Search

Little is known regarding which patients with ischemic cardiomyopathy (ICM) should be considered for prophylactic therapies, such as an implantable cardioverter-defibrillator (ICD), in the primary percutaneous intervention era. The aim of this study was to investigate the influence of non-sustained ventricular tachycardia (NSVT) on major adverse cardiac events (MACE) in heart failure with reduced ejection fraction (HFrEF) patients. We retrospectively analyzed patients of ICM and non-ICM who underwent ICD implantation at our institute from October 2006 to August 2020. MACE were defined as composite outcome of cardiovascular death, heart failure hospitalization, and appropriate ICD therapies. A total of 167 patients were enrolled [male, 138 (83 %); age, 62.1 ± 11.7 years; left ventricular ejection fraction, 23.5 ± 6.1 %; left ventricular diastolic diameter, 67.4 ± 9.0 mm; atrial fibrillation, 47 (28 %); NSVT, 124 (74 %); use of class III antiarrhythmic drugs, 55 (33 %); ischemic cardiomyopathy, 56 (34 %); cardiac resynchronization therapy, 73 (44 %)]. The median follow-up duration was 61 months. MACE occurred with 71 patients (43 %). When comparing baseline characteristics of the patients, left ventricular ejection fraction (p = 0.02) and atrial fibrillation (p = 0.04) were significantly associated with MACE. The multivariable Cox analysis for the target variable MACE identified atrial fibrillation (hazard ratio 2.00; 95 % confidence index 1.18–3.37; p = 0.01) as an independent predictor for MACE. Prior NSVT before ICD implantation was not an independent predictor of future MACE in patients with HFrEF with primary prophylactic ICD. In contrast, atrial fibrillation was associated with worse prognosis. To predict the prognosis of patients with primary prophylactic ICD, these factors should be assessed as comprehensive risk stratification factors for MACE. [Display omitted] • Long-term prophylactic implantable cardioverter defibrillator outcomes are poor. • Non-sustained ventricular tachycardia does not influence long-term outcomes. • Atrial fibrillation is associated with worse outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The main disadvantage of bioprosthetic valves is the susceptibility of their leaflets to structural changes, leading to bioprosthetic valve dysfunction requiring a repeated surgical intervention. This group of patients is characterized by high comorbidity, which increases the risk of hospital mortality during repeated interventions. At the same time, low left ventricular ejection fraction (LVEF) is the main independent predictor of adverse outcomes. Transcatheter valve-in-valve implantation can be an alternative to an open intervention in patients with high surgical risk. However, this technique is often associated with prosthesis-patient mismatch due to a smaller effective orifice area of a bioprosthetic valve, as well as with the high incidence of intraventricular conduction disorders and/or the need for a pacemaker, preventing the LVEF recovery even in the late period after the procedure.Objective: To demonstrate the role of transluminal balloon valvuloplasty in staged surgical treatment of bioprosthetic aortic valve dysfunction. Case report: We present our experience of successful staged surgical treatment of biodegenerative dysfunction of a biological prosthetic aortic valve using balloon valvuloplasty followed by “open” repeated valve replacement in a patient at very high cardiovascular risk.Conclusions: This staged approach may be justified in patients with extremely low LVEF to minimize risks and improve surgical outcomes.

Purpose: The extraaortic‐valvular cardiac damage (EVCD) Stage has shown potential for risk stratification for patients with aortic stenosis (AS). This study aimed to examine the usefulness of the EVCD Stage in risk stratification of patients with moderate AS and reduced left ventricular ejection fraction (LVEF). Methods: Clinical data from patients with moderate AS (aortic valve area,.60–.85 cm2/m2; peak aortic valve velocity, 2.0–4.0 m/s) and reduced LVEF (LVEF 20%–50%) were analyzed during 2010–2019. Patients were categorized into three groups: EVCD Stages 1 (LV damage), 2 (left atrium and/or mitral valve damage), and 3/4 (pulmonary artery vasculature and/or tricuspid valve damage or right ventricular damage). The primary endpoint included a composite of cardiac death and heart failure hospitalization, with non‐cardiac death as a competing risk. Results: The study included 130 patients (mean age 76.4 ± 6.8 years; 62.3% men). They were categorized into three groups: 26 (20.0%) in EVCD Stage 1, 66 (50.8%) in Stage 2, and 48 (29.2%) in Stage 3/4. The endpoint occurred in 54 (41.5%) patients during a median follow‐up of 3.2 years (interquartile range, 1.4–5.1). Multivariate analysis indicated EVCD Stage 3/4 was significantly associated with the endpoint (hazard ratio 2.784; 95% confidence interval 1.197–6.476; P =.017) compared to Stage 1, while Stage 2 did not (hazard ratio 1.340; 95% confidence interval.577–3.115; P =.500). Conclusion: The EVCD staging system may aid in the risk stratification of patients with moderate AS and reduced LVEF. [ABSTRACT FROM AUTHOR]

Objective: The study was carried out to evaluate the role of the AST (Aspartate transaminase)/ALT (Alanine transaminase) ratio as an indicator of the functional severity in people with chronic heart failure (CHF) with reduced left ventricular ejection fraction. Methods: A prospective cross-sectional study was conducted in a tertiary care centre in South India among the individuals who had left ventricular ejection fraction (LVEF) of ≤40 %. The study period was between January 2021 and December 2021. Consecutive patients with the criteria were enrolled in the study. Study participants were grouped based on their AST/ALT ratio value (ratio

Abstract Aim To examine the prognostic value of superoxide dismutase (SOD) activity for monitoring reduced left ventricular ejection fraction(LVEF)in the patients with type 2 diabetes and acute coronary syndrome (ACS). Methods The population of this cross-sectional study included 2377 inpatients with type 2 diabetes who had an ACS admitted to the Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2016 to January 2021. Results Diabetic patients with ACS were divided into 2 subgroups based on LVEF. The mean SOD activity was significantly lower in patients with an LVEF ≤ 45% than in those with an LVEF > 45% (149.1 (146.4, 151.9) versus 161.9 (160.8, 163.0)). Using ROC statistic, a cut-off value of 148.8 U/ml indicated an LVEF ≤ 45% with a sensitivity of 51.6% and a specificity of 73.7%. SODs activity were found to be correlated with the levels of NT-proBNP, hs-cTnT, the inflammatory marker CRP and fibrinogen. Despite taking the lowest quartile as a reference (OR 0.368, 95% CI 0.493–0.825, P = 0.001) or examining 1 normalized unit increase (OR 0.651, 95% CI 0.482–0.880, P = 0.005), SOD activity was found to be a stronger predictor of reduced LVEF than CRP and fibrinogen, independent of confounding factors. Conclusions Our cross-sectional study suggests that SOD activity might be a valuable and easily accessible tool for assessing and monitoring reduced LVEF in the diabetic patients with ACS.

Cardiac resynchronization therapy (CRT) has become part of the standard of care for symptomatic patients with heart failure, reduced ejection fraction (HRrEF), and wide QRS, despite optimal medical therapy. Device technology, operator experience, and post-implant optimization on follow-up have significantly improved CRT response during the last decade. In parallel, conduction system pacing (CSP) has emerged as a new and potentially better tool for maintaining physiological ventricular activation in patients with antibradycardia pacing, as well as an alternative for dyssynchrony correction in HFrEF patients. The current review focuses on cardiac dyssynchrony pathophysiology and correction methods, clinical evidence on CRT and CSP as therapies for cardiac dyssynchrony, and the role of each according to clinical evidence and current guidelines for HFrEF treatment.

Aim: To examine the prognostic value of superoxide dismutase (SOD) activity for monitoring reduced left ventricular ejection fraction(LVEF)in the patients with type 2 diabetes and acute coronary syndrome (ACS). Methods: The population of this cross-sectional study included 2377 inpatients with type 2 diabetes who had an ACS admitted to the Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2016 to January 2021. Results: Diabetic patients with ACS were divided into 2 subgroups based on LVEF. The mean SOD activity was significantly lower in patients with an LVEF ≤ 45% than in those with an LVEF > 45% (149.1 (146.4, 151.9) versus 161.9 (160.8, 163.0)). Using ROC statistic, a cut-off value of 148.8 U/ml indicated an LVEF ≤ 45% with a sensitivity of 51.6% and a specificity of 73.7%. SODs activity were found to be correlated with the levels of NT-proBNP, hs-cTnT, the inflammatory marker CRP and fibrinogen. Despite taking the lowest quartile as a reference (OR 0.368, 95% CI 0.493–0.825, P = 0.001) or examining 1 normalized unit increase (OR 0.651, 95% CI 0.482–0.880, P = 0.005), SOD activity was found to be a stronger predictor of reduced LVEF than CRP and fibrinogen, independent of confounding factors. Conclusions: Our cross-sectional study suggests that SOD activity might be a valuable and easily accessible tool for assessing and monitoring reduced LVEF in the diabetic patients with ACS. [ABSTRACT FROM AUTHOR]

Clinical outcomes in patients with reduced left ventricular systolic function undergoing rotational atherectomy (RA) for percutaneous coronary intervention (PCI) remain understudied. Our study sought to evaluate the impact of RA-PCI in patients with LV systolic dysfunction on long-term outcomes. Between 2015 and 2019, 4941 patients with reduced LV function (rEF) undergoing PCI (with or without RA) were included in the hospital database. The primary endpoint was in-hospital major adverse cardiovascular and cerebral events (MACCE). The secondary endpoint was 3-year MACCE. In-hospital MACCE rates were significantly higher in RA-PCI compared to standard PCI without RA (PCI) (7.6% vs. 3.9%, p = 0.0009). However, 3-years MACCE rates were similar in RA-PCI and PCI (26.40% vs. 26.6%, p = 0.948). In conclusion, RA-PCI in patients with rEF is feasible, safe, and shows similar long-term results to PCI. [ABSTRACT FROM AUTHOR]

Our aim was to analyse whether prophylactic preoperative intraaortic balloon pump (IABP) improves outcomes in hemodynamically stable patients with low left ventricular ejection fraction (LVEF ≤30%) undergoing elective myocardial revascularization (CABG) using cardiopulmonary bypass (CPB). Secondary aim was to identify the predictors for low cardiac output syndrome (LCOS). Prospectively collected data of 207 consecutive patients with LVEF ≤30% undergoing elective isolated CABG with CPB from 01/2009 to 12/2019, 136 with and 71 patients without IABP, were retrieved retrospectively. Patients with prophylactic IABP were matched 1:1 with patients without IABP by a propensity score matching. Stepwise logistic regression was conducted to identify predictors of postoperative LCOS in the propensity-matched cohort. P value ≤0.05 was considered significant. Reduced postoperative LCOS (9.9% vs. 26.8%, P = 0.017) was observed in patients receiving prophylactic IABP. Stepwise logistic regression identified preoperative IABP as preventive factor for postoperative LCOS [Odds Ratio (OR) 0.19,95% Confidence Interval (CI), 0.06–0.55, P = 0.004]. The need of vasoactive and inotropic support was lower in patients with prophylactic IABP at 24, 48 and 72 h after surgery (12.3 [8.2–18.6] vs. 22.2 [14.4–28.8], P < 0.001, 7.7 [3.3–12.3] vs.16.3 [8.9–27.8], P < 0.001 and 2.4 [0–7] vs. 11.5 [3.1–26], P < 0.001, respectively). The patients in both groups did not differ in terms of in-hospital mortality (7.0% vs. 9.9%, P = 0.763). There were no major IABP-related complications. Elective patients with left ventricular ejection fraction ≤30% undergoing CABG with CPB and prophylactic IABP insertion had less low cardiac output syndrome and similar in-hospital mortality. • Prophylactic IABP in patients with reduced LVEF ≤ 30% is associated with reduced postoperative low cardiac output syndrome; • It was paralleled by reduced need for vasoactive and inotropic medications after the surgery; • Preoperative insertion of an IABP was not associated with lower in-hospital mortality; • Advanced age and cardiopulmonary bypass duration were independent risk factors for low output syndrome; • No IABP-related complications were observed [ABSTRACT FROM AUTHOR]

Background: Heart failure is associated with aging. It is one of the leading causes of morbidity and mortality in Western countries and constitutes the main cause of hospitalization among elderly patients. The pharmacological therapy of patients with heart failure with reduced ejection fraction (HFrEF) has greatly improved during the last years. However, elderly patients less frequently receive recommended medical treatment. Summary: The quadruple therapy (sacubitril/valsartan, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors) is nowadays the cornerstone of medical treatment since it associates lower risk of heart failure hospitalizations and mortality (also of arrhythmic origin). Cardiac arrhythmias, including sudden cardiac death, are common in patients with HFrEF, entailing worse prognosis. Previous studies addressing the role of blocking the renin-angiotensin-aldosterone system and beta-adrenergic receptors in HFrEF have suggested different beneficial effects on arrhythmia mechanisms. Therefore, the lower mortality associated with the use of the four pillars of HFrEF therapy depends, in part, on lower sudden (mostly arrhythmic) cardiac death. Key Messages: In this review, we highlight and assess the role of the four pharmacological groups that constitute the central axis of the medical treatment of patients with HFrEF in clinical prognosis and prevention of arrhythmic events, with special focus on the elderly patient, since evidence supports that most benefits provided are irrespective of age, but elderly patients receive less often guideline-recommended medical treatment. [ABSTRACT FROM AUTHOR]

Screening for left ventricular systolic dysfunction (LVSD), defined as reduced left ventricular ejection fraction (LVEF), deserves renewed interest as the medical treatment for the prevention and progression of heart failure improves. We aimed to review the updated literature to outline the potential and caveats of using artificial intelligence–enabled electrocardiography (AIeECG) as an opportunistic screening tool for LVSD. We searched PubMed and Cochrane for variations of the terms "ECG," "Heart Failure," "systolic dysfunction," and "Artificial Intelligence" from January 2010 to April 2022 and selected studies that reported the diagnostic accuracy and confounders of using AIeECG to detect LVSD. Out of 40 articles, we identified 15 relevant studies; eleven retrospective cohorts, three prospective cohorts, and one case series. Although various LVEF thresholds were used, AIeECG detected LVSD with a median AUC of 0.90 (IQR from 0.85 to 0.95), a sensitivity of 83.3% (IQR from 73 to 86.9%) and a specificity of 87% (IQR from 84.5 to 90.9%). AIeECG algorithms succeeded across a wide range of sex, age, and comorbidity and seemed especially useful in non-cardiology settings and when combined with natriuretic peptide testing. Furthermore, a false-positive AIeECG indicated a future development of LVSD. No studies investigated the effect on treatment or patient outcomes. This systematic review corroborates the arrival of a new generic biomarker, AIeECG, to improve the detection of LVSD. AIeECG, in addition to natriuretic peptides and echocardiograms, will improve screening for LVSD, but prospective randomized implementation trials with added therapy are needed to show cost-effectiveness and clinical significance. [ABSTRACT FROM AUTHOR]

Introduction. The data of epidemiological studies indicate maintaining high prevalence of heart failure (HF) and an unfavorable prognosis for such patients, which creates the need to change the treatment approach. A feature of the case presented is the young age of the patient and a significant effect that was achieved with quadruple therapy for HF with reduced ejection fraction (EF) after myocarditis.Short description. A three-year follow-up of a patient with HFrEF was carried out. In 2019, at the age of 21, the patient had acute myocarditis, diagnosed according to magnetic resonance imaging. The outcome was postmyocarditis cardiosclerosis, complicated by HFrEF. She had two episodes of HF decompensation, followed by hospitalizations in a cardiology hospital. During the treatment, a quadruple therapy was initiated (angiotensin receptor-neprilysin inhibitor, beta-blocker, mineralocorticoid receptor antagonist, sodium-glucose cotransporter 2 inhibitor), against which a significant improve was noted in the form of decrease in congestion symptoms, natriuretic peptide level from 1956 to 501,4 pg/ml, an increase in LVEF from 33% to 39%. The patient is currently on the waiting list for a donor heart transplant.Conclusion. The case report focuses on the complexity of not only the timely diagnosis of myocarditis, but also the treatment of its consequences. The appointment of quadruple therapy for a patient with HF after myocarditis has improved the patient’s clinical condition before heart transplantation. However, this approach needs to be confirmed in a larger number of patients.

Background: Atrial fibrillation (AF) is common in patients with reduced left ventricle ejection fraction (RLVEF). The impact of concomitant surgical atrial fibrillation ablation (SAFA) in patients with RLVEF is uncertain. The purpose of this study was to assess the outcomes of concomitant SAFA in patients with RLVEF undergoing heart surgery on heart failure (HF) rehospitalization and mortality.Methods: Using a local registry and electronic health records linked with provincial civil register survival data from July 2002 to April 2019, we analyzed treatment and outcomes in a cohort of patients with AF and HF defined by left ventricle ejection fraction (LVEF) ≤40%. Health records were used to collect treatment and International Classification of Diseases (ICD 10) codes to determine outcomes. A negative binomial model was used to compare outcomes such as all-cause mortality and rehospitalization for heart failure.Results: The cohort included 682 patients with RLVEF and AF who underwent coronary artery bypass graft and/or valve surgery. A total of 196 patients (29%) underwent concomitant SAFA. After matching, 132 patients with concomitant SAFA were compared to 159 patients who did not undergo concomitant SAFA. At 6.0 ± 3.7 years of follow-up, concomitant SAFA was not associated with lower all-cause mortality (p = .9861) and reduction in rehospitalizations for heart failure decompensation (p = .31) compared to patients who did not have concomitant SAFA performed. Postoperatively, concomitant SAFA might be associated with less vasopressor and mechanical support use (p = .01).Conclusions: Concomitant SAFA during index cardiac surgery is safe but does not reduce mortality or rehospitalizations for HF. The effects of concomitant SAFA in the context of RLVEF need to be better studied with prospective trials. [ABSTRACT FROM AUTHOR]

Background: A subset of heart failure with reduced ejection fraction (HFrEF) patients qualifies for cardiac resynchronization therapy (CRT). However, a 30% CRT nonresponder rate persists, with patients having narrower QRS durations (ie, QRSd 120-149 ms) receiving less or inconsistent benefit. Cardiac contractility modulation (CCM) may be an important alternative therapy option but has largely been evaluated only in HFrEF patients with QRSd <120 ms., Objectives: The purpose of this study was to evaluate the impact of CCM on HF-related hospitalizations and on left ventricular ejection fraction (LVEF) as well as quality of life in HFrEF patients with QRSd 120-149 ms compared to QRSd <120 ms., Methods: The CCM-REG Registry enrolled a total of 503 HFrEF patients with follow-up up to 2 years. Hospitalization rates were available for 1 year preimplant. Safety was assessed by comparison of actual vs Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score- or Seattle Heart Failure Model (SHFM)-predicted mortality., Results: Among 111 of 455 patients with QRSd 120-149 ms (mean QRSd 130 ± 9 ms; 20% female; age 68 ± 11 years; LVEF 29% ± 9%; 82% New York Heart Association [NYHA] class III), CCM diminished HF-related hospitalization rate by 72% (pre- vs postimplant 0.90 vs 0.25 events per patient-year over 2 years; P <.001). LVEF improved by 7% ± 9% (P = .014 vs baseline), Minnesota Living with Heart Failure Questionnaire score by 10 ± 23 points (P = .010 vs baseline), and NYHA class by 0.5 ± 0.7 classes (<0.001 vs baseline). The effect sizes were similar to those in QRSd <120 ms patients. Mortality within the first year was 19% in QRSd 120-149 ms patients (ie, not significantly different from the MAGGIC risk score or SHFM prediction)., Conclusions: CCM significantly improved HF control in NYHA class III HFrEF with reduced ejection fraction patients with moderately prolonged QRSd of 120-149 ms. The effect was comparable to that in patients with QRSd <120 ms., Competing Interests: Disclosures Dr Fastner received consulting and/or lecture fees or reimbursement of travel expenses from AstraZeneca GmbH (Hamburg, Germany), Bayer Vital GmbH (Leverkusen, Germany), Impulse Dynamics Germany GmbH (Frankfurt am Main, Germany), and Edwards Lifesciences GmbH (Garching bei München, Germany). Dr Varma has received consulting and research compensation from Abbott (Chicago, IL), Biotronik (Berlin, Germany), Medtronic (Minneapolis, MN), and Impulse Dynamics Inc. (Marlton, NJ). Dr Rao is an employee and has stock ownership of Impulse Dynamics Inc. (Marlton, NJ). Mr Najarian received consulting fees from Impulse Dynamics Inc. (Marlton, NJ). Dr Kuschyk is a paid consultant to Boston Scientific (Marlborough, MA) and Impulse Dynamics Inc. (Marton, NJ). All other authors have no conflicts to disclose., (Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Abstract Aims Little is known regarding factors that predict the occurrence of lethal ventricular arrhythmias (VAs) occurring after acute myocardial infarction (AMI). This observational cohort study aimed to identify factors that predicted lethal VAs during the late phase after AMI in patients with reduced left ventricular ejection fraction (LVEF). Methods and results Data were collected from our AMI database regarding consecutive patients with an LVEF of ≤40% after AMI (January 2012 to July 2018). The ‘late phase’ was defined as ≥7 days after AMI onset, and the primary endpoint was defined as lethal VAs in the late phase. The study included 136 patients (82% men; mean age: 66 ± 13 years). The average LVEF at admission was 32.7 ± 8.2%. During a mean follow‐up period of 20.7 months, 14 patients (10%) experienced lethal VAs, including ventricular fibrillation (n = 8) and sustained ventricular tachycardia (n = 10). Univariate analyses revealed that lethal VAs were predicted by age and LVEF at admission. Receiver operating characteristic curve analysis indicated that the optimal cut‐off value was 23% for using the LVEF at admission to predict the primary endpoint (area under the curve: 0.77, P

Objective* To explore different surgical strategies in patients of moderate ischemic mitral regurgitation (IMR) complicated with reduced left ventricular ejection fraction (LVEF). Methods • From May 2013 to May 2019, 31 patients diagnosed as moderate IMR with LVEF <50% received surgical treatment in Department of Cardiovascular Surgery in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. The patients were divided into off-pump coronary artery bypass grafting (OPCABG) group and CABG+mitral valve plasty (MVP) group according to whether or not mitral valve procedure was performed. Preoperative, postoperative and follow-up echocardiography data and perioperative complications were compared to evaluate the surgical efficacy. Results • There were 12 patients in OPCABG group and 19 patients in CABG+MVP group. 1 patient died in CABG+MVP group postoperatively, which showed no significant difference in mortality (5.3% vs 0) between the groups. The degree of mitral regurgitation was significantly reduced in CABG+MVP group (P=0.000), while intensive care unit (ICU) length of stay significantly increased [3.0 (1.0, 4.0) d vs 1.0 (1.0, 2.0) d, P=0.027]. After 48.7 (30.2, 66.5) months of follow-up, there were no significant differences in mortality, degree of mitral regurgitation, LVEF and complications between the two groups. Conclusion • OPCABG procedure treating chronic moderate IMR with reduced LVEF could be beneficial for enhanced recovery after surgery and has satisfactory early and mid-term efficacy. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to evaluate retinal and optic nerve head (ONH) perfusion in patients with systolic chronic heart failure (CHF) compared to healthy control subjects. Methods: Twenty-seven eyes of 27 patients with CHF (study group) and 31 eyes of 31 healthy subjects (control group) were prospectively included in this study. CHF Patients had a left ventricular ejection fraction (LVEF) < 50% and were classified by New York Heart Association (NYHA) class. OCT-A was performed using RTVue XR Avanti with AngioVue (Optovue, Inc, Fremont, CA, USA). The area of the foveal avascular zone (FAZ) and flow density (FD) data were extracted and analyzed. Results: There was no significant difference in the signal strength index between the study group (group 1) and the control group (group 2) (ONH: p = 0.015; macula: p = 0.703). The difference in the area of the foveal avascular zone between the two groups was also not significant (p = 0.726). The flow density (whole en face) in the ONH (RPC) in group 1 was significantly lower compared to control (group 1 = 48.40 ± 2.48 (49.0 [46.7, 50.3]); group 2 = 50.15 ± 1.85 (50.6 [48.5, 51.70]); p = 0.008). There was a significant and strong correlation between LVEF and the macular flow density (whole en face) (superficial: rs = 0.605 deep: rs = 0.425, p < 0.01). Conclusions: Patients with CHF showed reduced flow density compared with healthy controls. The reduced FD correlated with the LVEF and the functional (NYHA) class. Retinal perfusion as measured using OCTA might provide an insight into the global microperfusion and hemodynamic state of heart failure patients. [ABSTRACT FROM AUTHOR]

In the EMPA-REG OUTCOME, CANVAS and DECLARE-TIMI 58 studies, in patients with type 2 diabetes and established cardiovascular diseases or risk factors, a decrease in the risk of cardiovascular events and development or worsening of heart failure course without an increase in hypoglycemia incidence was revealed in those receiving sodium-glucose co-transporter-2 (SGLT2) inhibitors compared with placebo. To date, various mechanisms of action of SGLT2 inhibitors have been described, which are considered from the standpoint of their influence on the course and prognosis of heart failure. In the EMPEROR-Reduced study in the group of patients receiving empagliflozin, a significant reduction in the risk of cardiovascular death and hospitalizations for heart failure, regardless of the type 2 diabetes presence, was revealed.

Aims: Data regarding the efficacy of catheter ablation in heart failure patients with severely dilated left atrium and reduced left ventricular ejection fraction (LVEF) are scanty. We sought to assess the efficacy of catheter ablation in patients with reduced LVEF and severe left atrial (LA) enlargement, and to compare it to those patients with preserved left ventricular function and equally dilated left atrium.Methods and Results: Three patient groups with paroxysmal or persistent atrial fibrillation (AF) undergoing a first pulmonary vein isolation (PVI) were considered: Group 1 included patients with normal or mildly abnormal LA volume (≤41 mL/m2) and normal LVEF; Group 2 included patients with severe LA enlargement (>48 mL/m2) and normal LVEF; and Group 3 included patients with severe LA enlargement and reduced LVEF. Time to event analysis was used to investigate AF recurrences. The study cohort includes 439 patients; Group 3 had a higher prevalence of cardiovascular risk factors. LA enlargement was associated with a two-fold in risk of AF recurrence, on the contrary only a smaller non-significant increase of 30% was shown with the further addition of LVEF reduction.Conclusions: The long-term outcome of patients with severe LA dilatation and reduced LVEF is comparable to those with severe LA enlargement but preserved LVEF. Long-term efficacy of PVI is certainly affected by the enlargement of the left atrium, but less so by the addition of a reduced LVEF. CA remains the best strategy for rhythm control both in paroxysmal and persistent AF in this subgroup of patients. [ABSTRACT FROM AUTHOR]

Background. Moderate aortic stenosis (AS) increases left ventricular afterload and results in unfavorable outcomes in patients with reduced left ventricular ejection fraction (LVEF). Velocity ratio (VR) may be appropriate for the evaluation of aortic valve (AV) hemodynamics because of the low dependence on flow. Therefore, this study investigated the usefulness of VR on the clinical outcomes of such patients. Method. Clinical data of patients with moderate AS (AV area, 0.60–0.85 cm2/m2; peak AV velocity, 2.0–4.0 m/s) and reduced LVEF (LVEF 20–50%) were analyzed during 2010–2018. VR was calculated as peak left ventricular outflow tract velocity/peak AV velocity. The primary endpoint included all-cause death, heart failure hospitalization, and AV replacement. Results. In total, 104 patients (mean age, 75.9 ± 7.0 years; 62.5% men) were included. LVEF was 39.5% ± 7.8%. The AV area was 0.72 ± 0.08 cm2/m2, peak AV velocity was 2.59 ± 0.40 m/s, and VR was 0.30 ± 0.07. The follow-up period was 1.7 (0.5–3.5) years. Kaplan–Meier estimates for the endpoint were 59.9% at 3 years. Multivariable analysis revealed that VR (hazard ratio, 0.947; 95% confidence interval, 0.905–0.990; p =.018) was significantly related to this endpoint. Patients with a VR <0.25 had significantly higher incidence rates of the endpoint than those with a VR ≥0.25 (85.6% versus 47.8% at 3 years; p <.001). Conclusions. Patients with moderate AS and reduced LVEF have unfavorable clinical outcomes, particularly those with low VR. [ABSTRACT FROM AUTHOR]

Background: Heart transplantation (HTx) remains the treatment of choice for patients with end‐stage advanced heart failure. In 2016, the Shumakov National Medical Research Center commenced performing HTx from donors with abnormal left ventricular systolic function (LVEF < 40%). The aim of this study was to evaluate early and late outcomes of recipients after HTx from donors with abnormal LV systolic function. Methods: Four hundred eighty seven patients underwent HTx in our institution from January 2016 to December 2018. 27 (5.5%) patients were transplanted using cardiac allografts from donors with LVEF <40%. Results: A total of 47 donors with LVEF <40% were evaluated for potential donation. Most heart donors revealed a left ventricular ejection fraction ranging between 30% and 40%. Twenty‐five recipients required urgent HTx. Four recipients presented with early allograft dysfunction. All surviving recipients demonstrated early (85.2%) or delayed (14.8%) recovery of systolic function (LVEF > 60%). Conclusion: The use of dysfunctional donor hearts with impaired LV systolic function may be a realistic approach for expanding the donor pool. However, organs from such donors should be used for recipient cohorts requiring an urgent HTx, particularly for those with pretransplant mechanical circulatory support allowing for hemodynamic support in cases of early graft dysfunction in the post‐transplant period. [ABSTRACT FROM AUTHOR]

Objective: The study was carried out to evaluate the role of the AST (Aspartate transaminase)/ALT (Alanine transaminase) ratio as an indicator of the functional severity in people with chronic heart failure (CHF) with reduced left ventricular ejection fraction., Methods: A prospective cross-sectional study was conducted in a tertiary care centre in South India among the individuals who had left ventricular ejection fraction (LVEF) of ≤40 %. The study period was between January 2021 and December 2021. Consecutive patients with the criteria were enrolled in the study. Study participants were grouped based on their AST/ALT ratio value (ratio<1 and ratio≥1)., Results: In present study of 100 participants, there was a statistically significant difference between two groups with respect to ALT, AST/ALT ratio, and ALP (Alkaline phosphatase). There was a significant correlation between the APRI (AST to platelet ratio index) and FIB-4 (Fibrosis-4) with AST/ALT ratio. Diagnostic analysis of AST/ALT ratio to predict the severity of CHF with reduced EF, the area under the curve (AUC) was 0.547 (p-value = 0.5654) with a 95 % confidence interval of 0.299-0.795 with an optimal cut-off value of 0.6, sensitivity of 96.70 %, and specificity of 33.33 %., Conclusion: The AST/ALT ratio is increased in patients with CHF patients with reduced left ventricular ejection fraction. It is a simple predictor of left ventricular dysfunction in patients with heart failure with reduced ejection fraction., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Cardiological Society of India. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.)

Background: The independent effect of pulmonary hypertension (PHT) severity on mortality in those with reduced left ventricular ejection fraction (LVEF) is not well known., Objectives: The authors aimed to examine the prognostic impact of increasingly elevated pulmonary pressures in a large clinical cohort of adults with reduced LVEF., Methods: The authors analyzed data from the National Echocardiography Database of Australia, a large clinical registry linking routine echocardiographic investigations to mortality. In 23,675 adults with a recorded tricuspid regurgitation peak velocity (TRV) and reduced LVEF (<50%), the authors evaluated the relationship between conventional thresholds of increasing risk of PHT and mortality during median follow-up of 2.9 years (Q1-Q3: 1.0-5.4 years)., Results: Mean age was 70 ± 15 years, and 7,498 (31.7%) individuals were female. Overall, 8,801 (37.2%) had normal (TRV <2.5 m/s), 7,061 (29.8%) had borderline (2.5-2.8 m/s), 5,676 (24.0%) intermediate (2.9-3.4 m/s), and 2,137 (9.0%) individuals had high-risk PHT (>3.4 m/s). With increasing risk of PHT, 1- and 5-year actuarial mortality increased from 13.3% and 43.8% to 41.5% and 81.4%, respectively (P < 0.0001) from normal to severely elevated TRV. The adjusted HR of mortality increased by 1.31-fold (95% CI: 1.23-1.38), 1.82-fold (95% CI: 1.72-1.93), and 2.38-fold (95% CI: 2.21-2.56) in those with borderline, intermediate, and high risk of PHT respectively, compared with normal TRV. Further analyses suggested a distinctive threshold with a TRV reached >2.41 m/s (adjusted HR: 1.18 [95% CI: 1.04-1.33])., Conclusions: The authors demonstrate the prevalence and negative prognostic impact of increasingly elevated TRV levels in individuals with reduced LVEF, with a threshold for mortality lying within the range of "borderline risk" PHT., Competing Interests: Funding Support and Author Disclosures This research did not receive any specific grants from funding agencies in the public, commercial, or not for profit sectors. However, the National Echo Database of Australia has received investigator-initiated funding support from Janssen, Novartis Pharmaceuticals, and Edwards Lifesciences in the past 3 years. Both the National Echo Database of Australia (grant 1055214) and Dr Stewart (grant 11358940) are supported by the National Health and Medical Research Council of Australia. Dr Ratwatte is supported by the National Heart Foundation of Australia (grant 106796). Drs Stewart, Strange, and Playford have previously received consultancy/speaker fees from Edwards Lifesciences. Drs Stewart and Playford have received consultancy fees from Medtronic, Edwards Lifesciences, Abbott Laboratories, and ECHO IQ Pty Ltd. Dr Celermajer has reported that he has no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Coronary artery disease (CAD) dominates in the contemporary world among the causes of left ventricular dysfunction (LVD). Prognosis of survival and the course of heart failure (HF) are worse in patients with CAD than in many kinds of non-ischemic cardiomyopathy. Development of cardiac surgery technologies and formation of the relevant evidence base have significantly expanded the role of revascularization in patients with CAD and reduced left ventricular ejection fraction (LVEF). The possibility and expediency of coronary artery bypass grafting (CABG) for improving left ventricular ejection fraction (LVEF), clinical course of HF and survival are evidence-based. Stenting is less effective than coronary artery bypass grafting (CABG) regarding the influence on primary endpoints but improves the quality of life of patients with CAD and ischemic LVD. Conclusions: In patients with ischemic LVD, surgical revascularization can ensure an improvement in the pumping function of the heart, provided there is a sufficient amount of viable myocardium. From the standpoint of evidence-based medicine, the effectiveness of CABG surgery in patients with multivessel lesion of the coronary bed and LVD has been proven for correction LVEF, improvement of the course of the disease and prediction of survival compared with the optimal drug therapy. Percutaneous intervention is inferior to surgical revascularization in terms of its effect on endpoints, but it can make an improvement in the quality of life of patients with ischemic LVD. Evaluation of myocardial viability may be of additional importance for the decision on the feasibility of CABG in the presence of multivessel coronary artery disease combined with a sharp decrease in LVEF.

This study sought to determine the incidence, clinical impact, and changes over time of mitral regurgitation (MR) in patients with low-flow, low-gradient aortic stenosis (LFLG-AS) undergoing transcatheter aortic valve replacement (TAVR). Few data exist on the clinical impact and changes in severity over time of MR in patients with LFLG-AS undergoing TAVR. A total of 308 TAVR candidates with LFLG-AS were included. Patients were categorized according to MR severity at baseline, and presence of MR improvement at 12-month follow-up. Clinical outcomes were assessed at 1 and 12 months (+ echocardiography), and yearly thereafter. Baseline mild and moderate-to-severe MR were present in 118 (38.3%) and 115 (37.3%) patients, respectively. MR was of functional and mixed etiology in 77.2% and 22.7% of patients, respectively. A total of 131 patients (42.5%) died after a median follow-up of 2 (1 to 3) years. Baseline moderate-or-greater MR had no impact on mortality (hazard ratio [HR]: 1.34; 95% confidence interval [CI]: 0.72 to 2.48) or heart failure hospitalization (HR: 1.02; 95% CI: 0.49 to 2.10). At 1-year follow-up, MR improved in 44.3% of patients and remained unchanged/worsened in 55.7%. The lack of MR improvement was associated with a higher risk of all-cause and cardiac mortality (HR: 2.02; 95% CI: 1.29 to 3.17; HR: 3.03; 95% CI: 1.27 to 7.23, respectively), rehospitalization for cardiac causes (HR: 1.50; 95% CI: 1.04 to 2.15), and an increased overall-mortality/heart failure rehospitalization (HR: 1.94; 95% CI: 1.25 to 3.02). A higher baseline left ventricular end-diastolic diameter and a higher increase in left ventricular ejection fraction were found to be independent predictors of MR improvement at 1-year follow-up (odds ratio: 0.69; 95% CI: 0.51 to 0.94; and odds ratio: 0.81; 95% CI: 0.67 to 0.96, respectively). Most TAVR candidates with LFLG-AS had some degree of MR, of functional origin in most cases. MR improved in about one-half of patients, with larger left ventricular size and a higher increase in left ventricular ejection fraction post-TAVR determining MR improvement over time. The lack of MR improvement at 1 year was associated with poorer outcomes. [ABSTRACT FROM AUTHOR]

Purpose of Review: The goal of this paper is to describe the treatment challenges in patients with aortic stenosis in combination with a reduced left ventricular function. Recent Findings: Since the risk of mortality is increased in this patient population, transcatheter aortic valve implantation emerged as an important treatment option. Concomitant factors such as mitral regurgitation or coronary artery disease are important co-factors that need to be evaluated and taken into account for treatment decision. Summary: Treatment of the severe aortic stenosis is key in this complex setting. Since several co-factors may exist in addition to aortic stenosis, treatment needs to be decided by a Heart Team. [ABSTRACT FROM AUTHOR]

Introduction. Chronic heart failure is one of the most common and serious diseases of cardiovascular system, resulting in permanent disability and significantly reducing the length and quality of life. Purpose of the study to find out the features of left ventricular remodeling in patients with stable angina of II-III functional class depending on the reduction or preserving of left ventricular ejection fraction. Materials and research methods. To achieve this objective was conducted a full clinical examination of 153 patients with CHF (105 men and 48 women, average age of patients being 68,80 ± 0,90 years) who were treated separately at the cardiology department for patients with arrhythmias of Vinnytsia Regional Clinical Center for Treatment and Diagnostics of cardiovascular diseases. All the patients were divided into 2 groups: first group consisted of patients with stable angina of II-III FC and heart failure with reduced LV EF (n = 47); second group – patients with stable angina of II-III FC and HF with preserved LV EF (n = 106). The control group comprised 30 healthy individuals. Results of the investigation and their discussion. In the examined patients with stable angina of II-III FC with HF of I-III FC with reduced LV EF (1 group) according to the results of echocardiography compared with healthy people was determined a significant increase in size of left atrium, the final systolic size, end- diastolic size, end-systolic volume, end-diastolic volume, end-systolic index volume, stroke volume, the thickness of the back wall of the left ventricle, interventricular septum thickness, left ventricular myocardial mass index, relative LV wall thickness (p < 0.01) and a significant decrease in ejection fraction (p < 0.01), indicating the presence of structural and functional changes in the myocardium and reduced inotropic function of the heart. In the examined patients with stable angina with heart failure of I-III FC (2 group) with preserved LV EF by echocardiography results were defined similarly structural and functional changes in the left ventricle. However, it is important that as a result of a comparison of echocardiographic indicators of patients of surveyed groups 1 and 2 were found the following changes: a significant increase in the size of left atrium, the final systolic size, end diastolic size, end systolic volume, end-diastolic volume index, end-systolic volume index, end-diastolic volume, index of left ventricular mass, relative wall thickness of the left ventricle (p < 0.01) and a significant decrease in ejection fraction (p < 0.01) in the presence of heart failure with reduced LV EF. In the examined patients with reduced and preserved LV EF prevailed a concentric LVH. In the examined patients with heart failure with reduced LV EF prevailed III (significant) degree of LVH (p < 0.01). However, in patients with heart failure with preserved LV EF in most cases were determined II (moderate) or less III (significant) degree of LVH (p < 0.01). The results indicate that the examined patients with reduced LV EF heart remodeling is due to more and more significant increase of the degree of LVH and cardiac remodeling, which has an adverse prognostic significance. Conclusions. A deeper study and understanding of left ventricular remodeling in chronic heart failure of ischemic origin enables a more accurate description of the disease and provides an adequate medical care to patients suffering from stable angina of II-III functional classes, complicated by heart failure with reduced and preserved left ventricular ejection fraction.

Improvement of risk scoring is particularly important for patients with preserved left ventricular ejection fraction (LVEF) who generally lack efficient monitoring of progressing heart failure. Here, we evaluated whether the combination of serum biomarkers and echocardiographic parameters may be useful to predict the remodeling-related outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and preserved LVEF (HFpEF) as compared to those with reduced LVEF (HFrEF). Echocardiographic assessment and measurement of the serum levels of NT-proBNP, sST2, galectin-3, matrix metalloproteinases, and their inhibitors (MMP-1, MMP-2, MMP-3, TIMP-1) was performed at the time of admission (1st day) and on the 10th–12th day upon STEMI onset. We found a reduction in NT-proBNP, sST2, galectin-3, and TIMP-1 in both patient categories from hospital admission to the discharge, as well as numerous correlations between the indicated biomarkers and echocardiographic parameters, testifying to the ongoing ventricular remodeling. In patients with HFpEF, NT-proBNP, sST2, galectin-3, and MMP-3 correlated with the parameters reflecting the diastolic dysfunction, while in patients with HFrEF, these markers were mainly associated with LVEF and left ventricular end-systolic volume/diameter. Therefore, the combination of the mentioned serum biomarkers and echocardiographic parameters might be useful for the prediction of adverse cardiac remodeling in patients with HFpEF.

Background: Myocardial surgical revascularization in patients with low left ventricular ejection fraction (LVEF) is accompanied by a high rate of morbidity and mortality., Objective: The aim of this study was to investigate and eliminate the reasons for the most common perioperative and postoperative complications., Methods: A total of 64 were analyzed. of patients during 2019 who underwent coronary artery bypass grafting (CABG), average age 61.29±9.12 years., Results: Out of the total number of operated patients, there were 16 women and 48 men. Patients were divided into two groups. The first group consisted of patients who underwent surgery with the use of cardiopulmonary bypass (cCABG-CPB) and the second group those who underwent surgery without the use of cardiopulmonary bypass (OPCAB). In 41 patients, myocardial infarction was previously recorded. Critical stenosis of the main trunk of the left coronary artery was present in 14 patients. The incidence of postoperative complications was higher in the cCABG-CPB 16/10 group (p0.030)., Conclusion: In our study, we confirmed that myocardial revascularization is justified, especially in the case of multivessel coronary disease. In the long term, it significantly improves the systolic function of the left ventricle, and thus and quality and length of life., Competing Interests: None declared., (© 2022 Nedzad Kadric, Enes Osmanovic, Sevleta Avdic, Mirza Jahic, Stojan Rajkovic, Edis Salihovic.)

Copyright of Remedia is the property of Medical Tribune CZ, s.r.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: Surgical revascularization is an established indication for patients with advanced coronary artery disease and reduced left ventricular ejection fraction (LVEF). Long-term outcomes for these patients are not well-defined. We studied the long-term outcomes of patients with ischaemic cardiomyopathy who underwent surgical revascularization in a well-defined nationwide cohort., Materials and Methods: A retrospective study on 2005 patients that underwent isolated coronary artery bypass grafting in Iceland between 2000 and 2016. Patients were categorized into two groups based on their preoperative LVEF; LVEF ≤35% (n = 146, median LVEF 30%) and LVEF >35% (n = 1859, median LVEF 60%). Demographics and major adverse cardiac and cerebrovascular events were compared between groups along with cardiac-specific and overall survival. The median follow-up was 7.6 years., Results: Demographics were similar in both groups regarding age, gender and most cardiovascular risk factors. However, patients with LVEF ≤35% more often had diabetes, renal insufficiency, chronic obstructive pulmonary disease and a previous history of myocardial infarction. Thirty-day mortality was 4 times higher (8% vs 2%, P < 0.001) in the LVEF ≤35%-group compared to controls. Overall survival was significantly lower in the LVEF ≤35%-group compared to controls, at 1 year (87% vs. 98%, P < 0.001) and 5 years (69% vs. 91%, P < 0.001). In multivariable analysis LVEF ≤35% was linked to inferior survival with an adjusted hazard ratio of 2.0 (95%-CI 1.5 - 2.6, p<0.001)., Conclusions: A good long-term outcome after coronary artery bypass grafting can be expected for patients with reduced LVEF, however, their survival is still significantly inferior to patients with normal ventricular function., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Abstract: Background: Effects of prophylactic implantable cardioverter–defibrillator (ICD) on quality-adjusted life years (QALYs) in patients with congestive heart failure are uncertain. Methods: We developed a decision model for patients at risk of sudden death due to reduced ejection fraction and who had no history of life-threatening ventricular arrhythmias. It estimated the QALYs for ICD strategy as a primary prevention for sudden cardiac death and conventional strategy without antiarrhythmic therapies. Results: In a 3-year time period, the QALYs for patients with conventional strategy were higher than that of ICD strategy (2.19 years vs. 2.14 years). When the mortality rate of conventional strategy exceeded 8.6%/year and the hazard ratio of death for the ICD strategy was lower than 0.70, the ICD strategy was the superior treatment option. Conclusions: The QALYs of patients with ICD could be lower than that of conventional strategy. Incorporating quality of life could affect decision making of ICD implantation. [Copyright &y& Elsevier]

To substantially reduce the risk of hospitalization and death among subjects with heart failure (HF) and reduced left ventricular ejection fraction, it is necessary to make a comprehensive approach of the different neurohormonal systems that are implied in its etiopathogenesis, including not only sympathetic nervous system, and renin-angiotensin system, but also vasoactive peptides and sodium-glucose transport protein 2. The DAPA-HF trial demonstrated that the addition of dapagliflozin to the standard treatment in HF with reduced left ventricular ejection fraction, markedly decreases the risk of cardiovascular death, HF hospitalization and overall death. In addition, dapagliflozin improves functional class and quality of life. Importantly, the prognostic benefit starts early after initiating treatment with dapagliflozin, regardless baseline therapy or the presence of diabetes. All these evidences make dapagliflozin as one of the mainstays of treatment for the management of HF with reduced left ventricular ejection fraction., (Copyright © 2021 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Despite traditional treatments, morbidity and mortality of patients with heart failure (HF) and reduced left ventricular ejection fraction remains unacceptably high. Traditionally, guidelines recommended a step by step approach in the management of this population. However, this approach could delay the prescription of some drugs with proven efficacy on morbidity and prognosis. As current HF guidelines recommend, an initial comprehensive approach with the aim of targeting all neurohormonal systems that are implied in the etiopathogenesis of HF seems necessary. The DAPA-HF trial demonstrated that dapagliflozin markedly reduces the risk of HF hospitalization, and also improves prognosis. Consequently, dapagliflozin should be considered as a first-line therapy in the management of these patients. On the other hand, primary care physicians are essential for the prevention and treatment of patients with HF and reduced left ventricular ejection fraction. As a result, it is mandatory that they know when and how dapagliflozin should be used. In this review, a practical approach for an appropriate use of this drug is provided., (Copyright © 2021 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Aims: Data regarding the efficacy of catheter ablation in heart failure patients with severely dilated left atrium and reduced left ventricular ejection fraction (LVEF) are scanty. We sought to assess the efficacy of catheter ablation in patients with reduced LVEF and severe left atrial (LA) enlargement, and to compare it to those patients with preserved left ventricular function and equally dilated left atrium., Methods and Results: Three patient groups with paroxysmal or persistent atrial fibrillation (AF) undergoing a first pulmonary vein isolation (PVI) were considered: Group 1 included patients with normal or mildly abnormal LA volume (≤41 mL/m2) and normal LVEF; Group 2 included patients with severe LA enlargement (>48 mL/m2) and normal LVEF; and Group 3 included patients with severe LA enlargement and reduced LVEF. Time to event analysis was used to investigate AF recurrences. The study cohort includes 439 patients; Group 3 had a higher prevalence of cardiovascular risk factors. LA enlargement was associated with a two-fold in risk of AF recurrence, on the contrary only a smaller non-significant increase of 30% was shown with the further addition of LVEF reduction., Conclusions: The long-term outcome of patients with severe LA dilatation and reduced LVEF is comparable to those with severe LA enlargement but preserved LVEF. Long-term efficacy of PVI is certainly affected by the enlargement of the left atrium, but less so by the addition of a reduced LVEF. CA remains the best strategy for rhythm control both in paroxysmal and persistent AF in this subgroup of patients., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.)

Aims: Little is known regarding factors that predict the occurrence of lethal ventricular arrhythmias (VAs) occurring after acute myocardial infarction (AMI). This observational cohort study aimed to identify factors that predicted lethal VAs during the late phase after AMI in patients with reduced left ventricular ejection fraction (LVEF)., Methods and Results: Data were collected from our AMI database regarding consecutive patients with an LVEF of ≤40% after AMI (January 2012 to July 2018). The 'late phase' was defined as ≥7 days after AMI onset, and the primary endpoint was defined as lethal VAs in the late phase. The study included 136 patients (82% men; mean age: 66 ± 13 years). The average LVEF at admission was 32.7 ± 8.2%. During a mean follow-up period of 20.7 months, 14 patients (10%) experienced lethal VAs, including ventricular fibrillation (n = 8) and sustained ventricular tachycardia (n = 10). Univariate analyses revealed that lethal VAs were predicted by age and LVEF at admission. Receiver operating characteristic curve analysis indicated that the optimal cut-off value was 23% for using the LVEF at admission to predict the primary endpoint (area under the curve: 0.77, P < 0.0001). Multivariable analysis also demonstrated that LVEF at admission was an independent predictor of the primary endpoint (risk ratio = 7.12, P = 0.001)., Conclusions: Lethal VAs in the late phase are common in patients with AMI, and reduced LVEF and cardiac function at admission play a significant role in the risk stratification for future lethal VAs in this population., (© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Improvement of risk scoring is particularly important for patients with preserved left ventricular ejection fraction (LVEF) who generally lack efficient monitoring of progressing heart failure. Here, we evaluated whether the combination of serum biomarkers and echocardiographic parameters may be useful to predict the remodeling-related outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and preserved LVEF (HFpEF) as compared to those with reduced LVEF (HFrEF). Echocardiographic assessment and measurement of the serum levels of NT-proBNP, sST2, galectin-3, matrix metalloproteinases, and their inhibitors (MMP-1, MMP-2, MMP-3, TIMP-1) was performed at the time of admission (1st day) and on the 10th–12th day upon STEMI onset. We found a reduction in NT-proBNP, sST2, galectin-3, and TIMP-1 in both patient categories from hospital admission to the discharge, as well as numerous correlations between the indicated biomarkers and echocardiographic parameters, testifying to the ongoing ventricular remodeling. In patients with HFpEF, NT-proBNP, sST2, galectin-3, and MMP-3 correlated with the parameters reflecting the diastolic dysfunction, while in patients with HFrEF, these markers were mainly associated with LVEF and left ventricular end-systolic volume/diameter. Therefore, the combination of the mentioned serum biomarkers and echocardiographic parameters might be useful for the prediction of adverse cardiac remodeling in patients with HFpEF. [ABSTRACT FROM AUTHOR]

Objective: To analyze whether there is a difference in the influence of coronary artery disease (CAD) on the clinical features and prognosis of three different types of heart failure patients. Methods: Complete clinical data of 1 520 hospitalized patients with heart failure from Tianjin Medical University General Hospital and Tianjin Chest Hospital from March 2014 to February 2016 was retrospectively reviewed. According to left ventricular ejection fraction (LVEF), the patients were divided into three groups: heart failure with reduced ejection fraction group (HFrEF), heart failure with mid-range ejection fraction group (HFmrEF)and heart failure with preserved ejection fraction group (HFpEF). Each group was further classified into two subgroups according to absence or presence of CAD (No CAD' and 'With CAD'). In the HFrEF group, 197 patients were categorized into 'No CAD' sub-group while 435 patients were into 'With CAD' sub-group. Likewise, 63 patients in HFmrEF group fell into 'No CAD' sub-group while 367 were into 'With CAD' sub-group. Seventy two patients in the HFpEF group were in the 'No CAD' sub-group with 386 in the 'With CAD' sub-group. Clinical features and 2-year prognosis between different subgroups were compared. Results: (1) The relationship between CAD and clinical features of different types of heart failure: the proportions of HFrEF, HFmrEF and HFpEF combined with CAD were 68.8%, 85.3% and 84.3%, respectively ( P< 0.05). Compared with the 'No CAD' subgroups, patients in the 'With CAD' subgroups were older, and had higher NT-proBNP levels, higher rates of hypertension and diabetes, and lower rates of atrial fibrillation. Also, there were more use of antiplatelet and nitrate drugs in the 'With CAD' sub-groups ( P< 0.05). (2) Risk of different types of heart failure combined with CAD: after multivariate adjustment, HFrEF had a lower risk of CAD (HFrEF vs HFmrEF: RR= 0.389, 95 %CI 0.281-0.540; HFrEF vs HFpEF: RR= 0.408, 95 %CI 0.298-0.560). (3)The influence of CAD on the prognosis of different types of heart failure: CAD increased the risk of mortality in the HFrEF group ( HR =1.631, 95 %CI 1.119-2.377), and cardiovascular events in all three types of heart failure ( HR : HFrEF 1.725, 95 %CI 1.325-2.246; HFmrEF 1.815, 95 %CI 1.144-2.879; HFpEF 1.900, 95 %CI 1.218-2.963). Conclusions: Patients with HFmrEF and HFpEF have a higher prevalence and risk of CAD than patients with HFrEF. CAD is associated with an increased risk of cardiovascular events in all types of heart failure and increases the risk of all-cause mortality among HFrEF group. CAD is an important factor influencing the clinical features and prognosis of patients with all types of heart failure.