Heart Failure with Preserved Ejection Fraction-a Concise Review.

PURPOSE OF REVIEW: Heart failure with preserved ejection fraction (HFpEF) is a relatively new disease entity used in medical terminology; however, both the number of patients and its clinical significance are growing. HFpEF used to be seen as a mild condition; however, the symptoms and quality of life of the patients are comparable to those with reduced ejection fraction. The disease is much more complex than previously thought. In this article, information surrounding the etiology, diagnosis, prognosis, and possible therapeutic options of HFpEF are reviewed and summarized. RECENT FINDINGS: It has recently been proposed that heart failure (HF) is rather a heterogeneous syndrome with a spectrum of overlapping and distinct characteristics. HFpEF itself can be distilled into different phenotypes based on the underlying biology. The etiological factors of HFpEF are unclear; however, systemic low-grade inflammation and microvascular damage as a consequence of comorbidities associated with endothelial dysfunction, oxidative stress, myocardial remodeling, and fibrosis are considered to play a crucial role in the pathogenesis of a disease. The H2FPEF score and the HFpEF nomogram are recently validated highly sensitive tools employed for risk assessment of subclinical heart failure. Despite numerous studies, there is still no evidence-based pharmacotherapy for HFpEF and the mortality and morbidity associated with HFpEF remain high. A better understanding of the etiological factors, the impact of comorbidities, the phenotypes of the disease, and implementation of machine learning algorithms may play a key role in the development of future therapeutic strategies.

The risk for subsequent coronary interventions in a local Polish population.

INTRODUCTION: Paradoxically, the literature lacks an assessment of the impact of various factors on subsequent coronary interventions in patients with coronary artery disease (CAD). AIM: To assess the impact of various factors on subsequent percutaneous transluminal coronary angioplasty (PTCA), as well as to characterize the clinical profile of people undergoing repeated diagnostic coronary angiography without significant coronary artery changes. MATERIAL AND METHODS: We investigated retrospective data from 4041 subjects according to the clinical factors which may affect the occurrence of unplanned future PTCA. RESULTS: The strongest risk factors for subsequent PTCA were significant stenosis of left descending artery (OR = 2.17, 95% CI: 1.09-4.32) during baseline coronary angiography, the atherosclerotic burden (number of critically narrowed vessels) (OR for narrowing lesions in 3 epicardial arteries 12.13, 95% CI: 5.40-27.27), and restenosis in a previously implanted stent (OR = 4.34, 95% CI: 1.96-9.62). A strong positive relationship between total mortality and the number of critically narrowed coronary arteries (during baseline hospitalization) was observed. Patients without significant coronary artery stenosis in two diagnostic angiographies (control group) differed from subjects with hemodynamic relevant CAD in: higher creatinine levels, more frequent presence of chronic obstructive pulmonary disease and more frequent symptoms of intermittent claudication. CONCLUSIONS: The results of the study are in accord with real clinical practice. The arteriosclerotic burden is a major cause of recurrent PTCA, but an important clinical issue is the qualification for recurrent coronary-angiography in those patients whose previous coronary angiography did not show significant stenosis, because other clinical causes may explain their symptoms.

Advanced heart failure: A review.

Heart failure (HF) has been recognized as a pandemic and is a serious clinical and health problem associated with significant mortality, morbidity and expenditure on healthcare, especially among older people. Progress in medicine has made it possible for an increasing number of people with HF to live longer than ever before. Therefore, a new and serious clinical problem has appeared - advanced heart failure (AHF). A better understanding of this issue is very important, because there are many more patients waiting for transplantations than there are available hearts. The role of the medical team is to keep the patient in the best condition until the heart transplant/implantation of left ventricular assist devices or at least to ensure the best possible quality of life. This article reviews the available data on AHF. The authors have succinctly presented different definitions and methods of the AHF diagnosis established by medical societies, as well as epidemiological data, methods of assessment, and possible treatment strategies.

Sudden Cardiac Death in Hypertrophic Cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is a heart disease characterized by hypertrophy of the left ventricular myocardium and is most often caused by mutations in sarcomere genes. The structural and functional abnormalities are not explained by flow-limiting coronary artery disease or loading conditions. The disease affects at least 0.2% of the population worldwide and is the most common cause of sudden cardiac death in young people and competitive athletes because of fatal ventricular arrhythmia. In some patients, however, HCM has a benign course. Therefore, it is of utmost importance to properly evaluate patients and single out those who would benefit from an implanted cardioverter defibrillator. In this article, we review and summarize the sudden cardiac death risk stratification algorithms, methods of preventing death due to HCM, and novel factors that may improve the existing prediction models.

Evaluation of bioresorbable vascular scaffolds in acute coronary syndrome: A two-center, one-year follow-up analysis.

BACKGROUND: Bioresorbable vascular scaffolds (BVS) have emerged as a new treatment option in cardiovascular medicine. Nonetheless, there is still limited data on the use of these novel devices in patients with acute coronary syndromes (ACS). The purpose of this study was to evaluate the feasibility and efficacy of BVS implantation in patients with ACS. METHODS: The present report is a prospective, two-center registry that involved 165 consecutive patients hospitalized with the diagnosis of ACS and treated with the Absorb BVS (Abbot Vascular, Santa Clara, USA). During 1-year, all patients were monitored for the following endpoints: death, myocardial infarction (MI), scaffold thrombosis (ST), target lesion revascularization (TLR), target vessel revascularization (TVR) and target vessel failure (TVF), defined as cardiac death, target vessel MI, and TVR. RESULTS: A total of 165 patients underwent 179 BVS implantations. 94 patients were diagnosed with unstable angina (UA; 57.6%), 45 with non-ST-segment elevation myocardial infarction (NSTEMI; 27.3%) and 26 with ST-segment elevation myocardial infarction (STEMI; 15.7%). Procedural success was achieved in all patients with thrombolysis in myocardial infarction flow 3. During a follow-up of 14.1 ± 8.5 months (median 12.4 months, IQR 8.7 [8.4 to 12.1] months) death occurred in 4 (2.4%) patients, including 2 (1.3%) cardiac deaths. There was only 1 case of subacute ST (0.66%), without late ST. The incidence of MI, TLR, TVR and TVF were: 2.65%, 2.65%, 7.95%, 9.3%, respectively. CONCLUSIONS: The present results suggest that BVS implantation in ACS patients is feasible and safe in highly experienced centers. One-year clinical results are encouraging with a low rate of stent thrombosis.

The Role of Toll-Like Receptors and Vitamin D in Cardiovascular Diseases-A Review.

Cardiovascular diseases are the leading cause of mortality worldwide. Therefore, a better understanding of their pathomechanisms and the subsequent implementation of optimal prophylactic and therapeutic strategies are of utmost importance. A growing body of evidence states that low-grade inflammation is a common feature for most of the cardiovascular diseases in which the contributing factors are the activation of toll-like receptors (TLRs) and vitamin D deficiency. In this article, available data concerning the association of cardiovascular diseases with TLRs and vitamin D status are reviewed, followed by a discussion of new possible approaches to cardiovascular disease management.

Esophageal pH Monitoring in Children: A Simple Mathematical Formula for pH Probe Positioning.

Correct pH probe placement is vital for the precision of esophageal pH monitoring. This study aimed at finding the optimal formula for placement of pH probe in the locus proposed by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition European Pediatric Impedance Working Group, that is, 2 vertebrae above the diaphragm. An analysis of data regarding 353 children ages 0-18 years in whom the position of the pH sensor was determined radiographically revealed that a mathematical formula (3.2 + 0.2 × body length or height, centimeter) could guide the probe to within 1/12 of thoracic spine length of the desired location in 71.7% of all of the patients.

Prevalence and correlates of vitamin K deficiency in children with inflammatory bowel disease.

Although vitamin K deficiency has been implicated in adult inflammatory bowel disease (IBD), its prevalence in pediatric IBD remains unknown. We carried out a cross-sectional study in 63 children with Crohn's disease (CD) and 48 with ulcerative colitis (UC) to assess the prevalence of vitamin K deficiency and to search for potential correlation between vitamin K status and pediatric IBD activity. Vitamin K status was assessed using protein induced by vitamin K absence-II (PIVKA-II; ELISA). Prevalence of vitamin K deficiency was 54.0% in CD and 43.7% in UC. Vitamin K deficiency was more common in patients with higher CD activity, in CD patients with higher mass Z-scores, and less common among children with CD treated with infliximab. Relation of vitamin K deficiency to pediatric IBD clinical course and treatment demand further research.

Comparison of fecal pyruvate kinase isoform M2 and calprotectin in assessment of pediatric inflammatory bowel disease severity and activity.

AIMS: Accurate assessment of inflammatory bowel disease (IBD) activity is the cornerstone of effective therapy. Fecal M2 isoform of pyruvate kinase (M2-PK) and fecal calprotectin (FC) are noninvasive markers of mucosal inflammation in IBD. The aim of this study was to compare performance of M2-PK and FC in assessment of pediatric ulcerative colitis (UC) and Crohn's disease (CD) severity and activity. MATERIALS AND METHODS: 121 patients with IBD, including 75 with UC and 46 with CD were recruited. Control group consisted of 35 healthy children (HS). Patients were assigned to groups depending on disease severity and activity. M2-PK and calprotectin concentration were determined in stool samples using ELISA. Areas under receiver operating characteristic curves (AUC) for FC and M2-PK with cut-off level at which M2-PK specificity was matching FC specificity were calculated and compared. RESULTS: Performance of M2-PK at identifying patients with IBD, UC and CD among HS was inferior to FC. The differences in AUC were respectively: -0.10 (95% confidence interval [CI] [-0.13-(-0.06)], p<0.0001), -0.14 (95% CI [-0.19-(-0.09)], p<0.0001) and -0.03 (95% CI [-0.05-(-0.001)], p<0.02). M2-PK was inferior to FC in discriminating patients with mild UC from those with HS (AUC difference -0.23, 95% CI [-0.31-(-0.15)], p<0.0001). CONCLUSIONS: FC reflects pediatric IBD severity and activity better than M2-PK. This difference is particularly pronounced when identifying patients with mild UC and UC in remission.