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The purpose of this study is to compare clinical assessment of congestion performed by a nurse to that performed by cardiologist and correlate them with NT-ProBNP levels. The nurses' role in heart failure has been strongly focused in therapeutic, educational and self-care interventions. The diagnostic performance of nurses in heart failure outpatients is not well explored. N-terminal pro-B-type natriuretic peptide is a cardiac marker that reflects elevated filling pressures. Cross-sectional contemporaneous study. Heart failure outpatients underwent a systematic clinical assessment of clinical congestion score performed by cardiologist and nurse during the same visit. Assessments were performed independently and N-terminal pro-B-type natriuretic peptide levels obtained. The nurses' ability to classify patients in hemodynamic profile was compared to the cardiologist's. Eighty-nine assessments were performed in 63 patients with heart failure. The correlation of clinical congestion scores obtained by nurse with those obtained by cardiologist was r = 0·86; p < 0·001. The correlation of clinical congestion scores from nurse and cardiologist with levels of N-terminal pro-B-type natriuretic peptide were as follows: r = 0·45; p < 0·0001 and r = 0·51, respectively, p < 0·0001. Patients with clinical congestion score ≥3 had levels of NT-ProBNP significantly higher than those with clinical congestion score <3, in the assessment performed by the cardiologist (1866 SD 1151 vs. 757 SD 988 pg/ml; p < 0·0001) and by the nurse (1720 SD 1228 vs. 821 SD 914 pg/ml; p < 0·0001). The nurse and cardiologist had similar capacity in classifying patients in congested quadrants ( p = 0·027) or in dry quadrants ( p = 0·03), according to the levels of N-terminal pro-B-type natriuretic peptide. Area under the receiver-operating characteristic curve of the nurse and cardiologist to detect congestion was, respectively, 0·77 and 0·72. Our data suggests that nurses trained in heart failure may have a similar performance to that of the cardiologist for the clinical detection of congestion and assessment of the hemodynamic profile in patients with chronic heart failure. Considering that consistent clinical assessment can identify congested or hypovolemic patients with reasonable reliability, as well as patients with low or normal cardiac output, our results may help confirm nurses' capability in performing reliable clinical assessment in heart failure patients. While nurses' led heart failure programmes are usually focused on the management of patients, nurses' ability to perform accurate assessment would expand nurses' role in these programmes. As many institutions now focus on home visits by heart failure nurses, accurate assessment would benefit patients and improve their clinical outcomes. [ABSTRACT FROM AUTHOR]

Non-ischemic dilated cardiomyopathies (DCM) are important causes of heart transplant worldwide. Previous international data suggest that familial etiology for heart failure may be frequently overlooked among patients undergoing heart transplant. A structured screening instrument may help to identify patients who would benefit from genetic testing. Fifty-nine heart transplanted patients from a single transplant center in South of Brazil were reviewed between 2015-2019; those with hypertrophic cardiomyopathies or confirmed ischemic DCM were excluded. Patients with non-ischemic CMP answered a structured screening questionnaire (Kushner et al., 2006), and familial etiology was classified in confirmed, probable, possible familial or non-familial DCM. Thirty-four heart transplant recipients were included (53% male, 85% Caucacian, 50±14 years). Etiologic classification pre and post structured screening is depicted in Figures 1A and 1B. There was a difference in suspected familial etiology pre and post structured screening (15% versus 32%; p = 0.037). These findings suggest that familial DCM is frequently overlooked by the time of heart transplant. Our prevalence of familial DCM is similar to international reports. Applying a structured, low-cost, screening tool may contribute to counseling patients and their relatives regarding special attention to cardiovascular conditions and proper indication of genetic testing in a resource-limited scenario. [ABSTRACT FROM AUTHOR]

Introduction Exercise-induced left bundle branch block (LBBB) is rarely observed in exercise testing, and usually implies a worse prognosis. Cardiac resynchronization therapy (CRT) is well validated in patients with heart failure with reduced ejection fraction (HFrEF) and LBBB. Although the indications of CRT do not include exercise-induced LBBB, the functional impairment secondary to dynamic electromechanical dyssynchrony could potentially be improved with CRT. Case Report A 57-year-old woman with long-standing idiopathic dilated cardiomyopathy (ejection fraction of 23%) presented with clinical deterioration to NYHA functional class 4 and recurrent hospitalizations despite optimal medical treatment. During evaluation for cardiac transplant, new-onset of intermittent LBBB was observed on the cardiopulmonary exercise test (her resting QRS duration was 100ms). A stress echocardiography showed exertion-induced intraventricular and interventricular dyssynchrony. Cardiac resynchronization therapy was then indicated, and 97% resynchronization rate was obtained. There was clinical improvement to NYHA class 2 and no hospitalizations since the CRT initiation. Functional reassessment at 6 and 12 months post-implant demonstrated significant improvement in prognostic exercise parameters (Figure). She currently remains off the transplant list. Summary In HFrEF patients with no LBBB at rest, exercise test and stress echocardiography may uncover dynamic electromechanical dyssynchrony that may benefit from CRT. This is the first report of CRT for treatment of an advanced heart failure patient with worsening symptoms attributed to exercise-induced LBBB. [ABSTRACT FROM AUTHOR]