American Heart Association

Not necessary to adjust NT-proBNP thresholds for HFrEF patients with atrial fibrillation

Contributor: Chris Sobowale

Heart failure patients with HFrEF and atrial fibrillation (HFrEF-AF) have higher NT-proBNP than HFrEF patients without atrial fibrillation (AF). This is thought to be a consequence of AF and not necessarily correlated with deleterious clinical outcomes.

HF clinical trials have stipulated different inclusion NT-proBNP levels for patients with HFrEF-AF. It turns out, a defined higher NT-proBNP level for patients with HFpEF-AF may not be necessary.

Old drug… new trick? Treatment with sildenafil may prevent device thrombosis and ischemic stroke in LVAD patients.

Contributor: Chris Sobowale

Bleeding and thrombosis account for almost half of adverse events in patients with CF-LVADs.

Saeed et al analyzed 144 HeartMate II (HMII) CF-LVAD patients in a single center, retrospective study. Patients in the sildenafil groups were on sildenafil for pulmonary hypertension or right ventricular dysfunction for at least 30 days after discharge from CF-LVAD implant. Patients were divided into four groups:

  1. Low level hemolysis not on sildenafil (n=31)
  2. Low level hemolysis on sildenafil (n= 16)
  3. No low level hemolysis not on sildenafil n= (76)
  4. No low level hemolysis on sildenafil (n=21)

Outcomes in Chagasic heart failure worse than other HFrEF subtypes

Contributor: Elise Vo

A young Latin American female patient walks into clinic with signs and symptoms of HF, a right bundle branch block on 12-lead EKG, and reduced EF on echo. She has Chagas disease and HFrEF, but what is her prognosis?

Despite its high prevalence in South America, reports of morbidity and mortality of this disease have been variant. Using post-hoc analysis, McMurray et al evaluated outcomes in 2552 Latin American patients from the PARADIGM-HF and ATMOSPHERE trials where 195 (7.6%) had Chagasic HFrEF. The authors discovered that despite younger age and fewer comorbidities, the Chagasic HFrEF cohort had higher CV death and hospitalization when compared to ischemic and non-ischemic groups. Chagasic HFrEF patients had worse quality of life compared to the non-ischemic group, measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ).