Does left ventricular diastolic dysfunction progress through stages? Insights from a community heart failure study.

UNLABELLED: We performed a retrospective pilot study on a group of symptomatic patients attending our community heart failure clinic with left ventricular diastolic dysfunction (LVDD), rising or elevated LV end diastolic pressure, elevated brain natriuretic peptide (BNP), but with no clinical or radiographic evidence of heart failure; a group we hypothesised may be in the pre-HFPEF stage. METHODS: Those with LVEF >45% and LV diastolic dysfunction were included and divided into two groups: E/e' <15 and E/e' ≥15 corresponding with rising and raised LVEDP, respectively. Clinical events (deaths and hospital admissions) were compared at 1year and were grouped into all-cause events or cardiovascular events. The total numbers of all-cause and cardiovascular events of the individual groups and the entire cohort were assessed at 1year. RESULTS: Out of 584 screened, 80 patients were included. Thirty five patients had E/e' <15 and 45 had E/e' ≥15. At 1year follow-up the 1year all-cause events in the E/e' ≥15 group was higher compared to the E/e' <15 group (p=0.03). At 12months, in the entire cohort there were a total of 45 clinical events (39 hospital admissions and 6 deaths) out of which 20 events were cardiovascular. CONCLUSION: Patients in the pre-HFPEF stage had many events and those with elevated E/e' ≥15 had a poor 1year outcome. As this was strongly influenced by comorbidities we suggest close monitoring of these patients in dedicated HFPEF clinics along with vigorous management of comorbidities.

A rare case of primary cardiac lymphoma.

A 71-year-old man presented with shortness of breath and tachycardia along with systemic symptoms of weight loss and lethargy. A pulmonary embolus was the initial suspected diagnosis but through extensive investigations a rarer cause of his symptoms was identified. This case demonstrates the importance of cardiac imaging in the assessment and non-invasive tissue characterisation of a suspected cardiac tumour; in our case, this was subsequently confirmed by careful histological/immunocytochemical evaluation of the pericardial effusion as a primary cardiac B-cell non-Hodgkin's lymphoma, thus enabling appropriate management leading to an excellent clinical outcome.

Retained temporary epicardial pacing wires: a rare cause of prosthetic valve endocarditis.

Temporary epicardial pacing wires (TEPWs) are commonly used during cardiac surgery to meet unforeseen complications like heart blocks or asystole. These are generally considered to be safe. The incidence of major complications with their use is low, but could be life threatening. Complications can be divided into those encountered during placement, removal, or retention of temporary epicardial pacing wires. We report a rare case of prosthetic mitral valve endocarditis caused by TEPWs that migrated into the pulmonary artery, presenting 5 months following mitral and aortic valve replacement surgery that required percutaneous removal of these temporary pacing wires via a right femoral vein approach. This case highlights the fact that delayed complications can rarely occur due to retained TEPWs and may have serious consequences. This fact should be taken into account when the strategy on dealing with such wires following cardiac surgery is determined. Routine retention of temporary epicardial pacing wires is not recommended.