Heart Asia最新文献

{"title":"Cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI in Thailand: a randomised trial.","authors":"Yotsawee Chotechuang, Arintaya Phrommintikul, Srun Kuanprasert, Roungtiva Muenpa, Jayanton Patumanond, Tuanchai Chaichuen, Apichard Sukonthasarn","doi":"10.1136/heartasia-2019-011201","DOIUrl":"10.1136/heartasia-2019-011201","url":null,"abstract":"<p><strong>Background: </strong>The benefit of an early coronary intervention after streptokinase (SK) therapy in low to intermediate-risk patients with ST-elevation myocardial infarction (STEMI) still remains uncertain. The current study aimed to evaluate the cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI after successful therapy with SK.</p><p><strong>Methods: </strong>We randomly assigned low to intermediate Global Registry of Acute Coronary Events risk score to patients with STEMI who had successful treatment with full-dose SK at Lampang Hospital and Maharaj Nakorn Chiang Mai Hospital into early and delayed coronary intervention groups. The primary endpoints were 30-day and 6-month composite cardiovascular outcomes (death, rehospitalised with acute coronary syndrome, rehospitalised with heart failure and stroke).</p><p><strong>Results: </strong>One hundred and sixty-two patients were included in our study. At the 30 days, composite cardiovascular outcomes were 4.9% in the early coronary intervention group and 2.5% in the delayed group (p=0.682). At the 6 months, the composite cardiovascular outcomes were 16.1% in the early group and 6.2% in the delayed group (p=0.054).</p><p><strong>Conclusions: </strong>The delayed coronary intervention (>24 hours) in low to intermediate STEMI after successful therapy with SK did not increase in short and long-term cardiovascular events compared with an early coronary intervention.</p><p><strong>Trial registration number: </strong>NCT02131103.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":" ","pages":"e011201"},"PeriodicalIF":0.0,"publicationDate":"2019-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c6/f6/heartasia-2019-011201.PMC6579563.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37392494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Finger necrosis with eosinophilia and symmetrical occlusion of the peripheral artery.","authors":"Ryo Nishikawa,&nbsp;Toru Hirano,&nbsp;Osami Kawarada","doi":"10.1136/heartasia-2019-011211","DOIUrl":"https://doi.org/10.1136/heartasia-2019-011211","url":null,"abstract":"<p><p><b>Case presentation:</b> A 59-year-old man with hypertension, dyslipidemia and a current smoking history had presented with bilateral painful finger ulcers (figure 1A). The patient was referred to our hospital for the diagnosis and treatment. On his arrival, his fingers showed the development from ulcer to necrosis during the 3 weeks (figure 1B). Diagnostic angiography at the previous hospital had revealed symmetrical occlusions of the forearm and crural arteries (figure 2). Laboratory blood tests demonstrated an eosinophilia (21 %, 1743 cells/µL) with marked elevation of IgE (4200 mg/dL) as well as inflammatory reaction such as erythrocyte sedimentation rate 84 mm/h and C-reactive protein 0.85 mg/dL. There was no evidence of thrombophilia, and autoantibodies were negative. A skin biopsy from the border of the necrosis demonstrated perivascular considerable infiltration of inflammatory cells including eosinophils (figure 3).Figure 1(A) Initial manifestation at the previous hospital. Note the ulcers in the bilateral fingers. (B) Development to finger necrosis on his admission in our hospital.Figure 2(A) Upper extremity angiography revealed extensive occlusions in the bilateral radial and ulnar arteries (arrow). (B) Lower extremity angiography revealed multiple occlusions in the right anterior tibial artery, the left anterior tibial artery and the left posterior tibial artery (arrow).Figure 3(A) Skin biopsy from the border of the finger necrosis demonstrated nodular inflammatory cell infiltration in dermis and subcutaneous tissue (H&E stain). (B) Magnified histopathological examination of the skin biopsy found eosinophilic infiltration (arrows) in granulomatous inflammation of upper dermis (H&E stain). Immunohistochemistry (inset) showing major basic protein of eosinophils (immunostaining).</p><p><strong>Question: </strong>What is the most likely diagnosis?Buerger's diseaseEosinophilic vasculitisDrug abuseCholesterol embolisation syndromeParaneoplastic syndrome.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":" ","pages":"e011211"},"PeriodicalIF":0.0,"publicationDate":"2019-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2019-011211","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37366560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transmitral inflow wave and progression from paroxysmal to permanent atrial fibrillation in Asian people","authors":"T. Nakagawa, H. Hara, Masaya Yamamoto, Y. Matsushita, Y. Hiroi","doi":"10.1136/heartasia-2018-011166","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011166","url":null,"abstract":"Objective Paroxysmal atrial fibrillation could progress to permanent atrial fibrillation. Whether the transmitral inflow waves could be used to predict progression from paroxysmal atrial fibrillation to permanent atrial fibrillation is unknown. Therefore, we investigated the association between the transmitral inflow waves and progression of paroxysmal atrial fibrillation. Method We performed a retrospective study by analysing clinical and echocardiographic data from 88 patients with paroxysmal atrial fibrillation. We excluded patients who had structural heart disease, significant valvular disease, cardiomyopathy, cardiac device implantation or a left ventricular ejection fraction <50%. Result The patients with progression to permanent atrial fibrillation were more likely to be male and had lower peak A velocity than those without progression. After adjusting for covariates, lower peak A velocity remained the independent predictor of progression to permanent atrial fibrillation (p=0.025). Conclusion The A velocity could be useful for predicting progression to permanent atrial fibrillation in Asian people.","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011166","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42415249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cornell product is an ECG marker of heart failure with preserved ejection fraction.","authors":"Eugene Sj Tan,&nbsp;Siew Pang Chan,&nbsp;Chang Fen Xu,&nbsp;Jonathan Yap,&nbsp;Arthur Mark Richards,&nbsp;Lieng Hsi Ling,&nbsp;David Sim,&nbsp;Fazlur Jaufeerally,&nbsp;Daniel Yeo,&nbsp;Seet Yoong Loh,&nbsp;Hean Yee Ong,&nbsp;Kui Toh Gerard Leong,&nbsp;Tze Pin Ng,&nbsp;Shwe Zin Nyunt,&nbsp;Liang Feng,&nbsp;Peter Okin,&nbsp;Carolyn Sp Lam,&nbsp;Toon Wei Lim","doi":"10.1136/heartasia-2018-011108","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011108","url":null,"abstract":"<p><strong>Objective: </strong>ECG markers of heart failure (HF) with preserved ejection fraction (HFpEF) are lacking. We hypothesised that the Cornell product (CP) is a risk marker of HFpEF and has prognostic utility in HFpEF.</p><p><strong>Methods: </strong>CP =[(amplitude of R wave in aVL+depth of S wave in V3)×QRS] was measured on baseline 12-lead ECG in a prospective Asian population-based study of 606 healthy controls (aged 55±10 years, 45% men), 221 hypertensive controls (62±9 years, 58% men) and 242 HFpEF (68±12 years, 49% men); all with EF ≥50% and followed for 2 years for all-cause mortality and HF hospitalisations.</p><p><strong>Results: </strong>CP increased across groups from healthy controls to hypertensive controls to HFpEF, and distinguished between HFpEF and hypertension with an optimal cut-off of ≥1800 mm*ms (sensitivity 40%, specificity 85%). Age, male sex, systolic blood pressure (SBP) and heart rate were independent predictors of CP ≥1800 mm*ms, and CP was associated with echocardiographic E/e' (r=0.27, p<0.01) and left ventricular mass index (r=0.46, p<0.01). Adjusting for clinical and echocardiographic variables and log N-terminal pro B-type natriuretic peptide (NT-proBNP), CP ≥1800 mm*ms was significantly associated with HFpEF (adjusted OR 2.7, 95% CI 1.0 to 7.0). At 2-year follow-up, there were 29 deaths and 61 HF hospitalisations, all within the HFpEF group. Even after adjusting for log NT-proBNP, clinical and echocardiographic variables, CP ≥1800 mm*ms remained strongly associated with a higher composite endpoint of all-cause mortality and HF hospitalisations (adjusted HR 2.1, 95% CI 1.2 to 3.5).</p><p><strong>Conclusion: </strong>The Cornell product is an easily applicable ECG marker of HFpEF and predicts poor prognosis by reflecting the severity of diastolic dysfunction and LV hypertrophy.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"e011108"},"PeriodicalIF":0.0,"publicationDate":"2019-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37372042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left ventricular vortex formation time in elite athletes: novel predictor of myocardial performance.","authors":"Kian Keong Poh,&nbsp;Nicholas Ngiam,&nbsp;Malissa J Wood","doi":"10.1136/heartasia-2019-011188","DOIUrl":"https://doi.org/10.1136/heartasia-2019-011188","url":null,"abstract":"<p><strong>Background: </strong>Efficient transportation of blood through the left ventricle (LV) during diastole depends on vortex formation. Vortex formation time (VFT) can be measured by echocardiography as a dimensionless index. As elite athletes have supranormal diastolic LV function, we aim to assess resting and post-exercise VFT in these athletes and hypothesised that VFT may predict myocardial performance immediately post-exercise.</p><p><strong>Method: </strong>Subjects were world class speedskaters training for the Winter Olympic Games. Echocardiographic measurements were obtained before and immediately after 3000 m of racing. VFT was computed as 4×(1-β)/π×α³×left ventricle ejection fraction where β is the fraction of diastolic stroke volume contributed by atrial contraction, α is the biplane end diastolic volume (EDV)^1/3 divided by mitral annular diameter during early diastole.</p><p><strong>Results: </strong>Baseline VFT was 2.6±0.7 (n=24, age 22±3 years, 67% males). Post-exercise, heart rates increased (64±10 vs 89±12 beats/min, p<0.01); however, VFT was unchanged (2.9±1.0, p>0.05). VFT at rest correlated modestly with post-exertion early diastolic mitral in-flow velocity (E; r=0.59, p=0.01), tissue Doppler-derived early mitral annular velocity (E'; septal and lateral, both r=0.59, p=0.01) and systolic annular velocity (S'; septal: r=0.46, p=0.02 and lateral: r=0.48, p=0.02) but not late diastolic mitral in-flow velocity (A; r=0.06, p>0.05) or annular velocity (A'; septal: r=0.34, p=NS and lateral: r=0.35, p>0.05).</p><p><strong>Conclusion: </strong>There was no significant difference between VFT at rest and immediately post-exercise. However, VFT at rest correlated with immediate post-exercise augmented systolic and early diastolic tissue Doppler indicators of myocardial performance in elite athletes.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"e011188"},"PeriodicalIF":0.0,"publicationDate":"2019-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2019-011188","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37366559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of a questionnaire measuring patient knowledge of atrial fibrillation in an Asian cohort.","authors":"Rebecca Hoe,&nbsp;Wanyun Lin,&nbsp;Mary Ann Cruz Bautista,&nbsp;Hubertus Johannes Maria Vrijhoef,&nbsp;Toon Wei Lim","doi":"10.1136/heartasia-2018-011143","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011143","url":null,"abstract":"<p><strong>Background: </strong>Poor patient understanding of atrial fibrillation (AF) may contribute to underuse of anticoagulation. There are no validated instruments to measure patient knowledge in Asian cohorts. This study aims to validate a disease-specific questionnaire measuring the level of understanding of AF and its treatment among patients with AF in Singapore.</p><p><strong>Methods: </strong>A 10-item interviewer-administered questionnaire was created based on previously published questionnaires. Face and content validity were assessed. 165 participants were identified by convenience sampling at cardiology clinics of a tertiary hospital. The questionnaire was administered in either English (n = 53) or Mandarin (n = 112). Exploratory factor analysis was performed using principal component method. Internal consistency was evaluated using Cronbach's alpha coefficient.</p><p><strong>Results: </strong>Face validity was tested by surveying 10 cardiologists who could all identify what the questionnaire was designed to measure. Mean content validity ratio across items was 0.9. Participants were 68.7 (SD 10.5) years old. 55.8% were male. 95.2% were on oral anticoagulation. Kaiser-Meyer-Olkin measure was 0.67 and Bartlett's test of sphericity was significant (p < 0.01). Four factors were retained based on the eigenvalue > 1. These were knowledge of the following: disease characteristics, disease-specific treatment, role of treatment in symptom management and treatment mechanisms. Internal consistency was good (Cronbach's alpha = 0.71).</p><p><strong>Conclusions: </strong>A questionnaire on the knowledge of AF and its treatment was validated in a cohort of Asian patients in English and Mandarin. It allows quantification of patient knowledge and may be useful in Asian populations to assess the efficacy of interventions to improve patient understanding of AF.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"e011143"},"PeriodicalIF":0.0,"publicationDate":"2019-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011143","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37372044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of heart failure on stroke mortality and recurrence.","authors":"Tiberiu A Pana,&nbsp;Adrian D Wood,&nbsp;Jesus A Perdomo-Lampignano,&nbsp;Somsak Tiamkao,&nbsp;Allan B Clark,&nbsp;Kannikar Kongbunkiat,&nbsp;Joao H Bettencourt-Silva,&nbsp;Kittisak Sawanyawisuth,&nbsp;Narongrit Kasemsap,&nbsp;Mamas A Mamas,&nbsp;Phyo K Myint","doi":"10.1136/heartasia-2018-011139","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011139","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to examine the impact of heart failure (HF) on stroke mortality (in-hospital and postdischarge) and recurrence in a national stroke cohort from Thailand.</p><p><strong>Methods: </strong>We used a large, insurance-based database including all stroke admissions in the public health sector in Thailand between 2004 and 2015. Logistic and Royston-Parmar regressions were used to quantify the effect of HF on in-hospital and long-term outcomes, respectively. All models were adjusted for age, sex and comorbidities and stratified by stroke type: acute ischaemic stroke (AIS) or intracerebral haemorrhage (ICH). Multistate models were constructed using flexible survival techniques to predict the impact of HF on the disease course of a patient with stroke (baseline-[recurrence]-death). Only first-ever cases of AIS or ICH were included in the multistate analysis.</p><p><strong>Results: </strong>608 890 patients (mean age 64.29±13.72 years, 55.07% men) were hospitalised (370 527 AIS, 173 236 ICH and 65 127 undetermined pathology). There were 398 663 patients with first-ever AIS and ICH. Patients were followed up for a median (95% CI) of 4.47 years (4.45 to 4.49). HF was associated with an increase in postdischarge mortality in AIS (HR [99% CI] 1.69 [1.64 to 1.74]) and ICH (2.59 [2.07 to 3.26]). HF was not associated with AIS recurrence, while ICH recurrence was only significantly increased within the first 3 years after discharge (1.79 [1.18 to 2.73]).</p><p><strong>Conclusions: </strong>HF increases the risk of mortality in both AIS and ICH. We are the first to report on high-risk periods of stroke recurrence in patients with HF with ICH. Specific targeted risk reduction strategies may have significant clinical impact for mortality and recurrence in stroke.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"e011139"},"PeriodicalIF":0.0,"publicationDate":"2019-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37372043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"22 Renal complications in LVAD and heart transplant patients","authors":"M. Kiernan","doi":"10.1136/heartasia-2019-apahff.22","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.22","url":null,"abstract":"Renal dysfunction remains a primary determinant of both short- and long-term outcomes following heart transplantation (HTx) and ventricular assist device (VAD) implantation.1 2 Challenging to the assessment of candidacy for advanced heart failure (HF) therapies is the ability to distinguish intrinsic parenchymal renal disease from reversible cardiorenal disease. Patients with haemodynamically mediated renal failure may recover kidney function once renal perfusion is restored following HTx or VAD surgery. Chronic hypoperfusion, however, can lead to progressive structural lesions that may not improve despite correction of underlying haemodynamic abnormalities. In patients undergoing kidney biopsy as part of their HTx evaluation, there was poor correlation between eGFR and the extent of tubular atrophy and interstitial fibrosis.3 Prolonged elevation of serum creatinine (SCr) levels suggest but do not prove irreversibility and SCr in isolation is unlikely the best biomarker to determine transplant candidacy in this clinical setting. Reasons for SCr elevation in HF including pharmacotherapies such as renin-angiotensin-aldosterone system antagonists which lead to SCr elevations unrelated to underlying renal dysfunction. Additionally, patients with HF are frequently malnourished with muscle wasting, in which case SCr levels may be misleading. Baseline proteinuria is associated with poor post-operative outcomes in LVAD recipients and is an easily measurable biomarker that can further help to risk stratify patients in advance of VAD surgery.4 While absolute thresholds of risk are difficult to define, if eligible for dual organ transplant, advanced HF patients with GFR <35 mL/min/m2 are likely to derive a survival benefit from simultaneous heart-kidney transplantation rather than HTx alone.5 References Kirklin JK, Naftel DC, Pagani FD, Kormos RL, Stevenson LW, Blume ED, Miller MA, Baldwin JT, Young JB. Sixth INTERMACS annual report: a 10,000-patient database. J Heart Lung Transplant 2014;33:555–564. Erratum in: J Heart Lung Transplant2015;34:1356. Hong KN, Merlo A, Chauhan D, Davies RR, Iribarne A, Johnson E, Jeevanandam V, Russo MJ. Evidence supports severe renal insufficiency as a relative contraindication to heart transplantation. J Heart Lung Transplant 2016;35:893–900. Labban B, Arora N, Restaino S, Markowitz G, Valeri A, Radhakrishnan J. The role of kidney biopsy in heart transplant candidates with kidney disease. Transplantation 2010;89:887–893. Topkara VK, Garan AR, Fine B, Godier-Furnémont AF, Breskin A, Cagliostro B, Yuzefpolskaya M, Takeda K, Takayama H, Mancini DM, Naka Y, Colombo PC. Myocardial recovery in patients receiving contemporary left ventricular assist devices: results from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Circ Heart Fail 2016;9. pii: e003157. Kilic A, Grimm JC, Whitman GJ, Shah AS, Mandal K, Conte JV, Sciortino CM. The survival benefit of simultaneous heart-kidney transplantation ext","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"A10 - A9"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2019-apahff.22","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48400989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"21 Surgical care and perioperative nursing management of LVADs","authors":"J. Casida","doi":"10.1136/heartasia-2019-apahff.21","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.21","url":null,"abstract":"The perioperative management of patients with a left ventricular assist device (LVAD) presents a whole set of challenges to the nurses at the bedside and outpatient settings.1 Despite the remarkable advancements in technology, the care of patients following LVAD implant remains complex for the multidisciplinary healthcare team. This presentation provides a brief overview of the currently used durable LVAD designs worldwide. These include axial (HeartMate IITM) and magnetic flow levitation (HeartMate 3TM and HeartWare HVAD®) LVADs.2 Discussion of the nursing management of patients post-LVAD implant in the critical care, progressive care, and in the outpatient care settings will be approached at conceptual level. This approach will equip the participant with a ‘thinking framework’ guiding his/her actions in caring for LVAD patients. Salient nursing actions include early detection and management of post-surgical complications, device-related complications, heart failure symptom exacerbations, infection, among others. The nurse’s role in helping patients attain an optimum level of functioning post-implantation during hospitalisation and the impact of the nurse in supporting patients (and caregivers) to attain an increase in quality of life are highlighted. References Chmielinski A, Koons B. Nursing care for the patient with a left ventricular assist device. Nursing 2018. 2017;47:34–40. Montalto A, Loforte A, Musumeci F, Krabatsch T, Slaughter M (Eds.). Mechanical circulatory support in end-stage heart failure: a practical manual. Cham, Switzerland: Springer International Publishing; 2017. doi:10.1007/978-3-319-43383-7","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"A9 - A9"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2019-apahff.21","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46266128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"26 CardiomemsTM in VAD patients","authors":"E. Fung","doi":"10.1136/heartasia-2019-apahff.26","DOIUrl":"https://doi.org/10.1136/heartasia-2019-apahff.26","url":null,"abstract":"Successive generations of left ventricular assist devices (LVADs) have been associated with improvement in patient outcomes and reduction in device-related complications.1 Beyond mortality reduction, quality of life improvement and reduction in hospitalisation are increasingly focused upon. Following LVAD implantation, the number of admissions per year is highest in the first year.2 3 In fact, within 30–90 days, hospitalisation for volume overload – indicative of acute worsening heart failure, haemodynamically significant arrhythmias or imbalance of haemodynamics due to suboptimal LVAD pump settings – could account for 11%–24% of admissions.2 4 5 To improve our understanding of mechanisms related to VAD therapy, investigators have reviewed data from LVAD patients with pre-operatively placed implantable pulmonary artery pressure (PAP) monitors (CardioMEMSTM). Studies have shown that implantation of PAP monitors can assist in management of haemodynamics, thus potentially reducing hospitalisation in a portion of LVAD patients with volume overload. Although retrospective analyses of PAP monitor data suggested that PAP could be effectively reduced by LVAD implantation,6 there remains a lack of prospective data to support routine use of PAP monitoring in LVAD patients to guide haemodynamic management. In the ongoing Intellect2, a multi-centre prospective observational 6 month follow-up study of 100 LVAD patients (https://clinicaltrials.gov/ct2/show/NCT03247829), CardioMEMS will be evaluated for its effects on haemodynamics optimisation to impact on patients’ functional status, quality of life and hospital medications. References Mehra MR, Goldstein DJ, Uriel N, Cleveland JC Jr, Yuzefpolskaya M, Salerno C, Walsh MN, Milano CA, Patel CB, Ewald GA, Itoh A, Dean D, Krishnamoorthy A, Cotts WG, Tatooles AJ, Jorde UP, Bruckner BA, Estep JD, Jeevanandam V, Sayer G, Horstmanshof D, Long JW, Gulati S, Skipper ER, O’Connell JB, Heatley G, Sood P, Naka Y; MOMENTUM 3 Investigators. Two-Year Outcomes with a Magnetically Levitated Cardiac Pump in Heart Failure. N Engl J Med 2018;378:1386–1395. Tripathi B, Arora S, Kumar V, Thakur K, Lahewala S, Patel N, Dave M, Shah M, Savani S, Sharma P, Bandyopadhyay D, Shantha GPS, Egbe A, Chatterjee S, Patel NK, Gopalan R, Figueredo VM, Deshmukh A. Hospital complications and causes of 90-Day readmissions after implantation of left ventricular assist devices. Am J Cardiol 2018;122:420–430. Vidula H, Kutyifa V, Johnson BA, Strawderman RL, Harrington D, Polonsky B, Papernov A, Alexis JD. Readmission Patterns During Long-Term Follow-Up After Left ventricular assist device implantation. Am J Cardiol 2018;122:1021–1027. Gupta S, Cogswell RJ, Roy SS, Spratt JR, Liao KK, Martin CM, John R. Impact of 30 Day Readmission After Left Ventricular Assist Device Implantation. ASAIO J 2018 May 7. doi:10.1097/MAT.0000000000000812. Patel S, Poojary P, Pawar S, Saha A, Patel A, Chauhan K, Correa A, Mondal P, Mahajan K, Chan L, Ferrandino R, Mehta D,","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":" ","pages":"A11 - A11"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2019-apahff.26","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46858516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}