Symptomatic Heart Failure Patients Research Articles

Efficacy of Native T1 Mapping for Patients With Non-Ischemic Cardiomyopathy and Ventricular Functional Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair.

We investigated the efficacy of left ventricular (LV) myocardial damage by native T1mapping obtained with cardiac magnetic resonance (CMR) for patients undergoing transcatheter edge-to-edge repair (TEER).Methods and Results: We studied 40 symptomatic non-ischemic heart failure (HF) patients and ventricular functional mitral regurgitation (VFMR) undergoing TEER. LV myocardial damage was defined as the native T1Z-score, which was converted from native T1values obtained with CMR. The primary endpoint was defined as HF rehospitalization or cardiovascular death over 12 months after TEER. Multivariable Cox proportional hazards analysis showed that the native T1Z-score was the only independent parameter associated with cardiovascular events (hazard ratio 3.40; 95% confidential interval 1.51-7.67), and that patients with native T1Z-scores <2.41 experienced significantly fewer cardiovascular events than those with native T1Z-scores ≥2.41 (P=0.001). Moreover, the combination of a native T1Z-score <2.41 and more severe VFMR (effective regurgitant orifice area [EROA] ≥0.30 cm2) was associated with fewer cardiovascular events than a native T1Z-score ≥2.41 and less severe VFMR (EROA <0.30 cm2; P=0.002). Assessment of baseline LV myocardial damage based on native T1Z-scores obtained with CMR without gadolinium-based contrast media is a valuable additional parameter for better management of HF patients and VFMR following TEER.

Fatigue and mental health among patients with heart failure in an outpatient setting

Background: Heart failure is a health problem that occurs in the cardiovascular system which globally is the highest cause of death in the world. Heart Failure is a complex clinical syndrome in which the heart cannot pump blood to meet the body's blood circulation needs for tissue metabolism in certain conditions, due to structural or functional damage to the heart chambers. It is usually characterized by excessive blood volume, inadequate tissue perfusion, poor activity tolerance, and usually easily feels tired, orthopnea and edema. The emergence of various clinical symptoms in heart failure patients will cause nursing problems and interfere with basic human needs, one of which is fatigue. Heart failure sufferers have problems with the heart system which results in a lack of blood and oxygen supply to the brain and muscles, so sufferers often experience fatigue to the point of fainting. Purpose: To determine the relationship between the level of fatigue and the mental health of heart failure patients. Method: This type of quantitative research with a design using a cross sectional approach. Carried out at the heart clinic dr. Moewardi Surakarta, Central Java of the regional general hospital from October to December 2023. The population of heart failure sufferers in this study was 186 people, however by using a purposive sampling technique in sampling, a sample of 148 patients was obtained. The inclusion criteria in this study were patients aged &gt;18 years, New York Heart Association (NYHA) class II and class III heart failure patients, while the exclusion criteria were heart failure patients who were unwilling or unable to take part in this study. The instruments used were the fatigue assessment scale (FAS) and depression anxiety and stress scale 21 (DASS-21) questionnaires. Data analysis used univariate and bivariate with the chi square test. Results: The majority of respondents experienced mild fatigue with anxious conditions, 53 people (53.0%). Meanwhile, 47 patients (47.0%) who complained of severe fatigue showed anxiety, 24 people (85.7%), and 12 people (60.0%) felt stressed. The results of the analysis obtained a significant value with a p-value of 0.001 (&lt;0.05) which indicates that H0 was rejected. So there is a relationship between the level of fatigue and mental health conditions in heart failure sufferers. Conclusion: There is a relationship between the level of fatigue and mental health in heart failure patients. The nursing implication that can be implemented is providing education about fatigue so that patients understand the impact it has on heart failure sufferers so that it does not cause mental health problems.

Profile of serum microRNAs in heart failure with reduced and preserved ejection fraction: Correlation with myocardial remodeling

Background and aimsCardiomyocyte hypertrophy and interstitial fibrosis are key components of myocardial remodeling in Heart Failure (HF) with preserved (HFpEF) or reduced ejection fraction (HFrEF). MicroRNAs (miRNAs) are non-coding, evolutionarily conserved RNA molecules that may offer novel insights into myocardial remodeling. This study aimed to characterize miRNA expression in HFpEF (LVEF ≥ 45%) and HFrEF (LVEF < 45%) and its association with myocardial remodeling. MethodsProspectively enrolled symptomatic HF patients (HFpEF:n = 36; HFrEF:n = 31) and controls (n = 23) underwent cardiac magnetic resonance imaging with T1-mapping and circulating miRNA expression (OpenArray system). Results13 of 188 miRNAs were differentially expressed between HF groups (11 downregulated in HFpEF). Myocardial extracellular volume (ECV) was increased in both HF groups (HFpEF 30 ± 5%; HFrEF 30 ± 3%; controls 26 ± 2%, p < 0.001). miR-128a-3p, linked to cardiac hypertrophy, fibrosis, and dysfunction, correlated positively with ECV in HFpEF (r = 0.60, p = 0.01) and negatively in HFrEF (r = −0.51, p = 0.04). miR-423-5p overexpression, previously associated HF mortality, was inversely associated with LVEF (r = − 0.29, p = 0.04) and intracellular water lifetime (τic) (r = −0.45, p < 0.05) in both HF groups, and with NT-proBNP in HFpEF (r = −0.63, p < 0.01). ConclusionsmiRNA expression profiles differed between HF phenotypes. The differential expression and association of miR-128a-3p with ECV may reflect the distinct vascular, interstitial, and cellular etiologies of HF phenotypes.

COVID-19 among heart failure patients: A retrospective study of 294 patients at a referral cardiac center in northern Iran

Cardiovascular disease, especially heart failure (HF), is the most important comorbidity that increases the risk of death in COVID-19 patients. This study aimed to assess and compare demographic characteristics, clinical features, and clinical outcomes in HF patients with and without COVID-19. Using a retrospective research, 294 patients with HF referred to a cardiac center in Guilan province, northern Iran were enrolled. Data were collected using census sampling from August 2020 to 2021. In this study, the medical records of all patients with HF were assessed. In this research, 294 HF patients were enrolled. Also, 26.53% of HF patients had COVID-19. Mean EF, blood pressure, and HF duration in HF patients with COVID-19 were 25.83 (SD=12.31), 126.65 (SD=24.67) mmHg, and 3.79 (SD=2.10) years, respectively. The most common symptoms in HF patients with COVID-19 were cough (52.56%), headache (44.87%), and gastrointestinal problems (43.59%), respectively. Finally, 55.13% of HF patients with COVID-19 died. The mean age of HF patients with COVID-19 was higher than in HF patients without COVID-19 (66.02 vs. 62.79 years; P=0.031). Hyperlipidemia was higher in HF patients with COVID-19 than in HF patients without COVID-19 (25.64% vs. 13.89%; P=0.018). Also, in-hospital mortality was higher in HF patients with COVID-19 than in HF patients without COVID-19 (55.13% vs. 16.20%; P&lt;0.001). Overall, HF patients with COVID-19 are at particular risk for severe complications and high mortality. Therefore, it is recommended to pay special attention to HF patients with COVID-19.

The associations of residential greenness with cortisol in patients with heart failure

ABSTRACT Heart failure (HF) is the leading cause of hospitalizations in cardiovascular disease patients, in many countries, including the United States, Europe, and Lithuania. HF patients often have elevated cortisol levels, associated with higher mortality. Urban greenery can improve physical and mental health. We hypothesize that greater residential environment greenness exposure is linked to reduced cortisol levels in symptomatic HF patients. During 2006-2009, in Kaunas, Lithuania, health data was collected from 85 urban patients (a population of ≥ 10,000 inhabitants) who underwent rehabilitation for symptomatic HF. Patients were assessed for general, cardiorespiratory systems parameters, also for blood cortisol levels at baseline and after 6 months. Greenness was assessed using the Normalized Difference Vegetation Index (NDVI) in buffer zones. A multivariate linear regression model was used to evaluate the effect of NDVI on cortisol change after 6 months. A decrease in cortisol by −30.8 mmol/l (SE = 14.7, p = 0.036) was associated with a 0.1 higher level of NDVI at 300 m. NDVI effect was stronger when cortisol test was done after 10 AM and in patients with ejection fraction < 30%. Our results confirm that greenness was related to a decrease in cortisol levels after 6 months in patients with symptomatic HF.

Machine learning-based gait analysis to predict clinical frailty scale in elderly patients with heart failure.

Although frailty assessment is recommended for guiding treatment strategies and outcome prediction in elderly patients with heart failure (HF), most frailty scales are subjective, and the scores vary among raters. We sought to develop a machine learning-based automatic rating method/system/model of the clinical frailty scale (CFS) for patients with HF. We prospectively examined 417 elderly (≥75 years) with symptomatic chronic HF patients from 7 centres between January 2019 and October 2023. The patients were divided into derivation (n = 194) and validation (n = 223) cohorts. We obtained body-tracking motion data using a deep learning-based pose estimation library, on a smartphone camera. Predicted CFS was calculated from 128 key features, including gait parameters, using the light gradient boosting machine (LightGBM) model. To evaluate the performance of this model, we calculated Cohen's weighted kappa (CWK) and intraclass correlation coefficient (ICC) between the predicted and actual CFSs. In the derivation and validation datasets, the LightGBM models showed excellent agreements between the actual and predicted CFSs [CWK 0.866, 95% confidence interval (CI) 0.807-0.911; ICC 0.866, 95% CI 0.827-0.898; CWK 0.812, 95% CI 0.752-0.868; ICC 0.813, 95% CI 0.761-0.854, respectively]. During a median follow-up period of 391 (inter-quartile range 273-617) days, the higher predicted CFS was independently associated with a higher risk of all-cause death (hazard ratio 1.60, 95% CI 1.02-2.50) after adjusting for significant prognostic covariates. Machine learning-based algorithms of automatically CFS rating are feasible, and the predicted CFS is associated with the risk of all-cause death in elderly patients with HF.

Determining whether LV filling time contributes to HF symptoms in different widths of QRS in LBBB patients: A clinical study.

Accurate assessment of left ventricular (LV) function is essential for managing patients with left bundle branch block (LBBB). This study aimed to evaluate the relationship between LV systolic function, left ventricular diastolic filling time (LVFT), QRS duration, and heart failure symptoms in patients with LBBB. This study was conducted between June 2021 and June 2022. Patients with LBBB and sinus rhythm who were referred to the echocardiography department were included in the study. All the patients underwent electrocardiogram-gated echocardiography using the same machine. In this study, the LVFT value was measured in absolute terms and as a ratio to the R-R interval (LVFT/RR). A total of sixty-five patients were included, forty-two (64.6%) were women, and the mean age was 60.71±8.72. We performed three one-way ANOVA tests that showed that LV filling time/RR ratio, QRS duration, and ejection fraction were significantly different between heart failure classes (p=0.008, p=0.001, and p<0.001, respectively). A weak correlation was observed between LVEF and LVFT/RR (r=0.349, p=0.004). Additionally, QRS duration was negatively correlated with LVEF (r=-0.395, p=0.004) and LVFT/RR (r=-0.350, p=0.004), although these correlations were weak. We showed that LVFT/RR ratio differed significantly between HF functional classes and was lower in patients with more severe HF symptoms. Additionally, QRS duration was negatively correlated with LVEF and LVFT/RR, and patients with more severe HF symptoms had longer QRS durations.

Efficacy of remote home telemonitoring (HTM) on congestion control and heart failure (HF) hospitalizations in HF out-patients

Abstract Introduction Heart failure (HF) burden is characterized by high hospitalizations rates, impairing patients survival and quality of life. Yet, early detection and control of congestion with home tele-monitoring (HTM) might help to reduce HF hospitalizations (HFH) (1). Aim To report our experience of congestion management with HTM for HF patients in out-hospital setting. Methods All HF patients followed with the HTM program of our HF clinic between July 2020 and December 2022 were included. For each patient, HTM consisted in daily body weight and symptoms tele-transmission through a connected device. History of HFH were recorded 18 months before and up to 18 months after inclusion in HTM. Alerts were defined as weight gain (WA) (≥ 3 kgs in 2 days or ≥ 2 kgs in 5 days) and/or new symptoms (SA) onset (≥ 3 in 1 day or identical 3 times in 4 days). Relevants HTM alerts were transmitted by the service provider to the local HF team to be managed within 48 hours : phone contact and/or NT-proBNP dosing and/or physical consultation and/or treatment adaptation. Results Among the 147 patients included, mean age was 60±12 years, 110 (75%) were males. Mean left ventricle ejection fraction (LVEF) was 34±11%, and 112 (76%) had HF-rEF, 19 (13%) HF-mrEF and 16 (11%) HF-pEF. Other baselines characteristics are resumed in Table1. Mean HTM duration was 391±250 days and mean device observance was 74±21%. During HTM, 85 (59%) alerts were managed by the HF team in a mean delay of 98±114 days after inclusion : 47 (32%) WA, 34 (23%) SA and 4 (3%) W+SA. After Student-paired test compared to D0 (day of alert transmission), mean weight (kgs) at D2, D5, D10, D21 and D30 were significantly lower (all p&amp;lt;10E-3), respectively 91±17 versus 90±17, 89±17, 89±16, 88±16 and 89±17 kgs (Fig.1A). After Wilcoxon paired-test, the same difference was observed for symptoms (all p&amp;lt;10E-3) : 3±2 (D0) versus 1±1 (D2), 0.7±1 (D5), 0.4±0.8 (D10), 0.5±0.7 (D21) and 0.5±0.9 (D30) (Fig.1B). Patients HFH rates were significantly lower after HTM inclusion : 19 HFH (13%) after HTM versus 70 (48%) before, according to McNemar's X2 test (p&amp;lt;10E-11) (Fig.1C). Notably, post-HTM observed HFH rates (13%) also differed significantly from the 20% expected in a general HF population (2). For the 15 patients (10%) with history of HFH both before and after HTM implementation, mean lengths of stay (LOS) were significantly lower when HFH occurs after HTM inclusion according to Wilcoxon signed rank test : 10±12 vs 22±19 days (-12±17 days, p=0.02) (Fig.1D). Conclusion In our experience, HTM is a efficient to help controling congestion and symptoms of HF patients in out-hospital setting, and can help to reduce HFH, providing that each alerts is being timely and appropriately addressed by the HF team. Prospective studies are needed to confirm these results.Impact of HTM on congestion and HFHTable 1.Patients characteristics.

Left ventricular reverse remodeling following initiation of sacubitril/valsartan for heart failure with reduced ejection fraction and low blood pressure

Abstract Background Sacubitril/valsartan has become an important first-line drug for symptomatic heart failure (HF) patients, especially with left ventricular (LV) ejection fraction (LVEF) &amp;lt; 50%. Since sacubitril/valsartan was reported to be more potent than renin-angiotensin-aldosterone system inhibitors for lowering blood pressure, HF patients with low blood pressure were not included in most clinical studies as a result of sacubitril/valsartan administration, and average systolic blood pressure of most enrolled patients was around 120 mmHg. Thus, the effect of sacubitril/valsartan on cardiovascular outcomes, especially LV reverse remodeling for HF patients with LVEF &amp;lt; 50% and low blood pressure, remains uncertain. Purpose The aim of this study was to examine the effect of sacubitril/valsartan on LV reverse remodeling after initiation of the maximum tolerated dose of sacubitril/valsartan for HF patients with LVEF &amp;lt; 50% and systolic blood pressure ≤ 100 mmHg, and a comparison of its efficacy with that for patients with systolic blood pressure &amp;gt; 100 mmHg. Methods We retrospectively studied 164 HF patients with LVEF &amp;lt; 50% who were treated with sacubitril/valsartan from two institutions. Echocardiography was performed before and 9.5 ± 5.1 months after initiation of maximum tolerated dose of sacubitril/valsartan. Results sacubitril/valsartan was discontinued for 17 (10.4%) as decided by the attending physician mainly due to hypotension. The prevalence of discontinuation of sacubitril/valsartan for the low blood pressure group was higher than that for the non-low blood pressure group, but the difference was not statistically significant (16.0% vs. 9.4%, P = 0.32). No serious adverse events occurred during this study. The maximum tolerated dose of sacubitril/valsartan was lower for the low blood pressure group than for the non-low blood pressure group (165 ± 106 mg vs. 238 ± 124 mg, P = 0.017). As expected, significant LV reverse remodeling was observed in the non-low blood pressure group after initiation of sacubitril/valsartan. It was noteworthy that significant LV reverse remodeling was also observed in the low blood pressure group after initiation of sacubitril/valsartan (LV end-diastolic volume: 177.3 ± 66.0 mL vs. 137.7 ± 56.1 mL, P&amp;lt;0.001, LV end-systolic volume: 131.6 ± 60.3 mL vs. 94.6 ± 55.7 mL, P&amp;lt;0.001, LVEF: 26.8 ± 10.3% vs. 33.8 ± 13.6%, P = 0.015). Relative changes in LV volumes and LVEF after initiation of sacubitril/valsartan were similar for the two groups (Figure). Conclusions Significant LV reverse remodeling can occur after initiation of sacubitril/valsartan even in HF patients with LVEF &amp;lt; 50% and systolic blood pressure ≤ 100 mmHg if tolerated. This finding is expected to offer new insights for better management of HF patients.Figure

Abstract 16541: Early Aortic Valve Replacement in Symptomatic Normal-Flow, Low-Gradient Severe Aortic Stenosis: A Propensity Score-Matched Retrospective Cohort Study

Introduction: Aortic valve replacement (AVR) is a class I indication for symptomatic severe aortic stenosis (AS). However, there is little evidence of the benefit of early AVR in symptomatic patients with normal-flow, low-gradient (NFLG) severe AS. Hypothesis: Early AVR has benefit in patients with NFLG severe AS Methods: Two-hundred eighty-one patients diagnosed with symptomatic NFLG severe AS (stroke volume index ≥ 35 mL/m 2 , mean transaortic pressure gradient &lt; 40 mmHg, peak transaortic velocity &lt; 4 m/s, and aortic valve area &lt; 1.0 cm 2 ) between January 2010 and December 2020 were retrospectively reviewed. After 1:1 propensity score matching, 121 patients aged 75.1 ± 9.8 years (including 63 women) who underwent early AVR within three months after index echocardiography were compared with 121 patients who received conservative care. The primary outcome was a composite of all-cause death and heart failure hospitalization. Results: During a median follow-up of 21.9 months, 48 primary outcomes (18 in the early AVR group and 30 in the conservative care group) occurred. The early AVR group presented a significantly lower incidence of primary outcomes (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.29-0.93; P = 0.028); specifically, there was no significant difference in all-cause death (HR, 0.51; 95% CI, 0.23-1.16; P = 0.110), although the early AVR group showed a significantly lower incidence of hospitalization for heart failure (HR, 0.43; 95% CI, 0.19-0.95, P = 0.037). Subgroup analyses supported the main findings. Conclusions: An early AVR strategy may benefit guard against a composite outcome of death or hospitalization for heart failure in symptomatic patients with NFLG severe AS. Future randomized studies must confirm our findings.

Abstract 15705: Perceived Control Over Own Health Buffers the Negative Impact of Patient Symptom Burden on Quality of Life in Patient-Caregiver Dyads: A Dyadic Mediation Analysis

Introduction: Patients with heart failure (HF) experience multiple physical and psychological symptoms that are associated with poor quality of life (QoL) for patients and family caregivers. Perceived control is known to buffer the adverse consequences of symptom burden on QoL among patients and caregivers at the individual level. However, there is limited knowledge about these associations within dyad members. Our aim was to determine whether perceived control over one’s personal health mediated the association of patient symptom burden and QoL in each member of the dyad. Methods: In this cross-sectional study, patients with HF (N= 154, 65% male, 50% NYHA III/V) reported physical and psychological symptom burden (Memorial Symptom Assessment Scale-HF). Informal caregivers (N = 154, 76% female) and patients completed surveys of perceived control (Control Attitudes Scale-Revised) and physical and mental well-being (MOS Health Survey-36v2). Dyadic data were analyzed using four multilevel Actor Partner Independence Mediation Models. Results: Symptom burden was associated with perceived control of each dyad member (P &lt;.05). Physical symptom burden was directly associated with physical well-being for patients, not caregivers. Physical and psychological symptom burden was directly associated with mental well-being for each dyad member. Perceived control significantly mediated the association of physical symptom burden with physical and mental well-being in each dyad member (Figures A &amp; C). Similarly, perceived control mediated the association of psychological symptom burden with physical and mental well-being in each dyad member (Figures B &amp; D). Perceived control did not influence QoL in partners. Conclusions: Physical and psychological symptoms in HF patients were linked with each dyad member's QoL through perceived control over their health. Fostering perceived control may minimize the negative impact of symptom burden on the QoL of dyad members.

Abstract 16327: Machine Learning-Based Prediction of Clinical Frailty Scale Based on Gait Analysis in Elderly Patients With Heart Failure

Background: Although frailty assessment is recommended for guiding treatment strategies and outcome prediction in elderly patients with heart failure (HF), most frailty scales are subjective, and the scores vary among raters. We sought to develop a machine learning-based automatic rating method/system/model of the clinical frailty scale (CFS) for patients with HF. Methods: We prospectively examined 358 elderly (≥75 years) with symptomatic chronic HF patients (mean age 82.3±5.2 years, left ventricular ejection fraction 58 [IQR 45-67]%) from six sites between January 2019 and September 2022. The CFS was evaluated based on the modified Delphi method by 10 independent trained cardiologists as the gold standard. We obtained body-tracking motion data using OpenPose ® , a deep learning-based pose estimation library, on a smartphone camera. Predicted CFS was calculated from 128 key features, including gait parameters, using the extremely randomized trees (ERT) model. To evaluate the performance of this model, we calculated Cohen’s weighted kappa and intraclass correlation coefficient (ICC) between the predicted and actual CFSs. The studied patients were divided into derivation (from a university hospital) and validation (from other five sites) cohorts. Results: In the derivation (n = 181) and validation (n = 177) cohorts, the ERT model showed sufficient agreement between the actual and predicted CFSs (kappa 0.864, ICC 0.864 and kappa 0.796, ICC 0.796, respectively) ( Figure ). During a median follow-up period of 421 (IQR 280-616) days, the higher predicted CFS was independently associated with a higher risk of all-cause death (HR 1.97, 95% CI 1.21-3.20) adjusted for the MAGGIC mortality risk prediction score, N-terminal pro-brain natriuretic peptide, and serum albumin levels. Conclusions: Machine learning-based algorithms that automatically rate the CFS are feasible, and the predicted CFS is associated with the risk of all-cause death in elderly patients with HF.

Galectin-3 as a Biomarker to Predict Cardiorenal Syndrome in Patients with Acute Heart Failure.

Galectin-3 affects cardiac tissue inflammation as an inflammatory mediator. The development of cardiorenal syndrome in heart failure patients is associated with a poor prognosis. This study aims to investigate whether serum galectin-3 levels can be used as a biomarker to predict cardiorenal syndrome in heart failure patients with reduced left ventricular ejection fraction. A total of 166 symptomatic heart failure patients [New York Heart Association (NYHA) functional class II-III] with reduced left ventricular ejection fraction (≤ 40%) were recruited prospectively. Cardiorenal syndrome type 1 was defined as an acute worsening of cardiac function leading to renal dysfunction. The patients were divided into two groups with and without cardiorenal syndrome. The galectin-3 levels of all patients were determined. The primary outcome of this study was the occurrence of cardiorenal syndrome. Cardiorenal syndrome developed in 41 patients. Galectin-3 levels were found to be higher in the patients with cardiorenal syndrome (+) compared to those without cardiorenal syndrome (-) (20.7 ± 2.9 ng/mL vs. 17.8 ± 3.1 ng/mL, p < 0.001). After performing a multivariable analysis, galectin-3 levels [odds ratio (OR): 3.21, p = 0.001], NYHA functional class (OR: 1.98, p = 0.009), creatinine (OR: 3.18, p = 0.006), furosemide dose (OR: 1.21, p = 0.033), and angiotensin-converting enzyme inhibitor/angiotensin-receptor blockers usage (OR: 0.54, p = 0.029) were identified as independent predictors for the development of cardiorenal syndrome. Moreover, galectin-3 level demonstrated predictive capability for cardiorenal syndrome development (AUC = 0.761, p < 0.001). Serum galectin-3 level showed an association with cardiorenal syndrome development in patients with heart failure, indicating potential usefulness as a prognostic biomarker.

Conduction System Pacing for Cardiac Resynchronization Therapy.

Cardiac resynchronization therapy (CRT) via biventricular pacing (BiVP-CRT) is considered a mainstay treatment for symptomatic heart failure patients with reduced ejection fraction and wide QRS. However, up to one-third of patients receiving BiVP-CRT are considered non-responders to the therapy. Multiple strategies have been proposed to maximize the percentage of CRT responders including two new physiological pacing modalities that have emerged in recent years: His bundle pacing (HBP) and left bundle branch area pacing (LBBAP). Both pacing techniques aim at restoring the normal electrical activation of the ventricles through the native conduction system in opposition to the cell-to-cell activation of conventional right ventricular myocardial pacing. Conduction system pacing (CSP), including both HBP and LBBAP, appears to be a promising pacing modality for delivering CRT and has proven to be safe and feasible in this particular setting. This article will review the current state of the art of CSP-based CRT, its limitations, and future directions.

Landscape of gut microbiota and metabolites and their interaction in comorbid heart failure and depressive symptoms: a random forest analysis study.

There is increasing evidence that alterations in gut microbial composition and function are associated with cardiovascular or psychiatric disease. Therefore, it is meaningful to investigate the taxonomic and functional characterization of the microbiota in HF patients who also have depressive symptoms. In this cross-sectional study, Cloacibacillus and alpha-tocopherol were determined as new diagnostic markers. Furthermore, intestinal microecosystem disorders are closely linked to depressive symptoms in HF patients, providing a new reference viewpoint for understanding the gut-heart/brain axis.

Evaluation of MADIT-II Risk Stratification Score Among Nationwide Registry of Heart Failure Patients With Primary Prevention Implantable Cardiac Defibrillators or Resynchronization Therapy Devices

Current guidelines advocate prophylactic Implantable Cardioverter Defibrillator (ICD) for all symptomatic heart failure (HF) patients with low LVEF. Since many patients will never use their device, a score delineating subgroups with differential ICD benefit is crucial. We aimed to Evaluate MADIT II-based Risk Stratification Score (MRSS) feasibility to delineate ICD survival benefit among nationwide registry of HF patients with prophylactic ICDs. Accordingly, all Israeli HF patients with prophylactic ICD/CRTDs were categorized into MRSS-based risk-subgroups. Study endpoints included overall mortality, sustained ventricular arrhythmia (VA), and a competing risk of VA (potential preventable arrhythmic death, where ICD could benefit survival) versus non-arrhythmic death. Potential ICD survival benefit was estimated by the area between these cumulative incidence curves. Among 2,177 HF patients implanted prophylactic device, 189 patients (8.7%) had VA and 316 (14.5%) died during median Follow-up (F/U) of 2.9 years. MRSS risk-subgroups were significantly associated with overall mortality (p < 0.001) and weakly with VA (p 0.3). Competing risk analysis of VA versus non-arrhythmic death revealed significantly shorter duration (p < 0.001) and smaller magnitude of ICD survival benefit with increased risk subgroups, yielding estimated 76, 60, 38, and 0 life-days gained from prophylactic ICD implant during 5-year F/U for the MRSS low, intermediate, high, and very-high risk subgroups, respectively (p for trend< 0.05). In conclusion, MRSS use among nationwide registry of ischemic and non-ischemic cardiomyopathy patients, revealed subgroups with differing ICD survival benefit, suggesting it could help evaluate prophylactic ICD survival benefit.

Prevalence of Severity-based Evaluation of Heart Failure (PROBE) and its Impact on Health-related Quality of Life: An Observational Study

Objectives: The study aims to evaluate the severity of heart failure (HF) and its impact on the patient's quality of life (QoL). Methodology: A multicenter, observational study was conducted across 100 medical facilities in Pakistan. Symptomatic HF patients (NYHA Class-II to IV) diagnosed ≥ 1 year ago, aged ≥ 18 years, and advised for echocardiography were invited. A total of 961 patients agreed to participate. HF severity was assessed based on ejection fraction (EF %) and NYHA class. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess the effect of HF on the patient's QoL. Results: The patients' overall health status exhibited poor scores, with a mean KCCQ score of 20.26±8.34. Concerning left ventricular ejection fraction (LVEF), 25.9% of patients displayed moderate dysfunction (LVEF 30% to 39%), while 29.1% had severe dysfunction (LVEF &lt; 30%). The distribution across NYHA classes was Class II included 451 patients (46.9%), Class III included 317 patients (33.0%), and Class IV included 193 patients (20.1%). High-quality-of-life (HR-QoL) assessments using the KCCQ exhibited significant correlations with both LVEF (rs=-0.394, p&lt;0.01) and NYHA class (rs=-0.615, p&lt;0.01). Notably, the mean KCCQ score displayed considerable variation across NYHA classes, Class II had a mean score of 25.42±7.95, Class III had 20.90±7.67, and Class IV had 16.41±8.94. Significant predictors of quality of life (KCCQ score) included age and NYHA. Conclusion: It is concluded from the study results that HR-QoL is significantly correlated with the severity of HF based on ejection fraction and NYHA class.

Nonsteroidal Mineralocorticoid Receptor Antagonist (Finerenone) in Cardiorenal Disease.

Nonsteroidal mineralocorticoid receptor antagonists (MRAs) present a promising therapeutic option in cardiorenal diseases, mitigating the limitations of steroidal MRAs. Finerenone, a third-generation nonsteroidal MRA, has demonstrated beneficial effects in heart failure (HF) and chronic kidney disease (CKD). Clinical trials, including FIDELIO-DKD and FIGARO-DKD, revealed finerenone's efficacy in improving kidney and cardiovascular (CV) outcomes. Patients with CKD and type 2 diabetes (T2DM) on finerenone experienced reduced rates of cardiovascular events, including hospitalization for HF. However, these trials excluded symptomatic HF patients, focusing on asymptomatic or early-stage HF. The ongoing FINEARTS-HF trial evaluates finerenone in HF with preserved ejection fraction (HFpEF). Additionally, studies exploring finerenone and sodium-glucose cotransporter 2 (SGLT2) inhibitors' (Empagliflozin) combination effects in CKD and T2DM (CONFIDENCE) and the selective MR modulator AZD9977 with another SGLT2 inhibitor (dapagliflozin) in HF and CKD (MIRACLE) aim to expand treatment options. While SGLT-2 inhibitors were shown to reduce hyperkalemia risk in FIDELIO-DKD and potentially lower new-onset HF incidence in FIGARO-DKD, further research is essential. So far, the evidence for the beneficial effect of finerenone in the spectrum of cardiorenal diseases is based only on the results of studies conducted in patients with T2DM, and clinical trials of finerenone in patients with nondiabetic kidney disease are ongoing. Nonsteroidal MRAs hold significant potential as pivotal treatment targets across the cardiorenal disease spectrum. This review will focus on the effects of finerenone on cardiorenal disease.

Left ventricular reverse remodeling following initiation of sacubitril/valsartan for heart failure with reduced ejection fraction and low blood pressure.

Sacubitril/valsartan has become an important first-line drug for symptomatic heart failure (HF) patients, especially with left ventricular (LV) ejection fraction (LVEF) < 50%. However, the impact of sacubitril/valsartan on cardiovascular outcomes, especially LV reverse remodeling for such patients with low blood pressure, remains uncertain. We retrospectively studied 164 HF patients with LVEF < 50% who were treated with sacubitril/valsartan from two institutions. Echocardiography was performed before and 9.5 ± 5.1months after initiation of maximum tolerated dose of sacubitril/valsartan. The maximum tolerated dose of sacubitril/valsartan was lower for the low blood pressure group (≤ 100mmHg in systole) than for the non-low blood pressure group (> 100mmHg in systole) (165 ± 106mg vs. 238 ± 124mg, P = 0.017). As expected, significant LV reverse remodeling was observed in the non-low blood pressure group after initiation of sacubitril/valsartan. It was noteworthy that significant LV reverse remodeling was also observed in the low blood pressure group after initiation of sacubitril/valsartan (LV end-diastolic volume: 177.3 ± 66.0mL vs. 137.7 ± 56.1mL, P < 0.001, LV end-systolic volume: 131.6 ± 60.3mL vs. 94.6 ± 55.7mL, P < 0.001, LVEF: 26.8 ± 10.3% vs. 33.8 ± 13.6%, P = 0.015). Relative changes in LV volumes and LVEF after initiation of sacubitril/valsartan were similar for the two groups. In conclusion, significant LV reverse remodeling occurred after initiation of sacubitril/valsartan, even in HF patients with LVEF < 50% and systolic blood pressure ≤ 100mmHg.

The Association of Metformin With Heart Failure in Patients With Diabetes Mellitus Receiving Anthracycline Chemotherapy

BackgroundThe prevention of heart failure (HF) is an important issue in patients treated with anthracyclines. Metformin, widely used to treat diabetes mellitus (DM), protects from anthracycline-induced cardiotoxicity in vitro and in animal models. ObjectivesThe aim of our study was to test the association of metformin with the occurrence of symptomatic HF in patients with DM receiving anthracyclines. MethodsA total of 561 patients with DM received new anthracycline therapy between 2008 and 2021 in a tertiary care center; propensity score matching was used to compare patients with or without metformin treatment. The primary outcome was new onset symptomatic HF occurring within 1 year of the initiation of anthracyclines. ResultsA total of 315 patients (65 ± 11 years of age, 33.7% male) were included. Patients with and without metformin were well matched for age, sex, type of cancer, medications, and cardiovascular risk factors. Six patients treated with metformin and 17 matched patients developed HF within 1 year of anthracycline initiation. The incidence of HF in patients treated with metformin was lower than patients without metformin within 1 year after anthracyclines (cumulative incidence: 3.6% vs 10.5%; P = 0.022; HR: 0.35; 95% CI: 0.14-0.90; P = 0.029). The use of metformin (HR: 0.71; 95% CI: 0.50-1.00; P = 0.049), was also associated with lower mortality. ConclusionsThe use of metformin was associated with a lower incidence of HF and overall mortality in patients with DM receiving anthracyclines. Our findings should be further confirmed by randomized control trials.