Landing on the spot: Approaches to outflow tract PVCs; from ECG to EGMs to intracardiac echocardiography.

Premature ventricular complexes (PVCs) are increasingly recognized, as the use of ECG wearables becomes more widespread. In particular, PVCs arising from both the right ventricular outflow tract (RVOT) and left ventricular outflow tract (LVOT) comprise the majority of these arrhythmias and form a significant component of an electrophysiology practice. A keen understanding of the correlative anatomy of the outflow tracts, in addition to recognizing key ECG indices illustrating PVC sites of origin, are fundamental in preparing for a successful ablation. Patient selection, incorporating symptomatology, structural disease, and PVC burden can pose a challenge, though tools such as the ABC-VT risk score may help identify those patients with a higher risk of clinical deterioration. Utilizing intracardiac echocardiography to highlight salient anatomic features not visible with fluoroscopy allows for a more precise and safer ablation. Interpretation of intracardiac EGMs, and the careful examination for low amplitude highly fractionated pre-potentials, enhanced by the advent of new developed mapping/ablation catheters, remains crucial. Utilizing these tools will guide the electrophysiologist to an efficient and effective outflow tract PVC ablation.

Cross-sectional relationship of a Mediterranean type diet to diastolic heart function in chronic heart failure patients.

Systolic and diastolic functions of both ventricles play a crucial role in the progression of chronic heart failure (CHF). As data about the role of dietary habits in ventricular dysfunction are lacking, we aimed to evaluate the relationship between biventricular diastolic and systolic function and dietary habits in patients with CHF. During 2007, 372 consecutive CHF patients were enrolled. Biventricular systolic and diastolic function was evaluated through echocardiography. Dietary habits were recorded using a food frequency questionnaire, and adherence to a Mediterranean diet was evaluated using the MedDietScore. The MedDietScore was positively correlated with log Smv, left atrial EF and V (p), and inversely correlated with log EA and log Emv/Amv levels (p < 0.05). After adjusting for potential confounders, only log E/A levels were inversely associated with the MedDietScore (p < 0.05). Following analysis per specific aliments, the log E/A ratio was inversely associated with fish intake and olive oil use; the log Emv/Amv ratio was inversely associated with fish intake; log Stv was positively associated with fish, olive oil and pasta intake; log LAKE was positively associated with olive oil use and alcohol drinking (all p < 0.05). This study demonstrated, in a cross-sectional design, a potential beneficial effect of a Mediterranean diet on biventricular systolic and diastolic function.

Cardiovascular effects of high-intensity interval aerobic training combined with strength exercise in patients with chronic heart failure. A randomized phase III clinical trial.

BACKGROUND: The aim of this work was to evaluate the effect of high-intensity interval exercise (i.e., 30s at 100% of max workload, followed by 30s at rest, 45 min 3 days/week working-out schedule for 12 weeks) on left ventricular function and aortic elastic properties among chronic heart failure (CHF) patients. METHODS: This study is a phase III clinical trial. Of the 100 consecutive CHF patients (NYHA classes II-IV, ejection fraction<50%) that were randomly allocated, 72 completed the study (exercise training group, n=33, 63 ± 9 years, 88% men, and control group, n=39, 56 ± 11 years, 82% men). All patients underwent cardiopulmonary stress test, non-invasive high-fidelity tonometry of the radial artery, pulse wave velocity measurement using a SphygmoCor device and echocardiography before and after the completion of the training program. RESULTS: Both groups reported similar medical characteristics and physical activity status. General mixed effects models revealed that the intervention group reduced pulse wave velocity by 9% (p=0.05); Emv/Vp by 14% (p=0.06); E to A ratio by 24% (p=0.004), E to Emv ratio by 8% (p=0.05), MLHFQ score by 66% (p=0.003) and the depression score by 19% (p=0.5); increased augmentation index by 29%; VTI by 4% (p=0.05), 6-minute-walk distance up to 13% (p=0.05), peak oxygen uptake by 28% (p=0.001) and peak power by 25% (p=0.005). There were no significant changes in the control group. CONCLUSION: Interval high-intensity aerobic training, combined with strength exercise, seems to benefit aortic dilatation capacity and augmented systolic pressure in parallel with improvement in left ventricular diastolic function and quality of life.

Fish Consumption Moderates Depressive Symptomatology in Elderly Men and Women from the IKARIA Study.

Background. The aim was to examine the association of depressive symptoms with fish eating habits, in elderly individuals. Methods. From June to October of 2009, we studied 330 men and 343 women, aged 65 to 100 years, permanent inhabitants of Ikaria Island. Among several characteristics, depression was assessed with the Geriatric Depression scale (GDS range 0-15), while dietary habits through a valid semiquantitative food frequency questionnaire. Results. Women had significantly higher values of the GDS compared to men (4.8 ± 3.5 versus 3.3 ± 3.1, P = .001). Participants in the upper tertile of depression scale ate less frequent fish and consumed higher quantities of alcohol, compared to those in the lowest tertile (all P < .05). Regarding fish consumption, 50% of the individuals reported consuming 1-2 times weekly, 32% 3 to 5 times weekly, 11% 2-3 times monthly, while the rest reported rare (4.5%) and everyday (1.2%) consumption. Logistic regression showed that increased fish consumption (>3 times/week versus never/rare) was inversely associated with the odds of having GDS greater the median value (i.e., 4) (odds ratio = 0.34, 95% CI: 0.19, 0.61), after controlling for several cofounders. Conclusion. Frequent fish consumption in elderly seems to moderate depression mood.