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International Cardiovascular Forum Journal
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This is an Open Access Journal

Open Access journal
ISSN (Print) 2409-3424 - ISSN (Online) 2410-2636
Published by Barcaray Publishing

[2 journals]

Sacubitril/Valsartan for Heart Failure: Exciting Times but Are Doctors
Informed and Ready'
- Authors: Prithwish Banerjee
  Abstract: Sacubitril/Valsartan in now being prescribed by heart failure/cardiology teams across the United Kingdom following the publication of the NICE technology appraisal guidance but is everyone ready for it' This article discusses the practical aspects of what to do and not to do in relation to the drug based on real world experience from our centre.
  PubDate: 2018-02-04
  Issue No: Vol. 12 (2018)
Heart Failure: The Dilemma of the 40-50% Ejection Fraction Range
- Authors: Michael Henein, Krister Lindmark, Andrew Coats, Per Lindqvist
  Abstract: The common pathophysiology contributing to fluid retention and dyspnoea in heart failure is a non-compliant and stiff myocardium with raised left ventricular end-diastolic pressure. With the rapid development of newer imaging technologies, particularly echocardiography, our understanding of the syndrome of heart failure has significantly changed. The most important imaging sign in the early eighties was reduced ejection fraction (HFrEF), with low values being used as an explanation for the development of signs and symptoms. In the early 2000s, similar Doppler echocardiographic signs became frequently recognised in patients with heart failure symptoms and signs who proved to have a relatively maintained ejection fraction (EF) of >40%, hence the description of the syndrome of “diastolic heart failure”. This was later rephrased as heart failure with normal ejection fraction (HFnEF) and more recently as heart failure with preserved ejection fraction (HFpEF). Since then, HFpEF has attracted the interest of many cardiologists and scientists worldwide, searching for specific features and treatment options for the syndrome. As for the features, two important findings have now been established, the first showed that LV systolic function mainly at the subendocardial level was abnormal in HFpEF, particularly manifesting during stress/exercise when the increase in heart rate was not associated with a commensurate increase in stroke volume and a second observation of a significant impairment of left atrial function (i.e. myocardial strain) and emptying fraction associated with increased left atrial pressures and the potential development of atrial arrhythmia in HFpEF. Such atrial abnormalities have been shown to be commonly associated with cavity enlargement and poor compliance. The latter observation has similarly been reported in patients with reduced EF. Despite the above similarities in cardiac physiology between HFpEF and HFrEF, treatments of the two conditions differ markedly. When comparing HFrEF and HFpEF, we can easily see that some patients fall into the grey area on the EF spectrum with values fluctuating above and below 40%, suggesting that the substrate for the expected drug effect may differ, possibly explaining the lack of consistent response in these patients.. In addition, it should not be forgotten that most heart failure medications work on the circulation rather than the heart itself, hence the need for shared circulatory disturbances between the two conditions before we can reasonably expect identical treatment benefits when using the same medications in different clinical settings. Therefore, it is clear that classifying heart failure patients according to a single measure of LV function i.e. ejection fraction fails to help at least 50% of patients presenting with this syndrome. In contrast, aggregating such patients based on clear evidence for raised LA pressures, irrespective of EF, might show evidence for a more consistent response to vasodilators and conventional heart failure therapy, particularly those patients currently described as HFpEF.
  PubDate: 2018-02-04
  Issue No: Vol. 12 (2018)
A Modified Anatomical-Functional-RoPE (AF-RoPE) Score Improves Patient
Selection for Patent Foramen Ovale Closure
- Authors: Gianluca Rigatelli, Marco Zuin, Fabio Dell'Avvocata, Luigi Pedon, Roberto Zecchel, Antonio Carrozza, Marco Zennaro, Marco Marcolo, Monia Russo, Mario Zanchetta
  Abstract: Background: RoPE score calculator has been proposed to stratify the patients in whom PFO may be considered not a confounding but presumably a causative factor.Objectives To implement the RoPE score calculator.Methods. We reviewed the medical data of 1040 consecutive patients (mean age 47.3±17.1 years) prospectively enrolled in two centres over a 13 years period for management of PFO in order to select anatomic and functional parameters to be incorporated in a modified RoPE score. A scoring system (AF-RoPE) was build up and applied in a prospective blind fashion to a cohort of 406 consecutive patients (mean age 43.6 ±17. 5 years, 264 females) with cryptogenic stroke and PFO comparing its performance with the standard RoPE.Results. Multiple stepwise logistic regression analysis demonstrated that right-to-left (R-L) shunt at rest (OR 5.9), huge ASA (> 20 mm) (OR 3.9), long tunnelized PFO (> 12 mm) (OR 3.5), and massive R-L shunt (grade 5 by TCD) (OR 1.9) conferred the highest risk of recurrent stroke. The AF-RoPE score resulted in a more precise separation of patients with RoPE score 8-10. Patients with AF-RoPE score > 11 had more stroke recurrences and more diffuse area of stroke on MRI in the medical history than those ranging 10 to 7 or less.Conclusion. The AF-RoPE score discriminates cryptogenic stroke patients who are more likely to develop recurrent stroke compared with a RoPE score between 8-10. These highest risk patients may be more likely to benefit from PFO closure.
  PubDate: 2018-02-04
  Issue No: Vol. 12 (2018)
Rationale and Design for the Peripartum Cardiomyopathy in Nigeria (PEACE)
Registry
- Authors: Kamilu Musa Karaye, Idris Y Mohammed, Okechukwu S Ogah, Basil N Okeahialam
  Abstract: Background: Nigeria probably has the highest burden of Peripartum Cardiomyopathy (PPCM) in the world. The primary objective is to describe the burden, ventricular remodelling and outcomes (rehospitalisation rate, cardio-embolic events and survival) of PPCM in Nigeria. In the sub-studies, we aim to describe the relationship between selenium deficiency, oxidative stress and PPCM, the impact of sodium selenite supplementation on cardiac function in PPCM, and the prevalence of selenium deficiency and its relationship with cardiac function in apparently healthy pregnant women.Methods: The main Registry and the first sub-study are prospective longitudinal studies, while the second sub-study is an open-label randomised trial. 36 study centres across Nigeria have been registered and 10 of them are already recruiting subjects. Patients will be recruited from June to December 2017 and followed up till December 2018. Serum selenium and glutathione peroxidase will be assayed at recruitment for consecutive PPCM patients with LV ejection fraction (LVEF) <45% at 6 months postpartum. 200 subjects with selenium deficiency will be randomised into treatment (Selenium Selenite 200µg tablets daily for 3 months) and control arms. In the second sub-study, 120 apparently healthy pregnant women will be recruited at 28-38 weeks of gestation and reviewed at 6-8 weeks postpartum, and their serum selenium and GPO levels will be measured at recruitment.Conclusion: This will be the largest systematic evaluation of PPCM in Nigeria, and it is hoped that the information will assist in developing locally applicable treatment guidelines and policies for the disease.
  PubDate: 2018-02-04
  Issue No: Vol. 12 (2018)
Quality of life in Maltese Adults with Congenital Heart Disease: a Second
Look – An APPROACH-IS Substudy
- Authors: Maryanne Caruana, Philip Moons, Adrienne Kovacs, Koen Luyckx, Corina Thomet, Werner Budts, Maayke Sluman, Katrine Eriksen, Mikael Dellborg, Malin Berghammer, Bengt Johansson, Alexandra Soufi, Edward Callus, Victor Grech, Silke Apers
  Abstract: Background: A first quality of life (QOL) study among Maltese adults with congenital heart disease (ACHD) in 2016 found no significant differences when compared to the general population. The aims of the present study were to (1) compare QOL between Maltese and other European ACHD patients and (2) investigate medical predictors (i.e. number of surgical/non-surgical interventions, heart failure, arrhythmias, pacemaker/implantable cardioverter-defibrillator, cardiac hospitalisation during preceding year, follow-up frequency, other medical conditions, mood/anxiety/psychiatric disorders) of QOL in Maltese patients.Methods: Data collected during “Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease–International Study” (APPROACH-IS) was used. QOL was measured using linear analog scale (LAS) and Satisfaction With Life Scale (SWLS). QOL in 109 Maltese and 1510 European participants was compared. Multivariable logistic regression was used to test the predictive value of medical factors on QOL in Maltese patients.Results: There were no significant differences in QOL between the two cohorts [mean LAS Malta 80.51 (95% CI 77.96,83.07) vs. European 79.43 (95% CI 78.65,80.21) (p=0.776); mean SWLS Malta 26.00 (95% CI 24.94,27.06) vs. European 26.26 (95% CI 25.95,26.57) (p=0.288)] and no significant differences when cohorts were divided by gender and age. Only a mood/anxiety/other psychiatric disorder significantly predicted poorer QOL on both scales in Maltese patients (LAS (ß=-.389, p<0.001), SWLS (ß=-.352, p=0.001)). Conclusions: Maltese ACHD patients have a good QOL comparable to that of European counterparts. Mood, anxiety and other psychiatric disorders can negatively impact Maltese patients’ QOL. Better access to clinical psychology services should be ensured.
  PubDate: 2018-02-04
  Issue No: Vol. 12 (2018)
Different Strategies to Treat Paroxysmal AF in Patients with Moderate CKD
and Severe OSA: a sub group Analysis
- Authors: Marcio Galindo Kiuchi, Shaojie Chen
  Abstract: Accentuated sympathetic nerve activity is a strong danger feature for cardiovascular major episodes, such as cerebral and myocardial ischemia/infarction. Peripheric sympathetic nerve activity is emphasized in the hypertensive state, congestive cardiac failure, OSA, heaviness, diabetes, and chronic kidney disease (CKD) subjects. Leastwise a half of individuals with hypertension present augmented sympathetic nerve activity. Our group believes that RSD can reduce AF recurrence in patients with CKD and OSA by modulation of the sympathetic hyperactivity present in these diseases. The goal of this prospective study was to compare the impact of different treatments including CPAP, PVI, RSD, and some combination of them in controlled hypertensive patients with paroxysmal AF, moderate CKD, and severe OSA. Our data suggest that the patients underwent RSD associated to CPAP treatment or PVI, or both of them presented an improvement in the renal function, a decrease in AHI and a lower chance to present AF recurrence than the ones that did not suffer this intervention. Although encouraging, our data are preliminary and need long-term validation in a large population.
  PubDate: 2018-02-04
  Issue No: Vol. 12 (2018)
A Giant Thrombosed Right Coronary Artery Aneurysm Presenting as an
Obstructing Left Atrial Mass.
- Authors: Stephen Micallef Eynaud, Alexander Manché
  Abstract: Giant coronary artery aneurysms are exceedingly rare. Symptoms are vague and often related to myocardial ischaemia or compression of a cardiac chamber. Surgery is indicated when obstruction to the circulation results in heart failure or syncope, as in our case. A clear elucidation of the pathology may not be possible before exploration and the surgical strategy is tailored to the individual case.
  PubDate: 2018-02-04
  Issue No: Vol. 12 (2018)
Is there a Title Role for Renal Sympathetic Denervation in Patients with
Symptomatic Myocardial Bridging Refractory to Clinical Treatment and
Ventricular Arrhythmias'
- Authors: Marcio Galindo Kiuchi, Shaojie Chen
  Abstract: The connection concerning the autonomic nervous system and coronary spasm during the systole is multifaceted. An augmentation in sympathetic activity, due to pain caused by angina and the several transient ischemic episodes may origin an augment in noradrenaline, the neurotransmitter of efferent sympathetic fibers, triggering more vasoconstriction by stimulating vascular smooth muscle cells, besides may lead the cardiac hypertrophy. Based on these concepts we aim to find a role to renal sympathetic denervation in patients with symptomatic myocardial bridging refractory to standard clinical treatment and ventricular arrhythmias. In conclusion, our findings suggest that RSD can be a role in myocardial bridging treatment, augmenting the LVEF, diminishing the LV mass and the number of transient ischemic segments measured by CMRI, besides to reduce the number of individuals presenting symptoms, the mean of NSVT recorded by 24-hour-Holter monitoring, and the number of patients with SVT inducible by the EPS. Perhaps such benefits are due to the decrease in the LV mass and sympathetic cardiac activity, consequently, there being less constriction of the arteries with myocardial bridges and less ventricular arrhythmias.We report preliminary data on 6 patients with controlled hypertension, with normal renal function, with symptomatic myocardial bridging refractory to clinical treatment and ventricular arrhythmias who underwent a pilot renal sympathetic denervation (RSD) procedure. At baseline, the 6 (100%) patients presented symptoms while 6 months after RSD only 1 (17%) subject still complained of the symptoms (P=0.0152). Our findings suggest that RSD can play a role in myocardial bridging treatment, augmenting LVEF, diminishing LV mass and the number of transient ischemic segments measured by CMRI.
  PubDate: 2018-02-04
  Issue No: Vol. 12 (2018)