AimsDiagnosis and risk stratification of patients with heart failure remain a challenge. The small non-coding RNAs known as microRNAs regulate gene expression and seem to play an important role in the pathogenesis of heart failure. In the current study, we aim to characterize the levels of microRNAs in the sera of chronic systolic heart failure patients vs. controls and assess the possible correlation between elevation in the levels of specific microRNAs and clinical prognostic parameters in heart failure patients. Methods and resultsThe levels of 186 microRNAs were measured in the sera of 30 stable chronic systolic heart failure patients and 30 controls using quantitative reverse transcription -polymerase chain reaction (qRT -PCR). The differences in micro-RNA levels between the two groups were characterized, and a score, based on the levels of four specific microRNAs with the most significant increase in the heart failure group (miR-423-5p, miR-320a, miR-22, and miR-92b), was defined. The score was used to discriminate heart failure patients from controls with a sensitivity and specificity of 90%. Moreover, in the heart failure group, there was a significant association between the score and important clinical prognostic parameters such as elevated serum natriuretic peptide levels, a wide QRS, and dilatation of the left ventricle and left atrium (r ¼ 0.63, P ¼ 3e-4; P ¼ 0.009; P ¼ 0.03; and P ¼ 0.01, respectively). ConclusionsElevated serum levels of specific microRNAs: miR-423-5p, miR-320a, miR-22, and miR-92b, identify systolic heart failure patients and correlate with important clinical prognostic parameters.--

AimTo investigate the characteristics long-term prognostic implications (up to ∼2.2 years) of atrial fibrillation (AF) compared to sinus rhythm (SR), between acute and chronic heart failure (HF) with reduced (HFrEF < 40%), mid-range (HFmrEF 40-49%), and preserved (HFpEF ≥ 50%) ejection fraction (EF). Methods and resultsData from the observational, prospective, HF long-term registry of the European Society of Cardiology were analysed. A total of 14 964 HF patients (age 66 ± 13 years, 67% male; 53% HFrEF, 21% HFmrEF, 26% HFpEF) were enrolled. The prevalence of AF was 27% in HFrEF, 29% in HFmrEF, and 39% in HFpEF. Atrial fibrillation was associated with older age, lower functional capacity, and heightened physical signs of HF. Crude rates of mortality and HF hospitalization were higher in patients with AF compared to SR, in each EF subtype. After multivariable adjustment, the hazard ratio of AF for HF hospitalizations was: 1.036 (95%

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3Despite current therapies and disease management approaches, rates of heart failure (HF) rehospitalization remain high. New tools are needed to assess preclinical (asymptomatic) pulmonary congestion to enable outpatient management. Hence, a novel monitoring system based on noninvasive remote dielectric sensing (ReDS) technology was developed. Validation of the ReDS technology was conducted in preclinical and clinical studies. In a porcine HF model, acute fluid overload followed by administration of diuretics were performed. Changes in ReDS values were correlated to serial computed tomographic (CT) assessments of lung fluid concentrations. In hospitalized decompensated HF patients, changes in ReDS values were correlated to net fluid balance changes. A nearly linear pattern between the changes in ReDS and CT fluid concentration values was observed in 6 discrete experiments (Intraclass correlation=0.95). Results from 24 patients demonstrated a reduction in ReDS values of 17.53%AE11% throughout hospitalization, consistent with a reduction in pulmonary congestion. This finding strongly correlated with changes in net fluid balance (Pearson correlation=0.86; 95% confidence interval, 0.68-0.94; R 2 =0.74). These findings suggest that ReDS technology accurately quantifies lung fluid concentration and has potential for monitoring HF patients through hospitalization and possibly at home. ª2013 Wiley Periodicals, Inc.Acutely decompensated heart failure (ADHF) is a major public health concern. Aside from being the most common cause of hospitalization in adults older than 65 years, ADHF is associated with high rates of morbidity and mortality and is a tremendous health economic burden.1-3 Exacerbation of heart failure (HF) is predominantly associated with elevated ventricular filling pressures eventually leading to pulmonary congestion, worsening symptoms of dyspnea, and the need for hospitalization as documented in major American and European registries. [4][5][6][7] Despite the widespread use of numerous telemonitoring approaches to reducing ADHF admissions, the number of admissions is rising in the United States and elsewhere, and the 30-day readmission rate of 25% for HF is the highest among all medical or surgical causes of hospitalization.8 Further evidence supporting the failure of current HF monitoring approaches comes from recent randomized controlled trials that demonstrate no benefit from electronic telemonitoring of HF using systems that assess changes in patient symptoms, daily weight, vital signs, or intrathoracic impedance. 7,[9][10][11] The ineffectiveness of these approaches was partially explained by the low sensitivity and specificity to HF exacerbation attributed to the monitored parameters. New, more precise tools are needed to assess preclinical (asymptomatic) pulmonary congestion, enable outpatient intervention, and reduce the rate of HF hospitalization. An implantable wireless pulmonary artery pressure monitoring device was shown to have a substantial effect on ADHF patient readmissions and quality of...