A review of outcomes and modes of presentation following liner dissociation from Harris-Galante uncemented acetabular components

Purpose Dissociation of the polyethylene liner is a known failure mechanism of the Harris Galante I and II uncemented acetabular components. The outcomes of revision surgery for this indication and the influence of time to diagnosis are not well described. Methods We report a series of 29 cases revised due to this failure mechanism. The median time from primary to revision surgery was 13 years. Results At a median of 4 years follow-up, the mean OHS was 34 (range 6-48) but results were poorer (mean 29; range 6-45) when the diagnosis and revision was delayed compared to when it was not (mean 39; range 20-48). A large proportion of our patients (n = 14) presented with sudden onset of symptoms with or without trauma. Osteolysis was common in this series but the cup was well fixed in 20/29 cases. There was macroscopic damage to the shell in all cases. Conclusions In our experience, prompt revision of liner dissociation optimises outcomes in this group of patients and radiology reporting alone is not sufficient to identify these cases. </jats:sec

Case Report of Multiembolic Cerebrovascular Event Associated with Ramp Study Echocardiogram

The incidence of ramp test echocardiogram-associated embolic events in the setting of therapeutic anticoagulation is likely rare and has not been reported. We present such a case in a patient with a HeartMate II left ventricular assist device (LVAD) whose serial head computed tomography images, deteriorating clinical course, and the multiembolic nature of the event suggest causality. If the pretest probability of pump thrombosis in an individual LVAD patient is sufficiently high, the potential risks of performing a ramp study echocardiogram may not be warranted, even in the setting of adequate anticoagulation

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Case Report of Multiembolic Cerebrovascular Event Associated with Ramp Study Echocardiogram

The incidence of ramp test echocardiogram-associated embolic events in the setting of therapeutic anticoagulation is likely rare and has not been reported. We present such a case in a patient with a HeartMate II left ventricular assist device (LVAD) whose serial head computed tomography images, deteriorating clinical course, and the multiembolic nature of the event suggest causality. If the pretest probability of pump thrombosis in an individual LVAD patient is sufficiently high, the potential risks of performing a ramp study echocardiogram may not be warranted, even in the setting of adequate anticoagulation

Heart Failure-Induced Brain Injury

Heart failure (HF) is a systemic illness with grave implications for bodily functions. The brain, among other vital organs, often suffers insults as a result of HF, and both anatomic and functional brain abnormalities were found in the HF population. This injury was demonstrated across a wide range of clinical conditions and cardiac functions and was shown to affect patients\u27 outcomes. Although reduced cardiac output and high burden of cardiovascular risk factors are the prevailing explanations for these findings, there are data showing the involvement of neurohormonal, nutritional, and inflammatory mechanisms in this complex process. Here, the authors review the suggested pathophysiology behind brain injury in HF, describe its effect on patients\u27 outcomes, offer a diagnostic approach, and discuss possible therapeutic options

Pulmonary Artery Pressure Changes Detected by CardioMEMS in Temporal Relation to Hemodialysis in Heart Failure Patients with End-Stage Renal Disease

Cardiorenal syndrome impacts many heart failure (HF) patients, and the need for hemodialysis (HD) is associated with worsening HF and increased risk of death. The CardioMEMS system (Abbott Medical) was shown to have efficacy in the CHAMPION trial, but cardiorenal patients were excluded from enrollment. Our aim is to determine pulmonary artery (PA) pressure characteristics for HF outpatients receiving routine HD. Eight HD-HF patients (54 ± 9 yrs, male =4, LVEF = 28 ± 8%) received the CardioMEMS system and were prospectively followed on an outpatient basis. PA pressures were transmitted twice on HD days (pre- and post- HD), and once on non-HD days. PA pressure was monitored weekly to observe long-term characteristics of parameter changes occurring at baseline and during meaningful clinical events (defined as emergent HD sessions or hospital encounter for volume overload). PA pressure was considered baseline if >21 days prior to clinical event or post-medication change. Paired t-test was used for comparisons; P-value <0.05 denoted statistical significance. The study was approved by the institutional IRB. PA pressures were elevated at implant (mean PA diastolic pressure [PADP] = 29 ± 10 mmHg), remained consistently high even though patients were at "dry weight," and were highest on HD days prior to dialysis (Figure 1). There were significant differences in PA pressure in temporal relation to HD schedule (Figure 2A), with the exception of PADP when compared between non-HD vs post-HD values. 3 patients had a HF event (3 emergent HD, 1 hospitalization) and, compared to patients without HF events, PA pressures exhibited loss of cyclical pressure variation with progressive elevation prior to decompensation (Figure 2B). HF outpatients with cardiorenal syndrome demonstrate elevated PA pressures at "dry weight." CardioMEMS reveals expected PA pressure changes in temporal association with HD-related fluid removal. Those experiencing HF decompensation do not demonstrate this pattern. Future studies are needed to determine if PA pressures can be used to determine HD-related fluid removal protocols to avoid HF decompensation in these patients