Search

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.

From the correlation between the blood flow dynamics and wall dynamics in the left ventriocle (LV) analyzed using echo-dynamography, the ejection mechanisms and role of the intra-ventricular vortex in the LV were elucidated in detail during the pre-ejection transitional period (pre-ETP), the very short period preceding LV ejection. The study included 10 healthy volunteers. Flow structure was analyzed using echo-dynamography, and LV wall dynamics were measured using both high-frame-rate two-dimensional echocardiography and a phase difference tracking method we developed. A large accelerated vortex occurred at the central basal area of the LV during this period. The main flow axis velocity line of the LV showed a linearly increasing pattern. The slope of the velocity pattern reflected the deformity of the flow route induced by LV contraction during the pre-ETP. The centrifugal force of the vortex at its junction with the main outflow created a stepwise increase of about 50% of the ejection velocity. Ejection of blood from the LV was accomplished by the extruding action of the ventricular wall and the centrifugal force of the accelerated vortex during this period. During ejection, acceralated outflow was considered to create a spiral flow in the aorta with help from the spherical structure of the Valsalva sinus.

Background Patients with heart failure with preserved ejection fraction (HFpEF) may have elevated left ventricular filling pressure with exercise (LVFP-ex), despite normal LVFP at rest. The aim of this study was to assess the diagnostic value of resting left atrial strain (LAS) in detecting elevated LVFP-ex in patients with dyspnea evaluated on exercise stress echocardiography. Methods Two-dimensional speckle-tracking analysis for LAS was performed in 669 consecutive patients (mean age, 64 ± 14 years; 53% men) who underwent treadmill echocardiographic evaluation and had left ventricular ejection fractions ≥ 50%. Assessment of LVFP at rest LVFP-ex was based on the 2016 American Society of Echocardiography guidelines for diastolic function assessment. An E/e′ ratio ≥ 15 after exercise is considered to indicate elevated LVFP-ex. A continuous diagnostic score of HFpEF was calculated on the basis of the European Society of Cardiology HFA-PEFF diagnostic algorithm. Results LASreservoir was lowest in patients with elevated LVFP at rest (n = 81) and lower in those with normal resting filling pressure who developed elevated LVFP-ex (n = 108) compared with those who maintained normal LVFP-ex (29.0 ± 5.2% vs 33.1 ± 5.0% vs 39.3 ± 4.8%, P Conclusions LASreservoir has potential to identify patients with intermediate scores for HFpEF who may develop elevated LVFP-ex only and is therefore a promising alternative to aid in diagnosis when exercise testing is not feasible.

Patients with left ventricular ejection fractions between 40% and 49% either discovered de novo, having declined from ≥50%, or improved from40% have been described as heart failure (HF) with mid-range ejection fraction (HFmrEF). Though clinical signs and symptoms are similar to other phenotypes, possible prognostic differences and therapeutic responses reinforce the need for further understanding of patients' characteristics especially in a rural community based population. The purpose of this study is to evaluate the clinical characteristics, comorbidities and prognosis of a rural patient population with HFmrEF.We queried the electronic medical record from a community based university practice for all patients with a HF diagnosis. We included only those patients with3 months follow-up and interpretable Doppler echocardiograms. We recorded demographic, Doppler-echo, and outcome variables (up to 2,083 days).There were 633 HF patients: 42.4% with preserved ejection fraction (HFpEF, EF ≥50%), 36.4% with HFmrEF, and 21.0% with reduced ejection fraction (HFrEF, EF40%). HFmrEF patients were older, had greater coronary disease prevalence, lower systolic blood pressure, elevated brain natriuretic peptide, lower hemoglobin, and higher creatinine than HFpEF. All-cause mortality was intermediate between HFrEF and HFpEF but was not significantly different. Landmark analysis revealed a trend toward greater second readmission in HFmrEF as compared to HFpEF (hazard ratio: 1.43 [0.96-2.14],P = 0.0767).Rural patients with HFmrEF without an ambulatory HF clinic represent a higher percentage of HF patients than previously reported with greater coronary disease prevalence with comparable readmission rates and nonsignificantly different all-cause mortality.

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.

The application of myocardial strain by two-dimensional speckle-tracking to quantify right ventricular (RV) function has recently been endorsed by the American Society of Echocardiography/European Association of Cardiovascular Imaging Joint Industry Task Force, with emphasis on the need for standardization and quality control.1 However, there are no specific recommendations to date for the level of training required for accurate RV strain analysis for independent reporting. Our group has previously demonstrated the existence of a learning curve for left ventricular global longitudinal strain analysis,2 while others have demonstrated similar learning curves for wall motion analysis during stress echocardiography3 and visual estimation of left ventricular ejection fraction.4 The aim of this study was to determine whether there is a learning curve for RV longitudinal strain analysis for novice readers to achieve independent competency in consistency and reproducibility.

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

IntroductionIntracardiac rhabdomyomas can cause severe ventricular dysfunction and outflow tract obstruction.Case reportA term newborn infant with antenatal diagnosis of giant left ventricle rhabdomyoma presented with cardiac failure and duct-dependent systemic circulation after birth. She was treated successfully with everolimus, showing decrease in tumour size and improvement in left ventricular ejection fraction.DiscussionTumour regression rate was 0.32 cm2/day and improved to 0.80 cm2/day with the use of everolimus. Herein we report a newborn with inoperable giant left ventricular cardiac rhabdomyoma and significant regression of the tumour. To our knowledge, this is the largest left ventricular rhabdomyoma reported. A review of the literature was undertaken for comparison.ConclusionEverolimus has proven to be efficacious in size reduction of cardiac rhabdomyomas in cases when surgical resection is not possible.

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 Follow-up costs among heart failure (HF) patients place a heavy burden on healthcare. We sought to quantify follow-up costs after a HF hospitalization, as well as, length of stay (LOS), time to readmission and mortality for patients with preserved (HFpEF) versus reduced (HFrEF) left ventricular ejection fractions. Methods We developed a retrospective cohort of consecutively admitted acutely decompensated HF patients who had at least 1 follow-up visit. We extracted baseline clinical data from electronic medical records, and collected follow-up data on number of readmissions, length of stay, mortality over a 2-year period, and cost data from our hospital's accounting system. Kaplan-Meier curves and log rank tests were used to evaluate survival and time to first readmission in the two HF groups. Results Our study included 444 patients, of whom 224 (51%) had HFrEF. Patients with HFrEF compared to HFpEF had higher median total costs per month alive during the 2-year follow-up period ($1684 vs. $1496, p = 0.02), and median inpatient costs per month alive ($1368 vs. $991, p = 0.03). HFrEF patients had higher total mean LOS per month alive post index hospitalization discharge (1.6 vs 1 days, p = 0.003). Similarly, HF related mean LOS per month alive was higher for HFrEF patients than for HFpEF patients (1.3 vs 0.3 days, p = 0.003). Patients with HFrEF had a trend for shorter time to first readmission and survival compared to those with HFpEF. Conclusions At 2 years following their index HF admission, patients with HFrEF have higher costs and longer LOS compared to HFpEF patients.

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.

There is a J-like dependence of mortality among patients with chronic heart insufficiency (CHI) on arterial pressure (AP). This implies the possibility of not only elevation but also fall of AP in such patients. The aim of the study was to determine the frequency and prognostic value of arterial hypotension episodes in CHI patients with preserved left ventricular ejection function (CHI-PEF). Materials and methods. The study included 169patients (74 men and 95 women) with CHI (mean age 56,3±10,9 yr). All of them had PEF higher than 50%. 105 patients had FCII CHI, 64 ones FCIII CHI. Stage IIA was documented in 136 and stage IIB in 33 patients. Duration of the study 24 months. The combined end point included non-fatal myocardial infarction and cardiovascular death. Results. Arterial hypotension at office AP was diagnosed in 16 (9,5%) patients, transient arterial hypotension based at 24 hr AP monitoring in 104 (61,6%) patients. A total of 8 combined end points were documented during the study period. All these patients had transient systole-diastolic and/or systolic arterial hypotension . No myocardial infarction or lethal outcome developed in CHI patients without episodes of arterial hypotension (x=4,28, р=0,04). Conclusion. 24 hr AP monitoring in CHI-PEF patients permits to significantly increase the frequency of detection ofpotentially dangerous changes of AP. Transient arterial pressure occurs in 61.6% of the FCII-III CHI-PEF patients. Transient systole-diastolic arterial hypotension significantly increases the risk of non-fatal myocardial infarction and cardiovascular death in CHI-PEF patients.

The prognosis of hypertensive patients with reduced left ventricular ejection fraction (LVEF) is poorer than that with normal LVEF. The influence of LVEF on blood pressure (BP)-lowering therapy remains unclear. The aim of this study was to clarify the impact of LVEF on clinical outcomes of BP-lowering therapy in hypertensive patients with coronary artery disease (CAD).This study was a post hoc analysis from Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Heart Disease trial, a total of 2049 hypertensive patients with CAD were included. We analyzed 1849 patients with available LVEF data on enrollment. They were divided into three groups based on LVEF; reduced (45%, n = 386), intermediate (45-55%, n = 524), and preserved (55%, n = 999). The 'achieved SBP' was defined as the mean value of SBP in patients who did not experience major adverse cardiac events (MACE) and the mean value of SBP prior to MACE in those who experienced MACE.During a median follow-up period of 4.2 years, MACE rates were 30.6, 27.6, and 24.0% in the reduced, intermediate, and preserved LVEF groups, respectively. A J-shaped association between achieved SBP and MACE was observed only in the preserved LVEF group [hazard ratio of MACE in patients with lower SBP (achieved SBP 120 mmHg) was 1.81 (1.13-2.90) compared to reference SBP patients (120 achieved BP 130 mmHg)], but not in the reduced or intermediate LVEF groups.In hypertensive patients with CAD, the goal of BP-lowering therapy should consider LVEF status.

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

This study presents a novel fully-automated mechanism for MRI-based profiling of left-ventricular (LV) chamber quantities and mechanical properties (3D strains, twist and torsion) for the cardiac cycle. Comprehensive LV contractile analysis was conducted by extending a validated semi-automated methodology for spatiotemporal myocardial boundary detection, whose underlying algorithm consists of a multi-threshold image quantization process and 3D phase-unwrapping of complex MRI images acquired with the Displacement Encoding with Stimulated Echoes (DENSE) sequence. Demonstrating this tool’s feasibility included cross-validating computations of LV torsion using two different techniques (a boundary deformation-based and a strain-based one) and by showing how torsional mechanics correlate with ejection fraction (EF) in the phase following isovolumetric contraction. The quantization and displacement results acquired in all 2D partitions at subsequent timeframes lead to 3D LV reconstructions and determination of contractile parameters in N=15 healthy subjects. Statistical tests consisted of Bland Altman analysis of results from the two torsional computations and establishing correlations between EF and torsion.Bland Altman biases and limits of agreement between the two methods for regional torsions were 0.20 ± 2.4° and 0.19 ± 1.97° for the mid-ventricular and basal sub-regions (both relative to apex), respectively. Strong Pearson’s correlations found between torsion and EF were R2 = 0.80 (p < 0.001) and R2 = 0.82 (p < 0.001) for the mid-ventricular and basal segments, respectively. The results from the statistical analysis demonstrate that the methodology developed for comprehensive cardiac contractility analysis can be used reliably in healthy subjects, with a potential for extending application in diagnosing cardiac dysfunction.

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.

The aortic and mitral valve share a common fibrous border call the aortic-mitral curtain. Due to this anatomic linkage, normal aortic and mitral valve function are interdependent demonstrating coupled reciprocal behavior. Thus, during the cardiac cycle when aortic annular area is at its maximum, mitral annular area is at its minimum and vice versa. Additionally, the angle between the aortic and mitral valves is smallest during left ventricular ejection. Overall, this annular area reciprocity and angulation likely play a role in the efficiency of the heart as a pump.

Summary Non-invasive assessment of central arterial pulse wave augmentation has been proved to be useful in predicting cardiovascular adverse events. Previous studies have shown that prepubescent girls had greater central augmentation pressure compared with height-matched boys. This study sought to investigate which factors contribute to the body height-independent sexual differences in central arterial wave reflection observed in childhood. This cross-sectional study involved 819 children and adolescents (6-18 years of age) of both sexes. Phenotypes of central haemodynamic were obtained by radial applanation tonometry. Heart rate corrected augmentation index (Aix@75) was greater in girls compared with boys (2.9 ± 10.7 vs. -1.7 ± 12.9%, p

Purpose of review The surgical management of patients with ischemic cardiomyopathy, especially those with left ventricular ejection fractions less than 20% has historically been controversial. The original trials of surgical revascularization versus medical therapy intentionally excluded those patients with an ejection fraction less than 35%. The significant advances in medical therapy for heart failure over the past 30 years (β-blockade, angiotensin converting enzyme inhibitors, internal cardiac defibrillator and so on) also mandated a reevaluation of the potential benefits of surgical revascularization in this high-risk subset. The purpose of this review is to examine the data from the Surgical Treatment for Ischemic Heart Failure (STICH) trial, initially reported in 2009 and 2011. Recent findings Recent reports published in 2016 have now clearly defined the role of surgery over medical therapy for these patients. Furthermore, although the benefits of surgical ventricular reconstruction were once questioned by the results of STICH, further analyses identify that an appropriately selected patient who undergoes a technically adequate operation will derive benefit from surgical ventricular reconstruction. Summary The conclusions from the various substudies examining STICH trial data now indicate that in surgical candidates with graftable coronary artery disease, surgical revascularization provides a reduction in overall mortality, cardiovascular deaths and hospitalizations, independent of symptoms, baseline left ventricular size or function and surprisingly, regardless of any viability or evidence of inducible ischemia.

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

ABSTRACT: Calcific aortic valve stenosis is common in the elderly. While history and examination can establish the diagnosis, determination of its severity typically requires echocardiography to define valve anatomy, measure stenosis severity and assess left ventricular response. The purpose of this review is to describe some of the commonly encountered challenges in the echocardiographic assessment of aortic stenosis. These include errors in the calculation of aortic valve area, assessment of aortic stenosis during atrial fibrillation, determining the presence of aortic stenosis in the setting of low transvalvular pressure gradients and discriminating other forms of obstruction to left ventricular ejection from aortic stenosis. Lastly, a review of how echocardiography is utilized to select patients for transcatheter aortic valve replacement is presented.

The current definition of peripartum cardiomyopathy (PC) is restricted to patients with left ventricular systolic dysfunction (ejection fraction [EF]45%). Data on peripartum heart failure (HF) with normal EF are sparse. We describe clinical characteristics of patients with normal (≥55%) and patients with low (45%) left ventricular ejection fractions (LVEFs). Electronic medical records (2006 to 2013) of our tertiary care center were retrospectively screened to identify peripartum HF with normal EF, defined as an entity meeting Framingham criteria for HF with symptom onset during the last month of pregnancy or up to 5 months after delivery and with an EF of ≥55%. Clinical characteristics, echocardiographic parameters, and outcomes of these patients were compared with age-matched control patients with traditionally defined PC (EF45%). A total of 25 patients with PC and EF≥55% were identified. Exclusion of hypertension (n=9), preeclampsia (n=1), and diabetes mellitus (n=2) yielded 13 patients with PC and EF≥55%. Age-matched patients with traditional PC (EF45%) constituted controls (n=16). Compared with patients with PC and low LVEF, patients with PC and normal LVEF had lower B-type natriuretic peptide levels, systolic and diastolic left ventricular dimensions, left atrial size, and incidence of decompensated HF during delivery (p0.05). Compared with historical age-matched controls, patients with normal LVEF exhibited attenuated E' mitral annular velocities. On follow-up, these patients were associated with a lower New York Heart Association functional class. In conclusion, peripartum HF with normal LVEF appears to be a distinct entity.

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