Automated home telephone self-monitoring reduces hospitalization in patients with advanced heart failure.

We studied 138 patients admitted for heart failure (HF). Patients were allocated one of three treatment strategies. Group 1 (G1, n = 50) were given usual care for HF, Group 2 (G2, n = 56) received a multi-disciplinary team approach, while Group 3 (G3, n = 32) had home telephone self-monitoring. Telemonitoring was based on the answers to three simple queries about bodyweight change, dyspnoea and general health. The system stratified the HF severity of each patient once a week, and recommended a prompt medical appointment or simple follow-up. Over a 12-month follow-up period, there were 43 adverse events (cardiovascular deaths and rehospitalizations for HF: G1 = 22, G2 = 14, G3 = 7). There was no difference between G2 and G3 (P = 0.78) but there was significant disadvantage with usual care (P = 0.02 vs. G2 and P = 0.04 vs. G3). Time to re-admission for HF increased in G2 and G3 compared to G1 (188 and 198 days vs. 95 days, P = 0.03 and P = 0.02 respectively). Automated home telephone self-monitoring reduced rehospitalization in patients with advanced HF.

Immediate and long-term echocardiographic findings after transcatheter aortic valve implantation for the treatment of aortic stenosis: the Cribier-Edwards/Edwards-Sapien valve experience.

BACKGROUND: The role of transcatheter aortic valve implantation in the treatment of calcific aortic stenosis is evolving. Immediate and long-term echocardiographic findings are poorly reported. METHODS: Eighty-eight patients in whom surgical aortic valve replacement was contraindicated were studied before and 1 and 7 days, 1 month, and 1 and 2 years after the transcatheter procedure by echocardiography for hemodynamic. Transaortic pressure gradient, permeability index, and aortic valve area were measured, and aortic regurgitation was estimated from a multiparametric approach. A subset group of 36 patients (23-mm valve, n = 18; 26-mm valve, n = 18) with optimal ultrasound window were investigated for valve geometry at 7 days. We measured the sphericity index (anteroposterior to sagittal diameter ratio) and the angulation of the prosthesis with the ascending aorta. RESULTS: By analysis of variance, transaortic pressure gradient significantly decreased and aortic valve area increased after the procedure (P < .0001 and P < .0001 respectively). Aortic regurgitation severity tended to decline at follow-up (P = .20) and was unaffected by valve size (P = .35). Leaks were paraprosthetic in 77% of cases, intraprosthetic in 6% of cases, and both in 17% of cases. Overall, the sphericity index was 1.03 +/- 0.07 and the angulation was 2.9 +/- 1.1 degrees. CONCLUSION: Echocardiography aids in the demonstration of appropriate prosthesis function and positioning after transcatheter aortic valve implantation.

Early improvement of left ventricular function after implantation of a transcutaneous aortic valve: a tissue Doppler ultrasound study.

INTRODUCTION: The long-term effects of surgical treatment for aortic narrowing in left ventricular (LV) remodelling have been well described. The immediate benefit after release of obstruction is unknown. METHOD AND RESULTS: Nineteen patients with significant and symptomatic aortic stenosis underwent transcutaneous implantation of an aortic valve. A conventional and tissue Doppler echocardiography was performed 48 hours before and 24 hours after the procedure. Apart from the dimensions, LV function and aortic haemodynamics, we measured systolic and diastolic myocardial velocities and systolic strain. The procedure resulted in a decrease to the mean transaortic gradient (from 43+/-13 to 10+/- 3 mmHg, p=0.001), an increase of the aortic surface area (from 0.6+/-0.1 to 1.7+/-0.1cm(2), p=0.001) and a reduction in the systolic LV volume (62+/-27 to 48+/-22, p=0.04). We observed an improvement in the systolic radial and longitudinal strain of the posterior wall (p<0.05), septal wall (p<0.05) and lateral wall (p<0.05). Improvement in systolic velocities on these walls and the inferior wall (p<0.01) was also recorded. The regional diastolic velocity was significantly better on the posterior (p<0.05) and septal (p<0.05) walls. CONCLUSION: The immediate drop in the transaortic gradient resulted in an improvement in myocardial velocities and strain, a sign of improvement in the regional systolic and diastolic regional function.