Aims Diastolic dysfunction is highly prevalent, and ageing is the main contributor due to impairments in active cardiac relaxation, ventriculo‐vascular stiffening, and endothelial dysfunction. Nitric oxide (NO) affects cardiovascular functions, and NO bioavailability is critically reduced with ageing. Whether replenishment of NO deficiency with dietary inorganic nitrate would offer a novel approach to reverse age‐related cardiovascular alterations was not known. Methods and results A dietary nitrate supplementation was applied to young (6 month) and old (20 month) wild‐type mice for 8 weeks and compared with controls. High‐resolution ultrasound, pressure–volume catheter techniques, and isolated heart measurements were applied to assess cardiac diastolic and vascular functions. Cardiac manganese‐enhanced magnetic resonance imaging was performed to study the effects of dietary nitrate on myocyte calcium handling. In aged mice with preserved systolic function, dietary nitrate supplementation improved LV diastolic function, arterial compliance, and coronary flow reserve. Mechanistically, improved cardiovascular functions were associated with an accelerated cardiomyocyte calcium handling and augmented NO/cyclic guanosine monophosphate/protein kinase G signalling, while enhanced nitrate reduction was related to age‐related differences in the oral microbiome. Conclusion Dietary inorganic nitrate reverses age‐related LV diastolic dysfunction and improves vascular functions. Our results highlight the potential of a dietary approach in the therapy of age‐related cardiovascular alterations.

Introduction Transthyretin (ATTR) amyloidosis is responsible for the majority of cardiac amyloidosis (CA) cases and can be reliably diagnosed with bone scintigraphy and the visual Perugini score. We aimed to implement a quantification method of cardiac amyloid deposits in patients with suspected cardiac amyloidosis and to compare performance to visual scoring. Methods and materials 136 patients received 99mTc-DPD-bone scintigraphy including SPECT/CT of the thorax in case of suspicion of cardiac amyloidosis. Imaging phantom studies were performed to determine the scaling factor for standardized uptake value (SUV) quantification from SPECT/CT. Myocardial tracer uptake was quantified in a whole heart volume of interest. Results Forty-five patients were diagnosed with CA. A strong relationship between cardiac SUVmax and Perugini score was found (Spearman r 0.75, p < 0.0001). Additionally, tracer uptake in bone decreased with increasing cardiac SUVmax and Perugini score (p < 0.0001). ROC analysis revealed good performance of the SUVmax for the detection of ATTR-CA with AUC of 0.96 ± 0.02 (p < 0.0001) with sensitivity 98.7% and specificity 87.2%. Conclusion We demonstrate an accessible and accurate quantitative SPECT approach in CA. Quantitative assessment of the cardiac tracer uptake may improve diagnostic accuracy and risk classification. This method may enable monitoring and assessment of therapy response in patients with ATTR amyloidosis.

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The role of mechanical circulatory support in COVID 19 patientsThe onset and impact of coronavirus disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has left dramatic effects on all aspects of life. Social life, economy, and medical care face challenge not seen before. With regard to end-stage heart failure and mechanical circulatory support (MCS), challenges, strategies, and preparations are addressed within this editorial.Indeed, MCS has become a true story of success, particularly following recent innovations in the last decade. Both, durable and temporary devices have changed the way we treat heart failure nowadays remarkably. [1][2][3][4] Nevertheless, the COVID-19 pandemic does not spare MCS at all. Instead, COVID-19 and MCS affect one another in two ways. Since we know that COVID-19 infection is not limited to the respiratory tract, but may also affect the heart, the matter of need for MCS in COVID-19 associated heart failure has arisen. 5 At the same time, the pandemic itself has caused significant limitations and restrictions to medical health systems as never before in modern times. Medical professionals and intensive-care resources have been and are still partially blocked for the treatment of patients suffering from severe COVID-19 infection. The focus of medical treatment altered towards diagnosis and treatment of COVID-19 and yet, the complete impact of the pandemic is unclear. As a result, elective admissions and surgery decreased consecutively and overall discomfiture and uncertainty in patients and healthcare professionals increased at the same time. Hence, outpatient care of permanent left ventricular assist device (LVAD) patients and immediate medical professional staff to patient interaction suffered, too. | COVID-19 AND CARDIAC INVOLVEMENTCOVID-19 is caused by SARS-CoV-2 and implicates the respiratory tract to be the main organ system affected by the virus. Notwithstanding, cardiovascular complications, including heart failure, may affect a large part of patients. [6][7][8] Acute virus-mediated myocardial injury and systemic inflammation may aggravate a pre-existing cardiac condition. Furthermore, reports have been published associating COVID-19 with thromboembolism. 9 However, with the immediate association of mechanical support and infectious disease, the role of MCS in this greater context of COVID-19 needs to be addressed.

In a single center analysis, data of 104 patients after LVAD implantation between August 2010 and March 2015 were analyzed retrospectively. According to INTERMACS level, 3 groups were compared: Group A (INTERMCAS level 1, n=27 patients), group B (INTERMACS level 2/3, n=47) and group C (INTERMACS level 4-6, n=30). Preoperative parameters and postoperative outcome were compared between groups. Results: Mortality was higher in group A compared to group B (p=0.017) and group C (p=0.017). Sepsis was the most common post-operative complication after LVAD implantation. Conclusion: INTERMACS level was related to outcome after LVAD implantation. Optimization of preoperative volume status, preload and sepsis management are recommended to lower mortality in these patients.