Search

The article describes the case of a 44 year old man with a long history of a narrow complex tachycardia and prior left lateral accessory pathway (LL-AP) ablation presented to the electrophysiology laboratory for a redo supraventricular tachycardia (SVT) ablation procedure. It notes that the case highlights the diagnostic challenge that occurs in case of recurrence of LL-AP in the setting of mitral annular block.

Aims The characteristics of heart failure ( HF) patients of different ethnic backgrounds in Israel are unknown. The purpose of the present study was to evaluate the clinical characteristics of Arab vs. Jewish patients with chronic HF. Methods and results Patients with a diagnosis of HF at a health maintenance organization in Jerusalem, Israel were evaluated. All patients were followed for cardiac-related hospitalizations and death. The study cohort included 6773 HF patients; 4991 (74%) were Jewish and 1735 (26%) were Arab. The overall prevalence of HF in the Jewish vs. Arab population was similar (women, 4.3% vs. 4.7%, respectively, P = 0.06; men, 5.3% vs. 5.2%, P = 0.61). The prevalence of HF was significantly higher in Arab subjects of younger age groups (50-70 years). Arabs developed HF on average 10 years earlier and had a significantly higher rate of diabetes and obesity. Standard of care based on prescribed medications was similar between the ethnic groups. Glucose and cholesterol levels were higher in the Arab cohort. Mortality was similar between the groups at median follow-up (576 days), with the exception of cardiovascular hospitalizations and death that were higher in Arab men. Conclusions Arab subjects develop HF at a much younger age compared with their Jewish counterparts and have a higher prevalence of diabetes and obesity. Standard of care and clinical outcome are comparable. Implementation of prevention programmes to reduce risk factors, particularly diabetes and obesity, may help reduce the disparity between Arabs and Jews. [ABSTRACT FROM AUTHOR]

Aims Glucose abnormalities are associated with heart failure ( HF), are increasingly prevalent, and may have an impact on outcome. Our aim was to evaluate the effect of fasting glucose levels on clinical outcome in patients with HF. Methods and results Patients with a diagnosis of HF as coded at a health maintenance organization in Jerusalem, Israel were evaluated retrospectively. Impaired fasting glucose ( IFG) was defined as fasting plasma glucose levels between 100 and 125 mg/ dL. All patients were followed for cardiac-related hospitalizations and death. A total of 6067 HF patients were included. Mean follow-up was 487 days; mean age 75 ± 13 years; 48% of the patients ( n = 2,942) had diabetes; and 11.9% ( n = 722) had IFG. Overall survival during the follow-up was 82.5%. Cox regression analysis after adjustment for significant predictors including age, gender, ischaemic heart disease, hyperlipidaemia, hypertension, body mass index, glomerular filtration rate, serum urea, sodium, and haemoglobin levels demonstrated that patients with diabetes and IFG had a very similar outcome. Both were significant predictors of reduced survival compared with 'normal' glucose levels (fasting glucose levels between 92 and 99 mg/ dL) [diabetes, hazard ratio ( HR) 1.42, 95% confidence interval ( CI) 1.08-1.86, P = 0.01; IFG, HR 1.55, 95% CI 1.13-2.15, P < 0.01]. Diabetes and IFG were also predictors of increased cardiac-related hospitalizations (diabetes HR 1.31, 95% CI 1.16-1.48, P < 0.001; IFG, HR 1.17, 95% CI 1.00-1.35, P < 0.05). Conclusions Diabetes and IFG are common in patients with HF and have a similar effect on outcome including survival and cardiac hospitalizations. Glucose abnormalities including subclinical diabetes confer significant risk in patients with HF. [ABSTRACT FROM AUTHOR]

Aims Thyroid dysfunction is known to effect cardiac function and is a risk factor for developing heart failure (HF). Data regarding the clinical significance of thyroid-stimulating hormone (TSH) levels alone as a predictor of outcome in patients with HF is sparse. We evaluated the significance of TSH on clinical outcome in a large cohort of patients with chronic HF. Methods and results Patients with a diagnosis of HF at a Health Maintenance Organization ( n = 5599) were followed for cardiac-related hospitalizations and death. Median TSH levels were 2.2 mIU/L (interquartile range 1.4-3.5). We divided patients into quartiles based on TSH levels. Median follow-up time was 434 days and the overall mortality rate was 13.2%. Both a high and a low TSH level was associated with an increased mortality rate. Cox regression analysis after adjustment for other significant predictors demonstrated that the highest TSH quartile was associated with increased mortality compared with those with the lowest mortality [second quartile: TSH 1.4-2.2 mIU/L, hazard ratio (HR) 1.36, 95% confidence interval (CI) 1.08-1.71, P = 0.01]. TSH was also an independent predictor of death and cardiac-related hospitalization. Analysis of patients not on levothyroxine treatment (78%) demonstrated that TSH was an even stronger predictor of mortality (HR 1.54, 95% CI 1.17-2.03, P = 0.002). Additional analysis based on accepted clinical cut-offs of TSH demonstrated that increasing TSH levels above normal were independently associated with increased mortality and cardiac-related hospitalizations. Conclusions Increased TSH levels are associated with worse clinical outcome in patients with HF. Thyroid imbalance confers significant risk in HF and warrants attention. [ABSTRACT FROM AUTHOR]

Aims Vitamin D deficiency is a highly prevalent, global phenomenon. The prevalence in heart failure (HF) patients and its effect on outcome are less clear. We evaluated vitamin D levels and vitamin D supplementation in patients with HF and its effect on mortality. Methods and results 25-Hydroxyvitamin D [25(OH)D] levels were evaluated in HF patients from a health maintenance organization (HMO), and compared them with those of the rest of the members of the HMO. Patients with HF (n = 3009) had a lower median 25(OH)D level compared with the control group (n = 46 825): 36.9 nmol/L (interquartile range 23.2–55.9) vs. 40.7 nmol/L (26.7–56.9), respectively, P < 0.00001. The percentage of patients with vitamin D deficiency [25(OH)D <25 nmol/L] was higher in patients with HF compared with the control group (28% vs. 22%, P < 0.00001). Only 8.8% of the HF patients had optimal 25(OH)D levels (≥75 nmol/L). Median clinical follow-up was 518 days. Cox regression analysis demonstrated that vitamin D deficiency was an independent predictor of increased mortality in patients with HF [hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.21–1.92, P < 0.001] and in the control group (HR 1.91, 95% CI 1.48–2.46, P < 0.00001). Vitamin D supplementation was independently associated with reduced mortality in HF patients (HR 0.68, 95% CI 0.54–0.85, P < 0.0001). Parameters associated with vitamin D deficiency in HF patients were decreased previous solar radiation exposure, body mass index, diabetes, female gender, pulse, and decreased calcium and haemoglobin levels. Conclusions Vitamin D deficiency is highly prevalent in HF patients and is a significant predictor of reduced survival. Vitamin D supplementation was associated with improved outcome. [ABSTRACT FROM PUBLISHER]