Sided Heart Failure Research Articles

Veno-venous extracorporeal membrane oxygenation for severe COVID-19 associated acute respiratory distress syndrome: A retrospective, nationwide, Danish cohort study.

Severe acute respiratory syndrome (ARDS) may require veno-venous extracorporeal membrane oxygenation (V-V ECMO). The aim of this study was to provide data on patient selection and outcome in a nationwide cohort study of patients with COVID-19 associated ARDS supported with V-V ECMO. We identified all patients with COVID-19, who were supported with V-V ECMO in Denmark from March 10, 2020, to December 31, 2021, and retrieved data on patients who were referred to- and accepted for ECMO, demographics, outcome data, and complications. Risk factors for mortality were analysed using multivariate Cox regression analysis. During the study period, 1836 patients were admitted to Danish intensive care units (ICUs). In the same period, there were 197 enquiries for ECMO of whom 118 patients were considered eligible. Overall, 71 patients were cannulated for ECMO; three patients were cannulated for veno-arterial extracorporeal membrane oxygenation (V-A ECMO) due to right sided heart failure and 68 patients were cannulated for V-V ECMO. Two patients accepted for V-V ECMO died during cannulation. The median age was 55 years (IQR 45-60) and 66% were males. The median duration of ECMO support was 13 days (IQR 7-21), mechanical ventilation median 26 days (IQR 14-42), ICU stay median 34 days (IQR 17-46), and length of hospital stay median 41 days (IQR 25-56). Ninety-day mortality was 43%. Age of 60 years or more was associated with an increased risk of mortality. Pre-existing hypertension was associated with a decreased risk of mortality. A nationwide, Danish cohort study of 68 COVID-19 patients supported with V-V ECMO, showed a 90-day survival of 43%, which is in accordance with reports from comparable cohorts. Age of 60 years or more was associated with an increased risk of mortality. Pre-existing hypertension was associated with a decreased risk of mortality.

Right ventricular dysfunction in chronic heart failure: clinical laboratory and echocardiographic characteristics. (the RIVED-CHF registry).

Right ventricular dysfunction (RVD) and pulmonary hypertension have been recognized as two important prognostic features in patients with left side heart failure. Current literature does not distinguish between right heart failure (RHF) and RVD, and the two terms are used indiscriminately to describe pulmonary hypertension and RVD as well as clinical sign of RHF. Therefore, the right ventricle (RV) adaptation across the whole spectrum of left ventricular ejection fraction (LVEF) values has been poorly investigated. This is a multicenter observational prospective study endorsed by the Italian Society of Cardiology aiming to analyze the concordance between the signs and symptoms of RHF and echocardiographic features of RVD. The protocol will assess patients affected by chronic heart failure in stable condition regardless of the LVEF threshold by clinical, laboratory, and detailed echocardiographic study. During the follow-up period, patients will be observed by direct check-up visit and/or virtual visits every 6 months for a mean period of 3 years. All clinical laboratory and echocardiographic data will be recorded in a web platform system accessible for all centers included in the study. The main study goals are: to investigate the concordance and discordance between clinical signs of RHF and RVD measured by ultrasonographic examination; to evaluate prognostic impact (in terms of cardiovascular mortality and heart failure hospitalization) of RVD and RHF during a mean follow-up period of 3 years; to investigate the prevalence of different right ventricular maladaptation (isolated right ventricular dilatation, isolated pulmonary hypertension, combined pattern) and the related prognostic impact. With this protocol, we would investigate the three main RVD patterns according to heart failure types and stages; we would clarify different RVD and pulmonary hypertension severity according to the heart failure types. Additionally, by a serial multiparametric analysis of RV, we would provide a better definition of RVD stage and how much is it related with clinical signs of RHF (ClinicalTrials.gov Identifier: NCT06002321).

Recognition and management of left atrial dissection during mitral repair

BackgroundLeft atrial dissection (LAtD) is a rare but potentially life-threatening complication of mitral valve surgery. Its management is not well stablished in the literature. However, early recognition through intraoperative TEE and attention to changes in the left atrial free wall during saline leak testing can lead to avoidance of severe complications.Case presentationWe report a case of LAtD detected by intraoperative transesophageal echocardiogram (TEE) following mitral valve repair for primary mitral valve regurgitation secondary to degenerative mitral valve disease with MAZE IV procedure for atrial fibrillation. LAtD was noted on TEE as an expanding double density along the wall of the left atrium with a jet originating at the posterior annulus flowing into the LAtD which was repaired. Separation from bypass following LAtD repair was complicated by severe biventricular dysfunction requiring significant inotropic support and placement of an intra-aortic balloon pump (IABP). Patient’s post-operative course was further complicated by right sided heart failure requiring placement of a right sided impella which was subsequently removed on POD 4. Patient was discharged home on POD 17. Transthoracic echo at 1 month, 3 months demonstrated resolution of the LAtD. A follow up echo at 4 years showed complete resolution of the LAtD with an intact mitral repair, trace mitral regurgitation, and a mean gradient across the repair of 3 mm Hg.ConclusionsLeft atrial dissection is a rare but serious complication of mitral valve surgery. We provide a review of the current literature regarding LAtD, emphasizing the need to consider this complication early during mitral surgery to allow for uncomplicated repair.

Prognostic and diagnostic utility of interleukin-6 in pediatric pulmonary arterial hypertension — a case-control study

Pulmonary arterial hypertension (PAH) in pediatrics is a progressive disease with significant vascular remodeling, right sided heart failure, and death if left untreated. Elevated interleukin-6 (IL-6) level in PAH patients is taken as an independent predictor of adverse outcome including mortality. The aim of this study was to investigate and compare serum levels of IL-6 in children with PAH and healthy matched controls, and correlate between IL-6 and degree of PAH, as well as mortality. IL-6 was measured by ELISA in serum samples in 40 children with PAH (age 1–12 years) and 40 age and sex-matched healthy controls. There was a statistically significant increase in IL-6 level among PAH cases compared with the controls (1.85 ng/L vs 1.30 ng/L, p-value = 0.004). IL-6 at cut off point 1.45 ng/L significantly predict pulmonary hypertension in children (AUC = 0.685, 75% sensitivity, and 65% specificity with p = 0.002). There was no statistically significant association between IL-6 level and degree of PAH (p = 0.218). There was no statistically significant association between IL-6 level and mortality (p = 0.662). Conclusion: IL-6 significantly predict PAH in pediatrics but there is no association between IL-6 level and degree of PAH or mortality. IL-6 may provide a less costly and less invasive method for disease detection.What is Known:• Definitive diagnosis of PAH is made by right heart catheterization, while echocardiography is the gold standard for tracking the course of the disease.What is New:• It was assumed that children with a diagnosis of PAH would have higher serum IL-6 levels than controls. Furthermore, an adverse relationship between the blood IL-6 level and PPAH was predicted.

Massive Bilateral Pulmonary Thromboembolism – A Bolt from the Blue Case Report

Thrombosis originating from the deep veins of the lower limbs can result in recurrent emboli leading to acute on chronic pulmonary thromboembolism. The death in such situations would be sudden and unexpected due to acute right sided heart failure (cor pulmonale). There can be few preceding non-specific symptoms such as cough and/or dyspnoea, especially in non-hospitalised decedents. Many a time pulmonary thromboembolism is only detected in a medicolegal autopsy. The sudden and unexpected death in an apparently healthy individual paves the way for a police inquest procedures, and a medicolegal autopsy would be the only legal and logical alternative to find a closure. However, massive bilateral pulmonary thromboembolism occluding almost more than 80 percentage of the pulmonary artery vasculature is an extremely rare phenomenon in a medicolegal autopsy. This case report has been prepared to discuss on such a rare presentation, discovered during the medicolegal autopsy of an apparently healthy 46-year-old individual who collapsed on the sides of a road, and was brought dead to the hospital.

Tricuspid regurgitation and heart failure: the faith of treated vs untreated cohort in the percutaneous era

Abstract Background/Introduction Tricuspid regurgitation (TR) is associated with heart failure and reduced survival.Within a short-time period, transcatheter tricuspid valve repair or replacement (TTVR)(TTVr) for TR has evolved from innovation to clinical reality. Still, most patients arrive in an advanced state of heart failure (HF), as well as most cohorts remained untreated for various reasons. The faith of these two therapeutic approaches gives differences in results among survival and clinical status at distance. Purpose The present study’s aim is to provide 1 year results between TR patients treated with TTVR and TTVr compared to untreated patients, in terms of cardiac survival, rehospitalization, right-side heart failure symptoms development, and NYHA improvement. The secondary endpoint is to analyze gender disparities as well as echocardiographic and medical therapy changes between groups. Methods 78 patients (pts) have been prospectively inserted into a dedicated database from January 2020 till January 2023. 26 pts (36%) have been treated with TTVR/r (Treated Group-TG) and 51 pts (65%) have been left untreated with medical therapy (MT) optimization (UN-Treated Group-UNTG). In TG, 9 (34%) underwent TEER (Transcatheter Edge-To-Edge Repair), 13 (50%) annuloplasty and 4(15%) TTVr. Tri-Score was used to define right-side pathology in both groups; the Tri-Score mean of 3.9 (8-1 +/- SD 1.68) was in TG, while 6,17 (10-2+/- SD 1.9) in UNTG. In UNTG 52% were female gender while 76%in TG. Most of the patients in UNTG were in TR stage 5 (47%) while in stage 4 in TG (42%). For 1 year follow-up (FUP), Kaplan-Meier weighted survival curves related to cardiac death and HF rehospitalization have been computed as well as Chi-squared test to evaluate right-side HF symptoms progression, echocardiographic changes in right ventricular function, NYHA progression and medical therapy changes, between the 2 groups. Results Analyzing the cardiac death between the 2 groups, there was a significant statistical difference since TG has a less incidence of exitus in the general population (p-value =0,05), Figure 1. Concerning gender, in female gender, the treated pts have lower cardiac death incidence (p-value =0,03).Concerning HF hospitalization, TG has a lower incidence with p-value =0,005, Figure 2. No difference according to gender. In TG there was a significant improvement in NYHA class at FUP (p-value =0,001) as well as an improvement of right-side HF symptoms (p-value =0,001). In UNTG there was a significant increase in the dosage of HF drugs compared to TG, (p-value =0,001) as well as an increase in right ventricular function and dimension at echocardiogram (p-value =0,001). Conclusion(s) this study shows that treatment in case of TR with right side HF has a positive impact upon cardiac death,HF hospitalisation at 1 year. As well as there is a significant improvement in clinical and ecocardiographic status at FUP in treated group.figure 1figure 2

126 Prevalence of Right Sided Heart Failure in Angus Influenced and Beef on Dairy Fattening Feedlot Cattle

Abstract Bovine Congestive Heart Failure (BCHF) exists in feedlot cattle at low to moderate elevations, but previous studies focused solely on beef cattle. The economic advantage of breeding beef sires to dairy dams results in an increase in the number of beef on dairy (DXB) crossed cattle in the feedlot system, though not much is known on the comparative prevalence of BCHF in DXB compared with beef cattle breeds. The inclusion of a new breeding program for dairy producers leads to another potential source of variability (i.e., dairy influenced genetics) for heart disease research in the feedlot sector. Heart failure in the feedlot is typically known as Feedlot Heart Disease (FHD) and has been reported to result in unfavorable carcass and growth performance damaging quality and efficiency throughout the lifetime of cattle. The unknown prevalence of heart failure in DXB cattle may be a problem for producers since little is known about which breeds are at greater risk. The severity of FHD for both beef and DXB cattle was determined by individually grading hearts at harvest using a 1 to 5 grading system corresponding to the stage of heart remodeling with a score of 1 (normal heart) and greater scores indicating increased remodeling. The objective of this study was to examine the prevalence of heart remodeling in both an Angus influenced group of beef cattle and a sample of DXB cattle. Heart scores were collected on an Angus influenced group raised in the panhandle of Texas (1,103m) and totaled 1,634 animals (Grade 1: 347; Grade 2: 848; Grade 3: 371; Grade 4: 68; Grade 5: 0). Heart scores were collected on a DXB group raised in western Kansas (846 m) and totaled 2,328 animals (Grade 1: 913; Grade 2: 1,162; Grade 3: 225; Grade 4: 27; Grade 5: 1). Proportions of moderate to severe heart remodeling were 0.27 and 0.11 for Angus influenced and DXB, respectively. In conclusion, preliminary research on heart remodeling in both samples indicates a greater proportion of cattle experiencing heart remodeling in beef breeds versus the DXB cattle, although further investigation is needed to make conclusions about the consistency of heart remodeling and breed effects.

Serum aldosterone in right ventricular failure versus left ventricular failure before and after mineralocorticoid receptor antagonists: case-control clinical trial

Background Heart failure (HF) is a global growing health threat. This case-control clinical trial aimed to detect the predictive value and difference in aldosterone level between right side heart failure, heart failure with decreased ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) and compare the efficacy and safety of adding mineralocorticoid receptor antagonist (MRA) for treatment. Patients and methods We recruited 151 participants, 135 HF patients divided equally into 45 patients in each group:(1) right side HF (2) HFrEF and (3) HFpEF and 16 healthy controls. Serum aldosterone, troponin and echocardiography were evaluated at the beginning of the study, three and six months after administration of MRA. Results Aldosterone level was significantly greater in HF patients relative to controls. Aldosterone level can detect HF with excellent accuracy. There were significantly lower levels of aldosterone in right side HF compared to left side HF. There was a significant decrease in right ventricle dimensions, pulmonary artery systolic pressure and pulmonary artery size and significant increase in tricuspid annular plane systolic excursion after treatment in patients with right side HF. In the HFrEF group, there was a significant decrease in left ventricular end diastolic dimension and a significant increase in left ventricular EF after treatment. In the HFpEF group, there was a significant decrease in E/A and E/e′ after treatment. Conclusions Aldosterone may have pathogenic role in HF. Measuring and follow-up of aldosterone levels should be considered in HF patients. MRA treatment gives a significant improvement in right side HF group.

Pulmonary hypertension and right-sided heart failure in hemodialysis patients

Background & Objectives: Cardiovascular complications are associated with poor outcomes in patients with End stage renal disease. This study is aimed to evaluate the prevalence of pulmonary hypertension and right side heart failure in hemodialysis patients, trying to decrease these complications by referring them to the cardiologist in order to manage them either by medical or interventional methods. Methods: A cross-sectional study for evaluation the prevalence of pulmonary hypertension and right sided heart failure in hemodialysis patients was carried out in Duhok kidney center in Kurdistan region-Iraq through a duration period of one year from first of February, 2020 to 31st of January, 2021 for 101 patients. Data were collected which included Age, gender, BMI, causes of renal failure and vascular access, and echocardiography was conducted by a cardiologist, he evaluated them by using tricuspid regurgitation jet peak gradient for pulmonary hypertension, and by using tricuspid annulus plane systolic excursion method for evaluation of right ventricular function. Results: In the current study 51 females with melasma. Their ages ranged between (19-46) years, with (59.9%) between (28-38) years. The duration of melasma was from 6 months to 9 years. Thirty-eight of them were married and had pregnancy. Thyroid stimulating hormone levels were high in 22 of them (43.1%), 20 out of 22 cases that was had high levels of thyroid stimulating hormone had dermal type of melasma by Wood’s lamp examination and their p-value was significant (0.001). Conclusion: The prevalence of pulmonary hypertension among patients on hemodialysis in Kurdistan region-Iraq is within the Iraqi and international range studies with low prevalence of right ventricular dysfunction.

A Case Study of Tricuspid Endocarditis in Post-Partum Female

Tricuspid valve endocarditis is uncommon thing compared to left-sided endocarditis which accounts for approximately 5-10 % of all cases of infective endocarditis. Tricuspid valve endocarditis is most commonly seen in patients who are addicted to intravenous drugs. Patients may present with symptoms like right- sided heart failure. Tricuspid endocarditis during pregnancy or peri-partum period is a rare entity with significant morbidity and mortality. Rheumatic heart disease was considered a significant risk factor previously which has changed over to intravenous drug abuse in recent decades. We hereby report a case of tricuspid native valve endocarditis complicating the post-partum period in a young female without underlying traditional risk factors, who improved with medical therapy alone.

Identifying patients at risk for chronic thromboembolic pulmonary hypertension

Patients with chronic thromboembolic pulmonary hypertension represent a subgroup of patients suffering from pulmonary hypertension. The disease is characterized by chronic, non-resolving thromboembolic obstruction of pulmonary arteries following one or more episodes of pulmonary embolism and involving both large vessel and small vessel dysfunction in the lungs [ [1] Piazza G. Goldhaber S.Z. Chronic thromboembolic pulmonary hypertension. N Engl J Med. 2011; 364: 351-360 Crossref PubMed Scopus (276) Google Scholar ]. Clinically, the most important manifestations are shortness of breath, fatigue and symptoms as a consequence of right sided heart failure, all resulting in a significantly affected quality of life and even enhanced mortality.

Case of An Isolated Tricuspid Valve Regurgitation Presenting as Right Sided Heart Failure

Trivial to mild tricuspid regurgitation is commonly seen in patients with a normal right heart. It is usually asymptomatic and when severe enough may cause symptoms of right-sided heart failure such as ascites, edema and congestive hepatopathy. We present a case of a 46-year-old female who presented with progressive bipedal edema. Transthoracic echocardiography showed dilated right atrium and right ventricle with severe tricuspid regurgitation. Patient then underwent tricuspid valve replacement with a 29mm bioprosthetic valve. Final histopath report showed myxomatous degeneration of valve leaflets. Post-operatively, patient developed increasing shortness of breath and orthopnea. A repeat transthoracic echo revealed decompensation of right ventricle with decline in right ventricular systolic function. Patient was then given inotropic support with milrinone and norepinephrine and adequate diuresis with IV furosemide. She was gradually weaned off the inotropes. Prior to discharge, a repeat transthoracic echocardiogram done showed improvement of right ventricular systolic function and she was discharged on oral furosemide and spironolactone.

Right-sided heart failure as a first presentation of portopulmonary hypertension

Introduction. Pulmonary artery hypertension and right ventricular failure are potentially fatal complications that can develop in patients with portal hypertension. The objective of this case report was to report a patient with end-stage liver disease, and portal and pulmonary artery hypertension and right heart failure. Case outline. A 57-year-old man was admitted to the Cardiology Department of a tertiary referral hospital due to signs of right-sided heart failure, ascites, pleural effusions, and pretibial edema. The patient had the history of alcohol abuse, arterial hypertension, and gout. Just prior to the admission, abdominal ultrasound revealed granular liver structure, as well as ascites. Laboratory tests showed microcytic anemia, values of transaminases below referent, hypoalbuminemia, low creatinine clearance. Echocardiography revealed pulmonary hypertension, and right ventricle failure. Right heart catheterization unraveled precapillary pulmonary hypertension, but thoracic CT scan and thoracocentesis excluded underlying pulmonary illness. Treatment continued at the Gastroenterology Department of the tertiary hospital. Abdominal CT scan diagnosed cirrhotic liver, and signs of portal hypertension. The patient was treated with symptomatic therapy, but developed acute-on-chronic renal failure and eventually died. Conclusion. Multidisciplinary approach is very important to distinguish portopulmonary hypertension early in the course of liver disease, because evolution of right sided heart failure precludes these patients from adequate lifesaving therapy.

14 Effect of Pulmonary Arterial Pressure and Precipitation Interaction on Reproductive Performance in Angus Heifers in South Central Wyoming

Abstract Variable precipitation in the western United States impacts forage availability, potentially influencing fertility. Furthermore, producers located above 1,500 meters contend with high altitude disease (HAD) due to reduced atmospheric oxygen, potentially resulting in right sided heart failure. Pulmonary arterial pressure (PAP) score is an indicator trait of HAD. The physiological stress of elevated PAP score could compound environmental stress, such as variable precipitation. Thus, the objective of this study was to investigate the interaction of precipitation and PAP score on beef heifer fertility. Data for this study were sourced from the Colorado State University Beef Improvement Center (CSU-BIC; 1993-2019; n = 3,834; 2,150 to 2,411 m elevation) near Saratoga, Wyoming. Records included identification, birth year, yearling year, yearling weight (YW), PAP, first service conception (FSC), overall heifer pregnancy (HPG) and sire. Precipitation data were sourced from the National Oceanic and Atmospheric Administration. Three classifications were created: cumulative precipitation from birth to breeding, precipitation from heifer birth to weaning, and precipitation from heifer weaning to breeding. Initial models contained sources of variation of precipitation classification, PAP, YW and a PAP by precipitation classification interaction for the response of HPG and FSC. Logistical regression was executed followed by analysis of variance. Yearling weight was a predictor of FSC (P < 0.01) while weaning to breeding precipitation was a predictor for HPG (P < 0.05). In general, the PAP by precipitation interaction was not detected; however, PAP by weaning to breeding precipitation tended to predict HPG (P < 0.10). A favorable, positive relationship was detected between YW and FSC (bi=0.00120 to 00120 to 0.00124; P < 0.01). A favorable, positive relationship also existed between weaning to breeding precipitation and HPG (bi=0.2528, P < 0.05). Those results suggested that increased precipitation during the development period from weaning to breeding was advantageous to HPG. The results also provided evidence to suggest that precipitation and PAP may interact to influence breeding success. Thus, we conclude that increased precipitation during the weaning to breeding period appears advantageous to overall breeding success of Angus heifers in a high-altitude production system.

Should we continue trusting bodyweight for HF volume telemonitoring?

Abstract Background Telemonitoring of body weight, blood pressure and heart rate has extensively been used to facilitate early recognition of heart failure (HF) decompensations in order to prevent hospital admissions. Mixed results have been shown by different clinical trials regarding the effectiveness of telemonitoring in HF management. It is recognized that HF decompensation starts with an increase in intra cardiac filling pressure. The relationship between daily pulmonary artery pressure (PAP) values measurements and body weight is not completely established. Purpose To study the relationship between daily changes in body weight and invasive daily measurements such as diastolic PAP assessed by a pulmonary artery pressure sensor (CardioMEMS). Methods Eleven patients with left sided chronic HF implanted with a CardioMEMS device were included in the study (age 75±9 years, ejection fraction 52±10%). Daily measured body weight and pulmonary artery pressures were recorded during 6 months. The primary endpoint was to assess the correlation between the “PAP deviation” – defined as the difference between daily diastolic PAP and mean diastolic PAP over the study period – and the “weight deviation” – defined as the difference between daily body weight determinations and mean body weight. Results During the 6-months study period, 1766 body weight and diastolic PAP measurements were recorded (158±47 daily measurements per patient). We found a weak although significant correlation between changes in body weight and changes in diastolic PAP (Figure 1). When analyzing data individually, no patient presented a strong correlation between the two variables. Conclusions Our results suggest that repeated measurements of body weight have limited utility in detecting left sided heart failure decompensations. More complex and patient-specific thresholds for the biometric measurements are needed to improve early detection of decompensation in HF patients. For the development of early detection algorithms, we may learn from invasive methods, such as the CardioMEMS device. Funding Acknowledgement Type of funding sources: None.

S2927 Persistent Spontaneous Bacterial Peritonitis in a Patient With Cardiogenic Ascites

Introduction: Ascites is defined as a collection of more than 25mL of fluid in the peritoneal cavity, most commonly caused by liver cirrhosis. Cardiogenic ascites from heart failure contributes to 5% of cases. Spontaneous bacterial peritonitis (SBP) is a common complication of ascites, defined as an infection of ascitic fluid in the absence of a surgically treatable source. This is more commonly associated with hepatic cirrhosis. Here we present a case of SBP in a patient with cardiogenic ascites. Case Description/Methods: Patient is a 37-year-old male with right sided heart failure secondary to bronchopulmonary dysplasia with no history of liver disease. The patient was found to have dyspnea and anasarca, so he was admitted for heart failure exacerbation. CT of the abdomen showed large volume ascites and hepatomegaly. While being diuresed, 5L of ascitic fluid was removed via paracentesis. Analysis revealed a serum albumin-ascites gradient (SAAG) of 0.7, protein 4.5, absolute neutrophil count (ANC) 948, and negative culture. The patient was then started on ceftriaxone for SBP. An additional 4.5L was removed via paracentesis 3 days later due to worsening ascites. Analysis at that time showed SAAG 0.6, protein 4.2, and ANC 4,808. No cultures were reported. Antibiotics were escalated to piperacillin-tazobactam due to worsening ANC. A third paracentesis was performed 3 days later after reaccumulation of ascites (3.2L) and to assess therapeutic response. Peritoneal fluid analysis revealed SAAG 0.8, protein 3.7, ANC 2,931, and negative culture. At this point, the infectious disease team was consulted, recommending discontinuation of antibiotics and close monitoring. Patient was discharged 6 days later as he was afebrile and without leukocytosis. Discussion: The pathophysiology of SBP is thought to be related to bacterial translocation and impaired immunity, specifically deficiencies in complement protein neutrophil function. This is reflected by low ascites protein. However, SBP is exceedingly rare in cardiogenic ascites with only 8 cases reported. This is likely secondary to the high protein and opsonic character in this type of ascites, developing from elevated intrahepatic pressures and congestive hepatopathy. This composition of ascites fluid yields antimicrobial activity similar to normal peritoneal fluid. Perhaps this was the reason for the patient’s elevated ANC despite negative cultures. Future studies could focus on the role of antibiotics and prophylaxis in these patients.

A CASE REPORT OF POLYCYTHEMIA RUBRA VERA MANIFESTING AS INTRACARDIAC THROMBOSIS AND PULMONARY EMBOLISM

Polycythemia vera (PV) is a myeloproliferative disorder, with significant risk for thrombotic complications. But intracardiac thrombosis and pulmonary embolism is a rare initial presentation of PV. We describe the case of female patient who presented with intracardiac thrombosis, pulmonary embolism and right sided heart failure. This case report presents a patient with very rare combination of polycythemia rubra vera and right heart thrombi along with pulmonary embolism who was successfully managed with anticoagulation and phlebotomy

Long Term Safety and Outcomes Utilizing the CardioMEMS Device in Patients with Pulmonary Arterial Hypertension

<h3>Purpose</h3> Baseline and periodic hemodynamic monitoring of pulmonary artery pressures using right heart catheterization (RHC) is recommended for initiating and titrating pulmonary arterial hypertension (PAH) therapies as well as for prognostication. The CardioMEMS HF System is an ambulatory implantable hemodynamic monitor, previously only used in patients with left heart failure (HF). In this study, we describe the long-term safety and outcomes using the CardioMEMS device in PAH patients implanted as a part of an investigational pilot study. <h3>Methods</h3> 23 PAH patients between the ages of 31-80 years, were implanted with CardioMEMS device as a part of an investigational pilot study (VITA contract HHSN268201400008C) between 08/2014 - 09/2018. 3 patients were lost to follow-up. Complete follow up data was available for 20 patients who were included in this analysis. <h3>Results</h3> 85% of the PAH patients were female, with a median post-implant follow-up period of 58.5 months. The number of right heart catheterization (RHC) prior to the device implant was 4.37 per patient year, while only 1.99 RHC per patient year were done post implant. In long term follow up there were no significant device related adverse events and all devices remain functional. 8 patients did require RHC for recalibration of the device. 12 patients are still undergoing active monitoring. Of the remaining patients, 1 was enrolled in hospice, 4 patients died from progression of PAH, 1 patient died from malignancy; 1 from end-stage cirrhosis. There was a total of 13 HF hospitalizations between these 20 patients over 3 to 7 year follow-up based on the time of implant. <h3>Conclusion</h3> The CardioMEMS device has previously been reported to reduce hospitalizations in patients with left sided heart failure. Based on our study, deployment of the device was safe in PAH patients with no long-term device related complications. It reduced the number of follow-up invasive RHC by more than 50%. Larger prospective studies are warranted before widespread use of the device for monitoring PA pressures in PAH patients.

Contemporary results of transcatheter mitral valve procedures: bi-centric retrospective analysis

BackgroundTranscatheter mitral valve-in-valve (TMVIV) or valve-in-ring (TMVIR) replacement offer an alternative therapy for high risk patients. We aimed to highlight the operative and postoperative results of TMVIV and TMVIR procedures.ResultsWe included all patients underwent TMVIV and TMVIR procedures between 2017 and 2020 at two heart centers in Germany. We included a total of 36 high risk patients in our study where 12 received TMVIV and 24 received TMVIR. All patients underwent TMVIV or TMVIR with Edwards Sapien XT or S3 transcatheter valves (Edwards Lifesciences). The mean age was 79 (75–83 years old). The median (IQR) preoperative STS score was 9 (7–13)% and EuroSCORE II was 14.5% (12–16). The majority of our patients were operated via transapical approach (n = 26) and the minority via transseptal approach (n = 10). Out of our records, none of our patients required reopening for bleeding or any other surgical complications. None of our patients required reintervention during the 6 months follow-up period. One mortality was recorded on fifth postoperative day due to low cardiac output syndrome (obviously because of LVOT obstruction by the anterior mitral leaflet). The average blood loss was 200 ml in the first 24 h in patients underwent transapical approach. Average operative time was 93 min and all patients were immediately extubated after the procedure in the operating room (even the patient with echocardiographically documented LVOT obstruction who died on the fifth postoperative day). Length of Intensive Care Unit stay was 2 ± 1.2 days and length of hospital stay was 4.1 ± 1.2 days. In the follow up period, echocardiograms showed normal prosthetic valve function with low transvalvular gradients, no LVOT obstruction in TMVIR cases and no evidence of valve migration or thrombosis (except in one patient). Concerning 6 months readmission, it was recorded in 2 patients due to right sided heart failure symptoms due to preexisting high degree of tricuspid valve regurge which did not disappear or even decrease after the operation and the other patient due to gastrointestinal bleeding.ConclusionsTMVIV and TMVIR offer an efficient, safe and less invasive alternative in high surgical risk patients.

Abstract 13856: Hydrogen Sulfide Donor, SG1002, Preserves Left Ventricular Global Function and Contractile Reserve in a Mouse Model of Doxorubicin Cardiotoxicity

Background: Despite being one of the most widely used chemotherapeutic agents, Doxorubicin [DOX] is limited by its dose-dependent side effects, including cardiotoxicity and heart failure (HF). Reactive oxygen species, inflammation, mitochondrial dysfunction, and dysregulated autophagy have been proposed as potential mediators of cardiotoxicity. Hydrogen sulfide (H 2 S) has been shown to promote mitochondrial stability and reduce inflammation in the setting of myocardial infarction. Hypothesis: To determine if the orally active, slow-releasing H 2 S-compound SG1002 attenuates DOX-induced cardiotoxicity. Methods: Following baseline echocardiography, male C57BL mice (12 weeks old) were treated with DOX (5 doses of 5mg/kg, ip; once a week) over 5 weeks. One week before the first DOX treatment, mice were placed onSG1002-enriched chow to achieve a dosage of 40 mg/kg/day for the duration of the study. The control group received normal chow. Mice were followed up to 5 weeks after the last DOX treatment. Left ventricular (LV) function was assessed via echocardiography, including LV global longitudinal strain [GLS]. Contractile reserve was measured as a percent increase in LV ejection fraction (LVEF) following isoproterenol challenge (10ng/mouse). Results: The cumulative dose of 25mg/kg of DOX led to impaired cardiac contractile reserve in control mice, which was preserved in SG1002-fed mice (Fig.A). Despite no changes observed in LVEF throughout the study, LV GLS detected early signs of cardiac dyssynchrony following the DOX regimen (Fig.B). SG1002 treatment prevented the early decline in cardiac function following chemotherapy. Conclusion: Our results indicate that LV GLS and cardiac contractile reserve are able to detect early changes in LV contractility due to cardiotoxicity following DOX treatment, which can be prevented with SG1002. This further highlights the importance of early screening with advanced imaging to identify signs of cardiotoxicity.