20 results on '"systolic"'
Search Results
2. Incidence, risk factors, natural history and outcomes of heart failure in patients with Graves' disease.
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Naser, Jwan A., Pislaru, Sorin, Stan, Marius N., and Lin, Grace
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ATRIAL fibrillation diagnosis ,LEFT heart ventricle ,HYPERTHYROIDISM ,ATRIAL fibrillation ,DISEASE incidence ,RETROSPECTIVE studies ,GRAVES' disease ,STROKE volume (Cardiac output) ,HEART physiology ,HEART failure ,DISEASE complications - Abstract
Objective: Graves' disease (GD) can both aggravate pre-existing cardiac disease and cause de novo heart failure (HF), but large-scale studies are lacking. We aimed to investigate the incidence, risk factors and outcomes of incident GD-related HF.Methods: Patients with GD (2009-2019) were retrospectively included. HF with reduced ejection fraction (HFrEF) was defined by left ventricular ejection fraction <50% and Framingham criteria, while HF with preserved ejection fraction (HFpEF) was defined according to the HFA-PEFF criteria. HF due to ischaemia, valve disorder or other structural heart disease was excluded. Proportional hazards regression was used to analyse risk factors and outcomes.Results: Of 1371 patients with GD, HF occurred in 74 (5.4%) patients (31 (2.3%) HFrEF; 43 (3.1%) HFpEF). In HFrEF, atrial fibrillation (AF) (HR 10.5 (3.0-37.3), p<0.001) and thyrotropin receptor antibody (TRAb) level (HR 1.05 (1.01-1.09) per unit, p=0.007) were independent risk factors. In HFpEF, the independent risk factors were chronic obstructive pulmonary disease (HR 7.2 (3.5-14.6), p<0.001), older age (HR 1.5 (1.2-2.0) per 10 years, p=0.001), overt hyperthyroidism (HR 6.4 (1.5-27.1), p=0.01), higher body mass index (BMI) (HR 1.07 (1.03-1.10) per unit, p=0.001) and hypertension (HR 3.1 (1.3-7.2), p=0.008). The risk of cardiovascular hospitalisations was higher in both HFrEF (HR 10.3 (5.5-19.4), p<0.001) and HFpEF (HR 6.7 (3.7-12.2), p<0.001). However, only HFrEF was associated with an increased risk of all-cause mortality (HR 5.17 (1.3-19.9), p=0.02) and ventricular tachycardia/fibrillation (HR 64.3 (15.9-259.7), p<0.001).Conclusion: De novo HF occurs in 5.4% of patients with GD and is associated with increased risk of cardiovascular hospitalisations and mortality. Risk factors include AF, higher TRAb, higher BMI and overt hyperthyroidism. [ABSTRACT FROM AUTHOR]- Published
- 2022
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3. Prognostic significance of longitudinal strain in dilated cardiomyopathy with recovered ejection fraction.
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Merlo, Marco, Masè, Marco, Perry, Andrew, La Franca, Eluisa, Deych, Elena, Ajello, Laura, Bellavia, Diego, Boscutti, Andrea, Gobbo, Marco, Romano, Giuseppe, Stolfo, Davide, Gorcsan, John, Clemenza, Francesco, Sinagra, Gianfranco, and Adamo, Luigi
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LEFT heart ventricle ,ECHOCARDIOGRAPHY ,PROGNOSIS ,RETROSPECTIVE studies ,DILATED cardiomyopathy ,RESEARCH funding ,HEART physiology ,STROKE volume (Cardiac output) ,LONGITUDINAL method - Abstract
Objective: Patients with non-ischaemic dilated cardiomyopathy (NICM) may experience a normalisation in left ventricular ejection fraction (LVEF). Although this correlates with improved prognosis, it does not correspond to a normalisation in the risk of death during follow-up. Currently, there are no tools to risk stratify this population. We tested the hypothesis that absolute global longitudinal strain (aGLS) is associated with mortality in patients with NICM and recovered ejection fraction (LVEF).Methods: We designed a retrospective, international, longitudinal cohort study enrolling patients with NICM with LVEF <40% improved to the normal range (>50%). We studied the relationship between aGLS measured at the time of the first recording of a normalised LVEF and all-cause mortality during follow-up. We considered aGLS >18% as normal and aGLS ≥16% as of potential prognostic value.Results: 206 patients met inclusion criteria. Median age was 53.5 years (IQR 44.3-62.8) and 56.6% were males. LVEF at diagnosis was 32.0% (IQR 24.0-38.8). LVEF at the time of recovery was 55.0% (IQR 51.7-60.0). aGLS at the time of LVEF recovery was 13.6%±3.9%. 166 (80%) and 141 (68%) patients had aGLS ≤18% and <16%, respectively. During a follow-up of 5.5±2.8 years, 35 patients (17%) died. aGLS at the time of first recording of a recovered LVEF correlated with mortality during follow-up (HR 0.90, 95% CI 0.91 to 0.99, p=0.048 in adjusted Cox model). No deaths were observed in patients with normal aGLS (>18%). In unadjusted Kaplan-Meier survival analysis, aGLS <16% was associated with higher mortality during follow-up (31 deaths (22%) in patients with GLS <16% vs 4 deaths (6.2%) in patients with GLS ≥16%, HR 3.2, 95% CI 1.1 to 9, p=0.03).Conclusions: In patients with NICM and normalised LVEF, an impaired aGLS at the time of LVEF recovery is frequent and associated with worse outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2022
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4. Implantable left ventricular assist device: indications, eligibility and current outcomes.
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Bhagra, Sai Kiran, Pettit, Stephen, and Parameshwar, Jayan
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HEART assist devices ,VENTRICULAR septal defects ,ARTIFICIAL blood circulation ,HIV infections ,HEART failure - Published
- 2022
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5. Norepinephrine, plasma renin activity and cardiovascular mortality in systolic heart failure.
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Aimo, Alberto, Prontera, Concetta, Passino, Claudio, Emdin, Michele, and Vergaro, Giuseppe
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HEART failure ,VENTRICULAR ejection fraction ,RENIN ,NORADRENALINE ,ARRHYTHMOGENIC right ventricular dysplasia - Abstract
Objective: We analysed the circulating levels and prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP), norepinephrine (NE), epinephrine (E), plasma renin activity (PRA) and aldosterone in patients with systolic heart failure (HF) receiving therapies that target the sympathetic system and the renin-angiotensin-aldosterone axis.Methods: We retrieved data from consecutive HF outpatients with left ventricular ejection fraction (LVEF) <50% and available neurohormones, evaluated at a tertiary referral centre for HF from 1999 to 2016.Results: Patients (n=1477) were aged 66±13 years, 75% were men, median LVEF was 32% (IQR 25-38), 77% had LVEF <40% and 44% ischaemic HF. At the time of sampling, 69% were on beta-blockers, 75% on ACE inhibitors/angiotensin receptor blockers and 48% on mineralocorticoid receptor antagonists vs 88%, 87% and 66%, respectively, after therapy optimisation. Median NT-proBNP, NE, E, PRA and aldosterone were 1441 ng/L, 494 ng/L, 30 ng/L, 1.2 ng/mL/hour and 130 ng/dL, respectively. Over a 4.8-year follow-up (2.4-8.2), 376 patients died from cardiovascular causes (26%). NT-proBNP and PRA predicted cardiovascular mortality after adjusting for all other univariable predictors. The risk of cardiovascular death increased by 8% or 7% per each doubling of PRA in 2 models considering therapies at the time of sampling or after therapy optimisation. PRA improved metrics of reclassification and discrimination, and independently predicted outcome even in the LVEF <40% subgroup.Conclusions: In patients with HF with LVEF <50% or <40%, PRA shows independent prognostic significance from a model that includes NT-proBNP, and might represent an additive tool for risk stratification. [ABSTRACT FROM AUTHOR]- Published
- 2021
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6. Improving the diagnosis of heart failure in patients with atrial fibrillation.
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Bunting, Karina V., Gill, Simrat K., Sitch, Alice, Mehta, Samir, O'Connor, Kieran, Lip, Gregory Y. H., Kirchhof, Paulus, Strauss, Victoria Y., Rahimi, Kazem, Camm, A. John, Stanbury, Mary, Griffith, Michael, Townend, Jonathan N., Gkoutos, Georgios V., Karwath, Andreas, Steeds, Richard P., Kotecha, Dipak, Lip, Gregory Yh, and RAte control Therapy Evaluation in permanent Atrial Fibrillation (RATE-AF) trial group
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HEART failure ,HEART failure patients ,ATRIAL fibrillation ,CARDIAC contraction ,HEART beat ,HEART block ,LEFT heart ventricle ,RESEARCH ,RESEARCH evaluation ,RESEARCH methodology ,MEDICAL cooperation ,EVALUATION research ,DOPPLER echocardiography ,COMPARATIVE studies ,IMPACT of Event Scale ,RESEARCH funding ,DIASTOLE (Cardiac cycle) ,STROKE volume (Cardiac output) ,HEART physiology ,PEPTIDE hormones ,PEPTIDES - Abstract
Objective: To improve the echocardiographic assessment of heart failure in patients with atrial fibrillation (AF) by comparing conventional averaging of consecutive beats with an index-beat approach, whereby measurements are taken after two cycles with similar R-R interval.Methods: Transthoracic echocardiography was performed using a standardised and blinded protocol in patients enrolled in the RATE-AF (RAte control Therapy Evaluation in permanent Atrial Fibrillation) randomised trial. We compared reproducibility of the index-beat and conventional consecutive-beat methods to calculate left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and E/e' (mitral E wave max/average diastolic tissue Doppler velocity), and assessed intraoperator/interoperator variability, time efficiency and validity against natriuretic peptides.Results: 160 patients were included, 46% of whom were women, with a median age of 75 years (IQR 69-82) and a median heart rate of 100 beats per minute (IQR 86-112). The index-beat had the lowest within-beat coefficient of variation for LVEF (32%, vs 51% for 5 consecutive beats and 53% for 10 consecutive beats), GLS (26%, vs 43% and 42%) and E/e' (25%, vs 41% and 41%). Intraoperator (n=50) and interoperator (n=18) reproducibility were both superior for index-beats and this method was quicker to perform (p<0.001): 35.4 s to measure E/e' (95% CI 33.1 to 37.8) compared with 44.7 s for 5-beat (95% CI 41.8 to 47.5) and 98.1 s for 10-beat (95% CI 91.7 to 104.4) analyses. Using a single index-beat did not compromise the association of LVEF, GLS or E/e' with natriuretic peptide levels.Conclusions: Compared with averaging of multiple beats in patients with AF, the index-beat approach improves reproducibility and saves time without a negative impact on validity, potentially improving the diagnosis and classification of heart failure in patients with AF. [ABSTRACT FROM AUTHOR]- Published
- 2021
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7. Remote monitoring in heart failure: current and emerging technologies in the context of the pandemic.
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Mohebali, Donya and Kittleson, Michelle M.
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HEART failure ,CARDIAC pacing ,CARDIAC pacemakers ,PANDEMICS ,COVID-19 ,HEART failure patients ,MEDICAL personnel ,COVID-19 pandemic - Abstract
The incidence of heart failure (HF) remains high and patients with HF are at risk for frequent hospitalisations. Remote monitoring technologies may provide early indications of HF decompensation and potentially allow for optimisation of therapy to prevent HF hospitalisations. The need for reliable remote monitoring technology has never been greater as the COVID-19 pandemic has led to the rapid expansion of a new mode of healthcare delivery: the virtual visit. With the convergence of remote monitoring technologies and reliable method of remote healthcare delivery, an understanding of the role of both in the management of patients with HF is critical. In this review, we outline the evidence on current remote monitoring technologies in patients with HF and highlight how these advances may benefit patients in the context of the current pandemic. [ABSTRACT FROM AUTHOR]
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- 2021
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8. Real-world utilisation of angiotensin-neprilysin inhibitors in older adults with heart failure.
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Griffin, Jan and Cheng, Richard
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OLDER people ,HEART failure ,ACE inhibitors ,SYSTOLIC blood pressure - Published
- 2021
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9. Cost-effectiveness of transcatheter edge-to-edge repair in secondary mitral regurgitation: is confirmation needed?
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Garbi, Madalina and Mariani, Alfredo
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- 2022
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10. Odd couple: premature ventricular contractions and heart failure.
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Deyell, Marc W. and Hawkins, Nathaniel M.
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ARRHYTHMIA ,CARDIAC contraction ,HEART failure ,HEART failure treatment ,ARRHYTHMIA diagnosis ,ELECTROCARDIOGRAPHY ,DISEASE complications - Published
- 2022
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11. Four pillars of heart failure: contemporary pharmacological therapy for heart failure with reduced ejection fraction
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Martin R Cowie, Bethan Davies, Thomas Woodcock, Yewande Adeleke, Bradley Porter, Sophia Hashmy, Ammu Mathew, Ron Grant, Agnes Kaba, Brigitte Unger-Graeber, Sadia Khan, Andi Orlowski, Bruno Petrungaro, Kam Ying Wong, Sara Sekelj, and Jordan Wallace
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medicine.medical_specialty ,Pharmacological therapy ,Population ,Disease ,clinical ,Pharmacotherapy ,Viewpoint ,Medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,education ,Intensive care medicine ,Heart Failure ,education.field_of_study ,Ejection fraction ,business.industry ,Cardiovascular Agents ,Stroke Volume ,medicine.disease ,Novel agents ,Current practice ,Heart failure ,RC666-701 ,systolic ,pharmacology ,Cardiology and Cardiovascular Medicine ,business - Abstract
The past two decades have heralded dramatic improvements in outcomes for people living with heart failure with reduced ejection fraction (HFrEF).1 The more widespread implementation of disease modifying pharmacological therapies,2 supported by landmark trials of renin-angiotensin system inhibitors3 and beta-blockers4 have improved longevity despite a background of an ageing and increasingly multimorbid population. Although the benefits of comprehensive pharmacological therapies are clear, the real-world attainment of target doses5 6 and utilisation of novel agents such as angiotensin receptor-neprilysin inhibitors (ARNI)7 remain low. Furthermore, HFrEF remains a disease associated with significant morbidity and reduced survival relative to those without HFrEF, even after taking into account comorbidities.8 Recently, trials have demonstrated improved outcomes in people with HFrEF receiving sodium-glucose co-transporter 2 inhibitors (SGLT2i).9 10 However, it is currently unclear how these agents will be used alongside established therapies. Now is therefore an opportune moment to pause and reflect on our current practice, barriers to further progress and how future guidelines might work better for our patients. In this viewpoint we summarise how our current linear approach, on a background of increasingly complex pharmacotherapy has the potential to cause confusion and consequent delays which could lead to even worse attainment of optimal therapies. On the other hand, a more parallel approach to the initiation and optimisation of the Four Pillars of Heart Failure would simplify our approach, yielding benefits for our patients and healthcare systems. Heart failure guidelines are based around inhibition of the renin-angiotensin and sympathetic nervous systems, two fundamental pathways which drive the pathophysiology of HFrEF using ACE inhibitors (ACEi) and beta-blockers. In both European2 and American guidelines11 additional therapies are recommended for patients who ‘remain symptomatic’ with persistently impaired left ventricular (LV) function despite maximally tolerated doses of ACEi and …
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- 2021
12. Association of early versus delayed normalisation of left ventricular ejection fraction with mortality in ischemic cardiomyopathy
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David L. Brown, Luigi Adamo, Andrew Perry, Elena Deych, and Walter Schiffer
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cardiomyopathies ,Male ,medicine.medical_specialty ,Time Factors ,Cardiomyopathy ,Myocardial Ischemia ,heart failure ,Ischaemic cardiomyopathy ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Post-hoc analysis ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,030212 general & internal medicine ,cardiovascular diseases ,Heart Failure and Cardiomyopathies ,Ejection fraction ,Ischemic cardiomyopathy ,Proportional hazards model ,business.industry ,Stroke Volume ,Middle Aged ,medicine.disease ,humanities ,United States ,Survival Rate ,Heart failure ,RC666-701 ,Cardiology ,cardiovascular system ,systolic ,Female ,Cardiology and Cardiovascular Medicine ,business ,therapeutics ,cardiomyopathy ,dilated ,coronary artery disease ,circulatory and respiratory physiology ,Follow-Up Studies - Abstract
ObjectiveIn patients with non-ischaemic cardiomyopathy and reduced left ventricular ejection fraction (LVEF), normalisation of LVEF is associated with improved outcomes. However, data on patients with ischaemic cardiomyopathy and recovered LVEF are lacking. The goal of this study was to assess the prognostic significance of normalisation of the LVEF in patients with ischaemic cardiomyopathy.Methods/ResultsWe performed a non-prespecified post hoc analysis of the Surgical Treatment for Ischaemic Heart Failure (STICH) trial to determine the association between normalisation of LVEF (>50%) and mortality during follow-up. Of the 1212 patients with LVEF ConclusionsIn patients with ischaemic cardiomyopathy, delayed normalisation of LVEF is associated with reduced mortality, whereas early recovery of LVEF is not. Further studies are needed to confirm these findings.
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- 2021
13. Long-term follow-up and sex differences in adults operated for tetralogy of Fallot
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Øyvind H. Lie, Helge Skulstad, Eirik Nestaas, Kristina H. Haugaa, Thor Edvardsen, Gunnar Erikssen, Mette E Estensen, Harald Lindberg, Alessia Quattrone, Charlotte de Lange, and Kirsti Try
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Adult ,Male ,Cardiac function curve ,medicine.medical_specialty ,Time Factors ,Adolescent ,cardiac ,medicine.medical_treatment ,heart failure ,Reference range ,Electrocardiography ,Young Adult ,QRS complex ,Sex Factors ,Internal medicine ,medicine ,echocardiography ,Humans ,Diseases of the circulatory (Cardiovascular) system ,cardiovascular diseases ,tetralogy of Fallot ,Cardiac Surgical Procedures ,Sex Distribution ,Risk factor ,Child ,Retrospective Studies ,Tetralogy of Fallot ,Ejection fraction ,Norway ,business.industry ,Congenital Heart Disease ,Infant ,Implantable cardioverter-defibrillator ,medicine.disease ,Child, Preschool ,RC666-701 ,Heart failure ,Cardiology ,systolic ,Female ,Morbidity ,Cardiology and Cardiovascular Medicine ,business ,arrhythmias ,Follow-Up Studies - Abstract
ObjectiveAdults operated for tetralogy of Fallot (TOF) have high risk of ventricular arrhythmias (VA). QRS duration >180 ms is an established risk factor for VA. We aimed to investigate heart function, prevalence of arrhythmias and sex differences in patients with TOF at long-term follow-up.MethodsWe included TOF-operated patients≥18 years from our centre’s registry. We reviewed medical records and the most recent echocardiographic exam. VA was recorded on ECGs, 24-hour Holter registrations and from implantable cardioverter defibrillator.ResultsWe included 148 patients (age 37±10 years). Left ventricular global longitudinal strain (LV GLS, −15.8±3.1% vs −18.8±3.2%, p=0.001) and right ventricular (RV) GLS (−15.8±3.9% vs −19.1±4.1%, p=0.001) were lower in men at all ages compared with women. Higher RV D1 (4.3±0.5 cm vs 4.6±0.6 cm, p=0.01), lower ejection fraction (55%±8% vs 50%±9%, p=0.02), lower RV GLS (−18.1±4.0 ms vs −16.1±4.8 ms, p=0.04) and N-terminal pro-brain natriuretic peptide (NT-proBNP) over reference range (n=27 (23%) vs n=8 (77%), p180 ms. QRS duration did not differ in those with and without VA (143±32 ms vs 137±28 ms, p=0.06).ConclusionsOur results confirmed reduced RV function in adults operated for TOF. Male patients had impaired LV and RV function expressed by lower LV and RV GLS values at all ages. Reduced cardiac function and elevated NT-proBNP were associated with higher incidence of VA and may be important in risk assessment.
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- 2021
14. Neurohormones and death in systolic heart failure: keep your friends close, but your enemies closer.
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Borovac, Josip A.
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HEART failure ,ARTIFICIAL implants ,NEUROHORMONES ,CARDIAC pacing - Published
- 2021
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15. Why do poor patients have poor outcomes? Shedding light on the neglected facet of poverty and heart failure.
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Zimerman, André and Rohde, Luis E.
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POOR people ,HEART failure patients ,POVERTY ,HEART failure ,HEART failure treatment - Published
- 2021
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16. Long-term follow-up and sex differences in adults operated for tetralogy of Fallot.
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Quattrone A, Lie OH, Nestaas E, de Lange C, Try K, Lindberg HL, Skulstad H, Erikssen G, Edvardsen T, Haugaa K, and Estensen ME
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- Adolescent, Adult, Child, Child, Preschool, Echocardiography, Electrocardiography, Female, Follow-Up Studies, Humans, Infant, Male, Morbidity trends, Norway epidemiology, Retrospective Studies, Sex Distribution, Sex Factors, Tetralogy of Fallot diagnosis, Tetralogy of Fallot surgery, Time Factors, Young Adult, Cardiac Surgical Procedures methods, Tetralogy of Fallot epidemiology
- Abstract
Objective: Adults operated for tetralogy of Fallot (TOF) have high risk of ventricular arrhythmias (VA). QRS duration >180 ms is an established risk factor for VA. We aimed to investigate heart function, prevalence of arrhythmias and sex differences in patients with TOF at long-term follow-up., Methods: We included TOF-operated patients≥18 years from our centre's registry. We reviewed medical records and the most recent echocardiographic exam. VA was recorded on ECGs, 24-hour Holter registrations and from implantable cardioverter defibrillator., Results: We included 148 patients (age 37±10 years). Left ventricular global longitudinal strain (LV GLS, -15.8±3.1% vs -18.8±3.2%, p=0.001) and right ventricular (RV) GLS (-15.8±3.9% vs -19.1±4.1%, p=0.001) were lower in men at all ages compared with women. Higher RV D1 (4.3±0.5 cm vs 4.6±0.6 cm, p=0.01), lower ejection fraction (55%±8% vs 50%±9%, p=0.02), lower RV GLS (-18.1±4.0 ms vs -16.1±4.8 ms, p=0.04) and N-terminal pro-brain natriuretic peptide (NT-proBNP) over reference range (n=27 (23%) vs n=8 (77%), p<0.001) were associated with higher incidence of VA. QRS duration was longer in men (151±30 ms vs 128±25 ms, p<0.001). No patients had QRS duration >180 ms. QRS duration did not differ in those with and without VA (143±32 ms vs 137±28 ms, p=0.06)., Conclusions: Our results confirmed reduced RV function in adults operated for TOF. Male patients had impaired LV and RV function expressed by lower LV and RV GLS values at all ages. Reduced cardiac function and elevated NT-proBNP were associated with higher incidence of VA and may be important in risk assessment., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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17. Determinants of LV dP/dt max and QRS duration with different fusion strategies in cardiac resynchronisation therapy.
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Odland HH, Holm T, Gammelsrud LO, Cornelussen R, and Kongsgaard E
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- Adolescent, Adult, Aged, Aged, 80 and over, Electrocardiography, Female, Heart Failure physiopathology, Humans, Male, Middle Aged, Young Adult, Cardiac Resynchronization Therapy methods, Cardiac Resynchronization Therapy Devices, Heart Failure therapy, Heart Ventricles physiopathology, Hemodynamics physiology, Practice Guidelines as Topic
- Abstract
Background: We designed this study to assess the acute effects of different fusion strategies and left ventricular (LV) pre-excitation/post-excitation on LV dP/dt
max and QRS duration (QRSd)., Methods: We measured LV dP/dtmax and QRSd in 19 patients having cardiac resynchronisation therapy (CRT). Two groups of biventricular pacing were compared: pacing the left ventricle (LV) with FUSION with intrinsic right ventricle (RV) activation (FUSION), and pacing the LV and RV with NO FUSION with intrinsic RV activation. In the NO FUSION group, the RV was paced before the expected QRS onset. A quadripolar LV lead enabled distal, proximal and multipoint pacing (MPP). The LV was stimulated relative in time to either RV pace or QRS-onset in four pre-excitation/post-excitation classes (PCs). We analysed the interactions of two groups (FUSION/NO FUSION) with three different electrode configurations, each paced with four different degrees of LV pre-excitation (PC1-4) in a statistical model., Results: LV dP/dtmax was higher with NO FUSION than with FUSION (769±46 mm Hg/s vs 746±46 mm Hg/s, p<0.01), while there was no difference in QRSd (NO FUSION 156±2 ms and FUSION 155±2 ms). LV dP/dtmax and QRSd increased with LV pre-excitation compared with pacing timed to QRS/RV pace-onset regardless of electrode configuration. Overall, pacing LV close to QRS-onset (FUSION) with MPP shortened QRSd the most, while LV dP/dtmax increased the most with LV pre-excitation., Conclusion: We show how a beneficial change in QRSd dissociates from the haemodynamic change in LV dP/dtmax with different biventricular pacing strategies. In this study, LV pre-excitation was the main determinant of LV dP/dtmax , while QRSd shortens with optimal resynchronisation., Competing Interests: Competing interests: LOG and RC are full-time employees in Medtronic. HHO has received honorary from Abbott Medical, Stockholder Pacertool; patent applications within the field of cardiac resynchronisation therapy., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2021
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18. Four pillars of heart failure: contemporary pharmacological therapy for heart failure with reduced ejection fraction.
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Straw S, McGinlay M, and Witte KK
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- Heart Failure physiopathology, Humans, Stroke Volume drug effects, Cardiovascular Agents therapeutic use, Heart Failure drug therapy, Stroke Volume physiology
- Abstract
Competing Interests: Competing interests: KKW has received speakers’ fees and honoraria from Medtronic, Cardiac Dimensions, Novartis, Abbott, BMS, Pfizer, Bayer and has received an unconditional research grant from Medtronic.
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- 2021
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19. Association of early versus delayed normalisation of left ventricular ejection fraction with mortality in ischemic cardiomyopathy.
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Schiffer WB, Perry A, Deych E, Brown DL, and Adamo L
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- Cardiomyopathies mortality, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Ischemia mortality, Survival Rate trends, Time Factors, United States epidemiology, Cardiomyopathies physiopathology, Myocardial Ischemia physiopathology, Stroke Volume physiology, Ventricular Function, Left physiology
- Abstract
Objective: In patients with non-ischaemic cardiomyopathy and reduced left ventricular ejection fraction (LVEF), normalisation of LVEF is associated with improved outcomes. However, data on patients with ischaemic cardiomyopathy and recovered LVEF are lacking. The goal of this study was to assess the prognostic significance of normalisation of the LVEF in patients with ischaemic cardiomyopathy., Methods/results: We performed a non-prespecified post hoc analysis of the Surgical Treatment for Ischaemic Heart Failure (STICH) trial to determine the association between normalisation of LVEF (>50%) and mortality during follow-up. Of the 1212 patients with LVEF <35% enroled in the STICH trial, 932 underwent assessment of LVEF at 4 months and/or 2 years after enrolment. Among them, 18 patients experienced normalisation in LVEF at 4-month follow-up and 35 patients experienced recovery in LVEF at 2 years. Recovery of LVEF at 4 months and recovery of LVEF at 2 years were not correlated. Recovery of LVEF at 4 months was not associated with reduced all-cause mortality in unadjusted analysis (log-rank test p=0.54) or in Cox proportional hazards analysis (HR: 0.93; 95% CI: 0.48 to 1.80; p=0.82). Ejection fraction recovery at 2 years was associated with a reduction in all-cause mortality, both in unadjusted analysis (log-rank test p=0.004) and in the Cox proportional hazard model (HR: 0.41; 95% CI: 0.21 to 0.80; p=0.009)., Conclusions: In patients with ischaemic cardiomyopathy, delayed normalisation of LVEF is associated with reduced mortality, whereas early recovery of LVEF is not. Further studies are needed to confirm these findings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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20. Characterisation of the patients with suspected heart failure: experience from the SHEAF registry.
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Garg P, Dakshi A, Assadi H, Swift AJ, Naveed U, Fent G, Lewis N, Rogers D, Charalampopoulos A, and Al-Mohammad A
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- Aged, Aged, 80 and over, Biomarkers blood, Female, Heart Failure blood, Heart Failure physiopathology, Hospitalization trends, Humans, Male, Prognosis, Protein Precursors, Heart Failure diagnosis, Natriuretic Peptide, Brain blood, Peptide Fragments blood, Registries, Stroke Volume physiology
- Abstract
Objectives: To characterise and risk-stratify patients presenting to a heart failure (HF) clinic according to the National Institute for health and Care Excellence (NICE) algorithm., Methods: This is an observational study of prospectively collected data in the Sheffield HEArt Failure registry of consecutive patients with suspected HF between April 2012 and January 2020. Outcome was defined as all-cause mortality., Results: 6144 patients were enrolled: 71% had HF and 29% had no HF. Patients with N-terminal pro-brain-type natriuretic peptide (NT-proBNP) >2000 pg/mL were more likely to have HF than those with NT-proBNP of 400-2000 pg/mL (92% vs 64%, respectively). Frequency of HF phenotypes include: HF with preserved ejection fraction (HFpEF) (33%), HF with reduced ejection fraction (HFrEF) (29%), HF due to valvular heart disease (4%), HF due to pulmonary hypertension (5%) and HF due to right ventricular systolic dysfunction (1%). There were 1485 (24%) deaths over a maximum follow-up of 6 years. The death rate was higher in HF versus no HF (11.49 vs 7.29 per 100 patient-years follow-up, p<0.0001). Patients with HF and an NT-proBNP >2000 pg/mL had lower survival than those with NT-proBNP 400-2000 pg/mL (3.8 years vs 5 years, p<0.0001). Propensity matched survival curves were comparable between HFpEF and HFrEF (p=0.88)., Conclusion: Our findings support the use by NICE's HF diagnostic algorithm of tiered triage of patients with suspected HF based on their NT-proBNP levels. The two pathways yielded distinctive groups of patients with varied diagnoses and prognosis. HFpEF is the most frequent diagnosis, with its challenges of poor prognosis and paucity of therapeutic options., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2021
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