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Background: In patients with type 2 diabetes (T2D) and a history of heart failure (HF), sodium-glucose cotransporter-2 inhibitors (SGLT2is) have demonstrated cardiovascular (CV) benefits. However, the comparative efficacy of individual SGLT2is remains uncertain. This network meta-analysis (NMA) compared the efficacy and safety of five SGLT2is (canagliflozin, dapagliflozin, empagliflozin, ertugliflozin, and sotagliflozin) on CV outcomes in these patients. Materials and methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched up to September 23, 2022, to identify all randomized controlled trials (RCTs) comparing SGLT2is to placebo in T2D patients with HF. The main outcomes included composite CV death/heart failure hospitalization (HFH), HFH, CV death, all-cause mortality, and adverse events. Pairwise and NMA approaches were applied. Results: Our analysis included 11 RCTs with a total of 20,438 patients with T2D and HF. All SGLT2is significantly reduced HFH compared to standard of care (SoC) alone. "Add-on" SGLT2is, except ertugliflozin, significantly reduced composite CV death/HFH relative to SoC alone. Moreover, canagliflozin had lower composite CV death/HFH compared to dapagliflozin. Based on the surface under the cumulative ranking curve (SUCRA), the top-ranked SGLT2is for reducing HFH were canagliflozin (95.5%), sotagliflozin (66.0%), and empagliflozin (57.2%). Head-to-head comparisons found no significant differences between individual SGLT2is in reducing CV death. "Add-on" SGLT2is reduced all-cause mortality compared with SoC alone, although only dapagliflozin was statistically significant. No SGLT2is were significantly associated with serious adverse events. A sensitivity analysis focusing on HF-specific trials found that dapagliflozin, empagliflozin, and sotagliflozin significantly reduced composite CV death/HFH, consistent with the main analysis. However, no significant differences were identified from their head-to-head comparisons in the NMA. The SUCRA indicated that sotagliflozin had the highest probability of reducing composite CV death/HFH (97.6%), followed by empagliflozin (58.4%) and dapagliflozin (44.0%). Conclusion: SGLT2is significantly reduce the composite CV death/HFH outcome. Among them, canagliflozin may be considered the preferred treatment for patients with diabetes and a history of heart failure, but it may also be associated with an increased risk of any adverse events compared to other SGLT2is. However, a sensitivity analysis focusing on HF-specific trials identified sotagliflozin as the most likely agent to reduce CV death/HFH, followed by empagliflozin and dapagliflozin. [ABSTRACT FROM AUTHOR]

The article discusses the 2023 HFCT Focused Update of the 2019 HFCT Heart Failure Guidelines Part 2, addressing the diagnosis and management of HFmrEF and HFpEF. Topics include prevalence and clinical characteristics of HFmrEF, diagnosis criteria, and treatment recommendations, emphasizing the potential benefits of SGLT2 inhibitors.

The article highlights the updated version of the Heart Failure Council of Thailand (HFCT) heart failure guidelines for the year 2022. Topics mentioned include the terminology of heart failure staging and classification, the cautions and contradictions before start of angiotensin-neprilysin inhibitor (ARNI), the contraindications of ARNI, and the factors that need to consider for the pharmacologic treatment of heart failure with reduced ejection fraction.

In 2011, the Heart Association of Thailand (HAT) approved the first Thai guideline for the diagnosis and management of patients with pulmonary hypertension (PH). Since then, significant changes have occurred in the diagnosis and management of patients with PH, such as risk assessment and new strategies for combination therapies based on the 2015 European Society of Cardiology (ESC)/European Respiratory Society (ERS) pulmonary hypertension guidelines. The most recently updated definition of PH was from the Sixth World Symposium on Pulmonary Hypertension in 2018. Hence, HAT has revised the Thai guidelines for the diagnosis and management of patients with PH, which was approved by the Royal College of Physicians of Thailand in 2019. These guidelines are intended for use by 1) general practitioners for preliminary diagnoses and referral to a PH referral center and 2) specialist physicians such as cardiologists and pulmonologists, to collaborate in the caring process and diagnosis and management, including the use of Pulmonary artery hypertension (PAH)-specific drugs. The guidelines were written in Thai language to be easily understood and approved by HAT and the Royal College of Physicians of Thailand in 2019. The current executive summary is aimed to highlight important details of the 2020 Thai Pulmonary Hypertension Guidelines for a broader distribution. This updated version of the executive summary of the guidelines is aimed to achieve three objectives, 1) early diagnosis by using the algorithm, including pathophysiology into one of five PH groups, 2) risk assessment for PAH patients into low, intermediate, or high risk, and 3) sequential combination therapy as indicated by the risk assessment for PAH-specific drugs to maintain PAH patients within the low-risk group as much as possible to improve their long-term survival. [ABSTRACT FROM AUTHOR]

Background and Objective: Echocardiography is usually performed to quantify the severity of regurgitation. Magnetic resonance imaging (MRI) can also quantify mitral regurgitation. This study was performed to determine whether MRI can reliably quantify the severity of mitral regurgitation when compared with echocardiography, Material and Method: The authors retrospectively studied patients who underwent cardiac MRI between January 2008 and January 2011. Echocardiography was performed within 3 months of MRI. Mitral regurgitation was quantified by 3 methods of MRI; 1) difference of left ventricular stroke volume and right ventricular stroke volume, 2) difference of left ventricular stroke volume and forward flow volume in ascending aorta and 3) calculation of regurgitation fraction from the ratio of area of regurgitantjet and area of the left atrium. Proximal isovelocity surface area was the echocardiography parameter for mitral regurgitation., Results: Forty-three subjects (24 women and 19 men; 47 to 85 years of age) were enrolled. Mitral regurgitation grading by MRI (2nd method) was mild (n = 28) moderate (n = 11) and severe (n = 4). There was moderate correlation between echocardiography and MRI assessments of regurgitation volume as follows; (1) difference between left ventricular stroke volume and right ventricular stroke volume (r = 0.48, p = 0.016), (2) subtracting forward flow volume of ascending aorta from left ventricular stroke volume (r = 0.48, p = 0.012). There was also correlation between regurgitation volume by echocardiography and fraction of maximal area of regurgitant jet divided by the area of the left atrium (r = 0.72, p < 0.001)., Conclusion: Cardiac MRI compares favorably with echocardiography for quantifying mitral regurgitation severity.

Background: Patients with non ST-segment elevation acute coronary syndrome (NSTEACS) present with diverse clinical, electrocardiographic, cardiac biomarker, echocardiographic and angiographic characteristics. We sought to determine whether there was any difference in the indices of left ventricular systolic and diastolic function among subgroups of patients with NSTEACS., Material and Method: We studied 121 consecutive patients (mean age 68.6 +/- 11.3 years, 45% male) with NSTEACS who underwent comprehensive echocardiography within 48 hours of admission. Two-dimensional and Doppler echocardiography was performed for the evaluation of left ventricular systolic and diastolic function., Results: Non ST-segment elevation myocardial infarction (NSTEMI) and unstable angina (UA) were reported in 59% and 41% of patients, respectively. Clinical characteristics (such as age, gender, cardiovascular risk factors, prior myocardial infarction and revascularization, medication) were not significantly different between patients with NSTEMI and UA. Patients with NSTEMI were more likely to have wall motion abnormalities and lower left ventricular ejection fraction (p < 0.05) as compared to those with UA. Diastolic dysfunction was significantly more frequent and more severe in patients with NSTEMI than in those with UA., Conclusion: Among patients with NSTEACS, left ventricular systolic and diastolic dysfunction was more frequent and more severe in patients with NSTEMI that in those with UA. These findings may be used to characterize the sicker group among patients with NSTEACS.

Background: Standard aortic root dimensional measurement by the two dimensional echocardiography should be routinely performed in all patients. There is limited data on the normal reference on Thai population., Objective: Aims of this study were (1) to determine the normal reference of aortic root dimension in Thai population and (2) to determine the difference in the aortic root size in patients with hypertension comparing with normal population., Material and Method: We retrospectively reviewed 81 patients who had the transthoracic echocardiographic examinations in our echocardiographic lab and had the aortic root measurement data. The patients with ascending aortic aneurysm, aortic dissection, aortic stenosis and/or regurgitation more than mild in degree, Marfan's syndrome and annuloaortic ectasia were excluded. The echocardiographic data of were collected; the aortic root dimensions at four levels; aortic valve annulus, sinus of Valsava, sinotubular junction and tubular parts. Hypertension was indentified if the patient had the prior diagnosis of hypertension and on antihypertensive medications, or who had blood pressure more than 140/90 mmHg for two or more occasions., Results: Eighty-one patients were enrolled. Sixty patients (74.1%) were diagnosed hypertension. Mean age was 66.9 +/- 11.2 years in hypertensive patients and 49.1 +/- 16.4 years in normotensive patients. Normal reference values based on 95% upper normal limit of aortic valve annulus, sinus of Valsava, sinotubular junction and tubular part were 2.30 (2.21-2.38), 3.56 (3.35-3.77), 2.79 (2.61-2.97), and 3.36 (3.13-3.59), respectively. Patients with hypertension had significant larger sinus of Valsava and tubular part of aortic root than patients with normotension., Conclusion: We reported a normal reference value for aortic root size in Thai population. The aortic root sizes are influenced by hypertensive status, age and gender.