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Background Heart failure is increasing in prevalence and carries a very poor prognosis. Heart failure centers (HFC) with specialized management programs have been proposed to improve treatment adherence, improve functional capacity and reduce mortality. Objective To evaluate the effect of the HFC in Beit Shemesh on clinical outcome and heath service utilization. Methods Retrospective cohort study. Data was retrieved from Clalit Health Service records for all heart failure patients in Beit Shemesh area for 2013–2014. Patients treated in the HFC were compared with heart failure patients not treated by the center. Results The cohort included 429 patients, 82 (19%) were treated in the HFC. Basic patients’ characteristics were similar in both groups. Patients who were treated at the HFC visited their family physician more often than patients who did not visit the center (62.4 visits vs. 38.5 P Fig. 1 ). Adjustment for various confounders did not change the result. Conclusion Treatment in the heart failure center in addition to standard care was associated with a higher health service utilization rate but a much lower mortality rate.

Background the diagnosis of infected protheses in patients with long standing fever is difficult, challenging and has major impact on the management. Aim Since 18-Fluo Desoxyglucose positron emission tomography performed together with computerized tomography (FDG PET-CT) has a role in the diagnosis and localization of infection; we evaluated its value in the diagnosis of infected prostheses, correlating its results with medical workup, echo-cardiogram and dedicated CT. Patients: Fourteen patients (pts) with cardiovascular prostheses (seven with a pacemaker, four with vascular grafts, two with pulmonary stent and one with mitral valve prosthesis were hospitalized for prolonged fever. Methods All pts received antibiotics and underwent repeated medical workup. Eight of the 14 pts had a proven bacteriemia. Transthoracic and transoesophagial echocardiogram was performed as well as CT, for most of them. FDG PET-CT was performed in all of them, following injection of 370 MBq of F-18 FDG. All patients were normoglycemic at the time of injection. Results of the FDG PET-CT were compared with other diagnostic modalities and clinical follow up. Results In the 7 pts with pacemaker, FDG PET-CT was positive in 4, echo in 2/4. IN 3/4 the device was removed. A new pacemaker was implanted for two patients after few weeks. FEG PET-CT was negative in 3/7 pts with 1 positive, 1 negative and 1 intermediate results. All patients with vascular graft had positive FDG PET-CT scan and only one had a positive echocardiogram. This patient had a surgical proven abscess. Two pts with pulmonary stent had a positive FDG PET-CT scan and 1 positive echo. In this patient the stent extracted was infected. FDG PET-CT and echo was negative in the patient with mitral prosthesis.Conventional CT was positive in only 1 patient. Twelve pts return to normal including all the patients after prostheses extraction except one who died during graft replacement. Conclusion FDG PET -CT is a useful tool for the diagnosis of infected cardiovascular prosthesis and is more accurate than stand alone CT. Correlation of the clinical, echo and FDG PET CT findings is crucial for the therapeutic decision.

Background the association of severe aortic stenosis and mitral regurgitation (MR) is not rare in patients undergoing transcatheter aortic valve implantation (TAVI). The effect of TAVI on MR and its impact on outcome was evaluated. Methods All patients undergoing TAVI in our center were evaluated. Patients with paravalvular leak or residual stenosis after TAVI were excluded. Ninety out of 166 patients undergoing TAVI had follow-up data on post-procedural MR and constituted the patient population. Mitral regurgitation was graded on a 0-4 scale and divided into two categories for survival analysis, minimal (none/mild MR [grade 0-1/4]) and significant MR (moderate /severe MR [grade 2-4/4]). Patients were followed for a median of 427 days for death and development of heart failure (HF). Results Average age was 81±6; 49% were male and the average Euroscore was 22±15. Mitral regurgitation before TAVI was minimal in 52 pts (58%) and significant in 38 pts (42%). Post TAVI, MR was minimal in 56 pts (62%) and significant in 34 pts (38%). Sixteen pts (18%)developed worsening MR with an increase of at least one MR grade post TAVI, 25 pts (28%) has an improvement in the MR (MR grade was less) and 49 pts (54%) no change occurred in the MR. Development of significant MR post successful TAVI was a strong predictor of the development of HF (49±9% vs 70±6%, respectively, p=0.02) as well as the combined end point of death and HF (event free survival 46%±9% versus 64%±7%). Conclusions MR post TAVI without aortic regurgitation or residual stenosis is a commmon issue and predicts the developemnt of HF and death.

BackgroundAortic stenosis (AS) is increasing in incidence with the aging of the population. Transcatheter Aortic Valve Implantation (TAVI) provides a therapeutic option for patients with severe AS who are high risk surgical candidates A large proportion of patients undergoind TAVI have at least mild aortic paravalvular regurgitation (APR) following the procedure.ObjectiveThe purpose of this study was to determine the clinical and prognostic significance of paravalvular regurgitation early after TAVI.MethodsHundred and five patients who underwent TAVI at our center from 9.2008 to 5.2012 were studied retrospectively. Echocardiography before and following the procedure but prior to discharge were reviewed. Aortic and mitral regurgitations were assessed using semi quantitative methods.ResultsAmong 105 patients who underwent TAVI, twenty four (23%) had significant (moderate and more) APR and eighty one (77%) had non significant (less than moderate) APR. There was not significant difference in the baseline characteristics of the two groups (age, sex, left ventricular ejection fraction, aortic valve area, aortic ventricular gradient, ischemic heart disease, pre-procedural aortic regurgitation). Mean follow up was up to 19 months. The mortality rate was higher in the group with significant PAR as compared with the group without APR (29% versus 11% p