Effect of impaired cardiac conduction after alcohol septal ablation on clinical outcomes: insights from the Euro-ASA registry

2018 ◽  
Vol 5 (3) ◽  
pp. 252-258 ◽  
Author(s):  
Morten Kvistholm Jensen ◽  
Lothar Faber ◽  
Max Liebregts ◽  
Jaroslav Januska ◽  
Jan Krejci ◽  
...  
Keyword(s):  
New York ◽  
Negative Impact ◽  
Nyha Class ◽  
Heart Association ◽  
Cardiac Conduction ◽  
Alcohol Septal Ablation ◽  
New York Heart Association ◽  
Symptomatic Outcome ◽  
The Impact

Abstract Aims We analysed the impact of bundle branch block (BBB) and pacemaker (PM) implantation on symptoms and survival after alcohol septal ablation (ASA) in patients with hypertrophic cardiomyopathy (HCM). Methods and results Among 1416 HCM patients from the Euro-ASA registry, 58 (4%) patients had a PM and 64 (5%) patients had an implantable cardioverter-defibrillator (ICD) before ASA. At latest follow-up (5.0 ± 4.0 years) after ASA, 118 (8%) patients had an ICD and 229 (16%) patients had a PM. In patients without an implantable device prior to ASA 13% had a PM and 5% had an ICD implanted following ASA. New onset BBB was present in 44% (right BBB in 31%) of patients without previous BBB. At latest follow-up, we found no associations between BBB and New York Heart Association (NYHA) Class 3–4 [odds ratio (OR) 0.98, 95% confidence interval (CI) 0.63–1.51; P = 0.91] or Canadian Cardiovascular Society (CCS) Class 3–4 (OR 1.5, CI 0.32–6.7; P = 0.62), respectively, and no associations between PM and NYHA Class 3–4 (OR 1.2, CI 0.70–2.0; P = 0.52) or CCS 3–4 (OR 1.3, CI 0.24–6.6; P = 0.79), respectively. The survival after ASA was not reduced in patients with BBB [hazard ratio (HR) 0.73, CI 0.53–1.01; P = 0.06] or PM (HR 0.78, CI 0.52–1.17; P = 0.24). Conclusions Development of BBB or need for a PM after ASA in patients with obstructive HCM was not associated with inferior symptomatic outcome or reduced survival, thus concerns for the negative impact of impaired cardiac conduction on the clinical outcome after ASA were not confirmed.

Parannular Elliptical Posterior Resection: A Low-Impact Reparative Technique for Mitral Valve Prolapse

2015 ◽  
Vol 10 (4) ◽  
pp. 252-257
Author(s):  
Uberto Da Col ◽  
Simone Perticoni ◽  
Enrico Ramoni
Keyword(s):  
New York ◽  
Mitral Valve ◽  
Heart Association ◽  
Safe Alternative ◽  
Mitral Prolapse ◽  
Association Class ◽  
New York Heart Association ◽  
Valve Function ◽  
The Impact

Objective Although effective, Carpentier technique for mitral regurgitation presents two “Achille's heel”: the resection of the whole prolapsing section of posterior mitral leaflet (PML) including chordae tendinae and the annular distortion due to plication. An alternative technique of limited PML resection, which preserves mitral anatomy decreasing the impact on valve function, and 9-year outcome are presented. Methods Since April 2005 till March 2014, of 205 patients affected by mitral prolapse scheduled for repair (mitral valve repair), 54 patients have been included in the study. The rationale of the new technique was to limit PML resection to achieve a fair reduction of the prolapsing scallop(s) height, to avoid leaflet and annular distortion, and to spare the coaptation surface and other substantial structures. According to the observation that the posterior smooth zone of PML is quite free from chordal insertions, an elliptical slice of tissue was resected from this area. Annuloplasty and neochordal insertion when indicated completed the procedure. Results Up to 9 years of follow-up was 98% complete. One inhospital death, two late noncardiac deaths, one redo operation due to endocarditis were reported. On late follow-up, 92% patients were on New York Heart Association class I. Late echocardiography showed stability of repair (regurgitation grade of ≤1 in 92% of patients). Nearly two third of valves preserved good PML mobility. Conclusions The parannular elliptical posterior leaflet resection, providing excellent stable midterm results, seems to be a safe alternative method for repair of PML prolapse. It avoids distortion and weakening of annulus and leaflet, and it allows restoring a proper coaptation surface and maintains a satisfactory PML motion.

Abstract 12817: Comparison of New York Heart Association Classification and Patient-reported Outcomes Among Heart Failure Patients in U.S. Clinical Practice: CHAMP-HF

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Stephen J Greene ◽  
Javed Butler ◽  
John Spertus ◽  
Muthiah Vaduganathan ◽  
Anne Hellkamp ◽  
...  
Keyword(s):  
New York ◽  
Clinical Practice ◽  
Lower Risk ◽  
Patient Reported Outcomes ◽  
Nyha Class ◽  
Heart Association ◽  
Risk Of Mortality ◽  
Patient Reported ◽  
New York Heart Association

Introduction: How the New York Heart Association classification system compares with patient-reported outcomes for HF patients in contemporary U.S. clinical practice is unclear. Methods: Among 2,872 U.S. outpatients with chronic HF with reduced ejection fraction (HFrEF) in the CHAMP-HF registry with complete NYHA class and Kansas City Cardiomyopathy Questionnaire Overall Score (KCCQ-OS) data at baseline and 12 months, longitudinal changes in the 2 measures and their correlation with each other were examined. Multivariable models landmarked at 12 months separately evaluated associations between improvement in NYHA and KCCQ-OS from baseline to 12 months with clinical outcomes occurring from months 12 through 24. Results: At 12-month follow-up, 65% of patients had no change in NYHA class, 18% had 1 class improvement, and 13% had 1 class worsening. For KCCQ-OS, 25% had no significant change (i.e., <5 point improvement or worsening), 48% had ≥5 point improvement, and 27% a ≥5 point worsening (Figure, Panel A) . NYHA class and KCCQ-OS showed modest correlation at baseline (r=0.33, p<0.01) and 12 months (r=0.33, p<0.01). After adjustment, improvement in NYHA class was not associated with 1-year mortality or composite mortality/ HF hospitalization ( Figure, Panel B) . For KCCQ-OS, ≥5-point improvement was independently associated with a 41% lower risk of mortality and a 27% lower risk of mortality/ HF hospitalization. Conclusions: In this contemporary U.S. outpatient HFrEF registry, as compared with NYHA class, the KCCQ-OS was substantially more likely to show meaningful change over 12-month follow-up and these changes had strong prognostic implications. These data support the advantages and relative importance of patient-reported outcomes for HFrEF, as compared with traditional clinician-reported functional assessments.

Illness Perception and Its Changes During Six Months After Cardiac Rehabilitation

2019 ◽  
Vol 26 (3) ◽  
pp. 90-100
Author(s):  
Justė Lukoševičiūtė ◽  
Kastytis Šmigelskas
Keyword(s):  
New York ◽  
Social Factors ◽  
Nyha Class ◽  
Illness Perception ◽  
Heart Association ◽  
Class Iii ◽  
Cognitive Representations ◽  
Coronary Syndrome ◽  
Type D ◽  
New York Heart Association

Abstract. Illness perception is a concept that reflects patients' emotional and cognitive representations of disease. This study assessed the illness perception change during 6 months in 195 patients (33% women and 67% men) with acute coronary syndrome, taking into account the biological, psychological, and social factors. At baseline, more threatening illness perception was observed in women, persons aged 65 years or more, with poorer functional capacity (New York Heart Association [NYHA] class III or IV) and comorbidities ( p < .05). Type D personality was the only independent factor related to more threatening illness perception (βs = 0.207, p = .006). At follow-up it was found that only self-reported cardiovascular impairment plays the role in illness perception change (βs = 0.544, p < .001): patients without impairment reported decreasing threats of illness, while the ones with it had a similar perception of threat like at baseline. Other biological, psychological, and social factors were partly associated with illness perception after an acute cardiac event but not with perception change after 6 months.

scholarly journals Long‐Term Outcome of Patients With Congenital Heart Disease Undergoing Cardiac Resynchronization Therapy

2021 ◽  
Author(s):  
Peter Kubuš ◽  
Jana Rubáčková Popelová ◽  
Jan Kovanda ◽  
Kamil Sedláček ◽  
Jan Janoušek
Keyword(s):  
New York ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Heart Association ◽  
Cardiac Resynchronization ◽  
New York Heart Association ◽  
Crt Response

Background Cardiac resynchronization therapy (CRT) is rarely used in patients with congenital heart disease, and reported follow‐up is short. We sought to evaluate long‐term impact of CRT in a single‐center cohort of patients with congenital heart disease. Methods and Results Thirty‐two consecutive patients with structural congenital heart disease (N=30) or congenital atrioventricular block (N=2), aged median of 12.9 years at CRT with pacing capability device implantation, were followed up for a median of 8.7 years. CRT response was defined as an increase in systemic ventricular ejection fraction or fractional area of change by >10 units and improved or unchanged New York Heart Association class. Freedom from cardiovascular death, heart failure hospitalization, or new transplant listing was 92.6% and 83.2% at 5 and 10 years, respectively. Freedom from CRT complications, leading to surgical system revision (elective generator replacement excluded) or therapy termination, was 82.7% and 72.2% at 5 and 10 years, respectively. The overall probability of an uneventful therapy continuation was 76.3% and 58.8% at 5 and 10 years, respectively. There was a significant increase in ejection fraction/fractional area of change ( P <0.001) mainly attributable to patients with systemic left ventricle ( P =0.002) and decrease in systemic ventricular end‐diastolic dimensions ( P <0.05) after CRT. New York Heart Association functional class improved from a median 2.0 to 1.25 ( P <0.001). Long‐term CRT response was present in 54.8% of patients at last follow‐up and was more frequent in systemic left ventricle ( P <0.001). Conclusions CRT in patients with congenital heart disease was associated with acceptable survival and long‐term response in ≈50% of patients. Probability of an uneventful CRT continuation was modest.

Real-Time Three-Dimensional Echocardiographic Study of Left Ventricular Function After Infarct Exclusion Surgery for Ischemic Cardiomyopathy

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Jian Xin Qin ◽  
Takahiro Shiota ◽  
Patrick M. McCarthy ◽  
Michael S. Firstenberg ◽  
Neil L. Greenberg ◽  
...  
Keyword(s):  
New York ◽  
Ischemic Cardiomyopathy ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Before And After ◽  
Infarct Exclusion ◽  
New York Heart Association ◽  
Lv Volume

Background —Infarct exclusion (IE) surgery, a technique of left ventricular (LV) reconstruction for dyskinetic or akinetic LV segments in patients with ischemic cardiomyopathy, requires accurate volume quantification to determine the impact of surgery due to complicated geometric changes. Methods and Results —Thirty patients who underwent IE (mean age 61±8 years, 73% men) had epicardial real-time 3-dimensional echocardiographic (RT3DE) studies performed before and after IE. RT3DE follow-up was performed transthoracically 42±67 days after surgery in 22 patients. Repeated measures ANOVA was used to compare the values before and after IE surgery and at follow-up. Significant decreases in LV end-diastolic (EDVI) and end-systolic (ESVI) volume indices were apparent immediately after IE and in follow-up (EDVI 99±40, 67±26, and 71±31 mL/m 2 , respectively; ESVI 72±37, 40±21, and 42±22 mL/m 2 , respectively; P <0.05). LV ejection fraction increased significantly and remained higher (0.29±0.11, 0.43±0.13, and 0.42±0.09, respectively, P <0.05). Forward stroke volume in 16 patients with preoperative mitral regurgitation significantly improved after IE and in follow-up (22±12, 53±24, and 58±21 mL, respectively, P <0.005). New York Heart Association functional class at an average 285±144 days of clinical follow-up significantly improved from 3.0±0.8 to 1.8±0.8 ( P <0.0001). Smaller end-diastolic and end-systolic volumes measured with RT3DE immediately after IE were closely related to improvement in New York Heart Association functional class at clinical follow-up (Spearman’s ρ=0.58 and 0.60, respectively). Conclusions —RT3DE can be used to quantitatively assess changes in LV volume and function after complicated LV reconstruction. Decreased LV volume and increased ejection fraction imply a reduction in LV wall stress after IE surgery and are predictive of symptomatic improvement.

scholarly journals Effects of Oral Amino Acid Supplements on Functional Capacity in Patients with Chronic Heart Failure

2014 ◽  
Vol 8 ◽  
pp. CMC.S14016 ◽  
Author(s):  
Carlo Lombardi ◽  
Valentina Carubelli ◽  
Valentina Lazzarini ◽  
Enrico Vizzardi ◽  
Filippo Quinzani ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
New York ◽  
Functional Capacity ◽  
Exercise Tolerance ◽  
Stress Test ◽  
Nyha Class ◽  
Heart Association

Amino acids (AAs) availability is reduced in patients with heart failure (HF) leading to abnormalities in cardiac and skeletal muscle metabolism, and eventually to a reduction in functional capacity and quality of life. In this study, we investigate the effects of oral supplementation with essential and semi-essential AAs for three months in patients with stable chronic HF. The primary endpoints were the effects of AA's supplementation on exercise tolerance (evaluated by cardiopulmonary stress test and six minutes walking test (6MWT)), whether the secondary endpoints were change in quality of life (evaluated by Minnesota Living with Heart Failure Questionnaire—MLHFQJ and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. We enrolled 13 patients with chronic stable HF on optimal therapy, symptomatic in New York Heart Association (NYHA) class II/III, with an ejection fraction (EF) <45%. The mean age was 59 ± 14 years, and 11 (84.6%) patients were male. After three months, peak VO2 (baseline 14.8 ± 3.9 mL/minute/kg vs follow-up 16.8 ± 5.1 mL/minute/kg; P = 0.008) and VO2 at anaerobic threshold improved significantly (baseline 9.0 ± 3.8 mL/minute/kg vs follow-up 12.4 ± 3.9 mL/minute/kg; P = 0.002), as the 6MWT distance (baseline 439.1 ± 64.3 m vs follow-up 474.2 ± 89.0 m; P = 0.006). However, the quality of life did not change significantly (baseline 21 ± 14 vs follow-up 25 ± 13; P = 0.321). A non-significant trend in the reduction of NT-proBNP levels was observed (baseline 1502 ± 1900 ng/L vs follow-up 1040 ± 1345 ng/L; P = 0.052). AAs treatment resulted safe and was well tolerated by all patients. In our study, AAs supplementation in patients with chronic HF improved exercise tolerance but did not change quality of life.

Serum Neopterin - Possible Marker to Predict Progression of Dilated Cardiomyopathy

Pteridines ◽  
1990 ◽  
Vol 2 (3) ◽  
pp. 165-167
Author(s):  
Mikhail Samsonov ◽  
Eugeney Nassonov ◽  
Valerei Masenko ◽  
Vladimir Naumov ◽  
Vjacheslav Mareev ◽  
...  
Keyword(s):  
New York ◽  
Dilated Cardiomyopathy ◽  
Clinical Diagnosis ◽  
Nyha Class ◽  
Heart Association ◽  
Serum Neopterin ◽  
Neopterin Level ◽  
Neopterin Concentration ◽  
New York Heart Association ◽  
Group 2

Summary Fifteen patients with clinical diagnosis of dilated cardiomyopathy (DCMP) were followed for 3 to 34 months. Serum neopterin and β2-microglobulin concentrations were measured by radioimmunoassay. According to the changes of neopterin and β2microglobulin levels in the follow-up study patients were divided into three groups. The course of disease in group 1 (5 patients with constant normal neopterin level <9 nmol/L) during the study) was stable without deterioration and increase of New York Heart Association (NYHA) Class. In group 2 (2 patients with raised neopterin in levels at the beginning of the study) some clinical improvement was associated with normalization of neopterin concentration. In group 3 (8 patients) the relation between the disease progression and increasing neopterin level was observed. The data of this study clearly indicated that neopterin measurements had a predictive value in patients with clinical diagnosis of DCMP.

scholarly journals The outcome of pulmonary hypertension and its association with pulmonary artery dilatation

2020 ◽  
Vol 28 (12) ◽  
pp. 645-655 ◽  
Author(s):  
A. L. Duijnhouwer ◽  
J. Lemmers ◽  
J. Smit ◽  
J. van Haren-Willems ◽  
H. Knaapen-Hans ◽  
...  
Keyword(s):  
New York ◽  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Nyha Class ◽  
Heart Association ◽  
Elevated Pressure ◽  
Walking Distance ◽  
Class Iii ◽  
Tertiary Centre ◽  
New York Heart Association

Abstract Background Pulmonary artery (PA) dilatation is often seen in pulmonary hypertension (PH) and is considered a long-term consequence of elevated pressure. The PA dilates over time and therefore may reflect disease severity and duration. Survival is related to the stage of the disease at the time of diagnosis and therefore PA diameter might be used to predict prognosis. This study evaluates the outcome of patients with pulmonary arterial hypertension (PAH) and chronic thrombo-embolic pulmonary hypertension (CTEPH) and investigates whether PA diameter at the time of diagnosis is associated with mortality. Methods Patients visiting an outpatient clinic of a tertiary centre between 2004 and 2018 with a cardiac catheterisation confirmed diagnosis of PAH or CTEPH and a CT scan available for PA diameter measurement were included. PA diameter and established predictors of survival were collected (New York Heart Association (NYHA) class, N‑terminal pro-brain natriuretic peptide (NT-proBNP) level and 6‑min walking distance (6MWD)). Results In total 217 patients were included (69% female, 71% NYHA class ≥III). During a median follow-up of 50 (22–92) months, 54% of the patients died. Overall survival was 87% at 1 year, 70% at 3 years and 58% at 5 years. The mean PA diameter was 34.2 ± 6.2 mm and was not significantly different among all the diagnosis groups. We found a weak correlation between PA diameter and mean PA pressure ( r = 0.23, p < 0.001). Male sex, higher age, shorter 6MWD and higher NT-proBNP level were independently associated with mortality, but PA diameter was not. Conclusion The prognosis of PAH and CTEPH is still poor. Known predictors of survival were confirmed, but PA diameter at diagnosis was not associated with survival in PAH or CTEPH patients.

Epirubicin (E) cardiac toxicity: A retrospective analysis of 1,097 patients (pts) treated for metastatic breast cancer (MBC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 1029-1029
Author(s):  
M. Ryberg ◽  
D. L. Nielsen ◽  
G. Cortese ◽  
G. Nielsen ◽  
P. K. Andersen ◽  
...  
Keyword(s):  
New York ◽  
Cumulative Dose ◽  
Cardiac Disease ◽  
Nyha Class ◽  
Performance Status ◽  
Metastatic Breast ◽  
Heart Association ◽  
Duration Of Treatment ◽  
X Ray ◽  
New York Heart Association

1029 Background: The object of the study was to conduct an analysis and assess a recommended cumulative dose of E corresponding to a 5 % risk for cardiotoxicity taking into account: dose administrations, concurrent risk of dying of MBC and possible predictors of cardiotoxicity. Methods: Data from 1097 consecutive anthracycline naïve pts was retrieved. Pts developing cardiac heart failure according to New York Heart Association (NYHA) Class =II were recorded as having E cardiotoxicity. Statistics: two extended Cox multivariate analysis (events: cardiotoxicity and mortality of MBC) followed by competing risk analysis. Results: 125 pts (11.4%) developed cardiotoxicity. Predictors for increasing the cardiotoxicity hazard ratio (HR) were: 1. cumulative dose of E: as the rate increased with 37% per every 100 mg/m2 E, when given as first line treatment for advanced disease, 2. increasing age as the rate increased with 28.7 % per additional 10 year, 3. x-ray including the heart (HR=2.08), 4. tamoxifen for relapse (HR=1.87), 5. pre-disposition to cardiac disease (HR=3.01). Mortality rate for MBC: the survival was significant lower in pts with increasing tumour burden, poorer performance status, previous adjuvant CMF, and with increasing age. The HR for mortality was significantly increased by increased duration of treatment with E and was highest in the first three months than later on. The risk of cardiotoxicity increased mostly during the first 8 months after cessation of E nearly becoming constant later on. The cumulative dose of E corresponding to a 5 % cardiotoxicity risk was found to be both significantly lower than previously assumed (900 mg/m2) and depend on predictors for mortality and cardiotoxicity. Thus, a pts with no predictors at age 40 the level of 5% risk was 806 mg/m2, at age 50 = 739 mg/m2, at age 60 = 673 mg/m2 and at age 70 = 609 mg/m2. Conclusion: The risk of cardiotoxicity of E was more pronounced than expected and occurred on a much lower cumulative dose of E. Increasing age, x-ray, tamoxifen and pre-disposition to cardiac disease contributed significantly to this. No significant financial relationships to disclose.

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