Measuring congestion with a non-invasive monitoring device in heart failure and haemodialysis: CONGEST-HF.

Aims: We examined the effectiveness of a novel cardiopulmonary management wearable sensor (worn for less than 5 mins) at measuring congestion and correlated the device findings with established clinical measures of congestion.

Methods And Results: We enrolled three cohorts of patients: (1) patients with heart failure (HF) receiving intravenous diuretics in hospital; (2) patients established on haemodialysis, and (3) HF patients undergoing right heart catheterization (RHC). The primary outcomes in the respective cohorts were a Spearman correlation between (1) change in weight and change in thoracic impedance (TI) (from enrolment, 24 h after admission to discharge) in patients hospitalized for HF; (2) lung ultrasound B-lines and volume removed during dialysis with device measured TI, and (3) pulmonary capillary wedge pressure (PCWP) and sub-acoustic diastolic, third heart sound (S3) in the patients undergoing RHC.

Defining Heart Failure Based on Imaging the Heart and Beyond.

Water and salt retention, in other words congestion, are fundamental to the pathophysiology of heart failure and are important therapeutic targets. Echocardiography is the key tool with which to assess cardiac structure and function in the initial diagnostic workup of patients with suspected heart failure and is essential for guiding treatment and stratifying risk. Ultrasound can also be used to identify and quantify congestion in the great veins, kidneys and lungs.

The utility of transthoracic echocardiographic measures of right ventricular systolic function in a lung resection cohort.

Right ventricular (RV) dysfunction occurs following lung resection and is associated with post-operative complications and long-term functional morbidity. Accurate peri-operative assessment of RV function would have utility in this population. The difficulties of transthoracic echocardiographic (TTE) assessment of RV function may be compounded following lung resection surgery, and no parameters have been validated in this patient group.

Which patients with heart failure should receive specialist palliative care?

Aims: We investigated which patients with heart failure (HF) should receive specialist palliative care (SPC) by first creating a definition of need for SPC in patients hospitalised with HF using patient-reported outcome measures (PROMs) and then testing this definition using the outcome of days alive and out of hospital (DAOH). We also evaluated which baseline variables predicted need for SPC and whether those with this need received SPC.

Methods And Results: PROMs assessing quality of life (QoL), symptoms, and mood were administered at baseline and every 4 months.

Symptom Onset in Aortic Stenosis: Relation to Sex Differences in Left Ventricular Remodeling.

Objectives: The aim of this study was to establish sex differences in remodeling and outcome in aortic stenosis (AS) and their associations with biomarkers of myocardial fibrosis.

Background: The remodeling response and timing of symptoms is highly variable in AS, and sex plays an important role.

Methods: A total of 174 patients (133 men, mean age 66.

First-in-Man Transcervical Surgical Aortic Valve Replacement Using the CoreVista System.

Objective: This study aimed to evaluate a novel device system for surgical aortic valve replacement (SAVR) using a unique new less invasive access approach. The hypothesis is that SAVR can be performed through a short transverse incision in the neck, similar to that used for transcervical thymectomy avoiding chest disruption.

Methods: A new device system was developed to provide retraction, step-by-step illumination, and on-screen visualization for the new approach.

Diagnosis of pneumococcal pericarditis using antigen testing and polymerase chain reaction.

Following the advent of antibiotics, pneumococcal pericarditis has become a rare clinical diagnosis. We discuss 2 cases of pneumococcal pericarditis that were preceded by community-acquired pneumonia. Cultures were negative in both patients and the diagnosis was made by antigen testing and polymerase chain reaction (PCR) of the pericardial fluid.

The use of 3D transoesophageal echocardiography in clarifying the mechanism underlying a 'flexing' strut of a mitral valve replacement.

We report the case of a 76-year-old lady who had a mitral valve (MV) replacement for severe MV stenosis. Several days following the procedure, a routine transthoracic echocardiogram (TTE) was performed. Despite the prosthesis leaflets opening well anterograde maximum velocities were elevated; MV peak velocity of 2.

[Transthoracic Doppler echocardiography for the non-invasive assessment of coronary flow reserve--a case report].

We describe a case of a 55-year-old male with anterior myocardial infarction, treated in the acute phase with thrombolysis. Transthoracic echocardiography showed hypokinetic apical segments, ejection fraction of 55% and reduced coronary flow reserve in the left anterior descending (LAD) coronary artery. Elective coronary angiography revealed a borderline (40-50%) lesion in LAD.