Cardiology

SUMMARY Chagas disease is a public health problem worldwide. The availability of diagnostic tools to predict the development of chronic Chagas cardiomyopathy is crucial to reduce morbidity and mortality. Here we analyze the prognostic value of adenosine deaminase serum activity (ADA) and C-reactive protein serum levels (CRP) in chagasic individuals. One hundred and ten individuals, 28 healthy and 82 chagasic patients were divided according to disease severity in phase I (n = 35), II (n = 29), and III (n = 18). A complete medical history, 12-lead electrocardiogram, chest X-ray, and M-mode echocardiogram were performed on each individual. Diagnosis of Chagas disease was confirmed by ELISA and MABA using recombinant antigens; ADA was determined spectrophotometrically and CRP by ELISA. The results have shown that CRP and ADA increased linearly in relation to disease phase, CRP being significantly higher in phase III and ADA at all phases. Also, CRP and ADA were positively correlated wit...

Classic takotsubo cardiomyopathy (TCM) is characterized by transient dysfunction of the apical portion of the left ventricle with hyperkinesis of the other parts of the heart wall. Recently, wall motion abnormalities in parts other than in the apical portion of the heart have been reported. Inverted TCM is one form of these anomalies. In this form, the basal segments rather than the apical part of the heart are akinetic/ dyskinetic, and the apex is hyperdynamic. Emotional or physical stress is known to trigger TCM, leading some authors to call TCM stress-induced cardiomyopathy (SC). Hypoglycemia is regarded as one of the physical stresses that cause TCM/SC. We present a case of inverted TCM/SC with hypoglycemia. In this case, a 60-year-old woman was ☆ This article is not supported by any grants and has not been presented before.

Pediatric heart transplantation has become a mainstream in the treatment of end-stage heart disease in infants and children. Heart rate variability is a measure of autonomic nervous influence on the heart. After heart transplantation, the donor heart loses its nervous control. Nonlinear analysis of heart rate is a method to study the physiologic mechanisms responsible for the control of heart rate fluctuations, in which the autonomic nervous system appears to play a primary role. This work evaluated the heart rate entropy in children who has undergone heart transplantation. Patients who underwent heart transplantation showed significant decrease in entropy as assessed by sample entropy (0.63 ± 0.31 vs. 0.90 ± 0.33, p < 0.05). System complexity as can be assessed by entropy methods decreases in transplanted patients and this may be related to loss of the neural modulation of heart rate.

OBJECTIVE. Intraventricular hemorrhage remains an important problem among very low birth weight infants and may result in long-term neurodevelopmental disabilities. Neonatologists have been unable to accurately predict impending intraventricular hemorrhage. Because alterations in the autonomic nervous system&#39;s control of heart rhythm have been associated with intraventricular hemorrhage after its development, we sought to determine if early subtle alterations of heart rhythm could be predictive of impending intraventricular hemorrhage in very low birth weight infants.METHODS. This case-control study included 10 newborn very low birth weight infants with intraventricular hemorrhage (5 grade IV, 4 grade III, and 1 grade II) and 14 control infants without intraventricular hemorrhage. Heart rhythm data from the first day of life before the development of intraventricular hemorrhage were evaluated. Detrended fluctuation analysis, a nonlinear fractal heart rate variability method, was...

Aims To assess heart rate complexity changes prior to the onset of atrial fibrillation (AF) using sample entropy. It has been proposed that the autonomic nervous system might have a role in the initiation of AF. The study included 25 patients with lone AF. Each record set contained two 30 min records from 25 subjects. Each patient had 30 min records containing the ECG immediately preceding an episode of AF (pre-AF) and 30 min of ECG during a period distant from any episode of AF (AFd). Sample entropy was used for complexity analysis. The sample entropy of R-R intervals was significantly reduced in the pre-AF period compared with the AFd period (0.45 + 0.25 vs. 0.78 + 0.46, P ¼ 0.003). The pre-AF periods were divided into three successive 10 min segments. There was a significant decreasing trend in entropy towards the onset of AF with linear mixed models (P ¼ 0.002). Conclusions The heart rate complexity is reduced with a significant decreasing trend as assessed by R-R interval entropy prior to the onset of AF. There is a need for well-defined studies with larger patient groups in order to assess the entropy changes further and to look for possible changes, which might predict impending AF episodes.

El Síndrome de Brugada o muerte súbita inesperada es la causa más frecuente de muerte natural en varones jóvenes en el sudeste asiático, es un fenómeno poco frecuente en Cuba y nunca antes reportado en la Isla de la Juventud, por lo que se realiza una revisión de los artículos más actualizados sobre: su historia, definición, epidemiología, manifestaciones clínico electrocardiográficas, diagnóstico y tratamiento. Se presentan los primeros dos casos diagnosticados en el territorio. En ambos casos se describen signos predictores de arritmias.

Despite the presence of clinical guidelines recommending that β-blocker treatment be initiated early after reperfused myocardial infarction (RMI), acute myocardial infarction remains a leading cause of chronic heart failure (CHF). In this study, we compared the effects of donepezil, metoprolol, and their combination on the progression of cardiac remodeling in rats with RMI. The animals were randomly assigned to untreated (UT), donepezil-treated (DT), metoprololtreated (MT), and a combination of donepezil and metoprolol (DMT) groups. On day 8 after surgery, compared to the UT, the DT and DMT significantly improved myocardial salvage, owing to the suppression of macrophage infiltration and apoptosis. After the 10-week treatment, the DT and DMT exhibited decreased heart rate, reduced myocardial infarct size, attenuated cardiac dysfunction, and decreased plasma levels of brain natriuretic peptide and catecholamine, thereby preventing subsequent CHF. These results suggest that donepezil monotherapy or combined therapy with β-blocker may be an alternative pharmacotherapy post-RMI.

Supplemental material, Supplemental_material_S2 for Survey of non-tunneled temporary hemodialysis catheter clinical practice and training by Christina M Yuan, James D Oliver, Dustin J Little, Rajeev Narayan, Lisa K Prince, Rajeev Raghavan and Robert Nee in The Journal of Vascular Access

Supplemental material, Supplemental_material_Fig_S3 for Survey of non-tunneled temporary hemodialysis catheter clinical practice and training by Christina M Yuan, James D Oliver, Dustin J Little, Rajeev Narayan, Lisa K Prince, Rajeev Raghavan and Robert Nee in The Journal of Vascular Access

HNa occurs frequently dunng the acute phase of STEMI and is a strong NSTSE (n=47) STSE (n=21) IL6 levels (pg/ml) Independent predictor of increased short-term mortality. IL6 gene polymorphism 53% G/G (n=31) 43% G/C (n=30) 4.3% c/c (n=7) 27% 3.2 * 2.9 47% 7.2 * 9.9 24% 13.1 * 15.4 P value 0.025 (&#61539;2) 0.049 (Kr-Wallis)

HNa occurs frequently dunng the acute phase of STEMI and is a strong NSTSE (n=47) STSE (n=21) IL6 levels (pg/ml) Independent predictor of increased short-term mortality. IL6 gene polymorphism 53% G/G (n=31) 43% G/C (n=30) 4.3% c/c (n=7) 27% 3.2 * 2.9 47% 7.2 * 9.9 24% 13.1 * 15.4 P value 0.025 (&#61539;2) 0.049 (Kr-Wallis)

Background ACE2 activity levels correlate with adverse left atrial remodelling in patients with atrial fibrillation (AF). Several biochemical and structural markers have been associated with embolic stroke of undetermined source (ESUS). The relationship between ACE2 activity and ESUS is unknown. Purpose Randomised controlled trials failed to demonstrate a clear benefit of oral anticoagulation in an unselected ESUS population. As selective use of oral anticoagulation guided by biomarker risk-profiling may benefit these patients, we evaluated the association between ACE2 activity and ESUS. Methods This prospective case control study compared patients with ESUS against a control group matched for vascular risk factors. ESUS was diagnosed following cerebral vascular imaging and 24 hours of cardiac monitoring to exclude AF. Blood samples were collected for measurement of ACE2 activity, D-Dimer and high sensitivity troponin T (hsTnT). Results A total of 51 patients in the ESUS group were ...

Introduction: Pulsatile left ventricular assist devices (LVADs) have been established for bridging of selected patients with advanced congestive heart failure to transplantation. Their clinical application, however, has been complicated by bleeding, thromboembolic and infectious adverse events. Recently, continuous flow LVADs have been introduced. They are expected to be associated with a reduced risk for such complications. Here we report our experience with 9 patients on the continuous flow DeBakey VAD™. Patients and Methods: Since February 2000, 9 patients have been supported by the continuous flow DeBakey VAD™ at our institution (all male, 38.6Ϯ13.1 years, 3 DCM, 3 ICM, 1 congenital, 1 postcardiotomy, 1 myocardial infarction). Before implantation, patients were in severe heart failure (NYHA IV) requiring inotropic support. Cardiac index was 1.64Ϯ0.49 l/min/m2. All patients fulfilled the requirements for listing to heart transplantation and were put on the waiting list at the time of LVAD implantation. Results: Current total support time (as of October 17, 2000) amounts to 900 patient days (14 Ϫ 232 days). One patient was transplanted 226 days following LVAD implantation, six patients are currently still on LVAD support. One patient died on postoperative day (POD) 14 due to multiorgan failure developing following preoperative cardiogenic shock due to myocardial infarction, one patient died on POD 15 after a thrombus generated from the left ventricle had caused the pump to stop. Bleeding complications requiring rethoracotomy occurred in 3 patients. There was no thromboembolic event. No driveline or device infection was observed. Moderate hemolysis was seen in 3 patients. In 4 patients, the LVAD was replaced (POD 76, 76, 137, 170) for another DeBakey VAD™. Device exchanges were associated with thrombus; however, its origin could not be determined. Our experience with the DeBakey VAD™ indicates that it is associated with a low risk for bleeding, hemolysis, thromboembolic and infectious complications which makes it a valuable alternative to pulsatile LVADs. Thrombus in the pump may be addressed with improved anticoagulation and platelet inhibition.

Cardiac contractility modulation (CCM) signals are non-excitatory signals applied during the absolute refractory period that have been shown to enhance the strength of left ventricular contraction without increasing myocardial oxygen consumption in studies carried out in animals and humans with heart failure and reduced ejection fraction. Studies from myocardial tissue of animals and humans with heart failure suggest that the mechanisms of these effects is that CCM drives expression of many genes that are abnormally expressed in heart failure towards normal, including proteins involved with calcium cycling and the myocardial contractile machinery. Clinical studies have primarily focused on patients with normal QRS durations in view of the fact that cardiac resynchronization (CRT) is a viable option for patients with prolonged QRS duration. These studies show that CCM improves exercise tolerance as indexed by peak oxygen consumption (VO 2 ) and quality of life indexed by the Minnesota Living with Heart Failure Questionnaire. The device is currently available for clinical use in countries recognizing the CE mark and is undergoing additional testing in the USA under a protocol approved by the Federal Drug Administration.

Anti-phospholipid (aPL) antibodies are important contributors to development of thrombosis in patients with the autoimmune rheumatic disease systemic lupus erythematosus (SLE). The underlying mechanism of aPL antibody-mediated thrombosis is not fully understood but existing data suggest that platelets and the complement system are key components. Complement activation on platelets is seen in SLE patients, especially in patients with aPL antibodies, and has been related to venous thrombosis and stroke. The aim of this study was to investigate if aPL antibodies could support classical pathway activation on platelets in vitro as well as in SLE patients. Furthermore, we investigated if complement deposition on platelets was associated with vascular events, either arterial or venous, when the data had been adjusted for traditional cardiovascular risk factors. Finally, we analyzed if platelet complement deposition, both C1q and C4d, was specific for SLE. We found that aPL antibodies suppo...

mutation analysis. The patient had no clinical or laboratory evidence of autoimmune or infectious illnesses. Early coronary angiography showed an 80% diameter stenosis and an aneurysm with a maximal diameter of 12 mm at the same site of mid-circumflex artery (Fig. -Panel 1, 2, 3 and Video 1. See corresponding video/movie images at www.anakarder. com). The patient was treated with a polytetrafluoroethylene (PTFE)covered stent graft with a good angiographic result (Fig. ). Multi-slice spiral computerized tomography performed after 1-month of stenting did not show aneurysm (Fig. ). Coronary artery aneurysms are defined as coronary dilatations, which exceed the diameter of normal adjacent segments by 1.5 times. The main causes for coronary artery aneurysms in the Western world are atherosclerosis, congenital origin, and mycotic-embolic disease. Congenital aneurysms, which are usually situated on the right coronary artery, are generally large and are most commonly found in young patients. Left main coronary artery is the least frequently involved artery with a prevalence of 0.1%. They can rupture into the pericardial space, causing cardiac tamponade or into the right atrium. The majority of coronary aneurysms are asymptomatic. When symptoms occur, angina or infarctions are the most common presenting features. This case is a good reminder that coronary aneurysms can be a cause for myocardial ischemia in the absence of a totally obstructive lesion. This patient has also factor V Leiden mutation and this is also interesting because to our knowledge, this coincidence or association has not been reported before in the literature.

Introduction: Biventricular pacing is a new method for the treatment of patients with severe chronic heart failure, especially in cases of intraventricular conduction disturbances. Patients and Methods: Biventricular pacing devices were implanted in 32 patients with chronic severe heart failure (10 pacemakers, 22 defibrillators). Initially, patients remained in their previous intrinsic rhythm (device set to VVI 40 bpm) for 1 month after implantation, following which baseline evaluation was conducted, including NYHA class assessment and quality of life estimation. A six minute walking test, cardiopulmonary treadmill test and echo study were also conducted at that time point. Following a subsequent 3-month period of biventricular pacing, patients were evaluated again in the same way. Results: Following device implantation, a significant decrease was observed in QRS duration (170±13 from 185±18 msec before implantation, p<0.05). In 20 patients who uneventfully completed a 3-month period of biventricular pacing, an improvement was observed in NYHA class (1.7±0.5 from 3.0±0.4 before implantation, p<0.0001), Minnesota quality of life score (24±8 from 45±16 respectively, p<0.001) as well as in the six minute walking distance achieved (464±81 from 424±24 m, p<0.001). Treadmill exercise duration was increased (9.5±3.0 from 8.2±3.0 min, p<0.005) without any significant improvement in VO 2 max (15.9±3.2 from 15.3±3.8 ml/kgr/min, p: NS). Cardiac output was increased (4.9±1.2 from 4.3±1.2 lit/min, p<0.05), while LVEF was not significantly elevated (26.5±7.1 from 25.0±8.1 %, p: NS). Conclusions: Permanent biventricular pacing is a safe method which improves the functional status and quality of life in patients with severe heart failure and intraventricular conduction disturbances. Following biventricular pacing, an improvement is also observed in exercise capacity and indexes of left ventricular performance.

Objective: to study the impact of the features of the atrial blood supply to the remodeling of left atrium (LA) in patients with different types of AF. Methods: A retrospective study was conducted on the basis of Regional clinical hospital of Khanty-Mansiysk, the analyzed period -from 2007 to 2014. The study included: group 1 -patients with different forms of AF (120), with the development of atrial arteries, of which 96 men (mean age of 56.767.2 years) and 24 women (mean age 61,368.4 years); group 2 -patients diagnosed with persistent AF (16 people), with no visible large atrial branches including 10 men (mean age of 54.365.8 years) and 6 women (mean age of 61.567.1 years).Coronary angiography was performed by transfemoral or transradial access. The analyzed echocardiographic parameters: the longitudinal and transverse dimensions of the LA in 4-chamber position. Results: patients of the first group in 62.5 % of atrial artery moved away from the envelope branch of the left coronary artery (LCA). Atrial artery extending from the RCA identified in 35.8 % of cases. The average diameter of the right AA made up 1.4060.38 mm, left -of 1.4260.35 mm. In both groups there has been a significant increase in the size of LA, the longitudinal size of LA in group 1 58,1þ6.7 mm, lateral of 39.8þ6.5 mm, longitudinal size of the LA in group 2 57,2þ5.5 mm, transverse 39,5þ8mm, however, statistically significant between-group differences were not obtained. Observed correlation between the size LA and diameter of the AA in the group of patients with paroxysmal AF, whereas in the group with persistent form of this relationship is observed only in patients with the right AA. When a permanent form of AF the relationship between the diameter of arteries and the size of the LA don't observed. Conclusions: We can conclude that AF is more common in developed left atrial blood flow, but no significant differences of the influence of right -and left atrial variants of the blood supply to the degree of dilatation of the Atria due to in the progression of AF.

BackgroundNoninvasive risk stratification aims to detect abnormalities in the pathophysiological mechanisms underlying ventricular arrhythmias. We studied the predictive value of repeating risk stratification in patients with an implantable cardioverter‐defibrillator (ICD).MethodsThe EUTrigTreat clinical study was a prospective multicenter trial including ischemic and nonischemic cardiomyopathies and arrhythmogenic heart disease. Left ventricular ejection fraction ≤40% (LVEF), premature ventricular complexes &gt;400/24 hr (PVC), non‐negative microvolt T‐wave alternans (MTWA), and abnormal heart rate turbulence (HRT) were considered high risk. Tests were repeated within 12 months after inclusion. Adjusted Cox regression analysis was performed for mortality and appropriate ICD shocks.ResultsIn total, 635 patients had analyzable baseline data with a median follow‐up of 4.4 years. Worsening of LVEF was associated with increased mortality (HR 3.59, 95% CI 1.17–11.04), as was consistent a...

Treatment of left ventricular outflow tract (LVOT) obstruction in hypertrophic obstructive cardiomyopathy (HOCM) with septal reduction, either with myectomy or alcohol septal ablation, is aiming to reduce the LVOT gradient and improve symptoms in patients who are refractory to or do not tolerate medical treatment. Apart from contributing to the evolution to heart failure, LVOT obstruction is considered a risk factor for sudden cardiac death (SCD). Both septal reduction treatments have been proven effective in reducing symptoms and seem to improve survival, which has been shown equal to the expected in the normal population. SCD is probably reduced after septal reduction, implying that LVOT obstruction is a major factor predisposing to ventricular tachyarrhythmias. Although available algorithms for SCD stratification have not been tested in patients after septal reduction treatments, effective treatment improves SCD risk profile substantially. Furthermore, high-risk patients with already implanted implantable cardioverter defibrillators (ICDs) before septal reduction show very low appropriate ICD shock rate after effective treatment. It should be noted, however, that the best outcomes for septal myectomy or ablation have been reported in HOCM patients treated in high-volume centres, which substantiates the need to refer patients to centres with high procedural expertise.

BACKGROUND In experimental models, stellate ganglion block (SGB) reduces the induction of atrial fibrillation (AF), while data in humans are limited. OBJECTIVE The aim of this study was to assess the effect of unilateral SGB on atrial electrophysiological properties and AF induction in patients with paroxysmal AF. METHODS Thirty-six patients with paroxysmal AF were randomized in a 2:1 order to temporary, transcutaneous, pharmaceutical SGB with lidocaine or placebo before pulmonary vein isolation. Lidocaine was 1:1 randomly infused to the right or left ganglion. Before and after randomization, atrial effective refractory period (ERP) of each atrium, difference between right and left atrial ERP, intra-and interatrial conduction time, AF inducibility, and AF duration were assessed. After SGB, right atrial ERP was prolonged from a median (1st-3rd quartile) of 240 (220-268) ms to 260 (240-300) ms (P o .01) and left atrial ERP from 235 (220-260) ms to 245 (240-280) ms (P o .01). AF was induced by atrial pacing in all 24 patients before SGB, but only in 13 patients (54%) after the intervention (P o .01). AF duration was shorter after SGB: 1.5 (0.0-5.8) minutes from 5.5 (3.0-12.0) minutes (P o .01). Intraand interatrial conduction time was not significantly prolonged. No significant differences were observed between right and left SGB. No changes were observed in the placebo group. CONCLUSION Unilateral temporary SGB prolonged atrial ERP, reduced AF inducibility, and decreased AF duration. An equivalent effect of right and left SGB on both atria was observed. These findings may have a clinical implication in the prevention of drug refractory and postsurgery AF and deserve further clinical investigation.

was similar in RIPC and sham groups both at rest (22.3±1.8 vs. 22.2±1.55 mfi; p=0.91) and following ADP stimulation (26.1±1.1 vs. 26.3±1.5 mfi; p=0.74). As shown in the table, compared to controls, RIPC was associated with a lower spontaneous and ADP-induced MPA formation and platelet CD41 expression both during the procedure and 24 hours later. Conclusion: Our data show that RIPC before RF catheter ablation for AF significantly reduces the increased platelet reactivity associated with the procedure.

The multi-electrode ablation catheter PVAC is used to simplify pulmonary vein isolation in patients undergoing ablation of atrial fibrillation. The use of the PVAC in cases of atrial tachycardia has not been reported before. In the present report, we present the use of the PVAC for the ablation of a left atrial tachycardia following pulmonary vein isolation. This case may suggest that the PVAC could ablate some atrial tachycardias without any adjunctive ablation catheter, given its ability to map, pace and apply energy over a relatively broad area.

Background: Biventricular pacing is emerging as a long-term therapy for symptomatic heart failure. Analysis of heart rate variability (HRV) has become an important predictive tool in this syndrome. Aim of the study: To assess whether chronic resynchronization therapy can affect HRV in patients with heart failure. Methods and results: Thirteen patients with heart failure were studied (mean age"1 S.E. 65"2.2 years, QRS 195"5.3 ms, NYHA class 3.2"0.1, LVEF 21"1.7%). The protocol included a preliminary no pacing period for 1 month following device implantation. Twenty-four hour Holter ECG recordings were performed at the end of this period (baseline) and after 3 months of biventricular stimulation (VDD mode). Prior to and following pacing patients underwent NYHA class evaluation, 6-min walk test, Quality of Life Assessment and a cardiopulmonary exercise test. Biventricular pacing improved functional class (P-0.0001) and Quality of life (P-0.0001), increased 6-min walk distance, (Ps0.008) and exercise duration (P-0.0001) but had no significant effect on peak exercise VO . Resynchronization 2 therapy increased mean 24-h RR (922"58 vs. 809"41 ms at baseline, Ps0.006), SDNN (111"11 vs. 83"8 ms, Ps0.003),

Mechanical circulatory support (MCS) with an implantable left ventricular assist device (LVAD) is an established therapeutic option for advanced heart failure. Most of the currently used LVADs generate a continuous stream of blood that decreases arterial pulse pressure. This study investigated whether a change of the pulse pressure during different pump speed settings would affect cerebral autoregulation and thereby affect cerebral blood flow (CBF). The study included 21 haemodynamically stable outpatients with a continuous-flow LVAD (HeartMate II, Abbott, USA) implanted a median of 6 months before the study (interquartile range 3 to 14 months). Arterial blood pressure (measured by finger plethysmography) was recorded simultaneously with CBF (measured by transcranial Doppler ultrasound) during baseline pump speed (8900 rpm [IQR 8800; 9200]) and during minimum and maximum tolerated pump speeds (8000 rpm [IQR 8000; 8200] and 9800 rpm [IQR 9800; 10 000]). An increase in LVAD pump speed...

Left ventricular assist devices (LVAD), currently used in treatment of terminal heart failure, are working on principle of rotary pump, which generates continuous blood flow. Non-pulsatile flow is supposed to expose endothelial cells to high stress and potential damage. Therefore, we investigated longitudinal changes in concentration of circulating endothelial microparticles (EMP) as a possible marker of endothelial damage before and after implantation of LVAD. Study population comprised 30 patients with end-stage heart failure indicated for implantation of the Heart Mate II LVAD. Concentrations of microparticles were measured as nanomoles per liter relative to phosphatidylserine before and 3 months after implantation. At 3 months after implantation we observed significant decrease in concentration of EMP [5.89 (95 % CI 4.31-8.03) vs. 3.69 (95 % CI 2.70-5.03), p=0.03] in the whole group; there was no difference observed between patients with ischemic etiology of heart failure (n=18)...

Primary graft dysfunction (PGD) is a life-threatening complication among heart transplant recipients and a major cause of early mortality. Although the pathogenesis of PGD is still unclear, ischemia/reperfusion injury has been identified as a predominant factor. Both necrosis and apoptosis contribute to the loss of cardiomyocytes during ischemia/reperfusion injury, and this loss of cells can ultimately lead to PGD. The aim of our prospective study was to find out whether cell death, necrosis and apoptosis markers present in the donor myocardium can predict PGD. The prospective study involved 64 consecutive patients who underwent orthotopic heart transplantation at our institute between September 2010 and January 2013. High-sensitive cardiac troponin T (hs-cTnT) as a marker of minor myocardial necrosis was detected from arterial blood samples before the donor’s pericardium was opened. Apoptosis (caspase-3, active + pro-caspase-3, bcl-2, TUNEL) was assessed from bioptic samples taken ...

Background: Determining the value of new imaging markers to predict aortic valve (AV) surgery in asymptomatic patients with severe aortic regurgitation (AR) in a prospective, observational, multicenter study. Methods: Consecutive patients with chronic severe AR were enrolled between 2015–2018. Baseline examination included echocardiography (ECHO) with 2- and 3-dimensional (2D and 3D) vena contracta area (VCA), and magnetic resonance imaging (MRI) with regurgitant volume (RV) and fraction (RF) analyzed in CoreLab. Results: The mean follow-up was 587 days (interquartile range (IQR) 296–901) in a total of 104 patients. Twenty patients underwent AV surgery. Baseline clinical and laboratory data did not differ between surgically and medically treated patients. Surgically treated patients had larger left ventricular (LV) dimension, end-diastolic volume (all p &lt; 0.05), and the LV ejection fraction was similar. The surgical group showed higher prevalence of severe AR (70% vs. 40%, p = 0....

Ventricular pressure–volume (PV) analysis is the reference method for the study of cardiac mechanics. Advances in calibration algorithms and measuring techniques brought new perspectives for its application in different research and clinical settings. Simultaneous PV measurement in the heart chambers offers unique insights into mechanical cardiac efficiency. Beat to beat invasive PV monitoring can be instrumental in the understanding and management of heart failure, valvular heart disease, and mechanical cardiac support. This review focuses on intra cardiac left ventricular PV analysis principles, interpretation of signals, and potential clinical applications.

Cardiac atrophy is the most common complication of prolonged application of the left ventricle assist device in patients with advanced heart failure. Our aim was to evaluate the course of unloading-induced cardiac atrophy in rats with failing hearts, and to examine if increased isovolumic loading obtained by intraventricular implantation of an especially designed spring expander would attenuate this process. Heterotopic abdominal heart transplantation (HT) was used as a rat model of heart unloading. Heart failure (HF) was induced by volume overload achieved by creation of the aorto-caval fistula. The degree of cardiac atrophy was assessed as the weight ratio of the heterotopically transplanted heart (HW) to the control heart. Isovolumic loading was increased by intraventricular implantation of a stainless steel three-branch spring expander. The course of cardiac atrophy was evaluated on days 7, 14, 21 and 28 after HT Seven-days unloading by HT in failing hearts sufficed to substanti...

B-type natriuretic peptide (BNP) is a strong predictor of prognosis in chronic heart failure. We aimed to evaluate the clinical correlates and interpretation of BNP monitoring in LVAD out-patient recipients. We performed a prospective study in 136 individuals after HeartMate II LVAD implantation. During follow-up they were divided into group A (severe adverse events requiring hospitalisation), group B (mild to moderate adverse events) and group C (an uneventful course). BNP was measured pre-implant, at the first out-patient visit, and then every 2 months. We identified the lowest level, and the level at the clinical event and/or the highest value in patients without clinical events (BNP peak). During a median follow-up of 298 days, 8 patients (6%) died, 21 patients (15%) experienced a severe adverse event (group A) and 38 patients (28%) had other adverse event (group B). Both the absolute value of BNP peak and its percentage values relative to pre-implant, first visit and minimum BN...

The HeartMate 3 (HM3) is a Conformiteé Européenne (CE) mark-approved left ventricular assist device (LVAD) with a fully magnetically levitated rotor with features consisting of a wide range of operational speeds, wide flow paths and an artificial pulse. We performed a hemodynamic and echocardiographic evaluation of patients implanted with the HM3 LVAD to assess the speed range for optimal hemodynamic support. METHODS: Sixteen HM3 patients underwent pump speed ramp tests with right heart catheterization (including central venous pressure [CVP], pulmonary artery pressure, pulmonary capillary wedge pressure [PCWP] and blood pressure [BP]) and 3-dimensional echocardiography (3DE). Data were recorded at up to 13 speed settings. Speed changes were in steps of 100 revolutions per minute (rpm), starting at 4,600 rpm and ramping up to 6,200 rpm. RESULTS: Mean original speed was 5,306 Ϯ 148 rpm, with a majority of patients (10 of 16, 62.5%) having normal CVPs and PCWPs at their original rpm settings. Going from lowest to highest speeds, cardiac output improved at the rate of 0.08 Ϯ 0.08 liter/min per 100 rpm (total change 1.25 Ϯ 1.20 liters/min) and PCWP decreased at the rate of -0.48 Ϯ 0.27 mm Hg per 100 rpm (total change -6.13 Ϯ 3.72 mm Hg). CVP and systolic BP did not change significantly with changes in rpm. Left ventricular end-diastolic dimension (LVEDD) decreased at a rate of -0.15 Ϯ 0.09 cm per 100 rpm. Number of rpm was adjusted based on test results to achieve CVPs and PCWPs as close to normal limits as possible, which was feasible in 13 (81.3%) patients. For the remaining 3 patients, medical management was pursued to optimize hemodynamic support. CONCLUSION: Hemodynamic normalization of pressures was achieved in the majority of patients implanted with the HM3 pump within a narrow speed range.

Background Cardiotoxicity caused by anticancer treatment affects cardiac conduction. Clinical outcomes of pacemaker patients with newly diagnosed cancer are insufficiently understood. Purpose The aim was to investigate the effect of anticancer therapy on pacemaker properties. Methods All patients with pacemaker and confirmed cancer diagnosis treated with chemotherapy at our tertiary university hospital were included in this study. The pacemaker database (containing pacemaker related information) was matched with hospital-wide electronic health records (containing cancer types, comorbidities and echo data). Survival data were retrieved from the Statistics Austria Federal Institute. Clinical and pacemaker data of patients with previously diagnosed cancer requiring pacemaker implantation (Group A) were compared to patients with pre-existing pacemaker followed by cancer diagnosis (Group B). Results Out of 972 included patients, 295 patients (30.3%) had the pacemaker implantation after t...

Background Currently no data are available whether the implantation of right ventricular (RV) pacemaker (PM) lead worsens preexisting primary or secondary (functional due to RV dilatation, RVD) tricuspid regurgitation (TR). Purpose The aim of the present retrospective analysis was to assess TR after PM implantation with a RV lead. Methods Patients with PM implantation (n=990) were enrolled if they had routine echocardiography including assessment of TR before first implantation and immediately after. RVD and severity of TR were characterized visually. Based on RVD in baseline echocardiography, patients were divided into 2 groups: with primary TR (without preexisting RVD, n=743) or secondary TR (with preexisting RVD, n=243). Results Lead-induced worsening of TR was present in both groups (Table 1). Progression from mild/moderate to severe TR was observed in 6.7% of patients with primary TR, compared to 25.6% of patients with secondary TR (P=0.001). Using an ordinal regression model, ...

The Arrhythmia Working Group of the Austrian Society of Cardiology (ÖKG) has set the goal of systematically structuring and organizing the acute care of patients with ventricular arrhythmias (VA), i.e. ventricular tachycardia (VT) or ventricular fibrillation (VF) in Austria. Within a consensus paper, national recommendations on the basic diagnostic work-up of VA (12-lead ECG, medical history, family history, laboratory analyses, echocardiography, search for reversible causes, ICD interrogation), as well as further medical treatment and therapeutic measures (indication of coronary angiography, ablation therapy) are established. Since acute ablation of VT is indicated in the current ESC guidelines as a class IB indication for scarassociated incessant VT or electrical storm (ES; 3 ICD therapies in 24 h) as well as for ischemic cardiomyopathy (iCMP) with recurrent ICD shocks, organizational measures must be taken to ensure that these guidelines can be implemented. Therefore, a VT network will be established covering all areas in Austria, consisting of primary and secondary VT centers. Organizational aspects of an acute VT network are defined and should subsequently be implemented by the participating hospitals. All electrophysiologic centers in Austria that deal with VT ablation are to be integrated into the network in the medium-term. Centers that co-operate in the network are divided into primary and secondary VT centers according to predefined criteria.