Objective: Epidemiological data indicate a high prevalence of cognitive dysfunction and dementia risk in patients with heart failure with preserved ejection fraction (HFpEF). However, underlying mechanisms are yet not fully understood. Common risk factors for HFpEF and cognitive decline are hypertension and arterial stiffness, which are characterized by structural and functional vascular changes causing microvascular dysfunction and end organ damages. We hypothesize that the effect of arterial stiffness on cognition in patients with HFpEF is mediated by microvascular brain disease (cerebral small vessel disease, CSVD). Design and method: In this prospective cohort study we included 14 HFpEF patients (age: 66.6 ± 10.0 years) and 11 cognitively normal, healthy controls (age: 69.4 ± 9.4), who underwent comprehensive cardiovascular assessment. Arterial stiffness was assessed with pulse wave velocity measurements. The CERAD-plus neuropsychological test battery was used to estimate cognitive decline. CSVD severity (summary SVD score) was quantified in accordance with the STandards for ReportIng Vascular changes on nEuroimaging criteria (STRIVE) using 3-Tesla brain magnetic resonance imaging. Results: Results: Patients with HFpEF showed increased arterial stiffness [F(1,20) = 7.33, p = .014], impaired cognition [F(1,20) = 33.34, p <.001), and higher CSVD burden [F(1,23) = 32.39, p <.001] in comparison to healthy, age-matched controls, whereas arterial stiffness correlated with cognitive dysfunction (r = -.44, p = .046) and summary SVD scores (r = .71, p = .0002). Moreover, summary SVD scores fully mediated the relationship of arterial stiffness and cognition (Figure 1). Conclusions: We showed that CSVD mediates the effect of arterial stiffness on cognition in patients with HFpEF. Our study demonstrated the fundamental role of cardiovascular factors in the development of cognitive decline, and the urgent need for interdisciplinary heart-brain research investigating the interrelationship of heart and brain diseases. Figure 1: Mediation Analysis. CSVD burden (summary SVD scores) fully mediated the relation between arterial stiffness (pulse wave velocity) and cognitive decline (assessed with CERAD-plus). Age was included as covariate into the model. Significant paths are marked with ∗∗/∗∗∗ for p < .01/.001.

Abstract Aims Failure of right ventricular (RV) function worsens outcome in pulmonary hypertension (PH). The adaptation of RV contractility to afterload, the RV‐pulmonary artery (PA) coupling, is defined by the ratio of RV end‐systolic to PA elastances (Ees/Ea). Using pressure–volume loop (PV‐L) technique we aimed to identify an Ees/Ea cut‐off predictive for overall survival and to assess hemodynamic and morphologic conditions for adapted RV function in secondary PH due to heart failure with reduced ejection fraction (HFREF). Methods and results This post hoc analysis is based on 112 patients of the prospective Magdeburger Resynchronization Responder Trial. All patients underwent right and left heart echocardiography and a baseline PV‐L and RV catheter measurement. A subgroup of patients (n = 50) without a pre‐implanted cardiac device underwent magnetic resonance imaging at baseline. The analysis revealed that 0.68 is an optimal Ees/Ea cut‐off (area under the curve: 0.697, P < 0.001) predictive for overall survival (median follow up = 4.7 years, Ees/Ea ≥ 0.68 vs. <0.68, log‐rank 8.9, P = 0.003). In patients with PH (n = 76, 68%) multivariate Cox regression demonstrated the independent prognostic value of RV‐Ees/Ea in PH patients (hazard ratio 0.2, P < 0.038). Patients without PH (n = 36, 32%) and those with PH but RV‐Ees/Ea ≥ 0.68 showed comparable RV‐Ees/Ea ratios (0.88 vs. 0.9, P = 0.39), RV size/function, and survival. In contrast, secondary PH with RV‐PA coupling ratio Ees/Ea < 0.68 corresponded extremely close to cut‐off values that define RV dilatation/remodelling (RV end‐diastolic volume >160 mL, RV‐mass/volume‐ratio ≤0.37 g/mL) and dysfunction (right ventricular ejection fraction <38%, tricuspid annular plane systolic excursion <16 mm, fractional area change <42%, and stroke‐volume/end‐systolic volume ratio <0.59) and is associated with a dramatically increased short and medium‐term all‐cause mortality. Independent predictors of prognostically unfavourable RV‐PA coupling (Ees/Ea < 0.68) in secondary PH were a pre‐existent dilated RV [end‐diastolic volume >171 mL, odds ratio (OR) 0.96, P = 0.021], high pulsatile load (PA compliance <2.3 mL/mmHg, OR 8.6, P = 0.003), and advanced systolic left heart failure (left ventricular ejection fraction <30%, OR 1.23, P = 0.028). Conclusions The RV‐PA coupling ratio Ees/Ea predicts overall survival in PH due to HFREF and is mainly affected by pulsatile load, RV remodelling, and left ventricular dysfunction. Prognostically favourable coupling (RV‐Ees/Ea ≥ 0.68) in PH was associated with preserved RV size/function and mid‐term survival, comparable with HFREF without PH.

Aims The aim of this study was to validate the tricuspid annular plane systolic excursion/systolic pulmonary artery (PA) pressure (TAPSE/PASP) ratio with the invasive pressure-volume (PV) loop-derived end-systolic right ventricular (RV) elastance/PA elastance (Ees/Ea) ratio in patients with heart failure with reduced ejection fraction (HFREF) and secondary pulmonary hypertension (PH). Methods and results The relationship of TAPSE and TAPSE/PASP with RV-PV loop (single-beat)-derived contractility Ees, afterload Ea, and Ees/Ea was assessed in 110 patients with HFREF with and without secondary PH. The results were compared with other surrogate parameters such as the fractional area change/PASP ratio. The association of the surrogates with all-cause mortality was evaluated. In patients with PH (n=74, 67%), TAPSE significantly correlated with Ees (r = 0.356), inverse with Ea (r = -0.514) but was most closely associated with Ees/Ea (r = 0.77). Placing TAPSE in a ratio with PASP slightly reduced the relationship to Ees/Ea (r = 0.71) but was more closely related to the parameters of PA vascular Load, diastolic RV function, and RV energetics. The area under the curve of TAPSE/PASP and TAPSE for discriminating overall survival in receiver operating characteristic analysis was not different (P = 0.78. Prognostic relevant cut-offs were 17mm for TAPSE and 0.38 mmimmHg for TAPSE/PASP. Both parameters in multivariate cox regression remained independently prognostically relevant. Conclusion TAPSE is an easily and reliably obtainable and valid surrogate parameter for RV-PA coupling in PH due to HFREF. Putting TAPSE into a ratio with PASP did not further improve the coupling information or prognostic assessment.

Ultrasound compounding techniques offer the possibility to enlarge the otherwise limited field of view of ultrasound. However, existing works mainly rely on larger ultrasound sensors. In this work, we attach electromagnetic (EM) tracking sensors to small tubular echo probes, namely an intracardiac echocardiographic (ICE) probe and a transesophageal echocardiographic (TEE) transducer. The EM tracking allows, when synchronized to the ultrasound, localization of the probes in either 5 DOF (Degrees of Freedom) or 6 DOF without line-of-sight requirement. For computation of the references between the two systems, we developed a novel customized 3D-printable phantom, which is especially convenient for tubular probes that acquire images laterally. Calibration with the phantom and 3D volume reconstruction was conducted in the Plus Toolkit. The volume reconstructor uses the captured position and orientation information to fuse 2D ultrasound slices into a compounded volume. Mean calibration error is below 2.5 mm for ICE and TEE. An accuracy evaluation of the 3D reconstruction using an object of known geometry revealed that tracking with 5 DOF provides unsatisfactory results, while the combination of 6 DOF and TEE achieved a mean absolute difference of 3.08 mm. Our calibration phantom fCal-Echo1.0 is openly available at http://perk-software.cs.queensu.ca/plus/doc/nightly/modelcatalog/.

Mehr als 10 % aller onkologischen Patienten entwickeln Metastasen des Herzens. Primäre Neubildungen des Herzens sind hingegen deutlich seltener. Die Häufigkeit liegt laut Autopsiestudien bei 0,02 %. Der Großteil primärer Neoplasien ist benigner Genese. Myxome sind mit 50–70 % die häufigsten gutartigen Raumforderungen. Nur 25 % der kardialen Tumoren sind maligne. Ihr Ursprung liegt häufig im rechten Vorhof, sie können jedoch ubiquitär in jeder Herzhöhle vorkommen. Angiosarkome stellen mit 30 % die häufigste Form maligner Neubildungen des Herzens dar. Das klinische Bild ist jedoch unspezifisch und stark abhängig von der jeweiligen Lokalisation und Infiltration (Hoffmeier A et al. Dtsch Arztebl Int 2014; 111: 205–211). Angiosarkome imponieren im CT in Bezug auf das umgebende Myokard als eine hypodense Raumforderung und können bei Kontrastmittelgabe in Abhängigkeit von der jeweiligen Kontrastmittelphase ein moderates Enhancement zeigen. Das ist bei intrakavitärem Wachstum das Hauptunterscheidungsmerkmal bei der Differenzialdiagnose zum Thrombus (Krombach GA et al. RöFo 2005; 177: 1205–1218).

Background: Right ventricular (RV) dysfunction is recognized as a cardinal prognostic marker in systolic heart failure patients. Conflicting data exist on the interaction of RV function and left ventricular (LV) reverse remodeling after cardiac resynchronization therapy (CRT). This prospective monocentric trial was set up to assess the predictive value of baseline RV function and corresponding RV-pulmonary artery (PA) coupling on LV reverse remodeling after CRT. Methods: 110 patients with a CRT indication were prospectively enrolled. RV function and RV-PA interaction were analyzed at baseline using echocardiographic and invasive pressure-volume loop catheter approach. The primary endpoint was reverse LV remodeling (CRT-responder) defined as a reduction in LV end-systolic volume of >= 15% at 6 months. Results: Responders had higher RV-PA coupling ratios (single-beat end-systolic elastance/PA elastance: Ees/Ea) at baseline, which corresponded to smaller RVs with better ejection fraction and lower afterload. After multivariate adjustment, the baseline Ees/Ea remained an independent predictor for LV response (OR 14.0 [1.5-130.8], p = 0.021). Normal coupling (Ees/Ea >= 1) was associated with higher responder rates (RR) (86%). Progressive uncoupling was associated with lower LV-RR (Ees/Ea <= 1-0.5: 57%, and Ees/Ea < 0.5: 32%, p < 0.001), corresponded with higher degrees of LV impairment and severity of mitral regurgitation, and was independently associated with an adverse outcome. Conclusions: A higher baseline RV-PA coupling, reflecting a lower degree of LV-induced pulmonary hypertension and secondary RV-dysfunction, is associated with an improved LV-reverse remodeling and is independently associated with better prognosis. The value of RV-PA ratio as potential guide for CRT patient selection warrants further investigation. (C) 2018 Elsevier B.V. All rights reserved.\

BACKGROUND:Persistent fever of unknown cause is only rarely of cardiac origin, but heart disease must be considered in the differential diagnosis. Aside from endocarditis, pericarditis and various other conditions may be responsible.METHODS:This review is based on pertinent articles retrieved by a selective search in PubMed and Google Scholar employing the term "fever" in combination with "myocardial infarction," "pericarditis," "endocarditis," and "postcardiac injury," with additional consideration of current cardiological guidelines.RESULTS:Endocarditis is associated with fever in 90% of cases, but 25-50% of patients also develop high body temperatures after acute myocardial infarction. In pericarditis, a temperature above 38°C indicates a poorer prognosis; if accompanied by other warning signs, it is an indication for hospitalization and pericardiocentesis. Fever can arise after cardiac surgical procedures as a manifestation of post - cardiotomy syndrome, a special type of perimyocarditis. There may be a latency period of up to 3 months.CONCLUSION:Fever can have both infectious and non-infectious cardiac causes. Its interpretation depends on the clinical context. The evidence base for treatment is sparse, and controlled trials are needed.

Background Closure of the left atrial appendage (LAA) to prevent cardioembolic events is an alternative therapy to oral anticoagulation in patients with non-valvular atrial fibrillation. The LAA is an important source of natriuretic peptides and its exclusion from the circulation may alter the blood level of these hormones, thereby influencing their diagnostic value and clinical effects. Methods We aimed to prospectively assess potential changes in mid-regional pro A-type natriuretic peptide (MRproANP) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels 6 weeks and 6 months after interventional LAA closure using the WATCHMAN device. Results In 29 consecutive patients with successful LAA closure baseline MR-proANP level was 274 +/- 208 pmol/l and decreased by - 24.5 +/- 68 (p = 0.07) and - 15.0 +/- 44 pmol/l (p = 0.10) after 6 weeks and 6 months, respectively. The drop in the MR-proANP level after 6 weeks and 6 months was significant in patients with elevated (-214 pmol/l) baseline MR-proANP level (n = 15: -54.3 +/- 78.0, p < 0.01 and -31.8 +/- 45.4 pmol/l, p = 0.03, respectively) and those with reduced left ventricular ejection fraction (LVEF < 45%, n = 7: -87.4 +/- 97.3, p = 0.02 and -60.3 +/- 42.6 pmol/l, p = 0.01, respectively). Baseline NT-proBNP level (median 1054 pg/ml; IQR 621-1977 pg/ml), sodium, potassium, mean systolic or diastolic blood pressure did not change significantly in the mentioned patient groups. Conclusions After LAA closure, MR-proANP level decreased significantly in patients with elevated baseline MRproANP level or reduced LVEF, whereas NT-proBNP level remained unchanged, thereby altering the correlation coefficient between the two biomarkers. Our findings should be considered when using these biomarkers for diagnostic or prognostic evaluation in patients with interventional LAA closure.

Interventional closure of the left atrial appendage (LAA) in patients with non-valvular atrial fibrillation, high thromboembolic and bleeding risk or bleeding history is an alternative therapeutic strategy to oral anticoagulation. It is not known if the exclusion of the LAA from the blood circulation affects the left atrial volume (LAV) and consequently its prognostic value or the circulatory performance of the heart in humans.