Is swimming safe in heart failure? : a systematic review

It is not clear whether swimming is safe in patients with chronic heart failure. Ten studies examining the hemodynamic effects of acute water immersion (WI) (155 patients; average age 60 years; 86% male; mean left ventricular ejection fraction (LVEF) 29%) and 6 randomized controlled trials of rehabilitation comparing swimming with either medical treatment only (n = 3) or cycling (n = 1) or aerobic exercise (n = 2), (136 patients, average age 59 years; 84% male, mean LVEF 31%) were considered. In 7 studies of warm WI (30–35°C): heart rate (HR) fell (2% to −15%), and both cardiac output (CO) (7–37%) and stroke volume (SV) increased (13–41%). In 1 study of hot WI (41°C), systemic vascular resistance (SVR) fell (41%) and HR increased (33%). In 2 studies of cold WI (12–22°C), there were no consistent effects on HR and CO. Compared with medical management, swimming led to a greater increase in peak Vo₂ (7–14%) and 6 minute walk test (6MWT) (7–13%). Compared with cycle training, combined swimming and cycle training led to a greater reduction in resting HR (16%), a greater increase in resting SV (23%) and SVR (15%), but no changes in resting CO and a lesser increase in peak Vo₂ (6%). Compared with aerobic training, combined swimming and aerobic training lead to a reduction in resting HR (19%) and SVR (54%) and a greater increase in SV (34%), resting CO (28%), LVEF (9%), and 6MWT (70%). Although swimming appears to be safe, the studies conducted have been small, very heterogeneous, and inconclusive

What proportion of patients with chronic heart failure are eligible for sacubitril-valsartan?

AIMS: The PARADIGM-HF trial showed that sacubitril-valsartan, an ARB-neprilysin inhibitor, is more effective than enalapril for some patients with heart failure (HF). It is uncertain what proportion of patients with HF would be eligible for sacubitril-valsartan in clinical practice. METHODS AND RESULTS: Between 2001 and 2014, 6131 patients consecutively referred to a community HF clinic with suspected HF were assessed. The criteria required to enter the randomized phase of PARADIGM-HF, including symptoms, NT-proBNP, and current treatment with or without target doses of ACE inhibitors or ARBs, were applied to identify the proportion of patients eligible for sacubitril-valsartan. Recognizing the diversity of clinical opinion and guideline recommendations concerning this issue, entry criteria were applied singly and in combination. Of 1396 patients with reduced left ventricular ejection fraction (≤40%, HFrEF) and contemporary measurement of NT-proBNP, 379 were on target doses of an ACE inhibitor or ARB at their initial visit and, of these, 172 (45%) fulfilled the key entry criteria for the PARADIGM-HF trial. Lack of symptoms (32%) and NT-proBNP <600 ng/L (49%) were common reasons for failure to fulfil criteria. A further 122 patients became eligible during follow-up (n = 294, 21%). However, if background medication and doses were ignored, then 701 (50%) were eligible initially and a further 137 became eligible during follow-up. CONCLUSIONS: Of patients with HFrEF referred to a clinic such as ours, only 21% fulfilled the PARADIGM-HF randomization criteria, on which the ESC Guidelines are based; this proportion rises to 60% if background medication is ignored

Cardiac Dysfunction, Congestion and Loop Diuretics: their Relationship to Prognosis in Heart Failure

Background: Diuretics are the mainstay of treatment for congestion but concerns exist that they adversely affect prognosis. We explored whether the relationship between loop diuretic use and outcome is explained by the underlying severity of congestion amongst patients referred with suspected heart failure. Method and Results: Of 1190 patients, 712 had a left ventricular ejection fraction (LVEF) ≤50 %, 267 had LVEF >50 % with raised plasma NTproBNP (>400 ng/L) and 211 had LVEF >50 % with NTproBNP ≤400 ng/L; respectively, 72 %, 68 % and 37 % of these groups were treated with loop diuretics including 28 %, 29 % and 10 % in doses ≥80 mg furosemide equivalent/day. Compared to patients with cardiac dysfunction (either LVEF ≤50 % or NT-proBNP >400 ng/L) but not taking a loop diuretic, those taking a loop diuretic were older and had more clinical evidence of congestion, renal dysfunction, anaemia and hyponatraemia. During a median follow-up of 934 (IQR: 513–1425) days, 450 patients were hospitalized for HF or died. Patients prescribed loop diuretics had a worse outcome. However, in multi-variable models, clinical, echocardiographic (inferior vena cava diameter), and biochemical (NTproBNP) measures of congestion were strongly associated with an adverse outcome but not the use, or dose, of loop diuretics. Conclusions: Prescription of loop diuretics identifies patients with more advanced features of heart failure and congestion, which may account for their worse prognosis. Further research is needed to clarify the relationship between loop diuretic agents and outcome; imaging and biochemical measures of congestion might be better guides to diuretic dose than symptoms or clinical signs

Takotsubo syndrome in the paediatric population

We describe the case of a takotsubo syndrome in a 12-year-old male patient following an acute intracranial haemorrhage, which had a favourable outcome. We also performed a systematic review of published case reports in patients younger than 18 years. Although takotsubo syndrome is common in postmenopausal women, in the paediatric population it equally affects both sexes. Compared with adults, paediatric patients more commonly present with heart failure symptoms or loss of consciousness. A higher proportion of paediatric patients have ST segment depression on ECG. Moreover, in younger patients, a high proportion has nonapical anatomical variants and more severe left ventricular impairment. The increase in troponin and the decrease in left ventricular ejection fraction, the prevalence of neurological or psychological disorders, and in-hospital outcome are similar between adults and children

Intravenous vernakalant for the rapid conversion of recent onset atrial fibrillation: systematic review and meta-analysis

Atrial fibrillation is the most common cardiac arrhythmia and is associated with increased mortality and morbidity. Conversion to sinus rhythm is usually appropriate in patients with acute, symptomatic atrial fibrillation in order to reduce symptoms and prevent complications. Electrical cardioversion is the most used and widespread technique, but requires deep sedation and a fasting state. Pharmacological alternatives are burdened by a delayed onset of action and potential proarrhythmic effects. Therefore, new therapeutic options are being sought. Among those, vernakalant, showed a good efficacy profile and a short onset of action, but with conflicting evidence regarding potential serious adverse events. This drug profile will summarize the pharmacology behind this new drug and review recent evidence in terms of safety and efficacy

Tachycardiomyopathy in Patients without Underlying Structural Heart Disease

Tachycardiomyopathy (TCM) is an underestimated cause of reversible left ventricle dysfunction. The aim of this study was to identify the predictors of recurrence and incidence of major cardiovascular events in TCM patients without underlying structural heart disease (pure TCM). The prospective, observational study enrolled all consecutive pure TCM patients. The diagnosis was suspected in patients admitted for heart failure (HF) with a reduced ejection fraction and concomitant persistent arrhythmia. Pure TCM was confirmed after the clinical and echocardiographic recovery during follow-up. From 107 pure TCM patients (9% of all HF admission, the median follow-up 22.6 months), 17 recurred, 51 were hospitalized for cardiovascular reasons, two suffered from thromboembolic events and one died. The diagnosis of obstructive sleep apnoea syndrome (OSAS, hazard ratio (HR) 5.44), brain natriuretic peptide on admission (HR 1.01 for each pg/mL) and the heart rate at discharge (HR 1.05 for each bpm) were all independent predictors of TCM recurrence. The left ventricular ejection fraction at discharge (HR 0.96 for each%) and the heart rate at discharge (HR 1.02 for each bpm) resulted as independent predictors of cardiovascular-related hospitalization. Pure TCM is more common than previously thought and associated with a good long-term survival but recurrences and hospitalizations are frequent. Reversing OSAS and controlling the heart rate could prevent TCM-related complications

New anthyarrhythmic drugs for atrial fibrillation

Atrial fibrillation (AF) is a common arrhythmia associated with increased mortality and morbidity. Different studies have shown no significant difference between rhythm and rate control strategies in terms of mortality. Moreover, the use of antiarrhythmic drugs is afflicted by cardiac and extracardiac toxicity and related costs of hospitalization. Nevertheless, some patients require a rhythm-control strategy and new anti-AF agents are being sought. Only few novel agents showed promising results in term of efficacy and safety. Dronedarone and vernakalant are two of these compounds, respectively introduced for the chronic and acute rhythm control of AF. This article will review pharmacology and clinical evidence on the use of dronedarone and vernakalant and will mention currently investigated new antiarrhythmic drugs

Una.Resin, WP2, T2.2: Benchmarking questionnaire on Research Infrastructures and Resources

The dataset is related to the Horizon 2020 Una.Resin project Work Package 2 mapping exercise (Task 2.2) on Research Infrastructures and Resources (RIRs). This task was carried out from February to August 2021 and was aimed at understanding and benchmarking the existing strategies, policies and initiatives on RIRs of the eight Una Europa universities participating in the project (University of Edinburgh; University of Helsinki; University of Bologna; Complutense University of Madrid; Freie Universität Berlin; Katholieke Universiteit Leuven; Jagiellonian University; Université Paris 1 Panthéon-Sorbonne) in order to identify the complementary strengths, opportunities and barriers for opening-up or sharing research infrastructures and resources across the Alliance. The questionnaire had three specific objectives: (i) to understand the national and regional policies that impact the institutional frameworks on RIRs; (ii) to map and understand the policies, funding mechanisms and organisational models/management of RIRs at the different institutions; (iii) to form an initial idea about the complementary strengths but also the possible barriers for opening or sharing RIRs. The questionnaire was targeted at the research service professionals and policy-makers at each of the eight Una Europa universities

Una.Resin, WP2, T2.4: Co-creation workshop on Research Infrastructures and Resources

The dataset is related to the Horizon 2020 Una.Resin project Work Package 2, co-creation workshop on Research Infrastructures and Resources – RIRs (Task 2.4). The workshop “From mapping to co-creation: Towards a Una Europa Strategy and Action plan for sharing RIRs” was held online on the 23rd of June 2022. The aim was to collect inputs and insights from the RIRs experts and academic communities from all the Una Europa universities to develop the strategy and action plan for sharing RIRs across the universities of the Alliance. The workshop was divided into two parts: (i) Presentations session; (ii) Co-creation exercise. The first part was dedicated to the presentations of two relevant RIRs from the Cultural Heritage and the One Health field and the presentation of key results from the WP2 mapping exercise. The second session was dedicated to an in-depth discussion organized in breakout rooms and involving 6 participants (3 from the field of Cultural Heritage and 3 from the field of One Health) from each partner university: University of Edinburgh (UEDIN), University of Helsinki (UH), University of Bologna (UNIBO), Complutense University of Madrid (UCM), Freie Universität Berlin (FUB), Katholieke Universiteit Leuven (KU Leuven), Jagiellonian University (JU), Université Paris 1 Panthéon-Sorbonne (UP1). A total of 87 people participated in the Presentations session, out of which 62 took part in the Co-creation exercise. During the Co-creation exercise, the results of the mapping exercises were used as driver to stimulate the discussions. In particular, four topics were proposed for the discussion: (i) relevant principles for opening and sharing RIRs across universities; (ii) funding opportunities to stimulate interuniversity cooperation around RIRs; (iii) strengthening skills and knowledge related to RIRs management; (iv) overcoming other barriers to share RIRs. The inputs emerging from the mapping exercises and collected during the co-creation workshop were used by WP2 team as a basis to draft the pillars of the Una Europa strategy and action plan for sharing RIRs and finalize the conceptual framework for WP2 pilot actions on RIRs

Una.Resin, WP2, T2.2: Thematic mapping of Research Infrastructures and Resources in the field of Cultural Heritage

The dataset is related to the Horizon 2020 Una.Resin project Work Package 2 mapping exercise (Task 2.2) on Research Infrastructures and Resources (RIRs). This task, carried out from July to October 2021, intended to map RIRs with the aim of providing a landscape analysis of the RIRs available within the Una Europa universities in the field of Cultural Heritage, for analyzing specific barriers and enablers to sharing RIRs across the alliance and for exploring opportunities for collaboration. Building on the Focus Area of Cultural Heritage and linking to the Focus Areas of European Studies and Data Science & AI, the scope of the thematic questionnaire was defined under the thematic challenge “Exploring cultural heritage to strengthen inclusion and participative communities”. A Concept Note, that was developed in collaboration with the Self-Steering Committee Cultural Heritage, defined the main orientations of the questionnaire, thus providing a clear thematic framework for the identification of the RIRs. Each institution was invited to identify the most important and promising RIRs and provide a maximum of 30 questionnaires. The total number of the RIRs mapped in the field of Cultural Heritage was 113. The target audience consisted of researchers and experts working in the field of the thematic challenge on Cultural Heritage, as defined in the Concept Note, with affinity to RIRs. The members of the Research Infrastructure Cluster acted as institutional contacts of the eight Una Europa universities participating in the Una.Resin project University of Edinburgh (UEDIN), University of Helsinki (UH), University of Bologna (UNIBO), Complutense University of Madrid (UCM), Freie Universität Berlin (FUB), Katholieke Universiteit Leuven (KU Leuven), Jagiellonian University (JU), Université Paris 1 Panthéon-Sorbonne (UP1). They were invited to identify the RIRs and consult the target audience with a methodology that could guarantee the quality of the collected data