The Association between CHA2DS2-VASc Score and Mortality in Patients with Heart Failure with Reduced Ejection Fraction.

BACKGROUND: Heart failure (HF) is associated with significant mortality and morbidity. Therefore, identifying high-risk patients may optimize treatment for HF patients and reduce adverse events. The aim of this study was to assess the role of the CHA2DS2-VASc score to predict mortality in patients with reduced left ventricular ejection fraction (LVEF). METHODS: A total of 106 patients with reduced LVEF were enrolled in this study. All patients completed a one-year follow-up, and a CHA2DS2-VASc score was calculated for each patient. RESULTS: Twenty-one patients (19.8%) died during the 1-year follow-up. We found that baseline functional status, CHA2DS2-VASc score, brain natriuretic peptide, blood urea and hemoglobin levels were associated with mortality. In the multivariate analysis, CHA2DS2-VASc score and functional capacity were the only predictors of 1-year mortality. CONCLUSIONS: Use of the CHA2DS2-VASc score appears to be feasible for risk stratification and mortality prediction in patients with reduced LVEF.

Influence of Intermittent Fasting During Ramadan on Circadian Variation of Symptom-Onset and Prehospital Time Delay in Acute ST-Segment Elevation Myocardial Infarction.

Ramadan interferes with circadian rhythms mainly by disturbing the routine patterns of feeding and smoking. The objective of this study was to investigate the circadian pattern of ST elevation acute myocardial infarction (STEMI) during the month of Ramadan. We studied consecutive STEMI patients 1 month before and after Ramadan (non-Ramadan group-NRG) and during Ramadan (Ramadan group-RG). The RG group was also divided into two groups, based on whether they chose to fast: fasting (FG) and non-fasting group (NFG). The time of STEMI onset was compared. A total of 742 consecutive STEMI patients were classified into 4 groups by 6 h intervals according to time-of-day at symptom onset. No consistent circadian variation in the onset of STEMI was observed both between the RG (P = .938) and NRG (P = .766) or between the FG (P = .232) and NFG (P = .523). When analyzed for subgroups of the study sample, neither smoking nor diabetes showed circadian rhythm. There was a trend towards a delay from symptom onset to hospital presentation, particularly at evening hours in the RG compared with the control group. In conclusion, there was no significant difference in STEMI onset time, but the time from symptom onset to hospital admission was significantly delayed during Ramadan.

Right ventricular outflow tract function in chronic heart failure.

BACKGROUND: Heart failure (HF) is a common, progressive, complex clinical syndrome and a subset of HF patients has symptoms out of proportion to the resting hemodynamics and left ventricular ejection fraction (LVEF). Right ventricular (RV) function is a powerful prognostic factor in HF, but assessing it is a challenge because of the right ventricle's complex geometry. OBJECTIVE: The aim of this study was to investigate the clinical application value of RV outflow tract (RVOT) function measured by transthoracic echocardiography in HF patients. METHOD: We prospectively investigated 36 chronic HF patients with dilated heart and LV systolic dysfunction and 21 healthy control subjects (normal ventricular function and ECG, and no cardiac risk factors). In addition to clinical and conventional echocardiographic parameters, RVOT size and fractional shortening (RVOT-FS) parameters were analyzed. RESULTS: The RVOT-FS was less in HF patients than healthy controls (18.8±15.7 vs 55.8±6.7, p<0.001) and correlated positively with TAPSE (r=0.814, p<0.001) and inversely with SPAP (r=-0.728, p<0.001) and functional capacity (r=-0.842, p<0.001). There was a statistically significant difference in RVOT-FS among the HF subgroups with regard to NYHA functional capacity (p<0.001), although there was no statistically significant difference with regard to LVEF. CONCLUSION: Although the apparent discordance between LVEF and the degree of functional impairment in HF is not well understood, it may be explained in part by alterations in RV function. We found that the RVOT-FS was a noninvasive and easily applicable measure of RV function and might be used for a comprehensive evaluation and follow-up of HF patients with a combined assessment of RV by other RV parameters.