Background Animal and human data suggest that glutamate can enhance recovery of myocardial metabolism and function after ischemia. N-terminal pro-brain natriuretic peptide (NT-proBNP) reflects myocardial dysfunction after coronary artery bypass surgery (CABG). We investigated whether glutamate infusion can reduce rises of NT-proBNP in moderate- to high-risk patients after CABG. Methods and findings A prospective, randomized, double-blind study enrolled patients from November 15, 2015 to September 30, 2020, with a 30-day follow-up at 4 academic cardiac surgery centers in Sweden. Patients underwent CABG ± valve procedure and had left ventricular ejection fraction ≤0.30 or EuroSCORE II ≥3.0. Intravenous infusion of 0.125 M L-glutamic acid or saline at 1.65 mL/kg/h started 10 to 20 minutes before releasing the aortic cross-clamp, then continued for another 150 minutes. Patients, staff, and investigators were blinded to the treatment. The primary endpoint was the difference between preoperative and day-3 postoperative NT-proBNP levels. Analysis was intention to treat. We studied 303 patients (age 74 ± 7 years; females 26%, diabetes 47%), 148 receiving glutamate group and 155 controls. There was no significant difference in the primary endpoint associated with glutamate administration (5,390 ± 5,396 ng/L versus 6,452 ± 5,215 ng/L; p = 0.086). One patient died ≤30 days in the glutamate group compared to 6 controls (0.7% versus 3.9%; p = 0.12). No adverse events linked to glutamate were observed. A significant interaction between glutamate and diabetes was found (p = 0.03). Among patients without diabetes the primary endpoint (mean 4,503 ± 4,846 ng/L versus 6,824 ± 5,671 ng/L; p = 0.007), and the incidence of acute kidney injury (11% versus 29%; p = 0.005) was reduced in the glutamate group. These associations remained significant after adjusting for differences in baseline data. The main limitations of the study are: (i) it relies on a surrogate marker for heart failure; and (ii) the proportion of patients with diabetes had almost doubled compared to the cohort used for the sample size estimation. Conclusions Infusion of glutamate did not significantly reduce postoperative rises of NT-proBNP. Diverging results in patients with and without diabetes agree with previous observations and suggest that the concept of enhancing postischemic myocardial recovery with glutamate merits further evaluation. Trial registration ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT02592824. European Union Drug Regulating Authorities Clinical Trials Database (Eudra CT number 2011-006241-15).

Physical activity (PA) is a cornerstone of prevention to decrease mortality in patients with chronic cardiovascular disease, including heart failure. 1,2 Implantable cardiac devices offer the opportunity to monitor PA and data derived from implantable devices have been associated with shortand long-term outcomes. 3,4 During the severe acute respiratory syndrome coronavirus 2 pandemic, restrictions to outdoor activity were imposed by national authorities. In Italy, after the first case of coronavirus disease-2019 (COVID-19) on February 21, the so-called lockdown act was passed on March 8, 2020. 5 These rigorous measures decreased the impact of COVID-19 pandemic on the National Health System, 6 but likely resulted in changes in the ability of patients to maintain PA levels. In the current study, we examined the impact of the COVID-19 and regulatory movement restrictions on the PA of patients with an implantable cardioverter defibrillator.

Systemic sclerosis (scleroderma) is a chronic systemic autoimmune disease of the connective tissue, which can involve the cardiac valves, the mitral valve being more frequently affected, although involvement of the aortic valve has been rarely described. We report a patient with aortic stenosis and systemic sclerosis who required aortic valve replacement. Awareness of this rare association may help to provide adequate management of such patients and prevent complications related to the underlying disease.

The SBP has shown excellent results in terms of clinical improvement and freedom from valve-related complications, even up to 17 years after AVR and MVR. It therefore seems to be a safe option whenever a mechanical prosthesis is needed.

Background Coronavirus Disease‐2019 (COVID‐19) has been associated with myocardial injury and higher risk of arrhythmic complications. However, no reports are available about the effect of the ongoing pandemic on arrhythmias in patients at risk. Objective To describe the effect of COVID‐19 pandemic on arrhythmic burden among high‐risk patients. Methods This is a cross‐sectional study on the incidence of ventricular arrhythmia (VA) during the pandemic outbreak (study period), compared to the same timeframe in 2019 (reference period). Inclusion criteria were age (>18 years) and having an implantable cardiac defibrillator (ICD). Results Among 455 patients enrolled (mean age 64.9 ± 15.7 years; 25.1% females and 39.6% with CRTD), in the study period, 45 (9.9%) patients experienced a total of 86 VA; 8 patients (1.7%) required antitachycardia‐pacing (ATP) and 6 (1.3%) at least one shock. In the reference period, a total of 69 events occurred in 36 patients (7.9%). Six patients (1.3%) required ATP and three (0.7%) at least one shock. The number of patients that suffered from any arrhythmic events in the study period (9.9% vs 7.9%) did not significantly differ from the reference period (χ 2 = 1.09, P = .29). The main predictor of VA during the COVID‐19 pandemic was the previous history of any ICD therapy (OR = 3.84, P < .001). Conclusions No evidence of an increase of arrhythmic burden was found during the COVID‐19 pandemic among patients with an ICD.