The perceived effects of COVID-19 while living with a chronic illness.

Introduction: A diagnosis of chronic illness posed a serious threat to people during the recent COVID-19 pandemic. People with chronic illnesses were faced with increased mortality and reduced access to healthcare. Self-care is the process of maintaining health and managing a chronic illness.

A survey-based triage tool to identify patients potentially eligible for referral to an advanced heart failure centre.

Aims: Accurate prevalence data for ambulatory advanced heart failure (HF) in European countries remains limited. This study was designed to identify the population of patients potentially eligible for referral for assessment for advanced surgical HF therapies to a National advanced HF and cardiac transplant centre.

Methods And Results: A survey comprising 13 potential clinical markers of advanced HF was developed, modified from the 'I NEED HELP' tool from the 2018 position statement of the Heart Failure Association of the European Society of Cardiology, and distributed to all HF clinic services (secondary and tertiary units) nationwide.

NT-proBNP/BNP ratio for prognostication in European Caucasian patients enrolled in a heart failure prevention programme.

Aims: Guidelines support the role of B-type natriuretic peptide (BNP) and amino-terminal pro-BNP (NT-proBNP) for risk stratification of patients in programmes to prevent heart failure (HF). Although biologically formed in a 1:1 ratio, the ratio of NT-proBNP to BNP exhibits wide inter-individual variability. A report on an Asian population suggests that molar NT-proBNP/BNP ratio is associated with incident HF.

Angiotensin Receptor Neprilysin Inhibitors in HFrEF: Is This the First Disease Modifying Therapy Drug Class Leading to a Substantial Reduction in Diuretic Need?

Despite significant advances in disease modifying therapy in heart failure (HF), diuretics have remained the cornerstone of volume management in all HF phenotypes. Diuretics, alongside their definite acute haemodynamic and symptomatic benefits, also possess many possible deleterious side effects. Moreover, questions remain regarding the prognostic impact of chronic diuretic use.

Changing to remote management of a community heart failure population during COVID-19 - Clinician and patient perspectives'.

Background: The COVID pandemic has challenged the traditional methods used in care of patients with heart failure (HF). Remote management of HF patients has been recommended in order to maintain routine standards of care, but satisfaction with this platform of care is unknown. We set out to address the physician and patient opinion of remote management of HF during COVID-19.

Incremental prognostic value of diastolic dysfunction in low risk patients undergoing echocardiography: beyond Framingham score.

We sought to assess the prognostic value of diastolic dysfunction (DD) in low-risk adults beyond Framingham risk score (FRS). Consecutive patients without cardiovascular risk factors or co-morbidities were identified from a retrospective cohort. Multivariate binary logistic regression was performed to identify factors associated with DD, and Cox proportional hazard model to evaluate the association of DD with all-cause death.

miRNA-548c: a specific signature in circulating PBMCs from dilated cardiomyopathy patients.

High fidelity genome-wide expression analysis has strengthened the idea that microRNA (miRNA) signatures in peripheral blood mononuclear cells (PBMCs) can be potentially used to predict the pathology when anatomical samples are inaccessible like the heart. PBMCs from 48 non-failing controls and 44 patients with relatively stable chronic heart failure (ejection fraction of ≤ 40%) associated with dilated cardiomyopathy (DCM) were used for miRNA analysis. Genome-wide miRNA-microarray on PBMCs from chronic heart failure patients identified miRNA signature uniquely characterized by the downregulation of miRNA-548 family members.

Effect of age, gender, and left ventricular diastolic function on left atrial volume index in adults without known cardiovascular disease or risk factors.

There are limited data on reference values of left atrial volume indexes (LAVIs) in adults without known cardiovascular disease or risk factors, as well as their stratification by age, gender, and diastolic stage. LAVIs were calculated using the biplane area-length method in accordance with guidelines in 966 consecutive patients (mean age 48.0 ± 15.

Impact of progression of diastolic dysfunction on mortality in patients with normal ejection fraction.

Background: Diastolic dysfunction is an independent predictor of mortality in patients with normal left ventricular ejection fraction. There are limited data, however, on whether worsening of diastolic function is associated with worse prognosis.

Methods And Results: We reviewed clinical records and echocardiograms of consecutive patients who had baseline echocardiograms between January 1, 2005, and December 31, 2009, that showed left ventricular ejection fraction ≥55% and who subsequently had a follow-up echocardiogram within 6 to 24 months.

Mortality rate in patients with diastolic dysfunction and normal systolic function.

Background: Diastolic dysfunction (DD) is known to be associated with increased mortality rate in the presence of impaired systolic function. However, few prognostic data exist regarding the effect of DD in patients with normal systolic function.

Methods: We reviewed clinical records and echocardiographic findings of consecutive patients who underwent an outpatient echocardiogram that revealed normal systolic function (ejection fraction, ≥55%) from January 1, 1996, through December 31, 2005.

Antiinflammatory autoimmune cellular responses to cardiac troponin I in idiopathic dilated cardiomyopathy.

Background: Autoimmune mechanisms, particularly through generation of autoantibodies, may contribute to the pathophysiology of idiopathic dilated cardiomyopathy (iDCM). The precise role of cellular autoimmune responses to cardiac-specific antigens has not been well described in humans. The purpose of this study was to characterize the cellular autoimmune response to cardiac troponin I (cTnI), specifically, the release of cytokines by peripheral blood mononuclear cells (PBMCs), in subjects with iDCM and healthy control subjects.

Gender differences in survival in patients with severe left ventricular dysfunction despite similar extent of myocardial scar measured on cardiac magnetic resonance.

Aims: We sought to determine the association between myocardial scarring, gender, and survival in patients with significant coronary artery disease (CAD) and severe systolic left ventricular (LV) dysfunction using delayed hyper-enhancement cardiac magnetic resonance imaging (DHE-CMR).

Methods And Results: We studied 339 patients (24% women, mean age 65 +/- 11 years) referred for assessment of myocardial viability by DHE-CMR. Scar was defined as myocardium with an intensity >2 SD above viable myocardium.

Characterization and outcome of patients with severe symptomatic aortic stenosis referred for percutaneous aortic valve replacement.

Objective: Many high-risk patients with severe symptomatic aortic stenosis are not referred for surgical aortic valve replacement. Although this patient population remains ill-defined, many of these patients are now being referred for percutaneous aortic valve replacement. We sought to define the characteristics and outcomes of patients referred for percutaneous aortic valve replacement.

Long-term outcomes in high-risk symptomatic patients with hypertrophic cardiomyopathy undergoing alcohol septal ablation.

Objectives: We sought to assess outcomes of alcohol septal ablation (ASA) in high-risk patients.

Background: Because surgical myectomy is the preferred treatment in patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM) at our institution, we perform ASA in patients who are at high risk for surgery.

Methods: We studied 55 symptomatic HOCM patients (mean age 63 +/- 13 years, 67% women, mean follow-up 8 +/- 1 years), at high risk for surgery (as the result of age/comorbidities) who had ASA between 1997 and 2000.

Extent of left ventricular scar predicts outcomes in ischemic cardiomyopathy patients with significantly reduced systolic function: a delayed hyperenhancement cardiac magnetic resonance study.

Objectives: The objective of the study was to determine whether the extent of left ventricular scar, measured with delayed hyperenhancement cardiac magnetic resonance (DHE-CMR), predicts survival in patients with ischemic cardiomyopathy (ICM) and severely reduced left ventricular ejection fraction (LVEF).

Background: Patients with ICM and reduced LVEF have poor survival. Such patients have a high myocardial scar burden.

Toward predictable repair of regurgitant aortic valves: a systematic morphology-directed approach to bicommissural repair.

Objectives: Our purpose was to investigate a new approach to bicommissural repair of regurgitant aortic valves.

Background: Repair of regurgitant aortic valves is not widely accepted, but interest is increasing, particularly for bicuspid valves. We hypothesize that a systematic, segmental approach to morphology and corresponding morphology-directed repair will improve decision making and success.

Pseudo atrial flutter.

Atrial flutter typically has a cycle length of 200 ms (300 cycles/min or 5 Hz); with 4:1 conduction through the AV node, this would lead to a ventricular rate of 75 bpm. We present a case of a patient with a Parkinsonian tremor at a frequency of 300 cycles/min that masqueraded as atrial flutter on the limb leads of a 12-lead ECG. He had presented with a respiratory tract infection and his bedside rhythm monitor appeared to show atrial flutter.