Profile and Prognostic Impact of Multimorbidity in Elderly Patients with Heart Failure: Are there Differences between Men and Women?

Purpose Of Review: Heart failure (HF) represents a pathology in constant growth, but, despite the fact that a significant proportion of its population is comprised of elderly patients, they are not adequately represented in clinical trials or registries. They constitute a heterogeneous population with their particularities and interaction of the multiple comorbidities that characterize this age group, which makes the clinical course, prognosis and outcomes of the disease different.

Recent Findings: Compared to men, women with HF tend to be older, with a greater burden of non-cardiovascular comorbidities, less ischemic heart disease and preserved ventricular function in most cases.

Left Atrial Peak Systolic Strain as an Indicator Pathway of Diastolic Dysfunction of the Left Ventricle.

Background: Left atrial peak systolic strain (LA-PSS) imaging is an emerging index of left atrial function, and it was shown to be decreased in heart failure with preserved ejection fraction (EF). We aimed to determine whether LA-PSS could be used as an additional diagnostic parameter to current existing guidelines for the presence of left ventricle diastolic dysfunction (LVDD).

Materials And Methods: A total of 190 consecutive adult patients with cardiovascular risk factors and normal left ventricle EF with no prior history of heart failure were included in the study.

ST-Segment Elevation Acute Myocardial Infarction Associated to Covid-19 Vaccination in A Healthy Young Adult with Normal Coronary Arteries.

Despite the beneficial effects of anti-COVID-19 vaccination, monitoring its safety has identified potential cardiac adverse events, mainly myocarditis and pericarditis. The case of a healthy 32-year-old male patient who developed acute myocardial infarction (AMI) 48 hours after the second dose of anti-COVID-19 mRNA vaccine (BNT162b2) is reported. This is the first reported case in the literature of an AMI associated to post-COVID-19 vaccination with mRNA vaccine (BNT162b2) in a healthy young adult without coronary risk factors and normal coronary arteries.

Role of the Electrocardiographic MVP Risk Score (Morphology-Voltage-P Wave Duration) in Predicting the Development of Atrial Fibrillation in Patients With Systemic Arterial Hypertension.

Background: There is a global tendency to emphasize the prevention and early diagnosis of diseases that have a great impact on public health. Atrial fibrillation (AF) has a prevalence affecting 1.5-2% of the general population.

Relationship of the T-wave Tpeak-Tend interval with conduction system disorders in arterial hypertension.

Purpose: The Tpeak-Tend interval of the T wave has emerged as a new electrocardiographic marker of increased transmural dispersion of ventricular repolarization. We aimed to determine the presence of cardiac conduction system disorders in patients with systemic arterial hypertension (SAH) who have altered Tpeak-Tend interval of the T wave.

Methods: The 67 patients with SAH were divided into two groups.

The relation between QRS complex fragmentation and segmental abnormalities of the myocardial contractility in patients with coronary artery disease.

Background: Fragmented QRS (fQRS) is defined as any QRS complex with duration of less than 120 ms (ms) and at least one notch in the R or S wave in two or more leads belonging to the same coronary territory. The fQRS represents a delay in ventricular conduction caused by a myocardial scar associated to arrhythmic events.

Methods: This is a descriptive, retrospective, cross-sectional study of a total of 123 patientsadmitted with ischemic heart disease.

Paroxysmal Atrial Fibrillation of Vagal Mechanism with Episodes of Wide QRS Complex Tachycardia Due to Gouaux-Ashman's Phenomenon.

A 38-year-old male patient consulted for nocturnal palpitations described as fast chest pounding that woke him up from sleep. A physical examination yielded no remarkable findings. A 24-hour Holter ECG monitoring demonstrated nocturnal episodes of paroxysmal atrial fibrillation (PAF) with the coexistence of wide QRS complex tachycardia.

Potential Mechanisms of Cardiac Injury and Common Pathways of Inflammation in Patients With COVID-19.

Due to the lack of prospective, randomized, controlled clinical studies on inflammation and cardiovascular involvement, the exact mechanism of cardiac injury among patients with Coronavirus Disease 2019 (COVID-19) still remains uncertain. It was demonstrated that there is a high and significantly positive linear correlation between troponin T and plasma high-sensitivity C-reactive protein levels, biomarkers of cardiac injury and systemic inflammation, respectively. Cardiac injury and inflammation is a relatively common association among patients hospitalized with COVID-19, and it is related to higher risk of in-hospital mortality.

The Association Between Atrial Fibrillation and Endurance Physical Activity: How Much is too Much?

Atrial fibrillation (AF) is the most common arrhythmia in middle-aged athletes. Physical exercise performed in a regular basis has been shown to be beneficial for cardiovascular health. Moderate physical exercise, aside from producing a nice, peaceful and well-being sensation, has been associated with a reduced risk of AF.

Myocardial Fibrosis as a Pathway of Prediction of Ventricular Arrhythmias and Sudden Cardiac Death in Patients With Nonischemic Dilated Cardiomyopathy.

The mechanism of sudden cardiac death (SCD) in patients with nonischemic dilated cardiomyopathy (NIDCM) is mostly due to sustained ventricular tachycardia and ventricular fibrillation. The clinical guidelines for the therapeutic management of this set of patients are mostly based on left ventricular ejection fraction value which has a low specificity to differentiate the risk of SCD from the risk of mortality associated with heart failure or other comorbidities. Moreover, since SCD can occur in patients with normal or mildly depressed ejection fraction, it is necessary to identify new markers to improve the prognostic stratification of SCD.

Atrioventricular Nodal Catheter Ablation in Atrial Fibrillation Complicating Congestive Heart Failure.

The development of atrial fibrillation (AF) during the course of the evolution of heart failure (HF) worsens the clinical outcomes and the prognosis accounting for an enormous economic burden on healthcare. AF is considered to be an independent predictor of morbidity and mortality increasing the risk of death and hospitalization in 76% in HF patients. Despite the good clinical results obtained with conventional pharmacological agents and different new drugs, the optimal medical treatment can fail in the intention to improve symptoms and quality of life of HF patients with severe left ventricular dysfunction and AF with uncontrolled ventricular rate.

Amiodarone-Induced Third Degree Atrioventricular Block and Extreme QT Prolongation Generating Torsade Des Pointes in Paroxysmal Atrial Fibrillation.

Amiodarone is still the most potent antiarrhythmic drug in the prevention of life threatening ventricular arrhythmias and demonstrates a very low incidence of torsade de pointes. An unusual case of an 81-year-old woman who developed serious abnormalities of the conduction system of the heart and torsade des pointes during intravenous infusion of amiodarone for the treatment of paroxysmal atrial fibrillation is described. To the best of our knowledge, this is the first case showing an association of intravenous amiodarone-induced third degree atrioventricular block and extreme QT interval prolongation generating torsade des pointes in a patient with paroxysmal atrial fibrillation who required an implantable cardioverter-defibrillator.

Carotid Intima-Media Thickness as a Cardiovascular Risk Factor and Imaging Pathway of Atherosclerosis.

Assessment of carotid intima-media thickness (IMT) has emerged as a simple and noninvasive technique for measuring atherosclerotic burden. Although serum biomarkers have been linked to the risk of developing atherosclerosis, carotid IMT has the theoretical advantage of directly visualizing a final consequence of the disease itself, namely atherosclerosis in the vessel wall. The current widespread application of carotid IMT measurements has been based on the validity, standardization, and reproducibility of the measurement and the evidence that an increased carotid IMT can be regarded as an attractive biomarker of atherosclerosis and of increased cardiovascular risk, potentially useful as a therapeutic target in those at increased cardiovascular risk.

Heparin Versus Bivalirudin in Acute Myocardial Infarction: Unfractionated Heparin Monotherapy Elevated to Primary Treatment in Contemporary Percutaneous Coronary Intervention.

Bivalirudin, a direct thrombin inhibitor, was developed as an antithrombin agent for patients undergoing percutaneous coronary interventions (PCI) with the hypothesis that it would reduce bleeding complications without compromising the rate of ischemic events compared to heparin plus GP IIb/IIIa inhibitors. Although the cumulative evidence makes a strong argument for the use of bivalirudin rather than heparin plus systematic GP IIb/IIIa inhibitors for the great majority of patients with acute myocardial infarction (AMI) undergoing PCI, the benefit observed with bivalirudin was achieved because of the major bleeding complications with the use of heparin plus GP IIb/IIIa inhibitors. When bivalirudin was compared with unfractionated heparin alone there was no benefit in ischemic complications with a decrease in major bleeding.

Serum biomarkers and source of inflammation in acute coronary syndromes and percutaneous coronary interventions.

There is robust information that confirms the enormous contribution of inflammation to plaque development, progression and vulnerability. The presence of plaques with inflammatory components associates with a greater likelihood of future cardiovascular events. The inflammatory cascade has been implicated during the entire plaque formation, from the early stages of endothelial dysfunction to the development of acute coronary syndromes (ACS).

Heparin Versus Bivalirudin in Contemporary Percutaneous Coronary Intervention: A Welcome Back to an Old Friend Unfractionated Heparin.

The results of randomized trials and observational studies make a strong argument for the use of bivalirudin rather than heparin plus systematic glycoprotein (GP) IIb/IIIa inhibitors for the great majority of patients undergoing percutaneous coronary interventions (PCI). However, there is no doubt that the benefit observed with bivalirudin was achieved because of the major bleeding complications with heparin plus GP IIb/IIIa inhibitors. Therefore, if we diminish bleeding complications by eliminating the systematic utilization of GP IIb/IIIa inhibitors, there would be a lesser benefit with the use of bivalirudin.

Rate Control Strategy Elevated To Primary Treatment For Atrial Fibrillation: Has The Last Word Already Been Spoken?

In the last decade, we were able to see the light shed by several trials and observational studies that dealt with the appropriate manner of treating patients with atrial fibrillation (AF). Recently the AF management by cardiologists has become more aggressive, in part because of an improved comprehension of this rhythm disturbance, as well as, the availability of new treatment strategies. Increasing awareness of AF as a disease rather than as an acceptable alternative to sinus rhythm has led to search for clear arguments to support a certain strategy as a gold standard.

Bivalirudin in contemporary percutaneous coronary intervention for non-ST-segment elevation acute coronary syndromes: what is the current role of platelet glycoprotein IIb/IIIa receptor inhibitor agents?

Currently, the wide variety of antithrombotic agents as adjunctive pharmacological therapy for non-ST-segment elevation acute coronary syndromes (ACS) in the setting of contemporary percutaneous coronary intervention (PCI) available for clinical use has made choosing the optimal drug therapy a complex and difficult task. In the stent era, bivalirudin, a semisynthetic direct thrombin inhibitor, has recently been shown to provide similar efficacy with less bleeding compared with unfractionated heparin plus platelet glycoprotein IIb/IIIa inhibitors in ACS patients treated with PCI. Although there are some controversial results and limitations in the studies with bivalirudin, this drug certainly is a plausible option in the treatment of ACS.

Atrial Fibrillation in the Wolff-Parkinson-White Syndrome.

Since the advent of catheter ablation for atrial fibrillation (AF) aiming the pulmonary veins a few years ago, there has been an overwhelming interest and a dramatic increase in AF investigation. AF has a different dimension in the context of the Wolff-Parkinson-White (WPW) syndrome. Indeed, AF may be a nightmare in a young person that has an accessory pathway (AP) with fast anterograde conduction.