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BackgroundHeart Failure (HF) decompensation is increasingly being managed in the outpatient setting. Following stabilisation, recurrent deterioration is frequently observed, presenting a challenge to physicians as accurate definition of clinical status is limited by the imprecise nature of clinical assessment. Therefore, the question arises as to whether clinical stability reflects true stability in resolved outpatient HF decompensation (HFD).AimsTo assess the clinical value of focused Doppler-Echocardiography (ECHO) in addition to clinical evaluation in defining stability following outpatient decompensation.MethodsThis is an interim analysis of an ongoing single-centre, observational study including all patients diagnosed with HFD in our HF clinic from December 2023-May 2025, defined as:A. ≥1 HF symptom or physical sign and ≥1 other feature of HFDORB. Patients not meeting these criteria but deemed to have HFD on the discretion of the treating physician. Both definitions require escalation in diuretic therapy.Upon stabilisation, ECHO analysis of volume status is carried out and assessed with persistent pressure/volume overload defined as an indirect measure of left ventricular filling pressure E/E’ ≥ 13 ± IVC respiratory variation < 50% (figure 1).Results248 patients are included in this study, of which 191 (77%) have been stabilised (table 1). ECHO assessment was completed in 137/191 and the following categories have been identified;A. Normal IVC and E/E’; 69/137(50%)B. Abnormal IVC/Normal E/E’; 39/137(29%)C. Normal IVC and elevated E/E’; 16/137(12%)D. Abnormal IVC and elevated E/E’; 13/137(9%ConclusionDetermination of clinical status post stabilisation is limited by the lack of sensitivity of clinical evaluation. The data reflects evidence of residual sub-clinical pressure/volume overload on ECHO, likely contributing to the risk of recurrence. ECHO analysis of volume status should be considered as a component of assessment in the evaluation of stability following HF decompensation.Abstract 2 Figure 1Breakdown of doppler-echocardiographic analysis of volume assessment upon stabilisation following outpatient heart failure decompensation. IVC = inferior vena cava; ECHO = doppler-echocardiographic[Image Omitted. See PDF.]Abstract 2 Table 1Selected baseline characteristics of patients. Values are reported as mean (S.D) or n (%) as appropriate. HFpEF = heart failure preserved ejection fraction; HFrEF = heart failure reduced ejection fraction; NT-proBNP HFD = NT-proBNP at the time of diagnosis of decompensated heart failure; NT-proBNP STABLE = NT-proBNP following resolved HFD when deemed stable[Image Omitted. See PDF.]

IntroductionTrastuzumab is associated with cardiotoxicity, necessitating interval cardiac monitoring. Our centre utilises cardiac magnetic resonance (CMR) measured ejection fraction (EF) for serial heart function assessment. This pilot study evaluated the accuracy and reliability of an AI-powered method using Global Longitudinal Strain (GLS) and long-axis EF (LA EF) compared to conventional volume-derived EF (SA EF) from CMR in patients undergoing Trastuzumab treatment for breast cancer.MethodsWe retrospectively analysed CMR imaging of five patients who had serial scans as per protocol between 2021–2024. AI-assisted software (Q Mass) generated GLS and LA EF from three long-axis views (4-chamber, 3-chamber, and 2-chamber), which were compared to SA EF derived manually from CMR, the gold standard for clinical decisions.ResultsFive patients underwent 34 scans during the monitoring period. Bland-Altman analysis showed a linear regression with no significant proportional bias between SA EF and LA EF (p = 0.377). GLS and SA EF demonstrated a strong inverse correlation (Spearman coefficient = 0.77, p < 0.0001) with a worsening GLS (i.e. becoming less negative) corresponding to a lower EF. ROC analysis indicated that GLS had a moderate ability to detect SA EF < 50% (AUC = 0.667).ConclusionEF derived by LA EF and SA EF methods showed consistent differences, supporting the reliability of AI-generated LA EF for serial LV function assessment. AI-based LA EF provides a rapid and reproducible monitoring method, reducing interobserver variability. While GLS and EF are strongly correlated, GLS shows moderate predictive ability for EF decline below 50%. Further studies are warranted to enhance its clinical utility.Conflict of InterestNone

Background In patients with heart failure, left atrial remodeling often occurs to varying degrees. Left atrial enlargement has been proved to be an important predictor of cardiovascular‐related adverse events. However, the relationship between left atrial diameter (LAD) with heart failure (HF) with preserved ejection fraction (HFpEF), reduced ejection fraction (HFrEF) and mid‐range ejection fraction (HFmrEF) remains unclear. Hypothesis We want to explore the correlation between left atrial diameter and HFpEF, HFmrEF, and HFrEF. Methods A total of 210 patients with heart failure who underwent hospitalization in Ningbo Medical Center Lihuili Hospital, Zhejiang, China, from January 1, 2020, to June 31, 2021, were reviewed. The basic demographic characteristics, blood test, and the related indexes of echocardiography of the subjects were collected and analyzed. Results There is a significant difference between HFpEF and HFrEF group in LAD (p = .007), and LAD is negatively correlated with left ventricular ejection fraction (LVEF) (p = .002, r = −.209). Conclusion LAD is negatively correlated with LVEF, which may predict the prevalence of HFrEF. We studied the data of 210 individuals with heart failure. There is a significant difference between HFpEF and HFrEF groups in LAD (p = .007). And LAD is negatively correlated with LVEF (p = .002, r = −.209), which may predict the prevalence of HFrEF.

Introduction2010 Task Force Criteria (TFC) for the diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) include a reduced right ventricular ejection fraction (RVEF) assessed using cardiac magnetic resonance (CMR).1 2 Conventional CMR sequences to assess TFC require extended or repeated breath holds of 12–20 seconds which patients may find difficult to tolerate. Accelerated compressed sensing (CS) sequences reduce breath hold times but require a compromise in image quality. We aim to establish if CS impacts the quantitative diagnostic parameters derived from CMR images.Materials and MethodsShort-axis stack cardiac cine images were acquired from 26 patients (16 male, 10 female, mean age 51, min. age 16, max. age 76) using 2-shot CS sequences in addition to standard TruFISP sequences on a 1.5T Siemens Magnetom Sola scanner. Measurements were made by two radiologists of the RVEF using Circle CVI software. Measured RVEF was compared between conventional and CS 2-shot sequences using a paired t-test (p=0.05). Radiologist agreement was assessed using Bland-Altman analysis.Results Ejection fraction measurement: A statistically significant difference was found in measurements of EF with the mean difference being a 3.1% underestimate of EF when measured on CS 2-shot for Radiologist 1 and a 1.7% underestimate for Radiologist 2. Radiologist agreement: Radiologist 1 typically measured the RVEF to be lower than Radiologist 2 by ~5% for both sequence types. Scan length: CS scan times were 30 seconds, compared to 2 minutes 15 seconds for TruFISP.DiscussionThe mean difference in EF between the radiologists was greater in magnitude than the mean difference in EF between the sequences. Therefore the difference between the sequences is not clinically significant. Despite one patient being a gene carrier for ARVC and two patients being found to have an EF <40%, no patients included in this study were diagnosed with ARVC. While we have tested CS for measuring RV volume and ejection fraction, this has not yet been applied to any symptomatic ARVC patients.ConclusionCS sequences significantly reduce the total breath hold time without degrading the diagnostic information that can be derived from clinical images. CS is therefore a feasible replacement for TruFISP in right heart imaging.AcknowledgementsThank you to Seb Atkinson for acting as second radiologist for the right ventricle contouring; to Sarah Branfoot, Andy Sawyer and other radiographers at the Freeman Hospital for carrying out the additional sequences, and to Mark Rickaby and Fiona Rose for their assistance with data anonymisation.ReferencesMarcus FI, et al. Circulation. 2010. doi:10.1161/circulationaha.108.840827.Bosman LP, et al. EP Europace. 2020. doi:10.1093/europace/euaa039.

BackgroundVericiguat is a novel drug class (soluble guanylate cyclase stimulator) approved for the treatment of symptomatic heart failure with reduced ejection fraction (HFrEF) patients, stable after recent decompensation. Its safety and efficacy in high-risk HFrEF patients (ejection fraction <45%) were demonstrated in the VICTORIA trial with added advantages: less impact on blood pressure, sustained efficacy up to eGFR 15 mL/min/1.73m2. Subgroup analyses according to NT-proBNP levels demonstrate variable heart failure hospitalisation (HFH) and cardiovascular death (CVD) reduction. While real-world candidacy for Vericiguat have been described in hospitalised patients, eligibility within contemporary heart failure outpatient (HF OPD) clinics have not been described. We describe the proportion of HFrEF patients reviewed in HF OPD clinics eligible for Vericiguat and likelihood of benefit according to NT-proBNP levels.MethodsA retrospective review was performed on HFrEF patients attending HF OPD services in 2022. Hospital records identified community managed HFrEF patients hospitalised in 2022. The VICTORIA trial’s selection criteria determined Vericiguat eligibility. Predicted efficacy (HFH and/or CVD reduction) of eligible patients were estimated according to NT-proBNP level cut-off: >8000 ng/L: no benefit; ≤8000 ng/L: net benefit; ≤5314 ng/L: strong benefit.Results333 HFrEF patients were reviewed in HF OPD services in 2022. 94 (28.2%) patients experienced HFH in 2022, of which 33 (9.9%) occurred after guideline directed medical therapy (GDMT) was optimized in HF OPD review. Pharmacotherapy patterns of patients with HFH were identified at HF OPD review: 24 (33.8%) quadruple GDMT, 18 (25.4%) triple GDMT, 21 (40.8%) dual or single GDMT. 71 (21.3%) patients with HFH met the VICTORIA trial criteria and were eligible for Vericiguat (table 1). When subdivided according to NT-proBNP level cut-off, the following predicted efficacy were identified: 52 (15.6%) net benefit, 42 (12.6%) strong benefit, and 19 (5.7%) no benefit (figure 1).Abstract 32 Table 1Community HFrEF patients eligible for Vericiguat and NT-proBNP cut-offAbstract 32 Figure 1Eligibility and predicted efficacy of Vericiguat in HFrEF patients attending contemporary outpatient heart failure clinics. HFH: heart failure hospitalisation, CVD: cardiovascular death[Figure omitted. See PDF]ConclusionThe proportion of community managed HFrEF patients eligible for Vericiguat is 21.3%. According to NT-proBNP level cut-off, the proportion likely to experience net and strong beneficial effects from Vericiguat therapy were 15.6% and 12.6% respectively. Considering the advantages over traditional GDMT (hypotension, renal function), our findings provide insight into the potential real-world use of Vericiguat within contemporary HF OPD clinics.

During the thirteenth encounter of the Parker Solar Probe (PSP) mission, the spacecraft traveled through a topologically complex interplanetary coronal mass ejection (ICME) beginning on 2022 September 5. PSP traversed through the flank and wake of the ICME while observing the event for nearly two days. The Solar Probe ANalyzer and FIELDS instruments collected in situ measurements of the plasma particles and magnetic field at ∼13.3 R S from the Sun. We observe classical ICME signatures, such as a fast-forward shock, bidirectional electrons, low proton temperatures, low plasma β, and high alpha particle to proton number density ratios. In addition, PSP traveled through two magnetic inversion lines, a magnetic reconnection exhaust, and multiple sub-Alfvénic regions. We compare these in situ measurements to remote-sensing observations from the Wide-field Imager for Solar PRobe Plus instrument on board PSP and the Sun Earth Connection Coronal and Heliospheric Investigation on the Solar Terrestrial Relations Observatory. Based on white-light coronagraphs, two CMEs are forward modeled to best fit the extent of the event. Furthermore, Air Force Data Assimilative Flux Transport magnetograms modeled from Global Oscillation Network Group magnetograms and Potential Field Source Surface modeling portray a global reconfiguration of the heliospheric current sheet (HCS) after the CME event, suggesting that these eruptions play a significant role in the evolution of the HCS.

BackgroundAdvanced imaging is a limited resource. Resting transthoracic echocardiography (TTE) is inexpensive and widely available. If TTE identifies clear viable or non-viable myocardium, viability testing could be reserved for “grey-zone” cases, with significant resource implications.MethodAdult patients with a clinical diagnosis of ischaemic cardiomyopathy (ICM), known multi-vessel coronary disease and a left ventricular ejection fraction (LVEF) ≤40% who had undergone both cardiac MRI with late gadolinium enhancement (CMR) and TTE were identified from a local database. TTE and MRI images were analysed by experts blinded to clinical and alternative modality information. End systolic wall thickness (ESWT) and end diastolic wall thickness (EDWT) were measured for each LV segment using the AHA 17-segment model. Viability was adjudicated by the standard late gadolinium enhancement transmurality threshold (<50% viable, ≥50% non-viable). Receiver operating characteristic curve analysis was performed to determine the accuracy of ESWT and EDWT in predicting CMR-determined viability. See Figure 1.Results237 patient records were screened, 44 met inclusion criteria. Nine of these patients were excluded due to poor image quality (7 TTE, 2 CMR). 35 patients were included for final analysis (72 ± 8 years, 91% male). LVEF was 27.8% ± 6.4. A total of 595 myocardial segments were available for analysis. 585 (98%) segments were analysed, 447 (75%) were assessed as viable and 138 (23%) as non-viable.Both EDWT and ESWT were significantly greater in viable compared to non-viable segments (7.6 ± 2.6mm vs. 6.3 ± 2.2mm, p<0.001 and 6.9 ± 2.8mm vs. 9.3 ± 3.2mm, p<0.001 respectively).The area under the curve (AUC) for EDWT was 0.646, with an optimal cut point of 6.5mm. ESWT was more accurate (AUC 0.715, optimal cut point 7.5mm). An ESWT >10.5mm had a specificity of 91% for viability; only 14% of segments were above this threshold. See Figure 2.Abstract 87 Figure 1ConclusionESWT and EDWT have limited accuracy in predicting segmental viability and the majority of segments would remain within the grey-zone. These data do not support the use of TTE as a filter for proceeding to advanced imaging for viability testing.Conflict of InterestNone

IntroductionInorganic nitrite is a potential nitric oxide (NO)-augmenting therapy that is of considerable interest due to the lack of tolerance to its effects, in contrast to organic nitrates. Previous work has shown that NO has beneficial effects on myocardial relaxation and diastolic function while abnormalities of NO-cGMP signalling are implicated in Heart Failure with Preserved Ejection Fraction (HFpEF). Systemic preparations of inorganic nitrite have therefore been tested in small clinical trials for its effects in patients with HFpEF. In humans, nitrite is an arterial dilator, demonstrating selectivity for conduit arteries over resistance arterioles but its direct cardiac effects in vivo have not been established. We hypothesised that intracoronary inorganic nitrite has direct beneficial effects on cardiac diastolic function.Methods20 patients with angiographically normal coronary arteries and normal left ventricular function were given an intracoronary infusion of sodium nitrite (8.7 micromol/min for 5 min, followed by 26 micromol/min for 5 min). LV pressure-volume relations were obtained via a micromanometer-conductance catheter, with recordings taken at baseline and after each dose of nitrite.The primary end-point was change in LV End-diastolic pressure (LVEDP). Secondary end-points included other indices of LV diastolic and systolic function. Statistical analyses were performed using ANOVA for repeated measures (or non-parametric equivalent) with multiple comparison testing, reported as mean [95% CI] unless otherwise specified.ResultsIntracoronary nitrite was associated with a significant dose-dependent decrease in LVEDP (P=0.001). The 26 micromol/min dose of nitrite resulted in a decrease of 1.9mmHg [0.5, 3.3] P=0.006 versus baseline and a decrease of 1.1mmHg [0.2, 2.1], P=0.02 versus 8.7 micromol/min nitrite.There were also significant decreases in the time to LV end-systole (LVEST, P=0.004, with 26micromol/min nitrite resulting in a decrease of 11ms [4, 18] P=0.002 versus baseline) and the LV end-diastolic pressure-volume relation (EDPVR, P=0.006).No significant changes in dP/dtmin (P=0.2) or tau (P=0.3) were seen. The changes in diastolic function occurred without any associated change in mean arterial pressure, heart rate or LV systolic function (all p=NS).Abstract 80 Figure 1The effect of intracoronary inorganic nitrite (8.7 and 26 μmol/min) on parametersof LV diastolic function and mean arterial pressure. Bar charts expressed as mean±SEM**P<0.01 for ANOVA. †p<0.05 vs baseline, ††p<0.01 vs baseline. ‡p<0.05 vs 8.7μmol/min nitriteConclusionIntracoronary Inorganic nitrite exerts a direct effect on LV diastolic function in humans, independent of changes in systolic function or blood pressure. Inorganic nitrite affects both the onset of relaxation and LV end-diastolic properties. These data indicate that the direct cardiac effects of inorganic nitrite contribute significantly to the overall effects of systemically-delivered nitrite and have potential implications for patients with LV diastolic dysfunction and HFpEF.Supported by the MRC, BHF and GSTT/KCL NIHR Biomedical Research Centre.Conflict of InterestNil

NOABSTRACTCardiac resynchronization therapy represents a well established treatment for heart failure patients, recommended for those with severely depressed left ventricular systolic function and left bundle branch block. The aim of this study was to determine the correlation between electrocardiographic changes, clinical, functional, and demographic parameters with the improvement in left ventricular ejection fraction after resynchronization therapy. Another focus of this study was to identify which parameters have predictive value for better patient selection and proper resynchronization strategy.The study included 69 patients who underwent cardiac resynchronization therapy in our center. The parameters were monitored at 4 different key moments: before the procedure and at 6, 9 and 12 months after procedure.There was a significant improvement in the ejection fraction, which reached a peak at the 12-month follow-up. The value of atrial natriuretic factor precursor was negatively associated with the evolution of ejection fraction. QRS duration and left ventricular enddiastolic volume correlate with improvement in ejection fraction. Newer variables, such as the QRS area, the R wave amplitude in the right precordial leads, the QS duration, the percentage of biventricular pacing, and the intraprocedural blood pressure, were examined for their potential association with cardiac resynchronization therapy outcomes. However, the presence or absence of significant correlations with ejection fraction improvement requires further analysis.Cardiac resynchronization induces cardiac remodeling, leading to echocardiographic and quality of life improvements. It also provides electrical improvements and correct ventricular dyssynchrony. Patients with narrower QRS durations after CRT experienced a rise in the ejection fraction based on higher rates of reverse remodeling.

Cardiovascular Diseases (CVDs) are the leading cause of death globally. More than 17 million people die worldwide from CVD per year. There is considerable evidence suggesting that estrogen modulates cardiovascular physiology and function in both health and disease, and that it could potentially serve as a cardioprotective agent. The effects of estrogen on cardiovascular function are mediated by nuclear and membrane estrogen receptors (ERs), including estrogen receptor alpha (ERα), estrogen receptor beta (ERβ), and G-protein-coupled ER (GPR30 or GPER). Receptor binding in turn confers pleiotropic effects through both genomic and non-genomic signaling to maintain cardiovascular homeostasis. Each ER has been implicated in multiple pre-clinical cardiovascular disease models. This review will discuss current reports on the underlying molecular mechanisms of the ERs in regulating vascular pathology, with a special emphasis on hypertension, pulmonary hypertension, and atherosclerosis, as well as in regulating cardiac pathology, with a particular emphasis on ischemia/reperfusion injury, heart failure with reduced ejection fraction, and heart failure with preserved ejection fraction.