American Heart Association

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).

Visual Abstract: Serum Transthyretin Linked to ATTRwt HF Survival

Contributor: Ike Chinyere

Use of Serum Transthyretin as a Prognostic Indicator and Predictor of Outcome in Cardiac Amyloid Disease Associated With Wild-Type Transthyretin

Study Link: Use of Serum Transthyretin as a Prognostic Indicator and Predictor of Outcome in Cardiac Amyloid Disease Associated With Wild-Type Transthyretin

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.