Symptomatic Heart Failure Patients Research Articles

Unveiling the clinical profiles of heart failure across diverse stages and phenotypes: insights from the national echocardiographic society registry

Abstract Background The modern comprehension of heart failure (HF), based on a staging paradigm, demands systematic screening to promptly identify individuals at risk, those in the pre-HF stage, and symptomatic HF patients across various phenotypes (HFpEF, HFmrEF, and HFrEF). The discernment of clinical profiles within these categories holds significant potential for improving screening and ensuring timely therapeutic interventions. Material and Methods Our national echocardiographic society executed a multicenter HF screening program. General practitioners in 13 primary care centers utilized the original mobile app to determine referrals for transthoracic echocardiography and N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing in patients without a prior HF diagnosis. The 2021 ESC guidelines' algorithms were employed for HF diagnosis (HFpEF, HFmrEF, HFrEF). This study identifies two pre-heart failure (pre-HF) stages: "heart stress" (elevated NT-proBNP in asymptomatic individuals with risk factors, regardless of structural heart disease or cardiac dysfunction) and individuals "at risk for HF" (normal NTproBNP and at least one HF risk factor). Ultimately, all patients were categorized into six groups: (I) no HF, no risk; (II) at risk for HF; (III) heart stress; (IV) HFpEF; (V) HFmrEF; and (VI) HFrEF. Subsequently, the eleven clinical variables were compared among groups (II) to (VI) using chi-square test. Results Among 930 screened outpatients (mean age 66±11 years, 61% female), diagnosis of HF was established in 34.2% (Figure, pie). Heart stress was found in 22.3% patients, and 38.1% were at risk for HF, while 5.5 % had neither HF nor risk factors. Group comparison revealed that older individuals were more frequent in the HFpEF group, females predominated in the heart-stress and HFpEF groups, and males in the HFrEF group (Figure, table). Obesity was the most frequent among those at risk and HFmrEF. Atrial fibrillation and pathological ECG increased gradually from those at risk to HFrEF. Previous MI was the most common in heart stress and HFmrEF groups, while arterial hypertension >10 years prevailed in HFpEF and HFmrEF patients. Diabetes mellitus > 5 years was present in 24-28% across groups. CKD or eGFR≤60 ml/min/1.73m² increased gradually towards HFmrEF. The family history of CMP or SCD was positive in 17-24%, with no significant differences observed across groups. Additionally, a small number of patients had a history of previous cardiotoxic cancer treatment, and no significant differences were found between groups. Conclusions The mobile phone application used in primary care successfully identified a significant number of pre-heart failure patients requiring further evaluation. Different HF stages and phenotypes exhibit distinct clinical profiles, aiding in the screening process and contributing to a deeper understanding of the heart's pathophysiological adaptation to diverse risk factors during HF development.

Efficacy of native T1 mapping for patients with non-ischemic cardiomyopathy and ventricular functional mitral regurgitation undergoing transcatheter edge-to-edge repair

Abstract Background The objectives of this study were to investigate the efficacy of LV myocardial damage assessment by native T1 mapping obtained with cardiac magnetic resonance (CMR) for symptomatic heart failure (HF) patients with non-ischemic cardiomyopathy (NICM) and ventricular functional mitral regurgitation (VFMR) undergoing transcatheter edge-to-edge repair (TEER). Methods We studied 40 symptomatic HF patients with NICM and VFMR undergoing TEER. LV myocardial damage was defined as the native T1 Z-score which was converted from native T1 value obtained with CMR before TEER. The primary endpoint was defined as first re-hospitalization for HF or cardiovascular death over a median follow-up period of 12 months after TEER. Results Multivariable Cox-proportional hazards analysis showed that a native T1 Z-score was the only independent parameter associated with cardiovascular events (hazard ratio: 3.40, 95% confidential interval: 1.51-7.67), and patients with native T1 Z-score < 2.41 experienced significantly fewer cardiovascular events than those with a native T1 Z-score ≥ 2.41 (log-rank P = 0.001). Moreover, such a low native T1 Z-score and more severe VFMR in an effective regurgitant orifice area (EROA) ≥ 0.30 cm2 was associated with fewer cardiovascular events than for a high native T1 Z-score of ≥ 2.41 and less severe VFMR of EROA < 0.30 cm2 (log-rank P = 0.002). Conclusion Assessment of baseline LV myocardial damage by means of native T1 Z-score obtained with CMR without the use of gadolinium-based contrast media is a valuable additional parameter for better management of symptomatic NICM patients with reduced LVEF and VFMR following TEER.

CRT should be recommended for all heart failure patients with mechanical dyssynchrony and a ventricular conduction delay regardless of the QRS morphology

Abstract Introduction Two recent meta-analyses displayed the heterogeneous effect of cardiac resynchronization therapy (CRT) in patients with a non-left bundle branch block (non-LBBB) and found an increased burden of ventricular arrhythmias after CRT (1,2). Careful patient selection is therefore paramount. Evidence suggests the assessment of mechanical dyssynchrony may guide decision-making to CRT in this challenging population. Purpose To assess the effect of CRT in patients with and without mechanical dyssynchrony compared to medication only, and in particular in patients with a non-LBBB morphology. Methods We retrospectively screened for symptomatic heart failure patients who presented between 2012 and 2018 at our clinic with a QRS duration ≥130ms and a left ventricular ejection fraction (LVEF) ≤35%. We identified 361 patients who received CRT and 1107 patients who could have been considered for CRT. Patients were excluded if echocardiographic data was unavailable, they received CRT after 2018, were 80 years or older, or had other significant co-morbidities. We enrolled the remaining 220 CRT patients ("CRT") and 124 patients treated with medication only ("Control") for analysis. Patients were categorized for the presence of mechanical dyssynchrony on echocardiography, defined as the presence of either septal flash, apical rocking, or both. Multivariable-adjusted Cox regression analyses, including stratification by the presence of dyssynchrony, was performed to compare the effect of CRT to medication only. Hazard ratios (aHR) were obtained after adjustment for age, sex, atrial rhythm, QRS duration, QRS morphology, ischemic disease, kidney function, medication and presence of a defibrillator. Sensitivity analysis was performed in patients with a non-LBBB morphology. Results The CRT and Control group were comparable except for the QRS duration (163±22ms vs 152±16ms, p<0.001), the proportion of patients on optimal medical therapy (64% vs 47%, p=0.001), patients with a defibrillator (81% vs 19%, p<0.001), and patients with a LBBB morphology (75% vs 47%, p<0.001). During an average follow-up of 6.0(±3.2) years, 162 patients (47%) died. In the overall cohort, CRT did not significantly improve survival (aHR: 0.66, p=0.065). There was, however, a marked survival benefit for CRT over medication only in patients with mechanical dyssynchrony (aHR: 0.37, p=0.001). In patients without dyssynchrony there was a trend towards harm due to CRT (aHR: 2.05, p=0.062). These results were consistent in the sub-cohort of patients with a non-LBBB morphology. Conclusion CRT significantly improves the life expectancy of patients with mechanical dyssynchrony, including patients with a non-LBBB morphology. These results add to the evidence that all heart failure patients with LVEF≤35%, QRS≥130ms and mechanical dyssynchrony should be recommended (Class I) for CRT regardless of QRS morphology, while awaiting the results of ongoing randomized controlled trials.

Extracellular Microvesicles vs. Mitochondria: Competing for the Top Spot in Cardiovascular Regenerative Medicine.

Regenerative medicine aims to restore, replace, and regenerate human cells, tissues, and organs. Despite significant advancements, many cell therapy trials for cardiovascular diseases face challenges like cell survival and immune compatibility, with benefits largely stemming from paracrine effects. Two promising therapeutic tools have been recently emerged in cardiovascular diseases: extracellular vesicles (EVs) and mitochondrial transfer. Concerning EVs, the first pivotal study with EV-enriched secretome derived from cardiovascular progenitor cells has been done treating heart failure. This first in man demonstrated the safety and feasibility of repeated intravenous infusions and highlighted significant clinical improvements, including enhanced cardiac function and reduced symptoms in heart failure patients. The second study uncovered a novel mechanism of endothelial regeneration through mitochondrial transfer via tunneling nanotubes (TNTs). This research showed that mesenchymal stromal cells (MSCs) transfer mitochondria to endothelial cells, significantly enhancing their bioenergetics and vessel-forming capabilities. This mitochondrial transfer was crucial for endothelial cell engraftment and function, offering a new strategy for vascular regeneration without the need for additional cell types. Combining EV and mitochondrial strategies presents new clinical opportunities. These approaches could revolutionize regenerative medicine, offering new hope for treating cardiovascular and other degenerative diseases. Continued research and clinical trials will be crucial in optimizing these therapies, potentially leading to personalized medicine approaches that enhance patient outcomes.

The effects of digoxin on heart failure mortality and re-admission in a single center cross-sectional study.

Mortality benefit of digoxin prescription in patients suffering from heart failure has been questioned many time. We evaluated these effects among admitted symptomatic heart failure patients. We retrospectively divided our patients into two groups: group A (n=205) were digoxin prescribed, and group B (n=96) were digoxin naïve patients. Both groups' medical records were gathered for one year, and the study endpoints were compared between the two groups. The mean age was 62.3±12.1 years and 54.8 % were male. All-cause mortality and readmission occurred in 26.7% and 31.7% of individuals, respectively, without significant differences between the two groups. However, in subgroup analysis, there was a significant relationship between in-hospital mortality and the presence of cardiovascular risk factors. Digoxin might increase in-hospital mortality in patients with underlying cardiovascular risk factors.

Cost savings associated with extended battery longevity in cardiac resynchronization therapy defibrillators (CRT-D)

BackgroundCardiac resynchronization therapy-defibrillators (CRT-D) are devices established as treatment for symptomatic heart failure patients at risk of sudden cardiac death. Battery depletion poses a significant clinical and economic burden; extended service life may reduce costs due to generator changes and associated complications. ObjectiveThis study estimated cost-savings associated with extended battery longevity in Medicare patients receiving CRT-D implantation. MethodsA decision tree was used to explore three battery capacities: 1.0 ampere-hours (Ah), 1.6Ah, and 2.1Ah. Yearly risk of all-cause mortality, device-related complications, and end of battery life were estimated. Over 6 years, estimated costs included device implantation, replacement, follow-up appointments, and complications. ResultsThe average total costs to Medicare over 6 years were $41,527, $48,515, and $56,647 per person (USD 2023) for the 2.1Ah, 1.6Ah, and 1.0Ah, respectively. The total per-person replacement cost for the 1.0Ah devices was more than 4 times that of the 2.1Ah devices ($20,126 versus $5,006). When extrapolated to the total number of CRT-D implants over a 6-year period, the difference in costs between 2.1Ah1.0Ah battery capacity exceeded $500 million. ConclusionExtended longevity CRT-D batteries demonstrate significant cost savings to Medicare over 6 years. These data indicate long-term economic considerations should be included in device selection.

Symptomatic Heart Failure and Clonal Hematopoiesis–Related Mutations in Patients With Acute Myeloid Leukemia

Clonal hematopoiesis of indeterminate potential (CHIP) is a common risk factor for both hematological malignancies and cardiovascular (CV) diseases. The purpose of this study was to investigate the association between CHIP-related mutations and symptomatic heart failure in patients diagnosed with acute myeloid leukemia (AML). A total of 563 patients with newly-diagnosed AML who underwent DNA sequencing of bone marrow before treatment were retrospectively investigated. Cox proportional hazard regression models and Fine and Gray's subdistribution hazard regression models were used to assess the association between CHIP-related mutations and symptomatic heart failure (HF). 79.0% patients had at least 1 CHIP-related mutation; the most frequent mutations were DNMT3A, ASXL1 and TET2. Fifty-one patients (9.1%) developed symptomatic HF. The incidence of symptomatic HF was more frequent in patients with DNMT3A mutations (P<0.01), with a 1-year cumulative incidence of symptomatic HF in patients with DNMT3A mutations of 11.4%, compared to 3.9% in wild-type DNMT3A patients (P<0.01). After adjustment for age and anthracyclines dose, DNMT3A mutations remained independently correlated with HF (HR: 2.32, 95% CI: 1.26-4.29, P=0.01). In conclusion, in patients with AML, the presence of DNMT3A mutations was associated with a 2-fold increased risk for symptomatic HF irrespective of age and anthracyclines use.

Locoregional anesthesia is associated with decreased cardiac complications in symptomatic heart failure patients undergoing carotid endarterectomy

ObjectiveAlthough the current literature reports no advantage for locoregional anesthesia (LRA) over general anesthesia (GA) in patients undergoing carotid endarterectomy (CEA), there remains a gap in understanding the impact of LRA on individuals with congestive heart failure (CHF). This study aims to assess whether the choice of anesthesia influences the rates of perioperative complications within this patient population. MethodsUsing the Vascular Quality Initiative CEA module, all patients undergoing CEA between 2013 and 2023 were identified. The subset of patients with CHF was included, and patients were divided based on the type of anesthesia received. Patient characteristics and outcomes were compared using the χ2 or Fischer's exact test as appropriate for categorical variables and the independent t test or Mann-Whitney U test as appropriate for continuous variables. A sensitivity analysis was performed based on the symptomatic status of CHF, and the association between anesthesia modality and postoperative outcomes was studied using multivariable logistic regression analysis. The primary outcomes of this study included perioperative stroke, myocardial infarction (MI), acute HF, and the combination of MI and acute HF defined as major cardiac complications. ResultsA total of 21,292 patients (19,730 receiving GA, 1562 receiving LRA) with a diagnosis of CHF undergoing CEA were identified. On multivariable logistic regression analysis, LRA was independently associated with lower MI (odds ratio [OR]; 0.35; 95% confidence interval [CI], 0.13–0.96), acute HF (OR, 0.27; 95% CI, 0.09-0.87), major cardiac complications (OR, 0.30; 95% CI, 0.13-0.67), hemodynamic instability (OR, 0.64; 95% CI, 0.53-0.78), cranial nerve injury (OR, 0.40; 95% CI, 0.19-0.81), shunt use (OR, 0.25; 95% CI, 0.20-0.31), and neuromonitoring device use (OR, 0.20; 95% CI, 0.17-0.24) compared with GA in patients with symptomatic CHF. No difference in MI, acute HF, and major cardiac complications was seen in patients with asymptomatic CHF. ConclusionsCEA can be performed safely in patients with CHF. Using LRA is associated with a decreased incidence of perioperative cardiac complications in patients with symptomatic HF undergoing CEA.

Left Atrial Improvement in Patients With Secondary Mitral Regurgitation and Heart Failure: The COAPT Trial

BackgroundFunctional mitral regurgitation induces adverse effects on the left ventricle and the left atrium. Left atrial (LA) dilatation and reduced LA strain are associated with poor outcomes in heart failure (HF). Transcatheter edge-to-edge repair (TEER) of the mitral valve reduces heart failure hospitalization (HFH) and all-cause death in selected HF patients. ObjectivesThe aim of this study was to evaluate the impact of LA strain improvement 6 months after TEER on the outcomes of patients enrolled in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) trial. MethodsThe difference in LA strain between baseline and the 6-month follow-up was calculated. Patients with at least a 15% improvement in LA strain were labeled as “LA strain improvers.” All-cause death and HFH were assessed between the 6- and 24-month follow-up. ResultsAmong 347 patients (mean age 71 ± 12 years, 63% male), 106 (30.5%) showed improvement of LA strain at the 6-month follow-up (64 [60.4%] from the TEER + guideline-directed medical therapy [GDMT] group and 42 [39.6%] from the GDMT alone group). An improvement in LA strain was significantly associated with a reduction in the composite of death or HFH between the 6-month and 24-month follow-up, with a similar risk reduction in both treatment arms (Pinteraction = 0.27). In multivariable analyses, LA strain improvement remained independently associated with a lower risk of the primary composite endpoint both as a continuous variable (adjusted HR: 0.94 [95% CI: 0.89-1.00]; P = 0.03) and as a dichotomous variable (adjusted HR: 0.49 [95% CI: 0.27-0.89]; P = 0.02). The best outcomes were observed in patients treated with TEER in whom LA strain improved. ConclusionsIn symptomatic HF patients with severe mitral regurgitation, improved LA strain at the 6-month follow-up is associated with subsequently lower rates of the composite endpoint of all-cause mortality or HFH, both after TEER and GDMT alone. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [COAPT]; NCT01626079)

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). 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 Prognostic Accuracy of Get With The Guidelines-Heart Failure Score Alone and with Lactate Among Acute Symptomatic Heart Failure Patients: A Retrospective Cohort Study.

To evaluate the prognostic accuracy of the Get With The Guidelines-Heart Failure (GWTG-HF) score, Shock Index (SI), Modified Shock Index (MSI), and Age Shock Index (Age-SI) alone and with lactate in patients with acute symptomatic heart failure (HF). A retrospective cohort study was conducted in the emergency department of a tertiary hospital between January 1, 2019, and December 31, 2019. Patients aged >18 years and diagnosed with acute symptomatic HF were consecutively included in the study. Patients referred from another center and missing medical records were excluded. Arrival type, vital parameters, demographic characteristics, comorbid diseases, consciousness status, laboratory results, and outcomes of the patients were recorded. The primary endpoint of the study was in-hospital mortality. A total of 368 patients were included in the final analysis. The in-hospital mortality rate of the patients was 7.6%. The GWTG-HF score outperformed other scores in predicting in-hospital, 24-hour, and 30-day mortality (area under the curve (AUC) = 0.807, 0.844, and 0.765, P <.001, respectively). The overall performance of the GWTG-HF score with lactate (GWTG-HF+L) was better in predicting in-hospital, 24-hour, and 30-day mortality than the original GWTG-HF score (AUC = 0.872, 0.936, and 0.801, P <.001, respectively). Adding lactate values to the SI, MSI, and Age-SI improved their overall performance for all 3 outcomes. Both the GWTG-HF and GWTG-HF+L scores have acceptable discriminatory power in patients with acute symptomatic HF. The GWTG-HF score, SI, MSI, and Age-SI can be used together with lactate to predict mortality in patients with acute HF.

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.