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Aims Methods and results Conclusions The aim of this study was to report safety and efficacy of aficamten in patients with non‐obstructive hypertrophic cardiomyopathy (nHCM) over 36 weeks in the ongoing FOREST‐HCM trial.Patients were started on aficamten 5 mg daily, with doses adjusted in 5‐mg increments (5–20 mg) at ≥2‐week intervals according to site‐read left ventricular ejection fraction (LVEF). Aficamten dose was increased if LVEF ≥55%, maintained if LVEF 50–54%, decreased if LVEF 40–<50%, and temporarily interrupted if LVEF <40%. Safety and efficacy were assessed over 36 weeks. Overall, 34 patients were enrolled (mean age 57.2 ± 15.3 years, 62% female, 41% in New York Heart Association [NYHA] class III). Over 36 weeks, 82.3% achieved 15–20 mg daily dose and there was a modest reduction in LVEF by −4.3% ± 5.2 from 70% ± 6.1 (p < 0.0001). At Week 36, NYHA class improved by ≥1 class in 27 (79.4%) patients. Mean Kansas City Cardiomyopathy Questionnaire clinical summary score improved by 13.8 ± 12.5 points relative to baseline. Median (interquartile range) levels of N‐terminal pro‐B‐type natriuretic peptide were significantly improved from baseline (−665.5 pg/ml [−1244.0, −232.0]; p < 0.0001), while high‐sensitivity cardiac troponin I was unchanged (−2.7 ng/L [−11.3, 1.6]; p = 0.25). There were no drug discontinuations due to adverse events. LVEF <50% occurred in 2 (5.9%) patients, one following pulmonary vein isolation and one associated with atrial fibrillation.Over 36 weeks, aficamten appeared safe and effective in the studied patients with nHCM. [ABSTRACT FROM AUTHOR]

Purpose This study aimed to investigate the relationship between symptoms of patients with severe mitral stenosis (MS), evaluated by the New York Heart Association (NYHA) functional class and Duke Activity Status Index (DASI) score, and echocardiographic parameters. We evaluated patients with severe rheumatic MS diagnosed as mitral valve area (MVA) less than 1.5 cm2. All patients underwent transthoracic echocardiography and the left atrium (LA) reservoir auto-strain (LASr) analysis. In addition, DASI and NYHA scores were determined to evaluate the functional capacity and symptoms of MS patients. We evaluated 60 patients with MS with a mean age of 50.13 ± 10.28 and a median DASI score of 26.95 (26.38). There were 6 (10%) and 28 (46.7%) patients with NYHA class I and II, and 25 (40.0%) and 2 (3.3%) patients with NYHA class III and IV, respectively. NYHA class was positively correlated with LA area (LAA, r = 0.638), LA volume (LAV, r = 0.652), LAV index (LAVI, r = 0.62), E (r = 0.45), A (r = 0.25), and pulmonary artery pressure (PAP, r = 0.34), while negatively correlated with LASr (r = − 0.73) and MVA (r = − 0.417). Furthermore, the DASI score was positively associated with LASr (r = 0.81) and MVA (r = 0.52) while negatively correlated with LAA (r = − 0.62), LAV (r = − 0.65), LAVI (r = − 0.56), E (r = − 0.46), A (r = − 0.3), and PAP (r = − 0.32). Our findings indicate that LAA, LAV, LAVI, E, A, PAP, MVA, and LASr are associated with NYHA and DASI scores in MS patients. Additionally, the LASr had the strongest correlation between all measured parameters in severe MS patients. [ABSTRACT FROM AUTHOR]

Aim. Assessment of the correlation between cardiac remodeling, functional status and electrical remodeling after cardiac resynchronisation therapy (CRT) in patients with non-ischaemic cardiomyopathy.Material and methods. A single center, prospective, observational study included 50 patients with non-ischaemic cardiomyopathy who were candidate for CRT implantation. All patients prior to CRT and then 3 months after implantation had standard 12-lead surface ECGs to assess QRSd for assessment electrical response, for assessment of left ventricular ejection fraction (LVEF) and volumes (left ventricular end diastolic and systolic volume, LVEDV and LVESV), mitral regurgitation (degree of mitral regurgitation), pulmonary artery systolic pressure (for diagnosis of pulmonary hypertension), NYHA class and 6 minute walk test (6MWT) to assess patient’s functional capacity.Results. 50 patients with CRT were included (35 males and 15 females, mean age 54.88±7.48 years). All patients were in sinus rhythm with QRS duration (QRSd) ≥120 ms, EF

Background: CardioMEMS is a device suitable for telemedicine that is currently being evaluated by the Regional Health Technology Assessment (HTA) Committee of Tuscany. Two detailed HTA reports are available in the specialized literature, the results of which need to be transferred to our regional setting. These decisions in Tuscany are made by the so-called Centro Operativo HTA. Aim: To validate, with local cost-effectiveness data, the decision on CardioMEMS that will be made in the Tuscany region. Methods: Two detailed international HTA reports were rearranged and adapted to our regional setting to generate a simplified analysis that could form the basis of our decision. Two willingness-to-pay (WTP) thresholds of €20,000/quality-adjusted life year (QALY) and €50,000/QALY were considered. Results: Based on epidemiological and regulatory information, the target population in Tuscany for this device is 166 cases. The value-based price of CardioMEMS is estimated to be €4,332 and €16,662 at WTP thresholds of 20,000/QALY and 50,000/QALY, respectively. Its current price in Italy is €12,000. Conclusion: In our region, the introduction of CardioMEMS is likely to be gradual, around 50 patients/year (or €0.60 million/year at current price). This example highlights the need to adapt the information published in the international literature to the local context in which the approval decision is made. In this context, simplified analyses are easier to apply than complex Markov models.

Introduction: In recent years, mitral valve (MV) repair has become the procedure of choice for treating isolated mitral regurgitation (MR). The aim of this study was to evaluate immediate and long-term clinical and echocardiographic results of MV repair performed at a tertiary hospital in Oman.Materials and Methods: The study population consisted of patients with severe MR above 18years of age who had isolated MV repair between 2006 and 2016 at Royal Hospital, Oman. Retrospective observational study. Primary Endpoints: 1-year freedom from reoperation, recurrence of severe MR and mortality. Secondary Endpoints: Five-year echocardiographic recurrence of severe MR, ejection fraction (EF), NYHA class and mortality.Results: The case records of 351 patients with MR who had MV surgery in Royal Hospital were reviewed. A total of 89 patients had isolated MV repair surgery with follow up 1 year. The etiology of mitral disease was degenerative in 58.42%, rheumatic in 20.22%, post endocarditis in 12.35%, congenital 5.61% and ischemic MR in 3.37%. Operative mortality was 2.24% (2/89). Pre-operative NHYA class III/IV was noted in 62.92% of patients (56/89). All the patients had an EF of > 60%. Among the 87 patients followed up for one-year, 95.40 % (83/87) of patients were free from reoperation. Four patients (4.59%) had recurrence of severe MR needing MV replacement surgery. Of the 87 patients, 56 patients were followed in our institute for 5 years had demonstrated trivial to mild MR in 73.2% (41/56) moderate MR in 16.07% (9/56), and severe MR in 10.07% (6/56) of patients though 83.92% (47/56) patients were in NYHA class I. Majority of grade 3 (10.71%) and 4 MR (8.92%) occurred in patients with rheumatic etiology who underwent MV repair. Ejection fraction remained > 60% in 89.28% patients. There was no mortality at 5 years among the 56 patients followed-up.Conclusions: MV repair in a tertiary center in Oman showed favorable early and one-year results as regards mortality, freedom from reoperation and recurrence of significant MR. Those followed-up at five years, majority of patients were asymptomatic though echocardiographic recurrence of moderate and severe MR was high predominantly in patients with rheumatic etiology.

Introduction: In recent years, mitral valve (MV) repair has become the procedure of choice for treating isolated mitral regurgitation (MR). The aim of this study was to evaluate immediate and long-term clinical and echocardiographic results of MV repair performed at a tertiary hospital in Oman. Materials and Methods: The study population consisted of patients with severe MR above 18years of age who had isolated MV repair between 2006 and 2016 at Royal Hospital, Oman. Retrospective observational study. Primary Endpoints: 1-year freedom from reoperation, recurrence of severe MR and mortality. Secondary Endpoints: Five-year echocardiographic recurrence of severe MR, ejection fraction (EF), NYHA class and mortality. Results: The case records of 351 patients with MR who had MV surgery in Royal Hospital were reviewed. A total of 89 patients had isolated MV repair surgery with follow up 1 year. The etiology of mitral disease was degenerative in 58.42%, rheumatic in 20.22%, post endocarditis in 12.35%, congenital 5.61% and ischemic MR in 3.37%. Operative mortality was 2.24% (2/89). Pre-operative NHYA class III/IV was noted in 62.92% of patients (56/89). All the patients had an EF of > 60%. Among the 87 patients followed up for one-year, 95.40 % (83/87) of patients were free from reoperation. Four patients (4.59%) had recurrence of severe MR needing MV replacement surgery. Of the 87 patients, 56 patients were followed in our institute for 5 years had demonstrated trivial to mild MR in 73.2% (41/56) moderate MR in 16.07% (9/56), and severe MR in 10.07% (6/56) of patients though 83.92% (47/56) patients were in NYHA class I. Majority of grade 3 (10.71%) and 4 MR (8.92%) occurred in patients with rheumatic etiology who underwent MV repair. Ejection fraction remained > 60% in 89.28% patients. There was no mortality at 5 years among the 56 patients followed-up. Conclusions: MV repair in a tertiary center in Oman showed favorable early and one-year results as regards mortality, freedom from reoperation and recurrence of significant MR. Those followedup at five years, majority of patients were asymptomatic though echocardiographic recurrence of moderate and severe MR was high predominantly in patients with rheumatic etiology. [ABSTRACT FROM AUTHOR]

Abstract Aims Data on the clinical course of hypertrophic cardiomyopathy (HCM) are mainly derived from tertiary HCM centre studies, and knowledge of clinical outcomes of patients leaving specialty care and returning to local physicians is limited due to gaps between clinical encounters or complete loss of follow‐up. This survey aims to describe the clinical course of HCM in patients following their evaluation at a tertiary referral centre. Methods and results A comprehensive outcomes survey was developed and sent to 4495 eligible patients with HCM previously evaluated at Mayo Clinic. Questions assessed general well‐being, New York Heart Association class, procedures performed, and probable HCM‐triggered ventricular arrhythmic events (VAEs) since last visit. In total, 2058 patients (mean age 63 ± 15 years; 42% female) responded to the survey covering a total of 10 510 patient‐years with an average of 5.4 ± 6.4 years of follow‐up since their last on‐campus/virtual visit to Mayo Clinic. During their time away from specialty care, 20% of patients reported having cardiac‐related hospitalizations and 25% reported having cardiac‐related procedures. Similar to high‐risk referral cohorts, 5% of patients reported VAEs with an event rate of 0.98 events/100 patient‐years. The prevalence of atrial fibrillation, syncope, pre‐syncope, cardiac‐related hospitalizations, and VAEs during time away from specialty care increased significantly with increasing New York Heart Association class (P

• The study measures the long-term outcomes of yoga therapy to validate the addition of yoga therapy in managing heart failure. • Yoga therapy improves prognosis, functional outcome, and left ventricular performance in heart failure patients. • Further studies in different continents and populations should be conducted to validate Yoga as an adjuvant therapy. Heart failure (HF) is a chronic complex disease that prevails as a prime cause of concern for healthcare sectors worldwide, with a concordant objective to improve the long-term prognosis. Analysis of the available literature is evidence that yoga therapy and basic lifestyle modifications have considerably augmented heart failure patients' quality of life and enhanced left ventricular ejection fraction and NYHA functional class. Our study aims to establish the long-term outcomes of yoga therapy to validate the addition of yoga therapy as a complementary treatment in managing HF. A prospective non-randomized study was conducted at a tertiary care center including seventy-five HF patients with NYHA class III or less who underwent coronary intervention, revascularization, or device therapy within the past six months to one year and continuing guideline-directed optimal medical therapy (GDMT). Thirty-five participants were part of the Interventional Group (IG), and forty were in the Non-Interventional Group (Non-IG). The IG received yoga therapy and GDMT, while the non-IG were only under standard GDMT. Echocardiographic parameters were compared at various follow-ups up to one year to see the impact of Yoga therapy on HF patients. A total of 75 heart failure patients, including 61 males and 14 females. The IG and non-IG had 35 subjects (31 males and 4 females) and 40 subjects (30 males and 10 females), respectively. Echocardiographic parameters were observed to compare the IG and Non-IG groups, and those did not demonstrate any significant difference between the two groups (p-value > 0.05). But, the echocardiographic parameters of the IG and non-IG from baseline to six months and one year showed a significant improvement (p-value of <0.05). The functional outcome (NYHA classes) was assessed after follow-up, and a p-value <0.05 showed a substantial improvement in the IG. Yoga therapy results in better prognosis, functional outcome, and left ventricular performance in HF patients with NYHA III or less. Hence this investigation has attempted to justify its importance as adjuvant/complimentary treatment for HF patients. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a chronic syndrome that requires patients to manage signs and symptoms and adhere to a complex medication regimen. This article discusses updates in HF care related to a universal definition and new therapies, focusing on the four pillars of therapy for HF with reduced ejection fraction. [ABSTRACT FROM AUTHOR]

Aims: Data on the clinical course of hypertrophic cardiomyopathy (HCM) are mainly derived from tertiary HCM centre studies, and knowledge of clinical outcomes of patients leaving specialty care and returning to local physicians is limited due to gaps between clinical encounters or complete loss of follow‐up. This survey aims to describe the clinical course of HCM in patients following their evaluation at a tertiary referral centre. Methods and results: A comprehensive outcomes survey was developed and sent to 4495 eligible patients with HCM previously evaluated at Mayo Clinic. Questions assessed general well‐being, New York Heart Association class, procedures performed, and probable HCM‐triggered ventricular arrhythmic events (VAEs) since last visit. In total, 2058 patients (mean age 63 ± 15 years; 42% female) responded to the survey covering a total of 10 510 patient‐years with an average of 5.4 ± 6.4 years of follow‐up since their last on‐campus/virtual visit to Mayo Clinic. During their time away from specialty care, 20% of patients reported having cardiac‐related hospitalizations and 25% reported having cardiac‐related procedures. Similar to high‐risk referral cohorts, 5% of patients reported VAEs with an event rate of 0.98 events/100 patient‐years. The prevalence of atrial fibrillation, syncope, pre‐syncope, cardiac‐related hospitalizations, and VAEs during time away from specialty care increased significantly with increasing New York Heart Association class (P < 0.001). Conclusions: Acknowledging ascertainment bias, the clinical course of patients away from tertiary care may be more severe than previously anticipated. Among those with exertional symptoms, HCM‐related morbidity increased substantially. Higher risk HCM patients should remain in contact with HCM specialty care. [ABSTRACT FROM AUTHOR]

Aim: To compare the risk of ventricular arrhythmias (VA) and sudden death (SD) between New York Heart Association (NYHA) class I and NYHA class II–III patients with non‐ischaemic cardiomyopathy (NICM). Methods and results: Observational retrospective cohort study including patients with NICM who underwent cardiac magnetic resonance at two hospitals. The primary endpoint included appropriate implantable cardioverter defibrillator (ICD) therapies, sustained ventricular tachycardia, resuscitated cardiac arrest and SD. The secondary endpoint included heart failure (HF) hospitalizations, heart transplant, left ventricular assist device implant or HF death. Overall, 698 patients were included, 33% in NYHA class I. During a median follow‐up of 31 months, the primary endpoint occurred in 57 patients (8%), with no differences between NYHA class I and NYHA class II–III cases (7% vs. 9%, p = 0.62). Late gadolinium enhancement (LGE) was the only independent predictor of the primary outcome both in NYHA class I and NYHA class II–III patients. LGE+ NYHA class I patients had a similar cumulative incidence of the primary endpoint as compared to LGE+ NYHA class II–III (p = 0.92) and a significantly higher risk as compared to LGE– NYHA class II–III cases (p < 0.001). The risk of the secondary endpoint was significantly higher in patients in NYHA class II–III as compared to those in NYHA class I (hazard ratio 3.2, p = 0.001). Conclusions: Patients with NICM in NYHA class I are not necessarily at low risk of VA and SD. Actually, LGE+ NYHA class I patients have a high risk. NYHA class I patients with high‐risk factors, such as LGE, could benefit from primary prevention ICD at least as much as those in NYHA class II–III with the same risk factors. [ABSTRACT FROM AUTHOR]

Abstract Background Heart failure with preserved ejection fraction (HFpEF)is challenging. Patients usually have normal LV size and ejection fraction. This clinical syndrome develops from a complex interaction of several risk factors that cause organ dysfunction and clinical symptoms. There’s evidence that testosterone deficiency is associated with a worse cardiometabolic profile and increased inflammatory markers. We thought that these changes might have an impact on heart failure pathogenesis. We aimed to study the relationship between testosterone level and symptoms in HFpEF. Methods We studied 120 male patients with HFpEF. According to New York Heart Association (NYHA), patients were classified into I, II and III classes; class IV patients were excluded. All patients were subjected to clinical and echocardiographic examinations. In addition, we measured serum testosterone, cardio-metabolic profile, intracellular adhesive molecule-1(ICAM-1), P-selectin and nitric oxide (NO) levels. Results Patients with testosterone deficiency had worse NYHA class and higher BNP P = (0.001). Additionally, they had a significantly worse metabolic profile; higher total cholesterol, triglycerides, LDL cholesterol, fasting insulin and HOMA-IR P = (0.005, 0.001, 0.001, 0.001), respectively. Also, they had higher inflammatory markers and worse endothelial functional parameters; (ICAM-1, NO and P- selectin) P = (0.001). Age, BNP and testosterone deficiency can be used as independent predictors of NYHA class III symptoms with a Testosterone cutoff value of 2.7 ng/ml. Conclusion Testosterone deficiency could be used as an independent predictor of symptom severity in HFpEF, and it aggravates systemic inflammation and endothelial dysfunction in these patients.

BACKGROUND: Cardiovascular abnormalities are considered to be the most important non obstetric cause of morbidity. Cardiac disease is an important cause of maternal mortality both in antepartum and postpartum period. The overall incidence of heart disease in pregnancy is <1%. METHODS: The present study was Prospective and Observational study, conducted at the Department of Obstetrics and Gynecology in Mallareddy Narayana Hospital, Suraram, Hyderabad, Telangana from 20182022. All women with cardiac disease diagnosed during antenatal visits, or diagnosed previously, or emergency admissions in the labor room, or referred with cardiac diseases, or who developed cardiac complications during peripartum period beyond 32 weeks period of gestation were included in the present study. Maternal outcome in terms of mode of delivery and fetal outcome in terms of preterm, intra uterine growth restriction was evaluated. RESULTS: In the current study, majority of the patients were less than 25 years of age group 25 (64.1%) and most of them were primigravidae 17 (43.58 %). Co-morbid conditions identified in 19(48.71%) women among them anemia followed by pregnancy induced hypertension was most common. Valvular heart disease with Rheumatic involvement was the most common presentation. The pregnancy outcome in terms of fetus preterm deliveries in 15 cases (38.46%), intrauterine growth restriction in 6 cases (15.38%) noted. In this study there was no maternal mortality. CONCLUSION: This current study conclude that the rheumatic heart disease is still a predominant heart disease in pregnancy. Prognosis is good with surgically corrected cases, NYHA class I and II. In this study, maternal complications occurred during labor and puerperium. Early diagnosis, preconceptional counselling, early initiation of treatment by cardiologist, maternal and fetal monitoring by skilled obstetrician with strict constant supervision can expect better outcome. [ABSTRACT FROM AUTHOR]

Background: Low-level laser therapy (LLLT) is a promising noninvasive physiotherapeutic approach that has been demonstrated to improve cardiac performance. This study aimed to assess the impact of low-level laser therapy on cardiac functions and clinical status in patients with chronic left ventricular systolic heart failure who were not candidates for cardiac revascularization or resynchronization. A case series of 27 patients received a course of low-level laser physiotherapy, the clinical outcomes, echocardiographic parameters, and serum nitric oxide levels were evaluated before and after LLLT. Results: Of the total patients enrolled in the study, 21 (or 77.8%) were male, with a mean age of 57.7 ± 6.89 years. NYHA classification significantly improved after low-level laser therapy, 15 patients were in class III,12 were in class IV, and no one was in class II before laser therapy while after laser therapy; 25 patients shifted to class II, two patients were in class III with P < 0.001, Six-minute walk distance test was performed, and the results showed that the mean of 6MWT was less than 200 m (148.556 ± 39.092) before the study but increased to more than 300 after laser therapy (385.074 ± 61.740), left ventricular ejection fraction before laser therapy was 26 ± 7.5 while after laser therapy it became 30 ± 8.6 but diastolic function did not change after low-level laser therapy, the mean peak TR pressure was 40.0 ± 9.0 mmHg and 33.0 ± 7.0 before and after laser therapy respectively P < 0.001. A significant change was observed in NO level from 4.1 ± 1.4 IU/ml before laser therapy to 5.2 ± 1.7 IU/ml after laser therapy P < 0.001. Conclusions: Low-level laser therapy may add benefits to improve symptoms, clinical condition, and quality of life in patients with left ventricular systolic dysfunction, further studies are necessary to evaluate the changes in cardiac functions at a longer follow-up duration. [ABSTRACT FROM AUTHOR]

Background: Heart failure with preserved ejection fraction (HFpEF)is challenging. Patients usually have normal LV size and ejection fraction. This clinical syndrome develops from a complex interaction of several risk factors that cause organ dysfunction and clinical symptoms. There's evidence that testosterone deficiency is associated with a worse cardiometabolic profile and increased inflammatory markers. We thought that these changes might have an impact on heart failure pathogenesis. We aimed to study the relationship between testosterone level and symptoms in HFpEF. Methods: We studied 120 male patients with HFpEF. According to New York Heart Association (NYHA), patients were classified into I, II and III classes; class IV patients were excluded. All patients were subjected to clinical and echocardiographic examinations. In addition, we measured serum testosterone, cardio-metabolic profile, intracellular adhesive molecule-1(ICAM-1), P-selectin and nitric oxide (NO) levels. Results: Patients with testosterone deficiency had worse NYHA class and higher BNP P = (0.001). Additionally, they had a significantly worse metabolic profile; higher total cholesterol, triglycerides, LDL cholesterol, fasting insulin and HOMA-IR P = (0.005, 0.001, 0.001, 0.001), respectively. Also, they had higher inflammatory markers and worse endothelial functional parameters; (ICAM-1, NO and P- selectin) P = (0.001). Age, BNP and testosterone deficiency can be used as independent predictors of NYHA class III symptoms with a Testosterone cutoff value of 2.7 ng/ml. Conclusion: Testosterone deficiency could be used as an independent predictor of symptom severity in HFpEF, and it aggravates systemic inflammation and endothelial dysfunction in these patients. [ABSTRACT FROM AUTHOR]

Aim: To investigate the utility of systemic immune-inflammation index (SII) in predicting response to cardiac resynchronization therapy (CRT) among patients with heart failure (HF). Method: A total of 78 patients with HF who underwent CRT device implantation were included in this 6-month follow up study. Data on laboratory findings including complete blood count, blood biochemistry and SII as well as the transthoracic echocardiography findings were recorded at baseline prior to CRT device implantation and 6 months after CRT. Results: The criteria for response to CRT including improvements in New York Heart Association (NYHA), left ventricular end-systolic volume (LVESV) (decreased by =15%) and ejection fraction (EF) (increased by=10%) were met by 73.1%, 65.4% and 69.2% of patients, respectively. In patients with decreased vs. increased SII values during 6-month therapy, the likelihood of meeting LVESV (84.3 vs. 15.7%, p<0.001), EF (81.5 vs. 18.5%, p<0.001) and NYHA (77.2 vs. 22.8%, p<0.001) response criteria for successful CRT were significantly higher. Multivariate analysis revealed that decrease in SII (OR 0.982, 95% CI: 0.970 to 0.995, p=0.006) and TAPSE (OR 0.602, 95% CI. 0.396 to 0.916, p=0.018) during treatment as the only significant determinants of presence of response to CRT in heart failure (HF) patients. Conclusions: Our findings seem to indicate the favorable utility of SII, as a non-invasive readily available marker, in predicting response to CRT and thus enabling a beneficial reverse remodeling process via timely implementation of advanced treatments in HF patients. [ABSTRACT FROM AUTHOR]

Background: In order to identify candidacy and treatment response for patients with obstructive hypertrophic cardiomyopathy (oHCM), clinicians need an accurate means of assessing symptoms, function, and quality of life. While the New York Heart Association (NYHA) Classification is most often used, the Kansas City Cardiomyopathy Questionnaire (KCCQ-23) is more accurate and sensitive to change, although less familiar to practicing clinicians. To support interpreting the KCCQ, we describe cross-sectional and changes in KCCQ scores in the context of the NYHA., Methods: Participants from the EXPLORER-HCM trial (NCT03470545) completed the KCCQ-23 and clinicians assigned NYHA classes at study visits. Participants were included if they had baseline and week 30 data for cross-sectional and longitudinal changes. Median KCCQ-23 scores were compared by NYHA class at baseline and week 30 and by change in NYHA class from baseline to week 30., Results: Cross-sectionally, the KCCQ-23 Overall Summary Scores (KCCQ-23 OSS) and Clinical Summary Scores (KCCQ-23 CSS) had an inverse relationship with NYHA at baseline and 30 weeks, with marked variations in KCCQ-23 scores among patients assigned to the same NYHA class. When improving from NYHA class II to I, the median changes in KCCQ-23 OSS and KCCQ-23 CSS were 10 (IQR 4, 22) and 8 (IQR 2, 20), respectively. The changes were larger when improving from NYHA class III to II and from NYHA class III to I., Conclusion: KCCQ-23 scores are inversely related to NYHA classes, with significant variability within classes. Changes in scores are not linear, suggest greater differences when patients move between NYHA Class II and III than Class I and II. These insights may help clinicians better understand cross-sectional and changes in KCCQ scores., (Copyright © 2024. Published by Elsevier Inc.)

Background. Currently, data on sacubitril/valsartan therapy from the real-world settings are scarce and the predictors of a good clinical responsiveness to this drug are unknown. Objectives. To assess efficacy and safety profile of sacubitril/valsartan and to identify predictors for a better clinical outcome. Materials and methods. Clinical, laboratory and echocardiographic data of 95 chronic heart failure (CHF) patients with reduced ejection fraction (HFrEF) were retrospectively analyzed. A good efficacy of sacubitril/ valsartan was defined as the fulfilment of at least 2 of the following criteria: improvement of left ventricular ejection fraction (LVEF) or functional status, and reduction of N-terminal pro-brain natriuretic peptide (NTproBNP) levels or hospitalization rates. Results. Under sacubitril/valsartan, major improvements were observed in LVEF, the New York Heart Association (NYHA) class, NT-proBNP levels, and hospitalization rates. Patients with a good efficacy of sacubitril/ valsartan were characterized by initially worse LVEF (median (interquartile range (IQR)): 29.0% (23.0-33.0%) compared to 32.0% (28.5-38.0%) with more frequent nonischemic etiology (65.4% compared to 41.9%) and hospitalizations for CHF/month (0.016 (0.004-0.057) compared to 0.000 (0.000-0.012)), lower cholesterol (42.3% compared to 65.1%), higher C-reactive protein (CRP) levels at baseline (0.5 mg/L (0.5-1.0 mg/L) compared to 0.5 mg/L (0.5-0.5 mg/L)), and a shorter timespan between CHF diagnosis and the start of sacubitril/valsartan treatment (66.0 (11.0-127.0) compared to 111 (73.0-211.0) months) (p < 0.05 each). In a multivariate Cox analysis, only the last 2 parameters were shown to be independent predictors of good clinical responsiveness to sacubitril/valsartan (hazard ratio (HR) = 1.263, 95% confidence interval (95% CI) = [1.048; 1.521]; HR = 0.992, 95% CI = [0.987; 0.997], p < 0.05, respectively). Conclusions. Sacubitril/valsartan improved LVEF, NYHA class, NT-proBNP levels, and hospitalization rates, mostly without relevant side effects. The independent predictors of a good clinical efficacy were higher CRP levels at baseline and a shorter delay between CHF diagnosis and the initialization of sacubitril/valsartan therapy. [ABSTRACT FROM AUTHOR]

Background: As cardio-vascular diseases are the leading cause of death worldwide, establishing measures to improve cardiovascular health is of crucial importance. Exercise plays an essential role in cardiac rehabilitation of patients with coronary artery disease (CAD), in whom an evaluation of the cardiorespiratory fitness (CRF) is necessary. CRF of CAD patients could be assessed using 6-min walk test (6MWT), and the results interpreted by using Enright-Sherill prediction equation which has mainly been designed and evaluated for a healthy population. Hypothesizing that the Enright-Sherill prediction equation might not be best suited for CAD patients, our aim was to reevaluate this equation in CAD patients, and potentially establish a more accurate 6MWD prediction equation to be applied in these patients. Methods: 6MWD was measured in a cross-sectional study in 67 CAD patients (44 women) who were members of the Coronary club Ljubljana, Slovenia. In addition, the predicted 6MWD was calculated for men and women using Enright-Sherill gender specific regression equation. Multivariate regression analysis was used to obtain a new prediction equation, and the agreement between the measured and the predicted 6MWD analyzed using the repeated measures ANOVA. Results: Men achieved 451 ± 122 m and women 485 ± 69 m without significant differences between sexes (F = 0.022, p = 0.882) when adjusted for age, height, body mass, and waist circumference. When comparing the measured (473 ± 91 m) and the predicted (422 ± 57 m) values of 6MWD in CAD patients we found that the Enright-Sherill prediction equation significantly (F = 27.734, p < 0.001) underestimated the 6MWD by 52 ± 81 m. A significant regression equation was established [F (3,63) = 44.663, p < 0.001], with a R 2 of 0.680 where 6MWD equals 1,057 m—4.966 x age (years)—0.614 x WC (cm)–68.629 x NYHA class. Conclusion: The results of this study stress the importance of regular and actual walking ability testing in patients with stable CAD to obtain their CRF, rather than simply predicting it from regression equations obtained from non-representative or non-comparable samples. Our developed prediction equation warrants additional validation and may represent a good substitute for currently used predictions obtained from a healthy population. [ABSTRACT FROM AUTHOR]

Background: As cardio-vascular diseases are the leading cause of death worldwide, establishing measures to improve cardiovascular health is of crucial importance. Exercise plays an essential role in cardiac rehabilitation of patients with coronary artery disease (CAD), in whom an evaluation of the cardiorespiratory fitness (CRF) is necessary. CRF of CAD patients could be assessed using 6-min walk test (6MWT), and the results interpreted by using Enright-Sherill prediction equation which has mainly been designed and evaluated for a healthy population. Hypothesizing that the Enright-Sherill prediction equation might not be best suited for CAD patients, our aim was to reevaluate this equation in CAD patients, and potentially establish a more accurate 6MWD prediction equation to be applied in these patients.Methods: 6MWD was measured in a cross-sectional study in 67 CAD patients (44 women) who were members of the Coronary club Ljubljana, Slovenia. In addition, the predicted 6MWD was calculated for men and women using Enright-Sherill gender specific regression equation. Multivariate regression analysis was used to obtain a new prediction equation, and the agreement between the measured and the predicted 6MWD analyzed using the repeated measures ANOVA.Results: Men achieved 451 ± 122 m and women 485 ± 69 m without significant differences between sexes (F = 0.022, p = 0.882) when adjusted for age, height, body mass, and waist circumference. When comparing the measured (473 ± 91 m) and the predicted (422 ± 57 m) values of 6MWD in CAD patients we found that the Enright-Sherill prediction equation significantly (F = 27.734, p < 0.001) underestimated the 6MWD by 52 ± 81 m. A significant regression equation was established [F (3,63) = 44.663, p < 0.001], with a R2 of 0.680 where 6MWD equals 1,057 m—4.966 x age (years)—0.614 x WC (cm)–68.629 x NYHA class.Conclusion: The results of this study stress the importance of regular and actual walking ability testing in patients with stable CAD to obtain their CRF, rather than simply predicting it from regression equations obtained from non-representative or non-comparable samples. Our developed prediction equation warrants additional validation and may represent a good substitute for currently used predictions obtained from a healthy population.

Aim: Assessment of blood lactate levels and lactate clearance in cardiac surgeries with cardiopulmonary bypass patients Methods: 100 patients undergoing elective cardiac surgery under cardiopulmonary bypass were included in this prospective observational study. Based on history, the patients were allocated to their respective class as per the New York Heart Association (NYHA) functional classification. Patients aged between 17-85 years posted for elective cardiac surgery under cardiopulmonary bypass were included. For measuring lactate levels, baseline arterial blood was collected from the intra-arterial catheter immediately after induction of anaesthesia. Subsequent samples were collected at intervals of 15 minutes and 45 minutes after institution of CPB, rewarming (at 35°C), immediately after termination of CPB, 24 hours and 48 hours post-surgery. Results: All four NYHA groups were comparable in terms of baseline lactate levels (P value 0.09). Higher mean levels of lactate were seen in NYHA group 4 compared to other three groups during rewarming, termination and post operatively (24 and 48 hours). After 45 minutes of CPB and during rewarming, NYHA 4 group varied significantly from NYHA 1, 2 and 3. In terms of mean lactate clearance, Tukey HSD (Assuming equal variances) post hoc test showed that both NYHA 3 and NYHA 4 were significantly different from each other as well as NYHA group 2. At 24 hours postoperatively, NYHA 2 varied significantly from NYHA 1, 3 and 4. After 48 hours, a significant difference in lactate clearance was seen between NYHA 1 and 2. The duration of inotropic support as well as mechanical ventilation was more in NYHA 3 and 4. Conclusion: There is an association between increased mean lactate levels and lactate clearance with a increase in NYHA class during the perioperative period. IHigher mean lactate levels and lactate clearance was associated with raised duration of mechanical ventilation and inotropic support as well. increased perioperative lactate levels also prolonged the ICU and hospital stay in later NYHA classes. [ABSTRACT FROM AUTHOR]

Endocardial left ventricular pacing is an alternative technique used in cardiac resynchronization therapy (CRT), when placement of a left ventricular lead is not possible via the coronary sinus or in non-responders to conventional CRT. To review the evidence regarding the efficacy and safety of endocardial left ventricular pacing. Systematic research on Medline (PubMed), ClinicalTrials.gov and Embase with the terms "endocardial left ventricular pacing", "biventricular pacing" or "endocardial left pacing" was performed with the identification of 1038 results. Eleven studies with endocardial left ventricular pacing patients were included, independent of the technique being applied to naïve CRT patients or con non-responders to conventional CRT. The end-point of this analysis was the impact of endocardial left ventricular pacing techniques regarding New York Heart Association (NYHA) functional classification, left ventricular ejection fraction (LVEF) and QRS width, and the occurrence of complications Mean differences (MD) and confidence interval (CI) was used as a measurement of treatment. A total of 560 patients were included, with different techniques used (trans-atrial septal technique, trans-ventricular septal technique and transapical technique). Significant improvement was registered in NYHA class (MD 0.73, CI 0.48–0.98, p <0.00001, I2 = 87%), LVEF (MD -7.63, CI -9.93 - -5.33, p <0.00001, I2 = 69%) and QRS width (MD 29.25, CI 9.99–48.50, p <0.00001, I2 = 91%). Several complications were reported after the procedure, 11 pocket infections, 22 transient ischemic attacks, 18 ischemic strokes, 41 thromboembolic events, among other complications. The mortality rate during the follow-up was 20.54%. Left ventricular endocardial pacing is a feasible alternative to conventional CRT, with clinical, electrocardiographic and echocardiogrphic improvement. However, first data regarding this procedure was associated with significant complications rates. [ABSTRACT FROM AUTHOR]

Abstract Aims Acute heart failure (AHF) leads to a drastic increase in mortality and rehospitalization. The aim of the study was to identify prognostic variables in a real‐life population of AHF patients admitted to the emergency department with acute shortness of breath. Methods and results We evaluated potential predictors of mortality in 728 consecutive patients admitted to the emergency department with AHF. Possible predictors of all‐cause and cardiovascular (CV) mortality were investigated by Cox and Fine and Gray models at multivariable analysis. Among the 728 patients, 256 died during the entire follow‐up, 142 of these due to CV cause. The 1 year mortality rate was 20%, with the highest risk of death during the index hospitalization (with 8% estimate in‐hospital mortality at 30 days). A higher risk of events during the index hospitalization was more evident for the CV deaths, for which we found a cumulative 1 year incidence of 12% with a cumulative incidence in the first 30 days of hospitalization of about 5%. At multivariable analysis, age (P

Objectives: The aim of this study was to evaluate the effects of invasive vagal nerve stimulation (VNS) in patients with chronic heart failure (HF) and reduced ejection fraction (HFrEF).Background: Heart failure is characterized by autonomic nervous system imbalance and electrical events that can lead to sudden death. The effects of parasympathetic (vagal) stimulation in patients with HF are not well-established.Methods: From May 1994 to July 2020, a systematic review was performed using PubMed, Embase, and Cochrane Library for clinical trials, comparing VNS with medical therapy for the management of chronic HFrEF (EF ≤ 40%). A meta-analysis of several outcomes and adverse effects was completed, and GRADE was used to assess the level of evidence.Results: Four randomized controlled trials (RCT) and three prospective studies, totalizing 1,263 patients were identified; 756 treated with VNS and 507 with medical therapy. RCT data were included in the meta-analysis (fixed-effect distribution). Adverse effects related to VNS were observed in only 11% of patients. VNS was associated with significant improvement (GRADE = High) in the New York Heart Association (NYHA) functional class (OR, 2.72, 95% CI: 2.07–3.57, p < 0.0001), quality of life (MD −14.18, 95% CI: −18.09 to −10.28, p < 0.0001), a 6-min walk test (MD, 55.46, 95% CI: 39.11–71.81, p < 0.0001) and NT-proBNP levels (MD −144.25, 95% CI: −238.31 to −50.18, p = 0.003). There was no difference in mortality (OR, 1.24; 95% CI: 0.82–1.89, p = 0.43).Conclusions: A high grade of evidence demonstrated that vagal nerve stimulation improves NYHA functional class, a 6-min walk test, quality of life, and NT-proBNP levels in patients with chronic HFrEF, with no differences in mortality.

Background: CardioMEMS is a device suitable for telemedicine that is currently being evaluated by the Regional Health Technology Assessment (HTA) Committee of Tuscany. Two detailed HTA reports are available in the specialized literature, the results of which need to be transferred to our regional setting. These decisions in Tuscany are made by the so-called Centro Operativo HTA., Aim: To validate, with local cost-effectiveness data, the decision on CardioMEMS that will be made in the Tuscany region., Methods: Two detailed international HTA reports were rearranged and adapted to our regional setting to generate a simplified analysis that could form the basis of our decision. Two willingness-to-pay (WTP) thresholds of €20,000/quality-adjusted life year (QALY) and €50,000/QALY were considered., Results: Based on epidemiological and regulatory information, the target population in Tuscany for this device is 166 cases. The value-based price of CardioMEMS is estimated to be €4,332 and €16,662 at WTP thresholds of 20,000/QALY and 50,000/QALY, respectively. Its current price in Italy is €12,000., Conclusion: In our region, the introduction of CardioMEMS is likely to be gradual, around 50 patients/year (or €0.60 million/year at current price). This example highlights the need to adapt the information published in the international literature to the local context in which the approval decision is made. In this context, simplified analyses are easier to apply than complex Markov models., (© 2024 The Authors.)

Objective: To evaluate the effects of Sacubitril/Valsartan on clinical and echocardiographic parameters in patients with heart failure with reduced ejection fraction who were previously being treated with ACE inhibitors. Study Design: Prospective cross-sectional study. Place and Duration of Study: Combined Military Hospital Bahawalpur, from Sep 2020 to Mar 2021. Methodology: A hundred patients with heart failure with reduced ejection fraction (HFrEF) previously treated with ACE inhibitors for at least 24 weeks were enrolled for the study. Fifty patients were then switched from treatment with ACE inhibitors to sacubitril/valsartan and defined as the A to S/V group and treated to observe changes in NYHA class and left ventricular ejection fraction up to 6 months. In the same period, the rest of the 50 patients were continued with ACE inhibitor treatment defined as the A to A group, the dose of ACE Inhibitor was maintained at the same level. NYHA class and echo-cardiography was performed in outdoor clinics at enrolment (baseline) and after 6 months of Sacubitril/Valsartan treatment. NYHA class and echocardiographic parameter were recorded and analyzed after 6 months. Results: There was no statistically significant difference in the age, gender, HR, Systolic BP, Diastolic BP, NYHA class and LVEF between the two groups at enrollment. In A to A group there was no significant change in LVEF and NYHA class after 6 month of observation and continued treatment with ACE inhibitors. A significant improvement was found in the baseline LVEF (%) (30.2 ± 2.62) to (32 ± 2.43) p-value (<0.001) in A to S/V group. At the end of the study, LVEF showed improvement in echocardiography in patients treated with sacubitril/valsartan compared to ACE Inhibitor treatment. Clinical improvement was observed in 16 (32%) patients who moved to NYHA class-II from NYHA class-III. Conclusion: Sacubitril/Valsartan in comparison to ACE Inhibitor treatment had a statistically significant clinical improvement in NYHA class II/III and LVEF on echocardiography at 6 months. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary bypass (CPB) is instituted, during various cardiac operations, to allow for optimal systemic perfusion. Tissue hypoperfusion is associated with lactic acidosis secondary to anaerobic metabolism. Measurement of blood lactate levels can hence be used as a marker to assess the adequacy of tissue perfusion. In this study we tried to find out the association between various preoperative NYHA classes and link their association with perioperative lactate and lactate clearance values. Methods: 100 patients undergoing elective cardiac surgery under cardiopulmonary bypass were included in this prospective observational study. Based on history, the patients were allocated to their respective class as per the New York Heart Association (NYHA) functional classification. Patients aged between 18-80 years posted for elective cardiac surgery under cardiopulmonary bypass were included. For measuring lactate levels, baseline arterial blood was collected from the intra-arterial catheter immediately after induction of anaesthesia. Subsequent samples were collected at intervals of 15 minutes and 45 minutes after institution of CPB, rewarming (at 35°C), immediately after termination of CPB, 24 hours and 48 hours post-surgery. Results: All four NYHA groups were comparable in terms of baseline lactate levels (P value 0.096). Higher mean levels of lactate were seen in NYHA group 4 compared to other three groups during rewarming, termination and post operatively (24 and 48 hours). After 45 minutes of CPB and during rewarming, NYHA 4 group varied significantly from NYHA 1, 2 and 3. In terms of mean lactate clearance, Tukey HSD (Assuming equal variances) post hoc test showed that both NYHA 3 and NYHA 4 were significantly different from each other as well as NYHA group 2. At 24 hours postoperatively, NYHA 2 varied significantly from NYHA 1, 3 and 4. After 48 hours, a significant difference in lactate clearance was seen between NYHA 1 and 2. The duration of inotropic support as well as mechanical ventilation was more in NYHA 3 and 4. Conclusion: There is a definite association between higher mean lactate levels and lactate clearance with a higher NYHA class during the perioperative period. Increased mean lactate levels and lactate clearance is also associated with increased duration of mechanical ventilation and inotropic support. Higher perioperative lactate levels also prolong the ICU and hospital stay in higher NYHA classes. [ABSTRACT FROM AUTHOR]

Purpose: To assess the burden among caregivers of patients with heart failure (HF) with left ventricular ejection fraction (LVEF) ≤ 60%. The burden by New York Heart Association (NYHA) functional class was also characterized. Patients and Methods: A cross-sectional study was conducted in France, Germany, Italy, Spain, and UK from June to November 2019. Patient record forms were completed by 257 cardiologists and 158 general practitioners for consecutive HF patients. Caregivers who accompanied the patient to their consultation completed a caregiver self-completion survey voluntarily, which included the Family Caregiver Quality of Life Questionnaire (FAMQOL) and 5-level 5-dimension EuroQol questionnaire (EQ-5D-5L). Results: We analyzed 361 caregivers of patients with HF (NYHA class I, n=41; II, n=212; III IV, n=108). Mean age of caregivers was 58.8 years (NYHA I/II/III–IV: 59.1/60.8/54.6 years; p=0.0029), with majority being females (73.1%). Caregivers spent on average 19.8 hours/week caring for a HF patient, which increased with increase in NYHA class (I/II/III–IV: 11.8/18.1/25.9 hours/week; p=0.0094). Caregivers (24.1%) reported providing emotional support/encouragement to patients as the most troublesome/inconvenient caregiving activity (no significant difference across NYHA class). Nearly one-third of caregivers experienced stress (NYHA I/II/III–IV: 17.1%/28.8%/40.7%; p=0.0111) and anxiety (26.8%/24.1%/39.8%; p=0.0127) due to caregiving burden. The overall FAMQOL mean score decreased significantly (poorer QoL) with increase in NYHA class (I/II/III–IV: 58.1/56.3/52.2; p=0.0069). A trend of decreasing scores with increasing NYHA class was observed across physical, emotional, and social domains (each p≤ 0.012). Conclusion: Caregivers of HF patients with LVEF ≤ 60% experienced a significant burden, which was higher among caregivers of patients with more severe and symptomatic disease. [ABSTRACT FROM AUTHOR]

Introduction Depression is commonly present among HF patients and is associated with adverse clinical outcomes. However, research regarding its association with New York Heart Association (NYHA) class is still scarce. Objectives To evaluate the presence of depression symptoms in HF outpatients and analyze its association with NYHA class. Methods This study is part of a larger research project (Deus Ex-Machina/NORTE-01-0145-FEDER-00026). HF patients were recruited from an outpatient clinic at a University Hospital. Exclusion criteria were: unable to communicate, severe visual acuity deficit or NYHA class IV. Sociodemographic data and NYHA class were registered. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression, with a score ≥10 indicating clinically relevant depression. Results A sample of 136 HF patients was included, with a median age of 59 (range: 24-81) years old, where 66% were men. Almost half of the patients (49%) were in NYHA class II, followed by class I (36%) and class III (15%). The median score of PHQ-9 was 4(range:0-18), with 26% showing clinically relevant depression. PHQ-9 total score was associated with NYHA class (p=0.001), with higher median scores in worse NYHA classes [class I: 3 (IQR: 5.5), class II: 4 (IQR: 8) and class III: 8.5 (IQR:9.3)]. Conclusions In this study, depression was present in 26% of HF outpatients and was associated with more severe HF symptoms. Consequently, preventing, monitoring, and treating depression in the management of these patients is recommended. Further research is needed for a deeper analysis of this association.

Introduction Heart failure (HF) is a worldwide public health problem and the main cause of morbidity and mortality in older people. Previous studies have demonstrated that psychological symptoms are associated with worse cardiovascular outcomes. Nevertheless, the research regarding the association between anxiety and HF is still scarce. Objectives To analyse the levels of anxiety in HF patients and its association with New York Heart Association (NYHA) class in HF patients. Methods This study takes part of a wider project named Deus Ex-Machina project (NORTE-01-0145-FEDER-00026). HF patients were recruited from an outpatient clinic at a University Hospital. Patient with inability to communicate, with severe visual impairment or with NYHA class IV were excluded. Sociodemographic data and NYHA class were recorded. Anxiety was assessed using the Generalized Anxiety Disorder-7 (GAD-7). Results Overall, 136 patients were included, with a mean age of 57(±13) years old. Most of them were men (66%) and married (76%), with mean education of 8 years (±4). Regarding NYHA class, 36%, 49% and 15% were at class I, II and III, respectively. The mean GAD-7 total score was 6.4 (±5.2) and 32% of patients showed moderate to severe anxiety symptoms. No association between the NYHA functional class and anxiety was found (p=0.106). Conclusions The results reveal that anxiety is frequent among HF patients. However, as found in previous studies, it was not associated with more severe HF symptoms. The coexistence of HF and anxiety deserves further studies, in order to build a better understanding of this association.

Background The New York Heart Association (NYHA) classification has served as a fundamental tool for risk stratification of heart failure (HF) and determines clinical trial eligibility and candidacy for drugs and devices. However, its ability to adequately stratify risk is unclear. Methods and Results To compare NYHA class with objective assessments and survival in patients with HF, we performed secondary analyses of 4 multicenter National Institutes of Health–funded HF clinical trials that included patients classified as NYHA class II or III: TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist), DIG (The Effect of Digoxin on Mortality and Morbidity in Patients With Heart Failure), HF‐ACTION (Efficacy and Safety of Exercise Training in Patients With Chronic Heart Failure), and GUIDE‐IT (Guiding Evidence‐Based Therapy Using Biomarker Intensified Treatment in Heart Failure). Twenty‐month cumulative survival was compared between classes using Kaplan–Meier curves and the log rank test. NT‐proBNP (N‐terminal pro–B‐type natriuretic peptide), Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, 6‐minute walk distances, left ventricular ejection fraction, and cardiopulmonary test parameters were compared using Wilcoxon rank sum tests and percentage overlap using kernel density estimations. Cumulative mortality varied significantly across NYHA classes and HF clinical trials (likelihood ratio, P

Aims: Acute heart failure (AHF) leads to a drastic increase in mortality and rehospitalization. The aim of the study was to identify prognostic variables in a real‐life population of AHF patients admitted to the emergency department with acute shortness of breath. Methods and results: We evaluated potential predictors of mortality in 728 consecutive patients admitted to the emergency department with AHF. Possible predictors of all‐cause and cardiovascular (CV) mortality were investigated by Cox and Fine and Gray models at multivariable analysis. Among the 728 patients, 256 died during the entire follow‐up, 142 of these due to CV cause. The 1 year mortality rate was 20%, with the highest risk of death during the index hospitalization (with 8% estimate in‐hospital mortality at 30 days). A higher risk of events during the index hospitalization was more evident for the CV deaths, for which we found a cumulative 1 year incidence of 12% with a cumulative incidence in the first 30 days of hospitalization of about 5%. At multivariable analysis, age (P < 0.001), New York Heart Association (NYHA) class IV vs. I–II–III (P = 0.001), systolic blood pressure (P < 0.001), non‐cardiac co‐morbidities (≥3 vs. 0, P = 0.05), oxygen saturation (P = 0.03), serum creatinine (P < 0.001), and left ventricular ejection fraction (LVEF) (40–49% vs. <40%, P = 0.004; ≥50% vs. <40%, P = 0.003) were independent predictors of all‐cause mortality during the entire follow‐up. Age (P = 0.03), systolic blood pressure (P = 0.01), oxygen saturation (P = 0.03), serum creatinine (P = 0.02), and LVEF (40–49% vs. <40%, P = 0.03; ≥50% vs. <40%, P = 0.004) were independent predictors of CV mortality during the entire follow‐up. NYHA class IV vs. I–II–III (P < 0.001), serum creatinine (P = 0.01), and LVEF (40–49% vs. <40%, P = 0.02; ≥50% vs. <40%, P < 0.001) remained independent predictors for in‐hospital death, while only serum creatinine (P = 0.04), LVEF (40–49% vs. <40%: 0.32, P = 0.04; ≥50% vs. <40%, P < 0.001), and NYHA class vs. I–II–III (P = 0.02) remained predictors for in‐hospital CV mortality. Conclusions: In this real‐life cohort of patients with AHF, the results showed a similar mortality rate comparing with other analysis and with the most important registries. Age, NYHA class IV, systolic blood pressure, creatinine levels, sodium levels, and ejection fraction were independent predictors of 1 year mortality, while LVEF <40% was the only predictor of both all‐cause mortality and CV mortality. [ABSTRACT FROM AUTHOR]

Purpose: To describe clinical and echocardiographic characteristics associated with reverse left ventricular (LV) remodeling after 6 months of cardiac resynchronization therapy (CRT) in patients with nonischemic dilated cardiomyopathy. Methods: Twenty‐four consecutive patients underwent 2D and 3D echocardiography before and after 6 months of CRT implant. Several echocardiographic parameters including global longitudinal strain (GLS) and 3D mechanical dyssynchrony (MD) index were calculated. CRT response was defined as a decrease in LV end‐systolic volume (LVESV) of at least 10% at follow‐up. Patients were divided in two groups according to CRT response. Results: Cardiac resynchronization therapy responder (CRTR+) rate was 50%. Nonresponder (CRTR−) patients showed a less significant improvement in NYHA class at follow‐up. At baseline, CRTR− presented with higher LV end‐diastolic volume (LVEDV) (P = 0.031), LVESV (P = 0.024), lower left ventricular ejection fraction (LVEF) (P = 0.002) and less negative GLS (P = 0.03), and with higher diastolic dysfunction, more impaired right ventricle (RV), and higher pulmonary artery systolic pressure (PASP) (P = 0.002). No significant differences in echocardiographic parameters of MD were found. Univariate determinants of CRTR+ were LVEF (OR = 1.59, CI 95% = 1.13–2.22, P = 0.007) and TAPSE (OR 1.21, CI 95% = 1.024–1.429, P = 0.025). A ROC curve analysis showed a cutoff value of LVEF of 22.15% significantly related to CRTR+ (SE 80%, SP 50%). Conclusions: Our findings suggest that end‐stage HF patients, presenting before CRT with LVEF <22.15%, may not benefit from the procedure after 6 months. Mechanical dyssyncronicity did not provide additional information to improve candidate selection. [ABSTRACT FROM AUTHOR]

Objective: To determine the clinical characteristics and outcomes of 57 cases of Pulmonary embolism in relation to use of thrombolytics and anticoagulants. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Adult cardiology department of AFIC & NIHD from Oct 2017 till Dec 2018. Material and Methods: Fifty seven patients with pulmonary embolism were included in the study using consecutive sampling technique. Clinical characteristics and outcomes of the patients were noted and analyzed. SPSS-23 was used for data analysis. Results: Fifty Seven cases of acute pulmonary embolism were included in our study and were admitted to the coronary care unit of hospital during the study period. Mean age of patients was 43.6 ± 17.88 years with minimum age 20 years and maximum 83 years. There were 47 (82.5%) male patients while 10 (17.50%) female patients. Most common NYHA class with which patients presented was, class III 27 (47.5%) followed by class IV 15 (26.3%), class II 9 (15.7) and class I 6 (10.5). The most common CT Pulmonary Angiogram finding of the patients was bilateral segmental embolism 30 (52.6%) followed by bilateral massive in 17 (29.8). Out of 57 patients, 22 (38.60%) patients received streptokinase and ten (17.5%) received tissue plasminogen activator (TPA). Nine patients were found to have deep venous thrombosis. Mortality was 12.30% (n=7). Conclusion: Acute pulmonary embolism is a relatively common medical emergency and accurate diagnosis in early period can help institute appropriate thrombolytic therapy to maximally benefit the patients. [ABSTRACT FROM AUTHOR]

Objective: To assess right ventricular function by echocardiography in 57 cases of hospitalized patients with Pulmonary Embolism. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Adult Cardiology Department of AFIC & NIHD from 1st October 2017 till 31st December, 2019. Material and Methods: 57 patients with pulmonary embolism were included in the study using consecutive sampling technique. Clinical characteristics and outcomes of the patients were noted and analyzed. SPSS-23 was used for data analysis. Results: Fifty Seven (57) cases of acute pulmonary embolism (based on CT pulmonary angiography) were included in our study and were admitted to the coronary care unit of hospital during the study period. Mean age of patients was 43.64 ± 17.8 years with minimum age 20 years and maximum 83 years. There were 47 (82.5%) male while 10 (17.5%) female patients. Most common New York Heart Association (NYHA) class with which patients presented was, class IIIin 27 (47.5%) followed by class IV in 15 patients (26.3%). The most common CT Pulmonary Angiogram finding of the patients was bilateral segmental embolism seen in 34 patients (59.64%). Out of 57 patients, 22 (38.6%) patients received streptokinase and ten (17.5%) received tissue plasminogen activator. Four patients were found to have deep venous thrombosis. Mortality was 12.3% (n=7). On 2D echocardiography, mean Pulmonary Artery Pressure (PAP) was 27.88 ± 19, mean RV size 41.56 ± 7 and mean RV/LV size ratio was 0.97 ± 0.15. Mean Tricuspid annular plane systolic excursion (TAPSE) as measure of right ventricular systolic function was 17.37 ±. Mortality was higher in patients with TAPSE less than 18. Conclusion: Acute pulmonary embolism is a relatively common medical emergency and accurate diagnosis in early period can help institute appropriate thrombolytic therapy to maximally benefit the patients. Right ventricular function can be assessed by echocardiography at bed side and its dysfunction correlates with prognosis and mortality in pulmonary embolism. [ABSTRACT FROM AUTHOR]