ObjectivesPulmonary arterial hypertension (PAH) is a rare, progressive condition associated with high morbidity and healthcare resource utilization. This study aimed to estimate the annual direct and indirect costs of PAH in Switzerland, from a societal perspective.Materials and methodsA cross-sectional cost-of-illness study was conducted across six Swiss PAH centres between April and December 2024. Adult patients with confirmed PAH (World Health Organization [WHO] Group 1) were invited to complete a standardized questionnaire on work productivity losses, informal care, and healthcare utilization outside the enrolling centre. Clinical data on hospitalizations, outpatient visits, diagnostics, and treatments at the enrolling centre were extracted from medical records. Disease-specific costs were calculated by multiplying resource use and work losses by Swiss-specific unit costs and extrapolated to one year. Estimates were stratified by WHO functional class (WHO-FC) and ESC/ERS 2022 risk strata.ResultsAmong 124 participants aged between 18 and 89 years, the mean disease-specific total annual cost per patient was €138,958. Direct healthcare costs represented 78.5% of this amount (€109,114), driven primarily by pharmacological treatment (65% of total costs). Indirect costs amounted to 21.5% (€29,844). Costs increased with disease severity, ranging from €81,957 in WHO-FC 1 to €166,569 in WHO-FC 4, and from €130,970 in ESC/ERS low risk to €291,728 in ESC/ERS high risk. The total national burden was estimated at €48.5 million annually.ConclusionsPAH imposes a substantial economic burden in Switzerland, largely due to treatment costs and productivity losses. These findings highlight the need for strategies to reduce disease progression and associated societal costs.

Whether longer cold ischemic time (CIT) increases early hemodynamic support after heart transplantation (HTx) with histidine-tryptophan-ketoglutarate (HTK) preservation is unclear. We examined the association between CIT and the vasoactive-inotropic score (VIS), a marker of circulatory support. We studied consecutive adults transplanted with HTK-preserved grafts at Lausanne University Hospital (January 2016-March 2025). VIS was calculated hourly for 48 h after ICU admission, and its association with CIT modeled using restricted cubic splines. Among 130 recipients (75% male, aged 52±12 years), mean CIT was 152±50 min. Longer CIT was associated with higher 24-hour VIS (Poverall=0.048), rising steeply beyond ≈200 min. Patients with CIT ≥200 min (n=14) had higher VIS (difference at 48 h 10.2 points, p=0.024), more post-transplant ECMO (43% vs 9%, p<0.001), and longer ICU stay (11.0 vs 6.1 days, p=0.014). The CIT-VIS relationship was non-linear, supporting CIT as a potentially modifiable determinant of early hemodynamic status after HTx.

Abstract Background Extracorporeal cardiopulmonary resuscitation (ECPR) can improve survival in patients with refractory cardiac arrest (CA). However, defining optimal selection criteria for ECPR remains a major challenge. Methods We retrospectively analyzed all ECPR treatments for refractory in-hospital CA (IHCA) and out-of-hospital CA (OHCA) in adult patients from January 1, 2010 through December 31, 2024 at our tertiary 35-bed Intensive Care Unit. Before July 2017 (Period 1), ECPR was implemented at physician discretion. From July 2017 (Period 2), a dedicated protocol recommended physicians to implement ECPR based on four criteria: age < 70 years, shockable rhythm, no-flow duration < 5 min, and total low-flow duration < 80 min. The primary outcome was hospital mortality. The secondary outcome was good neurological outcome at 3 months, defined by a cerebral performance category (CPC) score of 1 or 2. Results A total of 166 patients (45 in period 1, 121 in period 2), including 80 IHCAs and 86 OHCAs, were included. The proportion of patients fulfilling the 4 criteria was low yet significantly greater in period 2 than in period 1 (35.0 vs. 17.8%, p = 0.027). Hospital survival was improved in period 2 (26.5% vs. 8.9%, p = 0.015), whereas good neurological outcome was not (14.9 vs. 6.7%, p = 0.157). When evaluating the impact of the 4 criteria over the whole study period, patients with 4 criteria vs. those with < 4 criteria displayed marked improvements in survival (48.0 vs. 9.6%, p < 0.001) and good neurological outcome (30.0 vs. 5.2%, p < 0.001). In multivariable analysis, only the simultaneous presence of the 4 criteria was independently associated with a decreased risk of death (OR = 0.11, 95% CI 0.01–0.87, p = 0.037), whereas no single criterion alone was significantly predictive. Conclusion Implementing a clinical ECPR protocol in our institutional practice improved meaningful survival in patients with refractory IHCA and OHCA fulfilling four predefined criteria including an age < 70 years, a shockable rhythm, a no-flow < 5 min, and a low-flow < 80 min.

Developed to treat type 2 diabetes, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been associated with a reduced risk of cardiovascular events in high-risk patients with diabetes, and later in obese patients with cardiovascular disease without diabetes. More recently, semaglutide and tirzepatide have demonstrated benefits in obese patients with heart failure (HF) with preserved or mildly reduced ejection fraction, including fewer HF hospitalisations and improvements in symptoms and functional capacity. Data remain limited in heart failure with reduced ejection fraction. This article summarises current evidence on these therapies, particularly in HF, and provides practical guidance for their prescription and follow-up.

BACKGROUND:Anomalous origin of the left pulmonary artery from the aorta, also named hemitruncus arteriosus, is a rare congenital heart disease associated with high mortality. Patients are usually operated on in the first months of life to avoid irreversible damage caused by pulmonary arterial hypertension. CASE SUMMARY:The authors present a challenging case of an athletic male patient with an anomalous left pulmonary artery originating from the descending aorta that was diagnosed when he was aged 27 years, with severe segmental pulmonary arterial hypertension in the left lung. Following multidisciplinary team meetings, conservative management was chosen. DISCUSSION:Multimodality imaging plays a key role in both diagnosing and managing this birth defect and its potential complications. TAKE-HOME MESSAGE:Management of this extremely rare congenital anomaly in the adult is yet to be fully understood and requires a multidisciplinary team in a tertiary center.

OBJECTIVES:Chronic thromboembolic pulmonary hypertension is a rare disease, characterized by delays in diagnosis and curative surgical treatment. After establishing a surgical pulmonary endarterectomy centre in Switzerland and due to a historically low resection rate of 14%, a national multidisciplinary evaluation board was established in January 2018. Herein, we summarize the impact of the board on our programme. METHODS:Patients discussed in the national chronic thromboembolic pulmonary hypertension board from January 2018 to December 2023 were included. Clinical characteristics, treatment allocation and survival were compared between patients undergoing surgery, patients refusing surgery and non-operable patients. Fisher's exact test or three-way ANOVA and Kaplan-Meier analyses were used. RESULTS:188 patients were discussed at our national chronic thromboembolic pulmonary hypertension board; 131 (70%) presented with operable disease, 77 (41%) were referred for pulmonary endarterectomy and 34 (18%) of operable patients declined surgery. There is a significant difference in survival between these groups (P = 0.048). One- and 2-year survival in the subgroup undergoing pulmonary endarterectomy was 97% and 79%, respectively, while 1- and 2-year survival in the subgroup refusing pulmonary endarterectomy was 91% and 76%, respectively. The pulmonary endarterectomy rate has increased from a historical low of 14-41% since establishing the board. CONCLUSIONS:Establishing an interdisciplinary board is essential to address diagnostic and management challenges in chronic thromboembolic pulmonary hypertension patients. The Swiss national chronic thromboembolic pulmonary hypertension board played an important role in substantially increasing the rate of curative surgery.

This article explores the relationship between mitral regurgitation and heart failure, a dangerous combination with serious consequences. It reviews the pathophysiological mechanisms and current therapeutic options, ranging from medical treatments to percutaneous approaches, surgical interventions, and advanced modalities such as ventricular assist devices or heart transplantation. Recent studies exploring strategies to break this vicious cycle and improve patient outcomes are also reviewed.

Background The prognostic significance of cardiovascular‐kidney‐metabolic (CKM) multimorbidity in acute heart failure (AHF) remains unclear. We evaluated its association with clinical outcomes in a real‐world, multinational cohort of patients with AHF. Methods We included patients with AHF hospitalized from 2005 to 2020 at 2 tertiary care centers in Switzerland and Kyrgyzstan. Patients were categorized based on the number of CKM conditions in addition to HF (0–3). CKM conditions included prior myocardial infarction, impaired kidney function (estimated glomerular filtration rate <60 mL/min/m2), and diabetes. The association between the number of CKM conditions and the primary outcome of HF hospitalization or all‐cause death was assessed with Cox models. Results Among 1745 patients (69% Swiss, 44% female, age 74±13 years, left ventricular ejection fraction 43±16%), at baseline, 18.9% had HF alone, 39.0% had 1 CKM condition, 30.7% had 2, 11.4% had 3. Impaired kidney function was the most prevalent CKM condition (n=1011), followed by prior myocardial infarction (n=742) and diabetes (n=595). At 1 year, 731 patients (41.9%) experienced the primary outcome. Compared with HF alone, an increasing number of CKM conditions was associated with stepwise increases in the risk of the primary outcome (adjusted hazard ratios [HRs], 1.27 [95% CI, 1.01–1.59], 1.50 [95% CI, 1.19–1.89], and 2.10 [95% CI, 1.59–2.77] for 1, 2, and 3 CKM conditions). These associations remained consistent regardless of sex, age, and left ventricular ejection fraction (Pinteraction>0.05 for all). Conclusions In this real‐world cohort of hospitalized patients with AHF, CKM multimorbidity was common and associated with a stepwise increase in the risk of adverse outcomes. These data underscore the importance of comprehensive CKM assessment in an AHF setting.

Continuous-flow left ventricular assist devices (CF-LVADs) improve quality of life and survival in patients with advanced heart failure but are frequently complicated by gastrointestinal bleeding (GIB). Reduced pulsatile flow may induce mucosal hypoxia, upregulating factors such as hypoxia-inducible factor (HIF)-1α and triggering neo-angiogenesis, leading to the development of gastrointestinal angiodysplasias (GIADs), a common cause of GIB. Digoxin inhibits HIF-1α and may prevent GIAD development, although its impact on the incidence of GIB remains uncertain. This meta-analysis (PROSPERO ID: CRD42024626222) evaluated the association between digoxin use and GIB occurrence (primary outcome) in patients with CF-LVADs. Research articles including adults with CF-LVADs, comparing digoxin users versus nonusers were included. Overall, four studies were included (n = 14,917; age 55 ± 13 years, 21% female) with 2,742 patients in the digoxin group and 12,175 in the no-digoxin group. Continuous-flow left ventricular assist device was axial (HeartMate II) in 78% of cases and centrifugal (HeartMate 3/HeartWare) in 22%. Digoxin use was associated with a nonsignificant lower risk of GIB (hazard ratio [HR]: 0.70; 95% confidence interval [CI]: 0.49-1.01). However, regarding GIAD-related GIB, digoxin was associated with a significantly lower risk (HR: 0.33; 95% CI: 0.13-0.82). Among 14,917 patients with CF-LVADs, digoxin use was associated with a trend toward a lower risk of GIB and a lower risk of GIAD-related GIB.

The year 2023 has been extremely rich in new publications in the various subfields of cardiology. Furthermore, the European Society of Cardiology (ESC) has issued revised guidelines focused on the management of acute coronary syndrome (ACS) and endocarditis, as well as an update on the recommendations for the management of heart failure and cardiovascular prevention. The most significant updates according to the Cardiology Department of CHUV are summarized in this review article.

HomeCirculation: Heart FailureAhead of PrintAtrial Septal Defect, Pulmonary Arterial Hypertension, and Diastolic Left Heart Failure: When 3 Players Come into the Game No AccessCase ReportRequest AccessAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialNo AccessCase ReportRequest AccessAtrial Septal Defect, Pulmonary Arterial Hypertension, and Diastolic Left Heart Failure: When 3 Players Come into the Game Tobias Rutz, John-David Aubert, Maurice Beghetti, Eric Eeckhout, Olivier Muller, Judith Bouchardy and Patrick Yerly Tobias RutzTobias Rutz Correspondence to: Tobias Rutz, MD, Service of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland. Email E-mail Address: [email protected] https://orcid.org/0000-0001-5899-291X Service of Cardiology, Lausanne University Hospital and University of Lausanne, Switzerland. (T.R., E.E., O.M., J.B., P.Y.) , John-David AubertJohn-David Aubert https://orcid.org/0000-0001-8856-4000 Division of Pulmonology, Lausanne University Hospital and University of Lausanne, Switzerland. (J.-D.A.) , Maurice BeghettiMaurice Beghetti https://orcid.org/0000-0002-1841-0927 Pediatric Cardiology Unit and Centre Universitaire Romand de Cardiologie et Chirurgie Cardiaque Pédiatrique, Children's University Hospitals, Lausanne and Geneva, Switzerland (M.B.). , Eric EeckhoutEric Eeckhout Service of Cardiology, Lausanne University Hospital and University of Lausanne, Switzerland. (T.R., E.E., O.M., J.B., P.Y.) , Olivier MullerOlivier Muller https://orcid.org/0000-0003-2441-5799 Service of Cardiology, Lausanne University Hospital and University of Lausanne, Switzerland. (T.R., E.E., O.M., J.B., P.Y.) , Judith BouchardyJudith Bouchardy https://orcid.org/0000-0003-0149-288X Service of Cardiology, Lausanne University Hospital and University of Lausanne, Switzerland. (T.R., E.E., O.M., J.B., P.Y.) and Patrick YerlyPatrick Yerly https://orcid.org/0000-0001-8163-722X Service of Cardiology, Lausanne University Hospital and University of Lausanne, Switzerland. (T.R., E.E., O.M., J.B., P.Y.) Originally published21 Mar 2024https://doi.org/10.1161/CIRCHEARTFAILURE.123.010545Circulation: Heart Failure. 2024;0:e010545FootnotesFor Sources of Funding and Disclosures, see page xxx.Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCHEARTFAILURE.123.010545.Correspondence to: Tobias Rutz, MD, Service of Cardiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland. Email tobias.rutz@chuv.ch Previous Back to top Next FiguresReferencesRelatedDetails Advertisement Article InformationMetrics © 2024 American Heart Association, Inc.https://doi.org/10.1161/CIRCHEARTFAILURE.123.010545PMID: 38511310 Originally publishedMarch 21, 2024 Keywordsatrial septal defectcongenital heart diseasediastolic heart failureheart failure with preserved ejection fractionpulmonary arterial hypertensionrenin-angiotensin-systemPDF download Advertisement SubjectsCongenital Heart DiseaseHeart Failure

Post-pulmonary embolism syndrome is defined as exertional dyspnea or exercise intolerance after an acute pulmonary embolism treated with 3 months of anticoagulation. There are several etiologies including for example chronic thromboembolic pulmonary disease. A specialized work-up including echocardiography and pulmonary scintigraphy should be performed. A probability of chronic thromboembolic pulmonary hypertension is extrapolated so that invasive investigations can be performed if necessary. Identification of this pathology is decisive for specific management. Even without pulmonary hypertension, up to 20 % of patients after pulmonary embolism remain symptomatic with exertional dyspnea. Specific management for these patients needs to be defined.

The year 2023 has been extremely rich in new publications in the various subfields of cardiology. Furthermore, the European Society of Cardiology (ESC) has issued revised guidelines focused on the management of acute coronary syndrome (ACS) and endocarditis, as well as an update on the recommendations for the management of heart failure and cardiovascular prevention. The most significant updates according to the Cardiology Department of CHUV are summarized in this review article.

OBJECTIVES The choice of the cardiac preservation solution for myocardial protection at time of heart procurement remains controversial and uncertainties persist regarding its effect on the early and midterm heart transplantation (HTx) outcomes. We retrospectively compared our adult HTx performed with 2 different solutions, in terms of hospital mortality, mid-term survival, inotropic score, primary graft dysfunction and rejection score. METHODS From January 2009 to December 2020, 154 consecutive HTx of adult patients, followed up in pre- and post-transplantation by 2 different tertiary centres, were performed at the University Hospital of Lausanne, Switzerland. From 2009 to 2015, the cardiac preservation solution used was exclusively St-Thomas, whereafter an institutional decision was made to use HTK-Custodiol only. Patients were classified in 2 groups accordingly. RESULTS There were 75 patients in the St-Thomas group and 79 patients in the HTK-Custodiol group. The 2 groups were comparable in terms of preoperative and intraoperative characteristics. Postoperatively, compared to the St-Thomas group, the Custodiol group patients showed significantly lower inotropic scores [median (interquartile range): 35.7 (17.5-60.2) vs 71.8 (31.8-127), P < 0.001], rejection scores [0.08 (0.0-0.25) vs 0.14 (0.05-0.5), P = 0.036] and 30-day mortality rate (2.5% vs 14.7%, P = 0.007) even after adjusting for potential confounders. Microscopic analysis of the endomyocardial biopsies also showed less specific histological features of subendothelial ischaemia (3.8% vs 17.3%, P = 0.006). There was no difference in primary graft dysfunction requiring postoperative extracorporeal membrane oxygenation. The use of HTK-Custodiol solution significantly improved midterm survival (Custodiol versus St-Thomas: hazard ratio = 0.20, 95% confidence interval: 0.069-0.60, P = 0.004). CONCLUSIONS This retrospective study comparing St-Thomas solution and HTK-Custodiol as myocardial protection during heart procurement showed that Custodiol improves outcomes after HTx, including postoperative inotropic score, rejection score, 30-day mortality and midterm survival.

The Atrial Flow Regulator (AFR) is an innovative technology to treat patients with symptomatic heart failure (HF) and increased left atrial pressure, particularly HF with preserved ejection fraction (HFpEF). This device is percutaneously implanted in the interatrial septum to create a left-to-right shunt that may either reduce the abnormal pressure rise occurring initially during exercise in the left atrium (LA) in HFpEF or keep elevated LA pressure lower at rest in more advanced cases (1). This treatment is still under study and is not yet a part of therapeutic recommendations for heart failure.

INTRODUCTION: Real-world outcomes with the HeartMate 3 left ventricular assist device (LVAD) depending on whether it’s a bridge to transplantation (BTT) or destination therapy (DT) are poorly studied. We aimed to compare the profile and clinical outcomes of patients supported with HeartMate 3 according to a BTT or a DT pre-implantation strategy. METHODS: All patients consecutively implanted with HeartMate 3 at our centre (University Hospital of Lausanne, Switzerland) in 2015–2022 were analysed in a retrospective observational study. Indications for HeartMate 3 implantation were advanced heart failure despite optimal medical treatment. Patients were treated with a vitamin K antagonist anticoagulant combined with antiplatelet therapy after HeartMate 3 implantation and were followed up monthly at our institution. RESULTS: Among 71 patients implanted with HeartMate 3 between 2015 and 2022, 51 (71.8%) were implanted as a BTT and 20 (28.2%) as DT. Their median age was 58 (IQR: 52–69) years and 84% of patients were classified as INTERMACS profiles 2–4. The median follow-up duration was 18.3 (IQR: 7.5–33.9) months. Patients in the DT group were older than those in the BTT group (p <0.001) and had more chronic renal failure (p <0.001). They also had a lower 5-year survival rate (mean ± standard error: 87.3 ± 5.6% vs 49.4 ± 15.1%) and more adverse events such as renal dysfunction requiring temporary perioperative dialysis (p = 0.08) or bleeding (p = 0.06). CONCLUSION: Although patients supported with HeartMate 3 have favourable survival, those with LVAD-DT have poorer outcomes. There is a need to better select patients eligible for LVAD-DT in order to limit the burden of adverse events and improve their prognosis.