Heart failure with preserved ejection fraction in the elderly: pathophysiology, diagnostic and therapeutic approach

Heart failure with preserved ejection fraction(HFpEF)is a clinical syndrome characterized by symptoms and sings of heart failure with elevated left ventricular filling pressures at rest or during exercise.It is the most common type of heart failure in the elderly and its prevalence increases with age and is higher in females at any given age.HFpEF is frequently accompanied of comorbid conditions such as diabetes mellitus,obesity,atrial fibrillation and renal dysfunction.The diagnosis relies in the integration of clinical information,laboratory data and interpretation of cardiac imaging and hemodynamic findings at rest and during exercise.Conditions that have a specific treatment such as coronary artery disease,valvular disease,cardiac amyloidosis and constrictive pericarditis should be considered and evaluated as appropriate.Aggressive management of comorbidities,optimization of blood pressure control and volume status using diuretics as needed are among the current treatment recommendations.There are no specific therapies that have shown to decrease mortality in HFpEF.In symptomatic patients with history of hospital admission for decompensated heart failure,the implantation of a wireless pulmonary artery pressure monitor should be considered.Finally,given the high mortality of this condition,goals of care discussion should be initiated early and involvement of palliative care medicine should be considered.

Brugada electrocardiographic pattern induced by fever

Brugada syndrome is a major cause of sudden death in young adults.Fever has been described to induce a Brugada-type electrocardiogram in asymptomatic patients with a negative family history,to disclose Brugada syndrome and to increase the risk of death and induce T wave alternans in patients with diagnosed Brugada syndrome.Risk stratification is challenging and demands a careful evaluation.Here we present 2 case reports and review the literature.

Takotsubo cardiomyopathy in orthotopic liver transplant recipients: A cohort study using multi-center pooled electronic health record data

BACKGROUND Takotsubo cardiomyopathy(TCM),or stress-induced cardiomyopathy,is associated with adverse prognosis.Limited data suggest that TCM occurring in orthotopic liver transplant(OLT)recipients is associated with elevated perioperative risk.AIM To characterize the predictors of TCM in OLT recipients,using a large,multicenter pooled electronic health database.METHODS A multi-institutional database(Explorys Inc,Cleveland,OH,USA),an aggregate of de-identified electronic health record data from 26 United States healthcare systems was surveyed.A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms of“liver transplant”between 09/2015 and 09/2020 was identified.Subsequently,individuals who developed a new diagnosis of TCM following OLT were identified.Furthermore,the risk associations with TCM among this patient population were characterized using linear regression.RESULTS Between 09/2015 and 09/2020,of 37718540 patients in the database,38740(0.10%)had a history of OLT(60.6%had an age between 18-65 years,58.1%female).A new diagnosis of TCM was identified in 0.3%of OLT recipients(45.5%had an age between 18-65 years,72.7%female),compared to 0.04%in non-OLT patients[odds ratio(OR):7.98,95%confidence intervals:6.62-9.63,(P<0.0001)].OLT recipients who developed TCM,compared to those who did not,were more likely to be greater than 65 years of age,Caucasian,and female(P<0.05).There was also a significant association with cardiac arrhythmias,especially ventricular arrhythmias(P<0.0001).CONCLUSION TCM was significantly more likely to occur in LT recipients vs non-recipients.Older age,Caucasian ethnicity,female gender,and presence of arrhythmias were significantly associated with TCM in LT recipients.