Journal of Cardiac Failure最新文献

{"title":"Safety And Efficacy Of Outpatient Inotropic Therapy With Milrinone Versus Dobutamine As A Bridge To Orthotopic Heart Transplant Or Left Ventricular Assistive Device Implantation","authors":"Myoung Hyun Choi,&nbsp;Zubeen Azari,&nbsp;Jenna M Negrelli,&nbsp;Joshua Newman,&nbsp;Mingxi Dennis Yu","doi":"10.1016/j.cardfail.2024.10.052","DOIUrl":"10.1016/j.cardfail.2024.10.052","url":null,"abstract":"<div><h3>Background</h3><div>Patients with advanced heart failure may require an outpatient bridge with inotropes to orthotopic heart transplant (OHT) or left ventricular assist device (LVAD) implantation. While several studies compare milrinone and dobutamine with respect to their risk, cost, and efficacy in a variety of clinical settings, none address their comparative use specifically as an outpatient bridge to advanced therapies.</div></div><div><h3>Methods</h3><div>This is a single center, retrospective cohort study. Patients who received milrinone or dobutamine in the outpatient setting prior to undergoing LVAD implantation or OHT between 2000-2023 were included. We assessed the number and duration of hospitalizations and incidence of major adverse events including arrhythmia, bleeding, PICC-line related complications, infections, hypotension, heart failure admission, and shock between groups.</div></div><div><h3>Results</h3><div>Of 560 patients who underwent LVAD implantation or OHT, 128 met the inclusion criteria. Of these patients, 30% (38) were on dobutamine and 70% (90) were on milrinone. More patients on dobutamine had a history of valvular disease compared to milrinone (42.1% vs. 21.1%, p= 0.015). Otherwise, baseline characteristics including history of chronic kidney disease and arrhythmias were similar between groups. Patients bridged with dobutamine had a significantly higher median number of days hospitalized (27.5 vs. 19.0, p = 0.033, respectively), rate of admission per month (0.57 vs. 0.32, p = 0.005), and proportion of days hospitalized (0.43 vs. 0.21, p = 0.001) (Table 1). More patients were hospitalized in the dobutamine group (94.6% vs. 76.7%, p = 0.015). There was no significant difference in the incidence of arrhythmia, shock, PICC-line complications, infection, stroke, or heart failure exacerbation between groups.</div></div><div><h3>Conclusion</h3><div>In patients with advanced heart failure requiring outpatient inotrope as a bridge to LVAD or OHT, bridging with dobutamine was associated with higher rates of admission per month and proportion of days hospitalized compared to bridging with milrinone. In addition, bridging with dobutamine was associated with a higher incidence of hospitalizations.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Page 200"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heart Failure-related Mortality Before And During The Covid-19 Pandemic: A Cross-sectional Analysis Of A National Database","authors":"Rabbia Siddiqi ,&nbsp;Syed Husain Farhan ,&nbsp;Muhammad M Nasir ,&nbsp;Rizwan A Khan ,&nbsp;Imad Hariri ,&nbsp;George Moukarbel ,&nbsp;Muhammad Shahzeb Khan","doi":"10.1016/j.cardfail.2024.10.029","DOIUrl":"10.1016/j.cardfail.2024.10.029","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) with comorbid COVID-19 infection has worse outcomes. We compared HF mortality trends during the COVID-19 pandemic to the pre-pandemic period.</div></div><div><h3>Methods</h3><div>We used data from the Centers for Disease Control Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) database to identify trends in HF mortality in the pre-pandemic period (1999-2019) to the COVID-19 pandemic period (2020-2021). The following ICD-10 codes were used to find relevant data: I11.0, I13.0, I13.2, and I50. All deaths related to HF in adults aged ≥25 years were included. Age-adjusted mortality rates (AAMR) per 100,000 people were calculated and stratified by gender, race, census region, and age. Annual percentage change (APC) was calculated using the Joinpoint regression software.</div></div><div><h3>Results</h3><div>A total of 7,366,944 deaths occurred due to HF in adults aged ≥25 years from 1999 to 2021 (Table 1). The overall AAMR showed a decline prior to the COVID-19 pandemic (AAMR: 143.9; APC: -0.63 [-0.73 to -0.47]), followed by a sharp rise during the pandemic (AAMR: 167.8; APC: 7.91 [5.71 to 9.42]). Compared to women, men had a consistently higher AAMR before (AAMR men: 167.4 vs. women: 127.1) and during the pandemic (AAMR men: 200.4 vs. women: 142.6). Stratified by race/ethnicity, non-Hispanic (NH) Blacks showed a consistently higher AAMR before (AAMR NH Blacks: 157.3 vs. NH White: 150 vs. NH American Indian or Alaska Native: 135.7 vs. Hispanic: 94.6 vs. NH Asian or Pacific Islander: 65.5) and during the pandemic (AAMR NH Blacks: 200.4 vs. NH White: 175.4 vs. NH American Indian or Alaska Native: 168.4 vs. Hispanic: 112.4 vs. NH Asian or Pacific Islander: 70.4). Older adults (age ≥65 years) had the highest AAMR before (AAMR &gt;65 years: 673 vs. 45-64 years: 31.4 vs. 25-44 years: 3.4) and during the pandemic (AAMR &gt;65 years: 757.9 vs. 45-64 years: 49.2 vs. 25-44 years: 6.1). Moreover, when stratified by census regions, Midwestern region showed the highest AAMR, followed by the Southern, Western, and Northeastern regions in the before and during the pandemic period. During the pandemic, the rise in mortality (APC) was greater in younger and middle-aged adults compared with the elderly.</div></div><div><h3>Conclusion</h3><div>After more than two decades of consistent decline in HF-related mortality, a sharp surge in AAMR coinciding with the COVID-19 pandemic has been observed. HF mortality was greater in the pandemic period across all demographic groups; however, the rate of increase was greater in younger and middle-aged adults compared with the elderly.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Page 189"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"European Society of Cardiology Congress 2024 Meeting: Heart Failure Highlights","authors":"ELENA DONALD MD ,&nbsp;ALEXANDER HAJDUCZOK MD ,&nbsp;PATRICIA CAMPBELL MD","doi":"10.1016/j.cardfail.2024.09.001","DOIUrl":"10.1016/j.cardfail.2024.09.001","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 140-143"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between the Use of an Adaptive Cardiac Resynchronization Therapy Algorithm and Health Care Use and Cost","authors":"MICHAEL R. GOLD MD, PhD ,&nbsp;JIANI ZHOU PhD, MSPH ,&nbsp;LUCAS HIGUERA PhD ,&nbsp;DAVID P. LANCTIN MPH ,&nbsp;EUGENE S. CHUNG MD","doi":"10.1016/j.cardfail.2024.06.004","DOIUrl":"10.1016/j.cardfail.2024.06.004","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the association between the use of adaptive pacing on clinical and economic outcomes of cardiac resynchronization therapy (CRT) recipients in a real-world analysis.</div></div><div><h3>Background</h3><div>The adaptivCRT (aCRT) algorithm was shown in prior subgroup analyses of prospective trials to achieve clinical benefits, but a large prospective trial showed nonsignificant changes in the endpoint of mortality or hospitalizations due to heart failure.</div></div><div><h3>Methods</h3><div>CRT-implanted patients from the Optum Clinformatics database with ≥ 90 days of follow-up were included. Remote monitoring data were used to classify patients based on CRT setting—adaptive biventricular and left ventricular pacing (aCRT) vs standard biventricular pacing (Standard CRT). Inverse probability of treatment weighting was used to adjust for baseline differences between groups. Mortality, 30-day readmissions, health care use, and payer and patients’ costs were evaluated post-implantation.</div></div><div><h3>Results</h3><div>This study included 2412 aCRT and 1638 Standard CRT patients (mean follow-up: 2.4 ± 1.4 years), with balanced baseline characteristics after adjustment. The aCRT group was associated with lower all-cause mortality rates (adjusted hazard ratio = 0.88 [95% confidence interval (CI):0.80, 0.96]), fewer all-cause 30-day readmissions (adjusted incidence rate ratio = 0.87 [CI:0.81, 0.94]), and fewer all-cause and HF-related inpatient, outpatient and emergency department visits. The aCRT cohort was also associated with lower all-cause outpatient payer-paid amounts and lower all-cause and HF-related inpatient and emergency department patient-paid amounts.</div></div><div><h3>Conclusions</h3><div>In this retrospective analysis of a large real-world cohort, the use of an adaptive CRT algorithm was associated with lower mortality rates, reduced health care resource use and lower payer and patient costs.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 52-62"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baroreflex Function in Cardiovascular Disease","authors":"HUSAM M. SALAH MD ,&nbsp;RICHA GUPTA MD, MPH ,&nbsp;ALBERT J. HICKS III MD, MPH ,&nbsp;KIRAN MAHMOOD MD ,&nbsp;NICHOLAS A. HAGLUND MD ,&nbsp;AMARINDER S. BINDRA MD ,&nbsp;STEVE M. ANTOINE MD ,&nbsp;RACHEL GARCIA MD ,&nbsp;AMIN YEHYA MD ,&nbsp;DMITRY M. YARANOV ,&nbsp;PUJAN P. PATEL MD ,&nbsp;JASON P. FELIBERTI MD ,&nbsp;ALLMAN T. ROLLINS MD ,&nbsp;VISHAL N. RAO MD, MPH ,&nbsp;LAURIE LETARTE MD ,&nbsp;VIKRAM RAJE DO ,&nbsp;AMIT H. ALAM MD ,&nbsp;PATRICK McCANN ,&nbsp;NIRAV Y. RAVAL MD ,&nbsp;BRIAN HOWARD MD ,&nbsp;MARAT FUDIM MD, MHS","doi":"10.1016/j.cardfail.2024.08.062","DOIUrl":"10.1016/j.cardfail.2024.08.062","url":null,"abstract":"<div><div>The baroreflex system is involved in modulating several physiological functions of the cardiovascular system and can modulate cardiac output, blood pressure, and cardiac electrophysiology directly and indirectly. In addition, it is involved in regulating neurohormonal pathways involved in the cardiovascular function, such as the renin–angiotensin–aldosterone system and vasopressin release. Baroreflex dysfunction is characterized by sympathetic overactivation and parasympathetic withdrawal and is associated with several cardiovascular diseases, such as hypertension, heart failure, and coronary artery disease. Targeting the baroreflex system via invasive (eg, baroreflex activation therapy and endovascular baroreceptor amplification) and noninvasive approaches (eg, slow breathing exercises and exercise training) has emerged as a novel pathway to manage cardiovascular diseases. Studies examining the long-term safety and efficacy of such interventions in various cardiovascular diseases are needed.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 117-126"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142347280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The JCF 2024 Year-In-Review","authors":"Jennifer Maning DO ,&nbsp;Anuradha Lala MD ,&nbsp;Robert J. Mentz MD","doi":"10.1016/j.cardfail.2024.12.003","DOIUrl":"10.1016/j.cardfail.2024.12.003","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 1-3"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison Of The Risk Of Recurrent Atrial Fibrillation Ablation Between Racial Minorities And Whites Within Three Years After Index Ablation","authors":"Juzer Ali Asgar ,&nbsp;Amal Benchakroun ,&nbsp;Ashvin Zachariah ,&nbsp;Arie Szeinfeld ,&nbsp;Leonard Efuet-Ateh ,&nbsp;Paul Gurbel ,&nbsp;Kevin Bliden ,&nbsp;Udaya Tantry ,&nbsp;Robert Chait","doi":"10.1016/j.cardfail.2024.10.016","DOIUrl":"10.1016/j.cardfail.2024.10.016","url":null,"abstract":"&lt;div&gt;&lt;div&gt;AF is the most common type of cardiac arrhythmia, and its prevalence has been increasing worldwide. Current data shows that AF is more common in white males compared to blacks. Interestingly, despite multiple cardiovascular comorbidities, data suggests that blacks are less prone to development of AF. There is paucity of data showing the recurrence of AF re-ablation after index ablation specifically as it pertains to race, gender, and age. We sought to explore the rates of recurrent AF re-ablation in this retrospective cohort analysis. Using a multi-center database, we examined 23,558 encounters and 10,530 of had readmission records i.e. readmitted within 3 years. The encounters looked at adults (18+) who had an ablation procedure for atrial fibrillation between 1/1/2018-06/30/2020. We used binary logistic regression models to analyze pairwise comparisons among different subgroups of race, sex, and age group. The primary endpoint was recurrence of repeat ablation. Secondary endpoints included non-fatal stroke and myocardial infarction. Our sample size was 23,558 patients, 20,276 were white patients (86%) and 3,282 were non-white patients (14%). The average age was 66.29 years (SD 10.43) and average age at the time of repeat ablation was 65.97 years. The average BMI was 21.55. Out of the 23,558 patients, 14.30% (N= 3368) had re-ablation within 3 years of the index ablation. The odds ratio of re-ablation for patients in their 50s is 1.4229 (95% CI [1.1172, 1.8122]) times the odds for the patients in their 80s. Similarly, the odds ratio is 1.4330 (95% CI [1.1466, 1.7909]) for the 60s, 1.3075 (95%CI [1.0458, 1.6346]) for the 70s and 1.3443 (95% CI [1.0088, 1.7914]) for patients below 50 when comparing with patients over 80. The LR for re-ablation was 0.8438 (p=0.3583) in females when compared to males. The incidence of non-fatal stroke was 0.27% (N= 63) and non-fatal MI was 0.19% (N= 45). The average length of time to re-ablation was 415.5 days. There were 1649 patients with HF and 45% had recurrence of AF and 13.3% had repeat ablation therapy. When controlling for age group and sex, race was not significantly associated with an increased likelihood of repeat ablation. When controlling for race and age group, sex was not significantly associated with an increased likelihood of repeat ablation. When controlling for race only, females were not at a higher risk of re-ablation. However, when controlling for race and sex, patients in their 50s are 42.3% more likely to have re-ablation when compared to patients in their 80s. In contrast, pairwise comparison tests also found that as the age of patients at their first ablation increases and there appears to be a rising trend indicating a higher likelihood of AFIB recurrence within three years when controlling for race and sex. The incidence of repeat AF ablation is not higher in racial minorities when compared to whites. Interestingly, there appears to be a decreasing rate of AF re-ablation in older","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Page 183"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACORAMIDIS IMPROVES CLINICAL OUTCOMES IN PATIENTS WITH TRANSTHYRETIN AMYLOID CARDIOMYOPATHY: A POST HOC RECURRENT EVENT ANALYSIS OF ATTRIBUTE-CM STUDY","authors":"Daniel P Judge ,&nbsp;Kevin M Alexander ,&nbsp;Francesco Cappelli ,&nbsp;Marianna Fontana ,&nbsp;Pablo Garcia-Pavia ,&nbsp;Simon Gibbs ,&nbsp;Martha Grogan ,&nbsp;Mazen Hanna ,&nbsp;Ahmad Masri ,&nbsp;Mathew Maurer ,&nbsp;Laura Obici ,&nbsp;Prem Soman ,&nbsp;Xiaofan (Martha) Cao ,&nbsp;Kevin Wang ,&nbsp;Jean-Francois Tamby ,&nbsp;Suresh Siddhanti ,&nbsp;Jonathan Fox ,&nbsp;Julian Gillmore","doi":"10.1016/j.cardfail.2024.10.039","DOIUrl":"10.1016/j.cardfail.2024.10.039","url":null,"abstract":"<div><h3>Background</h3><div>Acoramidis is an investigational, next-generation, oral, near-complete stabilizer of transthyretin (TTR) for the treatment of transthyretin amyloid cardiomyopathy (ATTR-CM). The phase 3 ATTRibute-CM study demonstrated robust efficacy on clinical outcomes (all-cause mortality [ACM] and first cardiovascular hospitalization [CVH]) from 2 previously reported analyses: the 2-component, hierarchical Finkelstein-Schoenfeld method (p=0.0182) and the Cox proportional hazards model time to first event analysis (HR 0.645, p=0.0008). However, the previous models do not account for recurrent events. The objective of this post hoc reanalysis is to evaluate the overall effect of acoramidis vs placebo on the combination of ACM and all CVHs as recurrent events.</div></div><div><h3>Methods</h3><div>The Andersen-Gill (A-G) model is an extension of the Cox proportional hazards model that allows for handling recurrent events. In this analysis, the model was stratified by randomization stratification factors (genotype [ATTRm-CM vs ATTRwt-CM], baseline NT-proBNP level [≤3000 vs &gt;3000], eGFR level [≥45 vs &lt;45]), with treatment group, baseline 6-minute walk distance, and the number of events that occurred before a given interval included as covariates.</div></div><div><h3>Results</h3><div>Of 632 randomized patients, 611 were included in the A-G analysis (efficacy analysis population; acoramidis: 409; placebo: 202). ACM or CVH occurred in 147 (35.9%) and 102 (50.5%) of acoramidis and placebo-treated patients, respectively (Table). Patients treated with acoramidis also experienced fewer recurrent CVH or CVH and ACM events (14.4%) vs placebo (27.7%). The analysis using the A-G methodology demonstrated that acoramidis resulted in fewer ACM or CVH events compared with placebo (HR=0.695; p=0.0008).</div></div><div><h3>Conclusion</h3><div>The A-G analysis of time to recurrent event for ACM or CVH in ATTRibute-CM shows a highly significant reduction of singular and multiple, recurrent events in participants treated with acoramidis compared to placebo. These results add to and reinforce the conclusions from the primary analysis of ATTRibute-CM, that acoramidis leads to a significant improvement in clinical outcomes (ACM or CVH) in ATTR-CM patients.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 193-194"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"QT Interval Correction In Left Bundle Branch Areas Pacing (LBBAP)","authors":"Edward Xie ,&nbsp;Bharath Peddibhotla ,&nbsp;Hussein Krayem ,&nbsp;Jeffrey Kolominsky ,&nbsp;Jordana Kron ,&nbsp;Gautham Kalahasty ,&nbsp;Richard Shepard ,&nbsp;Jayanthi Koneru ,&nbsp;Jose Huizar ,&nbsp;Kenneth Ellenbogen ,&nbsp;Ajay Pillai","doi":"10.1016/j.cardfail.2024.10.076","DOIUrl":"10.1016/j.cardfail.2024.10.076","url":null,"abstract":"<div><h3>Background</h3><div>LBBAP results in greater electrical resynchronization than right ventricular apical pacing. The literature exploring the impact of LBBAP on QT interval is sparse, and may have impacts on anti-arrhythmic drug monitoring.</div></div><div><h3>Objective</h3><div>Establish differences in QT interval during native conduction (NC) and LBBAP following atrioventricular junction ablation to minimize confounding through fusion pacing.</div></div><div><h3>Methods</h3><div>Retrospective chart review of 34 consecutive patients who underwent LBBAP and subsequent AVJ. RR interval, QRS duration (QRSd), and QT intervals were measured from standard 12-lead ECG during native conduction and following LBBAP and AVJ. Linear regression models were used to estimate QT as a function of RR and correction of QTc as a function of change in QRSd.</div></div><div><h3>Results</h3><div>QRSd (ms) in the NC and LBBAP groups was 113±32 vs.135±18 (p&lt;0.01), respectively. Mean difference in QRSd with LBBAP was 22±35ms compared to NC. QT interval (ms) in the NC and LBBAP groups was 394±55 vs. 436±34 (p&lt;0.01), respectively. Mean QTc (ms, Bazzette's) in the NC and LBBAP groups was 478±43 vs. 504±38, respectively. Mean difference in QTc following LBBAP was 26±47ms compared to NC. QTc^NC could be modeled as QTc^NC = QTc^LBBAP - 0.792(QRSd^LBBAP-QRSd^NC) - 8.72. With mean difference QRSd of 22ms, this simplifies to QTc^NC = QTc^LBBAP - 26.14.</div></div><div><h3>Conclusion</h3><div>LBBAP significantly increases QRSd and QT intervals from native rhythm. Differences in linear regression between RR and QTc between LBBAP and NC can be explained changes in QRSd. Larger studies are required to improve the accuracy of the model.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 209-210"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated Donor-derived Cell-free Dna In Post-heart Transplant For Chagas Cardiomyopathy: A Case Study","authors":"Kayla Funk ,&nbsp;Abbey Hanks ,&nbsp;Shane Moore ,&nbsp;Shaun Cook ,&nbsp;Tonya Pullen ,&nbsp;Paulina Guajardo ,&nbsp;Cedric Spak ,&nbsp;Whitney Whitley","doi":"10.1016/j.cardfail.2024.10.060","DOIUrl":"10.1016/j.cardfail.2024.10.060","url":null,"abstract":"<div><h3>Introduction</h3><div>Chagas disease is caused by the parasite <em>Trypanosoma cruzi</em> (TC), transmitted via insect vectors most commonly found in Mexico, Central America, and South America, with ∼8 million current active cases. Heart transplantation (HT) can be lifesaving in patients developing severe cardiomyopathy due to Chagas cardiomyopathy (CC), with comparable survival to HT performed for other indications. However, patients are at risk for Chagas disease reactivation (CDR) as a consequence of immunosuppression following transplantation. Failure to identify CDR has been associated with severe or fatal outcomes. Herein, we describe a patient with a history of CC who underwent dd-cfDNA testing for rejection surveillance post HT.</div></div><div><h3>Methods</h3><div>A retrospective case report of a HT patient with a history of Chagas disease who was monitored for HT rejection using dd-cfDNA analysis using the Prospera^TM test (Natera Inc, Austin, TX).</div></div><div><h3>Results</h3><div>This is a 44 y/o Hispanic male post HT 11/25/2022 <strong>(Figure 1)</strong>. The patient was diagnosed with non-ischemic cardiomyopathy (NICM) in 2021 with an unclear etiology, however, reported “heart infection” at age 17 which was treated with antibiotics while living in El Salvador. Perioperative to HT, concomitant viral symptoms triggered an infectious disease consult. The patient was found to be positive for IgG TC antibodies while TC PCR was initially negative. The patient was treated with antibiotic therapies and the viral symptoms resolved. A stable postoperative course ensued. The patient underwent dd-cfDNA testing for rejection surveillance starting ∼1 month post HT. Rising trends in dd-cfDNA levels, above the patient's baseline dd-cfDNA% results (0.08%), and in one case above the 0.15% threshold for HT rejection risk, were noted between March and May 2023 (∼8 months post HT). However, there were no clinical/diagnostics suggestive for HT rejection. Notably, during this timeframe of rising dd-cfDNA%, a pre-scheduled followup of PCR testing for TC, came back positive. The patient remained asymptomatic and immunosuppressant regimen was modified; ultimately both dd-cfDNA% and TC PCR quiesced.</div></div><div><h3>Conclusions</h3><div>Transplant programs in the United States are being encouraged to implement a monitoring program for HT recipients with Chagas disease. This case suggests that the elevation of dd-cfDNA may have been a harbinger of CDR, however whether it was detecting Chagas related allograft injury is unknown. More research is needed on preemptive approaches for monitoring Chagas disease reactivation in patients undergoing HT.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Page 203"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}