Hearts, Volume 6, Issue 1 (March 2025) – 8 articles

Cardiac arrest remains a leading cause of death worldwide and is a global health crisis. First described in the medical literature in the 18th century, modern cardiopulmonary resuscitation (CPR) with closed chest compressions has remained the standard of care since 1960. Despite exponential advances in basic science research and technological innovations, cardiac arrest survival remains a dismal 10%. The standard of care closed chest compressions provide only 20–30% of baseline cardiac output to the body. Have modern therapies plateaued in effectiveness? This article reviews the history of cardiac arrest, its therapies, and opportunities for future treatments. Through an exploration into the history of CPR and breakthroughs in its treatment paradigms, modern-day researchers and providers may find further inspiration to combat the cardiac arrest public health crisis. Full article

Background: The increased hospital morbidity and mortality associated with hyponatremia is well recognized in the critically ill pediatric population. Neonates and infants exposed to vasopressin following cardiopulmonary bypass (CPB) may be at increased risk for hyponatremia. We aimed to determine the associated effect and potential risk factors leading to hyponatremia and sodium variability in the immediate postoperative period in neonates and infants up to 90 days of age exposed to vasopressin following surgery for congenital heart disease. Methods: This was a retrospective review of 75 consecutive patients at a single tertiary cardiac intensive care unit (CICU) from 2018 to 2020. Using mixed-effects linear regression, we compared sodium trends and variability between the groups who did and did not receive vasopressin. Results: While sodium levels fell in both groups, beyond the first postoperative day, the group exposed to vasopressin had a significantly increased fall in sodium relative to the control (p < 0.001). Vasopressin exposure was associated with increased within-day sodium variability on postoperative days one and two (p < 0.05). Total incidents of moderate to severe hyponatremia (sodium < 130 mmol/L) were higher in the vasopressin group but did not reach statistical significance. Age, volume of modified ultrafiltration, and total diuretic dose were not risk factors for either effect in this study. Conclusions: While all patients in this study appeared to be at risk of postoperative hyponatremia, cumulative vasopressin dose appeared to increase the risk for absolute hyponatremia as well as greater sodium variability within the early postoperative period. Full article

Transthyretin cardiac amyloidosis (TTR-CA) is a pathological condition characterized by the accumulation of misfolded transthyretin (TTR) protein in the heart, leading to restrictive cardiomyopathy. TTR-CA has gained increasing recognition in recent years due to its significant impact on morbidity and mortality. It is typically diagnosed when symptoms of heart failure appear. However, with advancements in non-invasive imaging, early and precise diagnosis of TTR-CA is now possible, enabling clinicians to take advantage of current therapeutic interventions that are more effective when initiated at an earlier stage of the disease. Moreover, genetic testing can now assist clinicians in identifying asymptomatic individuals who are at risk of developing the disease before clinical features manifest. In this review, we provide a general overview of TTR-CA and summarize expert opinions on pre-symptomatic testing and the management of asymptomatic patients, with a particular focus on the V122I mutation. This article aims to provide clinicians with a better understanding of TTR-CA and the current best practices for managing asymptomatic patients with this genetic predisposition. Full article

Background: Obesity presents a significant global health impact and is linked to cardiovascular diseases. While obesity often exacerbates the severity of cardiovascular conditions, an “obesity paradox” has previously been observed, where patients with higher body mass index (BMI) exhibit improved in-hospital and long-term outcomes in certain contexts. As minimally invasive procedures such as percutaneous coronary intervention (PCI) continue to become more relevant, understanding the impact of different patient characteristics on clinical outcomes becomes increasingly important. Methods: A comprehensive analysis was conducted using a large cohort of patients who underwent PCI. In this study, we identified patients who underwent PCI in the year 2020 using the International Classification of Disease (ICD) codes. Patients were categorized into five groups based on their Body Mass Index (BMI). This study aimed to examine the impact of BMI on inpatient outcomes among patients undergoing PCI, focusing on mortality, length of stay, and hospitalization costs across different BMI categories. Results: Our analysis revealed a U-shaped relationship between BMI and inpatient outcomes. Patients with a BMI ≥ 25 demonstrated significantly reduced inpatient mortality (adjusted odds ratio 0.31, 95% CI: 0.18 to 0.54 for BMI 25–29.9 group and adjusted odds ratio 0.32, 95% CI: 0.20 to 0.51 for the BMI 30–39.9 group, with p ≤ 0.001); shorter hospital stays (BMI of 25 or higher with mean reduction of −2.40 to −3.66 days, with p ≤ 0.001); and lower hospitalization costs with a cost reduction of −$40,881 (95% CI: −$64,540 to −$17,223) for the BMI 25–29.9 group, −$57,900 (95% CI: −$80,308 to −$35,492) for the BMI 30–39.9 group, and −$41,463 (95% CI: −$65,151 to −$17,775) for the BMI ≥40 group compared to those with normal BMI (20–24.9). However, these benefits diminished for patients with a BMI ≥ 40, where no significant differences in mortality or cost reductions were observed. Conclusions: These findings underscore the complexity of the obesity paradox and its limitations in extreme obesity. This study highlights the need for tailored management strategies in PCI patients with varying BMI profiles. Full article

The prevalence of cardiac amyloidosis (CA), especially as a cause of heart failure, has significantly increased in recent years. Early detection and accurate assessment of the disease burden are crucial for initiating timely treatment and ensuring precise prognosis. CA primarily results from the infiltration of the myocardium by either immunoglobulin light chain fibrils (AL) or transthyretin fibrils (ATTR), leading to restrictive cardiomyopathy and eventual death if untreated. Over the past decade, advancements in diagnostic imaging and heightened clinical awareness have revealed a substantial presence of CA, particularly ATTR, among the elderly. These diagnostic improvements encompass echocardiography, cardiac computerized tomography scans, magnetic resonance imaging, and radionuclide scintigraphy with bone-avid tracers. Concurrently, significant progress has been made in therapeutic options, with new disease-modifying treatments now available that can dramatically alter the disease trajectory and improve survival rates when administered early. However, despite these advancements, there remains an urgent need for the early and accurate detection of CA to ensure that patients can fully benefit from these emerging therapies. Full article

Atrial fibrillation is a prevalent cardiac arrhythmia influenced by multifactorial mechanisms, including the emerging role of epicardial adipose tissue. Left atrial epicardial adipose tissue, through its endocrine and paracrine activities, contributes to atrial remodeling by fostering inflammation, fibrosis, and electrical remodeling. Objectives: This review aims to explore the interaction between left atrial epicardial adipose tissue and atrial dysfunction, highlighting the utility of strain imaging as a diagnostic and prognostic tool in atrial fibrillation management. Additionally, it examines emerging therapeutic strategies targeting epicardial adipose tissue to improve outcomes. Methods: We analyzed recent advances in imaging techniques, with a specific focus on speckle-tracking echocardiography for non-invasive strain assessment. Strain imaging parameters, including atrial reservoir, conduit, and contractile strain, were evaluated alongside volumetric measures of epicardial adipose tissue. Emerging therapies, such as weight management and GLP-1 receptor agonists, were reviewed for their impact on left atrial epicardial adipose tissue and atrial remodeling. Results: Strain imaging demonstrates a significant association between reduced strain parameters and atrial remodeling induced by left atrial epicardial adipose tissue. Combining strain assessment with volumetric measures enhances diagnostic accuracy and stratification of patients at risk for recurrent or progressive atrial fibrillation. Emerging therapies, particularly GLP-1 receptor agonists, show promise in reducing epicardial adipose tissue volume and mitigating atrial remodeling, thereby improving catheter ablation outcomes. Conclusions: Strain imaging is a valuable tool for the early detection of atrial dysfunction and personalized treatment planning in atrial fibrillation. Integrating these imaging approaches into routine clinical practice can optimize atrial fibrillation management and improve patient outcomes. Full article

Introduction: Risk factors, a 75-year-old concept, are instrumental in the management of the general population. Newer biomarkers can explain residual risk and protection from risk. The population needs a new platform to make more comprehensible the importance of managing risk. Biologic age, the number of years left to live, is the platform that will receive the attention of patients. Method: Risk factor odds ratios are used to approximate the years lost to the modifiable risk, calculating a biologic age. Newer biomarkers confirm the predication and can be used to explain the pleomorphic properties of medications and unrealized risk. The biomarkers represent the following biologic processes: repair, inflammation, immune function, hematologic, clotting factors, metabolic-nutritional, organ maintenance, anthropomorphic, environmental, endothelial function, sleep, co-morbidities, frailty, and electromagnetic. Risk factors and biomarkers are ranked in the order of significance in reducing biologic age. Results: A six-step method of patient management using biologic age and biomarkers is presented. Conclusions: Knowledge of risk factors and therapies to improve risk has increased over the last 75 years. Biologic age is more appropriate in explaining the significance of this knowledge and may improve patient compliance to lifestyle changes and medication compliance. Appropriate counseling with utilization of biomarkers of biologic processes, such as high sensitivity-CRP, circulating stem cells, number of co-morbidities, frailty, electrocardiogram, and pulse wave velocity will improve compliance and personalize care. The 6-minute walk should be incorporated into the vital signs due to prognostic significance. Full article

Cardiac Contractility Modulation (CCM) is an electrical therapy based on an implantable device. This device is approved for patients with heart failure with reduced ejection fraction (HFrEF). Randomized clinical trials and thousands of described cases and studies have shown how CCM can improve exercise tolerance, quality of life, re-hospitalization for HF, and cardiac function by reverse left ventricular modelling. In this case report, we describe a patient candidate for a cardiac transplant based on dilated cardiomyopathy with severe LV dysfunction and narrow QRS. The patient had frequent heart failure-related hospitalizations, despite the optimal medical therapy. The strategy was to adopt the Cardiac Contractility Modulation (CCM) therapy while waiting for a cardiac transplant. During a consultation on all prospective therapy options, the patient refused the LVAD therapy, and was more confident in adopting a less invasive device therapy like CCM. This strategy had a very fast and beneficial impact on the patient’s health; the CCM improved heart failure symptoms, hemodynamics flow and cardiac functionality. Moreover, after a relatively short time, the patient went from persistent AF to Sinus Rhythm, although he started with a severe bi-atrial dilatation. These parameters were stable during an extended follow-up of 18 months. Full article