Therapy For Congestive Heart Failure Research Articles

Abstract Mo051: Phototherapy to stimulate carnosine activity and enhance global heart function: A promising adjunctive therapy for congestive heart failure (CHF)

Background: The emerging field of cardiac optogenetics uses pulses of light to stimulate optically-sensitive proteins in the heart, influencing cellular physiology with unprecedented spatiotemporal resolution. Effects include increased glutathione and carnosine activity, and promotion of ATP synthesis. Clinical benefits include improved functional capacity, heart rhythm stability, and relief form congestive heart failure (CHF). Transcutaneous phototherapy devices are now available (LifeWave Inc, San Diego, USA), which may provide these benefits without the requirement for an external power source. Objective: To investigate whether upregulation of carnosine activity using a wearable cutaneous phototherapy device may improve echocardiographic measures of global heart function, cardiac contractility, and hemodynamics. Methods: The Carnosine ® adhesive skin patch (34 mm outside diameter) contain an organic crystalline material that reflects back specific frequencies of infra-red light known to activate carnosine dipeptides throughout the body. These function as a high-energy phosphate system known to enhance muscle function. Study participants (n=12 healthy volunteers (7 male, 5 female), 40-66 years of age) underwent a focused baseline echocardiogram, which included atrial (A) and early (E) mitral valve inflow, peak tissue velocity (E’) at both the lateral and septal mitral annulus, and left ventricular ejection fraction (LVEF). 10-14 patches were then applied along the sternum and across the left thorax (3 rd -5 th interspace), incorporating the anterior axilla. The echocardiogram was repeated 20-30 minutes after patch application. Results: LVEF was improved following application of the phototherapy device, increasing from 59.8±6.3% to 66.65±5.8% (Δ 6.3%, p<0.05), indicating an improvement in overall cardiac function. Septal E’ also increased, from 7.3±0.7 cm/s to 8.2±0.6 cm/s (Δ 0.89 cm/s, p<0.05), indicating a direct effect on contractility. E and A wave velocities increased from 63.7 cm/s to 66.1 cm/s (Δ 2.5±0.4 cm/s, p<0.08) and from 56.8 cm/s to 62.6 cm/s (Δ 5.7±0.7 cm/s, p<0.1), indicating augmented hemodynamics trending towards significance. Conclusion: Self-powered wearable phototherapy devices may enhance myocardial contractility and overall cardiac function. Such technologies represent a promising therapy for CHF.

Efficacy of acetazolamide and loop diuretics combinatorial therapy in congestive heart failure: A meta-analysis

Acetazolamide, one of the carbonic anhydrase inhibitors, has been known to improve the efficacy of diuretic therapy in patients with in congestion heart failure. The aim this study was to investigate the effectiveness of acetazolamide when combined with loop diuretics in ameliorating diuresis and natriuresis in congestive heart failure using systematic review and meta-analysis. Randomized controlled trials (RCTs) and cohort studies were searched on PubMed, Scopus, and Embase on March 7, 2023, by using combinations of ‘acetazolamide’, ‘heart failure’ and along with their respective synonyms. The protocol had been registered on PROSPERO (CRD42023409864). The studies must investigate the effect of oral acetazolamide as the add-on to loop diuretic therapy to be included. Successful decongestion, natriuresis, and diuresis were set as the primary outcomes. The quality of the included studies was assessed using the Cochrane risk-of-bias tool for RCTs and Newcastle Ottawa Scale for observational studies. We identified 1176 titles in the initial search, and further reduced to five studies (three RCTs and two cohort studies) after in-depth screening. A total of 625 patients were recruited in the included studies published from 2015 to 2022. Results from meta-analysis revealed that acetazolamide and loop diuretics combination therapy ameliorated natriuresis (n=4; standardized means difference (SMD)=0.65; 95%CI: 0.07–1.24; p=0.03) and diuresis (n=2; SMD=0.29; 95%CI: 0.12–0.46; p=0.0009) when compared to loop diuretics alone. Acetazolamide and loop diuretics combinatorial therapy is efficacious in alleviating congestion in heart failure patients.

Embedded Cyber-Physical System for Physiological Control of Ventricular Assist Devices

Ventricular Assist Devices (VADs) play a crucial role in both bridging to transplantation and serving as destination therapy for congestive heart failure (CHF) management. This study aims to address the limitations of existing control strategies for VADs, specifically their inability to adapt automatically to hemodynamic changes. It proposes a novel embedded cyber-physical system (CPS) based on real-time data processing, reconfigurable architecture, and communication protocols aligned with Health 4.0 concepts to enhance physiological control over VADs (PC-VAD). The research employs a multi-objective PC-VAD approach within a hybrid cardiovascular simulator. An embedded CPS is introduced to overcome challenges related to differences in controller characteristics between computers and embedded systems. The study assesses the performance of the embedded CPS by comparing it with a computer-based control system. The embedded CPS demonstrates outcomes comparable to the computer-based control system, maintaining mean arterial pressure and cardiac output at physiological levels. Even in the face of variations in ejection fraction, the embedded CPS dynamically adjusts the pump's rotational speed based on simulated clinical conditions. Notably, there is no aortic reflux to the ventricle through the VAD during testing. These findings affirm the satisfactory control performance of the embedded CPS in regulating VADs. The study concludes that the embedded CPS effectively addresses the limitations of current VAD control strategies, exhibiting control performance comparable to computer-based systems. However, further experimentation and in vivo studies are necessary to validate and ensure its applicability in real-world scenarios.

Success in Heart Failure? An Investigation of Heart Failure Readmission Rates and Medication Regimen Optimization.

In May 2022, the American College of Cardiology updated their guideline-directed medical therapy for congestive heart failure (CHF) to include four pillars of therapy. These pillars aim to better control patients with heart failure (HF) and reduce the incidence of hospitalization by including an evidence-based beta-blocker, an angiotensin-converting enzyme inhibitor/ angiotensin receptor blocker/angiotensin receptor/ neprilysin inhibitor, a mineralocorticoid receptor antagonist, and newly recommended sodium glucose cotransporter 2-inhibitors. This study at University of Florida Health Central Florida Hospitals reviewed patients who were diagnosed with CHF and recorded if they were readmitted with a HF exacerbation within 30 days of an initial index admission. Patients had data obtained retrospectively using electronic medical records from patient hospital encounters within the study inclusion dates; 7/1/2022-9/30/2022. Hospital readmission rates for patients with CHF, and information on each patient's medication regimen was collected to see if they met medication optimization criteria. A total of 252 patients were evaluated, with 157 meeting the inclusion criteria. Of the patients included, 23 (14.6%) experienced a hospital readmission within 30 days because of acute HF exacerbation or worsening HF. After reviewing medication regimens, 60 patients (38.2%) were receiving treatment with one pillar of therapy, 72 (45.8%) with two pillars of therapy, 12 (7.6%) with three pillars of therapy, and one patient was treated with all four pillars of therapy. In conclusion, this study showed that the recommended pillars of therapy are not being implemented and patients with CHF may benefit from medication optimization.

Double Aneuploidy (Trisomy 21 and XXX) in a Child with Down Syndrome Phenotype: A Case Report with Review of Literature

Abstract Background: Down syndrome is the most common and extensively studied disorder arising out of human chromosomal aberration. Several aneuploidies are associated with Down syndrome, but double trisomy (48 XXX + 21) is rarely described. Clinical Description: A 3-year-old girl presented with respiratory distress and a chronic history of feeding fatigue and failure to thrive. She had phenotypic features suggestive of Down syndrome and clinical signs of acyanotic heart disease in congestive cardiac failure. Management and Outcome: Echocardiography revealed ventricular septal defect and atrial septal defect. Karyotyping showed double trisomy (trisomy 21 and XXX). Trisomy X was an incidental finding on karyotyping with no clinical features suggestive of XXX syndrome specifically at this age. The patient was managed conservatively with decongestive therapy for congestive heart failure and oral sildenafil for pulmonary hypertension. Additional evaluations were done to identify associated anomalies, and the parents were counseled. Conclusion: Down and XXX syndromes share many clinical signs and symptoms, making karyotyping the only way to make an early diagnosis. A child having a phenotype characteristic of Down syndrome may have an unsuspected double trisomy of X chromosome along with 21 trisomy, which can only be identified by karyotyping.

Biological Effects and Mechanisms of Taurine in Various Therapeutics.

More than two hundred years ago, taurine was first isolated from materials derived from animals. It is abundantly found in a wide range of mammalian and non-mammalian tissues and diverse environments. Taurine was discovered to be a by-product of the metabolism of sulfur only a little over a century and a half ago. Recently, there has been a renewed academic interest in researching and exploring various uses of the amino acid taurine, and recent research has indicated that it may be useful in the treatment of a variety of disorders, including seizures, high blood pressure, cardiac infarction, neurodegeneration, and diabetes. Taurine is currently authorised for the therapy of congestive heart failure in Japan, and it has shown promising results in the management of several other illnesses as well. Moreover, it was found to be effective in some clinical trials, and hence it was patented for the same. This review compiles the research data that supports the prospective usage of taurine as an antibacterial, antioxidant, anti-inflammatory, diabetic, retinal protective, and membrane stabilizing agent, amongst other applications.

Congestive Heart Failure in the Light of Ancient Wisdom of Unani Medicine: A Review

Congestive heart failure is a complex clinical syndrome that causes functional impairment of ventricular filling and ejection of blood. It can cause dyspnea, fatigue, and fluid retention, affecting exercise tolerance and causing pulmonary and peripheral edema. Moreover, it is a burgeoning and life-threatening syndrome characterized by significant morbidity and mortality, poor functional capacity and quality of life, and high costs. Worldwide congestive heart failure affects more than 64 million people. Nowadays: congestive heart failure is correlated with Suqūṭ-e-Qalb Imtilāʼī, by modern Unani physicians. However, the disease is mentioned in classical Unani literature under the headings of Ikhtilāj-e-qalbi (arrhythmia), Rabw (cardiac asthma), Buhr (cardiac asthma), Khafaqān (palpitation), Istisqā’ Laḥmī (anasarca), Du‘f al-Qalb (weakness of heart), Intiṣāb al-Nafas (orthopnoea), Sudda-e-Urooq-e-Qalb (coronary artery obstruction), Ghashī (syncope), Tasallub-al- Sharāyīn (arteriosclerosis) and Imtilā’ bi Hasbil Aw’iya (congestion of blood vessels). Congestive heart failure and mortality are on the rise despite the significant advancements in contemporary medicine and guidelines directed medical therapy for congestive heart failure. Congestive heart failure hospitalizations make up 1-2% of Western hospital admissions, with the highest 30-day readmission rate (20-25%) in congestive heart failure patients reflecting due to high comorbidity burden. Unani drugs, despite advancements in modern medicine, still significantly impact patient health. They are traditionally used for cardiac ailments like palpitations, coronary artery disease, heart weakness, and cardiotonic. Unani medicine especially Khamīrajat (fermented confections) used in various cardiac diseases is cardio-protective and cardiotonic. According to reports, complementary and alternative medicine is used by up to 61% of cardiac patients with coronary artery disease and those at risk for arteriosclerosis. Therefore, a thorough evaluation of the Unani literature on cardiac illness and its treatment in the Unani system of medicine is needed to decrease congestive heart failure social and economic burdens have become a major global public health priority. This review is an effort to summarize the Unani classical literature on congestive heart failure.

The effect of taurine supplementation on the renin–angiotensin–aldosterone system of dogs with congestive heart failure

The role of taurine in the treatment of congestive heart failure (CHF) in dogs without systemic deficiency is unexplored. Taurine might have beneficial cardiac effects aside from deficit replacement. We hypothesized that oral taurine supplementation administered to dogs with naturally-occurring CHF would suppress the renin-angiotensin aldosterone system (RAAS). Oral taurine was administered to 14 dogs with stable CHF. Serum biochemical variables, blood taurine concentrations, and comprehensive analysis of RAAS variables were compared before and 2 weeks after taurine supplementation added to background furosemide and pimobendan therapy for CHF. Whole blood taurine concentrations increased after supplementation (median 408 nMol/mL, range 248–608 before and median 493 nMol/mL, range 396–690 after; P = .006). Aldosterone to angiotensin II ratio (AA2) was significantly decreased after taurine supplementation (median 1.00, range 0.03–7.05 before and median 0.65, range 0.01–3.63 after; P = .009), but no other RAAS components significantly differed between timepoints. A subset of dogs showed marked decreases in RAAS metabolites after supplementation and these dogs were more likely to have been recently hospitalized for CHF treatment than dogs that did not show marked decreases in classical RAAS metabolites. Overall, taurine only lowered AA2 in this group of dogs, however, response heterogeneity was noted, with some dogs showing RAAS suppression.

A second-generation artificial intelligence-based therapeutic regimen improves diuretic resistance in heart failure: Results of a feasibility open-labeled clinical trial

IntroductionDiuretics are a mainstay therapy for congestive heart failure (CHF); however, over one-third of patients develop diuretic resistance. Second-generation artificial intelligence (AI) systems introduce variability into treatment regimens to overcome the compensatory mechanisms underlying the loss of effectiveness of diuretics. This open-labeled, proof-of-concept clinical trial sought to investigate the ability to improve diuretic resistance by implementing algorithm-controlled therapeutic regimens. MethodsTen CHF patients with diuretic resistance were enrolled in an open-labeled trial where the Altus Care™ app managed diuretics' dosage and administration times. The app provides a personalized therapeutic regimen creating variability in dosages and administration times within pre-defined ranges. Response to therapy was measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) score, 6-minute walk test (SMW), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, and renal function. ResultsThe second-generation, AI-based, personalized regimen alleviated diuretic resistance. All evaluable patients demonstrated clinical improvement within ten weeks of intervention. A dose reduction (based on a three-week average before and last three weeks of intervention) was achieved in 7/10 patients (70 %, p = 0.042). The KCCQ score improved in 9/10 (90 %, p = 0.002), the SMW improved in 9/9 (100 %, p = 0.006), NT-proBNP was decreased in 7/10 (70 %, p = 0.02), and serum creatinine was decreased in 6/10 (60 %, p = 0.05). The intervention was associated with reduced number of emergency room visits and the number of CHF-associated hospitalizations. SummaryThe results support that the randomization of diuretic regimens guided by a second-generation personalized AI algorithm improves the response to diuretic therapy. Prospective controlled studies are needed to confirm these findings.

Pathogenic BCS1L Mutation Resulting in Hypertrophic Cardiomyopathy: A Unique Presentation of Nuclear Mitochondrial Disease.

A 21-year-old man with sensorineural hearing loss and glaucoma presented with severely limited exercise capacity since childhood. He was found to have biventricular concentric hypertrophy with greatest wall thickening at the posterior and lateral walls of the left ventricle apex (1.7 cm) and the free wall of the right ventricle (1.1 cm). There was no inducible left ventricular outflow tract obstruction. Metabolic testing revealed marked lactic aciduria (1,650.1 μmol/mmol creatinine) and plasma lactate (3.9 mmol/L). A sarcomeric hypertrophic cardiomyopathy gene panel was unremarkable, but mitochondrial gene analysis revealed a homozygous c.385G>A (p.Gly129Arg) pathogenic mutation in the BCS1L gene. This gene is responsible for an assembly subunit of cytochrome complex III in the respiratory transport chain and is the rarest respiratory chain defect. This gene has not frequently been implicated in cardiomyopathy. Mitochondrial hypertrophic cardiomyopathy is more rare than hypertrophic cardiomyopathy resulting from sarcomeric mutations and is more likely to be symmetric, less frequently results in left ventricular outflow tract obstruction, and is more likely to progress to dilated cardiomyopathy. Evidence-based screening protocols have not been established; treatment follows guideline-directed medical therapy for congestive heart failure, including evaluation for heart transplantation. This report expands the phenotype of the BCS1L mutation and suggests that affected patients may need screening for underlying cardiomyopathy.

EFFECTIVENESS OF PIMOBENDAN IN CATS WITH CARDIOGENIC ARTERIAL THROMBOEMBOLISM

Cardiogenic arterial thromboembolism (CATE) is a common complication of cardiomyopathy in cats. Current research is aimed at developing effective protocols for the therapy and prevention of CATE. The main focus is on finding effective anticoagulants, antiaggregants, and methods that improve blood supply to the affected area. At the same time, interest in the use of pimobendan for the therapy of congestive heart failure in cats has increased among researchers. Published works show an increase in life expectancy in cats with hypertrophic cardiomyopathy (HCM) and a positive effect on left atrial function. Therefore, the study of the effect of pimobendan on life expectancy, the occurrence of relapses in cats according to CATE is relevant and became the goal of this work. The study included 24 animals that had a CATE incident due to HCM and lived more than 2 weeks after the crisis. Two groups were formed: the first - 13 cats that after stabilization of the condition received standard therapy (furosemide, ACE inhibitor, clopidogrel) and pimobendan; the second - 11 cats that received only standard therapy. The anamnesis, clinical examination, echocardiographic examination, and information about relapse, death or euthanasia were recorded in the animals. 91.7% of cats were males, the average age was 7 ± 0.7 years. Dyspnoea, pulmonary edema, hypothermia, change in mental status, paresis and anemia of the affected limb were found in the majority. Two pelvic limbs were more often affected. Relapse occurred in 37.5% of subjects. The time interval from the incident to the recurrence in the first group was 387.4 ± 104.5 and in the second 107.2 ± 32.1 days. Euthanasia was performed for 20.8% of animals and was always associated with relapse. The survival time in the first group averaged 403.7 ± 104.0, and in the second - 314 ± 47.3 days. The median survival time for the first group is 9.5 months and for the second 12.5. After the death of all the animals in the first group, 40% of cats who received pimobendan remained alive. We didn`t find statistical differences between the groups in the number of relapses, euthanasias, duration of life and survival. Was found a significant difference in the length of time before relapse. Pimobendan did not show a negative effect on life expectancy in cats according to CATE. The positive effect is probably not clear enough and needs to be studied in a larger cohort of animals.

281 CARDIAC RESYNCHRONIZATION TERHAPY IN PERSISTENT LEFT SUPERIOR VENA CAVA WITH A BRIDGING INNOMINATE VEIN

Abstract Background The Persistent Left (PL) Superior Vena Cava (SVC) is a congenital malformation of the thoracic venous return that has an incidence of 0.2-3% in the general population and an incidence of about 0.5% in patients undergoing cardiac implantable electronic device. In this case, the placement of the leads, especially for the Right Ventricle (RV) and Left Ventricle (LV) through one of the branches could be challenging. Methods A 66-year-old man with hypertension, diabetes and dyslipidemia, in optimal pharmacologic therapy for congestive heart failure (NYHA II), hospitalized for recurrent syncopal episodes, with extreme sinus bradycardia, first-degree AV block and Left Bundle Branch Block, The patient had a LV hypertrophy and mild global systolic function (LV ejection fraction of 40%) for these we opted for a pacemaker CRT device implantation. Results Isolation of left cephalic vein was used as venous access for right atrium (RA) and RV leads while Seldinger technique via subclavian vein was used as venous access for LV lead. The guidewire through the subclavian vein pointed out the presence of PLSVC. Left subclavian venogram confirmed PLSVC and revealed a bridging innominate vein. To pass through the innominate vein and reach the SVC, a 0.035-inch hydrophilic guidewire was used. A 6Fr-sheath was advanced through the hydrophilic guidewire, subsequently a second metallic guidewire was advanced through the same introducer by removing the dilator. The RV and RA leads were placed respectively on low right interventricular septum and RA appendage passing through bridging innominate vein. Electrical parameters were normal. For the placement of the LV lead a 9.5Fr sheath introducer was advanced over the guidewire through the PLSVC. A venogram showed a lateral and a postero-lateral branch of the coronary sinus with acute angulation. With a 6Fr quadripolar Josephson catheter the postero-lateral branch was entered, eventually a 9Fr peelable outer guide catheter was advanced through the electrophysiology catheter becoming selective with the interested branch. A quadripolar S shaped lead was used, it was advanced into the targeted vein through a 0,014fr hydrophilic guidewire. Adequate electrical parameters and stability were achieved. Conclusion Lead implantation in patient with PLSVC is challenging. Placing the RA and RV leads through SVC ensure a better stability along time. The cannulation of CS is easily achieved by approach via PLSVC while selective vein cannulation can be difficult due to the modified acute angulation.

Assessment of Cardio-Pulmonary and Renal Dysfunction As Well As Overall Outcomes in Sickle Cell Patients: A Community Hospital-Based Experience

Background: Improvements in medical care for Sickle Cell Disease (SCD) patients in the USA has led to increased survival rates, however, management of comorbidities associated with end organ damage remains challenging. ASH 2019 guidelines do not recommend obtaining screening echocardiogram in asymptomatic SCD patients but suggest management of confirmed Pulmonary Arterial Hypertension (PAH) with specific therapies. For those with Chronic Kidney Disease (CKD) or End Stage Renal Disease (ESRD) requiring dialysis, it is recommended to treat with combination of hydroxyurea and erythropoiesis-stimulating agents as well as consider early referral to transplant nephrology. Our study was aimed to assess the correlation between various characteristics, underlying comorbidities with cardio-pulmonary and renal dysfunction as well as overall outcomes in SCD patients treated at the Henry Ford Hospital sickle cell clinic. Methods: A retrospective chart review of 105 patients between June 2013-June 2022 was performed. Baseline characteristics including gender, ethnicity, BMI, presence or absence of various comorbidities such as acute chest syndrome, Congestive Heart Failure (CHF), PAH, Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE), CKD, ESRD requiring dialysis, use of medications such as folic acid, hydroxyurea and newer therapies including voxelotor, crizanlizumab and L-glutamine were obtained. Frequency of ER visits, hospitalizations and blood transfusion requirements were noted. Patients were divided in 2 groups- SS Disease including Sickle/Thalassemia (ST) and SC disease. Continuous variables were compared via ANOVA/Kruskal Wallace Test and categorical variables were compared via Chi Squared Test/Fisher's Exact Test. Results: In our study, 49.5% were females, 95% were African-American. SS/ST disease type was seen in majority (62.8%) followed by SC disease and 2 patients had sickle cell trait. SS/ST patients were noted to have elevated HbS, reticulocyte count and LDH levels as expected compared to SC disease, whereas those with SC disease were noted to have higher BMI levels likely due less complications. SS/ST patients were more significantly noted to have diagnosis of CHF (p=0.020) as well as CKD (p=0.029). Interestingly, ESRD requiring dialysis was only seen in SS/ST patients. 69.6% of all patients underwent an echocardiogram evaluation and 28.7% of those had a diagnosis of PAH. In our study, 23.8% with PAH were started on newer therapies. 88.5% of all patients were compliant with folic acid treatment and 34.2% were started on hydroxyurea with significantly higher treatment in those with CHF and elevated HbS levels. Overall, 15.9% patients were started on newer therapies and their use was noted to be significantly higher in patients with CKD and ESRD (p=0.011 and p=0.029 respectively). Hospitalizations were less frequent in patients with SC disease compared to SS/ST although not statistically significant (p=0.80) and frequency of ER visits was not significantly different between both groups. Also, patients were less frequently hospitalized if they received chronic simple transfusions on outpatient basis. Conclusion: SS disease patients at our institution had increased likelihood of developing CHF as well as CKD. Of note, those with CKD or ESRD were also more likely to be placed on newer therapies. Based on these findings, we have developed a multidisciplinary management care plan alongside nephrology service. In our study, about a third of total patients did not have an echocardiogram evaluation, however, 28% of those who had an echocardiogram were noted to have PAH. Therefore, we think that use of screening echocardiogram in all SCD patients could help with early diagnosis of PAH and prompt referral to pulmonary medicine team to prevent potential complications. Use of hydroxyurea was noted to be significantly higher in those with CHF and newer therapies were more frequently used in patients with CKD and ESRD in our patients. These results encourage better utilization of such therapies in SCD patients with other comorbidities as well as those who have frequent hospitalizations to improve outcomes in the future. SCD related end organ damage is increasing in incidence with improvement in survival rates and poses a challenge which demands a multidisciplinary system-based care approach. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Management of Chronic Congestive Heart Failure Caused by Myxomatous Mitral Valve Disease in Dogs: A Narrative Review from 1970 to 2020.

Simple SummaryMyxomatous mitral valve disease (MMVD) is the most common acquired cardiovascular disease in dogs. The progression of the disease and the increasing severity of valvular regurgitation cause a volume overload of the left heart, leading to left atrial and ventricular remodeling and congestive heart failure (CHF). The treatment of chronic CHF secondary to MMVD in dogs has not always been the same over time. In the last fifty years, the drugs utilized have considerably changed, as well as the therapeutic protocols. Some drugs have also changed their intended use. An analysis of the literature concerning the therapy of chronic heart failure in dogs affected by this widespread degenerative disease is not available; a synthesis of the published literature on this topic and a description of its current state of art are needed. To the authors’ knowledge, a review of this topic has never been published in veterinary medicine; therefore, the aim of this study is to overview the treatments of chronic CHF secondary to MMVD in dogs from 1970 to 2020 using the general framework of narrative reviews.The treatment of chronic congestive heart failure (CHF), secondary to myxomatous mitral valve disease (MMVD) in dogs, has considerably changed in the last fifty years. An analysis of the literature concerning the therapy of chronic CHF in dogs affected by MMVD is not available, and it is needed. Narrative reviews (NRs) are aimed at identifying and summarizing what has been previously published, avoiding duplications, and seeking new study areas that have not yet been addressed. The most accessible open-access databases, PubMed, Embase, and Google Scholar, were chosen, and the searching time frame was set in five decades, from 1970 to 2020. The 384 selected studies were classified into categories depending on the aim of the study, the population target, the pathogenesis of MMVD (natural/induced), and the resulting CHF. Over the years, the types of studies have increased considerably in veterinary medicine. In particular, there have been 43 (24.29%) clinical trials, 41 (23.16%) randomized controlled trials, 10 (5.65%) cross-over trials, 40 (22.60%) reviews, 5 (2.82%) comparative studies, 17 (9.60%) case-control studies, 2 (1.13%) cohort studies, 2 (1.13%) experimental studies, 2 (1.13%) questionnaires, 6 (3.40%) case-reports, 7 (3.95%) retrospective studies, and 2 (1.13%) guidelines. The experimental studies on dogs with an induced form of the disease were less numerous (49–27.68%) than the studies on dogs affected by spontaneous MMVD (128–72.32%). The therapy of chronic CHF in dogs has considerably changed in the last fifty years: in the last century, some of the currently prescribed drugs did not exist yet, while others had different indications.

Abstract 12611: Demographics and Readmissions of Patients With Congestive Heart Failure and Adverse Social Determinants of Health

Background: Safety Net Community Hospitals (SNCH) account for 1/3 of all US inpatient admissions. The congestive heart failure (CHF) population at our SNCH has high rates of adverse social and behavioral determinants of health (SBDH), but this high-risk population is not well represented in randomized clinical trials of CHF. We sought to determine whether differences in prescriptions of guideline-directed medical therapy (GDMT) for CHF explained worse outcomes in individuals with CHF and adverse SBDH. Methods: We performed a retrospective review of patients diagnosed with CHF (using ICD codes) in 2018, 2019 at Hennepin Healthcare, a SNCH in downtown Minneapolis. We obtained baseline demographics, comorbidities, insurance status, and outcomes from electronic health record. We compared these variables among those without and with adverse SBDH (homelessness, incarceration, substance abuse) using paired t-tests. Results: CHF patients with at least 1 adverse SBDH were more likely to be younger, male, black, with higher prevalent mental illness (Table). They were less likely to have commercial insurance or Medicare, more likely to have Medicaid. The prescription for GDMT for each of the individual categories was high; prescription patterns of GDMT were statistically similar or superior for CHF patients with vs. without adverse SBDH. Patients in SNCH with adverse SBDH had significantly higher hospitalizations and emergency department (ED) visits compared to those without adverse SBDH. Conclusions: CHF patients with adverse SBDH are demographically different from those without adverse SBDH. CHF in the presence of ≥1 adverse SBDH is associated with significantly higher rates of hospitalization and ED visits, without significant differences in prescriptions of GDMT for CHF. The disproportionate demographic burden of adverse SBDH in SNCH as well as causes underlying worse outcomes in CHF patients with adverse SBDH need further research.

Cardiac resynchronization therapy system implantation complications

Cardiac resynchronization therapy (CRT) using coronary sinus (CS) leads is an established method for the therapy of congestive heart failure (CHF) in the case of asynchronous ventricular contractions. Successful therapy depends on the placement of left ventricular leads usually via the coronary sinus (CS), a technically more challenging procedure than regular pacemaker implantations. Without specifi c precautions CRT implantation can be the gateway to a time-consuming nightmare. Therefore, CS lead implantation methods, with a focus on complications, were reviewed according to the literature and our own experience with approximately 4500 procedures from 2002-2021.

Impact of Remote Monitoring on Hospitalizations for Heart Failure: A Five-year Single-center Experience.

The impact of a provider-driven assessment and treatment algorithm based on remote OptiVol (Medtronic, Minneapolis, MN, USA) fluid index levels on hospitalizations for congestive heart failure (CHF) remains unknown. We implemented a physician-guided screening and educational strategy for elevated OptiVol fluid index levels measured on remote implantable cardioverter-defibrillator (ICD) monitoring and assessed clinical outcomes over a five-year period. Patients with CHF and a left ventricular ejection fraction (LVEF) of 40% or less with a previously implanted ICD underwent monthly remote monitoring from January 2015 to November 2019. An OptiVol fluid index of 60 Ω-days or more triggered a protocol-based CHF screening and therapy adjustment according to clinical presentation. Among 279 patients included in the study, 228 (81%) were male and 205 (73%) had ischemic cardiomyopathy. The average LVEF was 29% (± 7.3%). A total of 6,616 monthly transmissions were reviewed over five years; of those, 575 (8.7%) were associated with elevated OptiVol fluid index levels in 178 (64%) patients, and clinical follow-up data were available in 459 of 575 (80%) cases. Following abnormal OptiVol fluid levels on remote monitoring, CHF hospitalization occurred in 10 of 459 (2.2%) patient cases. In conclusion, monthly remote monitoring of OptiVol fluid index levels with a health care provider–guided CHF screening and an educational approach to abnormal OptiVol fluid index levels were associated with a low CHF hospitalization rate. This compared favorably to prior similar studies, and randomized controlled prospective studies evaluating similar algorithms are warranted.

Prospective clinical trial evaluating spironolactone in Doberman pinschers with congestive heart failure due to dilated cardiomyopathy

Introduction/objectivesWhether the aldosterone antagonist spironolactone has beneficial survival effects in dogs with dilated cardiomyopathy (DCM) is not known. The primary objective of the study was to evaluate the effect of spironolactone, when added to conventional therapy, on survival time in Doberman pinschers with congestive heart failure (CHF) due to DCM. AnimalsSixty-seven client-owned Doberman pinschers with CHF due to DCM. Materials and methodsThe trial design was prospective, randomized, blinded, and placebo controlled. Dogs were randomized to receive 50–75 mg of spironolactone twice daily (n = 34) or a placebo (n = 33), in addition to standard CHF therapy. Follow-up visits were targeted every one–six weeks until endpoint. Quality-of-life questionnaire and physical examination were performed at every visit, while renal biochemistry, ECG, echocardiography, and thoracic radiography were reassessed as needed. The primary endpoint was time to cardiac death, defined as death or euthanasia from CHF or sudden death. ResultsMedian time to primary endpoint in the spironolactone group (183 days) was not statistically significantly different than that for the placebo group (124 days) (P = 0.254). The development of atrial fibrillation (AF) was significantly less frequent in the spironolactone group (n = 7) than the placebo group (n = 15, P = 0.037). ConclusionsWhile median time to cardiac death in the spironolactone group was not statistically significantly different than that in the placebo group, adding spironolactone to conventional therapy resulted in reduced occurrence of AF.

Hypertrophic remodelling of retinal arterioles in patients with congestive heart failure.

AimsAnalysis of microvascular parameters in the retinal circulation—known to reflect those in the systemic circulation—allows us to differentiate between eutrophic and hypertrophic remodelling of small arteries. This study aimed to examine microvascular changes in patients with congestive heart failure (CHF) and reduced as well as mid‐range ejection fraction.Methods and resultsForty subjects with CHF underwent measurement of retinal capillary flow (RCF), wall‐to‐lumen ratio (WLR), vessel and lumen diameter, wall thickness, and wall cross‐sectional area (WCSA) of retinal arterioles of the right eye by scanning laser Doppler flowmetry (SLDF). Applying a matched pair approach, we compared this group with reference values of age‐matched controls from a random sample in the population of Pilsen, Czech Republic. There was no significant difference in RCF and WLR between the groups (RCF: P = 0.513; WLR: P = 0.106). In contrast, wall thickness and WCSA, indicators of hypertrophic remodelling, were higher in CHF subjects (WT: 15.0 ± 4.2 vs. 12.7 ± 4.2 μm, P = 0.021; WCSA: 4437.6 ± 1314.5 vs. 3615.9 ± 1567.8 μm2, P = 0.014). Similarly, vessel (109.4 ± 11.1 vs. 100.5 ± 14.4 μm, P = 0.002) and lumen diameter (79.0 ± 7.9 vs. 75.2 ± 8.5 μm, P = 0.009) were increased in CHF.ConclusionsIn CHF subjects, we observed hypertrophic remodelling of retinal arterioles indicative of similar changes of small resistance arteries in the systemic circulation. Microvascular structure and function assessed by SLDF may thereby represent a useful, non‐invasive method for monitoring of microvascular damage in patients with CHF and may offer innovative treatment targets for new CHF therapies.

Caloric restriction reduces sympathetic activity similar to beta-blockers but conveys additional mitochondrio-protective effects in aged myocardium

Increased activation of sympathetic nervous system contributes to congestive heart failure (CHF) progression, and inhibition of sympathetic overactivation by beta-blockers is successful in CHF patients. Similarly, caloric restriction (CR) reduces sympathetic activity but mediates additional effects. Here, we compared the cardiac effects of CR (− 40% kcal, 3 months) with beta-blocker therapy (BB), diuretic medication (DF) or control diet in 18-months-old Wistar rats. We continuously recorded blood pressure, heart rate, body temperature and activity with telemetric devices and analysed cardiac function, activated signalling cascades and markers of apoptosis and mitochondrial biogenesis. During our study, left ventricular (LV) systolic function improved markedly (CR), mildly (BB) or even deteriorated (DF; control). Diastolic function was preserved by CR and BB but impaired by DF. CR reduced blood pressure identical to DF and BB and heart rate identical to BB. Plasma noradrenaline was decreased by CR and BB but increased by DF. Only CR reduced LV oxidative damage and apoptosis, induced AMPK and Akt phosphorylation and increased mitochondrial biogenesis. Thus, additive to the reduction of sympathetic activity, CR achieves protective effects on mitochondria and improves LV function and ROS damage in aged hearts. CR mechanisms may provide additional therapeutic targets compared to traditional CHF therapy.