New guidelines for the heart failure treatment (2021)

At this year’s ESC congress in London, it was announced an update of the guidelines for the treatment of chronic heart failure with reduced left ventricular ejection fraction. Key change compared to last guidelines is withdrawal the long-term titration strategy and introducing a simpler and faster regimen based on four groups of drugs: blocking the renin–angiotensin–aldosterone system (ACE-I, ARNI), sodium-glucose co-transporter inhibitors (dapagliflozin, empagliflozin), β-adrenolytic drugs, mineralocorticoid receptor inhibitors.

Clinical, paraclinical characteristics and real –world treatment of acute heart failure at Hanoi Heart Hospital

Background: At Hanoi Heart Hospital, in recent years, along with the development of science and technology, the development of modern treatment measures such as percutaneous coronary intervention, coronary artery bypass surgery, heart valve replacement ... helped save the lives of many patients. However, these patients still require continued treatment for heart failure as a complication of the primary illness and thus also increase the number of patients with heart failure, both acute and decompensated. Objective: “Describe the clinical and subclinical characteristics of hospitalized patients with acute heart failure and the status of heart failure treatment according to current heart failure treatment guidelines at Hanoi Heart Hospital”. Method: Cross-sectional, prospective, descriptive analysis with convenient sample size. Results: From January 2018 to december 2018, 475 patients were hospitalized due to acute heart failure or decompensation ,63,8% male and 36, 2% female. Mean age 69,1 ± 13,8; 63,6% newly discovered heart failure; 41,4% EF 40 – 50% and 58,6% EF < 40%; number of Hopital days 8.3 ± 6.2 days(( 1- 46 days); there are five (1.1%) patients died in hospital; among them a patient who was treated for one day due to severe illness died; we have used interventions, assisted circulation and respiration such as CRT, CRT-D, CVVH, IABP, atrial septal defect and ECMO. Conclusion: Results of treatment of acute heart failure at Hanoi Heart Hospital is feasible with rate of discharge is 87,7%.

Mitral regurgitation severity dynamic during acute decompensated heart failure treatment

Acute decompensated heart failure (ADHF) treatment leads to significant hemodynamic changes. The aim of our study was to quantitatively analyze the dynamics of mitral regurgitation (MR) severity (evaluated by transthoracic echocardiography) which occur during the treatment of ADHF and to correlate these changes with the clinical condition of patients as well as heart failure biochemical markers. The study included 27 consecutive adult patients (40.7% females, mean age 71.19 ± 11.2 years) who required hospitalization due to signs of acute HF. Echocardiographic assessment was performed upon admission and discharge together with clinical and laboratory evaluation. Significant reduction in dyspnea intensity [0–100 scale] (81.48 ± 9.07 vs. 45.00 ± 11.04 pts, p < 0.001), body weight (84.98 ± 18.52 vs. 79.77 ± 17.49 kg, p < 0.001), and NT-proBNP level (7520.56 ± 5288.62 vs. 4949.88 ± 3687.86 pg/ml, p = 0.001) was found. The severity of MR parameters decreased significantly (MR volume 44.92 ± 22.83 vs. 30.88 ± 18.77 ml, p < 0.001; EROA 0.37 ± 0.17 vs. 0.25 ± 0.16 cm2, p < 0.001; VC 6.21 ± 1.48 vs. 5.26 ± 1.61 mm, p < 0.001). Left atrial area (35.86 ± 9.11 vs. 32.47 ± 9.37, p < 0.001) and mitral annular diameter (42.33 ± 6.63 vs. 39.72 ± 5.05. p < 0.001) also underwent statistically significant reductions. An increase in LVEF was observed (34.73 ± 13.88 vs. 40.24 ± 13.19%, p < 0.001). In 40.7% of patients, a change in MR severity class (transition from a higher class to a lower one) was observed: 6/8 (75%) patients transitioned from severe to moderate and 6/18 (33.3%) patients transitioned from moderate to mild class. Treatment of ADHF leads to a significant reduction in MR severity, together with significant reductions in left atrial and mitral annular dimensions. Quantitative measurement of MR dynamics offer valuable assistance for ADHF management.

Multiparameter Monitoring with a Wearable Cardioverter Defibrillator

A wearable cardioverter-defibrillator (WCD) is a temporary treatment option for patients at high risk for sudden cardiac death (SCD) and for patients who are temporarily not candidates for an implantable cardioverter defibrillator (ICD). In addition, the need for telemedical concepts in the detection and treatment of heart failure (HF) and its arrhythmias is growing. The WCD has evolved from a shock device detecting malignant ventricular arrhythmias (VA) and treating them with shocks to a heart-failure-monitoring device that captures physical activity and cardioacoustic biomarkers as surrogate parameters for HF to help the treating physician surveil and guide the HF therapy of each individual patient. In addition to its important role in preventing SCD, the WCD could become an important tool in heart failure treatment by helping prevent HF events by detecting imminent decompensation via remote monitoring and monitoring therapy success.

A Case of High Dose Metoprolol Poisoning; Case Report and Literature Review

β-Blockers are prescribed by physicians for many medical reasons (hypertension, long-term prophylaxis of angina pectoris, myocardial infarction, stable heart failure treatment, cardiac arrhythmias, etc.). Although cases of β-blocker poisoning have a low rate of 0.9% among all poisoning cases, they have a high mortality rate. In β-blocker poisoning with high lipid solubility; seizures, respiratory depression, coma, resistant bradycardia-hypotension and shock may occur. Metoprolol, a type of β-blocker, is a selective β1-adrenoceptor antagonist with sympathomimetic effect. It is also reported that metoprolol is the 2nd most commonly prescribed β-blocker after bisoprolol all over the world. This article aims to present a case who took high-dose metoprolol for suicidal purposes and to examine metoprolol poisoning and its treatment in the light of current literature.

Heart failure on peritoneal dialysis: Where do we stand?

Cardiovascular disease continues to be the most frequent cause of death in peritoneal dialysis patients and an important obstacle for the improvement of technique survival. Heart failure diagnosis and management is particularly challenging among dialysis patients, and this condi‑ tion remains underdiagnosed and undertreated in this population. The most common phenotype of heart failure among peritoneal dialysis patients is heart failure with preserved ejection fraction, diastolic disfunction and left ventricular hypertrophy. Unfortunately, unlike what happens with heart failure with reduced ejection fraction, there is lack of evidence to support a specific drug regimen to treat heart failure with preserved ejection fraction. Several conditions associated with end stage kidney disease, such as anemia, hyperphosphatemia, secondary hyperparathyroidism, inflammation, and insulin resistance seem to be involved in the pathogenesis of heart failure with preserved ejection fraction and for this reason, the term uremic cardiomyopathy has been proposed. There is a lack of evidence regarding the optimal heart failure treatment for peritoneal dialysis patients and more studies are needed to assess the efficacy and safety of the new drugs available for heart failure treatment. This review explores the spectrum of heart failure on peritoneal dialysis, its pathogenesis, risk factors and possible therapeutic and preventive measures.

Mitral Regurgitation Severity Dynamic During Acute Decompensated Heart Failure Treatment.

Purpose: Acute decompensated heart failure (ADHF) treatment leads to significant hemodynamic changes. The aim of our study was to quantitatively analyze the dynamics of mitral regurgitation (MR) severity (evaluated by transthoracic echocardiography) which occur during the treatment of ADHF and to correlate these changes with the clinical condition of patients as well as heart failure biochemical markers. Methods: The study included 27 consecutive adult patients (40.7% females, mean age 71.19±11.2 years) who required hospitalization due to signs of acute HF. Echocardiographic assessment was performed upon admission and discharge together with clinical and laboratory evaluation. Results: Significant reduction in dyspnea intensity [0-100 scale] (81.48±9.07 vs. 45.00±11.04 pts, p<0.001), body weight (84.98±18.52 vs. 79.77±17.49 kg, p<0,001), and NT-proBNP level (7520.56±5288.62 vs. 4949.88±3687.86 pg/ml, p=0.001) was found. The severity of MR parameters decreased significantly (MR volume 44.92±22.83 vs. 30.88±18.77 ml, p<0.001; EROA 0.37±0.17 vs. 0.25±0.16 cm2, p<0.001; VC 6.21±1.48 vs. 5.26±1.61 mm, p<0.001). Left atrial area (35.86±9.11 vs. 32.47±9.37, p<0.001) and mitral annular diameter (42.33±6.63 vs. 39.72±5.05. p<0.001) also underwent statistically significant reductions. An increase in LVEF was observed (34.73±13.88 vs. 40.24±13.19 %, p<0.001). In 40.7% of patients, a change in MR severity class (transition from a higher class to a lower one) was observed: 6/8 (75%) patients transitioned from severe to moderate and 6/18 (33.3%) patients transitioned from moderate to mild class.Conclusions: Treatment of ADHF leads to a significant reduction in MR severity, together with significant reductions in left atrial and mitral annular dimensions. Quantitative measurement of MR dynamics offer valuable assistance for ADHF management.