Heart Failure Association of the ESC, Heart Failure Society of America and Japanese Heart Failure Society Position statement on endomyocardial biopsy

AbstractEndomyocardial biopsy (EMB) is an invasive procedure, globally most often used for the monitoring of heart transplant (HTx) rejection. In addition, EMB can have an important complementary role to the clinical assessment in establishing the diagnosis of diverse cardiac disorders, including myocarditis, cardiomyopathies, drug‐related cardiotoxicity, amyloidosis, other infiltrative and storage disorders, and cardiac tumours. Improvements in EMB equipment and the development of new techniques for the analysis of EMB samples have significantly improved diagnostic precision of EMB. The present document is the result of the Trilateral Cooperation Project between the Heart Failure Association of the European Society of Cardiology, the Heart Failure Society of America, and the Japanese Heart Failure Society. It represents an expert consensus aiming to provide a comprehensive, up‐to‐date perspective on EMB, with a focus on the following main issues: (i) an overview of the practical approach to EMB, (ii) an update on indications for EMB, (iii) a revised plan for HTx rejection surveillance, (iv) the impact of multimodality imaging on EMB, and (v) the current clinical practice in the worldwide use of EMB

Subclinical Atherosclerosis in Patients with Rheumatoid Arthritis and Low Cardiovascular Risk: The Role of von Willebrand Factor Activity

<div><p>Background</p><p>To evaluate association between von Willebrand factor (vWF) activity, inflammation markers, disease activity, and subclinical atherosclerosis in patients with rheumatoid arthritis (RA) and low cardiovascular risk.</p><p>Methods</p><p>Above mentioned parameters were determined in blood samples of 74 non-diabetic, normotensive, female subjects, with no dyslipidemia(42 patients, 32 matched healthy controls, age 45.3±10.0 vs. 45.2±9.8 years). Intima-media thickness (IMT) was measured bilaterally, at common carotid, bifurcation, and internal carotid arteries. Subclinical atherosclerosis was defined as IMT>IMT_mean+2SD in controlsat each carotid level and atherosclerotic plaque as IMT>1.5 mm. Majority of RA patients were on methotrexate (83.3%), none on steroids >10 mg/day or biologic drugs. All findings were analysed in the entire study population and in RA group separately.</p><p>Results</p><p>RA patients with subclinical atherosclerosis had higher vWF activity than those without (133.5±69.3% vs. 95.3±36.8%, p<0.05). Predictive value of vWF activity for subclinical atherosclerosis was confirmed by logistic regression. vWF activity correlated significantly with erythrocyte sedimentation rate, fibrinogen, modified disease activity scores (mDAS28–ESR, mDAS28–CRP), modified Health Assessment Questionnaire (p<0.01 for all), duration of smoking, number of cigarettes/day, rheumatoid factor concentration (p<0.05 for all), and anti-CCP antibodies (p<0.01). In the entire study population, vWF activity was higher in participants with subclinical atherosclerosis (130±68% vs. 97±38%, p<0.05) or atherosclerotic plaques (123±57% vs. 99±45%, p<0.05) than in those without. Duration of smoking was significantly associated with vWF activity (β 0.026, p = 0.039).</p><p>Conclusions</p><p>We demonstrated association of vWF activity and subclinical atherosclerosis in low-risk RA patients as well as its correlation with inflammation markers, all parameters of disease activity, and seropositivity. Therefore, vWF might be a valuable marker of early atherosclerosis in RA patients.</p></div

The influence of respiratory pattern on heart rate variability analysis in heart failure

Introduction. Autonomic dysfunction is present early in the course of heart failure, and has a direct role on deterioration of cardiac function and prognosis. Heart rate variability (HRV) estimates sympathovagal control of heart frequency. The influence of respiratory pattern on HRV is clinically important. Breathing disorders are common in heart failure and highly affect HRV and autonomic evaluation. It was previously shown that slow and deep breathing increased parasympathetic tone, but effects of this respiratory pattern on HRV were not evaluated. Objective. The aim of the study was to estimate effects of slow and deep breathing (SDB) on HRV in heart failure patients. Method. In 55 patients with heart failure (78% male, mean age 57.18±10.8 yrs, mean EF=34.12±10.01%) and 14 healthy controls (57.1% male, mean age 53.1±8.2 yrs), short term HRV spectral analysis was performed (Cardiovit AT 60, Schiller). VLF, LF, HF and LF/HF were determined during spontaneous and deep and slow breathing at 0.1 Hz (SDB). Results. LF, HF and LF/HF significantly increased during SDB compared with spontaneous breathing both in controls (LF 50.71±61.55 vs. 551.14±698.01 ms2, p&lt;0.001; HF 31.42±29.98 vs.188.78±142.74 ms2, p&lt;0.001 and LF/HF 1.46±0.61 vs. 4.21±3.23, p=0.025) and heart failure patients (LF 27.37±36.04 vs. 94.50±96.13 ms2, p&lt;0.001; HF 12.13±19.75 vs. 41.58±64.02 ms2, p&lt;0.001 and LF/HF 3.77±3.79 vs. 6.38±5.98, p=0.031). Increments of LF and HF induced by SDB were significantly lower in patients than healthy controls. Heart failure patients had lower HRV compared to healthy controls both during spontaneous breathing and SDB. During spontaneous breathing, only HF was significantly lower between healthy controls and patients (p=0.002). During SDB VLF (p=0.022), LF (p&lt;0.001) and HF (p&lt;0.001) were significantly lower in heart failure patients compared to controls. Conclusion. These data suggest that SDB increases HRV both in healthy and heart failure patients; the highest increment is in LF range. Differences in spectral profile of HRV between healthy controls and heart failure patients become more profound during SDB. Controlled respiration during HRV analysis might increase sensitivity and reliability in detection of autonomic dysfunction in heart failure patients.

Validation of Heart Rate Estimation from Photoplethysmograph and Accelerometer Recordings During Post-Exercise Relaxation

Photoplethysmogrpah and accelerometer hardware have reached the stage at which the sensors are easily affordable and suitable for self-application as well as a part of multiparametric sensing schemes in health monitoring. However, the non-supervised extraction of biomarkers, as simple as heart rate, remains a challenge, largely due to the large variety in pulse shapes and poor signal quality when measured under stress. While a large body of work, including database generation, has been done for signals recorded distally at fingers, wrist, toes and temporal artery, the data recorded at distal arteries such as carotid, are lacking. Here we use the SensSmartTech multiparameter database to test the performance of the PPG and ACC in HR estimation at rest and during relaxation after the activity. PPG was recorded at carotid and brachial arteries and ACC in the vicinity of the precordial V4 electrode. HR is calculated using the available extrema-search functions. Results indicate excellent agreement with the reference HR extracted from the ECG signal, with the RMSE on both sensors below 3 bpm. The accuracy of the ACC measurement increased after the activity, while that of the PPG decreased, nevertheless remaining within the above error margin.11th International Conference on Electrical, Electronic and Computing Engineering : 03-06 June 2024, Niš

Role of optics in multiparameter monitoring of cardiovascular function

Cardiovascular diseases (CVDs) are the primary cause of human death worldwide. For example, they were responsible for 77.0% of deaths at ages 30 to 70 in 2019, with the burden expected to rise [1]. Therefore, diagnosis, prevention, monitoring and treatment of CVDs are among the primary societal challenges. Mobile sensor devices, notably electrocardiographs (ECGs) and photoplethysmographs (PPGs), are fundamentally changing the approach to CVD diagnostics and monitoring. Optics plays a significant role in this revolution, offering new noninvasive sensing solutions and access to new valuable information. [etc]XVII Photonics Workshop : March 10-14, 2024, Kopaonik

Correlation of haemostatic factors with clinical, laboratory features, and treatment in patients with rheumatoid arthritis.

<p>All values are Spearman's correlation coefficients.</p><p>*p<0.05;</p><p>** p<0.01;</p><p>*** p<0.001</p><p>vWF—von Willebrand factor, PAI—plasminogen activator inhibitor.</p><p>Correlation of haemostatic factors with clinical, laboratory features, and treatment in patients with rheumatoid arthritis.</p

Univariate and multivariate logistic regression analysis of association between traditional or RA related cardiovascular risk factors with the presence of subclinical atherosclerosis (mean IMT+2SD of the controls) or atherosclerotic plaque (IMT>1.5 mm) in the entire study group and patients with rheumatoid arthritis.

<p>β—regression coefficient in the univariate analysis, NA—not applicable, vWF—Von Willebrand factor, RF—rheumatoid factor.</p><p>^a Also significant in multiple regression analysis, which included parameters showing significant difference in the univariate analysis (p<0.01 for all, except for smoking habits and subclinical atherosclerosis, where p<0.05)</p><p>Univariate and multivariate logistic regression analysis of association between traditional or RA related cardiovascular risk factors with the presence of subclinical atherosclerosis (mean IMT+2SD of the controls) or atherosclerotic plaque (IMT>1.5 mm) in the entire study group and patients with rheumatoid arthritis.</p

Surgical revascularisation of the heart in patients with chronic ischaemic cardiomyopathy and left ventricular ejection fraction of less than 30%

INTRODUCTION Patients suffering from chronic ischaemic cardiomyopathy and left ventricular ejection fraction (LVEF) lower than 30% represent a difficult and controversial population for surgical treatment. OBJECTIVE The aim of this study was to evaluate the effects of surgical treatment on the early and long-term outcome of these patients. METHOD The patient population comprised SO patients with LVEF&lt; 30% (78% male, mean age: 583 years, range; 42-75 years) who underwent surgical myocardial revascuiarisation during the period 1995-2000. Patients with left ventricular aneurysms or mitral valve insufficiency were excluded from the study. The following echocardiography parameters were evaluated as possible prognostic indicators; LVEF, fraction of shortening (FS), left ventricular systolic and diastolic diameters (LVEDD, LVESD) and volumes (LVEDV, LVESV), as well as their indexed values (LVESVI). RESULTS Fifteen patients (30%) died during the follow-up, 2/50 intraoperatively (4%). The presence of diabetes mellitus, previous myocardial infarction, main left coronary artery disease, and three-vessel disease, correlated significantly with the surgical outcomes. The patient's age, family history, smoking habits, hypertension, hyperlipidaemia, history of stroke, peripheral vascular disease, and renal failure, did not correlate with the mortality rate. A comparison of preoperative echocardiography parameters between survivors and non-survivors revealed significantly divergent LVEF, LVEDD, LVESD, LVEDV, LVESV, and LVESVI values. Preoperative LVESVi offered the highest predictive value (R=0.595). CONCLUSION Diabetes mellitus, history of myocardial infarction, stenosis of the main branch, and three-vessel disease, significantly affected the peci opera five and long-term outcome of surgical revascuiarisation in patients with ischaemic cardiomyopathy and LVEF&lt;30%. in survivors, LVEF, FS, and systolic and diastolic echocardiography parameters, as well as their indexed values, significantly improved after surgical revascuiarisation. LVESVI provided the highest predictive value for mortality