Left ventricular mass etiology include thrombi, myxomas and foreign objects which can all compromise cardiac and neurologic function. Presentations of large tissue is of significant importance and requires urgent surgical evaluation and treatment. 51-year-old female presented with shortness of

BACKGROUND:Evaluation of patients with acute decompensated heart failure includes symptom review, biomarker measurement and comorbidity assessment. Early objective evaluation of functional status is generally not performed. AIM:To investigate whether a simple low-impact functional assessment and measurement of sarcopenia would be safe, feasible and predictive of hospital length of stay and all-cause 30-day hospital readmission. METHODS:We administered 3-minute bicycle ergometry and hand grip strength tests at admission and discharge to patients for whom a decision to admit for heart failure management was made in the emergency department. Associations were examined between test results and length of stay and 30-day readmission. Exclusion criteria included acute coronary syndrome, hypoxia, end-stage renal disease, dementia/delirium and inability to sit at bedside. The Kansas City Cardiomyopathy Questionnaire-12, the Patient Health Questionnaire-2 and the visual analogue scale for dyspnoea were administered at admission, the visual analogue scale at discharge and the Kansas City Cardiomyopathy Questionnaire-12 at 30 days. RESULTS:Fifty patients were enrolled: 58% were female; the mean age was 66.2±12.5 years; 24% had heart failure with preserved ejection fraction. Bicycle ergometry variables did not correlate with outcomes. Change in handgrip strength correlated with readmission, but not after adjustment (rpartial=0.14; P=0.35). Total diuretic dose correlated with length of stay; only discharge visual analogue scale and baseline lung disease had significant adjusted correlations with readmission. CONCLUSIONS:Functional assessment in the emergency department of patients admitted for heart failure did not predict outcomes. However, the prognostic value of these assessments for decision-making about disposition (admission or discharge) may still be warranted.

Congestive heart failure (CHF) rarely presents due to atrial myxomas. We present such a case with utilization of multiple echocardiographic imaging techniques prior to surgical resection. A 70 year-old with no significant past medical history presented to the hospital with several weeks of

We present a rare case of coronary steal syndrome secondary to formation of a left internal mammary artery - pulmonary artery (LIMA-PA) fistula after coronary artery bypass grafting (CABG). A 71 year-old presented to clinic with angina. Past medical history included ischemic cardiomyopathy status

A Survey of Unregulated Direct-to-Consumer Treatment Centers Providing Stem Cells for Patients With Heart Failure Stem cell therapy for the treatment of heart failure (HF) is under investigation but not approved by the US Food and Drug Administration (FDA).1 Nevertheless, through direct-toconsumer promotion, “stem cell centers” claim to offer this treatment to patients. We sought to assess the type of treatments, cost, and statements made about efficacy.

Introduction: Stem cell therapy for heart failure (HF) is under clinical investigation. Despite lack of FDA approval, stem cell centers (SCCs) in the U.S. are currently promoting this treatment for advanced HF. We obtained data about the procedures provided by these centers, including type, cost and clinical efficacy claims. Methods: Calls were made to SCCs listed in a published U.S. database. A structured script was used that included medical details of a standardized patient inquiring about: stem cell source, infusion method, need for medical records and follow-up, adjunctive therapy and pricing. When centers had multiple satellite locations, only one was contacted. Data were analyzed with standard descriptive statistics (mean ± standard deviation or median). Results: Of 39 unique SCCs advertising HF therapy in 2016, 4 did not respond to repeated calls, 4 did not offer therapy for advanced HF despite online advertisement and 1 required upfront payment for information, resulting in a final sample of 30. Half were located in 3 states (CA = 8, FL = 4, NY = 3). The number of procedures performed varied widely: 4 SCCs had no prior experience with HF, 5 claimed more than 100 procedures. Patient medical records or a cardiologist's note were required at 9 and 6 centers, respectively. Sources of stem cells were autologous in 25 (96% adipose-derived), allogeneic in 2 (umbilical, placental) and both in 3; infusions were intravenous in 29 and by coronary angiography in 1. Ancillary treatments (vitamin infusions and hyperbaric oxygen) were offered in 5. In-clinic follow-up was required at 2 centers. The mean price for a single autologous treatment was $7,694 ± $2,737; the corresponding price for allogeneic cells was $6,038 ± $3,145 (Table 1). Discounts were offered at 7 centers (median $4,000) for repeated treatments. Qualitative efficacy comments (not shown) were universally encouraging and positive. From the original sample of 39 centers, 79 affiliated physicians were identified: board certified in cardiology (n = 1) or another field (n = 55) and unverified board certification status (n = 13). Ten had no formal medical training (described as "naturopathic medical doctors"). Conclusions: Non-FDA approved procedures purported to provide stem cell treatment for HF are offered to patients at considerable financial cost and without rigorous pre-procedural evaluations or post-procedural follow-up. Most participating physicians are not board-certified in cardiology. This practice presents a potential risk to patients with significant implications for regulatory policy.Table 1Selected stem cell center characteristics and pricing.