A statement on ethics from the HEART Group.

peer reviewe

Cardiac magnetic resonance findings predict increased resource utilization in elective coronary artery bypass grafting

Morbidity following CABG (coronary artery bypass grafting) is difficult to predict and leads to increased healthcare costs. We hypothesized that pre-operative CMR (cardiac magnetic resonance) findings would predict resource utilization in elective CABG. Over a 12-month period, patients requiring elective CABG were invited to undergo CMR 1 day prior to CABG. Gadolinium-enhanced CMR was performed using a trueFISP inversion recovery sequence on a 1.5 tesla scanner (Sonata; Siemens). Clinical data were collected prospectively. Admission costs were quantified based on standardized actual cost/day. Admission cost greater than the median was defined as 'increased'. Of 458 elective CABG cases, 45 (10%) underwent pre-operative CMR. Pre-operative characteristics [mean (S.D.) age, 64 (9) years, mortality (1%) and median (interquartile range) admission duration, 7 (6–8) days] were similar in patients who did or did not undergo CMR. In the patients undergoing CMR, eight (18%) and 11 (24%) patients had reduced LV (left ventricular) systolic function by CMR [LVEF (LV ejection fraction) <55%] and echocardiography respectively. LE (late enhancement) with gadolinium was detected in 17 (38%) patients. The average cost/day was $2723. The median (interquartile range) admission cost was$19059 ($10891–157917). CMR LVEF {OR (odds ratio), 0.93 [95% CI (confidence interval), 0.87–0.99]; P=0.03} and SV (stroke volume) index [OR 1.07 (95% CI, 1.00–1.14); P=0.02] predicted increased admission cost. CMR LVEF (P=0.08) and EuroScore tended to predict actual admission cost (P=0.09), but SV by CMR (P=0.16) and LV function by echocardiography (P=0.95) did not. In conclusion, in this exploratory investigation, pre-operative CMR findings predicted admission duration and increased admission cost in elective CABG surgery. The cost-effectiveness of CMR in risk stratification in elective CABG surgery merits prospective assessment

National Heart, Lung, and Blood Institute (NHLBI) Strategy for Addressing Health Disparities

Throughout its history, the NHLBI has been a leader in conducting and supporting research to alleviate the health disparities that exist between various segments of the U.S. population, and its outstanding efforts in this area have been publicly recognized in Congressional hearings. Projects with a strong minority component have been initiated so that comparisons may be made between various populations. These projects have produced a wealth of information that enable identification of health disparities and provide clues about their causes

Transcriptional profile of c-kit positive cardiac stem-progenitor cells (c-kitpos eCSCs) isolated from the four chambers of the adult human heart

Introduction: Our findings and those of others show that the adult myocardium, including human, harbours a population of resident (endogenous) cardiac stem cells (eCSCs). They express the stem cell factor receptor c-kit, are distributed throughout the myocardium, are clonogenic, self-renewing and multi-potent, in that they differentiate into the 3 main cardiac lineages; cardiomyocytes, smooth muscle and endothelial cells in vitro and in vivo. The objective of this study is to determine whether c-kitpos eCSCs isolated from the different cardiac chambers have a distinct transcriptional profile depending on the chamber of origin. Methods: Pieces of myocardium have been obtained from all the 4 chambers of the adult human heart. All patients were fully consented before undergone open heart surgery. They were suffered of various cardiac pathologies such as ischemic heart disease, aortic, mitral and tricuspid valve insufficiency or stenosis, and various aortic pathologies. Ethical approval for these procedures has been given by NREC (08/H1306/91).c-kitpos eCSCs were isolated by enzymatic digestion and purified by Magnetic Activated Cell Sorting (MACS) from samples taken from the right and left atria (RA, LA), right and left ventricle (RV, LV) of the adult human heart. mRNA was isolated using Qiagen® mRNA kit, and reverse transcribed using first strand cDNA synthesis with random hexamers. qRT-PCR was performed using SYBR Green on a MyIQ thermocycler Bio-Rad® of specific genes representative of the primary and secondary heart field, and the developmental program of their chamber of origin. Results: c-kitpos eCSCs isolated from 15 human samples (5LA, 1RV, 4LV, 5RA) were processed. c-kitpos eCSCs are distributed throughout the human myocardium and in all 4 chambers of the heart. Transmitted light microscopic observations of c-kitpos eCSCs revealed that the c-kitpos cells from the human biopsies were generally small and rounded, consistent with a stable c-kitpos eCSCs phenotype, regardless of the chamber of origin. The eCSCs c-kitpos cells could be cultured under hypoxic conditions between 7 and 12 days to attain full confluency. Expression of transcripts for c-kit, Foxh1, Hand1, Hand2, Pitx2, Tbx5, Tbx20, Hrt1, Hrt2, Fgf8, Fgf10, and Isl1 were found at differential levels in c-kitpos CSCs isolated from the four cardiac chambers. Conclusion: This study is the first to show that c-kitpos eCSCs derived from human adult cardiac samples, do not appear to have a ‘chamber-specific’ transcript footprint, and are therefore potentially interchangeable between cardiac chambers, raising the potential of their therapeutic application

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Societyof Cardiology

Therapy has improved the survival of heart failure (HF) patients. However, many patients progress to advanced chronic HF (ACHF). We propose a practical clinical definition and describe the characteristics of this condition. Patients that are generally recognised as ACHF often exhibit the following characteristics: 1) severe symptoms (NYHA class III to IV); 2) episodes with clinical signs of fluid retention and/or peripheral hypoperfusion; 3) objective evidence of severe cardiac dysfunction, shown by at least one of the following: left ventricular ejection fraction1 HF hospitalisation in the past 6 months; 6) presence of all the previous features despite optimal therapy. This definition identifies a group of patients with compromised quality of life, poor prognosis, and a high risk of clinical events. These patients deserve effective therapeutic options and should be potential targets for future clinical research initiative

Prevalence of obstructive coronary artery disease and prognosis in patients with stable symptoms and a zero-coronary calcium score

© The Author 2017. Published by Oxford University Press on behalf of the European Society of Cardiology.Aims: CT calcium scoring (CTCS) and CT cardiac angiography (CTCA) are widely used in patients with stable chest pain to exclude significant coronary artery disease (CAD). We aimed to resolve uncertainty about the prevalence of obstructive coronary artery disease and long-term outcomes in patients with a zero-calcium score (ZCS). Methods and results: Consecutive patients with stable cardiac symptoms referred for CTCS or CTCS and CTCA from chest pain clinics to a tertiary cardiothoracic centre were prospectively enrolled. In those with a ZCS, the prevalence of obstructive CAD on CTCA was determined. A follow-up for all-cause mortality was obtained from the NHS tracer service. A total of 3914 patients underwent CTCS of whom 2730 (69.7%) also had a CTCA. Half of the patients were men (50.3%) with a mean age of 56.9 years. Among patients who had both procedures, a ZCS was present in 52.2%, with a negative predictive value of 99.5% for excluding ≥70% stenosis on CTCA. During a mean follow-up of 5.2 years, the annual event rate was 0.3% for those with ZCS compared with 1.2% for CS ≥1. The presence of non-calcified atheroma on CTCA in patients with ZCS did not affect the prognostic value (P = 0.98). Conclusion: In patients with stable symptoms and a ZCS, obstructive CAD is rare, and prognosis over the long-term is excellent, regardless of whether non-calcified atheroma is identified. A ZCS could reliably be used as a 'gatekeeper' in this patient cohort, obviating the need for further more expensive tests.Peer reviewedFinal Published versio