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Xanthopoulos A, Skoularigis J, Briasoulis A, Magouliotis DE, Zajichek A, Milinovich A, Kattan MW, Triposkiadis F, Starling RC. Analysis of the Larissa Heart Failure Risk Score: Predictive Value in 9207 Patients Hospitalized for Heart Failure from a Single Center. J Pers Med 2023; 13:1721. [PMID: 38138948 PMCID: PMC10744973 DOI: 10.3390/jpm13121721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023] Open
Abstract
Early risk stratification is of outmost clinical importance in hospitalized patients with heart failure (HHF). We examined the predictive value of the Larissa Heart Failure Risk Score (LHFRS) in a large population of HHF patients from the Cleveland Clinic. A total of 13,309 admissions for heart failure (HF) from 9207 unique patients were extracted from the Cleveland Clinic's electronic health record system. For each admission, components of the 3-variable simple LHFRS were obtained, including hypertension history, myocardial infarction history, and red blood cell distribution width (RDW) ≥ 15%. The primary outcome was a HF readmission and/or all-cause mortality at one year, and the secondary outcome was all-cause mortality at one year of discharge. For both outcomes, all variables were statistically significant, and the Kaplan-Meier curves were well-separated and in a consistent order (Log-rank test p-value < 0.001). Higher LHFRS values were found to be strongly related to patients experiencing an event, showing a clear association of LHFRS with this study outcomes. The bootstrapped-validated area under the curve (AUC) for the logistic regression model for each outcome revealed a C-index of 0.64 both for the primary and secondary outcomes, respectively. LHFRS is a simple risk model and can be utilized as a basis for risk stratification in patients hospitalized for HF.
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Affiliation(s)
- Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, 41110 Larissa, Greece; (J.S.)
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, 41110 Larissa, Greece; (J.S.)
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, Faculty of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
| | - Dimitrios E. Magouliotis
- Unit of Quality Improvement, Department of Cardiothoracic Surgery, University of Thessaly, 41110 Larissa, Greece;
| | - Alex Zajichek
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44196, USA (M.W.K.)
| | - Alex Milinovich
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44196, USA (M.W.K.)
| | - Michael W. Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44196, USA (M.W.K.)
| | - Filippos Triposkiadis
- Department of Cardiology, University General Hospital of Larissa, 41110 Larissa, Greece; (J.S.)
| | - Randall C. Starling
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, OH 44195, USA
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2
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Shafie D, Abhari AP, Fakhrolmobasheri M. Relative Values of Hematological Indices for Prognosis of Heart Failure: A Mini-Review. Cardiol Rev 2023:00045415-990000000-00088. [PMID: 36946981 DOI: 10.1097/crd.0000000000000546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Owing to the augmented perception of heart failure (HF) pathophysiology, management of the affected patients has been improved dramatically; as with the identification of the inflammatory background of HF, new avenues of HF prognosis research have been opened up. In this regard, relative values of hematologic indices were demonstrated by a growing body of evidence to successfully predict HF outcomes. Cost-effectiveness, accessibility, and easy obtainability of these relative values make them a precious option for the determination of HF prognosis; particularly in low-income developing countries. In this short review, we aimed to present the current literature on the predictability of these hematologic parameters for HF outcomes.
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Affiliation(s)
- Davood Shafie
- From the Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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3
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Zhao HL, Gao XL, Liu YH, Li SL, Zhang Q, Shan WC, Zheng Q, Zhou J, Liu YZ, Liu L, Guo N, Tian HS, Wei QM, Hu XT, Cui YK, Geng X, Wang Q, Cui W. Validation and derivation of short-term prognostic risk score in acute decompensated heart failure in China. BMC Cardiovasc Disord 2022; 22:307. [PMID: 35799104 PMCID: PMC9264535 DOI: 10.1186/s12872-022-02743-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Few prognostic risk scores (PRSs) have been routinely used in acute decompensated heart failure (ADHF). We, therefore, externally validated three published PRSs (3A3B, AHEAD, and OPTIME-CHF) and derived a new PRS to predict the short-term prognosis in ADHF. Methods A total of 4550 patients from the Heb-ADHF registry in China were randomly divided into the derivation and validation cohorts (3:2). Discrimination of each PRS was assessed by the area under the receiver operating characteristic curve (AUROC). Logistic regression was exploited to select the predictors and create the new PRS. The Hosmer–Lemeshow goodness-of-fit test was used to assess the calibration of the new PRS. Results The AUROCs of the 3A3B, AHEAD, and OPTIME-CHF score in the derivation cohort were 0.55 (95% CI 0.53–0.57), 0.54 (95% CI 0.53–0.56), and 0.56 (95% CI 0.54–0.57), respectively. After logistic regression analysis, the new PRS computed as 1 × (diastolic blood pressure < 80 mmHg) + 2 × (lymphocyte > 1.11 × 109/L) + 1 × (creatinine > 80 μmol/L) + 2 × (blood urea nitrogen > 21 mg/dL) + 1 × [BNP 500 to < 1500 pg/mL (NT-proBNP 2500 to < 7500 pg/mL)] or 3 × [BNP ≥ 1500 (NT-proBNP ≥ 7500) pg/mL] + 3 × (QRS fraction of electrocardiogram < 55%) + 4 × (ACEI/ARB not used) + 1 × (rhBNP used), with a better AUROC of 0.67 (95% CI 0.64–0.70) and a good calibration (Hosmer–Lemeshow χ2 = 3.366, P = 0.186). The results in validation cohort verified these findings. Conclusions The short-term prognostic values of 3A3B, AHEAD, and OPTIME-CHF score in ADHF patients were all poor, while the new PRS exhibited potential predictive ability. We demonstrated the QRS fraction of electrocardiogram as a novel predictor for the short-term outcomes of ADHF for the first time. Our findings might help to recognize high-risk ADHF patients.
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Affiliation(s)
- Hong-Liang Zhao
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China.,Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei province, China
| | - Xiao-Li Gao
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Renqiu, 062552, Hebei Province, China
| | - Ying-Hua Liu
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Renqiu, 062552, Hebei Province, China
| | - Sen-Lin Li
- Department of Cardiology, Zhangjiakou First Hospital, Zhangjiakou, 075000, Hebei Province, China
| | - Qi Zhang
- Department of Cardiology, Baoding First Central Hospital, Baoding, 071000, Hebei Province, China
| | - Wei-Chao Shan
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, 067000, Hebei Province, China
| | - Qun Zheng
- Department of Cardiology, Hengshui People's Hospital, Hengshui, 053000, Hebei Province, China
| | - Jiang Zhou
- Department of Cardiology, Chengde Central Hospital, Chengde, 067024, Hebei Province, China
| | - Yong-Zheng Liu
- Department of Cardiology, Qinhuangdao First Hospital, Qinhuangdao, 066099, Hebei Province, China
| | - Li Liu
- Department of Cardiology, Qinhuangdao First Hospital, Qinhuangdao, 066099, Hebei Province, China
| | - Nan Guo
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, 061011, Hebei Province, China
| | - Hong-Sen Tian
- Department of Cardiology, Handan Central Hospital, Handan, 056000, Hebei Province, China
| | - Qing-Min Wei
- Department of Cardiology, Xingtai People's Hospital, Xingtai, 054001, Hebei Province, China
| | - Xi-Tian Hu
- Department of Cardiology, Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei Province, China
| | - Ying-Kai Cui
- Department of Cardiology, The 252nd Hospital of People's Liberation Army, Baoding, 071000, Hebei Province, China
| | - Xue Geng
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China
| | - Qian Wang
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China
| | - Wei Cui
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China.
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4
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Dokoupil J, Hrečko J, Čermáková E, Adamcová M, Pudil R. Characteristics and outcomes of patients admitted for acute heart failure in a single-centre study. ESC Heart Fail 2022; 9:2249-2258. [PMID: 35388622 PMCID: PMC9288775 DOI: 10.1002/ehf2.13759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 11/07/2021] [Accepted: 12/01/2021] [Indexed: 11/12/2022] Open
Abstract
Aims Acute heart failure represents a medical condition with very high mortality. Accurate risk stratification can help physicians to improve the health care about these patients. The aim of our study was to characterize real‐life patients admitted for acute heart failure in a specific region with one tertiary medical centre and to describe risk factors of short‐term and long‐term mortality. Methods and results We performed a retrospective analysis of patients admitted from January 2017 to December 2017 to Department of cardiology of the tertiary medical centre University Hospital in Hradec Kralove. We identified 385 patients admitted for acute heart failure to the standard care and intensive care unit. The median of age was 74 years (IQR 67.5–80) and 34% of patients were female. Hospital admission was due to de novo heart failure in 222 (57.7%) patients. The most common comorbidities were arterial hypertension (77.7%), dyslipidaemia (67.3%) and coronary artery disease (63.1%). Coronary artery disease (52.7% of cases) and valve disease (28.1% of cases) were the most common aetiologies of heart failure. The all‐cause in‐hospital mortality was 12.7%, 30‐day mortality was 14.6% and 1 year mortality was 34%. Among risk factors of in‐hospital mortality, the most significant factors were haemodialysis during the hospitalization [odds ratio (OR) 15.82, 95% confidence interval (CI) 2.96–84.57, P = 0.0008], chronic heart failure (OR 4.27, 95% CI 1.66–11.03, P = 0.001) and STEMI as a precipitating factor of heart failure (OR 4.19, 95% CI 1.23–14.25, P = 0.023). Haemodialysis during the hospitalization (OR 4.28, 95% CI 1.17–15.61, P = 0.025) and the comorbidity depression and anxiety (OR 3.49, 95% CI 1.45–8.39, P = 0.005) were the most significant risk factors of long‐term mortality. Conclusions Our study confirms very high mortality rates among patients with acute heart failure underlying poor prognosis of these patients. Comorbidities (peripheral artery disease, atrial fibrillation, chronic heart failure and depression and anxiety), precipitating factors of heart failure (myocardial infarction with ST segment elevation), complications occurring during the hospitalization (acute kidney injury, pulmonary ventilation for respiratory failure and haemodialysis) and the age of patients should be included in the risk stratification of in‐hospital, 30 day and 1 year mortality.
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Affiliation(s)
- Jiří Dokoupil
- 1st Department of Medicine-Cardioangiology, Charles University, Faculty of Medicine and University Hospital in Hradec Králové, Sokolská 581, Hradec Králové, Czech Republic
| | - Juraj Hrečko
- 1st Department of Medicine-Cardioangiology, Charles University, Faculty of Medicine and University Hospital in Hradec Králové, Sokolská 581, Hradec Králové, Czech Republic
| | - Eva Čermáková
- Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
| | - Michaela Adamcová
- Department of Physiology, Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic
| | - Radek Pudil
- 1st Department of Medicine-Cardioangiology, Charles University, Faculty of Medicine and University Hospital in Hradec Králové, Sokolská 581, Hradec Králové, Czech Republic
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5
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Charles E, Dumont BL, Bonneau S, Neagoe PE, Villeneuve L, Räkel A, White M, Sirois MG. Angiopoietin 1 release from human neutrophils is independent from neutrophil extracellular traps (NETs). BMC Immunol 2021; 22:51. [PMID: 34344299 PMCID: PMC8336418 DOI: 10.1186/s12865-021-00442-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background Neutrophils induce the synthesis and release of angiopoietin 1 (Ang1), a cytosolic growth factor involved in angiogenesis and capable of inducing several pro-inflammatory activities in neutrophils. Neutrophils also synthesize and release neutrophil extracellular traps (NETs), comprised from decondensed nuclear DNA filaments carrying proteins such as neutrophil elastase (NE), myeloperoxidase (MPO), proteinase 3 (PR3) and calprotectin (S100A8/S100A9), which together, contribute to the innate immune response against pathogens (e.g., bacteria). NETs are involved in various pathological conditions through pro-inflammatory, pro-thrombotic and endothelial dysfunction effects and have recently been found in heart failure (HF) and type 2 diabetes (T2DM) patients. The aim of the present study was to investigate the role of NETs on the synthesis and release of Ang1 by the neutrophils in patients with T2DM and HF with preserved ejection fraction (HFpEF) (stable or acute decompensated; ADHFpEF) with or without T2DM. Results Our data show that at basal level (PBS) and upon treatment with LPS, levels of NETs are slightly increased in patients suffering from T2DM, HFpEF ± T2DM and ADHF without (w/o) T2DM, whereas this increase was significant in ADHFpEF + T2DM patients compared to healthy control (HC) volunteers and ADHFpEF w/o T2DM. We also observed that treatments with PMA or A23187 increase the synthesis of Ang1 (from 150 to 250%) in HC and this effect is amplified in T2DM and in all cohorts of HF patients. Ang1 is completely released (100%) by neutrophils of all groups and does not bind to NETs as opposed to calprotectin. Conclusions Our study suggests that severely ill patients with HFpEF and diabetes synthesize and release a greater abundance of NETs while Ang1 exocytosis is independent of NETs synthesis. Supplementary Information The online version contains supplementary material available at 10.1186/s12865-021-00442-8.
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Affiliation(s)
- Elcha Charles
- Research Center, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada.,Department of Pharmacology and Physiology , Université de Montréal, Montreal, QC, Canada
| | - Benjamin L Dumont
- Research Center, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada.,Department of Pharmacology and Physiology , Université de Montréal, Montreal, QC, Canada
| | - Steven Bonneau
- Research Center, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada.,Department of Pharmacology and Physiology , Université de Montréal, Montreal, QC, Canada
| | - Paul-Eduard Neagoe
- Research Center, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Louis Villeneuve
- Research Center, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Agnès Räkel
- Department of Medicine, Université de Montréal, Montreal, QC, Canada.,Faculty of Medicine, and Research Center-Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
| | - Michel White
- Research Center, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada. .,Department of Medicine, Université de Montréal, Montreal, QC, Canada.
| | - Martin G Sirois
- Research Center, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada. .,Department of Pharmacology and Physiology , Université de Montréal, Montreal, QC, Canada.
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6
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Goudot FX, Msadek S, Boukertouta T, Schischmanoff PO, Meune C. Routine use of natriuretic peptides: Lessons from a big data analysis. Ann Clin Biochem 2021; 58:481-486. [PMID: 34006120 DOI: 10.1177/00045632211020779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Natriuretic peptides have broad indications during heart failure and the detection of left ventricular dysfunction in high-risk patients. They can also be used for the diagnosis/management of other cardiac diseases. However, very little is known regarding their use in routine practice. METHODS We examined all biological tests performed from February 2010 to August 2015 in two districts from the French Brittany, covering 13,653 km2 and including 22,265 physicians. We report the settings and conditions of N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements (the only locally natriuretic peptide available). RESULTS From a total of 3,606,432 tests requested in 557,650 adult (older than 20 years) patients, only 56,653 (1.6%) included at least one NT-proBNP measurement. NT-proBNP measurements gradually increased, from 9188 in 2011 to 12,938 in 2014 (P < 0.001). Most NT-proBNP tests were measured in urban laboratories (72.7%) and in private (62.9%) non-hospital/clinics laboratories; they were mostly ordered by general practitioners (66% compared with 11% by cardiologists). The number of NT-proBNP measurements increased with age up to 80-90 years, and 70.3% of tests were measured in ≥75 years patients. Creatinine and electrolytes were not associated with NT-proBNP in 15.8% and 19.7% of tests, respectively. CONCLUSION Among a very large cohort, we observed that natriuretic peptides remain largely undermeasured. NT-proBNP is mostly measured in elderly patients, and its interpretation may be hazardous in up to 16% of all individuals because no measurement of creatinine was associated to NT-proBNP.
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Affiliation(s)
- F X Goudot
- Cardiology Department, Avicenne University Hospital, APHP, Université Sorbonne Paris Nord, Bobigny, France
| | - S Msadek
- Cardiology Department, Avicenne University Hospital, APHP, Université Sorbonne Paris Nord, Bobigny, France
| | - T Boukertouta
- Cardiology Department, Avicenne University Hospital, APHP, Université Sorbonne Paris Nord, Bobigny, France
| | - P O Schischmanoff
- Biochemistry Department, Avicenne University Hospital, APHP, Université Sorbonne Paris Nord, Bobigny, France
| | - C Meune
- Cardiology Department, Avicenne University Hospital, APHP, Université Sorbonne Paris Nord, Bobigny, France
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7
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Castro RRT, Lechnewski L, Homero A, Albuquerque DCD, Rohde LE, Almeida D, David J, Rassi S, Bacal F, Bocchi E, Moura L. Acute Hemodynamic Index Predicts In-Hospital Mortality in Acute Decompensated Heart Failure. Arq Bras Cardiol 2021; 116:77-86. [PMID: 33566969 PMCID: PMC8159496 DOI: 10.36660/abc.20190439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 03/16/2020] [Indexed: 01/13/2023] Open
Abstract
Fundamento O exame físico permite a avaliação prognóstica de pacientes com insuficiência cardíaca (IC) descompensada, porém não é suficientemente confiável e depende da experiência clínica do profissional. Considerando as respostas hemodinâmicas a situações do tipo “luta ou fuga” tais como a admissão no serviço de emergência, foi proposto o índice hemodinâmico agudo (IHA), calculado a partir da frequência cardíaca e pressão de pulso. Objetivo avaliar a capacidade prognóstica intra-hospitalar do IHA na IC descompensada. Métodos estudo prospectivo, multicêntrico e observacional baseado no registro BREATHE, incluindo dados de hospitais públicos e privados no Brasil. Foram utilizadas análises ROC (
Receiver Operating Characteristic
), de estatística c e de regressão multivariada, assim como o critério de informação de Akaike, para testar a capacidade prognóstica do IHA. O valor-p < 0,05 foi considerado estatisticamente significativo. Resultados Foram analisados dados de 463 pacientes com IC com fração de ejeção reduzida a partir do registro BREATHE. A mortalidade intra-hospitalar foi de 9%. A mediana do IHA foi considerada o valor de corte (4 mmHg⋅bpm). Um baixo IHA (≤ 4 mmHg⋅bpm) foi encontrado em 80% dos pacientes falecidos. O risco de mortalidade intra-hospitalar em pacientes com baixo IHA foi 2,5 vezes maior que aquele para pacientes com IHA > 4 mmHg⋅bpm. O IHA foi capaz de predizer independentemente a mortalidade intra-hospitalar na IC aguda descompensada [sensibilidade: 0,786; especificidade: 0,429; AUC (área sob a curva): 0,607 (0,540-0,674), p = 0,010] mesmo depois dos ajustes para comorbidades e uso de medicamentos [razão de chances (RC): 0,061 (0,007-0,114), p = 0,025]. Conclusões O IHA é capaz de predizer independentemente a mortalidade intra-hospitalar na IC aguda descompensada. Esse índice simples e realizado à beira do leito pode se mostrar útil em serviços de emergência. (Arq Bras Cardiol. 2021; 116(1):77-86)
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Affiliation(s)
- Renata R T Castro
- Brigham and Womens Hospital - Medicine, Boston - EUA.,Hospital Naval Marcilio Dias, Rio de Janeiro, RJ - Brasil.,Faculdade de Medicina, Universidade Iguaçu, Nova Iguaçu, RJ - Brasil
| | - Luka Lechnewski
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
| | - Alan Homero
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
| | | | | | - Dirceu Almeida
- Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | - João David
- Hospital de Messejana, Fortaleza, CE - Brasil
| | | | - Fernando Bacal
- Universidade de São Paulo Instituto do Coração, São Paulo, SP - Brasil
| | - Edimar Bocchi
- Universidade de São Paulo Instituto do Coração, São Paulo, SP - Brasil
| | - Lidia Moura
- Pontifícia Universidade Católica do Paraná, Curitiba, PR - Brasil
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8
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Kitai T, Xanthopoulos A, Tang WHW, Kaji S, Furukawa Y, Oishi S, Akiyama E, Suzuki S, Yamamoto M, Kida K, Okumura T, Skoularigis J, Triposkiadis F, Matsue Y. Validation of the Larissa Heart Failure Risk Score for risk stratification in acute heart failure. Int J Cardiol 2020; 307:119-124. [PMID: 31926640 DOI: 10.1016/j.ijcard.2019.12.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/12/2019] [Accepted: 12/27/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND The LHFRS is a simple score derived from three factors (history of hypertension, history of coronary artery disease/myocardial infarction, and red blood cell distribution width) deployed for the risk stratification of AHF in Greek population. This study aimed to validate the Larissa Heart Failure Risk Score (LHFRS) in patients with acute heart failure (AHF) in a Japanese population. METHODS We performed post-hoc analysis of 1670 consecutive patients enrolled in the REALITY-AHF. In all, 964 patients were finally enrolled. Exclusion criteria included patients with anemia, malignancies and sepsis. The primary outcome was defined as a composite of all-cause mortality and/or heart failure readmission, and the secondary outcome was defined as all-cause mortality. RESULTS The median admission LHFRS value was 1 (interquartile range [IQR]: 0-2). During a median follow-up of 365 (IQR: 161-365) days, the primary and secondary outcomes were observed in 321 and 157 patients, respectively. LHFRS was an independent predictor of both the primary (adjusted hazard ratio per 1-point increase, 95% confidence interval: 1.17 [1.04-1.32], p = 0.011), and the secondary outcomes (1.31 [1.12-1.55], p = 0.001). Patients with higher LHFRS scores (≥2) exhibited significantly worse outcomes than those with lower scores (<2) both for the primary outcome (1.40 [1.07-1.83], p = 0.014) and the secondary outcome (1.60 [1.09-2.34], p = 0.015). Additionally, LHFRS revealed an excellent goodness of fit (observed versus predicted outcomes) for predicting both the primary and the secondary outcomes (p > 0.99 and p = 0.99, respectively). CONCLUSION The simple LHFRS was proved as a reliable predictor of outcomes in patients with AHF.
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Affiliation(s)
- Takeshi Kitai
- Departments of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
| | - Andrew Xanthopoulos
- Department of Cardiovascular Medicine, University General Hospital of Larissa, Larissa, Greece
| | - W H Wilson Tang
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Shuichiro Kaji
- Departments of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Furukawa
- Departments of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shogo Oishi
- Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan
| | - Eiichi Akiyama
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Satoshi Suzuki
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Masayoshi Yamamoto
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - John Skoularigis
- Department of Cardiovascular Medicine, University General Hospital of Larissa, Larissa, Greece
| | - Filippos Triposkiadis
- Department of Cardiovascular Medicine, University General Hospital of Larissa, Larissa, Greece
| | - Yuya Matsue
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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9
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Kaku H, Funakoshi K, Ide T, Fujino T, Matsushima S, Ohtani K, Higo T, Nakai M, Sumita Y, Nishimura K, Miyamoto Y, Anzai T, Tsutsui H. Impact of Hospital Practice Factors on Mortality in Patients Hospitalized for Heart Failure in Japan - An Analysis of a Large Number of Health Records From a Nationwide Claims-Based Database, the JROAD-DPC. Circ J 2020; 84:742-753. [PMID: 32238643 DOI: 10.1253/circj.cj-19-0759] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND An inverse relationship exists between hospital case volume and mortality in patients with heart failure (HF). However, hospital performance factors associated with mortality in HF patients have not been examined. We aimed to identify these using exploratory factor analysis and assess the relationship between these factors and 7-day, 30-day, and in-hospital mortality among HF patients in Japan.Methods and Results:We analyzed the records of 198,861 patients admitted to 683 certified hospitals of the Japanese Circulation Society between 2012 and 2014. Records were obtained from the nationwide database of the Japanese Registry Of All cardiac and vascular Diseases-Diagnostic Procedure Combination (JROAD-DPC). Using exploratory factor analysis, 90 hospital survey items were grouped into 5 factors, according to their collinearity: "Interventional cardiology", "Cardiovascular surgery", "Pediatric cardiology", "Electrophysiology" and "Cardiac rehabilitation". Multivariable logistic regression analysis was performed to determine the association between these factors and mortality. The 30-day mortality was 8.0%. Multivariable logistic regression analysis showed the "Pediatric cardiology" (odds ratio (OR) 0.677, 95% confidence interval [CI]: 0.628-0.729, P<0.0001), "Electrophysiology" (OR 0.876, 95% CI: 0.832-0.923, P<0.0001), and "Cardiac rehabilitation" (OR 0.832, 95% CI: 0.792-0.873, P<0.0001) factors were associated with lower mortality. In contrast, "Interventional cardiology" (OR 1.167, 95% CI: 1.070-1.272, P<0.0001) was associated with higher mortality. CONCLUSIONS Hospital factors, including various cardiovascular therapeutic practices, may be associated with the early death of HF patients.
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Affiliation(s)
- Hidetaka Kaku
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Kouta Funakoshi
- Center for Clinical and Translational Research, Kyushu University Hospital
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Takeo Fujino
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Shouji Matsushima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Kisho Ohtani
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Taiki Higo
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Michikazu Nakai
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
| | - Yoko Sumita
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
| | - Kunihiro Nishimura
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
| | - Yoshihiro Miyamoto
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
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10
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Beldhuis IE, Streng KW, van der Meer P, Ter Maaten JM, O'Connor CM, Metra M, Dittrich HC, Ponikowski P, Cotter G, Cleland JG, Davison BA, Givertz MM, Teerlink JR, Bloomfield DM, Voors AA, Damman K. Trajectories of Changes in Renal Function in Patients with Acute Heart Failure. J Card Fail 2019; 25:866-874. [DOI: 10.1016/j.cardfail.2019.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 06/05/2019] [Accepted: 07/09/2019] [Indexed: 12/21/2022]
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11
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Ruiz-Ruiz F, Menéndez-Orenga M, Medrano FJ, Calderón EJ, Lora-Pablos D, Navarro-Puerto MA, Rodríguez-Torres P, Gómez de la Cámara A. The prognosis of patients hospitalized with a first episode of heart failure, validation of two scores: PREDICE and AHEAD. Clin Epidemiol 2019; 11:615-624. [PMID: 31413639 PMCID: PMC6660629 DOI: 10.2147/clep.s206017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/17/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose Heart failure (HF) is a chronic, frequent and disabling condition but with a modifiable course and a large potential for improving. The aim of this study was to validate the two available clinical prediction rules for mortality at one year in patients with primo-hospitalization for decompensated HF: PREDICE and AHEAD. The secondary aim was to evaluate in our setting the changes in the clinical pattern of HF in the last decade in patients hospitalized for a first episode of the disease. Patients and methods A prospective multicenter cohort study, which included 180 patients hospitalized with “de novo” HF was conducted to validate the PREDICE score. Calibration and discrimination measurements were calculated for the PREDICE model and the PREDICE score (using the validation cohort of the PREDICE) and the AHEAD score (using both the development and the validation cohort of the PREDICE). Results For the PREDICE models, the area under the curve (AUC) was 0.68 (95% confidence interval [CI]: 0.57–0.79) and the calibration slope 0.65 (95% CI: 0.21–1.20). For the PREDICE score AUC was 0.59 (95% CI: 0.47–0.71) and slope 0.42 (95% CI: −0.20–1.17). For the AHEAD score the AUC was 0.68 (95% CI: 0.62–0.73) and slope 1.38 (95% CI: 0.62–0.73) when used the development cohort of PREDICE and the AUC was 0.58 (95% CI: 0.49–0.67), and slope 0.68 (95% CI: −0.06 to 1.47) when used its validation cohort. Conclusion The present study shows that the two risk scores available for patients with primo-hospitalization for decompensated HF (PREDICE and AHEAD) are not currently valid for predicting mortality at one-year. In our setting the clinical spectrum of hospitalized patients with new-onset HF has been modified over time. The study underscores the need to validate the prognostic models before clinical implementation.
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Affiliation(s)
| | - Miguel Menéndez-Orenga
- Research Institute, Clinical Research Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Francisco J Medrano
- Service of Internal Medicine, Virgen del Rocio University Hospital, Seville, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP) , Madrid, Spain.,Instituto de Biomedicina de Sevilla, Department of Health of the Junta de Andalusia/CSIC/University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain
| | - Enrique J Calderón
- Service of Internal Medicine, Virgen del Rocio University Hospital, Seville, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP) , Madrid, Spain.,Instituto de Biomedicina de Sevilla, Department of Health of the Junta de Andalusia/CSIC/University of Seville, Seville, Spain.,Department of Medicine, University of Seville, Seville, Spain
| | - David Lora-Pablos
- Research Institute, Clinical Research Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Agustín Gómez de la Cámara
- Research Institute, Clinical Research Unit, Hospital Universitario 12 de Octubre, Madrid, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP) , Madrid, Spain
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12
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Molvin J, Jujic A, Navarin S, Melander O, Zoccoli G, Hartmann O, Bergmann A, Struck J, Bachus E, Di Somma S, Magnusson M. Bioactive adrenomedullin, proenkephalin A and clinical outcomes in an acute heart failure setting. Open Heart 2019; 6:e001048. [PMID: 31354956 PMCID: PMC6615850 DOI: 10.1136/openhrt-2019-001048] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/20/2019] [Accepted: 06/13/2019] [Indexed: 01/19/2023] Open
Abstract
Objectives In an acute heart failure (AHF) setting, proenkephalin A 119–159 (penKid) has emerged as a promising prognostic marker for predicting worsening renal function (WRF), while bioactive adrenomedullin (bio-ADM) has been proposed as a potential marker for congestion. We examined the diagnostic value of bio-ADM in congestion and penKid in WRF and investigated the prognostic value of bio-ADM and penKid regarding mortality, rehospitalisation and length of hospital stay in two separate European AHF cohorts. Methods Bio-ADM and penKid were measured in 530 subjects hospitalised for AHF in two cohorts: Swedish HeArt and bRain failure inVESTigation trial (HARVEST-Malmö) (n=322, 30.1% female; mean age 75.1+11.1 years; 12 months follow-up) and Italian GREAT Network Rome study (n=208, 54.8% female; mean age 78.5+9.9 years; no follow-up available). Results PenKid was associated with WRF (area under the curve (AUC) 0.65, p<0.001). In multivariable logistic regression analysis of the pooled cohort, penKid showed an independent association with WRF (adjusted OR (aOR) 1.74, p=0.004). Bio-ADM was associated with peripheral oedema (AUC 0.71, p<0.001), which proved to be independent after adjustment (aOR 2.30, p<0.001). PenKid was predictive of in-hospital mortality (OR 2.24, p<0.001). In HARVEST-Malmö, both penKid and bio-ADM were predictive of 1-year mortality (aOR 1.34, p=0.038 and aOR 1.39, p=0.030). Furthermore, bio-ADM was associated with rehospitalisation (aOR 1.25, p=0.007) and length of hospital stay (β=0.702, p=0.005). Conclusion In two different European AHF cohorts, bio-ADM and penKid perform as suitable biomarkers for early detection of congestion severity and WRF occurrence, respectively, and are associated with pertinent clinical outcomes.
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Affiliation(s)
- John Molvin
- Department of Cardiology, Skånes universitetssjukhus Malmö, Malmoe, Sweden.,Department of Clinical Science, Lunds University Faculty of Medicine, Malmoe, Sweden
| | - Amra Jujic
- Department of Cardiology, Skånes universitetssjukhus Malmö, Malmoe, Sweden.,Department of Clinical Science, Lunds University Faculty of Medicine, Malmoe, Sweden
| | - Silvia Navarin
- Departments of Medical-Surgery Sciences and Translational Medicine, School of Medicine and Psychology, Sapienza - University, Sant' Andrea Hospital, Roma, Italy.,GREAT Network; Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Rome, Italy
| | - Olle Melander
- Department of Clinical Science, Lunds University Faculty of Medicine, Malmoe, Sweden.,Department of Internal Medicine, Skånes universitetssjukhus Malmö, Malmoe, Sweden
| | - Giada Zoccoli
- Departments of Medical-Surgery Sciences and Translational Medicine, School of Medicine and Psychology, Sapienza - University, Sant' Andrea Hospital, Roma, Italy.,GREAT Network; Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Rome, Italy
| | | | | | | | - Erasmus Bachus
- Department of Clinical Science, Lunds University Faculty of Medicine, Malmoe, Sweden
| | - Salvatore Di Somma
- Departments of Medical-Surgery Sciences and Translational Medicine, School of Medicine and Psychology, Sapienza - University, Sant' Andrea Hospital, Roma, Italy.,GREAT Network; Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Rome, Italy
| | - Martin Magnusson
- Department of Cardiology, Skånes universitetssjukhus Malmö, Malmoe, Sweden.,Department of Clinical Science, Lunds University Faculty of Medicine, Malmoe, Sweden
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13
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Draker N, Torry DS, Torry RJ. Placenta growth factor and sFlt-1 as biomarkers in ischemic heart disease and heart failure: a review. Biomark Med 2019; 13:785-799. [DOI: 10.2217/bmm-2018-0492] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Coronary heart disease (CHD) and heart failure (HF) produce significant morbidity/mortality but identifying new biomarkers could help in the management of each. In this article, we summarize the molecular regulation and biomarker potential of PIGF and sFlt-1 in CHD and HF. PlGF is elevated during ischemia and some studies have shown PlGF, sFlt-1 or PlGF:sFlt-1 ratio, when used in combination with standard biomarkers, strengthens predictions of outcomes. sFlt-1 and PlGF are elevated in HF with sFlt-1 as a stronger predictor of outcomes. Although promising, we discuss additional study criteria needed to confirm the clinical usefulness of PlGF or sFlt-1 in the detection and management of CHD or HF.
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Affiliation(s)
- Nicole Draker
- Department of Pharmaceutical & Administrative Sciences, Ellis Pharmacogenomics Lab, College of Pharmacy & Health Sciences, Drake University, Des Moines, IA 50311, USA
| | - Donald S Torry
- Department of Medical Microbiology, Immunology, & Cell Biology, Department of OB/GYN, Southern Illinois University, School of Medicine, Springfield, IL 62702, USA
| | - Ronald J Torry
- Department of Pharmaceutical & Administrative Sciences, Ellis Pharmacogenomics Lab, College of Pharmacy & Health Sciences, Drake University, Des Moines, IA 50311, USA
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14
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Li KHC, Gong M, Li G, Baranchuk A, Liu T, Wong MCS, Jesuthasan A, Lai RWC, Lai JCL, Lee APW, Bayés-Genis A, de la Espriella R, Sanchis J, Wu WKK, Tse G, Nuñez J. Cancer antigen-125 and outcomes in acute heart failure: a systematic review and meta-analysis. HEART ASIA 2018; 10:e011044. [PMID: 30402141 DOI: 10.1136/heartasia-2018-011044] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/30/2018] [Accepted: 08/02/2018] [Indexed: 12/20/2022]
Abstract
Background Carbohydrate antigen-125 (CA125) is an ovarian cancer marker, but recent work has examined its role in risk stratification in heart failure. A recent meta-analysis examined its prognostic value in heart failure generally. However, there has been no systematic evaluation of its role specifically in acute heart failure (AHF). Methods PubMed and EMBASE databases were searched until 11 May 2018 for studies that evaluated the prognostic value of CA125 in AHF. Results A total of 129 and 179 entries were retrieved from PubMed and EMBASE. Sixteen studies (15 cohort studies, 1 randomised trial) including 8401 subjects with AHF (mean age 71 years old, 52% male, mean follow-up 13 months, range of patients 525.1±598.2) were included. High CA125 levels were associated with a 68% increase in all-cause mortality (8 studies, HRs: 1.68, 95% CI 1.36 to 2.07; p<0.0001; I2: 74%) and 77% increase in heart failure-related readmissions (5 studies, HRs: 1.77, 95% CI 1.22 to 2.59; p<0.01; I2: 73%). CA125 levels were higher in patients with fluid overload symptoms and signs compared with those without them, with a mean difference of 54.8 U/mL (5 studies, SE: 13.2 U/mL; p<0.0001; I2: 78%). Conclusion Our meta-analysis found that high CA125 levels are associated with AHF symptoms, heart failure-related hospital readmissions and all-cause mortality. Therefore, CA125 emerges as a useful risk stratification tool for identifying high-risk patients with more severe fluid overload, as well as for monitoring following an AHF episode.
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Affiliation(s)
- Ka Hou Christien Li
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Faculty of Medicine, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China.,Faculty of Medicine, Newcastle University, England, UK
| | - Mengqi Gong
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, china
| | - Guangping Li
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, china
| | - Adrian Baranchuk
- Department of Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | - Tong Liu
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, china
| | - Martin C S Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Rachel W C Lai
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Faculty of Medicine, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Jenny Chi Ling Lai
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Faculty of Medicine, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Alex Pui Wai Lee
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Faculty of Medicine, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Antoni Bayés-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - William K K Wu
- Faculty of Medicine, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China.,Department of Anaesthesia and Intensive Care, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Faculty of Medicine, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Julio Nuñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
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15
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El-Amrousy D, Hassan S, Hodeib H. Prognostic value of homocysteine and highly sensitive cardiac troponin T in children with acute heart failure. J Saudi Heart Assoc 2018; 30:198-204. [PMID: 29983495 PMCID: PMC6026391 DOI: 10.1016/j.jsha.2017.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/21/2017] [Accepted: 11/26/2017] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Heart failure (HF) is a progressive disorder in children. Many HF biomarkers have been identified to assess its severity and predict its course. The aim of this study was to evaluate the prognostic value of plasma levels of homocysteine (HCY) and highly sensitive cardiac troponin T (hs-cTnT) in children with HF. MATERIALS AND METHODS Eighty children with acute HF were enrolled in this study as the patient group and 80 healthy children of matched age and sex served as the control group. HCY and hs-cTnT serum levels were measured before and after HF treatment; additionally, echocardiographic examinations were performed before and after therapy. All patients were followed up for 3 months. RESULTS Plasma levels of HCY and hs-cTnT were significantly higher in children with HF before treatment, compared with their levels in children with HF after treatment and with the control group. This increase in serum levels of both biomarkers was associated with increased severity of HF according to the Ross classification of HF. HCY had higher specificity, positive predictive value, and accuracy than hs-cTnT. Serum levels of both biomarkers had a significant positive correlation with cardiomegaly and a significant negative correlation with left ventricular ejection fraction and fraction shortening. Marked elevation of both serum biomarkers was significantly associated with poor outcome with mortality rate of 10%. CONCLUSION Plasma HCY and serum hs-cTnT levels have a good prognostic value in children with congestive heart failure (CHF) and their levels significantly correlated with clinical and echocardiographic data, severity of HF, and adverse outcome in children with CHF.
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Affiliation(s)
- Doaa El-Amrousy
- Pediatric Department, Tanta University Hospital, Tanta, EgyptaEgypt
- Corresponding author at: Pediatric Department, Tanta University Hospital, El Motasem Street, Number 6, Tanta, Egypt.
| | - Samir Hassan
- Pediatric Department, Tanta University Hospital, Tanta, EgyptaEgypt
| | - Hossam Hodeib
- Clinical Pathology Department, Tanta University Hospital, Tanta, EgyptbEgypt
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16
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Circulating Biomarkers in Heart Failure. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1067:89-108. [PMID: 29392578 DOI: 10.1007/5584_2017_140] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Biological markers have served for diagnosis, risk stratification and guided therapy of heart failure (HF). Our knowledge regarding abilities of biomarkers to relate to several pathways of HF pathogenesis and reflect clinical worsening or improvement in the disease is steadily expanding. Although there are numerous clinical guidelines, which clearly diagnosis, prevention and evidence-based treatment of HF, a strategy regarding exclusion of HF, as well as risk stratification of HF, nature evolution of disease is not well established and requires more development. The aim of the chapter is to discuss a role of biomarker-based approaches for more accurate diagnosis, in-depth risk stratification and individual targeting in treatment of patients with HF.
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17
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Xanthopoulos A, Tryposkiadis K, Giamouzis G, Konstantinou D, Giannakoulas G, Karvounis H, Kattan MW, Skoularigis J, Parissis J, Starling RC, Triposkiadis F. Larissa Heart Failure Risk Score: a proposed simple score for risk stratification in chronic heart failure. Eur J Heart Fail 2017; 20:614-616. [PMID: 29271552 DOI: 10.1002/ejhf.1132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/30/2017] [Accepted: 12/04/2017] [Indexed: 12/16/2022] Open
Affiliation(s)
- Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece.,Department of Cardiovascular Medicine, Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, OH, USA
| | | | - Gregory Giamouzis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | | | - George Giannakoulas
- First Cardiology Department, University General Hospital AHEPA, Thessaloniki, Greece
| | - Haralambos Karvounis
- First Cardiology Department, University General Hospital AHEPA, Thessaloniki, Greece
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - John Parissis
- Department of Cardiology, Athens University Hospital Attikon, Athens, Greece
| | - Randall C Starling
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, OH, USA
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18
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Proenkephalin, Renal Dysfunction, and Prognosis in Patients With Acute Heart Failure: A GREAT Network Study. J Am Coll Cardiol 2017; 69:56-69. [PMID: 28057251 DOI: 10.1016/j.jacc.2016.10.038] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 09/29/2016] [Accepted: 10/04/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Proenkephalin A (PENK) and its receptors are widely distributed. Enkephalins are cardiodepressive and difficult to measure directly. PENK is a stable surrogate analyte of labile enkephalins that is correlated inversely with renal function. Cardiorenal syndrome is common in acute heart failure (HF) and portends poor prognosis. OBJECTIVES This study assessed the prognostic value of PENK in acute HF, by identifying levels that may be useful in clinical decisions, and evaluated its utility for predicting cardiorenal syndrome. METHODS This multicenter study measured PENK in 1,908 patients with acute HF (1,186 male; mean age 75.66 ± 11.74 years). The primary endpoint was 1-year all-cause mortality; secondary endpoints were in-hospital mortality, all-cause mortality or HF rehospitalization within 1 year, and in-hospital worsening renal function, defined as a rise in plasma creatinine ≥26.5 μmol/l or 50% higher than the admission value within 5 days of presentation. RESULTS During 1-year follow-up, 518 patients died. Measures of renal function were the major determinants of PENK levels. PENK independently predicted worsening renal function (odds ratio: 1.58; 95% confidence interval [CI]: 1.24 to 2.00; p < 0.0005) with a model receiver-operating characteristic area of 0.69. PENK was associated with the degree of worsening renal function. Multivariable Cox regression models showed that PENK level was an independent predictor of 1-year mortality (p < 0.0005) and 1-year death and/or HF (hazard ratio: 1.27; 95% CI: 1.10 to 1.45; p = 0.001). PENK levels independently predicted outcomes at 3 or 6 months and were independent predictors of in-hospital mortality, predominantly down-classifying risk in survivors when added to clinical scores; levels <133.3 pmol/l and >211.3 pmol/l detected low-risk and high-risk patients, respectively. CONCLUSIONS PENK levels reflect cardiorenal status in acute HF and are prognostic for worsening renal function and in-hospital mortality as well as mortality during follow-up.
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19
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Delgado A, Rodrigues B, Nunes S, Baptista R, Marmelo B, Moreira D, Gama P, Nunes L, Santos O, Cabral C. Acute Heart Failure Registry: Risk Assessment Model in Decompensated Heart Failure. Arq Bras Cardiol 2017; 107:557-567. [PMID: 28558086 PMCID: PMC5210460 DOI: 10.5935/abc.20160178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/31/2016] [Indexed: 11/20/2022] Open
Abstract
Background Heart failure (HF) is a highly prevalent syndrome. Although the long-term
prognostic factors have been identified in chronic HF, this information is
scarcer with respect to patients with acute HF. despite available data in
the literature on long-term prognostic factors in chronic HF, data on acute
HF patients are more scarce. Objectives To develop a predictor of unfavorable prognostic events in patients
hospitalized for acute HF syndromes, and to characterize a group at higher
risk regarding their clinical characteristics, treatment and outcomes. Methods cohort study of 600 patients admitted for acute HF, defined according to the
European Society of Cardiology criteria. Primary endpoint for score
derivation was defined as all-cause mortality and / or rehospitalization for
HF at 12 months. For score validation, the following endpoints were used:
all-cause mortality and / or readmission for HF at 6, 12 and 24 months. The
exclusion criteria were: high output HF; patients with acute myocardial
infraction, acute myocarditis, infectious endocarditis, pulmonary infection,
pulmonary artery hypertension and severe mitral stenosis. Results 505 patients were included, and prognostic predicting factors at 12 months
were identified. One or two points were assigned according to the odds ratio
(OR) obtained (p < 0.05). After the total score value was determined, a
4-point cut-off was determined for each ROC curve at 12 months. Two groups
were formed according to the number of points, group A < 4 points, and
group B = 4 points. Group B was composed of older patients, with higher
number of comorbidities and predictors of the combined endpoint at 6, 12 and
24 months, as linearly represented in the survival curves (Log rank). Conclusions This risk score enabled the identification of a group with worse prognosis at
12 months.
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Affiliation(s)
- Anne Delgado
- Serviço de Cardiologia, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Bruno Rodrigues
- Serviço de Cardiologia, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Sara Nunes
- Instituto Politécnico de Castelo Branco, Escola Superior de Gestão, Viseu, Portugal
| | - Rui Baptista
- IBILI Research Consortium, Faculdade de Medicina, Universidade de Coimbra, Viseu, Portugal
| | - Bruno Marmelo
- Serviço de Cardiologia, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Davide Moreira
- Serviço de Cardiologia, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Pedro Gama
- Serviço de Cardiologia, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Luís Nunes
- Serviço de Cardiologia, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Oliveira Santos
- Serviço de Cardiologia, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Costa Cabral
- Serviço de Cardiologia, Centro Hospitalar Tondela Viseu, Viseu, Portugal
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20
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Xanthopoulos A, Giamouzis G, Tryposkiadis K, Paraskevopoulou E, Paraskevopoulou P, Karagiannis G, Patsilinakos S, Parissis J, Farmakis D, Butler J, Skoularigis J, Triposkiadis F. A simple score for early risk stratification in acute heart failure. Int J Cardiol 2017; 230:248-254. [DOI: 10.1016/j.ijcard.2016.12.131] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/03/2016] [Accepted: 12/17/2016] [Indexed: 12/11/2022]
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21
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Xiao J, Gao R, Bei Y, Zhou Q, Zhou Y, Zhang H, Jin M, Wei S, Wang K, Xu X, Yao W, Xu D, Zhou F, Jiang J, Li X, Das S. Circulating miR-30d Predicts Survival in Patients with Acute Heart Failure. Cell Physiol Biochem 2017; 41:865-874. [PMID: 28214846 DOI: 10.1159/000459899] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 01/30/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/AIMS Identification of novel biomarkers to identify acute heart failure (AHF) patients at high risk of mortality is an area of unmet clinical need. Recently, we reported that the baseline level of circulating miR-30d was associated with left ventricular remodeling in response to cardiac resynchronization therapy in advanced chronic heart failure patients. However, the role of circulating miR-30d as a prognostic marker of survival in patients with AHF has not been explored. METHODS Patients clinically diagnosed with AHF were enrolled and followed up for 1 year. Quantitative reverse transcription polymerase chain reactions were used to determine serum miR-30d levels. The univariate logistic regression analysis and multivariate logistic regression analysis were used to determine the predictors for all-cause mortality in AHF patients. Kaplan-Meier survival analysis was used to analyze the role of miR-30d in prediction of survival. RESULTS A total of 96 AHF patients were enrolled and followed up for 1 year. Serum miR-30d was significantly lower in AHF patients who expired in the one year follow-up period compared to those who survived. Univariate logistic regression analysis yielded 18 variables that were associated with all-cause mortality in AHF patients, while the multivariate logistic regression analysis identified 4 variables including heart rate, hemoglobin, serum sodium, and serum miR-30d level associated with mortality. ROC curve analysis showed that hemoglobin, heart rate and serum sodium displayed poor prognostic value for AHF (AUCs not higher than 0.700) compared to miR-30d level (AUC = 0.806). Kaplan-Meier survival analysis confirmed that patients with higher serum miR-30d levels had significantly lower mortality (P=0.001). CONCLUSION In conclusion, this study shows evidence for the predictive value of circulating miR-30d as 1-year all-cause mortality in AHF patients. Large multicentre studies are further needed to validate our findings and accelerate the transition to clinical utilization.
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22
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El Amrousy D, Hodeib H, Suliman G, Hablas N, Salama ER, Esam A. Diagnostic and Prognostic Value of Plasma Levels of Cardiac Myosin Binding Protein-C as a Novel Biomarker in Heart Failure. Pediatr Cardiol 2017; 38:418-424. [PMID: 27878630 DOI: 10.1007/s00246-016-1532-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 11/12/2016] [Indexed: 02/05/2023]
Abstract
Heart failure (HF) has high morbidity and mortality in children. This study aimed to investigate the value of cardiac myosin binding protein-C (cMyBP-C) as a diagnostic and prognostic biomarker in children with heart failure. This study was a prospective case-control study that involved 50 children with acute HF and 25 healthy children of matched age and sex as a control group. cMyBP-C plasma levels were measured in patients with HF at the time of admission and 1 month after treatment. Echocardiographic assessment was done for all children. All patients were followed up for a period of 3 months. There was a significant increase in plasma levels of cMyBP-C (ng/ml) in patients with HF at admission (122.44 ± 41.01) as compared to patients after treatment (71.38 ± 49.68) and to control group (24.40 ± 9.83). This increase was associated with increased severity of HF according to pediatric Ross classification of HF. Significant increase in plasma levels of cMyBP-C at admission and its persistent increase after treatment were associated with adverse outcome of mortality and readmission. Plasma levels of cMyBP-C were significantly correlated with echocardiographic and clinical assessment of heart failure. Plasma levels of cMyBP-C were a good biomarker for diagnosis of HF with sensitivity 100% and specificity 96% at cutoff point of 45 ng/ml. Its value in predicting adverse outcome in HF patients was obtained by ROC curve with sensitivity of 90% and specificity 93% at a cutoff point of 152 ng/ml cMyBP-C at admission. cMyBP-C may be a novel useful diagnostic and prognostic biomarker in children with heart failure and determination of severity of HF in these patients.
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Affiliation(s)
- Doaa El Amrousy
- Pediatric Department, Tanta University Hospital, El Motasem Street, Tanta, Egypt.
| | - Hossam Hodeib
- Clinical Pathology Department, Tanta University Hospital, Tanta, Egypt
| | - Ghada Suliman
- Clinical Pathology Department, Tanta University Hospital, Tanta, Egypt
| | - Nahed Hablas
- Pediatric Department, Tanta University Hospital, El Motasem Street, Tanta, Egypt
| | | | - Ahmed Esam
- Anesthesiology and ICU Department, Tanta University Hospital, Tanta, Egypt
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23
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Chioncel O, Collins SP, Greene SJ, Pang PS, Ambrosy AP, Antohi EL, Vaduganathan M, Butler J, Gheorghiade M. Predictors of Post-discharge Mortality Among Patients Hospitalized for Acute Heart Failure. Card Fail Rev 2017; 3:122-129. [PMID: 29387465 DOI: 10.15420/cfr.2017:12:1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Acute Heart Failure (AHF) is a " multi-event disease" and hospitalisation is a critical event in the clinical course of HF. Despite relatively rapid relief of symptoms, hospitalisation for AHF is followed by an increased risk of death and re-hospitalisation. In AHF, risk stratification from clinically available data is increasingly important in evaluating long-term prognosis. From the perspective of patients, information on the risk of mortality and re-hospitalisation would be helpful in providing patients with insight into their disease. From the perspective of care providers, it may facilitate management decisions, such as who needs to be admitted and to what level of care (i.e. floor, step-down, ICU). Furthermore, risk-stratification may help identify patients who need to be evaluated for advanced HF therapies (i.e. left-ventricle assistance device or transplant or palliative care), and patients who need early a post-discharge follow-up plan. Finally, risk stratification will allow for more robust efforts to identify among risk markers the true targets for therapies that may direct treatment strategies to selected high-risk patients. Further clinical research will be needed to evaluate if appropriate risk stratification of patients could improve clinical outcome and resources allocation.
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Affiliation(s)
- Ovidiu Chioncel
- Carol Davila University of Medicine and Pharmacy, Emergency Institute for Cardiovascular Diseases,Bucharest, Romania
| | | | - Stephen J Greene
- Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center,Durham, NC, USA
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University School of Medicine,Indiana, IN, USA
| | - Andrew P Ambrosy
- Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center,Durham, NC, USA
| | - Elena-Laura Antohi
- Carol Davila University of Medicine and Pharmacy, Emergency Institute for Cardiovascular Diseases,Bucharest, Romania
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School,Boston, MA, USA
| | | | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine,Chicago, IL, USA
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24
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Díez J, Bayés-Genis A. What is on the horizon for improved treatments for acutely decompensated heart failure? Eur Heart J Suppl 2016. [DOI: 10.1093/eurheartj/suw043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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25
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Cubo-Romano P, Torres-Macho J, Soni NJ, Reyes LF, Rodríguez-Almodóvar A, Fernández-Alonso JM, González-Davia R, Casas-Rojo JM, Restrepo MI, de Casasola GG. Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure. J Hosp Med 2016; 11:778-784. [PMID: 27264844 DOI: 10.1002/jhm.2620] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 04/30/2016] [Accepted: 05/08/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prognostication of patients hospitalized with acute decompensated heart failure (ADHF) is important to patients, providers, and healthcare systems. Few bedside tools exist to prognosticate patients hospitalized with ADHF. OBJECTIVE The objective of this study was to assess the relationship between inferior vena cava (IVC) diameter and postdischarge mortality in patients hospitalized with ADHF. DESIGN Prospective observational study. SETTING A 247-bed urban teaching hospital in Spain PATIENTS: Ninety-seven patients hospitalized with ADHF. INTERVENTION None. MEASUREMENTS The IVC diameter and collapsibility were measured by a hospitalist at the time of admission and discharge. Primary outcome was 90-day all-cause mortality. Secondary outcomes were readmission rates at 90 and 180 days, and 180-day all-cause mortality. Patients were followed for 180 days. RESULTS Data from 80 patients were analyzed. From admission to discharge, a significant improvement in IVC maximum (IVCmax ) diameter (2.12 vs 1.87 cm; P < 0.001) and IVC collapsibility (25.7% vs 33.1%; P < 0.001) was seen in the total study cohort. During the 90-day follow-up period, 11 patients (13.7%) died. An admission IVCmax diameter ≥1.9 cm was associated with a higher mortality rate at 90 days (25.4% vs 3.4%; P = 0.009) and 180 days (29.3% vs 3.4%; P = .003). In a multivariate Cox proportional hazards regression analysis, admission IVCmax diameter was an independent predictor of 90-day mortality (hazard ratio [HR]: 5.88; 95% confidence interval [CI]: 1.21-28.10; P = 0.025) and 90-day readmission (HR: 3.20; 95% CI: 1.24-8.21; P = 0.016). CONCLUSION In patients hospitalized with acute decompensated heart failure, a dilated IVC by bedside ultrasound at the time of admission is associated with a higher 90-day mortality after hospitalization. Journal of Hospital Medicine 2016;11:778-784. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Pilar Cubo-Romano
- Department of Internal Medicine and Emergency Medicine, Infanta Cristina University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Juan Torres-Macho
- Department of Internal Medicine and Emergency Medicine, Infanta Cristina University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Nilam J Soni
- Section of Pulmonary and Critical Care Medicine, South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, Texas.
- Division of Hospital Medicine, University of Texas School of Medicine in San Antonio, Texas.
| | - Luis F Reyes
- Section of Pulmonary and Critical Care Medicine, South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, Texas
| | - Ana Rodríguez-Almodóvar
- Department of Medicine, Complutense University, Madrid, Spain
- Department of Cardiology, Infanta Cristina University Hospital, Madrid, Spain
| | | | - Rosa González-Davia
- Department of Medicine, Complutense University, Madrid, Spain
- Department of Cardiology, Infanta Cristina University Hospital, Madrid, Spain
| | - José Manuel Casas-Rojo
- Department of Internal Medicine and Emergency Medicine, Infanta Cristina University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
| | - Marcos I Restrepo
- Section of Pulmonary and Critical Care Medicine, South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, Texas
| | - Gonzalo García de Casasola
- Department of Internal Medicine and Emergency Medicine, Infanta Cristina University Hospital, Madrid, Spain
- Department of Medicine, Complutense University, Madrid, Spain
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26
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Andrieu S, Jouve B, Pansieri M. [Optimization of the management of acute heart failure. New concept of fast-track]. Ann Cardiol Angeiol (Paris) 2016; 65:330-333. [PMID: 27692752 DOI: 10.1016/j.ancard.2016.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/02/2016] [Indexed: 06/06/2023]
Abstract
The acute heart failure generates a very important number of hospitalizations for a high cost. A recent reflection on optimizing its management is ongoing, based on the fastest management in the emergency department, with a distinction between which patient should remain and who returns at home, and under what conditions, allowing to limit the number of hospitalizations. It will require a reorganization of emergency department and updating of decision algorithms and new guidelines of care.
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Affiliation(s)
- S Andrieu
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France.
| | - B Jouve
- Service de cardiologie, centre hospitalier du pays d'Aix, 13616 Aix-en-Provence, France
| | - M Pansieri
- Service de cardiologie, centre hospitalier d'Avignon, 84000 Avignon, France
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27
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Passantino A, Monitillo F, Iacoviello M, Scrutinio D. Predicting mortality in patients with acute heart failure: Role of risk scores. World J Cardiol 2015; 7:902-911. [PMID: 26730296 PMCID: PMC4691817 DOI: 10.4330/wjc.v7.i12.902] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/28/2015] [Accepted: 10/27/2015] [Indexed: 02/07/2023] Open
Abstract
Acute heart failure is a leading cause of hospitalization and death, and it is an increasing burden on health care systems. The correct risk stratification of patients could improve clinical outcome and resources allocation, avoiding the overtreatment of low-risk subjects or the early, inappropriate discharge of high-risk patients. Many clinical scores have been derived and validated for in-hospital and post-discharge survival; predictive models include demographic, clinical, hemodynamic and laboratory variables. Data sets are derived from public registries, clinical trials, and retrospective data. Most models show a good capacity to discriminate patients who reach major clinical end-points, with C-indices generally higher than 0.70, but their applicability in real-world populations has been seldom evaluated. No study has evaluated if the use of risk score-based stratification might improve patient outcome. Some variables (age, blood pressure, sodium concentration, renal function) recur in most scores and should always be considered when evaluating the risk of an individual patient hospitalized for acute heart failure. Future studies will evaluate the emerging role of plasma biomarkers.
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28
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NT-proBNP and the risk of incident hypertension: is change over time a better predictor than baseline value? J Hypertens 2015; 33:924-5. [PMID: 25909693 DOI: 10.1097/hjh.0000000000000571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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