AbstractAimsPatients with heart failure with preserved ejection fraction represent half of the heart failure patients nowadays, an at least steady trend due to the aging of the population. We investigated whether the parameters obtained from cardiopulmonary exercise testing (CPET) correlated with the prognosis of these patients. This prospective observational cohort study assesses the relationship between the CPET parameters peakVO2 and VE/VCO2 slope and the number of heart failure hospitalizations or cardiovascular death of these patients.Methods and resultsFrom August 2016 until May 2019, 99 patients from our outpatient unit with newly diagnosed heart failure with preserved ejection fraction underwent CPET. Median follow‐up was 30 months [interquartile range, 24–38.5]. We selected peakVO2 < 14 mL/min/kg and a VE/VCO2 slope > 34 as threshold values for our primary clinically relevant endpoint, a composite of hospitalization for heart failure or cardiovascular death. Mean age was 75.07 ± 7.31 years, 49% were women, 75% were at NYHA class II and median NTproBNP was 511 pg/mL. Mean peakVO2 was 15.09 ± 4.75, and mean VE/VCO2 was 36.05 ± 6.60. During follow‐up, there were 207 all‐cause hospitalizations, 126 cardiovascular hospitalizations, 58 heart failure hospitalizations and 4 deaths. Over a median follow‐up of 30 months, the primary clinically relevant endpoint occurred in 5 of 40 patients (12.5%) with a VE/VCO2 slope ≤ 34 and in 19 of 59 patients (32.2%) with a VE/VCO2 slope > 34 [hazard ratio, 2.69; 95% confidence interval (CI), 1.00–7.21; P = 0.04]. On multivariate analysis, VE/VCO2 slope was independently associated with heart failure hospitalization or cardiovascular death as a terminal event.ConclusionsIn patients with heart failure with preserved ejection fraction, a VE/VCO2 slope > 34 predicts heart failure hospitalizations and cardiovascular death.

Abstract Introduction Patients with heart failure with preserved ejection fraction represent half of the heart failure patients nowadays, an at least steady trend due to the aging of the population. We investigated whether the parameters obtained from cardiopulmonary exercise testing (CPET) correlated with the prognosis of these patients. This prospective observational cohort study looks into the relationship between the CPET parameters peak VO2 and VE/VCO2 slope and the heart failure hospitalizations or cardiovascular death of these patients. Methods From August 2016 until May 2019, 99 patients of our outpatient clinic with newly diagnosed with heart failure with preserved ejection fraction underwent cardiopulmonary exercise testing. Median follow-up was 30 months (interquartile range, 24-38.5). We selected peak VO2 <14 ml/min/kg and a VE/VCO2 slope > 34 as threshold values for our primary endpoint, a composite of hospitalization for heart failure or cardiovascular death. Results The mean age was 75.07 ± 7.31 years, 48.5% were women, 24.2% were at NYHA class III and mean NTproBNP was 511 pg/mL. Mean peakVO2 was 15.09 ± 4.75 and mean VE/VCO2 was 36.05 ± 6.60. During follow-up, they were 67 hospitalizations, 53 cardiovascular hospitalizations, 24 heart failure hospitalizations and 4 deaths. Over a median follow-up of 30 months, the primary outcome event occurred in 5 of 40 patients (12.5%) with a VE/VCO2 Slope ≤ 34 and in 19 of 59 patients (32.2%) with a VE/VCO2 Slope > 34 (hazard ratio, 2.688; 95% confidence interval (CI); P 0.04). On multivariate analysis, accounting for heart failure hospitalization or cardiovascular death as a terminal event, VE/VCO2 slope was independently associated with the risk of admission due to heart failure worsening. Conclusion In patients with heart failure with preserved ejection fraction, a VE/VCO2 Slope > 34 predicts heart failure hospitalizations and cardiovascular death.Primary Endpoint

The possible treatment strategies for defects of the pace-sense (P/S) part of a defibrillation lead are either implantation of a new high-voltage (HV)-P/S lead, with or without extraction of the malfunctioning lead, or implantation of a P/S lead.

Background The possible treatment strategies for defects of the pace-sense (P/S) part of a defibrillation lead are either implantation of a new high-voltage (HV)-P/S lead, with or without extraction of the malfunctioning lead, or implantation of a P/S lead. Methods We conducted a Web-based survey across cardiac implantable electronic device (CIED) centers to investigate their procedural practice and decision-making process in cases of failure of the P/S portion of defibrillation leads. In particular, we focused on the question of whether the integrity of the HV circuit is confirmed by a test shock before decision-making. The questionnaire included 14 questions and was sent to 951 German, 341 Austrian, and 120 Swiss centers. Results The survey was completed by 183 of the 1412 centers surveyed (12.7% response rate). Most centers (90.2%) do not conduct a test shock to confirm the integrity of the HV circuit before decision-making. Procedural practice in lead management varies depending on the presentation of lead failure and whether the center applies a test shock. In centers that do not conduct a test shock, the majority (69.9%) implant a new HV-P/S lead. Most centers (61.7%) that test the integrity of the HV system implant a P/S lead. The majority of centers favor DF-4 connectors (74.1%) over DF-1 connectors (25.9%) at first CIED implantation. Conclusion Either implanting a new HV-P/S lead or placing an additional P/S lead are selected strategies if the implantable cardioverter-defibrillator lead failure is localized to the P/S portion. However, conducting a test shock to confirm the integrity of the HV component is rarely performed.

Background: Heart failure with preserved ejection fraction (HFpEF) is increasingly common and well recognized as a major health burden in the Western world. The underlying cellular mechanisms remain hardly explored and solid treatment opportunities as well as tools for risk prediction are desperately needed. Small studies suggested that circulating miRNAs are also potential biomarkers for HFpEF. Therefore, we investigated 14 selected miRNAs regarding their potential to add prognostic information in patients with HFpEF.

Background: Current guidelines recommend implantable cardioverter defibrillator (ICD) to prevent sudden cardiac death (SCD) in heart failure (HF) patients (pts).The DANISH trial challenges guidelines, because no significant effect of ICDs on long-term mortality was seen among pts with non ischemic cardiomyopathy.In previous studies 123-iodine metaiodobenzylguanidine imaging (123-I MIBG) identified HF pts at high risk of SCD, who may benefit of ICD, independently from left ventricular ejection fraction (LVEF).[Heart/mediastinum (H/M) ratio ≤1.6 and a summed score (SS) >26].Purpose: The aim of our study is to evaluate the role of 123-I MIBG to predict malignant ventricular arrhythmias (VA) causing appropriate ICD therapy in pts with non ischemic cardiomyopathy.Methods: We enrolled 146 patients consecutively admitted to our hospital with diagnosis non ischemic HF (LVEF ≤35%, NYHA class II and III) who underwent 123-I MIBG imaging.Summed score of 26 was used as cut-off to identify low risk (Group A) versus high risk pts (Group B).All pts underwent to ICD implantation.Results: 98 pts (62.87±13.19years old; male 83.67%) were included in Group A and 48 pts (age 63.21±13.54years old; male 83.33%) in Group B. Pts of two groups were comparable in term of LVEF.After a median follow up of 36 months, the incidence of VA were significantly higher in Group B compared to Group A (31.25% vs 16.00%; p=0.03).No difference of mortality rate was observed in the two groups (Table 1).