The benefits of stem cell therapy for patients with chronic symptomatic systolic heart failure due to ischemic and nonischemic cardiomyopathy (ICM and NICM, respectively) are unclear. We performed a ...systematic review of major published and ongoing trials of stem cell therapy for systolic heart failure and compared measured clinical outcomes for both types of cardiomyopathy. The majority of the 29 published studies demonstrated clinical benefits of autologous bone marrow-derived mesenchymal stem cells (BM-MSCs). Left ventricular ejection fraction (LVEF) was improved in the majority of trials after therapy. Cell delivery combined with coronary artery bypass grafting was associated with the greatest improvement in LVEF. Left ventricular end-systolic volume (or diameter), New York Heart Association functional classification, quality of life, and exercise capacity were also improved in most studies after cell therapy. Most ICM trials demonstrated a significant improvement in perfusion defects, infarct size, and myocardial viability. Several larger clinical trials that are in progress employ alternative delivery modes, cell types, and longer follow-up periods. Stem cells are a promising therapeutic modality for patients with heart failure due to ICM or NICM. More data are required from larger blinded trials to determine which combination of cell type and delivery mode will yield the most benefit with avoidance of harm in these patient populations.
Several global high-resolution built-up surface products have emerged over the last five years, taking full advantage of open sources of satellite data such as Landsat and Sentinel. However, these ...data sets require validation that is independent of the producers of these products. To fill this gap, we designed a validation sample set of 50 K locations using a stratified sampling approach independent of any existing global built-up surface products. We launched a crowdsourcing campaign using Geo-Wiki ( https://www.geo-wiki.org/ ) to visually interpret this sample set for built-up surfaces using very high-resolution satellite images as a source of reference data for labelling the samples, with a minimum of five validations per sample location. Data were collected for 10 m sub-pixels in an 80 × 80 m grid to allow for geo-registration errors as well as the application of different validation modes including exact pixel matching to majority or percentage agreement. The data set presented in this paper is suitable for the validation and inter-comparison of multiple products of built-up areas.
The prognostic value of deformation parameters of the systemic right ventricle in adults with D-transposition of the great arteries and prior atrial switch has not been reported.
Sixty-four adults ...with D-transposition of the great arteries and prior atrial switch (mean age, 29 ± 6 years; 22 women; mean right ventricular RV fractional area change, 22.9 ± 7.5%; 31 with pacemakers at baseline) and no histories of heart failure or ventricular tachycardia were prospectively evaluated. Global longitudinal strain (GS), global systolic strain rate (GSRs), and global early diastolic strain rate (GSRe) of the right ventricle were measured using speckle tracking from apical views and compared with standard parameters of RV function (fractional area change, tricuspid annular plane systolic excursion, tissue Doppler velocities, and isovolumic acceleration) for association with and potential prediction of clinical events, defined as incident stage C heart failure or ventricular tachycardia.
Baseline RV GS, GSRs, and GSRe were -12.5 ± 3.0%, -0.59 ± 0.14 sec(-1), and 0.68 ± 0.22 sec(-1), respectively. After a median of 2.4 years (interquartile range, 1.5-4.1 years), 12 patients (19%) presented with clinical events (heart failure in 11 patients, ventricular tachycardia in one patient). In Cox models, RV GS had the strongest association with clinical events (hazard ratio HR per 1%, 1.35; 95% confidence interval CI, 1.14-1.58; P < .001), followed by GSRs (HR per 0.01 sec(-1), 1.06; 95% CI, 1.02-1.11; P = .006), GSRe (HR per -0.01 sec(-1), 1.04; 95% CI, 1.00-1.07; P = .031), and fractional area change (HR per -1%, 1.08; 95% CI, 1.00-1.17; P = .047). Other measures of RV function were not significantly associated with risk for events. In receiver operating characteristic analysis, RV GS ≥ -10% optimally predicted future events (C = 0.83; 95% CI, 0.71-0.91; P < .001).
Reduced longitudinal GS of the systemic right ventricle is associated with increased risk for clinical events among patients with D-transposition of the great arteries and prior atrial switch.
Background
Pulmonary hypertension (PH) in patients with heart failure (HF) is associated with worse outcomes and is rapidly being recognized as a therapeutic target. To facilitate pragmatic research ...efforts, data regarding the prognostic importance of noninvasively assessed pulmonary artery systolic pressure (PASP) in stable ambulatory patients with HF are needed.
Methods and Results
We examined the association between echocardiographic PASP and outcomes in 417 outpatients with HF (age, 54±13 years; 60.7% men; 50.4% whites; 24.9% with preserved ejection fraction). Median PASP was 36 mm Hg (interquartile range IQR: 29, 46). After a median follow‐up of 2.6 years (IQR: 1.7, 3.9) there were 72 major events (57 deaths; 9 urgent heart transplants; and 6 ventricular assist device implantations) and 431 hospitalizations for HF. In models adjusting for clinical risk factors and therapy, a 10‐mm Hg higher PASP was associated with 37% higher risk (95% CI: 18, 59; P<0.001) for major events, and 11% higher risk (95% CI: 1, 23; P=0.039) for major events or HF hospitalization. The threshold that maximized the likelihood ratio for both endpoints was 48 mm Hg; those with PASP ≥48 mm Hg (N=84; 20.1%) had an adjusted hazard ratio of 3.33 (95% CI: 1.96, 5.65; P<0.001) for major events and 1.47 (95% CI: 1.02, 2.11; P=0.037) for major events or HF hospitalization. Reduced right ventricular systolic function had independent prognostic utility over PASP for adverse outcomes. Right atrial pressure and transtricuspid gradient both contributed to risk.
Conclusions
Elevated PASP, determined by echocardiography, identifies ambulatory patients with HF at increased risk for adverse events.
IntroductionArrhythmias after orthotopic heart transplantation (OHT) are common. However the influence of pre-transplant atrial arrhythmia on post-OHT atrial arrhythmia has not been established. In ...this study we analyzed the occurrence of post-OHT atrial arrhythmias in patients with prior atrial fibrillation or flutter (afib/flutter).MethodsIn this retrospective single center study, 56 patients who underwent OHT from 2003-14 were enrolled. Patients were stratified based on history of pre-OHT afib/flutter. Baseline demographics, and post-transplant outcomes including atrial arrythmias were recorded. Post-OHT atrial arrhythmias were defined as afib/flutter, atrial tachycardia, multifocal atrial tachycardia, and wandering atrial pacemaker Data was analyzed using student’s t-test and X2 analysis.ResultsThe cohort comprised of 20 patients with pre-transplant history of afib/flutter and 36 patients without such diagnosis. There was no statistical difference in age, gender or BMI in patients between the two groups. Our analysis revealed that patients with afib/flutter prior to OHT had significantly more atrial arrhythmias at one year compared to those without afib/flutter (31.6% vs 8.8%, p=0.034), and this difference was maintained at five years follow-up (50% vs 11.1%, p=0.001). Additionally, there was a strong trend toward increased overall mortality in in this group (35% vs 13.9%, p=0.065).DiscussionOur results suggest a novel finding of a link between pre and post-OHT atrial arrhythmias, particularly in the first year after transplantation. This surprising finding may be related to residual recipient pulmonary vein activity, recipient atrial anastomotic tissue, or patient related factors. Further prospective research is indicated to confirm our findings.
Coronary artery disease (CAD) risk factors and catheterization data were compared to gender- and race-matched HIV(-) patients admitted with ACS from the same hospitals and time period.
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