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Abstract Background The coexistence of clinical atrioventricular nodal reentrant tachycardia (AVNRT) and drug‐induced type 1 Brugada pattern (DI‐Type 1 BrP) has been previously reported. The present study was designed to determine the 12‐lead ECG characteristics at baseline and during AVNRT and to identify a subset of 12‐lead ECG variables of benefit associated with underlying Brugada syndrome (BrS)/DI‐Type 1 BrP among patients with slow/fast AVNRT. Methods A total of 40 (11 numerical/29 categorical) 12‐lead ECG parameters were analyzed and compared between patients with (n = 69) and without (n = 104) BrS/DI‐Type1‐BrP matched for age, female gender, body mass index, left ventricular ejection fraction and comorbid conditions. Five distinct types of ECG pattern (Type A/B/C/D/E) in V1–V2 leads during AVNRT were defined. Results A total of nine electrocardiographic variables, four at baseline, and five during AVNRT were identified. At baseline, patients with BrS/DI‐Type 1 BrP had higher prevalence of interatrial block, leftward shift of frontal plane QRS axis, the absence of normal QRS pattern (the presence of rSr’ pattern or type 2/3 Brugada pattern) in V1–V2 and QRS fragmentation in inferior leads compared to patients without BrS/DI‐Type 1 BrP. During AVNRT, patients with BrS/DI‐Type 1 BrP had higher prevalence of Type A ECG pattern (“coved‐type” ST‐segment elevation) in V1–V2, Type C ECG pattern (pseudo‐r’ deflection in V1 and “RBBB‐like” pattern in V2), pseudo‐r’ deflection in V1, QRS fragmentation in inferior leads and “isolated” QRS fragmentation/notching/slurring in aVL compared to patients without BrS/DI‐Type 1 BrP. Conclusions We identify several electrocardiographic variables that point to an underlying type 1 BrP among patients with slow/fast AVNRT.

Objective: The prognostic impact of worsening renal function (WRF) in patients with acute decompensated heart failure (ADHF) with preserved ejection fraction is controversial, and the pathophysiological mechanisms of WRF are not clearly understood. Methods: Fifty-three patients with ADHF with preserved ejection fraction were analyzed. WRF was defined as an increase of ≥ 0.3 mg/dL in the serum creatinine level during the first 5 days of the hospitalization and occurred in 37.7% of the study population. Results: Although baseline C-reactive protein (CRP) levels on admission was similar between patients with and without WRF, patients with WRF had higher 48-h CRP and delta CRP (Δ−CRP = 48-h CRP value − baseline CRP value) levels than those of patients without WRF. Multivariable analysis revealed that the baseline creatinine level and Δ−CRP were the independent risk factors for the development of WRF. The length of hospital stay (LOS) was significantly longer in the WRF group (9.9 ± 10.2 vs. 5.4 ± 2.8 days; P = 0.020). The median follow-up of the study population was 683 days, and the all-cause mortality rate was higher in patients with WRF than those without WRF (40% vs. 9.1%, P = 0.007, respectively). Conclusion: Baseline creatinine levels and Δ−CRP were the independent predictors of WRF. Increased inflammatory status expressed by Δ−CRP is found to be a novel finding for predicting the development of WRF in patients with ADHF with preserved ejection fraction. The presence of WRF was found to be associated with a poorer prognosis, including longer LOS, higher all-cause in-hospital, and all-cause postdischarge mortality.

The coexistence of atrial septal defect (ASD) and mitral stenosis (MS) is defined as Lutembacher's syndrome (LS). LS was originally defined as the development of MS in a patient having a congenital ASD diagnosis. However, as the percutaneous interventions for MS have become widespread, the persistence of associated iatrogenic ASDs caused has given rise to a different form of the disease. LS may occur as spontaneous or iatrogenic ASD concomitant with acquired MS; this form is known as “acquired LS.” This report presents two cases illustrating congenital LS and “acquired LS.”

Abstract Aims The use of guideline‐directed medical therapy (GDMT) among patients with heart failure (HF) with reduced ejection fraction (HFrEF) remains suboptimal. The SMYRNA study aims to identify the clinical factors for the non‐use of GDMT and to determine the prognostic significance of GDMT in patients with HFrEF in a real‐life setting. Methods and results The SMYRNA study is a prospective, multicentre, and observational study that included outpatients with HFrEF. Patients were divided into three groups according to the status of GDMT at the time of enrolment: (i) patients receiving all classes of HF medications including renin‐angiotensin system (RAS) inhibitors, beta‐blockers, and mineralocorticoid receptor antagonists (MRAs); (ii) patients receiving any two classes of HF medications (RAS inhibitors and beta‐blockers, or RAS inhibitors and MRAs, or beta‐blockers and MRAs); and (iii) either patients receiving class of HF medications (only one therapy) or patients not receiving any class of HF medications. The primary outcome was a composite of hospitalization for HF or cardiovascular death. The study population consisted of 1062 patients with HFrEF, predominantly men (69.1%), with a median age of 68 (range: 20–96) years. RAS inhibitors, beta‐blockers, and MRAs were prescribed in 76.0%, 89.4%, and 55.1% of the patients, respectively. The proportions of patients receiving target doses of guideline‐directed medications were 24.4% for RAS inhibitors, 11.0% for beta‐blockers, and 11.1% for MRAs. Overall, 491 patients (46.2%) were treated with triple therapy, 353 patients (33.2%) were treated with any two classes of HF medications, and 218 patients (20.6%) were receiving only one class of HF medication or not receiving any HF medication. Patient‐related factors comprising older age, New York Heart Association functional class, rural living, presence of hypertension, and history of myocardial infarction were independently associated with the use or non‐use of GDMT. During the median 24‐month period, the primary composite endpoint occurred in 362 patients (34.1%), and 177 of 1062 (16.7%) patients died. Patients treated with two or three classes of HF medications had a decreased risk of hospitalization for HF or cardiovascular death compared with those patients receiving ≤1 class of HF medication [hazard ratio (HR): 0.65; 95% confidence interval (CI): 0.49–0.85; P = 0.002, and HR: 0.61; 95% CI: 0.47–0.79; P

Background: Despite advances in therapeutic management of patients with heart failure, there is still an increasing morbidity and mortality all over the world. In this study, we aimed to present the 3-year follow-up outcomes of patients included in the Journey HF-TR study in 2016 that has evaluated the clinical characteristics and management of patients with acute heart failure admitted to the hospital and present a national registry data. Methods: The study was designed retrospectively between November 2016 and December 2019. Patient data included in the previously published Journey HF-TR study were used. Among 1606 patients, 1484 patients were included due to dropout of 122 patients due to inhospital death and due to exclusion of 173 due to incomplete data. The study included 1311 patients. Age, gender, concomitant chronic conditions, precipitating factors, New York Heart Association, and left ventricular ejection fraction factors were adjusted in the Cox regression analysis. Results: During the 3-year follow-up period, the ratio of hospitalization and mortality was 70.5% and 52.1%, respectively. Common causes of mortality were acute decompensation of heart failure and acute coronary syndrome. Angiotensin receptor blockers, betablockers, statin, and sacubitril/valsartan were found to reduce mortality. Hospitalization due to acute decompensated heart failure, acute coronary syndrome, lung diseases, oncological diseases, and cerebrovascular diseases was associated with the increased risk of mortality. Implantation of cardiac devices also reduced the mortality. Conclusions: Despite advances in therapeutic management of patients with heart failure, our study demonstrated that the long-term mortality still is high. Much more efforts are needed to improve the inhospital and long-term survival of patients with chronic heart failure.

Objective: Despite recommendations from heart failure guidelines on the use of pharmacologic and device therapy in patients with heart failure with reduced ejection fraction (HFrEF), important inconsistencies in guideline adherence persist in practice. The aim of this study was to assess adherence to guideline-directed medical and device therapy for the treatment of patients with chronic HFrEF (left ventricular ejection fraction ≤40%). Methods: The Adherence to guideline-directed medical and device Therapy in outpAtients with HFrEF (ATA) study is a prospective, multicenter, observational study conducted in 24 centers from January 2019 to June 2019. Results: The study included 1462 outpatients (male: 70.1%, mean age: 67+-11 years, mean LVEF: 30%+-6%) with chronic HFrEF. Renin–angiotensin system (RAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs), and ivabradin were used in 78.2%, 90.2%, 55.4%, and 12.1% of patients, respectively. The proportion of patients receiving target doses of medical treatments was 24.6% for RAS inhibitors, 9.9% for beta-blockers, and 10.5% for MRAs. Among patients who met the criteria for implantable cardioverter–defibrillator (ICD) and cardiac resynchronization therapy (CRT), only 16.9% of patients received an ICD (167 of 983) and 34% (95 of 279) of patients underwent CRT (95 of 279). Conclusion: The ATA study shows that most HFrEF outpatients receive RAS inhibitors and beta-blockers but not MRAs or ivabradin when the medical reasons for nonuse, such as drug intolerance or contraindications, are taken into account. In addition, most eligible patients with HFrEF do not receive target doses of pharmacological treatments or guideline-recommended device therapy.

Objective: Atrial fibrillation (AF) and heart failure (HF) are common cardiovascular diseases. The impact of AF on in-hospital outcomes in acute decompensated heart failure (ADHF) is controversial. The aim of this study is to determine the prevalence of AF among hospitalized patients with ADHF and describe the clinical characteristics and in-hospital outcomes of these patients with and without AF. Methods: We examined the multicenter, observational data from the real-life data of hospitalized patients with HF: Journey HF-TR study in Turkey that studied the clinical characteristics and in-hospital outcomes of hospitalized patients with ADHF between September 2015 and September 2016. Results: Of the 1,606 patients hospitalized with ADHF, 626 (39%) had a history of AF or developed new-onset AF during hospitalization. The patients with AF were older (71+-12 vs. 65+-13 years; p

A 77-year-old man with a past medical history of myelodysplastic syndrome, coronary artery disease, hypertension, and chronic atrial fibrillation presented at the hematology outpatient clinic with progressive shortness of breath, weakness, and chest and back pain. Echocardiography was performed and the patient was diagnosed with severe pericardial effusion near the right ventricle. Pericardial drainage was performed. Erysipelothrix rhusiopathiae was isolated from the pericardial fluid. Complications of respiratory and renal failure developed during follow-up. The clinical and laboratory findings of vegetation on the tricuspid valve, pericardial effusion, and atrial fibrillation with a low heart rate suggested possible pancarditis. A multidisciplinary treatment approach with the cardiology and infectious disease departments was critical to successful management of this case.