Optimal Medical Treatment Research Articles

Effect of Colchicine in reducing MMP-9, NOX2, and TGF- β1 after myocardial infarction

BackgroundAccording to WHO 2020, CAD is the second leading cause of death in Indonesia with death cases reaching 259,297 or 15.33% of total deaths. Unfortunately, most of the patients of CAD in Indonesia did not match the golden period or decline to be treated with Percutaneous Coronary Intervention (PCI). Based on the recent study, there were increases in MMP-9, NOX2, and TGF-β1 in STEMI patients which contribute to cardiac remodeling. Moreover, there is controversy regarding the benefit of late PCI (12-48 hours after onset of STEMI) in stable patients. Lately, colchicine is widely used in cardiovascular disease. This study was conducted to explore the effect of colchicine to reduce MMP- 9, NOX2, and TGF-β1 levels after myocardial infarction in stable patients.MethodIn this clinical trial study, we assessed 129 STEMI patients, about 102 patients who met inclusion criteria were randomized into four groups. Around 25 patients received late PCI (12–48 h after the onset of chest pain), optimal medical treatment (OMT) for STEMI, and colchicine; 24 patients received late PCI and OMT; 22 patients didn’t get the revascularization (No Revas), OMT, and colchicine; and 31 patients received No Revas and OMT only. The laboratory test for MMP-9, NOX2, and TGF-β1 were tested in Day-1 and Day-5. The data were analyzed using Mann-Whitney.ResultsA total of 102 patients with mean age of 56 ± 9.9, were assigned into four groups. The data analysis showed significant results within No Revas + OMT + Colchicine group versus No Revas + OMT + Placebo in MMP-9 (Day-1: p = 0.001; Day-5: p = 0.022), NOX2 (Day-1: p = 0.02; Day-5: p = 0.026), and TGF-β1 (Day-1: p = 0.00; Day-5: p = 0.00) with the less three markers in OMT + Colchicine group than OMT + Placebo group. There were no significant differences within the late PCI + OMT + colchicine group and PCI + OMT + Placebo group.ConclusionsColchicine could significantly reduce MMP-9, NOX2, and TGF-β1 levels in stable STEMI patients. So that, colchicine could be a potential agent in STEMI patients and prevent cardiac remodeling events.

Carotid artery interventions - endarterectomy versus stenting.

Current management of patients with carotid artery stenosis is based on well-established guidelines, including surgical procedures - carotid endarterectomy (CEA) and endovascular carotid artery stenting (CAS) - and optimal medical treatment alone. Outcomes in the postprocedural period after CAS and CEA are similar, suggesting strong clinical durability for both treatments. Recent advances, which include the emergence of novel endovascular treatment tools and techniques, combined with more recent randomised trial data shed new light on optimal patient selection and treatment in contemporary practice. Improved, modern technologies including enhanced embolic protection devices and dual-layered micromesh stents yield better outcomes and should result in further improvements in CAS. In centres of excellence, nowadays, the majority of patients with severe carotid artery stenosis can be successfully treated with either CEA or CAS.

The evolving state of cardiac resynchronization therapy and conduction system pacing: 25 years of research at EP Europace journal.

Cardiac resynchronization therapy (CRT) was proposed in the 1990s as a new therapy for patients with heart failure and wide QRS with depressed left ventricular ejection fraction despite optimal medical treatment. This review is aimed first to describe the rationale and the physiologic effects of CRT. The journey of the landmark randomized trials leading to the adoption of CRT in the guidelines since 2005 is also reported showing the high level of evidence for CRT. Different alternative pacing modalities of CRT to conventional left ventricular pacing through the coronary sinus have been proposed to increase the response rate to CRT such as multisite pacing and endocardial pacing. A new emerging alternative technique to conventional biventricular pacing, conduction system pacing (CSP), is a promising therapy. The different modalities of CSP are described (Hirs pacing and left bundle branch area pacing). This new technique has to be evaluated in clinical randomized trials before implementation in the guidelines with a high level of evidence.

Effect of Cardiac Rehabilitation on Post Exercise Systolic Blood Pressure Recovery in Patients with Impaired Left Ventricular Ejection Fraction after Recent Myocardial Infarction

Abstract Background Ischemic Heart diseases (IHD) are significant causes of morbidity and mortality worldwide with an estimated 9 million deaths each year. Exercise-based Cardiac Rehabilitation (CR) is one of the most important and cost-effective aspects of secondary prevention in patients with IHD. Post-exercise Systolic Blood Pressure Recovery (SBPR) represents an important hemodynamic parameter that is associated with the risk and severity of ischemic artery disease and future cardiovascular events. Aim of the Work The aim of this study is to assess the effect of CR on post-exercise SBPR in patients with Left Ventricular Ejection fraction less than 45% following a recent Myocardial Infarction. Patients and Methods this study included patients with Left Ventricular Ejection fraction less than 45% following a recent Myocardial Infarction, presenting to Cardiac Rehabilitation Units. the study included two groups of patients. Study group included Patients on optimal medical treatment who are attending CR sessions, and control group included patients on optimal medical treatment who refused or failed to attend more than 50% of cardiac rehabilitation sessions. SBPR was assessed in each patient before and after the CR program. Results When compared to baseline findings, both groups had statistically significant improvement in LVEF, resting SBP, recovery SBP value and HRR. However, CR group had better improvement in LVEF, lower Resting SBP, lower Peak SBP, Better SBP recovery ratio and better HRR outcomes when compared to the changes in the control group. Conclusions Cardiac Rehabilitation after recent Ischemic coronary artery event can provide significant improvement in Systolic blood pressure recovery and heart rate recovery which are important haemodynamic parameters that are associated with the significance and severity of future cardiovascular events. Abbreviations IHD: Ischemic Heart Disease; CR: Cardiac Rehabilitation; LVEF: Left Ventricular Ejection fraction; SBP: Systolic Blood Pressure

Effect of causative genetic variants on atherosclerotic cardiovascular disease in heterozygous familial hypercholesterolemia patients.

Heterozygous familial hypercholesterolemia (HFH) is an autosomal dominant genetic disorder leading to a lifetime exposure to high low-density lipoprotein cholesterol (LDL-c) level and an increased risk of premature atherosclerotic cardiovascular disease (ASCVD). We evaluate the effect of a causative genetic variant to predict ASCVD in HFH patients undergoing treatment. A retrospective cohort was conducted on 289 patients with possible, probable, and definite diagnosis of HFH according to Dutch Lipid Clinic Network Score and in whom DNA analyses were performed and mean LDL-c level was above 155 mg/dl. The study population was divided into groups based on the presence or not of a causative variant (pathogenic or likely pathogenic). We observed each of the study's participants for the occurrence of ASCVD. A causative variant was detected in 42.2% of study participants, and ASCVD has occurred in 21.5% of HFH patients. The incidence of ASCVD (27% vs. 17.4%, p = 0.048) and the mean of LDL-c under an optimal medical treatment (226 ± 59 mg/dl vs. 203 ± 37 mg/dl, p = 0.001) were higher in HFH-causative variant carriers than others. After adjusting on confounders, ASCVD was positively associated with LDL-c level [OR = 2.347; 95% (1.305-4.221), p = 0.004] and tends toward a negative association with HDL-c level [OR = 0.140; 95% (0.017-1.166), p = 0.059]. There is no more association between the detection of a causative variant and the occurrence of ASCVD [OR = 1.708; 95% (0.899-3.242), p = 0.102]. Kaplan Meier and log rank test showed no significant differences in event-free survival analysis between study groups (p = 0.523). In this study population under medical care, it seems that the presence of a causative variant did not represent an independent predictor of adverse cardiovascular outcomes in HFH patients, and LDL-c level played an undisputable causal role.

Diffuse coronary artery disease management with drug-coated balloons

Drug-coated balloons (DCB) have emerged as a valid alternative for drug-eluting stents in the treatment of in-stent restenosis and de-novo lesions in small vessels. In the past years, a significant effort has been made to investigate the role of this strategy in larger vessel disease, with promising preliminary results being reported for several clinical scenarios, including complex lesions, such as bifurcations, chronic total occlusions and diffuse, long lesions. A DCB strategy appears to be of significant interest in diffuse coronary disease, as the total stent length represents an independent predictor for target-vessel failure and a surgical approach does not seem to improve mid- and long-term results compared to optimal medical treatment. Several studies have investigated the safety and efficacy of a non-stent-based approach in this complex setting, and as promising results have been reported, it is fair to assume that reducing the amount of implanted metal in diffusely affected vessels could become the standard of care for these patients if a full or blended therapy with DCB is adopted. However, long-term results from large-scale studies are awaited to confirm these preliminary and intriguing results.

Cardio-ankle brachial index is associated with prolonged Tp-e interval in patients with arterial hypertension.

The cardio-ankle vascular index (CAVI) is a marker of arterial stiffness, and elevated CAVI values have been reported to be associated with an increased risk of cardiovascular mortality and cardiac arrhythmia. This study aimed to evaluate the relationship between Tp-e interval and CAVI, which is associated with cardiac arrhythmia on electrocardiography (ECG). The study included patients with hypertension whose blood pressure values were taken under control with optimal medical treatment. Arterial stiffness and CAVI were measured using the vascular scanning system VaSera VS-1000. The patients were divided into two groups as CAVI<9 and CAVI≥9. Ventricular repolarization markers QT and QTc intervals, Tp-e interval, and Tp-e/QT and Tp-e/QTc ratios were measured using 12‑lead ECG. Tp-e interval (78.7±10.3 vs. 63.6±9.1, p<0.001), Tp-e/QT ratio (0.018±0.02 vs. 0.015±0.02, p<0.001), and Tp-e/QTc ratio (0.17±0.02 vs. 0.14±0.04, p=0.025) were statistically significantly higher in the CAVI≥9 group compared to the CAVI<9 group. In the prediction of patients in the CAVI≥9 group, Tp-e interval had an area under the curve value of 0.862 (0.784-0.940, p<0.001) at the cut-off point of >72.5msec, indicating a statistically significant result. Left CAVI and right CAVI were found to be significantly correlated with Tp-e interval (r=-0.650, p<0.001 and r=-0.663, p<0.001, respectively). We found that elevated CAVI values were associated and positively correlated with prolonged Tp-e interval values in patients with hypertension. Patients with elevated CAVI values should be followed up closely to prevent cardiac arrhythmic events.

Treatment adherence in patients without ST-elevation acute coronary syndrome.

Despite progress during the last decades, patients with coronary artery disease (CAD) remain with a high residual risk due to multiple reasons. Optimal medical treatment (OMT) provides a decrease of recurrent ischemic events after acute coronary syndrome (ACS). Therefore, treatment adherence results crucial to reduce further outcomes after the index event. No recent data are available in Argentinian population; the main objective of our study was to evaluate the adherence at 6 and 15 months in post non-ST elevation acute coronary syndrome (NST-ACS) consecutive patients. Secondary objective was to evaluate the relationship of adherence with 15-month events. A prespecified sub-analysis in the prospective registry Buenos Aires I was performed. The adherence was evaluated using the modified Morisky-Green Scale. A number of 872 patients had information about adherence profile. Of them 76.4% were classified as adherents at month 6 and 83.6% at 15 (P=0.06). We did not find any difference in baseline characteristic between the adherent and non-adherent patients at 6 months. The adjusted analysis showed that non-adherent patients had a rate of ischemic events at 15th month of 20% (27/135) vs. 11.5% (52/452) in adherent patients (P=0.001). The bleeding events defined were of 3.6% in the non-adherent group vs. 5% in the adherent group without a statistical difference (P=0.238). Adherence to treatment is still a major issue as almost 25% of patients should be considered as non-adherent to OMT. No clinical predictor of this phenomenon was identified but our criteria were not exhaustive. Good adherence to treatment was highly associated to a reduction of ischemic events, whereas no impact on bleeding events was found. These data support a better network and collaboration with shared decision between healthcare professionals with patients and family members to improve acceptance and adherence to optimal medical strategies.

The safety of SGLT-2 inhibitors in diabetic patients submitted to elective percutaneous coronary intervention regarding kidney function: SAFE-PCI pilot study

BackgroundPercutaneous coronary intervention (PCI) is one of the most performed well-succeeded therapeutic procedures worldwide, reducing symptoms and improving quality of life. Neutrophil Gelatinase-associated Lipocalin (NGAL) is a biomarker of acute kidney injury (AKI) produced early after an ischemic renal insult. Osmotic diuresis and the vasoconstriction of the afferent arteriole promoted by Sodium-glucose Cotransporter-2 Inhibitors (SGLT2i) generate a concern regarding the possibility of dehydration and consequent AKI. There is no consensus on the maintenance or discontinuation of SGTL2i in patients who will undergo PCI. This study aimed to evaluate the safety of empagliflozin in diabetic patients submitted to elective PCI regarding kidney function.MethodsSAFE-PCI trial is a prospective, open-label, randomized (1:1), single-center pilot study and a follow-up of 30 days. The SGLT2i empagliflozin 25 mg daily was initiated at least 15 days before PCI in the intervention group and maintained until the end of the follow-up period. Serum NGAL was collected 6 h after PCI and creatinine before PCI, 24 h, and 48 h after the procedure. As per protocol, both groups received optimal medical treatment and standard protocol of nephroprotection.ResultsA total of 42 patients were randomized (22 patients in the iSGLT-2 group and 20 patients in the control group). There was no difference between-group baseline data. The primary outcome (NGAL and creatinine values post PCI) did not differ in both groups: the mean NGAL value was 199 ng/dL in the empagliflozin group and 150 ng/dL in the control group (p = 0.249). Although there was an initial increase in creatinine in the SGLT-2i group compared to the control group between baseline creatinine and pre-PCI and 24 h post-PCI creatinine, no difference was detected in creatinine 48 h post-PCI (p = 0.065). The incidence of CI-AKI, determined by KDIGO criteria, in the iSGLT2-group was 13.6% and 10.0% in the control group without statistical difference.ConclusionThe present study showed that the use of empagliflozin is safe regarding kidney function during elective PCI in patients with T2D when compared with no use of SGLT2i.Trial registration Our clinical study is registered on ClinicalTrials.gov with the following number: NCT05037695.

Effect of Sacubitril/Valsartan and enalapril on left ventricular function in patients with hematologic malignancies after bone marrow transplantation

Abstract Funding Acknowledgements Type of funding sources: None. Background and Aims Chemotherapy is known for its potential adverse effects on myocardium. Optimal medical treatment for heart failure may reverse myocardial dysfunction in the early stages of toxicity development. We hypothesized that early initiation of treatment with sacubitril/valsartan (s/v) or enalapril (ena) might prevent cardiotoxicity. Patients and methods 90 patients (mean age 45.7 ± 14,1 years old, 52 male) with preserved ejection fraction, who suffered from hematologic malignancies (lymphoma, leukemia) and underwent bone marrow transplantation, were randomized to receive sacubitril/valsartan 24/26 mg bid daily or enalapril 5 mg bid daily or placebo. We measured at baseline, before transplantation and after six months: i) Global Longitudinal Strain (GLS) of left ventricle (LV) by speckle tracking imaging, ii) myocardial global work index (GWI), global constructive work (GCW), global wasted work (GWW) and myocardial global work efficiency (GWE), by longitudinal strain-peripheral blood pressure loops, and iii) Left Ventricular Ejection Fraction (LVEF Simpson’s Method). Results The two treatment groups had similar age, sex atherosclerotic risk factors and cardiotoxic medication before and after bone marrow transplantation. Compared to baseline, patients treated with sacubitril/valsartan or enalapril for six months did not show a deterioration of LV GLS (−19.8±2.8 vs −19.3±4.1%, p = 0.403 for s/v, −20.3±2.8 vs −20.0±3.6%, p = 0.634 for ena). Conversely, patients treated with placebo for six months, presented a significant impairment of LV GLS (−20.9±2.1% vs −18.5±2.2, p = 0,001). No significant changes were found in LVEF after treatment with sacubitril/valsartan or enalapril for six months (57.5±4.9 vs 57.9±6.8%, p = 0.826 for s/v, 58.8±5.4 vs 60.7±7.1%, p = 0.419, for ena), while a borderline deterioration was noticed after treatment with placebo for six months (60.6±5.4 vs 57.7±6.7%, p = 0,045). We did not notice any alteration in GWi, GCW, GWW, GWE in patients treated with enalapril. On the other hand, in patients treated with sacubitril/valsartan GWE was improved (94.2±3.1 vs 95.8±1.8 %, p = 0.030) and GWW was diminished (111.5±75.7 vs 86.4±43.1 mmHg%, p = 0.045), while GWI and GCW did not show any significant alteration. Conversely, in the placebo group, GWI was reduced (1909.9±336.4 vs 1727.9±340.9 mmHg%, p = 0.027), GWW was increased (80.7±60.6 vs 110.6±65.1 mmHg%, p = 0.045), GWE was diminished (95.9±2.1 vs 94.1±3.9 %, p = 0.039) and GCW did not change. Conclusions Treatment with sacubitril/valsartan or enalapril prevented deterioration of myocardial function six months after bone marrow transplantation in patients with hematologic malignancies and preserved ejection fraction. Moreover, sacubitril/valsartan showed a more favorable effect on myocardial work.

Carotid stenting for treatment of Carotid web which caused stroke: a report of 3 cases

ABSTRACT Introduction: Carotid web is a focal variant of fibromuscular dysplasia, creating a septal in the carotid bulb, from which thrombosis can occur and may cause stroke. It is a rare disease and there is not enough evidence to establish optimal treatment. Case report: We report on three patients with carotid web - related strokes: two males (ages 57 and 68) and one female (age 43). Despite optimal medical treatment, both male patients experienced early recurrent strokes, while the female patient presented with a first - time stroke. All three patients underwent carotid stenting, and during a follow - up period of up to 3 years, there were no procedure - related complications or recurrent stroke events. Conclusion: Carotid web is a cause of ischemic stroke with a high risk of recurrence. Carotid stenting is a safe and effective option for long - term prevention of stroke recurrence. There fore, carotid artery imaging should be carefully evaluated, with attention paid to carotid web in patients with cryptogenic stroke.

Immediate right chambers remodelling after orthotopic transcatheter valve tricuspid replacement.

An 84-year-old man with atrial fibrillation, ischemic heart disease with surgical and percutaneous revascularization, complained about effort abdominal pain and dyspnoea (NYHA III), with asthenia and peripheral oedema. Transoesophageal echocardiography showed torrential atrial tricuspid regurgitation and dilated right ventricle with preserved ejection fraction (Panels A–C). Invasive systolic pulmonary pressure was 30 mmHg. The TRI-SCORE was 30%. Considering the symptoms and signs of right heart failure despite optimal medical treatment and the prohibitive surgical risk, the patient was selected for tricuspid transcatheter valve replacement with Cardiovalve (VenusMedtech, Hangzhou, China) according to Heart Team evaluation. Repair percutaneous techniques were rejected, transcatheter annuloplasty due to right coronary artery proximity and thin tissue, and edge-to-edge approach because of the gap of 1 cm. The 32-F Large Cardiovalve system was inserted via surgically exposed femoral vein and was advanced into the right atrium. Under transesophageal echocardiographic and fluoroscopic guidance, the device legs were opened in the atrium and advanced into ventricle and grasp the 3 native leaflets by pulling the system (Panel D). Finally, the atrial followed the ventricular flanges that were released (Panel E). There was a posterior mild paravalvular regurgitation (Panels F and G, Supplementary data online, Videos S1 and S2). After 1 month, the patient is NYHA class I, neither having effort abdominal pain nor peripheral oedema. CT scan showed a significant reduction of the right ventricular diastolic volume from 256 to 216 mL, and the right atrium from 89 to 71 mL, even persisting atrial fibrillation (Panel H, Supplementary data online, Video S3).

How to fill the gap in the symptomatic HF patient journey between optimal medical therapy and advanced heart failure treatment: two Italian surveys

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart failure (HF) is the pandemic of our century and an estimated 64.3 million people are living with HF worldwide. New therapies alongside the old ones have been recently introduced in clinical practice with good results but the prognosis for a high percentage of patients remains poor with a high mortality rate and markedly reduced functional status. Purpose This study aims to investigate through two surveys what physicians think are the current needs in HF management to gain insight into the epidemiology and characteristics of patients followed by Italian HF outpatient clinics. In particular, we evaluated the gap that Cardiac Contractility Modulation (CCM) could fill in HF management in a real-world scenario. Methods a 20-question survey on HF management in different scenarios addressed to all physicians operating in Italian centers involved in HF care was published on the website Cardioinfo. A second survey was sent to Italian high-volume referral outpatient HF clinics. The participating centers were asked to collect the number of patients admitted during 4 weeks and to fill out a 19 items survey regarding some characteristics of these patients. Results A total of 105 physicians (77% cardiologists) and 14 high-volume referral outpatient HF clinics took part in the surveys. Despite regular clinical follow-up at 3-6 months in 94% of cases, the currently available medical therapy is considered insufficient in stabilizing HF patients in 30% of cases. 23% of physicians perceive to have a lack of treatment options in symptomatic patients with reduced ejection fraction and this percentage rises to 66% in patients without reduced ejection fraction (Figure 1). Cardiac contractility modulation is considered a valid option by 15% of physicians. According to Food and Drug Administration criteria, in the cohort of patients referred to HF clinics around 3% of patients are suitable for CCM implantation (2 patients a month per heart failure outpatient clinic), but considering additional selection criteria the percentage of patients eligible may increase to 5-6%. Conclusions The surveys confirm the significant attention paid to HF in Italian hospitals, however the lack of therapeutic options for a non-negligible number of patients, who are clinically evaluated regularly, but without associated substantial changes in therapy, leads to frustration for the patient and the physician, and an increase in costs for the health care system. A relatively small percentage of the total HF population fulfills the indication for immediate CCM treatment. Nevertheless, considering the size of the HF population, CCM, reducing hospitalizations, improving functional capacity and QoL may be of key importance for many HF patients, especially the elderly.

Cardiac rehabilitation in women. Have we improved care in recent years?

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): Ninguna. Introduction Cardiovascular disease is the main cause of morbidity and mortality worldwide, but there are inequalities in diagnosis and treatment between men and women. Although there is greater awareness of cardiovascular disease in women, diagnostic techniques are less used in women, they receive fewer pharmacological and invasive treatments, and have less access to cardiac rehabilitation. Objective To compare the assistance offered to men and women in our Cardiac Rehabilitation Unit up to 2018 with the assistance given from 2019 to 2022. Methods Patients treated in the Cardiac Rehabilitation Unit before 2018 (group 1) and from 2019 to 2022 (group 2) were analyzed, comparing the characteristics of male and female patients, as well as the attendance rate to Cardiac Rehabilitation and treatments indicated. Results In group 1, we analyzed the data of 399 patients, 19.8% women. In group 2, which included 167 patients, the rate of women rose to 26.3%, this difference being statistically significant (p&amp;lt;0. 05). Women were older than men in both groups (63 vs 59 years in group 1; 64 vs 59 years in group 2), less smokers (26.3% vs 57.3% in group 1; 25% vs 50.4% in group 2). The percentage of hypertensive patients was the same in both sexes in group 2. Until 2018, fewer coronary angiographies were performed on women (94% vs 99%, p&amp;lt;0.05); however, in the second period (group 2, 2019-2022), the percentage was similar in both sexes, (96% vs 98%, p= n.s.). Revascularization is less, possibly due to the characteristics of coronary disease in women (Table 1). Lipid-lowering treatments are used equally in both groups (Table 1). Conclusion In recent years, care for cardiovascular disease in women has been improving. The percentage of women who are included in Cardiac Rehabilitation program and who undergo coronary angiography has increased. The raising awareness that this disease has the same severity in both sexes has allowed the optimal medical treatment implemented to be similar.

Implantable cardioverter defibrillator for primary prevention in patients with non-ischemic cardiomyopathy in the era of novel therapeutic agents- meta-analysis.

Evidence regarding the mortality benefit of implantable cardioverter defibrillator (ICD) non-ischemic dilated cardiomyopathy (NIDCM) is inconsistent. The most recent randomized study, the DANISH trial, did not find improved outcomes with ICD. However, based on previous studies and meta-analyses, current guidelines still highly recommend ICD implantation in NIDCM patients. The introduction of novel medications for heart failure improved the clinical outcome dramatically. We aimed in this study to evaluate the effect of Angiotensin Receptor-Neprilysin Inhibitors (ARNi) and sodium-glucose transport protein 2 inhibitors (SGLT2i) on the mortality benefit of ICD in NIDCM. We used a previous metanalysis algorithm and added an updated comprehensive literature search in PubMed for randomized control trials that examined the mortality benefit of ICD in NIDCM vs. optimal medical treatment. The primary outcome included death from any cause. We did a meta-regression analysis to search for a single independent factor affecting mortality. Using previous data, we evaluated the theoretical effect of ICD implementation on patients treated with SGLT2 inhibitors and ARNi. No new articles were added to the results of the previous meta-analysis. 2,622 patients with NIDCM from 5 cohort studies published between 2002 and 2016 were included in the analysis. 50% of them underwent ICD implantation for primary prevention of sudden cardiac death, and 50% did not. ICD was associated with a significantly decreased risk for death from any cause compared to control (OR = 0.79, 95%CI: 0.66-0.95, p = 0.01, I2 = 0%). The theoretical addition of ARNi and the SGLT2 inhibitor dapagliflozin did not change the significant mortality effect of ICD (OR = 0.82, 95%CI: 0.7-0.9, p = 0.001, I2 = 0%) and (OR = 0.82, 95%CI: 0.7-0.9, p = 0.001, I2 = 0%). A meta-regression revealed no association between death from any cause and left bundle branch block (LBBB), use of amiodarone, use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers, year initiated enrollment, and the year ended enrollment (R2 = 0.0). In patients with NIDCM, the addition of ARNi and SGLT2i did not affect the mortality advantages of ICD for primary prevention. https://www.crd.york.ac.uk/prospero/, identifier: CRD42023403210.

Cardiac Surgery 2022 Reviewed.

PubMed displayed almost 37,000 hits for the search term "cardiac surgery AND 2022." As before, we used the PRISMA approach and selected relevant publications for a results-oriented summary. We focused on coronary and conventional valve surgery, their overlap with interventional alternatives, and briefly assessed surgery for aorta or terminal heart failure. In the field of coronary artery disease (CAD), key manuscripts addressed prognostic implications of invasive treatment options, classically compared modern interventions (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass grafting [CABG]), and addressed technical aspects of CABG. The general direction in 2022 confirms the superiority of CABG over PCI in patients with anatomically complex chronic CAD and supports an infarct-preventative effect as underlying mechanism. In addition, the relevance of proper surgical technique to achieve durable graft patency and the need for optimal medical treatment in CABG patients was impressively illustrated. In structural heart disease, the comparisons of interventional and surgical techniques have been characterized by prognostic and mechanistic investigations underscoring the need for durable treatment effects and reductions of valve-related complications. Early surgery for most valve pathologies appears to provide significant survival advantages, and two publications on the Ross operation prototypically illustrate an inverse association between long-term survival and valve-related complications. For surgical treatment of heart failure, the first xenotransplantation was certainly dominant, and in the aortic surgery field, innovations in arch surgery prevailed. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.

Myocardial strain assessment by 2D Speckle Tracking to evaluate the effect of cardiac rehabilitation in patients with or without heart failure

Cardiac rehabilitation improves the subjective condition of the patient but little is known about associated structural and functional cardiac adaptations specifically the myocardial strain. To evaluate the impact of rehabilitation on structural and functional cardiac parameters using myocardial strain assessment by 2D Speckle Tracking. The study group consisted of 86 patients: 46 with heart failure with optimal medical treatment and 40 after acute myocardial infarction. A monocentric cohort study has included all patients who performed a 2-months cardiac rehabilitation program during 1 year. Clinical characteristics, a resting ECG, 2-dimensional Doppler echocardiography with tissue Doppler and strain imaging, and an incremental maximal exercise test on a bicycle ergometer were collected before and after the rehabilitation program. Paired student t-test for comparison and Pearson's correlation coefficient were used for the statistical analysis. Performance capacity was significantly improved after cardiac rehabilitation: performance in watts 112 W (±50) vs. 69.8 W (±34.5); effort test duration 10.7 min (±4.4) vs. 6.9 min (±3.1) and 6 min walking time 565 m (±127) vs. 496 m (±113). TEE parameters were significantly improved: LVFE 52.9% (±13) vs. 46.9% (±12.7), E/E’ 6.7 (±1.54) vs. 7.38 (±2.9). Significant difference of strain before and after cardiac rehabilitation 15.38% (+/4.72) vs. 14.12 (±4,79) has been also recorded. BNP level decreased by 29 ng/dL but not statistically significant from baseline. No significant correlation was found between biological, functional and TTE parameters. Strain imaging could be an interesting additional parameter to evaluate the positive response and structural improvement in patients with or without chronic heart failure who are undergoing cardiac rehabilitation (Table 1).

Sleep disorders in patients with overweight and acute and exacerbated chronic heart failure

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Medical University - Sofia Background Often accompanying comorbidity in patients with acute heart failure and overweight is sleep disorders. Searching and treatment of sleep apnea will be helpful in these patients. CPAP therapy may improve the prognosis. Purpose To determine the frequency and the phenotypic characteristics and of sleep apnea in patients with overweight and exacerbated heart failure. To add continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA) and monitor changes in systolic and diastolic function. To assess the survival rate in CPAP therapy group and the control group. Methods 100 consecutive patients hospitalized for exacerbation heart failure in the cardiology department. After the selection, 61 patients meet inclusion criteria – Apnea-Hypopnea index (AHI) &amp;gt; 5, Epworth Sleepiness Scale (ESS) &amp;gt; 6, NTproBNP&amp;gt;900 pg/ml, and Body mass index(BMI) &amp;gt;25. All patients receiving optimal medical treatment. The follow-up period was 2 years. The primary endpoint was death for any reason. Sleep apnea screening was performed with ApneaLinkTM. Echocardiographic assessment of left ventricular ejection fraction (LVEF) and the E/e‘m ratio. Results From 61 with sleep disorders 82% (n=50) has OSA and 18% (n=11) has central sleep apnea (CSA). Detected significant changes in LVEF between the OSA group and CSA group (EF% 49.6±8.5vs41.8±11.4;p=0.013). Also statistical significant changes there was about E/e’m ratio and BMI (BMI-38.5±7.1vs31.9±4.5;p=0.005 and E/e’m-17.1±3.7vs20.9±2.5;p=0.002)(Tab. 1). We found a strong reverse correlation between the LVEF and the number of central sleep apnea events (r=-0,52;p&amp;lt;0,001). There was a strong correlation between BMI and ESS (r=0,649;p&amp;lt;0,001). In the OSA group, CPAP therapy was started in 13 patients, the rest of the group (n=37) continue on optimal medication therapy. At the end of the follow-up period in statistical analysis were included 11 patients from the CPAP group and 20 patients from the control group. There was improvement about LVEF, ESS and BMI in CPAP group at end of follow-up (EF%-start: 46,82±9,61vs end of study:49,45±8,23;p=0,019, ESS–start 13±2,6vs end of study 5,9 ±1,5;p&amp;lt;0,001, BMI–start: 39,9±5,6vs end of study: 35,9±4,4;p=0,001). There were no significant changes in E/e'm ratio (E/e'm:start 16,3±3,2vs end of study:15±5,1;p=0,327). In the control group, there were no significant changes. Kaplan-Meier analysis confirmed that the CPAP group has a better survival rate than the control group in the follow-up period (Log-Rank p=0.049). Conclusions Obstructive sleep apnea was more common in obese heart failure patients. The left ventricular systolic function is lower in patients with central sleep apnea. Additional CPAP treatment can improved ejection fraction in patients with heart failure and obstructive sleep apnea. There is a positive effect on BMI. Base on ESS, subjective daytime sleepiness was improved. CPAP therapy can improve the survival rate.

A Review On the Importance of Plain Data Aggregation in Patient Care: The Vital Sign-Based Scenario

Medical data need to be managed appropriately as singly it is meaningless. Data aggregation is important as it may transform a plain data into a meaningful facts known as information. It is crucial to gather an authentic and accurate data analysis for making a critical decision in patient care. We intend to describe on how vital sign-based scenario data can become a meaningful information to assist healthcare in improving patient management. It was hoping that, through vital sign-based scenario medical data aggregation it will highlight or create a new information and knowledge towards diagnoses. This will help in quality patient care management as it may formulate an accurate diagnosis thus provides a support for an optimal medical treatment. In medicine, failure to analysed a correct information will lead to significant morbidity and mortality.

Sodium-Glucose Cotransporter 2 Inhibitors First Strategy Improve Decongestion in Patients with Symptomatic Heart Failure and Reduced Ejection Fraction When Compared to Angiotensin Receptor Neprilysin Inhibitor First Strategy.

Angiotensin receptor neprilysin inhibitor (ARNI) and sodium-glucose cotransporter 2 inhibitor (SGLT2i) are emerging medical treatments for decompensated heart failure (HF) with reduced ejection fraction. In clinical practice, the combination of ARNI and SGLT2i cannot be administered owing to the poor hemodynamic status in patients with HF with reduced ejection fraction (HFrEF). This study aimed to compare different strategies of HF management for ARNI first or SGLT2i first in such a population. From January 2016 to December 2021, 165 patients were diagnosed with HFrEF and New York Heart Association functional class ≥II and already received optimal medical treatment. Ninety-five patients received the ARNI-first strategy, and 70 patients received the SGLT2i-first strategy according to the physician's choice. Age, sex, hemodynamic condition, etiologies of HF, comorbidities, serum creatinine, N-terminal pro-B-type natriuretic peptide (NT-ProBNP), echocardiographic parameters, and clinical outcomes were compared between the ARNI and SGLT2i-first strategy groups. In the SGLT2i-first group, the median interval between the addition of the second medication was longer (ARNI-first vs. SGLT2i-first; 74 [49-100] days vs. 112 [86-138] days; p = 0.044). Improvement in left ventricular ejection fraction (LVEF), change in left atrial dimension, and change in left ventricular end-diastolic and end-systolic volume (LVESV) did not differ between the two groups. The incidence of HF hospitalization, cardiovascular mortality, and all-cause mortality did not differ between the two groups. A non-significant trend of lower NT-proBNP levels (ARNI-first vs. SGLT2i-first; 1383 [319-2507] pg/mL vs. 570 [206-1314] pg/mL; p = 0.055) and significantly higher discontinuation rate of diuretic agents (ARNI-first vs. SGLT2i- first; 6.8% vs. 17.5%; p = 0.039) were noted in the SGLT2i-first group. When early combination (≤14D) compared to late combination (>14D), better positive remodeling of LVESV presented significantly in early combination subgroups. In patients with symptomatic HFrEF, SGLT2i-first strategy may provide a higher possibility of discontinuing diuretic agents than the ARNI-first strategy. Changes in LV performance, progression of renal function, and clinical outcomes did not differ between the two groups. Early combination (≤14D) provided better LV remodeling.