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Aims: To compare characteristics of left ventricular assist device (LVAD) recipients receiving a cardiac implantable electronic device (CIED) with a defibrillator component (implantable cardioverter-defibrillator and cardiac resynchronization therapy with defibrillation, CIED-D) vs. those without one, and to assess whether carrying such a device contiguously with an LVAD is associated with outcomes., Methods and Results: Overall, 448 patients were analysed (mean age 52 ± 13 years, 82% male) in the multicentre European PCHF-VAD registry. To account for all active CIED-Ds during ongoing LVAD treatment, outcome analyses were performed by a time-varying analysis with active CIED-D status post-LVAD as the time-varying covariate. At the time of LVAD implantation, 235 patients (52%) had an active CIED-D. Median time on LVAD support was 1.1 years (interquartile range 0.5-2.0 years). A reduction of 36% in the risk of all-cause mortality was observed in patients with an active CIED-D [hazard ratio (HR) 0.64, 95% confidence interval (CI) 0.46-0.91; P = 0.012), increasing to 41% after adjustment for baseline covariates (HR 0.59, 95% CI 0.40-0.87; P = 0.008) and 39% after propensity score adjustment (HR 0.61, 95% CI 0.39-0.94; P = 0.027). Other than CIED-D, age, LVAD implant as redo surgery, number of ventricular arrhythmia episodes and use of vasopressors pre-LVAD were remaining significant risk factors of all-cause mortality. Incident ventricular arrhythmias post-LVAD portended a 2.4-fold and 2.6-fold increased risk of all-cause and cardiovascular death, respectively; carrying an active CIED-D remained associated with a 47% and 43% reduction in these events, respectively., Conclusions: In an analysis accounting for all active CIED-Ds, including those implanted during LVAD support, carrying such a device was associated with significantly better survival during LVAD support., (© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology.)

Aims: To evaluate right-ventricular (RV) function during stress echocardiography (SE) and to assess its relationship with exercise capacity in heart failure (HF) patients., Methods and Results: We included 88 patients aged 60.9 +/- 11.2 years with a mean LVEF of 27.2 +/- 9.5%. The following RV parameters were measured at baseline and peak exercise during semi-supine SE: velocity (IVV) and acceleration during isovolumic contraction (IVA), S', E', A', and ratio of early diastolic tricuspid velocity to E' (E/E') and longitudinal strain and strain rate. Patients were stratified into two groups according to their VO(2peak) values: group 1 (n = 35) with VO(2peak) <14 mL/kg/min and group 2 (n = 53) with VO(2peak) >or=14 mL/kg/min. At rest, all analysed variables were similar in the two groups, but during stress IVV, S', and E' were significantly higher and the E/E' ratio significantly lower in group 2. In broad terms, parameters measured at stress correlated much better with VO(2peak) than parameters assessed at baseline. However, results of multivariable analysis determined that the independent predictors of VO(2peak) were solely the left-ventricular (LV) parameters: E/E' and S'., Conclusions: Right-ventricular function (whether at rest or during stress tests) was not significantly associated with exercise capacity in our patients with HF. In contrast, systolic and, to a greater extent, diastolic LV parameters during the stress tests emerged as the most important indicators linked to exercise capacity in HF.

Aim: To assess changes of systolic function using tissue Doppler imaging (TDI) during stress echocardiography and its impact on exercise capacity in heart failure (HF) patients (pts)., Material and Methods: 80 pts (65 male), mean age of 59.3 +/- 10.9 years, NYHA class 1.95 +/- 0.8, left ventricle ejection fraction (LVEF) 27.2 +/- 9.5 (10-45%). The etiology of HF was ischemic (ICM) in 50 pts and dilated cardiomyopathy (DCM) in 30 pts. Peak myocardial velocity (IVV) and acceleration (IVA) during isovolumic contraction and peak myocardial velocity during ejection phase (S') were measured at baseline and peak exercise during semi-supine stress-echo (20 Watts, 2-min increments). Concurrently peak oxygen uptake (VO(2) peak) was measured., Results: Rest values of analyzed parameters were comparable in groups according to etiology of HF and physical capacity. However, peak stress parameters mainly S' were significantly higher in the DCM group and the group with better VO(2) peak. The best correlation with exercise capacity was S' at peak stress (r = 0.66; p < 0.0001). The most useful parameter for identifying severe exercise intolerance, VO(2) peak < 14 ml/kg/min, was S' with an area under ROC curve of 0.82 +/- 0.05 (95% CI 0.71-0.89). The cutoff of 5.75 cm/s for S' at peak stress showed a sensitivity of 61% with a specificity of 96%., Conclusions: The evaluation of systolic function by means of TDI instead of LVEF shows more clearly that systolic function is at least partly responsible for exercise tolerance in HF. Assessment of echocardiographic systolic parameters at peak stress provides more accurate information about exercise capacity in HF pts.

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