Clinical and necropsy evaluation of endocardial fibroelastosis in a mixed-breed cat with left side heart failure

A two-month-old, male intact, mixed-breed cat weighing 0.6 kg was presented with respiratory distress and anorexia. From the transthoracic echocardiographic, reduced fractional shortening (FS) and increased endocardial echogenicity were recognised with severe congestive heart failure (CHF). The kitten was administered an antibiotic and pimobendane under oxygen supplementation in an ICU cage. However, the respiratory condition worsened and the cat died the next day, and the subsequent necropsy and histopathology examinations confirmed endocardial fibroelastosis (EFE). There is a lack of information regarding the antemortem cardiac function evaluated by tissue Doppler imaging (TDI) in EFE cases. We report on the echocardiographic findings including the TDI in the EFE cat with a concomitant necropsy and histopathology confirmation in this paper. The echocardiographic findings showed presence of a ventricular false tendon within the left ventricle, a decrease in the left ventricular contractility (FS 11.1%, and a marked CHF). In this case, the echocardiographic findings were consistent with the human counterpart. However, these findings were like those of dilated cardiomyopathy and, hence, non-specific to EFE. As a result, veterinarians should keep in mind that endocardial fibroelastosis might be a possible reason for respiratory distress resulting from CHF with a low fractional shortening in young cats.

Attention Autoencoder for Generative Latent Representational Learning in Anomaly Detection

Today, accurate and automated abnormality diagnosis and identification have become of paramount importance as they are involved in many critical and life-saving scenarios. To accomplish such frontiers, we propose three artificial intelligence models through the application of deep learning algorithms to analyze and detect anomalies in human heartbeat signals. The three proposed models include an attention autoencoder that maps input data to a lower-dimensional latent representation with maximum feature retention, and a reconstruction decoder with minimum remodeling loss. The autoencoder has an embedded attention module at the bottleneck to learn the salient activations of the encoded distribution. Additionally, a variational autoencoder (VAE) and a long short-term memory (LSTM) network is designed to learn the Gaussian distribution of the generative reconstruction and time-series sequential data analysis. The three proposed models displayed outstanding ability to detect anomalies on the evaluated five thousand electrocardiogram (ECG5000) signals with 99% accuracy and 99.3% precision score in detecting healthy heartbeats from patients with severe congestive heart failure.

Carfilzomib Induced Cardiotoxicity in a Multiple Myeloma Patient

Proteasome inhibitors such as carfilzomib are indicated in multiple myeloma patients showing relapse and/or refractoriness of clonal activity. However, this therapy has been associated with a significant incidence of cardiotoxicity, especially in patients with known cardiovascular risk factors. Here we report a case of a 60-year-old woman with multiple myeloma, who developed severe congestive heart failure with positive myocardial injury biomarkers together with impaired LVEF and GLS, after treatment with carfilzomib. Therefore, chemotherapeutic drug was discontinued and neurohormonal blocking and diuretic therapy was started resulting in amelioration of symptoms, without changes in LVEF but with significant GLS improvement. Although high-grade cardiotoxicity is relatively rare in patients with non previous cardiac risk factors, it was a predictable side effect of carfilzomib use. Recognition of this syndrome is critical to instauration of appropriate therapy and prevention of morbimortality

Targeting cardiac myocyte Na+-K+ pump function with β3 adrenergic agonist in rabbits and patients with severe congestive heart failure

BackgroundReported one- and two-year mortality for patients with advanced heart failure (HF) treated medically are ~75% and nearly 100%. In such patients, reversible cellular abnormalities are potential treatment targets and a raised cytosolic Na+ concentration that impairs their myocardial contractility is one potential target. β3 adrenoceptor (β3 AR) agonists stimulate the myocyte Na+-K+ pump.MethodsWe induced severe HF in rabbits by coronary ligation and measured indices of organ congestion after treatment with β3 AR agonists. Na+-K+ pump current was measured in voltage-clamped myocytes isolated from non-infarct myocardium. To assess if β3 ARs might add benefit to optimised guideline-directed medical treatment we report outcomes of giving the β3 AR agonist mirabegron to patients hospitalized with advanced, treatment-refractory stage D HF.ResultsTreatment of rabbits after coronary ligation with β3 AR agonist reversed a decreased myocyte Na+-K+ pump current and significantly reduced organ congestion and prevalence of ascites. Oral treatment with mirabegron rapidly improved signs and symptoms of 9 patients with advanced HF and improvement of ≥1 NYHA Class was maintained early post-discharge with continued treatment. One patient died from HF at 16 months, 4 died from other causes at 2 – 30 months and 4 remain alive at 38 ± 4 months with NYHA Class II symptoms.ConclusionsParallel β3 AR agonist-induced reversal of Na+-K+ pump inhibition and severe HF in rabbits identify pump inhibition as a treatment target, and changed in-hospital clinical trajectory and post-discharge course more favorable than expected suggest efficacy of mirabegron in advanced human HF.

LVAD Use in the Treatment of End-Stage Heart Failure

Circulatory failure, developing at a certain stage of the course of most heart diseases, is a progressive process, associated with high morbidity and mortality. The effectiveness of generally accepted conservative and resynchronizing therapy for disease progression is relatively low. Mortality of patients with clinically severe congestive heart failure (CHF) reaches 26-29% within a one year after diagnosis. Thus, heart transplantation is the main option for patients with endstage heart failure. About 5,000 heart transplants are performed annually in the world, with 95% of them occurring in North America and Western Europe. But even in countries with a high level of transplantation activity, donor organs of the required quality are still sorely lacking. In such a situation, the main alternative to transplantation may be the use of artificial heart ventricles usually called as ventricular assist device (VAD). In the long run, VAD therapy can serve as a tool for healing (“bridge to recovery”), as a tool of awaiting of further transplantation (“bridge to transplantation”), or as a destination therapy. The article presents the experience of using VAD (in the form of left ventricular bypass) in five patients with end-stage CHF. In order to replace the function of the heart LV, a miniature implant system for auxiliary blood circulation INCOR VAD (Berlin Heart GmbH, Berlin, Germany) was used. Our experience from 5 cases has successfully demonstrated that the implantation of a system for long-term mechanical support of the heart to patients with progressive heart failure can be an effective method of treatment that can safely extend the waiting time for heart transplantation.

Coil and Onyx embolization of a torcular herophili dural arteriovenous fistula in a full-term neonate with advanced heart failure using a transumbilical approach

Neonatal dural arteriovenous fistulas (DAVFs) are rare, but if left untreated will advance to life-threatening neurological and cardiovascular compromise. Endovascular treatment is the preferred treatment modality for DAVFs. The goal of endovascular therapy is to obliterate feeding vasculature and prevent secondary complications. Endovascular access can be difficult to obtain in a neonate. The authors present the case of a full-term, normal birth weight neonate with severe congestive heart failure secondary to a congenital DAVF of the torcular herophili that was successfully treated with transumbilical arterial coil embolization and a liquid embolic agent.