International Journal of the Cardiovascular Academy

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Background: The 6-min walk test (6MWT) is a useful tool in assessing patients' outcomes: morbidity and mortality in heart failure (HF) patients. It also helps in monitoring the effect of medications being developed for treatment of pulmonary hypertension (PH) as well as response to therapeutic interventions in HF and may better reflect the functional exercise level for daily physical activities of HF patients. Aim: This study aims to describe how exercise tolerance of HF patients with PH may differ from that in HF patients without PH as assessed using the 6MWT. Materials and Methods: This was a descriptive cross-sectional study in which 65 patients each in two groups of HF patients with and without PH were sampled. All patients had their body mass index (BMI) and blood pressure assessed. In addition, all patients had echocardiography done and 6-min walk distance assessed. Data obtained were analyzed using SPSS version 23.0. Results: There were more females than men who participated in the study. That heart failure (HF) patients with PH walked less distance in six minutes compared to HF without PH. The total distance walked in 6 min was farther in males, younger HF patients <50 years, patients with a higher BMI, and patients with HF with reduced ejection fraction. Furthermore, a negative significant correlation was observed between mean pulmonary artery pressure (MPAP) and total distance walked in 6 min in all 130 HF patients (r = −0.17; P = 0.005) with a significant correlation between left ventricular ejection fraction (r = 0.50; P < 0.001), MPAP (r = −0.24; P = 0.050), and total distance walked in HF patients with PH. Conclusion: This study's findings indicate that worse outcomes await HF patients with concurrent PH. Thus, continuous monitoring of their exercise tolerance capacity using the 6MWT is of significant clinical benefit as part of their overall management.

Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality worldwide. Although considerable progress has been made in the diagnosis, treatment, and prognosis of CVD, there still remains a critical need for novel diagnostic biomarkers and new therapeutic interventions to reduce the incidence of diseases. Recently, there has been increasing evidence that circulating MicroRNAs (miRNAs), which are endogenous, stable, single-stranded, short, noncoding RNAs (ncRNAs), can be used as diagnostic biomarkers. miRNAs are small ncRNA having approximately 21–25 nucleotides in length, and they mainly act as transcriptional regulators of gene expression in diverse biological processes such as cellular proliferation, differentiation, and tumorigenesis and death. miRNAs regulate in several cardiovascular pathologies, not only limited to hypertrophy, heart failure, arrhythmias, hypertension, myocardial infarction, dyslipidemias, and congenital heart diseases but are also present and circulate in various body fluids such as blood, pericardial fluid, and saliva and act as potential novel biomarkers in various cardiovascular pathologies. Furthermore, miRNAs represent potential novel therapeutic targets for several of above-mentioned CVD. This review presents detailed information about miRNAs regarding its structure and biogenesis, functions, expression profiles in serum/plasma of living organisms, diagnostic and prognostic potential as a novel biomarker and therapeutic applications in various CVD.

Background: To assess immediate and intermediate outcomes of percutaneous balloon pulmonary valvuloplasty (BPV) in children and adults. Materials and Methods: This retrospective, single-center study included patients who had undergone balloon valvuloplasty for the treatment of moderate to severe pulmonary stenosis at a tertiary care center in India between May 2011 and July 2018. Clinical profile, echocardiographic details, procedural details, complications, short term, and intermediate results were assessed. Results: A total of 43 patients were assessed. The mean age of the study population was 13.87 ± 11.71 years. Of them, 21 (48.8%) patients were men and 30 (69.8%) patients were children/adolescents. Single-balloon technique was used in all the cases. Balloon/annulus ratio was 1.28 ± 0.04. Immediate procedural success (Group 1) and partial procedural success (Group 2) were achieved in 26 (60.5%) and 17 (39.5%) patients, respectively. The right ventricular systolic pressure reduced from 117.70 ± 31.77 mmHg to 53.56 ± 13.29 mmHg postprocedure (P < 0.001). Peak-to-peak transvalvular gradient reduced from 102.81 ± 31.66 mmHg to 35.56 ± 12.47 mmHg postprocedure (P < 0.001). Intermediate follow-up was conducted for 2.61 ± 0.75 years (range: 2–4 years). At intermediate follow-up, peak-to-peak instantaneous gradient was 27.21 ± 5.80 mmHg. Restenosis, moderate, and severe pulmonary regurgitation were reported in 2 (7.1%), 4 (14.3%), and 2 (7.1%) patients, respectively. Conclusion: Percutaneous BPV is a safe and efficacious procedure for the treatment of moderate to severe pulmonary valve stenosis in children and adults. The procedure had excellent immediate and intermediate follow-up results.

Background: Right ventricular (RV) failure is a serious adverse event for patients with left ventricular assist devices (LVADs). Here, we seek to identify the risk factors which may predict the development of RV failure (RVF). Methods and Results: Forty-two patients were implanted with LVADs (32 HeartWare^® ventricular assist device and 10 Thoratec^® HeartMate II) between March 2013 and April 2014 at the Ege University Medical School, Izmir, Turkey. Baseline clinical, demographic, and laboratory information were measured and patients prospectively fallowed after surgery. Endpoint was defined RVF development for patients. Before surgery, hemodynamic parameters, electrocardiographic findings, standard echocardiographic measurements, and medications were recorded. Multivariate regression analysis showed that the presence of ascites, prealbumin <14 mg/dl, bilirubin >1.5 mg/dl, RV diameter >3.2 cm, RV-fractional area change (FAC) <24%, right atrial area (RAA) >28 cm,² and RV-myocardial performance index >0.35 were the strongest predictors of RVF after LVAD implantation. Conclusions: RAA and RV-FAC are easily obtained and should be evaluated in potential LVAD patients. Risk assessment systems should also take into account the presence of ascites and low prealbumin levels which are not currently incorporated into any risk models. Validation of the relative importance of all of these parameters requires further investigation.

Online since 14^th February 2018.