Background: Heart failure (HF) is becoming a growing public health concern. Diagnostic tests for determining the severity of HF often come with high costs and require specialized expertise, which makes it difficult to assess HF severity, especially in low-income countries or at primary healthcare facilities. Recently, red blood cell distribution width (RDW) has emerged as a promising, easily accessible marker associated with HF severity. The study aimed to assess changes in RDW levels in HF patients and the diagnostic value of RDW in detecting acute heart failure (AHF) among HF patients. Methods: We conducted a cross-sectional examination involving 351 participants divided into HF and non-HF cohorts. HF was defined and categorized according to the diagnostic and treatment guidelines for AHF and chronic heart failure (CHF) set forth by the European Society of Cardiology (2021). Univariate and multivariate analysis of factors associated with AHF was performed. Results: The study revealed that HF patients displayed higher median RDW levels (14.90% [13.70–17.00]) compared to non-HF individuals (13.00% [12.23–13.78]). RDW was notably elevated in HF patients with left ventricular ejection fraction < 50% compared to those with left ventricular ejection fraction ≥ 50%. ROC curve analysis of RDW for AHF detection identified a cutoff value of 13.85%, with a sensitivity of 86.05% and specificity of 47.18%, statistically significant at p < 0.001. RDW > 13.85% was identified as an independent risk factor for AHF in patients with HF, with odds ratios of 2.644 (95% CI, 1.190–5.875; p = 0.017). Conclusion: The study revealed significant RDW variations in patients with CHF and AHF compared to the control group. These findings suggest that RDW could be a biomarker for detecting HF severity.

Heart failure (HF) is a global health burden, with high hospitalization and mortality rates. Timely diagnosis is crucial in the management of HF. While noninvasive imaging techniques generally assess changes in the left atrium (LA) or left ventricle (LV) alone, the application of physiological connections between these chambers as echocardiographic parameters, such as the left atrioventricular coupling index (LACI), may be valuable as an early marker of HF. We conducted a cross-sectional study in which 1145 Vietnamese individuals were selected and 160 subjects met the inclusion criteria. These participants were divided into patient and healthy control groups, with 60 HF patients. LACI levels were significantly greater in HF patients, especially those with preserved ejection fraction (HFpEF), than in those with reduced ejection fraction (HFrEF) and controls (59.16 ± 17.94% vs. 41.28 ± 15.27% and 13.15 ± 3.92%, respectively). The LACI showed strong diagnostic value for HFpEF, with an area under the curve (AUC) of 0.951 and an optimal threshold of 33.07 (sensitivity: 97.1%, specificity: 87.3%). Multivariate analysis confirmed LACI as an independent predictor of HFpEF (OR = 1.144, 95% CI 1.087–1.205). Overall, LACI has emerged as an accessible, promising tool for diagnosing HFpEF.

Coronary bifurcation lesions (CBLs) present significant challenges in interventional cardiology, especially in low and middle-income countries like Vietnam. While the double-kissing (DK) crush technique is gaining attention for its potential benefits, its efficacy and safety compared with provisional stenting (PS) in the Vietnamese population remain underexplored. This study aimed to assess the effectiveness of the DK crush technique in reducing major adverse cardiovascular events (MACE) compared with those of PS, providing essential data to inform clinical decision-making in settings with limited resources. This prospective cohort study included 58 patients with CBL, 33 patients undergoing the DK crush technique and 25 receiving PS. Clinical follow-up at 1, 3, 9, and 12 months assessed MACE, including cardiovascular disease–related death, acute myocardial infarction, hospitalization for heart failure, and stroke. Post-percutaneous coronary intervention side branch diameter stenosis in the DK crush group was 5.64% ± 5.80%, significantly lower than the PS group (48.2% ± 28.5%; P < .001). One-year follow-up data revealed greater MACE reduction in the DK crush group (91% MACE-free vs 72% in the PS group; P = .03; hazard ratio [HR], 3.689; 95% CI, 1.034-13.160). However, the DK crush technique had longer procedural times (91.1 vs 54.6 minutes) and required higher contrast and radiation doses (P < .01). Although DK crush requires longer procedure times and greater radiation exposure, it results in greater MACE reduction than does PS in patients with CBL. Clinicians should weigh the benefits and limitations of both techniques, particularly in resource-limited settings.

Introduction: A thrombus straddling the patent foramen ovale (PFO) is a very rare clinical entity. Optimal management remains unclear due to the availability of various therapeutic options; thus, an individualized approach is recommended. Case presentation: The authors describe a case presenting with recurrent cerebral embolism and a large and mobile thrombus straddled in the PFO. Historically, cardiac surgery, thrombolysis or anticoagulation were possible management options for this patient. However, there are no guidelines on what the optimal treatment is. Our patient was a poor surgical candidate because of advanced age and multiple comorbidities. Furthermore, she had a recent ischaemic stroke which was a relative contraindication to thrombolysis. After consulting the Heart Team, medical treatment alone with systemic anticoagulation was administered. Subsequent transthoracic echocardiography (TTE) after 1 week showed complete thrombus resolution. After 4 months, the PFO was successfully occluded with an Amplatzer device. The patient received rehabilitation therapy and had good functional recovery. Clinical discussion: Anticoagulant therapy alone was chosen because of high risk for surgery. Complete thrombus resolution was achieved after 1 week although the initial thrombus size was quite large. Nevertheless, this approach may not be applicable to every patient. In addition to TTE, multimodality imaging using transesophageal echocardiography and cardiac magnetic resonance is helpful to identify the mechanism of stroke, which in our case is a thrombus-straddled PFO, and to make early treatment decisions. Serial TTEs help assess the response to anticoagulation. An individualized approach should be made with a multidisciplinary Heart Team. Conclusion: Echocardiography plays an important role in the diagnosis and treatment evaluation for patients with a thrombus straddling a PFO. An individualized approach to manage the patient should be made with a multidisciplinary Heart Team.

Background Heart failure (HF) is a global health challenge, with significant rates of hospitalization and mortality. Timely diagnosis is crucial for patient outcomes. Noninvasive imaging techniques assess early changes in HF but typically focus on specific aspects of the left atrium (LA) or left ventricle (LV). However, the close physiological interplay between the LA and LV suggests that indices evaluating both chambers, like the left atrioventricular coupling index (LACI), may offer superior diagnosis value for HF. Method This cross-sectional study involved 160 patients categorized into patient and healthy control groups. The patient group consisted of 60 adults meeting the criteria for HF diagnosis according to the 2022 AHA/ACC/HFSA Guideline. Results LACI levels were significantly higher in the HF group compared to the control group. Notably, LACI levels were higher in the HF with preserved ejection fraction (HFpEF) group than in the HF with reduced ejection fraction (HFrEF) group. The LACI showed a diagnostic value for HFpEF, with the highest AUC of 0.95 (95% CI: 0.921 - 0.981, p<0.001) compared to LASr, LAScd, and LAVI, with an optimal threshold of 33.07 (sensitivity: 97.1%, specificity: 87.3%). In multivariate analysis, LACI was an independent factor of HFpEF when compared to standard indices for diagnosing HFpEF (OR = 1.144, 95% CI: 1.087–1.205, p<0.001). Conclusion HF patients display increased LACI variability compared to healthy individuals, with the most significant increase observed in the HFpEF group. The LACI is an easily assessable parameter with potential value in diagnosing HFpEF. HFpEF, heart failure with preserved ejection fraction; LACI, left atrioventricular coupling index; LAVI, left atrial volume index, LASr, left atrial reservoir strain, LV GLS, left ventricular global longitudinal strain; LV EF, left ventricular ejection fraction; LAEDV, left atrial end-diastolic volume; LVEDV, left ventricular end-diastolic volume.

Heart failure (HF) is a growing public health concern, with red cell distribution width (RDW) gaining recognition as a cost-effective marker for predicting HF onset and progression. This study, conducted from February 2022 to February 2024 at Hue Central Hospital, aimed to assess RDW levels in hospitalized Vietnamese HF patients and its predictive value for HF severity, involving a cross-sectional analysis of 351 patients categorized into HF and non-HF groups. HF patients exhibited higher median RDW levels (14.90% [13.70% - 17.00%]) compared to non-HF individuals (13.10% [12.23% - 13.78%]). RDW was higher in HF patients with left ventricular ejection fraction (LVEF) < 50% (15.30%) than LVEF ≥ 50% (14.70%). ROC curve analysis for acute heart failure (AHF) prediction yielded an AUC of 0.651 (p < 0.001), with a cutoff point of 13.85%, sensitivity of 86.05%, and specificity of 36.94%. Elevated RDW levels were associated with HF risk (OR: 1.844, p < 0.001) and AHF (OR: 3.612, p < 0.001). Multivariate analysis identified associations between RDW and hemoglobin (Hb) (β = 2.431, p = 0.040) and hematocrit (HCT) (β = −3.355, p = 0.007) in HF. RBC and RDW > 13.85% were independent risk factors for AHF. This suggests that RDW levels can serve as biomarkers for diagnosing HF and predicting its severity. Their accessibility and cost-effectiveness indicate the potential utility of RDW in managing HF, particularly in settings with limited resources.