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Background: Heart Failure (HF) is associated with increased morbidity and mortality. Identification of patients at risk for adverse events could lead to improved outcomes. Few studies address the association of echocardiographic-derived PAWP with exercise capacity, readmissions, and mortality in HF., Methods: HF-ACTION enrolled 2331 outpatients with HF with reduced ejection fraction (HFrEF) who were randomized to aerobic exercise training versus usual care. All patients underwent baseline echocardiography. Echocardiographic-derived PAWP (ePAWP) was assessed using the Nagueh formula. We evaluated the relationship between ePAWP to clinical outcomes., Results: Among the 2331 patients in the HF-ACTION trial, 2125 patients consented and completed follow-up with available data. 807 of these patients had complete echocardiographic data that allowed the calculation of ePAWP. Of this cohort, mean age (SD) was 58 years (12.7), and 255 (31.6%) were female. The median ePAWP was 14.06 mmHg. ePAWP was significantly associated with cardiovascular death or HF hospitalization (Hazard ratio [HR] 1.02, coefficient 0.016, CI 1.002-1.030, p = 0.022) and all-cause death or HF hospitalization (HR 1.01, coefficient 0.010, CI 1.001-1.020, p = 0.04). Increased ePAWP was also associated with decreased exercise capacity leading to lower peak VO2 (p =  < 0.001), high Ve/VCO2 slope (p =  < 0.001), lower exercise duration (p =  < 0.001), oxygen uptake efficiency (p =  < 0.001), and shorter 6-MWT distance (p =  < 0.001)., Conclusions: Among HFrEF patients, echocardiographic-derived PAWP was associated with increased mortality, reduced functional capacity and heart failure hospitalization. ePAWP may be a viable noninvasive marker to risk stratify HFrEF patients., (© 2023. Japanese Society of Echocardiography.)

Introduction: Pulmonary hypertension (PH) is prevalent in those with end‐stage kidney disease (ESKD) and poses a barrier to kidney transplant due to its association with poor outcomes. Studies examining these adverse outcomes are limited and often utilize echocardiographic measurements of pulmonary artery systolic pressure (PASP) instead of the gold standard right heart catheterization (RHC). We hypothesized that in ESKD patients deemed ineligible for kidney transplant because of an echocardiographic diagnosis of PH the predominant cause of PH is hypervolemia and is potentially reversible. Methods: We conducted a prospective study of 16 patients with ESKD who were denied transplant candidacy. Prior echocardiograms and RHCs were reviewed for confirmation of PH. Patients were admitted for daily sessions of ultrafiltration for volume removal and repeat RHCs were performed following intervention. RHC parameters and body weight were compared before and after intervention. Statistical analysis was performed using PRISM GraphPad software. A p‐value <.05 was considered statistically significant. Results: Following intervention, the mean pulmonary artery pressure (mPAP) and pulmonary arterial wedge pressure decreased from 45.0 ± 3.06 to 29.1 ± 7.77 mmHg (p <.0001) and 22.2 ± 5.06 to 13.1 ± 7.25 mmHg (p =.003), respectively. The pulmonary vascular resistance decreased from 4.73 ± 1.99 to 4.28 ± 2.07 WU (p =.30). Eleven patients from the initial cohort underwent successful kidney transplantation post‐intervention with 100% survival at 1‐year. Conclusions: In ESKD patients, diagnoses of PH made by echocardiography may be largely due to hypervolemia and may be optimized using an intensive ultrafiltration strategy to restore transplant candidacy. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac point‐of‐care ultrasound (c‐POCUS) is an increasingly implemented diagnostic tool with the potential to guide clinical management. We sought to characterize and analyze the existing c‐POCUS literature with a focus on the temporal trends and differences across specialties. Methods: A literature search for c‐POCUS and related terms was conducted using Ovid (MEDLINE and Embase) and Web of Science databases through 2020. Eligible publications were classified by publication type and topic, author specialty, geographical region of senior author, and journal specialty. Results: The initial search produced 1761 potential publications. A strict definition of c‐POCUS yielded a final total of 574 cardiac POCUS manuscripts. A yearly increase in c‐POCUS publications was observed. Nearly half of publications were original research (48.8%) followed by case report or series (22.8%). Most publications had an emergency medicine senior author (38.5%), followed by cardiology (20.8%), anesthesiology (12.5%), and critical care (12.5%). The proportion authored by emergency medicine and cardiologists has decreased over time while those by anesthesiology and critical care has generally increased, particularly over the last decade. First authorship demonstrated a similar trend. Articles were published in emergency medicine (24.4%) and cardiology journals (20.5%) with comparable frequency. Conclusion: The annual number of c‐POCUS publications has steadily increased over time, reflecting the increased recognition and utilization of c‐POCUS. This study can help inform clinicians of the current state of c‐POCUS and augment the discussion surrounding barriers to continued adoption across all specialties. [ABSTRACT FROM AUTHOR]

We are reporting the use of three-dimensional transesophageal echocardiography as a supplement to two-dimensional transesophageal echocardiography in the percutaneous suture closure of the left atrial appendage. [ABSTRACT FROM AUTHOR]

The article offers updates on atrial fibrillation (AF) management. It reviews the classification of AF, the epidemiology, etiology, symptoms and manifestations and the strategic objectives in AF management involving rhythm control, rate control and thromboembolism prevention that can be achieved through non-pharmacological and pharmacological means. It also notes oral anticoagulant therapy, antiarrhythmic drugs, pacemaker therapy and implantable atrial defibrillators.