Development Of Severe Heart Failure Research Articles

Three-dimensional vector ECG analysis in the diagnosis of the left bundle branch block

The complete left bundle branch block (CLBBB) leads to the development of severe heart failure and requires resynchronization therapy(CRT). It is known that one third of patients do not respond to CRT. In this regard, it is necessary to search new diagnostic criteria for patient selection for CRT.Aim. Determination of the criteria for CLBBB using three-dimensional vectorcardiography data with analysis of the rate of vector loop formation.Material and research methods. The study included 137 patients. The main group consisted of 57 patients with CLBBB, which was based on D. G. Strauss et al. (2011) criteria. Causes of CLBBB and comorbidities were not considered. The control group included 80 healthy individuals. All patients underwent synchronous registration of 12 standard ECG leads and reconstruction of a three-dimensional vectorcardiogram (VCG) using the McFee-Parungao system.Research results. The following signs are characteristic for CLBBB according to three-dimensional VCG data: • fracture of the spatial vector loop due to a change in the direction of the excitation front in its middle part; • reduction in planarity index (PI) less than 80%; • a sharp, by a factor of 2 or more, decrease in the speed of tracing a spatial vector loop in its middle part with the formation of a “claw-shaped” curve with two peaks R and L.Conclusion. Three-dimensional VCG allows you to reliably determine the «true» CLBBB, based on the “fracture” of the spatial vector loop with a reduction in PI less than 80% and a significant decrease in the speed of tracing the vector loop in its middle part with the formation of a “clawshaped” curve and carry out a differential diagnosis with “false” СLBBB, in which changes on the ECG are associated with a combination of left ventricular hypertrophy and left anterior fascicular block, when there is no “fracture” of the loop, a reduction in PI, and the routing speed decreases at the end of the loop without forming a “claw-shaped” curve.

The use of hemosorption in patients with dilated cardiomyopathy and severe heart failure as an alternative to surgical left ventricular remodeling

Background. Currently, about 40 million people in the world suffer from heart failure (HF). The development of severe HF is most often caused by dilated cardiomyopathy (DCM) that is a frequent indication for heart transplantation worldwide. Despite significant advances in the medical treatment of this pathology, the morbidity, hospitalization rates, and mortality are constantly increasing. This study aimed to evaluate the effectiveness of hemosorption in patients with severe HF on the background of DCM compared to surgical left ventricular remodeling. Materials and methods. The study is based on the results of a retrospective study that included 80 patients with severe HF on the background of DCM (NYHA III–IV). In group 1 (59 patients; left ventricular ejection fraction (LVEF) 21.10 ± 4.66 %), conservative medical therapy was supplemented with a course of 3 hemosorption procedures using granular deligandizing hemosorbent. In group 2 (21 patients; LVEF 22.40 ± 2.27 %), patients underwent surgical interventions in the form of LV remodeling. Results. There was a significant improvement in the clinical state and LV contractility in both groups. In group 1, LVEF increased by 12.90 ± 2.06 % (p < 0.01), in group 2 — by 13.25 ± 2.98 % (p < 0.05). Howe­ver, more complications, longer hospital stay, and higher morta­lity were associated with LV remodeling. Conclusions. The use of extracorporeal hemocorrection methods in the comprehensive treatment of patients with DCM can improve the clinical state of patients, treatment outcomes and avoid the risks associated with surgical interventions.

The Role of Admission Platelet Count and B-type Natriuretic Peptide in Predicting in Hospital Morbidity in ST-Elevation Myocardial Infarction Patients

Context: Platelets play a major role in the pathophysiology of acute myocardial infarction. Aim: This study aims to evaluate the potential correlation between admission platelet count (PLT) and B-type natriuretic peptide (BNP) with the development of severe heart failure during the first 24 h post primary PCI (post-PPCI) in patients admitted with ST-elevation myocardial infarction (STEMI). Settings and Design: This was cross-sectional follow-up study. Methods: One hundred and forty-six patients admitted with STEMI. At the time of admission, blood samples were drawn to measure PLT and BNP level. Twenty-four h after reperfusion, patients were assessed using Killip score, and a transthoracic echo was done to determine ejection fraction (EF) using modified Simpson’s rule. Statistical Analysis: Comparison between parametric quantitative independent groups done by t-test. The area under the receiver operating characteristic (ROC) area under the curve was calculated to determine the sensitivity and specificity of PLT in diagnosing severe heart failure (Killip III and IV) Confounding bias has been addressed through a multivariate logistic regression model. Results: we found a significant negative correlation between admission PLT and left ventricular EF measured 24 h post-PPCI and a positive correlation between PLT and both BNP and CKMB level measured at admission (P = 0.001, 0.004 and P = 0.007, respectively). ROC curve analysis showed a platelet cut-off value of 290 × 103 to diagnose severe heart failure (Killip’s grades III and IV) (sensitivity of 70% and specificity of 83.1%.). Conclusion: BNP and PLT are easy, inexpensive blood tests that can be used as predictors of heart failure post-STEMI.

Gender characteristics of the course and treatment of acute myocardial infarction

Background and Aims : The aim of the study was to study the gender characteristics of the course of acute myocardial infarction (MI).Methods: The study included 372 patients aged 31 to 93 yrs (64.5 ± 12.3 years) with a diagnosis of MI, who were divided into 2 groups (gr.) by gender: Gr.1 - 140 (37.6%) , women, gr. 2 - 232 (62.4%) men.Results: The average age of women is 70.77 ± 11.7 yrs, of men - 60.52 ± 11.5. In women, MI was significantly more likely to develop against the background of arterial hypertension (p <0.044), diabetes mellitus (p <0.002) and obesity (p <0.043), and the prevalence of smoking was higher in the male (p <0.001). The GRACE in women is higher than in men (p <0.007). The most common complication of MI in both groups was acute heart failure (HF), which was recorded in 53.7% of women and 55.5% of men (RR 0.96; 95% CI 0.75– 1.23; p> 0.05). The frequency of deaths was statistically significantly higher in women; they were more often registered as hospitalized (11.4% versus 6.4%; RR 1.79; 95% CI 0.94–3.43; p <0.05), so and post-hospital mortality (9.2% versus 6.4%; RR 1.44; 95% CI 0.68–3.02; p> 0.05).Conclusions: The most significant risk factors for the development of MI in women are diabetes mellitus, arterial hypertension and obesity. The course of myocardial infarction in women is associated with the development of severe heart failure, and the immediate prognosis and outcome of myocardial infarction in women is more unfavorable than in men. Background and Aims : The aim of the study was to study the gender characteristics of the course of acute myocardial infarction (MI). Methods: The study included 372 patients aged 31 to 93 yrs (64.5 ± 12.3 years) with a diagnosis of MI, who were divided into 2 groups (gr.) by gender: Gr.1 - 140 (37.6%) , women, gr. 2 - 232 (62.4%) men. Results: The average age of women is 70.77 ± 11.7 yrs, of men - 60.52 ± 11.5. In women, MI was significantly more likely to develop against the background of arterial hypertension (p <0.044), diabetes mellitus (p <0.002) and obesity (p <0.043), and the prevalence of smoking was higher in the male (p <0.001). The GRACE in women is higher than in men (p <0.007). The most common complication of MI in both groups was acute heart failure (HF), which was recorded in 53.7% of women and 55.5% of men (RR 0.96; 95% CI 0.75– 1.23; p> 0.05). The frequency of deaths was statistically significantly higher in women; they were more often registered as hospitalized (11.4% versus 6.4%; RR 1.79; 95% CI 0.94–3.43; p <0.05), so and post-hospital mortality (9.2% versus 6.4%; RR 1.44; 95% CI 0.68–3.02; p> 0.05). Conclusions: The most significant risk factors for the development of MI in women are diabetes mellitus, arterial hypertension and obesity. The course of myocardial infarction in women is associated with the development of severe heart failure, and the immediate prognosis and outcome of myocardial infarction in women is more unfavorable than in men.

Usefulness of lung ultrasound in patients with acute coronary syndrome

Abstract Background The development of heart failure (HF) is a factor of poor prognosis in patients admitted due to acute coronary syndrome (ACS). Research question The aim of this study is to establish the usefulness of lung ultrasound (LU) to predict patients at risk of developing HF and the need for mechanical ventilation. Methods Prospective study with consecutive inclusion of patients with ACS type infarction without HF on admission and admitted to our centre between February 2017 and 2018. A lung ultrasound was performed in the first 24 hours, considering it positive when they presented 3 or more B lines in two or more quadrants of bilateral form. The result was related to the need for mechanical ventilation. Results We included 119 patients (65.1±12.8 years, 75.6% men), 12.6% presented a need for mechanical ventilation. Patients with a positive LU adjusted for a history of atrial fibrillation and the Killip-Kimball class have a risk 72.79 [95% CI: (9.21, 575.28)] times higher than needing mechanical ventilation at any time of the follow-up Adjusted for sex and heart rate, the result is 101.28 [95% CI: (12.83, 799.15); p=0.00005] times more risk of needing mechanical ventilation at any time of follow-up. Conclusions LU has a high positive predictive value for the development of severe HF and the need for mechanical ventilation, in patients admitted for ACS. Our findings suggest that LU should be incorporated in the initial stratification of patients with ACS. Survival analysis mechanical ventilation Funding Acknowledgement Type of funding source: None

Symmetric dimethylarginine in dogs with myxomatous mitral valve disease at various stages of disease severity

Symmetric dimethylarginine (SDMA) is a serum biomarker of renal damage in dogs. Moreover, SDMA concentration is an independent predictor of development of severe heart failure (HF) in humans with cardiac disease. This study evaluates whether the serum concentration of SDMA in dogs with myxomatous mitral valve disease (MMVD) is influenced by the severity of heart disease, pulmonary hypertension (PH) and treatment of HF. A total of 99 client-owned dogs were included in this retrospective case-control study; 78 dogs were affected by MMVD and classified according to the American College of Veterinary Internal Medicine (ACVIM) guidelines, and 21 were healthy controls. For each dog, history, physical examination, complete blood count, biochemical profile, thoracic radiography, 6-lead standard electrocardiogram and trans-thoracic echocardiography were available. Comparisons were performed between groups of dogs belonging to different ACVIM stages and between dogs with and without PH. The median SDMA concentration was neither significantly different among groups of dogs in different disease stages (overall P = 0.010), nor among dogs with MMVD, nor between those with [14.5 μg/dl (10.5–18.8)] and without PH [13 μg/dl (9–17.2)] (P = 0.295). The concentration of SDMA did not differ between dogs when considering the combined effect of the ACVIM group and cardiac treatment (overall P = 0.486). Furthermore, no correlation was found between SDMA concentration and radiographic and echocardiographic parameters associated with increased MMVD severity. In conclusion, this study failed to demonstrate the presence of renal impairment in dogs with MMVD, and the increase in renal parameters in some dogs in the more advanced stage of MMVD could be attributed to pre-renal azotemia.

Current Possibilities of Early Detection of Cardiotoxicity of Cytostatic Treatment.

Due to growing long-term survival rate of oncologic patients, there is increased interest in cardiotoxicity of oncologic treatment among medical professionals. It is concerning both paediatric and adult patients. When prescribing oncologic treatment, there should be focus on the efficacy and safety of the used drugs. Nowadays, the main problem is early dia-gnosis of cardiotoxicity. In our work we wanted to investigate whether the increase in bio-markers after the cytostatic therapy with anthracyclines can predict further increase in the left ventricular volume and decrease of the left ventricular ejection fraction. We were monitoring 36 patients with the dia-gnosis of non-Hodgkins lymphoma who received therapy with anthracyclines. After the therapy we were measuring the cardiac bio-markers NT-proBNP and high-sensitivity troponin I and performed echocardiography. In our group of patients there is a statistically significant correlation between increased levels of troponin I, NT-proBNP and increment of the left ventricular volume measured before the treatment and 3 months after the treatment. There is also a significant inverse correlation between the left ventricular volume and left ventricular ejection fraction. There was no relationship between higher cumulative doses of anthracyclines and the increment of the left ventricular volume. There is a significant correlation between higher cumulative doses of anthracyclines and higher levels of troponin I. The measurement of bio-markers troponin I and NT-proBNP should be considered for an early dia-gnosis of cardiotoxicity in oncologic patients. Echocardiography is also beneficial for the dia-gnosis in these patients. All efforts after the dia-gnosis should be focused on the therapy with cardioprotective drugs, which can prevent the development of severe heart failure.

Iron and stable ischemic heart disease - lessons from heart failure

Iron is an essential element for cardiomyocyte viability and contractility. Systemic iron deficiency, even without anemia, is reflected by iron deficiency in cardiomyocytes. As in other cells, there is here a complex, local and autonomous regulation of iron metabolism, based on two molecular systems: the hepcidin/ferroportin/transferrin receptor-1 axis; and the iron regulatory proteins-1,2 system. These molecular pathways allow cardiomyocytes to react to changes in serum iron availability. In mice, dietary manipulations of serum iron availability or cardio-specific deletions and mutations of regulatory genes for intracellular iron metabolism have clarified some aspects of the causal relationship between cardiomyocyte iron deficiency and the development of severe heart failure, prevented by intravenous iron treatment even without the occurrence of iron deficiency (sideropenic) anemia. The deleterious effects of iron deficiency and hypoxia on gene expression of the main regulators of intracellular iron and oxygen metabolism and on cardiac function are very similar in heart failure and in chronic stable ischemic heart disease, and conjure towards cardiomyocyte injury. We here hypothesize that in non-anemic patients with stable ischemic heart disease a chronic or acute serum iron deficiency can amplify the chronic activation of the cardiomyocyte hypoxia-inducible factor-1α. As a consequence, cardiac adaptative responses to chronic hypoxia/ischemia are significantly impaired, and cardiac dysfunction exacerbated. We hypothesize that, in such patients, iron replacement through forced iron supplementation may replete cardiomyocyte iron deficiency and improve ischemic heart disease. This hypothesis requires further experimental studies, but also, and already now, specific clinical trials.

Thrombolysis Versus Primary Percutaneous Coronary Intervention For ST-segment Elevation Myocardial Infarction In Elderly Patients

Only few studies reported the outcomes of thrombolysis among elderly patients with ST-segment elevation myocardial infarction (STEMI), which results in a controversial benefit-risk ratio and a lower usage rate of thrombolysis in this population. The aim of the present study was to compare efficacy and safety of thrombolysis therapy with primary percutaneous coronary intervention (p-PCI) in patients aged ≥ 70 years old. Data from 2841 patients (mean age: 78.1 ± 5.6 years, female: 36.1%) included in a prospective multicenter registry, and who underwent either thrombolysis therapy ( N = 269) or p-PCI ( N = 2572), were analyzed. The primary endpoint was in-hospital major adverse cardio-vascular events (MACE) defined as the composite of all-cause mortality, non-fatal MI, stroke and definite stent thrombosis (ST). Secondary endpoints included all-cause death, BARC 3 or 5 major bleeding, net adverse clinical events (NACE) and the development of in-hospital Killip class III or IV heart failure. Propensity-score matching and conditional logistic regression were used to adjust for confounders. Within the matched cohort, rates of MACE was not statistically different between the thrombolysis ( N = 247) and pPCI ( N = 958) groups, (11.3% vs. 9.0% respectively, OR: 1.25, 95% CI: 0.81–1.94; P = 0.31). Secondary endpoints were comparable between groups at the exception of a significant difference for the development of Killip class III or IV heart failure in favor of the thrombolysis group (3.3% vs. 9.3%, OR: 0.38, 95% CI: 0.18–0.79; P = 0.01) (Fig 1). Thrombolysis may be a safe and effective strategy in selected elderly patients, which may reduce the development of severe heart failure without a higher major bleeding rate.

Survival and Outcome in Pediatric Myocarditis - 3 Year Data from the German Multi-center Prospective Myocarditis Registry: “MYKKE”

In children myocarditis is one cause for the development of severe heart failure. “MYKKE”, a multicenter prospective registry on pediatric (<18 years) patients with suspected myocarditis, aims to gain knowledge on incidence, diagnostic, therapy and outcome.

Predictive value of copeptin in the development of severe heart failure in patients with acute coronary syndrome without ST-segment elevation

The authors present data on the role of new biochemical marker copeptin as the C-end part of the pro-vasopressin, in assessing the risk of severe heart failure in short observation period (30 days) in patients with acute coronary syndrome (ACS) without ST-segment elevation the first 3:00 from the manifestation of pain combined with the definition of the levels of troponin T. Materials and methods. Prospective single center study included 128 patients (including 52 persons with acute myocardial infarction (AMI) diagnosis, 58 persons with unstable angina pectoris and 18 people with unconfirmed coronary event) with suspected ACS without ST-segment elevation with risk factors for coronary heart disease, selected according to criteria of inclusion/exclusion, received information on the study and gave their written consent to participate. Within the framework of the study, levels of troponin T and copeptin were determined for every patient at the admission, a diagnostic test of troponin T was repeated in 12-72 hours. During hospitalization, all patients were subjected to medical diagnostic examination, laboratory diagnosis, drug therapy, prescribed by standards of care, including medical history and analysis of the medical records, registration of ECG, echocardiography, quantitative determination of troponin T, assessment of left ventricular failure on a scale Killip and level of copeptin. Results. The level of copeptin during the early 3 hours since the manifestation of pain identified a direct correlation (r=0.76) between the values of the Copeptin upon receipt and the exacerbation of severity of congestive heart failure (HF) Killip classification established in patients with AMI in the period of hospital treatment and 30-day observation period. The level of copeptin during the early 3 hours since the manifestation of pain was 2.99 ng/ml (95% confidence interval - CI 1.89-4.09) for patients with HF class Killip 3 and 5.57 ng/ml (95% CI 5.08-6.06) for patients with HF class Killip 4 respectively. The level of copeptin ≥2.95 ng/ml significantly increase the risk of severe HF in 11 times - relative risk 11.4 (5.64-22.9, p

Transcatheter Implantation of Mitral Valve Prostheses: Current Status of the Problem

Mitral valve disease is highly prevalent and quickly leads to development of severe heart failure. Mitral valve disease of degenerative or ischemic etiology affects 7.5 and 9.3% of population older than 65 and 75 years, respectively. "Open" (with cardiopulmonary bypass) surgical repair or valve replacement are not possible in almost half of affected patients because of their complications and concomitant diseases responsible for extremely high risk of these interventions. In the last decade, minimally invasive endovascular technology - transcatheter aortic valve implantation (TAVI) - has been widely introduced for correction of aortic valve disease in similar category of patients. However, transcatheter mitral valve implantation (TMVI) has been developed just during recent couple of years.

Aortopulmonary septal defect with interrupted aortic arch in a monochorionic diamniotic twin pregnancy.

We report a monochorionic diamniotic twin pregnancy with prenatal diagnosis of aortopulmonary septal defect combined with typeB interrupted aortic arch in one of the fetuses. The mother was referred for fetal echocardiography at 24weeks' gestation due to suspected congenital heart disease. Prenatal echocardiography revealed a defect of 2.8mm between the main pulmonary artery and the ascending aorta. The course of the ascending aorta was straight to the neck and head, and there was no continuity of the aortic arch after the origin of innominate and left common carotid arteries. Thus, aortopulmonary septal defect with typeB interrupted aortic arch was suspected. Postnatal echocardiography confirmed the diagnosis, and surgical repair was performed on the 10th day after birth. The combination of aortopulmonary septal defect with typeB interrupted aortic arch is a very rare condition that can be diagnosed by fetal echocardiographic examination in the second trimester of gestation. Prenatal diagnosis is important for the prognosis, since early surgical intervention is needed to prevent development of severe heart failure in the neonate.

Dilated Cardiomyopathy With Conduction Disease and Arrhythmia

case presentation: A 48-year-old woman presents with exertional dyspnea and recurrent syncope. One year earlier, a permanent pacemaker was placed after she complained of fatigue and was found to have high-grade atrioventricular block. Now, she has echocardiographic evidence of moderate to severe left ventricular (LV) systolic dysfunction with regional wall-motion abnormalities. Nuclear imaging is notable for heterogeneous myocardial uptake of technetium Tc99m sestamibi, and coronary angiography reveals widely patent epicardial vessels. Multiple episodes of nonsustained ventricular tachycardia (VT) are documented on continuous ECG monitoring. What are the diagnostic considerations for this patient, and what further evaluations are indicated? This patient presents with dilated cardiomyopathy (DCM) with electric instability (DCM+E), which we define as conduction disease and arrhythmia out of proportion to the severity of LV systolic dysfunction. Diverse causes can result in DCM+E and fall into general categories of inflammatory, infectious, hereditary, and infiltrative processes. Cardiac presentation associated with these conditions is distinct from more common causes of DCM such as ischemic heart disease, viral myocarditis, valvular dysfunction, pregnancy, or substance abuse. Clinical features that are suggestive of DCM+E include supraventricular arrhythmias or conduction disease that precedes cardiomyopathy, multiple VT morphologies, and features suggestive of ischemic heart disease (Q waves, regional wall-motion abnormalities, perfusion defects, ventricular aneurysm) in the absence of epicardial stenoses. In this Clinician Update, we focus on the diagnostic approach to patients with DCM+E. Emphasis is placed on diagnoses that are relatively common or for which the clinical management would be impacted significantly by recognition of the underlying cause. Ischemic heart disease may present with conduction disease and a high burden of arrhythmia, especially in the setting of acute myocardial ischemia/infarction. The exclusion of obstructive coronary artery disease is strongly recommended in patients with DCM+E because atherosclerosis is so prevalent, evidence-based treatment is readily available, and the …

Reversible Heart Failure in a Patient Receiving Etanercept for Ankylosing Spondylitis

A 42-year-old man with ankylosing spondylitis that was refractory to nonsteroidal anti-inflammatory drugs as well as various disease-modifying antirheumatic drugs was subjected to anti-TNF compounds. Administration of infliximab and adalimumab gave excellent clinical response but was discontinued due to adverse events. Introduction of etanercept was also clinically effective but followed by development of severe heart failure. Discontinuation of etanercept led to control of heart function. The unusually though potentially life-threatening possibility of heart failure secondary to anti-TNF use in ankylosing spondylitis merits attention.

Comparison of Clinical Outcomes Following Acute Myocardial Infarctions in Hypertensive Patients With or Without Diabetes

Background and ObjectivesIt is thought that patients with diabetes mellitus (DM) have a poor prognosis after an acute myocardial infarction (AMI), but the effect of diabetes on the outcomes of hypertensive patients with AMIs has not been elucidated in the Korean population. The aim of this study was to investigate the effects of diabetes on long-term clinical outcomes following AMIs in patients with hypertension.Subjects and MethodsUsing data from the Korea Acute Myocardial Infarction Registry (November 2005 to December 2006), 2,233 hypertensive patients with AMIs were grouped as follows based on the presence of DM: group I, diabetic hypertension (n=892, 544 men, mean age=66.2±10.9 years); and group II, non-diabetic hypertension (n=1341, 938 men, mean age=63.9±12.8 years). The primary study outcomes included in-hospital death and major adverse cardiac events (MACE; cardiac death, myocardial infarction (MI), repeat percutaneous coronary intervention, and coronary artery bypass surgery) at the 1 year follow-up.ResultsHypertensive patients with DM were older and more likely to be women. The diabetic group had lower blood pressure (p<0.001), a lower left ventricular ejection fraction (p<0.001), a more severe degree of heart failure (p<0.001), a longer duration of coronary care unit admission (p<0.001), and a higher incidence of hyperlipidemia (p=0.007). The N-terminal pro-brain natriuretic peptide level (4602.5±8710.6 pg/mL vs. 2320.8±5837.9 pg/mL, p<0.001) was higher and the creatinine clearance (62.4±29.9 mL/min vs. 73.0±40.8 mL/min, p<0.001) was lower in the diabetic group than the non-diabetic group. Coronary angiographic findings revealed more frequent involvement of the left main stem (p=0.002) and multiple vessels (p<0.001) in the diabetic group. The rate of in-hospital death was higher in the diabetic group (p<0.001). During follow-up, the rates of composite MACE at 1 month, 6 months, and 12 months were higher in the diabetic group (p<0.001).ConclusionIn hypertensive patients with AMI, DM was associated with worse clinical and angiographic features, with a higher risk of development of severe heart failure, and an increased risk of MACE on long-term clinical follow-up.

Mitral Valve Replacements in Redo Patients with Previous Mitral Valve Procedures: Mid-Term Results and Risk Factors for Survival

We aimed to investigate the risk factors for hospital mortality, short (five years) and mid-term (10 years) survival in patients who underwent mitral valve replacements in redo patients with previous mitral valve procedures. Between September 1989 and December 2003, 62 redo patients have undergone mitral valve replacements due to subsequent mitral valve problems. Preoperative, operative, and postoperative data were analyzed retrospectively and evaluated for risk factors affecting hospital mortality, mid- and long-term survival. The hospital mortality was 6.4%. The one-, five-, and 10-year actuarial survival rates were 94%+/- 2%, 89%+/- 6%, and 81 +/- 9%. New York Heart Association (NYHA) functional class IV, low left ventricular ejection fraction (<35%), increased left ventricular end-diastolic diameter (LVEDD) > 50 mm, female gender, pulmonary edema, and urgent operations were found to be risk factors in short-term survival. NYHA functional class IV, low left ventricular ejection fraction, increased LVEDD, and increased left atrial diameter (LA > 60 mm) were risk factors in mid-term survival. Redo mitral valve surgery with mechanical prosthesis offers encouraging short- and mid-term survival. NYHA functional class IV, low left ventricular ejection fraction, and increased left ventricular diameters were especially associated with increased short- and mid-term mortality. Earlier surgical management before the development of severe heart failure and myocardial dysfunction would improve the results of redo mitral valve surgery.

Abstract 3361: Progressive Left Ventricle, Myocyte Dysfunction, and Heart Failure in the Lethality of Anthrax Toxin in Conscious Dogs

Background . Bacillus anthracis ( BA ) infection is a cause of human and animal disease and associated with biowarfare. Although circulatory shock related to anthrax lethal toxin (LeTx) may play a primary role in lethality due to BA infection, its mechanisms are unclear. Methods . Six chronically-instrumented conscious dogs were assigned to receive a bolus injection of LeTx (10 ml saline with equivalent doses PA/LF, about 0.265 mg/kg, iv, n = 2) or saline (10 ml, iv, n = 4). Hemodynamic, left ventricular (LV) systolic and diastolic responses were determined periodically until 96 hours (h) in both groups. LV biopsies were performed at about 98H (before death). Isolated myocyte contractile function and histopathological alterations were determined. Results . Compared with control, in LeTx-treated animals, there were progressive decreases in LV contractility and slowed LV relaxation during the transition from LV dysfunction to heart failure (HF) over 96–98H. The cardiac depression was apparent about 6 – 8H after LeTx, but progressed through the subsequent 72–98H. At 72H after LeTx, heart rate (LeTx:129vsControl:95 bpm), LV end-diastolic pressure (P) (21vs9 mmHg), and the time constant of relaxation (40.9vs29.7 ms) were increased with markedly reduced ejection fraction, stroke volume (SV, 8.4vs15.8 ml), and end-systolic P (92vs118 mmHg). Moreover, LV contractility was decreased 49% (E ES , 4.1vs8.2 mmHg/ml and M SW , 44.9vs88.9 mmHg) with rightward shifts of LV P-V loops. At 96H, M SW , SV, and EF were further decreased accompanied by the development of severe HF. Pathologic finding of LV dilatation was associated with significantly increased length of LV myocytes (201±11vs122±13 μm). In LeTx-treated myocytes, there were about 46% reductions in cell contraction (79.0±9.7vs146.2±11.4 μm/s) and relaxation, respectively. LeTx produced lethality in dogs 4 days after LeTx treatment with similar time courses to those previously reported in man. Conclusions . LeTx causes direct and time-dependent progressive decrease in LV contractility, slow relaxation, cardiomyocyte dysfunction, LV, and myocyte remodeling and leads to HF, which suggests that the heart could be the primary target for the action of LeTx and plays an important role in lethality due to BA infection.

Glycemia in acute coronary syndromes

Diabetes is an established major factor of poor prognostis after an acute coronary syndrome. Recent studies have addressed the impact of abnormal glucose metabolism at the acute phase in patients without known diabetes. It has been found that abnormal glycemia regulation is more common than normal regulation in patients presenting with acute coronary syndrome, whatever the method used to evaluate blood glucose metabolism. High blood glucose at admission, whether fasting or not, are associated with worse outcome after an acute coronary syndrome, i.e. by increased mortality and development of severe heart failure. The prognosistic value of glycemia is valuable for both short and long term outcomes. Admission glycemia measurement allows therapeutic strategies at the acute phase. Fasting glycemia and oral glucose tolerance test performed during the hospital stay discloses valuable diagnostic information and provide useful tools for secondary prevention. Moreover, fasting glycemia is a more powerful predictor for short term outcome after myocardial infarction than admission glycemia. The mechanisms by which hyperglycemia deteriorates the cardiovascular prognosis, in particular for left ventricular dysfunction, are not fully understood. Stress hyperglycemia may be a marker of extensive cardiac damage, reflecting a surge of stress hormones such as catecholamines and cortisol that participate to insulinresistance and affect fatty acid and glucose homeostasis. Recent findings also argue for a direct deleterious effect of hyperglycemia on myocardium.

Submolecular mechanisms underlying in vitro and in vivo effect of cardiac glycosides on contractile activity of myocardial myofibrils during heart failure

The development of severe heart failure associated with toxicoallergic myocarditis is accompanied by profound structural and conformational changes in the outer domain of actin (major protein in a thin filament of cardiomyocyte sarcomere). These changes were revealed in subdomains 1 (Cys374 and Cys10) and 2 (Lys61 and Tyr69). Structural and conformational changes in the monomer and protomer of the actin thread during heart failure were energetically forbidden. Variations in the distance between amino acid residues exceeded 0.26 nm. They were partly or completely reversible in vivo under the influence of cardiotropic drug refracterin with high antihypoxic activity, as well as in vitro after treatment with digitalis preparations optimizing the concentration of ATP.