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!

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.

The more the merrier? Dose of ACE-I/ARBs and outcomes in HFrEF

Contributor: Steven Stroud

It is reported that more is more for HFrEF patients and angiotensin converting enzyme inhibitor (ACE-I) and angiotensin receptor blocker (ARB) therapy. In a recent meta-analysis of six randomized trials*, higher doses of ACE-I/ARBs were associated with a reduction in all-cause mortality. Of note, when the ARB trial (HEAAL) was taken out of the analysis, higher dose ACE-I alone did not reach statistical significance.

Rapid decline in high energy phosphate leads to exercise intolerance in HF patients

Contributor: Steven Stroud

Exercise intolerance is a hallmark of HF. We tend to blame the weak heart for not delivering enough oxygen to exercising muscles, but this is wrong.

Muscles without oxygen are hypoxic. This could happen because of poor cardiac output or because the skeletal muscle cells are not handling oxygen well. In other words, does low cardiac output cause fatigability or are there differences in skeletal muscle energetics in HF?