Introduction Heart failure (HF) is a complex clinical syndrome. Accurate risk stratification and early diagnosis of HF are challenging as its signs and symptoms are non-specific. We propose to address this global challenge by developing the STRATIFYHF artificial intelligence-driven decision support system (DSS), which uses novel analytical methods in determining the risk, diagnosis and prognosis of HF. The primary aim of the present study is to collect prospective clinical data to validate the STRATIFYHF DSS (in terms of diagnostic accuracy, sensitivity and specificity) as a tool to predict the risk, diagnosis and progression of HF. The secondary outcomes are the demographic and clinical predictors of risk, diagnosis and progression of HF.Methods and analysis STRATIFYHF is a prospective, multicentre, longitudinal study that will recruit up to 1600 individuals (n=800 suspected/at risk of HF and n=800 diagnosed with HF) aged ≥45 years old, with up to 24 months of follow-up observations. Individuals suspected of HF will be divided into two categories based on current definitions and predefined inclusion criteria. All participants will have their medical history recorded, along with data on physical examination (signs and symptoms), blood tests including serum natriuretic peptides levels, ECG and echocardiogram results, as well as demographic, socioeconomic and lifestyle data, and use of complete novel technologies (cardiac output response to stress test and voice recognition biomarkers). All measurements will be recorded at baseline and at 12-month follow-up, with medical history and hospitalisation also recorded at 24-month follow-up. Cardiovascular MRI assessment will be completed in a subset of participants (n=20–40) from eligible clinical centres only at baseline. Each clinical centre will recruit a subset of participants (n=30) who will complete a 6-month home-based monitoring of clinical characteristics and accelerometry (wrist-worn monitor) to determine the feasibility and acceptability of the STRATIFYHF mobile application. Focus groups and semistructured interviews will be conducted with up to 15 healthcare professionals and up to 20 study participants (10 at risk of HF and 10 diagnosed with HF) to explore the needs of patients and healthcare professionals prior to the development of the STRATIFYHF DSS and to evaluate the acceptability of this mobile application.Ethics and dissemination Ethical approval has been granted by the East Midlands - Leicester Central Research Ethics Committee (24/EM/0101). Dissemination activities will include journal publications and presentations at conferences, as well as development of training materials and delivery of focused training on the STRATIFYHF DSS and mobile application. We will develop and propose policy guidelines for integration of the STRATIFYHF DSS and mobile application into the standard of care in the HF care pathway.Trial registration number NCT06377319.

Background: The benefit of prophylactic implantable cardioverter defibrillators (ICDs) in patients with severe systolic dysfunction of non-ischemic origin is still unclear, and the identification of patients at risk for sudden cardiac death remains a major challenge. Aims/Methods: We retrospectively reviewed all consecutive patients with non-ischemic dilated cardiomyopathy (NICM) who underwent prophylactic ICD implantation between 2008 and 2020 in two tertiary centers. Our main goal was to identify the predictors of appropriate ICD therapies (anti-tachycardia pacing [ATP] and/or shocks) in this cohort of patients. Results: A total of 224 patients were included. After a median follow-up of 51 months, 61 patients (27.2%) required appropriate ICD therapies. Patients with appropriate ICD therapies were more frequently men (87% vs. 69%, p = 0.006), of younger age (59 years, (53–65) vs. 64 years, (57–70); p = 0.02), showed more right bundle branch blocks (RBBBs) (15% vs. 4%, p = 0.007) and less left bundle branch blocks (LBBBs) (26% vs. 47%, p = 0.005) in the ECG, and had higher left ventricular end-diastolic (100 mL/m2, (90–117) vs. 86, (71–110); p = 0.011) and systolic volumes (72 mL/m2, (59–87) vs. 61, (47–81), p = 0.05). In a multivariate competing-risks regression analysis, RBBB (HR 2.26, CI 95% 1.02–4.98, p = 0.043) was identified as an independent predictor of appropriate ICD therapies. Conclusion: RBBBs may help to identify patients with NICM at high risk of ventricular arrhythmias and requiring ICD intervention.

HomeCirculation: Heart FailureVol. 17, No. 2TAVI With ACURATE neo2 Valve in Aortic Regurgitation Due to Left Ventricular Assist Device: A Custom-Made Option No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialNo AccessCase ReportRequest AccessFull TextTAVI With ACURATE neo2 Valve in Aortic Regurgitation Due to Left Ventricular Assist Device: A Custom-Made Option Ana Pardo Sanz, Luisa Salido Tahoces, Marta Jiménez-Blanco Bravo, Jesús Álvarez García, José Luis Zamorano Gómez and Ángel Sánchez Recalde Ana Pardo SanzAna Pardo Sanz Correspondence to: Ana Pardo Sanz, MD, PhD, Department of Cardiology, University Hospital Ramón y Cajal, Ctra. Colmenar Viejo Km 9.1, 28034 Madrid, Spain. Email E-mail Address: [email protected] https://orcid.org/0000-0002-6066-3872 Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain. , Luisa Salido TahocesLuisa Salido Tahoces Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain. , Marta Jiménez-Blanco BravoMarta Jiménez-Blanco Bravo Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain. , Jesús Álvarez GarcíaJesús Álvarez García Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain. , José Luis Zamorano GómezJosé Luis Zamorano Gómez Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain. and Ángel Sánchez RecaldeÁngel Sánchez Recalde Department of Cardiology, University Hospital Ramón y Cajal, Madrid, Spain. Originally published12 Jan 2024https://doi.org/10.1161/CIRCHEARTFAILURE.123.010719Circulation: Heart Failure. 2024;17FootnotesFor Sources of Funding and Disclosures, see page 183.Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCHEARTFAILURE.123.010719.Correspondence to: Ana Pardo Sanz, MD, PhD, Department of Cardiology, University Hospital Ramón y Cajal, Ctra. Colmenar Viejo Km 9.1, 28034 Madrid, Spain. Email anapardosanz0@gmail.comREFERENCES1. Truby LK, Garan AR, Givens RC, Wayda B, Takeda K, Yuzefpolskaya M, Colombo PC, Naka Y, Takayama H, Topkara VK. Aortic insufficiency during contemporary left ventricular assist device support: analysis of the INTERMACS registry.JACC Heart Fail. 2018; 6:951–960. doi: 10.1016/j.jchf.2018.07.012CrossrefMedlineGoogle Scholar2. Purita PAM, Tahoces LS, Fraccaro C, Nai Fovino L, Kim WK, Espada-Guerreiro C, De Backer O, Seiffert M, Nombela-Franco L, Gomez RM, et al. Transcatheter treatment of native aortic valve regurgitation: results from an international registry using the transfemoral ACURATE neo valve.Int J Cardiol Hear Vasc. 2020; 27:100480. doi: 10.1016/j.ijcha.2020.100480CrossrefMedlineGoogle Scholar3. Dimarakis I, Callan P, Khorsandi M, Pal JD, Bravo CA, Mahr C, Keenan JE. Pathophysiology and management of valvular disease in patients with destination left ventricular assist devices.Front Cardiovasc Med. 2022; 9:1029825. doi: 10.3389/fcvm.2022.1029825CrossrefMedlineGoogle Scholar4. Fried JA, Nazif TM, Colombo PC. A new frontier for TAVR: aortic insufficiency in CF-LVAD patients.J Heart Lung Transplant. 2019; 38:927–929. doi: 10.1016/j.healun.2019.06.024CrossrefMedlineGoogle Scholar5. Mondal S, Dawood M, Bandyopadhyay D, Taylor BS, Tanaka K, Gupta A. Transcatheter aortic valve replacement: a potential option for aortic insufficiency management in patients with left ventricular assist device.Int J Cardiol Hear Vasc. 2020; 26:100425. doi: 10.1016/j.ijcha.2019.100425CrossrefMedlineGoogle Scholar6. Zaidi SH, Minhas AMK, Sagheer S, ManeshGangwani K, Dani SS, Goel SS, Alam M, Sheikh AB, Hirji S, Wasty N. Clinical outcomes of transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) in patients with durable left ventricular assist device (LVAD).Curr Probl Cardiol. 2022; 47:101313. doi: 10.1016/j.cpcardiol.2022.101313CrossrefMedlineGoogle Scholar7. Rali AS, Taduru SS, Tran LE, Ranka S, Schlendorf KH, Barker CM, Shah AS, Lindenfeld J, Zalawadiya SK. Transcatheter aortic valve replacement and surgical aortic valve replacement outcomes in left ventricular assist device patients with aortic insufficiency.Card Fail Rev. 2022; 8:e30. doi: 10.15420/cfr.2022.21CrossrefMedlineGoogle Scholar8. Dhillon AS, Jones BM, Hodson RW, Korngold EC. Transcatheter aortic valve replacement for severe aortic regurgitation in patients with a left ventricular assist device.J Invasive Cardiol. 2022; 34:E369–E373.MedlineGoogle Scholar9. Phan K, Haswell JM, Xu J, Assem Y, Mick SL, Kapadia SR, Cheung A, Ling FS, Yan TD, Tchantchaleishvili V. Percutaneous transcatheter interventions for aortic insufficiency in continuous-flow left ventricular assist device patients: a systematic review and meta-analysis.ASAIO J. 2017; 63:117–122. doi: 10.1097/MAT.0000000000000447CrossrefMedlineGoogle Scholar10. Blanke P, Pibarot P, Hahn R, Weissman N, Kodali S, Thourani V, Parvataneni R, Dvir D, Naoum C, Nørgaard BL, et al. Computed tomography-based oversizing degrees and incidence of paravalvular regurgitation of a new generation transcatheter heart valve.JACC Cardiovasc Interv. 2017; 10:810–820. doi: 10.1016/j.jcin.2017.02.021CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails February 2024Vol 17, Issue 2 Advertisement Article InformationMetrics © 2024 American Heart Association, Inc.https://doi.org/10.1161/CIRCHEARTFAILURE.123.010719PMID: 38214151 Originally publishedJanuary 12, 2024 Keywordsaortic valvefeasibility studieshumansprosthesis failuretranscatheter aortic valve replacementPDF download Advertisement SubjectsAortic Valve Replacement/Transcatheter Aortic Valve ImplantationCatheter-Based Coronary and Valvular InterventionsHeart FailureValvular Heart Disease

BACKGROUND:Incomplete treatment of congestion often leads to worsening heart failure (HF). The remote dielectric sensing (ReDS) system is an electromagnetic energy-based technology that accurately quantifies changes in lung fluid concentration noninvasively. OBJECTIVES:This study sought to assess whether an ReDS-guided strategy during acutely decompensated HF hospitalization is superior to routine care for improving outcomes at 1 month postdischarge. METHODS:ReDS-SAFE HF (Use of ReDS for a SAFE discharge in patients with acute Heart Failure) was an investigator-initiated, multicenter, single-blind, randomized, proof-of-concept trial in which 100 patients were randomized to a routine care strategy, with discharge criteria based on current clinical practice, or an ReDS-guided decongestion strategy, with discharge criteria requiring an ReDS value of ≤35%. ReDS measurements were performed daily and at a 7-day follow-up visit, with patients and treating physicians in the routine care arm blinded to the results. The primary outcome was a composite of unplanned visits for HF, HF rehospitalization, or death at 1 month after discharge. RESULTS:The mean age was 67 ± 14 years, and 74% were male. On admission, left ventricular ejection fraction was 37% ± 16%, and B-type natriuretic peptide was 940 pg/L (Q1-Q3: 529-1,665 pg/L). The primary endpoint occurred in 10 (20%) patients in the routine care group and 1 (2%) in the ReDS-guided strategy group (log-rank P = 0.005). The ReDS-guided strategy group experienced a lower event rate, with an HR of 0.094 (95% CI: 0.012-0.731; P = 0.003), and a number of patients needed to treat of 6 to avoid an event (95% CI: 3-17), mainly resulting from a decrease in HF readmissions. The median length of stay was 2 days longer in the ReDS-guided group vs the routine care group (8 vs 6; P = 0.203). CONCLUSIONS:A ReDS-guided strategy to treat congestion improved 1-month prognosis postdischarge in this proof-of-concept study, mainly because of a decrease of the number of HF readmissions. (Use of ReDS for a SAFE discharge in patients with acute Heart Failure [ReDS-SAFE HF]; NCT04305717).

Introduction and objectives: Advanced interatrial block has been linked with atrial fibrillation (AF) (Bayes syndrome). On the other hand, the aetiology of the stroke remains unknown in approximately 20-25% of patients admitted due to ischaemic stroke. The aim of this study was to evaluate whether advanced interatrial block and CHADS2-VASC scale is linked to AF in patients admitted due to ischaemic stroke without previous AF history. Methods: A prospective analysis of consecutive in-hospital patients admitted with ischemic stroke between January/2018 and April/2019 in a stroke hospital was performed. Patients had to be in sinus rhythm at admission and without previous history of AF/atrial flutter. During follow up patients receive the usual care. Results: A total of 236 patients were included. The median follow-up was 540 days (407-695). 19 patients (8.1%) had advanced interatrial block at admission. Advanced interatrial block was associated with the diagnosis of AF during follow up (5 (26.3%) Vs 21 (9.7%) p = 0.027). A CHADS2-VASC score > 4 at admission was also associated with AF diagnosis during follow up (23(14.6%) vs 3(3.9%) p = 0.009). Conclusion: This study confirms the association of advanced interatrial block and CHADS2-VASC > 4 at admission with the diagnosis of AF during follow up in patients with ischemic stroke. This association could have important implications in patients with ischemic stroke who present advanced interatrial block and without previous history of AF. (c) 2021 Elsevier Espan tilde a, S.L.U. All rights reserved.

Background:Heart Failure (HF) is a growing epidemic with a similar prevalence in men and women. However, women have historically been underrepresented in clinical trials, leading to uneven evidence regarding the benefit of guideline-directed medical therapy (GDMT). This review aims to outline the sex differences in the efficacy of pharmacological and non-pharmacological treatment of HF with reduced ejection fraction (HFrEF). Methods and results:We conducted a systematic review via Medline from inception to 31 January 2022, including all randomized clinical trials published in English including adult patients suffering HFrEF that reported data on the efficacy of each drug. Baseline clinical characteristics, primary outcomes, and sex-specific effects are summarized in tables. The systemic review has been conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. In total, 29 articles were included in the systematic review. We observed that the proportion of women enrolled in clinical trials was generally low, the absence of a prespecified analysis of efficacy by sex was frequent, and the level of quality of evidence on the efficacy of GDMT and implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy (CRT-) in women was relatively poor. Conclusions:Sex influences the response to treatment of patients suffering from HFrEF. All the results from the landmark randomized clinical trials are based on study populations composed mainly of men. Further studies specifically designed considering sex differences are warranted to elucidate if GDMT and new devices are equally effective in both sexes.

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has emerged as a new threat, not only to Health Care systems but also to citizen’s freedom of movement in many developed countries. Case summary We report a suicidal attempt in a destination therapy left ventricular assist device patient, potentially triggered by coronavirus disease 2019 (COVID-19) lockdown, highlighting the importance of regular and long-term psychological support for this vulnerable population. Discussion The psychological consequences of this pandemic, particularly in chronically ill patients, are yet to be defined.

Abstract: Recent studies have proven benefit of SGLT2i drugs in patients with heart failure with reduced ejection fraction (HFrEF), but their safety when combined with angiotensin-neprilysin inhibitor (ARNI) has not been established. The Safety and Efficacy of the Combination of Sacubitril/Valsartan and SGLT2i in HFrEF Patients registry was conducted to address this issue. SECSI registry is a consecutive, observational, retrospective, multicentre study conducted in 3 Heart Failure Units in Spain. It included 144 HFrEF patients who were treated with ARNI and iSGLT2. Data were collected at baseline, month 2, and month 6. The primary endpoint was the estimated glomerular filtration rate (eGFR), after the initiation of ARNI and sodium-glucose cotransporter-2 inhibitors (SGLT2i). Secondary endpoints included potassium levels and functional class (New York Heart Association class). There were 3 prespecified subgroup analyses: Elderly patients (≥70 years), patients with chronic kidney disease (KDIGO classification G3), and the sequence of drug initiation. Mean age was 69.9 ± 10.1 years, and 110 (76.4%) were men. Left ventricular ejection fraction was 32 ± 7.8%, and most patients were symptomatic [123 (87.2%) New York Heart Association II/III/IV]. eGFR decreased at month 2 and this trend was maintained at month 6 [eGFR baseline 68.5 ± 17.3, month 2 62 ± 19.7 and month 6 64.7 ± 8.6 mL/min/1.73 m2 (P < 0.01 for both)]. In prespecified analysis, elder patients and those who simultaneously initiate both treatments showed the steeper decrease in eGFR. To conclude, co-administration of SGLT2i and ARNI in routine care in HFrEF patients produced a slight decrease in eGFR at 6 months of follow-up. This decrease was especially significant in elder patients and those who initiate both drugs simultaneously.

In this preliminary experience, ddcf-DNA level did not seem to correlate with CAV, although sample size might be too small to reach definite conclusions. We hope that the ongoing recruiting (n=100) will shed light in this matter.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a new threat to healthcare systems. In this setting, heart failure units have faced an enormous challenge: taking care of their patients while at the same time avoiding patients’ visits to the hospital. Objective: The aim of this study was to evaluate the results of a follow-up protocol established in an advanced heart failure unit at a single center in Spain during the coronavirus disease 2019 (COVID-19) pandemic. Methods: During March and April 2020, a protocolized approach was implemented in our unit to reduce the number of outpatient visits and hospital admissions throughout the maximum COVID-19 spread period. We compared emergency room (ER) visits, hospital admissions, and mortality with those of January and February 2020. Results: When compared to the preceding months, during the COVID pandemic there was a 56.5% reduction in the ER visits and a 46.9% reduction in hospital admissions, without an increase in mortality (9 patients died in both time periods). A total of 18 patients required a visit to the outpatient clinic for decompensation of heart failure or others. Conclusion: Our study suggests that implementing an active-surveillance protocol in acutely decompensated heart failure units during the SARS-CoV-2 pandemic can reduce hospital admissions, ER visits and, potentially, viral transmission, in a cohort of especially vulnerable patients.