A variant form of acute reversible cardiomyopathy: a case report

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Doppler tissue imaging unmasks right ventricular function abnormalities in HIV-infected patients

Background: We sought to investigate right ventricular (RV) function with Doppler tissue imaging (DTI) in human immunodeficiency virus (HIV)-infected patients receiving highly-active antiretroviral treatment, without any heart-related symptoms. Methods: We studied 38 asymptomatic HIV patients (aged 44.5 ± 9.2 years, 22 of them men) and 25 age-matched and sex-matched controls. All subjects underwent conventional and DTI estimation of left ventricular (LV) systolic and diastolic function, measuring peak systolic and diastolic myocardial velocities at the mitral annulus (Sm, Em, Am). Two-dimensional (2-D) echocardiographic study of the right ventricle (RV) was performed from the four-chamber view, and RV end-diastolic dimensions were measured. DTI recordings from the RV free wall at the tricuspid annulus were used to determine systolic (SmRV) and diastolic function (EmRV and AmRV). Results: HIV-infected patients compared to controls exhibited significantly lower peak systolic velocities at the septal-SmIVS (7.9 ± 1.3 vs 9.1 ± 1.4 cm/s, p = 0.002) and lateral mitral annulus - SmLAT (9.8 ± 1.7 vs 11.2 ± 1.3 cm/s, p = 0.025); no difference was observed regarding conventional 2-D examination of LV systolic and diastolic function and DTI-derived Em and Am. No significant difference occurred between HIV patients and controls regarding RV end-diastolic dimensions and pulmonary artery systolic pressure. However, SmRV (13.8 ± 1.6 vs 14.9 ± 2.2 cm/s, p = 0.040), EmRV (11.6 ± 3 vs 13.5 ± 2.6 cm/s, p = 0.028) and AmRV (10.9 ± 2.5 vs 13.8 ± 4 cm/s, p = 0.003) were significantly reduced in HIV patients as compared to controls. Conclusions: DTI unmasks subtle and otherwise undetectable abnormalities of the longitudinal LV systolic function and both RV systolic and diastolic function, in asymptomatic HIV patients receiving highly-active antiretroviral treatment. (Cardiol J 2010; 17, 6: 587-593

Levosimendan beyond inotropy and acute heart failure: Evidence of pleiotropic effects on the heart and other organs: An expert panel position paper

Peer reviewe

How to develop a national heart failure clinics network: a consensus document of the Hellenic Heart Failure Association

Heart failure (HF) is rapidly growing, conferring considerable mortality, morbidity, and costs. Dedicated HF clinics improve patient outcomes, and the development of a national HF clinics network aims at addressing this need at national level. Such a network should respect the existing health care infrastructures, and according to the capacities of hosting facilities, it can be organized into three levels. Establishing the continuous communication and interaction among the components of the network is crucial, while supportive actions that can enhance its efficiency include involvement of multidisciplinary health care professionals, use of structured HF-specific documents, such as discharge notes, patient information leaflets, and patient booklets, and implementation of an HF-specific electronic health care record and database platform

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 < 100 mmHg (n = 1127), estimated glomerular filtration rate < 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

Long term prognostic vallue of release kinetics of troponint in patients with acute myocardial infarction treated successfully with primary angioplasty

Cardiac troponin is the best marker for diagnosis, risk stratification and guidance of therapy in acute coronary syndromes. In contrast to coronary angiography that estimates only the patent epicardial artery and the epicardial reperfusion, release kinetics of troponin T and more specifically the time to peak of troponin T has been suggested to be a better marker for evaluating the tissue reperfusion in AMI patients and consequently it may be a better marker of clinical outcome. The aim of this study was to assess if release kinetics of troponin T could predict a better long-term outcome, in patients with acute myocardial infarction and successful primary angioplasty. For this purpose were studied 104 patients with acute myocardial infarction and successful primary angioplasty within 4 hours after the onset of symptoms. Blood samples for measurement of cardiac troponin T were obtained on admission before primary PTCA, 15 min immediately after successful PTCA, then every 6 h on the first day and finally at 36, 48 and 72 hours. All alive patients had completed the minimal follow-up period of 24 months (mean 30.5 ± 3.7 months). The time from onset of symptoms to peak level of troponin T was 10.7 ± 4.8 h and the peak concentration of serum troponin T was 11.2 ± 6.5 ng/dl for the entire group. Cardiac mortality was 13.5% and the cumulative incidence of death, nonfatal reinfarction and percutaneous or surgical reintervention at the long follow-up period was 43.3%. The main finding of this study was that the patients with early time to peak troponin T < 11 hours from the symptom onset, had better cardiac survival and better cardiac event free survival. In addition, the time to peak troponin T was an independent predictor of cardiac event free survival and consequently it may be a useful marker for the subsequent stratification and management of the patients after the successful primary angioplasty.Οι τροπονίνες είναι πιο ειδικοί και ευαίσθητοι δείκτες μυοκαρδιακής βλάβης και έχουν μεγάλη κλινική σημασία όχι μόνο για τη διάγνωση αλλά και για την διαστρωμάτωση κινδύνου και την πρόγνωση των ασθενών με οξύ στεφανιαίο σύνδρομο. Σε αντίθεση με τη στεφανιογραφία που εκτιμά μόνο την βατότητα του αγγείου και την επικαρδιακή επαναιμάτωση, η κινητική απελευθέρωσης της τροπονίνης Τ και πιο συγκεκριμένα ο χρόνος κορύφωσής της, αποτελεί ένα αναίμακτο και αξιόπιστο δείκτη εκτίμησης της ιστικής μυοκαρδιακής επαναιμάτωσης και ως εκ τούτου θα μπορούσε να είναι ένας αξιόπιστος και καλύτερος προγνωστικός δείκτης της κλινικής έκβασης των ασθενών. Σκοπός της παρούσας μελέτης ήταν: α) να μελετηθεί η κινητική της τροπονίνης Τ σε ασθενείς με οξύ έμφραγμα του μυοκαρδίου και επιτυχημένη πρωτογενή αγγειοπλαστική, και β) να παρακολουθηθούν οι ασθενείς προοπτικά όσον αφορά τον καρδιακό θάνατο και τα μείζονα καρδιακά συμβάματα με τελικό στόχο να εκτιμηθεί η μακροχρόνια προγνωστική αξία της κινητικής της τροπονίνης Τ. Μελετήθηκαν 104 ασθενείς με οξύ έμφραγμα του μυοκαρδίου και επιτυχημένη πρωτογενή αγγειοπλαστική μέσα σε χρονικό διάστημα 4 ωρών από την έναρξη των συμπτωμάτων. Ελήφθησαν δείγματα φλεβικού αίματος για τη μέτρηση της τροπονίνης Τ με την εισαγωγή των ασθενών στο νοσοκομείο και πριν την πρωτογενή αγγειοπλαστική, αμέσως μετά τη πρωτογενή αγγειοπλαστική, στη συνέχεια ανά 6ωρο μέχρι τη συμπλήρωση του πρώτου 24ώρου και μετά στις 36, 48 και 72 ώρες. Καταγράφηκαν οι θάνατοι καρδιακής και μη καρδιακής αιτιολογίας, τα εμφράγματα του μυοκαρδίου καθώς και η ανάγκη για επαναιμάτωση είτε με αγγειοπλαστική είτε με αορτοστεφανιαία παράκαμψη. Όλοι οι ζώντες ασθενείς συμπλήρωσαν τον μικρότερο προβλεπόμενο χρόνο καρδιακής παρακολούθησης που ήταν δυο χρόνια με μέσο χρόνο καρδιακής παρακολούθησης 30,5 ± 3,7 μήνες. Ο χρόνος από την έναρξη των συμπτωμάτων μέχρι την κορύφωση της τροπονίνης Τ ήταν 10,7 ± 4,8 ώρες και η μέση τιμή της μέγιστης συγκέντρωσης της τροπονίνης Τ ήταν 11,2± 6,5 ng/dl για όλους τους ασθενείς μαζί. Η καρδιακή θνητότητα ήταν 13,5% (14/104) για όλους τους ασθενείς συνολικά. Η συνολική επίπτωση καρδιογενούς θανάτου, επανεμφράγματος του μυοκαρδίου και ανάγκης για επαναιμάτωση είτε με αγγειοπλαστική είτε με αορτοστεφανιαία παράκαμψη ήταν 43,3 %. Το κύριο εύρημα της μελέτης μας ήταν ότι, οι ασθενείς που είχαν πρώιμο χρόνο κορύφωσης της τροπονίνης Τ μικρότερο των 11 ωρών από την έναρξη των συμπτωμάτων παρουσίασαν καλύτερη συνολική καρδιακή επιβίωση και καλύτερη ελεύθερη καρδιακών συμβαμάτων επιβίωση. Επιπρόσθετα ο χρόνος κορύφωσης της τροπονίνης Τ ήταν ένας ανεξάρτητος προβλεπτικός δείκτης για την ελεύθερη καρδιακών συμβαμάτων επιβίωση και συνεπώς θα μπορούσε να χρησιμεύσει για την περαιτέρω διαστρωμάτωση και θεραπευτική αντιμετώπιση των ασθενών μετά από επιτυχημένη πρωτογενή αγγειοπλαστική

In-hospital management of acute heart failure: Practical recommendations and future perspectives

Acute heart failure (AHF) represents the first reason for hospitalization in the elderly and despite therapeutic advances, remains a syndrome with significant morbidity and dismal prognosis. Hospitalization for AHF, on the other hand, is the single most important contributor to the huge financial burden related to HF. As a result, there is a significant unmet need for more effective in-hospital management of patients with AHF in order to improve outcomes, reduce readmission rate and alleviate the socioeconomic burden of the syndrome. The in hospital management of AHF patients may schematically be divided into three phases, an early phase of intensive management of congestion and/or hypoperfusion, an intermediate phase of transition to oral life-saving medications and a late phase of discharge and transition to outpatient management. In the present paper, we attempt to provide a concise and practical roadmap for each of the above phases, focusing mainly on defining clinical and laboratory criteria for the evaluation of patients and on describing therapeutic algorithms that summarize the available evidence and guidelines. In addition, we highlight some key open issues that need to be addressed by future research. (C) 2015 Elsevier Ireland Ltd. All rights reserved