Effect of angiotensin receptor neprilysin inhibitor on physical activity in patients with heart failure with reduced ejection fraction, monitored by implantable electronic device home monitoring

AIMS

Angiotensin receptor neprilysin inhibitor (ARNI) therapy is a cornerstone in the treatment of heart failure with reduced ejection fraction (HFrEF), with significant improvement in mortality as well as morbidity and quality of life. However, maximal ARNI doses often result in hypotension. Recent studies with 'real world' experience suggest that lower doses of ARNI are as effective as higher doses.In order to evaluate the symptomatic effect of low-dose ARNI in HFrEF patients, we analyzed physical activity data obtained via home monitoring of patients with cardiac implantable electronic devices (CIEDs).

METHODS

We retrospectively analyzed physical activity data obtained from HFrEF patients with CIED-active home monitoring during the years 2021-2022. Patients with ARNI therapy were further divided into subgroups according to the administered dose. Low-dose ARNI included doses of up to 24/26 mg sacubitril/valsartan daily. Intermediate dose and high dose included doses of 72/78-120/130 mg/day, and 144/156-194/206 mg/day, respectively.

RESULTS

A total of 122 patients had home monitoring-compatible CIEDs and HFrEF during the study period. Sixty-four of these patients were treated with ARNI. Administration of low-dose ARNI resulted in a 20% increase in daily activity when compared with patients without ARNI treatment ( P  = 0.038). Change in physical activity of patients in the intermediate-dose and high-dose groups was not significant. Younger patients, patients with cardiac resynchronization therapy, and patients without diabetes mellitus were more physically active.

CONCLUSION

Low-dose ARNI had a beneficial effect on physical activity in HFrEF patients. MH via CIED provided real-life objective data for patients' follow-up.

Factors Associated with Left Ventricular Function Recovery in Patients with Atrial Fibrillation Related Cardiomyopathy

BACKGROUND

The diagnosis of atrial fibrillation (AFIB) related cardiomyopathy relies on ruling out other causes for heart failure and on recovery of left ventricular (LV) function following return to sinus rhythm (SR). The pathophysiology underlying this pathology is multifactorial and not as completely known as the factors associated with functional recovery following the restoration of SR.

OBJECTIVES

To identify clinical and echocardiographic factors associated with LV systolic function improvement following electrical cardioversion (CV) or after catheter ablation in patients with reduced ejection fraction (EF) related to AFIB and normal LV function at baseline.

METHODS

The study included patients with preserved EF at baseline while in SR whose LVEF had reduced while in AFIB and improved LVEF following CV. We compared patients who had improved LVEF to normal baseline to those who did not.

RESULTS

Eighty-six patients with AFIB had evidence of reduced LV systolic function and improved EF following return to SR. Fifty-five (64%) returned their EF to baseline. Patients with a history of ischemic heart disease (IHD), worse LV function, and larger LV size during AFIB were less likely to return to normal LV function. Multivariant analysis revealed that younger patients with slower ventricular response, a history of IHD, larger LV size, and more significant deterioration of LVEF during AFIB were less likely to recover their EF to baseline values.

CONCLUSIONS

Patients with worse LV function and larger left ventricle during AFIB are less likely to return their baseline LV function following the restoration of sinus rhythm.

Left Ventricular Systolic Dysfunction Due to Atrial Fibrillation: Clinical and Echocardiographic Predictors

Background: Diagnosis of AF-induced cardiomyopathy can be challenging and relies on ruling out other causes of cardiomyopathy and, after restoration of sinus rhythm, recovery of left ventricular (LV) function. The aim of this study was to identify clinical and echocardiographic predictors for developing cardiomyopathy with systolic dysfunction in patients with atrial tachyarrhythmia. Methods: This retrospective study was conducted in a large tertiary care centre and compared patients who experienced deterioration of LV ejection fraction (EF) during paroxysmal AF, demonstrated by precardioversion transoesophageal echocardiography with patients with preserved LV function during AF. All patients had documented preserved LVEF at baseline (EF >50%) while in sinus rhythm. Results: Of 482 patients included in the final analysis, 80 (17%) had reduced and 402 (83%) had preserved LV function during the precardioversion transoesophageal echocardiography. Patients with reduced LVEF were more likely to be men and to have a more rapid ventricular response during AF or atrial flutter (AFL). A history of prosthetic valves was also identified as a risk factor for reduced LVEF. Patients with reduced LVEF also had higher incidence of tricuspid regurgitation and right ventricular dysfunction. Conclusion: In ‘real-world’ experience, male patients with rapid ventricular response during paroxysmal AF or AFL are more prone to LVEF reduction. Patients with prosthetic valves are also at risk for LVEF reduction during AF/AFL. Finally, tricuspid regurgitation and right ventricular dysfunction may indicate relatively long-standing AF with an associated reduction in LVEF.

Clear Cell Sarcoma-Like Tumor of GI Tract – Rare and Aggressive Tumor: A Case Report

Clear cell sarcoma-like tumor of GI tract is an extremely rare and aggressive tumor affecting mainly young patients and usually involves the small bowel. Herein, we report a case of acute small bowel obstruction in a 31-year-old male, secondary to Clear cell sarcoma-like tumor

Usefulness of Pelvic Radiation Protection Shields During Transfemoral Procedures-Operator and Patient Considerations

Interventional cardiologists are increasingly exposed to radiation-induced hazards. The MAVIG shield is a lead-free drape and the RADPAD is a sterile, disposable, and lead-free shield, placed on the patient with the aim to minimize operator-received scatter radiation. The objective of the trial was to examine their efficacy in a real-world situation. We randomized 125 patients who underwent coronary procedures from the right femoral artery into 3 groups: Control group (n = 48 [39%]) without additional protection, MAVIG lead shield (n = 38 [30%]) and RADPAD shield (n = 39 [31%]). Multiple radiation dosimeters were used in each case. All 3 groups were with similar baseline and procedural characteristics. Fluoroscopy time and number of views were similar in all 3 study groups. Compared with the standard (no shield) protection [3.5 ± 5.57 mSv], the scatter radiation was reduced by a factor of 5 for the MAVIG group [0.46 ± 1.6 mSv and p = 0.001] and a factor of 4 for the RADPAD group [1.16 ± 2.29 mSv and p = 0.01]. The physician's radiation decreased with the 2 shields, but only the MAVIG shield showed statistically significant lower radiation: 0.49 ± 0.42 mSv in the standard group versus 0.26 ± 0.3 mSv in the MAVIG and 0.35 ± 0.44 mSv in the RADPAD (p = 0.135 for RADPAD and p = 0.005 for MAVIG). Patient's exposure was statistically similar to the control group. Although numerically there was an increase in radiation with the RADPAD and decrease with the MAVIG.

CONCLUSIONS

Our study found no statistically increase in patient radiation while the operator's radiation exposure was reduced. Decreasing scatter radiation can be done effectively using simple measurements and is of major importance.