American Heart Association

Hemodynamic measurements using QRS gating may more accurately classify pulmonary hypertension in heart transplant candidates

Contributor: Elise Vo

We’re talking Group 2 PAH here.  Diastolic pressure difference (DPD) [diastolic pulmonary artery pressure (dPAP) minus pulmonary capillary wedge pressure (PCWP)] identifies isolated post capillary pulmonary hypertension (Ipc-PH) (DPD ≤ 7 mmHg) in group 2 patients.  A diastolic pressure difference of > 7 mmHg defines combined pre-post capillary pulmonary hypertension (Cpc-PH)). Prior to heart transplantation, classification of pulmonary hypertension as Ipc-PH or Cpc-PH is important. Unlike Ipc-PH, Cpc-PH is associated with increased morbidity and mortality related to right ventricular graft failure post heart transplant. Even in the hands of seasoned invasive hemodynamic practitioners, measurement of DPD may not be as straightforward as it seems. Those tracings move, and these pressure differences are small!

Watch out for heart failure in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia

Contributor: Chris Sobowale

Natural history is catching up when arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) patients develop heart failure.

ARVC/D is an inherited cardiomyopathy in which myocardium is replaced with fibro-fatty tissue.  This is followed by development of right ventricular dysfunction and ventricular arrhythmia.

Why are heart failure specialists seeing more patients with ARVC/D? The patients are living longer. Increased awareness allows timely diagnosis. ICD implantation prevents sudden cardiac death. As a result, ARVC/D patients eventually develop heart failure. Gilotra et al explores the increased prevalence of HF related to ARVC/D and characterizes the evolution to HF.

Sacubitril/Valsartan improves quality of life in patients with HFrEF

Contributor: Nicholas Hawkes

Quality not quantity. Why not both? It is established that sacubitril/valsartan is superior to enalapril (or dose-equivalent ACE-I) when it comes to mortality and morbidity in HFrEF. But what about quality of life (QoL)? Patients enrolled in PARADIGM-HF had increased quality of life when randomized to sacubitril/valsartan.

Progenitor cells are decreased in heart failure and specific to HF type

Contributor: Mat Bull

Do progenitor cells matter for patients with HF? First, what is a progenitor cell? A progenitor cell is a stem cell that has potential to differentiate into multiple different cell types. Progenitor cells are classified by cluster of differentiation surface markers, which act as receptors and ligands to their target tissue. CD34+ progenitor cells have been shown to play a role in vascular and myocardial regeneration and in this article are shown to be an important biomarker in heart failure.

Concentric left ventricular hypertrophy rarely leads to dilated cardiomyopathy

Contributor: Jennifer Huang

Does concentric left ventricular hypertrophy (LVH) progress to dilated cardiomyopathy (DCM)? It may not be as common as we previously thought and the transition may occur over decades.

1,386 participants of the Dallas Heart Study without baseline LV dilation were included. Ten percent of the participants had baseline LVH (7.2 g/mL0.67  for men and 5.8 g/mL0.67 for women). The study population had a mean age of 44 years, 57% women and 43% black patients. Of note, patients that developed cardiovascular disease during the study period (MI, CABG, PCI, stroke or HF) were not included in the final cohort of 1282. Baseline and follow up cardiac magnetic resonance imaging was performed a median of 7 years after baseline imaging.