Ejection Fraction In Patients Research Articles

Electrocardiographic Patterns and Ejection Fraction in Patients with Nonischemic Dilated Cardiomyopathy: A Cross-sectional Retrospective Study

Background:: The relationship between ECG changes in dilated nonischemic cardiomyopathy and ejection fraction (EF) is complex and poorly understood. Thus, this study aimed to identify the most common patterns of ECG associated with dilated nonischemic cardiomyopathy and their relationship to EF. Methods:: A retrospective cross-sectional study was conducted between 2019 and 2022, including 100 consecutive patients with nonischemic dilated cardiomyopathy. ECG data were rate, axis, left (LBBB) and right bundle branch block (RBBB), first-degree heart block, premature ventricular contractions, depth of S wave in leads V1 and V2, length of R wave in leads V2 and V6, the ratio of R/S in the lead V4, left ventricular hypertrophy (LVH), maximum R wave length in leads I, II, and III, poor R wave progression, ST-segment elevation, and T wave inversion. Results:: The most common ECG pattern associated with cardiomyopathy was T-wave inversion (47%). The EF was 23.9± 8.87% in patients with LBBB and 25.5± 8.07% in patients without LBBB (P= 0.361). In patients with T-wave inversion, the EF was 23.4± 8.21%, and it was 26.28± 8.35% in patients without T-wave inversion (P= 0.086). In patients with LVH, the EF was 23.89± 7.84%, and it was 25.5± 8.66% in patients without LVH (P= 0.354). A negative nonsignificant correlation existed between SV1, SV2, RV2, RV6, R/S V4, and maximum R in I, II, III, and EF. Conclusions:: The study showed that T-wave inversion was the most common pattern associated with dilated nonischemic cardiomyopathy. The study provided insight into the negative correlation between EF and SV1, SV2, RV2, RV6, R/S V4, and maximum R in I, II, and III, although it did not reach a significant level.

TRIM11 expression levels was downregulated and prevents ferroptosis of cardiomyocyte by Dusp6 in acute myocardial infarction.

Acute myocardial infarction (AMI) is the high incidence rate and mortality of common cardiovascular disease. Herein, we explored the critical role of TRIM11 in AMI and its underlying mechanism. Serum from patients with AMI were collected from our hospital. Mice of model group received angiotensin II. Mice of model + TRIM11 group received with Ang II and TRIM11 vectors. Mice of sham group received normal saline. H9c2 cells were performed transfections using Lipofectamine 2000 (Thermo Fisher Scientific Inc, Shanghai, China), and treated with Ang II. TRIM11 mRNA expression was reduced, was negative correlation with collagen I/III mRNA expression, systolic blood pressure, diastolic blood pressure, left anteroposterior atrial diameter, right atrial diameter, or left ventricular ejection fraction in patient with AMI. TRIM11 mRNA and protein expression were also suppressed. METTL3 regulates TRIM11 methylation to reduce TRIM11 gene stability in model of AMI. TRIM11 gene ameliorated AMI in mice model. TRIM11 gene reduced reactive oxygen species production level of cardiomyocyte in-vitro model. TRIM11 gene reduced ferroptosis of cardiomyocyte in-vitro model. TRIM11 gene reduced ferroptosis by the inhibition of mitochondrial damage of cardiomyocyte in model of AMI. TRIM11 induced Dusp6 protein expression. Bioluminescence imaging showed that TRIM11 virus increased Dusp6 expression in heart tissue of mice model. The inhibition of Dusp6 reduced the effects of TRIM11 on ferroptosis of cardiomyocyte in model of AMI. In conclusion, this study demonstrates that TRIM11 improves AMI by regulating Dusp6 to inhibit ferroptosis of cardiomyocyte, and suggest a novel target for AMI.

Rationale and design of a prospective randomized study of the effect of ferric carboxymaltose therapy on quality of life and clinical picture of heart failure with preserved ejection fraction in patients with iron deficiency

Introduction. The prevalence of iron deficiency (ID) among patients with chronic heart failure (CHF) ranges from 50% to 80%. It has been established that ID is a significant predictor of adverse outcomes and mortality in CHF, and is also associated with a decrease in exercise tolerance. The use of oral iron preparations for the purpose of its correction is limited by the high frequency of adverse events and, in some cases, their ineffectiveness in CHF. Ferric carboxymaltose has a high potential in the correction of ID, which has proven itself well in the cohort of patients with CHF, but its effectiveness has not been precisely established in CHF.Aim: To evaluate the effect of ferric carboxymaltose therapy on the quality of life, functional status, and clinical picture of CHF in patients with diagnosed iron deficiency.Material and Methods. It is a prospective randomized cohort study. It is planned to include 70 adult patients with CHF (NYHA II-III) and diagnosed ID: group 1 (n = 35) – group of drug therapy with ferric carboxymaltose, group 2 (n = 35) – without drug therapy. A control group of patients without ID (n = 30) will also be recruited. The prospective part involves the observation of patients with repeated visits after 6, 12 months, during which the indicators of quality of life, functional status, clinical picture of CHF, structural and functional echocardiographic indicators of LV and right heart, as well as the presence of repeated hospitalizations for CHF and death from all causes will be evaluated.

Superoxide dismutases: marker in predicting reduced left ventricular ejection fraction in patients with type 2 diabetes and acute coronary syndrome

AimTo examine the prognostic value of superoxide dismutase (SOD) activity for monitoring reduced left ventricular ejection fraction(LVEF)in the patients with type 2 diabetes and acute coronary syndrome (ACS).MethodsThe population of this cross-sectional study included 2377 inpatients with type 2 diabetes who had an ACS admitted to the Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2016 to January 2021.ResultsDiabetic patients with ACS were divided into 2 subgroups based on LVEF. The mean SOD activity was significantly lower in patients with an LVEF ≤ 45% than in those with an LVEF > 45% (149.1 (146.4, 151.9) versus 161.9 (160.8, 163.0)). Using ROC statistic, a cut-off value of 148.8 U/ml indicated an LVEF ≤ 45% with a sensitivity of 51.6% and a specificity of 73.7%. SODs activity were found to be correlated with the levels of NT-proBNP, hs-cTnT, the inflammatory marker CRP and fibrinogen. Despite taking the lowest quartile as a reference (OR 0.368, 95% CI 0.493–0.825, P = 0.001) or examining 1 normalized unit increase (OR 0.651, 95% CI 0.482–0.880, P = 0.005), SOD activity was found to be a stronger predictor of reduced LVEF than CRP and fibrinogen, independent of confounding factors.ConclusionsOur cross-sectional study suggests that SOD activity might be a valuable and easily accessible tool for assessing and monitoring reduced LVEF in the diabetic patients with ACS.

The role of sodium glucose cotransporter or glucagon-like peptide-1 receptor agonists in treating heart failure with preserved ejection fraction in patients with type 2 diabetes mellitus

Background. Heart failure with preserved ejection fraction is not a single disease but a clinical syndrome secondary to important comorbidities, is increasing in prevalence, and is associated with high functional impairment. This study aimed to compare the results of treating patients with heart failure with preserved ejection fraction and type 2 diabetes mellitus with sodium-glucose cotransporter inhibitors (SGLT-2 inhibitors) or Glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Methods. Observational trial in one medical center with assessments at baseline and 6 months. Participants were patients with type 2 diabetes mellitus and heart failure with preserved ejection fraction. The primary endpoint was to measure the impact of treatment on weight loss, diastolic dysfunction, Kansas City Cardiomyopathy Questionnaire. We performed anthropometric measurements, blood samples and transthoracic echocardiography for systolic and diastolic dysfunction. Results. After 6 months of intervention, both groups had a significant increase in results of Kansas City Cardiomyopathy Questionnaire, and the mean change in the group treated with GLP-1 Ras was 15.88 ± 7.7 points (95% confidence interval[CI], 19.7-12.7, p<0.01) while in the group treated with sodium-glucose cotransporter inhibitors was 13.57 ± 7.96 points (95% confidence interval[CI], 16.22-10.91, p<0.01) so the quality of life was better. The weight loss was more important in the group with GLP-1 Ras with 5.8 ± 1.8 kg (95% confidence interval [CI], 4.7-7.0, p<0.01) while in the other group was 1.37 ± 1.4 kg (95% confidence interval [CI], 0.54-2.21, p<0.01). Diastolic dysfunction was improved in monitoring E/E' lateral and was 3.28 ±1.27 less (95% confidence interval [CI], 2.75-3.80, p<0.01) in the GLP-1 Ras group and 2.93 ± 2.15 less (95% confidence interval [CI], 2.21-3.64, p<0.01) in the SGLT-2 inhibitors group. Conclusions. The present study establishes an improvement in symptoms, diastolic dysfunction, and weight loss in patients with type 2 diabetes mellitus and heart failure with preserved ejection fraction and treatment with GLP-1 Ras or SGLT-2 inhibitors.

Predictors of improvement in left ventricular systolic function after catheter ablation in patients with persistent atrial fibrillation complicated with heart failure

AimsThe current management of patients with atrial fibrillation (AF) and concomitant heart failure (HF) remains a significant challenge. Catheter ablation (CA) has been shown to improve left ventricular ejection fraction (LVEF) in these patients, but which patients can benefit from CA is still poorly understood. The aim of our study was to determine the predictors of improved ejection fraction in patients with persistent atrial fibrillation (PeAF) complicated with HF undergoing CA.Methods and resultsA total of 435 patients with persistent AF underwent an initial CA between January 2019 and March 2023 in our hospital. We investigated consecutive patients with left ventricular systolic dysfunction (LVEF < 50%) measured by transthoracic echocardiography (TTE) within one month before CA. According to the LVEF changes at 6 months, these patients were divided into an improved group (fulfilling the ‘2021 Universal Definition of HF’ criteria for LVEF recovery) and a nonimproved group. Eighty patients were analyzed, and the improvement group consisted of 60 patients (75.0%). In the univariate analysis, left ventricular end-diastolic diameter (P = 0.005) and low voltage zones in the left atrium (P = 0.043) were associated with improvement of LVEF. A receiver operating characteristic analysis determined that the suitable cutoff value for left ventricular end-diastolic diameter (LVDd) was 59 mm (sensitivity: 85.0%, specificity: 55.0%, area under curve: 0.709). A multivariate analysis showed that LVDd (OR = 0.85; 95% CI: 0.76–0.95, P = 0.005) and low voltage zones (LVZs) (OR = 0.26; 95% CI: 0.07–0.96, P = 0.043) were significantly independently associated with the improvement of LVEF. Additionally, parameters were significantly improved regarding the left atrial diameter, LVDd and ventricular rate after radiofrequency catheter ablation (all p < 0.05).ConclusionsThe improvement of left ventricular ejection fraction (LVEF) occurred in 75.0% of patients. Our study provides additional evidence that LVDd < 59 mm and no low voltage zones in the left atrium can be used to jointly predict the improvement of LVEF after atrial fibrillation ablation.

Carbohydrate antigen 125 concentrations across the ejection fraction spectrum in chronic heart failure: The EMPEROR programme.

Vascular congestion may lead to an increase of carbohydrate antigen 125 (CA-125). The role of CA-125 as a biomarker of congestion or for prognosis across the full ejection fraction (EF) spectrum of chronic heart failure (HF) remains unknown. Serum CA-125 was measured in 1111 study participants from the EMPEROR-Reduced and EMPEROR-Preserved trials. Congestive signs and symptoms were evaluated across CA-125 tertiles. Cox regression was used to study the association with outcomes. The primary outcome was a composite of first HF hospitalization or cardiovascular (CV) death. No significant association was present between baseline CA-125 levels and congestive signs or symptoms. In the overall population, higher CA-125 levels were not associated with an increased risk of primary outcome (tertile 3 vs. tertile 1: hazard ratio [HR] 1.34; 95% confidence interval [CI] 0.91-1.96; p-trend = 0.11). However, higher CA-125 levels were associated with an increased risk of primary outcome in patients with HF and reduced EF (HFrEF; tertile 3 vs. tertile 1: HR 2.25 [95% CI 1.30-3.89]), but not among patients with preserved EF (HFpEF; tertile 3 vs. tertile 1: HR 0.68 [95% CI 0.38-1.21]); interaction-p = 0.02). Patients in the upper CA-125 tertile also showed the steepest estimated glomerular filtration rate decline over time (p-trend = 0.03). The effect of empagliflozin to reduce the risk of CV death or HF hospitalization appeared to be attenuated in those with lower baseline CA-125 levels (interaction-p-trend = 0.09). Across the range of EF in patients with chronic HF enrolled in the EMPEROR trials, the majority of whom did not have clinical evidence of congestion, CA-125 concentrations were not significantly associated with congestive signs or symptoms. CA-125 concentrations may predict HF hospitalization/CV death in patients with HFrEF, but not those with HFpEF. EMPEROR-Reduced (NCT03057977), EMPEROR-Preserved (NCT03057951).

Impact of preprocedural left ventricular systolic function on the safety and durability of percutaneous coronary intervention.

Percutaneous coronary intervention (PCI) is considered less safe in patients with reduced ejection fraction (EF), an impression based on older data. Whether the safety and durability of contemporary PCI are different in patients with reduced EF compared with normal EF patients is unknown. Patients from the BIOFLOW II, IV and V clinical trials were grouped as normal EF (≥50%) and reduced EF (30%-50%). Using multivariable logistic regression and cox proportional hazards regression, we determined relations of EF category with procedural safety (a composite of cardiac death, myocardial infarction, stroke and urgent coronary artery bypass grafting within 30 days of PCI) and target lesion failure (TLF; comprising cardiac death, target vessel myocardial infarction, target vessel revascularization within 1 year of PCI) respectively. In sensitivity analyses, we regrouped patients into EF < 45% and ≥55% and repeated the aforementioned analyses. In 1685 patients with normal EF (mean age 65 years; 27% women; mean EF 61%) and 259 with low EF (mean age 64 years; 17% women; mean EF 41%), 101 safety and 148 TLF events occurred. Compared with patients in the normal EF group, those with reduced EF had neither a statistically significant higher proportion of safety events, nor a higher multivariable-adjusted risk for such events. Similarly, patients with reduced EF and normal EF did not differ in terms of TLF event proportions or multivariable-adjusted risk for TLF. The results were similar in sensitivity analyses with EF groups redefined to create a 10% between-group EF separation. PCI safety and durability outcomes are similar in patients with mild-moderately reduced EF and normal EF.

A Single-Center Experience in Low Ejection Fraction Coronary Artery Bypass Surgery

Background. Coronary artery bypass graft (CABG) in patients with an ejection fraction (EF) ≤ 35% predisposes them to higher complications and mortality risks. Given the usually compromised status of other end organs in low EF patients, ONCAB, involving cardiopulmonary bypass (CPB) and aortic cross-clamping, might intuitively pose more complications than OPCAB. Objective. To explore short- and long-term outcomes between ONCAB and OPCAB procedures in patients with EF ≤ 35%. Methods. A retrospective and observational analysis was conducted in 196 patients with EF ≤ 35% who underwent ONCAB (n = 58) or OPCAB (n = 138) procedures at a single center between January 2015 and May 2023. Baseline characteristics were well matched using the stabilized inverse probability treatment weighted matching technique. Results. After matching, ONCAB and OPCAB had comparable 30-day mortality and 30-day cardiac mortality. OPCAB exhibited significantly shorter length of hospital and ICU stays, with a trend towards more discharges to home. Rates of composite complication and its individual components such as acute kidney injury, reoperation bleeding, stroke, pneumonia, GI disease, and atrial fibrillation were similar between the two groups. Rates of sepsis, liver dysfunction, and blood transfusion were significantly lower in the OPCAB group. As assessed by EF and LVDD, neither procedure showed superiority in improving cardiac function. Median follow-up time was 4.9 (interquartile range: 2.1–7.2) years. After matching, long-term overall survival (1, 3, 7 years) and cardiac mortality rates were comparable between OPCAB and ONCAB. Cumulative rates of cardiac arrest, heart failure, myocardial infarction (MI), atrial fibrillation (Afib), renal disease, and readmission (overall and cardiac) at 7 years were similar. Conclusion. This study demonstrates comparable short-term and long-term outcomes between ONCAB and OPCAB in patients with reduced EF, with OPCAB favoring faster recovery. OPCAB appears as a safer and equally effective option for low EF CABG patients. Larger samples and longer follow-ups are needed for conclusive clinical evidence.

Effect of sacubitril valsartan on heart failure with mid-range or preserved ejection fraction in patients on maintenance hemodialysis: real-world experience in a single-center, prospective study

BackgroundThis study aimed to evaluate the effect of sacubitril valsartan (SV) on heart failure (HF) hospitalization and cardiovascular mortality in patients on hemodialysis with HF with preserved ejection fraction (EF; HFpEF).MethodsThis single-center, prospective study enrolled 155 stable hemodialysis patients with EF > 40% who were followed up for 12 months. Fifty-nine patients were treated with SV; the others were matched for EF (57.89 ± 9.35 vs. 58.00 ± 11.82, P = 0.9) at a ratio of 1:1 and included as controls. The target dosage of SV was 200 mg/day.ResultsTwenty-three (23/155; 14.84%) had HF with mid-range EF (HFmrEF), while 132 (85.16%) had HFpEF. After SV treatment, the peak early diastolic transmitral flow velocity/peak early diastolic mitral annular tissue velocity(E/e’) improved from 17.19 ± 8.74 to 12.80 ± 5.52 (P = 0.006), the left ventricular (LV) end-diastolic diameter decreased from 53.14 ± 7.67 mm to 51.56 ± 7.44 mm (P = 0.03), and the LV mass index decreased from 165.7 ± 44.6 g/m2 to 154.8 ± 24.0 g/m2 (P = 0.02). LVEF (P = 0.08) and LV global longitudinal strain (P = 0.7) did not change significantly. The composite outcome of first and recurrent HF hospitalization or cardiovascular death showed no difference between group. However, the Acute Dialysis Quality Initiative Workgroup (ADQI) HF class improved in 39 and 15 patients and worsened in 1 and 11 patients in the SV and control groups, respectively (P < 0.001). Age, diabetes mellitus, and pulmonary arterial pressure were independent risk factors for HF hospitalization and cardiovascular mortality in patients with HFpEF.ConclusionsSV improved LV hypertrophy, diastolic function, and the ADQI class for HF; however, it failed to reduce the composite endpoints of HF hospitalization and cardiovascular disease-related mortality over 12 months of follow-up in patients on maintenance hemodialysis with EF of > 40%.

Natural increase in the efficiency of ablation of ventricular tachyarrhythmias using high-density mapping in patients with non-ischemic etiology

Objective This research is aimed at evaluating the efficacy and safety of ablation of ventricular tachyarrhythmias using high-density mapping in patients with non-ischemic etiology. Material and methods This study analyzed 60 patients with ventricular tachyarrhythmias, using diagnostic tools like electrocardiography and MRI. Treatment involved epicardial ablation following the E. Sosa method, with efficacy evaluated through the SF-36 survey and MRI. Success rates were categorized, and post-treatment care included troponin monitoring and aspirin. Data was analyzed using Excel and Statistika 11.0. Results Of the 60 patients, 30 underwent surgery at the City Cardiological Center in Almaty and 30 patients were operated on at the National Research Cardiac Surgery Center in Astana. Prior to surgery, all patients underwent a standard clinical diagnostic examination followed by ablation of ventricular tachyarrhythmias using high-density mapping. After six and 12 months from the beginning of the study, all patients underwent a follow-up examination, with an assessment of the effectiveness of the above treatment. After 12 months, follow-up examination of patients showed good results. Left ventricular ejection fraction in patients after 12 months increased from 47 ± 2.4 to 58 ± 4.5%. The end-diastolic diameter of the left ventricle decreased from 61.2 ± 2.31 to 50.1 ± 1.9 mm. Conclusion In summary, the study highlights the efficacy and safety of high-density mapping ablation in treating ventricular tachyarrhythmias, especially from the right ventricular outflow tract in patients with reduced left ventricular ejection fraction. The success rate of the procedure was 95%. This approach proves beneficial for patients unresponsive to antiarrhythmic therapy, enhancing both the quality of life and potentially reducing mortality in patients with ventricular arrhythmias.

Gender features of the relationship of ejection fractions in patients with heart failure in coronary heart disease with varying degrees of obesity

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Influence of left ventricular ejection fraction in patients undergoing contemporary pLVAD-supported high-risk PCI

Left ventricular (LV) systolic dysfunction worsens outcomes in patients undergoing percutaneous coronary intervention (PCI). The objective of this study, therefore, was to evaluate outcomes of pLVAD-supported high-risk PCI (HRPCI) patients according to LV ejection fraction (LVEF). Patients from the PROTECT III study undergoing pLVAD-supported HRPCI were stratified according to baseline LVEF: severe LV dysfunction (LVEF <30%), mild and moderate LV dysfunction (LVEF ≥30% to <50%), or preserved LV function (LVEF ≥50%). Major adverse cardiovascular and cerebrovascular events (MACCE: composite of all-cause death, myocardial infarction, stroke/transient ischemic attack, and repeat revascularization), and PCI-related complications were assessed at 90 days and mortality was assessed at 1-year. From March 2017 to March 2020, 940 patients had evaluable baseline LVEF recorded in the study database. Patients with preserved LV function were older, more frequently presented with myocardial infarction, and underwent more left main PCI and atherectomy. Immediate PCI-related coronary complications were infrequent (2.7%, overall), similar between groups (P=0.98), and not associated with LVEF. Unadjusted 90-day MACCE rates were similar among LVEF groups; however, as a continuous variable, LVEF was associated with both 90-day MACCE (adj.HR per 5% 0.89, 95% CI [0.80, 0.98], P=0.018) and 1-year mortality (adj.HR per 5% 0.84 [0.78, 0.90], P <0.0001). Patients who underwent pLVAD-supported HRPCI exhibited low incidence of PCI-related complications, regardless of baseline LVEF. However, LVEF was associated with 90-day MACCE and 1-year mortality.

Usefulness of Combined Ultrasound Assessment of E/e' Ratio, Pulmonary Pressure, and Cava Vein Status in Patients With Acute Heart Failure

Congestion is poorly investigated by ultrasound scans during acute heart failure (AHF) and systematic studies evaluating ultrasound indexes of cardiac pulmonary and systemic congestion during early hospital admission are lacking. We aimed to investigate the prevalence of ultrasound cardiac pulmonary and systemic congestion in a consecutive cohort of hospitalized patients with AHF, analyzing the relevance of each ultrasound congestion component (cardiac, pulmonary, and systemic) in predicting the risk of death and rehospitalization. This is a prospective research study of a single center that evaluates patients with an AHF diagnosis who are divided according to the left ventricular ejection fraction in patients with heart failure with preserved ejection fraction or reduced ejection fraction. We performed a complete bedside echocardiography and lung ultrasound analyses within the first 24hours of hospital admission. The ultrasound congestion score was preliminarily established by measuring the following parameters: cardiac congestion, which was defined as the contemporary presence of E/e' >15 and pulmonary systolic pressure >35mm Hg and the pulmonary congestion, defined as the total B-line number >25 at the lung ultrasound performed in 8 chest sites; moreover, the systemic congestion was defined if the inferior vena cava (IVC) was >21mm and if it was associated with a reduced inspiratory collapse >50%. We thoroughly assessed 230 patients and evaluated their results. Of these patients, 135 had heart failure with reduced ejection fraction and there were 95 patients with heart failure with preserved ejection fraction; 122 patients experienced adverse events during the 180-day follow-up. The receiver operating characteristic curve analysis showed that the tricuspid annular peak systolic excursion (TAPSE) (area under the curve [AUC] 0.34 [0.26 to 0.41], p <0.001), E/e' (AUC 0.62 [0.54 to 0.69], p=0.003), and IVC (AUC 0.70 [0.63 to 0.77], p <0.001) were all significantly related to poor prognosis detection. The univariate Cox regression analysis revealed that cardiac congestion in terms of E/e' and pulmonary systolic pressure (hazard ratio [HR] 1.49 [1.02 to 2.17], p=0.037), TAPSE (HR 0.90 [0.85 to 0.94], p <0.001), and systemic congestion (HR 2.64 [1.53 to 4.56], p <0.001) were all significantly related to the 180-day outcome. After adjustment for potential confounders, only TAPSE (HR 0.92 [0.88 to 0.98], p=0.005) and IVC (HR 1.92 [1.07 to 3.46], p=0.029) confirmed their prognostic role. The multivariable analysis of multiple congestion levels in terms of systemic plus cardiac (HR 1.54 [1.05 to 2.25], p=0.03), systemic plus pulmonary (HR 2.26 [1.47 to 3.47], p <0.001), and all 3 congestion features (HR 1.53 [1.06 to 2.23], p=0.02) revealed an incremental prognostic role for each additional determinant. In conclusion, among the ultrasound indexes of congestion, IVC and TAPSE are related to adverse prognosis, and the addition of pulmonary and cardiac congestion indexes increases the risk prediction accuracy. Our data confirmed that right ventricular dysfunction and systemic congestion are the most powerful predictive factors in AHF.

Прогностична цінність визначення sST2 та vWF у сироватці крові пацієнтів з артеріальною гіпертензією та на тлі коронавірусної хвороби

Background. The development of the coronavirus disease (COVID-19) occurs against the background of a systemic inflammatory response and can cause an adverse effect on the cardiovascular system. For better diagnosis of disease prognosis, and treatment, determination of sST2 and vWF is import- ant. These markers play an important role in the genesis of thrombosis in the pathophysiology of COVID- 19. Aim of the study. To analyze the prognostic value of sST2 and vWF levels in blood serum of patients with arterial hypertension (AH) and COVID-19. Materials and methods. 71 patients with AH and 16 practically healthy individuals, who were included in the control group, were examined. Patients were divided into two groups: group 1–36 patients with AH who were admit- ted to the hospital with a hypertensive crisis. Group 2 included 35 patients with AH and polysegmental pneumonia on the background of COVID-19. All patients underwent anthropometry, determination of biochemical blood tests, coagulogram, echocardiography (EchoCG), level of sST2 and vWF using ELISA in blood serum. Venous blood sampling was carried out on the 5-7th day after hospitalization against the background of the treatment according to current protocols. Results. The level of sST2 was the highest in the group of patients with AH and COVID-19, while the level of vWF was slightly lower than in patients with AH, which is probably due to the therapy with glucocorticosteroids and low molecular weight heparins. A positive correlation was found between the sST2 level and the size of the left atrium, left ventricle and ejection fraction in patients with AH, while a positive correlation with age was noted in the group of patients with AH and COVID-19 (p &lt; 0.05). Therefore, the level of sST2 was associated with structural changes in the myocardium, which are characteristic of AH and heart failure, which in turn are associated with age-related changes. A positive correlation was established between vWF and the thickness of the posterior wall of the left ventricle, the size of the right ventricle, in patients with AH, while in patients of the group 2, a correlation was found between vWF and the level of leukocytes (p &lt; 0.05). Conclusion. The levels of sST2 and vWF are important markers of disease severity in patients with cardiovascular pathology, as well as COVID-19. In patients with AH and in combination with COVID-19, a significant increase in the concentration of sST2 and vWF was observed compared to practically healthy individuals. Nevertheless, the presence of COVID-19 did not contribute to the emergence of significantly higher values of these markers compared to the group of individuals with AH, which is probably due to the specifics of the infectious pathology treatment.

Prognostic value of the severity of tricuspid regurgitation on Doppler echocardiography in patient with heart failure with reduced ejection fraction

Background: Tricuspid regurgitation severity has recently gained attention as a prognostic predictor of outcome events in patients who have leftsided heart failure. This study sought to define the relationship between tricuspid regurgitation and outcome in patients with heart failure with reduced ejection fraction. Objective: To investigate the characteristics of tricuspid regurgitation by Doppler echocardiography in patients with heart failure and reduced ejection fraction. To explore the association between the severity of tricuspid regurgitation and short-term mortality and hospital readmission in the study patients. Methods: 116 heart failurereduced ejection fraction patients were enrolled in this study, followed up, and evaluated after 3 - 6 months. Results: 48.3% of patients have mild tricuspid regurgitation, 33.6% of patients have moderate tricuspid regurgitation, and 18.1% of patients have severe tricuspid regurgitation. 47 events (40.5%) occurred: 11 deaths (9.5%) and 38 readmissions (32.8%). A Kaplan - Meier curve showed that the survival rate of the severe tricuspid regurgitation group was significantly lower than the group with mild to moderate tricuspid regurgitation. A multivariate Cox regression model identified that tricuspid regurgitation severity was an independent predictor of 3-to-6-month mortality or readmission (HR 1.94; CI 95% 1.30 - 2.91). Conclusion: Tricuspid regurgitation severity was an independent predictor of reduced ejection fraction in patients with heart failure.

Markers of heart failure with preserved ejection fraction in patients with unexplained dyspnea

Aim. To evaluate the prevalence of clinical, history, laboratory and ultrasound markers of heart failure with preserved ejection fraction (HFpEF) in patients with unexplained dyspnea, as well as to identify markers of structural myocardial remodeling in this group of patients.Material and methods. This retrospective study included 504 patients aged 18 to 84 years who were hospitalized from July 1, 2022 to March 31, 2023. Patients were divided into two groups depending on the presence of dyspnea. A comparative analysis of ultrasound parameters was carried out in order to identify myocardial structural remodeling.Results. A number of associated conditions and metabolic disorders, which are known to be risk factors for HFpEF, were detected more often in patients with unexplained dyspnea and myocardial remodeling. A model to determine the probability of structural remodeling was developed. Two most significant indicators were dyspnea and diabetes.Conclusion. This study demonstrated the relationship between unexplained dyspnea and structural myocardial remodeling. Identification of certain clinical and morphological signs of HFpEF in such patients requires apprehensive attitude and in-depth examination in order to rule out it.

The Safety and Efficacy of Human Umbilical Cord-Derived Mesenchymal Stem Cells in Patients With Heart Failure and Myocardial Infarction: A Meta-Analysis of Clinical Trials.

Evidence from preclinical and clinical studies suggests that human umbilical cord-derived mesenchymal stromal cells (HUC-MSCs) may be useful in treating heart failure and acute myocardial infarction (MI). However, the effects of stem cell therapy on patients with heart failure remain the subject of ongoing controversy, and the safety and effectiveness of HUC-MSCs therapy have not yet been proven. To date, there has been no systematic overview and meta-analysis of clinical studies using HUC-MSCs therapy for heart failure and MI. The purpose of this study is to assess the safety and efficacy of HUC-MSC therapy versus a placebo in patients with heart failure and MI. While preparing this systematic review and meta-analysis, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A computer literature search of PubMed was performed. We considered randomized controlled trials (RCTs) that reported data on the safety and efficacy of HUC-MSC transplantation in patients with heart failure and MI. Two investigators independently searched the literature, extracted data, and rated the quality of the included research. Pooled data were analyzed using the fixed-effect model or the random-effect model in Review Manager 5.3. The Cochrane risk of bias tool was used to assess the bias of included studies. The primary outcome was ejection fraction (EF), whereas the secondary outcomes were readmission and mortality rates. Three RCTs (201 patients) were included in this meta-analysis. The overall effect did not favor either of the two groups in terms of risk of readmission (risk ratio = 0.5, 95% confidence interval (CI) = 0.22-1.15, p = 0.10) as well as mortality rate (risk ratio = 0.44, 95% CI = 0.14-1.44, p = 0.18). However, there was an improvement in EF in patients who received HUC-MSCs compared to placebo after 12 months of transplantation (mean difference (MD) = 3.21, 95% CI = 2.91-3.51, p < 0.00001). At the six-month follow-up period, there was no significant improvement in EF (MD = 1.30, 95% CI = -1.94-4.54), p = 0.43), indicating that the duration of follow-up can shape the response to therapy. Our findings indicate that HUC-MSC transplantation can improve EF but has no meaningful effect on readmission or mortality rates. Existing evidence is insufficient to confirm the efficacy of HUC-MSCs for broader therapeutic applications. Therefore, additional double-blind RCTs with larger sample sizes are required.

A Phase 1b/2 Trial of Liposomal Cytarabine and Daunorubicin (CPX-351) in Intermediate to High-Risk Acute Myeloid Leukemia for Patients Who Have Failed an Initial Cycle of Induction Chemotherapy

Introduction Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy with a high rate of recurrence following standard chemotherapy that continues to have a poor prognosis. While there have been numerous recent advances in the treatment of AML, seven days of continuous infusion cytarabine combined with three doses of an anthracycline medication (7+3) remains the most common backbone treatment for younger (&amp;lt;60) patients. Following 7+3 treatment, patients are typically assessed by a bone marrow biopsy 14-21 days after initial treatment, and 20%-30% of patients will have persistent disease at this time. This residual disease is typically treated with an additional round of the same induction treatment at a full or slightly reduced dose. Unfortunately, a complete response (CR) following re-induction is infrequent in intermediate and high-risk AML patients (CR rates of 35% and 18%, respectively). We have performed mass cytometry studies of AML cell cycle state and find that in patients with residual disease at day 14-21 of induction, leukemia stem and progenitor cells have a low proliferative fraction. We hypothesize that this low rate of proliferation reduces the effectiveness of re-induction therapy and could be countered using CPX-351, which is FDA-approved for treatment of therapy-related AML and AML with myelodysplasia-related changes. CPX-351 is a formulation of cytarabine and daunorubicin in a liposomal structure at an optimal 5:1 molar ratio that has been shown to be preferentially absorbed by hematopoietic cells and to persist in serum and bone marrow for significantly longer than traditional 7+3 chemotherapy. We hypothesize that the unique properties of CPX-351 will better target quiescent leukemia stem and progenitor cells and we thus designed a phase 1b/2 study to determine the safety and efficacy of CPX-351 as re-induction treatment for patients with intermediate and high-risk AML with residual disease after a first round of induction. Patients and Methods Eight patients with intermediate or high-risk AML who had failed to achieve hypocellular marrow 14-21 days following initial treatment with traditional 7+3 cytarabine and daunorubicin were treated with CPX-351 re-induction in the phase 1b portion of the study with a CPX-351 dose of daunorubicin 44 mg/m 2 and cytarabine 100 mg/m 2 given two or three times every 48 hours. Concomitant midostaurin (days 8-21) was allowed for patients with FLT3 mutations (Patients #1 and #8). Four patients were ELN intermediate-risk and four adverse-risk; mean blast count before re-induction was 45%. Patients were assessed weekly for signs of toxicity and for treatment response. Samples were collected from bone marrow biopsies performed before and after treatment for correlative mass cytometry studies using a 50-antibody panel to determine cell cycle state, intracellular signaling markers, and DNA damage response. Results Of the eight patients treated to date, six received two doses of CPX-351 and two received three doses. Of the six patients receiving two doses, five achieved a morphologic CR (two with residual genetic alterations), and one patient achieved a CRi. Two patients received three doses of CPX-351, with one achieving a PR and the other MLFS. Five of the eight patients were able to proceed to an allogeneic stem cell transplant. Consistent with previous studies of CPX-351, treatment was well-tolerated, almost all grade 3 or 4 toxicities were due to cytopenias (including two DLTs for delayed count recovery) and the only significant drug-related non-hematologic toxicity was a decrease in cardiac ejection fraction in patient #1. All treated patients survived &amp;gt;150 days and all were able to receive additional AML-directed therapy or HSCT after CPX-351 treatment. Due to slow accrual, hematologic toxicity, and the 100% CR/CRi rate in the two-dose group, the trial was amended to use two doses for the phase 2 portion, and an additional study site was opened. Study accrual is ongoing with a target of 20 additional patients in the phase 2 portion. Conclusion This ongoing phase 1b/2 trial of CPX-351 (liposomal cytarabine and daunorubicin) as re-induction treatment for intermediate and high-risk AML has been safe and tolerable with early treatment outcomes that appear to be much better than reported historical controls. Correlative studies by mass cytometry will further establish the mechanistic reasons for the observed responses.

Early improvement of ejection fraction in patients with reduced ejection fraction after coronary artery bypass grafting

BackgroundDespite advancements in surgical technique, myocardial shield, and postoperative care, Coronary artery bypass grafting (CABG) among patients with reduced ejection fraction (EF) remains a surgical challenge due to their greater postoperative morbidity and mortality. This study aims to determine the early outcome of patients with reduced LVEF undergoing CABG and the improvement in the ejection fraction after revascularization. MethodsA total of 62 patients with impaired Left Ventricular (LV) systolic function (LVEF = 35–40 %) who underwent isolated On-pump CABG at the Department of Cardiothoracic Surgery in Assiut University Hospitals and who had met the listed inclusion and exclusion criteria were eligible for the study. Different variables (preoperative, intraoperative, and postoperative) were collected, studied, and compared. ResultsThe mean age of the patients was 57.81 ± 7.57 years, 66.1 % were male and 33.9 % were female. 44 (71.0%) patients were administered antegrade cardioplegia, whereas 18 (29.0%) patients were administered antegrade plus retrograde cardioplegia. Mean LVEF increased significantly from 37.97 ± 1.38% before surgery to 51.87 ± 3.54% after surgery (P ˂ 0.05). Post-operative low cardiac output syndrome occurred in 37 (59.7 %) of patients, pulmonary complications in 15 (24.2%), neurological complications in 10 (16.1%), sternal wound infection in 9 (14.5%), atrial fibrillation in 5 (8.1%) and acute kidney injury in 5 (8.1 %) of patients. In-hospital mortality was 16.1% (10 patients). ConclusionBased on the findings, CABG in patients with reduced preoperative LVEF improves the postoperative LVEF and NYHA functional class.