The IGR method is a simple, accurate, and reproducible noninvasive method for quantification of CO in patients with advanced heart failure. The prognostic value of this simple measurement needs to be studied prospectively.

Background and Aims There is little information on the incremental prognostic importance of frailty beyond conventional prognostic variables in heart failure (HF) populations from different country income levels. Methods A total of 3429 adults with HF (age 61 ± 14 years, 33% women) from 27 high-, middle- and low-income countries were prospectively studied. Baseline frailty was evaluated by the Fried index, incorporating handgrip strength, gait speed, physical activity, unintended weight loss, and self-reported exhaustion. Mean left ventricular ejection fraction was 39 ± 14% and 26% had New York Heart Association Class III/IV symptoms. Participants were followed for a median (25th to 75th percentile) of 3.1 (2.0–4.3) years. Cox proportional hazard models for death and HF hospitalization adjusted for country income level; age; sex; education; HF aetiology; left ventricular ejection fraction; diabetes; tobacco and alcohol use; New York Heart Association functional class; HF medication use; blood pressure; and haemoglobin, sodium, and creatinine concentrations were performed. The incremental discriminatory value of frailty over and above the MAGGIC risk score was evaluated by the area under the receiver-operating characteristic curve. Results At baseline, 18% of participants were robust, 61% pre-frail, and 21% frail. During follow-up, 565 (16%) participants died and 471 (14%) were hospitalized for HF. Respective adjusted hazard ratios (95% confidence interval) for death among the pre-frail and frail were 1.59 (1.12–2.26) and 2.92 (1.99–4.27). Respective adjusted hazard ratios (95% confidence interval) for HF hospitalization were 1.32 (0.93–1.87) and 1.97 (1.33–2.91). Findings were consistent among different country income levels and by most subgroups. Adding frailty to the MAGGIC risk score improved the discrimination of future death and HF hospitalization. Conclusions Frailty confers substantial incremental prognostic information to prognostic variables for predicting death and HF hospitalization. The relationship between frailty and these outcomes is consistent across countries at all income levels.

Background Floating right heart thrombi (RHT) represent an underdiagnosed, potentially hazardous, and to some extent rare phenomenon in patients presenting with acute pulmonary embolism (APE). Emergent treatment is usually required for such a condition. Case presentation A 19-year-old young lady presented with progressive shortness of breath, marked renal impairment, thrombocytopenia, and a highly oscillating huge right atrial mass. After she was admitted to the intensive care unit, she arrested in asystole and was resuscitated, and her electrocardiogram (ECG) showed evidence of acute anterior myocardial infarction. Urgent cardiac surgery to remove the right atrial mass was proposed by the heart team as the best option of management. Surgery was emergently performed with extra-corporeal membrane oxygenator (ECMO) as a support. Following surgery, mechanical support and vasopressors were successfully weaned and the patient achieved a good recovery. Conclusions A pulmonary embolism response team (PERT) approach should always be considered where a multidisciplinary team involving a cardiologist, radiologist, cardio-thoracic surgeon, radiologist, and intensivist shall determine the management strategy for a challenging presentation of a massive pulmonary embolism or floating right heart thrombi causing the hemodynamically unstable clinical condition.

Background: Wave intensity analysis is useful for analyzing coronary hemodynamics. Much of its clinical application involves the identification of waves indicated by peaks in the wave intensity and relating their presence or absence to different cardiovascular events. However, the analysis of wave intensity peaks can be problematic because of the associated noise in the measurements. This study shows how wave intensity analysis can be enhanced by using a Maximum Entropy Method (MEM).Methods: We introduce a MEM to differentiate between “peaks” and “background” in wave intensity waveforms. We apply the method to the wave intensity waveforms measured in the left anterior descending coronary artery from 10 Hypertrophic Obstructive Cardiomyopathy (HOCM) and 11 Controls with normal cardiac function. We propose a naming convention for the significant waves and compare them across the cohorts.Results: Using a MEM enhances wave intensity analysis by identifying twice as many significant waves as previous studies. The results are robust when MEM is applied to the log transformed wave intensity data and when all of the measured data are used. Comparing waves across cohorts, we suggest that the absence of a forward expansion wave in HOCM can be taken as an indication of HOCM. Our results also indicate that the backward compression waves in HOCM are significantly larger than in Controls; unlike the forward compression waves where the wave energy in Controls is significantly higher than in HOCM. Comparing the smaller secondary waves revealed by MEM, we find some waves that are present in the majority of Controls and absent in almost all HOCM, and other waves that are present in some HOCM patients but entirely absent in Controls. This suggests some diagnostic utility in the clinical measurement of these waves, which can be a positive sign of HOCM or a subgroup with a particular pathology.Conclusion: The MEM enhances wave intensity analysis by identifying many more significant waves. The method is novel and can be applied to wave intensity analysis in all arteries. As an example, we show how it can be useful in the clinical study of hemodynamics in the coronary arteries in HOCM.

[no abstract - showing first paragraph of article]Sodium-glucose co-transporter-2 (SGLT2) inhibitors are relatively new class of antihyperglycemic medication that is well established in the management of type 2 diabetes mellitus (DM). It has a unique mechanism of action that targets the kidneys through inhibiting 90% of glucose reabsorption.