Symptoms Of Congestive Heart Failure Research Articles

High Prevalence of Clinically Important Echocardiographic Abnormalities in Patients with a Normal Electrocardiogram Referred for Transthoracic Echocardiography

Normal electrocardiographic (ECG) results have been reported to be associated with a low prevalence of structural heart disease and thus may preclude the need for transthoracic echocardiographic (TTE) imaging. The goal of this study was to determine the prevalence of important TTE abnormalities in patients with a normal ECG referred for TTE imaging. Consecutive electrocardiograms over 6months were reviewed. Patients with a normal ECG who underwent TTE imaging within 30days formed the study group. TTE indication and appropriateness designation were determined. TTE findings were noted, including a composite, "major TTE abnormalities" (Maj TTE ABNs). Of 26,254 electrocardiograms reviewed, 3,955 (15%) were normal, 522 with qualifying TTE studies. Maj TTE ABNs were common (27%). The most common TTE indication was signs or symptoms of congestive heart failure (17%), 35% of which had Maj TTE ABNs. Two echocardiographic indications were found to have significantly fewer of Maj TTE ABNs: palpitations (4%, P<.01) and preoperative evaluation before noncardiac surgery (6%, P<.01). A majority of TTE studies were appropriate (76%), with only 14% rarely appropriate. Maj TTE ABNs were less common in rarely appropriate compared with appropriate TTE studies (13% vs 30%, P<.01), with a very low prevalence of Maj TTE ABNs in outpatient rarely appropriate TTE studies (4%). Clinically important TTE abnormalities in patients with a normal ECG are common, suggesting that normal ECG results should not routinely preclude TTE imaging to identify structural heart disease. However, recognition of common clinical indications and application of the appropriate use criteria may identify patients with a normal ECG in whom TTE imaging is of very low yield.

Predictors of long-term outcome in patients with biopsy proven inflammatory cardiomyopathy.

BackgroundThe objective of this study was to identify prognostic indicators in patients with inflammatory cardiomyopathy (iCM) on endomyocardial biopsy (EMB).Methods and resultsBetween 2007 and 2011 all consecutive patients with diagnosed with iCM at EMB were retrospectively analyzed. The combined primary endpoint (EP) (1°EP) was cardiac death, aborted sudden cardiac death/appropriate implantable cardioverter defibrillator (ICD) shock, progressive heart failure requiring left ventricular assist device (LVAD) implantation and heart transplantation. 503 patients (mean age 58 ± 12 years, 73% male) were available for analysis. Genomes of cardiotrophic viruses were detected in 396 patients (79%) and immuno-histochemical signs of inflammation were present in 223 individuals (44%). After 3.6 ± 2.4 years of follow-up, cardiac mortality was 3.0% (n = 14) and a total of 8.6% (n = 40) reached the primary endpoint. Independent predictors for the 1°EP were: age ≥ 50 years, presence and duration (≤ 28 days) of symptomatic heart failure. A risk stratification approach based on the results of the multivariate analysis demonstrated that absence of signs and/or symptoms of congestive heart failure in younger (< 50 years) patients with longer (> 28 days) duration of disease appear to have an excellent prognosis with 100% survival and no events during follow-up. The presence of all above mentioned independent risk factors results in an 1°EP occurrence of 35.9%.ConclusionsSymptoms of heart failure, short duration of disease, and older age are indicators of poor outcome in patients with iCM.

Catheter-Related Arterial Thrombosis in Neonates and Children: A Systematic Review.

Catheter-related arterial thrombosis (CAT) is increasingly recognized in children. Available data are scarce and based on expert opinions. This systematic review aimed to identify knowledge on paediatric CAT. Among 3,484 publications, 22 met inclusion criteria. Fourteen reported on CAT due to umbilical arterial catheter (UAC), two to extremity indwelling catheter (EIC), one to both and five to cardiac catheter (CC). The overall cumulative incidence of CAT was 21% (95% confidence interval [CI], 13-31) with a relative incidence of 20% (95% CI, 10-33) for UAC and 11% (95% CI, 3-21) for CC-related CAT. The incidence of EIC-related CAT ranged from 3.4 to 63%. Clinical presentation of CAT included symptoms of acute limb ischaemia (79%, 95% CI, 54-97), arterial hypertension (55%, 95% CI, 23-86) and congestive heart failure (28%, 95% CI, 7-53). Underlying conditions of UAC-related CAT included prematurity (70%, 95% CI, 31-98), respiratory distress syndrome (56%, 95% CI, 46-65), asphyxia (41%, 95% CI, 15-69), infection (32%, 95% CI, 13-55), persistent ductus arteriosus (28%, 95% CI, 13-45), meconium aspiration (16%, 95% CI, 8-25) and congenital heart disease (9%, 95% CI, 2-19). Congenital heart disease was the likely condition in EIC- and CC-related CAT. Antithrombotic treatment included thrombolysis (71%, 95% CI, 47-91), heparin (70%, 95% CI, 41-94) and thrombectomy (46%, 95% CI, 10-95) alone or in combination. Complete resolution rate of CAT was 82% (95% CI, 65-96). Long-term complications included arterial hypertension (26%, 95% CI, 0-66) and limb amputation (12%, 95% CI, 1-31). The overall all-cause mortality rate was 7% (95% CI, 2-14). In conclusion, CAT occurs at an increased incidence in neonates and children and is potentially associated with poor outcome. However, limited data are available on paediatric CAT. This systematic review identifies the rationale for further studies on CAT in paediatric patients.

Severe heart failure (NYHA Class IV) is associated with increased left ventricular mass index and short mitral deceleration time in severe aortic valve stenosis.

In aortic valve stenosis (AS), congestive heart failure (CHF) is a well-established symptom that indicates the need for surgical aortic valve replacement (SAVR). However, it is difficult to judge whether CHF symptoms such as dyspnea are caused by severe AS or other conditions, especially in elderly persons with restricted mobility or other organ complications. It is important to identify objective and noninvasive parameters associated with severe CHF symptoms in severe AS. One hundred ninety-eight patients with severe AS without left ventricular (LV) dysfunction were retrospectively studied. CHF symptoms were classified by New York Heart Association (NYHA) functional class. Echo parameters were compared between NYHA I-III and NYHA IV. Patients with NYHA IV (n=40; 20%) were older (86±6 vs 82±8years; P=.001) and had a larger LV mass index (LVMI) (157±43 vs 114±34g/m2 , P<.001), a higher transmitral flow velocity ratio (E/A) (1.31±0.62 vs 0.93±0.42; P=.001), a shorter deceleration time (DT) (202±72 vs 286±98ms; P<.001), and a higher systolic pulmonary arterial pressure (SPAP) (44±13 vs 35±13mmHg; P<.001) than patients with NYHA I-III. On multivariable analysis, LVMI and DT were independently associated with NYHA IV. Receiver operating characteristic curve analysis identified LVMI≥142g/m2 and DT≤194ms as the cutoff values associated with NYHA IV in patients with severe AS. Left ventricular mass index and DT were independently associated with severe heart failure (NYHA IV). These echo parameters could be helpful to judge whether CHF symptoms are caused by severe AS.

Q Fever Endocarditis: A Diagnostic Dilemma

Q fever is a zoonotic disease, typically spread by aerosol transmission from infected animals to humans. It can present with a variety of clinical manifestations, but endocarditis is the most common manifestation. We present a case of an 80-year-old man with a prior bioprosthetic aortic valve (AV) replacement who presented with chronic constitutional symptoms that acutely worsened over two days leading up to his presentation. An initial echocardiogram was equivocal for endocarditis, and bloodwork revealed a bicyotpenia, elevated ferritin, and negative blood cultures. He was diagnosed with Q fever endocarditis after positive serology for Coxiella burnetti. Treatment for this patient involved a 24-month course of doxycycline and hydroxychloroquine.&#x0D; Résumé&#x0D; Q la fièvre est une maladie zoonotique, généralement propagée par la transmission en aérosol des animaux infectés aux humains. Il peut présenter avec une variété de manifestations cliniques, mais l'endocardite est la manifestation la plus commune. Nous présentons un cas d'un homme de 80 ans avec une valve aortique antérieure de bioprothèse (AV) de remplacement qui a présenté des symptômes chroniques de la Constitution qui s'est aggravée de façon aiguë pendant deux jours menant à sa présentation. Un échocardiogramme initial a été équivoque pour l'endocardite, et analyses a révélé une bicyotpenia, une élévation de la ferritine et des cultures sanguines négatives. On lui a diagnostiqué une endocardite de fièvre Q après une sérologie positive pour Coxiella burnetti. Le traitement pour ce patient a impliqué un cours de 24 mois de doxycycline et de hydroxychloroquine.&#x0D; &#x0D; &#x0D;

Tricuspidalisdysplasie bij de hond

In dit artikel wordt een gedetailleerd overzicht gegeven van de verschillende aspecten van tricuspidalisklepdysplasie bij honden. Deze aangeboren aandoening werd beschreven bij diverse grote hondenrassen maar voornamelijk de labrador-retriever is gepredisponeerd. Tricuspidalisklepdysplasie is relatief zeldzaam met een prevalentie van ongeveer zeven procent van alle congenitale hartafwijkingen bij de hond. De asymptomatische fase kan meerdere jaren duren en hangt voornamelijk af van de ernst van de afwijking. Tijdens de klinische fase kunnen inspanningsintolerantie, vermoeidheid, anorexie, cardiale cachexie, dyspneu en tekenen van rechterharthalen aanwezig zijn. Echocardiografie inclusief een doppleronderzoek is noodzakelijk om de diagnose te bevestigen. Een definitieve behandeling bestaat uit het chirurgisch vervangen van de klep maar dit is technisch moeilijk en bevindt zich bij honden nog in de experimentele fase. Een ondersteunende therapie wordt ingesteld zodra de hond symptomen van congestief hartfalen ontwikkelt en bestaat uit het toedienen van diuretica, ace-inhibitoren en positief-inotrope farmaca.

Technique to Avoid Hemodialysis Catheter in Patients with Failing Aneurysmal Arteriovenous Fistula by Creating a Concomitant New Arteriovenous Fistula

Autogenous arteriovenous fistula (AVF) is the primary recommended access for hemodialysis. Long-term use will not uncommonly result in AVF aneurysmal degeneration. Aneurysm-associated complications encompass pain, skin ulceration, infection, thrombosis, cannulation difficulties, and life-threatening bleeding. Various methods to repair aneurysmal AVFs have been described. However, there may be circumstances when this is not possible and require insertion of a temporary hemodialysis catheter (HDC) until a new arteriovenous access is created. We describe a case series of creating a new simultaneous AVF while continuing to use the primary failing aneurysmal AVF to avoid placement of an HDC. Once the new AVF becomes operational, the primary aneurysmal AVF can be abandoned. Six patients underwent simultaneous new AVF creation, 4 ipsilateral, and 2 contralateral. None of the patients developed symptomatic steal syndrome or congestive heart failure. Five of 6 patients had successful usage of the new AVF, and subsequently underwent ligation and excision of the aneurysmal AVF, thus avoiding a temporary HDC. Close monitoring for skin compromise and bleeding in the aneurysmal AVF is recommended while the new AVF matures.

Is Cardiac Troponin I Valuable to Detect Low-Level Myocardial Damage in Congestive Heart Failure?

Objectives:Congestive heart failure (CHF) is a heart disease with a growing incidence and prevalence. Creatine kinase-myocardial base (CK-MB) is generally used to determine myocardial damage; however, it is insufficiently sensitive to measure the relatively low level of myocardial damage that typically occurs in heart failure (HF). The use of cardiac troponins, which are far more sensitive and specific, has become common to identify myocardial damage and permits the detection of even minute amounts of damage. The aim of this study was to ascertain whether cardiac troponin I (cTnI) can be used to detect low-level myocardial damage occurring in CHF in real-life conditions.Methods:Fifty patients with CHF symptoms (Group I) and 20 patients who were evaluated as normal (Group II) were included in this prospective study. The Framingham criteria were used to diagnose HF. Group I was divided into 3 subgroups according to the New York Heart Association classification of functional capacity: Class II, Group A; Class III, Group B, and Class IV, Group C. On the first day of admission, CK-MB and cTnI levels were measured and assessed quantitatively. The cTnI level was compared between these 3 subgroups and between Groups I and II. Linear regression analysis was performed to investigate the relationship between ejection fraction (EF) and cTnI.ResultsThe mean cTnI value was 0.084±0.07 ng/mL in Group I and 0.018±0.012 ng/mL in Group II (p=0.0001). The mean cTnI value was 0.047±0.016 ng/mL, 0.080±0.048 ng/mL, and 0.175± 0.102 ng/mL in Groups A, B, and C, respectively. The difference between the subgroups of Group I was statistically significant. In addition, it was observed that there was a significant difference in the EF (%) value between Groups I and II and between Groups A, B, and C. Linear regression analysis revealed an inverse relationship between EF and cTnI (r: -0.66) (p=0.0001).ConclusionAs the severity of HF increased, the cTnI serum level also increased. This increase was inversely related to the EF value. These results are consistent with other studies in the literature, suggesting that the cTnI level may be a useful marker in the diagnosis and evaluation of severity of HF.

The Endothelin Receptor Antagonist Macitentan Improves Isosorbide-5-Mononitrate (ISMN) and Isosorbide Dinitrate (ISDN) Induced Endothelial Dysfunction, Oxidative Stress, and Vascular Inflammation.

Objective Organic nitrates such as isosorbide-5-mononitrate (ISMN) and isosorbide dinitrate (ISDN) are used for the treatment of patients with chronic symptomatic stable coronary artery disease and chronic congestive heart failure. Limiting side effects of these nitrovasodilators include nitrate tolerance and/or endothelial dysfunction mediated by oxidative stress. Here, we tested the therapeutic effects of the dual endothelin (ET) receptor antagonist macitentan in ISMN- and ISDN-treated animals. Methods and Results Organic nitrates (ISMN, ISDN, and nitroglycerin (GTN)) augmented the oxidative burst and interleukin-6 release in cultured macrophages, whereas macitentan decreased the oxidative burst in isolated human leukocytes. Male C57BL/6j mice were treated with ISMN (75 mg/kg/d) or ISDN (25 mg/kg/d) via s.c. infusion for 7 days and some mice in addition with 30 mg/kg/d of macitentan (gavage, once daily). ISMN and ISDN in vivo therapy caused endothelial dysfunction but no nitrate (or cross-)tolerance to the organic nitrates, respectively. ISMN/ISDN increased blood nitrosative stress, vascular/cardiac oxidative stress via NOX-2 (fluorescence and chemiluminescence methods), ET1 expression, ET receptor signaling, and markers of inflammation (protein and mRNA level). ET receptor signaling blockade by macitentan normalized endothelial function, vascular/cardiac oxidative stress, and inflammatory phenotype in both nitrate therapy groups. Conclusion ISMN/ISDN treatment caused activation of the NOX-2/ET receptor signaling axis leading to increased vascular oxidative stress and inflammation as well as endothelial dysfunction. Our study demonstrates for the first time that blockade of ET receptor signaling by the dual endothelin receptor blocker macitentan improves adverse side effects of the organic nitrates ISMN and ISDN.

Balloon aortic valvuloplasty to improve candidacy of patients evaluated for transcatheter aortic valve replacement.

Evaluate the role of balloon aortic valvuloplasty (BAV) in improving candidacy of patients for transcatheter aortic valve replacement (TAVR). Patients who are not candidates for TAVR may undergo BAV to improve functional and clinical status. 117 inoperable or high-risk patients with critical aortic stenosis underwent BAV as a bridge-to-decision for TAVR. Frailty measures including gait speed, serum albumin, hand grip, activities of daily living (ADL); and NYHA functional class before and after BAV were compared. Mean age was 81.6 ± 8.5 years and the mean Society of Thoracic Surgeons predicted risk of mortality was 9.57 ± 5.51, with 19/117 (16.2%) patients non-ambulatory. There was no significant change in mean GS post-BAV, but all non-ambulatory patients completed GS testing at follow-up. Albumin and hand grip did not change after BAV, but there was a significant improvement in mean ADL score (4.85 ± 1.41 baseline to 5.20 ± 1.17, P = 0.021). The number of patients with Class IV congestive heart failure (CHF) was significantly lower post BAV (71/117 [60.7%] baseline versus 18/117 [15.4%], P = 0.008). 78/117 (66.7%) of patients were referred to definitive valve therapy after BAV. When evaluating frailty measures post BAV, we saw no significant improvement in mean GS, however, we observed a significant improvement in non-ambulatory patients and ADL scores. We also describe improved Class IV CHF symptoms. With this improved health status, the majority of patients underwent subsequent valve therapy, demonstrating that BAV may improve candidacy of patients for TAVR.

Surgical excision of a giant cardiac fibroma in an asymptomatic child

Cardiac fibroma is a rare primary tumor of the heart. Patients can be asymptomatic or present with palpitations, cardiac murmur, syncope, arrhythmias, symptoms of congestive heart failure, or sudden death. We report a case of successful surgical excision of a giant cardiac fibroma in an asymptomatic child.

Emerging Therapies for Congestive Heart Failure.

The treatment of atherosclerotic heart disease has improved remarkably over the last several decades; however, the outlook for patients with symptomatic congestive heart failure with reduced ejection fraction remains bleak. Current drug therapies target the neurohormonal activation that accompanies congestive heart failure, but do not address the fundamental pathology inherent in this condition-the loss of contractile capacity. Stem cell therapies offer the possibility of rectifying this deficiency and normalizing left ventricular dimensions and cardiac performance by regenerating novel contractile tissue, thereby reversing the negative remodeling that portends progressive left ventricular dysfunction, worsening symptoms, and ultimately cardiogenic shock. Here we review the promise of stem cell therapies in the treatment of heart failure with reduced ejection fraction, the current state of clinical developments, and briefly comment on the future of the field.

Truncus arteriosus Type ii

Background : Truncus arteriosus (TA) is an uncommon congenital cardiovascular anomaly that is characterized by a single arterial trunk arising from the normally formed ventricles by means of a single semilunar valve (ie, truncal valve).Case presentation : A 3-month-old female infant product of spontaneous vaginal delivery complaining from dyspnea , tachypnea , mild cyanosis since birth , decrease in feeding and activity ,She was admitted twice in different hospitals and diagnose as a case of VSD with pulmonary hypertention , given treatment but no response , the family picked her to Babylon for maternity and children hospital . ECHO and cardiac CT- angiography was done were revealed truncus arteriosus.She was treated by anti failure and drug which lower pulmonary vascular resistance, her condition improve and become stable . after that they went to turkey where operation was done in specialized cardiac centre before age of six month.Conclusion : In any infant with signs and symptoms of congestive heart failure and mild cyanosis truncus arteriosus shoud be suspected.Corrective operation should be done in first six month of ageTruncus arteriosus (TA) is a rare cardiac disorder,(1)account of about (0.7%-1.4%) of all congenital heart disease, in which aorta and pulmonary artery were not separated completely during fetal development and both originate jointly from left ventricle(2). It has an incidence of about 0.3/10,000 live birth,no striking sex difference although most series contain male more than female.(3,4..Etiology is multifactorial and it may be associated with microdeletion chromosome 22q11.2, maternal diabetes has been implicated as a risk factor for truncus arteriosus.(5)The number of truncal valve cusps varies from 2 to as many as 6 and the valve may stenotic,regurgitant, or both(6). Its had been classified by Collet and Edwards in 4 different types in 1949.Type I in which the pulmonary arteries can arise together from the posterior left side of the persistent truncus arteriosus and then divided into left and right pulmonary171arteries, in type II and III, no main pulmonary artery is present, and the right and left pulmonary arteries arise from separated orifice on posterior(type II) or lateral (type III) aspect of truncus arteriosus. Type IV truncus is a termno longer used, this essentially a form of pulmonary atresia.(6)During past 20 years, diagnostic and therapeutic methods along with immediate intervention for surgery in infancy with complete reparation of VSD lead to evident improvement and less morbidity in newborns. Truncus arteriosus canbe diagnosed in utero by fetal echocardiography.(7)

Severe hypoglycemia in diabetics requiring hospitalization and short-term mortality

We planned a prospective study to observe short-term mortality in diabetic patients with severe hypoglycemia requiring hospitalization. Total 50 patients were enrolled in the study. Diabetic patients presenting to hospital with plasma glucose <70 mg/dl requiring hospitalization for correction were enrolled in study. Patients with underlying malignancy, acute cerebro-vascular event, symptomatic congestive heart failure, and creatinine clearance <10 ml/min/1.73 m2 were excluded. All subjects were followed for 3 months from date of admission. Majority of patients were type 2 diabetics (41, 82%) and remaining were type 1 diabetics. Mean age of type 1 diabetic was 31.77 ± 8.9 years and for type 2 diabetic was 65.97 ± 10.5 years. Mean plasma glucose at presentation was 36.62 ± 11.57 mg/dl. Fourteen (28%) patients had previous admission with hypoglycemia. Thirty patients did not have knowledge about hypoglycemia management at home. Seventeen (34%) were on single drug (insulin/SU), 19 (38%) were on two drugs, and 14 (28%) were on three or more drugs. Mean creatinine clearance was 55.83 ± 26.5 ml/min/1.73 m2. Mean HbA1C was 8.58 ± 1.94%. Total in-hospital mortality was two (4%), and two more deaths were observed during 3-month follow-up. All four deaths occurred in type 2 diabetics who were illiterate and had no previous history of severe hypoglycemia. Total in-hospital mortality was 2/50 (4%) and 90-day all-cause mortality was 4/50 (8%). All patients who died were type 2 diabetic; hence, all-cause mortality was 4/41 (9.7%) in type 2 diabetes. Our study suggests that severe hypoglycemia, particularly in type 2 diabetes, is associated with very significant all-cause mortality in short term.

Use of Electronic Patient Reported Outcomes and Automated Devices for Heart Failure Disease Management

Background: Congestive heart failure (CHF) is a major public health issue. Today, CHF affects 6.5 million people in the U.S. and the incidence rate is projected to rise by 46% to more than 8 million cases by 2030. Current reimbursement policies use readmission rates and length of hospital stays as indicators of quality of care, and incentivize providers to meet these quality measures as the cost of hospitalization alone significantly contributes to the overall burden of CHF on patients and health systems. Symptoms of CHF can be unpredictable and presently there are no reliable solutions to track disease control for discharged patients.

Optymalna rozbudowa dwujamowego układu stymulującego u pacjentki z utrwalonym migotaniem przedsionków

In patients with sick sinus syndrome, and previously implanted dual-chamber pacemaker, the occurrence of atrial fibrillation finally assessed as permanent is most commonly regarded as a natural course of the disease. The inappropriate heart rate control and right ventricular pacing can both negatively influence left ventricle mechanical performance leading to cardiomyopathy and heart failure. It was presented the case of a 72-year-old woman with permanent atrial fibrillation with narrow QRS complex, after dual-chamber pacemaker implantation, admitted to our department with signs and symptoms of acute decompensated congestive heart failure. The modification of pharmacotherapy allowed to compensate heart failure, however with only small influence on structural remodelling and patient’s symptoms. The successful upgrade of the pacing system to the direct His-bundle pacing enabled the restoration of proper function of the heart and full symptoms relief. The direct His-bundle pacing is an approach of choice in such a group of patients.

175P - OHERA: A real world study of cardiac events in > 3700 patients with her2-positive early breast cancer treated with trastuzumab: Final analysis

Background: As of Sept 2016, > 2.2 million breast cancer (BC) patients (pts) have received trastuzumab (Herceptin®; H) in clinical trial or real world settings. Risk of cardiac failure in pts treated with H in real world practice may differ from that observed in a clinical trial setting. Methods: OHERA (NCT01152606) is a non-interventional post-approval safety study that investigated incidence of symptomatic congestive heart failure (CHF) and cardiac death in pts with HER2-positive early BC (EBC) receiving adjuvant intravenous H (H IV) in routine clinical practice, per the EU Summary of Product Characteristics (SmPC). Pts with HER2-positive EBC (stage I–IIIb) considered for treatment with H IV per the EU SmPC were enrolled, treated and monitored per local practice. Primary endpoints were incidence of symptomatic CHF (New York Heart Association [NYHA] class II–IV) and incidence of cardiac death. Secondary endpoints included time to onset of CHF. The final analysis included pt data collected for up to 5 years or until death, loss to follow-up or consent withdrawal. Results: Pts were enrolled Aug 2007–Nov 2010 at 199 sites across 9 countries. The safety population included 3733 pts with EBC treated with H IV. Median treatment duration was 11.8 months; median follow-up was 60.1 months. Incidence of symptomatic CHF was 2.8% (n = 106); including severe symptomatic CHF (NYHA class III–IV) in 1.0% (n = 38) pts. Median time to onset of symptomatic CHF was 5.7 months (95% CI 5.3–6.5) and 77 (72.6%) pts achieved CHF resolution. Incidence of cardiac death was 0.2% (n = 6). 251 pts had a left ventricular ejection fraction (LVEF) drop of ≥ 10% from baseline to < 50% and 169/251 (67.3%) achieved LVEF drop resolution. Incidence of CHF was higher in pts with baseline risk factors such as pre-existing cardiac conditions, age ≥65 years or baseline LVEF ≤55%. Pts who had left-side radiotherapy at baseline did not have higher CHF incidence. Conclusions: OHERA is the largest study investigating the cardiac safety of adjuvant H IV in a real world setting to date. Final analysis results were consistent with cardiac safety results from previous adjuvant H IV clinical trials in EBC, and the baseline risk factors for CHF reported in the H IV EU SmPC. Clinical trial identification: Protocol number: BO20652/RO 45-2317 ClinicalTrials.gov NCT01152606 Legal entity responsible for the study: F Hoffmann-La Roche Ltd Funding: F. Hoffmann-La Roche Ltd., Basel, Switzerland Disclosure: A. Bouhlel, M. Liste Hermoso: Employee of F Hoffmann-La Roche Ltd. S. Lauer: Contract work for Hoffmann-La Roche Ltd. E. Nüesch: Stock ownership: Roche. Employee of F. Hoffmann-La Roche Ltd. M. Shing: Previous employee of Genentech Inc. & current collaboration with Genentech Inc. V. Misra: Membership of an advisory board: Amgen, Eisai, Roche. All other authors have declared no conflicts of interest.

Syncope Due to Intracavitary Left Ventricular Obstruction Secondary to Giant Esophageal Hiatus Hernia

Esophageal hiatus hernia has been known to cause symptoms of congestive heart failure or syncope after meal due to compression of the heart, mainly the left atrium. However, compression of the left ventricle resulting in syncope has never been reported. Seventy-one year old woman developed syncope after taking a lunch. A chest roentgenogram showed possible mass lesion behind the heart. An echocardiogram revealed a mass lesion posterior to the left ventricle, resulting in “banana-shaped” deformity. A CT scan revealed a giant esophageal hiatus hernia which compressed the left ventricle. Cardiac catheterization revealed marked pressure gradient in the left ventricle suggestive of intracavitary obstruction after isoproterenol infusion. Left ventricular compression due to enlarged giant hiatus hernia after meal resulted in intracavitary obstruction of the left ventricle, causing syncopal episode in this particular patient. Dehydration and diastolic dysfunction may also have contributed.

Update on Valvular Heart Disease in Pregnancy.

Valvular heart disease in women of childbearing age poses an increased risk of adverse maternal and fetal outcomes, and management in pregnancy can be challenging. Ideally, patients with suspected valvular disease should have preconception counseling by a multidisciplinary team including cardiologists with expertise in pregnancy and a maternal-fetal medicine specialist. Preconception planning should include a cardiac assessment of maternal risk, determination of frequency of surveillance, and a cardiovascular management plan during delivery. Women with valvular heart disease should be followed closely by a cardiologist and monitored for signs and symptoms of congestive heart failure and arrhythmias. In general, stenotic lesions may become more symptomatic in pregnancy, whereas regurgitant lesions are generally well tolerated. Left-sided valvular lesions have higher complication rates than right-sided lesions. For patients with asymptomatic valvular stenosis, medical management during pregnancy may include beta blockade and/or diuretics. Exercise stress testing prior to pregnancy in sedentary patients can be helpful to unmask symptoms and determine functional capacity. Patients with symptomatic, severe left-sided valvular obstruction have a high maternal risk of cardiovascular events during pregnancy, and percutaneous balloon valvuloplasty or surgery is recommended prior to pregnancy. The type of prosthetic valve (mechanical vs bioprosthetic) should be selected after a careful discussion with the patient. Invasive procedures are generally reserved for when medical management fails. The second trimester may be the optimal time for intervention as fetal organogenesis is complete and the cardiac positioning has not been affected by the gravid uterus.

Cardiovascular comorbidity in multiple sclerosis patients treated with Mitoxantrone therapy: a cohort study

BackgroundMitoxantrone (MX) has been used as second line therapy for aggressive multiple sclerosis (MS). Potential cardiotoxic effects of MX limit its use; a cumulative dose of up to 100 mg/m2, has been long considered relatively safe. We calculated the frequency of cardiac side effects in MS patients treated with MX.MethodsWe performed a cohort study including all MS patients treated with MX at the Neurological Department of the University Hospital of Palermo, Italy. Two hundred-sixty-four MS patients diagnosed according to validated criteria were included and followed-up until the end of September 2010. Patients were treated with MX as a second line therapy if they had no previous heart diseases determined by clinical evaluation, electrocardiography, and echocardiography. Treatment administration was made at a monthly dose of 8 mg/m2 for the first three months and at a dose of 12 mg/m2 every three months. Echocardiography was routinely performed every six months. Treatment was stopped before reaching the final dose if signs had appeared of impaired heart function, confirmed left ventricular ejection fraction reduction lower to 50%, or a confirmed reduction of more than 10% with respect to the first examination.ResultsHeart involvement was observed in 12.4% of treated individuals, and symptomatic congestive heart failure occurred in 2.7% of the cohort. A patient had a myocardial infarction, and 3.1% showed electrocardiographic anomalies not present at baseline.ConclusionOur study confirms that cardiac adverse events associated with MX are more common than previously reported.