York Heart Association Criteria Research Articles

Circulating neurodegeneration biomarkers neurofilament light protein and p‐tau181 are increased in individuals with heart failure at risk for vascular cognitive impairment

AbstractBackgroundSystemic inflammation, which is present in heart failure (HF), is known to increase risk for dementia and development of vascular cognitive impairment and dementia (VCID). Both neurofilament light protein (NfL) and tau phosphorylated at threonine‐181 (p‐tau181) are well known biomarkers of neurodegeneration in both Alzheimer’s disease and non‐Alzheimer’s disease neurodegenerative diseases. The purpose of the present study was to determine if blood levels of NfL and p‐tau181 are increased in HF patients at risk for VCID.MethodWe performed a retrospective study of 58 participants from the previously completed TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist). TOPCAT participants had symptomatic HF categorized using New York Heart Association (NYHA) criteria, were > 50 years of age, and had ejection fraction (LVEF) ≥45%, assessed within 6 months from study start (n=58, 52% female). Control serum samples were obtained from age‐matched adults between 50‐85 with no known health issues (n=24, 50% female). NfL was measured using Simoa Quanterix and p‐Tau181 measured with SimoaHuman pTau‐181 V2 kit. Statistical analysis was performed using GraphPad and significance tested using Welch’s ANOVA, Dunnett’s post.ResultBaseline NfL levels were significantly higher in NYHA class I/II (n=56) and III/IV (n=54, p<.0001) than measured in age‐matched controls (see table for values). Over 12‐months follow‐up, participants in NYHA class I/II had an increase in NfL of 9.6±5% relative to baseline and those in class III/IV had a 31.7±17% increase from baseline. P‐tau181 levels were also significantly higher in both NYHA class I/II (n=56) and III/IV (n=54, p=.0002) as compared to age‐matched controls (see table for values) with levels were significantly higher in class III/IV than in class I/II participants (ANOVA, Dunnett’s post, p<.001). Levels of p‐tau181 did not show significant changes over the 12‐month time in any group.ConclusionThese results demonstrate that 2 well‐studied biomarkers of neurodegeneration, NfL and p‐tau181, are elevated in subjects with HF. Studies are underway to determine if biomarker levels correlate with measures of cognitive function and MRI measures of brain structure and function in HF patients. (Supported by NIA U01AG066623).

Comparison of Generic Dasatinib Versus Imatinib in Newly Diagnosed Chronic Phase Chronic Myeloid Leukemia with Reference to Early Molecular Response: Results from a Single-Center, Randomized Controlled Study from India

Background: Chronic myeloid leukemia (CML) is the commonest leukemia in adult population in India. The advent of tyrosine kinase inhibitors (TKI) targeting BCR-ABL1 fusion transcript in CML has dramatically improved survival of CML patients. Generic formulations of imatinib mesylate have been the mainstay of TKI therapy in Indian CML patients for more than a decade, due to prohibitive costs of 2nd generation TKIs and poor socio-economic status of majority of patients. However, with the availability of generic dasatinib in India since March 2021, the cost of dasatinib therapy has become comparable to that of generic imatinib treatment, thereby enabling more extensive use of dasatinib as first-line TKI therapy in CML patients in India. Achievement of early molecular response (EMR) after 3 months of first-line TKI therapy, defined as blood BCR-ABL1 transcript level ≤ 10% [international scale (IS)], has emerged as an important predictor of favorable long-term outcome in CML-CP. There is scarcity of data on efficacy & safety of generic formulations of dasatinib vis-à-vis generic imatinib in CML-CP patients in India, which the present study has attempted to explore at a tertiary care hospital in India. Objectives: The objectives of the study were to compare early molecular response (EMR) [defined as BCR-ABL1 transcript level ≤ 10%, I.S.] at 3 months of therapy with generic dasatinib versus generic imatinib in newly diagnosed CML-CP patients and to compare treatment-related adverse effects in the two groups. Methods: This randomized controlled study enrolled newly diagnosed CML-CP patients after obtaining institutional ethics committee approval & informed consent. Inclusion Criteria:Newly diagnosed patients with chronic phase CML.Age ≥ 12 years. Exclusion Criteria:Patients with de novo accelerated phase or blast phase CML.Pregnancy & lactation.Patients with pre-existing pleural effusion, grade ≥ 3 lung disease, or pulmonary arterial hypertension.Patients with angina, or grade ≥ 3 cardiac disease [as defined by the New York Heart Association (NYHA) criteria] at diagnosis.Patients with prolonged QTc interval (> 480 msec) at baseline. The EUTOS long-term survival (ELTS) risk score was calculated at diagnosis. Patients were randomized to one of the two following treatment groups: Group A: Dasatinib 100 mg p.o. once daily (60 mg/m2/day for age <18 years). Group B: Imatinib 400 mg p.o. once daily (340 mg/m2/day for age < 18 years). Follow up & monitoring of patients was done every 2 weekly till completion of 3 months of TKI therapy, followed by assessment of hematological response & molecular response as per standard criteria. Results: A total of 61 consecutive CML patients were screened between June 2021 and March 2022, out of which 54 patients with confirmed diagnosis of CML-CP were enrolled in the study and were randomized to receive generic dasatinib or generic imatinib as first-line therapy and were followed up for 3 months for EMR and complete hematological response (CHR). Four patients were lost to follow up and data was analyzed for 50 patients for whom EMR results at 3 months was available. Out of these 50 patients, 24 patients received dasatinib & 26 patients received imatinib. The median age of patients was 33 years (range 18-64 years), with male: female ratio of 1.3: 1. Achievement of CHR was documented in 96% of patients in both dasatinib & imatinib treatment arms. EMR at 3 months was achieved in overall 72% patients in study [19/24 patients (79%) in dasatinib arm & 17/26 patients (65%) in imatinib arm]. However, the difference was not statistically significant (p = 0.27). Notably, EMR rates in ELTS intermediate-risk group was 86% in dasatinib arm versus 42% in imatinib arm, and EMR rates in ELTS high-risk group was 82% in dasatinib arm versus 57% in imatinib arm (p = 0.33). The incidence of grade 3-4 adverse events was not significantly different in the two treatment groups. The patient characteristics & treatment results are summarized in Table 1 & Figure 1. Conclusion: The results of the present study suggested that generic formulations of dasatinib were well-tolerated and were associated with improved early molecular response rates compared to generic imatinib in CML-CP patients in India. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Yiqi Fumai Injection as an Adjuvant Therapy in Treating Chronic Heart Failure: A Meta-Analysis of 33 Randomized Controlled Trials.

Background Yiqi Fumai injection (YQFM) is a traditional Chinese medicine widely used for cardiovascular diseases in China. This systematic review aimed to evaluate whether YQFM could be an effective and safe complementary therapy for chronic heart failure (CHF). Methods Eight electronic literature databases were searched up to March 31, 2020. Randomized controlled trials (RCTs) comparing YQFM + conventional treatment with conventional treatment alone for CHF were included. The primary outcome was response to treatment, which was graded by improvements in heart function based on the New York Heart Association (NYHA) criteria, while the secondary outcomes included the left ventricular ejection fraction (LVEF), cardiac output, left ventricular end-systolic diameter (LVESD), amino-terminal pro-brain natriuretic peptide (NT-proBNP), 6-minute walk test performance (6MWT), quality of life (QoL) as assessed by the Minnesota Living with Heart Failure questionnaire, and adverse reactions. Data from individual RCTs were pooled by a random-effects meta-analysis with effect measures of proportional odds ratios (pORs) and 95% confidence intervals (95% CIs) for the ordinal outcomes and the mean difference (MD) and 95% CI for the continuous outcomes. Results In total, 33 RCTs involving 3070 patients with an overall moderate-to-high risk of bias were selected. The meta-analysis showed that compared with conventional treatment alone, YQFM plus conventional treatment had a significantly higher likelihood of improving the response to treatment (pOR 1.88, 95% CI 1.47 to 2.42, I2 = 0%). YQFM also significantly improved the LVEF (MD 5.53%, 95% CI 4.73 to 6.33, I2 = 82%), cardiac output (MD 0.32 L/min, 95% CI 0.19 to 0.45, I2 = 47%), and LVESD (MD −3.73 mm, 95% CI −5.51 to −1.95, I2 = 22%), reduced the NT-proBNP levels (MD −341.83 pg/mL, 95% CI −417.89 to −265.77, I2 = 88%), and improved the 6MWT (MD 61.86 m, 95% CI 45.05 to 78.67, I2 = 64%) and QoL (MD −9.82, 95% CI −14.17 to −5.46, I2 = 81%). No serious adverse events related to YQFM were reported. Conclusion Although limited by a moderate-to-high risk of bias, the current evidence suggests that YQFM as a complementary treatment significantly improves heart function and related indicators in patients with CHF. The clinical use of YQFM needs careful safety monitoring. Well-designed studies are still required to further evaluate the efficacy and safety of YQFM for CHF.

Laparoscopic Sleeve Gastrectomy in Patients with Left Ventricular Assist Device-Case Series and Review of Literature.

For patients with advanced heart failure, left ventricular assist device (LVAD) can serve as a bridge to heart transplantation. Patients with class II obesity are eligible for implantation of LVAD but do not meet criteria for cardiac transplant listing. Laparoscopic sleeve gastrectomy (LSG) is proposed as weight losing modality in order to reach the New York Heart Association (NYHA) criteria for listing. In our center, three patients on LVAD with need for weight-reducing therapy were treated with laparoscopic sleeve gastrectomy. We reviewed our data retrospectively and compared it with the literature. Successful weight loss was achieved in all patients, without postoperative adverse events. Two out of three were listed on transplant waiting list. Our results are similar to those described in other series.

Interleukin-10 and non-classical monocytes as biomarkers of ischemic cardiomyopathy

Background. Chronic heart failure frequently occurs against the background of ischemic heart disease (IHD), and has also been associated with the diagnosis of ischemic cardiomyopathy (ICMP). While there are significant commonalities with respect to underlying mechanisms, it would be most important to identify differential diagnostic markers to facilitate diagnosis and verification at the early stages of disease.Aim. The intent of this study was to perform a quantitative assessment of non-classical monocytes in patients diagnosed with IHD with or without ICMP and to identify any relationships between non-classical monocytes and plasma concentrations of proinflammatory (interleukin (IL)-1β, IL-6, tumour necrosis factor (TNF)-α) and anti-inflammatory (IL-4, IL-10, IL-13) cytokines.Methods. We examined 44 patients diagnosed with IHD, aged 49 - 63 years, with class II-III heart failure as per the New York Heart Association criteria. Of this group, 18 were also diagnosed with ICMP. The comparison group included 14 age-matched healthy controls. Percentages of non-classical (CD14+CD16+) monocytes in peripheral blood were determined by flow cytometry and the concentrations of IL-1β, IL-4, IL-6, IL-10, IL-13 and TNF-α were measured by enzyme-linked immunosorbent assay.Results. Amongst the patients diagnosed with ICMP, the concentration of IL-10 in blood plasma was higher than in those without this diagnosis, detected at 30.05 pg/ml (range 24.75 - 33.50 pg/ml, р=0.0412); the percentage of non-classical monocytes was lower, at 5.05% (range 4.08 - 6.58%, р=0.0094). Amongst patients diagnosed with IHD without ICMP, these parameters were within normal limits. The plasma concentrations of IL-1β, IL-6 and IL-13 in both groups were comparable to values obtained from healthy donors and IL-4 was undetectable throughout. Amongst patients diagnosed with ICMP, plasma TNF-α was detected at elevated levels that were comparable to those determined for patients diagnosed with IHD without ICMP.Conclusion. Imbalance of cytokines in blood in patients with coronary artery disease is characterized by excess TNF-α, absence of IL-4, and normal levels of IL-1β, IL-6 and IL-13, regardless of the type of ischemic myocardial injury. In patients with ICMP, we detected an overall decrease in the fraction of non-classical monocytes in association with an increase in plasma IL-10; these features were not detected in patients diagnosed with IHD without ICMP. As such, these biological responses may be used for timely diagnosis of ICMP. Received 27 May 2019. Revised 7 October 2019. Accepted 30 October 2019. Funding: The work is supported by grants of the Russian Foundation for Basic Research No. 18-015-00160\19 and the President of the Russian Federation No. НШ-2690.2018.7 and No. МД-2788.2019.7. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and study design: V.M. Shipulin, S.P. ChumakovaData collection and analysis: V.M. Shipulin, S.P. Chumakova, O.I. Urazova, M.V. Vins, V.V. NovickiyLiterature review: S.P. Chumakova, D.A. Pogonchenkova, A.S. PryakhinDrafting the article: S.P. Chumakova, D.A. Pogonchenkova, O.I. UrazovaCritical revision of the article: V.M. Shipulin, V.V. NovickiyStatistical analysis: S.P. ChumakovaFinal approval of the version to be published: V.M. Shipulin, S.P. Chumakova, D.A. Pogonchenkova, O.I. Urazova, M.V. Vins, A.S. Pryakhin, V.V. Novickiy

P1766Clinical impact of atrial fibrillation and heart failure in a cohort of patients with hypertrophic cardiomyopathy

Abstract Background Atrial fibrillation (AF) and heart failure (HF) are common complications in Hypertrophic Cardiomyopathy (HCM) patients, leading to a worsening of their quality of life, need of hospitalization and prognosis. Purpose To analyze clinical variables associated with the presence of AF and HF in HCM patients. Methods HCM patients followed-up in cardiological visits from 2005 to 2017 were included and a descriptive analysis of those with AF and HF was performed. Results Out of 168 patients, 28% had reported AF. They were older than those without arrhythmia (68±15 years (yrs) vs 56±20 yrs, p&lt;0.001) and had more comorbidities such as diabetes (27.7% vs 12.4%, p=0.02) and chronic renal disease (21.3% vs 6.6%, p=0.006). Echocardiographic findings are summarized in Table 1. In our cohort, 27.4% of the patients had HF with a functional class according to the New York Heart Association criteria ≥2. They were older than those without HF (69.3±11.6 yrs vs 55.9±20.6 yrs, p&lt;0.001) and had higher rate of cardiovascular (CV) risk factors such as hypertension (65.2% vs 44.3%, p=0.015). The presence of HF was directly associated with the presence of AF: 52.2% of the patients with HF and 18.9% of the patients without HF developed this arrhythmia (p&lt;0.001). HF patients associated larger left atrial diameter (48±8.1 vs 41.6±7.2mm, p&lt;0.001), myocardial thickness (21.7±3.9 vs 19.2±5.8mm, p=0.002) and higher left ventricular outflow obstruction (LVOO) (55±32 vs 34.3±31.3mmHg, p=0.021), without any differences in the left ventricular ejection fraction. HF patients had a worse prognosis (Picture 1). Multivariate analysis showed that the presence of AF (OR 2.6, CI 95% 1.1–6.3) and LVOO (OR 4.8, CI 95% 1.5–14.8) were independent risk factors of developing HF. Table 1. Echocardiographic findings AF (n=47) Non AF (n=121) p LVOO 27.7 19 0.22 Aortic regurgitation 12.8 3.3 0.02 Mitral regurgitation 27.7 12.4 0.02 Left atrial diameter (mm) 48.8±7.2 40.7±7 &lt;0.001 Myocardial thickness (mm) 20±5.4 19±5.2 0.02 Qualitative variables are expressed as percentages (%) and quantitative variables as mean and standard deviation (M ± SD). Picture 1. Main outcomes of HF patients Conclusions AF and HF were directly associated in our cohort, especially in elderly patients with higher comorbidities, leading to a worse prognosis with a higher hospitalization rate and CV death. This emphasizes the importance of a thorough search of both complications in order to initiate early treatment and improve the prognosis of HCM patients.

Cardiac Resynchronization Therapy: the Structural Response Is not Always Necessary

Up to 30-40% of patients undergoing cardiac resynchronization therapy (CRT) are described as nonresponders since the initial studies. This paradigm has inspired several modifications of the devices, electrodes and surgical technique in the implant. The definition of CRT response should be rethought, standardized, and ratings based on structural and/or clinical response should be proposed. The authors discuss a series of cases in which sustained clinical improvement was achieved despite structural worsening. Objective: To assess the profi le of clinical responders to CRT who have worsened structurally. Method: It is a retrospective cohort of patients in outpatient follow-up from January 2012 to March 2017. We included 13 patients (2.7%) out of a total of 476 submitted to CRT. Inclusion criteria were to present an improvement in functional class according to the New York Heart Association criteria (FC-NYHA) ≥ 1 sustained for at least one year and absence of improvement or worsening of the structural parameters evaluated by transthoracic echocardiogram [ejection fraction (EF), diastolic diameter (LVDD) and systolic diameter (LVSD)]. The variables analyzed were age, gender, FC-NYHA, cardiopathy, echocardiographic and electrocardiographic parameters, medications in use, location of implanted electrodes, device programming, cardiary defibrillator therapies, and mortality. Statistical analysis was performed using non-parametric Wilcoxon and McNemar tests. Results: There were 13 patients, 92% male, mean age 60.9 ± 9.2 years and mean follow-up of 3.3 ± 1.1 years, 76% of CRT associated with implantable cardioverter defibrillator (CRT-D). In pre-implantation, 84.6% were in FC-NYHA III and then 61.5% were in FC-NYHA I (p = 0.001). The mean pre-implantation EF was 31.3 ± 7.6% and 26.6 ± 7.3 (p = 0.002) in the last evaluation. The predominant heart disease was non-ischemic in 92.5%, most of which were chagasic cardiomyopathy (CCM) (66%). In the TRC-D group, no shock therapy was recorded in the period; there was one death in a patient with ischemic cardiomyopathy (IC) for the septic shock of pulmonary focus after 2.2 years of follow-up. The mean QRS was 189.9 ± 23.1 ms to 157.9 ± 35.2 after CRT (p = 0.032). There was no signifi cant change in pre-and postimplant medications during follow-up. Conclusion: The absence of structural improvement should not be considered therapeutic failure, since CRT seeks to modify the electrical activation, and may be related to better performance and decrease of symptoms, even in evolutionary heart diseases.

Terapia de Ressincronização Cardíaca: a Resposta Estrutural não se Faz Sempre Necessária

Até 30-40% dos pacientes submetidos à terapia de ressincronização cardíaca (TRC) são descritos como não respondedores desde os trabalhos iniciais. Esse paradigma tem inspirado diversas modificações dos dispositivos, eletrodos e técnica cirúrgica no implante. A definição de resposta à TRC deverá ser repensada, padronizada, e classificações pautadas na resposta estrutural e/ou clínica devem ser propostas. Os autores discutem uma série de casos em que se obteve melhora clínica sustentada a despeito da piora estrutural. Objetivo: Avaliar o perfi l dos pacientes respondedores clínicos à TRC que pioraram estruturalmente. Método: Trata-se de coorte retrospectiva de pacientes em seguimento ambulatorial de janeiro de 2012 a março de 2017. Foram incluídos 13 pacientes (2,7%) de um total de 476 submetidos à TRC. Os critérios de inclusão foram apresentar melhora da classe funcional pelos critérios da New York Heart Association (CF-NYHA) ≥ 1 sustentada por pelo menos um ano e ausência de melhora ou com piora dos parâmetros estruturais avaliados pelo ecocardiograma transtorácico [fração de ejeção (FE), diâmetro diastólico (DDVE) e diâmetro sistólico (DSVE)]. As variáveis analisadas foram idade, gênero, CF-NYHA, cardiopatia, parâmetros ecocardiográficos e eletrocardiográficos, medicações em uso, localização do implante dos eletrodos, programação do dispositivo, terapias do cardiodesfibrilador e mortalidade. A análise estatística foi realizada por meio dos testes não paramétricos de Wilcoxon e McNemar. Resultado: Foram 13 pacientes, sendo 92% do sexo masculino, idade média de 60,9 ± 9,2 anos e seguimento médio de 3,3 ± 1,1 anos, 76% de TRC associada a cardiodesfibrilador implantável (TRC-D). No pré-implante, 84,6% encontravam-se em CF-NYHA III e, em seguida, 61,5% estavam em CF-NYHA I (p = 0,001). A FE média pré-implante foi de 31,3 ± 7,6% e 26,6 ± 7,3 (p = 0,002) na última avaliação. A cardiopatia predominante foi a não isquêmica em 92,5%, sendo a maioria cardiomiopatia chagásica (CMC) (66%). No grupo TRC-D, não foi registrada terapia de choque no período; houve um óbito em um paciente com cardiomiopatia isquêmica (CMI) por choque séptico de foco pulmonar após 2,2 anos de seguimento. O QRS médio foi de 189,9 ± 23,1 ms para 157,9 ± 35,2 após TRC (p = 0,032). Não houve mudança significativa nas medicações administradas pré- e pós-implante durante o seguimento. Conclusão: A ausência de melhora estrutural não deve ser considerada falha terapêutica, pois a TRC procura modificar a ativação elétrica, podendo estar relacionada a melhor desempenho e diminuição dos sintomas, mesmo em cardiopatias evolutivas.

Modifiable predictors of severe heart failure in Morocco: a descriptive study using routinely collected health data.

IntroductionHeart Failure (HF) is a growing public health concern in Morocco and there is a striking paucity on determinants of severe HF (SHF) in this population. The aim of this study was to identify patients admitted with HF at Ibn Rochd Hospital, Casablanca from 2011 onwards, when electronic record keeping began.MethodsA total of 105 patients underwent a series of cardiological examinations between July 2011 and January 2014. The New York Heart Association (NYHA) criteria was used to evaluate the severity of HF. Patients with NYHA classification gradings of I and II were defined as having moderate HF (MHF) and those graded as III and IV were defined as having a SHF. Univariable and multivariable risk factors associated with SHF were explored using logistic regression. The results were reported following the RECORD (Reporting of studies Conducted using Observational Routinely-collected Data) statement.ResultsA total of 24 (33%) patients were identified as having a SHF. Four predictors of SHF were identified in univariate analysis: haemoglobin <12g/dL, neutrophil-to-lymphocyte ratio (NLR) >3, mean corpuscular haemoglobin concentration (MCHC) <32 picolitre, and high density lipoprotein (HDL) <0.35 (mmol/L). Only NLR>3 and HDL <0.35 mmol/L remained independent predictors in multivariable analysis. Patients with NLR >3 were at 6-fold increased odds of SHF [adjusted odds ratio (AOR): 6.78, 95% confidence interval (CI): 1.40-32.80, p=0.017], and those with HDL<0.35 (mmol/L) were at 10-fold increased odds of SHF [AOR: 10.11, 95% CI: 2.26-45.27, p=0.002].ConclusionThe independent biomarkers of SHF identified in this study provide valuable information to ward clinicians in resource-constrained facilities to identify patients vulnerable to developing severe heart complications.

Study of glucocorticoid therapy efficiency in patients with chronic myocarditis

One of the most urgent issues of non-coronary heart disease remains the expediency of prescribing immunosuppressive therapy with glucocorticoids (GC) in patients with chronic myocarditis. The purpose of the study was to perform a comparative analysis of the structural and functional heart state in patients with chronic myocarditis who received or did not receive glucocorticoid therapy. The study included 58 patients with chronic myocarditis with reduced left ventricular ejection fraction (LV) and presence of II or higher functional class of heart failure according to New York Heart Association criteria, which were divided into 2 groups: the 1st group consisted of 30 patients who, in addition to standard heart failure therapy, were treated with methylprednisolone 0.5 mg/kg for 4 months with a gradual subsequent dose reduction, and the 2nd group included 28 patients who did not receive immunosuppressive therapy. All patients underwent for a 6-minute walk test, echocardiography with speckle-tracking and cardiac magnetic resonance imaging (CMR). The examination was carried out before the appointment of the GC and after 6 months of treatment. For statistical processing of the results, the software Exсel XP (Missrosoft Office, USA) and statistical program Statistica for Windows 6.0 (Statsoft, USA) were used. Prior to treatment, both groups were comparable to the results of a 6-minute walk test and all echocardiographic parameters, inflammatory and fibrotic changes in the myocardium were detected with approximately same frequency. After 6 months of GC therapy, it was found that the end-diastolic volume index in the 1st group was 17.5% (P &lt;0.05) less and value LV ejection fraction was 13.5% (P &lt;0.05) higher in comparison with the 2nd group, in addition the value of global longitudinal systolic strain was also 27.5% (P &lt;0.01) higher in the 1st group. The frequency of active inflammatory changes detection on CMR - myocardial edema and hyperemia in the 1st group after 6 months was 16.6% and 20.0% respectively, that presented as almost twice lower than in the 1st group; fibrotic changes in the myocardium in 1st group were observed in 66.6% of cases, which was 1.7 times more frequent than in the 2nd group. Significant influence of the appointment of immunosuppressive therapy on the absence of inflammatory changes in the myocardium was confirmed by correlation analysis: the use of GC was associated with the absence of edema and myocardial hyperemia after 6 months of treatment - (r = -0,82; P &lt;0,01) and (r = -0.76; P &lt;0.01) respectively. In patients with chronic myocarditis receiving immunosuppressive therapy, inflammatory changes in the myocardium (edema and hyperemia) were found to be much less common, the end diastolic volume index was significantly lower, LV ejection fraction and parameters of longitudinal global systolic strain were higher in comparison with patients who did not receive GC treatment.

Features of coagulation hemostasis and anticoagulation system in patients with chronic heart failure due to ischemic heart disease

Aim. To study the features of coagulant and anticoagulant systems in patients with varoious functional classes of congestive heart failure secondary to coronary heart disease (according to New York Heart Association criteria) and to determine the most informative method for diagnosing the hemostasis disorders.&#x0D; Methods. 82 patients with congestive heart failure, who had previously survived myocardial infarction with Q-wave formation, and left ventricle ejection fraction (by Simpson) less than 50%, were included. Average age was 54.0 [50.0-64.0] years. Control group of 30 healthy people was formed. All patients were allocated to two groups. 1st group included patients with I-II functional class of congestive heart failure (n=57), 2nd group - patients with III-IV functional class of congestive heart failure (n=25). Activated partial thromboplastin time, prothrombin and fibrinogen levels, international normalized ratio, heparin cofactor activity of antithrombin, D-dimer level were measured in blood serum.&#x0D; Results. Only D-dimer level and heparin cofactor activity of antithrombin were changed in the main group compared to the controls. D-dimer level in patients of the general group was 0.2 [0.2-0.4] mg/L versus 0.2 [0.2-0.2] mg/L in control group (p=0.000064). There was no obvious deficit of heparin cofactor activity of antithrombin in patients with congestive heart failure, but the values were lower in the main group - 90.5 [82,7-100,4]% compared to the control group - 102 [90,0-104,0]% (p=0.0068). In subgroups, there were indicators (prothrombin, international normalized ratio, D-dimer) that changed according to the functional class. The lowest values of prothrombin were found in patients with III-IV functional class, the highest - in patients with I-II functional class. Indicators (prothrombin, INR, D-dimer) which changing with the growth of CHF FC were identified by separating the patients into subgroups. FC, the largest - in patients with FC I-II. Serum D-dimer level increased in accordance with congestive heart failure functional class (р1-2=0.0065).&#x0D; Conclusion. Congestive heart failure contributes to prothrombotic changes in hemostasis. The severity increases with increasing congestive heart failure functional class. D-dimer is the most sensitive marker of hemostasis activation at congestive heart failure. This parameter should be included in the routine hemostasis testing in patients with congestive heart failure.

Diastolic function and functional capacity after a single session of continuous positive airway pressure in patients with compensated heart failure

OBJECTIVE:The effects of acute continuous positive airway pressure therapy on left ventricular diastolic function and functional capacity in patients with compensated systolic heart failure remain unclear.METHODS:This randomized, double-blind, placebo-controlled clinical trial included 43 patients with heart failure and a left ventricular ejection fraction <0.50 who were in functional classes I-III according to the New York Heart Association criteria. Twenty-three patients were assigned to continuous positive airway pressure therapy (10 cmH2O), while 20 patients received placebo with null pressure for 30 minutes. All patients underwent a 6-minute walk test (6MWT) and Doppler echocardiography before and immediately after intervention. Clinicaltrials.gov: NCT01088854.RESULTS:The groups had similar clinical and echocardiographic baseline variables. Variation in the diastolic function index (e′) after intervention was associated with differences in the distance walked in both groups. However, in the continuous positive airway pressure group, this difference was greater (continuous positive airway pressure group: Δ6MWT = 9.44+16.05×Δe′, p = 0.002; sham group: Δ6MWT = 7.49+5.38×Δe′; p = 0.015). There was a statistically significant interaction between e′ index variation and continuous positive airway pressure for the improvement of functional capacity (p = 0.020).CONCLUSIONS:Continuous positive airway pressure does not acurately change the echocardiographic indexes of left ventricle systolic or diastolic function in patients with compensated systolic heart failure. However, 30-minute continuous positive airway pressure therapy appears to have an effect on left ventricular diastolic function by increasing functional capacity.

Adiponectin in coronary heart disease and newly diagnosed impaired glucose tolerance

Adiponectin is produced by adipose tissue and regarded as protective hormone for diabetes and coronary heart disease (CHD). Its role in heart failure is discussed controversially. In this study, 1015 consecutive patients admitted for acute (n = 149) or elective (n = 866) coronary angiography were enrolled. Patients with known diabetes mellitus (DM) were excluded. All patients were classified by oral glucose tolerance test (oGTT) according to World Health Organization (WHO) criteria and by the results of coronary angiography as no/minor coronary heart disease (CHD), single-vessel disease (1-VD), double-vessel disease (2-VD) or triple-vessel disease (3-VD), by New York Heart Association (NYHA) criteria and by echocardiography for heart failure. Adiponectin and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were measured in all patients. Adiponectin was higher in patients with normal glucose tolerance (NGT) (13.65 ± 10.31 mg/l) compared to impaired glucose tolerance (IGT) (11.12 ± 7.5, p < 0.001) or diabetes (11.22 ± 7.63, p < 0.001). There was a stepwise decrease in adiponectin from no CHD (18.16 ± 12.49 mg/L) to minor CHD (16.01 ± 11.42) to 1-VD (12.18 ± 8.8, p < 0.001 to no/minor CHD) to 2- and 3-VD (10.68 ± 7.5, p < 0.001 to no/minor CHD, p = 0.004 to 1-VD). Patients with heart failure NYHA III (17.4 ± 10.27) had higher adiponectin levels compared to NYHA II (12.94 ± 9.41, p < 0.001 to NYHA III) and NYHA I (10.3 ± 7.75, p < 0.001 to NYHA III/II). In this line, adiponectin levels were positively correlated to NT-proBNP levels (r = 0.303), and patients with ejection fraction (EF) < 50% had higher adiponectin levels than those with EF > 50% (14.96 ± 4.35 to 11.78 ± 3.71, p = 0.006). Adiponectin levels are inversely correlated to progressing CHD and glucose intolerance but positively correlated to increasing heart failure.

The diagnostic utility of brain natriuretic peptide in heart failure patients presenting with acute dyspnea: a meta-analysis

Heart failure with normal ejection fraction (HFNEF) accounts for approximately 50% of heart failure (HF) cases. To establish the utility of brain natriuretic peptide (BNP) in differentiating HF-related severe dyspnea from non-HF-related acute dyspnea, we used an estimation formula (eF) that was obtained from a series of three meta-regressions. We selected 60 out of 2721 case-control and follow-up studies that were published from 1998 to 2010. The heart failure levels (HFLs) were assessed using the New York Heart Association (NYHA) criteria. Random-effects meta-regression analyses of the natural logarithm (ln) of the BNP odds ratio (OR) were performed on the HFLs. The ln of the median BNP values (lnmBNP) was meta-regressed over the laboratory method (LM). A third meta-regression was performed on the HFLs to account for only the lnmBNP in the homogeneous LM subgroups. To determine the eF, the data from the diseased and control subjects were combined. The Bland-Altman method was used to detect eF bias. The overall BNP(OR) in the subgroup with severe HF was 35. The lnmBNP analysis showed that LM was a significant heterogeneity factor in the meta-regression (slope -0.38; CI -0.59 to -0.16). The meta-regression of lnmBNP on the HFL resulted in the following calculation for eF: estimated HFL (eHFL)=(lnmBNP-3.157)/0.886. The Bland-Altman test revealed no significant difference (0.0997; 95% CI -2.84 to 3.06) between HFL and eHFL. The severe eHFL showed a 78% accuracy. Based on the eF obtained from this meta-analysis, the BNP outcomes were shown to reliably diagnose severe dyspnea in HF and differentiate this condition from non-HF acute dyspnea.

Carvedilol Improves Uptake-1 in Patients With Systolic Congestive Heart Failure

The sympathetic nervous system (SNS) of the whole body, including cardiac sympathetic nerves, is activated in patients with severe congestive systolic heart failure (CHF). Carvedilol can improve clinical status in such patients. This study aimed to determine how carvedilol acts on the SNS to improve CHF. Ten subjects (New York Heart Association criteria III) were treated using carvedilol at 2.5 mg/d for 1 week. Before and after treatment, subjects walked on a treadmill for 6 minutes, and plasma concentrations of carvedilol, norepinephrine, and 3,4-dihydroxyphenyl glycol were measured. After treatment, norepinephrine was decreased at rest (3.2 ± 0.3 pmole/mL to 2.1 ± 0.4 pmole/mL, P < 0.05), while standing (5.4 ± 1.2 to 3.3 ± 0.7 pmole/mL, P < 0.01) and during exercise (6.5 ± 1.3 pmole/mL to 5.1 ± 1.1 pmole/mL, P < 0.05). Regression lines for percentage changes in norepinephrine and 3,4-dihydroxyphenyl glycol were compared before and after treatment, showing steeper slopes after treatment (P < 0.05). Plasma carvedilol concentrations (1.8 ± 0.3 ng/mL) did not reach β-adrenoceptor-blocking levels of effect. Carvedilol is considered to improve function of uptake-1 for the whole-body SNS, including the cardiac SNS, and does not seem to block adrenoceptors at such low doses in CHF patients. However, both effects seem to work at high doses in clinical settings.

Intraperitoneal Pressure and Intra-Abdominal Pressure: Are they the Same?

In peritoneal dialysis (PD), a standard therapy for patients with end-stage renal disease (ESRD), the effects of using the peritoneum as an exchange membrane and of dialysate dwelling within the peritoneal cavity creates some mechanical changes, including an increase in intraperitoneal pressure (IPP) that might lead to intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). The diagnosis of IAH and ACS depend on intra-abdominal measurement of IAP by an indirect technique. There is no clear distinction between IPP and intra-abdominal pressure (IAP). Our objective in this study was to find if there is real difference between IPP and IAP. This study was conducted at the PD unit of King Fahd Hospital of the University, Al-Khobar, between July 2008 and January 2009. To be included, patients had to have known ESRD for at least 5 years, to be 18 years of age or older at enrollment, with stable body weight and blood pressure, and with no clinical signs of overhydration. Patients with congestive heart failure III and IV (New York Heart Association criteria) and severe pulmonary disease, psychiatric illnesses, neurogenic bladder, known history of peritonitis, or medical or surgical abdominal intervention in the preceding 3 months were excluded. We measured IAP by the direct technique through the peritoneal catheter and by an indirect technique using an intravesical catheter. The 25 patients who met the inclusion criteria included 13 men and 12 women, with a mean age of 53 ± 2 years (range: 18 - 76 years). The predominant causes of ESRD were diabetes mellitus and glomerulonephritis. Mean IPP in the dry state (supine) was 9.49 ± 5 mmHg, and mean IAP was 9.4 ± 5.4 mmHg (p = 0.9). In the dry state (erect), the mean IPP increased to 16.9 ± 7.2 mmHg, and the mean IAP, to 16.4 ± 6.9 mmHg (p = 0.8). In the filled state (supine), mean IPP was 12.6 ± 4.7 mmHg, and mean IAP, 12.8 ± 4.8 mmHg (p = 0.88); the erect pressures were 21.4 ± 7 mmHg and 21.6 ± 6.9 mmHg respectively (p = 0.9). Our findings indicate that there is no statistical difference between IPP and IAP in either the erect or the supine position.

Psychological distress in Nigerian patients with heart failure

Summary Background Heart failure is commonly associated with psychological symptoms. These symptoms are often neglected, underdiagnosed or inadequately treated and therefore impact negatively on the recovery of and quality of life of these patients. This study aimed at determining the frequency of psychological distress (anxiety and/or depression) and its correlates in Nigerian patients with heart failure. Methods The subjects comprised one hundred (100) confirmed heart failure patients in steady state. They were recruited consecutively from the cardiology outpatient clinics of two tertiary hospitals in Nigeria. A self administered questionnaire was used to collect sociodemographic and clinical data. Psychological distress was assessed using a psychometric questionnaire – the Hospital Anxiety and Depression Scale (HADS) and the severity of heart failure was assessed according to the New York Heart Association criteria (NYHA). Results Anxiety was found in 16% of the patients, depression in 13% and 39% had anxiety co-morbidly presenting with depression. Psychological distress was more common in younger patients (less than 50years) ( p p >0.05). Conclusion Anxiety and depression have been found to be common in heart failure patients in Nigeria and affects more of the younger patients. More attention should be focused on psychological co-morbidity in heart failure in order to improve clinical outcome.

Recognition and Treatment of Depression and Anxiety Symptoms in Heart Failure

The aim of this prospective study was to examine the prevalence, recognition, and treatment of depression and anxiety in ambulatory patients with heart failure. A total of 158 heart failure participants were enrolled between November 2006 and April 2007. Each patient completed a telephone screening interview that included an assessment of heart-failure severity (New York Heart Assciation criteria) as well as measures for depression (Geriatric Depression Scale [GDS]) and anxiety (Geriatric Anxiety Inventory [GAI]). Following study recruitment, each patient's electronic medical record was comprehensively reviewed for the 12 months prestudy and 6 months poststudy assessments to determine whether patients had been recognized as having and/or treated for depression or anxiety. Prevalence of depression (GDS score ≥ 6) was 41.8%, and prevalence of anxiety (GAI score ≥ 9) was 25.3%. Of patients with a positive GDS or GAI result, 57.5% had a diagnosis or medical-record notation for depression and/or anxiety, and 60.3% received mental health treatment during the 18-month period of the EMR review. Of patients with a documented diagnosis of depression or anxiety, 92.3% received mental health treatment. Results showed that higher GDS scores were associated with recognition of depression/anxiety in the medical record, and a positive primary care depression screening predicted documented mental health treatment. These data suggest that symptomatic depression and anxiety are underrecognized in heart failure patients and that mental health screening may be important for receipt of care. Notably, once depression and/or anxiety was documented in the medical record, patients were highly likely to receive mental health treatment.

Soluble Tumor Necrosis Factor Receptor Type I and Granulysin as Immunological Markers in Congestive Heart Failure

Previous studies have shown that circulating levels of cytokines are increased in patients with congestive heart failure (CHF), resulting in myocardial depression. In this work, we have determined serum levels of TNF-α and IFN-γ by ELISA, detected sTNFR-I by dot ELISA, as well as TNFα, IL-6, IL-10 and granulysin mRNA in unstimulated peripheral blood mononuclear cells (PBMC) by RT-PCR in CHF patients. Such patients were classified using New York Heart Association criteria and compared to a control group of volunteers without CHF. The performed echocardiographic evaluations showed a significant difference between the control group and the patients. Additionally, the ejection fraction and the left ventricular fractional shortening showed a direct relation with functional classes, varying in inverse proportion. Generally, the studied cytokines in serum or PBMC did not correlate either to functional classes or to the presence/absence of CHF. However, the granulysin mRNA was detected in most of the patients tested as compared to controls. Moreover, the qualitative detection of the sTNFR-I also made it possible to discriminate between patients and the control group. Functional classes could be separated because of a direct association between CHF severity and elevated levels of sTNFR-I, defined by intensity of signal in dot-ELISA. Our results suggest that detection of granulysin mRNA as well as the detection of sTNFR-I appear to have a clinical relevance as markers of immune activation in CHF.

The medium-to-long-term outcome of Papua New Guinean children after cardiac surgery.

This study reports the medium-to-long-term outcome in Papua New Guinean (PNG) children selected to undergo cardiac surgery at the Royal Alexandra Hospital for Children in Sydney, Australia between 1978 and 1994. Follow-up ranged from 4 to 20 (median 11) years. The cohort comprised 125 children who had surgery and 31 who were initially selected in PNG for surgery but who on further investigation were found to be unsuitable. Through strenuous attempts, local health workers, the media and village and church leaders traced 122 (98%) of the operated and 29 (94%) of the non-operated children. One of the operated children and six of the non-operated children had died, giving respective survival rates among those traced of 99% and 79%. Altogether, 106 (88%) of the 121 operated and 20 (87%) of the 23 non-operated survivors were reviewed. Ninety-nine (93%) of the surgical patients were asymptomatic and all fulfilled the New York Heart Association criteria (NYHAC) class I or II. Mild pulmonary hypertension or residual defects of no haemodynamic significance were present in 47 (44%). In contrast, all 11 survivors from the 18 children originally classified as having inoperable lesions were symptomatic, all in NYHAC classes III or IV, six were on cardiac medication and four had been admitted at least once in the previous year. Ninety-two of 96 (96%) of the surgical group had a normal exercise test and 75 of 96 (78%) had normal chest X-rays. Thirty-nine of 99 had a normal electrocardiogram whilst the remainder had changes related to the underlying lesion and the surgery performed. This study shows that the PNG children who had cardiac surgery at RAHC between 1978 and 1994 had good medium-to-long-term survival.