#ventricular ejection

[er-cryptid]

Ventricular Ejection

-- follows isovolumetric ventricular contraction

-- both ventricles continue to contract

-- the ventricular pressures exceed aortic and pulmonary arterial pressure

-- the aortic valve and pulmonary valve open

-- blood is ejected into aorta and pulmonary artery

[wamathai]

AstraZeneca partners with Tricog Health and KCS to promote AI-Powered heart failure screening

AstraZeneca has partnered with Tricog Health, an innovator in AI-driven healthcare solutions, and the Kenya Cardiac Society (KCS) to conduct a groundbreaking study evaluating the effectiveness of an AI-based Left Ventricular Ejection Fraction (LVEF) model in screening for heart failure (HF). Launched in May 2024, the study is being conducted across seven centers in Kenya, strategically selected…

[covid-safer-hotties]

Reference included in our archive

I thought there were some interesting statistics here even thought it's a small study: Almost 1/4 of subjects developed myocarditis *after* recovering from covid.

Abstract Although COVID-19 is a disease consisting of mostly upper and lower respiratory symptoms, a subset of patients develop cardiac sequelae including myocarditis and pericarditis. For these patients, a standardized set of diagnostic imaging techniques and treatments has not been established. While there have been numerous case reports on this topic, there are few reviews that evaluate the effectiveness of different treatment modalities with a significant number of cases. We reviewed 146 cases of patients (ages ranging from 2 months old to mid 80 s) obtained from searches on PubMed, Google Scholar, and several case report journals. ECG abnormalities, elevated inflammatory markers, and reduced left ventricular ejection fraction were most associated with COVID-19 myocarditis. While classic symptoms of COVID-19 include upper respiratory symptoms, a subset of patients diagnosed with COVID-19 displayed no signs of respiratory disease at all. In 22% of cases, cardiac sequelae was not present until after the patient recovered from COVID-19. Steroids were given in 57.5% of cases. Cardiac MRI was used in 40.4% of cases for diagnosis of myocarditis. Of all the patients who were treated with ECMO, 82.1% of these patients were able to fully recover. The use of cardiac MRI and transthoracic echocardiogram for diagnosis of COVID-19 myocarditis should be heavily considered in any patient with COVID-19 infection. ECMO, IVIG, steroids, and anticoagulants should also be heavily considered. A randomized controlled trial should be conducted to better associate treatments with outcomes.

[teachingrounds]

Q. What does an atrial septal defect (ASD) sound like on auscultation?

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A. Unlike ventricular septal defects (VSDs), an inter-atrial defect causes no murmur itself. However, a number of adventitious sounds may be associated with it.

- wide and fixed S2, due to the larger-than-normal volume of blood that is sent through the right-sided circulation, causing a later-than-normal closing of the pulmonary valve (the second sound in S2)

- a crescendo-decrescendo early systolic ejection murmur from the pulmonic valve heard best at the right upper sternal border (RUSB)

- a rumbling mid-diastolic murmur from blood rushing through the tricuspid valve heard best at the left lower sternal border (LLSB)

Pro-Tip: S2 is only wide and fixed when pulmonary resistance is low; if the defect remains open long enough, the extra blood flow will increase pulmonary vascular resistance, decreasing blood flow into the lungs and across the ASD, eventually resulting in Eisenmenger Syndrome.

Example courtesy of Thinklabs

[myrawjcsmicasereports]

 Resolution of QRS-fragmentation: A case report and review of literature by Zhong Yi, MD in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

Background: It’s not clear whether the resolution of fQRS can be used to assess the effectiveness of cardiac resynchronization therapy defibrillator (CRT-D) in patients of heart failure with reduced ejection fraction (HFrEF).

Case presentation: Here we report a 78-year-old male patient with HFrEF and refractory ventricular tachycardia (VT), who’s 12-lead electrocardiogram (ECG) showed fQRS in leads V1-V6 with QRS duration of 134 ms on admission. Even though the optimized medication of metoprolol, amiodarone, lidocaine, and berberine was given, the recurrent VT and HFrEF were still refractory. For further management, a CRT-D with multipoint pacing (MPP) function (St. Jude Medical, Sylmar, CA) was considered and implanted. It’s very encouraging that no more VTs and fQRS were recorded 9 hours after a CRT-D with MPP function was implanted, and the left ventricle ejection fraction (LVEF) improved significantly later.

Conclusion: CRT-D with MPP is effective in improving the situation of the patient with ischemic cardiomyopathy and HFrEF, and the fQRS resolution can be considered as a sign of its effectiveness.

Keywords: Fragmented QRS; Heart failure; Cardiac resynchronization therapy; Multipoint pacing

Introduction

Fragmented QRS (fQRS) on the 12-lead electrocardiogram (ECG) is defined as the presence of additional notches buried within the QRS, which is widely accepted as a sign of myocardial infarction scar or fibrosis. [1, 2] The fQRS is derived from the abnormality of ventricular depolarization due to ventricular heterogeneity and derangement of ventricular conduction around the infarction zone or scar. [3-5]  And the fQRS is also a sign of left ventricular desynchronization in patients of heart failure with reduced ejection fraction (HFrEF) and the narrow QRS complex (<150 ms). [6] A meta-analysis showed that fQRS on patient’s baseline ECG increased all-cause mortality and major arrhythmic events in HFrEF patients. [7] However, it’s not clear whether the resolution of fQRS is useful to assess the effectiveness of cardiac resynchronization therapy defibrillator (CRT-D) in patients with ischemic cardiomyopathy, especially those CRT-D with multipoint pacing (MPP) function. Here we present an HFrEF patient who had fQRS on his admission ECG and frequent ventricular tachycardia (VT) on his Ambulatory ECG. But no more VT and fQRS were recorded, 9 hours after the implantation of a CRT-D with MPP function. The patient had provided informed consent for publication of this case.

Case presentation

A 78-year-old man presented with a complaint of chest congestion and short of breath lasted for 2 hours on his admission. He had hypertension for 10 years, but his blood pressure was normal on admission without taking any medicine. He had an old myocardial infarction and a coronary artery stent implanted 18 years before, and 2 more stents implanted 10 years before. The patient took a semi-sitting position, the blood pressure was 105/65 mmHg, and the heart rate was 80 bpm. Both lungs were clear, the apex was left out of the normal limit, and slight edema in lower extremities was found. His laboratory examination, including blood routine, hepatic and renal function, electrolyte, coagulation function, and Cardiac troponin I (CTNI), was normal, but the level of brain natriuretic peptide (BNP) elevated to 3082 pg/ml. The ECG showed sinus rhythm, ventricular bigeminy, fQRS in leads V1-V6, QRS duration of 134 ms, and abnormal Q wave in leads V4-V6 (Fig. 1a). His 24-hours Holter monitoring showed 41,320 polymorphic ventricular premature beats (PVCs), which is 42% of the total 98327 beats, and 254 paroxysmal polymorphic VT (Fig. 2a). His chest x-radiography revealed pulmonary congestion, pear-shaped heart and cardio-thoracic proportion of more than 50% (Fig. 3a). His transthoracic echocardiography showed left atrium and ventricle enlargement with the left ventricular end-diastolic diameter of 62 mm; there was a ventricular aneurysm of 5.2×2.0 cm2; there was minor regurgitation of mitral and aortic valves; the left ventricular ejection fraction (LVEF) was 28%. Moreover, no coronary artery or stent stenosis was shown by coronary angiography. We proposed the patient’s primary diagnosis was ischemic cardiomyopathy and HFrEF. Even though the optimized medication of metoprolol, amiodarone, lidocaine, and berberine was given, the recurrent VT and HFrEF were still refractory. For further management, a CRT-D with MPP function (St. Jude Medical, Sylmar, CA) was considered and implanted. It’s very encouraging that 9 hours after the procedure, no VT was monitored again (Fig. 2b); twenty-four hours later, the fQRS was absent and never been recorded after that, and the QRS duration decreased from 134 ms to 122 ms (Fig. 1b). Also, the level of BNP significantly dropped to 357 pg/ml. Furthermore, nine days after the procedure, the LVEF increased to 45%; 30 days later, no pulmonary congestion was found on his Chest x-radiography and the cardio-thoracic proportion improved significantly (Fig. 3b). While, over one year of follow-up, the patient has remained symptom-free of VT and HF.

The patient’s chest x-radiography revealed pulmonary congestion, pear-shaped heart, and cardio-thoracic proportion more than 50% at baseline; (b) There was no pulmonary congestion, and the cardio-thoracic percentage decreased significantly, 30 days after the CRT-D implantation.

Discussion

Considering this patient’s old MI history, we supposed that the possible reason for short of breath on admission was acute myocardial ischemia or acute heart failure. But there was no coronary artery or stent stenosis on his coronary angiography, and the level of CTNI was normal. Combined with clinical signs, chest x-radiography, echocardiographic signs, and elevated levels of BNP, the reason for short of breath was sure to be acute heart failure.

The fQRS is defined as various ‘RSR’ patterns, with or without a Q wave, located in two contiguous leads of a major coronary artery territory. And, the fQRS manifests as an extra R (R’) wave, ≥2 notches in R wave, or ≥2 notches in the down or up-stroke of S wave.[4] It’s reported that fQRS was associated with myocardial infarction scar or fibrosis, and was considered as a sign of old myocardial infarction. [1, 2] The fQRS was also considered as a marker of left ventricular dyssynchrony in HFrEF patients with narrow QRS complex (<150ms). [6] Furthermore, the fQRS was also associated with higher all-cause mortality, and cardiac event rate defined as MI, need for revascularization, VT and cardiac death. [8, 9] The fQRS found in contiguous 3 leads was a significant predictor of the cardiac death or heart failure hospitalization. [9] fQRS increased MAE in HFrEF patients. [7] In this HFrEF patient, the fQRS, with narrow QRS complex of 134 ms, presented on all the 6 precordial leads (V1-V6) on his admission ECG. As it was discussed on the above, the presence of fQRS, with narrow QRS complex on the ECG, was showed that he had left ventricular dyssynchrony caused by myocardial infarction scar or fibrosis. Therefore, our strategy focused on improving the ischemic cardiomyopathy induced HFrEF, and CRT-D with MPP was the best choice for the management of his refractory VT and HFrEF. Practically, the complete resolution of fQRS accompanied by the improvement of HFrEF in a relatively short hospital stay is strong evidence support for the effectiveness of CRT-D with MPP function.

Implantable CRT with MPP is a new quadripolar technology that involves a left ventricle lead with 4 different pacing electrodes and a dedicated device with multiple pacing options. [9] MPP is superior to the conventional biventricular pacing on the improvement of acute cardiac hemodynamics, left ventricle synchronization, and QRS complex narrowing, and all of this manifested as a higher number of acute responders to CRT. [10-12] Therefore, a CRT-D with MPP was implanted in our patient. Then, he had a significant improvement, such as the termination of VT, the narrowing of QRS, the elevation of LVEF, and the relief of HF symptoms.

In conclusion, CRT-D with MPP is very useful in improving the LVEF of the patient with ischemic cardiomyopathy and HFrEF. And the resolution of fQRS may be a sign of the alleviation of HFrEF by using CRT-D with MPP.

[market-insider]

Southeast Asia Pacemakers Market Insights: Detailed Overview of Market Size, Share, Projected Growth

The Southeast Asia pacemakers market size is expected to reach USD 97.67 million by 2030 and is projected to grow at a CAGR of 5.92% from 2024 to 2030, according to a new report by Grand View Research, Inc. South East Asia is witnessing a significant demographic shift towards an older population. Older individuals are more susceptible to heart-related issues, which increases the need for pacemakers. This aging trend is accelerating the demand for devices that help manage heart rhythm disorders. Moreover, the increasing prevalence of cardiovascular diseases, such as arrhythmias and heart block, is a major driver for the market.

South East Asia Pacemakers Market Report Highlights

The external pacemakers segment held the largest share of more than 50.0% in 2023 due to their widespread use is due to their versatility, ease of application, and the immediate, adjustable support they offer.

The conventional pacemakers segment held the largest share of around 60.0% in 2023. These devices have a long track record of effectiveness in treating bradycardia (slow heart rate) and other arrhythmias.

In 2023, the congestive heart failure (CHF) segment dominated the market, capturing a significant 33.18% share.

Hospitals & cardiac centers held the largest share of 42.27% in 2023. The availability of advanced diagnostic tools, surgical facilities, and post-operative care makes hospitals the preferred setting for pacemaker procedures.

For More Details or Sample Copy please visit link @: South East Asia Pacemakers Market Report

A report from the National Library of Medicine published in April 2024 highlights significant variations in heart failure classifications across Southeast Asia. The INTER-CHF study reveals that 39% of heart failure patients in Malaysia and the Philippines have a reduced left ventricular ejection fraction (LVEF) of less than 40%. Conversely, data from the International REPORT-HF registry shows that in Indonesia, and Thailand, the distribution of heart failure types is 59% HFrEF (heart failure with reduced ejection fraction), 18% HFmrEF (heart failure with mid-range ejection fraction), and 23% HFpEF (heart failure with preserved ejection fraction). Additionally, the NHFR (National Heart Failure Registry of India) reports that HFrEF is the most common classification in South Asia, affecting 65% of patients, followed by HFmrEF at 22% and HFpEF at 13%.

Moreover, government initiatives across Southeast Asia play a crucial role in enhancing access to cardiac pacemakers and improving overall cardiovascular care. The governments are upgrading healthcare infrastructure and modernizing hospitals to include advanced cardiac units, improving access to pacemaker treatments. Initiatives like the Philippines' Universal Health Care (UHC) Law enhance coverage and reduce financial barriers, making advanced cardiac care more accessible to a wider population.

List of major companies in the Southeast Asia Pacemakers Market

Boston Scientific Corporation

Medtronic

BIOTRONIK SE & Co. KG

MicroPort Scientific Corporation

Abbott

Lepu Medical Technology(Beijing)Co.,Ltd.

For Customized reports or Special Pricing please visit @: South East Asia Pacemakers Market Report

We have segmented the Southeast Asia pacemakers market based on product, type, application, end-use and country.

[neotia-getwel]

What is the pathophysiology of congestive heart failure?

Pathophysiology of Congestive Heart Failure (CHF):

Congestive heart failure (CHF) is a condition where the heart is unable to pump blood effectively, leading to inadequate blood flow to the body and fluid buildup in the lungs and other tissues. The pathophysiology involves several interconnected mechanisms:

Reduced Cardiac Output: CHF occurs when the heart's pumping capacity (either due to weakened heart muscle or stiffened heart walls) is insufficient to meet the body’s needs, leading to a reduction in cardiac output.

Increased Preload: When the heart cannot pump effectively, blood backs up in the veins (particularly in the lungs in left-sided heart failure) and increases the volume (preload) that the heart has to pump.

Neurohormonal Activation: The body responds to reduced cardiac output by activating compensatory mechanisms like the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system. This increases blood pressure and fluid retention, which further strains the heart and worsens heart failure.

Ventricular Remodeling: Chronic stress on the heart causes changes in the structure and function of the heart muscle, known as remodeling. This may involve dilation of the ventricles, thickening of the heart walls, and fibrosis, making the heart less efficient.

Fluid Retention: The kidneys respond to reduced blood flow by retaining salt and water, which worsens fluid buildup (edema) in tissues, leading to symptoms like swelling in the legs and shortness of breath (due to pulmonary congestion).

Decreased Ejection Fraction: In systolic heart failure, the heart's ability to contract is impaired, leading to a low ejection fraction (EF). In diastolic heart failure, the heart’s ability to relax and fill with blood is impaired, often with a preserved EF but reduced overall filling capacity.

These factors lead to a vicious cycle that worsens heart failure symptoms over time, contributing to fluid buildup in the lungs (pulmonary edema) and peripheral tissues (such as in the legs, abdomen, and liver).

If you're concerned about CHF symptoms or diagnosis, it's important to consult healthcare professionals, such as those at Neotia Getwell Multispecialty Hospital, for a comprehensive evaluation and management plan tailored to your condition.

[rahrahkaz]

Data is Power, Ignorance is Bliss

It was about a year and a half ago that Caleb was about the age that we thought he could tolerate a Cardiac MRI without sedation. He did amazing, partly because of him, but also because of the amazing staff that helped him to not be scared. That was on a Tuesday. On Wednesday we spent all morning at our typical coordinated clinic where he sees all of the specialists. The results of the MRI were not yet available. The appointments were difficult for Caleb as things become tougher for him and we grappled with a fairly invasive foot surgery. But what we didn’t know we found out through My Chart at 5:30 am the next morning while I was laying in bed back in Minnesota.

"There is delayed myocardial enhancement starting at the level of the base and extending into the mid chamber noted in the inferior and infero-lateral segments and extending into the antero-lateral segments. There is greater than 50% myocardial involvement."

I broke. I didn’t have much idea of what it meant, but I knew that any cardiac issues at 9 years old, is just far too young. And while I didn’t know the significance of the results, the “greater than 50%” part hit me hard. I knew it wasn’t good.

While I appreciate the immediate gratification of My Chart test results, I was once again left with these results and google until I could talk to our cardiologist. I read things like:

Death of the heart cells

Myocardial involvement is one of the main factors for mortality

Heart failure

And I googled things like:

Life expectancy for a 9-year-old with greater than 50% myocardial involvement

Quality of life with heart failure

Then I got smart and stopped the downward spiral and reached out to our Cardiologist. It’s been extremely important to me that our clinical care team is more than just a group of physicians that we see a few times a year. That is why we endure long travel days to Ohio from Minnesota, so that we can continue the relationships that we have built for so many years. So I texted our Cardiologist and within minutes had a call back. More than that, she was on a morning beach stroll with her husband while on vacation. I will always make sure we have the right people on our care team, people I know will have my back, and more importantly, Caleb and Dunky’s back.

This conversation was extremely beneficial, not because she said, “it’s okay” or “he’ll be okay” or “it’s no big deal” but because it was a conversation of her first listening to me cry, but then she said things like, “I’m so sorry”, “it’s a terrible disease” and “we will start more heart meds now”.

So here we sit a little over one year later with more data for both kids. Caleb has since had 2 more MRIs, he’s moved from watching Disney movies while getting his MRI to listening to Eminem. They are both now on 3 different heart medications (lisinopril, eplerenone and carvedilol) and we are increasing doses periodically as they grow. Caleb’s results are stable, hoping that the meds are helping to not have additional cardiac issues, at least for now. Stable is winning in Duchenne.

Dunky has had one MRI and his initial results were not good either. In fact, his Left Ventricular Ejection Fraction (LVEF) was worse than Caleb’s initial MRI. It read things like “low-normal” instead of “normal” and “approaching 50% myocardial thickness”. Still scary words and scary stuff, but data is power, and I was ready for this news. Thank you, Caleb, for paving the way so I could take this news better. I still cried, I still yelled, I still grieved this news, but I was able to recover a bit sooner. These results caused the Cardiologist to put Dunky on all the same heart meds as Caleb. He will have another MRI in about 6 months. We pray for stabilization in the LVEF (current state was 53%).

I’m grateful for technology, for EMR systems that talk to each other and for access to information. Duchenne is an interesting disease. I feel like we live in a community focused on data, especially with so many clinical trials in place for Duchenne. However, at the same time I feel like we live in a place of ignorance because there is still so much we don’t know about Duchenne. Like the Cardiologist told me while strolling that white sand beach, “there can be a kid with Duchenne in heart failure that stays at that level for years” but I can’t help but think about the 12-year-old with Duchenne that died of heart failure.

Yes, 12-years-old. Caleb turns 11 in two days. This is the unknown. People love to talk about adults with Duchenne that lived into their 30’s, but it seems that there are still far too many kiddos with Duchenne not making it to their 20’s. There is so much we truly don’t know. I went so far to ask at our last appointments “how much longer do you think we have?” and that question couldn’t be answered. They don’t know.

So what do we do with this data, with this power, with this ignorance and with this bliss? We embrace it. We use what data we have to make guided decisions on medications and how we spend our time. We use the unknown to treat life as if we may not get tomorrow. We stand back up when we feel so kicked down. We ask for help, we spoil them, we live our lives in a way that we won’t have regret.

Thank you to this village that helps us on this journey.

10/26/24

[crimsonpublishersgernotology]

Cardiac Metastasis in an Asymptomatic Geriatric Female

Tumors metastatic to the heart (cardiac metastases) are among the least known and highly debated issues in oncology, and few systematic studies are devoted to this topic [1]. Cardiac metastases are considered to be rare; however, when sought for, the incidence seems to be not as low as expected [2]. This case presents a 68-year-old female patient with worsening cardiac function and stage 4 lung cancers. The transthoracic echocardiogram revealed mildly diminished left ventricular ejection fraction of 40-45%, as well as a low-density mass noted in the left atrium with the left interatrial septum intact. Later, a transesophageal echocardiogram was performed and it revealed a 3 x 1.5cm mass in the left atrium which was thought to originate from or near the right superior pulmonary vein. While therapy was showing favorable results towards the lung mass, a cardiac mass was eventually discovered, and treatment was limited due to its position and size. This case shows that cardiac metastases may not be as rare as the literature suggests and can be asymptomatic despite the massive loss of efficient contractile material. It may be practical to monitor for cardiac metastases in lung cancer patients to prevent further metastasis and help guide therapy.

Read more about this aricle: https://crimsonpublishers.com/ggs/fulltext/GGS.000526.php

Read more articles: https://crimsonpublishers.com/ggs/index.php

[rnomics]

IJMS, Vol. 25, Pages 6661: Hypertension and Heart Failure: From Pathophysiology to Treatment

Hypertension represents one of the primary and most common risk factors leading to the development of heart failure (HF) across the entire spectrum of left ventricular ejection fraction. A large body of evidence has demonstrated that adequate blood pressure (BP) control can reduce cardiovascular events, including the development of HF. Although the pathophysiological and epidemiological role of hypertension in the development of HF is well and largely known, some critical issues still deserve to be clarified, including BP targets, particularly in HF patients. Indeed, the management of hypertension in HF relies on the extrapolation of findings from high-risk hypertensive patients in the general population and not from specifically designed studies in HF populations. In patients with hypertension and HF with reduced ejection fraction (HFrEF), it is recommended to combine drugs with documented outcome benefits and BP-lowering effects. In patients with HF with preserved EF (HFpEF), a therapeutic strategy with all major antihypertensive drug classes is recommended. Besides commonly used antihypertensive drugs, different evidence suggests that other drugs recommended in HF for the beneficial effect on cardiovascular outcomes exert advantageous blood pressure-lowering actions. In this regard, type 2 sodium glucose transporter inhibitors (SGLT2i) have been shown to induce BP-lowering actions that favorably affect cardiac afterload, ventricular arterial coupling, cardiac efficiency, and cardiac reverse remodeling. More recently, it has been demonstrated that finerenone, a non-steroidal mineralocorticoid receptor antagonist, reduces new-onset HF and improves other HF outcomes in patients with chronic kidney disease and type 2 diabetes, irrespective of a history of HF. Other proposed agents, such as endothelin receptor antagonists, have provided contrasting results in the management of hypertension and HF. A novel, promising strategy could be represented by small interfering #RNA, whose actions are under investigation in ongoing clinical trials. https://www.mdpi.com/1422-0067/25/12/6661?utm_source=dlvr.it&utm_medium=tumblr

[helthcareheven]

From Concept to Reality: The Beating Heart Patch Market Journey

The beating heart patch market represents advanced therapeutic solutions aiming to restore cardiac function and geometry after myocardial infarction (MI). Beating heart patches are soft, bioresorbable scaffolds seeded with cells that help in cardiac regeneration. The patches are deployed on the heart during minimally invasive surgeries without requiring cardiac bypass. This innovation holds promise to overcome limitations of conventional treatments for MI, such as ventricular remodeling and reduced ejection fraction over time. The global beating heart patch market is estimated to be valued at US$ 223.6 Mn in 2024 and is expected to exhibit a CAGR of 7.6% over the forecast period 2023 to 2030.

The market growth can be attributed to rising geriatric population, growing prevalence of cardiovascular diseases, and the need for advanced treatment alternatives. According to the World Health Organization, cardiovascular diseases cause over 17 million deaths annually and are a major cause of disability. Beating heart patches present an effective option for patients who are not eligible for coronary bypass surgery or left ventricular assist devices. Key Takeaways Key players operating in the beating heart patch market are BIOCARDIA, INC., Athersys, Inc., CorMatrix Cardiovascular, Inc., BD, LifeNet Health, Inc., and Admedus Ltd. These top players accounted for over 40% market share in 2022. BIOCARDIA, INC. leads with its portfolio of autologous cell-based therapies for cardiac repair. Growing private sector investments to support ongoing clinical trials offer significant growth opportunities in the market. Successful clinical results thus far have attracted venture capitalists and pharmaceutical companies looking to gain early access to innovative therapies. Major players are also exploring geographical expansion opportunities in Asia Pacific and Latin America. The large patient pools in developing economies and need for cost-effective treatments provide scope for international partnerships and product adoption. Market drivers Rising economic burden of cardiovascular diseases: The escalating healthcare costs of treating heart attacks, strokes, and other heart conditions has boosted research into cheaper and more durable cardiac repair solutions like beating heart patches. Their ability to prevent recurring hospitalizations makes them attractive. Increasing adoption of regenerative medicine approaches: Beating heart patches present an advanced application of cell-based regenerative strategies. With developments in tissue engineering and greater understanding of biomaterials, such techniques are increasingly gaining ground over traditional device-based or pharmacological interventions. Market restraints High research and production costs: Developing functioning cardiac patches is a technically challenging endeavor that requires extensive preclinical and clinical testing. This makes the overall commercialization costs for these novel products very high. Uncertain reimbursement scenario: Widespread insurance coverage and availability of public funding will determine the true market potential of beating heart patches. Unclear reimbursement policies act as a restraint for companies and limits patient access.

Segment Analysis The beating heart patch market is segmented into biological beating heart patches and synthetic beating heart patches. The biological beating heart patches segment currently dominates the market due to advantages such as better wound healing, and reduced rejection, when compared to synthetic patches. Biological patches are usually made from materials such as pericardium, small intestine submucosa, or collagen. These closely resemble native tissue and encourage natural tissue regrowth. Global Analysis North America is expected to be the fastest growing region in the beating heart patch market during the forecast period. This is attributed to factors such as rising prevalence of cardiovascular diseases, growing demand for advanced surgical procedures, and presence of major players in the region. Additionally, the region has a highly developed healthcare system and favorable reimbursement policies for advanced treatment options. Also, government support for research activities and clinical trials will contribute to market growth.

[corporatenews]

Exploring the Implantable Cardioverter Defibrillators (ICDs) Market: Trends, Growth, and Innovations

The implantable cardioverter defibrillators (ICDs) market is experiencing significant growth and innovation, driven by advancements in cardiac arrhythmia management, increasing prevalence of cardiovascular diseases, and growing adoption of implantable devices for the prevention of sudden cardiac death. As a leading player in this dynamic industry, we aim to provide a comprehensive overview of the market landscape, highlighting key trends, growth drivers, challenges, and future opportunities.

Understanding Implantable Cardioverter Defibrillators

Implantable cardioverter defibrillators (ICDs) are medical devices designed to monitor heart rhythm and deliver therapeutic interventions, including defibrillation and pacing, to treat life-threatening ventricular arrhythmias and prevent sudden cardiac death. ICDs consist of a pulse generator implanted subcutaneously in the chest wall and one or more leads inserted into the heart chambers to sense cardiac activity and deliver electrical shocks or pacing stimuli as needed. These devices are indicated for patients at risk of sudden cardiac arrest due to conditions such as ventricular tachycardia, ventricular fibrillation, or heart failure with reduced ejection fraction.

Market Overview

The global implantable cardioverter defibrillators market is poised for significant growth in the coming years, driven by factors such as the aging population, increasing prevalence of cardiovascular diseases, and technological advancements in device design and functionality. Market projections indicate robust expansion and a notable CAGR during the forecast period, reflecting the growing demand for implantable cardiac devices and the expansion of indications for ICD therapy.

Key Market Trends

1. Subcutaneous Implantable Cardioverter Defibrillators (S-ICDs)

Subcutaneous implantable cardioverter defibrillators (S-ICDs) represent a notable trend in the ICD market, offering an alternative to traditional transvenous ICDs for patients at risk of sudden cardiac death. S-ICDs utilize subcutaneous electrode placement and do not require intracardiac leads, reducing the risk of lead-related complications such as lead fracture, dislodgement, or venous thrombosis. S-ICDs are suitable for patients with limited vascular access, congenital heart disease, or a history of lead-related issues, providing a safe and effective alternative for implantable defibrillation therapy.

2. Remote Monitoring and Telehealth Integration

The integration of remote monitoring and telehealth technologies into ICD systems is transforming patient care and device management, enabling healthcare providers to remotely monitor device function, detect arrhythmias, and assess patient status without the need for in-person clinic visits. Remote monitoring platforms allow for real-time transmission of device data, including arrhythmia episodes, device performance metrics, and battery status, facilitating timely intervention, remote programming, and patient education. Telehealth integration enhances patient engagement, improves clinical outcomes, and reduces healthcare utilization and costs associated with in-office follow-up visits.

3. Advanced Device Features and Connectivity

Advancements in device technology are driving innovation in the ICD market, with the development of advanced features such as multi-site pacing, cardiac resynchronization therapy (CRT), and magnetic resonance imaging (MRI) compatibility. Multi-site pacing and CRT capabilities improve cardiac function and reduce heart failure symptoms in patients with conduction abnormalities or dyssynchrony, while MRI compatibility allows patients to undergo necessary imaging procedures without concerns about device compatibility or safety. Connectivity features enable seamless integration with electronic health records (EHRs), remote monitoring platforms, and mobile health apps, enhancing data accessibility, interoperability, and care coordination.

Growth Drivers

1. Increasing Prevalence of Cardiovascular Diseases

The increasing prevalence of cardiovascular diseases, including coronary artery disease, heart failure, and arrhythmias, is a primary driver of market growth for implantable cardioverter defibrillators. The aging population, sedentary lifestyles, and rising incidence of risk factors such as hypertension, diabetes, and obesity contribute to the growing burden of cardiovascular disease worldwide, driving demand for implantable cardiac devices for primary and secondary prevention of sudden cardiac death.

2. Technological Advancements in Device Design

Technological advancements in device design and functionality are driving innovation and adoption of implantable cardioverter defibrillators, with improvements in battery longevity, lead design, and therapy algorithms enhancing device performance, reliability, and patient outcomes. Miniaturization of device components, optimization of battery chemistry, and development of low-energy shock delivery systems enable smaller device sizes, longer battery life, and reduced energy consumption, enhancing patient comfort and device longevity.

Challenges

1. Complications and Adverse Events

Complications and adverse events associated with implantable cardioverter defibrillators pose challenges for patient management and device utilization. Common complications include lead dislodgement, infection, hematoma, and inappropriate shocks, which may require device repositioning, revision surgery, or medical therapy. Adherence to best practices in device implantation, programming, and follow-up monitoring is essential to minimize complications and optimize patient safety and outcomes.

2. Healthcare System Integration and Reimbursement

Integration of implantable cardioverter defibrillator therapy into healthcare systems and reimbursement policies poses challenges for device adoption and utilization. Coordination of care among cardiologists, electrophysiologists, and implanting physicians is essential to ensure appropriate patient selection, device programming, and long-term management of patients with ICDs. Reimbursement policies and coding guidelines for device implantation, remote monitoring, and follow-up care vary by jurisdiction and may impact access to care and financial sustainability for healthcare providers.

Future Outlook

The future of the implantable cardioverter defibrillators market holds promising opportunities for innovation and growth, driven by technological advancements, expanding indications for device therapy, and evolving healthcare delivery models. Industry stakeholders are poised to capitalize on emerging trends and technologies by investing in research and development, expanding product portfolios, and collaborating with healthcare providers and regulatory agencies to address unmet needs and improve patient outcomes.

In conclusion, the implantable cardioverter defibrillators market plays a crucial role in the prevention of sudden cardiac death and the management of life-threatening arrhythmias, with the potential to enhance

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Early Impairment of Left Ventricular Function in Hypertensive Patients with Preserved Ejection Fraction using Tissue Doppler Echocardiography

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Why should you choose EECP Treatment over BYPASS and ANGIOPLASTY surgeries?

Angioplasties and Bypass surgeries are the most common treatments to widen narrowed blood vessels and improve blood circulation for people with angina and blockages in the heart. However, some people may be unfit for angioplasty, such as those who have obstructions in arteries that run the length of the artery and are clogged with fatty plaques. Even if it is attempted, the chances of it happening again are very high. The chances of recurrence increase with each procedure for people who have had multiple procedures.

Thus, an alternative such as EECP (Enhanced External Counterpulsation) is recommended for such people.

Let’s discuss the BENEFITS of EECP over BYPASS or ANGIOPLASTY surgeries:

Bypass Surgery (shortcomings)

Angioplasty (shortcomings)

Benefits of EECP

This is not a permanent cure for angina or blockages, which is why people must undergo multiple bypass surgeries over the course of their lives.

Plaque is not removed during Angioplasty, but it is compressed within the arteries to allow blood flow.

One of the greatest benefits of EECP is that it removes plaque from the coronary arteries without invasive surgeries.

Plaque is not removed during bypass surgery, but a path is manually created to allow blood to flow to other parts of the heart muscles.

Coronary Bypass Surgery will not be able to revive or make alive damaged or dead heart tissues or muscles.

Even after treatment, the problem may recur every 2 months to 2 years.

It opens thousands of new collateral (thin arteries) in the heart and other vital organs of the human body, effectively creating redundancy within the human body. These new collaterals provide multiple pathways for fresh blood flow in various parts of the heart muscle. These new collateral create a natural ‘bypass’ in the Coronary Arteries without causing any damage.

In general, the problem recurs within 6 months to 5 years.

In thin arteries, bypass surgery is not possible; patients must live with critical blockages for the rest of their lives.

Inside the thin arteries, angioplasty is clinically impossible; patients live with such critical blockages in the thin arteries for the rest of their lives.

Because of the fresh blood flow through these new collateral tubes, the area of damaged or dead heart muscles begins to work on developing new tissues.

The affected area in the coronary arteries re-blocks at a rate of 10% to 20%, which is about 10 times faster than a natural process.

Coronary Angioplasty cannot bring damaged or dead heart tissues or muscles back to life.

Improvement in the ‘LVEF (Left Ventricular Ejection) factor’ – the heart’s ability to pump blood.

In most cases of coronary angioplasty, a stent is not inserted in blockages less than 70%, so all blockages less than 70% remain untreated in the coronary arteries.

The affected area in the coronary arteries re-blocks at a rate of 10% to 30%, which is about 15 times faster than the natural artery.

This treatment is regarded as a miracle for patients who are living their lives after a HEART ATTACK, regardless of whether they underwent Angioplasty or Bypass Surgery.

Patients must take their medications on a regular basis throughout their lives, and the dosages of the medications increase over time.

In most cases of coronary angioplasty, a stent is not inserted in blockages that are less than 70%, so all blockages that are less than 70% remain in the coronary arteries.

Benefits of EECP also include increased blood flow in the heart and other vital organs of the body by 25% to 50%, which improves the health of all those organs and regulates blood sugar levels phenomenally, lowering blood pressure. Patients are at ease and optimistic about their lives; they FEEL healthy.

Unlike the benefits of EECP, the ability to live a normal life after bypass surgery is always a topic of debate among cardiologists.

Patients must take their medications on a regular basis throughout their lives, with the dosages increasing over time.

Patients benefit greatly in the majority of curable and non-curable diseases, such as brain stroke, metabolic syndrome, chronic kidney disease (CKD), disease in the lymphatic syndrome, erectile dysfunction (or impotence), and peripheral arterial diseases (blockages in the lower extremities).

Bypass surgery is used to treat coronary artery disease that has progressed over the course of 30 to 50 years.

Angioplasty is a temporary and expensive solution, and people need to undergo repeated angioplasties throughout their lives for clearing the arterial blockage. So, if you compare it with the benefits of EECP, it is much lesser beneficial.

Talking more about the benefits of EECP – the need for medicines after treatment is minimal, if not non-existent.

What do RESEARCH STUDIES say?

Recently, European Heart Journal conducted a study to assess the effects of the enhanced external counterpulsation post-Covid 19. It was found that 66% of them had no heart failure symptoms post-treatment. 84% of treatment group participants had sustained NYHA class improvement at half a year follow-up. It was concluded that Enhanced external counterpulsation (EECP) therapy sustainably improves NYHA functional class and LVEF in patients with ischemic CHF exacerbation after COVID-19.

Furthermore, Frontiers in Cardiovascular Medicine (Indonesia) in one of their clinical trials aimed at studying whether or not External counterpulsation (EECP) provides long-term benefits of improved anginal frequency and exercise tolerance in patients with refractory angina. After a 35-hour EECP session, it was observed that conditions like Diabetes mellitus, hypertension, dyslipidemia, and family history of CAD proportions were more than half encountered in patients. Furthermore, no major adverse cardiovascular events were observed during the study period.

Not only this, but also the American College of Cardiology, in one a small study of long COVID-19 patients, found out that after 15-35 hours of enhanced external counterpulsation (EECP) therapy, patients with and without coronary artery disease improved a variety of symptoms, including fatigue, breathing difficulties, and chest discomfort.

Thus, we may say that the ongoing studies and observations pretty much coincide with the positive outcomes of EECP treatment in Heart diseases which clearly shows that EECP is probably the future of treatment in cardiovascular disorders.

At Poona Preventive Cardiology Center, we provide the safest and most clinically approved non-surgical treatments for cardiovascular diseases with our team of heart specialists and state-of-the-art facility. Our EECP treatment for heart block uses a series of blood pressure cuffs on both legs as part of our Preventive Cardiology treatments. It creates pressure on the blood vessels in the lower limbs in a gentle yet firm way that increases the blood flow to the heart. Our patients have significantly derived benefits of EECP and have experienced relief from heart block symptoms, and were able to resume their normal activities in no time.

Contact us today for non-invasive heart treatments.

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What are the ingredients of Qili Qiangxin capsule?

Heart failure is a critical manifestation of heart disease and an accident of sudden death with complications, so the condition must be closely observed. Qili Qiangxin capsule is a drug that can effectively control the disease.

Most patients with heart failure seek medical attention due to dyspnea or fatigue due to decreased exercise endurance. These symptoms can occur during rest or exercise and must be actively treated with medication. Qiliqiangxin capsule is a brown to dark brown granule, which tastes a little bitter. Qiliqiangxin ingredients are Radix Astragali, ginseng, aconite, Salvia miltiorrhiza, Fructus Alismatis, Polygonatum odoratum, cassia twig, safflower, incense plus peel, and tangerine peel.

Qiliqiangxin capsule has the advantages of diuretic, angiotensin converting enzyme inhibitor, β receptor blocker, digoxin and other western medicine in the treatment of heart failure. One drug equals four drugs, which can not only reduce the burden of kidney. It can also interfere with neuroendocrine activation, delay ventricular remodeling, increase capacity supply, and promote cardiomyocyte reproduction.

Qili Qiangxin capsule can relieve clinical symptoms such as palpitation and shortness of breath, fatigue, less edema in urine and inability to lie flat; at the same time, it can increase left ventricular ejection fraction in patients with chronic heart failure, improve cardiac function in patients with chronic heart failure, and increase 6-minute walking distance in patients with chronic heart failure. improve the quality of life of patients with chronic heart failure and reduce the rate of rehospitalization. It is suitable for long-term use in patients with chronic heart failure, and the clinical recurrence rate is low and the safety is good.

Specifically, Qili Qiangxin capsule is a Chinese patent medicine for the treatment of heart failure, which is developed according to the theory of collaterals disease of traditional Chinese medicine. Radix salvia miltiorrhiza activates blood circulation and blood, ginseng qi and blood double tonifying, descurili seed reducing lung by water; The adjuvant safflower activates blood circulation and removes blood stasis, tangerine peel cleans qi and dissipates phlegm, alisna and fragrans peel water detumescence, jade bamboo nourish Yin to prevent injury; Make the medicine cinnamomum twig warm Yang changes the composition of qi. The whole recipe plays the role of promoting temperature Yang, activating blood circulation and dredging collaterality, promoting water and reducing swelling. It has been clinically used in patients with heart failure syndrome of Yang qi deficiency, collateral-blood stasis and water stagnation, and has achieved good results.

What is good for heart failure? 1, low sodium diet: high sodium can cause water and sodium retention, high blood pressure, aggravate heart failure, limit salt and all kinds of sodium salt food intake, to prevent edema, vegetables in broccoli, celery, fennel, water spinach and other high sodium content should be less food. All kinds of pickles, bean products, pickled food (because of sodium salt) are contraindicated.

2, due to heart failure will long-term diuresis, order to reduce the amount of circulating fluid, so will cause low potassium, potassium deficiency can cause intestinal paralysis, and easily induce digitalis (cardiotonic drugs) poisoning, patients with long-term use of diuretics should eat more potassium-rich food and fruit, such as potatoes, lave, rape, tomatoes, milk, bananas, jujube, oranges and so on. Potassium supplementation is often given clinically. When taking Qili Qiangxin capsule for the treatment of the disease, we should pay attention to the amount of medicine taken, and take it reasonably and appropriately.

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Dr Ramji Mehrotra | What is cardiac resynchronization therapy?

Cardiac resynchronization therapy (CRT) is a specialized medical treatment designed to improve the function of the heart in individuals with certain types of heart failure. Also known as biventricular pacing, CRT involves the implantation of a device that helps coordinate the contractions of the heart's ventricles, thereby enhancing its pumping efficiency. This therapy has proven to be a valuable option for individuals who experience heart failure symptoms despite optimal medical management.

Heart failure can occur due to various underlying conditions, such as coronary artery disease, hypertension, or cardiomyopathy. As a result, individuals with heart failure may experience symptoms like fatigue, shortness of breath, fluid retention, and reduced exercise capacity.

According to Dr. Ramji Mehrotra, one of India’s most popular cardiac surgeons, CRT is primarily used to treat a specific subset of heart failure patients with "dyssynchrony". Dyssynchrony refers to a lack of coordination in the contraction of the heart's ventricles, the lower chambers responsible for pumping blood to the body. In these individuals, the right and left ventricles do not contract simultaneously, leading to inefficient pumping and reduced blood flow.

CRT involves the implantation of a small device known as a cardiac resynchronization therapy device (CRT-D) or pacemaker (CRT-P) under the skin, typically below the collarbone. This device is equipped with leads (thin insulated wires) that are threaded through veins and positioned in specific regions of the heart.

Once in place, the CRT device delivers precisely timed electrical impulses to the right and left ventricles. These impulses synchronize the contractions of the ventricles, ensuring that they pump together, which can significantly improve the heart's efficiency and overall function.

Not all heart failure patients are suitable candidates for CRT. Typically, it is recommended for individuals who meet specific criteria:

Reduced Ejection Fraction: CRT is usually reserved for individuals with reduced left ventricular ejection fraction (LVEF), which indicates a weakened heart muscle.

Symptoms Despite Medications: Candidates often continue to experience heart failure symptoms despite receiving optimal medical therapy.

Specific ECG Patterns: Certain ECG (electrocardiogram) patterns, such as left bundle branch block, may indicate the presence of dyssynchrony and make individuals suitable candidates for CRT.

Dr Ramji Mehrotra says that the primary goal of CRT is to improve the patient's quality of life by reducing symptoms and enhancing their ability to perform daily activities. Some of the key benefits include:

Improved Heart Function: CRT helps the heart pump more efficiently, increasing the amount of blood circulated with each beat.

Symptom Relief: Many patients experience a reduction in symptoms like fatigue, shortness of breath, and swelling.

Reduced Hospitalizations: CRT can lower the risk of hospitalizations related to heart failure exacerbations.

Prolonged Life: In some cases, CRT may extend the lifespan of individuals with heart failure.

It is crucial for individuals with heart failure to take their doctor’s opinion in determining whether CRT is an appropriate treatment option for them.