FACE-HF: Focused Assessment by Chest Sonography and Echocardiography in Acute Heart Failure Patients

Background: Acute heart failure (AHF) is a life-threatening condition that necessitates urgent evaluation and treatment with an urgent need for hospital admission. Among the available imaging modalities, echocardiography is the method of choice due to its feasibility and cost-effectiveness. Lung ultrasonography in emergency department, critical and cardiac care units is becoming popular. The present study aimed to assess the value of the focused echocardiography and lung ultrasound protocol for guiding treatment and its effect on the hospitalization period in AHF patients admitted to the CCU, 6 months re-hospitalization and mortality. Methods: This study included 40 consecutive patients admitted to the Cardiology and Angiology department after disposition from the emergency department at Alexandria main university hospital in Egypt with the diagnosis of (AHF). Patients were divided into 2 groups, 20 patients received the standard treatment while the other group received a modification of medication doses according to daily imaging changes. All patients were followed up for 6 months to assess the 6 months HF rehospitalization and death rates. Results: Group II patients had a significantly shorter duration of hospitalization;6.45 ± 2.01 days compared to 9.10 ± 3.82 days among group I patients (P = 0.02). There was no significant difference between the two groups regarding the 6 months rehospitalization and death rates. Conclusion: The focused echocardiography and lung ultrasound-guided therapy for AHF patients resulted in a shorter duration of hospitalization without increased adverse events.

The Hidden Value of Assessing Right Ventricular Performance with Exercise in Hypertensive Patients with Left Ventricular Diastolic Dysfunction

Background: Right ventricular (RV) dysfunction could develop during exercise in patients with both hypertension and left ventricular diastolic dysfunction and may contribute to the patient symptoms. The objective is to assess RV function, both at rest and during exercise in patients with hypertension and left ventricular diastolic dysfunction. Methods: We included 30 patients with hypertension and resting LV diastolic dysfunction. The systolic function of the right ventricle was assessed by TAPSE (Tricuspid Annular Plane Systolic Excursion) and S, while E/A ratio, annular lateral E’, E/E’ and E’/A’ were used to measure diastolic function. The global function of the right ventricle was assessed by measuring the right indexed myocardial performance. The dimensions and pulmonary pressures were also measured. Results: The following parameters of RV systolic function were increased significantly with exercise: TAPSE (P = 0.0054), S’ (P = 0.0045). Moreover, the following diastolic parameters of the RV increased significantly with exercise: E/E’ (P = 0.05), A’ (P = 0.04). The global RV function showed also a significant increase (P = 0.0011). The three RV dimensions as well as the pulmonary artery pressures also increased during exercise (P = 0.000004, 0.001, and 0.00000064 respectively). In addition, the presence of resting LV grade II DD predicted significantly higher pulmonary pressures during exercise (P = 0.006). The advanced resting grade of LVDD predicted significantly the presence of advanced grade of RVDD with exercise (P = 0.037). Conclusions: Some patients who have both hypertension and LV diastolic dysfunction showed structural and functional changes of the right ventricle at rest. However, all patients had RV functional changes during exercise.

Study of the Impact of the Patient Rhythm during Cryoballoon Ablation on the Acute Biophysical Parameters

Background: Pulmonary vein isolation by means of cryoballoon is a well-established way of treatment of atrial fibrillation. The aim of the study was to compare the acute cryoballoon biophysical parameters attained during energy applications to the individual pulmonary vein during sinus rhythm versus atrial fibrillation. Methods: 100 Patients who underwent their first-time PVI using second-generation cryoballoon for symptomatic and drug-refractory AF, between the beginning of March to end of August 2016, were initially screened. 61 patients with paroxysmal AF were included in the present study. 39 patients with persistent AF were excluded. No pre-procedural anatomical imaging was reported. Results: A total of 61 patients (male 80%, age 59.3 ± 13.4 years) were included in the present analysis. A total of 243 pulmonary veins were isolated with an average of 1.87 ± 1.14 cryo energy applications per individual vein. During cryo application, there were no significant differences between applications delivered during sinus rhythm or ongoing AF in the rate of temperature drop at 5 and 30 s, rate of warming at 5 s after freezing stop or achieved balloon nadir temperature. The same also was observed for both the balloon cooling rate and warming times. Conclusions: The present analysis shows no impact of the patient baseline rhythm at the time of energy application upon the acute balloon biophysical parameters in patients with normal sinus rhythm and those with ongoing atrial fibrillation using the second-generation cryoballoon.

Study of Bradyarrhythmias in Acute Myocardial Infarction

Background: Arrhythmias after acute myocardial infarction are common. Bradyarrhythmias need specific insight into when and how to treat them. Objectives: To delineate the incidence, course, and management of different types of bradyarrhythmias after acute myocardial infarction, the study period was five years. Methods: 453 patients with Acute Myocardial Infarction (AMI) were admitted to intensive care in five years. ECGs were analyzed for the presence of bradyarrhythmias and details of management. Results: 65 patients with bradycardia were found. Sinus bradycardia in 40, sick sinus syndrome in 10, junctional rhythm in 10, second-degree block in 10, complete heart block in 24. We divided patients with sinus bradycardia into a stable group and an unstable group. Unstable sinus bradycardia is more prevalent in cases with hypotension or shock, slower heart rates, gross or transmural infarction. Also, predictors of instability were changeable morphology of the “P” wave and inferior rather than anterior infarction. The indications and danger of atropine are defined. Complete heart block was found in 24 patients (0.053%). 13 were managed by drug therapy (isoprenaline, corticosteroids, and atropine);Eleven patients were paced. 14 out of the 24 patients died (58%), the total mortality rate among the 453 patients was 22%. The prognostic factors of CHB were defined. Techniques of introduction of the lead in RV without fluoroscopy are described. Conclusions: Sinus bradycardia in AMI is accompanied by a lower incidence of mortality. Atropine is not a safe drug to be given as routine. Complete heart block predictors of mortality are the association with heart failure, early-onset, and persistence of the block.