www.nature.com/articles/s41... FRESH-UP study. Fluid restriction to 1.5L vs liberal intake in HF.
NO difference in QoL over 3 months.
NO increase in HF hospitalisation, diuretic doses, BNP or weight.
BUT median NYHA II, mean EF 40%, median fruse 40mg.
www.jacc.org/doi/abs/10.1... I think the take home message here is "give more diuretics" but good to recap the different modalities, and I wonder if I under use tolvaptan?
www.ahajournals.org/doi/10.1161/...
XBP1 and EDEM2 identified as protective against myocardial lipid accumulation and downstream hypertrophy, fibrosis and myocardial stiffness in a rodent model of HFpEF. Metabolic answers for metabolic conditions!
And check this out - the capacity of these hearts to take up more energetic substrate - their mitochondrial flexibility - correlated with how much these hearts remodelled after 6 months of cardiac resynchronisation therapy.
For patients on an insulin-glucose infusion, switching on CRT shifted these patients to a greater proportion of lipid metabolism (the patients on a fat infusion presumably already maxed out!) [NEFA = non-esterified fatty acids]
We performed paired arteriovenous sampling on CRT implant patients while monitoring pressure volume loops and coronary artery flow
Delighted to be joint first author on this work published in
@ESC_Journals EHJ academic.oup.com/eurheartj/ad...
Learning is contextual. Think about this when wondering how you teach the next generation of clinicians…
PPAR-gamma is closely involved in lipid metabolism (see Watson et al Circ 2023 for more on that in heart failure).
The footnote is that PPAR-gamma agonists (glitazones) are well known diabetic treatments but are contra-indicated in heart failure due to an oedema effect.
In mice, Cannabidiol prevented heart failure via various linked means (preserved contractility, preserved calcium dynamics, preserved mitochondrial function), apparently facilitated by PPAR-gamma receptor www.jacc.org/doi/10.1016/...
We're slowly unpicking immune mechanisms of heart failure. A remarkable finding here that patients with higher levels of chemokine-receptor-type-5 expression on circulating lymphocytes were less likely to respond to cardiac resynchronisation therapy www.jacc.org/doi/10.1016/...
www.ahajournals.org/doi/10.1161/... has T1 mapping been as useful as we were hoping for in #whyCMR ? Here is shows an incremental ability to predict heart failure in HCM.
Mitochondrial encoded circular RNAs have a role in signalling, regulating mitochondrial permeability transition pore opening. Interfering with this pathway in this model reduced the release of reactive oxygen species into the cytosol. www.ahajournals.org/doi/10.1161/...
Interesting article - Critical Care Cardiology, its models of care delivery and training structures.
www.ahajournals.org/doi/full/10....
It's also (ironically) rejection of the idea that debate and discussion can refine an idea. No dissenting voices will be heard.
www.nature.com/articles/s41... the heart is a metabolic omnivore... some evidence that supplementing ketone into cardiac metabolism leads to it being metabolised and increasing cardiac contractility - a novel approach using carbon-13 labelling technology
Anyone have any advice? Like a lot of cardiology trainees I have accumulated a breadth of skills and interests and can’t decide between them for the rest of my career. How have others managed this?
www.nejm.org/doi/full/10.... @nejm.org update on HFpEF from Theresa McDonagh incorporating an integrated approach to diagnosis and review of the treatments (check out those hazard ratios!)
Work felt like the Christmas armistice in WW1. No shots fired, just people left to peacefully get on with their own thing. I wish it was always like this.
Slightly interesting - myocyte calcium overload is responsible for arrhythmogenesis and declining cardiac function basically across cardiac diseases - these data links an insulin signalling pathway to this state
www.ahajournals.org/doi/full/10....
doi.org/10.1001/jama... great editorial poking holes in our belief in Aspirin. Primary prevention evidence doesn't exist and secondary prevention evidence, as we see here, is very flimsy.
Predicted heart mass is the optimal metric for donor-recipient size matching in heart transplantation. But the maths is tough at 3am. Download our simple Heart Transplant Sizing App for free from the Apple Store.
apps.apple.com/gb/app/heart...
Assad day indeed.
www.ahajournals.org/doi/10.1161/... Cytotoxic T Cells Drive Outcome in Inflammatory Dilated Cardiomyopathy
I'm not bright enough to be an immunologist but there is an interesting story developing about certain myocarditis being driven by T-cells and zoning in on Th17 cells.
www.nature.com/articles/s41... immune checkpoint inhibitor myocarditis is becomming very well studied - the relationship with T-cells and their outcomes perhaps helps us understand myocarditis and cardiac inflammation.
Lots to think about in new directions for cardiomyopathy. In particular, how can we test better, and how can we personalise treatment for cardiomyopathies?
academic.oup.com/eurheartj/ar...
