Journal: J Card Fail

Sorted by: date / impact
Abstract

Assessment of Myocardial Fibrosis Using Two-Dimensional and Three-Dimensional Speckle Tracking Echocardiography in Dilated Cardiomyopathy with Advanced Heart Failure.

Wang J, Zhang Y, Zhang L, Tian F, ... Li Y, Xie M
Background
This study aimed to depict strain parameters derived from two-dimensional (2D)- and three-dimensional speckle tracking echocardiography (3D-STE) and to explore which may best reflect myocardial fibrosis (MF) in dilated cardiomyopathy (DCM) with advanced heart failure (HF), by comparing with histological fibrosis.
Methods
We analyzed 75 DCM patients with advanced HF who underwent echocardiographic examination before heart transplantation. Strain parameters derived from 2D- and 3D-STE were as follows: left ventricular (LV) global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and tangential strain (TS). The degree of MF was quantified using Masson\'s staining in LV myocardial samples obtained from all patients. 75 subjects were divided into 3 groups according to the tertiles of histological MF (mild, moderate, and severe MF group).
Results
Patients with severe MF had lower 3DGLS, 3DGRS, 3DTS and 2DGLS than those with mild and moderate MF. MF strongly correlated with 3DGLS (r = 0.72, P < 0.001), weakly with 3DGRS (r = -0.39, P =0.001), 3DGCS (r = 0.30, P = 0.009), 3DTS (r = 0.47, P < 0.001), 2DGLS (r =0.44, P < 0.001), but did not correlate with 2DGCS and 2DGRS. Receiver operating characteristic analysis revealed that the area under the curve of 3DGLS for detecting severe MF was significantly larger than that of other strain parameters (0.86 vs 0.59-0.70, P<0.05 for all). The multivariate linear regression models using 3DGLS (R = 0.76; Akaike Information Criterion [AIC] = 331) was found to be a more accurate indicator to predict MF than that with 3DTS (R = 0.65; AIC = 354) and 2DGLS (R = 0.66; AIC = 352).
Conclusions
3DGLS may be an optimal surrogate marker for reflecting MF in DCM patients with advanced HF.

Copyright © 2021. Published by Elsevier Inc.

J Card Fail: 13 Jan 2021; epub ahead of print
Wang J, Zhang Y, Zhang L, Tian F, ... Li Y, Xie M
J Card Fail: 13 Jan 2021; epub ahead of print | PMID: 33454418
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Catabolic/anabolic imbalance is accompanied by changes of LV steroid nuclear receptor expression in tachycardia-induced systolic heart failure in male pigsSteroid hormones in pig model of heart failure.

Zacharski M, Tomaszek A, Kiczak L, Ugorski M, ... Janiszewski A, Ponikowski P
Background
Steroid hormones play an important role in heart failure (HF) pathogenesis, and clinical data has revealed disordered steroidogenesis in male HF patients. However, there is still a lack of studies on steroid hormones and their receptors during HF progression. Therefore, a porcine model of tachycardia-induced cardiomyopathy corresponding to HF was used to assess steroid hormone concentrations in serum and their nuclear receptor levels in heart tissue during the consecutive stages of HF.
Methods and results
Male pigs underwent right ventricular pacing and developed a clinical picture of mild, moderate and severe HF. Serum concentrations of dehydroepiandrosterone (DHEA), testosterone, dihydrotestosterone, estradiol, aldosterone and cortisol were assessed by ELISA. Androgen (AR), estrogen α (ERα), mineralocorticoid (MR) and glucocorticoid (GR) receptor mRNAs levels in the left ventricle (LV) were determined by qPCR. The androgen level decreased in moderate and severe HF animals, while the corticosteroid level increased. The estradiol concentration remained stable. The qPCR revealed the down-regulation of AR in consecutive stages of HF and increased expression of MR mRNA under these conditions.
Conclusions
In the HF pig model deteriorated catabolic/anabolic balance, manifested by upregulation of aldosterone and cortisol and down-regulation of androgen signaling on the ligand level was augmented by changes in steroid hormone receptor expression in the heart tissue.

Copyright © 2021. Published by Elsevier Inc.

J Card Fail: 11 Jan 2021; epub ahead of print
Zacharski M, Tomaszek A, Kiczak L, Ugorski M, ... Janiszewski A, Ponikowski P
J Card Fail: 11 Jan 2021; epub ahead of print | PMID: 33450412
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Understanding longitudinal changes in pulmonary vascular resistance after left ventricular assist device implantation.

Gulati G, Ruthazer R, DeNofrio D, Vest AR, Kent D, Kiernan MS
Background
Elevated PVR is common in patients with advanced heart failure. PVR generally improves after LVAD implantation, but the rate of decrease has not been quantified and the patient characteristics most strongly associated with this improvement are unknown.
Methods and results
We analyzed 1581 patients from the INTERMACS registry that received a primary continuous-flow LVAD, had baseline PVR ≥ 3 Wood units (WU), and had PVR measured at least once postoperatively. Multivariable linear mixed effects modeling was used to evaluate independent associations between postoperative PVR and patient characteristics. PVR decreased by 1.53 WU (95% CI 1.27-1.79 WU) per month in the first 3 months postoperatively, and by 0.066 WU (95% CI 0.060-0.070 WU) per month thereafter. Severe mitral regurgitation (MR) at any time during follow up was associated with a 1.29 WU (95% CI 1.05-1.52 WU) higher PVR relative to absence of MR at that time. In a cross-sectional analysis, 15-25% of patients had persistently elevated PVR ≥ 3 WU at any given time within 36 months after LVAD implant.
Conclusion
PVR tends to decrease rapidly early after implant, and only more gradually thereafter. Residual MR may be an important contributor to elevated postoperative PVR. Future research is needed to understand the implications of elevated PVR after LVAD implantation and the optimal strategies for prevention and treatment.

Copyright © 2021. Published by Elsevier Inc.

J Card Fail: 11 Jan 2021; epub ahead of print
Gulati G, Ruthazer R, DeNofrio D, Vest AR, Kent D, Kiernan MS
J Card Fail: 11 Jan 2021; epub ahead of print | PMID: 33450411
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Biomarkers and their relation to cardiac function late after peripartum cardiomyopathy.

Ersbøll AS, Goetze JP, Johansen M, Hauge MG, ... Gustafsson F, Damm P
Background
Angiogenic imbalance involving the placental protein soluble Fms-like tyrosine kinase-1 (sFlt-1) and cleavage of the nursing-hormone prolactin by the enzyme cathepsin D (CD) both play a role in the pathogenesis of peripartum cardiomyopathy (PPCM). We hypothesized that angiogenic imbalance and increased activity of CD have a long-lasting impact in women with PPCM.
Methods and results
A nationwide Danish cohort of women with PPCM (PPCM-group, N=28), age-matched women with previous preeclampsia (PE-group, N=28) and uncomplicated pregnancies (UCP-group, N=28) participated in a follow-up study including biomarker analysis, exercise testing and cardiac magnetic resonance imaging (CMR). Eighty-four women participated. Median time to follow-up was 91 months (range 27-137) for the PPCM-group. Levels of sFlt-1, placental growth factor, N-terminal pro-natriuretic brain peptide and copeptin were all significantly higher in the PPCM-group. More women in the PPCM-group had detectable CD activity (68%) compared with the PE-group (29%) and UCP-group (36%) (p=0.0002). Levels of angiogenic factors and biomarkers correlated inversely with maximal exercise capacity and cardiac functional parameters assessed with CMR.
Conclusions
Women with PPCM had higher biomarker levels and CD activity up to seven years after diagnosis. Higher biomarker levels correlated inversely with maximal exercise capacity and markers of cardiac dysfunction suggesting that persistent angiogenic imbalance and increased CD activity is associated with residual cardiac dysfunction.

Copyright © 2021. Published by Elsevier Inc.

J Card Fail: 06 Jan 2021; epub ahead of print
Ersbøll AS, Goetze JP, Johansen M, Hauge MG, ... Gustafsson F, Damm P
J Card Fail: 06 Jan 2021; epub ahead of print | PMID: 33422687
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Prognostic Impact of Changes in Intrarenal Venous Flow Pattern in Patients With Heart Failure.

Yamamoto M, Seo Y, Iida N, Ishizu T, ... Ohte N, Ieda M
Background
It remains unclear whether intrarenal venous flow (IRVF) patterns in patients with heart failure (HF) could change over the clinical course, and whether the changes could have a clinical impact. Thus, this study aimed to clarify these characteristics as well as to identify the relation between changes in the IRVF pattern and renal impairment progression.
Methods and results
Patients with HF with repetitive IRVF evaluations were enrolled. Doppler waveforms of IRVF were classified into the following 3 flow patterns: continuous, biphasic discontinuous, and monophasic discontinuous. Primary end points included death from cardiovascular diseases and unplanned hospitalization for HF. Finally, 108 patients with adequate images were enrolled. The IRVF in 35 patients (32.4%) shifted to another pattern at the follow-up examinations. The median brain natriuretic peptide level in the continuous flow pattern at follow-up was significantly decreased (183 to 60 pg/mL, P < .001), whereas that of the discontinuous flow pattern at follow-up was increased (from 339 to 366 pg/mL, P = .042) and the estimated glomerular filtration rate was decreased (from 55 to 50 mL/min/1.73 m, P = .013). A multivariable Cox proportional hazard model analysis revealed that the discontinuous pattern at follow-up (P < .001) and brain natriuretic peptide (P = .021) were significantly associated with the end points, independent of age, estimated glomerular filtration rate, and serum sodium level.
Conclusions
The IRVF pattern could be changed depending on the status of congestion. Persistent or worsened renal congestion, represented by discontinuous flow patterns, during the clinical courses indicated a poor prognosis accompanied by renal impairment in patients with HF.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Dec 2020; 27:20-28
Yamamoto M, Seo Y, Iida N, Ishizu T, ... Ohte N, Ieda M
J Card Fail: 30 Dec 2020; 27:20-28 | PMID: 32652246
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Differential Impact of Class I and Class II Panel Reactive Antibodies on Post-Heart Transplant Outcomes.

Ivey-Miranda JB, Kunnirickal S, Bow L, Maulion C, ... Kransdorf EP, Bellumkonda L
Background
Sensitized patients awaiting heart transplantation spend a longer time on the waitlist and have higher mortality. We are now able to further characterize sensitization by discriminating antibodies against class I and II, but the differential impact of these has not been assessed systematically.
Methods and results
Using United Network for Organ Sharing data (2004-2015), we analyzed 17,361 adult heart transplant patients whose class I and II panel reactive antibodies were reported. Patients were divided into 4 groups: class I and II ≤25% (group 1); class I ≤25% and class II ˃25% (group 2); class II ≤25% and class I >25% (group 3); and both class I and II >25% (group 4). Outcomes assessed were treated rejection at 1-year mortality, all-cause mortality, and rejection-related mortality. Compared with group 1, only group 4 was associated with a higher risk of treated rejection at 1 year (odds ratio 1.31, 95% confidence interval [CI] 1.05-1.64), all-cause mortality (hazard ratio 1.24, 95% CI 1.06-1.46), and mortality owing to rejection (subhazard ratio 1.84, 95% CI 1.18-2.85), whereas groups 2 and 3 were not (P > .05).
Conclusions
Combined elevation in class I and II panel reactive antibodies seem to increase the risk of treated rejection and all-cause mortality, whereas risk with isolated elevation is unclear.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Dec 2020; 27:40-47
Ivey-Miranda JB, Kunnirickal S, Bow L, Maulion C, ... Kransdorf EP, Bellumkonda L
J Card Fail: 30 Dec 2020; 27:40-47 | PMID: 32750489
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cystatin C and Muscle Mass in Patients With Heart Failure.

Ivey-Miranda JB, Inker LA, Griffin M, Rao V, ... Levey AS, Testani JM
Background
The estimated glomerular filtration rate (eGFR) from cystatin C (eGFRcys) is often considered a more accurate method to assess GFR compared with an eGFR from creatinine (eGFRcr) in the setting of heart failure (HF) and sarcopenia, because cystatin C is hypothesized to be less affected by muscle mass than creatinine. We evaluated (1) the association of muscle mass with cystatin C, (2) the accuracy of eGFRcys, and (3) the association of eGFRcys with mortality given muscle mass.
Methods and results
We included 293 patients admitted with HF. Muscle mass was estimated with a validated creatinine excretion-based equation. Accuracy of eGFRcys and eGFRcr was compared with measured creatinine clearance. Cystatin C and creatinine were 31.7% and 59.9% higher per 14 kg higher muscle mass at multivariable analysis (both P < .001). At lower muscle mass, eGFRcys and eGFRcr overestimated the measured creatinine clearance. At higher muscle mass, eGFRcys underestimated the measured creatinine clearance, but eGFRcr did not. After adjusting for muscle mass, neither eGFRcys nor eGFRcr were associated with mortality (both P > .19).
Conclusions
Cystatin C levels were associated with muscle mass in patients with HF, which could potentially decrease the accuracy of eGFRcys. In HF where aberrations in body composition are common, eGFRcys, like eGFRcr, may not provide accurate GFR estimations and results should be interpreted cautiously.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Dec 2020; 27:48-56
Ivey-Miranda JB, Inker LA, Griffin M, Rao V, ... Levey AS, Testani JM
J Card Fail: 30 Dec 2020; 27:48-56 | PMID: 32750487
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Clinical significance of reactive oxidative metabolites in patients with heart failure with reduced left ventricular ejection fraction.

Nishihara T, Tokitsu T, Sueta D, Oike F, ... Yamamoto E, Tsujita K
Background
We investigated the clinical significance of the derivative of reactive oxygen metabolites (DROM), a new marker of reactive oxygen species (ROS), in patients with heart failure (HF) with reduced left ventricular ejection fraction (LVEF) (HFrEF).
Methods and results
Serum DROM concentrations were measured in 201 consecutive patients with HFrEF (EF < 50%) in stable condition. DROM values were significantly higher in patients with HFrEF than in risk-matched patients without HF (P < 0.01). They also correlated significantly with high-sensitivity C-reactive protein and B-type natriuretic peptide. Kaplan-Meier analysis demonstrated significantly higher probabilities of HF-related events in the high-DROM group than in the low-DROM group (log-rank test, P < 0.01). Multivariable Cox hazard analysis revealed that DROM were independent and significant predictors of cardiovascular events. In a subgroup analysis, DROM levels were also measured at the aortic root and coronary sinus in 49 patients. The transcardiac gradient of DROM values was significantly higher in patients with HFrEF than in patients without HF (P = 0.04), indicating an association between DROM production in the coronary circulation and HFrEF development. Changes in DROM following optimal therapy were significantly associated with LVEF improvement (r = 0.34, P = 0.04).
Conclusions
The higher levels of DROM and their association with cardiovascular events suggest the clinical benefit of DROM measurements in the risk stratification of patients with HFrEF.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Dec 2020; 27:57-66
Nishihara T, Tokitsu T, Sueta D, Oike F, ... Yamamoto E, Tsujita K
J Card Fail: 30 Dec 2020; 27:57-66 | PMID: 32791184
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Sex Differences in the Phenotype of Transthyretin Cardiac Amyloidosis Due to Val122Ile Mutation: Insights from Noninvasive Pressure-Volume Analysis.

Batra J, Rosenblum H, Defilippis EM, Griffin JM, ... Burkhoff D, Maurer MS
Background
Transthyretin cardiac amyloidosis (ATTR-CA) is an under-recognized cause of heart failure with preserved ejection fraction. In the United States, the valine-to-isoleucine substitution (Val122Ile) is the most common inherited variant. Data on sex differences in presentation and outcomes of Val122Ile associated ATTR-CA are lacking.
Methods and results
In a retrospective, single-center study of 73 patients diagnosed with Val122Ile associated ATTR-CA between 2001 and 2018, sex differences in clinical and echocardiographic data at the time of diagnosis were evaluated. Pressure-volume analysis using noninvasive single beat techniques was used to compare chamber performance. Compared with men (n = 46), women (n = 27) were significantly older at diagnosis, 76 years vs 69 years; P < .001. The end-systolic pressure-volume relationship, 5.1 mm Hg*m/mL vs 4.3 mm Hg*m/mL; P = .27, arterial elastance, 5.5 mm Hg*m/mL vs 5.7 mm Hg*m/mL; P = .62, and left ventricular capacitance were similar between sexes as was pressure-volume areas indexed to a left ventricular end-diastolic pressure of 30 mm Hg, a measure of overall pump function. The 3-year mortality rates were also similar, 34% vs 43%; P = .64.
Conclusions
Despite being significantly older at time of diagnosis with Val122Ile associated ATTR-CA, women have similar overall cardiac chamber function and rates of mortality to men, suggesting a less aggressive disease trajectory. These findings should be confirmed with longitudinal studies.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Dec 2020; 27:67-74
Batra J, Rosenblum H, Defilippis EM, Griffin JM, ... Burkhoff D, Maurer MS
J Card Fail: 30 Dec 2020; 27:67-74 | PMID: 32829019
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Possible Association Between Body Temperature and B-Type Natriuretic Peptide in Patients With Cardiovascular Diseases.

Kang R, Nagoshi T, Kimura H, Tanaka TD, ... Kawai M, Yoshimura M
Background
In addition to various biological effects of natriuretic peptides (NP) on cardiovascular systems, we recently reported that NP raises intracellular temperature in cultured adipocytes. We herein examined the possible thermogenic action of NP in consideration of hemodynamic parameters and inflammatory reaction by proposing structural equation models.
Methods and results
The study population consisted of 1985 consecutive patients who underwent cardiac catheterization. Covariance structure analyses were performed to clarify the direct contribution of plasma B-type NP (BNP) to body temperature (BT) by excluding other confounding factors. A hierarchical path model showed increase in BNP, increase in C-reactive protein and decrease in left ventricular ejection fraction were mutually associated. As expected, C-reactive protein was positively correlated with BT. Importantly, despite a negative correlation between BNP and left ventricular ejection fraction, a decrease in the left ventricular ejection fraction was associated with BT decrease, whereas elevation in BNP level was associated with BT increase independently of C-reactive protein level (P = .007).
Conclusions
Patients with LV dysfunction tend to manifest a decrease in BT, whereas BNP elevation is associated with an increase in BT independently of inflammatory response. These findings suggest the adaptive heat-retaining property of NP (and/or NP-associated factors) when BT falls owing to unfavorable hemodynamic conditions in a state of impaired cardiac function.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Dec 2020; 27:75-82
Kang R, Nagoshi T, Kimura H, Tanaka TD, ... Kawai M, Yoshimura M
J Card Fail: 30 Dec 2020; 27:75-82 | PMID: 32871239
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Clinical and Imaging Response to Tumor Necrosis Factor Alpha Inhibitors in Treatment of Cardiac Sarcoidosis: A Multicenter Experience.

Gilotra NA, Wand AL, Pillarisetty A, Devraj M, ... Chen ES, Sheikh FH
Background
Cardiac sarcoidosis (CS) is an increasingly recognized cause of cardiomyopathy; however, data on immunosuppressive strategies are limited. Treatment with tumor necrosis factor (TNF) alpha inhibitors is not well described; moreover, there may be heart failure-related safety concerns.
Methods
Retrospective multicenter study of patients with CS treated with TNF alpha inhibitors. Baseline characteristics, treatments, and outcomes were adjudicated.
Results
Thirty-eight patients with CS (mean age 49.9 years, 42% women, 53% African American) were treated with TNF alpha inhibitor (30 infliximab, 8 adalimumab). Prednisone dose decreased from time of TNF alpha inhibitor initiation (21.7 ± 17.5 mg) to 6 months (10.4 ± 6.1 mg, P = .001) and 12 months (7.3 ± 7.3 mg, P = .002) after treatment. On pre-TNF alpha inhibitor treatment positron emission tomography with 18-flourodoxyglucose (FDG-PET), 84% of patients had cardiac FDG uptake. After treatment, there was a significant decrease in number of segments involved (3.5 ± 3.8 to 1.0 ± 2.5, P = .008) and maximum standardized uptake value (3.59 ± 3.70 to 0.57 ± 1.60, P = .0005), with 73% of patients demonstrating complete resolution or improvement of cardiac FDG uptake. The left ventricular ejection fraction remained stable (45.0 ± 16.5% to 47.0 ± 15.0%, P = .10). Four patients required inpatient heart failure treatment, and 8 had infections; 2 required treatment cessation.
Conclusions
TNF alpha inhibitor treatment guided by FDG-PET imaging may minimize corticosteroid use and effectively reduce cardiac inflammation without significant adverse effect on cardiac function. However, infections were common, some of which were serious, and therefore patients require close monitoring for both infection and cardiac symptoms.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Dec 2020; 27:83-91
Gilotra NA, Wand AL, Pillarisetty A, Devraj M, ... Chen ES, Sheikh FH
J Card Fail: 30 Dec 2020; 27:83-91 | PMID: 32889044
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

The Effect of Decongestion on Intrarenal Venous Flow Patterns in Patients With Acute Heart Failure.

Ter Maaten JM, Dauw J, Martens P, Somers F, ... Dupont M, Mullens W
Background
Discontinuous intrarenal venous flow patterns, as assessed by renal Doppler ultrasound examination, are associated with changes in hemodynamics such as volume expansion and poorer diuretic response in patients with heart failure (HF). We aimed to study intrarenal venous and arterial flow patterns after decongestive treatment in patients with acute HF.
Methods and results
Fifteen patients with acute HF were enrolled. Intrarenal venous and arterial flow patterns were assessed at baseline, 1 hour after administration of loop diuretics, at day 2 and day 3. Among patients hospitalized for acute HF, 13 (87%) had a discontinuous venous flow pattern at admission. After decongestive treatment, a significant improvement of the venous impedance index (P = .021) and venous discontinuity index (P = .004) was observed at day 3 compared with baseline. There was no effect on the intrarenal arterial flow patterns.
Conclusions
In patients who exhibit discontinuous renal venous flow patterns hospitalized for decongestive treatment owing to acute HF led to a normalization of intrarenal venous flow to a continuous pattern.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 30 Dec 2020; 27:29-34
Ter Maaten JM, Dauw J, Martens P, Somers F, ... Dupont M, Mullens W
J Card Fail: 30 Dec 2020; 27:29-34 | PMID: 32927066
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Prominent Longitudinal Strain Reduction of Basal Left Ventricular Segments in Patients With Coronavirus Disease-19.

Goerlich E, Gilotra NA, Minhas AS, Bavaro N, Hays AG, Cingolani OH
Background
Coronavirus disease-19 (COVID-19) has been associated with overt and subclinical myocardial dysfunction. We observed a recurring pattern of reduced basal left ventricular (LV) longitudinal strain on speckle-tracking echocardiography in hospitalized patients with COVID-19 and subsequently aimed to identify characteristics of affected patients. We hypothesized that patients with COVID-19 with reduced basal LV strain would demonstrate elevated cardiac biomarkers.
Methods and result
Eighty-one consecutive patients with COVID-19 underwent speckle-tracking echocardiography. Those with poor quality speckle-tracking echocardiography (n = 2) or a known LV ejection fraction of <50% (n = 4) were excluded. Patients with an absolute value basal longitudinal strain of <13.9% (2 standard deviations below normal) were designated as cases (n = 39); those with a basal longitudinal strain of ≥13.9% were designated as controls (n = 36). Demographics and clinical variables were compared. Of 75 included patients (mean age 62 ± 14 years, 41% women), 52% had reduced basal strain. Cases had higher body mass index (median 34.1; interquartile range 26.5-37.9 kg/m vs median 26.9, interquartile range, 24.8-30.0 kg/m, P = .009), and greater proportions of Black (74% vs 36%, P = .0009), hypertensive (79% vs 56%, P = .026), and diabetic patients (44% vs 19%, P = .025) compared with controls. Troponin and N-terminal pro-brain natriuretic peptide levels trended higher in cases, but were not significantly different.
Conclusions
Reduced basal LV strain is common in patients with COVID-19. Patients with hypertension, diabetes, obesity, and Black race were more likely to have reduced basal strain. Further investigation into the significance of this strain pattern is warranted.

Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

J Card Fail: 30 Dec 2020; 27:100-104
Goerlich E, Gilotra NA, Minhas AS, Bavaro N, Hays AG, Cingolani OH
J Card Fail: 30 Dec 2020; 27:100-104 | PMID: 32991982
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Pregnancy Associated Heart Failure with Preserved Ejection Fraction (HFpEF): Risk Factors and Maternal Morbidity: Pregnancy Associated HFpEF.

Briller JE, Mogos MF, Muchira JM, Piano MR
Background
Cardiovascular conditions are leading contributors to rising maternal morbidity and mortality. Heart Failure with preserved ejection fraction (HFpEF) results in the majority of heart failure admissions in women, yet its impact in pregnancy is unknown. We examined prevalence rates, risk factors and adverse pregnancy outcomes in women with HFpEF during pregnancy-related hospitalizations in the United States.
Methods
We conducted a cross-sectional analysis of pregnancy-related hospitalizations from 2002 through 2014 using the National Inpatient Sample. HFpEF cases were identified using the 428.3 International Classification of Diseases, 9 Edition, Clinical Modification code. Weighting variables were used to provide national estimates, unconditional survey logistic regression to generate odds ratios and 95% confidence intervals representing adjusted associations with adverse pregnancy outcomes and Joinpoint regression to estimate temporal trends.
Results
Among 58,732,977 hospitalizations, there were 3,840 HFpEF cases, an overall rate of 7 cases/100,000 pregnancy-related hospitalizations; 56% occurred postpartum, 27% during delivery and 17% antepartum. Temporal trend for hospitalization increased throughout the timeframe by 19.4% (CI: 13.9, 25.1). HFpEF hospitalizations were more common for Black, older, or poor women. Risk factors included hypertension (chronic hypertension and hypertensive disorders of pregnancy), anemia, obesity, diabetes, renal disease and coronary atherosclerosis; all known risk factors for HFpEF. Women with HFpEF were 2.61 to 6.47 times more likely to experience adverse pregnancy outcomes.
Conclusions
Pregnancy-related HFpEF hospitalization prevalence has increased and is associated with adverse pregnancy outcomes. Risk factors resemble those outside pregnancy, emphasizing the need for screening and monitoring women with risk factors during pregnancy for HFpEF.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 30 Dec 2020; epub ahead of print
Briller JE, Mogos MF, Muchira JM, Piano MR
J Card Fail: 30 Dec 2020; epub ahead of print | PMID: 33388469
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

A Case-Control Study of Peripartum Cardiomyopathy Using the Rochester Epidemiology Project: PPCM in the Rochester Epidemiology Project.

Douglass EJ, Cooper JLT, Morales-Lara AC, Adedinsewo DA, ... Blauwet LA, Fairweather D
Background
The incidence of peripartum cardiomyopathy (PPCM) is known through referral center databases that may be affected by referral, misclassification, and other biases. We sought to determine the community-based incidence and natural history of PPCM using the Rochester Epidemiology Project (REP).
Methods and results
Incident cases of PPCM occurring between January 1, 1970 and December 31, 2014 were identified in Olmsted County, Minnesota. A total of 15 PPCM cases were confirmed yielding an incidence of 20.3 cases per 100,000 live births in Olmsted County, Minnesota. Clinical information, disease characteristics and outcomes were extracted from medical records in a 27 county region of the REP including Olmsted County and matched in a 1:2 ratio with pregnant women without PPCM. A total of 48 women were identified with PPCM in the expanded 27 county region. There was one death and no transplants over a median of 7.3 years of follow-up. Six of 23 women with subsequent pregnancies developed recurrent PPCM, all of whom recovered. Migraine and anxiety were identified as novel possible risk factors for PPCM.
Conclusions
The population-based incidence of PPCM was 20.3 cases per 100,000 live births in Olmsted County, Minnesota. Cardiovascular outcomes were generally excellent in this community cohort.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 30 Dec 2020; epub ahead of print
Douglass EJ, Cooper JLT, Morales-Lara AC, Adedinsewo DA, ... Blauwet LA, Fairweather D
J Card Fail: 30 Dec 2020; epub ahead of print | PMID: 33388468
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Risk Prediction for Peripartum Cardiomyopathy in Delivering Mothers: A Validated Risk Model: PPCM Risk Prediction Model.

Davis MB, Jarvie J, Gambahaya E, Lindenfeld J, Kao D
Background
Peripartum cardiomyopathy (PPCM) causes significant morbidity and mortality in childbearing women. Delays in diagnosis lead to worse outcomes; however, no validated risk prediction model exists. We sought to validate a previously described model and identify novel risk factors for PPCM presenting at the time of delivery.
Methods
Administrative hospital records from 5,277,932 patients from 8 states were screened for PPCM, identified by ICD-9 CM codes (674.5x) at the time of delivery. Demographics, comorbidities, procedures, and outcomes were quantified. Performance of a previously published regression model alone and with the addition of novel PPCM-associated characteristics was assessed using receiver operating characteristic area-under-the-curve (AUC) analysis. Novel risk factors were identified using multivariate logistic regression and the likelihood ratio test.
Results
In total, 1186 women with PPCM were studied, including 535/4,003,912 (0.013%) delivering mothers in the derivation set compared with 651/5,277,932 (0.012%) in the validation set. The previously published risk prediction model performed well in both the derivation (AUC 0.822) and validation datasets (AUC 0.802). Novel PPCM-associated characteristics in the combined cohort included diabetes mellitus (OR of PPCM 1.93 [1.23-3.02], p=0.004), mood disorders (OR 1.74 [1.22-2.47], p=0.002), obesity (OR 1.92 [1.45-2.55], p<0.001), and Medicaid insurance (OR 1.54 [1.22-1.96], p<0.001).
Conclusions
This is the first validated risk prediction model to identify women at increased risk for PPCM at the time of delivery. Diabetes mellitus, obesity, mood disorders, and lower socioeconomic status are risk factors associated with PPCM. This model may be useful for identifying women at risk and preventing delays in diagnosis.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 30 Dec 2020; epub ahead of print
Davis MB, Jarvie J, Gambahaya E, Lindenfeld J, Kao D
J Card Fail: 30 Dec 2020; epub ahead of print | PMID: 33388467
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Effects of low-level tragus stimulation on endothelial function in heart failure with reduced ejection fraction.

Dasari TW, Csipo T, Amil F, Lipecz A, ... Yabluchanskiy A, Po SS
Background
Autonomic dysregulation in HFrEF plays a major role in endothelial dysfuction. Low level Tragus stimulation (LLTS) is a novel, non-invasive method of autonomic modulation.
Methods
We enrolled 50 HFrEF patients (LVEF≤40%) in a randomized, double-blinded, crossover study. Day 1: patients underwent 60 minutes of LLTS with a transcutaneous stimulator (20Hz, 200 μs pulse width) or sham (ear lobule) stimulation. Macrovascular function was assessed using flow mediated dilatation (FMD) in brachial artery and cutaneous microcirculation with laser speckle contrast imaging in hand and nail bed. Day 2: patients were crossed over to other study arm and underwent sham or LLTS; vascular tests were repeated pre- and post-stimulation.
Results
Compared to sham, LLTS improved FMD by increasing the %-change in brachial artery diameter (5 to 7.5, LLTS on day 1, p=0.02; 4.9 to 7.1, LLTS on day 2, p= 0.003), compared to no significant change in the sham group (4.6 to 4.7, p=0.84 on day 1 and 5.6 to 5.9, p=0.65 on day 2). Cutaneous microcirculation in hand showed no improvement and perfusion of nail bed showed a trend towards improvement.
Conclusion
Our study demonstrated beneficial effects of acute neuromodulation on macrovascular function. Larger studies to validate these findings and understand mechanistic links are warranted.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 29 Dec 2020; epub ahead of print
Dasari TW, Csipo T, Amil F, Lipecz A, ... Yabluchanskiy A, Po SS
J Card Fail: 29 Dec 2020; epub ahead of print | PMID: 33387632
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Case Reports of Implantable Cardiac Device Physiologic Sensor Changes in Subjects with COVID-19 Infection.

Shumway JL, Stolen CM, Ahmed R, Plumer M, Capodilupo RC

The SARS-CoV-2 pandemic has established a new set of challenges to healthcare delivery. Remotely monitored physiologic sensors on implantable cardiac devices can provide insight into the differential diagnosis of dyspnea in the heart failure population. We report on a unique pattern of sensor deviations that appear to occur specifically with SARS-CoV-2 infection.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 28 Dec 2020; epub ahead of print
Shumway JL, Stolen CM, Ahmed R, Plumer M, Capodilupo RC
J Card Fail: 28 Dec 2020; epub ahead of print | PMID: 33385524
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Impact of Right Atrial Remodeling in Heart Failure with Preserved Ejection Fraction.

Ikoma T, Obokata M, Okada K, Harada T, ... Kurabayashi M, Murakami M
Background
Few studies have investigated right atrial (RA) remodeling in heart failure (HF) with a preserved ejection fraction (HFpEF). This study sought to characterize the RA remodeling in HFpEF and to determine its prognostic significance.
Methods and results
Patients with HFpEF were classified based on the presence of RA enlargement (RA volume index >39 mL/m in men and >33 mL/m in women). Compared to patients with normal RA size (n=234), patients with RA dilation (n=67) showed a higher prevalence of atrial fibrillation (AF), worse right ventricular (RV) systolic function, more severe pulmonary hypertension (PH), and higher prevalence of mild tricuspid regurgitation (TR), and impaired RA reservoir function, with increased hepatobiliary enzyme levels. AF was strongly associated with the presence of RA dilation (odds ratio [OR] 10.2, CI [4.00-26.1] current AF vs no AF and OR 3.38, CI 1.26-9.07, earlier AF vs no AF). Patients with RA dilation had more than two-fold increased risk of composite outcomes of all-cause mortality or HF hospitalization (adjusted HR 2.01, 95% CI, 1.09-3.70-, p=0.02). The presence of RA dilation also displayed an additive prognostic value over left atrial dilation alone.
Conclusions
These data demonstrate that HFpEF with RA remodeling is associated with distinct echocardiographic features characterizing advanced right heart dysfunction with an increased risk of adverse outcomes.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 28 Dec 2020; epub ahead of print
Ikoma T, Obokata M, Okada K, Harada T, ... Kurabayashi M, Murakami M
J Card Fail: 28 Dec 2020; epub ahead of print | PMID: 33385523
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Phosphodiesterase-5 Inhibitors and Outcomes During Left Ventricular Assist Device Support: A Systematic Review and Meta-Analysis.

Kittipibul V, Blumer V, Angsubhakorn N, Hernandez GA, ... Tedford RJ, Agarwal R
Background
Phosphodiesterase-5 Inhibitors (PDE5i) have been used to treat pulmonary hypertension and right ventricular failure (RVF) in patients with left ventricular assist devices (LVAD). Effects of PDE5i on post-LVAD outcomes including hemocompatibility-related adverse events (HRAE) are not well established.
Objective
This systematic review and meta-analysis aims to evaluate the effects of PDE5i on post-LVAD outcomes.
Methods
A comprehensive literature search was conducted using Pubmed and Embase databases from inception through November 25, 2020 to compare post-LVAD outcomes in patients with or without PDE5i use. Pooled odds ratio (OR) with 95% confidence intervals (CI) and I statistic were calculated.
Results
Thirteen observational studies were included in this analysis. Use of PDE5i was not significantly associated with lower postoperative RVF (OR 0.38, 95%CI 0.02-5.96, p=0.41). There was no significant association between PDE5i and gastrointestinal (GI) bleeding (OR 1.23, 95%CI 0.76-1.98, p=0.2), overall stroke (OR 0.60, 95%CI 0.21-1.68, p=0.17), ischemic stroke (OR 0.61, 95%CI 0.09-4.07, p=0.38), and pump thrombosis (OR 0.71, 95%CI 0.14-3.54, p=0.46).
Conclusions
Our meta-analysis showed no significant association between PDE5i and post-LVAD RVF. Despite the anti-platelet effects of PDE5i, there was no significant association between PDE5i and GI bleeding, overall stroke, ischemic stroke, and pump thrombosis. Randomized-controlled studies are warranted to evaluate the net benefits or harms of PDE5i in LVAD population.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 28 Dec 2020; epub ahead of print
Kittipibul V, Blumer V, Angsubhakorn N, Hernandez GA, ... Tedford RJ, Agarwal R
J Card Fail: 28 Dec 2020; epub ahead of print | PMID: 33385522
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Implantation of an Atrial Flow Regulator in a Child on Venoarterial Extracorporeal Membrane Oxygenator as a Bridge to Heart Transplant: A Case Report.

Piccinelli E, Castro-Verdes MB, Fraisse A, Bautista-Rodriguez C
Background
Balloon dilation and stenting of the atrial septum are techniques used to unload left heart cavities in acute or end-stage heart failure in children. However, they carry significant risks such as tamponade or device embolization.
Case presentation
We report the first case of a child with an end-stage mitochondrial cardiomyopathy on a venoarterial extracorporeal membrane oxygenator as a bridge to heart transplant where an atrial flow regulator device has been implanted.
Conclusions
This case illustrates the feasibility and safety of atrial flow regulator implantation in this setting. This procedure allowed to wean inotropic support while awaiting heart transplantation.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 23 Dec 2020; epub ahead of print
Piccinelli E, Castro-Verdes MB, Fraisse A, Bautista-Rodriguez C
J Card Fail: 23 Dec 2020; epub ahead of print | PMID: 33242607
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Influence of Donor Transmitted and Rapidly Progressive Coronary Vascular Disease on Long Term Outcomes After Heart Transplantation: A Contemporary Intravascular Ultrasound Analysis.

Sperry BW, Qarajeh R, Omer MA, Brandt H, ... Kao AC, Austin BA
Background
Donor transmitted atherosclerosis (DTA) and rapidly progressive cardiac allograft vasculopathy (CAV) at 1-year are intravascular ultrasound (IVUS)-derived measures shown to predict adverse cardiovascular outcomes in the setting of early generation immunosuppressive agents. Given the paucity of data on the prognostic value of IVUS-derived measurements in the current era, we sought to explore their association with adverse outcomes after heart transplantation.
Methods
This is a retrospective cohort analysis of patients who underwent heart transplantation at our center between 1/2009 and 6/2016 with baseline and 1-year IVUS. Five IVUS sections were prospectively analyzed for intimal thickness and lumen area. DTA was defined as maximum intimal thickness ≥0.5 mm at baseline, and rapidly progressive CAV as an increase in maximum intimal thickness by ≥0.5 mm at 1-year. Our primary analysis assessed the relationship of IVUS and other clinical data on a composite outcome: coronary intervention, CAV stage 2 or 3 (defined by ISHLT 2010 nomenclature), or cardiovascular death.
Results
A total of 249 patients (mean age 51.0 +/- 12.2 years and 74.3% male) were included in the analysis. DTA was detected in 118 (51.4%) patients. Over a median follow-up of 6.1 (IQR 4.2 - 8.0) years, 45 patients met the primary endpoint (23 PCI, 11 CAV 2 or 3, and 11 cardiovascular deaths as first event). DTA and rapidly progressive CAV were not associated with the primary endpoint nor with all-cause mortality or retransplantation. In an additional analysis including post-transplant events, incident rejection was strongly associated with poor outcomes, while cytomegalovirus infection was not.
Conclusions
In this contemporary cohort, IVUS-derived DTA and rapidly progressive CAV were not associated with medium to long term adverse events after heart transplantation.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 20 Dec 2020; epub ahead of print
Sperry BW, Qarajeh R, Omer MA, Brandt H, ... Kao AC, Austin BA
J Card Fail: 20 Dec 2020; epub ahead of print | PMID: 33358960
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Bariatric Surgery in Patients with Obesity and Ventricular Assist Devices Considered for Heart Transplantation: Systematic Review and Individual Participant Data Meta-analysis.

deAbreu AD, Alhafez BA, Curbelo-Pena Y, Lavie CJ, ... Loro-Ferrer JF, Mandras SA
Background
Class II obesity (≥ 35 kg/m) is a contraindication for heart transplantation (HT). Although few single-center studies (case reports/series and small cohorts) have reported promising outcomes of bariatric surgery (BS) in patients with obesity and ventricular assist devices (VADs), low sample sizes have made their analysis and interpretation challenging.
Methods
We conducted a systematic search in ClinicalTrials.gov, Cochrane, Embase, PubMed, Google Scholar, and most relevant bariatric and heart failure journals. We extracted baseline and outcome individual participant data for every VAD patient undergoing BS with reported postoperative BMI and their respective timepoints when BMI data were measured.
Results
Fourteen references with 29 patients were included. The mean age was 41.9 (± 12.2) years, 82.8% underwent laparoscopic sleeve gastrectomy, and 39.3% had reported perioperative adverse events. Mean pre-BS BMI was 45.5 (± 6.6) kg/m and decrease significantly during follow-up (rho -0.671; p < 0.00001). Among 23 patients with documented listing status, 78.3% got listed for HT. Thirteen (46.4%) of 28 patients underwent HT at 14.4 (± 7) months. There were no reported deaths for the HT-free 1-year period. Median follow-up was 24 (12-30) months. Twenty-two (78.6%) of 28 patients achieved the composite outcome (BMI < 35 kg/m/HT/listing for HT/myocardial recovery) at 11 (3-17) months. Patients with non-ischemic cardiomyopathy or BMI < 45 kg/m had higher chances of achieving the composite outcome (p values < 0.05).
Conclusions
Bariatric surgery may help patients with obesity and VADs to lose significant amount of weight and improve their candidacy for HT or even achieve myocardial recovery.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 20 Dec 2020; epub ahead of print
deAbreu AD, Alhafez BA, Curbelo-Pena Y, Lavie CJ, ... Loro-Ferrer JF, Mandras SA
J Card Fail: 20 Dec 2020; epub ahead of print | PMID: 33358959
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Effects of Depression on Heart Failure Self-Care.

Freedland KE, Skala JA, Steinmeyer BC, Carney RM, Rich MW
Background
Depression has been identified as a barrier to effective heart failure self-care, but recent studies suggest that the relationship between depression and self-care is more complex than was previously believed. This study was designed to clarify the relationship between depression and self-care in hospitalized patients with HF.
Methods
During hospitalization with a confirmed clinical diagnosis of HF, 400 patients completed a structured interview to diagnose DSM-5 depressive disorders, the PHQ-9 depression questionnaire, the Self-Care of Heart Failure Index (SCHFI), and several psychosocial questionnaires. Multivariable models were fitted to each SCHFI scale; separate models were run with DSM-5 disorders and PHQ-9 depression scores.
Results
Higher PHQ-9 depression scores were independently associated with lower (worse) scores on the SCHFI Maintenance (p<.05), Management (p<.01), and Confidence (p<.01) scales. No independent associations with DSM-5 depressive disorders were detected. Measures of perceived stress, anxiety, and low perceived social support were also significantly associated with poor HF self-care.
Conclusions
Patients with a combination of psychosocial problems, including symptoms of depression, stress, anxiety, and inadequate social support, may be more likely than other patients to display difficulties with HF self-care that can increase their risk for hospitalization. Research is needed on \"broad-spectrum\" psychosocial interventions for patients with HF self-care deficits.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 20 Dec 2020; epub ahead of print
Freedland KE, Skala JA, Steinmeyer BC, Carney RM, Rich MW
J Card Fail: 20 Dec 2020; epub ahead of print | PMID: 33358958
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Limited balloon atrial septostomy for left ventricular unloading in peripheral extracorporeal membrane oxygenation.

Amancherla K, Menachem JN, Shah AS, Lindenfeld J, O\'Leary J
Objectives
This study describes the authors\' experience with a limited balloon atrial septostomy (BAS) technique, using a median balloon size of 15 mm, as a left ventricular (LV) unloading strategy in veno-arterial extracorporeal membrane oxygenation (VA-ECMO).
Background
There has been increasing use of VA-ECMO in cardiogenic shock. While LV unloading strategies have been suggested to improve outcomes, it is unclear which strategy is optimal.
Methods
We performed a retrospective study of patients who underwent a limited BAS for LV unloading in peripheral VA-ECMO at a single center. The goal of this study was to define the procedural outcomes and clinical characteristics of these patients.
Results
Of the 12 patients identified, none had complications related to the procedure. There was a significant decrease in mean left atrial pressure and the majority of patients had radiological improvement in pulmonary vascular congestion. Of the twelve patients, 58.3% survived to discharge.
Conclusions
Limited BAS is an elegant and safe method for unloading the LV in peripheral VA-ECMO.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 20 Dec 2020; epub ahead of print
Amancherla K, Menachem JN, Shah AS, Lindenfeld J, O'Leary J
J Card Fail: 20 Dec 2020; epub ahead of print | PMID: 33358956
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Intravenous Infusion of the β-Adrenergic Receptor Antagonist APD418 Improves Left Ventricular Systolic Function in Dogs with Systolic Heart Failure: β-Adrenergic Receptor Antagonist in Heart Failure.

Sabbah HN, Zhang K, Gupta RC, Xu J, ... Nguyen N, Adams J
Background
Unlike β- and β-adrenergic receptors (ARs), β-AR stimulation inhibits cardiac contractility and relaxation. In the failing left ventricular (LV) myocardium, β-ARs are upregulated, and can be maladaptive in the setting of decompensation by contributing to LV dysfunction. This study examined the effects of intravenous (i.v.) infusions of the β-AR antagonist APD418 on cardiovascular function and safety in dogs with systolic heart failure (HF).
Methods
Three separate studies were performed in 21 dogs with coronary microembolization-induced HF (LV ejection fraction, LVEF∼35%). Studies 1 and 2 (n=7 dogs each) were APD418 dose-escalation studies (dosing range 0.35 to 15.0 mg/kg/hr) designed to identify an effective dose of APD418 to be used in study 3. Study 3, the sustained efficacy study, (n=7 dogs) was a 6-hour constant i.v. infusion of APD418 at a dose of 4.224 mg/kg (0.70 mg/kg/hr) measuring key hemodynamic endpoints (e.g. EF, CO, Ei/Ai).
Results
Study 1 and 2 showed a dose-dependent increase of LVEF and Ei/Ai, the latter being an index of LV diastolic function. In study 3, infusion of APD418 over 6 hours increased LVEF from 31±1% to 38±1% (p<0.05) and increased Ei/Ai from 3.4±0.4 to 4.9±0.5, (p<0.05). Vehicle had no effect on LVEF or Ei/Ai. In study 3, APD418 had no significant effects on HR or systemic blood pressure.
Conclusions
Intravenous infusions of APD418 in dogs with systolic HF elicit significant positive inotropic and lusitropic effects. The findings support the development of APD418 for the in-hospital treatment of patients with acute exacerbation of chronic HF.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 18 Dec 2020; epub ahead of print
Sabbah HN, Zhang K, Gupta RC, Xu J, ... Nguyen N, Adams J
J Card Fail: 18 Dec 2020; epub ahead of print | PMID: 33352205
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Contemporary Use of Veno-Arterial ECMO: Insights from the Multi-Center RESCUE Registry.

Loungani RS, Fudim M, Ranney D, Kochar A, ... DeVore AD, Daneshmand M
Background
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly utilized as life-saving therapy for patients with cardiovascular collapse, but identifying patients unlikely to benefit remains a challenge.
Methods and results
We created the RESCUE registry, a retrospective, observational registry of adult patients treated with VA-ECMO between January 2007 and June 2017 at three high-volume centers (Columbia University, Duke University, and Washington University) to describe short-term patient outcomes. In 723 patients treated with VA-ECMO, the most common indications for deployment were post-cardiotomy shock (31%), cardiomyopathy (including acute heart failure) (26%), and myocardial infarction (17%). Patients frequently suffered in-hospital complications, including acute renal dysfunction (45%), major bleeding (41%), and infection (33%). Only 40% (n=290) survived to discharge, with a minority receiving durable cardiac support (LVAD [n=48] or heart transplant [n=7]). Multivariable regression analysis identified risk factors for mortality on ECMO as older age (OR 1.26 [1.12-1.42]) and female sex (OR 1.44 [1.02-2.02]) and risk factors for mortality after decannulation as higher BMI (OR 1.17 [1.01-1.35]) and major bleeding while on ECMO support (OR 1.92 [1.23-2.99]).
Conclusions
Despite contemporary care at high-volume centers, patients treated with VA-ECMO continue to have significant in-hospital morbidity and mortality. Optimization of outcomes will require refinements in patient selection and improvement of care delivery.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 17 Dec 2020; epub ahead of print
Loungani RS, Fudim M, Ranney D, Kochar A, ... DeVore AD, Daneshmand M
J Card Fail: 17 Dec 2020; epub ahead of print | PMID: 33347997
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Diuresis-Related Weight Loss Reflects Interstitial Compartment Decongestion with Minimal Impact on Intravascular Volume Expansion or Outcomes in Post-Acute Heart Failure: Metrics of Decongestion and Volume Status.

Miller WL, Lobo R, Grill DE, Mullan BP
Background
Findings from heart failure (HF) studies linking diuresis-related weight loss to clinical decongestion and outcomes are mixed. Differential responses of interstitial and intravascular volume compartments to diuretic therapy and heterogeneity in volume profiles may confound the clinical interpretation of weight loss in HF patients.
Methods
Data were prospectively collected in hospitalized patients requiring diuresis. Plasma volume (PV) was measured using I-131-labelled albumin indicator-dilution methodology. Cohort was stratified by tertiles of weight loss and analyzed for interstitial fluid loss relative to changes in PV and HF-related morality or 1 re-hospitalization.
Results
Among 92 patients admission PV was expanded +42% (4.7±1.2 L) above normal with significant variability [14% normal PV, 18% mild-moderate expansion, and 68% with large PV expansion (>+25% above normal)]. With diuresis there were proportional decreases in interstitial volume (-6.5±4.4%) and PV (-7.5±11%), however, absolute reductions in PV [-254(-11,-583) mL] were <10% of interstitial volume loss [-5040 (-2800,-7989) mL]; greater interstitial fluid loss did not translate into better outcomes (log-rank p=0.430).
Conclusions
Diuresis-related decreases in weight reflect fluid loss from the interstitial compartment with only minor changes in PV and without impact on outcomes. Further, the degree of PV expansion at hospital admission does not drive the magnitude of the diuresis response even with a wide spectrum of body weights; interstitial fluid overload is preferentially targeted and PV relatively preserved. Therefore, greater interstitial fluid loss reflects clinical decongestion, but not better outcomes, and a limited association with intravascular volume profiles potentially confounding weight loss as a prognostic metric in HF.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 17 Dec 2020; epub ahead of print
Miller WL, Lobo R, Grill DE, Mullan BP
J Card Fail: 17 Dec 2020; epub ahead of print | PMID: 33347996
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Exercise Tolerance in Patients Treated with a Durable Left Ventricular Assist Device: Importance of Myocardial Recovery: LV recovery and exercise in LVAD patients.

Dridi NP, Vishram-Nielsen JK, Gustafsson F

The number of patients supported with left ventricular assist devices (LVADs) is growing and support times are increasing. This has led to a greater focus on functional capacity of these patients. LVADs greatly improve heart failure (HF) symptoms, but surprisingly, improvement in peak oxygen uptake (pVO2) is small and remains reduced at approximately 50 % of normal values. Inadequate increase in cardiac output (CO) during exercise is the main responsible factor for the low pVO2 in LVAD recipients. Some patients experience left ventricular (LV) recovery during mechanical unloading and these patients have a higher pVO2. Here we review the various components determining exercise CO in LVAD recipients and discuss the potential impact of cardiac recovery on these components. LV recovery may affect several components leading to improved hemodynamics during exercise and, in turn, physical capacity in patients with advanced HF undergoing LVAD implantation.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 17 Dec 2020; epub ahead of print
Dridi NP, Vishram-Nielsen JK, Gustafsson F
J Card Fail: 17 Dec 2020; epub ahead of print | PMID: 33347995
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Delirium among Hospitalized Older Adults with Acute Heart Failure Exacerbation.

Kwak MJ, Avritscher E, Holmes HM, Jantea R, ... Balan P, Dhoble A
Background
Delirium among older adults hospitalized with acute heart failure is associated with increased mortality. However, studies concomitantly assessing the association of delirium with both clinical and economic outcomes in this population, such as mortality, hospital cost or length of stay are lacking.
Methods
We conducted a retrospective observational study using National Inpatient Sample data from 2011 to 2014. Using multivariable logistic regression, we assessed the association of delirium with in-hospital mortality, then estimated the incremental hospital cost, and excessive length of stay adjusting for demographic and clinical factors using multivariable generalized linear regression. The association of other medical complications on clinical and economic outcomes was also assessed.
Results
A total of 568,565 (weighted N = 2,826,131) hospitalizations of patients 65 years or older with acute heart failure from 2011-2014 were included in the final analysis. The reported prevalence of delirium was 4.53%. After multivariable adjustment, delirium was associated with a 2.35-fold increase in the odds of in-hospital mortality (95% Confidence Interval (CI) 2.23 - 2.47), which was lower than the odds ratio for sepsis/septicemia (5.36 (95% CI 5.02 - 5.72)) or respiratory failure (4.53 (95% CI 4.38 - 4.69)), but similar to that for acute kidney injury (AKI) (2.39 (95% CI 2.31 - 2.48)) and higher than for non-ST elevation myocardial infarct (NSTEMI) (1.57 (95% CI 1.46 - 1.68)). Delirium increased total hospital cost by $4,262 (95% CI of $4,002 - 4,521) and length of stay by 1.73 days (95% CI 1.68 - 1.78), which was slightly lower than, but similar to AKI ($4,771 (95% CI $4,644 - 4,897) and 1.82 days (95% CI 1.79 - 1.84)), and higher than NSTEMI ($1,907 (95% CI $1,629 - 2,185) and 0.31 days (95% CI 0.25 - 0.37)).
Conclusions
Delirium was associated with increased in-hospital mortality, total hospital cost, and length of stay, and the magnitude of the effect was similar to that for AKI. Enhanced efforts to prevent delirium are needed to reduce its adverse impact on clinical and economic outcomes for hospitalized older adults with acute heart failure.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 17 Dec 2020; epub ahead of print
Kwak MJ, Avritscher E, Holmes HM, Jantea R, ... Balan P, Dhoble A
J Card Fail: 17 Dec 2020; epub ahead of print | PMID: 33347994
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Potential Utility of Cardio-Renal Biomarkers For Prediction and Prognostication of Worsening Renal Function in Acute Heart Failure: Cardio-Renal Biomarkers and WRF in AHF.

Horiuchi Y, Wettersten N, van Veldhuisen DJ, Mueller C, ... Maisel A, Murray PT
Background
Multiple different pathophysiologic processes can contribute to worsening renal function (WRF) in acute heart failure (AHF).
Methods and results
We retrospectively analyzed 787 AHF patients for the relationship between changes in serum creatinine and biomarkers including brain natriuretic peptide (BNP), high sensitivity cardiac troponin I (hscTnI), galectin 3, serum neutrophil gelatinase-associated lipocalin (NGAL) and urine NGAL. WRF was defined as an increase of ≥ 0.3 mg/dl or 50% in creatinine within first 5 days of hospitalization. WRF was observed in 25% of patients. Changes in biomarkers and creatinine were poorly correlated (r ≤ 0.21) and no biomarker predicted WRF better than creatinine. In the multivariable Cox analysis, BNP and hscTnI, but not WRF, were significantly associated with the one-year composite of death or HF hospitalization. WRF with an increasing urine NGAL predicted an increased risk of HF hospitalization.
Conclusions
Biomarkers were not able to predict WRF better than creatinine. One-year outcomes were associated with biomarkers of cardiac stress and injury but not with WRF, while a kidney injury biomarker may prognosticate WRF for HF hospitalization.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 05 Dec 2020; epub ahead of print
Horiuchi Y, Wettersten N, van Veldhuisen DJ, Mueller C, ... Maisel A, Murray PT
J Card Fail: 05 Dec 2020; epub ahead of print | PMID: 33296713
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Heart Failure in Patients Undergoing Elective and Emergency Noncardiac Surgery: Still a Poorly Addressed Risk Factor.

Faxén UL, Hallqvist L, Benson L, Schrage B, Lund LH, Bell M
Background
Noncardiac surgery is increasingly offered to an older, more comorbid population. The aim was to characterize patients with the diagnosis of heart failure (HF) undergoing elective and emergency noncardiac surgery in a broad, contemporary Swedish cohort, and to assess the short- and long-term mortality in patients with HF as compared with patients without HF.
Methods and results
Data from 200,638 and 97,129 patients undergoing elective and emergency surgical procedures at 23 Swedish university, county, and district hospitals during 2007 to 2013 were analyzed through linkage of the surgical Orbit Database to the National Patient and the Cause of Death registries. In total 7212 patients (3.6%) with a diagnosis of HF before surgery underwent elective and 6455 patients (6.6%) underwent emergency surgery. Patients with HF were older had more comorbidities, and higher mortality than patients without HF. Crude and adjusted risk ratios for 30-day mortality after elective surgery were 5.36 (95% confidence interval [CI] 4.67-6.16) and 1.79 (95% CI 1.50-2.14) (adjusted for comorbidities, surgical risk level, age, and sex). Corresponding data for emergency surgery was 3.84 (95% CI 3.58-4.12) and 1.48 (95% CI 1.31-1.62). Mortality in patients with HF after elective surgery at 30 days, 90 days, and 1 year was 3.2%, 6.5%, and 16.2% and after emergency surgery it was 13.7%, 22.4%, and 39.3%.
Conclusions
Patients with HF undergoing elective or emergency noncardiac surgery in a modern surgical setting have a substantial mortality risk and HF is both a risk factor and a strong marker for increasd risk. The reasons for the high mortality are not well-understood and warrant further attention.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 29 Nov 2020; 26:1034-1042
Faxén UL, Hallqvist L, Benson L, Schrage B, Lund LH, Bell M
J Card Fail: 29 Nov 2020; 26:1034-1042 | PMID: 32652244
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Lymphocytopenia During Hospitalization for Acute Heart Failure and Its Relationship With Portal Congestion and Right Ventricular Function.

Bouabdallaoui N, Sirois MG, Beaubien-Souligny W, Denault AY, Rouleau JL
Background
Lymphocytopenia is associated with mortality in acute heart failure (AHF), and portal congestion has been suggested to play a role in leukocyte distribution. The associations between lymphocytopenia and ultrasound surrogates for portal congestion have never been studied. We aimed to characterize the determinants of lymphocytopenia, explore the associations between lymphocytopenia and portal congestion, and explore the relationships between lymphocytopenia and outcomes in AHF.
Methods and results
Patients were compared according to tertiles of lymphocyte count (very low, <0.87 × 10/L; low, 0.87-1.2 × 10/L; or normal, >1.2 × 10/L). One hundred three patients with AHF were prospectively assessed at baseline and discharge. At baseline, 69% of patients had a lymphocyte count below the normal range. Patients with baseline very low lymphocyte count were older, had more advanced disease and higher portal vein pulsatility index when compared with those in the higher tertiles. Very low lymphocyte count at baseline was associated with age (odds ratio (OR) 1.098), portal vein pulsatility index (OR, 1.026), and tricuspid annular plane systolic excursion (OR, 0.865, all P < .05). The portal vein pulsatility index was the most powerful determinant of lymphocytopenia at discharge (OR 1.033, P < .05). In a Cox model, lymphocytopenia at discharge was associated with mortality (hazard ratio 4.796, P < .05).
Conclusions
In AHF, lymphocytopenia is associated with ultrasound surrogates for portal congestion and right ventricular dysfunction. Whether these associations depict a potent pathophysiologic pathway or whether they only reflect a more advanced disease remains uncertain.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 29 Nov 2020; 26:1043-1049
Bouabdallaoui N, Sirois MG, Beaubien-Souligny W, Denault AY, Rouleau JL
J Card Fail: 29 Nov 2020; 26:1043-1049 | PMID: 32659436
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Metabolomic Profile in HFpEF vs HFrEF Patients.

Hage C, Löfgren L, Michopoulos F, Nilsson R, ... Persson H, Linde C
Background
Heart failure with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) are associated with metabolic derangements, which may have different pathophysiological implications.
Methods and results
In new-onset HFpEF (EF of ≥50%, n = 46) and HFrEF (EF of <40%, n = 75) patients, 109 endogenous plasma metabolites including amino acids, phospholipids and acylcarnitines were assessed using targeted metabolomics. Differentially altered metabolites and associations with clinical characteristics were explored. Patients with HFpEF were older, more often female with hypertension, atrial fibrillation, and diabetes compared with patients with HFrEF. Patients with HFpEF displayed higher levels of hydroxyproline and symmetric dimethyl arginine, alanine, cystine, and kynurenine reflecting fibrosis, inflammation and oxidative stress. Serine, cGMP, cAMP, l-carnitine, lysophophatidylcholine (18:2), lactate, and arginine were lower compared with patients with HFrEF. In patients with HFpEF with diabetes, kynurenine was higher (P = .014) and arginine lower (P = .014) vs patients with no diabetes, but did not differ with diabetes status in HFrEF. Decreasing kynurenine was associated with higher eGFR only in HFpEF (P = .020).
Conclusions
Patients with new-onset HFpEF compared with patients with new-onset HFrEF display a different metabolic profile associated with comorbidities, such as diabetes and kidney dysfunction. HFpEF is associated with indices of increased inflammation and oxidative stress, impaired lipid metabolism, increased collagen synthesis, and downregulated nitric oxide signaling. Together, these findings suggest a more predominant systemic microvascular endothelial dysfunction and inflammation linked to increased fibrosis in HFpEF compared with HFrEF.
Clinical trial registration
ClinicalTrials.gov NCT03671122 https://clinicaltrials.gov.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 29 Nov 2020; 26:1050-1059
Hage C, Löfgren L, Michopoulos F, Nilsson R, ... Persson H, Linde C
J Card Fail: 29 Nov 2020; 26:1050-1059 | PMID: 32750486
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Performance of Electronic Health Record Diagnosis Codes for Ambulatory Heart Failure Encounters.

Goyal P, Bose B, Creber RM, Krishnan U, ... Brady J, Pathak J
Background
There is interest in leveraging the electronic medical records (EMRs) to improve knowledge and understanding of patients\' characteristics and outcomes of patients with ambulatory heart failure (HF). However, the diagnostic performance of International Classification of Diseases (ICD) -10 diagnosis codes from the EMRs for patients with HF and with reduced or preserved ejection fraction (HFrEF or HFpEF) in the ambulatory setting are unknown.
Methods
We examined a cohort of patients aged ≥ 18 with at least 1 outpatient encounter for HF between January 2016 and June 2018 and an echocardiogram conducted within 180 days of the outpatient encounter for HF. We defined HFrEF encounters as those with ICD-10 codes of I50.2x (systolic heart failure); and we defined HFpEF encounters as those with ICD-10 codes of I50.3x (diastolic heart failure). The referent definitions of HFrEF and HFpEF were based on echocardiograms conducted within 180 days of the ambulatory encounter for HF
Results:
We examined 68,952 encounters of 14,796 unique patients with HF. The diagnostic performance parameters for HFrEF (based on ICD-10 I50.2x only) depended on LVEF cutoff, with a sensitivity ranging from 68%-72%, specificity 63%-68%, positive predictive value 47%-63%, and negative predictive value 73%-84%. The diagnostic performance parameters for HFpEF depended on left ventricular ejection fraction cut-off, with sensitivity ranging from 34%-39%, specificity 92%-94%, positive predictive value 86%-93%, and negative predictive value 39%-54%.
Conclusions
ICD-10 coding abstracted from the EMR for HFrEF vs HFpEF in the ambulatory setting had suboptimal diagnostic performance and, thus, should not be used alone to examine HFrEF and HFpEF in the ambulatory setting.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 29 Nov 2020; 26:1060-1066
Goyal P, Bose B, Creber RM, Krishnan U, ... Brady J, Pathak J
J Card Fail: 29 Nov 2020; 26:1060-1066 | PMID: 32755626
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Transition to Advanced Therapies in Elderly Patients Supported by Extracorporeal Membrane Oxygenation Therapy.

Chouairi F, Vallabhajosyula S, Mullan C, Mori M, ... Ahmad T, Miller PE
Background
Although the use of extracorporeal membrane oxygenation (ECMO) continues to increase, very little is known about how age influences the transition to definitive advanced therapies.
Methods
Using the National Inpatient Sample database from 2008 to 2017, we analyzed patients supported by ECMO for cardiogenic shock and separated patients into 2 age cohorts: < 65 years and ≥ 65 years. Primary outcomes of interest included the proportion of patients undergoing orthotopic cardiac transplantation (OHT) and left ventricular assist device (LVAD) implantation.
Results
Over the study period, we identified 16,132 hospitalizations of people with cardiogenic shock requiring ECMO support. Significantly fewer patients in the older group underwent OHT compared to the younger group (0.4% vs 1.2%, P < 0.001). Compared to the younger group, a lower proportion of those ≥ 65 years received an LVAD (3.7% vs 5.8%, P < 0.001). LVAD implantation increased over the study period in both age cohorts, whereas OHT increased only in the < 65 group (P < 0.05, all). After multivariable adjustment, patients in the oldest age group were still less likely to receive an LVAD (odds ratio 0.54; confidence interval: 0.43-0.69, P < 0.001) and continued to have the highest odds of in-hospital mortality (odds ratio 1.53; confidence interval : 1.39-1.69, P < 0.001).
Conclusions
Survival of patients ≥ 65 years requiring ECMO for cardiogenic shock is poor and less commonly includes transition to definitive advanced therapies. Although we must stress that no patient should be denied ECMO based solely on age, we believe our results may be helpful for providers when counseling patients and their families.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 29 Nov 2020; 26:1086-1089
Chouairi F, Vallabhajosyula S, Mullan C, Mori M, ... Ahmad T, Miller PE
J Card Fail: 29 Nov 2020; 26:1086-1089 | PMID: 32777479
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiovascular Magnetic Resonance May Avoid Unnecessary Coronary Angiography in Patients With Unexplained Left Ventricular Systolic Dysfunction: A Retrospective Diagnostic Pilot Study.

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

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 29 Nov 2020; 26:1067-1074
Desroche LM, Milleron O, Safar B, Ou P, ... Ronchard T, Jondeau G
J Card Fail: 29 Nov 2020; 26:1067-1074 | PMID: 32942010
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Novel BAG3 Variants in African American Patients With Cardiomyopathy: Reduced β-Adrenergic Responsiveness in Excitation-Contraction.

Feldman AM, Gordon J, Wang J, Song J, ... Khalili K, Cheung JY
Background
We reported 3 novel nonsynonymous single nucleotide variants of Bcl2-associated athanogene 3 (BAG3) in African Americans with heart failure (HF) that are associated with a 2-fold increase in cardiac events (HF hospitalization, heart transplantation, or death).
Methods and results
We expressed BAG3 variants (P63A, P380S, and A479V) via adenovirus-mediated gene transfer in adult left ventricular myocytes isolated from either wild-type (WT) or cardiac-specific BAG3 haploinsufficient (cBAG3) mice: the latter to simulate the clinical situation in which BAG3 variants are only found on 1 allele. Compared with WT myocytes, cBAG3 myocytes expressed approximately 50% of endogenous BAG3 levels and exhibited decreased [Ca] and contraction amplitudes after isoproterenol owing to decreased L-type Ca current. BAG3 repletion with WT BAG3 but not P380S, A479V, or P63A/P380S variants restored contraction amplitudes in cBAG3 myocytes to those measured in WT myocytes, suggesting excitation-contraction abnormalities partly account for HF in patients harboring these mutants. Because P63A is near the WW domain (residues 21-55) and A479V is in the BAG domain (residues 420-499), we expressed BAG3 deletion mutants (Δ1-61 and Δ421-575) in WT myocytes and demonstrated that the BAG but not the WW domain was involved in enhancement of excitation-contraction by isoproterenol.
Conclusions
The BAG3 variants contribute to HF in African American patients partly by decreasing myocyte excitation-contraction under stress, and that both the BAG and PXXP domains are involved in mediating β-adrenergic responsiveness in myocytes.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 29 Nov 2020; 26:1075-1085
Feldman AM, Gordon J, Wang J, Song J, ... Khalili K, Cheung JY
J Card Fail: 29 Nov 2020; 26:1075-1085 | PMID: 32956817
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Pulsus Alternans as a Sign of Right Ventricular Failure After Left Ventricular Assist Device Implantation.

Balthazar T, Adriaenssens T, Rega F, Vandenbriele C

Temporary left ventricular assist devices such as the ImpellaTM are increasingly used in patients with cardiogenic shock. The right ventricle remains the Achilles heel of left ventricular assist device-supported circulation. However, right ventricular failure after implantation of a left ventricular assist device remains incompletely defined and understood. We describe the first case of pulsus paradoxus emerging after the initiation of circulatory support using a left ventricular ImpellaTM device, which is an early sign of right ventricular failure, that was completely abolished after the addition of a temporary right ventricular assist device.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 29 Nov 2020; 26:1093-1095
Balthazar T, Adriaenssens T, Rega F, Vandenbriele C
J Card Fail: 29 Nov 2020; 26:1093-1095 | PMID: 32956812
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Pulmonary Artery Wedge Pressure Respiratory Variation Increases With Sodium Nitroprusside Vasodilator Challenge.

Maurides SP, Blankinship D, Panneerselvam K, Jackson GR, ... Tedford RJ, Houston BA
Background
The physiologic factors leading to pulmonary arterial wedge pressure respiratory variation (PAWP) are underexplored. We hypothesized that PAWP is associated with baseline PAWP and would predict response to sodium nitroprusside (SNP).
Methods and results
We performed a retrospective study of right heart catheterization studies in 51 subjects with SNP challenge at our institution from 2012 to 2019. PAWP was defined as expiratory minus inspiratory PAWP. Baseline %PAWP was inversely correlated with baseline PAWP (R = -0.5). SNP administration led to increased %PAWP (+27%, P < .01). Subjects with low baseline PAWP (less than the median) had an increase in PAWP with SNP (3 ± 4 mm Hg), whereas those with a high baseline PAWP (greater than the median) did not (-0.6 ± 4 mm Hg, P = .003). Those who had a greater than the median PAWP increase with SNP had greater cardiac output augmentation compared with those who had less than a median increase in PAWP (1.7 ± 1.5 L/min vs 0.9 ± 0.7 L/min, P = .02). An increasing PAWP after SNP was associated with significant discrepancy in the number of subjects achieving transplant-acceptable pulmonary vascular resistance (<2.5 Wood units) when calculated by expiratory versus mean PAWP (37 vs 27 subjects, 20% discrepancy rate). Subjects with a higher PAWP after SNP were more likely to demonstrate discrepant transplant-acceptable pulmonary vascular resistance calculations comparing expiratory versus mean PAWP than those with lower PAWP post-SNP (47% vs 13%, odds ratio 5.5, P = .03).
Conclusions
Our findings indicate that PAWP is a meaningful physiologic parameter that is influenced by the compliance of the left heart/pulmonary vascular system and its relative preload and afterload states.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 29 Nov 2020; 26:1096-1099
Maurides SP, Blankinship D, Panneerselvam K, Jackson GR, ... Tedford RJ, Houston BA
J Card Fail: 29 Nov 2020; 26:1096-1099 | PMID: 33035683
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Association of Midlife Cardiovascular Risk Factors With the Risk of Heart Failure Subtypes Later in Life.

Cohen LP, Vittinghoff E, Pletcher MJ, Allen NB, ... Moran AE, Zhang Y
Background
Independent associations between cardiovascular risk factor exposures during midlife and later life development of heart failure (HF) with preserved ejection fraction (HFpEF) versus reduced EF (HFrEF) have not been previously studied.
Methods
We pooled data from 4 US cohort studies (Atherosclerosis Risk in Communities, Cardiovascular Health, Health , Aging and Body Composition, and Multi-Ethnic Study of Atherosclerosis) and imputed annual risk factor trajectories for body mass index, systolic and diastolic blood pressure, low-density lipoprotein and high-density lipoprotein cholesterol, and glucose starting from age 40 years. Time-weighted average exposures to each risk factor during midlife and later life were calculated and analyzed for associations with the development of HFpEF or HFrEF.
Results
A total of 23,861 participants were included (mean age at first in-person visit, 61.8 ±1 0.2 years; 56.6% female). During a median follow-up of 12 years, there were 3666 incident HF events, of which 51% had EF measured, including 934 with HFpEF and 739 with HFrEF. A high midlife systolic blood pressure and low midlife high-density lipoprotein cholesterol were associated with HFrEF, and a high midlife body mass index, systolic blood pressure, pulse pressure, and glucose were associated with HFpEF. After adjusting for later life exposures, only midlife pulse pressure remained independently associated with HFpEF.
Conclusions
Midlife exposure to cardiovascular risk factors are differentially associated with HFrEF and HFpEF later in life. Having a higher pulse pressure during midlife is associated with a greater risk for HFpEF but not HFrEF, independent of later life exposures.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 21 Nov 2020; epub ahead of print
Cohen LP, Vittinghoff E, Pletcher MJ, Allen NB, ... Moran AE, Zhang Y
J Card Fail: 21 Nov 2020; epub ahead of print | PMID: 33238139
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

When the At-Risk Do Not Develop Heart Failure: Understanding Positive Deviance Among Postmenopausal African American and Hispanic Women.

Breathett K, Kohler LN, Eaton CB, Franceschini N, ... Shadyab AH, Cené CW
Background
African American and Hispanic postmenopausal women have the highest risk for heart failure compared with other races, but heart failure prevalence is lower than expected in some national cohorts. It is unknown whether psychosocial factors are associated with lower risk of incident heart failure hospitalization among high-risk postmenopausal minority women.
Methods and results
Using the Women\'s Health Initiative Study, African American and US Hispanic women were classified as high-risk for incident heart failure hospitalization with 1 or more traditional heart failure risk factors and the highest tertile heart failure genetic risk scores. Positive psychosocial factors (optimism, social support, religion) and negative psychosocial factors (living alone, social strain, depressive symptoms) were measured using validated survey instruments at baseline. Adjusted subdistribution hazard ratios of developing heart failure hospitalization were determined with death as a competing risk. Positive deviance indicated not developing incident heart failure hospitalization with 1 or more risk factors and the highest tertile for genetic risk. Among 7986 African American women (mean follow-up of 16 years), 27.0% demonstrated positive deviance. Among high-risk African American women, optimism was associated with modestly reduced risk of heart failure hospitalization (subdistribution hazard ratio 0.94, 95% confidence interval 0.91-0.99), and social strain was associated with modestly increased risk of heart failure hospitalization (subdistribution hazard ratio 1.07, 95% confidence interval 1.02-1.12) in the initial models; however, no psychosocial factors were associated with heart failure hospitalization in fully adjusted analyses. Among 3341 Hispanic women, 25.1% demonstrated positive deviance. Among high-risk Hispanic women, living alone was associated with increased risk of heart failure hospitalization (subdistribution hazard ratio 1.97, 95% confidence interval 1.06-3.63) in unadjusted analyses; however, no psychosocial factors were associated with heart failure hospitalization in fully adjusted analyses.
Conclusions
Among postmenopausal African American and Hispanic women, a significant proportion remained free from heart failure hospitalization despite having the highest genetic risk profile and 1 or more traditional risk factors. No observed psychosocial factors were associated with incident heart failure hospitalization in high-risk African Americans and Hispanics. Additional investigation is needed to understand protective factors among high-risk African American and Hispanic women.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 21 Nov 2020; epub ahead of print
Breathett K, Kohler LN, Eaton CB, Franceschini N, ... Shadyab AH, Cené CW
J Card Fail: 21 Nov 2020; epub ahead of print | PMID: 33232822
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Acute Unloading Effects of Sildenafil Enhance Right Ventricular-Pulmonary Artery Coupling in Heart Failure.

Monzo L, Reichenbach A, Al-Hiti H, Borlaug BA, ... Kautzner J, Melenovsky V
Background
Phosphodiesterase-5A inhibitors (PDE5i) are sometimes used in patients with advanced heart failure with reduced ejection fraction before heart transplant or left ventricular assist device implantation to decrease right ventricular (RV) afterload and mitigate the risk of right heart failure. Conflicting evidence exists regarding the impact of these drugs on RV contractility. The aim of this study was to explore the acute effects of PDE5i on ventricular-vascular coupling and load-independent RV contractility.
Methods
Twenty-two patients underwent right heart catheterization and gated equilibrium blood pool single photon emission computed tomography, before and after 20 mg intravenous sildenafil. Single photon emission computed tomography and right heart catheterization-derived data were used to calculate RV loading and contractility.
Results
PDE5i induced a decrease in the right atrial pressure (-43%), pulmonary artery (PA) mean pressure (-26%), and PA wedge pressure (PAWP; -23%), with favorable reductions in pulmonary vascular resistance (-41%) and PA elastance (-40%), and increased cardiac output (+13%) (all P < 0.01). The RV ejection fraction increased with sildenafil (+20%), with no change of RV contractility (P = 0.74), indicating that the improvement in the RV ejection fraction was related to enhanced RV-PA coupling (r = 0.59, P = 0.004) by a decrease in the ventricular load. RV diastolic compliance increased with sildenafil. The decrease in the PAWP correlated with RV end-diastolic volume decrease; no relationship was observed with the change in LV transmural pressure, suggesting decreased pericardial constraint.
Conclusions
Acute PDE5i administration has profound RV afterload-reducing effects, improves the RVEF, decreases RV volumes, and decreases the PAWP, predominantly through relief of pericardial constraint, without effects on RV chamber contractility. These findings support further study of PDE5i in protection of RV function in advanced heart failure with reduced ejection fraction who are at risk of RV failure.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 20 Nov 2020; epub ahead of print
Monzo L, Reichenbach A, Al-Hiti H, Borlaug BA, ... Kautzner J, Melenovsky V
J Card Fail: 20 Nov 2020; epub ahead of print | PMID: 33232820
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Resting Heart Rate as an Important Predictor of Mortality and Morbidity in Ambulatory Patients With Heart Failure: A Systematic Review and Meta-Analysis.

Lau K, Malik A, Foroutan F, Buchan TA, ... Orchanian-Cheff A, Alba AC
Background
Resting heart rate is a risk factor of adverse heart failure outcomes; however, studies have shown controversial results. This meta-analysis evaluates the association of resting heart rate with mortality and hospitalization and identifies factors influencing its effect.
Methods and results
We systematically searched electronic databases in February 2019 for studies published in 2005 or before that evaluated the resting heart rate as a primary predictor or covariate of multivariable models of mortality and/or hospitalization in adult ambulatory patients with heart failure. Random effects inverse variance meta-analyses were performed to calculate pooled hazard ratios. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to assess evidence quality. Sixty-two studies on 163,445 patients proved eligible. Median population heart rate was 74 bpm (interquartile range 72-76 bpm). A 10-bpm increase was significantly associated with increased risk of all-cause mortality (hazard ratio 1.10, 95% confidence interval 1.08-1.13, high quality). Overall, subgroup analyses related to patient characteristics showed no changes to the effect estimate; however, there was a strongly positive interaction with age showing increasing risk of all-cause mortality per 10 bpm increase in heart rate.
Conclusions
High-quality evidence demonstrates increasing resting heart rate is a significant predictor of all-cause mortality in ambulatory patients with heart failure on optimal medical therapy, with consistent effect across most patient factors and an increased risk trending with older age.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 06 Nov 2020; epub ahead of print
Lau K, Malik A, Foroutan F, Buchan TA, ... Orchanian-Cheff A, Alba AC
J Card Fail: 06 Nov 2020; epub ahead of print | PMID: 33171294
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Prognostic Understanding and Preference for the Communication Process with Physicians in Hospitalized Heart Failure Patients.

Kitakata H, Kohno T, Kohsaka S, Fujisawa D, ... Yuasa S, Fukuda K
Background
Heart failure (HF) is a highly prevalent, heterogeneous, and life-threatening condition. Precise prognostic understanding is essential for effective decision making, but little is known about patients\' attitudes toward prognostic communication with their physicians.
Methods and results
We conducted a questionnaire survey, consisting of patients\' prognostic understanding, preferences for information disclosure, and depressive symptoms, among hospitalized patients with HF (92 items in total). Individual 2-year survival rates were calculated using the Seattle Heart Failure Model, and its agreement level with patient self-expectations of 2-year survival were assessed. A total of 113 patients completed the survey (male 65.5%, median age 75.0 years, interquartile range 66.0-81.0 years). Compared with the Seattle Heart Failure Model prediction, patient expectation of 2-year survival was matched only in 27.8% of patients; their agreement level was low (weighted kappa = 0.11). Notably, 50.9% wished to know \"more,\" although 27.7% felt that they did not have an adequate prognostic discussion. Compared with the known prognostic variables (eg, age and HF severity), logistic regression analysis demonstrated that female and less depressive patients were associated with patients\' preference for \"more\" prognostic discussion.
Conclusions
Patients\' overall prognostic understanding was suboptimal. The communication process requires further improvement for patients to accurately understand their HF prognosis and be involved in making a better informed decision.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 06 Nov 2020; epub ahead of print
Kitakata H, Kohno T, Kohsaka S, Fujisawa D, ... Yuasa S, Fukuda K
J Card Fail: 06 Nov 2020; epub ahead of print | PMID: 33171293
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Clinically Suspected Myocarditis in the Course of Severe Acute Respiratory Syndrome Novel Coronavirus-2 Infection: Fact or Fiction?

Ozieranski K, Tyminska A, Jonik S, Marcolongo R, ... Opolski G, Caforio ALP

Cardiac complications, including clinically suspected myocarditis, have been described in novel coronavirus disease 2019. Here, we review current data on suspected myocarditis in the course of severe acute respiratory syndrome novel coronavirus-2 (SARS-CoV-2) infection. Hypothetical mechanisms to explain the pathogenesis of troponin release in patients with novel coronavirus disease 2019 include direct virus-induced myocardial injury (ie, viral myocarditis), systemic hyperinflammatory response (ie, cytokine storm), hypoxemia, downregulation of angiotensin-converting enzyme 2, systemic virus-induced endothelialitis, and type 1 and type 2 myocardial infarction. To date, despite the fact that millions of SARS-CoV-2 infections have been diagnosed worldwide, there is no definitive proof that SARS-CoV-2 is a novel cardiotropic virus causing direct cardiomyocyte damage. Diagnosis of viral myocarditis should be based on the molecular assessment of endomyocardial biopsy or autopsy by polymerase chain reaction or in-situ hybridization. Blood, sputum, or nasal and throat swab virology testing are insufficient and do not correlate with the myocardial involvement of a given pathogen. Data from endomyocardial biopsies and autopsies in clinically suspected SARS-CoV-2 myocarditis are scarce. Overall, current clinical epidemiologic data do not support the hypothesis that viral myocarditis is caused by SARS-CoV-2, or that it is common. More endomyocardial biopsy and autopsy data are also needed for a better understanding of pathogenesis of clinically suspected myocarditis in the course of SARS-CoV-2 infection, which may include virus-negative immune-mediated or already established subclinical autoimmune forms, triggered or accelerated by the hyperinflammatory state of severe novel coronavirus disease 2019.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 05 Nov 2020; epub ahead of print
Ozieranski K, Tyminska A, Jonik S, Marcolongo R, ... Opolski G, Caforio ALP
J Card Fail: 05 Nov 2020; epub ahead of print | PMID: 33166657
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Association of Coronary Microvascular Dysfunction With Heart Failure Hospitalizations and Mortality in Heart Failure With Preserved Ejection Fraction: A Follow-up in the PROMIS-HFpEF Study.

Hage C, Svedlund S, Saraste A, Faxén UL, ... Lam CSP, Lund LH
Background
Coronary microvascular dysfunction (CMD) is common in heart failure with preserved ejection fraction (HFpEF). We assessed the association of CMD with hospitalization and mortality in HFpEF.
Methods and results
We assessed the 1-year outcomes in patients from the PROMIS-HFpEF study, a prospective observational study of patients with chronic stable HFpEF undergoing coronary flow reserve measurements. Outcomes were (1) time to cardiovascular (CV) death/first HF hospitalization, (2) CV death/recurrent HF hospitalizations, (3) all-cause death/first HF hospitalization, and (4) first and (5) recurrent all-cause hospitalizations. CMD was defined as coronary flow reserve of <2.5. Time to CV death/first hospitalization was compared by log-rank test and recurrent HF and all-cause hospitalizations by Poisson test. Of 263 patients enrolled, 257 were evaluable at 1 year. Where the coronary flow reserve was interpretable (n = 201), CMD was present in 150 (75%). The median follow-up was 388 days (Q1, Q3 365, 418). The outcome of CV death/first HF hospitalization occurred in 15 patients (4 CV deaths). The incidence rate was in CMD 96 per 1000 person-years, 95% confidence interval 54-159, vs non-CMD 0 per1000 person-years, 95% confidence interval 0-68, P = .023, and remained significant after accounting for selected clinical variables. In patients with CMD, the incidence rates were significantly higher also for CV death/recurrent HF hospitalizations, all-cause death/first HF, and recurrent but not first all-cause hospitalization.
Conclusions
In this exploratory assessment of the prognostic role of CMD in HFpEF, CMD was independently associated with primarily CV- and HF-specific events. The high prevalence of CMD and its CV and HF specific prognostic role suggest CMD may be a potential treatment target in HFpEF.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Oct 2020; 26:1016-1021
Hage C, Svedlund S, Saraste A, Faxén UL, ... Lam CSP, Lund LH
J Card Fail: 30 Oct 2020; 26:1016-1021 | PMID: 32846205
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Cardiovascular Death Risk in Recovered Mid-Range Ejection Fraction Heart Failure: Insights From Cardiopulmonary Exercise Test.

MagrÌ D, Piepoli M, CorrÀ U, Gallo G, ... Agostoni P,
Background
Heart failure with midrange ejection fraction (HFmrEF) represents a heterogeneous category where phenotype, as well as prognostic assessment, remains debated. The present study explores a specific HFmrEF subset, namely those who recovered from a reduced EF (rec-HFmrEF) and, particularly, it focuses on the possible additive prognostic role of cardiopulmonary exercise testing.
Methods and results
We analyzed data from 4535 patients with HFrEF and 1176 patients with rec-HFmrEF from the Metabolic Exercise combined with Cardiac and Kidney Indexes database. The end point was cardiovascular death at 5 years. The median follow-up was 1343 days (25th-75th range 627-2403 days). Cardiovascular death occurred in 552 HFrEF and 61 rec-HFmrEF patients. The multivariate analysis confirmed an independent role of the MECKI score\'s variables in HFrEF (C-index = 0.744) whereas, in the rec-HFmrEF group, only age and peak oxygen uptake (pVO) remained associated to the end point (C-index = 0.745). A peak oxygen uptake of ≤55% of predicted and a ventilatory efficiency of ≥31 resulted as the most accurate cut-off values in the outcome prediction.
Conclusions
Present data support the cardiopulmonary exercise test and, particularly, the peak oxygen uptake, as a useful tool in the rec-HFmrEF prognostic assessment. A peak VO of ≤55% predicted and ventilatory efficiency of ≥31 might help to identify a high-risk rec-HFmrEF subgroup.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Oct 2020; 26:932-943
MagrÌ D, Piepoli M, CorrÀ U, Gallo G, ... Agostoni P,
J Card Fail: 30 Oct 2020; 26:932-943 | PMID: 32428671
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Bariatric Surgery in End-Stage Heart Failure: Feasibility in Successful Attainment of a Target Body Mass Index.

Val FRD, Cheon O, Menser T, Kash B, ... Sherman V, Tariq N
Introduction
Orthotopic heart transplantation (OHT) is contraindicated in morbidly obese patients with end-stage heart failure (HF), for whom cardiac allograft is the only means for long-term survival. Bariatric surgery may allow them to achieve target body mass index (BMI) for OHT
Methods:
From 4/2014 to 12/2018, 26 morbidly obese HF patients who did not meet BMI eligibility criteria for OHT underwent laparoscopic bariatric surgery. Outcomes of interest were median difference in BMI, number of patients achieving target BMI for OHT, and 30-day mortality.
Results
Median age was 49 (IQR 14) years, and 13 (50%) were women. HF was mainly systolic (15 patients, 58%). The median LVEF was 27% (IQR 37%). At the time of bariatric surgery, 12 (46%) patients had mechanical circulatory support: 2 (8%) concomitant left ventricular assist device (LVAD) placements, 8 (31%) LVAD already-in-place, and 2 (8%) intra-aortic balloon pumps. There was no 30-day mortality, but one mortality on postoperative day 48. Over a median follow-up of 6 months (range 0-36 months, IQR 17), there was a significant reduction in BMI (p<0.0001). The median postoperative BMI was 36.7 (IQR 8.7), compared to preoperative median BMI of 42.7 (IQR 9.4). Target BMI of < 35 was achieved in 11 (42%) patients. Three patients (12%) have undergone OHT.
Conclusion
Bariatric surgery in end-stage HF is feasible and results in a high number of patients achieving target BMI, increasing their probability of undergoing OHT. The presence of a LVAD should not preclude these patients from undergoing a bariatric intervention.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Oct 2020; 26:944-947
Val FRD, Cheon O, Menser T, Kash B, ... Sherman V, Tariq N
J Card Fail: 30 Oct 2020; 26:944-947 | PMID: 32428670
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Myocardial Ketones Metabolism in Heart Failure.

Karwi QG, Biswas D, Pulinilkunnil T, Lopaschuk GD

Ketone bodies can become a major source of adenosine triphosphate production during stress to maintain bioenergetic homeostasis in the brain, heart, and skeletal muscles. In the normal heart, ketone bodies contribute from 10% to 15% of the cardiac adenosine triphosphate production, although their contribution during pathologic stress is still not well-characterized and currently represents an exciting area of cardiovascular research. This review focuses on the mechanisms that regulate circulating ketone levels under physiologic and pathologic conditions and how this impacts cardiac ketone metabolism. We also review the current understanding of the role of augmented ketone metabolism as an adaptive response in different types and stages of heart failure. This analysis includes the emerging experimental and clinical evidence of the potential favorable effects of boosting ketone metabolism in the failing heart and the possible mechanisms of action through which these interventions may mediate their cardioprotective effects. We also critically appraise the emerging data from animal and human studies which characterize the role of ketones in mediating the cardioprotection established by the new class of antidiabetic drugs, namely sodium-glucose co-transporter inhibitors.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Oct 2020; 26:998-1005
Karwi QG, Biswas D, Pulinilkunnil T, Lopaschuk GD
J Card Fail: 30 Oct 2020; 26:998-1005 | PMID: 32442517
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Wearable Patch-Based Estimation of Oxygen Uptake and Assessment of Clinical Status during Cardiopulmonary Exercise Testing in Patients With Heart Failure.

Shandhi MMH, Hersek S, Fan J, Sander E, ... Klein L, Inan OT
Background
To estimate oxygen uptake (VO) from cardiopulmonary exercise testing (CPX) using simultaneously recorded seismocardiogram (SCG) and electrocardiogram (ECG) signals captured with a small wearable patch. CPX is an important risk stratification tool for patients with heart failure (HF) owing to the prognostic value of the features derived from the gas exchange variables such as VO. However, CPX requires specialized equipment, as well as trained professionals to conduct the study.
Methods and results
We have conducted a total of 68 CPX tests on 59 patients with HF with reduced ejection fraction (31% women, mean age 55 ± 13 years, ejection fraction 0.27 ± 0.11, 79% stage C). The patients were fitted with a wearable sensing patch and underwent treadmill CPX. We divided the dataset into a training-testing set (n = 44) and a separate validation set (n = 24). We developed globalized (population) regression models to estimate VO from the SCG and ECG signals measured continuously with the patch. We further classified the patients as stage D or C using the SCG and ECG features to assess the ability to detect clinical state from the wearable patch measurements alone. We developed the regression and classification model with cross-validation on the training-testing set and validated the models on the validation set. The regression model to estimate VO from the wearable features yielded a moderate correlation (R of 0.64) with a root mean square error of 2.51 ± 1.12 mL · kg · min on the training-testing set, whereas R and root mean square error on the validation set were 0.76 and 2.28 ± 0.93 mL · kg · min, respectively. Furthermore, the classification of clinical state yielded accuracy, sensitivity, specificity, and an area under the receiver operating characteristic curve values of 0.84, 0.91, 0.64, and 0.74, respectively, for the training-testing set, and 0.83, 0.86, 0.67, and 0.92, respectively, for the validation set.
Conclusions
Wearable SCG and ECG can assess CPX VO and thereby classify clinical status for patients with HF. These methods may provide value in the risk stratification of patients with HF by tracking cardiopulmonary parameters and clinical status outside of specialized settings, potentially allowing for more frequent assessments to be performed during longitudinal monitoring and treatment.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Oct 2020; 26:948-958
Shandhi MMH, Hersek S, Fan J, Sander E, ... Klein L, Inan OT
J Card Fail: 30 Oct 2020; 26:948-958 | PMID: 32473379
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Prior Carpal Tunnel Syndrome and Early Concomitant Echocardiographic Findings Among Patients With Cardiac Amyloidosis.

Itzhaki Ben Zadok O, Abelow A, Vaxman I, Eisen A, ... Kornowski R, Vaturi M
Background
We aimed to characterize patients with systemic amyloidosis stratified by a prior diagnosis of carpal tunnel syndrome (CTS) and to describe early echocardiographic parameters concomitant with CTS.
Methods and results
Patients with suspected amyloidosis during CTS diagnosis were excluded. Our cohort included 108 patients with systemic amyloidosis of which 36% had a prior CTS at a median of 4 years (interquartile range [IQR] 2.8-6.7 years) before disease diagnosis. Patients with prior CTS were more likely to present subsequently with cardiac amyloidosis (78% vs 53%, P = .013), yet overall survival was comparable between groups (53% vs 61%, P = .825). Prior CTS was more commonly diagnosed in subsequent patients with transthyretin (62%) than in patients with immunoglobulin light chain (24%, P < .001). Furthermore, in a subanalysis of patients subsequently diagnosed with cardiac amyloidosis, findings at CTS diagnosis (n = 17) demonstrated a mild increase in septal thickness 1.3 cm (IQR 1.2-1.5 cm), increased relative wall thickness 0.46 cm (IQR 0.45-0.58 cm), and increased left ventricular mass index 155 g/m(IQR 92-177 g/m) compared with age-adjusted normal range echocardiographic values. Doppler mitral flow data was supportive of left ventricular diastolic dysfunction.
Conclusions
Early echocardiographic findings at CTS diagnosis, preceding the diagnosis of cardiac amyloidosis by several years, are suggestive of increased wall thickness and diastolic dysfunction.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Oct 2020; 26:909-916
Itzhaki Ben Zadok O, Abelow A, Vaxman I, Eisen A, ... Kornowski R, Vaturi M
J Card Fail: 30 Oct 2020; 26:909-916 | PMID: 32592896
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Elevated AT1R Antibody and Morbidity in Patients Bridged to Heart Transplant Using Continuous Flow Left Ventricular Assist Devices.

Chau VQ, Flattery M, Nicholson KS, Mcdougan F, ... Kimball PM, Shah KB
Background
We studied longitudinal levels of angiotensin-II type 1 receptor antibody (AT1R-Ab) and their effects on adverse events (death, treated rejection and cardiac allograft vasculopathy) in patients who were bridged to heart transplant using a continuous flow left ventricular assist device (LVAD).
Methods and results
Sera of 77 patients bridged to heart transplant (from 2009 to 2017) were tested for AT1R-Ab and CRP before and after LVAD. Elevated AT1R-Ab was defined as >10.0 U/mL. The median follow-up after transplant was 3.6 years (interquartile range, 2.2-5.6 years). After LVAD, AT1R-Ab levels increased from baseline and remained elevated until transplant. Freedom from adverse events at 5 years was lower in those with elevated AT1R-Ab levels at time of transplant. In an adjusted, multivariable Cox analysis, an AT1R-Ab level of >10 U/mL was associated with developing the primary end point (adjusted hazard ratio 3.4, 95% confidence interval 1.2-9.2, P = .017). Although C-reactive protein levels were high before and after LVAD placement, C-reactive protein did not correlate with AT1R-Ab.
Conclusions
In LVAD patients bridged to heart transplant, an increased AT1R-Ab level at time of transplant was associated with poor outcomes after heart transplant. Post-LVAD AT1R-Ab elevations were not correlated with serum markers of systemic inflammation. Larger studies are needed to examine the pathologic role of AT1R-Ab in heart transplant.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Oct 2020; 26:959-967
Chau VQ, Flattery M, Nicholson KS, Mcdougan F, ... Kimball PM, Shah KB
J Card Fail: 30 Oct 2020; 26:959-967 | PMID: 32592894
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

In-Hospital Serum Uric Acid Change Predicts Adverse Outcome in Patients With Heart Failure.

Yamamoto H, Nagatomo Y, Mahara K, Yoshikawa T
Background
Elevated serum uric acid (UA) is associated with an increased risk of adverse outcome in patients with heart failure (HF), but it remains unknown whether the change of serum UA level during the treatment of acute decompensated HF (ADHF) predicts adverse events.
Methods and results
We retrospectively analyzed consecutive 1562 patients who were hospitalized for ADHF. Serum UA levels both at admission and discharge were available in 1246 patients (78 years of age, range 69-84 years, 40% female). UA values increased or unchanged (group I) in 766 patients and it decreased in the remaining patients (group D). Group I was characterized by older age, higher proportion of females, preserved left ventricular ejection fraction, and the features of less severity of HF such as lower plasma N-terminal pro B-type natriuretic peptide level and lower percentage of catecholamine use. Nevertheless, group I was associated with higher incidence of the primary end point defined as the composite of all-cause death and ADHF rehospitalization (P = .013, log-rank test). UA change, but not UA at discharge, was an independent predictor of the primary end point (hazard ratio 1.30, interquartile range 1.04-1.64, P = .022). Age, estimated glomerular filtration rate, left ventricular ejection fraction, dose of loop diuretics, and thiazide prescription at discharge were independently associated with the UA change.
Conclusions
In patients with HF, UA change through the treatment of ADHF might predict future adverse outcome.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Oct 2020; 26:968-976
Yamamoto H, Nagatomo Y, Mahara K, Yoshikawa T
J Card Fail: 30 Oct 2020; 26:968-976 | PMID: 32652245
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Pulmonary Vascular Pressures and Gas Exchange Response to Exercise in Heart Failure With Preserved Ejection Fraction.

Fermoyle CC, Stewart GM, Borlaug BA, Johnson BD

Elevated left ventricular filling pressure (measured as mean pulmonary capillary wedge pressure) at rest or with exercise is diagnostic of heart failure with preserved ejection fraction. However, the capacity of the right ventricle to compensate for a high mean pulmonary capillary wedge pressure and thus maintain an appropriate transpulmonary gradient (TPG) and perfusion of the pulmonary capillaries is likely an important contributor to gas exchange efficiency and exercise capacity. Therefore, this study aimed to determine whether a higher TPG at peak exercise is associated with superior exercise capacity and gas exchange. Gas exchange data from dyspneic patients referred for exercise right heart catheterization were retrospectively analyzed and patients were split into two groups based on TPG. Patients with a higher TPG at peak exercise had a higher peak VO (1025 ± 227 vs 823 ± 276, P = .038), end-tidal partial pressure of carbon dioxide (42.2 ± 7.9 vs 38.0 ± 4.7, P = .044), and gas exchange estimates of pulmonary vascular capacitance (408 ± 90 vs 268 ± 108, P = .001). A higher TPG at peak exercise correlated with a higher peak oxygen uptake, O pulse, and stroke volume (R = 0.42, 0.44 and 0.42, respectively, all P < 0.05). These findings indicate that a greater TPG with exercise might be important for improving exercise capacity in heart failure with preserved ejection fraction.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Oct 2020; 26:1011-1015
Fermoyle CC, Stewart GM, Borlaug BA, Johnson BD
J Card Fail: 30 Oct 2020; 26:1011-1015 | PMID: 32750488
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Impact of Mental Stress and Anger on Indices of Diastolic Function in Patients With Heart Failure.

Harris KM, Gottdiener JS, Gottlieb SS, Burg MM, Li S, Krantz DS
Background
Under controlled conditions, mental stress can provoke decrements in ventricular function, yet little is known about the effect of mental stress on diastolic function in patients with heart failure (HF).
Methods and results
Twenty-four patients with HF with ischemic cardiomyopathy and reduced ejection fraction (n = 23 men; mean left ventricular [LV] ejection fraction 27 ± 9%; n = 13 with baseline elevated E/e\') completed daily assessment of perceived stress, anger, and negative emotion for 7 days, followed by a laboratory mental stress protocol. Two-dimensional Doppler echocardiography was performed at rest and during sequential anger recall and mental arithmetic tasks to assess indices of diastolic function (E, e\', and E/e\'). Fourteen patients (63.6%) experienced stress-induced increases in E/e\', with an average baseline to stress change of 6.5 ± 9.3, driven primarily by decreases in early LV relaxation (e\'). Age-adjusted linear regression revealed an association between 7-day anger and baseline E/e\'; patients reporting greater anger in the week before mental stress exhibited higher resting LV diastolic pressure.
Conclusions
In patients with HF with reduced ejection fraction, mental stress can provoke acute worsening of LV diastolic pressure, and recent anger is associated with worse resting LV diastolic pressure. In patients vulnerable to these effects, repeated stress exposures or experiences of anger may have implications for long-term outcomes.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Oct 2020; 26:1006-1010
Harris KM, Gottdiener JS, Gottlieb SS, Burg MM, Li S, Krantz DS
J Card Fail: 30 Oct 2020; 26:1006-1010 | PMID: 32750485
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Characterization of the Progression From Ambulatory to Hospitalized Heart Failure With Preserved Ejection Fraction.

Reddy YNV, Obokata M, Jones AD, Lewis GD, ... Redfield MM, Borlaug BA
Background
Heart failure (HF) with preserved ejection fraction (HFpEF) is a heterogeneous syndrome. Some patients develop elevated filling pressures exclusively during exercise and never require hospitalization, whereas others periodically develop congestion that requires inpatient treatment. The features differentiating these cohorts are unclear.
Methods
We performed a secondary analysis of 7 National Institutes of Health-sponsored multicenter trials of HFpEF (EF ≥ 50%, N = 727). Patients were stratified by history of hospitalization because of HF, comparing patients never hospitalized (HFpEF) to those with a prior hospitalization (HFpEF). Currently hospitalized (HFpEF) patients were included to fill the spectrum. Clinical characteristics, cardiac structure, biomarkers, quality of life, functional capacity, activity levels, and outcomes were compared.
Results
As expected, HFpEF (n = 338) displayed the greatest severity of congestion, as assessed by N-terminal pro B-type natriuretic peptide levels, edema and orthopnea. As compared to HFpEF (n = 109), HFpEF (n = 280) displayed greater comorbidity burden, with more lung disease, renal dysfunction and anemia, along with lower activity levels (accelerometry), poorer exercise capacity (6-minute walk distance and peak exercise capacity), and more orthopnea. Patients with current or prior hospitalization displayed higher rates of future HF hospitalization, but quality of life was similarly impaired in all patients with HFpEF, regardless of hospitalization history.
Conclusions
A greater burden of noncardiac organ dysfunction, sedentariness, functional impairment, and higher event rates distinguish patients with HFpEF and prior HF hospitalization from those never hospitalized. Despite lower event rates, quality of life is severely and similarly limited in patients with no history of hospitalization. These data suggest that the 2 clinical profiles of HFpEF may require different treatment strategies.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Oct 2020; 26:919-928
Reddy YNV, Obokata M, Jones AD, Lewis GD, ... Redfield MM, Borlaug BA
J Card Fail: 30 Oct 2020; 26:919-928 | PMID: 32827644
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Effects of Angiotensin-Neprilysin Inhibition in Canines with Experimentally Induced Cardiorenal Syndrome.

Sabbah HN, Zhang K, Gupta RC, Xu J, Singh-Gupta V
Background
Sacubitril/valsartan (Sac/Val), a combined angiotensin-II receptor blocker (Val) and neprilysin inhibitor (Sac) in a 1:1 molar ratio, was shown to decrease the risk of cardiovascular death or heart failure (HF) hospitalization in patients with HF and reduced left ventricular (LV) ejection fraction. This study examined the effects of Sac/Val on LV structure, function, and bioenergetics, and on biomarkers of kidney injury and kidney function in dogs with experimental cardiorenal syndrome.
Methods and results
Fourteen dogs with cardiorenal syndrome (coronary microembolization-induced HF and renal dysfunction) were randomized to 3 months Sac/Val therapy (100 mg once daily, n = 7) or no therapy (control, n = 7). LV ejection fraction and troponin-I, as well as biomarkers of kidney injury/function including serum creatinine and urinary kidney injury molecule-1 were measured before and at end of therapy and the change (treatment effect change) calculated. Mitochondrial function measures, including the maximum rate of adenosine triphosphate synthesis, were measured in isolated cardiomyocytes at end of therapy. In Sac/Val dogs, the change in ejection fraction increased compared with controls, 6.9 ± 1.4 vs 0.7 ± 0.6%, P < .002, whereas change in troponin I decreased, -0.16 ± 0.03 vs -0.03 ± 0.02 ng/mL, P < .001. Urinary change in kidney injury molecule 1 decreased in Sac/Val-treated dogs compared with controls, -17.2 ± 7.9 vs 7.7 ± 3.0 mg/mL, P < .007, whereas the change in serum creatinine was not significantly different. Treatment with Sac/Val increased adenosine triphosphate synthesis compared with controls, 3240 ± 121 vs 986 ± 84 RLU/µg protein, P < .05.
Conclusions
In dogs with cardiorenal syndrome, Sac/Val improves LV systolic function, improves mitochondrial function and decreases biomarkers of heart and kidney injury. The results offer mechanistic insights into the benefits of Sac/Val in HF with compromised renal function.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 30 Oct 2020; 26:987-997
Sabbah HN, Zhang K, Gupta RC, Xu J, Singh-Gupta V
J Card Fail: 30 Oct 2020; 26:987-997 | PMID: 32841710
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Uric Acid Is a Biomarker of Oxidative Stress in the Failing Heart: Lessons Learned from Trials With Allopurinol and SGLT2 Inhibitors.

Packer M

Hyperuricemia increases the risk of heart failure, and higher levels of serum uric acid are seen in patients who have worse ventricular function, functional capacity, and prognosis. Heart failure is also accompanied by an upregulation of xanthine oxidase, the enzyme that catalyzes the formation of uric acid and a purported source of reactive oxygen species. However, the available evidence does not support the premise that either uric acid or the activation of xanthine oxidase has direct injurious effects on the heart in the clinical setting. Xanthine oxidase inhibitors (allopurinol and oxypurinol) have had little benefit and may exert detrimental effects in patients with chronic heart failure in randomized controlled trials, and the more selective and potent inhibitor febuxostat increases the risk of cardiovascular death more than allopurinol. Instead, the available evidence indicates that changes in xanthine oxidase and uric acid are biomarkers of oxidative stress (particularly in heart failure) and that xanthine oxidase may provide an important source of nitric oxide that quenches the injurious effects of reactive oxygen species. A primary determinant of the cellular redox state is nicotinamide adenine dinucleotide, whose levels drive an inverse relationship between xanthine oxidase and sirtuin-1, a nutrient deprivation sensor that exerts important antioxidant and cardioprotective effects. Interestingly, sodium-glucose cotransporter 2 inhibitors induce a state of nutrient deprivation that includes activation of sirtuin-1, suppression of xanthine oxidase, and lowering of serum uric acid. The intermediary role of sirtuin-1 in both uric acid-lowering and cardioprotection may explain why, in mediation analyses of large-scale cardiovascular trials, the effect of sodium-glucose cotransporter 2 inhibitors to decrease serum uric acid is a major predictor of the ability of these drugs to decrease serious heart failure events.

Copyright © 2020 The Author. Published by Elsevier Inc. All rights reserved.

J Card Fail: 30 Oct 2020; 26:977-984
Packer M
J Card Fail: 30 Oct 2020; 26:977-984 | PMID: 32890737
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Ranolazine Improves Right Ventricular Function in Patients With Precapillary Pulmonary Hypertension: Results From a Double-Blind, Randomized, Placebo-Controlled Trial.

Han Y, Forfia P, Vaidya A, Mazurek JA, ... Chan SY, Waxman AB
Introduction
A major outcome determinant in patients with precapillary pulmonary hypertension (PH) is right ventricular (RV) function. We studied the effect of ranolazine on RV function over 6 months using cardiovascular magnetic resonance (CMR) imaging in patients with precapillary PH (groups I, III, and IV).
Methods and results
We enrolled patients with PH and RV dysfunction (CMR imaging ejection fraction [EF] of <45%) in a longitudinal, randomized, double-blinded, placebo controlled, multicenter study of ranolazine treatment. All enrolled patients were on stable PH-specific therapy. Enrolled patients were assessed using CMR imaging, New York Heart Association functional class, N-terminal pro brain natriuretic peptide, 6-minute walk test, and quality of life health outcomes at baseline and repeated at the end of treatment. The primary outcome was change in RVEF after 6 months of treatment. Analysis of covariance was used to analyze the longitudinal changes taking into account baseline values, age, and sex, based on per protocol population. Twenty-two patients were enrolled, and 9 patients completed follow-up CMR imaging after ranolazine treatment and 6 completed placebo treatment. There was significant increase in RVEF at end of treatment compared with baseline in the ranolazine group adjusted for baseline values, age, and sex. There were no statistically significant changes in secondary outcomes such as changes in New York Heart Association functional class, 6-minute walk distance, N-terminal pro brain natriuretic peptide, or quality of life measures. Ranolazine treated patients experienced a higher number of adverse events, but only one was discontinued owing to side effects.
Conclusions
Ranolazine may improve RV function in patients with precapillary PH. Larger studies are needed to confirm the beneficial effects of ranolazine.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 23 Oct 2020; epub ahead of print
Han Y, Forfia P, Vaidya A, Mazurek JA, ... Chan SY, Waxman AB
J Card Fail: 23 Oct 2020; epub ahead of print | PMID: 33223140
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Dual Vasopressin Receptor Antagonism to Improve Congestion in Patients With Acute Heart Failure: Design of the AVANTI Trial.

Goldsmith SR, Burkhoff D, Gustafsson F, Voors A, ... Dinh W, Udelson JE
Background
Loop diuretics are the main treatment for patients with acute heart failure, but are associated with neurohormonal stimulation and worsening renal function and do not improve long-term outcomes. Antagonists to arginine vasopressin may provide an alternative strategy to avoid these effects. The AVANTI study will investigate the efficacy and safety of pecavaptan, a novel, balanced dual-acting V1a/V2 vasopressin antagonist, both as adjunctive therapy to loop diuretics after admission for acute heart failure, and later as monotherapy.
Methods and results
AVANTI is a double-blind, randomized phase II study in 571 patients hospitalized with acute heart failure and signs of persistent congestion before discharge. In part A, patients will receive either pecavaptan 30 mg/d or placebo with standard of care for 30 days. In part B, eligible patients will continue treatment or receive pecavaptan or diuretics as monotherapy for another 30 days. The primary end points for part A are changes in body weight and serum creatinine; for part B, changes in body weight and blood urea nitrogen/creatinine ratio.
Conclusions
This study will provide the first evidence that a balanced V1a/V2 antagonist may safely enhance decongestion, both as an adjunct to loop diuretics and as an alternative strategy.
Trial registration number
NCT03901729.

Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

J Card Fail: 23 Oct 2020; epub ahead of print
Goldsmith SR, Burkhoff D, Gustafsson F, Voors A, ... Dinh W, Udelson JE
J Card Fail: 23 Oct 2020; epub ahead of print | PMID: 33188886
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Building a Heart Failure Clinic: A Practical Guide from the Heart Failure Society of America.

Greene SJ, Adusumalli S, Albert NM, Hauptman PJ, ... Butler J,

Heart failure (HF) remains a leading cause of mortality and morbidity and a primary driver of health care resource use in the United States. As such, there continues to be much interest in the development and refinement of HF clinics that manage patients with HF in a guideline-directed, technology-enabled, and coordinated approach. Optimization of resource use and maintenance of collaboration with other providers are also important themes when considering implementation of HF clinics. Through this document, the Heart Failure Society of America aims to provide a contemporary, practical guide to creating and sustaining a HF clinic. The guide discusses (1) patient care considerations for delivering guideline-directed and patient-centered care, and (2) operational considerations including development of a HF clinic business plan, setting goals, leadership support, triggers for patient referral and patient follow-up, patient population served, optimal clinic staffing models, relationships with subspecialists, and continuous quality improvement. This document was developed to empower providers and clinicians who wish to build and sustain community-based, successful HF clinics.

Copyright © 2020 Elsevier Inc. All rights reserved.

J Card Fail: 23 Oct 2020; epub ahead of print
Greene SJ, Adusumalli S, Albert NM, Hauptman PJ, ... Butler J,
J Card Fail: 23 Oct 2020; epub ahead of print | PMID: 33289664
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract

Feasibility and Consistency of Results with Deployment of an In-Line Filter for Exercise-Based Evaluations of Patients With Heart Failure During the Novel Coronavirus Disease-2019 Pandemic.

Bhat RR, Schoenike MW, Kowal A, White C, ... Malhotra R, Lewis GD
Background
Exercise testing plays an important role in evaluating heart failure prognosis and selecting patients for advanced therapeutic interventions. However, concern for severe acute respiratory syndrome novel coronavirus-2 transmission during exercise testing has markedly curtailed performance of exercise testing during the novel coronavirus disease-2019 pandemic.
Methods and results
To examine the feasibility to conducting exercise testing with an in-line filter, 2 healthy volunteer subjects each completed 2 incremental exercise tests, one with discrete stages of increasing resistance and one with a continuous ramp. Each subject performed 1 test with an electrostatic filter in-line with the system measuring gas exchange and air flow, and 1 test without the filter in place. Oxygen uptake and minute ventilation were highly consistent when evaluated with and without use of an electrostatic filter with a >99.9% viral efficiency.
Conclusions
Deployment of a commercially available in-line electrostatic viral filter during cardiopulmonary exercise testing is feasible and provides consistent data compared with testing without a filter.

Copyright © 2020. Published by Elsevier Inc.

J Card Fail: 20 Oct 2020; epub ahead of print
Bhat RR, Schoenike MW, Kowal A, White C, ... Malhotra R, Lewis GD
J Card Fail: 20 Oct 2020; epub ahead of print | PMID: 33098974
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:

This program is still in alpha version.