las características clínicas de la IC en la República Dominicana, con el objetivo de sugerir mejoras en los servicios de salud.&#x0D; Métodos: se identificaron 2,119 casos de pacientes con IC en el Hospital General de la Plaza de la Salud (HGPS) y con base en esta población se calculó una muestra de 326 casos, a partir de un intervalo de confianza de 95 % y un margen de error de 5 %. Partiendo del cálculo de la muestra, se seleccionaron aleatoriamente 378 casos. Este sobre muestreo se realizó previendo la posible eliminación de algunos casos en los análisis finales. Luego de esto, se procedió a la extracción de datos.&#x0D; Resultados: el estudio mostró que la edad promedio fue de 69 años. Se evidenciaron diversos factores de riesgos predominantes como la hipertensión arterial 87.5 %, cardiopatía isquémica 50.4 %, valvulopatías 40 %, y la diabetes mellitus un 34.7 %. También se observaron conductas de riesgo en las que predominan el uso de tabaco (23.7 %), obesidad (17.4 %) y consumo de alcohol (7.8 %). El síntoma más frecuente fue disnea con 84.7 %. La fracción de eyección promedio fue 48 %. El tratamiento más común fue los diuréticos. La mortalidad registrada fue 11.1 %.&#x0D; Discusión: este estudio evidencia una alta ocurrencia de conductas y factores de riesgo, cuya intervención y subsecuente disminución pudiera significar cambios importantes a la prevalencia de la IC en el país.

Frequency and Clinical Characteristics of Heart Failure with Preserved Ejection Fraction Patients in a Tertiary Level Hospital

Background: Heart failure with preserved ejection fraction (HFpEF) has already emerged as the predominant form of heart failure in the western world. We aimed to estimate the frequency and clinical characteristics of HFpEF cohort in Bangladesh as limited data are available about this extremely heterogeneous syndrome.&#x0D; Methods: This cross sectional study was conducted at the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka from December, 2017 to December, 2018. A total of 124 heart failure patients were enrolled in the study for the estimation of frequency of HFpEF. Comorbidities and presentation of 30 HFpEF patients were assessed. HFpEF diagnosis was made according to the 2016 European Society of Cardiology (ESC) Guidelines.&#x0D; Results: The frequency of HFpEF was 30 (24.1%) (95% confidence interval 16.6% to 31.7%). The mean (SD) age of was 65.0 (10.1) years. Majority of the patients (73.3 %) were between 60 to 79 years of age. Majority of the patients (60%) were male. Most of the patients had multiple comorbidities and risk factors. Hypertension was the most prevalent risk factor which was present in 80% cases. Dyslipidemia was found in 63.3% cases, DM in 53.3% cases. 36.6% patients had coronary artery disease (CAD). CKD was found in 30% cases. 26.6% patients had atrial fibrillation, which was the most common arrhythmia. 62.0% were overweight to obese. Anemia was found in 55.1% cases. 73.3% patients presented in a decompensated stage of NYHA IV. Breathlessness was the most common (100%) complaint, whereas bilateral lung base crepitations was the most frequent sign (96%).&#x0D; Conclusions: This study findings has paved the way for characterization of HFPEF in Bangladeshi population but more large scale epidemiological studies are needed.&#x0D; University Heart Journal Vol. 15, No. 2, Jul 2019; 63-67

Qualidade de vida e qualidade de sono na insuficiência cardíaca

Introdução: A insuficiência cardíaca (IC) é uma síndrome clínica complexa, caracterizada pela incapacidade do ventrículo esquerdo bombear sangue suficiente para o corpo. Dentre as características clínicas da IC estão a baixa qualidade de vida e de sono. Objetivo: Relacionar a qualidade de vida (QV) e a qualidade de sono (QS) com capacidade funcional de pacientes com IC e saudáveis. Métodos: Estudo transversal observacional, no qual foram avaliados 21 pacientes com IC (grupo IC) e 21 indivíduos auto relatados saudáveis (grupo controle). Foram avaliadas a QV e QS, a sonolência diurna excessiva (SDE) e a distância percorrida do teste da caminhada de 6 minutos (TC6M). Resultados: Foi observado uma melhor QV e QS no grupo IC em comparação ao grupo controle (p0,05). Encontramos correlações positivas entre o capacidade funcional e limitação por aspectos emocionais com a distância percorrida no TC6M (r=0,475, p=0,034) e (r=0,620, p=0,004,), respectivamente. Conclusão: Nossos resultados demonstram que a IC gera impactos negativos na QV e na QS da amostra estudada.

Understanding the Demographic and Clinical Characteristics of Heart Failure to Improve Management Practices: The Caribbean Perspective

Heart Failure is a worldwide burden. The prevalence, incidence, mortality and morbidity rates reported show geographic variations, depending on the different aetiologies and clinical characteristics observed among patients with this complex syndrome. In this review we focus on the Afro Caribbean population with Heart Failure providing data review about the Heart Failure etiology based in previous Clinical Trials In addition we provide suggestions based in these Trials and our recent observational clinical studies that might be useful to improve our current Heart Failure Guideline-Directed Medical Therapy . Finally we highlight the need for more regional research.

Antithrombin III is associated with acute liver failure in patients with end-stage heart failure undergoing mechanical circulatory support

ObjectiveThere are few data on the role of liver dysfunction in patients with end-stage heart failure supported by mechanical circulatory support. The aim of our study was to investigate predictors for acute liver failure in patients with end-stage heart failure undergoing mechanical circulatory support. MethodsA consecutive 164 patients with heart failure with New York Heart Association class IV undergoing mechanical circulatory support were investigated for acute liver failure using the King's College criteria. Clinical characteristics of heart failure together with hemodynamic and laboratory values were analyzed by logistic regression. ResultsA total of 45 patients (27.4%) with heart failure developed subsequent acute liver failure with a hospital mortality of 88.9%. Duration of heart failure, cause, cardiopulmonary resuscitation, use of vasopressors, central venous pressure, pulmonary capillary wedge pressure, pulmonary pulsatility index, cardiac index, and transaminases were not significantly associated with acute liver failure. Repeated decompensation, atrial fibrillation (P < .001) and the use of inotropes (P = .007), mean arterial (P = .005) and pulmonary pressures (P = .042), cholinesterase, international normalized ratio, bilirubin, lactate, and pH (P < .001) were predictive of acute liver failure in univariate analysis only. In multivariable analysis, decreased antithrombin III was the strongest single measurement indicating acute liver failure (relative risk per %, 0.84; 95% confidence interval, 0.77-0.93; P = .001) and remained an independent predictor when adjustment for the Model for End-Stage Liver Disease score was performed (relative risk per %, 0.89; 95% confidence interval, 0.80-0.99; P = .031). Antithrombin III less than 59.5% was identified as a cutoff value to predict acute liver failure with a corresponding sensitivity of 81% and specificity of 87%. ConclusionsIn addition to the Model for End-Stage Liver Disease score, decreased antithrombin III activity tends to be superior in predicting acute liver failure compared with traditionally thought predictors. Antithrombin III measurement may help to identify patients more precisely who are developing acute liver failure during mechanical circulatory support.

The heart failure pandemic: The clinical and economic burden in Greece

BackgroundThe objective of this study was to identify the epidemiological and clinical characteristics of heart failure (HF) patients in Greece as well as the economic burden and the distribution of costs for the management of the disease. MethodsEight Greek secondary and tertiary cardiology centres from different cities have participated in a prospective, observational survey, the ESC HF Pilot Survey. 307 patients with HF, 177 hospitalised and 130 outpatients, have been recruited and monitored for 12months. Clinical and epidemiological data, along with data on mortality, hospitalisations and health care resources used have been collected. The economic evaluation was conducted from the social security system perspective. ResultsThe annual mortality rate was 24.3% for the hospitalised patients vs 7.7% for the outpatients (P<0.001) and the annual rehospitalisation rate was 42.9% vs 19.2% respectively (P<0.001). Kaplan–Meier analyses revealed that patients with kidney dysfunction, S3 gallop and higher NYHA class have a significantly worse survival. The mean annual economic burden of the social security system per HF patient was estimated at €4411±4764. About two thirds of this cost is due to in-patient care. ConclusionsDespite the progress in the management of the disease, about one in four hospitalised patients dies and four in ten are rehospitalised in less than one year. Moreover, the disease imposes a significant economic burden for the social security system and national economy. Their findings suggest that there is still need of more effective drug treatment and efficient disease management programs focused in the reduction of the hospital admissions.

Heart failure with preserved systolic function: prevalence and clinical features in a cohort of patients admitted to internal medicine units. The study PRESYF-HF Tuscany

There is uncertainty about the prevalence and clinical characteristics of heart failure (HF) patients with preserved systolic function (PRESYF). To analyze the prevalence and clinical characteristics of patients with PRESYF in an unselected cohort of subjects consecutively hospitalized for HF. The study cohort included 338 patients consecutively admitted for HF at 24 Internal Medicine units homogeneously settled in Tuscany area (Italy). We did not have any criteria for exclusion. All patients had an echocardiographic measure of left ventricular ejection fraction (LVEF) within 72 hours from hospital admission. Patients with LVEF > or = 50% were considered to have PRESYF. The patients with PRESYF were 112 (33.1%), those with depressed systolic function (DESYF) 226 (66.9%). In the group PRESYF were prevalent female sex, hypertensive etiology, and elevated BMI. The distribution for classes of age shows a great frequency of PRESYF in the elderly. About one third of patients admitted for HF have a PRESYF. They are different compared to those with DESYF. A correct identification of this form of HF may be important in clinical practice for more targeted therapeutic options and for prognostic implications.

Clinical Characteristics of Heart Failure With Preserved Ejection Fraction in Children

Clinical Characteristics of Heart Failure With Preserved Ejection Fraction in Children

Abstractss from Other Journals

Context Heart failure (HF) is the most common complication of infective endocarditis. However, clinical characteristics of HF in patients with infective endocarditis, use of surgical therapy, and their associations with patient outcome are not well described. Objectives: To determine the clinical, echocardiography, and microbiological variables associated with HF in patients with definite infective endocarditis and to examine variables independently associated with in-hospital and 1 -year mortality for patients with infective endocarditis and HF, including the use and association of surgery with outcome. Design, Setting, and Patients: The International Collaboration on Endocarditis-Prospective Cohort Study, a prospective, multicenter study enrolling 4166 patients with definite nativeor prosthetic-valve infective endocarditis from 61 centers in 28 countries between June 2000 and December 2006. Main Outcome Measures In-hospital and 1 -year mortality.

Validation of a Mimic Heart Failure Model

Introduction: Animal models which mimic the clinical characteristics of heart failure (HF) with dyssynchrony play a critical role in development of new therapies. Existing HF animal models created by left bundle branch block (LBBB), rapid pacing, or microembolization alone or in combinations only mimic partial HF characteristics and are time-costuming and expensive. The microembolization model creates a stable reduction in left ventricular ejection fraction (LVEF) with minimal change in QRS. Methods: Ten dogs were implanted with two epicardial leads on the left ventricle (LV) and LBBB ablation increased QRS width by 2×. After 4 weeks, HF was induced by microembolization procedures every 1–3 weeks by injecting microspheres into one or both of the coronary arteries (LAD and Left Circumflex) until LVEF decreased to <35% by echocardiography. Results: Two dogs (20%) died during the microembolization procedure. All surviving canines developed severe ischemic cardiomyopathy with dyssynchrony. QRS width significantly increased after LBBB and was stable throughout multiple microembolizations. LVEF significantly decreased after multiple microembolizations but not after LBBB. The pathological examination was performed in the failed hearts at end of the study. Conclusion: This viable and reproducible canine model can mimic heart failure characteristics and serve as a useful tool to evaluate new HF therapies.

Predominance of Heart Failure in the Heart of Soweto Study Cohort

There is a paucity of data to describe the clinical characteristics of heart failure (HF) in urban African communities in epidemiological transition. Chris Hani Baragwanath Hospital services the 1.1 million black African community of Soweto, South Africa. Of 1,960 cases of HF and related cardiomyopathies in 2006, we prospectively collected detailed demographic and clinical data from all 844 de novo presentations (43%). Mean age was 55 +/- 16 years, and women (479 [57%]) and black Africans (739 [88%]) predominated. Most (761 [90%]) had > or =1 cardiovascular risk. Mean left ventricular ejection fraction was 45 +/- 18%. Overall, 180 patients (23%) had isolated diastolic dysfunction, 234 (28%) tricuspid regurgitation, 121 (14%) isolated right HF, and 100 (12%) mitral regurgitation. The most common diagnoses were hypertensive HF (281 [33%]), idiopathic dilated cardiomyopathy (237 [28%]), and, surprisingly, right HF (225 [27%]). Black Africans had less ischemic cardiomyopathy (adjusted odds ratio, 0.12; 95% CI, 0.07 to 0.20) but more idiopathic and other causes of cardiomyopathy (adjusted odds ratio, 4.80; 95% CI, 2.57 to 8.93). Concurrent renal dysfunction, anemia, and atrial fibrillation were found in 172 (25%), 72 (10%), and 53 (6.3%) cases, respectively. These contemporary data highlight the multiple challenges of preventing and managing an increasing and complex burden of HF in urban Africa. In addition to tackling antecedent hypertension, a predominance of young women and a large component of right HF predicate the development of tailored therapeutic strategies.

Chronic heart failure, selected risk factors and co‐morbidities among adults treated for hypertension in a cardiac referral hospital in Cameroon

Information on clinical characteristics of heart failure (HF) among Africans with hypertension is needed to help define the burden of hypertension in this population, but currently there is little data available. To determine the clinical characteristics of HF, related risk factors and co-morbidities among adult Cameroonians treated for hypertension. Medical files of 1218 patients with hypertension followed at the cardiac clinic of Yaounde General Hospital were evaluated over a 10-year period from 1995 to 2005. One hundred and forty (11.5%) patients with clinical HF or asymptomatic left ventricular dysfunction were included in the present analysis. Ages ranged from 26 to 84 years (mean 54.9 years) and 86 (61.4%) were men. Systolic dysfunction and isolated diastolic HF were found in 64% and 23% of patients, respectively. Seventy nine (56.4%) patients had at least one co-morbidity and 43 (30.7%) had multiple co-morbidities. Co-morbidities included: renal impairment (24.3%), overweight and obesity (20.7%), chronic obstructive pulmonary disease (17.1%), gout (16.4%), anaemia (15.7), diabetes mellitus (13.5%), atrial fibrillation (12.9%), stroke (9.3%), and ischaemic heart disease (5.7%). HF is frequent among Cameroonian patients treated for hypertension and is regularly associated with co-morbidities. Efforts are needed to improve the control of hypertension and enhance early detection of these co-morbidities in this context.

Heart Failure in Outpatients: Comorbidities and Management by Different Specialists. The EPISERVE Study

The aim of the EPISERVE study was to investigate the clinical characteristics of heart failure in outpatients and its diagnostic and therapeutic management by cardiology, internal medicine and primary care specialists. The study involved 507 physicians working in primary care (n=181, 36%), cardiology (n=172, 34%) or internal medicine (n=154, 30%) who treated 2249 consecutive outpatients with heart failure between June and November 2005. The prevalence of heart failure was 2% in primary care, 17% in cardiology and 12% in internal medicine. Hypertension or coronary disease was the cause in more than 80% of cases. The prevalence of comorbidities was high: atrial fibrillation, 46%; diabetes, 38%; obesity, 64%; dyslipidemia, 60%; anemia, 27%; and renal failure, 7%. In 40% of cases, systolic function was preserved (i.e., left ventricular ejection fraction > or =45%). Echocardiographic and coronary angiographic studies were performed more frequently in patients seen in cardiology and in male patients. There were significant differences between men and women in pharmacologic treatment involving beta-blockers (55% vs. 44%, respectively; P< .001), diuretics (88% vs. 92%, respectively; P< .01) and statins (57% vs. 47%, respectively; P< .001). Only 20% of patients received the treatment recommended by clinical practice guidelines. The factors independently associated with appropriate treatment were being treated in cardiology, hypercholesterolemia, age and etiology. The varied approaches of different specialists, the smaller effort put into diagnosis and therapy in women, and the low percentage of patients treated according to guidelines make it essential that an educational and multidisciplinary strategy should be developed for managing outpatients with heart failure.