Worsening Heart Failure Symptoms Research Articles

Short-term efficacy and safety of cardiac contractility modulation in patients with heart failure

Objective: To investigate the short-term efficacy and safety of cardiac contractility modulation (CCM) in patients with heart failure. Methods: This was a cross-sectional study of patients with heart failure who underwent CCM placement at the First Affiliated Hospital of Xinjiang Medical University from February to June 2022. With a follow-up of 3 months, CCM sensation, impedance, percent output, and work time were monitored, and patients were compared with pre-and 3-month postoperative left ventricular ejection fraction (LVEF) values, and 6-minute walk test distance and New York Heart Association (NYHA) cardiac function classification, and the occurrence of complications was recorded. Results: CCM was successfully implanted in all 9 patients. Seven(7/9) of them were male, aged (56±14) years, 3 patients had ischaemic cardiomyopathy and 6 patients had dilated cardiomyopathy. At 3-month postoperative follow-up, threshold was stable, sense was significantly lower at follow-up than before (right ventricle: (16.3±7.0) mV vs. (8.2±1.1) mV, P<0.05; local sense: (15.7±4.9) mV vs. (6.7±2.5) mV, P<0.05), and impedance was significantly lower at follow-up than before (right ventricle (846±179) Ω vs. (470±65) Ω, P<0.05, local sense: (832±246) Ω vs. (464±63) Ω, P<0.05). The CCM output percentage was (86.9±10.7) %, the output amplitude was (6.7±0.4) V, and the daily operating time was (8.6±1.0) h. LVEF was elevated compared to preoperative ((29.4±5.2) % vs. (38.3±4.3) %, P<0.05), the 6-minute walk test was significantly longer than before ((96.8±66.7)m vs. (289.3±121.7)m, P<0.05). No significant increase in the number of NYHA Class Ⅲ-Ⅳ patients was seen (7/9 vs. 2/9, P>0.05). The patient was not re-hospitalised for worsening heart failure symptoms, had no malignant arrhythmic events and experienced significant relief of symptoms such as chest tightness and shortness of breath. No postoperative complications related to pocket hematoma, pocket infection and rupture, electrode detachment, valve function impairment, pericardial effusion, or cardiac perforation were found. Conclusions: CCM has better short-term safety and efficacy in patients with heart failure.

Recurrent giant cell myocarditis following orthotopic heart transplant resulting in urgent redo orthotopic heart transplantation: a case report

Abstract Background Giant cell myocarditis (GCM) is a severe and rapidly progressing condition that can lead to end-stage heart failure. We present a case of a 51-year-old male with a history of orthotopic heart transplantation (OHTx) for GCM, who experienced recurrent GCM in the allograft, leading to progressive heart failure and the need for a second heart transplant. Case summary A 51-year-old male with a history of OHTx for GCM presented with rapidly worsening heart failure symptoms. Despite initial stability, he deteriorated to cardiogenic shock and required intensive support. His clinical course was complicated by recurrent COVID-19 infections, worsened left ventricular ejection fraction, and withdrawal of guideline-directed medical therapy. Imaging showed extensive scar burden, and subsequent investigations ruled out coronary artery disease. With declining functional status and worsening cardiogenic shock, he was re-listed for OHTx and successfully underwent a second heart transplant. Discussion Giant cell myocarditis poses challenges due to its aggressive nature. Early, aggressive immunosuppression and mechanical circulatory support are crucial. The recurrence rate of GCM post-OHTx is notable, often within the first year, and the optimal immunosuppressive regimen remains uncertain. In this case, GCM recurrence following OHTx led to continued deterioration despite treatment, necessitating a second heart transplant. This unique case emphasizes the complexity of managing recurrent GCM post-OHTx.

Abstract 18644: Disparities in Inpatients’ Perceptions, Evaluation, and Responses to Worsening Heart Failure Symptoms- Racial and Financial Status

Background: Most patients with heart failure (HF) exhibit a broad symptom profile, sporadically marked by periods of acute exacerbation and readmission that can be prevented by symptom monitoring and adequate self-care. Yet, patients are frequently unable to adhere to appropriate self-care measures. Reasons for non-adherence are multifactorial including disparities related to race and financial status, and are insufficiently investigated. Thus, a secondary analysis study was conducted to 1) compare HF inpatients’ knowledge, cognitive function and HF self-care based on their race (Black and White), and financial status (higher if they reported having “enough or more than enough to make ends meet” and lower if they “did not have enough to make ends meet”), and 2) investigate disparities in patients’ perception and evaluation of symptoms, and actions taken during HF exacerbation based on their race and financial status. Methods: A total of 185 patients (62 years ±13, 49 % female, 76% white) admitted for acute HF exacerbation completed standardized instruments measuring cognitive function, HF knowledge, HF self-care, perception of, and responses to HF symptoms. Chi-square and independent samples t-test analyses were used. Results: Black patient with HF had lower levels of HF knowledge, cognitive function, and engagement in self-care maintenance behaviors than White patients (p &lt;.05). Black patients believed medication nonadherence, excessive fluid intake, hypertension, and overeating were causes of their worsening symptoms (p &lt;.05). Black patients tended to call an ambulance in response to worsening symptoms while White patients took their water pill (p = 0.03). Patients with lower financial status reported higher body mass index than those with higher financial status (p = .03). Patients with lower financial status linked their symptoms to depression and lung problems (p =.02), but they did nothing to manage symptoms and hoped their symptoms would go away (p &lt; .05). Conclusions: Interventions that take into account culture and financial status are needed to mitigate racial disparities, improve symptom perception, and promote appropriate responses in HF patients.

PO-01-026 STEREOTACTIC CARDIAC RADIOTHERAPY FOR RECURRENT VENTRICULAR TACHYCARDIA IN PRESENCE OF WIRELESS LEFT VENTRICULAR ENDOCARDIAL STIMULATION SYSTEM

Cardiac stereotactic body radiotherapy (SBRT) is a novel therapy for refractory ventricular tachycardia (VT). However, there remain knowledge gaps due to limited experience. The wireless stimulation endocardial cardiac resynchronization therapy (WiSE CRT) is a promising method of left ventricular (LV) resynchronization using a receiver electrode implanted in LV and a transmitter implanted in the intercostal space that is connected to a subcutaneous battery. The safety of cardiac SBRT in the presence of WiSE CRT has not been reported. We present a case of successful cardiac SBRT for recurrent VT from the LV apex delivered safely in a patient with WiSE CRT. N/A An 83-year-old man had a history of ischemic cardiomyopathy with LV apical infarct, LV ejection fraction 20%, NYHA Class III, underlying left bundle branch block status post CRT-D placement, severe coronary artery disease, paroxysmal atrial fibrillation, chronic kidney disease stage III, hyperlipidemia and orthostatic hypotension. He had initially presented with appropriate defibrillator discharges due to paroxysmal VT. He underwent catheter ablation of VT originating from the LV apex. The procedure was complicated by pericardial effusion requiring emergent pericardiocentesis. He was discharged on amiodarone but this had to be discontinued due to adverse effects. He had recurrence of VT and defibrillator shock and mexiletine was started. He started experiencing worsening heart failure symptoms. CRT-D interrogation revealed recurrent episodes of VT terminated by antitachycardia pacing and LV lead malfunction with high impedance and elevated capture threshold with loss of LV pacing. He underwent WiSE CRT system implant and the transvenous LV lead was turned off. Subsequently he had multiple admissions for VT storm requiring device therapies despite antiarrhythmic medication changes including sotalol and mexiletine. Therefore, he underwent cardiac SBRT targeting the LV apical substrate with 25 Gy dose delivered in a single fraction. SBRT treatment plan was created by contouring the components of the Wise CRT system and limiting dose to them <10 Gy (Figure). He has been weaned off antiarrhythmic drugs and has had no recurrent VT for 2.5 months since SBRT. Wise CRT function and battery status remained stable with no detrimental effects based on device interrogation till 2.5 months post SBRT. With careful treatment planning, cardiac SBRT can be delivered safely in the presence of WiSE CRT.

Safety and efficacy of repeated balloon aortic valvuloplasty in patients with symptomatic severe aortic stenosis.

Long-term outcomes of balloon aortic valvuloplasty (BAV) in patients with severe symptomatic aortic stenosis (AS) are poor, and this procedure needs to be repeated in selected cases. We aimed to investigate the safety and efficacy of repeated BAV (reBAV). We included consecutive patients who underwent reBAV in three Polish centers between 2010 and 2019. Baseline clinical, echocardiographic, procedural, and outcome data were analyzed. Thirty-five patients (median age 81.5 years, 57.1% women) who underwent reBAV were enrolled. In 42.9% of the patients, index BAV was considered a palliative treatment, and in 54.3% a bridge to definitive treatment. Index BAV decreased peak aortic valve gradient (pAVG) from a median of 78.0 mm Hg to 46.0 mm Hg (P <0.001). After a mean of 255.8 days, reBAV was performed. In most cases (71.4%), the reason for reBAV was the worsening of heart failure symptoms and in 54.3% of patients, reBAV was still considered a palliative option. A decrease in pAVG max from a median of 73.0 mm Hg to 45.0 mm Hg (P <0.001), comparable to index BAV, was observed. The frequency of complications were numerically higher for repeated procedures. During the median (IQR) follow-up of 403.0 (152.0-787.0) days from the index procedure, 80.0% of the patients died. Acute hemodynamic results of reBAV are comparable to those achieved during index BAV. However, reBAV may carry an increased risk of complications. Moreover, mortality is high due to unfavorable risk profiles or delays in receiving definitive therapy.

The consequences of confinement on patients followed at the heart failure treatment unit (HFTU): experience of the cardiology department – CHU Ibn Rochd-Casablanca

Introduction In the absence of effective treatment for SARS-Cov2 (severe acute respiratory syndrome coronavirus 2), social distancing and containment measures are the most effective ways to fight the pandemic to date. Nevertheless, these latter measures may have repercussions in particular on heart failure. Objective To assess the impact of confinement in patients followed in the heart failure treatment unit at the cardiology department of Ibn Rochd hospital. Method We selected a random sample of patients followed in HFTU. We collected their demographic data as well as the evolution of their symptoms, their clinical parameters, biological, and their lifestyles at the beginning of the confinement and 1 year later. Results We included 100 patients at random. We found a significant increase in BMI of 6.85 kg/m2. The rate of sedentary lifestyle rose by 40% and 63.9% of patients increased their salt intake by more than 4 g/day. We noted a worsening of heart failure symptoms. Thus, 10.6% of patients with stage 2 dyspnea progressed to NYHA stage 3 (32.4 vs. 40.5%), while the percentage of patients with IMO increased by 21.5%. 11 deaths for end-stage heart failure, 38 hospitalizations for heart failure flare-ups including 12 patients following a deviation from diet and treatment, 10 to a rhythm disorder, 8 to an ischemic flare-up, 6 to a pulmonary embolism and 2 patients following a SARS COV2 infection. Conclusion The sanitary confinement has had a significant impact on patients followed for heart failure, from where the need to restructure our healthcare system and develop remote therapeutic education.

The predictive model of acute heart failure rehospitalization: A retrospective study in Prof. I.G.N.G Ngoerah Hospital

Introduction. Heart failure is one of the main causes of cardiovascular morbidity and mortality. Research stated that heart failure patients who have undergone 3 rehospitalizations have a survival rate of &lt;50% within 1 year. Therefore, the purpose of this study is to characterize the risk factors that contribute to the occurrence of heart failure rehospitalization. Method. This is a retrospective analysis of 113 patients with a first hospitalization for heart failure at Prof. I.G.N.G. Ngoerah Hospital between July 2018–February 2020. We collected and compared demographic data, clinical findings, electrocardiogram, laboratory, and echocardiography parameters during the first hospitalization between rehospitalized and non-rehospitalized patients. Rehospitalization was defined as recurrent hospital admission due to worsening heart failure symptoms. Patients were followed for rehospitalization events until death or November 2021. Results. The rehospitalization rate in this study was 62.8% during a median follow-up of 234 days (12–1098 days). The average of heart failure rehospitalizations during follow-up was 1.73 times (±1.97), with an average length of stay of 6.40 days (±3.27 days). We discovered that the presence of mid/apical rales at admission (odds ratio [OR] 3.509; p=0.027), hyponatremia (&lt;135 mmol/L) at pre-discharge (odds ratio [OR] 3.840; p=0.015), and tricuspid annular plane systolic excursion (TAPSE) values &lt;1.80 cm (odds ratio [OR] 2.905; p=0.020) were independent risk factors for rehospitalization due to worsening heart failure symptoms. Patients with these three independent risk factors have a probability of 96.24% being readmitted. Conclusion. Mid/apical rales at admission, hyponatremia at pre-discharge, and TAPSE values &lt;1.80 cm in patients admitted for heart failure are associated with further rehospitalization.

EVAHEART 2 with double cuff tipless inflow cannula is suitable for long-term support atrial switch operation in transposition of great arteries.

Implantation of continuous-flow left ventricular assist device in a narrow lumen is technically challenging to secure an optimal support. We experienced a patient with the transposition of the great arteries after the Senning procedure who was initially implanted with Jarvik 2000®. She presented with worsening heart failure symptoms 2 years after implanting Jarvik 2000®. We assumed that the inflow cannula was stuck in the highly developed trabeculae on the interventricular septum, which disturbed the VAD to maintain an expected support. After converting to the EVAHEART® 2, we successfully obtained an adequate inflow. We consider that the tipless cannula of EVAHEART® 2 is the most suitable when there is no sufficient room to place a conventional inflow cannula in the systemic ventricle.

Abstract 13878: A Case of Severe Tricuspid Regurgitation, Recurrent Ascites, Worsening Renal Function Leading to Hemodialysis Secondary to RV Lead Impingement, Resolved Completely With Lead Extraction

Introduction: 1. In contemporary practice, implantation of Cardiovascular Implantable Electronic Devices (CIED) is associated with low complication rate peri-procedurally. 2. However, in some patients these complications can have high morbidity and mortality; namely pneumothorax, pericardial tamponade, pacemaker syndrome, and rarely tricuspid regurgitation (TR) secondary to lead impingement. 3. TR secondary to RV lead impingement is not uncommon but infrequently lead to severe TR and worsening heart failure symptoms. 4. We present a case of severe TR secondary to RV lead impingement leading to splanchnic congestion and recurrent ascites, worsening renal failure leading to hemodialysis (HD), all of which resolved with lead extraction. Case: A 77-year-old woman with known CAD with prior PTCA, paroxysmal AF, and prior watchman implantation, evaluated in our clinic for severe TR. She had recurrent admissions for ascites needing paracentesis. Her liver function and ultrasound was normal. Her renal function worsened and HD was initiated. ECHO showed normal LVEF, severe TR with RVSP of 74mmHg, and mild RV dysfunction. Pericardial physiology was normal. The lead was noted to be impinging on the septal leaflet, and adherent. Normal pulmonary valve function. Follow up: We proceeded to perform RV lead extraction and implanted a new leadless pacemaker [MICRA-AV, Medtronic Inc]. Her follow up ECHO in 2 weeks showed mild TR and normal RV function. RVSP had dropped significantly to 34mmHg. Surprisingly, her needs for paracentesis came down and by 3 months follow up she did not need paracentesis anymore. Her renal function improved, and her HD needs stopped. Conclusions: 1. CIED implantations are associated with low complication rate (less than 5% in total) in most patient cohorts but in some patients it can be associated with significant complications increasing their morbidity and sometimes mortality. 2. Severe TR is a well-recognized complication of pacemaker implantation. It led to recurrent ascites needing paracentesis, ESRD requiring HD and multiple hospital admissions and thus increasing the morbidity. 3. It is important to recognize the uncommon complications of such commonly used intracardiac devices for electrophysiologists, cardiologists and PCPs.

Prediction of new-onset atrial fibrillation in patients with hypertrophic cardiomyopathy using proteomics profiling

Abstract Background Hypertrophic cardiomyopathy (HCM) is one of the most common genetic cardiac disorders and affects 1 in 200–500 individuals. HCM is known to be heterogeneous. Approximately 20–30% of patients with HCM develop atrial fibrillation (AF), which can lead to stroke and worsening of heart failure symptoms. As AF increases the risk of stroke by 8-fold, AF in HCM is a Class 1 indication for anticoagulation. Despite its high prevalence and clinical importance of early AF detection, there are no risk stratification tools available to predict new-onset AF in patients with HCM. Furthermore, it is still unknown which signaling pathways mediate AF in HCM. Proteomics profiling can determine concentrations of thousands of proteins and potentially reveal underlying molecular mechanisms of disease progression. Purpose To develop plasma proteomics-based model to predict new-onset AF in patients with HCM and to determine signaling pathways dysregulated in those who subsequently develop AF. Methods In this prospective, multi-center cohort study, we conducted plasma proteomics profiling of 5,032 proteins on 397 patients with HCM. We developed a proteomics-based random forest machine learning model to predict new-onset AF using samples from one institution (training set, n=278). We tested the predictive ability of the model using independent samples from the other institution (test set, n=119). We estimated the hazard ratio for new-onset AF using a Cox proportional hazards model comparing high- and low-risk groups as determined by the proteomics-based model. We also performed pathway analysis of proteins significantly (i.e., univariable P&amp;lt;0.05) associated with new-onset AF using a false discovery rate (FDR) threshold of 0.05. Results A total of 15 patients in the training set (5.4%) and 7 in the test set (5.9%) developed new-onset AF. Using the proteomics-based model developed in the training set, the area under the receiver-operating characteristic (ROC) curve to predict new-onset AF was 0.87 (95% confidence interval [CI] 0.77–0.98; Figure) in the test set. The sensitivity was 0.86 (95% CI 0.42–0.99) and the specificity was 0.77 (95% CI 0.68–0.84). In the test set, patients categorized as high-risk based on the proteomics model had a significantly higher rate of developing new-onset AF (hazard ratio 8.18; 95% CI 1.55–43.20; P=0.01). Pathway analysis revealed that the Ras-MAPK pathway was dysregulated in patients who subsequently developed AF (FDR=0.01; Table). Pathways involved in inflammation were also dysregulated. Conclusions This study serves as the first to demonstrate the ability of proteomics profiling to predict new-onset AF in patients with HCM, exhibiting dysregulation of both novel (e.g., Ras-MAPK) and known pathways in patients who subsequently experience AF. These results not only exhibit the utility of proteomics profiling for clinical risk stratification but also suggest mechanisms underlying the development of AF in HCM. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NIH/NHLBI

Dealing With Failure.

Dealing With Failure.

Prognostic significance of diastolic dysfunction in patients with systolic dysfunction undergoing atrial fibrillation ablation.

The relationship between pre-ablation left ventricular diastolic dysfunction (LVDD) and prognosis in patients with left ventricular systolic dysfunction (LVSD) undergoing atrial fibrillation (AF) ablation remains unclear. The prognosis of 173 patients with impaired left ventricular ejection fraction (<50%) who underwent AF ablation was examined. The primary outcome was a composite of all-cause mortality, heart failure (HF) hospitalization, and worsening HF symptoms requiring unplanned outpatient intensification of decongestive therapy. During the follow-up period (median, 3.5years), the primary outcome after AF ablation occurred in 28 patients (16%). The receiver operating characteristic curve analysis showed that early septal diastolic mitral annular velocity (e') had a larger area under the curve (0.70) than other LVDD parameters, and optimal cut-off values of LVDD, represented by e', septal E (early diastolic left ventricular filling velocity)/e', and peak tricuspid valve regurgitation velocity (TRV), were 5.0cm/s, 13.2, and 2.5m/s, respectively. Multivariate analysis revealed that e' ≤5.0cm/s (standard hazard ratio [HR], 3.87; 95% confidence interval [CI], 1.73-8.69; p=0.001), septal E/e' ≥13.2 (HR, 3.62; 95% CI, 1.60-8.21; p=0.002), and peak TRV≥2.5m/s (HR, 2.42; 95% CI, 1.13-5.16; p=0.02) independently predicted the outcome. Patients with New York Heart Association functional status≥III had a 3.3-4.5-fold higher risk of the outcome. LVDD or severe HF symptoms predict poor outcomes in patients with LVSD undergoing AF ablation. Therefore, patients with LVDD or severe HF symptoms should receive more intensive treatment even after AF ablation.

Acute management of atrial fibrillation in congestive heart failure with reduced ejection fraction in the emergency department

IntroductionAcute heart rate control for atrial fibrillation (AF) with rapid ventricular response (RVR) in the emergency department (ED) is often achieved utilizing intravenous (IV) non-dihydropyridine calcium channel blockers (CCB) or beta blockers (BB). For patients with concomitant heart failure with a reduced ejection fraction (HFrEF), the American Heart Association and other clinical groups note that CCB should be avoided due to their potential negative inotropic effects. However, minimal evidence exists to guide this current recommendation. The primary objective of this study was to compare the incidence of adverse effects in the HFrEF patient population whose AF with RVR was treated with IV diltiazem or metoprolol in the ED. MethodsThis single center, retrospective review included patients ≥18 years old with HFrEF who presented in AF with RVR and received IV diltiazem or metoprolol in the ED. The primary outcome was adverse effects of therapy defined as: 1) hypotension (systolic blood pressure < 90 mmHg requiring fluid bolus or vasopressors) or bradycardia (heart rate < 60 beats/min) within 60 min of medication administration 2) worsening heart failure symptoms defined as increased oxygen requirements within four hours or inotropic support within 48 h. Secondary outcomes included the incidence of rate control failure, patient disposition, ED length of stay, hospital length of stay, and in-hospital mortality. ResultsOne hundred and twenty-five patients met inclusion criteria, with 57 receiving diltiazem and 68 receiving metoprolol. Overall adverse effects for diltiazem and metoprolol were similar (32% vs. 21%, P = 0.217). However, there was a significantly higher incidence of worsening heart failure symptoms within the diltiazem group (33% vs 15%, P = 0.019). Rate control failure at 60 min did not differ significantly between diltiazem and metoprolol (51% vs 62%, P = 0.277). ConclusionsIn HFrEF patients with AF, there was no difference in total adverse events in patients treated with IV diltiazem compared to metoprolol. However, the diltiazem group had a higher incidence of worsening CHF symptoms defined as increased oxygen requirement within four hours or initiation of inotropic support within 48 h.

Clinical characteristics of severe aortic stenosis patients combined with diabetes mellitus after transcatheter aortic valve replacement and short-term outcome.

Type 2 diabetes (T2DM) is a common comorbidity in patients with degenerative aortic stenosis (AS).As a key item of the American Society of Thoracic Surgeons (STS) score, it has a vital impact on the clinical prognosis of traditional thoracic surgery. T2DM has an adverse effect on the morbidity and mortality of cardiovascular diseases. At the same time, studies have shown that T2DM are associated with myocardial hypertrophy and remodeling, decreased left ventricular function, and worsening heart failure symptoms in the AS patients. Transcatheter aortic valve replacement (TAVR) as an interventional method to replace the aortic valve has better safety for middle and high risk patients in surgery, but the impact of T2DM on the clinical outcome of TAVR in AS patients is not clear.By analyzing the clinical and image characteristics of patients with AS and T2DM who received TAVR treatment, so as to explore the effect of T2DM on the perioperative complications and prognosis of TAVR. A total of 100 consecutive patients with severe AS, who underwent TAVR treatment and were followed up for more than 1 month, were selectedin the Second Xiangya Hospital of Central South University from January 2016 to December 2020.Among them, 5 patients who were treated with TAVR due to simple severe aortic regurgitation were not included, therefore a total of 95 patients with severe aortic stenosis were enrolled in this study.The age of the patients was (72.7±4.8) years old, and there were 58 males (61.1%), and the patients with moderate or above aortic regurgitation had 30 cases (31.6%). The patients were divided into a diabetic group and a non-diabetic group according to whether they were combined with T2DM.There was no statistical difference in age, gender, body mass index (BMI), STS score, and New York Heart Association (NYHA) cardiac function classification between the 2 groups (all P>0.05). The primary end point was defined as a composite event consisting of all-cause death and stroke one month after surgery, and the secondary end point was defined as TAVR-related complications immediately after surgery and one month after surgery.The preoperative clinical data, cardiac ultrasound data, CT data, postoperative medication and the incidence of each endpoint event were compared between the 2 groups.The predictive model of adverse events was constructed by single factor and multivariate logistic regression. Compared with the non-diabetic group, the diabetic group had high blood pressure and chronic renal insufficiency.There was no significant difference in preoperative ultrasound echocardiography between the 2 groups. Preoperative CT evaluation found that the anatomical structure of the aortic root in the diabetic group was smaller than that in the non-diabetic group, and there was no significant difference in the incidence of bicuspid aortic valve between the 2 groups (all P<0.05). In terms of postoperative medication, the use of statins in the diabetes group was significantly higher than that in the non-diabetic group. In the diabetes group, 6 patients (37.5%) received insulin therapy, and 9 patients (56.3%) received oral medication alone.Univariate logistic regression analysis showed that the all-cause death and stroke compound events was increased in the diabetes group in 30 days after TAVR (OR=6.86; 95% CI: 2.14 to 21.79; P<0.01). Heart disease (OR=2.80; 95% CI: 0.99 to 7.88; P<0.05) and chronic renal insufficiency (OR=3.75; 95% CI: 1.24 to 11.34; P<0.05) were also risk factors for all-cause death and stroke compound events.In a multivariate analysis, after adjusting for age, gender, BMI, comorbidities, N-terminal pro-B type natriuretic peptide (NT-proBNP), total calcification score, ejection fraction, and degree of aortic regurgitation, T2DM was still a risk factor for all-cause death and stroke compound events in 30 days after TAVR (OR=12.68; 95% CI: 1.76 to 91.41; P<0.05). T2DM is a risk factor for short-term poor prognosis in patients with symptomatic severe AS after TAVR treatment. T2DM should play an important role in the future construction of the TAVR surgical risk assessment system, but the conclusions still need to be further verified by long-term follow-up of large-scale clinical studies.

JCS/JHRS 2021 guideline focused update on non-pharmacotherapy of cardiac arrhythmias.

JCS/JHRS 2021 guideline focused update on non-pharmacotherapy of cardiac arrhythmias.

Travelling with heart failure: risk assessment and practical recommendations.

Patients with heart failure are at a higher risk of cardiovascular events compared with the general population, particularly during domestic or international travel. Patients with heart failure should adhere to specific recommendations during travel to lower their risk of developing heart failure symptoms. In this Review, we aim to provide clinicians with a set of guidelines for patients with heart failure embarking on national or international travel. Considerations when choosing a travel destination include travel distance and time, the season upon arrival, air pollution levels, jet lag and altitude level because all these factors can increase the risk of symptom development in patients with heart failure. In particular, volume depletion is of major concern while travelling given that it can contribute to worsening heart failure symptoms. Pre-travel risk assessment should be performed by a clinician 4-6 weeks before departure, and patients should receive advice on potential travel-related illness and on strategies to prevent volume depletion. Oxygen supplementation might be useful for patients who are very symptomatic. Upon arrival at the destination, potential drug-induced photosensitivity (particularly in tropical destinations) and risks associated with the local cuisine require consideration. Special recommendations are needed for patients with cardiac implantable electronic devices or left ventricular assist devices as well as for those who have undergone major cardiac surgery.

Late presentation of middle aortic syndrome complicated with severe aortic regurgitation; the role of endovascular intervention as a bridging for Bentall surgery

Middle aortic syndrome presents with segment narrowing of the descending thoracic and abdominal aorta. A common manifestation is uncontrolled hypertension, which can lead to severe aortic regurgitation in the long term. We have presented the case of a 31-year-old woman with worsening heart failure symptoms and longstanding uncontrolled hypertension. Echocardiography revealed severe aortic regurgitation. Aortic computed tomography showed severe stenosis of the aorta at the diaphragm level. Stent graft implantation was performed, followed by Bentall surgery 1 year later. Endovascular stent graft implantation of the descending aorta can be used safely as a bridging surgery for the Bentall procedure to reduce the patient’s blood pressure and relieve heart failure symptoms.

The Prognostic Value of Lung Ultrasound in Patients With Newly Diagnosed Heart Failure With Preserved Ejection Fraction in the Ambulatory Setting.

Background: Heart failure with preserved ejection fraction (HFpEF) is a growing healthcare burden, and its prevalence is steadily increasing. Lung ultrasound (LUS) is a promising screening and prognostic tool in the heart failure population. However, more information on its value in predicting outcome is needed.Aims: The aim of our study was to assess the prognostic performance of LUS B-lines compared to traditional and novel clinical and echocardiographic parameters and natriuretic peptide levels in patients with newly diagnosed HFpEF in an ambulatory setting.Methods: In our prospective cohort study, all ambulatory patients with clinical suspicion of HFpEF underwent comprehensive echocardiography, lung ultrasound and NT-proBNP measurement during their first appointment at our cardiology outpatient clinic. Our endpoint was a composite of worsening heart failure symptoms requiring hospitalization or loop diuretic dose escalation and death.Results: We prospectively enrolled 75 consecutive patients with HFpEF who matched our inclusion and exclusion criteria. We detected 11 events on a 26 ± 10-months follow-up. We found that the predictive value of B-lines is similar to the predictive value of NT-proBNP (AUC 0.863 vs. 0.859), with the best cut-off at >15 B-lines. Having more B-lines than 15 significantly increased the likelihood of adverse events with a hazard ratio of 20.956 (p = 0.004). The number of B-lines remained an independent predictor of events at multivariate modeling. Having more than 15 B-lines lines was associated with a significantly worse event-free survival (Log-rank: 16.804, p < 0.001).Conclusion: The number of B-lines seems to be an independent prognostic factor for adverse outcomes in HFpEF. Since it is an easy-to-learn, feasible and radiation-free method, it may add substantial value to the commonly used diagnostic and risk stratification models.

PULMONARY EMBOLISM CAUSING INACCURATE READINGS OF CARDIOMEMS

TOPIC: Pulmonary Vascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: The CardioMEMS™ HF System is a wireless pulmonary artery (PA) pressure monitoring system implanted in the left lower lobe (LLL) PA branch; FDA approved in the management of heart failure (HF) patients with New York Heart Association (NYHA) class III symptoms and at least one hospitalization within the last year. This hemodynamic data is useful to reduce HF hospitalizations and mortality (1,2). We present the first reported case of a device-unrelated acute LLL pulmonary embolism (PE) leading to discordant CardioMEMS readings in a breast cancer patient with HF. CASE PRESENTATION: Patient is a 56 year-old female with past medical history of triple negative right breast cancer in 1998 treated with lumpectomy, anthracyclines, and radiation therapy that was complicated by recurrence in 2018 which was treated with bilateral mastectomy followed by adjuvant dose dense chemotherapy with doxorubicin, cyclophosphamide, and paclitaxel that resulted in anthracycline-induced cardiomyopathy with reduced left ventricular ejection fraction (LVEF) of 30%. LVEF eventually recovered to 60% after the initiation of optimal medical therapy for HF. Unfortunately, she remained with persistent NYHA class III symptoms requiring frequent hospitalizations. Thus, a CardioMEMS device was inserted to optimize HF management and reduce recurrent hospitalization by remote monitoring of PA pressure. Eight months later, she developed an acute PE within the LLL PA branch (originating from her left leg). She was eventually treated with anticoagulation therapy with resolution of her dyspnea and was eventually discharged home. On her post-hospitalization appointment, she reported worsening HF symptoms despite being euvolemic on exam. CardioMEMS (2 months after PE) showed persistently elevated PA pressures. Due to concerns for PE into the LLL affecting the CardioMEMS readings, a right heart catheterization was performed which showed marked discrepancy between PA pressure and CardioMEMS readings. DISCUSSION: In the setting of a recent PE to the same PA branch where the CardioMEMS implant was located, it was presumed that the PE caused device malfunction by falsely elevating CardioMEMS readings. It is worthy to mention, however, that the PE spared the actual implant. Despite proper management of the acute PE, PA pressure remained falsely elevated even after 2 months of anticoagulation therapy. Thus, given the discordant PA pressure readings, it was necessary to recalibrate the device. As a result of the recalibration, the patient's HF management was appropriately optimized using data from the recalibrated CardioMEMS device. CONCLUSIONS: In the correct clinical context, discordance between implantable hemodynamic monitoring device readings and physical exam should prompt right heart catheterization, as an acute PE at the sensor site is a rare, but diagnosable and easily treatable cause of CardioMEMS malfunction. REFERENCE #1: CardioMEMS TM HF System. (2014, May). Retrieved from https://www.accessdata.fda.gov/cdrh_docs/pdf10/p100045c.pdf. REFERENCE #2: Abraham, W. T., Stevenson, L. W., Bourge, R. C., Lindenfeld, J. A., Bauman, J. G., & Adamson, P. B. (2016). Sustained efficacy of pulmonary artery pressure to guide adjustment of chronic heart. REFERENCE #3: failure therapy: Complete follow-up results from the CHAMPION randomised trial. The Lancet, 387(10017), 453-461. doi:10.1016/s0140-6736(15)00723-0. DISCLOSURES: No relevant relationships by Rafael Garcia-Cortes, source=Web Response No relevant relationships by Saarik Gupta, source=Web Response no disclosure on file for KATHLEEN MORRIS; No relevant relationships by Amjed Zidan, source=Web Response

Efficacy of nurse-led cardiac rehabilitation on health care behaviours in adults with chronic heart failure: An experimental design

IntroductionNonadherence and poor health care behaviors contribute to worsening of heart failure symptoms, in many cases leading to increased morbidity and mortality. AimTo assess the efficacy of nurse-led cardiac rehabilitation on health care behaviours in adults with chronic heart failure. Method. An experimental design was conducted in India from January to December of 2019. A sample size of 200 adults with heart failure from a tertiary cardiac care center was enrolled. Participants were allocated into an intervention group (n = 100) and a control group (n = 100). A nurse-led cardiac rehabilitation program using a virtual educational video and reminder telephone calls was given to the intervention group for six months. A modified heart failure adherence and health care behaviours scale was used. Results78% of the adults in the intervention group and 79% of the adults in the control group were males. 43% of the adults in the intervention group and 32% of the adults in the control group had ≥2 years of chronic heart failure. 42.27% of the participants in the intervention group and 35.05% of the adults in the control group indicated that medical follow-ups were essential. 21.65% of the adults in the intervention group and 13.40% of the adults in the control group expressed no difficulty adhering to the sodium restriction in the posttest2. The participants in the intervention group had higher health care behaviours compared to control group, p < 0.001. Conclusion/ImplicationCardiac nurses need to adopt cardiac rehabilitation in continuity of care for improving health care behaviours for adults with chronic heart failure.