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Abstract Objectives This study aimed to assess the guideline recommended diagnostic tools NT-proBNP and NYHA classification, with a focus on sex-specific differences. Background Patients with Type 2 Diabetes (T2D) face a heart failure (HF) risk up to four times higher than those without T2D, particularly affecting women more than twice as much as men. Despite distinct pathophysiological differences between men and women, there are currently no sex-specific recommendations for the diagnostic algorithm of HF in diabetic patients. Methods A total of 2083 patients with T2D were enrolled, and the primary endpoint was heart failure during hospitalization within a 5-year timeframe. The secondary endpoint was all-cause death. Results In female patients, frequency of HF diagnosis prior to or during hospitalization and mortality did not differ significantly between NYHA II and III, in contrast to male patients. Additionally, there was no notable difference in mean NT-proBNP levels between NYHA stage II and III only in female patients. The multivariable regression analysis highlighted NYHA classification not to be a predictor of NT-proBNP levels in female but solely in male patients. On multivariable Cox regression NYHA score was also no significant risk factor for occurence of HF in female patients. Furthermore, there was no significant disparity in mortality between men with NT-proBNP levels between 125 and 400 pg/ml and those below 125 pg/ml, whereas in women mortality was significantly higher in the group with NT-proBNP levels between 125 and 400 pg/ml than below 125 pg/ml. Conclusion These findings suggest that NYHA classification may not be the most suitable tool for assessing the diagnosis of HF in female patients with T2D. Moreover, the need for consideration of a more symptom-independent screening for HF in female patients with T2D and re-evaluation of current guidelines especially regarding sex-specific aspects is highlighted.

Objectives: This study aimed to assess the guideline recommended diagnostic tools NT-proBNP and NYHA classification, with a focus on sex-specific differences. Background: Patients with Type 2 Diabetes (T2D) face a heart failure (HF) risk up to four times higher than those without T2D, particularly affecting women more than twice as much as men. Despite distinct pathophysiological differences between men and women, there are currently no sex-specific recommendations for the diagnostic algorithm of HF in diabetic patients. Methods: A total of 2083 patients with T2D were enrolled, and the primary endpoint was heart failure during hospitalization within a 5-year timeframe. The secondary endpoint was all-cause death. Results: In female patients, frequency of HF diagnosis prior to or during hospitalization and mortality did not differ significantly between NYHA II and III, in contrast to male patients. Additionally, there was no notable difference in mean NT-proBNP levels between NYHA stage II and III only in female patients. The multivariable regression analysis highlighted NYHA classification not to be a predictor of NT-proBNP levels in female but solely in male patients. On multivariable Cox regression NYHA score was also no significant risk factor for occurence of HF in female patients. Furthermore, there was no significant disparity in mortality between men with NT-proBNP levels between 125 and 400 pg/ml and those below 125 pg/ml, whereas in women mortality was significantly higher in the group with NT-proBNP levels between 125 and 400 pg/ml than below 125 pg/ml. Conclusion: These findings suggest that NYHA classification may not be the most suitable tool for assessing the diagnosis of HF in female patients with T2D. Moreover, the need for consideration of a more symptom-independent screening for HF in female patients with T2D and re-evaluation of current guidelines especially regarding sex-specific aspects is highlighted. [ABSTRACT FROM AUTHOR]

Abstract According to the European Society of Cardiology, globally the number of patients with heart failure nearly doubled from 33.5 million in 1990 to 64.3 million in 2017, and is further projected to increase dramatically in this decade, still remaining a leading cause of morbidity and mortality. One of the most frequently applied heart failure classification systems that physicians use is the New York Heart Association (NYHA) Functional Classification. Each NYHA class describes a patient’s symptoms while performing physical activities, delivering a strong indicator of the heart performance. In each case, a NYHA class is individually determined routinely based on the subjective assessment of the treating physician. However, such diagnosis can suffer from bias, eventually affecting a valid assessment. To tackle this issue, we take advantage of the machine learning approach to develop a decision-tree, along with a set of decision rules, which can serve as additional blinded investigator tool to make unbiased assessment. On a dataset containing 434 observations, the supervised learning approach was initially employed to train a Decision Tree model. In the subsequent phase, ensemble learning techniques were utilized to develop both the Voting Classifier and the Random Forest model. The performance of all models was assessed using 10-fold cross-validation with stratification.The Decision Tree, Random Forest, and Voting Classifier models reported accuracies of 76.28%, 96.77%, and 99.54% respectively. The Voting Classifier led in classifying NYHA I and III with 98.7% and 100% accuracy. Both Random Forest and Voting Classifier flawlessly classified NYHA II at 100%. However, for NYHA IV, Random Forest achieved a perfect score, while the Voting Classifier reported 90%. The Decision Tree showed the least effectiveness among all the models tested. In our opinion, the results seem satisfactory in terms of their supporting role in clinical practice. In particular, the use of a machine learning tool could reduce or even eliminate the bias in the physician’s assessment. In addition, future research should consider testing other variables in different datasets to gain a better understanding of the significant factors affecting heart failure.

According to the European Society of Cardiology, globally the number of patients with heart failure nearly doubled from 33.5 million in 1990 to 64.3 million in 2017, and is further projected to increase dramatically in this decade, still remaining a leading cause of morbidity and mortality. One of the most frequently applied heart failure classification systems that physicians use is the New York Heart Association (NYHA) Functional Classification. Each NYHA class describes a patient’s symptoms while performing physical activities, delivering a strong indicator of the heart performance. In each case, a NYHA class is individually determined routinely based on the subjective assessment of the treating physician. However, such diagnosis can suffer from bias, eventually affecting a valid assessment. To tackle this issue, we take advantage of the machine learning approach to develop a decision-tree, along with a set of decision rules, which can serve as additional blinded investigator tool to make unbiased assessment. On a dataset containing 434 observations, the supervised learning approach was initially employed to train a Decision Tree model. In the subsequent phase, ensemble learning techniques were utilized to develop both the Voting Classifier and the Random Forest model. The performance of all models was assessed using 10-fold cross-validation with stratification.The Decision Tree, Random Forest, and Voting Classifier models reported accuracies of 76.28%, 96.77%, and 99.54% respectively. The Voting Classifier led in classifying NYHA I and III with 98.7% and 100% accuracy. Both Random Forest and Voting Classifier flawlessly classified NYHA II at 100%. However, for NYHA IV, Random Forest achieved a perfect score, while the Voting Classifier reported 90%. The Decision Tree showed the least effectiveness among all the models tested. In our opinion, the results seem satisfactory in terms of their supporting role in clinical practice. In particular, the use of a machine learning tool could reduce or even eliminate the bias in the physician’s assessment. In addition, future research should consider testing other variables in different datasets to gain a better understanding of the significant factors affecting heart failure. [ABSTRACT FROM AUTHOR]

Hypertrophic cardiomyopathy (HCM) is an autosomal dominant disorder with risk of sudden cardiac death (SCD) in children and adolescents. Mavacamten, also referred to as MYK-461, a myosin inhibitor of cardiac myocytes is studied in symptomatic HCM. The safety and efficacy of this medication is not well studied in pooled meta-analysis. Online database search was performed from inception to September 2023. We selected randomized clinical trials that compared Mavacamten with placebo/guideline medical treatment for HCM. We studied safety outcomes (Serious adverse events (SAEs), treatment emergent adverse events (TEAs) and Atrial fibrillation). Functional status of patients was assessed as New York Heart Association (NYHA) Classification improvement of at least + 1 grade, Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS) change from baseline). Relative risk ratios were used in randomized model using Review Manager Version 5.4 statistical software. A total of 4 RCTs comprising 503 patients were included in meta-analysis. On random effect model, we found that HCM patients that received Mavacamten had significant symptomatic improvement as depicted by improvement in NYHA class by at least + 1 grade (RR = 2.15; P

Heart failure patients often experience respiratory symptoms due to diaphragmatic involvement, but the diaphragmatic motion in heart failure remains understudied. This research aimed to investigate the correlation between ultrasonographically assessed diaphragmatic motion and thickness with cardiac performance indexes in an emergency setting. Seventy-two acutely decompensated heart failure patients and 100 non-heart failure individuals were enrolled. Diaphragmatic motion and thickness were assessed via ultrasound. Cardiac and respiratory parameters were recorded, and regression analysis was performed. Heart failure patients exhibited reduced diaphragmatic motion at total lung capacity compared to controls, and an inverse association was found between motion and heart failure severity (NYHA stage). Diaphragmatic thickness was also higher in heart failure patients at tidal volume and total lung capacity. Notably, diaphragmatic motion inversely correlated with systolic pulmonary artery pressure. The study highlights diaphragmatic dysfunction in acutely decompensated heart failure, with reduced motion and increased thickness. These changes were associated with cardio-respiratory parameters, specifically systolic pulmonary artery pressure. Monitoring diaphragmatic motion via ultrasound may aid in evaluating heart failure severity and prognosis in emergency settings. Additionally, interventions targeting diaphragmatic function could improve heart failure management. Further research is warranted to enhance heart failure management and patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine whether treatment with intravenous iron (ferric carboxymaltose) in patient who had heart failure, and iron deficiency, either with or without anemia, would improve hematological and biochemical response, clinical determinants of the patients and functional status and capacity of the patients. Background: Recently it has been recognized that patients with heart failure (HF) may be prone to the development of iron deficiency (ID). Iron deficiency with or without anaemia diminishes aerobic performance, precipitates fatigue and exercise intolerance and consequently worsens the clinical symptoms of patients with HF. A recent randomized, double-blind study (Anker et al. 2009) showed that intravenous iron supplementation in ID patients with or without anemia and chronic heart failure (CHF) exerts favorable effects on functional status and quality of life. Therefore ID lately acquired a unique role in the field of HF and is the subject of novel studies. Methods: This prospective pre test and post test design study has been conducted in SRN hospital, M.L.N medical college, Prayagraj over 50 clinically stable patient of heart failure of NYHA class II or III, a left ventricular ejection fraction 45% or less with iron deficiency (ferritin level <100 micro gm per litre or between 100 and 299 micro gm per liter, if the transferrin saturation was <20%). Exercise capacity has been quantified using six minute walk test. Then patient has been received bolus of ferric carboxymaltose over 30 minute. Reassessment of symptoms of patients was made according to NYHA functional classification and exercise capacity using 6 minute walk test on day 90. Results: On day 90 it was observed that treatment with FCM significantly prolonged 6 MWT distance (pre-treatment 254.3±45.3 m vs. post-treatment 353.6±45.6 m, p value - <0.05), an improvement in NYHA was detected with statistical significance (p value <0.05), statistically significant reduction in value of BNP (pre-treatment 1174.6±560.6 pg/mL vs post-treatment 898.3±451.5 pg/mL, P value-<0.05) observed. Conclusion: Treatment with intra venous iron in patients with chronic heart failure and iron deficiency anemia, improves symptoms of heart failure, functional capacity and quality of life. [ABSTRACT FROM AUTHOR]

Background Results from ATTR‐ACT (Safety and Efficacy of Tafamidis in Patients With Transthyretin Cardiomyopathy) indicate that tafamidis prolongs survival and reduces cardiovascular hospitalizations in cardiac transthyretin amyloidosis (ATTR‐CA). However, real‐world data supporting these findings are scarce. Thus, we sought to characterize the clinical outcome of patients with ATTR‐CA treated with tafamidis in a real‐world setting and assess the prognostic role of the New York Heart Association (NYHA) classification. Methods and Results We conducted a retrospective observational study, enrolling a consecutive sample of patients with ATTR‐CA (wild‐type or variant) treated with tafamidis. Clinical outcome was tracked through follow‐up visits or phone calls. Primary outcomes were death and major adverse cardiac events (MACE), a composite end point of death and hospitalizations for acute cardiac decompensation, myocardial infarction, severe arrythmias, or stroke. Kaplan‐Meier analysis estimated overall and MACE‐free survival including NYHA subgroups (NYHA I/II versus NYHA III). One hundred sixty‐seven patients with ATTR‐CA (94.6% wild‐type) were enrolled and followed for a median of 539 [323–869] days. Median overall survival was not reached. Estimated 1‐year, 2‐year, and 5‐year overall survival among the whole cohort was 93.5%, 85.9%, and 70.2%, respectively. Overall survival was higher in the NYHA I/II subgroup (P=0.002). Median MACE‐free survival time was 1082 (95% CI, 962–1202) days. MACE‐free survival was higher in the NYHA I/II subgroup (P

The Pulmonary Arterial Hypertension-Quality Enhancement Research Initiative Extension Program was designed to support physicians' adherence to pulmonary arterial hypertension (PAH) guidelines. Guidelines were followed in >95% of patients with functional class (FC) II/III, but for only 28.6% of FC IV patients (Month 36). Low adherence was driven by FC IV patients' preference to avoid parenteral treatment.

The use of available treatments for Fabry disease (FD) (including enzyme replacement therapy [ERT]) may be restricted by their limited symptom improvement and mode of administration. Lucerastat is currently being investigated in the MODIFY study as oral substrate reduction therapy for the treatment of FD. By reducing the net globotriaosylceramide (Gb3) load in tissues, lucerastat has disease-modifying potential to improve symptoms and delay disease progression. MODIFY is a multicenter, double-blind, randomized, placebo-controlled, parallel-group Phase 3 study (ClinicalTrial.gov: NCT03425539); here we present the rationale and design of this study. Eligible adults with a genetically confirmed diagnosis of FD and FD-specific neuropathic pain entered screening. Patients were randomized (2:1) to receive either oral lucerastat twice daily or placebo for 6 months; treatment allocation was stratified according to sex and ERT treatment status. The main objectives of MODIFY are to assess the effects of lucerastat on neuropathic pain, gastrointestinal (GI) symptoms, FD biomarkers, and determine its safety and tolerability. Neuropathic pain and GI symptoms are key features of FD that have a significant impact on quality of life. Despite various tools available to assess pain and GI symptoms, there are currently limited tools available to assess neuropathic and GI symptoms in FD, validated according to health authority guidelines. Based on FDA recommendations, we undertook a patient-reported outcome (PRO) validation study, using a novel eDiary-based PRO tool to assess the validity of evaluating neuropathic pain as a primary efficacy endpoint in MODIFY. Results from the PRO validation study are included. To date, MODIFY is the largest Phase 3 clinical study conducted in patients with FD. Enrollment to MODIFY is now complete, with 118 patients randomized. Results will be presented in a separate publication. Long-term effects of lucerastat are being assessed in the ongoing open-label extension study (NCT03737214).

Background: In patients with symptomatic Heart Failure (HF) and wide QRS duration, cardiac resynchronization therapy (CRT) causes reduction of morbidity and mortality. However, it's unclear which patient features predict short-term response to this device therapy. The research aimed to study which cases characteristics could expect short-term clinical and echocardiographic response to CRT. Methods: This prospective cohort study involved 40 patients indicated for CRT device. The study was conducted in the cardiology departments, faculty of medicine, Zagazig University, and Police hospital at the period from October 2018 to October 2020. Clinical, laboratory, electrocardiographic, and echocardiographic assessments were performed pre and six months after implantation. Results: Forty patients undergoing CRT implantation were included among which, 30 (75%) patients were considered responders after six months. From the present study, the responders to CRT were more frequently to be females with younger age than non -responders. Nonischemic HF, left bundle branch block (LBBB) morphology and New York Heart Association (NYHA) functional class III were significantly more frequent in responders. Furthermore, responders had significantly wider baseline QRS duration, smaller baseline LV diastolic and systolic dimension and volumes, greater ejection fraction, lower levels of brain natriuretic peptide (BNP), and more baseline intra-ventricular dyssynchrony. Conclusions: We concluded that pre-implantation independent Predictors of good CRT response are LBBB morphology, septal to posterior wall mechanical delay, wide QRS duration, interventricular mechanical delay, NYHA functional class III, and lower levels of BNP. Large scale study is recommended for further verification of study results. [ABSTRACT FROM AUTHOR]

Coronary artery disease is one of the main causes of mortality and morbidity among chronic heart diseases worldwide. Patients reported chronic chest pain as the primary symptom of coronary artery disease. Due to its progressive nature, it affects the health status and functional capacity of the patients. The current study was planned to compare the effects of prehabilitation resistance training in mild to moderate clinically frail patients awaiting coronary artery bypass graft (CABG). A randomized controlled trial was conducted on 74 patients awaiting CABG at the Faisalabad Institute of Cardiology, Faisalabad, Pakistan. A Modified Healthy Heart Questionnaire was used for screening of the patients. Interventions applied were resistance training by using cuff weights/dumbbells at light intensity (40%–50%) of a maximum of one repetition (10–15 repetitions for one to three times a day) per major muscle groups of upper and lower limbs of the body on weekly basis. The main outcome measures were the 6-minute walk test (6MWT), the New York Heart Association (NYHA) for heart failure, the clinical frailty score, and the essential frailty toolset. Significant differences between group A (resistance training group) and group B (conventional physical therapy group) patients were observed. The mean ranks for 6MWT in group A and group B were 1.70 and 1.55, respectively. The mean ranks of NYHA in group A and group B were 1.68 and 2.84, respectively. Clinical frailty scores in group A and group B were 2.68 and 2.74, respectively, with the essential frailty toolset in group A and group B were 1.14 and 1.11, respectively. There were significant (p < 0.05) differences within and between groups for prehabilitation resistance training after CABG. The study showed that the resistance training group had improved the clinical frailty score, strength, endurance, and functional capacity in patients who underwent elective CABG. [ABSTRACT FROM AUTHOR]

To estimate healthcare resource use and direct healthcare costs of Transthyretin Amyloid Cardiomyopathy (ATTR-CM) in Sweden over 12 months across severity stages as defined by the New York Heart Association (NYHA). Secondary to investigate the current diagnostic trajectory for patients with ATTR-CM in Sweden. A stratified inclusion of patients with a confirmed diagnosis of ATTR-CM in different NYHA classes. Data was extracted from medical records in two cardiology clinics in Sweden. Healthcare resource use data were retrospectively collected for 12 months. 38 patients were included, of whom 7 were in NYHA class II, 20 in class III and 4 in class IV. The total cost of health care per patient increased from SEK 69,000 (€6800) in NYHA stage II, SEK 219,000 (€21,500) in NYHA stage III, to SEK 638,000 (€62,900) in stage IV, mainly due to an increase in inpatient stays. Mean time (standard deviation, SD) from any cardiac related diagnosis prior to ATTR-CM diagnosis was 3.5 (3.1) years. Advanced ATTR-CM stages are associated with significant healthcare costs, as patients more often require resource-intensive inpatient care. The current diagnostic trajectory of ATTR-CM in this study was characterized by a diagnostic delay of several years. This study shows that both healthcare resource use and healthcare costs increased considerably with a higher degree of ATTR-CM severity. The diagnostic trajectory of ATTR-CM in this study was characterized by a diagnostic delay of several years. Greater disease awareness and a lower threshold for screening risk groups for TTR-amyloidosis is prompted to establish an earlier diagnosis. [ABSTRACT FROM AUTHOR]

Recent randomised trials have shown that clinical outcomes with transcatheter aortic valve implantation (TAVI) are non-inferior to surgical aortic valve replacement (SAVR) in patients with symptomatic aortic stenosis at intermediate to low risk. Health-related quality of life (HrQoL) outcomes in these patient groups remain uncertain. A systematic search of the literature was conducted that included nine trials and 11,295 patients. Kansas City Cardiomyopathy Questionnaire (KCCQ), a heart-failure-specific measure and EuroQol-5D (EQ-5D) (a generic health status tool) changes were the primary outcomes. New York Heart Association (NYHA) classification was the secondary outcome. Improvement in KCCQ scores was greater with TAVI (mean difference (MD)=13.56, 95% confidence interval (CI) 11.67-15.46, p<0.001) at 1 month, as was the improvement in EQ-5D (MD=0.07, 95% CI 0.05-0.08, p<0.001). There was no difference in KCCQ (MD=1.05, 95% CI -0.11 to 2.21, p=0.08) or EQ-5D (MD=-0.01, 95% CI -0.03 to 0.01), p=0.37) at 12 months. NYHA functional class 3/4 was lower in patients undergoing TAVI at 1 month (MD=0.51, 95% CI 0.34-0.78, p=0.002), but there was no difference at 12 months (MD=1.10; 95% CI 0.87-1.38, p=0.43). Overall, TAVI offers early benefit in HRQoL outcomes compared with SAVR, but they are equivalent at 12 months. [ABSTRACT FROM AUTHOR]

Background/Objective: Nowadays, increasing clinical evidence on metabolic and weight-loss effects of bariatric surgery on improving cardiac structure in obese patients, but its application in improving the cardiac function of HF (heart failure) patients remains controversial. The objective of this meta-analysis was to assess the effects of BS on cardiac function by quantifying the changes of LVEF (left ventricular ejection fraction) and NYHA (New York Heart Association classification) after operations in non-HFpEF (heart failure and preserved ejection fraction) patients. Methods: Articles were searched using PubMed and Embase from inception to December 9, 2022, and the Minors scale was used for quality assessments. The included patients should be non-HFpEF and clinically severely obese, and their pre-operative and post-operative values of LVEF or NYHA should be reported. Result: Nine studies involving 146 patients were eventually included with a final result showing that the cardiac functional parameters were improved in non-HFpEF patients. After a weighted mean follow-up time of 15.8 months, the mean NYHA decreased by 0.59 (I2 = 0; 95% CI 0.27 ~ 0.92; p = 0.003), and the mean LVEF increased by 7.49% (I2 = 0; 95% CI − 9.99 ~ − 4.99; p < 0.00001). Conclusion: Bariatric surgery offers beneficial cardiac effects on non-HFpEF patients with obesity but failed to show a significant improvement in the pooled analysis for the changes of cardiac parameters. The improving degree may be related to the baseline BMI, the extent of BMI loss, and the baseline age. Future studies should focus on finding out the influencing factors of effectivenesses and defining the suitable crowd. [ABSTRACT FROM AUTHOR]

A 48-year-old woman who had been receiving long-term interferon-β for 8 years for multiple sclerosis developed drug-induced World Health Organization group I pulmonary arterial hypertension. Triple therapy for pulmonary arterial hypertension and suspension of interferon-β led to improvement from a high-risk to low-risk state and improvement in exercise hemodynamics, including vascular distensibility, and right ventricle-pulmonary artery coupling. (Level of Difficulty: Advanced.).

Background: Electrolyte imbalances, particularly hyponatremia and hypochloremia, are common in ADHF patients and can influence disease severity and outcomes. Understanding the correlation between admission S. Na+ and S. Cl- levels with ADHF severity and hospital stay is crucial for optimizing patient management. Aim: This study aimed to investigate the correlation between admission S. Na+ and S. Cl- levels with disease severity and length of hospital stay in ADHF patients. Discussion: Diagnostic studies based on sodium and chloride are not only widely available but also, practicable and relatively inexpensive in comparison to other modalities. A total of 150 ADHF patients were included in the study. The mean admission S. Na+ and S. Cl- levels were assessed in relation to NYHA functional class and EF. Statistical analysis revealed significant correlations between admission S. Na+ and S. Cl- levels and NYHA class, as well as EF. Conclusion: The correlation of admission S. Na+ and S. Cl- levels with disease severity and hospital stay in ADHF patients provides important insights. Monitoring and managing electrolyte imbalances, particularly S. Na+ and S. Cl- may have implications for optimizing patient care and improving outcomes in ADHF.

AbstractAims To estimate healthcare resource use and direct healthcare costs of Transthyretin Amyloid Cardiomyopathy (ATTR-CM) in Sweden over 12 months across severity stages as defined by the New York Heart Association (NYHA). Secondary to investigate the current diagnostic trajectory for patients with ATTR-CM in Sweden.Methods A stratified inclusion of patients with a confirmed diagnosis of ATTR-CM in different NYHA classes. Data was extracted from medical records in two cardiology clinics in Sweden. Healthcare resource use data were retrospectively collected for 12 months.Results 38 patients were included, of whom 7 were in NYHA class II, 20 in class III and 4 in class IV. The total cost of health care per patient increased from SEK 69,000 (€6800) in NYHA stage II, SEK 219,000 (€21,500) in NYHA stage III, to SEK 638,000 (€62,900) in stage IV, mainly due to an increase in inpatient stays. Mean time (standard deviation, SD) from any cardiac related diagnosis prior to ATTR-CM diagnosis was 3.5 (3.1) years.Conclusions Advanced ATTR-CM stages are associated with significant healthcare costs, as patients more often require resource-intensive inpatient care. The current diagnostic trajectory of ATTR-CM in this study was characterized by a diagnostic delay of several years.

Objective: To evaluate the outcome of Left Artrial Reduction by Auto Transplant technique in Giant LA with Mitral valve disease. Methods: This prospective study conducted in the Department of Cardio Thoracic and Vascular Surgery MGM Super Specialty Hospital Indore from 1"September 2022 to 30" August 2023.The aortic and bicaval cannulation was done and CPB instituted followed by cardioplegic arrest of heart. First the root, then the coronary ostia, provided cardioplegia. Transection of the Aorta, PA, SVC, and IVC followed by giant LA mobilization. An excised strip of LA wall and LAA (3-4cm width) was re-sutured with 5-0 prolene. Sutures repaired the SVC, IVC, PA, and aorta. Bleeding from Coseal-secured sutures. Interrupted stiches mobilized and sutured the mediastinal pleura and pericardium to reduce pulmonary vein suture line tension. Patient elective ventilation lasted 48 hours. Results: 10 patients underwent LA reduction. In 6 patients, concomitant Mitral valve replacement was done while in 4 patients concomitant Double valve replacement was done., 60% were in the age group between 33-35 years, and this was followed by the patients in the age group between 25-30 years of age (40%).Out of 5 patients who were included in the study, 8 patients had Atrial Fibrillation and 8 patients had Dysphagia. This was followed by previous history of thromboembolism seen in 4patients. LAA clot was seen in 4 patients. The mean LA size on Pre-Operative ECHO was 74 mm +/- 10 mm ranging from 64mm to 84mm. There was reduction in LA size (from 74+/- 10mm to 48 +/- 6mm) ranging from 42mm to 54mm. Conclusion: Giant LA associated with extra cardiac compressive symptoms should be reduced in size by Auto transplant technique which is safe in expert hands. Giant LA is typically found in patients with rheumatic mitral valve disease with severe regurgitation, Diagnosis is at times possible by routine chest x ray, Echocardiography is an excellent modality to establish its diagnosis, assess and direct correct management. [ABSTRACT FROM AUTHOR]

Background: The standard of treatment for treating individuals with severe left main stem and three-vessel coronary artery disease (CAD) is coronary artery bypass graft (CABG) surgery. Compared to medical care, it is linked to better survival. Objective: To compare the early effects of coronary artery bypass grafting on individuals with borderline vs decreased ejection fraction (EF). Patients and methods: This is a prospective study that included 61 patients with CAD who were subjected for CABG. The included patients were divided into 2 groups; HF with border line EF (HFbEF) group included 29 patients with borderline ejection fraction and HF with reduced EF (HFrEF) group included 32 patients in reduced ejection fraction. All patients were operated upon in Zagazig University Hospitals, Egypt and followed up during the period from September 2018 till September 2021. Each patient underwent: full history taking, thorough clinical examination, laboratory investigations and echocardiographic assessment. Results: There was great improvement of EF in HFrEF group exceeding HFbEF group. The EF at 6 months postoperative EF was 40.5±9.5% versus 43.2±7.85% in the HFbEF group versus in the HFrEF group respectively (p=0.151). Among borderline EF group there was no significant difference regarding EF before and after coronary artery revascularization (P-value= 0.34). There was a statistically significant improvement post-CABG regarding New York Heart Association (NYHA) classification among HFbEF group and HFrEF (P-value = 0.00004 and <0.0001, respectively). Conclusion: There was great improvement of systolic left ventricular EF in reduced ejection fraction group exceeding borderline EF group. [ABSTRACT FROM AUTHOR]

Background: Secundum atrial septal defects (ASDs) are the most common congenital heart diseases and its closure affords changes in the function of the pulmonary activities. Our study aimed to demonstrate that the closure ASD not only improves cardiac function but also results in symptomatic relief by improving functional class by improving exercise tolerance and pulmonary functions. Methods: This is a prospective study was conducted on 100 patients underwent device closure of secundum ASD. Investigations included NT-pro-brain natriuretic peptide levels (NT-pro-BNP), electrocardiography, chest X-ray, transthoracic echocardiogram, spirometry, and 6-min walk test, before and 3 months after the procedure. Results: All patients were classified according to significant symptomatic improvement into group I (not improved) and group II (improved). Regards NYHA classification, pulmonary hypertension, tricuspid regurgitation and NTpro-BNP, there was statistically significant lower values both pre-closure and postclosure in the improved group (p<0.001). There was statistical significant difference in pulmonary functions (spirometry and 6-minute walk test) in ASD patients before and 3 months after ASD closure in both groups as all parameters (FEF 25-75, FVC, and FEV1 and 6-minute walk test) as they were statistically significant higher values in the improved group both pre-closure and post-closure. The significant predictors was age < 48, ASD size ≤35, pulmonary hypertension (mild/moderate), FEF 75-25 ≥61, FVC≥67, FEV 1%≥64 and 6-MWTD ≥325 Conclusion: Transcatheter ASD device closure leads to significant improvement in the heart dimensions especially right-sided dimensions and functional class by improving exercise tolerance and pulmonary functions. [ABSTRACT FROM AUTHOR]

Several studies have examined the potential of adrenomedullin (ADM), pro-adrenomedullin (Pro-ADM), and mid-regional-pro-ADM (MR-Pro-ADM) as biomarkers for diagnosing and assessing the severity of heart failure (HF), with conflicting results. We aimed to investigate their diagnostic utility and their correlation with HF severity based on the New York Heart Association (NYHA) classification. We searched PubMed, EMBASE, and Scopus using a predefined search string. The quality assessment of included studies was conducted using the Newcastle Ottawa Scale (NOS), and the primary outcome was the mean difference (MD) in serum levels of ADM, Pro-ADM, and MR-Pro-ADM, in addition to the area under the curve (AUC). A total of 28 articles fulfilled our inclusion criteria and were included in our qualitative and quantitative synthesis, with a total of 15,405 subjects. Significant MD in ADM levels in HF patients vs. controls (6.024 [95 % CI 1.691, 10.356]), NYHA I vs. controls (−1.202 [95 % CI -2.111, −0.292]), NYHA IV vs. controls (−7.536 [95 % CI -12.680, −2.393]), NYHA III vs. NYHA IV (−4.438 [95 % CI -7.612, −1.263]), and NYHA I-II vs NYHA III-IV (−2.351 [95 % CI -4.361, −0.341]) were observed. Moreover, a significant MD was observed in pro-ADM levels in NYHA I-II patients vs. controls (−0.960 [95 % CI -1.479, −0.440]), NYHA III-IV vs. controls (−1.979 [95 % CI -2.958, −1.000]), and NYHA I-II vs. NYHA III-IV (−0.966 [95 % CI -1.407, −0.526]). Furthermore, MR-Pro-ADM levels were significantly different in NYHA I-II vs. NYHA III-IV (−0.428 [95 % CI -0.492, −0.365]). MR-Pro-ADM predicted HF with an AUC of 0.781 (95 % CI 0.755, 0.806). Among HF patients, there was a significant increase in ADM levels compared to control subjects, and these levels increased with the progression of NYHA classes. Similarly, both Pro-ADM and MR-Pro-ADM displayed higher concentrations in NYHA class III-IV HF patients compared to those in NYHA class I-II. However, MR-Pro-ADM exhibited lower accuracy in predicting HF compared to established biomarkers. • ADM levels are increased in HF patients compared to controls. • ADM, Pro-ADM, and MR-Pro-ADM levels rise according to the severity of the NYHA class. • Their role in gauging HF severity could hold significant clinical implications. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a clinical syndrome with a global burden. Signs and symptoms of HF are nonspecific and often shared with other conditions. The N-terminal prohormone of brain natriuretic peptide (NT-proBNP) serves as a useful biomarker for the diagnosis of HF not only in patients with acute symptoms but also in outpatients with an ambiguous clinical presentation. The aim of the analysis is to evaluate the cost-effectiveness of implementing NT-proBNP in the diagnostic algorithm in patients with/without type 2 diabetes mellitus (T2DM), compared with a diagnosis based primarily on clinical signs or symptoms from the perspective of the Austrian and Swiss healthcare system. A time-discrete Markov model was developed to simulate the effect/improvement (lifetime-costs, quality-adjusted life-years [QALYs], and life-years [LYs]) due to an NT-proBNP screening in undetected HF patients. Undetected HF patients are included in the model according to a distribution of New York Heart Association (NYHA) classes. The model considers disease progression by transition of NYHA classes. Undetected patients may remain undetected or be detected with the help of NT-proBNP or symptoms. Patients with known HF exhibit a slower disease progression. The probability of dying is influenced by the respective NYHA class. Direct costs (2021 € or CHF) were derived from published sources. QALYs, LYs, and costs were discounted (3% p.a.). In the per-patient analysis (at age 60 over lifetime), the incremental cost–utility ratio (ICUR)/QALY of NT-proBNP vs. no screening was €3,042 for HF patients in Austria. Considering the total cohort of undetected HF patients (n = 9,377) with the corresponding age structure over a lifetime, the ICUR increases to €4,356. In Switzerland, the per-patient results show an ICUR of CHF 897. Considering the total cohort of undetected HF patients (n = 6,826) the ICUR amounts to CHF 4,513. If indirect costs are considered, NT-proBNP screening becomes the dominant strategy in both countries. Overall, the analysis concludes that screening with NT-proBNP is a highly cost-effective or cost-saving diagnostic option for patients with HF, and a sensitivity analysis confirmed these findings. [ABSTRACT FROM AUTHOR]

Background: Patients with symptomatic aortic stenosis are a vulnerable population with associated cardiac damage and a significant comorbidity burden. This study aimed to determine the rate, factors associated with, and prognostic value of poor functional status (NYHA class III-IV) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR)., Methods: This multicenter study included 6,363 transarterial TAVR patients, classified according to baseline functional status (NYHA class I-II vs. III-IV)., Results: A total of 3,800 (60%) patients presented an NYHA class III-IV before the TAVR procedure. Atrial fibrillation (OR:1.32,95%CI:1.11-1.58,p=0.002), chronic kidney disease (OR:1.73, 95%CI:1.45-2.05, p<0.001), COPD (OR:1.65,95%CI: 1.32-2.05), p<0.001), reduced LVEF (OR:2.28, 95%CI:1.70-3.05, p<0.001), and moderate and severe pulmonary hypertension were associated with a poor functional status. At 1-year follow-up, patients with NYHA class III-IV presented a higher rate of mortality (8.81 per 100 person-years, 95%CI: 7.57-10.15 vs. 13.12 per 100 person-year - 95%CI: 11.80-14.58, log-rank p<0.001) and heart failure hospitalization (8.25 per 100 person-years - 95%CI: 7.05-9.65 vs. 12.5 per 100 person-years - 95%CI: 11.24-14.00, log-rank p=0.005). Comorbidity factors (COPD, CKD) and signs of cardiac damage (atrial fibrillation, pulmonary hypertension) determined an increased risk of poorer clinical outcomes (p<0.01 for all)., Conclusions: More than one-half of patients undergoing TAVR in the contemporary era presented an advanced functional class before the procedure, and this was associated with a greater comorbidity and cardiac damage burden. Patients with poorer baseline functional status exhibited worse clinical outcomes at 1-year follow-up. These findings highlight the importance of future studies on earlier interventions for aortic stenosis patients., (Copyright © 2024. Published by Elsevier Inc.)

Background: Patients with ventricular tachycardia (VT) frequently present in unstable VT and are subject to urgent/high-risk ablation procedures. Clinical predictors of prolonged hospitalization and mortality are needed for optimal management of these patients., Objectives: This study seeks to identify factors associated with prolonged hospitalization and mortality in emergent unplanned VT ablation procedures., Methods: Fifty consecutive patients hospitalized emergently for VT with structural heart disease who underwent catheter ablation were prospectively followed up for outcomes and complications., Results: Of the 50 patients (mean age 67.6 ± 12.8 years), 86.0% were male, 62.0% had ischemic cardiomyopathy, and their median left ventricular ejection fraction was 28.5%. Hospital stay <7 days (median 3 days) occurred in 28 (56.0%) patients (Group 1) and >7 days (median 10 days) or death <7 days occurred in 22 (44.0%) patients (Group 2). PAINESD score and left ventricular ejection fraction were similar between the groups. Compared with Group 1, Group 2 had significantly worse NYHA functional class III or higher (25.0% vs 63.6%; P = 0.006), electrical storm (46.4% vs 77.3%; P = 0.027), and prior failed VT ablation (35.7% vs 68.2%; P = 0.023). Multivariable analysis showed that NYHA functional class III or higher and prior failed VT ablation were predictive of prolonged hospital stay. After ablation, compared with Group 1, Group 2 had worse heart failure (10.7% vs 54.5%; P = 0.001), VT recurrences (3.6% vs 68.2%; P < 0.001), and 7 deaths within 30 days., Conclusions: Patients undergoing emergent VT ablation are at high risk for prolonged hospital stay, which is predicted by NYHA functional class III or higher and a prior failed ablation. Early VT recurrences and worsening heart failure contribute to prolonged hospitalization and a high 30-day mortality., Competing Interests: Funding Support and Author Disclosures Dr Uetake has received support from the Mitsukoshi Health and Welfare Foundation and Fukuda Foundation for medical technology. Dr Tandri has received research support from Abbott. Dr Hasegawa has received support from the International Rotary Fellowship of Healthcare Professionals (Global Grant GG2099197 Scholarship). Dr Kurata has received a scholarship from the Japanese Heart Rhythm Society. Dr Richardson has received speaking honoraria from Medtronic and research funding from Medtronic and Abbott; and has served as a consultant for Philips and Biosense Webster. Dr Kanagasundram has received speaking honoraria from Johnson & Johnson. Dr Stevenson has received speaking honoraria from Abbott, Boston Scientific, Biotronik, Biosense Webster, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The symptoms of chronic heart failure affect patients' emotional and physical well-being. Objectives: The aim of this cross-sectional study was to determine the prevalence of depression in hospitalized patients with chronic heart failure and its links to selected aspects. Methods: Depression was assessed with the Patient Health Questionnaire-9, data were obtained on functional independence, NYHA classes, illness perception, quality of life, and social support. Data were analyzed using descriptive statistics, the Kruskal--Wallis test, and Spearman's correlation coefficient at a 5% level of significance. Results: The sample comprised 173 patients with a mean age of 71.51 years (min. 50; max. 92), of whom 56.07% were males. Depression was identified in 47.40% of subjects; the mean score was 5.65 (SD = 4.61). Depression was more frequent in NYHA classes III and IV (p = 0.0018), as well as in patients with decreasing independence (p = 0.0002). Correlation analysis using Spearman's coefficient suggested that an increasing prevalence of depression was associated with lower quality of life (rSp = 0.5470; p < 0.05), illness perception (rSp = 0.537; p < 0.05), and social support (rSp = --0.2439; p < 0.05). Conclusions: Depression may be influenced by numerous aspects. To effectively manage depression, these aspects must be known. In hospital patients, one option could be a comprehensive intervention by a palliative team. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a serious and advanced stage of various cardiac diseases with high mortality and rehospitalization rates. Phosphoglycerate mutase 2 (PGAM2) overexpression was identified in the serum of patients with HF.

Introduction: Tuberculous pericarditis continues to be a leading cause of chronic constrictive pericarditis (CCP) in developing countries. Echocardiography plays a key role in the assessment and diagnosis. Methods: Twelve patients who underwent pericardiectomy for CCP in last 18 months of the study period were subjected to clinical and New York Heart Association (NYHA) functional class assessment along with comprehensive echocardiographic evaluation. The data were compared with their preprocedural status. Results: Significant reduction was noted in the incidence of inferior vena cava (IVC) congestion(P < 0.001) and mean left atrial (LA) size from 43.75 ± 4.43 mm to 31.58 ± 3.03 mm (P < 0.001), post pericardiectomy.Respiratory variation of 34.17 ± 8.76 % in the mitral E velocity was significantly reduced to 17 ± 3.69 % (P < 0.001) after surgery. Similarly, respiratory variation in tricuspid E velocities showed significant reduction from 62.17 ± 13.16 % to 32.58 ± 4.7 % (P < 0.001).Prior to pericardiectomy, medial e’ and lateral e’ mitral annular velocities was 15.5±1.24 cm/sec and13.08 ± 1.08 cm/sec, respectively. Following surgery, the medial e’ and lateral e’ was 12.5±1.17 cm/sec(P = 0.001) and 15.42±1.83 (P = 0.004), respectively. Conclusion: Echocardiography provides useful insight in pericardial constriction hemodynamics and worthwhile effects of pericardiectomy.

Background: Women with congenital heart disease (CHD) are at risk for peripartum cardiac deterioration. Previous studies focused on women after one or two pregnancies. We investigated effects of multiple births on maternal cardiac status by comparing women with CHD and ≥3 live births to women with

Morbid obesity (MO) is an increasingly common condition in patients with heart failure with reduced ejection fraction (HFrEF). Although substantial weight loss in morbidly obese patients has proved to slow the progression of heart failure, parallel alteration of ejection fraction (EF) and New York Heart Association (NYHA) functional class along with post-bariatric surgery weight loss is yet to be determined. This systematic review aimed to measure the effect of bariatric weight loss on EF and NYHA functional class in patients with HFrEF. A systematic literature review was performed in Medline/PubMed to identify studies in patients with MO and pre-existing HFrEF, who underwent bariatric surgery. A total of 11 studies encompassing 136 patients with HFrEF undergoing bariatric surgery for MO were included. Six studies provided patient-level data on 37 cases. Patients lost an average body mass index (BMI) of 12.9 ± 4.2 kg/m2 (5.1 to 23 kg/m2) after an average follow up of 22.43 ± 18.6 months (2–89 mo). There was a direct correlation between BMI loss and EF improvement (r = 0.61, P <.0001), but not between BMI loss and NYHA functional class changes (r = 0.17, P =.4). Weight loss induced by bariatric surgery results in parallel EF increase in patients with MO and HFrEF. However, current data does not indicate a parallel improvement of clinical symptoms (NYHA functional class) along with such an increase in EF in this population of patients. - Weight loss induced by bariatric surgery result in parallel increase in ejection fraction (EF) in morbidly obese patients with heart failure with reduced ejection fraction (HFrEF). - There is not sufficient data in the literature to support rapid improvement of clinical symptoms in and NYHA functional class parallel with improvement increasing EF. [ABSTRACT FROM AUTHOR]

Background: In a low-income setting like ours, chronic constrictive pericarditis is not uncommon. Affected patients present late for surgical management owing to poverty and ignorance. These two factors adversely affect the outcome of surgery. Objective: To review 45 cases of chronic constrictive pericarditis done in our center with a view to determining the challenges and outcome of surgery. Patients and Methods: This is a retrospective study spanning 10 years, 2011 to 2020. Data comprising of biodata, morphologic and histologic types including challenges and outcome of surgery were obtained from our hospital Record Department. Data were analyzed using SPSS version 22(Chicago) and results presented using bar chart, tables and pie chart. Results: There were 45 patients. Of this number, there were 33 males (73.3%) and 12 females (27.7%). Age ranges affected were from 11-20 to 61-70 years. Morphologic types were totally calcific chronic constrictive pericarditis (4.4%), effusive chronic constrictive pericarditis (40%) and isolated chronic constrictive pericarditis (55.6%). Histologically, tuberculosis (60.0%) was most common, followed by idiopathic (33.3%). 2 patients were treated using cardiopulmonary bypass while the remainder had off-pump pericardiectomy, ranging from partial, total and radical. The outcome was poor in 30%, because they were not able to progress beyond NYHA class III despite ionotropic support and repeated paracentesis abdominis. Conclusion: Chronic constrictive pericarditis especially when it presents late is a major cause of morbidity and mortality in the young population. Poorly equipped ICU and lack of highly trained personnels also affect adversely those who present for treatment.

Background: The study investigated the relationship between the concentrations of Mg, Ca, Fe, Cu, Zn, P and anthropometric and biochemical parameters in the blood serum of patients with heart failure (HF) and the potential influence on the development and progression of HF. Material & methods: The study included 214 patients (155 men and 59 women), aged 40–87 years, presenting symptoms or signs typical of HF (according to the NYHA functional classification). Serum concentrations were determined for Mg, Ca, Fe, Cu, Zn, P, C-reactive protein (CRP), creatinine, urea, triglyceride levels (TG), total cholesterol (CH), high density protein (HDL), low density protein (LDL). The levels of macro-and microminerals were analysed using inductively coupled serum optical emission spectrometry (ICP-OES). Results: Our study confirmed the role of known risk factors in the development of heart failure, including: overweight, diabetes, hypertension, high triglycerides (TG), high total cholesterol (CH), high levels of low density protein (LDL) and reduced levels of high density protein (HDL), high CRP, high creatinine. Moreover, deficient serum concentrations of Mg (47% of the studied men and 54% of the women) and Cu (in 44% of men and more than 30% of women) were observed, as well as subnormal serum Fe (2% of women) and Zn (1% of men). Elevated serum Ca was found in 50% of men and 49% of women. In 44% of the studied men and 52% of the studied women, P levels in serum were also above-average. The study revealed a significant positive correlation between serum levels of Ca and Mg, and also Ca and Cu in women. In men, serum Cu was positively correlated with Mg and Ca concentrations. In patients from group 1 (NYHA I–II), Mg content was positively correlated with Ca and Cu. In this patient group, Ca was also positively associated with Cu content in serum. In group 2 (NYHA III-IV), serum Mg concentration was significantly positively correlated with that of Cu and Ca. Conclusions: Changes in the serum concentrations of macro-and microminerals may significantly affect the severity of HF in Polish patients. [ABSTRACT FROM AUTHOR]

Background: The prevalence of child maltreatment in adults with congenital heart disease (ACHD) has not been assessed so far. Child maltreatment is a major risk factor for unfavorable behavioral, mental, and physical health outcomes and has been associated with decreased quality of life. Given the increased survival time of ACHD, it is essential to assess factors that may worsen the quality of life and interact with classical cardiovascular risk factors and mental well-being. Methods: In a cross-sectional study, 196 ACHD (mean age 35.21 ± 11.24 y, 44,4% female, 55.6% male) completed a thorough psychiatric and cardiac evaluation. Child maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ) and rates were compared to already existing data from the German general population. Further psychological measurements included the WHO Quality of Life Questionnaire, Hospital Anxiety and Depression Scale (HADS) and assessment of lifestyle factors (exercise, smoking, alcohol consumption, body mass index). To identify a relationship between current cardiac function and child maltreatment, we used logistic regression. Results: ACHD reported significantly higher rates of emotional neglect and emotional abuse and sexual abuse and lower rates of physical neglect when compared to the general German population. In addition, total CTQ-scores, emotional abuse, emotional neglect, physical abuse, and sexual abuse correlated with symptoms of depression, anxiety, and negatively correlated with QoL. Furthermore, CTQ scores contributed significantly in predicting higher New York Heart Association (NYHA) scores (p = 0.009). Conclusion: Child maltreatment is more common in ACHD and associated with decreased quality of life and depression and anxiety. Furthermore, we found evidence that self-reported child maltreatment is associated with decreased cardiac function. Given the longer survival time of patients with ACHD, identifying factors that may negatively influence the disease course is essential. The negative consequences of child maltreatment may be the subject of psychosocial interventions that have demonstrated efficacy in treating posttraumatic stress disorders. [ABSTRACT FROM AUTHOR]

This descriptive study evaluates the effectiveness of Bothrops in treating ischemic heart disease. Bothrops Lanceolatus is the venom of yellow viper. This snake belongs to the animalia kingdom of reptilia class and phylum chordate. They are also known as fer-de-lance, martinician pit viper generally found in the island of Martinique. Its venom is anticoagulant. So it is expected to be useful in thrombosis and thrombotic affections such as stroke[2]. In this study 10 patients diagnosed as coronary artery disease with coronary angiogram were given bothrops and effective improvement were noted in both exertional dypsnea assessed by NYHA classification and the occurrence of angina which is assessed by Canadian Cardiovascular Society Grading Of Angina Pectoris. [ABSTRACT FROM AUTHOR]

ObjectivesThis study sought to report full 1-year results, detailed magnetic resonance imaging analysis, and determinants of efficacy in the prospective, randomized, controlled CADUCEUS (CArdiosphere-Derived aUtologous stem CElls to reverse ventricUlar dySfunction) trial.BackgroundCardiosphere-derived cells (CDCs) exerted regenerative effects at 6 months in the CADUCEUS trial. Complete results at the final 1-year endpoint are unknown.MethodsAutologous CDCs (12.5 to 25 × 10(6)) grown from endomyocardial biopsy specimens were infused via the intracoronary route in 17 patients with left ventricular dysfunction 1.5 to 3 months after myocardial infarction (MI) (plus 1 infused off-protocol 14 months post-MI). Eight patients were followed as routine-care control patients.ResultsIn 13.4 months of follow-up, safety endpoints were equivalent between groups. At 1 year, magnetic resonance imaging revealed that CDC-treated patients had smaller scar size compared with control patients. Scar mass decreased and viable mass increased in CDC-treated patients but not in control patients. The single patient infused 14 months post-MI responded similarly. CDC therapy led to improved regional function of infarcted segments compared with control patients. Scar shrinkage correlated with an increase in viability and with improvement in regional function. Scar reduction correlated with baseline scar size but not with a history of temporally remote MI or time from MI to infusion. The changes in left ventricular ejection fraction in CDC-treated subjects were consistent with the natural relationship between scar size and ejection fraction post-MI.ConclusionsIntracoronary administration of autologous CDCs did not raise significant safety concerns. Preliminary indications of bioactivity include decreased scar size, increased viable myocardium, and improved regional function of infarcted myocardium at 1 year post-treatment. These results, which are consistent with therapeutic regeneration, merit further investigation in future trials. (CArdiosphere-Derived aUtologous stem CElls to reverse ventricUlar dySfunction [CADUCEUS]; NCT00893360).

Introduction: Tuberculous pericarditis continues to be a leading cause of chronic constrictive pericarditis (CCP) in developing countries. Echocardiography plays a key role in the assessment and diagnosis. Methods: Twelve patients who underwent pericardiectomy for CCP in last 18 months of the study period were subjected to clinical and New York Heart Association (NYHA) functional class assessment along with comprehensive echocardiographic evaluation. The data were compared with their preprocedural status. Results: Significant reduction was noted in the incidence of inferior vena cava (IVC) congestion (P < 0.001) and mean left atrial (LA) size from 43.75 ± 4.43 mm to 31.58 ± 3.03 mm (P < 0.001), postpericardiectomy. Respiratory variation of 34.17 ± 8.76 % in the mitral E velocity was significantly reduced to 17 ± 3.69 % (P < 0.001) after surgery. Similarly, respiratory variation in tricuspid E velocities showed significant reduction from 62.17 ± 13.16 % to 32.58 ± 4.7 % (P < 0.001). Prior to pericardiectomy, medial e' and lateral e' mitral annular velocities was 15.5 ± 1.24 cm/sec and 13.08 ± 1.08 cm/sec, respectively. Following surgery, the medial e' and lateral e' was 12.5 ± 1.17 cm/sec (P = 0.001) and 15.42 ± 1.83 (P = 0.004), respectively. Conclusion: Echocardiography provides useful insight in pericardial constriction hemodynamics and worthwhile effects of pericardiectomy. [ABSTRACT FROM AUTHOR]

Background ‒ Heart failure (HF) is a serious and advanced stage of various cardiac diseases with high mortality and rehospitalization rates. Phosphoglycerate mutase 2 (PGAM2) overexpression was identified in the serum of patients with HF. Material/methods ‒ One hundred and fifty-three cases of HF were included in the present work. According to New York Heart Association (NYHA) classification, 22 were grade II, 84 were grade III, and 47 were grade IV. Serum PGAM2, NT-proBNP, B-type natriuretic peptide (BNP), troponin T (TNT), and Cys-C of HF patients were detected using ELISA assay. Left ventricular ejection fraction, left ventricular end-diastolic inner diameter, and left atrium (LA) inner diameter of the included cases were also detected by the cardiac color Doppler. Results ‒ The number of patients with atrial fibrillation was significantly higher in NYHA IV group than in groups II and III with statistical difference (p < 0.05). The serum PGAM2, NT-proBNP, and Cys-C were significantly higher in NYHA IV group than in NYHA II and NYHA III groups (pall < 0.05). NT-proBNP had the highest prediction efficacy of HF severity and PGAM2 was also a potential biomarker for HF severity evaluation with relatively high sensitivity, specificity, and area under the ROC. The overall survival among NYHA II, III, and IV groups were statistically different (p = 0.04) with the median survival time of 25 months for NYHA III and IV groups. Conclusion ‒ PGAM2 is a new promising biomarker for evaluation of the severity of HF. Combination detection using multiple serum factors such as PGAM2, NT-proBNP, BNP, TNT, and Cys-C can improve the HF severity differential diagnosis performance. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a serious disease syndrome characterized by elevated pro‐inflammatory cytokines and inflammatory mediators presume to have significant contribution on disease progression. Galectins are carbohydrate‐binding proteins responsible of various physiological functions. Role of galectins in heart failure has been ill‐defined. In the present case‐controls study, 136 patients clinically diagnosed with heart failure and 125 healthy Chinese controls were recruited. Levels of galectins (Gal‐1, 3 and 9) and cytokines (IFN‐γ, IL‐17A, IL‐4 and TGF‐β) were quantified by ELISA. Increased levels of galectin‐1 and 3 was observed in HF patients and associated with clinical severity. In addition, pro‐inflammatory cytokines such as IFN‐γ and IL‐17A were increased in patients whereas, anti‐inflammatory TGFβ was decreased. Galectin‐3 was positively correlated with IFN‐γ, IL‐17A and inversely with TGF‐β. Furthermore, ROC curve analysis suggested galectin‐3 as a promising biomarker for diagnosis and HF and clinical severity. Interestingly, a two‐year follow‐up indicated significant association of elevated galectin‐3 with mortality due to HF. In conclusion, galectin‐3 associated with HF and clinical manifestations possibly by inducing pro‐inflammatory cytokines and could be a possible biomarker of HF and severe clinical conditions. [ABSTRACT FROM AUTHOR]

This study aimed that we were classification of physical activity in patients with heart failure categorized as New York Heart Association (NYHA) class I or II. We were a survey using a researcher- administered questionnaire, SF-8, the Specific Activity Scale (SAS), and the Scale to Measure Self-Care Behavior of Patients with Heart Disease. We included 70 patients who were treated in the Department of Cardiovascular Medicine at Hospital A. Regarding patient characteristics and clinical information after the cluster analysis, there were significant differences in the NYHA class (p = 0.001), BNP level (p = 0.012), self-management of medication adherence (p = 0.000), and exercise habits (p = 0.005). We summarized characteristics of each group as follows : Group A showed high tolerance to physical activity and near-perfect self-management; Group B showed moderate tolerance to physical activity but was not willing to commit to daily exercise and self-management; and Group C showed low tolerance to physical activity and often requested others to handle medication management. We needed that tolerance to physical activity and proposals for tailored instruction according to patient conditions, and needed that instructions tailored to the characteristics of heart failure patients in groups A-C. [ABSTRACT FROM AUTHOR]

We report a randomized, multicenter, open-label trial (ClinicalTrials.gov: NCT03096613) to investigate the clinical benefits of levothyroxine (L-T4) administration in subclinical hypothyroidism (SCH) patients with heart failure with reduced ejection fraction (HFrEF). Overall, 117 patients were enrolled and received L-T4 plus standard HFrEF treatment (experimental group, N = 57) or standard HFrEF therapy alone (control group, N = 60). The change of 6-min walk test distance in the experimental group was significantly higher than that in the control group at 24 weeks (70.08 ± 85.76 m vs. 27.73 ± 82.00 m, mean difference [95% confidence interval (CI)] 46.90 [12.90, 80.90], p < 0.001). Improvements in New York Heart Association (NYHA) classification (p = 0.033) and thyroid function were significant. Adverse event incidence was similar between groups (risk ratio [95% CI]: 0.942 1.053 (0.424, 2.616); p = 0.628). L-T4 addition to HFrEF treatment improved activity tolerance, NYHA class, and thyroid function within 6 months, suggesting its potential for combined therapy in HFrEF patients with SCH. Future double-blind, placebo-controlled trials should be performed to confirm these results., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Dilated Cardiomyopathy (DCM) is the most frequently diagnosed cardiomyopathy in Pakistan and patients have significant muscles dysfunction which affects their quality of life (QOL). Available evidence have supported the role of moderate intensity exercise for improving QOL but no such studies have been conducted in Pakistan so far. Methods: A single blinded randomized controlled trial was conducted in two different hospitals of Rawalpindi from September 2016-February 2017. Both genders clinically stable DCM patients with ejection fraction <40% were selected through purposive non-probability sampling and randomized to Training group and Control group (n=30 each). Training group protocol included bicycling on lower limb ergometer 4days/week on alternate days for 8 weeks. Patients in control group received usual care. Patients were assessed thrice during 8-week protocol. The tools used included structured questionnaire with different standard scales like 6 Minute Walk Test, Modified Medical Research Council Scale, Modified Borg Scale and Minnesota Living with Heart Failure Questionnaire. Data was analysed on SPSS 21 software. Results: Prior to conditioning in training group, 6 (21%) patients reported good and 23 (79%) have poor QOL whereas in control group 14 (56%) have good and 11 (44%) have poor QOL on MLHFQ score. After 8 weeks in training group, 28 (96%) patients reported excellent QOL and in control group, 11 (44%) reported good and 14(56%) have poor QOL on MLHFQ score. Between the groups analysis depicted highly significant p-values for QOL and New York Heart Association (NYHA) class (p<0.001). Conclusion: Supervised cardiac conditioning program significantly improves Quality of life and NYHA functional class in dilated cardiomyopathy. [ABSTRACT FROM AUTHOR]

Coronary artery disease is one of the main causes of mortality and morbidity among chronic heart diseases worldwide. Patients reported chronic chest pain as the primary symptom of coronary artery disease. Due to its progressive nature, it affects the health status and functional capacity of the patients. The current study was planned to compare the effects of prehabilitation resistance training in mild to moderate clinically frail patients awaiting coronary artery bypass graft (CABG). A randomized controlled trial was conducted on 74 patients awaiting CABG at the Faisalabad Institute of Cardiology, Faisalabad, Pakistan. A Modified Healthy Heart Questionnaire was used for screening of the patients. Interventions applied were resistance training by using cuff weights/dumbbells at light intensity (40%-50%) of a maximum of one repetition (10-15 repetitions for one to three times a day) per major muscle groups of upper and lower limbs of the body on weekly basis. The main outcome measures were the 6-minute walk test (6MWT), the New York Heart Association (NYHA) for heart failure, the clinical frailty score, and the essential frailty toolset. Significant differences between group A (resistance training group) and group B (conventional physical therapy group) patients were observed. The mean ranks for 6MWT in group A and group B were 1.70 and 1.55, respectively. The mean ranks of NYHA in group A and group B were 1.68 and 2.84, respectively. Clinical frailty scores in group A and group B were 2.68 and 2.74, respectively, with the essential frailty toolset in group A and group B were 1.14 and 1.11, respectively. There were significant (p < 0.05) differences within and between groups for prehabilitation resistance training after CABG. The study showed that the resistance training group had improved the clinical frailty score, strength, endurance, and functional capacity in patients who underwent elective CABG., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract: Aims: The poor control of symptoms in patients with advanced heart failure with reduced ejection function (HFrEF) can limit the functionality of patients. Sacubitril–valsartan, compared with enalapril, has been shown to reduce mortality and hospitalization, and nowadays, there is still little evidence about the improvement on functionality. The aim of our study is to analyse the improvement of the functional class and the 6 min walking test (6MWT) in patients with multiple pathologies and advanced heart failure. Methods and results: From September 2016 to March 2018, 65 multimorbidity patients with severe symptomatic HFrEF were initiated to receive sacubitril–valsartan. Mean age was 78.6 ± 7.4 years, and 68% were male. The Charlson co‐morbidity index was 8 points. Seventy‐four per cent had New York Heart Association (NYHA) Functional Class IV. After the treatment, patients were able to achieve 55.68 m or more on 6MWT, and 91% presented an improvement in the NYHA functional class. Conclusions: Sacubitril–valsartan relieves symptoms and improves functional class prognostic risk of patients with advanced HFrEF and co‐morbidity. [ABSTRACT FROM AUTHOR]

Introduction: The number of grown-up congenital heart disease (GUCH) patients is steadily increasing. Unfortunately, the majority of these patients suffer from late sequelae, with heart failure being the most common cause of death. Exercise training is beneficial and safe in patients with acquired heart failure, as well as in asymptomatic GUCH patients. However, its effect remains unknown in symptomatic GUCH patients. This could cause reticence on positive sports advice, with possible counterproductive effects. Areas covered: A review of current literature was performed to evaluate the effect of exercise training in symptomatic (NYHA≥2) GUCH patients. The search yielded a mere three studies including symptomatic patients, and another six studies including also patients in NYHA 1 without making clear distinction between the NYHA subgroups. Expert commentary: Suboptimal trial designs, low patient numbers, and homogeneity of investigated cardiac anomalies make this review insufficient to draw definite conclusions. However, all studies describe overall positive effects of exercise training in symptomatic GUCH patients in terms of exercise capacity and quality of life. There were no safety concerns. Larger-scaled, randomized controlled trials are needed to obtain certainty. [ABSTRACT FROM AUTHOR]

Introduction: Heart failure is a major cause of morbidity and mortality throughout the world. Despite advances in therapy, nearly half of patients receiving guideline-directed medical therapy remain limited by symptoms. Cardiac contractility modulation (CCM) can improve symptoms in this population, but efficacy and safety in prospective studies has been limited to 12 months of follow-up. We report on the first 2 year multi-site evaluation of CCM in patients with heart failure. Methods: One hundred and forty-three subjects with heart failure and reduced ejection fraction were followed via clinical registry for 24 months recording NYHA class, MLWHFQ score, 6 min walk distance, LVEF, and peak VO at baseline and 6 month intervals as clinically indicated. Serious adverse events, and all cause as well as cardiovascular mortality were recorded. Data are presented stratified by LVEF (all subjects, LVEF <35%, LVEF ≥35%). Results: One hundred and six subjects from 24 sites completed the 24 month follow-up. Baseline parameters were similar among LVEF groups. NYHA and MLWHFQ improved in all 3 groups at each time point. LVEF in the entire cohort improved 2.5, 2.9, 5.0, and 4.9% at 6, 12, 18, and 24 months, respectively. Insufficient numbers of subjects had follow-up data for 6 min walk or peak VO assessment, precluding comparative analysis. Serious adverse events ( n = 193) were observed in 91 subjects and similarly distributed between groups with LVEF <35% and LVEF ≥35%, and similar to other device trials for heart failure. Eighteen deaths (7 cardiovascularly related) over 2 years. Overall survival at 2 years was 86.4% (95% confidence intervals: 79.3, 91.2%). Conclusion: Cardiac contractility modulation provides safe and effective long-term symptomatic and functional improvement in heart failure. These benefits were independent of baseline LVEF and were associated with a safety profile similar to published device trials. [ABSTRACT FROM AUTHOR]

Objective: The Kansas City Cardiomyopathy Questionnaire (KCCQ) has emerged as a patient-centered heart failure-specific health status measure. It currently lacks routine and widespread use in clinical practice and trials. The purpose of this study was to examine the correlation between KCCQ and cardiopulmonary exercise testing (CPET) parameters and clinical outcomes, compared with the New York Heart Association functional classification (NYHA).Methods and Results: We performed a single-centered observational analysis of 432 patients who presented to the Heart Failure Department, completed the KCCQ, and underwent CPET. The 1-year clinical outcome assessed was a composite of mortality, heart failure hospitalization, and need for heart transplantation or left ventricular assist device. In the KCCQ, the physical limitation domain had a correlation with peak VO2 similar to NYHA (r = 0.48; P < .001; and r = -0.48; P < .001; respectively), and slightly better correlation with ventilatory threshold (r = 0.42; P < .001; and r = -0.40; P < .001; respectively). According to model validation, the KCCQ physical limitation domain and NYHA were similar predictors of peak VO2 (r2 = 0.229; and r2 = 0.227; respectively). KCCQ predicted the specified 1-year clinical outcome (hazard ratio 0.75, 95% confidence interval 0.69-0.82; P < .001) and provided incremental predictive ability when added to a model that included NYHA, with a net reclassification index of 76.1% (P < .001).Conclusions: KCCQ and NYHA provide similar assessment of functional capacity. KCCQ predicts 1-year clinical outcomes, providing incremental value over NYHA. These findings support its routine use in clinical care, as well as its potential to serve as a measure in clinical trials. [ABSTRACT FROM AUTHOR]