Cardiology

Lajos, P., R. Bangiyev, S. Safir, A. Weinberg, A. Vouyouka, P. Faries and R. Reddy (2021). “Placement of Simultaneous Inferior Vena Cava Filter During Emergent Open Pulmonary Thromboembolectomy.” Surg Technol Int Oct 13;39:sti39/1486. [Epub ahead of print].

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BACKGROUND: This study retrospectively reviewed results of simultaneous (SIM) inferior vena cava (IVC) filter and separate (SEP) IVC filter placement with open pulmonary thromboembolectomy (PTE) in pulmonary embolism and its clinical outcomes. MATERIALS AND METHODS: From November 2006 to May 2014, 23 patients (14 females and 9 males; median age 58 years; range, 21-88 years) underwent emergent PTE for submassive (12) or massive (11) pulmonary embolism (PE). All had a preoperative computed tomography (CT) scan and echocardiography consistent with right ventricular (RV) strain. Mean cardiopulmonary bypass times and temperatures; chest tube outputs; length of stay; perioperative complications; and survival were compared between groups. RESULTS: There were 13 patients in the SIM group and 10 in the SEP group. PE consisted of 14 acute (60.9%) and nine acute on chronic (39.1%). There were seven deaths (30.4%). Median follow up was 44 days (range, 2-2204 days). Follow up was 81% complete in surviving patients. Actuarial survival at one and three years was 83% for the SIM group and 43% for the SEP group, respectively. There were no differences in cardiopulmonary bypass (CPB) times and temperatures, chest tube outputs, or length of stay between groups. Using multivariable logistic regression, we found SIM was associated with increased survival (p=0.09). Further analysis showed patients >55 years in the SEP group were at significantly higher risk of death (hazard ratio [HR]=7.1:1; 95% confidence interval [CI]: 1.55, 32.5, p=0.011). CONCLUSION: IVC filter placement can be performed simultaneously and safely at PTE. Age >55 years and PTE with IVC filter placed separately were at significantly higher risk of death. A larger cohort is needed to evaluate efficacy of simultaneous IVC filter placement and PTE.

Packer, M., F. Zannad and S. D. Anker (2021). “Heart Failure and a Preserved Ejection Fraction: A Side-by-Side Examination of the PARAGON-HF and EMPEROR-Preserved Trials.” Circulation 144(15): 1193-1195.

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Heart failure and a preserved ejection fraction (HFpEF) is characterized in many patients by the coexistence of a systemic metabolic or inflammatory disorder that causes coronary endothelial dysfunction, microvascular rarefaction, and cardiac fibrosis, leading to impaired left ventricular distensibility. Neurohormonal antagonists that are effective in patients with heart failure and a reduced ejection fraction have generally not been useful in patients with HFpEF. Until recently, large-scale trials of patients with HFpEF have reported no benefit or only a modest reduction in the risk of heart failure outcomes, with borderline levels of statistical significance. The trials have also noted meaningful subgroup interactions, which have further complicated interpretation of the results.[No abstract; excerpt from article].

Tromp, J., M. Packer and C. S. Lam (2021). “The diverging role of epicardial adipose tissue in heart failure with reduced and preserved ejection fraction: not all fat is created equal.” Eur J Heart Fail Oct 16. [Epub ahead of print].

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In this issue of the Journal, the study by Pugliese et al. significantly extends prior knowledge on the role of EAT in HF by studying the association of EAT with clinical biomarkers and outcomes in patients with HFrEF and HFpEF. The authors measured EAT thickness on echocardiography in a total of 393 patients with HF (48% HFpEF) and 44 controls. The HF diagnosis in participants was corroborated by objective signs and symptoms of HF, a reduced ejection fraction or increased natriuretic peptides. All participants underwent comprehensive exercise testing with measurement of peak oxygen consumption (VO2 max) and arterial–venous oxygen content difference (AVO2diff) and were followed up for 21 months. EAT thickness was significantly increased in patients with HFpEF relative to controls and decreased in patients with HFrEF. In HFrEF, EAT was inversely associated with the inflammatory biomarkers high-sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), N-terminal pro-B-type natriuretic peptide and troponin T. In HFpEF, thicker EAT was associated with higher concentrations of troponin T, hs-CRP, and IL-6. Notably, thinner EAT was associated with worse (lower) VO2 max and an increased risk for cardiovascular death or hospitalization for HF in HFrEF. In HFpEF, the converse was true: thicker EAT was associated with a decreased VO2 max and increased risk for cardiovascular death or hospitalization for HF.

Packer, M., J. Butler, F. Zannad, S. J. Pocock, G. Filippatos, J. P. Ferreira, M. Brueckmann, W. Jamal, C. Zeller, C. Wanner and S. D. Anker (2021). “Empagliflozin and Major Renal Outcomes in Heart Failure.” N Engl J Med 385(16): 1531-1533.

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Sodium–glucose cotransporter 2 inhibitors reduce the risk of serious adverse renal outcomes in type 2 diabetes, but the renal effects of these drugs in patients with heart failure remain uncertain. Although empagliflozin and dapagliflozin have been reported to slow the rate of decline in the estimated glomerular filtration rate (eGFR), changes in the eGFR slope may not predict the effects of these drugs on major renal outcomes. [No abstract, excerpt from article].

Brown, K. D., J. S. van Zyl, B. da Graca, J. Adams and D. M. Meyer (2021). “Keep Your Move in the Tube® Method and Self-Confidence After Coronary Artery Bypass Graft Surgery.” J Cardiopulm Rehabil Prev 41(6): 438-440.

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Keep Your Move in the Tube® (KMIT) methodology, described in detail elsewhere, allows patients to perform load-bearing tasks after median sternotomy (MS) previously contraindicated by sternal precautions (SP). Utilizing KMIT is associated with improved discharge disposition and reduced difficulty performing functional tasks following discharge without increased incidence of sternal complications or readmissions. However, the impact of KMIT on patient perceptions of their ability to perform essential activities during the acute post-operative period has yet to be investigated. Psychological recovery, specifically self-confidence, has been suggested to be a key factor in the successful return to function after MS. This study aimed to investigate self-rated confidence in performing upper-body functional activities prior to and after KMIT education in patients following coronary artery bypass graft (CABG) surgery via MS. Our secondary aim was to compare the force exerted by the upper body when performing KMIT activities with the load limit typically prescribed under SP (5 lb). [no abstract; excerpt from article].