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The purpose of this work was to determine the influence of myocardial wringing on ventricular function in patients with cardiac amyloidosis (CA).Fifteen healthy volunteers (group 1) and 34 patients with CA (17 with left ventricular ejection fractions [LVEFs] ≥ 53% [group 2] and 17 with LVEFs 53% [group 3]) were evaluated using two-dimensional speckle-tracking echocardiography. A control group of mass-matched patients (n = 20) with left ventricular (LV) hypertrophy and LVEFs ≥ 53% was also included. Longitudinal strain (LS), circumferential strain, and LV twist and torsion were calculated. Deformation index (DefI), a new parameter of wringing, calculated as twist/LS, that takes into account actions that occur simultaneously during LV systole (i.e., longitudinal shortening and twist), was evaluated. Torsional and wringing parameters were calculated according to LVEF.Lower global values of LS and circumferential strain were observed among patients with CA (LS: group 1, -20.6 ± 2.5%; group 2, -11.6 ± 4.1%; group 3, -9.0 ± 3.1%; circumferential strain: group 1, -22.7 ± 4.9%; group 2, -14.4 ± 8.0%; group 3, -13.6 ± 3.8%; P .001 for both). Torsion did not vary between group 2 and group 1 (2.5 ± 1.1°/cm vs 2.7 ± 0.8°/cm, P = NS). In contrast, DefI was greater in group 2 than in group 1 (-1.8 ± 0.8°/% vs -1.0 ± 0.3°/%, P .01). Torsion and DefI were lower in group 3 (1.2 ± 0.7°/cm and -1.1 ± 0.6°/%, respectively, P .001 for both) than in group 2. DefI was similar in patients with LV hypertrophy (-1.7 ± 0.6°/%, P = NS) and group 2.In patients with CA, preservation of LVEF depends on greater ventricular wringing. DefI, a parameter that integrates the twist and the simultaneous longitudinal shortening of the left ventricle, is a more accurate indicator of the efficacy of this mechanism.

Background: Patients with low left ventricular ejection fraction (LVEF), low-flow, low-gradient (i.e. classical low flow [CLF]) aortic stenosis (AS) have a dismal short-term outcome without aortic ...

Objectives This study retrospectively assessed the safety and efficacy of permanent His bundle pacing (HBP) in patients with congenital complete heart block (CCHB). Background HBP has become an accepted form of pacing in adults. Its role in CCHB is not known. Methods Seventeen patients with CCHB who underwent successful HBP were analyzed at 6 academic centers between 2016 and 2019. Nine patients had de novo implants, and 8 patients had previous right ventricular (RV) leads. Three RV paced patients had reduced left ventricular ejection fractions at the time of HBP. Implant/follow-up device parameters, New York Heart Association functional class, QRS duration, and left ventricular ejection fraction data were analyzed. Results Patients’ mean age was 27.4 ± 11.3 years, 59% were women, and mean follow-up was 385 ± 279 days. The following parameters were found to be statistically significant between implant and follow-up, respectively: impedance, 602 ± 173 Ω versus 460 ± 80 Ω (p Conclusions HBP seems to be safe and effective, with improvement in clinical outcomes in patients with CCHB. Larger studies with longer follow-up periods are required to confirm our findings.

Objectives This study examined the independent predictors of all-cause mortality, all hospitalizations, and cardiac hospitalizations in patients with mild-to-moderate cardiomyopathy (left ventricular ejection fractions [LVEFs] of 36% to 50%). Background Patients with severe cardiomyopathy have high rates of death. Implantable cardioverter-defibrillators (ICDs) improve survival in this setting. It is not known whether the same applies to patients with mild-to-moderate cardiomyopathy. Methods All patients with cardiomyopathy of any etiology seen at our institution between 2011 and 2017 were included. Baseline characteristics and outcomes were compared between patients with mild-to-moderate cardiomyopathy and severe cardiomyopathy (LVEF ≤35%). Results Of the 18,003 patients with cardiomyopathy, 5,966 (33%) had a LVEF between 36% and 50%. Over a median follow-up of 3.35 years, 8,037 patients (45%) died and 11,056 (61%) were hospitalized for cardiac reasons. Independent predictors of all-cause mortality included older age (p Conclusions A history of DM predicts mortality in patients with cardiomyopathy and is associated with worse outcome than the actual severity of cardiomyopathy. Patients with mild-to-moderate cardiomyopathy and DM may therefore benefit from the same life-saving therapies (e.g., ICDs) that are indicated for patients with severe cardiomyopathy. This finding needs to be verified in a prospective, randomized setting.

Shuyu Li,1,2 Qingzhen Zhao,1 Yuzhi Zhen,1 Lizhuo Li,1 Yiqing Mi,1 Tongxin Li,1 Kunshen Liu,1 Chao Liu1 1The First Cardiology Division, First Affiliated Hospital of Hebei Medical University, Shijiazhuang, 050022, People’s Republic of China; 2The Second Cardiology Division, North China University of Science and Technology Affiliated Hospital, Tangshan, 063000, People’s Republic of ChinaCorrespondence: Chao LiuThe First Cardiology Division, First Affiliated Hospital of Hebei Medical University, Hebei Medical University, No. 89 of Donggang Road, Yuhua District, Shijiazhuang, Hebei, 050000, People’s Republic of ChinaTel +86 311 8591 7032Fax +86 311 8591 7290Email dr.liuchao@gmail.comBackground: Positive inotropic and renal protective actions of glucocorticoids have been observed clinically. Therefore, glucocorticoids may be used in patients with heart failure and low blood pressure (HF-LBP).Methods: The medical records of 144 consecutive patients with HF-LBP who received glucocorticoids as an adjunctive treatment to facilitate the up-titration of β-blocker and angiotensin-converting enzyme inhibitor were reviewed.Results: After four weeks of treatment, the metoprolol and captopril (or equivalent) dosages were progressively and consistently increased from 25 (interquartile range [IQR] = 12.5– 75 mg/day) to 100 mg/day (IQR = 50– 178.8 mg/day) and from 0 (IQR = 0– 25 mg/day) to 12.5 mg/day (IQR = 0– 50 mg/day), respectively. There was a remarkable beneficial hemodynamic response to the glucocorticoid treatment signified by an increase in blood pressure and decrease in heart rate. The average heart rate decreased by 6 beat per minute (bpm) (0.5– 16 bpm), and the mean arterial blood pressure increased from 74.06 ± 7.81 to 78.85 ± 7.91 mmHg. We also observed an improvement in renal function and an increased diuretic response following glucocorticoid treatment. As a result, the left ventricular ejection fraction increased from 28.92 ± 8.06% to 33.86 ± 8.76%, and the diuretic response increased from 776.7 mL/40 mg furosemide (IQR = 133.8– 2000 mL) to 4000 mL/40 mg furosemide on day 28 (IQR = 2200– 5925 mL).Conclusion: The use of glucocorticoid treatment to maintain hemodynamic and renal functional targets when titrating guideline-directed medical treatment in patients with HF-LBP may be safe, effective, and feasible.Keywords: cardiac output, β-blocker, angiotensin-converting enzyme inhibitor, diuretic response, left ventricular ejection, renal function

The effects of the apelinergic system components apelin (AP) and elabela (ELA) in the regulation of human cardiovascular homeostasis, and data concerning the relationship between ELA and AP and coronary artery disease (CAD) are yet unknown. The aim of the study was the evaluation of AP, ELA and APJ-receptor levels in the plasma of patients with chronic coronary syndromes (CCS) and acute coronary syndromes (ACS). The study group consisted of 114 patients with CAD and 33 healthy controls. Patients were divided into two groups: with CCS (n = 30) and ACS (n = 84). Routine laboratory tests and plasma ELA, AP-17, AP-13 and APJ receptor levels were measured. Echocardiographic data were analyzed in all patients. Levels of AP-17 and ELA were significantly lower in CCS than in healthy controls and ACS patients. We demonstrated significant increase of levels of plasma apelinergic system peptides, especially ELA and AP-17 in ACS patients compared with healthy controls and CCS, suggestive of compensating up-regulation mechanisms. There is a relationship between circulating ELA and AP-17 levels and classical, biochemical markers of ischemia and left ventricular ejection faction as well.

Objective: Patients with dilated cardiomyopathy (DCM) and severely reduced left ventricular ejection fractions (LVEFs) are at very high risks of experiencing adverse cardiac events. A machine learning (ML) method could enable more effective risk stratification for these high-risk patients by incorporating various types of data. The aim of this study was to build an ML model to predict adverse events including all-cause deaths and heart transplantation in DCM patients with severely impaired LV systolic function. Methods: One hundred and eighteen patients with DCM and severely reduced LVEFs (Results: Twelve patients died, and 17 patients underwent heart transplantation during the median follow-up of 508 days. The ML model included systolic blood pressure, left ventricular end-systolic and end-diastolic volume indices, and late gadolinium enhancement (LGE) extents on CMR imaging, and a support vector machine was selected as a classifier. The model showed excellent performance in predicting adverse events in DCM patients with severely reduced LVEF (the AUC and accuracy values were 0.873 and 0.763, respectively). Conclusions: This ML technique could effectively predict adverse events in DCM patients with severely reduced LVEF. Advances in knowledge: The ML method has superior ability in risk stratification in severe DCM patients.

Intracoronary cardiosphere-derived cells (icCDCs) infused into the infarct-related artery reduce scar volume but do not improve left ventricular (LV) ejection fraction (LVEF). We tested the hypothesis that this reflects the inability of regional delivery to prevent myocyte death or promote myocyte proliferation in viable myocardium remote from the infarct. Swine ( n = 23) pretreated with oral cyclosporine (200 mg/day) underwent a 1-h left anterior descending coronary artery (LAD) occlusion, which reduced LVEF from 61.6 ± 1.0 to 45.3 ± 1.5% 30 min after reperfusion. At that time, animals received global infusion of allogeneic icCDCs ( n = 8), regional infusion of icCDCs restricted to the LAD using the stop-flow technique ( n = 8), or vehicle ( n = 7). After 1 mo, global icCDCs increased LVEF from 44.8 ± 1.9 to 60.8 ± 3.8% ( P < 0.05) with no significant change after LAD stop-flow icCDCs (44.8 ± 3.6 to 50.9 ± 3.1%) or vehicle (46.5 ± 2.5 to 47.7 ± 2.6%). In contrast, global icCDCs did not alter infarct volume (%LV mass) assessed at 2 days (11.2 ± 2.3 vs. 12.6 ± 2.3%), whereas it was reduced after LAD stop-flow icCDCs (7.1 ± 1.1%, P < 0.05). Histopathological analysis of remote myocardium after global icCDCs demonstrated a significant increase in myocyte proliferation (147 ± 32 vs. 14 ± 10 nuclei/106 myocytes, P < 0.05) and a reduction in myocyte apoptosis (15 ± 9 vs. 46 ± 10 nuclei/106 myocytes, P < 0.05) that increased myocyte nuclear density (1,264 ± 39 vs. 1,157 ± 33 nuclei/mm2, P < 0.05) and decreased myocyte diameter (13.2 ± 0.2 vs. 14.5 ± 0.3 μm, P < 0.05) compared with vehicle-treated controls. In contrast, remote zone changes after regional LAD icCDCs were no different from vehicle. These data indicate that changes in global LVEF after icCDCs are dependent upon preventing myocyte loss and hypertrophy in myocardium remote from the infarct. These arise from stimulating myocyte proliferation and reducing myocyte apoptosis indicating the importance of directing cell therapy to viable remote regions. NEW & NOTEWORTHY Administration of allogeneic cardiosphere-derived cells to the entire heart via global intracoronary infusion shortly after myocardial infarction favorably influenced left ventricular ejection fraction by preventing myocyte death and promoting myocyte proliferation in remote, noninfarcted myocardium in swine. In contrast, regional intracoronary cell infusion did not significantly affect remote zone myocyte remodeling. Global cell administration targeting viable myocardium remote from the infarct may be an effective approach to prevent adverse ventricular remodeling after myocardial infarction.

Funding Acknowledgements Type of funding sources: None. Background Elevated left ventricular (LV) filling pressures are the main physiologic consequence of LV diastolic dysfunction. Left atrial (LA) strain was recently found useful to predict elevated LV filling pressures noninvasively. However, there are few reports on the role of LA strain when predicting LV filling pressure in patients with coronary artery disease (CAD). The aim of this study was to explore the correlation between LA strain and LV end-diastolic pressure (LVEDP) in patients with CAD and preserved LV ejection fraction. Methods Fifty-four patients with stable CAD were enrolled. Global atrial longitudinal strain was measured by averaging all atrial segments. Resorvoir (S-LAs), conduit (S-LAe), and contractile (S-LAa) phase strain were obtained. LVEDP was invasively obtained by left heart catheterization. Results Patients were divided into two groups: elevated LVEDP group (LVEDP > 15mmHg group: n = 23) and normal LVEDP group (LVEDP ≤ 15mmHg group: n = 31). Elevated LVEDP group showed significantly decreased S-LAs and S-LAa (S-LAs: 21.3 ± 7.2% vs. 27.5 ± 7.8%, p Conclusions LA strain, especially S-LAa, provided additional diagnostic value for the noninvasive assessment of LV filling pressure in CAD patients with preserved LV ejection fraction.

Introduction: Chemotherapy related cardiac dysfunction (CTRCD) is an undesired complication of anticancer treatment, roughly affecting 10% of patients undergoing therapy. The American Society of Echocardiography (ASE) and the European Association of Cardiovascular imaging (EACVI) defines CTRCD as a decrease in left ventricular ejection fraction (LVEF) greater than 10% from the lower limit of normal. Using this definition, several patients are diagnosed with CTRCD. Our study aims to understand the context of LVEF decline to help delineate the etiology of LVEF dysfunction in these patients. Methods: A retrospective descriptive study was conducted on registry of adult cancer patients (N=6754) referred to cardio-oncology clinic at the Cleveland Clinic between January 2011 and June 2018. The context of each LVEF decline event was independently adjudicated into one of nine categories: Chemotherapy induced, Valvular Heart Disease, Arrhythmia, Ischemia, Acute Hospitalization, Infiltrative disease, Misdiagnosed, Undifferentiated, or Other. Results: A cohort of patients (N=616) were identified to have CTRCD based on the ASE/EACVI definition. This cohort was 54% female and 80% Caucasian, with a median age of 58 years. In terms of therapy, 50% were exposed to anthracyclines, 15% exposed to HER2 neu inhibitors, 24% exposed to VEGF inhibitors. Upon adjudication of LVEF decline events, 31% of patients had isolated chemotherapy related decline, 24% caused by acute hospitalizations. 13% of events were multifactorial/undifferentiated and 11% of reported events were misdiagnosed. Conclusion: Our findings suggest left ventricular dysfunction in patients undergoing anticancer therapies can be multifaceted. Moreover, only a small proportion of reported CTRCD events were solely due to chemotherapy.

Implantable pacemakers have been the mainstay of therapy for patients with severely decreased left ventricular ejection fractions and recurrent arrhythmias, among other cardiac pathology. Twiddler's syndrome (TS) is an uncommon but potentially life-threatening complication of pacemaker therapy, defined as pacemaker malfunction in the setting of device lead dislodgment due to physical manipulation. Traditionally, there are three distinct TS variants (reeling, ratchet and coiling). This case offers evidence of a unique and new variant of TS, severe recurrent erosive subtype with pacemaker externalization.

AIMS Growth differentiation factor (GDF)-15 mirrors inflammation and oxidative stress in cardiovascular diseases. Brain natriuretic peptide (BNP) is associated with cardiomyocyte stretch in heart failure (HF). The objective of this study was to evaluate the prognostic impact of plasma GDF-15 and BNP in acute HF. METHODS AND RESULTS We studied a subgroup of patients prospectively recruited in an acute HF registry (follow-up: 2 years; endpoint: all-cause mortality). Cox regression multivariate models were built to study the association of GDF-15 and mortality. Further cross-classification according to discharge GDF-15 (mean) and BNP (mean) and association with mortality was studied. We studied 158 patients: seventy-nine were male, mean age was 75 years, 55.1% had left ventricular ejection fraction

Background The study was designed to investigate the effect of heart rate and pacing mode on QRS fragmentation (f‐QRS). Moreover, the usefulness of f‐QRS in distinguishing patients with impaired left ventricular ejection function (EF) and ventricular tachycardia (VT) from patients with normal EF was assessed. Methods Three hundred and six recipients, with dual‐chamber device, with intrinsic narrow or wide QRS complex and preserved atrioventricular conduction were grouped into normal‐EF or impaired‐EF VT. We analyzed intrinsic narrow f‐QRS and wide f‐QRS as well as ventricular‐paced f‐QRS following different heart rates (baseline, 100 bpm) and pacing modes. Results In the baseline state, overall, patients with impaired‐EF VT (35 ± 9%), compared to those with normal‐EF, had more f‐QRS (56% vs 27%, P

[Purpose] The initial cardiopulmonary response to exercise is hypothesized to be a useful predictor of aerobic threshold in patients with heart failure. This study aimed to evaluate the correlation between aerobic threshold and cardiopulmonary responses to exercise onset by comparing patients with heart failure using preserved (≥50%) and reduced (

The aim of the study was to examine the dependence of functional and morphological changes in the brain and factors of the severity of chronic heart failure. Materials and methods: 54 patients with chronic heart failure of ischemic genesis, I-IV functional class were cognitive tests, echocardiography, nuclear magnetic resonance imaging of the brain. Results. With an increase in the functional class of chronic heart failure, the worst results of Veksler-5 and 7 cognitive subtests are noted, a smaller thickness of gray matter of parietal lobes, lower diffusion coefficients of water molecules in the white matter of the parietal and occipital lobes, and a smaller thickness of the middle legs of the cerebellum. Comparative analysis of the central nervous system state indices in patients with chronic heart failure with different fraction of left ventricular ejection did not show significant differences. The conclusion. The established results confirm the significance of the functional class of chronic heart failure as a marker of cognitive dysfunction and pathological changes in both gray and white matter of the brain, whereas the size of the left ventricular ejection fraction is obviously less useful in this respect.

Background: The pre-ejection period (PEP) and left ventricular ejection time (LVET) are easily measured by impedance cardiography (ICG). We hypothesized that the PEP/LVET measured by ICG would correlate with that measured by echocardiography, and that PEP/LVET measured by ICG would be useful for cardiac resynchronization therapy (CRT) optimization. Methods: Newly CRT implanted patients were optimized by echocardiography. The PEP/LVET was measured by echocardiography and ICG in two different settings: optimized setting and right ventricle (RV)-only pacing. Results: The PEP/LVET was significantly decreased in the optimized setting compared with that in RV-only pacing (0.62±0.13 vs 0.75±0.16, p

Background The authors previously observed that some high-performance athletes, irrespective of type of sport, can show echocardiographically determined low left ventricular ejection fractions (LVEF

Background: The prognostic value of LA functional measures in heart failure patients with reduced ejection fraction (HFrEF) is unclear. Therefore, this study investigated the prognostic value of left atrial (LA) functional measures such as the left atrial emptying fraction (LAEF) and the minimal LA volume compared with left atrial volume index (LAVI) in HFrEF patients. Methods and Results: A total of 818 HFrEF patients with left ventricular ejection fractions 2 increase; LAVI: HR 1.06 (P =.16) per 5 mL/m 2 increase. Conclusions: LAEF is an independent predictor of all-cause mortality in HFrEF patients after multivariable adjustment. LAEF provides incremental prognostic value over LAVI in risk stratification of HFrEF patients.

Objetivo: mapear a literatura científica sobre as alterações cardiovasculares de maior incidência em pacientes com SARS-CoV-2 submetidos às unidades de cuidados intensivos. Método: scoping review seguindo o delineamento do Joanna Briggs Institute. Contemplou as bases de literatura branca e cinzenta, sem restrição temporal e idiomática. Realizadas três etapas de seleção dos estudos: seleção por título e resumo; leitura na íntegra dos estudos selecionados e leitura das referências dos estudos incluídos. Os estudos incluídos foram apresentados em síntese narrativa e tabelas. Resultados: obteve-se um total de 2269 publicações, obtendo oito estudos após as etapas de seleção. Os achados mais relevantes foram: leucocitopenia, aumento de marcadores de necrose cardíaca, alteração do segmentos ST, espessamento do ventrículo esquerdo e redução no fluxo de ejeção do ventrículo esquerdo. Conclusão: as alterações cardíacas com maior incidência encontrada nesses pacientes foram as causadas pela resposta inflamatória no coração e a sobrecarga da bomba cardíaca.

BACKGROUND The aim of this study was to assess the long-term clinical tolerance and cardiac safety during trastuzumab treatment for patients diagnosed as having breast cancer with human epidermal growth factor receptor 2 (HER2) overexpression. MATERIAL AND METHODS A total 105 female cases diagnosed as having breast cancer with high expression of Her2, were treated with trastuzumab (T). All of them underwent electrocardiography monitoring in the process of T treatment. Left ventricular ejection fractions (LVEFs) were estimated using echocardiography before the T treatment and every 3 months. General clinical data and above parameters were collected and reviewed as analysis. RESULTS The mean value of LVEFs with baseline was higher than those at other time points. All LVEFs were more than 50% during the course of trastuzumab treatment. The decline scope ≥15% of LVEFs ranged from 2 months to 16 months, and the ratios were counted for 3.1% at 2 months, 4.3% at 6 months, 3.8% at 10 months, and 5.4% at 16 months. Furthermore, a larger decrease of LVEF during the course occurred mainly in the patients with cumulative dose of A >300 mg/m², without CPD and 16-month duration of T treatment. There was a strong correlation between cumulative dose of A, cyto/cardio-protection drugs (CPD), duration of T, and the change of LVEF (P=0.82, P=0.744, and P=0.717, respectively), which indicated that 3 factors may be associated with the change in LVEF (P

Purpose: This study aimed to examine the relationships between the N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels with the sociodemographic and clinical factors, self-care behaviors, and the physical symptom experiences in patients with heart failure. Methods: This cross-sectional study utilized a convenience sample of adult outpatients and inpatients who attended a cardiology department in a tertiary hospital in Seoul, Korea. The data from 154 patients with heart failure were collected using a questionnaire, and their clinical data were extracted from their electronic medical records. Results: Compared with the patients with high NT-proBNP levels, those with low NT-proBNP levels had significantly lower physical symptom experiences scores. Patients with low- and mid-NT-proBNP levels were more likely to be employed compared with those with high NT-proBNP levels. Patients with low NT-proBNP levels had higher left ventricular ejection fractions, and were less likely to have arrhythmias and comorbidities. Conclusion: The results from this study showed that patients with more severe heart failure had higher physical symptom experiences scores; hence, individualizing treatment approaches based on heart failure severity is necessary.

High-risk candidates for percutaneous coronary intervention (PCI) include patients with severe multi-vessel coronary artery disease (CAD), unprotected left main (LM) coronary artery stenosis, or last remaining patent conduit with a stenosis, especially in patients with a left ventricular ejection

Background: The number of adults with heart failure (HF) and HIV infection is increasing. These patients may benefit from palliative care (PC). Objectives: Determine the association between HIV infection, other HIV characteristics, and PC among hospitalized patients with HF in the Veterans Health Administration (VHA). Design: Nested case–control study of patients with HF hospitalized from 2003 to 2015 and enrolled in the Veterans Aging Cohort Study. Setting/Patients: Two hundred and ten hospitalized patients with HF who received PC matched to 1042 patients with HF who did not receive PC, by age, discharge date, and left ventricular ejection fraction. Measurements: Palliative care use was the primary outcome. Independent variables included HIV infection identified by International Classification of Diseases Ninth Revision code and further characterized as the primary diagnosis for hospitalization, unsuppressed HIV-1 RNA, CD4 counts 3, and other covariates. We examined associations between independent variables and PC using conditional logistic regression. Results: The sample was 99% male, mean age was 64 years (standard deviation ±10), 54% of cases and 59% of controls were black, and 30% of cases and 31% of controls were HIV-infected. In adjusted models, HIV as the primary diagnosis for hospitalization (odds ratio [OR]: 3.69, 95% confidence interval [CI]: 1.30-10.52), unsuppressed HIV-1 RNA (OR: 2.62, 95% CI: 1.31-5.24), and CD4 counts 3 (OR: 3.47; 1.78-6.77), but not HIV infection (OR: 0.79, 95% CI: 0.55-1.13), were associated with PC. Conclusions: HIV characteristics indicative of severe disease are associated with PC for hospitalized VHA patients with HF. Increasing access to PC for patients with HF and HIV is warranted.

The major burden of sudden cardiac death (SCD) in patients with heart disease occurs in those with a left ventricular ejection fraction > 40%. Although the annual risk of SCD may be lower in these patients compared to those with lower LVEF, their lifetime cumulative risk of SCD may be greater due to a better overall prognosis. It is plausible that those with LVEF > 40% who are at highest risk of life-threatening arrhythmia will benefit from implantable cardioverter defibrillators. Features that identify patients with a LVEF > 40% at high risk of SCD are urgently needed. We review existing studies examining SCD markers in this sub-group and discuss gaps in the current evidence base.

Background Evaluation of central venous pressure (CVP) by inferior vena cava (IVC) measurements is crucial in the management of patients with cardiogenic shock to optimize drugs therapy. IVC has a complex 3-dimensional (3D) shape but measurements used to estimate CVP remain based on 2-dimensional (2D) echocardiographic imaging. Purpose The aim of this study was to investigate the accuracy of CVP estimation by IVC size and collapsibility index obtained using 3D-echocardiography compared with 2D in patients with cardiogenic shock. Methods Eighty consecutive echocardiographic examinations performed in 33 patients (72 ± 15 years, left ventricular ejection fraction = 19 ± 10%) admitted for cardiogenic shock were prospectively included. Two and three-dimensional images of the IVC, performed at baseline and when CVP was ≤ 10 mmHg, were acquired simultaneous with invasive measurement of CVP, both at rest and during sniff test. 2D and 3D IVC diameters, 3D IVC area and collapsibility index (IVCCI) were assessed. The eccentricity index (EI) was computed from 3D data as the ratio of maximum over minimum IVC diameter. The cut-off value of 10 mmHg of CVP defined patient with euvolemia hemodynamic status. Results At rest, the IVC diameter averaged 23 ± 7 mm by 2D and 25 ± 8 × 19 ± 7 mm by 3D. IVC had an eccentric shape (EI = 1.3) that increased when CVP was ≤10 mmHg and during sniff test (P Fig. 1 ). Conclusions In patients with cardiogenic shock, IVCCI from area by 3D echocardiography is reproducible and accurate to evaluate CVP.

Central arterial pulse pressure (PP), a strong predictor of cardiovascular disease, mainly consists of an incident wave generated by left ventricular ejection and a late-arriving reflected wave emanating from the lower body. We have tested the hypothesis that a reduction in leg vascular tone by heat treatment of the lower leg attenuates the central arterial PP. Pressure and wave properties of the peripheral and central arteries were measured in eight young men before and after heat treatment of the lower leg (temperature approx. 43 °C) for 30 and 60 min, respectively. Following the lower leg heat trial, leg (femoral-ankle) pulse wave velocity (PWV) was significantly decreased, but aortic (carotid-femoral) PWV and parameters of wave reflection and carotid arterial PP did not change significantly. No significant changes were observed in these parameters in the control trial. These results suggest that the reduction in leg vascular tone induced by heat treatment of the lower leg may not affect wave reflection and central arterial PP in young men.

Objectives To determine outcomes following balloon aortic valvuloplasty (BAV) in aortic stenosis (AS) patients with a left ventricular ejection fraction (LVEF)

Background: Left ventricular (LV) afterload patterns consisting of late-systolic loading has been linked to LV remodeling and fibrosis in a number of studies. The contributions from arterial wave reflections (WR) has therefore garnered much interest. Aortic dilation may facilitate the adverse effects of WRs through its effect on aortic inertance. Decreased aortic inertance from aortic dilation is particularly important in late-systole, when the LV-aortic pressure gradient generally reverses and ejection decelerates until time of aortic valve closure. Hypothesis: Decreased aortic inertance from aortic dilation is associated with LV hypertrophy. Methods: We measured carotid-femoral pulse wave velocity (PWV; a measure of arterial stiffness) and LV mass (LVM) with SSFP-MRI in 409 subjects (mean age = 61 years). Aortic geometry was measured using SSFP-MRI, with a novel 3D aortic analyzer (Medical Imaging Applications, Coralville, Iowa). We computed compliance and inertance from PWV and geometric measurements. Reflection magnitude (RM) was calculated from pressure-flow analysis of calibrated carotid tonometry and aortic flow (PC-MRI). Results: A non-linear relationship between inertance and LVM was found, with a more pronounced slope at lower inertance values (Figure). After log-transformation of LVM and adjusting for age, height, weight, sex, and area compliance of the thoracic aorta, decreased aortic inertance was independently associated with increased LVM (standardized β=−0.382; P

Background Overshoot phenomena of the gas exchange ratio (R:VCO2/VO2), ventilatory equivalent for O2 (VE/VO2), and end-tidal O2 pressure (PETO2) are commonly observed during recovery from maximal cardiopulmonary exercise testing (CPX). We investigated the clinical significance of the overshoots of these indices by comparing their magnitudes between healthy subjects and cardiac patients with left ventricular dysfunction. Methods In total, 121 subjects (73 healthy subjects and 48 cardiac patients with left ventricular ejection fraction Results The overshoot phenomena of R, VE/VO2, and PETO2 were observed in all the subjects. The magnitudes of the R (21.4 ± 12.4% vs. 29.3 ± 10.0%, p Conclusions We concluded that the overshoots of R, VE/VO2, and PETO2 during recovery from maximal exercise reflect the natural cardiopulmonary adaptation after exercise and are more prominent in subjects with better cardiopulmonary function.

Introduction: The subaortic diaphragm is a semilunar or circular membrane that is inserted into both the septal wall of the left ventricle and the base or adjacent part of the ventricular surface of the large mitral valve. It represents for 8-20% of all obstacles to left ventricular ejection. Material And Methods: This is a retrospective and descriptive study of patients with aortic stenosis under aortic diaphragmatic surgery operated over an 11-year period (January 2004-December 2015). Our study included 20 patients, 13 of which were male. The sex ratio was 1.85. The average age of patients was 16.6 years [4-51 years]. Stage 2 dyspnea (NYHA) was the primary reason for consultation (17 patients). The heartbeat was regular sinus rhythm in 17 patients. Transthoracic echocardiography (TTE) found left ventricular hypertrophy in 19 patients. The average trans-aortic gradient was 55.68mmHg [24 - 92.5 mmHg]. Aortic insufficiency (IA) was found in 14 patients. An associated congenital heart defect was found in 9 patients. The approach was vertical median sternotomy and transverse aortotomy. The diaphragm was circular in 12 patients and semicircular in 8 patients. The aortic valve was tricuspid in 18 patients and bicuspid in 2 patients. The mean duration of extracorporeal circulation (ECC) was 74.66 minutes [35-119mn] and the mean duration of aortic cross-clamping was 49.11 minutes [20-102mn]. Results: After surgery, disorders of rhythm and conduction were present in 6 patients. At transthoracic ultrasound, left ventricular dysfunction was noted in 3 patients. A tamponade occurred in 1 patient justifying emergency drainage. Two recurrences of subaortic diaphragm were noted, one of which was reoperated after 9 years with a resection of the membrane and a replacement of the aortic valve by a mechanical prosthesis. One death was recorded four days postoperatively. The average postoperative gradient was 21.46mmhg. The average follow-up time was 38 months [5 months - 115 months].

Recent studies have revealed the clinical usefulness of central blood pressure (BP) as an index of risk for cardiovascular disease. The arterial pulse waveform is the sum of the forward pressure wave generated by left ventricular ejection and a backward propagating wave that is subsequently reflected from the peripheral site, and the time point at which these forward and backward propagating waves merge and the amplitude of the reflected (backward) wave affect the level of central BP. The augmentation index (AIx) has been proposed as a measure of the wave reflection, and its clinical usefulness has also been evaluated. In the process, the non-linear relationship between age and AIx, the prognostic value of AIx, and the various effects of antihypertensive drugs on AIx have been shown. However, the clinical usefulness of AIx has not been established, and several questions about its use remain. Future studies will be needed to address these questions, and may contribute to important changes in the management of cardiovascular disease. In this review, we present recent findings on the AIx and discuss the role of this parameter in clinical practice.

La disfunción ventricular después de circulación extracorpórea causa síndrome de bajo gasto cardiaco en el posoperatorio (prevalencia de 10%). Levosimendan es un medicamento para mejorar la disfunción ventricular refractaria. Objetivo: describir la evolución de la función ventricular en adultos después de cirugía cardiaca manejados con levosimendan por disfunción ventricular refractaria en el Hospital de Santa Clara de Bogotá DC, entre octubre 2011 y septiembre de 2012. Métodos: se reportan las características clínicas y la evolución ecocardiográfica de la fracción de eyección (FEVI) con control a las 24 horas y a la semana del posoperatorio. Resultados: se evaluaron 13 pacientes con edad media de 59 años (DE; 10), rango de 39 a 78 años, nueve fueron hombres, dos presentaban diabetes mellitus. La fracción mediana de eyección ventricular izquierda prequirúrgica fue de 50% (RIQ 30%-60%). Como respuesta a la administración de levosimendan la mediana de la FEVI a las 24 horas fue 20% (RIQ 20% - 25%) y 35% a la semana (RIQ 35% - 40%). Dos pacientes fallecieron. Conclusiones: la utilización del levosimendan en pacientes con disfunción ventricular izquierda refractaria contribuye a la mejoría de la fracción de eyección.

A hydraulic teaching model of the human systemic circulation is proposed, based on the principles of the reservoir-wave approach. Reservoir characteristics are portrayed by the arterial tall-and-narrow and venous short-and-wide columns, the relative compliances of which are signified by their diameters. Wave characteristics are represented by proximal arterial and venous resistances; rapid left ventricular ejection and rapid right atrial filling cause flow-dependent pressure drops across the respective resistances. (The value of the proximal arterial resistance is numerically equal to the characteristic impedance.) The pressure drop across the proximal arterial resistance, excess pressure, is understood to be fundamentally wave-related and has been shown to be a measure of the efficiency of cardiac-vascular coupling. Excess pressure also predicts an incremental risk of cardiovascular morbidity and largely accounts for the hysteresis evidenced by an open aortic pressure-volume loop.

UNLABELLED Automated cardiac output measurement (ACOM), which integrates digital color Doppler velocities in space and in time, has been validated using transthoracic echocardiography but has not been tested using transesophageal echocardiography (TEE). Therefore, we determined the feasibility of the ACOM method by TEE in 36 patients undergoing cardiovascular surgery. Regions of interest for ACOM were placed within a color sector across the main pulmonary artery (PA), the mitral annulus, and the left ventricular outflow tract. Cardiac output was determined from the PA flow, the mitral flow, and the left ventricular ejection flow at each view using the ACOM method. We compared measurements of cardiac output derived from the ACOM method with measurements simultaneously obtained by thermodilution (TD). In the mitral flow analysis, the values derived from ACOM correlated well with those from TD (R(2) = 0.85; mean difference = 0.01 +/- 0.58 L/min in the 2-chamber view; R(2) = 0.78; mean difference = -0.10 +/- 0.68 L/min in the 4-chamber view). In the PA flow analysis, the values derived from ACOM did not correlate with those from TD (R(2) = 0.30). In the left ventricular outflow tract analysis, it was very difficult to obtain the optimal view (44%) in which color Doppler flow signals adequately appeared. Using the ACOM method, we obtained good correlation and agreement for cardiac output measurements in the mitral flow analysis compared with TD. The ACOM method is a practical and rapid method to measure cardiac output by TEE analysis of mitral flow. IMPLICATIONS Automated cardiac output measurement by transesophageal color Doppler echocardiography is a practical and rapid method to measure cardiac output. This technique is a promising new approach to echocardiographic quantification in the intraoperative setting.

The left ventricular global function index (LVGFI) is a novel indicator of left ventricular performance. Its role in patients after acute myocardial infarction is unknown. We sought to investigate the relationship between the LVGFI and infarct characteristics as well as left ventricular ejection

Weir et al1 suggest that concentrations of galectin-3 may be tentatively associated with ventricular remodeling after myocardial infarction, particularly in those with relatively higher left ventricular ejection fractions, although the basis of this observation was mainly bivariate correlations and linear regression between galectin-3 values and ventricular volumes; such an approach to inform mechanism is a …

Severe heart failure can be a rare symptom of hypocalcemia. We report a case of a 58 year-old male admitted with a diagnosis of acute coronary syndrome. The ECG showed prolonged QTc interval with severly impared left ventricular ejection fraction recognised in echocardiography. During the hospitalisation hypocalcemia due to primary hypoparathyreoidism was revealed to be the cause of those symptoms.

The measurement of the peripheral arterial tone (PAT) as a diagnostic function for detecting sleep disordered breathing in patients with heart failure and reduced ejection fraction is not carefully studied yet. A prospective series of patients with chronic heart failure (left ventricular ejection

ObjectiveTo characterize the prevalence, incidence, and risk factors for depression before and after cardiac surgery.MethodsPatients awaiting nonemergent surgery (N = 436), completed the Patient Health Questionnaire-9 for depression, as well as the International Physical Activity Questionnaire short version preoperatively (Q1, n = 436) and at hospital discharge (Q2, n = 374). At baseline patients were categorized depression “naïve,” “at risk,” or “depressed.” At each interval patients were identified as “not depressed” (Patient Health Questionnaire-9 score 0-3), “possibly depressed” (score 4-9), or “depressed” (score >9). Multivariate logistic regression analysis identified independent baseline and perioperative variables associated with depression.ResultsDepression prevalence at Q1 and Q2 was 23.6% and 37.7%, respectively (P 7 days (Q2: OR, 1.62; 95% CI, 1.03-2.55; P = .039).ConclusionsDepression is prevalent in one-third of cardiac surgery patients at time of discharge. It is not associated with operative or postoperative risk factors, with the exception of prolonged hospital stay >7 days. Preoperative depression or being at risk for depression, is associated with the highest risk for postoperative depression.

To the Editor: We read with interest the recent article by Clavel et al.1 With respect to their findings, we have the following comments and questions. First, transaortic valve implantation (TAVI) relieves valvular and subvalvular obstruction, whereas surgical aortic valve replacement (SAVR) relieves only valvular obstruction, which may explain the observed differences. We liberally use subaortic myectomy as an adjunct to SAVR for treating subvalvular obstruction and aortic root enlargement for valvular obstruction to left ventricular ejection; perhaps this is the fair comparison with TAVI. Second, stentless aortic valve replacement provides superior reduction of transvalvular gradients.2 It is notable that none of the surgically implanted valves were stentless valves. The authors have previously shown that …

Results The LV ED diameter was larger and LV ejection fraction was smaller in DCM compared to H (61±6 vs 46±4 mm, and 42±5 vs 61±3 %, respectively, both p

Evidence suggests no overall survival benefit if inserted within 40 days Despite major advances during the past two decades in the management of patients with acute myocardial infarction, sudden cardiac death remains an important contributor to overall mortality.1 Several randomised controlled trials have established the effectiveness of implantable cardioverter defibrillators in reducing overall mortality in patients with a history of myocardial infarction and reduced left ventricular ejection fraction.2 Although the risk of sudden cardiac death is greatest in the first 30 days after acute myocardial infarction, especially in patients with left ventricular dysfunction or heart failure,3 two trials found that the insertion of an implantable cardioverter defibrillator at this early stage did not reduce all cause mortality.4 5 A possible reason is an increase in non-arrhythmic death in the early post-infarct period. The findings of many of the early trials of implantable cardioverter defibrillators are reflected in current national and international guidelines, which recommend that these devices should be considered in patients with a previous myocardial infarction (after at least 40 days) and left ventricular ejection fraction below 30-35%⇓.6 7 A recent study has shed further …

Mutations in the X-linked gene encoding dystrophin cause skeletal and cardiac muscle diseases in men. Female "carriers" also can develop overt disease. The purpose of this study was to ascertain the prevalence of cardiac contractile abnormalities in dystrophinopathy carriers.Twenty-four dystrophinopathy heterozygotes and 24 normal women each underwent standard exercise stress echocardiography.Heterozygotes demonstrated mildly lower left ventricular ejection fractions (LVEFs) at rest compared with controls (0.56 + or - 0.10 vs 0.62 + or - 0.07, P = .02). After exercise, the mean LVEF fell to 0.53 + or - 0.14 in heterozygotes but rose to 0.73 + or - 0.07 in controls (P.001). Twenty-one of 24 dystrophinopathy heterozygotes demonstratedor = 1 of the following: abnormal resting LVEF, abnormal LVEF response to exercise, or exercise-induced wall motion abnormality.Women heterozygous for dystrophinopathy demonstrate significant left ventricular systolic dysfunction, which is unmasked by exercise. This finding has mechanistic implications for both inherited and acquired cardiac disease states.

To test the utility of electrocardiographically gated spin echo nuclear magnetic resonance (NMR) imaging in quantitating right and left ventricular volumes and function in patients with primary pulmonary hypertension, right and left ventricular end-diastolic and end-systolic volumes, stroke volumes and ejection fractions were determined in 11 patients with primary pulmonary hypertension and in 10 subjects with normal echocardiographic findings. Ventricular chamber volumes were computed by summing the ventricular chamber volumes of each NMR slice at enddiastole and end-systole. This technique was verified by comparison of results obtained by this method and with the water displacement volumes of eight water-filled latex balloons and ventricular casts of eight excised bovine hearts. In the patients with primary pulmonary hypertension, right ventricular volume indexes were 121 ± 45 ml/m 2 at end-diastole and 70.1 ± 41.6 ml/m 2 at end-systole; both values were significantly greater than values in the normal subjects (67.9 ± 13.4 and 27.9 ± 7.5 ml/m 2 , respectively). Left ventricular end-diastolic volume index was significantly less in the patients (44.9 ± 9.7 ml/m 2 ) than in the normal subjects (68.9 ± 13.1 ml/m 2 ). There was no significant difference in left ventricular end-systolic volume between the two groups (24.4 ± 8.6 and 27.1 ± 7.8 ml/m 2 , respectively). Right and left ventricular ejection fractions in the patients with primary pulmonary hypertension (0.43 ± 0.21 and 0.46 ± 0.15, respectively) were significantly less than values in normal subjects (0.59 ± 0.09 and 0.6 ± 0.11, respectively). The ratio of right to left ventricular stroke volume indexes was 0.97 ± 0.1 in the normal subjects, not significantly different from the expected value of 1. In the patients with primary pulmonary hypertension, this ratio was significantly greater (3.17 ± 2.3), in part reflecting the presence of tricuspid regurgitation in these patients. Intra- and interobserver errors in the computation of ventricular volumes were low but were greater in patients with primary pulmonary hypertension. Nuclear magnetic resonance imaging provides a means of ventricular volume determination in the normal and failing ventricle.

Radionuclide ventriculography was made in 49 asymptomatic diabetic patients, aged 30-70 years, to investigate cardiac function. Comparisons were made with 33 age- and sex-matched non-diabetic controls. Radionuclide ventriculography was performed at rest and during dynamic exercise by multigraded, supine bicycle ergometer. The resting left ventricular ejection fractions were similar between the diabetic patients and control subjects. No significant rise in the left ventricular ejection fractions during dynamic exercise was observed in the diabetic patients [58.4 +/- 9.8% (mean +/- SD) to 60.3 +/- 9.9]. In the control subjects, the left ventricular ejection fractions increased during dynamic exercise [59.3 +/- 8.4 to 63.0 +/- 11.4 (p less than 0.05)]. Peak ejection rates were similar in both groups at rest [-2.62 +/- 0.64 (s-1) vs -2.66 +/- 0.52] and during dynamic exercise [-3.25 +/- 0.74 vs -3.23 +/- 0.90]. Time to end-systole were similar in both groups at rest [315 +/- 42 (ms) vs 309 +/- 42] and during dynamic exercise [258 +/- 37 vs 262 +/- 37]. The resting peak filling rates were similar in both groups [2.27 +/- 0.62 (s-1) vs 2.45 +/- 0.58], and the peak filling rates increased (p less than 0.001) during dynamic exercise in both groups [2.68 +/- 0.61 vs 3.28 +/- 0.74]. However, the percent changes of the peak filling rates were significantly lower in diabetic patients (p less than 0.001). In four of the diabetic patients, hypokinesis of the intraventricular septum was observed.(ABSTRACT TRUNCATED AT 250 WORDS)