Over the last several years, the use of biomarkers in the diagnosis of patients with heart failure (HF) has skyrocketed. Natriuretic peptides are currently the most widely used biomarker in the diagnosis and prognosis of individuals with HF. Proenkephalin (PENK) activates delta-opioid receptors in cardiac tissue, resulting in a decreased myocardial contractility and heart rate. However, the goal of this meta-analysis is to evaluate the association between the PENK level at the time of admission and prognosis in patients with HF, such as all-cause mortality, rehospitalization, and decreasing renal function. High PENK levels have been associated with a worsened prognosis in patients with HF.

Background Left bundle branch area pacing (LBBAP) has recently become a promising option for the near‐natural restoration of electrical activation. However, the clinical relevance of therapeutic effects in individuals with heart failure with reduced ejection fraction (HFrEF) and dyssynchrony remains unknown. Methods MEDLINE, EMBASE, and Cochrane databases were searched from inception until June 2022. Data from each study was combined using a random‐effects model, the generic inverse variance method of DerSimonian and Laird, to calculate standard mean differences and pooled incidence ratio, with 95% confidence intervals (CIs). Results A total of 772 HFrEF patients were analyzed from 15 observational studies per protocol. The success rate of LBBAP implantation was 94.8% (95% CI 89.9–99.6, I2 = 79.4%), which was strongly correlated with shortening QRS duration after LBBAP implantation, with a mean difference of −48.10 ms (95% CI −60.16 to −36.05, I2 = 96.7%). Over a period of 6–12 months of follow‐up, pacing parameters were stable over time. There were significant improvements in left ventricular ejection fraction (LVEF), left ventricular end‐systolic volume (LVESV), left ventricular end‐diastolic diameter (LVEDD), and left ventricular end‐diastolic volume (LVEDV) with mean difference of 16.38% (95% CI 13.13–19.63, I2 = 90.2%), −46.23 ml (95% CI −63.17 to −29.29, I2 = 86.82%), −7.21 mm (95% CI −9.71 to −4.71, I2 = 84.6%), and −44.52 ml (95% CI −64.40 to −24.64, I2 = 85.9%), respectively. Conclusions LBBAP was associated with improvements in both cardiac function and electrical synchrony. The benefits of LBBAP in individuals with HFrEF and dyssynchrony should be further validated by randomized studies.

Background: Southeast Asia has the lowest rates of organ transplantation and donor registration globally. In Thailand, 95% of the population is Buddhist and its core teachings dissuade followers from any action following clinical death that may cause trauma in their journey to rebirth. We sought to determine the effects of Thai culture and Buddhist religion on attitudes toward transplantation and donor registration rates. Methods: This study utilized a convenience sample of 138 participants who were randomly selected to complete a survey assessing beliefs and opinions on organ transplantation. Results: Overall support of organ donation among participants was 91.67%, but only 20.83% of respondents were registered organ donors. 87.5% of registered donors disagreed with the importance of a body having all parts when buried, compared to only 58.33% of unregistered participants who disagreed (P=0.0357). However, 73.68% of unregistered organ donation supporters stated the desire to have their organs donated after death. The most important factor for organ donation among registered donors was health status of the recipient (38.10%), followed by assurance of respectful treatment of the organ (28.57%). Unregistered individuals indicated relationship to recipient as the most important factor in organ donation (43.66%), differing significantly from the registered group (P=0.02). Willingness to donate and receive an organ was 87.29% and 81.90%, respectively. Of organ donation supporters unwilling to register as an organ donor, 52.17% said they were change their mind if someone was in need. Conclusions: Survey responses indicated a high rate of acceptance for organ donation, despite low rates of donor registration among respondents. Low rates of transplantation in Thailand seem to be unrelated to Buddhist and cultural beliefs though registered donors demonstrate a greater degree of acceptance for postmortem removal of organs. Further investigation is necessary to identify future pathways for increasing organ donor registration in Thailand and other Southeast Asian countries.