Effect of Vericiguat on Left Ventricular Reverse Remodeling in Patients Who Have Heart Failure With Reduced Ejection Fraction - Special Focus on Patients Without Quadruple Medical Therapy.

Background: A novel cardioprotective drug, vericiguat, reduces the risk of cardiovascular mortality for patients already on guideline-directed medical therapy. However, the effect of vericiguat on left ventricular (LV) reverse remodeling in patients with reduced LV ejection fraction (LVEF) with or without guideline-directed medical therapy, known as quadruple medical therapy, remains undetermined.

Methods And Results: This study comprised 73 heart failure (HF) patients with reduced LVEF (<45%) from 5 institutions in Japan.

Impact of Chocolate percutaneous transluminal angioplasty balloon on vessel preparation in drug-coated balloon angioplasty for femoropopliteal lesion.

Purpose: To compare the impact of Chocolate and conventional balloons on vessel preparation in percutaneous transluminal angioplasty.

Materials And Methods: This single-center retrospective study included 111 endovascular therapy consecutive cases of femoropopliteal lesions using drug-coated balloon strategy with a 1:1 pre-dilation balloon diameter between February 2020 and August 2021, divided into the Chocolate percutaneous transluminal angioplasty (n = 48) and conventional (n = 63) groups. Before the availability of Chocolate balloons in Japan (December 2020), a standard semi-compliant or non-compliant balloon was used for vessel preparation.

Vascular Response after Directional Coronary Atherectomy for Left Main Bifurcation Lesion.

Aims: To evaluate the vascular response after directional coronary atherectomy (DCA) for left main (LM) bifurcation lesion.

Methods: This study was a retrospective, single-center study enrolling 31 patients who underwent stentless therapy using DCA followed by drug-coated balloon (DCB) angioplasty for LM bifurcation lesion. We compared intravascular ultrasound (IVUS) findings before and after DCA.

Efficacy of Complex Fractionated Atrial Electrogram-Guided Extensive Encircling Pulmonary Vein Isolation for Persistent Atrial Fibrillation.

In persistent AF, the effect of adjunctive ablation in addition to PV isolation (PVI) is controversial. We considered a new modified PVI including complex fractionated atrial electrogram (CFAE) area. In 57 patients with persistent AF undergoing first ablation, CFAE were mapped before ablation and CFAE-guided extensive encircling PVI (CFAE-guided EEPVI) was performed.

A Case of Acquired Haemophilia A in a Patient with Chronic Myelomonocytic Leukaemia.

A 67-year-old male, with a known diagnosis of myelodysplastic syndromes with multilineage dysplasia (MDS-MLD) was admitted to our hospital with a primary complaint of subcutaneous bleeding in his left thigh. Laboratory data showed anaemia and prolongation of activated partial thromboplastin time (85.8 s, normal range 24-39 s) without thrombocytopenia.

The optimization of iloprost inhalation under moderate flow of oxygen therapy in severe pulmonary arterial hypertension.

Inhaled iloprost efficiently improves pulmonary hemodynamics, exercise capacity, and quality of life in patients with pulmonary arterial hypertension (PAH). However, the process of inhalation is laborious for patients suffering from resting dyspnea. We describe a 75-year-old man with idiopathic PAH and a low gas transfer.

Impact of Right Ventricular Geometry on Mitral Regurgitation After Transcatheter Closure of Atrial Septal Defect.

Worsening of mitral regurgitation (MR) is sometimes observed after closure of an atrial septal defect (ASD). However, since the mechanism of this deterioration remains unclear, the aim of our study was to investigate the effect of left (LV) and right ventricular (RV) geometry on MR after transcatheter closure of ASD.We studied 27 patients with ASD who underwent transcatheter closure.

Combined baseline strain dyssynchrony index and its acute reduction predicts mid-term left ventricular reverse remodeling and long-term outcome after cardiac resynchronization therapy.

The objective of this study was to test the hypothesis that combining assessment of baseline radial strain dyssynchrony index (SDI), that expressed both left ventricular (LV) dyssynchrony and residual myocardial contractility, and of acute changes in this index can yield more accurate prediction of mid-term responders and long-term outcome after cardiac resynchronization therapy (CRT). Radial SDI for 75 CRT patients was calculated as the average difference between peak and end-systolic speckle tracking strain from 6 segments of the mid-LV short-axis view before and 8 ± 2 days after CRT. Mid-term responder was defined as ≥ 15% decrease in LV end-systolic volume 6 ± 2 months after CRT.

Dynamic left ventricular dyssynchrony assessed on 3-dimensional speckle-tracking area strain during dobutamine stress has a negative impact on cardiovascular events in patients with idiopathic dilated cardiomyopathy.

Background: Left ventricular (LV) dyssynchrony is not a stable phenomenon, but rather, changes dynamically. Given that the prognostic impact of dynamic dyssynchrony has not yet been elucidated, the objective was to investigate the clinical impact of dynamic dyssynchrony on patients with dilated cardiomyopathy (DCM).

Methods And Results: Seventy DCM patients with ejection fraction 32±9% were retrospectively recruited, and 3-dimensional speckle-tracking area strain was used to measure both contractile reserve and changes in dyssynchrony during dobutamine stress.

Utility of combined assessment of baseline dyssynchrony and its acute improvement to predict long-term outcomes after cardiac resynchronization therapy.

Although left ventricular (LV) mechanical dyssynchrony can predict the response to cardiac resynchronization therapy (CRT), the presence of baseline LV dyssynchrony might not be the only determinant of the response to CRT. The objectives of the present study were to test the hypothesis that a combined assessment of baseline LV dyssynchrony and its acute improvement can produce a more accurate prediction of the long-term outcomes after CRT. We studied 121 patients with heart failure undergoing CRT.

Capability of three-dimensional speckle tracking radial strain for identification of patients with cardiac sarcoidosis.

Since cardiac sarcoidosis (CS) leads to substantial morbidity and sudden death, early diagnosis and appropriate management are crucial for patients with CS. Echocardiography used to be considered a useful diagnostic tool for patients with CS, but CS may clinically present as dilated cardiomyopathy (DCM). Our objective was to investigate whether a novel three-dimensional (3-D) speckle-tracking strain can identify patients with CS more accurately.

Tissue Doppler imaging-derived myocardial acceleration during isovolumetric contraction predicts pulmonary capillary wedge pressure in patients with reduced ejection fraction.

Background: Tissue Doppler imaging-obtained isovolumetric myocardial acceleration (IVA) is load independent, reportedly predicts systolic functions, and correlates with exercise capacity in patients with reduced ejection fraction (EF). We hypothesized that IVA correlates with the pulmonary capillary wedge pressure (PCWP) in patients with reduced EF.

Methods And Results: Of 113 patients, correlations between PCWP and IVA were done for all patients, 48 patients with EF ≥55%, and 65 patients with EF <55%.

Multidirectional left ventricular performance detected with three-dimensional speckle-tracking strain in patients with chronic right ventricular pacing and preserved ejection fraction.

Aims: Although right ventricular (RV) pacing has a detrimental effect on global left ventricular (LV) function even in some patients with preserved ejection fraction (EF), its mechanism remains unclear.

Methods And Results: We studied 116 subjects; 56 patients with RV pacing and preserved EF (all ≥50%), 30 EF-matched controls, and 30 heart failure (HF) patients with RV pacing and reduced EF (all ≤35%). Radial, circumferential, and longitudinal dyssynchrony and function were quantified as standard deviations of the time-to-peak strain and global peak strain from all 16 LV segments using three-dimensional (3D) speckle-tracking strain.

Left ventricular dyssynchrony using three-dimensional speckle-tracking imaging as a determinant of torsional mechanics in patients with idiopathic dilated cardiomyopathy.

The aim of this study was to use 3-dimensional (3D) speckle-tracking echocardiography to test the hypothesis that left ventricular (LV) dyssynchrony may negatively affect LV torsional mechanics in patients with idiopathic dilated cardiomyopathy (IDC) and that LV torsion may improve after cardiac resynchronization therapy. This study included 65 subjects; 20 with IDC with ejection fractions ≤35% and wide QRS complexes (≥120 ms), 20 with IDC with ejection fractions ≤35% and narrow QRS complexes (<120 ms), and 25 controls. LV dyssynchrony index was determined as the SD of time to peak 3D speckle-tracking radial strain and regional heterogeneity of LV rotation (rotational dispersion index) as the SD of 3D speckle-tracking time to peak rotation.

Impact of left ventricular afterload on longitudinal dyssynchrony in patients with severe aortic stenosis and preserved ejection fraction.

Background: The purpose of this study was to investigate whether patients with severe aortic stenosis (AS) and preserved ejection fraction (EF) have dyssynchrony and whether it improves after aortic valve replacement (AVR).

Methods And Results: We studied 30 consecutive patients with severe AS and preserved EF undergoing AVR. For baseline comparison, we studied 17 EF-matched patients with mild-to-moderate AS, and 18 EF-matched normal volunteers.

Mechanical left ventricular dyssynchrony in heart failure patients with narrow QRS duration as assessed by three-dimensional speckle area tracking strain.

The aim of this study was to assess whether heart failure (HF) patients with narrow QRS durations have mechanical left ventricular (LV) dyssynchrony compared to those with wide QRS durations and with normal subjects. The strain dyssynchrony index with 3-dimensional area tracking (ASDI) was used, which represents mechanical LV dyssynchrony and residual endomyocardial function from circumferential as well as longitudinal directions. The study included 79 subjects: 32 HF patients with ejection fractions ≤ 35% and narrow QRS durations (<120 ms) and 22 with ejection fractions ≤ 35% and wide QRS durations (≥ 120 ms), all candidates for cardiac resynchronization therapy, and 25 normal controls.

Exercise-induced left bundle branch block and subsequent mechanical left ventricular dyssynchrony--resolved with pharmacological therapy.

A 53-year-old man with depressed ejection fraction (EF) of 35% and QRS width of 88 ms at rest was admitted to our institution with a complaint of exertional chest discomfort and dyspnea. During treadmill exercise, left bundle-branch block (LBBB) with a QRS width of 152 ms occurred at a heart rate of 100 bpm. During LBBB, the patient showed significant mechanical dyssynchrony as evidenced by a two-dimensional speckle tracking radial strain of 260 ms (≥ 130 ms), defined as the time difference between anterior-septum and posterior wall.