Medical Management Of Heart Failure Research Articles

Early Initiation of SGLT2 Inhibitor is Important Irrespective of Ejection Fraction

Introduction Sodium Glucose Cotransporter inhibitor (SGLTi) has revolutionized the medical management of heart failure in the last decade. This molecule was initially described as a glucose-lowering agent but now it has been recommended in patients with chronic heart failure irrespective of ejection fraction and diabetic status. SGLT2 inhibitor reduces preload by natriuresis and diuresis, reduces afterload, decreases pulmonary artery pressure, improves myocardial energetics, and decreases myocardial fibrosis. It also reduces NTpro BNP levels in heart failure patients, decreases serum uric acid, and promotes weight loss. It has also been proposed that this molecule has a favorable effect on vascular remodeling. SGLT-2i improves cardiac output and attenuates maladaptive cardiac remodeling, chronic inflammation, oxidative stress, and endothelial dysfunction (ED) by restoring the activity of nitric oxide (NO) within the vascular endothelium. As was foreseeable this molecule became one of the foundation pillars in the management of heart failure with reduced as well as preserved ejection fraction. SGLT2i also has a reno-protective effect, particularly in patients with heart failure and diabetes. Evidence with SGLT2 inhibitor in Heart failure with preserved ejection fraction (HFpEF) DELIVER TRIAL has evaluated the effect of dapagliflozin on total (first and recurrent) heart failure events in patients with heart failure having preserved ejection fraction (HFpEF) or mildly reduced ejection fraction (HFmrEF). A total of 6263 patients with LVEF of more than 40 %, NHYA Class II-IV, and high NT-pro BNP (>300pg/ml in sinus rhythm and > 600pg/ml in patients with atrial fibrillation) were included over the total study period of two years. Dapagliflozin 10 mg was compared to placebo. In patients with HFmrEF and HFpEF, dapagliflozin reduced the risk of total heart failure events and heart failurerelated hospital admissions. (1)

Acute Antipsychotic Use and Presence of Dysphagia Among Older Veterans with Heart Failure.

Examine whether new antipsychotic (AP) exposure is associated with dysphagia in hospitalized patients with heart failure (HF). Retrospective cohort. AP-naïve Veterans hospitalized with HF and subsequently discharged to a skilled nursing facility (SNF) between October 1, 2010, and November 30,2019. We linked Veterans Health Administration (VHA) electronic medical records with Centers for Medicare & Medicaid (CMS) Minimum Data Set (MDS) version 3.0 assessments and CMS claims. The exposure variable was administration of ≥1 dose of a typical or atypical AP during hospitalization. Our main outcome measure was dysphagia presence defined by (1) inpatient dysphagia diagnosis codes and (2) the SNF admission MDS 3.0 swallowing-related items to examine post-acute care dysphagia status. Inverse probability of treatment weighting was used for risk adjustment. The analytic cohort consisted of 29,591 Veterans (mean age 78.5±10.0years; female 2.9%; n= 865). Acute APs were administered to 9.9% (n= 2941). Those receiving APs had differences in prior dementia [37.1%, n= 1091, vs 22.3%, n= 5942; standardized mean difference (SMD)= 0.33] and hospital delirium diagnoses (7.7%, n= 227 vs 2.8%, n= 754; SMD= 0.22). Acute AP exposure was associated with nearly double the risk for hospital dysphagia diagnosis codes [adjusted (adj.) relative risk (RR) 1.9, 95% CI 1.8, 2.1]. At the SNF admission MDS assessment, acute AP administration during hospitalization was associated with an increased dysphagia risk (adj. RR 1.2, 95% CI 1.0, 1.5) both in the oral (adj. RR 1.7, 95% CI 1.2, 2.0) and pharyngeal phases (adj. RR 1.3, 95% CI 1.0, 1.7). In this retrospective study, AP medication exposure was associated with increased dysphagia coding and MDS assessment. Considering other adverse effects, acute AP should be cautiously administered during hospitalization, particularly in those with dementia. Swallowing function is critical to hydration, nutrition, and medical management of HF; therefore, when acute APs are initiated, a swallow evaluation should be considered.

Reversal of pacing-induced cardiomyopathy after left bundle branch area pacing: a case report

BackgroundConventional right ventricular apex (RVa) pacing increases the risk of pacing-induced cardiomyopathy (PICM), especially in elderly patients with a higher ventricular pacing burden. Left bundle branch area pacing (LBBAP) has been suggested as an alternative to conventional RVa pacing. However, there is a lack of evidence that LBBAP may reverse PICM. We report a case of a reversal of PICM after LBBAP.Case presentationAn 81-year-old woman with a history of complete atrioventricular block and baseline QRS duration of 142 ms received permanent pacemaker implantation with dual pacing. The ventricular lead was placed at the apical direction and paced QRS duration was 146 ms. After 8 months, the patient visited with acute heart failure. The patient’s ventricular pacing burden was > 99%, and echocardiography found severe depression of left ventricular ejection fraction (LVEF, 30%), left ventricular dyssynchrony, and global hypokinesia. Despite 3 months of optimal medical management of heart failure, there was minimal improvement in LVEF (35%) and ventricular dyssynchrony persisted. The patient's presentation was consistent with PICM. LBBAP was performed with a stylet-driven lead and a delivery sheath (Biotronik Selectra 3D, Biotronik, Berlin, Germany). The lead was placed at the area of the left bundle branch trunk and non-selective LBBAP was achieved with a left ventricular activation time of 71 ms, paced QRS duration of 110 ms, and bipolar stimulation to QRS end of 136 ms. After a month, echocardiography found improved LVEF (53%) and N-terminal Pro-B-Type natriuretic peptide was decreased from 1011 to 645 pg/mL. The patient was relieved from dyspnea.ConclusionsWe report a case that PICM was resolved after LBBAP. LBBAP could be a rescue therapy for PICM induced by conventional RVa pacing.

Medication Complexity Among Older Adults with HF: How Can We Assess Better?

Medical management of heart failure (HF) has evolved and has achieved significant survival benefits, resulting in highly complex medication regimens. Complex medication regimens create challenges for older adults, including nonadherence and increased adverse drug events, especially associated with cognitive impairment, physical limitations, or lack of social support. However, the association between medication complexity and patients' health outcomes among older adults with HF is unclear. The purpose of this review is to address how the complexity of HF medications has been assessed in the literature and what clinical outcomes are associated with medication regimen complexity in HF. Further, we aimed to explore how older adults were represented in those studies. The Medication Regimen Complexity Index was the most commonly used tool for assessment of medication regimen complexity. Rehospitalization was most frequently assessed as the clinical outcome, and other studies used medication adherence, quality of life, healthcare utilization, healthcare cost, or side effect. However, the studies showed inconsistent results in the association between the medication regimen complexity and clinical outcomes. We also identified an extremely small number of studies that focused on older adults. Notably, current medication regimen complexity tools did not consider a complicated clinical condition of an older adult with multimorbidity, therapeutic competition, drug interactions, or altered tolerance to the usual dose strength of the medications. Furthermore, the outcomes that studies assessed were rarely comprehensive or patient centered. More studies are required to fill the knowledge gap identifying more comprehensive and accurate medication regimen complexity tools and more patient-centered outcome assessment.

The impact of sleep disordered breathing on cardiac troponin in acutely decompensated heart failure

PurposeSleep disordered breathing in decompensated heart failure has physiological consequences (e.g., intermittent hypoxemia) that may predispose to subclinical myocardial injury, yet a temporal relationship between sleep apnea and troponin elevation has not been established.MethodsWe assessed the feasibility of performing respiratory polygraphy and measuring overnight high-sensitivity cardiac troponin T change in adults admitted to the hospital with acutely decompensated heart failure. Repeat sleep apnea tests (SATs) were performed to determine response to optimal medical heart failure therapy. Multivariable logistic regression was used to identify associations between absolute overnight troponin change and sleep apnea characteristics.ResultsAmong the 19 subjects with acutely decompensated heart failure, 92% of SATs demonstrated sleep disordered breathing (apnea–hypopnea index [AHI] > 5 events/h). For those with repeat SATs, AHI increased in 67% despite medical management of heart failure. Overnight troponin increase was associated with moderate to severe sleep apnea (vs. no to mild sleep apnea, odds ratio (OR = 18.4 [1.51–224.18]), central apnea index (OR = 1.11 [1.01–1.22]), and predominantly central sleep apnea (vs. obstructive, OR = 22.9 [1.29–406.32]).ConclusionsSleep apnea severity and a central apnea pattern may be associated with myocardial injury. Respiratory polygraphy with serial biomarker assessment is feasible in this population, and combining this approach with interventions (e.g., positive airway pressure) may help establish if a link exists between sleep apnea and subclinical myocardial injury.

Vein of Galen aneurysmal malformation: rationalizing medical management of neonatal heart failure.

Neonates who present in high output heart failure secondary to vein of Galen aneurysmal malformation can be difficult to manage medically due to the complex physiology that results from the large shunt through the malformation. Though the cardiac function is often normal, right ventricular dilation, severe pulmonary hypertension, and systemic steal can result in inadequate organ perfusion and shock. This report recommends medical management for stabilization of neonates prior to definitive management with endovascular embolization. IMPACT: Vein of Galen aneurysmal malformation (VGAM) is a rare intracranial arteriovenous malformation, which can present in the neonatal period with high output heart failure. Heart failure secondary to VGAM is often difficult to manage and is associated with high mortality and morbidity. Despite optimal medical management, many patients require urgent endovascular embolization for stabilization of their heart failure. This report offers discrete recommendations that can be used by clinicians as guidelines for the medical management of heart failure in newborns with VGAM.

Heart Failure in Older Adults: Medical Management and Advanced Therapies.

As the population ages and the prevalence of heart failure increases, cardiologists and geriatricians can expect to see more elderly patients with heart failure in their everyday practice. With the advancement of medical care and technology, the options for heart failure management have expanded, though current guidelines are based on studies of younger populations, and the evidence in older populations is not as robust. Pharmacologic therapy remains the cornerstone of heart failure management and has improved long-term mortality. Prevention of sudden cardiac death with implantable devices is being more readily utilized in older patients. Advanced therapies have provided more options for end-stage heart failure, though its use is still limited in older patients. In this review, we discuss the current guidelines for medical management of heart failure in older adults, as well as the expanding literature on advanced therapies, such as heart transplantation in older patients with end-stage heart failure. We also discuss the importance of a multidisciplinary care approach including consideration of non-medical co-morbidities such as frailty and cognitive decline.

Soluble Guanylate Cyclase Stimulators in Heart Failure.

Heart failure has a high global burden of morbidity and mortality. Despite significant advances in medical management of heart failure, the prognosis remains poor. This justifies the search for newer therapeutic agents. Recently, soluble guanylate stimulators have demonstrated favorable results in clinical trials. This article aims to summarize the guanylate cyclase signaling pathway, the role of soluble guanylate cyclase stimulators in heart failure, and data from recent clinical trials of these drugs. We concluded that soluble guanylate cyclase stimulators have significant benefits in reducing hospitalizations in patients with heart failure with reduced ejection fraction that are at high risk of cardiovascular events. There appears to be no benefit of these drugs in patients with heart failure with preserved ejection fraction.

B-PO04-217 CARDIAC RESYNCHRONISATION THERAPY IN A HEART TRANSPLANT RECIPIENT: A CASE REPORT

Atrioventricular block is the cause of 50-75% of late permanent pacemaker insertions after orthotopic heart transplant (OHT). However, there are only a few reports of cardiac resynchronisation therapy (CRT) in the OHT population. We report the case of a 60-year-old man who underwent OHT for idiopathic dilated cardiomyopathy 13 years prior and subsequently received CRT. N/A He had no symptoms of heart failure prior to his recent presentation and had been uncomplicated post-OHT with no episodes of significant rejection. Echocardiography performed 18 months prior to presentation had demonstrated normal left ventricular structure and function. The patient was admitted to hospital with decompensated heart failure. Repeat echocardiography demonstrated a dilated left ventricle with severe systolic dysfunction. Medical management for heart failure was initiated. Coronary catheterisation demonstrated only diffuse mild to moderate coronary artery disease. Endomyocardial biopsy revealed mild type 1R rejection, and the patient was treated with pulse intravenous methylprednisolone therapy. During his admission, the patient experienced worsening of his heart failure symptoms. ECG demonstrated intermittent high-grade atrioventricular block on a background of pre-existing right bundle branch block and QRS duration of 143ms. Cardiac pacing was required and given his symptomatic heart failure with reduced ejection fraction and expectation of high pacing burden a decision was made to implant a CRT-pacemaker. Left axillary access was uneventful. Venography demonstrated a lateral branch and a left ventricular lead was positioned uneventfully. The remainder of the procedure was uneventful. Post-implant testing revealed excellent sensing and pacing parameters, and biventricular pacing resulted in a QRS duration of 100ms. He had resolution of his heart failure symptoms and was successfully discharged. At two-weeks follow up, sensing and pacing parameters remained excellent and the patient had 100% biventricular pacing. Follow-up echocardiography is pending. We demonstrate the feasibility of CRT in a patient with previous OHT. It remains unclear whether the criteria for CRT differs for patients with OHT.

Diabetes, Heart Failure and Beyond: Elucidating the Cardioprotective Mechanisms of Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors.

Approximately 5 million individuals in the US are living with congestive heart failure (CHF), with 650,000 new cases being diagnosed every year. CHF has a multifactorial etiology, ranging from coronary artery disease, hypertension, valvular abnormalities and diabetes mellitus. Currently, guidelines by the American College of Cardiology advocate the use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, β-blockers, diuretics, aldosterone antagonists, and inotropes for the medical management of heart failure. The sodium glucose cotransporter 2 (SGLT2) inhibitors are a class of drug that have been widely used in the management of type 2 diabetes mellitus that work by inhibiting the reabsorption of glucose in the proximal convoluted tubule. Since the EMPA-REG OUTCOME trial, several studies have demonstrated the benefits of SGLT2 inhibitors in reducing cardiovascular risk related to heart failure. While the cardiovascular benefits could be explained by their ability to reduce weight, improve glycemic index and lower blood pressure, several recent trials have suggested that SGLT2 inhibitors exhibit pleiotropic effects that underlie their cardioprotective properties. These findings have led to an expansion in preclinical and clinical research aiming to understand the mechanisms by which SGLT2 inhibitors improve heart failure outcomes.

Cardiac Autonomic Nerves Stimulation Improves Hemodynamics and Clinical Status in Advanced Heart Failure Patients

Despite heart failure therapy advances, symptomatic congestion and low cardiac output in acute heart failure is a leading cause of mortality and morbidity. The purpose of this study was to investigate transvenous cardiac autonomic nerve stimulation (CANS) effects on in-hospital hemodynamics and clinical status. The study was a single-center, open label, clinical investigation of CANS. Twenty two subjects with LVEF <40% and at least two signs and symptoms of congestion were consented and enrolled. A purpose-built electrical stimulation catheter was placed in the left brachiocephalic vein via left subclavian vein access and connected to a purpose-built bedside neurostimulator used to deliver CANS therapy in-hospital for up to 96 hrs. The subjects had a mean baseline NT-proBNP of 10,518 pg/mL, LVEF of 25%, pulmonary capillary wedge pressure (PCWP) of 20 mmHg and presented with symptoms. CANS therapy was provided for a mean duration of 70 hrs. There were no device or study related adverse events reported. During CANS therapy mean cardiac index increased (1.8 to 2.0 L/min./m2), mean systemic vascular resistance decreased (24 to 20 WU), and mean PCWP decreased (20 to 14 mmHg) with stable MAP and HR. At discharge, mean edema pitting score improved 2 points, mean 6 minute hall walk distance (6MHW) increased 92 m and mean KCCQ-12 increased 12 points. At 30 day follow-up, edema pitting score improved 3 points, 6MHW increased 102 m and mean KCCQ-12 improved 38 points from baseline. Hemodynamic and clinical improvements occurred in the presence of stable medical management. Patients received at least 80 mg/day of furosemide, had minimal change to existing heart failure medical management, received no new IV vasoactive therapies, and a majority of the patients (17/22) received no furosemide dose uptitration during CANS Therapy. Alongside concomitant medical therapy, CANS holds promise as a tool to improve in-hospital hemodynamics and relieve congestion.

Heart Failure Nurse Navigator Program Interventions Based on LACE Scores Reduces Inpatient Heart Failure Readmission Rates

Objective This presentation will identify top causes for Heart Failure (HF) patient readmissions and strategies for HF readmission prevention. The HF Nurse Navigator's role in preventing readmissions will be described. The implementation of the HF standard work discharge tool with seven interventions based on LACE scores used in the HF Nurse Navigator program will also be defined. Background Heart Failure continues to be one of the leading causes for hospitalization (national 30-day All-Cause HF readmission rates average: 22%). The goal of this community hospital is to decrease their average 30-day All-Cause HF patients' readmission rates from 21% to Problem Statement Increasing Heart Failure readmission rates due to avoidable readmission causes are unfavorable for our cardiac patients' quality of life and contribute to payment penalties. Methods The Heart Failure Nurse Navigator (HF NN) role was created at this hospital with the goal of decreasing readmissions and improving patient outcomes for the HF patient across the continuum of care. The HF NN is an expert clinician leader and a resource to the healthcare team in Progressive Care and other inpatient units through one-on-one HF education with the patient or significant other and assists in identification of services unique to each patient's needs for a smooth transition from hospital to home. New Nurse Leader roles such as an Advanced Practice Nurse Navigator equipped with Evidence Based knowledge and training is vital to oversee a specialized patient population in Acute Care; to design and implement interventions that can improve patient outcomes and decrease the patient's risk for readmission within 30 days. The HF NN in collaboration with the HF Team designed a Quality Improvement project implementing a HF Standard Work Discharge Checklist with seven patient interventions for the Acute Heart Failure patient. These interventions include: HF Teach-Back education; HF clinic referral; Outpatient pharmacy prescription delivery to bedside; Discharge Medication list education by the Pharmacist; Follow-up appointments made prior to discharge; Transitional Medical Clinic appointment within 5 days of discharge; and Home Health RN HF Medical Management. LACE (Length of-Stay, Acuity, Co-Morbidities and ED visits) scoring developed by Van Walvaren et al. (2010) was used to assess for readmission risk and to implement interventions specific for each HF patient based on their LACE score. Results This hospital's average 6-month All-Cause HF readmission rate decreased to 12.94% after the pilot of the HF Nurse Navigator program, vs. 21.1% pre-intervention. After the HF NN role was implemented, the average 6-month HF 30-day All-Cause readmission rate decreased by 39% postintervention over the 6-month pilot period. Conclusions The team-based HF Nurse Navigator interventions described when implemented for every Acute HF patient admission decreased HF readmission rates. There is a need to have 7-day a week coverage by a HF NN in an institution to ensure identification of services unique to each HF patient's complex needs. The HF NN can ensure that the HF patient has a smooth transition from hospital to home with these interventions, resulting in a decreased readmission risk.

P626 Peripartum cardiomyopathy with persistent ventricular dysfunction and intracavitary thrombosis despite treatment with dopamine receptors agonist. The role of the three-dimensional echocardiography

Abstract Introduction Peripartum cardiomyopathy (MPP) is a type of cardiomyopathy characterized by heart failure secondary to left ventricular systolic dysfunction during the last month of pregnancy or in the first 5 months of puerperium without other apparent etiology, being a diagnosis of exclusion. The left ventricle is not always dilated, but the fraction of left ventricular ejection is always less than 45%. The natural history and prognosis of the disease is diverse. Ventricular dysfunction is usually transient and normalizes at 3-6 months in up to 60% of cases. Mortality is variable, with reports ranging from 0 to 28%, affecting more certain ethnic groups, in patients with persistent ventricular dysfunction, evidence of the efficacy of a specific treatment beyond optimal medical therapy for heart failure is limited. Clinical case We present the clinical case of a 22-year-old woman, who was referred to the our institute with an acute heart failure syndrome two months after the end of her first pregnancy. On admission to the hospital, dilated cardiomyopathy and intracavitary thrombi were documented by transthoracic echocardiography (TTE) with dilatation and eccentric left ventricular hypertrophy, generalized hypokinesia and mobile thrombi inside, the largest of 34x16mm with severe left ventricular dysfunction 3D LVEF of 28% and global longitudinal strain (GLS) of -5.8%, pulmonary hypertension and right ventricular dysfunction with severe functional tricuspid regurgitation. Other specific etiologies of dilated cardiomyopathy were investigated and discarded, finally establishing the diagnosis of peripartum cardiomyopathy. The support management was carried with inotropic, diuretic, supplemental oxygen and parenteral anticoagulation was initiated, with gradual improvement. Subsequently, optimal medical treatment was started for heart failure, cabergoline and vitamin K antagonist. He was released to his home on II NYHA. Two months later she presented with progressive dyspnea, increased abdominal perimeter. On March 14, 2018, a TTE was performed, with absence of improvement in conventional and advanced ventricular function parameters. Apical thrombi of smaller size compared with previous study, severe left ventricular dysfunction, which worsened with respect to the previous echocardiogram, with 3D LVEF of 25% and GLS 3.7% Discussion We present the case of a woman with MPP, in whom persistent left ventricular dysfunction after 6 months of diagnosis, although cabergoline scheme in addition to optimal medical management for heart failure, with no improvement. In patients who dont present an adequate response to the management, it is necessary to consider enlisting for heart transplantation. Abstract P626 Figure. TTE, severe ventricular dysfunction

A Clinical Review of Ventricular Arrhythmias in Patients with Congestive Heart Failure

Heart failure is an increasingly prevalent condition, which is associated with ventricular arrhythmias. The reduction in cardiac pumping efficiency leads to the activation of several compensatory mechanisms. These mechanisms eventually lead to cardiac remodelling and a decline in haemodynamic status, contributing to the formation of a substrate conducive to arrhythmias, including increased automaticity, triggered activity, and, most commonly, re-entry circuits. In turn, ventricular arrhythmias can lead to the worsening of heart failure. A diagnosis of heart failure and ventricular arrhythmias is obtained using the patient’s history, examination findings, and investigation results. A key tool in this is echocardiogram imaging, which visualises the cardiac chambers, determines ventricular ejection fraction, and identifies structural abnormalities. A reduction in ejection fraction is a significant risk factor for the development of ventricular arrhythmias. Arrhythmias are diagnosed by ECG, Holter monitoring, and telemetry or event monitoring, and should initially be treated by optimising the medical management of heart failure. Anti-arrhythmic drugs, including beta-blockers, are usually the first-line therapy. Sudden cardiac death is a significant cause of mortality in heart failure patients, and implantable cardioverter defibrillator devices are used in both primary and secondary prevention. Anti-arrhythmic drugs and catheter ablation are important adjunctives for minimising shock therapy. In addition, autonomic modulation may offer a novel method of controlling ventricular arrhythmias. The objective of this review is to provide a practical overview of this rapidly developing field in relation to current evidence regarding the underlying pathophysiology, burden of disease, and management strategies available.

A Clinical Review of Ventricular Arrhythmias in Patients with Congestive Heart Failure

Heart failure is an increasingly prevalent condition, which is associated with ventricular arrhythmias. The reduction in cardiac pumping efficiency leads to the activation of several compensatory mechanisms. These mechanisms eventually lead to cardiac remodelling and a decline in haemodynamic status, contributing to the formation of a substrate conducive to arrhythmias, including increased automaticity, triggered activity, and, most commonly, re-entry circuits. In turn, ventricular arrhythmias can lead to the worsening of heart failure. A diagnosis of heart failure and ventricular arrhythmias is obtained using the patient’s history, examination findings, and investigation results. A key tool in this is echocardiogram imaging, which visualises the cardiac chambers, determines ventricular ejection fraction, and identifies structural abnormalities. A reduction in ejection fraction is a significant risk factor for the development of ventricular arrhythmias. Arrhythmias are diagnosed by ECG, Holter monitoring, and telemetry or event monitoring, and should initially be treated by optimising the medical management of heart failure. Anti-arrhythmic drugs, including beta-blockers, are usually the first-line therapy. Sudden cardiac death is a significant cause of mortality in heart failure patients, and implantable cardioverter defibrillator devices are used in both primary and secondary prevention. Anti-arrhythmic drugs and catheter ablation are important adjunctives for minimising shock therapy. In addition, autonomic modulation may offer a novel method of controlling ventricular arrhythmias. The objective of this review is to provide a practical overview of this rapidly developing field in relation to current evidence regarding the underlying pathophysiology, burden of disease, and management strategies available.

Évaluation de la prise en charge médicale de l’insuffisance cardiaque à l’hôpital national Blaise COMPAORE

AimThe aim of this study was to assess the quality of medical management of heart failure at the National Hospital Blaise Compaoré according to the international guidelines. Patients and methodsA retrospective study was performed including consecutive patients admitted for heart failure documented sonographically from October 2012 to March 2015 in the Medicine and Medical Specialties Department of National Hospital Blaise Compaore with a minimum follow-up of six weeks. Data analysis was made by the SPSS 20.0 software. ResultsEighty-four patients, mean age of 57.61±18.24 years, were included. It was an acute heart failure in 84.5% of patients with systolic left ventricular function impaired (77.4%). The rate of prescription of different drugs in heart failure any type was 88.1% for loop diuretics; 77.1% for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and 65.5% for betablockers. In patients with systolic dysfunction, 84.62% of patients were received the combination of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and 75.38% for betablockers. Exercise rehabilitation was undergoing in 10.7% of patients. The death rate was 16.7% and hospital readmission rate of 16.7%. ConclusionThe prescription rate of major heart failure drugs is satisfactory. Cardiac rehabilitation should be developed.

Radiofrequency catheter ablation of a concealed accessory pathway of the heart in a Labrador Retriever

The presence of an accessory atrioventricular conduction pathway may provide the anatomical basis for some tachyarrhythmias. Persistent tachyarrythmias may result in the development of systolic dysfunction or tachycardiomyopathy and eventual progression to heart failure. In this paper we report the successful ablation of an accessory pathway involved in the pathogenesis of persistent orthodromic atrioventricular reciprocating tachycardia (AVRT) and heart failure in a 3-year-old male Labrador retriever. Electrophysiological study and radiofrequency (RF) catheter ablation were performed under general anesthesia. Electrophysiological study revealed AVRT resulting from a retrograde conduction via a right posteroseptal accessory pathway. The successful RF ablation of the accessory pathway resulted in the resolution of the tachycardia and return of normal sinus rhythm. Medical management of heart failure was withdrawn and no episodes of recurrent tachyarrhythmia were documented during a 3-month follow-up.

Preliminary Investigation of Cardiovascular-Renal Disorders in Dogs with Chronic Mitral Valve Disease.

BackgroundVeterinary literature lacks data about cardiovascular–renal disorders (CvRD) and cardiorenal‐anemia syndrome (CRAS) in dogs.HypothesisA direct correlation exists between ACVIM class and IRIS stage; chronic kidney disease (CKD) complicates chronic mitral valve disease (CMVD) more often than does anemia in dogs.AnimalsOne hundred and fifty‐eight client‐owned dogs with CMVD.MethodsSignalment, physical examination findings, electrocardiography, thoracic radiographs, echocardiography, and blood analysis were retrospectively evaluated to assess the prevalence of CKD and anemia in dogs with CMVD and to investigate the relationships among ACVIM class, IRIS stage, and survival.ResultsThe prevalence of CKD and anemia in dogs with CMVD was significantly higher than in the general population of dogs. Dogs being treated for heart failure had a significantly higher prevalence of CKD than did dogs that had not received treatment. A statistically significant direct correlation was found between ACVIM class and IRIS stage. Severe heart disease, severe renal disease or both, furosemide administration, and advanced age at diagnosis of heart disease were associated with shorter survival time. Survival time of dogs affected by CvRD was statistically shorter than survival time of dogs affected by CMVD alone.Conclusion and Clinical RelevanceChronic mitral valve disease is associated with increased prevalence of CKD and anemia in dogs. Treatment for medical management of heart failure may play a role in inducing CKD. Class of heart disease and IRIS stage were directly correlated. Cardiovascular–renal disorders decrease survival time compared to the only presence of CMVD alone, whereas anemia does not play a central role in worsening heart function.

Tropical Endomyocardial Fibrosis: Natural History, Challenges, and Perspectives.

Tropical endomyocardial fibrosis (EMF) is a neglected disease of poverty that afflicts rural populations in tropical low-income countries, with some certain high-prevalence areas. Tropical EMF is characterized by the deposition of fibrous tissue in the endomyocardium, leading to restrictive physiology. Since the first descriptions in Uganda in 1948, high-frequency areas for EMF have included Africa, Asia, and South America. Although there is no clear consensus on a unified hypothesis, it seems likely that dietary, environmental, and infectious factors may combine in a susceptible individual to give rise to an inflammatory process leading to endomyocardial damage and scar formation. The natural history of EMF includes an active phase with recurrent flare-ups of inflammation evolving to a chronic phase leading to restrictive heart failure. In the chronic phase, biventricular involvement is the most common presentation, followed by isolated right-sided heart disease. Marked ascites out of proportion to peripheral edema usually develops as a typical feature of EMF. EMF carries a very poor prognosis. In addition to medical management of heart failure, early open heart surgery (endocardectomy and valve repair/replacement) appears to improve outcomes to some extent; however, surgery is technically challenging and not available in most endemic areas. Increased awareness among health workers and policy makers is the need of the hour for the unhindered development of efficient preventive and therapeutic strategies.

Current and novel biomarkers in heart failure: bench to bedside.

Natriuretic peptides, high-sensitivity cardiac troponins, and suppression of tumorigenicity 2 are novel biomarkers that reflect the intricate pathophysiology of heart failure and can thus be used for the diagnosis, management, and prognosis of heart failure. This review article describes the significance of B-type natriuretic peptide (BNP), N-terminal prohormone of BNP, ST2, and cardiac troponins. We outline their new roles in guiding the management of heart failure as well as strong prognostic indicators for adverse cardiovascular outcomes. By recognizing the diagnostic and prognostic significance of these biomarkers, clinicians can utilize these biomarkers to more accurately evaluate and risk stratify patients. These markers can also be used to help guide the medical management of heart failure. The best approach for an accurate diagnosis, management, and prognosis of heart failure will likely involve a multimarker panel of biomarkers, which may include high-sensitivity troponins, BNP, N-terminal prohormone of BNP, and ST2.