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The acute response to therapeutic afterload reduction differs between heart failure with preserved (HFpEF) versus reduced ejection fraction (HFrEF), with larger left ventricular (LV) stroke work augmentation in HFrEF compared to HFpEF. This may (partially) explain the neutral effect of HFrEF-medication in HFpEF. It is unclear whether such differences in hemodynamic response persist and/or differentially trigger reverse remodeling in case of long-term afterload reduction.

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In every heartbeat, cardiac muscle cells perform excitation-Ca signaling-contraction (EC) coupling to pump blood against the vascular resistance. Cardiomyocytes can sense the mechanical load and activate mechano-chemo-transduction (MCT) mechanism, which provides feedback regulation of EC coupling. MCT feedback is important for the heart to upregulate contraction in response to increased load to maintain cardiac output.

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Background: Given the prevalence of cardiovascular disease, encountering difficult airways in this patient population is quite common. The challenge for anesthesiologists lies not only in establishing the airway but also in managing the hemodynamic instability caused by sympathetic activation during intubation. The purpose of this report is to describe the anesthetic experience of this patient with severe mitral and tricuspid regurgitation, atrial fibrillation with rapid ventricular response, and moderate pulmonary hypertension with an anticipated difficult airway.

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Introduction And Objectives: Cardiopulmonary exercise testing (CPET) is the gold standard for quantifying aerobic functional capacity, yet it is costly and not widely available. The CLINIMEX Aerobic Fitness Questionnaire (C-AFQ) may be a practical alternative as it estimates oxygen consumption at peak exercise (VO peak) based on patients' responses to a list of activities with known energy requirements. However, its applicability in cardiac patients is unclear and has not yet been studied.

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Outcomes after medical treatment for primary aldosteronism: an international consensus and analysis of treatment response in an international cohort.

Lancet Diabetes Endocrinol

January 2025

Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, VIC, Australia; Department of Endocrinology, Monash Health, Clayton, VIC, Australia.

Background: Primary aldosteronism can be treated medically but there is no standardised method to evaluate treatment outcomes. We aimed to develop criteria for assessing the outcomes of targeted medical treatment of primary aldosteronism, analyse outcomes across an international cohort, and identify factors associated with a complete treatment response.

Methods: An international panel of 31 primary aldosteronism experts used the Delphi method to reach consensus on the definition of complete, partial, or absent biochemical and clinical outcomes of medical treatment of primary aldosteronism.

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