Left Ventricular End-systolic Dimension Research Articles

Effect of sacubitril–valsartan on left ventricular remodeling in patients with acute myocardial infarction after primary percutaneous coronary intervention: a systematic review and meta-analysis

BackgroundSacubitril–valsartan has been widely reported for reducing the risk of cardiovascular death and improving left ventricular remodeling in patients with heart failure (HF). However, the effect of sacubitril–valsartan in patients with acute myocardial infarction (AMI) remains controversial. Therefore, we conducted this meta-analysis to investigate whether sacubitril–valsartan could reverse left ventricular remodeling and reduce cardiovascular adverse events in AMI patients after primary percutaneous coronary intervention (PPCI).Materials and methodsTwo researchers independently retrieved the relevant literature from PubMed, Embase, The Cochrane Library, China National Knowledge Infrastructure (CNKI), and the Wanfang database. The retrieval time was limited from inception to 1 June 2023. Randomized controlled trials (RCTs) meeting the inclusion criteria were included and analyzed.ResultsIn total, 21 RCTs involving 2442 AMI patients who underwent PPCI for revascularization were included in this meta-analysis. The meta-analysis showed that compared with the angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), sacubitril–valsartan treatment in AMI patients after PPCI significantly reduced left ventricular end-diastolic dimension (LVEDD) (weighted mean difference (WMD) −3.11, 95%CI: −4.05∼−2.16, p < 0.001), left ventricular end-diastolic volume (LVEDV) (WMD −7.76, 95%CI: −12.24∼−3.27, p = 0.001), left ventricular end-systolic volume (LVESV) (WMD −6.80, 95%CI: −9.45∼−4.15, p < 0.001) and left ventricular end-systolic dimension (LVESD) (WMD −2.53, 95%CI: −5.30–0.24, p < 0.001). Subgroup analysis according to the dose of sacubitril–valsartan yielded a similar result. Meanwhile, PPCI patients using sacubitril–valsartan therapy showed lower risk of major adverse cardiac events (MACE) (OR = 0.36, 95%CI: 0.28–0.46, p < 0.001), myocardial reinfarction (OR = 0.54, 95%CI: 0.30–0.98, p = 0.041) and HF (OR = 0.35, 95%CI: 0.26–0.47, p < 0.001) without increasing the risk of renal insufficiency, hyperkalemia, or symptomatic hypotension. At the same time, the change of LV ejection fraction (LVEF) (WMD 3.91, 95%CI: 3.41–4.41, p < 0.001), 6 min walk test (6MWT) (WMD 43.56, 95%CI: 29.37–57.76, p < 0.001) and NT-proBNP level (WMD −130.27, 95%CI: −159.14∼−101.40, p < 0.001) were statistically significant.ConclusionIn conclusion, our meta-analysis indicates that compared with ACEI/ARB, sacubitril–valsartan may be superior to reverse left ventricular remodeling, improve cardiac function, and effectively reduce the risk of MACE, myocardial reinfarction, and HF in AMI patients after PPCI during follow-up without increasing the risk of adverse reactions including renal insufficiency, hyperkalemia, and symptomatic hypotension.

Clinical journey for patients with aortic regurgitation: A retrospective observational study from a multicenter database.

Data using real-world assessments of aortic regurgitation (AR) severity to identify rates of Heart Valve Team evaluation and aortic valve replacement (AVR), as well as mortality among untreated patients, are lacking. The present study assessed these trends in care and outcomes for real-world patients with documented AR. Using a deidentified data set (January 2018-March 2023) representing 1,002,853 patients >18 years of age from 25 US institutions participating in the egnite Database (egnite, Inc.) with appropriate permissions, patients were classified by AR severity in echocardiographic reports. Rates of evaluation by the Heart Valve Team, AVR, and all-cause mortality without AVR were examined using Kaplan-Meier estimates and compared using the log-rank test. Within the data set, 845,113 patients had AR severity documented. For moderate-to-severe or severe AR, respectively, 2-year rates (95% confidence interval) of evaluation by the Heart Valve Team (43.5% [41.7%-45.3%] and 65.4% [63.3%-67.4%]) and AVR (19.4% [17.6%-21.1%] and 46.5% [44.2%-48.8%]) were low. Mortality at 2 years without AVR increased with greater AR severity, up to 20.7% for severe AR (p < 0.001). In exploratory analyses, 2-year mortality for untreated patients with left ventricular end-systolic dimension index > 25 mm/m2 was similar for moderate (34.3% [29.2%-39.1%]) and severe (37.2% [24.9%-47.5%]) AR. Moderate or greater AR is associated with poor clinical outcomes among untreated patients at 2 years. Rates of Heart Valve Team evaluation and AVR were low for those with moderate or greater AR, suggesting that earlier referral to the Heart Valve Team could be beneficial.

Plasma microRNA-143 and microRNA-145 levels are elevated in patients with left ventricular dysfunction.

MicroRNA(miR)-143 and miR-145 are mainly expressed in vascular smooth muscle cells. However, the relationship between plasma miR-143 or miR-145 levels and the left ventricular (LV) function in patients with heart diseases remains unclear. Blood samples were taken from the antecubital vein in patients with heart diseases (n = 52), such as coronary artery disease, old myocardial infarction, cardiomyopathy, and valvular heart disease, and controls without heart diseases (n = 22). We measured plasma miR-143 and -145 levels by quantitative RT-PCR using TaqMan MicroRNA Assays and THUNDERBIRD Probe qPCR Mix. Plasma BNP levels were also measured. Echocardiography was performed to measure the LV ejection fraction (LVEF) and LV dilation. Plasma miR-143 and miR-145 levels were significantly higher in patients with heart diseases than in controls, respectively. Plasma miR-143 and miR-145 levels were significantly higher in patients with LVEF < 50% than in those with LVEF ≧ 50%, respectively. Plasma miR-143 and miR-145 levels were inversely correlated with LVEF, respectively. Plasma miR-143 and miR-145 levels were positively correlated with LV end-systolic dimension, respectively. Plasma miR-143 and -145 levels were positively correlated with plasma BNP levels, respectively. Plasma BNP levels were inversely correlated with LVEF. Plasma miR-143 and miR-145 levels are elevated in patients with LV dysfunction and may counteract LV dysfunction.

Application Evaluation of Esmolol Hydrochloride-Assisted Interventional Therapy on New-Onset Atrial Fibrillation in Patients with Severe Sepsis: A Retrospective Study

Objective: This study aims to explore the application effect of adjuvant therapy with esmolol hydrochloride on new-onset atrial fibrillation (NOAF) in patients with severe sepsis. Methods: Retrospective analysis was conducted on 170 patients with NOAF and severe sepsis admitted to our hospital from January 2022 to January 2023. After excluding eight patients who did not meet the inclusion criteria, the remaining 162 patients were included in the study. Based on different treatment methods, the patients were divided into the control group (n = 83, routine treatment) and the observation group (n = 79, esmolol hydrochloride in combination with routine treatment). The cardiac function indexes such as left atrial diameter, left ventricular end-diastolic dimension, left ventricular end-systolic dimension and left ventricular ejection fraction; left atrial wall tension-related indexes, including atrial natriuretic peptide, B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide; inflammatory factors, including a C-reactive protein, high-sensitivity C-reactive protein, interleukin-6 and procalcitonin and the incidence of adverse reactions were compared between the two groups. Statistical methods were used to process and compare the above-mentioned data and index results. Results: No significant difference was observed in cardiac function indexes, left atrial wall tension-related indexes and inflammatory factors in both groups before treatment (p &gt; 0.05). After treatment, the observation group had lower cardiac function indexes, left atrial wall tension-related indexes and inflammatory factors than the control group (p &lt; 0.05), and the incidence of adverse reactions in the two groups was similar (p &lt; 0.05). Conclusion: The adjuvant therapy with esmolol hydrochloride has a certain clinical effect on patients with severe sepsis and NOAF, which improves the cardiac function of such patients and reduces their inflammation levels up to a point, showing a clinical application value.

Prognostic significance of growth differentiation factor-15 across age in chronic heart failure.

Growth differentiation factor-15 (GDF15), a cytokine in the transforming growth factor family, is up-regulated in stress and inflammatory conditions and is elevated in patients with heart failure (HF). However, the age-specific attributes and prognostic significance of GDF15 across age remain unknown in chronic HF (CHF). Serum levels of GDF15 were examinedin 942 hypertensive patients (median 68years) with CHF from the SUPPORT trial across the four age groups [under 50 (n=73), 51-59 (n=158), 60-69 (n=296), and 70-79years (n=415)] and in the continuous spectrum. Clinical correlates of GDF15 were explored using the classic stepwise and LASSO (least absolute shrinkage and selection operator) regression approaches. Interaction terms with age were tested in the LASSO regression approach. The associations with the composite outcome of HF hospitalization or all-cause death were investigated across ages. Median GDF15 levels (pg/mL) increased along with aging, from 691 in under 50years to 855 in 51-59years, 1114 in 60-69years, and 1516 in 70-79years (trend P<0.001). Age, sex, systolic blood pressure, history of diabetes, ischaemic heart disease, left ventricular (LV) end-systolic dimension, LV ejection fraction, estimated glomerular filtration rate, haemoglobin, N-terminal pro-brain natriuretic peptide (NT-proBNP), troponin, C-reactive protein, and the use of angiotensin-converting enzyme inhibitors, diuretics, and statins were mutually selected as clinical covariates of GDF15. The LASSO regression analysis identified significant interactions between age and the history of diabetes and NT-proBNP, with particularly robust associations in patients aged between 60 and 70years. During the mean follow-up of 8.6years, 474 composite endpoints of HF hospitalization or death occurred. GDF15 was associated with a higher risk of HF hospitalization or all-cause death [adjusted hazard ratio 1.84 (95% confidence interval 1.45-2.33)], with a particularly heightened risk in patients aged around 70years (Pinteraction =0.0008). The model with GDF15 on top of other established risk factors yielded marginally higher C-statistics compared with the model without GDF15 (0.803 and 0.796, P=0.045). The additive value of GDF15 on top of other established risk factors appeared similar across ages. A universal cut-off value of 1400pg/mL performed well in discriminating between those with and without HF hospitalization or death. Some clinical correlates of GDF15 have an interaction with age. GDF15 is an important determinant of cardiovascular endpoints, particularly in patients aged around 70years. The additive value of GDF15 appeared consistent across ages, suggesting the use of a universal cut-off value.

Effects of Phase Ⅰ Cardiac Rehabilitation Combined with Cognitive Behavioural Therapy on Cardiac Function, Exercise Capacity and Mental Health in Patients after Aortic Valve Replacement: A Retrospective Study.

To explore the application effect of phase Ⅰ cardiac rehabilitation (CR-Ⅰ) combined with cognitive behavioural therapy (CBT) on patients after aortic valve replacement (AVR). This study retrospectively analysed the data of 441 patients after AVR in our hospital from January 2020 to May 2023. A total of 38 patients who did not meet the inclusion criteria were excluded. A total of 403 patients were included. In accordance with different postoperative management schemes, the included patients were divided into the reference group (n = 202, received CR-Ⅰ) and the observation group (n = 201, received CR-Ⅰ+CBT). The cardiac function, exercise capacity and mental health of the two groups were compared. Before management, both groups had no significant differences in left ventricular end diastolic diameter (LVEDD), left ventricular end systolic dimension (LVESD), left ventricular ejection fraction (LVEF) and six-minute walking test (6MWT) scores (p > 0.05). At discharge and 3 months after discharge, the observation group had significantly lower LVEDD and LVESD and remarkably higher LVEF and 6MWT scores than the reference group (p < 0.001). The proportions of autonomous activity in bed within 3-4 days after surgery, autonomous out-of-bed activity within 8-10 days after surgery and autonomous walking 200 m within 12-15 days after surgery were distinctly higher (p < 0.001) and the incidence of adverse reactions was overtly lower (p < 0.001) in the observation group than in the reference group. Before management, both groups had no significant difference in their scores on the State-Trait Anxiety Inventory (STAI) (p > 0.05). At discharge and 3 months after discharge, the observation group had lower STAI scores than the reference group (p < 0.001). CR-Ⅰ combined with CBT effectively improves the cardiac function, independent exercise capacity and mental health level of patients after AVR and provides a new direction for the formulation and selection of follow-up clinical management.

Sex-Specific Prognosis of Left Ventricular Size and Function Following Repair of Degenerative Mitral Regurgitation

BackgroundPrior studies have demonstrated worse long-term outcomes for women after surgery for severe mitral regurgitation (MR). The current Class I indications for surgery for severe degenerative MR use cutoffs of left ventricular end-systolic dimension (LVESD) and left ventricular ejection fraction (EF) that do not account for known sex-related differences. ObjectivesThe primary objective of this study was to assess long-term mortality following mitral valve repair in women compared with men on the basis of preoperative left ventricular systolic dimensions and EF. MethodsConsecutive patients who underwent isolated mitral valve repair for degenerative MR at a single institution between 1994 and 2016 were screened. Adjusted HRs for all-cause mortality were compared according to baseline LVESD, LVESD indexed to body surface area (LVESDi), and EF for men and women. ResultsAmong 4,589 patients, 1,825 were women (40%), and after a median follow-up period of 7.2 years, 344 patients (7.5%) had died. The risk for mortality for women increased from the baseline hazard at an LVESD of 3.6 cm, whereas an inflection point for increased risk with LVESD was not evident in men. Regarding LVESDi, the risk for women increased at 1.8 cm/m2 compared with 2.1 cm/m2 in men. For EF, women and men had a similar inflection point (58%); however, mortality was higher for women as EF decreased. ConclusionsAfter mitral valve repair, women have a higher risk for all-cause mortality at lower LVESD and LVESDi and higher EF. These results support consideration of sex-specific thresholds for LVESDi in surgical decision making for patients with severe MR.

The impact of empagliflozin and metformin on cardiac parameters in patients with mid-range ejection fraction heart failure without diabetes.

Heart failure (HF) remains a significant problem for healthcare systems, requiring the use of intervention and multimodal management strategies. We aimed to assess the short-term effect of empagliflozin (EMPA) and metformin on cardiac function parameters, including ventricular dimension-hypertrophy, septal thickness, ejection fraction (EF), and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in patients with HF and mildly reduced EF. A case-control study included 60 newly diagnosed patients with HF. Patients were divided into two groups: Group E received standard HF treatment (carvedilol, bumetanide, sacubitril-valsartan, spironolactone) plus EMPA 10 mg daily, and Group M received standard HF treatment plus metformin 500 mg daily. After three months of treatment, Group E had a significantly higher EF than Group M compared to initial measurements (a change of 9.2% versus 6.1%, respectively). We found similar results in the left ventricular end-systolic dimension (LVESD), with mean reductions of 0.72 mm for Group E and 0.23 mm for Group M. Regarding cardiac indicators, the level of NT-proBNP was considerably decreased in both groups. However, the reduction was significantly greater in group E than in group M compared to the initial level (mean reduction: 719.9 vs. 973.6, respectively). When combined with quadruple anti-heart failure therapy, metformin enhanced several echocardiographic parameters, showing effects similar to those of EMPA when used in the same treatment regimen. However, the benefits of EMPA were more pronounced, particularly regarding improvements in EF and LVESD.

Beneficial impact of cardiac heavy metal scavenger metallothionein in sepsis-provoked cardiac anomalies dependent upon regulation of endoplasmic reticulum stress and ferroptosis but not autophagy

Aims: Sepsis represents a profound proinflammatory response with a major contribution from oxidative injury. Here we evaluated possible impact of heavy metal scavenger metallothionein (MT) on endotoxin lipopolysaccharide (LPS)-induced oxidative stress, endoplasmic reticulum (ER) stress, autophagy, and ferroptosis enroute to myocardial injury along with interplay among these stress domains. Materials and methods: Echocardiographic, cardiomyocyte mechanical and intracellular Ca2+ responses were monitored in myocardia from WT and transgenic mice with cardiac-selective MT overexpression challenged with LPS. Oxidative stress, stress signaling (p38, ERK, JNK), ER stress, autophagy, and ferroptosis were scrutinized. Key findings: RNAseq analysis revealed discrepant patterns in ferroptosis between LPS-exposed and normal murine hearts. LPS insult enlarged LV end systolic dimension, suppressed fractional shortening, ejection fraction, maximal velocity of shortening/relengthening and peak shortening, as well as elongated relengthening along with dampened intracellular Ca2+ release and reuptake. In addition, LPS triggered oxidative stress (lowered glutathione/glutathione disulfide ratio and O2− production), activation of stress cascades (p38, ERK, JNK), ER stress (GRP78, PERK, Gadd153, and IRE1α), inflammation (TNFα and iNOS), unchecked autophagy (LCB3, Beclin-1 and Atg7), ferroptosis (GPx4 and SLC7A11) and interstitial fibrosis. Although MT overexpression itself did not reveal response on cardiac function, it attenuated or mitigated LPS-evoked alterations in echocardiographic, cardiomyocyte contractile and intracellular Ca2+ characteristics, O2− production, TNFα level, ER stress and ferroptosis (without affecting autophagy, elevated AMP/ATP ratio, and iNOS). In vitro evidence revealed beneficial effects of suppression of oxidative stress, ER stress and ferroptosis against LPS-elicited myocardial anomalies. Significance: These data strongly support the therapeutic promises of MT and ferroptosis in septic cardiomyopathy.

What Happens to Mild-to-Moderate Chronic Ischemic Mitral Regurgitation Following Isolated Coronary Artery Bypass Surgery?

Introduction: The aim of this study was to assess the efficacy of isolated coronary artery bypass grafting (CABG) on preoperatively existing mild-to-moderate chronic ischemic mitral regurgitation. Patients and Methods: A retrospective analysis was conducted on 30 patients who had coronary artery disease and chronic ischemic mitral regurgitation, and underwent isolated CABG at the Department of Cardiovascular Surgery, Kocaeli University, between January 2012 and February 2014. Preoperative demographic and clinical characteristics, as well as postoperative outcomes, were evaluated. The degree of IMR, left ventricular ejection fraction (LVEF), left ventricular end-systolic dimension (LVESD), left ventricular end-diastolic dimension (LVEDD), and left atrial dimension (LAD) were assessed preoperatively, and at the postoperative 12th month. Results: There was no mortality during the early postoperative period. There were statistically similar measurements for LVEF, LVESD, LVEDD, and LAD between preoperative and postoperative periods (p&gt; 0.05). However, a decrease in the degree of IMR was detected during the specified periods (p&lt; 0.05). Conclusion: Isolated CABG can be safely performed in patients with mild/moderate chronic ischemic mitral regurgitation. The efficacy of isolated CABG was demonstrated to improve the degree of mitral regurgitation in selected patients based on echocardiographic measurements.

Effectiveness of Qiliqiangxin Combined with Trimetazidine Hydrochloride Tablets in Treating Coronary Heart Disease with Concurrent Heart Failure: A Comparative Study

This study investigated the effect of combining qiliqiangxin with trimetazidine hydrochloride tablets in treating patients with coronary heart disease complicated by heart failure. A total of 158 patients were randomly divided into two groups: a control group with 79 patients who were given trimetazidine hydrochloride tablets and a study group, also comprising 79 patients who received qiliqiangxin capsules in addition to the tablets. Results showed that the study group had a higher total effective rate compared to the control group. After treatment, the study group exhibited a more significant decline in left ventricular end-systolic dimension and end-diastolic diameter, as well as a higher increase in left ventricular ejection fraction. Serum levels of N-terminal pro-B-type natriuretic peptide, cardiac troponin I, Angiotensin, interleukin-6, high-sensitivity C-reactive protein, and tumor necrosis factor-α were lower in the study group compared to the control group. Furthermore, the study group demonstrated a longer 6-minute walking distance and a lower incidence of adverse reactions. In conclusion, combining qiliqiangxin and trimetazidine hydrochloride tablets is highly effective and safe for treating coronary heart disease complicated with heart failure, improving clinical symptoms and heart function.

Dapagliflozin effect on functional mitral regurgitation and myocardial remodeling (DEFORM trial)

Abstract Background Functional mitral regurgitation (FMR) has already been demonstrated to lead to various adverse outcomes. However, the therapeutic effect of current guideline-directed medical therapy (GDMT) in FMR still remained limited. The purpose of this study was to assess the efficacy of sodium-glucose cotransporter 2 (SGLT-2) inhibitor dapagliflozin in reducing the extent of mitral regurgitation and myocardial remodeling in FMR patients. Methods In this prospective, randomized, parallel controlled trial, we randomly assigned 104 patients with moderate or severe FMR in a 1:1 ratio to receive either dapagliflozin 10mg once daily or not in addition to GDMT for FMR and follow-up for 12 weeks. The primary outcome was the change in effective regurgitant orifice area (EROA) of mitral regurgitation. Secondary outcomes included changes in regurgitant volume (RV), left atrial dimension (LAD), left ventricular end-systolic dimension (LVESd), left ventricular end-diastolic dimension (LVEDd), left ventricular ejection fraction (LVEF) and E/e’ ratio. Furthermore, we additionally compared the occurrence rate of hospitalization for heart failure or cardiac death between groups. Results Dapagliflozin was associated with a significant reduction in EROA of FMR (-0.074±0.099 vs -0.030±0.058 cm2for dapagliflozin vs. control, P=0.008). Dapagliflozin was also associated with significant reduction of RV (-9.08±15.27 vs. -2.98±9.28 ml for dapagliflozin vs. control, P=0.017), LAD (-2.45±4.44 vs. -0.36±3.08 mm for dapagliflozin vs. control, P=0.007) and E/e’ ratio (-5.88±7.41 vs -1.98±7.63 for dapagliflozin vs. control, P=0.011), and improvement in LVEF (6.57±10.10 vs. 1.92±9.57 for dapagliflozin vs. control, P=0.017). There were no significant differences in the changes of LVESd (P=0.662) and LVEDd (P=0.677) between groups. Hospitalization for heart failure occurred in 6 patients of dapagliflozin group (11.5%) and 10 patients of control group (19.2%) (log-rank test, P=0.257), and 1 patient in dapagliflozin group (1.9%) and 2 patients in control group (3.8%) had cardiac death during the 12-week follow-up (log-rank test, P=0.552). Conclusion Dapagliflozin could further reduce the extent of mitral regurgitation and improve myocardial remodeling in FMR patients based on the current GDMT. Our findings suggest that SGLT-2 inhibitors might be considered for GDMT of patients with moderate or severe FMR.

Functional mitral regurgitation and ventricular arrhythmias in patients with cardiac resynchronization therapy

Abstract Introduction In patients with heart failure (HF), the occurrence of ventricular arrhythmias (VAs) is associated with prognosis, and advanced HF can cause VAs. In HF patients developed moderate to severe functional mitral regurgitation (FMR), a transcatheter mitral valve repair therapy has significantly reduced the hospitalization and mortality rates compared to guideline-directed medical therapy. Although the mechanisms of arrhythmias are multiple, it is unclear whether FMR is involved in the development of VAs advanced HF patients. Methods and results We retrospectively examined 176 cardiac resynchronization therapy (CRT) patients (78% men, median age 67 years) without FMR before CRT implanted between 2010 and 2018. Worsening FMR was defined as developing moderate to severe FMR after CRT. During median follow-up of 40 (quartile range, 23-60) months, worsening FMR was detected in 26 (15%) patients at a median of 30 (quartile range, 12–75) months after CRT implantation. There was no difference in age, New York Heart Association functional class, QRS width before CRT and the rate of responders between patients with and without worsening FMR. Patients with worsening FMR had a tendency of larger left ventricular end-systolic dimension (58 [53-68] vs. 53 [47-60] mm, p&amp;lt;0.10), a significantly higher rate of female (38% vs. 19%, p&amp;lt;0.05) and a significantly larger left atrial volume index (LAVI) (63 [43-81] vs. 48 [35-62] ml/m2, p&amp;lt;0.05). By multivariate logistic regression analysis, female gender (odds ratio 4.3) and baseline LAVI (odds ratio 1.04 per a ml/m2 increase) were independent factors associated with worsening FMR. There was a significantly higher incidence of HF hospitalization (50% vs 15%, log-rank P&amp;lt;0.05) (Figure 1) and a higher incidence of VAs, defined as sustained ventricular tachyarrhythmias requiring implantable-cardioverter defibrillator therapy or external defibrillation, in patients with worsening FMR than patients without worsening FMR (65% vs 38%, log-rank P&amp;lt;0.05) (Figure 2). Multivariate analysis showed that worsening FMR was independently associated with the development of VAs (hazard ratio 2.77, 95% confidence interval 1.13-6.83). Conclusions In patients with HF and CRT, female gender and baseline LAVI were associated with worsening FMR after CRT. We need to pay attention to changes in the FMR that can be associated with developing VAs after CRT implantation.

Effect of Telehealth Services on Mitral and Tricuspid Regurgitation Progression: Retrospective Study.

Mitral regurgitation (MR) and tricuspid regurgitation (TR) are common cardiac conditions with high mortality risks, which can be improved through early intervention. Telehealth services, which allow for remote monitoring of patient conditions, have been proven to improve the health management of chronic diseases, but the effects on MR and TR progression are unknown. This study aimed to explore whether patients receiving telehealth services have less MR and TR progression compared with a control group. We also aimed to identify the determinants of MR and TR progression. This single-center retrospective study conducted at the National Taiwan University Hospital compared MR and TR progression (defined as either progression to moderate or greater MR and TR or MR and TR progression by ≥2 grades during the study period) between the telehealth and control groups. Patients had a minimum of 2 transthoracic echocardiograms at least 6 months apart; baseline mild-moderate MR and TR or lower; and no prior surgeries on the mitral or tricuspid valve. Telehealth patients were defined as those who received telehealth services for at least 28 days within 3 months of baseline. Basic demographics, baseline blood pressure measurements, prescribed medication, and Charlson Comorbidity Index components were obtained for all patients. A total of 1081 patients (n=226 in the telehealth group and n=855 in the control group) were included in the study analyses. The telehealth group showed significantly lower baseline systolic blood pressure (P<.001), higher Charlson Comorbidity Index (P=.02), higher prevalence of prior myocardial infarction (P=.01) and heart failure (P<.001), higher beta-blocker (P=.03) and diuretic (P=.04) use, and lower nitrate use (P=.04). Both groups showed similar cardiac remodeling conditions at baseline. Telehealth was found to be neutral for both MR (hazard ratio 1.10, 95% CI 0.80-1.52; P=.52) and TR (hazard ratio 1.27, 95% CI 0.92-1.74; P=.14) progression. Determinants for moderate or greater MR progression included older age, female sex, diuretic use, larger left atrial dimension, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, and lower left ventricular ejection fraction. Determinants of moderate or greater TR progression included older age, female sex, diuretic use, presence of atrial fibrillation, LA dimension, left ventricular end-systolic dimension, and lower left ventricular ejection fraction; statin use was found to be protective. This is the first study to assess the association between telehealth services and the progression of MR and TR. Telehealth patients, who had more comorbidities, displayed similar MR and TR progression versus control patients, indicating that telehealth may slow MR and TR progression. Determinants of MR and TR progression included easy-to-measure traditional echo parameters of cardiac function, older age, female sex, and atrial fibrillation, which can be incorporated into a telehealth platform and advanced alert system, improving patient outcomes through personalized care.

Effects of comprehensive functional nursing on functional recovery and quality of life in patients with spinal cord injury.

This study evaluated the effects of comprehensive functional nursing on functional recovery and quality of life in patients with spinal cord injuries (SCIs). A total of 214 patients with SCIs treated in our hospital from October 2019 to October 2021 were included in the retrospective analysis and divided into a general care group (n = 107) and a comprehensive care group (n = 107), based on the care that they received. Patients in the general care group received general functional nursing, whereas those in the comprehensive care group received a comprehensive functional nursing intervention. The Rivermead Mobility Index (RMI), Barthel Index (BI), and Berg Balance Score (BBS) were used to evaluate patient neurobehavioral ability before and after nursing. Changes in cardiopulmonary function indexes, left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD), vital capacity (VC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, and maximal voluntary ventilation (MVV) were measured before and after nursing. The number of micturition, maximum micturition volume, bladder volume, residual urine volume, and lower urinary tract symptom (LUTS) score were recorded, and the improvement in bladder function were measured before and after nursing. The Hamilton Anxiety Scale (HAMA) and Beck Depression Inventory (BDI) scores were used to evaluate patients' emotional state. After nursing, the RMI, BI, BBS score, FEV1, FEV1/FVC, MVV, maximum micturition volume, bladder volume, and SF-36 scores of the comprehensive care group were significantly higher than those of the general care group, and the LVEDD, LVESD, micturition time, residual urine volume, and LUTS, HAMA, and BDI scores of the comprehensive care group were significantly lower than those of the general care group. In patients with SCIs, comprehensive functional nursing can promote the recovery of neurocognition, bladder function, and cardiorespiratory function, and improve their quality of life. Comprehensive functional nursing is worthy of clinical application.

Risk Factors and Outcomes With Progressive Mitral Annular Calcification.

Background Mitral annular calcification (MAC) is a chronic degenerative process that may progress. This study aimed to investigate associating factors and clinical implications of MAC progression. Methods and Results Among 560 patients with MAC identified by transthoracic echocardiography between January 2012 and June 2016, 138 patients (mean±SD age 72.7±10.2 years, 73 women) with mild or moderate MAC who received follow-up examination within 18 to 36 months were retrospectively analyzed. Progressive MAC was defined as hemodynamic or structural profiles that had worsened by more than 1 grade. Hemodynamic features were assessed by the transmitral mean diastolic pressure gradient (MDPG), and structural features were assessed by the MAC angle in the parasternal short-axis view. The clinical outcome was defined as a composite of all-cause mortality, hospitalization for heart failure, and occurrence of ischemic stroke. Forty-three patients (31.2%) showed progressive MAC. Patients with progressive MAC had higher systolic blood pressure, pulse pressure, MAC angle, and MDPG than those with stable MAC. Patients with progressive MAC had smaller left ventricular (LV) end-systolic dimensions and higher LV ejection fractions compared with those with stable MAC. In multivariate analysis, pulse pressure, LV ejection fraction, MAC angle, and MDPG at baseline were significantly associated with MAC progression. During a median of 39.2 months' follow-up, patients with progressive MAC showed poorer clinical outcomes than those with stable MAC (log-rank P=0.015). Conclusions MAC progression is not rare and is associated with structural substrate and hemodynamic loads that result in mechanical stress. Patients with progressive MAC have poor outcomes.

Acute heart failure and cardiogenic arterial thromboembolism in cats: clinical and echocardiographic features

Acute heart failure and arterial thromboembolism are common complications of hypertrophic cardiomyopathy in cats. These conditions have many common links in pathogenesis, so analyzing the differences between them improves the understanding of the impact of vessel occlusion on the body. In the study, 40 clinical cases were analyzed and two groups were formed: the first – cats with arterial thromboembolism and the second – cats with acute heart failure. The data from anamnesis, clinical examination and echocardiographic examination were collected. Age, sex, breed, weight, temperature, frequency of respiratory movements, signs of dyspnea, presence of pulmonary edema, presence of free fluid in the chest and pericardial cavities were analyzed. The following echocardiographic parameters were analyzed: left ventricular wall thickness, left ventricular end-systolic and end-diastolic dimensions, diameters of the aorta and left atrium, heart rate and left ventricular contraction fraction. It was established that the majority of animals from both groups were males. Acute heart failure was registered mainly in young cats (M = 3.7), in contrast to animals with arterial thromboembolism (M = 6.7), (P &lt; 0.01). There was no significant difference in the values of rectal temperature, weight, heart rate, aortic diameter, and left ventricular contraction fraction. Most animals from both groups had signs of dyspnoea. The difference in the frequency of respiratory movements was significant (P &lt; 0.01). In cats with acute heart failure, pulmonary edema was diagnosed in 85%, free fluid in the thoracic and/or pericardial cavities in 55 %. In animals with thromboembolism, edema was found in 45 %, and effusion in the chest and/or pericardial cavities in 30 % of animals. The established differences indicate that arterial thromboembolism develops in animals that have had heart pathology for a longer period of time, whereas acute heart failure occurs more suddenly in cats.

Impact of Premature Ventricular Complex (PVC) Burden on the Left Ventricle in the Structurally Normal Heart: Hemodynamic Alterations of Idiopathic PVC on Echocardiography.

Premature ventricular complex (PVC) without structural heart disease is mostly viewed as a benign arrhythmia. However, the high burden of PVC causes cardiomyopathy due to intraventricular dyssynchrony. The effects of ectopic contraction on left ventricular (LV) hemodynamics in the structurally normal heart are unclear. To examine the effect of PVC burden on LV dimension, LV systolic function, and intraventricular blood flow, and to determine whether ectopic ventricular contraction affects LV hemodynamics. Patients aged ≥ 18 years with PVC ≥ 5% on Holter recording were enrolled and divided into groups G1 (5-10%), G2 (10-20%), and G3 (≥ 20%). We excluded patients with structural heart diseases, pacemakers, and LV systolic dysfunction [LV ejection fraction (LVEF) < 50%]. Clinical characteristics and routine transthoracic echocardiography parameters were compared. The end-systolic LV internal dimension increased according to the PVC burden from G1 to G3 (p = 0.001). LVEF was inversely associated with PVC burden from G1 to G3 (p = 0.002). The same pattern was seen for LV outflow tract (LVOT) maximal velocity (p = 0.005) and maximal pressure gradient (PG) (p = 0.005), LVOT velocity time integral (VTI) (p = 0.03) and LV stroke volume index (LVSI) (p = 0.008). Systolic function and LV end-systolic dimension were inversely associated with PVC burden. Decreased LVOT flow velocity and PG were related to increased PVC burden. LVOT VTI and LVSI were smaller when the PVC burden exceeded 20%. These negative hemodynamic manifestations of idiopathic PVC were considerable even in structure normal hearts, hence the early elimination of PVC is strongly advised.

Efficacy of Radiofrequency Catheter Ablation versus Antiarrhythmic Drugs in Treating High Burden Premature Ventricular Contractions in Children with Structurally Normal Heart

Abstract Background Scarce literature on whether antiarrhythmic drugs (AADs) or radiofrequency catheter ablation (RFCA) is more efficacious when treating idiopathic high burden premature ventricular contractions (PVCs) in children with many questions remain unanswered in this age group. Objectives To compare the efficacy of RFCA versus AADs on high burden idiopathic PVCs in children. Methods A total of 60 eligible child ≤18 years with High burden PVCs (≥10% of total beats per day) that were treated by either AADs (group A) or RFCA (group B). Both Baseline and followup clinical symptoms were collected, Physical examination, repeat standard ECG, standard or 12-lead Holter recording, and echocardiography were performed. Results Among RFCA (n = 30) and AADs (n = 30) groups, treatment success was 80.0% and 20.0% respectively, while AADs medications cessation was 73.3% and 26.7% respectively, the differences were statistically significant. Conclusion RFCA appears to be more efficacious than AADs in PVC reduction and consequently AADs medications cessation postablation. Performing RFCA in children with classical mapping and navigation was a safe and highly effective therapeutic option. Abbreviations AADs: antiarrhythmic drugs; BBB: bundle branch block; CCB: calcium channel blocker; ECG: electrocardiogram; LVEDD: left ventricular end-diastolic dimension; LVEF: left ventricular ejection fraction; LVESD: left ventricular end-systolic dimension; LVOT: left ventricular outflow tract; NSVT: non sustained ventricular tachycardia; PVC: premature ventricular contraction; RFCA: radiofrequency catheter ablation; RV: right ventricular/ventricle; RVOT: right ventricular outflow tract

Comparative Efficacy of Different Drugs for the Treatment of Dilated Cardiomyopathy: A Systematic Review and Network Meta-analysis.

At present, the therapies of dilated cardiomyopathy concentrated on the symptoms of heart failure and related complications. The study is to evaluate the clinical efficacy of a combination of various conventional and adjuvant drugs in treating dilated cardiomyopathy via network meta-analysis. The study was reported according to the PRISMA 2020 statement. From inception through 27 June 2022, the PubMed, Embase, Cochrane library, and Web of Science databases were searched for randomized controlled trials on medicines for treating dilated cardiomyopathy. The quality of the included studies was evaluated according to the Cochrane risk of bias assessment. R4.1.3 and Revman5.3 software were used for analysis. There were 52 randomized controlled trials in this study, with a total of 25 medications and a sample size of 3048 cases. The network meta-analysis found that carvedilol, verapamil, and trimetazidine were the top three medicines for improving left ventricular ejection fraction (LVEF). Ivabradine, bucindolol, and verapamil were the top 3 drugs for improving left ventricular end-diastolic dimension (LVEDD). Ivabradine, L-thyroxine, and atorvastatin were the top 3 drugs for improving left ventricular end-systolic dimension (LVESD). Trimetazidine, pentoxifylline, and bucindolol were the top 3 drugs for improving the New York Heart Association classification (NYHA) cardiac function score. Ivabradine, carvedilol, and bucindolol were the top 3 drugs for reducing heart rate (HR). A combination of different medications and conventional therapy may increase the clinical effectiveness of treating dilated cardiomyopathy. Beta-blockers, especially carvedilol, can improve ventricular remodeling, cardiac function, and clinical efficacy in patients with dilated cardiomyopathy (DCM). Hence, they can be used if patients tolerate them. If LVEF and HR do not meet the standard, ivabradine can also be used in combination with other treatments. However, since the quality and number of studies in our research were limited, large sample size, multi-center, and high-quality randomized controlled trials are required to corroborate our findings.