Fulminant Giant Cell Myocarditis and Cardiogenic Shock: An Unusual Presentation of Malignant Thymoma

Malignant thymoma is rarely associated with giant cell myocarditis. We present a case study that illustrates this association and cardiogenic shock with underlying tamponade. The dramatic presentation of this scenario has not been previously described

“Bionic Women and Men” Part 1: Cardiovascular Lessons from Heart Failure Patients Implanted with Left Ventricular Assist Devices (LVADs)

Some humans with chronic, advanced heart failure are surgically implanted with a left ventricular assist device (LVAD). Because the LVAD produces a continuous flow, a palpable pulse is often absent in these patients. This allows for a unique investigation of the human circulation and has created a controversy around the ‘need’ for a pulse. The medical debate has also generated a more generic, fundamental discussion into what is ‘normal’ arterial physiology and health. The comprehensive study and understanding of the arterial responses to drastically altered haemodynamics due to continuous‐flow LVADs, at rest and during activity, presents an opportunity to significantly increase our current understanding of the fundamental components of arterial regulation (flow, blood pressure, sympathetic activity, endothelial function, pulsatility) in a way that could never have been studied previously. In a series of four articles, we summarize the talks presented at the symposium entitled ‘Bionic women and men – Physiology lessons from implantable cardiac devices’ presented at the 2019 Annual Meeting of The Physiological Society in Aberdeen, UK. The articles highlight the novel questions generated by physiological phenomena observed in LVAD patients and propose future areas of interest within the field of cardiovascular physiology

Chronic Kidney Disease and Mortality in Implantable Cardioverter-Defibrillator Recipients

Incidence of sudden cardiac death (SCD) in end-stage renal disease (ESRD) remains high. Limited data is available about whether implantable cardioverter-defibrillators (ICDs) can prevent arrhythmic death in patients with chronic kidney disease (CKD). The purpose of this retrospective study was to determine the impact of CKD on all-cause and sudden cardiac death in ICD recipients. We evaluated 441 consecutive patients who underwent ICD implantation at our center between 1994 and 2002. We found that mortality rate was higher in patients with eGFR <60 mL/min and those with ESRD on hemodialysis (43%, n = 69/162 and 54%, n = 12/22, resp.) than in patients with eGFR ≥60 mL/min (23%, n = 58/257; P < .0005). The SCD rate was also higher in the patients with ESRD (50%) than in CKD patients not on dialysis (10.2%; P < .0005). Mortality rate for single-chamber ICDs was 56.8% in comparison with dual-chamber ICDs (38.1%) and for biventricular ICDs (5.0%) (P < .0005)

“Bionic Women and Men” Part 4: Cardiovascular, Cerebrovascular and Exercise Responses Among Patients Supported with Left Ventricular Assist Devices

Current generation left ventricular assist devices (LVADs) have led to significant improvements in survival compared to medical therapy alone, when used for management of patients with advanced heart failure. However, there are a number of side-effects associated with LVAD use, including hypertension, gastrointestinal bleeding, stroke, as well as persistent and severe limitations in functional capacity despite normalization of a resting cardiac output (Qc). These issues are, in large part, related to chronic exposure to a non-physiologic pulse, which contributes to a hyperadrenergic environment characterized by markedly elevated levels of sympathetic nerve activity through a baroreceptor-mediated pathway. In addition, these machines are unable to participate in, or contribute to, normal cardiovascular/autonomic reflexes that attempt to modulate flow through the body. Efforts to advance device technology and develop biologically sensitive devices may resolve these issues, and lead to further improvements in quality-of-life, functional capacity, and ultimately, survival, for the patients they support

“Bionic Women and Men” Part 2: Arterial Stiffness in Heart Failure Patients Implanted with Left Ventricular Assist Devices (LVADs)

In parallel with the major advances in clinical care, technological advancements and implantation of mechanical circulatory support in patients with severe heart failure have resulted in these patients living longer. However, these patients are still at increased risk of stroke and gastrointestinal bleeding. The unique continuous flow produced by various left ventricular assist devices (LVAD) has been suggested as one potential reason for this increased risk of stroke and GI bleeding. Furthermore, these continuous‐flow (CF) devices challenge our understanding of circulatory blood pressure and flow regulation in relation to organ health. In healthy pulsatile and dynamic systems, arterial stiffness is a major independent risk factor for stroke. However, to date, there are limited data regarding the impact of CF‐LVAD therapy on arterial stiffness. The purpose of this report is to discuss the varied impact of CF‐LVAD therapy on arterial stiffness and attempt to highlight some potential mechanisms linking these associations in this unique population

Programma

Programma scientifico della nuova rivista pubblicata sul portale della Sorbonne Université, diretta da L. Cugny, V. Caporaletti e F. Araújo Costa, la "Revue d'études du Jazz et des Musiques Audiotactiles"

“Bionic Women and Men” Part 3: Right ventricular dysfunction in patients implanted with left ventricular assist devices

The adaptation of the right ventricular (RV) output to a left ventricular assist device (LVAD) often determines the fate of patients with pulmonary hypertension secondary to left heart failure. Pre‐existing right heart dysfunction in patients with advanced left heart failure is the consequence of increased (arterial) afterload and not simply the consequence of myocardial disease. If unaccounted for, it has the potential of accelerating into clinical right heart failure after LVAD, leading to significant morbidity and mortality. After LVAD implantation, the RV has to face increased flow generated by the LVAD, cardiac arrhythmias and exaggerated functional interactions between both ventricles. Understanding the key physiological mechanisms of RV dysfunction in patients with end‐stage heart failure will allow us to predict and therefore prevent RV failure after LVAD implantation