Heart Failure Research Articles

Post-TIPS Right Atrial Pressure and Left Atrial Volume Index Predict Heart Failure and Mortality: Dual Center Experience

Background: Heart failure (HF) after Transjugular Intrahepatic Portosystemic Shunt (TIPS) placement affects up to 20% of patients. Understanding factors associated with post-TIPS HF is critical. Cirrhotic Cardiomyopathy (CCM) is associated with adverse clinical outcomes. Aims: We aim to evaluate whether hemodynamic measurements and echocardiographic markers of CCM pre- and post-TIPS can predict post-TIPS HF and death. Methods: We performed a retrospective study of cirrhotic patients who underwent TIPS between 2010 and 2015 at two centers. Patients with cardiomyopathies other than CCM were excluded. A multivariable-adjusted time-to-event analysis assessed associations of clinical, hemodynamic, and echocardiographic parameters with post-TIPS HF and death during 2 years of follow-up. 180-day landmark analysis was used to assess association of echocardiographic changes with outcomes. Results: 360 patients met study criteria. 32 developed HF post-TIPS (8.8%). Right atrial pressure (RAP) measured intraprocedurally post-TIPS insertion was associated with increased risk for HF (adjusted HR 1.10 [1.04-1.17]), with a cut off of 22mm Hg associated with highest risk (multivariable HR 2.71, [1.22-6.02]. 92 patients died (25.5%). An increase in left atrial volume index (LAVI) within 180 days post-TIPS was associated with increased mortality (HR 1.08 [1.01-1.15]). Other echocardiographic CCM markers were not associated with HF or death. Conclusion: Increases in RAP and LAVI post-TIPS, but not CCM status, predict post-TIPS HF and death, respectively. Surveillance echocardiography may play a role in identifying those at highest risk of decompensation post-TIPS. Further prospective study of CCM and its markers in relation to TIPS outcomes is warranted.

A Proteomics-Based Approach for Prediction of Different Cardiovascular Diseases and Dementia.

Many studies have explored whether individual plasma protein biomarkers improve cardiovascular disease risk prediction. We sought to investigate the use of a plasma proteomics-based approach in predicting different cardiovascular outcomes. Among 51 859 UK Biobank participants (mean age, 56.7 years; 45.5% male) without cardiovascular disease and with proteomics measurements, we examined the primary composite outcome of fatal and nonfatal coronary heart disease, stroke, or heart failure (major adverse cardiovascular events), as well as additional secondary cardiovascular outcomes. An exposome-wide association study was conducted using relative protein concentrations, adjusted for a range of classic, demographic, and lifestyle risk factors. A prediction model using only age, sex, and protein markers (protein model) was developed using a least absolute shrinkage and selection operator-regularized approach (derivation: 80% of cohort) and validated using split-sample testing (20% of cohort). Their performance was assessed by comparing calibration, net reclassification index, and c statistic with the PREVENT (Predicting Risk of CVD Events) risk score. Over a median 13.6 years of follow-up, 4857 participants experienced first major adverse cardiovascular events. After adjustment, the proteins most strongly associated with major adverse cardiovascular events included NT-proBNP (N-terminal pro B-type natriuretic peptide; hazard ratio [HR], 1.68 per SD increase), proADM (pro-adrenomedullin; HR, 1.60), GDF-15 (growth differentiation factor-15; HR, 1.47), WFDC2 (WAP four-disulfide core domain protein 2; HR, 1.46), and IGFBP4 (insulin-like growth factor-binding protein 4; HR, 1.41). In total, 222 separate proteins were predictors of all outcomes of interest in the protein model, and 86 were selected for the primary outcome specifically. In the validation cohort, compared with the PREVENT risk factor model, the protein model improved calibration, net reclassification (net reclassification index +0.09), and c statistic for major adverse cardiovascular events (+0.051). The protein model also improved the prediction of other outcomes, including ASCVD (c statistic +0.035), myocardial infarction (+0.023), stroke (+0.024), aortic stenosis (+0.015), heart failure (+0.060), abdominal aortic aneurysm (+0.024), and dementia (+0.068). Measurement of targeted protein biomarkers produced superior prediction of aggregated and disaggregated cardiovascular events. This study represents an important proof of concept for the application of targeted proteomics in predicting a range of cardiovascular outcomes.

Exercise limitations in amyloid cardiomyopathy assessed by cardiopulmonary exercise testing-A multicentre study.

Amyloid cardiomyopathy is caused by the deposition of light chain (AL) or transthyretin amyloid (ATTR) fibrils, that leads to a restrictive cardiomyopathy, often resulting in heart failure (HF) with preserved or reduced ejection fraction. This study aimed to determine whether cardiac output reduction or ventilation inefficiency plays a predominant role in limiting exercise in patients with amyloid cardiomyopathy. We conducted a multicentre prospective study in patients with AL or ATTR cardiomyopathy who underwent cardiopulmonary exercise testing across four centres. Patients were compared with a propensity-score matched HF cohort based on age, gender, left ventricular ejection fraction (LVEF), and peak oxygen consumption (VO2). Data from 267 amyloid patients aged 77 (72, 81) years, 86% male, with a median N-terminal pro B-type natriuretic peptide (NT-proBNP) of 2187 (1140, 4383) ng/L, exercise parameters of peak VO2 of 14.1 (11.6;16.9) mL/min/kg, a minute ventilation to carbon dioxide production (VE/VCO2) slope of 37.4 (32.5, 42.6) and a LVEF of 50% (44%, 59%) were analysed. We identified 251 amyloid cardiomyopathy-HF matches. Amyloid patients had a signifnicantly higher VE/VCO2 slope [37.4, inter quartile range (IQR): 32.7, 43.1 vs. 32.1, IQR: 28.7, 37.0, P<0.0001], NT-proBNP (2249, IQR: 1187, 4420 vs. 718, IQR: 405, 2161ng/L, P<0.001), peak heart rate (121±28 vs. 115±27 beats/min, P=0.007) and peak ventilation (51, IQR: 42, 62 vs. 43, IQR: 33, 53L/min, P<0.0001) with earlier anaerobic threshold (VO2 at AT: 8.9, IQR: 6.8, 10.8 vs. 10.8, IQR: 8.9, 12.7mL/min/kg, P<0.0001) compared with HF. Between amyloid patients, AL patients (n=27) were younger (63, IQR: 58, 70 vs. 78, IQR: 72, 81years, P<0.0001), had lower VE/VCO2 slope (35.0, IQR: 30.0, 38.7 vs. 38.0, IQR: 32.8, 43.1, P=0.019), higher end-tidal carbon dioxide partial pressure both at AT (35.1±4.8 vs. 31.4±4.7mmHg, P<0.001) and peak exercise (32, IQR: 28, 35 vs. 30, IQR: 26, 33mmHg, P=0.039) as compared with ATTR (n=233). A higher VE/VCO2 slope and an earlier AT, determining functional capacity impairment, was assessed in patients with amyloid cardiomyopathy compared with the matched HF cohort. Additionally, patients with ATTR might display more severe exercise limitations as compared with AL.

Risk Factors and Incidence of 30-Day Readmission following Outpatient Total Knee Arthroplasty.

Reflecting advancements in surgical techniques and postoperative care, total knee arthroplasty (TKA) is being performed increasingly as an outpatient procedure. This study aimed to report the frequency and timing of unplanned readmission after outpatient TKA with updated data, identify risk factors for readmission after outpatient TKA, and identify common causes for readmission after outpatient TKA with a much larger cohort compared to previous studies. This study retrospectively analyzed data from 31,347 patients who underwent outpatient TKA between 2012 and 2021. Adverse events and unplanned readmissions were identified. Timing and reason for readmission were recorded. Statistical analysis involved multivariate logistic regression to identify patient risk factors for readmission. Following surgery, 1.86% of cases reported an unplanned readmission within 30 days. Multivariate analysis demonstrated that age (Odds ratio (OR): 1.042; P < 0.001), body mass index (BMI) (OR: 1.023; P = 0.002), operative time (OR: 1.003; P = 0.017), congestive heart failure (CHF) (OR: 3.079; P < 0.001), chronic obstructive pulmonary disease (OR: 2.577; P < 0.001), bleeding disorders (OR: 1.706; P = 0.025), hypertension (1.436; P < 0.001), and partially dependent functional status (OR: 2.486; P = 0.036) significantly increased the risk of 30-day readmission. Reasons unrelated to the surgical site contributed the most to readmission at 68.3%, while reasons related to the surgical site made up 27.3%, followed by knee-related complaints (4.40%). The most common days on which readmissions occurred were postoperative days two, four, and one. Our analysis revealed a low readmission risk (1.86%) after outpatient TKA. Readmission rates were found to decrease over the observed time, despite a dramatic increase in outpatient cases. The most common reason for 30-day readmission was an organ/space surgical site infection. Identified risk factors for readmission highlight areas for targeted mitigation to enhance patient outcomes and healthcare efficiency.

Utilization and Outcomes of Temporary Percutaneous Right Ventricular Assist Devices in Cardiogenic Shock

Acute right ventricular failure (RVF) is a common finding in cardiogenic shock (CS), yet the optimal method of supporting the failing RV remains unclear. This study aimed to describe CS patients receiving percutaneous right ventricular assist devices (pRVADs) using the multicenter Cardiogenic Shock Working Group (CSWG) registry. Among 6,201 patients with CS, 152 (2.4%) received pRVADs, with ProtekDuo and Impella RP being used in 71% and 29% of cases, respectively. The average age of this group was 58.5 years, with a higher proportion of men (66.4%). Heart failure–associated CS (HF-CS) was observed in 48% of patients, while myocardial infarction–associated CS (MI-CS) was seen in 27% (HF-CS versus MI-CS: 52.8% vs. 21.3% for ProtekDuo; 36.4% vs. 40.9% for Impella RP; p = 0.01). The overall in-hospital mortality rate was 54.6%, bleeding complications were more prevalent among ProtekDuo recipients (64.8% vs. 43.2%, p = 0.008), whereas Impella RP recipients had shorter hospital stays (20.4 ± 18.7 vs. 41.9 ± 31.5 days, p &lt; 0.001). ProtekDuo was more commonly used in patients with HF-CS and was associated with higher rates of bleeding and longer hospital stays compared with Impella RP, although overall mortality was similar. Further investigation is required to determine the ideal timing and clinical conditions warranting pRVAD deployment in CS.

Intensive care unit admissions following enhanced recovery video-assisted thoracoscopic surgery lobectomy.

Video-assisted thoracoscopic surgery (VATS) lobectomy combined with enhanced recovery after surgery (ERAS) protocols has improved postoperative outcomes, yet concerns persist regarding complications and readmissions. Limited research has explored intensive care unit (ICU) admissions and outcomes within this context. This study aimed to analyze ICU admissions following VATS lobectomy within an established ERAS protocol. Consecutive patients who underwent VATS lobectomy between 2018-2023 were included. Patient data were obtained from our prospective institutional database, while ICU data were extracted from electronic patients' records. Of 2099 patients included, 48 (2.3%) required ICU admission. Median-age was 70 (IQR : 64-76), with ICU patients being older and predominantly male (73%). Overall 30-day-mortality was 1.0% with an ICU mortality of 31%. Multiple logistic regression revealed significant associations between ICU admission and male gender (p = <0.001), diabetes mellitus (p = 0.026), heart failure (p = 0.040), DLCO%(0.013). Median time to ICU admission was 4 days (IQR : 2-10). Respiratory failure was the primary reason for ICU admission (60%). Severe surgical complications accounted for 8.3% of all ICU-admissions. In an ERAS setting, the incidence of ICU admission following VATS lobectomy was 2.3%, with a mortality rate of 31%. Respiratory failure was the leading cause of ICU admission.

CO-CREATION-HF protocol: clinical trial to evaluate the impact of a comprehensive and hybrid cardiac rehabilitation model on patients with heart failure

CO-CREATION-HF protocol: clinical trial to evaluate the impact of a comprehensive and hybrid cardiac rehabilitation model on patients with heart failure

Streptococcus suis infective endocarditis in patients with Streptococcus suis bacteremia: a retrospective study of prevalence and outcomes.

Streptococcus suis (S. suis) is a zoonotic disease that is transmitted to humans via contact or oral route. Although the major clinical presentation of this pathogen is known to be meningitis, S. suis infective endocarditis (IE) has recently emerged as a clinical manifestation of increasing interest. Echocardiography may be an underutilized modality for evaluating patients with S. suis bacteremia. The primary objective was to estimate the prevalence of S. suis IE in patients with S. suis bacteremia. The secondary objective was to investigate the predictors, echocardiographic features, and clinical outcomes of S. suis IE in patients with S. suis bacteremia. This single-center retrospective study was conducted at Siriraj Hospital - Thailand's largest university-based tertiary referral center. Adult patients (aged > 18 years) who were admitted to our center with confirmed diagnosis of S. suis bacteremia during January 2007 to September 2023 were included. Prevalence is reported as percentage and confidence interval. Baseline characteristics and clinical manifestation were compared between the IE and non-IE groups. Factors found to be statistically significant were further analyzed using binary logistic regression analysis to identify univariate predictors of S. suis IE. A total of 71 patients with S. suis bacteremia were included in this study. The prevalence of S. suis IE was 26.8% (95% confidence interval: 17.85-38.05). Perivalvular complications and significant valvular regurgitation were found in 52.6% and 80.0% of patients, respectively. Thirteen of 19 patients (68.4%) required valvular surgery according to standard guidelines. By univariate analysis, dyspnea, new murmur, immunologic phenomenon, and heart failure were predictors of S. suis IE in patients with S. suis bacteremia. The results of this study revealed a sizable prevalence of S. suis IE in patients with S. suis bacteremia, and there were high rates of both valvular damage and perivalvular complications. Our results strongly suggest that echocardiography may be indicated to evaluate for S. suis IE in patients diagnosed with S. suis bacteremia. Reclassification of S. suis from an atypical organism to a typical organism should be considered.

Prognosis of apparent treatment-resistant hypertension and poor adherence: a nationwide cohort study.

Large-scale studies of the prognosis of resistant hypertension in Asian populations are limited, and the impact of poor adherence on clinical prognosis in patients with apparent treatment-resistant hypertension has not been studied. A nationwide cohort analysis was done utilizing the National Health Insurance Service database in Korea, covering patients who participated in health examinations from 2013 to 2018. A total of 935,002 patients were classified into apparent treatment-resistant (N = 69,372) or nonresistant (N = 865,630) hypertension based on blood pressure control and antihypertensive medication use. Medication adherence was assessed using the proportion of days covered. The primary composite outcome included all-cause mortality, myocardial infarction, stroke, and heart failure. Other outcomes were the development of atrial fibrillation and progression to end-stage renal disease (ESRD). The median follow-up duration was 6.0 (interquartile range [IQR], 4.1-7.0) years. Patients with apparent treatment-resistant hypertension were at a higher risk for the primary composite outcome than those with nonresistant hypertension (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.29-1.35). The incidence rates of ESRD were notably higher in the resistant hypertension group (HR, 3.02; 95% CI, 2.85-3.20). Among participants with resistant hypertension, 3852 (5.7%), 11,667 (17.3%), and 51,879 (77%) had poor, suboptimal, and optimal adherence, respectively. Poor medication adherence in apparent treatment-resistant hypertension was associated with a higher risk of the primary composite outcome compared to optimal adherence (HR, 1.49; 95% CI, 1.36-1.63). Apparent treatment-resistant hypertension is associated with significant cardiovascular risks in the Korean population. Poor adherence to antihypertensive medication significantly elevates the risk of adverse clinical outcomes in patients with apparent treatment-resistant hypertension, underscoring the need for stringent management of these patients.

Optical control of cardiac electrophysiology by the photochromic ligand azobupivacaine 2.

Patients suffering from ischaemic heart disease and heart failure are at high risk of recurrent ventricular arrhythmias (VAs), eventually leading to sudden cardiac death. While high-voltage shocks delivered by an implantable defibrillator may prevent sudden cardiac death, these interventions themselves impair quality of life and raise both morbidity and mortality, which accentuates the need for developing novel defibrillation techniques. Photopharmacology allows for reversible control of biological processes by light. When relying on synthetic and externally applied chromophores, it renders genetic modification of target cells dispensable and may hence be advantageous over optogenetic approaches. Here, the photochromic ligand azobupivacaine 2 (AB2) was probed as a modulator of cardiac electrophysiology in an ex vivo intact mouse heart model. By reversibly blocking voltage-gated Na+ and K+ channels, photoswitching of AB2 modulated both the ventricular effective refractory period and the conduction velocity in native heart tissue. Moreover, photoswitching of AB2 was able to convert VA into sinus rhythm. The present study provides the first proof of concept that AB2 enables gradual control of cardiac electrophysiology by light. AB2 may hence open the door to the development of an optical defibrillator based on photopharmacology.

Moderately Increased Left Ventricular Filling Pressure Suggesting Early Stage of Heart Failure with Preserved Ejection Fraction in Patients with Invasively Assessed Coronary Microvascular Dysfunction

Background: With modern diagnostic tools, incidence ischemia with no obstructive coronary atherosclerosis (INOCA) and heart failure with preserved ejection fraction (HFpEF) are found to be much higher than previously believed, and—as they lead to adverse cardiovascular outcomes—their causes and development are subjects of ongoing research. There is growing evidence that coronary microvascular dysfunction might be the underlying cause of both INOCA and HFpEF. Methods: In 65 patients with effort angina but no obstructive coronary artery disease, the index of microvascular resistance and coronary flow reserve were measured invasively in the LAD. The echocardiographic parameters, including left atrial strain, left ventricular strain, and indices of left ventricular diastolic dysfunction, were compared between two groups of patients: those with normal coronary microcirculation parameters and those with impaired coronary microvascular function. Results: Patients with coronary microvascular dysfunction had higher a E/E′ index than those with normal microvessel reactivity. This finding was further confirmed by ROC analysis. The groups did not differ significantly in values of other echocardiographic parameters, including the left ventricular and left atrial strain. The prevalence of classical cardiovascular risk factors was similar in both groups. Conclusions: The coexistence of impaired coronary microvascular function with moderately elevated left ventricular filling pressures might correspond to the co-development of early stages of coronary microvascular dysfunction and HFpEF.

Outcomes of Left Main Chronic Total Occlusion Percutaneous Coronary Interventions.

Percutaneous coronary intervention (PCI) of left main (LM) chronic total occlusions (CTO) has received limited study. We compared the clinical and procedural characteristics and outcomes of patients who underwent LM versus non-LM CTO PCI at 41 US and non-US centers between 2012 and 2024. During the study period 85 of 15,254 CTO PCIs (0.6%) performed in 14,969 patients were LM CTO PCIs. LM CTO PCI patients were older, had higher rates of dyslipidemia and heart failure and most (88.8%) had prior coronary artery bypass graft surgery (CABG). They were more likely to have moderately or severely calcified lesions (80.7% vs. 45.7%, p < 0.001) and had higher J-CTO (2.76 ± 1.17 vs. 2.37 ± 1.26, p = 0.008), PROGRESS-CTO MACE (3.56 vs. 2.57, p < 0.001), Mortality (2.45 vs. 1.68, p < 0.001), Pericardiocentesis (2.74 vs. 1.87, p < 0.001), Acute MI (1.72 vs. 0.89, p < 0.001) and Perforation (3.21 vs. 2.19, p < 0.001) scores. There was no difference in technical success (80.5% vs. 87.2%, p = 0.086) or major cardiovascular adverse events (MACE) (2.4% vs. 2.0%, p = 0.700). LM CTO PCI patients with and without prior CABG surgery had similar technical success and MACE. The retrograde approach in prior CABG patients was more likely to be performed through saphenous vein grafts. LM CTO PCI is infrequently performed, is associated with high comorbidity burden and angiographic complexity but can be performed with high success and acceptable complication rates.

Real-world research on beta-blocker usage trends in China and safety exploration based on the FDA Adverse Event Reporting System (FAERS).

Beta-blockers are widely used, with continuously updated clinical recommendations. However, their application faces challenges in personalized treatment and safety. The study aimed to investigate the frequency and patterns of prescribing beta-blockers in China and to explore potential adverse event risk signals associated with beta-blockers, providing reference for rational medication use in clinical settings. Prescription data for beta-blockers from January 2018 to June 2023 were extracted through the Hospital Prescription Analysis Collaborative Project in China to analyze clinical usage trends. While adverse drug reaction reports for beta-blockers were obtained from the FDA Adverse Event Reporting System (FAERS) database. The classification and standardization of adverse drug event (ADE) reports were based on the preferred terms (PT) and corresponding system organ classes (SOC) from the Medical Dictionary for Regulatory Activities (MedDRA). Signal detection utilized a proportion imbalance method. In clinical practice, metoprolol dominated beta-blocker prescriptions in China, accounting for 62.2%. Beta-blockers were primarily prescribed to the elderly (65.7%) and male patients (57.0%). However, off-label use of beta-blockers was relatively widespread. For instance, sotalol was prescribed for hypertension at 18.25%, while esmolol was used for angina and heart failure at rates of 12.94% and 14.98%, respectively. In addition, we identified newly discovered adverse reactions associated with beta-blockers, such as BRASH syndrome (metoprolol: n = 186, ROR = 391.285; carvedilol: n = 72, ROR = 256.459), acute kidney injury (bisoprolol: n = 247, ROR = 5.641), premature baby (labetalol: n = 110, ROR = 91.385), and sleep disorder (propranolol: n = 254, ROR = 10.98). Metoprolol led the beta-blocker market in China. Attention was warranted regarding the newly discovered adverse reactions, such as the risk of acute kidney injury with bisoprolol and the potential for BRASH syndrome with metoprolol and carvedilol.

Effectiveness and safety of mineralocorticoid receptor antagonists in heart failure patients with and without diabetes: a systematic review and meta-analysis.

Mineralocorticoid receptor antagonists (MRAs) have been shown to improve outcomes in various populations of heart failure (HF) patients. However, the impact of concomitant diseases, such as diabetes mellitus (DM), on these outcomes remains unclear. This meta-analysis aimed to evaluate the efficacy and safety of MRAs in heart failure patients with and without diabetes mellitus. A systematic search was conducted on PubMed, Scopus, and Google Scholar databases up to April 30, 2024. Data analysis was performed using a random-effects model to account for variability across studies, and statistical analysis was carried out using Review Manager 5.4. Efficacy and safety parameters were evaluated in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. The meta-analysis included a total of 21,832 subjects from ten studies. The pooled results demonstrated that MRAs, compared to placebo, significantly reduced all-cause mortality in HF patients with and without DM (RR: 0.85; 95%CI 0.75-0.96; p = 0.009). A similar effect was observed in HF patients without DM (RR: 0.83; 95%CI 0.71-0.97; p = 0.02), while no significant effect was detected in the DM subgroup (RR: 0.87; 95%CI 0.69-1.11; p = 0.27). Both treatments had comparable effects on cardiovascular mortality in HF patients with and without DM (RR: 0.88; 95%CI 0.82-0.94; p = 0.0002), in HF patients with DM (RR: 0.90; 95%CI 0.81-1.01; p = 0.08), and in the non-DM subgroup (RR: 0.86; 95%CI 0.79-0.94; p = 0.0009). MRAs significantly reduced the risk of cardiovascular mortality in HF patients with and without DM (RR: 0.82; 95%CI 0.72-0.94; p = 0.005) and in HF patients with DM (RR: 0.79; 95%CI 0.63-0.98; p = 0.03), but no significant effect was observed in the non-DM subgroup (RR: 0.85; 95%CI 0.69-1.05; p = 0.13). Furthermore, compared to placebo, MRAs were associated with an increased risk of hyperkalemia (> 5.5 mEq/L) in HF patients with and without DM (RR: 1.63; 95%CI 1.18-2.24; p = 0.003), particularly in HF patients with DM (RR: 1.44; 95%CI 0.97-2.13; p = 0.07) and in the non-DM subgroup (RR: 1.87; 95%CI 1.34-2.61; p = 0.0002). MRAs are effective in reducing all-cause mortality, cardiovascular death, and cardiovascular mortality in heart failure patients. However, the use of MRAs is associated with an increased risk of hyperkalemia, necessitating careful monitoring, particularly in patients with diabetes mellitus.

Systemic capillary leak syndrome.

The vascular endothelial barrier maintains intravascular volume and metabolic homeostasis. Although plasma fluids and proteins extravasate continuously from tissue microvasculature (capillaries, post-capillary venules), systemic vascular leakage increases in critical illness associated with sepsis, burns and trauma, among others, or in association with certain drugs or toxin exposures. Systemically dysregulated fluid homeostasis, which can lead to hypovolaemia, hypotensive shock and widespread tissue oedema, has been termed systemic capillary leak syndrome (SCLS) when overt secondary causes (for example, heart or liver failure) are excluded. In severe forms, SCLS is complicated by compartment syndrome in the extremities and multi-organ dysfunction syndrome due to shock and systemic hypoperfusion. The different forms of SCLS include idiopathic SCLS (ISCLS) and secondary SCLS(SSCLS), which can be triggered by several conditions, including certain infections and haematological malignancies. A subgroup of patients with ISCLS have monoclonal gammopathy-associated SCLS (also known as Clarkson disease), which is an ultra-rare and extreme form of ISCLS. ISCLS can be managed effectively with monthly prophylactic immunoglobulin therapy whereas SSCLS frequently does not recur once the underlying condition resolves or the offending agent is discontinued. Thus, differentiation between ISCLS, SSCLS and other causes of oedema is crucial for quick diagnosis and positive patient outcomes.

Crossing-Borders: Experiences With International Transports on Extracorporeal Membrane Oxygenation: Special Considerations and Challenges

Extracorporeal membrane oxygenation (ECMO) is a crucial support for patients with severe cardiac or respiratory failure, but its availability is limited, often requiring patient transport to specialized centers. Only a few centers provide mobile ECMO services, and international ECMO transports are rare. This study reviews a department’s experience with international ECMO transports from 1998 to 2022. Out of 1,277 ECMO transports, 357 (28%) were international. Most of these (52%) were directed to ECMO Center Karolinska, whereas others involved transfers due to a lack of beds or between foreign centers. The majority (79%) of patients were cannulated at the referring hospital, with 63% supported by venoarterial ECMO. Transport distances averaged 1,200 km, using fixed-wing aircraft 89% of the time. Hospital survival for those transported to Karolinska was 82%, and 36% of transports experienced complications, though no deaths occurred during transport. This study highlights the safety and effectiveness of international ECMO transport with highly trained teams.

Unipolar Voltage Mapping to Predict Recovery of Left Ventricular Ejection Fraction in Patients With Recent-Onset Nonischemic Cardiomyopathy.

The ability to predict recovery of left ventricular ejection fraction (LVEF) in response to guideline-directed therapy among patients with nonischemic cardiomyopathy is desired. We sought to determine whether left ventricular endocardial unipolar voltage measured during invasive electroanatomic mapping could be used to predict LVEF recovery among those with recent-onset nonischemic cardiomyopathy. We analyzed the left ventricular voltage maps of patients included in the eMAP trial (Electrogram-Guided Myocardial Advanced Phenotyping; NCT03293381), a prospective, nonrandomized, interventional trial conducted at 2 institutions between 2017 and 2020. Patients had recent-onset nonischemic cardiomyopathy defined by LVEF ≤45% and development of symptoms or signs of heart failure within the past 6 months. Detailed voltage maps of the left ventricular endocardium were generated using the CARTO electroanatomic mapping system. Abnormal unipolar amplitude was defined as <8.27 mV. The primary end point was recovery of LVEF (Recovery) defined by a 1-year LVEF ≥50% or ≥45% with ≥10% increase from baseline. Of the 29 enrolled patients (median age, 49 years [25th percentile, 39; 75th percentile, 59], 8 females [27.6%]), LVEF recovered in 13 (44.8%) by 1-year follow-up. The percentage of total endocardial surface area with unipolar voltage abnormality (AUA) was significantly lower among Recovery patients than No Recovery patients (18.2% [6.4, 22.4] versus 80.0% [29.5, 90.9]; P=0.004). Percent AUA was associated with lower likelihood of Recovery (odds ratio, 0.64 per 10% increase in AUA; 95% CI, 0.47-0.88; P=0.006). A 28% cutoff value for percent AUA was 92% sensitive and 75% specific with an area under the receiver operating characteristic curve of 0.81 (95% CI, 0.63-0.99; P=0.001) for predicting recovery versus no recovery. The majority of patients (12 of 13; 92.3%) with a percent AUA >28% did not recover. Left ventricular unipolar voltage abnormality is a potent predictor of LVEF recovery among patients recently diagnosed with nonischemic cardiomyopathy. Detailed left ventricular unipolar voltage mapping could therefore be used as a valuable prognostic tool in guiding treatment decisions.

Chest pain and coronary artery disease in cardiac amyloidosis: Prevalence, mechanisms, and clinical implications.

Amyloidosis is a systemic disease affecting multiple organs, and often presents with cardiac involvement, with two primary underlying pathologies: amyloid light chain- and transthyretin cardiac amyloidosis. Chest pain can occur in both types with variable clinical presentations. This narrative review describes the relationship between CA and chest pain. A PubMed search (June 03. 2024) identified 393 articles related to chest pain in CA. Twenty-eight studies, in English and with full text, were selected. Articles included were case reports, reviews, perfusion- and autopsy studies. In CA patients 10-20% report chest pain as the initial symptom preceding the diagnosis, and the overall prevalence of chest pain is 38% of patients with CA and it is related to an increased risk of heart failure hospitalization. The mechanisms leading to chest pain in CA patients include increased left ventricular diastolic pressure, infiltration of amyloid fibrils inside and around coronary arteries, and amyloid compression of the microvasculature. The mechanisms commonly lead to elevations of plasma troponin levels, which are higher in amyloid patients with chest pain compared to amyloid patients without chest pain. Symptomatic treatment of chest pain can be challenging due to the low tolerability of medical therapy and poor outcomes of coronary interventions in alleviating the pain and with a higher rate of complications. Our review underscores the importance of recognizing chest pain as a CA symptom, particularly in the elderly. Persistent troponin elevation without coronary artery disease could indicate CA. Screening-based and longitudinal studies are crucial for understanding the relationship between chest pain and CA. Acknowledging the significance of chest pain in CA may facilitate early intervention and improve patient outcomes.

Determining optimal pretreatment in cardiac surgery: an experimental study.

Heart failure patients with reduced ejection fraction are currently treated with four drug combinations: angiotensin receptor/neprilysin inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors, resulting in improved survival outcomes. Herein, we examined whether myocardial protection by esaxerenone or sacubitril/valsartan may present a counter-effect to the harm caused by cardioplegic arrest. Male Wistar rats fed a normal diet were orally administered esaxerenone (3mg/kg; Esax) or sacubitril/valsartan (68mg/kg; SaV) once a day for 2weeks from 6weeks of age. Age-matched, untreated male Wistar rats served as controls (Control). Isolated rat hearts were aerobically Langendorff-perfused and subjected to 2min of St Thomas' Hospital 2 cardioplegia (STH2) infusion and 28min of normothermic global ischemia followed by 60min of reperfusion. The recovery of function was measured during 60min of reperfusion. Additionally, troponin T levels were measured after reperfusion as myocardial injury. The final recovery of left ventricular developed pressure (presented as the percentage of preischemic value) in the Control, Esax, and SaV groups was 50.7 ± 6.2%, 68.5 ± 7.4%*, and 69.3 ± 14.3%*, respectively (*p < 0.05 vs. Control). Troponin T (ng per gram wet weight) levels in the Control, Esax, and SaV groups were 166.8 ± 78.1, 77.0 ± 14.6*, and 74.2 ± 36.6*, respectively (*p < 0.05 vs. Control). Oral administration of esaxerenone or sacubitril/valsartan to rats 2weeks prior to surgery enhanced the myocardial protection afforded by STH2 and may attenuate the myocardial injury caused by hyperkalemic cardioplegic arrest.

Critical heart failure associated with beta-blocker-induced cardiac phospholipidosis: a case report

Critical heart failure associated with beta-blocker-induced cardiac phospholipidosis: a case report