Increase In Ejection Fraction Research Articles

C77 EFFECT OF SACUBITRIL/VALSARTAN ON BOTH METABOLIC PARAMETER AND INSULIN RESISTANCE IN NON OBESE NON DIABETIC PATIENTS WITH HEART FAILURE

Abstract Background Sacubitril/Valsartan has been shown to improve mortality and reduce hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF). Moreover Sacubitril/Valsartan showed a significantly reduction in the HbA1c in diabetic patients. The effect of Sacubitril/Valsartan on metabolic parameter and insulin resistence in both, non obese and non diabetic patients, have not been previously described. Aim We evaluated the effects of the Sacubitril/Valsartan on both glycaemic and metabolic parameter, on HOMA–IR and on echocardiographic parameters in patients with HFrEF. Methods A total of 59 non obese and non diabetic patients with a diagnosis of HFrEF (EF < 35%) have been enrolled. All the patients underwent a complete anthropometrical evaluation, laboratory determinations (including fasting glucose, fasting insulin, HbA1c) and echocardiogram evaluation. Data analysis was made after 24 weeks of treatment. The insulin resistance has been assessed by HOMA–IR. Results Data analysis demostrated a significant reduction in fasting plasma glucose (111.4 + 11.5 vs 106 + 10 mg/dl, P = 0.03), fasting plasma insulin (13.6 + 5.9 vs 10.5 + 4.4 µUI/ml), HbA1c value (6.14 + 0.5% vs 5.9 + 0.3%, P < 0.01) and insulin resistance (HOMA–IR, 3.74 + 2.2 vs 2.7 + 2.1, P = 0.03). The echocardiogram evaluation showed a significant reduction of the end–diastolic left ventricular volume (168 + 44 vs 150 + 38 ml, P < 0.05), a no significant reduction of the end–systolic left ventricular volume (98 + 26 vs 88 + 22 ml, P = 0.07), a significant reduction of E/e1 ratio and an average 7.8% increase in ejection fraction (EF), from a mean baseline of 32.3 + 2.4 to 40.1 + 3.8% (P < 0.0001). No differences in interventricular septal (IVS) thickness, posterior wall (PW) thickness, A–wave, E–wave and E/A ratio have been observed. No differences in anthropometrical parameters (weight, body mass index, waist circumference) and blood pressure were observed. Conclusions Our data, even if preliminary, seem to indicate that sacubitril/valsartan might enhance glycaemic control and improve insulin resistance in non obese/non diabetic patients with HFrEF. Also, our data confirm that sacubitril/valsartan treatment is able to improve ejection fraction in HFrEF patients.

Thoracoscopic Implantation of Epicardial Left Ventricular Lead for Cardiac Resynchronization Therapy.

(1) Background: Limited data exist on the safety and efficacy of epicardial left ventricular (LV) lead placement using video-assisted thoracoscopic surgery (VATS) for cardiac resynchronization therapy (CRT). (2) Methods: Acute and post-discharge outcomes of CRT were compared between patients with epicardial LV leads (Epicardial-LV group, n = 13) and those with endocardial LV leads (Endocardial-LV group, n = 243). (3) Results: Epicardial LV leads were implanted via VATS alone (n = 8) or along with mini-thoracotomy (n = 5), for failed endocardial implantation (n = 11) or recurrent lead dislodgement (n = 2). All epicardial procedures under general anesthesia with one-lung ventilation were successfully completed in 1.0 ± 0.4 h without phrenic nerve stimulation. LV pacing thresholds in the epicardial-LV (1.5 ± 1.0 V) and endocardial-LV (1.3 ± 0.8 V) were comparable (p = 0.651). All patients were discharged alive post-VATS 8.8 ± 3.9 days. During the follow-up (34.3 ± 28.6 months), all patients with epicardial LV leads stayed alive except for one cardiac death post-CRT 14 months and one heart transplantation post-CRT 30 months. All epicardial LV leads maintained stable performance without dislodgement/significant changes in pacing threshold/impedance. LV lead dislodgement occurred only in endocardial-LV (7/243, 2.9%). Efficacy in both groups was comparable in terms of QRS narrowing, increase in LV ejection fraction, and survival free of cardiac death, or heart-failure-related hospitalization. (4) Conclusions: Epicardial LV lead placement using VATS can be a safe and effective alternative to endocardial implantation, with comparable acute and post-discharge outcomes achieved by both approaches.

Left bundle branch area pacing in patients with heart failure and right bundle branch block: Results from International LBBAP Collaborative-Study Group.

BackgroundCardiac resynchronization therapy (CRT) using biventricular pacing has limited efficacy in patients with heart failure (HF) and right bundle branch block (RBBB). Left bundle branch area pacing (LBBAP) is a novel physiologic pacing option.ObjectiveThe aim of the study was to assess the feasibility and outcomes of LBBAP in HF patients with RBBB and reduced left ventricular systolic function, and indication for CRT or ventricular pacing.MethodsLBBAP was attempted in patients with left ventricular ejection fraction (LVEF) <50%, RBBB, HF, and indications for CRT or ventricular pacing. Procedural, pacing, and electrocardiographic parameters; clinical response (no HF hospitalization and improvement in NYHA class); and echocardiographic response (≥5% increase in ejection fraction) to LBBAP were assessed.ResultsLBBAP was attempted in 121 patients and successful in 107 (88%). Patient characteristics included age 74 ± 12 years, female 25%, ischemic cardiomyopathy 49%, and ejection fraction 35% ± 9%. QRS axis at baseline was normal in 24%, left axis 63%, right axis 13%. LBBAP threshold and R-wave amplitudes were 0.8 ± 0.3 V @ 0.5 ms and 10 ± 9 mV at implant and remained stable during mean follow-up of 13 ± 8 months. LBBAP resulted in narrowing of QRS duration (156 ± 20 ms to 150 ± 24 ms (P = .01) with R-wave peak times in V6 of 85 ± 16 ms. LVEF improved from 35% ± 9% to 43% ± 12% (P < .01). Clinical and echocardiographic response was observed in 60% and 61% of patients, respectively. Female sex and reduction in QRS duration with LBBAP were predictive of echocardiographic response and super-response.ConclusionLBBAP is a feasible alternative to deliver CRT or physiologic ventricular pacing in patients with RBBB, HF, and LV dysfunction.

The effectiveness of structured telephone support in the late phase of rehabilitation at home in patients with myocardial revascularization

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Institute of Cardiology Background Nowadays remote monitoring seems to be a promising solution for the surveillance of patients with chronic heart disease. Purpose Assessing the impact of structured telephone support in the late phase of home rehabilitation in patients with myocardial revascularization. Methods The study included 180 patients (mean age- 63.0±0.4 years, 75.6% were men, mean follow up duration- 28.8±0.5 months), discharged after completing the cardiac rehabilitation program after myocardial revascularization by coronary artery bypass grafting (81.7%) or percutaneous coronary angioplasty (18.3%). All subjects were divided into 2 groups. STS-Gr included 84 patients (mean age- 63.2±0.7 years, 69.8%- men, mean follow up- 30.5±1.1 months). In this group remote monitoring was applied through Structured Telephone Support - patients being contacted by telephone regularly with the issuance of recommendations for the correction of treatment and risk factors. Non-STS-Gr included 96 patients (mean age- 62.8±0.5 years, 78% being men, mean follow up- 28.1±0.6 months), who were not remotely monitored. At the discharge from the hospital and at the end of the surveillance, all patients underwent echocardiographycal examination, assessement of NT-proBNP level and evaluation of quality of life by SF-36 questionnaire. Results The two groups of patients were comparable in terms of NYHA functional class of heart failure, cardiovascular and non-cardiovascular comorbidities, type of myocardial revascularization. At the follow up visit, in the general group was observed a significant increase in left ventricular ejection fraction by 4.3% (p&amp;lt;0.05) and a decrease in NT-proBNP level (-935.9±357.7, p&amp;lt;0.05), with similar dynamics in both groups. The rate of cardiovascular (CV) hospitalization in the general group during surveillance was 51.2%. In STS-Gr the CV-hospitalization rate was significantly lower compared to non-STS-Gr (47% vs 61.2%, p &amp;lt;0.01). The mortality rate in the general group was 7.8% and did not differ between STS-Gr and non-STS-Gr (7.5% vs 7.9%). The quality of life of patients in the general group attested a statistically important increase of the physical composite score compared to the initial data (+32.3, p&amp;lt;0.001). The physical composite score did not show significant differences between groups at the end of the study (STS-Gr-188.2±10.2, non-STS-Gr- 194.7±7.3). At the initial stage, the mental composite score was significantly lower in STS-Gr (198.6±14.8 vs 239.6±10.6, p&amp;lt;0.05). In contrast, at the end of surveillance, the mean value of the mental composite score in STS-Gr was higher than in non-STS-Gr (246.4±7.9 vs 224.9±5.7, respectively, p&amp;lt;0.05). Conclusions Structured telephone support has been shown to be effective in reducing the rate of cardiovascular hospitalization and improving the SF-36 mental composite score of patients in the late phase of home rehabilitation after myocardial revascularization, but has not influenced mortality.

Effects of oxymatrine and matrine on left ventricular contractility using pressure-volume relationship analysis in anesthetized rats

The purpose of this study was to investigate the effects of oxymatrine and matrine on integrated cardiac function in rats using pressure-volume loop analysis. A pressure-volume loop catheter was advanced into the left ventricle in anesthetized rats. Steady-state hemodynamic and load-independent parameters were recorded before and after oxymatrine or matrine injection. Oxymatrine (200 mg/kg) and matrine (50, 100 mg/kg) significantly increased the preload recruitable stroke work, slope of maximal systolic pressure increase (dP/dtmax) – end-diastolic volume relationship, end-systolic elastance and volume axis intercept (V0), which are load-independent parameters. Furthermore, the observed increased cardiac efficiency, along with the decreased ventricular arterial coupling, pressure volume area and potential energy, reflect improved mechanoenergetics in oxymatrine (200 mg/kg) and matrine (25, 50 or 100 mg/kg) treated rats respectively. In addition, matrine (25, 50 mg/kg) decreased end-systolic volume and end-diastolic volume, and increased ejection fraction; matrine at 100 mg/kg further decreased end-systolic volume, end-diastolic volume, stroke volume and stroke work, shortened the time constant of left ventricular pressure decay, and increased dP/dtmax, and heart rate. These results suggest that both oxymatrine and matrine enhance left ventricular contractility and improve cardiac mechanical function. As the dose of matrine was much lower than that of oxymatrine, the effect of matrine on myocardial contractility was stronger than that of oxymatrine.

Heart failure correction in patients with chronic renocardiac syndrome

Abstract Funding Acknowledgements Type of funding sources: None. In case of inadequate diagnosis and correction of the basic disease, which triggers the development of chronic heart failure (CHF), left ventricular (LV) remodeling leads to myocardial dysfunction and decompensation. Patients who entered the study EUCLID, demonstrated nephroprotective effect of lisinopril, which reduces the appearance of microalbuminuria. Target Study the effectiveness of lisinopril in the correction of CHF in patients with chronic renocardiac syndrome based on a study of LV diastolic function. Methods 59 patients with chronic renocardiac syndrome were investigated. All patients received lisinopril 10-20 mg per day. LV diastolic function was evaluated for Acuson Sequoia-512 before and after treatment. Results Changes in the kinetics of myocardial contractility were characterized by high amplitude of the interventricular septum, increased by 20%, end-systolic contractility index by 9.1%, the degree of shortening of the left ventricular size by 11.4%. A significant decrease in the rate of diastolic filling by passive relaxation (E) of 23.4% and a filling rate due to atrial contraction (A) at 20%. Violation of intracardiac hemodynamics as manifested by increasing the restrictive properties of the myocardium, as well as reducing the effectiveness of time and deceleration rate of early LV filling flow by 23.2 and 27.4%, increase and decrease of LV filling time active by reducing atrial 49.9% . Decreased as the time of isovolumic LV relaxation of the heart. During treatment with lisinopril was an increase in ejection fraction (EF) of 16.4% (p=0.004) or 53.2% (49.1, 58.9) to 61.9% (53.4, 68.0 ). The rate of mitral filling period of relaxation (Ve) increased from 0.53 m/s (0.43, 0.58) to 0.56 m/s (90.47, 0.63), or 5.7 % (p=0.039), while maintaining the diastolic filling due to atrial contraction. This has led to the restructuring of diastolic filling of the normal type, which was confirmed by the change of the reflectance upwards: Ratio of Ve/Va to treatment was 1.45 units. (1.02, 1.63), vand during treatment - 1.58 units (1.21, 1.90), or a 9.0% increase (p = 0.013). Equally, there was a decrease IVRT: from 61.9 ms (54.6, 78.8) to 56.4 ms (50.3, 72.4) or 8.9% (p=0.044). Conclusions Improvement of LV diastolic function is due to improved myocardial relaxation. ACE inhibitor (lisinopril), as a means of LV remodeling, reduce the degree of diastolic dysfunction by improving myocardial relaxation in patients with chronic renocardiac syndrome.

A humanized anti‐cocaine mAb blocks the cardiovascular effects of cocaine in rats

Cocaine use and abuse is associated with significant morbidity and mortality. Further, its use has significant effects on cardiovascular function in humans and has been associated with development of chest pain, myocardial ischemia and in rare cases cardiac death. Currently, the FDA has no approved pharmacotherapy for cocaine abuse. We have developed and generated a humanized anti‐cocaine monoclonal antibody (mAb), h2E2, which dramatically decreases brain cocaine concentrations by sequestering cocaine in the plasma. As h2E2 proceeds into clinical trials, a significant question remains as to whether the increased plasma cocaine concentrations, increased circulation time of cocaine, and the decrease in cocaine excretion into the urine affects cardiac function. Therefore, the objective of this study was to determine the dose, duration and effects of cocaine administration in the presence and absence of mAb h2E2 on echocardiographic variables in an in vivo rat model.Echocardiography was performed on Sprague‐Dawley rats with indwelling catheters using the Vevo 2100 ultrasound machine with a 20mHz probe. Baseline echocardiographic long axis M‐mode images were collected prior to an i.v. cocaine push and at subsequent time points thereafter. Initial studies determined the dose‐dependent effect of cocaine on cardiac parameters including ejection fraction (EF), heart rate (HR) and cardiac output (CO). The most significant increase in EF was observed with 1.68mg/kg cocaineHCl, which was then used in the subsequent experiments.As noted, cocaine administration increased EF, with inversely proportional changes in left ventricular systolic volume. In addition, cocaine produced an immediate decrease in HR, which did not fully return to baseline over the 45 minute time course, likely due to the anesthesia, as the saline control group demonstrated comparable effects. Similarly, cocaine caused an immediate decrease in CO, which normalized over time.Pre‐administration of a single equimolar dose of h2E2 significantly blunted the effect of cocaine on EF, including both the initial drop as well as the subsequent increase. At one week and one month post h2E2, there was no significant blunting of the increased in cocaine‐induced inotropy. However, the initial decrease in EF was still blocked after one week. The initial cocaine‐induced drop in HR was blocked by h2E2, even at 1 week post‐injection. h2E2 similarly blocked the increase in CO, however this effect was not detectable after 1 week or 1 month.In conclusion, there were no significant adverse cardiac effects noted with h2E2 administration and co‐administration with cocaine resulted in significant blunting of both cocaine’s inotropic and chronotropic effects. Elevated plasma cocaine concentrations are pharmacologically inert in the presence of h2E2.

An injectable and conductive TEMPOL/polypyrrole integrated peptide co-assembly hydrogel promotes functional maturation of cardiomyocytes for myocardial infarction repair

A cell-implantation strategy offers a promising paradigm for cardiac repair after myocardial infarction (MI). However, the hostile reactive oxygen species (ROS) microenvironment in infarcted zone hinders the survival and maturation of implanted cells and affects the ultimate therapeutic outcome. Besides, the generation of fibrosis scarring deprives the myocardium of electrical communications and induces cardiac dysfunction, eventually resulting in heart failure. Herein, an injectable ROS-scavenging/conductive composite hydrogel (R&C-Gel) was constructed via specific binding between conductive polypyrrole (PPy) and multi-component co-assembly peptides. Integrating antioxidant TEMPOL into the peptide endows it with strong ROS-eliminating ability, and the nanoengineering of polypyrrole (PPy) by wet milling facilitates PPy uniformly binding to the target T59 peptide in nanofibers . The thixotropy of co-assembly hydrogels confirmed by rheology and the macroporous structure of the R&C-Gel surface observed by SEM together suggest that the R&C-Gel could be an ideal vehicle for cell engraftment. The antioxidant ability and electroconductivity of the R&C-Gel were verified. In vitro experiments demonstrated that the R&C-Gel could efficiently remove ROS in cardiomyocytes and reduce apoptosis under oxygen-glucose deprivation (OGD) conditions. The rhythmic intracellular Ca 2+ puffs and expression of Cx-43 protein further proved the R&C-Gel could enhance the electrical and contractile performance of cardiomyocytes. Echocardiography and histological analysis convincingly revealed that the R&C-Gel-combined cardiomyocytes significantly promoted cardiac repair and rebuilt cardiac function, such as reducing apoptosis, accelerating gap junction formation , increasing ejection fraction , and decreasing the fibrosis area. This study provides new insight into the design and construction of multifunctional conductive hydrogels for cardiac tissue engineering . • An injectable composite hydrogel (R&C-Gel) is prepared via specific binding between conductive PPy and multi-component peptides. • Integrating the TEMPOL endows the R&C-Gel with strong ROS-eliminating ability to reduce the apoptosis of CMs under hypoxia. • Nanoengineering of vapor-polymerized PPy membrane to conductive NanoClusters facilitates PPy uniformly binding to nanofibers of R&C-gel. • R&C-Gel promotes rhythmic intracellular Ca 2+ puffs and the expression of Cx-43 protein in the maturation of CMs. • Injection of CMs@R&C-Gel is capable of restoring cardiac function post-MI.

Chronic Central Nervous System Leptin Infusion Improves Cardiac Function and Metabolism after Ischemia/Reperfusion Injury

Important adverse changes in cardiac energy metabolism occur after ischemia/reperfusion injury (I/R), contributing to the worsening of cardiac function and development of heart failure. We recently showed that leptin, via its actions on the central nervous system (CNS), improves left ventricular (LV) function in a model of heart failure induced by permanent ligation of the left anterior descending coronary artery (LAD). In the present study, we examined whether the CNS‐ effects of leptin protect against myocardial I/R injury, and if chronic intracerebroventricular (ICV) leptin infusion improves cardiac substrate utilization, assessed by markers of myocardial fatty acid (FA) and glucose oxidation, NAD+/NADH redox state and plasma levels of β‐hydroxybutyrate (β‐HOB). Male Wistar rats were instrumented with an ICV cannula in the brain lateral ventricle. After recovery and baseline assessment of cardiac function by echocardiography (ECHO), myocardial I/R was induced by temporary (60 min) ligation of the LAD. Vehicle (saline, 0.5 µL/hr) or leptin (0.62 µg/hr) was infused chronically for 28 days starting 20 min after reperfusion using osmotic minipumps connected to the ICV cannula. ECHO assessment of cardiac function was performed weekly. At the end of week 4, +dP/dtmax was accessed by LV catheterization. Hearts and plasma samples were collected for evaluation of CD36, PPAR‐δ, PDK4 and p‐PDH1/PDH1 by western blot and cardiac NAD+/NADH ratio and plasma levels of β‐OHB were measured by ELISA. Our results showed that ICV leptin treatment improved cardiac function as evidenced by increased ejection fraction 4 weeks after I/R (46±3 vs. 26±3 %) and +dP/dtmax (10387±1686 vs. 5022±442 mmHg/s) when compared with vehicle‐treated rats. ICV leptin infusion also significantly increased cardiac protein expression of CD36 (1.4±0.1 vs. 1.0±0.1 au), PPAR‐δ (1.8±0.1vs. 1.0±0.01 au), PDK4 (1.8±0.1 vs. 1.0±0.1 au) and p‐PDH1/PDH1 (2.2±0.3 vs. 1.0±0.2 au) when compared with vehicle‐treated animals. In addition, ICV leptin infusion increased cardiac NAD+/NADH ratio (6.8±2 vs. 1.02±0.3 pmol/µL) and reduced plasma levels of β‐OHB (18.2±3 vs. 62.8±7.0 nmol/µL). These results demonstrate that chronic ICV leptin infusion improves cardiac function following I/R injury and suggest that leptin’s CNS‐mediated cardioprotective effects may involve improved myocardial FA oxidation and NAD+/NADH redox state, reducing the reliance on ketone bodies (β‐OHB) as an energy source.

Exercise training improves cardiac function and regulates myocardial mitophagy differently in ischaemic and pressure‐overload heart failure mice

What is the central question of this study? What are the cardioprotective effects of different aerobic exercises on chronic heart failure with different aetiologies, and is mitophagy involved? What is the main finding and its importance? Moderate-intensity continuous training may be the 'optimum' modality for improving cardiac structure and function in ischaemic heart failure, while both moderate-intensity continuous training and high-intensity interval training were suitable for pressure-overload heart failure. Various mitophagy pathways, especially parkin-dependent pathways, participated in the protective effects of exercise on heart failure. The cardioprotective effects of different aerobic exercises on chronic heart failure with different aetiologies and whether mitophagy is involved remain elusive. In the current research, left anterior descending ligation and transverse aortic constriction surgeries were used to establish mouse models of heart failure, followed by 8weeks of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT). The results showed that for ischaemic heart failure MICT significantly improved ejection fraction (P<0.05) and fractional shortening (P<0.05), mitigated left ventricular end-systolic dimension (P<0.01), decreased brain natriuretic peptide (P<0.0001) and mitigated fibrosis (P<0.0001), while HIIT only decreased brain natriuretic peptide (P<0.0001) and fibrosis (P<0.0001). For pressure-overload heart failure, both MICT and HIIT significantly increased ejection fraction (P<0.0001) and fractional shortening (MICT: P<0.001, HIIT: P<0.0001), and reduced left ventricular end-diastolic and end-systolic dimensions, brain natriuretic peptide (P<0.0001), and fibrosis (MICT: P<0.01, HIIT: P<0.0001); HIIT was even better in reducing brain natriuretic peptide. Myocardial autophagy and mitophagy were compromised in heart failure, and the exercises improved myocardial autophagic flux and mitophagy inconsistently in heart failure with different aetiologies. Significant correlations were found between multiple mitophagy pathways and the cardioprotection of the exercises. Collectively, MICT may be the 'optimum' modality for ischaemic heart failure, while both MICT and HIIT (especially HIIT) were suitable for pressure-overload heart failure. Exercises differently improved myocardial autophagy/mitophagy, and multiple mitophagy-related pathways were closely implicated in cardioprotection of exercises for chronic heart failure.

Pregnancy and Progression of Cardiomyopathy in Women With LMNA Genotype-Positive.

BackgroundWe aimed to assess the association between number of pregnancies and long‐term progression of cardiac dysfunction, arrhythmias, and event‐free survival in women with pathogenic or likely pathogenic variants of gene encoding for Lamin A/C proteins ( LMNA+).Methods and ResultsWe retrospectively included consecutive women with LMNA+ and recorded pregnancy data. We collected echocardiographic data, occurrence of atrial fibrillation, atrioventricular block, sustained ventricular arrhythmias, and implantation of cardiac electronic devices (implantable cardioverter defibrillator/cardiac resynchronization therapy defibrillator). We analyzed retrospectively complications during pregnancy and the peripartum period.We included 89 women with LMNA+ (28% probands, age 41±16 years), of which 60 had experienced pregnancy. Follow‐up time was 5 [interquartile range, 3–9] years. We analyzed 452 repeated echocardiographic examinations. Number of pregnancies was not associated with increased long‐term risk of atrial fibrillation, atrioventricular block, sustained ventricular arrhythmias, or implantable cardioverter defibrillator/cardiac resynchronization therapy defibrillator implantation. Women with previous pregnancy and nulliparous women had a similar annual deterioration of left ventricular ejection fraction (−0.5/year versus −0.3/year, P=0.37) and similar increase of left ventricular end‐diastolic diameter (0.1/year versus 0.2/year, P=0.09). Number of pregnancies did not decrease survival free from death, left ventricular assist device, or need for cardiac transplantation. Arrhythmias occurred during 9% of pregnancies. No increase in maternal and fetal complications was observed.ConclusionsIn our cohort of women with LMNA+, pregnancy did not seem associated with long‐term adverse disease progression or event‐free survival. Likewise, women with LMNA+ generally well‐tolerated pregnancy, with a small proportion of patients experiencing arrhythmias.

Orthodromic and Antidromic Snare Techniques for Left Ventricular Lead Implantation in Cardiac Resynchronization Therapy

The snare technique can be used to overcome unsuitable cardiac venous anatomies for left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT) procedures. However, limited data exist regarding performance of the snare technique. We classified 262 patients undergoing CRT procedure into the snare (n = 20) or conventional group (n = 242) according to the LV lead implantation method. We compared the safety, efficacy, and composite outcome (all-cause death and heart failure readmission) at 3 years post-implant between the snare and conventional groups. In the snare group, all LV leads were implanted safely using orthodromic (n = 15) or antidromic (n = 5) techniques, and no immediate complications occurred including vessel perforation, tamponade, and lead dislodgement. During follow-up, LV lead threshold and impedance remained stable without requiring lead revision in the snare group. There were no significant between-group differences regarding LV ejection fraction increase (12 ± 13% vs. 12 ± 13%, p = 0.929) and LV end-systolic volume reduction (18 ± 48% vs. 28 ± 31%, p = 0.501). Both groups exhibited comparable CRT-response rates (62.5% vs. 60.6%, p = 1.000). The risk of primary outcome was not significantly different between the two groups (25.9% vs. 30.9%, p = 0.817). In patients who failed conventional LV lead implantation for CRT, the snare technique could be a safe and effective solution to overcome difficult coronary venous anatomy.

The effect of cardiac rehabilitation on left ventricular diastolic function in patients with percutaneous revascularization procedures

A lot of studies have demonstrated the the cardiac rehabilitation program enhanced results in ischemic patients and was associated with a reduction in mortality in the post-myocardial period. The mechanisms of these in certain aspects of cardiac function, either systolic or diastolic are not fully understood. These studies have reported an increase in stroke volume and left ventricular ejection fraction as well as a decrease in heart rate and diastolic arterial pressure. In the present study, we aimed to evaluate the effect of the cardiac rehabilitation program on patients who underwent PCI by measuring and comparing their diastolic function as well as ventricular dimensions with those of un-rehabilitated patients who underwent PCI.

Cardiac resynchronization therapy in patients with congenital heart disease and systemic right ventricle.

Although patients with systemic right ventricle (SRV) represent a significant proportion of patients with congenital heart disease (CHD) implanted with cardiac resynchronization therapy (CRT), there are limited and conflicting data in this specific patient group. We aimed to analyze outcomes of patients with SRV implanted with a CRT device. Data were analyzed from an observational, retrospective, multicenter cohort study including all patients with CHD implanted with a CRT device from 6 French centers from 2004 to 2020. Response to CRT was defined as an increase in systemic ventricular ejection fraction of ≥10% and/or an improvement in New York Heart Association functional class by at least 1 grade. A total of 85 patients with CHD were enrolled (mean age 39.8 ± 20.0 years; 55 [64.7%] males; 25 defibrillators [29.4%]), including 31 patients with SRV (36.5%) (mean age 43.9 ± 19.8 years; 16 [51.6%] males). The mean change in QRS duration after implantation was similar as compared with patients with systemic left ventricle (-46 ± 26 ms vs -35 ± 32 ms; P = .16). During a mean follow-up of 5.1 ± 3.5 years, late complications included 2 lead dysfunctions (6.5%), 3 CRT-related infections (9.7%), and 1 inappropriate implantable cardioverter-defibrillator shock (3.2%). The proportion of CRT responders at 6, 12, and 24 months were 82.6%, 80.0%, and 77.8% in patients with SRV vs 66.7%, 64.3%, and 69.6% in patients with systemic left ventricle (P = NS). In this multicenter cohort, one-third of patients with CHD implanted with a CRT device had SRV. CRT in patients with SRV was associated with a high rate of responders, comparable to that of patients with systemic left ventricle.

Determination of the influence of risk factors for coronary artery disease on the effectiveness of cardiac surgery by the method of myocardial scintigraphy

Background. Myocardial revascularization is a life-saving technology that not only increases life expectancy, reduces recurrences of myocardial infarction and repeated surgery, but also improves its quality in patients with coronary artery disease. Risk assessment, the complexity of coronary artery disease, the presence of comorbidities, the area of hibernating myocardium, the patient’s consent are the basis for choosing a method of treatment. Positive structural and functional changes of the myocardium (increase in the area of viable myocardium), restoration or improvement of left ventricular systolic function (increase in ejection fraction and decrease in end-diastolic volume), reduction of angina are the expected result of the surgical treatment. Purpose – determining the influence of risk factors for coronary heart disease on the outcome of surgical treatment by aorto-coronary artery bypass grafting with the help of diagnostic evaluation of myocardial scintigraphy. Materials and Methods. To achieve the clinical tasks, 62 patients with coronary artery disease were examined. The mean age of the subjects was (59.6 ± 8.2) years. Myocardial scintigraphy was performed in SPECT with ECG synchronization (Gated SPECT). 99mTc-MIBI with an activity of 555–740 MBq was used. Myocardial scintigraphy was performed over time of treatment (before and after coronary artery bypass grafting) according to the protocol – One Day Rest. Results. The influence of risk factors was assessed using dynamic and static integrated indicators. The dynamic integral indicator did not show statistically significant risk factors: smoking (p = 0.54), left ventricular contractility (p = 0.43), the presence of myocardial infarction in past (p = 0.4), heart failure stage (p = 0.53) and functional class of angina (p = 0.08). The static integrated indicator also did not show statistically significant effects from smoking (p = 0.13), left ventricular contractility (p = 0.58), the presence of myocardial infarction in past (p = 0.1), heart failure stage (p = 0.11) and functional class of angina (p = 0.6). Conclusions. The risk factors for coronary artery disease, such as: myocardial infarction in past, left ventricular contractility, heart failure stage, functional class of angina and smoking, in the study group of patients, had no reported effect on revascularization by the method of aorto-coronary artery bypass grafting (static and dynamic integrated indicators p &gt; 0.05).

Role and place of radiotherapy in neoadjuvant treatment of pancreatic cancer

Background. Myocardial revascularization is a life-saving technology, which contributes to increase in lifespan, reduction in myocardial infarction recurrences and repeated surgeries along with improved life quality of the patients with coronary artery disease (CAD). Estimation of the risks, severity of coronary bed lesion, presence of concomitant diseases, and area of hibernating myocardium, as well as patient’s agreement are the basis of treatment method selection. Positive structural and functional changes in myocardium (increase in area of viable myocardium), restoration or improvement of systolic function of left ventricle (increase in ejection fraction and decrease in end-diastolic volume), reduction of angina symptoms are the expected results from the surgical treatment.&#x0D; Purpose – to determine the influence of risk factors for coronary artery disease on the outcome of surgical treatment by the method of aorto-coronary artery bypass grafting with the help of diagnostic evaluation of myocardial scintigraphy parameters.&#x0D; Materials and methods. For the implementation of the clinical objectives, 62 patients with coronary artery disease were examined. The average age of the patients was 59.6 ± 8.2 years. Myocardial scintigraphy was performed in the SPECT mode with ECG synchronization (Gated SPECT). 99mTc-MIBI with an activity of 555-740 MBq was used. Myocardial scintigraphy was conducted over time of treatment (before and after coronary artery bypass grafting) according to One Day Rest protocol.&#x0D; Results. The influence of risk factors was assessed using dynamic and static integral indices. The dynamic integral index didn’t reveal statistically significant risk factors: smoking (p = 0.54), left ventricular contractility impairment (p = 0.43), history of myocardial infarction (p = 0.4), stage of heart failure (p = 0.53), and functional class of angina (p = 0.08). The static integral index didn’t reveal statistically significant influence as well: smoking (p = 0.13), left ventricular contractility impairment (p = 0.58), history of myocardial infarction (p = 0.1), stage of heart failure (p = 0.11), and functional class of angina (p = 0.6).&#x0D; Conclusions. The studied risk factors for coronary artery disease, namely: history of myocardial infarction, left ventricular contractility impairment, stage of heart failure, functional class of angina, and smoking in the study group of patients had no registered influence on the revascularization effect by coronary artery bypass grafting method (integrated static and dynamic indices p &gt; 0.05).

Effects of acute ischemia and hypoxia in young and adult calsequestrin (CSQ2) knock-out and wild-type mice

Calsequestrin (CSQ2) is the main Ca2+-binding protein in the sarcoplasmic reticulum of the mammalian heart. In order to understand the function of calsequestrin better, we compared two age groups (young: 4–5 months of age versus adult: 18 months of age) of CSQ2 knock-out mice (CSQ2(−/−)) and littermate wild-type mice (CSQ2(+/+)). Using echocardiography, in adult mice, the basal left ventricular ejection fraction and the spontaneous beating rate were lower in CSQ2(−/−) compared to CSQ2(+/+). The increase in ejection fraction by β-adrenergic stimulation (intraperitoneal injection of isoproterenol) was lower in adult CSQ2(−/−) versus adult CSQ2(+/+). After hypoxia in vitro (isolated atrial preparations) by gassing the organ bath buffer with 95% N2, force of contraction in electrically driven left atria increased to lower values in young CSQ2(−/−) than in young CSQ2(+/+). In addition, after global ischemia and reperfusion (buffer-perfused hearts according to Langendorff; 20-min ischemia and 15-min reperfusion), the rate of tension development was higher in young CSQ2(−/−) compared to young CSQ2(+/+). Finally, we evaluated signs of inflammation (immune cells, autoantibodies, and fibrosis). However, whereas no immunological alterations were found between all investigated groups, pronounced fibrosis was found in the ventricles of adult CSQ2(−/−) compared to all other groups. We suggest that in young mice, CSQ2 is important for cardiac performance especially in isolated cardiac preparations under conditions of impaired oxygen supply, but with differences between atrium and ventricle. Lack of CSQ2 leads age dependently to fibrosis and depressed cardiac performance in echocardiographic studies.

PERFORMED FACTORS IN THE REHABILITATION OF CARDIAC PATIENTS ON AN OUTPATIENT BASIS

In older people, adequate pharmacological tactics when using modern antihypertensive drugs and their combinations, which provide maximum cardiovascular protection, can increase the duration and improve the quality of life, significantly reduce the likelihood of complications. An increase in the tone of the sympathetic nervous system leads to biliary dyskinesia by hypokinetic type, an increase in blood pressure.&#x0D; The aim is to optimize the treatment of patients with high blood pressure, rhythm disturbances, to analyze the possibility of using Poltava's Bischofite mineral compound, dietary magnesium-mineral supplements Bisheffect, in the complex treatment of hypertension for internal use.&#x0D; Matherials and methods. 68 patients with arterial hypertension with concomitant hepatobiliary pathology, which was confirmed by clinical and instrumental research methods, were under observation. The patients’ mean age was 47.9 ± 2.9 years. The analysis of heart rate variability was carried out during a test with physical activity on a bicycle ergometer with “Cardiolab+” equipment (“XAI-Medica, Kharkiv, Ukraine). In addition, daily monitoring of blood pressure was carried out using the ABPM-04 - Meditech apparatus.&#x0D; Result. By the end of the first week of treatment, most patients (82.34%) noted a significant improvement in well-being. During bicycle ergometry, autonomic nervous system stabilisation, blood pressure normalisation, a decrease in the number of extrasystoles, the sleep and the stool normalisation were recorded. The reason for the failure of standard antiarrhythmic therapy in this group of patients was determined based on the studies. Such a problem was observed due to dysfunction of the autonomic nervous system, which is an integral companion of the pathology of the gastrointestinal tract. This concept involves expanding the diagnostic search and stimulates the search for new ways of rhythm disturbances treatment in the pathology of the gastrointestinal tract. Also, the indices of blood pressure variability have decreased. Average 24h blood pressure in patients on the 10th day of treatment decreased by an average of 25-35 mm Hg, and there was a decrease in cranialgia attacks and autonomic disorders. An increase in the blood ejection fraction by 34%, a heart's stroke volume by 19%, and a normalisation of the minute volume (p˂0.05) were revealed, which confirms the positive effect of bischofite-therapy in the complex treatment of cardiac pathology.&#x0D; Conclusions. Treatment with standard LEIT-therapy, use of dietary magnesium-mineral Bisheffect supplements resulted in the autonomic nervous system stabilisation, blood pressure normalisation, a decrease in the number of extrasystoles, the sleep and the stool normalisation, increased exercise tolerance.

Short‐Term Changes in Left and Right Ventricular Cardiac Magnetic Resonance Feature Tracking Strain Following Ferric Carboxymaltose in Patients With Heart Failure: A Substudy of the Myocardial‐IRON Trial

BackgroundThe mechanisms explaining the clinical benefits of ferric carboximaltose (FCM) in patients with heart failure, reduced or intermediate left ventricular ejection fraction, and iron deficiency remain not fully clarified. The Myocardial‐IRON trial showed short‐term cardiac magnetic resonance (CMR) changes suggesting myocardial iron repletion following administration of FCM but failed to find a significant increase in left ventricular ejection fraction in the whole sample. Conversely, the strain assessment could evaluate more specifically subtle changes in contractility. In this subanalysis, we aimed to evaluate the effect of FCM on the short‐term left and right ventricular CMR feature tracking derived strain.Methods and ResultsThis is a post hoc subanalysis of the double‐blind, placebo‐controlled, randomized clinical trial that enrolled 53 ambulatory patients with heart failure and left ventricular ejection fraction <50%, and iron deficiency [Myocardial‐IRON trial (NCT03398681)]. Three‐dimensional left and 2‐dimensional right ventricular CMR tracking strain (longitudinal, circumferential, and radial) changes were evaluated before, 7 and 30 days after randomization using linear mixed‐effect analysis. The median (interquartile range) age of the sample was 73 years (65–78), and 40 (75.5%) were men. At baseline, there were no significant differences in CMR feature tracking strain parameters across both treatment arms. At 7 days, the only global 3‐dimensional left ventricular circumferential strain was significantly higher in the FCM treatment‐arm (difference: −1.6%, P=0.001). At 30 days, and compared with placebo, global 3‐dimensional left ventricular strain parameters significantly improved in those allocated to FCM treatment‐arm [longitudinal (difference: −2.3%, P<0.001), circumferential (difference: −2.5%, P<0.001), and radial (difference: 4.2%, P=0.002)]. Likewise, significant improvements in global right ventricular strain parameters were found in the active arm at 30 days (longitudinal [difference: −3.3%, P=0.010], circumferential [difference: −4.5%, P<0.001], and radial [difference: 4.5%, P=0.027]).ConclusionsIn patients with stable heart failure, left ventricular ejection fraction <50%, and iron deficiency, treatment with FCM was associated with short‐term improvements in left and right ventricular function assessed by CMR feature tracking derived strain parameters.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT03398681.

Influence of catheter ablation for atrial fibrillation on atrial and ventricular functional mitral regurgitation.

AimsThe purpose of this study was to compare the impact of catheter ablation on cardiac structural reverse remodelling and atrial (AFMR) and ventricular (VFMR) functional mitral regurgitation (MR), and the long‐term prognosis of patients with AFMR and VFMR.Methods and resultsThe retrospective study included persistent AF patients who had AFMR (n = 136, left atrial (LA) volume index >30 mL/m2 and left ventricular (LV) ejection fraction ≥40%) or VFMR (n = 31, LV ejection fraction <40% or LV regional asynergy) and had undergone the initial AF ablation from April 2015 to December 2019. Baseline and 6 month follow‐up echocardiography were performed to assess MR, LA, and LV sizes. MR improvement after ablation was comparable in the AFMR (64%) and VFMR groups (52%, P = 0.20). Patients with AFMR improvement showed a greater decrease in left atrial volume after ablation than those without (amount of change: −11.4 ± 15.1 vs. −2.3 ± 21.1 mL/m2, P = 0.01). Patients with VFMR improvement showed a greater increase in LV ejection fraction than those without (amount of change: 28.5 ± 13.6% vs. 9.0 ± 14.8%, P = 0.001). The composite endpoint of all‐cause death and heart failure hospitalization during the 2 year follow‐up period was more frequently observed in the VFMR than in the AFMR group (22.6% vs. 3.7%, P < 0.0001). Patients with MR improvement after catheter ablation less frequently demonstrated the composite endpoint than those without (1.9% vs. 15.6%, P < 0.0001).ConclusionsAtrial functional mitral regurgitation and VFMR improvement after ablation were associated with atrial and ventricular reverse remodelling, respectively. It is possible that long‐term prognosis is better in patients with AFMR than with VFMR, and in those with MR improvement than in those without.