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While the interplay between heart failure (HF) and atrial fibrillation (AF) has been extensively studied, little is known regarding HF and atrial flutter (AFL), which may be managed differently. We reviewed the incidence, prevalence, and predictors of HF in AFL and vice versa, and the outcomes of treatment of AFL in HF. A systematic literature review of PubMed/Medline and EMBASE yielded 65 studies for inclusion and qualitative synthesis. No study described the incidence or prevalence of AFL in unselected patients with HF. Most cohorts enrolled patients with AF/AFL as interchangeable diagnoses, or highly selected patients with tachycardia‐induced cardiomyopathy. The prevalence of HF in AFL ranged from 6% to 56%. However, the phenotype of HF was never defined by left ventricular ejection fraction (LVEF). No studies reported the predictors, phenotype, and prognostic implications of AFL in HF. There was significant variation in treatments studied, including the proportion that underwent ablation. When systolic dysfunction was tachycardia‐mediated, catheter ablation demonstrated LVEF normalization in up to 88%, as well as reduced cardiovascular mortality. In summary, AFL and HF often coexist but are understudied, with no randomized trial data to inform care. Further research is warranted to define the epidemiology and establish optimal management.

Objectives: –This prospective study with a sizable cohort was undertaken to assess changes in left and right ventricle systolic and diastolic functions after percutaneous patent ductus arteriosus device closure with appropriate follow up evaluation. Methods: – It is an observational analytical prospective study. Ninety-eight patients were recruited out of which sixty-eight patients underwent percutaneous PDA device closure and were taken for final analysis. The primary objective was to study the left and right ventricular systolic and diastolic functions pre- and post-procedure at 48 h with follow up analysis at six months. Results: – The mean age of the patients was 7.88 ± 5.05 years with the female to male ratio was 3.85:1. Thirty-three (48.52%) of the patients had immediate post PDA device closure LV systolic dysfunction. It was more common in those having pre-procedure mean low LVEF and those having a significant reduction in mitral A velocity. It became normal at six months follow up. The study reported immediate decrease in mea/n LVEF from 63.55 ± 8.11% to 48.19 ± 7.9%. The changes in LVEDD, LVEF, LVFS and LVEDV were statistically significant (p

Highlights • Chronic severe AR progresses slowly with a long asymptomatic compensated phase. • Stress echocardiography (SE) has the ability to uncover subclinical LV dysfunction. • SE can identify patients with severe AR who may benefit from earlier intervention., Graphical abstract

Introduction and Aims: Catheter ablation has been shown to improve left ventricular (LV) ejection fraction (LVEF) in patients with atrial fibrillation (AF) and heart failure (HF). Our aim was to assess the impact of AF ablation on the outcome of patients with HF and LV systolic dysfunction. Methods: We performed a retrospective observational cohort study of all patients with HF and LVEF

Aims The SMART (Strategic MAnagement to optimize response to cardiac Resynchronization Therapy) Registry was designed to assess real‐world outcomes for patients receiving a cardiac resynchronization therapy defibrillator (CRT‐D) and to better understand which programming and optimization techniques are used and how effective they are. Methods and results The SMART Registry is a global, multicentre, prospective, observational, post‐market CRT‐D registry with a planned enrolment of 2000 subjects from a maximum of 200 sites in Europe, North America, and Asia‐Pacific region. Each subject will be followed up for a minimum of 12 months. The primary endpoint of CRT response rate at 12 months is defined by a clinical composite score of all‐cause mortality, heart failure events, New York Heart Association Class, and quality of life as assessed by a patient global assessment instrument. A subgroup composed of the first 103 consecutive European subjects implanted with an NG4 device will have left ventricular multisite pacing feature enabled at any time during the initial 12 months of follow‐up. The primary endpoint for this sub‐analysis will be the NG4 PG‐related complication‐free rate at 36 months. Conclusions The SMART Registry achieved its recruitment target in August 2019, with 2014 patients enrolled. The baseline demographics demonstrated that patients were generally older, with greater co‐morbidity, and on more contemporary medical therapy than in the key CRT trials. The results of the SMART Registry will determine which programming and optimization techniques are effective in this real‐world population.

Background Obesity is a worldwide epidemic that has been associated with poor outcomes. Previous studies have demonstrated an inverse relationship between body mass index (BMI) and outcomes, the 'obesity paradox', in several diseases. Hypothesis We sought to evaluate whether the obesity paradox is present in patients with left ventricular systolic dysfunction (LVSD) of all etiologies, using all‐cause mortality as the primary endpoint and hospitalization as the secondary endpoint. Methods We conducted a retrospective cohort study of LVSD patients (n = 18 003) seen within the University of Pittsburgh Medical Center network between January 2011 and December 2017. Patients were divided into four BMI categories (underweight, normal weight, overweight, and obese) and stratified by left ventricular ejection fraction (LVEF)

Background: The relation between left anterior descending artery (LAD) anatomy and clinical outcomes in patients with anterior ST-segment elevation myocardial infarction (STEMI) has not been fully investigated. The aim of this study was to determine the frequency and severity of short-term cardiovascular outcomes in patients with Anterior ST-Segment Elevation Myocardial Infarction (STEMI) undergoing primary percutaneous intervention (PCI), based on wraparound and non-wraparound left anterior descending artery (LAD). Methods: In a cross-sectional study, 126 patients with anterior STEMI who were admitted to Shahid Chamran Hospital in Isfahan during 2020 were studied. Patients were evaluated for anatomical features of LAD coronary artery and clinical outcomes determined and compared based on wraparound LAD and non-wraparound LAD during hospitalization and up to one month after PCI. Results: The prevalence of wraparound LAD in the studied patients was 73% and left ventricular systolic dysfunction in admission was greater and more severe in patients with wraparound LADs compared with those with non-wraparound. Severe LV systolic dysfunction in the wraparound and non-wraparound groups was 39.6% and 8.8%, respectively (P < 0.001). Also, the frequency of arrhythmias in the wraparound group (21.7%) was higher than the non-wraparound group (5.9%) (P = 0.037). Conclusion: The patients with anterior STEMI and wraparound LAD have a worse clinical outcome and more severe left ventricular systolic dysfunction. Therefore, it seems that the study of the anatomical condition of the LAD artery at the time of angiography is of great importance in the way of observation and care, and treatment of patients.

Background This study aims to evaluate the early and mid-term outcomes of mitral valve repair for degenerative mitral regurgitation (MR) in patients with left ventricular systolic dysfunction. Methods From January 2005 to December 2016, the profiles of patients with degenerative MR who underwent mitral valve repair at our institution were analyzed. Left ventricular systolic dysfunction was defined as an ejection fraction 40 mm. Finally, 322 patients with left ventricular systolic dysfunction were included in this study. The prognosis of left ventricular function during follow-up was evaluated and preoperative factors associated with deteriorated left ventricular systolic function during follow-up were analyzed. Results The in-hospital mortality rate was 1.6%. The rate of eight-year overall survival, freedom from reoperation for mitral valve and freedom from recurrent MR were 96.9, 91.2 and 73.4%, respectively. Intraoperative residual mild MR (hazard ratio 4.82) and an isolated anterior leaflet lesion (hazard ratio 2.48) were independent predictive factors for recurrent MR. During follow-up, 212 patients underwent echocardiography examinations at our institution. Among them, 132 patients had improved left ventricular systolic function, and 80 patients had deteriorated left ventricular systolic. Freedom from recurrent MR was found in 75.9% of the improved left ventricular systolic function group and 56.2% of the deteriorated left ventricular systolic function group (P = 0.047). An age > 50 years (odds ratio 2.40), ejection fraction≤52% (odds ratio 2.79) and left ventricular end-systolic dimension≥45 mm (odds ratio 2.31) were independent risk factors for deteriorated left ventricular systolic function during follow-up. Conclusions Mitral valve repair could be safely performed for degenerative MR in patients with left ventricular systolic dysfunction. Intraoperative residual mild MR and an isolated anterior leaflet lesion were independent predictive factors for recurrent MR. An age > 50 years, ejection fraction≤52% and left ventricular end-systolic dimension≥45 mm were independent risk factors for deteriorated left ventricular systolic function during follow-up.

Background The effect of chronic total occlusion (CTO) revascularization on survival remains controversial. Furthermore, data regarding outcome differences for CTO revascularization based on left ventricular systolic function (LVSF) are limited. The differential outcomes from CTO revascularization in patients with preserved LVSF (PLVSF) versus reduced LVSF (RLVSF) were assessed. Methods A total of 2,173 CTO patients were divided into either a PLVSF (n = 1661, Ejection fraction ≥ 50%) or RLVSF (n = 512, Results Patients with RLVSF had a mean 37% ejection fraction (EF) and 19% had EF p p = 0.0019], which was mainly driven by a reduction in cardiac death. The difference in survival probability was greater and became more pronounced over time in patients with RLVSF than with PLVSF (1-year, p = 0.197; 3-years, p = 0.048; 5-years, p = 0.036). Conclusions SCR was associated with better survival benefit than OMT regardless of LVSF. The benefit was greater and became more significant over time in patients with RLVSF versus PLVSF. Graphic abstract

Objective: To assess the performance of ten electrocardiographic (ECG) parameters regarding the prediction of left ventricular systolic dysfunction (LVSD) after a first ST-segment-elevation myocardial infarction (STEMI). Methods: We analyzed 249 patients (74.7% males) treated with primary percutaneous coronary intervention (PCI) included into a single-center cohort study. We sought associations between baseline and post-PCI ECG parameters and the presence of LVSD (defined as left ventricular ejection fraction [LVEF] ≤ 40% on echocardiography) 6 months after STEMI. Results: Patients presenting with LVSD (n = 52) had significantly higher values of heart rate, number of leads with ST-segment elevation and pathological Q-waves, as well as total and maximal ST-segment elevation at baseline and directly after PCI compared with patients without LVSD. They also showed a significantly higher prevalence of anterior STEMI and considerably wider QRS complex after PCI, while QRS duration measurement at baseline showed no significant difference. Additionally, patients presenting with LVSD after 6 months showed markedly more severe ischemia on admission, as assessed with the Sclarovsky-Birnbaum ischemia score, smaller reciprocal ST-segment depression at baseline and less profound ST-segment resolution post PCI. In multivariate regression analysis adjusted for demographic, clinical, biochemical and angiographic variables, anterior location of STEMI (OR 17.78; 95% CI 6.45–48.96; p < 0.001), post-PCI QRS duration (OR 1.56; 95% CI 1.22–2.00; p < 0.001) expressed per increments of 10 ms and impaired post-PCI flow in the infarct-related artery (IRA; TIMI 3 vs. p = 0.001) were identified as independent predictors of LVSD (Nagelkerke’s pseudo R2 for the logistic regression model = 0.462). Similarly, in multiple regression analysis, anterior location of STEMI, wider post-PCI QRS, higher baseline number of pathological Q-waves and a higher baseline Sclarovsky-Birnbaum ischemia score, together with impaired post-PCI flow in the IRA, higher values of body mass index and glucose concentration on admission were independently associated with lower values of LVEF at 6 months (corrected R2 = 0.448; p < 0.00001). Conclusions: According to our study, baseline and post-PCI ECG parameters are of modest value for the prediction of LVSD occurrence 6 months after a first STEMI.

Takotsubo cardiomyopathy (TCM) is a cardiac condition that presents with features of acute myocardial infarction and transient systolic dysfunction without angiographic findings of obstructive coronary heart disease. Common presenting symptoms include acute substernal chest pain, dyspnea and syncope. It is usually triggered by recent emotional or physical stress such as head trauma, stroke, sepsis, overproduction of catecholamines such as pheochromocytoma or following Myasthenia crisis. We are here to report a case of TCM who does not have any identifiable emotional or physical stress prior to the event. The patient was a 76-year-old Caucasian female with a past medical history of hypertension who presented to the hospital with chest pain which initially was treated as non-ST elevation myocardial infarction (NSTEMI) with aspirin, ticagrelor and heparin infusion. Cardiac catheterization later revealed non-obstructive coronary artery disease but showed akinesis of inferior, apical and anterior walls with hyperdynamic basal segments indicating TCM.

BackgroundCushing’s disease is a rare condition associated with a high cardiovascular risk and hypercortisolemia-related hemodynamic dysfunction, the extent of which can be assessed with a noninvasive method, called impedance cardiography. The standard methods for hemodynamic assessment, such as echocardiography or ambulatory blood pressure monitoring may be insufficient to fully evaluate patients with Cushing’s disease; therefore, impedance cardiography is being currently considered a new modality for assessing early hemodynamic dysfunction in this patient population. The use of impedance cardiography for diagnosis and treatment of Cushing’s disease may serve as personalized noninvasive hemodynamic status assessment and provide a better insight into the pathophysiology of Cushing’s disease. The purpose of this study was to assess the hemodynamic profile of Cushing’s disease patients and compare it with that in the control group.Material and MethodsThis observational prospective clinical study aimed to compare 54 patients with Cushing’s disease (mean age 41 years; with 64.8% of this population affected with arterial hypertension) and a matched 54-person control group (mean age 45 years; with 74.1% of this population affected with arterial hypertension). The hemodynamic parameters assessed with impedance cardiography included the stroke index (SI), cardiac index (CI), systemic vascular resistance index (SVRI), velocity index (VI), (ACI), Heather index (HI), and thoracic fluid content (TFC).ResultsThe Cushing’s disease group was characterized by a higher diastolic blood pressure and a younger age than the control group (82.9 vs. 79.1 mmHg, p=0.045; and 41.1 vs. 44.9 years, p=0.035, respectively). Impedance cardiography parameters in the Cushing’s disease group showed: lower values of SI (42.1 vs. 52.8 ml/m2; p ≤ 0.0001), CI (2.99 vs. 3.64 l/min/m2; p ≤ 0,0001), VI (42.9 vs. 52.1 1/1000/s; p=0.001), ACI (68.7 vs. 80.5 1/100/s2; p=0,037), HI (13.1 vs. 15.2 Ohm/s2; p=0.033), and TFC (25.5 vs. 27.7 1/kOhm; p=0.006) and a higher SVRI (2,515 vs. 1,893 dyn*s*cm-5*m2; p ≤ 0.0001) than those in the control group.ConclusionsCushing’s disease is associated with significantly greater vasoconstriction and left ventricular systolic dysfunction. An individual assessment with impedance cardiography may be useful in Cushing’s disease patients in order to identify subclinical cardiovascular complications of chronic hypercortisolemia as potential therapeutic targets.

A 65-year-old female presented with 2 weeks of dyspnoea, associated with orthopnoea and lower limb pitting edema. There were no prior major physical or emotional stressors. Initial investigations showed elevated N-terminal pro-B-type natriuretic peptide (NT-ProBNP), Troponin-I and dynamic ST-T changes on electrocardiogram. Coronary angiography was normal and echocardiography demonstrated apical akinesis and ballooning with normokinesis of the base of the left ventricle. A diagnosis of Takotsubo cardiomyopathy (TC) was made. The patient was initially treated for heart failure as well but a thoracentesis of pleural fluid demonstrated adenocarcinoma. Computed tomography revealed newly diagnosed metastatic ovarian adenocarcinoma. To our knowledge, TC as a presentation of undiagnosed metastatic ovarian cancer has not been reported before and we believe that this case adds to the growing literature of the link between TC and cancer.

Coronary artery disease (CAD) can manifest as a classic chest pain, or atypical angina. At the same time, the prevalence of CAD in a group of male patients with atypical angina over the age of 60 can reach 59--78%. It should be noted that the clinic manifestation of the chronic heart failure (CHF), which will be the main limiting factor, may take centre stage in diffuse coronary artery atherosclerosis. In patients with coronary artery disease and heart failure, who take atorvastatin, one should expect a decrease in the risk of adverse outcomes and hospitalizations due to heart failure. However, this does not negate the need for treatment and optimization of heart failure, if necessary. The therapy of these patients is based on the administration of high doses of angiotensin converting enzyme inhibitors (ACE inhibitors), beta-blockers (BB) and statins. The routine use of statins in heart failure with low ejection fraction (EF) is not recommended for the management of patients with heart failure from clinical guidelines point of view. This conclusion is based on two multicenter randomized clinical trials that have purposefully studied the use of statins in heart failure (CORONA and GISSI-HF). However, this document recommends the use of statins to prevent heart failure in patients with coronary artery disease. Continuing statin therapy in patients, who are already receiving these drugs for coronary artery disease or hyperlipidemia, should also be discussed. Thus, the use of atorvastatin in patients with coronary artery disease and systolic left ventricular myocardial dysfunction can reduce the risk of adverse outcomes and hospitalizations due to heart failure. In patients with non-ischemic heart failure, taking statins is not associated with improved survival. Thus, the decision to prescribe this group of drugs in patients with chronic heart failure should take into account the specific clinical situation and be strictly individualized.

Background Factors associated with left ventricular systolic dysfunction (LVSD) of peritoneal dialysis (PD) patients are limited. We aim to explore and quantify the associated factors of LVSD among PD patients. Methods Participants from a PD clinic treated between 2012 and 2014 at the HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, Nakhon Nayok, Thailand were recruited and divided into 2 groups according to their left ventricular ejection fraction (LVEF) ( 3.6 [6.77 (1.41, 32.52)], and high serum phosphate [9.39 (2.16, 40.92)] were significantly associated with LVSD. Conclusions Prior history of CAD, DM, smoking, high NLR and serum phosphate levels were found to be associated with LVSD for our PD patients. The evidence from prospective study is needed to confirm the predictive value of these variables. Electronic supplementary material The online version of this article (10.1186/s12882-019-1418-7) contains supplementary material, which is available to authorized users.

BACKGROUND There is a high risk for sudden cardiac death (SCD) in certain patient groups that would not meet criteria for implantable cardioverter defibrillator (ICD) therapy. In conditions such as hypertrophic cardiomyopathy (HCM) there are clear risk scores that help define patients who are high risk for SCD and would benefit from ICD therapy. There are however many areas of uncertainty such as certain patients post myocardial infarction (MI). These patients are high risk for SCD but there is no clear tool for risk stratifying such patients. AIM To assess risk factors for sudden cardiac death in major cardiac disorders and to help select patients who might benefit from Wearable cardiac defibrillators (WCD). METHODS A literature search was performed looking for risk factors for SCD in patients post-MI, patients with left ventricular systolic dysfunction (LVSD), HCM, long QT syndrome (LQTS). There were 41 studies included and risk factors and the relative risks for SCD were compiled in table form. RESULTS We extracted data on relative risk for SCD of specific variables such as age, gender, ejection fraction. The greatest risk factors for SCD in post MI patients was the presence of diabetes [Hazard ratio (HR) 1.90-3.80], in patient with LVSD was ventricular tachycardia (Relative risk 3.50), in LQTS was a prolonged QTc (HR 36.53) and in patients with HCM was LVH greater than 20 mm (HR 3.10). A proportion of patients currently not suitable for ICD might benefit from a WCD CONCLUSION There is a very high risk of SCD post MI, in patients with LVSD, HCM and LQTS even in those who do not meet criteria for ICD implantation. These patients may be candidates for a WCD. The development of more sensitive risk calculators to predict SCD is necessary in these patients to help guide treatment.

Acute cerebral injuries are often accompanied by sudden electrocardiogram (ECG) changes such as cardiac arrhythmias, QT prolongation, and abnormal T-wave morphology. One rare phenomenon is “cerebral T-waves”, which are T-waves observed in the context of stroke and described as transient, symmetric, and deeply inverted. The classic cerebral T wave is defined as a T-wave inversion of ≥5 mm depth in at least four contiguous precordial leads, and it is more commonly observed in the setting of acute ischemic stroke rather than hemorrhagic stroke. We describe the case of a patient who initially presented with acute pulmonary edema, T-wave inversions in the precordial leads, and left ventricular dysfunction on echocardiogram raising suspicion of an ischemic cardiac event. However, a brain CT scan performed on the third day of admission proved us wrong.

Background: Neprilysin inhibition has demonstrated impressive benefits in heart failure treatment, and is the current focus of interest in cardiovascular (CV) and kidney diseases. However, the role of circulating neprilysin as a biomarker for CV events is unclear in hemodialysis (HD) patients.Methods: A total of 439 HD patients from the K-cohort were enrolled from June 2016 to April 2019. The plasma neprilysin level and echocardiographic findings at baseline were examined. The patients were prospectively followed up to assess the primary endpoint (composite of CV events and cardiac events).Results: Plasma neprilysin level was positively correlated with left ventricular (LV) mass index, LV end-systolic volume, and LV end-diastolic volume. Multivariate linear regression analysis revealed that neprilysin level was negatively correlated with LV ejection fraction (β = −2.14; p = 0.013). The cumulative event rate of the composite of CV events was significantly greater in neprilysin tertile 3 (p = 0.049). Neprilysin tertile 3 was also associated with an increased cumulative event rate of cardiac events (p = 0.016). In Cox regression analysis, neprilysin tertile 3 was associated with a 2.61-fold risk for the composite of CV events [95% confidence interval (CI), 1.37–4.97] and a 2.72-fold risk for cardiac events (95% CI, 1.33–5.56) after adjustment for multiple variables.Conclusions: Higher circulating neprilysin levels independently predicted the composite of CV events and cardiac events in HD patients. The results of this study suggest the importance of future studies on the effect of neprilysin inhibition in reducing CV events.

Background Post-transplant cyclophosphamide (PT-Cy) has become a standard of care in haploidentical hematopoietic stem cell transplantation (HSCT) to reduce the risk of graft-versus-host disease. However, data on cardiac events associated with PT-Cy are scarce. Objectives This study sought to assess the incidence and clinical features of cardiac events associated with PT-Cy. Methods The study compared clinical outcomes between patients who received PT-Cy (n = 136) and patients who did not (n = 195), with a focus on early cardiac events (ECE) occurring within the first 100 days after HSCT. All patients had the same systematic cardiac monitoring. Results The cumulative incidence of ECE was 19% in the PT-Cy group and 6% in the no–PT-Cy group (p < 0.001). The main ECE occurring after PT-Cy were left ventricular systolic dysfunction (13%), acute pulmonary edema (7%), pericarditis (4%), arrhythmia (3%), and acute coronary syndrome (2%). Cardiovascular risk factors were not associated with ECE. In multivariable analysis, the use of PT-Cy was associated with ECE (hazard ratio: 2.7; 95% confidence interval: 1.4 to 4.9; p = 0.002]. Older age, sequential conditioning regimen, and Cy exposure before HSCT were also associated with a higher incidence of ECE. Finally, a history of cardiac events before HSCT and ECE had a detrimental impact on overall survival. Conclusions PT-Cy is associated with a higher incidence of ECE occurring within the first 100 days after HSCT. Patients who have a cardiac event after HSCT have lower overall survival. These results may help to improve the selection of patients who are eligible to undergo HSCT with PT-Cy, especially older adult patients and patients with previous exposure to Cy., Central Illustration

Background Advantages of multiple arterial conduits for coronary artery bypass grafting (CABG) have been reported previously. We aimed to evaluate the mid-term outcomes of multiple arterial CABG (MABG) among patients with mild to moderate left ventricular systolic dysfunction (LVSD). Methods This multicenter study using propensity score matching took place from January 2013 to June 2019 in Jiangsu Province and Shanghai, China, with a mean and maximum follow-up of 3.3 and 6.8 years, respectively. We included patients with mild to moderate LVSD, undergoing primary, isolated multi-vessel CABG with left internal thoracic artery. The in-hospital and mid-term outcomes of MABG versus conventional left internal thoracic artery supplemented by saphenous vein grafts (single arterial CABG) were compared. The primary end points were death from all causes and death from cardiovascular causes. The secondary end points were stroke, myocardial infarction, repeat revascularization, and a composite of all mentioned outcomes, including death from all causes (major adverse events). Sternal wound infection was included with 6 months of follow-up after surgery. Results 243 and 676 patients were formed in MABG and single arterial CABG cohorts after matching in a 1:3 ratio. In-hospital death was not significantly different (MABG 1.6% versus single arterial CABG 2.2%, p = 0.78). After a mean (±SD) follow-up time of 3.3 ± 1.8 years, MABG was associated with lower rates of major adverse events (HR, 0.64; 95% CI, 0.44–0.94; p = 0.019), myocardial infarction (HR, 0.39; 95% CI, 0.16–0.99; p = 0.045) and repeat revascularization (HR, 0.42; 95% CI, 0.18–0.97; p = 0.034). There was no difference in the rates of death, stroke, and sternal wound infection. Conclusions MABG was associated with reduced mid-term rates of major adverse events and cardiovascular events and may be the procedure of choice for patients with mild to moderate LVSD requiring CABG.

Background: The number of coronary chronic total occlusion (CTO) patients with left ventricular (LV) systolic dysfunction is significant, but the clinical outcomes of these patients are rarely reported. The present retrospective cohort study aimed to investigate the long-term outcomes of successful recanalization vs. optimal medical therapy (MT) for CTOs in patients with preserved and impaired LV systolic function.Methods: A total of 1,895 patients with CTOs were stratified according to LV function. Of these, 1,420 patients (74.9%) with LV ejection fraction (LVEF) >45% and 475 patients (25.1%) with LVEF ≤45% were treated with optimal MT or successful CTO percutaneous coronary intervention (PCI). A 1:1 propensity score matching (PSM) was conducted to reduce the impact of potential confounding on the outcomes. The primary outcome was the frequency of major adverse cardiac events (MACEs).Results: Throughout a 2.6-year follow-up and after adjusting for confounders, among patients with preserved LV function, successful CTO PCI was associated with reduced incidence of MACE (14.2 vs. 23.9%, adjusted HR 0.63, 95% CI 0.48–0.83, p = 0.001) compared to MT. There was no significant difference in MACE occurrence (29.6 vs. 28.9%, adjusted HR 1.05, 95% CI: 0.71–1.56, p = 0.792) between successful recanalization and MT in patients with LV systolic dysfunction. The primary outcome among patients with impaired and preserved LV systolic function after PSM was similar to that from earlier findings before PSM was conducted. A significant interaction between LV function and therapeutic strategy for MACE was observed (interaction p = 0.038).Conclusions: Compared to MT alone for management of patients with CTOs, successful CTO PCI may reduce the risk of MACE in patients with preserved LV systolic function, but not in patients with LV dysfunction.

(1) Background: Coronavirus infection (Covid-19) has emerged as a severe medical condition, associated with high pulmonary morbidity and often with cardiovascular (CV) complications. This study aims to evidence the persistence of left ventricular (LV) systolic function (LV-SF) alterations and diastolic dysfunction (DD) in COVID-19 patients without history of cardiovascular (CV) diseases by transthoracic echocardiography (TTE). (2) Methods: 125 patients, aged under 55 years, hospitalized during the first outbreak of Covid-19 for moderate pneumonia, underwent a comprehensive cardiologic examination and TTE at 6–10 weeks after discharge. Their initial in-hospital laboratory data and thorax computer tomography (TCT) were accessed from the electronic database of the hospital. (3) Results: with TTE, we documented alterations of LV-SF and DD in 8.8% of patients and in 16.8% only patterns of DD, statistically correlated with the initial levels of creatin-kinase (CK-MB) and inflammatory factors. Multivariate regression analysis evidenced that CK-MB levels, age, and body mass index (BMI) are responsible for 65% of LV-SF decrease. (4) Conclusions: Alterations of LV-SF and DD are frequent in post-acute COVID-19 infection and are responsible for the persistence of symptoms. Elevated myocardial necrosis markers during the acute phase seem to predict subsequent alteration of cardiac performance.

A 22-year-old man presented with severe left ventricular (LV) dysfunction and progressive heart failure. The 12-lead electrocardiogram showed short runs of supraventricular tachycardia suggestive of focal atrial tachycardia. The patient underwent successful radiofrequency ablation. There was a complete recovery of symptoms and LV function at six months of follow-up. We discuss the importance of identifying tachycardiomyopathy as a reversible cause of heart failure.

A multicenter study to evaluate the prevalence and cardiovascular outcomes of diabetic cardiomyopathy in type II diabetic patients. Two hundred participants with type II diabetes mellitus (DM) were included, while participants with coronary artery disease (CAD), valvular heart disease, or history of alcohol or drug abuse were excluded. Participants were subjected to history taking for age, gender, body mass index, smoking, dyslipidemia, medications, DM, Framingham diagnostic criteria of heart failure (HF), comprehensive clinical examination, 12 leads resting electrocardiogram, transthoracic echocardiography and one of the following laboratory investigations: glycated hemoglobin, random blood sugar, fasting blood sugar, or 2-hour 75-gram oral glucose tolerance test. The prevalence of diabetic cardiomyopathy versus (vs) no diabetic cardiomyopathy, left ventricular (LV) diastolic dysfunction grade II and III, systolic dysfunction, and hypertrophy in the study population was 23.0% vs 77.0%, 18.5%, 5.0%, and 8.0%, respectively. There was a highly significant difference between LV diastolic dysfunction grade II and III, systolic dysfunction, and hypertrophy in the diabetic cardiomyopathy group vs no diabetic cardiomyopathy group, with an absolute risk increase of 80%, 22%, and 35% in the diabetic cardiomyopathy group, respectively. There was a highly significant difference between the mean ejection fraction (EF) in the diabetic cardiomyopathy group vs the no diabetic cardiomyopathy group. The mean EF for the diabetic cardiomyopathy group was 5.5% lower than the mean EF for the no diabetic cardiomyopathy group. The prevalence of HF and pre-clinical HF in the diabetic cardiomyopathy group was 65% and 35%, respectively. The mean age for HF was 4.1 years older than the mean age for pre-clinical HF in the diabetic cardiomyopathy group. Smoking was significantly and strongly associated with HF vs pre-clinical HF in the diabetic cardiomyopathy group. Diabetic cardiomyopathy was prevalent in an Egyptian type II diabetic patient population and could be considered a primary myocardial disease predisposing to HF in type II DM., Cilj: Proveli smo multicentričnu studiju kako bismo odredili prevalenciju i kardiovaskularne ishode kod dijabetičke kardiomiopatije (DCM) u bolesnika s dijabetesom tipa 2. Metode: U istraživanje je bilo uključeno dvjesto ispitanika s dijabetesom tipa 2 (DM). Isključeni su ispitanici s koronarnom bolesti srca (CAD), valvularnom bolesti srca ili anamnestičkim podatcima o zlouporabi droga ili alkohola. Nakon anamnestičkih podataka utvrđeni su indeks tjelesne mase, učestalost pušenja, dislipidemije, DM-a, uporaba lijekova te su provedeni procjena dijagnostičkih kriterija zatajivanja srca (HF) prema Framinghamskoj studiji, klinički pregled, 12-kanaln elektrokardiogram u mirovanju, transtorakalna ehokardiografija te jedna od laboratorijskih varijabli: HbA1c, nasumične ili natašte izmjerene vrijednost glukoze u krvi ili rezultat dvosatnog testa oralne podnošljivosti glukoze. Rezultati: Prevalencija u usporedbi s odsutnošću DCM-a, dijastolička disfunkcija lijeve klijetke (LV) II. i III. stupnja, sistolička disfunkcija i hipertrofija u istraživanoj skupini iznosile su, redom: 23,0 % prema 77,0 %, 18,5 %, 5,0 % i 8,0 %. U skupini s DCMom postojala je značajna razlika u učestalosti dijastoličke disfunkcije LV-a II. i III. stupnja, sistoličke disfunkcije i hipertrofiji u usporedi sa skupinom ispitanika bez DCM-a, s apsolutnim povećanjem rizika u skupini s DCM-om za ta stanja od, redom, 80 %, 22 % i 35 %. Pronađena je i signifikantna razlika u prosječnoj vrijednosti ejekcijske frakcije (EF) između skupina s DCM-om i bez DCM-a. Prosječna EF u skupini s DCM-om bila je za 5,5 % niža nego u skupini bez DCM-a. Zastupljenost HF-a i pretkliničke HF u skupini s DCM-om iznosila je 65 % i 35 %. U skupni s DCM-om prosječna je dob kod HF-a bila 4 ,1 godinu viša nego prosječna dob za pretklinički HF. Pušenje je bilo izrazito i značajno povezano s HF-om u odnosu prema predkliničkom HF-u u skupni s DCM-om. Zaključci: DCM je bio zastupljen u egipatskih bolesnika s dijabetesom tipa 2 te se može smatrati primarnom miokardijalnom bolešću koja uzrokuje predispoziciju za HF kod dijabetesa tipa 2.

Objective: Left ventricular systolic dysfunction (LVSD) after ST-segment elevation myocardial infarction (STEMI) is associated with poor outcome. Trimethylamine N-oxide (TMAO), a gut metabolite, is linked to cardiovascular diseases but its relationship with LVSD after STEMI remains unclear. The present study therefore aimed to investigate the relationship between TMAO and LVSD at 30 days after a first anterior STEMI.Methods: This was a sub-study from the OCTAMI (Optical Coherence Tomography Examination in Acute Myocardial Infarction) registry. Eligible patients were included in current study if they: (1) presented with a first anterior STEMI; (2) had available baseline TMAO concentration; (3) completed a cardiovascular magnetic resonance examination at 30 days after STEMI. LVSD was defined as left ventricular ejection fraction < 50%. Associations between TMAO and left ventricular ejection fraction, infarct size and left ventricular global strain were examined.Results: In total, 78 patients were included in final analysis. Overall, TMAO was moderately associated with peak cTnI (r = 0.27, p = 0.01), age (r = 0.34, p < 0.01), and estimated glomerular filtration rate (r = −0.30, p < 0.01). At 30-day follow-up, 41 patients were in the LVSD group and 37 in the non-LVSD group. Baseline TMAO levels were not significantly different between the two groups (LVSD vs. non-LVSD: median 1.9 μM, 25−75th percentiles 1.5–3.3 μM vs. median 1.9 μM, 25−75th percentiles 1.5–2.7 μM; p = 0.46). Linear regression analyses showed that TMAO was not associated with left ventricular ejection fraction, infarct size or left ventricular global strain at 30 days (all p > 0.05).Conclusions: TMAO was not significantly correlated with 30-day LVSD in patients with a first anterior STEMI after primary revascularization.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03593928.

Introduction The aim of this study was to compare the in-hospital outcomes of multiport antegrade cold blood cardioplegia through vein grafts versus conventional antegrade cold blood cardioplegia in patients with left ventricle systolic dysfunction who underwent coronary artery bypass grafting (CABG). Methods This prospective, randomized clinical study was comprised of patients undergoing on-pump CABG at the Ch. Pervaiz Elahi Institute of Cardiology in Multan, Pakistan from November 18, 2018 to December 17, 2019. Patients with multivessel coronary artery disease and left ventricular systolic dysfunction (ejection fraction < 50%) were included. In Group A (N = 73), multiport antegrade cold blood vein graft cardioplegia was given after every distal anastomosis completed for myocardial preservation. In Group B (N = 73), conventional antegrade cold blood cardioplegia was given for myocardial preservation. Results Spontaneous rhythm (without defibrillation applied) after cross-clamp removal was higher in Group A than in Group B (93.3% vs. 85.2%, p < 0.05). Duration of support, ventilation time, and hospital stay were also significantly lower in Group A than in Group B with p = 0.00001, p = 0.03, and p = 0.002, respectively. Intra-aortic balloon pump insertion (4.1% vs. 23.0%, p = 0.02) and operative mortality (0.5% vs. 4.0%, p = 0.35) were also lower in Group A than in Group B. Postoperative left ventricular ejection fraction (LVEF) increased more in Group A than in Group B, and the postoperative LVEF mean value was 44.68% in Group A versus 41.26% in Group B (p = 0.02). Conclusion Multiport vein graft blood cardioplegia provides superior myocardial protection in patients with left ventricular systolic dysfunction who underwent CABG. It is also easy to administer, so this technique can be adopted as a routine method for myocardial protection in patients with left ventricular dysfunction planned for on-pump CABG.

Background Cardiovascular disease is the most common cause of death in patients with end-stage kidney disease on haemodialysis. The potential clinical consequence of systematic echocardiographic assessment is however not clear. In an unselected, contemporary population of patients on maintenance haemodialysis we aimed to assess: the prevalence of structural and functional heart disease, the potential therapeutic consequences of echocardiographic screening and whether left-sided heart disease is associated with prognosis. Methods Adult chronic haemodialysis patients in two large dialysis centres had transthoracic echocardiography performed prior to dialysis and were followed prospectively. Significant left-sided heart disease was defined as moderate or severe left-sided valve disease or left ventricular ejection fraction (LVEF) ≤40%. Results Among the 247 included patients (mean 66 years of age [95%CI 64–67], 68% male), 54 (22%) had significant left-sided heart disease. An LVEF ≤40% was observed in 31 patients (13%) and severe or moderate valve disease in 27 (11%) patients. The findings were not previously recognized in more than half of the patients (56%) prior to the study. Diagnosis had a potential impact on management in 31 (13%) patients including for 18 (7%) who would benefit from initiation of evidence-based heart failure therapy. After 2.8 years of follow-up, all-cause mortality among patients with and without left-sided heart disease was 52 and 32% respectively (hazard ratio [HR] 1.95 (95%CI 1.25–3.06). A multivariable adjusted Cox proportional hazard analysis showed that left-sided heart disease was an independent predictor of mortality with a HR of 1.60 (95%CI 1.01–2.55) along with age (HR per year 1.05 [95%CI 1.03–1.07]). Conclusion Left ventricular systolic dysfunction and moderate to severe valve disease are common and often unrecognized in patients with end-stage kidney failure on haemodialysis and are associated with a higher risk of death. For more than 10% of the included patients, systematic echocardiographic assessment had a potential clinical consequence.

Acute cerebral injuries have been repeatedly correlated with sudden and different electrocardiogram (EKG) changes, such as cardiac arrhythmias, QT prolongation, and abnormal T-wave morphology. One rare phenomenon is "cerebral T-waves," which are T-waves observed in the context of stroke and described as transient, symmetric, and deeply inverted. Moreover, few studies linked acute cerebral injuries with transient cardiac dysfunction secondary to autonomic dysfunction. The classic cerebral T-waves are defined as a T-wave inversion of ≥5 mm depth in ≥4 contiguous precordial leads, and it is more commonly observed in the setting of acute ischemic stroke rather than hemorrhagic stroke. We present a patient who presented with acute pulmonary edema, T-wave inversions in the precordial leads, and left ventricular (LV) dysfunction initially suspicious for acute coronary syndrome (ACS). However, computer tomography of the brain performed on the third day of his hospital stay proved us wrong.

BackgroundLeft ventricular systolic dysfunction (LVSD) occurs frequently after acute ST-segment elevation myocardial infarction (STEMI). The predisposing factors and underlying mechanism of post-infarct LVSD are not fully understood. The present study mainly investigated the correlation between glycaemic gap, a novel index of stress-induced hyperglycaemia (SIH), and post-infarct LVSD.MethodsA total of 274 first STEMI patients were enrolled in this cross-sectional study. Transthoracic echocardiography was performed within 48 h after admission and at 6 months after discharge to obtain left ventricular ejection fraction (LVEF). The change in LVEF was calculated as LVEF at 6 months after discharge minus baseline LVEF. Additionally, post-infarct LVSD was defined as LVEF ≤ 50%. Most importantly, glycaemic gap was calculated as admission blood glucose (ABG) minus the estimated average glucose over the previous 3 months.ResultsIn patients without diabetes mellitus (DM), multivariate linear regression analysis revealed that both glycaemic gap (Beta = − 1.214, 95% CI − 1.886 to − 0.541, p ConclusionsGlycaemic gap was strongly associated with a change in LVEF and an increased risk of having post-infarct LVSD in patients following STEMI. In STEMI patients with DM, glycaemic gap could provide more valuable information than ABG in identifying patients at high risk of developing post-infarct LVSD.

Aims The Cardiac Arrhythmias and RIsk Stratification after Myocardial infArction (CARISMA) study was an observational trial including 312 patients with acute myocardial infarction (MI) and left ventricular ejection fraction (LVEF) Methods and results The study included the 268 patients without a history of AF. All patients received an implantable cardiac monitor (ICM) and were followed for 2 years. The choice of revascularization was made by the treating team independently of the trial and retrospectively divided into pPCI, subacute PCI, primary thrombolysis, or no revascularization. Endpoints were new-onset arrhythmia and MACE. A total of 77 patients received no revascularization, whereas 49 received thrombolysis only and 142 received any PCI. The adjusted hazard ratio (HR) for developing any arrhythmia and the subsequently risk of MACE were increased in non-revascularized or thrombolysed patients compared with PCI-patients (any arrhythmia, non-revascularization: HR = 1.7, P = 0.01 and thrombolysis: HR = 1.6, P = 0.05; MACE, non-revascularization: HR = 3.1, P = 0.05 and thrombolysis: HR = 3.1, P = 0.08). All HRs were adjusted for significant baseline and clinically considered covariates and stratified for calendar year. Conclusion This study is the first to demonstrate that the long-term risk of arrhythmia documented by an ICM and the subsequent risk of MACE were increased in non-revascularized or thrombolysed patients compared with PCI-patients in a post-MI population with LVEF

Sprague Dawley rats were subjected to acute myocardial infarction (AMI) by permanent ligation of the left anterior descending coronary artery. At the time of AMI, a subcutaneous mini-osmotic pump was implanted and animals were randomized into three groups, according to the intravenous therapy received during the first 72 h: placebo-treated (saline), serelaxin10-treated (SRLX10 = 10 mu g/kg/day), or serelaxin30-treated (SRLX30 = 30 mu g/kg/day). Treatment with SRLX30 reduced the expression of inflammatory cytokines and chemokines, as well as the infiltration of macrophages, and increased the expression of pro-angiogenic markers and vessel density in the infarcted myocardium after 7 days. SRLX30 did not reduce early myocardial fibrosis but reduced myocardial levels of sST2 and galectin-3. No significant effects were observed with SRLX10 treatment. A significant correlation was observed between plasma levels of serelaxin and effect measures. The results suggest serelaxin has a protective effect in early processes of cardiac remodeling after AMI.

International audience; Background: Coronary angiography (CA) is usually performed in patients with reduced left ventricular ejection fraction (LVEF) to search ischemic cardiomyopathy. Our aim was to examine the agreement between CA and cardiovascular magnetic resonance (CMR) imaging among a cohort of patients with unexplained reduced LVEF, and estimate what would have been the consequences of using CMR imaging as the first-line examination.Methods: Three hundred five patients with unexplained reduced LVEF of ≤45% who underwent both CA and CMR imaging were retrospectively registered. Patients were classified as CMR+ or CMR- according to presence or absence of myocardial ischemic scar, and classified CA+ or CA- according to presence or absence of significant coronary artery disease.Results: CMR+ (n = 89) included all 54 CA+ patients, except 2 with distal coronary artery disease in whom no revascularization was proposed. Among the 247 CA- patients, 15% were CMR+. CMR imaging had 96% sensitivity, 85% specificity, 99% negative predictive value, and 58% positive predictive value for detecting CA+ patients. Revascularization was performed in 6.5% of the patients (all CMR+). Performing CA only for CMR+ patients would have decreased the number of CAs by 71%.Conclusions: In reduced LVEF, performing CA only in CMR+ patients may significantly decrease the number of unnecessary CAs performed, without missing any patients requiring revascularization.

WOS: 000498406800001 PubMed: 31769072 Purpose In this study, the presence and severity of left ventricular (LV) systolic dysfunction were investigated by speckle tracking echocardiography (STE) technique in patients with mitral triphasic mitral flow pattern (TMFP). The aim of the study was to evaluate the possible role of TMFP in the ethiopathogenesis of congestive heart failure. Methods and results A total of 45 patients who were diagnosed with TMFP and 30 age- and gender-matched healthy volunteers were included in the study. The mean age in the study and control groups was 64 +/- 12 and 62 +/- 11 (P = .642), respectively. When echocardiographic parameters were evaluated, LV ejection fraction was found to be 63% +/- 14 and 64 +/- 12 (P = .745), in the study and control groups, respectively. LV end-diastolic and systolic diameters and LV mass index were also similar (P < .05). When LV diastolic parameters were compared, diastolic dysfunction was detected in 38 (84.4%) patients in the study population and 13 patients (43.3%) in the control group (P < .001). When STE findings were evaluated, both global longitidunal strain and global circumferential strain were significantly lower in the TMFP group when compared to controls (18.3 +/- 1.7 vs 21.5 +/- 1.5, P < .001 and 17.9 +/- 1.6 vs 21.3 +/- 2.1, P < .001, respectively). Conclusion TMFP results in LV systolic dysfunction. Therefore, these patients may develop congestive heart failure in the long term. It will be rational that the patients with TMFP should be followed up more closely in terms of preventing manifest heart failure symptoms.

Objectives: To assess the association between left ventricular (LV) systolic and diastolic dysfunction and grade ≥2 radiation pneumonitis (RP) for locally advanced lung cancer patients receiving definitive radiotherapy.Materials and Methods: A retrospective analysis was carried out for 260 lung cancer patients treated with definitive radiotherapy between 2015 and 2017. RP was evaluated according to Radiation Therapy Oncology Group (RTOG) toxicity criteria. Logistic regression analysis, 10-fold cross validation, and external validation were performed. The prediction model's discriminative performance was evaluated using the area under the receiver operating characteristic curve (AUC), and calibration of the model was assessed by the Hosmer-Lemeshow test and the calibration curve.Results: Within the first 6 months after radiotherapy, 70 patients (26.9%) developed grade ≥2 RP. Reduced left ventricular ejection fraction (LVEF) before radiotherapy was detected in 53 patients (20.4%). The odds ratio (OR) of developing RP for patients with LVEF

Left ventricular failure is strongly associated with secondary mitral valve regurgitation. Implantable soft robotic devices are an emerging technology that enables augmentation of a native function of a target tissue. We demonstrate the ability of a novel soft robotic ventricular assist device to dynamically augment left ventricular contraction, provide native pulsatile flow, simultaneously reshape the mitral valve apparatus, and eliminate the associated regurgitation in an Short-term large animal model of acute left ventricular systolic dysfunction.

Background Coronary artery bypass grafting is known to be associated with better outcome in ischemic heart disease patients with low ejection fraction. We aim to demonstrate the effect of coronary artery bypass grafting (CABG) on left ventricle (LV) systolic function and to identify the predictors that adversely lead to postoperative poor outcome. Result This is a cross-sectional prospective study; we included 110 patients with left ventricular ejection fraction (LVEF) < 50% who underwent CABG with a mean age of 56.1 ± 12.2 years old. Those patients were classified into two groups: group I, 76 (69%) patients with LVEF > 35%, and group II, 34 (31%) patients with LVEF < 35%. Our results as regards demographic and clinical data revealed that group II patients had a significantly higher prevalence of diabetes mellitus (DM) and Euro SCORE II compared to group I patients (p = 0.05 and < 0.001 respectively); otherwise, all other clinical predictors did not differ between the two studied groups. There was a significant improvement in LVEF post-surgery (p = 0.05) in both groups with observed no significant difference recorded for in-hospital mortality rate among patients with different groups. DM, significant diastolic dysfunction, and insertion of IABP are predictors of in-hospital mortality of the patients (p = 0.001, 0.03 and

Coarctation of the aorta is a leading cause of morbidity and mortality among adults with congenital heart disease (ACHD). Lifelong surveillance is mandatory to screen for possible long-term cardiovascular events.Left ventricular systolic dysfunction has been reported in association with recoarctation, and association with dilated cardiomyopathy (DCMP) is very rare. Herein, we report the case of a 19-year-old boy with coarctation of the aorta who complained of mild exertional dyspnea. Cardiac magnetic resonance revealed a moderately dilated, hypokinetic left ventricle (LV), with mildly reduced EF (45%), and residual isthmic coarctation was excluded. Genetic tests revealed a heterozygous missense variant in TNNT2 (NM_001001430.2): c.518G>A (p. Arg173Gln). This case highlights the role of careful history taking: a family history of cardiomyopathy should not be overlooked even when the clinical setting seems to suggest a predisposition to hemodynamic factors for LVSD.

Introduction: Investigating the clinical impact of serum uric acid (UA) and its lowering agents on the complications and mortality of acute ST-elevation myocardial infarction (STEMI) can open a new era in STEMI treatment. The aim of this study was to evaluate the effect of on admission serum UA level on the mortality and morbidity of patients admitted with STEMI. Methods: A number of 608 patients with STEMI were enrolled in this study from December 21, 2012 until February 19, 2014. Patients were followed for 20 months. Male to female ratio was 2.53, and the mean age of patients was 62.6±13.4. The relationship between the level of UA and patients’ mortality and morbidity, left ventricular ejection fraction (LVEF), atrial and ventricular arrhythmia was analyzed. Results: Patients with high serum UA level had higher Killip class after STEMI (P = 0.001). Mean LVEF was measured to be 39.5 ± 9.6 in normal UA group and 34.6 ± 11.6 in high UA group (P = 0.001). In comparison with normal UA group, high UA group had significantly higher cTnI (2.68 ± 0.09 vs 4.09 ± 0.42, respectively, P = 0.001), increased blood pressure (P = 0.009), and higher atrial fibrillation (AF) occurrence (P = 0.03), but no association was seen between ventricular tachycardia and serum UA level. Short term and midterm mortality were not different in two groups (P = 0.44 and 0.31, respectively). Conclusion: In the current study, high serum UA level in patients with acute myocardial infarction (MI) was not associated with higher in-hospital or midterm mortality, but it was associated with lower LVEF, higher Killip class, elevated cTnI, creatinine, triglyceride, and higher AF.

Introduction: Data on relationship between lipoprotein(a) [Lp(a)] and non-ischemic heart dysfunction are limited. This study is aimed to assess the association between Lp(a) and left ventricular systolic dysfunction in a Chinese population of patients with hypertension and without coronary artery disease (CAD). Material and methods: This cross-sectional study included 1611 patients with hypertension and without CAD in China. The factors associated with left ventricular ejection fraction (LVEF) were evaluated using univariate and multivariate analysis. Results : A higher percentage of hypertensive patients with LVEF

Background: Although heart failure is the most prevalent cardiovascular disease associated with adverse outcome in chronic kidney disease (CKD) and after kidney transplantation, left ventricular (LV) systolic function is often preserved in renal patients. The aim of this study was to evaluate global longitudinal strain (GLS), which is reportedly a more accurate tool for detecting subclinical LV systolic dysfunction, in patients with various degrees of renal function impairment, including kidney transplant recipients (KTRs). Methods: This prospective study evaluated demographic, clinical, and ultrasound data, including the assessment of LV GLS and mitral E peak velocity and averaged ratio of mitral to myocardial early velocities (E/e’), of 70 consecutive renal patients (20 with stage 2–4 CKD, 25 with end-stage renal disease on hemodialysis [HD], and 25 KTRs). All patients had an LV ejection fraction ≥50% and no history of heart failure or coronary artery disease. We used multivariable logistic analysis to assess the risk of compromised GLS. One hundred and twenty control subjects with or without hypertension served as controls. Results: A compromised GLS p < 0.0001). Patients with HD had higher systolic pressure and a significantly greater prevalence of increased LV mass and diastolic dysfunction. In renal patients, E/e’ (p = 0.025), and LV mass index (p = 0.063) were independent predictors of compromised GLS at logistic regression analysis. E/e’, systolic artery pressure, and LV mass also exhibited the greatest areas under the curve on receiver operating characteristic analysis to identify a compromised GLS. Conclusions: Renal disease proved to be associated with early and subclinical impairment of LV systolic function, which persists after starting dialysis and even in spite of successful kidney transplantation. An increased E/e’ resulted to be the most powerful independent predictor of abnormal GLS.

Background Early diagnosis and therapy improves outcomes in heart failure with severely reduced left ventricular ejection fraction (LVEF ≤35%), but some patients may remain undiagnosed. We hypothesized that a combination of electrocardiogram (ECG) markers may identify individuals with severely reduced LVEF. Methods From a community-based study in the Northwest US (the Oregon Sudden Unexpected Death Study), we evaluated the prevalence of conventional ECG markers by LVEF. We then evaluated the association of nine additional ECG markers and LVEF. We validated the correlation of these ECG markers and LVEF in a separate, large health system in Los Angeles, California. Results In the discovery population (n = 1,047), patients with LVEF ≤35% were twice as likely as those with LVEF >35% to have ≥1 conventional ECG abnormality. In the subset without conventional ECG abnormalities, ≥4 abnormal ECG markers from the expanded panel were found in 12% vs. 1% of patients with LVEF ≤35% and >35%, respectively. In the validation population (n = 9,742), 44% with LVEF ≤35% and 17% with LVEF >35% had ≥1 conventional ECG abnormality. In patients without conventional ECG abnormalities (n = 7,601), 40% with LVEF ≤35% and 5% with LVEF >35% had ≥4 abnormal ECG markers from the expanded panel. Each additional abnormal ECG marker from the expanded panel (range 0 to ≥4) more than doubled the odds of LVEF ≤35%. Conclusions An expanded panel of easily obtained ECG markers correlated strongly with severely reduced LVEF in two separate populations. This electrical surrogate score could facilitate diagnosis of severely reduced LVEF, and warrants prospective evaluation.

Objective – review current data on the use of beta-blockers (BB) in chronic heart failure (CHF). Materials and methods. This article discusses beneficial effects of BB administration in CHF patients. It has been demonstrated that decrease in heart rate underlies clinical efficacy of BB therapy in patients with chronic heart failure. We reviewed the question of the necessity to achieve target doses of BB in the treatment of CHF patients. It has been shown that administration of BB in patients with chronic heart failure and reduced left ventricular ejection fraction increase pumping function of heart, and thus reduce the number of hospitalizations for decompensated heart failure, reducing the risk of total and sudden mortality. We demonstrated substantial advantages of β1-selective BB over nonselective ones with respect to their impact on hemodynamics, metabolic processes, rheological parameters of blood and bronchi. We also considered therapeutic tactics in case of BB administration in CHF patients. Results. Based on the data of the current studies we proved high efficiency and safety of β1-selective BBs in CHF patients. Conclusion. Correct choice of BB in patients with CHF and decrease in heart rate during the treatment can significantly increase an effectiveness of the treatment.

Electrocardiogram (ECG)-based detection of left ventricular systolic dysfunction (LVSD) has poor specificity and positive predictive value, even when including major ECG abnormalities, such as left bundle branch block (LBBB) within the criteria for diagnosis. Although machine-read ECG algorithms do not provide information on LVSD, advanced ECG (A-ECG), using multiparameter scores, has superior diagnostic utility to strictly conventional ECG for identifying various cardiac pathologies, including LVSD. Methods: We evaluated the diagnostic utility of A-ECG in a case-control study of 40 patients with LVSD (LV ejection fraction &lt, 50% by echocardiography), due to non-ischemic cardiomyopathy (NICM), and 39 other patients without LVSD. Diagnostic sensitivity and specificity for LVSD were determined after applying a previously validated probabilistic A-ECG score for LVSD to stored standard (10 s) clinical 12L ECGs. In 25 of the NICM patients who had serial ECGs and echocardiograms, changes in the A-ECG score versus in echocardiographic LV ejection fraction were also studied to determine the level of agreement between the two tests. Results: Analyses by A-ECG had a sensitivity of 95% for LVSD (93% if excluding N = 11 patients with LBBB) and specificity of 95%. In the 29 NICM patients without LBBB who had serial ECGs, sensitivity improved to 97% when all ECGs were considered. By comparison, human readers in a busy clinical environment had a sensitivity of 90% and specificity of 63%. A-ECG score trajectories demonstrated improvement, deterioration or no change in LVSD, which agreed with echocardiography, in 76% of cases (n = 25). Conclusion: A-ECG scoring detects LVSD due to NICM with high sensitivity and specificity. Serial A-ECG score trajectories also represent a method for inexpensively demonstrating changes in LVSD. A-ECG scoring may be of particular value in areas where echocardiography is unavailable, or as a gatekeeper for echocardiography.

Aim The relationship between fibroblast growth factor 21 (FGF21) and cardiovascular disease has been well established in recent studies. This study aimed to investigate the relationship between FGF21 and left ventricular systolic dysfunction and cardiac death. Methods Two-dimensional echocardiography was used to measure the left ventricular ejection fraction (LVEF) to estimate left ventricular systolic function. The optimal cutoff of FGF21 for identifying left ventricular systolic dysfunction at baseline was analyzed via receiver operating characteristic (ROC) curves. The identification of different serum levels of FGF21 and their association with cardiac death was analyzed via Kaplan–Meier survival curves. Serum FGF21 level was measured by an enzyme-linked immunosorbent assay kit, and serum N-terminal pro-brain natriuretic peptide (NT-pro-BNP) level was determined by a chemiluminescent immunoassay. Results A total of 253 patients were recruited for this study at baseline. Patients were excluded if they lacked echocardiography or laboratory measurement data, and there were 218 patients enrolled in the final analysis. The average age was 66.32 ± 10.10 years. The optimal cutoff values of FGF21 and NT-pro-BNP for identifying left ventricular systolic dysfunction at baseline were 321.5 pg/mL and 131.3 ng/L, respectively, determined separately via ROC analysis. The areas under the curves were non-significant among FGF21, NT-pro-BNP and FGF21 + NT-pro-BNP as determined by pairwise comparisons. Both a higher serum level of FGF21 and a higher serum level of NT-pro-BNP were independent risk factors for left ventricular systolic dysfunction at baseline (odd ratio (OR) 3.138 [1.037–9.500], P = 0.043, OR 9.207 [2.036–41.643], P = 0.004, separately). Further Kaplan–Meier survival analysis indicated an association between both a higher serum level of FGF21 and a higher serum level of NT-pro-BNP with cardiac death in 5 years [RR 5.000 (1.326–18.861), P = 0.026; RR 9.643 (2.596–35.825), P = 0.009, respectively]. Conclusions Serum FGF21 level was significantly correlated with left ventricular systolic dysfunction at baseline. Patients with higher serum levels of FGF21 tended to suffer greater risks of cardiac death than patients with lower serum levels of FGF21. The identification of FGF21 and its relationship with left ventricular systolic function and cardiac death were non-inferior to NT-pro-BNP.

Background: Hemodialysis may acutely induce regional left ventricular (LV) systolic dysfunction, which is associated with increased mortality and progressive heart failure. We tested the hypothesis that hemodialysis-induced regional LV systolic dysfunction is associated with inflammation and endothelial injury. Additionally, we studied whether hemodialysis-induced LV systolic dysfunction is associated with an exaggerated bioincompatibility reaction to hemodialysis.Study Design: Cross-sectional study.Setting & Participants: 105 hemodialysis patients on a thrice-weekly dialysis schedule were studied between March 2009 and March 2010.Predictors: Plasma indexes of inflammation (high-sensitivity C-reactive protein, pentraxin 3 [PTX3], interleukin 6 [IL-6], and IL-6: IL-10 ratio), bioincompatibility (leukocytes, neutrophils, complement C3, and myeloperoxidase), and endothelial function (soluble intercellular adhesion molecule 1 [ICAM-1], von Willebrand factor, proendothelin, and endothelin) were measured just before dialysis and at 60, 180, and 240 minutes intradialysis.Outcomes: Hemodialysis-induced regional LV systolic function. Wall motion score was measured by echocardiography at 30 minutes predialysis, 60 and 180 minutes intradialysis, and 30 minutes postdialysis. We defined hemodialysis-induced regional LV systolic dysfunction as an increase in wall motion score in 2 or more segments.Results: Patients with hemodialysis-induced regional LV systolic dysfunction (n = 29 [27%]) had significantly higher predialysis high-sensitivity C-reactive protein, PTX3, IL-6, and lL-6: IL-10 ratio values. Predialysis levels of bioincompatibility and endothelial markers did not differ between groups. Intradialysis courses of markers of inflammation, bioincompatibility, and endothelial function did not differ in patients with versus without hemodialysis-induced regional LV systolic dysfunction.Limitations: Coronary angiography or computed tomography for quantification of coronary calcifications in our patients was not performed; therefore, we could not relate markers of inflammation to the extent of atherosclerosis.Conclusions: Patients with hemodialysis-induced regional LV systolic dysfunction have a proinflammatory cytokine profile. There was no indication of an association with an exaggerated bioincompatibility reaction to hemodialysis. (C) 2014 by the National Kidney Foundation, Inc.

The goal of our study was to determine the effects of combined renin-angiotensin-aldosterone system (RAAS) blocking therapy, including a selective aldosterone inhibitor eplerenone, on neurohumoral profile in patients with left ventricular (LV) systolic dysfunction following an acute myocardial infarction (MI). We also assessed the effect of multiple neuroendocrine inhibitors therapy on renal function and explored the interaction between changes in renal function and heart failure markers. Our study incorporated 74 patients aged between 39 and 86 (mean 64.5 +/- 11.4) with established acute MI and reduced left ventricular ejection fraction (EF ≤ 40%). The additive effect of eplerenone (25–50 mg/d) on top of the standard heart failure regimen on plasma concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP), renin and aldosterone were assessed at study entry and at six months. Renal function was determined by creatinine and estimated glomerular filtration rate (eGFR), calculated using the Cockcroft-Gault formula. The changes in LV volumes and systolic function were assessed by a transthoracic echocardiography at baseline and at the end of follow-up. Following 6 months of combined RAAS blocking therapy, incorporating aldosterone inhibitor eplerenone, plasma levels of NT-proBNP (−77.7%, p= 0.001) and renin (−52.2%, p= 0.083) decreased. As expected, an increase in aldosterone levels was observed (+36.8%, p= 0.758). A mild decline in eGFR (−2,0 ml/min, p= 0.028) was observed, with potassium levels increasing slightly, but remaining within the normal range (4.28 vs. 4.48 mmol/L, p= 0.028). We found that baseline creatinine correlated with measures characterising myocardial function (NT-proBNP, LVEF). The highest correlation was with NT-proBNP at baseline (r = 0.537, p

Echocardiography and cardiac biomarkers, such as cardiac troponin I (cTnI) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) are useful tools to evaluate cardiac dysfunction. Left ventricular systolic dysfunction (LVSD) is common in pediatric severe sepsis. The aim of this study is to evaluate the prognostic value of LVSD, cTnI, and NT-pro BNP for pediatric severe sepsis. A prospective, single center, observational study was conducted. Severe sepsis children were enrolled in the study from December 2015 to December 2016 in pediatric intensive care unit of Shanghai Children's Medical Center. Recorded general information, transthoracic echocardiography were performed at day 1, 2, 3, 7, and 10, using Simpson to measure left ventricular end-diastolic dimension and left ventricular end-systolic dimension, obtained echocardiography parameters: left ventricular ejection fraction (LVEF), left ventricular fractional shortening, left ventricular end-diastolic volume, left ventricular end- systolic volume, stroke volume, cardiac output. At the same time collecting the blood sample to measure cTnI, NT-pro BNP. The definition of LVSD was LVEF

Purpose To find out how resistin and leptin levels were affected in patients with acromegaly and whether there is a relation between resistin levels and cardiac parameters. We also aimed to investigate whether resistin and leptin may be a link between insulin resistance and cardiac functions as well as these affected cardiac functions in the patients with acromegaly. Methods We included 30 subjects (15 men and 15 women) who had a diagnosis of acromegaly and 30 healthy (10 men and 20 women) subjects. Serum glucose, insulin, growth hormone, insulinlike growth factor 1 (IGF-1), resistin, and leptin levels were obtained, and insulin resistance of subjects were calculated. Echocardiographic studies of the subjects were performed. Results Resistin levels of the patients with acromegaly were found lower than controls. This difference was statistically significant ( P = 0.001). Leptin levels were lower in the patients with acromegaly than in the controls, but this difference was not statistically significant. Resistin and leptin levels were not correlated with growth hormone, IGF-1, and with insulin-like growth factor binding protein 3 levels. Homeostasis model assessment of insulin resistance was positively correlated with resistin levels. ( P = 0.03; r = 0.531) but not correlated with leptin levels. There was a positive correlation between body mass index and leptin levels in the patients with acromegaly ( P = 0.007; r = 0.482). Interventricular septum thickness, posterior wall thickness, left ventricle mass index, peak early mitral inflow velocity–peak late mitral inflow velocity ratio, deceleration time, ejection time, isovolumetric relaxation time, velocity propagation, and left ventricular end-systolic volume values were significantly greater in the patients with acromegaly. Leptin levels in the acromegalic patients were not correlated with any of them. Conclusions We found biventricular hypertrophy and impairment of diastolic and systolic function in the patients with acromegaly. We conclude that changes in resistin and leptin levels are unlikely to account for the insulin resistance of acromegaly. They do not also seem to be contributing factors of cardiovascular changes in patients with acromegaly.

Objective The aim of the study was to investigate whether the deformation of left atrium (LA) measured by speckle-tracking analysis (STE) is associated with the presence of LA appendage thrombus (LAAT) during non-valvular atrial fibrillation (AF). Methods Eighty-seven patients (mean age 67 years, 59% men) were included to retrospective cross-sectional study. On top of standard echocardiography we assessed: LA longitudinal systolic strain (LS), systolic (LSSR) and early diastolic strain rate (LESR) in four-chamber and twochamber apical views. All patients underwent transesophageal echocardiography disclosing LAAT in 36 (41%) patients. Results Subgroups with and without thrombi did not differ with regard to clinical characteristics. Univariate factors associated with LAAT were as follows: CH2ADS2-VASc Score, left ventricular ejection fraction (LVEF), LV mass, and STE measurements. In a multivariate model only LVEF (p=0.002), LS (p=0.02), LESR (p=0.008), and LSSR (p=0.045) were independently associated with LAAT presence. Moreover, LVEF and LA STE measurements provided incremental value over the CH2ADS2-VASc Score. Conclusion Speckle-tracking TTE may be used to describe LA reservoir and conduit function during AF, allowing the identification of patients with higher risk of LAAT and providing incremental value over the CH2ADS2-VASc Score.

Introduction: Investigating the clinical impact of serum uric acid (UA) and its lowering agents on the complications and mortality of acute ST-elevation myocardial infarction (STEMI) can open a new era in STEMI treatment. The aim of this study was to evaluate the effect of on admission serum UA level on the mortality and morbidity of patients admitted with STEMI. Methods: A number of 608 patients with STEMI were enrolled in this study from December 21, 2012 until February 19, 2014. Patients were followed for 20 months. Male to female ratio was 2.53, and the mean age of patients was 62.6±13.4. The relationship between the level of UA and patients’ mortality and morbidity, left ventricular ejection fraction (LVEF), atrial and ventricular arrhythmia was analyzed. Results: Patients with high serum UA level had higher Killip class after STEMI (P=0.001). Mean LVEF was measured to be 39.5±9.6 in normal UA group and 34.6±11.6 in high UA group (P=0.001). In comparison with normal UA group, high UA group had significantly higher cTnI (2.68±0.09 vs 4.09±0.42, respectively, P=0.001), increased blood pressure (P=0.009), and higher atrial fibrillation (AF) occurrence (P=0.03), but no association was seen between ventricular tachycardia and serum UA level. Short term and midterm mortality were not different in two groups (P=0.44 and 0.31, respectively). Conclusion: In the current study, high serum UA level in patients with acute myocardial infarction (MI) was not associated with higher in-hospital or midterm mortality, but it was associated with lower LVEF, higher Killip class, elevated cTnI, creatinine, triglyceride, and higher AF.