Congestive Heart Failure Class Research Articles

Abstract 13656: Effects of Left Ventricular Ejection Fraction and NYHA CHF Class on Baroreceptor Function in Congestive Heart Failure

Background: Autonomic dysfunction is an important component in congestive heart failure (CHF) pathophysiology. The combined effects of reduced ejection fraction and advanced CHF Class on baroreceptor function in CHF have not been well investigated. Methods: A single center prospective study included 118 consenting patients, 68.3 ± 14.2 years old, 50 females (42.3%), BMI of 30.1 ± 8.5 kg/m 2 , with histories of HTN in 97 (82.2%), CAD in 64 (54.2%), diabetes in 49 (41.5%), and COPD or asthma in 39 (33.1%). Class I or II CHF were documented in 32 (27.1%), class III in 53 (44.9%), and class IV in 33 (28%) patients. Mean LV EF was 44.5+/-13.9%, HFrEF was present in 41 (34.7%) patients. Baroreceptor function was assessed by measuring resting and lowest heart rates (HR) during voluntary breath holding. Results: Despite treatment with beta-adrenergic blockers in 92 (78%) and non-dihydropyridine calcium channel blockers in 7 (5.9%) patients, increased CHF class was associated with significantly increased resting (71.7 ± 14.4 bpm in Class I-II, 73.1 ± 13.6 bpm in Class III, and 80.8 ± 16.9 bpm in Class IV, p=0.027) and breath holding HR (68.9 ± 15.3 bpm in Class I-II, 69.9 ± 12.2 bpm in Class III, and 80 ± 16.1 bpm in Class IV, p=0.002). In addition, when compared to the rest of the cohort, HFrEF patients manifested with increased resting (80.9 ± 14.5 vs. 71.6 ± 14.6 bpm, p=0.001) and breath holding HR (77.6 ± 13.9 vs. 69.7 ± 14.7 bpm, p=0.006). In multivariate analysis, both increased CHF NYHA class and reduced LVEF retained statistically significant independent effects on resting (p=0.037 and p=0.001, respectively) and breath holding HR (p=0.005, each). Conclusion: Decreased LV ejection fraction and increased CHF class independently and significantly contribute to autonomic dysfunction in CHF patients. Heart rate changes indicating abnormal baroreceptor function in CHF patients are apparent despite treatment with medications affecting chronotropic response.

Abstract 11820: Importance of Resting Heart Rate Assessment in Autonomic Dysfunction Evaluation in Congestive Heart Failure Patients

Background: Novel treatments in congestive heart failure (CHF) aim at ameliorating autonomic dysfunction. Autonomic dysfunction typically manifests with resting tachycardia and blunted baroreceptor reflex response and been classically described in CHF with reduced LV ejection fraction (EF) but baroreflex function in CHF with preserved EF has not been well investigated. Methods: A single center prospective study was conducted by measuring resting and lowest heart rates (HR) during voluntary breath holding in 118 CHF patients, 68 ± 14 years old, 50 females (42.3%), BMI 30.1 ± 8.5 kg/m 2 , HTN in 97 (82.2%), CAD in 64 (54.2%), diabetes in 49 (41.5%), and chronic lung disease in 39 patients (33.1%). HFrEF less than 40% was found in 41 (34.7%) patients; for the purposes of analysis HRmrEF and HFpEF groups were combined. Beta-blockers were used in 92 (78%) and non-dihydropyridine calcium channel blockers were used in 7 (5.9%) patients. Results: The majority of HFpEF or HFmrEF patients had resting HR less than 80 bpm (55/77 patients, 71.4%), while the majority of HFrEF patients had resting HR more than 70 bpm (32/41 patients, 78%, p=0.015). Furthermore, HFpEF and HFmrEF patients had lower breath holding HR (69.7 ± 14.7 bpm in HFpEF and HFmrEF patients vs. 77.6 ± 13.9 bpm in HFrEF patients, p=0.005). There was a trend of increased resting HR in patients with Class IV CHF (p=0.179). Furthermore, class IV CHF patients manifested with increased breath holding HR (68.9 ± 15.3 bpm in combined NYHA class I-II, 69.9 ± 12.2 bpm in NYHA class III, 79.9 ± 16.1 bpm in NYHA class IV, p=0.02). Regardless of the CHF class (p=0.060) and/or LV EF (p=0.913), increased resting HR was associated with higher breath holding HR. Patients with baseline HR <60 bpm had breath holding HR of 54.6 ± 6.2 bpm, as compared to 94.9 ± 9.0 bpm in patients with baseline HR >90 bpm, p<0.001. Conclusion: In CHF patients, increased resting HR is a strong indicator of abnormal baroreceptor function. HRmrEF and HFpEF patients have lower resting and breath holding HR, suggesting less pronounced autonomic dysfunction, as compared to more pronounced autonomic dysfunction in HFrEF patients. Additional studies are needed to investigate whether autonomic modulation treatment is equally beneficial in patients across the LVEF spectrum.

The Importance of Mehran Score to Predict Acute Kidney Injury in Patients with TAVI: A Large Multicenter Cohort Study.

Transcatheter aortic valve implantation (TAVI) has developed as an alternative to surgery for symptomatic high-risk patients with aortic stenosis (AS). An important complication of TAVI is acute kidney injury. The purpose of the study was to investigate if the Mehran Score (MS) could be used to predict acute kidney injury (AKI) in TAVI patients. This is a multicenter, retrospective, observational study including 1180 patients with severe AS. The MS comprised eight clinical and procedural variables: hypotension, congestive heart failure class, glomerular filtration rate, diabetes, age >75 years, anemia, need for intra-aortic balloon pump, and contrast agent volume use. We assessed the sensitivity and specificity of the MS in predicting AKI following TAVI, as well as the predictive value of MS with each AKI-related characteristic. Patients were categorized into four risk groups based on MS: low (≤5), moderate (6-10), high (11-15), and very high (≥16). Post-procedural AKI was observed in 139 patients (11.8%). MS classes had a higher risk of AKI in the multivariate analysis (HR 1.38, 95% CI, 1.43-1.63, p < 0.01). The best cutoff for MS to predict the onset of AKI was 13.0 (AUC, 0.62; 95% CI, 0.57-0.67), whereas the best cutoff for eGFR was 42.0 mL/min/1.73 m2 (AUC, 0.61; 95% CI, 0.56-0.67). MS was shown to be a predictor of AKI development in TAVI patients.

PS-C24-10: HAEMODYNAMIC CHARACTERISTICS OF THE HEART BEFORE AND AFTER CRT IN PATIENTS WITH HEART FAILURE

The aim of the study: to evaluate the clinical and hemodynamic effects of resynchronization therapy in patients with congestive heart failure. Materials and Methods: seventy-six consecutive patients underwent echocardiography, NYHA classification, 6-minute walk test before and after cardiac resynchronization therapy. All had complete left bundle branch block, with a QRS complex duration greater than 130 ms. and left ventricular ejection fraction less than 35%. Also, all patients had received optimal medical therapy for at least 3 months before inclusion to the study. Results: we observed significant increase in left ventricular ejection fraction (on 35.4 ± 3.7%, p &lt; 0.001, compared with baseline) and decrease in end-systolic volume of the left ventricle (on 20.2 ± 3.0%, p &lt; 0.001 compared with baseline). Improvement in functional class of congestive heart failure by NYHA classification by more than 1 was observed in 68.4% of individuals, in 26.3% of participants demonstrated no change and 5.3% of patients had worsening of CHF symptoms. Conclusions: the response of patients with congestive heart failure to cardiac resynchronization therapy is heterogeneous. The relationship between left ventricular reverse remodeling and the functional class of the congestive heart failure was not significant.

The effect of serum uric acid concentration on the severity of chronic congestive heart failure

This study aimed to investigate the adverse effects of serum uric acid concentration on the severity of chronic congestive heart failure. One hundred patients with chronic congestive heart failure (several risk factors include hypertension, smoking, and diabetes mellitus) were enrolled in this study (51 females and 49 males). Participants were admitted to Alsader Medical City in Al-Najaf from August 2018 to March 2019. Detailed medical history and complete clinical examination were performed for all patients. The patients' ages ranged from 13-90 years, with a mean of 62.1±15.8 years, and the median was 65 years. No statistically significant age difference was observed between males and females (P-value=0.687). Increased serum uric acid had a directly negative effect on the severity of chronic congestive heart failure and hypertension. High serum uric acid concentration was associated with increased severity of chronic congestive heart failure class NYHA III and NYHA IV and a decrement in ejection fraction of the left ventricle.

English

The Macruz Index is a simple electrocardiographic methodology indicated in the evaluation of possible left atrial remodeling in human medicine. In dogs, the main cause of left atrial remodeling is mitral valve myxomatous degeneration, a degenerative valvulopathy with high occurrence in the routine of the veterinary clinic. Thus, the objective was to determine the values of the Macruz Index and correlate them with the echocardiographic variable left atrium/aorta ratio in dogs with valvulopathy. For this, 11 healthy dogs, male and female, aged between 2 and 8 years, weighing up to 10 kg were selected; together with 60 dogs with mitral valve myxomatous degeneration, small breed and ages 7 to 17 years, which were subdivided into groups according to the class of congestive heart failure - B1 (n=20), B2 (n=20) and C (n=20). All dogs in the present study underwent clinical cardiological, electrocardiographic and echocardiographic evaluation in order to obtain the values of the Macruz Index and the left atrium/aorta ratio. The results showed a significant difference (p&lt;0.05) between the values of the Macruz Index of healthy dogs compared to the groups of dogs with the studied valvular disease (class B2 and C1). However, its correlation with the values of the left atrium/aorta ratio obtained in dogs with mitral valve myxomatous degeneration according to the congestive heart failure classes was low, positive and not statistically significant. Thus, we can conclude that the Macruz Index suggests left atrial remodeling in dogs with mitral valve myxomatous degeneration compared to healthy dogs. However, it does not correlate or evidence progressive left atrial remodeling between classes of congestive heart failure. Key words: Atrium, endocardiosis, macruz index, echocardiography.

Structural and functional characteristics of the heart before and after CRT in patients with heart failure

The aim of the study was to evaluate the clinical and hemodynamic effects of resynchronization therapy in patients with congestive heart failure. Materials and methods: Seventy-six consecutive patients underwent echocardiography, NYHA classification, 6-minute walk test and clinical assessment scale modified by Mareev, before and after cardiac resynchronization therapy. All had complete left bundle branch block, with a QRS complex duration ≥ 130 ms. and left ventricular ejection fraction ≤ 35%. Also, all patients had received optimal medical therapy for at least 3 months before inclusion to the study. Results: We observed significant increase in left ventricular ejection fraction (35.4±3.7%, p < 0.001, compared with baseline) and decrease in end-systolic volume of the left ventricle (20.2 ±3.0 %, p < 0.001 compared with baseline). Improvement in functional class of congestive heart failure by NYHA classification by > 1 was observed in 68.4% of individuals, in 26.3% of participants demonstrated no change and 5.3% of patients had worsening of CHF symptoms. Conclusions: The response of patients with congestive heart failure to cardiac resynchronization therapy is heterogeneous. The relationship between left ventricular reverse remodeling and the functional class of the congestive heart failure was not significant. Key words: congestive heart failure, cardiac resynchronizing therapy, optimal drug therapy.

Short-Term Complications and Readmission Following Total Shoulder Arthroplasty: A National Database Study.

The incidence of total shoulder arthroplasty (anatomic and reverse) is increasing as indications expand. The purpose of this study is to identify predictors of short-term complications and readmission following total shoulder arthroplasty for patients with glenohumeral osteoarthritis. The American College of Surgeons National Surgical Quality Improvement Program was used to identify 12,982 patients who underwent total shoulder arthroplasty (anatomic or reverse) from 2011-2016. Demographic data, postoperative complications, and readmission within 30 days were analyzed. Multivariable logistic regression was used to determine independent risk factors for complications and for readmission occurring within 30 days of surgery. The mean age of the cohort was 69.1 years, 56.1% were female. Mean American Society of Anesthesiologists (ASA) classification score was 2.6. The postoperative complication rate was 5.6% and the readmission rate was 2.8% within 30 days of surgery. Independent predictors for any complication included preoperative dependent functional status (OR 1.8, P<0.001), ASA class 3 (OR 3.6, P=0.021) and 4 (OR 8.5, P<0.001), age 70-79 (OR 1.4, P=0.019) age ≥ 80 years (OR 2.3, P<0.001, and female gender (OR 1.6, P=0.001). Independent predictors for readmission included congestive heart failure (OR 3.4, P=0.002) and ASA class 4 (OR 14, P = 0.013). Independent functional status was associated with decreased odds of readmission (OR 0.4, P<0.001). Patients with age greater than 70 years, congestive heart failure, and ASA class 3 and 4 are at increased risk for postoperative complications and readmission. Preoperative risk stratification and medical optimization are important in these patients.

Effect of exercise training on dimensions of quality of life and fatigue in people with congestive heart failure class II and III: A randomized controlled trial

Background: Improved living conditions and increased life expectancy have led to aging in societies. Increased incidence of chronic heart disease is one of the most important economic, social, and health challenges of the 21st century. Aim: This study aimed to examine the effect of exercise training on dimensions of quality of life and mental status in people with congestive heart failure Class II and III. Materials and Methods: This study was carried out on patients with chronic heart failure. For this purpose, 52 eligible patients were chosen and randomly divided into case and control groups. The participants in the case group were asked to follow an exercise program three sessions per week in the morning for 24 weeks. This exercise program comprised 5–10 min of warming, 20–30 min of exercise, and 5 min of cool-down. Data were collected by the SF-36 questionnaire and analyzed by the SPSS version 18. Results: The results revealed that there was a significant difference in the mean score of various dimensions of quality of life including NYHA functional Classes II (P = 0.032) and III (P = 0.027), fatigue, BP, and general health in Classes II (P

Myocardial Adiponectin Isoform Shift in Dogs with Congestive Heart Failure-A Comparison to Hibernating Brown Bears (Ursus arctos horribilis).

Adiponectin is the most abundant plasma adipokine, and is well known for its role in energy homeostasis and cardiac protection. In humans with dilated cardiomyopathy, myocardial adiponectin protein expression is reduced compared to normal hearts and has been implicated in the pathology of cardiomyopathy. Serum adiponectin levels are often conflicting, with higher levels associated with poor survival in humans with congestive heart failure (CHF). We evaluated adiponectin serum concentrations and myocardial protein expression in dogs with naturally occurring myxomatous mitral valve disease and CHF. We compared the findings to active and hibernating brown bears as bears are adapted to endure an extreme period of low cardiac output during their annual hibernation. Bears exhibited largely the active high-molecular weight (HMW) versus the low-molecular weight isoforms of myocardial adiponectin (HMW:LMW = 6.3) during both the active period and hibernation, while healthy dogs exhibited a more balanced mix of isoforms. Dogs with CHF expressed predominately HMW isoforms of adiponectin (HMW:LMW = 12.5), appearing more similar to bears. In contrast to humans, serum adiponectin was significantly lower in dogs with CHF and lowest levels in the severest CHF class. In both dogs and bears, myocardial adiponectin was expressed independent of circulating adiponectin concentrations, suggesting a local regulatory mechanism within the heart.

A ROLE OF SUPEROXIDE DISMUTASE IN DEVELOPMENT OF POST-OPERATION ATRIAL FIBRILLATION IN CORONARY HEART DISEASE PATIENTS

Aim. To evaluate the level of superoxide dismutase (SOD) in coronary heart disease (CHD) patients underwent coronary bypass (CBG), and to estimate its importance in development of post-surgery atrial fibrillation (PSAF). Material and methods . Totally, 96 patients studied, with CHD, admitted for CBG. Patients were selected to 2 groups: 1 group — non-PSAF (67 patients, 80,6% males, mean age 57,9±7,3 y.o.), 2 group — with first time AF in early period of CBG (29 patients, 86% males, mean age 64,0±8,4 y.o.). Results. During study period PSAF developed in 30,2% cases, mean on 4,9±3,8 day after surgery. Comparing with group 1, level of SOD was higher in group 2 patients (2589,8±1999,3 U/g vs 1572,8±1275,2 U/g, р=0,034). Patients of group 2 were older 4 years in average (64,0±8,4 vs 57,9±7,3 y., р=0,048), had longer duration of cardiovascular pathology (86,9±76,1 months vs 44,3±38,4 m., р=0,002). Patients with PSAF had III functional class of angina (72,4% vs 47,8%, р=0,028) and III functional class of congestive heart failure (38,0% vs 7,5%, р=0,006), they had larger left atrium (43,5±4,1 mm vs 37,9±3,4 mm, р<0,001). After multifactorial analysis, predictive value remained for the following: left atrium larger than 41 mm — 5,1 (95% CI, 2,1-9,8, р=0,0005), SOD more than 2948 U/g — 4,4 (95% CI, 1,1-8,9, р=0,04). Conclusion. The study showed that CBG operation is followed by activation of oxidation stress which is followed by the decrease of SOD concentration, probably due to its consumption. However, among patients with PSAF there is higher activity of this enzyme.

Evaluation of N-Terminal Pro Brain Natriuretic Peptide as a biomarker for clinical severity of heart failure in pediatric population

Background and study aim: Brain Natriuretic Peptide (BNP) and N-Terminal pro-Brain Natriuretic Peptide (NT-pro BNP) are frequently used in the diagnosis of congestive heart failure (CHF), especially for distinguishing between patients with dyspnea of cardiac and pulmonary origin. The present work aimed at evaluating N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) as a biomarker for diagnosis of congestive heart failure (CHF) in pediatrics and as well as its severity and hence, helping early diagnosis of CHF in absence of rapid echocardiographic examination. Subjects and Methods: The patients group (group I) consisted of 45 children (Session [UserIDID] males and 21 females) aging between 45 days and 12 years. All having the inclusion criterion of CHF. They were subclassified into: group I-1 including 15 patients having dilated cardiomyopathy (DCM), group I-2 including 15 patients having congenital heart disease (CHD) and group I-3 including 15 patients that have developed CHF due to non-cardiac causes. The control group was formed of 15 healthy children (group II) matched in age and gender with the patients groups. All children were subjected to full history taking, physical examination, classification of clinical severity of CHF cases according to Modified Ross Score, imaging and laboratory investigations including serum level of NT-proBNP. Results: The study revealed that serum NT-proBNP showed a highly statistically significant increase in CHF cases three groups (I-1, I-2 and I-3) in comparison to the control group (group II) (P<0.001). NT-proBNP level showed highly statisticallysignificant positive correlation with CHF class of clinical severity (P<0.001). Regarding echocardiographic parameters NT-proBNP showed a highly significant positive correlation with left ventricular end diastolic dimensions (LVEDD) and left ventricular end systolic dimensions (LVESD), and a highly significant negative correlation with left ventricular (LV) ejection fraction (EF), fractional shortening (FS) and mitral valve E/A ratio. At cutoff level of 1500 pg/ml, the sensitivity of NT-proBNP as a diagnostic biomarker in children with CHF was 98% and the specificity was 100%. Conclusion: NT-proBNP is significantly statistically correlated with clinical severity of CHF and echocardiographic parameters of CHF cases of different causes .We highly recommend a long-term study on the value of the level of NT-proBNP as a prognostic risk parameter.

Features of coagulation hemostasis and anticoagulation system in patients with chronic heart failure due to ischemic heart disease

Aim. To study the features of coagulant and anticoagulant systems in patients with varoious functional classes of congestive heart failure secondary to coronary heart disease (according to New York Heart Association criteria) and to determine the most informative method for diagnosing the hemostasis disorders.&#x0D; Methods. 82 patients with congestive heart failure, who had previously survived myocardial infarction with Q-wave formation, and left ventricle ejection fraction (by Simpson) less than 50%, were included. Average age was 54.0 [50.0-64.0] years. Control group of 30 healthy people was formed. All patients were allocated to two groups. 1st group included patients with I-II functional class of congestive heart failure (n=57), 2nd group - patients with III-IV functional class of congestive heart failure (n=25). Activated partial thromboplastin time, prothrombin and fibrinogen levels, international normalized ratio, heparin cofactor activity of antithrombin, D-dimer level were measured in blood serum.&#x0D; Results. Only D-dimer level and heparin cofactor activity of antithrombin were changed in the main group compared to the controls. D-dimer level in patients of the general group was 0.2 [0.2-0.4] mg/L versus 0.2 [0.2-0.2] mg/L in control group (p=0.000064). There was no obvious deficit of heparin cofactor activity of antithrombin in patients with congestive heart failure, but the values were lower in the main group - 90.5 [82,7-100,4]% compared to the control group - 102 [90,0-104,0]% (p=0.0068). In subgroups, there were indicators (prothrombin, international normalized ratio, D-dimer) that changed according to the functional class. The lowest values of prothrombin were found in patients with III-IV functional class, the highest - in patients with I-II functional class. Indicators (prothrombin, INR, D-dimer) which changing with the growth of CHF FC were identified by separating the patients into subgroups. FC, the largest - in patients with FC I-II. Serum D-dimer level increased in accordance with congestive heart failure functional class (р1-2=0.0065).&#x0D; Conclusion. Congestive heart failure contributes to prothrombotic changes in hemostasis. The severity increases with increasing congestive heart failure functional class. D-dimer is the most sensitive marker of hemostasis activation at congestive heart failure. This parameter should be included in the routine hemostasis testing in patients with congestive heart failure.

Right Minithoracotomy Versus Median Sternotomy for Mitral Valve Surgery: A Propensity Matched Study

The efficacy of conventional median sternotomy versus a right minithoracotomy (RT) approach to mitral valve surgery was evaluated in a single high-volume institution. A retrospective analysis of a single institution's experience was performed using propensity matching of 1,694 patients who underwent mitral valve surgery during a 15-year period. Patients who had procedures that were not usually performed through an RT approach were excluded. Using 1:1 propensity score matching, we obtained 215 matched patients in each group for outcomes analysis. There was no difference in the median year of operation between the two groups (2002 versus 2001; p= 0.142). The RT approach was not a predictor of postoperative mortality. Predictors of mortality included increasing age, diabetes, smoking, preoperative dialysis, lung disease, advanced congestive heart failure class, and peripheral vascular disease. The RT approach was associated with less new-onset atrial fibrillation (8% versus 16%; p= 0.018), pneumonia (1% versus 5%; p= 0.049), respiratory failure (3% versus 8%; p= 0.036), and acute renal failure (2% versus 7%; p= 0.006), lower chest tube output (350 versus 840 mL; p < 0.001), and fewer red blood transfusions (2 versus 3 units; p= 0.001). Right minithoracotomy compared with median sternotomy for mitral valve surgery was associated with less postoperative atrial fibrillation, respiratory complications, acute renal failure, chest tube output, and use of packed red blood cells. Given study limitations, the RT approach for mitral valve surgery may have advantages over median sternotomy in selected patients.

A comprehensive evaluation of respiratory status in patients with coronary artery disease undergoing coronary artery bypass surgery

The aim of the study was to analyze a potential role of lung function for a comprehensive evaluation of respiratory system in patients undergoing the coronary artery bypass surgery. Methods. The study involved 662 patients. Spirometry, body plethysmography and the singlebreath diffusing capacity for carbon monoxide (DLCO) were measured in all patients. All patients were divided into three groups according to the results of pulmonary function tests: patients with a known history of respiratory disease (n = 74; 11.2%), patients with newly diagnosed respiratory disease (n = 222; 33.5%) and patients without any respiratory disorders (n = 366, 55.3%). An integral index was calculated which characterizes the comprehensive pulmonary function evaluation based on weight coefficients. Results . Bronchial obstruction parameters, forced and slow vital capacities and diffusing capacity of alveolarcapillary membrane greatly contributed to the pulmonary function integral index. This index did not differed significantly between patients with newly and previously diagnosed respiratory diseases; however, it was significantly higher in patients without any respiratory disorders. Conclusion. A correlation analysis of the pulmonary function integral index, clinical and demographic data confirmed an inverse relationship between the pulmonary function integral index and duration of coronary artery disease, hypertension, number of previous myocardial infarctions, functional class of angina pectoris and congestive heart failure along with generally accepted factors affecting pulmonary function such as age, body mass index, smoking, and industrial xenobiotics.

ATRIAL FIBRILLATION ASSOCIATED WITH MYOCARDIAL INFARCTION OF DIFFERENT LOCALIZATIONS

Aim. To specify the mechanism of atrial fibrillation (AF) development and to evaluate the function of left atrium after restoration of sinus rhythm in patients with AF and acute myocardial infarction (MI) without significant reduction in left ventricular systolic function. Material and methods. 52 patients with MI were enrolled into the study and divided into 2 groups. The first group included 29 patients with inferior MI, the second one – 23 patients with anterior MI. All patients underwent percutaneous intervention within first 24 hours after the onset of MI symptoms. Time and triggering factors of AF symptoms onset, its duration, the size of the heart chambers and time of left atrium function recovery were evaluated. Results. In patients with anterior MI AF developed later than in those with inferior MI (on day 2 in 12 patients and on day 3 – in 11 patients with anterior MI versus on day 1 in 25 patients and on day 2 – in 4 patients with inferior MI, p&lt;0.05). Besides, in case of inferior MI the AF paroxysms were less persistent. The average duration in the first and second groups was 5.3±4.8 vs 42.3±12.1 hours, respectively; p&lt;0.0001. There were also differences in the triggering factors of AF paroxysms. So, only 5 patients with inferior MI had congestive heart failure class KIllip II or higher, while in the second group it was present in 20 patients; p&lt;0.0001. AF paroxysms in patients with anterior MI were accompanied by severe hemodynamic disorders and significantly worsened the prognosis. The assessment of left atrium function showed that it’s often not impaired in inferior MI after sinus rhythm restoration (we observed normal peak A on the Doppler transmitral flow image in 25 patients). In case of anterior MI the effective atrial systole was absent for at least 7 days in 13 patients; p&lt;0.005. Conclusion. AF has less favorable course in anterior MI. In this category of patients AF paroxysms are followed by hemodynamic disorders, and after the restoration of sinus rhythm the majority of patients has consistently impaired mechanical function of the left atrium, which is related to an increased risk of thromboembolic complications.

Three hundred robotic-assisted mitral valve repairs: The Cedars-Sinai experience

The study objective was to review our first 300 consecutive robotic-assisted mitral repairs performed from June 2005 to October 2012 and to compare the surgical outcomes of our previously reported initial 120 cases with the subsequent 180 procedures. Our initial 120 robotic-assisted mitral repairs were previously reported, and we now compare our early experience with the recent 180 consecutive procedures for a total of 300 robotic-assisted mitral repairs. There was no patient selection. Every patient in need of isolated mitral valve repair underwent this procedure. All patients received an annuloplasty band and 1 or more of the following: leaflet resection, secondary chordal transposition, or polytetrafluoroethylene neochordal replacement and edge-to-edge repair. All 300 patients had preoperative echocardiographic findings of severe mitral regurgitation. There were no differences (P=not significant) between the initial and the recent cohorts for preoperative characteristics, including age (58.4 ± 10.5 years vs 59.9 years), female gender (35.8% vs 36.1%), ejection fraction (61.9% vs 60.6%), congestive heart failure (35.0% vs 36.7%), creatinine (0.94 mg/dL vs 0.98 mg/dL), and New York Heart Association class. The incidence of anterior and posterior leaflet prolapse was similar in both groups, whereas Barlow syndrome was higher in group 2 (5.8% vs 27.8%). There was 1 (0.33%) hospital mortality and no deaths in the last 180 cases. Overall, 8 patients (2.7%) required subsequent mitral valve replacement via a median sternotomy, 6 (5.0%) in the first group and 2 (1.1%) in the second group (P=.06). One patient in each group had mitral valve re-repair through a right mini-thoracotomy, and 1 patient in the first group required a mitral valve replacement via a mini-thoracotomy during the original procedure. Two of the 180 patients had documented cerebrovascular accident, but both fully recovered clinically. There was no cerebrovascular accident in the last 120 patients. Crossclamp times decreased from 116 minutes to 91 minutes in the second group despite starting a training program with a junior associate performing part of the procedure at the console in the last 100 cases. Post-pump echocardiograms showed no/trace mitral regurgitation in 86.1% of the last 180 patients and mild mitral regurgitation in 11.1%. Follow-up echocardiography for the last 180 patients from 1 month to more than 1 year showed no/trace mitral regurgitation in 64.6% of patients and mild mitral regurgitation in 23.1% of patients. Seven patients (10.8%) had moderate mitral regurgitation, and 1 patient (1.5%) had severe mitral regurgitation. The majority of complications and reoperations occurred early in our experience, especially using the first-generation da Vinci robot (Intuitive Surgical Inc, Sunnyvale, Calif). The newer da Vinci Si HD system with the addition of an adjustable left atrial roof retractor together with increased experience has made robotic-assisted mitral repair of all types of degenerative mitral valve pathology reproducible. The training of young surgeons in a stepwise fashion in high-volume centers will help to avoid the complications encountered during the introduction of this technology.

Factors contributing to readmission of congestive heart failure patients admitted in internal ward of Hospitals of Shahid Beheshti University of Medical Sciences in Tehran

Factors contributing to readmission of congestive heart failure patients admitted in internal ward of Hospitals of Shahid Beheshti University of Medical Sciences in Tehran Ashktorab, T. 1 * (PhD); Bathaei, S A. 2 (MSN); Zohari Anbuhi, S. 3 (MSN); Alavi Majd, H. 4 (PhD); Ezati, J. 5 (MSN) 1. Associate Professor, Dept. of Medical-Surgical, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences. Tehran. Iran 2. Alumnus, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences. Tehran. Iran. 3. Lecturer, Dept. of Medical-Surgical, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences. Tehran. Iran. 4. Associate Professor, , Dept. of Biostatistics, Faculty of Paramedical, Shahid Beheshti University of Medical Sciences. Tehran. Iran. 5. Lecturer, Dept. of Medical-Surgical, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences. Tehran. Iran. Abstract Background and aim The prevalence of congestive heart failure (CHF) continues to rise and nearly 5 million people in the United States have CHF, with more than one-half million new cases diagnosed each year. The readmission rate within 3-6 months after discharge in these patients is 10-50 percent. The aim of this study was to determine factors contributing to readmission of patients with congestive heart failure (class 2 and 3) who were admitted in internal ward of Hospitals of Shahid Beheshti University of Medical Sciences in Tehran 2009. Materials and methods In this correlation -descriptive study, 110 patients with congestive heart failure based on 2 and 3 New York Heart Association Classification (NYHA) were included. Subjects were selected by quota purposive sampling and were divided into two groups (readmission and no readmission). Data were collected by a questionnaire. Content validity of the questionnaire was assessed by 10 nursing experts, 5 persons with congestive heart failure and 2 cardiologists. Reliability was measured by ted-retest (0/86). Data were analyzed by SPSS 15. Findings Results showed that, % 61.8 of samples was readmitted to the hospital during the previous 6 months period. In addition, two individual factors (age and literacy level) and two disease related factors (NYHA class and having other disease) contributed to readmissions. Therefore, age and higher NYHA class and having co morbidities had direct and also literacy level indirect relationship with readmissions. Conclusion The readmission rate of patients with congestive heart failure in this study was high . Therefore, attention to contributing factors is needed. Keywords: Congestive heart failure, Readmission, Factors. * Corresponding Author: Dr Ashktorab; Assistant Professor, Dept. of Medical-Surgical, Faculty of Nursing and Midwifery, Shaheed Beheshti Medical University, Shariati, Tehran, Iran. E-mail: t_ashktorab@sbmu.ac.ir

Abstract P3-15-04: The Clinical Course of Metastatic Breast Cancer Patients with a Congestive Heart Failure after an Epirubicin-Based Treatment

Abstract Background. Patients treated with epirubicin are at risk for the development of congestive heart failure (CHF). However, only limited data are available, which is describing the outcome for these patients. Materials and methods. The patients were recruited consecutively from 1,097 anthracycline-naïve patients with metastatic breast cancer, who were admitted to Herlev Hospital from November 1983 - November 2003 for an epirubicin-based chemotherapy. No patients had a history of heart disease. The outcome of 125 metastatic breast cancer patients, with a CHF Class ≥ II according to New York Heart Association (NYHA) guidelines after an epirubicin-based treatment, was performed retrospectively. Univariate ordinal logistic regression was used to study the association between NYHA class at time of CHF (II, III or IV) and possible risk factors. Two multiple Cox regression analyses (events: mortality of cardiotoxicity and mortality of other causes) were performed to evaluate the risk of cardiac death. Results. CHF was developed within a median time from cessation of epirubicin on 3 months (range 0 to 66.7 months). The distribution of patients in the NYHA class II, III, IV and NYHA class ≥2 was; 35 patients (28%), 38 patients (30.4%), 39 patients (31.2%) and 13 patients (10.4%), respectively. No predictive factors, including increasing cumulative dose of epirubicin, co-morbidities and age had an influence on the severity of CHF. The median survival of all patients was 7.3 months (range 0.01 to +121.1 months). Deaths caused by CHF occurred in 27 patients (21.6%) in a median time on 1.2 months (range 0 - 77 months), including 6 patients (4.8%) dying of cardiac failure &amp;lt; 10 days after the diagnosis. Only the NYHA class patient had was the only risk factor for dying of CHF (p = 0.0003). Compared to patients in NYHA class II and III, the risk of cardiac death in patients with NYHA class IV was increased with 93% and 74%, respectively. Survival in patients with stable CHF was comparable to other patients with metastatic breast cancer. Discussion. Although the information is obtained retrospectively during a period of twenty years; the study is important, as only limited information is available on the course of CHF patients. The study showed that the risk of cardiac death were closely related to the degree of cardiac toxicity as the risk of cardiac death was 93% or 74% higher for patients in NYHA class IV than for patients in NYHA class II or III. Moreover, the outcome for the patients when CHF is stabilized can be expected to be as patients without CHF. Furthermore, no predictive factors were identified, including increasing cumulative dose of epirubicin for the severity of cardiotoxicity developed. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-15-04.

The role of implantable cardioverter defibrillators in high-risk CABG patients identified early post-cardiac surgery

To assess clinical markers that can be used in predicting the outcome and role of implantable cardioverter defibrillators (ICD) in coronary artery bypass surgery (CABG) patients with severely depressed left ventricular ejection fraction (LVEF), independent of time from revascularization. The database was searched for patients who had CABG surgery and had an ICD within 4 months of surgery, between 1999 and 2005. The records were reviewed for LVEF, status of revascularization, programmed electrical stimulation results, and medications. The primary endpoints were: combined total mortality (TM) and appropriate ICD therapy (ICD-T), and the individual outcomes of TM and ICD-T. One hundred and sixty-four patients were identified, 69 had an ICD implanted for primary prevention of sudden cardiac death and were followed till June 2009. The mean pre- and post-operative LVEFs were 29 and 33%, 46 (67%) had incomplete revascularization, and 38 (55%) had inducible ventricular arrhythmias. Over the mean follow-up of 40 months, 20 patients (29%) died and 18 (26%) had ICD-T. In the Cox proportional hazard model, the following variables were significant at the 0.05 level; for the combined outcome TM and ICD-T: congestive heart failure (CHF) class III/IV and coronary artery disease (CAD) + valvular disease; for ICD-T outcome: CAD + valvular disease; for TM outcome: female gender, LVEF < 35%, CHF class III/IV, and lack of angiotensin converting enzyme-inhibitor therapy. Clinical assessment of CABG patients can assist in selecting a high-risk group with TM and ICD-T rates comparable to those of primary prevention studies and could be useful for future randomized ICD studies in this selective group of patients.