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Background: Heart failure is a major burden in Australia in terms of morbidity, mortality and healthcare expenditure. Multiple evidence‐based therapies are recommended for heart failure with reduced ejection fraction (HFrEF), but data on physician adherence to therapy guidelines are limited. Aim: To compare use of HFrEF therapies against current evidence‐based guidelines in an Australian hospital inpatient population. Methods: A retrospective review of patients admitted with a principal diagnosis of HFrEF across six metropolitan hospitals in Sydney, Australia, between January 2015 and June 2016. Use of medical and device therapies was compared with guideline recommendations using individual patient indications/contraindications. Readmission and mortality data were collected for a 1‐year period following the admission. Results: Of the 1028 HFrEF patients identified, 39 were being managed with palliative intent, leaving 989 patients for the primary analysis. Use of beta‐blockers (87.7% actual use/93.6% recommended use) and diuretics (88.4%/99.3%) was high among eligible patients. There were large evidence‐practice gaps for angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB; 66.4%/89.0%) and aldosterone antagonists (41.0%/77.1%). In absolute terms, use of these therapies each increased by over 11% from admission. Ivabradine (11.5%/21.2%), automated internal cardiac defibrillators (29.5%/66.1%) and cardiac resynchronisation therapy (13.1%/28.7%) were used in a minority of eligible patients. Over the 1‐year follow‐up period, the mortality rate was 14.8%, and 44.2% of patients were readmitted to hospital at least once. Conclusion: Hospitalisation is a key mechanism for initiation of HFrEF therapies. The large evidence‐practice gaps for ACEI/ARB and aldosterone antagonists represent potential avenues for improved HFrEF management. [ABSTRACT FROM AUTHOR]

Aims: In heart failure (HF) with reduced left ventricular ejection fraction (HFrEF), the prognosis appears better in non‐ischaemic than in ischaemic aetiology. Infrequent diagnostic work‐up for ischaemic heart disease (IHD) in HF is reported. In this study, we compared short‐term response to initiated guideline‐directed medical treatment (GDMT) in recent‐onset HFrEF of non‐ischaemic (non‐IHF) vs. ischaemic (IHF) aetiology and evaluated the frequency of coronary investigation. Methods and results: Patients hospitalized with recent‐onset HFrEF [left ventricular ejection fraction (LVEF) < 40%] between 1 January 2016 and 31 December 2019 were included. Treatment response was determined by use of a hierarchical clinical composite outcome classifying each patient as worsened, improved, or unchanged based on hard outcomes (mortality, heart transplantation, and HF hospitalization) and soft outcomes (± ≥10 unit change in LVEF, ± ≥30% change in N‐terminal pro‐B‐type natriuretic peptide, and ± ≥1 point change in New York Heart Association functional class) during 28 weeks of follow‐up. The associations between baseline characteristics and composite changes were analysed with multiple logistic regression. Among the 364 patients analysed, 47 were not investigated for IHD. Comparing non‐IHF (n = 203) vs. IHF (n = 114), patients were younger (mean age 61.0 vs. 69.4 years, P < 0.001) with lower mean LVEF (26% vs. 31%, P < 0.001), but with similar male predominance (70.4% vs. 75.4%, P = 0.363). For non‐IHF vs. IHF, the composite outcomes were worsened (19.1% vs. 43.9%, P < 0.001) and improved (74.2% vs. 43.9%, P < 0.001). After multivariable adjustments, IHF was associated with increased odds for worsening [odds ratio (OR) 2.94; 95% confidence interval (CI) 1.51–5.74; P = 0.002] and decreased odds for improvement (OR 0.35; 95% CI 0.18–0.65; P < 0.001). In cases without previous IHD or new‐onset myocardial infarction (n = 261), a decision for coronary investigation was made in 69.0%. Conclusions: In recent‐onset HFrEF, patients with non‐IHF responded better to GDMT than patients with IHF. Almost one‐third of patients selected for follow‐up at HF clinics were never investigated for IHD. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to evaluate the outcome and prognostic factors in patients with dilated cardiomyopathy (DCM) and long‐standing heart failure (LDCM) vs. recent‐onset heart failure (RODCM). Methods and results: We compared 2019 patients with RODCM (duration <6 months, mean age 58.6 years, 70.7% male) with 1714 patients with LDCM (duration ≥6 months, median duration 3.5 years, mean age 62.5 years, 73.7% male) included in the Swedish Heart Failure Registry in the years 2003–16. Outcome measures were all‐cause, cardiovascular (CV), and non‐CV death and hospitalizations; heart transplantation; and a combined outcome of all‐cause death, heart transplantation, or heart failure (HF) hospitalization. Multivariable risk factor analyses were performed for the combined endpoint. All outcomes were more frequent in LDCM than in RODCM. The multivariable‐adjusted hazard ratios (HRs) (95% confidence interval) for LDCM vs. RODCM were 1.56 (1.34–1.82), P < 0.0001, for all‐cause death over a median follow‐up of 4.2 and 5.0 years, respectively; 1.67 (1.36–2.05), P < 0.0001, for CV death; 2.12 (1.14–3.91), P < 0.0001, for heart transplantation; 1.36 (1.21–1.53), P < 0.0001, for HF hospitalization; and 1.37 (1.24–1.52), P < 0.0001, for the combined outcome. A propensity score‐matched analysis yielded similar results. CV death was the main cause of mortality in LDCM and was higher in LDCM than in RODCM (P < 0.0001). Almost all co‐morbidities were significantly more frequent in LDCM than in RODCM, and the mean number of co‐morbidities increased significantly with increased duration of disease, also after age adjustment. Age, New York Heart Association functional class, ejection fraction, and left bundle branch block were prognostically adverse. The only co‐morbidity associated with the combined outcome regardless of HF duration was diabetes, in LDCM [HR 1.34 (1.15–1.56), P = 0.0002] and in RODCM [HR 1.29 (1.04–1.59), P = 0.018]. Male sex [HR 1.38 (1.18–1.63), P < 0.0001] and aspirin use [HR 1.33 (1.14–1.55), P = 0.0004] carried increased risk only in RODCM. Heart rate ≥75 b.p.m. [HR 1.20 (1.04–1.37), P = 0.01], atrial fibrillation [HR 1.24 (1.08–1.42), P = 0.0024], musculoskeletal or connective tissue disorder [HR 1.36 (1.13–1.63), P = 0.0014], and diuretic therapy [HR 1.40 (1.17–1.67), P = 0.0002] were prognostically adverse only in LDCM. Conclusions: This nationwide study of patients with DCM demonstrates that longer disease duration is associated with worse prognosis. Co‐morbidities are more common in long‐standing HF than in recent‐onset HF and are associated with worse outcome. With the increased survival seen in the last decades, our results highlight the importance of careful attention to co‐morbid conditions in patients with DCM. [ABSTRACT FROM AUTHOR]

Objective: It is unknown whether systolic blood pressure (SBP) drop is part of the normal aging process or due to the onset of dementia for some people. SBP drop is referring to the decrease in blood pressure often seen before death. Thus, the aim of this study was to examine whether SBP at time of diagnosis of dementia, mild cognitive impairment, or subjective cognitive decline was associated with years prior to death, and whether these associations were modified by diagnoses, age, and sex. Methods: Participants were 2,236 patients from the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog), who died during follow‐up (2009–2017) for whom we had valid blood pressure measurements. Mean age at diagnosis was 77.5 years (SD 8.3), and patients were followed for an average of 3.9 years (SD 2.2, maximum 10.5 years). The patients had subjective cognitive decline (95), mild cognitive impairment (573), dementia (1,401), or no diagnoses related to cognitive deficits (167). SBP as dependent variable was regressed against years prior to death. Results: In men, SBP was 1.8 mmHg lower per year closer to death (p <.01), and this trend was linear without any acceleration. This association between years prior to death and SBP in men was not modified by age, year of diagnosis, or diagnosis. There was no such association in women. Conclusion: SBP was significantly lower for those diagnosed close to death in men, but not in women. This association was not modified by either age or onset of diagnosis. Thus, the lowering of SBP is more related to closeness to death and sex than to dementia or age. The downward trend was linear all 10 years prior to death, with no acceleration closer to death. [ABSTRACT FROM AUTHOR]

In a systematic review, the authors explored genetic association studies of essential hypertension in African populations. Studies reporting on the association of polymorphism(s) with hypertension in African populations were included. Appropriate studies were pooled using random effects model meta-analysis, under six potential inheritance models. In all, 46 polymorphisms in 33 genes were investigated for their association with hypertension or blood pressure levels. Meta-analysis was possible for three single nucleotide polymorphisms: rs4340, rs699, and rs5186. An association was found between rs5186, rs699, and hypertension under allele contrast and homozygous codominant models (odds ratio, 1.63 [95% confidence interval, 1.04-2.54] and 4.01 [95% confidence interval, 1.17-13.80] for rs5186, respectively; and 1.80 [95% confidence interval, 1.13-2.87] for rs699). Findings were mostly robust in sensitivity analyses. According to the systematic review, there is currently insufficient evidence on the specific polymorphisms that pose the risk of hypertension in African populations. Large-scale genetic studies are warranted to better understand susceptibility polymorphisms that may be specific to African populations. [ABSTRACT FROM AUTHOR]

Multiplication in finite fields is used in many applications, especially in cryptography. It is a basic and the most computationally intensive operation from among all such operations. Several systolic multipliers are proposed in the literature that offer low hardware complexity or high speed. In this paper, a bit-parallel polynomial basis systolic multiplier for generic irreducible polynomials is proposed based on a modified interleaved multiplication method. The hardware complexity and delay of the proposed multiplier are estimated, and a comparison with the corresponding multipliers available in the literature is presented. Of the corresponding multipliers, the proposed multiplier achieves a reduction in the hardware complexity of up to 20% when compared to the best multiplier for m = 163. The synthesis results of application-specific integrated circuit and fieldprogrammable gate array implementations of the proposed multiplier are also presented. From the synthesis results, it is inferred that the proposed multiplier achieves low power consumption and low area complexity when compared to the best of the corresponding multipliers. [ABSTRACT FROM AUTHOR]

Purpose: To develop and test the feasibility of a new method for non-ECG-gated first-pass perfusion (FPP) cardiac MR capable of imaging multiple short-axis slices at the same systolic cardiac phase. Methods: A magnetization-driven pulse sequence was developed for non-ECG-gated FPP imaging without saturationrecovery preparation using continuous slice-interleaved radial sampling. The image reconstruction method, dubbed TRACE, used self-gating based on reconstruction of a real-time imagebased navigator combined with reference-constrained compressed sensing. Data from ischemic animal studies (n=5) was used in a simulation framework to evaluate temporal fidelity. Healthy subjects (n=5) were studied using both the proposed approach and the conventional method to compare the myocardial contrast-to-noise ratio (CNR). Patients (n=2) underwent adenosine stress studies using the proposed method. Results: Temporal fidelity of the developed method was shown to be sufficient at high heart-rates. The healthy volunteers studies demonstrated normal perfusion and no dark-rim artifacts. Compared with the conventional scheme, myocardial CNR for the proposed method was slightly higher (8.660.6 versus 8.060.7). Patient studies showed stress-induced perfusion defects consistent with invasive angiography. Conclusion: The presented methods and results demonstrate feasibility of the proposed approach for high-resolution non-ECG-gated FPP imaging of 3 myocardial slices at the same systolic phase, and indicate its potential for achieving desirable image quality (high CNR and no dark-rim artifacts). [ABSTRACT FROM AUTHOR]

Aims: Hawthorn's efficacy when added to contemporary evidence-based heart failure therapy is unknown. We aimed to determine whether hawthorn increases submaximal exercise capacity when added to standard medical therapy. [ABSTRACT FROM PUBLISHER]

Background/Aims: Cytokines such as tumour necrosis factor (TNF-α) contribute to the pathogenesis of cirrhotic cardiomyopathy. Nuclear factor-κB (NF-κB) is crucial for cytokine regulation, and induces cardiac dysfunction in several heart disease models. We aimed to elucidate possible NF-κB involvement in cirrhotic cardiomyopathy. Methods: Rats were bile duct ligated (BDL) to produce cirrhosis; controls received sham operation. Animals were studied 4 weeks later. Two NF-κB inhibitors were used: pyrrolidine dithiocarbamate (PDTC) and Bay 11-7082. Four groups were studied in most protocols: sham control, sham+PDTC, BDL and BDL+PDTC. Additional contractility studies were performed with Bay 11-7082. Myocardial NF-κB and TNF-α expression was measured by Western blot and ELISA. The contractility of isolated cardiomyocytes was observed under direct microscopy. Results: Nuclear factor-κB and TNF-α levels were increased in cirrhotic hearts compared with controls. PDTC significantly reduced NF-κB activity and TNF-α expression in cirrhotic hearts; controls were unaffected. Cirrhotic cardiomyocytes showed decreased systolic and diatolic velocity compared with sham controls. Both PDTC and Bay 11-7082 restored contractile function in cirrhotic cardiomyocytes, but did not affect controls. Conclusions: Inhibition of the increased NF-κB activity in cirrhotic hearts was associated with improvement of attenuated cardiomyocyte contractility. NF-κB, via effects on cytokine expression, may contribute to the pathogenesis of cirrhotic cardiomyopathy. [ABSTRACT FROM AUTHOR]

Objectives To compare the systolic, early and late diastolic velocities of the aortic, mitral and tricuspid annuli in healthy subjects and to study the intraobserver and interobserver reproducibility (IIOR) of measuring the velocities at the aortic annulus. Methods Twenty healthy subjects with mean age 28 years were investigated with quantitative two-dimensional color Doppler tissue imaging and the systolic, early and late diastolic velocities were measured at the aortic, mitral and tricuspid annuli. Results The mitral annulus had significant higher systolic velocity and early diastolic velocity than the aortic annulus. The late diastolic velocity was significant lower at the aortic annulus compared with the both other annuli. At the different sites of the annuli the highest systolic velocity and early diastolic velocity were measured at the lateral site of the mitral annulus, whereas the lowest systolic velocity was measured at the septal site of the same annulus. The lowest early diastolic velocity was found at the septal site of the aortic annulus. The highest late diastolic velocity was measured at the lateral site of the tricuspid annulus and the lowest at the lateral site of the aortic annulus. Conclusions The mitral annulus has statistical significant higher systolic and early diastolic velocities than the aortic annulus. There are significant differences in velocities between several of the different sites of the annuli. IIOR of measuring the systolic and early diastolic velocities of the aortic annulus is good. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to assess left ventricular (LV) systolic and diastolic function, using Doppler tissue imaging (DTI), in patients with complete recovery of visual wall motion abnormalities six months after a first ST-elevation myocardial infarction (STEMI). Methods Out of 90 patients presenting with a STEMI, 68 patients without a history of heart disease were examined by echocardiography before discharge and after 6 months. The patients were compared to 41 age matched healthy subjects (HS). LV function was assessed by visual wall motion and mitral annular velocities using pulsed wave DTI. Results Sixty-eight patients had visual wall motion abnormalities at baseline. Of these, 19 patients showed complete recovery of wall motion at 6-months follow-up. Patients with complete recovery of wall motion abnormalities had significantly reduced peak systolic and peak early diastolic mitral annular velocities compared to HS at 6 months (8·3 cm s−1 versus 9·9 cm s−1, P<0·001 for systolic velocity and 9·3 cm s−1 versus 13·1 cm s−1, P<0·001 for diastolic velocity, respectively). Conclusion In patients presenting with a first STEMI, mitral annular systolic and early diastolic velocities assessed by DTI at 6-months follow-up are significantly reduced compared to HS, despite normal standard echocardiographic parameters of LV function. This probably reflects a residual subendocardial damage not detected by conventional echocardiographic methods. [ABSTRACT FROM AUTHOR]

Objectives: To investigate if the newly developed Doppler-derived myocardial performance index (MPI, also denoted TEI-index) is associated with variables reflecting both left ventricular (LV) systolic and diastolic function, as well as variables reflecting preload, afterload, and LV geometry. Material: An echocardiographic examination including Doppler was carried out in 446 men aged 70 in a population-based survey (the ULSAM-study, Uppsala Longitudinal Study of Adult Men). Results: In multiple regression analysis, MPI was independently associated with ejection fraction (P<0.001), E/A ratio (P<0.001), total peripheral resistance index (P<0.001), stroke volume to pulse pressure ratio (P<0.02), stroke index (P<0.01), and LV mass (P<0.04), but not with heart rate or blood pressure. Conclusion: The echocardiographically determined myocardial performance index is determined by both LV systolic and diastolic function as well as by afterload and left ventricular mass.(ECHOCARDIOGRAPHY, Volume 22, March 2005) [ABSTRACT FROM AUTHOR]

Background: All factors predisposing for congestive heart failure (CHF), such as coronary artery disease (CAD), hypertension and diabetes are increasing in prevalence in Egypt. Despite this, no data about CHF in our country are available. Aims: To study the relative contribution of systolic vs. diastolic heart failure in Egyptians and the prevalence of risk factors in this population, as well as their prognosis. Methods: This was a retrospective study of patients with a diagnosis of CHF over a 3.5-year period in a general cardiology clinic. Demographic, ECG and echocardiographic data for left ventricular systolic and diastolic function were collected. The differential effect of systolic versus diastolic CHF was analyzed regarding hospitalization and mortality. Results: After exclusion of valvular diseases, we found 155 patients diagnosed with heart failure, 102 patients (66%) had systolic heart failure, and 53 (34%) had diastolic heart failure. Mean age was 60±10 and 63±11 years, respectively (P=0.13). Systolic CHF patients had significantly more CAD, while those with diastolic failure were mostly hypertensives (P<0.01) for both. There was no significant difference in the incidence of diabetes mellitus, cerebrovascular accidents or atrial fibrillation between the two groups. Patients with systolic failure required more hospitalization, P<0.05, and had a mortality rate of 17.6% vs. 11.3% for patients with diastolic heart failure (P=0.3). Conclusion: Diastolic heart failure is present in one-third of cases of CHF in Egyptians. Hypertension is very common in this group. These patients require less hospitalization but have a similar mortality rate. [Copyright &y& Elsevier]

Objectives: To investigate changes in plasma atrial natriuretic peptide (ANP), N-terminal pro-atrial natriuretic peptide (NT-pro-ANP) and brain natriuretic peptide (BNP) during the development of doxorubicin-induced left ventricular systolic and diastolic dysfunction as measured by echocardiography (ECHO).Design: Prospective study.Setting: University hospital.Subjects: Twenty-eight adult patients with non-Hodgkin's lymphoma, who received doxorubicin to the cumulative dose of 400-500 mg m(-2).Main Outcome Measures: The relationship between plasma natriuretic peptides and systolic and diastolic ECHO indices after the cumulative doxorubicin doses of 200, 400 and 500 mg m(-2).Results: Left ventricular ejection fraction (LVEF, by 2D ECHO) decreased from 58 +/- 1.7 to 52.5 +/- 1.3% (P=0.036) and fractional shortening (FS) from 34.6 +/- 1.4 to 27.8 +/- 0.9% (P=0.002). Peak E wave velocity decreased from 63.3 +/- 3.2 to 51.3 +/- 2.6 cm s(-1) (P=0.008) resulting in a statistically nonsignificant decrease in E/A ratio from 1.08 +/- 0.01 to 0.85 +/- 0.07. A significant decrease was observed in the percentage of left ventricular filling during the 1/3 of diastole (1/3FF) from 42.2 +/- 1.7 to 36.5 +/- 2.0% (P < 0.001). LV end systolic diameter increased from 32 +/- 1 to 38 +/- 1 mm (P=0.011), whereas left atrial (LA) diameter remained unchanged. Peak filling rate decreased from 4.4 +/- 0.2 to 4.0 +/- 0.2 stroke volume s(-1) (SV s(-1)) (ns). Plasma levels of ANP increased from 16.4 +/- 1.3 to 22.7 +/- 2.4 pmol L(-1) (P=0.002), NT-pro-ANP from 288 +/- 22 to 380 +/- 42 pmol L(-1) (P=0.019) and BNP from 3.3 +/- 0.4 to 8.5 +/- 2.0 pmol L(-1) (P=0.020). There was a significant inverse correlation between the decrease in FS and the increases in plasma NT-pro-ANP (r= -0.524, P=0.018) and plasma BNP (r=0.462, P=0.04) and between the decrease in PFR and the increases in plasma ANP (r= -0.457, P=0.043) and plasma NT-pro-ANP (r= -0.478, P=0.033). Furthermore, after doxorubicin therapy, significant inverse correlations were observed between E/A ratio and plasma ANP (r= -0.535, P=0.008), between E/A ratio and plasma NT-pro-ANP (r= -0.432, P=0.04) and between E/A ratio and plasma BNP (r= -0.557, P=0.006) as well as between 1/3FF and plasma BNP (r= -0.493, P=0.017). There was also a trend for correlation between LA diameter and plasma BNP (r=0.395, P=0.062) and peak E wave velocity and plasma BNP (r= -0.414, P=0.05), respectively. However, no significant correlations were observed between any of the systolic parameters and natriuretic peptide levels.Conclusions: The results of this prospective study show that during the evolution of doxorubicin-induced LV dysfunction the secretion of natriuretic peptides is more closely associated with the impairment of left ventricular diastolic filling than with the deterioration of LV systolic function. [ABSTRACT FROM AUTHOR]

A new method proposed previously by us (1980) was described to evaluate its applicability in psychophysiological research. In this method, beat-to-beat systolic and diastolic pressure as well as the pressure waveform can be measured noninvasively in the human finger. By use of a hydraulic-servosystem, the photoplethysmographically detected vascular volume changes associated with intraarterial pressure in the finger are compensated by an applied counterpressure (cuff pressure) to maintain a proper value corresponding to the unloaded vascular volume. At this state the controlled cuff pressure follows instantaneously the intraarterial pressure. Comparison data were obtained by direct measurement of blood pressure in the brachial artery in 3 normotensive and 3 hypertensive subjects. High correlations between the two measures were obtained in each subject under various conditions. By maintaining circulation in the finger, this method enables the noninvasive and continuous measurement of instantaneous arterial pressure for more than one hour without much discomfort. This indirect method should be useful in many areas of psychophysiological research. [ABSTRACT FROM AUTHOR]