ESC heart failure
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Case Reports
Fulminant myocarditis in a patient with coronavirus disease 2019 and rapid myocardial recovery following treatment.
Coronavirus disease 2019 (COVID-19) is a global pandemic increasingly encountered in the clinical setting. It typically manifests as a respiratory illness, although cardiac involvement is common and portends a worse prognosis. ⋯ The various pathways of myocardial injury, including direct viral damage, macrophage activation, and lymphocytic infiltration, are outlined in detail in addition to associated pathology such as cytokine release syndrome. COVID-19 is a complex and multisystem disease process; in addition to supportive care, specific consideration should be given to the underlying mechanism of injury for each patient.
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Observational Study
Direct oral anticoagulants compared to vitamin K antagonist for the management of left ventricular thrombus.
Left ventricular (LV) thrombus is increasingly detected in patients with and without ischaemic heart disease due to the increased availability of cardiac magnetic resonance imaging. Risk factors include anterior ST elevation myocardial infarction, delayed reperfusion therapy, and non-ischaemic cardiomyopathy with severe LV systolic dysfunction. We aimed to report the characteristics and outcomes of patients with LV thrombus treated with either vitamin K antagonist (VKA) or direct oral anticoagulants (DOAC) with a view to describing differences in efficacy, specifically, subsequent thromboembolic events, thrombus resolution, and also side effects of therapy including clinically significant bleeding. ⋯ Our data suggest that DOACs are likely to be at least as effective and safe as VKA for stroke prevention in patients with LV thrombus and, despite their lack of a licence for this indication, are therefore likely to represent a reasonable and more convenient option for this setting. The optimal timing and type of anticoagulation for LV thrombus, as well as the role of screening for high-risk patients, should be tested in prospective, randomized trials.
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Comorbidities are highly prevalent in patients with heart failure (HF) and affect clinical outcome. The CHA2 DS2 -VASc score is a validated score to estimate assessment of thromboembolic risk in patients with atrial fibrillation. ⋯ The CHA2 DS2 -VASc score has a significant impact on outcome in HF patients.
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Heart rate reduction therapy using ivabradine, a selective inhibitor of the funny current of the sinoatrial node, is widely used in the systolic heart failure cohort. However, the optimal target of heart rate remains controversial. The association between heart rate and 'overlap' between E-wave and A-wave in the pulse wave transmitral flow Doppler echocardiography might be a key to find the ideal heart rate in each individual. ⋯ We proposed a novel formula using deceleration time to estimate ideal heart rate that achieves a zero overlap between E-wave and A-wave in patients with systolic heart failure. Prognostic impact of the formula-guided heart rate optimization should be studied.
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New-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) has been associated with poor survival, but the clinical implication of NOAF on heart failure (HF) is still not well characterized. We aimed to investigate the relationship between NOAF complicating AMI and HF hospitalization. ⋯ In patients with AMI, NOAF is strongly associated with an increased long-term risk of HF hospitalization. Our findings suggest that strengthened secondary prevention of HF should be considered in this high-risk population.