Category: Volume 1 Number 1

Mechanical Circulatory Support for the Failing Heart

Mechanical Circulatory Support for the Failing Heart: Which Device to Choose

Authors: Ahmed, Mustafa; Alvarez, Rene

Critical cardiogenic shock remains a problem with staggering mortality, with the best hope of survival depending on timely and aggressive intervention. This often requires the use of extracorporeal mechanical support in addition to vasoactive medications to manage patients through their initial insult. The decision to use such support must be made early in the clinical presentation, and is best done in a multidisciplinary fashion. In this article, we review the literature and provide an algorithm for the treatment of cardiogenic shock.

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Continuous Flow Left Ventricular Assist Device Therapy

Continuous Flow Left Ventricular Assist Device Therapy: A Focused Review on Optimal Patient Selection and Long-Term Follow-up Using Echocardiography

Authors: Vilaro, Juan R.; Szady, Anita; Ahmed, Mustafa M.; Dawson, Jacqueline; Aranda, Juan M.

Despite widespread awareness and use of scientifically proven life-prolonging medical and device-based therapies over the last two decades, heart failure remains a leading cause of morbidity, mortality, and health care expenditure in the United States. Mechanical circulatory support with a continuous-flow left ventricular assist device (CF-LVAD), either as a bridge to heart transplantation or as destination therapy, is an increasingly used treatment modality for patients with advanced heart failure syndromes that worsen despite their receiving standard therapies. CF-LVAD support creates unique hemodynamic alterations that must be understood to provide appropriate care for these patients before and after implantation. Echocardiography is essential in the evaluation of patients who are being considered for or are mechanically supported by CF-LVADs. Here we provide a focused clinical review on the use of echocardiography in two main aspects of the evaluation of these patients: (a) optimal patient selection for CF-LVAD support and (b) follow-up assessment of optimal pump function.

Document Type: Research Article

DOI: http://dx.doi.org/10.15212/CVIA.2015.0013

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Cardiac Resynchronization Therapy

Cardiac Resynchronization Therapy in 2015: Lessons Learned

Authors: Ketha, Siva; Kusumoto, Fred M.

Over 20 years of research has led to the now widely accepted role of cardiac resynchronization therapy (CRT) in medically refractory, mild to severe systolic heart failure (HF) with increased QRS duration. In addition to conferring a mortality benefit, CRT has been shown to reduce HF hospitalization rates and improve functional status in this population. However, not all patients consistently demonstrate a positive response to CRT. Efforts to improve response to CRT have focused on improving patient selection and optimizing device implantation and follow-up, thereby correcting electrical and mechanical dyssynchrony. In this article we review the pathobiology of cardiac dyssynchrony, the rationale for the use of CRT, the history and the state of the art of CRT, and guidelines and recommendations for CRT, while also focusing on the areas of controversy and potential future applications.

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Pulmonary Arterial Hypertension

Pulmonary Arterial Hypertension and the Failing Ventricle: Getting It Right

Authors: Mandras, Stacy A.; Oleck, Sylvia; Ventura, Hector O.

Right ventricular failure (RVF) remains the primary cause of death in patients with pulmonary arterial hypertension. We review the pathophysiology of RVF, including the remodeling and ventriculoarterial uncoupling that occurs when the failing right side of the heart is unable to compensate for a rising afterload. Secondly, the noninvasive imaging techniques used in the assessment of RVF are explored, including echocardiography, cardiac magnetic resonance imaging, computed tomography, and positron emission tomography. Third, we describe how these imaging techniques and a patient’s clinical characteristics may be used to determine prognosis. Lastly, we explore the medical and surgical/interventional treatment options for RVF. Despite these treatment options, morbidity and mortality remain high in this patient population. The discovery of new prognostic indicators, use of hybrid imaging for early detection of RVF, and strategies to prevent the development of RVF will be important if outcomes in this patient population are to improve.

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Evaluation of the Heart Failure Patient by Echocardiography

The Evaluation of the Heart Failure Patient by Echocardiography: Time to go beyond the Ejection Fraction

Authors: Dowe, Jacqueline Dawson; Vilaro, Juan; Hamilton, Karen; Szady, Anita; Aranda, Juan M.

Heart failure is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. The echocardiogram is the single most performed and useful study in these patients. This article reviews the role of the echocardiogram in the evaluation of the heart failure patient, without focusing on the left ventricle. The discussion includes the use of the echocardiogram in the assessment of the right ventricle and diastolic function and in detecting hemodynamic and morphologic changes in heart failure over a period of time. In addition, we highlight some of the limitations of echocardiography in the assessment of these patients.

Document Type: Research Article

DOI: http://dx.doi.org/10.15212/CVIA.2015.0008

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Noninvasive Hemodynamic Monitoring for Heart Failure

Noninvasive Hemodynamic Monitoring for Heart Failure: A New Era of Heart Failure Management

Authors: Hernandez, Gabriel A.; Navas, Viviana; Chaparro, Sandra

Despite the development of noninvasive tools as echocardiography, right-sided heart catheterization remains an integral part of the cardiovascular evaluation. In the last decade, better understanding of the hemodynamic process before heart failure decompensation led to improvement of outpatient strategies to prevent it. Advances in implantable wireless technology now allow frequent and direct measurement of intracardiac filling pressures, which can be monitored by health care providers to help tailor therapy to reduce filling pressures and hospital readmission rates.

Document Type: Research Article

DOI: http://dx.doi.org/10.15212/CVIA.2015.0009

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Epidemiological Study of Heart Failure in China

Epidemiological Study of Heart Failure in China

Authors: Guo, Yang; Zhao, Dong; Liu, Jing

Heart failure (HF) is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. HF is one of the most important and severe end stages of many cardiovascular diseases. Epidemiological studies of HF have focused mainly on the prevalence, incidence, mortality, fatality, and distribution and temporal trends of these indicators among different populations. This review highlights important epidemiological studies of HF in China.

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Cardiac Sarcoidosis

Cardiac Sarcoidosis: Sorting Fact from Fiction in This Rare Cardiomyopathy

Authors: Rajapreyar, Indranee; Langlois, Elizabeth

Sarcoidosis is a rare condition of granulomatous infiltration of many tissues of the body, including the heart. Cardiac sarcoidosis has been challenging to study, as it is often asymptomatic, although the initial presentation can be sudden cardiac death. The incidence and prevalence rates have been difficult to establish and no expert agreed upon guidelines for diagnosis and management of cardiac sarcoidosis exist, and clinical manifestations are varied. The pathophysiology of granuloma formation in the myocardium as well as other tissues is governed by immune response to some environmental antigen. Genetics is also thought to play a role, although gene alterations have not been extensively studied, and no specific set of genetic mutations has been identified to aid in identification of individuals at risk of developing disease. Epigenetic factors likely play a significant role in modulation of gene expression with respect to immune response. There is no standardized screening tool for the identification of cardiac sarcoidosis. The presence of systemic sarcoidosis and new-onset third-degree heart block or ventricular arrhythmias warrants further investigation for cardiac sarcoidosis. MRI and PET are useful in helping to identify cardiac sarcoidosis but are not stand-alone tests. Endomyocardial biopsy is the gold standard but has a low yield owing to the patchy nature of granuloma formation in the myocardium. Therapy should be instituted early and involves immunosuppressive therapy with predominant use of corticosteroids. Arrhythmias, either ventricular or high-grade heart blocks, are managed with device therapy. Clinical presentation may warrant use of antiarrhythmic agents and/or catheter ablation. Survival and disease prognosis are dependent on early diagnosis and treatment. This review details the current understanding of cardiac sarcoidosis and highlights diagnostic strategies and treatment with the aim of guiding the clinician to early identification of patients and implementation of appropriate management in this rare disease entity.

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Unusual Cardiomyopathies

Unusual Cardiomyopathies: Some May Be More Usual Than Previously Thought and Simply Underdiagnosed

Author: Smart, Frank W.

Heart failure is the most common cause of hospitalization in the United States. Just as the prevalence of heart failure has increased, the number of diseases identified that result in the heart failure syndrome has escalated. Certain cardiomyopathies that have previously been regarded as very rare are being recognized with increasing frequency, because of improved imaging techniques and an increased understanding of the pathophysiologic mechanisms that result in these diseases. Improved echocardiographic techniques and methods such as spectral Doppler and 3D image rendering, along with the use of advanced diagnostic tools such as cardiac CT angiography and cardiac magnetic resonance imaging are now common. These advanced imaging methods have led to an increased appreciation of the frequency of diseases such as isolated left ventricular noncompaction and cardiac amyloidosis. Left ventricular noncompaction, once thought to occur in roughly one in one million patients, may actually be seen in fewer than one in 1000 patients. Cardiac amyloidosis, in the senile form, may exist in 80% of 80-year-old patients, although the incidence of clinical symptoms is less. As the genetic alterations that contribute to these diseases are further elucidated, improved diagnosis and a better understanding of the prognosis of these uncommon cardiomyopathies will follow.

Document Type: Research Article

DOI: http://dx.doi.org/10.15212/CVIA.2015.0006

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Table of Contents Volume 1 Number 1

Inaugural Issue of Cardiovascular Innovations and Applications Journal Launches with Special Issue on Heart Failure.

Beijing, October 21, 2015: The new journal Cardiovascular Innovations and Applications (CVIA) has been launched with a Special Issue on Heart Failure. CVIA was founded on the occasion of the 25th anniversary of the Great Wall-International Congress of Cardiology (GW-ICC) in 2014 by Professor Dayi Hu, president of the GW-ICC and past president of the Chinese Society of Cardiology, who will serve as Founding Editor.

Richard Conti, MD, a past president of the American College of Cardiology and former Editor of Clinical Cardiology, servers as Editor-in-Chief of the new journal, which has published its first issue to coincide with the GW-ICC meeting in October 2015 in Beijing, China.

The GW-ICC is one of the largest congresses in the Asian-Pacific region and is the most comprehensive and influential academic conference on cardiology. Held as a regular annual conference since 1990, GW-ICC has provided a platform for continuing education in cardiovascular disease diagnosis, treatment, and technology training, through events that leverage the expertise of internationally renowned cardiologists and scholars from the United States, Europe and Asia.

The CVIA Special Issue on Heart Failure has been Guest Edited by Juan M. Aranda, Jr. of the University of Florida and brings together contributions from leading cardiologists from the United States, China and Europe.

Featured papers in this issue are:

A Clinician’s Commentary on Heart Failure Treatment in the Future  by C. Richard Conti.  This paper considers the results of the latest heart failure trial entitled ‘Efficacy and Safety of LCZ696 Compared to Enalapril on Morbidity and Mortality of Patients with Chronic Heart Failure.’ The drug LCZ696 has now been approved by the FDA and will be manufactured by Novartis as Entresto.

Strategies to Reduce Heart Failure Hospitalizations and Readmission: How Low Can We Go?  by Juan M. Aranda, Jr. This paper examines the strategies available to reduce heart failure readmission levels. It is estimated that more than one million heart failure hospitalizations occur each year and heart failure readmission rates continue to be about 25%. Strategies to reduce heart failure readmission are key to reducing hospitalization rates. This paper considers strategies available at three different stages of the treatment process: during hospitalization, before discharge and post-discharge. The interventions conducted by a multidisciplinary team adopting these strategies have great potential to reduce heart failure hospitalization rates.

Other papers in this issue are:

Editorial by the Founding Editor by Dayi Hu. This editorial notes the considerable rise in China-based cardiology papers in recent years, with China now the second largest source of cardiology papers in world research rankings. As such, it is now an opportune time to launch a new China-based cardiology journal to publish the best cardiology papers, with a wide range of contributors across China, the United States and Europe.

Congestive Heart Failure Clinics: How to Make Them Work in a Community-Based Hospital System  by Joshua Larned, Mohamad Kabach, Leonardo Tamariz, and Kristine Raimondo. This paper concludes that Congestive Heart Failure (CHF) Clinics in community hospitals that use a rapid and frequent follow-up with CHF-trained teams effectively reduce hospitalization rates up to 1 year.

Heart Failure Issues and Management: A European Perspective by Alberto Dominguez-Rodriguez, Julia Gonzalez-Gonzalez, Carima Belleyo-Belkasem and Pedro Abreu-Gonzalez. This review provides a European perspective on management of heart failure.

Unusual Cardiomyopathies: Some May Be More Usual Than Previously Thought and Simply Underdiagnosed by  Frank W Smart. This paper studies certain cardiomyopathies that have previously been regarded as very rare. These are being recognized with increasing frequency, because of improved imaging techniques and an increased understanding of the pathophysiologic mechanisms that result in these diseases.

Cardiac Sarcoidosis: Sorting Fact from Fiction in This Rare Cardiomyopathy by Indranee Rajapreyar and Elizabeth Langlois. This review details the current understanding of cardiac sarcoidosis and highlights diagnostic strategies and treatment with the aim of guiding the clinician to early identification of patients and implementation of appropriate management in this rare disease entity.

Epidemiological Study of Heart Failure in China by Yang Guo, Dong Zhao and Jing Liu:  This review highlights important epidemiological studies of heart failure in China.

Noninvasive Hemodynamic Monitoring for Heart Failure: A New Era of Heart Failure Management by Gabriel A. Hernandez, Viviana Navas and Sandra Chaparro.  This paper describes advances in implantable wireless technology that now allow frequent and direct measurement of intracardiac filling pressures, which can be monitored by health care providers to help tailor therapy to reduce filling pressures and hospital readmission rates.

The Evaluation of the Heart Failure Patient by Echocardiography: Time to go beyond the Ejection Fraction by Jacqueline Dawson Dowe, Juan Vilaro, Karen Hamilton, Anita Szady and Juan M. Aranda, Jr. This article reviews the role of the echocardiogram in the evaluation of the heart failure patient, without focusing on the left ventricle.

Pulmonary Arterial Hypertension and the Failing Ventricle: Getting It Right by Stacy A Mandras, Sylvia Oleck and Hector O. Ventura.  This paper concludes that the discovery of new prognostic indicators, use of hybrid imaging for early detection of Right Ventricular Failure (RVF), and strategies to prevent the development of RVF will be important if outcomes in this patient population are to improve.

Cardiac Resynchronization Therapy in 2015: Lessons Learned by Siva Ketha and Fred M. Kusumoto. This paper reviews the pathobiology of cardiac dyssynchrony, the rationale for the use of CRT, the history and the state of the art of CRT, and guidelines and recommendations for CRT, while also focusing on the areas of controversy and potential future applications.

Continuous Flow Left Ventricular Assist Device Therapy: A Focused Review on Optimal Patient Selection and Long-Term Follow-up Using Echocardiography by Juan R. Vilaro, Anita Szady, Mustafa M. Ahmed, Jacqueline Dawson  and Juan M. Aranda Jr.  This paper provides a focused clinical review on the use of echocardiography in two main aspects of the evaluation of patients who are being considered for or are mechanically supported by Continuous Flow Left Ventricular Assist Devices (CF-LVADs): (a) optimal patient selection for CF-LVAD support and (b) follow-up assessment of optimal pump function.

Mechanical Circulatory Support for the Failing Heart: Which Device to Choose by Mustafa Ahmed and Rene Alvarez, Jr. This article reviews the literature and provides an algorithm for the treatment of cardiogenic shock.

 

 

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