Division Of Cardiology Research Articles

Very High Cholesterol Mimicking Homozygous Familial Hypercholesterolemia.

HomeCirculationVol. 146, No. 15Very High Cholesterol Mimicking Homozygous Familial Hypercholesterolemia No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessCase ReportRequest AccessFull TextVery High Cholesterol Mimicking Homozygous Familial Hypercholesterolemia Matthew K. Shotwell, Mounica Vorla and Dinesh K. Kalra Matthew K. ShotwellMatthew K. Shotwell Division of Cardiology, University of Louisville, KY. Search for more papers by this author , Mounica VorlaMounica Vorla Division of Cardiology, University of Louisville, KY. Search for more papers by this author and Dinesh K. KalraDinesh K. Kalra Correspondence to: Dinesh K. Kalra, MD, Division of Cardiovascular Medicine, University of Louisville School of Medicine, Rudd Heart & Lung Center, 201 Abraham Flexner Way, Suite 600, Louisville, KY 40202. Email E-mail Address: [email protected] https://orcid.org/0000-0001-5254-4067 Division of Cardiology, University of Louisville, KY. Search for more papers by this author Originally published10 Oct 2022https://doi.org/10.1161/CIRCULATIONAHA.122.061578Circulation. 2022;146:1182–1188FootnotesCirculation is available at www.ahajournals.org/journal/circFor Sources of Funding and Disclosures, see page 1187–1188.Correspondence to: Dinesh K. Kalra, MD, Division of Cardiovascular Medicine, University of Louisville School of Medicine, Rudd Heart & Lung Center, 201 Abraham Flexner Way, Suite 600, Louisville, KY 40202. Email dinesh.[email protected]edu

Acute effect of empagliflozin on serum uric acid – a subanalysis of the EMPAG-HF trial (effects of empagliflozin on diuresis and renal function in patients with acute decompensated heart failure)

Abstract Background Elevated levels of uric acid (UA) have been associated with worsening of outcomes in cardiovascular and renal disease and may lead to gout. Patients with acute decompensated heart failure (ADHF) may develop hyperuricemia under intensified diuretic treatment. In this setting, the effect of empagliflozin on serum uric acid remains unknown. Aim/Purpose The aim of this subanalysis in patients with ADHF was to assess how additive treatment with empagliflozin influences the concentration of serum uric acid and potential related outcomes. Methods In the single-center, prospective, double-blind, placebo-controlled EMPAG-HF trial, patients with ADHF were screened and randomized within 12 hours following hospital admission to receive either empagliflozin 25 mg or placebo in addition to standard medical treatment over five days. Sixtypatients (mean age 74,7±9,9, 39% female) were enrolled and randomized 1:1 irrespective of left ventricular ejection fraction or the presence of diabetes. UA in serum was determined daily and renal handling of UA was evaluated by fractional excretion of UA (FEUA). Two-way mixed ANOVA and Wilcoxon rank-sum test were used for statistical analyses. Results The empagliflozin group comprised 30 patients and the placebo group comprised 29 patients. There were no differences in baseline patient characteristics including LVEF, NT-proBNP, eGFR, HbA1c. In the placebo group, UA increased from baseline 487.86±32.21 μmol/l to 500.38±28.37 μmol/l at day (d) 2 (p=0.045), 512.36±29.43 μmol/l at d3 (p=0.018), and 518.46±31.14 μmol/l at d4 (p=0.021). By contrast, in the empagliflozin group, UA tended to decrease compared to baseline and was significantly lower compared to placebo at d3 (436.08±23.94 vs. 512.36±29.43 μmol/l, p=0.049), d4 (423.20±24.12 vs. 518.46±31.14 μmol/l, p=0.018), and d5 (423.17±24.75 vs. 508.62±31.08 μmol/l, p=0.037). Serum UA returned to baseline levels in both groups 30 days after cessation of empagliflozin. The reduction of UA in the empagliflozin group was associated with a significant enhancement in FEUA (5.49±0.81% vs. 9.38±1.07%, p=0.004). Conclusion Our data suggest that the additive treatment with empagliflozin in patients with acute decompensated heart failure lowers the levels of serum uric acid compared to loop diuretics alone. This effect may be attributed to an improved renal elimination of UA and a better preservation of kidney function. It remains to be clarified whether this uricosuric effect of empagliflozin also contributes to its prognostic benefits in heart failure. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany) Boehringer Ingelheim Inc.

A Peculiar Wide Complex Tachycardia During Flecainide Treatment.

A Peculiar Wide Complex Tachycardia During Flecainide Treatment.

Truncal Valve Repair: 3-Dimensional Imaging and Modeling to Enhance Preoperative Surgical Planning.

HomeCirculation: Cardiovascular ImagingVol. 15, No. 12Truncal Valve Repair: 3-Dimensional Imaging and Modeling to Enhance Preoperative Surgical Planning No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsNo AccessCase ReportRequest AccessFull TextTruncal Valve Repair: 3-Dimensional Imaging and Modeling to Enhance Preoperative Surgical Planning Trevor R. Williams, MD, Alana R. Cianciulli, BS, Yan Wang, RDCS, Andras Lasso, PhD, Csaba Pinter, PhD, Alison M. Pouch, PhD, David M. Biko, MD, Muhammad Nuri, MD, Michael D. Quartermain, MD, Lindsay S. Rogers, MD, Jonathan M. Chen, MD and Matthew A. Jolley, MD Trevor R. WilliamsTrevor R. Williams Division of Cardiology (T.R.W., Y.W., M.D.Q., L.S.R., M.A.J.), Children’s Hospital of Philadelphia, PA. *T.R. Williams and A.R. Cianciulli contributed equally. Search for more papers by this author , Alana R. CianciulliAlana R. Cianciulli Department of Anesthesiology and Critical Care Medicine (A.R.C., M.A.J.), Children’s Hospital of Philadelphia, PA. *T.R. Williams and A.R. Cianciulli contributed equally. Search for more papers by this author , Yan WangYan Wang Division of Cardiology (T.R.W., Y.W., M.D.Q., L.S.R., M.A.J.), Children’s Hospital of Philadelphia, PA. Search for more papers by this author , Andras LassoAndras Lasso https://orcid.org/0000-0002-4220-7064 Laboratory for Percutaneous Surgery, Queens University, Kingston, Ontario, Canada (A.L.). Search for more papers by this author , Csaba PinterCsaba Pinter https://orcid.org/0000-0001-9982-3194 Pixel Medical, Kingston, Ontario, Canada (C.P.). Search for more papers by this author , Alison M. PouchAlison M. Pouch Departments of Radiology and Bioengineering, University of Pennsylvania, Philadelphia (A.M.P.). Search for more papers by this author , David M. BikoDavid M. Biko Department of Radiology (D.M.B.), Children’s Hospital of Philadelphia, PA. Search for more papers by this author , Muhammad NuriMuhammad Nuri Division of Pediatric Cardiac Surgery (M.N., J.M.C.), Children’s Hospital of Philadelphia, PA. Search for more papers by this author , Michael D. QuartermainMichael D. Quartermain Division of Cardiology (T.R.W., Y.W., M.D.Q., L.S.R., M.A.J.), Children’s Hospital of Philadelphia, PA. Search for more papers by this author , Lindsay S. RogersLindsay S. Rogers Division of Cardiology (T.R.W., Y.W., M.D.Q., L.S.R., M.A.J.), Children’s Hospital of Philadelphia, PA. Search for more papers by this author , Jonathan M. ChenJonathan M. Chen Division of Pediatric Cardiac Surgery (M.N., J.M.C.), Children’s Hospital of Philadelphia, PA. Search for more papers by this author and Matthew A. JolleyMatthew A. Jolley Correspondence to: Matthew Jolley, MD, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104. Email E-mail Address: [email protected] https://orcid.org/0000-0002-5626-0130 Division of Cardiology (T.R.W., Y.W., M.D.Q., L.S.R., M.A.J.), Children’s Hospital of Philadelphia, PA. Department of Anesthesiology and Critical Care Medicine (A.R.C., M.A.J.), Children’s Hospital of Philadelphia, PA. Departments of Radiology and Bioengineering, University of Pennsylvania, Philadelphia (A.M.P.). Search for more papers by this author Originally published12 Sep 2022https://doi.org/10.1161/CIRCIMAGING.122.014424Circulation: Cardiovascular Imaging. 2022;15Footnotes*T.R. Williams and A.R. Cianciulli contributed equally.Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCIMAGING.122.014424.Correspondence to: Matthew Jolley, MD, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104. Email [email protected]chop.edu

Not-So-Mild Consequences of Mild Hypertension in Pregnancy.

Sadiya S. Khan is from the Division of Cardiology, Department of Medicine, and Lynn M. Yee is from the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, at the Northwestern University Feinberg School of Medicine, Chicago, Illinois; email: [email protected]. Financial Disclosure The authors did not report any potential conflicts of interest.

To Identify Drug-Drug Interaction in Cardiac Patients in Tertiary Care Hospitals

The potential for drug-drug interactions (pDDIs) is higher with cardiac medications, and reports of pDDIs in cardiovascular patients are more common. Multimorbidity, a greater number of drugs prescribed, longer hospital stays, complexity of disease, physiological changes with advancing age or conditions like renal failure, shock, hepatic disease like cirrhosis or acute viral hepatitis, stages of disease, and the influence of heart disease on drug metabolism make patients with CVD especially susceptible to DDIs. Our research found that pDDIs occurred at a much higher rate than expected in the Cardiology Division. Incidence of pDDIs was observed to rise with age, polypharmacy, and duration of hospital stay; pDDIs were also more common in males than females. Most of the interactions were of a pharmacodynamic character and were considered to be quite serious. Most pDDIs involved aspirin and clopidogrel, then aspirin and enalapril, and finally enalapril and enalapril. The surveillance of pDDIs in cardiac inpatients may benefit from the creation of such a database in hospitals.

Enrolling patients in cardiogenic shock trials: are we missing someone? Insights from the Italian AltShock-2 registry.

European Journal of Heart FailureEarly View Viewpoint Enrolling patients in cardiogenic shock trials: are we missing someone? Insights from the Italian AltShock-2 registry Federico Pappalardo, Corresponding Author Federico Pappalardo fedepappa.71@gmail.com Cardiothoracic and Vascular Anesthesia and Intensive Care, Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy Corresponding author. Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo, Via Venezia 16, 15121 Alessandria, Italy. Email: fedepappa.71@gmail.comSearch for more papers by this authorGuido Tavazzi, Guido Tavazzi Anaesthesia and Intensive Care Unit, University of Pavia, Pavia, ItalySearch for more papers by this authorStefano Savonitto, Stefano Savonitto Division of Cardiology, Manzoni Hospital, Lecco, ItalySearch for more papers by this authorNuccia Morici, Nuccia Morici IRCCS S. Maria Nascente—Fondazione Don Carlo Gnocchi ONLUS, Milan, ItalySearch for more papers by this author Federico Pappalardo, Corresponding Author Federico Pappalardo fedepappa.71@gmail.com Cardiothoracic and Vascular Anesthesia and Intensive Care, Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy Corresponding author. Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo, Via Venezia 16, 15121 Alessandria, Italy. Email: fedepappa.71@gmail.comSearch for more papers by this authorGuido Tavazzi, Guido Tavazzi Anaesthesia and Intensive Care Unit, University of Pavia, Pavia, ItalySearch for more papers by this authorStefano Savonitto, Stefano Savonitto Division of Cardiology, Manzoni Hospital, Lecco, ItalySearch for more papers by this authorNuccia Morici, Nuccia Morici IRCCS S. Maria Nascente—Fondazione Don Carlo Gnocchi ONLUS, Milan, ItalySearch for more papers by this author First published: 06 August 2022 https://doi.org/10.1002/ejhf.2640Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Catastrophic Disruptions in Clinical Trials.

HomeCirculationVol. 146, No. 5Catastrophic Disruptions in Clinical Trials No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessArticle CommentaryRequest AccessFull TextCatastrophic Disruptions in Clinical Trials Josephine Harrington, MD, G. Michael Felker, MD, MHS and Robert J. Mentz, MD Josephine HarringtonJosephine Harrington https://orcid.org/0000-0001-5169-117X Department of Medicine, Division of Cardiology, Duke University, Durham, NC. Duke Clinical Research Institute, Durham, NC. Search for more papers by this author , G. Michael FelkerG. Michael Felker https://orcid.org/0000-0002-5931-1239 Department of Medicine, Division of Cardiology, Duke University, Durham, NC. Duke Clinical Research Institute, Durham, NC. Search for more papers by this author and Robert J. MentzRobert J. Mentz Correspondence to: Robert J. Mentz, MD, Duke University School of Medicine, 200 Trent Dr, 4th Floor, Orange Zone, Room 4221, Durham, NC 27710. Email E-mail Address: [email protected] https://orcid.org/0000-0002-3222-1719 Department of Medicine, Division of Cardiology, Duke University, Durham, NC. Duke Clinical Research Institute, Durham, NC. Search for more papers by this author Originally published1 Aug 2022https://doi.org/10.1161/CIRCULATIONAHA.122.060541Circulation. 2022;146:369–371FootnotesCirculation is available at www.ahajournals.org/journal/circThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Sources of Funding and Disclosures, see page 370.Correspondence to: Robert J. Mentz, MD, Duke University School of Medicine, 200 Trent Dr, 4th Floor, Orange Zone, Room 4221, Durham, NC 27710. Email robert.[email protected]edu

Should Polypills Be Used for Heart Failure With Reduced Ejection Fraction?

HomeCirculationVol. 146, No. 4Should Polypills Be Used for Heart Failure With Reduced Ejection Fraction? No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessArticle CommentaryRequest AccessFull TextShould Polypills Be Used for Heart Failure With Reduced Ejection Fraction? Ambarish Pandey, MD, MSCS, Neil Keshvani, MD and Thomas J. Wang, MD Ambarish PandeyAmbarish Pandey Correspondence to: Ambarish Pandey, MD, MSCS, Assistant Professor of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9047. Email E-mail Address: [email protected] https://orcid.org/0000-0001-9651-3836 Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, TX. Search for more papers by this author , Neil KeshvaniNeil Keshvani https://orcid.org/0000-0001-6890-8670 Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, TX. Search for more papers by this author and Thomas J. WangThomas J. Wang https://orcid.org/0000-0003-4063-6508 Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas, TX. Search for more papers by this author Originally published25 Jul 2022https://doi.org/10.1161/CIRCULATIONAHA.122.059661Circulation. 2022;146:276–278FootnotesCirculation is available at www.ahajournals.org/journal/circThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Sources of Funding and Disclosures, see page 278.Correspondence to: Ambarish Pandey, MD, MSCS, Assistant Professor of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9047. Email ambarish.[email protected]edu

Waves.

Division of Pediatric Cardiology, Children’s Healthcare of Atlanta/Emory University School of Medicine, Atlanta, GA. Dr. Mills has disclosed that he does not have any potential conflicts of interest.. For information regarding this article, E-mail: [email protected]

Cardiac Papillary Fibroelastoma: A Forgotten Cause of Stroke and Myocardial Infarction in Patients With Nonobstructive Coronary Artery Disease.

HomeCirculation: Cardiovascular ImagingVol. 15, No. 8Cardiac Papillary Fibroelastoma: A Forgotten Cause of Stroke and Myocardial Infarction in Patients With Nonobstructive Coronary Artery Disease No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialNo AccessCase ReportRequest AccessFull TextCardiac Papillary Fibroelastoma: A Forgotten Cause of Stroke and Myocardial Infarction in Patients With Nonobstructive Coronary Artery Disease Milos Brankovic, MD, PhD, MSc, Parul Kakar, MD, Nebojsa Markovic, MD, Luka Petrovic, MD, Volodymyr Vulkanov, DO and Alfonso H. Waller, MD Milos BrankovicMilos Brankovic Correspondence to: Milos Brankovic, MD, PhD, MSc, Department of Medicine, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, New Jersey 07103. Email E-mail Address: [email protected] https://orcid.org/0000-0002-4730-957X Department of Medicine (M.B., A.H.W.), Rutgers New Jersey Medical School, Newark, NJ. Transatlantic Cardiovascular Study Group, NJ (M.B., N.M., L.P.). Search for more papers by this author , Parul KakarParul Kakar Division of Cardiology, Department of Medicine (P.K., A.H.W.), Rutgers New Jersey Medical School, Newark, NJ. Search for more papers by this author , Nebojsa MarkovicNebojsa Markovic Department of Cardiology, Icahn School of Medicine, Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, NJ (N.M., L.P.). Transatlantic Cardiovascular Study Group, NJ (M.B., N.M., L.P.). Search for more papers by this author , Luka PetrovicLuka Petrovic Department of Cardiology, Icahn School of Medicine, Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, NJ (N.M., L.P.). Transatlantic Cardiovascular Study Group, NJ (M.B., N.M., L.P.). Search for more papers by this author , Volodymyr VulkanovVolodymyr Vulkanov Department of Neurology (V.V.), Rutgers New Jersey Medical School, Newark, NJ. Search for more papers by this author and Alfonso H. WallerAlfonso H. Waller Department of Medicine (M.B., A.H.W.), Rutgers New Jersey Medical School, Newark, NJ. Division of Cardiology, Department of Medicine (P.K., A.H.W.), Rutgers New Jersey Medical School, Newark, NJ. Search for more papers by this author Originally published30 Jun 2022https://doi.org/10.1161/CIRCIMAGING.122.013978Circulation: Cardiovascular Imaging. 2022;15FootnotesSupplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCIMAGING.122.013978.For Sources of Funding and Disclosures, see page 627.Correspondence to: Milos Brankovic, MD, PhD, MSc, Department of Medicine, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, New Jersey 07103. Email [email protected]rutgers.edu

Predicting Heart Failure in Arrhythmogenic Right Ventricular Cardiomyopathy

Predicting Heart Failure in Arrhythmogenic Right Ventricular Cardiomyopathy

Implementation of a Bedside Point-of-Care Ultrasound Program in a Large Academic Neonatal Intensive Care Unit.

In the adult and pediatric critical care population, point-of-care ultrasound (POCUS) can aid in diagnosis, patient management, and procedural accuracy. For neonatal providers, training in ultrasound and the use of ultrasound for diagnosis and management is increasing, but use in the neonatal intensive care unit (NICU) is still uncommon compared with other critical care fields. Our objective was to describe the process of implementing a POCUS program in a large academic NICU and evaluate the role of ultrasound in neonatal care during early adaption of this program. A POCUS program established in December 2018 included regular bedside scanning, educational sessions, and quality assurance, in collaboration with members of the cardiology, radiology, and pediatric critical care divisions. Core applications were determined, and protocols outlined guidelines for image acquisition. An online database included images and descriptive logs for each ultrasound. A total of 508 bedside ultrasounds (76.8% diagnostic and 23.2% procedural) were performed by 23 providers from December 2018 to December 2020 in five core diagnostic applications: umbilical line visualization, cardiac, lung, abdomen (including bladder), and cranial as well as procedural applications. POCUS guided therapy and influenced clinical management in all applications: umbilical line assessment (26%), cardiac (33%), lung (14%), abdomen (53%), and cranial (43%). With regard to procedural ultrasound, 74% of ultrasound-guided arterial access and 89% of ultrasound-guided lumbar punctures were successful. Implementation of a POCUS program is feasible in a large academic NICU and can benefit from a team approach. Establishing a program in any NICU requires didactic opportunities, a defined scope of practice, and imaging review with quality assurance. Bedside clinician performed ultrasound findings can provide valuable information in the NICU and impact clinical management. · Use of point-of-care ultrasound is increasing in neonatology and has been shown to improve patient care.. · Implementation of a point-of-care ultrasound program requires the definition of scope of practice and can benefit from the support of other critical care and imaging departments and providers.. · Opportunities for point-of-care ultrasound didactics, imaging review, and quality assurance can enhance the utilization of bedside ultrasound..

Ramping Up the Pressure on the Right Ventricle.

HomeCirculation: Heart FailureVol. 15, No. 6Ramping Up the Pressure on the Right Ventricle Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessResearch ArticlePDF/EPUBRamping Up the Pressure on the Right Ventricle Simone L. Savaris, MD, MSc, Isaac S. Chang, PhD, Stephen P. Wright, MSc, PhD and Susanna Mak, MD, PhD Simone L. SavarisSimone L. Savaris Correspondence to: Simone L. Savaris, MD, MSc, Division of Cardiology, Mount Sinai Hospital, 600 University Ave, Toronto, ON M5G 1X5, Canada. Email E-mail Address: [email protected] https://orcid.org/0000-0002-9049-1805 Division of Cardiology, Mount Sinai Hospital, Toronto, ON, Canada (S.L.S., S.M.). Search for more papers by this author , Isaac S. ChangIsaac S. Chang Mount Sinai Hospital, Toronto, ON, Canada (I.S.C.). Search for more papers by this author , Stephen P. WrightStephen P. Wright Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada (S.P.W.). Search for more papers by this author and Susanna MakSusanna Mak https://orcid.org/0000-0003-2193-602X Division of Cardiology, Mount Sinai Hospital, Toronto, ON, Canada (S.L.S., S.M.). Search for more papers by this author Originally published21 Apr 2022https://doi.org/10.1161/CIRCHEARTFAILURE.122.009671Circulation: Heart Failure. 2022;15Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: April 21, 2022: Ahead of Print A 49-year-old man underwent Heartmate 3 left ventricular assist device implantation as bridge to transplant candidacy for cardiogenic shock due to an ischemic cardiomyopathy which was complicated by a flail mitral valve leaflet resulting in severe regurgitation.Right heart catheterization was performed to assess residual pulmonary hypertension. Right ventricular (RV) and pulmonary artery (PA) pressures were recorded continuously. At baseline, mean PA pressure was 24 mm Hg and pulmonary vascular resistance was 3.0 WU at a speed of 5600 rpm. PA wedge pressure was altered by adjusting speed from 4600 to 5800 rpm. Further increases in speed did not change hemodynamics. Vasoreactivity testing with sodium nitroprusside was also used, based on recent evidence that even mildly elevated PA loading confers increased mortality risk.1,2 Pmax, a theoretical maximal RV systolic pressure derived by extrapolating the isovolumic portions of the waveform, was averaged over 10 cardiac cycles to calculate a single-beat estimate of RV end-systolic elastance, along with PA elastance and the end-systolic elastance:elastance ratio.3The incremental decline in the PA wedge pressure with attenuation of the V wave can be seen as left ventricular assist device speed was increased, and then with infusion of the vasodilator sodium nitroprusside (Figure and Table from left to right). Concomitant reductions in PA pressure and elastance were associated with shortening of the time to peak RVSP, and improved RV-PA coupling as reflected by increasing end-systolic elastance:elastance ratio. Importantly, mixed venous O2 saturation, stroke volume, and cardiac output increased steadily with afterload reduction.Table. Hemodynamics and Values Derived From Single-Beat Estimation of the Ees:Ea RatioUnsupportedRelatively unsupportedBaselineSNP (0.75 μg/kg per min)SNP (1.5 μg/kg per min)Speed4600 rpm5000 rpm5600 rpm5600 rpm5600 rpmMAP, mm Hg9492969065PAWP (a/v/mean), mm Hg18/37/1817/35/1710/24/1011/28/115/9/3PAP (S/D/M), mm Hg51/14/3047/13/2941/10/2441/9/2432/5/17RAP, mm Hg44320PVR, d/s per cm5192200240176168SVR, d/s per cm51532143613781193765MVO2, %61.663.365.168.573.3CO, L/min4.74.95.45.96.8SVi, mL/m2 per beat3941454955RVSP, mm Hg4946424334Time to RVSP, ms318226221210146Pmax, mm Hg166136143147142Ea, mm Hg/mL0.60.470.370.340.2Ees:Ea ratio2.72.73.63.76.7CO indicates cardiac output; Ea, pulmonary artery arterial elastance; Ees, RV end-systolic elastance; MAP, mean arterial pressure; MVO2, mixed venous oxygen saturation; PAP, pulmonary artery pressure; PAWP, pulmonary artery wedge pressure; Pmax, maximal predicted RV pressure; PVR, pulmonary vascular resistance; RAP, right atrium pressure; RV, right ventricle; RVSP, right ventricle systolic pressure; SNP, sodium nitroprusside; SVi, stroke volume index; and SVR, systemic vascular resistance.Download figureDownload PowerPointFigure. The figure shows that with alterations in speed and with a vasodilator challenge (from left to right), pulmonary artery wedge pressure (PAWP) and pulmonary artery pressure (PAP) declined, with measurable changes in the morphology of the right ventricular pressure (RVP) waveform. Pmax, the theoretical maximal RVP, and graphical representations of the coordinates employed for single-beat estimation of RV end-systolic elastance (Ees) are also illustrated. Ea indicates pulmonary artery arterial elastance; Pes, estimated end-systolic pressure; Pmax, maximal predicted RVP; RVSP, right ventricle systolic pressure; SNP, sodium nitroprusside; and SV, stroke volume.This case reinforces the effect of systemic vasodilation and venodilation to optimize hemodynamics in the setting of heart failure with reduced ejection fraction, mitral regurgitation, and a continuous flow left ventricular assist device. The upstream effects of adequate unloading of the left ventricle to improve the function of the RV-PA circulatory unit are also illustrated.Article InformationSources of FundingNone.Disclosures None.FootnotesFor Sources of Funding and Disclosures, see page 645.Correspondence to: Simone L. Savaris, MD, MSc, Division of Cardiology, Mount Sinai Hospital, 600 University Ave, Toronto, ON M5G 1X5, Canada. Email simonelouise.[email protected]ca

Comparison between oral procainamide and mexiletine for the treatment of recurrent and refractory ventricular tachyarrhythmias

Abstract Funding Acknowledgements Type of funding sources: None. Background The antiarrhythmic therapy of recurrent ventricular arrhythmias in patients having undergone catheter ablation and in whom amiodarone and/or beta blockers were ineffective or contraindicated, is a controversial issue. Purpose The present study sought to compare the efficacy and tolerability of oral procainamide and mexiletine in patients with recurrent ventricular arrhythmias, when the standard therapy strategy failed. Methods All patients with an implantable cardioverter defibrillator (ICD) treated with oral procainamide or mexiletine for recurrent ventricular tachycardia (VT) or ventricular fibrillation (VF) in 2 Cardiology Divisions between January 2010 and January 2020 were enrolled. The patients were divided in group A (oral procainamide) and group B (mexiletine) and the 2 groups were compared to each other. The primary endpoint was the efficacy of therapy; the secondary endpoint was the discontinuation of therapy. All the events occurring during procainamide or mexiletine treatment were compared with a matched duration period before the initiation of the therapy. Antiarrhythmic therapy was considered effective when an ≥80% reduction of the sustained ventricular arrhythmias (SVA) burden recorded by the ICD was achieved. Results A total of 68 consecutive patients (61 males, 89.7%; mean age 74 ± 10 years) were included in this retrospective analysis. In 27 (39.7%) patients catheter ablation of VT was attempted before therapy initiation. A concomitant therapy with amiodarone was present in 25 (36.8%) patients. The mean dose of procainamide was 1207±487 mg/die. The mean dose of mexiletine was 576±66 mg/die. After a median follow-up of 19 months, 38 (56%) patients had a significant reduction in the SVA burden. After multivariable adjustment (Table 1), therapy with procainamide was independently associated with an almost 3-fold higher efficacy on VA suppression compared to mexiletine (HR 2.54, 95% CI 1.06-6.14, p=0.03). Similar results (HR 2.89, 95% CI 1.26-6.62, p=0.01) were found after adjustment using inverse probability weighting by a propensity score including age, gender, left ventricular ejection fraction, ischemic heart disease and concomitant amiodarone therapy. Only 3 patients (9%) treated with procainamide presented severe side effects (dyspnea or hypotension) requiring discontinuation of therapy against 6 patients (18%) treated with mexiletine who interrupted therapy because of severe side effects (p=0.47). Conclusions Compared to mexiletine, oral procainamide has a higher efficacy for the treatment of recurrent and refractory VAs and shows a good profile of tolerability Table 1. Multivariable Cox Proportional Hazards Analysis of Baseline Covariates in Relation to effective VAs suppression.

C84 PERCUTANEOUS TREATMENT OF INTERATRIAL MULTIFENESTRATE ANEURYSM IN PAEDIATRIC POPULATION: INFLUENCE OF THE LAYOUT DURING MID–TERM AND LONG–TERM FOLLOW–UP

Abstract Background Multifenestrate aneurysms of interatrial septum (ISA) are a challenge in paediatric age, not only for the complex anathomy, but also for small body surface and small dimensions of cardiac chambers of the patients, that may limit the use of large and multiple devices. Aim of the study: to evaluate the efficacy of percutaneous closure of multifenestrate aneurysms during mid–term and long–term follow–up; to evaluate if the morphological characteristics of interatrial septum may influence the success of the procedure. Materials and Methods We retrospectively analyzed 63 patients (mean–age 9,12±3,12 years) undergone to cardiac catheterism from 2000 to 2021, for percutaneous closure of interatrial aneurysm in our division of Cardiology, subdivided into 3 groups on the basis of side and morphological characteristics of the interatrial aneurysm: Group I (2 o more defects DIA>5 mm); Group II (one defect >5 mm and more than one further fenestrations); Group III (multiple fenestrations). Results Percutaneous closure was efficacy in 60 patients (95%), while in 3 patients (5%) surgery closure was necessary. In half of the treated patients (30) we used 2 devices. Complications occurred in 4 patients (6%). Only in 2 patients occurred major complications (Atrio–Ventricular Block that needed PMK implantation and partial displacement of device, treated by removal and percutaneous replanting). Residual shunts, not emodynamically significant appear in the immediate post–operative period in 26% and during the follow–up in 18%. The group I was associated with greater risk of failure of the procedure (P < 0.01) and need of implantations of more than one devices (P < 0.01). Conclusions Percutaneous closure of multifenestrate aneurysm of interatrial septum in paediatric age are effective and shows low incidence of failure and complications. If is present residual shunt is not significant. The anathomy of interatrial septum influences procedural outcome.

P353 THE “TIMES” IN COVID–TIME: EXPERIENCE OF A CICU “SPOKE”

Abstract We analyzed data regarding patients hospitalized in the period 03/09/2020–03/09/2021 in the ICU–Cardiology Division of the “San Giovanni di Dio Hospital” of Frattamaggiore (NA), configured as “Spoke” CICu for the AMI Network of the Campania Region, and we compared them with the same parameters of patients hospitalized during 2019. In particular, we analyzed differences in epidemiologic parameters and, in patients hospitalized for acute coronary syndromes, we evaluated the waiting times for hemodynamic procedures. The total number of hospitalized patients decreased by about 25%, while the mean age of patients and the percentage of hemodynamic procedures were comparable. In particular we noted that, while the percentages of patients hospitalized for acute myocardial infarction were similar in COVID and PRE–COVID era, during the pandemic in patients affected by acute myocardial infarction.the percentages of STEMIs were superior to those of NSTEMIs. Finally, we examined door–to–balloon times. In patients affected by STEMI we found that, even during the pandemic, primary angioplasty was performed on average within 100 minutes, meaning that ultra–fast swabs (mandatory before the procedure) did not produce delay. Moreover, in the pandemic period patients with NSTEMI, despite a stay of about 8 hours in ER to obtain the result of the antigenic swab for SARS–COV2, received coronary arteriography in a shorter time than in the pre–pandemic era (52,8 and 62,4 hours respectively). This analysis seems to show that the pandemic has not affected the access and hospitalization times of patients with acute coronary syndrome, and that, although greatest difficulties have arisen, the times of access to hemodynamics have not been affected by COVID.

Gated SPECT Myocardial Perfusion Imaging at status-post Thrombolysis with Streptokinase

Background: Adequate reperfusion by thrombolysis (TL) with streptokinase (STK) after an ST elevation myocardial infarction (STEMI) is associated with better patient outcome. This study described theattributes of patients who at status-post TL underwent gated SPECT myocardial perfusion imaging (GSMPI). Patients and methods: This cross sectional retrospective study was conducted in 2017 on a group of patients who were referred to Nuclear Cardiology Division of National Institute of Nuclear Medicine and Allied Sciences (NINMAS) from February 2005 to October 2016 for GSMPI. Archive was reviewed to include those who received STK with diagnoses of an acute MI, then underwent coronary angiogram (CAG) and then underwent GSMPI. Findings from status-post TL CAG reports were compared with that from GSMPI. Results: Among 1347 patients, 59 (4.4%) were eligible for analysis with mean age of 51.2 ± 9.5 years. GSMPI revealed normal perfusion in 16 (27%), abnormal perfusion in 43 patients with mean LV infarct size at rest of 48.6 ± 17.2% and ischemia in 13 patients with mean ischemic LV of 12.1 ± 9.6%. Mean LVEF in normally perfused LV and in those with perfusion defects were 50.0 ± 18.7% and 39.5 ±14.9%respectively (p = 0.04). CAG was normal in one among 43 patients with abnormal myocardial perfusion. CAG was abnormal in 75% (12 of 16)of patients with normal perfusion. Six (10% of 59) among that 12 with abnormal CAG and normal perfusion had further coronary revascularization (CR). Conclusions: In this series, 27% (16/59) patients who had received STK had normal perfusion and at least in 10% (6/59) the normal perfusion despite an abnormal CAG and without further CR may indicate adequacy of TL using STK. Bangladesh J. Nuclear Med. 23(1&2): 29-36, 2020

Cardiometabolic risk, biomarkers of low-grade subclinical inflammation and flavonoid intake: A cross-sectional study in Argentina

BackgroundFlavonoids, the most abundant polyphenols present in the diet, may help to reduce the risk of cardiometabolic disease. Hence, the aim of this study was to know the potential associations between flavonoid source food intake, markers of low-grade inflammation and cardiometabolic risk status. Methods194 adult subjects attending at the Cardiology Division, Hospital Nacional de Clínicas, Córdoba, Argentina participated in the study. A validated food-frequency questionnaire was applied to establish the flavonoid source food intake. Clinical-pathological and anthropometric variables [height, weight, and waist circumference, and serum concentrations of high-sensitive C-reactive protein (hs-CRP) and cytokines (INF-γ, TNFα, IL-6, IL-8, IL-10, IL-18, IL-23) were measured. A cardiometabolic risk clustering score was constructed and correlation’s coefficients and multiple linear regression models were used to assess the relation between flavonoid source foods consumption of and markers of low-grade inflammation. Results40.4% of the subjects were obese and 60.3% showed a very high risk of developing cardiovascular diseases according to the WC classification. 43.3% had a high risk of cardiometabolic dysregulation and the hs-CRP levels indicated a high risk of developing cardiovascular disease in the future both in men and women. The predominant intake of flavonoids was from source food of flavanones, flavones and flavonols. Negative associations between isoflavone source food intake and TNFα, IL-6 and IL-8 concentrations (P ≤ 0.05) were observed. ConclusionsThe results of the present study provide evidence of the inverse association between isoflavone source foods intake and inflammation. Further studies are needed to confirm retrieved association.

Why are left ventricular linear internal diameters still so important for clinical decision-making to undergo surgery in asymptomatic patients with chronic severe aortic or primary mitral regurgitation?

Division of Cardiology, A.R.C., Policlinico San Giorgio, Via Gemelli 10, Pordenone, Italy Correspondence to Gian Luigi Nicolosi, MD, FESC, FACC, Division of Cardiology, A.R.C., Policlinico San Giorgio, Via Gemelli 10, Pordenone, Italy e-mail: [email protected] Received 24 September, 2021 Revised 21 November, 2021 Accepted 26 December, 2021