Heart Failure Functional Class Research Articles

Set of heart failure early mortality prevention methods

Heart failure is a common chronic disease with a poor prognosis that often ends in death. The research thus aims to thoroughly investigate ways in which the prognosis of heart failure could be improved. For this purpose, a 9-month study was conducted with a group of people who followed the Mediterranean diet, and the effects of this diet on the cardiovascular system and the state of the body as a whole were assessed. The study found that adherence to the principles of the Mediterranean diet improved the quality of life of patients, according to the quality-of-life questionnaire (the average score was 81.3 at the beginning of the study and 87 points at the end of the study), and the level of adherence to the Mediterranean diet in the study group increased from 30 points to 39.7, according to the MedDietScore (MDS) scale. There was also an improvement in appetite and sleep quality. A decrease in the average blood pressure in the group was recorded (from 140/95 to 137/88 mmHg). It was found that due to proper nutrition, the participant’s Body Mass Index (BMI) was reduced (from 31.2 kg/m2 to 29.6 kg/m2), and the percentage of overweight people in the study group was also reduced from 44% to 26%. It was noted that no deterioration in heart failure class or functional class was recorded during the study. The left ventricular ejection fraction remained unchanged.

Association of point-of-care testing for sST2 with clinical outcomes in patients hospitalized with heart failure.

This study aimed to investigate the association of soluble suppression of tumorigenicity-2 (sST2) measured by point-of-care testing assay with clinical outcomes in patients hospitalized with heart failure after adjusting for other predictors including N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT). A total of 1726 consecutive patients hospitalized with heart failure from July 2015 to December 2021 were enrolled. Baseline serum sST2 concentrations were measured by immunofluorescence assay. Primary endpoint event was the composite of all-cause death, heart transplantation, or left ventricular assist device. During the median follow-up duration of 682days, 434 patients (25.1%) suffered from primary endpoint events. Baseline sST2 remained an independent predictor of the primary endpoint event in patients hospitalized with heart failure after adjusting for other predictors including NT-proBNP and hs-cTnT [per log (unit) increase, adjusted hazard ratio (HR) (95% confidence interval) (CI): 1.20 (1.09, 1.32), P<0.001]. And baseline sST2 had a better prognostic value for patients with chronic decompensated heart failure [per log (unit) increase, adjusted HR (95% CI): 1.19 (1.07, 1.31)] than for those with acute new onset heart failure [per log (unit) increase, adjusted HR (95% CI): 1.28 (0.94, 1.75), P value for interaction <0.001], as well as a better prognostic value for patients with New York Heart Association (NYHA) functional class I-II [per log (unit) increase, adjusted HR (95% CI): 1.67 (1.11, 2.52)] than for those with NYHA functional class III-IV [per log (unit) increase, adjusted HR (95% CI): 1.18 (1.07, 1.31), P value for interaction <0.001]. Baseline sST2 was also a good predictor of the primary endpoint event in patients hospitalized with heart failure at 1month, 3months, 1year and 2years (area under the curve: 0.789, 0.775, 0.736 and 0.733, respectively), and the best cut-off values were 27.2ng/ml, 27.1ng/ml, 27.1ng/ml and 25.1ng/ml, respectively. Furthermore, baseline sST2 could provide additional prognostic value when added to baseline NT-proBNP and hs-cTnT (all P values <0.05). According to the category of elevated biomarkers (including NT-proBNP, hs-cTnT, and sST2), patients with three elevated biomarkers had a higher risk of the primary endpoint event compared with those with one or two elevated biomarkers (all P values <0.05). Baseline sST2 remained an independent predictor of adverse events after adjusting for other predictors including NT-proBNP and hs-cTnT, particularly in patients with chronic decompensated heart failure and NYHA functional class I-II. And in the basis of baseline NT-proBNP and hs-cTnT, adding baseline sST2 could provide additional prognostic value for patients hospitalized with heart failure.

Вибір блокатора ренін-ангіотензин-альдостеронової системи для лікування серцевої недостатності при гострому міокардиті

Вибір блокатора ренін-ангіотензин-альдостеронової системи для лікування серцевої недостатності при гострому міокардиті

Is the obesity paradox in outpatients with heart failure reduced ejection fraction real?

The obesity occurrence has achieved epidemic levels worldwide and several studies indicate a paradoxical similarity among obesity and the prognosis in heart failure (HF). The primary objective was to understand the association between body mass index (BMI) and heart failure with reduced ejection fraction (HFREF) of ischemic etiology in outpatients, using mortality as a parameter. The secondary objectives were to determine the differences in HF functional class, pharmacological therapy and evaluate the prognostic value of MAGGIC Score in this population. We analyzed 1,556 medical records from the HF outpatient clinic of a quaternary hospital and 242 were selected according to the criteria. Most were male, average age 62.6 (56-70), BMI 18.5-24.9 = 35.1%, 25-29.9 = 37.2%, 30-34.9 = 17.8%, 35-39.9 = 7%; BMI <18.5 and >40 groups were eliminated from the central analyzes because of scarce testing. BMI 30-34.9 and BMI 18.5-24.9 had the best prognosis, BMI 25-29.9 had an average performance, and BMI -39.9 group provided the worst outcome (p = 0.123). In the subcategory analysis, BMI 30-34.9 group had a better prognosis compared to the BMI 35-39.9 group (p = 0.033). In the multivariate analysis The MAGGIC score was not able to foretell mortality in this population according to BMI. In not hospitalized patients with HFREF of ischemic etiology, obesity was not a protective factor.

Multicenter registry and test bed for extended outpatient hemodynamic monitoring: the hemodynamic frontiers in heart failure (HF2) initiative

BackgroundHemodynamic Frontiers in Heart Failure (HF2) is a multicenter academic research consortium comprised of 14 US institutions with mature remote monitoring programs for ambulatory patients with heart failure (HF). The consortium developed a retrospective and prospective registry of patients implanted with a wireless pulmonary artery pressure (PAP) sensor.Goals/aimsHF2 registry collects demographic, clinical, laboratory, echocardiographic (ECHO), and hemodynamic data from patients with PAP sensors. The aims of HF2 are to advance understanding of HF and to accelerate development of novel diagnostic and therapeutic innovations.MethodsHF2 includes adult patients implanted with a PAP sensor as per FDA indications (New York Heart Association (NYHA) Class III HF functional class with a prior hospitalization, or patients with NYHA Class II or brain natriuretic peptide (BNP) elevation without hospitalization) at a HF2 member site between 1/1/19 to present. HF2 registry is maintained at University of Kansas Medical Center (KUMC). The registry was approved by the institutional review board (IRB) at all participating institutions with required data use agreements. Institutions report data into the electronic registry database using REDCap, housed at KUMC.ResultsThis initial data set includes 254 patients implanted from the start of 2019 until May 2023. At time of device implant, the cohort average age is 73 years old, 59.8% are male, 72% have NYHA Class III HF, 40% have left ventricular ejection fraction (LVEF) &amp;lt; 40%, 35% have LVEF &amp;gt; 50%, mean BNP is 560 pg/ml, mean N-Terminal pro-BNP (NTproBNP) is 5,490 pg/ml, mean creatinine is 1.65 mg/dl. Average baseline hemodynamics at device implant are right atrial pressure (RAP) of 11 mmHg, pulmonary artery systolic pressure (PASP) of 47 mmHg, pulmonary artery diastolic pressure (PADP) 21 mmHg, mean pulmonary artery pressure (mPAP) of 20 mmHg, pulmonary capillary wedge pressure (PCWP) of 19 mmHg, cardiac output (CO) of 5.3 L/min, and cardiac index (CI) of 2.5 L/min/m2.ConclusionA real-world registry of patients implanted with a PAP sensor enables long-term evaluation of hemodynamic and clinic outcomes in highly-phenotyped ambulatory HF patients, and creates a unique opportunity to validate and test novel diagnostic and therapeutic approaches to HF.

Clinical and echocardiographic findings in patients with COVID-19 across different severity levels.

Cardiovascular pathology can complicate the course of COVID-19. The study aimed to identify echocardiographic abnormalities and key prognostic factors influencing severe and fatal COVID-19 outcomes. This retrospective cohort study included clinical and echocardiogram data from 194 medical records of hospitalized patients with COVID-19: 100 moderate cases, 34 severe cases with favorable outcomes, and 60 severe cases with fatal outcomes. Severe patients with favorable outcomes had greater reductions in left ventricular systolic fraction of left ventricle compared to moderate cases (23.5% vs. 7.0%, respectively, p=0.008) and ejection fraction of left ventricle (14.7% vs. 3.0%, respectively, p=0.013), grade I diastolic dysfunction of the left ventricle (20.6% vs. 8.0%, respectively, p=0.044), and pulmonary hypertension (29.41% vs. 10.0%, respectively, p=0.006). Patients with fatal outcomes had a mean age of 67.1±1.51 years, chronic heart failure functional class II (58.3%), hypertension (50.0%), type 2 diabetes (43.3%), and obesity (33.3%). Compared to severe cases but with favorable outcomes, fatal cases had a greater decrease in left ventricular ejection fraction (36.7% vs. 14.7%, respectively, p=0.024), various types of myocardial dysfunction (51.7% vs. 29.4%, respectively, p=0.037) and a trend towards increased pulmonary hypertension (48.3% vs. 29.4%, respectively, p=0.074). Consequently, chronic heart failure class II, reduced left ventricular ejection fraction, various myocardial dysfunctions, and pulmonary hypertension emerged as key cardiac risk factors for severe disease progression and mortality in patients with COVID-19.

Atrial fibrillation in patients with dilated cardiomyopathy: prevalence, risk factors and prognostic significance

Aim. To study the epidemiological profile and long-term prognostic significance of atrial fibrillation (AF) as a risk factor for adverse clinical outcomes in patients with dilated cardiomyopathy (DCM).Material and methods. The study included 270 patients with DCM (206/76,3% men, age 47 [37; 56] years, left ventricular (LV) ejection fraction 29 [21; 35]%). The observation period was 6 years (Me 76 [57; 119] months). To assess the effect of AF on DCM prognosis, Kaplan-Meier curves and Cox regression of clinical outcomes, including cardiovascular death, heart transplantation, and ventricular assist device implantation, were analyzed.Results. Of 270 patients with DCM, paroxysmal AF was detected in 10 (3,7%) patients (initial, 5/1,85%; during the first follow-up year, 5/1,85%). After 5 years, another 65 (24,1%) individuals had AF (paroxysmal, persistent or permanent). Ventricular tachyarrhythmias were registered in 163 (60,4%) patients. Compared with patients maintaining sinus rhythm, patients with AF were older (51,4±10 vs 43,6±13 years, p=0,001) and had lower exercise tolerance (6-minute walk test: 379±45 vs 445±43 meters; p=0,0002) and a higher heart failure functional class (NYHA class III-IV: 38/50,7% vs 52/26,7%; χ2=13,6; p=0 ,0003). In patients with AF, initially more pronounced manifestations of right ventricular contractile dysfunction (TAPSE: 13,1±3,4 vs 15,5±4,6 mm; p=0,0001) and LV diastolic dysfunction (E/A: 2,9±1,5 vs 2,1±1,3; p=0,006; E/e' 15,6±6,9 vs 11,8±7,2; p=0,019), more dilated left atrium (left atrial volume index: 63,3±19 vs 50±18,7 ml/m2; p=0,006). During the 6-year median follow-up, AF was observed in 75 patients (0,46 new cases/100 patients/year). As a result of Cox regression analysis, AF as a time-dependent factor was identified as an independent predictor of cardiovascular death (hazard ratio 3,99; 95% confidence interval, 1,67-8,59; p=0,0001).Conclusion. AF, as one of the most common sustained atrial tachyarrhythmias in the population, demonstrated a lower prevalence (27,8%) in the DCM cohort compared to ventricular tachyarrhythmias (60,4%), but a high prognostic significance of the negative impact on the risk of fatal outcomes. The development of AF in patients with DCM is associated with a 4-fold increase in cardiovascular death risk over a 6-year period.

ИСХОДЫ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ У ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА: ПРОСПЕКТИВНОЕ 5-ЛЕТНЕЕ ИССЛЕДОВАНИЕ

Introduction. Epidemiology and trends in survival of patients with chronic heart failure have changed over the past decades. As an important reason for prognostic deviations is recognized, among other things, the steady worldwide increase in the prevalence of obesity and concomitant conditions associated with it, such as diabetes mellitus, arterial hypertension, and atrial fibrillation, especially in young patients with chronic heart failure, which creates the so- called survival paradox. The aim of the study is to assess the structure of 5-year outcomes in patients with ischemic heart failure and identify some new long-term prognosis markers (mortality and cardiovascular events). Materials and Methods. 313 patients with ischemic heart failure of functional class I-IV were examined. A clinical study was conducted, and 5-year prognosis endpoints were assessed (all-cause mortality, cardiovascular mortality, and non-fatal cardiovascular events). The composite endpoint included cardiovascular mortality and nonfatal cardiovascular events. Results. All-cause 5-year mortality was 28.1%, including the cardiovascular mortality of 24.6%. In patients of functional class III-IV chronic heart failure, the 5-year risk of death from any cause and cardiovascular death was higher than in class I-II patients. All-cause death, cardiovascular mortality, and the composite endpoint risks were higher in patients with reduced ejection fraction than in those with moderately reduced or reduced left ventricular ejection fraction. The risk of death within 5 years from all causes and cardiovascular death was higher in women with a body mass index of &lt;25 kg/m² and &gt;30 kg/m² than in those who were moderately overweight. Mortality from all causes was lower in functional class III-IV patients with some overweight than in those with a body mass index of &lt;25 kg/m² (p=0.03). With moderately reduced and reduced left ventricular ejection fraction, all-cause mortality and cardiovascular mortality were lower in overweight patients than in those with a body mass index of &lt;25 kg/m² (p=0.009 and p=0.022). In patients with heart failure with reduced left ventricular ejection fraction, their overweight was a protective factor for all-cause mortality (OR=0.07, CI: 0.001-0.76) as compared to those with a body mass index of &lt;25 kg/m²

The Role of Metabolic Syndrome in The Nature of Postinfarction Remodeling of The Heart in Patients with Chronic Heart Failure

The aim is to study of heart’s structure and hemodynamic indicators according to composition of metabolic syndrome components in the patient with chronic heart failure (CHF)functional class (FC) IIIII. 62 men-patient with cardiosclerosis after heart attack were examined by the way of echocardiography on CHF FC II-III (NYHA). According to metabolic syndrome components they are devided into 3 groups: 1 st group (n=20), patients without signs of metabolic syndrome; 2nd group (n=21) patients with combination of dyslipidemia (DLP), abdominal obesity (AO), arterial hypertenion (AG) and hypertriglyceridemia; 3rd group (n=21) with different combination of dyslipoproteinemia, diabetes and obesity also AG and hypertriglyceridemia. in CHF passed with metabolic syndrome is seen a clear sign of heart’s systolic and diastolic.the presence of metabolic syndrome in CHF also its progressing is the subject to be hypertrophy of left ventricle, breaking the transmitral blood flow, also thickening of barier between ventricles and left ventricle back thickness

#5434 EFFICACY OF SACUBITRIL/VALSARTAN IN MAINTENANCE HEMODIALYSIS PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION

Abstract Background and Aims Growing evidences have confirmed the effect of Sacubitril/Valsartan (SV) on hypertension and heart failure espacially EFrHF in general population. However, data on ARNI treatment in maintenance hemodialysis (MHD) patients with EfpHF are lacking. The present study was conducted to assess the efficacy and safety of sacubitril-valsartan in patients with HFpEF undergoing MHD. Method End-stage kidney disease (ESKD) patients undergoing MHD for more than 3 months with New York Heart Association (NYHA) class II–IV heart failure ejection fraction of 50% or higher, and elevated levels of N-terminal pro–B-type natriuretic peptide (NT-proBNP) were assigned to receive sacubitril-valsartan. Patients were followed up regularly after medication treatment. The alterations in clinical and biochemical parameters before and after taking sacubitril-valsartan (generally 50–200mg b.i.d) were investigated, and safety was also assessed. Results 120 patients were recruited in this study. Compared with baseline levels, NT-proBNP levels [7540.5 (3575.7–18373.0) vs. 4649.0 (2259.0–8187.0), P&amp;lt;0.001], systolic blood pressure[(157.8 ± 20.5) vs.(141.5 ± 16.8), P&amp;lt;0.001], diastolic blood pressure [(85.2 ± 14.9) vs.(78.5 ± 10.2), P&amp;lt;0.001], heart rate[(78.1 ± 9.0) vs.(74.5 ± 6.9), P&amp;lt;0.001], total cholesterol [4.7 ± 1.1 vs. 3.9 ± 1.3, P = 0.01] and Low Density Lipoprotein [2.4 ± 0.9 vs. 2.2 ± 1.1, P = 0.04] were markedly decreased after treatment with sacubitril-valsartan. The results of KCCQ scores[53.4 ± 16.1vs. 61.4 ± 15.7, P&amp;lt;0.001] and NYHA classification [P = 0.01] showed obviously improvement after a median follow-up of 13 months. None of the patients showed adverse drug reactions. Conclusion Sacubitril/valsartan treatment improves significantly quality of life, symptoms of heart failure, NT-ProBNP and NYHA functional class in patients with HFpEF undergoing hemodialysis. Sacubitril/valsartan was safe and well tolerated.

The course of chronic heart failure in patients after COVID-19 against the background of active cytomegalovirus infection

Background. A new coronavirus infection may be complicated in the post-COVID period by the development of adverse cardiovascular events associated with chronic heart failure.&#x0D; Aim. To study the features of the course of chronic heart failure in patients after COVID-19 infection against the background of active cytomegalovirus infection.&#x0D; Material and methods. The study included 102 patients with chronic heart failure with reduced and intermediate left ventricular ejection fractions, who underwent COVID-19 in mild and moderate forms. The control group consisted of 61 patients with chronic heart failure and no COVID-19. Within 6 months after the infection with COVID-19, the features of the course of chronic heart failure were assessed. Quantitative determination of deoxyribonucleic acid (DNA) of cytomegalovirus in blood plasma was carried out by polymerase chain reaction. To assess the risk of adverse events, the odds ratio (OR) with a 95% confidence interval (95% CI) was calculated. Quantitative data were presented as median and interquartile range (25th and 75th percentiles).&#x0D; Results. After coronavirus infection, the risk of an unfavorable course of chronic heart failure (OR=6.237; 95% CI=2.91113.362; p=0.001), hospitalization due to decompensation of chronic heart failure (OR=5.9; 95% CI=1.31326.504; p=0.033), an increase in the functional class of heart failure by 1 class or more (OR=4.19; 95% CI=1.63610.736; p=0.009), development of atrial fibrillation paroxysms (OR=3.832; 95% CI=1.38510.599, p=0.014), significantly increased. The number of copies of cytomegalovirus DNA in patients who underwent COVID-19 was significantly higher in the group of patients with an unfavorable course of chronic heart failure compared to the same group, in which patients did not tolerate COVID-19 2238.5 (1888.5; 2647.5) and 1411.5 (1112.5; 1684.5) copies/ml, respectively (p 0.001).&#x0D; Conclusion. Patients with chronic heart failure after 6 months of COVID-19 infection are at high risk of developing adverse cardiovascular events against the background of active cytomegalovirus infection.

Anaemia and Congestion in Heart Failure: Correlations and Prognostic Role

The aim of this study was to evaluate the relationship between anaemia and biomarkers of central/peripheral congestion in heart failure (HF) and the impact on mortality. We retrospectively evaluated 434 acute/chronic HF (AHF/CHF) patients. Anaemia was defined as haemoglobin levels <12 g/dL (women) or <13 g/dL (men). The brain natriuretic peptide (BNP) and hydration index (HI) were measured. The endpoint of the study was all-cause mortality. Anaemia occurred in 59% of patients with AHF and in 35% with CHF (p < 0.001) and showed a significant correlation with the NYHA functional class and renal function. BNP and HI were significantly higher in patients with anaemia than in those without anaemia. Independent predictors of anaemia included BNP, estimated creatinine clearance (eCrCL), and HI. The all-cause mortality rate was 21%, which was significantly higher in patients with anaemia than in those without anaemia (30% vs. 14%, p < 0.001; hazard ratio: 2.6). At multivariate Cox regression analysis, BNP, eCrCL, and HI were independent predictors for mortality (Hazard ratios: 1.0002, 0.97, and 1.05, respectively), while anaemia was not. Anaemia correlates with HF status, functional class, renal function, BNP, and HI. Anaemia was not an independent predictor for mortality, acting as a disease severity marker in congestive patients rather than as a predictor of death.

The Effect of Angiotensin Receptor and Neprilysin Inhibitors on Quality of Life in Patients with Heart Failure with Reduced Ejection Fraction and Functional Mitral Regurgitation

Aim. To compare the change in quality of life indicators and the main clinical and instrumental parameters in patients with chronic heart failure (CHF) and functional mitral regurgitation (FMR) under the influence of sacubitril/valsartan compared with valsartan in an outpatient practice.Material and Methods. The study included 90 patients with chronic FMR, who were observed for 12 months. They received sacubitril/valsartan or valsartan. Efficiency criteria were: the difference between groups in scores according to the Kansas questionnaire for patients with cardiomyopathy; MR degree parameters (change in effective regurgitation orifice area, vena contracta width, MR volume and MR fraction); indicators of the severity of myocardial remodeling (left ventricular EF; the level of N-terminal brain natriuretic propeptide), exercise tolerance based on a 6-minute walk test, a change in the functional class of heart failure according to NYHA.Results. In a treatment efficacy analysis, the Kansas City Cardiomyopathy Questionnaire–Overall Summary Score improved by 22.1 points in the sacubitril/valsartan group and by 4.5 points in the valsartan group (p&lt;0.001). EF, exercise tolerance, and the number of patients transitioning from NYHA functional class III to II increased in the sacubitril/valsartan group (p&lt;0.05). Also, in this group, the effective area of the regurgitation opening, the width of the vena contracta, the volume of regurgitation, the fraction of regurgitation, and the level of N-terminal brain natriuretic propeptide (p&lt;0.05) decreased more pronouncedly (p&lt;0.05).Conclusion. Compared with valsartan, treatment with sacubitril/valsartan leads to a significant improvement in the quality of life in patients with FMR and HF with reduced EF, which is largely associated with a change in NT-proBNP, echocardiographic characteristics of the severity of MR and the degree of myocardial remodeling.

Self-Care and Quality of Life Among Adult Patients With Heart Failure: Scoping Review.

Although self-care has a therapeutic effect on heart failure (HF), patients experience a marked reduction in physical and executive function, resulting in poor quality of life (QoL). A literature review revealed limited evidence regarding the possible relationship between self-care and QoL in HF patients. Therefore, this scoping review aimed to identify scientific evidence that examines the extent of self-care, QoL, and relationship between self-care and QoL in patients with HF. Full-text research published from March 23, 2010, to March 23, 2020, written in English, that had content on both self-care and QoL among adult patients with HF was included. A literature search of electronic databases and web searches was conducted for published articles. Four databases were used: MEDLINE, Scopus, Web of Science, and the Cochrane Library. Studies collected from Google and Google Scholar web searches were also included. Of 1,537 papers identified by the search, 12 were included. The reviewed studies included 3,127 patients. Ten articles used a cross-sectional study design, whereas the remaining articles used a longitudinal and quasi-experimental design. This review found that the extent of self-care practices among patients with HF was inadequate, a significant proportion of patients enrolled in the reviewed studies had a moderate QoL, and higher self-care practices were associated with a better QoL. Self-care behavior and QoL were affected by social support, sex, age, educational level, place of residence, illness knowledge, presence of comorbidities, and functional classification of HF. Self-care behavior was positively correlated with QoL in patients with HF. Self-care and QoL in these patients have been reported to be affected by several factors. Further research with a rigorous study design is recommended to investigate the influence of self-care practices on QoL in patients with HF.

Quality of Life and Type of Cardiac Resynchronization Therapy Device in Older Heart Failure Patients.

Background: Cardiac resynchronization therapy (CRT) improves quality of life (QOL) in heart failure (HF) patients with reduced ejection fraction. Clinicians may have difficulty choosing between CRT with a pacemaker (CRT-P) or a defibrillator (CRT-D) for older patients. CRT-P devices are smaller, have more battery longevity, are less prone to erosions or recalls, and do not deliver shocks. These factors may impact patients' QOL, but data on such comparisons are lacking. Objectives: We examined the impact of CRT-P versus CRT-D on the QOL of older (≥75 years) HF patients who qualified for implantable cardioverter defibrillator therapy. Settings/Subjects/Measurements: We enrolled 101 CRT recipients and assessed QOL at baseline and at six-month post-implant using the Short Form Health Survey (SF-36) and the Minnesota living with heart failure (MLHF) questionnaires. Results: The average age of enrolled patients was 81 years, 27% were women, and 40 received a CRT-P device. After adjusting for baseline QOL score, age, sex, HF functional class, and the occurrence of adverse events, we found no significant differences in QOL outcomes between CRT-P and CRT-D recipients based on either the subscales or the composite scores for the SF-36 or MLHF questionnaires at six-months post-implantation. Conclusions: Older CRT-P and CRT-D recipients report comparable QOL scores six months after device implantation. Larger cohort studies with longer follow-up are needed to accurately assess potential QOL differences between CRT-D and CRT-P recipients to guide clinical decision making and ensure the right balance of risk versus benefit in these patients. Appropriate goals-of-care discussions are the corner stone of clinical decision making regarding defibrillator therapy. As such, even as the data stand at present, there is a need for more deliberate referral of older patients with HF to Palliative Care Specialists, or to Cardiologists trained in Palliative Care Medicine. clinicaltrials.gov listing: NCT03031847.

Patients with congenital heart disease over the age of 60: experiences of a single tertiary centre

Abstract Background We are currently facing a shift in adult patients with congenital heart disease (ACHD) to older and more complex patients. The growing population of senior patients with congenital heart disease (CHD) is prone to acquired comorbidities. Purpose Purpose of our study was to identify the main comorbidities in ACHD patients ≥60 years. Methods 2726 patients had at least one visit at our ACHD centre between 2010 and 2021, 287 patients of them being 60 or older. Clinical data about the patients' last visit were obtained retrospectively from digital medical records. Based on the complexity of the CHD patients were classified as mild, moderate, and severe. Survival difference was analysed using the Kaplan-Meier method and the log rank test. Results Senior patients included in this study were predominantly female (73.2%) with the median age of 69 years. We included 287 patients with mild (47.4%), moderate (39.4%), and severe (13.2%) underlying heart disease. Median age at first visit in our centre was 60 years (IQR 54–67). Over the median follow-up time of 7.9 years (IQR: 3.2–13.2), 20 patients (7%) died with the incidence of 0.8 deaths/100 patient years. The most common complication in this populations were Heart failure (43.2%) and arrhythmia (12.5%). Meanwhile the highest prevalence of heart failure was seen in patients with Eisenmenger syndrome/Pulmonary Arterial Hypertension (84.8%), Tetralogy of Fallot patients had the highest prevalence of arrhythmias (77.8%). 51% of all patients had at least one cardiovascular risk factor (diabetes, hypertension, hyperlipidaemia, or chronic kidney disease). 42% of the patients underwent a non-coronary intervention over the age of 60. The highest mortality was seen in patients with severely complex lesions (p&amp;lt;0.002). As of the comorbidities, significantly higher mortality was observed in seniors with heart failure (p=0.001) or NYHA functional class III/IV (p&amp;lt;0.002). Conclusions Although the number of ACHD patients is growing constantly, the population of elderly patients with CHD is still mainly consists of patients with mild or moderate heart defects. Half of the patients had at least one cardiovascular risk factor by the age of 60. As expected, a significantly higher mortality was seen in those with severe heart defects. Funding Acknowledgement Type of funding sources: None.

Impact of remote monitoring in heart failure patients with cardiac implantable electronic devices during COVID-19 pandemic: a single center experience

BackgroundCoronavirus disease 2019 (COVID-19) had spread into a pandemic affecting healthcare providers worldwide. Heart failure patients with implanted cardiac devices require close follow-up in-spite of pandemic related healthcare restrictions.MethodsPatients were retrospectively registered and clinical outcomes were compared of 61 remote monitored (RMG) versus 71 conventionally (in-office only) followed (CFG) cardiac device implanted, heart failure patients. Follow-up length was 12 months, during the COVID-19 pandemic related intermittent insitutional restrictions. We used a specified heart failure detection algorithm in RMG. This investigation compared worsening heart failure-, arrhythmia- and device related adverse events as primary outcome and heart failure hospitalization rates as secondary outcome in the two patient groups.ResultsNo significant difference was observed in the primary composite end-point during the first 12 months of COVID-19 pandemic (p = 0.672).In RMG, patients who had worsening heart failure event had relative modest deterioration in heart failure functional class (p = 0.026), relative lower elevation of N terminal-pro BNP levels (p < 0.01) at in-office evaluation and were less hospitalized for worsening heart failure in the first 6 months of pandemic (p = 0.012) compared to CFG patients.ConclusionsSpecified remote monitoring alert-based detection algorithm and workflow in device implanted heart failure patients may potentially indicate early worsening in heart failure status. Preemptive adequate intervention may prevent further progression of deteriorating heart failure and thus prevent heart failure hospitalizations.

Expression of the β1-adrenergic receptor (ADRB1) gene in the myocardium and β-adrenergic reactivity of the body in patients with a history of myocardium infraction

β1-adrenergic receptors (β1-AR) directly affect on intracardiac hemodynamic and the ability of the heart to tolerate physical activity by regulating its inotropic and chronotropic functions. Severe hypersympathicotonia, specific to coronary artery disease (CAD) and chronic heart failure (HF), leads to impaired functioning of β1-AR. The aim of this research was to assess the expression level of the β1-AR ADRB1 gene in the myocardium, to evaluate the β-adrenergic reactivity of the membrane (β-ARM) of erythrocytes, and to analyze the association of these parameters with myocardial contractile dysfunction in patients with a myocardial infarction (MI) in the past and without it. The study included 126 patients with chronic CAD. Among the patients, 55.6 % had a history of MI at least 6 months ago. The expression of the ADRB1 gene was assessed using real-time polymerase chain reaction. With this purpose, we isolated RNA from the right atrial appendage, which was excised when a heart–lung machine was connected during a planned coronary bypass surgery. β-ARM was evaluated in 57 patients. This method is based on the fact of inhibition of hemolysis of erythrocytes, placed in a hyposmotic medium, in the presence of a β-blocker. Within the whole sample of patients, the expression of the ADRB1 gene is comparable in different functional classes of HF. There was no linear correlation between the expression of the ADRB1 gene and left ventricle ejection fraction (LVEF). In patients with a history of MI, the expression of the ADRB1 gene was elevated when compared to a group of patients without MI (p = 0.017). Patients with a history of MI had higher values of β-ARM than those without MI (p = 0.017). The reverse correlation between β-ARM and LVEF (r = -0,570, p = 0,002) was revealed in the group of patients without MI but not in the group of patients with a history of MI (r = -0,137, p = 0,479). In the sample of patients with chronic CAD, in the myocardium of subjects with a history of MI, the relative expression of ADRB1 gene was higher compared to the group of patients without MI. In patients with different functional classes (FC) of HF and with different ejection fraction, both with MI and without it, ADRB1 gene expression was comparable. In the group of patients with a history of MI, an increase in β-ARM was observed, i.e. decrease in the number or sensitivity of β-AR. Among patients without MI, an inverse correlation was found between β-ARM and LVEF.

Prognostic value of echocardiographic data in chronic heart failure patients

Background and Aims : Heart failure (HF) is one of the most common clinical syndrome worldwide, charasterised with high hospitalization and mortality. Echocardiography plays an important role in the diagnosis of HF. The aim of this study was evaluation of echocardiographic data and determine their prognostic significance in patients with different severity chronic HF.Results: The data was analysed among HF functional class, outcome, RVDD and EF quartiles. Statistical analysis was performed using IBM SPSS statistics 16.0. After 6 months follow up we investigated disease outcome. 10 patients died, from which 8 cases were cardiovascular (CV) mortality. A comparative analysis showed statistically significant increased level of RVDD (p <0.005) and RA (p<0.042) in mortality group, decreased level of total protein (p <0.000), albumin (p <0.000), total (p <0.012), LDL (p <0.039) and HDL (p <0.004) cholesterol, inflammatory markers ( MPO, hs-CRP) were statistically elevated. The association of EF with the disease outcome was not found.Conclusions: In chronic heart failure patients from the echocardiographic data of cardiac functional and structural characteristics, the right ventricular diastolic diameter and right atrium is an indicator of the poor outcome with increased systemic inflammatory parameters and protein-energy malnutrition. Background and Aims : Heart failure (HF) is one of the most common clinical syndrome worldwide, charasterised with high hospitalization and mortality. Echocardiography plays an important role in the diagnosis of HF. The aim of this study was evaluation of echocardiographic data and determine their prognostic significance in patients with different severity chronic HF. Results: The data was analysed among HF functional class, outcome, RVDD and EF quartiles. Statistical analysis was performed using IBM SPSS statistics 16.0. After 6 months follow up we investigated disease outcome. 10 patients died, from which 8 cases were cardiovascular (CV) mortality. A comparative analysis showed statistically significant increased level of RVDD (p <0.005) and RA (p<0.042) in mortality group, decreased level of total protein (p <0.000), albumin (p <0.000), total (p <0.012), LDL (p <0.039) and HDL (p <0.004) cholesterol, inflammatory markers ( MPO, hs-CRP) were statistically elevated. The association of EF with the disease outcome was not found. Conclusions: In chronic heart failure patients from the echocardiographic data of cardiac functional and structural characteristics, the right ventricular diastolic diameter and right atrium is an indicator of the poor outcome with increased systemic inflammatory parameters and protein-energy malnutrition.

Implication of inflammation on Coxsackie virus and Adenovirus receptor expression on cardiomyocytes and the role of platelets in patients with dilated cardiomyopathy

BackgroundCoxsackie Virus and Adenovirus Receptor (CXADR or CAR) is involved in the pathogenesis of inflammatory dilated cardiomyopathy (DCM). We aimed to examine the relationship of CAR expression on platelets and cardiomyocytes with virus persistence, local and systemic inflammation and platelet activity in patients with DCM. MethodsEndomyocardial biopsy (EMB) samples of 38 patients (mean age 39.5±11.3 years, 20 male) with DCM were analyzed for CAR expression, local inflammation grade by immunohistochemistry and virus persistence by real-time PCR. Platelet morphology was analyzed in all patients and 30 healthy subjects (HS) using scanning electron microscopy, platelet activity by light transmission aggregation, and CAR persistence by immunofluorescence. Platelets of 20 patients were analyzed for cytomegalovirus and herpes simplex virus 1-2 by immunofluorescence. Serum levels of tumor necrosis factor alpha (TNF α) and Interleukin-6 were assessed using ELISA in all studied subjects. ResultsCAR expression in EMB samples was related to the heart failure functional class and the level of IL-6. Platelets from DCM patients showed enhanced spontaneous and ADP induced aggregation. Platelets’ CAR expression was >4 fold higher in DCM than HS and was observed predominantly at sites of intercellular communications in microaggregates and leukocyte-platelet aggregates. CAR-positive patients showed significantly higher TNF-α and IL-6 serum levels in CAR-negative patients. Platelets of 6 (30%) DCM patients revealed the mature cytomegalovirus and herpes simplex viruses particles. ConclusionTight junction protein CAR may serve as a docking pin creating a new type of contact structure that could be responsible for signaling between neighboring cells in pathological conditions.