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The novel COVID-19 has had an unprecedented and devastating spread internationally. COVID-19 infection can lead to a number of cardiovascular sequelae, including heart failure, which may portend worse clinical outcomes. Here, we report a rare case of a 57-year-old woman who developed acute left ventricular systolic dysfunction with apical ballooning consistent with takotsubo cardiomyopathy (TCM), and mixed cardiogenic and septic shock in the setting of COVID-19 disease. We briefly review the pathophysiology and diagnosis of TCM (also described as apical ballooning syndrome and stress-induced cardiomyopathy). Additionally, this case highlights the importance of a multidisciplinary approach to clinical decision-making and resource allocation in diagnosis and management of critical illness in the setting of the ongoing international COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Takotsubo syndrome (TTS), or apical ballooning syndrome, is a transient and usually reversible form of cardiac dysfunction. It has classically been described in women with cardiac susceptibility when exposed to emotional or physical stress. Various hypotheses on the pathophysiology of TTS have been suggested, but the underlying mechanism remains unknown. There is increasing recognition of the sex differences in the presentation, triggers, severity, and complications of TTS. A literature review was conducted and found 75 relevant articles on PubMed Cochrane Library, and Google Scholar from 2001 to 2019 regarding TTS. We found remarkable sex differences existed in the underlying triggers, pathophysiology, illness severity, complications, and mortality. However, no sex differences were identified for baseline transthoracic echocardiogram findings, age at presentation, presenting symptoms, recurrence, and treatment approach. Much information regarding TTS remain lacking, but collaboration of national and international registries will be beneficial in addressing these gaps. [ABSTRACT FROM AUTHOR]

To improve heart failure quadruple therapy implementation and adherence at a large urban academic medical center. Heart failure (HF) affects over 6 million Americans and remains a burden on many US health care systems with rising cost. Despite strong evidence supporting the use of life saving medical therapy for HF with reduced ejection fraction (HFrEF), gaps persist in implementation. At a large urban academic medical center, strategies were targeted to increase the adherence and utilization of guideline directed medical therapy (GDMT) based on the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. An interdisciplinary team including advanced heart failure physicians and APPs, general cardiologists, the readmission engagement, and care transition (REACT) service, hospitalists, residents, fellows, social workers, nurses, and pharmacy was established. A HF risk score was developed in the electronic medical record to identify hospitalized patients with HF. HF quadruple medical therapy (beta blockers, mineralocorticoid receptors antagonist (MRAs), renin-angiotensin-aldosterone system (RAAS) inhibition, SGLT2i) was initiated in tandem with pharmacy support to assist with prior authorizations, monitoring for safety, and inpatient prior authorization to identify coverage barriers. Sodium-glucose contransporter-2 inhibitor (SGLT2i) was also added to the inpatient formulary. After hospital discharge a Care transition program consisting of case management, HF social workers, patient navigators, and advanced practice providers (APPs) provided care transition calls and follow up visits. To continue optimization and utilization of HF medical therapy an outpatient best practice advisory (BPA) reminded providers to start or increase HF GDMT. The hospital discharged 472 patients in 2020, 985 patients in 2021 and 578 patients with HF between Jan. -Aug. 2022. 48.6% of patients had a reduced ejection fraction (EF). HF Quadruple therapy medication inpatient prescribing showed an improvement from 6.7% in 2020 to 61.8% in 2022. SGLT2i at discharge also had an improvement in utilization from 3.4% in 2020 to 80% in 2022. The use of quadruple therapy was tracked over 30 days, 60.9% of patients remained on quadruple medication therapy. The results show an 822% improvement in adherence of quadruple medication therapy from 2022 to 2022. There was a 2,250% improvement in SGLT2i prescribing at discharge from 2020 to 2022. Overall heart failure 30-day readmission rate showed an improvement with 20.72% rate in 2020 to 17.2% in 2022. Implementation and optimization of GDMT in HF patients requires a multidisciplinary team approach. Pharmacy involvement and access to medications on inpatient formulary are critical for initiation and increasing medication compliance. Identifying patients with HF and having a dedicated team to ensure close follow up is essential in optimizing HF GDMT and reducing readmissions. In addition, the use of a HF BPA in outpatient clinics can further improve HF best practices. [ABSTRACT FROM AUTHOR]

This document is a report from the American Journal of Medical Quality that discusses two different interventions aimed at improving healthcare outcomes. The first intervention focuses on reducing heart failure readmissions at Rush University Medical Center. By implementing a transitional care program and closely monitoring high-risk patients, Rush was able to decrease readmission rates and improve overall cardiology readmission rates. The second intervention focuses on reducing costs within an integrated healthcare system by promoting the use of less expensive biosimilar drugs. Sharp HealthCare achieved high biosimilar adoption rates, resulting in significant cost savings and improved financial outcomes. Both interventions demonstrate successful strategies for improving patient care and reducing healthcare costs. [Extracted from the article]

Introduction: The abnormal structure, function and molecular makeup of dilated cardiomyopathic hearts can be partially normalized in patients supported by a left ventricular assist device (LVAD), a process called reverse remodeling. This leads to recovery of function in many patients, though the rate of full recovery is low and in many cases is temporary, leading to the concept of heart failure remission, rather than recovery. Areas covered: We summarize data indicative of ventricular reverse remodeling, recovery and remission during LVAD support. These terms were used in searches performed in Pubmed. Duplication of topics covered in depth in prior review articles were avoided. Expert commentary: Although most patients undergoing mechanical circulatory support (MCS) show a significant degree of reverse remodeling, very few exhibit sufficiently improved function to justify device explantation, and many from whom LVADs have been explanted have relapsed back to the original heart failure phenotype. Future research has the potential to clarify the ideal combination of pharmacological, cell, gene, and mechanical therapies that would maximize recovery of function which has the potential to improve exercise tolerance of patients while on support, and to achieve a higher degree of myocardial recovery that is more likely to persist after device removal. [ABSTRACT FROM AUTHOR]

Objective Peripartum cardiomyopathy ( PPCM) is a rare cause of heart failure that develops in the last month of pregnancy or within 5 months of delivery. Longitudinal systolic strain has been shown to be impaired in HF patients with both preserved and depressed EF, but has not previously characterized in patients with PPCM. Methods The purpose of our study was to investigate the prognosis and recovery in patients with PPCM and use 2D strain imaging to characterize regional and global LV strain in patients with PPCM. Between 2009 and 2014, we identified 47 newly diagnosed patients with PPCM and reduced EF ( rPPCM), and 14 patients within the first 4 weeks postpartum who presented with signs and symptoms of HF, and elevated BNP/pro- NT- BNP, but preserved LVEF ( pPPCM). We compared the echocardiographic characteristics of the patients with rPPCM and pPPCM with 14 healthy controls. Results All-cause mortality was 10.6% (5/47) and rehospitalization for HF rate was 31.9% (15/47) at a median follow-up of 12.5 months (range: 1-60 months) in the rPPCM group. In 25.5% (12/47) of patients with rPPCM, there was no recovery or worsening of LVEF, while complete and partial (more than 10% increase but less than 55%) recovery was seen in 57.4% (27/47) and 17% (8/47) of patients, respectively. Global and longitudinal strain ( GLS) values were not independent predictors of all-cause mortality or the composite endpoint of all-cause mortality, rehospitalization, or no LVEF recovery in these patients. GLS and segmental strain were significantly lower in the preserved EF group compared with controls but higher compared with PPCM with reduced EF. Conclusion Global and segmental longitudinal strain parameters were significantly reduced in PPCM patients. [ABSTRACT FROM AUTHOR]

Background Data on left ventricular (LV) strain profiles in patients with takotsubo cardiomyopathy (TC) in comparison with obstructive coronary artery disease (CAD) are limited. We sought to investigate regional and global LV longitudinal strain in a cohort of patients with known TC using two-dimensional strain imaging (2DS) in comparison with patients with acute cardiomyopathy (ACM) due to severe obstructive left anterior descending arterial disease or triple-vessel disease and healthy controls. Methods Transthoracic echocardiography was performed in 34 patients with established TC, 24 patients with ACM, and 30 healthy subjects. We measured the segmental longitudinal strain in apical views by the use of EchoInsight Epsilon software. Left ventricular global longitudinal strain (GLS) was calculated by averaging segmental wall strains. Results The TC and ACM groups were comparable for age and demographic characteristics. Systolic and diastolic function were significantly impaired in both groups compared to controls. LV global and segmental systolic strain was also significantly attenuated in patients with TC and ACM compared to controls (P < 0.001). Moreover, LV basal segmental longitudinal strain was higher in the patients with TC compared to ACM (P = 0.02). Global and apical segmental strain appear to be higher in patients with mid-ventricular variant compared to those with apical variant of TC with apical strain cutoff value of −7.85%, offering the best discriminatory value for differentiating these two patterns (P = 0.001). Conclusions The results of this hypothesis-generating study indicate that longitudinal LV strain parameters are similarly impaired in patients with TC and ACM due to severe obstructive left anterior descending arterial disease or triple-vessel disease. Assessment of two-dimensional LV strain parameters could help differentiate between different TC patterns. [ABSTRACT FROM AUTHOR]

The article discusses echocardiogram images that showed a fenestrated congenital membrane of the left atrial appendage orifice (LAA) in a 22-year-old woman with hypertension and end-stage renal disease.

Purpose of Review: Heart failure (HF) is a growing epidemic that can be prevented. Since hypertension is one of the most prevalent medical conditions and leading causes of morbidity and mortality, aggressive treatment is essential, especially for those at risk for HF.Recent Findings: There has been significant evidence developed over the past decade highlighting the necessity for rigid blood pressure management; with more recent guidelines addressing the importance of preventing hypertension from progressing to HF.Summary: In this review, we discuss hypertension management strategies as a preventative tool for HF development. [ABSTRACT FROM AUTHOR]

A Continuing Medical Education activity in the September 2016 issue of "Echocardiography" on the article "Longitudinal Systolic Strain Profiles and Outcomes in Peripartum Cardiomyopathy" is presented.