Background: The influence of intravenous ferric carboxymaltose (FCM) on reverse electrical remodeling (RER) in patients with heart failure with reduced ejection fraction (HFrEF) post-cardiac ...resynchronization therapy (CRT) is unknown. This study examines the effect of iron replacement using intravenous FCM on RER in CRT-implanted HFrEF patients with iron deficiency anemia. Methods: We retrospectively analyzed 65 patients with successful CRT-defibrillator between March 2017 and January 2020, all with iron deficiency anemia at implantation. The cohort comprised 35 patients in the FCM group and 30 in the non-FCM group. Follow-up data were obtained from visits 6 months post-CRT implantation including baseline characteristics, echocardiographic left ventricular measurements, and electrocardiograms. Changes in intrinsic QRS duration (iQRS) and left ventricular ejection fraction (LVEF) from baseline to 6 months were assessed. Results: The FCM group showed a greater reduction in iQRS duration compared to the non-FCM group (-10.4 ± 2.2 ms vs. -3 ± 2.9 ms, p ＜ 0.0001). Additionally, at the 6-month follow-up, the increase in LVEF was higher in the FCM group than in the non-FCM group (+3.6 ± 1.6% vs. -0.1 ± 1.7%, p ＜ 0.0001). Correlations were found between changes in ferritin levels and iQRS duration (r = -0.725, p ＜ 0.0001) and LVEF (r = 0.712, p ＜ 0.0001). Multivariate regression analysis revealed that elevated ferritin independently influenced the increase in LVEF (p = 0.006, β = 0.554) and the decrease in iQRS (p ＜ 0.001, β = -0.685). Conclusions: Intravenous iron treatment with FCM may reduce iQRS duration and improve LVEF and functional status in HFrEF patients with iron deficiency anemia following CRT.
Resumo Fundamento A nova doença por coronavírus (COVID-19) pode levar a uma enfermidade grave e causar a morte. Sabe-se que a COVID-19 afeta o sistema cardiovascular. A detecção precoce da progressão ...para um estágio grave da doença que afeta o sistema cardiovascular pode desempenhar um papel crítico no tratamento da COVID-19. Objetivos Explorar a possível relação entre a pneumonia por COVID-19 e os achados de strain do ventrículo direito no eletrocardiograma (ECG). Métodos Foi realizado um estudo retrospectivo de 141 pacientes hospitalizados com COVID-19. A correlação de Spearman e as análises de regressão logística foram aplicadas para avaliar as relações entre as manifestações de strain ventricular direito na ECG e os níveis de biomarcadores e outros achados laboratoriais e de imagem do tórax. O nível de significância foi considerado estabelecido como p < 0,05. Resultados Os sinais de ECG de estresse ventricular direito foram significativamente mais frequentes e os níveis de fibrinogênio, PCR e ferritina foram significativamente mais elevados em pacientes com COVID-19 com níveis elevados de hs-cTnI, procalcitonina e dímero-D. A análise univariada mostrou que existem relações significativas entre a presença de pneumonia bilateral, a maioria dos sinais eletrocardiográficos de strain ventricular direito e lesão cardíaca e biomarcadores inflamatórios e trombóticos. A análise multivariada revelou que o supradesnivelamento do segmento ST em V1 e padrão S1Q3T3 são preditores independentes de lesão cardíaca ( odds ratio =0,23; IC95%, 0,06 a 0,90; p=0,035) e níveis elevados de procalcitonina ( odds ratio =0,19; IC 95%, 0,06 a 0,62; p=0,006), respectivamente. Conclusão Os achados do presente estudo sugerem que a dano cardíaco direito é prevalente na COVID-19. Além disso, nosso estudo demonstra o valor clínico do ECG na avaliação e monitoramento de pacientes com pneumonia por COVID-19.
Microvascular angina (MVA) is a coronary microcirculation disease. Research on microcirculatory dysfunction has revealed several biomarkers involved in the etiopathogenesis of MVA. Platelet-derived ...growth factor receptor β (PDGFR-β) and brain-derived neurotrophic factor (BDNF) are 2 biomarkers associated with microcirculation, particularly pericytes function. The aim of this study was to investigate the role of PDGFR-β and BDNF in MVA.
Ninety-one patients (median age, 56 y; age range, 40-79 y; 36 men) with MVA and 61 control group subjects (median age, 52 y; age range, 38-76 y; 29 men) were included in the study. Serum concentrations of PDGFR-β and BDNF were measured with commercially available enzyme-linked immunosorbent assay kits.
PDGFR-β 2.82 ng/ml; interquartile range (IQR), 0.57-7.79 ng/ml vs. 2.27 ng/ml; IQR, 0.41-7.16 ng/ml; p<0.0005 and BDNF (2.41 ng/ml; IQR, 0.97-7.97 ng/ml vs. 1.92 ng/ml; IQR, 1.07-6.67 ng/ml; p=0.023) concentrations were significantly higher in patients with MVA compared with the controls. PDGFR-β correlated positively with age (r=0.26, p=0.001), low-density lipoprotein (r=0.18; p=0.02), and BDNF (r=0.47; p<0.001), and BDNF showed a significant positive correlation with age (r=0.20; p=0.01). In binary logistic regression analysis, high-sensitivity C-reactive protein, uric acid, and PDGFR-β values were found to be independent predictors of MVA.
MVA is associated with higher PDGFR-β and BDNF levels. This association may indicate an abnormality in microvascular function. Future studies are required to determine the role of these biomarkers in the pathogenesis of MVA.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Cardiac resynchronization therapy (CRT) is a treatment modality for selected patients with refractory heart failure. We intended to examine the usefulness of coronary venous system imagining with ...conventional coronary angiogram before the CRT implantation procedure. A total of 180 patients were scheduled for CRT and were prospectively randomized 1:2 into 2 groups. Group 1 (n = 60) received standard CRT procedure without the guidance of selective left coronary angiography. In group 2 (n = 120), CRT implantation was accomplished with the guidance of the preprocedural coronary angiography. We compared the 2 groups in terms of the total implantation time, total fluoroscopy time, the amount of contrast medium used, and cumulative radiation exposure. The total implantation and fluoroscopy times, the amount of contrast medium used, and cumulative radiation exposure were significantly less in group 2 compared with group 1 (53 ± 7 vs 66 ± 9 minutes, 11 ± 3 vs 20 ± 5 minutes, 24 ± 8 vs 42 ± 14 mL, 26 192 ± 6658 vs 37 388± 9064 mGy cm2, and 253 ± 49 vs 392 ± 79 mGy, P < .0001, respectively). We concluded that coronary angiography prior to CRT implantation is useful in simplifying the procedure, saving time, reducing radiation exposure, and reducing contrast use.
Retrospective study.
To identify the incidence of congenital cardiac abnormalities in patients who had scoliosis and underwent surgical treatment for scoliosis.
Congenital and idiopathic scoliosis ...(IS) are associated with cardiac abnormalities. We sought to establish and compare the incidence of congenital cardiac abnormalities in patients with idiopathic and congenital scoliosis (CS) who underwent surgical treatment for scoliosis.
Ninety consecutive scoliosis patients, who underwent surgical correction of scoliosis, were classified as CS (55 patients, 28 female 51%) and IS (35 patients, 21 female 60%). The complete data of the patients, including medical records, plain radiograph and transthoracic echocardiography were retrospectively assessed.
We found that mitral valve prolapse was the most common cardiac abnormality in both patients with IS (nine patients, 26%) and CS (13 patients, 24%). Other congenital cardiac abnormalities were atrial septal aneurysm (23% of IS patients, 18% of CS patients), pulmonary insufficiency (20% of IS patients, 4% of CS patients), aortic insufficiency (17% of IS patients), atrial septal defect (11% of IS patients, 13% of CS patients), patent foramen ovale (15% of CS patients), dextrocardia (4% of CS patients), bicuspid aortic valve (3% of IS patients), aortic stenosis (2% of CS patients), ventricular septal defect (2% of CS patients), and cardiomyopathy (2% of CS patients).
We determined the increased incidence of congenital cardiac abnormalities among patients with congenital and IS. Mitral valve prolapse appeared to be the most prevalent congenital cardiac abnormality in both groups.
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The effect of intravenous ferric carboxymaltose (FCM) on reverse electrical remodeling (RER) in patients with heart failure ...with reduced ejection fraction (HFrEF) following cardiac resynchronization therapy (CRT) implantation is unknown.
Purpose
The current study aims to examine the effect of iron replacement with intravenous FCM on RER in CRT-implanted patients with HFrEF and iron deficiency.
Methods
The present study retrospectively analyzed 65 patients with successful CRT-D device implantation between March 2017 and January 2020 with iron deficiency (defined as ferritin <100 μg/L) at implantation. Follow-up data were obtained from the 6-month routine follow-up visits of patients following CRT implantation. Demographic characteristics, laboratory results, medical history, medication details, functional status, information on whether intravenous FCM therapy was administered during CRT device implantation, echocardiographic left ventricular (LV) measurements, baseline electrocardiogram (ECG) recorded before CRT device implantation, and follow-up ECG were collected for analysis for each study patient. From baseline to 6-month follow-up, the change in intrinsic QRS duration (without biventricular pacing) was calculated as a primary endpoint, and the change in LV ejection fraction (LVEF) was assessed as a secondary endpoint of the study.
Results
Thirty-five of 65 patients were in the FCM group, while the remaining 30 study participants were in the non-FCM. The two study groups were similar regarding baseline characteristics, except for ferritin levels, which were minimally significantly lower in the FCM group (10.7±5.0μg/L vs 13.5 ±3.9μg/L, p= 0.012). At the 6-month follow-up, both mean ferritin levels increased significantly in the FCM group compared to baseline (from 10.7±5.0 to 86.5±7.6μg/L, p < 0.0001), while these levels were not significantly increased in the non-FCM group (from 13.5±3.9 to 14.1±4.2μg/L, p = 0.962). There was a significant reduction in intrinsic QRS durations compared to baseline at 6-month follow-up after CRT implantation in both FCM and non-FCM group (from 148.4±5.3 to 138.0±5.1ms, p < 0.0001; from 149.8±5.0 to 146.8±4.6ms, p < 0.0001, respectively). The change in intrinsic QRS duration from baseline to 6-month follow-up was significantly greater in the FCM group than in the non-FCM group (-10.4±2.2ms vs -3±2.9ms, p < 0.0001). At the 6-month follow-up, the change in LVEF from baseline was significantly higher in the FCM group than in the non-FCM group (+3.6±1.6% vs -0.1±1.7%, p < 0.0001). The change in ferritin level was negatively correlated with the change in intrinsic QRS duration (r = -0.725, p < 0.0001), whereas there was a positive correlation between the change in ferritin level and the change in LVEF (r = 0.712, p < 0.0001).
Conclusions
Treatment with FCM was induced RER and improvement in LVEF in HFrEF patients with iron deficiency following CRT implantation.
Inflammation is thought to play a role in the pathogenesis of atrial fibrillation. The relationship between CD40 ligand (CD40L), a prothrombotic and proinflammatory molecule, and lone atrial ...fibrillation was presently investigated for the first time. Levels of serum CD40L were also tested, regarding potential to distinguish patients with lone atrial fibrillation from healthy individuals.
Presently included were 35 patients with lone persistent atrial fibrillation and a control group of 30 healthy individuals. Serum levels of CD40L and high-sensitive C-reactive protein (hs-CRP) were measured, and transthoracic echocardiography was performed.
Mean serum CD40L, hs-CRP, left ventricular end-diastolic diameter, and left atrial diameter values were significantly higher in the group with lone persistent atrial fibrillation than in the control group (7.4±3.5 ng/mL vs 4.3±1.2 ng/mL, p<0.0001; 3.7±1.6 mg/L vs 1.7±0.8 mg/L, p<0.0001; 53.0±4.2 mm vs 46.0±3.8, p<0.0001; 43.5±3.5 mm vs 33.7±3.5, p<0.0001, respectively). Serum CD40L levels were positively correlated with left atrial diameter (r=0.81, p<0.0001) and hs-CRP (r=0.72, p<0.0001). Receiver operating characteristic curve analysis revealed that serum CD40L at the optimal cut-off level of >4.5 ng/mL successfully discriminated patients with lone atrial fibrillation from controls (area under the curve: 0.847; 95% confidence interval: 0.759-0.934; p<0.0001).
The present findings suggest that CD40L levels play a crucial role in the development of lone atrial fibrillation. In addition, results support that regular clinical follow-up of these patients is necessary, due to increased cardiovascular disease risk, determined by elevated CD40L levels.
The aim of this study was to assess the efficacy and feasibility of an enhanced heart failure (HF) education with a 6-month telephone follow- up program in post-discharge ambulatory HF patients.
The ...Hit-Point trial was a multicenter, randomized, controlled trial of enhanced HF education with a 6-month telephone follow-up program (EHFP) vs routine care (RC) in patients with HF and reduced ejection fraction. A total of 248 patients from 10 centers in various geographical areas were randomized: 125 to EHFP and 123 to RC. Education included information on adherence to treatment, symptom recognition, diet and fluid intake, weight monitoring, activity and exercise training. Patients were contacted by telephone after 1, 3, and 6 months. The primary study endpoint was cardiovascular death.
Although all-cause mortality didn't differ between the EHFP and RC groups (p=NS), the percentage of cardiovascular deaths in the EHFP group was significantly lower than in the RC group at the 6-month follow up (5.6% vs. 8.9%, p=0.04). The median number of emergency room visits was one and the median number of all cause hospitalizations and heart failure hospitalizations were zero. Twenty-tree percent of the EHFP group and 35% of the RC group had more than a median number of emergency room visits (p=0.05). There was no significant difference regarding the median number of all-cause or heart failure hospitalizations. At baseline, 60% of patients in EHFP and 61% in RC were in NYHA Class III or IV, while at the 6-month follow up only 12% in EHFP and 32% in RC were in NYHA Class III or IV (p=0.001).
These results demonstrate the potential clinical benefits of an enhanced HF education and follow up program led by a cardiologist in reducing cardiovascular deaths and number of emergency room visits with an improvement in functional capacity at 6 months in post-discharge ambulatory HF patients.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Coronary microvascular dysfunction plays a major role in the pathogenesis of microvascular angina (MVA). Along with endothelial dysfunction, microvascular atherosclerosis and inflammation seem to ...contribute to the development of coronary microvascular dysfunction. Serum soluble ST2 (sST2) and serum soluble CD40 ligand (sCD40L) are two biomarkers associated with inflammation and atherosclerosis. The aim of this study was to investigate the role of these biomarkers in the pathogenesis of MVA and determine their possible association with coronary microvascular dysfunction.
A total of 152 patients were included in the study. Ninety-one patients with MVA {median age 56 years (40–79), of which 55 are women} and sixty-one controls {median age 52 (38–76), of which 29 are women} were included in the study. Serum concentration of sST2 and sCD40L were measured with a commercially available ELISA kit.
Serum sST2 (median 13.6 ng/ml; interquartile range (IQR), 3.5–63.8 ng/ml vs median 10.6 ng/ml; IQR, 2.9–34.2 ng/ml, p < 0.0005) and sCD40L (median 5.3 ng/ml; IQR, 0.5–20.6 ng/ml vs median 2.2 ng/ml; IQR, 0.7–10.8 ng/ml, p < 0.0005) were significantly higher in patients with MVA compared to controls. Analysis of the associations between these biomarkers and potential contributors of MVA revealed that serum sST2 showed a positive correlation with LDL-cholesterol (r = 0.19, p = 0.016) and serum sCD40L concentrations correlated positively with hs-CRP (r = 0.22, p = 0.005). In logistic regression analysis, sCD40L and hs-CRP but not sST2 were found to be significantly associated with MVA.
Higher serum concentrations of sST2 and sCD40L in MVA patients may be associated with inflammatory activation and coronary microvascular dysfunction. Larger studies are required for understanding their role in the pathogenesis of inflammatory and possibly fibrotic process in MVA patients.
•Coronary microvascular dysfunction plays a major role in the pathogenesis of microvascular angina (MVA).•The pathophysiology of MVA is not well understood.•MVA carries significant morbidity and increases the risk for cardiovascular events.•Serum sST2 and sCD40L can play a role in myocardial fibrosis, endothelial dysfunction, and inflammation in patients with MVA.
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