Symptomatic Heart Failure Patients Research Articles

Resynchronization therapy with His bundle pacing in a patient after coronary sinus reducer implantation

Symptomatic heart failure patients with ischemic heart disease may require both coronary sinus reducer (CSR) implantation due to refractory angina pectoris and cardiac resynchronization therapy (CRT). Optimal approach to CRT in these patients is unknown as CSR implantation in the distal coronary sinus could deter left ventricular lead placement and thus preclude conventional CRT with biventricular pacing. We present a 70-year-old patient with ischemic cardiomyopathy and wide QRS complex after CSR implantation in whom we achieved successful cardiac resynchronization with His bundle pacing (HBP). HBP led to acute improvement in hemodynamic parameters and exercise capacity that persisted at follow-up. This case represents the first description of successful CRT with HBP in a patient after CSR implantation. HBP could present a feasible and safe resynchronization approach in these patients.<Learning objective: Optimal approach to cardiac resynchronization therapy in patients after coronary sinus reducer (CSR) implantation remains unknown as CSR implantation in the distal coronary sinus may deter left ventricular lead implantation and thus preclude conventional biventricular pacing. His bundle pacing could present a feasible and safe resynchronization approach in this growing group of patients.>

NT-proBNP for risk prediction of cardiovascular events and all-cause mortality: The getABI-study

BackgroundBeside their role in the diagnosis of heart failure in symptomatic patients with dyspnea, natriuretic peptides have been suggested to improve risk prediction of cardiac events and mortality in asymptomatic cohorts. We aimed to evaluate the prognostic value of NT-proBNP for cardiovascular and all-cause mortality above traditional risk factors in a prospective cohort study of unselected elderly patients in a representative primary care setting. MethodsWe followed 6382 patients of the getABI-study for 7 years. Associations of NT-proBNP levels (≤125; 125–300; >300pg/ml for all) with all-cause and cardiovascular mortality were assessed using cox regression analysis. ResultsThe incidence of all-cause and cardiovascular mortality was higher in subjects with higher levels of NT-proBNP (all-cause mortality/cardiovascular mortality: 35.4%/6% for NT-proBNP > 300 pg/ml; 16.2%/40% for NT-proBNP 125–300 pg/ml vs. 11.4%/4% for NT-proBNP ≤ 125 pg/ml. Participants with a NT-proBNP levels > 300pg/ml had increased incidence of hard endpoint (hazard ratio (HR) (95% confidence interval (CI)): 3.62 (3.15–4.17) for all-cause mortality, and 6.38 (4.84–8.41) for cardiovascular mortality). These associations remained after adjustment for traditional risk factors and cardiac medications and diseases (HR = 2.64 (2.26–3.08) for all-cause mortality, and HR = 3.93 (2.90–5.32) for cardiovascular mortality). ConclusionOur results show strong associations of higher NT-proBNP levels with cardiovascular and all-cause mortality in an unselected, large population of elderly patients in the primary care setting independent of traditional risk factors indicating that NT-proBNP can help identifying subjects at high risk for cardiac events.

Prevalence of depressive symptoms in patients with Heart Failure in China: a meta-analysis of comparative studies and epidemiological surveys

Background: Although depressive symptoms is a frequent psychiatric comorbidity in people with Heart Failure (HF) in China, its prevalence was not estimated. This is a meta-analysis of studies examining depressive symptoms in HF patients in China. Methods: The following databases including PubMed, the Cochrace Library, Embase, China National Knowledge Infrastructure (CNKI), WanFang and VIP were independently and systematically searched from inception until March 31, 2019. Statistical analyses were performed using the Stata 13.0 software. The pooled prevalence of depressive symptoms was performed using a random-effects model. In addition, subgroup analysis was conducted based on the New York Heart Association (NYHA) functional class, the assessment tools of depression and gender. Results: Altogether 53 studies (10649 participants) met the inclusion criteria for the analysis. The point prevalence of depressive symptoms in HF was 43%. In subgroup analyses, the prevalence of depressive symptoms was higher in females than in males (46% vs 34%, respectively), and the prevalence of depressive symptoms positively correlated with New York Heart Association functional classes (II 28%, III 46%, IV 52%) . Rates of depression were highest when measured using BDI scale (62%), and lowest when measured using the CES-D (31%). Conclusions: This meta-analysis confirmed that the prevalence of depressive symptoms was common in HF patients in China and it is related to the severity of heart failure, gender and the diversity of assessment tools. Appropriate strategies for prevention and treatment of depressive symptoms in this population need greater attention.

Digital health care solution for proactive heart failure management with the Cordella Heart Failure System: results of the SIRONA first‐in‐human study

AimsIncorporation of remote monitoring of pulmonary artery pressure and vital signs has been demonstrated to reduce heart failure (HF) hospitalization and all‐cause mortality in selected symptomatic HF patients. The aim of this study is to investigate the safety and accuracy of the new CordellaTM Pulmonary Artery Pressure Sensor (Endotronix, Inc., Chicago, IL, USA) and the usability of the comprehensive CordellaTM Heart Failure System (CHFS).Methods and resultsMulticentre, open‐label, first‐in‐human, feasibility study to evaluate the CHFS and the safety and accuracy of the Cordella™ Pulmonary Artery Pressure Sensor in 15 patients with New York Heart Association class III HF. All patients were successfully implanted with the Cordella Pulmonary Artery Pressure Sensor, without sensor failure. No device system‐related complications, defined as invasive treatment, device explant or death, occurred. The primary efficacy endpoint of a mean pulmonary artery pressure at 90 days was met in all but one patients with a cohort difference of 2.7 mmHg (Cordella Sensor 22.5 ± 11.8 mmHg, Swan–Ganz catheter 25.2 ± 8.5 mmHg). One patient did not go through the 90‐day right heart catheterization for safety reasons. Patient adherence to daily measurement, transmission of vital signs and pulmonary artery pressure sensor readings were recorded 99% of the time.ConclusionThe initial experience of the CHFS incorporating comprehensive vital signs and pulmonary artery pressure monitoring enables safe and accurate monitoring of HF status.

Peak Oxygen Uptake Recovery Delay After Maximal Exercise in Patients With Heart Failure.

Peak oxygen uptake recovery delay (V˙o2peakRD), measured as the time until post-exercise oxygen uptake (V˙o2) decreases below V˙o2peak following maximal cardiopulmonary exercise testing (CPX), has been recognized as an abnormal response, associated with reduced cardiac output reserve during exercise in patients with heart failure (HF). In the current study we examined the association of V˙o2peakRD during routine CPX testing of patients with symptomatic HF across a wide range of left ventricular ejection fraction (LVEF) values with clinical biomarkers. In this retrospective study, 80 clinically stable symptomatic HF patients across a wide range of LVEF at our institution were evaluated that put forth a minimally acceptable effort during CPX testing (respiratory exchange ratio ≥ 1.00). The V˙o2peakRD was measured in 10-sec intervals following maximal CPX testing. Markers of elevated cardiac filling pressures (N-terminal pro-brain natriuretic peptide [NTproBNP] and echocardio-Doppler E/e') and other key CPX parameters were explored for their association with V˙o2peakRD. The mean V˙o2peakRD and V˙o2peak were 10 (interquartile range 10, 40) sec and 13.9 (11.6, 16.4) mL· kg · min, respectively. V˙o2peakRD demonstrated a positive linear trend with serum NTproBNP levels and E/e' (TJT = 1239.500, z = 2.634, P < .01; TJT = 1081.000, z = 2.046, P = .04, respectively). Prolonged V˙o2peakRD following exercise is associated with markers of greater disease severity in patients with HF.

Mechanisms and prediction of short-term natriuretic effect of sodium-glucose cotransporter 2 inhibitor in heart failure patients coexisting type 2 diabetes mellitus.

The mechanisms of the diuretic effect of sodium-glucose cotransporter 2 (SGLT2) inhibitor and its predictors in heart failure (HF) patients with coexisting type 2 diabetes mellitus (T2DM) remain under investigation. A total of 40 hospitalized HF patients with T2DM (68 ± 13years old, male gender 63%) were prospectively enrolled and received ipragliflozin at a dose of 50mg once daily after breakfast for at least 4 consecutive days. They underwent first-morning blood and urine tests, and 24-h urine tests before and after short-term ipragliflozin therapy. Daily urine volume significantly increased from 1365 ± 511mL/day on day 0 to 1698 ± 595mL/day on day 3 (P < 0.001), which resulted in significant decreases in body weight and plasma brain natriuretic peptide level. Changes in 24-h urine volume were strongly and independently correlated with changes in 24-h urine sodium excretion (r = 0.80, P < 0.001), but was not significantly correlated with those in 24-h urine sugar excretion (r = 0.29, P = 0.07). Lower concentration of first-morning urine sodium and higher loop diuretic dosage before ipragliflozin therapy were associated with urine volume increment with ipragliflozin therapy, and former retained its independent predictor (Odds ratio 0.96, 95% CI 0.93-0.99, P = 0.02). First-morning urine sodium ≤ 53mEq/L and baseline loop diuretics ≥ 20mg/day predicted increased urine volume on day3 with high diagnostic accuracy. Ipragliflozin has acute natriuretic activity, and first-morning urine sodium and baseline dosage of loop diuretics strongly predicted the diuretic effects. Ipragliflozin therapy may restore responsiveness to loop diuretics in symptomatic HF patients with T2DM.

A comparison of Gordon's functional health patterns model and standard nursing care in symptomatic heart failure patients: A randomized controlled trial

BackgroundHeart failure (HF) is associated with poor quality of life and increased morbidity and mortality. AimThis study aimed to investigate effect of application of Gordon's functional health pattern (FHP) model in nursing care of symptomatic HF patients on quality of life, morbidity and mortality in the post-discharge 30-day. MethodsThis is a prospective randomized controlled study conducted in a single center. Experimental group received nursing care planned in accordance with Gordon's FHP model. 60 control and 60 experimental HF patients were included in the study. In the control group nursing care was given according to the standard protocol of the hospital whereas in the experimental group nursing care was given in accordance with Gordon's FHP model. Patients in both groups were followed up after discharge at 30th day. ResultsMean Minnesota Living with Heart Failure Questionnaire score improved significantly in the experimental group compared to the control group at 30th day (40.2 ± 23.5 vs 62.3 ± 22.9 respectively, p = 0.001). Seven patients (11.7%) in the experimental group and 17 patients (28.3%) in the control group were readmitted in the post discharge 30-day (p = 0.02). Kaplan-Meier survival curve analysis revealed significant difference in 30-day event free survival rates between groups (log-rank p = 0.31). ConclusionApplication of Gordon's FHP model in the nursing care of HF patients was associated with significantly improved quality of life, and reduced hospital readmission rates at 30th day. This was the only independent predictor of 30-day event free survival.

Abstract P317: Sex and Age Differences in a typical Chief Complains for Heart Failure in Emergency Department Visits

Background: Around 1 million United States emergency department (ED) visits per year are due to exacerbation of heart failure (HF) symptoms, with ~80% of those patients admitted to the hospital. However, sex and age differences in HF symptom presentation in the ED have not been thoroughly investigated. Objectives: To describe sex and age differences in chief complaints of ED patients with a HF diagnosis. Methods: We included patients ≥18 years old with an ED diagnosis of HF in NC DETECT, a statewide syndromic surveillance system. We defined a HF diagnosis using ICD-9-CM and ICD-10-CM codes from ED visits between 2010 and 2016. We classified the ED chief complaints into categories by symptom groups (e.g. respiratory complaint includes hypoxia, respiratory distress, breathing difficulties). Chief complaint categories are not mutually exclusive. We calculated frequencies of chief complaint categories for ED visits by sex and age (18-44 (n=55,216), 45-64 (n=260,397), ≥65 (n=578,313) years old) and evaluated for a 10% standardized difference between groups. Results: There were 422,720 patients with 893,950 total unique visits (1.6 average visits/person). Of these visits, 55.0% were by women and 59.5% patients were admitted. Overall, the top chief complaint categories were dyspnea (19.1%), chest pain (13.5%), and respiratory complaints (13.4%), and were similar by sex and by ED disposition (admitted or discharged) and sex. When stratified by sex and age group, in those 18-44 years old, women had more reports of nausea/vomiting (6.7%) compared with men (4.1%) and headache (4.2%) compared with men (2.0%). In those 45-64 and ≥65 years old, chief complaint categories were similar between women and men. When stratified by age group alone, reports of chest pain decreased with age (21.4% in 18-44, 17.7% in 45-64, and 10.8% in ≥65 year olds), whereas reports of balance issues (1.2% in 18-44, 2.4% in 45-64, and 6.0% in ≥65 year olds), weakness (1.7% in 18-44, 2.7% in 45-64, and 5.5% in ≥65 year olds), and confusion (0.8% in 18-44, 2.1% in 45-64, and 4.5% in ≥65 year olds) increased with age. Compared to those ≥65 years old, those 18-44 years old had fewer respiratory complaints (10.0% vs. 13.9%), but more reports of headache (3.2% vs. 0.8%) and nausea/vomiting (5.5% vs. 3.2%). Conclusion: In a state-wide population of ED patients with HF diagnoses, sex differences in chief complaint categories that are less obvious symptoms of HF were observed for those 18-44 years old, with women reporting more nausea/vomiting and headache compared to men. Chief complaint categories that are less obvious symptoms of HF were more common among patients 18-44 (nausea/vomiting, headache) and ≥65 (balance issues, confusion, weakness) years old. Characterizing the variation of symptoms of HF patients in the ED may help inform the identification of ED patients with HF and the outpatient management of HF-related symptoms.

Correlation between QRS duration and cardiac output measured by left ventricular outflow tract velocity in patient with cardiac resynchronization therapy

Abstract Background Cardiac resynchronization therapy (CRT) is proved as an effective treatment for moderate to severe heart failure. It reduces all-cause mortality in patients with advanced heart failure. There is strong evidence that CRT reduces mortality and hospitalization, improves cardiac function and structure in symptomatic chronic heart failure patients with optimal medical treatment, severely depressed LVEF (i.e. &amp;lt;35%) and complete LBBB. However 30% of patients may show negative response to CRT therapy. Therefore, optimization of CRT therapy in patients with heart failure seems to be a main subject for study in our researches. Methods of optimization includes optimization of medical therapy, control of risk factors and comorbidities, and optimization of device implantation and programming. Overall, studying the correlation between QRS duration and cardiac output will improve CRT programming optimization techniques. Aim To study the correlation between QRS duration and cardiac output measured by left ventricular outflow tract (LVOT) VTI in patients with CRT implantation. Methods Study included 100 CRT already implanted patients, they are requested to do a simple electrocardiographic and echocardiographic study. The relation between post implant QRS and cardiac output are studied among the patients. Results There was negative significant correlation between QRS duration and LVOT VTI and SVi. The optimal cut off values for optimal response to CRT using ROC curves were 130msec for post implant QRS duration and 17.1 cm for LVOT VTI. Conclusion CRT response is more in female patients with lower BSA, and without previous history of IHD or smoking. There is a significant negative correlation between QRS duration and LVOT VTI. Post implantation cut off value of QRS duration (&amp;lt;130) predict higher LVOT VTI and also the post implantation benefit for the patient with CRT implanted.

EFFICACY OF ENHANCED EXTERNAL COUNTERPULSATION; IN IMPROVING SIX MINUTES WALK TEST IN HEART FAILURE PATIENTS

Enhanced External Counterpulsation is an outpatient treatment to improve myocardial perfusion in chronic stable angina patients. We studied, the clinical response of symptomatic heart failure patients with reduced left ventricular ejection fraction improvement in the exercise tolerance and

Clinical and Laboratory Predictors of Mortality in Patients with Advanced Heart Failure (Stage D), Data Derived from Rajaie Acute Systolic Heart Failure (RASHF) Data Registry

Background: Mortality, morbidity and the burden of the advanced heart failure and also the cost of frequent admissions is high. Several registries were done all over the world to manage the patients with heart failure; however studies about the advanced stage are limited. Objectives: The present study aimed to determine the prognostic predictors of patients with advanced heart failure. Methods: In this study 178 (74.2% male) patients with advanced heart failure (stage D) from 2011 to 2016 were selected according to the following inclusion criteria; highly symptomatic heart failure patients with severe left ventricular (LV) systolic dysfunction (LV ejection fraction less than 30%) who have been admitted for at least two times in the recent year because of decompensation. The data regarding the clinical findings, readmissions, mortality, laboratory tests, electrocardiography, echocardiography, etc. of patients were all derived from Rajaie Acute Systolic Heart Failure (RASHF) data registry. Results: In a 5-year follow-up, we realized that more than 70% of the patients died. The rate of mortality were significantly higher in females (P value = 0.006) and there was a significant correlation between anemia and the mortality (P value = 0.002). There was no remarkable association between the serum creatinine, sodium and uric acid levels with the mortality of the patients. Conclusions: Data about stage D of heart failure are limited. The mortality rate for such patients is relatively high and there’s no clear best treatment approach. Large registries and data acquisition of these patients could be helpful for better management approaches.

Relationship between functional capacity, performance and symptoms in hospitalized patients with heart failure.

to evaluate the prevalence of symptoms in heart failure patients and to investigate the relationship between symptoms, functional capacity and performance. cross-sectional study, developed at a hospital specializing in cardiology. The sample (n=170) consisted of patients with heart failure, assessed by means of a sociodemographic form, New York Heart Association Functional Class, Edmonton Symptom Rating Scale and Karnofsky Physical Performance Scale. Analyzes were performed using Spearman's Correlation and Pearson's Chi-Square test. dyspnea, fatigue and edema were the main symptoms that led to the search for health services. During hospitalization, the main symptoms were anxiety, sleep disturbance and sadness. Weak negative correlations were observed between functionality, functional class, and symptom overload. the prevalence of symptoms was high and changed throughout the hospitalization period. Patients with poorer functional capacity and poorer performance had greater symptom overload.

Symptomatic Heart Failure in Acute Leukemia Patients Treated With Anthracyclines

ObjectivesThe purpose of this study was to investigate the occurrence and develop a risk score for heart failure (HF) in acute leukemia. BackgroundKnowledge is scarce regarding the incidence and risk factors of symptomatic HF in patients with acute leukemia. MethodsBaseline clinical and echocardiographic parameters, including indices of cardiac function (left ventricular ejection fraction and myocardial strain [global longitudinal strain; GLS]), were obtained in 450 patients with acute leukemia treated with anthracyclines, before chemotherapy initiation. Potential risk factors for HF were evaluated using Fine and Gray’s regression analysis, and from this, a 21-point risk score was generated. ResultsForty patients (8.9%) developed HF. The HF risk score included a baseline GLS >−15% (indicative of greater impairment) (6 points), baseline left ventricular ejection fraction <50%, pre-existing cardiovascular disease, acute myeloid leukemia (4 points each), cumulative anthracycline dose ≥250 mg/m2 (2 points), and age >60 years (1 point). Patients were stratified into low (score 0 to 6), moderate (score 7 to 13), and high risk (score 14 to 21). The estimated 1-year cumulative incidence of HF for low-, moderate-, and high-risk groups was 1.0%, 13.6%, and 35.0%, respectively (p < 0.001). The HF risk score was also predictive of all-cause mortality (p < 0.001). After adjustment for age and leukemia type, however, only GLS was significantly associated with all-cause mortality (hazard ratio: 1.73; 95% confidence interval: 1.30 to 2.31; p < 0.001). ConclusionsWe developed a baseline risk score to determine risk of HF in patients with acute leukemia. Additional studies are needed to determine the external validity of these findings.

Percutaneous repair or medical treatment for secondary mitral regurgitation: outcomes at 2 years.

The MITRA-FR trial showed that among symptomatic patients with severe secondary mitral regurgitation, percutaneous repair did not reduce the risk of death or hospitalization for heart failure at 12 months compared with guideline-directed medical treatment alone. We report the 24-month outcome from this trial. At 37 centres, we randomly assigned 304 symptomatic heart failure patients with severe secondary mitral regurgitation (effective regurgitant orifice area >20 mm2 or regurgitant volume >30 mL), and left ventricular ejection fraction between 15% and 40% to undergo percutaneous valve repair plus medical treatment (intervention group, n=152) or medical treatment alone (control group, n=152). The primary efficacy outcome was the composite of all-cause death and unplanned hospitalization for heart failure at 12 months. At 24 months, all-cause death and unplanned hospitalization for heart failure occurred in 63.8% of patients (97/152) in the intervention group and 67.1% (102/152) in the control group [hazard ratio (HR) 1.01, 95% confidence interval (CI) 0.77-1.34]. All-cause mortality occurred in 34.9% of patients (53/152) in the intervention group and 34.2% (52/152) in the control group (HR 1.02, 95% CI 0.70-1.50). Unplanned hospitalization for heart failure occurred in 55.9% of patients (85/152) in the intervention group and 61.8% (94/152) in the control group (HR 0.97, 95% CI 0.72-1.30). In patients with severe secondary mitral regurgitation, percutaneous repair added to medical treatment did not significantly reduce the risk of death or hospitalization for heart failure at 2 years compared with medical treatment alone.

P4529Atrioventricular optimization in cardiac resynchronization therapy with quadripolarleads, improves energy handling and quality of life in heart failure patients: HUMVEE Trial

Abstract Background Cardiac resynchronization therapy (CRT) is a well-established technique for symptomatic heart failure (HF) patients, producing significant clinical benefits. Recent studies have revealed the potential role of multipoint pacing (MPP) in improving response and clinical outcomes. The aim of Heart failUre study of Multisite pacing effects on VEntriculoartErial coupling (HUMVEE) trial was to evaluate the association between MPP of the left ventricle vs those of standard biventricular pacing (BVP) on: a) ventriculoarterial coupling (VAC) and energy efficiency of the failing heart, b) diastolic function, c) quality of life, and d) NT-proBNP levels. Methods HUMVEE is a single-center, prospective (13 months) trial (clinicaltrials.gov identifier NCT03189368), of 54 NYHA III patients (69±9 years; 79% men; 50% dilated cardiomyopathy), under optimal tolerated medical therapy, with standard BVP indication, having being implanted with a CRT system able to deliver both modes of pacing. Creatinine and NT-proBNP levels and echocardiographic measurements (VAC calculation, strain rate, diastolic function assessment), as well as 6-min-walking-test and quality of life (MLHF questionnaire) were measured at baseline, 6 months post BVP optimization (right before MPP activation) and at the end of follow-up (6 months post MPP optimization). Cardiac power (CP) was calculated according the equation: CP=Cardiac Output x Mean Aortic Pressure/451. Results Both CRT and MPP improved 6-min-walk (differences at baseline/6 mo/end of FU: 277±27 vs. 345±27 vs 363±27 m, p=0.07); left ventricular ejection fraction (24,2% vs 30,6%vs, 32%, p=0.05); end -diastolic diameters of left ventricle (65±1,4 vs. 63±1.7 vs. 61±1.1, p=0.03); end-systolic volume (150±15 vs. 140±10 vs. 131±13, p=0.08); stroke volume (41.6±9 vs. 53.6±14 vs. 62±9, p=0.0001 for MPP); left atrial volume (76±5 vs. 74±10 vs 61±6, p=0.001 for MPP), E/Emv (14±5 vs. 12±4 vs. 11±3, p=0.05 for MPP); NtproBNP (2782±1000 vs. 2080±2500 vs. 2000±1000, p=0.05 for MPP). VAC was reduced from 1.14±0.27 to 1.1±0.17 (p=0.1) while CP increased from 564.2±142 to 768±103 (p=0.009). Quality of life score (the lower the better) improved from 23.75±17 at baseline to 17.25±10 at end of FU (p=0.05). Conclusions MPP is a new, promising pacing modality with the potential to improve HF patients' outcome, offering additive effects on myocardial energy balance, cardiac power, systolic and diastolic ventricular function and aortoventricular coupling, especially in ischemic patients. HUMVEE trial illustrates those clinical, imaging and biochemical divergences of MPP from standard BVP that reflect significant improvement in quality of life in patients with advanced HF and cardiac dysychronization.

Mid-term results of valve repairs for atrial functional mitral and tricuspid regurgitations.

This study aimed to determine the mid-term outcomes of surgical valve repairs for atrial functional mitral regurgitation and tricuspid regurgitation in patients with atrial fibrillation. From October 2008 to August 2016, we performed mitral and tricuspid valve repairs in 45 patients with permanent atrial fibrillation, chronic heart failure, preserved left ventricular ejection fraction, and at least moderate functional mitral regurgitation and mild functional tricuspid regurgitation. The follow-up period ranged from 56 to 3283days (2-109months; median 932days). All patients underwent both mitral and tricuspid annuloplasty. Mitral regurgitation and tricuspid regurgitation improved from 2.6 ± 0.6 (0-3) and 2.0 ± 0.7 (0-3) preoperatively to 0.4 ± 0.3 (0-3) and 0.8 ± 0.5 (0-3) at the most recent echocardiography (p < 0.0001 and p < 0.0001), respectively. Further, the New York Heart Association functional class dramatically improved from 2.8 ± 0.7 to 1.5 ± 0.7 (p < 0.0001). Postoperative cardiovascular events occurred in 10 patients, including 3 with re-admissions for heart failure. The event-free rates were 93%, 87%, and 52% at 1, 3, and 5years after surgery, respectively. The preoperative left atrial volume index was the independent predictor of postoperative cardiovascular events. Our results suggest that mitral and tricuspid valve repairs lead to reductions in regurgitations and heart failure symptoms in patients with atrial functional mitral and tricuspid regurgitations. The preoperative left atrial size should be recognized as an important risk factor of postoperative cardiovascular events.

The metabolic syndrome in heart failure: insights to specific mechanisms.

The presence of comorbidities significantly influences long-term morbidity and mortality of symptomatic and asymptomatic heart failure (HF) patients. Metabolic syndrome and diabetic cardiomyopathy are two clinical conditions that share multiple pathophysiological mechanisms and that might be both responsible for cardiac dysfunction. However, it is argued whether metabolic syndrome (MS) independently increases HF risk or the association between MS and HF merely reflects the impact of individual risk factors included in its definition on HF development. Similarly, in the context of diabetic cardiomyopathy, many aspects are still challenging starting from the definition up to the therapeutic management. In this clinical review, we focused the attention on molecular pathways, myocyte alterations, and specific patterns of metabolic syndrome and diabetic cardiomyopathy in order to better define the potential diagnostic and therapeutic approaches of these two pathological conditions.

The role of concealment and relationship quality on patient hospitalizations, care strain and depressive symptoms in heart failure dyads

Heart failure is one of the most common reasons for hospitalization among older adults and negatively influences person-reported outcomes of patients and their care partners. Moreover, the majority of heart failure research examines patients and care partners separately, ignoring the interdependent nature of the heart failure dyad. The aim of this study was to examine the interpersonal factors associated with depressive symptoms of heart failure patients and spouse care partners, patient hospitalizations over the last 12 months and care strain. A descriptive, cross-sectional design was used to examine 60 community-dwelling adults with heart failure and their spouse care partners. Multilevel modeling controlled for the interdependent nature of the dyadic data. Patients had significantly worse depressive symptoms than their spouse care partners. More patient concealment (i.e. hiding concerns/worries) and worse relationship quality were significantly associated with greater depressive symptoms for patients, but not spouse care partners. Better relationship quality (reported by spouse care partners) was significantly associated with lower levels of care strain, whereas better relationship quality (reported by patients) was significantly associated with worse care strain. Patients who had one or more hospitalizations over the past 12 months were significantly more likely to report higher levels of concealment; relationship quality was not associated with patient hospitalizations. Findings highlight the interdependent nature of heart failure and the complexity of the interpersonal context. Greater focus on how the heart failure dyad navigates illness as a unit over time is needed to design and tailor innovative lines of clinical intervention to optimize dyadic and individual health.

Bridging Strategies and their Association with Post Heart Transplant Outcomes

Objective Heart transplant (HT) remains the definitive therapy for patients with end stage heart failure (HF). The rate of heart transplantation is limited by the availability of suitable donors, and thus waiting time varies. Bridging strategies have been implemented to stabilize hemodynamics and alleviate debilitating symptoms of HF in patients awaiting HT. In this study we performed a comparative analysis of bridging strategies and their association with post HT outcomes. Methods This was an analysis of 20,919 adult HT recipients captured in the United Network for Organ Sharing (UNOS) heart transplant registry that were bridged to transplant utilizing a bridging strategy inclusive of a left ventricular assist device (VAD), Intra-aortic balloon pump (IABP), or intravenous inotropic agents. Outcomes of interest included graft failure and patient survival. Chi square analysis was used to detect baseline differences between the three groups. Competing risk analysis was used to assess the outcomes of interest. Results In each group HT recipients were predominately Caucasian, and male with a median ischemic time of 3.2 hours (Table 1). Median patient survival was significantly highest in the Inotrope group, and lowest in the IABP group (1648 vs 828 days p= Conclusions Among bridging strategies inclusive of LVAD, IABP and intravenous intropic therapy, long term median survival was observed to be longest in those bridged with intravenous inotropes. No difference in the outcome of acute graft failure was observed. Further analysis is needed to understand the survival differences observed in this study.

The relationship between galectin-3 levels and fragmented QRS (fQRS) in patients with heart failure with reduced left ventricular ejection fraction.

Fragmented QRS (fQRS) complex is an electrocardiographic pattern which reflects myocardial scarring. We aimed to investigate the relationship between the presence of fragmented QRS (fQRS) on electrocardiogram (ECG) and plasma galectin-3 levels in patients with heart failure (HF) and severely decreased left ventricular ejection fraction (LVEF≤35%). We prospectively enrolled 125 symptomatic HF patients (NYHA class II-III) with severely reduced LVEF (≤35%). fQRS was identified in ECG. Galectin-3 and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were measured. Patients were divided into two groups based on the presence (n=40) or absence (n=85) of a fQRS on ECG. Majority of patients were male (87.70%), and mean age was 65.1±11.6. Galectin-3 and NT-proBNP levels were found to be significantly higher in the fQRS (+) group compared with the fQRS (-) group (NT-proBNP 5,362±701pg/ml vs. 4,452±698pg/ml; p<0.001, galectin-3 607±89.8pg/ml vs. 509.4±63.5pg/ml; p<0.001). Multivariate analyses revealed galectin-3 and NT-proBNP levels are the presence of fQRS on ECG (p<0.001 and p<0.001, respectively). The area under the curve using the galectin-3 level for fQRS was 0.819. fQRS and serum galectin-3 levels are associated with myocardial fibrosis and are associated with poor prognosis in heart failure. In our study, a positive correlation was found between serum galectin-3 levels and fQRS on ECG.