Mechanical Aortic Valve Thromboembolism During Pregnancy on Low Molecular Weight Heparin.

A 31-year-old pregnant woman with a mechanical aortic valve developed a thrombus on her mechanical aortic valve due to subtherapeutic low molecular weight heparin dosage. She received intravenous heparin followed by warfarin. low molecular weight heparin dosing in pregnancy should be individualized, considering weight, physiological changes, and adjusted based on levels.

Factors Predicting the Utilization of Center-Based Cardiac Rehabilitation Program.

Although cardiac rehabilitation (CR) is clearly beneficial to improving patients' physical functioning and reducing heart disease progression, significant proportions of patients do not complete CR programs. To evaluate the prevalence and predictors of completion of a center-based CR program in eligible cardiac patients, existing data collected from electronic medical records were used. To identify the predictors of CR completion, we used principal components analysis (PCA) and an artificial neural network (ANN) module.

A Phase 2a dose-escalation study of the safety, tolerability, pharmacokinetics and haemodynamic effects of BMS-986231 in hospitalized patients with heart failure with reduced ejection fraction.

Aims: This study was designed to evaluate the safety, tolerability and haemodynamic effects of BMS-986231, a novel second-generation nitroxyl donor with potential inotropic, lusitropic and vasodilatory effects in patients hospitalized with decompensated heart failure and reduced ejection fraction (HFrEF).

Methods And Results: Forty-six patients hospitalized with decompensated HFrEF were enrolled into four sequential dose-escalation cohorts in this double-blind, randomized, placebo-controlled Phase 2a study. Patients with baseline pulmonary capillary wedge pressure (PCWP) of ≥20 mmHg and a cardiac index of ≤2.

Clinical significance of left atrial volume in clinical outcomes of heart transplant recipients.

Background: Left atrial volume (LAV) is surgically kept enlarged in heart transplant (HT) recipients. On the other hand, LAV has been known an independent predictor of various cardiovascular diseases and is associated with exercise capacity of HT recipients. Thus, we evaluated the hypothesis that LAV is still associated with clinical outcomes in HT recipients whose left atria are artificially enlarged.

Potential aetiologies and prognostic implications of worsening renal function in acute decompensated heart failure.

Background: One third of patients hospitalized for acute decompensated heart failure (ADHF) develop a worsening renal function (WRF) that is associated with increased in-hospital morbidity and mortality. However, previous investigations have not evaluated the various etiologies of WRF and its impact on prognosis.

Methods: A retrospective chart review was performed of patients admitted with ADHF who had a rise of serum creatinine ≥ 0.

Left atrial thrombus mimicking atrial myxoma on imaging studies in a patient with cardiac transplant.

Left atrial thrombus can develop in patients with atrial fibrillation and/or a dilated left atrium such as seen in patients with heart failure. In cardiac transplant patients with bi-atrial anastomosis, the suture line can be a potential nidus for thrombus formation. These thrombi can be either organized or unstable with ulcerated surfaces.

Standardized reporting criteria for studies evaluating suspected acute heart failure syndromes in the emergency department.

Heart failure requiring urgent therapy represents a burgeoning health care burden. Although acute heart failure syndromes are commonly defined as a change in chronic heart failure signs and symptoms requiring urgent therapy, the presentation, development, and response to treatment is highly dependent on individual patient characteristics. This heterogeneity has led to challenges in interpreting widely differing study methods, including eligibility requirements and outcome measures.

Prospective evaluation of the association between cardiac troponin T and markers of disturbed erythropoiesis in patients with heart failure.

Background: Elevated cardiac troponin T is a well-documented marker of cardiomyocyte damage and poor prognosis in patients with heart failure. We prospectively evaluated the relationship between this marker and hematopoietic disturbances in heart failure.

Methods: Data were analyzed from 254 patients in the UNITE-HF Biomarker Registry, a prospective, observational, multicenter study of the clinical and biomarker correlates of anemia in heart failure.

Does left atrial volume affect exercise capacity of heart transplant recipients?

Background: Heart transplant (HT) recipients demonstrate limited exercise capacity compared to normal patients, very likely for multiple reasons. In this study we hypothesized that left atrial volume (LAV), which is known to predict exercise capacity in patients with various cardiac pathologies including heart failure and hypertrophic cardiomyopathy is associated with limited exercise capacity of HT recipients.

Methods: We analyzed 50 patients [age 57 ±2 (SEM), 12 females] who had a post-HT echocardiography and cardiopulmonary exercise test (CPX) within 9 weeks time at clinic follow up.

Sirolimus-eluting stent fractures leading to restenosis in cardiac allograft vasculopathy.

Cardiac allograft vasculopathy (CAV) is the most common cause of long-term graft failure after heart transplantation. In the absence of a specific treatment for this condition, percutaneous coronary revascularization (PCI) has been the main palliative treatment. Although long-term results are unknown, use of drug-eluting stents (DES) has been shown to have favorable outcome when used in heart transplant patients for treatment of focal lesions in CAV.

Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure.

Background: Adverse outcomes have recently been linked to elevated red cell distribution width (RDW) in heart failure. Our study sought to validate the prognostic value of RDW in heart failure and to explore the potential mechanisms underlying this association.

Methods And Results: Data from the Study of Anemia in a Heart Failure Population (STAMINA-HFP) registry, a prospective, multicenter cohort of ambulatory patients with heart failure supported multivariable modeling to assess relationships between RDW and outcomes.

Prospective evaluation of the association between hemoglobin concentration and quality of life in patients with heart failure.

Background: Reduced hemoglobin has been associated with adverse outcomes in heart failure, but the relationship of hemoglobin to health-related quality of life in outpatients with this syndrome has not been well studied.

Methods: We used data from the prospective, observational Study of Anemia in a Heart Failure Population Registry, which randomly selected outpatients with heart failure from specialty or community cardiology clinics. Hemoglobin was determined by finger stick at baseline and during medically indicated follow-up visits.

Prospective assessment of the occurrence of anemia in patients with heart failure: results from the Study of Anemia in a Heart Failure Population (STAMINA-HFP) Registry.

Background: Although a potentially important pathophysiologic factor in heart failure, the prevalence and predictors of anemia have not been well studied in unselected patients with heart failure.

Methods: The Study of Anemia in a Heart Failure Population (STAMINA-HFP) Registry prospectively studied the prevalence of anemia and the relationship of hemoglobin to health-related quality of life and outcomes among patients with heart failure. A random selection algorithm was used to reduce bias during enrollment of patients seen in specialty clinics or clinics of community cardiologists with experience in heart failure.

Spontaneous left main coronary artery dissection complicated by pseudoaneurysm formation in pregnancy: role of CT coronary angiography.

We report a case of a 26-year-old female, who presented at 34 weeks of an uncomplicated pregnancy with an acute ST elevation anterior wall myocardial infarction. Cardiac catheterization suggested a left main coronary artery dissection with pseudoaneurysm formation. The patient's course was complicated by congestive heart failure.

The presence of HLA-directed antibodies after heart transplantation is associated with poor allograft outcome.

Background: The clinical significance of HLA-directed antibodies newly detected after transplantation (HT) is controversial.

Methods: Seventy-one HT recipients consented to enroll. Mean follow-up time was 28 months (range 6-48).

Relationship between bridging with ventricular assist device on rejection after heart transplantation.

Background: Ventricular assist devices (VADs) are commonly used to bridge patients to heart transplantation. Recipients of VADs may develop anti-human histocompatibility leukocyte antigen antibodies, as reflected by elevated panel-reactive antibodies (PRA). The purpose of this study was to evaluate the relationship between bridging with VAD before heart transplantation and development of cellular rejection, humoral rejection, and allograft vasculopathy after transplantation.

The effects of a sliding scale diuretic titration protocol in patients with heart failure.

Patients with heart failure (HF) are often instructed to temporarily adjust their diuretic dose. This approach has become routine in some HF management programs; however, no study has specifically examined the effects of a patient-directed flexible diuretic protocol. For the purposes of this study, patients were randomized into a usual care (UC) group (n = 31) or a flexible diuretic titration (DT) group (n = 35).

Sideroblastic anemia due to linezolid in a patient with a left ventricular assist device.

An acquired form of sideroblastic anemia has been described in association with several drugs, especially anti-microbial agents. A case of sideroblastic anemia is presented in a patient with a left ventricular assist device drive-line infection who was receiving linezolid, an antibiotic used for serious infections with gram-positive organisms. This patient's anemia resolved after discontinuation of the drug; he subsequently underwent an uncomplicated orthotopic heart transplant with no recurrence of anemia.

Racial differences in patients' potassium concentrations during spironolactone therapy for heart failure.

Study Objective: To determine whether the effects of spironolactone on potassium homeostasis vary by race by comparing serum potassium concentrations and potassium supplement use in African-American and Caucasian patients receiving spironolactone for heart failure.

Design: Retrospective medical record review.

Setting: Two heart failure centers.

Survival rates are similar between African American and white patients with heart failure.

Background: The clinical characteristics of heart failure differ significantly between African American patients and white patients, apparently as a result of differences in the pathobiology of the condition in the races. We investigated the hypothesis that race also influences the survival of patients with heart failure.

Methods: Data from the University of North Carolina Heart Failure Database were analyzed for 853 patients (44% African American, 32% women) who had symptomatic heart failure (New York Heart Association class 2.