Short-term prognosis in admissions for acutely decompensated heart failure

Heart failure (HF) is among the leading causes of unplanned hospital admissions worldwide. Patients with HF carry a high burden of comorbidities; hence, they are frequently admitted for non-cardiac conditions and managed in Internal Medicine Departments (IMD). The aim of our study was to investigate differences in demographics, in-hospital management, and short-term outcomes of HF patients admitted to IMD vs. cardiology departments (CD). A prospective cohort study enrolling consecutive patients with acutely decompensated HF either as primary or as secondary diagnosis during the index hospitalization was conducted. Our primary endpoint was a combined endpoint of in-hospital mortality and 30-day rehospitalization for HF. A total of 302 patients participated in the study, with 45% of them admitted to IMD. Patients managed by internists were older with less pronounced HF symptoms on admission. In-hospital mortality was higher for patients admitted to IMD vs. CD (21% vs. 6%, p < 0.001). The composite endpoint of in-hospital death and heart failure hospitalizations at 30 days post-discharge was higher for patients admitted to IMD both in univariate [OR: 3.2, 95% CI (1.8–5.7); p < 0.001] and in multivariate analysis [OR 3.74, 95% CI (1.72–8.12); p = 0.001]. In addition, the HF rehospitalization rate at 6 months after discharge was higher in IMD patients [HR 1.65, 95% CI (1.1, 2.4), p = 0.01]. Overall, HF patients admitted to IMD have worse short-term outcomes compared to patients admitted to CD.Η καρδιακή ανεπάρκεια αποτελεί μία από τις κύριες αιτίες εισαγωγής στο νοσοκομείο παγκοσμίως και χαρακτηρίζεται από ποσοστά επανεισαγωγών που προσεγγίζουν το 50%. Οι ασθενείς με καρδιακή ανεπάρκεια εμφανίζουν υψηλό φορτίο συννοσηροτήτων, ως εκ τούτου συχνά εισάγονται για μη καρδιακά αίτια και αντιμετωπίζονται σε παθολογικές κλινικές. Ο σκοπός της παρούσας μελέτης ήταν η διερεύνηση των διαφορών στα βασικά χαρακτηριστικά, την ενδονοσοκομειακή διαχείριση και την ενδονοσοκομειακή και βραχυπρόθεσμη έκβαση ανάμεσα στους ασθενείς με καρδιακή ανεπάρκεια που εισάγονται σε καρδιολογικές κλινικές και τους ασθενείς που εισάγονται σε παθολογικές κλινικές. Πρόκειται για μια προοπτική μελέτη παρατήρησης ασθενών η οποία έλαβε χώρα στην Α΄Καρδιολογική Κλινική, την Α’ Παθολογική Κλινική και την Α’ Προπαιδευτική Παθολογική Κλινική του ΑΠΘ. Καταγράφηκαν διαδοχικοί ασθενείς με πρωταρχική ή δευτερεύουσα διάγνωση καρδιακής ανεπάρκειας και συλλέχθηκαν στοιχεία για τα χαρακτηριστικά, τις συννοσηρότητες, τη φαρμακευτική αγωγή και την έκβαση των ασθενών σε διάστημα παρακολούθησης 6 μηνών μετά το εξιτήριο. Το πρωτογενές καταληκτικό σημείο της μελέτης ήταν το σύνθετο καταληκτικό σημείο της ενδονοσοκομειακής θνητότητας και επανανοσηλείας για καρδιακή ανεπάρκεια στις 30 ημέρες. Συνολικά, 302 ασθενείς συμμετείχαν στη μελέτη. Το 45% των ασθενών νοσηλεύθηκε σε Παθολογική κλινική. Οι ασθενείς που εισήχθησαν σε παθολογική κλινική ήταν μεγαλύτερης ηλικίας [ 81 (38-94) έναντι 76 (44-90), p<0.001] με ηπιότερα συμπτώματα και σημεία καρδιακής ανεπάρκειας κατά την εισαγωγή. Η ενδονοσοκομειακή θνητότητα ήταν υψηλότερη για τους παθολογικούς ασθενείς [21% έναντι 6%, p<0.001]. Οι ασθενείς που νοσηλεύθηκαν σε παθολογικές κλινικές είχαν σημαντικά αυξημένο κίνδυνο για το σύνθετο καταληκτικό σημείο της ενδονοσοκομειακής θνητότητας και των επανανοσηλειών για απορρύθμιση καρδιακής ανεπάρκειας στις 30 ημέρες, τόσο κατά την μονοπαραγοντική [OR: 3.2, 95% CI (1.8–5.7); p < 0.001] όσο και κατά την πολυπαραγοντική ανάλυση [OR 3.74, 95% CI (1.72–8.12); p = 0.001]. Επιπλέον, οι παθολογικοί ασθενείς είχαν μεγαλύτερο κίνδυνο επανανοσηλειών για απορρύθμιση καρδιακής ανεπάρκειας στους 6 μήνες [HR 1.65, 95% CI (1.1, 2.4), p = 0.01]. Σε αυτή την πραγματικού κόσμου κοόρτη ασθενών με καρδιακή ανεπάρκεια βρέθηκαν σημαντικές διαφορές στα χαρακτηριστικά και την έκβαση ανάμεσα στους ασθενείς που νοσηλεύθηκαν σε παθολογικές και καρδιολογικές κλινικές. Συνεπώς, θα ήταν χρήσιμη η εφαρμογή στρατηγικών για την πρόληψη των επανεισαγωγών σε αυτό τον πληθυσμό ασθενών

Cardiovascular Magnetic Resonance Parametric Mapping Techniques for the Assessment of Chronic Coronary Syndromes

The term chronic coronary syndromes encompasses a variety of clinical presentations of coronary artery disease (CAD), ranging from stable angina due to epicardial coronary artery disease to microvascular coronary dysfunction. Cardiac magnetic resonance (CMR) imaging has an established role in the diagnosis, prognostication and treatment planning of patients with CAD. Recent advances in parametric mapping CMR techniques have added value in the assessment of patients with chronic coronary syndromes, even without the need for gadolinium contrast administration. Furthermore, quantitative perfusion CMR techniques have enabled the non-invasive assessment of myocardial blood flow and myocardial perfusion reserve and can reliably identify multivessel coronary artery disease and microvascular dysfunction. This review summarizes the clinical applications and the prognostic value of the novel CMR parametric mapping techniques in the setting of chronic coronary syndromes and discusses their strengths, pitfalls and future directions

Pregnancy outcome in women with congenital heart disease: A single-center experience

Objective: Pregnancies in patients with adult congenital heart disease (ACHD) are often complicated. We aimed to highlight the nature and the rate of these complications in a single-center patient population. Methods: We retrospectively studied all the pregnancies of women who presented on an outpatient basis, and all pregnancies were reviewed for maternal and fetal outcomes. Results: Of 117 pregnancies from 52 ACHD patients (age at pregnancy 28.3 ± 6.6 years), 10 were therapeutically aborted. A proportion of 41.1% of the remaining 107 pregnancies were complicated either with cardiac (3.7%), obstetric (15.0%), or fetal/neonatal (11.2%) adverse events or with spontaneous abortion (17.8%). Hospitalization during pregnancy was required in 10 patients. Elective cesarean sections were initially planned for 31% of the 87 pregnancies, which were finally completed, while 8% required an emergency cesarean section, mostly for obstetric reasons. NYHA class deterioration after pregnancy was detected in 9.3% of our cohort. Modified WHO class III/IV, prior medication use, and higher body mass index (BMI) were related to cardiac complications during pregnancy or NYHA deterioration. Conclusion: Pregnancies in ACHD patients are at high risk for complications. Advanced modified WHO class, prior medication use, and high BMI were related to adverse cardiac events. Keywords: Pregnancy, Adult congenital heart disease, Cardiac complications, Obstetric complications, Neonatal complication

Unmet Needs in the Assessment of Right Ventricular Function for Severe Tricuspid Regurgitation

Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease that has been long overlooked, but lately its independent association with adverse cardiovascular outcomes was recognized. The time point to intervene and repair the tricuspid valve is defined by the right ventricular (RV) dilation and dysfunction that comes up at a later stage. While guidelines favor tricuspid valve repair before severe RV dysfunction ensues, the definition of RV dysfunction in a universal manner remains vague. As a result, the candidates for transcatheter or surgical TR procedures are often referred late, when advanced RV dysfunction is established, and any derived procedural survival benefit is attenuated. Thus, it is of paramount importance to establish a universal means of RV function assessment in patients with TR. Conventional echocardiographic indices of RV function routinely applied have fundamental flaws that limit the precise characterization of RV performance. More recently, novel echocardiographic indices such as strain via speckle-tracking have emerged, demonstrating promising results in the identification of early RV damage. Additionally, evidence of the role of alternative imaging modalities such as cardiac computed tomography and cardiac magnetic resonance, for RV functional assessment in TR, has recently arisen. This review provides a systematic appraisal of traditional and novel multimodality indices of RV function in severe TR and aims to refine RV function assessment, designate future directions, and ultimately, to improve the outcome of patients suffering from severe TR

Epidemiology and management of chronic thromboembolic pulmonary hypertension: experience from two expert centers

Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, distinct pulmonary vascular disease, and therefore, there is a lack of data regarding its clinical presentation, diagnosis, and management at a national basis. We aimed to describe the demographics and management of patients with CTEPH in Northern Greece. Methods: We conducted a retrospective, observational study by a joint collaboration between two pulmonary hypertension expert centers in Greece, and the study included patients diagnosed with CTEPH. The patient population was divided into two groups depending on their operability. Results: Overall, 27 consecutive patients were included (59% female, mean age 59.3±15.1 years). Dyspnea and fatigue were the most common presenting symptoms. History of pulmonary embolism was present in 82%. Of patients, 18 (67%) were assessed as operable, of whom 10 (55%) finally underwent pulmonary endarterectomy (PEA). There were no differences in symptoms, WHO functional class, 6-min walking test distance, and hemodynamics between the operable and nonoperable groups. At the end of follow-up, all non-operable and operable patients who did not receive surgical treatment were treated with at least one pulmonary hypertension-specific drug. Conclusion: This is the first report that presents data of patients diagnosed with CTEPH in Greece. The percentage of patients who underwent surgical treatment is lower but approaches the reported rates in large registries. Considering that PEA is a relatively safe and potentially curative surgical procedure, we emphasize the need for establishing a designated PEA center in Greece. Keywords: Chronic thromboembolic pulmonary hypertension, pulmonary endarterectomy, registry, riocigua

Epidemiology and management of chronic thromboembolic pulmonary hypertension: experience from two expert centers

Objectives: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, distinct pulmonary vascular disease, and therefore, there is a lack of data regarding its clinical presentation, diagnosis, and management at a national basis. We aimed to describe the demographics and management of patients with CTEPH in Northern Greece. Methods: We conducted a retrospective, observational study by a joint collaboration between two pulmonary hypertension expert centers in Greece, and the study included patients diagnosed with CTEPH. The patient population was divided into two groups depending on their operability. Results: Overall, 27 consecutive patients were included (59% female, mean age 59.3±15.1 years). Dyspnea and fatigue were the most common presenting symptoms. History of pulmonary embolism was present in 82%. Of patients, 18 (67%) were assessed as operable, of whom 10 (55%) finally underwent pulmonary endarterectomy (PEA). There were no differences in symptoms, WHO functional class, 6-min walking test distance, and hemodynamics between the operable and nonoperable groups. At the end of follow-up, all non-operable and operable patients who did not receive surgical treatment were treated with at least one pulmonary hypertension-specific drug. Conclusion: This is the first report that presents data of patients diagnosed with CTEPH in Greece. The percentage of patients who underwent surgical treatment is lower but approaches the reported rates in large registries. Considering that PEA is a relatively safe and potentially curative surgical procedure, we emphasize the need for establishing a designated PEA center in Greece. Keywords: Chronic thromboembolic pulmonary hypertension, pulmonary endarterectomy, registry, riociguat