Exploring the link between myocardial bridging and left ventricular hypertrophy: Congenital factors or remodelling?

BACKGROUND: Myocardial bridging (MB) was considered a congenital anomaly and found increased frequency in coronary computed tomography angiography. Some case studies reported the association of MB with various cardiomyopathies. However, the association between MB severity and left ventricular hypertrophy remains unclear. This cross-sectional study aimed to evaluate whether myocardial bridge is related to left ventricular hypertrophy in patients referred for coronary computed tomography angiography (CCTA). METHODS: This cross-sectional study included two hundred and twenty-seven patients (age 53.2 [11.1] years, 48 % female) who underwent 640-slice CCTA and were diagnosed with MB. MB severity was measured as MB muscle index (MMI) (MB length x MB thickness) and, left ventricular hypertrophy (LVH) was assessed with transthoracic echocardiography. RESULTS: MB segments were detected in all patients on the left anterior descending artery. CCTA was performed to exclude coronary artery disease in most patients (90%, n=206). Eighty-two (36.1 %) had LVH, and MMI was significantly higher in patients with LVH than those without LVH (27.3[19.5-38.9] vs 24 [13.8-37.1], P = 0.022, respectively). There was a positive correlation between the left ventricular mass index and myocardial bridge length (r=0.414, P =0.001), MB index (r=0.310, P <0.001), and the age of the patients (r=0.191, P = 0.004). MB thickness and MMI were also positively correlated with relative wall thickness. CONCLUSION: MB is a common finding, and its severity is associated with left ventricular hypertrophy in patients undergoing CCTA.

Evaluation of the non-alcoholic fatty liver fibrosis score in predicting short-term outcomes and severe coronary artery disease in patients undergoing coronary computed tomography angiography.

Introduction: The correlation between non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease is well established. Aim: The objective of this study was to assess the short-term associations of the non-alcoholic fatty liver disease fibrosis score (NFS) with various outcomes, including mortality, severe coronary artery disease, myocardial infarction, and the need for coronary angiography, among patients who underwent coronary computed tomographic angiography (CCTA). Material and methods: In this study, we assessed 499 patients who underwent 640-slice CCTA and evaluated their liver fibrosis using the NFS. The NFS takes into account factors such as age, body mass index, impaired fasting glycemia or diabetes mellitus, aspartate aminotransferase/alanine aminotransferase ratio, platelets, and albumin. Our primary focus was myocardial infarction, the need for coronary angiography, and death. Additionally, we examined the association between NFS and severe coronary artery disease. Results: Patients with a higher NFS had a greater number of coronary angiography procedures and higher Agatston score (p < 0.001), with NFS and Agatston score emerging as independent predictors of severe coronary artery disease and the primary endpoint. An NFS value above -0.92 could predict the primary endpoint with 61% sensitivity and 63% specificity, while an NFS value above -0.88 could predict severe coronary artery disease with 62% sensitivity and 65% specificity. To analyze primary endpoints, the Kaplan-Meier method was used for survival analysis, with NFS groups compared using the log-rank test. During the follow-up period, patients with higher NFS were exposed to primary outcomes at an earlier period (p = 0.009). Conclusions: NFS is an effective predictor of major cardiovascular events such as death, myocardial infarction, severe coronary artery disease, and the need for coronary angiography. These findings underscore the importance of NFS as a valuable tool for risk assessment and early intervention in patients with suspected or confirmed coronary artery disease.

Predictors of the right ventricular perforation caused by active-fixation pacing and defibrillator leads: A single-centre experience.

INTRODUCTION: Active-fixation leads have been associated with higher incidence of cardiac perforation. Large series specifically evaluating radiographic predictors of right ventricular (RV) lead perforation are lacking. METHODS: We conducted a retrospective observational study including 1691 consecutive patients implanted with an active fixation pacing and defibrillator lead at our institution between January 2015 and January 2021. Fourteen patients who had clinically relevant RV perforation caused by pacemaker and implantable cardioverter-defibrillator leads were included in the study. RESULTS: Univariate and multivariate analyses were used to identify predictors of RV perforation. In multivariate analysis, lead slack score (odds ratio [OR]: 3.694, 95% confidence interval [CI]: 1.066-12.807; p = .039), change in lead slack height (OR: 1.218, 95% CI: 1.011-1.467; p = .038) and width (OR: 1.253, 95% CI: 1.120-1.402; p = .001), left ventricular ejection fraction (OR: 0.995, 95% CI: 0.910-1.088; p = .032) were independent predictors of RV perforation. CONCLUSION: Fluoroscopic predictors of RV perforation associated with RV lead can be easily determined during implantation. Identification of these predictors may prevent the sequelae of RV perforation associated with active-fixation leads.

Acute Myocardial Infarction Due to Myocardial Bridge Treated With Surgery: a Case Report.

Myocardial bridging is congenital anomaly characterized by segment of epicardial coronary arteries passing through the myocardium. Various ischemic conditions are related with this pathology. We report a case of myocardial bridging that was complicated with acute anterior myocardial infarction and a review of the literature. The patient was treated successfully with coronary bypass graft surgery after unsuccessful percutaneous intervention.

Long-Term Observational Study of the Isolated Ostial Diagonal Stenosis in Patients with Chronic Coronary Syndrome.

OBJECTIVE: Isolated ostial diagonal stenoses are very rare lesions in which percutaneous intervention could cause significant vessel compromise, and the long-term results have been reported in a few studies. This study sought the characteristics and long-term follow-up of the patients with isolated osteal diagonal stenosis regarding percutaneous coronary intervention and presence of angina. METHODS: The study was an observational retrospective study conducted between January 2014 and December 2020. A total of 9769 patients who underwent coronary angiography were analyzed, and 87 patients had isolated diagonal stenosis. The patients were evaluated according to treatment modality and angina severity in long-term pattern. RESULTS: Median follow-up time was 36 months. A total of 54 (83.1%) patients were followed up with only medical treatment, and 11 (16.9%) patients underwent revascularization in addition to medical treatment. The degree of stenosis of the diagonal artery was significantly higher in the percutaneous coronary intervention group than medical group (P = 0.002) and the patients with wider reference diameter of diagonal artery complaint of more angina (P = 0.007). Class I angina was significantly higher in percutaneous coronary intervention group than medical and the patients with no angina were significantly higher in medical group than percutaneous coronary intervention group. CONCLUSION: Percutaneous coronary intervention was mainly performed for diagonal arteries with a higher degree of stenosis; however, the patients who underwent percutaneous coronary intervention had angina more than 50% rates. Furthermore, the patients with ongoing angina had a larger diameter of the diagonal artery regardless of the type of treatment.

Electrocardiographic Predictors of Complete Heart Block During Right Ventricular Lead Implantation in Patients Who Underwent Cardiac Resynchronization Therapy.

Cardiac resynchronization therapy (CRT) device procedures have their own complications in addition to the complications associated with standard pacemaker implantations. This study aimed to analyze the predictors of the right bundle branch injury resulting in complete heart block (CHB) during right ventricular (RV) lead implantation in patients who underwent CRT with defibrillator. We conducted an observational study of consecutive 790 patients who underwent CRT with defibrillator device implantation at our institution from 2010 to 2022. Relevant clinical information and complete data regarding the echocardiographic data, implantation procedure, and clinical follow-up were collected into a computerized database. A total of 29 patients (3.7%) had CHB during RV lead implantation. In multivariate analysis, left axis deviation (odds ratio [OR] 2.408, 95% confidence interval [CI] 1.025 to 5.658, p = 0.044), QRS width (OR 1.022, 95% CI 1.001 to 1.043, p = 0.035) and QRS alternans (OR 4.214, 95% CI 1.788 to 9.930, p = 0.001) were found independently related to right bundle branch injury resulting in CHB development during RV lead implantation. In conclusion, left axis deviation, QRS width, and QRS alternans were associated with a higher rate of CHB, and these findings provide insight into optimal and safe CRT device implantation strategies based on preprocedural characteristics.

Prognostic value of non-alcoholic fatty liver disease fibrosis score in patients undergoing cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is an effective option in the treatment of patients with heart failure and wide QRS. Non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) has been shown to predict cardiac events in several patient populations. However, the relationship between NFS and response to CRT has not been investigated. The aim of the study was to investigate the predictive role of NFS in the assessment of response after CRT. METHODS: Three hundred thirty-six patients with heart failure undergoing CRT were prospectively studied. Liver fibrosis were assessed according to the non-alcoholic fatty liver disease fibrosis score (NFS), which includes age, body mass index, impaired fasting glycemia or diabetes mellitus, aspartate aminotransferase /alanine aminotransferase ratio, platelets, and albumin. Echocardiographic response to CRT was defined by a ≥15% reduction in left ventricular end-systolic volume at six months at follow-up. RESULTS: Two hundred thirty-eight patients (71%) had CRT response after 6 months of follow-up. Receiver-operator characteristic curve analysis showed NFS cutoff value of < -1.12 for predicting CRT response with a sensitivity of 70.4% and a specificity of 52.9%. The patients were also divided into four groups according to the quartiles of NFS. The proportion of response to CRT was increased with lower level of NFS value. Multivariate logistic regression analysis demonstrated the NFS score < -1.12 and LVIDs were independent predictors of the CRT response. In the second model of analysis which included NFS, quartiles demonstrated that fourth NFS quartile and LVIDs were independent predictors of CRT response. CONCLUSION: Liver fibrosis assessed by NFS can provide valuable information to predict reverse remodeling in patients undergoing CRT. The present study supports monitoring of NFS to improve preoperative risk stratification of these patients.

Radiographic predictors of failure of simple manual traction of transvenous implantable cardioverter-defibrillator leads: a single-center experience.

BACKGROUND: Extraction of the implantable cardioverter-defibrillator (ICD) leads could be a difficult procedure due to fibrous tissue around the lead and anatomical variations. In this report, we present our experience in the radiographic predictors of failure of simple manual traction (SMT) in patients with dual-coil ICD requiring lead extraction (LE). METHODS: Between January 2017 and February 2021, 103 leads were removed in 65 consecutive patients; 65 (63.1%) were dual-coil ICD leads, 22 (21.4%) were atrial, and 16 (15.5%) were coronary sinus leads. Patient-based and procedural data were collected and analyzed retrospectively. Clinical and procedural characteristics were compared and radiographic predictors of failure of SMT of ICD leads were assessed. Projected anteroposterior (AP) lead tortuosity was measured and lead slack score was estimated on chest X-ray (CXR). RESULTS: Simple manual traction failed in 27 (42%) of the ICD leads. Ottawa slack score (odds ratio [OR] 2.368, 95% CI [1.261-4.447]; P = 0.007), AP lead tortuosity > 1.10 (OR 7.477, 95% CI [1.718-35.542]; P = 0.007), and number of previous interventions (OR 6.016, 95% CI [1.184-30.557]; P < 0.030) were found to be independently related to the failure of SMT. Receiver-operator characteristic curve analysis yielded an AP lead tortuosity cutoff value of > 1.10 for predicting the failure of SMT. The area under the curve was 0.744; the 95% confidence interval (CI) was 0.617 to 0.871 (P = 0.001), with a sensitivity of 63% and a specificity of 73%. CONCLUSION: Simple manual traction success in our study varied based on radiographic lead-related parameters. Before planning the procedure, increased AP lead tortuosity in vasculature and higher lead slack score can be easily determined on CXR and may be associated with more fibrous adherences, the complexity of the LE, and failure of SMT.

Comparison of selective coronary angiography through the ablation catheter versus conventional coronary angiography to guide ablation of premature ventricular contractions originating from aortic cusp.

BACKGROUND: Intraprocedural coronary angiography (CA) is recommended in patients undergoing ablation in aortic cusps to assess the relation of catheter tip and coronary ostia. In this report, we aimed to compare selective coronary angiography (SCA) through the contact force (CF)-sensing radiofrequency catheter with conventional coronary angiography (CCA) to guide ablation of premature ventricular contractions (PVC). METHODS: This was a retrospective observational cohort study of prospectively collected data of 87 consecutive patients undergoing PVC ablation at a single institution between February 2016 and June 2021. Forty-six patients (53%) underwent SCA and forty-one patients (47%) underwent CCA. Data were consecutively collected case-by-case and entered into a computerized database. Procedural characteristics, complications, and clinical outcomes were compared between the SCA and CCA groups. RESULTS: Successful ablation was achieved in seventy-seven (89%) patients. Total procedure and fluoroscopy time and radiation dose were significantly lower in SCA group (93 ± 22 min vs 102 ± 20 min, p = 0.042; 12 ± 3 min vs 14 ± 4 min, p = 0.030; 3292 ± 1221 µGy m2 vs 3880 ± 1229 µGy m2, p = 0.028, respectively). Median ambulation time was significantly longer in CCA group (6.8 ± 1 h vs 17.8 ± 1.8 h, p = 0.006). CONCLUSIONS: Selective coronary angiography through the CF-sensing ablation catheter to assess the relation between the ablation site and the coronary ostia is feasible and safe. This technique precludes the requirement of an additional arterial access and decreases the total procedure and fluoroscopy time and radiation dose.

Selective angiography through radiofrequency catheter during ablation of premature ventricular contractions originating from aortic cusp: A single-centre experience.

INTRODUCTION: Intraprocedural coronary angiography is recommeded in patients undergoing ablation in aortic cusps to assess the relation of catheter tip and coronary ostia. In this report, we present our experience in selective coronary angiography through the radiofrequency catheter during premature ventricular contraction (PVC) ablation. METHODS AND RESULTS: We prospectively recruited 43 consecutive patients who underwent PVC ablation in the aortic cusps between March 2018 and April 2021. We performed coronary angiography through the contact force (CF)-sensing ablation catheter at the ablation site. Successful ablation was achieved in 38 (88%) of patients. No technical problems occurred after the contrast injection and ablation parameters were within the normal values, without any change of impedance and CF-sensing values and neither electrogram signal quality after contrast injection. No complications occurred during the procedure, hospital stay, and during one-year follow-up (15.3 ± 3.1 months). CONCLUSION: Selective coronary angiography through the CF-sensing ablation catheter to assess the relation between the ablation site and the coronary ostia is feasible and no minor or major complications occurred in our experience.

Stent Implantation May Fail Sometimes in Coronary Complications: Extension of an Iatrogenic Left Main Coronary Artery Hematoma.

Coronary artery perforations and dissections, associated with cardiac tamponade or acute vessel closure, are life-threatening complications of percutaneous coronary intervention. In some cases, subepicardial hematomas could occur and compress the vessel. A 59-year-old woman was admitted to our hospital with chest pain and was diagnosed with non-ST-elevation myocardial infarction. Coronary angiography showed the total occlusion of the diagonal artery. During the intervention, left main coronary artery dissection and intramural hematoma occurred as coronary complications. The left main coronary artery was stented; however, the extension of the hematoma through the ostium of the left anterior descending artery caused further complications. The patient underwent an urgent coronary artery bypass graft surgery and was discharged on the seventh postoperative day.

Systolic aortic root motion predicts response to cardiac resynchronization therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) is recommended for patients with advanced chronic heart failure. Systolic aortic root motion (SARM) has been investigated in dilated cardiomyopathy patients and found that heart failure patients had reduced SARM. We aimed to investigate the relationship between SARM and response to CRT. METHODS: Fifty-six patients with advanced heart failure, wide QRS complex, and LVEF ≤35% were included. Transthoracic echocardiography was performed before, and repeated at 6 months in follow-up. Systolic aortic root motion was measured in each patient before the device implantation. Echocardiographic response to CRT was defined by a ≥15% reduction in left ventricular end-systolic volume at 6 months follow-up. RESULTS: Forty patients (71%) had CRT response after 6 months of follow-up. In multivariate analysis, significant associates of response to CRT was evaluated adjusting for functional capacity, etiology of cardiomyopathy, QRS duration, baseline left ventricular dimensions/volumes and SARM. SARM was the only predictor of response to CRT (OR 1.818, 95% CI, 1.101-3.003, P = .019). CONCLUSIONS: SARM predicts non-response to CRT and may help in the selection of CRT candidates.

Reprogramming the tachycardia parameters with long-detection strategy in patients with pre-existing implantable cardioverter-defibrillator.

Background: A long-detection interval (LDI) programming has been proved to reduce shock therapy in patients who underwent de novo implantable cardioverter defibrillator (ICD) implantation. We aimed to evaluate effectiveness and safety of this new strategy in old ICD recipients. Methods: We included 147 primary prevention patients with ischaemic and non-ischaemic aetiology. Conventional setting parameters (18 of 24 intervals to detect ventricular arrhythmias (VA's)) were reprogrammed with LDI strategy (30 of 40 intervals to detect VA's). One monitoring zone (between 360 and 330 ms) and two therapy zones were programmed, treating all rhythms of cycle length <330 ms that met the duration criterion of 30/40 intervals and were discriminated as ventricular tachycardia/ventricular fibrillation (VT/VF). The supraventricular tachycardia (SVT) discriminators were used in all patients. Results: At a median follow-up of 24 months, 12.9% (n = 19) of patients received shock therapies (± antitachycardia pacing (ATP)). Appropriate and inappropriate shocks occurred in 7.5 and 5.4% of patients during follow-up, respectively. Only one patient experienced an arrhythmic syncope during the follow-up period. There was no death related to LDI programming. The LDI programming helped to stop unnecessary in 10 patients (6.8%), who otherwise would have been treated in the conventional programming. Conclusions: LDI programming was found safe and effective. Hence, old ICD recipients will benefit from this strategy.

Bendopnea and Its Clinical Importance in Outpatient Patients with Pulmonary Arterial Hypertension.

PURPOSE: Bendopnea is a recently reported novel symptom in patients with heart failure (HF) defined as shortness of breath when bending forward. It has been demonstrated that bendopnea is associated with advanced symptoms and worse outcomes. The aim of this study was to assess the presence of bendopnea and its clinical importance with regards to functional status, hemodynamic and echocardiographic characteristics in outpatient pulmonary arterial hypertension (PAH) patients. METHODS: We conducted this prospective observational study of 53 patients who were admitted to our PAH clinic for routine control visits. We determined the presence of bendopnea and analyzed hemodynamic parameters, World Heart Organization (WHO) functional class, transcutaneous oxygen saturation, 6-minute walking distance (6-MWD), N-terminal pro-brain natriuretic peptide (NT-proBNP) and right ventricular (RV) function indicators in patients with and without bendopnea. RESULTS: Bendopnea was present 33.9% of the PAH patients. The mean age was higher in the patients with bendopnea than in those without bendopnea, but the difference was not significant (p = 0.201). The patients with bendopnea had a lower 6-MWD and higher NT-proBNP level (p < 0.001), and worse WHO functional class symptoms (p = 0.010). Mean right atrial pressure, pulmonary artery pressure, and pulmonary vascular resistance were higher in the patients with bendopnea. The patients with bendopnea had a more dilated RV end-diastolic diameter and lower tricuspid annular plane systolic excursion value (p < 0.001 and p = 0.001, respectively). CONCLUSIONS: Bendopnea was associated with worse functional capacity status, hemodynamic characteristics and RV function in our outpatient PAH patients.

Predicting value of coupling interval variability in determining the origin of ventricular premature contractions with V3 transition.

PURPOSE: We aimed to investigate the predictive value of coupling interval variability (ΔCI) in determining the origin of idiopathic outflow tract ventricular tachycardia (OTVT) with V3 transition. METHODS: We reviewed data from 126 patients who underwent catheter ablation of OTVT between 2015 and 2018 at our institution. We identified 32 patients of successful OTVT ablation with a precordial transition at V3 derivation. The ΔCI (maximum - minimum CI) was measured. RESULTS: CI variability was significantly smaller for right ventricular (RV) OT than left ventricular  (LV) OT premature ventricular contractions (PVCs) (p = 0.004). In multivariate analysis, including QRS duration, R-wave duration in lead V1, R-wave amplitude in V1, PVC burden, and ΔCI, ΔCI was the only independent predictor of PVC origin (OR 0.963, 95% CI, 0.939-0.988, p < 0.001). A CI variability ≥ 30 predicted a PVC from LVOT origin with a sensitivity of 83% and specificity of 89%. ΔCI was compared with other previously proposed ECG criteria used to differentiate LVOT from RVOT PVCs. ΔCI exhibited a greater area under the curve (AUC) (0.867) than the other ECG criteria. A ΔCI ≥ 30 ms exhibited a high sensitivity of 89% and a specificity of 83%. CONCLUSIONS: ΔCI is outperformed other ECG criteria to differentiate LVOT from RVOT PVCs, and this parameter may be useful for planning the ablation strategy.

Surface electrogram-guided left ventricular lead placement improves response to cardiac resynchronization therapy.

OBJECTIVE: Failure to select the optimal left ventricular (LV) segment for lead implantation is one of the most important causes of unresponsiveness to the cardiac resynchronization therapy (CRT). In our study, we aimed to investigate the echocardiographic and clinical benefits of LV lead implantation guided by an intraoperative 12-lead surface electrocardiogram (ECG) in patients with multiple target veins. METHODS: We included 80 [42 (62.5%) male] heart failure patients who successfully underwent CRT defibrillator (CRT-D) implantation. Patients were divided into two groups. In group 1, LV lead was positioned at the site with the shortest biventricular-paced (BiV-paced) QRS duration (QRSd), as intraprocedurally measured using surface ECG. In group 2 (control), we included patients who underwent the standard unguided CRT. ECG, echocardiogram, and functional status were evaluated before and 6 months after CRT implantation in all patients. RESULTS: In group 1, BiV-paced QRSd measurements were successfully performed in 112 of 120 coronary sinus branches during CRT and an LV lead was successfully placed at the optimal site in all patients. Compared with group 2, group 1 had a significantly higher rate (85% vs. 50%, p=0.02) of response (>15% reduction in LV end-systolic volume) to CRT as well as a shorter QRSd (p<0.001) and a greater QRS shortening (ΔQRS) associated with CRT compared with baseline (p<0.001). The mean New York Heart Association functional class was significantly improved in both groups, and no significant differences were found in clinical response to CRT (85% vs. 70%, p=0.181). CONCLUSION: Surface ECG can be used to guide LV lead placement in patients with multiple target veins for improving response to CRT. Thus, it is a safe, feasible, and economic approach for CRT-D implantation.

Inhibition of PDE4 by low doses of rolipram induces changes in lipid and protein components of mice heart.

There is significant increasing interest in phosphodiesterase-4 (PDE4) inhibition in treatment of cardiovascular diseases. Related with this, research has focused on cellular, biochemical, molecular and structural changes in heart tissue induced by PDE4s inhibitors. However, for their clinical applicability additional studies are still needed. Fourier transform infrared spectroscopy offers promising approach to contribute such issue due to its ability in detection the changes in biomolecules. By utilizing this method, we examined the effects of PDE4 inhibition by rolipram at 0.05 mg/kg and 0.1 mg/kg doses on content of lipids and proteins, and fluidity, order and packing of membranes in naive mice heart. In treated groups, there was a significant decrease in unsaturated, saturated lipids, cholesterol esters, fatty acids, phospholipids and triacylgylcerols obtained from CH2, C=O, olefinic=CH, and COO- areas, and CH2/lipid, C=O/lipid, olefinic=CH/lipid, and COO-/lipid ratios. Additionally, olefinic=CH area and olefinic=CH/lipid ratio may suggest decreased lipid peroxidation, confirmed by thiobarbituric acid assay. Also, a higher degree of membrane order, slight increase in membrane fluidity and differences in membrane packing were obtained. Amide I and II areas and RNA/protein ratios showed that variation in protein content is not correlated with applied concentration. Analysis of amide I mode predicted alterations in secondary structures like an increase in random coils and decrease in alpha-helices. Moreover, all groups were successfully discriminated by cluster analysis. The corresponding results may help to understand the potential effects of PDE4 inhibition by rolipram.

A simple discharge risk model for predicting 1-year mortality in hospitalised acute decompansated heart failure patients with reduced ejection fraction.

OBJECTIVE: The risk stratification for prognosis in heart failure is very important for optimal disease management and decision making. The aim of this study was to establish a simple discharge 1-year mortality prediction model by integrating data obtained from demographic characteristics, clinical evaluation, laboratory biomarkers and echocardiographic evaluation of hospitalised heart failure with reduced ejection fraction (HFrEF) patients with acute decompensation. METHODS AND RESULTS: A risk score model was developed based on ß-coefficient number of variables in a multivariable logistic regression model which was created with the use of data on clinical, laboratory, imaging and therapeutic findings of 670 patients (65.4% males, 65 ± 11 years) who was hospitalised with acute decompensated HFrEF. The mean left ventricular ejection fraction (LVEF) was 26 ± 9%. Independent predictors of mortality were: age ≥75 years, sodium <130 mEq/L, hepatomegaly at admission, unable to use beta-blocker at discharge and LVEF ≤20%. The 1-year mortality rate was 7.8% in the study population. The existence of each predictor was scored as 1 point and the discharge risk score identified patients into low (0-1 points), intermediate (2-3 points) and high (4-5 points) risk individuals with 3, 15.6 and 44.4% 1-year mortality rates, respectively. The model performance evaluated by concordance index was 0.74. CONCLUSIONS: This simple discharge risk score model for hospitalised acute decompensated HFrEF patients using easily determined demographic characteristics, clinical signs, echocardiographic and laboratory data is a valuable and an easy risk assessment tool to use at point-of-care.