Moderate Aortic Stenosis in Patients With Heart Failure.

Background And Objectives: Moderate aortic stenosis (AS) confers a surprisingly adverse prognosis, approaching that of severe AS. The objective of this study was to describe the clinical course of patients with moderate AS with evidence of concomitant heart failure manifesting as elevated brain natriuretic peptide (BNP) levels.

Methods: This is a single-center, retrospective cohort study of 332 patients with elevated BNP.

Rapid diagnostic testing as an indicator of malaria prevalence in Rorya District, Tanzania.

Background: Rapid Diagnostic Testing (RDT), a point-of-care, qualitative test for antigen, has been a catalyst in the diagnosis of patients in malaria-endemic regions. While blood-smear microscopy remains the gold standard, RDT allows for swift diagnosis in resource-poor settings. Our study sought to utilize RDT to quantify local malaria prevalence in the Rorya district of Tanzania.

Transcatheter Aortic Valve Replacement and Left Ventricular Geometry: Survival and Gender Differences.

Background: The aim of this study was to examine the relationship between baseline left ventricular (LV) geometry and outcomes after transcatheter aortic valve replacement (TAVR).

Methods: Patients undergoing TAVR (n = 206) had baseline LV geometry classified as (1) concentric hypertrophy, (2) eccentric hypertrophy, (3) concentric remodeling, or (4) normal. Descriptive statistics, Kaplan-Meier time-to-event analysis, and Cox regression were performed.

Fifty Percent Reduction in Narcotic Use After Minimally Invasive Cardiac Surgery Using Liposomal Bupivacaine.

Objective: Minimally invasive cardiac surgery via a right minithoracotomy (RMT) is a common approach to different valve pathologies, tumor resection, and atrial septal defect (ASD) closure. We studied intraoperative field block using liposomal bupivacaine (LB) in these operations.

Methods: Consecutive 171 minimally invasive RMTs (fourth intercostal space) were studied, and patients in cardiogenic or septic shock, intravenous drug abuse, and those re-explored were excluded ( = 12).

Changes in mechanical dyssynchrony in severe aortic stenosis patients undergoing transcatheter aortic valve replacement.

Introduction: Aortic stenosis (AS) imposes a significant afterload on the left ventricle, but regional manifestations of the overall load may not be uniform, leading to mechanical dyssynchrony. Accordingly, we evaluated the prevalence of dyssynchrony in patients with severe AS at baseline as well as changes after transfemoral aortic valve replacement (TAVR).

Methods: This study is a retrospective analysis of 225 patients in sinus rhythm who underwent TAVR for severe AS, in whom inter-ventricular and intra-ventricular dyssynchrony were measured at baseline, discharge, 1 month, and 1 year.

Cardiac magnetic resonance tissue tracking in right ventricle: Feasibility and normal values.

Purpose: To investigate right ventricular (RV) strain in patients without identified cardiac pathology using cardiac magnetic resonance tissue tracking (CMR TT).

Methods: A total of 50 consecutive patients with no identified cardiac pathology were analyzed. RV longitudinal and circumferential strain was assessed by CMR TT.

Diagnostic Performance of Treadmill Exercise Cardiac Magnetic Resonance: The Prospective, Multicenter Exercise CMR's Accuracy for Cardiovascular Stress Testing (EXACT) Trial.

Background: Stress cardiac magnetic resonance (CMR) has typically involved pharmacologic agents. Treadmill CMR has shown utility in single-center studies but has not undergone multicenter evaluation.

Methods And Results: Patients referred for treadmill stress nuclear imaging (SPECT) were prospectively enrolled across 4 centers.

The Relationship Among Heart Failure Disease Management, Quality of Care, and Hospitalizations.

Heart failure (HF) affects 5.1 million adult patients, accounting for over 1 million hospitalizations, 1.8 million office visits, and nearly 680,000 emergency department visits annually.

A pilot study of target weight guided treatment in acute heart failure using ultrafiltration or usual care: effect on sodium removal.

Background And Objectives: In the Ultrafiltration versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure trial, ultrafiltration (UF) removed volume more effectively than usual care (UC). Hypothetically, UF may be superior to UC due to increased sodium (Na) removal and less neurohormonal activation. We compared UF and UC in a randomized pilot trial of target weight guided therapy for acute decompensated heart failure (ADHF).

A combined anatomic and electrophysiologic substrate based approach for sudden cardiac death risk stratification.

Background: Although left ventricular ejection fraction (LVEF) is the primary determinant for sudden cardiac death (SCD) risk stratification, in isolation, LVEF is a sub-optimal risk stratifier. We assessed whether a multi-marker strategy would provide more robust SCD risk stratification than LVEF alone.

Methods: We collected patient-level data (n = 3355) from 6 studies assessing the prognostic utility of microvolt T-wave alternans (MTWA) testing.

Ultrafiltration in heart failure with preserved ejection fraction: comparison with systolic heart failure patients.

Background: Ultrafiltration (UF) is a widely used technology for inpatient management of acute decompensated heart failure in patients with volume overload. However, the safety and efficacy of UF in patients with heart failure and preserved left ventricular ejection fraction (heart failure with preserved ejection fraction [HFPEF]) need further clarification. We hypothesized that UF could be used in this population with outcomes similar to acute decompensated heart failure patients with low left ventricular ejection fraction (HFLEF).

Effect of automated, point-of-care electronic medical record screening for appropriate implantable device use in heart failure patients.

The authors evaluated the effects of an electronic health record (EHR)-based real-time screening of outpatients for potential defibrillator therapy on practice metrics. Based on ejection fraction (EF) ≤ 35% and absence of a defibrillator, the physicians were prompted for an action: electrophysiology consultation, EF evaluation, or "not indicated." Although the number of patients screened remained stable at nearly 6000 per month, consultations and echocardiograms peaked early but returned to a low steady state by 10 months.

Clinical utility of microvolt T-wave alternans testing in identifying patients at high or low risk of sudden cardiac death.

Background: Previous studies have demonstrated that microvolt T-wave alternans (MTWA) testing is a robust predictor of ventricular tachyarrhythmias and sudden cardiac death (SCD) in at-risk patients. However, recent studies have suggested that MTWA testing is not as good a predictor of "appropriate" implantable cardioverter-defibrillator (ICD) therapy as it is a predictor of SCD in patients without ICDs.

Objective: To evaluate the utility of MTWA testing for SCD risk stratification in patients without ICDs.

Fragmented QRS and mortality risk in patients with left ventricular dysfunction.

Background: Fragmented QRS (fQRS) has been shown to predict cardiac events in select patient populations. Whether fQRS improves patient selection for primary prevention patients eligible for implantable cardioverter-defibrillator (ICD) therapy remains unknown.

Methods And Results: In a prospective, multisite cohort of 842 patients with left ventricular dysfunction (ejection fraction < or =35%) representing both ischemic and nonischemic etiology, the presence of fQRS on ECG was assessed using standardized criteria.

Impact of age and medical comorbidity on the effectiveness of implantable cardioverter-defibrillators for primary prevention.

Background: Although implantable cardioverter-defibrillators (ICDs) reduce mortality in primary prevention patients with left ventricular systolic dysfunction, recent studies have questioned their overall role in clinical practice, especially in older patients and those with major comorbid conditions.

Methods And Results: In a prospective cohort of 965 patients with ischemic and nonischemic cardiomyopathies (ejection fraction View Article and Find Full Text PDF

Comparison of ultrafiltration, nesiritide, and usual care in acute decompensated heart failure.

To study the short-term effects of initial treatment strategies for acute decompensated heart failure, 25 patients treated with ultrafiltration (UF) were retrospectively compared with 25 patients treated with usual care (UC) and 25 patients treated with UC plus adjunctive nesiritide infusion (UN), matched for age, sex, ejection fraction, etiology, and serum creatinine. The median length of hospitalization was 6 days for UF, 4 days for UC, and 6 days for UN. All-cause 30-day readmissions tended to be fewer in the UF (16%) compared with the UN (24%) or UC (24%) groups.

Usefulness of microvolt T-wave alternans to predict outcomes in patients with ischemic cardiomyopathy beyond one year.

Previous studies have demonstrated that microvolt T-wave alternans (MTWA) screening effectively risk-stratifies patients with ischemic cardiomyopathy. Whether the prognostic utility of MTWA diminishes over 3 years of follow-up remains unknown. In this study, a prospective cohort of 768 patients with ischemic cardiomyopathy (left ventricular ejection fraction <35%) and no previous sustained ventricular arrhythmia was developed, of whom 514 (67%) screened MTWA nonnegative (positive and indeterminate).

Relationship of a quality measure composite to clinical outcomes for patients with heart failure.

Background: To determine whether compliance with heart failure performance measures (HFPMs) is associated with short-term outcome benefit.

Methods: In a cohort study, 194 patients satisfying all the HFPMs for which they were eligible were compared with 206 controls. Over 6 months, time to death and first all-cause readmission data were collected.

Usefulness of microvolt T-wave alternans on predicting outcome in patients with ischemic cardiomyopathy with and without defibrillators.

Microvolt T-wave alternans (MTWA) was proposed as an effective tool to identify high-risk patients with ischemic cardiomyopathy. However, previous studies suggested that the prognostic utility of MTWA may be limited to only patients with normal QRS duration. It therefore was assessed whether MTWA and QRS duration >120 ms independently predict mortality in patients with ischemic cardiomyopathy and whether the prognostic utility of MTWA differs by QRS duration.

Prognostic implication of redefining indeterminate microvolt T-wave alternans studies as abnormal or normal.

Background: Prior studies involving microvolt T-wave alternans (MTWA) have combined positive and indeterminate studies into a high-risk "nonnegative" category. However, studies examining the prognostic utility of specific reasons for an indeterminate study are limited. The objective of this study was to assess if patients have differences in survival prognosis based on the reasons for an indeterminate MTWA result.

Microvolt T-wave alternans identifies patients with ischemic cardiomyopathy who benefit from implantable cardioverter-defibrillator therapy.

Objectives: This study sought to assess whether implantable cardioverter-defibrillators (ICDs) have different mortality benefits among patients with ischemic cardiomyopathy who screen negative and non-negative (positive and indeterminate) for microvolt T-wave alternans (MTWA).

Background: Microvolt T-wave alternans has been proposed as an effective tool for risk stratification. However, no studies have examined whether ICD benefits differ by MTWA group.

Prognostic utility of microvolt T-wave alternans in risk stratification of patients with ischemic cardiomyopathy.

Objectives: The purpose of this study was to assess if microvolt T-wave alternans (MTWA) is an independent predictor of mortality in patients with ischemic cardiomyopathy.

Background: Microvolt T-wave alternans has been proposed as an effective tool for identifying high-risk patients with ischemic cardiomyopathy who are likely to benefit from implantable cardioverter-defibrillator (ICD) therapy. However, earlier studies have been limited in their ability to control for baseline differences between MTWA-negative and -non-negative (positive and indeterminate) patients.