Digoxin Discontinuation in Patients With HFrEF on Beta-Blockers: Implication for Future 'Knock-Out Trials' in Heart Failure.

Background: National heart failure guidelines recommend quadruple therapy with renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors for patients with heart failure with reduced ejection fraction (HFrEF), most of whom also receive loop diuretics. However, the guidelines are less clear about the safe approaches to discontinuing older drugs whose decreasing or residual benefit is less well understood. The objective of this study was to examine whether digoxin can be safely discontinued in patients with HFrEF receiving beta-blockers.

Initiation of Anti-Hypertensive Drugs and Outcomes in Patients with Heart Failure with Reduced Ejection Fraction.

Background: In patients with heart failure with reduced ejection fraction (HFrEF) and hypertension, systolic blood pressure is recommended to be maintained below 130 mmHg, although this has not been shown to be associated with improved outcomes. We examined the association between anti-hypertensive drug initiation and outcomes in patients with HFrEF.

Methods: In the Medicare-linked OPTIMIZE-HF, 7966 patients with HFrEF (ejection fraction ≤40%) without renal failure were not receiving anti-hypertensive drugs before hospitalization, of whom 692 received discharge prescriptions for those drugs (thiazides and calcium channel blockers).

The prognostic role of RBP-4 and adiponectin in patients with peripheral arterial disease undergoing lower limb endovascular revascularization.

Background: RBP4 is an adipokine with an established role in atherosclerosis, while adiponectin has unique anti-inflammatory properties. We investigated the association of RBP4 and adiponectin with the presence of symptomatic peripheral artery disease (PAD) and their possible prognostic role in major adverse cardiovascular events (MACE).

Methods: We enrolled 168 consecutive patients with symptomatic, established PAD, requiring revascularization by endovascular means of any or both of their lower limbs.

Assessment of acute heart failure prognosis: the promising role of prognostic models and biomarkers.

Numerous models and biomarkers have been proposed to estimate prognosis and improve decision-making in patients with acute heart failure (AHF). The present literature review provides a critical appraisal of externally validated prognostic models in AHF, combining clinical data and biomarkers. We perform a literature review of clinical studies, using the following terms: "acute heart failure," "acute decompensated heart failure," "prognostic models," "risk scores," "mortality," "death," "hospitalization," "admission," and "biomarkers.

How to Manage a Patient with Haemophilia and ACS Requiring PCI: A Battle between Bleeding and Thrombosis.

We present the case of a 70-year-old man with a history of haemophilia B, who presented to our hospital with a non-ST-elevation myocardial infarction. The patient, following consultation by a haemophilia expert, was revascularized with percutaneous coronary intervention (PCI) under adequate clotting factor administration. Patients with haemophilia and acute coronary syndrome, are susceptible to periprocedural bleeding and thrombotic events during PCI, and therefore a balanced management plan should always be implemented by a multidisciplinary team.

Should Percutaneous Coronary Intervention be the Standard Treatment Strategy for Significant Coronary Artery Disease in all Octogenarians?

Coronary artery disease (CAD) remains the leading cause of cardiovascular death in octogenarians. This group of patients represents nearly a fifth of all patients treated with percutaneous coronary intervention (PCI) in real-world practice. Octogenarians have multiple risk factors for CAD and often greater myocardial ischemia than younger counterparts, with a potential of an increased benefit from myocardial revascularization.

Effect of Colchicine vs Standard Care on Cardiac and Inflammatory Biomarkers and Clinical Outcomes in Patients Hospitalized With Coronavirus Disease 2019: The GRECCO-19 Randomized Clinical Trial.

Importance: Severe acute respiratory syndrome coronavirus 2 infection has evolved into a global pandemic. Low-dose colchicine combines anti-inflammatory action with a favorable safety profile.

Objective: To evaluate the effect of treatment with colchicine on cardiac and inflammatory biomarkers and clinical outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19).

Shockwave Intravascular Lithotripsy for the Treatment of Severe Vascular Calcification.

Vascular calcification is a highly prevalent pathophenotype that is associated with aging, atherosclerotic cardiovascular disease, diabetes mellitus, and chronic kidney disease. When present, it portends a worse clinical outcome and predicts major adverse cardiovascular events. Heavily calcified coronary and peripheral artery lesions are difficult to dilate appropriately with conventional balloons during percutaneous intervention, and the use of several adjunctive strategies of plaque modification has been suggested.

The evolution of mapping and ablation techniques in the treatment of atrial tachycardias occurring after atrial fibrillation ablation.

Purpose: A possible consequence of atrial fibrillation (AF) ablation is the occurrence of organized atrial tachycardias (ATs). ATs after AF ablation (ATAAF) may be more symptomatic than AF itself, thus necessitating catheter ablation. We evaluated the prognostic significance of clinical and invasive characteristics for long-term sinus rhythm (SR) maintenance following ATAAF ablation and assessed the effect of technological developments on these results.

Spontaneous Coronary Artery Dissection (SCAD): Case Series and Mini Review.

Spontaneous coronary artery dissection (SCAD) has gained recognition in recent years as a non-atherosclerotic cause of acute coronary syndrome (ACS), especially in young and middle-aged women without any of the classic risk factors for cardiovascular disease. The booming use of coronary angiography in patients presenting with ACS combined with new, revolutionary methods of intravascular imaging, have led to increased rates of SCAD diagnosis. We aim to present a brief, up-to-date review of the existing literature, along with our experience as reflected in the recent management of nine SCAD cases in three tertiary care hospitals.

Selective Activation Re-Mapping Reveals the Mechanism in Apparently Unstable Atrial Tachycardias.

Following atrial fibrillation (AF) ablation procedures, patients may present with atrial tachycardias (ATs) that show remarkable stability for short periods of time but degenerate in unstable forms right afterwards. In order to map these types of ATs, we applied the sequential mapping capabilities only for time segments where ATs exhibited constant cycle length (CL) and activation sequence, excluding the segments with unstable recordings. We herein describe two cases of ATs after AF ablation which were mapped with this technique that allowed for the successful identification and subsequent ablation of the tachycardia circuit.

Digoxin Use and Outcomes in Patients With Heart Failure With Reduced Ejection Fraction.

Background: Heart failure is a leading cause for hospital readmission. Digoxin use may lower this risk in patients with heart failure with reduced ejection fraction (HFrEF), but data on contemporary patients receiving other evidence-based therapies are lacking.

Methods: Of the 11,900 patients with HFrEF (ejection fraction ≤45%) in Medicare-linked OPTIMIZE-HF, 8401 were not on digoxin, of whom 1571 received discharge prescriptions for digoxin.

Similar clinical benefits from below-target and target dose enalapril in patients with heart failure in the SOLVD Treatment trial.

Aims: To examine associations of below-target and target dose of enalapril, an angiotensin-converting enzyme (ACE) inhibitor, with outcomes in patients with heart failure and reduced ejection fraction (HFrEF) in the Studies of Left Ventricular Dysfunction (SOLVD) Treatment trial.

Methods And Results: Two thousand five hundred and sixty-nine patients with HFrEF (ejection fraction ≤35%) were randomized to below-target (5-10 mg/day) dose placebo (n = 1284) or enalapril (n = 1285). One month post-randomization, blind up-titration to target (20 mg/day) dose was attempted for both study drugs in 2458 patients.

Efficiency and safety of prolonged levosimendan infusion in patients with acute heart failure.

Background. Levosimendan is an inotropic drug with unique pharmacological advantages in patients with acute heart failure. Scope of this study is to determine whether longer infusion patterns without the hypotension-inducing loading dose could justify an effective and safe alternative approach.

Systems biology in heart diseases.

Systems biology based on integrative computational analysis and high technology is in a position to construct networks, to study the interactions between molecular components and to develop models of cardiac function and anatomy. Clinical cardiology gets an integrated picture of parameters that are addressed to ventricular and vessel mechanics, cardiac metabolism and electrical activation. The achievement of clinical objectives is based on the interaction between modern technology and clinical phenotype.

Carotid sinus hypersensitivity is common in patients presenting with hip fracture and unexplained falls.

Background: We tried to determine the prevalence of carotid sinus hypersensitivity (CSH) in patients with hip fractures with and without a clear history of an accidental fall.

Methods: We studied 51 patients hospitalized for a hip fracture and 51 matched controls from our outpatients department. All patients were subjected to a carotid sinus massage in the supine and upright position.

Comparison of felodipine and nitroglycerin actions on vasomotion physiology.

Felodipine is a Calcium blocker and nitroglycerin, a nitrate vasodilating agent, were compared. Two parameters were studied in vitro on bovine aortic media. Calcium uptake and vascular tone.

Plasma atrial natriuretic peptide in essential hypertension after treatment with irbesartan.

The aim of this study was to evaluate the medium-term effects of the selective AT1-blocker irbesartan on atrial natriuretic peptide (ANP) levels in patients with moderate essential hypertension. The drug was given orally in a daily dose of 300 mg for 30 days. Plasma ANP levels increased by 15.

Plasma atrial natriuretic peptide levels in essential hypertension after treatment with verapamil.

The aim of this study was to evaluate the long term effects of the selective Ca2+-blocker verapamil on atrial natriuretic peptide (ANP) levels in patients with moderate essential hypertension. The drug was given orally in a daily dose of 300 mg for 30 days. At the end of this clinical trial, plasma ANP levels increased by 16.

Effect of the beta 1-blocker/beta 2-agonist celiprolol on atrial natriuretic peptide plasma levels in hypertensive patients.

The aim of this study was to evaluate the long-term effects of the selective beta 1-blocker/beta 2-agonist celiprolol on atrial natriuretic peptide (ANP) levels in patients with moderate essential hypertension. The drug was given orally in a daily dose of 200 mg for 30 days. Plasma ANP levels increased by 187% despite the drop in blood pressure, while left atrial and ventricular diameters remained unchanged.