Surveillance and Alert-based Multiparameter Monitoring to Reduce Worsening Heart Failure Events: Results From SCALE-HF 1.

Background: There is a need for better noninvasive remote monitoring solutions that prevent hospitalizations through the early prediction and management of heart failure (HF). SurveillanCe and Alert-Based Multiparameter Monitoring to ReducE Worsening Heart Failure Events (SCALE-HF 1) evaluated the performance of a novel congestion index that alerts to fluid accumulation preceding HF events.

Methods And Results: SCALE-HF 1 was a multicenter, prospective, observational study investigating HF event prediction using data from the cardiac scale.

State-of-the-Art Imaging of Infiltrative Cardiomyopathies: A Scientific Statement From the American Heart Association.

Infiltrative cardiomyopathies comprise a broad spectrum of inherited or acquired conditions caused by deposition of abnormal substances within the myocardium. Increased wall thickness, inflammation, microvascular dysfunction, and fibrosis are the common pathological processes that lead to abnormal myocardial filling, chamber dilation, and disruption of conduction system. Advanced disease presents as heart failure and cardiac arrhythmias conferring poor prognosis.

Use of a Cardiac Scale to Predict Heart Failure Events: Design of SCALE-HF 1.

Background: There is a need for simple, noninvasive solutions to remotely monitor and predict worsening heart failure (HF) events. SCALE-HF 1 (Surveillance and Alert-Based Multiparameter Monitoring to Reduce Worsening Heart Failure Events) is a prospective, multicenter study that will develop and assess the accuracy of the heart function index-a composite algorithm of noninvasive hemodynamic biomarkers from a cardiac scale-in predicting worsening HF events.

Methods: Approximately 300 patients with chronic HF and recent decompensation will be enrolled in this observational study for model development.

Modification of a Transvalvular Microaxial Flow Pump for Instantaneous Determination of Native Cardiac Output and Volume.

Background: The current Impella cardiopulmonary (CP) pump, used for mechanical circulatory support in patients with cardiogenic shock (CS), cannot assess native cardiac output (CO) and left ventricular (LV) volumes. These data are valuable in facilitating device management and weaning. Admittance technology allows for accurate assessment of cardiac chamber volumes.

Health System-Level Performance in Prescribing Guideline-Directed Medical Therapy for Patients With Heart Failure With Reduced Ejection Fraction: Results From the CONNECT-HF Trial.

Background: Health system-level interventions to improve use of guideline-directed medical therapy (GDMT) often fail in the acute care setting. We sought to identify factors associated with high performance in adoption of GDMT among health systems in CONNECT-HF.

Methods And Results: Site-level composite quality scores were calculated at discharge and last follow-up.

Smart Drain for Post-Cardiac Surgery Left Ventricular Volumes Evaluated in Large Animal Models.

Background: Open heart surgeries for coronary arterial bypass graft and valve replacements are performed on 400,000 Americans each year. Unexplained hypotension during recovery causes morbidity and mortality through cerebral, kidney, and coronary hypoperfusion. An early detection method that distinguishes between hypovolemia and decreased myocardial function before onset of hypotension is desirable.

A Case of Mitral Annular Disjunction in Marfan Syndrome.

• Mitral annular disjunction is an underrecognized finding on echocardiography. • Mitral valve prolapse is strongly associated with mitral annular disjunction. • Patients with Marfan syndrome are potentially high risk for mitral annular disjunction.

Challenges of left atrial appendage closure device and anticoagulation in a patient with immune thrombocytopenia (ITP).

Among patients with atrial fibrillation (AF) who have high risk of bleeding secondary to haematologic disorders, left atrial appendage (LAA) occlusion therapy has been shown to be an excellent alternative to long-term use of oral anticoagulation for thromboembolic stroke prevention. However, there remains a major concern of device-associated thrombosis post-procedure, that can lead to life-threatening embolic events. To this date, there is no systematic guideline for the selection and management of patients with haematological disorders with LAA occlusion therapy, especially in those with platelet disorders such as immune thrombocytopenia (ITP).

Atypical presentation of cardiac sarcoidosis: role of multimodality imaging and review of literature.

Cardiac sarcoidosis (CS) is challenging to determine, consequently is under-recognised in clinical practice. The accurate prevalence of CS is possibly underestimated due to unspecific symptoms, subclinical illness and the dearth of universally accepted diagnostic criteria. Totally, non-invasive diagnosis of CS was proposed in 2015 by the Japanese Ministry of Health and Welfare using positron emission tomography and cardiac MRI findings as major criteria and substituting histological verification.

Early-Onset Bilateral Severe Valvular Regurgitation After Mediastinal Radiotherapy in Hodgkin Lymphoma Survivors: Should We Screen Prior to 10 Years After Mediastinal Radiotherapy?

Radiation-induced valvulopathy (RIV) is a common complication of mediastinal radiotherapy and usually occurs at least 10 years after exposure to radiotherapy. We report the case of a 37-year-old female with a history of stage IIIB Hodgkin lymphoma who was diagnosed with RIV after all other potential causes of shortness of breath and valvular dysfunction were excluded. The patient's presentation, 6 years after receiving chemotherapy and radiotherapy for Hodgkin lymphoma, was earlier than expected after mediastinal radiotherapy.

Why low-voltage shock impedance measurements fail to reliably detect insulation breaches in transvenous defibrillation leads.

Background: Implantable cardioverter-defibrillators (ICDs) use low-voltage measures of shock impedance (LVSZ) to monitor integrity of leads.

Objective: To determine the separation distance between conductors required for LVSZ to detect insulation breaches that produce short circuits during shocks, causing failed defibrillation.

Methods: We simulated in-pocket insulation breaches between the ICD generator (CAN) and cables to the distal coil of 10 leads from 2 manufacturers.

A Doppler Echocardiographic Pulmonary Flow Marker of Massive or Submassive Acute Pulmonary Embolus.

Background: To date, echocardiography has not gained acceptance as an alternative imaging modality for the detection of massive pulmonary embolism (MPE) or submassive pulmonary embolism (SMPE). The objective of this study was to explore the clinical utility of early systolic notching (ESN) of the right ventricular outflow tract (RVOT) pulsed-wave Doppler envelope in the detection of MPE or SMPE.

Methods: Two hundred seventy-seven patients (mean age, 56 ± 16 years; 52% women), without known pulmonary hypertension, who underwent contrast computed tomographic angiography for suspected pulmonary embolism (PE) and underwent echocardiography were retrospectively studied.

Echocardiography in Infective Endocarditis: State of the Art.

Purpose Of Review: In this review, we examine the central role of echocardiography in the diagnosis, prognosis, and management of infective endocarditis (IE).

Recent Findings: 2D transthoracic echocardiography (TTE) and transesophageal echocardiography TEE have complementary roles and are unequivocally the mainstay of diagnostic imaging in IE. The advent of 3D and multiplanar imaging have greatly enhanced the ability of the imager to evaluate cardiac structure and function.

The challenges of treating recurrent polymorphic ventricular tachycardia due to coronary vasospasm: Lessons from an interesting case.

Coronary artery vasospasm can cause recurrent anginal episodes with ST-segment elevation. Vasospasm induced myocardial ischemia can lead to arrhythmias including life threatening ventricular tachycardia (VT). Percutaneous coronary intervention (PCI), although not routinely recommended for treating vasospastic angina, can be considered for discrete coronary spasm that is not amenable to vasodilator therapy.

Validation of a defibrillation lead ventricular volume measurement compared to three-dimensional echocardiography.

Background: There is increasing evidence that using frequent invasive measures of pressure in patients with heart failure results in improved outcomes compared to traditional measures. Admittance, a measure of volume derived from preexisting defibrillation leads, is proposed as a new technique to monitor cardiac hemodynamics in patients with an implantable defibrillator.

Objective: The purpose of this study was to evaluate the accuracy of a new ventricular volume sensor (VVS, CardioVol) compared with 3-dimenssional echocardiography (echo) in patients with an implantable defibrillator.