Recurrent Congestive Heart Failure Research Articles

Pediatric restrictive Cardiomyopathy presenting with congestive heart failure: Rare case report and literature review

Restrictive cardiomyopathy (RCM) is an uncommon form of cardiomyopathy and is characterized by impaired diastolic filling of the ventricles due to increased myocardial stiffness and a normal ventricular systolic functions. In India, RCM is frequently observed in the young and endemic endomyocardial diseases are seen in a significant number of cases. RCM is the least common of all the cardiomyopathies among pediatric patients. RCM has a poor prognosis and commonly requires a cardiac transplant. We are reporting here a case of seven-year-old female child presenting with recurrent chest infections and congestive heart failure since early childhood.

Impact of chronic kidney disease and end-stage renal disease on the mid-term adverse outcomes in diabetic patients with cardiovascular diseases

The evidence for the impact of renal dysfunction in patients with diabetes mellitus (DM) and first cardiovascular diseases on mid-term adverse outcomes remain scarce. This study included the data of patients with DM having first atherosclerotic cardiovascular disease (ASCVD) or congestive heart failure (CHF) from the Taipei Medical University Clinical Research Database. A Cox proportional hazards regression model was used to assess the impact of chronic kidney disease (CKD) or end-stage renal disease (ESRD) on the 1-year mortality and recurrent ASCVD/CHF outcomes. We enrolled 21,320 patients with DM hospitalized for ASCVD or CHF; of them, 18,185, 2639, and 496 were assigned to the non-CKD, CKD, and ESRD groups, respectively. After propensity score matching, compared with the non-CKD group, the CKD and ESRD groups had higher mid-term all-cause mortality (adjusted hazard ratio 1.72 [95% confidence interval 1.48–1.99] and 2.77 [2.05–3.73], respectively), cardiovascular death (1.84 [1.44–2.35] and 1.87 [1.08–3.24], respectively), and recurrent hospitalization for ASCVD (1.44 [1.24–1.68] and 2.33 [1.69–3.23], respectively) and CHF (2.08 [1.75–2.47] and 1.50 [1.04–2.17], respectively). The advancing age was associated with mortality in CKD/ESRD groups. In CKD group, male sex was associated with all-cause mortality and recurrent ASCVD risk; the diuretics usage was associated with mortality and recurrent CHF risks. Our findings suggest that CKD and ESRD are significant risk factors for mid-term adverse outcomes in patients with DM and established cardiovascular diseases. Additionally, old age, male sex and diuretics usage requires attention. Further good quality studies are needed in the future.

Association of serum Sodium with mortality in patients of Congestive heart failure

Objectives: To determine the association of serum Sodium with mortality in patients of Congestive heart failure. Study Design: Prospective observational study Settings and Duration of study: Department of Medicine, Sir Ganga Ram Hospital, Lahore. ( 22-12-2021 to 22-6-2022 ). Methods: Sample size of 100 patients; 50 in each group in calculated with 90% power of study, 5% significance level and taking percentage of mortality i.e. 24.75% patients with low serum sodium level and in 4.21% patients with normal serum sodium level. Sample Selection: Inclusion Criteria: Patients aged between 30-70 years, both genders, Patients with congestive heart failure ,Group I: with serum sodium level <135 mEq/L, Group II: with serum sodium level ≥135 mEq/L. Exclusion Criteria: Liver disorders (AST>25IU, ALT>30IU, hepatitis B or C), renal disorders (eGFR ˂ 30 mL/min/1.73 m2 or creatinine >2.0mg/dl or on hemodialysis), any malignancy, anemia (Hb<9 g/dl), due to inherited hemoglobinopathy such as; sickle cell disease, and thalassemia, Patients with recurrent congestive heart failure or already taking treatment for deranged sodium level , valvular heart disease. Results: Patients in exposed group had 52% mortality rate as compared to unexposed group in which mortality rate was only 18% respective. Value of relative risk showed that patients in exposed group had 2.88 times higher chances of mortality as compared to those patients in unexposed group. Similarly, elderly patients (Relative Risk=3.23), Male patients (Relative Risk= 3.37), Overweight patients (Relative Risk=3.54), non-diabetic patients (Relative Risk=3.50), hypertensive patients (Relative Risk=2.95), ischemic heart disease patients (Relative Risk=4.12), Smoker (Relative risk=4.41) and duration of congestive HF as 0.5-3.5 (Relative Risk= 3.03) had higher risk for mortality. Conclusion: Results obtained from this study showed that low serum sodium level had significant impact on patients of congestive HF in terms of mortality. Keeping its prognostic importance, congestive HF patients should be strictly monitored for electrolyte imbalance. Key Words: Serum sodium, Prognostic, Indicator, Mortality,Congestive Heart Failure.

Clinical presentation, management, and survival in dogs with persistent atrial standstill in the United Kingdom

ObjectivesTo investigate the clinical and echocardiographic presentation of dogs with persistent atrial standstill (PAS), identify variables measured at first presentation that could predict their survival, and document the progression of the disease after pacing. Materials and methodsRetrospective study of medical records of dogs diagnosed with PAS at three referral hospitals of the United Kingdom over seven years. ResultsTwenty-six dogs were diagnosed with PAS during the study period. Median age of the population was three years (range: seven months–12.5 years). The most common clinical sign was syncope (14/26). Twenty-four dogs received artificial pacemakers (PM). Major complications after PM implantation were observed in four dogs (four/24). Serial echocardiographic examinations showed that cardiac dimensions of PAS dogs with left atrial or left ventricular dilation at first presentation did not return to reference range after pacing. Further dilation of the cardiac chambers, recurrence of congestive heart failure (CHF), or development of new episodes of CHF were documented in seven, four, and 10 PAS dogs, respectively, despite pacing. Median survival time for cardiac-related deaths after PM implantation was 1512 days (18–3207). Neither CHF nor echocardiographic variables at presentation predicted survival after PM implantation in PAS dogs. ConclusionsPersistent atrial standstill (PAS) is an uncommon bradyarrhythmia, occurring in young adult dogs. Affected dogs were often presented with syncope. Whilst syncope resolved, cardiac remodeling persisted after PM implantation. Long-term survival was favorable after PM implantation and was not predicted by congestive status or cardiac chamber size at first presentation.

Myocarditis as a rare, yet serious adverse event associated with immune checkpoint inhibitors in patients with non-small cell lung cancer: Case series from a large community-based cancer center.

e21047 Background: Patients (pts) with lung cancer and other cancers treated with immune checkpoint inhibitors (ICI) may experience immune related adverse events (irAE). These can present with variable severity and with single- or multi-organ involvement including pneumonitis, colitis, hepatitis, and myocarditis/pericarditis. The incidence of myocarditis has been reported between 0.06% and 2.4% and is associated with a high mortality (25% to 50%). This retrospective review of real-world data (RWD) investigates myocarditis as a high-grade adverse event in pts with lung cancer treated with ICIs. Methods: Pts were identified and characterized using RWD in the Syapse Learning Health Network platform from 2010 to 2020 at Advocate Aurora Health Care. Eligible pts included: ≥18 years old; histologically confirmed NSCLC; and myocarditis diagnosis by ICD codes. Additional chart review was performed to confirm timing of ICI treatment and myocarditis. All pts identification and review were performed after IRB review. Results: 12,686 pts with non-small cell lung cancer were eligible for review. The median age at diagnosis was 70; 54% were female; 86% were White and 12% were Black; 1,975 (15.6%) were treated with an ICI and of those 4 cases (0.2%) of myocarditis were identified. All 4 pts were White females, ages 46, 59, 65, and 74 years. Pathology included lung adenocarcinoma (3) and an undifferentiated lung carcinoma (1). All pts had metastatic disease, and none had a prior history of cardiac disease. ICIs were pembrolizumab (2), durvalumab (1), and nivolumab (1). Median time from initial dose of ICI to diagnosis of myocarditis was 62 days [range: 42-185]. All 4 pts presented with chest pain and elevated troponin T [median 0.07 ng/ml (range: 0.06-0.08)]. All pts had echocardiography at the time of diagnosis, and 2 pts had cardiac MRI that confirmed myocarditis. 3 pts were treated with a prednisone taper. 1 pt died of recurrent congestive heart failure and ventricular tachycardia despite rescue attempt with high dose corticosteroids. 2 pts had additional concomitant irAEs of hypothyroidism/colitis, and thyroiditis/pneumonitis, respectively. Conclusions: Many irAEs are reversible. This RWD analysis confirms that clinically evident myocarditis is a rare but serious adverse event of ICI therapy. Early consideration, diagnosis, and intervention may help prevent poor outcomes. Termination of ICI therapy along with initiation of corticosteroids constitute the current standard of management. Further research is warranted to better identify high risk groups, surveillance measures, and improved management of ICI associated myocarditis.

Time to percutaneous coronary intervention in patients with ST-elevation myocardial infarction undergoing successful systemic fibrinolysis: does early or late make a difference?

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf PHASE-MX Background/Introduction: Early routine angiography with subsequent Percutaneous Coronary Intervention (PCI) (if needed) after fibrinolysis reduced the rates of reinfarction and recurrent ischemia compared with a ‘watchful waiting’ strategy. A crucial issue is the optimal time delay between successful lysis and PCI, there is a wide variation in delay in trials from a median of 1.3 h to 17h (CAPITAL AMI, GRACIA-1 and STREAM trials). At present a time window of 2-24h after successful lysis is recommended. Purpose To analyze the incidence of major cardiovascular outcomes in patients with ST-segment elevation myocardial infarction (STEMI) according to the timing of PCI after lysis (pharmacoinvasive strategy, less/more than 24h). Methods A retrospective analysis of the PHASE-MX study (ClinicalTrials.gov Identifier: NCT03974581) including patients with STEMI whom underwent pharmacoinvasive strategy during the first 12h since symptom onset. Patients were further stratified according to the time from the use of fibrinolysis to sheat insertion (<24h or >24h) in the completion of pharmacoinvasive strategy. The primary composite endpoint included the occurrence of cardiovascular death, cardiogenic shock, recurrent myocardial infarction or congestive heart failure at 30 days of follow-up. Results A total of 171 patients were included, of whom 34 underwent PCI after fibrinolysis in less than 24 hours and 137 underwent PCI in more than 24 hours (95% CI 24-120h). Mostly were male (86.4%), mean age was 56.4 ±12.1 years. The primary composite endpoint occurred in 2 patients (5.8%) in PCI < 24 hours and 12 patients (8.6%) in PCI >24 hours (p 0.58). PCI in <24h after lysis was not associated with a reduced risk of the primary endpoint (HR 0.66 95%CI: 0.14-2.97). Conclusion In patients with successful fibrinolysis undergoing to PCI the first 24 h was not associated with a reduced risk of cardiovascular death, cardiogenic shock, recurrent MI or congestive heart failure at 30 days comparing with PCI after 24 h. Abstract Figure. Kaplan-Meier in primary endpoint

In-hospital ventricular arrhythmia in heart failure patients: 7year follow-up of the multi-centric HEARTS registry.

AimsThe aim of this study was to determine the incidence, predictors, and short‐term and long‐term outcomes associated with in‐hospital sustained ventricular tachycardia (VT) and ventricular fibrillation (VF) collectively termed ventricular arrhythmia (VA) in the heart failure (HF) patients.Methods and resultsThe HEart function Assessment Registry Trial in Saudi Arabia (HEARTS registry) is a prospective national registry of patients with chronic HF from18 tertiary care hospitals across Saudi Arabia. Diagnosis of HF was in accordance with American Heart Association/European Society of Cardiology definition criteria. The registry had enrolled 2610 HF patients during the 14 month recruitment period between October 2009 and December 2010. Occurrence of in‐hospital cardiac events, prognosis, and outcome were monitored during the 7 year follow‐up period. The incidence of in‐hospital VA in HF was 4.2%. VA was more common among men, and mean age was lesser than non‐VA patients (58.5 ± 16: 61.5 ± 15 years; P = 0.042). Smoking and family history of cardiomyopathy were significant risk factors of VA. Previous history of arrhythmia, ST elevated myocardial infarction, infections, and hypotension remained significant predictors of in‐hospital VA associated with three to seven times more risk. Patients with VA had higher rates of in‐hospital events like recurrent HF, haemodialysis, shock, sepsis, major bleeding, intra‐aortic balloon pump, and stroke compared with those without VA, all being highly significant (P < 0.001). After adjustment for age, gender, and co‐morbidities, in‐hospital VA increased the risk of cardiogenic shock by 24 times, dialysis and major bleeding by 10 times, and recurrent congestive HF and pacing by five times. Survival analysis showed that all‐cause mortality was significantly higher in the VA patients (P < 0.001). Presence of VA increased in‐hospital and 1 month mortality to 23 and 17 times, respectively.ConclusionsLower mean age of VA complicated HF patients is a matter of concern in the Saudi population. HF associated with VA increased in‐hospital events and all‐cause mortality indicating poor prognosis and survival. These findings enable risk stratification and reflect on the importance of early recognition of the clinical markers and predictors of VA prompting immediate management.

Outcomes, Costs, and 30-Day Readmissions After Catheter Ablation of Myocardial Infarct–Associated Ventricular Tachycardia in the Real World

Patients undergoing catheter ablation of myocardial infarction-associated ventricular tachycardia (VT) have significant comorbidities that can increase the risks of adverse outcomes. The rates of readmissions after VT ablation are unknown. We sought to examine in-hospital outcomes, costs, and 30-day readmissions after catheter ablation of myocardial infarction-associated VT. Using the Nationwide Readmissions Database, we evaluated 4109 admissions for catheter ablation of myocardial infarction-associated VT occurring between 2010 and 2015. On the basis of International Classification of Diseases, Ninth Revision, Clinical Modification and Clinical Classification Software codes, we identified comorbidities, procedural complications, 30-day readmissions, and costs associated with VT ablation. The index admission in-hospital mortality rate and procedural complication rate after VT ablation were 2.7% and 11.5%, respectively. Independent predictors of mortality included pulmonary hypertension, lung disease, obesity, and coagulopathy. Following discharge after VT ablation, the 30-day readmission rate was 19.2% with a median time to readmission of 10.0 days (IQR, 3.8-17.6 days) and an in-hospital mortality rate of 2.9%. Cardiac causes accounted for 74% of readmissions, with VT and congestive heart failure constituting 41% and 14% of all readmissions, respectively. Pulmonary hypertension, congestive heart failure, smoking, chronic pulmonary disease, and prolonged index hospitalization were significant independent predictors of 30-day readmission. After adjustment, 30-day readmissions were associated with a 38.9% increase in cumulative hospitalization costs. Thirty-day readmissions after catheter ablation of VT occur in nearly 1 out of 5 cases, with the majority of readmissions being caused by recurrent VT or congestive heart failure. Baseline comorbidities are significant predictors of procedural mortality, complications, and readmissions. Strategies to reduce recurrent VT postablation by improving procedural success, optimizing postablation heart failure treatment, and ensuring close postdischarge follow-up may help reduce readmissions and healthcare costs.

Clinical Features of the Patients with Recurrent Massive Pericardial Effusion: Single Center Experience

Objective: In this study, we aimed to determine the clinical features of patients with recurrent pericardial effusion. We also aimed to evaluate the clinical course and the outcomes of the patients with recurrent pericardial effusion who underwent percutaneous and surgical interventions. Method: 22 patients with recurrent massive pericardial effusion were retrospectively evaluated. We recorded the primary etiologies of effusion, laboratory parameters, and time of the recurrence of effusion, type of the pericardial drainage and also one year mortality of the patients after pericardial drainage. Results: Mean age of the patients was 60±16 and 64% were male. The most common cause was malignancy (31%) followed by idiopathic (27%), postcardiotomy syndrome (13,5%), renal failure(13,5%), autoimmune disease (10%), and heart failure (5%). Median recurrent time was 46 days (interquartile range 16-78 days). The characteristics of the pericardial fluid at initial intervention consist of 59.5% serohaemorrhagic, 27% serous and 13,5% hemorrhagic pericardial effusion . Majority of patients (73%) underwent subxiphoid tube drainage and the remaining patients (27%) underwent percutaneous pericardiocentesis in first intervention. 9 (40.9%) patients died in one year follow up. Of the dead patients, 55.5% had malignity, 22.2% had postcardiotomy syndrome and 22.2% had renal failure. Conclusion: The most common cause of death and recurrent pericardial effusion was malignancy. Idiopathic recurrent pericarditis, autoimmune disease and congestive heart failure are the most benign pathology in which the patients had no mortality in a 1 year follow up period.

Should the mitral valve be repaired for moderate ischemic mitral regurgitation at the time of revascularization surgery?

Ischemic mitral regurgitation (IMR) is associated with increased mortality and recurrent congestive heart failure following coronary artery bypass graft (CABG) surgery. While mitral surgery should be undertaken for severe MR during CABG, the treatment of moderate IMR remains controversial. We conducted a meta-analysis to determine the outcomes of CABG alone and combine with mitral valve repair (MVr) in moderate IMR. A literature search was conducted by Pubmed, Ovid, and Embase, which included 643 articles. Eleven studies (seven observational studies and four randomized controlled trials) with a total of 1406 patients were included (CABG alone = 864 and CABG plus MVr = 542). There was no difference in operative mortality (odds ratio 1.56, 95% confidence interval [CI] 0.92-2.71) or long-term survival at 1 or 5 years (hazard ratio 0.98, 95%CI 0.71-1.35, P = 0.49) between the two groups, and little evidence of heterogeneity was found in the studies (I2 = 0.0, P = 0.562). There was significantly greater improvement in MR grade (weighted mean difference [WMD] -1.15, 95%CI -1.67 to -0.064, P = < 0.001) and left ventricular systolic diameter (WMD -3.02, 95%CI -4.85 to -1.18, P = 0.001) following CABG and MVr compared to CABG alone. No difference in postoperative functional class or ejection fraction was found. Our results show that in the presence of moderate IMR, adding MVr to revascularization reduces MR grade on follow-up echocardiography and promotes ventricular remodeling, with no improvement in long-term survival or functional class.

Abstract 088: Characteristics of Congestive Heart Failure Patients Included in The Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program

Background: The Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program (HRRP) has created financial penalties for hospitals with higher risk-standardized readmission rates after hospitalization for specific conditions, including congestive heart failure (CHF). Identification and risk-standardization is performed with administrative data. Both to evaluate the utility of this metric for improving quality and to inform efforts by providers to reduce readmissions, more granular clinical information about patients included in the penalty is needed. Methods: All patients who contributed to the CHF component of the HRRP penalty at our hospital between June, 2012 and December, 2013 were identified and medical records were reviewed by a physician (A.J.C.). Information extracted included index inpatient service, cause of readmission, medications, scheduled follow-up, whether echocardiogram was performed, NT pro-BNP as measured at admission and discharge, weight documented during index hospitalization, last known ejection fraction, and discharge disposition. Results: During this time period, 212 readmitted CHF patients contributed to the HRRP penalty. Of those, 31 (14.6%) were excluded due to readmission to an outside hospital. Of the remaining 181, 6 (2.8%) were excluded as the cause of index admission was not confirmed to be CHF. These patients were excluded from all analyses. Of the remaining 175 patients, 79 (45.1%) were readmitted for recurrent CHF exacerbation while 96 (54.8%) were readmitted for reasons other than CHF. Seventy (40%) patients were discharged home with visiting nurse services, 44 (25.1%) discharged home without services, and 61 (34.9%) discharged to a skilled nursing facility. Of the 114 patients discharged home, 44 (38.6%) had follow-up scheduled at the time of discharge. The median length of time between the index admission and readmission was 13 days. Among the 79 patients readmitted for CHF-related causes, 39 (49.4%) initially had been hospitalized on the cardiology service while 40 (50.6%) were hospitalized on a general medical service. Of those 79 patients, 32 (40.5%) had left ventricular systolic dysfunction (LVSD). At time of index discharge, 28 (87.5%) of patients with LVSD had been prescribed a beta blocker and 12 (37.5%) had been prescribed an ACE inhibitor or ARB. Conclusions: About half of patients who contributed to the CHF component of the HRRP penalty at our hospital were readmitted for recurrent CHF, the other half for different diagnoses. Of those who were readmitted with recurrent CHF, more than half did not have systolic dysfunction. Many of the patients with recurrent CHF due to systolic dysfunction were not initially discharged on ACE or ARB therapy, largely due to hypotension or renal dysfunction. These findings underscore the challenges of reducing preventable hospital readmission in this HRRP penalty population.

O9-6 - Left Atrial Remodeling and Recurrence of Congestive Heart Failure in Patients with Atrial Fibrillation

O9-6 - Left Atrial Remodeling and Recurrence of Congestive Heart Failure in Patients with Atrial Fibrillation

Comparison of Left Ventricular Relaxation and Left Atrial Function in Patients With Heart Failure and Preserved Ejection Fraction Versus Patients With Systemic Hypertension and Healthy Subjects

Heart failure with preserved ejection fraction (HFpEF) may be characterized as impaired left ventricular (LV) relaxation and/or left atrial (LA) function, both of which are age and gender dependent. The aim of this study was to investigate LV relaxation and the LA function in HFpEF. A total of 71 HFpEF (mean age 73years, 38 men) were studied. Late transmitral flow velocity (A), late mitral annular velocity (a'), and early mitral annular velocity (e') were measured and compared with age- and gender-matched normal control subjects (CTL; n= 71) and hypertensive patients (HT; n= 71). To clarify prognostic impact of the LA function, cardiac event-free survival was compared between high a' (≥7.9cm/s, n= 36) and low a' (<7.9cm/s, n= 35) groups. Cardiac event was defined as a composite of all-cause death and hospitalization due to recurrent congestive heart failure. In both HFpEF and HT groups, e' was significantly and similarly decreased compared with CTL group (p= 0.005). Although A was similar among the 3 groups, a' was significantly lower in HFpEF group than in HT and CTL groups (7.9 ± 2.1 vs 9.0 ± 1.9 vs 9.3 ± 1.96cm/s, p <0.0001). HFpEF with low a' showed significantly lower cardiac event-free survival than HFpEF with high a' (log rank, p= 0.02). By multivariate Cox proportional analysis, low a' was the only independent predictor of cardiac events (hazard ratio 2.896, 95% confidence interval 1.004 to 8.355, p= 0.049). Both LV relaxation and LA function are impaired in HFpEF. Impaired LA function may be associated with worse prognosis in HFpEF.

Improvement of left ventricular filling and pulmonary artery pressure following unilateral renal artery total occlusion stenting in a patient with recurrent congestive heart failure complicated by renovascular hypertension and renal failure.

Recurrent congestive heart failure related to renal artery disease is an important clinical entity that is typically observed in bilateral renal artery stenosis or solitary functioning kidney. However, the relationship between heart failure and unilateral renal artery disease, especially that with total occlusion, remains unclear. We report a successful management by unilateral renal artery total occlusion stenting with an evidence of improvement of left ventricular filling and pulmonary artery pressure in case of a patient suffering from medical therapy resistant recurrent congestive heart failure with preserved ejection fraction.

PRM58 - Predicting heart failure recurrence after aortic valve replacement using a competing-risks model

Congestive heart failure (CHF) is a major health burden with an increasing prevalence and incidence. Risk factors associated with recurrent CHF following surgical aortic valve replacement (AVR) have been described in a multivariate model by Ruel et al.1 ■ A Cox proportional hazards model was used to estimate survival from a composite CHF endpoint de ned as CHF recurrence / exacerbation or CHF-related death after AVR ■ The model was developed based on 1563 patients who underwent AVR at the Ottawa Heart Institute between 1976 and 2001 ■ CHF-free survival was reported at years 1, 5, 10, and 15 after AVR

Effect of Direct Renin Inhibitor on Left Ventricular Remodeling in Patients With Primary Acute Myocardial Infarction

Some patients with acute myocardial infarction (AMI) have a poor prognosis due to left ventricular remodeling (LVR), resulting in the recurrence of congestive heart failure even when therapy with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II type 1 receptor blockers (ARBs) has been initiated. We investigated the effect of early administration of the direct renin inhibitor (DRI) aliskiren in combination with an ACEI or an ARB on LVR using cardiac magnetic resonance (CMR) imaging in patients with AMI.Twenty-one consecutive patients were treated with an ACEI or an ARB (non-DRI group), and another 21 consecutive patients received aliskiren 150 mg/day combined with an ACEI or an ARB (DRI group). CMR imaging was performed 7 days after AMI and 10 months later.CMR imaging revealed no significant changes in LV end-systolic volume, LV end-diastolic volume, or LV ejection fraction between the patients with and without DRI aliskiren. In the DRI group, plasma renin activity was significantly lower in both the acute and chronic phases; however, aldosterone levels were significantly lower in the acute but not the chronic phase.A low dose of aliskiren may be insufficient to maintain suppression of aldosterone under current standard therapies with an ACEI or an ARB and β-blocker in patients with primary AMI, and results in no attenuation of LVR.

Left Atrial Remodeling and Recurrence of Congestive Heart Failure in Patients Initially Diagnosed with Heart Failure

Left atrial volumes (LAVs) have been suggested to represent long-term exposure to elevated pressures. This study examined the recurrence of heart failure (HF) based on LAV in patients initially diagnosed with congestive HF (CHF). This study comprised 77 patients (age, 75±8years) with well-documented, clinically defined HF, and complete two-dimensional echocardiographic examinations. The echocardiographic examinations were performed on admission and after medical treatment (90±43days after initial examination). Patients with atrial fibrillation, flail mitral valve, or mitral valve replacement were excluded from this study. The initial left ventricular ejection fraction (LVEF) was 44±17% and the indexed LAV (LAVI) was 61±22mL/m(2) . After medical treatment, a decreased LAVI was observed in 38 patients and an increased LAVI (LA remodeling) was observed in 39 patients. With median follow-up periods of 454days, compared to patients with decreased LAVI, patients with LA remodeling had a significantly higher incidence of CHF recurrence (P=0.008). Patients with LA remodeling had a CHF-free survival rate of 36±13% vs. 81±9% (those without LA remodeling). A multivariate analysis indicated that, follow-up LV end-systolic volume (P=0.04), LVEF (P=0.005) and LAVI (P=0.04) independently predicted CHF recurrence. Patients initially diagnosed with CHF follow divergent courses based on their LAV. LA remodeling after medical treatment can be useful for predicting CHF recurrence during follow-up.

Prognostic value of late gadolinium enhancement in cardiovascular magnetic resonance imaging after acute ST-elevation myocardial infarction in comparison with single-photon emission tomography using Tc99m-Sestamibi

Infarct size is an important predictor of cardiac risk after acute myocardial infarction. The established modality for its assessment is Tc99m-Sestamibi Single-photon emission computed tomography (SPECT). In recent years, data are emerging demonstrating that scar size as assessed by late gadolinium enhancement in cardiovascular magnetic resonance imaging (CMR) as well as the presence of microvascular obstruction (MO) may also provide prognostic information, however, so far no direct comparisons of both modalities have been reported. We retrospectively analysed patients (n = 281) with acute ST-elevation myocardial infarction and primary angioplasty who underwent Tc99m-Sestamibi-SPECT and CMR on a 1.5 T scanner at a median of 4.3 (IQR: 3.7-5.1) and 4.9 (IQR: 4.1-5.9) days after the acute event, respectively. The primary endpoint of the study was a composite of all-cause mortality, recurrent myocardial infarction and congestive heart failure requiring hospitalization. During a median follow-up of 3.0 (IQR: 2.0-4.5) years, 24 events occurred. The best predictor was MO (P < 0.0001), followed by infarct size by CMR (P = 0.0043) and infarct size by SPECT (P = 0.012) (all P-values corrected for clinical risk). In a multivariate model including clinical and periprocedural parameters, MO remained the only significant predictor in addition to clinical risk. The extent of MO as determined by CMR has an excellent prognostic value in predicting cardiac events following acute myocardial infarction and may be used as an alternative to infarct size assessment by Tc99m-Sestamibi-SPECT.

Left Atrial Remodelling and Recurrence of Congestive Heart Failure in Patients Initially Diagnosed with Heart Failure

Left Atrial Remodelling and Recurrence of Congestive Heart Failure in Patients Initially Diagnosed with Heart Failure

Serum zinc values in children with congenital heart disease

Some children with congenital heart diseases (CHD) may have increased pulmonary blood flow that causes recurrent bronchopneumonia and congestive heart failure. Serum zinc is reduced in children with pneumonia and patients on diuretics. To evaluate the serum zinc level of children with CHD and their controls without CHD. The subjects were 41 children with CHD confirmed on echocardiography recruited from a paediatric cardiology clinic in a tertiary centre in Nigeria. The controls were 41 children without CHD. Biodata and anthropometric measurements were taken. The serum zinc was determined using atomic absorption spectrophotometer method. The mean difference in the serum zinc of the subjects 101.3 ± 21.6 µg/dl and controls 106.5 ± 18.3 µg/dl, was not significant, p = 0.351. The subjects with pneumonia had a lower mean serum zinc value 89.5 ± 15.0 µg/dl compared to those without pneumonia 103.9 ± 22.2 µg/dl, p = 0.006. The mean serum zinc values of the subjects on diuretic was not statistically different from those not on diuretic, p = 0.599. The serum zinc levels of the subjects and controls were not significantly different. Children with CHD and pneumonia had significantly lower zinc level compared to those without pneumonia.